CHIEF COMPLAINT: chest pain, right upper quadrant abdominal pain, mental status
change

PRESENT ILLNESS: 54 M with Met RCC with brain mets, mid brain, s/p xrt 4 doses
last on Monday [**2108-3-25**] w/ shunt placement, was placed at [**Hospital1 **]
then readmitted for a 5 week stay in [**3-27**] for multiple issues
then discharged home. Patient now presenting with 1.5 days of
diarrhea, decreased PO intake, confusion x3 days, generalized
weakness, tachycardic with chest pain in the setting of steroid
taper. He says that his gait has become more unsteady and his
vision is "gone." Was brought to the ED by his son.
.
Son says that the pt had a clinic visit with Dr. [**Last Name (STitle) 48151**] on
[**4-15**] (no note in OMR yet). Said at that time that the family
wanted to shorten the rate of the steroid taper to get him off
of it faster thinking it caused behavorial issues. The DC date
was moved from [**5-10**] to [**5-1**].
.
In the ED, vitals were 96.2, 102, 102/68, 18, 93% RA. ED was
concerend for PE since had chest pain, was tachycardic, and had
a clear CXR. Since had new ARF, no scan could be done in the ED
and they arranged to have V/Q done on the [**Hospital Ward Name **]. He was
noted to have hyperkalemia and hyponatremia. He was given 1 L
NS, morphine kayexelate, and dexamathasone 10 IV x1. Neuro was
consulted in the ED and felt the patient had no significant
changes on exam or on head CT.
.
On transfer to the [**Hospital Unit Name 153**], he was comfortable. Says has been
having diarrhea the last few days. Has been eating less. Has had
diploploa for the last 3 weeks, but says his near vision has
gotten worse over the last few days. Can see far still, though
double.

MEDICAL HISTORY: 1. RCC: The patient was initially found to have a renal cell
abnormality in [**2093**] when he p/w flank pain. A CT scan identified
a left adrenal nodule; this was biopsied and was negative. A bx
revealed a renal cell carcinoma and underwent a L nephrectomy in
[**12-25**]. with a left nephrectomy, that confirmed at 12.5 cm
carcinoma. There was some concern also for pancreatic
involvement. Followup CT
scans done in [**2-26**] showed a new nodule in the lungs. Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 437**] at [**Hospital1 112**] resected 3 L lung nodules, but the patient states
only one was positive, other two just showed necrosis. That
[**Month (only) 404**], he began to notice difficulty with his L leg and in [**Month (only) 116**]
had a lesion of the L femur. This was resected by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
at [**Hospital1 112**] and pathology was significant for metastatic clear cell
renal carcinoma. The patient was then seen on [**2109-2-6**], by Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) **] and based on the discussion
decided to proceed with IL-2 therapy. He therefore had a head CT
on [**2109-2-20**] that showed a 1.3 cm mid brain lesion and he was sent
by Dr. [**Last Name (STitle) 29267**] for consult. This was biopsied during this [**3-27**]
admission and showed renal cell.
2. DM dx after nephrectomy
3. Brain Mets s/p VP Shunt [**3-1**]

MEDICATION ON ADMISSION: Levetiracetam 500 mg [**Hospital1 **]
Pantoprazole 40 mg daily
Quetiapine 100 mg [**Hospital1 **]
Was DC on Dexamethasone 8 TID in [**3-27**] then has been on taper.
Has taken: Monday - Tuesday 2,2,2; Wednesday - Saturday 2,2;
Today took 2mg only per taper
Bactrim daily
Novolin 70/30 38 qAM, 26 qPM and Humalog in the afternoon

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 95.7 90/57 92 23 98% 2L NC
GEN: NAD in bed
HEENT: sclerae anicteric, EOMI. L eye with disconjugate gaze.
dry MM
Neck: no JVD
Lungs: CTA bilat, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Extr: no c/c/e, DP 2+ bilat
Neuro: CN II-XII grossly intact. 5/5 strength UE/LE, nl
sensation throughout. Toes- downgoing. Reflexes- 2+ thoughout.

FAMILY HISTORY: His mother died at 73 of MI and his father died at 72 of an MI.
He has three sisters, 67, 65, and 60 with high blood pressures.
His brother is 60 with prostate cancer. He has twin sons who are
30 years old who are in good health.

SOCIAL HISTORY: Divorced. 50-pack-year history of smoking. He quit ~one year
ago after his nephrectomy. He does not drink alcohol. Family has
been providing him with total care at home. He is unable to go
tot he bathroom, feed, or dress unassisted.
Acute kidney failure, unspecified,Secondary malignant neoplasm of brain and spinal cord,Hyposmolality and/or hyponatremia,Secondary malignant neoplasm of lung,Adult failure to thrive,Personal history of malignant neoplasm of kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diarrhea,Other chest pain
Acute kidney failure NOS,Sec mal neo brain/spine,Hyposmolality,Secondary malig neo lung,Failure to thrive-adult,Hx of kidney malignancy,DMII wo cmp nt st uncntr,Diarrhea,Chest pain NEC
Admission Date:  [**2109-4-28**]              Discharge Date:   [**2109-5-3**]

Date of Birth:  [**2055-1-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 10644**]
Chief Complaint:
chest pain, right upper quadrant abdominal pain, mental status
change

Major Surgical or Invasive Procedure:
none

History of Present Illness:
54 M with Met RCC with brain mets, mid brain, s/p xrt 4 doses
last on Monday [**2108-3-25**] w/ shunt placement, was placed at [**Hospital1 **]
then readmitted for a 5 week stay in [**3-27**] for multiple issues
then discharged home. Patient now presenting with 1.5 days of
diarrhea, decreased PO intake, confusion x3 days, generalized
weakness, tachycardic with chest pain in the setting of steroid
taper. He says that his gait has become more unsteady and his
vision is "gone." Was brought to the ED by his son.
.
Son says that the pt had a clinic visit with Dr. [**Last Name (STitle) 48151**] on
[**4-15**] (no note in OMR yet). Said at that time that the family
wanted to shorten the rate of the steroid taper to get him off
of it faster thinking it caused behavorial issues. The DC date
was moved from [**5-10**] to [**5-1**].
.
In the ED, vitals were 96.2, 102, 102/68, 18, 93% RA. ED was
concerend for PE since had chest pain, was tachycardic, and had
a clear CXR. Since had new ARF, no scan could be done in the ED
and they arranged to have V/Q done on the [**Hospital Ward Name **]. He was
noted to have hyperkalemia and hyponatremia. He was given 1 L
NS, morphine kayexelate, and dexamathasone 10 IV x1. Neuro was
consulted in the ED and felt the patient had no significant
changes on exam or on head CT.
.
On transfer to the [**Hospital Unit Name 153**], he was comfortable. Says has been
having diarrhea the last few days. Has been eating less. Has had
diploploa for the last 3 weeks, but says his near vision has
gotten worse over the last few days. Can see far still, though
double.

Past Medical History:
1. RCC: The patient was initially found to have a renal cell
abnormality in [**2093**] when he p/w flank pain. A CT scan identified
a left adrenal nodule; this was biopsied and was negative. A bx
revealed a renal cell carcinoma and underwent a L nephrectomy in
[**12-25**]. with a left nephrectomy, that confirmed at 12.5 cm
carcinoma. There was some concern also for pancreatic
involvement. Followup CT
scans done in [**2-26**] showed a new nodule in the lungs. Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 437**] at [**Hospital1 112**] resected 3 L lung nodules, but the patient states
only one was positive, other two just showed necrosis. That
[**Month (only) 404**], he began to notice difficulty with his L leg and in [**Month (only) 116**]
had a lesion of the L femur. This was resected by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
at [**Hospital1 112**] and pathology was significant for metastatic clear cell
renal carcinoma. The patient was then seen on [**2109-2-6**], by Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) **] and based on the discussion
decided to proceed with IL-2 therapy. He therefore had a head CT
on [**2109-2-20**] that showed a 1.3 cm mid brain lesion and he was sent
by Dr. [**Last Name (STitle) 29267**] for consult. This was biopsied during this [**3-27**]
admission and showed renal cell.
2. DM dx after nephrectomy
3. Brain Mets s/p VP Shunt [**3-1**]

Social History:
 Divorced. 50-pack-year history of smoking. He quit ~one year
ago after his nephrectomy. He does not drink alcohol. Family has
been providing him with total care at home. He is unable to go
tot he bathroom, feed, or dress unassisted.

Family History:
His mother died at 73 of MI and his father died at 72 of an MI.
He has three sisters, 67, 65, and 60 with high blood pressures.
His brother is 60 with prostate cancer. He has twin sons who are
30 years old who are in good health.

Physical Exam:
VS: 95.7 90/57 92 23 98% 2L NC
GEN: NAD in bed
HEENT: sclerae anicteric, EOMI. L eye with disconjugate gaze.
dry MM
Neck: no JVD
Lungs: CTA bilat, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Extr: no c/c/e, DP 2+ bilat
Neuro: CN II-XII grossly intact. 5/5 strength UE/LE, nl
sensation throughout. Toes- downgoing. Reflexes- 2+ thoughout.

Pertinent Results:
[**2109-4-28**] 05:35PM BLOOD WBC-13.1* RBC-4.36* Hgb-12.1* Hct-34.1*
MCV-78* MCH-27.8 MCHC-35.5* RDW-17.2* Plt Ct-289#
[**2109-4-29**] 05:27AM BLOOD WBC-12.4* RBC-3.65* Hgb-9.9* Hct-28.8*
MCV-79* MCH-27.1 MCHC-34.3 RDW-16.7* Plt Ct-256
[**2109-5-1**] 07:15AM BLOOD WBC-13.2* RBC-3.44* Hgb-9.2* Hct-26.6*
MCV-77* MCH-26.7* MCHC-34.5 RDW-16.7* Plt Ct-295
[**2109-5-2**] 07:15AM BLOOD WBC-12.9* RBC-3.19* Hgb-8.8* Hct-25.5*
MCV-80* MCH-27.6 MCHC-34.5 RDW-17.4* Plt Ct-253
[**2109-5-2**] 03:00PM BLOOD WBC-17.8* RBC-3.72* Hgb-10.1* Hct-29.4*
MCV-79* MCH-27.1 MCHC-34.3 RDW-16.8* Plt Ct-333
[**2109-4-28**] 05:35PM BLOOD PT-13.8* PTT-24.8 INR(PT)-1.2*
[**2109-5-1**] 07:15AM BLOOD PT-13.8* PTT-26.0 INR(PT)-1.2*
[**2109-5-2**] 07:15AM BLOOD Ret Aut-3.1
[**2109-4-28**] 05:35PM BLOOD Glucose-178* UreaN-59* Creat-1.5* Na-122*
K-6.2* Cl-93* HCO3-15* AnGap-20
[**2109-4-28**] 07:23PM BLOOD Glucose-170* UreaN-60* Creat-1.6* Na-122*
K-6.1* Cl-93* HCO3-16* AnGap-19
[**2109-4-29**] 01:17AM BLOOD Glucose-225* UreaN-63* Creat-1.8* Na-122*
K-6.1* Cl-92* HCO3-17* AnGap-19
[**2109-4-29**] 05:33PM BLOOD Na-125* K-5.4*
[**2109-4-30**] 04:30PM BLOOD Glucose-127* UreaN-38* Creat-1.0 Na-126*
K-5.2* Cl-96 HCO3-15* AnGap-20
[**2109-5-1**] 07:15AM BLOOD Glucose-105 UreaN-33* Creat-0.9 Na-130*
K-4.3 Cl-95* HCO3-24 AnGap-15
[**2109-5-2**] 07:15AM BLOOD Glucose-76 UreaN-34* Creat-0.9 Na-130*
K-3.9 Cl-97 HCO3-23 AnGap-14
[**2109-4-28**] 05:35PM BLOOD ALT-51* AST-23 CK(CPK)-20* AlkPhos-158*
Amylase-43 TotBili-0.4
[**2109-5-1**] 07:15AM BLOOD ALT-23 AST-9 AlkPhos-97 TotBili-0.3
[**2109-5-2**] 07:15AM BLOOD Hapto-376*
[**2109-4-28**] 07:23PM BLOOD Osmolal-280
[**2109-4-30**] 04:39AM BLOOD Osmolal-276
[**2109-4-30**] 04:30PM BLOOD Cortsol-1.3*
[**2109-4-30**] 08:15PM BLOOD Cortsol-3.8
[**2109-4-28**] 05:42PM BLOOD Lactate-2.4*
[**2109-5-1**] 08:32AM BLOOD Lactate-4.2*
.
.
STUDIES:
CT TORSO:
1.  Marked increase in the size of the right adrenal lesion,
multiple new
pulmonary nodules, multiple new regions of nodularity within the
omentum and peritoneum are all suggestive of marked disease
progression.
2.  New ascites in the abdomen likely relates to new
ventriculoperitoneal
shunt which is in place.
3.  Normal appendix.
4.  New small right pleural effusion.


Brief Hospital Course:
54 M with metastatic RCC presenting with w/ CP/FTT/abdominal
pain, found to have hypoNa, hyperK, low bicarb.  Pt admitted
initially to the ICU for close monitoring, then called out to
medical service after 24hrs.
.
# hypoNa, hyperK, NG acidosis - originally concerned that this
was [**2-22**] rapid withdrawal of prednisone resulting in adrenal
insufficiency, pt not frankly hypotensive on admission, and was
treated with dexamethasone in the ICU.  After arriving on the
medical service, pt noted to have SBPs 90s/60s, but responded
well to 500cc fluid bolus.  recurrent hypotension again [**5-1**] and
[**5-2**], responds to 500cc fluid boluses.
.
a renal consult was obtained [**5-1**], and per recs, pt's labs were
felt suggestive of SIADH [**2-22**] brain mets vs RTA.   electrolytes
improved with gentle fluid hydration, and bicarb replacement (PO
NaHCO3 [**Hospital1 **] + D5W + HCO3).  did not feel that pt's mental status
was related to electrolyte abnormalities, though plausbile.
given goals of care in light of progression of malignancy, plan
is to discharge pt on oral bicarb replacement (sodium bicarb
tablets) and steroid replacement (both prednisone and florinef).

.
.
# mental status - pt a&ox3, though frequently lethargic.
originally felt mental status was related to brain mets rather
than electrolyte imbalances, however his mental status has been
stable despite correction of electrolytes.  given goals care no
further intervention needed at present.
.
.
# abd pain/oncology - CT TORSO obtained in light of RUQ pain on
admission to medical floor which revealed substantial disease
progression as detailed in report above, including enlargement
of adrenal mass.  upon further discussion with pt and family,
decision made to change goals of care to comfort measures only,
and pt discharged to hospice, with possible plan for sutent
treatment.  pt made DNR/DNI.  pain control initiated with
oxycodone prn with bowel regimen prn.
.
.
# Diarrhea- resolved upon arrival to medical service, culture
data unremarkable.  Pt trated with Immodium PRN.
.
.
# Ronchi- ?bronchitis on initial presentation, though no
evidence of pneumonia on CT scan, pt with stable O2 sats,
started on MDI inhaler prn for SOB or wheezing.
.
.
# DM- Stable. given goals of care, no need for insulin.
.
# ARF- improved w/IVF.  pt treated with oral bicarb and D5W with
3amps BICARB per renal recs.  plan to d/c pt home with bicarb
repletion given ongoign acidosis (lactate 4.2, likely [**2-22**] renal
cell ca).
.
.
# FEN: diabetic diet, though could be switched to regular at
hospice.
.
# DISPO: pt discharged home with hospice.  will be followed by
PCP.  [**Name10 (NameIs) **] consider sutent therapy.

Medications on Admission:
Levetiracetam 500 mg [**Hospital1 **]
Pantoprazole 40 mg daily
Quetiapine 100 mg [**Hospital1 **]
Was DC on Dexamethasone 8 TID in [**3-27**] then has been on taper.
Has taken: Monday - Tuesday 2,2,2; Wednesday - Saturday 2,2;
Today took 2mg only per taper
Bactrim daily
Novolin 70/30 38 qAM, 26 qPM and Humalog in the afternoon


Discharge Medications:
1. HOSPITAL BED
please provide pt with HOSPITAL BED
2. Prednisone 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. Florinef 0.1 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Sodium Bicarbonate 650 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6
hours) as needed for 1 months.
Disp:*336 Tablet(s)* Refills:*0*
6. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO BID (2 times a day) as needed.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as
needed for constipation.
Disp:*30 Tablet(s)* Refills:*0*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed.
Disp:*60 Capsule(s)* Refills:*0*
9. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed.
Disp:*60 Tablet(s)* Refills:*2*
10. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
11. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
Disp:*30 Adhesive Patch, Medicated(s)* Refills:*2*
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
13. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
[**1-22**]  Inhalation every 4-6 hours as needed for shortness of
breath or wheezing.
Disp:*2 inhaler* Refills:*2*
14. seroquel 100mg po bid

Discharge Disposition:
Home With Service

Facility:
[**Hospital 71105**] Hospice

Discharge Diagnosis:
metastatic renal cell carcinoma


Discharge Condition:
stable.


Discharge Instructions:
you were admitted to the hospital with multiple complaints
including chest pain, abdominal pain, and mental status changes.
 a CT scan of your torso revealed significant progression of
your previous malignancy.  you are being discharged to home
hospice.

Followup Instructions:
if you have any questions or concerns please contact your
primary care physician.
{'Acute kidney failure, unspecified,Secondary malignant neoplasm of brain and spinal cord,Hyposmolality and/or hyponatremia,Secondary malignant neoplasm of lung,Adult failure to thrive,Personal history of malignant neoplasm of kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diarrhea,Other chest pain'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: chest pain, right upper quadrant abdominal pain, mental status
change

PRESENT ILLNESS: 54 M with Met RCC with brain mets, mid brain, s/p xrt 4 doses
last on Monday [**2108-3-25**] w/ shunt placement, was placed at [**Hospital1 **]
then readmitted for a 5 week stay in [**3-27**] for multiple issues
then discharged home. Patient now presenting with 1.5 days of
diarrhea, decreased PO intake, confusion x3 days, generalized
weakness, tachycardic with chest pain in the setting of steroid
taper. He says that his gait has become more unsteady and his
vision is "gone." Was brought to the ED by his son.
.
Son says that the pt had a clinic visit with Dr. [**Last Name (STitle) 48151**] on
[**4-15**] (no note in OMR yet). Said at that time that the family
wanted to shorten the rate of the steroid taper to get him off
of it faster thinking it caused behavorial issues. The DC date
was moved from [**5-10**] to [**5-1**].
.
In the ED, vitals were 96.2, 102, 102/68, 18, 93% RA. ED was
concerend for PE since had chest pain, was tachycardic, and had
a clear CXR. Since had new ARF, no scan could be done in the ED
and they arranged to have V/Q done on the [**Hospital Ward Name **]. He was
noted to have hyperkalemia and hyponatremia. He was given 1 L
NS, morphine kayexelate, and dexamathasone 10 IV x1. Neuro was
consulted in the ED and felt the patient had no significant
changes on exam or on head CT.
.
On transfer to the [**Hospital Unit Name 153**], he was comfortable. Says has been
having diarrhea the last few days. Has been eating less. Has had
diploploa for the last 3 weeks, but says his near vision has
gotten worse over the last few days. Can see far still, though
double.

MEDICAL HISTORY: 1. RCC: The patient was initially found to have a renal cell
abnormality in [**2093**] when he p/w flank pain. A CT scan identified
a left adrenal nodule; this was biopsied and was negative. A bx
revealed a renal cell carcinoma and underwent a L nephrectomy in
[**12-25**]. with a left nephrectomy, that confirmed at 12.5 cm
carcinoma. There was some concern also for pancreatic
involvement. Followup CT
scans done in [**2-26**] showed a new nodule in the lungs. Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 437**] at [**Hospital1 112**] resected 3 L lung nodules, but the patient states
only one was positive, other two just showed necrosis. That
[**Month (only) 404**], he began to notice difficulty with his L leg and in [**Month (only) 116**]
had a lesion of the L femur. This was resected by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
at [**Hospital1 112**] and pathology was significant for metastatic clear cell
renal carcinoma. The patient was then seen on [**2109-2-6**], by Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) **] and based on the discussion
decided to proceed with IL-2 therapy. He therefore had a head CT
on [**2109-2-20**] that showed a 1.3 cm mid brain lesion and he was sent
by Dr. [**Last Name (STitle) 29267**] for consult. This was biopsied during this [**3-27**]
admission and showed renal cell.
2. DM dx after nephrectomy
3. Brain Mets s/p VP Shunt [**3-1**]

MEDICATION ON ADMISSION: Levetiracetam 500 mg [**Hospital1 **]
Pantoprazole 40 mg daily
Quetiapine 100 mg [**Hospital1 **]
Was DC on Dexamethasone 8 TID in [**3-27**] then has been on taper.
Has taken: Monday - Tuesday 2,2,2; Wednesday - Saturday 2,2;
Today took 2mg only per taper
Bactrim daily
Novolin 70/30 38 qAM, 26 qPM and Humalog in the afternoon

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 95.7 90/57 92 23 98% 2L NC
GEN: NAD in bed
HEENT: sclerae anicteric, EOMI. L eye with disconjugate gaze.
dry MM
Neck: no JVD
Lungs: CTA bilat, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Extr: no c/c/e, DP 2+ bilat
Neuro: CN II-XII grossly intact. 5/5 strength UE/LE, nl
sensation throughout. Toes- downgoing. Reflexes- 2+ thoughout.

FAMILY HISTORY: His mother died at 73 of MI and his father died at 72 of an MI.
He has three sisters, 67, 65, and 60 with high blood pressures.
His brother is 60 with prostate cancer. He has twin sons who are
30 years old who are in good health.

SOCIAL HISTORY: Divorced. 50-pack-year history of smoking. He quit ~one year
ago after his nephrectomy. He does not drink alcohol. Family has
been providing him with total care at home. He is unable to go
tot he bathroom, feed, or dress unassisted. 

### Response:
{'Acute kidney failure, unspecified,Secondary malignant neoplasm of brain and spinal cord,Hyposmolality and/or hyponatremia,Secondary malignant neoplasm of lung,Adult failure to thrive,Personal history of malignant neoplasm of kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Diarrhea,Other chest pain'}
