CHIEF COMPLAINT: Abscess

PRESENT ILLNESS: 23 year old male with no medical history who was admitted on
[**5-15**] for cellulitis.  He initially developed a "pimple" on his
left inner thigh one week prior to admit.  He popped it and it
drained a small amount of pus.  It recurred one day later and he
popped it again.  It occured the next day but larger and he felt
that it was moving into his leg.  He assumed it was a boil and
started putting warm compresses on it.  The redness, swelling
and pain slowly spread in his inner thigh, into the inguinal
region and into his left gluteal region.  He was also having
fevers at home to 101.  He presented to the ED on [**5-15**] and was
admitted for cellulits.  In the ED a CT pelvis was done which
edema and fasciitis along the left medial and posterior thigh
from the mid thigh to the inguinal and lateral perineal regions
without fluid collection or sub cutaneous gas.
.
On admit he was not having any respiratory distress although his
sat was noted to be in the low 90s on room air.  A CXR was
normal and and it was presumed secondary to atalectasis as with
deep breaths his O2 sat would increase.  He did not have an O2
requirement.
.
He was started on Vancomycin, clindamycin and unasyn for his
cellulitis.  Over the next two days his cellulitis improved and
on [**5-16**] patient felt well.  Overnight on [**5-16**] patient started
complaining of some indigestion/chest pain/cough.  He later
clarified this as more respiratory than what he though chest
pain would feel like.  He was given maalox for the "indigestion"
and started on tele.  On tele he was noted to have some runs of
NSVT without symptoms.  In the morning he was evaluated and
noted to have a new O2 requirement of 4L.  Given the concern
overnight for atypical chest pain cardiac enzymes were added on
to his am labs.  His CE enzymes were elevated trop of 1.19, CK
of 700 with an MBI of 10.3.
.
He was sent for a stat CTA to rule out PE.  CT showed no PE but
ground glass opacities in lower lobes and bronchial wall
thickening, question of aspiration pneumonitis, mild
interstitial thickening consistent with interstitial edema. ECG
at the time showed new septal St depressions and taller septal t
waves from prior and sinus tach.  His O2 requirement increased
and he was started on a NRB.  He was given nebs x1, lasix 10 iv,
and transfered to the ICU for hypoxia.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: NyQuil prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ON ADMISSION:
Vitals: 101.3 130/72 110 20 98%RA
General: Alert, oriented, no acute distress, mildly diaphoretic

FAMILY HISTORY: Father with MI and PE at age 50. Father also with DM
Paternal GF with PE at age 50.

SOCIAL HISTORY: - Tobacco:  None
- Alcohol:  5-6 beers on the weekend
- Illicits:  None
Sex active with women, last 6 months ago, uses condoms, never
tested for HIV.
Fasciitis, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Systemic inflammatory response syndrome, unspecified,Left heart failure,Cellulitis and abscess of leg, except foot,Takotsubo syndrome,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Anemia, unspecified
Fasciitis NOS,Acute respiratry failure,Acute kidney failure NOS,SIRS, NOS,Left heart failure,Cellulitis of leg,Takotsubo syndrome,MRSA elsewhere/NOS,Anemia NOS
Admission Date:  [**2169-5-15**]              Discharge Date:   [**2169-5-24**]

Date of Birth:  [**2146-1-25**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 11892**]
Chief Complaint:
Abscess

Major Surgical or Invasive Procedure:
Left thigh incision and drainage ([**2169-5-17**])
Cardiac Catheterization ([**2169-5-17**])


History of Present Illness:
23 year old male with no medical history who was admitted on
[**5-15**] for cellulitis.  He initially developed a "pimple" on his
left inner thigh one week prior to admit.  He popped it and it
drained a small amount of pus.  It recurred one day later and he
popped it again.  It occured the next day but larger and he felt
that it was moving into his leg.  He assumed it was a boil and
started putting warm compresses on it.  The redness, swelling
and pain slowly spread in his inner thigh, into the inguinal
region and into his left gluteal region.  He was also having
fevers at home to 101.  He presented to the ED on [**5-15**] and was
admitted for cellulits.  In the ED a CT pelvis was done which
edema and fasciitis along the left medial and posterior thigh
from the mid thigh to the inguinal and lateral perineal regions
without fluid collection or sub cutaneous gas.
.
On admit he was not having any respiratory distress although his
sat was noted to be in the low 90s on room air.  A CXR was
normal and and it was presumed secondary to atalectasis as with
deep breaths his O2 sat would increase.  He did not have an O2
requirement.
.
He was started on Vancomycin, clindamycin and unasyn for his
cellulitis.  Over the next two days his cellulitis improved and
on [**5-16**] patient felt well.  Overnight on [**5-16**] patient started
complaining of some indigestion/chest pain/cough.  He later
clarified this as more respiratory than what he though chest
pain would feel like.  He was given maalox for the "indigestion"
and started on tele.  On tele he was noted to have some runs of
NSVT without symptoms.  In the morning he was evaluated and
noted to have a new O2 requirement of 4L.  Given the concern
overnight for atypical chest pain cardiac enzymes were added on
to his am labs.  His CE enzymes were elevated trop of 1.19, CK
of 700 with an MBI of 10.3.
.
He was sent for a stat CTA to rule out PE.  CT showed no PE but
ground glass opacities in lower lobes and bronchial wall
thickening, question of aspiration pneumonitis, mild
interstitial thickening consistent with interstitial edema. ECG
at the time showed new septal St depressions and taller septal t
waves from prior and sinus tach.  His O2 requirement increased
and he was started on a NRB.  He was given nebs x1, lasix 10 iv,
and transfered to the ICU for hypoxia.

Past Medical History:
None

Social History:
- Tobacco:  None
- Alcohol:  5-6 beers on the weekend
- Illicits:  None
Sex active with women, last 6 months ago, uses condoms, never
tested for HIV.


Family History:
Father with MI and PE at age 50. Father also with DM
Paternal GF with PE at age 50.


Physical Exam:
ON ADMISSION:
Vitals: 101.3 130/72 110 20 98%RA
General: Alert, oriented, no acute distress, mildly diaphoretic

HEENT: Sclera anicteric, MM slightly dry, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Tachycardic, regular, normal S1 + S2, no murmurs, rubs,
gallops appreciated although difficult to assess given HR
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema. L thigh with erythema along anterior and medial aspect
and extending to but not including scrotum and perineal area.
Extends slightly into posterior thigh. Induration noted along
medial aspect. No crepitus. Midly tender to palpation. Warm. No
pustules, fluctuance or drainage or open wounds.

ON DISCHARGE:
Vitals: Tmax: 98.5 Tc: 96.9 BP: 128/79 (118-128/68-79) P: 96
(61-104) RR: 18 O2sat: 98%RA
General: A&Ox3, no acute distress
HEENT: normocephalic, sclerae anicteric, pupils equal, round and
reactive to light, mucus membranes moist, oropharynx clear
Neck: No lymphadenopathy, JVD not visualized
Cardiac: Regular rate and rhythm, nl S1 & S2, no murmurs, rubs
or gallops
Pulm: Lungs Clear to auscultation bilaterally, no crackles,
rhonchi, rales or wheezes
Abd: Soft, non-tender, non-distended, no HSM, no guarding or
rebound tenderness, + bowel sounds
Extremities: L groin dressed, no tenderness to palpation.
Dressing clean and dry w/o purulence or discharge. No erythema
or warmth around dressing. No TTP. No peripheral edema. 2+
dorsal pedal pulses.

Pertinent Results:
ADMISSION LABS:
.
[**2169-5-15**] 02:45PM BLOOD WBC-16.2* RBC-4.51* Hgb-14.6 Hct-41.6
MCV-92 MCH-32.4* MCHC-35.1* RDW-13.3 Plt Ct-328
[**2169-5-15**] 02:45PM BLOOD Neuts-84* Bands-6* Lymphs-1* Monos-9
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2169-5-17**] 08:37AM BLOOD PT-14.3* PTT-27.1 INR(PT)-1.2*
[**2169-5-15**] 02:45PM BLOOD Glucose-101* UreaN-9 Creat-1.1 Na-139
K-4.2 Cl-101 HCO3-26 AnGap-16
[**2169-5-17**] 06:20AM BLOOD CK-MB-73* MB Indx-10.3* cTropnT-1.12*
[**2169-5-17**] 08:37AM BLOOD CK-MB-84* MB Indx-9.1* cTropnT-1.79*
[**2169-5-17**] 03:20PM BLOOD CK-MB-71* MB Indx-7.3* cTropnT-1.89*
[**2169-5-18**] 02:05AM BLOOD CK-MB-16* MB Indx-4.1 cTropnT-1.28*
[**2169-5-16**] 07:15AM BLOOD Calcium-9.0 Phos-5.3* Mg-1.8
[**2169-5-17**] 08:37AM BLOOD calTIBC-209* Ferritn-1156* TRF-161*
.
MICRO:
[**5-15**] Blood cultures x2: No Growth.
[**5-16**] Blood cultures x3: No Growth.
[**5-17**] ABSCESS      Source: left leg abscess.

                            **FINAL REPORT [**2169-5-21**]**

   GRAM STAIN (Final [**2169-5-17**]):
      3+  (5-10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      4+   (>10 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.

   FLUID CULTURE (Final [**2169-5-20**]):
      STAPH AUREUS COAG +.    MODERATE GROWTH.
         Oxacillin RESISTANT Staphylococci MUST be reported as
also
         RESISTANT to other penicillins, cephalosporins,
carbacephems,
         carbapenems, and beta-lactamase inhibitor combinations.

         Rifampin should not be used alone for therapy.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------<=0.25 S
ERYTHROMYCIN----------   =>8 R
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------   =>8 R
OXACILLIN-------------   =>4 R
RIFAMPIN-------------- <=0.5 S
TETRACYCLINE----------   <=1 S
TRIMETHOPRIM/SULFA---- <=0.5 S
VANCOMYCIN------------     1 S

   ANAEROBIC CULTURE (Final [**2169-5-21**]):    NO ANAEROBES ISOLATED.


[**5-17**] Blood culture: No Growth.
[**5-17**] Urine culture: No Growth.
[**5-18**] Blood culture: No Growth.

STUDIES:
[**5-15**] CT PELVIS:
Extensive subcutaneous edema and fascial thickening (fasciitis)
along the left medial and posterior thigh from the mid thigh to
the inguinal and lateral perineal regions. Edema tracks into the
medial left thigh musculature. No drainable fluid collection or
subcutaneous gas seen.
.
[**5-17**] CTA:
1. Multifocal mosaic attenuation and septal thickening are
suggestive of
pulmonary edema; a less likely consideration is viral pneumonia.

2. No pulmonary embolism.
.
TTE ([**2169-5-17**]):
The left atrium is elongated. Left ventricular wall thicknesses
are normal. The left ventricular cavity is mildly dilated.
Overall left ventricular systolic function is severely depressed
(LVEF= 25-30 %) with moderate to severe global hypokinesis and
relatively preserved function of the basal to mid septum and
basal lateral walls. The estimated cardiac index is normal
(>=2.5L/min/m2). Right ventricle appears normal in
size/function. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic stenosis or
aortic regurgitation. No masses or vegetations are seen on the
aortic valve. The mitral valve leaflets are structurally normal.
There is no mitral valve prolapse. No mass or vegetation is seen
on the mitral valve. Moderate (2+) mitral regurgitation is seen.
There is moderate pulmonary artery systolic hypertension. There
is no pericardial effusion.
IMPRESSION: Mildly dilated left ventricular cavity with moderate
to severe global hypokinesis (relatively preserved basal to mid
septum and basal lateral walls). Moderate mitral regurgitation.
Moderate pulmonary hypertension.
.
CARDIAC CATH:
1. Selective coronary anagiography demonstrated no flow limiting

lesions. The LMCA had no angiographically apparent disease. The
LAD had
no angiographically apparent disease. The Cx had no
angiographically
apparent disease. The RCA had no angiographically apparent
disease.
2. Limited resting hemodynamics revealed elevated left sided
filling
pressures with a PCWP of 26 mmHg. The mean pulmonary pressures
were also
elevated with a mean PA pressure of 30 mmHg. The cardiac index
was preserved at 2.6 L/min/m2. The central aortic pressure was
104/80
mmHg.
FINAL DIAGNOSIS:
1. Coronary arteries have no flow limiting lesions.
2. Mild pulmonary hypertension.
3. Moderate left ventricular diastolic dysfunction.
.
TTE ([**2169-5-23**]): The left atrium and right atrium are normal in
cavity size. Left ventricular wall thickness, cavity size and
regional/global systolic function are normal (LVEF >55%). There
is no left ventricular outflow obstruction at rest or with
Valsalva. Right ventricular chamber size and free wall motion
are normal. The diameters of aorta at the sinus, ascending and
arch levels are normal. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
stenosis or aortic regurgitation. 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 a very small pericardial
effusion.

IMPRESSION: Normal global and regional biventricular systolic
function. No pulmonary hypertension or clinically-significant
valvular disease seen.

Compared with the prior study (images reviewed) of [**2169-5-17**], LV
size and systolic dysfunction has normalized. Mitral
regurgitation has resolved.

DISCHARGE LABS:
140  102  18
------------<  105
4.6  26  1.0

Ca: 9.9 Mg: 2.4 P: 3.5


13.3 > 13.6 < 779
       40.6

Brief Hospital Course:
23 year-old male with left groin fasciitis and
stress/toxin-induced cardiomyopathy, now s/p incision and
washout.
.
#. Left groin fasciitis: He was initially treated with IV
vancomcyin/unasyn/clindamycin.  Patient taken to the OR by
surgery and had an incision and washout on [**5-17**].  Infectious
disease were consulted and he was subsequently switched to
linezolid as his abscess grew MRSA.  Dressing changes were
applied twice a day. Surgery followed and felt his wound was
clinically improving on antibiotics and further washout and
drainage were not indicated. He was discharged to complete a two
week course of antibiotics on linezolid.
.
#. Cardiomyopathy/Pulmonary Edema: On the morning of [**5-17**],
patient developed hypoxia with 100% non-rebreather requirement
with an increase in troponins and CK/MBi.  CTA was negative for
PE.  Patient was transferred to the MICU for respiratory
distress. In the MICU, bedside TTE showed apical hypokinesis,
approximate EF of 25-30%.  Based on family history of
hypercoagulability, patient was taken emergently to the cath
lab.  Cath showed clean coronary arteries, elevated PCWP 26,
depressed LVEF. Cardiomyopathy thought to be stress induced
(more likely) vs. toxin mediated from infection.  Patient was
aggressively diuresised with IV Lasix for 3 days, and O2
requirement significantly decreased.  Repeat TTE showed showed
normalization of EF and cardiac function.
.
#. Leukocytosis/thrombocytosis: Patient with signficant
leukocytosis which was attributed to infection, this trended
down during admission. His thrombocytosis was uptrending on
discharge. It was believed likely reactive in the setting of
infection, but should be followed up in the outpatient setting.
The patient was instructed to have a CBC drawn and sent to Dr.
[**Last Name (STitle) **] (his new PCP) on [**2169-5-29**].

Medications on Admission:
NyQuil prn

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*30 Tablet(s)* Refills:*0*
3. linezolid 600 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 10 days.
4. sodium hypochlorite 0.25 % Solution Sig: Two (2) tsps
Miscellaneous [**Hospital1 **] (2 times a day) as needed for dressing
changes.
Disp:*1 bottle* Refills:*0*
5. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every twelve
(12) hours as needed for pain: Please use 1 hour before dressing
changes. Do not drink or drive while taking this medication.
Disp:*25 Tablet(s)* Refills:*0*
6. Outpatient Lab Work
Please check complete blood count on [**Last Name (LF) 766**], [**2169-5-29**] and
fax results to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Hospital6 **]
Center. Phone: [**Telephone/Fax (1) 798**] ; Fax ([**Telephone/Fax (1) 89198**]


Discharge Disposition:
Home With Service

Facility:
VNA Community Health care

Discharge Diagnosis:
Primary Diagnosis
1. Left thigh MRSA fasciitis
2. Stress-induced cardiomyopathy
3. Pulmonary edema


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname 89199**],

You were admitted with fever and left thigh pain, swelling, and
redness which was diagnosed as fascitis. General surgery
performed incision and drainage on your left thigh to help with
fascitis.  You were treated with IV antibiotics and then
transitioned to an oral antibiotic called linezolid.

Your hospital course was complicated by shortness of breath
which required intensive care unit admission. You were noted to
have abnormal pump function of your heart which led to fluid
buildup in your lungs requiring diursesis with medication called
LASIX. You underwent cardiac catheterization which showed clean
coronary arteries- your heart dysfunction was believed related
to a stress response in the setting of your infection. Your
heart function normalized on a repeat ultrasound on [**5-23**].

We have made the following medication changes:
- Please take linezolid through [**2169-6-2**] when you follow up
at the infectious disease clinic.
- You may take oxycodone prior to your dressing changes for pain
control. Do not drink or drive while taking this medication as
it can be sedating. Please take colace (a stool softener) as
long as you are taking this medication to prevent constipation.
You may also take senna as needed for constipation.

Please follow up at the appointments below. Please also have
your blood drawn on [**2169-5-29**] and have the results faxed to Dr.
[**Last Name (STitle) **] (see lab slip).

It was a pleasure taking care of you. We wish you a speedy
recovery.

Followup Instructions:
Please follow up at the appointments below:

Department: GENERAL SURGERY/[**Hospital Unit Name 2193**]
When: THURSDAY [**2169-6-1**] at 2:30 PM
With: ACUTE CARE CLINIC [**Telephone/Fax (1) 2359**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

PRIMARY CARE: [**Last Name (LF) 2974**], [**6-2**] at 10:30AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 89200**],MD
Location: [**Hospital6 5242**] CENTER
Address: [**Location (un) 5243**], [**Location (un) **],[**Numeric Identifier 2260**]
Phone: [**Telephone/Fax (1) 798**]
** DR. [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] has been assigned as your as your new
PCP, [**Name10 (NameIs) **] let your insurance company know this information.

Department: INFECTIOUS DISEASE
When: [**Name10 (NameIs) **] [**2169-6-2**] at 9:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 88995**], MD [**Telephone/Fax (1) 457**]
Building: LM [**Hospital Unit Name **] [**Hospital 1422**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage


                             [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] DO 12-BDU

Completed by:[**2169-5-24**]

Name:  [**Known lastname 14142**],[**Known firstname **]                   Unit No:   [**Numeric Identifier 14143**]

Admission Date:  [**2169-5-15**]              Discharge Date:   [**2169-5-24**]

Date of Birth:  [**2146-1-25**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 14144**]
Addendum:
In clarification, pt's diagnoses include:
1. MRSA Fasciitis (non-necrotizing)
2. Acute Pulmonary Edema with Acute Respiratory Failure
3. Acute Cardiomyopathy

Discharge Disposition:
Home With Service

Facility:
VNA Community Health care

                             [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] DO 12-BDU

Completed by:[**2169-7-6**]
{'Fasciitis, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Systemic inflammatory response syndrome, unspecified,Left heart failure,Cellulitis and abscess of leg, except foot,Takotsubo syndrome,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Anemia, unspecified'}


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: Abscess

PRESENT ILLNESS: 23 year old male with no medical history who was admitted on
[**5-15**] for cellulitis.  He initially developed a "pimple" on his
left inner thigh one week prior to admit.  He popped it and it
drained a small amount of pus.  It recurred one day later and he
popped it again.  It occured the next day but larger and he felt
that it was moving into his leg.  He assumed it was a boil and
started putting warm compresses on it.  The redness, swelling
and pain slowly spread in his inner thigh, into the inguinal
region and into his left gluteal region.  He was also having
fevers at home to 101.  He presented to the ED on [**5-15**] and was
admitted for cellulits.  In the ED a CT pelvis was done which
edema and fasciitis along the left medial and posterior thigh
from the mid thigh to the inguinal and lateral perineal regions
without fluid collection or sub cutaneous gas.
.
On admit he was not having any respiratory distress although his
sat was noted to be in the low 90s on room air.  A CXR was
normal and and it was presumed secondary to atalectasis as with
deep breaths his O2 sat would increase.  He did not have an O2
requirement.
.
He was started on Vancomycin, clindamycin and unasyn for his
cellulitis.  Over the next two days his cellulitis improved and
on [**5-16**] patient felt well.  Overnight on [**5-16**] patient started
complaining of some indigestion/chest pain/cough.  He later
clarified this as more respiratory than what he though chest
pain would feel like.  He was given maalox for the "indigestion"
and started on tele.  On tele he was noted to have some runs of
NSVT without symptoms.  In the morning he was evaluated and
noted to have a new O2 requirement of 4L.  Given the concern
overnight for atypical chest pain cardiac enzymes were added on
to his am labs.  His CE enzymes were elevated trop of 1.19, CK
of 700 with an MBI of 10.3.
.
He was sent for a stat CTA to rule out PE.  CT showed no PE but
ground glass opacities in lower lobes and bronchial wall
thickening, question of aspiration pneumonitis, mild
interstitial thickening consistent with interstitial edema. ECG
at the time showed new septal St depressions and taller septal t
waves from prior and sinus tach.  His O2 requirement increased
and he was started on a NRB.  He was given nebs x1, lasix 10 iv,
and transfered to the ICU for hypoxia.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: NyQuil prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ON ADMISSION:
Vitals: 101.3 130/72 110 20 98%RA
General: Alert, oriented, no acute distress, mildly diaphoretic

FAMILY HISTORY: Father with MI and PE at age 50. Father also with DM
Paternal GF with PE at age 50.

SOCIAL HISTORY: - Tobacco:  None
- Alcohol:  5-6 beers on the weekend
- Illicits:  None
Sex active with women, last 6 months ago, uses condoms, never
tested for HIV. 

### Response:
{'Fasciitis, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Systemic inflammatory response syndrome, unspecified,Left heart failure,Cellulitis and abscess of leg, except foot,Takotsubo syndrome,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Anemia, unspecified'}
