CHIEF COMPLAINT: One day hematuria

PRESENT ILLNESS: This is a 63 year old male with a history of Down's syndrome,
seizure disorder, hypothyroidism who presents to the ED with
gross hematuria for one day.  Pt was in his USOH when his group
home staff found him to have bright red blood in his urine.  Pt
has had nocturnal enuresis over the last 3-4 months and was seen
by Dr. [**Last Name (STitle) 770**] on [**2141-10-18**] for enuresis and was found at that
time to have a large residual for which behavioral modifications
were implemented.  He also has a hx of holding his urine for
several years.  It is unknown if this enuresis is due to
neurogenic bladder or if pt does not choose to release his
urine.  He denies pain upon urination, but his sister reports
that he has intermittently reported sharp abdominal pain of
unknown origin 4x in the past 12 hours.  He has no prior hx of
hematuria.  No recent weight loss, fever, chills, diarrhea,
vomiting, nausea, abdominal pain.  No changes in his urinary
frequency, hesitancy, dribbling, or dysuria.  His sister does
report that the patient appears to have increased lethargy and
sleepiness today.  Denies trauma, recent change in medication,
travel, or sick contacts.

MEDICAL HISTORY: 1. Down's syndrome. Baseline oriented x 2 (person and place), is
wheelchair bound (s/p hip surgery), and is able to talk in
simple sentences.
2. Seizure disorder dx when pt was a teenager: Followed by Dr.
[**Last Name (STitle) 2442**].  Last seizure was in 06/[**2140**].  Seizure free > 1 year,
seizures are usually with partial right face twitching followed
by generalized tonic clonic convulsions.  On chornic treatment
with keppra and dilantin.
3. Hypothyrodism
4. Bilateral Hip Surgery in [**2113**]. Pt had a L hip infection in
[**2116**] that was treated w/ L hip removal
5. MRSA infection of buttock in [**10/2141**] improved with Bactrim
6. Bilateral knee arthritis
7. Bell's Palsy [**10/2140**], improved without treatment in 3 days

MEDICATION ON ADMISSION: DILANTIN 100 [**Hospital1 **], alternated with 100 qam, 200 qpm
FLONASE 1 spray daily
FOSAMAX 70 mg weekly
KEPPRA 1000 [**Hospital1 **] (used for 8 yrs)
LEVOXYL 125MCG daily
LOTRIMIN 1 % daily
MULTIVITAMIN daily
SIMVASTATIN 10 mg qhs
DEBROX EAR DROPS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Pleasantly smiling male resting comfortably, younger
appearing than stated age
Vital Signs: Tmax 101.7 Tc:101.7 86/58 HR 82 RR 18 95% RA
HEENT: NC/AT, large tongue with multiple elevated papillae, EOMI
Neck: Supple, no LAD, no JVP
Respiratory: CTA b/l
Cardiovascular: RRR, normal s1 s2, [**12-27**] holosystolic murmur at
base
Abdomen: BSx4, soft, non-tender, non-distended, no masses or
hepatomegaly
Extremities: No edema, left hip shortened and externally
rotated, 2+ DP/PT pulses, +Simian crease bilaterally
Neurological: CNII-XII grossly in tact, alert, oriented x 2
(person, place), grossly non-focal

FAMILY HISTORY: Mother: died of pancreatic CA
Father: died of unknown kidney disease, hx of chronic kidney
stones
Sister (65yrs): Down's Syndrome and [**Name (NI) 2481**] Disease
Sister (68 yrs): multi-nodular goiter, thyrodectomy without dx
CA
Brother (72yrs): thyroid CA at age 22, currently healthy
Brother (59 yrs): Healthy
Sisters (75 and 66yrs): Healthy

SOCIAL HISTORY: Lives in a group home at [**First Name4 (NamePattern1) 7306**] [**Last Name (NamePattern1) **] at [**Last Name (un) 21966**]in
[**Location (un) 686**].  Pt enjoys attending workshops from 6AM until 5PM
Monday through Friday at [**State 350**] Association for the
Blind.  Pt has no hx of alcohol, smoking, or illicit drug use.
He denies depression, enjoys talking to people, and cannot
tolerate loud noises.
Acute kidney failure, unspecified,Unspecified septicemia,Sepsis,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Cystitis, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Hydronephrosis,Hypotension, unspecified,Anemia, unspecified,Down's syndrome,Epilepsy, unspecified, without mention of intractable epilepsy,Urinary incontinence, unspecified,Unspecified acquired hypothyroidism,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Other abnormal glucose,Family history of malignant neoplasm of gastrointestinal tract,Family history of other specified malignant neoplasm
Acute kidney failure NOS,Septicemia NOS,Sepsis,Ac DVT/emb distl low ext,Cystitis NOS,Mth sus Stph aur els/NOS,Inf mcrg rstn pncllins,Hydronephrosis,Hypotension NOS,Anemia NOS,Down's syndrome,Epilep NOS w/o intr epil,Urinary incontinence NOS,Hypothyroidism NOS,Loc osteoarth NOS-l/leg,Abnormal glucose NEC,Family hx-gi malignancy,Family hx-malignancy NEC
Admission Date:  [**2141-12-12**]              Discharge Date:   [**2141-12-21**]

Date of Birth:  [**2078-9-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1666**]
Chief Complaint:
One day hematuria

Major Surgical or Invasive Procedure:
PICC line placement


History of Present Illness:
This is a 63 year old male with a history of Down's syndrome,
seizure disorder, hypothyroidism who presents to the ED with
gross hematuria for one day.  Pt was in his USOH when his group
home staff found him to have bright red blood in his urine.  Pt
has had nocturnal enuresis over the last 3-4 months and was seen
by Dr. [**Last Name (STitle) 770**] on [**2141-10-18**] for enuresis and was found at that
time to have a large residual for which behavioral modifications
were implemented.  He also has a hx of holding his urine for
several years.  It is unknown if this enuresis is due to
neurogenic bladder or if pt does not choose to release his
urine.  He denies pain upon urination, but his sister reports
that he has intermittently reported sharp abdominal pain of
unknown origin 4x in the past 12 hours.  He has no prior hx of
hematuria.  No recent weight loss, fever, chills, diarrhea,
vomiting, nausea, abdominal pain.  No changes in his urinary
frequency, hesitancy, dribbling, or dysuria.  His sister does
report that the patient appears to have increased lethargy and
sleepiness today.  Denies trauma, recent change in medication,
travel, or sick contacts.

Past Medical History:
1. Down's syndrome. Baseline oriented x 2 (person and place), is
wheelchair bound (s/p hip surgery), and is able to talk in
simple sentences.
2. Seizure disorder dx when pt was a teenager: Followed by Dr.
[**Last Name (STitle) 2442**].  Last seizure was in 06/[**2140**].  Seizure free > 1 year,
seizures are usually with partial right face twitching followed
by generalized tonic clonic convulsions.  On chornic treatment
with keppra and dilantin.
3. Hypothyrodism
4. Bilateral Hip Surgery in [**2113**]. Pt had a L hip infection in
[**2116**] that was treated w/ L hip removal
5. MRSA infection of buttock in [**10/2141**] improved with Bactrim
6. Bilateral knee arthritis
7. Bell's Palsy [**10/2140**], improved without treatment in 3 days

Social History:
Lives in a group home at [**First Name4 (NamePattern1) 7306**] [**Last Name (NamePattern1) **] at [**Last Name (un) 21966**]in
[**Location (un) 686**].  Pt enjoys attending workshops from 6AM until 5PM
Monday through Friday at [**State 350**] Association for the
Blind.  Pt has no hx of alcohol, smoking, or illicit drug use.
He denies depression, enjoys talking to people, and cannot
tolerate loud noises.

Family History:
Mother: died of pancreatic CA
Father: died of unknown kidney disease, hx of chronic kidney
stones
Sister (65yrs): Down's Syndrome and [**Name (NI) 2481**] Disease
Sister (68 yrs): multi-nodular goiter, thyrodectomy without dx
CA
Brother (72yrs): thyroid CA at age 22, currently healthy
Brother (59 yrs): Healthy
Sisters (75 and 66yrs): Healthy

Physical Exam:
General: Pleasantly smiling male resting comfortably, younger
appearing than stated age
Vital Signs: Tmax 101.7 Tc:101.7 86/58 HR 82 RR 18 95% RA
HEENT: NC/AT, large tongue with multiple elevated papillae, EOMI
Neck: Supple, no LAD, no JVP
Respiratory: CTA b/l
Cardiovascular: RRR, normal s1 s2, [**12-27**] holosystolic murmur at
base
Abdomen: BSx4, soft, non-tender, non-distended, no masses or
hepatomegaly
Extremities: No edema, left hip shortened and externally
rotated, 2+ DP/PT pulses, +Simian crease bilaterally
Neurological: CNII-XII grossly in tact, alert, oriented x 2
(person, place), grossly non-focal

Pertinent Results:
[**2141-12-14**] 04:10PM BLOOD Hct-33.5*
[**2141-12-14**] 07:05AM BLOOD WBC-11.8* RBC-3.72* Hgb-12.8* Hct-35.5*
MCV-95 MCH-34.3* MCHC-36.0* RDW-13.3 Plt Ct-100*
[**2141-12-13**] 07:20AM BLOOD WBC-15.3* RBC-4.33* Hgb-14.3 Hct-41.1
MCV-95 MCH-33.0* MCHC-34.7 RDW-13.5 Plt Ct-127*
[**2141-12-12**] 11:25AM BLOOD WBC-13.7*# RBC-4.71 Hgb-15.7 Hct-45.2
MCV-96 MCH-33.4* MCHC-34.8 RDW-13.5 Plt Ct-143*
[**2141-12-12**] 11:25AM BLOOD Neuts-91.8* Bands-0 Lymphs-5.1* Monos-2.9
Eos-0 Baso-0.1
[**2141-12-12**] 11:25AM BLOOD Hypochr-NORMAL Anisocy-NORMAL
Poiklo-NORMAL Macrocy-1+ Microcy-NORMAL Polychr-NORMAL
[**2141-12-14**] 07:05AM BLOOD Plt Ct-100*
[**2141-12-13**] 07:20AM BLOOD Plt Ct-127*
[**2141-12-12**] 11:25AM BLOOD Plt Ct-143*
[**2141-12-12**] 11:25AM BLOOD PT-14.2* PTT-29.5 INR(PT)-1.2*
[**2141-12-14**] 07:05AM BLOOD Glucose-129* UreaN-25* Creat-1.9* Na-139
K-4.0 Cl-104 HCO3-25 AnGap-14
[**2141-12-13**] 07:20AM BLOOD Glucose-114* UreaN-28* Creat-2.0* Na-137
K-4.3 Cl-101 HCO3-25 AnGap-15
[**2141-12-12**] 11:25AM BLOOD Glucose-168* UreaN-23* Creat-1.8* Na-139
K-4.5 Cl-102 HCO3-28 AnGap-14
[**2141-12-12**] 11:25AM BLOOD estGFR-Using this
[**2141-12-13**] 07:20AM BLOOD Calcium-8.4 Phos-3.2 Mg-1.8
[**2141-12-13**] 07:20AM BLOOD Phenyto-16.2

[**2141-12-12**] 11:25AM BLOOD RedHold-HOLD
[**2141-12-12**] 11:25AM BLOOD GreenHd-HOLD
[**2141-12-19**] 05:50AM BLOOD Phenyto-5.2*
[**2141-12-18**] 05:50AM BLOOD TSH-0.27
[**2141-12-18**] 05:50AM BLOOD Free T4-0.81*
.
Renal US [**12-12**]: IMPRESSION: Extensive clot filling the bladder
consistent with clot given history. There is bilateral
hydronephrosis, right worse than left. There has been interval
significant decrease in the size and cortical thickness of the
right kidney.
.
Renal US [**12-14**]: IMPRESSION:
1. Interval resolution of right hydronephrosis with persistent
mild left hydronephrosis.

2. Clotted blood within the urinary bladder, perhaps slightly
less than on prior.
.
CXR [**12-14**]: Widespread mild-to-moderately severe interstitial
pulmonary abnormality in the perihilar and right lower lung
could be due to pulmonary edema since the azygos vein is
distended indicating elevated central venous pressure.
Nevertheless heart is normal size. Pleural effusion, if any, is
minimal. More discrete areas of opacification at both lung bases
could represent pneumonia or atelectasis or, in the right
clinical setting, pulmonary infarction. Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and I
discussed these findings at the time of dictation.
.
CXR [**12-16**]: IMPRESSION:
1. Stable evidence of pulmonary edema, with bilateral effusions.
.
CXR [**12-19**]: IMPRESSION: Tip of new right-sided PICC line likely
terminating in the mid right atrium. Discussed with IV therapy.
.
ECHO [**12-15**]: IMPRESSION: Suboptimal image quality. Hyperdynamic
left ventricular systolic function with valvular [**Male First Name (un) **] and resting
LVOT gradient. Mild mitral regurgitation. No definite vegetation
seen (does not exclude).

Brief Hospital Course:
HEMATURIA: Mr. [**Known lastname 8389**] was admitted for hematuria and found to
have fevers, leukocytosis, and pyuria.  Renal ultrasound showed
clot filling the bladder consistent with bilateral
hydronephrosis R>L and decrease in the size and cortical
thickness of the right kidney.  He was placed on empiric
Ceftiaxone for the infection and monitored by urine lytes and
urine analysis.  Urology was consulted and recommended the
patient be placed on continuous bladder irrigation (CBI) with
three way [**Known lastname **] but the hematuria did not resolve on the third
hospital day.  Patient's in's and outs were monitored along with
renal function tests.  He had a urine culture return positive
for MRSA.  He was started on vancomycin, and this is to be
continued until [**2141-12-28**].  He will need a vancomycin trough
measured on [**2141-12-23**], and the level should be between 15 and 20.
The MD's at his rehab will need to adjust his dose to maintain
this level.

His urine cleared, and prior to discharge he had his [**Known lastname **]
catheter removed, and he voided clear urine.  He had no fever
issues in the subsequent days of the admission.

ARF: He was in acute renal failure on admission, with a
creatinine of 1.8 to 2.0.  He was hydrated, and his cystitis was
treated.  With treatment, his creatinine returned to his (?new)
baseline of 1.3 to 1.4.  He had good urine output.  He had a
elevated [**Last Name (LF) 21967**], [**First Name3 (LF) **] it was felt that the UTI / hydronephrosis was
responsible.

His hematuria resolved as mentioned above.  URology was
following, and he has an appointment with Dr. [**Last Name (STitle) 770**] in [**Month (only) 958**]
[**2141**] for follow up.

HYPOTENSION He developed hypotension on the medical floor.
Given concern for sepsis, he was transferred to the MICU and
given aggressive fluids.  Of note, upon transfer and placement
of an arterial line, his BP was read as normal (consistently
30mm Hg higher than the non-invasive measurements).  He was
returned to the medical floor after that.

DVT: He developed some brief hypoxia, corrected with oxygen, and
this was felt to be fluid overload from all of the fluids.  But,
he had a d.dimer checked for evidence of a DVT, and it was
positive.  Given his elevated creatinine, a CTA was deferred,
and LENI was done.  He was found to have a LE DVT, and was
started on heparin.  Discussion with his PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], as
well as his neurologist, Dr. [**Last Name (STitle) 2442**], ensued, and it was
decided to start him on warfarin for a 6 month course.  He was
transitioned to lovenox prior to dishcarge, and plan to bridge
to warfarin INR [**12-24**].  Of note, warfarin and phenytoin can
interact and lower BOTH levels, so they need to monitored
closely, especially with any dose adjustments.

SEIZURE D/O: He has a seizure disorder, and there was a question
of a possible seizure in the setting of a vagal episode while
getting his PICC line.  It was brief.  His phenytoin level was
low at 5.8 - and his dose was changed to 100mg qam and 200mg
qpm.  It needs to be rechecked after 4 days ([**2141-12-23**]), and if
still low, the new dose should be 200mg [**Hospital1 **].  The level should
be checked every 4 days until a good level is acheived.

ANEMIA (ACUTE BLOOD LOSS and RENAL): He was noted to be anemic,
which was felt to likely be due to his acute illness and
possible renal issues.  He was stable without any transfusions.

HYPOTHYROID: He has hypothyroidism, and had a TSH checked twice.
 At first it was low, and then it was low-normal.  The second
time it was checked his free T4 was also checked, and it was
low.  This was likley sick euthyroid, and he should have this
level rechecked in 4 weeks as an outpatient.

HYPERGLYCEMIA: He was also hyperglycemic, which appears to be a
new diagnosis.  Starting an oral [**Doctor Last Name 360**] was deffered as an
inpatient givne his otehr illnesses.  He will continue on an
insulin sliding scale and will need to decide about oral agents
as an outpatient.

He was DNR/DNI on admission, but this was changed to FULL CODE
during his ICU stay.

He has been eating a diabetic diet, and tolerating this without
problems.

His sister / guardian, was very involved in his plan of care and
agreeable to his discharge plan.



Medications on Admission:
DILANTIN 100 [**Hospital1 **], alternated with 100 qam, 200 qpm
FLONASE 1 spray daily
FOSAMAX 70 mg weekly
KEPPRA 1000 [**Hospital1 **] (used for 8 yrs)
LEVOXYL 125MCG daily
LOTRIMIN 1 % daily
MULTIVITAMIN daily
SIMVASTATIN 10 mg qhs
DEBROX EAR DROPS

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
3. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
4. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
5. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
6. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO QAM (once a day (in the morning)).
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
10. Insulin Lispro 100 unit/mL Solution Sig: One (1) injection
Subcutaneous ASDIR (AS DIRECTED).
11. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2)
Capsule PO QPM (once a day (in the evening)).
12. Warfarin 2.5 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)): Take 5mg for the next two days.  Check INR
after that and adjust dose for INR [**12-24**].  Then after 3 days of
this INR the lovenox can be stopped.
13. Enoxaparin 60 mg/0.6 mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours): 60 mg.
14. Vancomycin 1,000 mg Recon Soln Sig: One (1) gram Intravenous
once a day for 8 days.
15. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: Five
(5) ML Intravenous DAILY (Daily) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 8221**] - [**Location (un) 583**]

Discharge Diagnosis:
PRIMARY:
Hematuria
MRSA cystitis
Deep venous thrombosis
Seizure disorder
Acute renal failure
Hyperglycemia
Hypothyroidism
Anemia, stable


Discharge Condition:
Stable, tolerating PO diet, afebrile, clear urine


Discharge Instructions:
You were admitted with bloody urine, and found to have a bladder
infection.  Urology was consulted, and recommended keeping the
[**Known lastname **] catheter in place, and you should follow up with them in
one week.

You also were found to have a blood clot in your legs.  You were
treated with a blood thinner, heparin, and started on one by
mouth, called coumadin.  You will need to be given lovenox
injections twice daily until your INR is between 2 and 3 for
three days.

You will need to have your INR measured daily until then.  When
the lovenox is completed, you will have your INR adjusted by the
[**Company 191**] anticoagulation nurses through Dr.[**Name (NI) 20819**] office once
you leave rehab. You will be notified of an appointment.  But,
you can have your INR levels drawn and faxed to Dr.[**Name (NI) 20819**]
office attention [**Company 191**] anticoagulation nurses after discharge from
rehab.

Your bladder infection was caused by a resistant organism, MRSA,
and you will need to continue IV vancomycin for 7 more days.
You have a PICC line for that.  You will need to have your
vancomycin level checked on [**2141-12-23**], as a trough level (just
BEFORE your morning dose).  This level should be between 15 and
20 mg /dl.  This should be followed by the MD's at the rehab.
The dose should be adjusted to maintain this level.

You possibly had a seizure while here.  Your dilantin level was
low, and your dose was adjusted.  You need to have your
phenytoin level checked on [**2141-12-23**].  If the level is low, then
you should be on 200mg [**Hospital1 **].  If it is 9 or greater, then keep it
at 100mg qam and 200mg qpm.

If you have any worsening pain, difficulty breathing, or
profound bleeding, please seek immediate medical attention.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4653**], MD Phone:[**Telephone/Fax (1) 274**]
Date/Time:[**2142-1-22**] 2:30
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5377**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2142-3-30**] 11:00


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1672**] MD, [**MD Number(3) 1673**]
{"Acute kidney failure, unspecified,Unspecified septicemia,Sepsis,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Cystitis, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Hydronephrosis,Hypotension, unspecified,Anemia, unspecified,Down's syndrome,Epilepsy, unspecified, without mention of intractable epilepsy,Urinary incontinence, unspecified,Unspecified acquired hypothyroidism,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Other abnormal glucose,Family history of malignant neoplasm of gastrointestinal tract,Family history of other specified malignant neoplasm"}


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: One day hematuria

PRESENT ILLNESS: This is a 63 year old male with a history of Down's syndrome,
seizure disorder, hypothyroidism who presents to the ED with
gross hematuria for one day.  Pt was in his USOH when his group
home staff found him to have bright red blood in his urine.  Pt
has had nocturnal enuresis over the last 3-4 months and was seen
by Dr. [**Last Name (STitle) 770**] on [**2141-10-18**] for enuresis and was found at that
time to have a large residual for which behavioral modifications
were implemented.  He also has a hx of holding his urine for
several years.  It is unknown if this enuresis is due to
neurogenic bladder or if pt does not choose to release his
urine.  He denies pain upon urination, but his sister reports
that he has intermittently reported sharp abdominal pain of
unknown origin 4x in the past 12 hours.  He has no prior hx of
hematuria.  No recent weight loss, fever, chills, diarrhea,
vomiting, nausea, abdominal pain.  No changes in his urinary
frequency, hesitancy, dribbling, or dysuria.  His sister does
report that the patient appears to have increased lethargy and
sleepiness today.  Denies trauma, recent change in medication,
travel, or sick contacts.

MEDICAL HISTORY: 1. Down's syndrome. Baseline oriented x 2 (person and place), is
wheelchair bound (s/p hip surgery), and is able to talk in
simple sentences.
2. Seizure disorder dx when pt was a teenager: Followed by Dr.
[**Last Name (STitle) 2442**].  Last seizure was in 06/[**2140**].  Seizure free > 1 year,
seizures are usually with partial right face twitching followed
by generalized tonic clonic convulsions.  On chornic treatment
with keppra and dilantin.
3. Hypothyrodism
4. Bilateral Hip Surgery in [**2113**]. Pt had a L hip infection in
[**2116**] that was treated w/ L hip removal
5. MRSA infection of buttock in [**10/2141**] improved with Bactrim
6. Bilateral knee arthritis
7. Bell's Palsy [**10/2140**], improved without treatment in 3 days

MEDICATION ON ADMISSION: DILANTIN 100 [**Hospital1 **], alternated with 100 qam, 200 qpm
FLONASE 1 spray daily
FOSAMAX 70 mg weekly
KEPPRA 1000 [**Hospital1 **] (used for 8 yrs)
LEVOXYL 125MCG daily
LOTRIMIN 1 % daily
MULTIVITAMIN daily
SIMVASTATIN 10 mg qhs
DEBROX EAR DROPS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Pleasantly smiling male resting comfortably, younger
appearing than stated age
Vital Signs: Tmax 101.7 Tc:101.7 86/58 HR 82 RR 18 95% RA
HEENT: NC/AT, large tongue with multiple elevated papillae, EOMI
Neck: Supple, no LAD, no JVP
Respiratory: CTA b/l
Cardiovascular: RRR, normal s1 s2, [**12-27**] holosystolic murmur at
base
Abdomen: BSx4, soft, non-tender, non-distended, no masses or
hepatomegaly
Extremities: No edema, left hip shortened and externally
rotated, 2+ DP/PT pulses, +Simian crease bilaterally
Neurological: CNII-XII grossly in tact, alert, oriented x 2
(person, place), grossly non-focal

FAMILY HISTORY: Mother: died of pancreatic CA
Father: died of unknown kidney disease, hx of chronic kidney
stones
Sister (65yrs): Down's Syndrome and [**Name (NI) 2481**] Disease
Sister (68 yrs): multi-nodular goiter, thyrodectomy without dx
CA
Brother (72yrs): thyroid CA at age 22, currently healthy
Brother (59 yrs): Healthy
Sisters (75 and 66yrs): Healthy

SOCIAL HISTORY: Lives in a group home at [**First Name4 (NamePattern1) 7306**] [**Last Name (NamePattern1) **] at [**Last Name (un) 21966**]in
[**Location (un) 686**].  Pt enjoys attending workshops from 6AM until 5PM
Monday through Friday at [**State 350**] Association for the
Blind.  Pt has no hx of alcohol, smoking, or illicit drug use.
He denies depression, enjoys talking to people, and cannot
tolerate loud noises. 

### Response:
{"Acute kidney failure, unspecified,Unspecified septicemia,Sepsis,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Cystitis, unspecified,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Hydronephrosis,Hypotension, unspecified,Anemia, unspecified,Down's syndrome,Epilepsy, unspecified, without mention of intractable epilepsy,Urinary incontinence, unspecified,Unspecified acquired hypothyroidism,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Other abnormal glucose,Family history of malignant neoplasm of gastrointestinal tract,Family history of other specified malignant neoplasm"}
