CHIEF COMPLAINT: Gastrointestinal bleeding, bacteremia, and
fungemia.

PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old
male with multiple medical problems with the past medical
history significant for gastric cancer status post resection
with vagotomy, prostate cancer with likely bony metastasis,
recurrent aspiration pneumonia, chronic anemia, questionable
history of gastrointestinal bleeds with several
esophagogastroduodenoscopies in the past showing Candidal
esophagitis with nonbleeding fundal polyps, and dementia
thought to be secondary to Alzheimer disease.  The patient
was admitted to [**Hospital1 69**] on
[**9-30**], with a 30 pound weight loss over several
months and acute and chronic mental-status decline and
pneumonia.  He was treated for his pneumonia with Levaquin
and then changed to Azithromycin and sent to Core for
rehabilitation on [**2147-10-4**].  While there, the
patient had continued treatment of pneumonia and an
esophagogastroduodenoscopy was done on [**10-16**], which
showed esophagitis with nonbleeding fundal polyp.  He had
been started on TPN for unknown number of days, which was
being given through a PIC line, and on [**10-28**], grew
out MRSA from blood and E. coli from urine.  The patient was
started on Cefepime on [**2147-10-30**].  On [**2147-11-4**], the patient was febrile to 102 degrees and repeat blood
cultures at that time showed gram-positive cocci in pairs and
chains.  This grew from two sites including the patient's PIC
line.  In addition, the patient's blood grew out yeast, which
had not been speciated at the time of admission.  The patient
was started on Vancomycin and Fluconazole on [**2147-11-4**] at [**Hospital1 5042**].  The patient now presents to [**Hospital1 346**] with black-tarry stools, which have
been going on for an unknown number of days at [**Hospital1 5042**].  There
was no history of emesis or bright red blood per rectum.  The
patient's hematocrit was 19 on [**2147-11-6**].  He was
given two units of packed red blood cells at that time with
repeat hematocrit on [**11-8**], still at 19. The patient
was, therefore, transferred to [**Hospital1 188**] for further evaluation and treatment.

MEDICAL HISTORY: 1.  Gastric cancer, status post resection with vagotomy.
2.  Prostate cancer likely bony metastasis.
3.  Candidal esophagitis.
4.  Chronic anemia.
5.  Question of history of GI bleed.
6.  Recurrent aspiration pneumonias.
7.  Dementia, likely Alzheimer disease.
8.  Depression/anxiety.
9.  Atypical chest pain with a normal stress test in [**2145**].
10. Failure to thrive.  Poor nutritional status.
11. Lumbar fracture of L4.
12. Spinal column stenosis.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is Russian-speaking only.  He
has a daughter, [**Name (NI) **] [**Name (NI) 5043**].  Her phone # is [**Telephone/Fax (1) 5044**],
as well as son, [**Name (NI) 5045**] [**Name (NI) 5043**].  The patient is a retired
scientist.
Disseminated candidiasis,Hemorrhage of gastrointestinal tract, unspecified,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Atrial fibrillation,Secondary malignant neoplasm of bone and bone marrow,Intestinal infection due to Clostridium difficile,Malignant neoplasm of prostate
Disseminated candidiasis,Gastrointest hemorr NOS,Food/vomit pneumonitis,CHF NOS,Atrial fibrillation,Secondary malig neo bone,Int inf clstrdium dfcile,Malign neopl prostate
Admission Date:  [**2147-11-8**]       Discharge Date:  [**2147-11-27**]


Service:  [**Hospital1 139**].

CHIEF COMPLAINT:  Gastrointestinal bleeding, bacteremia, and
fungemia.

HISTORY OF THE PRESENT ILLNESS:  The patient is a [**Age over 90 **]-year-old
male with multiple medical problems with the past medical
history significant for gastric cancer status post resection
with vagotomy, prostate cancer with likely bony metastasis,
recurrent aspiration pneumonia, chronic anemia, questionable
history of gastrointestinal bleeds with several
esophagogastroduodenoscopies in the past showing Candidal
esophagitis with nonbleeding fundal polyps, and dementia
thought to be secondary to Alzheimer disease.  The patient
was admitted to [**Hospital1 69**] on
[**9-30**], with a 30 pound weight loss over several
months and acute and chronic mental-status decline and
pneumonia.  He was treated for his pneumonia with Levaquin
and then changed to Azithromycin and sent to Core for
rehabilitation on [**2147-10-4**].  While there, the
patient had continued treatment of pneumonia and an
esophagogastroduodenoscopy was done on [**10-16**], which
showed esophagitis with nonbleeding fundal polyp.  He had
been started on TPN for unknown number of days, which was
being given through a PIC line, and on [**10-28**], grew
out MRSA from blood and E. coli from urine.  The patient was
started on Cefepime on [**2147-10-30**].  On [**2147-11-4**], the patient was febrile to 102 degrees and repeat blood
cultures at that time showed gram-positive cocci in pairs and
chains.  This grew from two sites including the patient's PIC
line.  In addition, the patient's blood grew out yeast, which
had not been speciated at the time of admission.  The patient
was started on Vancomycin and Fluconazole on [**2147-11-4**] at [**Hospital1 5042**].  The patient now presents to [**Hospital1 346**] with black-tarry stools, which have
been going on for an unknown number of days at [**Hospital1 5042**].  There
was no history of emesis or bright red blood per rectum.  The
patient's hematocrit was 19 on [**2147-11-6**].  He was
given two units of packed red blood cells at that time with
repeat hematocrit on [**11-8**], still at 19. The patient
was, therefore, transferred to [**Hospital1 188**] for further evaluation and treatment.

In the emergency department here, the patient's temperature
was 100.7 rectally and he was found to be hypotensive with a
systolic blood pressure in the 80s; this responded to an IV
fluid bolus.  EKG done at that time showed new atrial
fibrillation with rapid ventricular response.  A femoral
triple-lumen was placed and NG-tube placement was attempted,
but not successful.  Blood transfusion was initiated in the
emergency department.

PAST MEDICAL HISTORY:
1.  Gastric cancer, status post resection with vagotomy.
2.  Prostate cancer likely bony metastasis.
3.  Candidal esophagitis.
4.  Chronic anemia.
5.  Question of history of GI bleed.
6.  Recurrent aspiration pneumonias.
7.  Dementia, likely Alzheimer disease.
8.  Depression/anxiety.
9.  Atypical chest pain with a normal stress test in [**2145**].
10. Failure to thrive.  Poor nutritional status.
11. Lumbar fracture of L4.
12. Spinal column stenosis.

MEDICATIONS:  (on admission).
1.  Fluconazole 200 mg IV q.d., day #1 of admission.
2.  Vancomycin 1-g IV q.d. day #5 of admission.
3.  MSO4, 3 mg ....................p.r.n.
4.  PPN 70 cc per hour.
5.  Cefepime 1-g IV b.i.d. day #10 of admission.
6.  Bupropion 100 mg b.i.d.
7.  Tylenol p.r.n.
8.  Kaopectate p.r.n.
9.  IV lipids 20% at 16 cc per hour.
10. Vitamin E q.d.
11. Calcitonin nasal spray.
12. Subcutaneous Heparin.

ALLERGIES:  The patient has no known drug allergies.

FAMILY HISTORY:  Noncontributory.

SOCIAL HISTORY:  The patient is Russian-speaking only.  He
has a daughter, [**Name (NI) **] [**Name (NI) 5043**].  Her phone # is [**Telephone/Fax (1) 5044**],
as well as son, [**Name (NI) 5045**] [**Name (NI) 5043**].  The patient is a retired
scientist.

PHYSICAL EXAMINATION:  Examination revealed the temperature
of 101.7 rectally.  Heart rate in the 80s and irregular.
Blood pressure 98/50; respiratory rate 20; pulse oximetry 95%
on two liters.  GENERAL:  In general, the patient is a
cachectic, chronically ill-appearing elderly man, lying in
bed.  He has multiple pressure sores with some skin breakdown
on his extremities and back.  He appears pale.  HEENT:  Exam
showed temporal muscle wasting.  He has a right surgical
pupil; left pupil is constricted.  Scleral are anicteric.
Conjunctivae are pale.  Neck was supple.  There are no
bruits.  There was no elevated JVP.  LUNGS:  Lungs are with
wheezes or crackles anteriorly.  There is good air movement.
HEART:  Heart revealed irregularly irregular rhythm with no
murmurs, rubs, or gallops.  ABDOMEN:  Abdomen was soft,
nondistended and nontender.  There were no active bowel
sounds.  EXTREMITIES:  Extremities are cool to the touch with
1+ to 2+ anasarca.

LABORATORY DATA:  Labs on admission revealed the following:
White count 15.8; hematocrit 20.7; platelets 120,000.
Differential showed 93% neutrophils, 3% bands, 4% lymphs; PT
13.9; INR 1.3; PTT 37; albumin 1.6; sodium 153; potassium
3.5; chloride 122; bicarbonate 122; BUN 80 and creatinine
1.1; glucose 100; serum osmolality 328; calcium 7.2;
magnesium 2.1; phosphorus 3.9; CK 42; troponin less than 0.3;
ALT 27; AST 33; alkaline phosphatase 110; amylase 80; total
bilirubin 0.4.  Microbiological studies showed urine cultures
at [**Hospital1 5042**] on [**11-4**], were negative.  Blood cultures at
[**Hospital1 5042**] on [**10-28**], grew out MRSA in two bottles.
Urine culture at [**Hospital1 5042**] on [**10-28**] grew out E. coli,
which was resistant only to Ampicillin.  Stool for C.
difficile at [**Hospital1 5042**] was negative on [**10-23**].  Blood
cultures at [**Hospital1 5042**] on [**11-24**], had gram-positive cocci
in pairs and chains, as well as yeast, growing two separate
sets of blood cultures.

RADIOLOGY:  Chest x-ray on admission showed a left pleural
effusion, question of basilar consolidation.

EKG:  The EKG showed atrial fibrillation with ventricular
rate of 103 with left axis deviation.  There were no Q waves
and no significant ST or T-wave changes.  The atrial
fibrillation was new, as compared with [**2147-9-30**],
which showed a sinus rhythm with APC.

HOSPITAL COURSE:  The patient was admitted to the MICU,
initially, for further evaluation and monitoring.  But, the
patient was transferred out after two days to the regular
medical floor, stabilized.

INFECTIOUS DISEASE:  The patient was admitted with fungemia
and bacteremia, as well as a question of aspiration
pneumonia. He was started on Vancomycin and Amphotericin B as
well as Ceftazidime.  His PIC line was discontinued.
Unfortunately, the patient received and excessive dose of
Amphotericin.  He received 125 mg instead of a test dose of
12.5 mg.  Therefore, his dose was held for two days and his
renal function was watched closely.  Infectious Disease
consultation was obtained on [**11-10**].  The patient was
started on AmBisome on [**2147-11-12**].  Echocardiogram
was obtained on [**11-13**] to look for possible
vegetations.  This was negative.  The Ceftazidime was
discontinued on [**11-12**] as there was no evidence of
gram-negative infection.  The blood cultures grew out E.
coccus, which was sensitive to Vancomycin.  The patient was
continued on AmBisome for his fungal infection, which was
speciated as [**Female First Name (un) 564**] parapsilosis.  Head CT was obtained on
[**11-13**].  The patient had been complaining of headache
and it came back negative for any evidence of abscess.  The
patient's Flagyl was discontinued on [**11-13**], as there
was no evidence of aspiration pneumonia and repeated stool
samples were negative for C. difficile.  The patient's
femoral line, which was placed on admission was discontinued
on [**11-15**], at which time, a single lumen PIC was placed
into the right arm, as surveillance cultures had been
negative for greater than 48 hours.  However, during the PIC
line placement, the patient was noted to have clot in the
right subclavian vein.  Therefore, the duration of his
treatment was extended to six weeks's total.  He needed to be
treated for possible endovascular source of infection.

The patient has remained hypothermic throughout this hospital
admission with temperatures ranging from 95 to 96, while he
was on a warming blanket.  His temperatures are 92 to
unregisterable when the warming blanket is off.  The
Vancomycin is currently being dosed p.r.n.  He gets a daily
Vancomycin level.  He is dosed with 1-g IV when the random
Vancomycin level is less than 15.

GI:  The patient was admitted with GI bleed with a decreased
hematocrit and bright red blood per rectum, by report at
[**Hospital1 5042**].  A GI consultation was obtained.  They felt that the
patient should be stabilized from an infectious standpoint.
Until then, they felt that the GI bleeding should be treated
conservatively with blood transfusions, as needed, as well as
IV Protonix.  They had no desire to scope the patient given
his unstable medical status.

A KUB was obtained on [**11-12**], as the patient had no
bowel sounds, but it was negative for toxic megacolon.  The
patient has been stable from a GI standpoint since then.
Until recently having a few episodes of bright red blood
mixed with stool, starting on [**11-25**].  The patient has
been transfused one unit since then, with his most current
hematocrit of 31.3 on [**2147-11-27**].  In addition, the
patient has tested positive again for C. difficile on
[**11-22**], and he has been restarted on Flagyl for this.

FEN:  The patient was very complicated regarding his
nutritional status since admission and NG tube was attempted
on admission, but unable to be placed, likely secondary to
his poor anatomy, due to previous gastric resection.  In
addition, his daughter was very reluctant to give the patient
TPN based on his history of fungal infection.  So, the
patient had no nutrition at all from [**2147-11-8**] until
[**2147-11-20**].  The patient had been a very difficulty
access problem, as he had several areas of cellulitis on his
extremities.  So, PIC line placement was difficult.  A PIC
line was finally placed on [**11-15**], but it was only able
to be placed into the axillary vein as there was closed in
the right subclavian vein, therefore, it could be used for
antibiotics only and not for TPN.  At that time a swallow
study was done at the bed side and they felt that the patient
could possibly be given pureed foods with nectar-thick
liquid.  However, they explained to the patient's daughter
that he was still at high risk for aspiration.  If she still
desired to feed him, she could attempt very small amounts by
mouth.  The PIC line was only in place until [**11-19**], at
which time the patient pulled out the PIC line himself.
Therefore, on [**11-20**], interventional radiology was
consulted and a new triple lumen catheter was placed in the
left IJ.  The patient was finally started on QuickMix TPN at
that time.  The patient's most recent albumin is 1.6, which
was measured on [**2147-11-20**].  He is on nonstandard TPN
of 1500 cc per day with 65-g amino acid 285-g dextrose and
30-g fat.  He get nonstandard electrolytes as determined by a
daily Chem 10.  He also is getting zinc daily to try to
augment wound healing.

As far as electrolytes, the patient has been hyponatremic
throughout his hospital stay with a high of 153 on admission
and most recent sodium of 148 on [**2147-11-27**].  At this time
the sodium is going to be decreased in his TPN and a FENa is
going to be measured to see if the patient may be volume
depleted.  He had received hypotonic fluids during his
hospital stay, which improved his sodium down to a low of
143.

CARDIOVASCULAR:  The patient remained hemodynamically stable
throughout his hospital stay after being hydration on
admission for his presenting hypotension.  The atrial
fibrillation, which he was found to be in on admission,
reverted back to a normal sinus rhythm with APC.  He did have
one episode of CHF after receiving blood on [**2147-11-15**].  He was given a small amount of Lasix with good effect.
 He also has had a few episodes of atypical chest pain.  He
ruled out for MI on admission with negative enzymes.
Echocardiogram on [**2147-11-13**], showed no wall-motion
abnormalities.  He had an episode of chest pain on [**2147-11-23**], which was felt to be likely musculoskeletal in
origin, as the pain seemed to be increased with palpation.
he was started on p.r.n. Morphine for this, but has really no
recurrences and has not required Morphine since that time.

RENAL:  The patient has no known history of any renal disease
with his baseline creatinine being .7 to .9.  The creatinine
was watched closely on admission, especially given the fact
that he was to receive a huge dose of Amphotericin.  However,
his creatinine did not bump at that time.  The creatinine had
been steady from 1.2 to 1.5 being started being started on
the AmBisome.  However, the most recent creatinine on [**2147-11-27**], is up to 1.7.  Therefore, FENa is going to be
measured today to determine whether this is prerenal in
origin versus some renal toxicity from the AmBisome.

SOCIAL:  There have been several meetings with the social
workers throughout this [**Hospital 228**] hospital stay, as his
daughter has been extremely difficult to deal with as she
wants to provide a lot of the nursing care to the patient
herself.  She repeatedly does activities, which the nursing
staff has asked her not to do, including, transporting the
patient herself, feeding the patient when asked not to,
rubbing unauthorized medications on the patient's skin,
namely honey and vodka, suctioning the patient so forcefully
that he either has hemoptysis or vomits secondary to her
inducing a gag reflex and attempting to suction the patient
with a Foley catheter in his nose, which resulted in
epistaxis.  In addition, she repositions the patient
constantly throughout the day and is extremely rough, and
given the friable nature of his skin, causes additional
sores.  The most recent meeting was on [**11-24**], at which
time the patient was given a written list of things, which
would be prohibited for her to perform on the patient,
including transferring the patient, repositioning the
patient, suctioning the patient, or feeding the patient.  She
was informed that a sitter would be obtained during her
visits with her father if she could not comply with the rules
outlined.  She stated that she understood the instructions
and agreed that she would not perform any the things outlined
in the list.  In addition, the patient still has no definite
health-care proxy.  Initially, the daughter was the person
making all decisions for the patient as she stated that she
was his only living relative.  However, during the hospital
admission it was uncovered that the patient also had a son,
[**Name (NI) 5045**].  [**Name2 (NI) **] has been in a few times to visit the patient,
and he appears to agree with what his sister, [**Name (NI) **] is
deciding for the patient.

At then time of this discharge summary, guardianship papers
have been obtained, but are not currently being filed.  They
will be filled if the patient's daughter performs any of the
prohibitive tasks, as already described.

NEUROLOGY:  The patient has complained intermittently of
headache throughout his hospital stay.  A head CT is already
described, but negative for any acute intracranial pathology.
A Lidoderm patch has been placed on the patient's neck q.d.,
which seems to have relieved his pain.

ACTIVITY:  The patient has been repeatedly evaluated by
physical therapy.  He does not tolerate physical therapy and
they deemed him to be not a rehabilitation candidate at this
time.  They recommend gentle range of motion activities to be
done by nursing.  Splints were obtained for the patient's
feet to help to prevent any contractures of the ankle.  He
has not been out of bed since his admission.

PULMONARY:  The patient has been saturating well on room air.
He had a few episodes of decreased saturations, which were
likely due to some aspiration, as well as his one episode of
CHF as was already described.  Chest x-ray showed is
difficult to determine as the patient is a poor inspiratory
effort.  His most recent chest x-ray done on [**2147-11-23**], showed that there are still diffuse opacities
bilaterally, which could represent aspiration or pneumonia,
which is not significantly changed from admission.  In
addition there are bilateral pleural effusions with the left
side greater than the right associated with compressive
atelectasis.  There is no evidence of pneumothorax.  Pleural
effusions have not been tapped as the patient has been
saturating well, and his morbidity is great if he were given
a pneumothorax in conjunction with the thoracentesis.

DISPOSITION:  The patient is to be evaluated for nursing home
placement as he does not appear to be a candidate for acute
rehabilitation at this time.

CONDITION ON DISCHARGE:  Poor.

MEDICATIONS ON DISCHARGE:  (current as of [**2147-11-27**]).
1.  Metronidazole 500 mg IV q.8h.
2.  Protonix 40 mg IV q.d.
3.  Lidoderm 5% patch to the back of neck, q.d.
4.  AmBisome 200 mg IV q twenty-four hours.
5.  Heparin 5000 units .................... b.i.d.
6.  Regular Insulin sliding scale.
7.  MSO4 one milligram IV q.4h. p.r.n. pain.
8.  Tylenol 650 mg p.o.4-6h.p.r.n.
9.  TPN with most recent formula as 1500 ml per day with 65-g
amino acid per day, 285-g dextrose per day, 30-g fat per day,
nonstandard electrolytes depending on chem 10, and zinc 10 mg
per day.

DISCHARGE FOLLOWUP:  Followup is to be determined when the
patient is placed in a nursing home.










DISCHARGE DIAGNOSIS:
1.  [**Female First Name (un) 564**] bacteremia.
2.  Enterococcal bacteremia.
3.  GI bleed.
4.  Failure to thrive.
5.  Poor nutritional status.
6.  Anasarca.
7.  C. difficile colitis.
8.  Dementia.
9.  Chronic atypical chest pain.
10. Anemia.




                            [**Name6 (MD) 251**] [**Last Name (NamePattern4) 1114**], M.D.  [**MD Number(1) 5046**]

Dictated By:[**Dictator Info **]
MEDQUIST36

D:  [**2147-11-27**]  12:14
T:  [**2147-11-27**]  13:12
JOB#:  [**Job Number 5047**]


Admission Date:  [**2147-11-8**]     Discharge Date:  [**2147-12-3**]


Service:  [**Hospital1 **]

HISTORY OF PRESENT ILLNESS:  This is a [**Age over 90 **] year-old Russian
male with a history of gastric and prostate cancer, anemia
and esophagitis who was transferred from the nursing home to
the MICU with a gastrointestinal bleed, fungemia and
bacteremia.  He had a very complicated medical course
including treatment for his fungemia and bacteremia as well
as for aspiration pneumonia given his poor mental status and
frequent aspirations.  Despite multiple courses of broad
spectrum antibiotics and other supportive measures he
eventually succumbed to one of his aspiration pneumonias on
the [**11-2**] and passed away.






                          [**Name6 (MD) 251**] [**Last Name (NamePattern4) 1114**], M.D.  [**MD Number(1) 5046**]

Dictated By:[**Name8 (MD) 1552**]

MEDQUIST36

D:  [**2147-12-16**]  18:20
T:  [**2147-12-20**]  14:46
JOB#:  [**Job Number 5048**]
{'Disseminated candidiasis,Hemorrhage of gastrointestinal tract, unspecified,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Atrial fibrillation,Secondary malignant neoplasm of bone and bone marrow,Intestinal infection due to Clostridium difficile,Malignant neoplasm of prostate'}


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: Gastrointestinal bleeding, bacteremia, and
fungemia.

PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old
male with multiple medical problems with the past medical
history significant for gastric cancer status post resection
with vagotomy, prostate cancer with likely bony metastasis,
recurrent aspiration pneumonia, chronic anemia, questionable
history of gastrointestinal bleeds with several
esophagogastroduodenoscopies in the past showing Candidal
esophagitis with nonbleeding fundal polyps, and dementia
thought to be secondary to Alzheimer disease.  The patient
was admitted to [**Hospital1 69**] on
[**9-30**], with a 30 pound weight loss over several
months and acute and chronic mental-status decline and
pneumonia.  He was treated for his pneumonia with Levaquin
and then changed to Azithromycin and sent to Core for
rehabilitation on [**2147-10-4**].  While there, the
patient had continued treatment of pneumonia and an
esophagogastroduodenoscopy was done on [**10-16**], which
showed esophagitis with nonbleeding fundal polyp.  He had
been started on TPN for unknown number of days, which was
being given through a PIC line, and on [**10-28**], grew
out MRSA from blood and E. coli from urine.  The patient was
started on Cefepime on [**2147-10-30**].  On [**2147-11-4**], the patient was febrile to 102 degrees and repeat blood
cultures at that time showed gram-positive cocci in pairs and
chains.  This grew from two sites including the patient's PIC
line.  In addition, the patient's blood grew out yeast, which
had not been speciated at the time of admission.  The patient
was started on Vancomycin and Fluconazole on [**2147-11-4**] at [**Hospital1 5042**].  The patient now presents to [**Hospital1 346**] with black-tarry stools, which have
been going on for an unknown number of days at [**Hospital1 5042**].  There
was no history of emesis or bright red blood per rectum.  The
patient's hematocrit was 19 on [**2147-11-6**].  He was
given two units of packed red blood cells at that time with
repeat hematocrit on [**11-8**], still at 19. The patient
was, therefore, transferred to [**Hospital1 188**] for further evaluation and treatment.

MEDICAL HISTORY: 1.  Gastric cancer, status post resection with vagotomy.
2.  Prostate cancer likely bony metastasis.
3.  Candidal esophagitis.
4.  Chronic anemia.
5.  Question of history of GI bleed.
6.  Recurrent aspiration pneumonias.
7.  Dementia, likely Alzheimer disease.
8.  Depression/anxiety.
9.  Atypical chest pain with a normal stress test in [**2145**].
10. Failure to thrive.  Poor nutritional status.
11. Lumbar fracture of L4.
12. Spinal column stenosis.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is Russian-speaking only.  He
has a daughter, [**Name (NI) **] [**Name (NI) 5043**].  Her phone # is [**Telephone/Fax (1) 5044**],
as well as son, [**Name (NI) 5045**] [**Name (NI) 5043**].  The patient is a retired
scientist. 

### Response:
{'Disseminated candidiasis,Hemorrhage of gastrointestinal tract, unspecified,Pneumonitis due to inhalation of food or vomitus,Congestive heart failure, unspecified,Atrial fibrillation,Secondary malignant neoplasm of bone and bone marrow,Intestinal infection due to Clostridium difficile,Malignant neoplasm of prostate'}
