CHIEF COMPLAINT: pericardial effusion with tamponade physiology

PRESENT ILLNESS: 77yo M with HTN, HL, COPD presenting with cardiac tamponade s/p
pericardiocentesis and drainage.  Patient presented for
scheduled echocardiogram today and was found to have a large
pericardial effusion with tamponade physiology. The pericardial
effusion was noted on a CT chest performed [**2132-8-26**], at which
time a 2cm spiculated mass was also noted in the RUL concerning
for malignancy.
    Patient reports that over the past several months he has had
worsening fatigue.  He swims regularly (1000 yards in 52
minutes) and has noted that lately he is unable to swim the same
distance and it takes him much longer.  He also reports
worsening shortness of breath.  Patient presented to his PCP
with these symptoms, and labs were significant for anemia,
macrocytosis, thrombocytopenia and small IgG kappa and IgM kappa
monoclonal proteins.  Patient was referred to a hematologist who
was concerned about the potential for a lymphoid neoplasm
associated with IgM such as lymphplasmacytic lymphoma, multiple
myeloma or Waldenstroms.  The hematologist ordered a CT
chest/abd/pelvis to investigate for adenopathy and organomegaly,
and the above findings were discovered.
    Patient denies recent weight loss or change in appetite.  He
reports a brief episode recently when his right lower leg was
dragging and "not responding".  This improved after several
hours and was not associated with numbness or tingling in the
limb, speech deficits, word finding difficulties or vision
changes.  He has never had similar symptoms and they have not
recurred since this original episode.
     He reports shortness of breath which has been worsening
over the past several weeks.  He does not use oxygen at home.
He denies chest pain or palpitations.  He reports constipation,
without change in caliber of stool, melena or hematochezia.  He
denies urinary urgency or frequency, hematuria or dysuria.  He
denies bowel or bladder incontinence.  He has had two episdoes
of prolonged bleeding; one nosebleed and one post-operative
bleeding after MOHS.
.
   Today after echocardiogram showed pericardial effusion with
tamponade physiology, patient was taken to cath lab for
drainage.  Approximately 1L of bloody fluid was drained and sent
for cytology, hematology and chemistries.  Patient tolerated
procedure without issue and a drain was left in place.  Patient
was transferred to CCU for further management.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: + Dyslipidemia, + Hypertension
2. CARDIAC HISTORY:  None.
3. OTHER PAST MEDICAL HISTORY:
-  squamous cell carcinoma, s/p MOHS
-  colonic polyps, last colonoscopy 1 year ago
-  COPD
-  gastritis
-  h/o gout
-  h/o nephrolithiasis

MEDICATION ON ADMISSION: - Verapamil SR 240mg po daily
- Lisinopril 20mg po daily
- Hydrochlorothiazide 50mg po daily
- Aspirin 81mg po daily
- Colchicine 0.6mg po daily
- Allopurinol 200mg po daily
- Albuterol INH 1-2puffs q4-6hrs PRN
- Flutcasone 220mcg/INH 2puffs [**Hospital1 **]
- Omeprazole 20mg po BID

ALLERGIES: Beta-Blockers (Beta-Adrenergic Blocking Agts)

PHYSICAL EXAM: Admission physical exam:
VS: T= 97.1 BP= 126/78 HR= 82 RR= 21 O2 sat= 91% RA
GENERAL: NAD. Oriented x3. Pursed lip breathing.  Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death
- Mother:  chronic leukemia, died at age 89
- Father:  h/o MI, pancreatic cancer, died at age 69

SOCIAL HISTORY: Lives with his wife in [**Location (un) **].  Retired hardware store
owner.  Has two boys, both live in [**State **], and one
grandson.
- Tobacco history:  97.5 pack-year history, still smokes 1.5 ppd
- ETOH:  1 glass of wine/night
- Illicit drugs:  denies
Acute pericarditis, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Acute kidney failure, unspecified,Cardiac tamponade,Chronic obstructive asthma, unspecified,Raynaud's syndrome,Monoclonal paraproteinemia,Unspecified essential hypertension,Carpal tunnel syndrome,Tobacco use disorder,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Gout, unspecified,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia,Personal history of colonic polyps,Personal history of other malignant neoplasm of skin,Personal history of urinary calculi
Acute pericarditis NOS,Mal neo upper lobe lung,Acute kidney failure NOS,Cardiac tamponade,Chronic obst asthma NOS,Raynaud's syndrome,Monoclon paraproteinemia,Hypertension NOS,Carpal tunnel syndrome,Tobacco use disorder,Gstr/ddnts NOS w/o hmrhg,Gout NOS,Dvrtclo colon w/o hmrhg,Hyperlipidemia NEC/NOS,Prsnl hst colonic polyps,Hx-skin malignancy NEC,Prsnl hst urnr dsrd calc
Admission Date:  [**2132-9-2**]              Discharge Date:   [**2132-9-6**]

Date of Birth:  [**2054-12-31**]             Sex:   M

Service: MEDICINE

Allergies:
Beta-Blockers (Beta-Adrenergic Blocking Agts)

Attending:[**First Name3 (LF) 2265**]
Chief Complaint:
pericardial effusion with tamponade physiology

Major Surgical or Invasive Procedure:
Pericardiocentesis


History of Present Illness:
77yo M with HTN, HL, COPD presenting with cardiac tamponade s/p
pericardiocentesis and drainage.  Patient presented for
scheduled echocardiogram today and was found to have a large
pericardial effusion with tamponade physiology. The pericardial
effusion was noted on a CT chest performed [**2132-8-26**], at which
time a 2cm spiculated mass was also noted in the RUL concerning
for malignancy.
    Patient reports that over the past several months he has had
worsening fatigue.  He swims regularly (1000 yards in 52
minutes) and has noted that lately he is unable to swim the same
distance and it takes him much longer.  He also reports
worsening shortness of breath.  Patient presented to his PCP
with these symptoms, and labs were significant for anemia,
macrocytosis, thrombocytopenia and small IgG kappa and IgM kappa
monoclonal proteins.  Patient was referred to a hematologist who
was concerned about the potential for a lymphoid neoplasm
associated with IgM such as lymphplasmacytic lymphoma, multiple
myeloma or Waldenstroms.  The hematologist ordered a CT
chest/abd/pelvis to investigate for adenopathy and organomegaly,
and the above findings were discovered.
    Patient denies recent weight loss or change in appetite.  He
reports a brief episode recently when his right lower leg was
dragging and "not responding".  This improved after several
hours and was not associated with numbness or tingling in the
limb, speech deficits, word finding difficulties or vision
changes.  He has never had similar symptoms and they have not
recurred since this original episode.
     He reports shortness of breath which has been worsening
over the past several weeks.  He does not use oxygen at home.
He denies chest pain or palpitations.  He reports constipation,
without change in caliber of stool, melena or hematochezia.  He
denies urinary urgency or frequency, hematuria or dysuria.  He
denies bowel or bladder incontinence.  He has had two episdoes
of prolonged bleeding; one nosebleed and one post-operative
bleeding after MOHS.
.
   Today after echocardiogram showed pericardial effusion with
tamponade physiology, patient was taken to cath lab for
drainage.  Approximately 1L of bloody fluid was drained and sent
for cytology, hematology and chemistries.  Patient tolerated
procedure without issue and a drain was left in place.  Patient
was transferred to CCU for further management.

Past Medical History:
1. CARDIAC RISK FACTORS: + Dyslipidemia, + Hypertension
2. CARDIAC HISTORY:  None.
3. OTHER PAST MEDICAL HISTORY:
-  squamous cell carcinoma, s/p MOHS
-  colonic polyps, last colonoscopy 1 year ago
-  COPD
-  gastritis
-  h/o gout
-  h/o nephrolithiasis

Social History:
Lives with his wife in [**Location (un) **].  Retired hardware store
owner.  Has two boys, both live in [**State **], and one
grandson.
- Tobacco history:  97.5 pack-year history, still smokes 1.5 ppd
- ETOH:  1 glass of wine/night
- Illicit drugs:  denies

Family History:
- No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death
- Mother:  chronic leukemia, died at age 89
- Father:  h/o MI, pancreatic cancer, died at age 69

Physical Exam:
Admission physical exam:
VS: T= 97.1 BP= 126/78 HR= 82 RR= 21 O2 sat= 91% RA
GENERAL: NAD. Oriented x3. Pursed lip breathing.  Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP at 5cm.
CARDIAC: RRR, normal S1, S2. II/VI holosystolic murmur best
heard at left lower sternal border.  +rub. No S3 or S4.
Pericardial drain at lower right sternal border draining bloody
fluid.
LUNGS: Poor inspiratory effort, course crackles diffusely with
diffuse end-expiratory wheezes.
ABDOMEN: Soft, obese, NTND. +BS.  No HSM or tenderness.
EXTREMITIES: No c/c/e.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+

Discharge physical exam:
Vital signs stable, afebrile
Exam largely unchanged.
Cardiac exam notable for lack of pericardial rub.  Drain site
c/d/i with no erythema or exudate.
Lungs with diffuse inspiratory and expiratory wheezes, course
crackles

Pertinent Results:
Pertinent admission labs/studies:
WBC 10.1 Hgb 11.9 Hct 34.6 Plts 172
PT 16.2 INR 1.4
TSH 1.7

Pericardial fluid:  Hct 27.5 WBC 8900- 40L 11M 12E 9Mac
Total protein 5.5 gluc 6 LDH 6690 Amylase 276 Albumin 3.1
 GRAM STAIN (Final [**2132-9-2**]):
      NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
      NO MICROORGANISMS SEEN.
 FLUID CULTURE (Final [**2132-9-5**]):    NO GROWTH.
 ANAEROBIC CULTURE (Preliminary):    NO GROWTH.
 ACID FAST SMEAR (Final [**2132-9-3**]):
      NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
 ACID FAST CULTURE (Preliminary): PENDING
 FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.

TTE ([**2132-9-2**]): The estimated right atrial pressure is 5-10 mmHg.
The left ventricular cavity size is normal. Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is normal (LVEF>55%). The right ventricular
cavity is mildly dilated with borderline normal free wall
function. The aortic valve leaflets (3) are mildly thickened.
There is no aortic valve stenosis. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. No mitral regurgitation is seen. The left ventricular
inflow pattern suggests impaired relaxation. The tricuspid valve
leaflets are mildly thickened. The pulmonary artery systolic
pressure could not be determined. There is a moderate to large
sized pericardial effusion. There is left atrial diastolic
collapse. There is right ventricular diastolic collapse,
consistent with impaired fillling/tamponade physiology.

CT Chest/Abd/Pelvis ([**2132-8-26**]): 2 cm spiculated mass right upper
lobe extending normal margins worrisome for malignancy.
Mediastinal and right hilar adenopathy present, full extent
difficult to ascertain in the absence of IV contrast.  Moderate
to large pericardial effusion.

Pertinent labs/studies:
Pericardial fluid cytology ([**2132-9-4**])- POSITIVE FOR MALIGNANT
CELLS, consistent with non-small cell carcinoma.

MRI Brain- pending

Discharge Echocardiogram ([**2132-9-6**])- pending. Preliminary read:
trace to small effusion without evidence of tamponade

Discharge labs:
WBC 10.1  Hgb 13.4  Hct 39.8 Plts 220
Na 140 K 4.4 Cl 100 HCO3 30 BUN 37 Cr 1.7 Glucose 120


Brief Hospital Course:
77 yo M with h/o HTN, HL, COPD with RUL lung mass and
pericardial effusion recently noted on CT scan, presenting with
pericardial effusion causing tamponade physiology, s/p drainage
of approximately 1L bloody fluid with malignant cells on
cytology

# Pericardial effusion - Given findings on CT scan of lung mass
and bloody fluid drained from pericardium, there was concern for
a malignant effusion. A pericardiocentesis was done with a
pericardial drain placed for two days until fluid output slowed
to a minimal level with a total of roughly 1L output from
initial drainage plus drain output. The drain was clamped and a
TTE was done 24hrs later which showed no significant fluid
reaccumulation and the drain was then pulled. Preliminary
cytology is positive for malignant cells, most likely non-small
cell lung cancer but final results and additional tissue
staining was pending at time of discharge. At the time of
discharge, echocardiogram showed small to trace reaccumulation
of fluid.  Patient had negative pulsus paradoxus on exam and JVP
was not elevated. There was no ongoing pericardial rub.

# RUL mass - Patient has been in the process of being worked up
for recent fatigue and anemia.  Outpatient laboratories were
concerning for a macrocytosis and IgG/IgM monoclonal gammopathy.
 Patient was seen by hematology who wanted to work him up
further for concern for a lymphocytoclastic leukemia.  Patient
had prior lung imaging with a spiculated lung nodule concerning
for malignancy.  In addition, the pericardial effusion was found
which was positive for malignant cells. Due to suspicion for
lung cancer, a brain MRI was done looking for metastatic
disease. Patient was followed by the [**Location (un) 2274**] oncology service
during admission and they will follow up with him as an
outpatient regarding final diagnosis and treatment. Decision was
made to hold off on a bronchoscopy until final results from the
pericardial fluid and until a PET scan was obtained as an
outpatient.

# HTN- Blood pressures were stable throughout pericardial
drainage and continue to be lowish but stable on arrival to CCU.
He was continued on his home lisinopril during admission.
Because of his lowish blood pressures, his home HCTZ dose was
decreased to 25mg daily and his verapamil was stopped as it
provides relatively little blood pressure control and their was
no need for nodal blocking.

# Smoking dependence- Patient has an extensive smoking history,
and currently smokes 1.5ppd. He was started on a nicotine patch
durin the hospitalization. There will need to be follow-up to
ensure complete smoking cessation.

# COPD - Patient was wheezing on exam but without gross sputum
production or fever. Patient is not on home oxygen. He was
continued on home fluticasone and albuterol PRN during
admission.

# H/o gout - No active flare.  Continue home allopurinol and
colchicine
.
# Gastritis - Continue home omeprazole

# Transitional Issues:
- Discussion with patient of final MRI results
- Discussion of patient with final pre-discharge ECHO results
- Follow-up on final cytology/pathology from pericardial fluid
- Outpatient PET Scan
- Possible outpatient bronchoscopy if final cytology not
diagnostic
- Outpatient [**Location (un) 2274**] heme/onc f/u to discuss diagnosis and
treatment
- Continuing support for smoking cessation

Medications on Admission:
- Verapamil SR 240mg po daily
- Lisinopril 20mg po daily
- Hydrochlorothiazide 50mg po daily
- Aspirin 81mg po daily
- Colchicine 0.6mg po daily
- Allopurinol 200mg po daily
- Albuterol INH 1-2puffs q4-6hrs PRN
- Flutcasone 220mcg/INH 2puffs [**Hospital1 **]
- Omeprazole 20mg po BID


Discharge Medications:
1. colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
3. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation q4-6 hours as needed for SOB, wheezing.
4. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
5. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. allopurinol 100 mg Tablet Sig: Two (2) Tablet PO once a day.

7. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*30 Tablet(s)* Refills:*1*
9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:  Malignant pericardial effusion

Secondary diagnosis:
1.  Hypertension
2.  COPD
3.  Right upper lobe pulmonary nodule
4.  Gastritis


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


Discharge Instructions:
Dear Mr. [**Known lastname 5057**],
It was a pleasure taking care of your during your recent
admission to [**Hospital1 69**].  You were
admitted because of an effusion that developed around your heart
and caused compression of your heart.  The effusion was drained
and we were able to pull the tube as the fluid was not
reaccumulating.  The preliminary findings in the fluid are for a
malignancy.  We discussed that the most likely source of the
malignancy is the mass in your right upper lung which was found
recently on a CAT scan.  You were seen by the oncologists and
pulmonologists, and will follow-up closely with them, as well as
with the cardiologists, as an outpatient.

Your home medications were continued as prescribed with the
exception of Verapamil and hydrochlorothiazide as your blood
pressures were low.  You should discuss these medication changes
with your primary care doctor at your follow-up appointment.

In addition, it will be important that you follow-up with your
oncologist regarding the results of your brain MRI and final
cytology results.

Followup Instructions:
Name: [**Name6 (MD) 17529**] [**Name8 (MD) 17528**], MD
Specialty: Internal Medicine
When: Friday [**9-12**] at 8:40am
Location: [**Location (un) 2274**]-[**University/College **]
Address: [**Hospital1 3470**], [**University/College **],[**Numeric Identifier 23943**]
Phone: [**Telephone/Fax (1) 17530**]

Cardiac Imaging: Echocardiogram
When: Wednesday, [**9-24**] at 10am
Location: [**Location (un) 2274**]-[**Location (un) **] Square, [**Location (un) 4363**]
[**Location (un) 86**], [**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 2258**]

Cardiology Appointment, Thursday, [**10-2**] at 8:50am
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2920**], MD
Location: [**Location (un) 2274**]-[**University/College **]
Address: [**Hospital1 3470**], [**University/College **],[**Numeric Identifier 23943**]
Phone: [**Telephone/Fax (1) 72622**]


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2273**]
{"Acute pericarditis, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Acute kidney failure, unspecified,Cardiac tamponade,Chronic obstructive asthma, unspecified,Raynaud's syndrome,Monoclonal paraproteinemia,Unspecified essential hypertension,Carpal tunnel syndrome,Tobacco use disorder,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Gout, unspecified,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia,Personal history of colonic polyps,Personal history of other malignant neoplasm of skin,Personal history of urinary calculi"}


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: pericardial effusion with tamponade physiology

PRESENT ILLNESS: 77yo M with HTN, HL, COPD presenting with cardiac tamponade s/p
pericardiocentesis and drainage.  Patient presented for
scheduled echocardiogram today and was found to have a large
pericardial effusion with tamponade physiology. The pericardial
effusion was noted on a CT chest performed [**2132-8-26**], at which
time a 2cm spiculated mass was also noted in the RUL concerning
for malignancy.
    Patient reports that over the past several months he has had
worsening fatigue.  He swims regularly (1000 yards in 52
minutes) and has noted that lately he is unable to swim the same
distance and it takes him much longer.  He also reports
worsening shortness of breath.  Patient presented to his PCP
with these symptoms, and labs were significant for anemia,
macrocytosis, thrombocytopenia and small IgG kappa and IgM kappa
monoclonal proteins.  Patient was referred to a hematologist who
was concerned about the potential for a lymphoid neoplasm
associated with IgM such as lymphplasmacytic lymphoma, multiple
myeloma or Waldenstroms.  The hematologist ordered a CT
chest/abd/pelvis to investigate for adenopathy and organomegaly,
and the above findings were discovered.
    Patient denies recent weight loss or change in appetite.  He
reports a brief episode recently when his right lower leg was
dragging and "not responding".  This improved after several
hours and was not associated with numbness or tingling in the
limb, speech deficits, word finding difficulties or vision
changes.  He has never had similar symptoms and they have not
recurred since this original episode.
     He reports shortness of breath which has been worsening
over the past several weeks.  He does not use oxygen at home.
He denies chest pain or palpitations.  He reports constipation,
without change in caliber of stool, melena or hematochezia.  He
denies urinary urgency or frequency, hematuria or dysuria.  He
denies bowel or bladder incontinence.  He has had two episdoes
of prolonged bleeding; one nosebleed and one post-operative
bleeding after MOHS.
.
   Today after echocardiogram showed pericardial effusion with
tamponade physiology, patient was taken to cath lab for
drainage.  Approximately 1L of bloody fluid was drained and sent
for cytology, hematology and chemistries.  Patient tolerated
procedure without issue and a drain was left in place.  Patient
was transferred to CCU for further management.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: + Dyslipidemia, + Hypertension
2. CARDIAC HISTORY:  None.
3. OTHER PAST MEDICAL HISTORY:
-  squamous cell carcinoma, s/p MOHS
-  colonic polyps, last colonoscopy 1 year ago
-  COPD
-  gastritis
-  h/o gout
-  h/o nephrolithiasis

MEDICATION ON ADMISSION: - Verapamil SR 240mg po daily
- Lisinopril 20mg po daily
- Hydrochlorothiazide 50mg po daily
- Aspirin 81mg po daily
- Colchicine 0.6mg po daily
- Allopurinol 200mg po daily
- Albuterol INH 1-2puffs q4-6hrs PRN
- Flutcasone 220mcg/INH 2puffs [**Hospital1 **]
- Omeprazole 20mg po BID

ALLERGIES: Beta-Blockers (Beta-Adrenergic Blocking Agts)

PHYSICAL EXAM: Admission physical exam:
VS: T= 97.1 BP= 126/78 HR= 82 RR= 21 O2 sat= 91% RA
GENERAL: NAD. Oriented x3. Pursed lip breathing.  Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death
- Mother:  chronic leukemia, died at age 89
- Father:  h/o MI, pancreatic cancer, died at age 69

SOCIAL HISTORY: Lives with his wife in [**Location (un) **].  Retired hardware store
owner.  Has two boys, both live in [**State **], and one
grandson.
- Tobacco history:  97.5 pack-year history, still smokes 1.5 ppd
- ETOH:  1 glass of wine/night
- Illicit drugs:  denies 

### Response:
{"Acute pericarditis, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Acute kidney failure, unspecified,Cardiac tamponade,Chronic obstructive asthma, unspecified,Raynaud's syndrome,Monoclonal paraproteinemia,Unspecified essential hypertension,Carpal tunnel syndrome,Tobacco use disorder,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Gout, unspecified,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia,Personal history of colonic polyps,Personal history of other malignant neoplasm of skin,Personal history of urinary calculi"}
