CHIEF COMPLAINT: RUQ pain, fever

PRESENT ILLNESS: Patient is Cantonese only speaking, so history obtained with the
aid of patient's son.

MEDICAL HISTORY: - Coronary artery disease s/p CABG [**3-/2119**] (LIMA to the LAD and
-separate SVGs to the PDA and an OM)
- HLD
- HTN
- BPH
- Emphysema per ct scan
- TB many years ago, treated for 2 years

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Family/Caregiver[**Name (NI) 581**].
1. Doxazosin 4 mg PO HS
2. Lisinopril 2.5 mg PO DAILY
3. Tiotropium Bromide 1 CAP IH DAILY
4. Metoprolol Succinate XL 25 mg PO DAILY
5. Atorvastatin 10 mg PO DAILY
6. Ropinirole 1 mg PO TID
7. Omeprazole 40 mg PO DAILY
8. Aspirin 81 mg PO DAILY

ALLERGIES: Penicillins / simvastatin

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T 102 HR 98 BP 121/57 RR 20 O2 96% 2L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP less than 7, no LAD, left IJ in place, no
tenderness at site
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Bibasilar rales, no wheezes or rhonchi, appears to be
splinting due to pain with deep inspiration
Abdomen: RUQ tenderness to palpation, soft, non-distended, bowel
sounds present, no organomegaly, no rebound or guarding
GU: no foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.

FAMILY HISTORY: Mother had hypertension and history of cancer.

SOCIAL HISTORY: Prior 20 pack year smoker, quit 20 years ago. Retired CEO of
auto parts business in [**Country 651**]. Lives with his wife and is
independent with ADLs. Rare alcohol, denies illicits.
Other septicemia due to gram-negative organisms,Calculus of bile duct with acute cholecystitis, with obstruction,Cholangitis,Sepsis,Aortocoronary bypass status,Other emphysema,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Retention of urine, unspecified,Restless legs syndrome (RLS),Esophageal reflux
Gram-neg septicemia NEC,Choledochlith/ac gb-obst,Cholangitis,Sepsis,Aortocoronary bypass,Emphysema NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,BPH w urinary obs/LUTS,Retention urine NOS,Restless legs syndrome,Esophageal reflux
Admission Date:  [**2124-9-3**]              Discharge Date:   [**2124-9-8**]

Date of Birth:  [**2045-8-27**]             Sex:   M

Service: SURGERY

Allergies:
Penicillins / simvastatin

Attending:[**First Name3 (LF) 46126**]
Chief Complaint:
RUQ pain, fever

Major Surgical or Invasive Procedure:
ERCP

History of Present Illness:
Patient is Cantonese only speaking, so history obtained with the
aid of patient's son.

History of Present Illness: Mr. [**Known lastname **] is a 79 year old Cantonese
only speaking man with HTN, HL, and CAD s/p CABG ([**2118**]) with a
recent admission to the [**Hospital1 18**] in [**2124-6-4**] for
cholecystitis/duodenitis and sepsis treated with percutaneous
cholecystostomy tube. The tube had been draining approximately
100cc/day sine that time until 2 weeks ago when the output
increased to 200cc/day. He reported no symptoms at that time.
Friday prior to admission ([**9-1**]), he noted decreased output of
only 85cc, and the subsequent two days he noted zero output from
his perc cholecystostomy tube. He has had severe RUQ pain that
began on Saturday and has also noted yellow/greenish drainage
from around the drain site. He noted some shaking chills, but
denied fever, nausea or vomiting.  No urinary symptoms, no black
or tarry stool.  His inspirations are limited due to RUQ pain.
He called ems this AM becuase of the lack of drainage from the
tube and pain and they sent him to [**Hospital1 3278**] where his labs at 14:36
today were consistent with a cholestatic picture with ALT 169,
AST 244, alk phos 359, T bili 1.3, CRP 15.79, WBC of 6.5. Since
all of his previous care was provided here his family elected
for transfer to the [**Hospital1 18**].

In the ED, initial VS were:  101, 113/76, hr 100, rr16, sat99
2ln/c. He he continued to complain of RUQ pain and dyspnea from
splinting due to pain.  He was noted to have a R percutaneous
cholecystostomy tube on R lat side with green drainage coming
through around the tube and an empty bag, and RUQ tenderness.
He spiked to 101.8 at 6:30pm and was tachycardic to the low
100s. Labs were notable for worsening LFTs with ALT: 353, AST:
707, AP: 537, Tbili: 1.6. A left IJ was placed and he was given
2 L NS and started on Vanco, cefepime, and Flagyl. Surgery was
consulted and performed a fluro study of the tube and felt the
perc chole tube was patent and the cystic duct was patent and
emptied into the duodenum. There was noted to be a filling
defect in the distal CBD likely from a stone. He was admitted to
the [**Hospital Unit Name 153**] for ERCP. Surgery is also following to discuss the
possibility of cholecystectomy.

On arrival to the MICU, patient's vital signs were T 100.9, HR
101, BP 142/91, RR 24, O2 sat 91%RA (O2 sat increased to 96-99%
on 2L NC). He reported the history above with his son who aided
in interpretation. He continued to complain of RUQ pain and mild
shortness of breath due to splinting with deep breaths. Patient
did note baseline mild shortness of breath with increasing
activity, and had seen a pulmonologist recently who prescribed
[**Name (NI) **] (unclear if patient is actually using this).  He appears
to have a very good baseline functional status. He does [**Doctor First Name **] [**Doctor First Name **]
every morning and walks several blocks without dyspnea.

Review of systems:
(+) Per HPI
(-) Denies headache, changes in vision, chest pain or pressure,
palpitations, orthopnea, cough, wheezing. Denies constipation,
diarrhea, dark, bloody or light colored stools. Denies dysuria,
frequency, urgency, or change in urine color. Denies arthralgias
or myalgias. Denies rashes or skin changes.


Past Medical History:
- Coronary artery disease s/p CABG [**3-/2119**] (LIMA to the LAD and
-separate SVGs to the PDA and an OM)
- HLD
- HTN
- BPH
- Emphysema per ct scan
- TB many years ago, treated for 2 years


Social History:
Prior 20 pack year smoker, quit 20 years ago. Retired CEO of
auto parts business in [**Country 651**]. Lives with his wife and is
independent with ADLs. Rare alcohol, denies illicits.


Family History:
Mother had hypertension and history of cancer.

Physical Exam:
Admission Physical Exam:
Vitals: T 102 HR 98 BP 121/57 RR 20 O2 96% 2L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP less than 7, no LAD, left IJ in place, no
tenderness at site
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Bibasilar rales, no wheezes or rhonchi, appears to be
splinting due to pain with deep inspiration
Abdomen: RUQ tenderness to palpation, soft, non-distended, bowel
sounds present, no organomegaly, no rebound or guarding
GU: no foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.

Admission Physical Exam:
Vitals: AFVSS
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: clear to auscultation bilaterally
Abdomen: abdomen minimally and appropriately tender to palpation
near incision sites, no organomegaly, no rebound or guarding
GU: Foley in place
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.


Pertinent Results:
Admission labs:
[**2124-9-3**] 04:13PM BLOOD WBC-7.5 RBC-4.47* Hgb-13.5* Hct-41.4
MCV-93 MCH-30.3 MCHC-32.7 RDW-14.4 Plt Ct-300
[**2124-9-3**] 04:13PM BLOOD Neuts-78.9* Lymphs-14.7* Monos-4.6
Eos-1.3 Baso-0.5
[**2124-9-3**] 04:13PM BLOOD PT-11.9 PTT-31.4 INR(PT)-1.1
[**2124-9-3**] 04:13PM BLOOD Glucose-124* UreaN-14 Creat-0.8 Na-139
K-3.7 Cl-103 HCO3-26 AnGap-14
[**2124-9-3**] 04:13PM BLOOD Albumin-4.4 Calcium-9.4 Phos-3.1 Mg-2.0
[**2124-9-3**] 04:13PM BLOOD ALT-353* AST-707* AlkPhos-537*
TotBili-1.6*
[**2124-9-3**] 04:13PM BLOOD Lipase-26
[**2124-9-3**] 08:45PM BLOOD ALT-467* AST-864* AlkPhos-547*
TotBili-1.8*
[**2124-9-3**] 08:45PM BLOOD Lipase-21
[**2124-9-3**] 08:45PM BLOOD Albumin-3.7
[**2124-9-3**] 04:20PM BLOOD Lactate-1.7
[**2124-9-3**] 08:57PM BLOOD Lactate-0.7

Discharge labs:




Studies:
[**2124-9-3**] RUQ u/s: The liver is heterogeneous in echogenicity with
a possible area of focal fatty sparing in the left lobe spanning
approximately 2.8 cm. This does not represent a definite lesion.
The gallbladder is collapsed, but does not appear mildly
edematous. There is no intra- or extra-hepatic biliary ductal
dilatation and the common bile duct measures 8 mm. The spleen
measures 11.0 cm and is unremarkable. There is a 1.4 x 0.8 x 0.7
cm simple cyst in the right lobe of liver, corresponding to
prior CT. The main portal vein is patent and displays
hepatopetal flow.

IMPRESSION: 1. No intra- or extra-hepatic biliary ductal
dilatation. 2. Collapsed gallbladder. 3. Heterogeneous liver
compatible with history of acute hepatitis or areas of focal
fatty deposition.

[**2124-9-3**] T-TUBE CHOLANGIO:
FINDINGS:  20 cc of Optiray iodinated contrast material was
injected into the patient's percutaneous cholecystostomy tube
under fluoroscopy.  The gallbladder followed by the cystic duct,
common bile duct, and common hepatic duct opacified without
evidence of obstruction.  No leak was identified. Contrast
passed freely into the duodenum.  Subsequently the
cholecystostomy tube was flushed with approximately 10 cc of
saline.

IMPRESSION:  Patent biliary system.  No malposition of the
cholecystostomy tube.

[**2124-9-3**] CXR: pending

Micro:
Blood cultures [**2124-9-3**]:
[**2124-9-3**] 4:30 pm BLOOD CULTURE

   Blood Culture, Routine (Preliminary):
      GRAM NEGATIVE ROD(S).

   Aerobic Bottle Gram Stain (Final [**2124-9-4**]):
      GRAM NEGATIVE ROD(S).
      Reported to and read back by DR. [**Last Name (STitle) 15413**] @ 07:40AM ON
[**2114-9-4**].


Brief Hospital Course:
Brief Course:
Mr. [**Known lastname **] is a 79 year old Cantonese only speaking man with HTN,
HL, history of distant TB s/p treatment, and CAD s/p CABG ([**2118**])
with perc chole tube for  cholecystitis/duodenitis and sepsis in
[**2124-6-4**], now back with decreased tube output, fevers, chills,
severe RUQ pain and tenderness with obstructing pattern on LFTs
concerning for cholangitis, admitted to the ICU for concern for
developing sepsis.

Active issues:
# Cholangitis: Patient with recent cholecystitis requiring perc
chole tube in [**2124-6-4**]. Did not have a cholecystectomy at that
time due to inflammation. Now presents with decreased tube
output, fever, RUQ pain, and LFTs with a cholestatic pattern
concerning for cholangitis. RUQ ultrasound revealed a collapsed
gallbladder and no biliary ductal dilation. Fluoro study
revealed patent tube and flow of contrast material up to the
intrahepatic ducts and flow to CBD draining into the duodenum.
There is a filling defect in the distal CBD that could represent
a stone.He was started on Vanc/Cefepime/Flagyl and ERCP was
consulted. He remained hemodynamically stable in the ICU. ERCP
showed a 6mm single stone that was removed. Cannulation of the
biliary duct was performed with a sphincterotomy. The common
bile duct measured about 8mm with a single mobile filling
defect. There was no significant dilatation of the intrahepatic
biliary tree. LFTs trended down after the procedure and patient
was restarted on a regular diet and tolerated it well. He also
reported improvement of his abdominal pain.

# Emphysema: Possible obstructive ventalitory defect on PFTs
from [**2117**] and CT scan with evidence of emphysema. He has noted
increasing dyspnea on exertion recently, though appears to have
a robust baseline functional status with daily [**Doctor First Name **] [**Doctor First Name **] and
walking for exercise without symptoms. He was recently seen by
pulm and prescribed [**Doctor First Name **], though it is unclear if patient has
been using this. It was noted that if he is intubated,
bronchodilators should be used post-extubation. He was placed on
nebs, and remained on nasal cannula while in the ICU satting in
the 90s.

# CAD s/p CABG: CAGB with LIMA to LAD and separate SVGs to PDA
in [**2118**]. Given his CAD history, we will continue ASA and beta
blocker. Denies symptoms currently and ECG revealed no ischemic
changes. He was continued on ASA, and beta blocker. His ACEI was
initially held in the ICU given low BP....

# Coagulopathy: On HD#1, his PTT and INR increased. Considered
antibiotics, decreased synthetic function given transaminitis,
and also possibly [**1-6**] heparin given acute increase after
starting heparin SC. He was given IV Vitamin K and his heparin
SC was decreased to [**Hospital1 **]....

Inactive issues:
# Hypertension: Initially hypotensive in the ICU, but fluid
responsive. His beta blocker was restarted and ACEI initially
held....

# Hyperlipidemia: Continued Atorvastatin 10 mg PO DAILY.

# BPH: Held doxazosin 4 mg PO HS initially in the ICU.  The
patient had difficulty urinating in PACU after his
cholecystectomy so a foley catheter was replaced.  He was
resumed on his home doxazosin and will be going home with the
catheter in place.  A Urology appointment has been scheduled for
the patient.

# GERD: Continued home omeprazole.

# Restless leg: Stable. Continued home ropinirole.

Mr. [**Known lastname **] [**Last Name (Titles) 1834**] a laparoscopic cholecystectomy on [**9-6**].
Please see the operative report for details of this procedure.
He tolerated the procedure well and was extubated upon
completion. He we subsequently taken to the PACU for recovery.
As noted above, Mr. [**Known lastname **] was unable to urinate after his Foley
catheter was discontinued.  The catheter was replaced and his
urine output was closely monitored.
He was transferred to the surgical floor hemodynamically stable.
His vital signs were routinely monitored and he remained
afebrile and hemodynamically stable. The patient was initially
given IV fluids postoperatively, which were discontinued when he
was tolerating oral intake. His diet was advanced on the morning
of [**9-7**] to regular, which he tolerated without abdominal pain,
nausea, or vomiting. He was voiding adequate amounts of urine
without difficulty. He was encouraged to mobilize out of bed and
ambulate as tolerated, which he was able to do independently.
His pain level was routinely assessed and well controlled at
discharge with an oral regimen as needed.

On the afternoon of [**9-8**], Mr. [**Known lastname **] was discharged home with
scheduled follow up in the [**Hospital 2536**] clinic as well as Urology to
address his urinary retention.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from Family/Caregiver[**Name (NI) 581**].
1. Doxazosin 4 mg PO HS
2. Lisinopril 2.5 mg PO DAILY
3. Tiotropium Bromide 1 CAP IH DAILY
4. Metoprolol Succinate XL 25 mg PO DAILY
5. Atorvastatin 10 mg PO DAILY
6. Ropinirole 1 mg PO TID
7. Omeprazole 40 mg PO DAILY
8. Aspirin 81 mg PO DAILY


Discharge Medications:
1. Aspirin 81 mg PO DAILY
2. Atorvastatin 10 mg PO DAILY
3. Doxazosin 4 mg PO HS
4. Omeprazole 40 mg PO DAILY
5. Ropinirole 1 mg PO TID
6. Acetaminophen 650 mg PO Q6H:PRN pain
7. Docusate Sodium 100 mg PO BID
8. Ciprofloxacin HCl 500 mg PO Q12H
last dose 10/11
RX *ciprofloxacin 500 mg 1 tablet(s) by mouth every twelve (12)
hours Disp #*12 Tablet Refills:*0
9. OxycoDONE (Immediate Release)  2.5-5 mg PO Q4H:PRN pain
RX *oxycodone 5 mg 0.5-1 tablet(s) by mouth every four (4) hours
Disp #*20 Tablet Refills:*0
10. Senna 1 TAB PO BID:PRN Constipation
11. Tiotropium Bromide 1 CAP IH DAILY
12. Metoprolol Succinate XL 25 mg PO DAILY
13. Lisinopril 2.5 mg PO DAILY


Discharge Disposition:
Home With Service

Facility:
Multicultural VNA

Discharge Diagnosis:
Chronic cholecystitis
BPH, urinary retention


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


Discharge Instructions:
You were admitted to the hospital with acute cholecystitis. You
were taken to the operating room and had your gallbladder
removed laparoscopically. You tolerated the procedure well and
are now being discharged home to continue your recovery with the
below instructions.

Please note that you are now going home with a urinary catheter
("Foley" catheter) in place because you had difficulty urinating
after your surgery.  You will go home with a leg bag.  A
follow-up appointment with Urology has been scheduled for you.
You will also follow up in the Acute Care Surgery clinic at the
appointment listed below.

ACTIVITY:

o Do not drive until you have stopped taking pain medicine and
feel you could respond in an emergency.
o You may climb stairs.
o  You may go outside, but avoid traveling long distances until
you see your [**Name (NI) 5059**] at your next visit.
o  Don't lift more than [**9-18**] lbs for 4 weeks. (This is about
the weight of a briefcase or a bag of groceries.) This applies
to lifting children, but they may sit on your lap.
o You may start some light exercise when you feel comfortable.
o You will need to stay out of bathtubs or swimming pools for a
time while your incision is healing. Ask your doctor when you
can resume tub baths or swimming.

HOW YOU [**Month (only) **] FEEL:
o  You may feel weak or "washed out" for a couple of weeks. You
might want to nap often. Simple tasks may exhaust you.
o  You may have a sore throat because of a tube that was in your
throat during surgery.
o  You might have trouble concentrating or difficulty sleeping.
You might feel somewhat depressed.
o  You could have a poor appetite for a while. Food may seem
unappealing.
o  All of these feelings and reactions are normal and should go
away in a short time.  If they do not, tell your [**Month (only) 5059**].

YOUR INCISION:
o Tomorrow you may shower and remove the gauzes over your
incisions. Under these dressing you have small plastic bandages
called steri-strips. Do not remove steri-strips for 2 weeks.
(These are the thin paper strips that might be on your
incision.) But if they fall off before that that's okay).
o Your incisions may be slightly red around the stitches. This
is normal.
o You may gently wash away dried material around your incision.
o Avoid direct sun exposure to the incision area.
o Do not use any ointments on the incision unless you were told
otherwise.
o You may see a small amount of clear or light red fluid
staining your dressing or clothes. If the staining is severe,
please call your [**Month (only) 5059**].
o You may shower. As noted above, ask your doctor when you may
resume tub baths or swimming.

YOUR BOWELS:
o Constipation is a common side effect of narcotic pain
medications. If needed, you may take a stool softener (such as
Colace, one capsule) or gentle laxative (such as milk of
magnesia, 1 tbs) twice a day. You can get both of these
medicines without a prescription.
o If you go 48 hours without a bowel movement, or have pain
moving the bowels, call your [**Month (only) 5059**].

PAIN MANAGEMENT:
o It is normal to feel some discomfort/pain following abdominal
surgery. This pain is often described as "soreness".
o Your pain should get better day by day. If you find the pain
is getting worse instead of better, please contact your [**Name2 (NI) 5059**].
o You will receive a prescription for pain medicine to take by
mouth. It is important to take this medicine as directed. o Do
not take it more frequently than prescribed. Do not take more
medicine at one time than prescribed.
o Your pain medicine will work better if you take it before your
pain gets too severe.
o Talk with your [**Name2 (NI) 5059**] about how long you will need to take
prescription pain medicine. Please don't take any other pain
medicine, including non-prescription pain medicine, unless your
[**Name2 (NI) 5059**] has said its okay.
o If you are experiencing no pain, it is okay to skip a dose of
pain medicine.
o Remember to use your "cough pillow" for splinting when you
cough or when you are doing your deep breathing exercises.

If you experience any of the following, please contact your
[**Name2 (NI) 5059**]:
- sharp pain or any severe pain that lasts several hours
- pain that is getting worse over time
- pain accompanied by fever of more than 101
- a drastic change in nature or quality of your pain

MEDICATIONS:
Take all the medicines you were on before the operation just as
you did before, unless you have been told differently.
If you have any questions about what medicine to take or not to
take, please call your [**Name2 (NI) 5059**].


Followup Instructions:
Department: SURGICAL SPECIALTIES/ UROLOGY
When: THURSDAY [**2124-9-14**] at 9:30 AM
With: PELVIC FLOOR UNIT [**Telephone/Fax (1) 274**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: GENERAL SURGERY/[**Hospital Unit Name 2193**]
With: [**First Name4 (NamePattern1) 5877**] [**Last Name (NamePattern1) 16471**],MD
When: WEDNESDAY [**2124-9-27**] at 3:00 PM
With: ACUTE CARE CLINIC [**Telephone/Fax (1) 600**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{'Other septicemia due to gram-negative organisms,Calculus of bile duct with acute cholecystitis, with obstruction,Cholangitis,Sepsis,Aortocoronary bypass status,Other emphysema,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Retention of urine, unspecified,Restless legs syndrome (RLS),Esophageal reflux'}


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: RUQ pain, fever

PRESENT ILLNESS: Patient is Cantonese only speaking, so history obtained with the
aid of patient's son.

MEDICAL HISTORY: - Coronary artery disease s/p CABG [**3-/2119**] (LIMA to the LAD and
-separate SVGs to the PDA and an OM)
- HLD
- HTN
- BPH
- Emphysema per ct scan
- TB many years ago, treated for 2 years

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Family/Caregiver[**Name (NI) 581**].
1. Doxazosin 4 mg PO HS
2. Lisinopril 2.5 mg PO DAILY
3. Tiotropium Bromide 1 CAP IH DAILY
4. Metoprolol Succinate XL 25 mg PO DAILY
5. Atorvastatin 10 mg PO DAILY
6. Ropinirole 1 mg PO TID
7. Omeprazole 40 mg PO DAILY
8. Aspirin 81 mg PO DAILY

ALLERGIES: Penicillins / simvastatin

PHYSICAL EXAM: Admission Physical Exam:
Vitals: T 102 HR 98 BP 121/57 RR 20 O2 96% 2L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP less than 7, no LAD, left IJ in place, no
tenderness at site
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Bibasilar rales, no wheezes or rhonchi, appears to be
splinting due to pain with deep inspiration
Abdomen: RUQ tenderness to palpation, soft, non-distended, bowel
sounds present, no organomegaly, no rebound or guarding
GU: no foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.

FAMILY HISTORY: Mother had hypertension and history of cancer.

SOCIAL HISTORY: Prior 20 pack year smoker, quit 20 years ago. Retired CEO of
auto parts business in [**Country 651**]. Lives with his wife and is
independent with ADLs. Rare alcohol, denies illicits. 

### Response:
{'Other septicemia due to gram-negative organisms,Calculus of bile duct with acute cholecystitis, with obstruction,Cholangitis,Sepsis,Aortocoronary bypass status,Other emphysema,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Retention of urine, unspecified,Restless legs syndrome (RLS),Esophageal reflux'}
