CHIEF COMPLAINT: shortness of breath, cough

PRESENT ILLNESS: HPI: 83yo M with DM and CAD, in the [**Hospital Unit Name 153**] for 1 day for
respiratory distress due to pneumonia who is stable and
transferred to the floor. Pt lives in an [**Hospital3 **]
facility, 1d PTA noticed that he felt extremely fatigued and
"unlike himself". He reports a cough x 2 days, productive of
whitish sputum, along with wheezing and shortness of breath. He
felt hot but did not have fevers assessed by temperature, but
had chills. He has never felt like this before. He was sent from
his living facility to the [**Hospital1 18**] ED for further evaluation.
.
In the ED, initial vitals were: T 98.5, HR 92, BP 153/81, RR 16,
94% on room air. Later in ED stay, however, he was febrile (Tmax
101.4), tachycardic (HR 110-140), hypertensive (SBP 165-200),
and tachypneic (RR 22-36), with O2sats 94% on 4L nc. He received
1.6L NS, 1gm IV ceftriaxone, 5mg IV lopressor x 3, guaifenesin
w/ codeine, and 650mg po tylenol. He was sent to the [**Hospital Unit Name 153**] for
further monitoring given his labored breathing and abnormal
vital signs. CTA c/w atypical pneumonia. In the [**Hospital Unit Name 153**] his course
consisted of albuterol nebulizer, azithromycin and ceftriaxone
for pneumonia and vancomycin for ankle cellulitis.
.
On ROS, he denies chest/arm/jaw pain, palpitations, LE edema,
orthopnea, or PND. He does report some nausea and decreased po
intake x 1 day, but denies abdominal pain, vomiting, diarrhea,
or constipation. He notes that several individuals at his
[**Hospital3 **] facility had unspecified illnesses recently.
.
Pt was transferred to the floor, stable. He says he feels much
improved. He has no pain, breathing is not as difficult,
although he still has some wheezing and SOB on minimal exertion
such as sitting up in bed. The cough has improved but he is
still producing white sputum.

MEDICAL HISTORY: CAD: cath [**2182-8-1**] w/ 60% proximal LAD lesion, 80% ramus lesion,
and 90% mid circumflex lesion. The ramus and left circumflex
arteries were stented with hepacoat stents.
H/o MI [**2175**]
HTN
NIDDM
Dyslipidemia
Anxiety and depression
BPH s/p TURP [**12/2182**]
L inguinal hernia s/p repair [**10/2182**]
Glaucoma
Macular degeneration, near blindness in both eyes
Bl hip pain, likely [**1-7**] L4/5 foraminal disc herniation

MEDICATION ON ADMISSION: Aspirin 325 mg PO DAILY
Amlodipine 10 mg PO DAILY
Lisinopril 20 mg PO DAILY
Metoprolol Tartrate 100 mg PO BID
Atorvastatin 10 mg PO qHS
Furosemide 20 mg PO DAILY
Glyburide 1.25 mg PO DAILY
Finasteride 5 mg PO qHS
Ranitidine 150mg po bid
Bimatoprost 0.03 % Drops One (1)  Ophthalmic QHS
Tylenol, extra strength, 1000 mg PO tid
Neurontin 200mg po daily
Codeine 30mg po q6h prn pain
Lidoderm Patch

ALLERGIES: Egg / Strawberry

PHYSICAL EXAM: T 97.7 P 86 BP 140/60 RR 20 O2sat 96% 3Lnc Glu 96
Gen: [**Last Name (un) **] elderley male in NAD
HEENT: MM dry, tounge furrowed, sclerae anicteric. Pharynx w/o
exudates. Spider angioma on chin. Left pupil not reactive to
light, right 2mm, minimally reactive
Neck: Supple, no LAD. JVP 10cm
Lungs: wheezes diffusely on expiration and inspiration, coarse
rhonchi, most prominent on the R posterior-lateral lower lobe
Chest: RRR, nl S1/S2, no murmurs.
Abd: soft, nt, nd, nabs, no hsm.
Extrem: trace edema both feet. 2+ dorsal pedal pulses. L ankle
with mildly erythematous patch of dry, scaly, yellow/brown
flaky, non-swollen, non-tender, skin. No blistering or pus
drainage.
Neuro: AOx3. sensation to light touch intact and symmetric
throughout.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Patient lives at [**Location (un) **], an [**Hospital3 **] facility.
Pneumonia, organism unspecified,Cellulitis and abscess of leg, except foot,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Tachycardia, unspecified,Macular degeneration (senile), unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Dysthymic disorder
Pneumonia, organism NOS,Cellulitis of leg,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Status-post ptca,Hypertension NOS,Tachycardia NOS,Macular degeneration NOS,BPH w/o urinary obs/LUTS,Hyperlipidemia NEC/NOS,Dysthymic disorder
Admission Date:  [**2185-3-28**]              Discharge Date:   [**2185-4-1**]


Service: MEDICINE

Allergies:
Egg / Strawberry

Attending:[**Doctor Last Name 10493**]
Chief Complaint:
shortness of breath, cough

Major Surgical or Invasive Procedure:
None

History of Present Illness:
HPI: 83yo M with DM and CAD, in the [**Hospital Unit Name 153**] for 1 day for
respiratory distress due to pneumonia who is stable and
transferred to the floor. Pt lives in an [**Hospital3 **]
facility, 1d PTA noticed that he felt extremely fatigued and
"unlike himself". He reports a cough x 2 days, productive of
whitish sputum, along with wheezing and shortness of breath. He
felt hot but did not have fevers assessed by temperature, but
had chills. He has never felt like this before. He was sent from
his living facility to the [**Hospital1 18**] ED for further evaluation.
.
In the ED, initial vitals were: T 98.5, HR 92, BP 153/81, RR 16,
94% on room air. Later in ED stay, however, he was febrile (Tmax
101.4), tachycardic (HR 110-140), hypertensive (SBP 165-200),
and tachypneic (RR 22-36), with O2sats 94% on 4L nc. He received
1.6L NS, 1gm IV ceftriaxone, 5mg IV lopressor x 3, guaifenesin
w/ codeine, and 650mg po tylenol. He was sent to the [**Hospital Unit Name 153**] for
further monitoring given his labored breathing and abnormal
vital signs. CTA c/w atypical pneumonia. In the [**Hospital Unit Name 153**] his course
consisted of albuterol nebulizer, azithromycin and ceftriaxone
for pneumonia and vancomycin for ankle cellulitis.
.
On ROS, he denies chest/arm/jaw pain, palpitations, LE edema,
orthopnea, or PND. He does report some nausea and decreased po
intake x 1 day, but denies abdominal pain, vomiting, diarrhea,
or constipation. He notes that several individuals at his
[**Hospital3 **] facility had unspecified illnesses recently.
.
Pt was transferred to the floor, stable. He says he feels much
improved. He has no pain, breathing is not as difficult,
although he still has some wheezing and SOB on minimal exertion
such as sitting up in bed. The cough has improved but he is
still producing white sputum.


Past Medical History:
CAD: cath [**2182-8-1**] w/ 60% proximal LAD lesion, 80% ramus lesion,
and 90% mid circumflex lesion. The ramus and left circumflex
arteries were stented with hepacoat stents.
H/o MI [**2175**]
HTN
NIDDM
Dyslipidemia
Anxiety and depression
BPH s/p TURP [**12/2182**]
L inguinal hernia s/p repair [**10/2182**]
Glaucoma
Macular degeneration, near blindness in both eyes
Bl hip pain, likely [**1-7**] L4/5 foraminal disc herniation


Social History:
Patient lives at [**Location (un) **], an [**Hospital3 **] facility.

His wife of many years is deceased since [**2181**].  He has no
children. His closest family member is his sister-in-law,
[**Name (NI) 26196**] [**Name (NI) 29392**].  He does not use tobacco, EtOH, or other drugs,
although he did smoke a pipe x 25 years (quit in [**2157**]'s)   He
used to work in the pharmacy at the [**Hospital **] Hospital.


Family History:
Non-contributory.


Physical Exam:
T 97.7 P 86 BP 140/60 RR 20 O2sat 96% 3Lnc Glu 96
Gen: [**Last Name (un) **] elderley male in NAD
HEENT: MM dry, tounge furrowed, sclerae anicteric. Pharynx w/o
exudates. Spider angioma on chin. Left pupil not reactive to
light, right 2mm, minimally reactive
Neck: Supple, no LAD. JVP 10cm
Lungs: wheezes diffusely on expiration and inspiration, coarse
rhonchi, most prominent on the R posterior-lateral lower lobe
Chest: RRR, nl S1/S2, no murmurs.
Abd: soft, nt, nd, nabs, no hsm.
Extrem: trace edema both feet. 2+ dorsal pedal pulses. L ankle
with mildly erythematous patch of dry, scaly, yellow/brown
flaky, non-swollen, non-tender, skin. No blistering or pus
drainage.
Neuro: AOx3. sensation to light touch intact and symmetric
throughout.


Pertinent Results:
[**2185-3-28**] 12:01PM BLOOD WBC-12.0*# RBC-4.79 Hgb-13.8* Hct-39.2*
MCV-82 MCH-28.7 MCHC-35.1* RDW-14.3 Plt Ct-264
[**2185-3-28**] 12:01PM BLOOD Neuts-83.2* Lymphs-11.1* Monos-5.4
Eos-0.2 Baso-0.1
[**2185-3-28**] 12:01PM BLOOD PT-13.1 PTT-27.8 INR(PT)-1.1
[**2185-3-28**] 12:01PM BLOOD Glucose-329* UreaN-15 Creat-0.8 Na-131*
K-4.0 Cl-92* HCO3-26 AnGap-17
[**2185-3-28**] 09:00PM BLOOD CK(CPK)-274*
[**2185-3-28**] 09:00PM BLOOD CK-MB-8
[**2185-3-28**] 09:00PM BLOOD cTropnT-<0.01
[**2185-3-29**] 05:22AM BLOOD CK-MB-12* MB Indx-3.0 cTropnT-0.02*
[**2185-3-29**] 01:47PM BLOOD CK-MB-8 cTropnT-0.01
[**2185-3-29**] 05:22AM BLOOD CK(CPK)-397*
[**2185-3-29**] 01:47PM BLOOD CK(CPK)-276*
[**2185-3-28**] 09:00PM BLOOD Calcium-9.0 Phos-3.1 Mg-1.8
[**2185-3-29**] 01:19AM BLOOD Type-ART pO2-72* pCO2-40 pH-7.44
calTCO2-28 Base XS-2 Comment-NASAL [**Last Name (un) 154**]
[**2185-3-28**] 12:14PM BLOOD Lactate-2.7*
[**2185-3-28**] 05:12PM BLOOD Lactate-1.43
[**2185-3-29**] 01:19AM BLOOD freeCa-1.09*

CTA ([**2185-3-28**])
1. No evidence of pulmonary embolism or aortic dissection.

2. Centrilobular opacities in the right lung most notable in the
superior segment of the right lower lobe and posterior segment
of the right upper lobe with underlying emphysema. Bilateral
peribronchial wall thickening. Differential diagnosis includes
atypical mycobacterium infection versus bronchopneumonia.

3. Hypodense lesion within segment IV of the liver is
incompletely characterized on this examination. Recommend
multiphase liver MRI for further evaluation.

4. Tubular soft tissue density in the region of the left adrenal
gland possibly representing adrenal hyperplasia.

5. Heterogeneous lesion within the left thyroid gland which may
be further evaluated with ultrasound.

6. Scattered mediastinal and hilar lymph nodes, the largest of
which measures 1.1 cm in short axis.

CXR [**2185-3-29**]
IMPRESSION: No evidence of acute pneumonia. No pleural effusions
or acute skeletal abnormalities are identified.

EKG: Sinus tachycardia@120BPM,L atrial abnormality, RBBB (new
relative to EKG [**2184-6-15**]) 1mm ST depressions V2-V3, frequent
PVC's.

Brief Hospital Course:
Assessment: 83yo M with DM and CAD, in the [**Hospital Unit Name 153**] 1 day for
respiratory distress due to pneumonia who was stable and
discharged from the floor.
Brief Hospital Course:
.
# Pneumonia: SOB, cough have improved, but are still present. He
has been afebrile since transfer from to the floor but his WBC
was still elevated until [**3-30**] when it was normal. Opacity on
chest CT c/w atypical pna. Also could represent viral
pneumonitis and aspiration. Speech and swallow team evaluated
and cleared for eating as pt has no apparent aspiration risk.
Sputum gram stain polymicrobial (2+GNR, 1+GPC, 1+GPR). CTA
negative for PE. Symptoms and imaging not c/w CHF. This is most
likely community aquired from his residence with multiple
elderly patients. Treated CAP with Azithromycin x 2 day course
(d1 [**3-29**]); CTX x 2d (d1 [**3-29**]). Transitioned to PO Levofloxacin
[**3-31**], will contiue Levo at rehab for 6 days.  Blood cultures,
urinary legionella antigen are pending. CXR [**3-31**] showed
atelectasis. PT evaluated and have recomended physical therapy
in rehabilitation center.
.
# Wheezing: pt w/ 25y h/o pipe smoking, stopped in [**2157**]'s.
Evidence of COPD on CT. Nebs improve breathing according to pt.
Albuterol/atrovent nebs administered in hospital, patient
discharged on albuterol and atrovent inhalers for home use.
.
# Skin lesion: the dry, scaly, mildly erythematous yellow/brown
skin on L ankle is less likely to be cellulitis as it is not
hot, tender or swollen. However, due to his residence at a
facility with many other elderly people MRSA contact is possible
and should be considered. He received three days of IV
Vancomycin and is being discharged with 1% hydrocortisone cream.

.
# Hypertension: pt w/ h/o HTN on amlodipine, lopressor, and
lisinopril, furosamide at home, hypertensive in ED to SBP 200.
Stable on floor w/ home regimen meds, lisinopril was increased
from 20mg to 40mg QD on [**3-30**] due to systolic pressures >135 on
[**3-30**]. Metoprolol also increased to 150mg [**Hospital1 **] for control of HR,
BP tolerating well on discharge.
.
# Tachycardia: Tachy resolved on night of [**3-28**] w/ 500cc NS,
lopressor PM dose, 0.5 mg ativan. Could have been to volume
depletion and anxiety. No evidence of PE on CTAngio. On night of
[**3-29**] episode of tachy with PVC resolved with lopressor.
Additional episode of tachy on night of [**3-31**] prompted increase
of lopressor from 100mg to 150mg [**Hospital1 **] as above.
.
# H/o CAD: Other than SOB, no symptoms of ischemia. However, new
RBBB on EKG concerning: ddx rate-related conduction delay vs.
PE/R-heart strain (unlikely given neg CT) vs. ischemia. s/p
coated stent x 2 in [**2181**], and 60% non-stented LAD lesion [**2181**].
CK elevated (274, 397), but MB fraction <2.5% and minimally
elevated Tn (0.02) make ACS unlikely. [**Month (only) 116**] be small enzyme leak
related to tachycardia (demand ischemia. Negative cardiac
enzymes x3. Pt was continued on ASA, statin, ACE, Furosemide and
lopressor increased from 100mg [**Hospital1 **] to 150mg [**Hospital1 **] on [**4-1**] for HR
control as above.  A repeat EKG ([**3-30**]) showed persistence of
RBBB, but with negative enzymes, did not mandate further
work-up.
.
# Frequent PVC's. Mg/K/Ca all normal. Pt was monitored on tele
and received home dose of lopressor 100bid (increased from 100mg
[**Hospital1 **] to 150mg [**Hospital1 **] on [**4-1**])
.
# Diabetes: NIDDM, on glyburide at home, currently blood sugars
are controlled. Received home dose of glyburide 2.5 [**Hospital1 **] and
humalog sliding scale prn.
.
# Glaucoma: latanaprost drops for both eyes as bimatoprost
initially not formulary. [**3-30**]- Patient started on Bimatoprost to
both eyes and Truopt to L eye as he was taking originally.
.

Medications on Admission:
Aspirin 325 mg PO DAILY
Amlodipine 10 mg PO DAILY
Lisinopril 20 mg PO DAILY
Metoprolol Tartrate 100 mg PO BID
Atorvastatin 10 mg PO qHS
Furosemide 20 mg PO DAILY
Glyburide 1.25 mg PO DAILY
Finasteride 5 mg PO qHS
Ranitidine 150mg po bid
Bimatoprost 0.03 % Drops One (1)  Ophthalmic QHS
Tylenol, extra strength, 1000 mg PO tid
Neurontin 200mg po daily
Codeine 30mg po q6h prn pain
Lidoderm Patch

Discharge Medications:
1. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
4. Finasteride 5 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
5. Gabapentin 100 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
6. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
7. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
8. Cortisone 1 % Cream Sig: One (1) Appl Topical QID (4 times a
day).
9. Gabapentin 100 mg Capsule Sig: Two (2) Capsule PO TID (3
times a day).
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID (3
times a day).
12. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
13. Bimatoprost 0.03 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
14. Albuterol 90 mcg/Actuation Aerosol Sig: [**12-7**]  Inhalation
every 4-6 hours as needed for shortness of breath or wheezing.
15. Atrovent 0.02 % Solution Sig: [**12-7**]  Inhalation every six (6)
hours as needed for shortness of breath or wheezing.
16. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
17. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 5 doses.
18. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 533**] [**Last Name (NamePattern1) **] for Extended Care - [**Location 1268**]

Discharge Diagnosis:
Primary diagnosis: Pneumonia
Secondary diagnosis: coronary artery disease, hypertension,
Diabetes Mellitus Type II, Dyslipidemia, anxiety, depression,
Benign prostatic hyperplasia, glaucoma, macular degeneration


Discharge Condition:
Improved


Discharge Instructions:
You have been in the hospital because you had a cough and
shortness of breath. You had an episode of respiratory distress,
fever and high blood pressure and were stabilized in the
intensive care unit. In the hospital it was found that you had
pneumonia. You were given antibiotics for the pneumonia, and you
will continue to take antibiotics at home. It is possible that
the antibiotics can affect your diabetic medication. It is
important to check your sugar level everyday, and to go to the
ED or call your PCP if you have feelings of lightheadedness,
tremulosness or tingling.
Please go to the ED or call your PCP if you begin to have
fever>100.6, increased shortness of breath, chest pain or heart
racing.
Please see your PCP [**Last Name (NamePattern4) **].[**Last Name (STitle) 1007**] within one week.

Followup Instructions:
Due to some episodes of high blood pressure your lisinopril was
increaed from 20mg to 40mg every day. Please discuss this change
with your PCP. [**Name Initial (NameIs) 2169**]: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**], MD
Phone:[**Telephone/Fax (1) 142**]


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 10491**] MD, [**MD Number(3) 10495**]

Completed by:[**2185-4-1**]
{'Pneumonia, organism unspecified,Cellulitis and abscess of leg, except foot,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Tachycardia, unspecified,Macular degeneration (senile), unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Dysthymic disorder'}


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: shortness of breath, cough

PRESENT ILLNESS: HPI: 83yo M with DM and CAD, in the [**Hospital Unit Name 153**] for 1 day for
respiratory distress due to pneumonia who is stable and
transferred to the floor. Pt lives in an [**Hospital3 **]
facility, 1d PTA noticed that he felt extremely fatigued and
"unlike himself". He reports a cough x 2 days, productive of
whitish sputum, along with wheezing and shortness of breath. He
felt hot but did not have fevers assessed by temperature, but
had chills. He has never felt like this before. He was sent from
his living facility to the [**Hospital1 18**] ED for further evaluation.
.
In the ED, initial vitals were: T 98.5, HR 92, BP 153/81, RR 16,
94% on room air. Later in ED stay, however, he was febrile (Tmax
101.4), tachycardic (HR 110-140), hypertensive (SBP 165-200),
and tachypneic (RR 22-36), with O2sats 94% on 4L nc. He received
1.6L NS, 1gm IV ceftriaxone, 5mg IV lopressor x 3, guaifenesin
w/ codeine, and 650mg po tylenol. He was sent to the [**Hospital Unit Name 153**] for
further monitoring given his labored breathing and abnormal
vital signs. CTA c/w atypical pneumonia. In the [**Hospital Unit Name 153**] his course
consisted of albuterol nebulizer, azithromycin and ceftriaxone
for pneumonia and vancomycin for ankle cellulitis.
.
On ROS, he denies chest/arm/jaw pain, palpitations, LE edema,
orthopnea, or PND. He does report some nausea and decreased po
intake x 1 day, but denies abdominal pain, vomiting, diarrhea,
or constipation. He notes that several individuals at his
[**Hospital3 **] facility had unspecified illnesses recently.
.
Pt was transferred to the floor, stable. He says he feels much
improved. He has no pain, breathing is not as difficult,
although he still has some wheezing and SOB on minimal exertion
such as sitting up in bed. The cough has improved but he is
still producing white sputum.

MEDICAL HISTORY: CAD: cath [**2182-8-1**] w/ 60% proximal LAD lesion, 80% ramus lesion,
and 90% mid circumflex lesion. The ramus and left circumflex
arteries were stented with hepacoat stents.
H/o MI [**2175**]
HTN
NIDDM
Dyslipidemia
Anxiety and depression
BPH s/p TURP [**12/2182**]
L inguinal hernia s/p repair [**10/2182**]
Glaucoma
Macular degeneration, near blindness in both eyes
Bl hip pain, likely [**1-7**] L4/5 foraminal disc herniation

MEDICATION ON ADMISSION: Aspirin 325 mg PO DAILY
Amlodipine 10 mg PO DAILY
Lisinopril 20 mg PO DAILY
Metoprolol Tartrate 100 mg PO BID
Atorvastatin 10 mg PO qHS
Furosemide 20 mg PO DAILY
Glyburide 1.25 mg PO DAILY
Finasteride 5 mg PO qHS
Ranitidine 150mg po bid
Bimatoprost 0.03 % Drops One (1)  Ophthalmic QHS
Tylenol, extra strength, 1000 mg PO tid
Neurontin 200mg po daily
Codeine 30mg po q6h prn pain
Lidoderm Patch

ALLERGIES: Egg / Strawberry

PHYSICAL EXAM: T 97.7 P 86 BP 140/60 RR 20 O2sat 96% 3Lnc Glu 96
Gen: [**Last Name (un) **] elderley male in NAD
HEENT: MM dry, tounge furrowed, sclerae anicteric. Pharynx w/o
exudates. Spider angioma on chin. Left pupil not reactive to
light, right 2mm, minimally reactive
Neck: Supple, no LAD. JVP 10cm
Lungs: wheezes diffusely on expiration and inspiration, coarse
rhonchi, most prominent on the R posterior-lateral lower lobe
Chest: RRR, nl S1/S2, no murmurs.
Abd: soft, nt, nd, nabs, no hsm.
Extrem: trace edema both feet. 2+ dorsal pedal pulses. L ankle
with mildly erythematous patch of dry, scaly, yellow/brown
flaky, non-swollen, non-tender, skin. No blistering or pus
drainage.
Neuro: AOx3. sensation to light touch intact and symmetric
throughout.

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: Patient lives at [**Location (un) **], an [**Hospital3 **] facility. 

### Response:
{'Pneumonia, organism unspecified,Cellulitis and abscess of leg, except foot,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Tachycardia, unspecified,Macular degeneration (senile), unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Dysthymic disorder'}
