CHIEF COMPLAINT: Swelling of tongue/mouth/neck, rash and shortness of breath

PRESENT ILLNESS: 71 year old female with COPD on 2L/min home O2 who presented
with rash, facial and tongue swelling starting 3 days prior to
admission. Her rash started first under her breasts and in her
groin area, then spread to her abdomen. Facial/tongue swelling
started day after rash first appeared, and then worsened over 2
days. She reports that it is worse on the day of admission with
scratchy throat and shortness of breath. Pt called her PCP's
office and was directed to come into the ED. Denied
nausea/vomiting, fever/chills, abdominal pain or any other
complaints. She denies any new medications, lotions/detergents
or foods. She can not think of any inciting trigger or event.
.
In the ED, initial vital signs were stable, she received 125mg
solumedrol, benadryl and pepcid. A machidascope showed swelling
of the arytenoids. She was admitted to the MICU for airway
monitoring. In the ICU she maintained sats on 2L O2 with no
further worsening of symptoms. She was started on 50mg oral
prednisone. She was restarted on a diet and called out to the
floor.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, or wheezing. Denies chest pain, chest
pressure, palpitations, or weakness. Denies nausea, vomiting,
diarrhea, constipation, abdominal pain, or changes in bowel
habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias.

MEDICAL HISTORY: - Coronary artery disease with h/o of MI, s/p stent
- COPD on 2L at baseline, PFTs: FEV1 68%, FVC 99% predicted, and
FEV1/FVC ratio of 49; consisitent with mild obstructive
ventilatory deficit.
- left upper lung mass; being followed by pulm with serial CTs,
mass noted to be getting smaller, RLL subpleural 6 mm nodule
remains stable in size.
- hypothyroidism
- chronic back pain
- polymyalgia rheumatica/gout (on low dose prednisone as
outpatient)
- diabetes, type II (without complications)
- cataracts s/p surgery

MEDICATION ON ADMISSION: ACETAMINOPHEN-CODEINE - 300 mg-30 mg Tablet, 1-2 tabs q6h prn
ALBUTEROL SULFATE neb q4h prn
ALBUTEROL SULFATE [PROAIR HFA] - q4-6h prn
ALLOPURINOL - 100 mg daily
COLCHICINE 0.6mg qod
FLUTICASONE-SALMETEROL 250 mcg-50 mcg/Dose, 1 puff [**Hospital1 **]
GABAPENTIN - 400 mg tid
GLIPIZIDE - 2.5 mg daily
HCTZ 12.5 mg daily (on hold, unclear if pt was taking)
LEVOTHYROXINE - 100 mcg daily
LISINOPRIL - 10 mg daily
NITROGLYCERIN - 0.4 mg prn
PREDNISONE - 10 mg/20mg on alternate days, with plan to taper by
5 every week. 20 mg
SIMVASTATIN - 20 mg qhs
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg daily
TRAVOPROST 0.004 % Drops qhs
ASPIRIN - 81 mg daily
DOCUSATE SODIUM - 100 mg [**Hospital1 **]
OMEPRAZOLE - 20 mg Tablet daily
POLYETHYLENE GLYCOL prn
SENNOSIDES 8.6 mg Tablet [**Hospital1 **]

ALLERGIES: lisinopril

PHYSICAL EXAM: ADMISSION EXAM:
Vitals: 97 114 56 14 972L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL,
mild facial edema, tongue not obviously edemetous though pt has
a bit of a lisp.
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no abdominal rash though pt pointed to show me where it was
present
Back: faint erythemetous urticarial rash on her back, was itchy.

FAMILY HISTORY: no h/o autoimmune disease or cancer

SOCIAL HISTORY: Pt lives in [**Location 686**] with grand-daughter. [**Name (NI) **] history of
alcohol use or drugs. Quit smoking in [**2171-7-10**].
Angioneurotic edema, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified acquired hypothyroidism,Polymyalgia rheumatica,Long-term (current) use of steroids,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Gout, unspecified
Angioneurotic edema,Chr airway obstruct NEC,Old myocardial infarct,Crnry athrscl natve vssl,Status-post ptca,Hypothyroidism NOS,Polymyalgia rheumatica,Long-term use steroids,DMII wo cmp nt st uncntr,Adv eff cardiovasc NEC,Gout NOS
Admission Date:  [**2175-10-7**]              Discharge Date:   [**2175-10-10**]

Date of Birth:  [**2104-4-18**]             Sex:   F

Service: MEDICINE

Allergies:
lisinopril

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Swelling of tongue/mouth/neck, rash and shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
71 year old female with COPD on 2L/min home O2 who presented
with rash, facial and tongue swelling starting 3 days prior to
admission. Her rash started first under her breasts and in her
groin area, then spread to her abdomen. Facial/tongue swelling
started day after rash first appeared, and then worsened over 2
days. She reports that it is worse on the day of admission with
scratchy throat and shortness of breath. Pt called her PCP's
office and was directed to come into the ED. Denied
nausea/vomiting, fever/chills, abdominal pain or any other
complaints. She denies any new medications, lotions/detergents
or foods. She can not think of any inciting trigger or event.
.
In the ED, initial vital signs were stable, she received 125mg
solumedrol, benadryl and pepcid. A machidascope showed swelling
of the arytenoids. She was admitted to the MICU for airway
monitoring. In the ICU she maintained sats on 2L O2 with no
further worsening of symptoms. She was started on 50mg oral
prednisone. She was restarted on a diet and called out to the
floor.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, or wheezing. Denies chest pain, chest
pressure, palpitations, or weakness. Denies nausea, vomiting,
diarrhea, constipation, abdominal pain, or changes in bowel
habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias.

Past Medical History:
- Coronary artery disease with h/o of MI, s/p stent
- COPD on 2L at baseline, PFTs: FEV1 68%, FVC 99% predicted, and
FEV1/FVC ratio of 49; consisitent with mild obstructive
ventilatory deficit.
- left upper lung mass; being followed by pulm with serial CTs,
mass noted to be getting smaller, RLL subpleural 6 mm nodule
remains stable in size.
- hypothyroidism
- chronic back pain
- polymyalgia rheumatica/gout (on low dose prednisone as
outpatient)
- diabetes, type II (without complications)
- cataracts s/p surgery

Social History:
Pt lives in [**Location 686**] with grand-daughter. [**Name (NI) **] history of
alcohol use or drugs. Quit smoking in [**2171-7-10**].


Family History:
no h/o autoimmune disease or cancer

Physical Exam:
ADMISSION EXAM:
Vitals: 97 114 56 14 972L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL,
mild facial edema, tongue not obviously edemetous though pt has
a bit of a lisp.
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no abdominal rash though pt pointed to show me where it was
present
Back: faint erythemetous urticarial rash on her back, was itchy.

GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact
.
DISCHARGE EXAM:
VS: 98.1 106/64 55 18 100% 2L NC
GEN: AOx3, NAD
HEENT: OP clear, facial edema improved; no airway compromise
HEART: RRR, nl S1/S2, no m/r/g
LUNGS: CTAB without wheezes/crackles
SKIN: hyperpigmented plaque under breasts, improving. faint [**Doctor Last Name **]
rash on abdomen, improving as well.

Pertinent Results:
ADMISSION LABS:
[**2175-10-7**] 01:20PM BLOOD WBC-6.4 RBC-3.83* Hgb-10.9* Hct-34.5*
MCV-90 MCH-28.4 MCHC-31.6 RDW-15.6* Plt Ct-204
[**2175-10-7**] 01:20PM BLOOD Neuts-67.0 Lymphs-25.6 Monos-2.5 Eos-4.3*
Baso-0.5
[**2175-10-7**] 01:20PM BLOOD Glucose-178* UreaN-26* Creat-1.2* Na-142
K-4.6 Cl-104 HCO3-26 AnGap-17
[**2175-10-9**] 05:15AM BLOOD ALT-20 AST-18 AlkPhos-61 TotBili-0.2
[**2175-10-9**] 05:15AM BLOOD Calcium-9.7 Phos-3.4 Mg-2.1
.
[**2175-10-8**] 04:48AM BLOOD C4-48*
[**2175-10-9**] 05:15AM BLOOD C3-173
.
DISCHARGE LABS:
[**2175-10-10**] 07:40AM BLOOD WBC-8.3 RBC-3.99* Hgb-12.0 Hct-36.0
MCV-90 MCH-30.0 MCHC-33.3 RDW-15.6* Plt Ct-212
[**2175-10-10**] 07:40AM BLOOD Glucose-92 UreaN-32* Creat-1.4* Na-142
K-4.5 Cl-104 HCO3-30 AnGap-13
.
IMAGING:
[**2175-10-7**] EKG: Sinus rhythm. Non-specific inferior ST-T wave
changes. Compared to the previous tracing of [**2175-6-26**] no
significant change.
.
[**2175-10-7**] CXR: Mild volume overload.


Brief Hospital Course:
71 yo F with a history of COPD presents with two days of facial
and tongue swelling accompanied by shortness of breath and a
rash. Pt was monitored briefly in MICU given concern for airway
compromise. Lisinopril and colchicine were stopped and she was
started on prednisone, benadryl and pepcid with improvement of
her symptoms.

# Angioedema/allergic reaction: Unknown trigger, but thought to
be due to her lisinopril. Patient had been taking it for years,
and then it was stopped, and restarted 2 months ago.
ACE-inhibitor induced angioedema can occur years after starting
treatment with the medication, so it is still possible.
Lisinopril was stopped in the hospital and patient was started
on steroids, benadryl and pepcid with good effect. C1 esterase,
C3/C4 and tryptase were drawn during this admission but are
pending. Her symptoms improved and patient did not experience
any airway compromise. Patient is being discharged on steroid
taper.

# COPD: pt has known COPD, the most recent PFTs of which show:
FEV1 68%, FVC 99% predicted, and FEV1/FVC ratio of 49. She was
continued on home O2 and medications and did well.

# CAD: stable s/p stent. denied chest pain throughout hospital
stay. She was continued on ASA.

# Diabetes Mellitus: she was continued on home glipizide. She
was also started on insulin SS and QACHS fingersticks given
increased dose of steroids, but her sugars remained in
relatively good control. She was not discharged on insulin given
the quick taper of steroids.

# Hypertension: per PCP, [**Name10 (NameIs) **] on lisinopril not for BP
management but more for her diabetes. Her lisinopril was held
and she was not started on any regimen. She may need some
antihypertensive [**Doctor Last Name 360**] in the future.

# Gout: Pt with recent gout flare, followed by rheumatology
here. She was started on steroids with slow taper, and then
started on  allopurinol and colchicine as well. Colchicine was
held on admission given that patient is not having an acute
flare of gout and also because it could cause hypersensitivity
reaction. This can be restarted more carefully in the future if
patient needs it for gout flares. She was continued on
allopurinol.

# Rash: much improved by the time she was on the floor. Given
the fungal infection appearance of rash under her breast on
exam, patient was started on miconazole powder.

# PMR: history of PMR in [**2172**] with flare in [**2174**], treated with
steroids by rheumatology. Has not really had recent symptoms
from PMR.

# hypothyroidism: patient was continued on home synthroid

Transitional Issues:
[ ] C1 esterase and tryptase still pending from this
hospitalization
[ ] patient instructed to do a quick taper by 10 mg each day
(from 50 mg on discharge), and then to continue 10 mg daily
until instructed by rheumatology otherwise
[ ] patient was referred to an allergy specialist given her
presentation with rash and angioedema
[ ] patient still has rash under her breast, being treated with
miconazole powder at the time of discharge - may need to be
followed
[ ] patient had PT evaluation in the hospital given her
complaint that she feels "weak." she was cleared by PT, but is
going home with home PT to further help with ambulation.

Medications on Admission:
ACETAMINOPHEN-CODEINE - 300 mg-30 mg Tablet, 1-2 tabs q6h prn
ALBUTEROL SULFATE neb q4h prn
ALBUTEROL SULFATE [PROAIR HFA] - q4-6h prn
ALLOPURINOL - 100 mg daily
COLCHICINE 0.6mg qod
FLUTICASONE-SALMETEROL 250 mcg-50 mcg/Dose, 1 puff [**Hospital1 **]
GABAPENTIN - 400 mg tid
GLIPIZIDE - 2.5 mg daily
HCTZ 12.5 mg daily (on hold, unclear if pt was taking)
LEVOTHYROXINE - 100 mcg daily
LISINOPRIL - 10 mg daily
NITROGLYCERIN - 0.4 mg prn
PREDNISONE - 10 mg/20mg on alternate days, with plan to taper by
5 every week. 20 mg
SIMVASTATIN - 20 mg qhs
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg daily
TRAVOPROST 0.004 % Drops qhs
ASPIRIN - 81 mg daily
DOCUSATE SODIUM - 100 mg [**Hospital1 **]
OMEPRAZOLE - 20 mg Tablet daily
POLYETHYLENE GLYCOL prn
SENNOSIDES 8.6 mg Tablet [**Hospital1 **]

Discharge Medications:
1. allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. gabapentin 400 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
3. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
4. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day).
Disp:*1 tub* Refills:*0*
7. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation every 4-6 hours as needed for shortness of
breath or wheezing.
8. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig:
One (1) puff Inhalation twice a day.
9. glipizide 2.5 mg Tablet Extended Rel 24 hr Sig: One (1)
Tablet Extended Rel 24 hr PO once a day.
10. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual once a day as needed for chest pain: Please call 911
or come to ED if chest pain does not improve.
11. simvastatin 20 mg Tablet Sig: One (1) Tablet PO at bedtime.

12. travoprost 0.004 % Drops Sig: One (1) drop Ophthalmic at
bedtime.
13. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day: for constipation.
14. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
15. Miralax 17 gram Powder in Packet Sig: One (1) packet PO once
a day as needed for constipation.
16. sennosides 8.6 mg Tablet Sig: One (1) Tablet PO twice a day:
for constipation.
17. acetaminophen-codeine 300-30 mg Tablet Sig: 1-2 Tablets PO
every six (6) hours as needed for pain.
18. albuterol sulfate 1.25 mg/3 mL Solution for Nebulization
Sig: One (1)  Inhalation every four (4) hours as needed for
shortness of breath or wheezing: please use this if your
shortness of breath is not improved with your inhalers.
19. prednisone 10 mg Tablet Sig: Five (5) Tablet PO once a day:
Please take 5 tablets on [**10-11**], take 4 on [**10-12**], take 3 on [**10-13**],
take 2 on [**10-14**],
take 1 daily from that point on.
Disp:*55 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
- Angioedema

Secondary diagnosis:
- Chronic obstructive pulmonary disease
- Diabetes mellitus

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Dear Ms. [**Known lastname 12143**],
It was a pleasure taking care of you at [**Hospital1 827**]. You were admitted with rash, swelling of your
tongue and neck and shortness of breath. In the emergency room,
you were noted to have swelling of your airway and was admitted
to ICU given the concern for your airway. You were started on
prednisone for the swelling, and your lisinopril was stopped.
Your swelling and breathing improved.
.
An appointment for an allergy doctor has been made for you given
the swelling you had. Please keep the appointments listed below.
.
These medications were STOPPED:
- Please stop taking your lisinopril (for blood pressure)
- Please stop taking your colchicine (for gout)
.
These medications were CHANGED:
- Prednisone: Please take 50 mg of prednisone on [**10-11**], then take
40 mg on [**10-12**] mg on [**10-13**] mg on [**10-14**], then 10 mg every
day from then on. Please discuss with your rheumatologist about
how to adjust your prednisone after that.
.
These NEW medications were started for you:
- Miconazole Powder 2% apply under your breast three times daily
for the rash for one week.
.
Complete Medication List:
allopurinol 100 mg Tablet: One Tablet Daily
gabapentin 400 mg Capsule: One Capsule 3 times a day
tiotropium bromide 18 mcg: One cap inhalation daily
levothyroxine 100 mcg Tablet: One Tablet Daily
aspirin 81 mg Tablet, Chewable: One Tablet Daily
miconazole nitrate 2 % Powder: One Appl Topical 3 times a day
albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler: [**12-11**]
puffs Inhalation every 4-6 hours as needed for shortness of
breath or wheezing.
fluticasone-salmeterol 250-50 mcg/dose Disk with Device: One
puff Inhalation twice a day.
glipizide 2.5 mg Tablet Extended Rel 24 hr: One Tablet Extended
Rel 24 hr once a day.
nitroglycerin 0.4 mg Tablet, Sublingual: One tablet under the
tongue once a day as needed for chest pain: Please call 911 or
come to ED if chest pain does not improve.
simvastatin 20 mg Tablet: One Tablet at bedtime.
travoprost  0.004 % Drops: one drop Ophthalmic at bedtime.

docusate sodium  100 mg Capsule: One Capsule twice a day: for
constipation.
omeprazole 20 mg Capsule, Delayed Release(E.C.): One Capsule,
Delayed Release(E.C.) once a day.
Miralax  17 gram Powder in Packet: One packet once a day as
needed for constipation.
sennosides 8.6 mg Tablet: One Tablet twice a day: for
constipation.
acetaminophen-codeine 300-30 mg Tablet:  1-2 Tablets every six
hours as needed for pain.
albuterol sulfate 1.25 mg/3 mL Solution for Nebulization: One
nebulization every four hours as needed for shortness of breath
or wheezing: please use this if your shortness of breath is not
improved with your inhalers.
prednisone 10 mg Tablet  Sig:  Five (5) Tablet PO once a day:
Please take 5 tablets on [**10-11**], take 4 on [**10-12**], take 3 on [**10-13**],
take 2 on [**10-14**], take 1 daily from that point on.

Followup Instructions:
Department: [**Hospital1 7975**] ST. HEALTH CENTER
When: THURSDAY [**2175-10-12**] at 3:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 11980**], MD [**Telephone/Fax (1) 7976**]
Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site
.
Department: DIV OF ALLERGY AND INFLAM
When: WEDNESDAY [**2175-11-1**] at 2:00 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 9703**], RNC [**Telephone/Fax (1) 9316**]
Building: One [**Location (un) **] Place ([**Location (un) **], MA) [**Location (un) 895**]
Campus: OFF CAMPUS     Best Parking: Parking on Site
.
{'Angioneurotic edema, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified acquired hypothyroidism,Polymyalgia rheumatica,Long-term (current) use of steroids,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Gout, unspecified'}


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: Swelling of tongue/mouth/neck, rash and shortness of breath

PRESENT ILLNESS: 71 year old female with COPD on 2L/min home O2 who presented
with rash, facial and tongue swelling starting 3 days prior to
admission. Her rash started first under her breasts and in her
groin area, then spread to her abdomen. Facial/tongue swelling
started day after rash first appeared, and then worsened over 2
days. She reports that it is worse on the day of admission with
scratchy throat and shortness of breath. Pt called her PCP's
office and was directed to come into the ED. Denied
nausea/vomiting, fever/chills, abdominal pain or any other
complaints. She denies any new medications, lotions/detergents
or foods. She can not think of any inciting trigger or event.
.
In the ED, initial vital signs were stable, she received 125mg
solumedrol, benadryl and pepcid. A machidascope showed swelling
of the arytenoids. She was admitted to the MICU for airway
monitoring. In the ICU she maintained sats on 2L O2 with no
further worsening of symptoms. She was started on 50mg oral
prednisone. She was restarted on a diet and called out to the
floor.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies cough, or wheezing. Denies chest pain, chest
pressure, palpitations, or weakness. Denies nausea, vomiting,
diarrhea, constipation, abdominal pain, or changes in bowel
habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias.

MEDICAL HISTORY: - Coronary artery disease with h/o of MI, s/p stent
- COPD on 2L at baseline, PFTs: FEV1 68%, FVC 99% predicted, and
FEV1/FVC ratio of 49; consisitent with mild obstructive
ventilatory deficit.
- left upper lung mass; being followed by pulm with serial CTs,
mass noted to be getting smaller, RLL subpleural 6 mm nodule
remains stable in size.
- hypothyroidism
- chronic back pain
- polymyalgia rheumatica/gout (on low dose prednisone as
outpatient)
- diabetes, type II (without complications)
- cataracts s/p surgery

MEDICATION ON ADMISSION: ACETAMINOPHEN-CODEINE - 300 mg-30 mg Tablet, 1-2 tabs q6h prn
ALBUTEROL SULFATE neb q4h prn
ALBUTEROL SULFATE [PROAIR HFA] - q4-6h prn
ALLOPURINOL - 100 mg daily
COLCHICINE 0.6mg qod
FLUTICASONE-SALMETEROL 250 mcg-50 mcg/Dose, 1 puff [**Hospital1 **]
GABAPENTIN - 400 mg tid
GLIPIZIDE - 2.5 mg daily
HCTZ 12.5 mg daily (on hold, unclear if pt was taking)
LEVOTHYROXINE - 100 mcg daily
LISINOPRIL - 10 mg daily
NITROGLYCERIN - 0.4 mg prn
PREDNISONE - 10 mg/20mg on alternate days, with plan to taper by
5 every week. 20 mg
SIMVASTATIN - 20 mg qhs
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg daily
TRAVOPROST 0.004 % Drops qhs
ASPIRIN - 81 mg daily
DOCUSATE SODIUM - 100 mg [**Hospital1 **]
OMEPRAZOLE - 20 mg Tablet daily
POLYETHYLENE GLYCOL prn
SENNOSIDES 8.6 mg Tablet [**Hospital1 **]

ALLERGIES: lisinopril

PHYSICAL EXAM: ADMISSION EXAM:
Vitals: 97 114 56 14 972L
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL,
mild facial edema, tongue not obviously edemetous though pt has
a bit of a lisp.
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no abdominal rash though pt pointed to show me where it was
present
Back: faint erythemetous urticarial rash on her back, was itchy.

FAMILY HISTORY: no h/o autoimmune disease or cancer

SOCIAL HISTORY: Pt lives in [**Location 686**] with grand-daughter. [**Name (NI) **] history of
alcohol use or drugs. Quit smoking in [**2171-7-10**]. 

### Response:
{'Angioneurotic edema, not elsewhere classified,Chronic airway obstruction, not elsewhere classified,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified acquired hypothyroidism,Polymyalgia rheumatica,Long-term (current) use of steroids,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Gout, unspecified'}
