CHIEF COMPLAINT: altered mental status

PRESENT ILLNESS: This is an 84 year-old with atrial fibrillation, COPD,
metastatic colon cancer to liver and pleura, recurrent right
pleural effusions, who presents with altered mental status.
Patient recently discharged to home from ICU with placement of
pleurex catheter for recurrent right pleural effusion leading to
acute respiratory distress. His family declined hospice services
and VNA services were set up on last discharge.

MEDICAL HISTORY: . Acute respiratory failure.
2. Status post insertion of right thoracic PleurX catheter.
3. Right pleural effusion.
4. Stage IV colon cancer (metastases to liver, pleura)
- [**2-28**]: diagnosed after labs revealing low HCT and Iron 19,
ferritin 30, TIBC within normal limits.
- [**2114-3-19**] (Colonscopy): A single sessile polyp of benign
appearance found.
- [**2114-3-20**] (CT abd): No colon mass visualized. Liver lesions
demonstrated; pleural effusions, right greater than left.
- [**2114-3-21**] (Ultrasound-guided liver biopsy): Metastatic
adenocarcinoma consistent with colonic origin. Immunostain for
CK-20 positive, CK-7 negative, consistent with colonic origin.
- s/p 5FU/LV chemotherapy (last chemo C2D8 on [**8-15**]), no further
chemo per most recent progress note
5. Chronic obstructive pulmonary disease (home oxygen
dependent, steroid dependent).
6. Congestive heart failure.
7. Pulmonary hypertension.
8. Macular degeneration.
9. Hypertension.
10. Status post torn right rotator cuff.
11. Atrial fibrillation.

MEDICATION ON ADMISSION: 1. Diltiazem HCl 240 mg daily
2. Lisinopril 40 mg daily
3. Furosemide 80 mg [**Hospital1 **]
4. Prednisone 20 mg Daily - started [**10-13**] then taper
5. Coumadin 3 mg daily
6. Fluticasone-Salmeterol 500-50 mcg/(1) [**Hospital1 **]
7. Albuterol Sulfate 0.083 % Q4hrs PRN
8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
eneral Appearance: pleasant, comfortable, NAD, non toxic
Eyes: : PERLLA, EOMI, no conjuctival injection, anicteric
ENT: no sinus tenderness, MMM, op without exudate or lesions, no
supraclavicular or cervical lymphadenopathy, JVP to cm, no
carotid bruits, no thyromegaly or thyroid nodules
Respiratory: CTA b/l with good air movement throughout
Cardiovascular: RR, S1 and S2 wnl, no murmurs, rubs or gallops
appreciated
Gastrointestinal: nd, +b/s, soft, nt, no masses or
hepatosplenomegaly
Musculoskeletal/extremities: no cyanosis, clubbing or edema
Skin/nails: warm, no rashes/no jaundice/no splinters
Neurological: AAOx3. Cn II-XII intact. 5/5 strength throughout.
No sensory deficits to light touch appreciated. No pass-pointing
on finger to nose. 2+DTR's-patellar and biceps.No pronator
drift, fluent speech. Positive myoclonus and asterixis.
Psychiatric:pleasant, appropriate affect
Heme/Lymph: no cervical or supraclavicular lymphadenopathy
GU: no catheter in place
Rectal: guiaic negative

FAMILY HISTORY: The patient's parents lived to be elderly. His sister has a
history of colon cancer, diagnosed in her 70s.

SOCIAL HISTORY: Lives at home w/wife of 50+ [**Name2 (NI) 1686**], has 2 children who are involved
in his care. Former smoker (40 pk [**Name2 (NI) 1686**]) quit approx 20 [**Name2 (NI) 1686**] pta.
No ETOH, no IVDU. Retired
Secondary malignant neoplasm of pleura,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Malignant neoplasm of colon, unspecified site,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Diastolic heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other and unspecified coagulation defects,Blood in stool,Hypoxemia,Other chronic pulmonary heart diseases,Macular degeneration (senile), unspecified,Atrial fibrillation,Other dependence on machines, supplemental oxygen,Encounter for palliative care,Diseases of tricuspid valve,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Anemia, unspecified,Hypotension, unspecified
Second malig neo pleura,Pneumonia, organism NOS,Hyposmolality,Malignant neo colon NOS,Urin tract infection NOS,Delirium d/t other cond,Diastolc hrt failure NOS,Obs chr bronc w(ac) exac,Mal neo lymph-intrathor,Coagulat defect NEC/NOS,Blood in stool,Hypoxemia,Chr pulmon heart dis NEC,Macular degeneration NOS,Atrial fibrillation,Depend-supplement oxygen,Encountr palliative care,Tricuspid valve disease,Enterococcus group d,Anemia NOS,Hypotension NOS
Admission Date:  [**2114-10-14**]              Discharge Date:   [**2114-10-21**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
altered mental status

Major Surgical or Invasive Procedure:
none

History of Present Illness:
This is an 84 year-old with atrial fibrillation, COPD,
metastatic colon cancer to liver and pleura, recurrent right
pleural effusions, who presents with altered mental status.
Patient recently discharged to home from ICU with placement of
pleurex catheter for recurrent right pleural effusion leading to
acute respiratory distress. His family declined hospice services
and VNA services were set up on last discharge.


Past Medical History:
. Acute respiratory failure.
2. Status post insertion of right thoracic PleurX catheter.
3. Right pleural effusion.
4. Stage IV colon cancer (metastases to liver, pleura)
- [**2-28**]: diagnosed after labs revealing low HCT and Iron 19,
ferritin 30, TIBC within normal limits.
- [**2114-3-19**] (Colonscopy): A single sessile polyp of benign
appearance found.
- [**2114-3-20**] (CT abd): No colon mass visualized. Liver lesions
demonstrated; pleural effusions, right greater than left.
- [**2114-3-21**] (Ultrasound-guided liver biopsy): Metastatic
adenocarcinoma consistent with colonic origin. Immunostain for
CK-20 positive, CK-7 negative, consistent with colonic origin.
- s/p 5FU/LV chemotherapy (last chemo C2D8 on [**8-15**]), no further
chemo per most recent progress note
5. Chronic obstructive pulmonary disease (home oxygen
dependent, steroid dependent).
6. Congestive heart failure.
7. Pulmonary hypertension.
8. Macular degeneration.
9. Hypertension.
10. Status post torn right rotator cuff.
11. Atrial fibrillation.


Social History:
Lives at home w/wife of 50+ [**Name2 (NI) 1686**], has 2 children who are involved
in his care. Former smoker (40 pk [**Name2 (NI) 1686**]) quit approx 20 [**Name2 (NI) 1686**] pta.
No ETOH, no IVDU. Retired

Family History:
The patient's parents lived to be elderly. His sister has a
history of colon cancer, diagnosed in her 70s.

Physical Exam:
Admission:
eneral Appearance: pleasant, comfortable, NAD, non toxic
Eyes: : PERLLA, EOMI, no conjuctival injection, anicteric
ENT: no sinus tenderness, MMM, op without exudate or lesions, no
supraclavicular or cervical lymphadenopathy, JVP to cm, no
carotid bruits, no thyromegaly or thyroid nodules
Respiratory: CTA b/l with good air movement throughout
Cardiovascular: RR, S1 and S2 wnl, no murmurs, rubs or gallops
appreciated
Gastrointestinal: nd, +b/s, soft, nt, no masses or
hepatosplenomegaly
Musculoskeletal/extremities: no cyanosis, clubbing or edema
Skin/nails: warm, no rashes/no jaundice/no splinters
Neurological: AAOx3. Cn II-XII intact. 5/5 strength throughout.
No sensory deficits to light touch appreciated. No pass-pointing
on finger to nose. 2+DTR's-patellar and biceps.No pronator
drift, fluent speech. Positive myoclonus and asterixis.
Psychiatric:pleasant, appropriate affect
Heme/Lymph: no cervical or supraclavicular lymphadenopathy
GU: no catheter in place
Rectal: guiaic negative


Pertinent Results:
CBC's
[**2114-10-14**] 04:00PM BLOOD WBC-32.6* RBC-3.49* Hgb-10.9* Hct-34.7*
MCV-99* MCH-31.2 MCHC-31.4 RDW-22.4* Plt Ct-409
[**2114-10-20**] 04:35AM BLOOD WBC-11.9* RBC-2.19* Hgb-6.7* Hct-21.7*
MCV-99* MCH-30.8 MCHC-31.0 RDW-20.6* Plt Ct-276
[**2114-10-21**] 04:06AM BLOOD WBC-18.8*# RBC-1.69* Hgb-5.3* Hct-17.1*
MCV-101* MCH-31.5 MCHC-31.2 RDW-21.6* Plt Ct-264
[**2114-10-21**] 11:44AM BLOOD Hct-16.1*
.
Coagulation panel
[**2114-10-15**] 01:35AM BLOOD PT-36.5* PTT-33.4 INR(PT)-4.0*
[**2114-10-17**] 02:19AM BLOOD PT-14.6* PTT-25.9 INR(PT)-1.3*
[**2114-10-19**] 04:51AM BLOOD PT-30.4* PTT-32.2 INR(PT)-3.2*
[**2114-10-20**] 06:25AM BLOOD PT-47.7* PTT-30.9 INR(PT)-5.6*
[**2114-10-21**] 04:06AM BLOOD PT-104.5* PTT-31.9 INR(PT)-14.6*
[**2114-10-21**] 11:44AM BLOOD PT-45.8* PTT-32.4 INR(PT)-5.3*
.
Chem 7's
[**2114-10-14**] 04:00PM BLOOD Glucose-177* UreaN-32* Creat-1.3* Na-127*
K-7.0* Cl-77* HCO3-46* AnGap-11
[**2114-10-21**] 04:06AM BLOOD Glucose-107* UreaN-58* Creat-1.1 Na-139
K-4.8 Cl-86* HCO3-GREATER THan 50
[**2114-10-14**] 04:00PM BLOOD Calcium-9.0 Phos-5.7* Mg-2.2.
.
Cardiac Enzymes
[**2114-10-19**] 12:01AM BLOOD CK-MB-7 cTropnT-0.07*
[**2114-10-19**] 04:51AM BLOOD CK-MB-6 cTropnT-0.08*
[**2114-10-19**] 01:00PM BLOOD CK-MB-5 cTropnT-0.08*
.
CT head [**2114-10-14**]
IMPRESSION: No intracranial hemorrhage or mass effect. Chronic
microvascular ischemic change and several remote lacunar
infarcts in the right basal ganglia.
.
CXR 's
[**10-14**]: The marked interval changes are predominantly focused
within the left lower lung with patchy opacity and air
bronchograms and associated pleural effusion. Given history of
altered mental status, an infectious process such as pneumonia
cannot be entirely excluded. There, therefore, may be an
associated parapneumonic effusion. There is known underlying
emphysema, and as such, pulmonary edema may have unusual
distributions. Correlate with other clinical signs of infection.
If not present, this may be an atypical manifestation of edema
and repeat radiography following diuresis is recommended to
assess for underlying infection.
[**10-15**]:Bilateral increasing pleural effusions, left worse than
right.Bibasilar atelectasis. Underlying pneumonia in left lower
lobe cannot be excluded. Tortuous right chest tube.
[**10-17**]: Grossly unchanged appearance of the chest with left lower
lobe consolidation which might be a combination of atelectasis
and infection. Clinical correlation is recommended.
[**10-21**]:Accounting for technical and positional differences, there
is no significant interval change. Persistent bilateral
effusions and retrocardiac density again noted. Pleural fluid
layers in the minor fissure. No PTX.
.
EKG's
[**10-14**]: Atrial fibrillation with controlled ventricular response.
Probable left anterior fascicular block. Probable prior anterior
myocardial infarction. Compared to prior tracing of [**2114-10-5**] no
diagnostic interim change.
[**10-18**]:Atrial fibrillation with a rapid ventricular response,
average
about 120 beats per minute. Borderline left axis deviation. Slow
R wave
progression. Cannot exclude underlying anterior myocardial
infarction.
Probable left ventricular hypertrophy. Non-specific ST-T wave
changes.
Compared with previous tracing of [**2114-10-18**] ventricular response
is somewhat faster. Clinical correlation is suggested.
[**10-19**]: Atrial fibrillation with a relatively rapid ventricular
response of about 105 beats per minute. Compared with previous
tracing of [**2114-10-18**] QRS axis is more leftward. Ventricular
response is not quite as fast. Multiple
other abnormalities are as reported.
.
Echocardiography [**10-19**]
The left atrium is moderately dilated. The right atrium is
markedly dilated. Left ventricular wall thicknesses are normal.
The left ventricular cavity size is normal. Overall left
ventricular EF is preserved (LVEF>55%). Inferior hypokinesis is
suggested, but due to varying R-R interval and resting
tachycardia, this is not confirmed. There is no ventricular
septal defect. The right ventricular cavity is moderately
dilated. Right ventricular systolic function is normal. The
aortic valve leaflets are moderately thickened. There is a
minimally increased gradient consistent with minimal aortic
valve stenosis. Mild (1+) aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. Moderate (2+) mitral regurgitation is seen. The
tricuspid valve leaflets are mildly thickened. Moderate to
severe [3+] tricuspid regurgitation is seen. There is severe
pulmonary artery systolic hypertension. There is no pericardial
effusion.
Compared with the prior study (images reviewed) of [**2114-8-3**] the
degree of mitral regurgitation and pulmonary hypertension
detected have increased. The patient is more tachycardic.
Inferior hypokinesis is suggested but not confirmed. If
clinically indicated, a repat study after better rate/rhtyhm
control may better define regional LV systolic function.
.
Cultures:
Blood Cultures: negative
UCx: >100,000 enterococcus sensitive to Vancomycin
Legionella Urinary Antigen: negative
UA: no WBC, no nitrites, no RBC's


Brief Hospital Course:
Mr. [**Known lastname 30984**] is an 84 year-old with atrial fibrillation, COPD,
metastatic colon cancer to liver and recurrent right pleural
effusions who initially presented on [**10-14**] with altered mental
status and was admitted to the hospital wards. He was first
transfered to the [**Hospital Unit Name 153**] with respiratory distress on the day of
admission. He was subsequently transfered back to the floor once
his mental and respiratory status improved. He was then
re-admitted to the [**Hospital Unit Name 153**] with afib w/ RVR. In the [**Hospital Unit Name 153**], the
patient developed GI bleeding. After discussion with the family,
it was decided not to escalate care (no pressors, FFP, IVF or
transusions) and the patient died on [**2114-10-21**]. The patient's
code status during his entire hospital course was DNR/DNI per
the patient's and family's wishes.
.
# Mental status change: Initially admitted on [**10-14**] with
concerns of changing mental status, difficulty ambulating and
increasing shortness of breath. At home was 88% on 2L. At the
time of admission, he was noted to be hyperkalemic (K = 7) with
a ABG showing 7.38/53/84 on 5 liter with bicarb >50 on Chem 7.
He was noted to have mycoclonus on exam consistent with
hypercarbia and elevated bicarbonate. He was also found to have
a pneumonia and UTI which along with hypercarbia likely
contributed to his altered mental status. His pneumonia and UTI
were treated with antibiotics - Zosyn and Vancomycin. He was
also briefly started on Theophylline to increase his respiratory
drive and to decrease his serum Co2 and bicarbonate levels.
However, he then developed atrial fibrillation w/RVR, and
theophylline was discontinued. His mental status waxed and waned
during his hospital stay with occaisonal agitation treated with
Haldol and then Zydis.
.
# Respiratory Distress: The patient was admitted to the hospital
wards but developed respiratory distress with tachypnea and SaO2
72%. His respiratory distress was thought to be multifactorial
with end-stage COPD, peumonia, pulmonary edema and pleural
effusions. He was maintained on Advair 250/50, Tiotoprium and
Prednisone 40mg daily for COPD. ABG's showed chronic respiratory
acidosis with significant hypercarbia compensated by high
bicarbonate levels. He was briefly started on Theophylline to
increase his respiratory drive and decrease his hypercarbia. He
received IV lasix dialy and PRN with some improvement of
pulmonary edema. An echo was obtained to evaluate heart function
and found an EF >55% but severe MR which may have contributed to
pulmonary edema. His pneumonia was treated with Zosyn and
Vancomycin. An attempt was made to drain his pleural effusions
via his right pleurex catheter but no fluid was obtained; per
family, his VNA had also been unable to obtain fluid on the last
visit prior to hospitalization. On [**10-18**], IP saw the patient and
were unsuccessful in removing any blockage in his pleurex
catheter or enabling any further drainage.  They also felt that
his desaturations were not secondary to pleural effusions but
rather from pulmonary edema and lymphangitic spread and
pneumonia. In addition, it was noted that his CXR showed
relatively little pleural effusion on the right side of his
chest and a significant amount of pleural effusion on his left
side. Due to an elevated INR, thoracentesis was not immediately
performed. And, on further disccusion with the family, it was
decided not to perform left chest thoracentisis because of
bleeding risk, limited benefit and likely rapid reaccumulation.
Given his respiratory distress and severe hypercarbia,
non-invasive positive pressure ventilation was offered although
the patient's underlying lung disease or respiratory distress
were unlikely to resolve. However, NIPPV was not initiated as
the family felt that this would distress the patient further and
as the patient refused it. His respiratory distress stabilized
enough at the end of his first [**Hospital Unit Name 153**] stay for him to be briefly
transfered to the floor on NC 4L.  He required high-flow oxygen
on face mask during the rest of his stay with SaO2 ranging
88-92%.
.
#Anemia: The patient was admitted with chronic iron deficiency
anemia secondary to colon cancer. Inititally, his HCT remained
stable from 27-30. His coumadin was intially held and vit K
given given the consideration of performing a thoracentisis.
When it was decided not to perform a thoracentesis, his coumadin
was briefly restarted while on the hospital wards but then
discontinued with supratherapeutic INR's. On readmission to the
[**Hospital Unit Name 153**], his INR climbed from 3.2->5.6->14.6->5.6. On [**10-20**], he was
noted to have a decreased HCT 21->17. He was found to be guiac
positive with dark stool suggestive of a GI bleed given the
setting of a high INR and colon CA. He was initially typed and
screened for transfusion, given vitamin K and given IVF as his
blood pressure began decreasing and his mental status worsened.
His respiratory status did not permit EGD or colonoscopy without
intubation. And, given his DNI status, he did not receive
endoscopy. His family was contact[**Name (NI) **] and indicated that they did
not want any further interventions including blood transfusion,
FFP, IVF or pressors. All anti-hypertensives and atrial
fibrillation rate controlling medications were held due to low
blood pressures.
.
#. Afib with RVR: While on the hospital wards, he was noted to
be in afib with RVR with HR 130's and SBP 100's. An EKG showed
afib with depressions in V4-V6 as complared to old. Was given
10mg IV diltiazem and 30mg PO. At the time, the patient also
complained of chest pain.  He was given SL nitro x1 and placed
on morphine PRN. In addition, he received ASA 325mg x1. Cardiac
enzymes were then found to be negative. He was transfered to the
[**Hospital Unit Name 153**], given a diltiazem bolus and placed on a diltiazem drip
overnight with improvement of HR to 90-100's. He was
subsequently changed to Diltiazem 60mg QID and digoxin. In
addition, his theophylline was discontinued.
.
# Leukocytosis: On admission, his WBC was found to be great than
30 but then trended down to 18.5 today with treatment of PNA and
UTI.
.
# Enterococcal UTI: UA was bland but Urine Culture grew
enteroccocus. Given the patient's change in mental status, he
was placed on Vancomycin
.
# Aspiration: The patient was noted to aspirate with wet cough
when drinking fluid. A speech/swallow evaluation showed no
"overt" aspiration but could not rule out silent aspiration.
Radiologic speach and swallow evaluation could not be obtained
given the pt's respiratory status. Based on clinical exam while
drinking, he most likely had silent aspiration and was at risk
for aspiration pneumonitis/ PNA. He was placed on aspiration
precautions and a diet order was placed for nectar thickened
liquids, crushed medications in puree with Ensure pudding
between meals.
.
# Colon CA: No treatment was given for his metastatic colon CA
but morphine PRN was administerd for abdominal pain.


Medications on Admission:
1. Diltiazem HCl 240 mg daily
2. Lisinopril 40 mg daily
3. Furosemide 80 mg [**Hospital1 **]
4. Prednisone 20 mg Daily - started [**10-13**] then taper
5. Coumadin 3 mg daily
6. Fluticasone-Salmeterol 500-50 mcg/(1) [**Hospital1 **]
7. Albuterol Sulfate 0.083 % Q4hrs PRN
8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device daily

9. Serax 15 mg QHS
10. Senna 8.6 mg QHS
11. Potassium Chloride 20 mEq SR QD


Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
N/A

Followup Instructions:
N/A
{'Secondary malignant neoplasm of pleura,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Malignant neoplasm of colon, unspecified site,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Diastolic heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other and unspecified coagulation defects,Blood in stool,Hypoxemia,Other chronic pulmonary heart diseases,Macular degeneration (senile), unspecified,Atrial fibrillation,Other dependence on machines, supplemental oxygen,Encounter for palliative care,Diseases of tricuspid valve,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Anemia, unspecified,Hypotension, 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: altered mental status

PRESENT ILLNESS: This is an 84 year-old with atrial fibrillation, COPD,
metastatic colon cancer to liver and pleura, recurrent right
pleural effusions, who presents with altered mental status.
Patient recently discharged to home from ICU with placement of
pleurex catheter for recurrent right pleural effusion leading to
acute respiratory distress. His family declined hospice services
and VNA services were set up on last discharge.

MEDICAL HISTORY: . Acute respiratory failure.
2. Status post insertion of right thoracic PleurX catheter.
3. Right pleural effusion.
4. Stage IV colon cancer (metastases to liver, pleura)
- [**2-28**]: diagnosed after labs revealing low HCT and Iron 19,
ferritin 30, TIBC within normal limits.
- [**2114-3-19**] (Colonscopy): A single sessile polyp of benign
appearance found.
- [**2114-3-20**] (CT abd): No colon mass visualized. Liver lesions
demonstrated; pleural effusions, right greater than left.
- [**2114-3-21**] (Ultrasound-guided liver biopsy): Metastatic
adenocarcinoma consistent with colonic origin. Immunostain for
CK-20 positive, CK-7 negative, consistent with colonic origin.
- s/p 5FU/LV chemotherapy (last chemo C2D8 on [**8-15**]), no further
chemo per most recent progress note
5. Chronic obstructive pulmonary disease (home oxygen
dependent, steroid dependent).
6. Congestive heart failure.
7. Pulmonary hypertension.
8. Macular degeneration.
9. Hypertension.
10. Status post torn right rotator cuff.
11. Atrial fibrillation.

MEDICATION ON ADMISSION: 1. Diltiazem HCl 240 mg daily
2. Lisinopril 40 mg daily
3. Furosemide 80 mg [**Hospital1 **]
4. Prednisone 20 mg Daily - started [**10-13**] then taper
5. Coumadin 3 mg daily
6. Fluticasone-Salmeterol 500-50 mcg/(1) [**Hospital1 **]
7. Albuterol Sulfate 0.083 % Q4hrs PRN
8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
eneral Appearance: pleasant, comfortable, NAD, non toxic
Eyes: : PERLLA, EOMI, no conjuctival injection, anicteric
ENT: no sinus tenderness, MMM, op without exudate or lesions, no
supraclavicular or cervical lymphadenopathy, JVP to cm, no
carotid bruits, no thyromegaly or thyroid nodules
Respiratory: CTA b/l with good air movement throughout
Cardiovascular: RR, S1 and S2 wnl, no murmurs, rubs or gallops
appreciated
Gastrointestinal: nd, +b/s, soft, nt, no masses or
hepatosplenomegaly
Musculoskeletal/extremities: no cyanosis, clubbing or edema
Skin/nails: warm, no rashes/no jaundice/no splinters
Neurological: AAOx3. Cn II-XII intact. 5/5 strength throughout.
No sensory deficits to light touch appreciated. No pass-pointing
on finger to nose. 2+DTR's-patellar and biceps.No pronator
drift, fluent speech. Positive myoclonus and asterixis.
Psychiatric:pleasant, appropriate affect
Heme/Lymph: no cervical or supraclavicular lymphadenopathy
GU: no catheter in place
Rectal: guiaic negative

FAMILY HISTORY: The patient's parents lived to be elderly. His sister has a
history of colon cancer, diagnosed in her 70s.

SOCIAL HISTORY: Lives at home w/wife of 50+ [**Name2 (NI) 1686**], has 2 children who are involved
in his care. Former smoker (40 pk [**Name2 (NI) 1686**]) quit approx 20 [**Name2 (NI) 1686**] pta.
No ETOH, no IVDU. Retired 

### Response:
{'Secondary malignant neoplasm of pleura,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Malignant neoplasm of colon, unspecified site,Urinary tract infection, site not specified,Delirium due to conditions classified elsewhere,Diastolic heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other and unspecified coagulation defects,Blood in stool,Hypoxemia,Other chronic pulmonary heart diseases,Macular degeneration (senile), unspecified,Atrial fibrillation,Other dependence on machines, supplemental oxygen,Encounter for palliative care,Diseases of tricuspid valve,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Anemia, unspecified,Hypotension, unspecified'}
