CHIEF COMPLAINT: Diarrhea

PRESENT ILLNESS: Ms [**Last Name (Titles) **]. [**Doctor Last Name **] is a  65 year old woman with signficant PMH of
atrial fibrillation on Coumadin, lung cancer s/p resection [**2109**],
congestive heart failure, diabetes, and hypertension who
presents with worsening diarrhea and dysuria who was found to be
hypotensive in the ED and admitted to the [**Hospital Unit Name 153**] for presumed
sepsis.

MEDICAL HISTORY: -s/p Left Lower Lobectomy ([**10/2110**]) for Large Cell Carcinoma of
Lung
- CHF (EF ~84 with mild MR, AS)
- A. Fib on coumadin
- DMII c/w peripheral neuropathy
- pansenitive e.coli uti
- c. diff
- COPD
- Chronic venous insuffiency LE cellulitis
- depression
- anemia baseline hct 28.7
- HLD
- Gastritis
- Nephrolithiasis
- Psoriasis
- History of choleycystectomy
- Obesity
- Osteoporosis
- Hypercholesterolemia

MEDICATION ON ADMISSION: -CLOBETASOL - 0.05 % Ointment - apply to affected skin twice a
day
60 gram tube
-DIGOXIN - 125 mcg  daily
-DULOXETINE 20 mg daily
-ENALAPRIL MALEATE - 20 mg daily
-INSULIN LISPRO ~ 40 units tid
-NPH 52 units wth breakfast, 56 units at night
-METFORMIN 1,000 mg tablet [**Hospital1 **]
-METOPROLOL TARTRATE 25 mg [**Hospital1 **]
-Metronidazole 500mg TID
-MIRTAZAPINE 30 mg QHS
-OMEPRAZOLE  40 mg daily
-PREGABALIN [LYRICA] - 150 mg [**Hospital1 **]
-SIMVASTATIN - 40 mg taQHS
-TORSEMIDE - 20 mg tablet - 3 Tablet(s) by mouth once a day
-WARFARIN - 5mg daily
-Asa 81 mg

ALLERGIES: Amoxicillin / Glipizide / Ciprofloxacin / Bactrim / Soriatane /
Potassium Chloride / Bupropion / Calcium Channel Blocking
Agents-Benzothiazepines / atenolol

PHYSICAL EXAM: ICU exam on admission:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP ~[**6-19**], no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Crackles halfway up back, scattered end-expiratory
wheezing rales, ronchi
Abdomen: obese, soft, non-distended, bowel sounds present, no
organomegaly, minimal suprapubic tenderness to palpation, no
rebound or guarding
GU: no foley
Ext: Warm, well perfused, 2+ pulses, 2+ edema mid-shin,
venous-stasis changes, no clubbing, cyanosis
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.

FAMILY HISTORY: +fh for diabetes, no FH for malignances

SOCIAL HISTORY: Lives with daughter.  Retired file clerk in a law
office. Current smoker 1 ppd (60 pack year history). No alcohol
or illicits. Ambulates with a cane because walker doesn't fit
well
in hallways.
Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Septic shock,Intestinal infection due to Clostridium difficile,Closed fracture of two ribs,Pathologic fracture of vertebrae,Chronic diastolic heart failure,Acute kidney failure, unspecified,Cirrhosis of liver without mention of alcohol,Atrial fibrillation,Iron deficiency anemia, unspecified,Dysphagia, unspecified,Thrombocytopenia, unspecified,Severe sepsis,Hypopotassemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Chronic airway obstruction, not elsewhere classified,Venous (peripheral) insufficiency, unspecified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Obesity, unspecified,Tobacco use disorder,Personal history, urinary (tract) infection,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bronchus and lung,Unspecified fall
Septicemia NOS,Food/vomit pneumonitis,Septic shock,Int inf clstrdium dfcile,Fracture two ribs-closed,Path fx vertebrae,Chr diastolic hrt fail,Acute kidney failure NOS,Cirrhosis of liver NOS,Atrial fibrillation,Iron defic anemia NOS,Dysphagia NOS,Thrombocytopenia NOS,Severe sepsis,Hypopotassemia,DMII neuro nt st uncntrl,Neuropathy in diabetes,Chr airway obstruct NEC,Venous insufficiency NOS,Hyperlipidemia NEC/NOS,Depressive disorder NEC,Obesity NOS,Tobacco use disorder,Personal history UTI,Long-term use anticoagul,Hx-bronchogenic malignan,Fall NOS
Admission Date:  [**2112-6-30**]              Discharge Date:   [**2112-7-6**]

Date of Birth:  [**2046-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Amoxicillin / Glipizide / Ciprofloxacin / Bactrim / Soriatane /
Potassium Chloride / Bupropion / Calcium Channel Blocking
Agents-Benzothiazepines / atenolol

Attending:[**First Name3 (LF) 1990**]
Chief Complaint:
Diarrhea

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Ms [**Last Name (Titles) **]. [**Doctor Last Name **] is a  65 year old woman with signficant PMH of
atrial fibrillation on Coumadin, lung cancer s/p resection [**2109**],
congestive heart failure, diabetes, and hypertension who
presents with worsening diarrhea and dysuria who was found to be
hypotensive in the ED and admitted to the [**Hospital Unit Name 153**] for presumed
sepsis.

She was recently hospitalized at [**Hospital1 2025**] in their ICU for diarrhea
and dyhydration.  Blood cx were negative, c.diff x3 negative,
and had a pansensitive e.coli UTI treated with ceftriaxone
x7days.  Discharge to rehab was recommended, but she declined
and came home last Monday. Since arriving home, patient has had
persistent diarrhea, up to 10 "mushy stools" per day and reports
persistent dysuria and feeling of incomplete voiding. She
visited her PCP today where she also complained of dysphagia to
solids and pills (s/p normal swallow study at [**Hospital1 2025**]) resulting in
poor po intake. She also reported a fall at home several days
ago resulting in increased back pain. She then presented to the
ED for further evaluation. Denies any fevers, chills, N/V,
abdominal pain, melena, hematochezia.

In the ED, initial VS were T 98.6 P 83 BP 81/47 RR 24 O296%. CVL
was placed and patient received 2LNS prior to initiation of
levophed with good effect. Blood, urine, and stool cultures were
sent and patient was started flagyl, vanco, cefepime for
presumed urosepsis and CDiff. NCHCT was unremarkable and CT
torso showed stable verterbral compression fx and acute
posterior rib fx. Additionally, there was concern for early PNA
and diverticulitis. She was admitted to the [**Hospital Unit Name 153**] for further
management.

On arrival to the MICU, patient was alert and interactive, she
had no complaints except some mild SOB and malaise.


Past Medical History:
-s/p Left Lower Lobectomy ([**10/2110**]) for Large Cell Carcinoma of
Lung
- CHF (EF ~84 with mild MR, AS)
- A. Fib on coumadin
- DMII c/w peripheral neuropathy
- pansenitive e.coli uti
- c. diff
- COPD
- Chronic venous insuffiency LE cellulitis
- depression
- anemia baseline hct 28.7
- HLD
- Gastritis
- Nephrolithiasis
- Psoriasis
- History of choleycystectomy
- Obesity
- Osteoporosis
- Hypercholesterolemia


Social History:
Lives with daughter.  Retired file clerk in a law
office. Current smoker 1 ppd (60 pack year history). No alcohol
or illicits. Ambulates with a cane because walker doesn't fit
well
in hallways.


Family History:
 +fh for diabetes, no FH for malignances


Physical Exam:
ICU exam on admission:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP ~[**6-19**], no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Crackles halfway up back, scattered end-expiratory
wheezing rales, ronchi
Abdomen: obese, soft, non-distended, bowel sounds present, no
organomegaly, minimal suprapubic tenderness to palpation, no
rebound or guarding
GU: no foley
Ext: Warm, well perfused, 2+ pulses, 2+ edema mid-shin,
venous-stasis changes, no clubbing, cyanosis
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.

Pertinent Results:
ADMISSION LABS
--------------
[**2112-6-30**] 12:42PM BLOOD WBC-26.5*# RBC-3.47* Hgb-8.9* Hct-28.7*
MCV-83 MCH-25.5* MCHC-30.9* RDW-20.6* Plt Ct-262#
[**2112-6-30**] 12:42PM BLOOD Neuts-81.4* Lymphs-14.4* Monos-3.1
Eos-0.9 Baso-0.3
[**2112-6-30**] 12:42PM BLOOD PT-24.5* PTT-34.2 INR(PT)-2.3*
[**2112-6-30**] 12:42PM BLOOD UreaN-22* Creat-1.4* Na-136 K-3.7 Cl-103
[**2112-6-30**] 12:42PM BLOOD Glucose-84
[**2112-6-30**] 02:35PM BLOOD ALT-19 AST-18 AlkPhos-90 TotBili-0.6
[**2112-6-30**] 12:42PM BLOOD Phos-2.3* Mg-1.4*
[**2112-6-30**] 12:42PM BLOOD TSH-1.5
[**2112-7-1**] 01:35AM BLOOD Digoxin-0.9
[**2112-6-30**] 02:39PM BLOOD Lactate-2.3*
.
DISCHARGE LABS
--------------
.


Brief Hospital Course:
Ms [**Last Name (Titles) **]. [**Doctor Last Name **] is a  65 year old woman with signficant PMH of
atrial fibrillation on Coumadin, lung cancer s/p resection [**2109**],
congestive heart failure, diabetes, and hypertension who
presents with worsening diarrhea and dysuria who was found to be
hypotensive in the ED and admitted to the [**Hospital Unit Name 153**] for presumed
sepsis.

Active Issues
====================
# Sepsis: Hypotensive with pronounced leukocytosis and multiple
potential sources for infection, including: UTI, PNA, CDiff, and
diverticulitis. CT scan was concerning for colitis, no
peritoneal fluids or free fluid in the abdomen. She was started
on vancomycin/meropenem/flagyl for diverticulitis.  Surgery was
consulted and agreed with antibiotic regimen.  No need for
surgery.  With positive, C.diff PCR, failed flagyl as
outpatient, and recent abx use, she was placed on po vancomycin.
She was fluid resuscitated and transiently required pressors.
Her WBC stabalzied while on the floor, ID was consulted and her
antibiotics were narrowed to cefepime IV and po vanco and
flagyl.  She will be sent on po vanco indefinately and ID will
assist with tapering in the future on follow up arranged for
[**2112-7-26**] with Dr. [**First Name (STitle) **] [**Name (STitle) **].
.
# RML PNA in the setting of dysphagia
The patient was intially treated with vancomycin/meropenum in
the ICU.  Give the patient multiple comorbidities including lung
cancer and findings on CT, we chose to treat the patient with
cefepime for a health care associate PNA.  She completed the
course of therapy with cefepime and flagyl as per ID team recs
prior to discharge from the hosptial.  The patient also was
evaluated by the speech and swallow service and passed the exam
(normal)
.
# Normocytic anemia
Patients baseline appears to be between [**10-22**] but more recently
in the last 6 months it's [**7-21**].  The patients hemoglobin
continued to decrease in house and an anemia work up revealed
iron deficiency.  Outpatient follow up with GI and PCP arranged
for consideration of iron supplementation and colonoscopy.
Colonoscopy and endoscopy at [**Location (un) 2274**] from [**2109**] reviewed.  EGD with
gastritis.  Colonoscopy was normal.  PPI held for the time being
given active c difficile infection.  Pt did not complain of any
gastritic symptoms during this hospitalization.
.
# s/p Fall:
Likely mechanical due to deconditioning from multiple recent
hospital stays + concurrent illness. No apparent LOC or
headstrike. Non contrast heat CT was negative.  CT of
abdomen/pelvis showed new, acute right 7th and 8th rib
fractures.
New compression fracture of the T8 vertebral body and interval
worsening of compression fracture of the T9 vertebral body.
Neurosurgery was consulted and recommended no brace and
Ca/Vitamin D with appropriate risk scanning of DEXA.
.
#  Liver cirrhosis
CT from this admission showed cirrhosis.  HAV/HBV and HCV
serologies were checked and were normal.  O/P follow up with GI
arranged.
.
# dCHF:
Primarily diastolic with LVEF >55% on TTE in [**Month (only) 547**]. Also with
mild AS. Home regimen includes enalapril, metoprolol, digoxin,
ASA, and torsemide. Enalapril, metoprolol, and torsemide were
held given sepsis as above, then resumed prior to discharge.
.
# Afib:
On coumadin at home, INR therapeutic when admitted. Continued on
home dose of digoxin.  Metoprolol was held given her
hypotension.  Medications resumde prior to d/c. Warfarin dose
down adjusted slightly to 3 mg daily.  Recommended home INR
check in 48 hours, and alerted the coumadin clinic to this
change and recommendation for ongoing monitoring at home, next
on [**2112-7-8**].

Inactive Issues
=============================
# DM:
Home regimen includes NPH 52/56 along with lispro 40 with meals.
Also on metformin 1000 [**Hospital1 **]. Last A1c 7.6 in [**Month (only) **].  Metformin
ultimately resumed.  Home insulin regimen resumded (NPH) with
down adjusted SSI.

# Gastritis - omeprozole held given c difficile colitis.


Medications on Admission:
-CLOBETASOL - 0.05 % Ointment - apply to affected skin twice a
day
60 gram tube
-DIGOXIN - 125 mcg  daily
-DULOXETINE 20 mg daily
-ENALAPRIL MALEATE - 20 mg daily
-INSULIN LISPRO ~ 40 units tid
-NPH 52 units wth breakfast, 56 units at night
-METFORMIN 1,000 mg tablet [**Hospital1 **]
-METOPROLOL TARTRATE 25 mg [**Hospital1 **]
-Metronidazole 500mg TID
-MIRTAZAPINE 30 mg QHS
-OMEPRAZOLE  40 mg daily
-PREGABALIN [LYRICA] - 150 mg [**Hospital1 **]
-SIMVASTATIN - 40 mg taQHS
-TORSEMIDE - 20 mg tablet - 3 Tablet(s) by mouth once a day
-WARFARIN - 5mg daily
-Asa 81 mg


Discharge Medications:
1. Aspirin 81 mg PO DAILY
2. Calcium Carbonate 500 mg PO TID
RX *Calcium 500 500 mg calcium (1,250 mg) 1 tablet(s) by mouth
three times per day, with meals Disp #*90 Tablet Refills:*0
3. Clobetasol Propionate 0.05% Ointment 1 Appl TP [**Hospital1 **]
4. Digoxin 0.125 mg PO DAILY
5. Duloxetine 20 mg PO DAILY
6. Enalapril Maleate 20 mg PO DAILY
hold for sbp less than 100
7. MetFORMIN (Glucophage) 1000 mg PO BID
8. Metoprolol Tartrate 25 mg PO BID
hold for sbp<105, hr<60
9. Mirtazapine 30 mg PO HS
10. Pregabalin 150 mg PO BID
11. Simvastatin 40 mg PO DAILY
12. Torsemide 60 mg PO DAILY
13. Vancomycin Oral Liquid 125 mg PO Q6H
RX *Vancocin 125 mg 1 capsule(s) by mouth every 6 hours Disp
#*120 Capsule Refills:*0
14. NPH 52 Units Breakfast
NPH 56 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
15. Vitamin D 800 UNIT PO DAILY
RX *ergocalciferol (vitamin D2) 400 unit [**Unit Number **] tablet(s) by mouth
twice a day Disp #*60 Tablet Refills:*0
16. Warfarin 3 mg PO DAILY16
start on [**2112-7-6**]
RX *Coumadin 1 mg 3 tablet(s) by mouth once a day Disp #*120
Tablet Refills:*0


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
recurrent c. difficile colitis
RML pneumonia
normocytic anemia
AF
possible underlying liver cirrhosis
Heart failure with preserved ejection fraction


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:
You presented to [**Hospital1 18**] with abdominal pain, diarrhea and falls.
you were found to have a recurrence of c. difficile and were
treated with antibitoics.  In addition, you were found to have a
pneumonia and you were treated with a course of antibiotics.
Evaluation following your fall your were found to have spinal
and rib fractures.  Conservative management was recommended by
the spine surgeons.

As you and I discussed during your hospitalization, I have
our gastroenterologists here (appointment requested for you);
you will also need to follow up with your primary md here (see
appt below) to have your cell counts checked (CBC) because your
hematocrit and platelet counts were slightly low as we
discussed.

Followup Instructions:
1) ID - Dr. [**First Name (STitle) **] [**Name (STitle) **] - on [**2112-7-26**].  Call to confirm: Office
Phone: ([**Telephone/Fax (1) 17490**]

Department: [**Hospital3 249**]
At this appt you need to have your cell counts checked (CBC)
When: WEDNESDAY [**2112-7-6**] at 10:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5377**], MD [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: [**Hospital3 1935**] CENTER
When: TUESDAY [**2112-7-12**] at 9:30 AM
With: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. [**Telephone/Fax (1) 253**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: TUESDAY [**2112-7-12**] at 10:30 AM
With: [**First Name8 (NamePattern2) 1903**] [**Last Name (NamePattern1) 1904**], NP [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: LIVER CENTER
When: FRIDAY [**2112-7-22**] at 9:20 AM
With: [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) **], MD [**Telephone/Fax (1) 2422**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 858**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage





Name:  [**Known lastname 13895**],[**Known firstname 1940**]                     Unit No:   [**Numeric Identifier 13896**]

Admission Date:  [**2112-6-30**]              Discharge Date:   [**2112-7-6**]

Date of Birth:  [**2046-9-9**]             Sex:   F

Service: MEDICINE

Allergies:
Amoxicillin / Glipizide / Ciprofloxacin / Bactrim / Soriatane /
Potassium Chloride / Bupropion / Calcium Channel Blocking
Agents-Benzothiazepines / atenolol

Attending:[**First Name3 (LF) 429**]
Addendum:
Pts platelets slightly low on day of discharge (130).  This was
possibly due to a medication effect of cefepime or flagyl (both
discontinued); it may also be a result of her likely underlying
liver disease.  Pt. will follow up with her primary MD [**First Name (Titles) **] [**Last Name (Titles) 13897**]y one week (arranged) at which time a CBC should be
checked given known iron deficiency anemia as well as this mild
thrombocytopenia; additionally, follow up with Gastroenterology
was arranged prior to D/C.

Discharge Disposition:
Home With Service

Facility:
[**Location (un) 42**] VNA

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 430**] MD [**MD Number(2) 431**]

Completed by:[**2112-7-6**]
{'Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Septic shock,Intestinal infection due to Clostridium difficile,Closed fracture of two ribs,Pathologic fracture of vertebrae,Chronic diastolic heart failure,Acute kidney failure, unspecified,Cirrhosis of liver without mention of alcohol,Atrial fibrillation,Iron deficiency anemia, unspecified,Dysphagia, unspecified,Thrombocytopenia, unspecified,Severe sepsis,Hypopotassemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Chronic airway obstruction, not elsewhere classified,Venous (peripheral) insufficiency, unspecified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Obesity, unspecified,Tobacco use disorder,Personal history, urinary (tract) infection,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bronchus and lung,Unspecified fall'}


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: Diarrhea

PRESENT ILLNESS: Ms [**Last Name (Titles) **]. [**Doctor Last Name **] is a  65 year old woman with signficant PMH of
atrial fibrillation on Coumadin, lung cancer s/p resection [**2109**],
congestive heart failure, diabetes, and hypertension who
presents with worsening diarrhea and dysuria who was found to be
hypotensive in the ED and admitted to the [**Hospital Unit Name 153**] for presumed
sepsis.

MEDICAL HISTORY: -s/p Left Lower Lobectomy ([**10/2110**]) for Large Cell Carcinoma of
Lung
- CHF (EF ~84 with mild MR, AS)
- A. Fib on coumadin
- DMII c/w peripheral neuropathy
- pansenitive e.coli uti
- c. diff
- COPD
- Chronic venous insuffiency LE cellulitis
- depression
- anemia baseline hct 28.7
- HLD
- Gastritis
- Nephrolithiasis
- Psoriasis
- History of choleycystectomy
- Obesity
- Osteoporosis
- Hypercholesterolemia

MEDICATION ON ADMISSION: -CLOBETASOL - 0.05 % Ointment - apply to affected skin twice a
day
60 gram tube
-DIGOXIN - 125 mcg  daily
-DULOXETINE 20 mg daily
-ENALAPRIL MALEATE - 20 mg daily
-INSULIN LISPRO ~ 40 units tid
-NPH 52 units wth breakfast, 56 units at night
-METFORMIN 1,000 mg tablet [**Hospital1 **]
-METOPROLOL TARTRATE 25 mg [**Hospital1 **]
-Metronidazole 500mg TID
-MIRTAZAPINE 30 mg QHS
-OMEPRAZOLE  40 mg daily
-PREGABALIN [LYRICA] - 150 mg [**Hospital1 **]
-SIMVASTATIN - 40 mg taQHS
-TORSEMIDE - 20 mg tablet - 3 Tablet(s) by mouth once a day
-WARFARIN - 5mg daily
-Asa 81 mg

ALLERGIES: Amoxicillin / Glipizide / Ciprofloxacin / Bactrim / Soriatane /
Potassium Chloride / Bupropion / Calcium Channel Blocking
Agents-Benzothiazepines / atenolol

PHYSICAL EXAM: ICU exam on admission:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP ~[**6-19**], no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Crackles halfway up back, scattered end-expiratory
wheezing rales, ronchi
Abdomen: obese, soft, non-distended, bowel sounds present, no
organomegaly, minimal suprapubic tenderness to palpation, no
rebound or guarding
GU: no foley
Ext: Warm, well perfused, 2+ pulses, 2+ edema mid-shin,
venous-stasis changes, no clubbing, cyanosis
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.

FAMILY HISTORY: +fh for diabetes, no FH for malignances

SOCIAL HISTORY: Lives with daughter.  Retired file clerk in a law
office. Current smoker 1 ppd (60 pack year history). No alcohol
or illicits. Ambulates with a cane because walker doesn't fit
well
in hallways. 

### Response:
{'Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Septic shock,Intestinal infection due to Clostridium difficile,Closed fracture of two ribs,Pathologic fracture of vertebrae,Chronic diastolic heart failure,Acute kidney failure, unspecified,Cirrhosis of liver without mention of alcohol,Atrial fibrillation,Iron deficiency anemia, unspecified,Dysphagia, unspecified,Thrombocytopenia, unspecified,Severe sepsis,Hypopotassemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Chronic airway obstruction, not elsewhere classified,Venous (peripheral) insufficiency, unspecified,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Obesity, unspecified,Tobacco use disorder,Personal history, urinary (tract) infection,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bronchus and lung,Unspecified fall'}
