CHIEF COMPLAINT: Seizure OSH ED transfer.

PRESENT ILLNESS: 51F former smoker with h/o CAD/ CHF with AICD placed transfered
for seizure, intra-axial masses. Patient was in her usual state
of health until the evening of [**9-15**] when she was more tired than
usual and noted a mass in her supraclavicular fossa. The morning
of [**9-16**] she was not responding to phone calls and was found by
her husband at approximately 3pm on the couch confused. She was
incontinent of stool and urine and had bit her tounge. She
denied any chest pain at the time. Her husband called EMS and
she was brought to an OSH ED.
There she was found to have intracranial masses with apical lung
masses by CT scan. Labs remarkable there for WBC of 23.4. Elbow
films negative. She was given 1 g fosphenytoin 1g IV ceftriaxone
and 500mg IV azithromycin. Patient transferred to [**Hospital1 18**] for
further evaluation.
Initial VS in the ED: 20:33 3 99.4 86 90/73 16 94% ra. Labs
notable for WBC of 16.9, Hct of 35.2, 231 platelets. Patient was
given 10mg IV dexamethasone and 4mg IV zofran.

MEDICAL HISTORY: - MI s/p angiography and stent placement [**2105**]
- CHF with AICD placement - Sprint Fidelis Lead - [**Company 1543**]
- HTN
- Hyperlipidemia

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientFamily/Caregiver.
1. Aspirin 81 mg PO DAILY
2. Clopidogrel 75 mg PO DAILY
3. Atorvastatin 40 mg PO DAILY
4. Lisinopril 5 mg PO DAILY
5. Spironolactone 25 mg PO DAILY
6. Pantoprazole 40 mg PO Q24H
7. Ezetimibe 10 mg PO DAILY
8. Furosemide 20 mg PO DAYS ([**Doctor First Name **],TU,TH)
9. Furosemide 40 mg PO DAYS (MO,WE,FR,SA)
10. Carvedilol 50 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:
Vitals: T: 98.0 BP: 114/65 P: 88 R: 18 O2: 94% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, left sided fullness felt in the
supraclavicular fossa.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII intact b/l. Motor [**5-7**] UE/LE, normal f/n/f, 2+
UE/LE reflexes (right leg moved when left patellar reflex
elicited). No clonus.

FAMILY HISTORY: Father died of colon cancer.
Mother had an MI at 60.

SOCIAL HISTORY: Lives with husband and dog at home; works part-time as
telemarketer; takes care of ailing mother; sister lives nearby;
former smoker, quit [**2105**] (had smoked 1ppd x 20 years). No h/o
recent travel, asbestos exposure, fungal exposure, exotic pets.
Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Pneumonia, organism unspecified,Acute on chronic systolic heart failure,Malignant neoplasm of other parts of bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Unspecified disease of pericardium,Other convulsions,Esophageal reflux,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of tobacco use
Sec mal neo brain/spine,Cerebral edema,Pneumonia, organism NOS,Ac on chr syst hrt fail,Mal neo bronch/lung NEC,Mal neo lymph-intrathor,Pericardial disease NOS,Convulsions NEC,Esophageal reflux,Old myocardial infarct,Hypertension NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,History of tobacco use
Admission Date:  [**2112-9-16**]              Discharge Date:   [**2112-9-24**]

Date of Birth:  [**2061-2-25**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3021**]
Chief Complaint:
Seizure OSH ED transfer.

Major Surgical or Invasive Procedure:
[**2112-9-21**] VATS (video-assisted thoracoscopic surgery) and
pericardial window placement to drain fluid around heart.
[**2112-9-21**] Bronchoscopy.

History of Present Illness:
51F former smoker with h/o CAD/ CHF with AICD placed transfered
for seizure, intra-axial masses. Patient was in her usual state
of health until the evening of [**9-15**] when she was more tired than
usual and noted a mass in her supraclavicular fossa. The morning
of [**9-16**] she was not responding to phone calls and was found by
her husband at approximately 3pm on the couch confused. She was
incontinent of stool and urine and had bit her tounge. She
denied any chest pain at the time. Her husband called EMS and
she was brought to an OSH ED.
There she was found to have intracranial masses with apical lung
masses by CT scan. Labs remarkable there for WBC of 23.4. Elbow
films negative. She was given 1 g fosphenytoin 1g IV ceftriaxone
and 500mg IV azithromycin. Patient transferred to [**Hospital1 18**] for
further evaluation.
Initial VS in the ED: 20:33 3 99.4 86 90/73 16 94% ra. Labs
notable for WBC of 16.9, Hct of 35.2, 231 platelets. Patient was
given 10mg IV dexamethasone and 4mg IV zofran.

On the floor, patient is comfortable and oriented. I had a
discussion about the potential that these masses could represent
cancer.
Patient reports having had a colonoscopy at 50 (1 year ago) with
a few polyps removed. Has been up to date with pap smear (all
negative) and mammography (most recently negative, but did have
a cyst removed a few years ago). Patient denies any recent
travel, exposures, sick contacts. [**Name (NI) **] recent f/c. No h/o IVDA.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.

Past Medical History:
- MI s/p angiography and stent placement [**2105**]
- CHF with AICD placement - Sprint Fidelis Lead - [**Company 1543**]
- HTN
- Hyperlipidemia

Social History:
Lives with husband and dog at home; works part-time as
telemarketer; takes care of ailing mother; sister lives nearby;
former smoker, quit [**2105**] (had smoked 1ppd x 20 years). No h/o
recent travel, asbestos exposure, fungal exposure, exotic pets.

Family History:
Father died of colon cancer.
Mother had an MI at 60.

Physical Exam:
ADMISSION EXAM:
Vitals: T: 98.0 BP: 114/65 P: 88 R: 18 O2: 94% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, left sided fullness felt in the
supraclavicular fossa.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII intact b/l. Motor [**5-7**] UE/LE, normal f/n/f, 2+
UE/LE reflexes (right leg moved when left patellar reflex
elicited). No clonus.

Pertinent Results:
Admission Labs:
[**2112-9-16**] 09:40PM   GLUCOSE-89 UREA N-21* CREAT-0.7 SODIUM-137
POTASSIUM-3.7 CHLORIDE-106 TOTAL CO2-20* ANION GAP-15
[**2112-9-16**] 09:40PM   estGFR-Using this
[**2112-9-16**] 09:40PM   WBC-16.9* RBC-3.78* HGB-11.7* HCT-35.2*
MCV-93 MCH-31.1 MCHC-33.4 RDW-12.5
[**2112-9-16**] 09:40PM   NEUTS-90.1* LYMPHS-4.7* MONOS-4.2 EOS-0.8
BASOS-0.1
[**2112-9-16**] 09:40PM   PLT COUNT-231
[**2112-9-16**] 09:40PM   [**Name (NI) 8255**] TO  PTT-UNABLE TO  INR(PT)-UNABLE
TO
.
Imaging:
[**2112-9-17**]: CT C/A/P: CONCLUSION:
1.  Left upper lobe mass is suspicious for primary lung cancer.
Consolidation and ground-glass opacities around the lesion could
be related to superimposed infection or post-obstructive
pneumonitis. Multiple necrotic lymph nodes in the mediastinum,
bilateral hila and supraclavicular station are seen.
2.  Multiple bilateral lung nodules are mostly bronchiolar
consistent with an inflammatory or infectious process.  This is
accompanied by right middle lobe bronchiectasis.
3.  Pericardial effusion with slightly high density could be
neoplastic, though this is uncertain.  A cardiac son[**Name (NI) **] is
suggested to rule out tamponade.
4.  11-mm hypodense liver lesion is too small to characterize
but is
suspicious for metastasis.
.
[**2112-9-20**] ECHO: IMPRESSION: Moderate to large pericardial effusion
with evidence of impaired ventricular filling, but no frank
tamponade. Pericardial fluid distribution is poorly suitable for
needle pericardiocentesis via the subxiphoid approach. Extensive
regional LV wall motion abnormalities, consistent with prior
anteroseptal myocardial.
.
[**2112-9-22**] CXR: FINDINGS: As compared to the previous radiograph,
the lung volumes are unchanged.  Unchanged appearance of the
left chest tube and left pectoral pacemaker.  On today's image,
there could be a minimal left apical pneumothorax.  No evidence
of tension.  Unchanged moderate cardiomegaly with signs of
minimal fluid overload.  No pleural effusions.  No pneumonia.
.
[**2112-9-22**] CXR: IMPRESSION: No evidence of pneumothorax following
chest tube removal.
.
DISCHARGE LABS:
[**2112-9-24**] 07:59AM BLOOD WBC-22.1* RBC-3.94* Hgb-12.1 Hct-36.3
MCV-92 MCH-30.7 MCHC-33.3 RDW-13.1 Plt Ct-233
[**2112-9-23**] 07:35AM BLOOD PT-11.9 PTT-32.9 INR(PT)-1.1
[**2112-9-23**] 07:35AM BLOOD Glucose-133* UreaN-19 Creat-0.7 Na-138
K-4.3 Cl-106 HCO3-23 AnGap-13
[**2112-9-23**] 07:35AM BLOOD Calcium-8.8 Phos-3.0 Mg-2.2
[**2112-9-23**] 07:35AM BLOOD ALT-37 AST-28 LD(LDH)-312* AlkPhos-55
TotBili-0.3
[**2112-9-18**] 07:03AM BLOOD CK(CPK)-233*
[**2112-9-18**] 07:03AM BLOOD CK-MB-3 cTropnT-<0.01 proBNP-2140*
[**2112-9-18**] 05:00PM BLOOD cTropnT-<0.01
[**2112-9-18**] 06:00PM BLOOD CK-MB-3 cTropnT-<0.01

Brief Hospital Course:
51yo woman with [**Hospital **] transferred from outside hospital for
seizure and new brain mets.  CT showed a left lung mass.
Transferred to ICU [**2112-9-18**] for hypoxia and dyspnea, likely due
to flash pulmonary edema as she improved with furosemide.
Pericardial window placed via VATS [**2112-9-21**] for a pericardial
effusion causing ventricular compromise, but no tamponade.
Bronchoscopy confirmed squamous cell CA.  She was transferred to
Oncology.  Radiation Oncology was consulted and whole brain XRT
will start on Monday as an outpatient.  This will be followed by
chemotherapy.  She will also need a PET scan as an outpatient
and possibly a port.
.
MICU Course 1:
The patient was transferred in the AM of [**2112-9-18**] with hypoxia to
83% on non rebreather, acutely short of breath. She improved
with nonrebreather, lasix, morphine, and nitro paste. The
patient put out almost 1L of urine in response to 20mg IV lasix.
She was requiring 2-3L NC by the mid afternoon and the remainder
of her vital signs were stable. Her aspirin and Plavix were
stopped due to concern for intracranial hemorrhage as well as
preparing for EBUS-guided biopsy of her lung masses later int he
week. This was discussed with cardiology. In discussion with
neurosurg, she was allowed to continue aspirin although with
recommendation for frequent neurology checks. She did have a
pericardial effusion without tamponade.
.
MICU Course 2:
She was transferred again [**2112-9-21**] to the ICU after pericardial
window and biopsy.  She arrived with a chest tube on the left
side on NC.  The chest tube was pulled [**2112-9-22**].  She was
transferred to Oncology [**2112-9-22**].
.
# Seizure: Due to new brain mets.  Given fosphenytoin at outside
hospital.  Neuro-oncology consulted.  No recurrence.  Continued
levetiracetam 500mg [**Hospital1 **] and dexamethasone.
.
# CNS mets: Two new lesions.  Started dexamethasone.
Neurosurgery and Neuro-oncology consulted.  Cannot have MRI due
to pacemaker.  Not a surgical candidate (high risk) due to need
for aspirin/clopidogrel with CAD.  Consulted Radiation Oncology.
 Plan to start whole brain XRT Monday as an outpatient.
Anti-emetics PRN.
.
# Metastatic squamous cell lung CA, LLL, mediastinal and
supraclavicular LNs, brain mets: Confirmed by EBUS/bronch
cytology.  Discussed treatment plan and prognosis with Ms.
[**Known lastname **] and her family.  Plan for PET as outpatient, port
placement, whole brain XRT, followed by platinum-doublet chemo
(no bevacizumab with squamous cell).  I explained to them that
this is not curable.  Discussed case with Dr. [**Last Name (STitle) 3274**] for
outpatient follow-up.  Anti-emetics PRN.
- PENDING path from pericardium.
.
# Hypoxia: She had episode of acute respiratory distress and
hypoxemia [**2112-9-18**], likely secondary to flash pulmonary edema.
She was diuresed with IV furosemide and improved.  Echo showed
severe regional left ventricular systolic dysfunction with
thinning and akinesis of the antero-septum, anterior, distal LV,
apical AND basal inferior segments.  Given torsemide 20 mg
daily.  Treated with antibiotics for possible pneumonia.
.
# Pericardial effusion: Pericardial window placed via VATS
[**2112-9-21**] for ventricular compromise, but no tamponade.  No need
for repeat echo s/p pericardial window per Cardiology, unless
she becomes symptomatic again.  No events on telemetry.
- PENDING path from pericardium.
.
# Pneumonia: Given ceftriaxone and azithromycin at outside
hospital.  Treated for 7-day course of IV antibiotics, first
cefepime, vancomycin, and metronidazole, then changed to
pip/tazo.
- PENDING blood cultures.
.
# Dyspnea/hypoxia: Resolved.  Albuterol PRN.
.
# Leukocytosis: Likely reactive/pneumonia and steroids.
.
# CAD/CHF: Held aspirin and clopidogrel for small
tumor-associated CNS hemorrhage and for procedures.  D/C'd
aspirin considering small CNS hemorrhage, but plan to restart
clopidogrel after planned tooth extraction on Monday considering
coronary stents.  Restarted spironolactone day of discharge.
Continued outpatient furosemide.  Continued outpatient ACE
inhibitor and carvedilol (changed to [**Hospital1 **] dosing for more
consistent steady state).
.
# Hyperlipidemia: Continued ezetimibe and statin.
.
# Pain (none): Acetaminophen, hydromorphone PRN.
.
# Constipation: Added laxatives.
.
# FEN: Regular diet.
.
# DVT prophylaxis: Heparin SC.
.
# GI prophylaxis: PPI while on steroids and for GERD.  Increased
bowel regimen for constipation.
.
# Lines: Peripheral IV.
.
# Precautions: None.
.
# CODE: FULL.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from PatientFamily/Caregiver.
1. Aspirin 81 mg PO DAILY
2. Clopidogrel 75 mg PO DAILY
3. Atorvastatin 40 mg PO DAILY
4. Lisinopril 5 mg PO DAILY
5. Spironolactone 25 mg PO DAILY
6. Pantoprazole 40 mg PO Q24H
7. Ezetimibe 10 mg PO DAILY
8. Furosemide 20 mg PO DAYS ([**Doctor First Name **],TU,TH)
9. Furosemide 40 mg PO DAYS (MO,WE,FR,SA)
10. Carvedilol 50 mg PO DAILY


Discharge Medications:
1. Atorvastatin 40 mg PO DAILY
2. Carvedilol 25 mg PO BID
Hold for SBP<100, HR<60
RX *carvedilol 25 mg 1 tablet(s) by mouth twice a day Disp #*60
Tablet Refills:*2
3. Ezetimibe 10 mg PO DAILY
4. Furosemide 20 mg PO DAYS ([**Doctor First Name **],TU,TH)
5. Furosemide 40 mg PO DAYS (MO,WE,FR,SA)
6. Lisinopril 5 mg PO DAILY
7. Pantoprazole 40 mg PO Q24H
8. Spironolactone 25 mg PO DAILY
9. Acetaminophen 325-650 mg PO Q4H:PRN fever, pain
10. Dexamethasone 4 mg PO Q6H
RX *dexamethasone 4 mg 1 tablet(s) by mouth q6HR Disp #*120
Tablet Refills:*1
11. Clopidogrel 75 mg PO DAILY
12. Bisacodyl 10 mg PO DAILY:PRN Constipation
13. Docusate Sodium 100 mg PO BID
14. LeVETiracetam 500 mg PO BID
RX *levetiracetam 500 mg 1 tablet(s) by mouth twice a day Disp
#*60 Tablet Refills:*3
15. Milk of Magnesia 30 mL PO Q6H:PRN Constipation
16. Senna 1 TAB PO BID
17. Prochlorperazine 5-10 mg PO Q6H:PRN Nausea
RX *prochlorperazine maleate 5 mg [**1-4**] tablet(s) by mouth q6HR
Disp #*20 Tablet Refills:*3
18. Ondansetron 4-8 mg PO Q8H:PRN Nausea
RX *ondansetron 4 mg [**1-4**] tablet(s) by mouth q8HR Disp #*20
Tablet Refills:*3
19. OxycoDONE (Immediate Release)  5-10 mg PO Q4H:PRN Pain
RX *oxycodone 5 mg [**1-4**] tablet(s) by mouth q4HR Disp #*50 Tablet
Refills:*0

Discharge Disposition:
Home

Discharge Diagnosis:
1. Seizure.
2. Brain metastases.
3. Metastatic lung cancer (squamous cell carcinoma).
4. Pericardial effusion (fluid around the heart).
5. Pneumonia.
6. Pulmonary edema (fluid on the lungs).
7. Coronary artery disease.
8. Congestive heart failure.

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

Discharge Instructions:
You were transferred to [**Hospital1 **] hospital from an
outside hospital for a seizure.  The seizure was due to brain
metastases from a new lung cancer seen on CT scan.  The seizure
was controlled with seizure medication which you will need to
continue at home.  YOU CAN [**Street Address(1) 103696**] A CAR.  CT scan
showed a tumor in the left lung, chest lymph nodes, and the
right and left brain.  You were transferred to the Intensive
Care Unit for low oxygen levels and shortness of breath.  This
was likely due to pulmonary edema (fluid on the lungs), a result
of congestive heart failure.  This resolved with a diuretic,
furosemide.  Echo of the heart showed fluid surrounding the
heart.  This was drained by placement of a pericardial window by
a surgical procedure called VATS.  A chest drain was left in
place for one day.  The fluid around the heart most likely was
caused by the cancer.  The cancer will be treated initially with
whole brain radiation, which will start on Monday as an
outpatient, and then followed by chemotherapy.  You will also
need a PET scan prior to chemotherapy and possibly an IV port to
administer chemotherapy.
.
MEDICATION CHANGES:
1. Dexamethasone (Decadron) 4x a day, to decrease the swelling
around the brain masses.
2. Levetiracetam (Keppra) 2x a day, to prevent seizures.
3. Stop aspirin, stopped to prevent any more bleeding in the
brain.
4. Restart clopidogrel (Plavix) after your planned dental
extraction on Monday.
.
YOU MUST [**Street Address(1) 103696**] UNTIL CLEARED BY A NEUROLOGIST.

Followup Instructions:
An appointment in Oncology is being made for you.  However, if
you are not contact[**Name (NI) **] by Tuesday, please call the office at
([**0-0-**] or ([**Telephone/Fax (1) 15512**].
.
Department: HEMATOLOGY/ONCOLOGY
When: THURSDAY [**2112-10-6**] at 3:00 PM
With: [**Name6 (MD) 1532**] [**Name8 (MD) 1533**], MD [**0-0-**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
Please report to the radiology department on the [**Location (un) **] of
the [**Hospital Ward Name 23**] Center 30 min prior to your apppointment for a chest
xray.
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Pneumonia, organism unspecified,Acute on chronic systolic heart failure,Malignant neoplasm of other parts of bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Unspecified disease of pericardium,Other convulsions,Esophageal reflux,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of tobacco use'}


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: Seizure OSH ED transfer.

PRESENT ILLNESS: 51F former smoker with h/o CAD/ CHF with AICD placed transfered
for seizure, intra-axial masses. Patient was in her usual state
of health until the evening of [**9-15**] when she was more tired than
usual and noted a mass in her supraclavicular fossa. The morning
of [**9-16**] she was not responding to phone calls and was found by
her husband at approximately 3pm on the couch confused. She was
incontinent of stool and urine and had bit her tounge. She
denied any chest pain at the time. Her husband called EMS and
she was brought to an OSH ED.
There she was found to have intracranial masses with apical lung
masses by CT scan. Labs remarkable there for WBC of 23.4. Elbow
films negative. She was given 1 g fosphenytoin 1g IV ceftriaxone
and 500mg IV azithromycin. Patient transferred to [**Hospital1 18**] for
further evaluation.
Initial VS in the ED: 20:33 3 99.4 86 90/73 16 94% ra. Labs
notable for WBC of 16.9, Hct of 35.2, 231 platelets. Patient was
given 10mg IV dexamethasone and 4mg IV zofran.

MEDICAL HISTORY: - MI s/p angiography and stent placement [**2105**]
- CHF with AICD placement - Sprint Fidelis Lead - [**Company 1543**]
- HTN
- Hyperlipidemia

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientFamily/Caregiver.
1. Aspirin 81 mg PO DAILY
2. Clopidogrel 75 mg PO DAILY
3. Atorvastatin 40 mg PO DAILY
4. Lisinopril 5 mg PO DAILY
5. Spironolactone 25 mg PO DAILY
6. Pantoprazole 40 mg PO Q24H
7. Ezetimibe 10 mg PO DAILY
8. Furosemide 20 mg PO DAYS ([**Doctor First Name **],TU,TH)
9. Furosemide 40 mg PO DAYS (MO,WE,FR,SA)
10. Carvedilol 50 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:
Vitals: T: 98.0 BP: 114/65 P: 88 R: 18 O2: 94% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, left sided fullness felt in the
supraclavicular fossa.
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII intact b/l. Motor [**5-7**] UE/LE, normal f/n/f, 2+
UE/LE reflexes (right leg moved when left patellar reflex
elicited). No clonus.

FAMILY HISTORY: Father died of colon cancer.
Mother had an MI at 60.

SOCIAL HISTORY: Lives with husband and dog at home; works part-time as
telemarketer; takes care of ailing mother; sister lives nearby;
former smoker, quit [**2105**] (had smoked 1ppd x 20 years). No h/o
recent travel, asbestos exposure, fungal exposure, exotic pets. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Pneumonia, organism unspecified,Acute on chronic systolic heart failure,Malignant neoplasm of other parts of bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Unspecified disease of pericardium,Other convulsions,Esophageal reflux,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of tobacco use'}
