CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 82 year old
male with a past medical history of hypertension, peripheral
vascular disease, status post left above the knee amputation,
who does not regularly seek medical care, who presented to
the Emergency Department at [**Hospital1 188**], on [**2108-10-26**], complaining of a two to four week
history of shortness of breath, productive cough, congestion,
brief choking sensation.  On arrival to the Emergency
Department, temperature was 98.5, heart rate 90, blood
pressure 139/71, respiratory rate 36, oxygen saturation 76%
in room air.

MEDICAL HISTORY: 1.  Hypertension.
2.  Peripheral vascular disease, status post right carotid
endarterectomy in [**2099**].
3.  Left above the knee amputation, status post World War II
injury.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient reports no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of early coronary artery disease.
The patient's brother deceased from complications of type 2
diabetes mellitus.  Sister deceased from episode of
respiratory distress.  The patient's parents lived into their
90s without major medical problems.

SOCIAL HISTORY: The patient reports a positive 50 to 75 pack
year tobacco history, having quit in [**2092**].  There is a remote
history of alcohol.  The patient is a retired mechanic.  He
is a World War II Veteran.  He lived alone prior to
admission.  His daughter, [**Name (NI) **], is actively involved in his
medical care and checks up on him frequently.  His wife is
deceased status post myocardial infarction approximately one
year ago.
Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure, unspecified
Obs chr bronc w(ac) exac,CHF NOS,Acute respiratry failure,Food/vomit pneumonitis,Meth sus pneum d/t Staph,Acute kidney failure NOS
Admission Date:  [**2108-10-26**]       Discharge Date:


Service:  C-MEDICINE/CCU/MICU

HISTORY OF PRESENT ILLNESS:  The patient is an 82 year old
male with a past medical history of hypertension, peripheral
vascular disease, status post left above the knee amputation,
who does not regularly seek medical care, who presented to
the Emergency Department at [**Hospital1 188**], on [**2108-10-26**], complaining of a two to four week
history of shortness of breath, productive cough, congestion,
brief choking sensation.  On arrival to the Emergency
Department, temperature was 98.5, heart rate 90, blood
pressure 139/71, respiratory rate 36, oxygen saturation 76%
in room air.

Of note, the patient's initial laboratories showed a
bicarbonate markedly elevated at 38.  Chest x-ray at that
time showed cardiac enlargement with mild upper lung zone
redistribution with small bilateral pleural effusions, left
greater than right, questionable right lower lobe pneumonia.
The patient was admitted to the C-Medicine service for
management of congestive heart failure.  Also of note, CT
scan of the chest in the Emergency Department ruled out
pulmonary embolism.

On the C-Medicine service, the patient was diuresed
aggressively with Lasix 40 mg intravenously twice a day,
started on Aspirin and Captopril, and was transiently on a
Nitroglycerin drip for blood pressure control.  He was ruled
out for myocardial infarction with three sets of cardiac
enzymes.  With these laboratories, the patient's
creatinine-kinase level was relatively flat, but he did have
a slight troponin leak felt to be consistent with heart
strain secondary to congestive heart failure.

While on the regular floor, the patient had issues with
confusion, agitation and refusing to take oral medications.
This required one to one sitter as well as medication with
Haldol and Risperidone.  On the evening of [**2108-10-28**], the
patient had increased agitation and confusion.  He was
medicated with Haldol and Risperidone.  At that time, he
dropped his oxygen saturation to 66% on nasal cannula oxygen
and was noted to have increased respiratory rate and some
gurgling.  The patient was placed on face mask and given
Lasix 40 mg intravenously, however, he failed to improve
dramatically.  Therefore, he was intubated after rapid
sequence medication with Etomidate and Succinylcholine.
Prior to intubation, his arterial blood gases revealed
7.24/108/164.  This was consistent with hypercarbic
respiratory failure.

The patient was therefore transferred to the CCU service
where the thinking was that the patient could possibly have
intermittent pulmonary emboli versus ischemia.  As the
patient had elevated blood urea nitrogen and creatinine and
was already over four liters negative for his hospital
course, diuresis was held.  Echocardiogram was performed
which showed a left ventricular ejection fraction of greater
than 50%, left ventricular hypertrophy, and evidence of
diastolic dysfunction with E:A ratio of 0.67, and impaired
relaxation.  No wall motion abnormalities were found.  The
patient was worked up for pulmonary embolism via positive
D-dimer, however, lower extremity ultrasounds were negative.
A repeat CT scan of the chest was not performed.  This is in
light of a negative CTA of the chest on admission. The
patient was started on Heparin drip for anticoagulation.
Heparin was later discontinued due to a large nosebleed.  The
patient was extubated while in the CCU service on [**2108-10-30**].
Preextubation arterial blood gas was 7.37/81/80 on 50%
nonrebreather face mask.  That evening, the patient
demonstrated increased work of breathing.  Arterial blood
gases were checked and showed values of 7.20/126/110.  The
patient was agitated and received Haldol and Ativan.  Repeat
gas was 7.14/131/128 with oxygen saturation 86%.  Chest x-ray
was performed which showed a questionable left sided
pneumothorax.  A repeat chest x-ray was performed in order to
further evaluate possible pneumothorax.  In the interim, the
patient was reintubated and a chest tube was placed by
surgical staff.  During chest tube placement, the repeat
chest x-ray was read as no evidence of pneumothorax. Decision
was made to continue chest tube placement and chest tube
drained 220cc of straw colored fluid.  All told the patient
tolerated these interventions well.

The patient was then transferred to the Medical Intensive
Care Unit service for further management of his pulmonary
issues including recurrent hypercarbic respiratory failure.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Peripheral vascular disease, status post right carotid
endarterectomy in [**2099**].
3.  Left above the knee amputation, status post World War II
injury.

ALLERGIES:  The patient reports no known drug allergies.

MEDICATIONS ON ADMISSION;  None.

MEDICATIONS ON TRANSFER FROM CCU SERVICE TO MEDICAL INTENSIVE
CARE UNIT SERVICE:
1.  Haldol.
2.  Fentanyl drip.
3.  Levofloxacin 500 mg once daily.
4.  Propofol.
5.  Albuterol and Atrovent nebulizers.
6.  Regular insulin sliding scale.
7.  Lorazepam.
8.  Famotidine.
9.  Aspirin.

SOCIAL HISTORY:  The patient reports a positive 50 to 75 pack
year tobacco history, having quit in [**2092**].  There is a remote
history of alcohol.  The patient is a retired mechanic.  He
is a World War II Veteran.  He lived alone prior to
admission.  His daughter, [**Name (NI) **], is actively involved in his
medical care and checks up on him frequently.  His wife is
deceased status post myocardial infarction approximately one
year ago.

FAMILY HISTORY:  No history of early coronary artery disease.
The patient's brother deceased from complications of type 2
diabetes mellitus.  Sister deceased from episode of
respiratory distress.  The patient's parents lived into their
90s without major medical problems.

PHYSICAL EXAMINATION:  On transfer to Medical Intensive Care
Unit service, temperature was 101.0, heart rate 64, blood
pressure 106/40, respiratory rate 14, oxygen saturation 99%.
The patient was being ventilated on assist control with tidal
volume 500 to 560, respiratory rate 10-14, pressure support
of 0, PEEP of 5, FIO2 0.60.  On those settings, arterial
blood gas was 7.41/65/186/43.  Generally, the patient is well
developed, thin male, opened eyes to voice, somewhat
agitated, in no acute distress, breathing comfortably.  Head,
eyes, ears, nose and throat examination - Normocephalic and
atraumatic.  The pupils are equal, round, and reactive to
light and accommodation.  Positive endotracheal tube,
positive oral gastric tube placed.  Neck was supple, no
masses or lymphadenopathy, 1+ carotid pulses, normal carotid
upstroke.  Positive faint left carotid bruit.  Lungs - Mild
bibasilar crackles; otherwise coarse breath sounds
anterolaterally secondary to ventilation settings.
Cardiovascular is regular rate and rhythm, S1 and S2 heart
sounds auscultated, no murmurs, rubs or gallops.   The
abdomen is soft, mildly distended, some left lower quadrant
fullness.  Extremities - left above the knee amputation,
right leg with no edema or erythema.  Foot warm.  Distal
pulses nonpalpable but auscultated via Doppler.
Genitourinary - Right scrotum markedly enlarged compared to
left.  No evidence of transillumination.  Skin - no rashes or
lesions.  Neurologically, awake, open eyes to voice, not
following commands consistently, moving all extremities.

LABORATORY DATA:  On transfer to the Medical Intensive Care
Unit service, the patient's complete blood count showed a
white blood cell count of 8.8, hematocrit 37.2, MCV 77,
platelet count 183,000.  Coagulation profile showed
prothrombin time 13.5, partial thromboplastin time 34.4, INR
1.2.  Serum chemistries showed sodium 148, potassium 3.7,
chloride 101, bicarbonate 46 up from 38 on admission, blood
urea nitrogen 42, creatinine 1.1, glucose 95.  Other
laboratories showed calcium 7.8, with free calcium 1.12,
phosphate 4.8, magnesium 2.1, albumin 3.1.

Chest x-ray from [**2108-10-29**], showed positive left sided chest
tube.  No evidence of pneumothorax.  Heart enlarged.
Positive intubation with endotracheal tube 2.8 centimeters
above carina in good position.  Right lung clear.  No
evidence of failure.  Lower extremity ultrasound from
[**2108-10-29**], showed no evidence of deep vein thrombosis.  CT
scan of the chest from [**2108-10-26**], showed no filling defects in
the pulmonary artery vasculature, no pulmonary embolism
identified, moderate bilateral pleural effusions, some
atelectasis at the bases bilaterally.  Lingular atelectasis.
Positive hiatal hernia.  Degenerative changes throughout the
thoracic spine.  Small pericardial effusion.

Echocardiogram from [**2108-10-29**], showed E:A ratio of 0.67, left
ventricular ejection fraction greater than 55%.  Left atrium
mildly dilated.  Right atrium mildly dilated.  Moderate
symmetric left ventricular hypertrophy.  Overall systolic
function was normal.  Right ventricular chamber size and free
wall motion were normal.  Trace aortic regurgitation. Left
ventricular inflow pattern suggestive of impaired relaxation.
Trivial tricuspid regurgitation.  Mild pulmonary artery
systolic hypertension.  Physiologic pericardial effusion.

HOSPITAL COURSE:
1.  Respiratory failure - The patient was reintubated while
in the CCU service on [**2108-10-30**], for recurrent hypercarbic
respiratory failure.  At that time, etiology of his acute
decompensation included hypercarbic respiratory failure
secondary to chronic obstructive pulmonary disease.
Evaluation of the patient's laboratories on admission showed
that he came in with elevated bicarbonate of 38.  This is
suggestive of the patient being a chronic CO2 retainer with
baseline carbon dioxide levels in the 60 to 80 range.
Although the patient did not come to the hospital with a
diagnosis of chronic obstructive pulmonary disease, it was
felt that he likely had baseline chronic obstructive
pulmonary disease based on extensive smoking history, his
clinical examination and could possibly have additional
pulmonary damage secondary to occupational history.  It was
felt possible that the patient's acute decompensation on the
floor while extubated could have been due to excessive
oxygenation, namely, that high flow oxygen blunted the
patient's hypoxic respiratory drive, increased VQ mismatch,
and also heavy effects of elevating the patient's carbon
dioxide level secondary to the [**Last Name (un) 12794**] effect.  Therefore,
the patient was treated for the obstruction component of his
chronic obstructive pulmonary disease with Albuterol and
Atrovent nebulizer treatments.  He was also maintained on
aggressive pulmonary toilet.  He had originally been on
Levofloxacin 500 mg intravenously q24hours started by the CCU
service in light of his history of increased cough and sputum
production.  He was also started on pulse dose steroids.  In
terms of his most recent arterial blood gas which showed pH
7.41, carbon dioxide 65, oxygen 186, the patient's vent
settings were changed to decrease his level of FIO2.  His
current level of ventilation was continued.  He was
maintained on Haldol p.r.n. for agitation.  Throughout the
following day, the patient was weaned off the ventilator and
had a trial of pressure support ventilation which he
tolerated well.  He was extubated on [**2108-10-31**].  Post
extubation, the patient's oxygen settings were maintained
conservatively to keep his oxygen saturation levels between
89 and 93% in light of his history of CO2 retention.  He
tolerated this well and was able to maintain adequate
oxygenation and ventilation off the ventilator on low flow
oxygen administered via face mask and cannula.  Levofloxacin
as well as steroids were discontinued later in the hospital
course secondary to the patient's mental status changes.

2.  Mental status changes secondary to delirium - Throughout
his stay in the Intensive Care Unit, the patient was agitated
and confused.  A workup for infectious etiologies including
blood cultures, sputum cultures, and urine cultures were all
negative.  A psychiatry consultation was obtained.  They
recommended medicating the patient with Seroquel and Haldol
p.r.n.  With Haldol and Seroquel administration, the patient
was less agitated but remained confused.  Folate, B12 and RPR
laboratories were evaluated and were all negative.  The
patient had a CT scan of the head performed to rule out
subdural bleed.  At the time of this dictation, results of
that are still pending.  In light of the aggressive
administration of Haldol, serial electrocardiograms were
checked to rule out Q-T interval prolongation.

3.  Congestive heart failure - Based on the patient's
admission chest x-ray as well as physical examination
findings, as well as improvement in respiratory status with
diuresis, it was felt that the patient most likely was in
mild congestive heart failure on admission.  Echocardiogram
showed normal systolic function, but evidence of diastolic
dysfunction.  At the time of transfer to the Medical
Intensive Care Unit service, the patient appeared euvolemic
on examination without signs or symptoms of congestive heart
failure.  Therefore, additional diuresis was held.  He was
started on low dose beta blocker for his congestive heart
failure.

4.  Coronary artery disease - In light of the patient's
presentation with congestive heart failure, as well as his
slight troponin leak during this hospitalization, it was felt
that the patient might have a component of ischemia
contributing to his dyspnea.  Initially, he was maintained on
Aspirin as well as beta blocker therapy.  After stabilization
from this hospital event, the patient should likely undergo
stress testing as an outpatient in order to further evaluate
his cardiac function.

5.  Possible pneumothorax - Prior to transfer to the Medical
Intensive Care Unit service, the patient had a chest tube
placed for possible pneumothorax.  However, repeat chest
x-ray showed no evidence of pneumothorax.  Chest tube was
removed on [**2108-10-31**].

6.  Acute renal failure - With diuresis, the patient's
creatinine level peaked at 1.4.  This acute increase is
likely secondary to overdiuresis and intravascular volume
depletion resulting in hyperperfusion of kidneys.  In light
of his prerenal picture, further diuresis was held after
transfer to the Medical Intensive Care Unit service.  All the
patient's medications were renally dosed and nephrotoxic
agents were avoided.

7.  Iron deficiency anemia - The patient's admission complete
blood count showed a low MCV and hypochromasia.  Iron studies
were performed consistent with iron deficiency anemia.  This
raised the question that the patient had an occult bleed,
namely, colon cancer. All his stools were guaiac negative.
It is recommended the patient undergo outpatient colonoscopy
for further workup of his iron deficiency anemia.

8.  Code Status - The patient is a full code.

9.  Communication/family issues - The patient's daughter,
[**Name (NI) **] [**Name (NI) 12795**], is extremely involved in his medical care.
Should the patient become unable to make medical decisions
for himself, he has appointed Ms. [**Name13 (STitle) 12795**] as his health
care proxy.

10. Disposition - On [**2108-11-3**], the patient was transferred to
the Medicine service from the Medical Intensive Care Unit.
The remainder of his hospital course as well as discharge
condition, discharge status, and discharge medications will
be dictated as a separate addendum to this report.




                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 292**]

Dictated By:[**Last Name (NamePattern1) 257**]
MEDQUIST36

D:  [**2108-11-4**]  12:51
T:  [**2108-11-4**]  13:33
JOB#:  [**Job Number 12796**]

cc:[**Male First Name (un) 12797**]

Admission Date:  [**2108-10-26**]     Discharge Date:  [**2108-11-14**]


Service:  ACOVE

ADDENDUM: Medicine

HOSPITAL COURSE SINCE PREVIOUS DICTATION:  1.  PULMONARY:  On
transfer to the ACOVE Service from the MICU, the patient improved
dramatically from a respiratory standpoint.  He was continued on
oxygen and his nebulizer treatments with oxygen saturations
approximately 90% on 2 liters.  The patient had a chest x-ray
that seemed consistent with aspiration and he was briefly started
on levofloxacin and Flagyl.

On [**2108-11-7**], the patient had an episode of hypoxia
to 68% with an ABG of 7.18/73/57.  The patient was placed on
humidified oxygen with saturations around 90-92% and was
suctioned.  The patient was noted to have thick tenacious
sputum.  A stat chest x-ray was ordered that showed no
changes.  The patient had chest PT at this time for
percussive therapy and was noted to have a blood pressure of
80/30 and was subsequently bolused with normal saline.

Given minimal responsiveness to sternal rub, the patient was
again transferred to the ICU for respiratory distress.  The
patient was intubated in the SICU and was placed on levo,
ceftazidime, and vancomycin for pneumonia.  The patient was
eventually weaned from the ventilator and improved dramatically
from a respiratory standpoint.  He was continued on all
nebulizers and received frequent suctioning.  The etiology of the
patient's hypoxic respiratory failure was considered likely
multifactorial including his diastolic heart failure, pneumonia,
and COPD.  The patient was treated for his mild diastolic heart
failure.

A sputum sent on [**2108-11-7**] grew out MRSA and the
patient's levofloxacin and ceftazidime were stopped and he
was kept on vancomycin IV.  He received a PICC line and it is
anticipated that the patient will receive a full 14 day
course of IV vancomycin for MRSA pneumonia.

2.  CARDIOVASCULAR:  While in the [**Hospital Unit Name 153**], the patient was noted
to have a troponin leak in the setting of respiratory
distress considered secondary to demand ischemia.  The
patient was continued on aspirin, Lopressor, and statin and
it is anticipated that he will have a more thorough cardiac
workup as an outpatient.  Notably, the patient's CK and CK MB
were normal and stable throughout his stay.

Prior to transfer to the [**Hospital Ward Name 516**], the patient had an
echocardiogram which was significant for an EF of over 55%,
moderate symmetrical LVH, mild pulmonary hypertension, and an
E/A ratio of 0.67.  It is likely that the patient has
diastolic dysfunction and in addition to a beta blocker was
kept on Lasix 40 mg q.d. for likely volume overload.

3.  INFECTIOUS DISEASE:  On discharge from the MICU, the
patient improved from a pulmonary standpoint but could not be
weaned from oxygen.  The chest x-ray was significant for a
retrocardiac pneumonia and the patient was started on
levofloxacin and Flagyl for presumed aspiration pneumonia.
The patient subsequently had a hypoxic respiratory distress
and was transferred to the [**Hospital Unit Name 153**] where sputum was sent and
came back with MRSA.  The patient was started on vancomycin
and will receive this for 14 days.  He remained afebrile
throughout his hospital stay.

4.  MENTAL STATUS:  The patient was transferred with the
diagnosis of delirium that was considered multifactorial,
potential etiologies include psychotropic medications that
the patient had received, hypercapnic and hypoxic respiratory
arrest as well as baseline dementia.  After the patient was
extubated for the third time, his mental status improved
significantly.  He was followed by the Psychiatry Team who
felt that his delirium was most likely secondary to his
multiple medical problems and recommended treating his
medical problems and following up in the future with an MRI
once the patient was stable.  The patient was noted to have
symptoms consistent with sundowning with an acute increase in
his confusion at night; however, the patient's mental status
was appropriate during the day and he was noted to be alert
and oriented prior to discharge.

5.  RENAL:  The patient was noted on transfer to have an
elevated creatinine which was thought likely secondary to
dehydration.  He was fluid resuscitated but continued to have
increasing creatinine to a maximum of 2.8.  The [**Hospital Unit Name 153**] Team
thought that the patient's acute renal failure was secondary
to possible hypoxemia and the patient's creatinine after he
was extubated eventually improved to 1.1 prior to discharge.

6.  FLUIDS, ELECTROLYTES, AND NUTRITION:  The patient was
evaluated by the Speech and Swallow Team and had a video
fluoroscopic swallowing evaluation which was negative for
aspiration.  Prior to discharge, his diet was advanced to
pureed solids and regular thin liquids.  It was anticipated
that the patient's diet will be advanced to a regular diet
after he is transferred to the rehabilitation hospital.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is discharged to the [**Hospital6 7068**].

DISCHARGE DIAGNOSIS:
1.  Diastolic dysfunction.
2.  Hypercarbic respiratory arrest.
3.  Chronic obstructive pulmonary disease.
4.  Methicillin-resistant Staphylococcus aureus pneumonia.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg p.o. q.d.
2.  Fluticasone two puffs b.i.d.
3.  Salmeterol 50 micrograms one inhalation q. 12 hours.
4.  Atorvostatin 10 mg p.o. q.d.
5.  Ipratropium bromide 0.02% one nebulizer q. six hours
p.r.n.
6.  Prednisone 20 mg p.o. q.d. times two days, 10 mg p.o.
q.d. times two days.
7.  Metoprolol 25 mg p.o. b.i.d.
8.  Vancomycin 1 gram IV q.d. times seven days.
9.  Heparin 5,000 units q. eight hours subcutaneously.
10. Pantoprazole 40 mg p.o. q.d.
11. Lasix 40 mg p.o. q.d.
12. Calcium carbonate 500 mg p.o. t.i.d.

FOLLOW-UP:  The patient is discharged to [**Hospital6 7068**] where he will continue on medications
as prescribed.  He will continue vancomycin for seven days
for MRSA pneumonia.  It is hoped at this time that he will
also be placed on an ACE inhibitor for his antihypertensive
regimen. The patient will be followed by the physicians at
the rehabilitation center.  He is encouraged to contact Dr.
[**Last Name (STitle) 12798**] at [**Hospital 882**] Hospital to schedule a follow-up
appointment within two weeks of being discharged from
[**Hospital1 **].  If Dr. [**Last Name (STitle) 12798**] is not taking any new patients,
the patient is welcome to follow-up with Dr. [**Last Name (STitle) **] in the
[**Hospital 191**] Clinic.




                          [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4446**]

Dictated By:[**Last Name (NamePattern4) 12799**]

MEDQUIST36

D:  [**2108-11-14**]  10:02
T:  [**2108-11-14**]  13:11
JOB#:  [**Job Number 12800**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure, 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: 

PRESENT ILLNESS: The patient is an 82 year old
male with a past medical history of hypertension, peripheral
vascular disease, status post left above the knee amputation,
who does not regularly seek medical care, who presented to
the Emergency Department at [**Hospital1 188**], on [**2108-10-26**], complaining of a two to four week
history of shortness of breath, productive cough, congestion,
brief choking sensation.  On arrival to the Emergency
Department, temperature was 98.5, heart rate 90, blood
pressure 139/71, respiratory rate 36, oxygen saturation 76%
in room air.

MEDICAL HISTORY: 1.  Hypertension.
2.  Peripheral vascular disease, status post right carotid
endarterectomy in [**2099**].
3.  Left above the knee amputation, status post World War II
injury.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient reports no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of early coronary artery disease.
The patient's brother deceased from complications of type 2
diabetes mellitus.  Sister deceased from episode of
respiratory distress.  The patient's parents lived into their
90s without major medical problems.

SOCIAL HISTORY: The patient reports a positive 50 to 75 pack
year tobacco history, having quit in [**2092**].  There is a remote
history of alcohol.  The patient is a retired mechanic.  He
is a World War II Veteran.  He lived alone prior to
admission.  His daughter, [**Name (NI) **], is actively involved in his
medical care and checks up on him frequently.  His wife is
deceased status post myocardial infarction approximately one
year ago. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Methicillin susceptible pneumonia due to Staphylococcus aureus,Acute kidney failure, unspecified'}
