CHIEF COMPLAINT: 84 year old male with multiple medical problems including
diabetes, CAD, CHF, CRI who is admitted with cholangitis.

PRESENT ILLNESS: Patient came to the ER with three days of right upper quadrant
pain. In ER was found to be afebrile but a CT of the abdomen was
suggestive of gall bladder pathology. He was admitted and
started on broad spectrum antibiotics with
Vancomycin/levo/flagyl administered in the ER. He had a
percutaneous cholecystostomy tube placed on [**5-16**] after elective
intubation for respiratory
distress. He underwent an [**Month/Year (2) **] which revealed a compacted
ampullary stone, likely cholangitis and possible CBD stone; a
biliary stent was placed.

MEDICAL HISTORY: 1. CAD, cath 5 years ago at NEBH (cardiologist [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **])
2. CHF, TTE [**3-5**] w/depressed EF
3. Hypertension, per daughter pt's bp usually 90s-100s on meds
4. Severe Lumbar Spinal stenosis, mild cervical stenosis
5. Sleep apnea, on 2L home O2 at night
6. Afib, s/p DCCV which failed, now rate controlled
7. Arthritis
8. Gout
9. COPD
10. NIDDM
11. E-coli-Sepsis (admission [**2122-12-23**] - [**2123-1-1**])
12. BPH
13. Parkinson's disease

MEDICATION ON ADMISSION: celebrex 200', coumadin 2.5/5 alternating', wellbutrin ER 100',
protonix 40', lasix 160', potassium 20', crestor 5', carbidopa
25/100''', flomax 0.4', glipizide 5'', colchicine 10.6 q2d,
trazadone 100', [**Doctor First Name 130**] 180', sotalol 80'', digoxin 0.125 q2d,
xalatan 1 drop L eye', lidoderm [**1-31**] patch'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 100.4  P: 64  R: 16-20 BP: 96/62
General: resp distress, acute pain, alert and oriented times
three
HEENT:	Mucous membranes moist
Neck: Supple without LAD
Cardiovascular: Irregular S1 S2
Respiratory: Diffuse wheezes throughout; decreased breath sounds
at right base
Gastrointestinal: Soft, NT, ND bowel sounds normal and active
Musculoskeletal: Knees swollen and warm bilaterally with
effusion
L>R,left elbow warm and swollen
Skin: Multiple eccymoses

FAMILY HISTORY: Notable for CAD, HTN, and stroke.

SOCIAL HISTORY: Patient uses a cane for assistance at baseline. He lives with
his daughter [**Name (NI) 13118**]. Formerly worked at Sears. Widowed. No tobacco
or EtOH use.
Cholangitis,Acute pancreatitis,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified septicemia,Severe sepsis,Urinary tract infection, site not specified,Calculus of bile duct with acute cholecystitis, with obstruction,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Paralysis agitans,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric),Chronic kidney disease, unspecified,Infection with microorganisms resistant to penicillins,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Congestive heart failure, unspecified
Cholangitis,Acute pancreatitis,Acute respiratry failure,Ac kidny fail, tubr necr,Meth sus pneum d/t Staph,Septicemia NOS,Severe sepsis,Urin tract infection NOS,Choledochlith/ac gb-obst,Atrial fibrillation,DMII wo cmp nt st uncntr,Paralysis agitans,Hypertension NOS,Chr airway obstruct NEC,Obstructive sleep apnea,Chronic kidney dis NOS,Inf mcrg rstn pncllins,BPH w urinary obs/LUTS,CHF NOS
Admission Date:  [**2125-5-15**]              Discharge Date:   [**2125-6-22**]


Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1556**]
Chief Complaint:
84 year old male with multiple medical problems including
diabetes, CAD, CHF, CRI who is admitted with cholangitis.

Major Surgical or Invasive Procedure:
[**5-16**] [**Month/Year (2) **] and stent placement
[**5-16**] percutaneous cholecystostomy tube placement
[**5-28**] Tracheostomy


History of Present Illness:
Patient came to the ER with three days of right upper quadrant
pain. In ER was found to be afebrile but a CT of the abdomen was
suggestive of gall bladder pathology. He was admitted and
started on broad spectrum antibiotics with
Vancomycin/levo/flagyl administered in the ER. He had a
percutaneous cholecystostomy tube placed on [**5-16**] after elective
intubation for respiratory
distress. He underwent an [**Month/Year (2) **] which revealed a compacted
ampullary stone, likely cholangitis and possible CBD stone; a
biliary stent was placed.

Past Medical History:
1. CAD, cath 5 years ago at NEBH (cardiologist [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **])
2. CHF, TTE [**3-5**] w/depressed EF
3. Hypertension, per daughter pt's bp usually 90s-100s on meds
4. Severe Lumbar Spinal stenosis, mild cervical stenosis
5. Sleep apnea, on 2L home O2 at night
6. Afib, s/p DCCV which failed, now rate controlled
7. Arthritis
8. Gout
9. COPD
10. NIDDM
11. E-coli-Sepsis (admission [**2122-12-23**] - [**2123-1-1**])
12. BPH
13. Parkinson's disease


Social History:
Patient uses a cane for assistance at baseline. He lives with
his daughter [**Name (NI) 13118**]. Formerly worked at Sears. Widowed. No tobacco
or EtOH use.


Family History:
Notable for CAD, HTN, and stroke.

Physical Exam:
T: 100.4  P: 64  R: 16-20 BP: 96/62
General: resp distress, acute pain, alert and oriented times
three
HEENT:	Mucous membranes moist
Neck: Supple without LAD
Cardiovascular: Irregular S1 S2
Respiratory: Diffuse wheezes throughout; decreased breath sounds
at right base
Gastrointestinal: Soft, NT, ND bowel sounds normal and active
Musculoskeletal: Knees swollen and warm bilaterally with
effusion
L>R,left elbow warm and swollen
Skin: Multiple eccymoses

Pertinent Results:
[**2125-5-15**] Abdominal CT - Thickened gallbladder wall with
stranding, without evidence of gallstones, however, concerning
for acute cholecystitis. This was posted to the ED dashboard on
the afternoon of the study.

[**2125-5-15**] Abdominal Ultrasound - There is a small area of
increased echogenicity in the gallbladder, which is not
shadowing and may represent sludge, polyp, or much less likely
gallstone. The gallbladder wall is 4 mm but not striated. There
was no tenderness when scanning over the gallbladder. The common
bile duct was normal measuring 3.2 mm. There is normal
hepatopetal flow in the portal vein.

[**2125-5-15**] Labs -
[**2125-5-15**] 10:06PM   GLUCOSE-132* UREA N-19 CREAT-1.4* SODIUM-134
POTASSIUM-3.7 CHLORIDE-97 TOTAL CO2-25 ANION GAP-16
[**2125-5-15**] 10:06PM   ALT(SGPT)-204* AST(SGOT)-236* LD(LDH)-360*
ALK PHOS-267* AMYLASE-148* TOT BILI-3.4*
[**2125-5-15**] 10:06PM   WBC-15.0* RBC-3.75* HGB-11.9* HCT-36.3*
MCV-97 MCH-31.6 MCHC-32.6 RDW-16.3*

[**2125-5-16**] - Successful ultrasound-guided placement of a
percutaneous cholecystostomy tube.

[**2125-5-22**] Central Line placement - In comparison with the study of
[**5-20**], there has been placement of a left subclavian line that
extends to the mid portion of the SVC. No evidence of
pneumothorax. There appears to be some increasing prominence of
the pulmonary markings, suggesting elevated pulmonary venous
pressure.

[**2125-5-29**] Hemodialysis Catheter placed.

[**2125-5-29**] 02:11AM BLOOD Glucose-127* UreaN-85* Creat-2.5* Na-133
K-4.2 Cl-99 HCO3-21* AnGap-17
[**2125-5-28**] 01:30AM BLOOD WBC-35.5* RBC-3.31* Hgb-10.0* Hct-30.7*
MCV-93 MCH-30.2 MCHC-32.5 RDW-16.7* Plt Ct-504*

[**2125-6-19**]
1. No evidence of colonic wall thickening or megacolon to
suggest C. difficile.
2. Bilateral pleural effusions with some adjacent consolidation
and atelectasis, right greater than left.
3. Anasarca.
4. Interval removal of cholecystostomy tube.

[**2125-6-21**] 05:14AM BLOOD WBC-6.6 RBC-2.93* Hgb-9.0* Hct-27.3*
MCV-93 MCH-30.8 MCHC-33.0 RDW-17.5* Plt Ct-373
[**2125-6-21**] 10:18AM BLOOD PTT-61.9*
[**2125-6-21**] 05:14AM BLOOD PT-15.5* PTT-52.9* INR(PT)-1.4*
[**2125-6-21**] 05:14AM BLOOD Glucose-136* UreaN-56* Creat-1.3* Na-143
K-3.7 Cl-107 HCO3-26 AnGap-14
[**2125-6-19**] 09:07AM BLOOD ALT-10 AST-26 AlkPhos-71 Amylase-35
TotBili-0.2
[**2125-6-19**] 09:07AM BLOOD Lipase-12

Microbiology:
5/16-8:C diff neg x 3
[**6-11**] BAL: staph aureus, coag +; yeast
([**6-3**]) sputum cx: coag MRSA
UCx >100k E. Coli
([**5-23**]) BAL: Coag + staph Pleural fluid: MRSA BCx: neg UCx: neg,
L elbow fluid: no WBCs, 97 polys, many monosodium urate crystals

([**5-22**]) cath tip: MRSE
([**5-21**]) Pancx: negative except, Sputum: MRSA and yeast,
Joint aspirate: WBC 25K Mod amount - monourate sodium crystals
([**5-19**]) Bile Cx: neg; BCx: neg, Sputum Cx: MRSA, UCx: neg;
([**5-18**]) Sputum: MRSA;

[**6-18**] Echo: LA, RA dilated. Mild symmetric LV hypertrophy.
LVEF>55%. Ao root moderately dilated @sinus level. Mildly
thickened Ao & mitral valve leaflets. Mild 1+ MR. [**First Name (Titles) **] [**Last Name (Titles) **] a
systolic HTN.


Brief Hospital Course:
The patient was admitted on [**2125-5-15**] and started on broad
spectrum antibiotics with Vancomycin/levo/flagyl administered in
the ER. He had a percutaneous cholecystostomy
tube placed on [**5-16**] after elective intubation for respiratory
distress. He underwent an [**Month/Year (2) **] which revealed a compacted
ampullary stone, likely cholangitis and possible CBD stone; a
biliary stent was placed.

He had post procedure hypotension and SIRS with progressive low
grade fever, elevated WBC and a pressor requirement and he
remained intubated. He spiked to 101.5 and was pan cultured on
[**5-18**]. Sputum from that date ultimately grew MRSA.

Neuro: The patient was initially sedated with fentanyl and
propofol as needed.  [**6-1**]: APS consult, started ketamine infusion
for acute gout flare.  PO Dilaudid started and fentanyl patch
started [**6-7**].  Fentanyl drip stopped [**6-10**].  For pain control, the
patient continued on a fentanyl patch, tylenol liquid and PO
dilaudid.

Cardiovascular: initially started on cardizem on arrival to ICU
but this was changed to levophed for hypotension.  The levophed
was titrated to a goal MAP >60.  Throughout his stay in the ICU,
his blood pressure and heart rate were treated intermittently
with neo, levo, lopressor, and IVF boluses.  Midodrine started
[**6-12**].  He was eventually weaned off all pressors on [**6-19**].  He
continued on metoprolol digoxin 0.125mg PO daily for rate
control.  A heparin drip was started on [**6-18**] for anticoagulation
for atrial fibrillation with a goal PTT of 60-80 until
therapeutic on coumadin.  Coumadin was started on [**6-19**] at low
doses with an INR goal of [**3-4**].  Lovenox was started on day of
discharge as a bridge to a therapeutic INR.

Pulmonary:  The patient was intubated on [**5-16**] for respiratory
distress.  He underwent a tracheostomy on [**5-28**].  The patient
continued on the ventilator and was weaned to a trach collar on
[**6-11**].  Pulmonary toilet continued with intermittent ventilator
support as needed.

GI: [**5-18**] dobbhoff feeding tube placed and enteral nutrition
started.  Nutren Renal full strength with beneprotein 40gm/day,
banana flakes 3 packets per day tube feedings continued at goal
rate of 40ml/hr.

GU: Foley catheter placed on admission.  A sore on the meatus
was noted.  Urology was consulted and recommended changing
position of the foley daily, changing the foley every six weeks
and appyling bacitracin ointment daily. [**6-7**]: Foley changed

FEN: The patient was initially started on IV lasix for fluid
overload and was dosed prn.  CVVH started on [**5-29**] for fluid
overload. It continued for a goal of 50-100ml/hr and eventually
stopped [**6-8**].  Lasix continued as a drip for a goal of keeping
the fluid balance even.  The lasix drip was stopped on day of
discharge and PO lasix was started.

Rheumatology :  consulted on [**5-23**] for acute, painful flare of
gout.  Colchicine and indocin were both used for treatment of
gout.

Endocrine: insulin drip was used prn to control blood sugars
followed by an insulin sliding scale.

ID: Vanc/zosyn started on [**5-17**] for MRSA PNA and biliary tract
coverage.  Changed to Linezolid/zosyn on [**5-23**].  [**5-28**] zosyn
discontinued and cipro and flagyl added. [**5-30**] flagyl and cipro
d/c.  Linezolid was discontinued on [**6-12**]
[**6-6**]: started Meropenem, urine cx positive for E.Coli.  Meropenem
was discontinued on [**6-15**].  Flagyl started on [**6-19**] empirically
for c diff colitis.

Medications on Admission:
celebrex 200', coumadin 2.5/5 alternating', wellbutrin ER 100',
protonix 40', lasix 160', potassium 20', crestor 5', carbidopa
25/100''', flomax 0.4', glipizide 5'', colchicine 10.6 q2d,
trazadone 100', [**Doctor First Name 130**] 180', sotalol 80'', digoxin 0.125 q2d,
xalatan 1 drop L eye', lidoderm [**1-31**] patch'

Discharge Medications:
1. Metronidazole 500 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO TID (3
times a day) for 7 days.
Disp:*21 Tablet(s)* Refills:*0*
2. Colchicine 0.6 mg Tablet [**Month/Day (2) **]: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Coumadin 3 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO once a day: goal
INR [**3-4**]
Dose daily.
Disp:*30 Tablet(s)* Refills:*2*
4. Carbidopa-Levodopa 25-100 mg Tablet [**Month/Day (3) **]: One (1) Tablet PO
TID (3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Month/Day (3) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
6. Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (3) **]: Ten (10) ml PO BID (2
times a day).
Disp:*600 ml* Refills:*2*
7. Bacitracin Zinc 500 unit/g Ointment [**Month/Day (3) **]: One (1) Appl Topical
[**Hospital1 **] (2 times a day).
Disp:*1 tube* Refills:*2*
8. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*30 Tablet(s)* Refills:*0*
9. Digoxin 125 mcg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Trazodone 50 mg Tablet [**Hospital1 **]: 1.5 Tablets PO HS (at bedtime)
as needed.
Disp:*60 Tablet(s)* Refills:*0*
11. Indomethacin 25 mg Capsule [**Hospital1 **]: Two (2) Capsule PO TID (3
times a day).
Disp:*180 Capsule(s)* Refills:*2*
12. Fentanyl 75 mcg/hr Patch 72 hr [**Hospital1 **]: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
Disp:*10 Patch 72 hr(s)* Refills:*2*
13. Chlorhexidine Gluconate 0.12 % Mouthwash [**Hospital1 **]: Fifteen (15)
ML Mucous membrane [**Hospital1 **] (2 times a day): Use only if patient is
on mechanical ventilation.
Disp:*400 ML(s)* Refills:*0*
14. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
Disp:*30 Tablet,Rapid Dissolve, DR(s)* Refills:*2*
15. Latanoprost 0.005 % Drops [**Last Name (STitle) **]: One (1) Drop Ophthalmic HS
(at bedtime).
Disp:*20 ml* Refills:*2*
16. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Two (2)
Puff Inhalation QID (4 times a day).
Disp:*1 unit* Refills:*2*
17. Acetaminophen 160 mg/5 mL Solution [**Last Name (STitle) **]: Six [**Age over 90 1230**]y
(650) mg PO Q6H (every 6 hours).
Disp:*500 ml* Refills:*2*
18. Levothyroxine Sodium 50 mcg IV DAILY
19. Albuterol 90 mcg/Actuation Aerosol [**Age over 90 **]: 1-2 Puffs Inhalation
Q6H (every 6 hours).
Disp:*1 unit* Refills:*2*
20. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Age over 90 **]:
One (1) Adhesive Patch, Medicated Topical Q24H (every 24 hours)
as needed for pain for 7 days.
Disp:*7 Adhesive Patch, Medicated(s)* Refills:*0*
21. Lorazepam 0.5 mg Tablet [**Age over 90 **]: 1-2 Tablets PO Q6H (every 6
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
22. Bupropion 75 mg Tablet [**Age over 90 **]: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
23. Erythromycin 5 mg/g Ointment [**Age over 90 **]: 0.5 in Ophthalmic QID (4
times a day).
Disp:*60 in* Refills:*2*
24. Metoprolol Tartrate 5 mg IV Q6H:PRN AFIB / RVR
25. Sodium Chloride 0.9%  Flush 10 mL IV PRN line flush
Temporary Central Access-ICU: Flush with 10mL Normal Saline
daily and PRN.
26. Furosemide 40 mg Tablet [**Age over 90 **]: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*2*
27. Enoxaparin 100 mg/mL Syringe [**Age over 90 **]: One Hundred (100) mg
Subcutaneous Q 12H (Every 12 Hours): until therapeutic on
coumadin (INR [**3-4**]) then may d/c lovenox.
Disp:*25 syringes* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 100**] Senior Life

Discharge Diagnosis:
Acute cholangitis
Gall Stone Pancreatitis
Respiratory Failure- MRSA Pneumoniae
Gout
Acute on Chronic Renal Failure
Congestive Heart Failure (LVEF > 55%)
Atrial Fibrillation
Coronary Artery Disease
Parkinson's Disease
Diverticulosis


Discharge Condition:
Fair


Discharge Instructions:
Please call your surgeon or return to the emergency room if you
have a fever greater than 101.5, chills, nausea, vomiting, chest
pain, shortness of breath, if your skin becomes yellow-tinged or
any other symptom that should worry you.

Please take all medications as prescribed.

Continue to wean off the vent as tolerated.

You are being discharged on blood thinners, you must have your
PT, PTT checked daily and have your coumadin dosed daily for an
INR goal of [**3-4**].  The heparin drip may stop once your INR is at
a therapeutic level.

Speech and swallow should assess for PMV placement and swallow
evaluation.

Please change position of Foley catheter qdaily to avoid further
erosion; bacitracin to meatus TID for lubrication and topical
antibiosis and we would recommend Foley change every 6 weeks.

You will need to stop the coumadin 5 days prior to your [**Date Range **] on
[**2125-7-19**].  Therefore, do not take your coumadin dose on [**7-29**], [**7-16**], [**7-17**], [**7-18**].

Followup Instructions:
Please call the office of Dr. [**Last Name (STitle) **] to make a follow up
appointment in [**3-4**] weeks at [**Telephone/Fax (1) 3201**]

Please call your cardiologist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] to make a follow
up appointment in [**3-4**] weeks. ([**Telephone/Fax (1) 5455**]

Please call rheumatology to make a follow-up appointment in [**3-4**]
weeks with Dr [**First Name (STitle) **]  at [**Telephone/Fax (1) 2226**]

Previously Scheduled Appointments:

Provider: [**Name Initial (NameIs) **] 2 (ST-4) GI ROOMS Date/Time:[**2125-7-19**] 10:00
Provider: [**Name10 (NameIs) 1948**] [**Last Name (NamePattern4) 1949**], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2125-7-19**] 10:00
{'Cholangitis,Acute pancreatitis,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified septicemia,Severe sepsis,Urinary tract infection, site not specified,Calculus of bile duct with acute cholecystitis, with obstruction,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Paralysis agitans,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric),Chronic kidney disease, unspecified,Infection with microorganisms resistant to penicillins,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Congestive heart 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: 84 year old male with multiple medical problems including
diabetes, CAD, CHF, CRI who is admitted with cholangitis.

PRESENT ILLNESS: Patient came to the ER with three days of right upper quadrant
pain. In ER was found to be afebrile but a CT of the abdomen was
suggestive of gall bladder pathology. He was admitted and
started on broad spectrum antibiotics with
Vancomycin/levo/flagyl administered in the ER. He had a
percutaneous cholecystostomy tube placed on [**5-16**] after elective
intubation for respiratory
distress. He underwent an [**Month/Year (2) **] which revealed a compacted
ampullary stone, likely cholangitis and possible CBD stone; a
biliary stent was placed.

MEDICAL HISTORY: 1. CAD, cath 5 years ago at NEBH (cardiologist [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **])
2. CHF, TTE [**3-5**] w/depressed EF
3. Hypertension, per daughter pt's bp usually 90s-100s on meds
4. Severe Lumbar Spinal stenosis, mild cervical stenosis
5. Sleep apnea, on 2L home O2 at night
6. Afib, s/p DCCV which failed, now rate controlled
7. Arthritis
8. Gout
9. COPD
10. NIDDM
11. E-coli-Sepsis (admission [**2122-12-23**] - [**2123-1-1**])
12. BPH
13. Parkinson's disease

MEDICATION ON ADMISSION: celebrex 200', coumadin 2.5/5 alternating', wellbutrin ER 100',
protonix 40', lasix 160', potassium 20', crestor 5', carbidopa
25/100''', flomax 0.4', glipizide 5'', colchicine 10.6 q2d,
trazadone 100', [**Doctor First Name 130**] 180', sotalol 80'', digoxin 0.125 q2d,
xalatan 1 drop L eye', lidoderm [**1-31**] patch'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 100.4  P: 64  R: 16-20 BP: 96/62
General: resp distress, acute pain, alert and oriented times
three
HEENT:	Mucous membranes moist
Neck: Supple without LAD
Cardiovascular: Irregular S1 S2
Respiratory: Diffuse wheezes throughout; decreased breath sounds
at right base
Gastrointestinal: Soft, NT, ND bowel sounds normal and active
Musculoskeletal: Knees swollen and warm bilaterally with
effusion
L>R,left elbow warm and swollen
Skin: Multiple eccymoses

FAMILY HISTORY: Notable for CAD, HTN, and stroke.

SOCIAL HISTORY: Patient uses a cane for assistance at baseline. He lives with
his daughter [**Name (NI) 13118**]. Formerly worked at Sears. Widowed. No tobacco
or EtOH use. 

### Response:
{'Cholangitis,Acute pancreatitis,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified septicemia,Severe sepsis,Urinary tract infection, site not specified,Calculus of bile duct with acute cholecystitis, with obstruction,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Paralysis agitans,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric),Chronic kidney disease, unspecified,Infection with microorganisms resistant to penicillins,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Congestive heart failure, unspecified'}
