CHIEF COMPLAINT: hypoxemia

PRESENT ILLNESS: Ms. [**Known lastname **] is a 53yo female with pmhx of T1-T2 paraplegia,
frequent admissions for pna and UTI, chronically on 2L NC at
home for COPD. She is presenting for increasing oxygen
requirement, cough. Her baseline is 90-95% on 2L and she
desatted to the 85% on 5L and was satting in the 80s on Venturi
mask. The patient's PCA attempted nebs and chest PT without
improvement this am so brought her into the hospital. She had
developed an increased oxygen requirement starting 2 days prior
to admission and had slowly increased to 5L at time of
presentation. The patient denies shortness of breath and says
that she feels well. She also denies fevers. She denies chest
pain and abdominal pain. She denies fevers (she did have low
grade fevers last week when she was dx with UTI but not over the
weekend). She does say that she has been having productive cough
and an associated sore throat. She does endorse wheezing.
.
Of note, she presented to the ED on [**2-23**] with c/o aspiration on
[**2-22**] and productive cough. At that time, her CXR looked
non-infected and unchanged from prior but her UA was positive.
Given her frequent resistant UTIs, she was started on cefepime
[**Hospital1 **] for 7 days (day 1 [**2-23**]). She continued to spike low grade
fevers to 99.5 and complained of incontinence and large volumes
of urine even while on abx. This resolved by 4 days prior to
admission and she reports that her urinary function has returned
back to her baseline.
.
In the ED, initial VS were:  107/59 HR 83 99% ON NRB with RR of
14. CVL in place. She was started on Combivent x3 and Solumedrol
125mg. A CXR revealed worsening RLL infiltrate. She received
levofloxacin, vancomycin, and flagyl, she had been receiving
cefepime for UTI. In the ED, she was placed on NRB satting 97%.
Her hematocrit was noted to be 28.1, which is her baseline.
.
On arrival to the MICU,  the patient is satting 95% on face mask
12L O2. She appears comfortable but is anxious and easily
tearful. She endorses chronic bilateral foot pain, which has
been ongoing but is otherwise comfortable. She does endorse nose
congestion. She also endorses constipation, with last BM on
Tuesday (6 days ago).
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea. Denies
cough, shortness of breath, or wheezing. Denies chest pain,
chest pressure, palpitations, or weakness. Denies nausea,
vomiting, diarrhea, constipation, abdominal pain, or changes in
bowel habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias. Denies rashes or skin changes.

MEDICAL HISTORY: #T1 to T2 paraplegia status post a motor vehicle accident.
#Recurrent pneumonia (followed by pulm - Last [**2149-4-9**])
- Per pulm, recurrent pneumonia likely from pulmonary toilet
issues secondary to neuromuscular disease with improvement with
consistent and aggressive bronchopulmonary therapy.
- Prior sputum cultures + for MRSA, pan-sensitive Klebsiella,
and Pseudomonas.
#Recurrent UTIs in the setting of urinary retention requiring
straight catheterization
#COPD
#Hx Pres syndrome
#hepatitis C
#anxiety
#DVT in [**2142**] -IVC filter placed in [**2142**]
#Pulmonary nodules
#Hypothyroidism
#Chronic pain
#Chronic gastritis
#Anemia of chronic disease
#S/p PEA arrest during hospitalization in [**2147-10-3**]

MEDICATION ON ADMISSION: 1. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Year (4 digits) **]: One (1) neb Inhalation q4-6hrs PRN as needed
for shortness of breath or wheezing.
2. citalopram 20 mg Tablet [**Year (4 digits) **]: Two (2) Tablet PO DAILY (Daily).

ALLERGIES: Ativan

PHYSICAL EXAM: ADMISSION EXAM
Vitals: T: 96 BP: 104/72 P: 78 R: 18 O2: 95% on NRB 12L
General: Alert, oriented, easily tearful and anxious. Obese and
appears older than stated age. Mild respiratory distress.
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP difficult to assess, no LAD
CV: Regular rate and rhythm, normal S1 + S2, difficult to assess
secondary to lung sounds
Lungs: diffuse expiratory wheezes, crackles bilaterally with
increased egophany and whispered pectriloquy at bases, dullness
to percussion at bases. No use of accessory muscles. No
tachypnea.
Abdomen: soft, non-tender, obese, bowel sounds present
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper extremities, grossly
normal sensation UE. No movement, no strength, no sensation
below T4 bilaterally.

FAMILY HISTORY: Mother passed away with lung disease.

SOCIAL HISTORY: Lives at home with husband and 2 adolescent children.
- Tobacco: 35-pack-years, now quit.
- Alcohol: Denies.
- Illicits: Denies.
Pneumonia, organism unspecified,Acidosis,Foreign body in larynx,Paraplegia,Late effect of spinal cord injury,Chronic hepatitis C without mention of hepatic coma,Chronic airway obstruction, not elsewhere classified,Foreign body accidentally entering other orifice,Late effects of motor vehicle accident,Constipation, unspecified,Dysthymic disorder,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Other diseases of lung, not elsewhere classified,Other chronic pain,Anemia of other chronic disease,Pain in limb,Pain in joint, shoulder region
Pneumonia, organism NOS,Acidosis,Foreign body in larynx,Paraplegia NOS,Late eff spinal cord inj,Chrnc hpt C wo hpat coma,Chr airway obstruct NEC,FB entering oth orifice,Late eff motor vehic acc,Constipation NOS,Dysthymic disorder,Hypothyroidism NOS,Atrph gastrtis w/o hmrhg,Other lung disease NEC,Chronic pain NEC,Anemia-other chronic dis,Pain in limb,Joint pain-shlder
Admission Date:  [**2150-3-2**]              Discharge Date:   [**2150-3-4**]

Date of Birth:  [**2096-10-22**]             Sex:   F

Service: MEDICINE

Allergies:
Ativan

Attending:[**First Name3 (LF) 3151**]
Chief Complaint:
hypoxemia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname **] is a 53yo female with pmhx of T1-T2 paraplegia,
frequent admissions for pna and UTI, chronically on 2L NC at
home for COPD. She is presenting for increasing oxygen
requirement, cough. Her baseline is 90-95% on 2L and she
desatted to the 85% on 5L and was satting in the 80s on Venturi
mask. The patient's PCA attempted nebs and chest PT without
improvement this am so brought her into the hospital. She had
developed an increased oxygen requirement starting 2 days prior
to admission and had slowly increased to 5L at time of
presentation. The patient denies shortness of breath and says
that she feels well. She also denies fevers. She denies chest
pain and abdominal pain. She denies fevers (she did have low
grade fevers last week when she was dx with UTI but not over the
weekend). She does say that she has been having productive cough
and an associated sore throat. She does endorse wheezing.
.
Of note, she presented to the ED on [**2-23**] with c/o aspiration on
[**2-22**] and productive cough. At that time, her CXR looked
non-infected and unchanged from prior but her UA was positive.
Given her frequent resistant UTIs, she was started on cefepime
[**Hospital1 **] for 7 days (day 1 [**2-23**]). She continued to spike low grade
fevers to 99.5 and complained of incontinence and large volumes
of urine even while on abx. This resolved by 4 days prior to
admission and she reports that her urinary function has returned
back to her baseline.
.
In the ED, initial VS were:  107/59 HR 83 99% ON NRB with RR of
14. CVL in place. She was started on Combivent x3 and Solumedrol
125mg. A CXR revealed worsening RLL infiltrate. She received
levofloxacin, vancomycin, and flagyl, she had been receiving
cefepime for UTI. In the ED, she was placed on NRB satting 97%.
Her hematocrit was noted to be 28.1, which is her baseline.
.
On arrival to the MICU,  the patient is satting 95% on face mask
12L O2. She appears comfortable but is anxious and easily
tearful. She endorses chronic bilateral foot pain, which has
been ongoing but is otherwise comfortable. She does endorse nose
congestion. She also endorses constipation, with last BM on
Tuesday (6 days ago).
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea. Denies
cough, shortness of breath, or wheezing. Denies chest pain,
chest pressure, palpitations, or weakness. Denies nausea,
vomiting, diarrhea, constipation, abdominal pain, or changes in
bowel habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias. Denies rashes or skin changes.


Past Medical History:
#T1 to T2 paraplegia status post a motor vehicle accident.
#Recurrent pneumonia (followed by pulm - Last [**2149-4-9**])
- Per pulm, recurrent pneumonia likely from pulmonary toilet
issues secondary to neuromuscular disease with improvement with
consistent and aggressive bronchopulmonary therapy.
- Prior sputum cultures + for MRSA, pan-sensitive Klebsiella,
and Pseudomonas.
#Recurrent UTIs in the setting of urinary retention requiring
straight catheterization
#COPD
#Hx Pres syndrome
#hepatitis C
#anxiety
#DVT in [**2142**] -IVC filter placed in [**2142**]
#Pulmonary nodules
#Hypothyroidism
#Chronic pain
#Chronic gastritis
#Anemia of chronic disease
#S/p PEA arrest during hospitalization in [**2147-10-3**]


Social History:
Lives at home with husband and 2 adolescent children.
- Tobacco: 35-pack-years, now quit.
- Alcohol: Denies.
- Illicits: Denies.


Family History:
Mother passed away with lung disease.

Physical Exam:
ADMISSION EXAM
Vitals: T: 96 BP: 104/72 P: 78 R: 18 O2: 95% on NRB 12L
General: Alert, oriented, easily tearful and anxious. Obese and
appears older than stated age. Mild respiratory distress.
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP difficult to assess, no LAD
CV: Regular rate and rhythm, normal S1 + S2, difficult to assess
secondary to lung sounds
Lungs: diffuse expiratory wheezes, crackles bilaterally with
increased egophany and whispered pectriloquy at bases, dullness
to percussion at bases. No use of accessory muscles. No
tachypnea.
Abdomen: soft, non-tender, obese, bowel sounds present
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper extremities, grossly
normal sensation UE. No movement, no strength, no sensation
below T4 bilaterally.


Pertinent Results:
ADMISSION LABS

[**2150-3-2**] 01:20PM BLOOD WBC-5.3 RBC-3.37* Hgb-8.7* Hct-28.1*
MCV-83 MCH-25.8* MCHC-31.0 RDW-16.2* Plt Ct-178
[**2150-3-2**] 01:20PM BLOOD Neuts-80.3* Lymphs-14.2* Monos-4.0
Eos-0.3 Baso-1.1
[**2150-3-2**] 01:20PM BLOOD UreaN-7 Creat-0.4 Na-136 K-3.6 Cl-93*
HCO3-38* AnGap-9
[**2150-3-3**] 03:02AM BLOOD Calcium-9.0 Phos-2.6* Mg-2.2
[**2150-3-2**] 01:24PM BLOOD Lactate-0.8 K-3.6

PERTINENT STUDIES
CXR [**2150-3-2**] 1. Right middle and possibly lower lobe
consolidation consistent with pneumonia.
2. Pneumonia involving the left lower lobe cannot be entirely
excluded.
2. Stable severe cardiomegaly with a right-sided predominance.



Brief Hospital Course:
Ms. [**Known lastname **] is a 53yo female with hx of T1/T2 paraplegia, frequent
UTI/aspiration pneumonias who is presenting with hypoxemia,
cough, multilobar peumonia. The patient did not have a
leukocytosis and was afebrile but she was requiring 10L on face
mask to maintain oxygenation. Her CXR revealed multilobar
pneumonia and the patient endorsed previous history of
aspiration one week prior to presentation. She had MRSA positive
sputum in [**2149-12-2**] so she was started on Vanc, and given
her hx of aspiration, she was also started on Zosyn. She
received nebs and was able to wean her oxygen requirement to 2L
NC, which is her baseline home requirement. The patient had been
to the ED the week prior and was found to have positive UA, no
UCx was sent at the time, and she was started on IV cefepime
based on sensitivies from previous UTIs, she had completed 6 out
of 7 days of cefepime at time of presentation and was
transitioned to Zosyn, as above. The patient has a PICC line and
she was discharged to complete an 8 day course of antibiotics.
On discharge, the patient was on her home O2 requirement.

Medications on Admission:
1. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Year (4 digits) **]: One (1) neb Inhalation q4-6hrs PRN as needed
for shortness of breath or wheezing.
2. citalopram 20 mg Tablet [**Year (4 digits) **]: Two (2) Tablet PO DAILY (Daily).

3. baclofen 10 mg Tablet [**Year (4 digits) **]: Two (2) Tablet PO BID (2 times a
day).
4. baclofen 10 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO q4pm
5. clonazepam 1 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO TID (3 times a
day) PRN anxiety.
6. levothyroxine 112 mcg Tablet [**Year (4 digits) **]: One (1) Tablet PO DAILY
(Daily).
7. trazodone 100 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.
8. sucralfate 1 gram liquid [**Year (4 digits) **]: One (1) Tablet PO QID (4 times
a day).
9. simvastatin 10 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO DAILY
(Daily).
10. Combivent 18-103 mcg/Actuation Aerosol [**Year (4 digits) **]: Two (2) puffs
Inhalation three times a day PRN wheezing.
11. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Year (4 digits) **]:
three (3) Adhesive Patch, Medicated Topical qhs: one
patch per leg and one on shoulder blade .
12. oxybutynin chloride 5 mg Tablet [**Year (4 digits) **]: Two (2) Tablet PO BID
(2 times a day).
13. oxybutynin chloride 5 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO q4pm
14. oxycodone 5 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO three times a
day PRN pain.
15. pregabalin 100 mg Capsule [**Year (4 digits) **]: One (1) Capsule PO TID (3
times a day).
16. omeprazole 20 mg Capsule, Delayed Release(E.C.) [**Year (4 digits) **]: One (1)

Capsule, Delayed Release(E.C.) PO BID (2 times a day).
17. polyethylene glycol 3350 17 gram/dose Powder [**Year (4 digits) **]: Seventeen
(17) gram PO DAILY (Daily) as needed for constipation.
18. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
[**Year (4 digits) **]: One (1) Tablet, Chewable PO BID (2 times a day).
19. methadone 5 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO TID (3 times a
day)

Discharge Medications:
1. vancomycin 1,000 mg Recon Soln [**Year (4 digits) **]: One (1) gram Intravenous
every twelve (12) hours for 5 days.
Disp:*qs qs* Refills:*0*
2. Zosyn 4.5 gram Recon Soln [**Year (4 digits) **]: 4.5 gram Intravenous every
eight (8) hours for 5 days.
Disp:*qs qs* Refills:*0*
3. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Year (4 digits) **]: One (1) neb Inhalation every 4-6 hours as
needed for shortness of breath or wheezing.
4. citalopram 20 mg Tablet [**Year (4 digits) **]: Two (2) Tablet PO DAILY (Daily).

5. baclofen 10 mg Tablet [**Year (4 digits) **]: Two (2) Tablet PO BID (2 times a
day).
6. baclofen 10 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO Q1600 ().
7. clonazepam 1 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO TID (3 times a
day) as needed for anxiety.
8. levothyroxine 112 mcg Tablet [**Year (4 digits) **]: One (1) Tablet PO DAILY
(Daily).
9. trazodone 100 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.
10. sucralfate 1 gram Tablet [**Year (4 digits) **]: One (1) Tablet PO QID (4 times
a day): Take 2 hrs before other meds.
11. simvastatin 10 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO DAILY
(Daily).
12. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated [**Year (4 digits) **]:
Three (3) Adhesive Patch, Medicated Topical DAILY (Daily): 1 to
each leg, 1 to shoulder blade.
13. oxybutynin chloride 5 mg Tablet [**Year (4 digits) **]: Two (2) Tablet PO BID
(2 times a day).
14. oxybutynin chloride 5 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO Q1600
().
15. oxycodone 5 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO three times a
day as needed for pain.
16. pregabalin 100 mg Capsule [**Year (4 digits) **]: One (1) Capsule PO TID (3
times a day).
17. omeprazole 20 mg Capsule, Delayed Release(E.C.) [**Year (4 digits) **]: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
18. polyethylene glycol 3350 17 gram/dose Powder [**Year (4 digits) **]: One (1)
packet PO DAILY (Daily).
19. methadone 5 mg Tablet [**Year (4 digits) **]: One (1) Tablet PO TID (3 times a
day).
20. calcium carbonate  Oral
21. Combivent 18-103 mcg/actuation Aerosol [**Year (4 digits) **]: Two (2) puffs
Inhalation three times a day as needed for shortness of breath
or wheezing.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Hospital Acquired Pneumonia
Hypoxemic respiratory distress


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Lethargic but arousable.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
You were admitted to the hospital with respiratory distress and
an increasing O2 requirement. In the hospital, we saw that you
had developed a multifocal pneumonia. For this, we started broad
antibiotics with Vancomycin and Zosyn. You will need to complete
an 8 day course of these medications. All of your other
medications will remain the same.

Followup Instructions:
Department: [**Hospital3 249**]
When: TUESDAY [**2150-3-10**] at 11:00 AM
With: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 1114**], M.D. [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Pneumonia, organism unspecified,Acidosis,Foreign body in larynx,Paraplegia,Late effect of spinal cord injury,Chronic hepatitis C without mention of hepatic coma,Chronic airway obstruction, not elsewhere classified,Foreign body accidentally entering other orifice,Late effects of motor vehicle accident,Constipation, unspecified,Dysthymic disorder,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Other diseases of lung, not elsewhere classified,Other chronic pain,Anemia of other chronic disease,Pain in limb,Pain in joint, shoulder region'}


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: hypoxemia

PRESENT ILLNESS: Ms. [**Known lastname **] is a 53yo female with pmhx of T1-T2 paraplegia,
frequent admissions for pna and UTI, chronically on 2L NC at
home for COPD. She is presenting for increasing oxygen
requirement, cough. Her baseline is 90-95% on 2L and she
desatted to the 85% on 5L and was satting in the 80s on Venturi
mask. The patient's PCA attempted nebs and chest PT without
improvement this am so brought her into the hospital. She had
developed an increased oxygen requirement starting 2 days prior
to admission and had slowly increased to 5L at time of
presentation. The patient denies shortness of breath and says
that she feels well. She also denies fevers. She denies chest
pain and abdominal pain. She denies fevers (she did have low
grade fevers last week when she was dx with UTI but not over the
weekend). She does say that she has been having productive cough
and an associated sore throat. She does endorse wheezing.
.
Of note, she presented to the ED on [**2-23**] with c/o aspiration on
[**2-22**] and productive cough. At that time, her CXR looked
non-infected and unchanged from prior but her UA was positive.
Given her frequent resistant UTIs, she was started on cefepime
[**Hospital1 **] for 7 days (day 1 [**2-23**]). She continued to spike low grade
fevers to 99.5 and complained of incontinence and large volumes
of urine even while on abx. This resolved by 4 days prior to
admission and she reports that her urinary function has returned
back to her baseline.
.
In the ED, initial VS were:  107/59 HR 83 99% ON NRB with RR of
14. CVL in place. She was started on Combivent x3 and Solumedrol
125mg. A CXR revealed worsening RLL infiltrate. She received
levofloxacin, vancomycin, and flagyl, she had been receiving
cefepime for UTI. In the ED, she was placed on NRB satting 97%.
Her hematocrit was noted to be 28.1, which is her baseline.
.
On arrival to the MICU,  the patient is satting 95% on face mask
12L O2. She appears comfortable but is anxious and easily
tearful. She endorses chronic bilateral foot pain, which has
been ongoing but is otherwise comfortable. She does endorse nose
congestion. She also endorses constipation, with last BM on
Tuesday (6 days ago).
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea. Denies
cough, shortness of breath, or wheezing. Denies chest pain,
chest pressure, palpitations, or weakness. Denies nausea,
vomiting, diarrhea, constipation, abdominal pain, or changes in
bowel habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias. Denies rashes or skin changes.

MEDICAL HISTORY: #T1 to T2 paraplegia status post a motor vehicle accident.
#Recurrent pneumonia (followed by pulm - Last [**2149-4-9**])
- Per pulm, recurrent pneumonia likely from pulmonary toilet
issues secondary to neuromuscular disease with improvement with
consistent and aggressive bronchopulmonary therapy.
- Prior sputum cultures + for MRSA, pan-sensitive Klebsiella,
and Pseudomonas.
#Recurrent UTIs in the setting of urinary retention requiring
straight catheterization
#COPD
#Hx Pres syndrome
#hepatitis C
#anxiety
#DVT in [**2142**] -IVC filter placed in [**2142**]
#Pulmonary nodules
#Hypothyroidism
#Chronic pain
#Chronic gastritis
#Anemia of chronic disease
#S/p PEA arrest during hospitalization in [**2147-10-3**]

MEDICATION ON ADMISSION: 1. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Year (4 digits) **]: One (1) neb Inhalation q4-6hrs PRN as needed
for shortness of breath or wheezing.
2. citalopram 20 mg Tablet [**Year (4 digits) **]: Two (2) Tablet PO DAILY (Daily).

ALLERGIES: Ativan

PHYSICAL EXAM: ADMISSION EXAM
Vitals: T: 96 BP: 104/72 P: 78 R: 18 O2: 95% on NRB 12L
General: Alert, oriented, easily tearful and anxious. Obese and
appears older than stated age. Mild respiratory distress.
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP difficult to assess, no LAD
CV: Regular rate and rhythm, normal S1 + S2, difficult to assess
secondary to lung sounds
Lungs: diffuse expiratory wheezes, crackles bilaterally with
increased egophany and whispered pectriloquy at bases, dullness
to percussion at bases. No use of accessory muscles. No
tachypnea.
Abdomen: soft, non-tender, obese, bowel sounds present
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper extremities, grossly
normal sensation UE. No movement, no strength, no sensation
below T4 bilaterally.

FAMILY HISTORY: Mother passed away with lung disease.

SOCIAL HISTORY: Lives at home with husband and 2 adolescent children.
- Tobacco: 35-pack-years, now quit.
- Alcohol: Denies.
- Illicits: Denies. 

### Response:
{'Pneumonia, organism unspecified,Acidosis,Foreign body in larynx,Paraplegia,Late effect of spinal cord injury,Chronic hepatitis C without mention of hepatic coma,Chronic airway obstruction, not elsewhere classified,Foreign body accidentally entering other orifice,Late effects of motor vehicle accident,Constipation, unspecified,Dysthymic disorder,Unspecified acquired hypothyroidism,Atrophic gastritis, without mention of hemorrhage,Other diseases of lung, not elsewhere classified,Other chronic pain,Anemia of other chronic disease,Pain in limb,Pain in joint, shoulder region'}
