CHIEF COMPLAINT: Headache, nausea and vomiting

PRESENT ILLNESS: Pt is a 68 y/o F with a hx of HTN, renal failure s/p transplant,
TIA (R sided numbness and slurred speech, now resolved) who
presents with acute onset headache, nausea, vomiting, found to
have hemorrhage in the corpus callosum with extension into the
ventricles.

MEDICAL HISTORY: -Hypertension (BP 115-170 at home per pt)
-TIA in her 30s- she remembers she "couldn't speak clearly" and
had R sided numbness, resolved after a few days, ? L sided
aneurysm per pt, no intervention.
-Renal Transplant in [**2172**]
-Hyperlipidemia
-Osteoporosis
-R knee replacement

MEDICATION ON ADMISSION: Neoral 100/75
Prednisone 5 QD
Septra 400-80 QD
ASA 81 mg QD
Prevacid 30 [**Hospital1 **]
Clonidine 0.3 [**Hospital1 **]
Metoprolol 100 [**Hospital1 **]
Lasix 20 QD
Cellcept [**Pager number **] VID
Vitamin D
Niacin 1000 mg Qpm
Simvastatin 20 mg Qpm

ALLERGIES: Vancomycin / Morphine / Penicillins

PHYSICAL EXAM: Exam on Admission:
T- 96.6 BP- 190/88 HR- 64 RR- 14 O2Sat- 100% on 2L
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: decreased ROM with head turning R and L
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Daughter with thyroid CA, mother with lymphoma, father with
DM, sister with leukemia, niece with breast CA, MGM and PGM with
strokes

SOCIAL HISTORY: Lives with daughter, on disability, no current tobacco use (quit
15 years ago, smoked 30 years prior), very occasional EtOH.
Intracerebral hemorrhage,Acute kidney failure, unspecified,Kidney replaced by transplant,Urinary tract infection, site not specified,Unspecified essential hypertension,Osteoporosis, unspecified
Intracerebral hemorrhage,Acute kidney failure NOS,Kidney transplant status,Urin tract infection NOS,Hypertension NOS,Osteoporosis NOS
Admission Date:  [**2182-4-15**]              Discharge Date:   [**2182-4-27**]

Date of Birth:  [**2113-12-18**]             Sex:   F

Service: NEUROLOGY

Allergies:
Vancomycin / Morphine / Penicillins

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Headache, nausea and vomiting

Major Surgical or Invasive Procedure:
Cerebral angiogram [**4-26**]


History of Present Illness:
Pt is a 68 y/o F with a hx of HTN, renal failure s/p transplant,
TIA (R sided numbness and slurred speech, now resolved) who
presents with acute onset headache, nausea, vomiting, found to
have hemorrhage in the corpus callosum with extension into the
ventricles.

She reports she was trying to go to sleep around midnight last
night when she suddenly developed a severe headache.  She
describes this as an aching, pressure between her shoulder
blades, in the back of her neck, and more diffusely in her head.
 It was not pounding and was [**9-13**] in severity.  She tried
taking Tylenol, had her daughter massage [**Name2 (NI) 78594**] balm on her neck,
and put
some cold compresses on it, but it got no better.  She finally
decided to present to the ED in [**Hospital1 **] around 4:30.  There head
CT was performed and showed an area of hemorrhage in the L
frontal lobe with extension into the corpus callosum and into
the ventricles on the right.  There was no evidence of
hydrocephalus, and she had a normal neurologic exam.  She
vomited several times
there (she estimates [**3-9**]) and received several anti-emetics.
She was transferred here for further evaluation.

On ROS she denies any other focal neurologic symptoms such as
diplopia, blurry vision, vision loss, facial droop, dysarthria,
dysphagia, confusion, word finding difficulties, problems with
comprehension of speech, back pain, weakness, numbness, or
tingling in her arms or legs, dizziness, vertigo, or bowel or
bladder incontinence.


Past Medical History:
-Hypertension (BP 115-170 at home per pt)
-TIA in her 30s- she remembers she "couldn't speak clearly" and
had R sided numbness, resolved after a few days, ? L sided
aneurysm per pt, no intervention.
-Renal Transplant in [**2172**]
-Hyperlipidemia
-Osteoporosis
-R knee replacement


Social History:
Lives with daughter, on disability, no current tobacco use (quit
15 years ago, smoked 30 years prior), very occasional EtOH.


Family History:
Daughter with thyroid CA, mother with lymphoma, father with
DM, sister with leukemia, niece with breast CA, MGM and PGM with
strokes


Physical Exam:
Exam on Admission:
T- 96.6 BP- 190/88 HR- 64 RR- 14 O2Sat- 100% on 2L
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: decreased ROM with head turning R and L
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
Mental status: Awake and alert, cooperative with exam, normal
affect.  Oriented to person, place, and date.  Attentive, says
[**Doctor Last Name 1841**] backwards.  Speech is fluent with normal comprehension and
repetition; naming intact. No dysarthria. [**Location (un) **] intact.
Registers [**2-4**], recalls [**2-4**] in 5 minutes.  No right left
confusion. No evidence of neglect.

Cranial Nerves:
Pupils equally round and reactive to light, 4 to 2 mm
bilaterally. Visual fields are full to confrontation.  No
papilledema on fundoscopic exam R or L.  Extraocular movements
intact bilaterally, no nystagmus. Sensation intact V1- V3.
Facial movement symmetric.  Hearing intact to finger rub
bilaterally.  Palate elevation symmetrical.  Sternocleidomastoid
and trapezius normal bilaterally. Tongue midline, movements
intact

Motor:
Normal bulk bilaterally. Tone normal. No observed myoclonus or
tremor
No pronator drift
  [**Doctor First Name **] Tri [**Hospital1 **]  WF WE FE FF  IP  H  Q DF PF TE TF
R  5   5   5  5  5  5  5   5   5  5  5  5  5  5
L  5   5   5  5  5  5  5   5   5  5  5  5  5  5

Sensation: Intact to light touch, pinprick, vibration and
proprioception throughout. No extinction to DSS

Reflexes:
+2 and symmetric throughout.
Toes downgoing bilaterally

Coordination: finger-nose-finger normal, heel to shin normal,
RAMs normal.

Gait: Narrow based, steady.

Romberg: Negative


Pertinent Results:
CT [**4-15**]
Again noted is parenchymal hyperdensity in the anterior genu of
corpus callosum compatible with acute hemorrhage. There is
intraventricular extension of the hemorrhage into the left
lateral ventricle frontal [**Doctor Last Name 534**]. Intraventricular hemorrhage is
seen within both lateral ventricles, 3rd and forth ventricle to
a similar extent as on prior study. There is no hydrocephalus.
There is no significant mass effect or shift of normally midline
structures. Overall extent of these changes is comparable to the
prior study. There is a large area of low attenuation centered
within the left frontal lobe and extending into the subcortical
white matters likely representing old infarct.
There are no obvious masses, acute major vascular territorial
infarcts. The [**Doctor Last Name 352**] and white matter differentiation in remainder
of the brain is well preserved. The osseous and soft tissue
structures are unremarkable.
IMPRESSION:
1. Unchanged appearance of parenchymal hemorrhage in the
anterior genu of the corpus callosum with intraventricular
extension of bleeding. No hydrocephalus.
2. Unchanged appearance of old left frontal infarct.

MRI [**4-15**]
Again seen is a hemorrhage involving the genu of the corpus
callosum with intraventricular extension into the lateral,
third, and fourth ventricles. The ventricular size has not
changed since the preceding head CT. Adjacent to the area of
corpus callosal hemorrhage is a tiny area of enhancement which
appears to be in continuity with the adjacent right anterior
cerebral artery. This may represent a tiny aneurysm versus a
fold of the artery and CTA is recommended.No enhancing mass is
identified. There are no areas of slow diffusion. Again seen is
encephalomalacia of the left frontal lobe. There are no areas of
susceptibility suggestive of amyloid angiopathy. There is
minimal amount of scattered subcortical, deep, and
periventricular white matter T2 hyperintensities which likely
represent chronic microangiopathic change. The visualized orbits
and major flow voids are normal. There are no suspicious bony
abnormalities.
IMPRESSION: Hemorrhage involving the genu of the corpus callosum
with extension into the ventricles as before.
NOTE: Tiny enhancing focus adjacent to the corpus callosum,
which may represent a tiny aneurysm versus a fold of the
anterior cerebral artery. This can be further evaluated by a CTA
of the head.

EKG
Sinus rhythm. Poor R wave progression. Non-specific diffuse T
wave
flattening. No previous tracing available for comparison.
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
62 172 96 [**Telephone/Fax (2) 78595**] 72

CT/CTA [**4-16**]
NON-CONTRAST HEAD CT: The small hemorrhage centered in the genu
of the corpus callosum with intraventricular extension is stable
in extent and appearance. Large hypoattenuating area of
encephalomalacia in the left high frontal lobe is consistent
with prior infarction. There is no new hemorrhage or evidence of
acute infarction. No mass effect. The ventricles are stable in
size and configuration.

CTA OF THE CIRCLE OF [**Location (un) **]: The cavernous portion of the left
internal carotid artery is mildly stenosed compared to the
right, and there is progressive stenosis of the supraclinoid ICA
until it is completely occluded at the level of the ICA
terminus. Beyond this point, there are multiple small collateral
vessels resembling a "moyamoya" appearance which feed the M2
branches of the left MCA. The left anterior cerebral artery
arises from small branches which are derived from the anterior
communicating artery. The callosal and pericallosal branches of
the ACA drape over the hemorrhage and may communicate with a
tortuous venous structure along the midline (2D:100) suggesting
an arteriovenous fistula with the inferior sagittal sinus before
it enters the straight sinus. Within the focus of hemorrhage in
the corpus collosum, there is also a small prominent 2 mm
vascular structure which cannot clearly be followed (2D:84), and
a tiny aneurysm cannot be excluded. There is moderate
opacification of the ethmoid air cells and small air-fluid
levels within the maxillary and sphenoid sinuses.
IMPRESSION:
1. Corpus callosal hemorrhage with no definite underlying
arteriovenous malformation or mass. Size of the hemorrhage and
intraventricular extension is unchanged.
2. Tiny 2-mm vessel within the area of hemorrhage is noted, and
an aneurysm cannot be excluded.
3. Possible arteriovenous fistula between branches of the
pericallosal arteries and the inferior sagittal sinus.
4. Occlusion of the left ICA terminus with multiple collateral
vessels feeding the M2 branches of the MCA, in a "moyamoya"
distribution.

CXR [**4-18**]: The hemidiaphragms are in normal position. There is
moderate cardiomegaly and mild signs of overhydration. No
evidence of pleural effusions. The transparency and structure of
the lung parenchyma is normal, there is no evidence of focal
parenchymal opacity suggestive of pneumonia.

CXR [**4-21**]: Lungs clear. Heart size normal. No pleural effusion.
Thoracic aorta heavily calcified but not dilated.

U/S Kidney [**4-22**]: 1. Sharp systolic upstroke within the main
renal artery at the renal hilum. 2. Normal son[**Name (NI) 493**]
appearance of the kidney.

ECHO [**4-24**]: The left atrium is mildly dilated. No atrial septal
defect is seen by 2D or color Doppler. There is mild symmetric
left ventricular hypertrophy with normal cavity size and
regional/global systolic function (LVEF>55%). Transmitral
Doppler and tissue velocity imaging are consistent with Grade I
(mild) LV diastolic dysfunction. There is no ventricular septal
defect. Right ventricular chamber size and free wall motion are
normal. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic regurgitation. There
is no aortic valve stenosis. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Mild (1+)
mitral regurgitation is seen. There is mild pulmonary artery
systolic hypertension. There is no pericardial effusion.

ANGIOGRAM [**4-26**]:
CONSENT: Written informed consent was obtained from the patient
after explaining the risks, benefits and alternative management
of the procedure. Risks included stroke, loss of vision and
speech, temporary or permanent, with possible treatment with
stents and coils if needed. Since the patient is a renal
transplant patient, risk of renal failure were also explained to
the patient.
TECHNIQUE: The patient was brought to the interventional
neuroradiology suite and placed in the biplane table in the
supine position. Both groins were prepped and draped in the
usual sterile fashion. A preprocedure timeout was performed
using two patient identifiers. Access to the right common
femoral artery was obtained using a 19-gauge single wall needle
under local anesthesia with 1% lidocaine. Through the needle, a
0.035 [**Last Name (un) 7648**] wire was introduced and the needle was taken out.
Over the wire, a 4 French vascular sheath was placed and
connected to a saline infusion (mixed with heparin 500 units in
500 cc of saline) with a continuous drip. Through the sheath, a
4 French Berenstein catheter was introduced and connected to a
continuous saline infusion (heparin mixture: 1000 units of
heparin in 1000 cc of saline). The following vessels were
selectively catheterized and arteriograms were performed:
1. Right internal carotid artery.
2. Right external carotid artery.
3. Left internal carotid artery.
4. Left external carotid artery.
5. Left vertebral artery.
6. Right iliac artery.
Given function, arteriograms of the external carotid arteries
and vertebral arteries were obtained using Visipaque 320. After
review of the films, the catheter and the sheath were withdrawn
and pressure was applied on the groin until hemostasis was
obtained. The procedure was uneventful and the patient tolerated
the procedure well. The patient was sent to the floor with
orders.
FINDINGS: Upon arteriogram of the left internal carotid artery,
the visualized A1 and A2 segment of the anterior cerebral artery
are occluded. The M1 segment of the left middle cerebral
arteries also occluded. There is a single M2 segment of the
middle cerebral artery that appears to be patent. There are
prominent lenticulostriate and pericallosal branches supplying
the left cerebral hemisphere. There is overall decreased
perfusion in the left anterior and middle cerebral artery
territory. The occlusion of the anterior and middle cerebral
arteries appears to be at the ICA terminus.
Arteriogram of the left external carotid artery demonstrates
normal appearance of the carotid artery and its major branches.
No arteriovenous fistula or vascular malformation identified.
Upon arteriogram of the right internal carotid artery and right
external carotid artery, the visualized distal ICA and right
anterior and middle cerebral arteries are within normal limits.
There is no vascular malformation or occlusion.
Left vertebral artery arteriogram demonstrate normal appearance
of the left vertebral artery, the basilar artery, and posterior
cerebral arteries.
IMPRESSION: Occlusion of the A1 and A2 segment of the left
anterior cerebral artery. The M1 segment of the left middle
cerebral arteries is also occluded with obstruction of the
distal M2 branches of the middle cerebral artery. There is a
single M2 division of the middle cerebral artery that appears to
be patent. There are prominent lenticulostriate and pericallosal
branches supplying the left cerebral hemisphere with overall
decreased perfusion along the ACA and MCA territories compared
to the right side.

Brief Hospital Course:
NEURO:
1 Dx: She was admitted to Neurology with a corpus callosum bleed
at the level of the genu with intraventricular extension. She
did not develop a hydrocephalus, and her neurological course was
relatively uncomplicated. Main neurological symptoms were
occipito-nuchal headache and nausea - her exam remained intact
throughout, and she was never confused. She was treated
symptomatically. She spiked a fever on approx D3 which was,
after laboratory, imaging and microbiology studies thought to be
central.
2 Workup: Her CTA, especially well visualized on the sagittal
images, demonstrated an abberant connection for the pericallosal
artery to the straight sinus, with a tortous morphology. She was
presented at the stroke conference and was subject of extensive
discussion. Renal "cleared" her for repeat contrast
administration so she underwent an angiogram on [**4-26**], shwowing
the following: "Occlusion of the A1 and A2 segment of the left
anterior cerebral artery. The M1 segment of the left middle
cerebral arteries is also occluded with obstruction of the
distal M2 branches of the middle cerebral artery.  There is a
single M2 division of the middle cerebral artery that appears to
be patent. There are prominent lenticulostriate and pericallosal
branches supplying the left cerebral hemisphere with overall
decreased perfusion along the ACA and MCA territories compared
to the right side."

CARDIO:
1 BP: Patient was admitted to the floor initially, but the same
night transferred to the ICU for better management of high SBP >
200's not responding to IV PRNs (hydralazine, metoprolol,
enalaprilat). In the ICU the pressures were measured much lower,
upper 150's - the explanation remains unclear. The patient did
say she was less stressed in a more private room, not measured
every 5 minutes. Possibly the medications had started to work by
the time she arrived in the ICU, or the cuff size was differnt.
Upon return her bloopressure remained [**Name (NI) 2480**], warranting
frequent IV interventions. An U/S of the transplant kidney
revealed no stenosis of the supplying artery. Renal was
consulted and helped titrate up the PO medications aggresively.
2 CHF She developed DOE and some dyspnoe at rest after aggresive
IV fluid suppletion for her contrast nephropathy. Due to her
nausea from the intraventricular blood, her oral intake was
insufficient initially. An ECHO showed mild diastolic
dysfunction, see "results" section.

RENAL
1 COURSE: Patient developed a contrast nephropathy with Cr up to
as high as 1.8, whereas her baseline is 0.9 - 1.1. With
intensive fluid resuscitation her kidney function normalized
prior to the Angiogram, but at the cost of CHF (see elsewhere).
She was hyperhydrated with bicarbonate and given acetylcysteine
prior to her angiogram. At time of discharge, her Cr was 1.5,
oral fluid intake was encouraged.
2 BP: See above.
3 History: The patient explained that she her slowly progressive
kidney faillure was [**1-5**] scarlet fever at younger age - so
possibly post-rheumatic. An impressive effort was made by one of
the medical students to obtain records including the biopsy
results from the hospital in [**State 108**], but she only partially
succeeded. Documents acquired mention "progressive renal
faillure of unknown etiology", the biopsy results never made it
to our hospital. The documents are stored in her clinical chart
for review.

Medications on Admission:
Neoral 100/75
Prednisone 5 QD
Septra 400-80 QD
ASA 81 mg QD
Prevacid 30 [**Hospital1 **]
Clonidine 0.3 [**Hospital1 **]
Metoprolol 100 [**Hospital1 **]
Lasix 20 QD
Cellcept [**Pager number **] VID
Vitamin D
Niacin 1000 mg Qpm
Simvastatin 20 mg Qpm


Discharge Medications:
1. Outpatient Lab Work
Serum creatinine and BUN.
Results to: [**Last Name (LF) **],[**First Name3 (LF) 21939**] W [**Telephone/Fax (1) 10508**]
2. Prednisone 5 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO DAILY (Daily).

3. Cyclosporine Modified 100 mg Capsule [**Telephone/Fax (1) **]: One (1) Capsule PO
QAM (once a day (in the morning)).
4. Cyclosporine Modified 25 mg Capsule [**Telephone/Fax (1) **]: Three (3) Capsule PO
QPM (once a day (in the evening)).
5. Clonidine 0.1 mg Tablet [**Telephone/Fax (1) **]: Three (3) Tablet PO BID (2 times
a day).
6. Mycophenolate Mofetil 250 mg Capsule [**Telephone/Fax (1) **]: Three (3) Capsule
PO BID (2 times a day).
7. Cholecalciferol (Vitamin D3) 400 unit Tablet [**Telephone/Fax (1) **]: One (1)
Tablet PO DAILY (Daily).
8. Calcium Carbonate 500 mg Tablet, Chewable [**Telephone/Fax (1) **]: One (1)
Tablet, Chewable PO BID (2 times a day).
9. Niacin 500 mg Capsule, Sustained Release [**Telephone/Fax (1) **]: Two (2)
Capsule, Sustained Release PO QHS (once a day (at bedtime)).
Disp:*60 Capsule, Sustained Release(s)* Refills:*2*
10. Metoprolol Tartrate 50 mg Tablet [**Telephone/Fax (1) **]: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*2*
11. Amlodipine 5 mg Tablet [**Telephone/Fax (1) **]: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
12. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet [**Telephone/Fax (1) **]: One (1)
Tablet PO DAILY (Daily).
13. Lisinopril 10 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
14. Simvastatin 10 mg Tablet [**Telephone/Fax (1) **]: Two (2) Tablet PO QHS (once a
day (at bedtime)).
Disp:*60 Tablet(s)* Refills:*2*
15. Furosemide 40 mg Tablet [**Telephone/Fax (1) **]: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
16. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR PO BID (2 times a day).

Discharge Disposition:
Home

Discharge Diagnosis:
1 corpus callosum hemorrhage
2 contrast nephropathy


Discharge Condition:
Stable. Neurologic examination normal. Creatinine 1.5.


Discharge Instructions:
Please call your primary care physician or return to the
emergency room if you experience a sudden onset intractable
headache, difficulty speaking, inabilty to understand language,
difficulties swallowing, numbness/weakness.

Please be sure to drink plenty of fluids to protect your
kidneys. Please remember to have you labwork drawn on Tuesday
[**4-30**] to ensure that your kidney function is improving.

Followup Instructions:
Please schedule a follow-up appointment with your primary care
doctor within the next two weeks.

Please call Dr. [**First Name (STitle) **] [**Name (STitle) **] office ([**Telephone/Fax (1) 7394**] for a
follow up appointment in the next month.

Renal:
Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2182-5-28**] 2:00


                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2182-11-20**]
{'Intracerebral hemorrhage,Acute kidney failure, unspecified,Kidney replaced by transplant,Urinary tract infection, site not specified,Unspecified essential hypertension,Osteoporosis, 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: Headache, nausea and vomiting

PRESENT ILLNESS: Pt is a 68 y/o F with a hx of HTN, renal failure s/p transplant,
TIA (R sided numbness and slurred speech, now resolved) who
presents with acute onset headache, nausea, vomiting, found to
have hemorrhage in the corpus callosum with extension into the
ventricles.

MEDICAL HISTORY: -Hypertension (BP 115-170 at home per pt)
-TIA in her 30s- she remembers she "couldn't speak clearly" and
had R sided numbness, resolved after a few days, ? L sided
aneurysm per pt, no intervention.
-Renal Transplant in [**2172**]
-Hyperlipidemia
-Osteoporosis
-R knee replacement

MEDICATION ON ADMISSION: Neoral 100/75
Prednisone 5 QD
Septra 400-80 QD
ASA 81 mg QD
Prevacid 30 [**Hospital1 **]
Clonidine 0.3 [**Hospital1 **]
Metoprolol 100 [**Hospital1 **]
Lasix 20 QD
Cellcept [**Pager number **] VID
Vitamin D
Niacin 1000 mg Qpm
Simvastatin 20 mg Qpm

ALLERGIES: Vancomycin / Morphine / Penicillins

PHYSICAL EXAM: Exam on Admission:
T- 96.6 BP- 190/88 HR- 64 RR- 14 O2Sat- 100% on 2L
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: decreased ROM with head turning R and L
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Daughter with thyroid CA, mother with lymphoma, father with
DM, sister with leukemia, niece with breast CA, MGM and PGM with
strokes

SOCIAL HISTORY: Lives with daughter, on disability, no current tobacco use (quit
15 years ago, smoked 30 years prior), very occasional EtOH. 

### Response:
{'Intracerebral hemorrhage,Acute kidney failure, unspecified,Kidney replaced by transplant,Urinary tract infection, site not specified,Unspecified essential hypertension,Osteoporosis, unspecified'}
