CHIEF COMPLAINT: Fluid overload

PRESENT ILLNESS: Pt is a 73 yo female w/ pmhx DM, HTN, PVD, afib, hyperlipidemia,
ESRD on HD who presents today with acute shortness of breath. Pt
was last dialyzed on wednesday and she reports that was given
back all of the fluid that was taken off. Per dialysis nurse she
is actually below her dry weight. Last night she reports waking
up feeling palpatations and sob when laying on her side, no LE
edema although she has b/l BKAs. At that point had no
diaphoresis, cp, nausea or vomiting. Patient reports eating
cheese and crackers and having chinese for dinner last night. No
changes to her medications that she knows of. Pt denies URI
symptoms, fever, chills, cough, cp, abd pain, nausea, vomiting,
diarrhea. She occasionally has constipation.
.
EMS had a difficult time getting an O2 sat and placed her on
cpap and brought her to the ED whree she was weaned to 4 liters
nasal cannula. She received 1 sl nitro. On exam in ED, she was
noted to have crackles on lung exam and she received Asa 325 mg
x 1, 100 IV lasix and she put out 400 cc which per patient made
her feel better. Renal was consulted and recommended emergent
dialysis in the ICU. She was also placed on nitro gtt because
her initial blood pressure in ED was 210/104 and pressures is
now down to 150/80s. EKG showed st elevation V1-V4 c/w prior ekg
and recent prior cath 8 days ago was negative.
.
Of note, she had a recent admission to [**Doctor Last Name 1263**] with acute dyspnea
and fluid overload and was dialyzed emergently there. She was
then transferred from osh with elevated troponins and negative
stress test to [**Hospital1 18**]. Pt had coronary catheterization which
showed patent arteries at [**Hospital1 **] last week. She was thought to have
elevated troponins in setting of renal failure and demand
ischemia with aflutter. She underwent caval-isthmus atrial
flutter ablation which was unsuccessful and she was put on
coumadin and rate controlled.
.
In the ICU, patient's initial vs were: T 97.4, HR 81, BP 124/62,
R 23, O2 sat 100% on 4 l nc. She felt much better after the
lasix given in the ED. Denied dizziness, cp, palp, sob, abd
pain, nausea, etc.

MEDICAL HISTORY: -Hypertension
-Diabetes
-Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)
-GERD
-Hypercholesterolemia
-ESRD on hemodialysis M,W,F. Right IJ Permanent Catheter in
place. Receives dialysis at [**Location (un) **] hemodialysis center in
[**Location (un) **].
-Paroxysmal atrial flutter, refused anticoagulation
-Peptic ulcer disease
-Hypertrophic Obstructive Cardiomyopathy.
-Mild mitral stenosis (MVA 1.5-2.0 cm2)
-Secondary Hyperparathyroidism

MEDICATION ON ADMISSION: from discharge summary on [**2163-1-13**]- pt reports no changes
1. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Temp: 97.4 BP: 124 /62 HR: 81 RR: 23 O2sat 100% on 4 l nc
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions
NECK: no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits, no thyromegaly or thyroid nodules
RESP: mild bibasilar crackles
CV: RR, S1 and S2 wnl, 2/6 sem at lusb and harsher hsm at apex
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: b/l bka, warm, no rashes
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No
sensory deficits to light touch appreciated.
RECTAL: deferred

FAMILY HISTORY: Her father died in his 90's and mother at the age of 102.
Patient unable to specify cause of death. She has one living
sister at the age of 75 and 6 sisters and one brother who passed
away. Her family history is significant for coronary artery
disease, cancer, and diabetes.

SOCIAL HISTORY: Social history is significant for the presence of current
tobacco use, [**12-22**] PPD x 50 years. There is no history of alcohol
abuse. Lives in [**Hospital3 **] facility and uses a mobile
wheelchair.
Congestive heart failure, unspecified,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial flutter,Secondary hyperparathyroidism (of renal origin),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Esophageal reflux,Pure hypercholesterolemia,Tobacco use disorder,Unspecified glaucoma,Below knee amputation status,Long-term (current) use of anticoagulants,Personal history of noncompliance with medical treatment, presenting hazards to health,Personal history of peptic ulcer disease,Family history of ischemic heart disease,Family history of diabetes mellitus,Family history of unspecified malignant neoplasm
CHF NOS,End stage renal disease,Hyp kid NOS w cr kid V,Atrial flutter,Sec hyperparathyrd-renal,DMII wo cmp nt st uncntr,Periph vascular dis NOS,Esophageal reflux,Pure hypercholesterolem,Tobacco use disorder,Glaucoma NOS,Status amput below knee,Long-term use anticoagul,Hx of past noncompliance,Prsnl hst peptic ulcr ds,Fam hx-ischem heart dis,Fam hx-diabetes mellitus,Family hx-malignancy NOS
Admission Date:  [**2163-1-21**]              Discharge Date:   [**2163-1-23**]

Date of Birth:  [**2090-1-9**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5266**]
Chief Complaint:
Fluid overload

Major Surgical or Invasive Procedure:
Hemodialysis

History of Present Illness:
Pt is a 73 yo female w/ pmhx DM, HTN, PVD, afib, hyperlipidemia,
ESRD on HD who presents today with acute shortness of breath. Pt
was last dialyzed on wednesday and she reports that was given
back all of the fluid that was taken off. Per dialysis nurse she
is actually below her dry weight. Last night she reports waking
up feeling palpatations and sob when laying on her side, no LE
edema although she has b/l BKAs. At that point had no
diaphoresis, cp, nausea or vomiting. Patient reports eating
cheese and crackers and having chinese for dinner last night. No
changes to her medications that she knows of. Pt denies URI
symptoms, fever, chills, cough, cp, abd pain, nausea, vomiting,
diarrhea. She occasionally has constipation.
.
EMS had a difficult time getting an O2 sat and placed her on
cpap and brought her to the ED whree she was weaned to 4 liters
nasal cannula. She received 1 sl nitro. On exam in ED, she was
noted to have crackles on lung exam and she received Asa 325 mg
x 1, 100 IV lasix and she put out 400 cc which per patient made
her feel better. Renal was consulted and recommended emergent
dialysis in the ICU. She was also placed on nitro gtt because
her initial blood pressure in ED was 210/104 and pressures is
now down to 150/80s. EKG showed st elevation V1-V4 c/w prior ekg
and recent prior cath 8 days ago was negative.
.
Of note, she had a recent admission to [**Doctor Last Name 1263**] with acute dyspnea
and fluid overload and was dialyzed emergently there. She was
then transferred from osh with elevated troponins and negative
stress test to [**Hospital1 18**]. Pt had coronary catheterization which
showed patent arteries at [**Hospital1 **] last week. She was thought to have
elevated troponins in setting of renal failure and demand
ischemia with aflutter. She underwent caval-isthmus atrial
flutter ablation which was unsuccessful and she was put on
coumadin and rate controlled.
.
In the ICU, patient's initial vs were: T 97.4, HR 81, BP 124/62,
R 23, O2 sat 100% on 4 l nc. She felt much better after the
lasix given in the ED. Denied dizziness, cp, palp, sob, abd
pain, nausea, etc.


Past Medical History:
 -Hypertension
-Diabetes
-Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)
-GERD
-Hypercholesterolemia
-ESRD on hemodialysis M,W,F. Right IJ Permanent Catheter in
place. Receives dialysis at [**Location (un) **] hemodialysis center in
[**Location (un) **].
-Paroxysmal atrial flutter, refused anticoagulation
-Peptic ulcer disease
-Hypertrophic Obstructive Cardiomyopathy.
-Mild mitral stenosis (MVA 1.5-2.0 cm2)
-Secondary Hyperparathyroidism

Cardiac Risk Factors: +Diabetes, +Dyslipidemia, +Hypertension


Social History:
Social history is significant for the presence of current
tobacco use, [**12-22**] PPD x 50 years. There is no history of alcohol
abuse. Lives in [**Hospital3 **] facility and uses a mobile
wheelchair.


Family History:
Her father died in his 90's and mother at the age of 102.
Patient unable to specify cause of death. She has one living
sister at the age of 75 and 6 sisters and one brother who passed
away. Her family history is significant for coronary artery
disease, cancer, and diabetes.


Physical Exam:
VS: Temp: 97.4 BP: 124 /62 HR: 81 RR: 23 O2sat 100% on 4 l nc
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions
NECK: no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits, no thyromegaly or thyroid nodules
RESP: mild bibasilar crackles
CV: RR, S1 and S2 wnl, 2/6 sem at lusb and harsher hsm at apex
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: b/l bka, warm, no rashes
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No
sensory deficits to light touch appreciated.
RECTAL: deferred


Pertinent Results:
Admission Labs:

[**2163-1-21**] WBC-18.8* RBC-3.99* Hgb-12.4 Hct-39.5 MCV-99* MCH-31.1
MCHC-31.4 RDW-19.8* Plt Ct-366 Neuts-83.4* Lymphs-12.9*
Monos-2.6 Eos-0.9 Baso-0.2
[**2163-1-21**] PT-40.7* PTT-43.9* INR(PT)-4.4*
[**2163-1-21**] Fibrino-506*
[**2163-1-21**] Glucose-119* UreaN-35* Creat-6.8* Na-139 K-5.0 Cl-101
HCO3-25 AnGap-18 Calcium-8.9 Phos-5.7*# Mg-2.3
[**2163-1-21**] CK(CPK)-48 Amylase-108*
[**2163-1-21**] CK-MB-4 proBNP-9533* cTropnT-0.12*

[**2163-1-21**]
AP PORTABLE CHEST: Dual-lumen catheter via right internal
jugular approach terminates near the cavoatrial junction. Heart
size is normal. Aorta is tortuous. The interstitial markings are
prominent and multiple peripheral septal lines are noted. Both
costophrenic sulci are blunted. There is no pneumothorax or
focal airspace consolidation. The bones are somewhat
demineralized.

IMPRESSION: Interstitial edema and small bilateral pleural
effusions.

[**2163-1-21**] EKG:
Sinus rhythm. Left atrial abnormality. Q waves in leads V1-V2
with poor
R wave progression. Suggest old anteroseptal myocardial
infarction.
Borderline left ventricular hypertrophy. ST-T wave
abnormalities, most likely related to secondary repolarization
abnormalities from left ventricular hypertrophy. Compared to the
previous tracing of [**2163-1-11**] there is no significant diagnostic
change.


Brief Hospital Course:
Patient is a 73 yo female with pmhx afib s/p failed ablation on
coumadin, htn, hyperlipidemia, DM and ESRD on HD who presented
with acute dyspnea and pulmonary edema, treated in the MICU with
urgent dialysis, called out to the floor on HD#2 euvolemic.

#. Dyspnea - Resolved quickly with hemodialysis, likely
secondary to volume overload from being underdialyzed and
dietary non-complaince. No evidence of PNA on admission CXR,
with resolved leukocytosis and afebrile. Anticoagulated so PE is
unlikely.
She was discharged to continue her dialysis on regular M/W/F
schedule.  Patient was educated about a low salt, heart healthy
diet.

#. HTN- Patient hypertensive to 200s when she came to ED and was
started on nitro gtt. On admission to MICU, SBP 120s and
nitroglycerin gtt was quickly weaned off. This episode is likely
secondary to fluid overload and sob [**1-22**] fluid overload. Patient
was normotensive on transfer to the floor and remained
normotensive on the day of discahrge.  She was discharged on her
home regimen with the uptitration of her beta blocker to
continue dialysis regimen as above.

#. ESRD- On dialysis M/W/F. Per report, patient was under
dialyzed on wednesday, two days prior to admission, because she
was under her dry weight.  She received HD on the evening of
admission emergently and was sent home to continue HD on M/W/F
when she was euvolemic. The renal followed during her stay and
we continued sevelemer and nephrocaps.  On the day of discharge,
patient was mildly hyperkalemic and received kayxalate prior to
discharge with plan for HD on the morning following discharge.

#. Leukocytosis- Patient's [**Known lastname **] count 18.8 on admission with no
localizing signs of infection or fever. [**Month (only) 116**] be stress related.
Resolved on transfer to the floor. Urine culture negative on
admission. Blood cultures x2 with no growth to date still
pending at time of discharge.

#. PAF- S/P failed ablation last admission on warfarin. INR
supratherapeutic on admission at 4.4. Her warfarin was held as
INR was supratherapeutic and resumed on discharge once INR fell
into therapeutic range.  She was continued on metoprolol with
uptitration to 100mg [**Hospital1 **] and diltiazem at home dose for rate
control. Telemetry showed continued paroxysmal atrial
fibrillation during her stay.

#. Hyperlipidemia- Continued simvastatin 80 mg qd.

#. PVD- continued aspirin.

#. DM - Most recent A1c in [**11-27**] was 6.9. She was maintained on
NPH 16 units qam as per home regimen.  QACHS finger sticks with
sliding scale coverage and diabetic diet were provided during
her stay.

#. Glaucoma- continued home meds.

#. GERD/PUD - continued ranitidine per home regimen.

# F/E/N: HD, Replete lytes PRN. diabetic/renal/cardiac diet

# PPx: Bowel regimen, H2 blocker, supratherapeutic INR

# Access: PIV, dialysis line

# Dispo: to home with HR and BP controlled and patient euvolemic
on exam.

# Code Status: Full


Medications on Admission:
from discharge summary on [**2163-1-13**]- pt reports no changes
1. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID

(2 times a day).
2. Sevelamer HCl 400 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
3. Isosorbide Dinitrate 10 mg Tablet Sig: One (1) Tablet PO BID

(2 times a day).
4. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap

PO DAILY (Daily).
6. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Diltiazem HCl 120 mg Tablet Sustained Release 24 hr Sig: One

(1) Tablet Sustained Release 24 hr PO once a day.
9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic DAILY

(Daily): Right eye.
11. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day): Left eye.
12. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic
DAILY (Daily): Left eye.
13. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS
(at bedtime): Left eye.
14. Vigamox 0.5 % Drops Sig: One (1) drop Ophthalmic TID (3
times a day): Left eye.
15. Lisinopril 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
16. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Sixteen

(16) units Subcutaneous once a day.
17. Warfarin 2 mg Tablet Sig: 2.5 Tablets PO once a day.
Disp:*90 Tablet(s)* Refills:*2*
18. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 5 days. (finished course)
Disp:*5 Tablet(s)* Refills:*0*


Discharge Medications:
1. Sevelamer HCl 400 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
2. Isosorbide Dinitrate 10 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
3. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic DAILY
(Daily).
7. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
8. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic
DAILY (Daily).
9. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
10. Lisinopril 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
11. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Sixteen
(16) units/ml Subcutaneous once a day.
12. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
13. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a
day.
14. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
15. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day.
16. Outpatient Lab Work
please check INR on [**1-25**] and fax results to [**Company 109100**] Anticoagulation
Management Service (ACMS)


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Pulmonary Edema from volume overload
end-stage renal disease on hemodialysis
hypertensive urgency
atrial fibrillation
insulin dependent diabetes mellitus


Discharge Condition:
hemodynamically stable, saturating well on room air with no
signs of volume overload on exam.


Discharge Instructions:
You have been treated for your SOB with dialysis.  Please adhere
to a low salt diet and take your medications as prescribed.
Your metoprolol was increased to 100mg twice daily from 75mg
during your stay.

During your stay, your coumadin was held because your INR was
elevated.  Please resume your 5mg daily dose and have your INR
checked on [**1-25**] by the VNA.  Your result should be faxed to [**Company 109100**]
Anticoagulation Management Service (ACMS).

Please resume your Monday, Wednesday, Friday dialysis schedule.

Please call your primary care provider or return to the
emergency department if you have any chest pain, shortness of
breath, fevers >100.8 or any other concerning symptoms.

Followup Instructions:
Please resume dialysis on [**2163-1-24**] and have your INR checked this
week by the VNA.

You have the following appointments scheduled:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] TRANSPLANT CENTER - NON BILLING
Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2163-1-27**] 1:00
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2163-2-1**] 12:00
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2163-2-16**]
10:40
{'Congestive heart failure, unspecified,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial flutter,Secondary hyperparathyroidism (of renal origin),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Esophageal reflux,Pure hypercholesterolemia,Tobacco use disorder,Unspecified glaucoma,Below knee amputation status,Long-term (current) use of anticoagulants,Personal history of noncompliance with medical treatment, presenting hazards to health,Personal history of peptic ulcer disease,Family history of ischemic heart disease,Family history of diabetes mellitus,Family history of unspecified malignant neoplasm'}


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: Fluid overload

PRESENT ILLNESS: Pt is a 73 yo female w/ pmhx DM, HTN, PVD, afib, hyperlipidemia,
ESRD on HD who presents today with acute shortness of breath. Pt
was last dialyzed on wednesday and she reports that was given
back all of the fluid that was taken off. Per dialysis nurse she
is actually below her dry weight. Last night she reports waking
up feeling palpatations and sob when laying on her side, no LE
edema although she has b/l BKAs. At that point had no
diaphoresis, cp, nausea or vomiting. Patient reports eating
cheese and crackers and having chinese for dinner last night. No
changes to her medications that she knows of. Pt denies URI
symptoms, fever, chills, cough, cp, abd pain, nausea, vomiting,
diarrhea. She occasionally has constipation.
.
EMS had a difficult time getting an O2 sat and placed her on
cpap and brought her to the ED whree she was weaned to 4 liters
nasal cannula. She received 1 sl nitro. On exam in ED, she was
noted to have crackles on lung exam and she received Asa 325 mg
x 1, 100 IV lasix and she put out 400 cc which per patient made
her feel better. Renal was consulted and recommended emergent
dialysis in the ICU. She was also placed on nitro gtt because
her initial blood pressure in ED was 210/104 and pressures is
now down to 150/80s. EKG showed st elevation V1-V4 c/w prior ekg
and recent prior cath 8 days ago was negative.
.
Of note, she had a recent admission to [**Doctor Last Name 1263**] with acute dyspnea
and fluid overload and was dialyzed emergently there. She was
then transferred from osh with elevated troponins and negative
stress test to [**Hospital1 18**]. Pt had coronary catheterization which
showed patent arteries at [**Hospital1 **] last week. She was thought to have
elevated troponins in setting of renal failure and demand
ischemia with aflutter. She underwent caval-isthmus atrial
flutter ablation which was unsuccessful and she was put on
coumadin and rate controlled.
.
In the ICU, patient's initial vs were: T 97.4, HR 81, BP 124/62,
R 23, O2 sat 100% on 4 l nc. She felt much better after the
lasix given in the ED. Denied dizziness, cp, palp, sob, abd
pain, nausea, etc.

MEDICAL HISTORY: -Hypertension
-Diabetes
-Peripheral vascular disease status post bilateral knee
amputations in [**2146**] (L) and [**2157**] (R)
-GERD
-Hypercholesterolemia
-ESRD on hemodialysis M,W,F. Right IJ Permanent Catheter in
place. Receives dialysis at [**Location (un) **] hemodialysis center in
[**Location (un) **].
-Paroxysmal atrial flutter, refused anticoagulation
-Peptic ulcer disease
-Hypertrophic Obstructive Cardiomyopathy.
-Mild mitral stenosis (MVA 1.5-2.0 cm2)
-Secondary Hyperparathyroidism

MEDICATION ON ADMISSION: from discharge summary on [**2163-1-13**]- pt reports no changes
1. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Temp: 97.4 BP: 124 /62 HR: 81 RR: 23 O2sat 100% on 4 l nc
GEN: pleasant, comfortable, NAD
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions
NECK: no supraclavicular or cervical lymphadenopathy, no jvd, no
carotid bruits, no thyromegaly or thyroid nodules
RESP: mild bibasilar crackles
CV: RR, S1 and S2 wnl, 2/6 sem at lusb and harsher hsm at apex
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: b/l bka, warm, no rashes
SKIN: no rashes/no jaundice
NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. No
sensory deficits to light touch appreciated.
RECTAL: deferred

FAMILY HISTORY: Her father died in his 90's and mother at the age of 102.
Patient unable to specify cause of death. She has one living
sister at the age of 75 and 6 sisters and one brother who passed
away. Her family history is significant for coronary artery
disease, cancer, and diabetes.

SOCIAL HISTORY: Social history is significant for the presence of current
tobacco use, [**12-22**] PPD x 50 years. There is no history of alcohol
abuse. Lives in [**Hospital3 **] facility and uses a mobile
wheelchair. 

### Response:
{'Congestive heart failure, unspecified,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Atrial flutter,Secondary hyperparathyroidism (of renal origin),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Esophageal reflux,Pure hypercholesterolemia,Tobacco use disorder,Unspecified glaucoma,Below knee amputation status,Long-term (current) use of anticoagulants,Personal history of noncompliance with medical treatment, presenting hazards to health,Personal history of peptic ulcer disease,Family history of ischemic heart disease,Family history of diabetes mellitus,Family history of unspecified malignant neoplasm'}
