CHIEF COMPLAINT: Transfer from OSH for hypoxia, hypotension, bilateral PE, s/p
MICU

PRESENT ILLNESS: 85 year-old female, Russian-speaking, with hypertension
presented to [**Hospital **] Hospital with nausea, vomiting,
"trembling", found to have bilateral PE, and transferred to
[**Hospital1 18**] for further management. She felt well yesterday. This
morning upon wakening she developed shaking, nausea/vomiting,
headache, and overall felling unwell. She was noted by her
family to be pale and cool. She was taken to OSH by EMS. At OSH,
fluctuating oxygen saturation as low as 83% RA. During ED course
developed syncope vs. presyncope, sBP to 80s with standing,
fluid responsive. CTA chest reveal bilateral PE, small. Received
fondaparinux 7.5mg SC at 11:45am [**2156-4-23**], 1.5L NS, Zofran,
morphine. CT head per records within normal limits. Transferred
to [**Hospital1 18**] for further management.
.
In the ED, 99.1 92 124/73 96% 2L NC. Physical examination
notable for comfortable appearing female. Laboratory data
significant for chemistry panel within normal limits, hematocrit
35.5, WBC 11.0 with bandemia (10%), INR 1.7, lactate 2.0,
unremarkable UA. OSH CTA chest uploaded, again showing small
bilateral PE. EKG with sinus rhythm at 89, without evidence of
right heart strain or ischemia. Received Tylenol, IVF (total not
known). On transfer to MICU, 100.8, 95/58, 85, 26, 100 2L NC.
.
In the MICU, patient was accompanied by her son and husband. [**Name (NI) **]
translated for patient. She felt well. She denied chest pain,
palpitations, shortness of breath, abdominal pain, nausea,
vomiting, diarrhea, lower extremity edema or swelling. Denied
recent sick contacts. Pt was monitored in the MICU overnight.
Given pt was stable, she was called out of the MICU and
transferred to the medicine floor on [**2156-4-24**]. On arrival to the
floor, pt felt well. Reported small headache and min. shortness
of breath, but no other acute complaints.
.
Review of systems:
(+) Per HPI. Recent 2lb weight loss, unintentional. Dry cough
for several weeks. Intermittent discomfort left ankle - s/p
fracture several months ago.
(-) Denies fever, chills, night sweats. Denies sinus tenderness,
rhinorrhea, sore throat. Denies dysuria, urinary frequency.
Denies rashes or skin changes.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
s/p fracture to left ankle several months ago after slipping on
ice; managed non-operatively, able to ambulate
Denies prior malignancy.
?recent unexplained hypercalcemia - was supposed to see
endocrinologist on day of admission.

MEDICATION ON ADMISSION: Simvastatin 40mg PO daily
HCTZ 25mg PO daily
Detrol 2mg PO daily
Aspirin 325mg PO daily
Propranolol 20mg PO daily
Lisinopril 2.5mg PO daily
Calcium/vitamin D

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM on admission:
VS - Temp 98.9F, BP 118/43 , HR 78, R 22, O2-sat 95% NC 1L
GENERAL - well-appearing woman in NAD, comfortable, appropriate
HEENT - NC/AT, PERRL, EOMI, sclerae anicteric,
NECK - supple, no thyromegaly, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, + peripheral pulses
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**6-17**] throughout, sensation grossly intact throughout.
.
PHYSICAL EXAM on discharge:
VS - VS: Tc 96.3 Tm:98.6 BP:108/62 HR:69 RR:18 O2 sat 97% RA
Exam: General: Sitting on bed, coughing
Cardiac: RRR
Pulm: CTA
Abdomen: soft, NT
Ext: Mild pedal edema, symmetric bilaterally, [**Location (un) 28048**] sign
absent

FAMILY HISTORY: Son with multiple lower extremity blood clots following period
of immobilization. Mother with multiple blood clots. Niece
passed due to pulmonary embolism. No family history of
malignancy.

SOCIAL HISTORY: Denies tobacco, alcohol use. Emigrated from [**Country 532**] in [**2142**].
Former engineer. Lives with her husband. [**Name (NI) **] lives in close
proximity.
Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Hypotension, unspecified,Anemia, unspecified
Pulm embol/infarct NEC,Pneumonia, organism NOS,Hypertension NOS,Pure hypercholesterolem,Hypotension NOS,Anemia NOS
Admission Date:  [**2156-4-23**]              Discharge Date:   [**2156-4-27**]

Date of Birth:  [**2071-1-17**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1253**]
Chief Complaint:
Transfer from OSH for hypoxia, hypotension, bilateral PE, s/p
MICU

Major Surgical or Invasive Procedure:
None


History of Present Illness:
85 year-old female, Russian-speaking, with hypertension
presented to [**Hospital **] Hospital with nausea, vomiting,
"trembling", found to have bilateral PE, and transferred to
[**Hospital1 18**] for further management. She felt well yesterday. This
morning upon wakening she developed shaking, nausea/vomiting,
headache, and overall felling unwell. She was noted by her
family to be pale and cool. She was taken to OSH by EMS. At OSH,
fluctuating oxygen saturation as low as 83% RA. During ED course
developed syncope vs. presyncope, sBP to 80s with standing,
fluid responsive. CTA chest reveal bilateral PE, small. Received
fondaparinux 7.5mg SC at 11:45am [**2156-4-23**], 1.5L NS, Zofran,
morphine. CT head per records within normal limits. Transferred
to [**Hospital1 18**] for further management.
.
In the ED, 99.1 92 124/73 96% 2L NC. Physical examination
notable for comfortable appearing female. Laboratory data
significant for chemistry panel within normal limits, hematocrit
35.5, WBC 11.0 with bandemia (10%), INR 1.7, lactate 2.0,
unremarkable UA. OSH CTA chest uploaded, again showing small
bilateral PE. EKG with sinus rhythm at 89, without evidence of
right heart strain or ischemia. Received Tylenol, IVF (total not
known). On transfer to MICU, 100.8, 95/58, 85, 26, 100 2L NC.
.
In the MICU, patient was accompanied by her son and husband. [**Name (NI) **]
translated for patient. She felt well. She denied chest pain,
palpitations, shortness of breath, abdominal pain, nausea,
vomiting, diarrhea, lower extremity edema or swelling. Denied
recent sick contacts. Pt was monitored in the MICU overnight.
Given pt was stable, she was called out of the MICU and
transferred to the medicine floor on [**2156-4-24**]. On arrival to the
floor, pt felt well. Reported small headache and min. shortness
of breath, but no other acute complaints.
.
Review of systems:
(+) Per HPI. Recent 2lb weight loss, unintentional. Dry cough
for several weeks. Intermittent discomfort left ankle - s/p
fracture several months ago.
(-) Denies fever, chills, night sweats. Denies sinus tenderness,
rhinorrhea, sore throat. Denies dysuria, urinary frequency.
Denies rashes or skin changes.

Past Medical History:
Hypertension
Hypercholesterolemia
s/p fracture to left ankle several months ago after slipping on
ice; managed non-operatively, able to ambulate
Denies prior malignancy.
?recent unexplained hypercalcemia - was supposed to see
endocrinologist on day of admission.

Social History:
Denies tobacco, alcohol use. Emigrated from [**Country 532**] in [**2142**].
Former engineer. Lives with her husband. [**Name (NI) **] lives in close
proximity.

Family History:
Son with multiple lower extremity blood clots following period
of immobilization. Mother with multiple blood clots. Niece
passed due to pulmonary embolism. No family history of
malignancy.

Physical Exam:
PHYSICAL EXAM on admission:
VS - Temp 98.9F, BP 118/43 , HR 78, R 22, O2-sat 95% NC 1L
GENERAL - well-appearing woman in NAD, comfortable, appropriate
HEENT - NC/AT, PERRL, EOMI, sclerae anicteric,
NECK - supple, no thyromegaly, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, + peripheral pulses
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**6-17**] throughout, sensation grossly intact throughout.
.
PHYSICAL EXAM on discharge:
VS - VS: Tc 96.3 Tm:98.6 BP:108/62 HR:69 RR:18 O2 sat 97% RA
Exam: General: Sitting on bed, coughing
Cardiac: RRR
Pulm: CTA
Abdomen: soft, NT
Ext: Mild pedal edema, symmetric bilaterally, [**Location (un) 28048**] sign
absent


Pertinent Results:
[**2156-4-26**] 06:55AM BLOOD WBC-9.5 RBC-3.84* Hgb-11.5* Hct-34.1*
MCV-89 MCH-29.9 MCHC-33.6 RDW-14.2 Plt Ct-156
[**2156-4-27**] 07:05AM BLOOD WBC-5.5 RBC-3.87* Hgb-11.4* Hct-34.3*
MCV-89 MCH-29.4 MCHC-33.1 RDW-14.4 Plt Ct-179
[**2156-4-26**] 06:55AM BLOOD PT-13.4 INR(PT)-1.1
[**2156-4-25**] 07:40AM BLOOD Glucose-94 UreaN-16 Creat-0.8 Na-144
K-3.6 Cl-112* HCO3-28 AnGap-8
[**2156-4-26**] 06:55AM BLOOD Glucose-95 UreaN-16 Creat-0.8 Na-143
K-4.1 Cl-113* HCO3-23 AnGap-11
[**2156-4-26**] 07:15PM BLOOD CK-MB-2 cTropnT-<0.01
[**2156-4-27**] 02:25AM BLOOD cTropnT-<0.01
[**2156-4-25**] 07:40AM BLOOD WBC-15.6* RBC-3.99* Hgb-11.8* Hct-35.6*
MCV-89 MCH-29.6 MCHC-33.2 RDW-14.1 Plt Ct-135*
[**2156-4-24**] 03:59AM BLOOD WBC-19.8*# RBC-3.97* Hgb-12.0 Hct-35.0*
MCV-88 MCH-30.1 MCHC-34.2 RDW-14.0 Plt Ct-150
[**2156-4-23**] 03:15PM BLOOD WBC-11.0 RBC-3.98* Hgb-12.2 Hct-35.5*
MCV-89 MCH-30.6 MCHC-34.4 RDW-14.0 Plt Ct-175
[**2156-4-24**] 03:59AM BLOOD Neuts-79* Bands-9* Lymphs-7* Monos-5
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2156-4-23**] 03:15PM BLOOD Neuts-89* Bands-10* Lymphs-0 Monos-1*
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2156-4-24**] 03:59AM BLOOD Hypochr-NORMAL Anisocy-NORMAL
Poiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL
[**2156-4-25**] 08:45AM BLOOD PT-14.1* PTT-58.1* INR(PT)-1.2*
[**2156-4-25**] 07:40AM BLOOD PT-14.3* PTT-70.7* INR(PT)-1.2*
[**2156-4-24**] 03:59AM BLOOD PT-16.8* PTT-39.4* INR(PT)-1.5*
[**2156-4-23**] 03:15PM BLOOD PT-18.6* PTT-43.1* INR(PT)-1.7*
[**2156-4-25**] 07:40AM BLOOD Glucose-94 UreaN-16 Creat-0.8 Na-144
K-3.6 Cl-112* HCO3-28 AnGap-8
[**2156-4-24**] 03:59AM BLOOD Glucose-107* UreaN-21* Creat-1.1 Na-142
K-3.8 Cl-109* HCO3-24 AnGap-13
[**2156-4-23**] 03:15PM BLOOD ALT-132* AST-180* AlkPhos-90 TotBili-0.9
[**2156-4-23**] 03:15PM BLOOD cTropnT-<0.01
[**2156-4-23**] 03:15PM BLOOD proBNP-590
[**2156-4-25**] 07:40AM BLOOD Albumin-3.1* Calcium-8.7 Phos-1.9*#
Mg-2.0
[**2156-4-24**] 03:59AM BLOOD Calcium-8.3* Phos-4.0# Mg-1.5*
[**2156-4-23**] 03:15PM BLOOD Albumin-3.4* Calcium-8.7 Phos-1.8*
Mg-1.5*
[**2156-4-23**] 03:21PM BLOOD Lactate-2.0
.
Studies:
-[**2156-4-23**]: CTA at OSH
-[**2156-4-24**]: There is normal compressibility, flow and augmentation
of bilateral common femoral, superficial femoral and popliteal
veins. There is normal color flow of the calf veins. IMPRESSION:
No evidence of lower extremity DVT.
-[**2156-4-24**]: There is unchanged mild cardiomegaly. Mediastinal
contours are unremarkable. There is no evidence of appreciable
pulmonary edema. Small bilateral pleural effusions are present
as well as minimal bibasilar atelectasis. Overall, no
significant changes compared to prior CT was noted.


Brief Hospital Course:
85F with hypertension with bilateral pulmonary emboli, relative
hypotension, bandemia, low-grade fever in context of recent
malaise, nausea/vomiting x1 day. She was initially admitted to
the MICU for close monitoring and transferred to the medicine
floor the next day.
.
-Active issues:
#. PE: appeared to be small, bilateral on CTA from OSH. There
was no evidence of right heart strain on EKG. Pt was
hemodynamically stable throughout her hospitalization. Pt was
initially started on the heparin drip, then was changed to
Lovenox while pt was started on Coumadin and INR was still <2.
Pt had bilateral lower extremity US and there was no evidence of
DVT. Of note, per pt and family, pt had received routine cancer
screening. Her last mammogram was in [**2155**] and the result was
WNL, and her last colonoscopy was in [**2154**], significant for
polyps. Pt also reported ongoing outpatient malignancy workup
for hypercalcemia, however while pt was in the hospital, her Ca
level was only from 8.3-8.7. Pt has significant family history
of blood clots, can consider w/u as outpt for hypercoagulation
and to best determine the duration of Coumadin treatment.
- Recommend continue lovenox until INR > 2 for 48 hours, then
d/c lovenox
- goal INR [**3-18**]
.
#. Bandemia( WBC 11 10% bandemia) in the context of low-grade
fever. Her Lactate was 2.0. There was no clear evidence of
infection. Given nausea, vomiting on arrival to OSH ED, there
was a possibility for gastroenteritis. There was no clear
infiltrate on chest CTA. Pt was initially started on Tamiflu,
Vancomycin/Cefepime which was then changed to Levofloxacin for
empiric treatment and droplet precaution. Urine culture with
mixed bacteria, likely d/t contamination. Her Flu screening and
Legionella screening were negative. Her CXR did not show any
evidence of acute process. The above antibiotics were stopped
with these negative result. However, the levofloxacin was
continued to complete a 5 day course for empriric treatment of
community aquired pneumonia. At the time of discharge, she was
afebrile and her blood cultures were still pending.
.
#. Hypotension/hypoxia: pt demonstrated relative hypotension
with baseline hypertension. Unlikely to be due to PE given small
size on CTA chest. [**Month (only) 116**] be related to poor PO intake,
nausea/vomiting. Given fever, elevated lactate septic shock was
on the differential, thus pt was admitted into the MICU for
close monitoring. Her EKG did not show any evidence of ischemic
changes.Pt was placed on oxygen supplement via NC, and gradually
weaned off as tolerated. We also held home anti-hypertensives
(hold HCTZ, Propanolol, Lisinopril), added back Lisinopril as BP
improved. At the time of discharge, we were still holding HCTZ
and Propanolol. The patient was instructed to see her primary
care doctor [**First Name (Titles) 5001**] [**Last Name (Titles) 9533**] blood pressure medications. On the
day before discharge, she had an episode of weakness and
dizziness that spontaneously resolved. Her blood glucose and
orthostatic blood pressure were normal. An EKG was obtained that
showed some minor changes from a previous and so cardiac enzymes
were obtained which were negative. A cardiology fellow was
requested to review the EKG and felt that the changes were not
worrisome in nature and that if she continued to be symptomatic
to consider an outpatient echo. The symptom did not recur during
her hospital stay.
.
#. Anemia: HCT was stable at 35 and normocytic. Baseline
unknown. Pt was instructed to follow up as outpatient with PCP.

.
# Disposition: D/C home with PCP follow up as outpatient for the
above issues.


Medications on Admission:
Simvastatin 40mg PO daily
HCTZ 25mg PO daily
Detrol 2mg PO daily
Aspirin 325mg PO daily
Propranolol 20mg PO daily
Lisinopril 2.5mg PO daily
Calcium/vitamin D

Discharge Medications:
1. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. warfarin 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours).
Disp:*6 injection* Refills:*1*
5. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
6. Calcium 500 + D 500 mg(1,250mg) -400 unit Tablet Sig: One (1)
Tablet PO once a day.
7. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day
for 2 days: Please take 1 pill on Tuesday and 1 on Wednesday.
Disp:*2 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 1952**], [**Location (un) 86**]

Discharge Diagnosis:
hypoxia, hypotension, bilateral PE


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: independent


Discharge Instructions:
Dear Ms.[**Last Name (Titles) 32737**],

It was a pleasure taking care of you at [**Hospital1 827**]. You were admitted for shortness of breath, low
blood pressure, and was found to have small blood clots in your
lung. We started you on blood thinning medications and it is
very important for you to follow up with your primary care
physician to check the level (your INR) to ensure the medication
(Coumadin) is at the appropriate dosage. You also had a fever,
you were started on antibiotics. We would like for you to
continue levaquin until Wednesday [**2156-4-28**]. As for your blood
pressure, it was on the lower side, so we held your blood
pressure medications except Lisinopril. Please talk to your
primary care physician to discuss this matter and determine when
to restart some of your home blood pressure medications. Also
you should follow up with your primary care physician for
anemia.

In summary, the following medication changes were made:
-Started Lovenox twice a day
-Started Coumadin
-Started levofloxacin for 2 more days (for pneumonia)
-Held HCTZ due to low blood pressure
-Held Propanolol due to low blood pressure
-Held Detrol
-Decreased aspirin to 81 mg (since started coumadin)

Followup Instructions:
- Please go to Dr.[**Name (NI) 32738**] office anytime on Thursday to have
your INR checked at [**Location (un) 270**] Family Practice in [**Location (un) 47**].
phone ([**Telephone/Fax (1) 32739**]. It is very important that you keep this
appointment to measure your INR, a measure of anticoagulation.
Please make a follow-up appointment at that time.
{'Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Hypotension, unspecified,Anemia, 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: Transfer from OSH for hypoxia, hypotension, bilateral PE, s/p
MICU

PRESENT ILLNESS: 85 year-old female, Russian-speaking, with hypertension
presented to [**Hospital **] Hospital with nausea, vomiting,
"trembling", found to have bilateral PE, and transferred to
[**Hospital1 18**] for further management. She felt well yesterday. This
morning upon wakening she developed shaking, nausea/vomiting,
headache, and overall felling unwell. She was noted by her
family to be pale and cool. She was taken to OSH by EMS. At OSH,
fluctuating oxygen saturation as low as 83% RA. During ED course
developed syncope vs. presyncope, sBP to 80s with standing,
fluid responsive. CTA chest reveal bilateral PE, small. Received
fondaparinux 7.5mg SC at 11:45am [**2156-4-23**], 1.5L NS, Zofran,
morphine. CT head per records within normal limits. Transferred
to [**Hospital1 18**] for further management.
.
In the ED, 99.1 92 124/73 96% 2L NC. Physical examination
notable for comfortable appearing female. Laboratory data
significant for chemistry panel within normal limits, hematocrit
35.5, WBC 11.0 with bandemia (10%), INR 1.7, lactate 2.0,
unremarkable UA. OSH CTA chest uploaded, again showing small
bilateral PE. EKG with sinus rhythm at 89, without evidence of
right heart strain or ischemia. Received Tylenol, IVF (total not
known). On transfer to MICU, 100.8, 95/58, 85, 26, 100 2L NC.
.
In the MICU, patient was accompanied by her son and husband. [**Name (NI) **]
translated for patient. She felt well. She denied chest pain,
palpitations, shortness of breath, abdominal pain, nausea,
vomiting, diarrhea, lower extremity edema or swelling. Denied
recent sick contacts. Pt was monitored in the MICU overnight.
Given pt was stable, she was called out of the MICU and
transferred to the medicine floor on [**2156-4-24**]. On arrival to the
floor, pt felt well. Reported small headache and min. shortness
of breath, but no other acute complaints.
.
Review of systems:
(+) Per HPI. Recent 2lb weight loss, unintentional. Dry cough
for several weeks. Intermittent discomfort left ankle - s/p
fracture several months ago.
(-) Denies fever, chills, night sweats. Denies sinus tenderness,
rhinorrhea, sore throat. Denies dysuria, urinary frequency.
Denies rashes or skin changes.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
s/p fracture to left ankle several months ago after slipping on
ice; managed non-operatively, able to ambulate
Denies prior malignancy.
?recent unexplained hypercalcemia - was supposed to see
endocrinologist on day of admission.

MEDICATION ON ADMISSION: Simvastatin 40mg PO daily
HCTZ 25mg PO daily
Detrol 2mg PO daily
Aspirin 325mg PO daily
Propranolol 20mg PO daily
Lisinopril 2.5mg PO daily
Calcium/vitamin D

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM on admission:
VS - Temp 98.9F, BP 118/43 , HR 78, R 22, O2-sat 95% NC 1L
GENERAL - well-appearing woman in NAD, comfortable, appropriate
HEENT - NC/AT, PERRL, EOMI, sclerae anicteric,
NECK - supple, no thyromegaly, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, + peripheral pulses
SKIN - no rashes or lesions
LYMPH - no cervical, axillary, or inguinal LAD
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**6-17**] throughout, sensation grossly intact throughout.
.
PHYSICAL EXAM on discharge:
VS - VS: Tc 96.3 Tm:98.6 BP:108/62 HR:69 RR:18 O2 sat 97% RA
Exam: General: Sitting on bed, coughing
Cardiac: RRR
Pulm: CTA
Abdomen: soft, NT
Ext: Mild pedal edema, symmetric bilaterally, [**Location (un) 28048**] sign
absent

FAMILY HISTORY: Son with multiple lower extremity blood clots following period
of immobilization. Mother with multiple blood clots. Niece
passed due to pulmonary embolism. No family history of
malignancy.

SOCIAL HISTORY: Denies tobacco, alcohol use. Emigrated from [**Country 532**] in [**2142**].
Former engineer. Lives with her husband. [**Name (NI) **] lives in close
proximity. 

### Response:
{'Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Hypotension, unspecified,Anemia, unspecified'}
