CHIEF COMPLAINT: unresponsive

PRESENT ILLNESS: History of Present Illness:  76 yo M w/ Hx of MS, PE, prostate
CA p/w AMS. Pt. was feeling weak this am and then went to his
day care class. At day care he was noted to be extremely
somnolent and essentially non-responsive, 911 was called and he
was brought to [**Hospital1 18**] ED where head CT was negative, CXR
negative. His mental status improved and he was transferred to
the floor where he was initially noted to be A/Ox3 but then
progressively deteriorated. He was bradycardic and was given
atropine in the field. On the floor he continued to be
bradycardic and the cardiology fellow was called to evaluate.
EKG showed sinus bradycardia and cards was not concerned. His
mental status deteriorated further until he was unresponsive to
all but painful stimuli.  He appeared apneic when supine but
this improved when he was sat up.
.
In the ED, initial vs were: T98.8, BP 98/60, 60 Patient was
given vanc, cipro for UTI and mental status improved.

MEDICAL HISTORY: 1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation
22. Shingles - [**2151**]
PAST SURGICAL HISTORY:
1. Status post ophthalmologic surgery

MEDICATION ON ADMISSION: BACLOFEN - 30mg Tablet HS
BRIMONIDINE-TIMOLOL [COMBIGAN] - 0.2 %-0.5 % Drops - OU [**Hospital1 **]
CLOPIDOGREL [PLAVIX] - 75 mg Tablet qday
DARIFENACIN [ENABLEX] - 7.5 mg daily
DORZOLAMIDE - 2 % Drops - OU TID
ENALAPRIL MALEATE [VASOTEC] - 10 mg qday
EXCEDRIN - prn
LATANOPROST [XALATAN] - 0.005 % Drops - 1 drop(s) OU HS
NITROFURANTOIN (MACROCRYST25%) [MACROBID] - 100 mg Capsule - 1
Capsule(s) by mouth daily Taking for one out of three weeks in
antibiotic cycle.
OMEPRAZOLE - 20 mg [**Hospital1 **]
SIMVASTATIN [ZOCOR] - 10 mg Tablet HS
Gabapentin 800mg PRN
ASPIRIN 325 mg Tablet daily
CALCIUM 600 + D - 600 mg (1,500 mg)-200 unit Tablet - TID
CASCARA SAGRADA - Dosage uncertain
DOCUSATE SODIUM [COLACE] 2 Capsule(s) once a day
MULTIVITAMIN - Dosage uncertain

ALLERGIES: Morphine / Coumadin

PHYSICAL EXAM: Physical Exam on Admission:
Vitals: T: 96.6 BP: 88/52 P: 47 R: 20 O2: 100%/2L
General: Minimally responsive to nail bed compression,
intermittently obstructing upper airway
Neuro: Depressed reflexes globally, chronically contracted L
hand, 4mm unreactive postoperative pupil on right, pinpoint
pupil on left
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: suprapubic foley
Ext: well perfused, 2+ pulses, no clubbing, cyanosis or edema

FAMILY HISTORY: Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia

SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via
Unspecified disorder of autonomic nervous system,Acute kidney failure, unspecified,Acute cystitis,Hypovolemia,Other specified cardiac dysrhythmias,Multiple sclerosis,Neurogenic bladder NOS,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension,Other constipation,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Attention to cystostomy
Autonomic nerve dis NEC,Acute kidney failure NOS,Acute cystitis,Hypovolemia,Cardiac dysrhythmias NEC,Multiple sclerosis,Neurogenic bladder NOS,Hx-prostatic malignancy,Hypertension NOS,Constipation NEC,Hyperlipidemia NEC/NOS,Obstructive sleep apnea,Atten to cystostomy
Admission Date:  [**2153-8-9**]              Discharge Date:   [**2153-8-13**]

Date of Birth:  [**2077-7-1**]             Sex:   M

Service: MEDICINE

Allergies:
Morphine / Coumadin

Attending:[**First Name3 (LF) 2610**]
Chief Complaint:
unresponsive

Major Surgical or Invasive Procedure:
Suprapubic catheter exchange [**2153-8-10**]


History of Present Illness:
History of Present Illness:  76 yo M w/ Hx of MS, PE, prostate
CA p/w AMS. Pt. was feeling weak this am and then went to his
day care class. At day care he was noted to be extremely
somnolent and essentially non-responsive, 911 was called and he
was brought to [**Hospital1 18**] ED where head CT was negative, CXR
negative. His mental status improved and he was transferred to
the floor where he was initially noted to be A/Ox3 but then
progressively deteriorated. He was bradycardic and was given
atropine in the field. On the floor he continued to be
bradycardic and the cardiology fellow was called to evaluate.
EKG showed sinus bradycardia and cards was not concerned. His
mental status deteriorated further until he was unresponsive to
all but painful stimuli.  He appeared apneic when supine but
this improved when he was sat up.
.
In the ED, initial vs were: T98.8, BP 98/60, 60 Patient was
given vanc, cipro for UTI and mental status improved.

Past Medical History:
1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation
22. Shingles - [**2151**]
PAST SURGICAL HISTORY:
1. Status post ophthalmologic surgery


Social History:
Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via

AA. Quit cigars a few years ago. Retired judge (at age 68 due to

fatigue).


Family History:
Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia


Physical Exam:
Physical Exam on Admission:
Vitals: T: 96.6 BP: 88/52 P: 47 R: 20 O2: 100%/2L
General: Minimally responsive to nail bed compression,
intermittently obstructing upper airway
Neuro: Depressed reflexes globally, chronically contracted L
hand, 4mm unreactive postoperative pupil on right, pinpoint
pupil on left
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: suprapubic foley
Ext: well perfused, 2+ pulses, no clubbing, cyanosis or edema


Pertinent Results:
Labs:
[**2153-8-9**]
- CBC with differential: WBC-9.0 RBC-4.07* Hgb-12.3* Hct-36.0*
MCV-88 MCH-30.1 MCHC-34.1 RDW-14.1 Plt Ct-155 Neuts-81.4*
Lymphs-11.5* Monos-4.5 Eos-2.5 Baso-0.2
- Coags: PT-12.5 PTT-26.8 INR(PT)-1.1
- CHEM 10: Glucose-123* UreaN-22* Creat-1.6* Na-135 K-5.9*
Cl-106 HCO3-19* Calcium-9.2 Phos-3.7 Mg-2.3
- Cardiac enzyme @ 1250PM: cTropnT-<0.01
- serum tox: ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG
- ABG @ 8:30PM: pO2-36* pCO2-40 pH-7.31* calTCO2-21 Base XS--5
Intubat-NOT INTUBA Vent-SPONTANEOUS
- Lactate- 1.0
- Blood cx 2x- pending*********
- UA***********
- Ucx: URINE CULTURE (Final [**2153-8-11**]):
      ESCHERICHIA COLI.    >100,000 ORGANISMS/ML..
         PRESUMPTIVE IDENTIFICATION.
                              SENSITIVITIES: MIC expressed in
MCG/ML
______________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--    16 I
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------   =>4 R
GENTAMICIN------------  =>16 R
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------   128 R
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------     4 S
TRIMETHOPRIM/SULFA----  =>16 R

[**2153-8-10**]
- LFTs: ALT-15 AST-17 LD(LDH)-107 AlkPhos-47 TotBili-0.5
- ABG: Temp-36.4 pO2-79* pCO2-36 pH-7.40 calTCO2-23 Base XS--1
Intubat-NOT INTUBA
- Albumin-3.2*
- VoidSpe-PND

[**2153-8-13**]
- CBC: WBC-6.1 RBC-3.49* Hgb-10.3* Hct-31.2* MCV-89 MCH-29.7
MCHC-33.2 RDW-14.4 Plt Ct-158
- CHEM 10: Glucose-103* UreaN-18 Creat-0.7 Na-141 K-3.6 Cl-110*
HCO3-26 Calcium-8.2* Phos-3.5 Mg-2.1

Images:
[**2153-8-9**]
- CXR Portable: Limited study not including the left
costophrenic angle and low lung volumes.  Cardiac silhouette is
mildly enlarged, unchanged from [**2152-4-27**]. The aorta is tortuous
with calcification at the knob. The hilar contours are overall
stable. There is no focal consolidation in the lungs. No
pneumothorax or pleural effusion is seen. Partially visualized
upper abdomen demonstrates air-filled dilated loops of bowel,
which is similar in appearance from [**2152-4-27**]. Surgical clips are
seen in the midline. Degenerative changes at the right shoulder
are similar from [**2152-4-24**].
IMPRESSION: No acute cardiopulmonary process.

- CT head without contrast: There is no hemorrhage or evidence
of acute major vascular territorial infarction. Again noted is a
6-mm hyperdensity in the left parietal lobe, unchanged in size
and appearance from [**2150-12-19**] and likely represents a cavernoma.
A 6 mm rounded hyperdensity at the midline along the roof of the
third ventricle is similar in size and appearance from
[**2150-12-19**] and likely represents a colloid cyst. The lateral
ventricles are stable in size. The ventricles and sulci are
stably prominent in size and configuration, compatible with
age-related global atrophy. Periventricular white matter
hypodensities are likely due to chronic small vessel ischemic
disease. Stable small areas of encephalomalacia involving the
left cerebellum, right parietal and bifrontal lobes. Visualized
paranasal sinuses and mastoid air cells are clear. No bony
abnormalities are noted.
IMPRESSION:
1. No acute intracranial abnormality.
2. Stable 6 mm rounded hyperdensity at the roof of the third
ventricle likely represents a colloid cyst. Lateral ventricles
are stable in size from [**2150-12-19**].
3. Hyperdense focus in the left parietal lobe is stable and
likely represents a cavernoma, as characterized on prior MRI.

[**2153-8-11**]
- CTA head and neck (prelim): Colloid cyst and left parietal
probable cavernoma are unchanged since [**2153-8-9**]. No evidence
of acute intracranial process. CTA demonstrates patent COW
vessels. Possible fetal origin of L PCA. Patent vertebral
arteries and ICAs, with atherosclerotic disease. Recons pending.
Reported to Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at 6:40pm by phone on [**2153-8-11**]

- 24 hour EEG- Began at 20:30 on the evening of [**8-11**].
It showed a widespread low voltage faster background that
appeared normal for wakefulness. The background included some
low voltage admixed alpha frequencies of 10 Hz or so. The
recording showed no areas of prominent focal slowing, and there
were no epileptiform features or electrographic seizures.
SPIKE DETECTION PROGRAMS: Showed no clear epileptiform
discharges.
SEIZURE DETECTION PROGRAMS: Showed plentiful lead and other
artifact but no electrographic seizures.
PUSHBUTTON ACTIVATIONS: There were none.
SLEEP: The patient progressed from wakefulness to sleep at
appropriate times, and sleep patterns appeared normal and
symmetric.
CARDIAC MONITOR: Showed a generally regular rhythm.
IMPRESSION: This telemetry showed a normal background in
wakefulness and in sleep. There were no areas of prominent focal
slowing. There were no epileptiform features or electrographic
seizures captured on continuous EEG or by automated detection
programs.

Brief Hospital Course:
76 year old male with MS, h/o sinus bradycardia and dx of
vasovagal syncope who prsents with two days of unresponsiveness.

.
#. Altered mental status.  Patient was transferred to the MICU
with another episode of unresponsiveness in the setting of
bradycardia (30s bpm) and hypotension (SBP 70s).  EKG showed
only sinus bradycardia.  He was volume resucitated, started on
Meropenem for h/o ESBL UTI, and was about to be intubated due to
concern for inability ot protect his airway.  Suddenly he awoke
with clear consciousness and stated that he was having a vagal
episode.  Neurology was consulted about this "vagal episode".
High concern was given to the likelyhood of non convulsive
seizures.  After his arousal his hemodynamic status had improved
and he was called out to the floor.  He underwent a 24 hours EEG
while in the hospital, which showed no signs of seizure.  Some
of his medications were adjusted with the question about timolol
having systemic effect and discontinuation of gabapention.  The
most likely cause of his altered mental status is likely due to
autonomic dysfunction and hypoperfusion in the setting of
dehydration and UTI.  This however should be followed up by his
primary care physician, [**Name10 (NameIs) **] cardiologist, and his
ophthalmologist.
.
#. Labile blood pressure: Hypotension & Hypertension.
Hypotension at the initial presentation is likely due to
hypovolemia given pre-renal state.  It improved with hydration.
However, given that he has MS [**First Name (Titles) **] [**Last Name (Titles) 5348**], likely has some
autonomic dysfuction, and post hydration, his SBP was elevated
up to the 180s.  In addition to the increase in lisinopril from
10 mg to 20 mg, he also received an additional dose of
hydralazine IV.  His BP improved from these measures, and he is
to go home on home medication given prior history of
hypotension.  This should be followed up by his primary care
doctor.
.
#. Urinary tract infection.  This was found in the UA on
admission as a part of the AMS work-up.  He was started on
meropenem [**2153-8-9**] initially given hsitory of ESBL UTI.  As the
culture grew out sensitive E. Coli, he was switched to Keflex
because of sensitivity to cefazolin on [**2153-8-11**].  The plan was
to complete a 10 day course of antibiotics on [**2153-8-17**].  This
can be followed up by his primary care provider.
.
#. Acute renal failure.  Patient initally presented elevated Crt
1.6 with [**Year (4 digits) 5348**] of 0.8-1.0.  He was fluid resuscitated in the
MICU, and his Crt returned to [**Year (4 digits) 5348**] on [**2153-8-10**].
.
#. Multiple sclerosis, non-acute issue.
.
#. Neurogenic bladder.  Patient received a new suprapubic
catheter on [**2153-8-10**].
.
#. Obstructive sleep apnea.  Patient continued with home BIPAP.

Medications on Admission:
BACLOFEN - 30mg Tablet HS
BRIMONIDINE-TIMOLOL [COMBIGAN] - 0.2 %-0.5 % Drops - OU [**Hospital1 **]
CLOPIDOGREL [PLAVIX] - 75 mg Tablet qday
DARIFENACIN [ENABLEX] - 7.5 mg daily
DORZOLAMIDE - 2 % Drops - OU TID
ENALAPRIL MALEATE [VASOTEC] - 10 mg qday
EXCEDRIN - prn
LATANOPROST [XALATAN] - 0.005 % Drops - 1 drop(s) OU HS
NITROFURANTOIN (MACROCRYST25%) [MACROBID] - 100 mg Capsule - 1
Capsule(s) by mouth daily Taking for one out of three weeks in
antibiotic cycle.
OMEPRAZOLE - 20 mg [**Hospital1 **]
SIMVASTATIN [ZOCOR] - 10 mg Tablet HS
Gabapentin 800mg PRN
ASPIRIN 325 mg Tablet daily
CALCIUM 600 + D - 600 mg (1,500 mg)-200 unit Tablet - TID
CASCARA SAGRADA - Dosage uncertain
DOCUSATE SODIUM [COLACE] 2 Capsule(s) once a day
MULTIVITAMIN - Dosage uncertain


Discharge Medications:
1. Baclofen 20 mg Tablet Sig: 1.5 Tablets PO at bedtime.
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 5 days.
Disp:*20 Capsule(s)* Refills:*0*
4. Combigan 0.2-0.5 % Drops Sig: One (1) drop Ophthalmic twice a
day.
5. Enalapril Maleate 10 mg Tablet Sig: One (1) Tablet PO once a
day.
6. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO twice a day.
8. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
9. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID (3
times a day).
10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO once
a day.
12. Calcium 600 + D(3) 600 mg(1,500mg) -200 unit Tablet Sig: One
(1) Tablet PO three times a day.
13. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
-Vasovagal syncope
-Acute complicated cystitis
-Acute kidney injury
-Multiple sclerosis
-Hypertension


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted to [**Hospital1 69**] after
an episode of unresponsiveness. It is possible that you had a
vasovagal episode. A CT scan of your head did not show evidence
of a stroke. EEG did not show seizures.

You were diagnosed with a urinary tract infection which was
partially treated with antibiotics.

The following medication changes were recommended:
- Please START Keflex 500 mg every 6 hours through Friday, [**8-17**]
- Please STOP gabapentin


Followup Instructions:
[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**], MD
[**Hospital1 2025**] Neurology
[**2153-8-15**]

Department: GERONTOLOGY
When: MONDAY [**2153-8-20**] at 10:30 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], RNC [**Telephone/Fax (1) 719**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: [**Hospital3 1935**] CENTER
When: THURSDAY [**2153-8-23**] at 3:30 PM
With: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 252**], M.D. [**Telephone/Fax (1) 253**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Name:[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **],MD
Specialty: Cardiology
When: [**9-3**] at 3pm
Address: [**Street Address(2) 2687**],STE 7C, [**Location (un) **],[**Numeric Identifier 822**]
Phone: [**Telephone/Fax (1) 5768**]
{'Unspecified disorder of autonomic nervous system,Acute kidney failure, unspecified,Acute cystitis,Hypovolemia,Other specified cardiac dysrhythmias,Multiple sclerosis,Neurogenic bladder NOS,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension,Other constipation,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Attention to cystostomy'}


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: unresponsive

PRESENT ILLNESS: History of Present Illness:  76 yo M w/ Hx of MS, PE, prostate
CA p/w AMS. Pt. was feeling weak this am and then went to his
day care class. At day care he was noted to be extremely
somnolent and essentially non-responsive, 911 was called and he
was brought to [**Hospital1 18**] ED where head CT was negative, CXR
negative. His mental status improved and he was transferred to
the floor where he was initially noted to be A/Ox3 but then
progressively deteriorated. He was bradycardic and was given
atropine in the field. On the floor he continued to be
bradycardic and the cardiology fellow was called to evaluate.
EKG showed sinus bradycardia and cards was not concerned. His
mental status deteriorated further until he was unresponsive to
all but painful stimuli.  He appeared apneic when supine but
this improved when he was sat up.
.
In the ED, initial vs were: T98.8, BP 98/60, 60 Patient was
given vanc, cipro for UTI and mental status improved.

MEDICAL HISTORY: 1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation
22. Shingles - [**2151**]
PAST SURGICAL HISTORY:
1. Status post ophthalmologic surgery

MEDICATION ON ADMISSION: BACLOFEN - 30mg Tablet HS
BRIMONIDINE-TIMOLOL [COMBIGAN] - 0.2 %-0.5 % Drops - OU [**Hospital1 **]
CLOPIDOGREL [PLAVIX] - 75 mg Tablet qday
DARIFENACIN [ENABLEX] - 7.5 mg daily
DORZOLAMIDE - 2 % Drops - OU TID
ENALAPRIL MALEATE [VASOTEC] - 10 mg qday
EXCEDRIN - prn
LATANOPROST [XALATAN] - 0.005 % Drops - 1 drop(s) OU HS
NITROFURANTOIN (MACROCRYST25%) [MACROBID] - 100 mg Capsule - 1
Capsule(s) by mouth daily Taking for one out of three weeks in
antibiotic cycle.
OMEPRAZOLE - 20 mg [**Hospital1 **]
SIMVASTATIN [ZOCOR] - 10 mg Tablet HS
Gabapentin 800mg PRN
ASPIRIN 325 mg Tablet daily
CALCIUM 600 + D - 600 mg (1,500 mg)-200 unit Tablet - TID
CASCARA SAGRADA - Dosage uncertain
DOCUSATE SODIUM [COLACE] 2 Capsule(s) once a day
MULTIVITAMIN - Dosage uncertain

ALLERGIES: Morphine / Coumadin

PHYSICAL EXAM: Physical Exam on Admission:
Vitals: T: 96.6 BP: 88/52 P: 47 R: 20 O2: 100%/2L
General: Minimally responsive to nail bed compression,
intermittently obstructing upper airway
Neuro: Depressed reflexes globally, chronically contracted L
hand, 4mm unreactive postoperative pupil on right, pinpoint
pupil on left
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: suprapubic foley
Ext: well perfused, 2+ pulses, no clubbing, cyanosis or edema

FAMILY HISTORY: Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia

SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via 

### Response:
{'Unspecified disorder of autonomic nervous system,Acute kidney failure, unspecified,Acute cystitis,Hypovolemia,Other specified cardiac dysrhythmias,Multiple sclerosis,Neurogenic bladder NOS,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension,Other constipation,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Attention to cystostomy'}
