CHIEF COMPLAINT: Right flank pain

PRESENT ILLNESS: 45-year-old Female with lupus nephritis s/p living related renal
x-plant in [**2136**] who presented with right flank pain for the past
4 days. She has had rising creatinine over the last couple of
months and had a biopsy in [**2147-2-11**] with evidence of chronic
allograft nephropathy. She is currently undergoing another
transplant evaluation from another brother as she is chronically
rejecting.
.
On admission, the patient reported 3-4 days of right flank pain.
She described the pain as a burning [**11-19**] pain, without
significant radiation, located over the flank and the back
approximately at the level of the iliac crest. She denied any
pain over her transplanted kidney. She had been tolerating POs
without any n/v/d. She denied any trauma to the site prior to
development of pain or musculoskeletal strain. She also denied
any f/c/r, hematuria, dysuria, and urinary frequency. The
patient also denied any sick contacts (although she works as a
clinical lab technician drawing labs from patients in local med
center), as well as any travel or exposure to new pets. Of note,
she did have an illness with diarrhea approximately one month
ago, but recently she had been having one regular stool/day. In
terms of medications, she has been compliant with her
medications without any missed doses. She has been prescribed
Ultram for PRN pain which she has been taking nightly for years.
With the onset of pain, she has been taking 1-2 tabs Q6 hours
over the last 4 days. The only new medications are Aranesp
injections as well as iron tablets started 6 weeks ago for
anemia. She was previously on lisinopril for several months
which was stopped in [**Month (only) 547**] due to Angioedema.
.
In the ED, she was thought to have had some tenderness to
palpation. A renal graft ultrasound was performed and
demonstrated increasing size and edema of the kidney. The
transplant service was called, but did not have any specific
recommendations. The patient was given morphine 2mg x2, at which
point she developed nausea and vomiting. She was subsequently
given Dilaudid 2mg x1, and Anzemet 12.5mg x2.
.
At 4AM her peripheral IV infiltrated. The IV nurse found her
unresponsive, grey, clammy, and hypoxic (?) with an oxygen sat
of 40%. She was hypotensive to 100/palp (nl sbp 180) and mildly
tachycardic with a heart rate of 100. Her fingerstick at that
time was 200. She was placed on a NRB with an increase of her
oxygen sats to 100% at which time she quickly regained
consciousness. She was rapidly titrated down to 2L via nasal
cannula with an O2 sat of 100%. Her ABG (?timing and ?FiO2) was
7.3/65/70.
.
On review of systems here in the ICU, she has not had any
fevers, chills, SOB, CP, weight loss, recent diarrhea, rashes,
hematuria, or traumatic injuries. She does snore at night and
likely has sleep apnea from what her husband has told her. On
further reflection, she has felt much more tired recently and
has been "sleepy."

MEDICAL HISTORY: 1. Lupus diagnosed in [**2120**].
2. Lupus nephritis status post transplant; baseline creatinine
rising over the last last 6mo.
3. Gout.
4. Childhood rheumatic fever.
5. Hypertension.
6. Cataracts.
7. S. pneumonia in her sputum in 02/[**2144**].
8. CMV viremia in [**2140**] treated with ganciclovir.
9. Squamous cell CA followed by derm.
10. CHF- EF 35%

MEDICATION ON ADMISSION: 1. Prednisone 5mg once daily
2. Rapamune 2mg alternating with 1mg once daily
3. Lasix 80 mg daily
4. Diltiazem 240 mg daily.
5. Allopurinol 200 mg daily.
6. Aspirin 325 mg daily
7. Aranesp once weekly
8. Ultram p.r.n. -> which she has been taking 1-2 tabs Q4-6hours
over the last couple of days
9. Potassium chloride 20 mEq daily
10. Fe
11. Calcium carbonate 600mg [**Hospital1 **].
12. Multivitamins.
13. Fish oil 1g [**Hospital1 **].

ALLERGIES: Sulfonamides / Erythromycin Base / Nsaids / Lisinopril / Lipitor

PHYSICAL EXAM: Initial Vitals on Admission: 98.3 162/104 16 93%3L
ICU Vitals: T 100.1, HR 112, BP 153/105, RR 14, O2 sat 83-87%
RA, 93-94% on 2L NC
GEN: Overweight. NAD.
HEENT: EOMI, anicteric, op clear, mmm.
CV: Regular tachycardia without m/r/g. Difficult to assess JVD.

FAMILY HISTORY: Mother: MI in her 60s.
Father: AAA rupture in 60s

SOCIAL HISTORY: Lab technician who lives with her husband and her two adopted
children. Tob: five-pack-year history of smoking but quit 10
years ago EtOH: three glasses of ethanol per week.
Herpes zoster without mention of complication,Complications of transplanted kidney,Systemic lupus erythematosus,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic glomerulonephritis in diseases classified elsewhere,Anemia in chronic kidney disease,Unspecified essential hypertension,Gout, unspecified
Herpes zoster NOS,Compl kidney transplant,Syst lupus erythematosus,Pneumonia, organism NOS,CHF NOS,Abn react-org transplant,Chr nephritis in oth dis,Anemia in chr kidney dis,Hypertension NOS,Gout NOS
Admission Date:  [**2148-6-20**]              Discharge Date:   [**2148-6-25**]

Date of Birth:  [**2102-7-10**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfonamides / Erythromycin Base / Nsaids / Lisinopril / Lipitor

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Right flank pain

Major Surgical or Invasive Procedure:
none

History of Present Illness:
45-year-old Female with lupus nephritis s/p living related renal
x-plant in [**2136**] who presented with right flank pain for the past
4 days. She has had rising creatinine over the last couple of
months and had a biopsy in [**2147-2-11**] with evidence of chronic
allograft nephropathy. She is currently undergoing another
transplant evaluation from another brother as she is chronically
rejecting.
.
On admission, the patient reported 3-4 days of right flank pain.
She described the pain as a burning [**11-19**] pain, without
significant radiation, located over the flank and the back
approximately at the level of the iliac crest. She denied any
pain over her transplanted kidney. She had been tolerating POs
without any n/v/d. She denied any trauma to the site prior to
development of pain or musculoskeletal strain. She also denied
any f/c/r, hematuria, dysuria, and urinary frequency. The
patient also denied any sick contacts (although she works as a
clinical lab technician drawing labs from patients in local med
center), as well as any travel or exposure to new pets. Of note,
she did have an illness with diarrhea approximately one month
ago, but recently she had been having one regular stool/day. In
terms of medications, she has been compliant with her
medications without any missed doses. She has been prescribed
Ultram for PRN pain which she has been taking nightly for years.
With the onset of pain, she has been taking 1-2 tabs Q6 hours
over the last 4 days. The only new medications are Aranesp
injections as well as iron tablets started 6 weeks ago for
anemia. She was previously on lisinopril for several months
which was stopped in [**Month (only) 547**] due to Angioedema.
.
In the ED, she was thought to have had some tenderness to
palpation. A renal graft ultrasound was performed and
demonstrated increasing size and edema of the kidney. The
transplant service was called, but did not have any specific
recommendations. The patient was given morphine 2mg x2, at which
point she developed nausea and vomiting. She was subsequently
given Dilaudid 2mg x1, and Anzemet 12.5mg x2.
.
At 4AM her peripheral IV infiltrated. The IV nurse found her
unresponsive, grey, clammy, and hypoxic (?) with an oxygen sat
of 40%. She was hypotensive to 100/palp (nl sbp 180) and mildly
tachycardic with a heart rate of 100. Her fingerstick at that
time was 200. She was placed on a NRB with an increase of her
oxygen sats to 100% at which time she quickly regained
consciousness. She was rapidly titrated down to 2L via nasal
cannula with an O2 sat of 100%. Her ABG (?timing and ?FiO2) was
7.3/65/70.
.
On review of systems here in the ICU, she has not had any
fevers, chills, SOB, CP, weight loss, recent diarrhea, rashes,
hematuria, or traumatic injuries. She does snore at night and
likely has sleep apnea from what her husband has told her. On
further reflection, she has felt much more tired recently and
has been "sleepy."


Past Medical History:
1. Lupus diagnosed in [**2120**].
2. Lupus nephritis status post transplant; baseline creatinine
rising over the last last 6mo.
3. Gout.
4. Childhood rheumatic fever.
5. Hypertension.
6. Cataracts.
7. S. pneumonia in her sputum in 02/[**2144**].
8. CMV viremia in [**2140**] treated with ganciclovir.
9. Squamous cell CA followed by derm.
10. CHF- EF 35%


Social History:
Lab technician who lives with her husband and her two adopted
children. Tob: five-pack-year history of smoking but quit 10
years ago EtOH: three glasses of ethanol per week.

Family History:
Mother: MI in her 60s.
Father: AAA rupture in 60s


Physical Exam:
Initial Vitals on Admission: 98.3 162/104 16 93%3L
ICU Vitals: T 100.1, HR 112, BP 153/105, RR 14, O2 sat 83-87%
RA, 93-94% on 2L NC
GEN: Overweight. NAD.
HEENT: EOMI, anicteric, op clear, mmm.
CV: Regular tachycardia without m/r/g. Difficult to assess JVD.

Chest: Bibasilar crackles
Back: slight point tenderness to palpation over right superior
iliac crest at its lateral margin.
Abd: soft, NT, ND, no tenderness to palpation over the
transplanted kidney, no rebound or guarding. +BS.
Ext: Warm. Trace bilateral LE edema. No pain with rotation or
flexion/extension of the right hip.
Skin: no rashes.


Pertinent Results:
[**2148-6-20**] 07:00PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.012
[**2148-6-20**] 07:00PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-500
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2148-6-20**] 07:00PM URINE  RBC-0-2 WBC-0-2 BACTERIA-RARE YEAST-NONE
EPI-0
[**2148-6-20**] 04:10PM   GLUCOSE-95 UREA N-57* CREAT-3.0* SODIUM-141
POTASSIUM-3.2* CHLORIDE-98 TOTAL CO2-32 ANION GAP-14
[**2148-6-20**] 04:10PM   CALCIUM-8.6 PHOSPHATE-3.2 MAGNESIUM-2.0
[**2148-6-20**] 04:10PM   WBC-8.2 RBC-4.15* HGB-11.9* HCT-34.7* MCV-84
MCH-28.8 MCHC-34.4 RDW-15.9*
[**2148-6-20**] 04:10PM   NEUTS-57.4 LYMPHS-34.5 MONOS-5.6 EOS-1.4
BASOS-1.1
[**2148-6-20**] 04:10PM   MICROCYT-1+
[**2148-6-20**] 04:10PM   PLT COUNT-172
[**2148-6-20**] 04:10PM   PT-11.0 PTT-19.9* INR(PT)-0.9
.
CT without contrast [**2148-6-21**]-
1. Comment on PE cannot be made without IV contrast.
2. Peribronchial cuffing and interstitial edema with bilateral
basilar pleural effusions and consolidation.
3. Atrophy of both native kidneys.
.
RENAL TRANSPLANT ULTRASOUND [**2148-6-20**]: Transplanted right kidney
now measures 12.3 cm in length, and previously measured 9.7 cm.
There is a heterogeneous and edematous appearance of the
transplanted kidney. There are no peritransplant fluid
collections. There is no hydronephrosis or stone. The arterial
and venous flow is patent and normal. The RIs range from
0.58-0.67. IMPRESSION: Compared to the prior examination, the
transplanted kidney has increased in size and has an edematous
appearance. There is normal flow demonstrated with RIs within
normal limits. There is no peritransplant fluid collection.
.
CXR: Subtle opacity in the right lower lobe concerning for early
pneumonia or aspiration. Mild cardiomegaly. Pulmonary arterial
hypertension.
.
V/Q scan [**2148-6-21**]:
Perfusion images in 8 views show slightly heterogeneous
perfusion without definite focal perfusion defect. Ventilation
images obtained with Tc-[**Age over 90 **]m aerosol in the same 8 views
demonstrate
some central deposition of tracer consistent with airway
disease. There are no mismatched defects.
Chest x-ray shows right lower lobe pneuomonia.
IMPRESSION: Low likehood ratio for recent pulmonary embolism.
.
[**2148-6-21**] Chest CT: IMPRESSION:
1. Comment on PE cannot be made without IV contrast.
2. Peribronchial cuffing and interstitial edema with bilateral
basilar pleural effusions and consolidation.
3. Atrophy of both native kidneys
.
ECHO [**2148-6-21**]: EF 35%, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 5660**] dilated, mild symm LVH,
moderate global LV HK, 1+ AR, 2+ MR


Brief Hospital Course:
# Hypoxia/Hypercarbia - The patient was ruled out for PE with a
V/Q scan that was low-prob. CXR was consistent with pneumonia
and the pt was started on levofloxacin. Her O2 sats improved
gradually as did her cough and on day of discharge her
ambulatory sats were 94% on RA. She was discharged to complete a
10 day course of levofloxacin.
.
# Flank pain: Given the increase in size as well as the
edematous appearance of the x-planted kidney with associated sx
of pain and nausea, there was a possibility of acute on chronic
rejection of the x-planted kidney. However she had no
pain/tenderness over her transplanted kidney and she has a
creatinine of 3 which was lower than it has been since [**Month (only) 958**]
[**2148**]. Ultrasound of the transplanted kidney showed that it had
increased in size and had an edematous appearance. However,
normal flow was demonstrated with RIs within normal limits. On
the 3rd day of admission the pt developed a vesicular rash on
the skin in her flank area consistent with herpes zoster. She
was started on valacyclovir and neurontin. This was felt to be
the likely culprit of her pain. She continued to have pain and
was d/c'd on oxycontin with oxycodone for breakthrough pain
related to the zoster. The rash did remain within one dermatome
and did not cross the midline.
.
# h/o kidney transplant: Pt was continued on prednisone 5mg and
rapamune alternating 2mg and 1mg doses. Rapamune levels were
therapeutic.
.
# HTN: The pt had elevated BP in ED of max SBP 200. It was felt
that pain may have been contributing, but even when her pain
appeared to be controlled she still was hypertensive. She was
continued on Diltiazem 240 mg daily and Imdur 30mg po daily was
added and her BP came down to the 140's/70's. The renal
transplant team recommended decreasing her lasix from 80 mg to
40mg daily since her Cr had risen slightly over the admission.
She was continued on Aspirin 325 mg daily for primary CAD ppx.
.
# Anemia: The pt has had chronic stable anemia with Hct in the
30s since [**Month (only) **]. of '[**47**]. Hct was relatively stable and she did not
require any transfusions. She was continued on Fe. Aranesp was
held while in house.
.
# FEN: She was continued on nutritional supplementation with
Calcium carbonate 500mg [**Hospital1 **], Multivitamins and Fish oil 1g [**Hospital1 **].

.
# PPx: Heparin SC, PPI
.
# Code Status = Full Code


Medications on Admission:
1. Prednisone 5mg once daily
2. Rapamune 2mg alternating with 1mg once daily
3. Lasix 80 mg daily
4. Diltiazem 240 mg daily.
5. Allopurinol 200 mg daily.
6. Aspirin 325 mg daily
7. Aranesp once weekly
8. Ultram p.r.n. -> which she has been taking 1-2 tabs Q4-6hours
over the last couple of days
9. Potassium chloride 20 mEq daily
10. Fe
11. Calcium carbonate 600mg [**Hospital1 **].
12. Multivitamins.
13. Fish oil 1g [**Hospital1 **].


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Sirolimus 1 mg Tablet Sig: Two (2) Tablet PO MWF
(Monday-Wednesday-Friday).
4. Sirolimus 1 mg Tablet Sig: One (1) Tablet PO QTU, THURS, SA,
SUN ().
5. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
6. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
7. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
8. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
9. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
10. Omega-3 Fatty Acids 550 mg Capsule Sig: Two (2) Capsule PO
BID (2 times a day).
11. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q48H
(every 48 hours) for 5 days: Last day [**6-30**].
Disp:*3 Tablet(s)* Refills:*0*
12. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
13. Valacyclovir 500 mg Tablet Sig: Two (2) Tablet PO qd () for
10 days.
Disp:*20 Tablet(s)* Refills:*0*
14. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 10 days: may refill if pain continues after 10
days. .
Disp:*20 Capsule(s)* Refills:*1*
16. Oxycodone 5 mg Tablet Sig: 1-3 Tablets PO Q4H (every 4
hours) as needed for 10 days: may cause sedation. Do not drive
or operate machinery while taking this med. .
Disp:*30 Tablet(s)* Refills:*0*
17. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
18. Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO BID
(2 times a day).
19. Promethazine 12.5 mg Suppository Sig: One (1) suppository
Rectal every 4-6 hours as needed for nausea.
Disp:*10 suppositories* Refills:*1*
20. OxyContin 10 mg Tablet Sustained Release 12HR Sig: [**2-12**]
Tablet Sustained Release 12HRs PO every twelve (12) hours as
needed for pain for 10 days: may cause sedation. Do not drive or
operate heavy machinery. .
Disp:*20 Tablet Sustained Release 12HR(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Shingles
pneumonia
hypertension


Discharge Condition:
stable

Discharge Instructions:
If you develop fevers, chills, irretractable nausea, vomiting,
chest pain, or shortness of breath, please call your PCP or
return to the ED.
Changes to medications:
allopurinol - please only take 100mg every other day.
lasix - please only take 40mg daily.


Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] in the next 1-2 weeks.
Provider: [**Name Initial (NameIs) 394**]/[**Name8 (MD) **] MD Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2148-7-3**] 10:30
Provider: [**Name10 (NameIs) 1344**] [**Last Name (NamePattern4) 3125**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2148-7-18**] 11:20
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] TRANSPLANT SOCIAL WORK
Date/Time:[**2148-7-18**] 2:00
{'Herpes zoster without mention of complication,Complications of transplanted kidney,Systemic lupus erythematosus,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic glomerulonephritis in diseases classified elsewhere,Anemia in chronic kidney disease,Unspecified essential hypertension,Gout, 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: Right flank pain

PRESENT ILLNESS: 45-year-old Female with lupus nephritis s/p living related renal
x-plant in [**2136**] who presented with right flank pain for the past
4 days. She has had rising creatinine over the last couple of
months and had a biopsy in [**2147-2-11**] with evidence of chronic
allograft nephropathy. She is currently undergoing another
transplant evaluation from another brother as she is chronically
rejecting.
.
On admission, the patient reported 3-4 days of right flank pain.
She described the pain as a burning [**11-19**] pain, without
significant radiation, located over the flank and the back
approximately at the level of the iliac crest. She denied any
pain over her transplanted kidney. She had been tolerating POs
without any n/v/d. She denied any trauma to the site prior to
development of pain or musculoskeletal strain. She also denied
any f/c/r, hematuria, dysuria, and urinary frequency. The
patient also denied any sick contacts (although she works as a
clinical lab technician drawing labs from patients in local med
center), as well as any travel or exposure to new pets. Of note,
she did have an illness with diarrhea approximately one month
ago, but recently she had been having one regular stool/day. In
terms of medications, she has been compliant with her
medications without any missed doses. She has been prescribed
Ultram for PRN pain which she has been taking nightly for years.
With the onset of pain, she has been taking 1-2 tabs Q6 hours
over the last 4 days. The only new medications are Aranesp
injections as well as iron tablets started 6 weeks ago for
anemia. She was previously on lisinopril for several months
which was stopped in [**Month (only) 547**] due to Angioedema.
.
In the ED, she was thought to have had some tenderness to
palpation. A renal graft ultrasound was performed and
demonstrated increasing size and edema of the kidney. The
transplant service was called, but did not have any specific
recommendations. The patient was given morphine 2mg x2, at which
point she developed nausea and vomiting. She was subsequently
given Dilaudid 2mg x1, and Anzemet 12.5mg x2.
.
At 4AM her peripheral IV infiltrated. The IV nurse found her
unresponsive, grey, clammy, and hypoxic (?) with an oxygen sat
of 40%. She was hypotensive to 100/palp (nl sbp 180) and mildly
tachycardic with a heart rate of 100. Her fingerstick at that
time was 200. She was placed on a NRB with an increase of her
oxygen sats to 100% at which time she quickly regained
consciousness. She was rapidly titrated down to 2L via nasal
cannula with an O2 sat of 100%. Her ABG (?timing and ?FiO2) was
7.3/65/70.
.
On review of systems here in the ICU, she has not had any
fevers, chills, SOB, CP, weight loss, recent diarrhea, rashes,
hematuria, or traumatic injuries. She does snore at night and
likely has sleep apnea from what her husband has told her. On
further reflection, she has felt much more tired recently and
has been "sleepy."

MEDICAL HISTORY: 1. Lupus diagnosed in [**2120**].
2. Lupus nephritis status post transplant; baseline creatinine
rising over the last last 6mo.
3. Gout.
4. Childhood rheumatic fever.
5. Hypertension.
6. Cataracts.
7. S. pneumonia in her sputum in 02/[**2144**].
8. CMV viremia in [**2140**] treated with ganciclovir.
9. Squamous cell CA followed by derm.
10. CHF- EF 35%

MEDICATION ON ADMISSION: 1. Prednisone 5mg once daily
2. Rapamune 2mg alternating with 1mg once daily
3. Lasix 80 mg daily
4. Diltiazem 240 mg daily.
5. Allopurinol 200 mg daily.
6. Aspirin 325 mg daily
7. Aranesp once weekly
8. Ultram p.r.n. -> which she has been taking 1-2 tabs Q4-6hours
over the last couple of days
9. Potassium chloride 20 mEq daily
10. Fe
11. Calcium carbonate 600mg [**Hospital1 **].
12. Multivitamins.
13. Fish oil 1g [**Hospital1 **].

ALLERGIES: Sulfonamides / Erythromycin Base / Nsaids / Lisinopril / Lipitor

PHYSICAL EXAM: Initial Vitals on Admission: 98.3 162/104 16 93%3L
ICU Vitals: T 100.1, HR 112, BP 153/105, RR 14, O2 sat 83-87%
RA, 93-94% on 2L NC
GEN: Overweight. NAD.
HEENT: EOMI, anicteric, op clear, mmm.
CV: Regular tachycardia without m/r/g. Difficult to assess JVD.

FAMILY HISTORY: Mother: MI in her 60s.
Father: AAA rupture in 60s

SOCIAL HISTORY: Lab technician who lives with her husband and her two adopted
children. Tob: five-pack-year history of smoking but quit 10
years ago EtOH: three glasses of ethanol per week. 

### Response:
{'Herpes zoster without mention of complication,Complications of transplanted kidney,Systemic lupus erythematosus,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic glomerulonephritis in diseases classified elsewhere,Anemia in chronic kidney disease,Unspecified essential hypertension,Gout, unspecified'}
