CHIEF COMPLAINT: Epigastric pain

PRESENT ILLNESS: 34 y/o F with h/o autonomic dystonia, gastroparesis,
neurocardiogenic syncpoe (pacer [**2121**]), bladder areflexia with
bladder stimulator implant and urostomy, who presents with 2
days of intermittent, epigastric pain that radiated to flanks
and back, exacerbated by eating. Abdominal pain is different in
quality from her usual gastroparesis. She has had chills, and
low grade fever to 99 the past 2 days. + nausea, increased
aspirate from g tube, copious, green and black. Pt has also had
urinary frequecy and foul smelling urine from urostomy. Pt
denies any new meds, no tylenol and no OTC/supplemental or new
therapies. Pt presented to OSH [**8-24**] found to have elevated [**Hospital 13550**]
transferred to [**Hospital1 18**] for further work up.
.
In the ED initial vitals were T 99 BP 99/56 AR 68 RR 16 O2 sat
98% RA. Her ALT and AST were found to be 1737 and 2212
respectively.
.
On Medical Floor: Pt was stable, after undergoing Abd CT with IV
contrast pt developed an exacerbation of her dystonia with
extensive rigidity, tachycardia HR 150s and "unresponsive". Pt
was given Benadryl 25mg IV x1, Valium 10mg IV x1. Per nursing
concern pt was transferred to MICU for further monitoring of
respiratory status given benzo requirement to relieve dystonia.
Pt was never hypoxic, VSS.

MEDICAL HISTORY: #. generalized dystonia - involving mainly her lower extremities
and intermittently her arms, right more than left, occasionally
her neck and voice; provoked exacerbations of the symptoms
without a clear direct inducer[seen by Dr. [**Last Name (STitle) 13551**] at [**Hospital1 2025**] and Dr.
[**Last Name (STitle) 13552**] at [**Hospital1 1774**]]
#. dysautonomia with orthostasis, baseline SBP 80s-90s -
followed by Dr. [**First Name (STitle) **]
#. neuro-cardiogenic syncope s/p pacer in [**12/2120**]
#. Parkinsonism- occasional adventitious choreiform movements in
both
upper extremities induced by action
#. gastric dysmotility s/p g-tube placement
#. bladder areflexia s/p bladder stimulator implant and urostomy
[**2126**]
#. depression with h/o suicide attempt
#. peripheral neuropathy
#. h/o chronic pupillary dilation
#. s/p lap CCY

MEDICATION ON ADMISSION: Midodrine 5mg PO TID
Nadolol 80mg PO daily
Trihexyphenidyl 3mg PO TID
Prilosec 20mg PO daily
Zoloft 75mg PO daily

ALLERGIES: Demerol / Dilaudid / Ciprofloxacin / Bacitracin / Neosporin /
Adhesive Tape / Latex / Optiray 300

PHYSICAL EXAM: Vitals: T 96.3, BP 93/55, HR 80, RR 18, O2 saat 98%RA
GEN: Pleasant young woman in NAD
HEENT: MMM, Dilated Pupils reactive to light 5mm-->3mm, EOMI,
anicteric sclera
RESP: CTA b/l, no stridor
CV: Reg Nml S1, S2, no M/R/G
ABD:Soft, ND, Tender at RUQ no rebound, no guarding +BS,
urostomy in place with pink stomal mucosa-clear urine in bag, GJ
tube in place
EXT: warm, no peripheral edema, 2+DP pulses b/l, legs locked in
place crossed at ankles--unable to uncross voluntarily with
dorsiflexed ankles, contracture of R hand and flexed at elbow,
unable to straighten out
NEURO: A&O x3, no focal deficits, unable to assess gait or
reflexes as pt's legs and right arm locked in, difficulty
sticking out tongue, no facial droop, clear voice

FAMILY HISTORY: Grandfather with frequent syncopy, who has since passed
away.

SOCIAL HISTORY: Married and lives with husband, no children. Has a dog. Not
working and on disability
Anemia of other chronic disease,Acute and subacute necrosis of liver,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Blood in stool,Candidiasis of mouth,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Unspecified hereditary and idiopathic peripheral neuropathy,Paralysis agitans,Depressive disorder, not elsewhere classified,Cardiac pacemaker in situ,Attention to other artificial opening of digestive tract,Acute dystonia due to drugs,Other drugs and medicinal substances causing adverse effects in therapeutic use,Gastroparesis
Anemia-other chronic dis,Acute necrosis of liver,Surg compl-urinary tract,Urin tract infection NOS,Blood in stool,Thrush,Cholelithiasis NOS,Gstr/ddnts NOS w/o hmrhg,Idio periph neurpthy NOS,Paralysis agitans,Depressive disorder NEC,Status cardiac pacemaker,Atten to enterostomy NEC,Acute dystonia d/t drugs,Adv eff medicinal NEC,Gastroparesis
Admission Date:  [**2127-8-25**]              Discharge Date:   [**2127-9-11**]

Date of Birth:  [**2093-1-14**]             Sex:   F

Service: MEDICINE

Allergies:
Demerol / Dilaudid / Ciprofloxacin / Bacitracin / Neosporin /
Adhesive Tape / Latex / Optiray 300

Attending:[**First Name3 (LF) 358**]
Chief Complaint:
Epigastric pain

Major Surgical or Invasive Procedure:
None

History of Present Illness:
34 y/o F with h/o autonomic dystonia, gastroparesis,
neurocardiogenic syncpoe (pacer [**2121**]), bladder areflexia with
bladder stimulator implant and urostomy, who presents with 2
days of intermittent, epigastric pain that radiated to flanks
and back, exacerbated by eating. Abdominal pain is different in
quality from her usual gastroparesis. She has had chills, and
low grade fever to 99 the past 2 days. + nausea, increased
aspirate from g tube, copious, green and black. Pt has also had
urinary frequecy and foul smelling urine from urostomy. Pt
denies any new meds, no tylenol and no OTC/supplemental or new
therapies. Pt presented to OSH [**8-24**] found to have elevated [**Hospital 13550**]
transferred to [**Hospital1 18**] for further work up.
.
In the ED initial vitals were T 99 BP 99/56 AR 68 RR 16 O2 sat
98% RA. Her ALT and AST were found to be 1737 and 2212
respectively.
.
On Medical Floor: Pt was stable, after undergoing Abd CT with IV
contrast pt developed an exacerbation of her dystonia with
extensive rigidity, tachycardia HR 150s and "unresponsive". Pt
was given Benadryl 25mg IV x1, Valium 10mg IV x1. Per nursing
concern pt was transferred to MICU for further monitoring of
respiratory status given benzo requirement to relieve dystonia.
Pt was never hypoxic, VSS.


Past Medical History:
#. generalized dystonia - involving mainly her lower extremities
and intermittently her arms, right more than left, occasionally
her neck and voice; provoked exacerbations of the symptoms
without a clear direct inducer[seen by Dr. [**Last Name (STitle) 13551**] at [**Hospital1 2025**] and Dr.
[**Last Name (STitle) 13552**] at [**Hospital1 1774**]]
#. dysautonomia with orthostasis, baseline SBP 80s-90s -
followed by Dr. [**First Name (STitle) **]
#. neuro-cardiogenic syncope s/p pacer in [**12/2120**]
#. Parkinsonism- occasional adventitious choreiform movements in
both
upper extremities induced by action
#. gastric dysmotility s/p g-tube placement
#. bladder areflexia s/p bladder stimulator implant and urostomy
[**2126**]
#. depression with h/o suicide attempt
#. peripheral neuropathy
#. h/o chronic pupillary dilation
#. s/p lap CCY


Social History:
Married and lives with husband, no children. Has a dog. Not
working and on disability

Family History:
Grandfather with frequent syncopy, who has since passed
away.


Physical Exam:
Vitals: T 96.3, BP 93/55, HR 80, RR 18, O2 saat 98%RA
GEN: Pleasant young woman in NAD
HEENT: MMM, Dilated Pupils reactive to light 5mm-->3mm, EOMI,
anicteric sclera
RESP: CTA b/l, no stridor
CV: Reg Nml S1, S2, no M/R/G
ABD:Soft, ND, Tender at RUQ no rebound, no guarding +BS,
urostomy in place with pink stomal mucosa-clear urine in bag, GJ
tube in place
EXT: warm, no peripheral edema, 2+DP pulses b/l, legs locked in
place crossed at ankles--unable to uncross voluntarily with
dorsiflexed ankles, contracture of R hand and flexed at elbow,
unable to straighten out
NEURO: A&O x3, no focal deficits, unable to assess gait or
reflexes as pt's legs and right arm locked in, difficulty
sticking out tongue, no facial droop, clear voice


Pertinent Results:
[**2127-8-24**] 10:35PM BLOOD WBC-5.0 RBC-3.36* Hgb-10.0* Hct-29.2*
MCV-87 MCH-29.9# MCHC-34.4 RDW-16.8* Plt Ct-115*
[**2127-8-25**] 06:46AM BLOOD WBC-4.8 RBC-3.15* Hgb-9.5* Hct-27.5*
MCV-87 MCH-30.1 MCHC-34.5 RDW-16.8* Plt Ct-101*
[**2127-8-26**] 03:12AM BLOOD WBC-6.1 RBC-3.25* Hgb-9.6* Hct-28.5*
MCV-88 MCH-29.6 MCHC-33.7 RDW-16.8* Plt Ct-111*
[**2127-8-24**] 10:35PM BLOOD Glucose-82 UreaN-15 Creat-0.5 Na-137
K-3.9 Cl-103 HCO3-25 AnGap-13
[**2127-8-25**] 06:46AM BLOOD Glucose-81 UreaN-14 Creat-0.5 Na-137
K-3.6 Cl-104 HCO3-25 AnGap-12
[**2127-8-26**] 03:12AM BLOOD Glucose-110* UreaN-10 Creat-0.6 Na-137
K-3.4 Cl-102 HCO3-25 AnGap-13
[**2127-8-24**] 10:35PM BLOOD ALT-1737* AST-2212* AlkPhos-436*
Amylase-33 TotBili-1.8*
[**2127-8-25**] 06:46AM BLOOD ALT-1443* AST-1502* AlkPhos-432*
Amylase-41 TotBili-1.7*
[**2127-8-26**] 03:12AM BLOOD ALT-1053* AST-694* LD(LDH)-233
AlkPhos-427* TotBili-0.8
[**2127-8-26**] 03:12AM BLOOD Calcium-9.1 Phos-3.8 Mg-2.0
[**2127-8-25**] 06:46AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE
HBcAb-NEGATIVE HAV Ab-NEGATIVE
[**2127-8-25**] 10:41AM BLOOD Smooth-NEGATIVE
[**2127-8-25**] 12:59PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
.
Imaging:
[**2127-8-24**] Liver U/S - Normal-appearing common bile duct, without
shadowing stones. Unchanged mild right hydronephrosis.
IMPRESSION: Normal Doppler ultrasound.
.
[**2127-8-25**] ABD CTA:
IMPRESSION:
1. No portal vein thrombosis.
2. Splenomegaly.
3. Right complex adnexal structure likely representing
hydrosalpinx.


Brief Hospital Course:
34 y/o F with h/o generalized dsytonia, orthostasis,
gastroparesis, bladder areflexia s/p urostomy who presented to
the hospital with epigastric pain and transaminitis, UTI.
.
1)Transaminitis: The patient presented to the hospital with
sharp epigastric pain and transaminitis on [**8-25**] with ALT/AST in
the [**1-/2120**]'s. During the hospitalization, the ALT and AST
trended down. The epigastric pain resolved by the day after
admission. Several etiologogies were considered for this acute
change in her liver status.  Patient denies using tylenol or
NSAIDs, and tylenol level was not elevated. The only new
medication used was Valtrex for shingles in early [**Month (only) 596**], given
the time that has passed between using the medication and
transaminitis, it is unlikely that this contribued.The patient
also had viral serologies, Hep A/B/C were all negative. CMV was
negative. EBV showed positive IgG and negative IgM. parvovirus
and HSV were negative. Additionally, the patient had autoimmune
work up, whcih was negative for RH, alpha 1 antitrypson,
cerruloplasmn. HSV, [**Doctor First Name **] parvo also negative. The patient is
status post cholecystectomy, and had a MRCP for the
consideration of stone in duct. Sludge was found, pt had
sphincerotomy, and sludge was removed. On [**8-31**], patient
complaining of repeat abd pain, now central on right side. Had
KUB, was normal, had EGD which was normal, small area of
gastritis, Small bowel follow through, normal. Pt has been on
TPN for several years, this was discontinued during the
beginning of the hospital stay. it was restarted on [**9-8**], and
LFTs did not increase at first, but around [**9-1**] they started
increasing slightly but consistently. It is likely that patient
had a stone that was passed, which caused the initial pain
patient felt before coming to the hosptital. Since the Liver
enzymes trended up, she got a liver biopsy on [**9-9**].  Pt's liver
enzymes have been trending down.
.
2) Autonomic Dystonia: longstanding since age 23, at baseline
uses wheelchair, exacerbations in setting of infectious
processes or without clear inducing agents noted. Per movement
disorder specialists her exam has shown severe dystonia with
some atypical features that raise a question of a psychogenic
component as well. During her first week here, while she had the
UTI, she had about 3 episodes of acute dystonia during which she
could not speak. The first was her first night in the hospital
([**8-25**]). When contrast for CT scan was done, she became acutely
dystonic. She got 5mg IV valium, and then 10mg IV valium plus
25mg IV benedryl. She became unresponsive, and was transferred
to the MICU for closer monitoring. She was transferred back to
the floor the next day. She had another episode overnight, which
resolved with 10mg IV valium x2 and 25 benedryl x2. This regimen
has been working for during the hospitization. For less sever
dystonia, she takes valium 5mg IV. Also during this
hospitalization, with neurologies approval, Sinemet was
restarted. she was taken of this medication a few months back.
Pt will be d/cd with PO valium 5mg Q8 prn severe dystonia and
25mg benedryl po.  She must not take these medications in
combination with her narcotic pain medications or other sedating
medications. She will be following up with hepatology and
neurology as outpatient for further care.
.
2. Ileoconduit infection: patient found to have pan resistent
klebsiella in urine in outside hospital. Put on 7 days of
meropenem. Showing signs of infection again on [**8-5**], but Cx was
contaminated. started on meropenem again. Patient has outpatient
follow up appt with ID, who saw her in the hospital. Also seen
by Urology, she should follow up with Dr. [**First Name (STitle) **] [**Name (STitle) **],
neurourologist for issues concerning ileoconduit, and removal of
badder stimulator that is no longer in use. She will be
following up with ID and urology as outpatient.
.
3. Diarrhea: since [**9-5**] patient has been complaining of blood in
stool and diarrhea. She has had 3 episodes of fecal
incontinence. Stool studies were negative. Diarrhea has
resolved.
.
4. Pain control: patient prescribed Methadone 5mg q8h at home,
but says she rarely takes it. She had significant RUQ pain
during her second week here, requiring 4mg morphine every 4
hours. I started her on methadone 2.5 Q8h, and changed her
morphine to 2mg q2h. She is requiring less PRN morphine since
starting the methadone. She will be discharged home on methadone
2.5mg [**Hospital1 **], and morphine IR 15mg Q8 prn as needed for severe
pain.

4. Depression, hx of suicide attempt in past
- continue zoloft.
.
5. FEN: Patient on TPN. Will continue at home with the
reinitiation of lipids.


Medications on Admission:
Midodrine 5mg PO TID
Nadolol 80mg PO daily
Trihexyphenidyl 3mg PO TID
Prilosec 20mg PO daily
Zoloft 75mg PO daily


Discharge Medications:
1. Midodrine 5 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
2. Baclofen 10 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
3. Trihexyphenidyl 2 mg Tablet Sig: 1.5 Tablets PO TID (3 times
a day).
4. Sertraline 50 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
5. Nadolol 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Carbidopa-Levodopa 25-100 mg Tablet Sig: One (1) Tablet PO
TID (3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
8. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO DAILY
(Daily).
9. TPN
Volume= 1500 ml/d; amino acid= 65 g/d; branched chain AA= zero;
dextrose = 345 g/d; fat= 50g lipids;trace elements; standard
adult multivitamins, Electrolytes:NaCl =95;NaAc=0;NaPO4 =25;KCL
=30;KAc=0;KPO4=0;MgSO4=10;CaGluc= 10. Add 1g carnitine. Cycle
over 12hours-9pm-9am.
10. Methadone 5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
Disp:*45 Tablet(s)* Refills:*0*
11. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H prn as
needed for pain from dystonia.
Disp:*30 Tablet(s)* Refills:*0*
12. Morphine 15 mg Tablet Sig: One (1) Tablet PO q8H prn as
needed for severe pain.
Disp:*30 Tablet(s)* Refills:*0*
13. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO
q6H prn as needed for acute dystonia: may take valium and
benedryl together for severe/painful dystonia.
Disp:*30 Capsule(s)* Refills:*0*
14. Prilosec OTC 20 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Primary:
Transaminitis
Dystonia
gastritis
complicated urinary tract infection
.
Secondary:
dysautonomia with orthostasis
neuro-cardiogenic syncope s/p pacer in [**2121**]
gastric dysmotility
bladder areflexia
depression
peripheral neuropathy


Discharge Condition:
stable.


Discharge Instructions:
You came to the hospital with abdominal pain. Your liver enzymes
were found to be elevated, and they have been trending down
since you have been here. You had a ERCP done, and it is likely
that this liver problem was caused by a passed gallstone. You
also underwent a liver biopsy. You will follow up the results
with the liver specialist.
.
While you were here you had several episodes of acute dystonia.
We treated these with IV valium 10mg and 25mg of IV benadryl. We
reassessed after 1-2 hours, and repeated this when necessary.
Additionally, we pretreated you prior to procedures with the
same regimen. We also gave Valium you started having a tonic
reaction, treating the contraction rather than the pain. Your
symptoms improved with this regimen. At home you may take valium
5mg by mouth every 6 hours for acute dystonia as well as 25mg of
benedryl by mouth.  You must be careful not to take these
medications and your pain medication, morphine at the same time.
 However, you make take valium and benedryl for severe/painful
dystonia. Do not take these medications if you feel drowsy or
confused. If you develop fevers, worsening abdominal pain, or
any other concerning symptom please contact your doctors [**Name5 (PTitle) **] [**Name5 (PTitle) **]
to the emergency room.
.
You were restarted on TPN
.


Followup Instructions:
1. ID: Dr. [**Last Name (STitle) 4020**]/Dr. [**Last Name (STitle) **]. [**Last Name (NamePattern1) **]. Basement suite
G.  Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2127-10-16**] 11:00. New patient
visit.
.
2. Urology: With Dr. [**Last Name (STitle) **]([**Telephone/Fax (1) 4376**] for management of your
diverting ileal loop Provider: [**First Name8 (NamePattern2) 161**] [**Name11 (NameIs) 162**] [**Name8 (MD) 163**], MD
Phone:[**Telephone/Fax (1) 921**] Date/Time:[**2127-9-19**] 10:30

3.BENIGN HEMATOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2127-10-3**] 3:00
.
4.Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] PCP Wed [**9-17**] at 11:45am [**Telephone/Fax (1) 13553**]
.
5.Dr. [**Doctor Last Name 13554**]. [**10-8**] at 9:30am. [**Telephone/Fax (3) **]
.
6. Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 13555**]. [**10-8**] at 9:30am. [**Telephone/Fax (1) 1040**]-
this may be a conflict with above appointment. You may call the
hepatology and neurology numbers to reschedule at your
convenience.
{'Anemia of other chronic disease,Acute and subacute necrosis of liver,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Blood in stool,Candidiasis of mouth,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Unspecified hereditary and idiopathic peripheral neuropathy,Paralysis agitans,Depressive disorder, not elsewhere classified,Cardiac pacemaker in situ,Attention to other artificial opening of digestive tract,Acute dystonia due to drugs,Other drugs and medicinal substances causing adverse effects in therapeutic use,Gastroparesis'}


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: Epigastric pain

PRESENT ILLNESS: 34 y/o F with h/o autonomic dystonia, gastroparesis,
neurocardiogenic syncpoe (pacer [**2121**]), bladder areflexia with
bladder stimulator implant and urostomy, who presents with 2
days of intermittent, epigastric pain that radiated to flanks
and back, exacerbated by eating. Abdominal pain is different in
quality from her usual gastroparesis. She has had chills, and
low grade fever to 99 the past 2 days. + nausea, increased
aspirate from g tube, copious, green and black. Pt has also had
urinary frequecy and foul smelling urine from urostomy. Pt
denies any new meds, no tylenol and no OTC/supplemental or new
therapies. Pt presented to OSH [**8-24**] found to have elevated [**Hospital 13550**]
transferred to [**Hospital1 18**] for further work up.
.
In the ED initial vitals were T 99 BP 99/56 AR 68 RR 16 O2 sat
98% RA. Her ALT and AST were found to be 1737 and 2212
respectively.
.
On Medical Floor: Pt was stable, after undergoing Abd CT with IV
contrast pt developed an exacerbation of her dystonia with
extensive rigidity, tachycardia HR 150s and "unresponsive". Pt
was given Benadryl 25mg IV x1, Valium 10mg IV x1. Per nursing
concern pt was transferred to MICU for further monitoring of
respiratory status given benzo requirement to relieve dystonia.
Pt was never hypoxic, VSS.

MEDICAL HISTORY: #. generalized dystonia - involving mainly her lower extremities
and intermittently her arms, right more than left, occasionally
her neck and voice; provoked exacerbations of the symptoms
without a clear direct inducer[seen by Dr. [**Last Name (STitle) 13551**] at [**Hospital1 2025**] and Dr.
[**Last Name (STitle) 13552**] at [**Hospital1 1774**]]
#. dysautonomia with orthostasis, baseline SBP 80s-90s -
followed by Dr. [**First Name (STitle) **]
#. neuro-cardiogenic syncope s/p pacer in [**12/2120**]
#. Parkinsonism- occasional adventitious choreiform movements in
both
upper extremities induced by action
#. gastric dysmotility s/p g-tube placement
#. bladder areflexia s/p bladder stimulator implant and urostomy
[**2126**]
#. depression with h/o suicide attempt
#. peripheral neuropathy
#. h/o chronic pupillary dilation
#. s/p lap CCY

MEDICATION ON ADMISSION: Midodrine 5mg PO TID
Nadolol 80mg PO daily
Trihexyphenidyl 3mg PO TID
Prilosec 20mg PO daily
Zoloft 75mg PO daily

ALLERGIES: Demerol / Dilaudid / Ciprofloxacin / Bacitracin / Neosporin /
Adhesive Tape / Latex / Optiray 300

PHYSICAL EXAM: Vitals: T 96.3, BP 93/55, HR 80, RR 18, O2 saat 98%RA
GEN: Pleasant young woman in NAD
HEENT: MMM, Dilated Pupils reactive to light 5mm-->3mm, EOMI,
anicteric sclera
RESP: CTA b/l, no stridor
CV: Reg Nml S1, S2, no M/R/G
ABD:Soft, ND, Tender at RUQ no rebound, no guarding +BS,
urostomy in place with pink stomal mucosa-clear urine in bag, GJ
tube in place
EXT: warm, no peripheral edema, 2+DP pulses b/l, legs locked in
place crossed at ankles--unable to uncross voluntarily with
dorsiflexed ankles, contracture of R hand and flexed at elbow,
unable to straighten out
NEURO: A&O x3, no focal deficits, unable to assess gait or
reflexes as pt's legs and right arm locked in, difficulty
sticking out tongue, no facial droop, clear voice

FAMILY HISTORY: Grandfather with frequent syncopy, who has since passed
away.

SOCIAL HISTORY: Married and lives with husband, no children. Has a dog. Not
working and on disability 

### Response:
{'Anemia of other chronic disease,Acute and subacute necrosis of liver,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Blood in stool,Candidiasis of mouth,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Unspecified hereditary and idiopathic peripheral neuropathy,Paralysis agitans,Depressive disorder, not elsewhere classified,Cardiac pacemaker in situ,Attention to other artificial opening of digestive tract,Acute dystonia due to drugs,Other drugs and medicinal substances causing adverse effects in therapeutic use,Gastroparesis'}
