CHIEF COMPLAINT: Dystonia

PRESENT ILLNESS: Mrs. [**Known lastname 13556**] is a 38 year old woman with longstanding dystonia
and autonomic dysfunction who develpoed a full body dystonic
reaction following IR guided replacement of her granulated G-J
tube on [**2130-3-20**]. At baseline she is wheelchair bound since [**2122**]
with severe dystonia of her lower extremities, but is able to
use her upper extremities to transfer by herself. She also has
laryngeal dystonia which has worsened over the past 6 months
causing her to speak in a whisper.  She has the G-J for
gastroparesis which she uses for decompression and receives her
nutrition via TPN 5 days per week. She is also s/p pacemaker
placement for neurocardiogenic syncope and s/p urostomy for
bladder areflexia.

MEDICAL HISTORY: - dystonia involving mainly her lower extremities and
intermittently her arms, laryngeal dystonia worse over past 6
months; 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**] (current
pacemaker detects low-BP and increases HR to 130 for 5min)
- Parkinsonism - occasional adventitious choreiform movements in
both upper extremities induced by action; takes Artane
- gastric dysmotility s/p g-tube placement and recently on TPN
- bladder areflexia s/p bladder stimulator implant and urostomy
- depression with h/o suicide attempt
- peripheral neuropathy
- chronic pupillary dilation
- s/p lap CCY
- Chronic anemia and intermittent low platelets
- EGD with gastritis ([**2127**])
- colonoscopy with friability ([**2122**])

MEDICATION ON ADMISSION: 1. baclofen 20mg tid
2. diazepam (Valium) 5mg tid PRN for anxiety
3. nadolol 80mg daily
4. omeprazole (Prilosec) 20mg [**Hospital1 **] PRN(?)
5. sertraline (Zoloft) 50mg daily
6. trihexyphenidyl (Artane) 3mg qAM / 3mg q1pm / 4mg qhs

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

PHYSICAL EXAM: On admission:

FAMILY HISTORY: Grandfather with frequent sycnope; 3 deceased paternal uncles
with [**Name (NI) 5895**] Disease. No family history of seizures or
strokes.

SOCIAL HISTORY: Lives with husband in [**Name (NI) **], Mass. ([**First Name8 (NamePattern2) 3613**] [**Known lastname 13556**]: cell
[**Telephone/Fax (1) 13557**], home [**Telephone/Fax (1) 13558**], work [**Telephone/Fax (1) 13566**]). Not
working, receives disability payments.
Genetic torsion dystonia,Urinary tract infection, site not specified,Paralysis agitans,Unspecified disorder of autonomic nervous system,Unspecified hereditary and idiopathic peripheral neuropathy,Depressive disorder, not elsewhere classified,Dyspepsia and other specified disorders of function of stomach,Cardiac pacemaker in situ,Tachycardia, unspecified,Ileostomy status,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other artificial opening of urinary tract status,Other alteration of consciousness
Genetic torsion dystonia,Urin tract infection NOS,Paralysis agitans,Autonomic nerve dis NEC,Idio periph neurpthy NOS,Depressive disorder NEC,Stomach function dis NEC,Status cardiac pacemaker,Tachycardia NOS,Ileostomy status,Abn react-external stoma,Urinostomy status NEC,Other alter consciousnes
Admission Date:  [**2131-3-20**]              Discharge Date:   [**2131-3-30**]

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

Service: NEUROLOGY

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

Attending:[**First Name3 (LF) 13565**]
Chief Complaint:
Dystonia

Major Surgical or Invasive Procedure:
G-J tube replacement


History of Present Illness:
Mrs. [**Known lastname 13556**] is a 38 year old woman with longstanding dystonia
and autonomic dysfunction who develpoed a full body dystonic
reaction following IR guided replacement of her granulated G-J
tube on [**2130-3-20**]. At baseline she is wheelchair bound since [**2122**]
with severe dystonia of her lower extremities, but is able to
use her upper extremities to transfer by herself. She also has
laryngeal dystonia which has worsened over the past 6 months
causing her to speak in a whisper.  She has the G-J for
gastroparesis which she uses for decompression and receives her
nutrition via TPN 5 days per week. She is also s/p pacemaker
placement for neurocardiogenic syncope and s/p urostomy for
bladder areflexia.

Prior to the G-J tube replacement on [**2131-3-20**] she was at her
baseline and received her daily doses of Artane and Baclofen and
was given midazolam by anesthesia (due to prior dystonic
reaction with propofol).  Following the case she developed a
full body dystonic reaction and anesthesia felt she was not safe
to go home despite diazepam 10 mg x 2, diphenhydramine 50 mg x
2. She was initially admitted to medicine for observation and
spent the night in the MICU. In the MICU, she had one more
episode of dystonia, where she received 20mg IV valium and 50 mg
IV benadryl. Since she has been heavily sedated and hypotensive
with SBP in the 70s (baseline 80s). She was initially responding
to questions by blinking once for yest and twice for no, but
eventually began to whisper.

Neurology was consulted and she was transferred to the general
neurology service on [**2131-3-21**].

Review of systems is notable for chills, constipation, headaches
since last night, and intermittent lightneadedness.  She denies
fevers, nausea, vomiting, or abdominal pain.


Past Medical History:
- dystonia involving mainly her lower extremities and
intermittently her arms, laryngeal dystonia worse over past 6
months; 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**] (current
pacemaker detects low-BP and increases HR to 130 for 5min)
- Parkinsonism - occasional adventitious choreiform movements in
both upper extremities induced by action; takes Artane
- gastric dysmotility s/p g-tube placement and recently on TPN
- bladder areflexia s/p bladder stimulator implant and urostomy
- depression with h/o suicide attempt
- peripheral neuropathy
- chronic pupillary dilation
- s/p lap CCY
- Chronic anemia and intermittent low platelets
- EGD with gastritis ([**2127**])
- colonoscopy with friability ([**2122**])

Social History:
Lives with husband in [**Name (NI) **], Mass. ([**First Name8 (NamePattern2) 3613**] [**Known lastname 13556**]: cell
[**Telephone/Fax (1) 13557**], home [**Telephone/Fax (1) 13558**], work [**Telephone/Fax (1) 13566**]). Not
working, receives disability payments.


Family History:
Grandfather with frequent sycnope; 3 deceased paternal uncles
with [**Name (NI) 5895**] Disease. No family history of seizures or
strokes.


Physical Exam:
On admission:

Vital signs:
Afebrile; HR: 80 --> 130 x 5min (pacemaker setting for HR < 70,
per husband); BP: 82/60 (baseline SBP 80-90, per husband); RR:
[**9-25**]; SaO2 98% RA

General: Awake, NAD, frowning, eyes closed, face fixed in frown.
HEENT: Normocephalic and atraumatic. No scleral icterus. I
cannot open the mouth.
Neck: Stiff, turned to left. No carotid bruits appreciated. No
lymphadenopathy was appreciated.
Pulmonary: Lungs CTA bilaterally. Slow, non-labored breathing
(post-morphine, BDZ).
Cardiac: RRR, normal S1/S2, no M/R/G appreciated.
Abdomen: G-tube/dressing and ileostomy/bag. Mildly tender near
G-tube site. No BS appreciated. Soft, non-distended, +
normoactive bowel sounds.
Extremities: Warm and well-perfused, no clubbing, cyanosis, or
edema. 2+ radial, DP pulses bilaterally.

Neurologic examination:

Mental Status exam:
Patient responds to my questions with eyeblinks only -- one
blink
for yes; two for no. She answers appropriately, but does not
(?cannot) speak. She does not follow any commands that do not
involve simply answering with eye-blink.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL, 4 to 2.5mm and brisk.
III, IV, VI: Eyes are midposition, and when I ask her to move
them she looks up slightly, nothing else. +strong corneal/blink
reflexes.
V: +corneals. Pt. blinks "yes" to can you feel this the same (lt
touch)
VII: No apparent asymmetry.
VIII: Pt. blinks "yes" to can you hear this on L/R.
IX, X: cannot open mouth to assess
[**Doctor First Name 81**]: cannot assess
XII: cannot assess

-Motor:
Face fixed in a grimace/frown. Head/neck turned down and to the
left. Hypertonic x all four limbs. Hands are fisted and do not
relax. Feet are inverted with toes curled under, fixed. When I
try to relax toes or move/relax feet/legs, she kicks/flexes knee
back and forth (and flexes hip / elevates leg) a few times, but
not like typical clonus. When I try to test tone/spasticity of
hand, she kicks legs and arms/torso/neck lurch a bit. No
tremor/fasciculations. Normal muscle bulk.

-Sensory:
No gross deficit to light touch -- Pt (with eyes closed)
endorses me touching her feet/legs/hands/arms with appropriate
eye-blink.

-Reflex examination:
No clonus or hyperreflexia (already hypertonic); could not
really elicit any reflexes on either side, UE/LE. and toes were
stuck in contracted position.

-Coordination/Gait: could not assess


Neurologic exam at discharge: Patient can open left eye with
much strain, and is unable to open right eye, but when lid is
passively opened, both eyes are midline. Horizontal movements
intact, but patient intermittently refuses to gaze upward.
Patient speaks in a soft whisper and makes intermittent audible
groaning sounds. Tongue and facial muscles with full strength
and sensation, palate elevates symmetrically.

Lower extremities are flexed at hip joints and flexed at knee
joint.  Feet are inverted with toes curled and fixed. When
attempting to passively move arms or legs she kicks and flexes
her lower extremities. No tremor/fasciculations. Normal muscle
bulk and tone. Right arm flexed at elbow and wrist and tone
increases when arm is touched.


Pertinent Results:
On admission:
[**2131-3-21**]:

CBC:
4.4 > 9.0 / 26.5 < 93

PT:14.5  PTT:33.0  INR:1.3

138 | 109 | 8   / 76
4.0 | 24  | 0.7 \

Ca:7.7  P:3.4  Mg:1.8

CK:375

ALT:19  AST:26  LDH:219  AP:110  TBili:0.3

On discharge:

ALT:24  AST:35  LDH:238  AP:112  TBili:0.4  Alb:3.9

CBC:
4.7 > 10.3 / 30.4 < 110

135 | 101 | 19  / 91
4.1 | 27  | 0.7 \

Ca:8.9  P:4.3  Mg:2.0

CK:175

[**2131-3-28**] 11:09AM URINE Color-Straw Appear-Hazy Sp [**Last Name (un) **]-1.009
[**2131-3-28**] 11:09AM URINE Blood-TR Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-LG
[**2131-3-28**] 11:09AM URINE RBC-2 WBC-101* Bacteri-MANY Yeast-RARE
Epi-0
[**2131-3-28**] 11:09AM URINE bnzodzp-POS barbitr-NEG opiates-POS
cocaine-NEG amphetm-NEG mthdone-NEG
[**2131-3-30**] 05:19AM BLOOD WBC-3.4* RBC-3.14* Hgb-9.6* Hct-27.4*
MCV-87 MCH-30.7 MCHC-35.1* RDW-14.2 Plt Ct-86*
[**2131-3-29**] 03:04AM BLOOD WBC-5.6 RBC-3.09* Hgb-9.4* Hct-26.9*
MCV-87 MCH-30.5 MCHC-35.0 RDW-14.2 Plt Ct-100*
[**2131-3-30**] 05:19AM BLOOD Glucose-97 UreaN-20 Creat-0.7 Na-137
K-4.3 Cl-104 HCO3-27 AnGap-10
[**2131-3-29**] 11:23AM BLOOD CK(CPK)-342*
[**2131-3-29**] 03:04AM BLOOD CK(CPK)-143
[**2131-3-28**] 11:09AM BLOOD ALT-35 AST-46* LD(LDH)-239 CK(CPK)-113
AlkPhos-117* TotBili-0.3
[**2131-3-29**] 11:23AM BLOOD CK-MB-8 cTropnT-<0.01
[**2131-3-29**] 03:04AM BLOOD Calcium-8.6 Phos-4.2 Mg-1.9
[**2131-3-28**] 10:03AM BLOOD Type-ART pO2-307* pCO2-42 pH-7.40
calTCO2-27 Base XS-1

Brief Hospital Course:
Ms [**Known lastname 13556**] is a 38 year old female with longstanding
dystonia/autonomic syndrome of unknown etiology who presents
with an episode of post procedural dystonia, s/p high doses of
benadryl and valium.

Medical ICU course: Following the onset of dystonic reaction
after G-tube replacement, Ms. [**Known lastname 13556**] was transferred from the
PACU to the medical ICU. There, she was noted to have blood
pressures stable in the SBP 80s-100s and heart rate was  80 with
occasional episodes of paced tachycardia to 130 (pacemaker
programmed to respond to drop in heart rate to less than 70 by
pacing at 130 for 5 minutes). She was evaluated by the neurology
consult team and transferred onto the neurology service.

On the neurology service, no clear etiology for her symptoms of
dystonia was discovered.  According to prior notes, she has
experienced post procedure dystonia in the past and would often
require prolonged hospital stays with large amounts of IV
morphine, benadryl, and valium.  On initial examination she had
increased tone in all four extremities with flexion at hips,
knees, curled toes, flexion at the elbow, wrist and clenched
fists.  She was also able to speak only in a soft whisper and
could not open her eyes despite normal movements of facial
muscles such as brow wrinkling, raising brows, orofacial
movements.  She was continued on her home regimen of Baclofen
and Artand and adamantly requested high doses of IV morphine,
valium, benedryl as she felt this is the only way to break her
dystonia.  She triggered multiple times while on the floor for
low blood pressure (has low BP at baseline) and for "marked
nursing concern" because as her heart rate drops, her pacer is
set to respond with tachycardia to 130 for 5 minutes. She was
unwilling to transition to PO or G-tube medications as she felt
the IV formulations worked better. Ultimately, her doses were
weaned given the recurrent questionable cardiovascular
depression.  Over several days, her dystonia was moderately
improved from admission and she was able to move her left arm,
and slightly open her left eye.

# Code blue: On the day of her proposed discharge to the
rehabilitation facility, within an hour of discharge, a code
blue was called on Mrs. [**Known lastname 13556**]. She was found unresponsive and
tachycardic without clear pacer spikes, and ventricular
tachycardia was suspected at the time.  Initially, a pulse was
not felt and she was having poor respiratory effort. Chest
compressions were started and a pulse was subsequently felt.
She was intubated due to the poor respiratory effort and
transferred to the intensive care unit. The ICU/code team noted
that she was fighting and grabbing as the tube was actually
inserted. ABG showed no evidence of hyercarbia. She was promptly
extubated and spent one night in the ICU before being
transferred back to the neurology service.  She was discharged
to a rehabilitation facility the following day to further manage
her dystonia where her expected length of stay is less than 30
days.  She should be progressively weaned off IV pain
medications and back onto her PO home regimen.

There is a strong belief that much of her presentation is
consistent with a psychodynamic process manifesting as
neurological complaints.  Factitious disorder cannot be ruled
out as there are many elements of her neurologic presentation
that are inconsistent.  We extensively counseled her on the
risks of sedative medications, particularly IV, given the
multiple episodes of bradycardia triggering her pacer.

# Nutrition: She is s/p G-tube placement. She is on TPN at home
since [**2122**] and uses her G-tube for decompression only, and takes
medications by mouth at home and food by mouth for pleasure.  In
the hospital she was started TPN and outpatient TPN was set-up
by nutrion.

Autonomic dysfunction: She has neurocardiogenic syncope s/p
pacemaker placement which activates when her heart rate falls
below 70.  It responds by increasing the HR to 130 for 5
minutes.  She is on nadolol at home and was continued on her
home dose of 80 mg daily.

Urinary Tract Infection:
She was found to have a positive UA.   URINE CULTURE (Final
[**2131-3-29**]):
      MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT
WITH SKIN
      AND/OR GENITAL CONTAMINATION.  She was placed on
Ceftriaxone for 2 days and switched over to cefpoxidime to
complete a 3 day course.

Medications on Admission:
1. baclofen 20mg tid
2. diazepam (Valium) 5mg tid PRN for anxiety
3. nadolol 80mg daily
4. omeprazole (Prilosec) 20mg [**Hospital1 **] PRN(?)
5. sertraline (Zoloft) 50mg daily
6. trihexyphenidyl (Artane) 3mg qAM / 3mg q1pm / 4mg qhs


Discharge Medications:


1. baclofen 10 mg Tablet [**Hospital1 **]: Two (2) Tablet PO TID (3 times a
day).
2. nadolol 80 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).
3. sertraline 50 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

4. trihexyphenidyl 2 mg Tablet [**Hospital1 **]: 0.5 Tablet PO QHS (once a
day (at bedtime)).
5. trihexyphenidyl 2 mg Tablet [**Hospital1 **]: 1.5 Tablets PO TID (3 times
a day).
6. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
7. DiphenhydrAMINE 25 mg IV Q4H:PRN anxiety/dystonia
8. Diazepam 5 mg IV Q6H:PRN pain
9. Morphine Sulfate 2-4 mg IV Q4H:PRN pain
10. heparin (porcine) 5,000 unit/mL Solution [**Last Name (STitle) **]: One (1)
Injection TID (3 times a day).
11. cefpodoxime 100 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q12H (every
12 hours) for 2 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital for Continuing Medical Care - [**Location (un) 1121**]
([**Hospital3 1122**] Center)

Discharge Diagnosis:
Primary diagnoses:
- Granulated G-J tube
- Full body dystonia (arms, legs, larynx, eyelids)

Secondary diagnoses:
- Autonomic dysfunction (s/p pacemaker, urostomy, G-J tube
- Depression
- Peripheral neuropathy
- Chronic anemia and intermittent low platelets


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

Neurologic exam at discharge: Patient can open left eye with
much strain, and is unable to open right eye, but when lid is
passively opened, both eyes are midline. Horizontal movements
intact, but patient intermittently refuses to gaze upward.
Patient speaks in a soft whisper and makes intermittent audible
groaning sounds. Tongue and facial muscles with full strength
and sensation, palate elevates symmetrically.

Lower extremities are flexed at hip joints and flexed at knee
joint.  Feet are inverted with toes curled and fixed. When
attempting to passively move arms or legs she kicks and flexes
her lower extremities. No tremor/fasciculations. Normal muscle
bulk and tone. Right arm flexed at elbow and wrist and tone
increases when arm is touched.


Discharge Instructions:
Dear Mrs. [**Known lastname 13556**]

You were admitted to the hospital because you developed a severe
full body dystonic reaction following surgery for replacement of
a G-J tube.  You were initially admitted to the medical
intensive care unit and were eventually transferred to the
neurology service for management of your dystonia. Following the
surgery, you were having symptoms of dystonia in your legs,
arms, voice box, and eyelids. Your dystonia symptoms improved
over several days while you were in the hospital, and you were
able to speak in a whisper, open one eye, and move your arms.
You were transferred to a rehabilitation facility for further
management of your remaining dystonia symptoms.

Estimated length of stay less than 30 days.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD Phone:[**Telephone/Fax (1) 1690**]
Date/Time:[**2131-4-11**] 10:00
Provider: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 26**] [**Last Name (NamePattern1) 8914**] Phone:[**Telephone/Fax (1) 1690**]
Date/Time:[**2131-4-16**] 10:00
Provider: [**First Name8 (NamePattern2) 161**] [**Name11 (NameIs) 162**] [**Name8 (MD) 163**], MD Phone:[**Telephone/Fax (1) 921**]
Date/Time:[**2131-7-23**] 11:15
Neurology with Dr. [**First Name (STitle) 951**]: If an appointment is needed sooner
please call.
Provider: [**Name Initial (NameIs) 1220**].[**First Name (STitle) **] & [**Doctor Last Name **] Phone:[**Telephone/Fax (1) 13567**]
Date/Time:[**2131-5-11**] 4:00



Completed by:[**2131-3-30**]
{'Genetic torsion dystonia,Urinary tract infection, site not specified,Paralysis agitans,Unspecified disorder of autonomic nervous system,Unspecified hereditary and idiopathic peripheral neuropathy,Depressive disorder, not elsewhere classified,Dyspepsia and other specified disorders of function of stomach,Cardiac pacemaker in situ,Tachycardia, unspecified,Ileostomy status,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other artificial opening of urinary tract status,Other alteration of consciousness'}


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: Dystonia

PRESENT ILLNESS: Mrs. [**Known lastname 13556**] is a 38 year old woman with longstanding dystonia
and autonomic dysfunction who develpoed a full body dystonic
reaction following IR guided replacement of her granulated G-J
tube on [**2130-3-20**]. At baseline she is wheelchair bound since [**2122**]
with severe dystonia of her lower extremities, but is able to
use her upper extremities to transfer by herself. She also has
laryngeal dystonia which has worsened over the past 6 months
causing her to speak in a whisper.  She has the G-J for
gastroparesis which she uses for decompression and receives her
nutrition via TPN 5 days per week. She is also s/p pacemaker
placement for neurocardiogenic syncope and s/p urostomy for
bladder areflexia.

MEDICAL HISTORY: - dystonia involving mainly her lower extremities and
intermittently her arms, laryngeal dystonia worse over past 6
months; 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**] (current
pacemaker detects low-BP and increases HR to 130 for 5min)
- Parkinsonism - occasional adventitious choreiform movements in
both upper extremities induced by action; takes Artane
- gastric dysmotility s/p g-tube placement and recently on TPN
- bladder areflexia s/p bladder stimulator implant and urostomy
- depression with h/o suicide attempt
- peripheral neuropathy
- chronic pupillary dilation
- s/p lap CCY
- Chronic anemia and intermittent low platelets
- EGD with gastritis ([**2127**])
- colonoscopy with friability ([**2122**])

MEDICATION ON ADMISSION: 1. baclofen 20mg tid
2. diazepam (Valium) 5mg tid PRN for anxiety
3. nadolol 80mg daily
4. omeprazole (Prilosec) 20mg [**Hospital1 **] PRN(?)
5. sertraline (Zoloft) 50mg daily
6. trihexyphenidyl (Artane) 3mg qAM / 3mg q1pm / 4mg qhs

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

PHYSICAL EXAM: On admission:

FAMILY HISTORY: Grandfather with frequent sycnope; 3 deceased paternal uncles
with [**Name (NI) 5895**] Disease. No family history of seizures or
strokes.

SOCIAL HISTORY: Lives with husband in [**Name (NI) **], Mass. ([**First Name8 (NamePattern2) 3613**] [**Known lastname 13556**]: cell
[**Telephone/Fax (1) 13557**], home [**Telephone/Fax (1) 13558**], work [**Telephone/Fax (1) 13566**]). Not
working, receives disability payments. 

### Response:
{'Genetic torsion dystonia,Urinary tract infection, site not specified,Paralysis agitans,Unspecified disorder of autonomic nervous system,Unspecified hereditary and idiopathic peripheral neuropathy,Depressive disorder, not elsewhere classified,Dyspepsia and other specified disorders of function of stomach,Cardiac pacemaker in situ,Tachycardia, unspecified,Ileostomy status,Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other artificial opening of urinary tract status,Other alteration of consciousness'}
