CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 79 year old
woman brought in by her daughter after a fall with head
trauma and possible loss of consciousness.  The patient has
recently had twelve previous falls in the past year.  Past
work ups for these falls include [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts on [**7-23**]
which showed no recorded events and an echocardiogram on
[**8-23**] which revealed an ejection fraction of greater than 60
percent.  Normal RV.  Mildly thickened arteriovenous.  Mildly
thickened mitral valve with 1+ MR; 1+ tricuspid regurgitation
and borderline hypertension.  An MRI of the head on [**9-22**]
showed mild to moderate cerebral atrophy with diffuse mild to
moderate areas of chronic microvascular infarction.  TSH on
[**7-23**] was 4.1.

MEDICAL HISTORY: 1.  The patient reportedly had black lung and is status post
right pneumonectomy in [**2137**].
2.  Depression.
3.  Hypertension.
4.  History of seizures, status post head injury.
5.  Hypothyroidism.
6.  Questionable Alzheimer's disease.
7.  Osteoporosis of the right hip.
8.  Questionable peptic ulcer disease.
9.  Status post total abdominal hysterectomy.
10. Gastroesophageal reflux disease.
11. Left pulmonary nodule.
12. Carotid stenosis.
13. Recurrent urinary tract infections.
14. Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: ALLERGIES INCLUDE ZESTRIL AND ATENOLOL.

PHYSICAL EXAM: 

FAMILY HISTORY: She has siblings with coronary artery bypass
graft, myocardial infarction.  Son with pulmonary
hypertension.  History of passive tobacco exposure.

SOCIAL HISTORY: She lives with her husband with a family
nearby in the surrounding three apartments.  No tobacco or
alcohol use.  The patient's CODE STATUS IS DNR/DNI.
Closed fracture of base of skull with cerebral laceration and contusion, with no loss of consciousness,Urinary tract infection, site not specified,Retention of urine, unspecified,Fall from other slipping, tripping, or stumbling,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Open wound of scalp, without mention of complication,Other disorders of neurohypophysis,Unspecified essential hypertension,Abnormality of gait
Cl skul base fx w/o coma,Urin tract infection NOS,Retention urine NOS,Fall from slipping NEC,Klebsiella pneumoniae,Open wound of scalp,Neurohypophysis dis NEC,Hypertension NOS,Abnormality of gait
Admission Date:  [**2185-3-8**]       Discharge Date:  [**2185-3-21**]


Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 79 year old
woman brought in by her daughter after a fall with head
trauma and possible loss of consciousness.  The patient has
recently had twelve previous falls in the past year.  Past
work ups for these falls include [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts on [**7-23**]
which showed no recorded events and an echocardiogram on
[**8-23**] which revealed an ejection fraction of greater than 60
percent.  Normal RV.  Mildly thickened arteriovenous.  Mildly
thickened mitral valve with 1+ MR; 1+ tricuspid regurgitation
and borderline hypertension.  An MRI of the head on [**9-22**]
showed mild to moderate cerebral atrophy with diffuse mild to
moderate areas of chronic microvascular infarction.  TSH on
[**7-23**] was 4.1.

The patient reportedly has baseline gait instability.  She is
supposed to use a walker but does not.  She has a positive
history of seizure disorder ten years ago and was on Dilantin
ten years ago.  She has no seizures since then and hasn't
taken Dilantin for over ten years.  The patient denies chest
pain, orthopnea, paroxysmal nocturnal dyspnea or
palpitations.

REVIEW OF SYSTEMS:  On review of systems, the patient has
urinary incontinence which often happens with a urinary tract
infection.  She has increasing urgency, increasing fatigue.
She reportedly had increasing edema recently and was placed
on Hydrochlorothiazide within the last year.  The patient
reports decreased p.o. intake for the last day and decreased
appetite.

PAST MEDICAL HISTORY:
1.  The patient reportedly had black lung and is status post
right pneumonectomy in [**2137**].
2.  Depression.
3.  Hypertension.
4.  History of seizures, status post head injury.
5.  Hypothyroidism.
6.  Questionable Alzheimer's disease.
7.  Osteoporosis of the right hip.
8.  Questionable peptic ulcer disease.
9.  Status post total abdominal hysterectomy.
10. Gastroesophageal reflux disease.
11. Left pulmonary nodule.
12. Carotid stenosis.
13. Recurrent urinary tract infections.
14. Hypercholesterolemia.

ALLERGIES:  ALLERGIES INCLUDE ZESTRIL AND ATENOLOL.

MEDICATIONS:
1.  Zoloft 150 mg q d.
2.  Elavil 10 mg q d.
3.  Hydrochlorothiazide 25 mg q d.
4.  Premarin .3 q d.
5.  Lipitor 5 q d.
6.  Levoxyl 88 mcg q d.
7.  Percocet prn.
8.  Aspirin q d.

SOCIAL HISTORY:  She lives with her husband with a family
nearby in the surrounding three apartments.  No tobacco or
alcohol use.  The patient's CODE STATUS IS DNR/DNI.

FAMILY HISTORY:  She has siblings with coronary artery bypass
graft, myocardial infarction.  Son with pulmonary
hypertension.  History of passive tobacco exposure.

PHYSICAL EXAMINATION:  Her temperature was 97.0; blood
pressure, 150/92; pulse, 64; respiratory rate, 16; satting
94% on room air.  The patient is an elderly woman with mild
confusion in no acute distress lying in bed.  She has a
bruise on the skull with dried blood.  Pupils are equal,
round, and reactive to light.  Extraocular movements intact.
Oropharynx, clear.  Neck, supple.  No lymphadenopathy.  No
bruit.  Regular rate and rhythm.  S1, S2.  No murmurs.
Lungs, clear to auscultation bilaterally.  Abdomen, soft,
nontender, nondistended.  Positive bowel sounds.
Extremities, no cyanosis, clubbing or edema.  2+ dorsalis
pedis pulses bilaterally.  Neurological examination, alert
and oriented to hospital, self and [**Hospital1 **] name.  Not
oriented to day and date.  Cranial nerves II through XII are
intact.  Strength, normal in upper and lower extremities.
Sensation, intact to light touch.  Deep tendon reflexes, 2+,
symmetric bilaterally.

LABORATORIES ON ADMISSION:  White blood count, 13.6; 76%
neutrophils; 13% lymphs; 9% monos.  Hematocrit, 44.3.
Platelets, 417.  Chemistry, sodium, 135; potassium, 4.3;
chloride, 94; bicarbonate, 31; BUN, 23; creatinine, 0.8;
glucose, 131; magnesium, 1.7.  Urinalysis on admission was
specific gravity, 1.02; glucose negative; negative ketones,
negative blood, negative nitrite, trace of leukocyte
esterase.  pH, 5.9.  Negative, bili.  0 red blood cells.  21
to 50 white blood cells.  Many bacteria and no yeast.

Electrocardiogram showed normal sinus rhythm, rate 84.
Normal axis.  R in V1; questionable Q in V1.  No acute ST
changes.  Head CT revealed microvascular disease in the white
matter, a large hematoma of the right paroccipital region.
No fracture, no hemorrhage.  C spine revealed no fracture.
Positive degenerative joint disease.

HOSPITAL COURSE:
1.  The patient was admitted to Medicine.  She was found to
have pyuria and started on Ciprofloxacin.  That evening, she
fell in her room and although she couldn't recall the fall,
her neurologic status was felt to be unchanged.  Head CT at
that time was again negative.

Early the next morning she fell again on the floor without
explanation given by the patient.  This third head CT
performed showed a 2 cm right frontal hemorrhage, left
frontal hemorrhage, likely both subarachnoid and subdural.  A
small right parietal subdural hemorrhage near the cerebral
vertex, lacunar in the lentiform nuclei, chronic
microvascular infarction as previously seen.

The patient was evaluated by Neurosurgery who recommended
admission to Intensive Care Unit for close follow up and
reversal of coagulopathy.  Of note, INR actually on admission
was 1.7.  The patient was sent to the SICU and treated with
vitamin K and fresh frozen plasma.  Her INR reversed from 1.7
to 1.1.

The patient had a C spine CT done which showed marked
degenerative changes in C5 through 6, C6 through 7, with
moderate spondylitic ridges, prominent left sided facet joint
degeneration causing moderate spinal cord compression.
Bilateral neuroforaminal narrowing of 2 to 3 mm, subluxation
of C3 to C4, C4 to C5, which was unchanged compared to MRI on
[**9-22**].  No fractures were noted.

Neurosurgery recommended repeat neurological examinations and
keeping her systolic blood pressure greater than 150.  All
sedatives were avoided.  The patient was kept NPO and her
coagulopathy was reversed.  On subsequent neurological
examinations, the patient remained stable.  She was
transferred back to the floor.

After transferring back to the floor, the patient was stable
for several days, but then seemed to have fluctuating mental
status.  Repeat CT of the head was done which showed stable
right frontal and right parietal intraparenchymal hemorrhage.
Stable right ST subdural hematoma and stable small right
temporal subarachnoid hemorrhage along with a nondisplaced
left occipital fracture.

The patient remained on the floor for the rest of the
hospital course.  Her neurological examination was stable.
Her blood pressure was maintained between 140s and 160s.  In
order to accomplish this, the patient was started on Norvasc
with Hydralazine ridden for systolic blood pressures greater
than 160.

As work up for possible causes of her fall, the patient had
another echocardiogram performed.  Echocardiogram was read as
left ventricular wall thickness.  Cavity size and systolic
function, normal.  Left ventricular ejection fraction,
greater than 55%.  Right ventricular chamber size and free
wall motion, normal.  Aortic root, mildly dilated.  Ascending
aorta is mildly dilated.  The aortic valves are mildly
thickened.  There is no aortic valve stenosis.  No aortic
regurgitation.  Mitral valve leaflets are mildly thickened.
Mitral regurgitation is present but cannot be quantified.
There is moderate pulmonary artery systolic hypertension.

2.  The patient's sodium was noted to fall following head
trauma. This was believed to be due to intracerebral sodium
wasting syndrome.  The patient was placed on fluid
restriction, however, her sodium continued to fall.  Fluid
restriction was decreased from 1,000 cc per day to 750 cc per
day.  The patient was also started on Salt Tablet.  As her
mental status seemed to be waxing and [**Doctor Last Name 688**], she was
monitored very closely during this time.  Hydrochlorothiazide
was also thought to be involved in the hyponatremia and was
discontinued.  Over the next several days, her hyponatremia,
after reaching 120, slowly rose and corrected itself to 130
by the time of discharge.  The Hydrochlorothiazide continues
to be withheld and the patient continues to be on fluid
restriction, however, this has been eased to 1,500 cc per day
at the time of discharge.  The patient should follow up with
her Primary Care Physician in one week to check on sodium
levels.

3.  Urinary tract infection - The patient was initially
started on Ciprofloxacin for urinary tract infection,
however, cultures came back positive Klebsiella which was
resistant to Ciprofloxacin.  She was switched to Ancef.  She
completed a seven day course of Ancef.  Repeat cultures were
negative.

4.  Blood pressure - The patient's blood pressure was, at
times, difficult to control.  This was felt to be due to her
anxiety and headaches.  The patient was initially tried on
Atenolol but then switched to Norvasc with Hydralazine for
elevated blood pressures.  The patient blood pressure
remained well controlled on this regimen, however, near the
end of her hospital course, it was slightly higher.  The
patient was increased to 10 mg p.o. q d of Norvasc at the
time of discharge.  She should follow up with her Primary
Care Physician in one week.  She will also be continued on 10
mg of Hydralazine q.i.d. in the interim.  Further decisions
on blood pressure management will be left to outpatient
setting.

5.  Headaches - The patient had several severe headaches
following her head trauma.  Due to her waxing and [**Doctor Last Name 688**]
mental status, narcotics were initially withheld, however, as
her mental status improved, it was felt that her pain was
best managed with Oxycodone.  The patient was initially on
one tablet of Oxycodone q 4 hours, however, this was
insufficient.  It was increased to two tablets q 4 to 6 hours
along with 1,000 mg of Tylenol q.i.d.  The patient headaches
slowly improved during the hospital course.  She will be
discharged the Tylenol and one to two tablets of Oxycodone q
4 to 6 hours prn with instructions to limit use of the
narcotics if possible.

6.  During the end of the hospital course, the patient had
problems with urinary retention.  The patient had several
voiding trials, however, failed.  The patient was started on
Urecholine.  She will be discharged without the Foley.  Her
daughter was instructed on how to properly do straight
catheterization technique.  The patient will be straight
catheterized.  She will be follow up with Urology on [**2185-3-29**], at which time further management of her urinary
retention will be addressed.

7.  Rehabilitation - The patient was seen by Physical Therapy
who initially felt the patient would require a short term
rehabilitation stay, however, the patient and family was
against this.  They prefer getting rehabilitation at home.
Over the hospital course, the patient's ambulation improved
to the extent that Physical Therapy felt the patient would be
OK to go home as long as she had some home physical therapy
established.  VNA will be established upon discharge in order
for home physical therapy to occur.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE MEDICATIONS:
1.  Norvasc 10 mg p.o. q d.
2.  Oxycodone one to two tablets p.o. q 6 hours prn.
3.  Colace 100 mg p.o. b.i.d.
4.  Urecholine 50 mg p.o. q.i.d.
5.  Tylenol 1,000 mg p.o. q 6 hours.
6.  Hydralazine 10 mg p.o. q 6 hours.
7.  Levoxyl 88 mcg p.o. q d.
8.  Zoloft 150 mg p.o. q d.
9.  Lipitor 5 mg p.o. q d.
10. Elavil, Aspirin and Premarin are currently being held.
Aspirin especially can be restarted at a later date if the
patient's neurological status remains stable.  This will be
left up to her Primary Care Physician.

FOLLOW UP:  The patient is to follow up with her Primary Care
Physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3306**].  The patient is instructed
to call Dr. [**Last Name (STitle) 3306**] and arrange for follow up appointment
in the next week.  The patient has also been scheduled for
Urology visit with Dr. [**Last Name (STitle) 4229**].  Number is [**Telephone/Fax (1) 10941**].  The
appointment is scheduled for [**2185-3-29**], at 10:00 a.m. at
[**Hospital Ward Name 23**] Building, [**Location (un) 436**].



                           [**Name6 (MD) 251**] [**Name8 (MD) **], M.D.  [**MD Number(1) 1197**]

Dictated By:[**First Name3 (LF) 40402**]
MEDQUIST36

D:  [**2185-3-21**]  14:41
T:  [**2185-3-21**]  16:08
JOB#:  [**Job Number 40403**]
{"Closed fracture of base of skull with cerebral laceration and contusion, with no loss of consciousness,Urinary tract infection, site not specified,Retention of urine, unspecified,Fall from other slipping, tripping, or stumbling,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Open wound of scalp, without mention of complication,Other disorders of neurohypophysis,Unspecified essential hypertension,Abnormality of gait"}


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: 

PRESENT ILLNESS: The patient is a 79 year old
woman brought in by her daughter after a fall with head
trauma and possible loss of consciousness.  The patient has
recently had twelve previous falls in the past year.  Past
work ups for these falls include [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts on [**7-23**]
which showed no recorded events and an echocardiogram on
[**8-23**] which revealed an ejection fraction of greater than 60
percent.  Normal RV.  Mildly thickened arteriovenous.  Mildly
thickened mitral valve with 1+ MR; 1+ tricuspid regurgitation
and borderline hypertension.  An MRI of the head on [**9-22**]
showed mild to moderate cerebral atrophy with diffuse mild to
moderate areas of chronic microvascular infarction.  TSH on
[**7-23**] was 4.1.

MEDICAL HISTORY: 1.  The patient reportedly had black lung and is status post
right pneumonectomy in [**2137**].
2.  Depression.
3.  Hypertension.
4.  History of seizures, status post head injury.
5.  Hypothyroidism.
6.  Questionable Alzheimer's disease.
7.  Osteoporosis of the right hip.
8.  Questionable peptic ulcer disease.
9.  Status post total abdominal hysterectomy.
10. Gastroesophageal reflux disease.
11. Left pulmonary nodule.
12. Carotid stenosis.
13. Recurrent urinary tract infections.
14. Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: ALLERGIES INCLUDE ZESTRIL AND ATENOLOL.

PHYSICAL EXAM: 

FAMILY HISTORY: She has siblings with coronary artery bypass
graft, myocardial infarction.  Son with pulmonary
hypertension.  History of passive tobacco exposure.

SOCIAL HISTORY: She lives with her husband with a family
nearby in the surrounding three apartments.  No tobacco or
alcohol use.  The patient's CODE STATUS IS DNR/DNI. 

### Response:
{"Closed fracture of base of skull with cerebral laceration and contusion, with no loss of consciousness,Urinary tract infection, site not specified,Retention of urine, unspecified,Fall from other slipping, tripping, or stumbling,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Open wound of scalp, without mention of complication,Other disorders of neurohypophysis,Unspecified essential hypertension,Abnormality of gait"}
