CHIEF COMPLAINT: Tachycardia, hypotension, altered mental status

PRESENT ILLNESS: Ms. [**Known lastname 1557**] is 79yo female with Parkinson's, AF not
anticoagulated [**2-6**] h/o recurrent falls and osteoporosis
initially admitted after unwitnessed fall, found to have L
intertrochanteric femur fx POD#1 s/p open reduction and IM rod
placement yesterday who is transferred to MICU in setting of AF
with RVR associated with hypotension in setting of witnessed
aspiration event and untreated UTI. This am, pt was found to be
in AF with RVR with SBPs 60s when seen by PT. She was given 2L
IVF with improvement in BP to 90s, also received Diltiazem 10mg
IV x 2 and metoprolol 5mg IV x 3 once BP was improved and HR
improved to 90s. Of note, she also had positive urine cx which
had not yet been treated and had witnessed aspiration event in
setting of altered mental status this am.
.
Regarding presenting fall, husband heard pt fall in bathroom and
found wife on ground, crying in pain. There was no reported
history of seiure activity, bladder or bowel incontinence and he
felt this was typical for her given her recurrent falls.
.
In ED, vitals 98.4 185/103 74 16 99% RA. She had one set of
negative cardiac enzymes. EKG with Q waves in V5 V6 and LAD. CT
head negative for hemorrhage. CT neck without fracture but with
canal stenosis C4-C7, seen previously. Hip plain films with
displaced left hip intertrochanteric fracture.
.
On arrival, HR 80s-90s, SBP 90s/60s, improved to 110s with IVF.

MEDICAL HISTORY: 1. Parkinson's disease.
2. Mitral valve replacement.
3. Atrial fibrillation - not on coumadin [**2-6**] balance issues
4. Dysarthria.
5. History of colitis [**2181**] - ?ischemic
6. Hypertension.
7. Hypothyroidism.
8. s/p appendectomy.
9. s/p TAH BSO
10. s/p thyroidectomy.
11. s/p left lumpectomy in [**2174**] (Dr. [**Last Name (STitle) 3100**] & XRT
12. s/p Right mastectomy in [**2140**]
13. GERD
14. osteoporosis
15. chronic constipation

MEDICATION ON ADMISSION: Sinemet CR 50/200 TID, Sinemet 25/100 half tab TID, Levoxyl
112mcg QD, Prevacid 30mg [**Hospital1 **], Norpace 100mg TID, Micro-K 6pills
but dose unknown per day TID, MVI, Toprol XL 25 QD, Norvasc 5
[**Hospital1 **], Azilect 1mg QD, Quinapril 20 QD, Evista 60 [**Last Name (LF) 244**], [**First Name3 (LF) **] 325 QD,
Coenzyme 1200mg Q10 qday

ALLERGIES: Dopamine / Mirapex / Demerol

PHYSICAL EXAM: Vitals: T: BP: P: R: 18 O2:
General: Alert, not oriented to place, oriented to self and
husband, no acute distress, interacts appropriately with husband
and son
[**Name (NI) 4459**]: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, JVP 7-8cm, no LAD
Lungs: Bibasilar rales, no wheezes, rhonchi
CV: Regular rate and rhythm, 3/6 systolic murmur LLSB radiating
to apex with no respirophasic variation, normal S1, prominent
S2, no rubs or gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 1+ pulses, no clubbing, cyanosis or
edema, Left thigh with dsg C/D/I, edema, mild tension,
ecchymoses

FAMILY HISTORY: Mother with hypertension died at age [**Age over 90 **].  Father died at age
77. Brother with [**Name2 (NI) **] in 60s. No  diabetes mellitus.

SOCIAL HISTORY: Lives with husband at home, with aids to help around the house.
She never used tobacco or alcohol. She lives with husband in
[**Name (NI) 745**] and is retired. Needs assistance with all ADLs including
dressing, cleaning.
Closed fracture of intertrochanteric section of neck of femur,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Fall from other slipping, tripping, or stumbling,Syncope and collapse,Paralysis agitans,Dementia in conditions classified elsewhere without behavioral disturbance,Osteoporosis, unspecified,Foreign body in pharynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Other iatrogenic hypotension,Dysphagia, oropharyngeal phase,Atrial fibrillation,Hypovolemia,Abnormality of gait,History of fall,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Heart valve replaced by transplant,Esophageal reflux,Other constipation,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple
Intertrochanteric fx-cl,Urin tract infection NOS,Ac posthemorrhag anemia,Fall from slipping NEC,Syncope and collapse,Paralysis agitans,Dementia w/o behav dist,Osteoporosis NOS,Foreign body in pharynx,Resp obstr-inhal obj NEC,Iatrogenc hypotnsion NEC,Dysphagia, oropharyngeal,Atrial fibrillation,Hypovolemia,Abnormality of gait,Personal history of fall,Hypertension NOS,Hypothyroidism NOS,Heart valve transplant,Esophageal reflux,Constipation NEC,Hx of breast malignancy,Acq absnce breast/nipple
Admission Date:  [**2186-7-29**]              Discharge Date:   [**2186-8-2**]

Date of Birth:  [**2106-11-12**]             Sex:   F

Service: MEDICINE

Allergies:
Dopamine / Mirapex / Demerol

Attending:[**First Name3 (LF) 689**]
Chief Complaint:
Tachycardia, hypotension, altered mental status

Major Surgical or Invasive Procedure:
[**7-30**]:  Left open reduction and intramedullary nailing of
a left intertrochanteric hip fracture


History of Present Illness:
Ms. [**Known lastname 1557**] is 79yo female with Parkinson's, AF not
anticoagulated [**2-6**] h/o recurrent falls and osteoporosis
initially admitted after unwitnessed fall, found to have L
intertrochanteric femur fx POD#1 s/p open reduction and IM rod
placement yesterday who is transferred to MICU in setting of AF
with RVR associated with hypotension in setting of witnessed
aspiration event and untreated UTI. This am, pt was found to be
in AF with RVR with SBPs 60s when seen by PT. She was given 2L
IVF with improvement in BP to 90s, also received Diltiazem 10mg
IV x 2 and metoprolol 5mg IV x 3 once BP was improved and HR
improved to 90s. Of note, she also had positive urine cx which
had not yet been treated and had witnessed aspiration event in
setting of altered mental status this am.
.
Regarding presenting fall, husband heard pt fall in bathroom and
found wife on ground, crying in pain. There was no reported
history of seiure activity, bladder or bowel incontinence and he
felt this was typical for her given her recurrent falls.
.
In ED, vitals 98.4 185/103 74 16 99% RA. She had one set of
negative cardiac enzymes. EKG with Q waves in V5 V6 and LAD. CT
head negative for hemorrhage. CT neck without fracture but with
canal stenosis C4-C7, seen previously. Hip plain films with
displaced left hip intertrochanteric fracture.
.
On arrival, HR 80s-90s, SBP 90s/60s, improved to 110s with IVF.

Past Medical History:
1. Parkinson's disease.
2. Mitral valve replacement.
3. Atrial fibrillation - not on coumadin [**2-6**] balance issues
4. Dysarthria.
5. History of colitis [**2181**] - ?ischemic
6. Hypertension.
7. Hypothyroidism.
8. s/p appendectomy.
9. s/p TAH BSO
10. s/p thyroidectomy.
11. s/p left lumpectomy in [**2174**] (Dr. [**Last Name (STitle) 3100**] & XRT
12. s/p Right mastectomy in [**2140**]
13. GERD
14. osteoporosis
15. chronic constipation

Social History:
Lives with husband at home, with aids to help around the house.
She never used tobacco or alcohol. She lives with husband in
[**Name (NI) 745**] and is retired. Needs assistance with all ADLs including
dressing, cleaning.

Family History:
 Mother with hypertension died at age [**Age over 90 **].  Father died at age
77. Brother with [**Name2 (NI) **] in 60s. No  diabetes mellitus.

Physical Exam:
Vitals: T: BP: P: R: 18 O2:
General: Alert, not oriented to place, oriented to self and
husband, no acute distress, interacts appropriately with husband
and son
[**Name (NI) 4459**]: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, JVP 7-8cm, no LAD
Lungs: Bibasilar rales, no wheezes, rhonchi
CV: Regular rate and rhythm, 3/6 systolic murmur LLSB radiating
to apex with no respirophasic variation, normal S1, prominent
S2, no rubs or gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 1+ pulses, no clubbing, cyanosis or
edema, Left thigh with dsg C/D/I, edema, mild tension,
ecchymoses


Pertinent Results:
Labs on Admission: [**2186-7-29**]
WBC-7.0 RBC-4.34 Hgb-12.8 Hct-40.6 MCV-93 MCH-29.4 RDW-13.6 Plt
Ct-238
Neuts-56.5 Lymphs-35.9 Monos-5.2 Eos-1.8 Baso-0.8
PT-12.4 PTT-25.3 INR(PT)-1.0
Glucose-102 UreaN-27* Creat-1.0 Na-141 K-4.6 Cl-106 HCO3-26
AnGap-14
Calcium-9.0 Phos-3.8 Mg-1.8
.
Cardiac Enzymes:
[**2186-7-31**] 01:27PM BLOOD CK(CPK)-243*
[**2186-7-31**] 04:02PM BLOOD CK(CPK)-590*
[**2186-7-31**] 11:22PM BLOOD CK(CPK)-579*
[**2186-8-1**] 03:50AM BLOOD CK(CPK)-374*
[**2186-8-1**] 07:00AM BLOOD CK(CPK)-681*
[**2186-7-29**] 08:45AM BLOOD cTropnT-<0.01
[**2186-7-31**] 01:27PM BLOOD CK-MB-7 cTropnT-0.13*
[**2186-7-31**] 04:02PM BLOOD CK-MB-15* MB Indx-2.5 cTropnT-0.33*
[**2186-7-31**] 11:22PM BLOOD CK-MB-10 MB Indx-1.7 cTropnT-0.24*
[**2186-8-1**] 03:50AM BLOOD CK-MB-7 cTropnT-0.13*
[**2186-8-1**] 07:00AM BLOOD cTropnT-0.25*
.
Other Labs
[**2186-7-31**] WBC-7.6 RBC-2.89* Hgb-8.9* Hct-27.6* MCV-96 RDW-13.8
Plt Ct-184
[**2186-8-1**] WBC-9.0 RBC-3.93* Hgb-11.4 Hct-34.7* MCV-88 RDW-15.8
Plt Ct-156
[**2186-8-1**] Lactate-0.9
.
Micro:
URINE CULTURE (Final [**2186-7-31**]):
ESCHERICHIA COLI
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--    16 I
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------     4 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------  <=16 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----  =>16 R
.
.
Other Studies:
[**2186-7-29**] EKG: Normal sinus rhythm, rate 74. Left axis deviation.
Left ventricular hypertrophy. Compared to the previous tracing
of [**2183-8-5**] septal repolarization abnormalities have resolved.
[**7-29**]/O9 CT head w/o: No evidence of hemorrhage
[**2186-7-29**] CT spine w/o: No acute fracture or dislocation.
Extensive multilevel degenerative changes, as detailed on prior
report from [**11-10**] with mild central canal stenosis at the levels
of C4-C7. Grade 1 anterolisthesis of C3 on C4 vertebral bodies.
[**2186-7-29**] Hip X-ray: Displaced left hip intertrochanteric fracture
[**2186-7-30**] Hip X-ray: Eight films from the OR demonstrate interval
placement of an intramedullary rod spanning the femoral
fracture. At the end of the
procedure, the alignment is near anatomic.
[**2186-7-30**] Echo: The left atrium and right atrium are normal in
cavity size. There is mild symmetric left ventricular
hypertrophy with normal cavity size and regional/global systolic
function (LVEF>55%). Right ventricular chamber size and free
wall motion are normal. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Trace aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. A mitral valve
annuloplasty ring is present. The mitral annular ring appears
well seated with normal gradient. Mild to moderate ([**1-6**]+) mitral
regurgitation is seen. There is mild pulmonary artery systolic
hypertension. There is a trivial/physiologic pericardial
effusion. Compared with the report of the prior study (images
unavailable for review) of [**2180-3-24**], mild pulmonary artery
systolic hypertension is now present and the severity of mitral
regurgitation is slightly increased.
[**2186-7-31**] CTA: No evidence of central PE. Small pleural effusions
with
subsequent atelectasis. No other parenchymal opacities. Healed
rib
fractures.
.




Brief Hospital Course:
This is a 79 woman transferred to MICU for hypotension and
tachycardia initially admitted s/p fall treated with open
reduction and IM rod placement.

#  Hypotension: Likely multifactorial triggered by AF with RVR
with poor perfusion in setting of NPO status and decreased PO
intake. BP now improved after IVF and with rate control as
below. We ruled out PE with a negative CTA.  Her UTI likely did
not cause sepsis related hypotension given her clinical picture.
However, her UTI was treated with ceftriaxone and blood cultures
were drawn.  We obtained an Echo to make sure she had adequte
EF. Also, we obtained serial cardiac enzymes to confirm that she
was not having an acute MI.  He was transfused 3 units of pRBC
while in the MICU for anemia. This coupled with IVF, resolved
that patient's hypotension. Her hematocrit and vitals were
stable upon discharge.

# AF: Pt has history of AF and had episode of AF with RVR this
am, possibly triggered by anemia/hypotension. Cardiology has
been following and recommended rate control with Metoprolol 25mg
po BID in addition to Norpase 100 TID. Her rate was well
controlled upon discharge.
.
# Anemia: Patient's hematocrits have been stable after the blood
transfusion.
.
# Intertrochanteric fx: S/P surgery for L intertrochanteric fx,
started on Lovenox today. Receieved Cefazolin x1 for the
operation. Her pain has been controlled with Tylenol and
Oxycodone prn. She will require further physical rehabilitation
at rehab.
.
#. s/p fall-- Most likely consistent with mechanical fall versus
brief episode of afib with RBR.  Head CT neagtive for acute
process on admission. Likely related to Parkinsons and gait
disturbance given recurrent falls.
.
#. Parkinson's- Continued Sinemet, discharged on Azilect per
home regimen
.
#. HTN--Restart on quapril, norvasc upon discharge.
.
#. Hypothyroidism-- Continue home Levothyroxyl.
.
#. Osteoporosis--Ca and VitD.
.
# FEN: Speach and swallow saw the patient and recommended nectar
thick liquids, with ground founds. Will require further speech
and swallow evaluation with video study as outpatient.
.
# Prophylaxis: Lovenox 40mg SC daily and home PPI
.
# Code: DNR/DNI confirmed with husband [**Name (NI) 6339**]
.
# Communication: Patient  and husband [**Name (NI) **] [**Telephone/Fax (5) 97477**]
C[**Telephone/Fax (5) 97478**]
Son [**Name (NI) **] [**Numeric Identifier 97479**]


Medications on Admission:
Sinemet CR 50/200 TID, Sinemet 25/100 half tab TID, Levoxyl
112mcg QD, Prevacid 30mg [**Hospital1 **], Norpace 100mg TID, Micro-K 6pills
but dose unknown per day TID, MVI, Toprol XL 25 QD, Norvasc 5
[**Hospital1 **], Azilect 1mg QD, Quinapril 20 QD, Evista 60 [**Last Name (LF) 244**], [**First Name3 (LF) **] 325 QD,
Coenzyme 1200mg Q10 qday

Discharge Medications:
1. Carbidopa-Levodopa 50-200 mg Tablet Sustained Release Sig:
One (1) Tablet PO TID (3 times a day).
2. Carbidopa-Levodopa 25-100 mg Tablet Sustained Release Sig:
One (1) Tablet PO TID (3 times a day).
3. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Raloxifene 60 mg Tablet Sig: One (1) Tablet PO daily ().
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Disopyramide 100 mg Capsule Sig: One (1) Capsule PO Q8H
(every 8 hours).
8. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) injection
Subcutaneous DAILY (Daily).
9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
10. Oxycodone 5 mg Tablet Sig: .5 to 1 Tablet PO Q6H (every 6
hours) as needed for pain.
11. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for pain.
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
13. Quinapril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 5 days.
15. Sodium Chloride 0.9%  Flush 3 mL IV Q8H:PRN line flush
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.
16. Azilect 1mg daily


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
Left intertrochanteric hip fracture, 3-part.
Atrial fibrillation with rapid ventricular response
Urinary tract infection.


Discharge Condition:
vital signs stable. Good condition


Discharge Instructions:
You were admitted with a fall. You had your hip replaced and
during your stay you had rapid heart beat that required
treatment in the ICU.  Your heart rate was stabilized and you
are being discharged to a rehab for further physical therapy and
care.

Continue to be weight bearing as tolerated on your left leg

Continue your lovenox injections for a total of 4 weeks after
surgery

Please resume all your medications as prescribed by your doctor.
You were given new medications; please take them as instructed.
.
If you have any increased redness, drainage, or swelling, or if
you have a temperature greater than 101.5, please call the
office or come to the emergency department.
Physical Therapy:
Activity:  Out of bed w/ assist
Left lower extremity:  Touchdown weight bearing

Treatments Frequency:
Staples/sutures out 14 days after surgery

Dry sterile dressing daily or as needed for drainage or comfort

Followup Instructions:
Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP in orthopaedics in 2

weeks, please call [**Telephone/Fax (1) 1228**] to schedule that appointment.


Followup Instructions:
Please follow up with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in orthopaedics in 2
weeks, please call [**Telephone/Fax (1) 1228**] to schedule that appointment.
.
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1941**], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 1942**]
Date/Time:[**2186-8-8**] 3:30
Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2186-8-28**] 9:00
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 43**], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 541**]
Date/Time:[**2186-10-25**] 2:30



Completed by:[**2186-10-9**]
{'Closed fracture of intertrochanteric section of neck of femur,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Fall from other slipping, tripping, or stumbling,Syncope and collapse,Paralysis agitans,Dementia in conditions classified elsewhere without behavioral disturbance,Osteoporosis, unspecified,Foreign body in pharynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Other iatrogenic hypotension,Dysphagia, oropharyngeal phase,Atrial fibrillation,Hypovolemia,Abnormality of gait,History of fall,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Heart valve replaced by transplant,Esophageal reflux,Other constipation,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple'}


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: Tachycardia, hypotension, altered mental status

PRESENT ILLNESS: Ms. [**Known lastname 1557**] is 79yo female with Parkinson's, AF not
anticoagulated [**2-6**] h/o recurrent falls and osteoporosis
initially admitted after unwitnessed fall, found to have L
intertrochanteric femur fx POD#1 s/p open reduction and IM rod
placement yesterday who is transferred to MICU in setting of AF
with RVR associated with hypotension in setting of witnessed
aspiration event and untreated UTI. This am, pt was found to be
in AF with RVR with SBPs 60s when seen by PT. She was given 2L
IVF with improvement in BP to 90s, also received Diltiazem 10mg
IV x 2 and metoprolol 5mg IV x 3 once BP was improved and HR
improved to 90s. Of note, she also had positive urine cx which
had not yet been treated and had witnessed aspiration event in
setting of altered mental status this am.
.
Regarding presenting fall, husband heard pt fall in bathroom and
found wife on ground, crying in pain. There was no reported
history of seiure activity, bladder or bowel incontinence and he
felt this was typical for her given her recurrent falls.
.
In ED, vitals 98.4 185/103 74 16 99% RA. She had one set of
negative cardiac enzymes. EKG with Q waves in V5 V6 and LAD. CT
head negative for hemorrhage. CT neck without fracture but with
canal stenosis C4-C7, seen previously. Hip plain films with
displaced left hip intertrochanteric fracture.
.
On arrival, HR 80s-90s, SBP 90s/60s, improved to 110s with IVF.

MEDICAL HISTORY: 1. Parkinson's disease.
2. Mitral valve replacement.
3. Atrial fibrillation - not on coumadin [**2-6**] balance issues
4. Dysarthria.
5. History of colitis [**2181**] - ?ischemic
6. Hypertension.
7. Hypothyroidism.
8. s/p appendectomy.
9. s/p TAH BSO
10. s/p thyroidectomy.
11. s/p left lumpectomy in [**2174**] (Dr. [**Last Name (STitle) 3100**] & XRT
12. s/p Right mastectomy in [**2140**]
13. GERD
14. osteoporosis
15. chronic constipation

MEDICATION ON ADMISSION: Sinemet CR 50/200 TID, Sinemet 25/100 half tab TID, Levoxyl
112mcg QD, Prevacid 30mg [**Hospital1 **], Norpace 100mg TID, Micro-K 6pills
but dose unknown per day TID, MVI, Toprol XL 25 QD, Norvasc 5
[**Hospital1 **], Azilect 1mg QD, Quinapril 20 QD, Evista 60 [**Last Name (LF) 244**], [**First Name3 (LF) **] 325 QD,
Coenzyme 1200mg Q10 qday

ALLERGIES: Dopamine / Mirapex / Demerol

PHYSICAL EXAM: Vitals: T: BP: P: R: 18 O2:
General: Alert, not oriented to place, oriented to self and
husband, no acute distress, interacts appropriately with husband
and son
[**Name (NI) 4459**]: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, JVP 7-8cm, no LAD
Lungs: Bibasilar rales, no wheezes, rhonchi
CV: Regular rate and rhythm, 3/6 systolic murmur LLSB radiating
to apex with no respirophasic variation, normal S1, prominent
S2, no rubs or gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 1+ pulses, no clubbing, cyanosis or
edema, Left thigh with dsg C/D/I, edema, mild tension,
ecchymoses

FAMILY HISTORY: Mother with hypertension died at age [**Age over 90 **].  Father died at age
77. Brother with [**Name2 (NI) **] in 60s. No  diabetes mellitus.

SOCIAL HISTORY: Lives with husband at home, with aids to help around the house.
She never used tobacco or alcohol. She lives with husband in
[**Name (NI) 745**] and is retired. Needs assistance with all ADLs including
dressing, cleaning. 

### Response:
{'Closed fracture of intertrochanteric section of neck of femur,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Fall from other slipping, tripping, or stumbling,Syncope and collapse,Paralysis agitans,Dementia in conditions classified elsewhere without behavioral disturbance,Osteoporosis, unspecified,Foreign body in pharynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Other iatrogenic hypotension,Dysphagia, oropharyngeal phase,Atrial fibrillation,Hypovolemia,Abnormality of gait,History of fall,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Heart valve replaced by transplant,Esophageal reflux,Other constipation,Personal history of malignant neoplasm of breast,Acquired absence of breast and nipple'}
