CHIEF COMPLAINT: Fall

PRESENT ILLNESS: HPI: [**Age over 90 **] yo F Russian speaking with MMP including CKD, HTN, s/p
colon ca, COPD presents after fall however, her only complaint
is for breast pain. She was walking on route to Bathroom and
sustained mechanical fall stating that she usuall walks with a
cain and has poor vision. She denied any LOC, CP, palpiations,
lhd, dizzyness prior to fall. She was unable to get back up, but
was able to crawl to the door to get help. She was reportedly
down for several hours, some neighbors found her and helped her
up and to hospital.
.
In ED, BP 178/100, HR 76, RR 20, 99%RA. CK 58. CT head no
hemorrhage. CT spine, no fracture. She recieved Levaquin 250 mg
X 1 for possible pna on CXR.
.
Upon arrival to floor, she denies any pain. Only complaint is
right breast pain X 2-3 days which is similar to when she had an
abscess 3 years ago. No recent trauma, cuts. no discharge. No
pain any where else.

MEDICAL HISTORY: Gout
Hypercholesterolemia
hypertension
Colon CA
Mild LV systolic and diastolic dysfunction.
LVEF 50% with baseline mid inferior hypokinesis. Moderate
LAE/mild [**Last Name (un) **]/mild symmetric LVH (echo [**2132**]).
COPD
Depression
Psoriasis
Eosinophilia

MEDICATION ON ADMISSION: ALLOPURINOL 100 mg Tablet - 1 Tablet(s) by mouth once a day
ASPIRIN - 81MG Capsule, Delayed Release(E.C.) - TAKE ONE TABLET

ALLERGIES: Ampicillin / Cephalexin

PHYSICAL EXAM: GENERAL: no acute distress. No pain at rest.
HEENT: OP clear, MMM
HEART: Regular rate and rhythm with 2/6 systolic murmur at the
right upper sternal border.
BREAST: R breast nipple missing/inverted, no expressible
discharge, 2 inch diameter ryethema and tenderness around
nipple. possible fluctuance
LUNGS: Clear to auscultation.
ABDOMEN: Soft, nontender, nondistended. Scar from colectomy
EXTREMITIES: Hips with full ROM not limited to pain. Strength
[**4-22**] LE.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home alone with 2 home health aides, sister in the
same building, son in [**Name2 (NI) **], no EtOH, no tobacco
Inflammatory disease of breast,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Abnormal mammogram, unspecified,Constipation, unspecified,Anxiety state, unspecified,Gout, unspecified,Pure hypercholesterolemia,Other psoriasis,Personal history of malignant neoplasm of large intestine,Fall from other slipping, tripping, or stumbling
Inflam disease of breast,Atrial fibrillation,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Chr airway obstruct NEC,Ab mammogram NOS,Constipation NOS,Anxiety state NOS,Gout NOS,Pure hypercholesterolem,Other psoriasis,Hx of colonic malignancy,Fall from slipping NEC
Admission Date:  [**2137-7-18**]              Discharge Date:   [**2137-7-25**]


Service: MEDICINE

Allergies:
Ampicillin / Cephalexin

Attending:[**First Name3 (LF) 1070**]
Chief Complaint:
Fall

Major Surgical or Invasive Procedure:
none

History of Present Illness:
HPI: [**Age over 90 **] yo F Russian speaking with MMP including CKD, HTN, s/p
colon ca, COPD presents after fall however, her only complaint
is for breast pain. She was walking on route to Bathroom and
sustained mechanical fall stating that she usuall walks with a
cain and has poor vision. She denied any LOC, CP, palpiations,
lhd, dizzyness prior to fall. She was unable to get back up, but
was able to crawl to the door to get help. She was reportedly
down for several hours, some neighbors found her and helped her
up and to hospital.
.
In ED, BP 178/100, HR 76, RR 20, 99%RA. CK 58. CT head no
hemorrhage. CT spine, no fracture. She recieved Levaquin 250 mg
X 1 for possible pna on CXR.
.
Upon arrival to floor, she denies any pain. Only complaint is
right breast pain X 2-3 days which is similar to when she had an
abscess 3 years ago. No recent trauma, cuts. no discharge. No
pain any where else.


Past Medical History:
Gout
Hypercholesterolemia
hypertension
Colon CA
Mild LV systolic and diastolic dysfunction.
LVEF 50% with baseline mid inferior hypokinesis. Moderate
LAE/mild [**Last Name (un) **]/mild symmetric LVH (echo [**2132**]).
COPD
Depression
Psoriasis
Eosinophilia


Social History:
 Lives at home alone with 2 home health aides, sister in the
same building, son in [**Name2 (NI) **], no EtOH, no tobacco


Family History:
NC

Physical Exam:
GENERAL: no acute distress. No pain at rest.
HEENT: OP clear, MMM
HEART: Regular rate and rhythm with 2/6 systolic murmur at the
right upper sternal border.
BREAST: R breast nipple missing/inverted, no expressible
discharge, 2 inch diameter ryethema and tenderness around
nipple. possible fluctuance
LUNGS: Clear to auscultation.
ABDOMEN: Soft, nontender, nondistended. Scar from colectomy
EXTREMITIES: Hips with full ROM not limited to pain. Strength
[**4-22**] LE.


Pertinent Results:
[**2137-7-18**] 05:57PM BLOOD WBC-13.8*# RBC-4.51 Hgb-12.2 Hct-38.9
MCV-86# MCH-27.0 MCHC-31.4 RDW-16.9* Plt Ct-183
[**2137-7-21**] 05:42AM BLOOD Neuts-76.2* Lymphs-10.1* Monos-4.4
Eos-9.1* Baso-0.3
[**2137-7-19**] 06:40AM BLOOD PT-14.6* PTT-26.5 INR(PT)-1.3*
[**2137-7-21**] 05:42AM BLOOD PT-14.0* PTT-130.0* INR(PT)-1.2*
[**2137-7-22**] 04:00PM BLOOD PTT-88.5*
[**2137-7-24**] 06:45AM BLOOD PTT-26.0
[**2137-7-18**] 05:57PM BLOOD Glucose-111* UreaN-37* Creat-1.8* Na-142
K-4.8 Cl-108 HCO3-25 AnGap-14
[**2137-7-20**] 08:28PM BLOOD Glucose-131* UreaN-35* Creat-1.8* Na-139
K-5.7* Cl-107 HCO3-24 AnGap-14
[**2137-7-24**] 06:45AM BLOOD Glucose-99 UreaN-43* Creat-1.8* Na-138
K-4.3 Cl-108 HCO3-25 AnGap-9
[**2137-7-18**] 05:57PM BLOOD cTropnT-0.01
[**2137-7-20**] 09:26AM BLOOD CK-MB-NotDone cTropnT-0.01
[**2137-7-20**] 08:28PM BLOOD CK-MB-NotDone cTropnT-0.01
[**2137-7-18**] 05:57PM BLOOD Calcium-10.0 Phos-3.3 Mg-2.0
[**2137-7-24**] 06:45AM BLOOD Calcium-9.3 Phos-4.1 Mg-2.2

Brief Hospital Course:
The patient was admited for a fall. In ED,her vital signs were
within normal range except an elevated BP of 178/100. CT head
did not show hemorrhage and CT of spine did not show a fracture.
CXR was concerning for PNA and she recieved Levaquin 250 mg X 1.
On admission she c/o of breast pain,and was treated for mastitis
with Clindamycin. She has currently received a 6 day regimen of
this mediciation and may continue for four more days. An
outpaitent mamogram of the breast bilaterally was recommended
again as the patient has yet to follow up on prior abnormal
mammogram.
.
In the hospital she was was noted to have HR in 150's. Rate
control was difficult to control on the floor and the patitent
required transfer to the MICU. In the MICU she was closely
monitored without any events. She was started on a Diltiazem
drip and was transitioned to oral verapramil. Also, based on a
CHADS score of 2 she was started on heparin drip. She remained
stable in the MICU and so she was transfered back to the floor.
.
In the wards the patient did not demonstrate signs of Afib on
telemetry monitoring or cardiovascular decompensation on
physical exam and she remained stable. She was transitioned from
verapramil to metoprolol for rate control. Appropriate control
was achieved with Metoprolol at 75 mg [**Hospital1 **]. This regimen appeared
sufficient for appropriate blood pressure control.
.
Because of the risk of bleeding secondary to this patients fall,
Heparin ggt was dicontinued. It was reasoned that the risk of
bleeding overweighed the risk of stroke secondary to
Afib/thrombus.

Medications on Admission:
ALLOPURINOL 100 mg Tablet - 1 Tablet(s) by mouth once a day
ASPIRIN - 81MG Capsule, Delayed Release(E.C.) - TAKE ONE TABLET

EVERY DAY
BUSPIRONE [BUSPAR] - 5 mg Tablet - one Tablet(s) by mouth twice
a
day
CLOTRIMAZOLE - 1 % Cream - apply under breasts once a day
LISINOPRIL - 20 mg Tablet - 1 Tablet(s) by mouth qam
LORAZEPAM [ATIVAN] - 0.5 mg Tablet - one Tablet(s) by mouth at
bedtime
MATRESS PAD - - apply to bed daily for urinary incontinence
788.30
METOPROLOL TARTRATE [LOPRESSOR] - 50 mg Tablet - [**12-19**] Tablet(s)
by
mouth twice a day
NITROGLYCERIN - 0.4MG Tablet, Sublingual - TAKE ONE TABLET Q5MIN

FOR CHEST PAIN
NITROGLYCERIN [NITRO-DUR] - 0.1 mg/hr Patch 24 hr - one patch on

AM/ off PM
POLYETHYLENE GLYCOL 3350 [MIRALAX] - 100 % Powder - 17 grams by

mouth daily
UNDERWEAR LINER - - for urinary incontinence 788.30 (5 per day)

VERAPAMIL - 40 mg Tablet - 1 Tablet(s) by mouth three times a
day

Medications - OTC
ASCORBIC ACID [VITAMIN C] - (Prescribed by Other Provider: [**Last Name (NamePattern4) **].
[**Last Name (STitle) 18685**] - 500 mg Tablet - Tablet(s) by mouth once a day
CARBAMIDE PEROXIDE [DEBROX] - 6.5 % Drops - 3 drops each ear
twice a day
DOCUSATE SODIUM [COLACE] - 100 mg Capsule - one Capsule(s) by
mouth twice a day
MULTIVITAMIN - Tablet - 1 Tablet(s) by mouth once a day
SENNOSIDES [EX-LAX (SENNOSIDES)] - 15 mg Tablet - one Tablet(s)

by mouth daily prn constipation


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
3. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO once a day.

4. Buspirone 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Clotrimazole 1 % Cream Sig: One (1)  Topical once a day:
apply under breast once a day.
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day.
7. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime.
8. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1)
Sublingual q5min as needed for chest pain.
9. Nitro-Dur 0.1 mg/hr Patch 24 hr Sig: One (1)  Transdermal
qam/ off pm.
10. Miralax 100 % Powder Sig: 17 gr  PO once a day: 17 gr by
mouth qd.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] of [**Location (un) 583**]

Discharge Diagnosis:
Afib
HTN
Mastitis


Discharge Condition:
Stable


Discharge Instructions:
You were admited after a fall, which we fond to be not related
to undelying disease. While in the hospital you were found to
have atrial fibrilation and we controlled your heart rate with
medications that slow the rate down. We are discharging you on
one such medication which is called Lopressor. This medicaiton
was also used to help control your blood pressure.  You were
also found to have infection of your breast that was treated
with antibiotics (Clindamycin).

Please be aware that we changed your outpatient medication
regimen from Verapramil to Lopressor.

Please return to the ED or call you regular doctor if you have
any of the following: chest pain, shortness of [**Last Name (un) **],
lightheadedness, palpitations/rapid hear rate, syncope/faining,
fever, chills, cough, rash, or any other complaint that is
abnormal for you.

Followup Instructions:
Please make sure to follow up with your regular physician, [**Name10 (NameIs) **]
[**Last Name (STitle) **], who also came to see you in the hospital.
Also please make sure to keep the following appointments:
1. Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) 1401**], M.D. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2137-8-1**] 4:00
2. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 12902**], MD Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2137-8-15**] 10:45
3. Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2967**], [**Name12 (NameIs) 280**] Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2137-9-26**] 1:30



Completed by:[**2137-7-25**]
{'Inflammatory disease of breast,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Abnormal mammogram, unspecified,Constipation, unspecified,Anxiety state, unspecified,Gout, unspecified,Pure hypercholesterolemia,Other psoriasis,Personal history of malignant neoplasm of large intestine,Fall from other slipping, tripping, or stumbling'}


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: Fall

PRESENT ILLNESS: HPI: [**Age over 90 **] yo F Russian speaking with MMP including CKD, HTN, s/p
colon ca, COPD presents after fall however, her only complaint
is for breast pain. She was walking on route to Bathroom and
sustained mechanical fall stating that she usuall walks with a
cain and has poor vision. She denied any LOC, CP, palpiations,
lhd, dizzyness prior to fall. She was unable to get back up, but
was able to crawl to the door to get help. She was reportedly
down for several hours, some neighbors found her and helped her
up and to hospital.
.
In ED, BP 178/100, HR 76, RR 20, 99%RA. CK 58. CT head no
hemorrhage. CT spine, no fracture. She recieved Levaquin 250 mg
X 1 for possible pna on CXR.
.
Upon arrival to floor, she denies any pain. Only complaint is
right breast pain X 2-3 days which is similar to when she had an
abscess 3 years ago. No recent trauma, cuts. no discharge. No
pain any where else.

MEDICAL HISTORY: Gout
Hypercholesterolemia
hypertension
Colon CA
Mild LV systolic and diastolic dysfunction.
LVEF 50% with baseline mid inferior hypokinesis. Moderate
LAE/mild [**Last Name (un) **]/mild symmetric LVH (echo [**2132**]).
COPD
Depression
Psoriasis
Eosinophilia

MEDICATION ON ADMISSION: ALLOPURINOL 100 mg Tablet - 1 Tablet(s) by mouth once a day
ASPIRIN - 81MG Capsule, Delayed Release(E.C.) - TAKE ONE TABLET

ALLERGIES: Ampicillin / Cephalexin

PHYSICAL EXAM: GENERAL: no acute distress. No pain at rest.
HEENT: OP clear, MMM
HEART: Regular rate and rhythm with 2/6 systolic murmur at the
right upper sternal border.
BREAST: R breast nipple missing/inverted, no expressible
discharge, 2 inch diameter ryethema and tenderness around
nipple. possible fluctuance
LUNGS: Clear to auscultation.
ABDOMEN: Soft, nontender, nondistended. Scar from colectomy
EXTREMITIES: Hips with full ROM not limited to pain. Strength
[**4-22**] LE.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home alone with 2 home health aides, sister in the
same building, son in [**Name2 (NI) **], no EtOH, no tobacco 

### Response:
{'Inflammatory disease of breast,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Abnormal mammogram, unspecified,Constipation, unspecified,Anxiety state, unspecified,Gout, unspecified,Pure hypercholesterolemia,Other psoriasis,Personal history of malignant neoplasm of large intestine,Fall from other slipping, tripping, or stumbling'}
