CHIEF COMPLAINT: Hip [**Hospital **] Transfer from OSH for cath

PRESENT ILLNESS: 87 yo man with CAD s/p CABG/PTCA, ischemic CMP EF 30%, A.fib
admitted to [**Hospital **] Hosp on [**2103-9-10**] s/p fall w/ L hip fx. No h/o
syncope. Patient with h/o A.fib apparently rate controlled at
OSH, no ischemic EKG changes, TnI negative and CK negative, BNP
459. Echo performed showed inferolateral hypokinesis c/w
ischemia and EF of 30%. Mild MR, Trace TR, mild LVH. Normal RV
size and function. Patient transferred to [**Hospital1 18**] for cath.  Upon
arrival, pt was taken to cath lab, which was subsequently
cancelled due to lack of evidence supporting intervention.
Vitals signs unremarkable.  Upon initial eval, pt denied any
complaints (no sob, cp, abd pain, some shoulder pain, no leg
pain).

MEDICAL HISTORY: 1. Ischemic CMP EF 30%
2. Paroxysmal A.fib
3. Aortic sclerosis
4. CAD s/p CABG x4 in [**2078**], PTCA [**2089**], s/p MI (remote).
5. HTN
6. PVD, carotids 50-70% on right; 80-90% on left
7. Normal pressure hydrocephalus with a right ventricular shunt
[**12-8**]
8. GERD
9. HOH
10. Dementia
11. L hip fracture, falls x 10 [**Month/Year (2) 1686**]
12. h/o UTIs
13. hyperlipidemia
14. h/o depression
15. TURP x 4 --last 2 [**Month/Year (2) 1686**] ago, bladder scapping to ?malignant
cells

MEDICATION ON ADMISSION: Outpatient Medications
- ASA EC 325 mg daily
- Coreg 12.5 mg [**Hospital1 **]
- Lexapro 5 mg daily
- Norvasc 10 mg daily
- Fibercom 625 mg [**Hospital1 **]
- Nexium 40 mg daily
- Imdur 20 mg daily
- Proscar 5 mg daily
- Nitro TP 0.2 mg/hr daily, removed at bedtime
- Lasix 40 mg [**Hospital1 **]
- Lisinopril 20 mg daily
- Lipitor 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98 78 150/74 20 95% RA
Ht 5'7" Wt 175 lbs
Gen: frail elderly M, NAD, lying flat in bed, HOH
Heent: OP clear, MM dry, anicteric, PERRL
Chest: Expiratory wheeze throughout. Bibasilar crackles, R>L.
CVS: nl S1 S2, RRR, [**2-12**] <> @ RUSB, [**2-12**] HSM at apex
Abd: soft NT/ND, BS+, no HSM appreciated
Ext: warm, L leg in brace, moves toes, 2+ dp pulses b/l
Neuro: HOH, responds appropriately, grossly intact

FAMILY HISTORY: Mother died of an MI suddenly in late 60s. No CA in family.

SOCIAL HISTORY: Worked in Wool trade. Assissted Living (Inn at [**Doctor Last Name **] [**Doctor Last Name **]).
Widowed, wife died 1 [**1-8**] [**Name2 (NI) 1686**] ago, married 54 [**Name2 (NI) 1686**]. Five sons, one
daughter. Denies tobacco use, alcohol socially in past.
Closed fracture of intertrochanteric section of neck of femur,Acute respiratory failure,Acute combined systolic and diastolic heart failure,Subendocardial infarction, initial episode of care,Atrial fibrillation,Toxic encephalopathy,Pneumonitis due to inhalation of food or vomitus,Fall from other slipping, tripping, or stumbling,Other convulsions,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Aortocoronary bypass status,Old myocardial infarction,Unspecified essential hypertension,Presence of cerebrospinal fluid drainage device,Delirium due to conditions classified elsewhere,Other specified paralytic syndrome,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Communicating hydrocephalus,Dementia in conditions classified elsewhere without behavioral disturbance
Intertrochanteric fx-cl,Acute respiratry failure,Ac syst/diastol hrt fail,Subendo infarct, initial,Atrial fibrillation,Toxic encephalopathy,Food/vomit pneumonitis,Fall from slipping NEC,Convulsions NEC,Hyperosmolality,Acute kidney failure NOS,Protein-cal malnutr NOS,Aortocoronary bypass,Old myocardial infarct,Hypertension NOS,Ventricular shunt status,Delirium d/t other cond,Oth spcf paralytic synd,Ocl crtd art wo infrct,Communicat hydrocephalus,Dementia w/o behav dist
Admission Date:  [**2103-9-11**]              Discharge Date:   [**2103-10-1**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Hip [**Hospital **] Transfer from OSH for cath

Major Surgical or Invasive Procedure:
LHORIF
PICC placement

History of Present Illness:
87 yo man with CAD s/p CABG/PTCA, ischemic CMP EF 30%, A.fib
admitted to [**Hospital **] Hosp on [**2103-9-10**] s/p fall w/ L hip fx. No h/o
syncope. Patient with h/o A.fib apparently rate controlled at
OSH, no ischemic EKG changes, TnI negative and CK negative, BNP
459. Echo performed showed inferolateral hypokinesis c/w
ischemia and EF of 30%. Mild MR, Trace TR, mild LVH. Normal RV
size and function. Patient transferred to [**Hospital1 18**] for cath.  Upon
arrival, pt was taken to cath lab, which was subsequently
cancelled due to lack of evidence supporting intervention.
Vitals signs unremarkable.  Upon initial eval, pt denied any
complaints (no sob, cp, abd pain, some shoulder pain, no leg
pain).


Past Medical History:
1. Ischemic CMP EF 30%
2. Paroxysmal A.fib
3. Aortic sclerosis
4. CAD s/p CABG x4 in [**2078**], PTCA [**2089**], s/p MI (remote).
5. HTN
6. PVD, carotids 50-70% on right; 80-90% on left
7. Normal pressure hydrocephalus with a right ventricular shunt
[**12-8**]
8. GERD
9. HOH
10. Dementia
11. L hip fracture, falls x 10 [**Month/Year (2) 1686**]
12. h/o UTIs
13. hyperlipidemia
14. h/o depression
15. TURP x 4 --last 2 [**Month/Year (2) 1686**] ago, bladder scapping to ?malignant
cells

Social History:
Worked in Wool trade. Assissted Living (Inn at [**Doctor Last Name **] [**Doctor Last Name **]).
Widowed, wife died 1 [**1-8**] [**Name2 (NI) 1686**] ago, married 54 [**Name2 (NI) 1686**]. Five sons, one
daughter. Denies tobacco use, alcohol socially in past.

Family History:
Mother died of an MI suddenly in late 60s. No CA in family.

Physical Exam:
VS: 98 78 150/74 20 95% RA
Ht 5'7" Wt 175 lbs
Gen: frail elderly M, NAD, lying flat in bed, HOH
Heent: OP clear, MM dry, anicteric, PERRL
Chest: Expiratory wheeze throughout. Bibasilar crackles, R>L.
CVS: nl S1 S2, RRR, [**2-12**] <> @ RUSB, [**2-12**] HSM at apex
Abd: soft NT/ND, BS+, no HSM appreciated
Ext: warm, L leg in brace, moves toes, 2+ dp pulses b/l
Neuro: HOH, responds appropriately, grossly intact


Pertinent Results:
At OSH:
WBC 12.8 Hct 34.8 Plts 194 Cl 101 HCO3 27 Glu 125 Bun 16 Cr 1.0
Ca 9.8
TP 6.4 Alb 4.2 T.bili 0.7 AP 94 AST 15 ALT 13
Na 139 K 3.3 Cl
CK 61 TnI <0.1
BNP 459

On Admission:
WBC 12.9 Hct 31.3 Plts 169 Na 142 K 3.6 Cl 103 HCO3 30 Glu 117
Bun 22 Cr 1.2 Ca 8.9 Phos 4.0 Mg 2.1

Cardiac Enzymes   CK    CKMB    TropT  Hct
[**9-24**] 9:10A        40     ND      0.68  33.9
[**9-24**] 6:20A        42     ND      0.63  33.8 (1U tx)
[**9-18**] 0[**Telephone/Fax (2) 107048**].2
[**9-18**] 0110         95             0.82
[**9-17**] 1538        119     14      0.86  (2U tx)
[**9-17**] 0615        147     12      0.78  23.9
[**9-16**] 2215        149     11      0.63  23.8
[**9-16**] 0416        106     15      0.51  21.7
[**9-15**]  0530         99      7      0.18  22.9
[**9-14**]  [**2028**]        110      2      0.05  25.2
.
Studies:
EKG [**2103-9-13**]: SR at 75 bpm, RBBB, VPB, prolonged PR , old Q-waves
in 2,3,aVF; these were unchanged compared to previous EKG
.
Echo [**2103-9-11**]
Aortic sclerosis with adequate opening, septal knuckle, mild MR,
trace TR, RV wnl, LVH, Reverse E/A ratio c/w non compliant LV,
mitral annular calcification, EF of 30% with inferolateral
hypkinesis c/w infarction. Per Daughter [**4-11**] [**Month/Day (1) 1686**] ago had echo
with EF 40-45%.
.
[**2103-9-15**]
EF 35%. 3+/4+ MR.
.
Carotid Duplex ([**2103-9-12**]): b/l 60-69% stenosis
.
EEG ([**2103-9-14**]): This is an abnormal EEG in the waking and drowsy
states due to the slow background rhythm and bursts of
generalized delta slowing. These abnormalities suggest a
moderate encephalopathy, which may be seen with infections,
medication effect, toxic metabolic abnormalities, or ischemia.
.
MRI/MRA head ([**2103-9-14**]):
No acute stroke. No hemorrhage.Moderate ventriculomegaly.
Diffuse  thickening of the meninges most likely secondary to
right parietal  shunt. Old left cerebellarinfarct. Normal circle
of [**Location (un) 431**] with no  areas of abnormality.
.
CT Head w/out contrast ([**2103-9-14**]):
Allowing for differences in technique from MR,no significant
change. Please note that this examination is very limited by
motion artifact.
.
CXR Pa/lat ([**2103-9-18**]):
Interval development of bilateral basal hazy opacities which may
represent multifocal pneumonia
.
CT Head w/o contrast ([**2103-9-20**]):
1) Severely motion limited study.
2) Allowing for this, no evidence of hemorrhage.
3) Ventricles are just slightly more prominent than the CT of
[**2103-9-14**]; without a baseline study for reference, it is difficult
to assess for shunt malfunction.
.
Neck soft tissues ([**2103-9-21**]):
Suboptimal exam. Normal airway.
.
CT Head w/o contrast ([**2103-9-23**]):
1.  No significant change in size of enlarged ventricles with
shunt present in the right lateral ventricle.
2.  No evidence of hemorrhage.
.
CXR [**9-24**] r/o CHF (final):
1. Small bilateral pleural effusions persist.
2. Slight interval improvement in pulmonary vascular congestion.

.
CTA Chest ([**2103-9-24**]) (final):
1.  No evidence of PE.
2.  Bilateral pleural effusions and atelectases.
3.  Small scattered subcentimeter lymph nodes.
4.  Scattered peripheral nonspecific opacities in the right
upper lobe.
.
[**2103-9-26**] CATH [**Last Name (LF) 60559**],[**First Name3 (LF) **]/C
Successful placement of a 4 French single lumen 42 cm PICC by
way
of the right brachial vein with the tip at the cavoatrial
junction.  The line is ready for use.
.
[**9-27**] EEG
Abnormal EEG due to the disorganized and mildly slow background
and due to the bursts of generalized slowing. These slowings
indicate a widespread encephalopathic condition affecting both
cortical and subcortical structures. Medications, metabolic
disturbances, and infection are among the most common causes.
There was occasional additional focal slowing in the right
anterior quadrant. No epileptiform features were evident.
.
[**9-28**] CXR
Mild pulmonary edema has improved substantially since [**9-27**] and small bilateral pleural effusions have decreased.  The
heart is normal size.  Left lower lobe atelectasis is stable.
No pneumothorax.  Tip of the right PICC line projects over the
right atrium.
.
[**9-28**] CXR
Left base airspace disease and probable small pleural effusion,
without appreciable interval change allowing for differences in
positioning
.
[**9-28**] CT Left Lower Ext
1.  Hematoma with layering fluid-fluid level expanding the
vastus intermedius, lateralis, and rectus femoris.
2.  No evidence for hardware complication.
3.  Dense atherosclerotic disease of the visualized arteries.
.
[**9-30**] CXR
Bibasilar atelectasis with mild hydrostatic edema.


Brief Hospital Course:
Pt had several issues addressed during this admission:
.
1. Hip Fracture: The patient fractured his L hip in a mechanical
fall. The L hip was repaired with an ORIF on [**2103-9-13**]. DVT
prophylaxis with Lovenox 30 [**Hospital1 **]. Physical therapy worked with
him to improve weight bearing on his L leg.
.
2. Neuro: The patient had a GTC seizure soon after hip surgery.
The patient was evaluated by both neurology and neurosurgery.
Neurology was concerned that his presentation of L sided
weakness on the floor could represent either a new stroke or a
[**Doctor Last Name 555**] paralysis after seizure activity.  MRI/MRA of the brain
was negative for an acute lesion although it did reveal an old L
sided infarct.  Mild ventriculomegaly was noted but, in
consultation with neurosurgery, this was felt to not represent
malfunctioning of his VP shunt and the decision was made to
defer tapping the shunt.  An EEG showed no specific seizure
focus but rather demonstrated a diffuse encephalopathy c/w a
toxic-metabolic derangement.  He was loaded with phenytoin and
tolerated the load well.  His mental status improved in the ICU
until he was near his baseline per his daughter, sleeping much
of the day, occasionally disoriented/confused but able to answer
questions and interact. He remained disoriented on the floor and
phenytoin 300 daily was continued for 10 days for his seizures.
Keppra was started and titrated up to 1000 [**Hospital1 **], with no
subsequent seizures.  His mental status continued a
waxing/[**Doctor Last Name 688**] course consistent with delerium. Geriatrics was
consulted and thought his delerium was multifactorial, likely a
combination of reversed day/night cycles, unfamiliar location,
pneumonia and multiple medications.  Soft restraints and a
sitter were required for his delerium. Zyprexa was started at
bedtime to help with agitation and have him sleep at night.
Trazadone was started for insomnia.  In the hours prior to his
passing, pt was comfortable in no acute distress.
.
3. CV: The patient was initially transferred for cardiac
catheterization but this was deferred prior to surgery.  In the
ICU, an ECHO was checked and demonstrated new (since [**2094**]) 4+MR
along with significant hypokinesis and akinesis of the LV.  His
cardiac medications were discontinued after his seizure and were
restarted back on the floor.  There were several cardiovascular
sub-issues addressed during his course:
a. Ischemia: Patient dropped hematocrit to 21 during his ICU
stay.  He had increase in CE, max troponin T of 0.86.  After
transfusion to 33, his CE trended downward. However, he
complained of chest pain on several occasions, demanding
sublingual nitrates.  Patient had  baseline ST depressions in
V2-V5 which were stable during these events.  Pt was started on
isosorbide dinitrate, and thereafter pt was chest-pain free.
b. CHF: Echo from [**2094**] showed EF of 35%. Echo on [**9-15**] w/ EF of
25-30%. Patient had bilateral crackles on exam consistently and
evidence of pulmonary edema on multiple CXRs throughout his
course.  Afterload reduction with AceI and isosorbide dinitrate
were started.  Lasix 40 [**Hospital1 **] was started on HD 14, with
improvement in respiratory symptoms.  Lasix was dosed both
orally and IV depending on the gravity of need.  Ultimately,
pt's pulmonary edema became significant one day before his
demise following a blood transfusion; he received Lasix and
improved.  However, due to continued need for transfusion, pt's
family was consulted, and it was agreed that pt should be made
CMO on [**2103-9-30**].  All measures were discontinued beyond pain
management, and his respiratory status began to decline, likely
in absence of diuresis.  Pt ultimately died peacefully from
cardiopulmonary failure, likely secondary to decompensated CHF
w/ pulmonary edema.
c. Rhythm: History of Afib, but Afib was not appreciated on
telemetry. Metoprolol was continued until pt was made CMO.
d. LV thrombus: 3 cm LV thrombus seen on ECHO. Anticoagulation
with coumadin was started, goal INR [**2-9**]. INR to 9.1 on [**9-24**],
recovery with vitamin K. Coumadin restarted on [**9-25**].  Once pt
developed a left thigh hematoma, however, anticoagulation was
ceased and reversal was initiated with vitamin K.
e. HTN: Controlled using BB, AceI, isordil, and lasix; goal SBP
> 120 (due to carotid stenosis) but < 140 (due to CHF); pt's BP
was well-controlled on the floor using this regimen.
.
4. Respiratory: Once transferred to floor, patient became
tachypneic w/ RR 25-40 and appeared to be in moderate distress.
Distress resolved with ipratropium neb. CXR revealed bilateral
infiltrates suggestive of pneumonia. Zosyn was added to
patient's regimen for 6 days and Levofloxacin/flagyl for 3 days.
Repeat CXR showed resolution of infiltrates but respiratory
distress remained. Neck soft tissue film showed no evidence of
oropharyngeal or tracheal abnormality. After restarting home
Lasix, respiratory status improved; oxygen, prn Lasix, and
Atrovent nebs were the mainstays of pt's respiratory support.
.
5. Fever: The patient developed low grade temps in the ICU that
were first attributed to post-surgical atelectasis.  However, on
the day prior to call-out his BCX grew GPC and he was started on
vancomycin.  No speciation was available at the time of call out
to tailor therapy.  However, based on the cultures being
positive in [**2-14**] bottles this may represent a skin contamination.
Patient was on vancomycin for 7 days. Subsequent blood cultures
were negative.  Pt remained afebrile for the remainder of his
course.
.
6. Hypernatremia: Due to poor po water intake, patient had serum
sodium up to 147, with a free water deficit of 2.1L. He was
initially encouraged to drink thickened water, with no benefit.
1L of free water was given by IV.  Once CMO was instituted, pt's
sodium continued to rise.
.
7. Left Thigh Hematoma: on [**9-29**] pt developed a swollen, tender,
firm left thigh, but retained distal dorsalis pedis pulses;
sensation was difficult to ascertain given pt's ALOC.  CT of the
LLE revealed a hematoma expanding the vastus intermedius,
lateralis, and rectus femoris muscle bellies.  Given the
proximity of this hematoma to pt's ORIF on [**2103-9-13**], orthopedic
attending E.K. [**Doctor Last Name 1005**] was consulted and evaluated pt.  Dr.
[**Last Name (STitle) 1005**] did not advise draining the hematoma given the high
likelihood of reexpansion; rather, he opted for reliance on
tamponade effect slowing blood collection, INR reversal with
vitamin K, and stopping anticoagulation as a means of therapy.
The medicine team agreed with this approach, and serial HCTs
were followed.  Pt's HCT remained unstable (although vitals were
unchanged), so he was transfused several units (each followed by
lasix for developing pulmonary edema) until pt's family agreed
to CMO on [**2103-9-30**].
.
Pt's last living examination was performed at 08:30 AM on [**10-1**],
when he was breathing but failed to respond to verbal or touch;
his lung sounds were congested bilaterally, but were not
significantly changed from his inpatient baseline.  He was
comfortable and in no acute distress.  At 09:00, pt was found
breathless; examination revealed the following: unresponsive to
noxious stimuli, no breath sounds, no heart sounds, no carotid
pulse, pupils fixed and dilated at 5 mm w/o reaction to light,
and no corneal reflex.  Pt was pronounced dead at 09:00 on
[**2103-10-1**].  Upon his passing, pt's daughter was [**Name (NI) 653**]; autopsy
was offered, but the family deferred.  Pt's PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 13013**] of
[**Hospital **] Medical Associates, was notified of his passing.


Medications on Admission:
Outpatient Medications
- ASA EC 325 mg daily
- Coreg 12.5 mg [**Hospital1 **]
- Lexapro 5 mg daily
- Norvasc 10 mg daily
- Fibercom 625 mg [**Hospital1 **]
- Nexium 40 mg daily
- Imdur 20 mg daily
- Proscar 5 mg daily
- Nitro TP 0.2 mg/hr daily, removed at bedtime
- Lasix 40 mg [**Hospital1 **]
- Lisinopril 20 mg daily
- Lipitor 10 mg daily


Discharge Medications:
None

Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary Diagnosis:
1. Left Hip Fracture s/p ORIF w/ subsequent hematoma.
2. NSTEMI.
3. Systolic Heart Failure EF ~ 25%
4. Atrial Fibrillation.
5. LV Apical Thrombus.
6. Generalized Tonic-Clonic Seizure - Left Sided [**Doctor Last Name 555**]
Paralysis.
7. Aspiration Pneumonia.
8. Delirium.
9. Malnutrition - Moderate Degree.

Secondary:
1. Dementia.
2. Normal Pressure Hydrocephalus s/p VP Shunt.
3. Coronary Artery Disease s/p CABG
4. Ischemic Cardiomyopathy 4+ Mitral Regurgitation.


Discharge Condition:
Deceased.

Discharge Instructions:
None.

Followup Instructions:
None.


Completed by:[**2103-10-2**]
{'Closed fracture of intertrochanteric section of neck of femur,Acute respiratory failure,Acute combined systolic and diastolic heart failure,Subendocardial infarction, initial episode of care,Atrial fibrillation,Toxic encephalopathy,Pneumonitis due to inhalation of food or vomitus,Fall from other slipping, tripping, or stumbling,Other convulsions,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Aortocoronary bypass status,Old myocardial infarction,Unspecified essential hypertension,Presence of cerebrospinal fluid drainage device,Delirium due to conditions classified elsewhere,Other specified paralytic syndrome,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Communicating hydrocephalus,Dementia in conditions classified elsewhere without behavioral disturbance'}


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: Hip [**Hospital **] Transfer from OSH for cath

PRESENT ILLNESS: 87 yo man with CAD s/p CABG/PTCA, ischemic CMP EF 30%, A.fib
admitted to [**Hospital **] Hosp on [**2103-9-10**] s/p fall w/ L hip fx. No h/o
syncope. Patient with h/o A.fib apparently rate controlled at
OSH, no ischemic EKG changes, TnI negative and CK negative, BNP
459. Echo performed showed inferolateral hypokinesis c/w
ischemia and EF of 30%. Mild MR, Trace TR, mild LVH. Normal RV
size and function. Patient transferred to [**Hospital1 18**] for cath.  Upon
arrival, pt was taken to cath lab, which was subsequently
cancelled due to lack of evidence supporting intervention.
Vitals signs unremarkable.  Upon initial eval, pt denied any
complaints (no sob, cp, abd pain, some shoulder pain, no leg
pain).

MEDICAL HISTORY: 1. Ischemic CMP EF 30%
2. Paroxysmal A.fib
3. Aortic sclerosis
4. CAD s/p CABG x4 in [**2078**], PTCA [**2089**], s/p MI (remote).
5. HTN
6. PVD, carotids 50-70% on right; 80-90% on left
7. Normal pressure hydrocephalus with a right ventricular shunt
[**12-8**]
8. GERD
9. HOH
10. Dementia
11. L hip fracture, falls x 10 [**Month/Year (2) 1686**]
12. h/o UTIs
13. hyperlipidemia
14. h/o depression
15. TURP x 4 --last 2 [**Month/Year (2) 1686**] ago, bladder scapping to ?malignant
cells

MEDICATION ON ADMISSION: Outpatient Medications
- ASA EC 325 mg daily
- Coreg 12.5 mg [**Hospital1 **]
- Lexapro 5 mg daily
- Norvasc 10 mg daily
- Fibercom 625 mg [**Hospital1 **]
- Nexium 40 mg daily
- Imdur 20 mg daily
- Proscar 5 mg daily
- Nitro TP 0.2 mg/hr daily, removed at bedtime
- Lasix 40 mg [**Hospital1 **]
- Lisinopril 20 mg daily
- Lipitor 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98 78 150/74 20 95% RA
Ht 5'7" Wt 175 lbs
Gen: frail elderly M, NAD, lying flat in bed, HOH
Heent: OP clear, MM dry, anicteric, PERRL
Chest: Expiratory wheeze throughout. Bibasilar crackles, R>L.
CVS: nl S1 S2, RRR, [**2-12**] <> @ RUSB, [**2-12**] HSM at apex
Abd: soft NT/ND, BS+, no HSM appreciated
Ext: warm, L leg in brace, moves toes, 2+ dp pulses b/l
Neuro: HOH, responds appropriately, grossly intact

FAMILY HISTORY: Mother died of an MI suddenly in late 60s. No CA in family.

SOCIAL HISTORY: Worked in Wool trade. Assissted Living (Inn at [**Doctor Last Name **] [**Doctor Last Name **]).
Widowed, wife died 1 [**1-8**] [**Name2 (NI) 1686**] ago, married 54 [**Name2 (NI) 1686**]. Five sons, one
daughter. Denies tobacco use, alcohol socially in past. 

### Response:
{'Closed fracture of intertrochanteric section of neck of femur,Acute respiratory failure,Acute combined systolic and diastolic heart failure,Subendocardial infarction, initial episode of care,Atrial fibrillation,Toxic encephalopathy,Pneumonitis due to inhalation of food or vomitus,Fall from other slipping, tripping, or stumbling,Other convulsions,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Aortocoronary bypass status,Old myocardial infarction,Unspecified essential hypertension,Presence of cerebrospinal fluid drainage device,Delirium due to conditions classified elsewhere,Other specified paralytic syndrome,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Communicating hydrocephalus,Dementia in conditions classified elsewhere without behavioral disturbance'}
