CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 81-year-old female
with a history of a brain abscess complicated by residual
memory impairment and hyperlipidemia who was admitted on
[**4-19**] with a left femoral fracture in the setting of
falling when out of bed.  The etiology of the fall was
unclear.  The patient had declined any chest pain, shortness
of breath, or syncope.

MEDICAL HISTORY: 1.  Hyperlipidemia.
2.  Spinal stenosis.
3.  Osteoarthritis.
4.  Brain abscess with left facial weakness.
5.  Obstructive sleep apnea; not on continuous positive
airway pressure secondary to intolerance.
6.  A right hip fracture; status post open reduction/internal
fixation with osteonecrosis.
7.  Left corneal abrasion/scar.

MEDICATION ON ADMISSION: (Medications at home included)
1.  Aricept 5 mg p.o. q.d.
2.  Colace.
3.  Fosamax 10 mg p.o. q.d.
4.  Imdur 30 mg p.o. q.d.
5.  Neurontin 100 mg p.o. t.i.d.
6.  Oxybutynin 5 mg p.o. b.i.d.
7.  Prednisone 5 mg p.o. q.d.
8.  Hyoscyamine 250 mg p.o. t.i.d.
9.  Timolol 0.25% right eye q.h.s.

ALLERGIES: PENICILLIN, ERYTHROMYCIN, BETADINE, BACITRACIN
(the reactions to these were unknown).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: A 50-pack-year tobacco history; half to one
pack per day.
Closed fracture of unspecified part of neck of femur,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other chest pain,Accidental fall from bed,Stress incontinence, female,Unspecified sleep apnea,Spinal stenosis, lumbar region, without neurogenic claudication
Fx neck of femur NOS-cl,Hemorrhage complic proc,Ac posthemorrhag anemia,Urin tract infection NOS,Chest pain NEC,Fall from bed,Fem stress incontinence,Sleep apnea NOS,Spin sten,lumbr wo claud
Admission Date:  [**2140-4-19**]     Discharge Date:  [**2140-4-26**]


Service:

HISTORY OF PRESENT ILLNESS:  This is an 81-year-old female
with a history of a brain abscess complicated by residual
memory impairment and hyperlipidemia who was admitted on
[**4-19**] with a left femoral fracture in the setting of
falling when out of bed.  The etiology of the fall was
unclear.  The patient had declined any chest pain, shortness
of breath, or syncope.

The patient was admitted to Orthopaedics and taken to the
operating room on [**4-19**] for a left bipolar hip
arthroplasty.  The immediate postoperative course was
complicated by an episode of oxygen desaturation; she was
100% on 30% face mask and 88% on room air.  Later that
evening, on [**4-19**], the patient developed diffuse left-sided
chest pain, [**8-28**] to [**5-28**] after two sublingual nitroglycerin
tablets.  She was sent for a computed tomography angiogram to
rule out pulmonary embolism, and cardiac enzymes were cycled
to rule out myocardial infarction, and was empirically
started on a heparin drip for treatment of pulmonary embolism
or acute coronary syndrome.

On the morning of [**4-20**], following the computed tomography
angiogram and heparin initiation, the patient was noted to be
hypotensive with complaints of chest pain without any change
in mental status.  She was bolused a total of 3 liters of
normal saline without sustainable improvement in her chest
pain.

Of note, the patient had new T wave inversions in V2 through
V4 and new 0.5-mm ST depressions in lead II.  She was also
complaining of severe left hip pain that was greater than her
chest pain during the entire above episode.

The patient was transferred to the Medical Intensive Care
Unit for management of blood loss anemia secondary to a
hemorrhage from surgical wound in the setting of a
supratherapeutic anticoagulation after surgery for
prophylaxis during pulmonary embolus rule out.

The Medical Intensive Care Unit course was complicated by
continued bleeding from the surgical wound requiring a
transfusion of a total of 10 units of packed red blood cells,
with the last transfusion on [**4-22**].  She was continued on
Lovenox until [**4-22**], as Orthopaedics was concerned of an
increased risk of pulmonary embolism greater than blood loss.
The Lovenox was eventually discontinued.  She was ruled out
for a myocardial infarction for a total of three times.  The
patient's chest pain was thought not secondary to cardiac
origin with the plan for a stress or catheterization at a
later time when the patient was stable from an orthopaedic
standpoint.  She is status post treatment for a urinary tract
infection with Levaquin.  She is now transferred to the
floor.

PAST MEDICAL HISTORY:
1.  Hyperlipidemia.
2.  Spinal stenosis.
3.  Osteoarthritis.
4.  Brain abscess with left facial weakness.
5.  Obstructive sleep apnea; not on continuous positive
airway pressure secondary to intolerance.
6.  A right hip fracture; status post open reduction/internal
fixation with osteonecrosis.
7.  Left corneal abrasion/scar.

ALLERGIES:  PENICILLIN, ERYTHROMYCIN, BETADINE, BACITRACIN
(the reactions to these were unknown).

MEDICATIONS ON ADMISSION:  (Medications at home included)
1.  Aricept 5 mg p.o. q.d.
2.  Colace.
3.  Fosamax 10 mg p.o. q.d.
4.  Imdur 30 mg p.o. q.d.
5.  Neurontin 100 mg p.o. t.i.d.
6.  Oxybutynin 5 mg p.o. b.i.d.
7.  Prednisone 5 mg p.o. q.d.
8.  Hyoscyamine 250 mg p.o. t.i.d.
9.  Timolol 0.25% right eye q.h.s.

MEDICATIONS ON TRANSFER:  (Her medications on transfer from
the Medical Intensive Care Unit included)
 1.  Donepezil 5 mg p.o. q.6h.
 2.  Colace 100 mg p.o. b.i.d.
 3.  Alendronate 10 mg p.o. q.d.
 4.  Gabapentin 100 mg p.o. t.i.d.
 5.  Oxybutynin 5 mg p.o. b.i.d.
 6.  Timolol 0.25% one drop right eye q.d.
 7.  Morphine sulfate 2 mg to 4 mg intravenously q.4h. as
needed.
 8.  Sublingual nitroglycerin.
 9.  Prednisone 5 mg p.o. q.d.
10.  Regular insulin sliding-scale.
11.  Pantoprazole 40 mg p.o. q.24h.
12.  Tylenol.
13.  Trazodone 50 mg p.o. q.h.s. as needed.

SOCIAL HISTORY:  A 50-pack-year tobacco history; half to one
pack per day.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on transfer from the Medical Intensive Care Unit revealed
temperature was 97.9, heart rate was 79, blood pressure was
122/47, respiratory rate was 12, and oxygen saturation was
100% 3 liters.  Ins-and-outs were negative 1.83 liters out.
In general, a pleasant elderly female lying in bed, in no
acute distress.  Head, eyes, ears, nose, and throat
examination revealed left eye surgical.  Right eye pupil was
reactive.  No jugular venous distention.  No carotid bruits.
Mucous membranes were dry.  A left facial droop.  Left eye
droop; closed.  Heart examination revealed a regular rate and
rhythm.  Normal first heart sounds and second heart sounds.
No murmurs, rubs, or gallops.  Lung examination revealed
right lower lobe with crackles.  The rest of the lungs were
clear to auscultation bilaterally.  The abdomen was soft,
nontender, and nondistended.  Bowel sounds were positive.
Extremity examination revealed pneumo boots, left ankle with
an ACE bandage, left hip dressing was clean, dry, and intact
with minimal bleeding, 1 to 2+ edema.  Neurologic examination
revealed alert and oriented times three.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Her white blood
cell count was 11.8, her hematocrit was 30.8, and her
platelets were 154.  Her prothrombin time was 12.7, her
partial thromboplastin time was 25.4, and her INR was 1.1.
Sodium was 140, potassium was 4.3, chloride was 110,
bicarbonate was 22, blood urea nitrogen was 35, creatinine
was 1, and blood glucose was 93.  Calcium was 8, phosphorous
was 2.4, and magnesium was 2.

HOSPITAL COURSE BY ISSUE/SYSTEM:   Essentially, this is an
81-year-old female with a history of a brain abscess
complicated by residual memory impairment who was admitted on
[**4-19**] with a left hip fracture, status post a left hip
arthroplasty.  Her postoperative course was complicated by a
hemorrhage from the surgical wound requiring 10 units of
packed red blood cells and multiple episodes of chest pain
(ruling out for a myocardial infarction during each of these
episodes).

1.  ORTHOPAEDIC ISSUES:  The patient was status post left hip
arthroplasty.  The issue of anticoagulation status post
surgery was a difficult one given the increased risk of
pulmonary embolus, status post the orthopaedic surgery.
However, given that the patient had significant bleeding, it
was decided by the Orthopaedic team that she would be placed
on aspirin 81 mg p.o. q.d. as her form of anticoagulation.

The patient should be following up with the orthopaedic
surgeon (Dr. [**Last Name (STitle) 9694**] in one week from her discharge, and she
was to call telephone number [**Telephone/Fax (1) 4301**] to make an
appointment.

The patient had also complained of ankle pain on the left
side, and it was unclear whether when she had originally
fallen and sustained a hip fracture if she had also developed
an ankle fracture.  The ankle film showed diffuse osteopenia
with soft tissue swelling about the ankle, but no fracture
had been identified.

She was seen by Physical Therapy, and it was deemed that she
would benefit from rehabilitation.

The patient also has a history of osteoarthritis and was on
prednisone 5 mg p.o. per day.  The patient's wound was slow
to heal; likely thought secondary to her prednisone use.  She
also has a history of some serosanguineous drainage from the
wound, so it was thought that she would benefit from a 1-week
course of Keflex 500 mg p.o. q.i.d. that she was started on
on the day of discharge (on [**2140-4-26**]).

2.  CARDIOVASCULAR SYSTEM:  The patient has no known coronary
artery disease with a stress MIBI in [**2136**] showing no
perfusion defects; however, she had multiple episodes of
chest pain, and one episode with electrocardiogram changes.
Otherwise, her enzymes were flat.  Thus, it was unclear if
this was cardiac in etiology.

The plan was for further risk stratification with a stress
MIBI or catheterization when she was stable from an
orthopaedic standpoint.

We continued her on metoprolol which was initiated while she
was in the hospital at 12.5 mg p.o. b.i.d., and she was
started on aspirin again for anticoagulation postoperatively
and also for cardiovascular benefit.

3.  NEUROLOGIC ISSUES:  The patient has a history of a brain
abscess complicated by memory impairment.  She was continued
on Aricept 5 mg p.o. q.d. and gabapentin 100 mg p.o. t.i.d.
for a history of neuropathy.

4.  GENITOURINARY ISSUES:  The patient has a history of
urinary incontinence, which she exhibited while she in the
hospital.  She was continued on oxybutynin 5 mg p.o. b.i.d.

5.  OPHTHALMOLOGIC ISSUES:  She was continued on Timolol.

6.  PULMONARY ISSUES:  Pulmonary wise, the patient's
respiratory status was stable.  We monitored her respiratory
rate and oxygen saturation which were stable throughout her
hospitalization.  There was a low threshold for obtaining a
computed tomography angiogram.  She had pleuritic chest pain
with decreased oxygen saturations.  However, this was not
exhibited during her hospitalization.  Of course, the risk
was still for a pulmonary embolism given her proximity to
recent orthopaedic surgery.

7.  INFECTIOUS DISEASE ISSUES:  The patient had a low-grade
temperature once during her hospitalization with a white
blood cell count of 15.  Her white blood cell count was
unexplainable as there was no focal signs or symptoms.  She
had a Foley catheter until urinalysis was checked (which was
negative for any signs of infection).  Given that she had
previously had minor serosanguineous drainage and was on
prednisone, we thought it was reasonable to start her on a
7-day course of Keflex for treatment of postoperative
surgical wound, and she was to continue on this for one week.

8.  HEMATOLOGIC ISSUES:  The patient's hematocrit remained
stable after the Lovenox was discontinued, and her creatinine
remained between 30 and 35 with no more evidence of continued
bleeding, and no more increase in left hip pain.  She
continued to be monitored during her hospitalization.

DISCHARGE STATUS:  The patient was discharged to an extended
care facility; [**Location (un) **].

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to seek medical attention if she develops
worsening left hip pain, acute shortness of breath, or any
other symptoms of concern.
2.  The patient was to follow up with Orthopaedics as
previously mentioned with Dr. [**Last Name (STitle) 9694**] in one week.  The
patient was to call telephone number [**Telephone/Fax (1) 4301**] to make an
appointment.

FINAL DISCHARGE DIAGNOSES:
1.  Left hip fracture.
2.  Status post total hip arthroplasty.
3.  Blood loss anemia.
4.  Atypical chest pain.

MAJOR SURGICAL/INVASIVE PROCEDURES:  Her major
surgical/invasive procedures were left hip arthroplasty.

CONDITION AT DISCHARGE:  The patient was ambulating with
physical therapy assistance, tolerating oral intake,
urinating, and was having bowel movements.

MEDICATIONS ON DISCHARGE:  (Her discharge medications
included)
 1.  Aricept 5 mg p.o. q.d.
 2.  Alendronate 10 mg p.o. q.d.
 3.  Gabapentin 100 mg p.o. t.i.d.
 4.  Oxybutynin 5 mg p.o. b.i.d.
 5.  Timolol 0.25% one drop right eye q.d.
 6.  Metoprolol 12.5 mg p.o. b.i.d.
 7.  Aspirin 81 mg p.o. q.d.
 8.  Prednisone 5 mg p.o. q.d.
 9.  Colace 100 mg p.o. b.i.d.
10.  Keflex 500 mg p.o. q.6h. (for seven days; the start date
was [**2140-4-26**]).





                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1211**], M.D.  [**MD Number(1) 1212**]

Dictated By:[**Name8 (MD) 9633**]

MEDQUIST36

D:  [**2140-4-26**]  10:09
T:  [**2140-4-26**]  10:12
JOB#:  [**Job Number 104399**]
{'Closed fracture of unspecified part of neck of femur,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other chest pain,Accidental fall from bed,Stress incontinence, female,Unspecified sleep apnea,Spinal stenosis, lumbar region, without neurogenic claudication'}


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: This is an 81-year-old female
with a history of a brain abscess complicated by residual
memory impairment and hyperlipidemia who was admitted on
[**4-19**] with a left femoral fracture in the setting of
falling when out of bed.  The etiology of the fall was
unclear.  The patient had declined any chest pain, shortness
of breath, or syncope.

MEDICAL HISTORY: 1.  Hyperlipidemia.
2.  Spinal stenosis.
3.  Osteoarthritis.
4.  Brain abscess with left facial weakness.
5.  Obstructive sleep apnea; not on continuous positive
airway pressure secondary to intolerance.
6.  A right hip fracture; status post open reduction/internal
fixation with osteonecrosis.
7.  Left corneal abrasion/scar.

MEDICATION ON ADMISSION: (Medications at home included)
1.  Aricept 5 mg p.o. q.d.
2.  Colace.
3.  Fosamax 10 mg p.o. q.d.
4.  Imdur 30 mg p.o. q.d.
5.  Neurontin 100 mg p.o. t.i.d.
6.  Oxybutynin 5 mg p.o. b.i.d.
7.  Prednisone 5 mg p.o. q.d.
8.  Hyoscyamine 250 mg p.o. t.i.d.
9.  Timolol 0.25% right eye q.h.s.

ALLERGIES: PENICILLIN, ERYTHROMYCIN, BETADINE, BACITRACIN
(the reactions to these were unknown).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: A 50-pack-year tobacco history; half to one
pack per day. 

### Response:
{'Closed fracture of unspecified part of neck of femur,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Urinary tract infection, site not specified,Other chest pain,Accidental fall from bed,Stress incontinence, female,Unspecified sleep apnea,Spinal stenosis, lumbar region, without neurogenic claudication'}
