CHIEF COMPLAINT: Fall

PRESENT ILLNESS: 63 year old man with HIV, cryptogenic cirrhosis, hx of frequent
syncope with an extensive workup and multiple falls presents
after witnessed fall on street. Pt denies prodrome and does not
recall fall. The pt hit his head w/ occipital abrasion.
.
In the ED, initial vs were: T P 70 BP 103/78 R 23 O2 sat 97%2L.
Patient was given tentanus booster, keppra, zofran. EKG (sinus,
but with junctional beats) was concerning for dysrrhythmia,
cardiology was consulted. FAST scan was negative, but CT imaging
of the head showed right SDH, EDH and bilateral parenchymal
hemorrhages. The pt was seen by neurosurgery, and it was
determined that the pt did not require surgical intervention. Pt
was also found to have old rib fractures on CT, and trauma
surgery saw the pt. The pt was transfered to the MICU for
frequent neuro checks and further evaluation of his syncope.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: HIV, [**2156-6-28**]: CD4 count: 131 VL: < 48.
Cryptogenic cirrhosis w/ h/o variceal bleed w/ esophageal
banding, last GI bleed in [**2154**], followed at [**Hospital1 3278**]
Macrocytic anemia
BPH
R hip pain s/p R hip surgery
Gait disorder due to:
s/p right hip fracture, fixated with plate and screws
s/p right shoulder separation fixated with wire

MEDICATION ON ADMISSION: Truvada/Emtricitabine-Tenofovir 1 tab daily
Norvir/Ritonavir daily
Prezista/Darunavir 2 tabs daily
Metformin 500 qam
Nadolol 40 daily
Citalopram 20 mg DAILY
Lorazepam 1 mg HS
Nortriptyline 50 mg HS
Omeprazole 20 mg DAILY
Seroquel 25 [**Hospital1 **]
Oxycodone 5 mg [**1-23**] q 4h prn
Trimethoprim-Sulfamethoxazole 160-800 mg DAILY
Lipitor 40 daily
Aspirin 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Vitals: T: 97.6 BP: 111/72 P: 68 R: 22 O2: 95% on 2L
NC
General: Alert, oriented to name
HEENT: Sclera anicteric, MMM, oropharynx clear, + temporal
wasting
Neck: supple, JVP not elevated, no LAD
Lungs: + left basilar crackles, no wheeze
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Alert, oriented to name, confused, has difficulty
cooperating with exam, fails to extinguish
CN: left ptosis (mild), otherwise CN intact and symmetric
Motor: [**5-25**] strenght in upper and lower extremities bilaterally,
right pronator drift
[**Last Name (un) **]: intact
Coordination: Bilateral FNF dysmetria; gait assessment deferred

FAMILY HISTORY: His mother died at old age. He listed his father's medical
problem as "can't read". He has one brother. There is no family
history of neurologic disease.

SOCIAL HISTORY: He was employed in investment banking. He is single and lives
alone. He smoked for 30 years in the past. He never drank. He
never used any drugs.
Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Closed fracture of three ribs,Acidosis,Human immunodeficiency virus [HIV] disease,Closed fracture of malar and maxillary bones,Fall from other slipping, tripping, or stumbling,Syncope and collapse,Personal history of tobacco use,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cirrhosis of liver without mention of alcohol,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abnormality of gait,Other chronic pain,Pain in joint, pelvic region and thigh,Unspecified hereditary and idiopathic peripheral neuropathy
Cl skl vlt fx/mening hem,Acute kidney failure NOS,Lung contusion-closed,Fracture three ribs-clos,Acidosis,Human immuno virus dis,Fx malar/maxillary-close,Fall from slipping NEC,Syncope and collapse,History of tobacco use,BPH w/o urinary obs/LUTS,Cirrhosis of liver NOS,DMII wo cmp nt st uncntr,Abnormality of gait,Chronic pain NEC,Joint pain-pelvis,Idio periph neurpthy NOS
Admission Date:  [**2156-9-25**]              Discharge Date:   [**2156-10-1**]

Date of Birth:  [**2093-2-14**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 13024**]
Chief Complaint:
Fall

Major Surgical or Invasive Procedure:
none

History of Present Illness:
63 year old man with HIV, cryptogenic cirrhosis, hx of frequent
syncope with an extensive workup and multiple falls presents
after witnessed fall on street. Pt denies prodrome and does not
recall fall. The pt hit his head w/ occipital abrasion.
.
In the ED, initial vs were: T P 70 BP 103/78 R 23 O2 sat 97%2L.
Patient was given tentanus booster, keppra, zofran. EKG (sinus,
but with junctional beats) was concerning for dysrrhythmia,
cardiology was consulted. FAST scan was negative, but CT imaging
of the head showed right SDH, EDH and bilateral parenchymal
hemorrhages. The pt was seen by neurosurgery, and it was
determined that the pt did not require surgical intervention. Pt
was also found to have old rib fractures on CT, and trauma
surgery saw the pt. The pt was transfered to the MICU for
frequent neuro checks and further evaluation of his syncope.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.


Past Medical History:
HIV, [**2156-6-28**]: CD4 count: 131 VL: < 48.
Cryptogenic cirrhosis w/ h/o variceal bleed w/ esophageal
banding, last GI bleed in [**2154**], followed at [**Hospital1 3278**]
Macrocytic anemia
BPH
R hip pain s/p R hip surgery
Gait disorder due to:
s/p right hip fracture, fixated with plate and screws
s/p right shoulder separation fixated with wire


Social History:
He was employed in investment banking. He is single and lives
alone. He smoked for 30 years in the past. He never drank. He
never used any drugs.


Family History:
His mother died at old age. He listed his father's medical
problem as "can't read". He has one brother. There is no family
history of neurologic disease.


Physical Exam:
Admission Vitals: T: 97.6 BP: 111/72 P: 68 R: 22 O2: 95% on 2L
NC
General: Alert, oriented to name
HEENT: Sclera anicteric, MMM, oropharynx clear, + temporal
wasting
Neck: supple, JVP not elevated, no LAD
Lungs: + left basilar crackles, no wheeze
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Alert, oriented to name, confused, has difficulty
cooperating with exam, fails to extinguish
CN: left ptosis (mild), otherwise CN intact and symmetric
Motor: [**5-25**] strenght in upper and lower extremities bilaterally,
right pronator drift
[**Last Name (un) **]: intact
Coordination: Bilateral FNF dysmetria; gait assessment deferred


Discharge vitals: T: 98.7 HR 71 BP 111/69 RR18 O2Sat: 94%RA
General: alert and oriented, slowed speech, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, bruises R max/R
posterior ear, bitemporal wasting
Neck: supple, JVP not elevated, no LAD
Lungs: decreased BS R lung base, no wheezes, rales, ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, bowel sounds present, mildly
distended, no TTP, no rebound tenderness or guarding, no
organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: No rash, bruises as above
Neuro: CN2-12intact, no nystagmus, asterixis. strength 5/5
UE/LE, 2+ DTRs, [**Name (NI) 14451**] toes bilaterally, sensation intact,
gait deferred. slow FTN but intact without dysmetria.

Pertinent Results:
[**2156-9-25**] 03:30PM BLOOD WBC-7.4# RBC-3.78* Hgb-12.7* Hct-38.4*
MCV-102* MCH-33.6* MCHC-33.1 RDW-14.8 Plt Ct-169
[**2156-9-25**] 03:30PM BLOOD Neuts-68.4 Lymphs-22.3 Monos-7.2 Eos-1.8
Baso-0.3
[**2156-9-25**] 05:45PM BLOOD PT-13.8* PTT-30.6 INR(PT)-1.2*
[**2156-9-27**] 06:41PM BLOOD  WBC-6.8 Lymph-16* Abs [**Last Name (un) **]-1088 CD3%-74
Abs CD3-801 CD4%-17 Abs CD4-184* CD8%-54 Abs CD8-584
CD4/CD8-0.3*
[**2156-9-25**] 03:30PM BLOOD Glucose-126* UreaN-21* Creat-1.5* Na-138
K-5.0 Cl-103 HCO3-26 AnGap-14
[**2156-9-27**] 03:23AM BLOOD ALT-38 AST-53* LD(LDH)-265* CK(CPK)-324*
AlkPhos-120* TotBili-2.1* DirBili-0.8* IndBili-1.3
[**2156-9-27**] 03:23AM BLOOD Lipase-12
[**2156-9-25**] 03:30PM BLOOD CK-MB-8
[**2156-9-25**] 03:30PM BLOOD cTropnT-<0.01
[**2156-9-25**] 11:41PM BLOOD CK-MB-5 cTropnT-<0.01
[**2156-9-25**] 03:30PM BLOOD Calcium-10.0 Phos-3.5 Mg-2.2
[**2156-9-26**] 04:58AM BLOOD Calcium-8.5 Phos-2.5* Mg-1.8
[**2156-9-28**] 04:13AM BLOOD Osmolal-272*
[**2156-9-25**] 03:40PM BLOOD Lactate-3.7*
[**2156-9-25**] 06:13PM BLOOD Lactate-2.9*
[**2156-9-26**] 12:04AM BLOOD Lactate-2.0

CT head
FINDINGS: Two adjacent extra-axial hyperdense collections with
convex
margins, suggestive of epidural blood, measure 14 mm at greatest
depth
overlying the right parietal and frontal lobes. This is
associated with mild sulcal effacement, without significant
shift of normal midline structures. Also noted is bilateral
subarachnoid hemorrhage with a small intraventricular component,
and blood in the sulci overlying the temporal and frontal lobes
bilaterally. At the floor of the anterior cranial fossa are
numerous hyperdense foci within the frontal lobes bilaterally,
though more prominently on the left, indicative of parenchymal
blood. Small subdural hematoma is also noted over the left
frontal [**Month/Day/Year 3630**].

Ventricles are normal in size and in configuration. Extracranial
soft tissue structures are notable for a large hematoma
overlying the right parietal bone. The included osseous
structures reveal a fracture on the right, extending from the
superior aspect of the right temporal bone into the right
occipital bone. The included mastoid air cells and paranasal
sinuses are unremarkable. Small amounts of likely cerumen are
noted in the external auditory canals bilaterally.

IMPRESSION:
1. Extra-axial hematoma on the right with subjacent fracture.
Configuration suggests epidural location, concerning for
arterial or underlying dural venous injury.
2. Subarachnoid, subdural and parenchymal hemorrhage as detailed
above.

CTA chest
MPRESSION:
1. No pulmonary embolus, dissection or aortic aneurysm.
2. Bibasilar atelectasis.
3. Left ninth rib fracture, new since [**2156-3-21**], and chronic
right fourth
rib fracture.

CT chest [**2156-9-27**]
IMPRESSIONS:
1. Right-sided rib fractures, as detailed, with associated small
extrapleural hematoma.

2. Small-to-moderate size right pleural effusion, and tiny left
pleural
effusion.

3. Opacification of bilateral lower lobes, may reflect
consolidation or
aspiration with atelectasis.

4. Patchy ground-glass opacities in the left upper [**Last Name (LF) 3630**], [**First Name3 (LF) **]
reflect
infectious/inflammatory change, or could reflect superimposed
pulmonary edema.

ECHO
The left atrium is normal in size. The right atrium is
moderately dilated. The estimated right atrial pressure is
10-20mmHg. There is mild symmetric left ventricular hypertrophy.
The left ventricular cavity size is normal. Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is normal (LVEF>55%). There is no left
ventricular outflow obstruction at rest or with Valsalva. Right
ventricular chamber size and free wall motion are normal. The
aortic root is moderately dilated at the sinus level. The
ascending aorta is mildly dilated. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. The mitral valve leaflets are structurally
normal. Mild (1+) mitral regurgitation is seen. There is
borderline pulmonary artery systolic hypertension. There is no
pericardial effusion.

Compared with the prior study (images reviewed) of [**2156-4-17**],
there is no significant change.

Carotid ultrasound
IMPRESSION: Less than 40% stenosis of the bilateral extracranial
internal
carotid arteries.


Brief Hospital Course:
63 year old man with HIV, cryptogenic cirrhosis, hx of frequent
syncope with an extensive workup and multiple falls presents
after fall on street after syncope, found to have SDH, EDH on CT
head.

# Intracranial hemorrhage: Given multiple sites on hemorrhage
visualized on CT pt required frequent neuro checks and so was
admitted to the MICU. Etiology of hemorrhages was most likely
fall in setting of syncope. Head CTs were followed without any
changes in his bleeding. Pt had no focal neurological findings.
Neurosurgery recommended pt to be on keppra and to f/u with a
repeat head CT in 8 weeks and out pt follow up with Dr. [**Last Name (STitle) **].
Heparin sub Q was started once bleed was stable for DVT
prophylaxis. The patient's daily Aspirin was stopped due to
bleeding risk and can be re-started as an out-patient.

# Syncope: Differential includes symptomatic bradycardia,
orthostasis, mechanical fall. Difficult to separate these as pt
currently does not remember fall and states that he was at home.
Prior workups for syncope revealed abnormal tilt table testing
(notable for orthostasis) as well as concern by neurology that
pt has peripheral neuropathy as well as mechanical risk for
syncope due to pain from right hip. Given pt's pulmonary
hypertension on old ECHO, there was some concern for syncope
secondary to pulmonary hypertension, however, repeat echo did
not show any increased in his borderline pulm htn. Pt was
monitored on tele which was only notable for bradycardia briefly
to 48, but mostly in the 60s. His home nadolol was held. His
Ativan was held for concern that this could worsen his balance
and contribute to syncope; it was restarted at Ativan 0.5 QHS
prn insomnia per discussion with regular provider. [**Name10 (NameIs) **] may need
an out pt [**Name (NI) **] monitor; this can be arranged by his regular
provider who is aware.

# Dyspnea/Rib Fractures: after admission, pt had acute SOB,
required 4 liters of oxygen. CXR showed pulmonary edema. Was
treated with Lasix and improved. Had severe right lower chest
pain. RUQ ultrasound without acute liver or gallbladder process.
Chest CT showed rib fractures on right chest with associated
hematoma and likely lung contusion. Pt was treated with pain
medication and incentive spirometry. Pt also has fractures on
left that are not associated with lung injury. Before transfer
from the MICU pt no longer needed supplementary oxygen and had
no more episodes of desaturation during his hospitalization.

# Hyponatremia: Na dropped form 133 to 130, was in setting of
Lasix and likely due to diuresis. However, was monitored due to
head injury and concern for SIADH. His sodium remained stable
throughout the rest of his admission.

# Lactic acidosis: Was on two culprit meds (tenofovir and
metformin). His lactate improved with stopping metformin and
giving IVF. No evidence of infection was found.

# Right zygoma hairline fracture: from fall. Per plastics will
not need surgical repair.

# ARF: Cr at 1.5 up from baseline 0.9 on admission, was prerenal
and improved with IVF.

# HIV: He was continued on his HAART medications and Bactrim for
PCP [**Last Name (NamePattern4) **]. CD4 was 184. HIV viral load undectable.

# Psych meds: Was continued on Seroquel. Ativan held, restarted
as above.

# CV risk: Aspirin was held due to bleeding risk and can be
restarted after follow up. Lipitor was continued. Nadolol was
stopped.

# Chronic R hip pain: Well-controlled on oxycodone and TCA.


Medications on Admission:
Truvada/Emtricitabine-Tenofovir 1 tab daily
Norvir/Ritonavir daily
Prezista/Darunavir 2 tabs daily
Metformin 500 qam
Nadolol 40 daily
Citalopram 20 mg DAILY
Lorazepam 1 mg HS
Nortriptyline 50 mg HS
Omeprazole 20 mg DAILY
Seroquel 25 [**Hospital1 **]
Oxycodone 5 mg [**1-23**] q 4h prn
Trimethoprim-Sulfamethoxazole 160-800 mg DAILY
Lipitor 40 daily
Aspirin 81 mg daily


Discharge Medications:
1. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
2. Ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
3. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
7. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Tablet(s)
8. Darunavir 400 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

9. Nortriptyline 25 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
10. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
11. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
12. Metformin 500 mg Tablet Sig: One (1) Tablet PO Qam.
13. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 583**] House Rehabilitation Center

Discharge Diagnosis:
Primary diagnoses: 1) intracranial hemorrhage
2) syncope
3) pulmonary contusion
4) rib fractures

Secondary diagnoses: 1) HIV
2) cryptogenic cirrhosis
3) right hip pain s/p right hip surgery


Discharge Condition:
Stable. Patient is neurologically intact but has some
discoordination with planning activities requiring multiple
steps. Patient may need [**Location (un) **] monitor as an out-patient; this
will be arranged by his regular provider.

Discharge Instructions:
You were admitted to the hospital after a fall. You had
intracranial (in and around your brain) bleeding. You were
evaluated by neurosurgery who did not think you needed surgical
intervention at this time. While you were in the ICU, you became
very short of breath and had low oxygen in your blood one night.
 You appear to have a contusion (bruise) on your rib underneath
your rib fractures.

We changed several of your medications:
1) We stopped your blood pressure medication Nadolol as this
medication my increase your risk of falling.
2) We lowered your ativan dose to 0.5 mg at night due to concern
for risk of falling.
4) You may take oxycodone 10-15mg by mouth as needed for pain.
5) We stopped your daily Aspirin as that may increase your risk
of bleeding. This may be re-started as an out-patient.
6) We started Keppra to prevent seizures.

Followup Instructions:
You have appointments scheduled for:

Appointment #2: Specialty: Radiology
Date and time: Tuesday, [**11-23**], 1pm
Location: [**Hospital1 32464**], [**Hospital Ward Name 517**] Clinical Center, [**Location (un) 470**]
Phone number: [**Telephone/Fax (1) 327**]
Special instructions if applicable: This is for a CT scan.  Your
appt with Dr. [**Last Name (STitle) **] will follow the scan.

Appointment #2
MD: [**First Name8 (NamePattern2) **] [**Doctor Last Name **]
Specialty: Neurosurgery
Date and time: Tuesday, [**11-23**], 1:45pm
Location: [**Last Name (NamePattern1) **], [**Hospital Unit Name **], [**Location (un) 470**]
Phone number: [**Telephone/Fax (1) 1669**]
Special instructions if applicable:

After discharge from rehab, you need to call your regular doctor
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1538**] at [**Telephone/Fax (1) 2776**] for a follow up appointment.
Patient may need [**Telephone/Fax (1) **] monitor as an out-patient; this will be
arranged by Dr. [**Last Name (STitle) 1538**].
{'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Closed fracture of three ribs,Acidosis,Human immunodeficiency virus [HIV] disease,Closed fracture of malar and maxillary bones,Fall from other slipping, tripping, or stumbling,Syncope and collapse,Personal history of tobacco use,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cirrhosis of liver without mention of alcohol,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abnormality of gait,Other chronic pain,Pain in joint, pelvic region and thigh,Unspecified hereditary and idiopathic peripheral neuropathy'}


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: 63 year old man with HIV, cryptogenic cirrhosis, hx of frequent
syncope with an extensive workup and multiple falls presents
after witnessed fall on street. Pt denies prodrome and does not
recall fall. The pt hit his head w/ occipital abrasion.
.
In the ED, initial vs were: T P 70 BP 103/78 R 23 O2 sat 97%2L.
Patient was given tentanus booster, keppra, zofran. EKG (sinus,
but with junctional beats) was concerning for dysrrhythmia,
cardiology was consulted. FAST scan was negative, but CT imaging
of the head showed right SDH, EDH and bilateral parenchymal
hemorrhages. The pt was seen by neurosurgery, and it was
determined that the pt did not require surgical intervention. Pt
was also found to have old rib fractures on CT, and trauma
surgery saw the pt. The pt was transfered to the MICU for
frequent neuro checks and further evaluation of his syncope.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest pain
or tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: HIV, [**2156-6-28**]: CD4 count: 131 VL: < 48.
Cryptogenic cirrhosis w/ h/o variceal bleed w/ esophageal
banding, last GI bleed in [**2154**], followed at [**Hospital1 3278**]
Macrocytic anemia
BPH
R hip pain s/p R hip surgery
Gait disorder due to:
s/p right hip fracture, fixated with plate and screws
s/p right shoulder separation fixated with wire

MEDICATION ON ADMISSION: Truvada/Emtricitabine-Tenofovir 1 tab daily
Norvir/Ritonavir daily
Prezista/Darunavir 2 tabs daily
Metformin 500 qam
Nadolol 40 daily
Citalopram 20 mg DAILY
Lorazepam 1 mg HS
Nortriptyline 50 mg HS
Omeprazole 20 mg DAILY
Seroquel 25 [**Hospital1 **]
Oxycodone 5 mg [**1-23**] q 4h prn
Trimethoprim-Sulfamethoxazole 160-800 mg DAILY
Lipitor 40 daily
Aspirin 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Vitals: T: 97.6 BP: 111/72 P: 68 R: 22 O2: 95% on 2L
NC
General: Alert, oriented to name
HEENT: Sclera anicteric, MMM, oropharynx clear, + temporal
wasting
Neck: supple, JVP not elevated, no LAD
Lungs: + left basilar crackles, no wheeze
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Alert, oriented to name, confused, has difficulty
cooperating with exam, fails to extinguish
CN: left ptosis (mild), otherwise CN intact and symmetric
Motor: [**5-25**] strenght in upper and lower extremities bilaterally,
right pronator drift
[**Last Name (un) **]: intact
Coordination: Bilateral FNF dysmetria; gait assessment deferred

FAMILY HISTORY: His mother died at old age. He listed his father's medical
problem as "can't read". He has one brother. There is no family
history of neurologic disease.

SOCIAL HISTORY: He was employed in investment banking. He is single and lives
alone. He smoked for 30 years in the past. He never drank. He
never used any drugs. 

### Response:
{'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Closed fracture of three ribs,Acidosis,Human immunodeficiency virus [HIV] disease,Closed fracture of malar and maxillary bones,Fall from other slipping, tripping, or stumbling,Syncope and collapse,Personal history of tobacco use,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cirrhosis of liver without mention of alcohol,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abnormality of gait,Other chronic pain,Pain in joint, pelvic region and thigh,Unspecified hereditary and idiopathic peripheral neuropathy'}
