CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 58 year-old
male with multiple medical problems including chronic
obstructive pulmonary disease on home O2, hypertension,
[**Doctor Last Name 21568**] syndrome resulting in blindness and deafness,
diastolic congestive heart failure, cirrhosis of unknown
etiology complicated by hepatic encephalopathy, recurrent
pneumonias and chronic renal insufficiency who was admitted
from rehab facility after nursing noted the patient had
shortness of breath and wheezing.  The patient's O2 sat was
noted to be 85% on room air.  He was given 40 mg of Lasix for
presumed congestive heart failure and sent to the [**Hospital1 346**] Emergency Department for further
treatment.  History is difficult to obtain given that the
patient has blindness and deafness and interpretation is
through a tactile sign language interpreter.  In the
Emergency Department the patient was very agitated and
appeared in some distress.  His O2 sats were 90% on room air
and increased to 92% on 4 liters nasal cannula.  The patient
was noted to be febrile at 101.2 with no clear etiology of
infection.  In the Emergency Department the patient had a
right upper quadrant ultrasound, which was negative and given
1 liter of normal saline.  Through interpretation the patient
was not complaining of anything specific, no pain, no cough.
The patient was recently discharged from [**Hospital1 346**] on [**12-2**] with a negative workup for
presyncope.

MEDICAL HISTORY: 1.  Peripheral neuropathy.
2.  Chronic obstructive pulmonary disease on 2 liters nasal
cannula at home.
3.  Hypertension.
4.  [**Doctor Last Name 21568**] syndrome.
5.  Congenital progressive blindness and deafness.
6.  Question diastolic congestive heart failure with ejection
fraction of 55%, dilated right ventricle.
7.  Hepatic encephalopathy.
8.  Cirrhosis of unknown etiology with negative hepatitis
serologies.
9.  Recurrent pneumonia.
10.  Past gastrointestinal bleed.
11.  History of iron deficiency anemia.
12.  Chronic renal insufficiency with a baseline creatinine
of 1.4.
13.  Internal hemorrhoids, severe.
14.  Pulmonary hypertension.
15.  Diverticulosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives in skilled nursing facility and in
care of the state since [**2127-2-15**].  His proxy is his
attorney [**Name (NI) **] [**Name (NI) 50245**].  Independent with activities of daily
living except for cooking.  Walks independently.
Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Cirrhosis of liver without mention of alcohol,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Unspecified essential hypertension
Food/vomit pneumonitis,Chr airway obstruct NEC,Diastolc hrt failure NOS,Cirrhosis of liver NOS,Acute kidney failure NOS,Urin tract infection NOS,Pneumonia, organism NOS,Hypertension NOS
Admission Date:  [**2127-12-25**]       Discharge Date:  [**2127-12-31**]

Date of Birth:   [**2069-10-18**]       Sex:  M

Service:  [**Hospital1 212**]

HISTORY OF PRESENT ILLNESS:  The patient is a 58 year-old
male with multiple medical problems including chronic
obstructive pulmonary disease on home O2, hypertension,
[**Doctor Last Name 21568**] syndrome resulting in blindness and deafness,
diastolic congestive heart failure, cirrhosis of unknown
etiology complicated by hepatic encephalopathy, recurrent
pneumonias and chronic renal insufficiency who was admitted
from rehab facility after nursing noted the patient had
shortness of breath and wheezing.  The patient's O2 sat was
noted to be 85% on room air.  He was given 40 mg of Lasix for
presumed congestive heart failure and sent to the [**Hospital1 346**] Emergency Department for further
treatment.  History is difficult to obtain given that the
patient has blindness and deafness and interpretation is
through a tactile sign language interpreter.  In the
Emergency Department the patient was very agitated and
appeared in some distress.  His O2 sats were 90% on room air
and increased to 92% on 4 liters nasal cannula.  The patient
was noted to be febrile at 101.2 with no clear etiology of
infection.  In the Emergency Department the patient had a
right upper quadrant ultrasound, which was negative and given
1 liter of normal saline.  Through interpretation the patient
was not complaining of anything specific, no pain, no cough.
The patient was recently discharged from [**Hospital1 346**] on [**12-2**] with a negative workup for
presyncope.

PAST MEDICAL HISTORY:
1.  Peripheral neuropathy.
2.  Chronic obstructive pulmonary disease on 2 liters nasal
cannula at home.
3.  Hypertension.
4.  [**Doctor Last Name 21568**] syndrome.
5.  Congenital progressive blindness and deafness.
6.  Question diastolic congestive heart failure with ejection
fraction of 55%, dilated right ventricle.
7.  Hepatic encephalopathy.
8.  Cirrhosis of unknown etiology with negative hepatitis
serologies.
9.  Recurrent pneumonia.
10.  Past gastrointestinal bleed.
11.  History of iron deficiency anemia.
12.  Chronic renal insufficiency with a baseline creatinine
of 1.4.
13.  Internal hemorrhoids, severe.
14.  Pulmonary hypertension.
15.  Diverticulosis.

MEDICATIONS:
1.  Lasix 40 b.i.d.
2.  Valsartan 80 q day.
3.  Nifedipine 30 q day.
4.  Lactulose 30 q day.
5.  Buspirone 15 b.i.d.
6.  Trazodone 75 mg prn.
7.  Flovent two puffs b.i.d.
8.  Neurontin 500 t.i.d.
9.  Metoprolol 25 b.i.d.
10.  Albuterol as needed.
11.  Colace 100 b.i.d.
12.  Protonix 40 q day.
13.  Multivitamin.
14.  Dulcolax 10 q day.
15.  Atrovent q 6 hours prn.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Lives in skilled nursing facility and in
care of the state since [**2127-2-15**].  His proxy is his
attorney [**Name (NI) **] [**Name (NI) 50245**].  Independent with activities of daily
living except for cooking.  Walks independently.

PERTINENT LABORATORIES AND STUDIES ON ADMISSION:  White blood
cell count was 10.5, hematocrit 40.1, platelets 92 with a
baseline 68 to 147.  Differential showed 83 neutrophils, 0
bands, 9 lymphocytes, 6 monocytes.  His smear showed
occasional schistocytes.  Sodium 140, potassium 3.7, chloride
108, bicarb 16, BUN 33, creatinine 1.7 with a baseline of 1.2
to 1.5, glucose 138.  CK 486, troponin less then 0.01.
Lactate 2.7, ALT 43, AST 78, alkaline phosphatase 85, total
bilirubin 4.9 up from 1.5.  LDH 1250 up from 520, albumin
3.9.  Right lower quadrant ultrasound showed cholelithiasis
but no cholecystitis, no choledocholithiasis, no ductal
dilatation.  Chest x-ray showed right lower lobe
consolidation with associated right effusion.  Blood cultures
were pending at that time.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature 101.2.  Blood
pressure 161/54.  Heart rate 112, breathing at 26.  89 to 93%
on 4 liters nasal cannula.  In general, mildly obese,
restless, moaning with some labored breathing, appearing
uncomfortable.  HEENT pupils dilated and equal bilaterally,
sluggish to react.  Slightly icteric sclera.  Oropharynx is
clear.  Mucous membranes are slightly dry.  Neck was supple.
No lymphadenopathy.  No thyromegaly.  Lungs decreased breath
sounds at the right base with crackles a third of the way up.
Cardiovascular examination was tachy, positive S1 and S2.  No
murmurs, rubs or gallops.  Abdomen obese, soft.  No focal
tenderness.  Nondistended.  Normoactive bowel sounds.
Extremities bilateral lower extremity venostasis changes with
superficial abrasions with scabbing.  Trace to 1+ edema.  No
erythema or warmth.  Neurological examination he is moving
all four extremities.  Babinski's down going bilaterally with
symmetric patellar reflexes.

HOSPITAL COURSE:  The patient is a 58 year-old male with
congenital blindness and deafness now with fevers, shortness
of breath, questionable change in mental status, rise in
liver function tests.  The patient was initially sent to the
medical [**Hospital1 **], but had some increased shortness of breath and
respiratory distress and noted arterial blood gas of 7.52,
19, 56 and was sent to the Intensive Care Unit for closer
monitoring.

1.  Hypoxia:  The patient was thought to possibly have a new
pneumonia by chest x-ray with a question of increased
infiltrate in the right lower lobe.  For this reason he was
started on Levo and Flagyl for a questionable aspiration
pneumonia as well as started on Vancomycin for a questionable
MRSA pneumonia.  There is some evidence of fluid overload on
chest x-ray, but was thought not to be the cause of the acute
hypoxia given very limited amount of pulmonary edema noted.
An echocardiogram was checked with a bubble study to evaluate
for a patent foramen ovale resulting in a right to left shunt
as well as causing a pulmonary hypertension.  The
echocardiogram revealed no PFO, good ejection fraction of 55%
with no mention of pulmonary pressures.  The patient's
hypoxia improved throughout the hospital stay and required
minimal oxygen supplementation throughout.  The patient will
have outpatient pulmonary follow up including formal
pulmonary function test evaluation in approximately one
month.  The patient's pulmonary hypertension will be
evaluated at that time as well.  A Legionella antigen was
checked in the urine, which was negative.  The patient was
continued on his Levofloxacin for a total of a fourteen day
course.  The Vancomycin and Flagyl were discontinued after
approximately 30 days of treatment.

2.  Urinary tract infection:  The patient noted to have a
pops urine culture on [**2127-12-26**] for Enterococcus that was
sensitive to Vancomycin and Ampicillin, but resistant to
Levofloxacin. The patient was initially started until the
sensitivities were reported.  The patient was switched to
oral Ampicillin and will be treated for a total seven day
course.

3.  Liver dysfunction:  The patient was noted to have
cirrhosis on a prior CAT scan of the abdomen and has
chronically elevated bilirubin and mild elevation in his
transaminases.  There is a question of the cause of his
cirrhosis is unclear at this time with negative hepatitis B
and C serologies.  Further outpatient workup is warranted
including celiac sprue laboratories given the patient's iron
deficiency anemia as well as possible autoimmune workup.

4.  Hemolysis:  The patient's haptoglobin was less then 20
and his indirect bili was elevated as well as an elevated LDH
indicating some occasional schistocytes on blood smear
indicating likely hemolysis.  The cause of hemolysis is
unclear at this time thought to be related to splenic
excretion secondary to his portal hypertension versus low
grade chronic DIC.  The patient does have elevated coags with
an INR of approximately 1.5, which has been elevated for
greater then two months.

5.  Iron deficiency anemia:  The patient was noted to have a
low ferritin on the last admission, however, his hematocrit
was stable throughout this hospital stay.  He had an
outpatient colonoscopy and esophagogastroduodenoscopy, which
were negative for any acute process, but showed
diverticulosis and hemorrhoids, which is the likely cause of
the patient's past gastrointestinal bleed.  The patient was
given intravenous ferrous gluconate two days prior to
discharge to increase iron and was discharged on oral iron
therapy.

6.  Cardiovascular:  The patient was ruled out with enzymes
for myocardial infarction with three negative sets of
troponins and no clear electrocardiogram changes.  Given the
patient's questionable congestive heart failure diagnosis he
will be seen as an outpatient by Dr. [**Last Name (STitle) 284**] of cardiology
and will also haver an outpatient stress test done in
approximately one month to evaluate for any signs of
ischemia. There is a question whether the left heart failure
was the question of the patient's right heart failure from
ischemia.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  A long term care facility.

DISCHARGE DIAGNOSES:
1.  Pneumonia.
2.  Cirrhosis.
3.  Pulmonary hypertension.
4.  Chronic obstructive pulmonary disease.
5.  [**Doctor Last Name 21568**] syndrome.
6.  Iron deficiency anemia.
7.  Urinary tract infection.
8.  Hypertension.

DISCHARGE MEDICATIONS:
1.  Lactulose 30 cc po q day.
2.  Fluticasone 110 micrograms two puffs b.i.d.
3.  Gabapentin 500 t.i.d.
4.  Colace 100 b.i.d.
5.  Protonix 40 q day.
6.  Bisacodyl 10 q day.
7.  Levofloxacin 500 q day for nine days.
8.  Buspirone 15 b.i.d.
9.  Ampicillin 500 q 6 hours for four days.
10.  Combivent two puffs every six hours.
11.  Ferrous sulfate 325 q day.
12.  Lasix 40 q day.

FOLLOW UP PLANS:  The patient is to have an outpatient MIBI
stress test on [**2128-2-4**].  He has an appointment with Dr.
[**Last Name (STitle) 284**] of cardiology on [**2128-2-16**] at 2:30 p.m.  He has an
appointment for pulmonary function tests on [**2128-1-23**]
at 8:00 a.m. in the [**Hospital Ward Name 23**] Building.  He has an appointment
with Dr. [**Last Name (STitle) 43207**] [**2128-1-23**] at 9:30 a.m.






                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 2506**]

Dictated By:[**Last Name (NamePattern1) 3480**]
MEDQUIST36

D:  [**2127-12-31**]  08:32
T:  [**2127-12-31**]  08:34
JOB#:  [**Job Number 50248**]
{'Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Cirrhosis of liver without mention of alcohol,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Unspecified essential hypertension'}


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: The patient is a 58 year-old
male with multiple medical problems including chronic
obstructive pulmonary disease on home O2, hypertension,
[**Doctor Last Name 21568**] syndrome resulting in blindness and deafness,
diastolic congestive heart failure, cirrhosis of unknown
etiology complicated by hepatic encephalopathy, recurrent
pneumonias and chronic renal insufficiency who was admitted
from rehab facility after nursing noted the patient had
shortness of breath and wheezing.  The patient's O2 sat was
noted to be 85% on room air.  He was given 40 mg of Lasix for
presumed congestive heart failure and sent to the [**Hospital1 346**] Emergency Department for further
treatment.  History is difficult to obtain given that the
patient has blindness and deafness and interpretation is
through a tactile sign language interpreter.  In the
Emergency Department the patient was very agitated and
appeared in some distress.  His O2 sats were 90% on room air
and increased to 92% on 4 liters nasal cannula.  The patient
was noted to be febrile at 101.2 with no clear etiology of
infection.  In the Emergency Department the patient had a
right upper quadrant ultrasound, which was negative and given
1 liter of normal saline.  Through interpretation the patient
was not complaining of anything specific, no pain, no cough.
The patient was recently discharged from [**Hospital1 346**] on [**12-2**] with a negative workup for
presyncope.

MEDICAL HISTORY: 1.  Peripheral neuropathy.
2.  Chronic obstructive pulmonary disease on 2 liters nasal
cannula at home.
3.  Hypertension.
4.  [**Doctor Last Name 21568**] syndrome.
5.  Congenital progressive blindness and deafness.
6.  Question diastolic congestive heart failure with ejection
fraction of 55%, dilated right ventricle.
7.  Hepatic encephalopathy.
8.  Cirrhosis of unknown etiology with negative hepatitis
serologies.
9.  Recurrent pneumonia.
10.  Past gastrointestinal bleed.
11.  History of iron deficiency anemia.
12.  Chronic renal insufficiency with a baseline creatinine
of 1.4.
13.  Internal hemorrhoids, severe.
14.  Pulmonary hypertension.
15.  Diverticulosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Lives in skilled nursing facility and in
care of the state since [**2127-2-15**].  His proxy is his
attorney [**Name (NI) **] [**Name (NI) 50245**].  Independent with activities of daily
living except for cooking.  Walks independently. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Cirrhosis of liver without mention of alcohol,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Unspecified essential hypertension'}
