CHIEF COMPLAINT: Progressive bilateral claudication.

PRESENT ILLNESS: (obtained from patient, who is
reliable)  The patient is a 68 year old white female with a
history of chronic lung disease, status post left lower
lobectomy for bronchiectasis, oxygen dependent at bedtime,
Prednisone dependent, who was evaluated at [**Hospital 1474**] Hospital
in [**Month (only) **] for severely limiting claudication, hip and
behind the knees at less than one-quarter block.  Symptoms
have since progressed to less than 50 feet and onset of rest
pain, requiring Vicodin at bedtime to sleep.  Claudication is
greater on the left than right.  The patient was referred to
Dr. [**Last Name (STitle) **], who recommends aortobifemoral bypass graft.  The
patient is now admitted for elective surgery.

MEDICAL HISTORY: 1.  Asthma.  2.  Chronic sinusitis,
status post polypectomy.  3.  Arthritis.  4.  Osteoporosis.
5.  Coronary artery disease with a history of angina,
asymptomatic now.  6.  Migraines secondary to sinus problems,
treated with [**Name (NI) 34491**].  7.  Cataracts.  8.  History of
depression, treated with Paxil times four months while in
nursing home, off treatment since discharge from nursing
home, without any recurrence of depression.

MEDICATION ON ADMISSION: Diltiazem 180 mg p.o.q.d.,
Prednisone 5 mg p.o.q.d., Levoxyl 0.75 mg p.o.q.d., Lasix 20
mg p.o.q.d., Serevent two puffs b.i.d., Flovent three puffs
b.i.d., [**Year (4 digits) 34492**] two puffs p.r.n., [**Year (4 digits) 34492**] nebulizers
q.8h., trazodone 100 mg p.o.q.h.s., Drisdol 50,000 units q.
Sunday, vitamin B12 q. month, Vicodin 50/500 mg
p.o.q.i.d.p.r.n., nitroglycerin patch 0.4 mg/hr q.12h.,
[**Year (4 digits) 34491**] p.r.n.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone.  She is limited in
ambulation secondary to claudication and respiratory disease.
Atherosclerosis of native arteries of the extremities with intermittent claudication,Chronic airway obstruction, not elsewhere classified,Iron deficiency anemia secondary to blood loss (chronic),Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hip joint replacement
Ath ext ntv at w claudct,Chr airway obstruct NEC,Chr blood loss anemia,Crnry athrscl natve vssl,Hypertension NOS,Hypothyroidism NOS,Osteoporosis NOS,Joint replaced hip
Admission Date:  [**2127-5-14**]       Discharge Date:  [**2127-5-24**]

Date of Birth:   [**2059-3-27**]       Sex:  F

Service:  Vascular Surgery

CHIEF COMPLAINT:
Progressive bilateral claudication.

HISTORY OF PRESENT ILLNESS:  (obtained from patient, who is
reliable)  The patient is a 68 year old white female with a
history of chronic lung disease, status post left lower
lobectomy for bronchiectasis, oxygen dependent at bedtime,
Prednisone dependent, who was evaluated at [**Hospital 1474**] Hospital
in [**Month (only) **] for severely limiting claudication, hip and
behind the knees at less than one-quarter block.  Symptoms
have since progressed to less than 50 feet and onset of rest
pain, requiring Vicodin at bedtime to sleep.  Claudication is
greater on the left than right.  The patient was referred to
Dr. [**Last Name (STitle) **], who recommends aortobifemoral bypass graft.  The
patient is now admitted for elective surgery.

REVIEW OF SYSTEMS:  Review of systems is negative for
myocardial infarction.  There was a history of angina.
Exercise tolerance test for workup could not be completed
secondary to shortness of breath.  The patient was started on
nitroglycerin paste and, since then, has had no symptoms.
She denies palpitations or orthopnea.  She does admit to end
of the day edema, which is relieved with elevation.  There is
no history of cerebrovascular accident, transient ischemic
attack or seizures.  She has a history of migraine headaches
and takes [**Last Name (STitle) 34491**].  She has dyspnea on exertion, is oxygen
dependent at bedtime, no wheezing, cough or hemoptysis.

ALLERGIES:  The patient has no known drug allergies.

PAST MEDICAL HISTORY:  1.  Asthma.  2.  Chronic sinusitis,
status post polypectomy.  3.  Arthritis.  4.  Osteoporosis.
5.  Coronary artery disease with a history of angina,
asymptomatic now.  6.  Migraines secondary to sinus problems,
treated with [**Name (NI) 34491**].  7.  Cataracts.  8.  History of
depression, treated with Paxil times four months while in
nursing home, off treatment since discharge from nursing
home, without any recurrence of depression.

PAST SURGICAL HISTORY:  1.  Colostomy with reversal secondary
to diverticulitis.  2.  Bilateral total hip replacements.  3.
Left cataract.  4.  Thyroidectomy for hyperthyroidism in the
[**2085**].  5.  Open cholecystectomy for cholecystitis in the
[**2095**].  6.  Left lower lobectomy secondary to bronchiectasis
in [**2105**].  7.  Sinus surgery.

MEDICATIONS ON ADMISSION:  Diltiazem 180 mg p.o.q.d.,
Prednisone 5 mg p.o.q.d., Levoxyl 0.75 mg p.o.q.d., Lasix 20
mg p.o.q.d., Serevent two puffs b.i.d., Flovent three puffs
b.i.d., [**Year (4 digits) 34492**] two puffs p.r.n., [**Year (4 digits) 34492**] nebulizers
q.8h., trazodone 100 mg p.o.q.h.s., Drisdol 50,000 units q.
Sunday, vitamin B12 q. month, Vicodin 50/500 mg
p.o.q.i.d.p.r.n., nitroglycerin patch 0.4 mg/hr q.12h.,
[**Year (4 digits) 34491**] p.r.n.

SOCIAL HISTORY:  The patient lives alone.  She is limited in
ambulation secondary to claudication and respiratory disease.

PHYSICAL EXAMINATION:  On physical examination, the patient
had stable vital signs with a pulse rate of 86, respiratory
rate 14 and blood pressure 120/70.  General:  Alert, pleasant
white female.  Head, eyes, ears, nose and throat:
Normocephalic, unremarkable.  Chest:  Increased AP diameter,
no wheezing or rhonchi.  Cardiovascular:  Regular rate and
rhythm but distant in sound, no murmur, rub or gallop.
Abdomen:  Soft, obese, nontender, nondistended, positive
bowel sounds, without bruits.  Rectal:  Deferred.
Extremities:  Feet pink and warm without ulcerations.
Pulses:  Palpable carotid, brachial, radial bilaterally
without carotid bruits; abdominal aorta not prominent, no
palpable pulses in femoral, popliteal or pedal pulses
bilaterally, there were no bruits.

LABORATORY DATA:  Complete blood count showed a white blood
cell count of 15.5, hematocrit 47, and platelet count
293,000.  Electrolytes showed a BUN of 18, creatinine 0.1 and
potassium 4.4.  Prothrombin time was 12.4, INR 1 and partial
thromboplastin time 22.4.  Urinalysis showed 5 white blood
cells, many bacteria and positive nitrites.
Electrocardiogram showed normal sinus rhythm, left axis
deviation, left anterior fascicular block and old
anterolateral infarction.  Chest x-ray showed chronic
obstructive pulmonary disease, no congestive heart failure or
infiltrates, degenerative changes above humeral heads, either
secondary to steroids or presence of avascular necrosis;
cardiology consult would be requested for perioperative risk
assessment.

HOSPITAL COURSE:  The patient was seen by the cardiology
service, who recommended a dobutamine echocardiogram for risk
stratification.  This was done and showed a left ventricular
ejection fraction of 60% to 65% without ischemia.  The
patient was at intermediate risk for planned surgery.  No
further recommendations were made and we could proceed with
surgery.

The patient underwent, on [**2127-5-16**], an aortobifemoral to
profunda bypass graft.  The patient tolerated the procedure
well and was transferred to the Post Anesthesia Care Unit in
stable condition.  She remained hemodynamically stable, with
a postoperative hematocrit of 41.  Potassium, magnesium and
calcium were normal.  The patient continued to do well and
was transferred to the Vascular Intensive Care Unit for
continued monitoring and care.

On postoperative day one, overnight events were none but the
patient did complain of flank discomfort.  Her hematocrit was
35.9.  Her chest had bilateral wheezes.  Abdomen was soft.
The incision had slight ecchymosis at the edges.  The groins
were dry, the feet were warm and she had a Dopplerable
popliteal, posterior tibialis and anterior tibialis
bilaterally.  Pulmonary toilette and aggressive pulmonary
therapy was begun.  The nasogastric tube was removed and sips
of clear liquids were begun.  She remained in the Vascular
Intensive Care Unit.  The acute pain service followed the
patient during her initial postoperative period.

On postoperative day two, there were no events.  The patient
ran a low grade temperature of 101.7 to 100.4.  Aggressive
pulmonary toilette was continued with incentive spirometry.
Lasix was begun for increased postoperative weight.

On postoperative day three, the patient continued to run a
low grade temperature.  Diuresis was continued.  Her
hematocrit remained at 28.  The epidural was removed and she
was begun on oral analgesic agents.  She required transfusion
of one unit of packed red blood cells for a hematocrit of 28.
Physical therapy worked with the patient.  She continued to
improve with ambulation and endurance.  She sustained a
better cough and had a productive cough.  Her potassium on
postoperative day seven was 3.1 and she was supplemented and
serial potassium levels were followed.

Physical therapy felt that the patient could be discharged to
home in the next several days after the last evaluation,
which was on [**2127-5-23**].  The patient was discharged home
in stable condition.  Wounds were clean, dry and intact.

DISCHARGE MEDICATIONS:
Percocet 5/325 mg one to two tablets p.o.q.4h.p.r.n. pain.
Prednisone 5 mg p.o.q.d.
Lasix q.d., dose to be confirmed with primary care physician.
[**Name10 (NameIs) **] nebulizers q.8h.
Nitroglycerin patch 0.4 mg/hr q.d. 8:00 a.m. to 8:00 p.m.

DISCHARGE DIAGNOSES:
Aortoiliac disease, status post aortobifemoral bypass graft.
Blood loss anemia, transfused, stable.
Hypertension, controlled.
Chronic obstructive pulmonary disease, stable.





                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 19472**]

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

D:  [**2127-5-23**]  12:38
T:  [**2127-5-23**]  09:38
JOB#:  [**Job Number 34493**]
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Chronic airway obstruction, not elsewhere classified,Iron deficiency anemia secondary to blood loss (chronic),Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hip joint replacement'}


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: Progressive bilateral claudication.

PRESENT ILLNESS: (obtained from patient, who is
reliable)  The patient is a 68 year old white female with a
history of chronic lung disease, status post left lower
lobectomy for bronchiectasis, oxygen dependent at bedtime,
Prednisone dependent, who was evaluated at [**Hospital 1474**] Hospital
in [**Month (only) **] for severely limiting claudication, hip and
behind the knees at less than one-quarter block.  Symptoms
have since progressed to less than 50 feet and onset of rest
pain, requiring Vicodin at bedtime to sleep.  Claudication is
greater on the left than right.  The patient was referred to
Dr. [**Last Name (STitle) **], who recommends aortobifemoral bypass graft.  The
patient is now admitted for elective surgery.

MEDICAL HISTORY: 1.  Asthma.  2.  Chronic sinusitis,
status post polypectomy.  3.  Arthritis.  4.  Osteoporosis.
5.  Coronary artery disease with a history of angina,
asymptomatic now.  6.  Migraines secondary to sinus problems,
treated with [**Name (NI) 34491**].  7.  Cataracts.  8.  History of
depression, treated with Paxil times four months while in
nursing home, off treatment since discharge from nursing
home, without any recurrence of depression.

MEDICATION ON ADMISSION: Diltiazem 180 mg p.o.q.d.,
Prednisone 5 mg p.o.q.d., Levoxyl 0.75 mg p.o.q.d., Lasix 20
mg p.o.q.d., Serevent two puffs b.i.d., Flovent three puffs
b.i.d., [**Year (4 digits) 34492**] two puffs p.r.n., [**Year (4 digits) 34492**] nebulizers
q.8h., trazodone 100 mg p.o.q.h.s., Drisdol 50,000 units q.
Sunday, vitamin B12 q. month, Vicodin 50/500 mg
p.o.q.i.d.p.r.n., nitroglycerin patch 0.4 mg/hr q.12h.,
[**Year (4 digits) 34491**] p.r.n.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone.  She is limited in
ambulation secondary to claudication and respiratory disease. 

### Response:
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Chronic airway obstruction, not elsewhere classified,Iron deficiency anemia secondary to blood loss (chronic),Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Hip joint replacement'}
