CHIEF COMPLAINT: Fever

PRESENT ILLNESS: 83 year old male with multiple medical problems including [**Name2 (NI) **]
glioblastoma, coronary artery disease, aortic stenosis, and
hypertension was admitted from the ED with 4 days of cough and
fever.

MEDICAL HISTORY: 1. Glioblastoma multiforme
2. Prostate Cancer
3. HTN
4. Hyperlipidemia
5. Total hip replacement
6. Erectile dysfunction
7. H/o hematuria
8. Aortic stenosis
9. Coronary artery disease
10. Irritable bowel syndrome
11. Lower back pain
12. Spinal stenosis
13. Osteoarthritis
14. Bilateral extensor tendon subluxation

MEDICATION ON ADMISSION: 1. Atenolol 75mg PO daily
2. Atorvastatin 80mg PO daily
3. Dexamethasone taper 2mg
4. Nystatin suspension qid
5. Pantoprazole 40mg PO daily
6. Quinapril 20mg PO daily
7. Chondroitin Sulfate
8. Ibuprofen prn
9. Multivitamin daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: The patient had no distal pulses, heart and lung sounds could
not be appreciated.  Pupils fixed and dilated.  Time of death
1:25pm.

FAMILY HISTORY: - Mother: died in her 20s of childbirth.
- Father: died at 86 of renal failure.

SOCIAL HISTORY: Home: Widowed and lives by himself; has VNA services 3x/week.
Occupation: Retired furrier.
EtOH: one shot of Scotch a day
Drugs: denies any recreational drug use
Tobacco: quit 30 years ago. He has about a 40-pack-year history
of smoking. He smoked two packs a day for 20 years
Unspecified septicemia,Septic shock,Pneumocystosis,Acute respiratory failure,Malignant neoplasm of other parts of brain,Candidiasis of mouth,Cerebral edema,Other disorders of neurohypophysis,Mixed acid-base balance disorder,Severe sepsis,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Unspecified essential hypertension,Spinal stenosis, unspecified region,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Irritable bowel syndrome,Impotence of organic origin,Other and unspecified hyperlipidemia,Pressure ulcer, lower back,Anemia, unspecified,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health
Septicemia NOS,Septic shock,Pneumocystosis,Acute respiratry failure,Malig neo brain NEC,Thrush,Cerebral edema,Neurohypophysis dis NEC,Mixed acid-base bal dis,Severe sepsis,Crnry athrscl natve vssl,Aortic valve disorder,Hypertension NOS,Spinal stenosis NOS,Osteoarthros NOS-unspec,Irritable bowel syndrome,Impotence, organic orign,Hyperlipidemia NEC/NOS,Pressure ulcer, low back,Anemia NOS,Hx-prostatic malignancy,Hx of irradiation
Admission Date:  [**2153-6-13**]              Discharge Date:   [**2153-6-21**]

Date of Birth:  [**2069-12-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5893**]
Chief Complaint:
Fever

Major Surgical or Invasive Procedure:
Intubation, Mechanical Ventilation
Arterial Line placement
Central line placement


History of Present Illness:
83 year old male with multiple medical problems including [**Name2 (NI) **]
glioblastoma, coronary artery disease, aortic stenosis, and
hypertension was admitted from the ED with 4 days of cough and
fever.

He initially presented to his PCP [**Name Initial (PRE) **] week ago for cough, nasal
congestion, and sore throat. He was diagnosed with postnasal
drip and given a decongestant with little relief. Pt developed
increasing fatigue and chills over the past four days
accompanied by decreased po intake. This AM, his VNA noted a
fever to 103.1 as well as "low blood pressure," and referred him
to his PCP who sent him to the ED. Of note, pt completed his
last round of chemo/RT on [**2153-5-23**] and has since been on a
chronic steroid taper. He denies any sick contacts or recent
travel. No associated chest pain, shortness of breath, dizziness
or lightheadedness.
.
Upon arrival to the ED, VS: T 98.6, HR 74, BP 94/64. RR 18, and
pulse ox 98% on RA. His exam was notable for rales over RLL. His
labs were notable for lactate of 2.2. CXR demonstrated new
diffuse bilateral parenchymas opacity suggestion of pulmonary
edema and pneumonia. He received ceftriaxone 2gm VI x 1,
azithromycin 500mg IV x 1, and vancomycin 1g IV x 1 as well as
2.8L NS IV fluids and was subsequently transferred to the [**Hospital Unit Name 153**].
.
On the unit, pt reports continued fatigue, congestion, and sore
throat. ROS significant for abdominal discomfort and
constipation. No dysuria. No headache or neck stiffness.


Past Medical History:
1. Glioblastoma multiforme
2. Prostate Cancer
3. HTN
4. Hyperlipidemia
5. Total hip replacement
6. Erectile dysfunction
7. H/o hematuria
8. Aortic stenosis
9. Coronary artery disease
10. Irritable bowel syndrome
11. Lower back pain
12. Spinal stenosis
13. Osteoarthritis
14. Bilateral extensor tendon subluxation

Social History:
Home: Widowed and lives by himself; has VNA services 3x/week.
Occupation: Retired furrier.
EtOH: one shot of Scotch a day
Drugs: denies any recreational drug use
Tobacco: quit 30 years ago. He has about a 40-pack-year history
of smoking. He smoked two packs a day for 20 years


Family History:
- Mother: died in her 20s of childbirth.
- Father: died at 86 of renal failure.


Physical Exam:
The patient had no distal pulses, heart and lung sounds could
not be appreciated.  Pupils fixed and dilated.  Time of death
1:25pm.

Pertinent Results:
[**2153-6-13**] 02:10PM BLOOD WBC-6.3 RBC-3.73* Hgb-11.5*# Hct-33.1*#
MCV-89 MCH-30.8 MCHC-34.8 RDW-16.8* Plt Ct-141*
[**2153-6-13**] 02:10PM BLOOD Neuts-84.5* Lymphs-12.2* Monos-2.4
Eos-0.6 Baso-0.3
[**2153-6-13**] 02:10PM BLOOD PT-12.5 PTT-23.7 INR(PT)-1.1
[**2153-6-13**] 02:10PM BLOOD Glucose-82 UreaN-33* Creat-1.0 Na-144
K-3.8 Cl-108 HCO3-27 AnGap-13
[**2153-6-13**] 02:10PM BLOOD ALT-41* AST-46* LD(LDH)-492* AlkPhos-61
TotBili-0.8
[**2153-6-13**] 02:31PM BLOOD Lactate-2.2*
[**2153-6-13**] 06:22PM BLOOD Lactate-1.5
[**2153-6-13**] 11:58PM BLOOD Lactate-1.7
.
Micro:
[**2153-6-13**] Blood cultures
[**2153-6-13**] Urine culture
[**2153-6-13**] Legionella Ag: negative
[**2153-6-13**] Influenza DFA
.
Imaging:
.
[**2153-6-13**] CT head:
1. No acute intracranial pathology in the interval.
2. Hypodense left inferior collicular lesion which demonstrates
interval
decrease in density.
3. Unchanged right basal ganglia developmental venous anomaly.
.
[**2153-6-13**] CXR:

Brief Hospital Course:
83yo male with multiple medical problems including [**Name2 (NI) 99087**]
multiforme was admitted with fever and CXR findings suggestive
of pneumonia. After a prolonged course of hemodynamic
instability while ventilated, the family was consulted and
decided to focus on patient comfort.  A moprhine drip was
started, his endotracheal tube was removed and he passed moments
later.

1. Pneumocystis pneumonia. Patient presented with increasing
respiratory distress in the setting of a steroid wean for his
brain cancer.  He was initially covered broadly including
atipical and PCP [**Name Initial (PRE) 21150**].  His initial oxygenation on his ABG
was 40 and his was placed on 100% FiO2 which increased him to
about 80.  A CMV viral load came back elevated but ID did not
real it warrented treatment given his immunosupression from
steroids.  He did not improve and required intubation on [**2153-6-15**].
 A BAL revealed PCP. [**Name10 (NameIs) **] patient was started on therapy
including steroids.

2. HTN: Patient arrived hypotensive and septic.  His BP
medications were held and aggressive fluid resuscitation was
initated.  He required blood pressure support at times to keep
his MAP > 65.  After his initial fluids, he was volume
overloaded and required diuresis.

3. Thrush: Likely [**3-12**] immunosuppression on dexamethasone taper.
The patient was continued on Nystatin and prn medication for
comfort

4. GBM: Currently on prolonged dexamethasone taper [**3-12**] radiation
with resultant edema in brainstem.  The patient's dexamethasone
taper was overridden by high dose steroids for PCP [**Name Initial (PRE) **].

Medications on Admission:
1. Atenolol 75mg PO daily
2. Atorvastatin 80mg PO daily
3. Dexamethasone taper 2mg
4. Nystatin suspension qid
5. Pantoprazole 40mg PO daily
6. Quinapril 20mg PO daily
7. Chondroitin Sulfate
8. Ibuprofen prn
9. Multivitamin daily


Discharge Medications:
Expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Glioblastoma Multiforme
Pneumocystis Pneumonia


Discharge Condition:
Expired


Discharge Instructions:


Followup Instructions:
{'Unspecified septicemia,Septic shock,Pneumocystosis,Acute respiratory failure,Malignant neoplasm of other parts of brain,Candidiasis of mouth,Cerebral edema,Other disorders of neurohypophysis,Mixed acid-base balance disorder,Severe sepsis,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Unspecified essential hypertension,Spinal stenosis, unspecified region,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Irritable bowel syndrome,Impotence of organic origin,Other and unspecified hyperlipidemia,Pressure ulcer, lower back,Anemia, unspecified,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health'}


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: Fever

PRESENT ILLNESS: 83 year old male with multiple medical problems including [**Name2 (NI) **]
glioblastoma, coronary artery disease, aortic stenosis, and
hypertension was admitted from the ED with 4 days of cough and
fever.

MEDICAL HISTORY: 1. Glioblastoma multiforme
2. Prostate Cancer
3. HTN
4. Hyperlipidemia
5. Total hip replacement
6. Erectile dysfunction
7. H/o hematuria
8. Aortic stenosis
9. Coronary artery disease
10. Irritable bowel syndrome
11. Lower back pain
12. Spinal stenosis
13. Osteoarthritis
14. Bilateral extensor tendon subluxation

MEDICATION ON ADMISSION: 1. Atenolol 75mg PO daily
2. Atorvastatin 80mg PO daily
3. Dexamethasone taper 2mg
4. Nystatin suspension qid
5. Pantoprazole 40mg PO daily
6. Quinapril 20mg PO daily
7. Chondroitin Sulfate
8. Ibuprofen prn
9. Multivitamin daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: The patient had no distal pulses, heart and lung sounds could
not be appreciated.  Pupils fixed and dilated.  Time of death
1:25pm.

FAMILY HISTORY: - Mother: died in her 20s of childbirth.
- Father: died at 86 of renal failure.

SOCIAL HISTORY: Home: Widowed and lives by himself; has VNA services 3x/week.
Occupation: Retired furrier.
EtOH: one shot of Scotch a day
Drugs: denies any recreational drug use
Tobacco: quit 30 years ago. He has about a 40-pack-year history
of smoking. He smoked two packs a day for 20 years 

### Response:
{'Unspecified septicemia,Septic shock,Pneumocystosis,Acute respiratory failure,Malignant neoplasm of other parts of brain,Candidiasis of mouth,Cerebral edema,Other disorders of neurohypophysis,Mixed acid-base balance disorder,Severe sepsis,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Unspecified essential hypertension,Spinal stenosis, unspecified region,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Irritable bowel syndrome,Impotence of organic origin,Other and unspecified hyperlipidemia,Pressure ulcer, lower back,Anemia, unspecified,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health'}
