CHIEF COMPLAINT: difficulty breathing, diplopia

PRESENT ILLNESS: 25yo RH F h/o asthma since childhood and myasthenia [**Last Name (un) 2902**]
diagnosed last spring, who presents with shortness of breath and
diplopia. History and physical are abbreviated due to her
shortness of breath. She felt increased wheezing on Saturday and
was concerned that her asthma was getting worse and took an
increased dose of prednisone (baseline: 20mg every other day;
she
took 60mg). She now is experiencing horizontal diplopia, worse
when looking far away, and feels generally tired and weak and is
finding it hard to breathe.

MEDICAL HISTORY: Asthma since childhood
Myasthenia [**Last Name (un) 2902**]
GERD

MEDICATION ON ADMISSION: cellcept 1000mg [**Hospital1 **]
Mestinon 60mg QID
Optivar 1 drop ou [**Hospital1 **]
Prednisone 20mg QOD (took 60mg yest)
PPI
Singulair 10

ALLERGIES: Penicillins

PHYSICAL EXAM: VS 97.3 79 125/76 32 100% NIF -40
Gen Awake, cooperative, in clear respiratory distress on
nebulizer
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck Supple, no carotid bruits appreciated. No nuchal rigidity
Lungs wheezes bilaterally
CV RRR, nl S1S2, no M/R/G noted
Abd soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted
Ext No C/C/E b/l
Skin no rashes or lesions noted

FAMILY HISTORY: First cousins with asthma.

SOCIAL HISTORY: h/o smoking, drinks 2-3times per month, denies drugs, single
mom,
Acute respiratory failure,Myasthenia gravis with (acute) exacerbation,Asthma, unspecified type, unspecified
Acute respiratry failure,Myasthna gravs w ac exac,Asthma NOS
Admission Date:  [**2146-1-3**]              Discharge Date:   [**2146-1-10**]

Date of Birth:  [**2120-12-21**]             Sex:   F

Service: NEUROLOGY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2090**]
Chief Complaint:
difficulty breathing, diplopia


Major Surgical or Invasive Procedure:
Intubation.

History of Present Illness:
25yo RH F h/o asthma since childhood and myasthenia [**Last Name (un) 2902**]
diagnosed last spring, who presents with shortness of breath and
diplopia. History and physical are abbreviated due to her
shortness of breath. She felt increased wheezing on Saturday and
was concerned that her asthma was getting worse and took an
increased dose of prednisone (baseline: 20mg every other day;
she
took 60mg). She now is experiencing horizontal diplopia, worse
when looking far away, and feels generally tired and weak and is
finding it hard to breathe.


Past Medical History:
Asthma since childhood
Myasthenia [**Last Name (un) 2902**]
GERD

Social History:
h/o smoking, drinks 2-3times per month, denies drugs, single
mom,

Family History:
First cousins with asthma.


Physical Exam:
VS 97.3 79 125/76 32 100% NIF -40
Gen Awake, cooperative, in clear respiratory distress on
nebulizer
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck Supple, no carotid bruits appreciated. No nuchal rigidity
Lungs wheezes bilaterally
CV RRR, nl S1S2, no M/R/G noted
Abd soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted
Ext No C/C/E b/l
Skin no rashes or lesions noted

NEURO
MS Awake, alert. Speech fluent.

CN
CN I: not tested
CN II: VFF to confrontation, no extinction. Pupils 4->2 b/l.
CN III, IV, VI: she has horizontal diplopia, worse on looking
right and worse with continued rightward gaze
CN V: intact to LT throughout
CN VII: full facial symmetry but seems to have b/l facial
weakness with difficulty puffing out her cheeks
CN VIII: hearing intact to FR b/l
CN IX, X: palate rises symmetrically
CN [**Doctor First Name 81**]: shrug [**5-29**] and symmetric
CN XII: tongue midline and agile

Motor
Normal bulk and tone. No pronator drift
  D  T  IP
L 4+ 5  5
R 4+ 5  5
The left deltoid was exercised and then became [**3-29**]

Sensory intact to LT, PP, JPS, vibration throughout. No
extinction.

Reflexes
   Br  [**Hospital1 **]  Tri  Pat  Ach  Toes
L  2+  2+  2+   2+   2+   down
R  2+  2+  2+   2+   2+   down

Coordination FFM, RAMs, FTN, HTS all normal

Gait deferred due to respiratory distress


Pertinent Results:
[**2146-1-7**] 02:56AM BLOOD WBC-8.2 RBC-4.16* Hgb-12.3 Hct-35.8*
MCV-86 MCH-29.5 MCHC-34.3 RDW-13.6 Plt Ct-207
[**2146-1-4**] 01:53AM BLOOD Neuts-76.4* Lymphs-14.1* Monos-7.8
Eos-1.5 Baso-0.2
[**2146-1-7**] 02:56AM BLOOD PT-13.4 PTT-27.9 INR(PT)-1.2*
[**2146-1-5**] 10:17AM BLOOD Fibrino-289
[**2146-1-5**] 10:17AM BLOOD Ret Aut-1.9
[**2146-1-7**] 02:56AM BLOOD Glucose-140* UreaN-18 Creat-0.6 Na-146*
K-3.8 Cl-108 HCO3-29 AnGap-13
[**2146-1-7**] 02:56AM BLOOD Calcium-9.1 Phos-2.6* Mg-2.0

[**2146-1-3**]
CXR
IMPRESSION: Prominence of the bronchovascular markings likely
related to low lung volumes. No definite airspace consolidation.

[**2146-1-3**]
Sinus rhythm. No previous tracing available for comparison.



Brief Hospital Course:
Patient admitted with respiratory failure believed to be related
to asthma and recent diagnosis of myasthenia [**Last Name (un) 2902**].

The patient was intubated in the ED.  She spent 4 days on the
ventilator.  She recieved 2 rounds of every other day
plasmapheresis prior to extubation.  She then got one more round
of plasmapheresis, after which it was felt that she had improved
to the point that such therapy was no longer indicated.   During
this time her cellcept was increased from 1000 to 1500BID, her
prednisone was changed from 20mg QOD to solumedrol 48mg qd
(equivalent of 60mg qod), and mestinon was held.  The patient's
respiratory function further improved with albuterol PRN and
advair, which was started after the patient reached the floor.


The patient had low grade fevers for which cultures and chest
imaging were obtained.  These were negative.

Blood sugar was kept below 140 with a RISS.

The patient was put on tube feeds whiles she was intubated.

The patient had a paradoxical elevation of her PTT to
subcutaneous heparin.  This was then held and then restarted at
[**Hospital1 **] rather than TID dosing.  Her PTT stablized with these
interventions.



Medications on Admission:
cellcept 1000mg [**Hospital1 **]
Mestinon 60mg QID
Optivar 1 drop ou [**Hospital1 **]
Prednisone 20mg QOD (took 60mg yest)
PPI
Singulair 10


Discharge Medications:
1. Zantac 150 mg Capsule Sig: One (1) Capsule PO twice a day.
2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q4H (every 4 hours) as needed for shortness of breath or
wheezing.
3. Mycophenolate Mofetil 500 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
5. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
6. Mestinon 60 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for double vision or droopy eyelid. .


Discharge Disposition:
Home

Discharge Diagnosis:
Respiratory distress.
Asthma
Myasthenia [**Last Name (un) **].


Discharge Condition:
Vital signs stable.  No fatigueable weakness.  respiratory
status at baseline.


Discharge Instructions:
Please take your medications as prescribed.
Please follow up with your appointments as documented below.

Please return to the hospital if you should have worsening of
your respiratory status beyond what is manageable with your home
medications.

Followup Instructions:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2146-1-26**] 9:00


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 43**] MD [**MD Number(1) 2107**]

Completed by:[**2146-1-10**]
{'Acute respiratory failure,Myasthenia gravis with (acute) exacerbation,Asthma, unspecified type, unspecified'}


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: difficulty breathing, diplopia

PRESENT ILLNESS: 25yo RH F h/o asthma since childhood and myasthenia [**Last Name (un) 2902**]
diagnosed last spring, who presents with shortness of breath and
diplopia. History and physical are abbreviated due to her
shortness of breath. She felt increased wheezing on Saturday and
was concerned that her asthma was getting worse and took an
increased dose of prednisone (baseline: 20mg every other day;
she
took 60mg). She now is experiencing horizontal diplopia, worse
when looking far away, and feels generally tired and weak and is
finding it hard to breathe.

MEDICAL HISTORY: Asthma since childhood
Myasthenia [**Last Name (un) 2902**]
GERD

MEDICATION ON ADMISSION: cellcept 1000mg [**Hospital1 **]
Mestinon 60mg QID
Optivar 1 drop ou [**Hospital1 **]
Prednisone 20mg QOD (took 60mg yest)
PPI
Singulair 10

ALLERGIES: Penicillins

PHYSICAL EXAM: VS 97.3 79 125/76 32 100% NIF -40
Gen Awake, cooperative, in clear respiratory distress on
nebulizer
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck Supple, no carotid bruits appreciated. No nuchal rigidity
Lungs wheezes bilaterally
CV RRR, nl S1S2, no M/R/G noted
Abd soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted
Ext No C/C/E b/l
Skin no rashes or lesions noted

FAMILY HISTORY: First cousins with asthma.

SOCIAL HISTORY: h/o smoking, drinks 2-3times per month, denies drugs, single
mom, 

### Response:
{'Acute respiratory failure,Myasthenia gravis with (acute) exacerbation,Asthma, unspecified type, unspecified'}
