CHIEF COMPLAINT: cc:[**CC Contact Info 35172**]
Major Surgical or Invasive Procedure:
Nasopharyngeal scope done by ENT.

PRESENT ILLNESS: hpi: 27 y/o female who p/w 1 wk h/o sob, difficulty lying flat,
pleuritic CP, onset of swelling of tongue, and most recently
cough. cough is the final symptom that brought the patient to
the ED. started last night with green sputum, no blood. Approx
one week ago first noted swelling of feet and hands.
subsequently noted increased swelling of tongue and difficulty
lying flat. Reports that she would develop difficulty getting
air because of "her neck". Has been sleeping sitting up. +nasal
congestion, nasal discharge. Also has noted the subacute onset
of increased SOB. Even while sitting up the patient states that
she cannot "get enough air". No sudden onset SOB. +DOE.
+pleuritic CP which she describes as "lightening sensation"
shooting down L arm. generally lasts approx one minute, worse w/
inspiration. unchanged w/ ambulation. Has also developed cough
over the last day, productive of green sputum. No known sick
contacts. [**Name (NI) **] recent travel. No insect/tick bites. No exposure to
[**Doctor Last Name 6641**]/forest.
.
Pt reports a history of LE edema which is common and states that
her current swelling is of normal amounts in the LE. No prior
h/o hand/tongue swelling. Denies changes in urinary habits (does
not go frequently). No n/v/d. still able to take p.o. No
f/chills/rash/joint pain/arthralgias.
.
In [**Name (NI) **], pt initially stable w/ bp 112/50, dropped to 89/54, by
report to the 70s systolic. Patient asymptomatic throughout (no
cp/sob/LH). By report, responded to IVF. Cardiology consulted,
bedside TTE performed showing minimal pericardial fluid and nl
biv fxn.

MEDICAL HISTORY: hypothyroidism
migraine ha
? encephalitis-[**2128**]
? ADHD
? abdominal hernia
s/p cholecystectomy in [**2128**]

MEDICATION ON ADMISSION: synthroid 125mg
ibuprofen 800mg [**Hospital1 **] over the last week

ALLERGIES: Sulfa (Sulfonamides) / Penicillins

PHYSICAL EXAM: VS: T 98.4, BP 110/80, P 66, R 22, SpO2 91%
Gen: NAD, comfortable, morbidly obese woman, speaking in full
sentances
HEENT: PERRLA, NC/AT, hair coarse, +hirsutism, OP with mild soft
palate edema
Neck: No LAD, FROM, no thyromegally, soft tissues swollen
Resp: ? soft expriatory wheeze, no s
tridor, no rales/rhonchi, good air movement
CV: RRR, S1, S2 present, no M/R/G, difficult to auscultate [**1-31**]
body habitus
Abd: obese with silvery striae, +BS, no masses, no HSM, no
obvious ventral hernia, NT, ND
Ext: 1+ pedal edema
Neuro: alert and oriented x3, CNII-XII intact though decreased
sensation to light touch in right CN V; extremities with intact
sensation-no saddle anesthesia, 2+ symmetrical DTRs, [**5-3**] upper
and lower ext strength, no pronator drift.

FAMILY HISTORY: Mother-50's-HTN, Father-deceased age 51-sudden cardiopulmonary
arrest, hypothyroid, OSA, knee problems

SOCIAL HISTORY: Married, not currently working, has 3 children currently in the
care of DSS, lives with husband in [**Name (NI) 487**], husband recovering
from heart surgery for valve replacement. Sexually active with
her husband only. Denies EtOH and IVDU, admits to cocaine use by
snorting only, reportedly intermittantly only for the past 6
months, denies other illicit drug use, reports + tob for 15
years 1/2-1 PPD.
Acute upper respiratory infections of unspecified site,Cocaine abuse, unspecified,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Morbid obesity
Acute uri NOS,Cocaine abuse-unspec,Urin tract infection NOS,Chr airway obstruct NEC,Hypothyroidism NOS,Obstructive sleep apnea,Morbid obesity
Admission Date:  [**2137-9-3**]              Discharge Date:   [**2137-9-8**]

Date of Birth:  [**2109-10-24**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamides) / Penicillins

Attending:[**First Name3 (LF) 465**]
Chief Complaint:
cc:[**CC Contact Info 35172**]
Major Surgical or Invasive Procedure:
Nasopharyngeal scope done by ENT.


History of Present Illness:
hpi: 27 y/o female who p/w 1 wk h/o sob, difficulty lying flat,
pleuritic CP, onset of swelling of tongue, and most recently
cough. cough is the final symptom that brought the patient to
the ED. started last night with green sputum, no blood. Approx
one week ago first noted swelling of feet and hands.
subsequently noted increased swelling of tongue and difficulty
lying flat. Reports that she would develop difficulty getting
air because of "her neck". Has been sleeping sitting up. +nasal
congestion, nasal discharge. Also has noted the subacute onset
of increased SOB. Even while sitting up the patient states that
she cannot "get enough air". No sudden onset SOB. +DOE.
+pleuritic CP which she describes as "lightening sensation"
shooting down L arm. generally lasts approx one minute, worse w/
inspiration. unchanged w/ ambulation. Has also developed cough
over the last day, productive of green sputum. No known sick
contacts. [**Name (NI) **] recent travel. No insect/tick bites. No exposure to
[**Doctor Last Name 6641**]/forest.
.
Pt reports a history of LE edema which is common and states that
her current swelling is of normal amounts in the LE. No prior
h/o hand/tongue swelling. Denies changes in urinary habits (does
not go frequently). No n/v/d. still able to take p.o. No
f/chills/rash/joint pain/arthralgias.
.
In [**Name (NI) **], pt initially stable w/ bp 112/50, dropped to 89/54, by
report to the 70s systolic. Patient asymptomatic throughout (no
cp/sob/LH). By report, responded to IVF. Cardiology consulted,
bedside TTE performed showing minimal pericardial fluid and nl
biv fxn.


Past Medical History:
hypothyroidism
migraine ha
? encephalitis-[**2128**]
? ADHD
? abdominal hernia
s/p cholecystectomy in [**2128**]

Social History:
Married, not currently working, has 3 children currently in the
care of DSS, lives with husband in [**Name (NI) 487**], husband recovering
from heart surgery for valve replacement. Sexually active with
her husband only. Denies EtOH and IVDU, admits to cocaine use by
snorting only, reportedly intermittantly only for the past 6
months, denies other illicit drug use, reports + tob for 15
years 1/2-1 PPD.

Family History:
Mother-50's-HTN, Father-deceased age 51-sudden cardiopulmonary
arrest, hypothyroid, OSA, knee problems


Physical Exam:
VS: T 98.4, BP 110/80, P 66, R 22, SpO2 91%
Gen: NAD, comfortable, morbidly obese woman, speaking in full
sentances
HEENT: PERRLA, NC/AT, hair coarse, +hirsutism, OP with mild soft
palate edema
Neck: No LAD, FROM, no thyromegally, soft tissues swollen
Resp: ? soft expriatory wheeze, no s
tridor, no rales/rhonchi, good air movement
CV: RRR, S1, S2 present, no M/R/G, difficult to auscultate [**1-31**]
body habitus
Abd: obese with silvery striae, +BS, no masses, no HSM, no
obvious ventral hernia, NT, ND
Ext: 1+ pedal edema
Neuro: alert and oriented x3, CNII-XII intact though decreased
sensation to light touch in right CN V; extremities with intact
sensation-no saddle anesthesia, 2+ symmetrical DTRs, [**5-3**] upper
and lower ext strength, no pronator drift.

Pertinent Results:
135 | 98 | 12
-------------<81
3.8 | 26 | 1.0
Comments: Hemolysis Falsely Elevates K
CK: 2239  MB: 12  MBI: 0.5  Trop-*T*: <0.01  --> CK on [**9-8**]: 239
Ca: 9.3 Mg: 2.3 P: 4.4
proBNP: 51
      12.2
12.5 >----< 222
      34.0
N:63.8 L:30.2 M:2.4 E:3.3 Bas:0.5
.
[**Doctor First Name **] NEG
.
Human Chorionic Gonadotropin <5
.
Serum Tox:
Salicylate NEG
Ethanol NEG
Acetaminophen NEG
Barbiturate Screen NEG
Tricyclic Antidepressant Screen NEG
.
Urine Tox:
URINE
Benzodiazepine Screen, Urine NEG
Barbiturate Screen, Urine NEG
Opiate Screen, Urine NEG
Cocaine, Urine POS
Amphetamine Screen, Urine NEG
Methadone, Urine NEG
.
ABG [**9-3**]: PO2: 164* PCO2: 48* pH: 7.40 HCO3: 31*
.
micro:
blood cx pending NGTD [**9-4**] x2
sputum gram stain/cx [**9-4**]-OP flora
urine cx pending NGTD [**9-4**], [**9-5**] x2
.
ECHO [**2137-9-3**]:
The left atrium is normal in size. The left ventricular cavity
size is normal. Overall left ventricular systolic function is
normal (LVEF>55%). Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
regurgitation. The mitral valve appears structurally normal with
trivial mitral regurgitation. There is a trivial/physiologic
pericardial effusion (may be small in subcostal views but views
suboptimal) without evidence of tamponade.
.
ECG [**2137-9-4**]: Sinus rhythm, Rightward axis - is nonspecific given
age
Late precordial QRS transition, Diffuse nonspecific T
abnormalities
Since previous tracing of [**2137-9-3**], no significant change
.
CXR [**2137-9-3**]: No acute cardiopulm process.
.
MRI Spine [**2137-9-7**]: Disc degenerative changes from L3-4 to L5-S1
level with mild bulging at L5-S1 level. No evidence of epidural
abscess or intraspinal fluid collection.


Brief Hospital Course:
A/P: 27 yo f admitted for hypotension with SOB, URI symptoms,
mild soft palate swelling, elevated CK, vaginal discharge and
chronic low-back pain.
.
Hypotension: She was admitted to the MICU out of concern for
hypotension as her BP in the ED was initially 112/50, but
dropped to 89/54. She has been normotensive in the ICU and this
hypotension may have been [**1-31**] difficulty getting an accurate
[**Location (un) 1131**] as she is obese. She was normotensive throughout her
hospital stay.
.
Oropharyngeal edema-Not significant on OP scope done by ENT,
subjectively continued to improve during her hospitalization.
Quincke's edema induced by cocaine was thought to be possible so
she was treated with dexamethasone for total 5 doses with
benedryl and famotidine but this did not seem to help her
subjective symptoms. ENT suggested that edema could be [**1-31**] OSA,
if so may improve with CPAP. CPAP arranged for home use, she
will need OP f/u and sleep study to be arranged. C1 esterase
inhibitor assay was also sent and pending at the time of
discharge. In the chance that they may be contributing, NSAIDS
were stopped at the time of discharge.
.
Elevated CK-On admission she had an elevated CK with flat
tropnin/MB. This was thought likely related to recent cocaine
use and trended down steadily during her hospital course.
.
Leukocytosis-WBC was noted to rise after initiation of steroids,
and peaked at 18.6. During this time she did not show any
obvious signs of infection but a urine specimen from [**9-5**] grew
>100,000 e. coli sensitive to cipro. Though she did not complain
of symptoms of UTI she was started on 3 day course of cipro and
her WBC fell 14.1 on day of discharge.
.
E.coli on Urine culture [**9-5**]-subsequent cultures no growth, pt.
asymptomatic, urine without LE or WBC's, however as leukocytosis
increasing she was started on cipro 500mg po q12 (day 1=[**9-7**]) for
3 days.
.
SOB-likely related to upper airway edema/OSA/URI-improved during
this hospitalization apparently related to CPAP use. DDimer neg
making PE unlikely, it was not thought to be [**1-31**] myocarditis as
repeat ECHO showed trivial/physiologic pericardial effusion,
unlikely to be [**1-31**] CHF as EF on ECHO >55%, CXR no edema. Pt
hypercarbic on ABG with pH 7.4, likely chronic CO2 retention
from obstructive lung disease.
.
Peripheral Edema-was improved by time of discharge, unclear
etiology, no evidence of protein in urine on admission, likely
not nephrotic syndrome, likley related to poor venous return in
obese.
.
Low back pain-chronic, midline, no saddle-anesthesia/bowel
incontinence, urinary incontinence sounds like stress
incontinence rather than neurogenic, not unusual given
obesity/h/o constipation; MRI showed degenerative disk disease
of the L3-L4 with mild bulging of L5-S1 with no herniation,
spinal stenosis, or nerve root compression, also abscess or
fluid collection. Per recommendation of chronic pain service she
was started on tramadol 50mg PO QID initially with no relief.
She was also seen by PT who recommended OP PT but cleared her
for discharge.
.
URI-She continued to have cough productive of mild amounts of
grey sputum during her hospital course. Culture and gram stain
as well as CXR were unremarkable. She was treated with
guaifenesin/dextromethorophan with minimal relief. We tried
albuterol/atrovent but she noted no response so it is unlikely
that RAD was contributing. Repeat CXR showed no PNA/pleural
effusions/pulmonary edema.
.
Cocaine Abuse-pt with + urine screen on [**9-5**], approx 36 hours
after admission so must have used 36 hours prior to presentation
though she denies this. SW spoke with pt, I have also
emphasizeed the dangers of cocaine abuse.
.
Vaginal discharge-She reported history of thin, white, foul
smelling vaginal discharge without blood, dysuria, pruritis or
dyspareunia, thought to be BV by hitory and started on flagyl
500mg TID PO to complete a 7 day course with some improvement.
It was recommend she f/u with PCP/OBGYN as OP.
.
Pericardial [**Month/Day (4) 18440**]-unclear etiology, could be [**1-31**] cocaine
use?, no tamponade physiology, repeat ECHO showed
trivial/physiologic pericardial [**Last Name (LF) 18440**], [**First Name3 (LF) **] negative.
.
ppx- hep sc, famotidine, BR
.
# fen- general diet.
.
# Full code.

Medications on Admission:
synthroid 125mg
ibuprofen 800mg [**Hospital1 **] over the last week


Discharge Medications:
1. Levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Fluticasone 50 mcg/Actuation Aerosol, Spray Sig: Two (2)
Spray Nasal [**Hospital1 **] (2 times a day).
Disp:*QS * Refills:*2*
3. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**12-31**] Sprays Nasal
TID (3 times a day).
Disp:*QS * Refills:*2*
4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 9 doses: DO NOT CONSUME ALCOHOL WHILE ON THIS
MEDICATION.
Disp:*9 Tablet(s)* Refills:*0*
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
6. Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
Disp:*120 Capsule(s)* Refills:*2*
7. Dextromethorphan-Guaifenesin 10-100 mg/5 mL Syrup Sig: [**5-8**]
MLs PO Q4H (every 4 hours) as needed for cough.
Disp:*QS * Refills:*0*
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
9. Tramadol 50 mg Tablet Sig: One (1) Tablet PO QID (4 times a
day).
Disp:*120 Tablet(s)* Refills:*0*
10. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 4 doses.
Disp:*4 Tablet(s)* Refills:*0*
11. CPAP
CPAP with heated humididity at pressure 8 cm of water with mask
to fit.
12. Outpatient Physical Therapy
Patient needs outpatient physical therapy.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Upper respiratory infection, subjective orophayrngeal
swelling, suspected obstructive sleep apnea.
.
Secondary: Obesity, cocaine abuse, hypothyroidism.


Discharge Condition:
Good.


Discharge Instructions:
Please take all medications as prescribed. Please keep all
follow-up appointments. Please call your PCP or return to the ED
if you experience worsening shortness of breath, head ache,
fevers, chills, nausea, vomitting, abdominal pain, diarrhea,
constipation, swelling or any symptoms that concern you.

Followup Instructions:
Please call [**Hospital6 733**] at ([**Telephone/Fax (1) 1300**] or your
primary care physician to schedule [**Name Initial (PRE) **] follow-up visit in the next
1-2 weeks. This is very important as you will need to be
schedueled for an outpatient sleep study at that time to assess
Obstructive Sleep Apnea and titrate your CPAP machine settings
and to reassess your thyroid medication.


                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 472**]
{'Acute upper respiratory infections of unspecified site,Cocaine abuse, unspecified,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Morbid obesity'}


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: cc:[**CC Contact Info 35172**]
Major Surgical or Invasive Procedure:
Nasopharyngeal scope done by ENT.

PRESENT ILLNESS: hpi: 27 y/o female who p/w 1 wk h/o sob, difficulty lying flat,
pleuritic CP, onset of swelling of tongue, and most recently
cough. cough is the final symptom that brought the patient to
the ED. started last night with green sputum, no blood. Approx
one week ago first noted swelling of feet and hands.
subsequently noted increased swelling of tongue and difficulty
lying flat. Reports that she would develop difficulty getting
air because of "her neck". Has been sleeping sitting up. +nasal
congestion, nasal discharge. Also has noted the subacute onset
of increased SOB. Even while sitting up the patient states that
she cannot "get enough air". No sudden onset SOB. +DOE.
+pleuritic CP which she describes as "lightening sensation"
shooting down L arm. generally lasts approx one minute, worse w/
inspiration. unchanged w/ ambulation. Has also developed cough
over the last day, productive of green sputum. No known sick
contacts. [**Name (NI) **] recent travel. No insect/tick bites. No exposure to
[**Doctor Last Name 6641**]/forest.
.
Pt reports a history of LE edema which is common and states that
her current swelling is of normal amounts in the LE. No prior
h/o hand/tongue swelling. Denies changes in urinary habits (does
not go frequently). No n/v/d. still able to take p.o. No
f/chills/rash/joint pain/arthralgias.
.
In [**Name (NI) **], pt initially stable w/ bp 112/50, dropped to 89/54, by
report to the 70s systolic. Patient asymptomatic throughout (no
cp/sob/LH). By report, responded to IVF. Cardiology consulted,
bedside TTE performed showing minimal pericardial fluid and nl
biv fxn.

MEDICAL HISTORY: hypothyroidism
migraine ha
? encephalitis-[**2128**]
? ADHD
? abdominal hernia
s/p cholecystectomy in [**2128**]

MEDICATION ON ADMISSION: synthroid 125mg
ibuprofen 800mg [**Hospital1 **] over the last week

ALLERGIES: Sulfa (Sulfonamides) / Penicillins

PHYSICAL EXAM: VS: T 98.4, BP 110/80, P 66, R 22, SpO2 91%
Gen: NAD, comfortable, morbidly obese woman, speaking in full
sentances
HEENT: PERRLA, NC/AT, hair coarse, +hirsutism, OP with mild soft
palate edema
Neck: No LAD, FROM, no thyromegally, soft tissues swollen
Resp: ? soft expriatory wheeze, no s
tridor, no rales/rhonchi, good air movement
CV: RRR, S1, S2 present, no M/R/G, difficult to auscultate [**1-31**]
body habitus
Abd: obese with silvery striae, +BS, no masses, no HSM, no
obvious ventral hernia, NT, ND
Ext: 1+ pedal edema
Neuro: alert and oriented x3, CNII-XII intact though decreased
sensation to light touch in right CN V; extremities with intact
sensation-no saddle anesthesia, 2+ symmetrical DTRs, [**5-3**] upper
and lower ext strength, no pronator drift.

FAMILY HISTORY: Mother-50's-HTN, Father-deceased age 51-sudden cardiopulmonary
arrest, hypothyroid, OSA, knee problems

SOCIAL HISTORY: Married, not currently working, has 3 children currently in the
care of DSS, lives with husband in [**Name (NI) 487**], husband recovering
from heart surgery for valve replacement. Sexually active with
her husband only. Denies EtOH and IVDU, admits to cocaine use by
snorting only, reportedly intermittantly only for the past 6
months, denies other illicit drug use, reports + tob for 15
years 1/2-1 PPD. 

### Response:
{'Acute upper respiratory infections of unspecified site,Cocaine abuse, unspecified,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Morbid obesity'}
