CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 45-year-old female
patient with a history of asthma, obstructive sleep apnea,
morbid obesity and PTSD/depression who was transferred from
an outside hospital with massive right-sided PE.

MEDICAL HISTORY: PTSD secondary to abuse as a child.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN, SHELLFISH, AND SEROQUEL.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of clotting disorders or cancer.
The patient's mother had a TIA/CVA and hypertension.

SOCIAL HISTORY: The patient lives alone.  She denies tobacco
use, but reports previous heavy alcohol use.  She quit
alcohol in [**2116**].  She denies history of drug use.
Other pulmonary embolism and infarction,Hyperpotassemia,Posttraumatic stress disorder,Dissociative identity disorder,Depressive disorder, not elsewhere classified,Other specified cardiac dysrhythmias,Morbid obesity,Asthma, unspecified type, unspecified,Iron deficiency anemia, unspecified
Pulm embol/infarct NEC,Hyperpotassemia,Posttraumatic stress dis,Dissociatve identity dis,Depressive disorder NEC,Cardiac dysrhythmias NEC,Morbid obesity,Asthma NOS,Iron defic anemia NOS
Admission Date: [**2137-4-3**]        Discharge Date: [**2137-4-11**]

Date of Birth:  [**2091-7-1**]        Sex:  F

Service:  MED


HISTORY OF PRESENT ILLNESS:  This is a 45-year-old female
patient with a history of asthma, obstructive sleep apnea,
morbid obesity and PTSD/depression who was transferred from
an outside hospital with massive right-sided PE.

The patient was in her usual state of health until the day
prior to admission when she experienced mild shortness of
breath that she attributed to the heat and a flare in her
asthma.  She awoke the next day feeling "odd" with heavy
bilateral lower extremities that felt like "concrete blocks."
As she was sitting on the edge of her bed, she lost
consciousness and felt back on to the bed.  On regaining
consciousness, she describes a feeling of fatigue and mild
chest pressure.  She called her neighbor, who called EMS.
She began to experience right-sided pleuritic chest pain [**4-1**]
and worse with deep breathing.  She had a second fainting
episode during transfer to the hospital.

She was taken to an outside hospital where she was noted to
have a blood pressure of 80/40.  She lost consciousness third
time.  D-dimer and troponin were noted to be elevated, and
the patient was evaluated with a V/Q scan, which was notable
for a massive high probability right-sided PE and 2 small
subsegmental left-sided PEs.  She was given Lovenox and
Plavix and transferred to [**Hospital1 18**] for further treatment.

In the emergency department, the patient complained of mild
right shoulder/neck/chest pain.  She reported four recent car
trips to [**State 622**], the most recent of which was 1-week prior
to admission.  She also had mild left calf pain that she
attributed to her varicose veins.  She denied history of
clots or oral contraceptive pills.

PAST MEDICAL HISTORY:  PTSD secondary to abuse as a child.

Multiple personality disorder.

Mild asthma.

Obstructive sleep apnea.

Status post cholecystectomy.

Depression.

Morbid obesity.

ALLERGIES:  PENICILLIN, SHELLFISH, AND SEROQUEL.

MEDICATIONS:
1. Omeprazole 40 mg p.o. q.d.
2. Effexor 300 mg p.o. q.d.
3. Risperdal 2 mg q.a.m, 1 mg q.p.m.
4. Trazodone 200 mg q.h.s.
5. Mirapex 1.25 mg p.o. q.d.
6. Multivitamins 1 cap p.o. q.d.


SOCIAL HISTORY:  The patient lives alone.  She denies tobacco
use, but reports previous heavy alcohol use.  She quit
alcohol in [**2116**].  She denies history of drug use.

FAMILY HISTORY:  No history of clotting disorders or cancer.
The patient's mother had a TIA/CVA and hypertension.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 98.8
degrees, BP 133/83, heart rate 120, respiratory rate 26, and
96 percent on a 100 percent nonrebreather.  General:
Morbidly obese woman, lying in bed, mildly dyspneic.  HEENT:
Normocephalic, atraumatic.  Pupils equal, round, and reactive
to light.  Extraocular movements intact.  Moist mucous
membranes.  Speaking in full sentences.  Neck:  Soft, supple,
and full range of motion.  Chest:  Clear to auscultation
bilaterally.  Cardiac:  Tachycardic with a regular rhythm.
No murmurs, rubs, or gallops.  Abdomen:  Obese, soft,
nontender, and nondistended.  No guarding or rebound.
Normoactive bowel sounds.  Rectal:  Guaiac negative.
Extremities:  No calf tenderness or asymmetry.  Extremities:
Warm with 1 plus DP pulses bilaterally.  Neurologic:  Alert
and oriented times 3.  Cranial nerves II through XII intact.
Muscle strength is [**3-27**] throughout.  Sensory is intact by
light touch.

LABORATORY DATA:  White blood cells 13.8, hematocrit 35.0,
and platelets 282.  Sodium 139, potassium 4.8, chloride 100,
bicarbonate 20, BUN 15, creatinine 0.7, and glucose 120.  PT
11.7, PTT 24.3, and INR 1.0.  CK 87, CK-MB 6, and troponin
0.11.  D-dimer 500 to 1000.

RADIOGRAPHIC STUDIES:  EKG, sinus tachycardia at 117 beats
per minute.  Normal axis, normal intervals.  No acute
ischemic changes.  There is evidence of S1, Q3, T3.  No
evidence of P pulmonale.  Chest x-ray, no acute
cardiopulmonary process.  Echo, mild symmetric LV
hypertrophy, LV ejection fraction of 70 percent, RV dilated,
RV pressure overload.

HOSPITAL COURSE:  PE.  The patient was admitted to the MICU
where she was started on a heparin drip and did not receive
thrombolytic therapy.  The patient was evaluated with lower
extremity noninvasives that were negative for DVTs.  An
echocardiogram was performed, which was significant for RV
pressure overload and preserved LV systolic function.  The
patient improved clinically with heparin drip and did not
require thrombolysis given that she appeared clinically
stable on admission.  The patient was transferred to the
general medical floor on [**2137-4-5**], at which time she was
continued on her heparin drip until her INR was therapeutic
on Coumadin.  The patient's oxygen was weaned to off.  Given
persistently subtherapeutic INRs, the patient was switched
from a heparin drip to Lovenox for potential discharge.
Given the patient's obesity, antifactor Xa level was ordered,
but could not be successfully coordinated with her Lovenox
dosing and blood draws on the floor.  Arrangements were made
with the patient and her primary care physician for blood
draws and monitoring of her Coumadin and Lovenox doses.  The
patient's oxygenation and respiratory status remained stable
throughout remainder of her hospitalization.

Cardiac.  While in the medical intensive care unit, the
patient was noted to have a troponin leak in the setting of
right heart strain from her submassive pulmonary emboli.  Her
troponin was noted to trend down throughout the remainder of
her hospitalization.  The patient complained of episodic
chest pain throughout her stay on the general medical floor.
She described this chest pain has a "tightness" in her left
chest.  An initial EKG taken during one of these episodes was
significant for Q-wave inversions in the anterior leads that
was considered likely secondary to lead placement.  The
patient's cardiac enzymes trended down throughout her
hospitalization, and her chest pain was considered likely
secondary to a submassive pulmonary emboli.  As noted
previously, the patient was anticoagulated for her pulmonary
emboli.

Anemia.  The patient was noted to have somewhat low, but
stable, hematocrit throughout her hospitalization.  Looking
through her previous records, this appeared to be within her
baseline.  The patient was evaluated with iron studies, which
suggested an iron deficiency anemia.  She was placed on iron
sulfate as well as vitamin C for absorption.  It is
anticipated that she will be evaluated with a colonoscopy as
an outpatient.

Psych.  The patient was admitted with a history of
depression, PTSD, and multiple personality disorder.  Her
Effexor, omeprazole, and Risperdal were continued.  Multiple
discussions took place with the patient and case management
regarding her fear of needles given her history of childhood
trauma.  The patient agreed to take Lovenox, which will be
administered by a nurse as an outpatient.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is discharged to home.

DISCHARGE DIAGNOSES:  Pulmonary emboli.

Anemia.

Depression.

Posttraumatic stress disorder.

DISCHARGE MEDICATIONS:
1. Omeprazole 40 mg p.o. q.d.
2. Risperidone 2 mg p.o. q.a.m., 1 mg p.o. q.h.s.
3. Venlafaxine 75 mg capsules 4 capsules p.o. q.d.
4. Pramipexole 0.25 mg tablet 2.5 tablets p.o. q.d.
5. Multivitamin 1 cap p.o. q.d.
6. Trazodone 200 mg p.o. q.h.s.
7. Fluticasone 2 puffs inhaled b.i.d.
8. Albuterol 1-2 puffs inhaled q.6h. p.r.n.
9. Coumadin 15 mg p.o. q.h.s.
10.      Oxycodone 5 mg p.o. q.4-6h. p.r.n. pain.
11.      Lovenox 100 mg subcu b.i.d. times 10 doses.
12.      Ferrous sulfate 325 mg p.o. b.i.d.
13.      Ascorbic acid 500 mg p.o. b.i.d.


FOLLOW-UP:  The prescription has a follow-up appointment with
her primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 5448**] on [**2137-4-17**] at 2:30
p.m.  She also has a follow-up appointment with her therapist
on [**2137-4-12**] at 12 p.m.

She is encouraged to call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3060**] in the
thrombophilia clinic to schedule follow-up appointment.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 5704**], [**MD Number(1) 5705**]

Dictated By:[**Last Name (NamePattern1) 12325**]
MEDQUIST36
D:  [**2137-7-1**] 15:34:25
T:  [**2137-7-2**] 11:31:17
Job#:  [**Job Number 108660**]
{'Other pulmonary embolism and infarction,Hyperpotassemia,Posttraumatic stress disorder,Dissociative identity disorder,Depressive disorder, not elsewhere classified,Other specified cardiac dysrhythmias,Morbid obesity,Asthma, unspecified type, unspecified,Iron deficiency anemia, 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: 

PRESENT ILLNESS: This is a 45-year-old female
patient with a history of asthma, obstructive sleep apnea,
morbid obesity and PTSD/depression who was transferred from
an outside hospital with massive right-sided PE.

MEDICAL HISTORY: PTSD secondary to abuse as a child.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN, SHELLFISH, AND SEROQUEL.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of clotting disorders or cancer.
The patient's mother had a TIA/CVA and hypertension.

SOCIAL HISTORY: The patient lives alone.  She denies tobacco
use, but reports previous heavy alcohol use.  She quit
alcohol in [**2116**].  She denies history of drug use. 

### Response:
{'Other pulmonary embolism and infarction,Hyperpotassemia,Posttraumatic stress disorder,Dissociative identity disorder,Depressive disorder, not elsewhere classified,Other specified cardiac dysrhythmias,Morbid obesity,Asthma, unspecified type, unspecified,Iron deficiency anemia, unspecified'}
