CHIEF COMPLAINT: 

PRESENT ILLNESS: Mrs. [**Known lastname 15427**] is a 62-year-old
woman who was transferred from [**Hospital6 3105**] for
shortness of breath over the last two days.

MEDICAL HISTORY: The past medical history revealed
atrial fibrillation status post cardioversion on Sotalol,
last echocardiogram in 1/00 showed an ejection fraction
greater than 55% and normal systolic function; chronic
obstructive pulmonary disease with an FEV1/FVC of 68%; atrial
septal defect status post repair in [**2155**]; and small cell
carcinoma status post radiation and Cisplatin.  A
transthoracic echocardiogram in [**2158-11-25**] showed an
ejection fraction of greater than 55%, mild right ventricular
dilatation and hypokinesis, mild to moderate mitral
regurgitation, and pulmonary hypertension.  A MIBI in [**2159-11-26**] showed mild partial reversible defect in the vascular
portion of the inferior wall.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient had smoked tobacco times 30
years with none in the last eight years.  She drank three
glasses of wine per night.  She had no IV drug abuse.  She
lives with her husband and one son.  She was born in [**Location (un) **]
but has lived here times 40 years.
Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure, unspecified,Rheumatoid arthritis,Malignant neoplasm of other parts of bronchus or lung
Obs chr bronc w(ac) exac,CHF NOS,Atrial fibrillation,Acute kidney failure NOS,Rheumatoid arthritis,Mal neo bronch/lung NEC
Admission Date:  [**2160-4-28**]       Discharge Date:  [**2160-5-1**]

Date of Birth:   [**2097-12-31**]       Sex:  F

Service:  MICU

HISTORY OF PRESENT ILLNESS:  Mrs. [**Known lastname 15427**] is a 62-year-old
woman who was transferred from [**Hospital6 3105**] for
shortness of breath over the last two days.

She is a 62-year-old woman with history of small cell lung
cancer, congestive heart failure, and chronic obstructive
pulmonary disease who was well until one week ago when she
began to develop a productive cough streaked with blood.
Over the last two days, she noticed worsening shortness of
breath with exertion particularly with stairs.  She also
complained of pleurisy in her left back particularly when
taking in deep breaths.  Because of the worsening breathing,
her husband brought her to the Emergency Department of
[**Hospital6 3105**].

At the outside hospital, she was noted to be pale, dry, and
with cool extremities.  Blood pressure was 75-85 systolic.
O2 saturation was 85% and increased to 100% on
non-rebreather.  A chest x-ray showed increased pleural
effusion.  She was treated with fluids, Albuterol, and
Ceftriaxone, and subsequently transferred here.

The patient denied fever, chest pain, orthopnea (sleeps on
one pillow), and peripheral edema.  There was no abdominal
pain, diarrhea, dysuria, or bloody stool.  At baseline she is
able to walk a block but becomes short of breath with
inclines.

PAST MEDICAL HISTORY:  The past medical history revealed
atrial fibrillation status post cardioversion on Sotalol,
last echocardiogram in 1/00 showed an ejection fraction
greater than 55% and normal systolic function; chronic
obstructive pulmonary disease with an FEV1/FVC of 68%; atrial
septal defect status post repair in [**2155**]; and small cell
carcinoma status post radiation and Cisplatin.  A
transthoracic echocardiogram in [**2158-11-25**] showed an
ejection fraction of greater than 55%, mild right ventricular
dilatation and hypokinesis, mild to moderate mitral
regurgitation, and pulmonary hypertension.  A MIBI in [**2159-11-26**] showed mild partial reversible defect in the vascular
portion of the inferior wall.

FAMILY HISTORY:  Noncontributory.

MEDICATIONS:  Prednisone 10 mg q. day, Lasix 20 mg q. day,
Singulair 10 mg q. day, Coumadin 5/7.5 mg q.h.s., Betapace 40
mg p.o. b.i.d., Xanax 5 mg p.o. q.d., Paxil 10 mg p.o. q.d.,
Motrin 400 mg p.o. b.i.d., Serevent inhaler 2 puffs b.i.d.,
Combivent inhaler 2 puffs b.i.d. p.r.n., Albuterol p.r.n.

SOCIAL HISTORY:  The patient had smoked tobacco times 30
years with none in the last eight years.  She drank three
glasses of wine per night.  She had no IV drug abuse.  She
lives with her husband and one son.  She was born in [**Location (un) **]
but has lived here times 40 years.

PHYSICAL EXAMINATION:  The patient was a pleasant 62-year-old
woman sitting upright in minimal distress.  She was afebrile
with blood pressure of 112/90, pulse 84, saturation 91% on 4
liters nasal cannula and 80% on room air.  On head and neck
examination, the fundi showed sharp discs.  The pupils were
equal and reactive to light.  The oropharynx was moist.  The
chest showed coarse breath sounds bilaterally with wheezing
and crackles bibasilarly.  There was a scar from her previous
ASD repair.  The rate was regular with no murmurs.  The
abdomen was soft and nontender with no edema.  The
extremities were nontender.

LABORATORY DATA:  White blood cell count was 11, hematocrit
35, platelets 277,000, MCV 97.  Differential revealed
neutrophils 40, bands 43, lymphocytes 6, metamyelocytes 5,
occasional Dohle bodies.  SMA-7 showed sodium 129, potassium
4.9, chloride 94, bicarbonate 28, BUN 34, creatinine 2.8,
glucose 122, CK 46.

EKG revealed normal sinus rhythm at 84-86.  Axis was 90.
There was right bundle branch block, T wave inversions from
V2-V3, and ST depressions in V4 and V6 which were old.
Troponin was less than 0.03.  INR was 4.3, PTT 44.

HOSPITAL COURSE:  In brief, Mrs. [**Known lastname 15427**] is a 62-year-old
woman with a history of chronic obstructive pulmonary
disease, oat cell carcinoma, and congestive heart failure who
presented in respiratory distress with one week of productive
cough and hemoptysis.  Her presentation was likely consistent
with COPD exacerbation secondary to bronchitis; however
pulmonary embolism could not be excluded based on her risk
factors such as cancer, immobility, and pleuritic pain.
Laboratory workup was also concerning for acute renal failure
and hyponatremia.  Her hospital course can be summarized as
follows.

Cardiovascular:  Electrocardiogram was concerning for
anterior subendocardial ischemia; however this was unchanged
from previously.  She eventually ruled out for myocardial
infarction by CKs and as per Dr. [**Last Name (STitle) 1911**] we continued
Sotalol for her atrial fibrillation despite her COPD
exacerbation.  The final [**Location (un) 1131**] on the EKG showed worsening
T wave inversions in leads III and aVF.  Upon discussion with
Dr. [**Last Name (STitle) 1911**], he felt that her presentation was most
likely secondary to chronic obstructive pulmonary disease
exacerbation rather than an acute coronary syndrome.  An
outpatient stress test was not recommended because of her
clinical presentation.  She was continued on telemetry and
there were no further events.

Pulmonary:  Chronic obstructive pulmonary disease
exacerbation secondary to bronchitis versus pneumonia.  The
patient received pulse dose of steroids with Solu-Medrol 80
mg intravenously t.i.d. and this was transitioned to
Prednisone 60 mg p.o. q.a.m. for a tapered course over 14
days.  Albuterol and Atrovent nebulizers were continued as
well as Flovent.  She received empiric treatment of pneumonia
given her cough, hemoptysis, and bandemia with Levaquin.

Rule out pulmonary embolus:  The PE test probability for
pulmonary embolus was low to moderate given her risk factors.
The D-dimer at [**Hospital6 3105**] was positive by
[**Doctor First Name **], therefore, it was not very useful.  We could not
initiate CT angiogram given her renal failure nor VQ given
her effusions.  LENIs were checked on hospital day #2 and
were negative for clots.  She was already in part
anticoagulated for her atrial fibrillation and she came in
with an INR of 4.5.

As for her hemoptysis, this engaged a broad differential
including bronchitis, cancer, and pneumonia versus pulmonary
embolus.  She had no further episodes of hemoptysis in
hospital.

Renal:  Acute renal failure was likely secondary to prerenal
versus Motrin.  A FENA was checked and this was 0.1% which
concurred with prerenal failure.  She was hydrated with goal
intake and output positive one liter and her creatinine
subsequently climbed close to baseline on discharge.  All her
medications were renally dosed.  Urine electrolytes were
checked and revealed a FENA of 0.1%.

Hyponatremia was felt to be secondary to hypovolemia and
possibly a combination of syndrome of inappropriate diuretic
hormone.  Cortisol was sent and was falsely elevated due to
her already being on steroids.  The cortisol level was 53.
Urine osmolalities and urine electrolytes were also checked
and free water was restricted.  TSH was normal.

Infectious disease:  It was unclear where the source of her
bandemia originated.  All blood cultures remained negative
and urine cultures as well.  Followup bands obtained in the
hospital revealed a band level of 8 on admission and then 0
on hospital day #2.  Levofloxacin was continued for presumed
pneumonia.

Gastrointestinal:  There were no active issues and she ate
well.

Social:  The patient was seen by physical therapy who felt
that she had no acute rehabilitation needs.  Upon ambulation,
she desaturated to 88% on room air.  Resting on room air, she
also improved and ranged from 88% to 92%.  The patient was
reluctant to use oxygen at home but following review with
case management, this could be provided by her insurance and
she agreed to this.

DISCHARGE DIAGNOSES:  Chronic obstructive pulmonary disease
exacerbation secondary to pneumonia; acute renal failure
secondary to dehydration.

DISCHARGE MEDICATIONS:  Lasix 20 mg p.o. q.d., Singulair 10
mg p.o. q.d., Coumadin 5 mg alternating with 7.5 mg p.o.
q.h.s., Betapace 40 mg p.o. b.i.d., Xanax 0.5 mg p.o. q.d.,
Paxil 10 mg p.o. q.d., no Motrin, Combivent 2 puffs q.i.d.,
Albuterol p.r.n., Prednisone taper beginning with 50 mg to
taper over 10 days, Levaquin 500 mg p.o. q.d. for a total 10
day course to end on [**2160-5-8**], Zantac 150 mg p.o. b.i.d.
to end concurrent with the Prednisone taper.

DISCHARGE FOLLOWUP:  The patient was to follow up with Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] within a week.  The patient will call to arrange
an appointment.

Outpatient pulmonary rehabilitation.

DISPOSITION:  To home.






                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**], M.D.  [**MD Number(1) 2438**]

Dictated By:[**Last Name (NamePattern1) 19923**]
MEDQUIST36

D:  [**2160-5-1**]  16:45
T:  [**2160-5-1**]  18:16
JOB#:  [**Job Number 21123**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure, unspecified,Rheumatoid arthritis,Malignant neoplasm of other parts of bronchus or lung'}


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: Mrs. [**Known lastname 15427**] is a 62-year-old
woman who was transferred from [**Hospital6 3105**] for
shortness of breath over the last two days.

MEDICAL HISTORY: The past medical history revealed
atrial fibrillation status post cardioversion on Sotalol,
last echocardiogram in 1/00 showed an ejection fraction
greater than 55% and normal systolic function; chronic
obstructive pulmonary disease with an FEV1/FVC of 68%; atrial
septal defect status post repair in [**2155**]; and small cell
carcinoma status post radiation and Cisplatin.  A
transthoracic echocardiogram in [**2158-11-25**] showed an
ejection fraction of greater than 55%, mild right ventricular
dilatation and hypokinesis, mild to moderate mitral
regurgitation, and pulmonary hypertension.  A MIBI in [**2159-11-26**] showed mild partial reversible defect in the vascular
portion of the inferior wall.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient had smoked tobacco times 30
years with none in the last eight years.  She drank three
glasses of wine per night.  She had no IV drug abuse.  She
lives with her husband and one son.  She was born in [**Location (un) **]
but has lived here times 40 years. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure, unspecified,Rheumatoid arthritis,Malignant neoplasm of other parts of bronchus or lung'}
