CHIEF COMPLAINT: Shortness of [**First Name3 (LF) 1440**]

PRESENT ILLNESS: Mr. [**Known lastname 106548**] is a 52 year old male with history of chronic
lymphocytic leukemia status post allogeneic bone marrow
transplant in [**2188**],
cutaneous GVHD recent admission for pneumonia who presents with
3 days of shortness of [**Year (4 digits) 1440**].
He was feeling "okay" until 3 days prior to admission when he
noted shortness of [**Year (4 digits) 1440**] upon awakening. It was worse with
exertion/walking but improved throughout the day. This occurred
again over the next two days. The shortness of [**Year (4 digits) 1440**] was not
associated with chest pain, palpitations, lightheadedness,
diaphoresis, nausea, vomiting.  He notes orthopnea x several
months. No PND/leg swelling. He does note some
nausea/lightheadedness after taking famvir. He denies fevers,
chills, sweats, worse/productive cough. He denies diarrhea. He
does note some decreased appetite and PO intake.
He called Dr.[**Name (NI) 6168**] office today and was told to increase his
prednisone from 20 mg to 40 mg. Of note, he receives inhaled
pentamadine for PCP [**Name9 (PRE) **] but has missed a few doses. He is unsure
the date of his last dose.
In the ED, the CTA was negative for PE, but notable for
resolving pna and stable tree and [**Male First Name (un) 239**] appearance. He was given 1
dose of ceftriaxone/vanco.  His ECG was sinus 94, old q in avF,
LAD, LVH and new TWI in V4-V6. He was given asa and 1 set of CE
was negative.

MEDICAL HISTORY: 1. Chronic lymphocytic leukemia, status post
allo-bone marrow transplant 10 years ago at [**Hospital1 336**]. Oncologist is
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**].
2. extensive chronic graft vs. host
3. diffuse osteopenia treated with bisphosphonate
4. cyclosporine induced renal toxicity
5. shingles - admitted in [**2197-5-11**] with IV acyclovir
6. left parietal actinic keratosis s/p
nitrogen treatment
7. SCC, R 3rd finger, recurrent, pt referred for Mohs excision
on [**11-15**]

MEDICATION ON ADMISSION: Cellcept 500mg PO BID
Prednisone 40 mg PO QD
Warfarin 1mg PO QD
Plaquenil 200 mg PO bid
Protonix 40mg PO QD
Metoprolol 25mg PO BID
Neurontin 300mg PO QHS
Lorazepam 0.5mg PO QHS prn
Fentanyl patch 50 mcg
Oxycodone 5mg PO Q4-6hrs prn
Pentamidine inh Q monthly - unclear when last dose
[**Name (NI) 10687**] 1 tab PO BID
Simethicone 40-80mg PO QID prn
Famvir - ? dose or start date
Fluconazole - ?dose or start date
Advair

ALLERGIES: Bactrim / Imipenem

PHYSICAL EXAM: VS - T 97.2, BP 110/60, HR 100, RR 22, sats 95% RA
Gen: Thin, cachectic male, +alopecia, NAD, nontoxic, no
increased work of breathing
HEENT: PERRL, EOMI. Sclera anicteric. MMM. OP clear. chronic GVH
scleritic type lesions but no ulcers, vesicles, lesions
suggestive of thrush
NECK: supple, no JVD, no LAD
CV: RR, normal S1, S2. No m/r/g.
Lungs: decreased BS throughout, no wheeze/crackle/rhonci, no
egophony
Abd: SNTND. NABS
Ext: cold hands and feet. Erythematous shins. small areas of
breakdown. Could not palpate PT pulses, 2+ radial pulses
bilaterally. No c/c/e.
Derm: Skin thick, firm, pale.Extensive chronic GVHD of the
scleroderma type.
Neuro: CN II-XII grossly intact.

FAMILY HISTORY: Mother had lung cancer due to tobacco abuse, his father died at
[**Age over 90 **] years of age, his sister died of Asthma at age 51.

SOCIAL HISTORY: Lives in [**Location 4047**], Married for many years, one son 14 years old.
He has been disabled for many years but previously worked as a
systems analyst for several companies throughout his life. No
tob or etoh.  He has 6 brothers and 4 sisters.
Acute and chronic respiratory failure,Chronic lymphoid leukemia, without mention of having achieved remission,Complications of transplanted bone marrow,Acute kidney failure, unspecified,Hyperpotassemia,Chronic kidney disease, unspecified,Blood in stool,Pneumonia due to other gram-negative bacteria,Thrombocytopenia, unspecified,Circumscribed scleroderma,Disorder of bone and cartilage, unspecified,Unspecified essential hypertension,Long-term (current) use of steroids,Personal history of other malignant neoplasm of skin,Open wound of scalp, without mention of complication,Unspecified fall,Disorders of phosphorus metabolism,Other chest pain,Foreign body in other specified parts bronchus and lung,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation
Acute & chronc resp fail,Ch lym leuk wo achv rmsn,Compl marrow transplant,Acute kidney failure NOS,Hyperpotassemia,Chronic kidney dis NOS,Blood in stool,Pneumo oth grm-neg bact,Thrombocytopenia NOS,Circumscribe scleroderma,Bone & cartilage dis NOS,Hypertension NOS,Long-term use steroids,Hx-skin malignancy NEC,Open wound of scalp,Fall NOS,Dis phosphorus metabol,Chest pain NEC,FB trach/bronch/lung NEC,Resp obstr-inhal obj NEC
Admission Date:  [**2200-8-20**]              Discharge Date:   [**2200-9-19**]

Date of Birth:  [**2148-3-18**]             Sex:   M

Service: MEDICINE

Allergies:
Bactrim / Imipenem

Attending:[**First Name3 (LF) 6169**]
Chief Complaint:
Shortness of [**First Name3 (LF) 1440**]

Major Surgical or Invasive Procedure:
Fiberoptic intubation [**2200-8-23**], [**2200-8-28**]; left subclavian central
venous line placement [**2200-8-23**], left radial arterial line
placement [**2200-8-23**]; surgical tracheostomy tube placement and PEG
tube placement [**2200-9-4**]; staple insertion in head laceration
[**2200-8-23**], removal [**2200-9-2**]

History of Present Illness:
Mr. [**Known lastname 106548**] is a 52 year old male with history of chronic
lymphocytic leukemia status post allogeneic bone marrow
transplant in [**2188**],
cutaneous GVHD recent admission for pneumonia who presents with
3 days of shortness of [**Year (4 digits) 1440**].
He was feeling "okay" until 3 days prior to admission when he
noted shortness of [**Year (4 digits) 1440**] upon awakening. It was worse with
exertion/walking but improved throughout the day. This occurred
again over the next two days. The shortness of [**Year (4 digits) 1440**] was not
associated with chest pain, palpitations, lightheadedness,
diaphoresis, nausea, vomiting.  He notes orthopnea x several
months. No PND/leg swelling. He does note some
nausea/lightheadedness after taking famvir. He denies fevers,
chills, sweats, worse/productive cough. He denies diarrhea. He
does note some decreased appetite and PO intake.
He called Dr.[**Name (NI) 6168**] office today and was told to increase his
prednisone from 20 mg to 40 mg. Of note, he receives inhaled
pentamadine for PCP [**Name9 (PRE) **] but has missed a few doses. He is unsure
the date of his last dose.
In the ED, the CTA was negative for PE, but notable for
resolving pna and stable tree and [**Male First Name (un) 239**] appearance. He was given 1
dose of ceftriaxone/vanco.  His ECG was sinus 94, old q in avF,
LAD, LVH and new TWI in V4-V6. He was given asa and 1 set of CE
was negative.

Past Medical History:
1. Chronic lymphocytic leukemia, status post
allo-bone marrow transplant 10 years ago at [**Hospital1 336**]. Oncologist is
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**].
2. extensive chronic graft vs. host
3. diffuse osteopenia treated with bisphosphonate
4. cyclosporine induced renal toxicity
5. shingles - admitted in [**2197-5-11**] with IV acyclovir
6. left parietal actinic keratosis s/p
nitrogen treatment
7. SCC, R 3rd finger, recurrent, pt referred for Mohs excision
on [**11-15**]


Social History:
Lives in [**Location 4047**], Married for many years, one son 14 years old.
He has been disabled for many years but previously worked as a
systems analyst for several companies throughout his life. No
tob or etoh.  He has 6 brothers and 4 sisters.


Family History:
Mother had lung cancer due to tobacco abuse, his father died at
[**Age over 90 **] years of age, his sister died of Asthma at age 51.

Physical Exam:
VS - T 97.2, BP 110/60, HR 100, RR 22, sats 95% RA
Gen: Thin, cachectic male, +alopecia, NAD, nontoxic, no
increased work of breathing
HEENT: PERRL, EOMI. Sclera anicteric. MMM. OP clear. chronic GVH
scleritic type lesions but no ulcers, vesicles, lesions
suggestive of thrush
NECK: supple, no JVD, no LAD
CV: RR, normal S1, S2. No m/r/g.
Lungs: decreased BS throughout, no wheeze/crackle/rhonci, no
egophony
Abd: SNTND. NABS
Ext: cold hands and feet. Erythematous shins. small areas of
breakdown. Could not palpate PT pulses, 2+ radial pulses
bilaterally. No c/c/e.
Derm: Skin thick, firm, pale.Extensive chronic GVHD of the
scleroderma type.
Neuro: CN II-XII grossly intact.


Pertinent Results:
137 | 93 | 47   88
---------------/
5.8 | 34 | 1.7

     \ 13.1 /
17.3 ------- 211
     / 40.7 \
N:81 Band:12 L:2 M:3 E:0 Bas:0 Metas: 2
Anisocy: OCCASIONAL Macrocy: OCCASIONAL
Plt-Est: Normal
PT: 15.1  PTT: 25.7  INR: 1.4
.
Imaging:
[**2200-8-20**] Chest CTA:
1. Resolution of left lower lobe consolidation with mild
scarring or atelectasis remaining.
2. Small 2 cm and 1 cm areas of patchy opacity of the anterior
base of the left lower lobe and peripheral right upper lobe are
nonspecific but unchanged.
3. No change in 7 mm soft tissue density in the rightchest
wallt, which may represent a sebaceous cyst.
.
[**8-23**] CT C Spine (prelim):
1. No evidence of fracture or malalignment within the cervical
spine.
2. Right upper lobe pulmonary nodule.
.
[**8-23**] CT Head: No intracranial hemorrhage or mass effect.
.
[**8-23**] EKG: NSR 97, lat TWI, no ST changes
.
[**2200-8-25**] TTE: Conclusions:
The left atrium is normal in size. A patent foramen ovale is
present. A
right-to-left shunt across the interatrial septum is seen at
rest. Left
ventricular wall thickness, cavity size, and systolic function
are normal (LVEF>55%). Regional left ventricular wall motion is
normal. There is no
ventricular septal defect. Right ventricular chamber size and
free wall motion are normal. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. Mild (1+)
aortic regurgitation is seen. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no mitral valve prolapse. The pulmonary artery systolic pressure
could not be determined. There is no pericardial effusion.
Compared with the prior study (images reviewed) of [**2199-7-30**], no
change. IMPRESSION: Patent formamen ovale with right to left
shunting at rest (probably mild).
.
[**8-27**]: Right hip XR
IMPRESSION: Limited exam. No obvious right proximal femur
fracture identified. Alignment of the right hip is within normal
limits on the AP view, but not well evaluated on the lateral.
.
[**2200-8-30**] ECG: Sinus tachycardia. Possible right atrial
abnormality. Left ventricular hypertrophy with ST-T wave
abnormalities. The ST-T wave changes are diffuse. Clinical
correlation is suggested. Since the previous tracing of [**2200-8-29**]
sinus tachycardia is now present.


Brief Hospital Course:
A/P: 52yo M w/ CLL s/p alloBMT in [**2188**] with chronic skin GVHD
admitted for hypercarbic respiratory failure of unclear etiology
with GI bleed, leukopenia.
.
1. Respiratory failure-This patient developed apneic hypoxic and
hypercarbic respiratory failure. DDx includes pulmonary GVHD,
pleural fibrosis, sleep apnea, or airway obstruction. DDx for
acute cause of respiratory failure include hypophosphatemia
(0.3), increase in sedation, mucus plug, CVA, or acute head
injury. Pt was intubated and doing well but had poor negative
inspiratory force with moderately reduced combined lung and
chest wall compliance secondary to chronic GVHD changes. Though
he had a favorable RSBI when he was extubated on [**8-28**] he
required reintubation after approx 2 hrs of extubation for
increased work of breathing, likely related to mechanical muscle
weakness.  He had a tracheostomy tube and PEG tube surgically
placed on [**9-4**] for for more slow weaning off the vent via
sprint-rest trach mask trials and was awaiting placement in a
respiratory rehabilitation center, however throughout the week
prior to his death, he was requiring higher vent settings and
continued to desaturate. Repeat bronchoscopy did not alleviate
his respiratory failure and it was felt that he was continuing
to mucous plug secondary to VAP and his inability to clear his
own secretions. His health care proxy (wife) along with the
team, made the decision to make Mr. [**Known lastname 106548**] [**Last Name (Titles) **] measures
only, and expired on the morning of [**2200-9-19**].
.
2. VAP-While awaiting tracheostomy tube placement he developed
increased FIO2 requirement, low-grade fever, and leukopenia with
bandemia in the setting of new LLL and RUL opacity, so [**9-3**] was
started on cefipime, vanco, levofloxacin for VAP. He also was
found to have gram + rods and cocci on sputum culture.
.
3. Leukopenia-he developed leukopenia [**9-2**], with WBC count
trending down during his hospital course, possibly
myelosupression from medication vs infection vs myleodysplastic
syndrome, differential showed bandemia suggestive of infection.
He was on cellcept for GVHD whcih was held starting [**9-4**] but he
was continued on steroid taper and plaquenil and followed by
BMT.
.
4. Chest pain- Around the time of extubation he developed chest
pain with ST-T wave changes on ECG and elevated troponin thought
to be stress induced tropinism. DDx includes cardiac ischemia vs
noncardiac causes including pleuritis due to resolving
pneumonia/fibrosis, esophagitis, ulcer, or myopathy. Aspirin and
heparin were held as he also had bright red blood per recutm,
enzymes trending down, ECG changes resolved. He was maintained
on metoprolol.
.
5. Blood per rectum-he developed BRBPR on [**8-30**] and continued to
have melenotic stools, most likely lower GI source due to rapid
onset, DDx includes diverticulosis, AVM, hemmroids, ulcer,
gastritis, DIC labs neg. GI was consulted but preferred not to
scope emergently as hct stabilized and he was high risk given
recent cardiac changes. He was maintained on pantoprazole [**Hospital1 **].
.
6. Thrombocytopenia: He developed relative thrombocytopenia [**8-30**]
that was likely consumptive (GI bleed) vs drug induced
cellcept/pentamidine) that stablized. DIC labs neg, heparin
dependent antibody neg, cellcept decreased per BMT rec due to
potencial cause of thrombocytopenia .
.
7. HTN-He had quite labile blood pressures ranging from 80's to
200's systolic with tachycardia that were controlled ultimately
with metoprolol, captopril and PRN hydralazine.
.
8. GVHD: chronic cutaneous disease, stable, continued on
fluconazole for fungal prophylaxis, pentamidine for PCP
[**Name Initial (PRE) 1102**] (last [**2200-8-24**]), steroids, plaquenil, but cellcept
held [**9-4**] for leukopenia.
.
9. Chronic renal insufficiency - cyclosporine induced renal
toxicity, baseline creat 1, creatinine stable during this
hospital course.
.


Medications on Admission:
Cellcept 500mg PO BID
Prednisone 40 mg PO QD
Warfarin 1mg PO QD
Plaquenil 200 mg PO bid
Protonix 40mg PO QD
Metoprolol 25mg PO BID
Neurontin 300mg PO QHS
Lorazepam 0.5mg PO QHS prn
Fentanyl patch 50 mcg
Oxycodone 5mg PO Q4-6hrs prn
Pentamidine inh Q monthly - unclear when last dose
[**Name (NI) 10687**] 1 tab PO BID
Simethicone 40-80mg PO QID prn
Famvir - ? dose or start date
Fluconazole - ?dose or start date
Advair

Discharge Medications:
none

Discharge Disposition:
Extended Care

Discharge Diagnosis:
deceased

Discharge Condition:
deceased

Discharge Instructions:
deceased

Followup Instructions:
deceased
{'Acute and chronic respiratory failure,Chronic lymphoid leukemia, without mention of having achieved remission,Complications of transplanted bone marrow,Acute kidney failure, unspecified,Hyperpotassemia,Chronic kidney disease, unspecified,Blood in stool,Pneumonia due to other gram-negative bacteria,Thrombocytopenia, unspecified,Circumscribed scleroderma,Disorder of bone and cartilage, unspecified,Unspecified essential hypertension,Long-term (current) use of steroids,Personal history of other malignant neoplasm of skin,Open wound of scalp, without mention of complication,Unspecified fall,Disorders of phosphorus metabolism,Other chest pain,Foreign body in other specified parts bronchus and lung,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation'}


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: Shortness of [**First Name3 (LF) 1440**]

PRESENT ILLNESS: Mr. [**Known lastname 106548**] is a 52 year old male with history of chronic
lymphocytic leukemia status post allogeneic bone marrow
transplant in [**2188**],
cutaneous GVHD recent admission for pneumonia who presents with
3 days of shortness of [**Year (4 digits) 1440**].
He was feeling "okay" until 3 days prior to admission when he
noted shortness of [**Year (4 digits) 1440**] upon awakening. It was worse with
exertion/walking but improved throughout the day. This occurred
again over the next two days. The shortness of [**Year (4 digits) 1440**] was not
associated with chest pain, palpitations, lightheadedness,
diaphoresis, nausea, vomiting.  He notes orthopnea x several
months. No PND/leg swelling. He does note some
nausea/lightheadedness after taking famvir. He denies fevers,
chills, sweats, worse/productive cough. He denies diarrhea. He
does note some decreased appetite and PO intake.
He called Dr.[**Name (NI) 6168**] office today and was told to increase his
prednisone from 20 mg to 40 mg. Of note, he receives inhaled
pentamadine for PCP [**Name9 (PRE) **] but has missed a few doses. He is unsure
the date of his last dose.
In the ED, the CTA was negative for PE, but notable for
resolving pna and stable tree and [**Male First Name (un) 239**] appearance. He was given 1
dose of ceftriaxone/vanco.  His ECG was sinus 94, old q in avF,
LAD, LVH and new TWI in V4-V6. He was given asa and 1 set of CE
was negative.

MEDICAL HISTORY: 1. Chronic lymphocytic leukemia, status post
allo-bone marrow transplant 10 years ago at [**Hospital1 336**]. Oncologist is
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**].
2. extensive chronic graft vs. host
3. diffuse osteopenia treated with bisphosphonate
4. cyclosporine induced renal toxicity
5. shingles - admitted in [**2197-5-11**] with IV acyclovir
6. left parietal actinic keratosis s/p
nitrogen treatment
7. SCC, R 3rd finger, recurrent, pt referred for Mohs excision
on [**11-15**]

MEDICATION ON ADMISSION: Cellcept 500mg PO BID
Prednisone 40 mg PO QD
Warfarin 1mg PO QD
Plaquenil 200 mg PO bid
Protonix 40mg PO QD
Metoprolol 25mg PO BID
Neurontin 300mg PO QHS
Lorazepam 0.5mg PO QHS prn
Fentanyl patch 50 mcg
Oxycodone 5mg PO Q4-6hrs prn
Pentamidine inh Q monthly - unclear when last dose
[**Name (NI) 10687**] 1 tab PO BID
Simethicone 40-80mg PO QID prn
Famvir - ? dose or start date
Fluconazole - ?dose or start date
Advair

ALLERGIES: Bactrim / Imipenem

PHYSICAL EXAM: VS - T 97.2, BP 110/60, HR 100, RR 22, sats 95% RA
Gen: Thin, cachectic male, +alopecia, NAD, nontoxic, no
increased work of breathing
HEENT: PERRL, EOMI. Sclera anicteric. MMM. OP clear. chronic GVH
scleritic type lesions but no ulcers, vesicles, lesions
suggestive of thrush
NECK: supple, no JVD, no LAD
CV: RR, normal S1, S2. No m/r/g.
Lungs: decreased BS throughout, no wheeze/crackle/rhonci, no
egophony
Abd: SNTND. NABS
Ext: cold hands and feet. Erythematous shins. small areas of
breakdown. Could not palpate PT pulses, 2+ radial pulses
bilaterally. No c/c/e.
Derm: Skin thick, firm, pale.Extensive chronic GVHD of the
scleroderma type.
Neuro: CN II-XII grossly intact.

FAMILY HISTORY: Mother had lung cancer due to tobacco abuse, his father died at
[**Age over 90 **] years of age, his sister died of Asthma at age 51.

SOCIAL HISTORY: Lives in [**Location 4047**], Married for many years, one son 14 years old.
He has been disabled for many years but previously worked as a
systems analyst for several companies throughout his life. No
tob or etoh.  He has 6 brothers and 4 sisters. 

### Response:
{'Acute and chronic respiratory failure,Chronic lymphoid leukemia, without mention of having achieved remission,Complications of transplanted bone marrow,Acute kidney failure, unspecified,Hyperpotassemia,Chronic kidney disease, unspecified,Blood in stool,Pneumonia due to other gram-negative bacteria,Thrombocytopenia, unspecified,Circumscribed scleroderma,Disorder of bone and cartilage, unspecified,Unspecified essential hypertension,Long-term (current) use of steroids,Personal history of other malignant neoplasm of skin,Open wound of scalp, without mention of complication,Unspecified fall,Disorders of phosphorus metabolism,Other chest pain,Foreign body in other specified parts bronchus and lung,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation'}
