CHIEF COMPLAINT: shortness of breath, ICU transfer for unstable respiratory
status

PRESENT ILLNESS: 63M with Hx of COPD, recent hospital stay for COPD exacerbation
due to Influenza A viral (antigen+) [**Date range (1) **], returns with 2d
worsening dyspnea, continued productive cough, and subjective
fevers at home. Patient was treated with prednisone 50 mg x 5
days, antibiotics x 5 days, and nebulized albuterol, tiotropium
and fluticasone. Patient improved within the first two days,
with normal O2 Sats on room air, was discharged with two more
days of
antibiotics (Azythromycin) and prednisone 50mg. Currently he
reports...
In the ED: sats initially 80s on RA, up to mid 90s on 3L. CxR
showing new lobar PNA ceftriaxone, cefepime, vanco, nebs.
Vitals: 102 107/55 93% 4L 20. Has had tenuous sat in ED and 3-4L
NC, desatted on nebulizer. ABG okay, but working on NRB
.
.
On the floor, pt feel much better, satting 90% on 60% face mask,
changed to NRB.
ROS: 2 days of worsening SOB, tightness, and subjective fevers,
no CP, no dizziness, no n/v/ but some loose stools atributed to
milk and cereal.

MEDICAL HISTORY: - COPD: mild-moderate; FEV1 66% predicted, FEV1/FVC 80%
predicted
- Cauda equina syndrome: dx [**8-7**], s/p L2-laminectomy in [**11-6**],
with baseline BLE paresis, neuropathic pain, and neurogenic
bladder/bowel
- Abdominal pain / Dyspepsia
- H. pylori gastritis, s/p treatment; ?hiatal hernia on CXR
today
- Hyperthyroidism [**1-9**] [**Doctor Last Name 933**] disease s/p radioi-active iodine
ablation [**10/2191**], now on replacement therapy
- Erectile dysfunction
- h/o Pneumonia, [**2186**]
- L hip sebaceous cyst
- chronic groin pain, on Ultram

MEDICATION ON ADMISSION: 1. Albuterol
2. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

ALLERGIES: Primidone

PHYSICAL EXAM: Vitals: T: BP: 120/73 P: 102 R: 16 18 O2 99% NRB:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: good air movement, minimal posterior wheezes, and left
lll crackles,
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops, distant
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Denies any major family illnesses. Father died age [**Age over 90 **], mother
died age [**Age over 90 **]. Sister w/breast cancer. No premature heart disease
or other cancers.

SOCIAL HISTORY: 60 pk-yr smoker, quit 5 yrs ago. Denies EtOH use, no IVDA. He is
divorced and lives alone in [**Location 4288**]. He went on disability
after the surgery for the cauda equina syndrome. Semi-retired,
previously worked in administration for construction company.
Methicillin resistant pneumonia due to Staphylococcus aureus,Obstructive chronic bronchitis with (acute) exacerbation,Cauda equina syndrome without mention of neurogenic bladder,Esophageal reflux,Other chronic pain,Postsurgical hypothyroidism,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus
Meth res pneu d/t Staph,Obs chr bronc w(ac) exac,Cauda equina synd NOS,Esophageal reflux,Chronic pain NEC,Postsurgical hypothyroid,Meth resis Staph carrier
Admission Date:  [**2192-2-3**]              Discharge Date:   [**2192-2-9**]

Date of Birth:  [**2128-12-25**]             Sex:   M

Service: MEDICINE

Allergies:
Primidone

Attending:[**First Name3 (LF) 2167**]
Chief Complaint:
shortness of breath, ICU transfer for unstable respiratory
status

Major Surgical or Invasive Procedure:
none

History of Present Illness:
63M with Hx of COPD, recent hospital stay for COPD exacerbation
due to Influenza A viral (antigen+) [**Date range (1) **], returns with 2d
worsening dyspnea, continued productive cough, and subjective
fevers at home. Patient was treated with prednisone 50 mg x 5
days, antibiotics x 5 days, and nebulized albuterol, tiotropium
and fluticasone. Patient improved within the first two days,
with normal O2 Sats on room air, was discharged with two more
days of
antibiotics (Azythromycin) and prednisone 50mg. Currently he
reports...
In the ED: sats initially 80s on RA, up to mid 90s on 3L. CxR
showing new lobar PNA ceftriaxone, cefepime, vanco, nebs.
Vitals: 102 107/55 93% 4L 20. Has had tenuous sat in ED and 3-4L
NC, desatted on nebulizer. ABG okay, but working on NRB
.
.
On the floor, pt feel much better, satting 90% on 60% face mask,
changed to NRB.
ROS: 2 days of worsening SOB, tightness, and subjective fevers,
no CP, no dizziness, no n/v/ but some loose stools atributed to
milk and cereal.


Past Medical History:
- COPD: mild-moderate; FEV1 66% predicted, FEV1/FVC 80%
predicted
- Cauda equina syndrome: dx [**8-7**], s/p L2-laminectomy in [**11-6**],
with baseline BLE paresis, neuropathic pain, and neurogenic
bladder/bowel
- Abdominal pain / Dyspepsia
- H. pylori gastritis, s/p treatment; ?hiatal hernia on CXR
today
- Hyperthyroidism [**1-9**] [**Doctor Last Name 933**] disease s/p radioi-active iodine
ablation [**10/2191**], now on replacement therapy
- Erectile dysfunction
- h/o Pneumonia, [**2186**]
- L hip sebaceous cyst
- chronic groin pain, on Ultram


Social History:
60 pk-yr smoker, quit 5 yrs ago. Denies EtOH use, no IVDA. He is
divorced and lives alone in [**Location 4288**]. He went on disability
after the surgery for the cauda equina syndrome. Semi-retired,
previously worked in administration for construction company.


Family History:
Denies any major family illnesses. Father died age [**Age over 90 **], mother
died age [**Age over 90 **]. Sister w/breast cancer. No premature heart disease
or other cancers.

Physical Exam:
Vitals: T: BP: 120/73 P: 102 R: 16 18 O2 99% NRB:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: good air movement, minimal posterior wheezes, and left
lll crackles,
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops, distant
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema


Pertinent Results:
[**2192-2-3**] 06:15AM   PLT COUNT-194
[**2192-2-3**] 06:15AM   WBC-6.2 RBC-5.53 HGB-14.9 HCT-45.7 MCV-83
MCH-26.9* MCHC-32.6 RDW-15.2
[**2192-2-3**] 06:15AM   ALT(SGPT)-49* AST(SGOT)-38 ALK PHOS-71 TOT
BILI-0.7
[**2192-2-3**] 06:24AM   LACTATE-1.3
[**2192-2-3**] 08:25AM   LACTATE-1.0
[**2192-2-3**] 08:25AM   TYPE-ART PO2-77* PCO2-33* PH-7.46* TOTAL
CO2-24 BASE XS-0 INTUBATED-NOT INTUBA

[**2-3**] CXR:
FINDINGS: There has been interval development of new patchy
opacities
projecting over the left mid and lower hemithorax with stable
appearance to left basilar atelectasis and elevation of the left
hemidiaphragm. Remaining lungs appear clear. No large effusions
or pneumothorax, pulmonary edema is identified. IMPRESSION: New
left-sided pneumonia.


Brief Hospital Course:
Assessment and Plan: This is a 63 yo with COPD, recent hospital
stay for Influenza A, returning with SOB and CxR showing new
left sided PNA.

# SOB: combination of COPD exacerbation in the setting of viral
and now bacterial superinfection. good air movement, not
tachypnic, not retaining
Recv'd abx for HAP. Gram positive cocci in pairs, sensitivities
pend, MRSA screen +
Recv'd Solumedrol 3 doses with quick taper of po prednisone
afterwards. Remained influenza positive.  Weaned o2 - not on at
d/c. Started with standing nebs - transitioned to prn.
.
#. Hyperthyroidism - The patient had a history of Grave's
disease s/p radioactive iodine ablation.  Synthroid was
continued at home dose.
.
#. GERD / dyspepsia - The patient had a history of H Pylori
gastritis, s/p tx with ongoing symptoms. CXR showed large hiatal
hernia.  Home regimen of Protonix 20mg daily and Pepcid [**Hospital1 **] was
continued.
.
#. Cauda equina syndrome - Symptoms were at baseline per
patient, with right foot drop requiring brace, which he brought
with him.  Gabapentin was continued at outpatient dose.
.
#. Chronic pain - Tramadol and ibuprofen PRN. High dose
Gabapentin, stabilized at home, but impressive dose. pt insists
on continuation of this dose. will cont for now, needs to be
readressed on the floor and as outpatient
.
# FEN: 1L NS IVF, repletee electrolytes prn, regular diet
.
# Prophylaxis: Subcutaneous heparin

Medications on Admission:
1. Albuterol
2. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

3. Fluticasone 110 mcg
4. Gabapentin 800 mg, PO Q4H
5. Omeprazole 20 mg Capsule
6. Levothyroxine 125 mcg
7. Tramadol 50 mg  PO DAILY (Daily).
8. Tiotropium Bromide 18 mcg Capsule, w/Inhalation
9. Calcium Carbonate 500 mg 3 times a day
10. Cholecalciferol (Vitamin D3) 400 unit [**Unit Number **] times a day
11. Multivitamin,Tx-Minerals
12. Cyanocobalamin  Oral
13. Pepcid  Oral
14. Prednisone 50 mg PO DAILY 2 days.
15. Azithromycin 250 mg Tablet PO Q24H for 2 days.
16. Ibuprofen 400 mg  PO Q8H as needed.

Discharge Medications:
1. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

2. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
3. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
5. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO QID (4 times a day).
7. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO TID (3 times a day).
8. Cyanocobalamin 500 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
9. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
10. Omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
11. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q4H (every 4 hours) as needed.
12. Prednisone 10 mg Tablet Sig: One (1) dose PO DAILY (Daily)
for 6 days: TWO tablets on days 1 and 2, ONE tablet on day 3 and
4, and half a tablet on days 5 and 6.  Stop on day 7 .
Disp:*7 tablets* Refills:*0*
13. Gabapentin 400 mg Capsule Sig: Two (2) Capsule PO 6 TIMES A
DAY ().
14. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO at bedtime as
needed for insomnia.
15. Pepcid 40 mg Tablet Sig: One (1) Tablet PO once a day.
16. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*60 Tablet(s)* Refills:*0*
17. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary
Bacterial pneumonia
Influenza
COPD

Secondary
Chronic pain
Hypothyroid


Discharge Condition:
Improved


Discharge Instructions:
You were admitted with pneumonia after having had influenza.
You received antibiotics for seven days and improved during the
course of your admission.

Please take the medications we have prescribed as directed.

Please call your doctor or return to the ER for:
* Increased shrortness of breath
* Fevers, chills, nausea, vomiting
* Worsening symtpoms
* With any new or concerning issues

Followup Instructions:
Please call Dr. [**Last Name (STitle) 13959**] [**Telephone/Fax (1) 250**] and Dr. [**Last Name (STitle) **]
[**Telephone/Fax (1) 612**] tomorrow to arrange for follow-up appointments
early next week.  It is important that you mention that you were
recently hospitalized for pneumonia and will need close
follow-up.

Please keep your other appointments as scheduled below:

Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2192-2-10**] 10:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5340**], MD Phone:[**Telephone/Fax (1) 1803**]
Date/Time:[**2192-3-23**] 4:40
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13960**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2192-4-16**] 8:00





Name:  [**Known lastname **],[**Known firstname 63**]                    Unit No:   [**Numeric Identifier 6748**]

Admission Date:  [**2192-2-3**]              Discharge Date:   [**2192-2-9**]

Date of Birth:  [**2128-12-25**]             Sex:   M

Service: MEDICINE

Allergies:
Primidone

Attending:[**First Name3 (LF) 6749**]
Addendum:
Regarding Mr. [**Known lastname 6750**] shortness of breath - he was influenza
positive and was superinfected and being actively treated for
HAP which speciated MRSA in his sputum.

Discharge Disposition:
Home

                             [**First Name11 (Name Pattern1) 1194**] [**Last Name (NamePattern1) 6751**] MD [**MD Number(2) 6752**]

Completed by:[**2192-3-5**]
{'Methicillin resistant pneumonia due to Staphylococcus aureus,Obstructive chronic bronchitis with (acute) exacerbation,Cauda equina syndrome without mention of neurogenic bladder,Esophageal reflux,Other chronic pain,Postsurgical hypothyroidism,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus'}


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 breath, ICU transfer for unstable respiratory
status

PRESENT ILLNESS: 63M with Hx of COPD, recent hospital stay for COPD exacerbation
due to Influenza A viral (antigen+) [**Date range (1) **], returns with 2d
worsening dyspnea, continued productive cough, and subjective
fevers at home. Patient was treated with prednisone 50 mg x 5
days, antibiotics x 5 days, and nebulized albuterol, tiotropium
and fluticasone. Patient improved within the first two days,
with normal O2 Sats on room air, was discharged with two more
days of
antibiotics (Azythromycin) and prednisone 50mg. Currently he
reports...
In the ED: sats initially 80s on RA, up to mid 90s on 3L. CxR
showing new lobar PNA ceftriaxone, cefepime, vanco, nebs.
Vitals: 102 107/55 93% 4L 20. Has had tenuous sat in ED and 3-4L
NC, desatted on nebulizer. ABG okay, but working on NRB
.
.
On the floor, pt feel much better, satting 90% on 60% face mask,
changed to NRB.
ROS: 2 days of worsening SOB, tightness, and subjective fevers,
no CP, no dizziness, no n/v/ but some loose stools atributed to
milk and cereal.

MEDICAL HISTORY: - COPD: mild-moderate; FEV1 66% predicted, FEV1/FVC 80%
predicted
- Cauda equina syndrome: dx [**8-7**], s/p L2-laminectomy in [**11-6**],
with baseline BLE paresis, neuropathic pain, and neurogenic
bladder/bowel
- Abdominal pain / Dyspepsia
- H. pylori gastritis, s/p treatment; ?hiatal hernia on CXR
today
- Hyperthyroidism [**1-9**] [**Doctor Last Name 933**] disease s/p radioi-active iodine
ablation [**10/2191**], now on replacement therapy
- Erectile dysfunction
- h/o Pneumonia, [**2186**]
- L hip sebaceous cyst
- chronic groin pain, on Ultram

MEDICATION ON ADMISSION: 1. Albuterol
2. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

ALLERGIES: Primidone

PHYSICAL EXAM: Vitals: T: BP: 120/73 P: 102 R: 16 18 O2 99% NRB:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: good air movement, minimal posterior wheezes, and left
lll crackles,
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops, distant
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Denies any major family illnesses. Father died age [**Age over 90 **], mother
died age [**Age over 90 **]. Sister w/breast cancer. No premature heart disease
or other cancers.

SOCIAL HISTORY: 60 pk-yr smoker, quit 5 yrs ago. Denies EtOH use, no IVDA. He is
divorced and lives alone in [**Location 4288**]. He went on disability
after the surgery for the cauda equina syndrome. Semi-retired,
previously worked in administration for construction company. 

### Response:
{'Methicillin resistant pneumonia due to Staphylococcus aureus,Obstructive chronic bronchitis with (acute) exacerbation,Cauda equina syndrome without mention of neurogenic bladder,Esophageal reflux,Other chronic pain,Postsurgical hypothyroidism,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus'}
