CHIEF COMPLAINT: cough, shortness of breath

PRESENT ILLNESS: 22 year old male w/questionable asthma history, hiatal hernia,
and allergies presenting with 2 days of increasing cough,
congestion, with progressive SOB. The patient has a questionable
history of asthma and was prescribed a albuterol inhaler last
year. He has been using the albuterol inhaler multiple times a
week both during the day and at night. His shortness of breath
is exacerbated by exertion and sometimes food intake. It
improves with albuterol and sometimes laying flat. His shortness
of breath is sometimes associated with a chest pressure which
the patient describes as "my chest is going to explode." For the
last 2 days the patient has experienced the new symptoms of
productive cough and sharp non-radiating substernal chest pain
which is exacerbated by deep inspiration and cough. The patient
denies recent travel but has been in contact with [**Name2 (NI) **] contacts
at work who have the flu. He has not received his flu vaccine
this year.The patient denies frank chest pain, palpitations,
dysuria, fevers, arthralgias.
.
The patient says he saw a doctor in the past who diagnosed him
with cat, pollen allergy with "blood tests." He feels nasally
congested all year long and has suffered from "bronchitis" in
the past with at least 1 episode of pneumonia in the last 5
years.
.
He also has been experiencing intermittent watery diarrhea for
years and lower abdominal cramping pain which wakes him up from
sleep in the morning hours. He denies any hematochezia, melena.
He denies nausea and vomiting, weight loss.
.
Upon presentation to the ED vitals were: T 97.4, HR 126, BP
142/86, RR 22, O2Sat 96% RA. The patient was also complaining of
chest pain in the E.D. A D-dimer and cardiac enzymes were
negative. Chest X ray did not show any acute pulmonary process.
He received nebulizers without much effect. He was desaturating
into the 89-92% range on RA and exertion. However his
oxygenation normalized with supplemental oxygen with a venturi
mask. The patient received Combivent X3, Solumedrol 125mg IV for
his respiratory distress and Toradol, Ativan for anxiety and
abdominal pain. He denies nausea and vomiting, diarrhea. Peak
flow was 200cc initially in E.D.
.
Prior to transfer to the floor vitals were: afebrile, HR 141, BP
159/115, RR 20, O2Sat 98% venturi 50%.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, palpitations, or weakness. Denies nausea,
vomiting, constipation. Denies dysuria, frequency, or urgency.
Denies arthralgias or myalgias. Denies rashes or skin changes.

MEDICAL HISTORY: Hiatal Hernia
Fatty Liver
Asthma

MEDICATION ON ADMISSION: Albuterol inhaler

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
Vitals: T afebrile, HR 141, BP 159/115, RR 20, O2Sat 98% venturi
50%.
General: Alert, oriented, no acute distress, overweight male
laying in bed
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs:Inspiratory and longer expiratory wheezes diffusely in all
lung fields. No rales, ronchi auscultated.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops, tachycardic
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Mother with allergies, h/o uterine cancer. Grandfather had MI.
Notable for h/o HTN, HLD, CAD in several family members.

SOCIAL HISTORY: No tobacco or illicit drug use.  Has several beers once or twice
a month. Sexually active in monogamous relationship with fiance.
No recent travel.
Asthma, unspecified type, with (acute) exacerbation,Pneumonia, organism unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other specified cardiac dysrhythmias,Hypoxemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Abdominal pain, epigastric
Asthma NOS w (ac) exac,Pneumonia, organism NOS,Diaphragmatic hernia,Cardiac dysrhythmias NEC,Hypoxemia,Elev transaminase/ldh,Abdmnal pain epigastric
Admission Date:  [**2152-10-24**]              Discharge Date:   [**2152-10-26**]

Date of Birth:  [**2130-4-5**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
cough, shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
22 year old male w/questionable asthma history, hiatal hernia,
and allergies presenting with 2 days of increasing cough,
congestion, with progressive SOB. The patient has a questionable
history of asthma and was prescribed a albuterol inhaler last
year. He has been using the albuterol inhaler multiple times a
week both during the day and at night. His shortness of breath
is exacerbated by exertion and sometimes food intake. It
improves with albuterol and sometimes laying flat. His shortness
of breath is sometimes associated with a chest pressure which
the patient describes as "my chest is going to explode." For the
last 2 days the patient has experienced the new symptoms of
productive cough and sharp non-radiating substernal chest pain
which is exacerbated by deep inspiration and cough. The patient
denies recent travel but has been in contact with [**Name2 (NI) **] contacts
at work who have the flu. He has not received his flu vaccine
this year.The patient denies frank chest pain, palpitations,
dysuria, fevers, arthralgias.
.
The patient says he saw a doctor in the past who diagnosed him
with cat, pollen allergy with "blood tests." He feels nasally
congested all year long and has suffered from "bronchitis" in
the past with at least 1 episode of pneumonia in the last 5
years.
.
He also has been experiencing intermittent watery diarrhea for
years and lower abdominal cramping pain which wakes him up from
sleep in the morning hours. He denies any hematochezia, melena.
He denies nausea and vomiting, weight loss.
.
Upon presentation to the ED vitals were: T 97.4, HR 126, BP
142/86, RR 22, O2Sat 96% RA. The patient was also complaining of
chest pain in the E.D. A D-dimer and cardiac enzymes were
negative. Chest X ray did not show any acute pulmonary process.
He received nebulizers without much effect. He was desaturating
into the 89-92% range on RA and exertion. However his
oxygenation normalized with supplemental oxygen with a venturi
mask. The patient received Combivent X3, Solumedrol 125mg IV for
his respiratory distress and Toradol, Ativan for anxiety and
abdominal pain. He denies nausea and vomiting, diarrhea. Peak
flow was 200cc initially in E.D.
.
Prior to transfer to the floor vitals were: afebrile, HR 141, BP
159/115, RR 20, O2Sat 98% venturi 50%.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, palpitations, or weakness. Denies nausea,
vomiting, constipation. Denies dysuria, frequency, or urgency.
Denies arthralgias or myalgias. Denies rashes or skin changes.

Past Medical History:
Hiatal Hernia
Fatty Liver
Asthma

Social History:
No tobacco or illicit drug use.  Has several beers once or twice
a month. Sexually active in monogamous relationship with fiance.
No recent travel.

Family History:
Mother with allergies, h/o uterine cancer. Grandfather had MI.
Notable for h/o HTN, HLD, CAD in several family members.

Physical Exam:
Admission Exam:
Vitals: T afebrile, HR 141, BP 159/115, RR 20, O2Sat 98% venturi
50%.
General: Alert, oriented, no acute distress, overweight male
laying in bed
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs:Inspiratory and longer expiratory wheezes diffusely in all
lung fields. No rales, ronchi auscultated.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops, tachycardic
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Discharge Exam:
Vitals:  98.3 140/84 110 18 96% RA
General: awake, alert, NAD
HEENT: NCAT, PEERL, EOMI, sclera anicteric, MMM, OP clear
Neck: supple, no LAD, no JVD
CV: RRR, normal S1  S2, no r/m/g appreciated
Lungs: scattered bilateral inspiratory and expiratory wheezing,
most notable in lower posterior lung fields and anterior lung
fields, no crackles/rhonchi appreciated
Abdomen: bowel sounds present, soft, non-tender, non-distended,
bowel sounds present, no rebound tenderness or guarding, no
organomegaly
Ext: warm, well perfused, DPs 2+, no clubbing, cyanosis or edema


Pertinent Results:
Admission Labs:
[**2152-10-23**] 08:47PM BLOOD WBC-12.1* RBC-5.71 Hgb-17.1 Hct-46.1
MCV-81* MCH-29.9 MCHC-37.0* RDW-13.7 Plt Ct-225
[**2152-10-23**] 08:47PM BLOOD Neuts-84.0* Lymphs-9.3* Monos-4.7 Eos-1.4
Baso-0.6
[**2152-10-23**] 08:47PM BLOOD Glucose-90 UreaN-11 Creat-0.9 Na-139
K-4.0 Cl-105 HCO3-21* AnGap-17
[**2152-10-23**] 08:47PM BLOOD ALT-101* AST-48* CK(CPK)-230 AlkPhos-69
TotBili-0.9
[**2152-10-23**] 08:47PM BLOOD Lipase-19
[**2152-10-23**] 08:47PM BLOOD CK-MB-3 proBNP-78
[**2152-10-24**] 12:10AM BLOOD D-Dimer-161
[**2152-10-23**] 08:47PM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG
[**2152-10-23**] 08:47PM BLOOD cTropnT-<0.01
.
Other Labs:
[**2152-10-24**] 04:36AM BLOOD Lactate-1.2
[**2152-10-25**] 06:14AM BLOOD HIV Ab-NEGATIVE
.
Discharge Labs:
[**2152-10-26**] 06:20AM BLOOD WBC-7.3 RBC-5.48 Hgb-16.5 Hct-46.4 MCV-85
MCH-30.0 MCHC-35.5* RDW-13.2 Plt Ct-234
[**2152-10-26**] 06:20AM BLOOD PT-11.6 PTT-19.9* INR(PT)-1.0
[**2152-10-26**] 06:20AM BLOOD Glucose-108* UreaN-14 Creat-1.0 Na-143
K-3.4 Cl-102 HCO3-30 AnGap-14
[**2152-10-26**] 06:20AM BLOOD ALT-77* AST-35 AlkPhos-62 TotBili-0.4
[**2152-10-26**] 06:20AM BLOOD Calcium-10.1 Phos-5.2*# Mg-2.5
.
Urine:
[**2152-10-23**] 11:55PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.009
[**2152-10-23**] 11:55PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG
[**2152-10-24**] 01:07AM URINE cocaine-NEG
.
Microbiology:
[**2152-10-24**] Respiratory Culture: No respiratory viruses isolated.
Culture screened for Adenovirus, Influenza A & B, Parainfluenza
type 1, 2 & 3, and Respiratory Syncytial Virus.
.
[**2152-10-24**] Respiratory Viral Antigen Screen: Negative for
Respiratory Viral Antigen. Specimen screened for: Adeno,
Parainfluenza 1, 2, 3, Influenza A, B, and RSV by
immunofluorescence.
.
[**2152-10-25**]: HIV Viral Load negative
[**2152-10-25**]: Urine legionella antigen negative
.
Imaging:
[**2152-10-23**] CXR: No acute cardiopulmonary process.
.
[**2152-10-24**] CXR: As compared to the previous radiograph, there is
no relevant
change. Normal size of the cardiac silhouette. Normal appearance
of the
hilar and mediastinal structures. No pleural effusions. No
pneumothorax.
Normal appearance of the lung parenchyma, no acute pulmonary
changes.
.
[**2152-10-24**] CTA Chest:
1. Multifocal geographic ground-glass opacities throughout both
lungs, the
appearance is suggestive of foreign substance inhalation,
although with an
appropriate clinical history, aspiration, hemorrhage and viral
pneumonia are also considered possible.
2. No evidence of pulmonary embolism.
.
[**2152-10-25**] EKG: Sinus tachycardia. RSR' pattern in lead V1. Since
the previous tracing of [**2152-10-23**] the rate is slower. ST-T wave
abnormalities are less prominent. RSR' pattern in leads V1-V2 is
not seen.

Brief Hospital Course:
22yo male with h/o hiatal hernia, allergies, and asthma who
initially presented with two days of increasing cough and
shortness of breath, likely secondary to acute on chronic asthma
exacerbation in setting of infectious process.
.
#. Asthma Exacerbation: Patient initially treated in the MICU
for presumed asthma exacerbation with nebulizers and steroids.
Exacerbation likely secondary to either viral or atypical
pneumonia, based on CT chest findings.  CTA was done given
hypoxia and respiratory distress; did not show evidence of PE
but did show findings concerning for left mid-lower lung
pneumonia, for which he was started on ceftriaxone and
azithromycin. Of note, urine legionella antigen negative, HIV
antibody and viral load negative, and respiratory viral antigen
screen and viral culture negative.  Patient's symptoms improved
rapidly and he was transferred to the floor.  He was discharged
on a short prednisone taper, and instructed to start using an
inhaled steroid (fluticasone) after completing taper.  He was
also discharged on azithromycin to complete 5 day course of
treatment for presumed pneumonia.  Will have outpatient
pulmonology follow-up and PFTs.
.
#. Transaminitis: Patient noted to have mild ALT and AST
elevation, which trended down during hospital course.  Elevation
nonspecific and perhaps part of an acute viral syndrome. Of
note, patient reports history of being diagnosed with "fatty
liver."  If transaminitis persists, can have further workup as
an outpatient.
.
#. Abdominal Pain: Patient reported mild abdominal pain during
this admission, particularly in epigastric area, that resolved
prior to discharge.  Of note, patient has had previous work-up
for abdominal pain including EGD and colonoscopy per report, and
has been diagnosed with a hiatal hernia. Pain may be secondary
to GERD symptoms in setting of hiatal hernia. Patient was
started on PPI.

Medications on Admission:
Albuterol inhaler

Discharge Medications:
1. azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
Disp:*3 Tablet(s)* Refills:*0*
2. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation every 4-6 hours as needed for shortness of
breath or wheezing.
3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
4. prednisone 10 mg Tablet Sig: as directed Tablet PO once a day
for 10 days: take 6 tabs on first day, then take 4 tabs for 2
days, then take 2 tabs for 2 days, then take 1 tab for 2 days,
then stop.
Disp:*18 Tablet(s)* Refills:*0*
5. fluticasone 110 mcg/Actuation Aerosol Sig: One (1) INH
Inhalation twice a day: please start after you finish
prednisone.
Disp:*1 device* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosies:
Asthma Exacerbation
Community-acquired pneumonia

Secondary Diagnoses:
Fatty liver
GERD


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Mr. [**Known lastname **],

It was a pleasure taking care of you during your stay at [**Hospital1 1535**].  You were admitted to the
hospital with cough and shortness of breath.  Your symptoms were
likely due to an asthma exacerbation, which may have been
triggered by a pneumonia.

We treated you with steroids, nebulizer treatments, and
antibiotics, and your symptoms improved.  You will need to take
a steroid taper over the next several days, and after you finish
the prednisone, you should start taking an inhaled steroid
called fluticasone.

We made the following changes to your medications while you were
here:
1. STARTED prednisone
2. STARTED azithromycin (an antibiotic)
3. WILL START fluticasone (after you finish the prednisone)
4. STARTED omeprazole

Please continue to use your albuterol inhaler as needed for
shortness of breath or wheezing symptoms.

Please follow-up with your new primary care doctor, Dr. [**Last Name (STitle) **],
on [**2152-11-14**].  The clinic number is [**Telephone/Fax (1) 250**] if you
have any questions. You should also be seen next week in the
[**Hospital 1944**] [**Hospital 702**] clinic, to make sure your asthma
continues to improve.  Please call [**Telephone/Fax (1) 250**] on Monday
[**2152-10-30**] to make an appointment.

You should also see a pulmonologist (lung specialist) to further
evaluate your asthma.

Followup Instructions:
Please call the [**Hospital6 733**] Clinic at [**Telephone/Fax (1) 250**] to
schedule an appointment next week.  You will have a follow-up
appointment with your new primary care doctor in 2 weeks, but it
is important that a doctor see you next week to be sure that
your asthma symptoms are continuing to improve.

Department: [**Hospital3 249**]
When: TUESDAY [**2152-11-14**] at 3:45 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 13210**], MD [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

You should also see a pulmonologist.  The clinic number for Dr.
[**Last Name (STitle) **] is [**Telephone/Fax (1) 612**].  Please call to schedule an appointment
with either Dr. [**Last Name (STitle) **] or the first available specialist.  If you
have any difficulty scheduling this appointment, please call Dr.
[**Last Name (STitle) **] in clinic at [**Telephone/Fax (1) 250**].


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Asthma, unspecified type, with (acute) exacerbation,Pneumonia, organism unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other specified cardiac dysrhythmias,Hypoxemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Abdominal pain, epigastric'}


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: cough, shortness of breath

PRESENT ILLNESS: 22 year old male w/questionable asthma history, hiatal hernia,
and allergies presenting with 2 days of increasing cough,
congestion, with progressive SOB. The patient has a questionable
history of asthma and was prescribed a albuterol inhaler last
year. He has been using the albuterol inhaler multiple times a
week both during the day and at night. His shortness of breath
is exacerbated by exertion and sometimes food intake. It
improves with albuterol and sometimes laying flat. His shortness
of breath is sometimes associated with a chest pressure which
the patient describes as "my chest is going to explode." For the
last 2 days the patient has experienced the new symptoms of
productive cough and sharp non-radiating substernal chest pain
which is exacerbated by deep inspiration and cough. The patient
denies recent travel but has been in contact with [**Name2 (NI) **] contacts
at work who have the flu. He has not received his flu vaccine
this year.The patient denies frank chest pain, palpitations,
dysuria, fevers, arthralgias.
.
The patient says he saw a doctor in the past who diagnosed him
with cat, pollen allergy with "blood tests." He feels nasally
congested all year long and has suffered from "bronchitis" in
the past with at least 1 episode of pneumonia in the last 5
years.
.
He also has been experiencing intermittent watery diarrhea for
years and lower abdominal cramping pain which wakes him up from
sleep in the morning hours. He denies any hematochezia, melena.
He denies nausea and vomiting, weight loss.
.
Upon presentation to the ED vitals were: T 97.4, HR 126, BP
142/86, RR 22, O2Sat 96% RA. The patient was also complaining of
chest pain in the E.D. A D-dimer and cardiac enzymes were
negative. Chest X ray did not show any acute pulmonary process.
He received nebulizers without much effect. He was desaturating
into the 89-92% range on RA and exertion. However his
oxygenation normalized with supplemental oxygen with a venturi
mask. The patient received Combivent X3, Solumedrol 125mg IV for
his respiratory distress and Toradol, Ativan for anxiety and
abdominal pain. He denies nausea and vomiting, diarrhea. Peak
flow was 200cc initially in E.D.
.
Prior to transfer to the floor vitals were: afebrile, HR 141, BP
159/115, RR 20, O2Sat 98% venturi 50%.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, palpitations, or weakness. Denies nausea,
vomiting, constipation. Denies dysuria, frequency, or urgency.
Denies arthralgias or myalgias. Denies rashes or skin changes.

MEDICAL HISTORY: Hiatal Hernia
Fatty Liver
Asthma

MEDICATION ON ADMISSION: Albuterol inhaler

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:
Vitals: T afebrile, HR 141, BP 159/115, RR 20, O2Sat 98% venturi
50%.
General: Alert, oriented, no acute distress, overweight male
laying in bed
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs:Inspiratory and longer expiratory wheezes diffusely in all
lung fields. No rales, ronchi auscultated.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops, tachycardic
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Mother with allergies, h/o uterine cancer. Grandfather had MI.
Notable for h/o HTN, HLD, CAD in several family members.

SOCIAL HISTORY: No tobacco or illicit drug use.  Has several beers once or twice
a month. Sexually active in monogamous relationship with fiance.
No recent travel. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Pneumonia, organism unspecified,Diaphragmatic hernia without mention of obstruction or gangrene,Other specified cardiac dysrhythmias,Hypoxemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Abdominal pain, epigastric'}
