CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 62 year old
male with longstanding, severe chronic obstructive pulmonary
disease, requiring home oxygen and with a recent exacerbation
in [**2180-2-19**] requiring [**Hospital6 2018**]-Medicine Intensive Care Unit admission, intubation and
antibiotics who presents two days after discharge to
rehabilitation, with shortness of breath.  The patient was
admitted to [**Hospital6 256**] on [**2180-3-2**] with shortness of breath requiring intubation and a
Medicine Intensive Care Unit stay, with a course complicated
by a non-Q wave myocardial infarction.  The patient was
treated for ................. pneumonia and discharged to
[**Hospital **] rehabilitation on [**2180-3-10**].  The patient was
then discharged to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**] House on [**2180-3-24**].  The
patient was discharged from [**Hospital **] Rehabilitation on a
medicine regimen that differed from his previously which had
included chronic Prednisone 20 mg q.d.  The patient at this
time of discharge from [**Hospital **] Rehabilitation was not on any
chronic Prednisone dosage.  Over the next two days, the
patient noted that he had increased shortness of breath, a
productive cough with sputum change to a yellow color,
increased watery eyes, and increased nasal discharge.  On the
morning of [**2180-3-26**], the patient noted that he was in
extreme shortness of breath and "couldn't do this anymore."
The patient called 9-1-1 and was taken to the [**Hospital6 1760**] Emergency Department.  The
patient denies recent fevers, chest pain, nausea, vomiting,
abdominal pain, change in stools, diarrhea, constipation,
dysuria, or joint pain.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease - Per the patient
diagnosed since [**2163**].  On home oxygen, 2 liters nasal cannula
for 24 hours a day.  Has been on chronic Prednisone 20 mg a
day for multiple months.  The patient sleeps on three
pillows.  He can not lay flat secondary to shortness of
breath.  No pulmonary function tests were on record for our
examination.
2.  Asthma.
3.  Coronary artery disease - Non-Q wave myocardial
infarction in [**2180-2-19**] - Cardiac echocardiogram on [**2180-3-7**] showed ejection fraction of 55%, right ventricular
wall hypertrophy and cavity dilatation with marked wall
motion hypokinesis, normal left and right atria, left
ventricular wall thickness but no wall motion abnormalities.
Mild tricuspid regurgitation and mitral regurgitation.
Moderate pulmonary artery systolic hypertension.  Upon
discharge in [**2180-2-19**], the patient had been recommended to
have an outpatient stress test; the patient is awaiting
outpatient workup.
4.  Hypertension.
5.  Hypercholesterolemia.
6.  History of stroke.
7.  Seizure disorder.
8.  Atopic dermatitis.
9.  Iron deficiency anemia/anemia of chronic disease.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has a questionable allergy to Bactrim
which causes edema.

PHYSICAL EXAM: 

FAMILY HISTORY: Notable for the patient might have one
brother with diabetes mellitus although the patient is unsure
of this.  The patient denies health problems in any of his
three other siblings who are between the ages of 70 and 80
years old.  The patient notes five children to be in good
health with no known health problems.  The patient denies any
family history of cancer or heart disease.

SOCIAL HISTORY: The patient's social history is notable for
the patient smoking one to two packs per day for 20+ years.
Per the patient he quit in [**2163**].  Per the social worker and
resident nurse [**First Name8 (NamePattern2) **] [**Name (NI) **] [**Name (NI) 34620**] House there is evidence that
either the patient is smoking in his apartment or someone
else is smoking in the patient's apartment where the patient
has his home oxygen.  The patient also has a history of
alcohol (one-half pint of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**] per day), per the
patient he quit in [**2163**].  The patient has a history of
marijuana use.  The patient denies intravenous drug use or
further street drug use.  The patient lives at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**]
House, a home for the homeless elderly.  He has a Section
VIII Housing apartment there.  The patient has multiple
children, but all but one live in [**State 2748**].  The patient
has one daughter who lives in [**Name (NI) 16174**], her name is [**Name (NI) 19948**],
the patient also has a nephew who lives in [**Name (NI) 86**] and checks
in on the patient, nephew's name is [**Name (NI) **] [**Name (NI) **].
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Other convulsions,Iron deficiency anemia, unspecified,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Abnormality of gait,Personal history of tobacco use
Acute respiratry failure,Obs chr bronc w(ac) exac,Convulsions NEC,Iron defic anemia NOS,Old myocardial infarct,Crnry athrscl natve vssl,Hypertension NOS,Abnormality of gait,History of tobacco use
Admission Date:  [**2180-3-26**]       Discharge Date:  [**2180-4-1**]

Date of Birth:   [**2118-2-15**]       Sex:  M

Service:  [**Hospital1 139**]

HISTORY OF PRESENT ILLNESS:  The patient is a 62 year old
male with longstanding, severe chronic obstructive pulmonary
disease, requiring home oxygen and with a recent exacerbation
in [**2180-2-19**] requiring [**Hospital6 2018**]-Medicine Intensive Care Unit admission, intubation and
antibiotics who presents two days after discharge to
rehabilitation, with shortness of breath.  The patient was
admitted to [**Hospital6 256**] on [**2180-3-2**] with shortness of breath requiring intubation and a
Medicine Intensive Care Unit stay, with a course complicated
by a non-Q wave myocardial infarction.  The patient was
treated for ................. pneumonia and discharged to
[**Hospital **] rehabilitation on [**2180-3-10**].  The patient was
then discharged to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**] House on [**2180-3-24**].  The
patient was discharged from [**Hospital **] Rehabilitation on a
medicine regimen that differed from his previously which had
included chronic Prednisone 20 mg q.d.  The patient at this
time of discharge from [**Hospital **] Rehabilitation was not on any
chronic Prednisone dosage.  Over the next two days, the
patient noted that he had increased shortness of breath, a
productive cough with sputum change to a yellow color,
increased watery eyes, and increased nasal discharge.  On the
morning of [**2180-3-26**], the patient noted that he was in
extreme shortness of breath and "couldn't do this anymore."
The patient called 9-1-1 and was taken to the [**Hospital6 1760**] Emergency Department.  The
patient denies recent fevers, chest pain, nausea, vomiting,
abdominal pain, change in stools, diarrhea, constipation,
dysuria, or joint pain.

ALLERGIES:  The patient has a questionable allergy to Bactrim
which causes edema.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease - Per the patient
diagnosed since [**2163**].  On home oxygen, 2 liters nasal cannula
for 24 hours a day.  Has been on chronic Prednisone 20 mg a
day for multiple months.  The patient sleeps on three
pillows.  He can not lay flat secondary to shortness of
breath.  No pulmonary function tests were on record for our
examination.
2.  Asthma.
3.  Coronary artery disease - Non-Q wave myocardial
infarction in [**2180-2-19**] - Cardiac echocardiogram on [**2180-3-7**] showed ejection fraction of 55%, right ventricular
wall hypertrophy and cavity dilatation with marked wall
motion hypokinesis, normal left and right atria, left
ventricular wall thickness but no wall motion abnormalities.
Mild tricuspid regurgitation and mitral regurgitation.
Moderate pulmonary artery systolic hypertension.  Upon
discharge in [**2180-2-19**], the patient had been recommended to
have an outpatient stress test; the patient is awaiting
outpatient workup.
4.  Hypertension.
5.  Hypercholesterolemia.
6.  History of stroke.
7.  Seizure disorder.
8.  Atopic dermatitis.
9.  Iron deficiency anemia/anemia of chronic disease.

FAMILY HISTORY:  Notable for the patient might have one
brother with diabetes mellitus although the patient is unsure
of this.  The patient denies health problems in any of his
three other siblings who are between the ages of 70 and 80
years old.  The patient notes five children to be in good
health with no known health problems.  The patient denies any
family history of cancer or heart disease.

SOCIAL HISTORY:  The patient's social history is notable for
the patient smoking one to two packs per day for 20+ years.
Per the patient he quit in [**2163**].  Per the social worker and
resident nurse [**First Name8 (NamePattern2) **] [**Name (NI) **] [**Name (NI) 34620**] House there is evidence that
either the patient is smoking in his apartment or someone
else is smoking in the patient's apartment where the patient
has his home oxygen.  The patient also has a history of
alcohol (one-half pint of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**] per day), per the
patient he quit in [**2163**].  The patient has a history of
marijuana use.  The patient denies intravenous drug use or
further street drug use.  The patient lives at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**]
House, a home for the homeless elderly.  He has a Section
VIII Housing apartment there.  The patient has multiple
children, but all but one live in [**State 2748**].  The patient
has one daughter who lives in [**Name (NI) 16174**], her name is [**Name (NI) 19948**],
the patient also has a nephew who lives in [**Name (NI) 86**] and checks
in on the patient, nephew's name is [**Name (NI) **] [**Name (NI) **].

PHYSICAL EXAMINATION:  The patient's physical examination
upon presentation included vital signs of 95.8, heartrate
104, blood pressure 164/136, respiratory rate 40, oxygen
saturation 98% on nonrebreather.
Constitutional-severe respiratory distress, alert,
cooperative.
Head, eyes, ears, nose and throat-Pupils equal, round and
reactive to light, extraocular movements intact.
Neck-Positive use of accessory respiratory muscles.
Chest-Poor air entry bilaterally, no wheezes noted.
Cardiovascular-Tachycardiac, regular rhythm, S1 and S2
present.
Genitourinary-No costovertebral angle tenderness bilaterally.
Gastrointestinal-Bowel sounds present, soft, nontender,
nondistended belly.
Skin-No rashes, capillary refill less than 2 seconds.
Neurologic-Cranial nerves II through XII intact, strength and
sensory within normal limits.

LABORATORY DATA:  Pertinent laboratory data included a white
blood cell count of 8.7, hematocrit 37.4, platelets 297, MCV
73, differential for white blood cell count 47.7 polys, 33.1
lymphocytes, 12.1 monocytes, 6.5 eosinophils, 0.6 basophils.
The patient's arterial blood gases included PH 7.18, pCO2
109, pO2 92.  The patient's bicarbonate at the time was 34.
Chest x-ray was notable for emphysema, no evidence of
pneumonia or heart failure.

HOSPITAL COURSE:  In the Emergency Department, the patient
was noted to be in extreme shortness of breath with accessory
respiratory muscle use, inability to speak a full sentence,
occasional hypertension to the 190s/120s and arterial blood
gas of 7.18, 109, 92.  The patient refused intubation.  The
patient was given multiple Albuterol and Atrovent nebulizers
and started on intravenous steroids.  The patient's shortness
of breath improved with the nebulizers and his blood pressure
normalized.  The patient was admitted to the Medicine
Intensive Care Unit.

Upon arrival in the Medicine Intensive Care Unit, the patient
was started on biPAP and an empiric course of Levofloxacin
for presumed respiratory infection.  The patient ruled out
for an myocardial infarction.  The patient was able to be
weaned off of biPAP and onto oxygen nasal cannula on the
morning of hospital day #2.  As the patient had minimal
shortness of breath and required nebulizers only every 4
hours he was deemed in condition for floor transfer.  The
patient was transferred to the [**Hospital 139**] Medical Service.

Over the next four days, the patient was given a two day
course of high dose Methylprednisolone and then restarted on
Prednisone 40 mg q.d.  The patient was also weaned off of 4
liters nasal cannula oxygen to oxygen 2 liters nasal cannula
which is the patient's home dose.  The patient's respiratory
status returned to baseline within the next few days of
hospitalization.

Occupational therapy was consulted to visit the patient.
Occupational therapy noted the patient had decreased
mobility, decreased cognition of safety and general
deconditioning.  They recommended either longterm placement
or increased services in his current home.  Physical therapy
saw the patient and noted he had impaired gait and locomotion
when ambulating.  They worked with him for two days at the
hospitalization at the end of which he was at his baseline.
Physical therapy recommended either longterm placement or
increased services at his current location.  Due to concerns
over the patient's ability to take his home medicine regimen,
Neuropsychiatry was consulted.  Upon their testing, they
determined he had moderate to severe global dysfunctioning,
decreased attention span, decreased memory and decreased
breathing.  They did not see him likely to be able to work
from a pill dispenser.  They did not see him likely to be
able to handle his medicine regimen.  They could not make any
assessment about his competency without further assessment.

The [**Hospital6 256**] House Staff,
attending, care [**Hospital6 **], and social worker were concerned
that the patient would be unable to handle his medicine
regimen at home.  Multiple meetings were held between those
individuals as well as including the [**First Name (Titles) 1587**] [**Last Name (Titles) **], the social worker from [**Name (NI) **] [**Last Name (NamePattern1) 34620**]
House, and the resident nurse [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**] House.  After
much discussion together, and with the patient and his
daughter, and nephew, [**Name (NI) **], it was decided that the patient
could return home to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**] House with [**Hospital6 1587**] services and with the understanding that his
nephew and daughter were to stop in and visit him twice a day
to help him manage his medications.  The patient's nephew and
daughter understood and agreed to this.  The patient also
understood that he can not smoke or allow smoking in his
apartment or anywhere near his home oxygen.  The patient
understands that this is a [**Doctor Last Name 13205**] not only to himself but to
his neighbors at the [**Name (NI) **] [**Last Name (NamePattern1) 34620**] House.  The [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**]
landlord and the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**] social worker drew up an
agreement that the patient signed, agreeing that he would no
longer smoke or allow smoking in his apartment.  Upon this
condition, the patient is being allowed to return home to the
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**] House.  Hence, the patient was discharged to the
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**] House with [**Hospital6 407**] services and
the understanding that his nephew and daughter would further
aid him in his medications.  The patient also agreed to visit
his nurse practitioner, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], more often to better
optimize for chronic obstructive pulmonary disease
management.

DISCHARGE MEDICATIONS:
1.  Verapamil 120 mg p.o. b.i.d.
2.  Aspirin 325 mg p.o. q.d.
3.  Atorvastatin 10 mg p.o. q.d.
4.  Primidone 50 mg p.o. q.d.
5.  Imdur extended release 30 mg p.o. q.d.
6.  Calcium Carbonate 500 mg p.o. q.d.
7.  Cholecalciferol 400 units p.o. q.d.
8.  Salmeterol 21 mcg one to two puffs inhaler b.i.d.
9.  Montelukast Sodium 10 mg p.o. q.d.
10. Fexofenadine 60 mg p.o. b.i.d.
11. Levofloxacin 500 mg p.o. q.d. for four days
12. Pantoprazole 40 mg p.o. q.d.
13. Ferrous Sulfate 325 mg p.o. q.d.
14. Prednisone 40 mg p.o. q.d. from [**3-31**] to [**2107-4-8**]
mg p.o. q.d. for [**4-8**] through [**2097-4-15**] mg p.o. q.d.
thereafter
15. Combivent 103/18 mcg two puffs inhaled q. 6 hours
16. Atrovent 0.2 mg/ml solution, one ml nebulizer every 6
hours
17. Albuterol Sulfate 0.83 mg/ml solution one nebulizer every
two hours prn wheezing
18. Albuterol Sulfate 0.83 mg/ml one nebulizer every 6 hours
19. Albuterol Sulfate 0.83 mg/ml one to two puffs inhaled q.
2 hours prn shortness of breath or wheezing

CONDITION ON DISCHARGE:  The patient is being discharged in
fair condition.

FINAL DIAGNOSIS:  Chronic obstructive pulmonary disease
exacerbation





                            [**Name6 (MD) 2415**] [**Last Name (NamePattern4) 3474**], M.D.  [**MD Number(1) 3475**]

Dictated By:[**Last Name (NamePattern1) 34621**]
MEDQUIST36

D:  [**2180-3-31**]  18:44
T:  [**2180-3-31**]  20:28
JOB#:  [**Job Number 34622**]
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Other convulsions,Iron deficiency anemia, unspecified,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Abnormality of gait,Personal history of tobacco use'}


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: The patient is a 62 year old
male with longstanding, severe chronic obstructive pulmonary
disease, requiring home oxygen and with a recent exacerbation
in [**2180-2-19**] requiring [**Hospital6 2018**]-Medicine Intensive Care Unit admission, intubation and
antibiotics who presents two days after discharge to
rehabilitation, with shortness of breath.  The patient was
admitted to [**Hospital6 256**] on [**2180-3-2**] with shortness of breath requiring intubation and a
Medicine Intensive Care Unit stay, with a course complicated
by a non-Q wave myocardial infarction.  The patient was
treated for ................. pneumonia and discharged to
[**Hospital **] rehabilitation on [**2180-3-10**].  The patient was
then discharged to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**] House on [**2180-3-24**].  The
patient was discharged from [**Hospital **] Rehabilitation on a
medicine regimen that differed from his previously which had
included chronic Prednisone 20 mg q.d.  The patient at this
time of discharge from [**Hospital **] Rehabilitation was not on any
chronic Prednisone dosage.  Over the next two days, the
patient noted that he had increased shortness of breath, a
productive cough with sputum change to a yellow color,
increased watery eyes, and increased nasal discharge.  On the
morning of [**2180-3-26**], the patient noted that he was in
extreme shortness of breath and "couldn't do this anymore."
The patient called 9-1-1 and was taken to the [**Hospital6 1760**] Emergency Department.  The
patient denies recent fevers, chest pain, nausea, vomiting,
abdominal pain, change in stools, diarrhea, constipation,
dysuria, or joint pain.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease - Per the patient
diagnosed since [**2163**].  On home oxygen, 2 liters nasal cannula
for 24 hours a day.  Has been on chronic Prednisone 20 mg a
day for multiple months.  The patient sleeps on three
pillows.  He can not lay flat secondary to shortness of
breath.  No pulmonary function tests were on record for our
examination.
2.  Asthma.
3.  Coronary artery disease - Non-Q wave myocardial
infarction in [**2180-2-19**] - Cardiac echocardiogram on [**2180-3-7**] showed ejection fraction of 55%, right ventricular
wall hypertrophy and cavity dilatation with marked wall
motion hypokinesis, normal left and right atria, left
ventricular wall thickness but no wall motion abnormalities.
Mild tricuspid regurgitation and mitral regurgitation.
Moderate pulmonary artery systolic hypertension.  Upon
discharge in [**2180-2-19**], the patient had been recommended to
have an outpatient stress test; the patient is awaiting
outpatient workup.
4.  Hypertension.
5.  Hypercholesterolemia.
6.  History of stroke.
7.  Seizure disorder.
8.  Atopic dermatitis.
9.  Iron deficiency anemia/anemia of chronic disease.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has a questionable allergy to Bactrim
which causes edema.

PHYSICAL EXAM: 

FAMILY HISTORY: Notable for the patient might have one
brother with diabetes mellitus although the patient is unsure
of this.  The patient denies health problems in any of his
three other siblings who are between the ages of 70 and 80
years old.  The patient notes five children to be in good
health with no known health problems.  The patient denies any
family history of cancer or heart disease.

SOCIAL HISTORY: The patient's social history is notable for
the patient smoking one to two packs per day for 20+ years.
Per the patient he quit in [**2163**].  Per the social worker and
resident nurse [**First Name8 (NamePattern2) **] [**Name (NI) **] [**Name (NI) 34620**] House there is evidence that
either the patient is smoking in his apartment or someone
else is smoking in the patient's apartment where the patient
has his home oxygen.  The patient also has a history of
alcohol (one-half pint of [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**] per day), per the
patient he quit in [**2163**].  The patient has a history of
marijuana use.  The patient denies intravenous drug use or
further street drug use.  The patient lives at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 34620**]
House, a home for the homeless elderly.  He has a Section
VIII Housing apartment there.  The patient has multiple
children, but all but one live in [**State 2748**].  The patient
has one daughter who lives in [**Name (NI) 16174**], her name is [**Name (NI) 19948**],
the patient also has a nephew who lives in [**Name (NI) 86**] and checks
in on the patient, nephew's name is [**Name (NI) **] [**Name (NI) **]. 

### Response:
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Other convulsions,Iron deficiency anemia, unspecified,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Abnormality of gait,Personal history of tobacco use'}
