CHIEF COMPLAINT: 

PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname 41485**] is a 72 year old
female with a history of hypertension who presented to an
outside Emergency Department after she experienced the sudden
onset of low back pain.  She had associated symptoms
including abdominal pain which was a band-like pain and
constant, diaphoresis, and nausea and vomiting.  There was no
chest pain, no shortness of breath, no lightheadedness.
There were no paresthesias or weakness.  She has never had
any such pain before in her life.

MEDICAL HISTORY: 1.  Hypertension.
2.  Osteoarthritis.
3.  Glaucoma.
4.  Polymyalgia rheumatica.
5.  Status post cholecystectomy.
6.  Status post removal of part of the pancreas, right
nephrectomy and splenectomy due to a pancreatic cyst which
was later found to be benign.

MEDICATION ON ADMISSION: 

ALLERGIES: Plaquenil.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Thirty to forty pack year smoking history
and she drinks two drinks per day.
Dissection of aorta, thoracoabdominal,Cerebral artery occlusion, unspecified with cerebral infarction,Unspecified essential hypertension,Hemiplegia, unspecified, affecting unspecified side,Osteoarthrosis, localized, not specified whether primary or secondary, hand,Urinary incontinence, unspecified,Tobacco use disorder,Unspecified glaucoma,Anxiety state, unspecified
Dsct of thoracoabd aorta,Crbl art ocl NOS w infrc,Hypertension NOS,Unsp hemiplga unspf side,Loc osteoarth NOS-hand,Urinary incontinence NOS,Tobacco use disorder,Glaucoma NOS,Anxiety state NOS
Admission Date:  [**2153-12-30**]       Discharge Date:  [**2154-1-6**]

Date of Birth:   [**2081-10-15**]       Sex:  F

Service:  CCU

HISTORY OF PRESENT ILLNESS:   [**First Name8 (NamePattern2) **] [**Known lastname 41485**] is a 72 year old
female with a history of hypertension who presented to an
outside Emergency Department after she experienced the sudden
onset of low back pain.  She had associated symptoms
including abdominal pain which was a band-like pain and
constant, diaphoresis, and nausea and vomiting.  There was no
chest pain, no shortness of breath, no lightheadedness.
There were no paresthesias or weakness.  She has never had
any such pain before in her life.

At the outside hospital, an abdominal ultrasound was
performed which revealed aortic dissection.  The patient was
transferred to [**Hospital1 69**] for
further management.

Blood pressure upon arrival to the Emergency Department was
190/79.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Osteoarthritis.
3.  Glaucoma.
4.  Polymyalgia rheumatica.
5.  Status post cholecystectomy.
6.  Status post removal of part of the pancreas, right
nephrectomy and splenectomy due to a pancreatic cyst which
was later found to be benign.

ALLERGIES:   Plaquenil.

CURRENT MEDICATIONS AT HOME:
1.  Lotensin 20 mg p.o. q. day.
2.  Vioxx.
3.  Pepcid.

SOCIAL HISTORY:   Thirty to forty pack year smoking history
and she drinks two drinks per day.

PHYSICAL EXAMINATION:   On admission, temperature of 96.0 F.;
blood pressure of 146/50 while on Nipride and Esmolol drip.
Heart rate of 61.  Physical examination is notable for
regular rate and rhythm, with no evidence of aortic
insufficiency murmur.  There are no carotid bruits.  There is
no abdominal bruit.  Abdominal examination is benign.
Neurological examination obtained in the Emergency Department
shows cranial nerves II through XII to be intact.  Dorsalis
pedis and posterior tibialis pulses are present bilaterally.

LABORATORY:  EKG shows normal sinus rhythm at a rate of 61.
There are no ST segment elevations or Q waves.

Labs are remarkable for an elevated white blood cell count of
17.1 but the remainder of her labs are unremarkable.

CT scan of the chest, abdomen and pelvis showed an aortic
dissection extending from the level of the pulmonary vein
beyond the left subclavian and into the celiac artery but not
including the celiac artery.  There was no evidence of
contract extravasation.  There is no ascending aortic
involvement.  There is no aortic arch involvement.

HOSPITAL COURSE:
1.  AORTIC DISSECTION:  The patient was admitted with a Type
B aortic dissection.  She was initially placed on a Nipride
and Esmolol drip to maintain her systolic blood pressures
between 100 and 120.  She was noted to have a very labile
systolic blood pressure.  She was noted to become easily
agitated which would cause her blood pressures to rise up to
the 160s.

In the Coronary Care Unit, she was slowly transitioned to
p.o. medication and off Nipride and esmolol.  Eventually, she
was able to be weaned off drip.  In the Emergency Department,
a Vascular Surgery consultation had been obtained.  Vascular
Surgery followed her for the remainder of the
hospitalization.

They recommended continuing medical management as they did
not feel that there was indication for surgical intervention.
At the time of discharge, the patient was requiring
amlodipine 10 mg p.o. q. day, labetalol 800 mg p.o. twice a
day and Lisinopril 40 mg p.o. q. day, to maintain her
systolic blood pressure in the one-teens to 120 range.  The
patient was also counseled about smoking cessation, which she
agreed to.  She was also asked to limit alcohol intake to a
maximum of one to two drinks per day.

During the course of the hospitalization, the patient
complained of left flank pain which was positional.  A repeat
chest, abdomen and pelvic CT angiogram was performed.  It
showed no extension of the aortic dissection.

2.  CEREBROVASCULAR ACCIDENT:  On admission, the patient had
no focal neurological findings.  CT angiogram on admission
showed no involvement of the aortic arch to suspect extension
of the dissection up into the carotids.  On approximately
hospital day number four, the patient was noted to have
difficulty using her right hand to lift up a drinking cup.
The patient was examined and was found to have no appreciable
weakness on examination.

Her blood pressure was being tightly controlled with a goal
systolic blood pressure between 100 and 120 due to her Type B
aortic dissection.  At one point, she was noted to have very
labile blood pressures and became briefly hypotensive but she
quickly returned to baseline after Nipride drip was turned
off.  The patient again complained of weakness in the right
leg greater than the right arm.  Again, neurological
examination showed some mild right upper extremity weakness
with four out of five strength proximally but no pronator
drift on examination.  She was also noted to have give-way
weakness of the right lower extremity.

A repeat chest CT angiogram was performed which showed no
involvement of the aortic arch to suggest dissection to the
carotids.  An MRI / MRA of the brain was obtained which
showed possible narrowing of the left posterior cerebral
artery and inferior division of the left middle cerebral
artery origin, but the study was severely limited by motion.
It also showed a left sided subcortical subacute watershed
infarction of the posterior frontal lobe and extending into
the parietal lobe and toward the posterior portion of the
lateral ventricle.

A Neurology consultation was obtained to recommend further
management given the patient's aortic dissection.  Neurology
recommended aiming for the highest systolic blood pressure
possible in the goal range for aortic dissection, which is
120.  They also recommended doing studies of her carotids.
The patient was started on aspirin 325 mg p.o. q. day as well
as Lipitor.

At the time of discharge, the patient's neurologic findings
were resolving but her walking was still limited by the right
lower extremity weakness.

3.  RHEUMATOLOGY:  On admission, the patient was noted to
have arthritic changes of the hand.  There was concern that
possibly the patient may have a vascular disease which may be
effecting her aorta and thus leading to her aortic
dissection.  A Rheumatology consultation was obtained.

Work-up included as follows: Plain x-rays of the hand showed
findings most consistent with osteoarthritis.  ESR was
negative.  [**Doctor First Name **] was negative and rheumatoid factor was
negative.  Rheumatology noted that given the patient's past
medical history of polymyalgia rheumatica that giant cell
arteritis is associated with aortic dissection.  However, the
patient had no jaw claudication or temporal tenderness on
examination.  Her ESR was also 15.  Based on these, were not
consistent with giant cell arteritis.

They felt that her physical examination findings were most
consistent with osteoarthritis and recommended continuing
Vioxx.  Rheumatology also noted that renal artery stenosis
can be associated with certain arthritides.  Abdomen CT
angiogram showed no evidence of renal artery stenosis in her
one remaining renal artery.

4.  URINARY INCONTINENCE:  On admission, a Foley catheter was
placed to monitor input and output.  During the hospital
stay, the Foley was removed, however, the patient had
difficulty holding her urine and difficulty getting up out of
bed to go to the urinal.  She decided to have the Foley put
back in.  The patient states that she has a history of
urinary incontinence at home.

CONDITION ON DISCHARGE:   Condition on discharge was stable.
A Foley catheter was in place due to urinary incontinence
which is an old medical problem.  She is chest pain and back
pain free with no evidence of continuing dissection.  The
patient continues to have difficulty ambulating due to her
right lower extremity weakness but has good use of the right
upper extremity, and no evidence of cranial nerve involvement
or sensory deficit.

DISCHARGE STATUS:   The patient is discharged to
Rehabilitation for Physical [**Hospital **] rehabilitation as well as
[**Hospital 4038**] rehabilitation.

DISCHARGE DIAGNOSES:
1.  Type B aortic dissection, thoraco-abdominal.
2.  Hypertension.
3.  Ischemic stroke (watershed infarction of the left middle
cerebral artery territory).
4.  Anxiety.
5.  Urinary incontinence.

DISCHARGE MEDICATIONS:
1.  Vitamin D 400 units p.o. q. day.
2.  Calcium carbonate 500 mg p.o. three times a day.
3.  Senna p.o. twice a day p.r.n.
4.  Docusate 100 mg p.o. twice a day.
5.  Ambien 5 mg p.o. q. h.s. p.r.n.
6.  Famotidine at 20 mg p.o. twice a day.
7.  Amlodipine 10 mg p.o. q. day.
8.  Diazepam 5 mg p.o. q. six hours p.r.n.
9.  Vioxx 12.5 mg p.o. q. day.
10. Labetalol 800 mg p.o. twice a day.
11. Lisinopril 40 mg p.o. q. day.
12. Lipitor 10 mg p.o. q. day.
13. Enteric-coated aspirin 325 mg p.o. q. day.

DISCHARGE INSTRUCTIONS:
1.  The patient is asked to follow-up with her primary care
physician for strict control of her blood pressure.  The
patient will schedule an appointment with her primary care
physician.
2.  The patient is discharged to an extended care facility,
[**Hospital6 1293**] in [**Location (un) **].



                            [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.

Dictated By:[**Name8 (MD) 41486**]
MEDQUIST36

D:  [**2154-1-5**]  17:04
T:  [**2154-1-5**]  17:42
JOB#:  [**Job Number 41487**]
{'Dissection of aorta, thoracoabdominal,Cerebral artery occlusion, unspecified with cerebral infarction,Unspecified essential hypertension,Hemiplegia, unspecified, affecting unspecified side,Osteoarthrosis, localized, not specified whether primary or secondary, hand,Urinary incontinence, unspecified,Tobacco use disorder,Unspecified glaucoma,Anxiety state, unspecified'}


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: [**First Name8 (NamePattern2) **] [**Known lastname 41485**] is a 72 year old
female with a history of hypertension who presented to an
outside Emergency Department after she experienced the sudden
onset of low back pain.  She had associated symptoms
including abdominal pain which was a band-like pain and
constant, diaphoresis, and nausea and vomiting.  There was no
chest pain, no shortness of breath, no lightheadedness.
There were no paresthesias or weakness.  She has never had
any such pain before in her life.

MEDICAL HISTORY: 1.  Hypertension.
2.  Osteoarthritis.
3.  Glaucoma.
4.  Polymyalgia rheumatica.
5.  Status post cholecystectomy.
6.  Status post removal of part of the pancreas, right
nephrectomy and splenectomy due to a pancreatic cyst which
was later found to be benign.

MEDICATION ON ADMISSION: 

ALLERGIES: Plaquenil.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Thirty to forty pack year smoking history
and she drinks two drinks per day. 

### Response:
{'Dissection of aorta, thoracoabdominal,Cerebral artery occlusion, unspecified with cerebral infarction,Unspecified essential hypertension,Hemiplegia, unspecified, affecting unspecified side,Osteoarthrosis, localized, not specified whether primary or secondary, hand,Urinary incontinence, unspecified,Tobacco use disorder,Unspecified glaucoma,Anxiety state, unspecified'}
