CHIEF COMPLAINT: Cough, SOB.

PRESENT ILLNESS: This is an 80 y/o M w/COPD, DM, hyperlipidemia who presents with
cough x 2 days. He noted a nonproductive cough as well as fevers
at home to 102 (although pt currently denies this). He denies
any chest pain or shortness of breath. He has noticed polyuria
and polydipsia. Mild rhinorrhea, no sore throat. Denies all
other complaints. Does not check his fingersticks at home.

MEDICAL HISTORY: 1. Type 2 DM: on glucophage and possibly avandia (pt knows he is
on medicine that starts with an "a")
2. Hypercholesterolemia: had been on vytorin but felt badly on
this medicine (but was on avandia at the same time so unclr what
is causing adverse rxn)
3. COPD - never been intubated. baseline bicarb 32
4. Prostate Ca s/p XRT
5. Radiation cystitis
6. stage 2 transitional cell Ca of bladder
7. RBBB, hx atrial ectopy

MEDICATION ON ADMISSION: flomax 0.4
folate 1 mg
lisinopril 2.5 mg
glucophage reg 850 mg
avandia 2 mg
ipratropium MDI
protonix 40 qd
prednisone 60 qd (started [**2-4**])
insulin sc
simvastatin
dilt 30 qid ([**2-5**])
metoprolol 12.5 tid ([**2-5**])
levoflox ([**2-5**])

ALLERGIES: Penicillins

PHYSICAL EXAM: PE: T: 97 P: 82 SR BP: 118/72 R: 18 98% 40% face mask
Gen: alert and oriented pleasant male in NAD, very hard of
hearing
Neck: JVD not elevated.
Lungs: decreased air movement, rare wheezes. no egophony.
hyperresonant to percussion throughout. prolonged expiratory
phase.
CV: distant heart sounds, regular rate and rhythym, no m/r/g
Abd: soft, nontender, nondistended. NABS.
Ext: trace pedal edema bilaterally

FAMILY HISTORY: Father died of MI at 77 y/o, numerous other family members with
CAD.

SOCIAL HISTORY: Lives with his wife, homes in [**Name (NI) 108**] and here in [**Name (NI) 745**]. smoked
up to 3 ppd x 52 years, quit in [**2113**]. rare EtOH. used to work in
advertising, then ran architectural lighting firm.
Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Atrial fibrillation,Urinary tract infection, site not specified,Irradiation cystitis,Mixed acid-base balance disorder,Thrombocytopenia, unspecified,Blood in stool,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Unspecified drug-induced mental disorder,Other chronic pulmonary heart diseases,Adrenal cortical steroids causing adverse effects in therapeutic use,Personal history of malignant neoplasm of prostate,Personal history of malignant neoplasm of bladder,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified disorder of kidney and ureter
Obs chr bronc w(ac) exac,Acute respiratry failure,Atrial fibrillation,Urin tract infection NOS,Irradiation cystitis,Mixed acid-base bal dis,Thrombocytopenia NOS,Blood in stool,DMII wo cmp uncntrld,Acute kidney failure NOS,Drug mental disorder NOS,Chr pulmon heart dis NEC,Adv eff corticosteroids,Hx-prostatic malignancy,Hx of bladder malignancy,Late effect of radiation,Abn react-radiotherapy,Renal & ureteral dis NOS
Admission Date:  [**2132-2-2**]              Discharge Date:   [**2132-2-21**]

Date of Birth:  [**2051-4-8**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Cough, SOB.

Major Surgical or Invasive Procedure:
Bubble study
S/P intubation for hypercarbic resp failure


History of Present Illness:
This is an 80 y/o M w/COPD, DM, hyperlipidemia who presents with
cough x 2 days. He noted a nonproductive cough as well as fevers
at home to 102 (although pt currently denies this). He denies
any chest pain or shortness of breath. He has noticed polyuria
and polydipsia. Mild rhinorrhea, no sore throat. Denies all
other complaints. Does not check his fingersticks at home.

In the ED, he was slightly febrile and tachycardic. He was
empirically started on steroid therapy, and Levofloxacin, as
well as nebs. He was also hyperglycemic to the mid 300s and was
given insulin. He was admitted to medicine.

Past Medical History:
1. Type 2 DM: on glucophage and possibly avandia (pt knows he is
on medicine that starts with an "a")
2. Hypercholesterolemia: had been on vytorin but felt badly on
this medicine (but was on avandia at the same time so unclr what
is causing adverse rxn)
3. COPD - never been intubated. baseline bicarb 32
4. Prostate Ca s/p XRT
5. Radiation cystitis
6. stage 2 transitional cell Ca of bladder
7. RBBB, hx atrial ectopy

Social History:
Lives with his wife, homes in [**Name (NI) 108**] and here in [**Name (NI) 745**]. smoked
up to 3 ppd x 52 years, quit in [**2113**]. rare EtOH. used to work in
advertising, then ran architectural lighting firm.

Family History:
Father died of MI at 77 y/o, numerous other family members with
CAD.

Physical Exam:
PE: T: 97 P: 82 SR BP: 118/72 R: 18 98% 40% face mask
Gen: alert and oriented pleasant male in NAD, very hard of
hearing
Neck: JVD not elevated.
Lungs: decreased air movement, rare wheezes. no egophony.
hyperresonant to percussion throughout. prolonged expiratory
phase.
CV: distant heart sounds, regular rate and rhythym, no m/r/g
Abd: soft, nontender, nondistended. NABS.
Ext: trace pedal edema bilaterally


Pertinent Results:
Relevant laboratory data on admission:
[**2132-2-1**] 11:00PM BLOOD WBC-8.0 RBC-4.66 Hgb-13.9* Hct-40.5
MCV-87 MCH-29.9 MCHC-34.4 RDW-13.3 Plt Ct-123*
[**2132-2-1**] 11:00PM BLOOD Neuts-90.9* Lymphs-5.0* Monos-3.5 Eos-0.3
Baso-0.3
[**2132-2-1**] 11:00PM BLOOD PT-12.4 PTT-22.3 INR(PT)-1.1
[**2132-2-1**] 11:00PM BLOOD Plt Ct-123*
[**2132-2-1**] 11:00PM BLOOD Glucose-349* UreaN-19 Creat-1.1 Na-139
K-4.1 Cl-97 HCO3-30 AnGap-16
[**2132-2-1**] 11:00PM BLOOD CK(CPK)-34*
[**2132-2-3**] 06:15AM BLOOD ALT-24 AST-34 AlkPhos-79 TotBili-0.6
[**2132-2-1**] 11:00PM BLOOD cTropnT-<0.01
[**2132-2-4**] 07:20AM BLOOD proBNP-558
[**2132-2-5**] 07:40AM BLOOD CK-MB-7 cTropnT-<0.01
[**2132-2-8**] 02:48AM BLOOD CK-MB-5 cTropnT-<0.01
[**2132-2-1**] 11:00PM BLOOD Theophy-2.4*

CXR [**2132-2-1**]: No acute cardiopulmonary process.

ECG [**2132-2-1**]: Sinus arrhythmia. Incomplete right bundle-branch
block. Since the previous tracing of [**2129-4-27**] no significant
change.

Echo [**2132-2-5**]: The left atrium is normal in size. Left
ventricular wall thicknesses are normal. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
are mildly thickened. The mitral valve leaflets are mildly
thickened. Trivial mitral regurgitation is seen. There is
moderate pulmonary artery systolic hypertension. There is an
anterior space which most likely represents a fat pad, though a
loculated anterior pericardial effusion cannot be excluded.

CT chest [**2132-2-7**]: 1. No evidence of pulmonary embolism. 2.
Disproportionate enlargement of the left pulmonary artery
compared to the main and right pulmonary arteries, as shown on
the prior chest radiograph. While no pulmonary embolism is seen,
this finding may be also be seen more chronically in the setting
of pulmonary artery stenosis and pulmonart artery hypertension
may be [**Last Name (un) **] chronic lung disease. 3. Moderate centrilobular
emphysema. 4. Parenchymal subpleural opacities in the dependent
portions of the left lower lobe as well as the right upper lobe.
Right upper lobe findings appear to be dependent atelectasis.
Left lower lobe findings are probably a combination of
atelectasis and perhaps a degree of aspiration as well. However,
given the presence of underlying emphysema, recommend followup
examination to ensure resolution. 5. Coronary artery
calcifications.

Brief Hospital Course:
80 year-old male, ex-smoker, admitted with cough and shortness
of breath. His hospital course will be reviewed by problems.

1) Cough/SOB: His initial presentation was felt most consistent
with a COPD flare, and he was started on parenteral steroids,
bronchodilator therapy with nebulizers and Levofloxacin for
coverage of possible tracheobronchitis. His CXR was without
evidence of pneumonia. He was eventually converted to oral
steroids, but continued to have marked bronchospasm and high
osygen requirement. He was eventually transferred to the [**Hospital Unit Name 153**]
for high nursing care requirements, and proceeded to develop
hypercarbic respiratory failure following Haldol therapy
requiring intubation. He was succesfully extubated, and
transferred back to the floor.

He continued to have high oxygen requirements. A CTA on [**2-7**]
was nnegative for PE and without significant massess or
lymphadenopathy, but showed evidence of a dilated left pulmonary
artery suggestive of PA hypertension. A prior echo on [**2-5**] was
also consistent with moderate pulmonary hypertension, without TV
dilatation or atrial enlargemet.

The pulmonary service was consulted to further comment on his
hypoxemia. His hypoxemia was felt to be multifactorial, with
severe COPD (PFTs obtained on [**2132-2-14**] revealed FVC 0.97 (24%),
FEV1 0.51 (20%), ratio 83%) the most important contributor. The
possibility of a R->L shunt was also raised, but bubble study
was negative for ASD or PFO.
He completed a course of levofloxacin and was started on a slow
prednisone taper for the COPD. His oxygen saturations slowly
improved, and at discharge was requiring 0-1 liters via nasal
cannula. He will need to be evaluated for home oxygen use.

2. Arrhythmia: While on the [**Hospital Ward Name 516**], Mr. [**Known lastname 95655**] had
repeated episodes of supraventricular tachycardia to the 160's.
Review of the EKGs reveal that he had intermittent aflutter with
RVR. At other times, EKGs showed ST with PACs versus MAT. He was
initially started on beta blockade therapy for rate control,
which was changed to Verapamil per EP given his concomitant
pulmonary disease and bronchospasm. EP was consulted, and
recommendation was made to transfer to the [**Hospital Ward Name **] for
chemical conversion with Dofetilide therapy (poor candidate for
amiodarone given his pulmonary disease). Of note, he was also
started on Coumadin for anticoagulation.

Upon transfer, Verapamil was changed to Diltiazem, and he was
started on Dofetilide on [**2132-2-13**]. He continues to have
occasional episodes of supraventricular tachycardia while on
Dofetilide. QTc has been stable. The Diltiazem was titrated up
to 90 mg QID and will be discharged on Diltiazem ER 360 mg
daily.

4. Metabolic alkalosis/respiratory acidosis: While in hospital,
his HCO3 rose up to 41. His metabolic alkalosis was felt to be a
combination of chronic hypercarbia, with likely contribution
from steroid therapy. We started Diamox on [**2132-2-15**], with
improvement in HCO3 to 35, (goal HCO3 = 35 per Pulmonary). His
HCO3 will need to be monitored after discharge weekly. The
diomox was discontinued on [**2132-2-19**] because his creatinine was
beginning to rise slightly and his bicarb normalized.

5. DM type 2: He was continued on his out-patient regimen of
Avandia. Metformin was discontinued in the hospital in the
setting of ongoing hypoxemia, variable PO intake. He was covered
with a RISS QID. His glycemic control was further exacerbated by
steroid therapy, with suboptimal fingerstick values. We
increased his Avandia was increased to 2 mg [**Hospital1 **].

6. Renal: His creatinine increased slightly to 1.3 from baseline
fo 1-1.1, possibly due to diomox. Diomox was stopped. FENA was
not less than one so felt not to be prerenal, and urianlysis was
normal. It should be monitored at rehab.

Medications on Admission:
flomax 0.4
folate 1 mg
lisinopril 2.5 mg
glucophage reg 850 mg
avandia 2 mg
ipratropium MDI
protonix 40 qd
prednisone 60 qd (started [**2-4**])
insulin sc
simvastatin
dilt 30 qid ([**2-5**])
metoprolol 12.5 tid ([**2-5**])
levoflox ([**2-5**])


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
COPD
DMII
Hypercholesterolemia
H/O prostate cancer s/p XRT
RBBB
Atrial fibrillation/flutter
CKD


Discharge Condition:
Stable


Discharge Instructions:
Take all medications as prescribed. You will go to rehab with a
one week supply of Dofetilide.
You will have [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of hearts monitor to evaluate your heart
rhythm upon discharge. Please return it to the holter lab.




Name:  [**Known lastname 16537**],[**Known firstname 16538**]                 Unit No:   [**Numeric Identifier 16539**]

Admission Date:  [**2132-2-2**]              Discharge Date:   [**2132-2-21**]

Date of Birth:  [**2051-4-8**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 211**]
Addendum:
Mr. [**Known lastname **] had a positive urinalysis with 6-1- WBC and postive
nitrite, so he was started on ciprofloxacin. His creatinine had
improved to 1.1 on day of discharge.

Chief Complaint:
same

Major Surgical or Invasive Procedure:
Bubble study
S/P intubation for hypercarbic resp failure


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 41**] - [**Location (un) 42**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 224**] MD [**MD Number(1) 225**]

Completed by:[**2132-2-21**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Atrial fibrillation,Urinary tract infection, site not specified,Irradiation cystitis,Mixed acid-base balance disorder,Thrombocytopenia, unspecified,Blood in stool,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Unspecified drug-induced mental disorder,Other chronic pulmonary heart diseases,Adrenal cortical steroids causing adverse effects in therapeutic use,Personal history of malignant neoplasm of prostate,Personal history of malignant neoplasm of bladder,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified disorder of kidney and ureter'}


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, SOB.

PRESENT ILLNESS: This is an 80 y/o M w/COPD, DM, hyperlipidemia who presents with
cough x 2 days. He noted a nonproductive cough as well as fevers
at home to 102 (although pt currently denies this). He denies
any chest pain or shortness of breath. He has noticed polyuria
and polydipsia. Mild rhinorrhea, no sore throat. Denies all
other complaints. Does not check his fingersticks at home.

MEDICAL HISTORY: 1. Type 2 DM: on glucophage and possibly avandia (pt knows he is
on medicine that starts with an "a")
2. Hypercholesterolemia: had been on vytorin but felt badly on
this medicine (but was on avandia at the same time so unclr what
is causing adverse rxn)
3. COPD - never been intubated. baseline bicarb 32
4. Prostate Ca s/p XRT
5. Radiation cystitis
6. stage 2 transitional cell Ca of bladder
7. RBBB, hx atrial ectopy

MEDICATION ON ADMISSION: flomax 0.4
folate 1 mg
lisinopril 2.5 mg
glucophage reg 850 mg
avandia 2 mg
ipratropium MDI
protonix 40 qd
prednisone 60 qd (started [**2-4**])
insulin sc
simvastatin
dilt 30 qid ([**2-5**])
metoprolol 12.5 tid ([**2-5**])
levoflox ([**2-5**])

ALLERGIES: Penicillins

PHYSICAL EXAM: PE: T: 97 P: 82 SR BP: 118/72 R: 18 98% 40% face mask
Gen: alert and oriented pleasant male in NAD, very hard of
hearing
Neck: JVD not elevated.
Lungs: decreased air movement, rare wheezes. no egophony.
hyperresonant to percussion throughout. prolonged expiratory
phase.
CV: distant heart sounds, regular rate and rhythym, no m/r/g
Abd: soft, nontender, nondistended. NABS.
Ext: trace pedal edema bilaterally

FAMILY HISTORY: Father died of MI at 77 y/o, numerous other family members with
CAD.

SOCIAL HISTORY: Lives with his wife, homes in [**Name (NI) 108**] and here in [**Name (NI) 745**]. smoked
up to 3 ppd x 52 years, quit in [**2113**]. rare EtOH. used to work in
advertising, then ran architectural lighting firm. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Atrial fibrillation,Urinary tract infection, site not specified,Irradiation cystitis,Mixed acid-base balance disorder,Thrombocytopenia, unspecified,Blood in stool,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Unspecified drug-induced mental disorder,Other chronic pulmonary heart diseases,Adrenal cortical steroids causing adverse effects in therapeutic use,Personal history of malignant neoplasm of prostate,Personal history of malignant neoplasm of bladder,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified disorder of kidney and ureter'}
