CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname **] is an 89 year old male with past medical history of
hyperlipidemia and pulmonary embolism who presented to [**Hospital1 **]
[**Location (un) 620**] with shortness of breath.

MEDICAL HISTORY: - Hyperlipidemia
- BPH
- History of pulmonary embolism
- Hypertension
- Gallstones
- Cataracts

MEDICATION ON ADMISSION: Aspirin 81 mg daily
Ranitidine 150 mg b.i.d.
Folic acid 1 mg
Simvastatin 20 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Alert, oriented, no acute distress.  Mild cough.
Conversational with no difficulty speaking/breathing
HEENT: Sclera anicteric, MMM, oropharynx clear.  NC in place.
Neck: supple, JVP not elevated, no LAD
Lungs: Rhonchorous breath sounds bilaterally.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
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: Notable for bladder cancer in his father and pancreatic cancer
in mother.

SOCIAL HISTORY: Social History: [**Hospital3 **] home, fairly independent.
Artillery division in WWII.  Denies any recent travel history.
Does have hx of positive PPD at age 12 that was never treated.
- Tobacco:  Denies
- Alcohol:  Denies
- Illicits:  Denies
Pneumonitis due to inhalation of food or vomitus,Abscess of lung,Other specified forms of effusion, except tuberculous,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Bronchiectasis without acute exacerbation,Hypoxemia
Food/vomit pneumonitis,Abscess of lung,Effusion NEC exc tb,Hypertension NOS,Hx-ven thrombosis/embols,BPH w/o urinary obs/LUTS,Bronchiectas w/o ac exac,Hypoxemia
Admission Date:  [**2179-7-3**]              Discharge Date:   [**2179-7-9**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 905**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname **] is an 89 year old male with past medical history of
hyperlipidemia and pulmonary embolism who presented to [**Hospital1 **]
[**Location (un) 620**] with shortness of breath.

Of note, he was recently admitted to [**Hospital1 **] [**Location (un) 620**] from [**2179-6-20**]
to [**2179-6-22**] after presenting with bradycardia from his nursing
home. At that time he endorsed back pain, some wheezing, and
dizziness. he was evaluated by pulmonary, and it was felt he
likely had an upper respiratory tract infection. He received
antibiotics (unknown which--discharge summary reports they were
"broadened" when patient was febrile); he was eventually
discharged on azithromycin.

He returned to the [**Hospital1 **] [**Location (un) 620**] ED today due to continued
respiratory symptoms and a few days of small-volume hemoptysis.
CT scan chest today was remarkable for a cavitary left lung
lesion. There is a question of TB as etiology since patient did
report a positive PPD test when he was 12 and was never placed
on prophylaxis.  Patient transferred to [**Hospital1 18**] for further
management.

In the [**Hospital1 18**] ED, initial vital signs were: T 97.8 P 66 BP 130/71
R 18 O2 sat- 92% on 5L.  Patient received dose of vanc and zosyn
in the ED.  Seen by IP in the ED- will be available if needed.
Thoracics was also consulted in the ED.  Given increased oxygen
requirement and possible need for bronchoscopy, patient was
admitted to the MICU team.

On the floor, patient was doing well.  Denied any shortness of
breath, chest pain, dizziness.  He did have a productive cough-
no blood seen in sputum.  Patient denies recent travel history,
sick contacts, night sweats.  He does report intentional weight
loss via diet and exercise.

Review of systems:
(+) Per HPI- cough and shortness of breath
(-) Denies fever, chills, night sweats, recent unintentional
weight loss or gain. Denies headache, sinus tenderness,
rhinorrhea or congestion. Denies wheezing. Denies chest pain,
chest pressure, palpitations, or weakness. Denies nausea,
vomiting, diarrhea, constipation, abdominal pain, or changes in
bowel habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias. Denies rashes or skin changes.

Past Medical History:
- Hyperlipidemia
- BPH
- History of pulmonary embolism
- Hypertension
- Gallstones
- Cataracts

Social History:
Social History: [**Hospital3 **] home, fairly independent.
Artillery division in WWII.  Denies any recent travel history.
Does have hx of positive PPD at age 12 that was never treated.
- Tobacco:  Denies
- Alcohol:  Denies
- Illicits:  Denies

Family History:
Notable for bladder cancer in his father and pancreatic cancer
in mother.

Physical Exam:
General: Alert, oriented, no acute distress.  Mild cough.
Conversational with no difficulty speaking/breathing
HEENT: Sclera anicteric, MMM, oropharynx clear.  NC in place.
Neck: supple, JVP not elevated, no LAD
Lungs: Rhonchorous breath sounds bilaterally.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
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

Pertinent Results:
Admission Labs:
[**2179-7-3**] 02:20PM   WBC-9.7 RBC-4.96 HGB-14.8 HCT-45.2 MCV-91
MCH-29.8 MCHC-32.7 RDW-13.3
[**2179-7-3**] 02:20PM   NEUTS-77.4* LYMPHS-15.0* MONOS-5.3 EOS-1.9
BASOS-0.4
[**2179-7-3**] 02:20PM   PLT COUNT-296
[**2179-7-3**] 02:20PM   PT-12.6 PTT-25.6 INR(PT)-1.1
[**2179-7-3**] 02:20PM   GLUCOSE-59* UREA N-20 CREAT-1.1 SODIUM-141
POTASSIUM-3.8 CHLORIDE-103 TOTAL CO2-29 ANION GAP-13
[**2179-7-3**] 02:36PM   LACTATE-2.3*
[**2179-7-3**] 10:26PM   PT-13.4 PTT-26.7 INR(PT)-1.1
[**2179-7-3**] 10:26PM   PLT SMR-NORMAL PLT COUNT-262

Studies:

OSH: CT Chest ([**7-3**])- 1. NEW BILATERAL LOWER LOBE PNEUMONIA
COMPARED TO [**2179-6-21**] WITH LARGE CAVITARY LESION VERSUS
LOCULATED HYDROPNEUMOTHORAX WITH AIR FLUID LEVEL EXTENDING
OBLIQUELY ALONG THE COURSE OF THE MAJOR FISSURE ON THE LEFT. NO
EVIDENCE OF PULMONARY EMBOLUS; A DIMINUTIVE VESSEL WITHIN THE
AREA OF PNEUMONIA [**Month (only) **] REFLECT BASAL CONSTRUCTION OR COMPRESSION.
BIBASILAR BRONCHIECTASIS WITH AREAS OF MUCUS PLUGGING, APPEARING
NEW FROM THE PREVIOUS EXAMINATION.  2. PULMONARY ARTERY
ENLARGEMENT CONSISTENT WITH PULMONARY ARTERY HYPERTENSION.
AORTIC AND CORONARY ARTERY VASCULAR CALCIFICATIONS CONSISTENT
WITH ATHEROMATOUS DISEASE.
.
EKG [**7-3**]: Sinus rhythm. Probable anterior wall myocardial
infarction of indeterminate age. Diffuse T wave flattening which
is non-specific. No previous tracing available for comparison.
.
CXR [**7-5**]: No substantial opacification in the lungs is left
lower lobe with volume loss indicates this is largely
atelectasis. A smaller concurrent pneumonia could be present
there and in a small region of opacification projecting inferior
to the minor fissure on the right. Small left pleural effusion
is probably present, increased since the earlier study. Upper
lungs clear. Heart size normal.

CT chest [**2179-7-6**]: Left lower lobe pneumonia.  Air collection
with small amount of fluid paralleling the left major fissure
just superior to the left lower lobe consolidation could be a
loculated hydropneumothorax. There is no evident pneumothorax in
the left apices or on the right side.  Coronary calcifications.
Hiatal hernia.  Evidence of granulomatous infection in the liver
and spleen.

Brief Hospital Course:
89 year old male with h/o HL, HTN, and PE who presented to [**Hospital1 **]
[**Location (un) 620**] with shortness of breath and was admitted to the MICU
[**2179-7-3**] for a cavitary lung lesion and hypoxia, transferred to
the floor [**2179-7-6**].
.
#. Cavitary pneumonia:  Patient admitted to the MICU for
increased oxygen requirement and possibility of urgent
bronchoscopy.  He remained on oxygen throughout his stay in the
ICU.  He did have a few episodes of desaturation that each
resolved with nebs and chest PT.  He continued to have a
productive cough with some blood streaking in his sputum.  He
was initially on vanc/zosyn but was eventually switched to
unasyn for improved anaerobic coverage for his likely aspiration
PNA.  He was kept in respiratory isolation until he was ruled
out for TB.  He denied fevers, chills, weight loss
(unintentional) and night sweats.  He underwent repeat CT chest
on [**2179-7-6**].  On [**7-8**], IV unasyn was discontinued and he was
switched to PO augmentin. Patient is to complete a four week
course of augmentin.  A swallow eval was done with no acute
concerns but do recommend diet with reflux precautions and
possibly outpatient f/u for further assessment.  Nebs were
stopped [**7-8**] and oxygen was weaned. Patient was maintaining SpO2
> 94% with 3 L NC. Patient was discharged home with supplemental
oxygen that should be weaned over the following month. Recommend
follow up chest x-ray in [**6-22**] weeks to ensure resolution.
.
#. CAD: Continued his home statin.  Aspirin was initially held
due to recent hemoptysis but restarted at discharge.
.
#. Communication: Daughter [**Name (NI) **] [**Telephone/Fax (1) 82117**], and Son
[**Telephone/Fax (1) 82118**]
.
#. Code status: Full (discussed with patient)
.
#  Dispo: home to [**Hospital3 **] facility with home PT and VNA
services

Medications on Admission:
Aspirin 81 mg daily
Ranitidine 150 mg b.i.d.
Folic acid 1 mg
Simvastatin 20 mg daily

Discharge Medications:
1. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
5. Amoxicillin-Pot Clavulanate 250-125 mg Tablet Sig: One (1)
Tablet PO Q8H (every 8 hours) for 4 weeks.
Disp:*84 Tablet(s)* Refills:*0*
6. Guaifenesin 400 mg Tablet Sig: One (1) Tablet PO three times
a day as needed for cough for 4 weeks.
Disp:*90 Tablet(s)* Refills:*0*
7. Supplemental Oxygen
Please provide continuous supplemental oxygen [**1-17**] LPM via nasal
cannula. Pulse dose for portability.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Home Health Care

Discharge Diagnosis:
Primary Diagnosis:
Cavitary Pneumonia
.
Secondary Diagnosis:
Hypertension


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid
(rolling walker).
Oxygen saturation with ambulation 90-95% on 3 L NC.


Discharge Instructions:
You were admitted to the hospital due to coughing up blood.
Your oxygen level in your blood was also low.  You were found to
have a pneumonia and a cavitary lung lesion.  You were treated
with IV antibiotics and your coughing and oxygen levels
improved. You were switched to oral antibiotics on discharge.
You will continue to need supplemental oxygen over the next few
weeks.  Once your oxygen levels returned to [**Location 213**] you will be
able to discontinue the supplemental oxygen.
.
The following changes were made to your home medications:
1) START Augmentin 1 tablet by mouth every 8 hours for 1 month.
This is antibiotic to help treat your infection.
2) START Guaifenesin 1 tablet by mouth every 4 to 6 hours as
needed for cough suppression.
..

Followup Instructions:
You have the following appointments scheduled:

Department: [**Hospital **] HEALTHCARE OF [**Location (un) **]
When: THURSDAY [**2179-7-22**] at 02:50 PM
With: [**First Name11 (Name Pattern1) 20**] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 3070**]
Building: [**Street Address(2) 8172**] ([**Location (un) 620**], MA) Ground
Campus: OFF CAMPUS     Best Parking: Parking on Site
.
Department: [**Hospital **] HEALTHCARE OF [**Location (un) **]
When: TUESDAY [**2179-8-17**] at 10:40 AM
With: [**First Name11 (Name Pattern1) 20**] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 3070**]
Building: [**Street Address(2) 8172**] ([**Location (un) 620**], MA) Ground
Campus: OFF CAMPUS     Best Parking: Parking on Site


                             [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**]
{'Pneumonitis due to inhalation of food or vomitus,Abscess of lung,Other specified forms of effusion, except tuberculous,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Bronchiectasis without acute exacerbation,Hypoxemia'}


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

PRESENT ILLNESS: Mr. [**Known lastname **] is an 89 year old male with past medical history of
hyperlipidemia and pulmonary embolism who presented to [**Hospital1 **]
[**Location (un) 620**] with shortness of breath.

MEDICAL HISTORY: - Hyperlipidemia
- BPH
- History of pulmonary embolism
- Hypertension
- Gallstones
- Cataracts

MEDICATION ON ADMISSION: Aspirin 81 mg daily
Ranitidine 150 mg b.i.d.
Folic acid 1 mg
Simvastatin 20 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Alert, oriented, no acute distress.  Mild cough.
Conversational with no difficulty speaking/breathing
HEENT: Sclera anicteric, MMM, oropharynx clear.  NC in place.
Neck: supple, JVP not elevated, no LAD
Lungs: Rhonchorous breath sounds bilaterally.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
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: Notable for bladder cancer in his father and pancreatic cancer
in mother.

SOCIAL HISTORY: Social History: [**Hospital3 **] home, fairly independent.
Artillery division in WWII.  Denies any recent travel history.
Does have hx of positive PPD at age 12 that was never treated.
- Tobacco:  Denies
- Alcohol:  Denies
- Illicits:  Denies 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Abscess of lung,Other specified forms of effusion, except tuberculous,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Bronchiectasis without acute exacerbation,Hypoxemia'}
