CHIEF COMPLAINT: fevers, cough

PRESENT ILLNESS: Patient is a 36 yo male with a history of cerebral palsy,
epilepsy, aspiration, aphasia who was previously diagnosed with
right lower lobe pneumonia on [**2191-10-5**] and completed a 10 day
course of levofloxacin. However, he was brought to ED by group
home staff on [**2191-11-7**] with fevers to 101 and productive cough -
unclear if white or yellow phlegm. The patient was febrile in
the ED with a WBC of 18.8 and placed on Levo/Flagyl for
aspiration pneumonia with CXR showing persistent cavitary RLL
pneumonia with effusion. He was found to have a lung abscess and
treated with IV Levo/Clinda.

MEDICAL HISTORY: cerebral palsy
mental retardation
seizures

MEDICATION ON ADMISSION: Outpatient:

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc=96.1  P=114  BP=130/78  RR=23 100% O2 I/O = 2075/1630

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: denies drugs, EtOH, tobacco
Lives in group home
Abscess of lung,Pneumonitis due to inhalation of food or vomitus,Unspecified protein-calorie malnutrition,Depressive disorder, not elsewhere classified,Unspecified intellectual disabilities,Epilepsy, unspecified, without mention of intractable epilepsy,Infantile cerebral palsy, unspecified
Abscess of lung,Food/vomit pneumonitis,Protein-cal malnutr NOS,Depressive disorder NEC,Intellect disability NOS,Epilep NOS w/o intr epil,Cerebral palsy NOS
Name:  [**Known lastname 415**],[**Known firstname 126**]              Unit No:   [**Numeric Identifier 416**]

Admission Date:  [**2191-11-7**]              Discharge Date:   [**2191-11-25**]

Date of Birth:  [**2155-5-17**]             Sex:   M

Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 417**]
Chief Complaint:
fevers, cough

Major Surgical or Invasive Procedure:
none


Pertinent Results:
[**2191-11-7**] 08:46PM URINE  COLOR-Amber APPEAR-Clear SP [**Last Name (un) 418**]-1.010
[**2191-11-7**] 08:46PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM  UROBILNGN-4* PH-8.0
LEUK-NEG
[**2191-11-7**] 08:46PM URINE  RBC-0 WBC-0 BACTERIA-NONE YEAST-NONE
EPI-<1
[**2191-11-7**] 04:40AM   GLUCOSE-106* UREA N-10 CREAT-0.7 SODIUM-135
POTASSIUM-4.3 CHLORIDE-97 TOTAL CO2-25 ANION GAP-17
[**2191-11-7**] 04:40AM   LD(LDH)-194
[**2191-11-7**] 04:40AM   WBC-18.8* RBC-3.81* HGB-12.1* HCT-37.8*
MCV-99* MCH-31.8 MCHC-32.0 RDW-12.8
[**2191-11-7**] 04:40AM   PHENYTOIN-2.2*
[**2191-11-7**] 04:40AM   NEUTS-80* BANDS-10* LYMPHS-7* MONOS-3 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2191-11-7**] 04:40AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL
[**2191-11-7**] 04:40AM   PLT SMR-HIGH PLT COUNT-595*

Brief Hospital Course:
See discharge summary.

Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 419**] [**Last Name (NamePattern1) **] Rehabilitation & Nursing Center - [**Location (un) 164**]

Discharge Diagnosis:
Lung abscess
Epilepsy
Aspiration


Discharge Condition:
Stable

Discharge Instructions:
Please call your primary care physician or return to the ER if
you experience any shortness of breath or persistent fevers
despite antibiotics.

Followup Instructions:
The patient should follow up with his primary care physician,
[**Last Name (NamePattern4) **]. [**Last Name (STitle) 420**], in 2 weeks by calling 1-[**Telephone/Fax (1) 421**] to schedule an
appointment.

Provider [**First Name11 (Name Pattern1) 422**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 188**], M.D. Where: [**Hospital6 189**]
NEUROLOGY Phone:[**Telephone/Fax (1) 423**] Date/Time:[**2191-12-6**] 11:30


                             [**Name6 (MD) **] [**Last Name (NamePattern4) 424**] MD [**MD Number(1) 425**]

Completed by:[**2191-11-25**]

Admission Date:  [**2191-11-7**]              Discharge Date:   [**2191-11-25**]

Date of Birth:  [**2155-5-17**]             Sex:   M

Service: MED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2641**]
Chief Complaint:
Fevers, cough

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Patient is a 36 yo male with a history of cerebral palsy,
epilepsy, aspiration, aphasia who was previously diagnosed with
right lower lobe pneumonia on [**2191-10-5**] and completed a 10 day
course of levofloxacin. However, he was brought to ED by group
home staff on [**2191-11-7**] with fevers to 101 and productive cough -
unclear if white or yellow phlegm. The patient was febrile in
the ED with a WBC of 18.8 and placed on Levo/Flagyl for
aspiration pneumonia with CXR showing persistent cavitary RLL
pneumonia with effusion. He was found to have a lung abscess and
treated with IV Levo/Clinda.

Past Medical History:
cerebral palsy
mental retardation
seizures

Social History:
denies drugs, EtOH, tobacco
Lives in group home

Family History:
noncontributory


Physical Exam:
Tc=96.1  P=114  BP=130/78  RR=23 100% O2 I/O = 2075/1630

Gen - aphasic, very thin male, may at times respond to command,
alert
HEENT - PERLA, EOMI
Heart - increased rate, RRR, no M/R/G, clear S1, S2
Lungs - decreased BS at right base with crackles in mid-right
lung and bibasilar
Abd - NT, ND + BS
Ext - no cyanosis/positive clubbing/no edema, moves all four
extremities spontaneously


Pertinent Results:
CXR [**2191-11-7**] AP: Peristent right lung opacification - pleural
effusion with rounded lucency suggesting cavitation.

Brief Hospital Course:
36 yo M w/cerebral palsy, epilepsy, history of recurrent
aspiration pneumonias, aphasia now with right lower lobe lung
asbcess.

CT Chest [**2191-11-7**]: Necrotizing pneumonia in RML and RLL, lung
abscess. Cannot tell if effusions given limited study secondary
to scoliosis. Of note, bright contrast in gallbladder - sludge
vs. stone vs. contrast reaction vs. prior study residual

1. RLL pneumonia - CT notable for lung abscess. Pulmonology was
consulted and recommended Levofloxacin/Clindamycin. The patient
will need a course of 4 weeks of Levofloxacin/Clindamycin and
then clinda for as long as needed. Last day of levofloxacin is
[**12-5**]. Once the four week course is concluded, a repeat
chest xray should be taken to evaluate for resolution of the
lung abscess. If the abscess persists or the patient's
fevers/cough persist, clindamycin should be continued until
these resolve. An active issue in-house was the patient's
ability to take oral antibiotics as he intermittently spit the
antibiotics out.  Therefore, a PICC was placed on [**2191-11-11**] for IV
antibiotics. Near the date of discharge, the patient was
tolerating his oral antibiotics. However, if he does not take
these antibiotics, he should be administered the IV form through
the PICC in his right arm. The PICC may then be removed after
antibiotics use has been completed.

2. Fevers -  Patient's temp down to 100s with antibiotics. He
remained afebrile while on antibiotics.

3. Epilepsy - The patient's dilantin dose was adjusted secondary
to a subtherapeutic level. He was maintained on Dilantin 100 mg
PO Q8 hours. Plan to continue dilantin at current dose and check
dilantin level on Monday, [**11-28**] and adjust dilantin level
as needed.

4. Recurrent aspirations - The patient's family was concerned
that the patient had lost at lost a great deal of weight at the
group home where he staying. He had tolerated ground feeds while
at home with his mother one year ago. As a result, a video
speech and swallow evaluation was performed and showed that the
patient was aspirating all consistencies of food and had a
suppressed cough reflex most of the time. While eating on the
floor with aspiration precautions, the patient aspirated and
became hypoxic to 40% and went up to 90% with aggressive
suctioning. He was therefore transferred to the [**Hospital Unit Name 153**] for
aggressive respiratory management where he was maintained on a
shovel face mask of 9 L O2, kept NPO and continued on IV
antibiotics. Intubation was not required and he was subsequently
transferred to the floor.

Neurology was consulted to evaluate the patient (known to Dr.
[**Last Name (STitle) 2442**] to evaluate if the patient's dysphagia was related to
his known cerebral palsy or represented a new neurologic event.
The family was also concerned because they stated that the
patient was able to walk with assistance one year ago. A CT of
the head showed no acute change that would explain the patient's
decline and inabilities to swallow or walk. Neurology
recommended the patient follow up with Dr. [**Last Name (STitle) 2442**]. In terms of
the patient's dysphagia, the family indicated that they felt the
patient most enjoyed eating and in order to maintain his quality
of life, we should continue to feed him ground food knowing that
he will ultimately aspirate. Thus, the patient was continued on
a ground diet with thickened liquids which he tolerated.

5. Tachycardia - Of note patient with noted resting tachycardia
in 110-120 level. It is believed this is related to dehydration
as the patient responded to IV fluids.

6. Depression - The patient was noticed to be withdrawn during
most of his hospital course. However, he interacts more when his
family is present. As a result, Remeron 7.5 mg was started to
treat his depression.


Medications on Admission:
Outpatient:

Dilantin 300 mg PO daily
Tums
Vitamin D


Discharge Medications:
1. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO QD (once a day).
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
4. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 4 weeks.
Disp:*28 Tablet(s)* Refills:*0*
5. Clindamycin Palmitate 75 mg/5 mL Recon Soln Sig: Twenty (20)
ml PO Q6H (every 6 hours) for 6 weeks.
Disp:*3360 ml* Refills:*0*
6. Phenytoin 100 mg/4 mL Suspension Sig: Six (6) ml PO Q12H
(every 12 hours).
7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
9. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
injection
injection Injection TID (3 times a day).


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 3504**] [**Last Name (NamePattern1) **] Rehabilitation & Nursing Center - [**Location (un) 538**]

Discharge Diagnosis:
Lung abscess
Epilepsy
Aspiration


Discharge Condition:
Stable

Discharge Instructions:
Please call your primary care physician or return to the ER if
you experience any shortness of breath or persistent fevers
despite antibiotics.

Followup Instructions:
The patient should follow up with his primary care physician,
[**Last Name (NamePattern4) **]. [**Last Name (STitle) **], in 2 weeks by calling 1-[**Telephone/Fax (1) 3505**] to schedule an
appointment.

Provider [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. Where: [**Hospital6 29**]
NEUROLOGY Phone:[**Telephone/Fax (1) 3506**] Date/Time:[**2191-12-6**] 11:30
{'Abscess of lung,Pneumonitis due to inhalation of food or vomitus,Unspecified protein-calorie malnutrition,Depressive disorder, not elsewhere classified,Unspecified intellectual disabilities,Epilepsy, unspecified, without mention of intractable epilepsy,Infantile cerebral palsy, 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: fevers, cough

PRESENT ILLNESS: Patient is a 36 yo male with a history of cerebral palsy,
epilepsy, aspiration, aphasia who was previously diagnosed with
right lower lobe pneumonia on [**2191-10-5**] and completed a 10 day
course of levofloxacin. However, he was brought to ED by group
home staff on [**2191-11-7**] with fevers to 101 and productive cough -
unclear if white or yellow phlegm. The patient was febrile in
the ED with a WBC of 18.8 and placed on Levo/Flagyl for
aspiration pneumonia with CXR showing persistent cavitary RLL
pneumonia with effusion. He was found to have a lung abscess and
treated with IV Levo/Clinda.

MEDICAL HISTORY: cerebral palsy
mental retardation
seizures

MEDICATION ON ADMISSION: Outpatient:

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc=96.1  P=114  BP=130/78  RR=23 100% O2 I/O = 2075/1630

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: denies drugs, EtOH, tobacco
Lives in group home 

### Response:
{'Abscess of lung,Pneumonitis due to inhalation of food or vomitus,Unspecified protein-calorie malnutrition,Depressive disorder, not elsewhere classified,Unspecified intellectual disabilities,Epilepsy, unspecified, without mention of intractable epilepsy,Infantile cerebral palsy, unspecified'}
