CHIEF COMPLAINT: Cough, Fever

PRESENT ILLNESS: [**Age over 90 **]yo M presenting with productive cough and fever.  Onset: 3d
prior, pt notes productive (yellow sputum, no blood) cough.
Preceeded by 14d of non-productive cough with outpatient eval
that included Z-pack (last dose 10d prior). Course: increasing
severity of cough over last 3 days.  Associated Sx: 1d of
elevated T to 101.6 max, decreased energy this AM with inability
to exit bed.  Denies additional ASx including SOB, CP, n/v,
change in GI or GU habits, HA, chills, change in vision,
pre-syncope, syncope, or seizure activity.  Denies any known
immunosuppression or recurrent infections.

MEDICAL HISTORY: 1. Complex partial seizures
2. Prostate cancer, diagnosed 5 years ago. Being followed
expectantly and treated with Proscar.
3. Sleep apnea with daytime sleepiness and sleep disordered
breathing noted in past. Trialed on Modafanil but this caused
oral buccal dyskinesias. Did not tolerate BiPap. Daytime
sleepiness improved after discontinuation of Depakote.
4. History of orthostatic hypotension in remote past, on Cortef

MEDICATION ON ADMISSION: Kepra [**12-2**] 750mg [**Hospital1 **]
avodart 0.5mg qhs
coumadin 2.5 to 5mg daily
hydrocort 10mg [**Hospital1 **]
restatis (cyclosporine) bilateral 1 drop daily
Azopt 1 % risolimide

ALLERGIES: Depakote ER

PHYSICAL EXAM: Vitals: T: 97.4 BP: 130/56 P:75 R:16 O2:99% on RA
General: Alert, oriented to person and place, no acute distress

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The pt is widowed since [**2151**]. Retired at age 70. Was on the
Board of Directors at [**Hospital1 18**]. Former smoker of 10 pack years but
quit 50+ years ago. Drinks one shot or cocktail nightly. Has 24
hour housekeeping and homecare assistance, driver. Walks with
cane for past one year.
Bacterial pneumonia, unspecified,Other acute and subacute forms of ischemic heart disease, other,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Volume depletion, unspecified,Unspecified disorder of autonomic nervous system,Unspecified glaucoma,Obstructive sleep apnea (adult)(pediatric),Lumbago,Personal history of venous thrombosis and embolism,Urinary frequency,Cardiac pacemaker in situ
Bacterial pneumonia NOS,Ac ischemic hrt dis NEC,Part epil w/o intr epil,Volume depletion NOS,Autonomic nerve dis NEC,Glaucoma NOS,Obstructive sleep apnea,Lumbago,Hx-ven thrombosis/embols,Urinary frequency,Status cardiac pacemaker
Admission Date:  [**2159-9-17**]              Discharge Date:   [**2159-9-19**]


Service: MEDICINE

Allergies:
Depakote ER

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Cough, Fever

Major Surgical or Invasive Procedure:
None

History of Present Illness:
[**Age over 90 **]yo M presenting with productive cough and fever.  Onset: 3d
prior, pt notes productive (yellow sputum, no blood) cough.
Preceeded by 14d of non-productive cough with outpatient eval
that included Z-pack (last dose 10d prior). Course: increasing
severity of cough over last 3 days.  Associated Sx: 1d of
elevated T to 101.6 max, decreased energy this AM with inability
to exit bed.  Denies additional ASx including SOB, CP, n/v,
change in GI or GU habits, HA, chills, change in vision,
pre-syncope, syncope, or seizure activity.  Denies any known
immunosuppression or recurrent infections.

Per son, pt was not at baseline mental status this AM; following
the below treatment within the ED, the son reports that his
father has now returned to his baseline.
.
In the ED, initial vs were: Temp:97.4 HR:74 BP:92/37 Resp:18
O(2)Sat:97 normal. Physical exam was consistent with decreased
volume status and pneumonia (Crackles at the right base,
diminished breath sounds on the left base).  A cxray confirmed
the LLL alveolar process consistent with PNA.

. Clinical course complicated by 1 episode of hypotension
(asymptomatic) with a systolic pressure in the 80s.  Patient was
rehydrated with 1.5L of NS; his BP returned to his baseline SBP
in the 90s.  In additional, pt received initial course of Abx
for CAP, ceftriaxone and levofloxacin following blood Cx, urine
Cx, and sputum Cx.

In addition, the patient had an intermediate troponin, 0.04,
with no evidence of an acute process on EKG. He has had this in
the past, although his most recent troponin was negative. The ED
team discussed this with cardiology and provided the patient
with a 325mg of aspirin here in the ED.
.
On the floor, the pt has remained appropriate and provided the
above history; his 24hour aide is at his bedside and confirms
the aforesaid details.


Past Medical History:
1. Complex partial seizures
2. Prostate cancer, diagnosed 5 years ago. Being followed
expectantly and treated with Proscar.
3. Sleep apnea with daytime sleepiness and sleep disordered
breathing noted in past. Trialed on Modafanil but this caused
oral buccal dyskinesias. Did not tolerate BiPap. Daytime
sleepiness improved after discontinuation of Depakote.
4. History of orthostatic hypotension in remote past, on Cortef

5. Left eye cataract status post surgery
6. Ptosis on right as a result of surgery for detached retina
7. Peripheral neuropathy
8. ? Esophageal diverticulum
9. Pacemaker

Social History:
The pt is widowed since [**2151**]. Retired at age 70. Was on the
Board of Directors at [**Hospital1 18**]. Former smoker of 10 pack years but
quit 50+ years ago. Drinks one shot or cocktail nightly. Has 24
hour housekeeping and homecare assistance, driver. Walks with
cane for past one year.



Family History:
Noncontributory.

Physical Exam:
Vitals: T: 97.4 BP: 130/56 P:75 R:16 O2:99% on RA
General: Alert, oriented to person and place, no acute distress

HEENT: Sclera anicteric, MMM, oropharynx clear with no
pharyngeal exudate
Neck: supple, JVP not elevated, no LAD
Lungs: Crackles LLB
CV: Paced AV at 75bpm, 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 or cyanosis, 1+
edema from feet through ankles BL.


Pertinent Results:
CLINICAL INFORMATION: [**Age over 90 **]-year-old male with history of fever,
cough, rule out
infiltrate.

COMPARISON: [**2157-4-22**].

FINDINGS: Patchy left base opacity raises concern for
consolidation/pneumonia. There is slight blunting of the left
costophrenic
angle may be due to a trace effusion. Mild right base
atelectasis is noted.
Cardiac silhouette is mildly enlarged. The aorta is calcified
and tortuous.
No pulmonary edema is seen. A dual-lead left-sided pacemaker is
again seen,
unchanged in position, with leads extending in the expected
positions of the
right atrium and right ventricle. Degenerative changes are seen
at the right
shoulder and acromioclavicular joints. There is diffuse
osteopenia. Evidence
of DISH is seen along the thoracic spine.


Brief Hospital Course:
[**Age over 90 **]yo M presenting with s/sx consistent with CAP.

MICU Course: [**Date range (3) 97316**]
Patient was admitted to MICU overnight for observation. He was
started on cetriaxone and levofloaxacin for CAP coverage when
admitted and then transitioned to clindamycin. When admitted was
transiently hypotesnive to SBP 90s. He was encouraged to take PO
and SBPs remained in 110s. Initial labs also showed a troponin
leak with no evidence of ischemia. This was thought to be [**1-2**]
demand. Serial troponins stable. No interventioned was needed.
INR was subtherapeutic on admission and coumadin was increased
for one dose. Repeat INR was within therapeutic ranges. He was
transferred to the floor where he was HD stable and had no
oxygen requirement. He was discharged to complete a 10 day
course of Clindamycin and follow up with his PCP. [**Name10 (NameIs) **]
discharge medication list and scheduled f/u appointments can be
found below.

Medications on Admission:
Kepra [**12-2**] 750mg [**Hospital1 **]
avodart 0.5mg qhs
coumadin 2.5 to 5mg daily
hydrocort 10mg [**Hospital1 **]
restatis (cyclosporine) bilateral 1 drop daily
Azopt 1 % risolimide


Discharge Medications:
1. hydrocortisone 10 mg Tablet Sig: One (1) Tablet PO twice a
day.
2. levetiracetam 750 mg Tablet Sig: 0.5 Tablet PO twice a day.
3. clindamycin HCl 300 mg Capsule Sig: One (1) Capsule PO three
times a day for 5 days.
Disp:*16 Capsule(s)* Refills:*0*
4. cyclosporine 0.05 % Dropperette Sig: One (1) Drop Ophthalmic
DAILY (Daily).
5. brinzolamide 1 % Drops, Suspension Ophthalmic
6. warfarin 1 mg Tablet Sig: 1.5 Tablets PO EVERY OTHER DAY
(Every Other Day).
7. Avodart 0.5 mg Capsule Sig: One (1) Capsule PO at bedtime.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] Family & [**Hospital1 1926**] Services

Discharge Diagnosis:
Community Acquired Pneumonia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
You were admitted to [**Hospital1 18**] because you had symptoms that were
concerning for a community acquired pneumonia. We initiated
treatment with antibiotics. While you were here you had an
episode of low blood pressure that resolved when we gave you
fluids.

We would like you to take the following medicines:

1) Clindamycin 300 MG three times a day for 5 more days

2) Warfarin 1.5mg every other day

You should continue to take your other medicines as directed by
your primary care physician. [**Name10 (NameIs) **] [**Name11 (NameIs) 97317**] also continue to drink
fluids when you are thirsty.

The antibiotics you are on can interfere with your blood
thinners. It is important that you have your blood tested within
48 hours of going home so that any adjustments in dosing can be
made.

Followup Instructions:
PCP appointment with Dr. [**First Name8 (NamePattern2) 1312**] [**Last Name (NamePattern1) **] MD
[**Last Name (Titles) 766**] [**2159-9-24**] at 3pm please call [**Telephone/Fax (1) 7318**] if you are
unable to make the appointment or need to reschedule.

Department: NEUROLOGY
When: THURSDAY [**2159-9-27**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 16747**], M.D. [**Telephone/Fax (1) 16748**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: TUESDAY [**2159-10-16**] at 1:30 PM
With:  DEVICE CLINIC [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: TUESDAY [**2159-10-16**] at 2:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Bacterial pneumonia, unspecified,Other acute and subacute forms of ischemic heart disease, other,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Volume depletion, unspecified,Unspecified disorder of autonomic nervous system,Unspecified glaucoma,Obstructive sleep apnea (adult)(pediatric),Lumbago,Personal history of venous thrombosis and embolism,Urinary frequency,Cardiac pacemaker in situ'}


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, Fever

PRESENT ILLNESS: [**Age over 90 **]yo M presenting with productive cough and fever.  Onset: 3d
prior, pt notes productive (yellow sputum, no blood) cough.
Preceeded by 14d of non-productive cough with outpatient eval
that included Z-pack (last dose 10d prior). Course: increasing
severity of cough over last 3 days.  Associated Sx: 1d of
elevated T to 101.6 max, decreased energy this AM with inability
to exit bed.  Denies additional ASx including SOB, CP, n/v,
change in GI or GU habits, HA, chills, change in vision,
pre-syncope, syncope, or seizure activity.  Denies any known
immunosuppression or recurrent infections.

MEDICAL HISTORY: 1. Complex partial seizures
2. Prostate cancer, diagnosed 5 years ago. Being followed
expectantly and treated with Proscar.
3. Sleep apnea with daytime sleepiness and sleep disordered
breathing noted in past. Trialed on Modafanil but this caused
oral buccal dyskinesias. Did not tolerate BiPap. Daytime
sleepiness improved after discontinuation of Depakote.
4. History of orthostatic hypotension in remote past, on Cortef

MEDICATION ON ADMISSION: Kepra [**12-2**] 750mg [**Hospital1 **]
avodart 0.5mg qhs
coumadin 2.5 to 5mg daily
hydrocort 10mg [**Hospital1 **]
restatis (cyclosporine) bilateral 1 drop daily
Azopt 1 % risolimide

ALLERGIES: Depakote ER

PHYSICAL EXAM: Vitals: T: 97.4 BP: 130/56 P:75 R:16 O2:99% on RA
General: Alert, oriented to person and place, no acute distress

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The pt is widowed since [**2151**]. Retired at age 70. Was on the
Board of Directors at [**Hospital1 18**]. Former smoker of 10 pack years but
quit 50+ years ago. Drinks one shot or cocktail nightly. Has 24
hour housekeeping and homecare assistance, driver. Walks with
cane for past one year. 

### Response:
{'Bacterial pneumonia, unspecified,Other acute and subacute forms of ischemic heart disease, other,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Volume depletion, unspecified,Unspecified disorder of autonomic nervous system,Unspecified glaucoma,Obstructive sleep apnea (adult)(pediatric),Lumbago,Personal history of venous thrombosis and embolism,Urinary frequency,Cardiac pacemaker in situ'}
