CHIEF COMPLAINT: fever, rigors s/p cystolitholopaxy

PRESENT ILLNESS: The patient is an 82M w/ h/o HTN, CAD, nephrolithiasis and
recent Proteus UTI who presents after routine cystolitholopaxy
for nephrolithiasis with fever and rigors. Per urology, he had
been treated for recent Proteus UTI, but he states he took Cipro
for this 6 months ago.
.
The patient arrived to day surgery for elective
cystolitholopaxy. The procedure was uncomplicated and he was
routinely treated with intra-op cefazolin. In the PACU, he was
noted to have a fever to 100.6 and rigors. He was tachycardic to
the 110s and hypertensive to 160/65 and was given 2.5mg IV
lopressor. His O2 sats remained in the high 90s. BCx and UCx
were sent and he was given 80mg IV gentamicin.

MEDICAL HISTORY: 1. HTN
2. CAD
3. Prostate ca s/p TURP and radiation in [**2177**]
3. h/o CVA in 98 without residual
4. Hypothyroidism
4. h/o nephrolithiasis, recent proteus UTI in this setting
5. GERD
6. Radiation enteropathy
7. Skin cancer- BCC/SCC
8. s/p appy
9. Hyperlipidemia
10. Depression
11. Bladder cancer

MEDICATION ON ADMISSION: 1. Metoprolol 12.5mg qd
2. nexium 40mg qd
3. synthroid 88mcg qd
4. asacol 400mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 102.3, 107, 119/63, 17, 96% 3L NC
Gen: alert, interactive, pleasant elderly man in NAD
HEENT: PERRL, EOMI, OP clear, MM dry, anicteric
Neck: supple, no JVD, no LAD
CV: tachy, RR, nl S1S2, no m/r/g
Resp: CTAB
Abd: +BS, S/ND, mild TTP RLQ
Ext: no c/c/e
Neuro: AAOx3, no focal deficits

FAMILY HISTORY: prostate ca; S: died of lung cancer; M: died of an aneurysm

SOCIAL HISTORY: Pt is widowed and lives by himself. He is a former race dog
trainer. No smoking/EtOH/drugs
Calculus in urethra,Other postoperative infection,Bacteremia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bladder,Esophageal reflux,Personal history of other diseases of circulatory system,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of prostate
Urethral calculus,Other postop infection,Bacteremia,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx of bladder malignancy,Esophageal reflux,Hx-circulatory dis NEC,Hypothyroidism NOS,Hx-prostatic malignancy
Admission Date:  [**2189-12-21**]              Discharge Date:   [**2189-12-23**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
fever, rigors s/p cystolitholopaxy

Major Surgical or Invasive Procedure:
Cystolitholopaxy

History of Present Illness:
The patient is an 82M w/ h/o HTN, CAD, nephrolithiasis and
recent Proteus UTI who presents after routine cystolitholopaxy
for nephrolithiasis with fever and rigors. Per urology, he had
been treated for recent Proteus UTI, but he states he took Cipro
for this 6 months ago.
.
The patient arrived to day surgery for elective
cystolitholopaxy. The procedure was uncomplicated and he was
routinely treated with intra-op cefazolin. In the PACU, he was
noted to have a fever to 100.6 and rigors. He was tachycardic to
the 110s and hypertensive to 160/65 and was given 2.5mg IV
lopressor. His O2 sats remained in the high 90s. BCx and UCx
were sent and he was given 80mg IV gentamicin.


Past Medical History:
1. HTN
2. CAD
3. Prostate ca s/p TURP and radiation in [**2177**]
3. h/o CVA in 98 without residual
4. Hypothyroidism
4. h/o nephrolithiasis, recent proteus UTI in this setting
5. GERD
6. Radiation enteropathy
7. Skin cancer- BCC/SCC
8. s/p appy
9. Hyperlipidemia
10. Depression
11. Bladder cancer


Social History:
Pt is widowed and lives by himself. He is a former race dog
trainer. No smoking/EtOH/drugs

Family History:
prostate ca; S: died of lung cancer; M: died of an aneurysm

Physical Exam:
102.3, 107, 119/63, 17, 96% 3L NC
Gen: alert, interactive, pleasant elderly man in NAD
HEENT: PERRL, EOMI, OP clear, MM dry, anicteric
Neck: supple, no JVD, no LAD
CV: tachy, RR, nl S1S2, no m/r/g
Resp: CTAB
Abd: +BS, S/ND, mild TTP RLQ
Ext: no c/c/e
Neuro: AAOx3, no focal deficits

Pertinent Results:
EKG: sinus tach at 109, nl axis, LBBB (intermittent LBBB seen as
far back as [**3-5**], LVH


Brief Hospital Course:
82M w/ HTN, CAD, nephrolithiasis, presents following
cystolitholopaxy with fever, rigors.
.
# Fever: Given onset of fevers post procedure, likely represent
transient bacteremia after urologic procedure; relative
leukopenia at that time in elderly pt may be explained by
infection.  His white blood cell count normalized, however, and
he remained afebrile for >24 hours prior to discharge.
Throughout his stay, and while he was febrile, he remained
hemodynamically stable.  He was on gentamicin and ancef while in
the hospital and he will be discharged on a 2 week course of
bactrim DS.
Blood cultures were obtained and these should be followed up;
showed no growth as of date of discharge.  Urine cultures were
ordered although it appears were not collected.
.
# S/P cystolitholopaxy: Post procedure fever as outline above.
CBI was continued postprocedure, was discontinued POD1 and foley
was removed.  Post void residual was assessed at 48cc.  He was
continued on pyridium prn and will be discharged on the same.
He will follow up with Dr. [**First Name (STitle) **] on [**1-5**] at 10:45am.
.
# HTN: He has been normotensive during his hospital stay.  He
was continued on his outpatient dose of metoprolol.
.
# Hypothyroidism:  He was continued on his home dose of
synthroid.
.
# Radiation enteropathy:  Continued on home dose asacol.
.
# CAD:  Patient has h/o CAD, but was admitted on beta blocker
alone.  It is unclear why he is not taking ASA, which would have
been held peri urologic procedure anyhow.  He also has, by
report, a history of hyperlipidemia and was not admitted on a
statin.  In reviewing his past medications, it appears that he
has been on both ASA and Lipitor in the past.  Per patient, he
had GI intolerance of his statin and ASA was d/c'd in the
setting of hematuria.  His medication regimen in the setting of
CAD can be followed up with PCP as an outpatient.
.
# Hyperlipidemia:  As above.
.
# GERD:  He was continued on PPI while inpatient.

Medications on Admission:
1. Metoprolol 12.5mg qd
2. nexium 40mg qd
3. synthroid 88mcg qd
4. asacol 400mg qd


Discharge Medications:
1. Bactrim DS 160-800 mg Tablet Sig: One (1) Tablet PO twice a
day for 14 days.
Disp:*28 Tablet(s)* Refills:*0*
2. Pyridium 100 mg Tablet Sig: One (1) Tablet PO three times a
day as needed for pain for 15 doses: For urinary/bladder
discomfort.
Disp:*15 Tablet(s)* Refills:*0*
3. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
5. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO Q 24H (Every 24 Hours).


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Nephrolithiasis
.
Secondary:
Coronary artery disease
Hypertension
Hypothyroidism
Radiation enteropathy


Discharge Condition:
Stable, afebrile


Discharge Instructions:
Please call your doctor or present to the emergency room if you
develop fevers, shaking chills, pain when you urinate, inability
to urinate, worsening abdominal/pelvic pain or any other
symptoms that concern you.
.
Please be sure to continue your antibiotics as prescribed (you
are to complete a 2 week course of bactrim).
.
Please resume taking your other medications at preadmission
doses.

Followup Instructions:
Please follow up with Dr. [**First Name (STitle) **] ([**Telephone/Fax (1) 7287**] on [**1-5**]
at 10:45am in the [**Hospital Ward Name 23**] building.  Dr. [**First Name (STitle) **] should follow up
on your urine and blood cultures at that time.
{'Calculus in urethra,Other postoperative infection,Bacteremia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bladder,Esophageal reflux,Personal history of other diseases of circulatory system,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of prostate'}


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: fever, rigors s/p cystolitholopaxy

PRESENT ILLNESS: The patient is an 82M w/ h/o HTN, CAD, nephrolithiasis and
recent Proteus UTI who presents after routine cystolitholopaxy
for nephrolithiasis with fever and rigors. Per urology, he had
been treated for recent Proteus UTI, but he states he took Cipro
for this 6 months ago.
.
The patient arrived to day surgery for elective
cystolitholopaxy. The procedure was uncomplicated and he was
routinely treated with intra-op cefazolin. In the PACU, he was
noted to have a fever to 100.6 and rigors. He was tachycardic to
the 110s and hypertensive to 160/65 and was given 2.5mg IV
lopressor. His O2 sats remained in the high 90s. BCx and UCx
were sent and he was given 80mg IV gentamicin.

MEDICAL HISTORY: 1. HTN
2. CAD
3. Prostate ca s/p TURP and radiation in [**2177**]
3. h/o CVA in 98 without residual
4. Hypothyroidism
4. h/o nephrolithiasis, recent proteus UTI in this setting
5. GERD
6. Radiation enteropathy
7. Skin cancer- BCC/SCC
8. s/p appy
9. Hyperlipidemia
10. Depression
11. Bladder cancer

MEDICATION ON ADMISSION: 1. Metoprolol 12.5mg qd
2. nexium 40mg qd
3. synthroid 88mcg qd
4. asacol 400mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 102.3, 107, 119/63, 17, 96% 3L NC
Gen: alert, interactive, pleasant elderly man in NAD
HEENT: PERRL, EOMI, OP clear, MM dry, anicteric
Neck: supple, no JVD, no LAD
CV: tachy, RR, nl S1S2, no m/r/g
Resp: CTAB
Abd: +BS, S/ND, mild TTP RLQ
Ext: no c/c/e
Neuro: AAOx3, no focal deficits

FAMILY HISTORY: prostate ca; S: died of lung cancer; M: died of an aneurysm

SOCIAL HISTORY: Pt is widowed and lives by himself. He is a former race dog
trainer. No smoking/EtOH/drugs 

### Response:
{'Calculus in urethra,Other postoperative infection,Bacteremia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bladder,Esophageal reflux,Personal history of other diseases of circulatory system,Unspecified acquired hypothyroidism,Personal history of malignant neoplasm of prostate'}
