CHIEF COMPLAINT: Wheezing

PRESENT ILLNESS: Ms. [**Known lastname 805**] is an 81-year-old woman with a history of
hypercholesterolemia, hypertension, nonallergic rhinitis,
chronic sinusitis, and chronic cough who presents with cough,
wheezing, and shortness of breath.  Per the patient, she
developed an increasing cough over the last week associated with
wheezy.  She was seen in [**Company 191**] on [**4-30**] and was sent to the ED for
evaluation due to the concern of hypoxia to 94% and possible
ischemia based on an EKG.  She was admitted overnight (discharge
summary not complete) and treated for asthma exacerbation
(although no clear history of this) with nebs and steroids, and
advair was added back to her regimen.  She went home on [**5-1**] and
started to wheeze again.  Her granddaughter called Dr. [**Last Name (STitle) **]
on [**5-2**] because they thought she was supposed to be on a steroid
taper, but was not discharged on steroids.  He prescribed a
short steroid burst which she started taking on [**5-2**] with mild
improvement.  However, last night her wheezing got much worse
and she couldn't stop coughing due to her GERD and nasal drip.
She normally feels SOB when coughing, but otherwise did not feel
SOB.  She was concerned about her wheezing and presented to OSH
for evaluation.  Of note, she denies PND but does not like to
lie flat because her coughing worsens.  She states that the only
time she feels SOB is when she is coughing, and the coughing
fits can happen either at rest or with exertion, and there is no
pattern.  The coughing worsens if she has a URI or allergy
symptoms.  Additionally, when asked what is more concerning to
her, her audible wheeze or feeling SOB, she states the wheezy is
her most prominent and concerning symptom and that the SOB is in
the setting of the cough.  No fevers, chills, nausea, vomiting.
No chest pain, palpatations, weight gain, or LE edema (edema
improved).

MEDICAL HISTORY: # Status post right shoulder replacement
# Status post right hip replacement.
# Sinusitis.
# Nonallergic Rhinitis
# Bronchial asthma - not supported by PFTs
# OSA and ? obesity hypoventilation syndrome - followed by Dr.
[**Last Name (STitle) **]
# GERD.
# Hypertension.
# History of glaucoma.
# Arthritis.
# CAD with normal persantine MIBI in [**9-19**].
# History of cataract surgery.
# Influenza A [**1-19**]

MEDICATION ON ADMISSION: Atenolol 50mg daily
Atorvastatin 10mg daily
Azelastine 137mcg, 2 sprays nasal [**Hospital1 **]
Vitamin D 400 units daily
Advair 500/50 1 inhalation daily (but was recently stopped by
her PCP given no definitive evidence of asthma)
Furosemide 20mg daily
HCTZ 12.5mg daily
Lisinopril 20mg daily
Omeprazole 40mg EC [**Hospital1 **]
Potassium 20 mEQ daily

ALLERGIES: Sulindac / Aspirin / Hycodan

PHYSICAL EXAM: Tmax: 36.4 ??????C (97.6 ??????F)
Tcurrent: 36.4 ??????C (97.6 ??????F)
HR: 79 (79 - 79) bpm
BP: 137/71(88) {137/71(88) - 137/71(88)} mmHg
SpO2: 92%
Heart rhythm: SR (Sinus Rhythm)

FAMILY HISTORY: Her family history is significant for mother with breast cancer
at age 63 and a father who died of prostate cancer in his 80s.

SOCIAL HISTORY: The patient current resides in [**Location (un) **] with her granddaughter
and great grandchild.
She is retired, previously working as a meal tray delivery aid
at a hospital in [**State 531**].
She smoked for approximately 30 years, and quit 15 years ago.
She states that she smoked approximately 1 pack a day or less.
She denies any alcohol use.
Obstructive chronic bronchitis with (acute) exacerbation,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Hypopotassemia,Unspecified sinusitis (chronic),Obstructive sleep apnea (adult)(pediatric)
Obs chr bronc w(ac) exac,Hypertension NOS,Crnry athrscl natve vssl,Hypopotassemia,Chronic sinusitis NOS,Obstructive sleep apnea
Admission Date:  [**2145-5-4**]              Discharge Date:   [**2145-5-5**]

Date of Birth:  [**2063-3-28**]             Sex:   F

Service: MEDICINE

Allergies:
Sulindac / Aspirin / Hycodan

Attending:[**Last Name (NamePattern1) 495**]
Chief Complaint:
Wheezing

Major Surgical or Invasive Procedure:
transient bipap

History of Present Illness:
Ms. [**Known lastname 805**] is an 81-year-old woman with a history of
hypercholesterolemia, hypertension, nonallergic rhinitis,
chronic sinusitis, and chronic cough who presents with cough,
wheezing, and shortness of breath.  Per the patient, she
developed an increasing cough over the last week associated with
wheezy.  She was seen in [**Company 191**] on [**4-30**] and was sent to the ED for
evaluation due to the concern of hypoxia to 94% and possible
ischemia based on an EKG.  She was admitted overnight (discharge
summary not complete) and treated for asthma exacerbation
(although no clear history of this) with nebs and steroids, and
advair was added back to her regimen.  She went home on [**5-1**] and
started to wheeze again.  Her granddaughter called Dr. [**Last Name (STitle) **]
on [**5-2**] because they thought she was supposed to be on a steroid
taper, but was not discharged on steroids.  He prescribed a
short steroid burst which she started taking on [**5-2**] with mild
improvement.  However, last night her wheezing got much worse
and she couldn't stop coughing due to her GERD and nasal drip.
She normally feels SOB when coughing, but otherwise did not feel
SOB.  She was concerned about her wheezing and presented to OSH
for evaluation.  Of note, she denies PND but does not like to
lie flat because her coughing worsens.  She states that the only
time she feels SOB is when she is coughing, and the coughing
fits can happen either at rest or with exertion, and there is no
pattern.  The coughing worsens if she has a URI or allergy
symptoms.  Additionally, when asked what is more concerning to
her, her audible wheeze or feeling SOB, she states the wheezy is
her most prominent and concerning symptom and that the SOB is in
the setting of the cough.  No fevers, chills, nausea, vomiting.
No chest pain, palpatations, weight gain, or LE edema (edema
improved).

Vitals recorded by EMS were 146/52, 82, 18, 100%. At [**Hospital 8**]
Hospital she received duoneb, Solumedrol 125mg and magnesium.
Transferred to [**Hospital1 18**] where initial vitals were 96.7, 73, 162/90,
20, 98% on 4L.  CXR initially thought to have LLL infiltrate and
received ceftriaxone and azithromycin, but radiology later read
it as normal.  Was audibly wheezing and received an additional
125mg IV solumedrol and multiple rounds of albuterol and
atrovent nebs.  Flu sent and was negative.  EKG with new ST
depressions in V4-V6, CE's negative.  Recieved 500cc IVFs and
100mg thiamine.  ABG prior to BIPAP was 7.37/40/109.  Received
BIPAP for one hour with some improvement in symptoms. Of note
lactate 5.5 to 5.3 to 8.2 over 6 hrs, unclear etiology as no
abdominal pain, hypotension, not felt to be septic physiology.

Currently the patient is without complaints.  She is not SOB or
wheezy and feels much better when compared to presentation.  No
chest pain.


Past Medical History:
# Status post right shoulder replacement
# Status post right hip replacement.
# Sinusitis.
# Nonallergic Rhinitis
# Bronchial asthma - not supported by PFTs
# OSA and ? obesity hypoventilation syndrome - followed by Dr.
[**Last Name (STitle) **]
# GERD.
# Hypertension.
# History of glaucoma.
# Arthritis.
# CAD with normal persantine MIBI in [**9-19**].
# History of cataract surgery.
# Influenza A [**1-19**]

Social History:
The patient current resides in [**Location (un) **] with her granddaughter
and great grandchild.
She is retired, previously working as a meal tray delivery aid
at a hospital in [**State 531**].
She smoked for approximately 30 years, and quit 15 years ago.
She states that she smoked approximately 1 pack a day or less.
She denies any alcohol use.


Family History:
Her family history is significant for mother with breast cancer
at age 63 and a father who died of prostate cancer in his 80s.


Physical Exam:
Tmax: 36.4 ??????C (97.6 ??????F)
Tcurrent: 36.4 ??????C (97.6 ??????F)
HR: 79 (79 - 79) bpm
BP: 137/71(88) {137/71(88) - 137/71(88)} mmHg
SpO2: 92%
Heart rhythm: SR (Sinus Rhythm)

General Appearance: Well nourished, No acute distress, audible
wheeze
Eyes / Conjunctiva: No(t) PERRL, No(t) Pupils dilated, No(t)
Conjunctiva pale
Head, Ears, Nose, Throat: No(t) Normocephalic, Poor dentition,
No(t) Endotracheal tube, No(t) NG tube
Lymphatic: Cervical WNL, Supraclavicular WNL
Cardiovascular: (S1: Normal), (S2: Normal), No(t) S3, No(t) S4,
No(t) Rub, (Murmur: No(t) Systolic, No(t) Diastolic)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Wheezes : squeeky throughout, Diminished: )
Abdominal: Soft, Non-tender, Bowel sounds present
Extremities: Right: Trace, Left: Trace, No(t) Cyanosis, No(t)
Clubbing
Musculoskeletal: No(t) Muscle wasting
Skin:  Warm, No(t) Rash: , No(t) Jaundice
Neurologic: Attentive, Follows simple commands, Responds to: Not
assessed, Oriented (to): x3, Movement: Not assessed, Tone: Not
assessed

Pertinent Results:
[**2145-5-4**] CXR: IMPRESSION: No interval changes since [**2145-4-30**]. No acute cardiopulmonary process.

[**2145-5-5**] 2D ECHO: The left atrium is mildly dilated. No atrial
septal defect is seen by 2D or color Doppler. The right atrial
pressure is indeterminate. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%) There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. The mitral valve
appears structurally normal with trivial mitral regurgitation.
There is mild pulmonary artery systolic hypertension. There is
no pericardial effusion.

Compared with the prior study (images reviewed) of [**2143-6-13**], the
degree of pulmonary hypertension detected has slightly
decreased.

[**2145-5-4**] 07:23PM   GLUCOSE-210* UREA N-15 CREAT-0.9 SODIUM-145
POTASSIUM-3.8 CHLORIDE-107 TOTAL CO2-23 ANION GAP-19
[**2145-5-4**] 07:23PM   CK(CPK)-39
[**2145-5-4**] 07:23PM   CK-MB-3 cTropnT-<0.01 proBNP-334
[**2145-5-4**] 07:23PM   CALCIUM-8.6 PHOSPHATE-3.1 MAGNESIUM-2.4
[**2145-5-4**] 04:01PM   TYPE-ART PO2-109* PCO2-40 PH-7.37 TOTAL
CO2-24 BASE XS--1 INTUBATED-NOT INTUBA
[**2145-5-4**] 04:01PM   LACTATE-8.2*
[**2145-5-4**] 12:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.013
[**2145-5-4**] 12:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2145-5-4**] 11:38AM   PO2-103 PCO2-43 PH-7.38 TOTAL CO2-26 BASE
XS-0
[**2145-5-4**] 11:38AM   LACTATE-5.3*
[**2145-5-4**] 10:27AM   LACTATE-5.5*
[**2145-5-4**] 10:15AM   GLUCOSE-210* UREA N-18 CREAT-1.0 SODIUM-146*
POTASSIUM-3.0* CHLORIDE-105 TOTAL CO2-26 ANION GAP-18
[**2145-5-4**] 10:15AM   ALT(SGPT)-17 AST(SGOT)-15 CK(CPK)-39 ALK
PHOS-89 TOT BILI-0.2
[**2145-5-4**] 10:15AM   LIPASE-21
[**2145-5-4**] 10:15AM   CK-MB-NotDone cTropnT-<0.01
[**2145-5-4**] 10:15AM   CALCIUM-9.1 PHOSPHATE-2.8 MAGNESIUM-2.8*
[**2145-5-4**] 10:15AM   WBC-10.9# RBC-4.91 HGB-12.7 HCT-40.3 MCV-82
MCH-25.9* MCHC-31.6 RDW-16.9*
[**2145-5-4**] 10:15AM   NEUTS-89.9* LYMPHS-8.6* MONOS-1.4* EOS-0.2
BASOS-0
[**2145-5-4**] 10:15AM   PLT COUNT-197

Brief Hospital Course:
A/P:  The patient is a 82 y.o.f. with nonallergic rhinitis,
sinusitis, post-nasal drip, GERD, chronic cough and wheezing,
HTN, hypercholesteremia, and CAD who presents with cough and
wheezing.

# Cough/Wheeze/SOB ?????? Significant workup as outpatient with
possibly some component of asthma based on flow/volume curves on
recent spirometry.  Seems that most of the complaint is from
hearing herself wheeze which further exacerbates the cough which
then leads to SOB.  Post nasal drip present causing cough, as
well as GERD.  She was transiently treated with BiPAP in the ED
with improvement in her symptoms.  The morning after admission,
she was not requiring oxygen and her wheezing had improved.  It
seemed that most of her wheezing was upper airway generated near
her neck.  She will need followup with Pulmonary and Sleep to
further assess the question of whether asthma is present based
on the PFT tracings. Sleep study was done, but results are still
pending.  The patient tolerated CPAP in house, so getting her
CPAP machine at home would be beneficial.  She will need to
followup with the sleep clinic for further titration of her CPAP
settings.  The patient is closely followed by allergy, but she
would likely also benefit from further evaluation by ENT to
address the issue of chronic sinusitis and post nasal drip to
see if there are any other options available.  PCP followup will
be arranged to discuss further therapy.  She needs close
followup as an outpatient to prevent frequent hospitalization
for these symptoms.  She will need [**Hospital1 **] PPI and GI followup for
possible EGD to evaluate her GERD.  She will continue her home
medications.  The prednisone will be tapered off rapidly (40 mg
on [**5-6**] mg [**5-7**], 10 mg [**5-8**], then off).  She had 3 sets of
cardiac enzymes which were negative.  CXR did not show any acute
process.  An ECHO was done which showed normal EF and slightly
decreased pulmonary artery sytolic hypertension.

# Elevated lactate ?????? lactate improving- unclear etiology.  No
metabolic acidosis present, though did have gap 15.  It was
unclear how to interpret these results. It resolved with some
IVFs.  She was hemodynamically stable.

# GERD - [**Hospital1 **] PPI

# HTN - cont home HCTZ, lisinopril, atenolol

# Anemia - Currently stable.  Iron deficiency on past labs.
Continue to  monitor


Medications on Admission:
Atenolol 50mg daily
Atorvastatin 10mg daily
Azelastine 137mcg, 2 sprays nasal [**Hospital1 **]
Vitamin D 400 units daily
Advair 500/50 1 inhalation daily (but was recently stopped by
her PCP given no definitive evidence of asthma)
Furosemide 20mg daily
HCTZ 12.5mg daily
Lisinopril 20mg daily
Omeprazole 40mg EC [**Hospital1 **]
Potassium 20 mEQ daily


Discharge Medications:
1. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Azelastine 137 mcg Aerosol, Spray Sig: One (1) spray Nasal
[**Hospital1 **] (2 times a day).
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
8. Potassium Chloride 10 mEq Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO once a day.
9. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal [**Hospital1 **] (2 times a day).
Disp:*1 bottle* Refills:*2*
10. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
11. Mucinex 600 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO every six (6) hours.
12. Prednisone 10 mg Tablet Sig: 1-4 Tablets PO once a day: 4
pills: [**2145-5-6**]
2 pills: [**2145-5-7**]
1 pill: [**2145-5-8**].
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis: Reactive Airway Disease
Post Nasal Drip
Chronic Sinusitis


Discharge Condition:
stable


Discharge Instructions:
You were admitted for wheezing and shortness of breath.  It is
thought that this is likely due to your post nasal drip and
chronic sinsusitis causing a cough and leading to reactive
airways.  You were transiently on BiPAP and then treated with
inhalers and a rapid steroid taper.  You improved during this
hospitalization.  You were also started on CPAP at night for
your likely obstructive sleep apnea.  Please take all
medications as prescribed.  Please keep all scheduled
appointments.

If you develop any of the following concerning symptoms, please
call your PCP or go to the ED: chest pains, shortness of breath,
inability to breath, fever, chills, nausea or vomiting.

Followup Instructions:
Primary [**Hospital **] Clinic: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], NP [**2145-5-6**] at 10:40am.

Ear-Nose-Throat: Dr. [**Last Name (STitle) **] [**2145-6-10**] at 2:45pm.

Pulmonary: Dr. [**Last Name (STitle) **] [**2145-5-13**] 8:30am

Sleep: Dr. [**First Name (STitle) 437**] [**2145-5-18**] at 11am
{'Obstructive chronic bronchitis with (acute) exacerbation,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Hypopotassemia,Unspecified sinusitis (chronic),Obstructive sleep apnea (adult)(pediatric)'}


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: Wheezing

PRESENT ILLNESS: Ms. [**Known lastname 805**] is an 81-year-old woman with a history of
hypercholesterolemia, hypertension, nonallergic rhinitis,
chronic sinusitis, and chronic cough who presents with cough,
wheezing, and shortness of breath.  Per the patient, she
developed an increasing cough over the last week associated with
wheezy.  She was seen in [**Company 191**] on [**4-30**] and was sent to the ED for
evaluation due to the concern of hypoxia to 94% and possible
ischemia based on an EKG.  She was admitted overnight (discharge
summary not complete) and treated for asthma exacerbation
(although no clear history of this) with nebs and steroids, and
advair was added back to her regimen.  She went home on [**5-1**] and
started to wheeze again.  Her granddaughter called Dr. [**Last Name (STitle) **]
on [**5-2**] because they thought she was supposed to be on a steroid
taper, but was not discharged on steroids.  He prescribed a
short steroid burst which she started taking on [**5-2**] with mild
improvement.  However, last night her wheezing got much worse
and she couldn't stop coughing due to her GERD and nasal drip.
She normally feels SOB when coughing, but otherwise did not feel
SOB.  She was concerned about her wheezing and presented to OSH
for evaluation.  Of note, she denies PND but does not like to
lie flat because her coughing worsens.  She states that the only
time she feels SOB is when she is coughing, and the coughing
fits can happen either at rest or with exertion, and there is no
pattern.  The coughing worsens if she has a URI or allergy
symptoms.  Additionally, when asked what is more concerning to
her, her audible wheeze or feeling SOB, she states the wheezy is
her most prominent and concerning symptom and that the SOB is in
the setting of the cough.  No fevers, chills, nausea, vomiting.
No chest pain, palpatations, weight gain, or LE edema (edema
improved).

MEDICAL HISTORY: # Status post right shoulder replacement
# Status post right hip replacement.
# Sinusitis.
# Nonallergic Rhinitis
# Bronchial asthma - not supported by PFTs
# OSA and ? obesity hypoventilation syndrome - followed by Dr.
[**Last Name (STitle) **]
# GERD.
# Hypertension.
# History of glaucoma.
# Arthritis.
# CAD with normal persantine MIBI in [**9-19**].
# History of cataract surgery.
# Influenza A [**1-19**]

MEDICATION ON ADMISSION: Atenolol 50mg daily
Atorvastatin 10mg daily
Azelastine 137mcg, 2 sprays nasal [**Hospital1 **]
Vitamin D 400 units daily
Advair 500/50 1 inhalation daily (but was recently stopped by
her PCP given no definitive evidence of asthma)
Furosemide 20mg daily
HCTZ 12.5mg daily
Lisinopril 20mg daily
Omeprazole 40mg EC [**Hospital1 **]
Potassium 20 mEQ daily

ALLERGIES: Sulindac / Aspirin / Hycodan

PHYSICAL EXAM: Tmax: 36.4 ??????C (97.6 ??????F)
Tcurrent: 36.4 ??????C (97.6 ??????F)
HR: 79 (79 - 79) bpm
BP: 137/71(88) {137/71(88) - 137/71(88)} mmHg
SpO2: 92%
Heart rhythm: SR (Sinus Rhythm)

FAMILY HISTORY: Her family history is significant for mother with breast cancer
at age 63 and a father who died of prostate cancer in his 80s.

SOCIAL HISTORY: The patient current resides in [**Location (un) **] with her granddaughter
and great grandchild.
She is retired, previously working as a meal tray delivery aid
at a hospital in [**State 531**].
She smoked for approximately 30 years, and quit 15 years ago.
She states that she smoked approximately 1 pack a day or less.
She denies any alcohol use. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Hypopotassemia,Unspecified sinusitis (chronic),Obstructive sleep apnea (adult)(pediatric)'}
