CHIEF COMPLAINT: CC: SOB, fever, cough

PRESENT ILLNESS: HPI: Ms. [**Known lastname **] is a 68 year-old African-American female with a

MEDICAL HISTORY: Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI

MEDICATION ON ADMISSION: MEDS:
1. Metoprolol 25 mg PO BID
2. Aspirin 325 mg PO DAILY
3. Zidovudine 200 mg PO BID
4. Nevirapine 200 mg PO BID
5. Lamivudine 50 mg PO DAILY
6. B-Complex with Vitamin C PO DAILY
7. Pantoprazole 40 mg PO Q24H
8. Albuterol-Ipratropium 103-18 mcg 1-2 puffs Q6H PRN SOB.
9. Isosorbide Dinitrate 10 mg PO BID
10. Lisinopril 5 mg PO DAILY
11. Calcium Acetate 667 mg PO TID W/MEALS
12. Fluticasone-Salmeterol 250-50 mcg/Dose [**Hospital1 **]
13. Prednisone 20 mg PO QOD
14. Warfarin 5 mg PO DAILY
15. NPH 10 units qAM. Please also continue your sliding scale as
you
were prior to admission.
16. ? Flagyl

ALLERGIES: Motrin / Lipitor

PHYSICAL EXAM: *
PE:
VITALS: T 97.7 Tmax: 98.6, BP 110/52 (93-122)/ (34/76), HR 90,
RR 20, Sat 97% on 2 liters
.
GEN: Obese African American woman, in NAD, speaking in full
sentences.
HEENT: PERRL. EOMI. Clear OP. MMM
NECK: JVP not elevated.
RESP: Distant breath sounds. scattered wheezes bilaterally
CV: tachycardic. Normal S1, S2. No S3, S4. Sys murmur at apex,
Abd: Obese abdomen. BS normoactive. Abdomen soft and mild
tenderness to palp over LQ. No rebound, guarding. No HSM.
EXT: No pedal edema. Pulses difficult to palpate. AVF left UE
with thrill, NT, no erythema
CVL right groin.
NEURO: CN intact. MAE. grossly normal. AO x3
old notes indicate, guiac positive stool
*

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: The patient currently lives in [**Location 16174**] with her daughter aged
50 years old. She was previously a housewife.  She denies
current alcohol or drug use. She quit drinking >20 years ago.
She smoked 2 packs a day for 30 years.
Pneumonia due to Pseudomonas,Obstructive chronic bronchitis with (acute) exacerbation,Candidiasis of mouth,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other acute and subacute forms of ischemic heart disease, other,Blood in stool,Mitral valve disorders,Influenza with pneumonia,Pulmonary eosinophilia,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin
Pseudomonal pneumonia,Obs chr bronc w(ac) exac,Thrush,Hyp kid NOS w cr kid V,Ac ischemic hrt dis NEC,Blood in stool,Mitral valve disorder,Influenza with pneumonia,Pulmonary eosinophilia,Asymp hiv infectn status,DMII wo cmp nt st uncntr,Long-term use of insulin
Admission Date:  [**2115-3-24**]              Discharge Date:   [**2115-4-15**]

Date of Birth:  [**2046-6-27**]             Sex:   F

Service: MEDICINE

Allergies:
Motrin / Lipitor

Attending:[**First Name3 (LF) 562**]
Chief Complaint:
CC: SOB, fever, cough

Major Surgical or Invasive Procedure:
none

History of Present Illness:
HPI: Ms. [**Known lastname **] is a 68 year-old African-American female with a

complicated past medical history significant for HIV CD4 986
([**10-22**]), CAD s/p MI and PTCA, insulin dependent DM2, ESRD on HD,
diastolic dysfunction, and history of PE on anticoagulation.
Recently hospitalized in early [**Month (only) 404**] for SOB/pleuritic
left-sided chest pain and treated with antibiotics for likely
pneumonia. Admitted again later in [**Month (only) 404**] for left-sided chest
pain during dialysis and ruled out by enzymes.
*
Patient reports a 3 day history of non-productive cough, HA,
sore throat, and fever/chills. No sick contacts at home. She
presents today with worsening SOB over the last 3 days; denies
chest pain. Last HD was [**3-22**]. ROS also significant for decreased
appetite, but taking fluids, + N/V ([**3-22**] x in last few days), +
racing heart, chronic LQ abd pain (unchanged). Normal BMs.
*
In [**Name (NI) **] pt with T 103.3, BP 150/80, HR 140s. Received Metoprolol
5mg IV x 1 to slow rate, became hypotensive to SBP 70-80s,
started on Levophed. Also got Vancomycin/CTX/Flagyl, atrovent
nebs, ASA/morphine/tylenol, solu-medrol 125mg, 2L NS
*
Currently, patient states that she has some shortness of breath
but is feeling better. Occ diarrhea. nl urination. still with a
decreased appetite. no cp


Past Medical History:
Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI

[**4-22**] without symptoms or EKG changes. MIBI images significant
for severe fixed inferior defect, EF 58%.
2. DM type 2, on NPH.
3. HIV, with last CD4 on [**2114-11-14**] = 986
4. ESRD on HD since '[**10**]
5. History of RUL segmental PE, on Coumadin anticoagulation
([**2114-12-5**])
6. Diastolic dysfunction. Last echo [**2114-12-4**] with 4+MR, [**1-20**]+TR
and complex aortic atheroma. EF>55%.
7. H/o multiple AVF clots, s/p thrombectomies, last in [**2115-1-8**]

8. H/o GIB in the setting of coagulopathy and NSAIDs
9. Eosinophilic pneumonia diagnosed [**4-22**], on chronic
prednisone.
10. Anemia [**2-20**] CRF
11. Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].
12. [**Year (4 digits) 2182**]. PFTs with FVC 0.69 (27%), FEV1 0.46 (24%), FEV1/FVC
92%.
*


Social History:
The patient currently lives in [**Location 16174**] with her daughter aged
50 years old. She was previously a housewife.  She denies
current alcohol or drug use. She quit drinking >20 years ago.
She smoked 2 packs a day for 30 years.

Family History:
Non-contributory

Physical Exam:
*
PE:
VITALS: T 97.7 Tmax: 98.6, BP 110/52 (93-122)/ (34/76), HR 90,
RR 20, Sat 97% on 2 liters
.
GEN: Obese African American woman, in NAD, speaking in full
sentences.
HEENT: PERRL. EOMI. Clear OP. MMM
NECK: JVP not elevated.
RESP: Distant breath sounds. scattered wheezes bilaterally
CV: tachycardic. Normal S1, S2. No S3, S4. Sys murmur at apex,
Abd: Obese abdomen. BS normoactive. Abdomen soft and mild
tenderness to palp over LQ. No rebound, guarding. No HSM.
EXT: No pedal edema. Pulses difficult to palpate. AVF left UE
with thrill, NT, no erythema
CVL right groin.
NEURO: CN intact. MAE. grossly normal. AO x3
old notes indicate, guiac positive stool
*


Pertinent Results:
[**2115-3-24**] 09:57PM   CK(CPK)-723*
[**2115-3-24**] 09:57PM   CK-MB-34* MB INDX-4.7 cTropnT-1.34*
[**2115-3-24**] 02:10PM   LACTATE-2.6*
[**2115-3-24**] 01:55PM   CK(CPK)-585*
[**2115-3-24**] 01:55PM   cTropnT-1.46*
[**2115-3-24**] 01:55PM   CK-MB-28* MB INDX-4.8
[**2115-3-24**] 01:55PM   HCT-35.1*
[**2115-3-24**] 08:00AM   GLUCOSE-152* UREA N-68* CREAT-8.6*#
SODIUM-135 POTASSIUM-4.4 CHLORIDE-89* TOTAL CO2-25 ANION GAP-25*
[**2115-3-24**] 08:00AM   ALT(SGPT)-25 AST(SGOT)-44* CK(CPK)-330* ALK
PHOS-78 AMYLASE-629* TOT BILI-0.2
[**2115-3-24**] 08:00AM   LIPASE-18
[**2115-3-24**] 08:00AM   CK-MB-11* MB INDX-3.3
[**2115-3-24**] 08:00AM   CALCIUM-8.6 PHOSPHATE-5.0* MAGNESIUM-1.8
[**2115-3-24**] 08:00AM   PT-20.7* PTT-36.1* INR(PT)-2.7
[**2115-3-24**] 08:00AM URINE  BLOOD-LG NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-TR
[**2115-3-24**] 08:00AM URINE  RBC-[**3-23**]* WBC-[**6-28**]* BACTERIA-OCC
YEAST-NONE EPI-0

..
EKG: ST 114, normal intervals, nl axis. no ST-T changes
*
CXR: NO evidence of acute cardiopulmonary pathology
*
CTA: 1. No evidence of pulmonary embolism. 2. Mucous impaction
in the right upper lobe posterior subsegmental bronchus.
3. There are two (2) patchy areas of air space opacity within
the left lung as described above. These probably represent
atypical foci of inflammation or infection. However, given
slight changes or architectural distortion, CT examination is
recommended after appropriate treatment.
Chest x-ray ([**3-25**]) - early, mild congestive heart failure

* culture data-legionella urinary antigen
positive for direct influenza A viral antigen
blood cultures - [**3-24**]- NGTD
C. diff toxin - [**3-24**] negative
urine cultures- no growth

chest x-ray ([**4-4**]): [**Month/Year (2) 2182**],  no change since the prior
examination.  No acute
cardiopulmonary pathology.

Chest CT ([**4-4**])-  1)  Interval progression of tree-in-[**Male First Name (un) 239**]
opacities, involving all of the right lung (with some apical
sparing) and the mid portion of the left lung.  There has been
no significant interval change of the 2 patchy areas of ground
glass opacity within the superior segment of the left upper lobe
and within the lingula.  Diagnostic considerations include
atypical infectious agents, such as mycoplasma, mycobacteria,
fungus and viral etiology.
2)  The ground glass opacities of the left lung should continue
to be followed to document complete resolution and exclude
malignancy.
3)  Incidental gallstone.

[**4-13**]-
IMPRESSION:
1. Significant interval resolution of tree and [**Male First Name (un) 239**] opacities
involving the right lung with only a few residual opacities
still present.
2. Nodular ground-glass opacities within the lingula and left
lower lobe are stable.

[**2115-4-15**] 06:27AM BLOOD WBC-12.5* RBC-2.14* Hgb-8.2* Hct-26.4*
MCV-124* MCH-38.5* MCHC-31.2 RDW-22.0* Plt Ct-232
[**2115-4-15**] 06:27AM BLOOD Neuts-80* Bands-0 Lymphs-17* Monos-3
Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 NRBC-5*
[**2115-4-15**] 06:27AM BLOOD Hypochr-2+ Anisocy-3+ Poiklo-2+
Macrocy-3+ Microcy-NORMAL Polychr-1+ Ovalocy-1+
Target-OCCASIONAL Stipple-OCCASIONAL
[**2115-4-15**] 06:27AM BLOOD Plt Ct-232
[**2115-4-15**] 06:27AM BLOOD Glucose-64* UreaN-93* Creat-8.2*# Na-134
K-5.6* Cl-94* HCO3-28 AnGap-18
[**2115-4-8**] 04:03PM BLOOD LD(LDH)-399* TotBili-0.2 DirBili-0.1
IndBili-0.1
[**2115-4-5**] 07:30AM BLOOD CK-MB-NotDone
[**2115-4-15**] 06:27AM BLOOD Calcium-8.7 Phos-3.5 Mg-2.6
[**2115-4-9**] 03:17AM BLOOD calTIBC-176* VitB12-[**2038**]* Folate-11.0
Ferritn-1186* TRF-135*
[**2115-4-12**] 11:00AM BLOOD Genta-0.5*
[**2115-4-4**] 10:54AM BLOOD Type-ART pO2-124* pCO2-43 pH-7.45
calHCO3-31* Base XS-5 Comment-HV
[**2115-3-30**] 10:56AM BLOOD Lactate-1.9

Brief Hospital Course:
*
1. Hypotension/Sepsis- Patient was briefly placed in pressors,
and were then weaned. Etiology was unclear. Perhaps related to
adrenal insufficiency and patient was placed on hydrocortisone
with improvement, she was switched to prednisone when called out
of MICU. Blood cultures and urine cultures were negative.
Patient ruled in for flu. Patient will need a very slow taper of
prednisone given her history of a chronic eosinophilic pna, and
perhaps outpatient [**Last Name (un) 104**] stim test. Patient bp improved as her
underlying lung infection (see below) was treated. She was dc'ed
on beta-blocker and ace
*
2. CV/elevated troponin- Likely demand ischemia in setting of
tachycardia  Patient  was not having cp. Felt to be related to
sepsis and renal failure.
--Patient was continued on ASA and beta blocker, Ace inhibitor
held secondary to hypotension (and was restarted prior to dc)
*
3. Resp- Patient thought to be having [**Last Name (un) 2182**] flare secondary to
flu. Patient was given round the clock albuterol, atrovent nebs
with inhaled steroids and prednisone. She was very slow to
respond. Repeat chest x-ray showed no evidence of pna, but given
her slowness to respond levoquin was added for question for
bacterial superinfection-? tracheobronchitis. A pulmonary
consult was obtained, and a chest CT was obtained (see results
section). In addition, wbc count began to increase.  Pulm
consulted indicated that likely she has a chronic eosinophilic
pna and has been treated with too short courses of steroids in
past. They also recommended that she should be placed on bactrim
ppx. Patient chest CT should a tree in [**Male First Name (un) 239**] distribution in both
the right and left lung; this has a a Broad differential
including mycobacteria, viral etiology, untreated bacterial
infection. It was decided that the patient should be placed on
respiratory isolation in order to rule out TB and to send sputum
 x 3 for AFB, PCP, [**Name10 (NameIs) **], bacterial cultures, and cytology
(concern for malignancy given smoking history). The sputum
cultures grew gram neg rods, and given her history of
pseudomonal pna, patient was placed on gentamycin. Also,
patients sputum grew out stentrophomonas maltophilia that was
sensitive to bactrim. At this point, the levoquin was stopped
(she had been on levo for 9 days). Eventually it was decided
that patient would be treated with 14 days of gent and cipro for
pseudomonas, and 14 days of bactrim for stentrophomonas
maltophilia. Patient began to clinically improve, however her
aspergillus antigen came back at 3000, but antibodies were
negative. Pulm was not sure what to make of this info and and ID
consult was obtained. ID recommended repeat CT which showed
interval improvement and resending the aspergillus antigen. ID
recommended that patient be treated only with cipro for
pseudomonal infection (gent was dc'ed), and bactrim be lowered
to PCP [**Name9 (PRE) **] dose (felt that stentrophomonas maltophilia was
likely a colonizer). Patient was also placed on a 14 days of
diflucan for oral thrush.

*
4. ESRD- On HD MWF. Fluid removal helped respiratory status.
*
5. DM2- cont home regimen of NPH and ISS for coverage.
*
6. h/o PE- Patient was placed on coumadin, and at one point was
supratheraputic with an inr of 6.3 (in the setting of starting
bactrim and levoquin) and was guiac positive. Patient was
hemodynamically stable and patient was given some vitamin K.
Coumadin was held until decreased.  Eventually coumadin was
restarted with heparin bridge until inr was therapeutic. INR
will need to monitored daily to assure stability (currently at
3.1, goal - 2 and 3). Patient will need outpatient colonscopy
*
7. HIV- last CD4 435 in [**2-23**] with undetectable viral load. Cont
outpt antiretrovirals.
*


Medications on Admission:
MEDS:
1. Metoprolol 25 mg PO BID
2. Aspirin 325 mg PO DAILY
3. Zidovudine 200 mg PO BID
4. Nevirapine 200 mg PO BID
5. Lamivudine 50 mg PO DAILY
6. B-Complex with Vitamin C PO DAILY
7. Pantoprazole 40 mg PO Q24H
8. Albuterol-Ipratropium 103-18 mcg 1-2 puffs Q6H PRN SOB.
9. Isosorbide Dinitrate 10 mg PO BID
10. Lisinopril 5 mg PO DAILY
11. Calcium Acetate 667 mg PO TID W/MEALS
12. Fluticasone-Salmeterol 250-50 mcg/Dose [**Hospital1 **]
13. Prednisone 20 mg PO QOD
14. Warfarin 5 mg PO DAILY
15. NPH 10 units qAM. Please also continue your sliding scale as
you
were prior to admission.
16. ? Flagyl


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 672**] Hospital

Discharge Diagnosis:
Pseudmonas lung infection
Influenza
[**Hospital3 2182**]
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI

[**4-22**] without symptoms or EKG changes. MIBI images significant
for severe fixed inferior defect, EF 58%.
2. DM type 2, on NPH.
3. HIV, with last CD4 on [**2114-11-14**] = 986
4. ESRD on HD since '[**10**]
5. History of RUL segmental PE, on Coumadin anticoagulation
([**2114-12-5**])
6. Diastolic dysfunction. Last echo [**2114-12-4**] with 4+MR, [**1-20**]+TR
and complex aortic atheroma. EF>55%.
7. H/o multiple AVF clots, s/p thrombectomies, last in [**2115-1-8**]

8. H/o GIB in the setting of coagulopathy and NSAIDs
9. Eosinophilic pneumonia diagnosed [**4-22**], on chronic
prednisone.
10. Anemia [**2-20**] CRF
11. Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].
12. [**Year (4 digits) 2182**]. PFTs with FVC 0.69 (27%), FEV1 0.46 (24%), FEV1/FVC
92%.


Discharge Condition:
stable

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet

Please call your doctor or come to ED if you develop nausea,
vomiting, shortness of breath, fevers/chills

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D. Where: [**Hospital6 29**]
CARDIAC SERVICES Phone:[**Telephone/Fax (1) 127**] Date/Time:[**2115-5-28**] 9:30
Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 252**], M.D. Where: [**Hospital6 29**]
[**Hospital3 1935**] CENTER Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2115-6-18**] 10:15
Please call your doctor, Dr. [**Last Name (STitle) **] and make an appointment
within one week of dc - number to call is [**Telephone/Fax (1) 102277**]
Please call and make an appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in
pulmonary within 1-2 months- # to call is [**Telephone/Fax (1) 612**]



Completed by:[**2115-4-15**]
{'Pneumonia due to Pseudomonas,Obstructive chronic bronchitis with (acute) exacerbation,Candidiasis of mouth,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other acute and subacute forms of ischemic heart disease, other,Blood in stool,Mitral valve disorders,Influenza with pneumonia,Pulmonary eosinophilia,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin'}


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: CC: SOB, fever, cough

PRESENT ILLNESS: HPI: Ms. [**Known lastname **] is a 68 year-old African-American female with a

MEDICAL HISTORY: Past Medical History:
1. CAD s/p NSTEMI [**5-19**], s/p PTCA/stent LCX [**2113**]. Latest
catheterization in [**10-21**] with 2-vessel disease. Persantine MIBI

MEDICATION ON ADMISSION: MEDS:
1. Metoprolol 25 mg PO BID
2. Aspirin 325 mg PO DAILY
3. Zidovudine 200 mg PO BID
4. Nevirapine 200 mg PO BID
5. Lamivudine 50 mg PO DAILY
6. B-Complex with Vitamin C PO DAILY
7. Pantoprazole 40 mg PO Q24H
8. Albuterol-Ipratropium 103-18 mcg 1-2 puffs Q6H PRN SOB.
9. Isosorbide Dinitrate 10 mg PO BID
10. Lisinopril 5 mg PO DAILY
11. Calcium Acetate 667 mg PO TID W/MEALS
12. Fluticasone-Salmeterol 250-50 mcg/Dose [**Hospital1 **]
13. Prednisone 20 mg PO QOD
14. Warfarin 5 mg PO DAILY
15. NPH 10 units qAM. Please also continue your sliding scale as
you
were prior to admission.
16. ? Flagyl

ALLERGIES: Motrin / Lipitor

PHYSICAL EXAM: *
PE:
VITALS: T 97.7 Tmax: 98.6, BP 110/52 (93-122)/ (34/76), HR 90,
RR 20, Sat 97% on 2 liters
.
GEN: Obese African American woman, in NAD, speaking in full
sentences.
HEENT: PERRL. EOMI. Clear OP. MMM
NECK: JVP not elevated.
RESP: Distant breath sounds. scattered wheezes bilaterally
CV: tachycardic. Normal S1, S2. No S3, S4. Sys murmur at apex,
Abd: Obese abdomen. BS normoactive. Abdomen soft and mild
tenderness to palp over LQ. No rebound, guarding. No HSM.
EXT: No pedal edema. Pulses difficult to palpate. AVF left UE
with thrill, NT, no erythema
CVL right groin.
NEURO: CN intact. MAE. grossly normal. AO x3
old notes indicate, guiac positive stool
*

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: The patient currently lives in [**Location 16174**] with her daughter aged
50 years old. She was previously a housewife.  She denies
current alcohol or drug use. She quit drinking >20 years ago.
She smoked 2 packs a day for 30 years. 

### Response:
{'Pneumonia due to Pseudomonas,Obstructive chronic bronchitis with (acute) exacerbation,Candidiasis of mouth,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other acute and subacute forms of ischemic heart disease, other,Blood in stool,Mitral valve disorders,Influenza with pneumonia,Pulmonary eosinophilia,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin'}
