CHIEF COMPLAINT: auditory hallucinations

PRESENT ILLNESS: 62 yo female with history of PUD, memory deficits, history of
auditory hallucinations who presents after hearing voices
telling her to kill herself.  Per report, patient has had AH
intermittently in since [**2124**] and had previously been on
medications which patient states helped her. Hallucinations are
described as a woman's voice telling her to fall down her
stairs.  Patient also states that she believes snakes are inside
of her and that she sees snakes.  The snakes tell her to hurt
herself.  Per report, the patient has long-standing memory
difficulties (leaves gas stove on).  The patient went to [**Hospital1 112**]
yesterday for auditory hallucinations where she was found to
have a negative head CT.  Infectious workup for delerium
revealed a UTI and the patient was started on a course of
macrobid.
.
Patient currently complains of epigastric pain, which worsens
with spicy food and is improved with maalox. She also complains
of left flank pain.  She denies currently hearing voices, but
states that she hears them frequently.

MEDICAL HISTORY: -- History of Auditory Hallucinations since [**2124**] after the birth
of her son. Was treated with seroquel and zoloft at that time
per the records with good response.
-- Depression
-- Peptic Ulcer Disease
-- Diverticulosis
-- Tension Headache
-- Memory Deficits

MEDICATION ON ADMISSION: Nitrofurantoin 100mg [**Hospital1 **] x 5 days (started [**2130-3-23**])
Ranitidine 150mg [**Hospital1 **]
Meclizine unknown dose

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission physical exam:
VS - Temp 98.3, BP 125/73, HR 82, R 18, O2-sat 98 % RA
GENERAL - well-appearing in NAD, comfortable, well groomed
HEENT - PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, mildly enlarged thyroid with tenderness on
palpation, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/ND, mild epigastric tenderness on
palpation, no masses or HSM, no rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - scars from burns on the thighs bilaterally
NEURO - awake, A&Ox3, attention good with days of the week
backwards (mixed up monday and tuesday), CNs II-XII intact,
muscle strength 5/5 deltoids/triceps/biceps, illiopsoas,
sensation grossly intact throughout, cerebellar exam intact,
steady gait
.
Discharge physical exam:
VS -  98.6  122/84  92  18, 96% RA
GENERAL - pleasant woman laying comfortably in bed
NECK - supple, mildly enlarged thyroid with tenderness on
palpation, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/non-tender/non-distended, no masses or HSM,
no rebound/guarding
BACK - area of lumbar puncture non-erythematous
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)

FAMILY HISTORY: Older sister with memory deficits. Mother with [**Name2 (NI) **] (died
at 81). No psychiatric family history.

SOCIAL HISTORY: Lives with son [**Name (NI) **]. Not currently working. Prior history of
smoking, no tobacco now. No drugs or alcohol.
Neurosyphilis, unspecified,Suicidal ideation,Urinary tract infection, site not specified,Candidiasis of vulva and vagina,Asthma, unspecified type, unspecified,Depressive disorder, not elsewhere classified,Penicillins causing adverse effects in therapeutic use,Esophageal reflux,Acute pharyngitis,Personal history of peptic ulcer disease,Psychophysical visual disturbances
Neurosyphilis NOS,Suicidal ideation,Urin tract infection NOS,Candidal vulvovaginitis,Asthma NOS,Depressive disorder NEC,Adv eff penicillins,Esophageal reflux,Acute pharyngitis,Prsnl hst peptic ulcr ds,Psychophysic visual dist
Admission Date:  [**2130-3-24**]              Discharge Date:   [**2130-4-4**]

Date of Birth:  [**2067-10-22**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 603**]
Chief Complaint:
auditory hallucinations

Major Surgical or Invasive Procedure:
none


History of Present Illness:
62 yo female with history of PUD, memory deficits, history of
auditory hallucinations who presents after hearing voices
telling her to kill herself.  Per report, patient has had AH
intermittently in since [**2124**] and had previously been on
medications which patient states helped her. Hallucinations are
described as a woman's voice telling her to fall down her
stairs.  Patient also states that she believes snakes are inside
of her and that she sees snakes.  The snakes tell her to hurt
herself.  Per report, the patient has long-standing memory
difficulties (leaves gas stove on).  The patient went to [**Hospital1 112**]
yesterday for auditory hallucinations where she was found to
have a negative head CT.  Infectious workup for delerium
revealed a UTI and the patient was started on a course of
macrobid.
.
Patient currently complains of epigastric pain, which worsens
with spicy food and is improved with maalox. She also complains
of left flank pain.  She denies currently hearing voices, but
states that she hears them frequently.

Past Medical History:
-- History of Auditory Hallucinations since [**2124**] after the birth
of her son. Was treated with seroquel and zoloft at that time
per the records with good response.
-- Depression
-- Peptic Ulcer Disease
-- Diverticulosis
-- Tension Headache
-- Memory Deficits

Social History:
Lives with son [**Name (NI) **]. Not currently working. Prior history of
smoking, no tobacco now. No drugs or alcohol.


Family History:
Older sister with memory deficits. Mother with [**Name2 (NI) **] (died
at 81). No psychiatric family history.


Physical Exam:
Admission physical exam:
VS - Temp 98.3, BP 125/73, HR 82, R 18, O2-sat 98 % RA
GENERAL - well-appearing in NAD, comfortable, well groomed
HEENT - PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, mildly enlarged thyroid with tenderness on
palpation, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/ND, mild epigastric tenderness on
palpation, no masses or HSM, no rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - scars from burns on the thighs bilaterally
NEURO - awake, A&Ox3, attention good with days of the week
backwards (mixed up monday and tuesday), CNs II-XII intact,
muscle strength 5/5 deltoids/triceps/biceps, illiopsoas,
sensation grossly intact throughout, cerebellar exam intact,
steady gait
.
Discharge physical exam:
VS -  98.6  122/84  92  18, 96% RA
GENERAL - pleasant woman laying comfortably in bed
NECK - supple, mildly enlarged thyroid with tenderness on
palpation, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/non-tender/non-distended, no masses or HSM,
no rebound/guarding
BACK - area of lumbar puncture non-erythematous
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)

SKIN - scars from burns on the thighs bilaterally; no lesions on
hands or feet
NEURO:  CN II-XII intact; pupils equal, round and reactive to
light; strength 5/5; romberg negative
PSYCH:  endorses pleasant voices telling her to walk around,
denies SI/HI


Pertinent Results:
Admission labs:
[**2130-3-24**] 05:50PM BLOOD WBC-8.1 RBC-4.68 Hgb-12.9 Hct-39.5 MCV-84
MCH-27.5 MCHC-32.7 RDW-12.5 Plt Ct-294
[**2130-3-24**] 05:50PM BLOOD Glucose-122* UreaN-16 Creat-0.8 Na-142
K-4.0 Cl-105 HCO3-27 AnGap-14
[**2130-3-24**] 05:50PM BLOOD ALT-14 AST-19 AlkPhos-82 TotBili-0.1
[**2130-3-24**] 05:50PM BLOOD Lipase-74*
[**2130-3-24**] 05:50PM BLOOD Calcium-9.0 Phos-3.2 Mg-2.2
[**2130-3-24**] 05:50PM BLOOD VitB12-877 Folate-11.1
[**2130-3-24**] 05:50PM BLOOD TSH-3.6
[**2130-3-24**] 05:50PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
.
CSF analysis:
[**2130-3-28**] 12:33PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-0 Polys-0
Lymphs-67 Monos-33
[**2130-3-28**] 12:33PM CEREBROSPINAL FLUID (CSF) TotProt-55*
Glucose-72
[**2130-3-28**] 12:33PM Syphilis (VDRL) (CSF)   Non-Reactive (-)
[**2130-3-28**] 12:33PM Herpes Simplex Virus PCR (CSF) Negative
.
Discharge labs:
[**2130-3-31**] 07:03AM BLOOD WBC-6.4 RBC-4.70 Hgb-13.2 Hct-40.1 MCV-85
MCH-28.0 MCHC-32.8 RDW-12.8 Plt Ct-294
[**2130-3-31**] 07:03AM BLOOD Glucose-106* UreaN-14 Creat-0.8 Na-136
K-5.3* Cl-101 HCO3-27 AnGap-13
[**2130-3-31**] 07:03AM BLOOD Calcium-9.5 Phos-3.7 Mg-2.3
[**2130-3-31**] 07:03AM BLOOD HIV Ab-NEGATIVE
.
CXR [**2130-3-24**]:  Frontal and lateral views of the chest were
obtained. In the left upper to mid lung, there is a 0.5 cm
calcified nodule most likely representing a calcified granuloma.
No focal consolidation, pleural effusion, or evidence of
pneumothorax is seen. The cardiac and mediastinal silhouettes
are unremarkable. No overt pulmonary edema is seen.

Brief Hospital Course:
62 year old woman with history of PUD, dementia of unclear
etiology, and auditory hallucinations who presents after hearing
voices telling her to harm herself.

#. Hallucinations/SI:  The patient has a history of auditory
hallucinations and subacute memory decline since [**2124**].  The
patient was seen by psychiatry for hallucinations, who
recommended Risperdal [**Hospital1 **] for symptoms.   RPR, TSH, HIV, and B12
were negative on admission.  However, the patient was noted to
have positive RPR and anti-treponemal antibody at an OSH in
[**2128**], untreated per records and discussion with PCP.
[**Name10 (NameIs) 92169**] antibody had been repeated at the OSH just prior
to the patient's admission to [**Hospital1 18**], and again returned positive
during her hospital stay.  Positive anti-treponemal antibody
with subacute memory decline and vivid visual and auditory
hallucinations concerning for neuro-syphilis as source of
symptoms.  The patient underwent lumbar puncture that showed 1
WBC and elevated protein to 55 that may be consistent with late
neuro-syphilis.  CSF-VDRL and HSV PCR negative, anti-treponemal
antibody pending.  As the patient was noted to have a penicillin
allergy, she was transferred to the ICU for penicillin
desensitization.  She then was started on a 10 day course of
penicillin G to be completed night of [**2130-4-7**].  Given the
patient underwent desensitization, she may not miss a dose of
medication, as it may result in serious side effects.  The
patient should follow up with her PCP on discharge regarding her
symptoms, and for referral to cognitive neurology.  She should
undergo neuropsychiatric testing as an outpatient. Under the
guidance of psychiatry, she was started on risperidone. She had
marked improvement in her hallucinations on this medication.

#. Abdominal pain: On admission, the patient complained of mild
abdominal pain that by history was consistent with GERD.  She
was also found to have a mildly elevated lipase to 74.
Abdominal pain may also be a manifestation of the hallucinations
i.e. snakes in stomach. She was started on ranitidine and Maalox
for symptoms.  With improvement in her symptoms, she was
transitioned to pantoprazole.  She should follow up with her PCP
if symptoms recur.

#. Vulvovaginitis: Patient reported whitish vaginal discharge
and pruritis after starting penicillin.  Pelvic exam revealed
erythema, and the patient was given fluconazole 150mg PO x1.

# CODE: FULL CODE

# CONTACT: HCP: [**Name (NI) **] (son)-[**Telephone/Fax (1) 92170**]
===============================================================
TRANSITIONAL ISSUES
# Patient should complete 10-day penicillin course night of
[**4-7**].  She may not miss a dose, as she has a PCN allergy and is
s/p desensitization.
# Patient needs follow up with cognitive neurology.  Must make
appointment through PCP for insurance purposes.

Medications on Admission:
Nitrofurantoin 100mg [**Hospital1 **] x 5 days (started [**2130-3-23**])
Ranitidine 150mg [**Hospital1 **]
Meclizine unknown dose

Discharge Medications:
1. alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed for GERD.
2. risperidone 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. risperidone 1 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
4. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. penicillin G potassium 20 million unit Recon Soln Sig: 4
million units Injection Q4H (every 4 hours) for 4 days: Patient
may not miss dose due to hypersensitivity, last dose 2/24 PM.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 745**] Health Care Center

Discharge Diagnosis:
PRIMARY DIAGNOSIS:  Auditory hallucinations, depression,
syphilis
SECONDARY DIAGNOSIS:  urinary tract infection, GERD


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Ms. [**Known lastname **],

You were admitted to the hospital for hearing voices that were
telling you to hurt yourself.  Prior to your admission, you were
also discovered to have a urinary tract infection.  You were
continued on 3 days of ciprofloxacin for your urinary tract
infection.  For the voices you were hearing, you were evaluated
by psychiatry, who recommended medication to help resolve the
voices.  You were also noted to have tests indicative of a
chronic syphilis infection that we think may be causing the
voices. The voices improved over the course of your
hospitalization.  Because you have had a penicillin allergy in
the past, you were transferred to the ICU during your admission
to start you on a course of penicillin.  You had a special IV
placed, and will complete a 10 day course of penicillin for your
syphilis.  It is important that you do not miss a dose of
penicillin.  On discharge, please follow up with your primary
care physician for [**Name Initial (PRE) **] referral to a cognitive neurologist.

.
Medications changed this admission:
START risperidol 1 mg every morning and 2 mg every evening
START Penicillin G Potassium 4 Million Units IV Q4H (LAST DAY
[**2130-4-8**])
START Aluminum-Magnesium Hydrox.-Simethicone 15-30 mL PO/NG 4
times daily as needed for heartburn
START pantoprazole 40 mg daily.  Discuss stopping this
medication with your primary care physician on discharge.
STOP nitrofurantoin
STOP ranitidine

Followup Instructions:
Please call your primary care physician for [**Name Initial (PRE) **] follow up
appointment on discharge:

Name: [**First Name8 (NamePattern2) 2411**] [**Last Name (NamePattern1) 38279**], NP
Location: [**Hospital1 641**]
Address: [**Location (un) **], [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 3530**]

You should follow up with cognitive neurology.  Your primary
care physician will set up this appointment for you on
follow-up.
{'Neurosyphilis, unspecified,Suicidal ideation,Urinary tract infection, site not specified,Candidiasis of vulva and vagina,Asthma, unspecified type, unspecified,Depressive disorder, not elsewhere classified,Penicillins causing adverse effects in therapeutic use,Esophageal reflux,Acute pharyngitis,Personal history of peptic ulcer disease,Psychophysical visual disturbances'}


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: auditory hallucinations

PRESENT ILLNESS: 62 yo female with history of PUD, memory deficits, history of
auditory hallucinations who presents after hearing voices
telling her to kill herself.  Per report, patient has had AH
intermittently in since [**2124**] and had previously been on
medications which patient states helped her. Hallucinations are
described as a woman's voice telling her to fall down her
stairs.  Patient also states that she believes snakes are inside
of her and that she sees snakes.  The snakes tell her to hurt
herself.  Per report, the patient has long-standing memory
difficulties (leaves gas stove on).  The patient went to [**Hospital1 112**]
yesterday for auditory hallucinations where she was found to
have a negative head CT.  Infectious workup for delerium
revealed a UTI and the patient was started on a course of
macrobid.
.
Patient currently complains of epigastric pain, which worsens
with spicy food and is improved with maalox. She also complains
of left flank pain.  She denies currently hearing voices, but
states that she hears them frequently.

MEDICAL HISTORY: -- History of Auditory Hallucinations since [**2124**] after the birth
of her son. Was treated with seroquel and zoloft at that time
per the records with good response.
-- Depression
-- Peptic Ulcer Disease
-- Diverticulosis
-- Tension Headache
-- Memory Deficits

MEDICATION ON ADMISSION: Nitrofurantoin 100mg [**Hospital1 **] x 5 days (started [**2130-3-23**])
Ranitidine 150mg [**Hospital1 **]
Meclizine unknown dose

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission physical exam:
VS - Temp 98.3, BP 125/73, HR 82, R 18, O2-sat 98 % RA
GENERAL - well-appearing in NAD, comfortable, well groomed
HEENT - PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, mildly enlarged thyroid with tenderness on
palpation, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/ND, mild epigastric tenderness on
palpation, no masses or HSM, no rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - scars from burns on the thighs bilaterally
NEURO - awake, A&Ox3, attention good with days of the week
backwards (mixed up monday and tuesday), CNs II-XII intact,
muscle strength 5/5 deltoids/triceps/biceps, illiopsoas,
sensation grossly intact throughout, cerebellar exam intact,
steady gait
.
Discharge physical exam:
VS -  98.6  122/84  92  18, 96% RA
GENERAL - pleasant woman laying comfortably in bed
NECK - supple, mildly enlarged thyroid with tenderness on
palpation, no JVD
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/non-tender/non-distended, no masses or HSM,
no rebound/guarding
BACK - area of lumbar puncture non-erythematous
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)

FAMILY HISTORY: Older sister with memory deficits. Mother with [**Name2 (NI) **] (died
at 81). No psychiatric family history.

SOCIAL HISTORY: Lives with son [**Name (NI) **]. Not currently working. Prior history of
smoking, no tobacco now. No drugs or alcohol. 

### Response:
{'Neurosyphilis, unspecified,Suicidal ideation,Urinary tract infection, site not specified,Candidiasis of vulva and vagina,Asthma, unspecified type, unspecified,Depressive disorder, not elsewhere classified,Penicillins causing adverse effects in therapeutic use,Esophageal reflux,Acute pharyngitis,Personal history of peptic ulcer disease,Psychophysical visual disturbances'}
