CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 68-year-old male with
a history of chronic obstructive pulmonary disease,
bronchiectasis, hypertension, and hypercholesterolemia who
was admitted to the Medical Intensive Care Unit on [**2160-3-23**] for a chronic obstructive pulmonary disease
exacerbation.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease.
2.  Bronchiectasis.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Pyloric stenosis.
6.  History of bladder cancer.

MEDICATION ON ADMISSION: (Medications on transfer to the
floor were)
1.  Prednisone 60 mg p.o. q.d.
2.  Flovent meter-dosed inhaler.
3.  Zantac.
4.  Norvasc 5 mg p.o. q.d.
5.  Zoloft 250 mg p.o. q.d.
6.  Albuterol and Atrovent nebulizers q.4h.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history with coronary artery disease.

SOCIAL HISTORY: A 55-pack-year history of tobacco; now, he
smokes five to six cigarettes per day.  No drug or alcohol
use.  The patient lives with his wife.
Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Unspecified essential hypertension,Osteoporosis, unspecified
Pneumonia, organism NOS,Obs chr bronc w(ac) exac,Hypertension NOS,Osteoporosis NOS
Admission Date:  [**2160-3-23**]     Discharge Date:  [**2160-3-28**]

Date of Birth:   [**2092-1-11**]     Sex:  M

Service:  [**Company 191**]

HISTORY OF PRESENT ILLNESS:  This is a 68-year-old male with
a history of chronic obstructive pulmonary disease,
bronchiectasis, hypertension, and hypercholesterolemia who
was admitted to the Medical Intensive Care Unit on [**2160-3-23**] for a chronic obstructive pulmonary disease
exacerbation.

The patient has had recent admissions for chronic obstructive
pulmonary disease exacerbations in [**2159-11-27**] and in
[**2159-12-28**].  He was in his usual state of health until
three days prior to admission when he developed acute
shortness of breath and cough.  There was no hemoptysis or
fevers, chills, nausea, vomiting, chest pain, abdominal pain,
orthopnea of paroxysmal nocturnal dyspnea.  He had a
productive cough with brownish sputum.

In the Emergency Department, his saturations were 70% on room
air and 90% on 7 liters of oxygen.  He was given Solu-Medrol
and levofloxacin as well as Combivent nebulizers and
transferred to the Medical Intensive Care Unit.

During the course of his stay in the Medical Intensive Care
Unit, his oxygen saturations were 92% on 50% oxygen.  A chest
x-ray showed a right middle lobe opacity.  He was maintained
on q.1h. nebulizers and changed to p.o. prednisone, and
eventually changed to q.4h. nebulizers with oxygen
saturations of 96% on 3 liters via nasal cannula.  At that
point, he was transferred to the floor for further care.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease.
2.  Bronchiectasis.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Pyloric stenosis.
6.  History of bladder cancer.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  (Medications on transfer to the
floor were)
1.  Prednisone 60 mg p.o. q.d.
2.  Flovent meter-dosed inhaler.
3.  Zantac.
4.  Norvasc 5 mg p.o. q.d.
5.  Zoloft 250 mg p.o. q.d.
6.  Albuterol and Atrovent nebulizers q.4h.

SOCIAL HISTORY:  A 55-pack-year history of tobacco; now, he
smokes five to six cigarettes per day.  No drug or alcohol
use.  The patient lives with his wife.

FAMILY HISTORY:  Family history with coronary artery disease.

PHYSICAL EXAMINATION ON PRESENTATION:   On physical
examination, temperature of 98.6, blood pressure of 119/68,
pulse of 80, respiratory rate of 23, oxygen saturation 96% on
3 liters through a nasal cannula.  Generally, lying
comfortably in bed, in no apparent distress.  Head, eyes,
ears, nose, and throat revealed anicteric sclerae, bilateral
surgical pupils.  Extraocular muscles were intact.  The
oropharynx was clear.  Mucous membranes were dry.  Neck
revealed no lymphadenopathy or jugular venous distention.
Lungs revealed prolonged expiratory phase with positive
end-expiratory wheezing.  Cardiovascular examination revealed
distant heart sounds, a regular rate and rhythm.  The abdomen
was soft and obese with a well-healed epigastric scar.  No
tenderness or distention.  Extremities revealed left hand
clubbing.  No cyanosis or edema.  Neurologically, alert and
oriented times three.  No focal neurologic deficits.

PERTINENT LABORATORY DATA ON PRESENTATION: White blood cell
count of 22.5, hematocrit of 39.6, platelets of 195.  Chem-7
revealed sodium of 141, potassium of 3.8, chloride of 97,
bicarbonate of 34, blood urea nitrogen of 15, creatinine
of 0.7, blood sugar of 157.

RADIOLOGY/IMAGING:  Chest x-ray showed a right middle lobe
pericardiac pneumonia with possible involvement of right
lower lobe.

HOSPITAL COURSE:

1.  PULMONARY:  The patient remained stable from a pulmonary
standpoint during the course of his stay on the [**Hospital6 2399**] Firm.  He continued to have oxygen saturations in
the middle 90s on 3 liters via nasal cannula.  The patient
had a Physical Therapy consultation which deemed him
requiring supplemental oxygen at home.

The patient's white blood cell count decreased throughout the
course of his stay in the hospital.  His cough also cleared
throughout the course of his stay in the hospital.  The
patient remained afebrile throughout the course of his stay
in the hospital.  Prior to his discharge, a chest CT was
obtained which showed bilateral lower lobe bronchial wall
thickening, worse in the right lower lobe than the left with
associated areas of mucoid impaction in the right lower lobe.
There was also multifactorial patchy ground-glass opacity in
both lower lobes and the lingula as well as some minimal
consolidation at the right lung base.  These findings likely
represented acute infectious bronchiectasis with associated
early developing bronchial pneumonia.

There was also a 5-mm diameter lung nodule in the right upper
lobe separated from areas of previous presumed infectious
changes in the lower lung zones.  This nodule could
potentially represent a very early focus of tumor; however,
an acute infectious or inflammatory process was also on the
differential diagnosis.  A follow-up chest CT was recommended
by Radiology in two to three months.  The patient's primary
care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (Titles) **], was to schedule a
follow-up chest CT in two to three months to assess this new
lung nodule in the right upper lobe.

The patient was treated with Levaquin for his pneumonia.

2.  CARDIOVASCULAR:  The patient's blood pressure was
elevated during the course of his stay in the hospital, and
his Norvasc was increased to 7.5 mg p.o. q.d. with good
results.

DISCHARGE DIAGNOSES:
1.  Chronic obstructive pulmonary disease exacerbation with a
right middle lobe pneumonia.
2.  Chest CT evidence of new lung nodule in the right upper
lobe; to be followed up by chest CT in two to three months.

MEDICATIONS ON DISCHARGE:
 1.  Levofloxacin 500 mg p.o. q.d. (times 10 more days).
 2.  Prednisone 50 mg p.o. q.d. (with slow taper).
 3.  Albuterol and Atrovent nebulizers t.i.d.
 4.  Albuterol and Atrovent meter-dosed inhaler p.r.n.
 5.  Flovent meter-dosed inhaler 2 puffs b.i.d.
 6.  Norvasc 7.5 mg p.o. q.d.
 7.  Zoloft 250 mg p.o. q.d.
 8.  Calcium carbonate 500 mg p.o. t.i.d.
 9.  Vitamin D 800 IU p.o. q.d.
10.  Home oxygen 2 liters.
11.  Dyazide (37.5/25) 1 tablet p.o. q.d.

CONDITION AT DISCHARGE:  The patient's condition was stable.

DISCHARGE STATUS:  Discharged to home.

DISCHARGE FOLLOWUP:  The patient was to follow up with his
primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Name (STitle) **].




                          [**Name6 (MD) 251**] [**Last Name (NamePattern4) 6366**], M.D.  [**MD Number(1) 6367**]

Dictated By:[**Name8 (MD) 5753**]

MEDQUIST36

D:  [**2160-4-1**]  11:08
T:  [**2160-4-1**]  13:47
JOB#:  [**Job Number 6368**]
{'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Unspecified essential hypertension,Osteoporosis, unspecified'}


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: 

PRESENT ILLNESS: This is a 68-year-old male with
a history of chronic obstructive pulmonary disease,
bronchiectasis, hypertension, and hypercholesterolemia who
was admitted to the Medical Intensive Care Unit on [**2160-3-23**] for a chronic obstructive pulmonary disease
exacerbation.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease.
2.  Bronchiectasis.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Pyloric stenosis.
6.  History of bladder cancer.

MEDICATION ON ADMISSION: (Medications on transfer to the
floor were)
1.  Prednisone 60 mg p.o. q.d.
2.  Flovent meter-dosed inhaler.
3.  Zantac.
4.  Norvasc 5 mg p.o. q.d.
5.  Zoloft 250 mg p.o. q.d.
6.  Albuterol and Atrovent nebulizers q.4h.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history with coronary artery disease.

SOCIAL HISTORY: A 55-pack-year history of tobacco; now, he
smokes five to six cigarettes per day.  No drug or alcohol
use.  The patient lives with his wife. 

### Response:
{'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Unspecified essential hypertension,Osteoporosis, unspecified'}
