CHIEF COMPLAINT: SOB, hypoxia

PRESENT ILLNESS: 55F with COPD, paranoid schizophrenia, seizure disorder presents
with episode of SOB at her group home with hypoxia to the 70s,
increasing cough productive of yellow sputum. Patient reports
that she got up to go to the bathroom and felt SOB. She has had
a productive cough for months but has recently had more sputum
production. Denies sick contacts (although she lives in a group
home), hemoptysis, chills, fevers, unwanted weight loss. She has
had some night sweats and has been having episodes of vertigo
which have been controlled with anivert. She continues to smoke
[**2-15**] PPD.
.
In the ED, T 97.3, HR 109, BP 101/69, RR 20 O2 98% on 6 L to 94
% on RA. She had 2 episodes of hypotension to SBP high 70s-80s
which initialy responded to IVF, but given second episode, was
tranferred to the ICU for close monitoring. She recieved
combivent nebs x3, 5 L NS, levofloxacon 500 mg IV x 1 and
solumedrol 125 mg IV x1.
.
Per discussion with PCP; baseline BP runs in the 90s-100s.
.
ROS: Denies diarrhea, constipation, headache, CP. She has had a
10 lb intentional weight loss over the past months. Slight sore
throat 2 days ago which resolved. She continues to hear voices.
Most recently last night when people were trying to "slay her."
She also sees "faces" and feel people are talking to her from
the TV. Denies HI, SI.

MEDICAL HISTORY: Paranoid Schizophrenia
Seizure disorder-unclear history
COPD - no PFTs in [**Hospital1 **] system, patient's Pulmonologist is Dr.
[**Last Name (STitle) 3278**] at [**Hospital **] Hospital.  CXRs at [**Hospital1 18**] however demonstrate
         interstitial changes c/w ILD
Vertigo
Hypercholesterolemia
Foot pain - unclear etiology
Urinary incontinence s/p "bladder surgery" 8 years ago

MEDICATION ON ADMISSION: Clozaril 600 mg PO QHS
Abilify 30 mg PO QAM
Lexapro 15 mg PO QAM
Diazepam 5 mg PO TID
Vitamin E 400 mg PO BID
Prednisone 10 mg PO BID x 7 days (day 2)
Azmacort 4 puffs Po BID
Claritin 10 mg Po QD
Colace 100 mg PO BID
Dilantin 200 mg Po BID
Lasix 40 mg Po QAM
Antivert 25 mg PO BID:PRN vertigo
Lipitor 10 mg PO QD
MVI PO QAM
DDAVP 0.4 mg PO QHS
PPD placed (needs to be read [**2-28**])
C-Pap with 1.2 liters O2 overnight
Relafen 500 mg QD PRN
Albuterol nebs PRN
Albuterol MDI PRN
Robitussion 100 cc PO Q4H PRN
Tylenol PRN
Ibuprofen PRN
MOM PRN
Nicotine gum PRN
Trazadone 50 mg Po QHS PRN sleep
Lidomantle cream [**Hospital1 **] for foot pain
Ditropan XL 15 daily

ALLERGIES: Haldol

PHYSICAL EXAM: Vitals:Tm 100.5
General: Middle aged female lying flat in bed breathing
comfortably in NAD
HEENT: MMM, OP clear, PERRL
Neck: no cervical LAD, no JVD
CV: RR, nl S1, S2 no m/g/r
Pulm: diffusely rhonchorous with occasional wheezes
Abd: NABS, soft, NT/ND
Ext: + clubbing right>>left, no LE edema, no calf tenderness, 2
+ DP pulses, right forearm with slight erythema at site of PPD
but no induration
Neuro:AAOx3, CN intact, strength in upper and LE [**6-18**] and equal
b/l
Psych: reports auditory and visual hallucinations as above. No
HI/SI. Somewhat flattened affect
Skin: No rashes

FAMILY HISTORY: 2 daughter with "mental health problems." Did not want to speak
about her parents. Denies any family history of CAD or stroke.
Did have a grandfather with COPD.

SOCIAL HISTORY: Patient lives in a group home. Smokes [**2-15**] ppd. Before this
smoked PPD since age 13. Denies illicit drug use. Has 2
duaghters.
Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Postinflammatory pulmonary fibrosis,Dehydration,Paranoid type schizophrenia, chronic,Hypoxemia,Dizziness and giddiness,Epilepsy, unspecified, without mention of intractable epilepsy,Pure hypercholesterolemia,Tobacco use disorder
Obs chr bronc w(ac) exac,Pneumonia, organism NOS,Postinflam pulm fibrosis,Dehydration,Paranoid schizo-chronic,Hypoxemia,Dizziness and giddiness,Epilep NOS w/o intr epil,Pure hypercholesterolem,Tobacco use disorder
Admission Date:  [**2135-2-27**]              Discharge Date:   [**2135-3-2**]

Date of Birth:  [**2079-12-3**]             Sex:   F

Service: MEDICINE

Allergies:
Haldol

Attending:[**First Name3 (LF) 3507**]
Chief Complaint:
SOB, hypoxia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
55F with COPD, paranoid schizophrenia, seizure disorder presents
with episode of SOB at her group home with hypoxia to the 70s,
increasing cough productive of yellow sputum. Patient reports
that she got up to go to the bathroom and felt SOB. She has had
a productive cough for months but has recently had more sputum
production. Denies sick contacts (although she lives in a group
home), hemoptysis, chills, fevers, unwanted weight loss. She has
had some night sweats and has been having episodes of vertigo
which have been controlled with anivert. She continues to smoke
[**2-15**] PPD.
.
In the ED, T 97.3, HR 109, BP 101/69, RR 20 O2 98% on 6 L to 94
% on RA. She had 2 episodes of hypotension to SBP high 70s-80s
which initialy responded to IVF, but given second episode, was
tranferred to the ICU for close monitoring. She recieved
combivent nebs x3, 5 L NS, levofloxacon 500 mg IV x 1 and
solumedrol 125 mg IV x1.
.
Per discussion with PCP; baseline BP runs in the 90s-100s.
.
ROS: Denies diarrhea, constipation, headache, CP. She has had a
10 lb intentional weight loss over the past months. Slight sore
throat 2 days ago which resolved. She continues to hear voices.
Most recently last night when people were trying to "slay her."
She also sees "faces" and feel people are talking to her from
the TV. Denies HI, SI.


Past Medical History:
Paranoid Schizophrenia
Seizure disorder-unclear history
COPD - no PFTs in [**Hospital1 **] system, patient's Pulmonologist is Dr.
[**Last Name (STitle) 3278**] at [**Hospital **] Hospital.  CXRs at [**Hospital1 18**] however demonstrate
         interstitial changes c/w ILD
Vertigo
Hypercholesterolemia
Foot pain - unclear etiology
Urinary incontinence s/p "bladder surgery" 8 years ago


Social History:
Patient lives in a group home. Smokes [**2-15**] ppd. Before this
smoked PPD since age 13. Denies illicit drug use. Has 2
duaghters.


Family History:
2 daughter with "mental health problems." Did not want to speak
about her parents. Denies any family history of CAD or stroke.
Did have a grandfather with COPD.


Physical Exam:
Vitals:Tm 100.5
General: Middle aged female lying flat in bed breathing
comfortably in NAD
HEENT: MMM, OP clear, PERRL
Neck: no cervical LAD, no JVD
CV: RR, nl S1, S2 no m/g/r
Pulm: diffusely rhonchorous with occasional wheezes
Abd: NABS, soft, NT/ND
Ext: + clubbing right>>left, no LE edema, no calf tenderness, 2
+ DP pulses, right forearm with slight erythema at site of PPD
but no induration
Neuro:AAOx3, CN intact, strength in upper and LE [**6-18**] and equal
b/l
Psych: reports auditory and visual hallucinations as above. No
HI/SI. Somewhat flattened affect
Skin: No rashes


Pertinent Results:
EKG: Sinus tachy, rate 100, nl axis, nl interval, <1mm St
depressions in II, II, avF
.
CXR: b/l lateral interstitial changes. Unchanged from [**2130**]. No
evidence of PNA.
.
[**2135-2-27**] 12:09PM BLOOD Lactate-1.6
[**2135-2-27**] 06:03PM BLOOD Phenyto-9.8*
[**2135-2-27**] 09:20AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2135-2-27**] 06:03PM BLOOD CK-MB-2 cTropnT-<0.01
[**2135-2-27**] 09:20AM BLOOD CK(CPK)-48
[**2135-2-27**] 06:03PM BLOOD CK(CPK)-61
[**2135-2-27**] 09:20AM BLOOD Glucose-135* UreaN-22* Creat-0.8 Na-141
K-4.0 Cl-102 HCO3-30 AnGap-13
[**2135-2-27**] 09:20AM BLOOD WBC-17.7* RBC-4.83 Hgb-14.4 Hct-43.7
MCV-91 MCH-29.9 MCHC-33.1 RDW-13.4 Plt Ct-290
[**2135-3-1**] 07:50AM BLOOD WBC-11.4* RBC-4.24 Hgb-12.3 Hct-36.6
MCV-86 MCH-29.0 MCHC-33.5 RDW-13.5 Plt Ct-228

Brief Hospital Course:
55 yo female with h/o COPD, paranoid schizophrenia, seizure
disorder presenting with episode of increasing SOB and cough
likely [**3-18**] bronchitis v COPD exacerbation v PNA.
.
# Dyspnea and hypoxia: The patient carries the dx of COPD,
however, PA/Lat during this admission demonstrated unchanged
interstitial pattern compared to [**2130**]. No PFTs in [**Hospital1 18**] system.
She may have a component of both COPD and ILD.
Nevertheless,there was a ? of a retrocardiac opacity on the
lateral film.  Pt to complete 7 day course of Levofloxacin for
CAP.  She should have her ECG monitored every few days as there
is a theoretical interaction between Quinolones and her
antipsychotics.  She was started on Spiriva and advair for more
agressive COPD regimen, and will complete a quick steroid taper.
 Should f/u with her Pulmonologist, Dr [**Last Name (STitle) 3278**].
.
# Hypotension: Patient reports that he SBP run in high 80 to
110s usually. She may have been mildly dehydrated on admission
as she says she has not been drinking much and felt dry. She
receievd 5.5 L IVF. Was not truly orthostatic on the floor.
Lasix held upon discharge.
.
# Schizophrenia: Has hallucinations at baseline. No current
SI/HI.  Continued abilify, clozaril, lexapro, diazepam
.
# Seizure disorder: Unclear history. No recent seizures.
Dilantin level at goal corrected for albumin
.
# ST depressions: Patient had no CP, no increasing DOE and no
cardiac history and is not diabetic. Very slight <1mm ST
depression in the inferior leads. 2 sets CE's negative.
.
# Vertigo: Patient says that she has been having feeling that
the "room is spinning" for the past couple of weeks. Improved
with antivert.


Medications on Admission:
Clozaril 600 mg PO QHS
Abilify 30 mg PO QAM
Lexapro 15 mg PO QAM
Diazepam 5 mg PO TID
Vitamin E 400 mg PO BID
Prednisone 10 mg PO BID x 7 days (day 2)
Azmacort 4 puffs Po BID
Claritin 10 mg Po QD
Colace 100 mg PO BID
Dilantin 200 mg Po BID
Lasix 40 mg Po QAM
Antivert 25 mg PO BID:PRN vertigo
Lipitor 10 mg PO QD
MVI PO QAM
DDAVP 0.4 mg PO QHS
PPD placed (needs to be read [**2-28**])
C-Pap with 1.2 liters O2 overnight
Relafen 500 mg QD PRN
Albuterol nebs PRN
Albuterol MDI PRN
Robitussion 100 cc PO Q4H PRN
Tylenol PRN
Ibuprofen PRN
MOM PRN
Nicotine gum PRN
Trazadone 50 mg Po QHS PRN sleep
Lidomantle cream [**Hospital1 **] for foot pain
Ditropan XL 15 daily

Discharge Medications:
1. Clozapine 100 mg Tablet Sig: Six (6) Tablet PO HS (at
bedtime).
2. Aripiprazole 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
3. Escitalopram 10 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).

4. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
5. Vitamin E 400 unit Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
7. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
8. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2)
Capsule PO BID (2 times a day).
11. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
13. Desmopressin 0.1 mg Tablet Sig: Four (4) Tablet PO QHS (once
a day (at bedtime)).
14. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) as needed.
15. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 6 days.
16. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal DAILY (Daily).
17. Albuterol Sulfate 0.083 % Solution Sig: One (1) inhl
Inhalation Q4H (every 4 hours) as needed.
18. Prednisone 10 mg Tablet Sig: as directed Tablet PO once a
day for 2 days: Please take 20 mg on [**3-2**] and 10 mg on [**3-3**] then
stop.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary Diagnoses:
1. COPD vs ILD exascerbation
2. ?Community Acquired PNA

Secondary Diagnoses:
Paranoid Schizophrenia
Seizure disorder-unclear history
Vertigo
Hypercholesterolemia
Urinary incontinence s/p "bladder surgery" 8 years ago


Discharge Condition:
stable


Discharge Instructions:
Please come back to the emergency room should you develop any
worsening shortness of breath, fevers, chills, worsening cough,
or any other serious concerns.

Followup Instructions:
Please call to make appiontments for the patient with the
following providers.

[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 42596**], M.D.
Specialty: Pulmonary Medicine
Address 1: [**Hospital 42597**] Medical Building
[**Apartment Address(1) 42598**]
[**Hospital1 **], [**Telephone/Fax (1) 42599**]

Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 42600**], M.D.
Specialty: Family Practice
Address 1: Family Medicine Associates, PC
38R [**Hospital1 42601**], [**Telephone/Fax (1) 42602**]
{'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Postinflammatory pulmonary fibrosis,Dehydration,Paranoid type schizophrenia, chronic,Hypoxemia,Dizziness and giddiness,Epilepsy, unspecified, without mention of intractable epilepsy,Pure hypercholesterolemia,Tobacco use disorder'}


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: SOB, hypoxia

PRESENT ILLNESS: 55F with COPD, paranoid schizophrenia, seizure disorder presents
with episode of SOB at her group home with hypoxia to the 70s,
increasing cough productive of yellow sputum. Patient reports
that she got up to go to the bathroom and felt SOB. She has had
a productive cough for months but has recently had more sputum
production. Denies sick contacts (although she lives in a group
home), hemoptysis, chills, fevers, unwanted weight loss. She has
had some night sweats and has been having episodes of vertigo
which have been controlled with anivert. She continues to smoke
[**2-15**] PPD.
.
In the ED, T 97.3, HR 109, BP 101/69, RR 20 O2 98% on 6 L to 94
% on RA. She had 2 episodes of hypotension to SBP high 70s-80s
which initialy responded to IVF, but given second episode, was
tranferred to the ICU for close monitoring. She recieved
combivent nebs x3, 5 L NS, levofloxacon 500 mg IV x 1 and
solumedrol 125 mg IV x1.
.
Per discussion with PCP; baseline BP runs in the 90s-100s.
.
ROS: Denies diarrhea, constipation, headache, CP. She has had a
10 lb intentional weight loss over the past months. Slight sore
throat 2 days ago which resolved. She continues to hear voices.
Most recently last night when people were trying to "slay her."
She also sees "faces" and feel people are talking to her from
the TV. Denies HI, SI.

MEDICAL HISTORY: Paranoid Schizophrenia
Seizure disorder-unclear history
COPD - no PFTs in [**Hospital1 **] system, patient's Pulmonologist is Dr.
[**Last Name (STitle) 3278**] at [**Hospital **] Hospital.  CXRs at [**Hospital1 18**] however demonstrate
         interstitial changes c/w ILD
Vertigo
Hypercholesterolemia
Foot pain - unclear etiology
Urinary incontinence s/p "bladder surgery" 8 years ago

MEDICATION ON ADMISSION: Clozaril 600 mg PO QHS
Abilify 30 mg PO QAM
Lexapro 15 mg PO QAM
Diazepam 5 mg PO TID
Vitamin E 400 mg PO BID
Prednisone 10 mg PO BID x 7 days (day 2)
Azmacort 4 puffs Po BID
Claritin 10 mg Po QD
Colace 100 mg PO BID
Dilantin 200 mg Po BID
Lasix 40 mg Po QAM
Antivert 25 mg PO BID:PRN vertigo
Lipitor 10 mg PO QD
MVI PO QAM
DDAVP 0.4 mg PO QHS
PPD placed (needs to be read [**2-28**])
C-Pap with 1.2 liters O2 overnight
Relafen 500 mg QD PRN
Albuterol nebs PRN
Albuterol MDI PRN
Robitussion 100 cc PO Q4H PRN
Tylenol PRN
Ibuprofen PRN
MOM PRN
Nicotine gum PRN
Trazadone 50 mg Po QHS PRN sleep
Lidomantle cream [**Hospital1 **] for foot pain
Ditropan XL 15 daily

ALLERGIES: Haldol

PHYSICAL EXAM: Vitals:Tm 100.5
General: Middle aged female lying flat in bed breathing
comfortably in NAD
HEENT: MMM, OP clear, PERRL
Neck: no cervical LAD, no JVD
CV: RR, nl S1, S2 no m/g/r
Pulm: diffusely rhonchorous with occasional wheezes
Abd: NABS, soft, NT/ND
Ext: + clubbing right>>left, no LE edema, no calf tenderness, 2
+ DP pulses, right forearm with slight erythema at site of PPD
but no induration
Neuro:AAOx3, CN intact, strength in upper and LE [**6-18**] and equal
b/l
Psych: reports auditory and visual hallucinations as above. No
HI/SI. Somewhat flattened affect
Skin: No rashes

FAMILY HISTORY: 2 daughter with "mental health problems." Did not want to speak
about her parents. Denies any family history of CAD or stroke.
Did have a grandfather with COPD.

SOCIAL HISTORY: Patient lives in a group home. Smokes [**2-15**] ppd. Before this
smoked PPD since age 13. Denies illicit drug use. Has 2
duaghters. 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Postinflammatory pulmonary fibrosis,Dehydration,Paranoid type schizophrenia, chronic,Hypoxemia,Dizziness and giddiness,Epilepsy, unspecified, without mention of intractable epilepsy,Pure hypercholesterolemia,Tobacco use disorder'}
