CHIEF COMPLAINT: cough, fatigue, back pain

PRESENT ILLNESS: 46yoW with pmh HIV, renal infarcts [**2-6**] emboli, p/w cough
fatigue, back pain for 2 days.  Denies sick contacts, admits to
smoking crack.  Cough productive of scant white sputum only.
States she has been compliant with taking her coumadin.

MEDICAL HISTORY: PMHx:
1. AIDS: dx [**2176**] with CD4 ct ~180. Last CD4 count 368, VL 14,720
[**12-9**]. not on HIV meds
2. Hepatitis C: VL non-detectable [**2185**]
3. Dilated cardiomyopathy. Last echo [**2185-12-5**] EF less than 20%.

MEDICATION ON ADMISSION: 

ALLERGIES: Zidovudine

PHYSICAL EXAM: VSS
Cachectic, NAD
PERRLA, EOMI
No JVD
RRR nl s1s2 no mrg
Lungs with decreased bs b/l
Abd soft nt nd nabs
LE wwp
No spinal or paraspinal tenderness, no cva tenderness

FAMILY HISTORY: Mother has DM.

SOCIAL HISTORY: 
Pneumonia, organism unspecified,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Cocaine dependence, continuous,Chronic hepatitis C without mention of hepatic coma,Candidiasis of mouth
Pneumonia, organism NOS,Human immuno virus dis,Prim cardiomyopathy NEC,Cocaine depend-contin,Chrnc hpt C wo hpat coma,Thrush
Admission Date:  [**2189-9-14**]              Discharge Date:   [**2189-9-20**]

Date of Birth:  [**2143-7-12**]             Sex:   F

Service: MEDICINE

Allergies:
Zidovudine

Attending:[**First Name3 (LF) 1674**]
Chief Complaint:
cough, fatigue, back pain

Major Surgical or Invasive Procedure:
none


History of Present Illness:
46yoW with pmh HIV, renal infarcts [**2-6**] emboli, p/w cough
fatigue, back pain for 2 days.  Denies sick contacts, admits to
smoking crack.  Cough productive of scant white sputum only.
States she has been compliant with taking her coumadin.

ROS: No fever, chills, dysuria, weakness, numbness.  All other
ROS negative.

Past Medical History:
PMHx:
1. AIDS: dx [**2176**] with CD4 ct ~180. Last CD4 count 368, VL 14,720
[**12-9**]. not on HIV meds
2. Hepatitis C: VL non-detectable [**2185**]
3. Dilated cardiomyopathy. Last echo [**2185-12-5**] EF less than 20%.

4. Multiple pneumonias since [**2177**]  (pnuemococcal vaccine in
[**2184**])
5. Myocardial Infarction [**2184**], cath with clean coronaries
6. History of LV thrombus: [**2185**]
7. History of left lower extremity arterial thrombus: [**2185**]
8. History of L MCA stroke with residual R hemiparesis: [**2185**]
9. Sinus tachycardia
10. Asthma (FEV1/FVC 73, 94%in [**2-9**])
11. mandibular fx s/p repair and revision c/p asp pna.
12. +anti-cardiolipin Ab
13. Crack cocaine use (last use [**2188-1-11**])
.
PSHx:
1. s/p TAH [**2184**] for sx fibroids, c/b multiple adhesions per op
note
2. s/p C/S x2
3. s/p D&C x2
.


Family History:
Mother has DM.


Physical Exam:
VSS
Cachectic, NAD
PERRLA, EOMI
No JVD
RRR nl s1s2 no mrg
Lungs with decreased bs b/l
Abd soft nt nd nabs
LE wwp
No spinal or paraspinal tenderness, no cva tenderness

Pertinent Results:
CT chest:
Innumberable 1-2mm wide nodules, many centrilobular, are
scattered through the lungs, more profuse in some regions than
on prior studies.
There is no pleural effusion. Atelectais is present in the
dependent portions of both lungs. The heart demonstrates left
ventricular dilatation. The great vessels are normal in size.
Bilateral hilar and mediastinal lymphadenopathy is stable.
Bilateral axillary lymphadenopathy is again noted and unchanged.
There is a stable left thyroid lobe nodule.
No bone findings suspicious for malignancy.
The study is not designed for the subdiaphragmatic evaluation
except to note a
26 x 23 mm hypodense lesion in the left lobe of the liver with
peripheral enhancement, likely a hemangioma.
IMPRESSION:
1. Patchy ground-glass opacity in the anterior segment of the
left upper lobe, just above the lingula may represent an acute
infectious process including PCP.
2. 11 x 8 mm nodule in the left lower lobe. Followup CT in three
months is recommended to document stability.
3. Bilateral [**Year (4 digits) **] small nodules in the range of [**1-6**] mm in a
peribronchial distribution. Differential diagnosis includes
peribronchial granulomas from inhalation of foreign substances,
sarcoid although not typical in distribution, and chronic
lymphocytic interstitial pneumonia.
4. Stable 2.6 x 2.3 cm hepatic hemangioma.

Sputum AFB negative x 3, PCP [**Name Initial (PRE) 5963**].  Fungal markers negative.


Brief Hospital Course:
1)Pneumonia: Pt was admitted with pneumonia, started on
Ceftriaxone/Azithromycin. Induced sputum AFB and PCP [**Name Initial (PRE) 5963**].
Discharged on Levofloxacin with plan to continue for 7 more
days.

2)Thrush:  Patient states that nystatin had not worked for her
in the past and so she was treated with fluconazole.

3)Back pain:  CT abd to r/o renal infart was unchanged.  Back
pain was clinically consistent with musculo skeletal pain.

4)HIV:  Follow up scheduled this week with infectious disease
team.  ID team followed her throughout hospital course.  She is
not on HAART or prophylactic antibiotics.

5)Anticardiolopin ab syndrome:  Pt's INR was therapuetic on
admission, was initially given doses she reported that she took
at home, but as her INR drifted down on these doses, she was
re-questioned, and admitted that she had forgotten that she had
more recently been on a higher dose of coumadin 4 mg po qd,
advised by [**Hospital 191**] [**Hospital **] clinic.  Her dose was increased to
coumadin 5 mg po qd, no interactions with levofloxacin, and she
was advised to have her INR checked within one week.

6)Depression/anxiety: Patient was started on Prozac and ativan
bridge, showed great improvement.  Follow up to be made with
PCP.

Discharge Medications:
1. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).
Disp:*7 Tablet(s)* Refills:*0*
2. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*0*
3. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*5 Tablet(s)* Refills:*0*
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

7. Fluconazole 100 mg Tablet Sig: One (1) Tablet PO once a day
for 6 days.
Disp:*6 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
pneumonia


Discharge Condition:
stable


Discharge Instructions:
Take your new medications Levofloxacin, fluconazole, fluoxetine.
 Dr. [**Last Name (STitle) **] will call you Monday with an appointment to see your
new primary care doctor.  On the day you see your new primary
care doctor you will also get your coumadin level checked.

Followup Instructions:
1)Dr. [**Last Name (STitle) **] will call you Monday with an appointment to see your
new primary care doctor.  On the day you see your new doctor you
will also get your coumadin level checked.

2)Please go to see your infectious disease doctor, Dr. [**First Name8 (NamePattern2) 803**]
[**Last Name (NamePattern1) **], on [**9-23**] at 10:30 in the [**Hospital Unit Name **] on [**Last Name (NamePattern1) 12939**] at [**Hospital3 **] Hospital [**Hospital Ward Name **].


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1677**]

Completed by:[**2189-9-23**]
{'Pneumonia, organism unspecified,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Cocaine dependence, continuous,Chronic hepatitis C without mention of hepatic coma,Candidiasis of mouth'}


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: cough, fatigue, back pain

PRESENT ILLNESS: 46yoW with pmh HIV, renal infarcts [**2-6**] emboli, p/w cough
fatigue, back pain for 2 days.  Denies sick contacts, admits to
smoking crack.  Cough productive of scant white sputum only.
States she has been compliant with taking her coumadin.

MEDICAL HISTORY: PMHx:
1. AIDS: dx [**2176**] with CD4 ct ~180. Last CD4 count 368, VL 14,720
[**12-9**]. not on HIV meds
2. Hepatitis C: VL non-detectable [**2185**]
3. Dilated cardiomyopathy. Last echo [**2185-12-5**] EF less than 20%.

MEDICATION ON ADMISSION: 

ALLERGIES: Zidovudine

PHYSICAL EXAM: VSS
Cachectic, NAD
PERRLA, EOMI
No JVD
RRR nl s1s2 no mrg
Lungs with decreased bs b/l
Abd soft nt nd nabs
LE wwp
No spinal or paraspinal tenderness, no cva tenderness

FAMILY HISTORY: Mother has DM.

SOCIAL HISTORY:  

### Response:
{'Pneumonia, organism unspecified,Human immunodeficiency virus [HIV] disease,Other primary cardiomyopathies,Cocaine dependence, continuous,Chronic hepatitis C without mention of hepatic coma,Candidiasis of mouth'}
