CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 78F with DM on oral agents and Hypertension on lisinopril for
~10 years who was admitted via [**Hospital **] Hospital for angioedema.
Relevant history includes upper teeth extraction 2 weeks ago and
placement of partial dental prosthesis. On Thursday [**11-23**] 1d
PTA, she noticed upper lip swelling after her usual breakfast of
oatmeal (no diet changes). She presented to her dentist and OMFS
who recommended benadryl and close follow-up. This morning at
12:30am, she awoke with tongue swelling that "filled my mouth,"
and called her daughter. In ~45-60 [**Name2 (NI) **], she was unable to speak
and taken to [**Hospital **] Hospital. There, she was afebrile and
hypertensive 209/101 satting 94% on room air. She received 125mg
of solumedrol and 25mg of IV benadryl with ranitidine and
albuterol, and transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: Diabetes Type II on metformin
Hypertension on HCTZ and lisinopril
Hyperlipidemia
Osteoporosis

MEDICATION ON ADMISSION: ASA 81
Lisinopril 40 PO daily
HCTZ 25mg PO daily
Lovastatin 40mg PO daily
Metformin 1000mg PO daily
Calcim + Vitamin D
Percocet PRN for back pain (rare)
Cod Liver Oil

ALLERGIES: Lisinopril

PHYSICAL EXAM: 97.8  180/76  77  18  93% RA

FAMILY HISTORY: No h/o DM. No other contrib fam hx

SOCIAL HISTORY: Occupation: retired
Drugs: none
Tobacco: 1ppd for 60 years
Alcohol: 1glass [**Doctor First Name **] or wine/night, no prev withdrawal
Other: Lives in senior community, retired, daughter [**Name (NI) **] [**Telephone/Fax (1) 63926**] next of [**Doctor First Name **]
Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Benign essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,Other diseases of lung, not elsewhere classified,Other and unspecified hyperlipidemia,Nontoxic multinodular goiter,Diverticulum of esophagus, acquired
Angioneurotic edema,Adv eff cardiovasc NEC,Benign hypertension,DMII wo cmp nt st uncntr,Osteoporosis NOS,Other lung disease NEC,Hyperlipidemia NEC/NOS,Nontox multinodul goiter,Acq esophag diverticulum
Admission Date:  [**2119-11-24**]              Discharge Date:   [**2119-11-26**]

Date of Birth:  [**2041-9-2**]             Sex:   F

Service: MEDICINE

Allergies:
Lisinopril

Attending:[**First Name3 (LF) 4760**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
None

History of Present Illness:
78F with DM on oral agents and Hypertension on lisinopril for
~10 years who was admitted via [**Hospital **] Hospital for angioedema.
Relevant history includes upper teeth extraction 2 weeks ago and
placement of partial dental prosthesis. On Thursday [**11-23**] 1d
PTA, she noticed upper lip swelling after her usual breakfast of
oatmeal (no diet changes). She presented to her dentist and OMFS
who recommended benadryl and close follow-up. This morning at
12:30am, she awoke with tongue swelling that "filled my mouth,"
and called her daughter. In ~45-60 [**Name2 (NI) **], she was unable to speak
and taken to [**Hospital **] Hospital. There, she was afebrile and
hypertensive 209/101 satting 94% on room air. She received 125mg
of solumedrol and 25mg of IV benadryl with ranitidine and
albuterol, and transferred to [**Hospital1 18**] for further management.



In the [**Hospital1 18**] ED, she was afebrile with HR of 103 and BP 191/88
satting 90% on RA. She was admitted to the medical ICU for
further/ongoing management.



On arrival to the MICU, she was able to speak clearly in full
sentences, but still with some tongue swelling. She descriibes
some swelling in her neck as well. She denied pain and described
her breathing was comfortable. She received one additional dose
of benadryl for throat fullness but required no further
intervention.


Past Medical History:
Diabetes Type II on metformin
Hypertension on HCTZ and lisinopril
Hyperlipidemia
Osteoporosis

Past Surgeries
Zenker Diverticulum s/p cricomyotomy and diverticulopexy on
[**2117-8-27**]
Tonsillectomy as a child
Deviated Septum repair

Social History:
Occupation: retired
Drugs: none
Tobacco: 1ppd for 60 years
Alcohol: 1glass [**Doctor First Name **] or wine/night, no prev withdrawal
Other: Lives in senior community, retired, daughter [**Name (NI) **] [**Telephone/Fax (1) 63926**] next of [**Doctor First Name **]

Family History:
No h/o DM. No other contrib fam hx


Physical Exam:
97.8  180/76  77  18  93% RA

General Appearance: Well nourished, No acute distress,
Overweight / Obese, Not Anxious, Not Diaphoretic
Eyes / Conjunctiva: PERRL, Pupils not dilated, Conjunctiva nml,
No Sclera edema
Head, Ears, Nose, Throat: Normocephalic, soft tissue swelling
under neck/pre-tracheal
Lymphatic: Cervical adenopathy
Cardiovascular: S1: Normal, S2: Normal, No murmur
Respiratory / Chest: Expansion: Symmetric, Breath Sounds:
Crackles 3/4 up on right, at left base,
Abdominal: Soft, Non-tender, Not Distended
Extremities: Right: Trace, Left: Trace Edema
Skin:  Warm
Neurologic: Attentive

Pertinent Results:
[**2119-11-24**] 05:45AM   WBC-10.0 RBC-4.94 HGB-15.1 HCT-44.2 MCV-90
MCH-30.6 MCHC-34.3 RDW-14.0
[**2119-11-24**] 05:45AM   NEUTS-86.3* LYMPHS-11.5* MONOS-1.7* EOS-0.3
BASOS-0.2
[**2119-11-24**] 05:45AM   PLT COUNT-353
[**2119-11-24**] 05:45AM   PT-11.8 PTT-19.3* INR(PT)-1.0
[**2119-11-24**] 05:45AM   GLUCOSE-272* UREA N-16 CREAT-0.8 SODIUM-137
POTASSIUM-4.0 CHLORIDE-100 TOTAL CO2-23 ANION GAP-18
[**2119-11-24**] 05:45AM   C4-31
TSH:0.57 Free-T4:1.1

CHEST, AP UPRIGHT: No prior studies are available. The heart has
a left
ventricular configuration. There is a moderate left pleural
effusion. The
aortic arch is calcified. There is a minimal atelectasis at the
right base or effusion at the right base.
  IMPRESSION: Moderate left pleural effusion.

CT Chest, wet read: centrilobar emphysema and small pulmonary
nodules, consistent with interstitial lung disease. no pleural
effusion, but there is atelectasis of the base of the left lung.


CT nec, wet read: nonpathologic enlargement of perivascular
lymph nodes, multiple thyroid nodules.

final interpretation of both CT scans is pending.


Brief Hospital Course:
78F with HTN, DM, recent dental work, transferred from OSH with
angioedema, monitored in the ICU but did not require invasive
airway management

# angioedema: progressive throat and tongue swelling with
impending airway compromise has resolved after treatment with
solumedrol, benadryl, famotidine, and albuterol, and
discontinuation of lisinopril, which was the likely culprit. C1
inhibitor level pending to screen for acquired angioedema.

# HTN: continue HCTZ; need to start an additional [**Doctor Last Name 360**] now that
lisinopril has been stopped; titrated up to amlodipine 10mg
daily, and will need BP checked at outpt followup.

# possible L pleural effusion: appeared to be free-flowing based
on lat decubitus films, but CT chest did not show any effusion
of appreciable size. There is some basilar atelectasis of the L
lower lobe.

# lung nodules, incidental on CT scan: outpt followup
recommended.

# thyroid nodules, incidental on neck CT: TSH 0.75, fT4 1.1.
Recommend outpatient thyroid ultrasound.

# hypercholesterolemia: home dose lovastatin 40mg

# DM: increased metformin from 1g to 2g daily for elevated blood
sugars.

# Osteoporosis: continue calcium, vit D

# CV risk reduction: continue ASA 81mg daily

# Zenker's diverticulum: planned for upcoming surgery with Dr
[**First Name (STitle) 2819**]; ICU team emailed him re: admission; she will need to
reschedule surgery after discharge

# Access: PIV

# Code: says she would not want "artificially sustained life,"
but would agree to intubation, etc, for reversible events, so
full code

Medications on Admission:
ASA 81
Lisinopril 40 PO daily
HCTZ 25mg PO daily
Lovastatin 40mg PO daily
Metformin 1000mg PO daily
Calcim + Vitamin D
Percocet PRN for back pain (rare)
Cod Liver Oil

Discharge Medications:
1. Lovastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
2. Metformin 1,000 mg Tab,Sust Rel Osmotic Push 24hr Sig: Two
(2) Tab,Sust Rel Osmotic Push 24hr PO once a day.
Disp:*60 Tab,Sust Rel Osmotic Push 24hr(s)* Refills:*2*
3. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
4. Calcium Carbonate 500 mg (1,250 mg) Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
7. Lidocaine Viscous 2 % Solution Sig: One (1) teaspoonful
Mucous membrane four times a day as needed for pain for 5 days.
Disp:*100 mL* Refills:*0*
8. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
angioedema

Secondary:
hypertension
diabetes
osteoporosis


Discharge Condition:
good


Discharge Instructions:
You were treated for angioedema, most likely a reaction to
lisinopril. You should not take any ACE-inhibitors (lisiopril,
captopril, other drugs of that class) under any circumstances.
Lab tests to evaluate an acquired or hereditary
cause/predisposition are pending and should be discussed with
your doctor at your follow up appointment. You can get a copy of
these labs when the results are back in [**2-8**] weeks by calling
medical records at ([**Telephone/Fax (1) 39110**]

We started amlodipine for your blood pressure since stopping
lisinopril.

A chest CT was performed to evaluate what looked like a pleural
effusion on CXR, but was actually atelectasis (partial collapse)
of the lower left lung. You do have some signs of emphysema and
small nodules scattered throughout your lung, and nodules in the
thyroid that should be evaluated with an ultrasound.

Followup Instructions:
On Monday, call Dr [**Last Name (STitle) **] for a follow-up visit to discuss
your chest CT. The final report of the CT is available by
calling [**Telephone/Fax (1) 63927**].

You should have an ultrasound of your thyroid to evaluate
thyroid nodules seen on chest CT.

Call Dr [**First Name (STitle) 2819**], your surgeon, to reschedule your planned surgery
for Zenker's diverticulum: ([**Telephone/Fax (1) 6347**]
{'Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Benign essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,Other diseases of lung, not elsewhere classified,Other and unspecified hyperlipidemia,Nontoxic multinodular goiter,Diverticulum of esophagus, acquired'}


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: shortness of breath

PRESENT ILLNESS: 78F with DM on oral agents and Hypertension on lisinopril for
~10 years who was admitted via [**Hospital **] Hospital for angioedema.
Relevant history includes upper teeth extraction 2 weeks ago and
placement of partial dental prosthesis. On Thursday [**11-23**] 1d
PTA, she noticed upper lip swelling after her usual breakfast of
oatmeal (no diet changes). She presented to her dentist and OMFS
who recommended benadryl and close follow-up. This morning at
12:30am, she awoke with tongue swelling that "filled my mouth,"
and called her daughter. In ~45-60 [**Name2 (NI) **], she was unable to speak
and taken to [**Hospital **] Hospital. There, she was afebrile and
hypertensive 209/101 satting 94% on room air. She received 125mg
of solumedrol and 25mg of IV benadryl with ranitidine and
albuterol, and transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: Diabetes Type II on metformin
Hypertension on HCTZ and lisinopril
Hyperlipidemia
Osteoporosis

MEDICATION ON ADMISSION: ASA 81
Lisinopril 40 PO daily
HCTZ 25mg PO daily
Lovastatin 40mg PO daily
Metformin 1000mg PO daily
Calcim + Vitamin D
Percocet PRN for back pain (rare)
Cod Liver Oil

ALLERGIES: Lisinopril

PHYSICAL EXAM: 97.8  180/76  77  18  93% RA

FAMILY HISTORY: No h/o DM. No other contrib fam hx

SOCIAL HISTORY: Occupation: retired
Drugs: none
Tobacco: 1ppd for 60 years
Alcohol: 1glass [**Doctor First Name **] or wine/night, no prev withdrawal
Other: Lives in senior community, retired, daughter [**Name (NI) **] [**Telephone/Fax (1) 63926**] next of [**Doctor First Name **] 

### Response:
{'Angioneurotic edema, not elsewhere classified,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Benign essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,Other diseases of lung, not elsewhere classified,Other and unspecified hyperlipidemia,Nontoxic multinodular goiter,Diverticulum of esophagus, acquired'}
