CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 57-year-old
woman with a history of myasthenia [**Last Name (un) 2902**] diagnosed in [**2163**]
who presented to the [**Hospital1 69**]
Emergency Department on [**2168-5-21**] with the complaint of four
days of cough, increasing shortness of breath, and low-grade
fever.  On initial examination, she had a temperature of
99.4, oxygen saturation of 93% and appeared mildly dyspneic.
Lung examination revealed basilar rales.  Chest x-ray showed
atelectasis of the lower lobes and could not rule out
infiltrates.  She was initially admitted to the medicine
service for pneumonia versus bronchitis.  On arrival to the
floor, on the night of admission, she was found to be in
respiratory arrest with an ABG showing a pH of 7.11, pCO2 of
102 and pO2 of 147.  She was intubated in rapid sequence and
transferred to the Medical Intensive Care Unit.  She was on
antibiotics at that time for possible pneumonia.

MEDICAL HISTORY: 1.  Myasthenia [**Last Name (un) 2902**] diagnosed in [**2163**].
2.  Hypertension.
3.  Migraines.
4.  Gastroesophageal reflux disease.
5.  Pneumonia in [**2163**] and [**2167**].
6.  Vertebral compression fractures with chronic back pain.
7.  Hyperlipidemia.

MEDICATION ON ADMISSION: 1.  Mestinon.
2.  Lipitor.
3.  OxyContin.
4.  Hydrochlorothiazide.
5.  Propanolol.

ALLERGIES: The patient has no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone.  She formerly
worked as a histotech at [**Hospital1 188**].  She has no history of tobacco or alcohol.
Pneumonia, organism unspecified,Acute respiratory failure,Urinary tract infection, site not specified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux
Pneumonia, organism NOS,Acute respiratry failure,Urin tract infection NOS,Hyperlipidemia NEC/NOS,Hypertension NOS,Esophageal reflux
Admission Date:  [**2168-5-21**]       Discharge Date:  [**2168-6-2**]

Date of Birth:   [**2110-10-7**]       Sex:  F

Service:

ADDENDUM:

Urine culture from [**5-31**] shows Enterococcus growth.  The
patient will be started on Levaquin 500 mg intravenous q day
for a course of 7 days to treat the urinary tract infection.




                          DR.[**Last Name (STitle) **],ALVARODIS 13-250

Dictated By:[**Last Name (NamePattern4) 40280**]
MEDQUIST36

D:  [**2168-6-2**]  14:19
T:  [**2168-6-2**]  14:37
JOB#:  [**Job Number 95368**]


Admission Date:  [**2168-5-21**]       Discharge Date:  [**2168-6-2**]

Date of Birth:   [**2110-10-7**]       Sex:  F

Service:  MICU-NEURO

MEDICATIONS ON DISCHARGE:
1.  Colace 100 mg p.o.b.i.d.
2.  Prednisone 50 mg p.o.q.d.
3.  Oxycodone 10 mg p.o.q.4h. to 6h.p.r.n.
4.  Albuterol two puffs q.6h.p.r.n.
5.  Morphine sulfate 2 mg IV q.6h.p.r.n.
6.  Oxycodone sustained release 20 mg p.o.q.12h.
7.  Heparin 5000 units subcutaneously b.i.d.
8.  Lipitor 10 mg p.o.q.d.
9.  CellCept 1 gram p.o.b.i.d.
10. Calcium carbonate 500 mg p.o.b.i.d.
11. Mestinon 30 mg p.o.t.i.d.
12. Evista 60 mg p.o.q.d.
13. Protonix 40 mg p.o.q.d.

The patient has no known drug allergies.

PLAN:  (by issue).

1.  NEUROLOGICAL:  Status post myasthenia crisis in the
setting of pneumonia.  The patient will continue on CellCept,
Prednisone, and Mestinon.  She will followup with her
outpatient neurologist, Dr. [**Last Name (STitle) **].  She should continue to
have respiratory function monitoring with monitoring of NIS
and SVCs b.i.d. to assure that her respiratory function
continues to improve.

2.  INFECTIOUS DISEASE:  The patient is status post a
seven-day course of antibiotics for pneumonia.  She did have
an increased white count three days prior to discharge with a
low-grade temperature at that time. Cultures, thus far,
including blood, sputum, and catheter tip have been negative.
Urine culture is positive for Enterococcus.  She will be
treated with seven days of antibiotics.  White blood cell
count is coming down and she has been afebrile since that
time.

3.  FLUIDS, ELECTROLYTES, AND NUTRITION:  She is tolerating
p.o. diet without difficulties.

4.  She remains on subcutaneous heparin for DVT prophylaxis.
She also remains on OxyContin with Oxycodone and morphine
p.r.n. for control of her chronic back pain.

DISCHARGE DIAGNOSES:   Myasthenia crisis requiring intubation
in the setting of a pneumonia.

FOLLOW-UP CARE:  The patient will followup with
Dr.  [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in the Department of Neurology.  She is
stable for discharge to rehabilitation




                          DR.[**Last Name (STitle) **],ALVARODIS 13-250

Dictated By:[**First Name3 (LF) 25362**]
MEDQUIST36

D:  [**2168-6-2**]  14:05
T:  [**2168-6-2**]  14:12
JOB#:  [**Job Number 23416**]


Admission Date:  [**2168-5-21**]       Discharge Date:  [**2168-6-2**]

Date of Birth:   [**2110-10-7**]       Sex:  F

Service:  MICU-NEURO

ON THE NEUROLOGY SERVICE THE DISCHARING ATTENDING IS
DR.  [**Last Name (STitle) **].

HISTORY OF THE PRESENT ILLNESS:  The patient is a 57-year-old
woman with a history of myasthenia [**Last Name (un) 2902**] diagnosed in [**2163**]
who presented to the [**Hospital1 69**]
Emergency Department on [**2168-5-21**] with the complaint of four
days of cough, increasing shortness of breath, and low-grade
fever.  On initial examination, she had a temperature of
99.4, oxygen saturation of 93% and appeared mildly dyspneic.
Lung examination revealed basilar rales.  Chest x-ray showed
atelectasis of the lower lobes and could not rule out
infiltrates.  She was initially admitted to the medicine
service for pneumonia versus bronchitis.  On arrival to the
floor, on the night of admission, she was found to be in
respiratory arrest with an ABG showing a pH of 7.11, pCO2 of
102 and pO2 of 147.  She was intubated in rapid sequence and
transferred to the Medical Intensive Care Unit.  She was on
antibiotics at that time for possible pneumonia.

NEUROLOGIC:  Neurology consultation was obtained for
management of her myasthenia [**Last Name (un) 2902**].  She was felt to be in
myasthenic crisis in the setting of pneumonia.  While she was
intubated, she received five plasmapheresis treatments.  She
was also started on steroids.  She began the plasmapheresis
treatments on [**5-22**] and completed the fifth treatment on [**5-30**].
She was also started on CellCept for the myasthenia [**Last Name (un) 2902**].
The Mestinon was held while she was on the ventilator.
Respiratory function improved with the plasmapheresis as did
her strength in the extremities.  She was extubated on [**5-30**]
after she completed her fifth plasmapheresis treatment and
did well and the respiratory status has remained stable since
extubation.  She also completed a seven-day course of
Ceftriaxone and Azithromycin for pneumonia.

On [**2168-6-1**] the patient was transferred from the ICU to the
neurology floor.  At the time of transfer she was feeling
much improved.  She had no shortness of breath, no dysphagia,
and she was tolerating a p.o. diet well.  She also stated
that she felt her strength was significantly improved in her
arms, legs, and neck.

PAST MEDICAL HISTORY:
1.  Myasthenia [**Last Name (un) 2902**] diagnosed in [**2163**].
2.  Hypertension.
3.  Migraines.
4.  Gastroesophageal reflux disease.
5.  Pneumonia in [**2163**] and [**2167**].
6.  Vertebral compression fractures with chronic back pain.
7.  Hyperlipidemia.

MEDICATIONS ON ADMISSION:
1.  Mestinon.
2.  Lipitor.
3.  OxyContin.
4.  Hydrochlorothiazide.
5.  Propanolol.

ALLERGIES:  The patient has no known allergies.

SOCIAL HISTORY:  The patient lives alone.  She formerly
worked as a histotech at [**Hospital1 188**].  She has no history of tobacco or alcohol.

PHYSICAL EXAMINATION:  Examination revealed the following:
On transfer to the Neurology floor on [**6-1**], blood pressure
was 117/52, pulse 95, respiratory rate 13, oxygen saturation
92% to 95% on 40% face mask.  GENERAL:  The patient is in no
acute distress.  HEART:  Regular rate and rhythm.  LUNGS:
Clear to auscultation bilaterally.  ABDOMEN:  Soft,
nontender, nondistended.  EXTREMITIES:  Without edema with
ecchymosis on the right shin.  NEUROLOGICAL:  The patient is
awake, alert, and oriented times three with fluent speech.
On cranial nerves examination she has pupils are equal,
round, and reactive to light, extraocular muscles are intact.
There is binocular diplopia that is longstanding for
approximately ten years per the patient.  Facial movements
are symmetric.  Tongue and palate are midline.  She has a
good cough.  MOTOR:  Examination of the bilateral upper
extremity revealed 4/5 strength of the deltoids and triceps
otherwise, strength is [**6-12**].  On the bilateral lower
extremities strength is [**6-12**] throughout.  Neck flexion
strength is [**5-13**].  Deep tendon reflexes are 3+ at the
bilateral upper extremities, 2+ at the knees, could not be
elicited at the ankles and toes downgoing bilaterally.
Sensation is intact throughout to light touch, temperature,
and vibration.

LABORATORY DATA:  Laboratory values at the time of discharge
are the following:  Slightly elevated white count of 14.8,
which is trending down.  Hematocrit 34.5, which has been
stable over several days.  Coagulations are within normal
limits.  Chem 7 shows a BUN of 27, creatinine 0.6,
electrolytes within normal limits.




MEDICATIONS ON DISCHARGE: ....................




                        DR.[**Last Name (STitle) **],ALVARODIS 13-250

Dictated By:[**First Name3 (LF) 25362**]
MEDQUIST36

D:  [**2168-6-2**]  14:05
T:  [**2168-6-2**]  15:43
JOB#:  [**Job Number 7981**]
{'Pneumonia, organism unspecified,Acute respiratory failure,Urinary tract infection, site not specified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux'}


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: The patient is a 57-year-old
woman with a history of myasthenia [**Last Name (un) 2902**] diagnosed in [**2163**]
who presented to the [**Hospital1 69**]
Emergency Department on [**2168-5-21**] with the complaint of four
days of cough, increasing shortness of breath, and low-grade
fever.  On initial examination, she had a temperature of
99.4, oxygen saturation of 93% and appeared mildly dyspneic.
Lung examination revealed basilar rales.  Chest x-ray showed
atelectasis of the lower lobes and could not rule out
infiltrates.  She was initially admitted to the medicine
service for pneumonia versus bronchitis.  On arrival to the
floor, on the night of admission, she was found to be in
respiratory arrest with an ABG showing a pH of 7.11, pCO2 of
102 and pO2 of 147.  She was intubated in rapid sequence and
transferred to the Medical Intensive Care Unit.  She was on
antibiotics at that time for possible pneumonia.

MEDICAL HISTORY: 1.  Myasthenia [**Last Name (un) 2902**] diagnosed in [**2163**].
2.  Hypertension.
3.  Migraines.
4.  Gastroesophageal reflux disease.
5.  Pneumonia in [**2163**] and [**2167**].
6.  Vertebral compression fractures with chronic back pain.
7.  Hyperlipidemia.

MEDICATION ON ADMISSION: 1.  Mestinon.
2.  Lipitor.
3.  OxyContin.
4.  Hydrochlorothiazide.
5.  Propanolol.

ALLERGIES: The patient has no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives alone.  She formerly
worked as a histotech at [**Hospital1 188**].  She has no history of tobacco or alcohol. 

### Response:
{'Pneumonia, organism unspecified,Acute respiratory failure,Urinary tract infection, site not specified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux'}
