CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 88-year-old man with
a history of metastatic prostate carcinoma and diastolic
dysfunction, who was recently discharged from [**Hospital6 1760**] on [**2138-3-31**], where
he was admitted for progressive dyspnea.

MEDICAL HISTORY: 1.  Prostate cancer in [**2131**] with
metastases to the ribs, high PSA value, treated with hormone
therapy.  2.  Congestive heart failure with diastolic
dysfunction, ejection fraction of 55% and symmetric left
ventricular hypertrophy.  3.  Ostomy status post ileal loop
diversion in [**2132**].  4.  Status post median nerve
decompression.  5.  Exertional dyspnea evaluated by Pulmonary
in [**2137-2-13**], who thought this was secondary to congestive
heart failure.  6.  Obstructive sleep apnea.  7.  Bone marrow
dysfunction.  8.  Anemia.

MEDICATION ON ADMISSION: Prochlorperazine 10 mg q.6 hours
p.r.n. nausea, Naproxen 250-500 mg q.8 hours as needed, Lasix
20 mg p.o. q.d., Colace 100 mg b.i.d., Senna 1 tab b.i.d.,
Dronabinol 2.5 b.i.d. for nausea, Tizanidine 2 mg h.s. for
muscle relaxation, Tramadol 150 mg q.6 hours, Levofloxacin
250 mg q.d., Flagyl 500 mg t.i.d. from previous
hospitalization.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Pneumonitis due to inhalation of food or vomitus,Diastolic heart failure, unspecified,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Acute kidney failure, unspecified,Other closed fracture of lower end of humerus,Secondary malignant neoplasm of bone and bone marrow
Food/vomit pneumonitis,Diastolc hrt failure NOS,Ac posthemorrhag anemia,Thrombocytopenia NOS,Acute kidney failure NOS,Fx lower humerus NEC-cl,Secondary malig neo bone
Admission Date:  [**2138-4-2**]       Discharge Date: [**2138-4-15**]


Service:  ACOVE

HISTORY OF PRESENT ILLNESS:  This is an 88-year-old man with
a history of metastatic prostate carcinoma and diastolic
dysfunction, who was recently discharged from [**Hospital6 1760**] on [**2138-3-31**], where
he was admitted for progressive dyspnea.

He presented with right arm pain.  The patient reported that
he had been leaning on the door frame, and slipped and fell
onto his right arm.  The patient was unable to move his arm
and had severe pain, 10 out of 10.

He went to the Emergency Department.  He denied chest pain,
shortness of breath, palpitations, or increasing edema.

He was seen by the Orthopedic Service and was found to have
displaced distal third of the right humerus.  The patient's
arm was placed in a sling, and pain was controlled.

The patient denied any numbness or tingling or loss of
sensation.

PAST MEDICAL HISTORY:  1.  Prostate cancer in [**2131**] with
metastases to the ribs, high PSA value, treated with hormone
therapy.  2.  Congestive heart failure with diastolic
dysfunction, ejection fraction of 55% and symmetric left
ventricular hypertrophy.  3.  Ostomy status post ileal loop
diversion in [**2132**].  4.  Status post median nerve
decompression.  5.  Exertional dyspnea evaluated by Pulmonary
in [**2137-2-13**], who thought this was secondary to congestive
heart failure.  6.  Obstructive sleep apnea.  7.  Bone marrow
dysfunction.  8.  Anemia.

MEDICATIONS ON ADMISSION:  Prochlorperazine 10 mg q.6 hours
p.r.n. nausea, Naproxen 250-500 mg q.8 hours as needed, Lasix
20 mg p.o. q.d., Colace 100 mg b.i.d., Senna 1 tab b.i.d.,
Dronabinol 2.5 b.i.d. for nausea, Tizanidine 2 mg h.s. for
muscle relaxation, Tramadol 150 mg q.6 hours, Levofloxacin
250 mg q.d., Flagyl 500 mg t.i.d. from previous
hospitalization.

IMAGES:  X-ray revealed acute fracture in the midshaft of the
right humerus with distal segment angulation medially.

IMPRESSION:  This was a man with metastatic prostate and
diastolic dysfunction who has had a traumatic humeral
fracture.

There was concern that the fracture was due to pathologic
fracture given the presence of bone lesions seen on a bone
scan; however, the lesions were not in the exact region of
the fracture.

The patient was sent to the Operating Room and had a right
humeral open reduction and internal fixation on [**4-7**].

After the procedure, peripheral pulses were intact.  There
was some sensory dysfunction in the ulnar distribution.  This
was monitored postoperatively.

After the operation, the patient had respiratory distress and
hypovolemia and was transferred to the SICU.  This was due to
worsening congestive heart failure.  He was monitored
carefully.  He was ruled out for myocardial infarction, and
he was given careful diuresis.  Hypoxia was worsened by his
history of restrictive lung disease according to past
pulmonary function tests.

The patient required pressor support on Neo-Synephrine.  He
was given frequent intravenous fluid boluses.  He was very
tachycardiac.  This was treated with increasing beta-blockers
to maximize his diastolic filling and optimize cardiac
output.

CVP was found to be low.  The patient was given 1 U packed
red blood cells.  He received BIPAP at night for his
obstructive sleep apnea.

The patient had persistent anemia due to blood loss
postoperatively during his SICU course.  He received a total
of 4 U packed red blood cells.

The patient was ruled out for adrenal insufficiency.  There
was no evidence for sepsis.

Throughout the SICU course, the patient received a large
amount of intravenous fluids and had increasing edema
throughout his body.  The patient was weaned off
Neo-Synephrine and transferred out of the SICU where he was
stable but with low blood pressure, off blood pressure
medications, requiring 2 L nasal cannula.

On the floor, diuresis was continued gently to prevent
hypovolemia.  The patient was slowly started on ACE inhibitor
to maximize cardiac output in the setting of congestive heart
failure.  The patient was then restarted on Metoprolol to
maximize his diastolic filling and lower his heart rate if
possible.

He was seen by Physical Therapy, as well as Occupational
Therapy who recommended rehabilitation.

Across this time, the patient was noted to be
thrombocytopenic, and platelets were stable in the low 60s to
high 50s.  This was discussed with the patient's oncologist
who reported that the patient had been taking a medication
called Samarian.  .................. causes for platelets to
be low, but there was no cause being Lovenox.

On the day of discharge the patient was ambulating well,
breathing 96% on room air, voiding via Foley, and pain was
fully controlled, even during Physical Therapy.

The patient was discharged to [**Hospital **] Rehabilitation for
continued management.

The patient was instructed to continue all of his medications
as prescribed and to the Emergency Room if he has increasing
pain, shortness of breath, or hypotension.

DISCHARGE DIAGNOSIS:
1.  Fractured right humerus.
2.  Diastolic dysfunction.
3.  Metastatic prostate cancer.
4.  Aspiration pneumonia.
5.  Status post right open reduction and internal fixation.
6.  Congestive heart failure.
7.  Pulmonary edema.
8.  Hypoxia.
9.  Thrombocytopenia.
10. Anemia due to blood loss.
11. Obstructive sleep apnea.

FOLLOW-UP:  The patient was instructed to follow-up with Dr.
[**Last Name (STitle) **] in Oncology on [**4-8**] and to reschedule this.
The patient was instructed to see the ostomy nurse in the
clinic on [**2138-5-15**], and with the podiatrist on [**2138-5-16**].  He was also instructed to see Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 216**] once he
is discharged from [**Hospital1 **].

DISCHARGE MEDICATIONS:  Compazine 10 mg q.6 hours as needed
for nausea, Colace 100 mg b.i.d. for constipation, Dronabinol
2.5 mg b.i.d. for nausea, Tizanidine 2 mg h.s. for muscle
relaxation, Ambien 5 mg h.s. p.r.n. insomnia, Tylenol 500 mg
[**2-14**] tab p.o. q.6 hours for pain, Lovenox 40 mg subcutaneously
q.d. until [**2138-5-15**], Atrovent 2 puffs 4 times a day as
needed for wheezing, Ultram 50 mg p.o. q.i.d., Lasix 40 mg
p.o. q.d., Lisinopril 2.5 mg p.o. q.d.




                            [**Name6 (MD) 251**] [**Name8 (MD) **], M.D.  [**MD Number(1) 1197**]

Dictated By:[**Last Name (NamePattern1) 6374**]
MEDQUIST36

D:  [**2138-4-15**]  10:55
T:  [**2138-4-15**]  11:10
JOB#:  [**Job Number 99449**]
{'Pneumonitis due to inhalation of food or vomitus,Diastolic heart failure, unspecified,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Acute kidney failure, unspecified,Other closed fracture of lower end of humerus,Secondary malignant neoplasm of bone and bone marrow'}


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 an 88-year-old man with
a history of metastatic prostate carcinoma and diastolic
dysfunction, who was recently discharged from [**Hospital6 1760**] on [**2138-3-31**], where
he was admitted for progressive dyspnea.

MEDICAL HISTORY: 1.  Prostate cancer in [**2131**] with
metastases to the ribs, high PSA value, treated with hormone
therapy.  2.  Congestive heart failure with diastolic
dysfunction, ejection fraction of 55% and symmetric left
ventricular hypertrophy.  3.  Ostomy status post ileal loop
diversion in [**2132**].  4.  Status post median nerve
decompression.  5.  Exertional dyspnea evaluated by Pulmonary
in [**2137-2-13**], who thought this was secondary to congestive
heart failure.  6.  Obstructive sleep apnea.  7.  Bone marrow
dysfunction.  8.  Anemia.

MEDICATION ON ADMISSION: Prochlorperazine 10 mg q.6 hours
p.r.n. nausea, Naproxen 250-500 mg q.8 hours as needed, Lasix
20 mg p.o. q.d., Colace 100 mg b.i.d., Senna 1 tab b.i.d.,
Dronabinol 2.5 b.i.d. for nausea, Tizanidine 2 mg h.s. for
muscle relaxation, Tramadol 150 mg q.6 hours, Levofloxacin
250 mg q.d., Flagyl 500 mg t.i.d. from previous
hospitalization.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Diastolic heart failure, unspecified,Acute posthemorrhagic anemia,Thrombocytopenia, unspecified,Acute kidney failure, unspecified,Other closed fracture of lower end of humerus,Secondary malignant neoplasm of bone and bone marrow'}
