CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 22 year-old
female that was admitted to the MICU at [**Hospital3 **] on
[**2132-6-22**].  The patient was seen at [**Hospital 487**] Hospital with
reports of "jaw numbness," agitation, headache and
temperature of 103.5.  The patient was given Haldol, Ativan
and later was found to be unresponsive.  LP was done and
notably to have 9 white blood cells with pleomorphic
differentiation.  The patient was started on Vancomycin,
Ceftriaxone, Gentamycin and Acyclovir.  Toxicology screen was
negative.  Urinalysis negative dip stick.  Activated charcoal
was used and ESR was noted to be 46.

MEDICAL HISTORY: Significant for hypothyroidism.  The
patient was status post normal spontaneous vaginal delivery
on [**2132-6-16**] and had a post partum tubal ligation on [**2132-6-18**] with no complications.  The patient is G3 P3.
History of migraine headaches.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: No history of seizure disorders.  No
coronary artery disease.

SOCIAL HISTORY: The patient smokes tobacco half a pack her
day.  No alcohol use.  The patient, mother and sister denied
drug use.  Children have been taken by DSS secondary to
abusive boyfriend.
Unspecified viral meningitis,Unspecified acquired hypothyroidism,Tobacco use disorder
Viral meningitis NOS,Hypothyroidism NOS,Tobacco use disorder
Admission Date:  [**2132-6-22**]     Discharge Date:  [**2132-6-26**]

Date of Birth:   [**2109-10-24**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 22 year-old
female that was admitted to the MICU at [**Hospital3 **] on
[**2132-6-22**].  The patient was seen at [**Hospital 487**] Hospital with
reports of "jaw numbness," agitation, headache and
temperature of 103.5.  The patient was given Haldol, Ativan
and later was found to be unresponsive.  LP was done and
notably to have 9 white blood cells with pleomorphic
differentiation.  The patient was started on Vancomycin,
Ceftriaxone, Gentamycin and Acyclovir.  Toxicology screen was
negative.  Urinalysis negative dip stick.  Activated charcoal
was used and ESR was noted to be 46.

On admission to the MICU the patient had reports of malaise
times one day.  No fevers or chills or night sweats. The
patient did complain of lower abdominal pain and lochia.

PAST MEDICAL HISTORY:  Significant for hypothyroidism.  The
patient was status post normal spontaneous vaginal delivery
on [**2132-6-16**] and had a post partum tubal ligation on [**2132-6-18**] with no complications.  The patient is G3 P3.
History of migraine headaches.

PAST SURGICAL HISTORY:  Question cholecystectomy in [**2128**],
umbilical hernia repair in [**2128**].

MEDICATIONS AT HOME:  Percocet and Synthroid.  On transfer
the patient was on Vancomycin 1 gram, Gentamycin 160 mg q 8,
Pepcid 20 mg b.i.d., Tylenol prn and Ceftriaxone 2 grams
intravenous b.i.d.

SOCIAL HISTORY:  The patient smokes tobacco half a pack her
day.  No alcohol use.  The patient, mother and sister denied
drug use.  Children have been taken by DSS secondary to
abusive boyfriend.

FAMILY HISTORY:  No history of seizure disorders.  No
coronary artery disease.

REVIEW OF SYSTEMS:  Malaise times one day.  No fevers or
chills or night sweats.  Positive for lower abdominal pain.
No hematuria.  No dysuria.  No melena.  No vaginal discharge,
but mild lochia secondary to being status post spontaneous
vaginal delivery.

PHYSICAL EXAMINATION:  Her vital signs, temperature 99.1.
Heart rate 54.  Blood pressure 100/46.  Respiratory rate 19.
O2 sats in room air 97%.  In general, the patient is in no
acute distress, sleeping, but arousable following commands.
HEENT examination, extraocular movements intact.  Anicteric
sclera.  Dry mucous membranes.  Neck supple.  No
lymphadenopathy.  No JVD.  Cardiovascular examination regular
rate and rhythm with a 2 out of 6 systolic MLLSB
holosystolic.  Respiratory examination, clear to auscultation
bilaterally.  Abdomen positive for normal bowel sounds, soft,
tender incision inferior to the umbilicus with mild
ecchymosis status post PPTO.  Extremities no clubbing,
cyanosis or edema.  2+ dorsalis pedis pulse bilaterally.
Skin no rashes except folliculitis in the bilateral median
thigh and stria on abdomen.  Neurological examination alert
and oriented times two and a half ([**2132-5-30**], [**Hospital 86**]
Hospital).  Dulled affect.  Follows commands.  Good recall
attention.  Motor 5 out of 5.  Sensation was grossly intact.
Deep tendon reflexes 2+ throughout symmetric.  Down going
toes.  Genitourinary examination positive for lochia.  No
evidence of labial excisions or cellulitis.  No erythema.  No
discharge.

LABORATORIES ON ADMISSION FROM [**Hospital3 **] HOSPITAL:
Tox screen was negative.  White count is 13.3, hemoglobin
13.4, hematocrit 40.9, platelets 273.  Differential 88
neutrophils.  Chem 7 noted sodium 134, potassium 3.8,
chloride 95, bicarb 31, BUN 10, creatinine .7, glucose 118.
Urine dip stick was negative.  LP was done, tube number four
showed red blood cells [**Pager number **], white blood cells 9, with a
differential of 39 neutrophils, 37 lymphocytes, 20 monocytes
and 4 "odd small lymph cells" with dark cytoplasm, "monocytes
like cells in clusters."  Gram stain showed rare PMNs and no
bacteria.  Glucose was 63 and protein was elevated at 71.
Erythrocyte sedimentation rate was 46.

IMPRESSION:  The patient was admitted with a diagnosis of
mental status changes versus possible domestic violence.

HOSPITAL COURSE:  The patient was seen by obstetrics in the
MICU and was ruled out for endometritis, amniotic fluid
embolism and cerebral vein thrombosis.  Obstetrics did not
seem to think this was related to her recent delivery and her
post partum tubal ligation.  The patient's course of
medications was adjusted in the MICU.  The patient was placed
on Vancomycin 1 gram q 12, Ceftriaxone 2 grams q 12 and
Acyclovir 800 q 8.  During the brief hospital course the
patient was monitored for signs of meningitis and mental
status changes.  During the course of her stay her mental
status did in fact improve and social work was also involved
secondary to the issue of domestic violence.  The patient was
noted to have an elevated TSH of 6.4 for which she was
started on her Synthroid at 50 micrograms q.d.

Laboratory tests as follows:  Chest x-ray was done to confirm
central line placement.  CT of the head without contrast was
normal.  CT of the abdomen was normal.  Electrocardiogram was
done showing sinus arrhythmia.  Normal axis, Q, 2, 3 and F.
LP was also done, no polys, no organisms and no growth, 46
protein, 59 glucose.  Blood cultures times two showed no
growth.  Urine culture showed no growth.

The patient continued to show improvement during the course
of her hospital stay.  HSV PCR from [**Hospital3 **] showed
negative for HSV1 or HSV2.  The patient defervesced and
continued to make improvement and was transferred out of the
MICU on day three and the patient was discharged to home on
[**2132-6-26**].

DISCHARGE DIAGNOSIS:
Probable viral meningitis that was resolving.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3022**], M.D.  [**MD Number(1) 3023**]

Dictated By:[**Last Name (NamePattern4) 8102**]

MEDQUIST36

D:  [**2132-12-5**]  10:17
T:  [**2132-12-10**]  05:57
JOB#:  [**Job Number 35171**]
{'Unspecified viral meningitis,Unspecified acquired hypothyroidism,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: 

PRESENT ILLNESS: The patient is a 22 year-old
female that was admitted to the MICU at [**Hospital3 **] on
[**2132-6-22**].  The patient was seen at [**Hospital 487**] Hospital with
reports of "jaw numbness," agitation, headache and
temperature of 103.5.  The patient was given Haldol, Ativan
and later was found to be unresponsive.  LP was done and
notably to have 9 white blood cells with pleomorphic
differentiation.  The patient was started on Vancomycin,
Ceftriaxone, Gentamycin and Acyclovir.  Toxicology screen was
negative.  Urinalysis negative dip stick.  Activated charcoal
was used and ESR was noted to be 46.

MEDICAL HISTORY: Significant for hypothyroidism.  The
patient was status post normal spontaneous vaginal delivery
on [**2132-6-16**] and had a post partum tubal ligation on [**2132-6-18**] with no complications.  The patient is G3 P3.
History of migraine headaches.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: No history of seizure disorders.  No
coronary artery disease.

SOCIAL HISTORY: The patient smokes tobacco half a pack her
day.  No alcohol use.  The patient, mother and sister denied
drug use.  Children have been taken by DSS secondary to
abusive boyfriend. 

### Response:
{'Unspecified viral meningitis,Unspecified acquired hypothyroidism,Tobacco use disorder'}
