CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname **] is a 47 year-old left-handed woman with PMH
significant for myasthenia [**Last Name (un) 2902**], HTN, and DM who presents for
evaluation of increasing shortness of breath over the past month
and difficulty clearing secretions over the past 1-2 weeks. She
says she has noticed increased difficulty breathing over the
past
month, but this has been noticeably worse over the past week.
This is exacerbated by laying flat. Over the past week, she has
noticed it more difficult to either walk or talk. She says over
this time, she also has a lot of phlegm production and is having
difficulty clearing the mucus from her throat; she says "it
feels
like there is a big glob of mucus in my throat". She notes
difficulty swallowing because of the mucus that she feels liks
is
stuck in her throat. She does not think she would have
difficulty
swallowing if there was no mucus there. She was able to eat
breakfast and drink liquid today without choking.
  With regards to her myasthenia, she was diagnosed in [**2161**]
after
presenting with diplopia and is s/p thymectomy. She has been
treated with Cytoxan, Prednisone and Azathioprine in the past.
Her Neurologist is Dr. [**Last Name (STitle) **] at [**Hospital1 47763**]. She is
currently taking Cellcept [**Pager number **] mg daily and Prednisone 15 mg
daily. The Cellcept was started in [**2178**] for erythema nodosum.
There have been no recent changes to her medications. In the
past, her myasthenic exacerbations have usually been
characterized by either diplopia or severe weakness, but has had
respirartory exacerbations many years ago. Of note, last year,
she was admitted with dyspnea and was diagnosed with
bronchospasm
that was relieved with Albuterol. At that time, difficulty with
clearing secretions was not an issue as it is now. She did try
an
Albuterol inhaler earlier this week with little relief, but did
note some improvement with Albuterol nebs at her PCP office
earlier in the week. She tried an Albuterol inhaler today at
home, which did not provide any relief. For her exacerbations,
she takes Mestinon prn along with Atropine. She tried taking 30
mg Mestinon this past weekend, with little effect. She has never
been treated with IVIG or Plasmapheresis in the past.

MEDICAL HISTORY: Myasthenia [**Last Name (un) 2902**] (diagnosed [**2161**])
 - s/p thymectomy
 - associated erythema nodosum
Hypertension
History of migraines
Obstructive sleep apnea not on therapy as cannot tolerate mask
GERD
Allergic rhinitis
Evaluated in [**Hospital1 18**] ED with an exercise stress test [**2186-7-7**]; she
achieved [**4-26**] mets and had atypical chest pain with no ECG
changes

MEDICATION ON ADMISSION: -Glipizide XL 5 mg daily
-Fiorocet prn headache
-Albuterol prn shortness of breath
-Depo-Provera 150 mg IM q12 wk x 4 doses
-Trazodone 50 mg qhs prn insomnia
-Losartan 25 mg daily
-Miralax 17 gm [**Hospital1 **]
-Cellcept [**Pager number **] mg daily
-Prednisone 15 mg daily
-Sucralafate 1 gram 4 times daily
-Ranitidine 150 mg daily
-Fluticasone 110 mcg 2 inh [**Hospital1 **]
-Pyridostigmine 30 mg [**Hospital1 **] (she takes prn for crisis)
-Atropine 0.4 mg with mestinon dose

ALLERGIES: Aspirin / Norvasc

PHYSICAL EXAM: Physical Exam on Admission:

FAMILY HISTORY: Mother with history of diabetes, migraines and brain
aneurysm. Father deceased with lung cancer. No family history of
myasthenia.

SOCIAL HISTORY: She lives with her daughter She does not work. No
smoking, drinking, or illicit drug use.
Myasthenia gravis with (acute) exacerbation,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia
Myasthna gravs w ac exac,Hypertension NOS,Obstructive sleep apnea,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS
Admission Date:  [**2187-12-13**]              Discharge Date:   [**2187-12-16**]

Date of Birth:  [**2140-9-8**]             Sex:   F

Service: NEUROLOGY

Allergies:
Aspirin / Norvasc

Attending:[**First Name3 (LF) 6075**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname **] is a 47 year-old left-handed woman with PMH
significant for myasthenia [**Last Name (un) 2902**], HTN, and DM who presents for
evaluation of increasing shortness of breath over the past month
and difficulty clearing secretions over the past 1-2 weeks. She
says she has noticed increased difficulty breathing over the
past
month, but this has been noticeably worse over the past week.
This is exacerbated by laying flat. Over the past week, she has
noticed it more difficult to either walk or talk. She says over
this time, she also has a lot of phlegm production and is having
difficulty clearing the mucus from her throat; she says "it
feels
like there is a big glob of mucus in my throat". She notes
difficulty swallowing because of the mucus that she feels liks
is
stuck in her throat. She does not think she would have
difficulty
swallowing if there was no mucus there. She was able to eat
breakfast and drink liquid today without choking.
  With regards to her myasthenia, she was diagnosed in [**2161**]
after
presenting with diplopia and is s/p thymectomy. She has been
treated with Cytoxan, Prednisone and Azathioprine in the past.
Her Neurologist is Dr. [**Last Name (STitle) **] at [**Hospital1 47763**]. She is
currently taking Cellcept [**Pager number **] mg daily and Prednisone 15 mg
daily. The Cellcept was started in [**2178**] for erythema nodosum.
There have been no recent changes to her medications. In the
past, her myasthenic exacerbations have usually been
characterized by either diplopia or severe weakness, but has had
respirartory exacerbations many years ago. Of note, last year,
she was admitted with dyspnea and was diagnosed with
bronchospasm
that was relieved with Albuterol. At that time, difficulty with
clearing secretions was not an issue as it is now. She did try
an
Albuterol inhaler earlier this week with little relief, but did
note some improvement with Albuterol nebs at her PCP office
earlier in the week. She tried an Albuterol inhaler today at
home, which did not provide any relief. For her exacerbations,
she takes Mestinon prn along with Atropine. She tried taking 30
mg Mestinon this past weekend, with little effect. She has never
been treated with IVIG or Plasmapheresis in the past.

Neuro ROS: Dysphagia associated with mucus, but cannot rule out
contribution of underlying myasthenia. No headache, loss of
vision, blurred vision, diplopia, dysarthria, lightheadedness,
vertigo, tinnitus or hearing difficulty. No difficulties
producing or comprehending speech. No focal weakness, numbness,
parasthesiae. No bowel or bladder incontinence or retention. No
difficulty with gait.

General ROS: Positive for the dyspnea, mucus production and
difficulty with coughing/clearing secretion. No fever or chills.
No chest pain or tightness, palpitations, nausea, vomiting,
diarrhea, constipation or abdominal pain. No dysuria. No rash.

Past Medical History:
Myasthenia [**Last Name (un) 2902**] (diagnosed [**2161**])
 - s/p thymectomy
 - associated erythema nodosum
Hypertension
History of migraines
Obstructive sleep apnea not on therapy as cannot tolerate mask
GERD
Allergic rhinitis
Evaluated in [**Hospital1 18**] ED with an exercise stress test [**2186-7-7**]; she
achieved [**4-26**] mets and had atypical chest pain with no ECG
changes

Social History:
She lives with her daughter She does not work. No
smoking, drinking, or illicit drug use.

Family History:
Mother with history of diabetes, migraines and brain
aneurysm. Father deceased with lung cancer. No family history of
myasthenia.

Physical Exam:
Physical Exam on Admission:

Vitals: T: 98.2 P: 100 R: 18  BP: 182/108 SaO2: 100% RA

General: Awake, cooperative, continuously trying to clear
secretions
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple
Pulmonary: lcta b/l
Cardiac: RRR, S1S2, no murmurs appreciated
Abdomen: soft, NT/ND, +BS
Extremities: warm, well perfused
Skin: no rashes or lesions noted.

Neurologic:

Mental Status: Awake, alert, oriented to person, place and date.

Able to relate history without difficulty.  Attentive, able to
name [**Doctor Last Name 1841**] backward without difficulty. Able to follow both
midline
and appendicular commands. No right-left confusion. Able to
register 3 objects and recall [**2-22**] at 5 minutes. No evidence of
apraxia or neglect

Language: Voice is hoarse and sounds as if there is a lot of
mucus in throat when she is trying to speak. Otherwise, speech
is
clear, fluent, nondysarthric with intact naming, repetition and
comprehension.

Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  VFF to confrontation. Funduscopic
exam revealed no papilledema, exudates, or hemorrhages.
III, IV, VI: She is not fully able to bury sclera on abduction
of
either eye, but otherwise EOMI without nystagmus. Saccadic
intrusions on tracking. There is mild right ptosis, but it does
not cover the pupil. She is unable to fully close her eyes, with
sclera still present bilaterally.
V: Facial sensation intact to light touch.
VII: No facial droop
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.

Motor: Normal bulk, tone throughout. No pronator drift
bilaterally.
Mild left postural tremor. No asterixis noted. She has mild
weakness of neck flexors greater than neck extensors, though
there seemed to be giveway component to this (with
encouragement,
strength seemed to improve but still mild weakness noted)
  Delt Bic Tri WrE FFl FE IP Quad Ham TA Gastroc
L  5    5   5   5   5  5  5-   5    5  5     5
R  5    5   5   5   5  5  5-   5    5  5     5

Sensory: No deficits to light touch, pinprick, vibratory sense,
proprioception throughout. No extinction to DSS.

DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  0  0    0    0   0
R  0  0    0    0   0
Plantar response was flexor bilaterally.

Coordination: No intention tremor or dysmetria on finger-nose,
FNF or HKS bilaterally.

Gait: deferred given dyspnea

Specialized testing: She was able to count up to 5 without
needing to take breath. She was only able to sustain upgaze for
about 15 seconds before needing to look down; no diplopia in the
15 seconds of upgaze. No fatigueability of deltoid strength
after
arm flapping for 30 seconds.

Physical Exam on Discharge:
Vitals: T 97.6 BP 132/60 HR 74 RR 20 O2 100% RA
NIF -70, VC 1L

General: Awake, cooperative, NAD
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple
Pulmonary: CTAB
Cardiac: RRR, S1S2, no murmurs appreciated
Abdomen: soft, NT/ND, +BS
Extremities: warm, well perfused
Skin: no rashes or lesions noted.

Neurologic:

Mental Status: Awake, alert, oriented to person, place and date.

Able to relate history without difficulty.  Attentive, able to
name [**Doctor Last Name 1841**] backward without difficulty. Able to follow both
midline
and appendicular commands. No right-left confusion. No evidence
of
apraxia or neglect

Language: Voice is somewhat nasal but speech is otherwise speech
is
clear, fluent, nondysarthric with intact naming, repetition and
comprehension.

Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  VFF to confrontation.
III, IV, VI: She is not fully able to bury sclera on abduction
of
either eye, but otherwise EOMI without nystagmus. Saccadic
intrusions on tracking. There is mild right ptosis, but it does
not cover the pupil. She is unable to fully close her eyes, with
sclera still present bilaterally.
V: Facial sensation intact to light touch.
VII: No facial droop
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.

Motor: Normal bulk, tone throughout. No pronator drift
bilaterally. No asterixis noted.
Full strength of neck flexors and extensors.

  Delt Bic Tri WrE FFl FE IP Quad Ham TA Gastroc
L  5    5   5   5   5  5  5   5    5  5     5
R  5    5   5   5   5  5  5   5    5  5     5

Sensory: No deficits to light touch, pinprick, vibratory sense,
proprioception throughout. No extinction to DSS.

DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  0  0    0    0   0
R  0  0    0    0   0
Plantar response was flexor bilaterally.

Coordination: No intention tremor or dysmetria on finger-nose,
FNF or HKS bilaterally.

Pertinent Results:
[**2187-12-13**] 05:30PM   GLUCOSE-165* UREA N-12 CREAT-0.8 SODIUM-145
POTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-31 ANION GAP-14
[**2187-12-13**] 05:30PM   estGFR-Using this
[**2187-12-13**] 05:30PM   IgA-325
[**2187-12-13**] 05:30PM URINE  HOURS-RANDOM
[**2187-12-13**] 05:30PM URINE  UCG-NEGATIVE
[**2187-12-13**] 05:30PM   WBC-12.5* RBC-4.19* HGB-12.9 HCT-40.7 MCV-97
MCH-30.9 MCHC-31.8 RDW-12.7
[**2187-12-13**] 05:30PM   NEUTS-84.9* LYMPHS-11.5* MONOS-2.3 EOS-1.1
BASOS-0.2
[**2187-12-13**] 05:30PM   PLT COUNT-360
[**2187-12-13**] 05:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.023
[**2187-12-13**] 05:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-4* PH-7.0
LEUK-NEG
[**2187-12-13**] 05:30PM URINE  RBC-0 WBC-3 BACTERIA-FEW YEAST-NONE
EPI-3
[**2187-12-13**] 05:30PM URINE  MUCOUS-RARE

EKG: Sinus rhythm. Possible left ventricular hypertrophy.

CXR [**12-13**]:
IMPRESSION: Subsegmental atelectasis in the left lung base.

CXR [**12-16**]:
FINDINGS: As compared to the previous radiograph, there is no
relevant
change. Status post sternotomy. Mediastinal clips. Borderline
size of the
cardiac silhouette without overt pulmonary edema. Mild
atelectasis at the
left lung bases. No pleural effusions. No parenchymal opacity
suggesting
pneumonia.

Brief Hospital Course:
47 year-old left-handed woman with PMH significant for
myasthenia [**Last Name (un) 2902**], HTN, and DM who presents with increasing
shortness of breath over the past month and difficulty clearing
secretions over the past 1-2 weeks. On exam, she appears to be
breathing comfortably, though her voice is somewhat nasal and
seems to be affected by increased mucus and she is notably
having difficulty clearing her secretions. She has mild right
ptosis (though lid not covering pupil) and is unable to close
either eye tightly, which are old findings. There are otherwise
no focal deficits on her exam. Her dyspnea, worse with lying
down and her difficulty clearing secretions are concerning for a
myasthenic crisis.

Neuro:
Her NIF and VC were low on admission (-22 and 850 respectively)
and she was thus admitted to the ICU for close monitoring due to
possible impending respiratory decompensation. Her Mestinon was
increased to 30mg Q8 and her prednisone was increased to 40mg
daily. She was continued on Cellcept 1g daily. She improved on
this regimen and was transferred to the floor on [**12-15**]. Her
neurologic exam remained stable with mild weakness of eye
closing b/l but full neck flexors/extensors and full strength
throughout.

Respiratory:
Her respiratory status was monitored closely with Q4hr NIF and
VC as well as continuous O2 sat monitoring. Her NIF and VC
steadily improved during her admission and she remained stable
on room air. CXR x 2 were negative for pneumonia.
-continuous O2 sat monitoring

CV:
She was maintained on tele monitoring throuhgout her admission.
She was continued on her home Losartan for BP control.

GI
She was cleared by speech/swallow for a regular diet with thin
liquids. She was continued on her home Ranitidine given daily
Prednisone use.

Endo
She was continued on her home Glipizide and maintained on
fingersticks ACHS with SSI.

ID
She remained afebrile with no signs of infection during her
admission. CXR was negative for pneumonia.

DVT proph:
She was maintained on hep SQ for DVT prophylaxis.

By [**2187-12-16**] Ms. [**Known lastname **] had improved symptomatically and her
respiratory status had also improved with NIF -70 and VC 1L. CXR
was again negative for pneumonia. She was discharged home in
good condition on increased doses of Mestinon 30mg TID and
Prednisone 40mg daily, in addition to Cellcept 1g daily. She has
a follow-up appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].

Medications on Admission:
-Glipizide XL 5 mg daily
-Fiorocet prn headache
-Albuterol prn shortness of breath
-Depo-Provera 150 mg IM q12 wk x 4 doses
-Trazodone 50 mg qhs prn insomnia
-Losartan 25 mg daily
-Miralax 17 gm [**Hospital1 **]
-Cellcept [**Pager number **] mg daily
-Prednisone 15 mg daily
-Sucralafate 1 gram 4 times daily
-Ranitidine 150 mg daily
-Fluticasone 110 mcg 2 inh [**Hospital1 **]
-Pyridostigmine 30 mg [**Hospital1 **] (she takes prn for crisis)
-Atropine 0.4 mg with mestinon dose

Discharge Medications:
1. glipizide 5 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet
Extended Rel 24 hr PO DAILY (Daily).
2. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
3. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q4H (every 4 hours) as
needed for shortness of breath.
4. losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
6. pyridostigmine bromide 60 mg Tablet Sig: 0.5 Tablet PO Q8H
(every 8 hours): can decrease frquency of dose if no symptoms
noted.
Disp:*45 Tablet(s)* Refills:*2*
7. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
9. atropine 0.4 mg Tablet Sig: One (1) Tablet PO as directed:
can take with mestinon dose.
10. sucralfate 1 gram Tablet Sig: One (1) Tablet PO four times a
day.
11. Miralax 17 gram Powder in Packet Sig: One (1)  PO twice a
day as needed for constipation.
12. trazodone 50 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.


Discharge Disposition:
Home

Discharge Diagnosis:
Myasthenia [**Last Name (un) **] Flare


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
CN, motor, sensory exam intact
last NIF was -70, last VC was 1 liter


Discharge Instructions:
Ms. [**Known lastname **],
You were admitted because of concern of increasing shortness of
breath and inability to clear sputum, which appeared to be
slowly progressing over the last few months, but worsened over
the last few days before you came to [**Hospital3 **] Hospital.  As
you have myasthenia [**Last Name (un) 2902**] we were concerned that this
represented a myasthenic crisis.  You have had flares of your
myasthenia before but this was the first time you had any
respiratory involvement.  Your initial pulmonary funciton tests
were concerning, however after review of you records it seems
that they are not far off your baseline.  You were admitted to
the ICU for close monitoring.  As you had decreased your
prednisone over time, and were on a once a day dosing of
Cell-cept, we increased the dose of prednisone to 40mg daily,
and increased the dosing of cell-cept to 1000mg [**Hospital1 **].  We
discussed these changes with your outpatient neurologsit Dr.
[**Last Name (STitle) **]. Your pulmonary tests improved over the next day and you
were discharged from the intensive care unit.  We had another
chest x-ray done and you were discharged home.

Your medications we changed as follows:
Prednisone increased to 40mg daily
Cell - Cept (mycophenolate mofetil) increased to 1000mg [**Hospital1 **]
Mestinon: can take more frequently as needed

You should take all medications as prescribed.  Please make all
follow up appointments, particularly with Dr. [**Last Name (STitle) **].  If you
have any concerns about problems breathing, problems swallowing,
problems speaking or weakness, you should call your doctor and
return to the nearest emergency room, as this may represent a
flare.

Followup Instructions:
Please follow up with your outpatient neurologist Dr. [**Last Name (STitle) **],
you have an appointment in [**Month (only) **].  As it is the holiday
weekend the office is currently closed and we cannot confirm
this but it is important that you follow up with him

Please also see your PCP:  [**Name10 (NameIs) **],[**Name11 (NameIs) 8031**] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 2261**] after
discharge
{'Myasthenia gravis with (acute) exacerbation,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}


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: Ms. [**Known lastname **] is a 47 year-old left-handed woman with PMH
significant for myasthenia [**Last Name (un) 2902**], HTN, and DM who presents for
evaluation of increasing shortness of breath over the past month
and difficulty clearing secretions over the past 1-2 weeks. She
says she has noticed increased difficulty breathing over the
past
month, but this has been noticeably worse over the past week.
This is exacerbated by laying flat. Over the past week, she has
noticed it more difficult to either walk or talk. She says over
this time, she also has a lot of phlegm production and is having
difficulty clearing the mucus from her throat; she says "it
feels
like there is a big glob of mucus in my throat". She notes
difficulty swallowing because of the mucus that she feels liks
is
stuck in her throat. She does not think she would have
difficulty
swallowing if there was no mucus there. She was able to eat
breakfast and drink liquid today without choking.
  With regards to her myasthenia, she was diagnosed in [**2161**]
after
presenting with diplopia and is s/p thymectomy. She has been
treated with Cytoxan, Prednisone and Azathioprine in the past.
Her Neurologist is Dr. [**Last Name (STitle) **] at [**Hospital1 47763**]. She is
currently taking Cellcept [**Pager number **] mg daily and Prednisone 15 mg
daily. The Cellcept was started in [**2178**] for erythema nodosum.
There have been no recent changes to her medications. In the
past, her myasthenic exacerbations have usually been
characterized by either diplopia or severe weakness, but has had
respirartory exacerbations many years ago. Of note, last year,
she was admitted with dyspnea and was diagnosed with
bronchospasm
that was relieved with Albuterol. At that time, difficulty with
clearing secretions was not an issue as it is now. She did try
an
Albuterol inhaler earlier this week with little relief, but did
note some improvement with Albuterol nebs at her PCP office
earlier in the week. She tried an Albuterol inhaler today at
home, which did not provide any relief. For her exacerbations,
she takes Mestinon prn along with Atropine. She tried taking 30
mg Mestinon this past weekend, with little effect. She has never
been treated with IVIG or Plasmapheresis in the past.

MEDICAL HISTORY: Myasthenia [**Last Name (un) 2902**] (diagnosed [**2161**])
 - s/p thymectomy
 - associated erythema nodosum
Hypertension
History of migraines
Obstructive sleep apnea not on therapy as cannot tolerate mask
GERD
Allergic rhinitis
Evaluated in [**Hospital1 18**] ED with an exercise stress test [**2186-7-7**]; she
achieved [**4-26**] mets and had atypical chest pain with no ECG
changes

MEDICATION ON ADMISSION: -Glipizide XL 5 mg daily
-Fiorocet prn headache
-Albuterol prn shortness of breath
-Depo-Provera 150 mg IM q12 wk x 4 doses
-Trazodone 50 mg qhs prn insomnia
-Losartan 25 mg daily
-Miralax 17 gm [**Hospital1 **]
-Cellcept [**Pager number **] mg daily
-Prednisone 15 mg daily
-Sucralafate 1 gram 4 times daily
-Ranitidine 150 mg daily
-Fluticasone 110 mcg 2 inh [**Hospital1 **]
-Pyridostigmine 30 mg [**Hospital1 **] (she takes prn for crisis)
-Atropine 0.4 mg with mestinon dose

ALLERGIES: Aspirin / Norvasc

PHYSICAL EXAM: Physical Exam on Admission:

FAMILY HISTORY: Mother with history of diabetes, migraines and brain
aneurysm. Father deceased with lung cancer. No family history of
myasthenia.

SOCIAL HISTORY: She lives with her daughter She does not work. No
smoking, drinking, or illicit drug use. 

### Response:
{'Myasthenia gravis with (acute) exacerbation,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}
