CHIEF COMPLAINT: difficulty breathing

PRESENT ILLNESS: Pt is a 27 yo female with MMP incl asthma, fibromyalgia and
tobacco abuse here with complaint of difficulty breathing and
wheezing for last 3 days.  Has been having similar problems for
the last few months, but more acute now. Pt states that she had
fevers upto 101.4 and chills at home.  Generalized weakness, and
myalgias as well.  Pt admits to a cough, but hasn't been able to
cough up anything.  Denies any sick contacts.  Denies nasal
congestion or sore throat. Was recently treated for a UTI with
7d course of Cipro. Pt also complains of chest pain in the
epigarstic area, no radiation, worse with deep inspiration and
certain movements. Took her inhalers/nebs and 40 mg of
Prednisone yesterday, with no improvement of symptoms.
.
Of note, pt went to see her PCP yesterday, and had a CT chest
that showed bilateral opacities.  She was told to come to the ED
in the setting of increased SOB. Pt was noted to have
lymphadenopathy in the past, and is being worked up for
sarcoidosis.
.
In the ED, initial vs were: T 98.8 P 111 BP 146/88 R 20 O2 sat
95% on RA. Patient's O2 sats went down to 88% on RA.  She
received nebs, but was still hypoxic, eventually requiring NRB.
Pt also received 2L NS for IVF and Solumedrol 125mg IV,
Levofloxacin and Ceftriaxone.
.
She was then transferred to the ICU.
.
Review of sytems:
(+) Per HPI
(-) Admits to fever, chills, 20 lb recent weight loss in the
last 2-3wks. Admits to migraine headaches, denies rhinorrhea or
congestion. Admits to cough, shortness of breath, chest pain.
Admits to some nausea and low PO intake, but denies vomiting,
diarrhea, constipation or abdominal pain. No recent change in
bowel or bladder habits. No dysuria. Admits to chronic arthritis
and myalgias.

MEDICAL HISTORY: - Depression
- Fibromyalgia
- Asthma
- Tobacco abuse
- Obesity
- Anemia
- Internal hemorrhoids
- Gasteoperesis/GERD/hiatal hernia
- Vid D deficiency

MEDICATION ON ADMISSION: Albuterol Sulfate 90 mcg 2 puffs q4-6h as needed
Butalbital-Acetaminophen-Caff 50 mg-325 mg-40 mg Tablet QID prn
Ciprofloxacin 500 mg Tablet [**Hospital1 **] [**2196-10-5**]
Diazepam 5 mg q6h
Duloxetine [Cymbalta] 20 mg [**Hospital1 **]
Esomeprazole Magnesium [Nexium] 40 mg [**Hospital1 **]
Fluticasone 50 mcg 2 sprays nasally daily
Advair Diskus 500 mcg-50 mcg/Dose 1 whiff(s) [**Hospital1 **]
Ondansetron 4 mg q6h PRN for nausea
Oxycodone-Acetaminophen 5 mg-325 mg q4-6 hours PRN for pain
Phenazopyridine 100 mg TID PRN [**2196-10-5**]
Pregabalin [Lyrica] 75 mg [**Hospital1 **]
Tretinoin [Retin-A] 0.025 % Cream
wig use as directed daily For alopecia
Vitamin D 1000 units M-F, [**2187**] units SaSun
Ferrous Gluconate 325 mg daily
Loratadine 10 mg Tablet daily PRN for allergies
Multivitamins-Minerals-Lutein daily
Ranitidine 75 mg 1-2 times daily

ALLERGIES: Codeine

PHYSICAL EXAM: Vitals: T: 98 BP: 148/95 P: 101 R: 17  O2: 99% on NRB
General: Alert, oriented, no acute distress
HEENT: MMM, oropharynx clear, dentures in place
Neck: supple, JVP not elevated, no LAD
Lungs: diffuse wheezes, no crackles
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen:  obese, soft, non-distended, TTP in RUQ, bowel sounds
present, no rebound tenderness or guarding
GU: no suprapubic tenderness
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: 4/5 strength in BLE, 5/5 strength in BUE, decr sensation
on R leg up to knee, CNII-XII intact, gait deferred

FAMILY HISTORY: Maternal aunt with breast cancer in her mid 30s,
maternal great aunt with breast cancer and rectal cancer of
unknown age.  Maternal grandfather diagnosed with pancreatic
cancer and died at the age of 70. Mother with sarcoidosis.

SOCIAL HISTORY: She is a CNA worker in surgery here at [**Hospital1 1444**], but currently is on medical
leave due to all of her chronic conditions.  She currently is
smoking five cigarettes per day, started at age of 10, and
smoked
up to two packs per day in the past.  Denies any alcohol use.
Viral pneumonia, unspecified,Chronic respiratory failure,Asthma, unspecified type, with (acute) exacerbation,Myalgia and myositis, unspecified,Tobacco use disorder,Unspecified vitamin D deficiency,Obesity, unspecified,Anemia, unspecified,Gastroparesis,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Depressive disorder, not elsewhere classified,Hypoxemia
Viral pneumonia NOS,Chronic respiratory fail,Asthma NOS w (ac) exac,Myalgia and myositis NOS,Tobacco use disorder,Vitamin D deficiency NOS,Obesity NOS,Anemia NOS,Gastroparesis,Esophageal reflux,Diaphragmatic hernia,Depressive disorder NEC,Hypoxemia
Admission Date:  [**2196-10-7**]              Discharge Date:   [**2196-10-13**]

Date of Birth:  [**2168-11-16**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 2195**]
Chief Complaint:
difficulty breathing

Major Surgical or Invasive Procedure:
Placement of a midline IV


History of Present Illness:
Pt is a 27 yo female with MMP incl asthma, fibromyalgia and
tobacco abuse here with complaint of difficulty breathing and
wheezing for last 3 days.  Has been having similar problems for
the last few months, but more acute now. Pt states that she had
fevers upto 101.4 and chills at home.  Generalized weakness, and
myalgias as well.  Pt admits to a cough, but hasn't been able to
cough up anything.  Denies any sick contacts.  Denies nasal
congestion or sore throat. Was recently treated for a UTI with
7d course of Cipro. Pt also complains of chest pain in the
epigarstic area, no radiation, worse with deep inspiration and
certain movements. Took her inhalers/nebs and 40 mg of
Prednisone yesterday, with no improvement of symptoms.
.
Of note, pt went to see her PCP yesterday, and had a CT chest
that showed bilateral opacities.  She was told to come to the ED
in the setting of increased SOB. Pt was noted to have
lymphadenopathy in the past, and is being worked up for
sarcoidosis.
.
In the ED, initial vs were: T 98.8 P 111 BP 146/88 R 20 O2 sat
95% on RA. Patient's O2 sats went down to 88% on RA.  She
received nebs, but was still hypoxic, eventually requiring NRB.
Pt also received 2L NS for IVF and Solumedrol 125mg IV,
Levofloxacin and Ceftriaxone.
.
She was then transferred to the ICU.
.
Review of sytems:
(+) Per HPI
(-) Admits to fever, chills, 20 lb recent weight loss in the
last 2-3wks. Admits to migraine headaches, denies rhinorrhea or
congestion. Admits to cough, shortness of breath, chest pain.
Admits to some nausea and low PO intake, but denies vomiting,
diarrhea, constipation or abdominal pain. No recent change in
bowel or bladder habits. No dysuria. Admits to chronic arthritis
and myalgias.


Past Medical History:
- Depression
- Fibromyalgia
- Asthma
- Tobacco abuse
- Obesity
- Anemia
- Internal hemorrhoids
- Gasteoperesis/GERD/hiatal hernia
- Vid D deficiency


Social History:
She is a CNA worker in surgery here at [**Hospital1 1444**], but currently is on medical
leave due to all of her chronic conditions.  She currently is
smoking five cigarettes per day, started at age of 10, and
smoked
up to two packs per day in the past.  Denies any alcohol use.


Family History:
Maternal aunt with breast cancer in her mid 30s,
maternal great aunt with breast cancer and rectal cancer of
unknown age.  Maternal grandfather diagnosed with pancreatic
cancer and died at the age of 70. Mother with sarcoidosis.

Physical Exam:
Vitals: T: 98 BP: 148/95 P: 101 R: 17  O2: 99% on NRB
General: Alert, oriented, no acute distress
HEENT: MMM, oropharynx clear, dentures in place
Neck: supple, JVP not elevated, no LAD
Lungs: diffuse wheezes, no crackles
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen:  obese, soft, non-distended, TTP in RUQ, bowel sounds
present, no rebound tenderness or guarding
GU: no suprapubic tenderness
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: 4/5 strength in BLE, 5/5 strength in BUE, decr sensation
on R leg up to knee, CNII-XII intact, gait deferred


Pertinent Results:
[**2196-10-7**] 10:31PM URINE  COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.009
[**2196-10-7**] 10:31PM URINE  BLOOD-SM NITRITE-POS PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-SM UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2196-10-7**] 10:31PM URINE  RBC-[**3-31**]* WBC-0-2 BACTERIA-MOD YEAST-NONE
EPI-[**3-31**]
[**2196-10-7**] 09:09PM URINE  HOURS-RANDOM
[**2196-10-7**] 09:09PM URINE  UCG-NEGATIVE
[**2196-10-7**] 09:09PM URINE  UHOLD-HOLD
[**2196-10-7**] 08:52PM   LACTATE-3.1*
[**2196-10-7**] 08:40PM   GLUCOSE-167* UREA N-5* CREAT-0.7 SODIUM-136
POTASSIUM-3.5 CHLORIDE-97 TOTAL CO2-28 ANION GAP-15
[**2196-10-7**] 08:40PM   estGFR-Using this
[**2196-10-7**] 08:40PM   WBC-17.4*# RBC-4.18* HGB-12.9 HCT-40.9 MCV-98
MCH-30.9 MCHC-31.5 RDW-14.3
[**2196-10-7**] 08:40PM   NEUTS-85.9* LYMPHS-10.5* MONOS-2.0 EOS-0.9
BASOS-0.7
[**2196-10-7**] 08:40PM   PLT COUNT-420

[**2196-10-13**]
WBC-14.8* RBC-4.13* Hgb-12.9 Hct-40.4 MCV-98  Plt Ct-361
Glucose-85 UreaN-7 Creat-1.1 Na-141 K-3.2* Cl-99 HCO3-33*
AnGap-12
Calcium-8.8 Phos-3.6 Mg-2.2

Imaging:
[**2196-10-6**] Chest CT: New widespread areas of ground-glass opacities
in both lungs involving all lobes with no central or peripheral
predisposition as well as with no apical basal gradient with
slightly more of the abnormality seen within the upper lungs.
The differential diagnosis might include infectious process such
as viral pneumonia or mycoplasma. Less likely , hypersensitivity
pneumonitis, eosinophilic pneumonia , vasculitis or COP may be
also suggested. Clinical correlation is recommended.

[**2196-10-7**] CXR: The CT scan of one day prior demonstrates scattered
areas of
ground-glass opacity throughout both lungs, predominantly in the
apices. The current x-ray study, though limited as above,
demonstrates increased density in the left perihilar and lower
lung regions. It is unlikely that the process noted on the CT
has resolved; however, some of the opacity in the left lung that
is now visualized may be due to atelectasis. If clinically
feasible, consider PA and lateral view for more sensitive
evaluation. However, there is likely underlying evolving
infection as detailed in the chest CT report.

[**2196-10-9**] CXR: Cardiomediastinal silhouette remains stable. The
patient is in mild volume overload. There is still no focal
consolidation demonstrated with the focal areas of ground-glass
opacities seen on prior chest CT from [**2197-1-5**] can be
seen in the left upper lung and as previously mentioned might
represent infectious process.


Brief Hospital Course:
27 yo female with MMP incl asthma, fibromyalgia and tobacco
abuse admitted to ICU for hypoxia/respiratory distress.

# Respiratory distress/hypoxia: On admission to the [**Hospital Unit Name 153**],
patient was satting at 97%-100% on NRB.  Patient reports this
episode felt different from her usual asthma exacerbation as she
felt much worse this time. The differential diagnoses included
CAP pneumonia / atypical pneumonia, viral pneumonia, influenza
complicated by asthma exacerbation.  PE, ACS, CHF on
differential but unlikely.  Eosinophilic PNA less likely as no
peripheral eosinophila, no other signs of vasculitis at this
time (ESR and CRP only mildly elevated).  Per patient's PCP
patient has long reported excessive mold in her building which
could be significant given ddx includes hypersensitivity
pneumonitis. Patient was put on Levoquin for possible CAP vs
atypical pna. CXR showed no consolidations or clear infiltrate;
together with her clinical exam of severe wheezing, this was
most consistent with viral pneumonia complicated by asthma
exacerbation despite her negative viral cultures.  Patient was
put on Advair, Flovent, Xopenex. In addition, solumedrol and
singulair were started. Patient was initially put on high flow
aerosol mask, which was slowly weaned to nasal cannula. On the
day of transfer to floor, patient walked 3 laps on ICU floor on
room air with oxygen saturation of around 93%. While on the
floor she remained stable, with improvement in her tachycardia.

# Chest pain: Differential included pneumonia, asthma
exacerbation and chest tightness, PE, GERD, anxiety or ACS.  EKG
showed no acute changes. Patient had very low risk for CAD.
Cardiac enzymes were negative x 2. Outpatient percocet was
continued.

# Fibromyalgia: Patient complained of bilateral leg pain on
admission. Home Percocet q4-6h PRN was continued for pain. Home
dose Lyrica was continued as well.

# Depression: Stable. Home Cymbalta and Valium were continued.

# GERD/gasteoperesis: Home dose pantoprazole and ranitidine were
continued.

# Vit D def: Home dose calcium and vitD supplementation were
continued.

FEN: regular diet
Prophylaxis: SC heparin, bowel regimen
Code:  Full code
Communication: Patient


Medications on Admission:
Albuterol Sulfate 90 mcg 2 puffs q4-6h as needed
Butalbital-Acetaminophen-Caff 50 mg-325 mg-40 mg Tablet QID prn
Ciprofloxacin 500 mg Tablet [**Hospital1 **] [**2196-10-5**]
Diazepam 5 mg q6h
Duloxetine [Cymbalta] 20 mg [**Hospital1 **]
Esomeprazole Magnesium [Nexium] 40 mg [**Hospital1 **]
Fluticasone 50 mcg 2 sprays nasally daily
Advair Diskus 500 mcg-50 mcg/Dose 1 whiff(s) [**Hospital1 **]
Ondansetron 4 mg q6h PRN for nausea
Oxycodone-Acetaminophen 5 mg-325 mg q4-6 hours PRN for pain
Phenazopyridine 100 mg TID PRN [**2196-10-5**]
Pregabalin [Lyrica] 75 mg [**Hospital1 **]
Tretinoin [Retin-A] 0.025 % Cream
wig use as directed daily For alopecia
Vitamin D 1000 units M-F, [**2187**] units SaSun
Ferrous Gluconate 325 mg daily
Loratadine 10 mg Tablet daily PRN for allergies
Multivitamins-Minerals-Lutein daily
Ranitidine 75 mg 1-2 times daily


Discharge Medications:
1. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety.
2. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
3. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
5. Pregabalin 75 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
7. Ferrous Gluconate 325 mg (37.5 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Ranitidine HCl 150 mg Tablet Sig: 0.5 Tablet PO BID (2 times
a day).
10. Ipratropium Bromide 0.02 % Solution Sig: One (1) treatment
Inhalation every six (6) hours as needed for shortness of breath
or wheezing.
11. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
13. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed for thrush.
14. Prednisone 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*10 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Viral Pneumonia
Asthma Exacerbation

Discharge Condition:
Improved

Discharge Instructions:
Please return to the hospital if you develop fevers, chills,
nausea, vomiting, chest pain or shortness of breath. Please
follow-up with Dr.[**Last Name (STitle) 1007**] to have a complete blood count checked
and to plan a steroid taper.

Followup Instructions:
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1007**] [**Last Name (LF) 766**], [**10-17**] at 1:45
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 558**]  [**2196-12-5**] at 11:30
{'Viral pneumonia, unspecified,Chronic respiratory failure,Asthma, unspecified type, with (acute) exacerbation,Myalgia and myositis, unspecified,Tobacco use disorder,Unspecified vitamin D deficiency,Obesity, unspecified,Anemia, unspecified,Gastroparesis,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Depressive disorder, not elsewhere classified,Hypoxemia'}


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: difficulty breathing

PRESENT ILLNESS: Pt is a 27 yo female with MMP incl asthma, fibromyalgia and
tobacco abuse here with complaint of difficulty breathing and
wheezing for last 3 days.  Has been having similar problems for
the last few months, but more acute now. Pt states that she had
fevers upto 101.4 and chills at home.  Generalized weakness, and
myalgias as well.  Pt admits to a cough, but hasn't been able to
cough up anything.  Denies any sick contacts.  Denies nasal
congestion or sore throat. Was recently treated for a UTI with
7d course of Cipro. Pt also complains of chest pain in the
epigarstic area, no radiation, worse with deep inspiration and
certain movements. Took her inhalers/nebs and 40 mg of
Prednisone yesterday, with no improvement of symptoms.
.
Of note, pt went to see her PCP yesterday, and had a CT chest
that showed bilateral opacities.  She was told to come to the ED
in the setting of increased SOB. Pt was noted to have
lymphadenopathy in the past, and is being worked up for
sarcoidosis.
.
In the ED, initial vs were: T 98.8 P 111 BP 146/88 R 20 O2 sat
95% on RA. Patient's O2 sats went down to 88% on RA.  She
received nebs, but was still hypoxic, eventually requiring NRB.
Pt also received 2L NS for IVF and Solumedrol 125mg IV,
Levofloxacin and Ceftriaxone.
.
She was then transferred to the ICU.
.
Review of sytems:
(+) Per HPI
(-) Admits to fever, chills, 20 lb recent weight loss in the
last 2-3wks. Admits to migraine headaches, denies rhinorrhea or
congestion. Admits to cough, shortness of breath, chest pain.
Admits to some nausea and low PO intake, but denies vomiting,
diarrhea, constipation or abdominal pain. No recent change in
bowel or bladder habits. No dysuria. Admits to chronic arthritis
and myalgias.

MEDICAL HISTORY: - Depression
- Fibromyalgia
- Asthma
- Tobacco abuse
- Obesity
- Anemia
- Internal hemorrhoids
- Gasteoperesis/GERD/hiatal hernia
- Vid D deficiency

MEDICATION ON ADMISSION: Albuterol Sulfate 90 mcg 2 puffs q4-6h as needed
Butalbital-Acetaminophen-Caff 50 mg-325 mg-40 mg Tablet QID prn
Ciprofloxacin 500 mg Tablet [**Hospital1 **] [**2196-10-5**]
Diazepam 5 mg q6h
Duloxetine [Cymbalta] 20 mg [**Hospital1 **]
Esomeprazole Magnesium [Nexium] 40 mg [**Hospital1 **]
Fluticasone 50 mcg 2 sprays nasally daily
Advair Diskus 500 mcg-50 mcg/Dose 1 whiff(s) [**Hospital1 **]
Ondansetron 4 mg q6h PRN for nausea
Oxycodone-Acetaminophen 5 mg-325 mg q4-6 hours PRN for pain
Phenazopyridine 100 mg TID PRN [**2196-10-5**]
Pregabalin [Lyrica] 75 mg [**Hospital1 **]
Tretinoin [Retin-A] 0.025 % Cream
wig use as directed daily For alopecia
Vitamin D 1000 units M-F, [**2187**] units SaSun
Ferrous Gluconate 325 mg daily
Loratadine 10 mg Tablet daily PRN for allergies
Multivitamins-Minerals-Lutein daily
Ranitidine 75 mg 1-2 times daily

ALLERGIES: Codeine

PHYSICAL EXAM: Vitals: T: 98 BP: 148/95 P: 101 R: 17  O2: 99% on NRB
General: Alert, oriented, no acute distress
HEENT: MMM, oropharynx clear, dentures in place
Neck: supple, JVP not elevated, no LAD
Lungs: diffuse wheezes, no crackles
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen:  obese, soft, non-distended, TTP in RUQ, bowel sounds
present, no rebound tenderness or guarding
GU: no suprapubic tenderness
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: 4/5 strength in BLE, 5/5 strength in BUE, decr sensation
on R leg up to knee, CNII-XII intact, gait deferred

FAMILY HISTORY: Maternal aunt with breast cancer in her mid 30s,
maternal great aunt with breast cancer and rectal cancer of
unknown age.  Maternal grandfather diagnosed with pancreatic
cancer and died at the age of 70. Mother with sarcoidosis.

SOCIAL HISTORY: She is a CNA worker in surgery here at [**Hospital1 1444**], but currently is on medical
leave due to all of her chronic conditions.  She currently is
smoking five cigarettes per day, started at age of 10, and
smoked
up to two packs per day in the past.  Denies any alcohol use. 

### Response:
{'Viral pneumonia, unspecified,Chronic respiratory failure,Asthma, unspecified type, with (acute) exacerbation,Myalgia and myositis, unspecified,Tobacco use disorder,Unspecified vitamin D deficiency,Obesity, unspecified,Anemia, unspecified,Gastroparesis,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Depressive disorder, not elsewhere classified,Hypoxemia'}
