CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 34 yo woman with history of steroid dependent asthma presenting
with chest tightness and wheezing and back pain x2 days. Of
note, she was recently seen at [**Hospital1 18**] for asthma flare [**12-27**] and
went home on steroid taper which she remained on when admitted.
She also recently was started on a zpak by her pcp. [**Name10 (NameIs) **] initial
evaluation, her VSS. She had chest tightness, SOB as well as
urinary frequency and subjective fevers. She recieved nebs,
morphine and oxycodone in the ED and was then notes to have a ?
anaphylaxtic rx with subjective sensation of throat closing, and
was given Epinephrine with improvement. She was given additional
nebs but then transferred to the MICU for closer monitoring
(likely b/c pt has had many admissions for asthma exacerbation
requiring intubation).
In the MICU, pt was continued on nebs and home inhalers with
good improvement in her symptoms. She was noted to be
tachycardic and given her h/o DVT she had a CTA done to rule out
PE. CTA showed no major PE but subsegmental PE could not be
ruled out b/c of body habitus and poor imaging study.
.
Currently pt feels well. She does not occasional chest tightness
but her sx improve with nebulizers. She denies SOB or
palpitations. She does report some + flank pain and dysuria
which she states is ongoing x3 years. Says she doesn't have
pelvic issue but something is wrong with her kidneys that no one
has found. Otherwise pt feels well. No N/V, tolerating PO, no
diarrha/constipation or abdominal pain.
.

MEDICAL HISTORY: 1. Asthma- since age of 13, intubated x 14, followed [**Hospital1 112**]. Nl
peak flow 550.
2. DM 1 - since age 19
3. HTN - since age 16, does not recall a workup for this
4. h/o panic attacks
5. Schizophrenia
6. h/o CVA 6 years ago, unclear circumstance, maybe in the
context of hypoglycemia
7. H/o seizure-grand mal, last 2 weeks ago during
hospitalization at [**Hospital3 **]. Per pt, had multiple szs as child

MEDICATION ON ADMISSION: Advair 500/50 [**Hospital1 **]
abilify 20 mg daily
Calcium 600 + D
Depakote 1000 daily
Colace 100 daily
Duoneb qid
flovent 2 [**Hospital1 **]
fluoxetine 60 mg daily
HCTZ 25 mg daily
NPH 26 u [**Hospital1 **]
lisinopril 30 mg dialy
montelukast 10 mg daily
dilantin 300 mg qam
Prilosec 40 mg daily
senna PRN
Ziprasidone

ALLERGIES: Penicillins / Aspirin / Motrin / Tylenol

PHYSICAL EXAM: Vitals: 99 122/50 61 18 95%RA
Gen:NAD, walking around bed getting dressed
HEENT: NC/AT, EOMI, PERRL, o/P clear, MMM
Neck: no JVD
CV: RRR no murmurs
Resp: End expiratory wheezing b/l
Abd: Obese, soft, NT, ND +BS
Ext: no LE edema

FAMILY HISTORY: multiple family members with CAD, HTN

SOCIAL HISTORY: Not married, lives alone. Has 5 children. No tobacco, occ EtOH,
no illicits, IVDA.
Asthma, unspecified type, with (acute) exacerbation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Generalized convulsive epilepsy, without mention of intractable epilepsy,Pelvic congestion syndrome,Other diseases of vocal cords,Unspecified schizophrenia, unspecified,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other specified cardiac dysrhythmias,Abdominal pain, unspecified site,Long-term (current) use of anticoagulants
Asthma NOS w (ac) exac,DMI wo cmp nt st uncntrl,Gen cnv epil w/o intr ep,Pelvic congestion synd,Vocal cord disease NEC,Schizophrenia NOS-unspec,Hypertension NOS,Obstructive sleep apnea,Cardiac dysrhythmias NEC,Abdmnal pain unspcf site,Long-term use anticoagul
Admission Date:  [**2158-2-16**]              Discharge Date:   [**2158-2-18**]

Date of Birth:  [**2124-1-18**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Aspirin / Motrin / Tylenol

Attending:[**First Name3 (LF) 93742**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
34 yo woman with history of steroid dependent asthma presenting
with chest tightness and wheezing and back pain x2 days. Of
note, she was recently seen at [**Hospital1 18**] for asthma flare [**12-27**] and
went home on steroid taper which she remained on when admitted.
She also recently was started on a zpak by her pcp. [**Name10 (NameIs) **] initial
evaluation, her VSS. She had chest tightness, SOB as well as
urinary frequency and subjective fevers. She recieved nebs,
morphine and oxycodone in the ED and was then notes to have a ?
anaphylaxtic rx with subjective sensation of throat closing, and
was given Epinephrine with improvement. She was given additional
nebs but then transferred to the MICU for closer monitoring
(likely b/c pt has had many admissions for asthma exacerbation
requiring intubation).
In the MICU, pt was continued on nebs and home inhalers with
good improvement in her symptoms. She was noted to be
tachycardic and given her h/o DVT she had a CTA done to rule out
PE. CTA showed no major PE but subsegmental PE could not be
ruled out b/c of body habitus and poor imaging study.
.
Currently pt feels well. She does not occasional chest tightness
but her sx improve with nebulizers. She denies SOB or
palpitations. She does report some + flank pain and dysuria
which she states is ongoing x3 years. Says she doesn't have
pelvic issue but something is wrong with her kidneys that no one
has found. Otherwise pt feels well. No N/V, tolerating PO, no
diarrha/constipation or abdominal pain.
.


Past Medical History:
1. Asthma- since age of 13, intubated x 14, followed [**Hospital1 112**]. Nl
peak flow 550.
2. DM 1 - since age 19
3. HTN - since age 16, does not recall a workup for this
4. h/o panic attacks
5. Schizophrenia
6. h/o CVA 6 years ago, unclear circumstance, maybe in the
context of hypoglycemia
7. H/o seizure-grand mal, last 2 weeks ago during
hospitalization at [**Hospital3 **]. Per pt, had multiple szs as child

and dx'd with possible epilepsy
8. H/o diverticulosis
9. OSA, on CPAP (10cmH20)
10. DVT? - [**2156**] around [**Month (only) 205**]? at [**Hospital1 112**].

Social History:
Not married, lives alone. Has 5 children. No tobacco, occ EtOH,
no illicits, IVDA.


Family History:
multiple family members with CAD, HTN

Physical Exam:
Vitals: 99 122/50 61 18 95%RA
Gen:NAD, walking around bed getting dressed
HEENT: NC/AT, EOMI, PERRL, o/P clear, MMM
Neck: no JVD
CV: RRR no murmurs
Resp: End expiratory wheezing b/l
Abd: Obese, soft, NT, ND +BS
Ext: no LE edema


Pertinent Results:
[**2158-2-16**] 01:05PM   GLUCOSE-91 UREA N-12 CREAT-0.8 SODIUM-138
POTASSIUM-4.2 CHLORIDE-105 TOTAL CO2-24 ANION GAP-13
[**2158-2-16**] 01:05PM   GLUCOSE-91 UREA N-12 CREAT-0.8 SODIUM-138
POTASSIUM-4.2 CHLORIDE-105 TOTAL CO2-24 ANION GAP-13
[**2158-2-16**] 01:05PM   WBC-6.9 RBC-4.36 HGB-12.4 HCT-38.1 MCV-87
MCH-28.5 MCHC-32.7 RDW-14.3
[**2158-2-16**] 01:05PM   NEUTS-47.4* LYMPHS-46.1* MONOS-5.7 EOS-0.6
BASOS-0.2
[**2158-2-16**] 01:05PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.024
[**2158-2-16**] 01:05PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-4* PH-6.5
LEUK-NEG

CTA CHEST W&W/O C&RECONS, NON-CORONARY  [**2158-2-17**] 3:03 PM

CTA CHEST W&W/O C&RECONS, NON-

Reason: Please eval for PE
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
34 year old woman with persistent tachycardia, questionable hx
of DVT
REASON FOR THIS EXAMINATION:
Please eval for PE
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: 34-year-old female with persistent tachycardia and
questionable history of DVT to rule out pulmonary embolism.

TECHNIQUE: CT of the chest was performed post-administration of
intravenous contrast, reconstructions were performed in the
axial, sagittal, and coronal planes.

COMPARISON: With CT of [**2157-12-27**].

FINDINGS:

CT CHEST POST-ADMINISTRATION OF INTRAVENOUS CONTRAST:

The examination is severely limited due to patient's body
habitus as well as artifact from breathing. There is no central
pulmonary embolism, however, segmental and subsegmental
pulmonary emboli cannot be excluded given the poor quality.
There is no aortic dissection. There is atelectasis in the lower
lobes. There is no pericardial or pleural effusion.

The visualized liver and spleen appear unremarkable.

MUSCULOSKELETAL: There are no worrisome bone lesions.

CONCLUSION:

The study is suboptimal due to patient body habitus as well as
artifact due to breathing. There is no central pulmonary
embolism, however, the possibility of subsegmental and
subsegmental pulmonary emboli cannot be excluded and if there is
high clinical suspicion, a CT chest may be repeated.

RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2158-2-16**] 1:09 PM

CHEST (PA & LAT)

Reason: Evaluate for PNA, other intrathoracic process

[**Hospital 93**] MEDICAL CONDITION:
34 year old woman with worsening dyspnea, wheezing and R flank
pain
REASON FOR THIS EXAMINATION:
Evaluate for PNA, other intrathoracic process
INDICATION: Worsening dyspnea, wheezing and right flank pain.

COMPARISONS: [**2158-1-13**].

CHEST, PA AND LATERAL: The cardiac and mediastinal contours are
stable with unfolding of the aorta. The lungs are clear. There
are no pleural effusions. The pulmonary vasculature is within
normal limits.

IMPRESSION: No acute cardiopulmonary disease.

Brief Hospital Course:
#SOB/Wheezing: Upon initial evaluation the patient had chest
tightness, wheezing and shortness of breath. Her vital signs
were stable.  She recieved nebulizer treamtents, morphine and
oxycodone in the ED and was then notes to have a ? anaphylaxtic
reaction with subjective sensation of throat closing, and was
given Epinephrine with improvement. She was given additional
nebs but then transferred to the MICU for closer monitoring
(likely b/c pt has had many admissions for asthma exacerbation
requiring intubation).  In the MICU, pt was continued on nebs
and home inhalers with good improvement in her symptoms. SHe was
also given a dose of Solumedrol and then started on 60mg
Prednisone.  She was noted to be tachycardic and given her h/o
DVT she had a CTA done to rule out PE. CTA showed no evidence of
a pulmonary embolism. Overall it as felt the patient suffered an
asthma exacerbation plus ? component of paradoxical vocal cord
dysfunction. After 16 hours in the MICU she was transferred the
floor.  She was continued on the high dose prednisone, nebs,
home inhalers.  Pts breathing has subsequently improved and she
was satting 99% on RA.   She was discharged on the high dose
Prednisone 60mg with a slow taper to 20mg daily and asked to
follow up with pulmonary.   In addition, given the chronic
prednisone use, she was started on PCP prophylaxis with Bactrim.
 She was continued on her home nebulizers and inhalers on
discharge.
.
2. Right flank pain: Per OMR notes, this has been chronic for
patient for many months. A U/A was negative on admission. On
review of old records, a CT scan in [**12-27**] was suggestive of
pelvic congestion syndrome and she was asked to see gynecology.
Also, a RUQ U/S [**12-27**] showed no evidence of gallstones. On this
admission, the patients pain was improved with a lidocaine patch
and she was mildly symptomatic.  She remained afebrile and had
no other sign of infection.  She was again asked to make a
follow up appointment with gynecology on discharge.  She was
given 7 days of a lidocaine patch to help with the pain but
asked to return if the pain worsens or persists.
.
3. DMI: The patient was continued on her home insulin regimen
during this hospitalization.
.
4. HTN: The patients BP remained well controlled on her home
HCTZ and ACE.
.


Medications on Admission:
Advair 500/50 [**Hospital1 **]
abilify 20 mg daily
Calcium 600 + D
Depakote 1000 daily
Colace 100 daily
Duoneb qid
flovent 2 [**Hospital1 **]
fluoxetine 60 mg daily
HCTZ 25 mg daily
NPH 26 u [**Hospital1 **]
lisinopril 30 mg dialy
montelukast 10 mg daily
dilantin 300 mg qam
Prilosec 40 mg daily
senna PRN
Ziprasidone


Discharge Medications:
1. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] ().
2. Aripiprazole 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO once a
day.
4. Fluoxetine 20 mg Capsule Sig: Three (3) Capsule PO DAILY
(Daily).
5. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
6. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: One (1)
26U QAM and QPM Subcutaneous twice a day: Please return to your
home insulin regimen.
7. Lisinopril 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
8. Prilosec 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
9. Senna  Oral
10. Ziprasidone HCl 80 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
11. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Phenytoin Sodium Extended 100 mg Capsule Sig: Three (3)
Capsule PO QAM (once a day (in the morning)).
13. Phenytoin Sodium Extended 100 mg Capsule Sig: Four (4)
Capsule PO QPM (once a day (in the evening)).
14. DuoNeb 0.5-2.5 mg/3 mL Solution for Nebulization Sig: One
(1)  Inhalation four times a day.
15. Flovent Diskus 50 mcg/Actuation Disk with Device Sig: Two
(2)  Inhalation twice a day.
16. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 5 days: You will do a prednisone taper. You will
take 60mg for 5 days (until [**2-22**]) then you will start 40mg daily
([**Date range (1) 12431**]) and then return to your home dose of prednisone 20mg
daily.
Disp:*10 Tablet(s)* Refills:*0*
17. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO once a day
for 5 days: Please start this on [**2158-2-23**].
Disp:*10 Tablet(s)* Refills:*0*
18. Prednisone 20 mg Tablet Sig: One (1) Tablet PO once a day:
Please start [**2-28**].
Disp:*30 Tablet(s)* Refills:*2*
19. Divalproex 500 mg Tablet Sustained Release 24 hr Sig: Two
(2) Tablet Sustained Release 24 hr PO DAILY (Daily).
20. Bactrim DS 160-800 mg Tablet Sig: One (1) Tablet PO Monday,
Wednesday and Friday: Please take on M,W and Friday. YOu can
stop this medicine if you stop the Prednisone.
Disp:*12 Tablet(s)* Refills:*2*
21. Lidoderm 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1)  Topical once a day for 7 doses: Place on for 12 hours,
and take off for 12 hours.
Disp:*7 patches* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary
Asthma Exacerbation
.
Secondary
DM
Seizure D/O
Schizophrenia
HTN
OSA


Discharge Condition:
Stable


Discharge Instructions:
You were admitted to the hospital with an asthma exacerbation.
You were treated with nebulizer treatments and oxygen.  In
addition, the dose of your prednisone was increased to 60mg
daily.  You will need to continue this higher dose of prednisone
for 5 days at home.  It will then be tapered down slowly to 20mg
which is your usual dose.
.
Since you are on steroids (prednisone) we started you on a
medicine called Bactrim. It is an antibiotic to help prevent
future infections.  You will take one tablet on Mondays, one on
Wednesdays and one on Fridays.  If you stop the Prednisone, you
can stop taking this medicine.
.
You will need to follow up with pulmonary doctors as [**Name5 (PTitle) **]
outpatient. Please call on Monday to make an appointment. ([**Telephone/Fax (1) 514**]
.
In addition, you had some pain in your lower back. It was felt
that this may be related to some pelvic congestion as explained
to you while you were here. It is important that you call and
make an appt with gynecology on Monday to have this followed.
You were given a Lidocaine patch to help with the pain.  If you
have ongoing pain, you will need to see our PCP or come back to
the ER.
.
If you have any more shortness of breath, chest tightness,
wheezing, abdominal or flank pain, fevers, chills or other
concerning symptoms, please call your doctor or return to the
ER.
.

Followup Instructions:
Please call pulmonary clinic an make an appt in the next [**1-22**]
weeks. ([**Telephone/Fax (1) 513**]
.
Please call gynecology to make an appt.([**Telephone/Fax (1) 22754**]
{'Asthma, unspecified type, with (acute) exacerbation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Generalized convulsive epilepsy, without mention of intractable epilepsy,Pelvic congestion syndrome,Other diseases of vocal cords,Unspecified schizophrenia, unspecified,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other specified cardiac dysrhythmias,Abdominal pain, unspecified site,Long-term (current) use of anticoagulants'}


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: 34 yo woman with history of steroid dependent asthma presenting
with chest tightness and wheezing and back pain x2 days. Of
note, she was recently seen at [**Hospital1 18**] for asthma flare [**12-27**] and
went home on steroid taper which she remained on when admitted.
She also recently was started on a zpak by her pcp. [**Name10 (NameIs) **] initial
evaluation, her VSS. She had chest tightness, SOB as well as
urinary frequency and subjective fevers. She recieved nebs,
morphine and oxycodone in the ED and was then notes to have a ?
anaphylaxtic rx with subjective sensation of throat closing, and
was given Epinephrine with improvement. She was given additional
nebs but then transferred to the MICU for closer monitoring
(likely b/c pt has had many admissions for asthma exacerbation
requiring intubation).
In the MICU, pt was continued on nebs and home inhalers with
good improvement in her symptoms. She was noted to be
tachycardic and given her h/o DVT she had a CTA done to rule out
PE. CTA showed no major PE but subsegmental PE could not be
ruled out b/c of body habitus and poor imaging study.
.
Currently pt feels well. She does not occasional chest tightness
but her sx improve with nebulizers. She denies SOB or
palpitations. She does report some + flank pain and dysuria
which she states is ongoing x3 years. Says she doesn't have
pelvic issue but something is wrong with her kidneys that no one
has found. Otherwise pt feels well. No N/V, tolerating PO, no
diarrha/constipation or abdominal pain.
.

MEDICAL HISTORY: 1. Asthma- since age of 13, intubated x 14, followed [**Hospital1 112**]. Nl
peak flow 550.
2. DM 1 - since age 19
3. HTN - since age 16, does not recall a workup for this
4. h/o panic attacks
5. Schizophrenia
6. h/o CVA 6 years ago, unclear circumstance, maybe in the
context of hypoglycemia
7. H/o seizure-grand mal, last 2 weeks ago during
hospitalization at [**Hospital3 **]. Per pt, had multiple szs as child

MEDICATION ON ADMISSION: Advair 500/50 [**Hospital1 **]
abilify 20 mg daily
Calcium 600 + D
Depakote 1000 daily
Colace 100 daily
Duoneb qid
flovent 2 [**Hospital1 **]
fluoxetine 60 mg daily
HCTZ 25 mg daily
NPH 26 u [**Hospital1 **]
lisinopril 30 mg dialy
montelukast 10 mg daily
dilantin 300 mg qam
Prilosec 40 mg daily
senna PRN
Ziprasidone

ALLERGIES: Penicillins / Aspirin / Motrin / Tylenol

PHYSICAL EXAM: Vitals: 99 122/50 61 18 95%RA
Gen:NAD, walking around bed getting dressed
HEENT: NC/AT, EOMI, PERRL, o/P clear, MMM
Neck: no JVD
CV: RRR no murmurs
Resp: End expiratory wheezing b/l
Abd: Obese, soft, NT, ND +BS
Ext: no LE edema

FAMILY HISTORY: multiple family members with CAD, HTN

SOCIAL HISTORY: Not married, lives alone. Has 5 children. No tobacco, occ EtOH,
no illicits, IVDA. 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Generalized convulsive epilepsy, without mention of intractable epilepsy,Pelvic congestion syndrome,Other diseases of vocal cords,Unspecified schizophrenia, unspecified,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other specified cardiac dysrhythmias,Abdominal pain, unspecified site,Long-term (current) use of anticoagulants'}
