CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 349**] is a 50 yo male with history of lymphoma as a
child, now in remission for many years, HLD, and current smoker
(30 PY) who presents with shortness of breath.  He does not have
any known history of COPD or asthma.  He reports that he has had
intermittent cough and viral symptoms for the past 1-2 months,
but he has not been SOB until about 3 days ago.  He has had
severe cough and some wheezing for the past 3 days as well.
Cough is productive of clear sputum.  He reports low grade
fevers for 1 day, low 100s in ED.  He denies chills, chest pain
or pressure.  He was admitted to OSH earlier today, he was given
steroids and antibiotics, but eloped as he was unstatisfied with
their care.  He was still SOB so came here for further
evaluation.  He denies any recent sick contacts.
.
In the ED, initial VS were: T 98.2, HR 117, BP 135/73, RR 18,
SpO2 90% on RA.  Patient was found to be tachypneic and wheezy
on exam.  His peak flow was noted to be 200.  He was given
Duonebs x3, Solumedrol, Ceftriaxone, and Azithromycin.  No
elevated WBC, but lactate increased at 4.4.  EKG showed sinus
tachycardia at 112, no ischemia.  CTA chest was negative for PE.
 His VS prior to transfer were: T 98.5, HR 110, BP 139/79, SpO2
96% on NRB.

MEDICAL HISTORY: # Lymphocytic non-Hodgkin's lymphoma, in remission, diagnosed at
age 16, presented with a right tongue lesion as well as a neck
mass, underwent surgeries to excise these and also Adriamycin,
vincristine, 6-MP, prednisone and methotrexate at [**Hospital1 108069**].  He also underwent XRT at [**Hospital1 756**].  He had
some peripheral neuropathy from the vincristine, which has since
resolved.  Has poor denition due to radiation.
# Hyperlipidemia
# Scoliosis.  Wears a right shoe-lift.
# Bilateral inguinal hernia repair as a child
# Tonsillectomy and adenoidectomy x2 as a child.
# Tobacco abuse

MEDICATION ON ADMISSION: Not taking any medication currently.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam On Admission:
General: Alert, oriented, SOB with speaking in full sentences
and with mild
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP at 8cm, no LAD
Lungs: faint wheezes heard more in the upper lung fields, poor
airflow. no rales/ronchi
CV: rapid rate/rhythm, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A&O x3, CN grossly intact, MAE.
.

FAMILY HISTORY: The patient is adopted and does know know his biological family
medical history.

SOCIAL HISTORY: He lives in [**Hospital1 392**] with his wife, no kids.  He works as an
attorney.  Has 2 birds at home.
- Tobacco: Current 1PPD for past 30 years.
- Alcohol: Rarely
- Illicits: Denies
Viral pneumonia, unspecified,Bacterial pneumonia, unspecified,Tobacco use disorder,Personal history of lymphosarcoma and reticulosarcoma,Pure hypercholesterolemia,Scoliosis [and kyphoscoliosis], idiopathic,Tachycardia, unspecified,Nontoxic uninodular goiter,Hypoxemia
Viral pneumonia NOS,Bacterial pneumonia NOS,Tobacco use disorder,Hx-lymphosarcoma,Pure hypercholesterolem,Idiopathic scoliosis,Tachycardia NOS,Nontox uninodular goiter,Hypoxemia
Admission Date:  [**2166-2-17**]              Discharge Date:   [**2166-2-21**]

Date of Birth:  [**2115-12-9**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2108**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
None


History of Present Illness:
[**Known firstname **] [**Known lastname 349**] is a 50 yo male with history of lymphoma as a
child, now in remission for many years, HLD, and current smoker
(30 PY) who presents with shortness of breath.  He does not have
any known history of COPD or asthma.  He reports that he has had
intermittent cough and viral symptoms for the past 1-2 months,
but he has not been SOB until about 3 days ago.  He has had
severe cough and some wheezing for the past 3 days as well.
Cough is productive of clear sputum.  He reports low grade
fevers for 1 day, low 100s in ED.  He denies chills, chest pain
or pressure.  He was admitted to OSH earlier today, he was given
steroids and antibiotics, but eloped as he was unstatisfied with
their care.  He was still SOB so came here for further
evaluation.  He denies any recent sick contacts.
.
In the ED, initial VS were: T 98.2, HR 117, BP 135/73, RR 18,
SpO2 90% on RA.  Patient was found to be tachypneic and wheezy
on exam.  His peak flow was noted to be 200.  He was given
Duonebs x3, Solumedrol, Ceftriaxone, and Azithromycin.  No
elevated WBC, but lactate increased at 4.4.  EKG showed sinus
tachycardia at 112, no ischemia.  CTA chest was negative for PE.
 His VS prior to transfer were: T 98.5, HR 110, BP 139/79, SpO2
96% on NRB.

Review of systems:
(+) Per HPI and for rhinorrhea and sneezing
(-) Denies weight gain, orthopnea, PND or LE edema.
Denieschills, night sweats. Denies headache, sinus tenderness or
congestion.  Denies chest pain, chest pressure, palpitations, or
weakness. Denies nausea, vomiting, diarrhea, constipation,
abdominal pain, or changes in bowel habits. Denies dysuria,
frequency, or urgency. Denies arthralgias or myalgias. Denies
rashes or skin changes.


Past Medical History:
# Lymphocytic non-Hodgkin's lymphoma, in remission, diagnosed at
age 16, presented with a right tongue lesion as well as a neck
mass, underwent surgeries to excise these and also Adriamycin,
vincristine, 6-MP, prednisone and methotrexate at [**Hospital1 108069**].  He also underwent XRT at [**Hospital1 756**].  He had
some peripheral neuropathy from the vincristine, which has since
resolved.  Has poor denition due to radiation.
# Hyperlipidemia
# Scoliosis.  Wears a right shoe-lift.
# Bilateral inguinal hernia repair as a child
# Tonsillectomy and adenoidectomy x2 as a child.
# Tobacco abuse


Social History:
He lives in [**Hospital1 392**] with his wife, no kids.  He works as an
attorney.  Has 2 birds at home.
- Tobacco: Current 1PPD for past 30 years.
- Alcohol: Rarely
- Illicits: Denies


Family History:
The patient is adopted and does know know his biological family
medical history.

Physical Exam:
Physical Exam On Admission:
General: Alert, oriented, SOB with speaking in full sentences
and with mild
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP at 8cm, no LAD
Lungs: faint wheezes heard more in the upper lung fields, poor
airflow. no rales/ronchi
CV: rapid rate/rhythm, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A&O x3, CN grossly intact, MAE.
.


Pertinent Results:
Labs On Admission:
[**2166-2-16**] 11:30PM BLOOD WBC-7.0 RBC-4.74 Hgb-14.6 Hct-41.4 MCV-87
MCH-30.8 MCHC-35.3* RDW-13.9 Plt Ct-223
[**2166-2-16**] 11:30PM BLOOD Neuts-91.1* Lymphs-6.1* Monos-2.4 Eos-0.4
Baso-0.1
[**2166-2-16**] 11:30PM BLOOD PT-12.4 PTT-23.4 INR(PT)-1.0
[**2166-2-16**] 11:30PM BLOOD UreaN-14 Creat-0.9
[**2166-2-16**] 11:30PM BLOOD freeCa-1.13

Other Relevant Labs:
[**2166-2-17**] 07:01AM BLOOD proBNP-1302*
[**2166-2-17**] 07:01AM BLOOD Calcium-8.1* Phos-2.0* Mg-1.6
[**2166-2-17**] 07:01AM BLOOD TSH-0.79
[**2166-2-17**] 04:13PM BLOOD IgG-671* IgA-47* IgM-11*

ABG:
[**2166-2-17**] 07:28AM BLOOD Type-ART pO2-80* pCO2-34* pH-7.39
calTCO2-21 Base XS--3 Intubat-NOT INTUBA
.
Lactate Trend:
[**2166-2-16**] 11:30PM BLOOD Lactate-4.4*
[**2166-2-17**] 12:24AM BLOOD Lactate-3.5*
[**2166-2-17**] 01:58AM BLOOD Lactate-3.5*
[**2166-2-17**] 07:28AM BLOOD Lactate-3.2*
[**2166-2-18**] 06:16AM BLOOD Lactate-1.6

Urinalyis:
[**2166-2-17**] 01:17PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.018
[**2166-2-17**] 01:17PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG

Toxicology:
[**2166-2-17**] 07:01AM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG
[**2166-2-17**] 01:17PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG

Microbiology:
[**2166-2-17**] 7:08 am Influenza A/B by DFA (Source: Nasopharyngeal
swab)
   DIRECT INFLUENZA A ANTIGEN TEST (Final [**2166-2-17**]):
      Negative for Influenza A.
   DIRECT INFLUENZA B ANTIGEN TEST (Final [**2166-2-17**]):
      Negative for Influenza B.
   Respiratory Viral Culture (Pending):

Imaging / Studies:
# CHEST (PA & LAT) ([**2166-2-16**] at 11:29 PM):
FINDINGS: AP and lateral chest with no prior for comparison
demonstrates low lung volumes, though the lungs are clear. There
is no pleural effusion or pneumothorax. The heart is at the
upper limits of normal for size, the mediastinal contours are
unremarkable. The pulmonary vasculature appears normal.
IMPRESSION: No acute thoracic pathology.

CTA CHEST W&W/O C&RECONS, NON-CORONARY ([**2166-2-17**] at 2:30 AM):
FINDINGS: Vascular opacification is somewhat suboptimal, but no
pulmonary embolism is present to the level of the segemental
vessels. The main pulmonary artery is slightly enlarged
measuring 3.2 cm. The thoracic aorta appears within normal
limits. No pericardial, or pleural effusions are present.
Minimal bibasilar dependent atelectasis is present. Otherwise,
the lungs are clear and the airways are patent. No significant
hilar, mediastinal, or axillary lymphadenopathy is present. In
the right lobe of the thyroid is a 14-mm nodule, a small nodule
is present in the left lobe. Although not evaluated for
subdiaphragmatic evaluation, the liver appears diffusely fatty
infiltrated without focal lesions. Remainder of the abdomen
appears normal.
BONE WINDOWS: Spinal degenerative changes are present but no
suspicious bone lesions are present.
IMPRESSION:
1. No pulmonary embolism. Main pulmonary artery is somewhat
enlarged, could indicate pulmonary hypertension.
2. Thyroid nodules, for which ultrasound should be performed to
better evaluate.
3. Fatty liver without focal lesions; however, this evaluation
for lesions is limited on this study.

Portable TTE ([**2166-2-18**] at 8:37:01 AM):
The left atrium is mildly dilated. No definite atrial septal
defect or patent foramen ovale is seen by 2D, color Doppler or
saline contrast with maneuvers. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
The mitral valve appears structurally normal with trivial mitral
regurgitation. There is no pericardial effusion.

CHEST (PORTABLE AP) ([**2166-2-18**] at 4:48 AM):
FINDINGS: In comparison with study of [**2-16**], there is no interval
change or evidence of acute cardiopulmonary disease. Relatively
low lung volumes but no pneumonia, vascular congestion, or
pleural effusion.

Brief Hospital Course:
50 yo male with a history of childhood lymphoma in remission
after chemotherapy and radiation, HLD, and significant smoking
history (30 PY) who presents with shortness of breath.

Dyspnea/Hypoxia: very likely related to a severe viral pneumonia
or an atypical pneumonia.  CTA of the chest without PE or any
infiltrate.  Viral culture and flu swab negative although the
patient was treated with a full course of tamiflu.  In addition
he was treated with a 7 day total course of levofloxacin. For
the first few days he was on steroids given significant
wheezing, the steroids were stopped without any recurrance of
wheezing.  Dry mild cough persisted at the time of discharge,
but he felt generally well and was without fevers.  His Ig panel
was low in IgG, IgA, and IgM.  He will f/u with a pulmonologist.
 He was sating well on room air upon discharge.


Medications on Admission:
Not taking any medication currently.

Prescribed:
Aspirin 81 mg PO daily
Fenofibrate micronized 200 mg PO daily


Discharge Medications:
1. nicotine 21-14-7 mg/24 hr Patch Daily, Sequential Sig: One
(1) patch Transdermal once a day: use 21mg/24hr patch daily for
4 weeks then 14mg/24hr patch daily for 2-4 weeks then 7mg/24hr
patch daily for 2-4 weeks .
2. aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
3. fenofibrate micronized 200 mg Capsule Sig: One (1) Capsule PO
once a day.
4. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 2 days: take 1 tablet on [**2-22**] and 1 tablet on [**2-23**].
Disp:*2 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Viral Pneumonia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital with severe pneumonia, you
were treated for the flu and for a bacterial pneumonia with
antibiotics.  You should take levofloxacin (antibiotic) for 2
additional days (1 pill on [**2-22**] and 1 on [**2-23**])

Please take your medications as prescribed and make your follow
up appointments.

Followup Instructions:
Department: [**Hospital3 249**]
When: FRIDAY [**2166-2-28**] at 9:10 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD. [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
*This appointment is with a hospital-based doctor as part of
your transition from the hospital back to your primary care
provider.  [**Name10 (NameIs) 616**] this visit, you will see your regular primary
care doctor in follow up.

Name: [**Last Name (LF) 3517**], [**Name8 (MD) 915**] MD.
Location: [**Hospital1 2025**] PULMONARY AND CRITICAL CARE
Address:[**Street Address(2) 12266**], [**Location (un) **],[**Numeric Identifier 18228**]
Phone: [**Telephone/Fax (1) 86145**]
*Please call the number above to register with [**Hospital1 2025**] and set up an
appointment with Dr. [**Last Name (STitle) 3517**].

Department: [**Hospital3 249**]
When: WEDNESDAY [**2166-3-26**] at 10:00 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Viral pneumonia, unspecified,Bacterial pneumonia, unspecified,Tobacco use disorder,Personal history of lymphosarcoma and reticulosarcoma,Pure hypercholesterolemia,Scoliosis [and kyphoscoliosis], idiopathic,Tachycardia, unspecified,Nontoxic uninodular goiter,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: Shortness of breath

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 349**] is a 50 yo male with history of lymphoma as a
child, now in remission for many years, HLD, and current smoker
(30 PY) who presents with shortness of breath.  He does not have
any known history of COPD or asthma.  He reports that he has had
intermittent cough and viral symptoms for the past 1-2 months,
but he has not been SOB until about 3 days ago.  He has had
severe cough and some wheezing for the past 3 days as well.
Cough is productive of clear sputum.  He reports low grade
fevers for 1 day, low 100s in ED.  He denies chills, chest pain
or pressure.  He was admitted to OSH earlier today, he was given
steroids and antibiotics, but eloped as he was unstatisfied with
their care.  He was still SOB so came here for further
evaluation.  He denies any recent sick contacts.
.
In the ED, initial VS were: T 98.2, HR 117, BP 135/73, RR 18,
SpO2 90% on RA.  Patient was found to be tachypneic and wheezy
on exam.  His peak flow was noted to be 200.  He was given
Duonebs x3, Solumedrol, Ceftriaxone, and Azithromycin.  No
elevated WBC, but lactate increased at 4.4.  EKG showed sinus
tachycardia at 112, no ischemia.  CTA chest was negative for PE.
 His VS prior to transfer were: T 98.5, HR 110, BP 139/79, SpO2
96% on NRB.

MEDICAL HISTORY: # Lymphocytic non-Hodgkin's lymphoma, in remission, diagnosed at
age 16, presented with a right tongue lesion as well as a neck
mass, underwent surgeries to excise these and also Adriamycin,
vincristine, 6-MP, prednisone and methotrexate at [**Hospital1 108069**].  He also underwent XRT at [**Hospital1 756**].  He had
some peripheral neuropathy from the vincristine, which has since
resolved.  Has poor denition due to radiation.
# Hyperlipidemia
# Scoliosis.  Wears a right shoe-lift.
# Bilateral inguinal hernia repair as a child
# Tonsillectomy and adenoidectomy x2 as a child.
# Tobacco abuse

MEDICATION ON ADMISSION: Not taking any medication currently.

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam On Admission:
General: Alert, oriented, SOB with speaking in full sentences
and with mild
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP at 8cm, no LAD
Lungs: faint wheezes heard more in the upper lung fields, poor
airflow. no rales/ronchi
CV: rapid rate/rhythm, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A&O x3, CN grossly intact, MAE.
.

FAMILY HISTORY: The patient is adopted and does know know his biological family
medical history.

SOCIAL HISTORY: He lives in [**Hospital1 392**] with his wife, no kids.  He works as an
attorney.  Has 2 birds at home.
- Tobacco: Current 1PPD for past 30 years.
- Alcohol: Rarely
- Illicits: Denies 

### Response:
{'Viral pneumonia, unspecified,Bacterial pneumonia, unspecified,Tobacco use disorder,Personal history of lymphosarcoma and reticulosarcoma,Pure hypercholesterolemia,Scoliosis [and kyphoscoliosis], idiopathic,Tachycardia, unspecified,Nontoxic uninodular goiter,Hypoxemia'}
