CHIEF COMPLAINT: Transfered from [**Hospital3 **] due to power failure at that
facility; diagnosis of catheter-related enterococcal bacteremia,
vertebral compression fracture, and abdominal pain NOS.

PRESENT ILLNESS: Ms. [**Known lastname 4223**] was transfered from [**Hospital3 **] after a power
shortage there.  She is a 61F with PMH T2DM, O2-dependent COPD,
vertebral compression fracture T9 s/p vertebroplasty, h/o VTE,
anxiety, and chronic back pain who was admitted to [**Hospital1 **] with acute on chronic back pain, abdominal pain, and
shortness of breath.  Evaluation there was notable for
enterococcal bacteremia, presumed arising from an infected
Port-a-Cath which was subsequently removed.  Evaluation for
source of abdominal discomfort, including CT scan, abdominal
ultrasound, HIDA, was reportedly unrevealing other than
demonstration of a probable acute T10 vertebral fracture.  She
was treated with unasyn and gentamycin prior to transfer to our
ICU, where she arrived in stable condition.
Initially underwent a lap-CCY on [**10-28**].  Discharged to home.
Re-admitted with mental status change and back pain.  Went back
to OR with no issues.  Recent vertebral fractures at T9-10
levels.  Already had T9 vertebroplasty done at OSH.
Vertebroplasty was planned at T10 level however patient
developed enteroccal bacteremia and was held.
Enterococcus in blood around [**11-6**].  Started on unasyn/gent.
Also received azithromycin x once there. Further records are
currently unavailable from OSH.
.
Also on chroinc steroids for COPD.
.
Portacath d/c'd.
.
Patient currently has abdominal pain.  Denies chest pain or any
other pain.  Has had 2 BM per day, nonbloody.  Denies SOB.
Asking for food.
.

MEDICAL HISTORY: 1. Diabetes
2. Chronic obstructive pulmonary disease:  Home O2 (2 liters)
and BiPAP at night (15/5).  Trying to wean off on steroids given
right knee ostonecrosis and vertebral fractures.  Started on
Methotrexate.
3. Recently diagnosed T9 s/p verteroplasty.
4. h/o DVT/PE
5. Chronic back pain
6. Right knee osteonecrosis s/p right knee replacement [**Doctor First Name **]
7. Anxiety
8. Hypothyroidism

MEDICATION ON ADMISSION: Lasix 40 mg daily
Lovenox 80 mg SC bid
Prednisone 30mg x2days, 20 mg x 2days, 10 mg day
Methotrexate 20 mg daily
MS Contin 30mg [**Hospital1 **]
Dilaudid 4mg SC prn q3h
Folic acid 1 mg daily
Ferrous sulfate 325 mg daily
[**Last Name (un) **]-dur 300 mg at breakfast and 200 mg at bedtime
Trazadone 150 mg at bedtime
K-dur 60 mEq at bedtime
Mucinix 1200 mg [**Hospital1 **]
Protonix
Tums
Metamucil 1 pkt daily
Miralax 1 pkt daily
Fortical 1 spray Left nostril q48h
Singulair 1 mg po daily
Gentamycin 40 mg IV q8h
Ampicillin + sulbactam 3 gm IV q6h

ALLERGIES: Celebrex / Zithromax / Sulfa (Sulfonamides)

PHYSICAL EXAM: vitals - T 98.8  P 120 ST  BP 154/74  RR 17  89% O2 sat on 4L NC

FAMILY HISTORY: Multiple family members with cancer, including ovarian,
pancreatic, and lung cancer.

SOCIAL HISTORY: Widow, former smoker, no illicit drugs.  Currently denies
alcohol, smoking.
Streptococcal septicemia,Acute and subacute bacterial endocarditis,Obstructive chronic bronchitis with (acute) exacerbation,Pathologic fracture of vertebrae,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abdominal pain, unspecified site,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants
Streptococcal septicemia,Ac/subac bact endocard,Obs chr bronc w(ac) exac,Path fx vertebrae,Sepsis,DMII wo cmp nt st uncntr,Abdmnal pain unspcf site,Hx-ven thrombosis/embols,Long-term use anticoagul
Admission Date:  [**2117-11-13**]              Discharge Date:   [**2117-11-17**]

Date of Birth:  [**2055-11-29**]             Sex:   F

Service: MEDICINE

Allergies:
Celebrex / Zithromax / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
Transfered from [**Hospital3 **] due to power failure at that
facility; diagnosis of catheter-related enterococcal bacteremia,
vertebral compression fracture, and abdominal pain NOS.

Major Surgical or Invasive Procedure:
PICC placement

History of Present Illness:
Ms. [**Known lastname 4223**] was transfered from [**Hospital3 **] after a power
shortage there.  She is a 61F with PMH T2DM, O2-dependent COPD,
vertebral compression fracture T9 s/p vertebroplasty, h/o VTE,
anxiety, and chronic back pain who was admitted to [**Hospital1 **] with acute on chronic back pain, abdominal pain, and
shortness of breath.  Evaluation there was notable for
enterococcal bacteremia, presumed arising from an infected
Port-a-Cath which was subsequently removed.  Evaluation for
source of abdominal discomfort, including CT scan, abdominal
ultrasound, HIDA, was reportedly unrevealing other than
demonstration of a probable acute T10 vertebral fracture.  She
was treated with unasyn and gentamycin prior to transfer to our
ICU, where she arrived in stable condition.
Initially underwent a lap-CCY on [**10-28**].  Discharged to home.
Re-admitted with mental status change and back pain.  Went back
to OR with no issues.  Recent vertebral fractures at T9-10
levels.  Already had T9 vertebroplasty done at OSH.
Vertebroplasty was planned at T10 level however patient
developed enteroccal bacteremia and was held.
Enterococcus in blood around [**11-6**].  Started on unasyn/gent.
Also received azithromycin x once there. Further records are
currently unavailable from OSH.
.
Also on chroinc steroids for COPD.
.
Portacath d/c'd.
.
Patient currently has abdominal pain.  Denies chest pain or any
other pain.  Has had 2 BM per day, nonbloody.  Denies SOB.
Asking for food.
.


Past Medical History:
1. Diabetes
2. Chronic obstructive pulmonary disease:  Home O2 (2 liters)
and BiPAP at night (15/5).  Trying to wean off on steroids given
right knee ostonecrosis and vertebral fractures.  Started on
Methotrexate.
3. Recently diagnosed T9 s/p verteroplasty.
4. h/o DVT/PE
5. Chronic back pain
6. Right knee osteonecrosis s/p right knee replacement [**Doctor First Name **]
7. Anxiety
8. Hypothyroidism

Social History:
Widow, former smoker, no illicit drugs.  Currently denies
alcohol, smoking.

Family History:
Multiple family members with cancer, including ovarian,
pancreatic, and lung cancer.

Physical Exam:
vitals - T 98.8  P 120 ST  BP 154/74  RR 17  89% O2 sat on 4L NC

gen - Alert awake
skin - dry and scaly
heent - MMM, No icterus, no signs of conjunctivitis
cv - S1S2 RRR
pulm - Coarse breath sounds anteriorly, Decreased BS b/l, no
wheezes or crackles
abd - BS present, soft, mildly distended, diffuse tenderness in
abdomen, no guarding or rebound.
ext - warm, no edema.  Multiple echymosis.
neuro - alert and awake.  No focal abnormalities.


Pertinent Results:
---OSH ([**2117-11-13**])---
.
137  94   3
----------- 124
3.5  31  0.6
.
Ca 7.7  Mg 1.9
.
Gent trough 1.3
.
WBC: 8.7
PLT: 315
HCT: 37.7
.
---ADMISSION---
.
134  89  5
------------ 204
5.1  29  0.6
.
Ca: 8.7 Mg: 2.0 P: 2.8
ALT: 12 AP: 116 Tbili: 0.5 Alb: 3.1
AST: 23 LDH: 879
HCT: 39.8
PLT: 383
WBC: 13.6
PT: 14.0  PTT: 33.8  INR: 1.2
.
EKG: Sinus tachycardia.  Non specific ST-T wave flattening
lateral leads.
.
CT abd/pelvis w/o contrast [**11-14**]:
1. No CT explanation for abdominal pain.
2. Cholelithiasis without evidence of cholecystitis.
3. T9 and T10 compression fracture. Status post T9
vertebroplasty.
4. Non-obstructive right renal calculi.
5. Bibasilar atelectasis.
6. Soft tissue prominence adherent to the wall of the cecum,
likely represents stool. Normal appendix.
.
TTE on [**11-15**]: Technically suboptimal study. The left atrium is
elongated. Left ventricular wall thicknesses are normal. The
left ventricular cavity size is normal. Due to suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded. Overall left ventricular systolic function is
normal (LVEF 70%). There is no ventricular septal defect. 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. No masses or
vegetations are seen on the aortic valve. The pulmonary artery
systolic pressure could not be determined. No vegetation/mass is
seen on the pulmonic valve. There is no pericardial effusion.
If clinically suggested, the absence of a vegetation by 2D
echocardiography does not exclude endocarditis.


Brief Hospital Course:
[**Hospital1 18**] PROBLEM-BASED SUMMARY:
.
1. Enterococcal bactermemia: The patient remained afebrile and
hemodynamically stable throughout her admission.  TTE failed to
demonstrate vegetation.  ID consultation was requested, who
advised completion of a 6-week course of IV antibiotic therapy
with ampicillin and gentamycin (goal gent peak [**3-14**], goal trough
<1); 6-week course will be completed as of [**12-26**].  Follow-up in
[**Hospital **] clinic is scheduled for Tuesday [**11-23**] at 2PM;
CBC/CHEM/LFTs/Gent levels should be drawn on Monday [**11-22**], with
results faxed to ID fellow Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1075**] at [**Telephone/Fax (1) 432**].  The
patient should have surveillance blood cultures drawn two weeks
s/p cessation of antibiotics.
.
3. COPD exacerbation: Steroid taper, theophylline, and
bronchodilator therapy were continued.  Methotrexate was held.
She remained stable from a respiratory standpoint during her
hospital course.
.
4. Abdominal pain of uncertain etiology: Given recent extensive
workup without diagnosis, it was suspected that her abdominal
complaints might represent a referred pain syndrome related to
her acute vertebral compression fracture.  Pain Service
consultation was requested, who advised multi-[**Doctor Last Name 360**] analgesic
regimen with long-acting morphine, percocet, duloxetine,
gabapentin, and lidocaine patch.
.
5. History of venous thromboembolism: She was maintained on
enoxaparin at 1mg/kg [**Hospital1 **] during her hospital stay, without
evidence of complication.
.
6. Vertebral fracutures at T9 and 10 levels: She had vertebral
plasty at T9 level at OSH.  Cont calcitonin nasal spray and
current pain management.  Cont tapering of steroids.
.
7. Sinus tachycardia: The patient had a persistent resting
tachycardia during her inpatient stay, despite appearing roughly
euvolemic.  Persistent pain, beta-agonist effect, and possibly
theophylline may have been contributing factors.  There was no
evidence of significant structural or pericardial disease on
transthoracic echocardiogram.  Further cardiac assessment may be
warranted should her tachycardia persist beyond this current
hospitalization.
.
8. ?Depression/Anxiety: Continued on cymbalta.
.
9. Hypothyroidism: TFTs within normal limtis. Continued on home
levothyroxine.
PCP [**Name9 (PRE) 11422**] [**Name9 (PRE) 22552**] - [**Telephone/Fax (1) 76066**].  [**Name (NI) **] sister - [**Name (NI) 2048**]
[**Telephone/Fax (1) 76067**]
.

Medications on Admission:
Lasix 40 mg daily
Lovenox 80 mg SC bid
Prednisone 30mg x2days, 20 mg x 2days, 10 mg day
Methotrexate 20 mg daily
MS Contin 30mg [**Hospital1 **]
Dilaudid 4mg SC prn q3h
Folic acid 1 mg daily
Ferrous sulfate 325 mg daily
[**Last Name (un) **]-dur 300 mg at breakfast and 200 mg at bedtime
Trazadone 150 mg at bedtime
K-dur 60 mEq at bedtime
Mucinix 1200 mg [**Hospital1 **]
Protonix
Tums
Metamucil 1 pkt daily
Miralax 1 pkt daily
Fortical 1 spray Left nostril q48h
Singulair 1 mg po daily
Gentamycin 40 mg IV q8h
Ampicillin + sulbactam 3 gm IV q6h


Discharge Medications:
1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
4. Trazodone 50 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime) as needed.
5. Duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
6. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO QID (4 times a day) as needed.
9. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1)  Subcutaneous
[**Hospital1 **] (2 times a day).
10. Psyllium     Packet Sig: One (1) Packet PO DAILY (Daily).
11. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
12. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
13. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Calcitonin (Salmon) 200 unit/Actuation Aerosol, Spray Sig:
One (1)  Nasal Q48H (every 48 hours).
15. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
16. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
 Inhalation Q6H (every 6 hours).
17. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
18. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
19. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
20. Morphine 15 mg Tablet Sustained Release Sig: Two (2) Tablet
Sustained Release PO Q8H (every 8 hours).
21. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: Two (2) Tablet
PO Q4H (every 4 hours) as needed for pain.
22. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours).
23. Theophylline 100 mg Tablet Sustained Release 12 hr Sig:
Three (3) Tablet Sustained Release 12 hr PO QAM (once a day (in
the morning)).
24. Theophylline 100 mg Tablet Sustained Release 12 hr Sig: Two
(2) Tablet Sustained Release 12 hr PO QPM (once a day (in the
evening)).
25. Ampicillin Sodium 2 gram Recon Soln Sig: One (1) Recon Soln
Injection Q4H (every 4 hours).
26. Gentamicin 60 mg IV Q8H


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary:
1. Enterococcal bacteremia
2. COPD exacerbation, improving
3. Abdominal pain of uncertain etiology, possible referred pain
syndrome
4. Vertebral fracture s/p vertebroplasty at T9 level, with
(?)acute T10 fracture

Secondary:
1. Diabetes Mellitus
2. Chronic obstructive pulmonary disease
3. h/o venous thromboembolism
4. Hypothyroidism


Discharge Condition:
Stable.


Discharge Instructions:
You have been transfered to [**Hospital1 69**]
after a power failure at [**Hospital3 **].  Treatment for your
bloodstream infection was continued.  Workup for cause of your
abdominal pain was inconclusive; you have been prescribed
multiple medications to alleviate your discomfort.  You will be
transfered to [**Hospital3 **] per your request.

Please follow the recommendations per your doctors [**First Name (Titles) **] [**Last Name (Titles) **].

You are welcome to contact us regarding the care you received
here.

Followup Instructions:
Per your doctors [**First Name (Titles) **] [**Hospital3 **] who will continue to manage
your in-hospital issues


                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]

Completed by:[**0-0-0**]
{'Streptococcal septicemia,Acute and subacute bacterial endocarditis,Obstructive chronic bronchitis with (acute) exacerbation,Pathologic fracture of vertebrae,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abdominal pain, unspecified site,Personal history of venous thrombosis and embolism,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: Transfered from [**Hospital3 **] due to power failure at that
facility; diagnosis of catheter-related enterococcal bacteremia,
vertebral compression fracture, and abdominal pain NOS.

PRESENT ILLNESS: Ms. [**Known lastname 4223**] was transfered from [**Hospital3 **] after a power
shortage there.  She is a 61F with PMH T2DM, O2-dependent COPD,
vertebral compression fracture T9 s/p vertebroplasty, h/o VTE,
anxiety, and chronic back pain who was admitted to [**Hospital1 **] with acute on chronic back pain, abdominal pain, and
shortness of breath.  Evaluation there was notable for
enterococcal bacteremia, presumed arising from an infected
Port-a-Cath which was subsequently removed.  Evaluation for
source of abdominal discomfort, including CT scan, abdominal
ultrasound, HIDA, was reportedly unrevealing other than
demonstration of a probable acute T10 vertebral fracture.  She
was treated with unasyn and gentamycin prior to transfer to our
ICU, where she arrived in stable condition.
Initially underwent a lap-CCY on [**10-28**].  Discharged to home.
Re-admitted with mental status change and back pain.  Went back
to OR with no issues.  Recent vertebral fractures at T9-10
levels.  Already had T9 vertebroplasty done at OSH.
Vertebroplasty was planned at T10 level however patient
developed enteroccal bacteremia and was held.
Enterococcus in blood around [**11-6**].  Started on unasyn/gent.
Also received azithromycin x once there. Further records are
currently unavailable from OSH.
.
Also on chroinc steroids for COPD.
.
Portacath d/c'd.
.
Patient currently has abdominal pain.  Denies chest pain or any
other pain.  Has had 2 BM per day, nonbloody.  Denies SOB.
Asking for food.
.

MEDICAL HISTORY: 1. Diabetes
2. Chronic obstructive pulmonary disease:  Home O2 (2 liters)
and BiPAP at night (15/5).  Trying to wean off on steroids given
right knee ostonecrosis and vertebral fractures.  Started on
Methotrexate.
3. Recently diagnosed T9 s/p verteroplasty.
4. h/o DVT/PE
5. Chronic back pain
6. Right knee osteonecrosis s/p right knee replacement [**Doctor First Name **]
7. Anxiety
8. Hypothyroidism

MEDICATION ON ADMISSION: Lasix 40 mg daily
Lovenox 80 mg SC bid
Prednisone 30mg x2days, 20 mg x 2days, 10 mg day
Methotrexate 20 mg daily
MS Contin 30mg [**Hospital1 **]
Dilaudid 4mg SC prn q3h
Folic acid 1 mg daily
Ferrous sulfate 325 mg daily
[**Last Name (un) **]-dur 300 mg at breakfast and 200 mg at bedtime
Trazadone 150 mg at bedtime
K-dur 60 mEq at bedtime
Mucinix 1200 mg [**Hospital1 **]
Protonix
Tums
Metamucil 1 pkt daily
Miralax 1 pkt daily
Fortical 1 spray Left nostril q48h
Singulair 1 mg po daily
Gentamycin 40 mg IV q8h
Ampicillin + sulbactam 3 gm IV q6h

ALLERGIES: Celebrex / Zithromax / Sulfa (Sulfonamides)

PHYSICAL EXAM: vitals - T 98.8  P 120 ST  BP 154/74  RR 17  89% O2 sat on 4L NC

FAMILY HISTORY: Multiple family members with cancer, including ovarian,
pancreatic, and lung cancer.

SOCIAL HISTORY: Widow, former smoker, no illicit drugs.  Currently denies
alcohol, smoking. 

### Response:
{'Streptococcal septicemia,Acute and subacute bacterial endocarditis,Obstructive chronic bronchitis with (acute) exacerbation,Pathologic fracture of vertebrae,Sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Abdominal pain, unspecified site,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}
