CHIEF COMPLAINT: Respiratory distress

PRESENT ILLNESS: Ms. [**Known lastname 34418**] is a 25 year old female with history of Myasthenia
[**Last Name (un) **] (dx [**5-2**], with two associated intubations) and asthma
presents with dyspnea, malaise and diplopia. The patient reports
that over the past week she developed URI-like symptoms
including frontal headache, rhinnorhea, clear productive cough,
nausea and one episode of emesis consisting of sputum. She also
noted increased instances of her typical diplopia, blurred
vision, and general malaise.  She also notes worsening of her
wheezing. On Friday ([**2146-10-28**]), the patient was reportedly
feeling worse and called her neurologist (Dr. [**Last Name (STitle) **] who
recommended increasing her Prednisone to 10mg daily from 5mg,
and her Mestinon 60mg from [**Hospital1 **] to TID. The patient reports that
the albuterol inhaler ran out on Friday night and since then has
used her albuterol nebulizer on mulitiple occassions with some
alleviation of symptoms. On Saturday, ([**2146-10-29**]), the patient
slept most the day.  On Sunday, ([**2146-10-30**]), the patient reported
increased activity including going to the park with her son,
laundry, and grocery shopping. However, on the morning of
admission, the patient awoke continued weakness and shortness of
breath, prompting her presentation to the [**Hospital1 18**] ER.
Upon arrival to the ED, her vitals were T: 98.0, BP: 133/81, HR:
72 RR: 19, O2sat: 100%RA.  Her initial NIF was -50cm and vital
capacity 1.8L. The pt was given Combivent Nebs x3 and Prednisone
60mg x1.
On ROS: The pt also states that her son was recently sick with a
cold. In addition the pt reports that she has been cleaning and
dusting her house. Also pt reports she has an allergy to dogs
and was recently exposed to dogs while at work.

MEDICAL HISTORY: -Myasthenia [**Last Name (un) 2902**], Dx [**5-2**].  Intubated for respiratory distress
during exacerbation [**1-1**] when she also presentewd with dipolpia
and
dyspnea.  Was also intubated for respiratory distress after
initial presentation in [**2145-4-25**].  Received plasmapheresis on
both occasions.
- Asthma since childhood
- Ventilator associated pneumonia
- Right lung nodule
- GERD
- s/p C-section

MEDICATION ON ADMISSION: -Advair Diskus 100 mcg-50 mcg two puffs daily
-Cellcept [**Pager number **] mg [**Hospital1 **]
-Prednisone 10 mg daily (taper)
-Mestinon 60 mg TID
-Albuterol nebulizer (has increased use to four times daily over
past three days)
-Zantac 75 mg [**Hospital1 **]

ALLERGIES: Penicillins

PHYSICAL EXAM: Gen: Mild distess, not speaking in full sentences, AOx3
HEENT: PERRLA, Extra-ocular movements intact however there is
difficulty tracking objects. Bilateral ptosis. MMM.
Neck: Supple without LAD
Resp: Scattered, Diffuse Wheezes, decrease airmovement
Card: S1S2 No MRG
Abd: Soft NT ND BS+
Extr: No C/C/E
Neuro: CN II-XII otherwise intact with exception of eye deficits
listed above.
Skin: No rashes

FAMILY HISTORY: Father- CAD, [**Name (NI) 2320**]
Mother- Mental Health Disease (Details unknown)
Son [**Name (NI) **] 5)- Health
No brothers of sisters

SOCIAL HISTORY: Single mother of 5yo son. Lives in [**Location 8391**], works as
pediatric  medical assistant in [**Hospital1 **], MA. Tobacco hx 14
years, still smoking up to 7 cigarettes per day, though none
since last week.  Occassional EtOH, non recently.  Denies drug
use.
Myasthenia gravis with (acute) exacerbation,Asthma, unspecified type, with (acute) exacerbation,Esophageal reflux
Myasthna gravs w ac exac,Asthma NOS w (ac) exac,Esophageal reflux
Admission Date:  [**2146-10-31**]              Discharge Date:   [**2146-11-3**]

Date of Birth:  [**2120-12-21**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2167**]
Chief Complaint:
Respiratory distress

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Ms. [**Known lastname 34418**] is a 25 year old female with history of Myasthenia
[**Last Name (un) **] (dx [**5-2**], with two associated intubations) and asthma
presents with dyspnea, malaise and diplopia. The patient reports
that over the past week she developed URI-like symptoms
including frontal headache, rhinnorhea, clear productive cough,
nausea and one episode of emesis consisting of sputum. She also
noted increased instances of her typical diplopia, blurred
vision, and general malaise.  She also notes worsening of her
wheezing. On Friday ([**2146-10-28**]), the patient was reportedly
feeling worse and called her neurologist (Dr. [**Last Name (STitle) **] who
recommended increasing her Prednisone to 10mg daily from 5mg,
and her Mestinon 60mg from [**Hospital1 **] to TID. The patient reports that
the albuterol inhaler ran out on Friday night and since then has
used her albuterol nebulizer on mulitiple occassions with some
alleviation of symptoms. On Saturday, ([**2146-10-29**]), the patient
slept most the day.  On Sunday, ([**2146-10-30**]), the patient reported
increased activity including going to the park with her son,
laundry, and grocery shopping. However, on the morning of
admission, the patient awoke continued weakness and shortness of
breath, prompting her presentation to the [**Hospital1 18**] ER.
Upon arrival to the ED, her vitals were T: 98.0, BP: 133/81, HR:
72 RR: 19, O2sat: 100%RA.  Her initial NIF was -50cm and vital
capacity 1.8L. The pt was given Combivent Nebs x3 and Prednisone
60mg x1.
On ROS: The pt also states that her son was recently sick with a
cold. In addition the pt reports that she has been cleaning and
dusting her house. Also pt reports she has an allergy to dogs
and was recently exposed to dogs while at work.

Past Medical History:
-Myasthenia [**Last Name (un) 2902**], Dx [**5-2**].  Intubated for respiratory distress
during exacerbation [**1-1**] when she also presentewd with dipolpia
and
dyspnea.  Was also intubated for respiratory distress after
initial presentation in [**2145-4-25**].  Received plasmapheresis on
both occasions.
- Asthma since childhood
- Ventilator associated pneumonia
- Right lung nodule
- GERD
- s/p C-section

Social History:
Single mother of 5yo son. Lives in [**Location 8391**], works as
pediatric  medical assistant in [**Hospital1 **], MA. Tobacco hx 14
years, still smoking up to 7 cigarettes per day, though none
since last week.  Occassional EtOH, non recently.  Denies drug
use.

Family History:
Father- CAD, [**Name (NI) 2320**]
Mother- Mental Health Disease (Details unknown)
Son [**Name (NI) **] 5)- Health
No brothers of sisters

Physical Exam:
Gen: Mild distess, not speaking in full sentences, AOx3
HEENT: PERRLA, Extra-ocular movements intact however there is
difficulty tracking objects. Bilateral ptosis. MMM.
Neck: Supple without LAD
Resp: Scattered, Diffuse Wheezes, decrease airmovement
Card: S1S2 No MRG
Abd: Soft NT ND BS+
Extr: No C/C/E
Neuro: CN II-XII otherwise intact with exception of eye deficits
listed above.
Skin: No rashes

Pertinent Results:
[**2146-10-31**] 10:00AM BLOOD WBC-6.2 RBC-4.78 Hgb-14.1 Hct-40.5 MCV-85
MCH-29.5 MCHC-34.8 RDW-13.6 Plt Ct-261
[**2146-11-3**] 06:05AM BLOOD WBC-12.1* RBC-4.38 Hgb-12.9 Hct-38.3
MCV-88 MCH-29.5 MCHC-33.8 RDW-13.9 Plt Ct-242
[**2146-10-31**] 10:00AM BLOOD Neuts-74.7* Lymphs-15.4* Monos-3.0
Eos-6.6* Baso-0.4
[**2146-10-31**] 10:00AM BLOOD Plt Ct-261
[**2146-11-1**] 07:25AM BLOOD PT-15.2* INR(PT)-1.3*
[**2146-10-31**] 10:00AM BLOOD Glucose-95 UreaN-14 Creat-0.8 Na-141
K-4.2 Cl-107 HCO3-25 AnGap-13
[**2146-10-31**] 06:08PM BLOOD Calcium-9.6 Phos-2.3* Mg-1.6

Relevant Imaging:
Cxray ([**10-31**]): Normal appearing chest radiograph without evidence
for pneumonia.

Brief Hospital Course:
Ms. [**Known lastname **] is a 25yo female with hx of Myasthenia [**Last Name (un) **] and
asthma presents with dyspnea, wheezing, malaise and diplopia.

1)Respiratory Distress: Likely excerbation of Myasthenia in the
setting of asthma excerbation [**2-26**] to recent URI. She was
initially started on IV steroids but then transitioned to an
extended Prednisone taper at the time of discharge. Neurology
was consulted and recommended holding her Mestinon given its
potential to worsen her respiratory status [**2-26**] cholinergic
effects. She was also placed on standing nebulizer treatments.
At time of discharge, her respiratory status had significantly
improved and she had minimal wheezing on exam. She was asked to
follow-up in the neurology clinic to determine when the Mestinon
could be restarted. She was continued on Cellcept.

2)GERD: She was continued on Ranitidine.


Medications on Admission:
-Advair Diskus 100 mcg-50 mcg two puffs daily
-Cellcept [**Pager number **] mg [**Hospital1 **]
-Prednisone 10 mg daily (taper)
-Mestinon 60 mg TID
-Albuterol nebulizer (has increased use to four times daily over
past three days)
-Zantac 75 mg [**Hospital1 **]

Discharge Medications:
1. Ranitidine HCl 75 mg Tablet Sig: One (1) Tablet PO twice a
day.
Disp:*60 Tablet(s)* Refills:*2*
2. Mycophenolate Mofetil 500 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
3. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) bottle Inhalation Q4H (every 4 hours)
as needed for shortness of breath or wheezing.
Disp:*2 bottles* Refills:*2*
4. Ipratropium Bromide 0.02 % Solution Sig: One (1) bottle
Inhalation Q4H (every 4 hours) as needed for shortness of breath
or wheezing.
Disp:*2 bottles* Refills:*2*
5. Prednisone 20 mg Tablet Sig: 1 - 3 Tablet PO once a day for
10 days: 1) Please take 60 mg of prednisone once a day from [**11-4**] - 11, [**2146**].
2) Please take 40 mg of prednisone from [**11-6**]. 3)
Please take 20 mg of prednisone from [**11-10**].   .
Disp:*18 Tablet(s)* Refills:*0*
6. Prednisone 10 mg Tablet Sig: 0.5 - 1 Tablet PO once a day for
4 days: Please take 10 mg of prednisone once a day from [**11-14**]
- 23, [**2146**].  Please take 5 mg ([**1-26**] tablet) once a day from [**11-18**] - 27, [**2146**].
Disp:*6 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Asthma
Myasthenia [**Last Name (un) 2902**]

Secondary:
Gastroesophageal Reflex Disease


Discharge Condition:
Stable


Discharge Instructions:
1) You were admitted to the hospital because you presented with
worsening shortness of breath, wheezing, and double vision.  You
were evaluated via laboratory values, imaging, and by neurology.
You were diagnosed with an acute exacerbation of your asthma and
myasthenia [**Last Name (un) 2902**].

2) You were started on a new medication called prednisone during
your hospital course.  Please pay careful attention to the
instructions regarding the taper of this medication.  You will
take 60 mg of prednisone for the next two days, [**11-4**].  You will take 40 mg of prednisone from [**11-6**].  You will take 20 mg of prednisone from [**11-10**].  You will take 10 mg of prednisone from [**11-14**].  You will take 5 mg of prednisone from [**11-18**].
 After [**2146-11-21**], pending no other changes from another
physician, [**Name10 (NameIs) **] will no longer continue taking prednisone.

3)During your hospitalization, your Mestinon was discontinued as
it can aggravate your asthma.  Per neurology, this medication
will continue to be held until you see your outpatient
neurologist on [**2146-11-21**].

4) Please take all other medications as listed.

5) Please attend all follow- up appointments.

6) If you experience any fevers, chills, chest pain, shortness
of breath, blurry vision, or any other concerning symptoms,
please seek immediate medical attention.

Followup Instructions:
1) Please [**Year (4 digits) **] a follow- up appointment with your primary
care physician within the next 1 - 2 weeks.

2) Please attend all appointments as listed below.

Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2146-11-21**] 11:00
{'Myasthenia gravis with (acute) exacerbation,Asthma, unspecified type, with (acute) exacerbation,Esophageal reflux'}


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: Respiratory distress

PRESENT ILLNESS: Ms. [**Known lastname 34418**] is a 25 year old female with history of Myasthenia
[**Last Name (un) **] (dx [**5-2**], with two associated intubations) and asthma
presents with dyspnea, malaise and diplopia. The patient reports
that over the past week she developed URI-like symptoms
including frontal headache, rhinnorhea, clear productive cough,
nausea and one episode of emesis consisting of sputum. She also
noted increased instances of her typical diplopia, blurred
vision, and general malaise.  She also notes worsening of her
wheezing. On Friday ([**2146-10-28**]), the patient was reportedly
feeling worse and called her neurologist (Dr. [**Last Name (STitle) **] who
recommended increasing her Prednisone to 10mg daily from 5mg,
and her Mestinon 60mg from [**Hospital1 **] to TID. The patient reports that
the albuterol inhaler ran out on Friday night and since then has
used her albuterol nebulizer on mulitiple occassions with some
alleviation of symptoms. On Saturday, ([**2146-10-29**]), the patient
slept most the day.  On Sunday, ([**2146-10-30**]), the patient reported
increased activity including going to the park with her son,
laundry, and grocery shopping. However, on the morning of
admission, the patient awoke continued weakness and shortness of
breath, prompting her presentation to the [**Hospital1 18**] ER.
Upon arrival to the ED, her vitals were T: 98.0, BP: 133/81, HR:
72 RR: 19, O2sat: 100%RA.  Her initial NIF was -50cm and vital
capacity 1.8L. The pt was given Combivent Nebs x3 and Prednisone
60mg x1.
On ROS: The pt also states that her son was recently sick with a
cold. In addition the pt reports that she has been cleaning and
dusting her house. Also pt reports she has an allergy to dogs
and was recently exposed to dogs while at work.

MEDICAL HISTORY: -Myasthenia [**Last Name (un) 2902**], Dx [**5-2**].  Intubated for respiratory distress
during exacerbation [**1-1**] when she also presentewd with dipolpia
and
dyspnea.  Was also intubated for respiratory distress after
initial presentation in [**2145-4-25**].  Received plasmapheresis on
both occasions.
- Asthma since childhood
- Ventilator associated pneumonia
- Right lung nodule
- GERD
- s/p C-section

MEDICATION ON ADMISSION: -Advair Diskus 100 mcg-50 mcg two puffs daily
-Cellcept [**Pager number **] mg [**Hospital1 **]
-Prednisone 10 mg daily (taper)
-Mestinon 60 mg TID
-Albuterol nebulizer (has increased use to four times daily over
past three days)
-Zantac 75 mg [**Hospital1 **]

ALLERGIES: Penicillins

PHYSICAL EXAM: Gen: Mild distess, not speaking in full sentences, AOx3
HEENT: PERRLA, Extra-ocular movements intact however there is
difficulty tracking objects. Bilateral ptosis. MMM.
Neck: Supple without LAD
Resp: Scattered, Diffuse Wheezes, decrease airmovement
Card: S1S2 No MRG
Abd: Soft NT ND BS+
Extr: No C/C/E
Neuro: CN II-XII otherwise intact with exception of eye deficits
listed above.
Skin: No rashes

FAMILY HISTORY: Father- CAD, [**Name (NI) 2320**]
Mother- Mental Health Disease (Details unknown)
Son [**Name (NI) **] 5)- Health
No brothers of sisters

SOCIAL HISTORY: Single mother of 5yo son. Lives in [**Location 8391**], works as
pediatric  medical assistant in [**Hospital1 **], MA. Tobacco hx 14
years, still smoking up to 7 cigarettes per day, though none
since last week.  Occassional EtOH, non recently.  Denies drug
use. 

### Response:
{'Myasthenia gravis with (acute) exacerbation,Asthma, unspecified type, with (acute) exacerbation,Esophageal reflux'}
