CHIEF COMPLAINT: 

PRESENT ILLNESS: Ms. [**Known lastname 12933**] is a 65-year-old
female, with multiple medical problems including COPD,
diabetes mellitus, history of a DVT, and hypothyroidism, who
was transferred from [**Hospital 1562**] Hospital on [**1-16**], after
failing to wean from the ventilator.  The patient, according
to the hospital transfer, had a sore throat for four or five
days, and symptoms of a lower respiratory tract infection.
She presented to [**Hospital 1562**] Hospital on [**1-10**] and proceeded to
rapidly decompensate with hypoxemic and hypercapnic
respiratory failure.  She was found to have a left lower lobe
consolidation and required mechanical intubation.

MEDICAL HISTORY: 1. Hypothyroidism.
2. COPD.
3. Diabetes mellitus.
4. History of DVT several years ago.
5. Peptic ulcer disease.
6. GERD.
7. Chronic lower back pain, on narcotics for spinal stenosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: On presentation, the patient's vital signs
were as follows:  Temperature 99.9, blood pressure 156/93,
heart rate 77, respirations 14, satting 97% on room air.  She
was on AC 550x18 with pressure support of 10, PEEP 5, FIO2
0.5.
GENERAL:  She was an obese female, intubated, following
simple commands, in no acute distress.
HEENT:  Normocephalic, atraumatic.  Pupils 2 mm and reactive,
anicteric.  Oropharynx clear with moist mucous membranes.
NECK:  Supple.  No lymphadenopathy appreciated.  I was unable
to assess her JVP.  There were no bruits.
CARDIOVASCULAR:  Regular rate and rhythm with occasional
premature beats, a II/VI systolic murmur at the left sternal
border.  No rubs or gallops.
LUNGS:  She was moving a good amount of air bilaterally with
the exception of the right base, but she had crackles at the
midlung fields bilaterally.  There were no wheezes.
ABDOMEN:  Obese, soft, diffusely tender to palpation at that
point.  No rebound or guarding.  Normal bowel sounds.  No
masses or hepatosplenomegaly appreciated.
EXTREMITIES:  Trace pitting edema, bilateral lower
extremities.
NEUROLOGIC:  Squeezes both hands.  There was 4/5 strength.
Wiggles toes bilaterally.  Toes were downgoing.

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not work.  She lives with
her husband on [**Hospital3 **].  She has a remote tobacco history
and minimal alcohol use.  No intravenous drug use.
Methicillin susceptible pneumonia due to Staphylococcus aureus,Other pulmonary insufficiency, not elsewhere classified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Subendocardial infarction, initial episode of care,Critical illness myopathy,Long-term (current) use of steroids,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism
Meth sus pneum d/t Staph,Other pulmonary insuff,Obs chr bronc w(ac) exac,CHF NOS,Subendo infarct, initial,Critical illness myopthy,Long-term use steroids,DMII wo cmp nt st uncntr,Hypothyroidism NOS
Admission Date:  [**2136-1-16**]       Discharge Date:  [**2136-1-24**]

Date of Birth:   [**2070-7-12**]       Sex:  F

Service:  MICU [**Location (un) **]

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 12933**] is a 65-year-old
female, with multiple medical problems including COPD,
diabetes mellitus, history of a DVT, and hypothyroidism, who
was transferred from [**Hospital 1562**] Hospital on [**1-16**], after
failing to wean from the ventilator.  The patient, according
to the hospital transfer, had a sore throat for four or five
days, and symptoms of a lower respiratory tract infection.
She presented to [**Hospital 1562**] Hospital on [**1-10**] and proceeded to
rapidly decompensate with hypoxemic and hypercapnic
respiratory failure.  She was found to have a left lower lobe
consolidation and required mechanical intubation.

The hospital course there was notable for thick pulmonary
secretions, an MSSA growing out of sputum, and a chest CT
showing extensive alveolar interstitial process involving
both the left and right lung, with left greater than right.
The patient underwent bronchoscopy.  It was notable just for
the thick secretions.  She received aggressive antibiotics
including vancomycin, piperacillin, tazobactam, Levofloxacin
and clindamycin, but was unable to be weaned from the
ventilator for persistent hypoxemia.  She was transferred to
[**Hospital6 256**] for further evaluation
and treatment of her hypoxemic and hypercapnic respiratory
failure.

PAST MEDICAL HISTORY:
1. Hypothyroidism.
2. COPD.
3. Diabetes mellitus.
4. History of DVT several years ago.
5. Peptic ulcer disease.
6. GERD.
7. Chronic lower back pain, on narcotics for spinal stenosis.

ALLERGIES:  No known drug allergies.

MEDS ON TRANSFER:
1. Cleocin 600 mg q 8.
2. Levofloxacin 500 mg q 24.
3. Protonix 40 mg q 24.
4. Digoxin 0.25 q 24.
5. Metoprolol 25 mg IV q 6.
6. Fluconazole 100 mg IV q 24.
7. Synthroid 0.125 mg q 24.
8. Flexeril 10 mg q 8.
9. Chlorzoxazone 500 mg po tid.

SOCIAL HISTORY:  The patient does not work.  She lives with
her husband on [**Hospital3 **].  She has a remote tobacco history
and minimal alcohol use.  No intravenous drug use.

PHYSICAL EXAM:  On presentation, the patient's vital signs
were as follows:  Temperature 99.9, blood pressure 156/93,
heart rate 77, respirations 14, satting 97% on room air.  She
was on AC 550x18 with pressure support of 10, PEEP 5, FIO2
0.5.
GENERAL:  She was an obese female, intubated, following
simple commands, in no acute distress.
HEENT:  Normocephalic, atraumatic.  Pupils 2 mm and reactive,
anicteric.  Oropharynx clear with moist mucous membranes.
NECK:  Supple.  No lymphadenopathy appreciated.  I was unable
to assess her JVP.  There were no bruits.
CARDIOVASCULAR:  Regular rate and rhythm with occasional
premature beats, a II/VI systolic murmur at the left sternal
border.  No rubs or gallops.
LUNGS:  She was moving a good amount of air bilaterally with
the exception of the right base, but she had crackles at the
midlung fields bilaterally.  There were no wheezes.
ABDOMEN:  Obese, soft, diffusely tender to palpation at that
point.  No rebound or guarding.  Normal bowel sounds.  No
masses or hepatosplenomegaly appreciated.
EXTREMITIES:  Trace pitting edema, bilateral lower
extremities.
NEUROLOGIC:  Squeezes both hands.  There was 4/5 strength.
Wiggles toes bilaterally.  Toes were downgoing.

OUTSIDE LABORATORY VALUES:  Notable for white blood cell
count 22.6, hematocrit 32.  Her chem-7 was within normal
limits with the exception of a glucose of 214.  She had also
a dig level of less than 1 at the outside hospital.  A
troponin-I peaked at 0.20.

[**Hospital3 **] LABS AT PRESENTATION:  White count 23.4,
hematocrit 32.9.  Her coags were normal, as was her chem-10.
Her CK was 23, troponin less than 0.01.  ABG - 7.44, 43, 103.
Chest x-ray showed diffuse air space opacities involving the
left middle and lower lobes, and the right lower lobe.

HOSPITAL COURSE - 1) PNEUMONIA:  The patient was continued on
clindamycin for her MSSA pneumonia before being switched to
oxacillin.  The oxacillin was continued for a total of a
10-day course.  The patient was extubated 2 days after
admission, and thereafter remained stable on 2 liters nasal
cannula with oxygen saturations greater than 95%, and her
lungs remained fairly clear.  It was presumed that the
respiratory failure was due to an MSSA pneumonia superimposed
on her chronic obstructive pulmonary disease.

2) LEUKOCYTOSIS:  The patient had a leukocytosis which we
attributed to her steroid use.  Her steroids were tapered,
and her white blood cell count was down to 13 the day prior
to discharge.  She had no further signs of infection, such as
fever.

3) WEAKNESS:  The patient, 3 days prior to discharge, was
noticed to have diffuse peripheral weakness and bifacial
weakness with some garbled speech.  The patient underwent a
lumbar puncture which was unremarkable.  She was due to have
an MRI prior to discharge, and seen by the neurology service
who felt that it was possible that the patient had suffered a
CVA during her Intensive Care Unit stay, or that she was
suffering from ICU neuropathy or myopathy.  The day prior to
discharge, however, her strength was slightly better.  At
baseline, the patient is dependent on a scooter to move about
secondary to her lower back pain, but she has full strength
in her upper extremities and is able to lift her scooter.

4) CHF:  The patient had an outside hospital echo showing an
EF of roughly 40%.  She was continued on ACE inhibitor and
beta blocker which she tolerated well during her hospital
stay.  She required occasional doses of hydralazine for
systolic blood pressures above 160.

5) CORONARY ARTERY DISEASE:  The patient had a non-Q wave MI
versus CHF troponin leak at outside hospital.  She was
continued on beta blocker, aspirin, ACE inhibitor while in
house.

DISCHARGE MEDICATIONS:  They are to be dictated the day of
discharge.

DISCHARGE DIAGNOSES:
1. Methicillin sensitive Staphylococcus aureus pneumonia,
left greater than right.
2. Weakness likely secondary to ICU neuropathy/myopathy
versus cerebrovascular accident.
3. Leukocytosis secondary to steroid use.
4. Congestive heart failure.
5. Coronary artery disease.

DISCHARGE CONDITION:  The patient was discharged in stable
condition.

DISPO:  The patient is being discharged to possibly
[**Location (un) **]-[**Location (un) 9188**].

FOLLOW-UP:  The patient is to follow-up with her primary care
physician on [**Location (un) **].




                            [**Name6 (MD) **] [**Last Name (NamePattern4) 5837**], M.D.  [**MD Number(1) 5838**]

Dictated By:[**Last Name (NamePattern1) 11801**]
MEDQUIST36

D:  [**2136-1-23**]  13:04
T:  [**2136-1-23**]  13:07
JOB#:  [**Job Number 12934**]
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Other pulmonary insufficiency, not elsewhere classified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Subendocardial infarction, initial episode of care,Critical illness myopathy,Long-term (current) use of steroids,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism'}


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: 

PRESENT ILLNESS: Ms. [**Known lastname 12933**] is a 65-year-old
female, with multiple medical problems including COPD,
diabetes mellitus, history of a DVT, and hypothyroidism, who
was transferred from [**Hospital 1562**] Hospital on [**1-16**], after
failing to wean from the ventilator.  The patient, according
to the hospital transfer, had a sore throat for four or five
days, and symptoms of a lower respiratory tract infection.
She presented to [**Hospital 1562**] Hospital on [**1-10**] and proceeded to
rapidly decompensate with hypoxemic and hypercapnic
respiratory failure.  She was found to have a left lower lobe
consolidation and required mechanical intubation.

MEDICAL HISTORY: 1. Hypothyroidism.
2. COPD.
3. Diabetes mellitus.
4. History of DVT several years ago.
5. Peptic ulcer disease.
6. GERD.
7. Chronic lower back pain, on narcotics for spinal stenosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: On presentation, the patient's vital signs
were as follows:  Temperature 99.9, blood pressure 156/93,
heart rate 77, respirations 14, satting 97% on room air.  She
was on AC 550x18 with pressure support of 10, PEEP 5, FIO2
0.5.
GENERAL:  She was an obese female, intubated, following
simple commands, in no acute distress.
HEENT:  Normocephalic, atraumatic.  Pupils 2 mm and reactive,
anicteric.  Oropharynx clear with moist mucous membranes.
NECK:  Supple.  No lymphadenopathy appreciated.  I was unable
to assess her JVP.  There were no bruits.
CARDIOVASCULAR:  Regular rate and rhythm with occasional
premature beats, a II/VI systolic murmur at the left sternal
border.  No rubs or gallops.
LUNGS:  She was moving a good amount of air bilaterally with
the exception of the right base, but she had crackles at the
midlung fields bilaterally.  There were no wheezes.
ABDOMEN:  Obese, soft, diffusely tender to palpation at that
point.  No rebound or guarding.  Normal bowel sounds.  No
masses or hepatosplenomegaly appreciated.
EXTREMITIES:  Trace pitting edema, bilateral lower
extremities.
NEUROLOGIC:  Squeezes both hands.  There was 4/5 strength.
Wiggles toes bilaterally.  Toes were downgoing.

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not work.  She lives with
her husband on [**Hospital3 **].  She has a remote tobacco history
and minimal alcohol use.  No intravenous drug use. 

### Response:
{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Other pulmonary insufficiency, not elsewhere classified,Obstructive chronic bronchitis with (acute) exacerbation,Congestive heart failure, unspecified,Subendocardial infarction, initial episode of care,Critical illness myopathy,Long-term (current) use of steroids,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism'}
