CHIEF COMPLAINT: cough

PRESENT ILLNESS: 51 y/o F COPD, Crohn's disease, AS s/p bioprosthetic aortic
valve replacement who presents with worsening of chronic cough.
Patient developed non-productive cough one week ago which
continued to worsen. Patient describes associated fevers
(according to patient 102), chills, fatigue, and mild nausea.
Patient denies shortness of breath or chest pain. At home she
wears 3 L of oxygen at night, and occasionally during the day -
she has not had to increase her oxygen recently. Patient
presented to [**Company 191**] today for an urgent care appointment to and was
referred to the ED.
.
In the ED, initial vs were: T 98.4 P 93 BP 94/55 R 26 O2 sat
85%. BP ranged from 84-104/48-56. O2 sat 85% RA, patient was
initially stable on 6L NC in the low 90s but dropped to 85% and
consequently was started on non-rebreather. Patient was given
NEBs, Solumedrol, Ceftriaxone, Levofloxacin, 1 L NS. Patient was
admitted to ICU for further monitoring.
.
Patient reports her blood pressure has been low the past several
weeks (SBP 90-100) and consequently has not been taking her
atenolol. During this time she was experiencing significant
diarrhea secondary to crohn's disease which mildy improved last
week since starting Budesonide [**2151-2-18**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: ATENOLOL - 25 mg Tablet - 1 Tablet(s) by mouth once daily Hold
if
systolic blood pressure < 100 - not been taking recently
ATORVASTATIN [LIPITOR] - 80 mg Tablet - 1 Tablet(s) by mouth
once
a day
FLUTICASONE-SALMETEROL [ADVAIR DISKUS] - 250 mcg-50 mcg/Dose
Disk
with Device - 1 puff inhaled twice a day
FOLIC ACID - 1 MG TABLET - ONE TABLET BY MOUTH EVERY DAY
HYDROMORPHONE - 4 mg Tablet - 1 Tablet(s) by mouth three times
daily as needed as needed for pain 3 tabs/day - 28 day supply is
84 tabs
IBANDRONATE [BONIVA] - 150 mg Tablet - 1 Tablet(s) by mouth q
month
LISINOPRIL - 5 mg Tablet - 1 Tablet(s) by mouth daily in the
evening
OXYGEN 3 LITERS AT NIGHT AND WITH EXERTION -  (Prescribed by
Other Provider) - Dosage uncertain
PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1 (One)
Tablet, Delayed Release (E.C.)(s) by mouth twice a day
Budesonide 6 mg qd
PREGABALIN [LYRICA] - 75 mg Capsule - 3 Capsule(s) by mouth
twice
daily
PROMETHAZINE - 25 mg Tablet - 1 Tablet(s) by mouth every 6 hours
as needed for nausea
SUCRALFATE - 1 gram Tablet - 1 Tablet(s) by mouth twice daily
with  meals
SULFASALAZINE - 500 MG TABLET - 2 tablets by mouth three times a
day
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg Capsule,
w/Inhalation Device - 1 capsule inhaled Once daily at hs
TIZANIDINE - 4 mg Tablet - 1 Tablet(s) by mouth every 8 hours as
needed for as needed for muscle spasm do not combine with
cyclobenzaprine (flexeril). Do not take before driving or
operating machinery.
TRAZODONE - 100 mg Tablet - [**1-16**] Tablet(s) by mouth at bedtime as
needed for insomnia
Medications - OTC
ASPIRIN - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by
mouth daily
CALCIUM - 500 mg Tablet - 1 Tablet(s) by mouth twice a day
CYANOCOBALAMIN [VITAMIN B-12] - 100 mcg Tablet - 1 Tablet(s) by
mouth daily
FERROUS SULFATE [SLOW FE] - 160 mg (50 mg) Tablet Sustained
Release - 1 Tablet(s) by mouth daily
LIDOCAINE [LMX 4] - 4 % Cream - AAA ear at bedtime
MULTIVITAMIN -   Tablet - 1 Tablet(s) by mouth once a day
ONE TOUCH II TEST -   Strip - as directed twice a day

ALLERGIES: Penicillins / Darvocet-N 100 / Aspirin / Amitriptyline /
Wellbutrin

PHYSICAL EXAM: Vitals: T: 98.1 BP: 98/70 P: 72 R: 19 O2: 95% NRB
General: Alert, oriented, no acute distress, on non-rebreather
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Wheezes bilateral
CV: Regular rate and rhythm, normal S1 + S2, systolic murmurs
with click
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

FAMILY HISTORY: Family History: No history of lung disease.

SOCIAL HISTORY: - Tobacco: 1 pack a day past 34 years
- Alcohol: Denies
- Illicits: Denies
Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Regional enteritis of unspecified site,Hypovolemia,Nonspecific low blood pressure reading,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Other chronic pain,Pure hypercholesterolemia,Heart valve replaced by transplant,Tobacco use disorder,Other dependence on machines, supplemental oxygen
Obs chr bronc w(ac) exac,Pneumonia, organism NOS,Regional enteritis NOS,Hypovolemia,Low blood press reading,Iron defic anemia NOS,Hypertension NOS,Chronic pain NEC,Pure hypercholesterolem,Heart valve transplant,Tobacco use disorder,Depend-supplement oxygen
Admission Date:  [**2151-3-5**]              Discharge Date:   [**2151-3-7**]

Date of Birth:  [**2100-1-23**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Darvocet-N 100 / Aspirin / Amitriptyline /
Wellbutrin

Attending:[**First Name3 (LF) 9454**]
Chief Complaint:
cough

Major Surgical or Invasive Procedure:
None


History of Present Illness:
51 y/o F COPD, Crohn's disease, AS s/p bioprosthetic aortic
valve replacement who presents with worsening of chronic cough.
Patient developed non-productive cough one week ago which
continued to worsen. Patient describes associated fevers
(according to patient 102), chills, fatigue, and mild nausea.
Patient denies shortness of breath or chest pain. At home she
wears 3 L of oxygen at night, and occasionally during the day -
she has not had to increase her oxygen recently. Patient
presented to [**Company 191**] today for an urgent care appointment to and was
referred to the ED.
.
In the ED, initial vs were: T 98.4 P 93 BP 94/55 R 26 O2 sat
85%. BP ranged from 84-104/48-56. O2 sat 85% RA, patient was
initially stable on 6L NC in the low 90s but dropped to 85% and
consequently was started on non-rebreather. Patient was given
NEBs, Solumedrol, Ceftriaxone, Levofloxacin, 1 L NS. Patient was
admitted to ICU for further monitoring.
.
Patient reports her blood pressure has been low the past several
weeks (SBP 90-100) and consequently has not been taking her
atenolol. During this time she was experiencing significant
diarrhea secondary to crohn's disease which mildy improved last
week since starting Budesonide [**2151-2-18**].

Social History:
- Tobacco: 1 pack a day past 34 years
- Alcohol: Denies
- Illicits: Denies

Family History:
Family History: No history of lung disease.

Physical Exam:
Vitals: T: 98.1 BP: 98/70 P: 72 R: 19 O2: 95% NRB
General: Alert, oriented, no acute distress, on non-rebreather
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Wheezes bilateral
CV: Regular rate and rhythm, normal S1 + S2, systolic murmurs
with click
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

Pertinent Results:
CXR [**2151-3-5**]:
IMPRESSION: Right middle lobe and left lower lobe opacity likely
represent a combination of atelectasis and pneumonia.

CXR [**2151-3-6**]:
IMPRESSION:
1. Redemonstrated bibasilar airspace disease likely representing
atelectasis.
2. Stable post-surgical changes.


Brief Hospital Course:
Assessment and Plan: 51 y/o F PMH COPD, Crohn's disease, AS s/p
replacement who presents with chronic cough and hypoxia.

# Pneumonia/COPD exacerbation: Patient with clinical history,
symptoms & CXR supporting a pneumonia. CXR demonstrated a RML
and LLL infiltrate. The patient was initially admitted to the
ICU due to her oxygen requirement, but she improved with
Prednisone, Azithromycin, and Ceftriaxone. She was maintained on
standing Albuterol/Ipratropium nebulizers and O2 by NC (she
requires 3L at home at baseline). She was transferred to the
medicine floor within one hospital day and was discharged on a
Prednisone taper, a 7 day course of Cefpodoxime & a 5 day course
of Azithromycin.

# Hypotension: Patient admitted with hypotension [**2-16**] diarrhea &
insensible losses from infection, that resolved with IVF's. She
demonstrated no positive SIRS criteria suggesting underlying
sepsis. Two sets of cardiac enzymes were negative. When her
hypotension resolved, her home antihypertensives were restarted
without incident.

# Microcytic anemia: Patient with a baseline Hct of 32 (baseline
ranges from 25-32), likely secondary to iron deficiency from
Crohn's disease. Patient's stools were guaiac negative during
this admission.

# Crohn's disease: Patient continued her home Budesonide and
Sulfasalazine. A bowel regimen was held at the patient's request
given tendency toward diarrhea.

# HTN: Patient's home Lisinopril 5mg qPM & Atenolol 25mg PO
daily were held in the context of hypotension & restarted when
her hypotension resolved.

# Chronic pain: Patient continue her outpatient medications
Dilaudid and Lyrica.

# Hypercholesterolemia: Patient continued her home Atorvastatin
80mg PO daily


Medications on Admission:
ATENOLOL - 25 mg Tablet - 1 Tablet(s) by mouth once daily Hold
if
systolic blood pressure < 100 - not been taking recently
ATORVASTATIN [LIPITOR] - 80 mg Tablet - 1 Tablet(s) by mouth
once
a day
FLUTICASONE-SALMETEROL [ADVAIR DISKUS] - 250 mcg-50 mcg/Dose
Disk
with Device - 1 puff inhaled twice a day
FOLIC ACID - 1 MG TABLET - ONE TABLET BY MOUTH EVERY DAY
HYDROMORPHONE - 4 mg Tablet - 1 Tablet(s) by mouth three times
daily as needed as needed for pain 3 tabs/day - 28 day supply is
84 tabs
IBANDRONATE [BONIVA] - 150 mg Tablet - 1 Tablet(s) by mouth q
month
LISINOPRIL - 5 mg Tablet - 1 Tablet(s) by mouth daily in the
evening
OXYGEN 3 LITERS AT NIGHT AND WITH EXERTION -  (Prescribed by
Other Provider) - Dosage uncertain
PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1 (One)
Tablet, Delayed Release (E.C.)(s) by mouth twice a day
Budesonide 6 mg qd
PREGABALIN [LYRICA] - 75 mg Capsule - 3 Capsule(s) by mouth
twice
daily
PROMETHAZINE - 25 mg Tablet - 1 Tablet(s) by mouth every 6 hours
as needed for nausea
SUCRALFATE - 1 gram Tablet - 1 Tablet(s) by mouth twice daily
with  meals
SULFASALAZINE - 500 MG TABLET - 2 tablets by mouth three times a
day
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg Capsule,
w/Inhalation Device - 1 capsule inhaled Once daily at hs
TIZANIDINE - 4 mg Tablet - 1 Tablet(s) by mouth every 8 hours as
needed for as needed for muscle spasm do not combine with
cyclobenzaprine (flexeril). Do not take before driving or
operating machinery.
TRAZODONE - 100 mg Tablet - [**1-16**] Tablet(s) by mouth at bedtime as
needed for insomnia
Medications - OTC
ASPIRIN - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by
mouth daily
CALCIUM - 500 mg Tablet - 1 Tablet(s) by mouth twice a day
CYANOCOBALAMIN [VITAMIN B-12] - 100 mcg Tablet - 1 Tablet(s) by
mouth daily
FERROUS SULFATE [SLOW FE] - 160 mg (50 mg) Tablet Sustained
Release - 1 Tablet(s) by mouth daily
LIDOCAINE [LMX 4] - 4 % Cream - AAA ear at bedtime
MULTIVITAMIN -   Tablet - 1 Tablet(s) by mouth once a day
ONE TOUCH II TEST -   Strip - as directed twice a day


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Pneumonia, COPD exacerbation
Secondary: Crohn's Disease
Chronic pain
Hypertension
Hyperlipidemia


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


Discharge Instructions:
Ms. [**Known lastname **], It was a pleasure taking care of you.

You were admitted to the hospital for fever, cough, and
shortness of breath. In the hospital, you were found to have a
pneumonia and an exacerbation of your COPD. You were given
antibiotics and steroids and your symptoms improved. You were
discharged home with a short course of steroids and antibiotics.

Medications: The following changes were made to your [**Known lastname 4085**]
regimen,
1. Cefpodoxime: This is an antibiotic to treat your pneumonia.
Please continue to take this [**Known lastname 4085**] as directed for the next
5 days.
2. Azithromycin: This is an antibiotic to treat your pneumonia.
Please continue to take this [**Known lastname 4085**] as directed for the next
3 days.
3. Prednisone: This is a steroid used to treat your COPD
exacerbation. Please continue to take this [**Known lastname 4085**] with the
following tapered dose:
60 mg on [**3-8**]
40 mg on [**2-25**]
20 mg on [**3-20**]

Followup Instructions:
Please follow-up with your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], in
the next 1-2 weeks. Please call [**Telephone/Fax (1) 250**] to schedule an
appointment.
{'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Regional enteritis of unspecified site,Hypovolemia,Nonspecific low blood pressure reading,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Other chronic pain,Pure hypercholesterolemia,Heart valve replaced by transplant,Tobacco use disorder,Other dependence on machines, supplemental oxygen'}


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: cough

PRESENT ILLNESS: 51 y/o F COPD, Crohn's disease, AS s/p bioprosthetic aortic
valve replacement who presents with worsening of chronic cough.
Patient developed non-productive cough one week ago which
continued to worsen. Patient describes associated fevers
(according to patient 102), chills, fatigue, and mild nausea.
Patient denies shortness of breath or chest pain. At home she
wears 3 L of oxygen at night, and occasionally during the day -
she has not had to increase her oxygen recently. Patient
presented to [**Company 191**] today for an urgent care appointment to and was
referred to the ED.
.
In the ED, initial vs were: T 98.4 P 93 BP 94/55 R 26 O2 sat
85%. BP ranged from 84-104/48-56. O2 sat 85% RA, patient was
initially stable on 6L NC in the low 90s but dropped to 85% and
consequently was started on non-rebreather. Patient was given
NEBs, Solumedrol, Ceftriaxone, Levofloxacin, 1 L NS. Patient was
admitted to ICU for further monitoring.
.
Patient reports her blood pressure has been low the past several
weeks (SBP 90-100) and consequently has not been taking her
atenolol. During this time she was experiencing significant
diarrhea secondary to crohn's disease which mildy improved last
week since starting Budesonide [**2151-2-18**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: ATENOLOL - 25 mg Tablet - 1 Tablet(s) by mouth once daily Hold
if
systolic blood pressure < 100 - not been taking recently
ATORVASTATIN [LIPITOR] - 80 mg Tablet - 1 Tablet(s) by mouth
once
a day
FLUTICASONE-SALMETEROL [ADVAIR DISKUS] - 250 mcg-50 mcg/Dose
Disk
with Device - 1 puff inhaled twice a day
FOLIC ACID - 1 MG TABLET - ONE TABLET BY MOUTH EVERY DAY
HYDROMORPHONE - 4 mg Tablet - 1 Tablet(s) by mouth three times
daily as needed as needed for pain 3 tabs/day - 28 day supply is
84 tabs
IBANDRONATE [BONIVA] - 150 mg Tablet - 1 Tablet(s) by mouth q
month
LISINOPRIL - 5 mg Tablet - 1 Tablet(s) by mouth daily in the
evening
OXYGEN 3 LITERS AT NIGHT AND WITH EXERTION -  (Prescribed by
Other Provider) - Dosage uncertain
PANTOPRAZOLE - 40 mg Tablet, Delayed Release (E.C.) - 1 (One)
Tablet, Delayed Release (E.C.)(s) by mouth twice a day
Budesonide 6 mg qd
PREGABALIN [LYRICA] - 75 mg Capsule - 3 Capsule(s) by mouth
twice
daily
PROMETHAZINE - 25 mg Tablet - 1 Tablet(s) by mouth every 6 hours
as needed for nausea
SUCRALFATE - 1 gram Tablet - 1 Tablet(s) by mouth twice daily
with  meals
SULFASALAZINE - 500 MG TABLET - 2 tablets by mouth three times a
day
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg Capsule,
w/Inhalation Device - 1 capsule inhaled Once daily at hs
TIZANIDINE - 4 mg Tablet - 1 Tablet(s) by mouth every 8 hours as
needed for as needed for muscle spasm do not combine with
cyclobenzaprine (flexeril). Do not take before driving or
operating machinery.
TRAZODONE - 100 mg Tablet - [**1-16**] Tablet(s) by mouth at bedtime as
needed for insomnia
Medications - OTC
ASPIRIN - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by
mouth daily
CALCIUM - 500 mg Tablet - 1 Tablet(s) by mouth twice a day
CYANOCOBALAMIN [VITAMIN B-12] - 100 mcg Tablet - 1 Tablet(s) by
mouth daily
FERROUS SULFATE [SLOW FE] - 160 mg (50 mg) Tablet Sustained
Release - 1 Tablet(s) by mouth daily
LIDOCAINE [LMX 4] - 4 % Cream - AAA ear at bedtime
MULTIVITAMIN -   Tablet - 1 Tablet(s) by mouth once a day
ONE TOUCH II TEST -   Strip - as directed twice a day

ALLERGIES: Penicillins / Darvocet-N 100 / Aspirin / Amitriptyline /
Wellbutrin

PHYSICAL EXAM: Vitals: T: 98.1 BP: 98/70 P: 72 R: 19 O2: 95% NRB
General: Alert, oriented, no acute distress, on non-rebreather
HEENT: Sclera anicteric, dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Wheezes bilateral
CV: Regular rate and rhythm, normal S1 + S2, systolic murmurs
with click
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

FAMILY HISTORY: Family History: No history of lung disease.

SOCIAL HISTORY: - Tobacco: 1 pack a day past 34 years
- Alcohol: Denies
- Illicits: Denies 

### Response:
{'Obstructive chronic bronchitis with (acute) exacerbation,Pneumonia, organism unspecified,Regional enteritis of unspecified site,Hypovolemia,Nonspecific low blood pressure reading,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Other chronic pain,Pure hypercholesterolemia,Heart valve replaced by transplant,Tobacco use disorder,Other dependence on machines, supplemental oxygen'}
