CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 76-year-old
woman with a history of hypertension, who was recently
changed from atenolol and hydrochlorothiazide to lisinopril.
Three days prior to admission, she began to experience facial
swelling which started on the left side of her face and
gradually spread bilaterally through her lips.  The patient
was given some Benadryl two days prior to admission without
any resolution of symptoms.

MEDICAL HISTORY: 1. Hypothyroidism.
2. Hypertension.
3. Right knee surgery for a total right knee replacement.
4. Hypercholesterolemia.
5. Postoperative delirium.
6. Left cataract surgery.
7. Osteoarthritis.
8. Left femoral cutaneous nerve syndrome.

MEDICATION ON ADMISSION: 1. Synthroid 125 mg a day.
2. Lipitor 10 mg a day.
3. Lisinopril 40 mg a day.
4. Benadryl 40 mg twice a day.
5. She had previously been on Neurontin and amitriptyline as
well.

ALLERGIES: Haldol and ACE inhibitors.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient lives with her granddaughter.
There is no family history of reaction to ACE inhibitors or
other substances.  The patient's daughter died of ovarian
cancer and her son died of brain cancer.

SOCIAL HISTORY: The patient smoked one pack a day for 30
years.  She denies ethanol or drug abuse.  The patient's
granddaughter is a RN who had helped her at home.
Angioneurotic edema, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Precipitous drop in hematocrit,Other antihypertensive agents causing adverse effects in therapeutic use
Angioneurotic edema,Hypothyroidism NOS,Hypertension NOS,Pure hypercholesterolem,Anemia NOS,Drop, hematocrit, precip,Adv eff antihyperten agt
Admission Date:  [**2184-11-16**]     Discharge Date:  [**2184-11-19**]

Date of Birth:   [**2108-10-18**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 76-year-old
woman with a history of hypertension, who was recently
changed from atenolol and hydrochlorothiazide to lisinopril.
Three days prior to admission, she began to experience facial
swelling which started on the left side of her face and
gradually spread bilaterally through her lips.  The patient
was given some Benadryl two days prior to admission without
any resolution of symptoms.

One to two days prior to arrival, the patient had some
pruritus in the mouth and noticed that her lip was swelling.
She was given additional Benadryl and Atarax, however, the
swelling continued to worsen to the point where her tongue
additionally swelled and she could not talk.  Note that her
ACE inhibitor was stopped two days prior to admission.

In the Emergency Department, the patient was given two doses
of Epinephrine, Pepcid, Benadryl, and Solu-Medrol.
Anesthesia was consulted, and the patient was taken to the
operating room for possible endotracheal intubation versus
tracheostomy.  However, the swelling began to improve, and
the patient's airway was not compromised.  The patient did
note some difficulty with her tongue swelling in terms of her
breathing, and she also noted some hives when she arrived in
the Emergency Department.

REVIEW OF SYSTEMS:  The patient denied fever or chills,
diaphoresis, sick contacts, cough, or shortness of breath, or
chest pain.  She also denied nausea, vomiting, urinary
symptoms, or any change in bowel movements.  She denied
having any snake or spider bites.  She denied having any new
pets, foods, perfumes, or soaps.  She did note recent travel
to Barbados about 10 days prior to admission.

PAST MEDICAL HISTORY:
1. Hypothyroidism.
2. Hypertension.
3. Right knee surgery for a total right knee replacement.
4. Hypercholesterolemia.
5. Postoperative delirium.
6. Left cataract surgery.
7. Osteoarthritis.
8. Left femoral cutaneous nerve syndrome.

ALLERGIES:  Haldol and ACE inhibitors.

MEDICATIONS ON ADMISSION:
1. Synthroid 125 mg a day.
2. Lipitor 10 mg a day.
3. Lisinopril 40 mg a day.
4. Benadryl 40 mg twice a day.
5. She had previously been on Neurontin and amitriptyline as
well.

SOCIAL HISTORY:  The patient smoked one pack a day for 30
years.  She denies ethanol or drug abuse.  The patient's
granddaughter is a RN who had helped her at home.

FAMILY HISTORY:  The patient lives with her granddaughter.
There is no family history of reaction to ACE inhibitors or
other substances.  The patient's daughter died of ovarian
cancer and her son died of brain cancer.

HOSPITAL COURSE:  The patient was admitted to the Intensive
Care Unit for monitoring and IV steroids.  On the 2nd
hospital day, the patient was transferred to the floor at
which time a physical examination was performed by our
medical team.

The patient's temperature was 99.0 F, blood pressure was
146/70, heart rate of 88, respiratory rate of 20, and a pulse
oximetry of 98% on room air.  She was alert and oriented in
no apparent distress and quite pleasant.  HEENT:  Pupils are
equal, round, and reactive to light and accommodation with
some left pupil asymmetry.  Extraocular motions intact.
Bilateral arcus senilis.  The patient's throat and oropharynx
examination was notable for tongue swelling and a barely
visible uvula.  There was no stridor over her airway.  Chest
examination was clear to auscultation bilaterally, although
breath sounds were distant.  There were no wheezes or
rhonchi.  Cardiac examination:  Regular, rate, and rhythm,
S1, S2, no murmurs, rubs, or gallops.  Abdominal examination:
positive bowel sounds, obese, soft, nontender, and
nondistended, and no guarding and no rebound.  Extremities:
No edema in the lower extremities.  She had some limited left
knee flexion.  Distal pulses were intact upper and lower
extremities.  Distal and proximal strength was [**4-18**].  Cranial
nerves II through XII are intact and sensation was grossly
intact.

LABORATORIES:  Laboratories on transfer from Intensive Care
Unit to floor:  Her Chem-7 was normal.  Her hematocrit was
35.7, which had decreased from 41.8 on admission.  Her coags
were normal.  TSH was 0.89 and a C1 esterase laboratory
inhibitor was pending.  The C1 esterase test later came back
in the normal range at 21, reference range for that is [**6-8**].
A functional C1 inhibitor level came back greater than 100%,
and again the reference range for normal is greater than 68%.

HOSPITAL COURSE:  The [**Hospital 228**] hospital course on the floor
was essentially unremarkable.  She did complain of a
subjective sensation of some throat swelling on her stay on
the medical floor, and there was some question of stridor
over her airway, although minimal.  She was continued for
another day on intravenous Solu-Medrol, and then changed to
po prednisone.  The patient's blood pressure was treated with
hydrochlorothiazide, triamterene, and maintained within
normal range.

The patient was discharged home in good condition with a
diagnosis of presumptive angioedema secondary to ACE
inhibitor.

FOLLOWUP:  She was to followup with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] within a
week of discharge.

DISCHARGE MEDICATIONS:
1. Synthroid 125 mg once a day.
2. Lipitor 10 mg once a day.
3. Triamterene/hydrochlorothiazide 37.5/25 mg tablets.
4. Atarax 25 mg a day.
5. Zantac 150 mg twice a day.




                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 15868**]

Dictated By:[**Last Name (NamePattern1) 2215**]

MEDQUIST36

D:  [**2184-11-29**]  08:57
T:  [**2184-12-2**]  08:15
JOB#:  [**Job Number 29687**]
{'Angioneurotic edema, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Precipitous drop in hematocrit,Other antihypertensive agents causing adverse effects in therapeutic use'}


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: The patient is a 76-year-old
woman with a history of hypertension, who was recently
changed from atenolol and hydrochlorothiazide to lisinopril.
Three days prior to admission, she began to experience facial
swelling which started on the left side of her face and
gradually spread bilaterally through her lips.  The patient
was given some Benadryl two days prior to admission without
any resolution of symptoms.

MEDICAL HISTORY: 1. Hypothyroidism.
2. Hypertension.
3. Right knee surgery for a total right knee replacement.
4. Hypercholesterolemia.
5. Postoperative delirium.
6. Left cataract surgery.
7. Osteoarthritis.
8. Left femoral cutaneous nerve syndrome.

MEDICATION ON ADMISSION: 1. Synthroid 125 mg a day.
2. Lipitor 10 mg a day.
3. Lisinopril 40 mg a day.
4. Benadryl 40 mg twice a day.
5. She had previously been on Neurontin and amitriptyline as
well.

ALLERGIES: Haldol and ACE inhibitors.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient lives with her granddaughter.
There is no family history of reaction to ACE inhibitors or
other substances.  The patient's daughter died of ovarian
cancer and her son died of brain cancer.

SOCIAL HISTORY: The patient smoked one pack a day for 30
years.  She denies ethanol or drug abuse.  The patient's
granddaughter is a RN who had helped her at home. 

### Response:
{'Angioneurotic edema, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Precipitous drop in hematocrit,Other antihypertensive agents causing adverse effects in therapeutic use'}
