CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 68 yo f w/ HIV (cd4 209, VL undetectable earlier this month),
ESRD on HD, CAD s/p IMI w/ 2 LCX stents, CHF, COPD, DMII, h/o
eosinophilic PNA [**4-22**], who p/w sudden onset of SOB while sitting
in bed, 1 night PTA.  Accompanied by R sided CP, worse w/
inspiration. reports dry cough, unchanged X many months.  +subj
fevers/chills X1 day. no LE edema/ urinary changes/sore throat/
photophobia/ orthopnea. Pt was recently admitted on [**9-28**] with
chest pain and SOB, which was ultimately attributed to recurrent
eosinophilic PNA, as her prior steroid course was too short. At
that time she was d/c'ed on 9 month taper starting at 40mg per
day. She was currently taking 20mg of prednisone per day prior
to admission.

MEDICAL HISTORY: Coronary artery disease status post
non-ST elevation MI in [**2111-5-19**], status post PTCA/stent to
the left circumflex, status post PTCA/stent of mid left
circumflex in [**2113-5-18**], latest catheterization in [**2113-10-18**] with two-vessel disease.  ETT MIBI done on [**2114-5-10**] significant for no symptoms, EKG changes, and with only
a fixed inferior defect, ejection fraction 58 percent.

MEDICATION ON ADMISSION: zidovudine 200mg [**Hospital1 **]
nevirapine 200 [**Hospital1 **]
neprhocap 1 po qd
atrovent neb q4h prn
ipratroprium neb q4h
Advarr 5oo/50
Metoprolol 50 mg qd (presumably toprol xl)
Isordil 10 [**Hospital1 **]
ECASA 325mg
Prilosec 20 mq qd
mycelex torche 10mg x 5d
Procrit- at dialysis
colace 100 [**Hospital1 **]
Senna 2 po prn
Lactulos 2tabs, hs prn
immodium 2mg
Lumigan 1gtt ou
Aldara cream [**Hospital1 **] taper per wk
reglan 10mg po qd
RISS
Lisinopril 2.5 mg po qd
Prednisone 20mg po qd (titrated down from 30 on [**11-12**])
NPH 8U qam

ALLERGIES: Motrin / Lipitor

PHYSICAL EXAM: PE on admit to [**Hospital Unit Name 153**]
t 97.1, bp 88/34, p 85, r18
lying in flat in bed, in NAD
PERRL. MMM
poor dentition, no carries
no JVD
Regular s1,s2. no m/r/g
LCA b/l.
+bs. soft. nt. nd.
1 +trace edema

FAMILY HISTORY: NC

SOCIAL HISTORY: SOCIAL HISTORY:  The patient currently lives in [**Location 102241**]
her niece.  She was previously a housewife.  She denies alcohol
or drug use.  She smoked 2 packs a day for 40 years.
Pulmonary eosinophilia,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease,Asymptomatic human immunodeficiency virus [HIV] infection status,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status
Pulmonary eosinophilia,Pneumonia, organism NOS,Hyp kid NOS w cr kid V,CHF NOS,Chr airway obstruct NEC,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Anemia in chr kidney dis,Asymp hiv infectn status,Old myocardial infarct,Status-post ptca
Admission Date:  [**2114-11-13**]              Discharge Date:   [**2114-11-17**]

Date of Birth:  [**2046-6-27**]             Sex:   F

Service: MED

Allergies:
Motrin / Lipitor

Attending:[**First Name3 (LF) 562**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
none

History of Present Illness:
68 yo f w/ HIV (cd4 209, VL undetectable earlier this month),
ESRD on HD, CAD s/p IMI w/ 2 LCX stents, CHF, COPD, DMII, h/o
eosinophilic PNA [**4-22**], who p/w sudden onset of SOB while sitting
in bed, 1 night PTA.  Accompanied by R sided CP, worse w/
inspiration. reports dry cough, unchanged X many months.  +subj
fevers/chills X1 day. no LE edema/ urinary changes/sore throat/
photophobia/ orthopnea. Pt was recently admitted on [**9-28**] with
chest pain and SOB, which was ultimately attributed to recurrent
eosinophilic PNA, as her prior steroid course was too short. At
that time she was d/c'ed on 9 month taper starting at 40mg per
day. She was currently taking 20mg of prednisone per day prior
to admission.

In ED, f102, hr 118, bp 104/59, r28, 100%NRB. Rec'd levofloxacin
300mg IV, vancomycin 1g.  BP decreased to 75 systolic, but
increased w/ 500cc bolus of NS.
Transfered to MICU and treated with prednisone, 30mg each day,
and azithromycin/ceftriazone to cover ? eosinophilic PNA vs CAP,
respectively. She notes resolution of SOB and Chest pain. still
c/o dry cough- at baseline. tolerating PO's without residual
n/v. Transfered to floor for further treatment of PNA.

Past Medical History:
Coronary artery disease status post
non-ST elevation MI in [**2111-5-19**], status post PTCA/stent to
the left circumflex, status post PTCA/stent of mid left
circumflex in [**2113-5-18**], latest catheterization in [**2113-10-18**] with two-vessel disease.  ETT MIBI done on [**2114-5-10**] significant for no symptoms, EKG changes, and with only
a fixed inferior defect, ejection fraction 58 percent.

Diabetes mellitus type 2, diet controlled.

HIV.  Last viral load undetectable.  CD4 count 209 in [**4-22**]
Factor VIII deficiency diagnosed in [**2109-10-18**] thought
secondary to a rapid steroid taper.

End-stage renal disease on hemodialysis.

History of GI bleed in the setting of coagulopathy and NSAID
use.

Recent pericarditis.

Eosinophilic pneumonia diagnosed in [**2114-4-19**] and treated
with prednisone.

Chronic anemia of end-stage renal disease.

Vulvar intraepithelial neoplasia diagnosed in [**2113-4-18**].

CHF with her latest echo in [**2114-4-19**] with an ejection
fraction of 60 percent and 3 plus MR.

COPD.


Social History:
SOCIAL HISTORY:  The patient currently lives in [**Location 102241**]
her niece.  She was previously a housewife.  She denies alcohol
or drug use.  She smoked 2 packs a day for 40 years.

Family History:
NC

Physical Exam:
PE on admit to [**Hospital Unit Name 153**]
t 97.1, bp 88/34, p 85, r18
lying in flat in bed, in NAD
PERRL. MMM
poor dentition, no carries
no JVD
Regular s1,s2. no m/r/g
LCA b/l.
+bs. soft. nt. nd.
1 +trace edema

PE on transfer to floor:
T:
Gen: Ms. [**Known lastname **] currently getting dialysis, appears very
comfortable, talking in complete sentences, pleasant, NAD
HEENT: PERRL, EOMI, muddly sclerae, OP-pink, no lesions, mmmp,
poor dentition, no carries; neck: supple. FROM, no LAD
LUNGS: CTA b/l with slight [**Month (only) **]. [**Month (only) 1440**] sounds at bases b/l. no
egophany, inc fremitis on R.
Cardiac: rrr, no m/g/r
ABD: soft, nt/nd, +BS
LE: no c/c/e
Neuro: A&OX3, responding appropriately, following commands, [**5-23**]
strength throughout.

Pertinent Results:
CBC
[**2114-11-13**] 10:35PM BLOOD WBC-19.3* RBC-2.56* Hgb-10.5* Hct-31.7*
MCV-124* MCH-41.0* MCHC-33.1 RDW-23.5* Plt Ct-137*
[**2114-11-13**] 10:35PM BLOOD Neuts-83* Bands-6* Lymphs-5* Monos-3
Eos-0 Baso-0 Atyps-1* Metas-0 Myelos-0 Hyperse-2*
[**2114-11-13**] 10:47AM BLOOD PT-13.5 PTT-19.7* INR(PT)-1.1

Chemistries
[**2114-11-13**] 10:35PM BLOOD Glucose-147* UreaN-71* Creat-7.6* Na-140
K-4.6 Cl-94* HCO3-26 AnGap-25*
[**2114-11-14**] 01:58AM BLOOD Calcium-7.1* Phos-PND Mg-1.6
[**2114-11-13**] 01:15PM BLOOD Acetone-SMALL
[**2114-11-13**] 01:15PM BLOOD Cortsol-22.0*
[**2114-11-13**] 01:15PM BLOOD CRP-23.54*

MVO
[**2114-11-14**] 12:51AM BLOOD Type-MIX Temp-36.1 Rates-/24 pO2-41*
pCO2-44 pH-7.38 calHCO3-27 Base XS-0 Intubat-NOT INTUBA
Comment-NASAL [**Last Name (un) 154**]

Lactate
[**2114-11-13**] 12:39PM BLOOD Lactate-3.0*
[**2114-11-13**] 01:46PM BLOOD Lactate-2.5*
[**2114-11-13**] 04:13PM BLOOD Lactate-2.0
[**2114-11-13**] 05:11PM BLOOD Glucose-229* Lactate-1.4
[**2114-11-13**] 06:20PM BLOOD Glucose-221* Lactate-1.4
[**2114-11-13**] 07:57PM BLOOD Glucose-241* Lactate-3.4*
[**2114-11-13**] 09:13PM BLOOD Glucose-216* Lactate-4.3*
[**2114-11-13**] 10:56PM BLOOD Glucose-140* Lactate-3.8*
[**2114-11-14**] 12:51AM BLOOD Glucose-95
[**2114-11-14**] 02:15AM BLOOD Glucose-269* Lactate-1.6

Ca
[**2114-11-14**] 02:15AM BLOOD freeCa-0.86*

Brief Hospital Course:
A/P: 68 yo f w/ HIV, CAD, CHF, CRF who p/w acute onset SOB,
febrile on presentation w/ intermittent hypotension in ED, elev
WBCC, lactate, w/ RUL peripheral opacity, no ECG changes.

1) SOB- RUL infiltrate concerning for pneumonia (CAP vs
eosinophilic vs atypical) vs PE.  Elev WBCC and story most c/w
pneumococcal PNA.   Given hx and low clinical probability of as
well as alternative diagnosis, [**Doctor Last Name 3012**] criteria low.  Also PE not
c/w intermittent hypotension responsive to volume presentation.
Ms. [**Known lastname **] had been on prednisone taper for eosinophilic
pneumonia in [**Month (only) 547**](mult recurrences, most recent in [**Month (only) **])
and was down to to 20 qd prior to admission.  Rec'd solumedrol
in ED.  IN [**Hospital Unit Name 153**] she was treated with azithromycin and
ceftriaxone to cover CAP(will hold on vanc and levo for now),
prednisone 30mg each day (for possible eosinophilic PNA),
ipratroprium/albuterol nebs. On transfer to floor, still unclear
etiology of RUL consolidation - most likely CAP vs eosinophilic
PNA. No peripheral eosinophils at this time, which could be due
to the fact that she has been partially tx with steroids and now
she was rebounding as steroids continued to be taperred. Less
likely to be OI (such as PCP/nocardia) given that repeat CD4
during admission was>800. Repeat PA/lat on [**11-15**] showed
resolving RUL infiltrate. Ms [**Known lastname **] also had improved clinically
by HD #4, reported no SOB and minimally R sided pleuritic chest
pain. She was discharged on 14 day course of levofloxacin and
30mg of steroids to be tappered slowly by Dr. [**Last Name (STitle) **] over the
next many months.
2) Hypotension - On admission, concerned about sepsis as Ms.
[**Known lastname **] presented with  elev lactate (3.0-->4.3-->1.6) and anion
gap (22) c/w possible infection resulting in mild sepsis.
Anti-hypertension meds held on admit and she responded well to
1L fluid challenge. Hemodynamically stable throughout rest of
admission. Lactate trended towards nml. No pressors needed.
Blood cx with no growth at time of discharge. SBP b/w 100-130
and ace and bblocker restarted prior to discharge. Per Dr.
[**Last Name (STitle) **], BP tend to run in 100's after dialysis, but Ms. [**Known lastname **]
often gets worsening of CHF and chest pain when off HTN
medications. As discussed with Dr. [**Last Name (STitle) **], did not restart
imdur on d/c but will restart at f/u appt.
3) [**Name (NI) **] pt on stable HAART regimen.  No evidence of infection.
CD4 on [**11-14**]: 986; suggest f/u counts as outpt when current
episode of infection resolves.

4) DMII- Ms. [**Known lastname **] presented with anion gap, most likely [**2-19**] to
uremia, but component of uncontrolled blood sugars could not be
excluded. Was on insulin drip in [**Hospital Unit Name 153**] with BG well controlled in
low 100's. On transfer to floor, she was restarted on outpt 8
units of NPH in am and cover with RISS. However, BG levels
occasionally jump to levels >300 and NPH was increased to 12
units in AM. Additionally, Ms. [**Known lastname **] follows sliding scale at
home, which was continued on discharge.

5) ESRD- Ms. [**Known lastname **] has baseline oliguria. Followed by renal
team during admission. Anion gap much improved s/p dialysis.
Continue m/w/f dialysis after discharge.

6) h/o CHF - Not clinically volume overloaded, but evidence of
CHF on CXR (not seen on admission) after fluid challenge in ICU
to tx hypotension.  CHF much improved on CXR [**11-15**] prior to
discharge.

7) CAD- no evidence of ongoing ischemia.  Antihypertensives
(lisinopril/toprol) were held on admission as pt was
hypotensive, but restarted prior to discharge. ASA was continued
throughout admission.

8) Factor VII def- no current need for intervention.

9) Anemia-cont EPO at dialysis.

10) Full Code

Medications on Admission:
zidovudine 200mg [**Hospital1 **]
nevirapine 200 [**Hospital1 **]
neprhocap 1 po qd
atrovent neb q4h prn
ipratroprium neb q4h
Advarr 5oo/50
Metoprolol 50 mg qd (presumably toprol xl)
Isordil 10 [**Hospital1 **]
ECASA 325mg
Prilosec 20 mq qd
mycelex torche 10mg x 5d
Procrit- at dialysis
colace 100 [**Hospital1 **]
Senna 2 po prn
Lactulos 2tabs, hs prn
immodium 2mg
Lumigan 1gtt ou
Aldara cream [**Hospital1 **] taper per wk
reglan 10mg po qd
RISS
Lisinopril 2.5 mg po qd
Prednisone 20mg po qd (titrated down from 30 on [**11-12**])
NPH 8U qam

Discharge Medications:
1. Zidovudine 100 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
2. Nevirapine 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
3. Lamivudine 100 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
4. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
5. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

7. Clotrimazole 10 mg Troche Sig: One (1) Troche Mucous membrane
 QID (4 times a day).
8. Bimatoprost 0.03 % Drops Sig: One (1) drops Ophthalmic  HS
(at bedtime).
9. Metoclopramide HCl 10 mg Tablet Sig: One (1) Tablet PO
QIDACHS (4 times a day (before meals and at bedtime)).
10. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
11. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
[**Hospital1 **]:*90 Tablet(s)* Refills:*2*
12. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q48H
(every 48 hours) for 14 days.
[**Hospital1 **]:*7 Tablet(s)* Refills:*0*
13. NPH insulin
Please continue to take your 12 units of NPH each morning.
Please continue to check your sugar level each evening and
adjust to your sliding scale.
14. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day.

15. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO once
a day.
16. Albuterol-Ipratropium 2.5-0.5 mg/3 mL Solution Sig: [**1-19**]
puffs Inhalation three times a day as needed for shortness of
[**Month/Day (2) 1440**] or wheezing.
[**Month/Day (2) **]:*1 inhaler* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Uphams Corner Home Care

Discharge Diagnosis:
1. Pneumonia - eosinophilic vs CAP
2. ESRD on hemodialysis
3. Diabetes Type II
4. HIV
5. Anemia
6. CHF

Discharge Condition:
stable

Discharge Instructions:
Please call your PCP or return to the ED if you develop
worsening shortness of [**Month/Day (2) 1440**], chest pain, abdominal pain,
non-resolving diarrhea, or other worrisome symptom.
Please do not restart your IMDUR until you discuss this with Dr.
[**Last Name (STitle) **].
Please continue to take your 12 units of NPH each morning and
recheck your sugars in the evening with your sliding scale.
Please continue 14 day course of levofloxacin as prescribed, one
(1) 250mg tablet every OTHER day.

Followup Instructions:
Appointment with Dr. [**Last Name (STitle) **] on TUESDAY [**2114-11-27**] at
3:20PM. [**Telephone/Fax (1) 2393**]
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D. Where: [**Hospital6 29**]
CARDIAC SERVICES Phone:[**Telephone/Fax (1) 127**] Date/Time:[**2114-12-11**] 11:45
Provider: [**First Name8 (NamePattern2) **] [**Name8 (MD) 4174**], MD Where: [**Hospital6 29**] OBSTETRICS
AND GYNECOLOGY Phone:[**Telephone/Fax (1) 2664**] Date/Time:[**2114-12-19**] 2:15
Provider: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD Where: LM [**Hospital Unit Name 3126**] CENTER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2115-1-8**] 9:10
{'Pulmonary eosinophilia,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease,Asymptomatic human immunodeficiency virus [HIV] infection status,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}


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: SOB

PRESENT ILLNESS: 68 yo f w/ HIV (cd4 209, VL undetectable earlier this month),
ESRD on HD, CAD s/p IMI w/ 2 LCX stents, CHF, COPD, DMII, h/o
eosinophilic PNA [**4-22**], who p/w sudden onset of SOB while sitting
in bed, 1 night PTA.  Accompanied by R sided CP, worse w/
inspiration. reports dry cough, unchanged X many months.  +subj
fevers/chills X1 day. no LE edema/ urinary changes/sore throat/
photophobia/ orthopnea. Pt was recently admitted on [**9-28**] with
chest pain and SOB, which was ultimately attributed to recurrent
eosinophilic PNA, as her prior steroid course was too short. At
that time she was d/c'ed on 9 month taper starting at 40mg per
day. She was currently taking 20mg of prednisone per day prior
to admission.

MEDICAL HISTORY: Coronary artery disease status post
non-ST elevation MI in [**2111-5-19**], status post PTCA/stent to
the left circumflex, status post PTCA/stent of mid left
circumflex in [**2113-5-18**], latest catheterization in [**2113-10-18**] with two-vessel disease.  ETT MIBI done on [**2114-5-10**] significant for no symptoms, EKG changes, and with only
a fixed inferior defect, ejection fraction 58 percent.

MEDICATION ON ADMISSION: zidovudine 200mg [**Hospital1 **]
nevirapine 200 [**Hospital1 **]
neprhocap 1 po qd
atrovent neb q4h prn
ipratroprium neb q4h
Advarr 5oo/50
Metoprolol 50 mg qd (presumably toprol xl)
Isordil 10 [**Hospital1 **]
ECASA 325mg
Prilosec 20 mq qd
mycelex torche 10mg x 5d
Procrit- at dialysis
colace 100 [**Hospital1 **]
Senna 2 po prn
Lactulos 2tabs, hs prn
immodium 2mg
Lumigan 1gtt ou
Aldara cream [**Hospital1 **] taper per wk
reglan 10mg po qd
RISS
Lisinopril 2.5 mg po qd
Prednisone 20mg po qd (titrated down from 30 on [**11-12**])
NPH 8U qam

ALLERGIES: Motrin / Lipitor

PHYSICAL EXAM: PE on admit to [**Hospital Unit Name 153**]
t 97.1, bp 88/34, p 85, r18
lying in flat in bed, in NAD
PERRL. MMM
poor dentition, no carries
no JVD
Regular s1,s2. no m/r/g
LCA b/l.
+bs. soft. nt. nd.
1 +trace edema

FAMILY HISTORY: NC

SOCIAL HISTORY: SOCIAL HISTORY:  The patient currently lives in [**Location 102241**]
her niece.  She was previously a housewife.  She denies alcohol
or drug use.  She smoked 2 packs a day for 40 years. 

### Response:
{'Pulmonary eosinophilia,Pneumonia, organism unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease,Asymptomatic human immunodeficiency virus [HIV] infection status,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}
