CHIEF COMPLAINT: Presenting on transfer for stent to Left carotid

PRESENT ILLNESS: HPI: 69 y/o female with PMH significant for type 2 DM, CAD s/p
angioplasty, and [**Hospital **] transferred from OSH for neuro eval and
probable stenting of the carotid artery. Over the past two
months, pt has been experiencing [**6-7**] minute episodes of slurred
speech, right arm and leg weakness and confusion.  The episodes
come on quickly with no warning signs and resolve just as
quickly with no residual deficits.  Pt's daughter reports that
the pt has had approximately 20 of these episodes.  There was
one episode in which pt choked at a restaurant and vomited which
may have been due to swallowing difficulties.  One day prior to
admission, the pt's daughter witnessed another episdoe of
slurred speech and weakness but this episode lasted 30 minutes
before resolution.  This caused the pt to present to the [**Hospital3 **].  An ultrasound done recently at
her PCP's office showed a 99% stenosis of the left carotid
artery.  An MRI was also done at OSH that showed diffuse
atherosclerotic disease within the intracerebral vessels.  The
pt comes to [**Hospital1 18**] with the films for stenting of the left
carotid artery by Dr. [**First Name (STitle) **].

MEDICAL HISTORY: 1. Type 2 diabetes mellitus
2. CAD s/p angioplasty- Pt's last cardiac cath in the [**Hospital1 18**]
system was from 02/25/200. It showed a righ dominant system with
two vessel branch CAD. The left main had a 20% distal stenosis,
LAD with a mid and distal 30% stenosis, 40% ostial stenosis in
the first diagonal, 50% ostial stenosis in the second diagonal,
and a 40% ostial stenosis in the RCA. These findings were
unchanged from [**2151-11-23**] except for some progression of the OM1
disease.
3. HTN
4. Diabetic neuropathy
5. S/P discectomy
6. S/P tonsillectomy
7. S/P cholecystectomy
8. S/P hysterectomy
9. DJD

MEDICATION ON ADMISSION: 1. Imdur 120 mg daily
2. Lasix 40 mg daily
3. Potassium 20 mEq QAM and 10 mEq QPM
4. Neurontin 120 mg QAM and 60 mg QPM
5. ASA 81 mg daily
6. Zocor 20 mg QHS
7. Metformin 500 mg QAM and 1000 mg QPM
8. Norvasc 5 mg daily
9. Plavix 75 mg daily
10. Lopressor 50 mg [**Hospital1 **]
11. Colace 100 mg daily
12. Tylenol PRN
13. Pepcid 20 mg daily
14. Lisinopril 40 mg daily
15. BeneCor 40 mg daily
16. NPH insulin 36 units QAM and 48 untis QHS
17. Regular insulin sliding scale

ALLERGIES: Codeine

PHYSICAL EXAM: temp 99.4, BP 158/78, HR 71, RR 16, O2 95% RA, BG 149
Gen: NAD, lying comfortably in bed
HEENT: PERRL, EOMI, MMM, OP clear
Neck: unable to appreciate JVD but appears not elevated; no
bruits heard
CV: RR, nl s1/s2, 2/6 systolic murmur at RUSB, cap refill <3 sec
Chest: clear
Abd: +BS, soft, NT, ND, no organomegaly
Ext: warm, no edema, decreased sensation, pulses not palpable
Neuro: CN 2-12 intact, reflexes 2+ upper ext, unable to obtain
knee reflexes, sensation decreased in lower ext; strength 5/5
throughout; negative Babinski.

FAMILY HISTORY: Father with stroke at age 57.  Mother with HTN, deceased at 81.

SOCIAL HISTORY: Pt lives with daughter, no tobacco, ETOH or illicit substance
use.
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Retention of urine, unspecified,Examination of participant in clinical trial,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status
Ocl crtd art wo infrct,Retention urine NOS,Exam-clincal trial,DMII neuro nt st uncntrl,Neuropathy in diabetes,Crnry athrscl natve vssl,Hypertension NOS,Osteoarthros NOS-unspec,Long-term use of insulin,Hyperlipidemia NEC/NOS,Status-post ptca
Admission Date:  [**2157-2-2**]              Discharge Date:   [**2157-2-4**]

Date of Birth:  [**2087-6-18**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Presenting on transfer for stent to Left carotid

Major Surgical or Invasive Procedure:
Thoracic aorta and subclavian angiography
carotid (with and without cerebral) angiography
PTA/stent x1 to Left Internal Carotid Artery.


History of Present Illness:
HPI: 69 y/o female with PMH significant for type 2 DM, CAD s/p
angioplasty, and [**Hospital **] transferred from OSH for neuro eval and
probable stenting of the carotid artery. Over the past two
months, pt has been experiencing [**6-7**] minute episodes of slurred
speech, right arm and leg weakness and confusion.  The episodes
come on quickly with no warning signs and resolve just as
quickly with no residual deficits.  Pt's daughter reports that
the pt has had approximately 20 of these episodes.  There was
one episode in which pt choked at a restaurant and vomited which
may have been due to swallowing difficulties.  One day prior to
admission, the pt's daughter witnessed another episdoe of
slurred speech and weakness but this episode lasted 30 minutes
before resolution.  This caused the pt to present to the [**Hospital3 **].  An ultrasound done recently at
her PCP's office showed a 99% stenosis of the left carotid
artery.  An MRI was also done at OSH that showed diffuse
atherosclerotic disease within the intracerebral vessels.  The
pt comes to [**Hospital1 18**] with the films for stenting of the left
carotid artery by Dr. [**First Name (STitle) **].

ROS: Pt denies chest pain, shortness of breath, abd pain, n/v/d,
fevers, chills

Past Medical History:
1. Type 2 diabetes mellitus
2. CAD s/p angioplasty- Pt's last cardiac cath in the [**Hospital1 18**]
system was from 02/25/200. It showed a righ dominant system with
two vessel branch CAD. The left main had a 20% distal stenosis,
LAD with a mid and distal 30% stenosis, 40% ostial stenosis in
the first diagonal, 50% ostial stenosis in the second diagonal,
and a 40% ostial stenosis in the RCA. These findings were
unchanged from [**2151-11-23**] except for some progression of the OM1
disease.
3. HTN
4. Diabetic neuropathy
5. S/P discectomy
6. S/P tonsillectomy
7. S/P cholecystectomy
8. S/P hysterectomy
9. DJD

Social History:
Pt lives with daughter, no tobacco, ETOH or illicit substance
use.

Family History:
Father with stroke at age 57.  Mother with HTN, deceased at 81.

Physical Exam:
temp 99.4, BP 158/78, HR 71, RR 16, O2 95% RA, BG 149
Gen: NAD, lying comfortably in bed
HEENT: PERRL, EOMI, MMM, OP clear
Neck: unable to appreciate JVD but appears not elevated; no
bruits heard
CV: RR, nl s1/s2, 2/6 systolic murmur at RUSB, cap refill <3 sec
Chest: clear
Abd: +BS, soft, NT, ND, no organomegaly
Ext: warm, no edema, decreased sensation, pulses not palpable
Neuro: CN 2-12 intact, reflexes 2+ upper ext, unable to obtain
knee reflexes, sensation decreased in lower ext; strength 5/5
throughout; negative Babinski.

Pertinent Results:
[**2157-2-2**] WBC-8.7 Hgb-11.8* Hct-35.0* MCV-86 MCH-29.0 RDW-15.2
Plt Ct-223
[**2157-2-4**] WBC-8.4 Hgb-10.0* Hct-29.7* MCV-86 MCH-28.8 RDW-15.5
Plt Ct-179

[**2157-2-2**] PT-13.9* PTT-70.7* INR(PT)-1.2
[**2157-2-4**] PT-12.9 PTT-22.2 INR(PT)-1.0

[**2157-2-2**] Glucose-127* UreaN-16 Creat-1.2* Na-139 K-4.0 Cl-102
HCO3-28 [**2157-2-4**] Glucose-89 UreaN-24* Creat-1.8* Na-139 K-3.5
Cl-104 HCO3-27

[**2157-2-2**] Calcium-8.0* Phos-3.2 Mg-1.8
[**2157-2-4**] Calcium-8.3* Phos-3.7 Mg-1.9

[**2157-2-2**] Cholest-111 Triglyc-141 HDL-44 CHOL/HD-2.5 LDLcalc-39
LDLmeas-56

Catheterization report:
Procedures:  Thoracic aorta and subclavian angiography, carotid
(with and without cerebral) angiography, PTA/stent x 1 [**Doctor First Name 3098**].
Hemodynamics: AO 196/70, RFA 163/106
Findings:  Thoracic aorta - Type 1 arch.  Subclavian artery:
RSCA normal, LSCA normal.  Carotid/vertebral arteries:  RCCA
normal.  [**Country **] mild disease.  [**Country **] fills the ipsilateral ACA,
MCA, and contralateral ACA.  The LCCA has an origin 30% lesion.
The [**Doctor First Name 3098**] has a focal 99% lesion.  The [**Doctor First Name 3098**] fills the ipsilateral
MCA.

Brief Hospital Course:
A/P: 69 yr old female with hx of CAD s/p stent placement now
with worsening TIA sx over the past two months and found to have
99% stenosis of the left carotid; transferred here from outside
hospital for catheterization and stenting of her L ICA.

1. TIAs with 99% stenosis of the L internal carotid artery:  The
patient was transferred to [**Hospital1 18**] where she had a catheterization
on arrival that demonstrated a 99% stenosis of the L ICA.  She
underwent uncomplicated stenting on the [**Doctor First Name 3098**] and was transferred
to the CCU for observation overnight on a nitroprusside drip for
blood pressure control.  The introprusside drip was weaned off
within the first few hours, and blood pressure was kept at goal
of 110-150.  She was walked by PT on the following morning and
it was felt that she was somewhat unsteady, therefore she was
kept for one more night in the hospital for observation.  She
also complained of one episode of slurred speech lasting only
seconds on the following morning, which she thought was from a
dry mouth.  She was seen by the sroke service who felt that her
unsteadiness of gait was related to her history of neuropathy
for which she takes gabapentin.  She walked with PT on the day
of discharge, who felt that she was safe to go home.  The stroke
service did not believe her seconds of slurred speech
represented any further TIA, and recommended holding her imdur
to assure that her b.p. stayed above 110 systolic.  She was
discharged on her metoprolol 50 [**Hospital1 **], Lisinopril 40 daily, and
amlodipine 5 daily.  She was instructed to hold her imdur until
she is seen by Dr. [**Last Name (STitle) 7047**] in a couple of days for a blood
pressure check.  She will be on lifelong Plavix and Aspirin.

2. Urinary retention:  She had good urine output until removal
of her foley catheter at which time she did not void for 8
hours.  She was straight catheterized yielding only 330 cc's of
urine.  Her blood pressure had also dropped to 100-110 systolic,
and creatinine had gone up to 1.8 (from 1.2 on admission),
therefore it was felt she may have been slightly dry.  She was
started on NS at 100 cc/hr and recieved 500-1000 cc's prior to
discharge, at which time she had spontaneously voided twice,
approximately 50 cc each time.  Her blood pressure had been back
up to 140 for the two hours prior to discharge.  She was
instructed to stop taking her lasix for now, and have a chem 7
panel drawn in 3 days.  The results will be sent to Dr. [**Last Name (STitle) 7047**],
who will then instruct her regarding her lasix.

3. CAD: R dominant, s/p RCA stent, OM1 disease chronic.  She had
no evidence of cardiac ischemia.  We checked a fasting lipid
panel which showed an LDL at goal.  We kept her on her
outpatient dose of lipitor, and other medications as above.

4. DM2:  We kept her on a regular insulin sliding scale while in
house.

5. Diabetic Neuropathy: We continued her Neurontin.

6. FEN: She was given a cardiac/diabetic diet.  She was given
IVF post-angio for renal prophylaxis.


Medications on Admission:
1. Imdur 120 mg daily
2. Lasix 40 mg daily
3. Potassium 20 mEq QAM and 10 mEq QPM
4. Neurontin 120 mg QAM and 60 mg QPM
5. ASA 81 mg daily
6. Zocor 20 mg QHS
7. Metformin 500 mg QAM and 1000 mg QPM
8. Norvasc 5 mg daily
9. Plavix 75 mg daily
10. Lopressor 50 mg [**Hospital1 **]
11. Colace 100 mg daily
12. Tylenol PRN
13. Pepcid 20 mg daily
14. Lisinopril 40 mg daily
15. BeneCor 40 mg daily
16. NPH insulin 36 units QAM and 48 untis QHS
17. Regular insulin sliding scale

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Gabapentin 300 mg Capsule Sig: Four (4) Capsule PO QAM (once
a day (in the morning)).
4. Amlodipine Besylate 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
7. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*0*
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day). Tablet(s)
9. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
10. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime). Capsule(s)
11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
12. Outpatient Lab Work
Please check a chem 7 panel.  Please process STAT.


Discharge Disposition:
Home

Discharge Diagnosis:
TIA
hypertension
hyperlipidemia


Discharge Condition:
good

Discharge Instructions:
Take all of your medications as directed. Stop taking your lasix
until seen by Dr. [**Last Name (STitle) 7047**] on Tuesday.  Also stop taking your
Imdur for now until Dr. [**Last Name (STitle) 7047**] checks her blood pressure on
Tuesday and tells you it's o.k. to resume.

Your goal blood pressure is 120-150s systolic. Monitor it at
least a few times weekly.

Call your doctors [**Name5 (PTitle) **] [**Name5 (PTitle) **] to the ER if you have any more
headaches, weakness or trouble speaking.

Followup Instructions:
See Dr. [**First Name (STitle) **] as directed.

See Dr. [**Last Name (STitle) 28688**] regularly every 3-4 months.

You have an appointment with Dr. [**Last Name (STitle) 7047**] on Tuesday so that he
can check your blood pressure and follow the results of your lab
work.  You will need to get your labs drawn on Monday (the day
before your appt.).

Follow up with the neurologists regarding your TIAs, call for an
appointment at [**Telephone/Fax (1) 1694**].  You should have one within the
next 2-3 weeks.  They will schedule you for a repeat carotid
ultrasound 3 months from now.
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Retention of urine, unspecified,Examination of participant in clinical trial,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,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: Presenting on transfer for stent to Left carotid

PRESENT ILLNESS: HPI: 69 y/o female with PMH significant for type 2 DM, CAD s/p
angioplasty, and [**Hospital **] transferred from OSH for neuro eval and
probable stenting of the carotid artery. Over the past two
months, pt has been experiencing [**6-7**] minute episodes of slurred
speech, right arm and leg weakness and confusion.  The episodes
come on quickly with no warning signs and resolve just as
quickly with no residual deficits.  Pt's daughter reports that
the pt has had approximately 20 of these episodes.  There was
one episode in which pt choked at a restaurant and vomited which
may have been due to swallowing difficulties.  One day prior to
admission, the pt's daughter witnessed another episdoe of
slurred speech and weakness but this episode lasted 30 minutes
before resolution.  This caused the pt to present to the [**Hospital3 **].  An ultrasound done recently at
her PCP's office showed a 99% stenosis of the left carotid
artery.  An MRI was also done at OSH that showed diffuse
atherosclerotic disease within the intracerebral vessels.  The
pt comes to [**Hospital1 18**] with the films for stenting of the left
carotid artery by Dr. [**First Name (STitle) **].

MEDICAL HISTORY: 1. Type 2 diabetes mellitus
2. CAD s/p angioplasty- Pt's last cardiac cath in the [**Hospital1 18**]
system was from 02/25/200. It showed a righ dominant system with
two vessel branch CAD. The left main had a 20% distal stenosis,
LAD with a mid and distal 30% stenosis, 40% ostial stenosis in
the first diagonal, 50% ostial stenosis in the second diagonal,
and a 40% ostial stenosis in the RCA. These findings were
unchanged from [**2151-11-23**] except for some progression of the OM1
disease.
3. HTN
4. Diabetic neuropathy
5. S/P discectomy
6. S/P tonsillectomy
7. S/P cholecystectomy
8. S/P hysterectomy
9. DJD

MEDICATION ON ADMISSION: 1. Imdur 120 mg daily
2. Lasix 40 mg daily
3. Potassium 20 mEq QAM and 10 mEq QPM
4. Neurontin 120 mg QAM and 60 mg QPM
5. ASA 81 mg daily
6. Zocor 20 mg QHS
7. Metformin 500 mg QAM and 1000 mg QPM
8. Norvasc 5 mg daily
9. Plavix 75 mg daily
10. Lopressor 50 mg [**Hospital1 **]
11. Colace 100 mg daily
12. Tylenol PRN
13. Pepcid 20 mg daily
14. Lisinopril 40 mg daily
15. BeneCor 40 mg daily
16. NPH insulin 36 units QAM and 48 untis QHS
17. Regular insulin sliding scale

ALLERGIES: Codeine

PHYSICAL EXAM: temp 99.4, BP 158/78, HR 71, RR 16, O2 95% RA, BG 149
Gen: NAD, lying comfortably in bed
HEENT: PERRL, EOMI, MMM, OP clear
Neck: unable to appreciate JVD but appears not elevated; no
bruits heard
CV: RR, nl s1/s2, 2/6 systolic murmur at RUSB, cap refill <3 sec
Chest: clear
Abd: +BS, soft, NT, ND, no organomegaly
Ext: warm, no edema, decreased sensation, pulses not palpable
Neuro: CN 2-12 intact, reflexes 2+ upper ext, unable to obtain
knee reflexes, sensation decreased in lower ext; strength 5/5
throughout; negative Babinski.

FAMILY HISTORY: Father with stroke at age 57.  Mother with HTN, deceased at 81.

SOCIAL HISTORY: Pt lives with daughter, no tobacco, ETOH or illicit substance
use. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Retention of urine, unspecified,Examination of participant in clinical trial,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status'}
