CHIEF COMPLAINT: Cough, increased work of breathing.

PRESENT ILLNESS: 84 yo F with h/o HTN, HL, OSA, with two admissions for
productive cough of unclear etiology in [**9-/2147**] who was sent to
the ED when her home physical therapist found her hypoxic to the
80's on RA. There, she c/o productive cough x3d, increase WOB,
increase LE edema, no f/c, and stable weight.

MEDICAL HISTORY: # Status post right shoulder replacement
# Status post right hip replacement.
# Sinusitis.
# Nonallergic Rhinitis
# Bronchial asthma - not supported by PFTs
# OSA and ? obesity hypoventilation syndrome - followed by Dr.
[**Last Name (STitle) **]
# GERD.
# Hypertension.
# History of glaucoma.
# Arthritis.
# CAD with normal persantine MIBI in [**9-19**].
# History of cataract surgery.
# Influenza A [**1-20**]

MEDICATION ON ADMISSION: - albuterol inhalers
- alendronate 70 mg weekly
- amlodipine 10 mg daily
- atenolol 100 daily
- azelastine 137 mcg 2 sprays each nostril daily
- benzonatate 100 mg tid prn cough
- HCTZ 25 mg daily
- Omeprazole 40 mg [**Hospital1 **]
- KCl 20 daily
- Sertraline 75 mg daily
- Simvastatin 10 daily
.
- Of note, pt states not taking Lisinopril 40 mg daily or
Ipratropium nebs

ALLERGIES: Sulindac / Aspirin / Hycodan

PHYSICAL EXAM: 96% on RA, satting mid 90's on RA while conversing during
interview
Tired appearing, speaking full sentences but sounds out of
breath doing so, not in distress
Mouth very dry appearing, OP clear no lesions noted
No JVD noted
Slight, fine crackle at R lung base but otherwise CTAB, no
wheezes appreciated, but with poor air movement
Faint S1, S2 but no audible m/g appreciated
Soft, NT ND abdomen, BS+
No BLE edema noted, extremities warm
CN 2-12 grossly intact, moving all extremities, conversant and
lucid

FAMILY HISTORY: Family History: per OMR
Prostate Cancer: positive
Breast Cancer: Her mother, a daughter and a granddaughter.  [**Name (NI) **]
[**Name2 (NI) 8401**] died of breast cancer at age 40.
COPD: Her daughter died of complications associated w/ COPD
CAD: none

SOCIAL HISTORY: Social History: per OMR
-Support: lives with granddaughter [**Name (NI) 8399**] [**Name (NI) 284**].  Her
family is in [**State 531**] City.  She has four children, three of
whom are living, many grand children, 7 great grand children and
Chronic obstructive asthma with (acute) exacerbation,Obesity hypoventilation syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Esophageal reflux,Osteoporosis, unspecified
Ch obst asth w (ac) exac,Obesity hypovent synd,Hypertension NOS,Pure hypercholesterolem,Depressive disorder NEC,Esophageal reflux,Osteoporosis NOS
Admission Date:  [**2147-12-18**]              Discharge Date:   [**2147-12-19**]

Date of Birth:  [**2063-3-28**]             Sex:   F

Service: MEDICINE

Allergies:
Sulindac / Aspirin / Hycodan

Attending:[**First Name3 (LF) 8404**]
Chief Complaint:
Cough, increased work of breathing.

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
84 yo F with h/o HTN, HL, OSA, with two admissions for
productive cough of unclear etiology in [**9-/2147**] who was sent to
the ED when her home physical therapist found her hypoxic to the
80's on RA. There, she c/o productive cough x3d, increase WOB,
increase LE edema, no f/c, and stable weight.

Initial ED vitals: 98.0  52  111/49  26  95% on unclear O2. She
appeared to be SOB and dyspneic after several words, reportedly
with tight and wheezy sounding lungs, and was having CP from all
the coughing. Denied fevers. She had a CXR with wet read showing
cardiomegaly but no focal acute process. ABG showed: 7.48 / 46 /
63 / 35. She was treated like a COPD exacerbation and received
albuterol nebs x2, ipratropium nebs x2, Methylpred 125mg IV x1,
Ceftriaxone 1g IV x1, Azithromycin 500 mg IV x1. She was briefly
put on Bipap.

Most recent vitals before transfer: 62  115/66  19  90% on
Bipap; however also per report, "her RA sats were fine while in
the ED."

Per OMR notes, the cough is longstanding and thought to be due
to GERD vs postnasal drip. She was admitted from [**10-1**], again on
[**10-7**] with productive cough, shortness of breath, and wheezing.
The first admission, she was given Azithromycin and Prednisone
x5 days, and nebulizers and felt better and was discharged home.
She represented [**10-7**] with the same sxs, CXR did not show
infiltrates and reactive airway from viral process was suspected
and she was given Combivent nebs, IS, Tessalon perles, and
Guaifenesin. She did not require oxygen that admission.

ROS on arrival to [**Hospital Unit Name 153**]: Endorses 6mo to 1yr h/o of this cough,
dysphagia but not outright odynophagia such that she has to take
her pills with water or applesauce, nasal congestion, trouble
sleeping due to the coughing, and occasional heartburn.
She denies f/c/ns, postnasal gtt, or any other symptoms other
than as above. She states her Bipap is under her bed and she's
not using it.

Past Medical History:
# Status post right shoulder replacement
# Status post right hip replacement.
# Sinusitis.
# Nonallergic Rhinitis
# Bronchial asthma - not supported by PFTs
# OSA and ? obesity hypoventilation syndrome - followed by Dr.
[**Last Name (STitle) **]
# GERD.
# Hypertension.
# History of glaucoma.
# Arthritis.
# CAD with normal persantine MIBI in [**9-19**].
# History of cataract surgery.
# Influenza A [**1-20**]

Social History:
Social History: per OMR
-Support: lives with granddaughter [**Name (NI) 8399**] [**Name (NI) 284**].  Her
family is in [**State 531**] City.  She has four children, three of
whom are living, many grand children, 7 great grand children and

one great great grandchild.  Most of these family members in
live in [**Name (NI) 7349**] and she is able to visit them often.  She used to
work in [**Hospital 8400**] Hospital in the cafeteria.
-Tobacco history: quit 30+ years ago, started when she was 18 yo
-ETOH: denies, formerly used to drink socially at parties
-Activity: Severely deconditioned, able to walk < 1 block with a

walker, uses a scooter much of the time. Endorses ability to
carry out her ADL's.

Family History:
Family History: per OMR
Prostate Cancer: positive
Breast Cancer: Her mother, a daughter and a granddaughter.  [**Name (NI) **]
[**Name2 (NI) 8401**] died of breast cancer at age 40.
COPD: Her daughter died of complications associated w/ COPD
CAD: none


Physical Exam:
96% on RA, satting mid 90's on RA while conversing during
interview
Tired appearing, speaking full sentences but sounds out of
breath doing so, not in distress
Mouth very dry appearing, OP clear no lesions noted
No JVD noted
Slight, fine crackle at R lung base but otherwise CTAB, no
wheezes appreciated, but with poor air movement
Faint S1, S2 but no audible m/g appreciated
Soft, NT ND abdomen, BS+
No BLE edema noted, extremities warm
CN 2-12 grossly intact, moving all extremities, conversant and
lucid


Pertinent Results:
Admissions Labs:
[**2147-12-18**] 03:50PM BLOOD WBC-7.9 RBC-4.52 Hgb-13.3 Hct-38.9 MCV-86
MCH-29.4 MCHC-34.1 RDW-15.2 Plt Ct-218
[**2147-12-18**] 03:50PM BLOOD Neuts-59.6 Lymphs-28.9 Monos-5.1 Eos-5.2*
Baso-1.1
[**2147-12-18**] 03:50PM BLOOD PT-13.7* PTT-24.2 INR(PT)-1.2*
[**2147-12-18**] 03:50PM BLOOD Glucose-99 UreaN-10 Creat-0.9 Na-140
K-4.1 Cl-100 HCO3-31 AnGap-13
[**2147-12-18**] 04:42PM BLOOD Type-ART pO2-63* pCO2-46* pH-7.48*
calTCO2-35* Base XS-9
[**2147-12-18**] 03:58PM BLOOD Lactate-2.2*

Discharge Labs:
[**2147-12-19**] 05:20AM BLOOD WBC-6.6 RBC-5.00 Hgb-14.2 Hct-41.5 MCV-83
MCH-28.4 MCHC-34.1 RDW-14.7 Plt Ct-209
[**2147-12-19**] 05:20AM BLOOD Glucose-292* UreaN-15 Creat-1.0 Na-142
K-3.1* Cl-102 HCO3-27 AnGap-16

Chest x-ray ([**2147-12-18**]):
Prominence of the hila appears similar to prior examinations.
There is mild cardiomegaly and tortuosity of the aorta. Within
the lung parenchyma, no overt pulmonary edema is seen. No focal
opacity to suggest pneumonia is present. No pneumothorax is
identified. No pleural effusion is seen. The pleural surface
contours are normal. There are bilateral shoulder prostheses.
IMPRESSION: No evidence of acute cardiopulmonary process.

CT chest: full report pending at time of discharge. Film was
reviewed with ICU team and did not show evidence of acute
process such as infiltrate or pleural effusion.


Brief Hospital Course:
A/P: In summary this is an 84yoF with chronic sinusitis and
bronchitis, 2 recent admissions for cough, who presents with
persistent cough and shortness of breath.

1. Persistent cough: Unclear etiology:  On presentation Ms.
[**Known lastname 805**] appeared to be SOB and dyspneic after several words,
reportedly with tight and wheezy sounding lungs, and was having
CP from repeated coughing. Denied fevers. She had a CXR with wet
read showing cardiomegaly but no focal acute process. ABG
showed: 7.48 / 46 / 63 / 35. She was treated like a COPD
exacerbation and received albuterol nebs x2, ipratropium nebs
x2, Methylpred 125mg IV x1, Ceftriaxone 1g IV x1, Azithromycin
500 mg IV x1. She was briefly put on Bipap. Vitals before
transfer to ICU: 62  115/66  19  90% on Bipap; however also per
report, "her RA sats were fine while in the ED."

Per OMR notes, the cough is longstanding and thought to be due
to GERD vs postnasal drip.   In the ICU, pt chart reviewed.
PFT's with mild restrictive defect, can't r/o obstructive
defect, TLC's normal without change in FVC since last measured.
Seen by Dr. [**Last Name (STitle) **] in [**11/2147**] who found her cough was improved
with azelastine and felt her PFT's were near enough to normal.
Etiologies to consider include postnasal gtt, restrictive vs
obstructive lung disease, GERD/laryngeopharyngeal reflux,
chronic aspiration, recurrent viral URI's in the setting of
reactive airway disease/asthma exacerbations, Lisinopril effect
(was discontinued 2 wks ago), lung cancer (h/o smoking present
but not strong), and allergic reaction. Her ABG indicated some
degree of CO2 retention and possible OSA. Per PCP, [**Name10 (NameIs) **] increased
LE edema and TTE was considered but not performed in house as
patient appeared clinically well in the ICU.  While in the ICU,
held off on providing further steroids.  She was given
albuterol/ipartropium nebs q2 hours as needed.  No further
antibiotics were provided.
Her presentation was stable, with a persistent hacking cough.
Went for a CT chest which was suggestive of severe
bronchomalacia of the right main stem
bronchus, with inflammatory changes of the bronchi and
bronchioles to the lower lobes, but no acute process. When her
respiratory status was felt to be at baseline, Ms. [**Known lastname 805**] was
d/c home with PRN nebulizers and close PCP follow up.
Would recommend f/u with GI, ENT, pulm, allergy as outpt
(allergy testing has been negative x2)

2. CAD/HTN: Uneventful in the hospital.  Continued home HCTZ,
Atenolol, Amlodipine, Simvastatin.

3. Depression: Continued home Sertraline.

Emergency Contact:  [**Name (NI) **] [**Last Name (NamePattern1) 284**]
Code:  DNR/DNI, confirmed with pt.

Medications on Admission:
- albuterol inhalers
- alendronate 70 mg weekly
- amlodipine 10 mg daily
- atenolol 100 daily
- azelastine 137 mcg 2 sprays each nostril daily
- benzonatate 100 mg tid prn cough
- HCTZ 25 mg daily
- Omeprazole 40 mg [**Hospital1 **]
- KCl 20 daily
- Sertraline 75 mg daily
- Simvastatin 10 daily
.
- Of note, pt states not taking Lisinopril 40 mg daily or
Ipratropium nebs


Discharge Medications:
- albuterol inhalers
- alendronate 70 mg weekly
- amlodipine 10 mg daily
- atenolol 100 daily
- azelastine 137 mcg 2 sprays each nostril daily
- benzonatate 100 mg tid prn cough
- HCTZ 25 mg daily
- Omeprazole 40 mg [**Hospital1 **]
- KCl 20 daily
- Sertraline 75 mg daily
- Simvastatin 10 daily
- Albuterol nebs q4 hours PRN
- Ipratroprium nebs q4 hours PRN

Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Chronic Obstructive Pulmonary Disease exacerbation
.
Secondary:
 Coronary Artery Disease
 Hypertension
 Bronchial asthma
 Hypercholesterolemia
 Depression
 Gastroesophageal Reflux Disease
 Osteoporosis
 Chronic sinusitis


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


Discharge Instructions:
You were admitted to the hospital because of shortness of breath
and cough.  In the emergency room, physicians treated you for a
Chronic Obstructive Pulmonary Disease (COPD) flare, which you
have had in the past.  You were given nebulizers as well as
steroids and antibitoics to help with your shortness of breath.
Because you were continuing to have difficulty breathing, you
were admitted to the ICU for closer monitoring.  In the ICU, you
did well without steroids or antibiotics, but continued to have
a hacking cough.  You were given albuterol and ipratropium
nebulizer treatments to help with your breathing.  It was felt
you were stable to go home, and have your cough evaluated by
your primary care doctor.  You will be going home with
prescriptions with nebulizers, as well as cough suppressants.
.
If you develop fever, chest pain, worsening shortness of breath,
dizziness, or worsening fatigue, please see your primary care
doctor or return to the closest emergency department for further
evaluation.
.
It has been a pleasure taking care of you Ms. [**Known lastname 805**]!

Followup Instructions:
Department: [**Hospital3 249**]
When: WEDNESDAY [**2147-12-20**] at 1:45 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 26**] [**Last Name (NamePattern1) 8402**], MD [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: [**Hospital3 249**]
When: THURSDAY [**2147-12-28**] at 11:40 AM
With: [**First Name8 (NamePattern2) 1238**] [**Last Name (NamePattern1) 1239**] [**Name8 (MD) **], NP [**Telephone/Fax (1) 250**]
Building: [**Hospital6 29**] [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: ORTHOPEDICS
When: TUESDAY [**2148-1-30**] at 11:15 AM
With: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 5500**], M.D. [**Telephone/Fax (1) 1228**]
Building: [**Hospital6 29**] [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 8405**]

Completed by:[**2147-12-21**]
{'Chronic obstructive asthma with (acute) exacerbation,Obesity hypoventilation syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Esophageal reflux,Osteoporosis, unspecified'}


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, increased work of breathing.

PRESENT ILLNESS: 84 yo F with h/o HTN, HL, OSA, with two admissions for
productive cough of unclear etiology in [**9-/2147**] who was sent to
the ED when her home physical therapist found her hypoxic to the
80's on RA. There, she c/o productive cough x3d, increase WOB,
increase LE edema, no f/c, and stable weight.

MEDICAL HISTORY: # Status post right shoulder replacement
# Status post right hip replacement.
# Sinusitis.
# Nonallergic Rhinitis
# Bronchial asthma - not supported by PFTs
# OSA and ? obesity hypoventilation syndrome - followed by Dr.
[**Last Name (STitle) **]
# GERD.
# Hypertension.
# History of glaucoma.
# Arthritis.
# CAD with normal persantine MIBI in [**9-19**].
# History of cataract surgery.
# Influenza A [**1-20**]

MEDICATION ON ADMISSION: - albuterol inhalers
- alendronate 70 mg weekly
- amlodipine 10 mg daily
- atenolol 100 daily
- azelastine 137 mcg 2 sprays each nostril daily
- benzonatate 100 mg tid prn cough
- HCTZ 25 mg daily
- Omeprazole 40 mg [**Hospital1 **]
- KCl 20 daily
- Sertraline 75 mg daily
- Simvastatin 10 daily
.
- Of note, pt states not taking Lisinopril 40 mg daily or
Ipratropium nebs

ALLERGIES: Sulindac / Aspirin / Hycodan

PHYSICAL EXAM: 96% on RA, satting mid 90's on RA while conversing during
interview
Tired appearing, speaking full sentences but sounds out of
breath doing so, not in distress
Mouth very dry appearing, OP clear no lesions noted
No JVD noted
Slight, fine crackle at R lung base but otherwise CTAB, no
wheezes appreciated, but with poor air movement
Faint S1, S2 but no audible m/g appreciated
Soft, NT ND abdomen, BS+
No BLE edema noted, extremities warm
CN 2-12 grossly intact, moving all extremities, conversant and
lucid

FAMILY HISTORY: Family History: per OMR
Prostate Cancer: positive
Breast Cancer: Her mother, a daughter and a granddaughter.  [**Name (NI) **]
[**Name2 (NI) 8401**] died of breast cancer at age 40.
COPD: Her daughter died of complications associated w/ COPD
CAD: none

SOCIAL HISTORY: Social History: per OMR
-Support: lives with granddaughter [**Name (NI) 8399**] [**Name (NI) 284**].  Her
family is in [**State 531**] City.  She has four children, three of
whom are living, many grand children, 7 great grand children and 

### Response:
{'Chronic obstructive asthma with (acute) exacerbation,Obesity hypoventilation syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Esophageal reflux,Osteoporosis, unspecified'}
