CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: 55M with history of HTN, GERD, and asthma presenting with 7 days
of worsening SOB and cough productive of thick, occasionally
brown sputum. Initially with sinus/congestion symptoms last week
which since resolved, but now with respiratory symptoms. Has
been taking albuterol hfa/nebs without significant relief. He
takes fluticasone INH [**Hospital1 **] as control medication; this was
started in [**2-/2181**] by his PCP when [**Name9 (PRE) 4010**] was stopped. Pt reports
this current SOB does not feel like his prior asthma
exacerbations. Also notes increased LE edema bilaterally x 1
week, which he has never had before, in the setting of taking in
more fluid. Recently increased pillows from 2 to 4. No
fevers/chills, no CP, no left arm or jaw pain, no syncope, +
increase in abdominal girth, no n/v/d, no constipation. Coughing
exacerbates shortness of breath.
.
Denies sick contacts. Does have allergies to pet dander and did
experience his allergy symptoms of itchy eyes, lacrimation, and
rhinorrhea last Monday after someone else drove his truck over
the weekend. Only one prior hospitalization for asthma flare,
>30 years ago.
.
In the ED, he was found to be uncomfortable, tachypnic, and with
visibly using accessory muscles of respiration. Initial vs were:
T 99.4 P 103 BP 173/103 R 26 O2 sat 97/RA .Pulmonary exam
+L-sided crackles w/diffuse wheezes, LE w/1+ pitting edema
bilaterally. O2 62%/2L. ABG 7.42/40/62. CXR showed prominent
vasculature but no e/o PNA or other acute process. BNP 26, EKG
w/inferior q waves, troponin negative x1. Blood cultures were
sent. He received 1 dose of 60mg prednisone, 500mg azithro, IV
magnesium, and continuous nebs (received x3). He was admitted
directly to the ICU for asthma exacerbation, bronchitis, or
possible new CHF.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss.
Denies headache, rhinorrhea. Denies chest pain, chest pressure,
palpitations, or weakness. Denies nausea, vomiting, diarrhea,
constipation, abdominal pain, or changes in bowel habits. Denies
dysuria, frequency, or urgency. Denies arthralgias or myalgias.
Denies rashes or skin changes.

MEDICAL HISTORY: Asthma
GERD
Hypertension
Partial L rotator cuff tear

MEDICATION ON ADMISSION: Albuterol HFA 90 mcg 2 piffs q4h PRN
Flovent 110 mcg 2 puffs [**Hospital1 **]
Amlodipine 10 mg daily
HCTZ 25 mg daily
Methocarbamol 750 mg [**Hospital1 **] prn back spasm
Metoprolol SR 25 mg QD
Naproxen 500 mg [**Hospital1 **] prn back spasm
Omeprazole 40 mg [**Hospital1 **]
Psyllium husk 1 capsule (0.52 g) [**Hospital1 **]
Simethicone 180 mg [**Hospital1 **]:prn

ALLERGIES: lisinopril

PHYSICAL EXAM: Upon admission:
Vitals: T96.4 BP 144/88 HR 103 RR 10 O2sat 96/RA
General: AOX3, well-appearing NAD sitting up w/2 pillows, no
cough
HEENT: NCAT EOMI PERRL MMM OP clear, neck supple, JVP 6cm above
sternal angle, no LAD
Lungs: barrel-chested, distant breath sounds, +L distant exp
wheeze
CV: RRR, nl S1 + S2, no m/r/g
Abdomen: soft, NTND +BS
Ext: WWP, 2+ pulses, no c/c/e

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Married, truck driver with predominantly local routes.
- Tobacco: none
- Alcohol: social
- Illicits: none
Asthma, unspecified type, with (acute) exacerbation,Acute bronchitis,Unspecified essential hypertension,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)
Asthma NOS w (ac) exac,Acute bronchitis,Hypertension NOS,Esophageal reflux,Obstructive sleep apnea
Admission Date:  [**2181-7-17**]              Discharge Date:   [**2181-7-20**]

Date of Birth:  [**2125-8-8**]             Sex:   M

Service: MEDICINE

Allergies:
lisinopril

Attending:[**First Name3 (LF) 602**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
None


History of Present Illness:
55M with history of HTN, GERD, and asthma presenting with 7 days
of worsening SOB and cough productive of thick, occasionally
brown sputum. Initially with sinus/congestion symptoms last week
which since resolved, but now with respiratory symptoms. Has
been taking albuterol hfa/nebs without significant relief. He
takes fluticasone INH [**Hospital1 **] as control medication; this was
started in [**2-/2181**] by his PCP when [**Name9 (PRE) 4010**] was stopped. Pt reports
this current SOB does not feel like his prior asthma
exacerbations. Also notes increased LE edema bilaterally x 1
week, which he has never had before, in the setting of taking in
more fluid. Recently increased pillows from 2 to 4. No
fevers/chills, no CP, no left arm or jaw pain, no syncope, +
increase in abdominal girth, no n/v/d, no constipation. Coughing
exacerbates shortness of breath.
.
Denies sick contacts. Does have allergies to pet dander and did
experience his allergy symptoms of itchy eyes, lacrimation, and
rhinorrhea last Monday after someone else drove his truck over
the weekend. Only one prior hospitalization for asthma flare,
>30 years ago.
.
In the ED, he was found to be uncomfortable, tachypnic, and with
visibly using accessory muscles of respiration. Initial vs were:
T 99.4 P 103 BP 173/103 R 26 O2 sat 97/RA .Pulmonary exam
+L-sided crackles w/diffuse wheezes, LE w/1+ pitting edema
bilaterally. O2 62%/2L. ABG 7.42/40/62. CXR showed prominent
vasculature but no e/o PNA or other acute process. BNP 26, EKG
w/inferior q waves, troponin negative x1. Blood cultures were
sent. He received 1 dose of 60mg prednisone, 500mg azithro, IV
magnesium, and continuous nebs (received x3). He was admitted
directly to the ICU for asthma exacerbation, bronchitis, or
possible new CHF.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss.
Denies headache, rhinorrhea. Denies chest pain, chest pressure,
palpitations, or weakness. Denies nausea, vomiting, diarrhea,
constipation, abdominal pain, or changes in bowel habits. Denies
dysuria, frequency, or urgency. Denies arthralgias or myalgias.
Denies rashes or skin changes.

Past Medical History:
Asthma
GERD
Hypertension
Partial L rotator cuff tear


Social History:
Married, truck driver with predominantly local routes.
- Tobacco: none
- Alcohol: social
- Illicits: none


Family History:
Noncontributory.

Physical Exam:
Upon admission:
Vitals: T96.4 BP 144/88 HR 103 RR 10 O2sat 96/RA
General: AOX3, well-appearing NAD sitting up w/2 pillows, no
cough
HEENT: NCAT EOMI PERRL MMM OP clear, neck supple, JVP 6cm above
sternal angle, no LAD
Lungs: barrel-chested, distant breath sounds, +L distant exp
wheeze
CV: RRR, nl S1 + S2, no m/r/g
Abdomen: soft, NTND +BS
Ext: WWP, 2+ pulses, no c/c/e


Pertinent Results:
Labs upon admission:
[**2181-7-17**] 09:10AM BLOOD WBC-11.2* RBC-5.20 Hgb-16.1 Hct-45.7
MCV-88 MCH-31.0 MCHC-35.2* RDW-13.4 Plt Ct-222
[**2181-7-17**] 09:10AM BLOOD Neuts-77.2* Lymphs-13.0* Monos-5.1
Eos-4.1* Baso-0.5
[**2181-7-17**] 10:34PM BLOOD PT-13.9* PTT-26.2 INR(PT)-1.2*
[**2181-7-17**] 09:10AM BLOOD Glucose-100 UreaN-9 Creat-0.8 Na-139
K-4.2 Cl-103 HCO3-25 AnGap-15
[**2181-7-17**] 09:10AM BLOOD proBNP-26
[**2181-7-17**] 09:10AM BLOOD cTropnT-<0.01
[**2181-7-17**] 09:10AM BLOOD Calcium-9.5 Phos-3.1 Mg-1.9
[**2181-7-17**] 01:38PM BLOOD D-Dimer-164
[**2181-7-17**] 01:36PM BLOOD Type-ART pO2-62* pCO2-40 pH-7.42
calTCO2-27 Base XS-0

Micro:
[**2181-7-17**] blood cultures pending
[**2181-7-18**] sputum culture
GRAM STAIN (Final [**2181-7-18**]):
      [**10-30**] PMNs and <10 epithelial cells/100X field.
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE ROD(S).

Echo: IMPRESSION: Symmetric left ventricular hypetrophy with
vigorous biventricular systolic function. No
clinically-significant valvular disease seen.

Discharge Labs:
[**2181-7-20**] 10:30AM BLOOD WBC-15.0* RBC-4.90 Hgb-14.9 Hct-43.0
MCV-88 MCH-30.4 MCHC-34.6 RDW-12.9 Plt Ct-221
[**2181-7-20**] 10:30AM BLOOD Neuts-77* Bands-1 Lymphs-15* Monos-4
Eos-3 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2181-7-19**] 04:50AM BLOOD Glucose-123* UreaN-12 Creat-0.8 Na-138
K-3.8 Cl-101 HCO3-26 AnGap-15
[**2181-7-18**] 06:14AM BLOOD CK(CPK)-91
[**2181-7-18**] 06:14AM BLOOD Calcium-9.1 Phos-3.1 Mg-2.2

Brief Hospital Course:
55 yo male with history of asthma & HTN who presented with 2
weeks of progressive shortness of breath likely due to acute
bronchitis and allergies triggering a severe asthma flare.

#Asthma exacerbation:
He was initially admitted to the ICU and transferred to floor
medical service quickly, not needing NIPPV. He received standing
nebs and was started on prednisone 60mg daily which he was
discharged to continue for 10 days without a taper. His flovent
110mcg was also stepped up to Adavir 100/50 and singulair was
added given his history of allergies and his recollection of
symptoms after being in a truck that smelled like an animal had
been there. He was discharged to follow up with his new
pulmonologist [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4011**].

#Acute bronchitis:
Upon presentation in addition to shortness of breath patient had
copious amounts of dark thick green sputum production with mild
hypoxia and clear CXR. Sputum cxs with neutrophil predominance
showed GPC in pairs and clusters and GPR and cx grew commensal
flora. Given initial gram stain data patient was treated with
CTX and azithromycin. However, he did not have significant
improvement in his symptoms with this medication so he was
changed from ceftriaxone to augmentin to complete a total of an
8 day course. His symptoms seemed to improve slowly when changed
to augmentin (to cover bronchitis from MSSA).

#Probable OSA: Patient should have outpatient sleep study and
outpatient PFTs.

#HTN: Patient was hypertensive during admission. THis was felt
to be due to respiratoy work of breathing. BPs improved over
admission. Although unlikely to be playing a role, his BB was
changed to Diltiazem for BP and HR control and his amlodipine
and HCTZ were continued. An echo showed symmetric LVH so his BPs
should be controlled aggressively upon discharge when his
respiratory status is back to baseline. He at no time received
diuretics for CHF.

#CODE: Full

#Left rotator cuff tear:  Patient takes naproxen at home.

Medications on Admission:
Albuterol HFA 90 mcg 2 piffs q4h PRN
Flovent 110 mcg 2 puffs [**Hospital1 **]
Amlodipine 10 mg daily
HCTZ 25 mg daily
Methocarbamol 750 mg [**Hospital1 **] prn back spasm
Metoprolol SR 25 mg QD
Naproxen 500 mg [**Hospital1 **] prn back spasm
Omeprazole 40 mg [**Hospital1 **]
Psyllium husk 1 capsule (0.52 g) [**Hospital1 **]
Simethicone 180 mg [**Hospital1 **]:prn


Discharge Medications:
1. prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 6 days.
Disp:*18 Tablet(s)* Refills:*0*
2. azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 1 doses.
Disp:*1 Tablet(s)* Refills:*0*
3. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
6. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO QID (4 times a day) as needed for gas.
7. montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. fluticasone-salmeterol 100-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 Disk with Device(s)* Refills:*2*
9. diltiazem HCl 120 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO once a day.
Disp:*30 Capsule, Ext Release 24 hr(s)* Refills:*2*
10. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO Q12H (every 12 hours) for 4 days.
Disp:*9 Tablet(s)* Refills:*0*
11. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours) as needed for
shortness of breath or wheezing.
Disp:*1 inhaler* Refills:*2*
12. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler
Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for
shortness of breath or wheezing.
Disp:*1 inhaler* Refills:*2*
13. methocarbamol 750 mg Tablet Sig: One (1) Tablet PO twice a
day as needed for back spasm.
14. psyllium husk 0.52 g Capsule Sig: One (1) Capsule PO twice a
day.


Discharge Disposition:
Home

Discharge Diagnosis:
Asthma
Bronchitis
Probable sleep apnea


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


Discharge Instructions:
You were admitted to [**Hospital1 18**] for shortness of breath, cough, and
sputum production and were found to have an asthma exacerbation
due to bronchitis. You were treated with steroids and given
inhalers which you should continue to take as needed after you
are discharged from the hospital. You were also given
antibiotics to treat bacterial bronchitis. You were also given a
medication called singulair to help prevent your allergies from
flaring.

Please take the full course of prednisone and antibiotics until
your prescriptions are complete. You have also been prescribed
Advair which you should take as directed. You have also been
prescriptions for Albuterol and Atrovent (Ipratropium) which you
should take together as needed for shortness of breath and
wheezing.

Please also note that your Metoprolol has been discontinued and
you have been started on Diltiazem. This medication is similar
but may cause less problems for your lungs.

You should not return to work until you feel back to normal
since the allergens and dust that you are exposed to at work
could exacerbate your symptoms.

If you feel your symptoms are starting to worsen please call
your doctor right away.

Followup Instructions:
Department: [**Hospital1 18**] [**Location (un) 2352**]- ADULT MED
When: THURSDAY [**2181-7-26**] at 10:10 AM
With: [**First Name11 (Name Pattern1) 1569**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 4012**], MD [**Telephone/Fax (1) 1144**]
Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

Department: PULMONARY FUNCTION LAB
When: THURSDAY [**2181-8-16**] at 3:40 PM
With: PULMONARY FUNCTION LAB [**Telephone/Fax (1) 609**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: MEDICAL SPECIALTIES
When: THURSDAY [**2181-8-16**] at 4:00 PM
With: DRS. [**Name5 (PTitle) 4013**] & [**Doctor Last Name **] [**Telephone/Fax (1) 612**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Asthma, unspecified type, with (acute) exacerbation,Acute bronchitis,Unspecified essential hypertension,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)'}


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: Dyspnea

PRESENT ILLNESS: 55M with history of HTN, GERD, and asthma presenting with 7 days
of worsening SOB and cough productive of thick, occasionally
brown sputum. Initially with sinus/congestion symptoms last week
which since resolved, but now with respiratory symptoms. Has
been taking albuterol hfa/nebs without significant relief. He
takes fluticasone INH [**Hospital1 **] as control medication; this was
started in [**2-/2181**] by his PCP when [**Name9 (PRE) 4010**] was stopped. Pt reports
this current SOB does not feel like his prior asthma
exacerbations. Also notes increased LE edema bilaterally x 1
week, which he has never had before, in the setting of taking in
more fluid. Recently increased pillows from 2 to 4. No
fevers/chills, no CP, no left arm or jaw pain, no syncope, +
increase in abdominal girth, no n/v/d, no constipation. Coughing
exacerbates shortness of breath.
.
Denies sick contacts. Does have allergies to pet dander and did
experience his allergy symptoms of itchy eyes, lacrimation, and
rhinorrhea last Monday after someone else drove his truck over
the weekend. Only one prior hospitalization for asthma flare,
>30 years ago.
.
In the ED, he was found to be uncomfortable, tachypnic, and with
visibly using accessory muscles of respiration. Initial vs were:
T 99.4 P 103 BP 173/103 R 26 O2 sat 97/RA .Pulmonary exam
+L-sided crackles w/diffuse wheezes, LE w/1+ pitting edema
bilaterally. O2 62%/2L. ABG 7.42/40/62. CXR showed prominent
vasculature but no e/o PNA or other acute process. BNP 26, EKG
w/inferior q waves, troponin negative x1. Blood cultures were
sent. He received 1 dose of 60mg prednisone, 500mg azithro, IV
magnesium, and continuous nebs (received x3). He was admitted
directly to the ICU for asthma exacerbation, bronchitis, or
possible new CHF.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss.
Denies headache, rhinorrhea. Denies chest pain, chest pressure,
palpitations, or weakness. Denies nausea, vomiting, diarrhea,
constipation, abdominal pain, or changes in bowel habits. Denies
dysuria, frequency, or urgency. Denies arthralgias or myalgias.
Denies rashes or skin changes.

MEDICAL HISTORY: Asthma
GERD
Hypertension
Partial L rotator cuff tear

MEDICATION ON ADMISSION: Albuterol HFA 90 mcg 2 piffs q4h PRN
Flovent 110 mcg 2 puffs [**Hospital1 **]
Amlodipine 10 mg daily
HCTZ 25 mg daily
Methocarbamol 750 mg [**Hospital1 **] prn back spasm
Metoprolol SR 25 mg QD
Naproxen 500 mg [**Hospital1 **] prn back spasm
Omeprazole 40 mg [**Hospital1 **]
Psyllium husk 1 capsule (0.52 g) [**Hospital1 **]
Simethicone 180 mg [**Hospital1 **]:prn

ALLERGIES: lisinopril

PHYSICAL EXAM: Upon admission:
Vitals: T96.4 BP 144/88 HR 103 RR 10 O2sat 96/RA
General: AOX3, well-appearing NAD sitting up w/2 pillows, no
cough
HEENT: NCAT EOMI PERRL MMM OP clear, neck supple, JVP 6cm above
sternal angle, no LAD
Lungs: barrel-chested, distant breath sounds, +L distant exp
wheeze
CV: RRR, nl S1 + S2, no m/r/g
Abdomen: soft, NTND +BS
Ext: WWP, 2+ pulses, no c/c/e

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Married, truck driver with predominantly local routes.
- Tobacco: none
- Alcohol: social
- Illicits: none 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Acute bronchitis,Unspecified essential hypertension,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)'}
