CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 45 year-old
gravida 5 para 1, last menstrual period [**2131-7-11**] who
presented with severe dysmenorrhea and dysfunctional uterine
bleeding.  The patient had known uterine fibroids.  She
complained of irregular bleeding and endometrial biopsy,
however, was not possible given her discomfort.  The most
recent ultrasound revealed a multifibroid uterus with the
largest fibroid posterior and measuring 3 cm.  The
endometrial stripe was 8 mm and homogenous.  The right ovary
was normal with two small clear cysts.  The patient desired
definitive therapy for her dysmenorrhea.

MEDICAL HISTORY: History of multiple pneumonias most
recently in [**2131-5-26**], status post pelvic fracture
following a fall on 11/[**2129**].  The patient was hospitalized
times two weeks, rehab times one week.  The patient still has
arthritis and limited mobility.  The patient was also
hospitalized for a coma after a beating in [**2111**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: History of smoking two packs per day,
history of alcohol abuse in the past.  Normal liver function
tests [**4-25**].  History of domestic violence.
Leiomyoma of uterus, unspecified,Pneumonia, organism unspecified,Candidiasis of mouth,Congestive heart failure, unspecified,Dysmenorrhea,Tobacco use disorder,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Uterine leiomyoma NOS,Pneumonia, organism NOS,Thrush,CHF NOS,Dysmenorrhea,Tobacco use disorder,Abn react-surg proc NEC
Admission Date:  [**2131-7-25**]     Discharge Date:  [**2131-7-30**]

Date of Birth:   [**2086-7-8**]     Sex:  F

Service:  GYNECOLOGY

HISTORY OF PRESENT ILLNESS:  The patient is a 45 year-old
gravida 5 para 1, last menstrual period [**2131-7-11**] who
presented with severe dysmenorrhea and dysfunctional uterine
bleeding.  The patient had known uterine fibroids.  She
complained of irregular bleeding and endometrial biopsy,
however, was not possible given her discomfort.  The most
recent ultrasound revealed a multifibroid uterus with the
largest fibroid posterior and measuring 3 cm.  The
endometrial stripe was 8 mm and homogenous.  The right ovary
was normal with two small clear cysts.  The patient desired
definitive therapy for her dysmenorrhea.

PAST OB HISTORY:  C section for twins.

PAST GYN HISTORY:  Last menstrual period [**2131-7-11**], menorrhagia
and dysmenorrhea, unable to do endometrial biopsy due to
patient discomfort.  Status post tubal ligation.  No history
of sexually transmitted disease.  Last pap [**2131-6-15**] normal.
Last mammogram [**2131-2-7**] abnormal with a 3 by 4 mm right benign
appearing density.  Follow up scheduled in [**7-27**].

PAST MEDICAL HISTORY:  History of multiple pneumonias most
recently in [**2131-5-26**], status post pelvic fracture
following a fall on 11/[**2129**].  The patient was hospitalized
times two weeks, rehab times one week.  The patient still has
arthritis and limited mobility.  The patient was also
hospitalized for a coma after a beating in [**2111**].

PAST SURGICAL HISTORY:  C section times one, bilateral tubal
ligation.  Status post left salpingo-oophorectomy.

MEDICATIONS:  Celexa and Trazodone.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  History of smoking two packs per day,
history of alcohol abuse in the past.  Normal liver function
tests [**4-25**].  History of domestic violence.

PHYSICAL EXAMINATION:  Vital signs stable.  Heart regular
rate and rhythm.  Lungs clear bilaterally.  Neck no
lymphadenopathy.  Breast normal breast examination.  No
masses.  Abdomen soft, nontender, nondistended.  No masses.
Pelvic, normal external genitalia.  Cervix normal appearing.
Uterus anteverted, nontender, irregular contour and mobile.
No adnexal masses or tenderness.  Extremities no clubbing,
cyanosis or edema.

ASSESSMENT:  The patient is a 45 year-old gravida 5 para 1
with complaints of fibroids, dysmenorrhea and dysfunctional
uterine bleeding who desired surgical treatment.  The patient
was admitted for a total abdominal hysterectomy on [**2131-7-25**].

HOSPITAL COURSE:  1.  Gyn:  On [**2131-7-25**] the patient underwent
a total abdominal hysterectomy.  The patient was noted to
have a small uterus with a 3 cm posterior fibroid, absent
left tube and ovary, normal right ovary with small
hemorrhagic cyst.  There were a few adhesions of the omentum
to the uterus.  Estimated blood loss was 100 cc.  There were
on complications.  Please see operative note for details.
Following the surgery the patient had no complications from a
gyn perspective.  Her incision was clean, dry and intact.

2.  Pulmonary:  On postoperative day number two the patient
was noted to have a decreased oxygen saturation of 69% on
room air, which increased to 86% on nonrebreather.  Her lungs
were noted to have bilateral coarse crackles.  She had an
arterial blood gas, which revealed a pH of 7.36, PO2 of 55
and PCO2 of 52.  She had a chest x-ray, which showed diffuse
opacities consistent with congestive heart failure.  Given
the patient's oxygen status she was transferred to the MICU.
There she was placed on a 100% nonrebreather.  She underwent
a CT angiogram, which was negative for pulmonary embolus,
however, revealed diffuse alveolar and interstitial
infiltrates.  The differential diagnosis at this time was a
diffuse atypical pneumonia versus congestive heart failure
versus other underlying process.  She was maintained on the
O2.  A repeat arterial blood gas revealed a pH of 7.39, PO2
of 72 and PCO2 of 50.  She received multiple doses of
intravenous Lasix to which she had a good diuresis.  She was
also started on antibiotics (see below).  The pulmonary
service considered performing a lung biopsy, however, it was
decided that this would be performed after the patient was
stabilized.  The patient was also seen by thoracic surgery
who recommended follow up lung biopsy when stabilized.  The
patient was gradually weaned off the O2 and her oxygen
saturation improved.  She was stable for transfer to the
regular floor on postoperative day number four.  On the
regular floor her oxygen saturation was 91% on room air with
improvement to 96% on room air after incentive spirometry.
Her bilateral crackles had also resolved.

3.  Infectious disease:  The patient was seen by the ID
Service who thought that she could potentially have an
atypical pneumonia.  She was initially started on intravenous
Levo, Vancomycin and Flagyl.  The patient had multiple tests
sent including HIV, Legionella, cryptococcal antigen,
immunoglobulin studies and sputum cultures.  She was noted to
have some thrush in her mouth and was started on Mycelex.  On
postoperative day number three the Vancomycin and Flagyl were
discontinued and she was switched to just po Levaquin.  Her
white blood cell count was elevated at 21.8 with 8 bands.
Follow up white blood cell count came down to 13.  The
patient remained afebrile throughout the course of
hospitalization.  She was discharged to home on Levaquin for
ten days.

4.  Cardiovascular:  The patient was thought to have an
element of mild congestive heart failure.  She received Lasix
diuresis to which there was noted to be clinical improvement.
She underwent an echocardiogram, which revealed mild
pulmonary hypertension with an ejection fraction of greater
then 55%.  The patient remained stable from that standpoint.

5. [**Last Name (STitle) 43161**]hylaxis:  The patient was maintained on subcutaneous
heparin until she was ambulatory.  She was also maintained on
Protonix for gastrointestinal prophylaxis.  The patient was
discharged to home on postoperative day number five.  She was
to follow up as an outpatient with Dr. [**Last Name (Prefixes) 14004**] as well
as her primary care physician and the pulmonary specialist
for possible lung biopsy.

DISCHARGE STATUS:  Stable.

DISCHARGE DIAGNOSES:
1.  Status post total abdominal hysterectomy.
2.  Status post respiratory failure with MICU transfer.
3.  Congestive heart failure versus atypical pneumonia versus
chronic lung process.

DISCHARGE MEDICATIONS:  Percocet, Motrin and Levofloxacin
times ten days.






                          [**Location (un) 680**] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 43162**]

Dictated By:[**Name8 (MD) 21942**]

MEDQUIST36

D:  [**2131-7-30**]  10:34
T:  [**2131-8-6**]  11:46
JOB#:  [**Job Number 43163**]
{'Leiomyoma of uterus, unspecified,Pneumonia, organism unspecified,Candidiasis of mouth,Congestive heart failure, unspecified,Dysmenorrhea,Tobacco use disorder,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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 45 year-old
gravida 5 para 1, last menstrual period [**2131-7-11**] who
presented with severe dysmenorrhea and dysfunctional uterine
bleeding.  The patient had known uterine fibroids.  She
complained of irregular bleeding and endometrial biopsy,
however, was not possible given her discomfort.  The most
recent ultrasound revealed a multifibroid uterus with the
largest fibroid posterior and measuring 3 cm.  The
endometrial stripe was 8 mm and homogenous.  The right ovary
was normal with two small clear cysts.  The patient desired
definitive therapy for her dysmenorrhea.

MEDICAL HISTORY: History of multiple pneumonias most
recently in [**2131-5-26**], status post pelvic fracture
following a fall on 11/[**2129**].  The patient was hospitalized
times two weeks, rehab times one week.  The patient still has
arthritis and limited mobility.  The patient was also
hospitalized for a coma after a beating in [**2111**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: History of smoking two packs per day,
history of alcohol abuse in the past.  Normal liver function
tests [**4-25**].  History of domestic violence. 

### Response:
{'Leiomyoma of uterus, unspecified,Pneumonia, organism unspecified,Candidiasis of mouth,Congestive heart failure, unspecified,Dysmenorrhea,Tobacco use disorder,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
