CHIEF COMPLAINT: Wet, produtive cough, shortness of breath, dyspnea on exertion,
hypoxia and abnormal chest x-ray

PRESENT ILLNESS: [**Age over 90 **] year old female with multiple chronic medical problems
presenting with a several week history of wet, produtive cough,
shortness of breath, dyspnea on exertion, hypoxia and abnormal
chest x-ray. Several weeks ago, Ms. [**Known lastname 7336**] developed fever,
chest congestion and shortness of breath. She had several Xray
evaluations which demonstrated focal nodular abnormality of the
RUL and extensive abnormal density at the lung bases with
pleural disease and low lung volumes. Over time, the lung base
lesions increased and small effusions developed. She was treated
with antibiotics--levofloxacin, then clindamycin then
combination Vancomycin/Ceftriaxone and Flagyl (day 1 [**2195-6-13**]).
Follow up CXR on [**6-25**] was without significant change. During
this time, she also had evaluation for influenza and was treated
with oseltamivir for 2 days, but this was discontinued, as the
H1N1 evaluation was negative.
.
Despite treatment with antimicrobials and supportive
medications, the patient failed to improve clinically or on
imaging. She continued to have a wet productive cough, low grade
fever, night sweats, poor appetite (progressive over disease
course) and hypoxia since [**5-16**].

MEDICAL HISTORY: 1. CHF: EF 60%, 3+ MR, 2+ TR, 1+ AR, mod [**Last Name (un) 6879**] in [**6-15**]
2. Atrial fibrillation s/p pacer, not on AC due to falls
3. AAA s/p stent [**9-13**]/[**Doctor Last Name **]
4. Right breast cancer: s/p lumpectomy and radiation
5. Chronic renal insufficiency with baseline 1.5
6. Anxiety/depression
7. DJD/DDD/recurrent pseudocout, LBP, L4/5 spondylolithesis
8. GERD with stricture s/p dilation
9. Anemia--baseline per provided labs is 28-30

MEDICATION ON ADMISSION: -Acetaminophen 650 mg qhs
-Albuterol nebs four times daily
-Aspirin 81 mg daily
-Calcium carbonate 650 mg [**Hospital1 **]
-Vitamin D 1000 u daily
-Celexa 30 mg daily
-Plavix 75 mg daily
-Diltiazem CD 120 mg qhs daily
-Gabapentin 100 mg tid
-Ipratropium nebs four times daily
-Isordil 5 mg daily
-Metoprolol 100 mg daily qhs
-Omeprazole 40 mg [**Hospital1 **]
-Zofran 8 mg [**Hospital1 **]
-Oxycontin 10 mg qhs
-Senna [**Hospital1 **]

ALLERGIES: Penicillins / Sulfa (Sulfonamides) / Erythromycin Base /
Macrolide Antibiotics

PHYSICAL EXAM: 97.6 102/65 101 23 94% 5L NC
Gen: elderly female, well appearing, no distress, lying
comfortably at 30 deg angle, speaks in full sentences
HEENT: PERRL, EOMI, OP clear, MM dry/without lesion
Neck: JVP at 8 cm H2O, HJR to 10 cm H2O
Car: Irregular, tachycardic, no audible murmur
Resp: Crackles 1/2 up bilaterally, broncial breath sounds left
base with egophony
Abd: s/nt/nd/nabs
Ext: in TEDS, no LE edema

FAMILY HISTORY: heart disease

SOCIAL HISTORY: widowed, lives at [**Hospital3 **], 2 sons, 4 [**Name2 (NI) 7337**],
worked in clerical work, smoked [**1-9**] ppd X 40 years, no alcohol,
no drugs
Neoplasm of uncertain behavior of trachea, bronchus, and lung,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Orthostatic hypotension,Atrial fibrillation,Cardiac pacemaker in situ,Congestive heart failure, unspecified,Neoplasm of unspecified nature of endocrine glands and other parts of nervous system,Other chronic pain,Osteoporosis, unspecified,Anemia, unspecified,Dysthymic disorder,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Spondylolisthesis,Personal history of tobacco use,Encounter for palliative care
Unc behav neo lung,Pneumonia, organism NOS,Hyposmolality,Orthostatic hypotension,Atrial fibrillation,Status cardiac pacemaker,CHF NOS,Endocrine/nerv neo NOS,Chronic pain NEC,Osteoporosis NOS,Anemia NOS,Dysthymic disorder,Osteoarthros NOS-unspec,Esophageal reflux,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hx of breast malignancy,Hx of irradiation,Spondylolisthesis,History of tobacco use,Encountr palliative care
Admission Date:  [**2195-6-25**]              Discharge Date:   [**2195-6-28**]


Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamides) / Erythromycin Base /
Macrolide Antibiotics

Attending:[**First Name3 (LF) 2840**]
Chief Complaint:
Wet, produtive cough, shortness of breath, dyspnea on exertion,
hypoxia and abnormal chest x-ray

Major Surgical or Invasive Procedure:
None.


History of Present Illness:
[**Age over 90 **] year old female with multiple chronic medical problems
presenting with a several week history of wet, produtive cough,
shortness of breath, dyspnea on exertion, hypoxia and abnormal
chest x-ray. Several weeks ago, Ms. [**Known lastname 7336**] developed fever,
chest congestion and shortness of breath. She had several Xray
evaluations which demonstrated focal nodular abnormality of the
RUL and extensive abnormal density at the lung bases with
pleural disease and low lung volumes. Over time, the lung base
lesions increased and small effusions developed. She was treated
with antibiotics--levofloxacin, then clindamycin then
combination Vancomycin/Ceftriaxone and Flagyl (day 1 [**2195-6-13**]).
Follow up CXR on [**6-25**] was without significant change. During
this time, she also had evaluation for influenza and was treated
with oseltamivir for 2 days, but this was discontinued, as the
H1N1 evaluation was negative.
.
Despite treatment with antimicrobials and supportive
medications, the patient failed to improve clinically or on
imaging. She continued to have a wet productive cough, low grade
fever, night sweats, poor appetite (progressive over disease
course) and hypoxia since [**5-16**].

In the ED, vitals were: 98.1 96/65 100 18 99% 4L NC. Her BP
remained low throughout the ED course 78-106/39-51. She was
given ceftriaxone, flagyl, asa 325 mg and 2 L IVF and admitted
to the ICU for hypotension.

Currently, she is bothered only by her cough, otherwise, she is
feeling well.


Past Medical History:
1. CHF: EF 60%, 3+ MR, 2+ TR, 1+ AR, mod [**Last Name (un) 6879**] in [**6-15**]
2. Atrial fibrillation s/p pacer, not on AC due to falls
3. AAA s/p stent [**9-13**]/[**Doctor Last Name **]
4. Right breast cancer: s/p lumpectomy and radiation
5. Chronic renal insufficiency with baseline 1.5
6. Anxiety/depression
7. DJD/DDD/recurrent pseudocout, LBP, L4/5 spondylolithesis
8. GERD with stricture s/p dilation
9. Anemia--baseline per provided labs is 28-30


Social History:
widowed, lives at [**Hospital3 **], 2 sons, 4 [**Name2 (NI) 7337**],
worked in clerical work, smoked [**1-9**] ppd X 40 years, no alcohol,
no drugs

Family History:
heart disease

Physical Exam:
97.6 102/65 101 23 94% 5L NC
Gen: elderly female, well appearing, no distress, lying
comfortably at 30 deg angle, speaks in full sentences
HEENT: PERRL, EOMI, OP clear, MM dry/without lesion
Neck: JVP at 8 cm H2O, HJR to 10 cm H2O
Car: Irregular, tachycardic, no audible murmur
Resp: Crackles 1/2 up bilaterally, broncial breath sounds left
base with egophony
Abd: s/nt/nd/nabs
Ext: in TEDS, no LE edema


Pertinent Results:
ADMISSION LABS:
===============
[**2195-6-25**] 03:55PM   WBC-6.9# RBC-3.27* HGB-9.4* HCT-29.7* MCV-91
MCH-28.7 MCHC-31.6 RDW-16.4*
[**2195-6-25**] 03:55PM   NEUTS-76.5* LYMPHS-17.4* MONOS-4.4 EOS-1.4
BASOS-0.3
[**2195-6-25**] 03:55PM   PLT COUNT-150
[**2195-6-25**] 03:55PM   CK-MB-NotDone
[**2195-6-25**] 03:55PM   CK(CPK)-11*
[**2195-6-25**] 03:55PM   cTropnT-<0.01
[**2195-6-25**] 03:55PM   GLUCOSE-107* UREA N-20 CREAT-1.3* SODIUM-132*
POTASSIUM-4.7 CHLORIDE-96 TOTAL CO2-31 ANION GAP-10
[**2195-6-25**] 03:58PM   LACTATE-1.6
[**2195-6-25**] 07:13PM   LACTATE-1.0
[**2195-6-25**] 07:29PM URINE  RBC-0-2 WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0
[**2195-6-25**] 07:29PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2195-6-25**] 07:29PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.019

MICROBIOLOGY
============
[**6-25**] Blood Cultures x 2: pending
[**6-25**] Urine Culture: pending

[**2195-6-26**] 2:27 pm SPUTUM      Source: Expectorated.

   GRAM STAIN (Pending):

   RESPIRATORY CULTURE (Pending):

STUDIES:
========
[**6-25**] PORTABLE CXR: IMPRESSION: Nonspecific lung opacities
predominante in the lung bases but also affect the right upper
lobe. The differential diagnosis includes infectious,
inflammatory, and neoplastic process. Recommend CT chest for
further evaluation.

[**6-25**] CT CHEST/ABDOMEN/PELVIS:
Multifocal airspace consolidation with airbronchograms in the
bilateral lower lobes concerning for superimposed infection.
Known right apical mass
increasing in size with newly apparent left apical mass highly
concerning for neoplasm. Ill-defined soft tissue densities
posterior to the kidneys, stable since prior examinations.
Stable AAA status post stent.

DISCHARGE LABS:
[**2195-6-26**] 03:46AM BLOOD WBC-5.2 RBC-2.98* Hgb-8.7* Hct-26.6*
MCV-89 MCH-29.1 MCHC-32.6 RDW-17.2* Plt Ct-116*
[**2195-6-26**] 03:46AM BLOOD Glucose-79 UreaN-15 Creat-1.1 Na-136
K-4.3 Cl-103 HCO3-28 AnGap-9
[**2195-6-26**] 03:46AM BLOOD Calcium-8.3* Phos-3.7 Mg-1.8

Brief Hospital Course:
[**Age over 90 **] year old female with multiple chronic medical problems
presenting with 3 weeks of pulmonary symptoms and hypoxia
without improvement.

1. Hypotension: Clinically, appeared most consistent with
dehydration.  Bolused IVFs on night of admission with
appropriate BP response.

2. Lung masses: CT showed known right apical mass increasing in
size with newly apparent left apical mass highly concerning for
neoplasm.  In [**8-15**], CT then had noted R apical mass and positive
PET concerning for malignancy.  Also noted to have thyroid
lesion.  Discussed findings with family.  Patient was too
tenuous for bronchoscopy given high oxygen requirment.  Family
meeting completed and she was confirmed DNR/DNI as well comfort
being paramount goal.  She was started on tessalon perles and
morphine IV prn. At rehab, please continue oxygen
supplmenentation.

3. Pneumonia: Likely post-obstructive.  PCN allergy.  Planned 7
day course of levofloxacin and flagyl.  day # 1 is [**2195-6-27**].

4. Atrial fibrillation: HR usually in 100s per [**Hospital1 1501**] as well as
during ICU hospitalization.  Continued rate control with nodal
agents as in the d/c medication list.

5. AAA s/p repari: Initially held ASA and plavix, but as no
procedure, restarted these upon discharge.

6. CHF: clinically dry on exam, no need for diuretics.

7. Chronic pain: Continued oxycontin, gabapentin, acetaminophen.
Continue bowel regimen. Patient reports having stools.

8. Osteoporosis: ca/vit D.

9. Chronic renal insufficiency: at baseline

10. Anemia: at baseline

11. Hyponatremia: likely hypovolemic hyponatremia, resolved in
AM after IVFs

Access: PIV, PICC, Foley
Communication: with patient
HCP is son
DNR/[**Name2 (NI) 835**]

Medications on Admission:
-Acetaminophen 650 mg qhs
-Albuterol nebs four times daily
-Aspirin 81 mg daily
-Calcium carbonate 650 mg [**Hospital1 **]
-Vitamin D 1000 u daily
-Celexa 30 mg daily
-Plavix 75 mg daily
-Diltiazem CD 120 mg qhs daily
-Gabapentin 100 mg tid
-Ipratropium nebs four times daily
-Isordil 5 mg daily
-Metoprolol 100 mg daily qhs
-Omeprazole 40 mg [**Hospital1 **]
-Zofran 8 mg [**Hospital1 **]
-Oxycontin 10 mg qhs
-Senna [**Hospital1 **]


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
2. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation Q6H (every 6 hours).
3. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO TID (3 times a day).
4. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: 2.5 Tablets
PO DAILY (Daily).
5. Citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
6. Gabapentin 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
7. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb
Inhalation Q6H (every 6 hours).
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
9. Ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO BID (2 times a day).
10. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours).
11. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day) as needed for constipation.
12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
13. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
14. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
15. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
16. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
17. Morphine Sulfate 1 mg IV Q4H:PRN pain
18. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
injection Injection TID (3 times a day).
19. Levofloxacin 25 mg/mL Solution Sig: Seven [**Age over 90 1230**]y
(750) mg Intravenous Q48H (every 48 hours) for 7 days: day 1 is
[**6-27**] .
20. Metronidazole in NaCl (Iso-os) 500 mg/100 mL Piggyback Sig:
Five Hundred (500) mg Intravenous Q8H (every 8 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Primary Diagnosis:
1. Lung masses
2. Pneumonia

Secondary Diagnosis:
1. Atrial fibrillation
2. Congestive Heart Failure


Discharge Condition:
Stable. Needs supplemental oxygen 6 L NC to keep O2 > 90%


Discharge Instructions:
You were admitted with shortness of breath and hypotension.
Your blood pressure improved with oxygen. You were found to have
a new left upper lobe mass and the known right upper lobe mass
in your lungs.  You also have a superimposed pneumonia.  After a
discussion with your family and in line with your wishes, you
will be treated with antibiotics for the pneumonia.  You were
given supplemental oxygen for comfort as well as cough
medications for your cough.

Please continue all your medications as prescribed.  Please keep
all your medical appointments.

If you have any concerning symptoms, please ask your doctors [**First Name (Titles) **] [**Name5 (PTitle) 7338**] Rehab.  Comfort is paramount.

Followup Instructions:
Please follow up with your primary care doctor as needed.
{'Neoplasm of uncertain behavior of trachea, bronchus, and lung,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Orthostatic hypotension,Atrial fibrillation,Cardiac pacemaker in situ,Congestive heart failure, unspecified,Neoplasm of unspecified nature of endocrine glands and other parts of nervous system,Other chronic pain,Osteoporosis, unspecified,Anemia, unspecified,Dysthymic disorder,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Spondylolisthesis,Personal history of tobacco use,Encounter for palliative care'}


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: Wet, produtive cough, shortness of breath, dyspnea on exertion,
hypoxia and abnormal chest x-ray

PRESENT ILLNESS: [**Age over 90 **] year old female with multiple chronic medical problems
presenting with a several week history of wet, produtive cough,
shortness of breath, dyspnea on exertion, hypoxia and abnormal
chest x-ray. Several weeks ago, Ms. [**Known lastname 7336**] developed fever,
chest congestion and shortness of breath. She had several Xray
evaluations which demonstrated focal nodular abnormality of the
RUL and extensive abnormal density at the lung bases with
pleural disease and low lung volumes. Over time, the lung base
lesions increased and small effusions developed. She was treated
with antibiotics--levofloxacin, then clindamycin then
combination Vancomycin/Ceftriaxone and Flagyl (day 1 [**2195-6-13**]).
Follow up CXR on [**6-25**] was without significant change. During
this time, she also had evaluation for influenza and was treated
with oseltamivir for 2 days, but this was discontinued, as the
H1N1 evaluation was negative.
.
Despite treatment with antimicrobials and supportive
medications, the patient failed to improve clinically or on
imaging. She continued to have a wet productive cough, low grade
fever, night sweats, poor appetite (progressive over disease
course) and hypoxia since [**5-16**].

MEDICAL HISTORY: 1. CHF: EF 60%, 3+ MR, 2+ TR, 1+ AR, mod [**Last Name (un) 6879**] in [**6-15**]
2. Atrial fibrillation s/p pacer, not on AC due to falls
3. AAA s/p stent [**9-13**]/[**Doctor Last Name **]
4. Right breast cancer: s/p lumpectomy and radiation
5. Chronic renal insufficiency with baseline 1.5
6. Anxiety/depression
7. DJD/DDD/recurrent pseudocout, LBP, L4/5 spondylolithesis
8. GERD with stricture s/p dilation
9. Anemia--baseline per provided labs is 28-30

MEDICATION ON ADMISSION: -Acetaminophen 650 mg qhs
-Albuterol nebs four times daily
-Aspirin 81 mg daily
-Calcium carbonate 650 mg [**Hospital1 **]
-Vitamin D 1000 u daily
-Celexa 30 mg daily
-Plavix 75 mg daily
-Diltiazem CD 120 mg qhs daily
-Gabapentin 100 mg tid
-Ipratropium nebs four times daily
-Isordil 5 mg daily
-Metoprolol 100 mg daily qhs
-Omeprazole 40 mg [**Hospital1 **]
-Zofran 8 mg [**Hospital1 **]
-Oxycontin 10 mg qhs
-Senna [**Hospital1 **]

ALLERGIES: Penicillins / Sulfa (Sulfonamides) / Erythromycin Base /
Macrolide Antibiotics

PHYSICAL EXAM: 97.6 102/65 101 23 94% 5L NC
Gen: elderly female, well appearing, no distress, lying
comfortably at 30 deg angle, speaks in full sentences
HEENT: PERRL, EOMI, OP clear, MM dry/without lesion
Neck: JVP at 8 cm H2O, HJR to 10 cm H2O
Car: Irregular, tachycardic, no audible murmur
Resp: Crackles 1/2 up bilaterally, broncial breath sounds left
base with egophony
Abd: s/nt/nd/nabs
Ext: in TEDS, no LE edema

FAMILY HISTORY: heart disease

SOCIAL HISTORY: widowed, lives at [**Hospital3 **], 2 sons, 4 [**Name2 (NI) 7337**],
worked in clerical work, smoked [**1-9**] ppd X 40 years, no alcohol,
no drugs 

### Response:
{'Neoplasm of uncertain behavior of trachea, bronchus, and lung,Pneumonia, organism unspecified,Hyposmolality and/or hyponatremia,Orthostatic hypotension,Atrial fibrillation,Cardiac pacemaker in situ,Congestive heart failure, unspecified,Neoplasm of unspecified nature of endocrine glands and other parts of nervous system,Other chronic pain,Osteoporosis, unspecified,Anemia, unspecified,Dysthymic disorder,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Esophageal reflux,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Spondylolisthesis,Personal history of tobacco use,Encounter for palliative care'}
