CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 33 year old female with past medical history significant for
Asthma on Symbicort (not used in [**6-22**] months)and albuterol QID
(no ICU or intubation history)and significant smoking history
who presents to the [**Hospital1 18**] ED with shortness of breath for past
day.
.
She reports five day history of productive cough, 3-day history
of rhinorrhea for past 3 days and increased shortness of breath
for past day but no fever, headache, change in bowel movement or
chest pain.  Her mother had similar clinical presentation with
cough, rhinorrhea and wheezing last week which resolved on its
own.  She has been using her albuterol nebs persisently every 30
minutes for the past day (26 times) with progressive worsening
of her shortness of breath.
.
In the ED, she tachycardic in 130s with oxygen saturation of
100% on nebs. She was noted to have poor air movement with
diffuse wheezing.  She received stacked nebs, solemedrol,
azithromycin and magnesium.  CXR showed RUL collapse. CT scan
showed bronchial wall thickening.
.
She was admitted to the MICU for further management and possible
bronchoscopy to therapeutic remove her ?plug causing RUL
collapse. Her vitals prior to transfer were 125 24 119/59 97% on
nebs.
.

MEDICAL HISTORY: Asthma
Polycystic ovarian syndrome
Breast Reduction

MEDICATION ON ADMISSION: Albuterol sulfate 2.5 mg/3 mL nebs q4 hr prn
Albuterol sulfate 90 mcg HFA 2 puffs q4-6 hrs prn
Budesonide-formoterol 160 mcg-4.5 mcg/Actuation HFA Aerosol
Inhaler
2 puff(s) inhaled twice a day (not used in six - eight months)
Metformin 500 mg po qdaily
Norethindrone-ethin estradiol 0.4 mg-35 mcg po qdaily
Chantix

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL:
Gen: Female in mild respiratory distress. Alert and oriented to
person place and time
Vitals: 97.9 134/57  120  95%2LNC; Peak flow 98 cc (good effort)
 FEV1: 0.71
HEENT: PERRLA. EOMI. Anicteric.
Chest: Using accessory muscles to breathe.  Moving air.
Inspiratory and expiratory wheezing throughout all lungs fields
except LUL where there was only bronchial sounds.
Heart: Tachycardic. Regular rhythm.
Abdomen: Soft, nontender and nondistended. NABS
External: No edema. No rash
Neuro: CN 2-12 intact.  [**5-19**] muscle strength. Sensation intact.
Negative FTN test.

FAMILY HISTORY: Positive for CAD.

SOCIAL HISTORY: Quit smoking a month ago ([**2162-12-29**]).  Social alcohol
intake.  No IVDU.  Works as a legal assistant. Lives at home
with mom, dad, 2 nieces (15 and 18) and nephew (14).
Asthma, unspecified type, with (acute) exacerbation,Alkalosis,Acute upper respiratory infections of unspecified site,Personal history of noncompliance with medical treatment, presenting hazards to health,Long-term (current) use of steroids
Asthma NOS w (ac) exac,Alkalosis,Acute uri NOS,Hx of past noncompliance,Long-term use steroids
Admission Date:  [**2163-1-26**]              Discharge Date:   [**2163-1-28**]

Date of Birth:  [**2129-12-7**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1115**]
Chief Complaint:
Shortness of breath


Major Surgical or Invasive Procedure:
None.


History of Present Illness:
33 year old female with past medical history significant for
Asthma on Symbicort (not used in [**6-22**] months)and albuterol QID
(no ICU or intubation history)and significant smoking history
who presents to the [**Hospital1 18**] ED with shortness of breath for past
day.
.
She reports five day history of productive cough, 3-day history
of rhinorrhea for past 3 days and increased shortness of breath
for past day but no fever, headache, change in bowel movement or
chest pain.  Her mother had similar clinical presentation with
cough, rhinorrhea and wheezing last week which resolved on its
own.  She has been using her albuterol nebs persisently every 30
minutes for the past day (26 times) with progressive worsening
of her shortness of breath.
.
In the ED, she tachycardic in 130s with oxygen saturation of
100% on nebs. She was noted to have poor air movement with
diffuse wheezing.  She received stacked nebs, solemedrol,
azithromycin and magnesium.  CXR showed RUL collapse. CT scan
showed bronchial wall thickening.
.
She was admitted to the MICU for further management and possible
bronchoscopy to therapeutic remove her ?plug causing RUL
collapse. Her vitals prior to transfer were 125 24 119/59 97% on
nebs.
.

Past Medical History:
Asthma
Polycystic ovarian syndrome
Breast Reduction

Social History:
Quit smoking a month ago ([**2162-12-29**]).  Social alcohol
intake.  No IVDU.  Works as a legal assistant. Lives at home
with mom, dad, 2 nieces (15 and 18) and nephew (14).


Family History:
Positive for CAD.


Physical Exam:
ADMISSION PHYSICAL:
Gen: Female in mild respiratory distress. Alert and oriented to
person place and time
Vitals: 97.9 134/57  120  95%2LNC; Peak flow 98 cc (good effort)
 FEV1: 0.71
HEENT: PERRLA. EOMI. Anicteric.
Chest: Using accessory muscles to breathe.  Moving air.
Inspiratory and expiratory wheezing throughout all lungs fields
except LUL where there was only bronchial sounds.
Heart: Tachycardic. Regular rhythm.
Abdomen: Soft, nontender and nondistended. NABS
External: No edema. No rash
Neuro: CN 2-12 intact.  [**5-19**] muscle strength. Sensation intact.
Negative FTN test.

DISCHARGE PHYSICAL EXAM:
VS: 98.8 94 130/71 18 97% RA, ambulatory sat 98% on RA; Peak
flow 250cc (good effort)
HEENT: PERRLA. EOMI. Anicteric.
Pulmonary: No accessory muscle use. Good diaphragmatic
excursion. Diffuse inspiratory and expiratory wheezing
throughout all lungs fields.
Heart: RRR, S1 S2 no murmurs, gallops or rubs.
Abdomen: Soft, nontender and nondistended. +BS
External: No edema. No rash
Neuro: CN 2-12 intact.  [**5-19**] muscle strength. Sensation intact.

Pertinent Results:
Admission Labs
[**2163-1-26**] 12:30AM BLOOD WBC-13.8* RBC-4.21 Hgb-12.4 Hct-35.0*
MCV-83 MCH-29.5 MCHC-35.5* RDW-15.0 Plt Ct-380
[**2163-1-26**] 12:30AM BLOOD Neuts-81.4* Lymphs-11.5* Monos-2.3
Eos-4.1* Baso-0.6
[**2163-1-26**] 12:30AM BLOOD Glucose-222* UreaN-8 Creat-0.8 Na-138
K-3.8 Cl-107 HCO3-22 AnGap-13
[**2163-1-26**] 08:27AM BLOOD Albumin-4.3 Calcium-9.2 Phos-1.4* Mg-2.3
[**2163-1-26**] 06:56AM BLOOD Lactate-2.8*
[**2163-1-26**] 06:56AM BLOOD freeCa-1.22
.
CXR ([**2163-1-26**]):Complete right upper lobe collapse, with
perihilar convexity that may represent lymphadenopathy. However,
central obstructing mass cannot be excluded. Please correlate
clinically, and followup with serial radiographs or CT to rule
out underlying mass lesion.
.
CT Chest ([**2163-1-26**]): Right upper lobe collapse. No definite
obstructing mass seen, but short-term follow-up radiographs are
recommended to document resolution, and correlation with
bronchoscopy should be considered if clinically indicated,
particularly if the abnormality does not resolve.
.
MRSA SCREEN (Final [**2163-1-28**]):    No MRSA isolated.
Respiratory Viral Antigen Screen (Final [**2163-1-26**]): Negative for
Respiratory Viral Antigen. Specimen screened for: Adeno,
Parainfluenza 1, 2, 3, Influenza A, B, and RSV by
immunofluorescence.
.
IgE, glactomannan pending. Pt to follow-up with pulmonology.


Brief Hospital Course:
33 year old female with past medical history significant for
Asthma on Symbicort (not used in [**6-22**] months)and albuterol QID
(no ICU or intubation history) and significant smoking history
who presents to the [**Hospital1 18**] ED with shortness of breath due to
viral infection induced asthma exacerbation. Her brief hospital
course is as follows:
.
#Asthma exacerbation: With history of cough and rhinorrhea for
few days with sick contact (mom) and no fever or pleuritic chest
pain, this episode likel represented a d viral bronchitis
leading to asthma exacerbation in setting of not using her
Symbicort for several months (6-8 weeks) and becoming toleratent
to her short acting albuterol. She was given solumedrol, stacked
nebs, magnesium and azithromycin in the ED. She was admitted to
the MICU where she had a peak flow of only 98 cc with FEV of
0.71 with decreased breath sound on LUL (RUL on CXR/CT).  An ABG
showed good pO2 on 2LNC and respiratory alkalosis. She was
continued on duo-nebs and started on 60mg of PO prednisone.
Viral studies were obtained which were negative. The patient
improved over night with the above treatments, such that a
bronchoscopy was not performed (was considered for possible
mucus plugging). She was transferred to the floor on the
following afternoon and her prednisone was stepped down to 40mg
PO. The following morning, she was significantly improved. She
had an ambulatory 02 sat of 98% on RA and she had a peak flow of
250cc. She was discharged on a 14 day steroid taper and her home
symbicort plus albuterol. She was also placed on calcium,
vitamin D and omeprazole to protect her from the side-effects of
the steroids. She will follow-up with pulmonology on [**2-9**], who
also ordered some labs for fungal testing, please see below. Her
vital signs and respiratory status was closely monitored during
this admission.
.
#RUL collapse and bronchial inflammation on CT Chest concerning
for allergic bronchopulmonary aspergillusis: She was seen by
pulmonology in the ICU. It was determined that she would be
discharged on a two week steroid taper and follow-up with
pulmonology as the confirmatory labs are all send-outs. A
discussion was held with the patient and she states that she
understands the importance of following up with pulmonology and
of taking her controller medications. It is likely that she will
need inhaled steroids. She will follow-up with pulmonology.
.
#PCOS/Prediabetes: Her metformin was held in the context of her
CTA chest and a contrast load. She was covered with an insulin
sliding scale, particularly since she was on prednisone. Her
metformin was restarted upon discharge. She will follow-up with
her primary care doctor, with the recommendation for a fasting
blood sugar check as well.
.
#Prophylaxis: She received subcutanous heparin for DVT
prophylaxis, omeprazole for GI prophylaxis, and senna and
docusate for her bowels.
.
At the time of discharge she was tolerating a regular diet, her
pain was controlled, her respiratory status was stable and vital
signs were within normal limits. She will follow-up with her
primary care doctor and pulmonology.


Medications on Admission:
Albuterol sulfate 2.5 mg/3 mL nebs q4 hr prn
Albuterol sulfate 90 mcg HFA 2 puffs q4-6 hrs prn
Budesonide-formoterol 160 mcg-4.5 mcg/Actuation HFA Aerosol
Inhaler
2 puff(s) inhaled twice a day (not used in six - eight months)
Metformin 500 mg po qdaily
Norethindrone-ethin estradiol 0.4 mg-35 mcg po qdaily
Chantix


Discharge Medications:
1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
[**1-16**]  Inhalation Q4-6hrs PRN  as needed for shortness of breath
or wheezing.
2. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q4:PRN as needed for
shortness of breath or wheezing.
3. budesonide-formoterol 160-4.5 mcg/Actuation HFA Aerosol
Inhaler Sig: Two (2)  Inhalation twice a day.
Disp:*2 inhalers* Refills:*0*
4. metformin 500 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
5. norethindrone-ethin estradiol 0.4-35 mg-mcg Tablet Sig: One
(1) Tablet PO once a day.
6. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*0*
7. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO BID (2 times a day).
Disp:*60 Tablet, Chewable(s)* Refills:*0*
8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
9. prednisone 10 mg Tablet Sig: see below Tablet PO once a day
for 14 days: Take 4 pills (40mg) for 5 days, then 3 pills (30mg)
for 4 days, then 2 pills (20mg) for 3 days, then 1 pill (10mg)
for 2 days.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Asthma Exacerbation
Upper Respiratory Infection (likely viral)


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


Discharge Instructions:
Ms. [**Known lastname 1004**],

You were admitted to the medical service at [**Hospital1 18**] on [**2163-1-26**] for
an asthma exacerbation. You were quite sick when you presented
to the emergency room, such that you were initially admitted to
the ICU. You were treated with steroids and inhalers and your
breathing status improved. It is likely that your asthma
exacerbation is a result of a viral respiratory infection, along
with your not using your asthma medications. You were started on
oral steroids, called prednisone.
You will need to take this medication for two weeks as described
below and follow-up with pulmonology. Please take your
symbiocort as previously directed.

1. Prednisone: Please take 40mg for 5 days (4 pills), then take
30mg for 4 days (3 pills), then take 20mg (2 pills) for 3 days,
then take 10mg (1 pill) for 2 days.
2. Calcium & Vitamin D. It is important that you take these
medications to protect your bone density while your are on
prednisone.
3. Omeprazole. It is important that you take this medication to
protect your stomach.

Please take all of you other home medications as before your
admission.

Followup Instructions:
Please follow-up with your primary care doctor this week
concerning this admission. Please call Dr. [**First Name (STitle) 1395**] at
[**Telephone/Fax (1) 2205**]. You should have follow-up fasting blood sugar
testing.

You will need to follow-up with the pulmonology department. They
may need to continue your steriods and follow-up with you on
some lab tests that were ordered while you were in the hospital.
You have an appointment with Pulmonology on [**2163-2-9**] with Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at 2:00PM. [**Hospital Ward Name 516**], [**Hospital Ward Name 23**] Building, [**Location (un) 3971**]. Their number is [**Telephone/Fax (1) 612**] for questions. It is VERY
important that you keep this appointment.

You also already have a follow-up appointment scheduled with
[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 16921**], MD Phone:[**Telephone/Fax (1) 4649**] Date/Time:[**2163-3-24**] at
11:00.
{'Asthma, unspecified type, with (acute) exacerbation,Alkalosis,Acute upper respiratory infections of unspecified site,Personal history of noncompliance with medical treatment, presenting hazards to health,Long-term (current) use of steroids'}


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: Shortness of breath

PRESENT ILLNESS: 33 year old female with past medical history significant for
Asthma on Symbicort (not used in [**6-22**] months)and albuterol QID
(no ICU or intubation history)and significant smoking history
who presents to the [**Hospital1 18**] ED with shortness of breath for past
day.
.
She reports five day history of productive cough, 3-day history
of rhinorrhea for past 3 days and increased shortness of breath
for past day but no fever, headache, change in bowel movement or
chest pain.  Her mother had similar clinical presentation with
cough, rhinorrhea and wheezing last week which resolved on its
own.  She has been using her albuterol nebs persisently every 30
minutes for the past day (26 times) with progressive worsening
of her shortness of breath.
.
In the ED, she tachycardic in 130s with oxygen saturation of
100% on nebs. She was noted to have poor air movement with
diffuse wheezing.  She received stacked nebs, solemedrol,
azithromycin and magnesium.  CXR showed RUL collapse. CT scan
showed bronchial wall thickening.
.
She was admitted to the MICU for further management and possible
bronchoscopy to therapeutic remove her ?plug causing RUL
collapse. Her vitals prior to transfer were 125 24 119/59 97% on
nebs.
.

MEDICAL HISTORY: Asthma
Polycystic ovarian syndrome
Breast Reduction

MEDICATION ON ADMISSION: Albuterol sulfate 2.5 mg/3 mL nebs q4 hr prn
Albuterol sulfate 90 mcg HFA 2 puffs q4-6 hrs prn
Budesonide-formoterol 160 mcg-4.5 mcg/Actuation HFA Aerosol
Inhaler
2 puff(s) inhaled twice a day (not used in six - eight months)
Metformin 500 mg po qdaily
Norethindrone-ethin estradiol 0.4 mg-35 mcg po qdaily
Chantix

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL:
Gen: Female in mild respiratory distress. Alert and oriented to
person place and time
Vitals: 97.9 134/57  120  95%2LNC; Peak flow 98 cc (good effort)
 FEV1: 0.71
HEENT: PERRLA. EOMI. Anicteric.
Chest: Using accessory muscles to breathe.  Moving air.
Inspiratory and expiratory wheezing throughout all lungs fields
except LUL where there was only bronchial sounds.
Heart: Tachycardic. Regular rhythm.
Abdomen: Soft, nontender and nondistended. NABS
External: No edema. No rash
Neuro: CN 2-12 intact.  [**5-19**] muscle strength. Sensation intact.
Negative FTN test.

FAMILY HISTORY: Positive for CAD.

SOCIAL HISTORY: Quit smoking a month ago ([**2162-12-29**]).  Social alcohol
intake.  No IVDU.  Works as a legal assistant. Lives at home
with mom, dad, 2 nieces (15 and 18) and nephew (14). 

### Response:
{'Asthma, unspecified type, with (acute) exacerbation,Alkalosis,Acute upper respiratory infections of unspecified site,Personal history of noncompliance with medical treatment, presenting hazards to health,Long-term (current) use of steroids'}
