CHIEF COMPLAINT: Resp Distress

PRESENT ILLNESS: 44F with h/o including COPD, restrictive lung dz secondary to
neuromuscular disease (muscular dystrophy, possibly congential
myasthenia [**Last Name (un) 2902**]) and scoliosis, central sleep apnea, h/o ARDS,
s/p cath [**4-9**] w/ clean coronaries admitted w/ upper respiratory
symptoms x 2 weeks followed by onset of cough productive of dark
[**Location (un) 2452**] colored sputum, dyspnea, chest tightness, and pleuritic
chest pain between scaplae x 3-4 days. The patient was seen by a
VNA today who was concerned b/o symptoms the patient was having
and called her pulmonologist, Dr. [**Last Name (STitle) **]. Dr. [**Last Name (STitle) **] advised the
patient to go to the emergency room.

MEDICAL HISTORY: Neuromuscular disease (followed by Dr. [**Last Name (STitle) 174**] at [**Hospital1 2025**])
central sleep apnea
H/O ARDS
s/p trach (for cardiopulmonary arrest after giving birth)
h/o DVT
COPD
Restrictive lung dz
severe scoliosis,
depression
Fe deficiency anemia
s/p clean cath [**4-9**]
migraines
h/o ventricular tachycardia with question of RV dysplasia
s/p appyndectomy
C-section

MEDICATION ON ADMISSION: 1. Lexapro 10 mg Tablet 2 tabs po qd
2. Pantoprazole 40 mg po qd
3. Senna 8.6 mg PO BID prn
4. Gabapentin 300 mg po bid
5. Oxycodone onaverage 20 mg po per day
6. Diazepam 10 mg po q 12 hrs as needed.
7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) 2 po qd prn
8. Furosemide 20 mg  PO QD (on the list but paitent states she
does not take)
9. Atenolol 25 mg po qd
10. Polysaccharide Iron Complex 150 mg po qd
11. Advair discus
12. VitD and Calcium
13. Methadone 20 mg po tid for chronic pain

ALLERGIES: Penicillins / Tetracyclines / Compazine / Aminoglycosides

PHYSICAL EXAM: Physical Exam:
Tc 98.3   110/37   89   18   97% on 4L O2
General:  Pale woman who appears older than her stated age,
breathing comfortably on supplemental O2. A&Ox3. NAD.
HEENT: Marked ptosis bilaterally. Dry muc membranes. OP clear,
no erythema, no tonsillar enlargement.
Cardiac:  RRR. Nml S1, S2. No M/G/R.
Lungs: Bilateral crackles at bases.
Abdomen: +BS, soft NT, ND
Extremities: No C/C/E.
Neuro:   CN 2-12 grossly intact. Decreased tone. 4/5 strength
proximally and 4+/5 distally. Intact sensation to light
touch throughout. + Clonus at ankles with passive flexion.
Patellar reflexes brisk bilaterally.

FAMILY HISTORY: Mother, 67 colon cancer, heart problems.
Father died from EtOH.
Sister with NM disease.
Two sisters with cancer.

SOCIAL HISTORY: Lives at home with her boyfriend and daughter, 17.
Smoking: 100+ py history (5 packs per day) quit 8 year ago.
EtOH: denies
IVDU: denies
Immunizations UTD
Pneumonia, organism unspecified,Acute and chronic respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Myasthenia gravis with (acute) exacerbation,Diastolic heart failure, unspecified,Hematoma complicating a procedure,Pneumonitis due to inhalation of food or vomitus,Hypotension, unspecified,Other chronic pulmonary heart diseases
Pneumonia, organism NOS,Acute & chronc resp fail,Obs chr bronc w(ac) exac,Myasthna gravs w ac exac,Diastolc hrt failure NOS,Hematoma complic proc,Food/vomit pneumonitis,Hypotension NOS,Chr pulmon heart dis NEC
Admission Date:  [**2108-8-29**]              Discharge Date:   [**2108-9-4**]

Date of Birth:  [**2063-9-19**]             Sex:   F

Service: MED

Allergies:
Penicillins / Tetracyclines / Compazine / Aminoglycosides

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
Resp Distress

Major Surgical or Invasive Procedure:
Intubation and Mechanical Ventilation

History of Present Illness:
44F with h/o including COPD, restrictive lung dz secondary to
neuromuscular disease (muscular dystrophy, possibly congential
myasthenia [**Last Name (un) 2902**]) and scoliosis, central sleep apnea, h/o ARDS,
s/p cath [**4-9**] w/ clean coronaries admitted w/ upper respiratory
symptoms x 2 weeks followed by onset of cough productive of dark
[**Location (un) 2452**] colored sputum, dyspnea, chest tightness, and pleuritic
chest pain between scaplae x 3-4 days. The patient was seen by a
VNA today who was concerned b/o symptoms the patient was having
and called her pulmonologist, Dr. [**Last Name (STitle) **]. Dr. [**Last Name (STitle) **] advised the
patient to go to the emergency room.

The patient was in her usual state of health until approximately
two weeks ago when she developed subjective fevers (checked temp
at home but was afebrile), chills, rhinorrhea, sore throat with
associated headaches. This was followed by productive cough,
then she developed sensation of chest tightness. She is on
chronic oxygen at home 3L during the day and 4L at night and her
O2 requirement have not changed. The patient's daughter was ill
with upper respiratory infecton prior to the onset of the
patient's symptoms two weeks ago.

The patient was recently admitted to [**Hospital1 18**] from [**Date range (1) 108982**] for
dyspnea and abdominal pain and was treated for PNA/COPD
exacerbation and then was discharged to [**Hospital **] Rehab. Extensive
GI w/u was unrevealing. She walks with walker or cane.

ROS she has chronic generalized muscular pain/aches and c/o
burning with urination here in the emergency room because of
Foley. Denies N/V, abd pain, diarrhea, constipation. No recent
swelling in her legs.

Allergies:
Tetracyclin (vomiting)
Penicillin (edema)


Past Medical History:
Neuromuscular disease (followed by Dr. [**Last Name (STitle) 174**] at [**Hospital1 2025**])
central sleep apnea
H/O ARDS
s/p trach (for cardiopulmonary arrest after giving birth)
h/o DVT
COPD
Restrictive lung dz
severe scoliosis,
depression
Fe deficiency anemia
s/p clean cath [**4-9**]
migraines
h/o ventricular tachycardia with question of RV dysplasia
s/p appyndectomy
C-section


Social History:
Lives at home with her boyfriend and daughter, 17.
Smoking: 100+ py history (5 packs per day) quit 8 year ago.
EtOH: denies
IVDU: denies
Immunizations UTD


Family History:
Mother, 67 colon cancer, heart problems.
Father died from EtOH.
Sister with NM disease.
Two sisters with cancer.

Physical Exam:
Physical Exam:
Tc 98.3   110/37   89   18   97% on 4L O2
General:  Pale woman who appears older than her stated age,
breathing comfortably on supplemental O2. A&Ox3. NAD.
HEENT: Marked ptosis bilaterally. Dry muc membranes. OP clear,
no erythema, no tonsillar enlargement.
Cardiac:  RRR. Nml S1, S2. No M/G/R.
Lungs: Bilateral crackles at bases.
Abdomen: +BS, soft NT, ND
Extremities: No C/C/E.
Neuro:   CN 2-12 grossly intact. Decreased tone. 4/5 strength
proximally and 4+/5 distally. Intact sensation to light
touch throughout. + Clonus at ankles with passive flexion.
Patellar reflexes brisk bilaterally.


Pertinent Results:
[**2108-8-28**] 04:12PM   WBC-11.0 RBC-4.49 HGB-13.0# HCT-37.4 MCV-83
MCH-28.9 MCHC-34.7 RDW-13.5
[**2108-8-28**] 04:12PM   PLT SMR-NORMAL PLT COUNT-248 PLTCLM-1+
[**2108-8-28**] 04:12PM   NEUTS-77* BANDS-7* LYMPHS-10* MONOS-4 EOS-2
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2108-8-28**] 04:12PM   GLUCOSE-74 UREA N-10 CREAT-0.5 SODIUM-138
POTASSIUM-3.7 CHLORIDE-100 TOTAL CO2-26 ANION GAP-16
[**2108-8-28**] 04:12PM   CK-MB-4 cTropnT-<0.01

[**2108-8-28**] 04:12PM   CK(CPK)-232*
[**2108-8-28**] 04:12PM   ALBUMIN-4.0
[**2108-8-28**] 05:35PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.026
[**2108-8-28**] 05:35PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-150 BILIRUBIN-NEG UROBILNGN-0.2 PH-5.0
LEUK-NEG
[**2108-8-28**] 05:35PM URINE  RBC-0-2 WBC-0-2 BACTERIA-NONE YEAST-NONE
EPI-0-2 TRANS EPI-[**2-10**]

Other:
Lung Volumes [**6-/2108**] c/w restrictive
Echo [**8-/2107**]  EF 60-70% RV dilated. Mod PA HTN.

Brief Hospital Course:
Patient was admitted to the MICU with respiratory distress
presumed secondary to underlying lung disease along with a new
pneumonia. Unfortunately, Mrs.[**Known lastname 108983**] progressive respiratory
failure was refractory to ventilatory efforts and antibiotic
management and she passed away.

1. PNA: Again, the patient's pneumonia caused her acute
respiratory failure. It was a presumed community-aquired
pneumonia, but antibiotics were broadened to cover MRSA and
gram-negative organisms. She was continued on Vancomycin HCl
1000 mg IV Q12H, Metronidazole 500 mg IV Q8H, Azithromycin 500
mg IV Q24H, Aztreonam 1000 mg IV Q8H. Blood cultures and sputum
cultures were unremarkable.

2. Resp Failure: As the patient did not with to be intubated,
she was ventilated on BiPAP with suboptimal results. She had
several episodes of agitation and required sedation to decrease
her work of breathing and increase her level of comfort. The
causes of her respiratory failure were a combination of PNA as
well as her underlying COPD/Restrictive Lung Disease (Congenital
[**First Name9 (NamePattern2) **] [**Last Name (un) **]). She was also continued on albuterol and
atrovent nebs. Her outpatient pulmonologist ([**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD)
also followed her throughout her course.

3. Myasthenia: Pt had known congenital MG. She was followed by
Neuro for her course. They recommened no 3,4-DAP or
Pyridostigmine for concern of worsening her resp status (along
with avoiding CCBs, Mg2+, Quinidine-derivitives and
Aminoglycosides). She was initially started on dexamethasone 3
mg IV Q8H, but this was tapered off as the benefit of this was
unclear with her MG subtype.

Medications on Admission:
1. Lexapro 10 mg Tablet 2 tabs po qd
2. Pantoprazole 40 mg po qd
3. Senna 8.6 mg PO BID prn
4. Gabapentin 300 mg po bid
5. Oxycodone onaverage 20 mg po per day
6. Diazepam 10 mg po q 12 hrs as needed.
7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) 2 po qd prn
8. Furosemide 20 mg  PO QD (on the list but paitent states she
does not take)
9. Atenolol 25 mg po qd
10. Polysaccharide Iron Complex 150 mg po qd
11. Advair discus
12. VitD and Calcium
13. Methadone 20 mg po tid for chronic pain


Discharge Medications:
None

Discharge Disposition:
Home

Facility:
Death

Discharge Diagnosis:
Primary Diagnosis: Pneumonia, [**Last Name (NamePattern1) **] [**Last Name (un) **], Death

Discharge Condition:
Death

Discharge Instructions:
None

Followup Instructions:
None
{'Pneumonia, organism unspecified,Acute and chronic respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Myasthenia gravis with (acute) exacerbation,Diastolic heart failure, unspecified,Hematoma complicating a procedure,Pneumonitis due to inhalation of food or vomitus,Hypotension, unspecified,Other chronic pulmonary heart diseases'}


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: Resp Distress

PRESENT ILLNESS: 44F with h/o including COPD, restrictive lung dz secondary to
neuromuscular disease (muscular dystrophy, possibly congential
myasthenia [**Last Name (un) 2902**]) and scoliosis, central sleep apnea, h/o ARDS,
s/p cath [**4-9**] w/ clean coronaries admitted w/ upper respiratory
symptoms x 2 weeks followed by onset of cough productive of dark
[**Location (un) 2452**] colored sputum, dyspnea, chest tightness, and pleuritic
chest pain between scaplae x 3-4 days. The patient was seen by a
VNA today who was concerned b/o symptoms the patient was having
and called her pulmonologist, Dr. [**Last Name (STitle) **]. Dr. [**Last Name (STitle) **] advised the
patient to go to the emergency room.

MEDICAL HISTORY: Neuromuscular disease (followed by Dr. [**Last Name (STitle) 174**] at [**Hospital1 2025**])
central sleep apnea
H/O ARDS
s/p trach (for cardiopulmonary arrest after giving birth)
h/o DVT
COPD
Restrictive lung dz
severe scoliosis,
depression
Fe deficiency anemia
s/p clean cath [**4-9**]
migraines
h/o ventricular tachycardia with question of RV dysplasia
s/p appyndectomy
C-section

MEDICATION ON ADMISSION: 1. Lexapro 10 mg Tablet 2 tabs po qd
2. Pantoprazole 40 mg po qd
3. Senna 8.6 mg PO BID prn
4. Gabapentin 300 mg po bid
5. Oxycodone onaverage 20 mg po per day
6. Diazepam 10 mg po q 12 hrs as needed.
7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) 2 po qd prn
8. Furosemide 20 mg  PO QD (on the list but paitent states she
does not take)
9. Atenolol 25 mg po qd
10. Polysaccharide Iron Complex 150 mg po qd
11. Advair discus
12. VitD and Calcium
13. Methadone 20 mg po tid for chronic pain

ALLERGIES: Penicillins / Tetracyclines / Compazine / Aminoglycosides

PHYSICAL EXAM: Physical Exam:
Tc 98.3   110/37   89   18   97% on 4L O2
General:  Pale woman who appears older than her stated age,
breathing comfortably on supplemental O2. A&Ox3. NAD.
HEENT: Marked ptosis bilaterally. Dry muc membranes. OP clear,
no erythema, no tonsillar enlargement.
Cardiac:  RRR. Nml S1, S2. No M/G/R.
Lungs: Bilateral crackles at bases.
Abdomen: +BS, soft NT, ND
Extremities: No C/C/E.
Neuro:   CN 2-12 grossly intact. Decreased tone. 4/5 strength
proximally and 4+/5 distally. Intact sensation to light
touch throughout. + Clonus at ankles with passive flexion.
Patellar reflexes brisk bilaterally.

FAMILY HISTORY: Mother, 67 colon cancer, heart problems.
Father died from EtOH.
Sister with NM disease.
Two sisters with cancer.

SOCIAL HISTORY: Lives at home with her boyfriend and daughter, 17.
Smoking: 100+ py history (5 packs per day) quit 8 year ago.
EtOH: denies
IVDU: denies
Immunizations UTD 

### Response:
{'Pneumonia, organism unspecified,Acute and chronic respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Myasthenia gravis with (acute) exacerbation,Diastolic heart failure, unspecified,Hematoma complicating a procedure,Pneumonitis due to inhalation of food or vomitus,Hypotension, unspecified,Other chronic pulmonary heart diseases'}
