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CHIEF COMPLAINT: Altered mental status, need for BiPAP PRESENT ILLNESS: [**Known firstname **] [**Known lastname 40718**] is an 83 yo female with morbid obesity, DMII, diastolic CHF, asthma, and pemphigus folleacious, and a recent 20-day [**Hospital Unit Name 153**] admission for complex wound care for worsening skin sloughing and bullae and severe pain, who is now transferred back from rehab for hypoventilation in the setting of narcotic administration. During her admission, her pemphigus skin lesions were thought due to CMV/HSV with psuedomonal superinfection, and she had chronic narcotic requirements (at one point was on dilaudid PCA in ICU). She was d/c'ed to [**Hospital 100**] Rehab on [**5-22**]. Of note, she was persistently hypothermic during her admission and was d/c'ed to rehab with a temp of 92.9. Since that time, she has continued to have lots of pain, possibly post-herpetic, with all turns, movements, etc. Per her daughter, she has been "getting too much pain medication." Today, with her turning and cleaning in bed, she got 2mg IV dilaudid, then 2mg again. After that she was noted to be hypopneic, altered/less responsive, and was referred to ED. . In ED, VS: hypothermic to 85.8, 62, 138/78, 6, 100% on BiPAP. Got 0.1mg narcan, with improvement in repsiratory rate to 18-20. Lungs were noted to be wheezy, but no crackles were heard. She was given a nebulizer treatment and solumedrol. CXR showed stable mild cardiomegaly with increased perihilar opacities reflecting volume overload and atelectasis. She complained of difficulty breathing and was placed on BiPAP 14/4/100%. ABG on these settings was 7.33/55/579, so FiO2 was decreased to 50%. Shortly thereafter, her SBP briefly dropped down to 90s, and she got 500cc bolus with reutn of BP's to 110s. EKG showed NSR at 70, NA/NI, diffuse TW flattening. No effusion was seen on bedside ultrasound. CE's negative. Other labs showed normal WBC count, stable anemia, and new thrombocytopenia to 109, as well as renal insufficieny (Cr 1.3, was 0.7 on d/c, but by report has CRI with baseline 1.3). Lactate was 3.6. Urine and blood cultures were sent and she was given vancomycin 1g and levofloxacin 750mg. Access is with her [**Hospital1 18**] PICC line. Most recent VS: rectal temp 88 67 14 108/71 100% on BiPAP. Hypothermia was only addressed later in her ED course, with plan to begin warming down in ED and to check TSH. MEDICAL HISTORY: Chronic diastolic heart failure - repeat Echo with EF 75% Diabetes mellitus, type 2 on insulin Chronic kidney disease, stage 3, baseline Cr 1.3-1.5 Obesity Hypertension Colostomy for diverticulitis Asthma Pemphigus foliaceus diagnosed last admission, with CMV/HSV superinfection (in addition to disseminated CMV/HSV disease) Macrocytic anemia, unclear etiology Dyslipidemia Sacral decubitus ulcer, stage 2 MEDICATION ON ADMISSION: Medications per [**5-22**] d/c summary: Discharge Medications: 1. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q12H (every 12 hours). 2. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 4. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 5. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) unit dose Inhalation every four (4) hours as needed for shortness of breath. 6. Atovaquone 750 mg/5 mL Suspension Sig: 1500 (1500) mg PO DAILY (Daily). 7. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Four (4) Tablet PO DAILY (Daily). 8. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 9. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ALLERGIES: Penicillins PHYSICAL EXAM: Vitals: 31.5 (88.7) 66 121/59 10 100% on 2L General: Obese, eldery, anasarcic african american female, no acute distress, lethargic but rousable HEENT: anisocoria, L>R, with sluggush light reaction, adentulous FAMILY HISTORY: No history of any severe dermatologic issues. SOCIAL HISTORY: Never smoked, no alcohol use. Retired from the [**Location (un) 86**] School District after 32 years.

Other septicemia due to gram-negative organisms,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Nutritional marasmus,Septic shock,Chronic diastolic heart failure,Pressure ulcer, lower back,Pemphigus,Cytomegaloviral disease,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Unspecified pleural effusion,Chronic kidney disease, Stage III (moderate),Thrombocytopenia, unspecified,Herpes simplex without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Morbid obesity,Colostomy status,Hypercalcemia,Anemia, unspecified,Edema,Other disorders of plasma protein metabolism,Severe sepsis,Diverticulosis of colon (without mention of hemorrhage)

Gram-neg septicemia NEC,Pneumonia, organism NOS,Acute respiratry failure,Acute kidney failure NOS,Nutritional marasmus,Septic shock,Chr diastolic hrt fail,Pressure ulcer, low back,Pemphigus,Cytomegaloviral disease,Urin tract infection NOS,Hyposmolality,Pleural effusion NOS,Chr kidney dis stage III,Thrombocytopenia NOS,Herpes simplex NOS,DMII wo cmp nt st uncntr,Long-term use of insulin,Hy kid NOS w cr kid I-IV,Morbid obesity,Colostomy status,Hypercalcemia,Anemia NOS,Edema,Dis plas protein met NEC,Severe sepsis,Dvrtclo colon w/o hmrhg

Admission Date: [**2164-5-28**] Discharge Date: [**2164-6-27**] Date of Birth: [**2080-10-18**] Sex: F Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 1257**] Chief Complaint: Altered mental status, need for BiPAP Major Surgical or Invasive Procedure: Central line placement Arterial line placement Endotracheal intubation History of Present Illness: [**Known firstname **] [**Known lastname 40718**] is an 83 yo female with morbid obesity, DMII, diastolic CHF, asthma, and pemphigus folleacious, and a recent 20-day [**Hospital Unit Name 153**] admission for complex wound care for worsening skin sloughing and bullae and severe pain, who is now transferred back from rehab for hypoventilation in the setting of narcotic administration. During her admission, her pemphigus skin lesions were thought due to CMV/HSV with psuedomonal superinfection, and she had chronic narcotic requirements (at one point was on dilaudid PCA in ICU). She was d/c'ed to [**Hospital 100**] Rehab on [**5-22**]. Of note, she was persistently hypothermic during her admission and was d/c'ed to rehab with a temp of 92.9. Since that time, she has continued to have lots of pain, possibly post-herpetic, with all turns, movements, etc. Per her daughter, she has been "getting too much pain medication." Today, with her turning and cleaning in bed, she got 2mg IV dilaudid, then 2mg again. After that she was noted to be hypopneic, altered/less responsive, and was referred to ED. . In ED, VS: hypothermic to 85.8, 62, 138/78, 6, 100% on BiPAP. Got 0.1mg narcan, with improvement in repsiratory rate to 18-20. Lungs were noted to be wheezy, but no crackles were heard. She was given a nebulizer treatment and solumedrol. CXR showed stable mild cardiomegaly with increased perihilar opacities reflecting volume overload and atelectasis. She complained of difficulty breathing and was placed on BiPAP 14/4/100%. ABG on these settings was 7.33/55/579, so FiO2 was decreased to 50%. Shortly thereafter, her SBP briefly dropped down to 90s, and she got 500cc bolus with reutn of BP's to 110s. EKG showed NSR at 70, NA/NI, diffuse TW flattening. No effusion was seen on bedside ultrasound. CE's negative. Other labs showed normal WBC count, stable anemia, and new thrombocytopenia to 109, as well as renal insufficieny (Cr 1.3, was 0.7 on d/c, but by report has CRI with baseline 1.3). Lactate was 3.6. Urine and blood cultures were sent and she was given vancomycin 1g and levofloxacin 750mg. Access is with her [**Hospital1 18**] PICC line. Most recent VS: rectal temp 88 67 14 108/71 100% on BiPAP. Hypothermia was only addressed later in her ED course, with plan to begin warming down in ED and to check TSH. Past Medical History: Chronic diastolic heart failure - repeat Echo with EF 75% Diabetes mellitus, type 2 on insulin Chronic kidney disease, stage 3, baseline Cr 1.3-1.5 Obesity Hypertension Colostomy for diverticulitis Asthma Pemphigus foliaceus diagnosed last admission, with CMV/HSV superinfection (in addition to disseminated CMV/HSV disease) Macrocytic anemia, unclear etiology Dyslipidemia Sacral decubitus ulcer, stage 2 Social History: Never smoked, no alcohol use. Retired from the [**Location (un) 86**] School District after 32 years. Family History: No history of any severe dermatologic issues. Physical Exam: Vitals: 31.5 (88.7) 66 121/59 10 100% on 2L General: Obese, eldery, anasarcic african american female, no acute distress, lethargic but rousable HEENT: anisocoria, L>R, with sluggush light reaction, adentulous Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi CV: distant HS, regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, + ostomy in LLQ, no organomegaly GU: foley in place. Ext: cold to touch, anasarcic Skin: diffuse hypopigmented lesions and desquamated skin rash most severe in intertriginous areas, as well as surrounding stoma, upper chest, face, and sacral area. Estimated that desquamation covers approx 30-40% BSA. None of the lesions appear infected. . On [**Hospital Unit Name 196**]: PHYSICAL EXAM VITALS: T97.1, BP116/41, HR86. RR18, O2sat100% on face mask, 96% on RA GEN: Alert and oriented X3, pleasant, NAD HEENT: EOMI, NCAT, normal oro/nasopharynx, moist mucus membranes NECK: Soft, supple, RIJ in place - c/d/i, no JVD but unable to assess clearly given body habitus CV: RRR, no murmurs, gallops, rubs, normal S1/S2 PULM: Scattered wheezes, bibasilar crackles but distant lung sounds - no rhonchi/rales ABD: Soft, +BS, non-tender, non-distended, morbidly obese, colostomy sink c/d/i with pink granulation tissue EXT: 1+ pitting edema bilaterally to above the knees, symmetrical, pulses intact Neuro: Moves arms and legs but with proximal weakness Skin: Pemphigus lesions (purplish papules with yellowish, hypopigmented reticular borders Pertinent Results: CBCs: [**2164-5-28**] 04:07PM BLOOD WBC-5.1 RBC-2.90* Hgb-8.6* Hct-31.2* MCV-108* MCH-29.8 MCHC-27.6* RDW-19.1* Plt Ct-109* [**2164-5-29**] 09:43AM BLOOD WBC-6.2# RBC-2.19* Hgb-6.8* Hct-22.4* MCV-103* MCH-31.3 MCHC-30.5* RDW-19.5* Plt Ct-81* [**2164-5-31**] 03:47AM BLOOD WBC-6.4 RBC-3.14* Hgb-9.7* Hct-30.9* MCV-98 MCH-30.9 MCHC-31.5 RDW-19.9* Plt Ct-81* [**2164-6-3**] 12:31AM BLOOD WBC-8.0 RBC-3.07* Hgb-9.8* Hct-29.8* MCV-97 MCH-31.9 MCHC-32.9 RDW-18.9* Plt Ct-55* . CHEMs: [**2164-5-28**] 04:07PM BLOOD Glucose-217* UreaN-30* Creat-1.3* Na-136 K-3.2* Cl-98 HCO3-30 AnGap-11 [**2164-5-30**] 03:20AM BLOOD Glucose-176* UreaN-28* Creat-1.1 Na-141 K-3.8 Cl-111* HCO3-25 AnGap-9 [**2164-6-1**] 02:44AM BLOOD Glucose-397* UreaN-39* Creat-1.2* Na-136 K-4.1 Cl-108 HCO3-23 AnGap-9 [**2164-6-2**] 02:43AM BLOOD Glucose-98 UreaN-47* Creat-1.5* Na-140 K-3.8 Cl-109* HCO3-25 AnGap-10 [**2164-6-3**] 12:31AM BLOOD Glucose-246* UreaN-54* Creat-1.3* Na-142 K-3.8 Cl-109* HCO3-25 AnGap-12 . ENDOCRINE: [**2164-5-28**] 04:07PM BLOOD TSH-4.9* [**2164-5-28**] 04:07PM BLOOD Free T4-0.49* [**2164-5-29**] 02:52AM BLOOD Cortsol-14.9 . MICRO: [**2164-5-28**] 4:15 pm BLOOD CULTURE **FINAL REPORT [**2164-6-3**]** Blood Culture, Routine (Final [**2164-6-3**]): PROTEUS MIRABILIS. FINAL SENSITIVITIES. ENTEROCOCCUS FAECALIS. FINAL SENSITIVITIES. HIGH LEVEL GENTAMICIN SCREEN: Susceptible to 500 mcg/ml of gentamicin. Screen predicts possible synergy with selected penicillins or vancomycin. Consult ID for details. HIGH LEVEL STREPTOMYCIN SCREEN: Susceptible to 1000mcg/ml of streptomycin. Screen predicts possible synergy with selected penicillins or vancomycin. Consult ID for details.. SENSITIVE TO Daptomycin (MIC =0.19 MCG/ML). Sensitivity testing performed by Etest. DR. [**Last Name (STitle) 40719**] ([**Numeric Identifier 40720**]) REQUESTED SENSITIVITIES TO CIPROFLOXACIN AND LEVOFLOXACIN [**2164-6-3**]. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ PROTEUS MIRABILIS | ENTEROCOCCUS FAECALIS | | AMPICILLIN------------ <=2 S <=2 S AMPICILLIN/SULBACTAM-- <=2 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN---------<=0.25 S =>8 R DAPTOMYCIN------------ S GENTAMICIN------------ <=1 S LEVOFLOXACIN---------- =>8 R MEROPENEM-------------<=0.25 S PENICILLIN G---------- 4 S PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S VANCOMYCIN------------ 1 S . [**2164-5-28**] 4:20 pm BLOOD CULTURE **FINAL REPORT [**2164-6-3**]** Blood Culture, Routine (Final [**2164-6-3**]): ENTEROBACTER CLOACAE. FINAL SENSITIVITIES. This organism may develop resistance to third generation cephalosporins during prolonged therapy. Therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. For serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROBACTER CLOACAE | CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S Anaerobic Bottle Gram Stain (Final [**2164-5-29**]): GRAM NEGATIVE ROD(S). . [**2164-5-28**] 4:49 pm URINE Site: CATHETER **FINAL REPORT [**2164-5-30**]** URINE CULTURE (Final [**2164-5-30**]): Culture workup discontinued. Further incubation showed contamination with mixed skin/genital flora. Clinical significance of isolate(s) uncertain. Interpret with caution. ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | AMPICILLIN------------ 4 S AMPICILLIN/SULBACTAM-- 4 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN---------<=0.25 S GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- <=16 S PIPERACILLIN/TAZO----- <=4 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S . [**2164-5-29**] 9:43 am STOOL CONSISTENCY: NOT APPLICABLE Source: Stool. **FINAL REPORT [**2164-5-30**]** CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2164-5-30**]): Feces negative for C.difficile toxin A & B by EIA ,. [**2164-5-30**] 3:20 am Immunology (CMV) Source: Line-aline. **FINAL REPORT [**2164-6-1**]** CMV Viral Load (Final [**2164-6-1**]): CMV DNA not detected. Performed by PCR. Detection Range: 600 - 100,000 copies/ml. FOR RESEARCH USE ONLY. NOT FOR USE IN DIAGNOSTIC PROCEDURES. This test has been validated by the Microbiology laboratory at [**Hospital1 18**]. . IMAGING: [**5-28**] CXR: IMPRESSION: 1. Stable cardiomegaly, with findings suggestive of CHF. 2. Bibasilar atelectasis with bilateral pleural effusions. . [**2164-5-29**] ECHO: The left atrium is normal in size. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Left ventricular systolic function is hyperdynamic (EF>75%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets are mildly thickened (?#). There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Physiologic mitral regurgitation is seen (within normal limits). There is mild pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. There is an anterior space which most likely represents a prominent fat pad. Compared with the prior study (images reviewed) of [**2164-4-18**], findings are similar. . [**2164-5-29**] CXR: FINDINGS: The new right CVP line tip is 1 cm above the cavoatrial junction. The NG tube passes below the diaphragm and out of view. Bilateral small pleural effusions are stable since the chest radiograph earlier on today; however a slight increase in peribronchial cuffing and perihilar haziness is due to new mild pulmonary edema. IMPRESSION: Stable bilateral pleural effusions with new mild pulmonary edema. . [**6-1**] CT CHEST IMPRESSION: Large bilateral pleural effusions with adjacent atelectasis. Right middle lobe and probably left upper lobe pneumonic consolidation. Cardiomegaly. Large hiatal hernia. . [**6-1**] CT HEAD IMPRESSION: There is no evidence of acute intracranial hemorrhage. Left mastoid air cells opacities, possibly related with an ongoing inflammatory process, please correlate clinically. Diffuse fat stranding is demonstrated in the soft tissues, likely related with the provided history of anasarca . EEG [**2164-6-3**] IMPRESSION: As noted above, this is a technically unsatisfactory study due to physiologic artifact of prominent and persistent muscle artifact. Although no evidence for non-convulsive status epilepticus was seen, the background was otherwise largely uninterpretable. . Brief Hospital Course: This is an 83 year old woman with a history of pemphigus foliaceous and a recent ICU admission for complex wound care, worsening skin sloughing, and HSV/CMV and pseudomonal skin superinfection who was admitted with altered mental status from polymicrobial sepsis and hypercapnic failure. She was intubated for apnea and CO2 retention. A CT of chest showed RML pneumonia (antibiotics as below). Bronchoscopy sowed edematous, collapsible airways. She was extubated on [**2164-6-5**]. Her altered mental status was multifactorial due to sepsis and over-narcosis from Dilaudid received during turning and maneuvering at nursing home. She was unable to tolerate LP due to body habitus, and MRI was unobtainable due to patient girth. EEG was technically unsatisfactory, but did not reveal status epilepticus. When she got extubated, she was very weak in the setting of steroids and anasarca without any focal deficits. Patient's mental status dramatically improved. In regards to her sepsis, blood cultures grew PROTEUS MIRABILIS, ENTEROCOCCUS FAECALIS, and ENTEROBACTER CLOACAE and urine culture grew ESCHERICHIA COLI. She initially received vancomycin, meropenem, and levofloxacin. She came off pressors on [**2164-5-29**] after fluid and blood transfusions. On TTE, there was no evidence of cardiogenic shock or tamponade (EF >75%), and serum cortisol was at normal range at 14.7. TTE did not show vegetations. Of note, she grew pansensitive Klebsiella in the sputum which was felt to be a colonizer. She finished a full course of vancomycin and levofloxacin x total 14 days. The patient had clinical anasarca, and was on a Lasix drip while in the ICU and then metolazone and oral Lasix. She developed significant contraction alkalosis (Bicarb >50) at some point but this has resolved. She also had acute kidney failure on chronic kidney disease, stage 3. Her renal function improved with Lasix discontinuation. In regards to the pemphigus foliaceus, she had HSV/CMV superinfection during previous admission with CMV viremia. She had a skin biopsy that was consistent with disseminated HSV and was treated with acyclovir and then valacyclovir. Skin lesions also grew pseudomonas and proteus which were felt to be colonizing and was treated with skin care including acetic acid only. Ophthalmology was also consulted and they recommended erythromycin and ciprofloxacin eye drops for pseudomonas given she had skin lesions abutting her eyes. [**Date Range 2652**] consult advised high dose oral steroids, continuing ganciclovir for CMV suppression, and monthly IVIG. She received her first course of IVIG which was complicated by mild hyponatremia. Since then her skin condition remained stable. She should be seen by Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (immunobullous expert at [**Hospital1 112**]) to discuss any further IVIG and taper steroids gradually. The prednisone should be tapered over four months otherwise she is at risk for relapse. The patient developed thrombocytopenia that worsened in the setting of sepsis and ganciclovir. PF4 AB was negative. PPI was changed to H2 blocker. Platelets started to improve but she relapsed again. We could not stop ganciclovir as she is at risk for relapsed CMV/HSV infection. However, platelets have been stable at 70-80 without bleeding complications. There is no alternative for this medication per ID. However, it could be stopped if she develops bleeding or severe thrombocytopenia (benefit/risk ratio changes). Her metoprolol was held upon admission for sepsis and then for bradycardia. She had severe malnutrition and hypoalbuminemia. She initially received tube feeds (diabetic formulation) for poor PO intake. Speech and swallow evaluated the patient and started pureed solids and nectar thickened liquids. Her tube feeds then were discontinued. She had severe hyperglycemia and frequent hypoglycemia from prednisone and further worsened in the setting of tube feeds. [**Last Name (un) **] was consulted and adjusted her Insulin (see printed SS)The patient was full code despite her chronic condition and acute illnesses. Her HCP, daughter [**Name (NI) 123**] [**Name (NI) 40713**] [**Telephone/Fax (1) 40714**], refused DNR/DNI and asked the patient remains in hospital despite resolution of acute medical problems. She was finally transfered to [**Hospital 100**] rehab after 2 family meetings 2 weeks apart. She will need follow up with both infectious disease ([**Last Name (LF) **],[**First Name3 (LF) **]) and [**First Name3 (LF) 2652**] (Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**First Name3 (LF) **] immunobullous expert at [**Hospital1 112**]). CMV viral load testing should be done every 2 weeks and next testing should be done with infectious disease appointment. CBC and chem 7 should be checked every 2-3 days. Discontinue diuretics if she develops alkalosis or acute renal failure. Please discontinue valganciclovir if severe thrombocytopenia or bleeding complications. She would need continuous wound care. Foley catheter last changed on [**2164-6-22**] (genital skin lesions). I discssed her case with rehab M.D/NP, [**Year (4 digits) 2652**], and ID upon discharge. Total discharge time 145 minutes. Medications on Admission: Medications per [**5-22**] d/c summary: Discharge Medications: 1. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q12H (every 12 hours). 2. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 4. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 5. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) unit dose Inhalation every four (4) hours as needed for shortness of breath. 6. Atovaquone 750 mg/5 mL Suspension Sig: 1500 (1500) mg PO DAILY (Daily). 7. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Four (4) Tablet PO DAILY (Daily). 8. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 9. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 10. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 11. Furosemide 10 mg/mL Solution Sig: Twenty (20) mg Injection [**Hospital1 **] (2 times a day). 12. Fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 13. Fondaparinux 2.5 mg/0.5 mL Syringe Sig: One (1) Subcutaneous DAILY (Daily). 14. Hydromorphone 2 mg Tablet Sig: 1-2 mg PO Q3H (every 3 hours) as needed for Pain. 15. Hydromorphone in NS 2 mg/10 mL (0.2 mg/mL) Syringe Sig: 0.5 to 1 mg Intravenous Q2H (every 2 hours) as needed for For pain related to turning patient. 16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 17. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 18. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain, fever. 19. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1) packet PO DAILY (Daily) as needed for constipation. 20. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 21. Petrolatum Ointment Sig: One (1) Appl Topical TID (3 times a day) as needed for dry skin. 22. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day) as needed for thrush. 23. White Petrolatum-Mineral Oil 42.5-56.8 % Ointment Sig: One (1) Appl Ophthalmic QID (4 times a day). 24. Acetic Acid 0.25 % Solution Sig: One (1) Appl Irrigation [**Hospital1 **] (2 times a day) as needed for to affected area for dressing changes: Use on areas with open blisters. 25. Insulin Fixed Dose and Sliding Scale NPH 20units Subcutaneous QAC breakfast and 10units QHS Humalog sliding scale, check accucheck QAC and QHS: Breakfast, Lunch, or Dinner, for BS: <70 give 1 amp of D50 or [**Location (un) 2452**] juice 70-120 give 0 units 121-170 give 6 units 171-220 give 8 units 221-270 give 10 units 271-320 give 12 units 321-370 give 14 units >371 give 16 units and [**Name8 (MD) 138**] M.D. For QHS bloodsugars, if BS: <70 give 1 amp of D50 or [**Location (un) 2452**] juice 70-220 give 0 units 221-270 give 3 units 271-320 give 5 units 321-370 give 7 units >371 give 9 units and [**Name8 (MD) 138**] M.D. 26. Prednisone 10 mg Tablet Sig: Seven (7) Tablet PO DAILY (Daily). 27. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): (through [**2164-6-8**]). 28. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 7 days: through [**2164-5-28**]. 29. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 30. Calcium Carbonate 500 mg/5 mL (1,250 mg/5 mL) Suspension Sig: One (1) PO BID (2 times a day). 31. Potassium & Sodium Phosphates 280-160-250 mg Powder in Packet Sig: One (1) Powder in Packet PO BID (2 times a day). 32. IV fluids IV NS @ 100cc/hr Discharge Medications: 1. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for SOB/wheezing. 3. Atovaquone 750 mg/5 mL Suspension Sig: One (1) PO DAILY (Daily). 4. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain/fever. 7. Petrolatum Ointment Sig: One (1) Topical TID (3 times a day) as needed for dry skin: Petrolatum *NF* 1 application Topical TID dry skin . 8. Bacitracin-Polymyxin B Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day): Bacitracin-Polymyxin Ointment 1 Appl TP [**Hospital1 **] open areas . 9. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 10. Cinacalcet 30 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-31**] Drops Ophthalmic PRN (as needed) as needed for dry eyes. 12. Metolazone 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 13. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 14. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day): Please stop if patient develops bleeding complications or severe thrombocytopenia. 15. Prednisone 20 mg Tablet Sig: Eighty (80) MG PO DAILY (Daily): This medication should be tapered slowly over 4 months period starting [**2164-6-17**]. 16. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 17. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 18. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 19. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 20. Insulin Glargine 100 unit/mL Solution Sig: Please see printed paper Subcutaneous twice a day. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: Mulitmicrobial sepsis Pemphigus CMV/HSV skin infection Pseudomonas skin colonization Acute renal failure Chronic Kidney disease Hyperglycemia with diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: You were treated for sepsis (blood infection) and skin infection. Your Penmphigus was treated with steroids and IV immunoglobulin. You may need monthly infusions of IV immunoglobulin if you and Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] agree. Your will need to decrease your steroid dose very slowly over 4 months period. Foley catheter has to be changed frequently to avoid infections. It was last changed on [**2164-6-22**]. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Please call [**Last Name (LF) **],[**First Name3 (LF) **] S. [**Telephone/Fax (1) 40715**] for an appointment Please follow up with Dr. [**Last Name (STitle) **],[**First Name3 (LF) **], M.D with infectious disease. Please call [**Telephone/Fax (1) 457**] to schedule an appointment in [**12-31**] weeks for CMV viral load. You will have an appointment with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (an immunobullous expert at [**Hospital1 756**] and Women Hospital [**Hospital1 112**]) with possible plans to continue IVIG 5 days every month. Dr. [**Last Name (STitle) 10270**],[**First Name7 (NamePattern1) 2191**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**First Name (Titles) 767**] [**Last Name (Titles) 2652**] will call you to provide you with the details of your appointment.

038,486,518,584,261,785,428,707,694,078,599,276,511,585,287,054,250,V586,403,278,V443,275,285,782,273,995,562

{'Other septicemia due to gram-negative organisms,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Nutritional marasmus,Septic shock,Chronic diastolic heart failure,Pressure ulcer, lower back,Pemphigus,Cytomegaloviral disease,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Unspecified pleural effusion,Chronic kidney disease, Stage III (moderate),Thrombocytopenia, unspecified,Herpes simplex without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Morbid obesity,Colostomy status,Hypercalcemia,Anemia, unspecified,Edema,Other disorders of plasma protein metabolism,Severe sepsis,Diverticulosis of colon (without mention of hemorrhage)'}

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: Altered mental status, need for BiPAP PRESENT ILLNESS: [**Known firstname **] [**Known lastname 40718**] is an 83 yo female with morbid obesity, DMII, diastolic CHF, asthma, and pemphigus folleacious, and a recent 20-day [**Hospital Unit Name 153**] admission for complex wound care for worsening skin sloughing and bullae and severe pain, who is now transferred back from rehab for hypoventilation in the setting of narcotic administration. During her admission, her pemphigus skin lesions were thought due to CMV/HSV with psuedomonal superinfection, and she had chronic narcotic requirements (at one point was on dilaudid PCA in ICU). She was d/c'ed to [**Hospital 100**] Rehab on [**5-22**]. Of note, she was persistently hypothermic during her admission and was d/c'ed to rehab with a temp of 92.9. Since that time, she has continued to have lots of pain, possibly post-herpetic, with all turns, movements, etc. Per her daughter, she has been "getting too much pain medication." Today, with her turning and cleaning in bed, she got 2mg IV dilaudid, then 2mg again. After that she was noted to be hypopneic, altered/less responsive, and was referred to ED. . In ED, VS: hypothermic to 85.8, 62, 138/78, 6, 100% on BiPAP. Got 0.1mg narcan, with improvement in repsiratory rate to 18-20. Lungs were noted to be wheezy, but no crackles were heard. She was given a nebulizer treatment and solumedrol. CXR showed stable mild cardiomegaly with increased perihilar opacities reflecting volume overload and atelectasis. She complained of difficulty breathing and was placed on BiPAP 14/4/100%. ABG on these settings was 7.33/55/579, so FiO2 was decreased to 50%. Shortly thereafter, her SBP briefly dropped down to 90s, and she got 500cc bolus with reutn of BP's to 110s. EKG showed NSR at 70, NA/NI, diffuse TW flattening. No effusion was seen on bedside ultrasound. CE's negative. Other labs showed normal WBC count, stable anemia, and new thrombocytopenia to 109, as well as renal insufficieny (Cr 1.3, was 0.7 on d/c, but by report has CRI with baseline 1.3). Lactate was 3.6. Urine and blood cultures were sent and she was given vancomycin 1g and levofloxacin 750mg. Access is with her [**Hospital1 18**] PICC line. Most recent VS: rectal temp 88 67 14 108/71 100% on BiPAP. Hypothermia was only addressed later in her ED course, with plan to begin warming down in ED and to check TSH. MEDICAL HISTORY: Chronic diastolic heart failure - repeat Echo with EF 75% Diabetes mellitus, type 2 on insulin Chronic kidney disease, stage 3, baseline Cr 1.3-1.5 Obesity Hypertension Colostomy for diverticulitis Asthma Pemphigus foliaceus diagnosed last admission, with CMV/HSV superinfection (in addition to disseminated CMV/HSV disease) Macrocytic anemia, unclear etiology Dyslipidemia Sacral decubitus ulcer, stage 2 MEDICATION ON ADMISSION: Medications per [**5-22**] d/c summary: Discharge Medications: 1. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q12H (every 12 hours). 2. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 4. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 5. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) unit dose Inhalation every four (4) hours as needed for shortness of breath. 6. Atovaquone 750 mg/5 mL Suspension Sig: 1500 (1500) mg PO DAILY (Daily). 7. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Four (4) Tablet PO DAILY (Daily). 8. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 9. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ALLERGIES: Penicillins PHYSICAL EXAM: Vitals: 31.5 (88.7) 66 121/59 10 100% on 2L General: Obese, eldery, anasarcic african american female, no acute distress, lethargic but rousable HEENT: anisocoria, L>R, with sluggush light reaction, adentulous FAMILY HISTORY: No history of any severe dermatologic issues. SOCIAL HISTORY: Never smoked, no alcohol use. Retired from the [**Location (un) 86**] School District after 32 years. ### Response: {'Other septicemia due to gram-negative organisms,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Nutritional marasmus,Septic shock,Chronic diastolic heart failure,Pressure ulcer, lower back,Pemphigus,Cytomegaloviral disease,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Unspecified pleural effusion,Chronic kidney disease, Stage III (moderate),Thrombocytopenia, unspecified,Herpes simplex without mention of complication,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Morbid obesity,Colostomy status,Hypercalcemia,Anemia, unspecified,Edema,Other disorders of plasma protein metabolism,Severe sepsis,Diverticulosis of colon (without mention of hemorrhage)'}

CHIEF COMPLAINT: Headache PRESENT ILLNESS: 35-year-old man with history of complex partial epilepsy s/p right temporal radiotherapy in [**10/2131**] who was referred to the ED from epilepsy clinic for a five-week history of headaches. His epilepsy has been well controlled, with his last seizure in [**2133-7-16**] and the last one before that in [**2132-11-15**]. However during his epilepsy appointment today he mentioned a history of five weeks of headaches. Describes them as constant, dull, mostly unilateral on either side, but occasionally bilateral, located behind the eye, pounding, and about 5/10 intensity. Nothing in particular makes them worse or better. The medicines given by his PCP (Fioricet, steroids, antibiotics) and ibuprofen did not help. Describes hesitance opening eyes due to headache, but denies photophobia or any other associated symptoms. Concerned about these HAs, his PCP ordered [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 72787**] on the day prior admission. Today, his results revealed a significant abnormality and his PCP notified his primary epileptologist, Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) 851**], who then recommended that he come to the [**Hospital1 18**] ED for urgent evaluation. MEDICAL HISTORY: Complex partial epilepsy s/p right temporal CyberKnife procedure in [**10/2131**] MEDICATION ON ADMISSION: LAMOTRIGINE - 100 mg Tablet - 3 Tablet(s) by mouth twice a day LAMOTRIGINE [LAMICTAL] - 25 mg Tablet - 2 Tablet(s) by mouth twice a day. LEVETIRACETAM [KEPPRA] - 750 mg Tablet - 4 Tablet(s) by mouth twice a day BRAND NAME MEDICALLY NECESSARY. NO SUBSTITUTION. - No Substitution LORAZEPAM - 0.5 mg Tablet - 1 Tablet(s) by mouth as needed every 6 hours for seizures- do not exceed 2 tablets in a 24 hour period ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission PHYSICAL EXAM: T BP 126/52 HR 78 RR 12 O2% 99% RA General: Awake, cooperative, lying in bed in NAD with eyes intermittently closed secondary to headache rather than fatigue FAMILY HISTORY: There is a history of seizures in some cousins on his father's side of the family. Otherwise non-conntributory. SOCIAL HISTORY: Taking classes to be an electrician. No smoking history, alcohol intake or illicit drug use.

Other conditions of brain,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Homonymous bilateral field defects,Hemiplegia, unspecified, affecting unspecified side

Brain conditions NEC,Part epil w/o intr epil,Abn react-radiotherapy,Homonymous hemianopsia,Unsp hemiplga unspf side

Admission Date: [**2133-9-29**] Discharge Date: [**2133-10-5**] Date of Birth: [**2098-4-16**] Sex: M Service: NEUROLOGY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 17813**] Chief Complaint: Headache Major Surgical or Invasive Procedure: none History of Present Illness: 35-year-old man with history of complex partial epilepsy s/p right temporal radiotherapy in [**10/2131**] who was referred to the ED from epilepsy clinic for a five-week history of headaches. His epilepsy has been well controlled, with his last seizure in [**2133-7-16**] and the last one before that in [**2132-11-15**]. However during his epilepsy appointment today he mentioned a history of five weeks of headaches. Describes them as constant, dull, mostly unilateral on either side, but occasionally bilateral, located behind the eye, pounding, and about 5/10 intensity. Nothing in particular makes them worse or better. The medicines given by his PCP (Fioricet, steroids, antibiotics) and ibuprofen did not help. Describes hesitance opening eyes due to headache, but denies photophobia or any other associated symptoms. Concerned about these HAs, his PCP ordered [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 72787**] on the day prior admission. Today, his results revealed a significant abnormality and his PCP notified his primary epileptologist, Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) 851**], who then recommended that he come to the [**Hospital1 18**] ED for urgent evaluation. On neurologic review of systems, the patient denied loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denied difficulties producing or comprehending speech. Denied focal weakness, numbness, parasthesiae. No bowel or bladder incontinence or retention. Denied difficulty with gait. On general review of systems, the patient denied recent fever or chills. No night sweats or recent weight loss or gain. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. Denied rash. Past Medical History: Complex partial epilepsy s/p right temporal CyberKnife procedure in [**10/2131**] Social History: Taking classes to be an electrician. No smoking history, alcohol intake or illicit drug use. Family History: There is a history of seizures in some cousins on his father's side of the family. Otherwise non-conntributory. Physical Exam: Admission PHYSICAL EXAM: T BP 126/52 HR 78 RR 12 O2% 99% RA General: Awake, cooperative, lying in bed in NAD with eyes intermittently closed secondary to headache rather than fatigue Head and Neck: no cranial abnormalities, no scleral icterus noted, mmm, no lesions noted in oropharynx Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs clear to auscultation bilaterally Cardiac: regular rate and rhythm, normal s1/s2. No murmurs, rubs, or gallops appreciated. Abdomen: soft, non-tender, normoactive bowel sounds, no masses or organomegaly noted. Extremities: 2+ radial, DP pulses bilaterally. Skin: Surgical scar over right fronto-parietal scalp. Neurologic: -Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Attentive. Able to count months backward from [**Month (only) 1096**] without significant delay. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Speech was not dysarthric. There was no evidence of apraxia or neglect, calculations intact. Registered [**1-15**] and recalled [**1-15**] at 5 minutes. -Cranial Nerves: I: Olfaction not tested. II: PERRL 4 to 3mm and brisk. Visual field testing revealed likely left visual field cut in form of left homonymous hemianopia. Funduscopic exam revealed papilledema on the right side. III, IV, VI: EOMI without nystagmus. Normal saccades. Ptosis of the right eyelid to mid-pupil, although comparison with patient's drivers license indicates this may be near his baseline. V: Facial sensation intact to light touch. VII: Left facial droop and flattening of left nasolabial fold, although comparison with patient's drivers license indicates he may have a mild left NLF flattening at baseline. VIII: Hearing intact to finger-rub bilaterally. IX, X: Palate elevates symmetrically. [**Doctor First Name 81**]: 5/5 strength in trapezii and sternocleidomastoid bilaterally. XII: Tongue protrudes in midline. -Motor: Normal bulk, tone throughout. No pronator drift bilaterally, although mild postural tremor with arms extended and pronated. No rigidity. No adventitious movements, such as tremors, noted. No asterixis. Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB L 5 5 5 5 5 5 5 5 5 5 5 5 5 5 R 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -Sensory: No deficits to light touch or proprioception throughout. -Deep tendon reflexes: [**Hospital1 **] Tri [**Last Name (un) 1035**] Pat Ach L 2 1 2 2 1 R 2 1 2 2 1 Plantar response was mute bilaterally. -Coordination: No intention tremor, no dysdiadochokinesia noted. Mild intention tremor on FNF bilaterally -Gait: Good initiation. Narrow-based, normal stride and arm swing. Able to walk in tandem without difficulty. Romberg absent. . . Discharge physical exam: Mild partial right ptosis and slight left facial droop. No limb weakness. Aisocoria left pupil 5.5 right 4.5mm. Otherwise normal examination save bilateral tremor. Pertinent Results: Laboratory investigations: [**2133-9-29**] 04:44PM [**Month/Day/Year 3143**] WBC-6.6 RBC-4.38* Hgb-13.1* Hct-39.0* MCV-89 MCH-30.0 MCHC-33.7 RDW-12.7 Plt Ct-309 [**2133-9-29**] 04:44PM [**Month/Day/Year 3143**] Neuts-62.1 Lymphs-29.8 Monos-6.0 Eos-1.7 Baso-0.3 [**2133-9-29**] 04:44PM [**Month/Day/Year 3143**] PT-11.0 PTT-26.4 INR(PT)-0.9 [**2133-9-29**] 04:44PM [**Month/Day/Year 3143**] UreaN-15 Creat-1.2 [**2133-9-30**] 03:08AM [**Month/Day/Year 3143**] Albumin-4.8 Calcium-10.3 Phos-4.4 Mg-2.4 [**2133-9-29**] 04:44PM [**Month/Day/Year 3143**] pH-7.39 [**2133-9-29**] 04:44PM [**Month/Day/Year 3143**] Glucose-101 Lactate-1.4 Na-139 K-4.2 Cl-98 calHCO3-31* [**2133-9-29**] 04:44PM [**Month/Day/Year 3143**] freeCa-1.18 . Other pertinent labs: [**2133-9-30**] 10:56AM [**Month/Day/Year 3143**] WBC-12.0* Lymph-10* Abs [**Last Name (un) **]-1200 CD3%-68 Abs CD3-815 CD4%-41 Abs CD4-488 CD8%-29 Abs CD8-343 CD4/CD8-1.4 [**2133-9-30**] 03:08AM [**Month/Day/Year 3143**] ALT-48* AST-18 AlkPhos-91 TotBili-0.4 [**2133-9-30**] 03:08AM [**Month/Day/Year 3143**] Osmolal-290 [**2133-9-30**] 10:56AM [**Month/Day/Year 3143**] Osmolal-279 [**2133-9-30**] 05:54PM [**Month/Day/Year 3143**] Osmolal-295 [**2133-10-1**] 03:02AM [**Month/Day/Year 3143**] Osmolal-293 [**2133-10-1**] 11:30AM [**Month/Day/Year 3143**] Osmolal-295 [**2133-10-1**] 11:08PM [**Month/Day/Year 3143**] Osmolal-296 [**2133-10-2**] 04:35AM [**Month/Day/Year 3143**] Osmolal-291 [**2133-10-2**] 08:40AM [**Month/Day/Year 3143**] Osmolal-297 [**2133-10-3**] 04:55AM [**Month/Day/Year 3143**] Osmolal-291 . Discharge labs: [**2133-10-5**] 04:55AM [**Month/Day/Year 3143**] WBC-12.6* RBC-4.48* Hgb-13.1* Hct-40.3 MCV-90 MCH-29.3 MCHC-32.6 RDW-12.8 Plt Ct-299 [**2133-10-5**] 04:55AM [**Month/Day/Year 3143**] PT-10.9 PTT-24.7 INR(PT)-0.9 [**2133-10-5**] 04:55AM [**Month/Day/Year 3143**] Glucose-111* UreaN-20 Creat-0.9 Na-140 K-4.4 Cl-102 HCO3-28 AnGap-14 . . Urine: [**2133-9-29**] 10:37PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.015 [**2133-9-29**] 10:37PM URINE [**Month/Day/Year **]-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG . . Microbiology: [**2133-9-29**] 10:06 pm MRSA SCREEN Source: Nasal swab. **FINAL REPORT [**2133-10-2**]** MRSA SCREEN (Final [**2133-10-2**]): No MRSA isolated. . . Radiology: CT HEAD W/O CONTRAST Study Date of [**2133-9-29**] 4:25 PM CT OF THE HEAD: There is extensive right cerebral vasogenic edema new from the [**2132-11-15**] involving the right temporal lobe, parietal and frontal lobes. There is a small central rounded about 10 mm hyperdensity (series 601B, image 50 and series 2, image 11) within the edema. The edema causes significant mass effect on the right cerebral peduncle and moderate mass effect to the right cerebral hemisphere with effacement of the sulci, effacement of the right lateral ventricle, midline shift to the left by 6-7 cm as well as entrapment of the left temporal [**Doctor Last Name 534**]. There is no evidence of acute intracranial hemorrhage, intracranial herniation or acute territorial infarction. The paranasal sinuses and mastoids are clear. There are no suspicious lytic or sclerotic bony lesions. Burr holes are seen in both frontal and parietal bones. IMPRESSION: 1. New extensive right cerebral vasogenic edema with a central slighty hyperdense focus is concerning for an underlying neoplasm. MRI with contrast is recommended for further workup. 2. Severe mass effect on the right cerebral peduncle, midline shift to the left by 6-7 mm and effacement of the right lateral ventricle as well as entrapment of the left temporal [**Doctor Last Name 534**]. . MR HEAD W & W/O CONTRAST Study Date of [**2133-9-29**] 8:19 PM IMPRESSION: Heterogeneous rim-enhancing lesion in the right medial temporal lobe, with enhancing satellite nodules and extensive vasogenic edema, extending into the right frontal, temporal and parietal lobes. There is mass effect on the right lateral ventricle, right cerebral peduncle and pons with midline shift of 8 mm towards the left. Right ambient cistern is obliterated. There is edema of the right mid brain as described. Imaging differentials include radiation necrosis, high-grade glioma. MR perfusion and [**Date Range 41307**] are suggested for further evaluation. . CHEST (PORTABLE AP) Study Date of [**2133-9-30**] 1:48 PM FINDINGS: In comparison with study of [**2131-4-12**], there is no interval change or evidence of acute cardiopulmonary disease. No pneumonia, vascular congestion, or pleural effusion. . MR [**Date Range **] W PERFUSION Study Date of [**2133-10-2**] 1:10 PM FINDINGS: Again seen is a heterogeneous rim-enhancing lesion in the right medial temporal lobe with extensive surrounding vasogenic edema and mass effect on the right lateral ventricle and right cerebral peduncle and pons. There is no interval change in the lesion from the prior MRI from [**9-29**]. ASL perfusion scans reveal hypoperfusion in the region of the lesion. Dynamic susceptibility MRI images reveal decreased cerebral [**Month (only) **] flow and [**Month (only) **] volume in the right temporal lobe. Multivoxel MR [**First Name (Titles) 41307**] [**Last Name (Titles) 4059**] moderate elevation of choline with elevated choline to creatine and choline to NAA ratios in the voxels corresponding to the enhancing portions of the lesion. MR [**Last Name (Titles) 41307**] from the voxels adjacent to the lesion reveal normal spectra. IMPRESSION: No evidence of increased perfusion in the right temporal lobe lesion. MR [**Last Name (Titles) 41307**] reveals areas of increased choline/NAA ratio that do raise concern for neoplasm but this can also be seen in radiation necrosis. Based on the history of radiation in the right temporal lobe, decreased perfusion and relative cerebral [**Name2 (NI) **] volume, radiation necrosis appears more likely. Attention on followup imaging is recommended. Brief Hospital Course: 35-year-old man with a history of complex partial epilepsy s/p right temporal CyberKnife therapy [**10/2131**] who presented with five weeks of headache and found to have significant right cerebral edema and subfalcine herniation on CT head requested at epilepsy clinic. After the scan results were available, the patient was sent directly to the ED. Initial examination was notable for apparent right papilledema, left visual field defect in addition to right ptosis and left facial droop. Given midline shift despite benign examination, he was transferred to the ICU on [**2133-9-29**] for observation and treatment with dexamethasone and IV mannitol. MRI [**9-29**] showed rim-enhancing, centrally necrotic lesion with multiple enhancing nodules with extensive surrounding vasogenic edema involving the right temporal, parietal and frontal lobes with 8mm midline shift to the left and abutting the right optic nerve at the optic chiasm with mass effect and compression of the right cerebral peduncle and edema of the right sided midbrain and focal edema in the right pons. Radiology felt imaging differentials were radiation necrosis vs high-grade glioma. Radiation oncology and neurosurgery reviewed the patient and scans and felt that this represented radiation necrosis as opposed to glioma. Patient remained clinically stable and the following day [**9-30**] apparent papilledema had completely resolved as had the apparent visual field defect. Dexamethasone was continued at 4mg Q6H and mannitol was decreased to 25g Q12H on [**10-1**] and latterly stopped. Patient was transferred to floor on [**10-1**] and remained stable throughout his hospital stay. He proceeded to an MRS [**Last Name (STitle) 151**] perfusion on [**10-2**] with perfusion showing no evidence of increased perfusion in the right temporal lobe lesion and MR [**Month/Year (2) 41307**] revealing areas of increased choline/NAA ratio that raise possible concern for neoplasm; however, based on the history of radiation in the right temporal lobe, decreased perfusion and relative cerebral [**Name2 (NI) **] volume, radiation necrosis appeared more likely, after discussion with Dr. [**Last Name (STitle) 3929**] from radiology oncology. He remained stable and was discharged on [**2133-10-5**] with neurology (on [**10-21**]), radiation oncology ([**11-6**]) and neurosurgery follow-up ([**11-10**]). He is scheduled to have a repeat MRI with and without contrast on [**2133-11-10**], the day of his neurosurgery appointment. He was also started on a dexamethasone taper to start 1 week after discharge tapering from 4mg Q6H and decreasing by 1mg every 3 days until stopping. He was commenced on po omeprazole while he is on the dexamethasone for gastric protection. He was continued on his home anti-epileptic doses and had no seizures while in house. Medications on Admission: LAMOTRIGINE - 100 mg Tablet - 3 Tablet(s) by mouth twice a day LAMOTRIGINE [LAMICTAL] - 25 mg Tablet - 2 Tablet(s) by mouth twice a day. LEVETIRACETAM [KEPPRA] - 750 mg Tablet - 4 Tablet(s) by mouth twice a day BRAND NAME MEDICALLY NECESSARY. NO SUBSTITUTION. - No Substitution LORAZEPAM - 0.5 mg Tablet - 1 Tablet(s) by mouth as needed every 6 hours for seizures- do not exceed 2 tablets in a 24 hour period Discharge Medications: 1. lamotrigine 100 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day): Total dose 350mg twice daily. 2. lamotrigine 25 mg Tablet Sig: Two (2) Tablet PO twice a day: Total dose 350mg twice daily. 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 4. dexamethasone 1 mg Tablet Sig: Four (4) Tablet PO every six (6) hours for 7 weeks: Taper as directed will giev 1 month supply. Disp:*364 Tablet(s)* Refills:*0* 5. Keppra 750 mg Tablet Sig: Four (4) Tablet PO twice a day: BRAND NAME ONLY NO SUBSTITUTIONS. Tablet(s) Discharge Disposition: Home Discharge Diagnosis: Likely radiation Necrosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neurology: Chronnci left facial droop and mild right ptosis. No other focal findings. Discharge Instructions: Mr. [**Name14 (STitle) 93751**] you were admitted with five weeks of headache and found to have significant right cerebral edema and subfalcine herniation (swelling in your brain causing it to move) on scan of your head. You had mild weakness on the right side of your body. You were given medications to lower the pressure (steroids - dexamethasone and mannitol - a diuretic) and to closely monitor, you were admitted to the ICU. MRI showed a lesion involving the right side of your brain. You were reviewed by neurology, neurosurgery and the consensus opinion was that this is a result a radiation necrosis from your surgery in [**2130**], however we will want to take another MRI in [**Month (only) 1096**] to ensure that the swelling has sufficiently improved and to re-evaluate this lesion. Please continue the taper od dexamethasone as below. We started omeprazole 20mg to reduce stomach acid as dexamethasone can be irrative to the stomach. You should follow-up with neurology, neurosurgery and radiation oncology as below. . . Medication changes: We STARTED dexamethasone 4mg 4 times per day and this should be tapered (reduced) after 1 week decreasing every 3 days by 1mg as follows 7am 12pm 5pm 10pm 4mg 4mg 4mg 4mg for 1 week 4mg 4mg 4mg 3mg for 3 days 3mg 4mg 4mg 3mg for 3 days 3mg 3mg 4mg 3mg for 3 days 3mg 3mg 3mg 3mg for 3 days 3mg 3mg 3mg 2mg for 3 days 2mg 3mg 3mg 2mg for 3 days 2mg 2mg 3mg 2mg for 3 days 2mg 2mg 2mg 2mg for 3 days 7am 1pm 6pm 2mg 2mg 2mg - every 8 hours for 3 days 7am 6pm 2mg 2mg - twice daily for 3 days 7am 2mg - once daily for 3 days 1mg - once daily for 3 days After this STOP . We started omeprazole 20mg daily to reduce stomach acid as dexamethasone can be irrative to the stomach Continue your home doses of your seizure medications Keppra 3000mg twice daily Lamotrigine 350mg twice daily Followup Instructions: Department: NEUROLOGY When: WEDNESDAY [**2133-10-21**] at 9:00 AM With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], RN [**Telephone/Fax (1) 857**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: NEUROSURGERY When: TUESDAY [**2133-11-10**] at 1 PM With: [**Name6 (MD) **] [**Last Name (NamePattern4) 9151**], MD [**Telephone/Fax (1) 1669**] Building: LM [**Hospital Unit Name **] [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: RADIATION ONCOLOGY When: FRIDAY [**2133-11-6**] at 11 AM With: [**Last Name (LF) **], [**Name8 (MD) **] MD, ([**Telephone/Fax (1) 8082**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name 23**] Garage We have organised an MRI for before your neurosurgery appointment on [**2133-11-10**] - please call [**Telephone/Fax (1) 22726**] to confirm

348,345,E879,368,342

{'Other conditions of brain,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Homonymous bilateral field defects,Hemiplegia, unspecified, affecting unspecified side'}

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: Headache PRESENT ILLNESS: 35-year-old man with history of complex partial epilepsy s/p right temporal radiotherapy in [**10/2131**] who was referred to the ED from epilepsy clinic for a five-week history of headaches. His epilepsy has been well controlled, with his last seizure in [**2133-7-16**] and the last one before that in [**2132-11-15**]. However during his epilepsy appointment today he mentioned a history of five weeks of headaches. Describes them as constant, dull, mostly unilateral on either side, but occasionally bilateral, located behind the eye, pounding, and about 5/10 intensity. Nothing in particular makes them worse or better. The medicines given by his PCP (Fioricet, steroids, antibiotics) and ibuprofen did not help. Describes hesitance opening eyes due to headache, but denies photophobia or any other associated symptoms. Concerned about these HAs, his PCP ordered [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 72787**] on the day prior admission. Today, his results revealed a significant abnormality and his PCP notified his primary epileptologist, Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) 851**], who then recommended that he come to the [**Hospital1 18**] ED for urgent evaluation. MEDICAL HISTORY: Complex partial epilepsy s/p right temporal CyberKnife procedure in [**10/2131**] MEDICATION ON ADMISSION: LAMOTRIGINE - 100 mg Tablet - 3 Tablet(s) by mouth twice a day LAMOTRIGINE [LAMICTAL] - 25 mg Tablet - 2 Tablet(s) by mouth twice a day. LEVETIRACETAM [KEPPRA] - 750 mg Tablet - 4 Tablet(s) by mouth twice a day BRAND NAME MEDICALLY NECESSARY. NO SUBSTITUTION. - No Substitution LORAZEPAM - 0.5 mg Tablet - 1 Tablet(s) by mouth as needed every 6 hours for seizures- do not exceed 2 tablets in a 24 hour period ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission PHYSICAL EXAM: T BP 126/52 HR 78 RR 12 O2% 99% RA General: Awake, cooperative, lying in bed in NAD with eyes intermittently closed secondary to headache rather than fatigue FAMILY HISTORY: There is a history of seizures in some cousins on his father's side of the family. Otherwise non-conntributory. SOCIAL HISTORY: Taking classes to be an electrician. No smoking history, alcohol intake or illicit drug use. ### Response: {'Other conditions of brain,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Homonymous bilateral field defects,Hemiplegia, unspecified, affecting unspecified side'}

CHIEF COMPLAINT: V fib arrest PRESENT ILLNESS: 35yo man with history of htn and tobacco who presented to [**Hospital **] after collapsing at a friend's house. CPR initiated by friend/nurse. [**First Name (Titles) **] [**Last Name (Titles) 71342**] and found to be in VF, then shocked out of VF. At [**Hospital3 15402**], found to have anterior STE-MI. Given 1/2 dose reteplase, eptifibitide, plavix load and transferred to [**Hospital1 18**]. EKG in-transit showed resolution of STE. Cath at [**Hospital1 18**] showed lesion at mid-LAD and prior to D1, DES placed to LAD. On arrival to the CCU, he was confused, repeatedly asking what had happened and to call his workplace. Pt c/o mild chest pain at sternum otherwise had no complaints. Patient has limited memory of event, but denies preceding illness, chest pain, diaphoresis, SOB. MEDICAL HISTORY: PMH: Anxiety panic attacks ptsd ?htn MEDICATION ON ADMISSION: Doxepin 300qhs Xanax 2mg TID:PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: VS: BP 149/98 HR 71 RR 18 Gen: Pleasant wn/wd young man, anxious HEENT: pupils dilated, MMM CV: Nl s1/s2, rrr, no m/r/g Pul: CTA b/l Abd: Soft,NT Ext: DP 2+ b/l sheath in place FAMILY HISTORY: Unknown SOCIAL HISTORY: 2 drinks the night of arrest, 1ppd smoker (now 1/3ppd). Denies illicits but tox at OSH showed cannabis. Works at transitional house as cook. Reportedly lives in an apartment that he rents. Per friends' report pt does binge drink at least once per week, usually on weekends. Has a h/o crack/cocaine abuse, now clean x 1yr. No history of IVDU (per pt's psychiatrtist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3517**] [**Telephone/Fax (1) 71343**] at [**Location (un) 22870**] Mental Health. on SSDI [**1-25**] psych issues. . Pt was born in [**Country 6257**]. Lived in the US in [**Location (un) **]. Goes to [**Country **] often. MSM. unknown HIV status. Former user of cocaine and heroin. . Patient has no family here. Has 1 aunt that he doesn't really talk to. Is closest to his friends: [**Name (NI) **] [**Last Name (NamePattern1) **] ([**Hospital1 112**] Cardiac nurse) H: [**Numeric Identifier 71344**] C: [**Telephone/Fax (1) 71345**]

Acute myocardial infarction of anterolateral wall, initial episode of care,Other primary cardiomyopathies,Pneumonitis due to inhalation of food or vomitus,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Memory loss,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure

AMI anterolateral, init,Prim cardiomyopathy NEC,Food/vomit pneumonitis,Hematoma complic proc,Crnry athrscl natve vssl,Hypertension NOS,Tobacco use disorder,Memory loss,Depressive disorder NEC,Anxiety state NOS,Abn react-cardiac cath

Admission Date: [**2153-12-18**] Discharge Date: [**2153-12-21**] Date of Birth: [**2118-12-1**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Doctor First Name 1402**] Chief Complaint: V fib arrest Major Surgical or Invasive Procedure: Cardiac Catheterization with drug eluting stent placement. History of Present Illness: 35yo man with history of htn and tobacco who presented to [**Hospital **] after collapsing at a friend's house. CPR initiated by friend/nurse. [**First Name (Titles) **] [**Last Name (Titles) 71342**] and found to be in VF, then shocked out of VF. At [**Hospital3 15402**], found to have anterior STE-MI. Given 1/2 dose reteplase, eptifibitide, plavix load and transferred to [**Hospital1 18**]. EKG in-transit showed resolution of STE. Cath at [**Hospital1 18**] showed lesion at mid-LAD and prior to D1, DES placed to LAD. On arrival to the CCU, he was confused, repeatedly asking what had happened and to call his workplace. Pt c/o mild chest pain at sternum otherwise had no complaints. Patient has limited memory of event, but denies preceding illness, chest pain, diaphoresis, SOB. Past Medical History: PMH: Anxiety panic attacks ptsd ?htn Social History: 2 drinks the night of arrest, 1ppd smoker (now 1/3ppd). Denies illicits but tox at OSH showed cannabis. Works at transitional house as cook. Reportedly lives in an apartment that he rents. Per friends' report pt does binge drink at least once per week, usually on weekends. Has a h/o crack/cocaine abuse, now clean x 1yr. No history of IVDU (per pt's psychiatrtist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3517**] [**Telephone/Fax (1) 71343**] at [**Location (un) 22870**] Mental Health. on SSDI [**1-25**] psych issues. . Pt was born in [**Country 6257**]. Lived in the US in [**Location (un) **]. Goes to [**Country **] often. MSM. unknown HIV status. Former user of cocaine and heroin. . Patient has no family here. Has 1 aunt that he doesn't really talk to. Is closest to his friends: [**Name (NI) **] [**Last Name (NamePattern1) **] ([**Hospital1 112**] Cardiac nurse) H: [**Numeric Identifier 71344**] C: [**Telephone/Fax (1) 71345**] Family History: Unknown Physical Exam: PE: VS: BP 149/98 HR 71 RR 18 Gen: Pleasant wn/wd young man, anxious HEENT: pupils dilated, MMM CV: Nl s1/s2, rrr, no m/r/g Pul: CTA b/l Abd: Soft,NT Ext: DP 2+ b/l sheath in place Pertinent Results: Please call [**Telephone/Fax (1) 2756**] for cath report (not available at discharge). . Admission Labs: [**2153-12-18**] 03:51AM GLUCOSE-110* UREA N-14 CREAT-0.9 SODIUM-137 POTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-26 ANION GAP-12 ALT(SGPT)-63* AST(SGOT)-98* LD(LDH)-283* CK(CPK)-475* CK-MB-36* MB INDX-7.6* cTropnT-1.32* MAGNESIUM-2.2 . ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG . WBC-22.8* RBC-4.14* HGB-13.4* HCT-38.4* MCV-93 MCH-32.4* MCHC-34.9 RDW-13.8 Plts 429 NEUTS-90.9* LYMPHS-6.0* MONOS-2.8 EOS-0.3 BASOS-0.1 . PT-12.0 PTT-68.8* INR(PT)-1.0 . URINE bnzodzpn-POS barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG . [**2153-12-20**]: TSH 1.8, VitB12 230, Folate 5.9, RPR negative . [**2153-12-19**] Head CT: IMPRESSIONS: 1. No acute intracranial abnormality. 2. No specific evidence of anoxic brain injury, with normal appearance of the deep [**Doctor Last Name 352**] matter structures. If clinical suspicion persists, MR imaging would be more sensitive in this regard. . ECHO REPORT [**2153-12-18**]: PATIENT/TEST INFORMATION: Indication: Left ventricular function. Myocardial infarction. Height: (in) 70 Weight (lb): 150 BSA (m2): 1.85 m2 BP (mm Hg): 129/82 HR (bpm): 80 Status: Inpatient Date/Time: [**2153-12-18**] at 10:52 Test: Portable TTE (Complete) Doppler: Full Doppler and color Doppler Contrast: None Tape Number: 2006W050-0:32 Test Location: West CCU Technical Quality: Adequate . MEASUREMENTS: Left Atrium - Long Axis Dimension: 2.6 cm (nl <= 4.0 cm) Left Atrium - Four Chamber Length: 3.9 cm (nl <= 5.2 cm) Right Atrium - Four Chamber Length: 3.9 cm (nl <= 5.0 cm) Left Ventricle - Septal Wall Thickness: 1.0 cm (nl 0.6 - 1.1 cm) Left Ventricle - Inferolateral Thickness: 1.1 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 4.5 cm (nl <= 5.6 cm) Left Ventricle - Ejection Fraction: 30% (nl >=55%) Aorta - Valve Level: *3.9 cm (nl <= 3.6 cm) Aorta - Ascending: *3.5 cm (nl <= 3.4 cm) Aorta - Arch: 2.2 cm (nl <= 3.0 cm) Mitral Valve - E Wave: 0.8 m/sec Mitral Valve - A Wave: 0.7 m/sec Mitral Valve - E/A Ratio: 1.14 Mitral Valve - E Wave Deceleration Time: 154 msec TR Gradient (+ RA = PASP): 8 mm Hg (nl <= 25 mm Hg) INTERPRETATION: Findings: LEFT ATRIUM: Normal LA size. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. The IVC is normal in diameter with <50% decrease during respiration (estimated RAP 11-15mmHg). LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size. Cannot exclude LV mass/thrombus. Moderately depressed LVEF. No resting LVOT gradient. No VSD. RIGHT VENTRICLE: Normal RV wall thickness. Normal RV chamber size. Focal apical hypokinesis of RV free wall. AORTA: Mildly dilated aortic sinus. Mildly dilated ascending aorta. Normal aortic arch diameter. No 2D or Doppler evidence of distal arch coarctation. AORTIC VALVE: ?# aortic valve leaflets. No AS. No AR. MITRAL VALVE: Normal mitral valve leaflets with trivial MR. No MVP. Normal mitral valve supporting structures. Normal LV inflow pattern for age. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. Normal tricuspid valve supporting structures. Normal PA systolic pressure. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets with physiologic PR. Normal main PA. No Doppler evidence for PDA PERICARDIUM: No pericardial effusion. . Conclusions: The left atrium is normal in size. The estimated right atrial pressure is 11-15mmHg. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. An apical left ventricular mass/thrombus cannot be excluded with certainty. Overall left ventricular systolic function is moderately-to-severely depressed (ejection fraction 30 percent) secondary to severe hypokinesis of the anterior septum and anterior free wall (with basal segment function relatively preserved) and extensive apical akinesis with focal dyskinesis. There is no ventricular septal defect. Right ventricular chamber size is normal. There is focal hypokinesis of the apical free wall of the right ventricle. The aortic root is mildly dilated at the sinus level. The ascending aorta is mildly dilated. The number of aortic valve leaflets cannot be determined. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. Brief Hospital Course: A/P: 35M with h/o HTN, tobacco, admitted s/p VF arrest with anterior STEMI s/p PCI. . # STEMI: Patient had PCI with DES to mid LAD lesion. peak CK at [**Hospital1 18**] 509, peak MB 7.6. Patient was treated with Integrillin x 18hrs peri placement of the stent. We began medical management with Aspirin 325mg, Plavix 75, Toprolol XL 50mgQD, atorvastatin 80mg QD, Lisinopril 10mgQD. . #Cardiomyopathy/Pump: His post MI echo shows EF < 30% with akinetic apex and could not rule out LV thrombis. He was started on lisinopril and toprolol. He was started IV heparin and coumadin for ?LV thrombus and apical akinesis. He will be discharged on coumadin with lovenox bridge and scheduled INR/PTT/PT checks. He will need MRI, TWA, and signal avg EKGs in 4-6wks post dc for risk stratification and ICD implantation consideration. . #Rhythm: Normal sinus with rate of 60-70 with very rare PVCs. He will be discharged with a holter monitor and the results will be faxed to his cardiologist, Dr. [**First Name (STitle) 1169**]. . #Risk factors: Patient is a smoker, +etoh, +h/o crack/cocaine use. Lipids profile: Triglyc: 156 HDL: 36 CHOL/HD: 2.9 LDLcalc: 39. These can be falsely lowered in setting of acute event and patient will need retested as outpatient. He will continue atorvastatin 80mg for cardiac protection. We have given him a prescription for nicotine patches and have encouraged him to stop. . #Aspiration PNA/leukocytosis/fever: wbc of 22 on admission, no bands, likely in a setting of AMI. But wbc count bumped from 11 to 12 on hospital day 3, with low grade fever and with mild peribronchovascular opacity suggestive of early infiltrate. In the setting of v fib arrest and time down we will treat with Clindamycin x 7 days (last day [**2152-12-26**]) for aspiration pna (no levoflox b/c of long QT). After one day of treatment his WBC decreased, he defervesced and His urine cultures were negative . #Groin hematoma: This was likely from movement of leg. Initially treated with compression dressing. His hematoma is resolving and his hct was stable throughout. . #ST memory loss: Slowly improving. Per converstaion with the patient's psychiatrist, the patient has a h/o depressive sx, ? ptsd, panic attacks, [**1-25**] h/o of prior abusive relationships. CT head with no evidence of anoxic brain injury. No focal neurological symptoms. Improving memory and insight. Psychiatry was consulted. We tested for causes of early dementia (syphilis, folate, b12 and tsh), which was negative except a slightly low B12, for which he was started on supplements. . #psych: h/o depression, anxiety, panic attacks. on xanax, doxepin. sees oupt psych. has substance abuse issues with active etoh use and crack/cocaine use. Patient reports to be clean for 1yr. Initially on CIWA scale with valium, he was switched to xanax at home dose. . #Hematuria: Patient self reported small amounts of gross blood in urine, which was confirmed by dipstick. This was in setting of foley placement and discontinuation and heparin. We would recommend outpatient pcp/urology follow-up. . #FEN: cardiac diet . #FULL CODE . #Follow up plans: will need MRI, signal avg ekg, t-wave alterans upon discharge (4-6wks after) . PCP: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 71346**]/[**Last Name (un) **] ([**Telephone/Fax (1) 71347**] . Contacts: [**Name2 (NI) **] has no family here. Has 1 aunt that he doesn't really talk to. Is closest to his friends: [**Name (NI) **] [**Last Name (NamePattern1) **] ([**Hospital1 112**] Cardiac nurse) H: [**Numeric Identifier 71344**] C: [**Telephone/Fax (1) 71345**]/1 . Psych: Dr. [**Last Name (STitle) 3517**], [**Location (un) 22870**] health [**Telephone/Fax (1) 71343**] Medications on Admission: Doxepin 300qhs Xanax 2mg TID:PRN Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): for a minimum duration of 1 year. Disp:*30 Tablet(s)* Refills:*12* 3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*2* 6. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig: Two (2) Tablet Sustained Release 24HR PO DAILY (Daily). Disp:*90 Tablet Sustained Release 24HR(s)* Refills:*2* 7. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. Clindamycin HCl 150 mg Capsule Sig: Three (3) Capsule PO Q6H (every 6 hours) for 6 days. Disp:*72 Capsule(s)* Refills:*0* 9. Alprazolam 1 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for anxiety. 10. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 11. Enoxaparin 60 mg/0.6 mL Syringe Sig: One (1) 60mg Subcutaneous twice a day for 7 days: Until coumadin/INR is therapeutic. Disp:*14 syringes* Refills:*0* 12. Lab work Sig: One (1) ONCE for 1 doses: Please draw PT/INR, ALT, AST, BUN and Cr on Sunday [**2153-12-23**] and have the results faxed to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1169**] [**Last Name (NamePattern1) 71348**]fax [**Telephone/Fax (1) 71349**], phone [**Telephone/Fax (1) 40420**]. . Disp:*1 1* Refills:*0* 13. Doxepin 25 mg Capsule Sig: Six (6) Capsule PO HS (at bedtime): Please only take 150mg QD until instructed otherwise. . Disp:*QS Capsule(s)* Refills:*2* 14. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR Transdermal DAILY (Daily): Please readdress with your PCP at the next visit. . Disp:*QS Patch 24HR(s)* Refills:*2* 15. Xanax 2 mg Tablet Sig: One (1) Tablet PO three times a day as needed for anxiety. Discharge Disposition: Home With Service Facility: [**Hospital1 **] VNA [**Location (un) 5503**] Discharge Diagnosis: Primary ST elevation MI s/p ventricular fib arrest and defibrillation CHF with EF of <30% suspicion of LV thrombis apical akenesis h/o ?HTN Secondary hematuria . Discharge Condition: Stable Discharge Instructions: It is very important that you take your medications. . The most important medications are aspirin and plavix (also called clopidigrel). If you were to stop taking these you would have a high likelihood of having another major heart attack and possibly dying. . We have started you on several other medications that are important for your heart. They are all listed below. . You are on antibiotics for pneumonia. You will need to complete a seven day course. . Your dose of doxepin was decreased by half. Please take this until you see your psychiatrist and cardiologist. It was decreased for possible effects on your heart. . Please call your doctor or seek medical attention if you have increasing chest pain, palpitations, lightheadedness, difficulty breathing, weight gain, feet swelling. You will need to weigh yourself daily. Please contact your doctor if you gain more than 3 pounds a day. Please limit your sodium intake to 2 grams daily. . We have made you an appointment with a cardiologist. It is very important that you keep this appointment as you will need closely followed by a cardiologist from now on. Followup Instructions: You need to have VNA follow up for the next few weeks with medication checks, INR checks, weight checks. Please talk to your PCP about cardiac rehab. . You need to return your holter monitor to the [**Hospital1 18**] for analysis. . Please see your PCP, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 71346**]/[**Last Name (un) **] ([**Telephone/Fax (1) 58547**]), in the next 7-10 days. Have her follow up on medications, anticoagulation and hematuria. . You have an appointment with a cardiologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1169**], on [**2153-12-26**] at 3:30. The office is at [**Last Name (NamePattern1) **]. The phone number is [**Telephone/Fax (1) 40420**] ([**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]). [Patient prefers to follow up at [**Hospital6 302**]. The cardiologists all have private offices.] . Patient will need risk stratification including Signal Average EKG, cardiac MRI, TWA in 6 weeks and follow up with EP. . Please follow-up with your psychiatrist. This was a major event and your life will change. You will also need to address your medications.

410,425,507,998,414,401,305,780,311,300,E879

{'Acute myocardial infarction of anterolateral wall, initial episode of care,Other primary cardiomyopathies,Pneumonitis due to inhalation of food or vomitus,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Memory loss,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}

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: V fib arrest PRESENT ILLNESS: 35yo man with history of htn and tobacco who presented to [**Hospital **] after collapsing at a friend's house. CPR initiated by friend/nurse. [**First Name (Titles) **] [**Last Name (Titles) 71342**] and found to be in VF, then shocked out of VF. At [**Hospital3 15402**], found to have anterior STE-MI. Given 1/2 dose reteplase, eptifibitide, plavix load and transferred to [**Hospital1 18**]. EKG in-transit showed resolution of STE. Cath at [**Hospital1 18**] showed lesion at mid-LAD and prior to D1, DES placed to LAD. On arrival to the CCU, he was confused, repeatedly asking what had happened and to call his workplace. Pt c/o mild chest pain at sternum otherwise had no complaints. Patient has limited memory of event, but denies preceding illness, chest pain, diaphoresis, SOB. MEDICAL HISTORY: PMH: Anxiety panic attacks ptsd ?htn MEDICATION ON ADMISSION: Doxepin 300qhs Xanax 2mg TID:PRN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: VS: BP 149/98 HR 71 RR 18 Gen: Pleasant wn/wd young man, anxious HEENT: pupils dilated, MMM CV: Nl s1/s2, rrr, no m/r/g Pul: CTA b/l Abd: Soft,NT Ext: DP 2+ b/l sheath in place FAMILY HISTORY: Unknown SOCIAL HISTORY: 2 drinks the night of arrest, 1ppd smoker (now 1/3ppd). Denies illicits but tox at OSH showed cannabis. Works at transitional house as cook. Reportedly lives in an apartment that he rents. Per friends' report pt does binge drink at least once per week, usually on weekends. Has a h/o crack/cocaine abuse, now clean x 1yr. No history of IVDU (per pt's psychiatrtist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3517**] [**Telephone/Fax (1) 71343**] at [**Location (un) 22870**] Mental Health. on SSDI [**1-25**] psych issues. . Pt was born in [**Country 6257**]. Lived in the US in [**Location (un) **]. Goes to [**Country **] often. MSM. unknown HIV status. Former user of cocaine and heroin. . Patient has no family here. Has 1 aunt that he doesn't really talk to. Is closest to his friends: [**Name (NI) **] [**Last Name (NamePattern1) **] ([**Hospital1 112**] Cardiac nurse) H: [**Numeric Identifier 71344**] C: [**Telephone/Fax (1) 71345**] ### Response: {'Acute myocardial infarction of anterolateral wall, initial episode of care,Other primary cardiomyopathies,Pneumonitis due to inhalation of food or vomitus,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Memory loss,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}

CHIEF COMPLAINT: EtOH withdrawal PRESENT ILLNESS: 40M with h/o EtOH abuse, withdrawal,and withdrawal seizures was found down intoxicated by EMS. He had a FS of 10 at the time, and an oral airway was placed. He received naloxone with no effect. He had no apparent trauma. He was minimally cooperative with history and exam, but denied any focal complaints. His EtOH level was 578, and his tox screen was significant for benzodiazepines. In the ED, initial vitals were 97.6, 98, 132/86, 16, and 96% on NRB. Thereafter, he remained tachycardic in the 110s-130s. . In the ED, he desaturated to the 80s on room air and 90-91% on NRB, and chest film demonstrated a questionable LLL opacity vs. atelectasis. Repeat chest film done 3h later then demonstrated a patchy RLL opacity. For this reason, he was started empirically on levaquin and flagyl. . In the ED he complained of tremors and scored consistently over 30 by CIWA scale. In total, he received 2L of NS, 1L of D5 [**1-28**] NS with folate/thiamine/Mg, and 4mg ativan and 35mg valium. MEDICAL HISTORY: 1. EtOH abuse 2. EtOH withdrawal seizures MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 98.6, 113, 128/73, 20, 93%RA General - lying in bed, poorly groomed HEENT - dry mucous membranes, pupils small and sluggishly reactive Neck - no LAD CV - RRR, no murmur appreciated, s1s2 normal Chest - scattered crackles, decr breath sounds at bases Abdomen - soft, NT/ND, no guarding or rigidity Ext - no c/c/e FAMILY HISTORY: His father and mother both died of cancer. SOCIAL HISTORY: The patient reports being homeless. He denies using any drugs, although he does report that he used to. He acknowledges using alcohol, but will not state how much. Smokes 1ppd x17 years.

Alcohol withdrawal delirium,Acute alcoholic intoxication in alcoholism, continuous,Lack of housing

Delirium tremens,Ac alcohol intox-contin,Lack of housing

Admission Date: [**2126-1-1**] Discharge Date: [**2126-1-4**] Date of Birth: [**2085-10-23**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 7934**] Chief Complaint: EtOH withdrawal Major Surgical or Invasive Procedure: none History of Present Illness: 40M with h/o EtOH abuse, withdrawal,and withdrawal seizures was found down intoxicated by EMS. He had a FS of 10 at the time, and an oral airway was placed. He received naloxone with no effect. He had no apparent trauma. He was minimally cooperative with history and exam, but denied any focal complaints. His EtOH level was 578, and his tox screen was significant for benzodiazepines. In the ED, initial vitals were 97.6, 98, 132/86, 16, and 96% on NRB. Thereafter, he remained tachycardic in the 110s-130s. . In the ED, he desaturated to the 80s on room air and 90-91% on NRB, and chest film demonstrated a questionable LLL opacity vs. atelectasis. Repeat chest film done 3h later then demonstrated a patchy RLL opacity. For this reason, he was started empirically on levaquin and flagyl. . In the ED he complained of tremors and scored consistently over 30 by CIWA scale. In total, he received 2L of NS, 1L of D5 [**1-28**] NS with folate/thiamine/Mg, and 4mg ativan and 35mg valium. Past Medical History: 1. EtOH abuse 2. EtOH withdrawal seizures Social History: The patient reports being homeless. He denies using any drugs, although he does report that he used to. He acknowledges using alcohol, but will not state how much. Smokes 1ppd x17 years. Family History: His father and mother both died of cancer. Physical Exam: VS: 98.6, 113, 128/73, 20, 93%RA General - lying in bed, poorly groomed HEENT - dry mucous membranes, pupils small and sluggishly reactive Neck - no LAD CV - RRR, no murmur appreciated, s1s2 normal Chest - scattered crackles, decr breath sounds at bases Abdomen - soft, NT/ND, no guarding or rigidity Ext - no c/c/e Pertinent Results: Admission Labs: [**2126-1-1**] 11:45AM BLOOD WBC-7.1 RBC-5.02 Hgb-16.3 Hct-47.1 MCV-94 MCH-32.5* MCHC-34.6 RDW-14.5 Plt Ct-291 [**2126-1-1**] 11:45AM BLOOD Neuts-55.1 Lymphs-38.3 Monos-4.3 Eos-1.6 Baso-0.8 [**2126-1-1**] 11:45AM BLOOD Plt Ct-291 [**2126-1-1**] 11:45AM BLOOD PT-12.8 PTT-25.6 INR(PT)-1.1 [**2126-1-1**] 11:45AM BLOOD Glucose-176* UreaN-8 Creat-0.7 Na-144 K-3.8 Cl-100 HCO3-29 AnGap-19 [**2126-1-1**] 11:45AM BLOOD CK(CPK)-184* [**2126-1-1**] 11:20PM BLOOD ALT-52* AST-105* CK(CPK)-231* AlkPhos-63 Amylase-43 TotBili-0.2 [**2126-1-1**] 11:20PM BLOOD Lipase-68* [**2126-1-1**] 11:45AM BLOOD CK-MB-2 [**2126-1-1**] 11:20PM BLOOD TotProt-6.4 Calcium-7.1* Phos-2.5* Mg-1.6 [**2126-1-2**] 04:45AM BLOOD calTIBC-239* VitB12-540 Folate-7.8 Hapto-35 Ferritn-180 TRF-184* [**2126-1-1**] 11:45AM BLOOD ASA-NEG Ethanol-578* Acetmnp-NEG Bnzodzp-POS Barbitr-NEG Tricycl-NEG [**2126-1-1**] 11:49AM BLOOD Lactate-3.5* . [**1-1**] CXR:Irregular opacity within the left lower lobe that could represent aspiration, atelectasis, or scarring. . [**1-1**] CXR: Right lower lobe opacity concerning for pneumonia. . [**1-2**] CXR: Resolution of opacity in both lower lobes previously identified. . [**1-3**] Head CT: Moderate region of encephalomalacia in the left frontal lobe, likely residua of prior trauma. Comparison with any previous outside hospital imaging would be helpful. No acute intracranial hemorrhage or mass effect. Brief Hospital Course: 40M with h/o EtOH abuse and withdrawal now admitted with EtOH/benzodiazepine intoxication and signs of EtOH withdrawal. . 1. EtOH withdrawal: The timing of the patient's last drink was uncertain, but he had signs and symptoms of withdrawal, incuding tachycardia, agitation, and tremors. In the ED he was given fluids, thiamine, folate, MVI, valium, and ativan. On transfer to the ICU, IV hydration was continued, as well as folate, thiamine, and MVI. He was kept on a CIWA scale with valium. Social work was consulted for substance abuse, as well as for help with resources, but the patient was not able to talk with SW initally because of his withdrawal symptoms. On [**2126-1-4**] the patient asked to leave the hospital AMA because he did not feel that the valium was working for him, and when this was not immediately allowed he tried to leave the hospital. A code purple was called, with security and psychiatry arriving to the patient's room to assess his capacity given that he was still in withdrawal and receiving frequent valium doses. He was found to have capacity, so he did sign out AMA. He refused help in finding a homeless shelter. . 2. Aspiration pneumonitis: The patient's chest xray in the ED was initially read as possible pneumonia, so he was started on levofloxacin and flagyl. However, the patient did not have a fever, elevated WBC count, or other evidence of infection, so this was considered to be more likely an aspiration pneumonitis and antibiotics were discontinued. Repeat chest xray showed resolution of the opacity. . 3. FEN: The patient was given IV hydration while not taking PO. His diet was then advanced as tolerated. Electrolytes were monitored and aggressively repleted. Thiamine, folate, and MVI were given. . 4. Prophylaxis: The patient was on SC heparin for DVT prophylaxis. Medications on Admission: none Discharge Medications: none Discharge Disposition: Home Discharge Diagnosis: EtOH withdrawal Discharge Condition: stable, still in EtOH withdrawal, left AMA Discharge Instructions: Patient left AMA after being seen by psychiatry and deemed to have capacity. He refused help in finding a shelter. Followup Instructions: Patient left AMA.

291,303,V600

{'Alcohol withdrawal delirium,Acute alcoholic intoxication in alcoholism, continuous,Lack of housing'}

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: EtOH withdrawal PRESENT ILLNESS: 40M with h/o EtOH abuse, withdrawal,and withdrawal seizures was found down intoxicated by EMS. He had a FS of 10 at the time, and an oral airway was placed. He received naloxone with no effect. He had no apparent trauma. He was minimally cooperative with history and exam, but denied any focal complaints. His EtOH level was 578, and his tox screen was significant for benzodiazepines. In the ED, initial vitals were 97.6, 98, 132/86, 16, and 96% on NRB. Thereafter, he remained tachycardic in the 110s-130s. . In the ED, he desaturated to the 80s on room air and 90-91% on NRB, and chest film demonstrated a questionable LLL opacity vs. atelectasis. Repeat chest film done 3h later then demonstrated a patchy RLL opacity. For this reason, he was started empirically on levaquin and flagyl. . In the ED he complained of tremors and scored consistently over 30 by CIWA scale. In total, he received 2L of NS, 1L of D5 [**1-28**] NS with folate/thiamine/Mg, and 4mg ativan and 35mg valium. MEDICAL HISTORY: 1. EtOH abuse 2. EtOH withdrawal seizures MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 98.6, 113, 128/73, 20, 93%RA General - lying in bed, poorly groomed HEENT - dry mucous membranes, pupils small and sluggishly reactive Neck - no LAD CV - RRR, no murmur appreciated, s1s2 normal Chest - scattered crackles, decr breath sounds at bases Abdomen - soft, NT/ND, no guarding or rigidity Ext - no c/c/e FAMILY HISTORY: His father and mother both died of cancer. SOCIAL HISTORY: The patient reports being homeless. He denies using any drugs, although he does report that he used to. He acknowledges using alcohol, but will not state how much. Smokes 1ppd x17 years. ### Response: {'Alcohol withdrawal delirium,Acute alcoholic intoxication in alcoholism, continuous,Lack of housing'}

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 74yo F referred to [**Hospital1 18**] for chest tightness and dyspnea for the past month. It occurs both at rest and with exertion, related to stress. She reports associated dizziness. She has episodes [**3-28**] times per week. They last for a few minutes and resolve when she lies down and relaxes. MEDICAL HISTORY: Diabetes mellitus Hypertension C section hysterectomy mild LV systolic dysfunction at baseline MEDICATION ON ADMISSION: Lisinopril 40mg daily Nifedical 60mg daily Metformin HCL 1000mg qam, 500mg qlunch, 1000mg qpm Lipitor 40mg daily Atenolol 25mg daily Protonix 40mg daily Aspirin 325mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 93.6 P88-96 BP 114/70 IABP 1:1 vent: Fi)2 0.8 550 x 16, PEEP5 Gen-sedated HEENT-anicteric, mmm, JVD hard to visualizes CV-RRR, no r/m/g resp-CTAB(anterior exam) [**Last Name (un) 103**]-soft, NT/ND, mostly in bandage extremities-cold extremities, no pitting edema, pulses dopplerable bilaterally, left groin hematoma noted FAMILY HISTORY: noncontributory SOCIAL HISTORY: Married, lives with her husband in [**Location (un) 686**]. No stairs. Daughter lives on the [**Location (un) **] of her house.

Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute myocardial infarction of other specified sites, initial episode of care,Ventricular fibrillation,Cardiogenic shock,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hemorrhage complicating a procedure,Acute and subacute necrosis of liver,Mitral valve disorders,Acidosis,Unspecified hypertensive heart disease with heart failure,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

Crnry athrscl natve vssl,Surg compl-heart,AMI NEC, initial,Ventricular fibrillation,Cardiogenic shock,CHF NOS,Food/vomit pneumonitis,Abn react-cardiac cath,Hemorrhage complic proc,Acute necrosis of liver,Mitral valve disorder,Acidosis,Hyp ht dis NOS w ht fail,Anemia NOS,DMII wo cmp nt st uncntr

Admission Date: [**2127-3-24**] Discharge Date: [**2127-4-1**] Date of Birth: [**2053-3-5**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Location (un) 1279**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: cardiac catheterization ECMO History of Present Illness: 74yo F referred to [**Hospital1 18**] for chest tightness and dyspnea for the past month. It occurs both at rest and with exertion, related to stress. She reports associated dizziness. She has episodes [**3-28**] times per week. They last for a few minutes and resolve when she lies down and relaxes. During cardiac catheterization, she clotted off her left circumflex artery and left anterior descending artery. Patient became hypotensive requiring atropine and dopamine. Code was called. Patient required 7 defibrillations.An IABP was placed. A temporary RV pacing wire was placed. The patient was intubated. Cardiopulmonary support (ECMO)was initiated via CPS perfusion catheters placed in the RFA and RFV (the IABP and RV pacing wire were removed). Access obtained in the LFA and LFV. Emergent bedside echo showed no evidence of tamponade.She was successfully resuscitated using CPS with emergent deployment of drug eluting stents in LAD and LCx(Kissing stenting of the LMCA into the LAD and LCX ).Patient had resumption of pulsatile central aortic pressure after stenting of the LAD and LCx. An IABP was placed.PA cath c/w ischemic MR. She has massive blood loss during the procedure and has recieved 5U PRBC and 1u platelet prior to transfer to CCU. Echo post cath showed small pericardial effusion, mild aymmetric LVH, nl LV size, mildly depressed LVEF Patient did well in cath lab and ECMO weaned off. Given the ACT of >900, it was determined to be safer to have the ECMO catheters removed in OR. Patient went to the OR and vascular surgery removed the ECMO catheters Past Medical History: Diabetes mellitus Hypertension C section hysterectomy mild LV systolic dysfunction at baseline Social History: Married, lives with her husband in [**Location (un) 686**]. No stairs. Daughter lives on the [**Location (un) **] of her house. Family History: noncontributory Physical Exam: T 93.6 P88-96 BP 114/70 IABP 1:1 vent: Fi)2 0.8 550 x 16, PEEP5 Gen-sedated HEENT-anicteric, mmm, JVD hard to visualizes CV-RRR, no r/m/g resp-CTAB(anterior exam) [**Last Name (un) 103**]-soft, NT/ND, mostly in bandage extremities-cold extremities, no pitting edema, pulses dopplerable bilaterally, left groin hematoma noted Pertinent Results: -echo [**2127-3-24**] 1. The left atrium is normal in size. 2.There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. LV appears underfilled. Overall left ventricular systolic function is mild to moderately depressed. Resting regional wall motion abnormalities include inferior and inferoseptal akinesis. 3. Right ventricular chamber size is normal. Right ventricular systolic function appears depressed with apical akinesis. 4.The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. 5.The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. 6.There is a small pericardial effusion. There are no echocardiographic signs of tamponade. 7. There is an echogenic density in the right ventricle consistent with a catheter. PROCEDURE DATE: [**2127-3-24**] INDICATIONS FOR CATHETERIZATION: chest pain FINAL DIAGNOSIS: 1. Acute embolic occlusion of the LCx artery during cardiac catherization complicated by cardiac arrest requiring initiation of cardiopulmonary support. 2. Kissing stenting of the LMCA into the LAD and LCX. COMMENTS: 1. Initial resting hemodynamics revealed normal right and left sided filling pressures. 2. Left ventriculography revealed normal systolic function. 3. In preparation for selective coronary angiography, the JL4 was advanced into the ascending aorta. This was done without difficulty and the catheter was cleared and flushed per routine, with contrast clearing in the ascending aorta (well outside the sinuses of Valsalva). The first puff in the LMCA suggested occlusion of the LCx. The first cineangiogram showed mild LMCA plaquing with abrupt cutoff and total occlusion of the LCx. There was mild diffuse plaqing in the LAD. 4. The patient became progressively bradycardic and hypotensive (SBP < 40mmHg) and a code was called. Atropine, dopamine and epinephrine were given. Chest compressions were started. The patient developed recurrent VT and VF and the patient was defibrillated at 360J approximately 7 times. An IABP was placed. A temporary RV pacing wire was placed. The patient was intubated. 5. CT surgery was emergently consulted. Cardiopulmonary support (ECMO) was initiated via CPS perfusion catheters placed in the RFA and RFV (the IABP and RV pacing wire were removed). Access obtained in the LFA and LFV. Emergent bedside echo showed no evidence of tamponade. 6. Limited angiography of the RCA showed minimal CAD. 7. Successful kissing stenting of the LAD/LCX back to the ostium of the LMCA was performed with a 3.0 x 33 mm Cypher DES (LAD) and LCX 2.5 x 28 mm Cypher DES (LCX). 8. Patient had resumption of pulsatile central aortic pressure after stenting of the LAD and LCx. An IABP was placed. 9. HCt from ABG 20%. Transfusion with emergency release blood products was begun. 10. PA catheterization was performed via the LFV. It showed a marked increase in filling pressures (RA mean 23mmHg, PCWP mean 40 with tall v-waves and rounded dicrotic notch on PA pressure tracing. Findings consistent with iscehmic mitral regurgitation. 11. Repeat emergent echo showed a small pericardial space, posterobasal hypokinesis and a hyperdynamic anterior wall with moderate mitral regurgitation. 12. Hand injection of the LFA showed no obvious major extravasation. 13. Vascular surgery consulted (together with CT surgery) regarding weaning of CPS and removal of CPS catheter CT abdomen and pelvis [**2127-3-25**]: CT OF THE ABDOMEN WITHOUT CONTRAST: There are bilateral pleural effusions and bibasilar collapse/consolidation. An NG tube is noted coiled within the stomach. The inflated portion of the intraaortic balloon pump terminates just above the aortic bifurcation. Note is made of a non-calcified gallstone. There is biliary excretion of previously administered contrast. The liver is unremarkable on this noncontrast study. The adrenal glands, pancreas, kidneys, spleen, and intraabdominal loops of bowel are unchanged. There is high attenuation fluid in the anterior and posterior pararenal spaces consistent with hemorrhage. There is perihepatic ascites. No pathologically enlarged lymph nodes are identified. CT OF THE PELVIS WITHOUT IV CONTRAST: There is diffuse stranding in the subcutaneous tissues in the left groin with obliteration of the normal fat planes with asymmetry with expansion of the anterior thigh musculature consistent with a hematoma. There is low-density free pelvic fluid. A Foley catheter is noted in the bladder. There is sigmoid diverticulosis, without evidence of diverticulitis. Bone windows reveal no suspicious lytic or sclerotic foci. There are degenerative changes. IMPRESSION: 1) Left groin hematoma. 2) Retroperitoneal hemorrhage as described above. 3) Apparent low position of intraaortic balloon pump terminating with its inflated portion just above the aortic bifurcation. Echo [**2127-3-28**]: 1. The left atrium is mildly dilated. 2.There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. No left ventricular aneurysm is seen. There is mild regional left ventricular systolic dysfunction. Overall left ventricular systolic function is modertately depressed. Resting regional wall motion abnormalities include basal and mid inferior hypokinesis with basal and mid inferolateral and lateral akinesis. 3. Right ventricular chamber size and free wall motion are normal. 4.The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Mild (1+) aortic regurgitation is seen. 5.The mitral valve leaflets are structurally normal. Mioderate (2+) mitral regurgitation is seen. 6.There is mild pulmonary artery systolic hypertension. [**2127-3-24**] 07:42PM TYPE-ART TEMP-33.7 PO2-135* PCO2-35 PH-7.35 TOTAL CO2-20* BASE XS--5 INTUBATED-INTUBATED [**2127-3-24**] 07:42PM LACTATE-7.3* [**2127-3-24**] 07:42PM O2 SAT-98 [**2127-3-24**] 07:42PM freeCa-1.13 [**2127-3-24**] 07:28PM GLUCOSE-188* UREA N-17 CREAT-1.0 SODIUM-146* POTASSIUM-3.1* CHLORIDE-112* TOTAL CO2-20* ANION GAP-17 [**2127-3-24**] 07:28PM ALT(SGPT)-1093* AST(SGOT)-2155* LD(LDH)-[**2149**]* CK(CPK)-4492* ALK PHOS-54 TOT BILI-0.6 [**2127-3-24**] 07:28PM cTropnT-13.41* [**2127-3-24**] 07:28PM ALBUMIN-2.4* CALCIUM-8.0* PHOSPHATE-3.7 MAGNESIUM-1.1* [**2127-3-24**] 07:28PM WBC-16.2* RBC-5.00 HGB-15.4 HCT-43.1 MCV-86 MCH-30.8 MCHC-35.7* RDW-14.8 [**2127-3-24**] 07:28PM NEUTS-71* BANDS-16* LYMPHS-10* MONOS-1* EOS-1 BASOS-0 ATYPS-1* METAS-0 MYELOS-0 [**2127-3-24**] 07:28PM PLT SMR-LOW PLT COUNT-122* [**2127-3-24**] 07:28PM PT-18.3* PTT-72.1* INR(PT)-2.1 [**2127-3-24**] 07:28PM FIBRINOGE-201 [**2127-3-24**] 05:45PM WBC-14.7* RBC-4.48# HGB-13.8# HCT-39.4# MCV-88# MCH-30.8 MCHC-35.0# RDW-14.7 [**2127-3-24**] 05:45PM PLT COUNT-115* [**2127-3-24**] 05:45PM PT-17.0* PTT-66.1* INR(PT)-1.8 [**2127-3-24**] 05:45PM FIBRINOGE-178 [**2127-3-24**] 05:41PM TYPE-ART PO2-143* PCO2-39 PH-7.26* TOTAL CO2-18* BASE XS--8 INTUBATED-INTUBATED VENT-CONTROLLED [**2127-3-24**] 05:41PM GLUCOSE-317* NA+-139 K+-4.2 [**2127-3-24**] 05:41PM HGB-13.4 calcHCT-40 [**2127-3-24**] 05:41PM freeCa-1.16 [**2127-3-24**] 05:02PM TYPE-ART PO2-131* PCO2-47* PH-7.26* TOTAL CO2-22 BASE XS--5 INTUBATED-INTUBATED [**2127-3-24**] 05:02PM GLUCOSE-370* NA+-140 K+-3.5 [**2127-3-24**] 05:02PM HGB-10.3* calcHCT-31 [**2127-3-24**] 05:02PM freeCa-1.41* [**2127-3-24**] 04:31PM TYPE-ART PO2-427* PCO2-20* PH-7.43 TOTAL CO2-14* BASE XS--7 INTUBATED-INTUBATED [**2127-3-24**] 04:31PM GLUCOSE-428* NA+-137 K+-2.8* [**2127-3-24**] 04:31PM HGB-9.8* calcHCT-29 [**2127-3-24**] 04:31PM freeCa-0.84* [**2127-3-24**] 02:45PM GLUCOSE-569* UREA N-17 CREAT-1.1 SODIUM-136 POTASSIUM-2.7* CHLORIDE-99 TOTAL CO2-14* ANION GAP-26* [**2127-3-24**] 02:45PM ALT(SGPT)-1177* AST(SGOT)-874* CK(CPK)-460* ALK PHOS-54 AMYLASE-162* TOT BILI-0.3 [**2127-3-24**] 02:45PM CK-MB-28* MB INDX-6.1* cTropnT-0.66* [**2127-3-24**] 02:45PM ALBUMIN-2.1* [**2127-3-24**] 02:45PM WBC-11.9*# RBC-2.65*# HGB-7.8*# HCT-25.2*# MCV-95 MCH-29.5 MCHC-30.9* RDW-13.0 [**2127-3-24**] 02:45PM NEUTS-60 BANDS-12* LYMPHS-19 MONOS-4 EOS-1 BASOS-1 ATYPS-3* METAS-0 MYELOS-0 [**2127-3-24**] 02:45PM HYPOCHROM-2+ ANISOCYT-NORMAL POIKILOCY-OCCASIONAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL [**2127-3-24**] 02:45PM PLT SMR-NORMAL PLT COUNT-177 [**2127-3-24**] 02:45PM PT->100* PTT->150* INR(PT)->63 [**2127-3-24**] 02:25PM TYPE-ART RATES-16/ TIDAL VOL-500 PEEP-5 O2 FLOW-100 PO2-389* PCO2-27* PH-7.30* TOTAL CO2-14* BASE XS--11 -ASSIST/CON INTUBATED-INTUBATED COMMENTS-VENTED [**2127-3-24**] 02:25PM GLUCOSE-565* LACTATE-13.2* K+-2.6* [**2127-3-24**] 02:25PM HGB-6.7* calcHCT-20 O2 SAT-97 [**2127-3-24**] 01:30PM RATES-16/ TIDAL VOL-500 PEEP-5 O2 FLOW-100 PO2-582* PCO2-29* PH-7.25* TOTAL CO2-13* BASE XS--12 -ASSIST/CON INTUBATED-INTUBATED [**2127-3-24**] 01:30PM GLUCOSE-496* LACTATE-13.1* NA+-132* K+-3.2* CL--105 [**2127-3-24**] 01:30PM HGB-7.5* calcHCT-23 O2 SAT-99 Brief Hospital Course: 74yo female with history of hypertension and nonobstructive coronary artery disease referred to [**Hospital1 18**] for cardiac catheterization because of increasing dyspnea. During procedure, she clotted off her LCx and LAD. She had 7 ventricular fibrillation arrest requiring ECMO being placed by surgery. She had emergent placement of kissing stents to LAD and LCx. Post procedure, she went to the OR to have ECMO catheters removed on the right groin, IABP and PA catheter placed on the left groin. She recieved a total of 6 units of blood during the procedure. On arrival to the CCU, she was on pressors and intubated. Over the course of the next few days, her hemodynamics were monitored by swan and improved. She was eventually extubated. IABP and pressors were removed on [**2127-3-26**] with good hemodynamics. However, she developed acute respiratory distress on the night of [**2127-3-26**] responsive to lasix, nitroglycerin drip and positive pressure ventilation with CPAP. Her blood pressure dropped drastically requiring a brief period of pressure support with levophed, which was quickly weaned off. It was thought that she could have had acute pulmonary edema. She continues to improve thereafter and was eventually transferred to regular floors for a few days. She is currently on aspirin, lipitor, plavix(minimal 3 months). SHe was also started on lisinopril and toprol. Echo was performed on [**2127-3-28**] with the concern of posterior wall aneurysm seen by ECG changes. That turned out to be negative. SHe was started on daily lasix for heart failure. SHe also had a short run of atrial fibrillation which spontanouesly converted on [**2127-3-29**]. Her blood pressure control is satisfactory with metoprolol, lisinopril and imdur. During this hospitalization, she also had retroperitoneal bleed. She was transfused to keep her hematocrit above 30. Her hematocrit remained stable thereafter. Vancomycin, levofloxacin and metronidazole was initially started for presumed aspiration penumonia given that she spiked temperature, had increased WBC and increasing sputum production. She continued the course of levofloxacin and metronidazole for 7 days. Vancomycin was discontinued since sputum culture did not grow any organism. SHe was also c.diff negative. Medications on Admission: Lisinopril 40mg daily Nifedical 60mg daily Metformin HCL 1000mg qam, 500mg qlunch, 1000mg qpm Lipitor 40mg daily Atenolol 25mg daily Protonix 40mg daily Aspirin 325mg daily Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 300 days. Disp:*30 Tablet(s)* Refills:*2* 3. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 5 days. Disp:*15 Tablet(s)* Refills:*0* 5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 2 days. Disp:*2 Tablet(s)* Refills:*0* 6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2* 8. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: acute coronary syndrome diabetes hypertension retroperitoneal bleed Discharge Condition: stable Discharge Instructions: PLease return to the hospital or call your doctor if you experience chest pain or shortness of breath or if there are any concerns at all Please take all prescribed medication Followup Instructions: please follow up with your cardiologist(Dr. [**Last Name (STitle) 1911**] within one month of your discharge Completed by:[**2127-4-1**]

414,997,410,427,785,428,507,E879,998,570,424,276,402,285,250

{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute myocardial infarction of other specified sites, initial episode of care,Ventricular fibrillation,Cardiogenic shock,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hemorrhage complicating a procedure,Acute and subacute necrosis of liver,Mitral valve disorders,Acidosis,Unspecified hypertensive heart disease with heart failure,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

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: chest pain PRESENT ILLNESS: 74yo F referred to [**Hospital1 18**] for chest tightness and dyspnea for the past month. It occurs both at rest and with exertion, related to stress. She reports associated dizziness. She has episodes [**3-28**] times per week. They last for a few minutes and resolve when she lies down and relaxes. MEDICAL HISTORY: Diabetes mellitus Hypertension C section hysterectomy mild LV systolic dysfunction at baseline MEDICATION ON ADMISSION: Lisinopril 40mg daily Nifedical 60mg daily Metformin HCL 1000mg qam, 500mg qlunch, 1000mg qpm Lipitor 40mg daily Atenolol 25mg daily Protonix 40mg daily Aspirin 325mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 93.6 P88-96 BP 114/70 IABP 1:1 vent: Fi)2 0.8 550 x 16, PEEP5 Gen-sedated HEENT-anicteric, mmm, JVD hard to visualizes CV-RRR, no r/m/g resp-CTAB(anterior exam) [**Last Name (un) 103**]-soft, NT/ND, mostly in bandage extremities-cold extremities, no pitting edema, pulses dopplerable bilaterally, left groin hematoma noted FAMILY HISTORY: noncontributory SOCIAL HISTORY: Married, lives with her husband in [**Location (un) 686**]. No stairs. Daughter lives on the [**Location (un) **] of her house. ### Response: {'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute myocardial infarction of other specified sites, initial episode of care,Ventricular fibrillation,Cardiogenic shock,Congestive heart failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hemorrhage complicating a procedure,Acute and subacute necrosis of liver,Mitral valve disorders,Acidosis,Unspecified hypertensive heart disease with heart failure,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: Arthralgias, failure to thrive PRESENT ILLNESS: 51 yo M with HCV cirrhosis, COPD, eosinophilic pneumonitis, eosinophilia, diffuse lymphadenopathy (? lymphoma), HTN, spinal stenosis (wheelchair bound), DVT on warfarin with acute on chronic shoulder pain and arthralgias. He reports that he has had worsening R shoulder pain over the last few months and it reached a point that he "couldn't take it anymore". He reports that it feels "like he has a rotator [**Last Name **] problem" but notes that he has pain, numbness, swelling in the joints of his upper extremities (wrists, fingers). He has not had any fevers, chills, cough, chest pain, nausea, vomiting, diarrhea. Per nursing home report, he c/o more severe shoulder pain, has been very "weepy", lethargic. MEDICAL HISTORY: spinal stenosis - wheelchair bound eosinophilic pneumonitis - diagnosed in summer [**2139**] at [**Hospital1 **] Hypereosinophilia Diffuse Lymphadenopathy, ? T-cell lymphoma COPD Lung nodules (2-3 mm) HCV hypertension chronic back pain MVA [**2103**] with subsequent shoulder pain, chronic back pain Arthritis Grand Mal seizures - described as "lightning in my shoulders", last seizure in [**2135**], says controlled on Keppra MEDICATION ON ADMISSION: Albuterol prn Advair 250-50 1 puff [**Hospital1 **] Spiriva 1 capsule daily Cyclobenzaprine 5- 10 mg [**Hospital1 **] Doxepin 10mg qhs hydromorphone 4mg q3 hours prn levetiracetam 500mg [**Hospital1 **] MS [**First Name (Titles) **] [**Last Name (Titles) **] 60mg [**Hospital1 **] Omeprazole 20 mg daily warfarin 3-3.5 mg daily ASA 81mg daily Colace 100mg [**Hospital1 **] ibuprofen 600mg q6 hours Senna bisacodyl mylanta milk of magnesia ALLERGIES: hydrochlorothiazide / Ribavirin PHYSICAL EXAM: Physical Exam on Admission: 98.3 115/81 79 18 95% 2L 90% RA Gen: quiet, interactive, uncomfortable Eyes: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus noted Ears/Nose/Mouth/Throat: dry mm, no lesions noted in OP Neck: supple, no JVD or carotid bruits appreciated Respiratory: Lungs CTA bilaterally without R/R/W Cardiovascular: Reg S1S2, no M/R/G noted Gastrointestinal: soft, tender in RUQ, LUQ Skin: large hyperpigmented area over sacral spine, macular, erythematous rash over back, ? petechial rash on LE bilaterally, Left heel skin breakdown Extremities: No C/C/E bilaterally. Tender to palpation over R lateral shoulder, fingers slightly swollen bilaterally, tender over R over wrist Neurologic: -mental status: Alert, oriented x 3. Able to relate history but somewhat tangential -cranial nerves: II-XII intact -motor: normal bulk, 1/5 strength in LE bilaterally (? limited by pain), 2/5 strength in UE Psychiatric: very depressed/flat mood FAMILY HISTORY: Brother - CAD s/p PCI Mother - DM2 Daughter- asthma SOCIAL HISTORY: Lives at [**Hospital **] Health Care Center. No other home to go to. Sister is HCP. [**Name (NI) 1139**] - current 1ppd x 43 yrs; quit for 2 months and restarted ETOH - previous use, but denies current use Illicits - Denies

Chronic hepatitis C with hepatic coma,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Unspecified septicemia,Severe sepsis,Other and unspecified coagulation defects,Acidosis,Candidiasis of mouth,Cirrhosis of liver without mention of alcohol,Adult failure to thrive,Spinal stenosis, unspecified region,Pain in joint, multiple sites,Pyogenic granuloma of skin and subcutaneous tissue,Other acute pain,Enlargement of lymph nodes,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants

Chrnc hpt C w hepat Coma,Ac kidny fail, tubr necr,Acute respiratry failure,Septicemia NOS,Severe sepsis,Coagulat defect NEC/NOS,Acidosis,Thrush,Cirrhosis of liver NOS,Failure to thrive-adult,Spinal stenosis NOS,Joint pain-mult jts,Pyogenic granuloma,Acute pain NEC,Enlargement lymph nodes,Epilep NOS w/o intr epil,Hypertension NOS,Depressive disorder NEC,Hx-ven thrombosis/embols,Long-term use anticoagul

Admission Date: [**2140-8-21**] Discharge Date: [**2140-8-26**] Date of Birth: [**2089-4-28**] Sex: M Service: MEDICINE Allergies: hydrochlorothiazide / Ribavirin Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: Arthralgias, failure to thrive Major Surgical or Invasive Procedure: Arterial line placement RIJ CVL placement HD catheter placement Patient Expired. History of Present Illness: 51 yo M with HCV cirrhosis, COPD, eosinophilic pneumonitis, eosinophilia, diffuse lymphadenopathy (? lymphoma), HTN, spinal stenosis (wheelchair bound), DVT on warfarin with acute on chronic shoulder pain and arthralgias. He reports that he has had worsening R shoulder pain over the last few months and it reached a point that he "couldn't take it anymore". He reports that it feels "like he has a rotator [**Last Name **] problem" but notes that he has pain, numbness, swelling in the joints of his upper extremities (wrists, fingers). He has not had any fevers, chills, cough, chest pain, nausea, vomiting, diarrhea. Per nursing home report, he c/o more severe shoulder pain, has been very "weepy", lethargic. In ED, triage vitals: 99.4 (rectal) 64 128/88 20 94% RA. Given vancomycin and levofloxacin for possible pneumonia. Also received IV hydromorphone (1.5mg total) for pain. Past Medical History: spinal stenosis - wheelchair bound eosinophilic pneumonitis - diagnosed in summer [**2139**] at [**Hospital1 **] Hypereosinophilia Diffuse Lymphadenopathy, ? T-cell lymphoma COPD Lung nodules (2-3 mm) HCV hypertension chronic back pain MVA [**2103**] with subsequent shoulder pain, chronic back pain Arthritis Grand Mal seizures - described as "lightning in my shoulders", last seizure in [**2135**], says controlled on Keppra Social History: Lives at [**Hospital **] Health Care Center. No other home to go to. Sister is HCP. [**Name (NI) 1139**] - current 1ppd x 43 yrs; quit for 2 months and restarted ETOH - previous use, but denies current use Illicits - Denies Family History: Brother - CAD s/p PCI Mother - DM2 Daughter- asthma Physical Exam: Physical Exam on Admission: 98.3 115/81 79 18 95% 2L 90% RA Gen: quiet, interactive, uncomfortable Eyes: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus noted Ears/Nose/Mouth/Throat: dry mm, no lesions noted in OP Neck: supple, no JVD or carotid bruits appreciated Respiratory: Lungs CTA bilaterally without R/R/W Cardiovascular: Reg S1S2, no M/R/G noted Gastrointestinal: soft, tender in RUQ, LUQ Skin: large hyperpigmented area over sacral spine, macular, erythematous rash over back, ? petechial rash on LE bilaterally, Left heel skin breakdown Extremities: No C/C/E bilaterally. Tender to palpation over R lateral shoulder, fingers slightly swollen bilaterally, tender over R over wrist Neurologic: -mental status: Alert, oriented x 3. Able to relate history but somewhat tangential -cranial nerves: II-XII intact -motor: normal bulk, 1/5 strength in LE bilaterally (? limited by pain), 2/5 strength in UE Psychiatric: very depressed/flat mood Patient Expired on Discharge. Pertinent Results: [**2140-8-20**] 11:35PM WBC-15.8* RBC-4.45* HGB-15.3 HCT-45.6 MCV-103* MCH-34.5* MCHC-33.6 RDW-16.0* [**2140-8-20**] 11:35PM NEUTS-24* BANDS-1 LYMPHS-20 MONOS-2 EOS-48* BASOS-5* ATYPS-0 METAS-0 MYELOS-0 [**2140-8-20**] 11:35PM PLT SMR-LOW PLT COUNT-135* [**2140-8-20**] 11:35PM PT-38.7* PTT-43.5* INR(PT)-3.9* [**2140-8-20**] 11:35PM GLUCOSE-86 UREA N-14 CREAT-0.6 SODIUM-140 POTASSIUM-4.0 CHLORIDE-107 TOTAL CO2-26 ANION GAP-11 [**2140-8-20**] 11:35PM ALT(SGPT)-183* AST(SGOT)-127* CK(CPK)-24* ALK PHOS-78 TOT BILI-0.6 [**2140-8-20**] 11:35PM ALBUMIN-3.1* CALCIUM-9.4 PHOSPHATE-3.6 MAGNESIUM-1.9 [**2140-8-20**] 11:35PM AMMONIA-65* [**2140-8-20**] 11:35PM LIPASE-18 CXR (personally reviewed): L atelectasis vs. infiltrate, interstitial opacities throughout [**6-1**] PET scan: New moderate left pleural effusion. 2. FDG avid lymphadenopathy of the neck, axilla, mediastinum, hila, porta hepatis, iliac and inguinal regions as described above. 3. Splenomegaly. EKG: SR@66, nml axis, no ischemic changes [**8-21**] Blood cultures: pending Labs on Discharge (Death): [**2140-8-25**] 08:34PM BLOOD WBC-23.7* RBC-3.08* Hgb-11.2* Hct-33.9* MCV-110* MCH-36.4* MCHC-33.1 RDW-16.5* Plt Ct-135* [**2140-8-25**] 03:00AM BLOOD Neuts-52 Bands-8* Lymphs-5* Monos-2 Eos-31* Baso-2 Atyps-0 Metas-0 Myelos-0 [**2140-8-25**] 03:00AM BLOOD Hypochr-NORMAL Anisocy-OCCASIONAL Poiklo-2+ Macrocy-1+ Microcy-NORMAL Polychr-1+ Burr-2+ [**2140-8-25**] 03:46PM BLOOD PT-32.1* PTT-54.3* INR(PT)-3.2* [**2140-8-25**] 10:21AM BLOOD PT-70.0* PTT-57.5* INR(PT)-7.9* [**2140-8-25**] 03:46PM BLOOD Fibrino-243 [**2140-8-25**] 03:46PM BLOOD ESR-21* [**2140-8-26**] 02:38AM BLOOD Glucose-44* UreaN-37* Creat-3.9* Na-138 K-5.3* Cl-100 HCO3-10* AnGap-33* [**2140-8-25**] 03:46PM BLOOD ALT-258* AST-335* LD(LDH)-930* CK(CPK)-334* AlkPhos-100 TotBili-5.1* DirBili-3.4* IndBili-1.7 [**2140-8-25**] 03:46PM BLOOD CK-MB-6 cTropnT-0.13* [**2140-8-26**] 02:38AM BLOOD Calcium-8.8 Phos-6.4* Mg-2.2 [**2140-8-25**] 03:46PM BLOOD D-Dimer-[**2100**]* [**2140-8-25**] 03:46PM BLOOD Ferritn-1358* [**2140-8-25**] 03:46PM BLOOD ANCA-PND [**2140-8-25**] 03:46PM BLOOD CRP-127.9* [**2140-8-24**] 07:38PM BLOOD IgG-1414 IgA-402* IgM-67 [**2140-8-25**] 03:46PM BLOOD C3-82* C4-26 [**2140-8-24**] 08:44PM BLOOD Vanco-15.7 [**2140-8-26**] 02:48AM BLOOD Type-ART pO2-110* pCO2-32* pH-7.16* calTCO2-12* Base XS--16 [**2140-8-25**] 11:41PM BLOOD Type-ART pO2-113* pCO2-33* pH-7.24* calTCO2-15* Base XS--12 [**2140-8-25**] 08:52PM BLOOD Type-ART Temp-38.3 Tidal V-550 FiO2-50 pO2-68* pCO2-34* pH-7.23* calTCO2-15* Base XS--12 Intubat-INTUBATED [**2140-8-26**] 02:48AM BLOOD Lactate-11.8* [**2140-8-25**] 08:52PM BLOOD Lactate-9.5* [**2140-8-25**] 06:55PM BLOOD Lactate-9.7* [**2140-8-25**] 08:52PM BLOOD O2 Sat-92 [**2140-8-25**] 06:55PM BLOOD O2 Sat-94 [**2140-8-26**] 02:48AM BLOOD freeCa-0.94* [**2140-8-25**] 11:41PM BLOOD freeCa-1.18 [**2140-8-24**] 07:38PM BLOOD STRONGYLOIDES ANTIBODY,IGG-PND Brief Hospital Course: Primary Reason for Hospitalization: 51M with multiple medical problems including COPD, spinal stenosis leading him to be wheelchair bound, eosinophilic pneumonitis, HCV, and diffuse lymphadenopathy and hypereosinophilia leading to concern for T cell lymphoma who p/w progressive arthralgias and [**Hospital **] transfered to the ICU for multisystem organ failure. Active Diagnoses: #) Hypotension: Unclear etiology, but was worked up for infectious etiologies with negative blood & urine cultures. CT scan w/ pulmonary nodules and effusion, but no clear infiltrate. Has no significant cardiac history to suggest cardiogenic shock or ischemia. Adrenal insufficiency was possible, especially in the setting of severe stress from underlying proces whether rheumatologic or oncologic, but AM cortisol normal. Blood cultures were pending, and he was empirically covered w/ vancomycin and cefepime. He was provided with fluid boluses as was volume responsive and on the morning of his death was 5.5 L positive compared to the day prior. At the time of his death, he was supported by 4 pressors and still hypotensive to the 80s/40s. When pressors were ultimately withdrawn based on family decision to withdraw care, his blood pressure eventually fell to 60s/30s shortly before death. #) Fevers: As high as 104 degrees w/ associated rigors since a day prior to ICU transfer. CT torso without clear infectious source except for pleural effusion. On transfer, WBC high at 21.7 with 11% bands, eventually trending up to 36. He was put on vancomycin and cefepime. Not currently covering for [**Hospital 89877**] or anaerobes. Given abdominal distention, there was a question of SBP, but no clear ascites. Patient was also sent for blood cultures, lyme serologies, urine legionella. Per ID, ordered mycolytic blood cx, repeat strongyloides, and put on Meropenem q8h. He was given tylenol (2g max daily), ibuprofen and motrin PRN and cooling blanket to bring his temperature down. A source of infection/inflammation was not identified prior to his death. #) Hypoxia: New over the past two days. Unclear what precipitated the hypoxia; no clear infiltrate on CT, pleural effusion is not so impressive to account for sats on 5L. Given question of immunosuppression wth possible underlying process PCP, [**Name10 (NameIs) 89878**], [**Name11 (NameIs) 89877**], [**First Name3 (LF) **] be in differential as well. Also has hx of COPD, eosinophilic pneumonia. He underwent a BAL that showed polys and no growth. Has h/o DVT, coumadin has been held given coagulopathy, but LENIs were negative for DVT. He was eventually intubated with PSV, as he was not able to tolerate A/C. Eventually, he was started on a paralytic to reduce autoPEEP to gain better control of his acid/base status. #) Severe eosinophilia: Trending down but still abnormally high and a chronic process. Differential has included Sezary syndrome, T cell lymphoma/leukemia, vasculitis, IgE eosinophilia. Derm consult was obtained and differential included perivascular granulomas, histiocytes/eos around blood vessels,? churg [**Doctor Last Name **] (want us to consult rheum, they will come by tomorrow), pseudo lymphoma [**2-17**] keppra (ask neuro if substitute for keppra). Per ID recommendations, blood cultures were sent for mycolytic blood cx, repeat strongyloides. A cause of his eosinophilia was not identified prior to his death. #) Metabolic Acidosis: On the night of ICU night 2, he developed worsening metabolic acidosis, non-gap to pH 7.2 and was given D5W, and abx was changed from cefepime to meropenem to provide greater coverage of any infectious causes. the next day, his pH 7.11, bicarb 10, lactate increased to 11. He was started on a paralytic in an effort to reduce autoPEEP. He was given bicarb, which mom[**Name (NI) 11711**] increased his pH, which would then trend down again. At the time of his death, after numerous amps of bicarb, pH remained in the 7.1 range with lactate in the 10s. #) Coagulopathy: INR continues to trend up despite holding coumadin. Given low albumin as well, likely underlying synthetic problems secondary to liver dysfunction. Underlying cause may be related to malignancy, eosinophilic process, or rheumatologic disease infiltrating liver. HCV less likely. He began oozing from his CVL site, INR was 3.7. Bleeding was controlled with surgicel and 5mg PO VitK. Patient was planned for a mixing study for inhibitor and considered for vitamin K to address nutritional component if the coagulopathy progresses. His coagulopathy was noted to have worsened when he clotted off his CRRT filter, yet persisted to ooze from line sites. #) Acute kidney injury: Progressive with rising creatinine from baseline of 0.6 on admission. Likely hypovolemic and ATN components. UA, renally dose medications, including antibiotics. He was started on CRRT, but quickly clotted off his filter, indicating worsening coagulopathy. #) Arthralgias: No marked synovitis and imaging has been relatively unremarkable. CK was not elevated on admission. Likely due to cytokine storm and inflammatory mileau. ESR flat, CRP not significantly elevated. #) Toxic/Metabolic encephalopathy: Oriented x2. Mentating well consider level of hypotension. Disorientation likely related to combination of fever, infectious process and troublesome meds. Lactulose [**Hospital1 **] unless having [**1-17**] BM per day. His home opiates as this could worsen encephalopathy. #) LLE DVT: Consider LENIs to see if DVT still present and warranting anticoagulation. INR was trended, and warfarin was held. #) HCV with transaminitis/cirrhosis: HCV viral load moderate and unlikely to be primary motivator of ongoing eosinophilia (though could be driving transaminitis). CT abdomen. CT abdomen shows mediastinal, axillary, pelvic, and inguinal lymphadenopathy, all unchanged. New left lung pleural effusion. Right lung base atelectasis. Pulmonary nodules, unchanged from prior examination. #) Spinal stenosis: Reports lower extremity weakness stable. Pain was controlled with home opiates. #) Depression: Very flattened affect currently though unclear if encephalopathy vs depression. Social work was consulted. #) Seizure disorder: He was initially continued on levetiracetam, but this was discontinued out of concern for keppra being the underlying cause of his dermatologic disorder. Medications on Admission: Albuterol prn Advair 250-50 1 puff [**Hospital1 **] Spiriva 1 capsule daily Cyclobenzaprine 5- 10 mg [**Hospital1 **] Doxepin 10mg qhs hydromorphone 4mg q3 hours prn levetiracetam 500mg [**Hospital1 **] MS [**First Name (Titles) **] [**Last Name (Titles) **] 60mg [**Hospital1 **] Omeprazole 20 mg daily warfarin 3-3.5 mg daily ASA 81mg daily Colace 100mg [**Hospital1 **] ibuprofen 600mg q6 hours Senna bisacodyl mylanta milk of magnesia Discharge Medications: Patient expired. Discharge Disposition: Expired Discharge Diagnosis: Patient Expired. Discharge Condition: Patient Expired. Discharge Instructions: Patient Expired. Followup Instructions: Patient Expired. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] Completed by:[**2140-8-29**]

070,584,518,038,995,286,276,112,571,783,724,719,686,338,785,345,401,311,V125,V586

{'Chronic hepatitis C with hepatic coma,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Unspecified septicemia,Severe sepsis,Other and unspecified coagulation defects,Acidosis,Candidiasis of mouth,Cirrhosis of liver without mention of alcohol,Adult failure to thrive,Spinal stenosis, unspecified region,Pain in joint, multiple sites,Pyogenic granuloma of skin and subcutaneous tissue,Other acute pain,Enlargement of lymph nodes,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}

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: Arthralgias, failure to thrive PRESENT ILLNESS: 51 yo M with HCV cirrhosis, COPD, eosinophilic pneumonitis, eosinophilia, diffuse lymphadenopathy (? lymphoma), HTN, spinal stenosis (wheelchair bound), DVT on warfarin with acute on chronic shoulder pain and arthralgias. He reports that he has had worsening R shoulder pain over the last few months and it reached a point that he "couldn't take it anymore". He reports that it feels "like he has a rotator [**Last Name **] problem" but notes that he has pain, numbness, swelling in the joints of his upper extremities (wrists, fingers). He has not had any fevers, chills, cough, chest pain, nausea, vomiting, diarrhea. Per nursing home report, he c/o more severe shoulder pain, has been very "weepy", lethargic. MEDICAL HISTORY: spinal stenosis - wheelchair bound eosinophilic pneumonitis - diagnosed in summer [**2139**] at [**Hospital1 **] Hypereosinophilia Diffuse Lymphadenopathy, ? T-cell lymphoma COPD Lung nodules (2-3 mm) HCV hypertension chronic back pain MVA [**2103**] with subsequent shoulder pain, chronic back pain Arthritis Grand Mal seizures - described as "lightning in my shoulders", last seizure in [**2135**], says controlled on Keppra MEDICATION ON ADMISSION: Albuterol prn Advair 250-50 1 puff [**Hospital1 **] Spiriva 1 capsule daily Cyclobenzaprine 5- 10 mg [**Hospital1 **] Doxepin 10mg qhs hydromorphone 4mg q3 hours prn levetiracetam 500mg [**Hospital1 **] MS [**First Name (Titles) **] [**Last Name (Titles) **] 60mg [**Hospital1 **] Omeprazole 20 mg daily warfarin 3-3.5 mg daily ASA 81mg daily Colace 100mg [**Hospital1 **] ibuprofen 600mg q6 hours Senna bisacodyl mylanta milk of magnesia ALLERGIES: hydrochlorothiazide / Ribavirin PHYSICAL EXAM: Physical Exam on Admission: 98.3 115/81 79 18 95% 2L 90% RA Gen: quiet, interactive, uncomfortable Eyes: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus noted Ears/Nose/Mouth/Throat: dry mm, no lesions noted in OP Neck: supple, no JVD or carotid bruits appreciated Respiratory: Lungs CTA bilaterally without R/R/W Cardiovascular: Reg S1S2, no M/R/G noted Gastrointestinal: soft, tender in RUQ, LUQ Skin: large hyperpigmented area over sacral spine, macular, erythematous rash over back, ? petechial rash on LE bilaterally, Left heel skin breakdown Extremities: No C/C/E bilaterally. Tender to palpation over R lateral shoulder, fingers slightly swollen bilaterally, tender over R over wrist Neurologic: -mental status: Alert, oriented x 3. Able to relate history but somewhat tangential -cranial nerves: II-XII intact -motor: normal bulk, 1/5 strength in LE bilaterally (? limited by pain), 2/5 strength in UE Psychiatric: very depressed/flat mood FAMILY HISTORY: Brother - CAD s/p PCI Mother - DM2 Daughter- asthma SOCIAL HISTORY: Lives at [**Hospital **] Health Care Center. No other home to go to. Sister is HCP. [**Name (NI) 1139**] - current 1ppd x 43 yrs; quit for 2 months and restarted ETOH - previous use, but denies current use Illicits - Denies ### Response: {'Chronic hepatitis C with hepatic coma,Acute kidney failure with lesion of tubular necrosis,Acute respiratory failure,Unspecified septicemia,Severe sepsis,Other and unspecified coagulation defects,Acidosis,Candidiasis of mouth,Cirrhosis of liver without mention of alcohol,Adult failure to thrive,Spinal stenosis, unspecified region,Pain in joint, multiple sites,Pyogenic granuloma of skin and subcutaneous tissue,Other acute pain,Enlargement of lymph nodes,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}

CHIEF COMPLAINT: fevers and shakes PRESENT ILLNESS: Mr. [**Known lastname **] is a 71 yo male with a h/o CAD, afib on coumadin, and pulmonary vasculitis who presented to [**Hospital3 **] on [**7-15**] with fever to 103.6, complaining of shakes. Patient states that he was previously feeling well and had taken care of his grandkids and went swimming earlier in the day. On the night of presentation, he developed chills, rigors x 1 hour, and a fever to 103.6. On arrival to the ED at [**Hospital1 **], a CXR was interpreted to show a RLL infiltrate, and he was started empirically on levofloxacin. Patient was witnessed to rigor again and become very hypoxic and cyanotic with SpO2 in 50's, improved with 100% NRB. ABG at that time 7.34/39/100. He was transferred to the ICU at [**Hospital1 **] for closer monitoring, and antibiotic coverage was broadened to Vanc and Zosyn. On the morning of [**7-16**], a d-dimer returned at 472.5; a CTA chest was performed and was reported as negative for PE. He was noted to have elevated troponins and thus was transferred to the CCU at [**Hospital1 18**]. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. As above, ROS is notable for recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . MEDICAL HISTORY: 1. pANCA/MPO positive vasculitis - diagnosed during admission for hemoptysis from [**Date range (3) 103195**]. Started on prednisone in [**7-/2187**], now on 7.5 mg qd. Cytoxan [**9-/2187**]/23/[**2187**]. Started on Imuran [**2188-5-12**]. 2. CAD s/p CABG in [**2163**], s/p PCI in [**2176**] and [**2180**], s/p repeat CABG in [**11/2184**] with LIMA to LAD, SVG to OM, and SVG to PDA. 3. Atrial Fibrillation on coumadin 4. Seizure disorder [**7-/2187**] 5. Hypertension 6. Hyperlipidemia 7. Restless leg syndrome 8. s/p bilateral hernia repair 9. GERD 10. Sleep apnea 11. Chronic anxiety 12. Rt knee arthritis 13. s/p Cholecystectomy in [**3-/2188**] 14. H/o Hepatitis B in [**2159**]'s MEDICATION ON ADMISSION: - azathioprine 50 mg daily - prednisone 7.5 mg daily - pantoprazole 40 mg daily - TMP/SMX 400/80 mg daily - calcium citrate 1000 mg [**Hospital1 **] - vitamin D3 400 units [**Hospital1 **] - aledronate 70 mg every week - levetiracetam 1000 mg [**Hospital1 **] - tamsulosin 0.4 mg qHS - aspirin 325 mg daily - Mirapex 0.25 mg 1-3x daily PRN - Lorazepam 1 mg TID PRN - Folic acid 5 mg daily - Warfarin 4-6 mg daily as directed - metoprolol 12.5 mg [**Hospital1 **] ALLERGIES: Zosyn PHYSICAL EXAM: VS: T 96.8, BP 103/67, HR 55, RR 12, O2 99% on RA Gen: elderly male in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple without JVD. CV: Irregularly, irregular rhythm. PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2, with third heart sound. LV impulse is hyperdynamic. [**12-26**] harsh blowing murmur best heard at the apex. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: 1+ lower extremity edema to mid-tibia bilaterally. No femoral bruits. Skin: Non-blanching petechiae over ankles to mid-tibia. No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: Father had DM and CAD, 1st MI age 51 and later died of MI at age 62. Brother with CAD. SOCIAL HISTORY: Widowed, has 4 sons. Lives with one son in [**Name (NI) 1268**], retired from electrical engineering but works one day a week at golf course during spring/summer season. Very active at baseline and golfs frequently. No prior tobacco history. Rare ETOH in the past, and none now. No illicits/IVDU. Was out vacationing in [**Hospital3 **] three weeks ago. No pets.

Polyarteritis nodosa,Coronary atherosclerosis of autologous vein bypass graft,Other specified diseases of pulmonary circulation,Anemia, unspecified,Leukocytopenia, unspecified,Thrombocytopenia, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Diarrhea,Epilepsy, unspecified, without mention of intractable epilepsy,Restless legs syndrome (RLS),Hypoxemia,Internal hemorrhoids without mention of complication,Epistaxis,Unspecified sleep apnea,Dysthymic disorder

Polyarteritis nodosa,Crn ath atlg vn bps grft,Pulmon circulat dis NEC,Anemia NOS,Leukocytopenia NOS,Thrombocytopenia NOS,Adv eff antineoplastic,Adv eff anticoagulants,Atrial fibrillation,Diarrhea,Epilep NOS w/o intr epil,Restless legs syndrome,Hypoxemia,Int hemorrhoid w/o compl,Epistaxis,Sleep apnea NOS,Dysthymic disorder

Admission Date: [**2188-7-16**] Discharge Date: [**2188-7-23**] Date of Birth: [**2116-11-8**] Sex: M Service: MEDICINE Allergies: Zosyn Attending:[**First Name3 (LF) 800**] Chief Complaint: fevers and shakes Major Surgical or Invasive Procedure: Bronchoscopy History of Present Illness: Mr. [**Known lastname **] is a 71 yo male with a h/o CAD, afib on coumadin, and pulmonary vasculitis who presented to [**Hospital3 **] on [**7-15**] with fever to 103.6, complaining of shakes. Patient states that he was previously feeling well and had taken care of his grandkids and went swimming earlier in the day. On the night of presentation, he developed chills, rigors x 1 hour, and a fever to 103.6. On arrival to the ED at [**Hospital1 **], a CXR was interpreted to show a RLL infiltrate, and he was started empirically on levofloxacin. Patient was witnessed to rigor again and become very hypoxic and cyanotic with SpO2 in 50's, improved with 100% NRB. ABG at that time 7.34/39/100. He was transferred to the ICU at [**Hospital1 **] for closer monitoring, and antibiotic coverage was broadened to Vanc and Zosyn. On the morning of [**7-16**], a d-dimer returned at 472.5; a CTA chest was performed and was reported as negative for PE. He was noted to have elevated troponins and thus was transferred to the CCU at [**Hospital1 18**]. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. As above, ROS is notable for recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . Past Medical History: 1. pANCA/MPO positive vasculitis - diagnosed during admission for hemoptysis from [**Date range (3) 103195**]. Started on prednisone in [**7-/2187**], now on 7.5 mg qd. Cytoxan [**9-/2187**]/23/[**2187**]. Started on Imuran [**2188-5-12**]. 2. CAD s/p CABG in [**2163**], s/p PCI in [**2176**] and [**2180**], s/p repeat CABG in [**11/2184**] with LIMA to LAD, SVG to OM, and SVG to PDA. 3. Atrial Fibrillation on coumadin 4. Seizure disorder [**7-/2187**] 5. Hypertension 6. Hyperlipidemia 7. Restless leg syndrome 8. s/p bilateral hernia repair 9. GERD 10. Sleep apnea 11. Chronic anxiety 12. Rt knee arthritis 13. s/p Cholecystectomy in [**3-/2188**] 14. H/o Hepatitis B in [**2159**]'s Cardiac History: CABG, in [**2165**] and re-do in [**2184**], anatomy as follows: CABG [**2165**] - SVG->LAD+D1 with subsequent ostial stent 4X8 Bx Velodity in [**2176**] and also LAD stent in [**2180**]; other grafts SVG->OM and SVG->RPDA occluded; most recently SVG->LAD/D1 with slow flow Redo CABG in [**2184**]: LIMA->LAD, SVG->OM and SVG->PDA Social History: Widowed, has 4 sons. Lives with one son in [**Name (NI) 1268**], retired from electrical engineering but works one day a week at golf course during spring/summer season. Very active at baseline and golfs frequently. No prior tobacco history. Rare ETOH in the past, and none now. No illicits/IVDU. Was out vacationing in [**Hospital3 **] three weeks ago. No pets. Family History: Father had DM and CAD, 1st MI age 51 and later died of MI at age 62. Brother with CAD. Physical Exam: VS: T 96.8, BP 103/67, HR 55, RR 12, O2 99% on RA Gen: elderly male in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple without JVD. CV: Irregularly, irregular rhythm. PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2, with third heart sound. LV impulse is hyperdynamic. [**12-26**] harsh blowing murmur best heard at the apex. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: 1+ lower extremity edema to mid-tibia bilaterally. No femoral bruits. Skin: Non-blanching petechiae over ankles to mid-tibia. No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP Brief Hospital Course: # Microscopic polyangiitis: Pt with BAL positive for blood and macrophages consistent with flare of his pulmonary vasculitis. Rheumatology consulted. Pt was given 1g solumedrol per day for three days and then planned for steroid taper. Azathioprine was held. Pt did extremely well on this regimen and was transfered off of the MICU service for further management and steroid taper. Pt was restarted on cyclophosphamide per rheumatology recs. It is worth noting that the Pt has some blood and protein in his urine with R CVA tenderness for the past few weeks, the same timeframe in which this flare occured. This raises the concern for renal involvement by his disease, but there is no clear evidence for renal vasculitis at this time. Pt was discharged on cyclophosphamide and prednisone. Pt will follow up with Dr. [**Last Name (STitle) 2087**] at [**Hospital1 2025**], Rheumatology at [**Hospital1 18**], and Pulmonology at [**Hospital1 18**]. He will be monitored with weekly CBCs and UAs. . # Pancytopenia: leukopenia and anemia seemingly a sequelae of azathioprine use. Given the pancytopenia and the polyangiitis flare while on this drug, azathioprine was held. Pancytopenia resolved and pt was restarted on cyclophosphamide per rheumatology. . # Fevers: An extensive fever work up was undertaken before the etiology of his symptoms and signs were clear. As of transfer off of the MICU service all cultures, serologies, and test were negative. Fever likely secondary to alveolar hemorrhage. Fever resolved and did not return during hospitalization. . # A-fib: Stable; Pt was continued on home meds for rate control. Coumadin was held in setting of alveolar hemorrhage. Will be restarted in one week under the supervision of his PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 4469**]. Medications on Admission: - azathioprine 50 mg daily - prednisone 7.5 mg daily - pantoprazole 40 mg daily - TMP/SMX 400/80 mg daily - calcium citrate 1000 mg [**Hospital1 **] - vitamin D3 400 units [**Hospital1 **] - aledronate 70 mg every week - levetiracetam 1000 mg [**Hospital1 **] - tamsulosin 0.4 mg qHS - aspirin 325 mg daily - Mirapex 0.25 mg 1-3x daily PRN - Lorazepam 1 mg TID PRN - Folic acid 5 mg daily - Warfarin 4-6 mg daily as directed - metoprolol 12.5 mg [**Hospital1 **] Discharge Medications: 1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 2. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). Disp:*21 Tablet(s)* Refills:*0* 3. Cyclophosphamide 25 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily): Please take with at least 500 mL of water. Disp:*21 Tablet(s)* Refills:*0* 4. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Calcium Citrate 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. Alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week. 8. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 9. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Pramipexole 0.25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed. 12. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO three times a day as needed for anxiety. 13. Folic Acid 1 mg Tablet Sig: Five (5) Tablet PO DAILY (Daily). 14. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 16. Outpatient Lab Work CBC, Urinalysis Please send results to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and Dr [**Last Name (STitle) 4469**] at [**Telephone/Fax (1) 4475**] Discharge Disposition: Home Discharge Diagnosis: Microscopic polyangitis Alveolar hemorrhage Anemia Leukopenia Thrombocytopenia Discharge Condition: Good. Hemodynamically stable and afebrile. No signs of active bleeding. Discharge Instructions: You were transferred to the [**Hospital1 18**] from an outside hospital after having fevers, shaking chills and a low oxygen level. You were found to have a condition known as alveolar hemorrhage which means you had bleeding into your lungs because of your known history of microscopic polyangitis. Prior to admission, you had a change in your medications from cyclophoshpamide to azathioprine. It was felt that your current relapse was because of this medication change and we would recommend that you continue treatment with cyclophosphamide. We also stopped your coumadin because of the active bleeding. You should follow up with Dr. [**Last Name (STitle) 4469**] within 2 weeks to discuss restarting this medication. The following changes were made to your medications: 1) Stopped coumadin - discuss with Dr. [**Last Name (STitle) 4469**] when to restart this medication 2) Stopped azathioprine 3) Started cyclophosphamide at 75 mg daily 4) Increased prednisone from 7.5 mg to 60 mg daily Please return to the emergency department if you develop shortness of breath, bleeding from any site, cough with or without blood, fevers, chills or night sweats, diarrhea, abdominal pain, chest pain or any other symptoms that are concerning to you. Followup Instructions: Please follow up with Dr [**Last Name (STitle) 4469**] within 1 week to discuss when to restart coumadin. Call [**Telephone/Fax (1) 4475**] for an appointment. . Please follow up with Dr. [**Last Name (STitle) 2087**] at [**Hospital1 2025**] within 1 week to discuss treatment for your vasculitis. You were started on high dose steroids and cyclophosphamide and need to be monitored closely while on this therapy. Please discuss with Dr. [**Last Name (STitle) 2087**] when to taper steroids. . Please follow up with Dr. [**First Name (STitle) **] [**Name (STitle) 103196**] from Rheumatology. You have an appointment scheduled for Friday [**8-1**] at noon in the [**Hospital1 18**] [**Hospital Ward Name 517**] [**Hospital Unit Name **]. . Please follow up with Dr. [**Last Name (STitle) **] from Pulmonology. You have an appointment scheduled for [**8-6**] at 2pm on [**Hospital1 18**] [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] builiding. . You will need weekly blood and urine tests for monitoring while you are receving cyclophosphamide. A prescription has been given to you for these tests and results will be sent to Dr. [**First Name (STitle) **] [**Name (STitle) 103196**] and Dr. [**Last Name (STitle) 4469**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**]

446,414,417,285,288,287,E933,E934,427,787,345,333,799,455,784,780,300

{'Polyarteritis nodosa,Coronary atherosclerosis of autologous vein bypass graft,Other specified diseases of pulmonary circulation,Anemia, unspecified,Leukocytopenia, unspecified,Thrombocytopenia, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Diarrhea,Epilepsy, unspecified, without mention of intractable epilepsy,Restless legs syndrome (RLS),Hypoxemia,Internal hemorrhoids without mention of complication,Epistaxis,Unspecified sleep apnea,Dysthymic disorder'}

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: fevers and shakes PRESENT ILLNESS: Mr. [**Known lastname **] is a 71 yo male with a h/o CAD, afib on coumadin, and pulmonary vasculitis who presented to [**Hospital3 **] on [**7-15**] with fever to 103.6, complaining of shakes. Patient states that he was previously feeling well and had taken care of his grandkids and went swimming earlier in the day. On the night of presentation, he developed chills, rigors x 1 hour, and a fever to 103.6. On arrival to the ED at [**Hospital1 **], a CXR was interpreted to show a RLL infiltrate, and he was started empirically on levofloxacin. Patient was witnessed to rigor again and become very hypoxic and cyanotic with SpO2 in 50's, improved with 100% NRB. ABG at that time 7.34/39/100. He was transferred to the ICU at [**Hospital1 **] for closer monitoring, and antibiotic coverage was broadened to Vanc and Zosyn. On the morning of [**7-16**], a d-dimer returned at 472.5; a CTA chest was performed and was reported as negative for PE. He was noted to have elevated troponins and thus was transferred to the CCU at [**Hospital1 18**]. . On review of symptoms, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. As above, ROS is notable for recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . MEDICAL HISTORY: 1. pANCA/MPO positive vasculitis - diagnosed during admission for hemoptysis from [**Date range (3) 103195**]. Started on prednisone in [**7-/2187**], now on 7.5 mg qd. Cytoxan [**9-/2187**]/23/[**2187**]. Started on Imuran [**2188-5-12**]. 2. CAD s/p CABG in [**2163**], s/p PCI in [**2176**] and [**2180**], s/p repeat CABG in [**11/2184**] with LIMA to LAD, SVG to OM, and SVG to PDA. 3. Atrial Fibrillation on coumadin 4. Seizure disorder [**7-/2187**] 5. Hypertension 6. Hyperlipidemia 7. Restless leg syndrome 8. s/p bilateral hernia repair 9. GERD 10. Sleep apnea 11. Chronic anxiety 12. Rt knee arthritis 13. s/p Cholecystectomy in [**3-/2188**] 14. H/o Hepatitis B in [**2159**]'s MEDICATION ON ADMISSION: - azathioprine 50 mg daily - prednisone 7.5 mg daily - pantoprazole 40 mg daily - TMP/SMX 400/80 mg daily - calcium citrate 1000 mg [**Hospital1 **] - vitamin D3 400 units [**Hospital1 **] - aledronate 70 mg every week - levetiracetam 1000 mg [**Hospital1 **] - tamsulosin 0.4 mg qHS - aspirin 325 mg daily - Mirapex 0.25 mg 1-3x daily PRN - Lorazepam 1 mg TID PRN - Folic acid 5 mg daily - Warfarin 4-6 mg daily as directed - metoprolol 12.5 mg [**Hospital1 **] ALLERGIES: Zosyn PHYSICAL EXAM: VS: T 96.8, BP 103/67, HR 55, RR 12, O2 99% on RA Gen: elderly male in NAD, resp or otherwise. Oriented x3. Mood, affect appropriate. Pleasant. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. Neck: Supple without JVD. CV: Irregularly, irregular rhythm. PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2, with third heart sound. LV impulse is hyperdynamic. [**12-26**] harsh blowing murmur best heard at the apex. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheeze, rhonchi. Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial bruits. Ext: 1+ lower extremity edema to mid-tibia bilaterally. No femoral bruits. Skin: Non-blanching petechiae over ankles to mid-tibia. No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP FAMILY HISTORY: Father had DM and CAD, 1st MI age 51 and later died of MI at age 62. Brother with CAD. SOCIAL HISTORY: Widowed, has 4 sons. Lives with one son in [**Name (NI) 1268**], retired from electrical engineering but works one day a week at golf course during spring/summer season. Very active at baseline and golfs frequently. No prior tobacco history. Rare ETOH in the past, and none now. No illicits/IVDU. Was out vacationing in [**Hospital3 **] three weeks ago. No pets. ### Response: {'Polyarteritis nodosa,Coronary atherosclerosis of autologous vein bypass graft,Other specified diseases of pulmonary circulation,Anemia, unspecified,Leukocytopenia, unspecified,Thrombocytopenia, unspecified,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Diarrhea,Epilepsy, unspecified, without mention of intractable epilepsy,Restless legs syndrome (RLS),Hypoxemia,Internal hemorrhoids without mention of complication,Epistaxis,Unspecified sleep apnea,Dysthymic disorder'}

CHIEF COMPLAINT: Transfer from OSH for bleeding s/p liver bx of suspected HCC. PRESENT ILLNESS: 69 yo M with alcoholic cirrhosis transferred from OSH s/p liver biopsy on [**8-27**] c/b bleeding and hypotension. On [**8-27**] Pt became hypotensive to the 50s (SBP) during a CT-guided liver bx of a R liver lobe lesion discovered earlier on CT. Bx was completed and tract was embolized with Gelfoam pledgets. f/u CT scan revealed blood adjacent to liver and in pericolic gutter. Repeat angiogram was done by IR without intervention. Pt received a total of 3 u. pRBCs and 2 platelets with appropriate HCT correction from 24 to 30 and improvement in vital signs. Patient was transfered to ICU at [**Hospital6 **] and received 3 additional u. of pRBCs and 3 of platelets. Pt developed intermittent encephalopathy and was treated with rifaximin and continued tx with lactulose. Pt was started on doxycycline for SBP prophylaxis - he remained afebrile throughout. Nadalol was held [**12-24**] hypotension. Creatinine increased from ~1.5 baseline to 4.1 and on discharge with decreased UOP (15/20mL/hr). O2 requirements increased over course of stay likely [**12-24**] fluid overload and ARF - at time of discharge, Pt was on 4 L O2 NC (sat 95%). Pt's tolerated regular diabetic diet with daily BMs at mount hospital. MEDICAL HISTORY: EtOH cirrhosis, diabetes, HTN, pulmonary HTN, chronic gastropathy, Hx of esophageal varices, lower back pain. MEDICATION ON ADMISSION: - Humalong SS - Lantus 46 u. QHS - Prilosec OTC QD - spironolactone PO BID - Lactulose 10 g PO BID - Nadolol 40 mg PO QD - Lasix 40 mg PO QAM and 20 mg PO QPM - Simvastatin 10 mg PO QHS ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission: T: 98.2 P: 75 BP: 104/51 RR: 19 O2sat: 95% on 4L NC Afebrile for >48 hours General: awake, alert, NAD, on 4L NC HEENT: NCAT, EOMI, no scleral icterus, R central line in place Heart: RRR, NMRG Lungs: right lung base decreased breath sounds, L base inspirtatory crackles, normal excursion, no respiratory distress Back: no CVAT Abdomen: nonfocal diffuse tenderness, mild-moderate abdominal distention with tympany, no rebound/guarding. postitive bowel sounds. No splenomegaly Neuro: strength intact/symmetric, sensation intact/symmetric Extremities: WWP, no edema, no tenderness Pyschiatric: normal judgment/insight, normal memory, normal mood/affect FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: H/o alcohol abuse. Abstinent for 20 years. Denies smoking.

Malignant neoplasm of liver, secondary,Acute pancreatitis,Acute and subacute necrosis of liver,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Malignant neoplasm of liver, primary,Acute kidney failure, unspecified,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Mixed acid-base balance disorder,Urinary tract infection, site not specified,Other malignant neoplasm without specification of site,Atrial fibrillation,Other chronic pulmonary heart diseases,Other specified disorders of stomach and duodenum,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Other specified disorders resulting from impaired renal function,Barrett's esophagus,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Do not resuscitate status,Lumbago

Second malig neo liver,Acute pancreatitis,Acute necrosis of liver,Mal neo lymph intra-abd,Mal neo liver, primary,Acute kidney failure NOS,Portal hypertension,Esoph varice oth dis NOS,Mixed acid-base bal dis,Urin tract infection NOS,Malignant neoplasm NOS,Atrial fibrillation,Chr pulmon heart dis NEC,Gastroduodenal dis NEC,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Alcohol cirrhosis liver,Alcoh dep NEC/NOS-remiss,Impair ren funct dis NEC,Barrett's esophagus,Enterococcus group d,Do not resusctate status,Lumbago

Admission Date: [**2111-8-30**] Discharge Date: [**2111-9-7**] Date of Birth: [**2041-12-3**] Sex: M Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 5569**] Chief Complaint: Transfer from OSH for bleeding s/p liver bx of suspected HCC. Major Surgical or Invasive Procedure: None. History of Present Illness: 69 yo M with alcoholic cirrhosis transferred from OSH s/p liver biopsy on [**8-27**] c/b bleeding and hypotension. On [**8-27**] Pt became hypotensive to the 50s (SBP) during a CT-guided liver bx of a R liver lobe lesion discovered earlier on CT. Bx was completed and tract was embolized with Gelfoam pledgets. f/u CT scan revealed blood adjacent to liver and in pericolic gutter. Repeat angiogram was done by IR without intervention. Pt received a total of 3 u. pRBCs and 2 platelets with appropriate HCT correction from 24 to 30 and improvement in vital signs. Patient was transfered to ICU at [**Hospital6 **] and received 3 additional u. of pRBCs and 3 of platelets. Pt developed intermittent encephalopathy and was treated with rifaximin and continued tx with lactulose. Pt was started on doxycycline for SBP prophylaxis - he remained afebrile throughout. Nadalol was held [**12-24**] hypotension. Creatinine increased from ~1.5 baseline to 4.1 and on discharge with decreased UOP (15/20mL/hr). O2 requirements increased over course of stay likely [**12-24**] fluid overload and ARF - at time of discharge, Pt was on 4 L O2 NC (sat 95%). Pt's tolerated regular diabetic diet with daily BMs at mount hospital. On presentation to [**Hospital1 18**] SICU; Patient c/o fatigue, 5 lb weight loss, decreased urine, temperature intolerance to cold and decreased appetite over past week, cough productive of "cloudy sputum", midline abdominal pain, back pain, intermitent vomiting x 1 week, diarrhea. Patient denies SOB, vision changes, DOE, hemopysis, chestpain, dysuria, hematuria, hematchezia, joint pain, HA, easy bruising or bleeding or parasthesias. Past Medical History: EtOH cirrhosis, diabetes, HTN, pulmonary HTN, chronic gastropathy, Hx of esophageal varices, lower back pain. Past Surgical History: Basal cell excisions from b/l arms and ears, b/l cataract surgery. CT guided needle biopsy R lobe liver mass. No Hx of intra-abdominal surgeries. Social History: H/o alcohol abuse. Abstinent for 20 years. Denies smoking. Family History: Noncontributory. Physical Exam: On admission: T: 98.2 P: 75 BP: 104/51 RR: 19 O2sat: 95% on 4L NC Afebrile for >48 hours General: awake, alert, NAD, on 4L NC HEENT: NCAT, EOMI, no scleral icterus, R central line in place Heart: RRR, NMRG Lungs: right lung base decreased breath sounds, L base inspirtatory crackles, normal excursion, no respiratory distress Back: no CVAT Abdomen: nonfocal diffuse tenderness, mild-moderate abdominal distention with tympany, no rebound/guarding. postitive bowel sounds. No splenomegaly Neuro: strength intact/symmetric, sensation intact/symmetric Extremities: WWP, no edema, no tenderness Pyschiatric: normal judgment/insight, normal memory, normal mood/affect Pertinent Results: [**2111-8-27**] Liver biopsy: POORLY-DIFFERENTIATED CARCINOMA WITH LYMPHOVASCULAR INVASION; HEPATIC CIRRHOSIS. THE FINDINGS WOULD BE CONSISTENT WITH A METASTATIC CARCINOMA OF GASTROINTESTINAL, PANCREATICOBILIARY OR UROTHELIAL ORIGIN, OR A PRIMARY CHOLANGIOCARCINOMA. [**2111-8-30**] 02:00PM BLOOD WBC-9.0 RBC-2.79* Hgb-9.6* Hct-26.1* MCV-94 MCH-34.3* MCHC-36.7* RDW-18.7* Plt Ct-61* [**2111-8-30**] 10:03PM BLOOD WBC-7.6 RBC-3.11* Hgb-10.7* Hct-29.7* MCV-96 MCH-34.4* MCHC-36.0* RDW-17.3* Plt Ct-53* [**2111-8-31**] 01:49AM BLOOD WBC-7.6 RBC-3.21* Hgb-10.6* Hct-30.7* MCV-96 MCH-33.1* MCHC-34.6 RDW-17.3* Plt Ct-61* [**2111-8-31**] 09:51AM BLOOD WBC-8.3 RBC-3.19* Hgb-10.9* Hct-30.7* MCV-97 MCH-34.1* MCHC-35.3* RDW-17.4* Plt Ct-58* [**2111-8-31**] 10:18PM BLOOD WBC-7.4 RBC-3.03* Hgb-10.6* Hct-29.2* MCV-97 MCH-34.9* MCHC-36.2* RDW-19.0* Plt Ct-43* [**2111-9-1**] 02:32AM BLOOD WBC-7.0 RBC-3.08* Hgb-10.6* Hct-29.6* MCV-96 MCH-34.3* MCHC-35.7* RDW-18.9* Plt Ct-57* [**2111-9-1**] 12:34PM BLOOD WBC-9.7 RBC-3.39* Hgb-11.9* Hct-32.8* MCV-97 MCH-35.0* MCHC-36.1* RDW-19.2* Plt Ct-68* [**2111-9-2**] 02:13AM BLOOD WBC-6.9 RBC-3.25* Hgb-11.2* Hct-30.9* MCV-95 MCH-34.4* MCHC-36.3* RDW-19.5* Plt Ct-59* [**2111-9-2**] 12:23PM BLOOD WBC-6.6 RBC-3.31* Hgb-11.4* Hct-32.0* MCV-97 MCH-34.5* MCHC-35.6* RDW-18.3* Plt Ct-63* [**2111-9-3**] 02:00AM BLOOD WBC-10.9# RBC-3.73* Hgb-12.8* Hct-36.2* MCV-97 MCH-34.2* MCHC-35.2* RDW-19.2* Plt Ct-65* [**2111-9-3**] 07:54PM BLOOD WBC-9.7 RBC-3.74* Hgb-12.7* Hct-37.1* MCV-99* MCH-34.0* MCHC-34.3 RDW-19.5* Plt Ct-55* [**2111-9-4**] 01:31AM BLOOD WBC-10.2 RBC-3.88* Hgb-13.3* Hct-38.4* MCV-99* MCH-34.2* MCHC-34.6 RDW-19.2* Plt Ct-57* [**2111-8-30**] 02:00PM BLOOD PT-16.9* PTT-32.5 INR(PT)-1.5* [**2111-8-30**] 10:03PM BLOOD PT-17.6* PTT-34.0 INR(PT)-1.6* [**2111-8-31**] 01:49AM BLOOD PT-17.4* PTT-31.7 INR(PT)-1.6* [**2111-8-31**] 09:51AM BLOOD PT-17.6* PTT-31.1 INR(PT)-1.6* [**2111-8-31**] 10:18PM BLOOD PT-18.2* PTT-29.7 INR(PT)-1.6* [**2111-9-1**] 02:32AM BLOOD PT-18.2* PTT-31.8 INR(PT)-1.6* [**2111-9-1**] 12:34PM BLOOD PT-17.9* PTT-31.4 INR(PT)-1.6* [**2111-9-2**] 02:13AM BLOOD PT-18.0* PTT-29.5 INR(PT)-1.6* [**2111-9-2**] 12:23PM BLOOD PT-18.7* PTT-31.6 INR(PT)-1.7* [**2111-9-3**] 02:00AM BLOOD PT-19.1* PTT-34.1 INR(PT)-1.7* [**2111-9-3**] 07:54PM BLOOD PT-18.5* PTT-32.3 INR(PT)-1.7* [**2111-9-4**] 01:31AM BLOOD PT-20.2* PTT-37.4* INR(PT)-1.8* [**2111-8-30**] 10:03PM BLOOD Fibrino-273 [**2111-8-31**] 01:49AM BLOOD Fibrino-258 [**2111-8-31**] 09:51AM BLOOD Fibrino-319 [**2111-8-31**] 10:18PM BLOOD Fibrino-312 [**2111-9-1**] 12:34PM BLOOD Fibrino-319 [**2111-9-2**] 02:13AM BLOOD Fibrino-292 [**2111-9-2**] 12:23PM BLOOD Fibrino-277 [**2111-9-3**] 02:00AM BLOOD Fibrino-235 [**2111-8-30**] 02:00PM BLOOD Glucose-145* UreaN-112* Creat-4.7* Na-133 K-4.5 Cl-98 HCO3-17* AnGap-23* [**2111-8-31**] 01:49AM BLOOD Glucose-127* UreaN-120* Creat-5.1* Na-134 K-4.2 Cl-99 HCO3-16* AnGap-23* [**2111-9-1**] 02:32AM BLOOD Glucose-121* UreaN-136* Creat-5.9* Na-133 K-4.6 Cl-98 HCO3-15* AnGap-25* [**2111-9-1**] 12:34PM BLOOD Glucose-136* UreaN-141* Creat-6.2* Na-131* K-4.5 Cl-95* HCO3-14* AnGap-27* [**2111-9-2**] 02:13AM BLOOD Glucose-142* UreaN-99* Creat-4.3*# Na-133 K-3.7 Cl-93* HCO3-20* AnGap-24* [**2111-9-2**] 12:23PM BLOOD Glucose-157* UreaN-75* Creat-3.4* Na-130* K-3.7 Cl-92* HCO3-22 AnGap-20 [**2111-9-2**] 06:02PM BLOOD Glucose-180* UreaN-79* Creat-3.0* Na-132* K-3.9 Cl-95* HCO3-22 AnGap-19 [**2111-9-3**] 02:00AM BLOOD Glucose-173* UreaN-67* Creat-2.7* Na-132* K-3.7 Cl-94* HCO3-24 AnGap-18 [**2111-9-3**] 01:39PM BLOOD Glucose-222* UreaN-49* Creat-2.1* Na-132* K-4.0 Cl-93* HCO3-23 AnGap-20 [**2111-9-3**] 07:54PM BLOOD Glucose-204* UreaN-46* Creat-2.1* Na-131* K-3.8 Cl-91* HCO3-23 AnGap-21* [**2111-9-4**] 01:31AM BLOOD Glucose-227* UreaN-40* Creat-1.8* Na-131* K-3.8 Cl-90* HCO3-25 AnGap-20 [**2111-9-4**] 03:55PM BLOOD Glucose-205* UreaN-31* Creat-1.5* Na-132* K-3.7 Cl-93* HCO3-26 AnGap-17 [**2111-8-30**] 02:00PM BLOOD ALT-319* AST-344* LD(LDH)-301* AlkPhos-166* Amylase-36 TotBili-10.0* [**2111-8-31**] 01:49AM BLOOD ALT-278* AST-262* AlkPhos-156* TotBili-12.3* [**2111-9-1**] 02:32AM BLOOD ALT-223* AST-173* LD(LDH)-284* AlkPhos-152* TotBili-15.2* DirBili-11.2* IndBili-4.0 [**2111-9-2**] 02:13AM BLOOD ALT-177* AST-135* AlkPhos-157* TotBili-17.9* [**2111-9-3**] 02:00AM BLOOD ALT-150* AST-140* AlkPhos-169* TotBili-21.1* [**2111-9-3**] 07:54PM BLOOD ALT-140* AST-150* AlkPhos-200* TotBili-24.9* [**2111-9-4**] 01:31AM BLOOD ALT-136* AST-153* AlkPhos-211* TotBili-25.3* [**2111-9-1**] Liver US: No detectable flow within the main, right or left portal vein, which may indicate occlusive thrombosis or extremely slow flow. [**2111-9-2**] CT abdomen: 1. Portal vein thrombosis from the confluence with the superior mesenteric vein extending to the proximal bilateral intrahepatic branches. 2. The large heterogeneously-enhancing lesion in the right lobe of the liver is most consistent with atypical hepatocellular carcinoma or metastatic disease and less likely hypoperfusion. 3. Sequelae of portal venous hypertension including splenomegaly, moderate ascites, and anasarca. 4. Right middle lobe infectious or inflammatory process. Brief Hospital Course: On [**2111-8-30**], the patient was admitted to the SICU on the hepatobiliary surgery service after a liver biopsy complicated by hemorrhage and acute renal failure. He was transfused 2u PRBC and hct stabilized. On [**2111-8-31**], he was also transufsed 1pk platelets. He did not require additional transfusions. His diet was advanced to regular. He became oliguric which did not improve with furosemide. On [**2111-9-1**], a hemodialysis line was placed and he was started on CVVH for fluid overload. On [**2111-9-2**], he developed atrial fibrillation with RVR requiring amiodarone gtt. All of the above was in the setting of worsening liver failure. His Tbili on presentation was 10.0 and continued to climb (it was 25.3 on [**2111-9-4**], the last day it was checked). To workup the cause of his worsening liver failure, a ultrasound was performed on [**2111-9-1**] assessing the portal vasculature and consistent with no flow in the portal vein. A CT scan on [**2111-9-2**] suggested the cause of the portal venous obstruction was malignancy, likely metastatic in origin. On [**2111-9-3**], pathology results from [**Hospital6 **] from the liver biopsy were consistent with undifferentiated malignancy and discussed with the patient and his family (official pathology final report from [**Hospital3 2568**] pending at time of this discharge summary). Mr. [**Known lastname **], after discussion with his family and the palliative care team at [**Hospital1 18**], decided upon DNR/DNI status and a slow de-escalation of care. CVVH was discontinued on [**9-4**] and he was transferred to the floor on [**2111-9-5**]. He was officially made "comfort measures only" on [**2111-9-6**]. He expired at 9:01 PM on [**2111-9-7**]. Medications on Admission: - Humalong SS - Lantus 46 u. QHS - Prilosec OTC QD - spironolactone PO BID - Lactulose 10 g PO BID - Nadolol 40 mg PO QD - Lasix 40 mg PO QAM and 20 mg PO QPM - Simvastatin 10 mg PO QHS Discharge Disposition: Expired Discharge Diagnosis: liver failure secondary to malignancy Discharge Condition: expired Discharge Instructions: n/a Followup Instructions: n/a Completed by:[**2111-9-8**]

197,577,570,196,155,584,572,456,276,599,199,427,416,537,403,585,571,303,588,530,041,V498,724

{"Malignant neoplasm of liver, secondary,Acute pancreatitis,Acute and subacute necrosis of liver,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Malignant neoplasm of liver, primary,Acute kidney failure, unspecified,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Mixed acid-base balance disorder,Urinary tract infection, site not specified,Other malignant neoplasm without specification of site,Atrial fibrillation,Other chronic pulmonary heart diseases,Other specified disorders of stomach and duodenum,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Other specified disorders resulting from impaired renal function,Barrett's esophagus,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Do not resuscitate status,Lumbago"}

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: Transfer from OSH for bleeding s/p liver bx of suspected HCC. PRESENT ILLNESS: 69 yo M with alcoholic cirrhosis transferred from OSH s/p liver biopsy on [**8-27**] c/b bleeding and hypotension. On [**8-27**] Pt became hypotensive to the 50s (SBP) during a CT-guided liver bx of a R liver lobe lesion discovered earlier on CT. Bx was completed and tract was embolized with Gelfoam pledgets. f/u CT scan revealed blood adjacent to liver and in pericolic gutter. Repeat angiogram was done by IR without intervention. Pt received a total of 3 u. pRBCs and 2 platelets with appropriate HCT correction from 24 to 30 and improvement in vital signs. Patient was transfered to ICU at [**Hospital6 **] and received 3 additional u. of pRBCs and 3 of platelets. Pt developed intermittent encephalopathy and was treated with rifaximin and continued tx with lactulose. Pt was started on doxycycline for SBP prophylaxis - he remained afebrile throughout. Nadalol was held [**12-24**] hypotension. Creatinine increased from ~1.5 baseline to 4.1 and on discharge with decreased UOP (15/20mL/hr). O2 requirements increased over course of stay likely [**12-24**] fluid overload and ARF - at time of discharge, Pt was on 4 L O2 NC (sat 95%). Pt's tolerated regular diabetic diet with daily BMs at mount hospital. MEDICAL HISTORY: EtOH cirrhosis, diabetes, HTN, pulmonary HTN, chronic gastropathy, Hx of esophageal varices, lower back pain. MEDICATION ON ADMISSION: - Humalong SS - Lantus 46 u. QHS - Prilosec OTC QD - spironolactone PO BID - Lactulose 10 g PO BID - Nadolol 40 mg PO QD - Lasix 40 mg PO QAM and 20 mg PO QPM - Simvastatin 10 mg PO QHS ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission: T: 98.2 P: 75 BP: 104/51 RR: 19 O2sat: 95% on 4L NC Afebrile for >48 hours General: awake, alert, NAD, on 4L NC HEENT: NCAT, EOMI, no scleral icterus, R central line in place Heart: RRR, NMRG Lungs: right lung base decreased breath sounds, L base inspirtatory crackles, normal excursion, no respiratory distress Back: no CVAT Abdomen: nonfocal diffuse tenderness, mild-moderate abdominal distention with tympany, no rebound/guarding. postitive bowel sounds. No splenomegaly Neuro: strength intact/symmetric, sensation intact/symmetric Extremities: WWP, no edema, no tenderness Pyschiatric: normal judgment/insight, normal memory, normal mood/affect FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: H/o alcohol abuse. Abstinent for 20 years. Denies smoking. ### Response: {"Malignant neoplasm of liver, secondary,Acute pancreatitis,Acute and subacute necrosis of liver,Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes,Malignant neoplasm of liver, primary,Acute kidney failure, unspecified,Portal hypertension,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Mixed acid-base balance disorder,Urinary tract infection, site not specified,Other malignant neoplasm without specification of site,Atrial fibrillation,Other chronic pulmonary heart diseases,Other specified disorders of stomach and duodenum,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Other specified disorders resulting from impaired renal function,Barrett's esophagus,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Do not resuscitate status,Lumbago"}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 69 year old male who was found to have a duodenal polyp on routine upper and lower endoscopy in [**2117-7-10**]. The patient was referred to Dr. [**Last Name (STitle) 103500**] for potential endoscopic resection. The patient underwent an upper gastrointestinal endoscopy on [**7-26**], at which time an unsuccessful attempt was made at resection. The patient was referred to Dr. [**Last Name (STitle) 468**] for operative treatment. MEDICAL HISTORY: Steroid dependent asthma, chronic obstructive pulmonary disease, osteoporosis, diverticulitis. MEDICATION ON ADMISSION: Actinol, Drisdol, Azmacort, Advair, Albuterol prn, Prednisone, K-Dur, Hydrochlorothiazide, Zantac, Humibid, Lactulose and OxyContin. ALLERGIES: The patient had an allergy to Penicillin and had also been asked to avoid using Aspirin or other non-steroidal anti-inflammatory drugs because of his severe asthma. PHYSICAL EXAM: FAMILY HISTORY: Only notable for asthma and chronic obstructive pulmonary disease. SOCIAL HISTORY: The patient is married and retired. The patient quit smoking 40 years ago. The patient does not use alcohol.

Benign neoplasm of liver and biliary passages,Chronic obstructive asthma with (acute) exacerbation,Aneurysm of splenic artery

Ben neo liver/bile ducts,Ch obst asth w (ac) exac,Splenic artery aneurysm

Admission Date: [**2117-8-4**] Discharge Date: [**2117-8-12**] Date of Birth: [**2048-6-14**] Sex: M Service: HISTORY OF PRESENT ILLNESS: The patient is a 69 year old male who was found to have a duodenal polyp on routine upper and lower endoscopy in [**2117-7-10**]. The patient was referred to Dr. [**Last Name (STitle) 103500**] for potential endoscopic resection. The patient underwent an upper gastrointestinal endoscopy on [**7-26**], at which time an unsuccessful attempt was made at resection. The patient was referred to Dr. [**Last Name (STitle) 468**] for operative treatment. On presentation the patient denied fever or chills, nausea, vomiting, weight loss, fatigue, abdominal pain, difficulty passing stool or taking food, bright red blood per rectum or hematochezia. PAST MEDICAL HISTORY: Steroid dependent asthma, chronic obstructive pulmonary disease, osteoporosis, diverticulitis. PAST SURGICAL HISTORY: Bilateral inguinal hernia repair, lumbar disk procedure, nasal polyp removal, umbilical hernia repair. MEDICATIONS ON ADMISSION: Actinol, Drisdol, Azmacort, Advair, Albuterol prn, Prednisone, K-Dur, Hydrochlorothiazide, Zantac, Humibid, Lactulose and OxyContin. ALLERGIES: The patient had an allergy to Penicillin and had also been asked to avoid using Aspirin or other non-steroidal anti-inflammatory drugs because of his severe asthma. SOCIAL HISTORY: The patient is married and retired. The patient quit smoking 40 years ago. The patient does not use alcohol. FAMILY HISTORY: Only notable for asthma and chronic obstructive pulmonary disease. PHYSICAL EXAMINATION: General, the patient was alert, conversing fluently, pleasant but visibly dyspneic. Head examination, pupils were equal, round and reactive to light. Extraocular movements intact and he was anicteric. Neck: No cervical masses were noted. Chest: Rhonchorous, poor AP excursion, positive expiratory wheezes. Heart: Regular rate and rhythm, no murmurs. Abdomen: Soft, nontender, nondistended, no masses and no hernias. Extremities, no lower extremity edema. LABORATORY DATA: Laboratory data on admission revealed white blood count 14.2, hematocrit 35.4, platelets 216, sodium 139, potassium 4.2, chloride 109, bicarbonate 29, BUN 23, creatinine 0.5, glucose 92, calcium 7.8, magnesium 1.7, ALT 23, AST 25, alkaline phosphatase 71, total bilirubin 0.5, lipase 38. Relevant tests reveal esophagogastroduodenoscopy, lobulated mass noted at the duodenal ampulla. Computerized tomography scan showed a splenic artery aneurysm. Ampullary tumor was not noted to have any vascular involvement. ASSESSMENT AND PLAN: Mr. [**Known lastname 103501**] is a 69 year old male admitted to [**Hospital6 256**] for transduodenal ampullary resection of tumor of cystectomy, common bile duct exploration and splenic artery aneurysm ligation. HOSPITAL COURSE: The patient was taken to Surgery on [**2117-8-4**]. He was extubated on postoperative day #1 and an nasogastric tube was placed to low continuous wall suction. On postoperative day #2, the patient's epidural catheter was discontinued following a leak and he was placed on PCA pump. Later on postoperative day #2 the patient was deemed stable enough for transfer to a General Surgical Floor. On postoperative day #3 the patient's nasogastric tube was discontinued following satisfactory low output. Steroid taper was also initiated. On the day following removal of the patient's nasogastric tube he began to develop some nausea for which Zofran was prescribed. On this day, postoperative day #4, the patient also had his first bowel movement with some flatus. On postoperative day #5 an attempt was made to advance the patient's diet to sips and then clears but with worsening nausea this plan was discontinued and the patient was made NPO again. Reglan was also prescribed to try to improve his gastric motility. On postoperative day #6 because of persistent nausea, a KUB was obtained of the patient's abdomen which revealed an unremarkable gas stool distribution in the abdomen, no free air and no evidence of obstruction. At this point continued workup of the patient's nausea was initiated. The patient's Dilaudid PCA was discontinued and Tylenol 650 mg increased to 1500 mg q. [**5-15**] around the clock per rectum was in initiated. By postoperative day #7 it was clear that the Tylenol was inadequately managing the patient's pain particularly his chronic inguinal pain at which point the decision was made to start the patient on Dilaudid 2 mg by mouth every 2 to 6 hours. At this point the patient's overall status had markedly improved and the decision was made to advance the patient's diet first to clears and then to regular food. The patient tolerated this transition well with no recurrence of nausea and absolutely no problems. The patient also had a series of bowel movements on postoperative day #7, the same day which the patient transitioned from clear liquids to regular diets. The patient's home medications which included Hydrochlorothiazide, Neurontin, and K-Dur were started. The patient's white cell count which had been observed to increase marginally was also noted trending downward at this point. Plans were made to discharge the patient home on postoperative day #8 which was [**8-12**]. At this point, the patient appears stable for discharge. DISCHARGE STATUS: Improved and stable. DISCHARGE MEDICATIONS: 1. Actinol 2. Drisdol 3. Azmacort 4. Advair 5. Albuterol prn 6. K-Dur 7. Hydrochlorothiazide 8. Protonix 9. Humibid 10. Lactulose 11. OxyContin for his chronic inguinal pain 12. The patient has also been started on Reglan for the time being [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **], M.D. [**MD Number(1) 4984**] Dictated By:[**Name8 (MD) 997**] MEDQUIST36 D: [**2117-8-11**] 18:14 T: [**2117-8-11**] 18:34 JOB#: [**Job Number 103502**]

211,493,442

{'Benign neoplasm of liver and biliary passages,Chronic obstructive asthma with (acute) exacerbation,Aneurysm of splenic artery'}

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 69 year old male who was found to have a duodenal polyp on routine upper and lower endoscopy in [**2117-7-10**]. The patient was referred to Dr. [**Last Name (STitle) 103500**] for potential endoscopic resection. The patient underwent an upper gastrointestinal endoscopy on [**7-26**], at which time an unsuccessful attempt was made at resection. The patient was referred to Dr. [**Last Name (STitle) 468**] for operative treatment. MEDICAL HISTORY: Steroid dependent asthma, chronic obstructive pulmonary disease, osteoporosis, diverticulitis. MEDICATION ON ADMISSION: Actinol, Drisdol, Azmacort, Advair, Albuterol prn, Prednisone, K-Dur, Hydrochlorothiazide, Zantac, Humibid, Lactulose and OxyContin. ALLERGIES: The patient had an allergy to Penicillin and had also been asked to avoid using Aspirin or other non-steroidal anti-inflammatory drugs because of his severe asthma. PHYSICAL EXAM: FAMILY HISTORY: Only notable for asthma and chronic obstructive pulmonary disease. SOCIAL HISTORY: The patient is married and retired. The patient quit smoking 40 years ago. The patient does not use alcohol. ### Response: {'Benign neoplasm of liver and biliary passages,Chronic obstructive asthma with (acute) exacerbation,Aneurysm of splenic artery'}

CHIEF COMPLAINT: s/p elective PVI, hypotension PRESENT ILLNESS: Mr. [**Known lastname 34071**] is a 68 year old man with h/o mitral valve prolapse, s/p MV repair [**2131**] and atrial fibrillation s/p PVI in [**2135**], on Coumadin, with recurrence of atrial fibrillation in summer [**2139**]. He had a cardioversion in [**10-23**] which converted him to sinus rhythm; however, he was back in Atrial fibrillation one week later. He underwent an elective PVI and cardioversion earlier today with conversion back into sinus rhythm. He was given lasix 30mg IV during the case with approximately 2.2L out. His case was complicated by mild hematoma in the right groin with a pressure dressing placed. He was given fluid boluses totaling 3L in the PACU, but was persistently hypotensive and started on a dopamine gtt. Echo was performed and was negative for effusion. He is asympomatic with the hypotension. He is being transferred to the CCU for further monitoring and management of his hypotension. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: No Diabetes, No Dyslipidemia, No Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: [**2131**] normal coronaries -PACING/ICD: none - mitral valve prolapse with severe MR, s/p MV repair [**2131**] - atrial fibrillation, s/p ablation [**2135**] 3. OTHER PAST MEDICAL HISTORY: - arthritis - gout - Left THR - Right femur pinning [**2115**] - Left leg skin graft d/t burn [**2133**] MEDICATION ON ADMISSION: Metoprolol Tartrate 50mg PO BID Warfarin 5 mg PO daily (for past 2 days was 7.5 mg daily) ALLERGIES: Percocet PHYSICAL EXAM: GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: Brother died of MI at age 50. SOCIAL HISTORY: Lives with wife. [**Name (NI) **] 3 grown children. Occupation: retired. -Tobacco history: none -ETOH: 1-2 drinks/day -Illicit drugs: none

Atrial fibrillation,Hematoma complicating a procedure,Precipitous drop in hematocrit,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other iatrogenic hypotension,Other antihypertensive agents causing adverse effects in therapeutic use,Other diuretics causing adverse effects in therapeutic use,Other sedatives and hypnotics causing adverse effects in therapeutic use,Mitral valve disorders,Arthropathy, unspecified, site unspecified,Gout, unspecified,Hip joint replacement,Long-term (current) use of anticoagulants

Atrial fibrillation,Hematoma complic proc,Drop, hematocrit, precip,Abn react-procedure NEC,Iatrogenc hypotnsion NEC,Adv eff antihyperten agt,Adv eff diuretics NEC,Adv eff sedat/hypnot NEC,Mitral valve disorder,Arthropathy NOS-unspec,Gout NOS,Joint replaced hip,Long-term use anticoagul

Admission Date: [**2140-1-4**] Discharge Date: [**2140-1-5**] Date of Birth: [**2071-12-12**] Sex: M Service: MEDICINE Allergies: Percocet Attending:[**Doctor First Name 1402**] Chief Complaint: s/p elective PVI, hypotension Major Surgical or Invasive Procedure: [**1-4**] PVI ablation History of Present Illness: Mr. [**Known lastname 34071**] is a 68 year old man with h/o mitral valve prolapse, s/p MV repair [**2131**] and atrial fibrillation s/p PVI in [**2135**], on Coumadin, with recurrence of atrial fibrillation in summer [**2139**]. He had a cardioversion in [**10-23**] which converted him to sinus rhythm; however, he was back in Atrial fibrillation one week later. He underwent an elective PVI and cardioversion earlier today with conversion back into sinus rhythm. He was given lasix 30mg IV during the case with approximately 2.2L out. His case was complicated by mild hematoma in the right groin with a pressure dressing placed. He was given fluid boluses totaling 3L in the PACU, but was persistently hypotensive and started on a dopamine gtt. Echo was performed and was negative for effusion. He is asympomatic with the hypotension. He is being transferred to the CCU for further monitoring and management of his hypotension. On the floor he reports feeling much better in a normal heart rhythm. He had been feeling fatigued, mildly SOB with some DOE prior to the case because of his atrial fibrillation. He can generally feel palpitations when he is in atrial fibrillation. He denies any lightheadedness, chest pain, orthopnea, PND, LE edema, syncope. On review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. Past Medical History: 1. CARDIAC RISK FACTORS: No Diabetes, No Dyslipidemia, No Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: [**2131**] normal coronaries -PACING/ICD: none - mitral valve prolapse with severe MR, s/p MV repair [**2131**] - atrial fibrillation, s/p ablation [**2135**] 3. OTHER PAST MEDICAL HISTORY: - arthritis - gout - Left THR - Right femur pinning [**2115**] - Left leg skin graft d/t burn [**2133**] Social History: Lives with wife. [**Name (NI) **] 3 grown children. Occupation: retired. -Tobacco history: none -ETOH: 1-2 drinks/day -Illicit drugs: none Family History: Brother died of MI at age 50. Physical Exam: GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with JVP of 8 cm. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB anteriorly, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. pressure dressing on right. dressing bilat C-D-I. Skin soft. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ right fem with pressure dressing. DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Pertinent Results: ADMISSION LABS [**2140-1-4**]: [**2140-1-4**] 07:00AM WBC-5.4 Hgb-14.8 Hct-43.2 Plt Ct-301 [**2140-1-4**] 07:00AM PT-20.2* PTT-26.9 INR(PT)-1.9* [**2140-1-4**] 07:00AM UreaN-23* Creat-1.2 Na-142 K-4.5 Cl-106 HCO3-27 AnGap-14 STUDIES: [**1-4**] ECHO: The left atrium is mildly dilated. Left ventricular wall thickness and cavity size are normal. Global systolic function is low normal (LVEF 50-55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. A mitral valve annuloplasty ring is present. The mitral annular ring appears well seated with high normal gradient. There is moderate thickening of the mitral valve chordae. There is a minimally increased gradient consistent with trivial mitral stenosis. Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is no pericardial effusion. IMPRESSION: Suboptimal image quality. No pericardial effusion. Mild aortic regurgitation. Mild mitral regurgitation. Well seated annuloplasty ring with minimal mitral stenosis. On discharge: WBC-7.8 RBC-3.63* Hgb-11.2* Hct-32.1* Plt Ct-240 PT-21.3* PTT-46.0* INR(PT)-2.0* Glucose-127* UreaN-17 Creat-1.0 Na-129* K-3.2* Cl-99 HCO3-24 AnGap-9 Calcium-6.3* Phos-2.9 Mg-1.9 Brief Hospital Course: Mr. [**Known lastname 34071**] is a 68 yo male with h/o Mitral valve prolapse s/p repair and atrial fibrillation s/p second PVI (all veins re-isolated) and cardioversion. 1. Hypotension: Likely secondary to combination of bleeding into hematoma with substantial Hct drop, medication effect of antihypertensives and sedation, and excessive diuresis. No evidence of pericardial effusion or tamponade on echo. No evidence of infection. Pt was intially started on dopamine to maintain BP, bolused several liters and dopamine was weaned off overnight. Post cath check with no hematoma or vascular dissection at groin site or peripheral vasculature. Repeat Hct stable at 33.4. Remained hemodynamically stable through duration of hospital stay 2. Atrial fibrillation: s/p PVI and cardioversion on day of admission. Remained in sinus rhythm through duration of hospital staywith [**2-17**] brief episodes 3-20 seconds of asymptomatic SVT. Metoprolol was resumed when blood pressure could tolerate. Coumadin was resumed, INR on discharge was 2.0. Medications on Admission: Metoprolol Tartrate 50mg PO BID Warfarin 5 mg PO daily (for past 2 days was 7.5 mg daily) Discharge Medications: 1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Warfarin 2.5 mg Tablet Sig: Three (3) Tablet PO Once Daily at 4 PM. Discharge Disposition: Home Discharge Diagnosis: atrial fibrillation mitral valve disease Discharge Condition: Ambulatory Mental Status:Clear and coherent Level of Consciousness:Alert and interactive Activity Status:Ambulatory - Independent Ambulatory Mental Status:Clear and coherent Level of Consciousness:Alert and interactive Activity Status:Ambulatory - Independent Discharge Instructions: It was a pleasure taking care of you during your hospitalization. You had a procedure to ablate atrial tachycardia and atrial fibrillation. You were monitored after the procedure in the Intensive Care Unit because of low blood pressure. Your blood pressure improved and remained stable without any complications. Please continue all current medicines. -- You should continue your coumadin 7.5mg daily and have an INR checked in one week. -- You should continue your metoprolol 50mg twice a day Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 3321**] in [**2-17**] weeks

427,998,790,E879,458,E942,E944,E937,424,716,274,V436,V586

{'Atrial fibrillation,Hematoma complicating a procedure,Precipitous drop in hematocrit,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other iatrogenic hypotension,Other antihypertensive agents causing adverse effects in therapeutic use,Other diuretics causing adverse effects in therapeutic use,Other sedatives and hypnotics causing adverse effects in therapeutic use,Mitral valve disorders,Arthropathy, unspecified, site unspecified,Gout, unspecified,Hip joint replacement,Long-term (current) use of anticoagulants'}

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: s/p elective PVI, hypotension PRESENT ILLNESS: Mr. [**Known lastname 34071**] is a 68 year old man with h/o mitral valve prolapse, s/p MV repair [**2131**] and atrial fibrillation s/p PVI in [**2135**], on Coumadin, with recurrence of atrial fibrillation in summer [**2139**]. He had a cardioversion in [**10-23**] which converted him to sinus rhythm; however, he was back in Atrial fibrillation one week later. He underwent an elective PVI and cardioversion earlier today with conversion back into sinus rhythm. He was given lasix 30mg IV during the case with approximately 2.2L out. His case was complicated by mild hematoma in the right groin with a pressure dressing placed. He was given fluid boluses totaling 3L in the PACU, but was persistently hypotensive and started on a dopamine gtt. Echo was performed and was negative for effusion. He is asympomatic with the hypotension. He is being transferred to the CCU for further monitoring and management of his hypotension. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: No Diabetes, No Dyslipidemia, No Hypertension 2. CARDIAC HISTORY: -CABG: none -PERCUTANEOUS CORONARY INTERVENTIONS: [**2131**] normal coronaries -PACING/ICD: none - mitral valve prolapse with severe MR, s/p MV repair [**2131**] - atrial fibrillation, s/p ablation [**2135**] 3. OTHER PAST MEDICAL HISTORY: - arthritis - gout - Left THR - Right femur pinning [**2115**] - Left leg skin graft d/t burn [**2133**] MEDICATION ON ADMISSION: Metoprolol Tartrate 50mg PO BID Warfarin 5 mg PO daily (for past 2 days was 7.5 mg daily) ALLERGIES: Percocet PHYSICAL EXAM: GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: Brother died of MI at age 50. SOCIAL HISTORY: Lives with wife. [**Name (NI) **] 3 grown children. Occupation: retired. -Tobacco history: none -ETOH: 1-2 drinks/day -Illicit drugs: none ### Response: {'Atrial fibrillation,Hematoma complicating a procedure,Precipitous drop in hematocrit,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other iatrogenic hypotension,Other antihypertensive agents causing adverse effects in therapeutic use,Other diuretics causing adverse effects in therapeutic use,Other sedatives and hypnotics causing adverse effects in therapeutic use,Mitral valve disorders,Arthropathy, unspecified, site unspecified,Gout, unspecified,Hip joint replacement,Long-term (current) use of anticoagulants'}

CHIEF COMPLAINT: Vomiting PRESENT ILLNESS: HPI: 34 yo M with a history of HTN, and alcohol abuse complicated by withdrawal requiring prior ICU stay who presented to his PCPs office complaining of cough and vomiting. Patient mentioned that his symptoms began 5 days prior to admission; he had several bouts of vomiting daily and had difficulty keeping down POs. No abdominal pain. No loose stools. He also had nasal congestion, productive cough of whitish sputum, headache, and body ache. Recorded temperature at home of 103. Vitals in clinic were BP:140/90 Temp:99.2 HR:122 O2 sat 97%. He was conversant but tremulous on exam. He was sent to the ED with concerns of influenza with possible etoh withdrawal. He personally denies any recent alcohol history (states his last drink was 1 month ago) however his girlfriend endorses that he stopped drinking just as illness came on. . . In the ED, initial VS: T96-->100.1 BP 167/92 HR 120 RR 16. Patient was found to be altered, perseverating on words, and had a seizure thereafter. Per the ED signout, he was violently thrashing in his post-ictal state, and bit his tongue. He was intubated thereafter. He received Vancomycin, Ceftriaxone, and Acyclovir with concerns for meningitis. Tamiflu was not given because the patient was intubated and did not have an OG tube. And requires both a propofol gtt at 80mg and versed gtt for sedation. He was paralyzed with vecuronium for lumbar puncture. Head CT was negative. LP yielded clear fluid, though opening pressure was unmeasurable because pressure was over 36. Neurology was consulted in the ED. Vitals prior to transfer to ICU were T 99.1 HR 108 BP 132/83 RR 23 100%. In the MICU, was placed on CIWA scale and started on Tamiflu. Following resolution of withdrawal symptoms, was extubated and transferred to floor for further care. MEDICAL HISTORY: Left closed midshaft humerus fracture Alcohol abuse Hypertension MEDICATION ON ADMISSION: 1. Amlodipine 5 mg po daily 2. Ibuprofen 600 mg po PRN pain 3. B-100 Complex po daily 4. Multivitamins po daily 5. Folic Acid 1 mg po daily ALLERGIES: Codeine / Thiamine PHYSICAL EXAM: PHYSICAL EXAM: VS: 99.6, 142/98, 85, 22, 97% 3L Gen: Lying in bed, moderately uncomfortable appearing, clammy skin Neck: No appreciable lymphadenopathy Cardiac: Nl s1/s2 Lungs: No rales or appreciably decreased breath sounds Abd: Nontender and nondistended Ext: no lower extremity edema FAMILY HISTORY: Father with EtOH abuse. Maternal aunt with CAD. No h/o cancer. SOCIAL HISTORY: Born in MA. Lived in CA x several years with ex-wife and children. Remaining 15 yo daughter (twin) and 13 yo son with difficulty coping as present at time of daughter's death. Currently 3rd year law student here with plans to return to [**State 4565**]. Has girlfriend here, [**Name (NI) 1356**]; prior notes allude to possible issues with abuse. EtOH history as above. Denies smoking and illicit drug use.

Influenza with other respiratory manifestations,Alcohol withdrawal,Hematemesis,Other and unspecified alcohol dependence, unspecified,Other convulsions,Unspecified essential hypertension,Thrombocytopenia, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]

Flu w resp manifest NEC,Alcohol withdrawal,Hematemesis,Alcoh dep NEC/NOS-unspec,Convulsions NEC,Hypertension NOS,Thrombocytopenia NOS,Elev transaminase/ldh

Admission Date: [**2176-1-1**] Discharge Date: [**2176-1-7**] Date of Birth: [**2141-1-18**] Sex: M Service: MEDICINE Allergies: Codeine / Thiamine Attending:[**First Name3 (LF) 759**] Chief Complaint: Vomiting Major Surgical or Invasive Procedure: Intubation for airway protection History of Present Illness: HPI: 34 yo M with a history of HTN, and alcohol abuse complicated by withdrawal requiring prior ICU stay who presented to his PCPs office complaining of cough and vomiting. Patient mentioned that his symptoms began 5 days prior to admission; he had several bouts of vomiting daily and had difficulty keeping down POs. No abdominal pain. No loose stools. He also had nasal congestion, productive cough of whitish sputum, headache, and body ache. Recorded temperature at home of 103. Vitals in clinic were BP:140/90 Temp:99.2 HR:122 O2 sat 97%. He was conversant but tremulous on exam. He was sent to the ED with concerns of influenza with possible etoh withdrawal. He personally denies any recent alcohol history (states his last drink was 1 month ago) however his girlfriend endorses that he stopped drinking just as illness came on. . . In the ED, initial VS: T96-->100.1 BP 167/92 HR 120 RR 16. Patient was found to be altered, perseverating on words, and had a seizure thereafter. Per the ED signout, he was violently thrashing in his post-ictal state, and bit his tongue. He was intubated thereafter. He received Vancomycin, Ceftriaxone, and Acyclovir with concerns for meningitis. Tamiflu was not given because the patient was intubated and did not have an OG tube. And requires both a propofol gtt at 80mg and versed gtt for sedation. He was paralyzed with vecuronium for lumbar puncture. Head CT was negative. LP yielded clear fluid, though opening pressure was unmeasurable because pressure was over 36. Neurology was consulted in the ED. Vitals prior to transfer to ICU were T 99.1 HR 108 BP 132/83 RR 23 100%. In the MICU, was placed on CIWA scale and started on Tamiflu. Following resolution of withdrawal symptoms, was extubated and transferred to floor for further care. Past Medical History: Left closed midshaft humerus fracture Alcohol abuse Hypertension Social History: Born in MA. Lived in CA x several years with ex-wife and children. Remaining 15 yo daughter (twin) and 13 yo son with difficulty coping as present at time of daughter's death. Currently 3rd year law student here with plans to return to [**State 4565**]. Has girlfriend here, [**Name (NI) 1356**]; prior notes allude to possible issues with abuse. EtOH history as above. Denies smoking and illicit drug use. Family History: Father with EtOH abuse. Maternal aunt with CAD. No h/o cancer. Physical Exam: PHYSICAL EXAM: VS: 99.6, 142/98, 85, 22, 97% 3L Gen: Lying in bed, moderately uncomfortable appearing, clammy skin Neck: No appreciable lymphadenopathy Cardiac: Nl s1/s2 Lungs: No rales or appreciably decreased breath sounds Abd: Nontender and nondistended Ext: no lower extremity edema Pertinent Results: CSF Analysis: CEREBROSPINAL FLUID (CSF) PROTEIN-48* GLUCOSE-92 CEREBROSPINAL FLUID (CSF) WBC-0 RBC-0 POLYS-0 LYMPHS-0 MONOS-0 CRYPTOCOCCAL ANTIGEN NOT DETECTED. No fungus isolated HSV pending . URINALYSIS: URINE HOURS-RANDOM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG URINE COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.028 URINE BLOOD-LG NITRITE-NEG PROTEIN-500 GLUCOSE-NEG KETONE-15 BILIRUBIN-SM UROBILNGN-4* PH-6.5 LEUK-TR . ELECTROLYTES: GLUCOSE-125* UREA N-10 CREAT-0.9 SODIUM-139 POTASSIUM-3.4 CHLORIDE-95* TOTAL CO2-28 ANION GAP-19 . ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG . HEMATOLOGY: WBC-5.9# RBC-4.59* HGB-14.2 HCT-41.0 MCV-89# MCH-30.8 MCHC-34.5 RDW-15.8* NEUTS-71* BANDS-0 LYMPHS-9* MONOS-17* EOS-0 BASOS-2 ATYPS-0 METAS-1* MYELOS-0 . Right upper quadrant ultrasound: IMPRESSIONS: 1. Diffusely echogenic liver consistent with fatty deposition. However, more advanced liver disease including hepatic fibrosis or cirrhosis cannot be excluded on the basis of imaging. Liver lesions noted on the [**2175-8-9**] scan are not appreciated. 2. No biliary or gallbladder abnormalities identified. 3. Borderline splenomegaly. . MRI head: IMPRESSION: 1. Unremarkable MRI of the brain, without evidence of hemorrhage or acute territorial infarct. There is no definite evidence of an epileptogenic substrate, although evaluation is suboptimal given patient motion. If the semiology suggests a focal origin, repeat MRI with seizure protocol may be helpful when the patient is better able to tolerate the study. 2. Air-fluid levels in the sphenoid sinuses and mastoid air cells, new since the prior CT. This likely is related to recent intubation. The study and the report were reviewed by the staff radiologist. . EEG: IMPRESSION: This is a mildly abnormal portable EEG in the waking, drowsy and briefly asleep states because of slow alpha rhythm. These findings are indicative of mild diffuse cerebral dysfunction, which is etiologically nonspecific. There were no focal abnormalities or epileptiform discharges. . Chest Xray: IMPRESSION: Stable mild pulmonary edema and cardiomegaly, no new consolidation. The study and the report were reviewed by the staff radiologist. . CT head: IMPRESSION: No acute intracranial process. Prominent involutional changes for age. The study and the report were reviewed by the staff radiologist. Brief Hospital Course: # Influenza like illness: Patient complained of 5 days of cough and vomiting. Unable to take pos. A viral respiratory culture was performed which was negative for H1N1, Adeno, Parainfluenza 1, 2, 3, Influenza A, B. Chest x-ray showed no obvious infiltrates. Blood and urine cultures remained negative. Given high suspicion of influenza-like syndrome, he was started on tamiflu and completed a 5 day course during his hospitalization. While in the ED, he had a seizure that was thought secondary to alcohol withdrawal after cessation of drinking in the setting of the ILI. Required airway protection and was briefly transferred to the MICU for overnight observation with airway protection. Given seizure and fevers, an LP was done which showed a clear CSF. HSV cultures were obtained which were pending. Following stabilization of his airway, he was extubated and returned to the floor for further management. While on the floor, he was afebrile. His tamiflu course was continued. His LFTs trended up which we suspected could be secondary to nonspecific transaminitis in the setting of an underlying viral syndrome or from mild hepatocellular damage from oseltamivir. Could also be secondary to acute alcohol ingestion (see below). Was discharged following stabilization of LFTs, and when he was afebrile > 48 hours. Was urged to follow up with his PCP [**Name Initial (PRE) 176**] 1 wk for recheck of his laboratory work, including HSV PCR from his CSF. . # Altered mental status/Seizure: Again, we felt this was secondary to alcohol withdrawal in the setting of an influenza like-illness. He was placed on a CIWA scale while he withdrew. Required overnight MICU stay with intubation for airway protection because of his seizure as above. CT head negative. MRI negative. Was transiently covered with antibiotics broadly for meningitis but LP was benign and antibiotics were discontinued. In the last 24 hours prior to discharge, did not require CIWA. He was continued on thiamine and folate. HSV pending from CSF at time of discharge. Was advised to discontinue driving for 6 months given his seizure. . # HTN: Increased amlodipine to 10 mg daily as was hypertensive during hospitalization. Started on HCTZ at time of discharge as pressures still had not improved (were around 140 systolic). We told him that he should follow up with primary care at the end of the week for a lab check and for follow up blood pressure check. . # Thrombocytopenia: Platelets initially low during admission (around 40) although they improved over the course of admission. Low platelets likely secondary to EtOH, with improvement with cessation of alcohol. . # LFT elevation - Likely nonspecific but thought to be secondary to oseltamavir use versus nonspecific transaminitis in setting of viral syndrome versus NASH versus alcohol binge. Stabilized at time of discharge with instructions to follow up with primary care within one week after discharge. Was asymptomatic with no RUQ tenderness during hospitalization. Medications on Admission: 1. Amlodipine 5 mg po daily 2. Ibuprofen 600 mg po PRN pain 3. B-100 Complex po daily 4. Multivitamins po daily 5. Folic Acid 1 mg po daily Discharge Medications: 1. Vitamin B-100 Complex Tablet Sig: One (1) Tablet PO once a day. 2. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: 1-2 Puffs Inhalation Q4H (every 4 hours) as needed for shorntess of breath. Disp:*1 1* Refills:*0* 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day. 4. Multivitamin Capsule Sig: One (1) Capsule PO once a day. 5. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO once a day as needed for pain. 6. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 7. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO once a day. Disp:*30 Capsule(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: 1. Influenza-like illness 2. Likely alcohol withdrawal 3. Hypertension Discharge Condition: Stable for home. Afebrile. Saturating well on room air. Discharge Instructions: Dear Mr [**Known lastname **], You were admitted with a flu-like illness. While our tests revealed that you did not test positive for the flu, your symptoms were serious enough to suggest a diagnosis of flu. For this reason, we started you on oseltamavir, which is a medicine that treats the flu. You should continue to take this daily until [**2176-1-10**]. . While you were in the emergency department, you suffered a seizure. To make sure this wasn't because of infection, we performed a CT scan and an MRI, both of which were negative. We also did a lumbar puncture which was also negative for infection. To provide you with airway protection during and after the seizure, we did need to intubate you and transferred you to the intensive care unit for further management. While in the unit, your breathing stabilized and we were able to take the breathing tube out. We started you on influenza treatment at this time and your breathing improved. One possibility for why you had a seizure could be from alcohol use. Staying off alcohol will prevent these problems in the future; your health is also more likely to improve overall. Seeking out resources like AA can be helpful in helping you reach this goal. . **IMPORTANT** As discussed, please DO NOT drive for 6 months time as you need to be re-evaluated by an outpatient physician after having recent seizures. . We made the following medication changes during this admission: (1) You can take the albuterol inhaler as needed for shortness of breath or wheezing. (2) You should start taking hydrochlorothiazide (HCTZ) which is a water pill to help lower your blood pressure. . If you experience worsening fevers, productive cough, vomiting, continued diarrhea, seizures, or any other concerning symptoms, please let your primary care doctor know or return to the emergency department. Followup Instructions: 1. Please follow up with your primary care doctor, Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5717**], within 1 week of discharge. His phone number to set up an appointment is [**Telephone/Fax (1) 1247**].

487,291,578,303,780,401,287,790

{'Influenza with other respiratory manifestations,Alcohol withdrawal,Hematemesis,Other and unspecified alcohol dependence, unspecified,Other convulsions,Unspecified essential hypertension,Thrombocytopenia, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}

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: Vomiting PRESENT ILLNESS: HPI: 34 yo M with a history of HTN, and alcohol abuse complicated by withdrawal requiring prior ICU stay who presented to his PCPs office complaining of cough and vomiting. Patient mentioned that his symptoms began 5 days prior to admission; he had several bouts of vomiting daily and had difficulty keeping down POs. No abdominal pain. No loose stools. He also had nasal congestion, productive cough of whitish sputum, headache, and body ache. Recorded temperature at home of 103. Vitals in clinic were BP:140/90 Temp:99.2 HR:122 O2 sat 97%. He was conversant but tremulous on exam. He was sent to the ED with concerns of influenza with possible etoh withdrawal. He personally denies any recent alcohol history (states his last drink was 1 month ago) however his girlfriend endorses that he stopped drinking just as illness came on. . . In the ED, initial VS: T96-->100.1 BP 167/92 HR 120 RR 16. Patient was found to be altered, perseverating on words, and had a seizure thereafter. Per the ED signout, he was violently thrashing in his post-ictal state, and bit his tongue. He was intubated thereafter. He received Vancomycin, Ceftriaxone, and Acyclovir with concerns for meningitis. Tamiflu was not given because the patient was intubated and did not have an OG tube. And requires both a propofol gtt at 80mg and versed gtt for sedation. He was paralyzed with vecuronium for lumbar puncture. Head CT was negative. LP yielded clear fluid, though opening pressure was unmeasurable because pressure was over 36. Neurology was consulted in the ED. Vitals prior to transfer to ICU were T 99.1 HR 108 BP 132/83 RR 23 100%. In the MICU, was placed on CIWA scale and started on Tamiflu. Following resolution of withdrawal symptoms, was extubated and transferred to floor for further care. MEDICAL HISTORY: Left closed midshaft humerus fracture Alcohol abuse Hypertension MEDICATION ON ADMISSION: 1. Amlodipine 5 mg po daily 2. Ibuprofen 600 mg po PRN pain 3. B-100 Complex po daily 4. Multivitamins po daily 5. Folic Acid 1 mg po daily ALLERGIES: Codeine / Thiamine PHYSICAL EXAM: PHYSICAL EXAM: VS: 99.6, 142/98, 85, 22, 97% 3L Gen: Lying in bed, moderately uncomfortable appearing, clammy skin Neck: No appreciable lymphadenopathy Cardiac: Nl s1/s2 Lungs: No rales or appreciably decreased breath sounds Abd: Nontender and nondistended Ext: no lower extremity edema FAMILY HISTORY: Father with EtOH abuse. Maternal aunt with CAD. No h/o cancer. SOCIAL HISTORY: Born in MA. Lived in CA x several years with ex-wife and children. Remaining 15 yo daughter (twin) and 13 yo son with difficulty coping as present at time of daughter's death. Currently 3rd year law student here with plans to return to [**State 4565**]. Has girlfriend here, [**Name (NI) 1356**]; prior notes allude to possible issues with abuse. EtOH history as above. Denies smoking and illicit drug use. ### Response: {'Influenza with other respiratory manifestations,Alcohol withdrawal,Hematemesis,Other and unspecified alcohol dependence, unspecified,Other convulsions,Unspecified essential hypertension,Thrombocytopenia, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}

CHIEF COMPLAINT: dyspnea, chest pain and pre-syncope PRESENT ILLNESS: 83 year old female transferred from OSH for cardiac catheterization. She had been experiencing a constellation of symptoms including chest pressure, palpitations, lightheadedness, dyspnea on exertion, and presyncope for several days prior to admission. On [**3-11**] she presented to her cardiologist's office where TTE showed (NEW?) aortic stenosis. EKG revealed Afib with ST segment and T wave abnormalities in the inferior and lateral leads. She was admitted to an OSH for further evaluation. Given the severity of aortic stenosis seen on echo, she was referred to [**Hospital1 18**] for right and left cardiac catheterization and for a surgical evaluation for an aortic valve replacement. MEDICAL HISTORY: Aortic Stenosis, s/p AVR cecal perforation, s/p ex-lap, right hemicolectomy PMH: Hypertension Hyperlipidemia Afib CKD (stage II) Chronic pedal edema ? meningioma Degenerative arthritis Gout L great toe MEDICATION ON ADMISSION: Lopressor 100(3) Lovenox [**Hospital1 **] Lipitor 40(1) Aspirin 81mg Daily Cipro 250(2) started [**2177-3-19**] for e.coli UTI mupiricin 2%NU [**2177-3-19**] for MSSA swab ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pulse:59 Resp:18 O2 sat:98/RA B/P 117/68 Height:5'4" Weight:157 lbs FAMILY HISTORY: Mother with CHF in her 70s, Father died of CVA at age [**Age over 90 **], prostate cancer. No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Lives alone. Previously a teacher, now [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and writer. - Tobacco history: quit [**2142**] - ETOH: 1/month - Illicit drugs: denies

Aortic valve disorders,Acute appendicitis with generalized peritonitis,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Paralytic ileus,Urinary tract infection, site not specified,Other digestive system complications,Iron deficiency anemia secondary to blood loss (chronic),Other iatrogenic hypotension,Chronic kidney disease, Stage II (mild),Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Other and unspecified hyperlipidemia,Atrial fibrillation,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Gout, unspecified,Personal history of tobacco use,Other and unspecified Escherichia coli [E. coli]

Aortic valve disorder,Ac append w peritonitis,Chr systolic hrt failure,Hy kid NOS w cr kid I-IV,Paralytic ileus,Urin tract infection NOS,Oth digestv system comp,Chr blood loss anemia,Iatrogenc hypotnsion NEC,Chro kidney dis stage II,Abn reac-organ rem NEC,Accid in resident instit,Hyperlipidemia NEC/NOS,Atrial fibrillation,Osteoarthros NOS-unspec,Gout NOS,History of tobacco use,E.coli infection NEC/NOS

Admission Date: [**2177-3-24**] Discharge Date: [**2177-4-8**] Date of Birth: [**2093-6-9**] Sex: F Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1505**] Chief Complaint: dyspnea, chest pain and pre-syncope Major Surgical or Invasive Procedure: [**2177-3-25**] - Aortic Valve Replacement (21mm St. [**Male First Name (un) 923**] tissue) [**2177-3-31**] - Exploratory laparotomy, right colectomy History of Present Illness: 83 year old female transferred from OSH for cardiac catheterization. She had been experiencing a constellation of symptoms including chest pressure, palpitations, lightheadedness, dyspnea on exertion, and presyncope for several days prior to admission. On [**3-11**] she presented to her cardiologist's office where TTE showed (NEW?) aortic stenosis. EKG revealed Afib with ST segment and T wave abnormalities in the inferior and lateral leads. She was admitted to an OSH for further evaluation. Given the severity of aortic stenosis seen on echo, she was referred to [**Hospital1 18**] for right and left cardiac catheterization and for a surgical evaluation for an aortic valve replacement. Past Medical History: Aortic Stenosis, s/p AVR cecal perforation, s/p ex-lap, right hemicolectomy PMH: Hypertension Hyperlipidemia Afib CKD (stage II) Chronic pedal edema ? meningioma Degenerative arthritis Gout L great toe Social History: Lives alone. Previously a teacher, now [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and writer. - Tobacco history: quit [**2142**] - ETOH: 1/month - Illicit drugs: denies Family History: Mother with CHF in her 70s, Father died of CVA at age [**Age over 90 **], prostate cancer. No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Physical Exam: Pulse:59 Resp:18 O2 sat:98/RA B/P 117/68 Height:5'4" Weight:157 lbs General: Skin: intact [x] HEENT: EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur [x] grade 3 systolic, best heard at R 2nd rib interspace Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema [-] _____ Varicosities: None [x] Neuro: Grossly intact [x] Pulses: Femoral Right: Left: DP Right: 1+ Left:1+ Radial Right: Left: Carotid Bruit Right: none Left: none Pertinent Results: [**2177-3-25**] - ECHO PREBYPASS: Preserved LV systolic function with LVEF > 55%. The left atrium is mildly dilated. There is severe symmetric left ventricular hypertrophy. Right ventricular chamber size and free wall motion are normal. The ascending, transverse and descending thoracic aorta are normal in diameter and have minimal atherosclerotic plaque. The aortic valve leaflets are severely thickened/deformed. There is critical aortic valve stenosis (valve area <0.8cm2). The mitral valve leaflets are mildly thickened. Mild to moderate ([**12-9**]+) mitral regurgitation is seen. Mild TR, Mild PI. There is no pericardial effusion. No PFO, No clot in LAA seen. POSTBYPASS: Normally functioning AV prosthesis in place. No AI No AS. Otherwise unchanged. [**2177-3-31**] Chest XRay Final Report CHEST RADIOGRAPH INDICATION: Followup to look for free intraperitoneal air. TECHNIQUE: Upright and lateral chest views were read in comparison with the prior radiograph from [**2177-3-30**]. FINDINGS: Large free intraperitoneal air has substantially increased over the last 24 hours. Right-sided PICC line tip ends at lower SVC/cavoatrial junction. Mildly enlarged heart size is stable. Mediastinal and hilar contours are unremarkable. Both lungs are clear, no opacities concerning for pneumonia or aspiration. There is evidence of prior median sternotomy and sternal sutures are intact. IMPRESSION: Large free intraperitoneal air substantially increased over the last 24 hours. Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] discussed the findings with [**Last Name (LF) **], [**First Name4 (NamePattern1) 1439**] [**Last Name (NamePattern1) **], by phone on [**2177-3-31**] at 9:14 a.m. The study and the report were reviewed by the staff radiologist. DR. [**First Name8 (NamePattern2) 16988**] [**Name (STitle) 16989**] DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**] Approved: MON [**2177-3-31**] 11:43 AM Imaging Lab There is no report history available for viewing. . [**2177-4-4**] Abd Final Report INDICATION: Recent colectomy. Evaluation for ileus or obstruction. COMPARISON: [**2177-4-1**]. FINDINGS: Supine and upright abdominal radiographs demonstrate dilated loops of small bowel and air-fluid levels measuring up to 5 cm in diameter. There is no evidence of free intraperitoneal air. Midline surgical staples are noted. Mild left pleural effusion is unchanged. Osseous structures are unremarkable. FINDINGS: Marked small-bowel dilatation, most likely representing post-operative ileus. However, if there is concern for obstruction, CT would be beneficial. The study and the report were reviewed by the staff radiologist. DR. [**First Name (STitle) 251**] [**Name (STitle) 20492**] DR. [**First Name (STitle) 5432**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Approved: SAT [**2177-4-5**] 9:46 AM . [**2177-4-8**] 05:11AM BLOOD WBC-13.5* RBC-3.59* Hgb-10.6* Hct-33.7* MCV-94 MCH-29.6 MCHC-31.5 RDW-14.8 Plt Ct-416 [**2177-4-7**] 05:45AM BLOOD WBC-12.5* RBC-3.80* Hgb-11.0* Hct-36.0 MCV-95 MCH-28.8 MCHC-30.5* RDW-15.2 Plt Ct-425 [**2177-4-8**] 05:11AM BLOOD PT-29.8* INR(PT)-2.9* [**2177-4-7**] 05:45AM BLOOD PT-34.2* INR(PT)-3.3* [**2177-4-6**] 05:27AM BLOOD PT-29.8* INR(PT)-2.9* [**2177-4-5**] 04:01AM BLOOD PT-17.5* INR(PT)-1.6* [**2177-4-4**] 04:32AM BLOOD PT-16.0* INR(PT)-1.5* [**2177-4-3**] 05:08AM BLOOD PT-18.3* PTT-32.9 INR(PT)-1.7* [**2177-4-2**] 05:14AM BLOOD PT-30.3* PTT-35.1 INR(PT)-2.9* [**2177-4-1**] 10:57PM BLOOD PT-42.7* PTT-41.3* INR(PT)-4.2* [**2177-4-1**] 02:08AM BLOOD PT-25.8* PTT-32.0 INR(PT)-2.5* [**2177-3-31**] 12:56PM BLOOD PT-22.8* PTT-31.8 INR(PT)-2.2* [**2177-3-31**] 11:14AM BLOOD PT-29.6* PTT-33.5 INR(PT)-2.9* [**2177-3-31**] 06:40AM BLOOD PT-27.2* INR(PT)-2.6* [**2177-3-30**] 09:46PM BLOOD PT-34.0* INR(PT)-3.3* [**2177-3-30**] 12:37PM BLOOD PT-35.6* INR(PT)-3.5* [**2177-4-8**] 05:11AM BLOOD Glucose-114* UreaN-33* Creat-1.7* Na-142 K-4.0 Cl-102 HCO3-32 AnGap-12 [**2177-4-7**] 05:45AM BLOOD Glucose-137* UreaN-35* Creat-1.7* Na-140 K-3.6 Cl-102 HCO3-27 AnGap-15 [**2177-4-6**] 05:27AM BLOOD Glucose-107* UreaN-39* Creat-1.5* Na-140 K-4.1 Cl-103 HCO3-26 AnGap-15 [**2177-4-7**] 05:45AM BLOOD Mg-1.8 Brief Hospital Course: Ms. [**Known lastname 110877**] was admitted to the [**Hospital1 18**] on [**2177-3-24**] for surgical management of her aortic valve disease. She was placed on heparin as she had been off her coumadin for five days. She was worked-up in the usual preoperative manner. On [**2177-3-25**], she was taken to the operating room where she underwent an aortic valve replacement using a tissue valve. Please see operative note for details. Postoperatively she was taken to the intensive care unit for monitoring. On postoperative day one, she was neurologically intact and extubated. Beta blocker was initiated and the patient was gently diuresed toward the preoperative weight. Chest tubes and pacing wires were discontinued without complication. She developed rapid atrial fibrillation. Amiodarone was started and Lopressor titrated. Also, anti-coagulation was intiated with Warfarin. The patient converted to sinus rhythm then developed bradycardia with 1st degree AV block. Amiodarone and lopressor were discontinued. Rapid AFib returned and Lopressor was titrated accordingly. The patient was noted to have free air under the diaphragm on routine CXR. Initially, abdominal exam was benign, she was soft and non-tender. Tenderness developed and the abdomen became distended. Follow-up Abdominal film revealed significant increase in free air. General surgery took the patient emergently to the OR for exploratory laparotomy. She was found to have perforation of the cecum. She underwent a right hemicolectomy on [**2177-3-31**] with Dr. [**Last Name (STitle) **]. Overall, she tolerated this procedure well and was transferred back to CVICU post-operatively. ID was consulted for appropriate antibiotic recommendations. Diet was advanced as tolerated. Coumadin was resumed. The patient was transferred to the telemetry floor for further recovery. The patient was evaluated by the physical therapy service for assistance with strength and mobility. By the time of discharge on post-op days 14 and 8 the patient was ambulating freely, the wounds were healing and pain was controlled with oral analgesics. The patient was discharged home with [**Name (NI) 269**], PT and home infusion services for antibiotics. Appropriate follow-up instructions are given. Dr. [**First Name (STitle) 7756**] will follow the patient's coumadin dosing. She will follow-up with the [**Hospital 2536**] clinic and Cardiac Surgery clinic. Medications on Admission: Lopressor 100(3) Lovenox [**Hospital1 **] Lipitor 40(1) Aspirin 81mg Daily Cipro 250(2) started [**2177-3-19**] for e.coli UTI mupiricin 2%NU [**2177-3-19**] for MSSA swab Discharge Medications: 1. piperacillin-tazobactam 2.25 gram Recon Soln Sig: 2.25 Recon Solns Intravenous Q6H (every 6 hours) for 6 days. Disp:*24 doses* Refills:*0* 2. Outpatient Lab Work Labs: PT/INR for, Dx: AFib Goal INR 2.0 - 2.5 First draw [**2177-4-9**] Dr. [**First Name (STitle) 7756**] to manage via [**Hospital **] clinic Results to phone [**Telephone/Fax (1) 4496**], fax [**Telephone/Fax (1) 71187**] 3. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM: Dose to change daily per Dr. [**First Name (STitle) 7756**] for goal INR 2-2.5, dx: afib. Disp:*30 Tablet(s)* Refills:*2* 4. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day: 400mg daily x 1 week, then 200mg daily until further instructed. Disp:*60 Tablet(s)* Refills:*2* 5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 7. Heparin Flush (10 units/ml) 2 mL IV PRN line flush PICC, heparin dependent: Flush with 10mL Normal Saline followed by Heparin as above daily and PRN per lumen. 8. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 9. furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day for 10 days. Disp:*20 Tablet(s)* Refills:*0* 10. potassium chloride 10 mEq Tablet Extended Release Sig: Two (2) Tablet Extended Release PO twice a day for 10 days. Disp:*40 Tablet Extended Release(s)* Refills:*0* 11. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 12. Outpatient Lab Work CBC, Creatinine, BUN [**2177-4-10**] results to [**Hospital **] clinic: fax: [**Telephone/Fax (1) 11959**] phone: ([**Telephone/Fax (1) 4170**] Discharge Disposition: Home With Service Facility: [**Hospital3 3765**] Hospice Program Discharge Diagnosis: Aortic Stenosis, s/p AVR Cecal perforation, s/p ex-lap, right hemicolectomy PMH: Hypertension Hyperlipidemia Afib CKD (stage II) Chronic pedal edema ? meningioma Degenerative arthritis Gout L great toe Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with tylenol Incisions: Sternal - healing well, no erythema or drainage Abdominal - staples, healing well, no erythema or drainage 2+ Edema bilateral lower extremities Discharge Instructions: 1) Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage. 2) Please NO lotions, cream, powder, or ointments to incisions. 3) Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart provided. 4) No driving for approximately one month and while taking narcotics. Driving will be discussed at follow up appointment with surgeon when you will likely be cleared to drive. 5) No lifting more than 10 pounds for 10 weeks 6) Please call with any questions or concerns [**Telephone/Fax (1) 170**] *Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments: Wound Check [**Hospital Ward Name **] [**Location (un) 551**] [**Hospital Unit Name **] [**2177-4-15**] at 10:30am ACUTE CARE CLINIC Phone:[**Telephone/Fax (1) 600**] Date/Time:[**2177-4-17**] 4:00 Surgeon: Dr. [**Last Name (STitle) **], [**Telephone/Fax (1) 170**], [**2177-5-7**] 1:15 in the [**Hospital **] medical office building [**Hospital Unit Name **], [**Doctor First Name **]. . Cardiologist/PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) 20**] [**Telephone/Fax (1) 71179**], [**2177-4-21**] at 2:00pm . **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Labs: PT/INR for, Dx: AFib Goal INR 2.0 - 2.5 First draw [**2177-4-9**] Dr. [**First Name (STitle) 7756**] to manage via [**Hospital **] clinic Results to phone [**Telephone/Fax (1) 4496**], fax [**Telephone/Fax (1) 71187**] Completed by:[**2177-4-8**]

424,540,428,403,560,599,997,280,458,585,E878,E849,272,427,715,274,V158,041

{'Aortic valve disorders,Acute appendicitis with generalized peritonitis,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Paralytic ileus,Urinary tract infection, site not specified,Other digestive system complications,Iron deficiency anemia secondary to blood loss (chronic),Other iatrogenic hypotension,Chronic kidney disease, Stage II (mild),Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Other and unspecified hyperlipidemia,Atrial fibrillation,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Gout, unspecified,Personal history of tobacco use,Other and unspecified Escherichia coli [E. coli]'}

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, chest pain and pre-syncope PRESENT ILLNESS: 83 year old female transferred from OSH for cardiac catheterization. She had been experiencing a constellation of symptoms including chest pressure, palpitations, lightheadedness, dyspnea on exertion, and presyncope for several days prior to admission. On [**3-11**] she presented to her cardiologist's office where TTE showed (NEW?) aortic stenosis. EKG revealed Afib with ST segment and T wave abnormalities in the inferior and lateral leads. She was admitted to an OSH for further evaluation. Given the severity of aortic stenosis seen on echo, she was referred to [**Hospital1 18**] for right and left cardiac catheterization and for a surgical evaluation for an aortic valve replacement. MEDICAL HISTORY: Aortic Stenosis, s/p AVR cecal perforation, s/p ex-lap, right hemicolectomy PMH: Hypertension Hyperlipidemia Afib CKD (stage II) Chronic pedal edema ? meningioma Degenerative arthritis Gout L great toe MEDICATION ON ADMISSION: Lopressor 100(3) Lovenox [**Hospital1 **] Lipitor 40(1) Aspirin 81mg Daily Cipro 250(2) started [**2177-3-19**] for e.coli UTI mupiricin 2%NU [**2177-3-19**] for MSSA swab ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pulse:59 Resp:18 O2 sat:98/RA B/P 117/68 Height:5'4" Weight:157 lbs FAMILY HISTORY: Mother with CHF in her 70s, Father died of CVA at age [**Age over 90 **], prostate cancer. No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: Lives alone. Previously a teacher, now [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] and writer. - Tobacco history: quit [**2142**] - ETOH: 1/month - Illicit drugs: denies ### Response: {'Aortic valve disorders,Acute appendicitis with generalized peritonitis,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Paralytic ileus,Urinary tract infection, site not specified,Other digestive system complications,Iron deficiency anemia secondary to blood loss (chronic),Other iatrogenic hypotension,Chronic kidney disease, Stage II (mild),Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Other and unspecified hyperlipidemia,Atrial fibrillation,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Gout, unspecified,Personal history of tobacco use,Other and unspecified Escherichia coli [E. coli]'}

CHIEF COMPLAINT: syncope PRESENT ILLNESS: 75 year old female with aortic stenois, mitral stenosis and "previous MI in [**2135**]" and subsequent "small MI" w/ 3 "clean caths" (all per patient report) recent admission to [**Hospital6 **] for pleural effusion, treated with diuretics, p/w non-exertional syncope in setting of diaphoresis/lightheadedness with elevated troponins. She was transferred to [**Hospital1 18**] for further evaluation. She is now being referred to cardiac surgery for an aortic valve replacement. MEDICAL HISTORY: Diabetes Dyslipidemia Hypertension "MI" in [**2135**], [**Hospital3 **] w/ "neg cath", w/ 2 more caths at LGH/[**Hospital 2940**] which were "negative" Atrial fibrillation Anemia with UGIB in [**2139**] Aortic stenosis Mitral stenosis Asthma Past Surgical History: Hysterectomy tonsillectomy MEDICATION ON ADMISSION: gemfibrozil 600mg [**Hospital1 **] metformin 500mg [**Hospital1 **] glimepiride 2mg 1 day isosorbide Imdur 60mg QD aspirin 81mg QD lasix 80mg/40mg QD KCL 10mEq QD omeprazole 40mg [**Hospital1 **] simvastatin 80mg QD vitamin [**2130**] units [**Hospital1 **]? metolazone 2.5mg QD gabapentin 400mg TID tramadol 50mg TID prn pain symbicort 160/4.5 2 puffs qAM/qPM ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Admission: Pulse:76 Resp:24 O2 sat:96/RA B/P Right:147/87 Left:152/60 Height:5'1" Weight:167 lbs FAMILY HISTORY: noncontributory SOCIAL HISTORY: Race:Caucasian Last Dental Exam:> 1 year ago Lives with:Husband Contact: [**First Name8 (NamePattern2) **] [**Name (NI) **] (daughter) Occupation:retired Cigarettes: Smoked no [x] yes [] Other Tobacco use:denies ETOH: < 1 drink/week [x] [**1-22**] drinks/week [] >8 drinks/week [] Illicit drug use:denies

Mitral valve stenosis and aortic valve stenosis,Urinary tract infection, site not specified,Chronic combined systolic and diastolic heart failure,Other acute and subacute forms of ischemic heart disease, other,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Old myocardial infarction,Unspecified essential hypertension,Atrial fibrillation,Asthma, unspecified type, unspecified,Examination of participant in clinical trial,Unspecified hereditary and idiopathic peripheral neuropathy,Chronic gingivitis, plaque induced,Anemia, unspecified,Hypopotassemia

Mitral/aortic stenosis,Urin tract infection NOS,Chr syst/diastl hrt fail,Ac ischemic hrt dis NEC,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Old myocardial infarct,Hypertension NOS,Atrial fibrillation,Asthma NOS,Exam-clincal trial,Idio periph neurpthy NOS,Chronc gingititis,plaque,Anemia NOS,Hypopotassemia

Admission Date: [**2143-5-4**] Discharge Date: [**2143-5-14**] Date of Birth: [**2067-9-9**] Sex: F Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 165**] Chief Complaint: syncope Major Surgical or Invasive Procedure: -cardiac cath -Urgent aortic valve replacement with a size [**Street Address(2) 86239**]. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 4041**] tissue valve History of Present Illness: 75 year old female with aortic stenois, mitral stenosis and "previous MI in [**2135**]" and subsequent "small MI" w/ 3 "clean caths" (all per patient report) recent admission to [**Hospital6 **] for pleural effusion, treated with diuretics, p/w non-exertional syncope in setting of diaphoresis/lightheadedness with elevated troponins. She was transferred to [**Hospital1 18**] for further evaluation. She is now being referred to cardiac surgery for an aortic valve replacement. Past Medical History: Diabetes Dyslipidemia Hypertension "MI" in [**2135**], [**Hospital3 **] w/ "neg cath", w/ 2 more caths at LGH/[**Hospital 2940**] which were "negative" Atrial fibrillation Anemia with UGIB in [**2139**] Aortic stenosis Mitral stenosis Asthma Past Surgical History: Hysterectomy tonsillectomy Social History: Race:Caucasian Last Dental Exam:> 1 year ago Lives with:Husband Contact: [**First Name8 (NamePattern2) **] [**Name (NI) **] (daughter) Occupation:retired Cigarettes: Smoked no [x] yes [] Other Tobacco use:denies ETOH: < 1 drink/week [x] [**1-22**] drinks/week [] >8 drinks/week [] Illicit drug use:denies Family History: noncontributory Physical Exam: Physical Exam on Admission: Pulse:76 Resp:24 O2 sat:96/RA B/P Right:147/87 Left:152/60 Height:5'1" Weight:167 lbs General: NAD Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur [x] grade __systolic grade 2/6____ Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema [x] _1+, had compression stockings on. Varicosities: None [x] Neuro: Grossly intact [x] Pulses: Femoral Right: 2 Left:2 DP Right: 2 Left:2 PT [**Name (NI) 167**]: 2 Left:2 Radial Right: 2 Left:2 Carotid Bruit Right: radiating bruit Left: radiating bruit Pertinent Results: [**2143-5-13**] 05:00AM BLOOD WBC-7.9 RBC-3.59* Hgb-10.1* Hct-31.2* MCV-87 MCH-28.0 MCHC-32.3 RDW-16.8* Plt Ct-176 [**2143-5-4**] 03:15PM BLOOD WBC-6.8 RBC-4.46 Hgb-12.4 Hct-39.1 MCV-88 MCH-27.7 MCHC-31.6 RDW-15.5 Plt Ct-311 [**2143-5-13**] 03:34PM BLOOD PT-15.9* INR(PT)-1.5* [**2143-5-5**] 07:03AM BLOOD PT-11.1 PTT-55.7* INR(PT)-1.0 [**2143-5-14**] 05:03AM BLOOD Glucose-49* UreaN-28* Creat-1.1 Na-135 K-3.2* Cl-94* HCO3-32 AnGap-12 [**2143-5-4**] 03:15PM BLOOD Glucose-102* UreaN-17 Creat-1.0 Na-139 K-3.3 Cl-90* HCO3-29 AnGap-23* [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 111867**], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 111868**] (Complete) Done [**2143-5-10**] at 9:42:39 AM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) **] Division of Cardiothoracic [**Doctor First Name **] [**First Name (Titles) **] [**Last Name (Titles) **] [**Hospital Unit Name 4081**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2067-9-9**] Age (years): 75 F Hgt (in): 61 BP (mm Hg): / Wgt (lb): 168 HR (bpm): BSA (m2): 1.76 m2 Indication: Aortic valve stenosis ? Mitral valve stenosis ICD-9 Codes: 424.1, 424.0 Test Information Date/Time: [**2143-5-10**] at 09:42 Interpret MD: [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3893**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2012AW01-: Machine: Echocardiographic Measurements Results Measurements Normal Range Left Ventricle - Septal Wall Thickness: *1.3 cm 0.6 - 1.1 cm Left Ventricle - Inferolateral Thickness: *1.3 cm 0.6 - 1.1 cm Left Ventricle - Diastolic Dimension: 4.0 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 55% >= 55% Aorta - Ascending: 3.1 cm <= 3.4 cm Aortic Valve - Peak Velocity: *3.4 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: *44 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 21 mm Hg Aortic Valve - LVOT diam: 1.8 cm Aortic Valve - Valve Area: *0.8 cm2 >= 3.0 cm2 Mitral Valve - Peak Velocity: 6.0 m/sec Mitral Valve - Mean Gradient: 2 mm Hg Mitral Valve - Pressure Half Time: 138 ms Mitral Valve - MVA (P [**12-17**] T): 1.6 cm2 Mitral Valve - E Wave: 1.5 m/sec Mitral Valve - A Wave: 0.6 m/sec Mitral Valve - E/A ratio: 2.50 Findings LEFT ATRIUM: Normal LA size. No spontaneous echo contrast or thrombus in the LA/LAA or the RA/RAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or color Doppler. LEFT VENTRICLE: Mild symmetric LVH with normal cavity size. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. Focal calcifications in aortic root. Normal ascending aorta diameter. Focal calcifications in ascending aorta. Normal aortic arch diameter. Focal calcifications in aortic arch. Complex (>4mm) atheroma in the descending thoracic aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). Severe AS (area 0.8-1.0cm2). Mild (1+) AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. No TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: The patient was under general anesthesia throughout the procedure. No TEE related complications. The patient appears to be in sinus rhythm. Resting bradycardia for the patient. See Conclusions for post-bypass data Conclusions PRE-BYPASS: The left atrium is normal in size. No spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy with normal cavity size. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. There are focal calcifications in the aortic arch. There are complex (>4mm) atheroma in the descending thoracic aorta. The aortic valve leaflets (3) are thickened. There is severe aortic valve stenosis (valve area 0.8cm2). Trivial aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild mitral regurgitation is seen. There is no pericardial effusion. Dr. [**First Name (STitle) **] was notified in person of the results before surgical incision. POST-BYPASS: The patient is A paced on low dose phenylephrine infusion. There is a well seated bioprosthetic valve in the aortic position. Peak & mean gradients across the valve are 11mmHg & 4mmHg, respectively. The mitral regurgitation is now moderate. Biventricular function is maintained. The aorta remains intact. [**Male First Name (un) **] appreciated postoperatively, rate reduced, preload & afterload increased with improvement in [**Male First Name (un) **]. Surgeon informed. Intact thoracic aorta. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting physician [**Last Name (NamePattern4) **] [**2143-5-10**] 18:32 ?????? [**2133**] CareGroup IS. All rights reserved. Brief Hospital Course: This 75-year-old patient with a history of aortic stenosis presented with an episode of syncope, and further investigations revealed critical aortic stenosis with mild mitral regurgitation and mild mitral stenosis. The coronary arteries had no significant occlusive disease. In view of her symptoms and the severity of the aortic stenosis, she was kept in-house for urgent aortic valve replacement. The plan was to do the replacement with a tissue valve. On [**2143-5-10**] she was taken to the operating room and underwent an urgent aortic valve replacement with a size [**Street Address(2) 86239**]. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 4041**] tissue valve. cardiopulmonary Bypass time=87minutes. Cross Clamp time=75 minutes.Please refer to operative note for further surgical details. She tolerated the procedure well and was transferred to the CVICU intubated and sedated for hemodynamic monitoring. She awoke neurologically intact and was extubated without difficulty. She weaned off pressor support. Beta-blocker, statin, aspirin and diuresis were initiated. All lines and drains were discontiued per protocol. She continued to progress and was transferred to the step down unit on POD#2. Physical Therapy was consulted for evaluation of strength and mobility. Postoperatively her rhythm remained in her preop paroxysmal atrial fibrillation. Per Dr.[**First Name (STitle) **], she was not anticoagulated due to her history of GI bleed. Her rhythm was mostly rate controlled with some bursts of atrial fibrillation with rapid ventricular response rate treated with extra beta-blocker and electrolyte repletion. The remainder of her hospital course was essentially uneventful. She continued to progress and on POD# 4 she was discharged to [**Hospital3 **] in NH. All follow up appointments were advised. Medications on Admission: gemfibrozil 600mg [**Hospital1 **] metformin 500mg [**Hospital1 **] glimepiride 2mg 1 day isosorbide Imdur 60mg QD aspirin 81mg QD lasix 80mg/40mg QD KCL 10mEq QD omeprazole 40mg [**Hospital1 **] simvastatin 80mg QD vitamin [**2130**] units [**Hospital1 **]? metolazone 2.5mg QD gabapentin 400mg TID tramadol 50mg TID prn pain symbicort 160/4.5 2 puffs qAM/qPM Discharge Medications: 1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO DAILY (Daily) as needed for constipation. 4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 7. cholecalciferol (vitamin D3) 1,000 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 9. metolazone 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. glimepiride 2 mg Tablet Sig: One (1) Tablet PO daily (). 11. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day) as needed for wheezing, sob. 12. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 13. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*45 Tablet(s)* Refills:*0* 14. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day). 16. potassium chloride 10 mEq Tablet Extended Release Sig: Four (4) Tablet Extended Release PO BID (2 times a day). 17. insulin regular human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 18. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital3 7665**] Discharge Diagnosis: primary: aortic stenosis -status post Urgent aortic valve replacement with a size [**Street Address(2) 64790**]. [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 4041**] tissue valve Secondary: Diabetes Dyslipidemia Hypertension "MI" in [**2135**], [**Hospital3 **] w/ "neg cath", w/ 2 more caths at LGH/[**Hospital 2940**] which were "negative" Atrial fibrillation Anemia with UGIB in [**2139**] Aortic stenosis Mitral stenosis Asthma Past Surgical History: Hysterectomy tonsillectomy Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with oral analgesia Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments Surgeon: Dr.[**First Name (STitle) **], MD Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2143-6-11**] 2:15 Cardiologist/PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **] [**Telephone/Fax (1) 63780**] please call to set up an appointment in [**12-17**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2143-5-14**]

396,599,428,411,250,272,412,401,427,493,V707,356,523,285,276

{'Mitral valve stenosis and aortic valve stenosis,Urinary tract infection, site not specified,Chronic combined systolic and diastolic heart failure,Other acute and subacute forms of ischemic heart disease, other,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Old myocardial infarction,Unspecified essential hypertension,Atrial fibrillation,Asthma, unspecified type, unspecified,Examination of participant in clinical trial,Unspecified hereditary and idiopathic peripheral neuropathy,Chronic gingivitis, plaque induced,Anemia, unspecified,Hypopotassemia'}

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: syncope PRESENT ILLNESS: 75 year old female with aortic stenois, mitral stenosis and "previous MI in [**2135**]" and subsequent "small MI" w/ 3 "clean caths" (all per patient report) recent admission to [**Hospital6 **] for pleural effusion, treated with diuretics, p/w non-exertional syncope in setting of diaphoresis/lightheadedness with elevated troponins. She was transferred to [**Hospital1 18**] for further evaluation. She is now being referred to cardiac surgery for an aortic valve replacement. MEDICAL HISTORY: Diabetes Dyslipidemia Hypertension "MI" in [**2135**], [**Hospital3 **] w/ "neg cath", w/ 2 more caths at LGH/[**Hospital 2940**] which were "negative" Atrial fibrillation Anemia with UGIB in [**2139**] Aortic stenosis Mitral stenosis Asthma Past Surgical History: Hysterectomy tonsillectomy MEDICATION ON ADMISSION: gemfibrozil 600mg [**Hospital1 **] metformin 500mg [**Hospital1 **] glimepiride 2mg 1 day isosorbide Imdur 60mg QD aspirin 81mg QD lasix 80mg/40mg QD KCL 10mEq QD omeprazole 40mg [**Hospital1 **] simvastatin 80mg QD vitamin [**2130**] units [**Hospital1 **]? metolazone 2.5mg QD gabapentin 400mg TID tramadol 50mg TID prn pain symbicort 160/4.5 2 puffs qAM/qPM ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam on Admission: Pulse:76 Resp:24 O2 sat:96/RA B/P Right:147/87 Left:152/60 Height:5'1" Weight:167 lbs FAMILY HISTORY: noncontributory SOCIAL HISTORY: Race:Caucasian Last Dental Exam:> 1 year ago Lives with:Husband Contact: [**First Name8 (NamePattern2) **] [**Name (NI) **] (daughter) Occupation:retired Cigarettes: Smoked no [x] yes [] Other Tobacco use:denies ETOH: < 1 drink/week [x] [**1-22**] drinks/week [] >8 drinks/week [] Illicit drug use:denies ### Response: {'Mitral valve stenosis and aortic valve stenosis,Urinary tract infection, site not specified,Chronic combined systolic and diastolic heart failure,Other acute and subacute forms of ischemic heart disease, other,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Old myocardial infarction,Unspecified essential hypertension,Atrial fibrillation,Asthma, unspecified type, unspecified,Examination of participant in clinical trial,Unspecified hereditary and idiopathic peripheral neuropathy,Chronic gingivitis, plaque induced,Anemia, unspecified,Hypopotassemia'}

CHIEF COMPLAINT: sepsis, hypotension, cellulitis PRESENT ILLNESS: 71 YO M w AFIB, vasculopath w 4.5cm AAA s/p R profunda-[**Doctor Last Name **] bypass ([**11-20**]) and left common femoral to anterior tibial bypass ([**12/2131**]) who presented after his son noted him to be altered for several hours at home. The patient's sister spoke with the patient at 6pm on the night prior to admission at which time he was alert, oriented and acting normally. . In the ED, the patient was initially triggered for nursing concern. His first documented VS were: 98.6 --> 104 108 145/67 24 99% on NRB --> 96%4L. He was oriented to self only and had extensive RLE cellulitis from the groin covering the entire leg with initial c/f Fournier's. Labs were notable for WBC 13.6 with left shift (3% bands, 1% metas), Plts 84K, lactate 4.4 --> 4.0. U/A was negative for infection. Blood and urine cultures were sent. CXR showed mild pulm congestion. The patient was intubated w a 7.5 ett, etomidate and succinylcholine for airway protection in order to complete a CT torso. CT torso was c/f bibasilar aspiration but no evidence of Fournier's or abscess. After return from CT, the patient was noted to be in a SVT to the 160s. He was given bolus amiodarone and started on an amio gtt. He was thereafter hypotensive to the high 70s so was started on levophed. A subclavian CVL was placed. He was given vanc, cipro and flagyl along with 6-8L NS. [**Year (4 digits) **] and general surgery were called and neither team reportedly felt there was any indication for surgical intervention. VS prior to transfer: 87 99/62 22 100% VENT 500/22/5/0.5. MEDICAL HISTORY: PMH: Hypertension, hyperlipidemia, atrial fibrillation (s/p cardioversion), rheumatoid arthritis, prostate cancer (XRT), neuropathy, lumbar spinal stenosis, rosacea, ocular migraines, RA, AAA-being followed MEDICATION ON ADMISSION: FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth once a day METHYLPREDNISOLONE - (Prescribed by Other Provider; Dose adjustment - no new Rx) - 4 mg Tablet - 2 Tablet(s) by mouth METOPROLOL SUCCINATE - 100mg qd OXYCODONE-ACETAMINOPHEN - 5 mg-325 mg Tablet - 1 Tablet(s) by mouth as needed for pain SIMVASTATIN - 10 mg Tablet - 2 Tablet(s) by mouth DAILY (Daily) DIGOXIN - unknown dose ALLERGIES: Penicillins PHYSICAL EXAM: VS: 97, HR 69 BP 144/86 16 96% on RA In: 1000cc Out 1700cc GENERAL: Well-appearing obese man in NAD, alert and oriented X3. FAMILY HISTORY: Parents both smokers and died of lung cancer, father at 57 [**Name2 (NI) **] and mother at [**Age over 90 **] [**Name2 (NI) **]. SOCIAL HISTORY: Normally lives alone, independent. Previously in [**Hospital 38**] Rehab. Retired security guard. H/o tobacco use 2 ppd x 40 years, quit 18 years ago. H/o heavy EtOH use (beer) for many years, stopped few months ago. Denies illicit drug use. Able to drive on his own, buys his own groceries. Has son and sister who are his support structure.

Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Cellulitis and abscess of leg, except foot,Atrial flutter,Severe sepsis,Abdominal aneurysm without mention of rupture,Peripheral vascular disease, unspecified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Rheumatoid arthritis,Long-term (current) use of steroids,Personal history of malignant neoplasm of prostate

Septicemia NOS,Septic shock,Food/vomit pneumonitis,Cellulitis of leg,Atrial flutter,Severe sepsis,Abdom aortic aneurysm,Periph vascular dis NOS,Thrombocytopenia NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Anemia NOS,Rheumatoid arthritis,Long-term use steroids,Hx-prostatic malignancy

Admission Date: [**2133-3-10**] Discharge Date: [**2133-3-14**] Date of Birth: [**2061-8-12**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 2641**] Chief Complaint: sepsis, hypotension, cellulitis Major Surgical or Invasive Procedure: Central line placement Intubation History of Present Illness: 71 YO M w AFIB, vasculopath w 4.5cm AAA s/p R profunda-[**Doctor Last Name **] bypass ([**11-20**]) and left common femoral to anterior tibial bypass ([**12/2131**]) who presented after his son noted him to be altered for several hours at home. The patient's sister spoke with the patient at 6pm on the night prior to admission at which time he was alert, oriented and acting normally. . In the ED, the patient was initially triggered for nursing concern. His first documented VS were: 98.6 --> 104 108 145/67 24 99% on NRB --> 96%4L. He was oriented to self only and had extensive RLE cellulitis from the groin covering the entire leg with initial c/f Fournier's. Labs were notable for WBC 13.6 with left shift (3% bands, 1% metas), Plts 84K, lactate 4.4 --> 4.0. U/A was negative for infection. Blood and urine cultures were sent. CXR showed mild pulm congestion. The patient was intubated w a 7.5 ett, etomidate and succinylcholine for airway protection in order to complete a CT torso. CT torso was c/f bibasilar aspiration but no evidence of Fournier's or abscess. After return from CT, the patient was noted to be in a SVT to the 160s. He was given bolus amiodarone and started on an amio gtt. He was thereafter hypotensive to the high 70s so was started on levophed. A subclavian CVL was placed. He was given vanc, cipro and flagyl along with 6-8L NS. [**Year (4 digits) **] and general surgery were called and neither team reportedly felt there was any indication for surgical intervention. VS prior to transfer: 87 99/62 22 100% VENT 500/22/5/0.5. Past Medical History: PMH: Hypertension, hyperlipidemia, atrial fibrillation (s/p cardioversion), rheumatoid arthritis, prostate cancer (XRT), neuropathy, lumbar spinal stenosis, rosacea, ocular migraines, RA, AAA-being followed PSH: right right profunda to BK-[**Doctor Last Name **] bypass ([**2131-11-16**]), angioplasty left [**Doctor Last Name **] artery and left AT ([**9-19**]), debridement left lateral malleolar ulcer ([**10-20**]), split-thickness skin [**Month/Year (2) **] to left lateral malleolar ulcer ([**10-20**]), dx angio ([**11-19**]) Social History: Normally lives alone, independent. Previously in [**Hospital 38**] Rehab. Retired security guard. H/o tobacco use 2 ppd x 40 years, quit 18 years ago. H/o heavy EtOH use (beer) for many years, stopped few months ago. Denies illicit drug use. Able to drive on his own, buys his own groceries. Has son and sister who are his support structure. Family History: Parents both smokers and died of lung cancer, father at 57 [**Name2 (NI) **] and mother at [**Age over 90 **] [**Name2 (NI) **]. Physical Exam: VS: 97, HR 69 BP 144/86 16 96% on RA In: 1000cc Out 1700cc GENERAL: Well-appearing obese man in NAD, alert and oriented X3. HEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear. NECK: Supple, no thyromegaly, no JVD, no carotid bruits. LUNGS: rhoncorous, no crackles auscultated, no wheezes. HEART: regular,no murmurs auscultated, distant heart sounds, S1 , S2. ABDOMEN: Soft/NT/ND, no masses or HSM, + BS no rebound/guarding, obese. EXTREMITIES: B/L medial scars from bypass surgery appear well-healed, dopplerable peripheral pulses, + chronic venous dermatitis; mild warmth, mild erthema (mostly ant tibial and groin - not involving the scrotum), , pitting (1+ of RLE to mid calves, + right inguinal LAD . Non pitting edema to 1+ edema of left lower extremity to mid calf. Pertinent Results: Admission Labs [**2133-3-10**] 10:37PM TYPE-MIX COMMENTS-GREEN-TOP [**2133-3-10**] 10:37PM LACTATE-1.7 [**2133-3-10**] 10:37PM O2 SAT-87 [**2133-3-10**] 10:26PM GLUCOSE-178* UREA N-21* CREAT-1.1 SODIUM-136 POTASSIUM-4.5 CHLORIDE-106 TOTAL CO2-24 ANION GAP-11 [**2133-3-10**] 10:26PM CK(CPK)-113 [**2133-3-10**] 10:26PM CK-MB-6 cTropnT-0.08* [**2133-3-10**] 10:26PM CALCIUM-7.5* PHOSPHATE-4.7*# MAGNESIUM-2.1 [**2133-3-10**] 10:26PM WBC-20.9* RBC-3.49* HGB-10.0* HCT-31.2* MCV-89 MCH-28.7 MCHC-32.2 RDW-17.3* [**2133-3-10**] 10:26PM PLT COUNT-68* [**2133-3-10**] 04:29PM TYPE-MIX COMMENTS-GREEN-TOP [**2133-3-10**] 04:29PM LACTATE-2.5* [**2133-3-10**] 04:29PM O2 SAT-94 [**2133-3-10**] 04:09PM TYPE-ART PO2-95 PCO2-36 PH-7.36 TOTAL CO2-21 BASE XS--4 [**2133-3-10**] 04:09PM LACTATE-2.2* [**2133-3-10**] 11:50AM TYPE-ART TEMP-38.0 RATES-22/22 TIDAL VOL-500 PEEP-5 O2-50 PO2-113* PCO2-38 PH-7.35 TOTAL CO2-22 BASE XS--3 INTUBATED-INTUBATED VENT-CONTROLLED [**2133-3-10**] 11:50AM LACTATE-2.9* [**2133-3-10**] 11:50AM O2 SAT-97 [**2133-3-10**] 11:50AM freeCa-1.09* [**2133-3-10**] 11:31AM GLUCOSE-147* UREA N-20 CREAT-1.2 SODIUM-142 POTASSIUM-2.9* CHLORIDE-108 TOTAL CO2-22 ANION GAP-15 [**2133-3-10**] 11:31AM CK(CPK)-118 [**2133-3-10**] 11:31AM CK-MB-4 cTropnT-0.13* [**2133-3-10**] 11:31AM CALCIUM-7.3* PHOSPHATE-1.5* MAGNESIUM-1.4* [**2133-3-10**] 11:31AM WBC-31.2*# RBC-3.89* HGB-11.0* HCT-34.3* MCV-88 MCH-28.3 MCHC-32.1 RDW-17.1* [**2133-3-10**] 11:31AM NEUTS-85* BANDS-3 LYMPHS-7* MONOS-5 EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 [**2133-3-10**] 11:31AM HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-OCCASIONAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL OVALOCYT-OCCASIONAL [**2133-3-10**] 11:31AM PLT SMR-LOW PLT COUNT-92* [**2133-3-10**] 10:38AM TYPE-MIX COMMENTS-GREEN TOP [**2133-3-10**] 10:38AM LACTATE-4.1* [**2133-3-10**] 10:38AM O2 SAT-86 [**2133-3-10**] 08:23AM freeCa-1.08* [**2133-3-10**] 05:40AM LACTATE-4.4* [**2133-3-10**] 05:30AM GLUCOSE-149* UREA N-25* CREAT-1.2 SODIUM-140 POTASSIUM-3.4 CHLORIDE-102 TOTAL CO2-24 ANION GAP-17 [**2133-3-10**] 05:30AM estGFR-Using this [**2133-3-10**] 05:30AM ALT(SGPT)-17 AST(SGOT)-26 LD(LDH)-244 CK(CPK)-75 ALK PHOS-68 TOT BILI-0.4 [**2133-3-10**] 05:30AM CK-MB-2 cTropnT-0.04* [**2133-3-10**] 05:30AM ALBUMIN-3.7 CALCIUM-9.2 PHOSPHATE-1.5*# MAGNESIUM-1.7 [**2133-3-10**] 05:30AM TRIGLYCER-83 [**2133-3-10**] 05:30AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2133-3-10**] 05:30AM WBC-13.6*# RBC-4.36*# HGB-12.5*# HCT-37.7*# MCV-87 MCH-28.6 MCHC-33.0 RDW-17.5* [**2133-3-10**] 05:30AM NEUTS-91* BANDS-3 LYMPHS-3* MONOS-2 EOS-0 BASOS-0 ATYPS-0 METAS-1* MYELOS-0 [**2133-3-10**] 05:30AM PT-12.7 PTT-19.1* INR(PT)-1.1 [**2133-3-10**] 05:30AM PT-12.7 PTT-19.1* INR(PT)-1.1 [**2133-3-10**] 05:30AM FIBRINOGE-463*# [**2133-3-10**] 05:20AM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.007 [**2133-3-10**] 05:20AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG . Discharge Labs [**2133-3-14**] 07:15AM BLOOD WBC-10.5 RBC-3.58* Hgb-10.0* Hct-31.1* MCV-87 MCH-27.9 MCHC-32.1 RDW-17.4* Plt Ct-106* [**2133-3-13**] 06:30AM BLOOD WBC-17.2* RBC-3.33* Hgb-9.3* Hct-29.2* MCV-88 MCH-27.8 MCHC-31.7 RDW-17.2* Plt Ct-88* [**2133-3-13**] 06:30AM BLOOD Neuts-93.6* Lymphs-3.9* Monos-1.5* Eos-0.8 Baso-0.2 [**2133-3-12**] 07:25AM BLOOD Neuts-94.6* Lymphs-3.2* Monos-2.0 Eos-0.1 Baso-0.1 [**2133-3-11**] 04:16AM BLOOD Neuts-84* Bands-14* Lymphs-0 Monos-2 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2133-3-14**] 07:15AM BLOOD Plt Ct-106* [**2133-3-13**] 06:30AM BLOOD Plt Ct-88* [**2133-3-12**] 07:25AM BLOOD Plt Ct-73* [**2133-3-11**] 04:16AM BLOOD Plt Ct-67* [**2133-3-10**] 05:30AM BLOOD Fibrino-463*# [**2133-3-12**] 07:25AM BLOOD Ret Aut-1.6 [**2133-3-14**] 07:15AM BLOOD Glucose-100 UreaN-16 Creat-0.9 Na-144 K-4.1 Cl-106 HCO3-32 AnGap-10 [**2133-3-13**] 06:30AM BLOOD Glucose-112* UreaN-22* Creat-1.0 Na-137 K-3.6 Cl-104 HCO3-27 AnGap-10 [**2133-3-12**] 07:25AM BLOOD Glucose-117* UreaN-19 Creat-1.1 Na-138 K-4.0 Cl-106 HCO3-28 AnGap-8 [**2133-3-13**] 06:30AM BLOOD CK-MB-3 cTropnT-0.12* [**2133-3-11**] 05:56AM BLOOD CK-MB-6 cTropnT-0.09* [**2133-3-10**] 10:26PM BLOOD CK-MB-6 cTropnT-0.08* [**2133-3-10**] 11:31AM BLOOD CK-MB-4 cTropnT-0.13* [**2133-3-10**] 05:30AM BLOOD CK-MB-2 cTropnT-0.04* [**2133-3-14**] 07:15AM BLOOD Calcium-8.5 Phos-4.1 Mg-1.8 [**2133-3-13**] 06:30AM BLOOD Calcium-8.4 Phos-3.3 Mg-1.7 [**2133-3-12**] 07:25AM BLOOD Calcium-8.0* Phos-3.0 Mg-2.1 Iron-19* [**2133-3-12**] 07:25AM BLOOD calTIBC-251* Ferritn-214 TRF-193* [**2133-3-11**] 05:56AM BLOOD Digoxin-0.5* [**2133-3-10**] 10:38AM BLOOD Lactate-4.1* [**2133-3-10**] 11:50AM BLOOD Lactate-2.9* [**2133-3-10**] 10:37PM BLOOD Lactate-1.7 [**2133-3-11**] 06:12AM BLOOD Lactate-1.4 [**2133-3-11**] 11:02AM BLOOD Lactate-1.4 . Reports [**3-10**] EKG Atrial tachycardia. Leftward axis. RSR' pattern in leads V1-V2. ST-T wave abnormalities. Since the previous tracing of [**2132-1-3**] the rate is faster. Atrial tachycardia is new. Axis is more leftward. ST-T wave abnormalities are more marked. . [**3-10**] CT head IMPRESSION: No evidence of an acute pathologic intracranial process. MRI would be more sensitive for small lesions, if indicated. . [**3-10**] CXR IMPRESSION: Low lung volumes. Stable moderate cardiomegaly. No acute cardiopulmonary process. . [**3-10**] Ct abdomen 1. No CT evidence of intra-abdominal infection or Fournier gangrene. 2.4 cm necrotic-appearing right inguinal lymph node, likely reactive from the known right lower extremity cellulitis. 2. Fusiform infrarenal abdominal aortic aneurysm measures up to 4.7 cm in diameter, which has increased from the last documented size of 4.2 cm in the inhouse abdominal ultrasound on [**2130-9-10**]. Unchanged thrombosed [**Female First Name (un) 899**]. 3. Focal airspace consolidation in the right medial base, compatible with pneumonia. 4. Cholelithiasis without acute cholecystitis. 5. Bypass grafts originating the left superficial femoral artery and the right deep femoral artery, incompletely imaged but grossly patent. . [**3-12**] CXR IMPRESSION: 1. No evidence of aspiration. 2. Stable cardiomegaly. 3. Stable mild bibasilar atelectasis and small pleural effusions. Brief Hospital Course: Mr [**Known lastname 12130**] is 71 year old Male with Atrial Fibrillation and vasculopathy presented with hypotension and chills/fever with evidence of bilateral aspiration and right leg cellulitis. He was briefly intubated and on vasopressors in the ICU and was subsequently hemodynamically stable after transfer to the floor. . # Septic shock. Hypotension may be largely attributed to amiodarone and propofol given the ED although given additional evidence of infection, he was treated as though he had septic shock with vancomycin and Zosyn initially. He responded to intravenous fluids and was hemodynamically stable off vasopressors. His left lower extremity cellulitis was the likely source of his infection. He additionally had evidence of aspiration on CT, however he never had signs or symptoms of a pneumonia and follow up Chest xray was negative for pneumonia. Given this, he was transitioned to clindamycin to cover MRSA cellulitis. He was initially covered with 20mg methylprednisolone given home steroid use, which was later transitioned back to his 8mg daily methylprednisone dose after he was hemodynamically stable. Sputum cultures grew sparse yeast and Blood cultures are pending at the time of discharge Surgery recs for lower extremities included bilateral ACE wraps and leg elevation . # SVT. He had an episode of heart rate in the 160s after intubation, by ECG this was diagnosed as either atrial tachycardia or atrial flutter. This responded to amiodarone. He had no further episodes of tachycardia while monitored on telemetry. He has a history of atrial fibrillation with a CHADS score of 1. However he is not on Coumadin because his INR was difficult to control. Therefore, he has been managed on full-dose aspirin which was continued on discharge.He had his home metoprolol, and home digoxin restarted. . # Altered mental status requiring intubation. This was likely secondary to infection. CT head was negative for any acute process. This had resolved by the time of transfer to the floor. . # Questionable Initial hypoxia. While on the floor, he tolerated room air well with oxygen saturation above 96% and no complaints of significant cough. Despite receiving 6-8 liters of fluid he did not appear fluid overloaded on exam on the wards. His home Lasix was initially held in the setting of hypotension and subsequently restarted after transfer to the floor. . # Thrombocytopenia. Relatively chronically stable in the 60s to 70s. No evidence of cirrhosis on CT scan of abdomen, INR and fibrinogen is normal. Blood smear did show evidence of MDS which he needs outpatient hematology oncology followup for. . #Anemia- His Hct has been around 30 for several years. His Hct trended down during his hospitalization, however this likely just reflects recussication with large volumes. Sent iron studies which indicated iron deficiency and was started on iron supplements. . #HTN: Restarted home Lasix and metoprolol after transfer to the floor. . #Troponin leak- had troponin elevation in the setting of hypotension and tachycardia up to 0.14 with normal CK-MB. His EKG was unremarkable on the floor with some nonspecific lateral ST changes in V5-V6. The patient denied chest pain or pressure. His troponin remains elevated to 0.12 with normal CK Mb and without EKG changes and clinical symptoms. Cardiology was not impressed with the clinical scenario and the patient was discharged with cardiology follow up. Consider outpatient cardiac stress test. Blood smear and thrombocytopenia is concerning for MDS- please have the patient see Hematology/Oncology as a outpatient. Consider outpatient cardiac stress test given troponin leak per above. Needs podiatry follow up for small ulcer on the third right digit on right foot. Medications on Admission: FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth once a day METHYLPREDNISOLONE - (Prescribed by Other Provider; Dose adjustment - no new Rx) - 4 mg Tablet - 2 Tablet(s) by mouth METOPROLOL SUCCINATE - 100mg qd OXYCODONE-ACETAMINOPHEN - 5 mg-325 mg Tablet - 1 Tablet(s) by mouth as needed for pain SIMVASTATIN - 10 mg Tablet - 2 Tablet(s) by mouth DAILY (Daily) DIGOXIN - unknown dose Medications - OTC ASPIRIN - (OTC) - 81 mg Tablet, Delayed Release (E.C.) - 1 Tablet(s) by mouth once a day CALCIUM CARBONATE - (Prescribed by Other Provider) - Dosage uncertain MULTIVITAMIN,TX-MINERALS [MULTI-VITAMIN HP/MINERALS] - (Prescribed by Other Provider) - Capsule - 1 Capsule(s) by mouth DAILY (Daily) Discharge Medications: 1. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. ferrous sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. clindamycin HCl 150 mg Capsule Sig: Three (3) Capsule PO Q6H (every 6 hours) for 7 days: Please take to [**3-19**]. Disp:*63 Capsule(s)* Refills:*0* 8. loperamide 2 mg Capsule Sig: One (1) Capsule PO QID (4 times a day) as needed for diarrhea . Disp:*30 Capsule(s)* Refills:*0* 9. metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: 1.5 Tablet Extended Release 24 hrs PO once a day. Disp:*45 Tablet Extended Release 24 hr(s)* Refills:*0* 10. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice a day: Do not take if have diarrhea. Disp:*60 Capsule(s)* Refills:*0* 11. senna 8.6 mg Tablet Sig: One (1) Tablet PO once a day as needed for constipation: Do not take if have diarrhea. Disp:*30 Tablet(s)* Refills:*0* 12. methylprednisolone 4 mg Tablet Sig: Two (2) Tablet PO once a day. Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Primary Diagnosis -Altered mental status -Hypotension -Aspiration pneumonitis Secondary Diagnosis -PVD -HTN -Atrial fibrilliation/flutter Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: It was a pleasure to care for you as your doctor. You were brought to the hospital after you were observed to be confused. You were briefly put on a respiratory machine and given medication to support your blood pressure. After intravenous fluids and antibiotics you stabilized and were transferred to the medical floor. Your intravenous antibiotics were converted to oral antibiotics and you were discharged home. We made the following changes to your home medication list: -INCREASE metoprolol from 100mg to 150mg daily -START Clindamycin (an antibiotic to treat your skin infection) until [**2133-3-19**]. -START loperamide as needed for diarrhea -START ferrous sulfate (iron) for anemia --> while taking ferrous sulfate (iron), you may have constipation, so please also START docusate and senna for constipation once your diarrhea resolves See below for outpatient follow-up appointments. Followup Instructions: Department: [**Year (4 digits) **] SURGERY When: THURSDAY [**2133-3-26**] at 10:00 AM With: [**Year (4 digits) **] LAB [**Telephone/Fax (1) 1237**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: [**Hospital **] HEALTHCARE OF [**Location (un) **] When: FRIDAY [**2133-3-20**] at 11:40 AM With: [**First Name11 (Name Pattern1) 20**] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 3070**] Building: [**Street Address(2) 8172**] ([**Location (un) 620**], MA) Ground Campus: OFF CAMPUS Best Parking: Parking on Site Department: PODIATRY When: FRIDAY [**2133-3-20**] at 3:50 PM With: [**Known firstname **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 542**], DPM [**Telephone/Fax (1) 543**] Building: Ba [**Hospital Unit Name 723**] ([**Hospital Ward Name 121**] Complex) [**Location (un) **] Campus: WEST Best Parking: [**Street Address(1) 592**] Garage Name: [**Last Name (LF) **], [**First Name7 (NamePattern1) 122**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Specialty: Cardiology Address: [**Street Address(2) 3001**] [**Location (un) 620**] [**Numeric Identifier 3002**] Phone: [**Telephone/Fax (1) 4105**] Appointment: Monday [**3-23**] at 3:45PM

038,785,507,682,427,995,441,443,287,401,272,285,714,V586,V104

{'Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Cellulitis and abscess of leg, except foot,Atrial flutter,Severe sepsis,Abdominal aneurysm without mention of rupture,Peripheral vascular disease, unspecified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Rheumatoid arthritis,Long-term (current) use of steroids,Personal history of malignant neoplasm of prostate'}

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: sepsis, hypotension, cellulitis PRESENT ILLNESS: 71 YO M w AFIB, vasculopath w 4.5cm AAA s/p R profunda-[**Doctor Last Name **] bypass ([**11-20**]) and left common femoral to anterior tibial bypass ([**12/2131**]) who presented after his son noted him to be altered for several hours at home. The patient's sister spoke with the patient at 6pm on the night prior to admission at which time he was alert, oriented and acting normally. . In the ED, the patient was initially triggered for nursing concern. His first documented VS were: 98.6 --> 104 108 145/67 24 99% on NRB --> 96%4L. He was oriented to self only and had extensive RLE cellulitis from the groin covering the entire leg with initial c/f Fournier's. Labs were notable for WBC 13.6 with left shift (3% bands, 1% metas), Plts 84K, lactate 4.4 --> 4.0. U/A was negative for infection. Blood and urine cultures were sent. CXR showed mild pulm congestion. The patient was intubated w a 7.5 ett, etomidate and succinylcholine for airway protection in order to complete a CT torso. CT torso was c/f bibasilar aspiration but no evidence of Fournier's or abscess. After return from CT, the patient was noted to be in a SVT to the 160s. He was given bolus amiodarone and started on an amio gtt. He was thereafter hypotensive to the high 70s so was started on levophed. A subclavian CVL was placed. He was given vanc, cipro and flagyl along with 6-8L NS. [**Year (4 digits) **] and general surgery were called and neither team reportedly felt there was any indication for surgical intervention. VS prior to transfer: 87 99/62 22 100% VENT 500/22/5/0.5. MEDICAL HISTORY: PMH: Hypertension, hyperlipidemia, atrial fibrillation (s/p cardioversion), rheumatoid arthritis, prostate cancer (XRT), neuropathy, lumbar spinal stenosis, rosacea, ocular migraines, RA, AAA-being followed MEDICATION ON ADMISSION: FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth once a day METHYLPREDNISOLONE - (Prescribed by Other Provider; Dose adjustment - no new Rx) - 4 mg Tablet - 2 Tablet(s) by mouth METOPROLOL SUCCINATE - 100mg qd OXYCODONE-ACETAMINOPHEN - 5 mg-325 mg Tablet - 1 Tablet(s) by mouth as needed for pain SIMVASTATIN - 10 mg Tablet - 2 Tablet(s) by mouth DAILY (Daily) DIGOXIN - unknown dose ALLERGIES: Penicillins PHYSICAL EXAM: VS: 97, HR 69 BP 144/86 16 96% on RA In: 1000cc Out 1700cc GENERAL: Well-appearing obese man in NAD, alert and oriented X3. FAMILY HISTORY: Parents both smokers and died of lung cancer, father at 57 [**Name2 (NI) **] and mother at [**Age over 90 **] [**Name2 (NI) **]. SOCIAL HISTORY: Normally lives alone, independent. Previously in [**Hospital 38**] Rehab. Retired security guard. H/o tobacco use 2 ppd x 40 years, quit 18 years ago. H/o heavy EtOH use (beer) for many years, stopped few months ago. Denies illicit drug use. Able to drive on his own, buys his own groceries. Has son and sister who are his support structure. ### Response: {'Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Cellulitis and abscess of leg, except foot,Atrial flutter,Severe sepsis,Abdominal aneurysm without mention of rupture,Peripheral vascular disease, unspecified,Thrombocytopenia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Rheumatoid arthritis,Long-term (current) use of steroids,Personal history of malignant neoplasm of prostate'}

CHIEF COMPLAINT: COPD exacerbation PRESENT ILLNESS: 62 yo female, with severe (stage 4) COPD, who presented with worsening dyspnea at rest for 2-3 days prior to admission (she is followed by Dr. [**Last Name (STitle) **] for COPD). She was admitted to the floor on [**12-5**] with shortness of breath, productive cough, and low grade fever. Prior to this, she had been on a slow steroid taper for 1-2 months (tapered to 10mg 2 days prior to admission). One day prior to admission, she was seen in the ED and given IV solumedrol, started on Z-pack, and discharged on 40 mg Prednisone. She returned a day later with no improvement in her symptoms (cough productive of yellow sputum, sob, wheezing, labored breathing), and was admitted at this time for management of COPD flare. At this time, she was 83% RA (improved to 94% on 4L) with a peak flow of 100 L/minute. She was given solumedrol, continued on nebs/MDI/antibiotics. MEDICAL HISTORY: Cardiac PMH: [**8-15**]: P-MIBI: no defects/wall motion abnormalities; EF=65% Other PMH: 1. Severe COPD (PFT's from [**10-16**]: FEV1= 42% pred, FEV1/FVC=35); not on home O2 2. Osteoporosis [**1-15**] steroids 3. Bilateral Cataracts (left surgery 1 yr ago, right surgery 1 month ago) 4. Asthma (no intubations, no ICU admits) 5. GERD 6. C-scope [**8-14**]: sessile polyps, path c/w adenoma and hyperplastic polyps MEDICATION ON ADMISSION: Meds on Admission: Prednisone (taper) CaCO3 Theophylline Fluticasone/Serevent Azithromycin (5d) Vit D Albuterol Atrovent Fosamax ALLERGIES: Penicillins / Ciprofloxacin PHYSICAL EXAM: VS: 97.9 113 (sinus) 124/51 98% 6L NC 20 Gen: very pleasant female, speaking in short sentences, not using accessory muscles, relatively comfortable but on NC O2, leaning forward somewhat HEENT: OP clear, EOM grossly intact Neck: no JVD appreciated Lungs: decreased breath sounds throughout, some wheezing and prolonged expiratory phase, no rales CV: tachy s1/s2, no m/r/g appreciated Abd: soft, nt/nd, nabs Extr: no c/c/e, PT 2+ bilaterally Neuro: grossly intact FAMILY HISTORY: Father with Emphysema Mother with CAD SOCIAL HISTORY: 30+ year smoking hx; quit 10 yrs ago EtOH 1 drink per week no IVDU or other illicit drugs Married, former executive secretary, now works out of home as artist Can do most things at home; +SOB with stairs, exertional cleaning

Chronic obstructive asthma, unspecified,Acute respiratory failure,Esophageal reflux,Other osteoporosis,Adrenal cortical steroids causing adverse effects in therapeutic use

Chronic obst asthma NOS,Acute respiratry failure,Esophageal reflux,Osteoporosis NEC,Adv eff corticosteroids

Admission Date: [**2171-12-7**] Discharge Date: [**2171-12-16**] Date of Birth: [**2109-6-22**] Sex: F Service: MEDICINE Allergies: Penicillins / Ciprofloxacin Attending:[**First Name3 (LF) 19684**] Chief Complaint: COPD exacerbation Major Surgical or Invasive Procedure: none History of Present Illness: 62 yo female, with severe (stage 4) COPD, who presented with worsening dyspnea at rest for 2-3 days prior to admission (she is followed by Dr. [**Last Name (STitle) **] for COPD). She was admitted to the floor on [**12-5**] with shortness of breath, productive cough, and low grade fever. Prior to this, she had been on a slow steroid taper for 1-2 months (tapered to 10mg 2 days prior to admission). One day prior to admission, she was seen in the ED and given IV solumedrol, started on Z-pack, and discharged on 40 mg Prednisone. She returned a day later with no improvement in her symptoms (cough productive of yellow sputum, sob, wheezing, labored breathing), and was admitted at this time for management of COPD flare. At this time, she was 83% RA (improved to 94% on 4L) with a peak flow of 100 L/minute. She was given solumedrol, continued on nebs/MDI/antibiotics. Pt has a long history of severe COPD and is followed by Dr. [**Last Name (STitle) **]. She recently had PFT's in [**10-16**] revealing an FVC 42% predicted, FEV1 21% predicted; FEV1/FVC=35% (no significant change from PFT's in [**7-16**]). Past Medical History: Cardiac PMH: [**8-15**]: P-MIBI: no defects/wall motion abnormalities; EF=65% Other PMH: 1. Severe COPD (PFT's from [**10-16**]: FEV1= 42% pred, FEV1/FVC=35); not on home O2 2. Osteoporosis [**1-15**] steroids 3. Bilateral Cataracts (left surgery 1 yr ago, right surgery 1 month ago) 4. Asthma (no intubations, no ICU admits) 5. GERD 6. C-scope [**8-14**]: sessile polyps, path c/w adenoma and hyperplastic polyps Meds on Admission: Prednisone (taper) CaCO3 Theophylline Fluticasone/Serevent Azithromycin (5d) Vit D Albuterol Atrovent Fosamax ALL: PCN, cipro (?rash) Social History: 30+ year smoking hx; quit 10 yrs ago EtOH 1 drink per week no IVDU or other illicit drugs Married, former executive secretary, now works out of home as artist Can do most things at home; +SOB with stairs, exertional cleaning Family History: Father with Emphysema Mother with CAD Physical Exam: VS: 97.9 113 (sinus) 124/51 98% 6L NC 20 Gen: very pleasant female, speaking in short sentences, not using accessory muscles, relatively comfortable but on NC O2, leaning forward somewhat HEENT: OP clear, EOM grossly intact Neck: no JVD appreciated Lungs: decreased breath sounds throughout, some wheezing and prolonged expiratory phase, no rales CV: tachy s1/s2, no m/r/g appreciated Abd: soft, nt/nd, nabs Extr: no c/c/e, PT 2+ bilaterally Neuro: grossly intact Pertinent Results: LABS: WBC-9.2 Hgb-14.7 Hct-45.8 MCV-93 Plt Ct-292 Neuts-84.9* Lymphs-9.0* Monos-5.3 Eos-0.3 Baso-0.5 144 98 15 ---------------< 89 4.4 40 0.5 [**12-9**] CXR: no focal infiltrate/consolidation Micro: [**12-10**]: sputum cx: NGTD Brief Hospital Course: 1. COPD flare secondary to UTI: At admission she had a saturation of 83% on RA (improved to 94% on 4L) with a peak flow of 100 L/minute. She was given solumedrol, continued on nebs/MDI/antibiotics. She was stable on the floor for approximately 48 hours. She was transferred to the [**Hospital Unit Name 153**] on [**12-9**] for hypercarbic respiratory failure (ABG on 2L 7.28/78/53) and was maintained on non-invasive positive pressure ventilation and monitored overnight. She did well, and was transferred back to the floor the following day, satting adequately on 6L NC. She remained on IV steroids at time of transfer back to the floor. She was relatively comfortable, able to speak short sentences. She was continued on IV steroids for two days due to continued wheezing. The day prior to discharge she was transitioned to PO Prednisone as she was no longer having wheezes. She tolerated the PO prednisone and was felt ready for discharge home on a slow steroid taper. She was s/p a 5 day course of azithromycin and it was felt there was no additional need for antibiotics. She was afebrile for the course of her admission on the hospital floor. She was continued on nebulizers. Her albuterol was titrated down secondary to tachycardia. She was continued on inhalers and theophylline. She was discharged on inhalers, home nebulizers, her home medications, and home O2. 2. Tachycardia: She was tachycardic to the 130s it was felt to be likely due to frequent albuterol with a possible component of anxiety. She was monitored on telemetry and the tachycardia was sinus. Her albuterol nebulizers were titrated down to decrease her tachycardia. 3. Osteoporosis - She was continued on fosamax, calcium supplements/vit D. 4. Cataracts - She used her own steroid drops while she was in the hospital. Medications on Admission: Meds on Admission: Prednisone (taper) CaCO3 Theophylline Fluticasone/Serevent Azithromycin (5d) Vit D Albuterol Atrovent Fosamax ALL: PCN, cipro (?rash) Discharge Medications: 1. Theophylline 100 mg Tablet Sustained Release 12HR Sig: Three (3) Tablet Sustained Release 12HR PO BID (2 times a day). 2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 3. Trazodone HCl 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for insomnia. 4. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 7. Salmeterol Xinafoate 50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation Q12H (every 12 hours). 8. Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop Ophthalmic DAILY (Daily). 9. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 10. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q8H (every 8 hours) as needed for shortness of breath or wheezing. Disp:*qs * Refills:*0* 11. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. Disp:*qs * Refills:*0* 12. Prednisone 10 mg Tablet Sig: 1-6 Tablets PO once a day: Take 6 tablets for 3 days, then take 5 tablets for 3 days, then take 4 tablets for 3 days, then take 3.5 tablets for 3 days, then take 3 tablets for 3 days, then take 2.5 tabs for 3 days, then 2 tabs for 3 days, then 1.5 tabs for 3 days, then 1 tab for 3 days, then 0.5 tab for 3 days, then stop. Disp:*90 Tablet(s)* Refills:*0* 13. Nebulizer Nebulizer machine 14. Oxygen-Air Delivery Systems Device Sig: One (1) Miscell. once a day. Disp:*1 * Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital3 **] VNA Discharge Diagnosis: Chronic obstructive pulmonary disease Secondary diagnosis Osteoporosis Asthma Tachycardia GERD Discharge Condition: good Discharge Instructions: Continue to take all medications as prescribed, continue on home O2 as needed. Contact Dr. [**Last Name (STitle) 141**] or come into the emergency department if you have any fevers, increased shortness of breath, or lightheadedness. Followup Instructions: Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] R. [**Telephone/Fax (1) 142**] Call for appointment.

493,518,530,733,E932

{'Chronic obstructive asthma, unspecified,Acute respiratory failure,Esophageal reflux,Other osteoporosis,Adrenal cortical steroids causing adverse effects in therapeutic use'}

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: COPD exacerbation PRESENT ILLNESS: 62 yo female, with severe (stage 4) COPD, who presented with worsening dyspnea at rest for 2-3 days prior to admission (she is followed by Dr. [**Last Name (STitle) **] for COPD). She was admitted to the floor on [**12-5**] with shortness of breath, productive cough, and low grade fever. Prior to this, she had been on a slow steroid taper for 1-2 months (tapered to 10mg 2 days prior to admission). One day prior to admission, she was seen in the ED and given IV solumedrol, started on Z-pack, and discharged on 40 mg Prednisone. She returned a day later with no improvement in her symptoms (cough productive of yellow sputum, sob, wheezing, labored breathing), and was admitted at this time for management of COPD flare. At this time, she was 83% RA (improved to 94% on 4L) with a peak flow of 100 L/minute. She was given solumedrol, continued on nebs/MDI/antibiotics. MEDICAL HISTORY: Cardiac PMH: [**8-15**]: P-MIBI: no defects/wall motion abnormalities; EF=65% Other PMH: 1. Severe COPD (PFT's from [**10-16**]: FEV1= 42% pred, FEV1/FVC=35); not on home O2 2. Osteoporosis [**1-15**] steroids 3. Bilateral Cataracts (left surgery 1 yr ago, right surgery 1 month ago) 4. Asthma (no intubations, no ICU admits) 5. GERD 6. C-scope [**8-14**]: sessile polyps, path c/w adenoma and hyperplastic polyps MEDICATION ON ADMISSION: Meds on Admission: Prednisone (taper) CaCO3 Theophylline Fluticasone/Serevent Azithromycin (5d) Vit D Albuterol Atrovent Fosamax ALLERGIES: Penicillins / Ciprofloxacin PHYSICAL EXAM: VS: 97.9 113 (sinus) 124/51 98% 6L NC 20 Gen: very pleasant female, speaking in short sentences, not using accessory muscles, relatively comfortable but on NC O2, leaning forward somewhat HEENT: OP clear, EOM grossly intact Neck: no JVD appreciated Lungs: decreased breath sounds throughout, some wheezing and prolonged expiratory phase, no rales CV: tachy s1/s2, no m/r/g appreciated Abd: soft, nt/nd, nabs Extr: no c/c/e, PT 2+ bilaterally Neuro: grossly intact FAMILY HISTORY: Father with Emphysema Mother with CAD SOCIAL HISTORY: 30+ year smoking hx; quit 10 yrs ago EtOH 1 drink per week no IVDU or other illicit drugs Married, former executive secretary, now works out of home as artist Can do most things at home; +SOB with stairs, exertional cleaning ### Response: {'Chronic obstructive asthma, unspecified,Acute respiratory failure,Esophageal reflux,Other osteoporosis,Adrenal cortical steroids causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: Delirium PRESENT ILLNESS: Ms. [**Known lastname 84181**] is a 34-year-old woman with bipolar disorder and lupus who was transferred from [**Hospital3 8063**] for delirium resistant to neuroleptics and is admitted to the MICU for question of alcohol withdrawal. MEDICAL HISTORY: Bipolar disorder with psychosis Lupus (cutaneous and pulmonary per sister) MEDICATION ON ADMISSION: AT HOME: clonidine 0.1 mg q8h xanax 2 mg po bid prn anxiety flexeril 10 mg po tid prn spasm Carisoprodol 350 mg po bid reglan 10 mg po q6h nausea percocet 5/325 mg po q6h pain ?Seroquel 300 mg daily ALLERGIES: Benadryl PHYSICAL EXAM: VS: 98.4 106 140/90 25 99%ra GEN:The patient is in no distress and appears comfortable SKIN:No rashes or skin changes noted HEENT:No JVD, neck supple, No lymphadenopathy in cervical, posterior, or supraclavicular chains noted. CHEST:Lungs are clear without wheeze, rales, or rhonchi. CARDIAC: Regular rhythm; no murmurs, rubs, or gallops. ABDOMEN: No apparent scars. Non-distended, and soft without tenderness EXTREMITIES:no peripheral edema, warm without cyanosis NEUROLOGIC: Alert and appropriate. CN II-XII grossly intact. BUE [**5-19**], and BLE [**5-19**] both proximally and distally. No pronator drift. Reflexes were symmetric. Downward going toes. FAMILY HISTORY: mother has [**Name (NI) 8372**] and her father abuses ETOH. SOCIAL HISTORY: Per report, she has been abusing Xanax, Clonidine, Flexeril, Soma, Vicodin, percocet, and other benzos. No ETOH. Tobacco 1ppd. Sister believes she may have had mild w/d (tremors) in past. She lives w/her boyfriend. Endorses cocaine use.

Poisoning by benzodiazepine-based tranquilizers,Acute kidney failure, unspecified,Encephalopathy, unspecified,Drug-induced delirium,Alcohol withdrawal,Urinary tract infection, site not specified,Acidosis,Accidental poisoning by benzodiazepine-based tranquilizers,Accidental poisoning by central nervous system stimulants,Cocaine abuse, unspecified,Other and unspecified alcohol dependence, unspecified,Systemic lupus erythematosus,Bipolar disorder, unspecified,Myalgia and myositis, unspecified

Pois-benzodiazepine tran,Acute kidney failure NOS,Encephalopathy NOS,Drug-induced delirium,Alcohol withdrawal,Urin tract infection NOS,Acidosis,Acc poisn-benzdiaz tranq,Acc poison-cns stimulant,Cocaine abuse-unspec,Alcoh dep NEC/NOS-unspec,Syst lupus erythematosus,Bipolar disorder NOS,Myalgia and myositis NOS

Admission Date: [**2162-1-22**] Discharge Date: [**2162-1-26**] Date of Birth: [**2127-2-8**] Sex: F Service: MEDICINE Allergies: Benadryl Attending:[**First Name3 (LF) 2009**] Chief Complaint: Delirium Major Surgical or Invasive Procedure: None History of Present Illness: Ms. [**Known lastname 84181**] is a 34-year-old woman with bipolar disorder and lupus who was transferred from [**Hospital3 8063**] for delirium resistant to neuroleptics and is admitted to the MICU for question of alcohol withdrawal. The patient presented to [**Hospital3 **] with mania and was transferred to [**Hospital1 **] on [**2162-1-21**] for further management. There, she was noted to be extremely agitated and psychotic, walking around naked and behaving erratically. During her stay she was given ativan, thorazine, seroquel, congentin and haldol. She was noted to have worsening delirium after each medication administration. On the day of admission, she was also noted to have BPs ranging from 78/59 to 122/84 and tachycardia to the 120s, but no fever was reported. She was also noted to be refusing food and fluids. Per her father,she has a history of polysubstance abuse and reportedly filled her prescriptions for Clonidine, Xanax, Percocet, Flexiril and Soma three days ago; most are now gone. In addition, pt has a reported h/o abusing opiates and benzos but no known IVDU. In the ED, vital signs were initially: 98.1 113 124/68 18 100%ra. Urine tox was positive for TCAs and she was thought to be in alcohol withdrawal and hallucinating. She was also intermittently hypotensive to the 80s and tachy to the 120s. She received 4L IVFs, diazepam 20 mg, haldol 2.5 mg, and decadron 10 mg empirically for lupus. An LP was also performed. Because of concern for alcohol withdrawal, she was admitted to the MICU. In the MICU, the patient became acutely deliriurs and psychotic upon arrival. Psychiatry was consulted and a code purple was called. The patient was given 87 mg of haldol PO/IV and 2mg of ativan with mild improvement in agitation. The patient was watched for TCA intoxication and had toxic-metabolic evaluation. She had a 1:1 sitter. She originally had [**Last Name (un) **] which improved after IV fluids. The patient has a UA which looks positive of UTI and she also has some abdominal pain. She was started on Cipro. REVIEW OF SYSTEMS: Denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, constipation, BRBPR, melena, hematochezia, dysuria, hematuria. Past Medical History: Bipolar disorder with psychosis Lupus (cutaneous and pulmonary per sister) Social History: Per report, she has been abusing Xanax, Clonidine, Flexeril, Soma, Vicodin, percocet, and other benzos. No ETOH. Tobacco 1ppd. Sister believes she may have had mild w/d (tremors) in past. She lives w/her boyfriend. Endorses cocaine use. Family History: mother has [**Name (NI) 8372**] and her father abuses ETOH. Physical Exam: VS: 98.4 106 140/90 25 99%ra GEN:The patient is in no distress and appears comfortable SKIN:No rashes or skin changes noted HEENT:No JVD, neck supple, No lymphadenopathy in cervical, posterior, or supraclavicular chains noted. CHEST:Lungs are clear without wheeze, rales, or rhonchi. CARDIAC: Regular rhythm; no murmurs, rubs, or gallops. ABDOMEN: No apparent scars. Non-distended, and soft without tenderness EXTREMITIES:no peripheral edema, warm without cyanosis NEUROLOGIC: Alert and appropriate. CN II-XII grossly intact. BUE [**5-19**], and BLE [**5-19**] both proximally and distally. No pronator drift. Reflexes were symmetric. Downward going toes. Pertinent Results: [**2162-1-22**] 09:25PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2162-1-22**] 07:08PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-236* POLYS-59 LYMPHS-33 MONOS-8 [**2162-1-22**] 07:08PM CEREBROSPINAL FLUID (CSF) PROTEIN-50* GLUCOSE-59 [**2162-1-22**] 04:45PM URINE BLOOD-NEG NITRITE-POS PROTEIN-25 GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-TR [**2162-1-22**] 04:45PM URINE RBC-0-2 WBC-21-50* BACTERIA-MANY YEAST-NONE EPI-[**3-19**] [**2162-1-22**] 03:40PM LACTATE-0.7 [**2162-1-22**] 03:05PM GLUCOSE-93 UREA N-21* CREAT-2.2* SODIUM-139 POTASSIUM-3.5 CHLORIDE-104 TOTAL CO2-23 ANION GAP-16 [**2162-1-22**] 03:05PM ALT(SGPT)-13 AST(SGOT)-14 LD(LDH)-178 CK(CPK)-233* ALK PHOS-59 TOT BILI-0.5 [**2162-1-22**] 03:05PM ALBUMIN-4.8 CALCIUM-9.7 PHOSPHATE-4.3 MAGNESIUM-2.1 [**2162-1-22**] 03:05PM VIT B12-261 [**2162-1-22**] 03:05PM TSH-4.4* [**2162-1-22**] 03:05PM FREE T4-1.6 [**2162-1-22**] 03:05PM HCG-<5 [**2162-1-22**] 03:05PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-POS [**2162-1-22**] 03:05PM WBC-7.6 RBC-3.75* HGB-11.7* HCT-34.4* MCV-92 MCH-31.1 MCHC-33.9 RDW-14.3 [**2162-1-22**] 03:05PM NEUTS-69.4 LYMPHS-24.5 MONOS-5.2 EOS-0.5 BASOS-0.4 . [**2162-1-22**] CT Head: No acute intracranial abnormality. Brief Hospital Course: Ms. [**Known lastname 84181**] is a 34-year-old female with bipolar disorder and lupus who was transferred from [**Hospital3 8063**] for delirium resistant to neuroleptics. #. Delirium: The patient was delirius and aggitated on arrival. Psychiatry was consulted and a code purple was called. The patient received ativan and high doses of haldol with mild improvement in agitation. The patient was restrained and had a 1:1 sitter. She had an LP which was normal and a head CT which was negative for acute pathology. Her T4, B12 were normal. RPR was negative. ESR was slightly increased from normal limits. EKG was checked and QTc was not significantly prolonged. The patient was given valium TID and PRN valium per CIWA to prevent withdrawal. She was given haldol qHS and TID PRN. She was also started on Depakote as a mood stabilizer and to prevent seizures. She was also continued on clonidine. She had a UTI which was treated with 3 days of Bactrim DS (she will need to take 1 dose day of discharge and 1 dose the morning after discharge to complete course). Her delirium resolved over the course of the hospitalization and she states that she thinks she took "too many of her pills" and cocaine. This intoxication most likely was the cause of her delirium and aggitation. # Acute kidney injury: likely pre-renal in the setting of decreased PO intake. She was given IVF with a return of her creatinine to baseline. # Lupus: Unclear overall involvement. Per sister has had cutaneous involvement and pleuritis. ESR slightly elevated from reference range. No active signs of lupus flare. Would continue home management and follow clinically. She should be seen by her primary care physician or rheumatologist as an outpatient. # Urinary tract infection: The patient had a UA which was consistent with a UTI. Urine cultures grew out E.Coli. She was initially started on ciprofloxacin and then switched to Bactrim DS for a 3 day course (day 1 [**2162-1-24**], 2 remaining doses at discharge) after sensitivities returned. #. Tobacco history: Continued nicorette gum and nicotine patch. The patient was medically stable to go to a psychiatric or dual diagnosis facility. Medications on Admission: AT HOME: clonidine 0.1 mg q8h xanax 2 mg po bid prn anxiety flexeril 10 mg po tid prn spasm Carisoprodol 350 mg po bid reglan 10 mg po q6h nausea percocet 5/325 mg po q6h pain ?Seroquel 300 mg daily AT TRANSFER: Haloperidol 5 mg PO TID:PRN agitation Haloperidol 5 mg PO HS Ciprofloxacin HCl 500 mg PO/NG Q12H Miconazole Nitrate Vag Cream 2% 1 Appl VG HS Duration: 7 Days CloniDINE 0.1 mg PO TID Nicotine Patch 21 mg TD DAILY Bisacodyl 10 mg PO/PR DAILY:PRN Constipation Discharge Medications: 1. Haloperidol 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 2. Haloperidol 5 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for agitation. 3. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Vaginal HS (at bedtime) for 4 days. 4. Divalproex 125 mg Tablet, Delayed Release (E.C.) Sig: Three (3) Tablet, Delayed Release (E.C.) PO BID (2 times a day). 5. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 6. Nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). 7. Nicotine (Polacrilex) 2 mg Gum Sig: [**1-16**] Gums Buccal Q1H (every hour) as needed for tobacco urge. 8. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for per CIWA. 9. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q 8H (Every 8 Hours). 10. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. 11. Bactrim DS 160-800 mg Tablet Sig: One (1) Tablet PO twice a day for 2 doses: Please take 1 tab tonight [**1-25**] and 1 tab tomorrow AM [**1-26**] to finish your course of antibiotics. Discharge Disposition: Extended Care Facility: [**Hospital3 8063**] - [**Location (un) **] Discharge Diagnosis: Primary Diagnosis: 1. Delirium secondary to medications and substance abuse 2. Bipolar disorder 3. Urinary tract infection Secondary Diagnosis: 1. Lupus Discharge Condition: Mental Status:Clear and coherent Level of Consciousness:Alert and interactive Activity Status:Ambulatory - Independent Discharge Instructions: You were admitted with delirium from [**Hospital3 8063**]. While you were here you became aggitated and required treatment with a medication called haldol. You calmed down and your delirium cleared. It is likely that your delirium was caused by taking too many of your medications as well as cocaine use. Please take your medications as prescribed and refrain from using cocaine in the future. You also had a urine sample that looked infected. You were started on an antibiotic for this. You will need to take 1 dose tonight and 1 dose tomorrow for treatment. You were medically stable to go to the [**Hospital1 **] Facility. You will need to follow up with your primary care physician as an outpatient after you are discharged from your extrended care facility. These appointments are very important for your future health. Followup Instructions: Please follow up with your primary care physician (Dr. [**Last Name (STitle) 84182**] as an outpatient after your are discharged from your extended care facility.

969,584,348,292,291,599,276,E853,E854,305,303,710,296,729

{'Poisoning by benzodiazepine-based tranquilizers,Acute kidney failure, unspecified,Encephalopathy, unspecified,Drug-induced delirium,Alcohol withdrawal,Urinary tract infection, site not specified,Acidosis,Accidental poisoning by benzodiazepine-based tranquilizers,Accidental poisoning by central nervous system stimulants,Cocaine abuse, unspecified,Other and unspecified alcohol dependence, unspecified,Systemic lupus erythematosus,Bipolar disorder, unspecified,Myalgia and myositis, unspecified'}

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: Delirium PRESENT ILLNESS: Ms. [**Known lastname 84181**] is a 34-year-old woman with bipolar disorder and lupus who was transferred from [**Hospital3 8063**] for delirium resistant to neuroleptics and is admitted to the MICU for question of alcohol withdrawal. MEDICAL HISTORY: Bipolar disorder with psychosis Lupus (cutaneous and pulmonary per sister) MEDICATION ON ADMISSION: AT HOME: clonidine 0.1 mg q8h xanax 2 mg po bid prn anxiety flexeril 10 mg po tid prn spasm Carisoprodol 350 mg po bid reglan 10 mg po q6h nausea percocet 5/325 mg po q6h pain ?Seroquel 300 mg daily ALLERGIES: Benadryl PHYSICAL EXAM: VS: 98.4 106 140/90 25 99%ra GEN:The patient is in no distress and appears comfortable SKIN:No rashes or skin changes noted HEENT:No JVD, neck supple, No lymphadenopathy in cervical, posterior, or supraclavicular chains noted. CHEST:Lungs are clear without wheeze, rales, or rhonchi. CARDIAC: Regular rhythm; no murmurs, rubs, or gallops. ABDOMEN: No apparent scars. Non-distended, and soft without tenderness EXTREMITIES:no peripheral edema, warm without cyanosis NEUROLOGIC: Alert and appropriate. CN II-XII grossly intact. BUE [**5-19**], and BLE [**5-19**] both proximally and distally. No pronator drift. Reflexes were symmetric. Downward going toes. FAMILY HISTORY: mother has [**Name (NI) 8372**] and her father abuses ETOH. SOCIAL HISTORY: Per report, she has been abusing Xanax, Clonidine, Flexeril, Soma, Vicodin, percocet, and other benzos. No ETOH. Tobacco 1ppd. Sister believes she may have had mild w/d (tremors) in past. She lives w/her boyfriend. Endorses cocaine use. ### Response: {'Poisoning by benzodiazepine-based tranquilizers,Acute kidney failure, unspecified,Encephalopathy, unspecified,Drug-induced delirium,Alcohol withdrawal,Urinary tract infection, site not specified,Acidosis,Accidental poisoning by benzodiazepine-based tranquilizers,Accidental poisoning by central nervous system stimulants,Cocaine abuse, unspecified,Other and unspecified alcohol dependence, unspecified,Systemic lupus erythematosus,Bipolar disorder, unspecified,Myalgia and myositis, unspecified'}

CHIEF COMPLAINT: CC:"nausea" PRESENT ILLNESS: This is a 65 year old man on 81 mg Aspirin daily who presumably fell this week but is amnestic to the event. He is accompanied by his wife who states that he has been in bed with nausea and vomiting since Wednesday. He states that he went out with friends and has alcoholic beverages on Tuesday evening but does not recall falling. He was brought to the ED at [**Hospital **] Hospital after his daughter noted that he was not acting "right" according to his wife who does not reside in the same home. MEDICAL HISTORY: COPD, prostate CA s/p prostatectomy [**2130**] at [**Hospital1 18**] by Dr [**First Name (STitle) **], +ETOH MEDICATION ON ADMISSION: advair ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAM: O: T:100 BP: 182/116 HR:60 R: 18 O2Sats:95% Gen: Drowsy, Head comfortable, NAD. HEENT:healed large laceration over the top of the head- no sutures or staples in place. No active drainage. small area ecchymosis at right inner canthus. No Battle/NO Raccoon sign, No otorrhea NO rhinorrhea. Pupils: 4-3mm bilaterally EOMs:intact Neck: Supple. Extrem: Warm and well-perfused. Painful HIP ROM on RIGHT Neuro: Mental status: Drowsy and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: unable to participate or recall Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: non contributory SOCIAL HISTORY: lives at home alone. + daily ETOH 6 oz Vodka

Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Cerebral edema,Unspecified fall,Closed fracture of other facial bones,Open wound of scalp, without mention of complication,Chronic airway obstruction, not elsewhere classified,Personal history of malignant neoplasm of prostate

Subdural hem w/o coma,Cerebral edema,Fall NOS,Fx facial bone NEC-close,Open wound of scalp,Chr airway obstruct NEC,Hx-prostatic malignancy

Admission Date: [**2139-1-3**] Discharge Date: [**2139-1-7**] Date of Birth: [**2073-11-22**] Sex: M Service: NEUROSURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1835**] Chief Complaint: CC:"nausea" Major Surgical or Invasive Procedure: none History of Present Illness: This is a 65 year old man on 81 mg Aspirin daily who presumably fell this week but is amnestic to the event. He is accompanied by his wife who states that he has been in bed with nausea and vomiting since Wednesday. He states that he went out with friends and has alcoholic beverages on Tuesday evening but does not recall falling. He was brought to the ED at [**Hospital **] Hospital after his daughter noted that he was not acting "right" according to his wife who does not reside in the same home. The patient presented to [**Hospital **] Hospital with a healed laceration over the top of his head and ecchymosis around the inner canthus of the right eye. A Head CT was performed which was consistent with Sub Dural Hematoma. The patient was transferred to [**Hospital1 18**] for further management. Currently, the patient denies numbness tingling sensation, bowel or bladder dysfunction, or weakness. He reports right hip pain and nausea. He appears sleepy during the exam and requires encouragement to participate in the exam. The patient is unable to say with confidence that he participated in work on from Wednesday on this week. Past Medical History: COPD, prostate CA s/p prostatectomy [**2130**] at [**Hospital1 18**] by Dr [**First Name (STitle) **], +ETOH Social History: lives at home alone. + daily ETOH 6 oz Vodka Family History: non contributory Physical Exam: PHYSICAL EXAM: O: T:100 BP: 182/116 HR:60 R: 18 O2Sats:95% Gen: Drowsy, Head comfortable, NAD. HEENT:healed large laceration over the top of the head- no sutures or staples in place. No active drainage. small area ecchymosis at right inner canthus. No Battle/NO Raccoon sign, No otorrhea NO rhinorrhea. Pupils: 4-3mm bilaterally EOMs:intact Neck: Supple. Extrem: Warm and well-perfused. Painful HIP ROM on RIGHT Neuro: Mental status: Drowsy and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: unable to participate or recall Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light, 4 to 3mm mm bilaterally. Visual fields are full to confrontation. III, IV, VI: Extraocular movements intact bilaterally without nystagmus. V, VII: Facial strength and sensation intact and symmetric. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**4-25**] throughout. No pronator drift Sensation: Intact to light touch, proprioception poor- pt unable to state if toes are up or down bilaterally, Toes downgoing bilaterally Coordination: normal on finger-nose-finger, rapid alternating movements, heel to shin On the Day of Discharge:AOx3. Follows commands. MAE with full strength Pertinent Results: Radiology Report CAROTID SERIES COMPLETE Study Date of [**2139-1-5**] 8:39 AM *********** [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 54877**]Portable TTE (Complete) Done [**2139-1-5**] at 2:58:37 PM FINAL Conclusions The left atrium is elongated. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is 0-5 mmHg. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). There is no left ventricular outflow obstruction at rest or with Valsalva. Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The aortic arch is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. IMPRESSION: Normal biventricular cavity sizes with preserved global and regional biventricular systolic function. Mild mitral regurgitation with normal valve morphology. Mild pulmonary artery hypertension. Dilated ascending aorta. No structural cardiac cause of syncope identified. CLINICAL IMPLICATIONS: Based on [**2133**] AHA endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is NOT recommended. Clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. Radiology Report CT HEAD W/O CONTRAST Study Date of [**2139-1-4**] 4:42 AM IMPRESSION: Unchanged degree of right SDH. Left frontal SDH appears slightly more prominent on todays study. Blood is also noted within the falx and the right tentorium. Stable right frontal parenchymal hematoma with surr vasogenic edema as well as parenchymal hemorrhage affecting the left frontal lobe is noted. Possible intraventricular extension with blood layering in the left ventricle. 2. 5mm leftward shift of midline structures is unchanged. Radiology Report PELVIS (AP ONLY) Study Date of [**2139-1-3**] 7:30 PM IMPRESSION: No fracture or dislocation. Brief Hospital Course: On [**1-3**], The patient was consulted by this service in the Emergency Department. The patient was loaded with Dilantin 1 gm IV for seizure prophylaxis. Decision was made to hold his daily Aspirin 81mg. The patient had painful range of motion of the right hip. A hip xray was performed which was consistent with no fracture or dislocation. A head Ct was performed which was consistent with right SDH, Left frontal SDH and Falx SDH and along the right tentorium. Right frontal parenchymal hematoma. The patient was admitted to the Neurosurgery service to the intensive care unit with q 1 hour neurological assessment. Blood presure goal was systolic range of 100-140. On [**1-4**], The patient was transferred to floor on telemetry. The patient required nicardipine intravenous drip which was trnsitioned to Labetalol 200 mg PO/NG TID labetolol for blood pressure control. The primary care physician was called to notify of patient's admission to the hospital. The patient was febrile to 101. On [**1-5**], The patient's serum NA 130 was and Sodium Chloride tabs 1 gm TID were initiated. The serum potassium was low and was repleated. The patient had low grade fevers and the tylenol was held as to not mask a temperature spike. The patient was tremulous in the bilateral upper extremities and was treated with ativan PRN per CIWA scale. An ECHOcardiogram was performed which was normal. A carotid ultrasound was performed which showed <40% stenosis bilaterally. A dilantin level was sent and was 8.2. Overnight into 1.17 he was febrile to 102.8 On [**1-6**] he was neurologically intact, his dilantin was changed to keppra, his diet was advanced, and he worked with PT. He was DC'd to rehab facility on [**1-7**] in stable condition. Medications on Admission: advair Discharge Medications: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) ml Injection TID (3 times a day). 3. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 7. labetalol 200 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 8. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 9. sodium chloride 1 gram Tablet Sig: Two (2) Tablet PO TID (3 times a day). 10. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain or T >101.5F. Discharge Disposition: Extended Care Facility: [**Hospital6 **] Hospital [**Location (un) 4047**] Discharge Diagnosis: bilateral Subdural Hematoma right frontal parenchymal hematoma Discharge Condition: AOx3. Activity as tolerated. Discharge Instructions: General Instructions ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. ?????? You were on Aspirin 81 mg every day prior to your injury, you may safely resume taking this only after follow up with Dr. [**Last Name (STitle) **] with repeat CT head ?????? If you have been prescribed Dilantin (Phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. This can be drawn at your PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**]. If you have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ?????? New onset of tremors or seizures. ?????? Any confusion, lethargy or change in mental status. ?????? Any numbness, tingling, weakness in your extremities. ?????? Pain or headache that is continually increasing, or not relieved by pain medication. ?????? New onset of the loss of function, or decrease of function on one whole side of your body. Followup Instructions: Follow-Up Appointment Instructions ??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr. [**Last Name (STitle) **], to be seen in 4 weeks. ??????You will need a CT scan of the brain without contrast prior to your appointment. This can be scheduled when you call to make your office visit appointment. ??????We recommend you see Dr [**First Name (STitle) **] in the Traumatic Brain Injury (TBI) clinic the phone number is [**Telephone/Fax (1) 6335**]. If you have any problems booking this appointment please ask for [**First Name8 (NamePattern2) 16367**] [**Last Name (NamePattern1) 16368**]. Completed by:[**2139-1-7**]

852,348,E888,802,873,496,V104

{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Cerebral edema,Unspecified fall,Closed fracture of other facial bones,Open wound of scalp, without mention of complication,Chronic airway obstruction, not elsewhere classified,Personal history of malignant neoplasm of prostate'}

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: CC:"nausea" PRESENT ILLNESS: This is a 65 year old man on 81 mg Aspirin daily who presumably fell this week but is amnestic to the event. He is accompanied by his wife who states that he has been in bed with nausea and vomiting since Wednesday. He states that he went out with friends and has alcoholic beverages on Tuesday evening but does not recall falling. He was brought to the ED at [**Hospital **] Hospital after his daughter noted that he was not acting "right" according to his wife who does not reside in the same home. MEDICAL HISTORY: COPD, prostate CA s/p prostatectomy [**2130**] at [**Hospital1 18**] by Dr [**First Name (STitle) **], +ETOH MEDICATION ON ADMISSION: advair ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: PHYSICAL EXAM: O: T:100 BP: 182/116 HR:60 R: 18 O2Sats:95% Gen: Drowsy, Head comfortable, NAD. HEENT:healed large laceration over the top of the head- no sutures or staples in place. No active drainage. small area ecchymosis at right inner canthus. No Battle/NO Raccoon sign, No otorrhea NO rhinorrhea. Pupils: 4-3mm bilaterally EOMs:intact Neck: Supple. Extrem: Warm and well-perfused. Painful HIP ROM on RIGHT Neuro: Mental status: Drowsy and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Recall: unable to participate or recall Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: non contributory SOCIAL HISTORY: lives at home alone. + daily ETOH 6 oz Vodka ### Response: {'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Cerebral edema,Unspecified fall,Closed fracture of other facial bones,Open wound of scalp, without mention of complication,Chronic airway obstruction, not elsewhere classified,Personal history of malignant neoplasm of prostate'}

CHIEF COMPLAINT: Esophageal Cancer PRESENT ILLNESS: Mrs. [**Known lastname 97982**] is a 71 year-old woman who has a T2N1 esophageal cancer (Stage IIb) who is s/p chemo/radiation treatment. She recently underwent PET scan which shows no evidence of distant uptake, but does show two distinct areas of the esophagus with FDG avidity. She presented for surgical resection of her esophageal cancer. Throughout she denies denies fevers, chills, nightsweats, heartburn, nausea, vomiting, abdominal pain, odynophagia or dysphagia. Denies changes in weight. MEDICAL HISTORY: Diabetes mellitus type II hypertension hyperlipidemia anemia large hiatel hernia asthma chronic sinus infections MEDICATION ON ADMISSION: citalopram 20 mg daily, diltiazem 240 mg daily, flovent [**Hospital1 **], glipizide 10 mg daily, lisinopril 30 mg daily, ativan 0.5 as needed, magic mouthwash, metformin 1000 mg daily, omeprazole 20 mg daily, zofran 8 mg as needed for nausea, roxicet [**3-27**] mL every 8 hours as needed for pain, compazine 5 mg every 8 hours as needed for nausea, simvastatin 20 mg daily, B vitamins, Vitamin D, Iron, MVI, fish oil ALLERGIES: mold / dust mites PHYSICAL EXAM: VS: T: 97.2 HR: 80's SR BP: 120-140/70-90 Sats: 96% 4L Wt: 77 kg General: 71 year-old female sitting up in no apparent distress HEENT: normocephalic, mucus membranes moist Neck: supple no lymphadenopathy Card: RRR Resp: decreased breath sounds no crackles or wheezes GI: abdomen soft non-tender Incision: R chest incision clean dry intact Neuro: awake, alert oriented FAMILY HISTORY: Mother died of liver and colon cancer at age 83, father- died of liver, colon and prostate cancer at age 89, son with atrial fibrillation. SOCIAL HISTORY: Widowed with three supportive sons. [**Name (NI) 1403**] part time as a social worker with her own company. Never smoker. ETOH: red wine 3-4x per week, [**11-19**] glasses each time. Denies illicit drug use. No known exposures.

Malignant neoplasm of other specified part of esophagus,Pneumonitis due to inhalation of food or vomitus,Methicillin susceptible pneumonia due to Staphylococcus aureus,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Diaphragmatic hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Anemia, unspecified,Personal history of antineoplastic chemotherapy,Other specified cardiac dysrhythmias,Other iatrogenic hypotension,Other fluid overload

Mal neo esophagus NEC,Food/vomit pneumonitis,Meth sus pneum d/t Staph,Mal neo lymph-intrathor,Diaphragmatic hernia,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Asthma NOS,Anemia NOS,Hx antineoplastic chemo,Cardiac dysrhythmias NEC,Iatrogenc hypotnsion NEC,Fluid overload NEC

Admission Date: [**2103-5-25**] Discharge Date: [**2103-6-7**] Date of Birth: [**2032-1-20**] Sex: F Service: CARDIOTHORACIC Allergies: mold / dust mites Attending:[**First Name3 (LF) 4679**] Chief Complaint: Esophageal Cancer Major Surgical or Invasive Procedure: 1. [**First Name9 (NamePattern2) 12351**] [**Doctor Last Name **] esophagectomy with intrathoracic esophagogastric anastomosis. 2. Laparoscopic jejunostomy feeding tube. 3. Wrapping of intrathoracic anastomosis with pericardial fat. 4. Esophagogastroduodenoscopy . 5. Laparoscopic reduction of hiatal hernia. History of Present Illness: Mrs. [**Known lastname 97982**] is a 71 year-old woman who has a T2N1 esophageal cancer (Stage IIb) who is s/p chemo/radiation treatment. She recently underwent PET scan which shows no evidence of distant uptake, but does show two distinct areas of the esophagus with FDG avidity. She presented for surgical resection of her esophageal cancer. Throughout she denies denies fevers, chills, nightsweats, heartburn, nausea, vomiting, abdominal pain, odynophagia or dysphagia. Denies changes in weight. She has a concurrent hiatial hernia Past Medical History: Diabetes mellitus type II hypertension hyperlipidemia anemia large hiatel hernia asthma chronic sinus infections Social History: Widowed with three supportive sons. [**Name (NI) 1403**] part time as a social worker with her own company. Never smoker. ETOH: red wine 3-4x per week, [**11-19**] glasses each time. Denies illicit drug use. No known exposures. Family History: Mother died of liver and colon cancer at age 83, father- died of liver, colon and prostate cancer at age 89, son with atrial fibrillation. Physical Exam: VS: T: 97.2 HR: 80's SR BP: 120-140/70-90 Sats: 96% 4L Wt: 77 kg General: 71 year-old female sitting up in no apparent distress HEENT: normocephalic, mucus membranes moist Neck: supple no lymphadenopathy Card: RRR Resp: decreased breath sounds no crackles or wheezes GI: abdomen soft non-tender Incision: R chest incision clean dry intact Neuro: awake, alert oriented Pertinent Results: [**2103-6-7**] 06:45AM BLOOD WBC-10.8 RBC-3.22* Hgb-9.1* Hct-27.7* MCV-86 MCH-28.4 MCHC-33.1 RDW-18.1* Plt Ct-723* [**2103-6-6**] 04:19AM BLOOD WBC-12.8* RBC-3.26* Hgb-9.2* Hct-28.2* MCV-86 MCH-28.3 MCHC-32.7 RDW-18.2* Plt Ct-698* [**2103-6-2**] 03:21AM BLOOD WBC-11.2*# RBC-2.87* Hgb-8.3* Hct-24.9* MCV-87 MCH-28.8 MCHC-33.3 RDW-17.8* Plt Ct-300 [**2103-5-25**] 04:05PM BLOOD WBC-11.3*# RBC-3.79* Hgb-10.8* Hct-32.1* MCV-85 MCH-28.3 MCHC-33.5 RDW-19.6* Plt Ct-223 [**2103-6-7**] 06:45AM BLOOD Glucose-238* UreaN-18 Creat-0.6 Na-137 K-4.7 Cl-99 HCO3-27 AnGap-16 [**2103-5-30**] BRONCHIAL WASHINGS FINAL REPORT [**2103-6-3**]** GRAM STAIN (Final [**2103-5-31**]): 3+ (5-10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 2+ (1-5 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CLUSTERS. 1+ (<1 per 1000X FIELD): BUDDING YEAST. RESPIRATORY CULTURE (Final [**2103-6-3**]): ~1000/ML Commensal Respiratory Flora. STAPH AUREUS COAG +. >100,000 ORGANISMS/ML.. YEAST. >100,000 ORGANISMS/ML.. STAPH AUREUS COAG + | CLINDAMYCIN----------- R ERYTHROMYCIN---------- =>8 R GENTAMICIN------------ <=0.5 S LEVOFLOXACIN----------<=0.12 S OXACILLIN------------- 0.5 S TRIMETHOPRIM/SULFA---- <=0.5 S CXR: [**2103-6-6**]: Pulmonary edema has markedly improved. Left lower lobe opacity is unchanged, likely atelectasis. Cardiomediastinal contours are unchanged. Right subclavian catheter remains in place with tip in the standard position. Multifocal right lung opacities are unchanged. Bilateral pleural effusions are small, associated with adjacent atelectasis. Patient is status post esophagectomy. Esophagus: [**2103-6-4**] Single-contrast upper GI series was performed. Barium passes freely into the esophagus and at the site of anastomosis. There is no evidence of a leak at this site. Barium is pooled within the stomach. After 30 minutes, a followup scout film and followup fluoroscopy image was taken, which continued to show barium retained within the stomach with little passing to the small intenstine. IMPRESSION: 1. No evidence of anastomotic leak. 2. Delayed gastric emptying MRI spine: [**2103-6-1**] IMPRESSION: No evidence of epidural abscess. Mild disc protrusion at T10-T11 level with anterior thecal sac indentation but no significant spinal canal narrowing or neural foraminal compromise seen. Chest/Pelvic CT [**2103-6-1**]: IMPRESSION: 1. Improving pleural effusion, pneumomediastinum and pneumothorax as compared to previous study. 2. No evidence of pneumonic process/evidence of pneumonia. 3. No evidence of lymphadenopathy in the visualized areas. 4. All tubes and lines appear well placed 5. No obvious foci of infection. 6. Area of reduced perfusion in left lobe of liver may reflect sequelae from retraction. Brief Hospital Course: Mrs. [**Known lastname 97982**] was admitted [**2103-5-25**] following [**First Name9 (NamePattern2) 12351**] [**Doctor Last Name **] esophagectomy with intrathoracic esophagogastric anastomosis. Laparoscopic jejunostomy feeding tube.Wrapping of intrathoracic anastomosis with pericardial fat. Esophagogastroduodenoscopy. Laparoscopic reduction of hiatal hernia. She was transfer to the ICU extubated with an NGT, Foley and Epidural managed by the acute pain service. While in the SICU she required multiple fluid challenges for hypotension. Once hemodynamically stable she transfer to the Floor on [**2103-5-29**]. Events: [**2103-5-30**] developed respiratory distress (hypoxic) requiring intubation and transfer to the ICU. Bedside bronchoscopy was done [**2103-5-31**] with aspiration of sections and bile. An NGT was placed. Temp 102 Vancomycin and Zosyn started. Over the next few days here respiratory status improved. She was successfully extubated [**2103-6-1**]. Her oxygen requirements improved with nebs, incentive spirometer. Oxygen saturations of 93-97% on 4L NC. CT was done showed no anastomic leak. ID: she was seen by infectious disease. Cultures grew MSSA continue coverage for GNR/anaerobes, can switch vancomycin to Ampicillin/Sulbactam 3gm IV q6h x 14 days starting from [**2103-5-31**]. Of note an MRI of the spine was negative of epidural abscess following Epidural removal [**2103-5-30**]. Cardiovascular: Immediately postop was sinus tachycardia. IV Lopressor was started. She was hypotensive which responded to fluid bolus. Once taking PO's her home dose diltiazem was restarted. Sinus rhythm 80-100's and blood pressure improved to 130's. Lisinopril was titrated as an outpatient. GI: NGT was removed POD 4 requring placment on [**2103-6-1**] following aspiration event and removed [**2103-6-2**]. PPI and bowel regime continued Nutrition: Tube feeds Replete Full strength started POD increase to Goal of 75 mL/18hrs. Following esophagus study [**2103-6-4**] full liquid diet and will continue until seen by Dr. [**First Name (STitle) **]. Aspiration precautions at all times. Renal: Volume overload. She was gently diuresed with IV lasix converted to PO lasix until at preop weight of 72 kg. Her renal function remain normal with good urine output. Her electrolytes were replete as needed. Endocrine: maintained on insulin sliding scale to keep blood sugars < 150. She will restart her PO diabetic medications upon discharge. Heme: Chronic anemia HCT stable 25-19 Dispo: Followed by physical therapy. She was discharged to [**Hospital1 15454**] in [**Location (un) 701**] [**Telephone/Fax (1) 40835**]. She will follow-up with Dr. [**First Name (STitle) **] as an outpatient. Medications on Admission: citalopram 20 mg daily, diltiazem 240 mg daily, flovent [**Hospital1 **], glipizide 10 mg daily, lisinopril 30 mg daily, ativan 0.5 as needed, magic mouthwash, metformin 1000 mg daily, omeprazole 20 mg daily, zofran 8 mg as needed for nausea, roxicet [**3-27**] mL every 8 hours as needed for pain, compazine 5 mg every 8 hours as needed for nausea, simvastatin 20 mg daily, B vitamins, Vitamin D, Iron, MVI, fish oil Discharge Medications: 1. heparin (porcine) 5,000 unit/mL Solution [**Month/Year (2) **]: One (1) Injection TID (3 times a day). 2. ipratropium bromide 0.02 % Solution [**Month/Year (2) **]: Three (3) mL Inhalation Q6H (every 6 hours) as needed for wheezing. 3. levalbuterol HCl 0.63 mg/3 mL Solution for Nebulization [**Month/Year (2) **]: Three (3) ML Inhalation Q6H (every 6 hours). 4. sodium chloride 0.9 % 0.9 % Syringe [**Month/Year (2) **]: Three (3) ML Injection Q8H (every 8 hours) as needed for line flush. 5. ampicillin-sulbactam 3 gram Recon Soln [**Month/Year (2) **]: Three (3) Recon Soln Injection Q6H (every 6 hours) for 8 days. 6. oxycodone-acetaminophen 5-325 mg/5 mL Solution [**Month/Year (2) **]: 5-10 MLs PO Q4H (every 4 hours) as needed for pain. 7. simvastatin 10 mg Tablet [**Month/Year (2) **]: Two (2) Tablet PO DAILY (Daily). 8. citalopram 20 mg Tablet [**Month/Year (2) **]: One (1) Tablet PO DAILY (Daily). 9. fluticasone 110 mcg/Actuation Aerosol [**Month/Year (2) **]: Four (4) Puff Inhalation [**Hospital1 **] (2 times a day). 10. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 11. diltiazem HCl 60 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO QID (4 times a day). 12. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler [**Last Name (STitle) **]: Two (2) Puff Inhalation Q6H (every 6 hours). 13. acetaminophen 650 mg/20.3 mL Solution [**Last Name (STitle) **]: Twenty (20) mL PO Q6H (every 6 hours) as needed for fevers/HA. 14. ondansetron HCl (PF) 4 mg/2 mL Solution [**Last Name (STitle) **]: Four (4) mg Injection Q6H (every 6 hours) as needed for nausea. 15. lisinopril 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day: home dose 30 mg daily please increase as SBP tolerates. 16. metformin 500 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO twice a day: home dose 1000 mg [**Hospital1 **] increase as blood sugars tolerate. 17. lorazepam 0.5 mg Tablet [**Hospital1 **]: One (1) Tablet PO every twelve (12) hours as needed for anxiety. 18. Humalog insulin sliding scale 71-100 mg/dL 0 Units 101-150 mg/dL 2 Units 151-200 mg/dL 4 Units 201-250 mg/dL 6 Units 251-300 mg/dL 8 Units 301-350 mg/dL 10 Units 19. furosemide 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO once a day: Monitor daily weights and adjust as needed. 20. potassium chloride 10 mEq Tablet, ER Particles/Crystals [**Hospital1 **]: One (1) Tablet, ER Particles/Crystals PO once a day: give with lasix. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Esophageal Cancer s/p esophagectomy T2 diabetes mellitus Hypertension Hyperlipidemia Large hiatal hernia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience: -Fevers > 101 or chills -Increased shortness of breath, cough or chest pain -Your incisions develop drainage -Difficult or painful swallowing -Nausea (take anti-nausea medication) or vomiting -Increased abdominal pain Pain -Acetaminophen 650 mg every 6-8 hours as needed for pain -Roxicet [**11-19**] teaspoon every 4-6 hours as needed for pain Acitivity -Shower daily. Wash incision with mild soap & water, rinse pat dry -No tub bathing, swimming or hot tubs until incision healed -Do Not apply lotions to incision sites -No driving while taking narcotics -Take stool softner with narcotics Followup Instructions: Follow-up with Dr. [**First Name (STitle) **] [**0-0-**] [**2103-6-21**] 4:00 on the [**Hospital Ward Name 5074**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) 24**] Chest X-Ray [**Location (un) 861**] Radiology 30 minutes before your appointment Completed by:[**2103-6-7**]

150,507,482,196,553,250,401,272,493,285,V874,427,458,276

{'Malignant neoplasm of other specified part of esophagus,Pneumonitis due to inhalation of food or vomitus,Methicillin susceptible pneumonia due to Staphylococcus aureus,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Diaphragmatic hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Anemia, unspecified,Personal history of antineoplastic chemotherapy,Other specified cardiac dysrhythmias,Other iatrogenic hypotension,Other fluid overload'}

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: Esophageal Cancer PRESENT ILLNESS: Mrs. [**Known lastname 97982**] is a 71 year-old woman who has a T2N1 esophageal cancer (Stage IIb) who is s/p chemo/radiation treatment. She recently underwent PET scan which shows no evidence of distant uptake, but does show two distinct areas of the esophagus with FDG avidity. She presented for surgical resection of her esophageal cancer. Throughout she denies denies fevers, chills, nightsweats, heartburn, nausea, vomiting, abdominal pain, odynophagia or dysphagia. Denies changes in weight. MEDICAL HISTORY: Diabetes mellitus type II hypertension hyperlipidemia anemia large hiatel hernia asthma chronic sinus infections MEDICATION ON ADMISSION: citalopram 20 mg daily, diltiazem 240 mg daily, flovent [**Hospital1 **], glipizide 10 mg daily, lisinopril 30 mg daily, ativan 0.5 as needed, magic mouthwash, metformin 1000 mg daily, omeprazole 20 mg daily, zofran 8 mg as needed for nausea, roxicet [**3-27**] mL every 8 hours as needed for pain, compazine 5 mg every 8 hours as needed for nausea, simvastatin 20 mg daily, B vitamins, Vitamin D, Iron, MVI, fish oil ALLERGIES: mold / dust mites PHYSICAL EXAM: VS: T: 97.2 HR: 80's SR BP: 120-140/70-90 Sats: 96% 4L Wt: 77 kg General: 71 year-old female sitting up in no apparent distress HEENT: normocephalic, mucus membranes moist Neck: supple no lymphadenopathy Card: RRR Resp: decreased breath sounds no crackles or wheezes GI: abdomen soft non-tender Incision: R chest incision clean dry intact Neuro: awake, alert oriented FAMILY HISTORY: Mother died of liver and colon cancer at age 83, father- died of liver, colon and prostate cancer at age 89, son with atrial fibrillation. SOCIAL HISTORY: Widowed with three supportive sons. [**Name (NI) 1403**] part time as a social worker with her own company. Never smoker. ETOH: red wine 3-4x per week, [**11-19**] glasses each time. Denies illicit drug use. No known exposures. ### Response: {'Malignant neoplasm of other specified part of esophagus,Pneumonitis due to inhalation of food or vomitus,Methicillin susceptible pneumonia due to Staphylococcus aureus,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Diaphragmatic hernia without mention of obstruction or gangrene,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Anemia, unspecified,Personal history of antineoplastic chemotherapy,Other specified cardiac dysrhythmias,Other iatrogenic hypotension,Other fluid overload'}

CHIEF COMPLAINT: Altered mental status PRESENT ILLNESS: Discussed patient w primary team resident. In brief, this is a 75yo M PMHx DM, ESRD on HD, anoxic brain injury, recent hospitalization for PNA presenting now w AMS. Patient was recently admitted [**Date range (1) 5356**] with chief complaint AMS, was found to have a Rsided consolidation, treated for HCAP with vanco and cefepime w subsequent improvement in mental status. Of note, patient did not ever demonstrate objective signs of systemic infection on that admission (no fever, leukocytosis). Per report, after discharge to rehab facility, patient was noted to have leaking stools in diaper. At scheduled HD session today, patient reported to have AMS and was referred to [**Hospital1 18**] ED after completion of HD. . In ED initial vital signs were 88 192/87 16 100%10LNRB. He triggered for AMS. Workup was notable for FS 139, unchanged NCHCT. UA demonstrated 10 WBCs, few bacteria. CXR w/o acute changes. Patient was given cipro for presumed UTI and was admitted to medicine service. Vital signs prior to transfer from ED were 99.8 100 215/85 17 100%RA. On arrival to the floor patient was noted to have SBP 210s and was non-verbal. SBP improved to 200 w nitropaste. Patient was evaluated by ICU resident for persistent HTN and possible AMS. . In the ICU, patient denied CP, SOB, HA, dizziness. Given limited responsiveness, review of systems was limited, however he denied cough, shortness of breath, chest pain, abdominal pain, nausea. MEDICAL HISTORY: - CKD stage V, on HD MWF - HTN - DM II - Anoxic brain injury - Severe peripheral neuropathy - Glaucoma - Depression MEDICATION ON ADMISSION: 1. amlodipine 10mg daily 2. lisinopril 40mg daily 3. citalopram 20mg daily 4. isosorbide dinitrate 10 mg TID 5. B complex-vitamin C-folic acid 1 mg daily 6. sevelamer carbonate 800mg [**Hospital1 **] w meals 7. brimonidine 0.2 % Drops [**Hospital1 **] 8. levobunolol 0.25 % [**Hospital1 **] 9. gabapentin 300mg qHD 10. acetaminophen 500mg QOD 11. lidocaine patch daily to left knee 12. omeprazole 20mg daily 13. olanzapine 5mg Tablet, [**Hospital1 **] prn 14. humalog sliding scale 15. cefepime 1g daily ([**9-15**] - [**9-21**]) 16. vancomycin 1g qHD ([**9-15**] - [**9-21**]) 17. carvedilol 6.25mg [**Hospital1 **] ALLERGIES: Lovenox PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: 97.5 89 187/79 16 100%RA General: tonic/clonic jerking, moaning yes or no answers HEENT: PERRL, Sclera anicteric, MM dry Neck: supple, no JVD, no LAD Lungs: CTA bilaterally, no wheezes, rales, ronchi CV: RRR, II/VI systolic murmur at apex Abdomen: Soft, NT/ND, no rebound/guarding, naBS GU: +Foley Ext: WWP, 2+ pulses, no c/c/e, +LUE fistula c/d/i NEURO: AOx1, follows directions slowly, exam limited by ability to comply, 2+ patellar reflexes . DISCHARGE PHYSICAL EXAM: T: 98.4 (Tm 99.4) HR 73 (70s-80s) BP 178/pulse (118-178/pulse-76) RR 20 SaO2 100% RA (96-100%RA) FSBS: <-[9H]- 302 <-[2H]- 203 <-[9H]- 313 <-[12H]- 445 <-[6H]- 263 General: NAD, answers questions and follows instructions HEENT: MMM, +cataracts, PERRL, clear oropharynx without tongue plaque Neck: supple, no carotid bruits, flat neck veins Lungs: Anteriorly, slightly diminished breath sounds at b/l bases, end-inspiratory rales at bases bilaterally CV: RRR, continuous murmur at LSB louder in systole to III/VI at LLSB. Abdomen: Soft, NT/ND, no rebound/guarding, normactive bowel sounds Ext: WWP, 2+ DP, no c/c/e, +LUE fistula audible w/ palpable thrill NEURO: Following commands. Open eyes and mouth, squeezes them closed when examiner tries to open them. Squeezes examiner's hands bilaterally. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives at [**Hospital3 537**] in JP. niece/HCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Telephone/Fax (3) 105203**] 043

Anoxic brain damage,Pneumonitis due to inhalation of food or vomitus,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Altered mental status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified glaucoma,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, unspecified,Renal dialysis status

Anoxic brain damage,Food/vomit pneumonitis,End stage renal disease,Hyp kid NOS w cr kid V,Urin tract infection NOS,Altered mental status,DMII wo cmp nt st uncntr,Glaucoma NOS,Idio periph neurpthy NOS,Anemia NOS,Renal dialysis status

Admission Date: [**2140-9-19**] Discharge Date: [**2140-9-29**] Date of Birth: [**2064-11-4**] Sex: M Service: MEDICINE Allergies: Lovenox Attending:[**First Name3 (LF) 3256**] Chief Complaint: Altered mental status Major Surgical or Invasive Procedure: None History of Present Illness: Discussed patient w primary team resident. In brief, this is a 75yo M PMHx DM, ESRD on HD, anoxic brain injury, recent hospitalization for PNA presenting now w AMS. Patient was recently admitted [**Date range (1) 5356**] with chief complaint AMS, was found to have a Rsided consolidation, treated for HCAP with vanco and cefepime w subsequent improvement in mental status. Of note, patient did not ever demonstrate objective signs of systemic infection on that admission (no fever, leukocytosis). Per report, after discharge to rehab facility, patient was noted to have leaking stools in diaper. At scheduled HD session today, patient reported to have AMS and was referred to [**Hospital1 18**] ED after completion of HD. . In ED initial vital signs were 88 192/87 16 100%10LNRB. He triggered for AMS. Workup was notable for FS 139, unchanged NCHCT. UA demonstrated 10 WBCs, few bacteria. CXR w/o acute changes. Patient was given cipro for presumed UTI and was admitted to medicine service. Vital signs prior to transfer from ED were 99.8 100 215/85 17 100%RA. On arrival to the floor patient was noted to have SBP 210s and was non-verbal. SBP improved to 200 w nitropaste. Patient was evaluated by ICU resident for persistent HTN and possible AMS. . In the ICU, patient denied CP, SOB, HA, dizziness. Given limited responsiveness, review of systems was limited, however he denied cough, shortness of breath, chest pain, abdominal pain, nausea. Past Medical History: - CKD stage V, on HD MWF - HTN - DM II - Anoxic brain injury - Severe peripheral neuropathy - Glaucoma - Depression Social History: Lives at [**Hospital3 537**] in JP. niece/HCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Telephone/Fax (3) 105203**] 043 Family History: Non-contributory Physical Exam: ADMISSION PHYSICAL EXAM: VS: 97.5 89 187/79 16 100%RA General: tonic/clonic jerking, moaning yes or no answers HEENT: PERRL, Sclera anicteric, MM dry Neck: supple, no JVD, no LAD Lungs: CTA bilaterally, no wheezes, rales, ronchi CV: RRR, II/VI systolic murmur at apex Abdomen: Soft, NT/ND, no rebound/guarding, naBS GU: +Foley Ext: WWP, 2+ pulses, no c/c/e, +LUE fistula c/d/i NEURO: AOx1, follows directions slowly, exam limited by ability to comply, 2+ patellar reflexes . DISCHARGE PHYSICAL EXAM: T: 98.4 (Tm 99.4) HR 73 (70s-80s) BP 178/pulse (118-178/pulse-76) RR 20 SaO2 100% RA (96-100%RA) FSBS: <-[9H]- 302 <-[2H]- 203 <-[9H]- 313 <-[12H]- 445 <-[6H]- 263 General: NAD, answers questions and follows instructions HEENT: MMM, +cataracts, PERRL, clear oropharynx without tongue plaque Neck: supple, no carotid bruits, flat neck veins Lungs: Anteriorly, slightly diminished breath sounds at b/l bases, end-inspiratory rales at bases bilaterally CV: RRR, continuous murmur at LSB louder in systole to III/VI at LLSB. Abdomen: Soft, NT/ND, no rebound/guarding, normactive bowel sounds Ext: WWP, 2+ DP, no c/c/e, +LUE fistula audible w/ palpable thrill NEURO: Following commands. Open eyes and mouth, squeezes them closed when examiner tries to open them. Squeezes examiner's hands bilaterally. Pertinent Results: ADMISSION LABS [**2140-9-19**] 11:45PM GLUCOSE-204* UREA N-22* CREAT-4.6* SODIUM-137 POTASSIUM-3.6 CHLORIDE-93* TOTAL CO2-29 ANION GAP-19 [**2140-9-19**] 11:45PM CK(CPK)-129 [**2140-9-19**] 11:45PM CK-MB-4 cTropnT-0.31* [**2140-9-19**] 11:45PM CALCIUM-9.5 PHOSPHATE-3.3 MAGNESIUM-2.2 [**2140-9-19**] 11:45PM WBC-8.7 RBC-3.83* HGB-9.6* HCT-30.9* MCV-81* MCH-25.1* MCHC-31.2 RDW-17.8* [**2140-9-19**] 11:45PM PLT COUNT-296 [**2140-9-19**] 07:15PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2140-9-19**] 07:15PM URINE COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.011 [**2140-9-19**] 07:15PM URINE BLOOD-MOD NITRITE-NEG PROTEIN-300 GLUCOSE-TR KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.5 LEUK-LG [**2140-9-19**] 07:15PM URINE RBC-51* WBC-10* BACTERIA-FEW YEAST-NONE EPI-0 [**2140-9-19**] 03:05PM LACTATE-1.1 K+-3.4* [**2140-9-19**] 03:00PM ALT(SGPT)-15 AST(SGOT)-20 ALK PHOS-97 TOT BILI-0.3 [**2140-9-19**] 03:00PM LIPASE-13 [**2140-9-19**] 03:00PM WBC-8.3# RBC-4.08* HGB-10.1* HCT-32.2* MCV-79* MCH-24.8* MCHC-31.4 RDW-17.8* [**2140-9-19**] 03:00PM NEUTS-82.9* BANDS-0 LYMPHS-10.3* MONOS-5.4 EOS-1.1 BASOS-0.3 [**2140-9-19**] 03:00PM HYPOCHROM-3+ ANISOCYT-2+ POIKILOCY-OCCASIONAL MACROCYT-2+ MICROCYT-OCCASIONAL POLYCHROM-1+ SCHISTOCY-OCCASIONAL STIPPLED-OCCASIONAL [**2140-9-19**] 03:00PM PT-12.0 PTT-27.3 INR(PT)-1.0 . DISCHARGE LABS [**2140-9-29**] 06:29AM BLOOD WBC-6.7 RBC-3.28* Hgb-8.3* Hct-26.0* MCV-79* MCH-25.4* MCHC-32.1 RDW-16.1* Plt Ct-251 [**2140-9-29**] 06:29AM BLOOD Glucose-113* UreaN-18 Creat-3.5*# Na-140 K-3.4 Cl-95* HCO3-37* AnGap-11 [**2140-9-29**] 06:29AM BLOOD Calcium-8.9 Phos-4.1 Mg-1.9 [**2140-9-28**] 07:13AM BLOOD Vanco-17.5 . MICROBIOLOGY: MRSA screen [**2140-9-19**]: No MRSA isolated. Urine culture [**2140-9-20**]: No growth. Urine culture [**2140-9-22**]: No growth. Blood culture [**2140-9-22**]: No growth. Blood culture [**2140-9-23**]: Pending. Blood culture [**2140-9-27**]: Pending. Blood culture [**2140-9-27**]: Pending. C. difficile antigen [**2140-9-28**]: Negative. . IMAGING CXR [**2140-9-19**] - No acute cardiopulmonary processes . CT head non-contrast [**2140-9-19**] - Evaluation is severely limited due to motion artifact. However, there is no evidence of acute intracranial hemorrhage, edema, shift of normally midline structures, or large vascular territorial infarction. Again is prominence of the ventricles and sulci, consistent with age-related cortical atrophy. No acute fractures are noted. However, fluid is again noted throughout bilateral sphenoid sinuses, greater on the left than the right. The remainder of the visualized paranasal sinuses and mastoid air cells are clear. IMPRESSION: Severely limited study due to motion artifact, but no gross intracranial injury. . CXR [**2140-9-22**]: As compared to the prior examination, an esophageal catheter has been advanced with side port now just beyond the gastroesophageal junction. A right-sided PICC is unchanged with tip reaching the mid-to-low SVC. No new focal parenchymal opacity is seen. No pleural effusion or pneumothorax. The cardiomediastinal silhouette is unchanged. Surgical clips projecting over tthe mid abdomen are unchanged. . CXR [**2140-9-24**]: As compared to the previous radiograph, there is a subtle newly appeared opacity at the right lung base. This opacity could represent recent aspiration. Otherwise, unremarkable appearance of the lung parenchyma. No pulmonary edema. No pleural effusions. No pneumothorax. Normal course of the monitoring and support devices. . CXR [**2140-9-25**]: Bibasilar consolidations have worsened, consistent with worsening bilateral aspiration pneumonia. There is no evident pneumothorax or large pleural effusions. Cardiomediastinal contours are normal. NG tube tip is in the stomach. Right PICC is in standard position. Multiple surgical clips project in the upper mid abdomen. . CXR [**2140-9-27**]: Bibasilar consolidations have slightly increased. No pleural effusion, pneumothorax, or pulmonary edema is seen. The cardiomediastinal silhouette is within normal limits. Right PICC is unchanged with tip in SVC. An esophageal catheter has been removed. Multiple surgical clips project over the upper and mid abdomen. . RELEVANT STUDIES: EEG [**2140-9-19**]: This EEG continues to give evidence for a moderate diffuse encephalopathy. There were no clear focal or lateralizing features. There was some suggestion of cycling although that may just be part and parcel of the more diffuse encephalopathy. No clear epileptic activity identified. Brief Hospital Course: Mr. [**Known lastname 1058**] is a 75 year old gentleman, with a past medical history of DM, ESRD on HD, anoxic brain injury and recent hospitalization for PNA, presented with uncontrolled hypertension, encephalopathy and shaking motions, who was initially admitted to the ICU with a question of hypertensive urgency, then stabilized and was transferred to the floor. His hospital course was complicated by aspiration pneumonia and high blood glucose. . . Active issues: # Uncontrolled hypertension - Initially had question of hypertensive urgency. The patient was admitted with SBP 215 requiring transfer to ICU; given HD on day of admission unlikely volume overload; likely secondary to medications not being administered prior to HD or after (as he was in ED). Since his altered mental status was thought to be related to high blood pressure, hypertension was initially controlled aggressively with IV hydralazine, while his home PO regimen of amlodipine, lisinopril, isosorbide dinitrate and carvedilol was held. After the patient was transferred to the floor, an NG tube was placed, and home blood pressure medications were administered through NG, after which pt had adequate blood pressure control. After removal of NGT, the patient was able to tolerate PO antihypertensives and blood pressure was better-controlled. Additionally, ultrafiltration of several hundred CCs during hemodialysis sessions relieved volume overload and helped stabilize blood pressures. . # Encephalopathy with shaking motions - Patient with an anoxic brain injury, with baseline AOx1, presented with concern for encephalopathy in setting of hypertension and shaking motions; concern initially for hypertensive encephalopathy, but did not resolve with improved BP; seizure activity considered, but 24-hour video EEG monitoring showed no evidence of seizures, and likelihood low given occurrence only when patient was talking; no focal neuro signs or acute process on non-contrast head CT; no focal infection to suggest toxic metabolic; no new medications changes and Utox negative making drug effect unlikely; per discussion with HCP, patient has had subacute onset of AMS and increased lethargy. The patient was initially NPO given altered mental status, then transitioned to thin liquids and pureed solids per speech and swallow, but switched back to NPO as pt had new bilateral lower lobe opacities concerning for aspiration pneumonia. During his course on the floor, the patient's mental status gradually improved, as he was treated with empiric broad-spectrum antibiotics (vanc/Zosyn) for aspiration pneumonia. At the time of discharge, he was no longer tremulous, and he was able to participate in conversations with full sentences. His olanzapine and gabapentin were held during hospital course given concern for altered mental status and discontinued upon discharged. . # Bilateral lower lobe pneumonias - During his hospital course, the patient developed bilateral lower lobe consolidations after an NG tube had been placed for administration of PO meds during waxing and [**Doctor Last Name 688**] mental status. He was treated with a seven-day course of intravenous vancomycin and Zosyn for empiric broad coverage of aspiration pneumonia. His oxygen saturations and low-grade fevers improved. At time of discharge, he was afebrile with oxygen saturation in the 90s on room air. . # Labile blood glucose - During admission, the patient was continued on SS humalog, as he had at home. His blood sugar, however, was not well-controlled, and he required better baseline control with glargine. Glargine was started at 5 units at bedtime along with humalog sliding scale with improvement in blood sugars. . . Chronic issues: # Depression - The patient's citalopram and olanzapine were initially held while he was NPO. Additionally, a Neurology consultation recommended continuing to hold olanzapine, as it may have contributed to rigidity that the patient had on presentation. Thus, only his citalopram was restarted when he was able to take medications PO. . # ESRD on HD - The patient continue hemodialysis three times a week, with ultrafiltration as tolerated. While he was NPO, his nephrocaps and sevelamer carbonate were held, but these were restarted when the patient was able to tolerated PO medications. . # Glaucoma - Documented history of this problem. The patient was continued on his home doses of brimonidine and levobunolol. . # Chronic Pain - While he was NPO, the patient's home gabapentin and acetaminophen were held. His pain was controlled with a lidocaine patch. Even after the patient was tolerating PO medications, his gabapentin was held, per advice of Neurology, since this medication may have contributed to his altered metal status. . # GERD - Omeprazole was initially held while NPO, but then restarted when he was able to tolerate PO medications. . . Transitional issues: - Follow up urine cytology and consider bladder ultrasound/cystoscopy as outpatient. Patient has had persistent hematuria this and last admission with concerns for possible underlying bladder cancer - Full code per discussion w HCP three times during this admission, will likely need to be readdressed as underlying process is better evaluated - Patient will likely benefit from effort to improve communication at transition of care, as well as disease course expectations (to help minimize future rehospitalizations) Medications on Admission: 1. amlodipine 10mg daily 2. lisinopril 40mg daily 3. citalopram 20mg daily 4. isosorbide dinitrate 10 mg TID 5. B complex-vitamin C-folic acid 1 mg daily 6. sevelamer carbonate 800mg [**Hospital1 **] w meals 7. brimonidine 0.2 % Drops [**Hospital1 **] 8. levobunolol 0.25 % [**Hospital1 **] 9. gabapentin 300mg qHD 10. acetaminophen 500mg QOD 11. lidocaine patch daily to left knee 12. omeprazole 20mg daily 13. olanzapine 5mg Tablet, [**Hospital1 **] prn 14. humalog sliding scale 15. cefepime 1g daily ([**9-15**] - [**9-21**]) 16. vancomycin 1g qHD ([**9-15**] - [**9-21**]) 17. carvedilol 6.25mg [**Hospital1 **] Discharge Medications: 1. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. isosorbide dinitrate 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 5. levobunolol 0.25 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 6. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily): Apply to left knee. 12 hours on, 12 hours off. 7. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO QODHS (every other day (at bedtime)). 8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 9. carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 11. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 12. insulin glargine 100 unit/mL Solution Sig: Five (5) units Subcutaneous at bedtime. units 13. brimonidine 0.2 % Drops Sig: One (1) drop Ophthalmic twice a day. 14. Humalog 100 unit/mL Solution Sig: One (1) Subcutaneous four times a day: sliding scale; please see attached. Discharge Disposition: Extended Care Facility: [**Hospital3 537**]- [**Location (un) 538**] Discharge Diagnosis: Primary Altered Mental Status . Secondary Hypertensive urgency Aspiration pneumonia Chronic renal failure Diabetes Mellitus II Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Dear Mr. [**Known lastname 1058**], It was a pleasure taking care of you while you were in the hospital. You were admitted to [**Hospital3 **] Hospital [**Hospital1 **] Center due to confusion after your hemodialysis session and you were found to have dangerously high blood pressure. . We looked for a source of infection, and you were found to have pneumonia on chest x-ray and your confusion improved as we gave you antibiotics. Your blood pressure improved when we were able to give you your home blood pressure medications. Neurology evaluated you while you were in the hospital, and you did not have any evidence of seizures when neurology looked at your brain waves with an EEG. . Please continue taking your home medications, along with the following changes: 1.) START insulin glargine 5 units at bedtime 2.) STOP olanzapine 3.) STOP gabapentin 4.) INCREASE lisinopril to 40mg daily Followup Instructions: You will be seen by a doctor at your long-term care facility. You also have the following eye appointment. Department: [**Hospital3 1935**] CENTER When: TUESDAY [**2140-10-18**] at 10:30 AM With: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2334**], M.D. [**Telephone/Fax (1) 253**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

348,507,585,403,599,780,250,365,356,285,V451

{'Anoxic brain damage,Pneumonitis due to inhalation of food or vomitus,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Altered mental status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified glaucoma,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, unspecified,Renal dialysis status'}

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: Altered mental status PRESENT ILLNESS: Discussed patient w primary team resident. In brief, this is a 75yo M PMHx DM, ESRD on HD, anoxic brain injury, recent hospitalization for PNA presenting now w AMS. Patient was recently admitted [**Date range (1) 5356**] with chief complaint AMS, was found to have a Rsided consolidation, treated for HCAP with vanco and cefepime w subsequent improvement in mental status. Of note, patient did not ever demonstrate objective signs of systemic infection on that admission (no fever, leukocytosis). Per report, after discharge to rehab facility, patient was noted to have leaking stools in diaper. At scheduled HD session today, patient reported to have AMS and was referred to [**Hospital1 18**] ED after completion of HD. . In ED initial vital signs were 88 192/87 16 100%10LNRB. He triggered for AMS. Workup was notable for FS 139, unchanged NCHCT. UA demonstrated 10 WBCs, few bacteria. CXR w/o acute changes. Patient was given cipro for presumed UTI and was admitted to medicine service. Vital signs prior to transfer from ED were 99.8 100 215/85 17 100%RA. On arrival to the floor patient was noted to have SBP 210s and was non-verbal. SBP improved to 200 w nitropaste. Patient was evaluated by ICU resident for persistent HTN and possible AMS. . In the ICU, patient denied CP, SOB, HA, dizziness. Given limited responsiveness, review of systems was limited, however he denied cough, shortness of breath, chest pain, abdominal pain, nausea. MEDICAL HISTORY: - CKD stage V, on HD MWF - HTN - DM II - Anoxic brain injury - Severe peripheral neuropathy - Glaucoma - Depression MEDICATION ON ADMISSION: 1. amlodipine 10mg daily 2. lisinopril 40mg daily 3. citalopram 20mg daily 4. isosorbide dinitrate 10 mg TID 5. B complex-vitamin C-folic acid 1 mg daily 6. sevelamer carbonate 800mg [**Hospital1 **] w meals 7. brimonidine 0.2 % Drops [**Hospital1 **] 8. levobunolol 0.25 % [**Hospital1 **] 9. gabapentin 300mg qHD 10. acetaminophen 500mg QOD 11. lidocaine patch daily to left knee 12. omeprazole 20mg daily 13. olanzapine 5mg Tablet, [**Hospital1 **] prn 14. humalog sliding scale 15. cefepime 1g daily ([**9-15**] - [**9-21**]) 16. vancomycin 1g qHD ([**9-15**] - [**9-21**]) 17. carvedilol 6.25mg [**Hospital1 **] ALLERGIES: Lovenox PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: 97.5 89 187/79 16 100%RA General: tonic/clonic jerking, moaning yes or no answers HEENT: PERRL, Sclera anicteric, MM dry Neck: supple, no JVD, no LAD Lungs: CTA bilaterally, no wheezes, rales, ronchi CV: RRR, II/VI systolic murmur at apex Abdomen: Soft, NT/ND, no rebound/guarding, naBS GU: +Foley Ext: WWP, 2+ pulses, no c/c/e, +LUE fistula c/d/i NEURO: AOx1, follows directions slowly, exam limited by ability to comply, 2+ patellar reflexes . DISCHARGE PHYSICAL EXAM: T: 98.4 (Tm 99.4) HR 73 (70s-80s) BP 178/pulse (118-178/pulse-76) RR 20 SaO2 100% RA (96-100%RA) FSBS: <-[9H]- 302 <-[2H]- 203 <-[9H]- 313 <-[12H]- 445 <-[6H]- 263 General: NAD, answers questions and follows instructions HEENT: MMM, +cataracts, PERRL, clear oropharynx without tongue plaque Neck: supple, no carotid bruits, flat neck veins Lungs: Anteriorly, slightly diminished breath sounds at b/l bases, end-inspiratory rales at bases bilaterally CV: RRR, continuous murmur at LSB louder in systole to III/VI at LLSB. Abdomen: Soft, NT/ND, no rebound/guarding, normactive bowel sounds Ext: WWP, 2+ DP, no c/c/e, +LUE fistula audible w/ palpable thrill NEURO: Following commands. Open eyes and mouth, squeezes them closed when examiner tries to open them. Squeezes examiner's hands bilaterally. FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives at [**Hospital3 537**] in JP. niece/HCP [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Telephone/Fax (3) 105203**] 043 ### Response: {'Anoxic brain damage,Pneumonitis due to inhalation of food or vomitus,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Altered mental status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified glaucoma,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, unspecified,Renal dialysis status'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is an 80-year-old male with history of congestive heart failure, coronary artery disease, diabetes mellitus and pneumonia who was admitted to [**Hospital1 1444**] for dyspnea and found to have a right pneumothorax. He had a chest tube placed during hospital course. The patient has a history of multiple prior admissions in the past few months for pneumonias. Chest tube was placed during this hospital course. The chest tube was discontinued shortly afterwards after discovery that it was misplaced. The right lung was re-expanded. Pleural effusions managed with diuresis. MEDICAL HISTORY: 1. Coronary artery disease status post coronary artery bypass graft in [**2123**], four vessel disease, LIMA to LAD, SVG to D2, SVG to circumflex and SVG to PDA. 2. Congestive heart failure. 3. Diabetes mellitus. 4. Chronic renal insufficiency. 5. CTCL. 6. Bilateral renal artery stenosis 60% on the left, 70% on the right. 7. Osteoarthritis. 8. Gout. 9. Recent echocardiogram revealed LV ejection fraction of less than 20% MEDICATION ON ADMISSION: ALLERGIES: 1. Penicillin. 2. Ambien which leads to confusion. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Congestive heart failure, unspecified,Mycosis fungoides, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Unspecified pleural effusion,Methicillin susceptible Staphylococcus aureus septicemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of renal artery

CHF NOS,Mycs fng unsp xtrndl org,Acute kidney failure NOS,Pleural effusion NOS,Meth susc Staph aur sept,DMII wo cmp nt st uncntr,Renal artery atheroscler

Admission Date: [**2137-10-4**] Discharge Date: [**2137-10-15**] Service: CCU HISTORY OF PRESENT ILLNESS: This is an 80-year-old male with history of congestive heart failure, coronary artery disease, diabetes mellitus and pneumonia who was admitted to [**Hospital1 1444**] for dyspnea and found to have a right pneumothorax. He had a chest tube placed during hospital course. The patient has a history of multiple prior admissions in the past few months for pneumonias. Chest tube was placed during this hospital course. The chest tube was discontinued shortly afterwards after discovery that it was misplaced. The right lung was re-expanded. Pleural effusions managed with diuresis. A renal consult was obtained for an increasing BUN and creatinine. It was thought that there was a prerenal picture was developing. Renal ultrasound was recommended. Heart Failure Service was consulted and recommended transfer to CCU for aggressive diuresis, pressor support and Swan-Ganz placement. During hospital course, the patient also had 2/4 bottles positive for MRSA, sputum positive for MRSA, increased white blood cell count to 22. While on the floor the patient was started on Levofloxacin and Vancomycin prior to transfer to CCU. PAST MEDICAL HISTORY: 1. Coronary artery disease status post coronary artery bypass graft in [**2123**], four vessel disease, LIMA to LAD, SVG to D2, SVG to circumflex and SVG to PDA. 2. Congestive heart failure. 3. Diabetes mellitus. 4. Chronic renal insufficiency. 5. CTCL. 6. Bilateral renal artery stenosis 60% on the left, 70% on the right. 7. Osteoarthritis. 8. Gout. 9. Recent echocardiogram revealed LV ejection fraction of less than 20% ALLERGIES: 1. Penicillin. 2. Ambien which leads to confusion. MEDICATIONS ON TRANSFER TO CCU: 1. Dopamine drip. 2. Metoprolol 25 mg p.o. b.i.d. 3. Levofloxacin 250 mg p.o. q. 48 hours. 4. Vancomycin 1 gram IV dosed by levels. 5. Regular insulin sliding scale. 6. Morphine p.r.n. 7. Zofran p.r.n. 8. Compazine. PHYSICAL EXAMINATION: Vital signs with a temperature of 98.2 F, pulse 60, blood pressure 107/36, respirations 16. Pulse oximetry 92%. In general elderly male who is lethargic. Head, eyes, ears, nose and throat: Moist mucous membranes. Cardiovascular: S1, S2, no murmurs, rubs, or gallops appreciated. Pulmonary: Loud breath sounds, rhonchorus. Abdomen is obese and soft. Extremities: Pitting edema bilaterally. INITIAL LABORATORY: White blood cell count of 19.2, hematocrit of 29.6, platelets 252. INR 1.1. Fibrinogen 581. INITIAL ASSESSMENT: This is an 80 year-old male admitted to CCU for aggressive congestive heart failure management, MRSA bacteremia. HOSPITAL COURSE: 1. HEART FAILURE: Patient required pressor support with Dopamine and eventually Norepinephrine as a bridge for dialysis. After dialysis, the patient's heart function eventually improved and he was able to be weaned off all pressures. Patient had no chest pain or chest discomfort during the entire hospital course. The patient was monitored on telemetry during hospital course with no known abnormalities or runs of ectopy. The patient was known to have severe coronary artery disease and was kept on aspirin and Lipitor throughout hospital course. 2. RENAL: Patient with increasing BUN and creatinine in the setting of congestive heart failure thought to be a prerenal condition. Acute renal failure on top of a chronic renal failure. Patient's mental status and renal function improved after a session of dialysis, however patient refused further dialysis sessions as he thought it would be a new chronic management that he would need. 3. PULMONARY: Patient with decreasing O2 saturations on presentation. Patient is known to have coronary artery disease and it was felt that his decreased pulmonary function was secondary to congestive heart failure. Pulmonary function did improve after dialysis and removal of fluid. The patient also noted to have MRSA positive sputum and MRSA positive blood cultures. The patient was kept on Vancomycin therapy until the end of hospital course. 4. ENDOCRINE: Patient is a known diabetic who placed on fingersticks q.i.d. with regular insulin sliding scale until he changed his code status later in hospital course. 5. CODE STATUS: Patient and patient's family initially wanted "everything done", however after a session of dialysis and a clearing of mental status, the patient and patient's family were extensively counseled in what lay probably in his medical future in terms of his extremely grim prognosis given his multiple medical conditions. Decision was made by the patient to become DNR, DNI and to institute comfort measures only. All non-necessary medications were discontinued. The patient was kept only on comfort medications such as Morphine, Scopolamine patch. Fingersticks were discontinued and a palliative care nurse consultation was performed. The patient requested not to be transferred out of the hospital to a Hospice type setting, but rather requested to remain in the hospital to pass away there. Overall, once patient was transferred to CMO type care, the patient lingered for approximately 30 hours before expiring. CONDITION ON DISCHARGE: Expired. DISCHARGE STATUS: Autopsy refused by family. Attending and family made aware of patient's expiration. [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D. [**MD Number(2) 2139**] Dictated By:[**Name8 (MD) 110497**] MEDQUIST36 D: [**2137-11-5**] 14:00 T: [**2137-11-7**] 10:24 JOB#: [**Job Number 110498**]

428,202,584,511,038,250,440

{'Congestive heart failure, unspecified,Mycosis fungoides, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Unspecified pleural effusion,Methicillin susceptible Staphylococcus aureus septicemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of renal artery'}

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: This is an 80-year-old male with history of congestive heart failure, coronary artery disease, diabetes mellitus and pneumonia who was admitted to [**Hospital1 1444**] for dyspnea and found to have a right pneumothorax. He had a chest tube placed during hospital course. The patient has a history of multiple prior admissions in the past few months for pneumonias. Chest tube was placed during this hospital course. The chest tube was discontinued shortly afterwards after discovery that it was misplaced. The right lung was re-expanded. Pleural effusions managed with diuresis. MEDICAL HISTORY: 1. Coronary artery disease status post coronary artery bypass graft in [**2123**], four vessel disease, LIMA to LAD, SVG to D2, SVG to circumflex and SVG to PDA. 2. Congestive heart failure. 3. Diabetes mellitus. 4. Chronic renal insufficiency. 5. CTCL. 6. Bilateral renal artery stenosis 60% on the left, 70% on the right. 7. Osteoarthritis. 8. Gout. 9. Recent echocardiogram revealed LV ejection fraction of less than 20% MEDICATION ON ADMISSION: ALLERGIES: 1. Penicillin. 2. Ambien which leads to confusion. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Congestive heart failure, unspecified,Mycosis fungoides, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Unspecified pleural effusion,Methicillin susceptible Staphylococcus aureus septicemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of renal artery'}

CHIEF COMPLAINT: melena PRESENT ILLNESS: 83F w/ CAD s/p CABG, anemia, who reports "fainting and waking up incontinent of black liquid stool". She got up, cleaned up in bathtub, but continued to have a couple more episodes of small liquid, black stool yesterday. Her last BM was this day of adm. She also notes some lightheadedness, + nausea and diaphoresis. She does take aspirin and aleve 4 pills daily X 4-5 days for back pain. . In [**Hospital1 18**] ED, 98.4, 102, 166/78. She was in NAD, abd benign, euvolemic, melena on rectal. NG lavage negative. EKG unchanged. MEDICAL HISTORY: 1. Venous insufficiency. 2. CAD status post acute MI [**2148**]. 3. Hypertension. 4. Cataract OS. 5. Hyperlipidemia. 6. Dysfunctional uterine bleeding. 7. Cystocele complicated by mixed incontinence. 8. Anemia. 9. DJD, right knee. MEDICATION ON ADMISSION: - Aspirin 81 mg once daily - atenolol 75 mg once daily - enalapril 5 mg once daily - furosemide 20 mg once daily - Plavix 75 mg once daily (per daughter, not sure of taking) - simvastatin 80 mg once daily, - nitroglycerin p.r.n. - calcium with vitamin D t.i.d. - MVI - aleve and tylenol PRN ALLERGIES: Lipitor PHYSICAL EXAM: VITALS: 98.7 115/78 85 16 100% 2LNC HEENT: PERRL, EOM intact, MM moist PULM: CTAB HEART: well-healed midline scar, RRR, [**1-27**] HSM LPSA ABD: soft, NT/ND, normoactive BS EXT: no edema, +DP blaterally; hypersensitive to light touch NEURO: AAoX3 RECTAL: guaiac positive, black stool in rectal vault FAMILY HISTORY: Positive for diabetes in her sister. Positive for CAD in her brother, questionable malignancy in an aunt. [**Name (NI) **] family history of hypertension. SOCIAL HISTORY: She grew up in [**Location (un) **]. She is widowed. She worked as a stitcher but was mostly a housewife. No tobacco use. She did smoke but quit many years ago. Social alcohol use, no drug use.

Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Atrial flutter,Iron deficiency anemia secondary to blood loss (chronic),Hypovolemia,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Accidents occurring in unspecified place

Chr stomach ulc w hem,Acute kidney failure NOS,Ac posthemorrhag anemia,Atrial flutter,Chr blood loss anemia,Hypovolemia,Hypertension NOS,Cor ath unsp vsl ntv/gft,Adv eff analgesic NOS,Accident in place NOS

Admission Date: [**2161-10-10**] Discharge Date: [**2161-10-12**] Service: MEDICINE Allergies: Lipitor Attending:[**First Name3 (LF) 330**] Chief Complaint: melena Major Surgical or Invasive Procedure: endoscopy History of Present Illness: 83F w/ CAD s/p CABG, anemia, who reports "fainting and waking up incontinent of black liquid stool". She got up, cleaned up in bathtub, but continued to have a couple more episodes of small liquid, black stool yesterday. Her last BM was this day of adm. She also notes some lightheadedness, + nausea and diaphoresis. She does take aspirin and aleve 4 pills daily X 4-5 days for back pain. . In [**Hospital1 18**] ED, 98.4, 102, 166/78. She was in NAD, abd benign, euvolemic, melena on rectal. NG lavage negative. EKG unchanged. . In the unit, she reports feeling well with no chest pain, SOB, LHD, dizzyness, abd pain. Per daughter, pt has never had seizure like activity, syncope, GIB bleed before. She has never had a colonoscopy. She received 2 U PRBC so far. Past Medical History: 1. Venous insufficiency. 2. CAD status post acute MI [**2148**]. 3. Hypertension. 4. Cataract OS. 5. Hyperlipidemia. 6. Dysfunctional uterine bleeding. 7. Cystocele complicated by mixed incontinence. 8. Anemia. 9. DJD, right knee. PAST SURGICAL HISTORY: 1. Status post cataract extraction, OS. 2. Status post excision of [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 4675**] cyst, right knee. 3. Status post CABG, four vessels. . GYNECOLOGIC HISTORY: Gravida 3, para 2, two vaginal deliveries. Menarche in her teens. Menopause at age 53. Last Pap smear 5/[**2160**]. Last mammogram 2/[**2159**]. . Social History: She grew up in [**Location (un) **]. She is widowed. She worked as a stitcher but was mostly a housewife. No tobacco use. She did smoke but quit many years ago. Social alcohol use, no drug use. Family History: Positive for diabetes in her sister. Positive for CAD in her brother, questionable malignancy in an aunt. [**Name (NI) **] family history of hypertension. Physical Exam: VITALS: 98.7 115/78 85 16 100% 2LNC HEENT: PERRL, EOM intact, MM moist PULM: CTAB HEART: well-healed midline scar, RRR, [**1-27**] HSM LPSA ABD: soft, NT/ND, normoactive BS EXT: no edema, +DP blaterally; hypersensitive to light touch NEURO: AAoX3 RECTAL: guaiac positive, black stool in rectal vault Pertinent Results: Labs on discharge: [**2161-10-12**] WBC-11.8* Hct-29.4* Plt Ct-221 . PT-12.3 PTT-21.2* INR(PT)-1.0 . Glucose-139* UreaN-15 Creat-0.8 Na-146* K-3.9 Cl-114* HCO3-25 . . Endoscopy: Esophagus: Mucosa: Normal mucosa was noted in the whole esophagus. Stomach: Excavated Lesions There were 3 ulcers found in the pre-pyloric area ranging from 3mm to 1cm. All ulcers had clear bases. There was no active bleeding noted. Duodenum: Mucosa: Normal mucosa was noted in the first part of the duodenum and second part of the duodenum. Impression: Normal mucosa in the whole esophagus; Ulcer in the pre-pylorus Normal mucosa in the first part of the duodenum and second part of the duodenum; Otherwise normal EGD to second part of the duodenum Brief Hospital Course: 83 y/o F hx CAD s/p CABG now with 10 point HCT drop and melanotic stools concerning for GIB . # GIB: She presented with likely UGI source in the settig of taking aspirin, plavix, and NSAIDS. She received 2UPRBCs and Hct remained stable in 28-30 without need for further transfusions. Endoscopy showed three well healed pre-pyloric ulcers with no active bleeding. H pylori was checked and pending at discharge. She was advised to stop all NSAID use. Aspirin was restarted at discharge. She will need repeat endoscopy 6 weeks after discharge. . # Syncope: Suspect [**12-26**] hypovolemia and orthostasis in setting of blood loss although in the MICU, pt was not orthostatic (after reciving fluids and blood in ED). Pt was ruled out with 2 sets of cardiac enzymes and was monitored on tele. On the morning after admission to MICU, pt developed SVT (aflutter) to 140-150s which slowed with 3 doses of metoprolol 5mg iv. EKG after iv metoprolol was sinus with PVCs and APCs. Pt was started on metoprolol 12.5mg TID which will need uptitration (pt was on atenolol 75mg daily at home) . # CAD: s/p CABG. Patient was still taking plavix although her CABG was 1.5 years ago. Her primary cardiologist, Dr. [**Last Name (STitle) **], confirmed that she should no longer be on plavix any more. This was clarified with patient. She can still continue aspirin. . # ARF: Baseline 0.9, now 1.2. Suspect prerenal azotemia and improved with fluids/blood . # HTN: BP meds intially held in setting of GIB. By day of discharge, she restarted BB and ACEi. . # Hypersensitivity in LE: Unclear etiology; ?RSD or restless leg, but not an active issue during this admission. . # FEN: diet was advanced after endoscopy. . # PPX: pneumoboots, PPI . # ACCESS: PIV X 2 . # CODE: Full, discussed with patient and HCP Medications on Admission: - Aspirin 81 mg once daily - atenolol 75 mg once daily - enalapril 5 mg once daily - furosemide 20 mg once daily - Plavix 75 mg once daily (per daughter, not sure of taking) - simvastatin 80 mg once daily, - nitroglycerin p.r.n. - calcium with vitamin D t.i.d. - MVI - aleve and tylenol PRN Discharge Medications: 1. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 2. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day: please start taking this on Thursday, [**10-15**]. 3. Atenolol 25 mg Tablet Sig: Three (3) Tablet PO once a day. 4. Enalapril Maleate 5 mg Tablet Sig: One (1) Tablet PO once a day. 5. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day. 6. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 8. Calcium + Vitamin D 600-200 mg-unit Tablet Sig: One (1) Tablet PO once a day. 9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO at bedtime for 1 doses. Discharge Disposition: Home Discharge Diagnosis: Primary: - duodenal ulcers - atrial flutter - anemia: [**12-26**] GI bleed - HTN Secondary: - CAD s/p MI [**2148**] - hyperlipidemia - DJD Discharge Condition: well Discharge Instructions: You came in with blood in your stool and a fainting episode. You received two units of blood in the emergency department and were admitted to the ICU. Your blood levels stabilized. You underwent an EGD which showed three ulcers in your duodenum. These were not bleeding. Please continue to hold your plavix. You can restart your aspirin on Thursday, [**10-15**]. We also are starting prilosec 20mg twice daily. Please take this at least until your repeat EGD and colonoscopy in [**5-1**] weeks. We restarted all your other medications (except the plavix). . Please monitor for any dizziness, bloody or black stools, or abdominal pain. If so, please stop your aspirin and return to the emergency department. Please contact your PCP if you experience chest pain, shortness of breath, constipation/diarrhea. . Please followup with your PCP to see if you have H. Pylori. . Please do NOT take Advil, motrin, Aleve, or other NSAIDs. . Please take metoprolol 25mg x1 tonight at 7pm. Then you can resume your atenolol normally in the morning. Followup Instructions: Please followup with GI: Dr. [**Last Name (STitle) **] on Monday, [**11-23**]. Please arrive at 9:30am. Plan for a pickup at around 12:30. Your appointment is on the [**Hospital Ward Name **]: [**Hospital Ward Name 1950**] entrance, [**Location (un) **]. You will receive information by mail regarding your preparation for the EGD and colonoscopy. Number: [**Telephone/Fax (1) **] . Please followup with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] on Tuesday, [**10-20**] at 11:15am. . Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], MD Date/Time:[**2161-12-1**] 11:30 Provider: [**First Name11 (Name Pattern1) 10588**] [**Last Name (NamePattern4) 10589**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 10590**] Date/Time:[**2162-1-5**] 11:15

531,584,285,427,280,276,401,414,E935,E849

{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Atrial flutter,Iron deficiency anemia secondary to blood loss (chronic),Hypovolemia,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Accidents occurring in unspecified place'}

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: melena PRESENT ILLNESS: 83F w/ CAD s/p CABG, anemia, who reports "fainting and waking up incontinent of black liquid stool". She got up, cleaned up in bathtub, but continued to have a couple more episodes of small liquid, black stool yesterday. Her last BM was this day of adm. She also notes some lightheadedness, + nausea and diaphoresis. She does take aspirin and aleve 4 pills daily X 4-5 days for back pain. . In [**Hospital1 18**] ED, 98.4, 102, 166/78. She was in NAD, abd benign, euvolemic, melena on rectal. NG lavage negative. EKG unchanged. MEDICAL HISTORY: 1. Venous insufficiency. 2. CAD status post acute MI [**2148**]. 3. Hypertension. 4. Cataract OS. 5. Hyperlipidemia. 6. Dysfunctional uterine bleeding. 7. Cystocele complicated by mixed incontinence. 8. Anemia. 9. DJD, right knee. MEDICATION ON ADMISSION: - Aspirin 81 mg once daily - atenolol 75 mg once daily - enalapril 5 mg once daily - furosemide 20 mg once daily - Plavix 75 mg once daily (per daughter, not sure of taking) - simvastatin 80 mg once daily, - nitroglycerin p.r.n. - calcium with vitamin D t.i.d. - MVI - aleve and tylenol PRN ALLERGIES: Lipitor PHYSICAL EXAM: VITALS: 98.7 115/78 85 16 100% 2LNC HEENT: PERRL, EOM intact, MM moist PULM: CTAB HEART: well-healed midline scar, RRR, [**1-27**] HSM LPSA ABD: soft, NT/ND, normoactive BS EXT: no edema, +DP blaterally; hypersensitive to light touch NEURO: AAoX3 RECTAL: guaiac positive, black stool in rectal vault FAMILY HISTORY: Positive for diabetes in her sister. Positive for CAD in her brother, questionable malignancy in an aunt. [**Name (NI) **] family history of hypertension. SOCIAL HISTORY: She grew up in [**Location (un) **]. She is widowed. She worked as a stitcher but was mostly a housewife. No tobacco use. She did smoke but quit many years ago. Social alcohol use, no drug use. ### Response: {'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Acute kidney failure, unspecified,Acute posthemorrhagic anemia,Atrial flutter,Iron deficiency anemia secondary to blood loss (chronic),Hypovolemia,Unspecified essential hypertension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified analgesic and antipyretic causing adverse effects in therapeutic use,Accidents occurring in unspecified place'}

CHIEF COMPLAINT: PRESENT ILLNESS: This patient was admitted to the CCU under the care of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. He is a 60-year-old gentleman with history of rheumatic arthritis and hypercholesterolemia who is a transfer from an outside hospital with an acute anterior MI. The patient had several episodes of chest tightness without exertion over the last week prior to admission. The night prior to admission at 9:30 p.m., he had 9 out of 10 chest pain, shortness of breath, and nausea. EMS arrived and took patient to [**Hospital6 3622**] where anterolateral hyperacute T waves were noted and ST elevations in I, aVL, and V1 through V5. Aspirin, Plavix, heparin, and Integrilin were started. The patient was brought to the [**Hospital1 18**] where catheterization revealed a thrombotic LAD occlusion and the patient underwent CYPHER stent placement. MEDICAL HISTORY: The patient's past medical history, otherwise, is significant for rheumatoid arthritis and hypercholesterolemia. MEDICATION ON ADMISSION: ALLERGIES: ERYTHROMYCIN, WHICH CAUSES A RASH. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory per the patient. SOCIAL HISTORY: He can do all his ADLs. No ETOH, occasional tobacco, no other drugs.

Acute myocardial infarction of inferolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Rheumatoid arthritis

AMI inferolateral, init,Crnry athrscl natve vssl,Hypertension NOS,Rheumatoid arthritis

Admission Date: [**2105-6-5**] Discharge Date: [**2105-6-8**] Date of Birth: [**2045-1-4**] Sex: M Service: CCU HISTORY OF PRESENT ILLNESS: This patient was admitted to the CCU under the care of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. He is a 60-year-old gentleman with history of rheumatic arthritis and hypercholesterolemia who is a transfer from an outside hospital with an acute anterior MI. The patient had several episodes of chest tightness without exertion over the last week prior to admission. The night prior to admission at 9:30 p.m., he had 9 out of 10 chest pain, shortness of breath, and nausea. EMS arrived and took patient to [**Hospital6 3622**] where anterolateral hyperacute T waves were noted and ST elevations in I, aVL, and V1 through V5. Aspirin, Plavix, heparin, and Integrilin were started. The patient was brought to the [**Hospital1 18**] where catheterization revealed a thrombotic LAD occlusion and the patient underwent CYPHER stent placement. ALLERGIES: ERYTHROMYCIN, WHICH CAUSES A RASH. MEDICATIONS: Medications on admission included, 1. Methotrexate. 2. Celebrex. 3. Enbrel. 4. Lipitor. PAST MEDICAL HISTORY: The patient's past medical history, otherwise, is significant for rheumatoid arthritis and hypercholesterolemia. SOCIAL HISTORY: He can do all his ADLs. No ETOH, occasional tobacco, no other drugs. FAMILY HISTORY: Noncontributory per the patient. PHYSICAL EXAMINATION: On admission, the patient's temperature is 97.8 degrees, blood pressure is 130/60, heart rate is in the 70s. Generally, the patient is a very pleasant male, in no acute distress. HEENT: Normocephalic, atraumatic. Extraocular movements are intact. Oropharynx is clear. JVP is 7. No bruits are noted. Heart: Regular rate and rhythm with no murmurs. Lungs: Clear to auscultation bilaterally. Abdomen: Soft, nontender, and nondistended with no hepatosplenomegaly palpated. Extremities: Free of any clubbing, cyanosis, or edema; 2 plus dorsalis pedis pulses are palpated. EKG on admission, normal sinus rhythm at 53, ST elevations in I, aVL, and V1 through V5. After catheterization, the patient had persistent ST elevations. Echocardiogram, none to date. Cardiac catheterization: LMCA, okay; LAD, thrombotic proximal lesion; D1 60 percent ostial; left circumflex, diffuse small, AV good, RA pressure 3; RV 40/12; cardiac index 1.8; pulmonary capillary wedge pressure of 12. Other labs pending at the time of admission. Telemetry, AIVR. Official catheterization report revealed the following: Cardiac output 3.35, index 1.80, PA mean 24, RA 3, pulmonary capillary wedge pressure is 12, LMCA normal. Right dominant system, LAD 95 percent proximal with thrombus 60 percent, origin of bifurcating D1 diffusely diseased beyond left circumflex, mid lumen irregularities throughout proximal left circumflex and large OM1, OM2 normal, distal left circumflex 70 percent before small OM3; RCA, mild lumen irregularities and ectasia throughout. Minimal stenosis of 30 percent. Interventional details include the following: LAD culprit lesion crossed with a 0.14 PT [**Name (NI) 9165**] wire and AngioJet performed x2 passes with good thrombus removal. Then, proximal LAD was stented with 3.0 x 30 mm CYPHER drug- eluting stent and post dilated with proximal two-third of stent with 3.9 x 9 mm NC ranger at 16 atm. Mild no flow treated with IC diltiazem and with good response. Final result is zero percent residual in-stent, no compromise to first septal or origins, normal flow noted. HOSPITAL COURSE: Acute anterior MI was managed successfully with primary angioplasty and drug-eluting stent placement. The patient was maintained on aspirin, Plavix, Integrilin, and IV heparin was started after Integrilin finished. The patient was maintained on beta-blocker and high-dose statin. The patient underwent TEE on [**2105-6-8**], which revealed an EF of 40 to 45 percent. Left atrium was normal in size, but mildly elongated. Mild symmetric LVH with following wall motion abnormalities noted: Anterior apex, akinetic; septal apex, akinetic; apex akinetic. Right ventricle, chamber size and free wall motion were normal. By the time of discharge, the patient was maintained on aspirin, Plavix, Coumadin for apical akinesis, Lopressor, and lisinopril. For rheumatoid arthritis, the patient's medications were discontinued secondary to his MI. In the past, the patient did respond to ibuprofen. The case was discussed with his primary rheumatologist and he advised that the patient should be kept off medication for approximately one month. FEN. The patient was maintained on cardiac diet. Electrolytes were repleted. Prophylaxis. The patient was on heparin, Coumadin, and bowel regimen. DISCHARGE DIAGNOSES: Myocardial infarction status post stent to LAD. Hypertension. Coronary artery disease. Rheumatoid arthritis. FOLLOW UP: He is to set up a followup with his primary care physician on the morning of discharge. The patient is also to see his cardiologist within one week of discharge. The patient is to remain on Coumadin due to akinesis of his heart apex and will need to do the INR checked regularly. He will also need to remain on Coumadin for four to six months. The patient is status post cardiac catheterization with PTCA and stent to proximal LAD. DISCHARGE CONDITION: Stable. He is oxygenating on room air. He has had no further episodes of chest pain, no active pain in telemetry, and is hemodynamically stable. DISCHARGE STATUS: He will be discharged to home. DISCHARGE MEDICATIONS: 1. Plavix 75 mg 1 p.o. q.d. 2. Atorvastatin 80 mg 1 p.o. q.d. 3. Metoprolol tartrate 25 mg 1 p.o. t.i.d 4. Coumadin 5 mg 1 p.o. q.h.s. 5. Aspirin 325 mg 1 p.o. q.d. 6. Lisinopril 10 mg 1 p.o. q.d. 7. Oxycodone/acetaminophen 5/325 1 to 2 tablets q.[**4-21**] h. p.r.n. pain. Outpatient lab work on [**2105-6-10**] includes PT/INR and results are to be called in to Dr.[**Name (NI) 6001**] office at [**Telephone/Fax (1) 7164**] and chem-10 and PT/INR are to be checked on [**2105-6-12**] and again results to be called in to Dr.[**Name (NI) 6001**] office at [**Telephone/Fax (1) 56416**]. Additionally, the patient received Lovenox 80 mg subcutaneous injection 1 p.o. b.i.d. for 2 days till INR is therapeutic. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**MD Number(2) 13600**] Dictated By:[**Last Name (NamePattern1) 18827**] MEDQUIST36 D: [**2105-8-13**] 13:21:55 T: [**2105-8-13**] 15:50:44 Job#: [**Job Number 56417**]

410,414,401,714

{'Acute myocardial infarction of inferolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Rheumatoid arthritis'}

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: This patient was admitted to the CCU under the care of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. He is a 60-year-old gentleman with history of rheumatic arthritis and hypercholesterolemia who is a transfer from an outside hospital with an acute anterior MI. The patient had several episodes of chest tightness without exertion over the last week prior to admission. The night prior to admission at 9:30 p.m., he had 9 out of 10 chest pain, shortness of breath, and nausea. EMS arrived and took patient to [**Hospital6 3622**] where anterolateral hyperacute T waves were noted and ST elevations in I, aVL, and V1 through V5. Aspirin, Plavix, heparin, and Integrilin were started. The patient was brought to the [**Hospital1 18**] where catheterization revealed a thrombotic LAD occlusion and the patient underwent CYPHER stent placement. MEDICAL HISTORY: The patient's past medical history, otherwise, is significant for rheumatoid arthritis and hypercholesterolemia. MEDICATION ON ADMISSION: ALLERGIES: ERYTHROMYCIN, WHICH CAUSES A RASH. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory per the patient. SOCIAL HISTORY: He can do all his ADLs. No ETOH, occasional tobacco, no other drugs. ### Response: {'Acute myocardial infarction of inferolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Rheumatoid arthritis'}

CHIEF COMPLAINT: Fatigue PRESENT ILLNESS: Mr. [**Known lastname 86647**] is a very pleasant 78 year old man with a PMH significant for dyslipidemia, hypertension, CKD, COPD, afib, bladder ca s/po cystectomy/prostectomy with urostomy, parathyroid resection, and lung nodule resection who presented to [**Hospital3 26615**] with a day's worth of weaknes. There, he was found to be hypotense to the 80s sytolic (normally 110s at home on 2 BP meds), WBC 34,000, a creatinine doubled to 4, and a lactate of 4.9, with an INR of 4.8. He had a recent U/A at a PCP's office a week ago which apparently showed a Klebsiella UTI, for which he was treated with a week's worth of ABX (he is not sure which kind). [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] gave him Levoquin and Vancomyin. He was also noted at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] to have a tropinin of 0.21. . In our ED, he got a CVL for SBPs int he 80s, and got 2 L NS. He also recieved a dose of Zosyn. Our ED labs were notable for WBC count of 30.4, with a bandemia of 5%, and a HCT of 37.1, with plts of 11. Lactate in the ED was 3.1. Levophed was placed at bedside but not hung. . He says that his story started two mondays ago, when he had some profuse vomiting leading to some back [**Doctor Last Name **], for which his PCP prescribed him oxycodone. The next Wed (1.5 weeks ago) he noticed some dark urine; his PCP thus prescribed him an antibiotic to be taken for a week, which he took diligently. He MEDICAL HISTORY: Dyslipidemia Hypertension CKD (last Cr 2.9 on [**2-1**]) COPD Atrial fibrillation (paroxysmal, on Coumadin) Bladder CA s/p cystectomy/prostatectomy Hyperparathyroidism s/p parathyroid resection [**2135**] Lung nodule resection (PCP's office has record of adenocarcinoma of the lung but no info on tx) Gout CAD s/p stent placement to LAD and LCx [**2126**] MEDICATION ON ADMISSION: Coumadin 2 mg Daily (changed to 1 mg [**2-14**]) Allopurinol 100 mg PO BID Metoprolol Succinate 50 mg Daily Levoxyl 50 mcg Daily Simvastatin 10 mg Daily Isosorbide Mononitrate 30 mg Daily Furosemide 40-80 mg Daily. Sodium Bicarb 650 mg QID. Spectravite Feosol 65 mg Daily Stool Softener Coquenzyme Q-10 100 mg Daily Spiriva 18 daily Imdur 30 daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: General: Alert, oriented, no acute distress HEENT: Dry Neck: supple, JVP not elevated, no LAD CV: Afib Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: urostomy Ext: cool Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . DISCHARGE PHYSICAL EXAM: Vitals: 98.8, 98.8, 158/90 (121-158/78-95), 84 (54-84), 20, 99RA FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Patient lives [**Location (un) **] with his wife. [**Name (NI) **] a 55 pk/yr history but quit 10 yrs ago. Has ~2 drinks/week and denies drug use. He is retired and used to work as at metal worker.

Unspecified septicemia,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Chronic systolic heart failure,Other primary cardiomyopathies,Acidosis,Other acute and subacute forms of ischemic heart disease, other,Urinary tract infection, site not specified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Herpes simplex without mention of complication,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypoxemia,Atrial fibrillation,Thrombocytopenia, unspecified,Old myocardial infarction,Cardiac pacemaker in situ,Personal history of malignant neoplasm of bladder,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bronchus and lung,Personal history of malignant neoplasm of prostate,Personal history of tobacco use,Other artificial opening of urinary tract status

Septicemia NOS,Septic shock,Ac kidny fail, tubr necr,Acute necrosis of liver,Chr systolic hrt failure,Prim cardiomyopathy NEC,Acidosis,Ac ischemic hrt dis NEC,Urin tract infection NOS,Severe sepsis,Hy kid NOS w cr kid I-IV,Herpes simplex NOS,Chronic kidney dis NOS,Crnry athrscl natve vssl,Hypoxemia,Atrial fibrillation,Thrombocytopenia NOS,Old myocardial infarct,Status cardiac pacemaker,Hx of bladder malignancy,Status-post ptca,Long-term use anticoagul,Hx-bronchogenic malignan,Hx-prostatic malignancy,History of tobacco use,Urinostomy status NEC

Admission Date: [**2137-2-21**] Discharge Date: [**2137-2-27**] Date of Birth: [**2059-2-18**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 4358**] Chief Complaint: Fatigue Major Surgical or Invasive Procedure: Midline Placement History of Present Illness: Mr. [**Known lastname 86647**] is a very pleasant 78 year old man with a PMH significant for dyslipidemia, hypertension, CKD, COPD, afib, bladder ca s/po cystectomy/prostectomy with urostomy, parathyroid resection, and lung nodule resection who presented to [**Hospital3 26615**] with a day's worth of weaknes. There, he was found to be hypotense to the 80s sytolic (normally 110s at home on 2 BP meds), WBC 34,000, a creatinine doubled to 4, and a lactate of 4.9, with an INR of 4.8. He had a recent U/A at a PCP's office a week ago which apparently showed a Klebsiella UTI, for which he was treated with a week's worth of ABX (he is not sure which kind). [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] gave him Levoquin and Vancomyin. He was also noted at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] to have a tropinin of 0.21. . In our ED, he got a CVL for SBPs int he 80s, and got 2 L NS. He also recieved a dose of Zosyn. Our ED labs were notable for WBC count of 30.4, with a bandemia of 5%, and a HCT of 37.1, with plts of 11. Lactate in the ED was 3.1. Levophed was placed at bedside but not hung. . He says that his story started two mondays ago, when he had some profuse vomiting leading to some back [**Doctor Last Name **], for which his PCP prescribed him oxycodone. The next Wed (1.5 weeks ago) he noticed some dark urine; his PCP thus prescribed him an antibiotic to be taken for a week, which he took diligently. He A CXR showed a R IJ in place, but no overt pulmonary edema. . On arrival to the MICU, he was very pleasant, AAOx3. . Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. 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: Dyslipidemia Hypertension CKD (last Cr 2.9 on [**2-1**]) COPD Atrial fibrillation (paroxysmal, on Coumadin) Bladder CA s/p cystectomy/prostatectomy Hyperparathyroidism s/p parathyroid resection [**2135**] Lung nodule resection (PCP's office has record of adenocarcinoma of the lung but no info on tx) Gout CAD s/p stent placement to LAD and LCx [**2126**] Social History: Patient lives [**Location (un) **] with his wife. [**Name (NI) **] a 55 pk/yr history but quit 10 yrs ago. Has ~2 drinks/week and denies drug use. He is retired and used to work as at metal worker. Family History: There is no family history of premature coronary artery disease or sudden death. Physical Exam: ADMISSION PHYSICAL EXAM: General: Alert, oriented, no acute distress HEENT: Dry Neck: supple, JVP not elevated, no LAD CV: Afib Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: urostomy Ext: cool Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . DISCHARGE PHYSICAL EXAM: Vitals: 98.8, 98.8, 158/90 (121-158/78-95), 84 (54-84), 20, 99RA General: Alert, oriented, no acute distress, very pleasant HEENT: Anicteric sclerae, MMM, oropharynx clear, no JVD, significant crusting and superficial ulceration of the upper and lower lips and perioral area CV: Irregularly irregular rhythm, no m/r/g Lungs: minimal rales at bases bilaterally, otherwise clear, no wheezes Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, urostomy site clear without bloody output, no CVA tenderness Ext: No peripheral edema, no calf tenderness Pertinent Results: ADMISSION LABS: . [**2137-2-21**] 09:57PM BLOOD WBC-30.4*# RBC-4.07* Hgb-12.6* Hct-37.1* MCV-91 MCH-31.0 MCHC-34.0 RDW-15.1 Plt Ct-111*# [**2137-2-21**] 09:57PM BLOOD Neuts-87* Bands-5 Lymphs-1* Monos-7 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2137-2-21**] 09:57PM BLOOD Hypochr-NORMAL Anisocy-OCCASIONAL Poiklo-OCCASIONAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL Ovalocy-OCCASIONAL [**2137-2-22**] 05:42AM BLOOD PT-118.7* PTT-55.3* INR(PT)-12.7* [**2137-2-22**] 07:39AM BLOOD Fibrino-661* [**2137-2-22**] 01:38PM BLOOD FDP-0-10 [**2137-2-21**] 09:57PM BLOOD Glucose-135* UreaN-77* Creat-4.6*# Na-138 K-3.7 Cl-100 HCO3-25 AnGap-17 [**2137-2-22**] 05:42AM BLOOD CK(CPK)-438* [**2137-2-22**] 02:08AM BLOOD CK-MB-15* cTropnT-0.15* [**2137-2-22**] 05:42AM BLOOD CK-MB-14* MB Indx-3.2 cTropnT-0.15* [**2137-2-22**] 01:06PM BLOOD CK-MB-12* MB Indx-4.2 cTropnT-0.16* [**2137-2-22**] 05:42AM BLOOD Calcium-7.5* Phos-5.4*# Mg-1.9 [**2137-2-22**] 01:06PM BLOOD Vanco-9.4* [**2137-2-22**] 05:52AM BLOOD Type-ART Temp-35.8 pO2-106* pCO2-34* pH-7.40 calTCO2-22 Base XS--2 Intubat-NOT INTUBA [**2137-2-21**] 10:04PM BLOOD Lactate-3.1* [**2137-2-22**] 03:15AM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.009 [**2137-2-22**] 03:15AM URINE Blood-MOD Nitrite-NEG Protein-TR Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-LG [**2137-2-22**] 03:15AM URINE RBC-7* WBC-86* Bacteri-MOD Yeast-NONE Epi-0 [**2137-2-22**] 03:15AM URINE Mucous-RARE . PERTINENT LABS: . [**2137-2-21**] 09:57PM BLOOD WBC-30.4*# RBC-4.07* Hgb-12.6* Hct-37.1* MCV-91 MCH-31.0 MCHC-34.0 RDW-15.1 Plt Ct-111*# [**2137-2-22**] 05:42AM BLOOD PT-118.7* PTT-55.3* INR(PT)-12.7* [**2137-2-22**] 07:39AM BLOOD Fibrino-661* [**2137-2-22**] 01:38PM BLOOD FDP-0-10 [**2137-2-21**] 09:57PM BLOOD Glucose-135* UreaN-77* Creat-4.6*# Na-138 K-3.7 Cl-100 HCO3-25 AnGap-17 [**2137-2-23**] 04:13AM BLOOD ALT-112* AST-63* AlkPhos-309* TotBili-1.1 [**2137-2-22**] 02:08AM BLOOD CK-MB-15* cTropnT-0.15* [**2137-2-22**] 05:42AM BLOOD CK-MB-14* MB Indx-3.2 cTropnT-0.15* [**2137-2-22**] 01:06PM BLOOD CK-MB-12* MB Indx-4.2 cTropnT-0.16* [**2137-2-21**] 10:04PM BLOOD Lactate-3.1* [**2137-2-22**] 03:15AM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.009 [**2137-2-22**] 03:15AM URINE Blood-MOD Nitrite-NEG Protein-TR Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-LG [**2137-2-22**] 03:15AM URINE RBC-7* WBC-86* Bacteri-MOD Yeast-NONE Epi-0 . DISCHARGE LABS: . [**2137-2-27**] 07:20AM BLOOD WBC-7.5 RBC-4.18* Hgb-12.6* Hct-37.7* MCV-90 MCH-30.1 MCHC-33.4 RDW-15.9* Plt Ct-149* [**2137-2-27**] 07:20AM BLOOD PT-29.8* INR(PT)-2.9* [**2137-2-27**] 07:20AM BLOOD Glucose-97 UreaN-39* Creat-2.2* Na-144 K-4.0 Cl-113* HCO3-24 AnGap-11 [**2137-2-27**] 07:20AM BLOOD Calcium-8.4 Phos-2.3* Mg-2.0 . MICRO/PATH: . Blood Culture x 2 [**2-22**]: No growth . Urine Culture [**2-22**]: MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT WITH FECAL CONTAMINATION. . MRSA Screen [**2-22**]: No MRSA . IMAGING: . CXR [**2137-2-21**]: FINDINGS: There has been interval placement of a right-sided internal jugular venous catheter. The tip is slightly obscured by overlapping lead from pacemaker; however, appears to terminate in the low SVC. A single-lead left-sided pacemaker is unchanged.Within the lungs, no focal opacity to suggest pneumonia is seen. No pleural effusion, pulmonary edema, or pneumothorax is present. There is mild vascular congestion. The heart size is top normal, unchanged. Chain suture is noted in the left hemithorax with volume loss suggestive of prior resection. IMPRESSION: Central catheter in standard position without pneumothorax. . Abdominal U/S [**2137-2-22**]: IMPRESSION: 1. Small amount of gallbladder sludge. No specific son[**Name (NI) 493**] sign to suggest acute cholecystitis. Top normal common bile duct diameter. 2. Bilateral renal cysts and mild cortical thinning. Brief Hospital Course: 78 year old man with h/o dyslipidemia, hypertension, CKD, COPD, afib, bladder ca s/po cystectomy/prostectomy with urostomy, parathyroid resection, and lung nodule resection who presented to OSH with a one day of weakness transfered to [**Hospital1 18**] for evaluation and treatment of sepsis from suspected urinary source. . ACTIVE DIAGNOSES: . # Sepsis from Urinary Source: Patient had a UA with 86 WBCs and large bacteria in setting of unusual urologic anatomy with urostomy. He was pan-cultured and treated with vanc and zosyn initially empirically for urosepsis. He was volume resuscitated with 2L in the ED with CVPs at goal, but continued to by hypotensive and was started on both levophed and vasopressin in the MICU. He was able to be weaned off these by the following day. His antibiotics were changed to vanc/cefepime/flagyl after obtaining information from his PCP that he had recently been treated with doxycycline for a Klebsiella UTI (resistant to ampicillin, nitrofurantoin, piperacillin; sensitive to cephalsporins; non-ESBL). He was called out to the floor on [**2-23**] for further management. His antibiotics were narrowed to ceftriaxone. His fevers, leukocytosis (34K->7K), lactatemia, and other evidence of end organ ischemia resolved and he no longer required IV fluids to maintain his pressures. All in-house culture data was negative or c/w contamination, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] blood cultures were also negative (no urine cultures there). A midline was placed for him to finish his 10-day total course of ceftriaxone (last day [**3-3**]). . #Acute Renal Failure on CKD, Concern for Acute Tubular Necrosis: Resolved. Cr peaked in house to 4.6, up from prior baseline of 2.2 but trended back down to 2.2 with pressors and fluids rec'd in the unit and on the floor. The likely cause for his ARF was thought to be hypoperfusion secondary to distributive shock from sepsis causing ATN. . # CAD/Troponin Leak: Has known h/o CAD s/p stenting to the LAD and LCx in [**2126**]. Is not on anti-platelet agents (ASA/plavix) given h/o heavy bleeding. Was noted at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] to have a tropinin of 0.21 and at [**Hospital1 18**] was 0.15 with normal MB index, remaining stable on trend. EKG was w/o acute ischemic changes and pt was asymptomatic. Enzyme leak was attributed to demand in setting of shock as well as retention from ARF. . #. Atrial Fibrillation: Patient presented in AF, but not in RVR, with supratherapeutic INR (12.7) likely in setting of recent antibiotics. Per his PCP, [**Name10 (NameIs) **] coumadin dose had recently been changed from 2 to 1 mg in the setting of his elevated INRs. His beta blocker and coumadin were held in the setting of his acute illness and elevated INR. He received 5 mg of vitamin K to help correct his INR of 12.7. He was restarted on coumadin and his beta blocker on discharge. . # Thrombocytopenia: In setting of elevated INR, concern for DIC- fibrinogen and FDP were sent and negative. Low platelets were attributed to septis. . # Transaminitis: Likely from mild shock-liver picture from hypoperfusion. Downtrending and almost wnl's at the time of discharge. [**Name10 (NameIs) 5283**] U/S unremarkable for structural cause. . #Oral Herpes Simplex Recurrence: Not causing many symptoms or pain. Started during his hospitalization likely related to the severe stress of medical illness. He was started on a 3-day course of renally-dosed valacyclovir. . CHRONIC DIAGNOSES: . # sCHF: Stable. His home diuretic regimen was held during his acute illness but re-started at the time of discharge. . # COPD: Stable. He was continued on his home tioproprium. . TRANSITIONAL ISSUES: . #Code Status: Patient was Full Code during this admission. . #Antibiotics: Patient is receiving a 10 day course of IV cephalosporins (first cefepime, now ceftriaxone) to end [**3-3**]. . #Urology Follow-up: Patient may benefit from urology follow-up for strategies to avoid severe UTI's in the past given his altered anatomy. . #CHF: Patient is not on an Ace inhibitor which is indicated for his systolic CHF. . #Transaminitis: Patient had mild transaminitis on discharge that was downtrending and almost within normal limits. He had a relatively unremarkable [**Name (NI) 5283**] U/S. We defer further evaluation of this issue to the outpatient setting. . #INR: This patient will need very tight monitoring of his INR given his fairly large swings even on low doses. Medications on Admission: Coumadin 2 mg Daily (changed to 1 mg [**2-14**]) Allopurinol 100 mg PO BID Metoprolol Succinate 50 mg Daily Levoxyl 50 mcg Daily Simvastatin 10 mg Daily Isosorbide Mononitrate 30 mg Daily Furosemide 40-80 mg Daily. Sodium Bicarb 650 mg QID. Spectravite Feosol 65 mg Daily Stool Softener Coquenzyme Q-10 100 mg Daily Spiriva 18 daily Imdur 30 daily Discharge Medications: 1. warfarin 1 mg Tablet Sig: One (1) Tablet PO every other day. Disp:*15 Tablet(s)* Refills:*0* 2. allopurinol 100 mg Tablet Sig: One (1) Tablet PO twice a day. 3. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 4. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO once a day. 5. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 7. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day. 8. sodium bicarbonate 650 mg Tablet Sig: One (1) Tablet PO four times a day. 9. Spectravite Tablet Sig: One (1) Tablet PO once a day. 10. Feosol 325 mg (65 mg iron) Tablet Sig: One (1) Tablet PO once a day. 11. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. 12. coenzyme Q10 100 mg Capsule Sig: One (1) Capsule PO once a day. 13. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device Sig: One (1) Inhalation once a day. 14. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. Disp:*30 Tablet(s)* Refills:*0* 15. sodium chloride 0.65 % Aerosol, Spray Sig: [**1-7**] Sprays Nasal QID (4 times a day) as needed for dry nares. Disp:*1 bottle* Refills:*0* 16. ipratropium-albuterol 18-103 mcg/actuation Aerosol Sig: [**1-7**] puff Inhalation four times a day as needed for shortness of breath or wheezing. Disp:*1 device* Refills:*0* 17. ceftriaxone in dextrose,iso-os 1 gram/50 mL Piggyback Sig: One (1) Intravenous Q24H (every 24 hours) for 4 days: Last Dose [**2137-3-3**]. Disp:*4 doses* Refills:*0* 18. valacyclovir 1 g Tablet Sig: One (1) Tablet PO once a day for 1 days. Disp:*1 Tablet(s)* Refills:*0* 19. Ensure Liquid Sig: One (1) PO three times a day. Disp:*2 cases* Refills:*0* 20. heparin, porcine (PF) 10 unit/mL Syringe Sig: One (1) ML Intravenous PRN (as needed) as needed for line flush. Disp:*8 syringes* Refills:*0* Discharge Disposition: Home With Service Facility: [**Last Name (LF) 486**], [**First Name3 (LF) 487**] Discharge Diagnosis: Primary: -Sepsis from urinary source -Acute Renal Failure -Mild shock liver . Secondary: -sCHF -CKD -Atrial fibrillation -COPD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname 86647**], . It was a pleasure taking care of you! You were transferred to [**Hospital1 18**] for evaluation and treatment of sepsis from a urinary tract infection. You were treated in the ICU with fluids, pressors, and antibiotics and your condition improved dramatically. You were further evaluated on the floor and you continued to improve with return of your kidney and liver function to your prior normal levels. We placed a temporary line in you for further antibiotic administration to complete your course. . The following changes have been made to your medications: -START Ceftriaxone 1gram IV once daily for 4 more days (last day [**3-3**]) -START Valtrex 1gram by mouth once daily for 1 more day (last day [**2-28**]) -START Ipratropium/Albuterol MDI [**1-7**] inhalations four times a day as needed for shortness of breath/wheezes -START Saline nasal spray as needed -START Senna 1 tab by mouth twice daily as needed for constipation -DECREASE Coumadin (warfarin) to 1mg by mouth every other day (START taking it [**2-28**]) -Continue taking your other home medications as directed -Please have your INR checked on Friday [**3-1**] . Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. . Please follow-up with the appointments listed below. Followup Instructions: Name: [**Last Name (un) **],[**Last Name (un) 75760**] A. --Primary Care Location: [**Hospital **] MEDICAL ASSOCIATES Address: [**Apartment Address(1) 86648**], [**Location (un) **],[**Numeric Identifier 32948**] Phone: [**Telephone/Fax (1) 75761**] Appt: [**3-6**] at 9:45am Completed by:[**2137-3-2**]

038,785,584,570,428,425,276,411,599,995,403,054,585,414,799,427,287,412,V450,V105,V458,V586,V101,V104,V158,V446

{'Unspecified septicemia,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Chronic systolic heart failure,Other primary cardiomyopathies,Acidosis,Other acute and subacute forms of ischemic heart disease, other,Urinary tract infection, site not specified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Herpes simplex without mention of complication,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypoxemia,Atrial fibrillation,Thrombocytopenia, unspecified,Old myocardial infarction,Cardiac pacemaker in situ,Personal history of malignant neoplasm of bladder,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bronchus and lung,Personal history of malignant neoplasm of prostate,Personal history of tobacco use,Other artificial opening of urinary tract status'}

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: Fatigue PRESENT ILLNESS: Mr. [**Known lastname 86647**] is a very pleasant 78 year old man with a PMH significant for dyslipidemia, hypertension, CKD, COPD, afib, bladder ca s/po cystectomy/prostectomy with urostomy, parathyroid resection, and lung nodule resection who presented to [**Hospital3 26615**] with a day's worth of weaknes. There, he was found to be hypotense to the 80s sytolic (normally 110s at home on 2 BP meds), WBC 34,000, a creatinine doubled to 4, and a lactate of 4.9, with an INR of 4.8. He had a recent U/A at a PCP's office a week ago which apparently showed a Klebsiella UTI, for which he was treated with a week's worth of ABX (he is not sure which kind). [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] gave him Levoquin and Vancomyin. He was also noted at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] to have a tropinin of 0.21. . In our ED, he got a CVL for SBPs int he 80s, and got 2 L NS. He also recieved a dose of Zosyn. Our ED labs were notable for WBC count of 30.4, with a bandemia of 5%, and a HCT of 37.1, with plts of 11. Lactate in the ED was 3.1. Levophed was placed at bedside but not hung. . He says that his story started two mondays ago, when he had some profuse vomiting leading to some back [**Doctor Last Name **], for which his PCP prescribed him oxycodone. The next Wed (1.5 weeks ago) he noticed some dark urine; his PCP thus prescribed him an antibiotic to be taken for a week, which he took diligently. He MEDICAL HISTORY: Dyslipidemia Hypertension CKD (last Cr 2.9 on [**2-1**]) COPD Atrial fibrillation (paroxysmal, on Coumadin) Bladder CA s/p cystectomy/prostatectomy Hyperparathyroidism s/p parathyroid resection [**2135**] Lung nodule resection (PCP's office has record of adenocarcinoma of the lung but no info on tx) Gout CAD s/p stent placement to LAD and LCx [**2126**] MEDICATION ON ADMISSION: Coumadin 2 mg Daily (changed to 1 mg [**2-14**]) Allopurinol 100 mg PO BID Metoprolol Succinate 50 mg Daily Levoxyl 50 mcg Daily Simvastatin 10 mg Daily Isosorbide Mononitrate 30 mg Daily Furosemide 40-80 mg Daily. Sodium Bicarb 650 mg QID. Spectravite Feosol 65 mg Daily Stool Softener Coquenzyme Q-10 100 mg Daily Spiriva 18 daily Imdur 30 daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: General: Alert, oriented, no acute distress HEENT: Dry Neck: supple, JVP not elevated, no LAD CV: Afib Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: urostomy Ext: cool Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . DISCHARGE PHYSICAL EXAM: Vitals: 98.8, 98.8, 158/90 (121-158/78-95), 84 (54-84), 20, 99RA FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Patient lives [**Location (un) **] with his wife. [**Name (NI) **] a 55 pk/yr history but quit 10 yrs ago. Has ~2 drinks/week and denies drug use. He is retired and used to work as at metal worker. ### Response: {'Unspecified septicemia,Septic shock,Acute kidney failure with lesion of tubular necrosis,Acute and subacute necrosis of liver,Chronic systolic heart failure,Other primary cardiomyopathies,Acidosis,Other acute and subacute forms of ischemic heart disease, other,Urinary tract infection, site not specified,Severe sepsis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Herpes simplex without mention of complication,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypoxemia,Atrial fibrillation,Thrombocytopenia, unspecified,Old myocardial infarction,Cardiac pacemaker in situ,Personal history of malignant neoplasm of bladder,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of bronchus and lung,Personal history of malignant neoplasm of prostate,Personal history of tobacco use,Other artificial opening of urinary tract status'}

CHIEF COMPLAINT: BPBPR PRESENT ILLNESS: 77 y/o with h/o colon adenomas, esophageal rings / dysmotility, CAD s/p CABG, and DM presents with BRBPR and diarrhea x1 day. Pt had EGD and colonoscopy [**2133-10-15**] with removal of 2 polyps in the ascending colon. Last evening after dinner she had approximately 10 episode of diarrhea with blood "filling the toilet bowl". The patient denies Abd pain. Reports chonic intermittant dark stools attributed to constipation (not temporally related to Fe). No blood in her stool prior to last evening. Had nausea this am without vomitting. Reports lightheadness without syncope. No F/C/NS. . Review of systems: no F/C/S. 10 lb wt loss over 3 months. Fatigue for 4 months. Chronic excersional leftsided CP with walking across a parking lot. None in last week. No SOB, Cough. No dysuria. Chronic back and leg pain. . In the emergency department initial VS 96.5, HR 54, BP 117/49, 18, 100% RA. She was starting 1L IVF and 1 U pRBC had had been ordered but not given. 2 PIV in place. EKG with sinus bradycardia but no ischemic changes. CXR without free air. GI requesting ICU admission for likely colonoscopy tomorrow. VS prior to transfer 96.5 53, 120/42, 100RA. MEDICAL HISTORY: - DM2 - HTN - CAD - s/p CABG [**2127**] LIMA-->LAD, SVG--> D1, SVG--> PDA - hypercholesterolemia - s/p laminectomy [**2115**] - spondylosis - Lumbar Spinal Stenosis S/P L1-L3 Laminectomy and Fusion of L2-L3 in [**2129**] - s/p bilateral carpal tunnel release [**2105**] - cataracts - GERD - dysphagia: esophageal manometry ([**10/2130**]) shows evidence of ineffective esophageal peristalsis in just under 50% of wet swallows with a borderline low [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 23216**] pressure - 6mm lung nodule in RML two year stability in [**2133**] - adenomatous polyps on colonoscopy [**2131**]. 2 Polypectomys in ascending colon on [**2133-10-15**] - [**2130**] gastritis and doudenitis on EGD (NSIAD induced?) - esophogeal ring [**2130**] egd MEDICATION ON ADMISSION: Amlodipine 10mg daily citalopram 10mg daily HCTZ 25mg dailiy ibuprofen 600mg TID-QID prn pain Glargine 22 units daily in pm losartan 50mg daily metformin 1000mg [**Hospital1 **] Metoprolol succinate 50mg daily in pm prilosec 40mg [**Hospital1 **] Repaglinide 1mg daily acetaminophen 650mg SR [**Hospital1 **] Ascorbic acid 500mg daily Aspirin 81mg daily Calcium carbonate - Vit D3 600mg-400U daily Ferrous sulfate 142mg SR dailiy Garlic 400mg daily multivitamin daily Vitamin E 400 U daily ALLERGIES: Sulfonamides / Latex PHYSICAL EXAM: VITAL SIGNS: T=96 BP=130-53 HR=59 RR=14 O2= 100 RA. . . PHYSICAL EXAM GENERAL: Pleasant, pale appearing elderly female in NAD HEENT: Normocephalic, atraumatic. Conjunctival pallor. No scleral icterus. PERRLA/EOMI. Dry MM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. 3/6 SEM at LUSB, [**1-13**] holosystolic murmur at apex. JVP= 1cm above clavicle LUNGS: CTAB, good air movement biaterally. ABDOMEN: NL BS. Soft, NT, ND. No HSM EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. Gait assessment deferred PSYCH: Listens and responds to questions appropriately, pleasant FAMILY HISTORY: mother: [**Name (NI) 11398**], deceased from MI age 62 father: lung cancer, deceased Brother renal cancer SOCIAL HISTORY: Widow x 13 years. Lives alone in [**Location 1268**]. Has six children and six granchildren. Independent in daily activities. Walks without aid of a cane or a walker. Catholic, goes to church every morning. Denies tobacco, IVDU. Occasional EtOH with dinner.

Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Dysphagia, unspecified,Benign neoplasm of colon,Hyperpotassemia,Iron deficiency anemia, unspecified,Depressive disorder, not elsewhere classified,Pure hypercholesterolemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status

Hemorrhage complic proc,Acute kidney failure NOS,Abn react-surg proc NEC,Esophageal reflux,Dysphagia NOS,Benign neoplasm lg bowel,Hyperpotassemia,Iron defic anemia NOS,Depressive disorder NEC,Pure hypercholesterolem,Hypertension NOS,DMII wo cmp nt st uncntr,Cor ath unsp vsl ntv/gft,Aortocoronary bypass

Admission Date: [**2133-10-23**] Discharge Date: [**2133-10-25**] Date of Birth: [**2056-5-21**] Sex: F Service: MEDICINE Allergies: Sulfonamides / Latex Attending:[**First Name3 (LF) 3531**] Chief Complaint: BPBPR Major Surgical or Invasive Procedure: none History of Present Illness: 77 y/o with h/o colon adenomas, esophageal rings / dysmotility, CAD s/p CABG, and DM presents with BRBPR and diarrhea x1 day. Pt had EGD and colonoscopy [**2133-10-15**] with removal of 2 polyps in the ascending colon. Last evening after dinner she had approximately 10 episode of diarrhea with blood "filling the toilet bowl". The patient denies Abd pain. Reports chonic intermittant dark stools attributed to constipation (not temporally related to Fe). No blood in her stool prior to last evening. Had nausea this am without vomitting. Reports lightheadness without syncope. No F/C/NS. . Review of systems: no F/C/S. 10 lb wt loss over 3 months. Fatigue for 4 months. Chronic excersional leftsided CP with walking across a parking lot. None in last week. No SOB, Cough. No dysuria. Chronic back and leg pain. . In the emergency department initial VS 96.5, HR 54, BP 117/49, 18, 100% RA. She was starting 1L IVF and 1 U pRBC had had been ordered but not given. 2 PIV in place. EKG with sinus bradycardia but no ischemic changes. CXR without free air. GI requesting ICU admission for likely colonoscopy tomorrow. VS prior to transfer 96.5 53, 120/42, 100RA. Past Medical History: - DM2 - HTN - CAD - s/p CABG [**2127**] LIMA-->LAD, SVG--> D1, SVG--> PDA - hypercholesterolemia - s/p laminectomy [**2115**] - spondylosis - Lumbar Spinal Stenosis S/P L1-L3 Laminectomy and Fusion of L2-L3 in [**2129**] - s/p bilateral carpal tunnel release [**2105**] - cataracts - GERD - dysphagia: esophageal manometry ([**10/2130**]) shows evidence of ineffective esophageal peristalsis in just under 50% of wet swallows with a borderline low [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 23216**] pressure - 6mm lung nodule in RML two year stability in [**2133**] - adenomatous polyps on colonoscopy [**2131**]. 2 Polypectomys in ascending colon on [**2133-10-15**] - [**2130**] gastritis and doudenitis on EGD (NSIAD induced?) - esophogeal ring [**2130**] egd Social History: Widow x 13 years. Lives alone in [**Location 1268**]. Has six children and six granchildren. Independent in daily activities. Walks without aid of a cane or a walker. Catholic, goes to church every morning. Denies tobacco, IVDU. Occasional EtOH with dinner. Family History: mother: [**Name (NI) 11398**], deceased from MI age 62 father: lung cancer, deceased Brother renal cancer Physical Exam: VITAL SIGNS: T=96 BP=130-53 HR=59 RR=14 O2= 100 RA. . . PHYSICAL EXAM GENERAL: Pleasant, pale appearing elderly female in NAD HEENT: Normocephalic, atraumatic. Conjunctival pallor. No scleral icterus. PERRLA/EOMI. Dry MM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. 3/6 SEM at LUSB, [**1-13**] holosystolic murmur at apex. JVP= 1cm above clavicle LUNGS: CTAB, good air movement biaterally. ABDOMEN: NL BS. Soft, NT, ND. No HSM EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. Gait assessment deferred PSYCH: Listens and responds to questions appropriately, pleasant Pertinent Results: [**2133-10-23**] 08:45AM BLOOD WBC-4.4 RBC-3.17*# Hgb-7.4* Hct-23.9* MCV-75* MCH-23.5* MCHC-31.2 RDW-19.8* Plt Ct-196 [**2133-10-23**] 07:38PM BLOOD Hct-27.0* [**2133-10-24**] 04:29AM BLOOD WBC-4.8 RBC-3.99*# Hgb-10.3*# Hct-31.5* MCV-79* MCH-25.8* MCHC-32.7 RDW-17.8* Plt Ct-162 [**2133-10-24**] 10:24AM BLOOD Hct-32.1* [**2133-10-24**] 04:25PM BLOOD Hct-29.9* [**2133-10-25**] 12:20AM BLOOD WBC-5.1 RBC-3.97* Hgb-10.4* Hct-31.4* MCV-79* MCH-26.1* MCHC-33.0 RDW-18.0* Plt Ct-160 [**2133-10-25**] 06:10AM BLOOD WBC-5.0 RBC-4.12* Hgb-10.6* Hct-32.3* MCV-78* MCH-25.7* MCHC-32.8 RDW-18.6* Plt Ct-161 [**2133-10-23**] 08:45AM BLOOD Neuts-71.5* Lymphs-23.6 Monos-2.6 Eos-1.3 Baso-1.0 [**2133-10-24**] 04:29AM BLOOD Neuts-67.7 Bands-0 Lymphs-25.2 Monos-5.3 Eos-1.5 Baso-0.3 [**2133-10-24**] 04:29AM BLOOD Hypochr-2+ Anisocy-1+ Poiklo-1+ Macrocy-NORMAL Microcy-1+ Polychr-OCCASIONAL Spheroc-1+ Ovalocy-1+ Schisto-OCCASIONAL [**2133-10-23**] 08:45AM BLOOD PT-12.0 PTT-18.3* INR(PT)-1.0 [**2133-10-23**] 08:45AM BLOOD Plt Ct-196 [**2133-10-24**] 04:29AM BLOOD PT-11.8 PTT-20.4* INR(PT)-1.0 [**2133-10-24**] 04:29AM BLOOD Plt Smr-NORMAL Plt Ct-162 [**2133-10-25**] 12:20AM BLOOD Plt Ct-160 [**2133-10-25**] 06:10AM BLOOD Plt Ct-161 [**2133-10-23**] 08:45AM BLOOD Glucose-176* UreaN-37* Creat-1.3* Na-138 K-5.7* Cl-104 HCO3-23 AnGap-17 [**2133-10-23**] 02:44PM BLOOD Glucose-71 UreaN-28* Creat-0.9 Na-140 K-4.6 Cl-109* HCO3-24 AnGap-12 [**2133-10-24**] 04:29AM BLOOD Glucose-82 UreaN-19 Creat-0.9 Na-140 K-4.1 Cl-108 HCO3-24 AnGap-12 [**2133-10-25**] 06:10AM BLOOD Glucose-84 UreaN-13 Creat-1.0 Na-140 K-3.9 Cl-105 HCO3-23 AnGap-16 [**2133-10-23**] 08:45AM BLOOD ALT-12 AST-17 AlkPhos-46 TotBili-0.2 [**2133-10-23**] 02:44PM BLOOD Calcium-8.8 Phos-3.2 Mg-1.8 [**2133-10-25**] 06:10AM BLOOD Calcium-9.3 Phos-4.4 Mg-1.8 [**2133-10-23**] 08:56AM BLOOD Lactate-3.8* [**2133-10-23**] 04:32PM BLOOD Lactate-1.9 STUDIES: [**2133-10-23**] CXR: IMPRESSION: No evidence of intra-abdominal free air. No acute cardiopulmonary process. Brief Hospital Course: ASSESSMENT AND PLAN: 77 y/o with CAD, DM, h/o gastritis, and recent ascending colon polyopectomy presenting with 1 day of BRBPR. . #. BRBPR: The temporal correlation with recent polyopectomy on [**2133-10-15**] and onset of painless BRBPR makes post-polypectomy bleeding most likely. The presence of BRBPR from a site in the ascending colon suggest a brisk rate of bleeding. The onset with diarrhea makes infection possible, however less likely without abd pain, leukocytosis, or fever. UGI bleed is possible given h/o gastritis but unlikely given recent normal EGD. Pt has h/o grade 1 hemmirhoids on past colonoscopy, but not noted on most recent Colonoscopy. In addition no diverticulosis noted on colonoscopy. . GI was consulted and felt by the time she was in the ICU, she did not appear to be bleeding and was hemodynamically stable. Emergent colonscopy was deferred. She was closely monitored in the ICU for > 24 hours. Patient received 3 units PRBC's to maintain Hct > 30 per GI recs. She was also started on high dose pantoprazole IV BID. She was given IVF's for hydration and her Hct remained stable near 30 for over 12 hours. Her diet was advanced to clear liquids prior to transfer to the floor. Orthostatics were done and were negative prior to transfer. . Upon arrival to the medical floor, her HCT remained stable x36hrs without transfusion. Her diet was advanced without difficulty. She was discharged home with instructions to follow-up with her PCP [**Last Name (NamePattern4) **] 4 days, and to arrange for f/u with her gastroenterologist for further workup of her anemia. She was instructed to resume aspirin 1 day after discharge, but to avoid NSAIDs until she had followed-up with her GI physician. . # Hyperkalemia: Normalized during ICU course. Likely [**2-9**] dehydration as it improved with IVFs. Cr near baseline. No EKG changes. . # Renal: Cr mildly elevated to 1.3 from baseline of 1.0 to 1.1. Likely prerenal given diarrhea and blood loss. Improved with hydration and prbc's. 0.9 upon transfer to the floor. . #. CAD: s/p stents in [**2125**], CABG [**2127**]. [**9-15**] normal p MIBI. No CP or ischemic changes on EKG in setting of HCT drop. ASA was held given no recent stents and active bleeding initially. BP meds were also held in this setting. . Upon arrival to the medical floor her BP regimen was resumed (metoprolol, [**Last Name (un) **], HCTZ). After discussion with the GI service, she was instructed to resume aspirin 81mg po qdaily on 1d after discharge ([**10-26**]). . #. DMII: oral hypoglycemics were held while in ICU, and she was maintained on glargine and sliding scale coverage. upon discharge home, her oral regimen was resumed. . #. GERD: pt was treated with IV PPI [**Hospital1 **] in ICU, then switched back to oral PPI [**Hospital1 **] upon discharge. . # Fe deficiency anemia: etiology remains unclear, and pt will continue to have outpatient workup. . # Depression: continued SSRI. Medications on Admission: Amlodipine 10mg daily citalopram 10mg daily HCTZ 25mg dailiy ibuprofen 600mg TID-QID prn pain Glargine 22 units daily in pm losartan 50mg daily metformin 1000mg [**Hospital1 **] Metoprolol succinate 50mg daily in pm prilosec 40mg [**Hospital1 **] Repaglinide 1mg daily acetaminophen 650mg SR [**Hospital1 **] Ascorbic acid 500mg daily Aspirin 81mg daily Calcium carbonate - Vit D3 600mg-400U daily Ferrous sulfate 142mg SR dailiy Garlic 400mg daily multivitamin daily Vitamin E 400 U daily Discharge Medications: 1. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. Citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 3. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. 4. Losartan 50 mg Tablet Sig: One (1) Tablet PO once a day. 5. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 6. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 7. Prilosec 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 8. Prandin 1 mg Tablet Sig: One (1) Tablet PO once a day. 9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO once a day. 11. Lantus 100 unit/mL Solution Sig: 22 UNITS Subcutaneous once a day. 12. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO twice a day as needed for pain. 13. Vitamin E 400 unit Tablet Sig: One (1) Tablet PO once a day. 14. Calcium Carbonate-Vitamin D3 600-400 mg-unit Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: primary: lower gi bleeding from polypectomy site Discharge Condition: tolerating regular diet, stable HCT, no abdominal pain. Discharge Instructions: you were admitted to the hospital with bleeding from your rectum, after a recent colonoscopy with polypectomy. you were evaluated by the GI service, who felt your bleeding was due to the polypectomy site. your blood count stabilized after receiving 3 units of blood, and the decision was made not to repeat your colonoscopy. . the following changes were made to your medication regimen: 1. your aspirin is being held, you may resume this on [**10-26**] as per the GI service. 2. you should avoid taking motrin for your back pain until you see Dr. [**Last Name (STitle) 2161**], once the polyp site heals. . if you have recurrent episodes of rectal bleeding, light headedness, dizziness, abdominal pain, or other worrisome symptoms please contact your primary care physician or the emergency department. Followup Instructions: Please follow-up with your PCP, [**Name10 (NameIs) **] appointment already exists for you: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2133-10-29**] 9:20 . upon arriving home, please contact Dr. [**Last Name (STitle) 2161**], and arrange for follow-up with him as you had discussed previously. . Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2133-12-11**] 10:20 Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**], DPM Phone:[**Telephone/Fax (1) 543**] Date/Time:[**2134-1-18**] 9:25

998,584,E878,530,787,211,276,280,311,272,401,250,414,V458

{'Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Dysphagia, unspecified,Benign neoplasm of colon,Hyperpotassemia,Iron deficiency anemia, unspecified,Depressive disorder, not elsewhere classified,Pure hypercholesterolemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}

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: BPBPR PRESENT ILLNESS: 77 y/o with h/o colon adenomas, esophageal rings / dysmotility, CAD s/p CABG, and DM presents with BRBPR and diarrhea x1 day. Pt had EGD and colonoscopy [**2133-10-15**] with removal of 2 polyps in the ascending colon. Last evening after dinner she had approximately 10 episode of diarrhea with blood "filling the toilet bowl". The patient denies Abd pain. Reports chonic intermittant dark stools attributed to constipation (not temporally related to Fe). No blood in her stool prior to last evening. Had nausea this am without vomitting. Reports lightheadness without syncope. No F/C/NS. . Review of systems: no F/C/S. 10 lb wt loss over 3 months. Fatigue for 4 months. Chronic excersional leftsided CP with walking across a parking lot. None in last week. No SOB, Cough. No dysuria. Chronic back and leg pain. . In the emergency department initial VS 96.5, HR 54, BP 117/49, 18, 100% RA. She was starting 1L IVF and 1 U pRBC had had been ordered but not given. 2 PIV in place. EKG with sinus bradycardia but no ischemic changes. CXR without free air. GI requesting ICU admission for likely colonoscopy tomorrow. VS prior to transfer 96.5 53, 120/42, 100RA. MEDICAL HISTORY: - DM2 - HTN - CAD - s/p CABG [**2127**] LIMA-->LAD, SVG--> D1, SVG--> PDA - hypercholesterolemia - s/p laminectomy [**2115**] - spondylosis - Lumbar Spinal Stenosis S/P L1-L3 Laminectomy and Fusion of L2-L3 in [**2129**] - s/p bilateral carpal tunnel release [**2105**] - cataracts - GERD - dysphagia: esophageal manometry ([**10/2130**]) shows evidence of ineffective esophageal peristalsis in just under 50% of wet swallows with a borderline low [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 23216**] pressure - 6mm lung nodule in RML two year stability in [**2133**] - adenomatous polyps on colonoscopy [**2131**]. 2 Polypectomys in ascending colon on [**2133-10-15**] - [**2130**] gastritis and doudenitis on EGD (NSIAD induced?) - esophogeal ring [**2130**] egd MEDICATION ON ADMISSION: Amlodipine 10mg daily citalopram 10mg daily HCTZ 25mg dailiy ibuprofen 600mg TID-QID prn pain Glargine 22 units daily in pm losartan 50mg daily metformin 1000mg [**Hospital1 **] Metoprolol succinate 50mg daily in pm prilosec 40mg [**Hospital1 **] Repaglinide 1mg daily acetaminophen 650mg SR [**Hospital1 **] Ascorbic acid 500mg daily Aspirin 81mg daily Calcium carbonate - Vit D3 600mg-400U daily Ferrous sulfate 142mg SR dailiy Garlic 400mg daily multivitamin daily Vitamin E 400 U daily ALLERGIES: Sulfonamides / Latex PHYSICAL EXAM: VITAL SIGNS: T=96 BP=130-53 HR=59 RR=14 O2= 100 RA. . . PHYSICAL EXAM GENERAL: Pleasant, pale appearing elderly female in NAD HEENT: Normocephalic, atraumatic. Conjunctival pallor. No scleral icterus. PERRLA/EOMI. Dry MM. OP clear. Neck Supple, No LAD, No thyromegaly. CARDIAC: Regular rhythm, normal rate. Normal S1, S2. 3/6 SEM at LUSB, [**1-13**] holosystolic murmur at apex. JVP= 1cm above clavicle LUNGS: CTAB, good air movement biaterally. ABDOMEN: NL BS. Soft, NT, ND. No HSM EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis SKIN: No rashes/lesions, ecchymoses. NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved sensation throughout. 5/5 strength throughout. Gait assessment deferred PSYCH: Listens and responds to questions appropriately, pleasant FAMILY HISTORY: mother: [**Name (NI) 11398**], deceased from MI age 62 father: lung cancer, deceased Brother renal cancer SOCIAL HISTORY: Widow x 13 years. Lives alone in [**Location 1268**]. Has six children and six granchildren. Independent in daily activities. Walks without aid of a cane or a walker. Catholic, goes to church every morning. Denies tobacco, IVDU. Occasional EtOH with dinner. ### Response: {'Hemorrhage complicating a procedure,Acute kidney failure, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Dysphagia, unspecified,Benign neoplasm of colon,Hyperpotassemia,Iron deficiency anemia, unspecified,Depressive disorder, not elsewhere classified,Pure hypercholesterolemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}

CHIEF COMPLAINT: Mental status changes and RUQ pain PRESENT ILLNESS: This is an 87 yom with a complicated recent course including a laparoscopic converted to open cholecystectomy at [**Hospital 8**] Hospital in [**8-/2152**] , which was complicated by a bile leak and post-cholecystectomy stricturing. Since then, he has required six to seven ERCPs due to issues with biliary blockages and strictures and has had numerous stents placed. He has also had klebsiella bacteremia in 11/[**2151**]. He was subsequently admitted from [**2152-11-24**] through [**2152-12-2**] for evaluation of elevated LFTs and underwent a CT scan which was concerning for pancreatic mass with EUS/biopsies confirming 2.7 x 2.2 cm ill-defined mass consistent with pancreatic adenocarcinoma with metastases. . He had a recent admission from [**Date range (1) 90717**] for nausea/vomitting which improved with antiemtics and hydration. This hospitalization was also complicated by [**Last Name (un) **] and hyperK+ which stabilized on discharge. . The patient presented this admission with AMS, poor appetite, and leukocytosis. LFTs were also elevated beyond recent baseline but [**Female First Name (un) 7925**]/AP normal. Per son's report on admission to floor, pt was feeling better at time of discharge, but developed increased nausea and poor PO intake after recent discharge, as well as cough x 3 days (initially dry, now becoming productive). He has also been weaker than normal in that at baseline he is able to do is ADLs independently but now his son has had to hold him up to walk. No fevers at home. MEDICAL HISTORY: Oncologic History: Mr. [**Known lastname 90716**] initially had a cholecystectomy on [**8-13**]. At the time of this procedure, it turned into an open cholecystectomy and since that time he has had discomfort at the surgical site. Following this, he has required six to seven ERCPs due to issues with biliary blockages and strictures and has had numerous stents placed. He was admitted from [**2152-11-24**] through [**2152-12-2**] for evaluation of elevated LFTs and during that time had an [**Year (4 digits) **] and underwent a CT scan on [**2152-11-30**] that showed a concerning pancreatic mass. Based upon that, he went on to undergo an EUS on [**2152-12-1**] that noted a 2.7 x 2.2 cm ill-defined mass in the body/tail of the pancreas. FNA was performed at that time. . Other Past Medical History: - Diabetes mellitus, type II, with recent episodes of hypoglycemia, on insulin - Hypertension - Hyperlipidemia - Coronary artery disease (off aspirin in recent months for serial procedures) - Complete heart-block s/p pacemaker - Chronic pancreatitis - S/p cholecystectomy [**8-/2152**] - Post-herpetic neuralgia - Pulmonary nodules [**5-/2152**] - Arthritis - s/p Cataract surgery MEDICATION ON ADMISSION: Reviewed with son on admission amlodipine 10 mg Tablet Tablet(s) by mouth once a day carvedilol 6.25 mg Tablet Tablet(s) by mouth twice a day insulin lispro protam & lispro [Humalog Mix 75-25] 100 unit/mL (75-25) Suspension- 12 units AM, 6 units pm NO LONGER TAKING THIS SINCE [**2152-12-13**] lactulose 10 gram/15 mL Solution 30ml by mouth three times a day as needed for constipation lidocaine 5 % (700 mg/patch) Adhesive Patch, Medicated 1 Adhesive(s) DAILY (Daily) PRN lisinopril 20 mg Tablet Tablet(s) by mouth once a day D/C'ED omeprazole 20 mg Capsule, Delayed Release(E.C.) Capsule(s) by mouth once a day ondansetron 4 mg Tablet, Rapid Dissolve One Tablet(s) by mouth four times a day as needed for nausea [**2152-12-10**] oxycodone [OxyContin] 10 mg Tablet Extended Release 12 hr 1 Tablet(s) by mouth twice a day [**2152-12-8**] ALLERGIES: ciprofloxacin PHYSICAL EXAM: PHYSICAL EXAM: 1. VS T 97 P 110 BP 129/80 RR 24 O2Sat on _95% on 2L liters O2 FAMILY HISTORY: [**Hospital 6961**] medical history unknown. SOCIAL HISTORY: He is originally from [**Country 63412**] and moved to the United States in [**2140**]. He is retired, but was involved in USAID when living in [**Country 63412**]. He currently lives with his wife, son, daughter and his son's wife. [**Name (NI) **] stopped drinking and smoking approximately 40 years ago, but his son notes that he was a relatively heavy drinker previously.

Cholangitis,Abscess of liver,Acute respiratory failure,Bacteremia,Malignant neoplasm of other specified sites of pancreas,Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension,Hyperpotassemia,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ

Cholangitis,Abscess of liver,Acute respiratry failure,Bacteremia,Malig neo pancreas NEC,Sec mal neo peritoneum,Gastrointest hemorr NOS,Acute kidney failure NOS,Enterococcus group d,Chr blood loss anemia,DMII wo cmp uncntrld,Long-term use of insulin,Hypertension NOS,Hyperpotassemia,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Status cardiac pacemaker

Admission Date: [**2152-12-17**] Discharge Date: [**2152-12-29**] Service: MEDICINE Allergies: ciprofloxacin Attending:[**First Name3 (LF) 2042**] Chief Complaint: Mental status changes and RUQ pain Major Surgical or Invasive Procedure: [**2152-12-18**] [**Month/Day/Year **] [**2152-12-22**] Percutaneous drainage of liver abscess [**2152-12-28**] PICC History of Present Illness: This is an 87 yom with a complicated recent course including a laparoscopic converted to open cholecystectomy at [**Hospital 8**] Hospital in [**8-/2152**] , which was complicated by a bile leak and post-cholecystectomy stricturing. Since then, he has required six to seven ERCPs due to issues with biliary blockages and strictures and has had numerous stents placed. He has also had klebsiella bacteremia in 11/[**2151**]. He was subsequently admitted from [**2152-11-24**] through [**2152-12-2**] for evaluation of elevated LFTs and underwent a CT scan which was concerning for pancreatic mass with EUS/biopsies confirming 2.7 x 2.2 cm ill-defined mass consistent with pancreatic adenocarcinoma with metastases. . He had a recent admission from [**Date range (1) 90717**] for nausea/vomitting which improved with antiemtics and hydration. This hospitalization was also complicated by [**Last Name (un) **] and hyperK+ which stabilized on discharge. . The patient presented this admission with AMS, poor appetite, and leukocytosis. LFTs were also elevated beyond recent baseline but [**Female First Name (un) 7925**]/AP normal. Per son's report on admission to floor, pt was feeling better at time of discharge, but developed increased nausea and poor PO intake after recent discharge, as well as cough x 3 days (initially dry, now becoming productive). He has also been weaker than normal in that at baseline he is able to do is ADLs independently but now his son has had to hold him up to walk. No fevers at home. Past Medical History: Oncologic History: Mr. [**Known lastname 90716**] initially had a cholecystectomy on [**8-13**]. At the time of this procedure, it turned into an open cholecystectomy and since that time he has had discomfort at the surgical site. Following this, he has required six to seven ERCPs due to issues with biliary blockages and strictures and has had numerous stents placed. He was admitted from [**2152-11-24**] through [**2152-12-2**] for evaluation of elevated LFTs and during that time had an [**Year (4 digits) **] and underwent a CT scan on [**2152-11-30**] that showed a concerning pancreatic mass. Based upon that, he went on to undergo an EUS on [**2152-12-1**] that noted a 2.7 x 2.2 cm ill-defined mass in the body/tail of the pancreas. FNA was performed at that time. . Other Past Medical History: - Diabetes mellitus, type II, with recent episodes of hypoglycemia, on insulin - Hypertension - Hyperlipidemia - Coronary artery disease (off aspirin in recent months for serial procedures) - Complete heart-block s/p pacemaker - Chronic pancreatitis - S/p cholecystectomy [**8-/2152**] - Post-herpetic neuralgia - Pulmonary nodules [**5-/2152**] - Arthritis - s/p Cataract surgery Social History: He is originally from [**Country 63412**] and moved to the United States in [**2140**]. He is retired, but was involved in USAID when living in [**Country 63412**]. He currently lives with his wife, son, daughter and his son's wife. [**Name (NI) **] stopped drinking and smoking approximately 40 years ago, but his son notes that he was a relatively heavy drinker previously. . Family History: [**Hospital 6961**] medical history unknown. Physical Exam: PHYSICAL EXAM: 1. VS T 97 P 110 BP 129/80 RR 24 O2Sat on _95% on 2L liters O2 BS = 473 and 474 GENERAL: Thin elderly male laying in bed. His mental status waxes and wanes. He is able to speak English at times. Nourishment: at risk Grooming: good Mentation 2. Eyes: [] WNL PERRL- pupils are sluggish and do not clearly react but he is recently post cataract surgery, EOMI without nystagmus, Conjunctiva: clear/injection/exudates/icteric Ears/Nose/Mouth/Throat: MMM, no lesions noted in OP 3. ENT [X] WNL [] Moist [] Endentulous [] Ulcers [] Erythema [] JVD ____ cm [] Dry [] Poor dentition [] Thrush [] Swelling [] Exudate 4. Cardiovascular [] WNL [] Regular [X] Tachy [X] S1 [X] S2 [] Systolic Murmur /6, Location: [] Irregular []Brady []S3 [] S4 [] Diastolic Murmur /6, Location: [] Edema RLE 2+ [] Bruit(s), Location: [] Edema LLE 2+ [] PMI [] Vascular access [X] Peripheral [] Central site: 5. Respiratory [ ] [X] CTA bilaterally [ ] Rales [ ] Diminshed [] Comfortable [ ] Rhonchi [ ] Dullness [ ] Percussion WNL [ ] Wheeze [] Egophony 6. Gastrointestinal [ ] WNL [x] Soft/firm [] Rebound [] No hepatomegaly [] Non-tender [x] Tender [] No splenomegaly [X] 2cm masses appreciated at site of CCY. [] Non distended [x] distended [X] bowel sounds Yes/No [] guiac: brown stool Large amt of soft stool in the vault. Pt was manually disempacted. 7. Musculoskeletal-Extremities [X] WNL [ ] Tone WNL [ ]Upper extremity strength 5/5 and symmetrical [ ]Other: [ ] Bulk WNL [] Lower extremity strength 5/5 and symmetrica [ ] Other: [] Normal gait []No cyanosis [ ] No clubbing [] No joint swelling 8. Neurological [] WNL [ ] Alert and Oriented x 3 [ ] Romberg: Positive/Negative [ ] CN II-XII intact [ ] Normal attention [ ] FNF/HTS WNL [] Sensation WNL [ X] Delirious/confused [ ] Asterixis Present/Absent [ ] Position sense WNL [ ] Demented [ ] No pronator drift [] Fluent speech 9. Integument [] WNL [X] Warm [] Dry [] Cyanotic [] Rash: none/diffuse/face/trunk/back/limbs [ ] Cool [] Moist [] Mottled [] Ulcer: None 10. Psychiatric [] WNL [] Appropriate [] Flat affect [] Anxious [] Manic [] Intoxicated [] Pleasant [] Depressed [] Agitated [] Psychotic [X] delirious [] Combative 11. Genitourinary [X] WNL [ ] Catheter present [] Normal genitalia [ ] Other: TRACH: []present [X]none PEG:[]present [X]none [ ]site C/D/I COLOSTOMY: :[]present [X]none [ ]site C/D/I Pertinent Results: Admission CXR: R pleural effusion. Bibasilar streaky opacities reflecting areas of atelectasis. . Admission EKG:Sinus tachycardia at 108 bpm. LBBB, no acute changes. . [**2152-12-17**] 09:15PM GLUCOSE-363* UREA N-50* CREAT-1.3* SODIUM-129* POTASSIUM-5.4* CHLORIDE-94* TOTAL CO2-25 ANION GAP-15 [**2152-12-17**] 09:15PM estGFR-Using this [**2152-12-17**] 09:15PM ALT(SGPT)-38 AST(SGOT)-42* ALK PHOS-336* TOT BILI-0.4 [**2152-12-17**] 09:15PM LIPASE-6 [**2152-12-17**] 09:15PM WBC-14.4*# RBC-2.88* HGB-8.7* HCT-25.8* MCV-89 MCH-30.1 MCHC-33.7 RDW-13.9 [**2152-12-17**] 09:15PM NEUTS-84.1* LYMPHS-11.3* MONOS-4.5 EOS-0.1 BASOS-0.2 [**2152-12-17**] 09:15PM PLT COUNT-273 [**2152-12-17**] 09:15PM PT-12.0 PTT-26.2 INR(PT)-1.1 . [**2152-12-17**] 11:19 pm BLOOD CULTURE #2. **FINAL REPORT [**2152-12-21**]** Blood Culture, Routine (Final [**2152-12-21**]): KLEBSIELLA PNEUMONIAE. FINAL SENSITIVITIES. Piperacillin/Tazobactam sensitivity testing performed by KirbyBauer. Cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. ENTEROCOCCUS FAECALIS. FINAL SENSITIVITIES. HIGH LEVEL GENTAMICIN SCREEN: Susceptible to 500 mcg/ml of gentamicin. Screen predicts possible synergy with selected penicillins or vancomycin. Consult ID for details. HIGH LEVEL STREPTOMYCIN SCREEN: Susceptible to 1000mcg/ml of streptomycin. Screen predicts possible synergy with selected penicillins or vancomycin. Consult ID for details.. Daptomycin = 0.064 MCG/ML. Daptomycin Sensitivity testing performed by Etest. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ KLEBSIELLA PNEUMONIAE | ENTEROCOCCUS FAECALIS | | AMPICILLIN------------ <=2 S AMPICILLIN/SULBACTAM-- 4 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN---------<=0.25 S DAPTOMYCIN------------ S GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S PENICILLIN G---------- 4 S PIPERACILLIN/TAZO----- S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S VANCOMYCIN------------ 1 S Anaerobic Bottle Gram Stain (Final [**2152-12-18**]): GRAM NEGATIVE ROD(S). GRAM POSITIVE COCCI IN PAIRS AND CHAINS. Reported to and read back by DR. [**Last Name (STitle) **] [**2152-12-18**] 14:10. Aerobic Bottle Gram Stain (Final [**2152-12-18**]): GRAM NEGATIVE ROD(S). . [**2152-12-20**] 3:14 am BLOOD CULTURE Source: Venipuncture. **FINAL REPORT [**2152-12-26**]** Blood Culture, Routine (Final [**2152-12-26**]): ENTEROCOCCUS FAECIUM. FINAL SENSITIVITIES. Daptomycin Sensitivity testing performed by Etest. Daptomycin 3 MCG/ML. HIGH LEVEL GENTAMICIN SCREEN: Susceptible to 500 mcg/ml of gentamicin. Screen predicts possible synergy with selected penicillins or vancomycin. Consult ID for details. HIGH LEVEL STREPTOMYCIN SCREEN: Susceptible to 1000mcg/ml of streptomycin. Screen predicts possible synergy with selected penicillins or vancomycin. Consult ID for details.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS FAECIUM | AMPICILLIN------------ =>32 R DAPTOMYCIN------------ S LINEZOLID------------- 2 S PENICILLIN G---------- =>64 R VANCOMYCIN------------ =>32 R Anaerobic Bottle Gram Stain (Final [**2152-12-21**]): GRAM POSITIVE COCCI IN PAIRS AND CHAINS. . [**2152-12-22**] 3:13 pm FLUID,OTHER LIVER BILOMA/ABSCESS. GRAM STAIN (Final [**2152-12-22**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. PAIR AND SHORT CHAINS. FLUID CULTURE (Preliminary): Due to mixed bacterial types (>=3) an abbreviated workup is performed; P.aeruginosa, S.aureus and beta strep. are reported if present. Susceptibility will be performed on P.aeruginosa and S.aureus if sparse growth or greater.. WORK UP REQUESTED BY DR. [**Last Name (STitle) 4091**] [**2152-12-25**]. DR. [**Last Name (STitle) 4091**] ([**Numeric Identifier **] REQUESTED ERTAPENEM SENSITIVITIES [**2152-12-28**] ON ALL GRAM NEGATIVE RODS. ENTEROCOCCUS SP.. SPARSE GROWTH. KLEBSIELLA PNEUMONIAE. SPARSE GROWTH. Cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h Piperacillin/tazobactam sensitivity testing available on request. ENTEROBACTER CLOACAE COMPLEX. SPARSE GROWTH. Piperacillin/tazobactam sensitivity testing available on request. This organism may develop resistance to third generation cephalosporins during prolonged therapy. Therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. For serious infections, repeat culture and sensitivity testing may. PSEUDOMONAS AERUGINOSA. RARE GROWTH. Piperacillin/Tazobactam sensitivity testing performed by [**First Name8 (NamePattern2) 3077**] [**Last Name (NamePattern1) 3060**]. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | KLEBSIELLA PNEUMONIAE | | ENTEROBACTER CLOACAE | | | PSEUDOMONAS au | | | | AMPICILLIN------------ =>32 R AMPICILLIN/SULBACTAM-- 4 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S <=1 S 4 S CEFTAZIDIME----------- <=1 S <=1 S 16 I CEFTRIAXONE----------- <=1 S <=1 S CIPROFLOXACIN--------- <=0.25 S <=0.25 S <=0.25 S GENTAMICIN------------ <=1 S <=1 S <=1 S LINEZOLID------------- 2 S MEROPENEM------------- <=0.25 S <=0.25 S 1 S PENICILLIN G---------- =>64 R PIPERACILLIN/TAZO----- R TOBRAMYCIN------------ <=1 S <=1 S <=1 S TRIMETHOPRIM/SULFA---- <=1 S <=1 S VANCOMYCIN------------ =>32 R ANAEROBIC CULTURE (Final [**2152-12-26**]): NO ANAEROBES ISOLATED. . CXR [**2152-12-17**]:Bibasilar streaky opacities likely reflecting areas of atelectasis. Small right pleural effusion. . CT torso [**2152-12-21**] w/o contrast:[**2152-12-21**]: 1. No evidence of hemorrhage in the chest, abdomen or pelvis. 2. Three nonhemorrhagic fluid collections in the left hepatic lobe, concerning for bilomas/abscesses, new from [**2152-11-30**]. 3. Stable pancreatic tail mass. Unchanged mesenteric soft tissue density, likely representing a tumor deposit, and left adrenal nodule. 4. Multiple bilateral pulmonary nodules, unchanged from [**Month (only) **] [**2151**]. Small amount of secretions within the distal trachea. 5. Moderate right pleural effusion and small left pleural effusion, increased from [**2152-11-30**]. 6. Moderate nonhemorrhagic intra-abdominal ascites. Diffuse body wall edema. . [**2152-12-24**]: US LUE IMPRESSION: No evidence of deep venous thrombosis in the left upper extremity. Brief Hospital Course: 87 y.o. M with h/o recently diagnosed metatstatic pancreatic cancer s/p multiple ERCPs and stent placements over past few months who presented with lethargy and mental status changes. Found to have G+ cocci and G- rod bactermia. . # Cholangitis, bacteremia, and hepatic abscess: Patient developed elevated LFTS (although t.bili remained normal)and presented with leukocytosis and mental status changes. Blood cultures grew both klebsiella and enterococcus (two species including VRE). Treated with pip/tazo and vancomycin, then unasyn, then daptomycin & Ceftriaxone as sensitivities of bacteria became available. On [**2151-12-19**] pt underwent an [**Date Range **] and during the procedure two plastic stent removed. Pus and sludge were noted at stent removal. Metal stents were placed. During the procedure patient began vomiting and required intubation for airway protection. Patient was transferred to the [**Hospital Unit Name 153**] and extubated on [**12-19**] without difficulty and returned to floor. Subsequent imaging revealed hepatic abscesses for which patient underwent percutaneous external drainage on [**2152-12-22**]. Bile grew the klebsiella and enterococcus with the same sensitivities as blood cultures. In addition, bile grew pseudomonas. Patient was changed to Daptomycin and Cefepime ultimately with PICC placed on [**2152-12-28**]. HE WILL REQUIRE WEEKLY CK'S CHECKED ON DAPTOMYCIN. . # Metastatic pancreatic cancer: Underwent a biopsy of subcutaneous nodules at site of RUQ surgical sutures which were thought to be the source of pain as an outpatient. Biopsy positive for adenocarcinoma. Given poor performance status and ongoing infectious process he was not a candidate for chemotherapy and goals of care will be supportive with a transition to more palliative approach. Dr. [**Last Name (STitle) **] had an initial discussion with the son and have also with primary oncologist, Dr [**Last Name (STitle) **]. After further discussions with the patient's son and HCP on [**2152-12-26**], he was made DNR/DNI but will continue to treat his infection and support his transfusion needs. After further discussions with the patient's son and health care proxy on [**2152-12-28**] the patient will not be transferred to an intensive care unit but care will be focused on his symptoms should he become acutely ill. . # GI bleeding: Stool became guaiac positive on [**2152-12-21**]. Patient's hematocrit has slowly decreased. He was kept typed and crossed 2 units PRBCs, but remained stable. Suspect blood loss is from occult metastatic tumor oozing into GI tract. No role for colonoscopy at this point given palliative approach and his debilitation. ASA was discontinued in this setting. . # Anemia: Gradual decrease in hct. With g+ stool since [**2152-12-21**]. Hemodynamically stable. During [**Month/Day/Year **] no clear evidence of upper gI bleed. Transfused 4 units PRBCs total all with appropriate response. . . # Acute renal failure/hyperkalemia: On admission . Likely due to volume depletion. Resolved with IVF. . # UE Edema: Developed in setting of fluid resuscitation, now resolved. Ultrasound LUE [**2152-12-24**] was negative for DVT. Suspect edema was due to third spacing and albumen<2. . # Chest discomfort & dysphagia: Discomfort was related to dysphagia and eating. EKG with LBBB. Seen by speech and swallow. Improved on PPI. Plan to continue PPI [**Hospital1 **], change diet to liquids and mechanical soft. . . # Pain: Abdominal pain at operative site and upper abdomen. Improved over course of hospitalization. Was on oxycontin on admission which was held because of MS changes. Changed to oxycodone 5.0 mg q6hrs and increased prn dose 5-10mg because patient does not reliably ask for prn pain medication. . # Transaminitis: ALT and AST fell after [**Hospital1 **] and stent replacement but alk phos continues to slowly rise likely due to disease progression. He is assymptomatic and further work up is not appropriate at this time, since his biliary obstruction is stented and he has percutaeous drainage of abscesses. . # ARF/hyperkalemia: On admission. Likley due to volume depletion. -Resolved with IVF fluids. . # Diabetes/hyperglycema: Minimally hyperglycemic. Given the palliative goals of care, his finger sticks have been decreased to [**Hospital1 **] and insulin sliding scale has been discontinued. . # CAD: Cannot tolerate ASA due to GI bleeding. . # Hypertension: Normotensive off meds. . FEN: Soft solids, diabetic diet . DVT PPx: pneumoboots, g+ stool . Precautions for: fall. . Lines:PICC . CODE: DNR/DNI. No ICU transfer # TRANSITIONAL ISSUES: - ongoing GI blood loss requiring periodic transfusion - rising alk phos, likely progressive pancreatic cancer - transitioning to a more palliative approach to his care, but still getting IV antibiotics for bacteremic cholangitis with hepatic abscess formation requiring biliary drainage. Per conversations with the son (and health care proxy), the patient would NOT be transferred to an intensive care unit. - will require weekly monitoring of CK while on daptomycin Medications on Admission: Reviewed with son on admission amlodipine 10 mg Tablet Tablet(s) by mouth once a day carvedilol 6.25 mg Tablet Tablet(s) by mouth twice a day insulin lispro protam & lispro [Humalog Mix 75-25] 100 unit/mL (75-25) Suspension- 12 units AM, 6 units pm NO LONGER TAKING THIS SINCE [**2152-12-13**] lactulose 10 gram/15 mL Solution 30ml by mouth three times a day as needed for constipation lidocaine 5 % (700 mg/patch) Adhesive Patch, Medicated 1 Adhesive(s) DAILY (Daily) PRN lisinopril 20 mg Tablet Tablet(s) by mouth once a day D/C'ED omeprazole 20 mg Capsule, Delayed Release(E.C.) Capsule(s) by mouth once a day ondansetron 4 mg Tablet, Rapid Dissolve One Tablet(s) by mouth four times a day as needed for nausea [**2152-12-10**] oxycodone [OxyContin] 10 mg Tablet Extended Release 12 hr 1 Tablet(s) by mouth twice a day [**2152-12-8**] * OTCs * aspirin 81 mg Tablet, Chewable 1 Tablet(s) by mouth DAILY (Daily) Has not taken inlast 2 weeks bisacodyl 10 mg Suppository 1 Suppository(s) rectally at bedtime as needed for constipation [**2152-12-15**] docusate sodium 100 mg Capsule glucosamine sulfate 500 mg Tablet 1 Tablet(s) by mouth daily (OTC) [**2152-11-24**] multivitamin Tablet 1 Tablet(s) by mouth daily omega-3 fatty acids-vitamin E [Fish Oil] Dosage uncertain 8.6 mg Tablet 1 Tablet(s) by mouth twice a day (Prescribed by Other Provider) [**2152-11-20**] simethicone 80 mg Tablet, Chewable 1 Tablet(s) by mouth four times a day as Discharge Medications: 1. Fingerstick Glucose [**Hospital1 **] and record, [**Name8 (MD) 138**] MD for values > 250 or < 70 2. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: [**12-11**] Tablet, Rapid Dissolves PO every eight (8) hours as needed for nausea. 3. oxycodone 5 mg/5 mL Solution Sig: [**4-19**] ml PO Q4H (every 4 hours) as needed for pain including dysphagia. 4. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for belching and gas. 5. daptomycin 500 mg Recon Soln Sig: Three [**Age over 90 10973**]y (330) Recon Soln(s) mg Intravenous Q24H (every 24 hours) for 3 weeks: until [**2153-1-19**]. 6. cefepime 2 gram Recon Soln Sig: Two (2) Recon Soln(s) grams Injection Q12H (every 12 hours) for 3 weeks: until [**2153-1-19**]. 7. polyethylene glycol 3350 17 gram/dose Powder Sig: Seventeen (17) grams PO DAILY (Daily) as needed for constipation. 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): Hold for loose stools. 9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 10. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: [**12-11**] Tablet, Chewables PO QID (4 times a day) as needed for heartburn. 11. Outpatient Lab Work Draw CBC w/diff, BUN/Cr, LFTs, CK on Mondays and Thursdays Fax results to: 1. Dr [**Last Name (STitle) **] at ([**Telephone/Fax (1) 11708**] 2. Infectious disease R.Ns. at ([**Telephone/Fax (1) 1353**] 12. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 13. multivitamin Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. 14. oxycodone 5 mg/5 mL Solution Sig: Five (5) ml PO every six (6) hours. 15. heparin lock flush 10 unit/mL Solution Sig: Two (2) ml Intravenous Q8H and prn line flush per PICC protocol as needed for line flush. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Hospital1 8**] Discharge Diagnosis: Cholangitis Bacteremia - enterococcus x 2, pseudomonas, klebsiella Liver abscess Metastatic pancreatic cancer with subcutaneous nodules, peritoneal mets, pulmonary mets Pain Anemia GI bleeding GERD Liver function abnormalities Acute renal failure and hyperkalemia Diabetes Coronary artery disease - h/o complete heart block, s/p pacer Hypertension Hypoalbumenemia Dependent edema Pleural Effusions Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Discharge Instructions: You were admitted with nausea, vomiting, confusion, and an elevated white blood cell count from a severe infection from your biliary tract (Liver, pancreas, and gallbladder)that is due to your pancreatic cancer. You had bacteria in your blood from the infection and developed a liver abscess. You needed an [**Hospital1 **] to replace the stent in your liver and a drain placed in your liver abscess. Your infections are being treated with IV antibiotics. You will need several weeks of treatment and have had a PICC line placed so you receive antibiotics as an outpatient. You have also had problems with bleeding in your stools that has been treated with blood transfusions. It is likely that this problem is also from your tumor. Because there are no treatments for your tumor, we do not recommend further work up for the bleeding but continued symptom [**Hospital1 **] with blood transfusions as needed. Your pancreatic cancer has continued to grow and we expect that it will cause you more symptoms over time. The cancer is not treatable. For this reason, you have decided (with your son's help) to be DNR/DNI and NOT to go to an intensive care unit but focus on your comfort if you become sicker. . The following changes have been made to your medications: STOP Amlodipine STOP Carvedilol STOP Insulin STOP Lactulose STOP Lisinopril STOP Oxycontin STOP Aspirin STOP Bisacodyl suppository STOP Glucosamine and Omega 3 START Daptomycin IV antibiotic once daily for 3 weeks START Cefepime IV antibiotic twice daily for 3 weeks START Oxycodone 5 ml every 6 hours as a scheduled dose and [**4-19**] ml every 4 hours as needed for pain START Mirilax 17 grams daily as needed for constipation START Calcium carbonate (TUMS) 1-2 tablets as needed for heartburn START Senna [**12-11**] twice daily as needed for constipation Followup Instructions: Department: HEMATOLOGY/ONCOLOGY When: WEDNESDAY [**2153-1-3**] at 3:30 PM With: [**Last Name (LF) 3150**],[**Name8 (MD) **] MD [**Telephone/Fax (1) 11133**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage . Name: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 90718**], MD Specialty: Internal Medicine Address: [**Hospital1 **], [**Hospital1 **],[**Numeric Identifier 4293**] Phone: [**Telephone/Fax (1) 70526**] Please discuss with the staff at the facility a follow up appointment with your PCP when you are ready for discharge. They can call the number listed above. . Department: DIGESTIVE DISEASE CENTER When: MONDAY [**2153-2-12**] at 7:30 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6953**], MD [**Telephone/Fax (1) 463**] Building: [**First Name8 (NamePattern2) **] [**Hospital Ward Name 1950**] Building ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) 1951**] Campus: EAST Best Parking: Main Garage

576,572,518,790,157,197,578,584,041,280,250,V586,401,276,272,414,V450

{'Cholangitis,Abscess of liver,Acute respiratory failure,Bacteremia,Malignant neoplasm of other specified sites of pancreas,Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension,Hyperpotassemia,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ'}

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: Mental status changes and RUQ pain PRESENT ILLNESS: This is an 87 yom with a complicated recent course including a laparoscopic converted to open cholecystectomy at [**Hospital 8**] Hospital in [**8-/2152**] , which was complicated by a bile leak and post-cholecystectomy stricturing. Since then, he has required six to seven ERCPs due to issues with biliary blockages and strictures and has had numerous stents placed. He has also had klebsiella bacteremia in 11/[**2151**]. He was subsequently admitted from [**2152-11-24**] through [**2152-12-2**] for evaluation of elevated LFTs and underwent a CT scan which was concerning for pancreatic mass with EUS/biopsies confirming 2.7 x 2.2 cm ill-defined mass consistent with pancreatic adenocarcinoma with metastases. . He had a recent admission from [**Date range (1) 90717**] for nausea/vomitting which improved with antiemtics and hydration. This hospitalization was also complicated by [**Last Name (un) **] and hyperK+ which stabilized on discharge. . The patient presented this admission with AMS, poor appetite, and leukocytosis. LFTs were also elevated beyond recent baseline but [**Female First Name (un) 7925**]/AP normal. Per son's report on admission to floor, pt was feeling better at time of discharge, but developed increased nausea and poor PO intake after recent discharge, as well as cough x 3 days (initially dry, now becoming productive). He has also been weaker than normal in that at baseline he is able to do is ADLs independently but now his son has had to hold him up to walk. No fevers at home. MEDICAL HISTORY: Oncologic History: Mr. [**Known lastname 90716**] initially had a cholecystectomy on [**8-13**]. At the time of this procedure, it turned into an open cholecystectomy and since that time he has had discomfort at the surgical site. Following this, he has required six to seven ERCPs due to issues with biliary blockages and strictures and has had numerous stents placed. He was admitted from [**2152-11-24**] through [**2152-12-2**] for evaluation of elevated LFTs and during that time had an [**Year (4 digits) **] and underwent a CT scan on [**2152-11-30**] that showed a concerning pancreatic mass. Based upon that, he went on to undergo an EUS on [**2152-12-1**] that noted a 2.7 x 2.2 cm ill-defined mass in the body/tail of the pancreas. FNA was performed at that time. . Other Past Medical History: - Diabetes mellitus, type II, with recent episodes of hypoglycemia, on insulin - Hypertension - Hyperlipidemia - Coronary artery disease (off aspirin in recent months for serial procedures) - Complete heart-block s/p pacemaker - Chronic pancreatitis - S/p cholecystectomy [**8-/2152**] - Post-herpetic neuralgia - Pulmonary nodules [**5-/2152**] - Arthritis - s/p Cataract surgery MEDICATION ON ADMISSION: Reviewed with son on admission amlodipine 10 mg Tablet Tablet(s) by mouth once a day carvedilol 6.25 mg Tablet Tablet(s) by mouth twice a day insulin lispro protam & lispro [Humalog Mix 75-25] 100 unit/mL (75-25) Suspension- 12 units AM, 6 units pm NO LONGER TAKING THIS SINCE [**2152-12-13**] lactulose 10 gram/15 mL Solution 30ml by mouth three times a day as needed for constipation lidocaine 5 % (700 mg/patch) Adhesive Patch, Medicated 1 Adhesive(s) DAILY (Daily) PRN lisinopril 20 mg Tablet Tablet(s) by mouth once a day D/C'ED omeprazole 20 mg Capsule, Delayed Release(E.C.) Capsule(s) by mouth once a day ondansetron 4 mg Tablet, Rapid Dissolve One Tablet(s) by mouth four times a day as needed for nausea [**2152-12-10**] oxycodone [OxyContin] 10 mg Tablet Extended Release 12 hr 1 Tablet(s) by mouth twice a day [**2152-12-8**] ALLERGIES: ciprofloxacin PHYSICAL EXAM: PHYSICAL EXAM: 1. VS T 97 P 110 BP 129/80 RR 24 O2Sat on _95% on 2L liters O2 FAMILY HISTORY: [**Hospital 6961**] medical history unknown. SOCIAL HISTORY: He is originally from [**Country 63412**] and moved to the United States in [**2140**]. He is retired, but was involved in USAID when living in [**Country 63412**]. He currently lives with his wife, son, daughter and his son's wife. [**Name (NI) **] stopped drinking and smoking approximately 40 years ago, but his son notes that he was a relatively heavy drinker previously. ### Response: {'Cholangitis,Abscess of liver,Acute respiratory failure,Bacteremia,Malignant neoplasm of other specified sites of pancreas,Secondary malignant neoplasm of retroperitoneum and peritoneum,Hemorrhage of gastrointestinal tract, unspecified,Acute kidney failure, unspecified,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension,Hyperpotassemia,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Cardiac pacemaker in situ'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 54-year-old female with no prior coronary artery disease history. Her coronary artery disease risk factors include smoking 3-4 packs per week and remote family history. She was in her usual state of health until the evening of admission when she developed severe substernal chest pain that radiated to her jaw and upper extremities bilaterally. She states that the pain lasted for approximately one hour and was associated with exertion. She attempted to relieve the pain with over-the-counter pain medications and lying in bed. Neither one of these worked, however, she describes the pain as being a [**2173-5-27**]. The pain lasted for approximately one hour prior to calling the EMS service. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Acute myocardial infarction of other inferior wall, initial episode of care,Ventricular fibrillation,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Pernicious anemia

AMI inferior wall, init,Ventricular fibrillation,Urin tract infection NOS,Crnry athrscl natve vssl,Hypothyroidism NOS,Pernicious anemia

Admission Date: [**2166-3-8**] Discharge Date: [**2166-3-13**] Date of Birth: [**2111-11-10**] Sex: F Service: CCU HISTORY OF PRESENT ILLNESS: This is a 54-year-old female with no prior coronary artery disease history. Her coronary artery disease risk factors include smoking 3-4 packs per week and remote family history. She was in her usual state of health until the evening of admission when she developed severe substernal chest pain that radiated to her jaw and upper extremities bilaterally. She states that the pain lasted for approximately one hour and was associated with exertion. She attempted to relieve the pain with over-the-counter pain medications and lying in bed. Neither one of these worked, however, she describes the pain as being a [**2173-5-27**]. The pain lasted for approximately one hour prior to calling the EMS service. When the EMS service arrived, they found the patient to have ST elevations in the inferior leads. They gave her a dose of sublingual nitroglycerin to try to relieve the pain. She developed what appears to be V-fib arrest, and required defibrillation at both 200 and then 300 joules. She then converted to a bradycardic wide complex rhythm before a normal sinus rhythm. She was then transferred to an outside hospital Emergency Room, where she was given thrombolytic therapy. Unfortunately, following the thrombolytic therapy, the patient continued to complain of a minor chest discomfort. She was then transferred to [**Hospital3 **] for further management. In the Emergency Room at [**Hospital3 **], the patient had ST elevations of approximately 1-2 mm in leads II, III, and aVF along with a ST elevation in V4 in the right sided leads of approximately 1 mm. She was then transferred to the CCU unit for further observation. Fifteen to twenty minutes after arriving at the CCU, the patient again had an episode of V-fib arrest for which she received defibrillation at 200 joules and subsequently converted to normal sinus rhythm. It was then determined that the patient should be taken to Coronary Catheterization Laboratory for evaluation of her coronaries. In the Catheterization Laboratory, the patient was found to have a 90% occlusion in the proximal right coronary which was subsequently stented. The patient was then subsequently transferred back to the CCU unit for further observation. LABORATORIES UPON ADMISSION: White blood cell count of 15.9, hematocrit of 33.9, platelet count of 206. Her coags showed a PT of 13.4, PTT of 33, INR of 1.2. Her Chem-10 showed a sodium of 140, potassium of 4.7, chloride of 110, bicarb of 23, BUN of 17, creatinine of 0.6, glucose of 130, magnesium is 1.7, phosphate of 3.0, and calcium of 8.3. Her CK values peaked at 1,570, and her peak CK MB of 272. PHYSICAL EXAMINATION: The patient was afebrile, heart rate of 60 beats per minute, blood pressure of 115-137 systolic from 61-70 diastolic, respiratory rate of 18 breaths per minute with an O2 saturation of 97% on room air. In general, this is a well-developed and well-nourished pleasant female, who is in no apparent distress. She was alert and oriented to person, place, and situation. Neurological examination: cranial nerves II through XII were grossly intact. There were no sensory or motor deficits. Her heart examination showed a regular, rate, and rhythm with a normal S1, S2. There were no murmurs, rubs, or gallops appreciated. Her neck was soft, nontender without lymphadenopathy or jugular venous distention. Pulmonary examination revealed bibasilar rales with the right being greater than the left. Her abdomen was soft, nontender, nondistended with positive bowel sounds. Her extremities were without cyanosis or clubbing. She had +2 dorsalis pedis pulses bilaterally. She had an echocardiogram performed. The echocardiogram showed mild regional left ventricular systolic dysfunction with focal severe hypokinesis of the basal half of the inferior wall, in the basal inferolateral wall. She also showed mild mitral regurgitation, ejection fraction was estimated to be approximately 50%. HOSPITAL COURSE: This 54-year-old female with a history of an acute inferior myocardial infarction status post thrombolytics at the outside hospital, was emergently taken to the catheterization laboratory and found to have a right coronary artery lesion which was successfully stented. 1. Cardiac: Following the cardiac catheterization, the patient was transferred back to the CCU for further observation. She remained on a Heparin and Integrilin drip. Unfortunately, she developed an episode of emesis that required discontinuing the Integrilin. She was then started up on an aspirin, Plavix, low dose beta blocker, and a statin. She remained on Telemetry without any events. On day three of her admission, the patient was transferred to the regular medical floors, where she started to work with the Physical Therapy team. She remained stable on the floor and a low dose of ACE inhibitor was then added to her regimen. Throughout her stay, the patient continued to improve. She did not complain of any chest pain, shortness of breath, or palpitations. In addition, there were a number of discussions with the patient concerning lifestyle changes, which included changes to her diet, exercise regimen, and ways to reduce stress. She is also setup to followup with a cardiologist in two weeks for further management. 2. Infectious Disease: The patient developed a urinary tract infection, and was started up on ciprofloxacin 500 [**Hospital1 **]. 3. Endocrine: The patient remained on her Synthroid dose. DISCHARGE DIAGNOSES: 1. Coronary artery disease status post acute inferior myocardial infarction receiving both thrombolytic therapy at outside hospital and a right coronary artery stent at [**Hospital3 **]. 2. Hypothyroidism. 3. Urinary tract infection. DISCHARGE MEDICATIONS: 1. Aspirin 325 mg po q day. 2. Plavix 75 mg q day. 3. Atorvastatin 10 mg q day. 4. Lisinopril 2.5 mg q day. 5. Toprol XL 25 mg q day. 6. Levothyroxine 150 mcg q day. DISCHARGE INSTRUCTIONS: 1. Follow up with her cardiologist, a Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**3-21**] at 1:45. Discussed with Dr. [**Last Name (STitle) **] setting up an appointment for risk stratification. 2. Follow up with her primary care physician ([**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in one month). 3. Please return to the Emergency Room if you develop any further chest pain, shortness of breath, or heart palpitations. 4. The patient should remain on a healthy heart diet. 5. Patient should begin a mild physical exercise regimen which includes simply walking 10 minutes per day and gradually building up. 6. Patient should refrain from sexual intercourse or heavy physical activity until meeting with her cardiologist on [**3-21**]. 7. The patient should not return to work until she has met with her new cardiologist on [**3-21**]. [**First Name11 (Name Pattern1) 420**] [**Last Name (NamePattern4) 421**], M.D. [**MD Number(1) 422**] Dictated By:[**Name8 (MD) 6284**] MEDQUIST36 D: [**2166-3-13**] 11:51 T: [**2166-3-13**] 12:06 JOB#: [**Job Number 49153**] cc:[**Numeric Identifier 49154**]

410,427,599,414,244,281

{'Acute myocardial infarction of other inferior wall, initial episode of care,Ventricular fibrillation,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Pernicious anemia'}

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: This is a 54-year-old female with no prior coronary artery disease history. Her coronary artery disease risk factors include smoking 3-4 packs per week and remote family history. She was in her usual state of health until the evening of admission when she developed severe substernal chest pain that radiated to her jaw and upper extremities bilaterally. She states that the pain lasted for approximately one hour and was associated with exertion. She attempted to relieve the pain with over-the-counter pain medications and lying in bed. Neither one of these worked, however, she describes the pain as being a [**2173-5-27**]. The pain lasted for approximately one hour prior to calling the EMS service. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Acute myocardial infarction of other inferior wall, initial episode of care,Ventricular fibrillation,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Pernicious anemia'}

CHIEF COMPLAINT: PRESENT ILLNESS: MEDICAL HISTORY: Osteoporosis, hypercholesterolemia. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Brother died of myocardial infarction at age 52. Mother had a myocardial infarction in her 60s. Father myocardial infarction in 70s. Family history is positive for osteoporosis and hypercholesterolemia. One of his aunts has diabetes. SOCIAL HISTORY: He lives alone. No children. Denies smoking, intravenous drug or ethanol use.

Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Pure hypercholesterolemia,Osteoporosis, unspecified

AMI anterolateral, init,Crnry athrscl natve vssl,CHF NOS,Pure hypercholesterolem,Osteoporosis NOS

Admission Date: [**2199-7-14**] Discharge Date: [**2199-7-18**] Date of Birth: [**2137-1-9**] Sex: M Service: CCU HISTORY OF PRESENT ILLNESS The patient is a 62 year-old male with no known history of coronary artery disease, history of hypercholesterolemia and osteoporosis who presented on [**7-6**] with substernal chest pain without radiation while driving. He denies shortness of breath, paroxysmal nocturnal dyspnea, nausea, vomiting. He reports some diaphoresis and tingling in his fingers. Two Gas-X without relief and went to the Emergency Department for further evaluation. At the [**Hospital 8125**] Hospital Emergency Department initial electrocardiogram revealed large ST elevation myocardial infarction anterolaterally. He received aspirin and nitroglycerin drip, heparin and full dose of tissue plasminogen activator. His chest pain resolved after 45 minutes with decrease in ST elevations on electrocardiogram. However, they reported worsening elevations on repeat electrocardiograms. He received increased nitro drip, morphine sulfate with a total of 16 mg intravenous was given and Ativan. He also got Atropine 0.5 mg times one for a heart rate of 56 prior to the administration of Lopressor intravenous. Given the increase in chest pain after lysis he was transferred to [**Hospital1 346**] catheterization laboratory for rescue TCI in stable condition. In the catheterization laboratory he underwent stenting of mid left anterior descending coronary artery lesion. In the process of stenting two diagonals were jailed one of them was percutaneous transluminal coronary angioplastied and the out flow with 80% stenosis residual. Right heart catheterization with pulmonary capillary wedge pressure of 18 and MB of O2 sat in the 70s. The patient was transferred to Coronary Care Unit for further management. He was reportedly agitated and confused in the catheterization laboratory. Upon transfer, however, he was alert, oriented times two. PAST MEDICAL HISTORY: Osteoporosis, hypercholesterolemia. MEDICATIONS AT HOME: Lipitor 40 mg once a day, Fosamax once a week, calcium and vitamin D, aspirin 325 mg b.i.d., zinc, vitamin C and vitamin E. ALLERGIES: No known drug allergies. SOCIAL HISTORY: He lives alone. No children. Denies smoking, intravenous drug or ethanol use. FAMILY HISTORY: Brother died of myocardial infarction at age 52. Mother had a myocardial infarction in her 60s. Father myocardial infarction in 70s. Family history is positive for osteoporosis and hypercholesterolemia. One of his aunts has diabetes. PHYSICAL EXAMINATION: Vital signs on admission temperature 95.9. Heart rate 82. Blood pressure 122/70. Respirations 20. Oxygen saturation 98% on room air. In general,the patient is a pleasant middle aged male in no acute distress lying in bed. HEENT pupils are equal, round and reactive to light and accommodation bilaterally. Extraocular movements intact. Oropharynx is clear. Mucous membranes are moist. Neck JVP at about 8 cm. Neck is supple. No thyromegaly. Carotid pulses are 2+ without bruits. Chest clear to auscultation anteriorly. Cardiovascular examination regular rate and rhythm. Normal S1 and S2. No murmurs. Point of maximal impulse not displaced. Abdomen soft, nontender, nondistended. Positive bowel sounds. Two small masses subcutaneously on the abdomen consistent with small lipomas. Extremities 2+ distal pulses. No edema. Groin with sheath in place. Neurological examination was nonfocal. LABORATORY: Troponin less then 0.03, sodium 134, potassium 3.3, chloride 97, bicarb 24, BUN 15, creatinine 0.6, glucose 163, white blood cell count 12.2, hematocrit 52.3, platelets 284, CK 3066. Cardiac catheterization showed cardiac output of 3.9 and index of 2.2. Wedge pressure was found to be 19, SVR 1395. It showed diffusely diseased proximal left anterior descending coronary artery, discreet lesions in mid left anterior descending coronary artery and second diagonal with other vessels being normal. The proximal left anterior descending coronary artery have mild diffuse disease with 40% focal stenosis just before diagonal one followed by total occlusion just after D1. After crossing the lesion with the guidewire the second diagonal also was occluded. Left circumflex and obtuse marginal have no angiographic disease. Right coronary artery had some mild distal luminal irregularities, but no angiographic disease. Resting hemodynamics revealed mildly elevated right and left sided filling pressures with RA pressure of 10. Right ventricular diastolic pressure 15 and mean capillary wedge of 19. The occluded left anterior descending coronary artery was successfully treated with angioplasty stenting as mentioned above. HOSPITAL COURSE: The patient was transferred to the Coronary Care Unit in stable condition. He was started on aspirin, Plavix, Lipitor was continued. He was also started on Lopressor. The next day echocardiogram was done and showed left ventricular ejection fraction of 35 to 40% with mildly dilated left atrium, normal in size right atrium. Overall depressed left ventricular systolic function, anterior distal septal and apical hypokinesis to akinesis was present. The aortic root was mildly dilated. The aortic valve leaflets were mildly thickened. The mitral valve leaflets were mildly thickened as well. Cardiovascular wise the patient was continued on aspirin and Plavix, Lipitor and beta blockers. He remained tachycardic over the next two days with good blood pressure control. His lipid panel was done and showed triglycerides to be 79, EL 44, cholesterol to HDL ratio 3.0 and LDL cholesterol 72. His troponin was elevated the next day above 50 and CK peaked at 3066 with subsequent decrease over the next 24 hours down to 1134. His echocardiogram showed hyper versus akinesis. The need for anticoagulation was discussed and it was decided that the patient would need reevaluation of his cardiac function as an outpatient one month after discharge. Pulmonary wise, Mr. [**Known lastname **] had lung examination and chest x-ray consistent with mild congestive heart failure. He was diuresed nicely over the next two days after admission with significant improvement on clinical examination as well as improvement in oxygen saturation. Endocrine wise, he remained on his outpatient medications for osteoporosis. Hemoglobin A1C was ordered and came back mildly elevated at 6.2. Mr. [**Known lastname **] was transferred to the regular floor on [**7-16**]. He continued to do well over the next two days without any complaints. He did not have any chest pain or shortness of breath. His physical examination remained normal. He maintained good oxygen saturations on walking and was discharged to home on a cardiac healthy diet in good condition on his outpatient medications plus Lisinopril 10 mg once a day, Toprol XL 50 mg once a day and Plavix 75 mg once a day for twenty eight days. The patient was to arrange follow up with his primary care physician. DISCHARGE DIAGNOSES: 1. Acute anterior myocardial infarction. 2. Osteoporosis. 3. Hyperlipidemia. [**First Name8 (NamePattern2) 2053**] [**Last Name (NamePattern1) 2052**], M.D. [**MD Number(1) **] Dictated By:[**Doctor Last Name 16524**] MEDQUIST36 D: [**2199-7-18**] 12:31 T: [**2199-7-18**] 12:50 JOB#: [**Job Number 43991**]

410,414,428,272,733

{'Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Pure hypercholesterolemia,Osteoporosis, unspecified'}

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: MEDICAL HISTORY: Osteoporosis, hypercholesterolemia. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Brother died of myocardial infarction at age 52. Mother had a myocardial infarction in her 60s. Father myocardial infarction in 70s. Family history is positive for osteoporosis and hypercholesterolemia. One of his aunts has diabetes. SOCIAL HISTORY: He lives alone. No children. Denies smoking, intravenous drug or ethanol use. ### Response: {'Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Pure hypercholesterolemia,Osteoporosis, unspecified'}

CHIEF COMPLAINT: Shortness of Breath PRESENT ILLNESS: 45 y/o female with known CAD s/p CABG [**2140**] presenting to [**Hospital1 18**] upon transfer from [**Hospital1 34**] for shortness of breath. She was recently admitted to [**Hospital1 34**] (discharged on [**9-17**]) with CHF and eventually transferred to [**Hospital1 18**] for management. She was medically managed and discharged home. This most recent episode began two nights ago. She had some shortness of breath that resolved after she took her home dose of lasix (20mg). Denied any symptoms over the day yesterday but then woke up over night and felt quite short of breath. She took 20mg PO lasix but said she "could not urinate". Symptoms progressively worsened so she called 911 and was taken to [**Hospital1 34**]. Upon arrival to [**Hospital1 34**], O2 sat was 80% with rapid respirations. The patient was started on CPAP and sats increased to 100%. The patient was also given 20mg IV lasix at [**Hospital1 34**]. Remained pain free. Then transferred for cardiac catheterization. Prior to transfer to [**Hospital1 18**] the patient was changed to non rebreather and was satting 98-100%. . Upon arrival to [**Hospital1 18**], patient underwent cardiac cath, which showed no changes from her previous cath. No intervention performed given results. ECHO today: "compared with the prior study (images reviewed) of [**2148-9-3**], the inferolateral wall systolic dysfunction is more evident and the severity of mitral regurgitation has decreased slightly." . Upon arrival to CCU, patient was comfortable. Reported improvement of her symptoms but still was requiring non-rebreather. Satting 96%. Denies any chest pain, syncope, headaches or dizziness. VS: BP- 102/45, HR- 78, RR- 17, O2- 96% on NRB. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, ankle edema, palpitations, syncope or presyncope. Reports orthopnea and shortness of breath. MEDICAL HISTORY: CAD s/p coronary bypass surgery [**5-1**]- LIMA to LAD, SVG to OM, SVG to Diagonal, and SVG to PDA. SVG to the OM and diagonal occluded. Diastolic Heart Failure Diabetes Mellitus-type I s/p living-related kidney transplant [**2140-10-31**] (baseline Cr 0.8-1.1 over the last year) s/p MI tobacco use osteoporosis gastroparesis s/p right tibial fracture peripheral [**Year (4 digits) 1106**] disease: s/p right femoropopliteal bypass and left SFA drug-eluting [**Last Name (LF) **], [**2147-5-2**] retinopathy- legally blind s/p left patella open reduction and fixation, [**2147**] s/p right leg fracture (cast), [**2147**] s/p left wrist fracture, [**2147**] s/p fall and intracranial bleed, [**2147**] s/p cholecystectomy sarcoid, reported lung nodule neuropathy depression hypertension blood group specific substance. Blood products (red cells and platelets) should be leukoreduced. chronic heel ulcers hyponatremia MEDICATION ON ADMISSION: 1. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily): ALLERGIES: Codeine / Amoxicillin / Blood-Group Specific Substance / Adhesive Tape PHYSICAL EXAM: PE on admission: VS: T=97.7 BP=130/60 HR=77 RR=17 O2 sat= 95% on NRB GENERAL: WDWN woman in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: There is no history of diabetes or kidney disease. Her father had an MI at 74 and mother has hypertension. Grandfather had leukemia and hypertension. SOCIAL HISTORY: -Tobacco history: smokes half a pack per day -ETOH: none -Illicit drugs: smokes marijuana several times per week to help with nausea and appetite

Coronary atherosclerosis of native coronary artery,Acute on chronic diastolic heart failure,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Ulcer of heel and midfoot,Kidney replaced by transplant,Pulmonary congestion and hypostasis,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled

Crnry athrscl natve vssl,Ac on chr diast hrt fail,Ac posthemorrhag anemia,Hyp kid NOS w cr kid V,End stage renal disease,Ulcer of heel & midfoot,Kidney transplant status,Pulm congest/hypostasis,DMI wo cmp nt st uncntrl

Admission Date: [**2148-9-25**] Discharge Date: [**2148-10-2**] Date of Birth: [**2103-6-23**] Sex: F Service: MEDICINE Allergies: Codeine / Amoxicillin / Blood-Group Specific Substance / Adhesive Tape Attending:[**First Name3 (LF) 106**] Chief Complaint: Shortness of Breath Major Surgical or Invasive Procedure: Cardiac catheterization [**2148-9-25**] and [**2148-9-30**] IR guided PICC line [**2148-9-26**] History of Present Illness: 45 y/o female with known CAD s/p CABG [**2140**] presenting to [**Hospital1 18**] upon transfer from [**Hospital1 34**] for shortness of breath. She was recently admitted to [**Hospital1 34**] (discharged on [**9-17**]) with CHF and eventually transferred to [**Hospital1 18**] for management. She was medically managed and discharged home. This most recent episode began two nights ago. She had some shortness of breath that resolved after she took her home dose of lasix (20mg). Denied any symptoms over the day yesterday but then woke up over night and felt quite short of breath. She took 20mg PO lasix but said she "could not urinate". Symptoms progressively worsened so she called 911 and was taken to [**Hospital1 34**]. Upon arrival to [**Hospital1 34**], O2 sat was 80% with rapid respirations. The patient was started on CPAP and sats increased to 100%. The patient was also given 20mg IV lasix at [**Hospital1 34**]. Remained pain free. Then transferred for cardiac catheterization. Prior to transfer to [**Hospital1 18**] the patient was changed to non rebreather and was satting 98-100%. . Upon arrival to [**Hospital1 18**], patient underwent cardiac cath, which showed no changes from her previous cath. No intervention performed given results. ECHO today: "compared with the prior study (images reviewed) of [**2148-9-3**], the inferolateral wall systolic dysfunction is more evident and the severity of mitral regurgitation has decreased slightly." . Upon arrival to CCU, patient was comfortable. Reported improvement of her symptoms but still was requiring non-rebreather. Satting 96%. Denies any chest pain, syncope, headaches or dizziness. VS: BP- 102/45, HR- 78, RR- 17, O2- 96% on NRB. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, ankle edema, palpitations, syncope or presyncope. Reports orthopnea and shortness of breath. Past Medical History: CAD s/p coronary bypass surgery [**5-1**]- LIMA to LAD, SVG to OM, SVG to Diagonal, and SVG to PDA. SVG to the OM and diagonal occluded. Diastolic Heart Failure Diabetes Mellitus-type I s/p living-related kidney transplant [**2140-10-31**] (baseline Cr 0.8-1.1 over the last year) s/p MI tobacco use osteoporosis gastroparesis s/p right tibial fracture peripheral [**Year (4 digits) 1106**] disease: s/p right femoropopliteal bypass and left SFA drug-eluting [**Last Name (LF) **], [**2147-5-2**] retinopathy- legally blind s/p left patella open reduction and fixation, [**2147**] s/p right leg fracture (cast), [**2147**] s/p left wrist fracture, [**2147**] s/p fall and intracranial bleed, [**2147**] s/p cholecystectomy sarcoid, reported lung nodule neuropathy depression hypertension blood group specific substance. Blood products (red cells and platelets) should be leukoreduced. chronic heel ulcers hyponatremia Social History: -Tobacco history: smokes half a pack per day -ETOH: none -Illicit drugs: smokes marijuana several times per week to help with nausea and appetite Family History: There is no history of diabetes or kidney disease. Her father had an MI at 74 and mother has hypertension. Grandfather had leukemia and hypertension. Physical Exam: PE on admission: VS: T=97.7 BP=130/60 HR=77 RR=17 O2 sat= 95% on NRB GENERAL: WDWN woman in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with no JVP CARDIAC: Regular rate and rhythm. [**4-5**] holosystolic murmur heard best at apex. PMI located in 5th intercostal space, midclavicular line. Normal S1, S2. No rubs or gallops. No thrills, lifts. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. Femoral cath sites bandaged- no signs of hematoma, erythema. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ . PE on discharge: Vitals: Afebrile Tc 98.1, BP 133/71(100-133/57-71), HR 85 (79-85), RR 20 Sa02 95% RA Gen: NAD, AAOx3, resting comfortably in bed HEENT: NCAT, Sclera anicteric, EOMI, OP clear NECK: Supple, no JVD CARDIAC: Regular rate and rhythm. [**3-8**] holosystolic murmur heard best at LUSB. Normal S1, S2. No rubs or gallops. No thrills, lifts. LUNGS: CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits. GROIN: Left cath site with no hemotoma present. Bilateral soft femoral bruits audible. EXTREMITIES: No c/c/e. 2+ DP pulse on Rt. (left with hard cast) SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Pertinent Results: Cardiac Cath [**2148-9-25**]: COMMENTS: 1. Coronary angiography in this right dominant system revealed diffuse multivessel coronary artery disease. The LMCA had no significant stenosis. The LAD had a 70% mid-portion stenosis after the D1 branch with competitive flow from a patent LIMA that filled the distal vessel. The LCX had severe diffuse disease in the mid-portion extending into a distal branching OM that was unchanged compared with prior caths in [**2145**] and [**2141**] performed after known SVG-OM occlusion. The RCA was not injected. The SVG-->R-PDA was patent with filling of a diffusely diseased distal RCA. The LIMA-LAD was patent. 2. Resting hemodynamics performed on intravenous nitroglycerine revealed slightly [**Year (4 digits) **] left and right filling pressures with mean RA pressure of 10 mmHg and mean PCWP of 15 mmHg. FINAL DIAGNOSIS: 1. Diffuse coronary artery disease. 2. Slightly [**Year (4 digits) **] left and right filling pressures on IV nitroglycerine. . Cardiac echo [**2148-9-25**]: The left atrium is mildly dilated. The estimated right atrial pressure is 0-5 mmHg. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with inferolateral hypokinesis and distal anterior hypokinesis. Overall left ventricular systolic function is low normal (LVEF 50-55%). The estimated cardiac index is high (>4.0L/min/m2). Transmitral Doppler imaging is consistent with Grade II (moderate) LV diastolic dysfunction. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. The end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. . Compared with the prior study (images reviewed) of [**2148-9-3**], the inferolateral wall systolic dysfunction is more evident and the severity of mitral regurgitation has decreased slightly. . Cardiac Cath [**2148-9-30**]: 1. Limited angiography in this right dominant system demonstrated multi vessel disease. The LCx was diffusely diseased in the mid to distal vessel. The RCA was not injected. 2. Successful PTCA of the LCx with a 2.0 x 30mm Voyager balloon. Final angiography revealed 30% residual stenosis, no angiographically apparent dissection, and TIMI 3 flow. (see PTCA comments for details) FINAL DIAGNOSIS: 1. Three vessel coronary artery disease. 2. Mild diastolic ventricular dysfunction. 3. Successful PTCA of the LCx. . Labs on Admission: [**2148-9-25**] 09:41PM BLOOD WBC-6.6 RBC-3.24* Hgb-9.3* Hct-29.1* MCV-90 MCH-28.7 MCHC-31.9 RDW-13.6 Plt Ct-454* [**2148-9-26**] 05:30AM BLOOD WBC-6.3 RBC-3.19* Hgb-9.2* Hct-28.8* MCV-90 MCH-28.7 MCHC-31.8 RDW-13.2 Plt Ct-415 [**2148-9-25**] 09:41PM BLOOD Glucose-30* UreaN-29* Creat-1.3* Na-137 K-4.2 Cl-105 HCO3-23 AnGap-13 [**2148-9-26**] 05:30AM BLOOD Glucose-185* UreaN-24* Creat-1.1 Na-138 K-4.7 Cl-105 HCO3-23 AnGap-15 [**2148-9-25**] 09:41PM BLOOD Calcium-9.0 Phos-4.1 Mg-1.9 [**2148-9-26**] 05:30AM BLOOD Calcium-9.1 Phos-3.4 Mg-2.0 [**2148-9-28**] 11:47AM BLOOD tacroFK-3.4* rapmycn-4.0* . Labs on discharge: [**2148-10-1**] 07:24AM BLOOD WBC-3.9* RBC-2.95* Hgb-8.6* Hct-27.0* MCV-91 MCH-29.0 MCHC-31.8 RDW-12.9 Plt Ct-423 [**2148-10-2**] 06:26AM BLOOD WBC-3.8* RBC-2.98* Hgb-8.3* Hct-26.9* MCV-90 MCH-27.7 MCHC-30.7* RDW-13.1 Plt Ct-493* [**2148-10-1**] 07:24AM BLOOD PT-11.5 PTT-25.5 INR(PT)-1.0 [**2148-10-2**] 06:26AM BLOOD PT-11.8 PTT-24.2 INR(PT)-1.0 [**2148-10-1**] 07:24AM BLOOD Glucose-417* UreaN-30* Creat-1.3* Na-132* K-4.2 Cl-98 HCO3-26 AnGap-12 [**2148-10-2**] 06:26AM BLOOD Glucose-252* UreaN-30* Creat-1.3* Na-137 K-4.4 Cl-101 HCO3-27 AnGap-13 [**2148-10-1**] 07:24AM BLOOD CK(CPK)-18* [**2148-10-1**] 07:24AM BLOOD Calcium-8.8 Phos-4.0 Mg-1.8 [**2148-10-2**] 06:26AM BLOOD Calcium-9.1 Phos-4.2 Mg-2.0 Tacro and rapamycin levels pending Brief Hospital Course: Patient is a 45 y/o female with CAD s/p CABG, diastolic HF and kidney transplant presenting from OSH with shortness of breath. . # CORONARIES: Known CAD s/p CABG in [**2140**]. Was cathed on admission which showed no change from previous cath in [**5-8**]. Report was as follows: Coronary angiography in this right dominant system revealed diffuse multivessel coronary artery disease. The LMCA had no significant stenosis. The LAD had a 70% mid-portion stenosis after the D1 branch with competitive flow from a patent LIMA that filled the distal vessel. The LCX had severe diffuse disease in the mid-portion extending into a distal branching OM that was unchanged compared with prior caths in [**2145**] and [**2141**] performed after known SVG-OM occlusion. The RCA was not injected. The SVG-->R-PDA was patent with filling of a diffusely diseased distal RCA. The LIMA-LAD was patent. Resting hemodynamics performed on intravenous nitroglycerine revealed slightly [**Year (4 digits) **] left and right filling pressures with mean RA pressure of 10 mmHg and mean PCWP of 15 mmHg. No intervention was performed at this time. Patient denied chest pain or anginal equivalent while in hospital. The patient underwent a repeat cardiac cath on [**9-30**] with PTCA of the left circumflex artery, which was thought to be contributing to the patient's symptoms. Final angiography revealed 30% residual stenosis, no angiographically apparent dissection, and TIMI 3 flow. Patient was continued on telemetry without events. She was continued on aspirin, atorvastatin, plavix, and metoprolol was changed to 12.5 mg XL. . # PUMP: History of diastolic dysfunction now presented with CHF exacerbation. ECHO [**9-25**] showed low normal LVEF (50-55%), Grade II (moderate) LV diastolic dysfunction, and Moderate (2+) mitral regurgitation. The patient also had an episode of flash pulmonary edema, which responded to lasix diuresis and temporary NRB mask. Patient was treated with metoprolol 12.5 XL, nifedipine was changed to Lisinopril and Lasix was increased to 40 mg daily. In addition, the patient was extensively counseled on self-monitoring fluid status with daily self weights and titration of lasix as needed to prevent further episodes of pulmonary edema. Weight at discharge was 59 kg. . # RHYTHM: Patient remained in NSR. Her metoprolol was changed from 50 mg [**Hospital1 **] to 12.5 mg extended release. . # Immune Suppression: Patient is s/p living donor kidney transplant. She was continued on sirolimus 3 mg daily and tacrolimus 2 mg twice daily, as per home regimen. Home dose of prednisone (4mg daily) and bactrim prophylaxis continued as well. . # Diabetes Mellitus Type I: Last A1C on [**9-16**] was 8.7%. During admission, pt was continued on Lantus plus sliding scale insulin with good blood glucose control. She has a follow-up appt with her endocrinologist in 1 week. . # Chronic Renal Disease: Patient is s/p kidney transplant. Her creatinine over the last year has ranged from 0.8-1.1. During the course of her hospitalization, the patient had a Cr mildly [**Month/Year (2) **] from baseline, consistent with acute on chronic renal failure, likely secondary to contrast administration from multiple cardiac catheterizations. On discharge, Cr was 1.3. . # Hypertension: Patient was initially continued on home doses of metoprolol and nifedipine extended release. After diuresis, patient had an episode of hypotension and nifedipine was discontinued, and metoprolol 50 mg [**Hospital1 **] changed to 12.5 mg XR po daily. Lisinopril was added for afterload reduction and can be tapered up as needed to keep SBP in goal range of 120-140. . # Depression: continued on home medications of bupropion and citalopram. She has f/u with her ouptpt psychiatrist. . # Pain: Questionable allergy to codeine- patient reports nausea/vomiting but has been taking oxycodone recently for ankle fracture. Discharged on Ultram for left leg pain. Note that pt has tolerated oxycodone Po for treatment of her left leg pain. . # Insomnia: Continued on home dose of trazodone. . # Nausea: Continued on reglan and zofran. . # Osteoporosis: Continued vitamin D and calcium. Medications on Admission: 1. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily): Please take at 5 PM everyday. 2. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every 12 hours). 3. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) Tablet PO [**Hospital1 12075**] (Monday-Wednesday-Friday). 4. Trazodone 50 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as needed for insomnia. 5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. Bupropion HCl 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 8. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 13. Citalopram 20 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 14. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 15. Nifedipine 30 mg Tablet Sustained Release Sig: Two (2) Tablet Sustained Release PO DAILY (Daily). 16. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO BID (2 times a day). 17. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 18. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for left ankle pain for 5 days. Disp:*30 Tablet(s)* Refills:*0* 19. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 20. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation: Please take as needed for constipation while you are taking pain medications. 21. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation: Please take if needed for constipation while you are taking pain medications. 22. Compazine 25 mg Suppository Sig: One (1) Rectal three times a day as needed for nausea. 23. Reglan 10 mg Tablet Sig: One (1) Tablet PO four times a day as needed for nausea. 24. Insulin Glargine 100 unit/mL Solution Sig: Eighteen (18) units Subcutaneous at bedtime. 25. Insulin Lispro 100 unit/mL Solution Sig: sliding scale Subcutaneous four times a day: Please use according to your sliding scale. 26. Prednisone 1 mg Tablet Sig: Four (4) Tablet PO once a day. 27. Ergocalciferol (Vitamin D2) 400 unit Capsule Sig: One (1) Capsule PO twice a day. 28. Atrovent HFA 17 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation every six (6) hours as needed for cough. Discharge Medications: 1. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Bupropion HCl 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*11* 5. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)) as needed for nausea. 6. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 7. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every 12 hours). 8. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) Tablet PO [**Hospital1 12075**] (Monday-Wednesday-Friday). 9. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. Colace 100 mg Capsule Sig: [**2-2**] Capsules PO twice a day. 11. Vitamin D 400 unit Capsule Sig: One (1) Capsule PO twice a day. 12. Glucerna Shake Liquid Sig: One (1) can PO up to 6 times per day. 13. Citalopram 40 mg Tablet Sig: 1.5 Tablets PO once a day. 14. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 15. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO DAILY (Daily). 16. Lantus 100 unit/mL Solution Sig: 18-20 units Subcutaneous once a day. 17. Humalog 100 unit/mL Solution Sig: per sliding scale units Subcutaneous four times a day. 18. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation QID (4 times a day) as needed for cough. 19. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig: 0.5 Tablet Sustained Release 24 hr PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* 20. Prednisone 1 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily). 21. Prochlorperazine 25 mg Suppository Sig: One (1) Suppository Rectal TID (3 times a day) as needed for nausea. 22. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 23. Trazodone 100 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia. 24. Tramadol 50 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours) as needed for Leg pain. Disp:*60 Tablet(s)* Refills:*0* 25. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 26. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital3 **] VNA Discharge Diagnosis: Primary Diagnoses: Coronary Artery Disease Acute on Chronic Diastolic Congestive Heart Failure . Secondary Diagnoses: Diabetes Mellitus Chronic Kidney Disease s/p Transplant Discharge Condition: Good; afebrile, hemodynamically stable, ambulatory Discharge Instructions: You have a diagnosis of coronary artery disease and were admitted to the hospital for shortness of breath, found to be related to your underlying heart disease. You underwent cardiac catheterization two times while in the hospital in order to open up a narrow segment found in one of your coronary arteries. In addition, your shortness of breath resolved with diuretic treatment. Information about a low sodium diet and fluid restriction was discussed with you before discharge. . Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs in 1 day or 6 pounds in 3 days. A presciption for a talking scale was given to you. Adhere to 2 gm sodium diet Medications changes: 1. DISCONTINUE Imdur 2. DISCONTINUE Nifedical 3. DISCONTINUE Zetia 4. INCREASE your Lasix (Furosemide) to 40 mg daily 5. Your Metoprolol was changed to a long acting type and decreased to 12.5 mg daily 6. START Ultram to treat the pain in your leg 7. INCREASE your Aspirin to 325 mg daily from 81 mg daily 8. START Lisinopril to treat your high blood pressure . Please call Dr. [**Last Name (STitle) **] if you have any fevers, chills, chest pain, trouble breathing, unusual swelling, cough, right groin pain or for any other concerning symptoms. . Please check your blood pressure daily at different times of the day. Record the pressures and bring them to your appts with Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) **]. Followup Instructions: Cardiology: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:Tuesday [**2148-11-5**] at 11:00am Endocrinology ([**Last Name (un) **]) Provider: [**First Name4 (NamePattern1) 8990**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1803**] Date/Time:[**2148-10-14**] 2:30 Psychiatry: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 20430**], MD Date/Time:[**2148-10-15**] 10:20 Primary Care: [**Last Name (LF) 2879**],[**First Name3 (LF) 2878**] A. Phone: [**Telephone/Fax (1) 250**] Date/Time: Friday [**10-11**] at 11:00.

414,428,285,403,585,707,V420,514,250

{'Coronary atherosclerosis of native coronary artery,Acute on chronic diastolic heart failure,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Ulcer of heel and midfoot,Kidney replaced by transplant,Pulmonary congestion and hypostasis,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled'}

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: 45 y/o female with known CAD s/p CABG [**2140**] presenting to [**Hospital1 18**] upon transfer from [**Hospital1 34**] for shortness of breath. She was recently admitted to [**Hospital1 34**] (discharged on [**9-17**]) with CHF and eventually transferred to [**Hospital1 18**] for management. She was medically managed and discharged home. This most recent episode began two nights ago. She had some shortness of breath that resolved after she took her home dose of lasix (20mg). Denied any symptoms over the day yesterday but then woke up over night and felt quite short of breath. She took 20mg PO lasix but said she "could not urinate". Symptoms progressively worsened so she called 911 and was taken to [**Hospital1 34**]. Upon arrival to [**Hospital1 34**], O2 sat was 80% with rapid respirations. The patient was started on CPAP and sats increased to 100%. The patient was also given 20mg IV lasix at [**Hospital1 34**]. Remained pain free. Then transferred for cardiac catheterization. Prior to transfer to [**Hospital1 18**] the patient was changed to non rebreather and was satting 98-100%. . Upon arrival to [**Hospital1 18**], patient underwent cardiac cath, which showed no changes from her previous cath. No intervention performed given results. ECHO today: "compared with the prior study (images reviewed) of [**2148-9-3**], the inferolateral wall systolic dysfunction is more evident and the severity of mitral regurgitation has decreased slightly." . Upon arrival to CCU, patient was comfortable. Reported improvement of her symptoms but still was requiring non-rebreather. Satting 96%. Denies any chest pain, syncope, headaches or dizziness. VS: BP- 102/45, HR- 78, RR- 17, O2- 96% on NRB. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. . Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, ankle edema, palpitations, syncope or presyncope. Reports orthopnea and shortness of breath. MEDICAL HISTORY: CAD s/p coronary bypass surgery [**5-1**]- LIMA to LAD, SVG to OM, SVG to Diagonal, and SVG to PDA. SVG to the OM and diagonal occluded. Diastolic Heart Failure Diabetes Mellitus-type I s/p living-related kidney transplant [**2140-10-31**] (baseline Cr 0.8-1.1 over the last year) s/p MI tobacco use osteoporosis gastroparesis s/p right tibial fracture peripheral [**Year (4 digits) 1106**] disease: s/p right femoropopliteal bypass and left SFA drug-eluting [**Last Name (LF) **], [**2147-5-2**] retinopathy- legally blind s/p left patella open reduction and fixation, [**2147**] s/p right leg fracture (cast), [**2147**] s/p left wrist fracture, [**2147**] s/p fall and intracranial bleed, [**2147**] s/p cholecystectomy sarcoid, reported lung nodule neuropathy depression hypertension blood group specific substance. Blood products (red cells and platelets) should be leukoreduced. chronic heel ulcers hyponatremia MEDICATION ON ADMISSION: 1. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily): ALLERGIES: Codeine / Amoxicillin / Blood-Group Specific Substance / Adhesive Tape PHYSICAL EXAM: PE on admission: VS: T=97.7 BP=130/60 HR=77 RR=17 O2 sat= 95% on NRB GENERAL: WDWN woman in NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: There is no history of diabetes or kidney disease. Her father had an MI at 74 and mother has hypertension. Grandfather had leukemia and hypertension. SOCIAL HISTORY: -Tobacco history: smokes half a pack per day -ETOH: none -Illicit drugs: smokes marijuana several times per week to help with nausea and appetite ### Response: {'Coronary atherosclerosis of native coronary artery,Acute on chronic diastolic heart failure,Acute posthemorrhagic anemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Ulcer of heel and midfoot,Kidney replaced by transplant,Pulmonary congestion and hypostasis,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: chest pain while running. + stress test and he was referred for cardiac catheterization. MEDICAL HISTORY: Diabetes Mellitus s/p lithotripsy for kidney stones 2 years ago Hypertension DM type 2 GERD MEDICATION ON ADMISSION: Asprin 325mg Prilosec ALLERGIES: Percocet PHYSICAL EXAM: Pulse: 84Resp: 18 O2 sat: 98/RA B/P Right:192/98 Height:6' Weight:235 lbs FAMILY HISTORY: Notable for his father having CABG x2 in his 40's - died suddenly at 63. SOCIAL HISTORY: -Tobacco history: Never -ETOH: None -Illicit drugs: None Lives with wife. [**Name (NI) 1403**] as landscaper.

Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris

DMII wo cmp nt st uncntr,Hypertension NOS,Esophageal reflux,Crnry athrscl natve vssl,Angina pectoris NEC/NOS

Admission Date: [**2174-11-11**] Discharge Date: [**2174-11-15**] Date of Birth: [**2123-6-24**] Sex: M Service: CARDIOTHORACIC Allergies: Percocet Attending:[**First Name3 (LF) 1406**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: [**2174-11-2**] - Coronary artery bypass grafting x4 with the left internal mammary artery to left anterior descending artery and reverse saphenous vein graft to the posterior descending artery, second obtuse marginal artery and diagonal artery. History of Present Illness: chest pain while running. + stress test and he was referred for cardiac catheterization. Past Medical History: Diabetes Mellitus s/p lithotripsy for kidney stones 2 years ago Hypertension DM type 2 GERD Social History: -Tobacco history: Never -ETOH: None -Illicit drugs: None Lives with wife. [**Name (NI) 1403**] as landscaper. Family History: Notable for his father having CABG x2 in his 40's - died suddenly at 63. Physical Exam: Pulse: 84Resp: 18 O2 sat: 98/RA B/P Right:192/98 Height:6' Weight:235 lbs General: NAD, WGWN, appears stated age Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema-none Varicosities: None [x] Neuro: Grossly intact x Pulses: Femoral Right: 2+ Left:2+ DP Right: 2+ Left:2+ PT [**Name (NI) 167**]: 2+ Left:2+ Radial Right: 2+ Left:2+ Carotid Bruit Right: Left: Pertinent Results: [**2174-11-11**] - ECHO PRE BYPASS No spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. Left ventricular wall thicknesses and cavity size are normal. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is mildly depressed (LVEF= 45 %). The right ventricle displays mild global free wall hypokinesis. There are simple atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room at the time of the study. POST-BYPASS Normal biventricular systolic function. No change in valvular function from the pre-bypass study. The thoracic aorta is intact after decannulation. Brief Hospital Course: Mr. [**Known lastname 4223**] was admitted to the [**Hospital1 18**] on [**2174-11-11**] for surgical management of his coronary artery disease. He was taken directly to the operating room where he underwent coronary artery bypass grafting to four vessels. Please see operative note for details. Postoperatively he was taken to the intensive care unit for monitoring. Over the next 24 hours, he awoke neurologically intact and was extubated. Beta blockade, aspirin and a statin were started. On postoperative day one, he was transferred to the step down unit for further recovery. He was gently diuresed towards his preoperative weight. The physical therapy service was consulted for assistance with his postoperative strength and mobility. He continued to make steady progress and was discharged home on postoperative day 4. He will follow-up with Dr. [**Last Name (STitle) **], his cardiologist and his primary care physician as an outpatient. Medications on Admission: Asprin 325mg Prilosec Discharge Medications: 1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 2. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 3. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 6. hydrocodone-acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*65 Tablet(s)* Refills:*0* 7. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) Puff Inhalation QID (4 times a day). Disp:*1 MDI* Refills:*2* 8. Lasix 20 mg Tablet Sig: Two (2) Tablet PO once a day for 5 days. Disp:*10 Tablet(s)* Refills:*0* 9. potassium chloride 10 mEq Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO once a day for 5 days. Disp:*5 Capsule, Sustained Release(s)* Refills:*0* 10. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: 1-2 Puffs Inhalation Q6H (every 6 hours). Disp:*1 MDI* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) **] Nursing Services Discharge Diagnosis: Coronary artery disease Hypertension DM type 2 GERD kidney stones Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with vicodin Incisions: Sternal - healing well, no erythema or drainage Leg Left - healing well, no erythema or drainage. Trace left lower extremity Edema Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: You are scheduled for the following appointments Surgeon: Dr. [**Last Name (STitle) **] [**2174-11-30**] at 1:15pm [**Telephone/Fax (1) 170**] Cardiologist: [**Last Name (un) 1918**] [**Doctor Last Name **] Phone: [**Telephone/Fax (1) 11767**] Date/Time:[**2174-12-5**] 11:00 Please call to schedule appointments with your Primary Care Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 35783**] in [**3-28**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Completed by:[**2174-11-15**]

250,401,530,414,413

{'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris'}

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: Chest pain PRESENT ILLNESS: chest pain while running. + stress test and he was referred for cardiac catheterization. MEDICAL HISTORY: Diabetes Mellitus s/p lithotripsy for kidney stones 2 years ago Hypertension DM type 2 GERD MEDICATION ON ADMISSION: Asprin 325mg Prilosec ALLERGIES: Percocet PHYSICAL EXAM: Pulse: 84Resp: 18 O2 sat: 98/RA B/P Right:192/98 Height:6' Weight:235 lbs FAMILY HISTORY: Notable for his father having CABG x2 in his 40's - died suddenly at 63. SOCIAL HISTORY: -Tobacco history: Never -ETOH: None -Illicit drugs: None Lives with wife. [**Name (NI) 1403**] as landscaper. ### Response: {'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris'}

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is a 51-year-old gentleman transferred from an outside hospital with subarachnoid hemorrhage by head CT scan, blood in the superior sagittal plane. He describes the onset of the worst headache of his life six days prior to admission. Had difficulty sleeping. Patient describes dry heaves with headache. MEDICAL HISTORY: 1. Hypertension. 2. Noninsulin-dependent diabetes. MEDICATION ON ADMISSION: ALLERGIES: No known allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Intracerebral hemorrhage,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

Intracerebral hemorrhage,Hypertension NOS,DMII wo cmp nt st uncntr

Admission Date: [**2199-7-8**] Discharge Date: [**2199-7-11**] Date of Birth: Sex: M Service: HISTORY OF PRESENT ILLNESS: Patient is a 51-year-old gentleman transferred from an outside hospital with subarachnoid hemorrhage by head CT scan, blood in the superior sagittal plane. He describes the onset of the worst headache of his life six days prior to admission. Had difficulty sleeping. Patient describes dry heaves with headache. PAST MEDICAL HISTORY: 1. Hypertension. 2. Noninsulin-dependent diabetes. PAST SURGICAL HISTORY: None. ALLERGIES: No known allergies. MEDICATIONS: 1. Elavil. 2. Inderal. PHYSICAL EXAMINATION: On physical exam, the patient is awake, alert, and oriented times three. Strength is [**4-22**] in the upper extremities and lower extremities. Reflexes are intact. Cranial nerves II through XII intact. Pupils are equal, round, and reactive to light. CT scan at the outside hospital shows blood in the superior sagittal sinus. CT angiogram showed no evidence of aneurysm. Patient was neurologically stable with a nonfocal exam, admitted to the Intensive Care Unit for close observation. On [**2199-7-10**], patient underwent arteriogram, which showed no evidence of aneurysm, AVM, or any vascular malformation. Postprocedure, the patient was awake, alert, and oriented times three, moving all extremities with good peripheral pulses and no hematoma in the groin. His vital signs remained stable, and he was discharged on [**2198-5-11**] with followup with his PCP as needed. [**Name6 (MD) 6911**] [**Last Name (NamePattern4) 6912**], MD [**MD Number(1) 6913**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2199-7-15**] 11:24 T: [**2199-7-25**] 11:49 JOB#: [**Job Number 43765**]

431,401,250

{'Intracerebral hemorrhage,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

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: Patient is a 51-year-old gentleman transferred from an outside hospital with subarachnoid hemorrhage by head CT scan, blood in the superior sagittal plane. He describes the onset of the worst headache of his life six days prior to admission. Had difficulty sleeping. Patient describes dry heaves with headache. MEDICAL HISTORY: 1. Hypertension. 2. Noninsulin-dependent diabetes. MEDICATION ON ADMISSION: ALLERGIES: No known allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Intracerebral hemorrhage,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: Known left MCA aneurysm PRESENT ILLNESS: Ms. [**Known lastname **] is a 57 y/o female who had a subarachnoid hemorrhage in [**2169**] from a left MCA aneurysm which was coiled. She returns on this hospitalization for recoiling of the left MCA aneurysm which had recanulized. MEDICAL HISTORY: Subarachnoid hemorrhage [**2169**] MEDICATION ON ADMISSION: Asa 81mg Enalapril 5mg daily HCTZ Zocor 10mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission and on discharge patient is neurologically intact without any focal defecits. FAMILY HISTORY: NC SOCIAL HISTORY: Two children, no history of smoking

Cerebral aneurysm, nonruptured

Nonrupt cerebral aneurym

Name: [**Known lastname 11840**],[**Known firstname 11841**] FEN Unit No: [**Numeric Identifier 11842**] Admission Date: [**2172-9-9**] Discharge Date: [**2172-9-10**] Date of Birth: [**2115-9-6**] Sex: F Service: NEUROSURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 40**] Addendum: Patient's follow up will need to be in 2 months with Dr. [**First Name (STitle) **]. Discharge Disposition: Home Followup Instructions: Please return to the office to seee Dr. [**First Name (STitle) **] in 2 months, call [**Telephone/Fax (1) 11843**] for your appointment. [**Name6 (MD) **] [**Last Name (NamePattern4) 43**] MD [**MD Number(2) 44**] Completed by:[**2172-9-10**] Admission Date: [**2172-9-9**] Discharge Date: [**2172-9-10**] Date of Birth: [**2115-9-6**] Sex: F Service: NEUROSURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 78**] Chief Complaint: Known left MCA aneurysm Major Surgical or Invasive Procedure: Recoiling of Left MCA aneurysm History of Present Illness: Ms. [**Known lastname **] is a 57 y/o female who had a subarachnoid hemorrhage in [**2169**] from a left MCA aneurysm which was coiled. She returns on this hospitalization for recoiling of the left MCA aneurysm which had recanulized. Past Medical History: Subarachnoid hemorrhage [**2169**] Social History: Two children, no history of smoking Family History: NC Physical Exam: On admission and on discharge patient is neurologically intact without any focal defecits. Brief Hospital Course: Ms. [**Known lastname **] was admitted and evaluated by anesthesia. She was taken to the angio suite, intubated and underwent a flouro guided coiling of her Left MCA aneurysm. Angio puncture site was closed with angio seal; no complications were noted. Patient was extubated in the angio suite and taken to the PACU post procedure. She remained on a heparin drip at 700units an hour until 7am. The day after the procedure, patient was eating, her foley was discontinued, she ambulated and was discharged home from the PACU to home. Medications on Admission: Asa 81mg Enalapril 5mg daily HCTZ Zocor 10mg daily Discharge Medications: 1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Month (only) 116**] also resume all pre op medications Discharge Disposition: Home Discharge Diagnosis: Left MCA aneurysm Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Angiogram with Embolization and/or Stent placement Medications: ?????? Take Aspirin 325mg (enteric coated) once daily. ?????? Continue all other medications you were taking before surgery, unless otherwise directed ?????? You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort. What activities you can and cannot do: ?????? When you go home, you may walk and go up and down stairs. ?????? You may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal). ?????? After 1 week, you may resume sexual activity. ?????? After 1 week, gradually increase your activities and distance walked as you can tolerate. ?????? No driving until you are no longer taking pain medications What to report to office: ?????? Changes in vision (loss of vision, blurring, double vision, half vision) ?????? Slurring of speech or difficulty finding correct words to use ?????? Severe headache or worsening headache not controlled by pain medication ?????? A sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg ?????? Trouble swallowing, breathing, or talking ?????? Numbness, coldness or pain in lower extremities ?????? Temperature greater than 101.5F for 24 hours ?????? New or increased drainage from incision or white, yellow or green drainage from incisions ?????? Bleeding from groin puncture site *SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site) Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call our office. If bleeding does not stop, call 911 for transfer to closest Emergency Room! Followup Instructions: Please return to the office to seee Dr. [**First Name (STitle) **] in 6 months with an MRI/MRA ([**Doctor Last Name **] protocol) prior to your appointment. Our office will schedule this study for you when you call: [**Telephone/Fax (1) 69653**] Completed by:[**2172-9-10**]

437

{'Cerebral aneurysm, nonruptured'}

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: Known left MCA aneurysm PRESENT ILLNESS: Ms. [**Known lastname **] is a 57 y/o female who had a subarachnoid hemorrhage in [**2169**] from a left MCA aneurysm which was coiled. She returns on this hospitalization for recoiling of the left MCA aneurysm which had recanulized. MEDICAL HISTORY: Subarachnoid hemorrhage [**2169**] MEDICATION ON ADMISSION: Asa 81mg Enalapril 5mg daily HCTZ Zocor 10mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: On admission and on discharge patient is neurologically intact without any focal defecits. FAMILY HISTORY: NC SOCIAL HISTORY: Two children, no history of smoking ### Response: {'Cerebral aneurysm, nonruptured'}

CHIEF COMPLAINT: S/p fall, Anemia PRESENT ILLNESS: 85 yo F w/ h/o achalasia, Type II DM, CAD presents s/p fall. Yesterday, she was getting up from bed and reaching for her walker, when she felt dizzy, stumbled and fell forward, striking her left forehead and left knee/hip. The fall was not witnessed. No associated chest pain, shortness of breath, loss of bowel/bladder function. (+) LOC "a couple of seconds". She was unable to rise and her husband called EMS -> [**Hospital1 18**] [**Location (un) 620**]. CT head/pelvis unrevealing. She was noted to have a hematocrit of 26.5 (36.4 [**10/2199**]) and sodium 120. U/A positive and given cipro. She was transferred to [**Hospital1 18**] for further evaluation. Currently, she notes left hip/leg pain, worse with movement, [**1-23**], and a headache "all over my head" with tenderness over left frontal area. (+) low back pain, chronic. The patient has a history of recurrent nausea/vomiting, attributed to achalasia and GERD, which has worsened recently. She notes frequent nausea, without vomiting on a daily basis. It appears to be getting worse. Its timing is not clearly associated with time of day or food, although she has noted decreased appetite/oral intake. She denies hemetemesis, coffee-ground emesis, diarrhea, BRBPR. (+) black stool chronically (takes iron); marked constipation, last BM 4 days ago. She has a chronic non-productive cough, no recent change. She does note pleuritic central chest pain without SOB, which started this morning, intermittent, sharp. . The ICU was asked to evaluate the patient for placement of central line as no other access was available. Shortly thereafter, the patient became tachycardic to 140's but not hypotensive. At time of [**Hospital Unit Name 153**] eval, the chest pain was absent and the patient cannot remember enough about it to describe it in more detail. She was transferred for line placement and closer monitoring. . ROS: As above, in addition: No weight loss. (+) fatigue/malaise. No fever, chills, night sweats, change in vision (legally blind), (+) mild rhinorrhea. No sore throat. palpitations, lower extremity edema, hemoptysis, abdominal pain, bleeding, bruising, dysuria, hematuria, rash, numbness, weakness/tingling, lightheadedness. (+) increase urinary frequency. MEDICAL HISTORY: Anemia (Hct range 3/04 ?????? [**8-17**]: 24.0-35.6) secondary to Gastric Polys; followed by Dr. [**Last Name (STitle) **] @ [**Hospital1 18**] [**Location (un) 620**] CAD s/p MI in 04 with normal dobutamine echo ([**6-16**]): No 2D echocardiographic evidence of inducible ischemia to achieved MEDICATION ON ADMISSION: diovan 320mg PO daily duragesic patch 75mcg q 3 days (due tomorrow) fluoxetine 10mg PO daily Glucatrol 5mg PO daily isosorbide 120mg PO daily levothyroxine 0.125mcg PO daily omeprazole 20mg PO daily percocet 5/325 PRN mirtazapine 7.5 mg PO daily chloropromazine 25mg PO daily zocor 10mg PO BID requip 0.25mg PO PRN nifedipine 120mg PO daily lopressor 50mg PO TID iron [**Hospital1 **] ALLERGIES: Morphine / Sulfa (Sulfonamides) PHYSICAL EXAM: Tc 98.7, bp 147/72, HR 140, resp 20, 100% RA Gen: Writhing around uncomfortably HEENT: pale conjunctiva, oral mucosa dry, oropharynx clear, neck supple, no bony tenderness over neck Cardiac: tachy and regular. No TTP over chest Pulm: (+) occasional rhonic, crackles at bases bilaterally Abd: NABS, soft, NT/ND Ext: Full ROM hips bilaterally to passive movement; no tenderness to int/ext rotation, full ROM knees bilaterally. (+) pain left hip with active flexion. Neuro: A&OX3, normal attention, CN II-XII grossly intact and symmetric bilaterally, sensation intact to light touch proximally and distally in upper and lower extremities bilaterally, 5/5 strength proximally and distally in upper and lower extremities bilaterally, 2+ DTR throughout [**Name2 (NI) **]: no CVA tenderness; (+) tenderness to percussion over L4 Rectal: hard, black, guaiac positive stool in vault (per hospitalist) FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Location 620**] with husband and is an ex nurse. Occasional ETOH, stopped smoking 40 years ago.

Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Hyposmolality and/or hyponatremia,Mitral valve disorders,Benign neoplasm of stomach,Achalasia and cardiospasm,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Urinary tract infection, site not specified

Ac posthemorrhag anemia,Food/vomit pneumonitis,Hyposmolality,Mitral valve disorder,Benign neoplasm stomach,Achalasia & cardiospasm,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Pure hypercholesterolem,Hypertension NOS,Hypothyroidism NOS,Urin tract infection NOS

Admission Date: [**2202-4-1**] Discharge Date: [**2202-4-7**] Service: MEDICINE Allergies: Morphine / Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 3507**] Chief Complaint: S/p fall, Anemia Major Surgical or Invasive Procedure: Central venous catheter placement History of Present Illness: 85 yo F w/ h/o achalasia, Type II DM, CAD presents s/p fall. Yesterday, she was getting up from bed and reaching for her walker, when she felt dizzy, stumbled and fell forward, striking her left forehead and left knee/hip. The fall was not witnessed. No associated chest pain, shortness of breath, loss of bowel/bladder function. (+) LOC "a couple of seconds". She was unable to rise and her husband called EMS -> [**Hospital1 18**] [**Location (un) 620**]. CT head/pelvis unrevealing. She was noted to have a hematocrit of 26.5 (36.4 [**10/2199**]) and sodium 120. U/A positive and given cipro. She was transferred to [**Hospital1 18**] for further evaluation. Currently, she notes left hip/leg pain, worse with movement, [**1-23**], and a headache "all over my head" with tenderness over left frontal area. (+) low back pain, chronic. The patient has a history of recurrent nausea/vomiting, attributed to achalasia and GERD, which has worsened recently. She notes frequent nausea, without vomiting on a daily basis. It appears to be getting worse. Its timing is not clearly associated with time of day or food, although she has noted decreased appetite/oral intake. She denies hemetemesis, coffee-ground emesis, diarrhea, BRBPR. (+) black stool chronically (takes iron); marked constipation, last BM 4 days ago. She has a chronic non-productive cough, no recent change. She does note pleuritic central chest pain without SOB, which started this morning, intermittent, sharp. . The ICU was asked to evaluate the patient for placement of central line as no other access was available. Shortly thereafter, the patient became tachycardic to 140's but not hypotensive. At time of [**Hospital Unit Name 153**] eval, the chest pain was absent and the patient cannot remember enough about it to describe it in more detail. She was transferred for line placement and closer monitoring. . ROS: As above, in addition: No weight loss. (+) fatigue/malaise. No fever, chills, night sweats, change in vision (legally blind), (+) mild rhinorrhea. No sore throat. palpitations, lower extremity edema, hemoptysis, abdominal pain, bleeding, bruising, dysuria, hematuria, rash, numbness, weakness/tingling, lightheadedness. (+) increase urinary frequency. Past Medical History: Anemia (Hct range 3/04 ?????? [**8-17**]: 24.0-35.6) secondary to Gastric Polys; followed by Dr. [**Last Name (STitle) **] @ [**Hospital1 18**] [**Location (un) 620**] CAD s/p MI in 04 with normal dobutamine echo ([**6-16**]): No 2D echocardiographic evidence of inducible ischemia to achieved workload. Compared to the prior stress echo report ([**2197-5-15**]), mild fixed posterobasal defect is unchanged. Hypercholesterolemia HTN DM-2 Achalasia: s/p multiple botox injections Hiatal Hernia Hypothyroidism S/p Right mastectomy for breast CA [**2187**] Colon CA in [**2171**] Depression with psychosis Restless leg syndrome Macular degeneration, legally blind CRI Possible seizure [**10/2201**]: seen in neurology clinic. The episode she describes most likely represents epilepsy partialis continuum, a prolonged focal seizure. Social History: Lives in [**Location 620**] with husband and is an ex nurse. Occasional ETOH, stopped smoking 40 years ago. Family History: Non-contributory Physical Exam: Tc 98.7, bp 147/72, HR 140, resp 20, 100% RA Gen: Writhing around uncomfortably HEENT: pale conjunctiva, oral mucosa dry, oropharynx clear, neck supple, no bony tenderness over neck Cardiac: tachy and regular. No TTP over chest Pulm: (+) occasional rhonic, crackles at bases bilaterally Abd: NABS, soft, NT/ND Ext: Full ROM hips bilaterally to passive movement; no tenderness to int/ext rotation, full ROM knees bilaterally. (+) pain left hip with active flexion. Neuro: A&OX3, normal attention, CN II-XII grossly intact and symmetric bilaterally, sensation intact to light touch proximally and distally in upper and lower extremities bilaterally, 5/5 strength proximally and distally in upper and lower extremities bilaterally, 2+ DTR throughout [**Name2 (NI) **]: no CVA tenderness; (+) tenderness to percussion over L4 Rectal: hard, black, guaiac positive stool in vault (per hospitalist) Pertinent Results: [**2202-4-6**] 02:53PM BLOOD Hct-32.4* [**2202-4-3**] 04:02PM BLOOD Hct-35.0* [**2202-4-1**] 01:30PM BLOOD WBC-10.7 RBC-2.64*# Hgb-7.5*# Hct-21.8*# MCV-83 MCH-28.3 MCHC-34.2 RDW-15.5 Plt Ct-284# [**2202-4-6**] 05:05AM BLOOD Glucose-106* UreaN-12 Creat-0.7 Na-132* K-4.6 Cl-99 HCO3-26 AnGap-12 [**2202-4-1**] 01:30PM BLOOD Glucose-148* UreaN-41* Creat-0.7 Na-129* K-4.7 Cl-96 HCO3-24 AnGap-14 [**2202-4-6**] 05:05AM BLOOD CK(CPK)-13* [**2202-4-2**] 07:24PM BLOOD CK(CPK)-178* [**2202-4-1**] 10:09PM BLOOD CK(CPK)-38 [**2202-4-6**] 05:05AM BLOOD CK-MB-3 cTropnT-0.61* [**2202-4-2**] 07:24PM BLOOD CK-MB-27* MB Indx-15.2* cTropnT-0.77* [**2202-4-2**] 04:58AM BLOOD CK-MB-17* MB Indx-11.8* cTropnT-0.46* [**2202-4-1**] 10:09PM BLOOD CK-MB-4 cTropnT-0.03* [**2202-4-6**] 05:05AM BLOOD Calcium-9.6 Phos-3.0 Mg-1.7 Cholest-113 [**2202-4-3**] 05:05AM BLOOD VitB12-612 Folate-15.1 [**2202-4-3**] 06:00AM BLOOD %HbA1c-5.5 [**2202-4-6**] 05:05AM BLOOD Triglyc-130 HDL-41 CHOL/HD-2.8 LDLcalc-46 LDLmeas-53 [**2202-4-1**] 01:30PM BLOOD TSH-2.4 . The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with focal akinesis of the distal inferior wall, distal anterior wall and apex. The remaining left ventricular segments contract normally. No masses or thrombi are seen in the left ventricle. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild-moderate ([**12-15**]+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is an anterior space which most likely represents a fat pad. . IMPRESSION: Mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w CAD (distal LAD lesion). Mild-moderate mitral regurgitation. Brief Hospital Course: GI bleed/acute blood loss anemia: Upper GI source suspected. Attempt at NG lavage by hospitalist was unsuccessful (tube coiled in throat) and the patient declined further attempts. The hospitalist spoke with her gastroenterologist, who revealed that the patient has a history of fundic polyps with recurrent bleeding. HCT 32 [**10-19**] -> 21. Hct stable s/p transfusions. No active bleed. Vit B12/folate WNL. Continue PPI. GI recommending f/u with PCP as outpatient. Plan outpatient EGD. Restart Fe after abx. . # Hyponatremia: likely hypovolemic - GI bleed, poor PO intake, N/V. It resolved after administration of one liter NS. . # UTI: Dx by positive U/A at OSH. Was treated with Cefpodoxime. . #Troponin leak/NSTEMI: Developed tachycardia with ST segement depressions in V3-V6 in the setting of low HCT. TnT peaked 0.77, with flat CKs and elevated MBs; likely demand ischemia in setting of active tachycardia and anemia. Continued on beta-blocker, statin, ASA (given hct stable). [**3-17**] TTE LVH, EF 60-65%, 1+MR, [**6-16**] DTE with fixed postero basal defect (unchanged from [**2196**]). Repeat TTE done, which showed mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w CAD (distal LAD lesion). Mild-moderate mitral regurgitation. BB increased to 75 TID and Imdur decreased to 60 mg on discharge. Pt never developed chest pain or anginal sx. Case discussed without patient cardiologist, who agreed with medical management as pt high risk for bleeding. LDL checked and was excellent (50s). . # s/p fall: Head CT/C-spine negative; full ROM left hip, pelvic CT negative. PT consulted for falls risk- close to baseline. Discharged with home services. . #N/V: attributed to achalasia/hiatal hernia. Medications on Admission: diovan 320mg PO daily duragesic patch 75mcg q 3 days (due tomorrow) fluoxetine 10mg PO daily Glucatrol 5mg PO daily isosorbide 120mg PO daily levothyroxine 0.125mcg PO daily omeprazole 20mg PO daily percocet 5/325 PRN mirtazapine 7.5 mg PO daily chloropromazine 25mg PO daily zocor 10mg PO BID requip 0.25mg PO PRN nifedipine 120mg PO daily lopressor 50mg PO TID iron [**Hospital1 **] Discharge Medications: 1. Fentanyl 75 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr Transdermal Q72H (every 72 hours). 2. Valsartan 160 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Fluoxetine 10 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 5. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day): 75 mg po TID. Disp:*45 Tablet(s)* Refills:*2* 7. Nifedipine 60 mg Tablet Sustained Release Sig: Two (2) Tablet Sustained Release PO DAILY (Daily). 8. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2* 9. Requip 0.25 mg Tablet Sig: One (1) Tablet PO at bedtime. 10. Mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime). 11. Glucotrol 5 mg Tablet Sig: One (1) Tablet PO once a day. 12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO every 4-6 hours. 13. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Zocor 10 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Primary Diagnosis 1. Acute Blood Loss Anemia 2. Troponin leak secondary to above 3. ?Aspiration PNA 4. Restless Leg Syndrome Secondary Diagnoses: Hypertension DM Achalasia Discharge Condition: Stable Discharge Instructions: Please come back to the Emergency Room should you develop any lightheadedness, fevers, chills, chest pain, shortness of breath, blood in your stools, black stools or any other complaints. Followup Instructions: 1. Please follow up in the sleep clinic for your sleepless leg syndrome by calling [**Telephone/Fax (1) 6856**] and ask for [**Doctor First Name 12983**] to make an appointment. We tried to make an appointment for you, but the sleep clinic would like to talk to the patient directly before making the appointment. 2. You have an appointment scheduled with Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 3259**]) on Wednesday [**2202-4-14**] at 1:00. 3. Dr.[**Name (NI) 42458**] office should be contacting you in the next few days to schedule a follow up appointment.

285,507,276,424,211,530,250,414,272,401,244,599

{'Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Hyposmolality and/or hyponatremia,Mitral valve disorders,Benign neoplasm of stomach,Achalasia and cardiospasm,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Urinary tract infection, site not specified'}

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: S/p fall, Anemia PRESENT ILLNESS: 85 yo F w/ h/o achalasia, Type II DM, CAD presents s/p fall. Yesterday, she was getting up from bed and reaching for her walker, when she felt dizzy, stumbled and fell forward, striking her left forehead and left knee/hip. The fall was not witnessed. No associated chest pain, shortness of breath, loss of bowel/bladder function. (+) LOC "a couple of seconds". She was unable to rise and her husband called EMS -> [**Hospital1 18**] [**Location (un) 620**]. CT head/pelvis unrevealing. She was noted to have a hematocrit of 26.5 (36.4 [**10/2199**]) and sodium 120. U/A positive and given cipro. She was transferred to [**Hospital1 18**] for further evaluation. Currently, she notes left hip/leg pain, worse with movement, [**1-23**], and a headache "all over my head" with tenderness over left frontal area. (+) low back pain, chronic. The patient has a history of recurrent nausea/vomiting, attributed to achalasia and GERD, which has worsened recently. She notes frequent nausea, without vomiting on a daily basis. It appears to be getting worse. Its timing is not clearly associated with time of day or food, although she has noted decreased appetite/oral intake. She denies hemetemesis, coffee-ground emesis, diarrhea, BRBPR. (+) black stool chronically (takes iron); marked constipation, last BM 4 days ago. She has a chronic non-productive cough, no recent change. She does note pleuritic central chest pain without SOB, which started this morning, intermittent, sharp. . The ICU was asked to evaluate the patient for placement of central line as no other access was available. Shortly thereafter, the patient became tachycardic to 140's but not hypotensive. At time of [**Hospital Unit Name 153**] eval, the chest pain was absent and the patient cannot remember enough about it to describe it in more detail. She was transferred for line placement and closer monitoring. . ROS: As above, in addition: No weight loss. (+) fatigue/malaise. No fever, chills, night sweats, change in vision (legally blind), (+) mild rhinorrhea. No sore throat. palpitations, lower extremity edema, hemoptysis, abdominal pain, bleeding, bruising, dysuria, hematuria, rash, numbness, weakness/tingling, lightheadedness. (+) increase urinary frequency. MEDICAL HISTORY: Anemia (Hct range 3/04 ?????? [**8-17**]: 24.0-35.6) secondary to Gastric Polys; followed by Dr. [**Last Name (STitle) **] @ [**Hospital1 18**] [**Location (un) 620**] CAD s/p MI in 04 with normal dobutamine echo ([**6-16**]): No 2D echocardiographic evidence of inducible ischemia to achieved MEDICATION ON ADMISSION: diovan 320mg PO daily duragesic patch 75mcg q 3 days (due tomorrow) fluoxetine 10mg PO daily Glucatrol 5mg PO daily isosorbide 120mg PO daily levothyroxine 0.125mcg PO daily omeprazole 20mg PO daily percocet 5/325 PRN mirtazapine 7.5 mg PO daily chloropromazine 25mg PO daily zocor 10mg PO BID requip 0.25mg PO PRN nifedipine 120mg PO daily lopressor 50mg PO TID iron [**Hospital1 **] ALLERGIES: Morphine / Sulfa (Sulfonamides) PHYSICAL EXAM: Tc 98.7, bp 147/72, HR 140, resp 20, 100% RA Gen: Writhing around uncomfortably HEENT: pale conjunctiva, oral mucosa dry, oropharynx clear, neck supple, no bony tenderness over neck Cardiac: tachy and regular. No TTP over chest Pulm: (+) occasional rhonic, crackles at bases bilaterally Abd: NABS, soft, NT/ND Ext: Full ROM hips bilaterally to passive movement; no tenderness to int/ext rotation, full ROM knees bilaterally. (+) pain left hip with active flexion. Neuro: A&OX3, normal attention, CN II-XII grossly intact and symmetric bilaterally, sensation intact to light touch proximally and distally in upper and lower extremities bilaterally, 5/5 strength proximally and distally in upper and lower extremities bilaterally, 2+ DTR throughout [**Name2 (NI) **]: no CVA tenderness; (+) tenderness to percussion over L4 Rectal: hard, black, guaiac positive stool in vault (per hospitalist) FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lives in [**Location 620**] with husband and is an ex nurse. Occasional ETOH, stopped smoking 40 years ago. ### Response: {'Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Hyposmolality and/or hyponatremia,Mitral valve disorders,Benign neoplasm of stomach,Achalasia and cardiospasm,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Urinary tract infection, site not specified'}

CHIEF COMPLAINT: hypertension PRESENT ILLNESS: This 63 year old Korean speaking male underwent a CTA of the chest on [**10-11**] for a questionable right lung nodule. Thsi revealed a dilated aortic arch with intramural thrombus. he was contact[**Name (NI) **] by the hospital to return to the ED ,which he did on [**10-12**]. He denied any symptoms related to this. He was admitted to the [**Last Name (LF) 42137**], [**First Name3 (LF) **] A line was placed and Esmolol/Nipride begun. Again he remained pain free. MEDICAL HISTORY: hypertension-no treatment being taken by patient MEDICATION ON ADMISSION: none ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: admission: Pulse: Resp:24 O2 sat:98% B/P Right:153/106 Left:149/113 Height: Weight: FAMILY HISTORY: pt unaware SOCIAL HISTORY: live with wife. korean speaking only smokes 2 ppd

Dissection of aorta, thoracic,Other ill-defined heart diseases,Other diseases of lung, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,Tobacco use disorder

Dsct of thoracic aorta,Ill-defined hrt dis NEC,Other lung disease NEC,Hypertension NOS,Pure hypercholesterolem,Tobacco use disorder

Admission Date: [**2159-10-12**] Discharge Date: [**2159-10-14**] Date of Birth: [**2096-4-16**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1505**] Chief Complaint: hypertension Major Surgical or Invasive Procedure: none History of Present Illness: This 63 year old Korean speaking male underwent a CTA of the chest on [**10-11**] for a questionable right lung nodule. Thsi revealed a dilated aortic arch with intramural thrombus. he was contact[**Name (NI) **] by the hospital to return to the ED ,which he did on [**10-12**]. He denied any symptoms related to this. He was admitted to the [**Last Name (LF) 42137**], [**First Name3 (LF) **] A line was placed and Esmolol/Nipride begun. Again he remained pain free. Past Medical History: hypertension-no treatment being taken by patient Social History: live with wife. korean speaking only smokes 2 ppd Family History: pt unaware Physical Exam: admission: Pulse: Resp:24 O2 sat:98% B/P Right:153/106 Left:149/113 Height: Weight: General:AAO x 3 in NAD Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [], well-perfused [] Edema Varicosities: None [] Neuro: Grossly intact Pulses: Femoral Right:2 Left:2 DP Right:2 Left:2 PT [**Name (NI) 167**]:2 Left:2 Radial Right:2 Left:2 Carotid Bruit Right:n Left:n Pertinent Results: [**2159-10-14**] 03:24AM BLOOD WBC-7.0 RBC-4.01* Hgb-11.4* Hct-32.1* MCV-80* MCH-28.4 MCHC-35.5* RDW-14.3 Plt Ct-152 [**2159-10-12**] 06:40PM BLOOD WBC-7.1 RBC-4.96 Hgb-13.9* Hct-40.5 MCV-82 MCH-28.1 MCHC-34.3 RDW-14.2 Plt Ct-161 [**2159-10-14**] 03:24AM BLOOD Glucose-89 UreaN-31* Creat-1.4* Na-132* K-4.2 Cl-103 HCO3-22 AnGap-11 [**2159-10-12**] 06:40PM BLOOD Glucose-82 UreaN-17 Creat-1.1 Na-139 K-3.5 Cl-100 HCO3-29 AnGap-14 Brief Hospital Course: Blood pressure was controlled with IV medications. A repeat CTA [**10-14**] was relatively unchanged, without intramural hematoma seen now. He was adament on leaving the hospital and his son spoke to him. Risk of progression of disease, rupture and the need for careful follow up and BP control were discussed. He will be discharged on medications listed. Follow up with the vascular clinic, cardiac surgery and his primary care were instructed. Medications on Admission: none Discharge Medications: 1. valsartan 320 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 2. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 3. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: hypertension Aortic arch aneurysm Discharge Condition: Stable. Ambulatory Discharge Instructions: Take all medications as directed. return to ED if back pain occurs Followup Instructions: Dr. [**Last Name (STitle) 16365**] ([**Telephone/Fax (1) 17826**]) Vascular surgery (call [**Numeric Identifier 75816**]- call for appointment in [**6-2**] days Dr. [**Last Name (STitle) 914**]([**Telephone/Fax (1) 170**]cardiac surgery-please call for appointment Completed by:[**2159-10-14**]

441,429,518,401,272,305

{'Dissection of aorta, thoracic,Other ill-defined heart diseases,Other diseases of lung, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,Tobacco use disorder'}

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: hypertension PRESENT ILLNESS: This 63 year old Korean speaking male underwent a CTA of the chest on [**10-11**] for a questionable right lung nodule. Thsi revealed a dilated aortic arch with intramural thrombus. he was contact[**Name (NI) **] by the hospital to return to the ED ,which he did on [**10-12**]. He denied any symptoms related to this. He was admitted to the [**Last Name (LF) 42137**], [**First Name3 (LF) **] A line was placed and Esmolol/Nipride begun. Again he remained pain free. MEDICAL HISTORY: hypertension-no treatment being taken by patient MEDICATION ON ADMISSION: none ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: admission: Pulse: Resp:24 O2 sat:98% B/P Right:153/106 Left:149/113 Height: Weight: FAMILY HISTORY: pt unaware SOCIAL HISTORY: live with wife. korean speaking only smokes 2 ppd ### Response: {'Dissection of aorta, thoracic,Other ill-defined heart diseases,Other diseases of lung, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,Tobacco use disorder'}

CHIEF COMPLAINT: Esophageal cancer PRESENT ILLNESS: The patient presented with Barrett's esophagus and had undergone 2 prior photodynamic therapies for ablative therapy. He developed an area of localized invasive cancer of the distal esophagus. Therefore, he was taken forward for a minimally invasive subtotal esophagogastrectomy. MEDICAL HISTORY: GERD, Barrett's esophagus, esophageal cancer, s/p right inguinal hernia repair [**2109**] MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Has not smoke since in his twenties; occasional drink; no drugs

Malignant neoplasm of lower third of esophagus,Dehydration,Pulmonary collapse,Urinary tract infection, site not specified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Barrett's esophagus

Mal neo lower 3rd esoph,Dehydration,Pulmonary collapse,Urin tract infection NOS,Pure hypercholesterolem,BPH w urinary obs/LUTS,Barrett's esophagus

Admission Date: [**2124-2-29**] Discharge Date: [**2124-3-11**] Date of Birth: [**2046-6-14**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1481**] Chief Complaint: Esophageal cancer Major Surgical or Invasive Procedure: 1. Minimally invasive esophagogastrectomy. 2. Jejunostomy tube placement. History of Present Illness: The patient presented with Barrett's esophagus and had undergone 2 prior photodynamic therapies for ablative therapy. He developed an area of localized invasive cancer of the distal esophagus. Therefore, he was taken forward for a minimally invasive subtotal esophagogastrectomy. Past Medical History: GERD, Barrett's esophagus, esophageal cancer, s/p right inguinal hernia repair [**2109**] Social History: Has not smoke since in his twenties; occasional drink; no drugs Pertinent Results: BARIUM SWALLOW/UPPER GI AIR/SMALL BOWEL FOLLOW THROUGH [**2124-3-6**] 9:17 AM IMPRESSION: Status post esophagectomy with gastric pull-through. No evidence of cervical anastomotic leak. PATHOLOGY REPORT: SPECIMEN SUBMITTED: ESOPHAGOGASTSTRECTOMY, NODAL TISSUE & AZYGOUS. DIAGNOSIS I. Nodal tissue (A): One lymph node, no malignancy identified (0/1). II. Azygous (B): Two lymph nodes, no malignancy identified (0/2). III. Esophago-gastrectomy (C-U): a. Invasive adenocarcinoma, see synoptic report. b. Eighteen regional lymph nodes, no malignancy identified (0/18): Brief Hospital Course: The patient was admitted for an elective laprascopic esophagogastrectomy [**2124-2-29**] by Dr. [**Last Name (STitle) **] (see op note for details). He remained intubated postoperatively and was transferred to the CSRU. Extubation was attempted on post op day 2, but he became too agitated to extubate successfully. Reattempt on post op day 2 was successful. Tube feeds were initiated on post op day 3. He progressed nicely and was transferred to the cardiac floor for close monitoring. An upper GI study was done several days after she was transferred to the floor which showed no leaks. He was started on clear liquids and eventually to a regular diet. Although he ate small amounts at first, he progressed nicely with boost supplementation. Hence, with the recomendation from the Nutrition Service, his tubefeeds were held. Post-operatively, he did have a minor problems with urination retention. A foley had to be re-inserted, flomax restarted, and Urology consulted. He will be discharged in stable condition to a rehabilitation facility to complete his treatment. Post-hospital instructions will be included, as well as follow-up, upon being released to the rehab center. [Note: this discharge summary was completed the night before the patient is to be discharged in order to facilitate the patient's discharge by the covering team. His foley was be d/c'd at midnight of discharge. Depending if he voids in the morning, he was be discharged with or without a foley.] Discharge Medications: 1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One (1) PO DAILY (Daily): via J tube. 3. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q4H (every 4 hours). 4. Albuterol Sulfate 0.083 % Solution Sig: Two (2) Inhalation Q6H (every 6 hours) as needed. 5. Haloperidol Lactate 5 mg/mL Solution Sig: One (1) Injection HS (at bedtime) as needed. 6. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1) Capsule, Sust. Release 24HR PO DAILY (Daily). 8. Ibuprofen 100 mg/5 mL Suspension Sig: One (1) PO Q6H (every 6 hours) as needed for pain: via J tube. 9. Acetaminophen-Codeine 300-30 mg Tablet Sig: One (1) Tablet PO Q3-4H (Every 3 to 4 Hours) as needed: via J tube. 10. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1) PO BID (2 times a day). 11. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 12. insulin sliding scale Insulin SC (per Insulin Flowsheet) Sliding Scale 13. Aspirin EC 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day: via J tube. 14. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed: fever/pain. 15. Proscar 5 mg Tablet Sig: One (1) Tablet PO once a day. 16. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day as needed: lower extremity edema, decreased urine output. Discharge Disposition: Extended Care Facility: [**Hospital1 **] Senior Healthcare - [**Location (un) 1887**] Discharge Diagnosis: Esophageal cancer Discharge Condition: Stable Discharge Instructions: [**Month (only) 116**] return to taking outpatient medications. Please follow directions as discussed previously with Dr. [**Last Name (STitle) **]. Please take medications as prescribed and read warning labels carefully. If signs of infections such as purulent discharge from wound, increased pain and redness at wound, please call or go to the emergency room. Remember to call for a follow up appointment (bellow). Light activities until seen in clinic. [**Month (only) 116**] take quick showers but no baths. Absolutely no smoking. Followup Instructions: Please call Dr.[**Name (NI) 1482**] office for a follow up appointment to be seen in two weeks ([**Telephone/Fax (1) 1483**]. Completed by:[**2124-3-10**]

150,276,518,599,272,600,530

{"Malignant neoplasm of lower third of esophagus,Dehydration,Pulmonary collapse,Urinary tract infection, site not specified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Barrett's esophagus"}

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: Esophageal cancer PRESENT ILLNESS: The patient presented with Barrett's esophagus and had undergone 2 prior photodynamic therapies for ablative therapy. He developed an area of localized invasive cancer of the distal esophagus. Therefore, he was taken forward for a minimally invasive subtotal esophagogastrectomy. MEDICAL HISTORY: GERD, Barrett's esophagus, esophageal cancer, s/p right inguinal hernia repair [**2109**] MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Has not smoke since in his twenties; occasional drink; no drugs ### Response: {"Malignant neoplasm of lower third of esophagus,Dehydration,Pulmonary collapse,Urinary tract infection, site not specified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Barrett's esophagus"}

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is a 71-year-old right handed woman with complaints of dizziness and unsteady gait x1-2 years. Patient has had progressive unsteady gait over the last year with falls as recent as three weeks ago, nonprogressing about the same and constant. Son also claims the patient has had slurred speech, and has had dizziness on and off progressing over the last year lasting hours to days with no nausea, vomiting, or other neurologic symptoms. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Benign neoplasm of cerebral meninges,Complications affecting other specified body systems, not elsewhere classified, hypertension,Unspecified essential hypertension,Urinary tract infection, site not specified,Schizophrenic disorders, residual type, chronic,Obstructive hydrocephalus,Atherosclerosis of renal artery,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site

Ben neo cerebr meninges,Surg comp - hypertension,Hypertension NOS,Urin tract infection NOS,Schizophr dis resid-chr,Obstructiv hydrocephalus,Renal artery atheroscler,Proteus infection NOS

Admission Date: [**2106-8-11**] Discharge Date: [**2106-8-18**] Date of Birth: [**2034-9-8**] Sex: F Service: HISTORY OF PRESENT ILLNESS: Patient is a 71-year-old right handed woman with complaints of dizziness and unsteady gait x1-2 years. Patient has had progressive unsteady gait over the last year with falls as recent as three weeks ago, nonprogressing about the same and constant. Son also claims the patient has had slurred speech, and has had dizziness on and off progressing over the last year lasting hours to days with no nausea, vomiting, or other neurologic symptoms. Patient had a head CT which showed a cerebellar mass. The patient was initially admitted on [**2106-8-3**] and diagnosed with the cerebellar mass. She was sent home and then brought back for excision of this cerebellar tumor. PHYSICAL EXAMINATION: On physical exam, she was alert, awake, oriented, fluent speech. Cranial nerves II through XII are intact. She had mild tongue deviation to the right with decreased gag reflex. Pupils are equal, round, and reactive to light. EOMs are full. Visual fields were full. Her motor strength: She had 4+ deltoids, 5 biceps, 4 triceps, 4+ intrinsics, and 4+ IPs bilaterally, otherwise she was [**4-5**]. Her sensation to light touch and proprioception were intact. Her coordination was intact. She had mild dysmetria bilaterally. Negative Romberg. Patient was taken to the OR on [**2106-8-11**] for a left suboccipital craniotomy for excision of tumor without intraoperative complication. Postoperatively, vital signs were stable. The patient was monitored, and in the recovery room, her blood pressure was 140/60. She was awake, alert, following commands. EOMs were full. Pupils were 3 down to 2 mm. No nystagmus. Face symmetric. Mild dysmetria. Dressing was clean, dry, and intact. She was transferred to the regular floor, where she continued to be afebrile with stable vital signs. Although her blood pressure was continuously an issue, she had blood pressures up as high as in the 209/90 range. She was seen by the Cardiology service, and transferred to the ICU, where she was placed on a Nipride drip. Her medications were maxed out. She was on lisinopril 40 q.d., metoprolol 100 b.i.d., and placed on a Nipride drip. She had a CTA of her renal arteries, which did show renal artery stenosis. She had 60% stenosis of one of four renal arteries. Cardiology did not feel treatment was indicated given the high amount of stenosis on this renal artery. Patient is currently receiving hydralazine 75 mg q.i.d., metoprolol 150 mg b.i.d., lisinopril 40 mg q.d., hydrochlorothiazide 25 q.d., and diltiazem 120 mg q.i.d. The patient's are under better control 120-160/40s-60s, and off the Nipride for 48 hours at this point. Patient had a TSH which was in the normal range. Patient's TSH level was somewhat decreased, although in the setting of acute hospitalization, it is difficult to interpret patient should have TSH rechecked in a week to 10 days posthospitalization. DISCHARGE MEDICATIONS: 1. Currently decadron q6 to be weaned to b.i.d. over a week to 10 days. 2. Metoprolol 150 mg p.o. b.i.d., hold for systolic less than 110, heart rate less than 55. 3. Hydralazine 75 p.o. q6. 4. Levothyroxine 500 mg p.o. q.24h. for another day for UTI. 5. Diltiazem 120 mg p.o. q.i.d. 6. Hydrochlorothiazide 25 mg p.o. q.d. 7. Lorazepam 0.5 mg p.o. q.6h. prn. 8. Heparin 5,000 units subQ q.12h. 9. Senna one tablet p.o. b.i.d. 10. Colace 100 mg p.o. b.i.d. 11. Metformin 500 mg q.d. 12. Pantoprazole 40 mg p.o. q.24h. 13. Lisinopril 40 mg p.o. q.d. 14. Levothyroxine 100 mcg p.o. q.d. CONDITION ON DISCHARGE: Patient's condition was stable at the time of discharge. Staples should be removed on postoperative day #10. FOLLOW-UP INSTRUCTIONS: Follow up with Dr. [**First Name (STitle) **] in the Brain [**Hospital 341**] Clinic in two weeks. [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D. [**MD Number(1) 343**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2106-8-18**] 10:22 T: [**2106-8-18**] 10:44 JOB#: [**Job Number 34774**]

225,997,401,599,295,331,440,041

{'Benign neoplasm of cerebral meninges,Complications affecting other specified body systems, not elsewhere classified, hypertension,Unspecified essential hypertension,Urinary tract infection, site not specified,Schizophrenic disorders, residual type, chronic,Obstructive hydrocephalus,Atherosclerosis of renal artery,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}

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: Patient is a 71-year-old right handed woman with complaints of dizziness and unsteady gait x1-2 years. Patient has had progressive unsteady gait over the last year with falls as recent as three weeks ago, nonprogressing about the same and constant. Son also claims the patient has had slurred speech, and has had dizziness on and off progressing over the last year lasting hours to days with no nausea, vomiting, or other neurologic symptoms. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Benign neoplasm of cerebral meninges,Complications affecting other specified body systems, not elsewhere classified, hypertension,Unspecified essential hypertension,Urinary tract infection, site not specified,Schizophrenic disorders, residual type, chronic,Obstructive hydrocephalus,Atherosclerosis of renal artery,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site'}

CHIEF COMPLAINT: Transfer from OSH after seizure in setting of recent spinal cord surgery and meningitis. PRESENT ILLNESS: Pt is a 78 yof with PMH Of T2DM, Spinal stenosis who was admitted to [**Hospital3 **] on [**3-16**] for elective decompression of spinal stenosis. She underwent decompressive L3, L4, L5 laminectomies and radical left L5 and S1 formainectomies. ?L4 level dural perforation, reporedly no spillage of csf in notes. She had serosanguineous drainage from surgical wound. Pt febrile to 101.5 postop day 1 she had received peri op oxicillin. She was transfereed to TCU for rehab. On [**3-21**] pt noted to have increased confusion and per family had visual hallucinations. This was attributed to discontinuation of cymbalta. Cymbalta was restarted and her symptoms improved. She had a urine culture sent which grew Pseudomonas ([**Last Name (un) 36**] to zosyn, ceftz and amikcin). Head CT at the time unremarkable. She continued to have drainage from back. [**3-26**] area noted to be erythematous and pt was febrile. On [**4-1**] she underwent exploration in OR where 2 JP drains were placed. Wound culture grew, Pseudomonas, Klebsiella and Enteroccus. CSF analysis done in [**3-30**] showed 5950 wbc (71P, 8L, 21M) 3 RBC, glucose 22, (protein not reported). Pt was started on Ceftaz, Amikacin and Ampicillin at OSH. . Earlier day of admission pt was complaining of back pain. She received demerol around 2:15pm and another dose 5:15pm per family. 5 [**Name (NI) **] pt noted to be choking followed by jerking motions of upper ext. Unknown lower extremities movement. no incontinence. Also at this time pt noted to have a wide complex tachycardia. Pt soon bacame pulseless and and was shocked X 1 with 200J and became responsive thereafter. Episode lasted 5 [**Name (NI) **]. After discussion with family pt was transferred to [**Hospital1 18**]. MEDICAL HISTORY: Lung cancer resected 15 years ago spinal stenosis pancreatitis hypertension anxiety depression reflux hypothyroid diabetes type 2 s/p appendectomy s/p hysterectomy r hip replacement MEDICATION ON ADMISSION: levothyroixine glipizide digoxin cartia pravachol propranolol colace amitriptyline senokot. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 96.7 BP 122/50 HR 52 RR 19 O2sat 100% 3LNC. GEN: Elderly female lying in bed in nad. Drowsy but easily arousable able to cooperate with exam. HEENT: PERRL, MMM, EOMI Chest: CTAB, no crackles CVR: RRR, nl s1, s2, no r/m/g Abdomen: soft, nt, nd, obese Ext: no edema, 1+dp/pt pulses. Back: Incision site with staples intact, some erythema around the site no warmth. 2 JP drains in place. Neuro: CN II-XII intact. [**6-4**] UE and LE strength. sensation intact to light touch thruout. 2+ patellar reflex. . PE on call out from MICU: Vitals: Tm: 98.6 Tc: 98.6 BP: 148/79 P: 80s RR: 16 O2sat: 100% 2L NC I/O: 1480/405 +1.07. General: 78 y/o CF in NAD. Pleasant, cooperative, joking with staff. AOX3. HEENT: PERRL, MMM. OP clear. Lungs: CTAB CV: RRR S1 and S2 audible w/o M/R/G Abd: obese, Soft, NT, ND. NABS, No masses, No HSM. + [**Female First Name (un) **] intertrigo in skin folds under pannus. 2 JP drains in place in the back ~5 cc serosanguinous drainage in each. Incision sites appear clean. Peripheral: 2+ edema, ext wwp, moving all extremities, no focal neuro deficits. No clonus. FAMILY HISTORY: FH: unknown. SOCIAL HISTORY: SH: retired foremrly worked in highschool cafeteria serving food. former smoker, no etoh.

Other postoperative infection,Meningitis due to gram-negative bacteria, not elsewhere classified,Other convulsions,Urinary tract infection, site not specified,Long QT syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anxiety state, unspecified,Personal history of malignant neoplasm of bronchus and lung,Candidiasis of skin and nails

Other postop infection,Mningts gram-neg bct NEC,Convulsions NEC,Urin tract infection NOS,Long QT syndrome,DMII wo cmp nt st uncntr,Hypertension NOS,Anxiety state NOS,Hx-bronchogenic malignan,Cutaneous candidiasis

Admission Date: [**2106-4-2**] Discharge Date: [**2106-4-9**] Date of Birth: [**2028-2-4**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 783**] Chief Complaint: Transfer from OSH after seizure in setting of recent spinal cord surgery and meningitis. Major Surgical or Invasive Procedure: femoral central line placement [**2106-4-2**] History of Present Illness: Pt is a 78 yof with PMH Of T2DM, Spinal stenosis who was admitted to [**Hospital3 **] on [**3-16**] for elective decompression of spinal stenosis. She underwent decompressive L3, L4, L5 laminectomies and radical left L5 and S1 formainectomies. ?L4 level dural perforation, reporedly no spillage of csf in notes. She had serosanguineous drainage from surgical wound. Pt febrile to 101.5 postop day 1 she had received peri op oxicillin. She was transfereed to TCU for rehab. On [**3-21**] pt noted to have increased confusion and per family had visual hallucinations. This was attributed to discontinuation of cymbalta. Cymbalta was restarted and her symptoms improved. She had a urine culture sent which grew Pseudomonas ([**Last Name (un) 36**] to zosyn, ceftz and amikcin). Head CT at the time unremarkable. She continued to have drainage from back. [**3-26**] area noted to be erythematous and pt was febrile. On [**4-1**] she underwent exploration in OR where 2 JP drains were placed. Wound culture grew, Pseudomonas, Klebsiella and Enteroccus. CSF analysis done in [**3-30**] showed 5950 wbc (71P, 8L, 21M) 3 RBC, glucose 22, (protein not reported). Pt was started on Ceftaz, Amikacin and Ampicillin at OSH. . Earlier day of admission pt was complaining of back pain. She received demerol around 2:15pm and another dose 5:15pm per family. 5 [**Name (NI) **] pt noted to be choking followed by jerking motions of upper ext. Unknown lower extremities movement. no incontinence. Also at this time pt noted to have a wide complex tachycardia. Pt soon bacame pulseless and and was shocked X 1 with 200J and became responsive thereafter. Episode lasted 5 [**Name (NI) **]. After discussion with family pt was transferred to [**Hospital1 18**]. . On transfer here pt denies any complaints. Denies any headache, chest pain, shortness of breath. She is somnolent however easily arousable. Denies any photophobia. . MICU Course: Pt was given Amikacin, Ceftaz IV. Ampicillin IV was held given it lowers the seizure threshold, awaiting ID input. Neuro was curbsided, and stated that there is no benefit to dilantin for meningitis for seizure prophylaxis, so this was discontinued. Neuro stated if the sz recurs, to formally consult and give Ativan 2mg IV. Ortho was consulted. From a cardiac standpoint, we still do not have a clear cause for pulseless VT. The pt was ruled out by 2 sets of negative cardiac enzymes. Cardiology was notified upon transfer of the pt to the medical floor, and plan was made to discuss EKGs, antiarrhythmics and obtain TTE. The pt underwent LE doppler US on [**2106-4-3**] to rule out DVT. Femoral line was d/c'd. . Past Medical History: Lung cancer resected 15 years ago spinal stenosis pancreatitis hypertension anxiety depression reflux hypothyroid diabetes type 2 s/p appendectomy s/p hysterectomy r hip replacement Social History: SH: retired foremrly worked in highschool cafeteria serving food. former smoker, no etoh. Family History: FH: unknown. Physical Exam: T 96.7 BP 122/50 HR 52 RR 19 O2sat 100% 3LNC. GEN: Elderly female lying in bed in nad. Drowsy but easily arousable able to cooperate with exam. HEENT: PERRL, MMM, EOMI Chest: CTAB, no crackles CVR: RRR, nl s1, s2, no r/m/g Abdomen: soft, nt, nd, obese Ext: no edema, 1+dp/pt pulses. Back: Incision site with staples intact, some erythema around the site no warmth. 2 JP drains in place. Neuro: CN II-XII intact. [**6-4**] UE and LE strength. sensation intact to light touch thruout. 2+ patellar reflex. . PE on call out from MICU: Vitals: Tm: 98.6 Tc: 98.6 BP: 148/79 P: 80s RR: 16 O2sat: 100% 2L NC I/O: 1480/405 +1.07. General: 78 y/o CF in NAD. Pleasant, cooperative, joking with staff. AOX3. HEENT: PERRL, MMM. OP clear. Lungs: CTAB CV: RRR S1 and S2 audible w/o M/R/G Abd: obese, Soft, NT, ND. NABS, No masses, No HSM. + [**Female First Name (un) **] intertrigo in skin folds under pannus. 2 JP drains in place in the back ~5 cc serosanguinous drainage in each. Incision sites appear clean. Peripheral: 2+ edema, ext wwp, moving all extremities, no focal neuro deficits. No clonus. Pertinent Results: Imaging: [**2106-4-2**] CXR: IMPRESSION: 1. Cardiomegaly without evidence of pulmonary edema. 2. No evidence of pneumonia. . [**2106-4-3**]: RLE dopper: negative for DVT . ECG read by MICU (unable to find EKG in chart): sinus rhythm, bradycardic, left axis, qt ~500. twave flattening diffusely V2-V6. Rhythm strip from OSH: demonstrating a wide complex tachycardia, monomorphic VT. . CULTURE DATA: [**2106-4-2**]: Blood culture negative [**2106-4-3**]: Urine culture negative [**2106-4-3**]: Blood culture negative . ABD US [**2106-4-5**] Impression: Likely post operative ileus. Tubular foreign bodies over the lumbar spine and right abdomen, as discussed above. Clinical correlation with placed drains placed in the OR recommended. . ECHOCARDIOGRAM [**2106-4-6**] MEASUREMENTS: Left Atrium - Long Axis Dimension: 3.8 cm (nl <= 4.0 cm) Left Atrium - Four Chamber Length: 4.6 cm (nl <= 5.2 cm) Right Atrium - Four Chamber Length: 4.7 cm (nl <= 5.0 cm) Left Ventricle - Septal Wall Thickness: *1.6 cm (nl 0.6 - 1.1 cm) Left Ventricle - Inferolateral Thickness: *1.6 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 4.2 cm (nl <= 5.6 cm) Left Ventricle - Ejection Fraction: >= 55% (nl >=55%) Aorta - Valve Level: 3.6 cm (nl <= 3.6 cm) Aortic Valve - Peak Velocity: 1.6 m/sec (nl <= 2.0 m/sec) Mitral Valve - E Wave: 0.7 m/sec Mitral Valve - A Wave: 1.0 m/sec Mitral Valve - E/A Ratio: 0.70 Mitral Valve - E Wave Deceleration Time: 291 msec TR Gradient (+ RA = PASP): *31 mm Hg (nl <= 25 mm Hg) Conclusions: The left atrium is normal in size. There is moderate symmetric left ventricular hypertrophy with normal cavity size and systolic function (LVEF >55%). Regional left ventricular wall motion is normal. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets appear structurally normal with good leaflet excursion. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is an anterior space which most likely represents a fat pad. IMPRESSION: Symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Mild pulmonary artery systolic hypertension. Mild mitral regurgitation. . CT L spine, done [**2106-4-9**] and formal read pending. Brief Hospital Course: Impression: Pt is a 78 yo female with h/o lung cancer, Type II Diabetes Mellitus and spinal stenosis s/p recent laminectomy/foraminectomy surgery complicated by nosocomial meningitis who is transferred to [**Hospital1 18**] after seizure, pulseless VT arrest. . # Pulseless Ventricular tachycardia at outside hospital, in normal sinus rhythm status post shock with 200 joules - Unclear etiology of pulseless VT, precipitant. No EKGs from OSH prior to or immediately after pulseless VT. One strip from OSH with code blue note demonstrated monomorphic VT. The pt was ruled out for myocardial infarction by cardiac enzymes here. A 12 Lead EKG obtained here was significant for prolonged QTc at 450-470 msec, however this was felt to be acquired long QT syndrome, unrelated to her pulseless VT episode. Her fluoxetine and amitryptline was discontinued, however, given the pt has severe depression, added fluoxetine back and followed QTc with EKGs. Cardiology, Electrophysiology was consulted and recommened pt undergo electophysiology study/T wave alternans/possible VT ablation, however, given her infectious issues, it was decided by the primary medicine team to hold off until her antibiotic course was continued. Her electrolytes were repleted aggresively to keep K>4.0, Mg>2.0. TTE completed [**2106-4-6**] showing EF>55%, 1+ MR, otherwise preserved biventricular systolic function, no evid of structural heart disease playing a role in VT. The patient will continue a beta blocker, metoprolol upon discharge to rehab. She is to follow up with EP as an outpatient for EPS/TW alternans/VT ablation. An appointment has been set up for her. . # Meningitis - Bacterial meningitis with Pseudomonas and Klebsiella per report, growing out of wound cx with Enterococcus growing out of broth only. ID was consulted here, and there was communication between the OSH ID attending, Dr. [**Last Name (STitle) 51919**], and our ID team. The pt was treated with Ceftazidime 2g IV q8 and Amikacin 500mg IV q12h for now, planned 21 day course (day [**7-21**]). We obtained Amikacin peak and trough labs: (directions on how to obtain accurate troughs and peaks: 30 min prior to giving dose, and 1 hour after infusing dose with goal peak 20-30, goal trough <8). Of note, there was a question here on whether there was hardware in the back after her laminectomy, as the pt underwent KUB, and curvilinear densities were seen L2-L4, which were discussed w/ Dr. [**Last Name (STitle) 363**] and felt to be the JP drains. These were removed [**2106-4-7**]. There was also an ongoing academic discussion on the true efficacy of the Ceftaz. Per Dr. [**Last Name (STitle) 51919**], the Pseudomonas (which is [**Last Name (un) 36**] to only Amikacin and Ceftaz) tested positive on Extended Spectrum Beta Lactamase test at OSH, and furthermore, the Pseudomonas was Aztreonam resistant, which are both indications the Ceftazidime is not really having much effect on the Pseudomonas. It was felt the Amikacin was responsible for her improvement, however, aminoglycosides do not penetrate CSF as well, and w/ signficant side effects, therefore not an ideal choice, however, the pt does not have many other options given the resistant Pseudomonas. The pt did not undergo repeat LP given she was doing clinically very well, with no HA, nuchal rigidity, afebrile. To obtain idea of baseline lumbar fluid collection/surgical site-- ID requesting CT lumbar spine. Pt agreed and will order (pt refused MRI). Will d/c after C-spine MRI with ID follow up in 3 weeks w/ Dr. [**Last Name (STitle) **]. Of note, after the JP drains were removed, there was minimal drainage from the JP sites seen on her bandages. Her surgical site is with minimal erythema, no drainage, sutures intact and appears to be healing well. Since the pt is on amikacin IV, which causes hearing loss, she was set for audiology eval, however, b/c of back and hip pain, was not able to tolerate being transported in wheelchair. She will need to have an audiology eval as an outpatient. She has a PICC line in the left arm for IV antibiotics, and will complete 15 more days. She continues to look clinically well, with no headache, neck stiffness, weakness, or pain. . # Seizure - Unclear if patient has a primary seizure disorder. No previous history per family. Continue management of meningitis as above. Pt could also have become hypoxic after pulseless VT/arrest and thus seized [**3-4**] hypoxia/decreased cerebral blood flow. Also in ddx: pt received demerol, which can lower seizure threshold. she was loaded with dilantin at OSH. We consulted neurology about continuing dilantin however consult stated that dilantin has not been shown to prevent seizures in meningitides, so we discontinued it. . # Post op Spine surgery - Ortho Spine at [**Hospital1 18**] with Dr. [**Last Name (STitle) 363**] was following the patient throughout her course. The surgical site appears clean, with minimal drainage, and healing well. . # Type 2 DM - Her blood sugars were well controlled on glipizide ER 20mg po qAM, and an ISS. She is tolerating po well. . # HTN - well controlled: - incr metoprolol to 37.5 mg po tid, dilt 90mg po qid, triam/HCTZ 37.5/25 po qd. - all w/ hold parameters. . # Anxiety/depression - Stable. - added back fluoxetine 40mg po qd. # [**Female First Name (un) 564**] intertrigo: The pt demonstrated marked improvement on ketoconazole 2% topically [**Hospital1 **] under her pannus and groin area. She can be transitioned to nystatin powder [**Hospital1 **] at rehab. . #FEN: diabetic/cardiac diet. . #Prophy: SC heparin, Protonix at home . #Access: PICC line placed in left arm . #Comm: Daughter [**Name (NI) 2270**] [**Name (NI) **] (HCP) H [**Telephone/Fax (1) 66184**]; Cell [**Telephone/Fax (1) 66185**]. . #Code: Full Medications on Admission: levothyroixine glipizide digoxin cartia pravachol propranolol colace amitriptyline senokot. Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*100 Tablet(s)* Refills:*3* 2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 3. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Pramoxine-Mineral Oil-Zinc 1-12.5 % Ointment Sig: One (1) Appl Rectal TID (3 times a day). Disp:*qs 1 tube* Refills:*2* 5. Diltiazem HCl 30 mg Tablet Sig: Three (3) Tablet PO QID (4 times a day). Disp:*360 Tablet(s)* Refills:*2* 6. Trazodone 50 mg Tablet Sig: 0.25 Tablet PO HS (at bedtime) as needed. Disp:*15 Tablet(s)* Refills:*2* 7. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day). Disp:*135 Tablet(s)* Refills:*2* 8. Amikacin 500 mg IV Q12H 9. Ceftazidime 2 gm IV Q8H 10. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). Disp:*60 Capsule(s)* Refills:*2* 11. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q6H UNTIL BM DAILY (). Disp:*qs ML(s)* Refills:*2* 12. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 13. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig: One (1) puff Inhalation [**Hospital1 **] (2 times a day). Disp:*1 disk w/ device* Refills:*2* 14. Glipizide 10 mg Tab, Sust Release Osmotic Push Sig: One (1) Tab, Sust Release Osmotic Push PO DAILY (Daily). Disp:*30 Tab, Sust Release Osmotic Push(s)* Refills:*2* 15. Triamterene-Hydrochlorothiazid 37.5-25 mg Capsule Sig: One (1) Cap PO DAILY (Daily). Disp:*30 Cap(s)* Refills:*2* 16. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every 8 hours) as needed. Disp:*qs ML(s)* Refills:*2* 17. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 18. Ketoconazole 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) for 7 days. Disp:*1 largest stock tube* Refills:*0* 19. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed for pain for 14 days. Disp:*100 Tablet(s)* Refills:*0* 20. Heparin Flush PICC (100 units/ml) 2 ml IV DAILY:PRN 10 ml NS followed by 2 ml of 100 Units/ml heparin (200 units heparin) each lumen Daily and PRN. Inspect site every shift. 21. Outpatient Lab Work Please check CBC with differential, chem 10, LFTs q week. Also check Amikacin peak and trough qweek (30 minutes prior to giving amikacin dose, draw level for trough, and 1 hour after infusing amikacin, draw level for peak). Fax these results to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at Infectious Disease clinic. Her fax number is: [**Telephone/Fax (1) 1419**]. 22. antibiotic instructions You will have a minimum of 21 days on Amikacin IV and Ceftazidime IV, you are on day 6 of therapy. You will need to see Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (see appointment) in follow up for re-evaluation of how long you need to take your antibiotic. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: 1. Nosocomial Meningitis status post laminectomy, foraminectomy, possible dural tear 2. Pulseless Ventricular Tachycardia 3. history of seizure at outside hospital prior to transfer 4. Type II Diabetes Mellitus 5. Hypertension 6. Anxiety disorder 7. Major Depressive Disorder 8. history of spinal stenosis Discharge Condition: Good, stable Discharge Instructions: If you experience any worsening of your symptoms, including headache, weakness in your legs, numbness, urinary or bowel incontinence, decreased sensation in your extremities, neck stiffness, chest pain, palpititations, please report to the emergency dept. immediately. Please take all of your medications as directed. Please follow up with your physicians, information below. Followup Instructions: 1. You have a follow up appointment with your Primary Care Physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 18323**] on Friday, [**2106-4-16**], at 1:45pm. His office number is: [**Telephone/Fax (1) 18325**]. 2. You have a follow up appointment with Infectious Disease with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. Your appointment is set for [**2106-4-30**] at 10:00am at the [**Hospital Unit Name **], basement, suite J, [**Hospital1 1535**] [**Hospital Ward Name 517**]. Her office number is: [**Telephone/Fax (1) 457**] if you have any questions. 3. You will need to follow up with Cardiology/Electrophysiology for possible procedure on your heart for your abnormal rhythm. Your appointment is for Wednesday, [**2106-5-12**] at 12:30pm, in [**Hospital Ward Name 23**] 7, [**Hospital Ward Name 516**] [**Hospital1 18**], with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**]. His office number is: [**Telephone/Fax (1) 902**]. 4. Repeat CT L-spine w/ contrast on Monday, [**4-12**] at 8:00 AM. Go to [**Hospital Ward Name 452**] 3. No solid foods 3 hours prior. Please call [**Telephone/Fax (1) 18715**] if questions. [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**] Completed by:[**2106-4-9**]

998,320,780,599,426,250,401,300,V101,112

{'Other postoperative infection,Meningitis due to gram-negative bacteria, not elsewhere classified,Other convulsions,Urinary tract infection, site not specified,Long QT syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anxiety state, unspecified,Personal history of malignant neoplasm of bronchus and lung,Candidiasis of skin and nails'}

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: Transfer from OSH after seizure in setting of recent spinal cord surgery and meningitis. PRESENT ILLNESS: Pt is a 78 yof with PMH Of T2DM, Spinal stenosis who was admitted to [**Hospital3 **] on [**3-16**] for elective decompression of spinal stenosis. She underwent decompressive L3, L4, L5 laminectomies and radical left L5 and S1 formainectomies. ?L4 level dural perforation, reporedly no spillage of csf in notes. She had serosanguineous drainage from surgical wound. Pt febrile to 101.5 postop day 1 she had received peri op oxicillin. She was transfereed to TCU for rehab. On [**3-21**] pt noted to have increased confusion and per family had visual hallucinations. This was attributed to discontinuation of cymbalta. Cymbalta was restarted and her symptoms improved. She had a urine culture sent which grew Pseudomonas ([**Last Name (un) 36**] to zosyn, ceftz and amikcin). Head CT at the time unremarkable. She continued to have drainage from back. [**3-26**] area noted to be erythematous and pt was febrile. On [**4-1**] she underwent exploration in OR where 2 JP drains were placed. Wound culture grew, Pseudomonas, Klebsiella and Enteroccus. CSF analysis done in [**3-30**] showed 5950 wbc (71P, 8L, 21M) 3 RBC, glucose 22, (protein not reported). Pt was started on Ceftaz, Amikacin and Ampicillin at OSH. . Earlier day of admission pt was complaining of back pain. She received demerol around 2:15pm and another dose 5:15pm per family. 5 [**Name (NI) **] pt noted to be choking followed by jerking motions of upper ext. Unknown lower extremities movement. no incontinence. Also at this time pt noted to have a wide complex tachycardia. Pt soon bacame pulseless and and was shocked X 1 with 200J and became responsive thereafter. Episode lasted 5 [**Name (NI) **]. After discussion with family pt was transferred to [**Hospital1 18**]. MEDICAL HISTORY: Lung cancer resected 15 years ago spinal stenosis pancreatitis hypertension anxiety depression reflux hypothyroid diabetes type 2 s/p appendectomy s/p hysterectomy r hip replacement MEDICATION ON ADMISSION: levothyroixine glipizide digoxin cartia pravachol propranolol colace amitriptyline senokot. ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T 96.7 BP 122/50 HR 52 RR 19 O2sat 100% 3LNC. GEN: Elderly female lying in bed in nad. Drowsy but easily arousable able to cooperate with exam. HEENT: PERRL, MMM, EOMI Chest: CTAB, no crackles CVR: RRR, nl s1, s2, no r/m/g Abdomen: soft, nt, nd, obese Ext: no edema, 1+dp/pt pulses. Back: Incision site with staples intact, some erythema around the site no warmth. 2 JP drains in place. Neuro: CN II-XII intact. [**6-4**] UE and LE strength. sensation intact to light touch thruout. 2+ patellar reflex. . PE on call out from MICU: Vitals: Tm: 98.6 Tc: 98.6 BP: 148/79 P: 80s RR: 16 O2sat: 100% 2L NC I/O: 1480/405 +1.07. General: 78 y/o CF in NAD. Pleasant, cooperative, joking with staff. AOX3. HEENT: PERRL, MMM. OP clear. Lungs: CTAB CV: RRR S1 and S2 audible w/o M/R/G Abd: obese, Soft, NT, ND. NABS, No masses, No HSM. + [**Female First Name (un) **] intertrigo in skin folds under pannus. 2 JP drains in place in the back ~5 cc serosanguinous drainage in each. Incision sites appear clean. Peripheral: 2+ edema, ext wwp, moving all extremities, no focal neuro deficits. No clonus. FAMILY HISTORY: FH: unknown. SOCIAL HISTORY: SH: retired foremrly worked in highschool cafeteria serving food. former smoker, no etoh. ### Response: {'Other postoperative infection,Meningitis due to gram-negative bacteria, not elsewhere classified,Other convulsions,Urinary tract infection, site not specified,Long QT syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anxiety state, unspecified,Personal history of malignant neoplasm of bronchus and lung,Candidiasis of skin and nails'}

CHIEF COMPLAINT: Jaundice PRESENT ILLNESS: This is a 58 y/o M with recently diagnosed alcoholic cirrhosis who is being called out of the ICU where he was admitted overnight for monitoring post-ERCP. . Initially transferred from [**Hospital6 **] on [**2-24**] for diagnosis of obstructive jaundice with radiographic evidence of dilated intra-hepatic duct on the left lobe of liver. Presented with several days of fatigue, lethargy and ?ruq pain. At OSH, noted to be hypotensive to 80's with leukocytosis to 22K and elevated bilirubin to 23. Abdominal u/s demonstrated evidence of perihepatic/perisplenic ascites, ?cirrhosis and focal biliary ductal dilation on left lobe liver. MRI confirmed these findings and ERCP at OSH showed suggestion of polyp at bifurcation of CHD. . Transferred to [**Hospital1 18**] for further evaluation via repeat ERCP but procedure limited by bowel wall edema and unable to cannulate ampulla. Hemodymically stable in procedure and PACU but transferred to MICU for further montioring. In MICU overnight, blood pressure low/stable in 90's with prn NS boluses. Maintaining urine output at 30cc per hour. Mentating but with mild encephalopathy. lactate 1.4. OSH demonstrated GPC in blood cx. Blood, urine cultures repeated here. In addition CXR was performed which demonstrated ?infiltrate. . He underwent repeat ultrasound on [**2-25**] which did not show intra or extra hepatic ductal dilatation. A 1.7 cm hypoechoic lesion was seen in the central portion of the liver which was thought to possibly represent hepatoma. Of note there was normal hepatopedal flow and non-distended sludge was visualized in gallbladder. Initial discussion in regards to percutaneous decompression of dilated duct, however hepatology was consulted and recommeded holding off on this procedure. Felt that findings most consistent with acute on chronic ETOH cirrhosis. Recommend continued work-up for underlying infection and MRCP/repeat ERCP for further evaluation. (See consult note for formal recommendations). . Given hemodynamic stability overnight, called out to floor ([**Hospital Ward Name 121**] 10) on [**2121-2-25**]. MEDICAL HISTORY: No major medical history prior to this hospitalization, was not taking any medications. 1. ? Hilar tumor on abdominal ct 2. Obstructive jaundice 3. Alcoholism 4. Cirrhosis as per hpi 5. Anemia at osh MEDICATION ON ADMISSION: Was not taking any medications prior to hospitalization. Meds on Transfer: Levaquin 500mg IV q24 Flagyl 500mg IV q8 Vanco 1g IV q12 Midodrine 5 mg po TID Vit K 5mg SC x 3 days folic acid valium CIWA scale ALLERGIES: Penicillins PHYSICAL EXAM: vitals- T 96.4, L arm 96/52, R arm 82/38, P 94, R 16, 100% on RA gen- Sleepy but arousable, cachectic. heent- Icteric sclerae, jaundice, OP clear pulm- CTA bilaterally CV- RRR, nl S1, S2, no extra sounds ABD- Distended, soft, NT, ND ext- trace pedal edema neuro- A&O x 4, no asterixis FAMILY HISTORY: - Divorced, used to be truck driver until 6mos ago. - smokes 1 ppd x years, [**1-3**] vodka tonics/day since age 23 (no EtOH x 2 weeks), no IVDU, lives alone SOCIAL HISTORY: Maternal grandmother with gastric Ca.

Alcoholic cirrhosis of liver,Acute and subacute necrosis of liver,Hematemesis,Other and unspecified alcohol dependence, unspecified,Hyposmolality and/or hyponatremia,Acquired coagulation factor deficiency,Thrombocytopenia, unspecified,Bacteremia,Acute kidney failure, unspecified,Cholangitis,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other specified disorders of stomach and duodenum,Diaphragmatic hernia without mention of obstruction or gangrene,Tobacco use disorder,Folate-deficiency anemia,Other disorders of plasma protein metabolism

Alcohol cirrhosis liver,Acute necrosis of liver,Hematemesis,Alcoh dep NEC/NOS-unspec,Hyposmolality,Acq coagul factor defic,Thrombocytopenia NOS,Bacteremia,Acute kidney failure NOS,Cholangitis,Esoph varice oth dis NOS,Gastroduodenal dis NEC,Diaphragmatic hernia,Tobacco use disorder,Folate-deficiency anemia,Dis plas protein met NEC

Admission Date: [**2121-2-24**] Discharge Date: [**2121-3-15**] Date of Birth: [**2062-10-3**] Sex: M Service: MEDICINE Allergies: Penicillins Attending:[**Known firstname 1055**] Chief Complaint: Jaundice Major Surgical or Invasive Procedure: Paracentesis [**2-27**], [**3-2**] Left subclavian central venous line [**2-27**] History of Present Illness: This is a 58 y/o M with recently diagnosed alcoholic cirrhosis who is being called out of the ICU where he was admitted overnight for monitoring post-ERCP. . Initially transferred from [**Hospital6 **] on [**2-24**] for diagnosis of obstructive jaundice with radiographic evidence of dilated intra-hepatic duct on the left lobe of liver. Presented with several days of fatigue, lethargy and ?ruq pain. At OSH, noted to be hypotensive to 80's with leukocytosis to 22K and elevated bilirubin to 23. Abdominal u/s demonstrated evidence of perihepatic/perisplenic ascites, ?cirrhosis and focal biliary ductal dilation on left lobe liver. MRI confirmed these findings and ERCP at OSH showed suggestion of polyp at bifurcation of CHD. . Transferred to [**Hospital1 18**] for further evaluation via repeat ERCP but procedure limited by bowel wall edema and unable to cannulate ampulla. Hemodymically stable in procedure and PACU but transferred to MICU for further montioring. In MICU overnight, blood pressure low/stable in 90's with prn NS boluses. Maintaining urine output at 30cc per hour. Mentating but with mild encephalopathy. lactate 1.4. OSH demonstrated GPC in blood cx. Blood, urine cultures repeated here. In addition CXR was performed which demonstrated ?infiltrate. . He underwent repeat ultrasound on [**2-25**] which did not show intra or extra hepatic ductal dilatation. A 1.7 cm hypoechoic lesion was seen in the central portion of the liver which was thought to possibly represent hepatoma. Of note there was normal hepatopedal flow and non-distended sludge was visualized in gallbladder. Initial discussion in regards to percutaneous decompression of dilated duct, however hepatology was consulted and recommeded holding off on this procedure. Felt that findings most consistent with acute on chronic ETOH cirrhosis. Recommend continued work-up for underlying infection and MRCP/repeat ERCP for further evaluation. (See consult note for formal recommendations). . Given hemodynamic stability overnight, called out to floor ([**Hospital Ward Name 121**] 10) on [**2121-2-25**]. Past Medical History: No major medical history prior to this hospitalization, was not taking any medications. 1. ? Hilar tumor on abdominal ct 2. Obstructive jaundice 3. Alcoholism 4. Cirrhosis as per hpi 5. Anemia at osh Social History: Maternal grandmother with gastric Ca. Family History: - Divorced, used to be truck driver until 6mos ago. - smokes 1 ppd x years, [**1-3**] vodka tonics/day since age 23 (no EtOH x 2 weeks), no IVDU, lives alone Physical Exam: vitals- T 96.4, L arm 96/52, R arm 82/38, P 94, R 16, 100% on RA gen- Sleepy but arousable, cachectic. heent- Icteric sclerae, jaundice, OP clear pulm- CTA bilaterally CV- RRR, nl S1, S2, no extra sounds ABD- Distended, soft, NT, ND ext- trace pedal edema neuro- A&O x 4, no asterixis Pertinent Results: Labs: Admission labs: wbc 32.2, hct 27.6 (mcv 108), plt 206 na 133, k 5.3, cl 105, hco3 16, bun 38, cr 0.9 alt 107, ast 250, alk phos 295, LDH 266, t bili 24.5 Hepatitis serologies: negative. AFP: <1.0. CA [**33**]/9: HIV: negative. [**Doctor First Name **]: negative. AMA: positive at 1:160. Microbiology: [**2-24**] Blood cultures at OSH - 2/4 bottles (one from each set) positive for coag. negative staph aureus, resistant to oxacillin, sensitive to vancomycin. [**2-25**], 29 Blood cultures: pending. [**2-25**] Urine culture: negative. [**2-26**], [**2-28**], [**3-1**] Stool: c. difficile negative. . [**2-25**] Paracentecis: WBC RBC Polys Lymphs Monos Eos Basos Mesothe Macroph 39 572 47 27 0 1 1 6 18 . Studies at [**Hospital1 18**]: [**2-25**] RUQ Liver U/S: FINDINGS: The liver has a nodular surface contour in keeping with underlying cirrhotic change. In the central portion of the right lobe of liver, there is an ovoid hypoechoic nodular lesion measuring up to 1.7 cm in size. Some vascular flow demonstrated along its anterior aspect on color Doppler assessment. This lesion could represent a small hepatoma and as such, further evaluation with MRI of the liver is advised. Normal hepatopetal direction of flow is demonstrated in the right portal vein. Normal venous flow demonstrated in the middle hepatic vein. Assessment of the left lobe of liver and main portal vein was difficult due to the presence of a larger amout of intra-abdominal ascites. An ink mark was placed over the largest depth of ascites in the right lower quadrant to facilitate any planned paracentesis. Non-distended sludge containing gallbladder. No intra- or extra-hepatic biliary dilatation. . CONCLUSION: 1. Cirrhotic liver. 2. A 1.7-cm hypoechoic nodule in the central portion of the right lobe, could represent a small hepatoma. Further evaluation with MRI of the liver advised. 3. Large amount of intra-abdominal ascites (ink mark placed over the largest area in the right lower quadrant. Preferably paracentesis should be performed prior to any liver MRI). . [**2-25**] CXR: Lung volumes are low. Consolidation at the medial aspect of the left lung base could be pneumonia. Configuration of the diaphragmatic pleural contour suggests small bilateral pleural effusions. Opacified structure in the right upper abdominal quadrant looks more like a gallbladder than kidney. If the patient has not received any contrast agents, this finding suggests biliary obstruction. . [**2-24**] ERCP: 1. Portal hypertensive gastropathy was present. Scant coffee grounds were present. 2. The bowel wall was edematous. 3. The ampulla was extremely edematous. The papilla was intermittently visualized behind collapsing mucosal folds, but cannulation was not successful due to this limitation. . [**3-3**] MRCP: 1. Extensive peribiliary cysts within the hepatic hilum and left hepatic lobe greater than the right. Mild-moderate peripheral left hepatic biliary ductal dilatation suggests a compressive effect of the cysts on the drainage of left biliary system. Right biliary system does not show dilation. 2. Narrow common hepatic duct near its origin with lack of visualization of the confluence from the right and left hepatic ducts. This is likely from compression by peribiliary cysts. No filling defects within the common hepatic duct or common bile duct evident, though the common hepatic duct is not completely visualized. 3. Cirrhosis and portal hypertension without evidence of HCC. 4. Splenic infarcts. . [**3-5**] EGD: 1. Medium hiatal hernia. Linear erosion in hernia sac. 2. Mosaic appearance in the antrum and stomach body compatible with portal gastropathy. 3. Erythema in the gastroesophageal junction. 4. Varices at the gastroesophageal junction and lower third of the esophagus. 5. Otherwise normal egd to second part of the duodenum. . [**3-7**] ERCP: 1. Grade I esophageal varices were seen. A small hiatal hernia was noted. 2. Changes of portal hypertensive gastropathy were seen involving the stomach. 3. Duodenal bulb erosions were seen. 4. Cannulation of the pancreatic duct was performed with a sphincterotome using a free-hand technique. Contrast medium was injected resulting in partial opacification of the distal PD. Limited pancreatogram revealed a normal distal pancreatic duct. 5. Selective cannulation of the biliary duct was difficult with a sphincterotome. Therefore, a pre-cut sphincterotomy was performed with a needle knife to gain access to the bile duct. 6. Cholangiogram revealed a dilated bile duct with extrinsic compression at the hilum. The left intrahepatic duct filled with contrast preferentially and appeared mildly dilated. 7. A 10 Fr 12 cm Cotton [**Doctor Last Name **] biliary stent was placed successfully across the hilum into the left hepatic duct and bile was seen draining into the duodenum. Brief Hospital Course: Mr. [**Known lastname 31966**] is a 58 y/o M with recently diagnosed alcoholic cirrhosis, w/?obstructive jaundice, who was transferred from [**Hospital6 33**] to [**Hospital1 18**]. . # Leukocytosis: His white blood cell count was initially elevated near 30,000. Although he did not have a fever or focal signs, he did have positive blood cultures from [**Hospital6 33**] (coagulase negative staph in [**1-4**] bottles - one from each set). Surveillance blood cultures were negative at [**Hospital1 18**]. Urine cultures and stool tests for c. difficile were negative as well. A diagnostic paracentecis was done at [**Hospital1 18**] which was negative but was performed while he was already on antibiotics. Initially he was broadly covered with vancomycin, levofloxacin, and flagyl. As his white count began to come down and his cultures remained negative, vancomycin was discontinued and he was continued on levofloxacin and flagyl. . # Cirrhosis: This was thought most likely due to EtOH given his history of heavy EtOH use. Hepatitis serologies were negative as were [**First Name8 (NamePattern2) **] [**Doctor First Name **] and HIV test. An AMA was positive at 1:160. He was treated supportively with nutrition, folate, MVI, and vitamin K and multiple therapeutic paracenteces for dyspnea. Complications included hematemesis which an associated fall in hematocrit. An EGD showed no active site of bleeding but did show grade 2 varices, portal gastropathy, and linear erosions. He also had a persistently elevated bilirubin. An MRCP revealed multiple peribiliary cysts some of which were extrinsically compressing the biliary system. An ERCP was performed and a stent was placed into the left hepatic duct. Following this his bilirubin remained elevated and at discharge was around 40. . # Hypotension: He was initially hypotensive to the 70s and required to be in the MICU for one night following his ERCP. His blood pressure stabilized into the mid 90s and he was called out to the floor. The differential for his hypotension included hypoalbuminemia due to his cirrhosis vs. sepsis due to his staph bacteremia. He had persistent hypotension with systolics in the 70s to 90s but he had good mentation through this and this was thought to be due to his underlying liver disease. He was supported with intermittent albumin. . # Heme: He had a baseline macrocytic anemia due to his alcoholism. He also had a few episodes of hematemesis and an EGD showed grade 2 varices, portal gastropathy, and linear erosions but no active site of bleeding. He required intermittent support with red blood cell transfusions. He also had thrombocytopenia thought secondary to his liver disease and alcoholism and he required intermittent platelet transfusions. . # Hyponatremia: This was thought to be secondary to his cirrhosis and he was fluid restricted. . # Non-gap metabolic acidosis: This was thought most likely due to diarrhea as his renal function was normal. . # Dispo: After several weeks of supportive treatment, he felt subjectively about the same but, given the severity of his disease and his poor prognosis, he wished to orient his care towards comfort measures. At this point non-essential medications were stopped and he was treated supportively with pain medications and anti-emetics as needed. On [**3-14**] he passed away. Medications on Admission: Was not taking any medications prior to hospitalization. Meds on Transfer: Levaquin 500mg IV q24 Flagyl 500mg IV q8 Vanco 1g IV q12 Midodrine 5 mg po TID Vit K 5mg SC x 3 days folic acid valium CIWA scale Discharge Medications: N/A Discharge Disposition: Extended Care Discharge Diagnosis: 1. Alcoholic hepatitis/cirrhosis. Discharge Condition: expired. Discharge Instructions: N/A Followup Instructions: N/A Completed by:[**2121-3-16**]

571,570,578,303,276,286,287,790,584,576,456,537,553,305,281,273

{'Alcoholic cirrhosis of liver,Acute and subacute necrosis of liver,Hematemesis,Other and unspecified alcohol dependence, unspecified,Hyposmolality and/or hyponatremia,Acquired coagulation factor deficiency,Thrombocytopenia, unspecified,Bacteremia,Acute kidney failure, unspecified,Cholangitis,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other specified disorders of stomach and duodenum,Diaphragmatic hernia without mention of obstruction or gangrene,Tobacco use disorder,Folate-deficiency anemia,Other disorders of plasma protein metabolism'}

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: Jaundice PRESENT ILLNESS: This is a 58 y/o M with recently diagnosed alcoholic cirrhosis who is being called out of the ICU where he was admitted overnight for monitoring post-ERCP. . Initially transferred from [**Hospital6 **] on [**2-24**] for diagnosis of obstructive jaundice with radiographic evidence of dilated intra-hepatic duct on the left lobe of liver. Presented with several days of fatigue, lethargy and ?ruq pain. At OSH, noted to be hypotensive to 80's with leukocytosis to 22K and elevated bilirubin to 23. Abdominal u/s demonstrated evidence of perihepatic/perisplenic ascites, ?cirrhosis and focal biliary ductal dilation on left lobe liver. MRI confirmed these findings and ERCP at OSH showed suggestion of polyp at bifurcation of CHD. . Transferred to [**Hospital1 18**] for further evaluation via repeat ERCP but procedure limited by bowel wall edema and unable to cannulate ampulla. Hemodymically stable in procedure and PACU but transferred to MICU for further montioring. In MICU overnight, blood pressure low/stable in 90's with prn NS boluses. Maintaining urine output at 30cc per hour. Mentating but with mild encephalopathy. lactate 1.4. OSH demonstrated GPC in blood cx. Blood, urine cultures repeated here. In addition CXR was performed which demonstrated ?infiltrate. . He underwent repeat ultrasound on [**2-25**] which did not show intra or extra hepatic ductal dilatation. A 1.7 cm hypoechoic lesion was seen in the central portion of the liver which was thought to possibly represent hepatoma. Of note there was normal hepatopedal flow and non-distended sludge was visualized in gallbladder. Initial discussion in regards to percutaneous decompression of dilated duct, however hepatology was consulted and recommeded holding off on this procedure. Felt that findings most consistent with acute on chronic ETOH cirrhosis. Recommend continued work-up for underlying infection and MRCP/repeat ERCP for further evaluation. (See consult note for formal recommendations). . Given hemodynamic stability overnight, called out to floor ([**Hospital Ward Name 121**] 10) on [**2121-2-25**]. MEDICAL HISTORY: No major medical history prior to this hospitalization, was not taking any medications. 1. ? Hilar tumor on abdominal ct 2. Obstructive jaundice 3. Alcoholism 4. Cirrhosis as per hpi 5. Anemia at osh MEDICATION ON ADMISSION: Was not taking any medications prior to hospitalization. Meds on Transfer: Levaquin 500mg IV q24 Flagyl 500mg IV q8 Vanco 1g IV q12 Midodrine 5 mg po TID Vit K 5mg SC x 3 days folic acid valium CIWA scale ALLERGIES: Penicillins PHYSICAL EXAM: vitals- T 96.4, L arm 96/52, R arm 82/38, P 94, R 16, 100% on RA gen- Sleepy but arousable, cachectic. heent- Icteric sclerae, jaundice, OP clear pulm- CTA bilaterally CV- RRR, nl S1, S2, no extra sounds ABD- Distended, soft, NT, ND ext- trace pedal edema neuro- A&O x 4, no asterixis FAMILY HISTORY: - Divorced, used to be truck driver until 6mos ago. - smokes 1 ppd x years, [**1-3**] vodka tonics/day since age 23 (no EtOH x 2 weeks), no IVDU, lives alone SOCIAL HISTORY: Maternal grandmother with gastric Ca. ### Response: {'Alcoholic cirrhosis of liver,Acute and subacute necrosis of liver,Hematemesis,Other and unspecified alcohol dependence, unspecified,Hyposmolality and/or hyponatremia,Acquired coagulation factor deficiency,Thrombocytopenia, unspecified,Bacteremia,Acute kidney failure, unspecified,Cholangitis,Esophageal varices in diseases classified elsewhere, without mention of bleeding,Other specified disorders of stomach and duodenum,Diaphragmatic hernia without mention of obstruction or gangrene,Tobacco use disorder,Folate-deficiency anemia,Other disorders of plasma protein metabolism'}

CHIEF COMPLAINT: Shortness of breath and Diaphoresis PRESENT ILLNESS: 47 yo F with h/o cardiomyapathy, schizoaffective disorder, bipolar disorder, hypertension who was brought in by ambulance. She complained of 2 hours of SOB and diaphoresis. EMS gave her nitro Slx3, lasix and ASA. She had rales [**1-27**] way up, satting 80's on NRB, and hypotensive initially. VS were 74/42, HR 134, T 101.8, RR 40. ECG showed sinus tachycardia, vent bigeminy, STE in V1-V4, STD with TWI in v5-v6. MEDICAL HISTORY: . Hypertension, poorly controlled. 2. Hypertrophic cardiomyopathy. 3. Left heart failure with a BNP of 4900 and EF of 50%. 4. Diabetes mellitus, type 2 uncontrolled with an A1c of 8.1. 5. Morbid obesity. 6. Iron deficiency anemia. 7. Epigastric pain, now resolved. 8. Schizo-affective disorder 9. CKD MEDICATION ON ADMISSION: Nifedipine 60 mg tablets sustained release once a day Aspirin 81 mg once a day Lasix 20 mg once a day Lisinopril 10 mg once a day Glyburide 5 mg once a day Ferrous sulfate 325 mg twice a day Colace 100 mg twice a day Geodon 100 mg [**Hospital1 **] (80 QAM, 20 QHS) Depakote 500 mg [**Hospital1 **] Haldol 100 mg IM Q3 weeks ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 101.8, 88, 175/96, 25 on vent AC 500x18, PEEP 5, 100% GENL: sedated, obese, unkempt HEENT: JVP unable to be assessed given body habitus CV: RRR no MRG Lungs: Rales [**1-27**] way up Abd: obese, soft, nontender, +BS Ext: no edema, 2+ pedal pulses FAMILY HISTORY: no early cardiac deaths, diabetes mellitus, or hyperlipidemia SOCIAL HISTORY: smokes free tobacco, drinks occasionally, remote marijuana use. Lives in group living arrangement.

Acute respiratory failure,Congestive heart failure, unspecified,Schizoaffective disorder, unspecified,Other primary cardiomyopathies,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Morbid obesity

Acute respiratry failure,CHF NOS,Schizoaffective dis NOS,Prim cardiomyopathy NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Iron defic anemia NOS,Hx of past noncompliance,Morbid obesity

Admission Date: [**2189-10-11**] Discharge Date: [**2189-10-14**] Date of Birth: [**2142-5-5**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2704**] Chief Complaint: Shortness of breath and Diaphoresis Major Surgical or Invasive Procedure: Intubation History of Present Illness: 47 yo F with h/o cardiomyapathy, schizoaffective disorder, bipolar disorder, hypertension who was brought in by ambulance. She complained of 2 hours of SOB and diaphoresis. EMS gave her nitro Slx3, lasix and ASA. She had rales [**1-27**] way up, satting 80's on NRB, and hypotensive initially. VS were 74/42, HR 134, T 101.8, RR 40. ECG showed sinus tachycardia, vent bigeminy, STE in V1-V4, STD with TWI in v5-v6. She was intubated in the ED. Tox screen was negative. Labs notable for slightly elevated WBC 11., HCO3 20, creat 1.4 (bl 1.1), CK 172, MB 4, Trop 0.02, lact 5.6. After intubation she became hypertensive with SBP>200. She was given ASA, started on nitro gtt and BPs were in 170's/90's. She was guaiac positive. Past Medical History: . Hypertension, poorly controlled. 2. Hypertrophic cardiomyopathy. 3. Left heart failure with a BNP of 4900 and EF of 50%. 4. Diabetes mellitus, type 2 uncontrolled with an A1c of 8.1. 5. Morbid obesity. 6. Iron deficiency anemia. 7. Epigastric pain, now resolved. 8. Schizo-affective disorder 9. CKD Social History: smokes free tobacco, drinks occasionally, remote marijuana use. Lives in group living arrangement. Family History: no early cardiac deaths, diabetes mellitus, or hyperlipidemia Physical Exam: 101.8, 88, 175/96, 25 on vent AC 500x18, PEEP 5, 100% GENL: sedated, obese, unkempt HEENT: JVP unable to be assessed given body habitus CV: RRR no MRG Lungs: Rales [**1-27**] way up Abd: obese, soft, nontender, +BS Ext: no edema, 2+ pedal pulses Pertinent Results: [**2189-10-10**] 10:53PM PLT COUNT-378 [**2189-10-10**] 10:53PM PT-12.6 PTT-24.6 INR(PT)-1.1 [**2189-10-10**] 10:53PM NEUTS-60.8 LYMPHS-32.9 MONOS-3.4 EOS-2.1 BASOS-0.7 [**2189-10-10**] 10:53PM WBC-11.8* RBC-4.72 HGB-11.6* HCT-36.7 MCV-78* MCH-24.6* MCHC-31.6 RDW-20.7* [**2189-10-10**] 10:53PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2189-10-10**] 10:53PM DIGOXIN-0.2* [**2189-10-10**] 10:53PM HCG-<5 [**2189-10-10**] 10:53PM CK-MB-4 cTropnT-0.02* proBNP-4139* [**2189-10-10**] 10:53PM LIPASE-21 [**2189-10-10**] 10:53PM ALT(SGPT)-14 AST(SGOT)-40 CK(CPK)-172* ALK PHOS-86 AMYLASE-51 TOT BILI-0.5 [**2189-10-10**] 10:53PM GLUCOSE-292* UREA N-13 CREAT-1.4* SODIUM-134 POTASSIUM-4.4 CHLORIDE-98 TOTAL CO2-20* ANION GAP-20 [**2189-10-10**] 11:04PM LACTATE-5.6* [**2189-10-11**] 12:35AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-100 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2189-10-11**] 12:35AM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.005 [**2189-10-11**] 12:35AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2189-10-11**] 12:35AM URINE HOURS-RANDOM [**2189-10-11**] 02:38AM LACTATE-1.1 K+-3.2* [**2189-10-11**] 02:38AM TYPE-ART PO2-278* PCO2-41 PH-7.41 TOTAL CO2-27 BASE XS-1 [**2189-10-11**] 03:31AM PLT COUNT-307 [**2189-10-11**] 03:31AM CALCIUM-8.8 PHOSPHATE-4.4 MAGNESIUM-1.7 [**2189-10-11**] 03:31AM CK-MB-10 MB INDX-5.8 cTropnT-0.31* [**2189-10-11**] 03:31AM CK(CPK)-173* [**2189-10-11**] 03:31AM GLUCOSE-235* UREA N-14 CREAT-1.3* SODIUM-137 POTASSIUM-3.5 CHLORIDE-99 TOTAL CO2-26 ANION GAP-16 [**2189-10-11**] 03:31AM GLUCOSE-235* UREA N-14 CREAT-1.3* SODIUM-137 POTASSIUM-3.5 CHLORIDE-99 TOTAL CO2-26 ANION GAP-16 [**2189-10-11**] 05:50AM HGB-10.0* calcHCT-30 [**2189-10-11**] 05:50AM K+-3.6 [**2189-10-11**] 05:50AM TYPE-ART PO2-109* PCO2-48* PH-7.37 TOTAL CO2-29 BASE XS-1 [**2189-10-11**] 09:34AM PT-13.7* PTT-31.1 INR(PT)-1.2* [**2189-10-11**] 09:34AM PLT COUNT-294 [**2189-10-11**] 09:34AM CK-MB-9 cTropnT-0.18* [**2189-10-11**] 09:34AM CK(CPK)-223* [**2189-10-11**] 10:58AM TYPE-ART PO2-161* PCO2-44 PH-7.37 TOTAL CO2-26 BASE XS-0 [**2189-10-11**] 05:30PM HCT-28.6* [**2189-10-11**] 05:30PM CK-MB-7 [**2189-10-11**] 05:30PM CK(CPK)-278* [**2189-10-11**] 05:30PM POTASSIUM-3.7 [**2189-10-11**] 05:40PM TYPE-ART PO2-86 PCO2-45 PH-7.40 TOTAL CO2-29 BASE XS-1 . P MIBI [**7-/2189**]: No anginal symptoms or ECG changes from baseline. Fixed perfusion defects predominantly involving the inferior and inferolateral walls. No evidence of reversible perfusion defect. Mild LV hypokinesis, including likely akinesis of the basal inferior wall, with a moderately depressed EF of 37%. . Echo [**7-/2189**] Prominent symmetric LVH (septum 1.7 cm) with mild global hypokinesis c/w diffuse process. Moderate MR. [**First Name (Titles) **] [**Last Name (Titles) 16631**] hypertension. Mild aortic regurgitation. No valvular [**Male First Name (un) **] or resting LVOT gradient is identified. Findings are suggestive of a primary cardiomyopathy (HCM) or possibly an infiltrative process. . Bedside echo: no focal wall motion [**Last Name (LF) 16632**], [**First Name3 (LF) **] about 45%. Brief Hospital Course: A/P: 47 yo F with h/o HTN, schizoaffective disorder, cardiomyopathy who presented with SOB, diaphoresis, hypotension, respiratory distress and was subsequently intubated. The following issues were investigated during this hospitalization: . CARDIAC #Ischemia: Presenting symptoms were not likely due to ischemia as CKs were flat and the Troponin elevation was minimal. However, because the patient has CAD risk factors (HTN, DM), she was maintained on her outpatient cardio-protective meds (ASA, and Ace inhibitor) and a low dose statin was added. . # Pump: Pt. has a history of diastolic heart failure and can thus benefit from beta blockade with resultant increased filling time. She was started on Labetalol as an in-patient to control both her hypertension and her heart rate. However, in an effort to encourage medication compliance given the patient's history of non-compliance, Labetalol was switched to QD Atenolol. . # Rhythm: Pt had atrial bigeminy on admission, but shortly thereafter converted to normal sinus rhythm without further incident. . # HTN: Pt. has poorly controlled HTN as an outpatient (200/100 daily, per caseworker) with known medication non-compliance. No renal artery stenosis by imaging. During this hospitalization, her goal SBP was 150-160, achieved with Labetalol gtt and Labetalol PO. She was even found to sustain SBPs in the 130s. The patient tolerated this lower BP well and was discharged on a QD regimen of BP meds for better compliance. . # SOB: Likely flash pulmonary edema secondary to hypertensive crisis on admission. Pt was intubated in the ED and extubated the following day in the CCU without incident and continued to saturate well on room air. . # Psych: Pt. has a history of schizoaffective disorder. She did not give permission for her psych history to be disclosed so she was only maintained on her outpatient regimen of Geodon and Depakote with no other intervention. She also receives 100 mg IM of Haldol every 3 weeks and received her scheduled injection on discharge. . # Decreased UOP: Patient had a brief period of decreased urinary output during the hospitalization, approximating 10-15ccs/hr. Her creatinine also increased. She received a fluid bolus and her I&Os were monitored with a goal of even fluid status. Eventually, she began to autodiurese and her creatinine trended downward. She was discharged on her outpatient dose of Lasix. . # DM: Patient was maintained on a RISS. . # Anemia: Pt. has a history of iron deficiency anemia and takes iron as an outpatient. She was found to be guaiac positive on NGL and rectally. Her Hct was at baseline during the hospitalization. She was started on Pantoprazole [**Hospital1 **] and continued on iron. Pt. will need a colonoscopy as an outpatient. . # Comm: [**Name (NI) **] [**Name2 (NI) 16633**]: [**First Name8 (NamePattern2) **] [**Name (NI) 16634**] - [**Telephone/Fax (1) 16635**], cell-[**Telephone/Fax (1) 16636**] (9 AM - 5 PM). Medications on Admission: Nifedipine 60 mg tablets sustained release once a day Aspirin 81 mg once a day Lasix 20 mg once a day Lisinopril 10 mg once a day Glyburide 5 mg once a day Ferrous sulfate 325 mg twice a day Colace 100 mg twice a day Geodon 100 mg [**Hospital1 **] (80 QAM, 20 QHS) Depakote 500 mg [**Hospital1 **] Haldol 100 mg IM Q3 weeks Discharge Medications: 1. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 2. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 5. Divalproex 250 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO BID (2 times a day). Disp:*120 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Ziprasidone HCl 80 mg Capsule Sig: One (1) Capsule PO QAM (once a day (in the morning)). Disp:*30 Capsule(s)* Refills:*2* 7. Ziprasidone HCl 20 mg Capsule Sig: One (1) Capsule PO QHS (once a day (at bedtime)). Disp:*30 Capsule(s)* Refills:*2* 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 9. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 10. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 11. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 12. Furosemide 20 mg Tablet Sig: One (1) Tablet PO ONCE (Once). Disp:*30 Tablet(s)* Refills:*2* 13. Glyburide 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Hypertensive emergency with pulmonary flash edema Discharge Condition: Stable, afebrile, saturating well on room-air. Discharge Instructions: 1. Please take all medications as directed. 2. Please keep all follow-up appointments 3. Call your doctor or go to the ER for any of the following: Chest pain, shortness of breath, fevers, chills or any other concerning symptoms. Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2967**], [**Name12 (NameIs) 280**] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2189-10-29**] 2:10 Provider: [**First Name8 (NamePattern2) 640**] [**First Name8 (NamePattern2) 16637**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2189-11-27**] 2:00

518,428,295,425,401,250,280,V158,278

{'Acute respiratory failure,Congestive heart failure, unspecified,Schizoaffective disorder, unspecified,Other primary cardiomyopathies,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Morbid obesity'}

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 and Diaphoresis PRESENT ILLNESS: 47 yo F with h/o cardiomyapathy, schizoaffective disorder, bipolar disorder, hypertension who was brought in by ambulance. She complained of 2 hours of SOB and diaphoresis. EMS gave her nitro Slx3, lasix and ASA. She had rales [**1-27**] way up, satting 80's on NRB, and hypotensive initially. VS were 74/42, HR 134, T 101.8, RR 40. ECG showed sinus tachycardia, vent bigeminy, STE in V1-V4, STD with TWI in v5-v6. MEDICAL HISTORY: . Hypertension, poorly controlled. 2. Hypertrophic cardiomyopathy. 3. Left heart failure with a BNP of 4900 and EF of 50%. 4. Diabetes mellitus, type 2 uncontrolled with an A1c of 8.1. 5. Morbid obesity. 6. Iron deficiency anemia. 7. Epigastric pain, now resolved. 8. Schizo-affective disorder 9. CKD MEDICATION ON ADMISSION: Nifedipine 60 mg tablets sustained release once a day Aspirin 81 mg once a day Lasix 20 mg once a day Lisinopril 10 mg once a day Glyburide 5 mg once a day Ferrous sulfate 325 mg twice a day Colace 100 mg twice a day Geodon 100 mg [**Hospital1 **] (80 QAM, 20 QHS) Depakote 500 mg [**Hospital1 **] Haldol 100 mg IM Q3 weeks ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 101.8, 88, 175/96, 25 on vent AC 500x18, PEEP 5, 100% GENL: sedated, obese, unkempt HEENT: JVP unable to be assessed given body habitus CV: RRR no MRG Lungs: Rales [**1-27**] way up Abd: obese, soft, nontender, +BS Ext: no edema, 2+ pedal pulses FAMILY HISTORY: no early cardiac deaths, diabetes mellitus, or hyperlipidemia SOCIAL HISTORY: smokes free tobacco, drinks occasionally, remote marijuana use. Lives in group living arrangement. ### Response: {'Acute respiratory failure,Congestive heart failure, unspecified,Schizoaffective disorder, unspecified,Other primary cardiomyopathies,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Iron deficiency anemia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Morbid obesity'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 72-year-old female with a past medical history of coronary artery disease (status post coronary artery bypass graft in [**2162**] with a left internal mammary artery to left anterior descending artery graft, and saphenous vein graft to obtuse marginal graft, and saphenous vein graft to diagonal graft). She also has a past medical history of non-insulin-dependent diabetes mellitus, hypertension, and peripheral vascular disease. MEDICAL HISTORY: (The patient's past medical history included) 1. Coronary artery disease. 2. Hypertension. 3. Non-insulin-dependent diabetes mellitus. 4. Gout. 5. Peripheral vascular disease. 6. Osteoarthritis. 7. Reflux disease. MEDICATION ON ADMISSION: The patient's medications prior to admission included aspirin, Lopressor 50 mg p.o. b.i.d., Prilosec, ibuprofen, Lasix, K-Dur, Trental, Roccal, allopurinol. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Acute myocardial infarction of inferoposterior wall, initial episode of care,Congestive heart failure, unspecified,Ventricular fibrillation,Acute posthemorrhagic anemia,Hematoma complicating a procedure,Coronary atherosclerosis of autologous vein bypass graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

AMI inferopost, initial,CHF NOS,Ventricular fibrillation,Ac posthemorrhag anemia,Hematoma complic proc,Crn ath atlg vn bps grft,DMII wo cmp nt st uncntr

Admission Date: [**2171-8-5**] Discharge Date: [**2171-8-12**] Date of Birth: [**2099-6-25**] Sex: F Service: CCU HISTORY OF PRESENT ILLNESS: The patient is a 72-year-old female with a past medical history of coronary artery disease (status post coronary artery bypass graft in [**2162**] with a left internal mammary artery to left anterior descending artery graft, and saphenous vein graft to obtuse marginal graft, and saphenous vein graft to diagonal graft). She also has a past medical history of non-insulin-dependent diabetes mellitus, hypertension, and peripheral vascular disease. She presented to an outside hospital six hours after developing [**10-8**] substernal chest pain that radiated to her back, both arms, and neck. The patient has had occasions of similar intermittent chest pain over the last six week prior to admission; however, the episodes had remitted in the past, and on the day of admission these symptoms were recalcitrant to Maalox, Pepto, Mylanta, and rest. The patient's chest pain grew worse, and she reported to the Emergency Department at [**Hospital6 3105**] where she was found to have ST elevations in III and aVF with reciprocal depressions in aVL, V2, and V3. She had flipped T waves in V1 and V2. She was given Retavase times two with decreased chest pain from [**9-7**] to [**9-7**] to [**5-8**] to [**6-7**]. The patient was also given heparin, nitroglycerin drip, morphine, and aspirin. She was transferred to [**Hospital1 69**] for percutaneous coronary intervention due to persistent pain after lytic therapy. She was taken to the catheterization laboratory where she was found to have elevated right and left filling pressures. She had a 50% left main lesion, an left anterior descending artery with mild luminal irregularities, left circumflex to second obtuse marginal TO, right coronary artery with 40% proximal, saphenous vein graft to second obtuse marginal with a TO distally with thrombus, saphenous vein graft to second diagonal diffusely diseased with 90% stenosis distally, left internal mammary artery to left anterior descending artery with TO in the mid portion of the graft. The right iliac had a 90% calcified stenosis. The occluded second obtuse marginal was crossed with a wire and was treated with rheolytic thrombectomy followed by hepakote stent placement with zero residual stenosis with normal flow. Chest pain was completely resolved after her procedure. PAST MEDICAL HISTORY: (The patient's past medical history included) 1. Coronary artery disease. 2. Hypertension. 3. Non-insulin-dependent diabetes mellitus. 4. Gout. 5. Peripheral vascular disease. 6. Osteoarthritis. 7. Reflux disease. MEDICATIONS ON ADMISSION: The patient's medications prior to admission included aspirin, Lopressor 50 mg p.o. b.i.d., Prilosec, ibuprofen, Lasix, K-Dur, Trental, Roccal, allopurinol. PHYSICAL EXAMINATION ON PRESENTATION: The patient's physical examination upon admission revealed a temperature of 95.7, blood pressure was 126/56, respiratory rate was 12, pulse was 64, and the patient was saturating 96% on 2 liters. Generally, the patient was alert and oriented times three, in no acute distress. An elderly and obese female. Her head, eyes, ears, nose, and throat examination revealed she had pupils were equal, round, and reactive to light and accommodation. The mucous membranes were moist. The patient's dentures were intact. Her oropharynx was clear. Neck examination revealed jugular venous pressure was 8 cm lying flat. The patient had no lymphadenopathy and no thyromegaly. On cardiovascular examination the patient had a regular rate, normal first heart sound and second heart sound. A [**5-4**] diamond shaped systolic murmur. Pulmonary examination was clear to auscultation bilaterally. No wheezes. Abdominal examination was soft, nontender, obese, with hyperactive bowel sounds. No hepatosplenomegaly. Extremities revealed 1+ dorsalis pedis pulses bilaterally, 1+ edema. The patient had arterial sheath in place during her admission physical. PERTINENT LABORATORY DATA ON PRESENTATION: The patient's laboratories on admission revealed a white blood cell count of 7.2, hemoglobin was 11.8, hematocrit was 34.6, platelets were 204. Sodium of 140, potassium of 3.6, chloride of 105, bicarbonate of 23, blood urea nitrogen of 11, creatinine of 0.5, blood glucose of 97. The patient's creatine kinases were peaked at [**2136**], with a CK/MB of 249, and a CK/MB index of 12.7. The patient's lipid panel showed a triglyceride level of 332, high-density lipoprotein of 46, low-density lipoprotein of 171. HOSPITAL COURSE: 1. CARDIOVASCULAR: (a) Coronary artery disease: The patient was started on Plavix, aspirin, Lipitor, and an ACE inhibitor during her hospitalization. The patient was not given Integrilin because she was already receiving lytic therapy prior to her admission to [**Hospital1 190**]. The patient was taken back to the catheterization laboratory on [**8-8**] where her saphenous vein graft to first diagonal lesion was crossed, ballooned, and stented. This procedure was complicated by an episode of ventricular fibrillation which was halted by one defibrillation. The patient was discharged on 75 mg of Plavix per day for 26 days; to complete a course of 30 days, aspirin every day, Lipitor 10 mg every day (which should be titrated upward to decrease her low-density lipoprotein cholesterol to below 100). If the patient's triglycerides do not significantly decrease with Lipitor treatment, a second lipid-lowering [**Doctor Last Name 360**] should be considered. The second catheterization was necessary because of the significant lesion that had not been stented in the first procedure. Unfortunately, both vessels could not be stented in one procedure to the large amount of dye necessary to do a longer procedure. (b) Pump: The patient was given 25 mg b.i.d. of Lopressor and 20 mg q.d. of lisinopril upon discharge. She had two echocardiograms done during her admission; the second of which was done after her second procedure, and it showed a left atrium that was mildly dilated and somewhat elongated. The left ventricular wall thickness was normal. The left ventricular cavity size was normal. Overall, left ventricular systolic function was hard to assess but was probably low-normal in the 50% to 55% range. The patient's right ventricular chamber size and free wall motion were normal. The ascending aorta was mildly dilated. The aortic valve leaflets were mildly thickened, and there was mild 1+ aortic regurgitation seen. The mitral valve leaflets were mildly thickened, trivial mitral regurgitation was also seen. There was borderline pulmonary artery systolic hypertension. There was trivial physiologic pericardial effusion. (c) Rhythm: The patient went into atrial fibrillation on [**8-8**] with a rapid response. The patient was asymptomatic; however, she was loaded with p.o. amiodarone at 400 mg p.o. t.i.d. The patient re-entered atrial fibrillation on the last night of her admission. The patient was sent home on additional anticoagulation therapy with Coumadin and Lovenox for a target INR of 2. The patient was not thought to need lifetime anticoagulation and amiodarone if cardioversion is successfully pursued roughly six months after anticoagulation has been administered. The amiodarone should be weaned down to a target dose of 200 mg q.d. The regimen should include 400 mg p.o. b.i.d. for two weeks; then 400 mg p.o. q.d. for two weeks; then 200 mg p.o. q.d. from that time onward to complete a 6-month course; at which cardioversion could be considered. The Coumadin should be dosed in a manner to target INR to 2; keeping in mind that Coumadin and amiodarone interact and a lower dose of Coumadin may be needed than would otherwise be needed. 2. PULMONARY: The patient was with slight crackles at her bases throughout her hospitalization. They improved by the time she was discharged but had not resolved. It was thought that she had baseline crackles that persisted since her coronary artery bypass graft in the early [**2159**]. Her chest x-ray was clear and showed no evidence congestive heart failure or pneumonia. Her saturations were in the middle 90s with room air on the night prior to discharge. 3. HEMATOLOGY: The patient's hematocrit was stable at 30 on the morning of discharge. Her hematocrit had been stable since she was transfused on [**8-9**] for blood loss related to her catheterization. She was started on anticoagulation as noted above, and the patient will have an aggressive regimen of anticoagulation including Lovenox, Coumadin, Plavix, and aspirin. The patient has been informed that she is at a high risk for bleeding and that she should report to the Emergency Room if falls in any manner or hits her head. It was thought that the patient's risk of fall and bleeding was less than her risk of adverse effects associated with arrhythmia and no anticoagulation. 4. RENAL: The patient's blood urea nitrogen and creatinine were stable throughout her hospitalization. She had several doses of intravenous Lasix to treat what was thought to be pulmonary edema associated with congestive heart failure. The patient responded well to Lasix with good diuresis and improvement of her oxygenation. 5. ENDOCRINE: The patient had q.i.d. fingersticks with sliding-scale insulin coverage for her non-insulin-dependent diabetes. Her sugars ranged in the low 100s, and she did not require sliding-scale insulin. 6. FLUIDS/ELECTROLYTES/NUTRITION/GASTROINTESTINAL: The patient had a cardiac diabetic diet, and she had good urine output and appropriate electrolyte management throughout her hospitalization. 7. PROPHYLAXIS: The patient was given Protonix for peptic ulcer disease and Docusate for constipation. She was continued on her allopurinol regimen of 300 mg p.o. q.d. for gout prophylaxis. 8. PERIPHERAL VASCULAR DISEASE: The patient had evidence of severe peripheral vascular disease during her catheterization. There was a 90% common iliac lesion on the right. Additionally, there was diffuse disease noted in the left, and the patient had worsening symptoms after her second percutaneous coronary intervention on the left. The patient's sheaths were pulled early because the patient had worsening left leg pain while the sheaths were in. The pain improved with sheath removal and elevated blood pressures. The patient had difficulty with bleeding at her left catheterization site due to the premature pulling of the sheath while the patient was still anticoagulated from her procedure. This was treated with a fem-stop device that applied 100 mmHg of pressure. This was applied for three to four hours, during which the patient had intermittent worsening left leg pain with intermittent loss of dopplerable pulses in the lower extremity. Both the patient's symptoms and her pulses improved when her blood pressure came up above 100. The patient had intermittent symptoms of left leg pain and right leg pain throughout the remainder of her hospitalization which improved with reversed Trendelenburg positioning of her bed, good blood pressure control, and pain medications. The patient was to follow up with Dr. [**First Name (STitle) **] for possible percutaneous treatment of her peripheral vascular disease with balloon angioplasty and possibly stenting of the occluded vessels. The patient was discharged with Doppler-positive pulses bilaterally, good capillary refill, and minimal resting claudication pain. DISCHARGE DISPOSITION: The patient was discharged with home nursing to get for at least two weeks to help the patient with her new drug regimen and her Lovenox injections. MEDICATIONS ON DISCHARGE: 1. Lovenox 100 mg subcutaneous b.i.d. 2. Plavix 75 mg p.o. q.d. (times 26 days; to complete a course of 30 days). 3. Aspirin 81 mg p.o. q.d. 4. Coumadin 3 mg p.o. q.d. (with target INR of 2; at which time Lovenox can be discontinued). 5. Lopressor 25 mg p.o. b.i.d. 6. Lisinopril 20 mg p.o. q.d. 7. Allopurinol 300 mg p.o. q.d. 8. Lipitor 10 mg p.o. q.d. 9. Lasix 80 mg p.o. q.d. 10. Amiodarone 400 mg p.o. b.i.d. times two weeks; then 400 mg p.o. q.d. times two weeks; then 200 mg p.o. q.d. ongoing. 11. Sublingual nitroglycerin 0.4 mg sublingually as needed for chest pain. 12. Vicodin 5/500 one tablet q.6h. as needed for pain. CONDITION AT DISCHARGE: Condition on discharge was good. DISCHARGE DIAGNOSES: 1. Coronary artery disease. 2. Acute myocardial infarction. 3. Peripheral vascular disease. 4. Non-insulin-dependent diabetes mellitus. 5. Gastroesophageal reflux disease. 6. Gout. 7. Hypertension. 8. Arthritis. 9. Atrial fibrillation. 10. Ventricular fibrillation. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D. [**MD Number(1) 5211**] Dictated By:[**Last Name (NamePattern1) 7942**] MEDQUIST36 D: [**2171-8-15**] 22:47 T: [**2171-8-15**] 00:48 JOB#: [**Job Number 39603**]

410,428,427,285,998,414,250

{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Congestive heart failure, unspecified,Ventricular fibrillation,Acute posthemorrhagic anemia,Hematoma complicating a procedure,Coronary atherosclerosis of autologous vein bypass graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

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 72-year-old female with a past medical history of coronary artery disease (status post coronary artery bypass graft in [**2162**] with a left internal mammary artery to left anterior descending artery graft, and saphenous vein graft to obtuse marginal graft, and saphenous vein graft to diagonal graft). She also has a past medical history of non-insulin-dependent diabetes mellitus, hypertension, and peripheral vascular disease. MEDICAL HISTORY: (The patient's past medical history included) 1. Coronary artery disease. 2. Hypertension. 3. Non-insulin-dependent diabetes mellitus. 4. Gout. 5. Peripheral vascular disease. 6. Osteoarthritis. 7. Reflux disease. MEDICATION ON ADMISSION: The patient's medications prior to admission included aspirin, Lopressor 50 mg p.o. b.i.d., Prilosec, ibuprofen, Lasix, K-Dur, Trental, Roccal, allopurinol. ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Acute myocardial infarction of inferoposterior wall, initial episode of care,Congestive heart failure, unspecified,Ventricular fibrillation,Acute posthemorrhagic anemia,Hematoma complicating a procedure,Coronary atherosclerosis of autologous vein bypass graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a previously healthy 77-year-old male with a T3,N0,M0 cancer of his right vocal cord. MEDICAL HISTORY: The past medical history was significant only for a previous left vocal cord biopsy as well as a Port-A-Cath placement. MEDICATION ON ADMISSION: ALLERGIES: The patient had no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient did have a significant smoking history, which he quit five months ago.

Malignant neoplasm of thyroid gland,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Secondary malignant neoplasm of other respiratory organs,Other diseases of lung, not elsewhere classified,Personal history of tobacco use

Malign neopl thyroid,Mal neo lymph-head/neck,Sec malig neo resp NEC,Other lung disease NEC,History of tobacco use

Admission Date: [**2156-1-20**] Discharge Date: Service: DIAGNOSIS: Laryngeal cancer. HISTORY: This is a 77-year-old male with laryngeal cancer, Stage T3/N0/M0, of the right vocal cord. His past medical history is significant for the above. He has had a vocal cord biopsy in the past, as well as a port-A-Cath. He has no known drug allergies. He is taking Claritin for medication. He does have a 30-pack year history of smoking but he quit five months ago. EXAMINATION: He is alert and oriented x 3. His neck has full range of motion. His chest is clear to auscultation. Heart has regular rate and rhythm. He has no focal neurological deficits. HOSPITAL COURSE: The patient was taken to the operating room on [**2156-1-20**] for laryngoscopy, tracheoscopy, esophagoscopy. Dictated By:[**Name8 (MD) 34705**] MEDQUIST36 D: [**2156-2-15**] 18:03 T: [**2156-2-16**] 07:18 JOB#: [**Job Number 34706**] Admission Date: [**2156-2-3**] Discharge Date: [**2156-2-15**] Service: DISCHARGE DIAGNOSIS: Laryngeal cancer. HISTORY OF PRESENT ILLNESS: The patient is a previously healthy 77-year-old male with a T3,N0,M0 cancer of his right vocal cord. PAST MEDICAL HISTORY: The past medical history was significant only for a previous left vocal cord biopsy as well as a Port-A-Cath placement. ALLERGIES: The patient had no known drug allergies. MEDICATIONS: The only medication that the patient took was Claritin. SOCIAL HISTORY: The patient did have a significant smoking history, which he quit five months ago. PHYSICAL EXAMINATION: On examination, the patient was alert and oriented times three. His oral mucosa showed no obvious lesions. The heart had a regular rate and rhythm. The lungs were clear to auscultation. The neurological examination was nonfocal. HOSPITAL COURSE: On [**2156-2-3**], the patient went to the operating room for a total laryngectomy with a permanent tracheostomy. Findings included no gross extension of the tumor to the inferior incision of the tracheostomy. There were no complications at that time. The patient was admitted to the Surgical Intensive Care Unit for overnight monitoring of his fresh tracheostomy site. He did very well overnight with no airway issues. He was therefore transferred to the floor in good condition. A nutrition consultation was obtained early in order to adequately start tube feeds on the patient. They started the tube feeds slowly and progressively increased them to goal. There was a question of a lung nodule on the patient's chest CT scan. To further evaluate this, a cardiothoracic consultation was obtained. The surgeons recommended a follow up CT scan in four to six weeks after laryngectomy, just to rule out postoperative changes. An oncology consultation was obtained at nearly the same time and recommended the same. A speech and swallowing consultation was also obtained to aid in the patient's care during his stay in the hospital. They continued to work with the patient on a daily basis and his speech and swallowing techniques. Otherwise, the patient progressed very well. He was making good urine and was caring for the tracheostomy site. On [**2156-2-13**], a barium swallow was obtained to rule out the presence of an anastomotic [**Year (4 digits) 3564**] or fistula. Of note, clinically the patient had no evidence of fistula at this time. The study came back as showing no evidence of [**Last Name (LF) 3564**], [**First Name3 (LF) **] the patient's nasogastric tube was discontinued and the patient was started on an oral diet. He tolerated his diet very well at this time. It was decided that the patient was ready for rehabilitation placement. He was screened by the [**Hospital1 **] [**Location (un) 511**] Center and was transferred as soon as a bed was available. CONDITION ON DISCHARGE: The patient will be discharged in good condition. DISCHARGE MEDICATIONS: Roxicet 5 to 10 ml p.o. every six hours p.r.n. for pain. Bacitracin ointment, one applicator topical p.r.n. around his tracheostomy site. DISCHARGE INSTRUCTIONS: The treatment that the patient required was assistance in his tracheostomy care. A laryngectomy tube was inserted into the site prior to his discharge in order to ensure the patency of his tracheostomy. This will be removed in the office by Dr. [**First Name (STitle) **] at a later time. The patient will eat a regular soft diet. FOLLOW UP: The patient will follow up with Dr. [**First Name (STitle) **] in the office; he will call for an appointment in one week. He will also follow up with a CT scan on [**2156-3-4**] at 10:15 AM and after that with Dr. [**Last Name (STitle) 20042**] on [**2156-3-11**] at 9:30 AM for review of the CT scan findings. DISPOSITION: The patient is discharged to rehabilitation as instructed. [**Name6 (MD) **] [**Last Name (NamePattern4) 13798**], M.D. [**MD Number(1) 13799**] Dictated By:[**Name8 (MD) 34707**] MEDQUIST36 D: [**2156-2-15**] 18:26 T: [**2156-2-15**] 18:47 JOB#: [**Job Number 32513**] Admission Date: [**2156-2-3**] Discharge Date: Date of Birth: Sex: Service: ADMISSION DIAGNOSIS: Laryngeal cancer. HISTORY OF PRESENT ILLNESS: This is a 77 year old male with laryngeal cancer. PAST MEDICAL HISTORY: Significant for core biopsy, laryngoscopy, tracheostomy and esophagoscopy done on [**2156-1-20**], as well as a porta-cath placement in the past. ALLERGIES: He has allergic reaction to Claritin. SOCIAL HISTORY: He has a 30 pack year history of smoking but he quit five months ago. PHYSICAL EXAMINATION: On examination, he is alert and oriented. His airway is clear. His neck has full range of motion. His chest is clear to auscultation. Heart: Regular rate and rhythm. He has no focal neurological deficits. HOSPITAL COURSE: On [**2156-2-3**], the patient was taken to the operating room for a total laryngectomy with a permanent tracheostomy. They found no gross extension of the tumor to the inferior incision of the tracheostomy. He underwent a total laryngectomy with a permanent tracheostomy. He was transferred to the surgical Intensive Care Unit in good condition. He was monitored in the Surgical Intensive Care Unit overnight for tracheostomy monitoring. He did well overnight and was transferred to the floor the following day. On [**2156-2-4**], thoracic surgery consult was obtained for a long nodule that was seen on a chest CT. They recommended that follow-up chest CT be done in the future, to rule out postoperative change. The patient was otherwise doing well. He was started on tube feeds, which were quickly advanced to goal. A speech and swallow consult was obtained to assist in swallowing. An oncology consult was obtained as well. They agreed with the cardiothoracic surgeon's evaluation that we should repeat the chest CT in four to six weeks. Speech and swallowing pathology continued to work with the patient during his hospital stay. The patient did prefer to write as his primary mode of communication. He is planning on pursuing outpatient voice therapy after discharge from the hospital. The patient was monitored in the hospital until [**2156-2-13**] when a barium swallow was obtained, to make sure that the patient had not developed a fistula. Of note, the patient clinically had no evidence of a fistula. The radiologic study revealed no evidence of a [**Year (4 digits) 3564**]. The patient was, therefore, started on a regular diet and his nasogastric tube was taken out. The patient was then screened for rehabilitation placement to [**Hospital1 **]. Plans were made for his transfer and the patient was discharged in good condition. DISPOSITION AND DISCHARGE INSTRUCTIONS: He will be discharged on Roxicet 3/325 5 to 10 mls p.o. every six hours prn for pain. Bacitracin ointment, one applicator topically, prn around the tracheostomy site. He will need assistance in caring for his tracheostomy at this point. We did put a laryngectomy tube #10, back into the stoma, to ensure that the stoma stayed open and patent. This will be removed in the office by Dr. [**First Name (STitle) **] when he sees the patient in one week. He can eat a regular/soft diet. He will follow-up with his CT scan on [**2156-3-4**] at 10:15 a.m. and then follow-up with Dr. [**Last Name (STitle) 20042**] on [**2156-3-11**] at 9:30 a.m. to review the scan findings. He will call Dr.[**Name (NI) 18353**] office for an appointment. [**Name6 (MD) **] [**Last Name (NamePattern4) 13798**], M.D. [**MD Number(1) 13799**] Dictated By:[**Name8 (MD) 34707**] MEDQUIST36 D: [**2156-2-15**] 18:12 T: [**2156-2-16**] 08:03 JOB#: [**Job Number 34708**]

193,196,197,518,V158

{'Malignant neoplasm of thyroid gland,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Secondary malignant neoplasm of other respiratory organs,Other diseases of lung, not elsewhere classified,Personal history of tobacco use'}

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 previously healthy 77-year-old male with a T3,N0,M0 cancer of his right vocal cord. MEDICAL HISTORY: The past medical history was significant only for a previous left vocal cord biopsy as well as a Port-A-Cath placement. MEDICATION ON ADMISSION: ALLERGIES: The patient had no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient did have a significant smoking history, which he quit five months ago. ### Response: {'Malignant neoplasm of thyroid gland,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Secondary malignant neoplasm of other respiratory organs,Other diseases of lung, not elsewhere classified,Personal history of tobacco use'}

CHIEF COMPLAINT: ASPVD, dyspnea on exertion. PRESENT ILLNESS: An 87-year-old man with ASPVD, dyspnea on exertion over the past year. He has had near syncope 3 to 4 times. He is referred to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for cardiac catheterization. MEDICAL HISTORY: The patient's past medial history is significant for permanent pacer done in [**2118-4-1**] for syncope and bradycardia, abdominal aortic aneurysm repair in [**2117-11-1**], left CEA in [**2112**], hypertension, hypercholesterolemia, and peripheral vascular disease with positive claudication. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: The patient's family history is negative for coronary artery disease. SOCIAL HISTORY: Retired dentist who has a remote tobacco history. Last use was over 50 years ago. Social alcohol use with 1 to 4 drinks per day.

Aortic valve disorders,Diastolic heart failure, unspecified,Atrial fibrillation,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Fitting and adjustment of cardiac pacemaker,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia

Aortic valve disorder,Diastolc hrt failure NOS,Atrial fibrillation,Chr pulmon heart dis NEC,Hypertension NOS,Crnry athrscl natve vssl,Ftng cardiac pacemaker,Ath ext ntv at w claudct,Hyperlipidemia NEC/NOS

Admission Date: [**2118-6-28**] Discharge Date: [**2118-7-7**] Service: CSU CHIEF COMPLAINT: ASPVD, dyspnea on exertion. HISTORY OF PRESENT ILLNESS: An 87-year-old man with ASPVD, dyspnea on exertion over the past year. He has had near syncope 3 to 4 times. He is referred to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for cardiac catheterization. This 87-year-old man with dyspnea on exertion after 50 to 100 feet with known aortic stenosis undergoing cardiac catheterization on the day of admission which revealed an aortic valve area of 0.8 cm squared, as well as calcified left main without stenosis, 95% LAD, 40% circumflex, after the OM and osteostenosis of 50 to 60% with mid lesion of 99%. PAST MEDICAL HISTORY: The patient's past medial history is significant for permanent pacer done in [**2118-4-1**] for syncope and bradycardia, abdominal aortic aneurysm repair in [**2117-11-1**], left CEA in [**2112**], hypertension, hypercholesterolemia, and peripheral vascular disease with positive claudication. FAMILY HISTORY: The patient's family history is negative for coronary artery disease. SOCIAL HISTORY: Retired dentist who has a remote tobacco history. Last use was over 50 years ago. Social alcohol use with 1 to 4 drinks per day. ALLERGIES: No known drug allergies. MEDICATIONS: Medications at home include: 1. Nifedipine. 2. Lipitor. 3. Lotensin. 4. Aspirin. 5. Toprol. REVIEW OF SYMPTOMS: No angina. Positive gastroesophageal reflux type epigastric pain. Positive orthopnea, positive dyspnea on exertion and shortness of breath. No diabetes, no CVA, no nausea, vomiting, diarrhea or constipation. No melena. Productive cough with yellow to brown sputum x 2 weeks. PHYSICAL EXAMINATION: He is in no acute distress lying flat in bed. CARDIOVASCULAR: Regular rate and rhythm S1 and S2 with a holosystolic murmur at the base. LUNGS: Bilateral wheezes. EXTREMITIES: Warm and well perfused with no edema and no varicosities. 2+ pulses throughout. ABDOMEN: Soft, nontender, nondistended. LABORATORY DATA: White blood cell 7.3, hematocrit 35, platelet count 146, PT 12.5 with an INR of 1.0. Sodium 138, potassium 3.7, chloride 106, CO2 23, BUN 17, creatinine 1.0, glucose 158, ALT 12, AST 14, alkaline phosphatase 60, amylase 40, direct bilirubin 0.3. Carotid ultrasound from [**2117-9-1**] showed left sided stenosis with 40 to 60% LCA stenosis and chronically occluded right internal carotid artery. The patient was seen by the dental service and was cleared by that service. On [**6-30**] he was brought to the operating room. Please see the OR report for full details. In summary, the patient had an AVL with 21 mm [**Last Name (un) 3843**]- [**Doctor First Name 7624**] pericardial valve as well as coronary artery bypass graft x 2 with left internal mammary artery to the LAD and saphenous vein graft to the patent ductus arteriosus. His bypass time was 122 minutes with cross-clamp time of 102 minutes. He tolerated the operation well and was transferred from the operating room to the cardiothoracic intensive care unit. At the time of transfer the patient was a paced at 100 beats per minute with mean arterial pressure of 60. He had propofol at 20 mics/kg per minute as well as Levophed at 0.04 mics/kg per minute, epinephrine at 0.04 mics/ kg per minute and milrinone at 0.25 mics/kg per minute. The patient did well in the immediate postoperative period. His anesthesia was reversed and he was successfully extubated. He remained hemodynamically stable throughout the day of the surgery. Over the course of the first postoperative night, the patient was weaned from his epinephrine drip and on postoperative day 2 he was weaned off his milrinone as well as his Levophed infusions. Additionally, the patient was slowly diuresed during that period. On postoperative day 3, the electrophysiology service was called to interrogate the patient's permanent pacemaker. It was noted that he was in atrial fibrillation at that time, has an underlying rhythm below his pacemaker and amiodarone was begun at that time following which the patient converted back in sinus rhythm. On postoperative day 4, it was decided that the patient was stable and ready to be transferred to the floor for continued postoperative care and cardiac rehabilitation. Once on the floor the patient had an uneventful postoperative course. His activity level was increased with the assistance of the nursing staff as well as the physical therapy staff. His medications were adjusted to maintain an adequate blood pressure and keep him in the normal sinus rhythm as well as to diurese effectively. On postoperative day 6, it was decided that the following day, the patient would be stable and ready to be transferred to rehabilitation, with postoperative care. At the time of this dictation the patient's physical examination is as follows. PHYSICAL EXAMINATION: VITAL SIGNS: Temperature 98.6, heart rate 73 and in sinus rhythm, blood pressure 110/69, respiratory rate 18, oxygen saturations 93% on room air. NEUROLOGIC: Alert and oriented. Moves all extremities and follows commands. Nonfocal examination. PULMONARY: Bibasilar crackles, otherwise clear to auscultation. CARDIAC: Regular rate and rhythm S1 and S2 with no murmurs. Sternum is stable. Incision is clean and dry without erythema or drainage. ABDOMEN: Soft and nontender, nondistended with normal active bowel sounds. EXTREMITIES: Warm and well perfused with trace edema. Left lower extremity incision with Steri-Strips clean and dry. LABORATORY DATA: White blood cell 8.1, hematocrit 32, platelet count 189, sodium 139, potassium 4.3, chloride 100, CO2 30, BUN 30, creatinine 1.3, glucose 107. DISCHARGE DISPOSITION: The patient is to be discharged to rehabilitation. DISCHARGE DIAGNOSIS: 1. Status post AVL with No. 21 [**Last Name (un) 3843**]-[**Doctor Last Name **] pericardial valve as well as coronary artery bypass graft x 2 with left internal mammary artery to the LAD and saphenous vein graft to the patent ductus arteriosus. 2. Hypertension. 3. Peripheral vascular disease. 4. Hypercholesterolemia. 5. Status post permanent pacemaker. 6. Status post abdominal aortic aneurysm repair. J7. Status post left CEA. The patient's condition at the time of discharge is good. He is to have follow up with Dr. [**Last Name (STitle) 32017**] at the [**Hospital3 **] [**Hospital **] Clinic in 1 to 2 weeks. Follow up with Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 4469**], in 3 to 4 weeks and follow up with Dr. [**First Name (STitle) **] [**Name (STitle) **], in 4 weeks. The patient's discharge medications include: 1. Lasix 40 mg q d x 2 weeks. 2. Potassium chloride 20 mEq q d x 2 weeks. 3. Colace 100 mg b.i.d. 4. Aspirin 81 mg q d. 5. Percocet 5/325 one to two tabs q 4 to 6 hours as needed for pain. 6. Atorvastatin 40 mg q d. 7. Pantoprazole 40 mg q day. 8. Amiodarone 400 mg b.i.d. x 1 week, then 400 mg q day x 1 week, and then 200 mg q d. 9. Metoprolol 12.5 mg b.i.d. 10. Atrovent 2 puffs b.i.d. 11. Captopril 12.5 mg t.i.d. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 5897**] Dictated By:[**Last Name (NamePattern4) 1718**] MEDQUIST36 D: [**2118-7-6**] 23:29:30 T: [**2118-7-7**] 01:14:16 Job#: [**Job Number 32018**]

424,428,427,416,401,414,V533,440,272

{'Aortic valve disorders,Diastolic heart failure, unspecified,Atrial fibrillation,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Fitting and adjustment of cardiac pacemaker,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia'}

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: ASPVD, dyspnea on exertion. PRESENT ILLNESS: An 87-year-old man with ASPVD, dyspnea on exertion over the past year. He has had near syncope 3 to 4 times. He is referred to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for cardiac catheterization. MEDICAL HISTORY: The patient's past medial history is significant for permanent pacer done in [**2118-4-1**] for syncope and bradycardia, abdominal aortic aneurysm repair in [**2117-11-1**], left CEA in [**2112**], hypertension, hypercholesterolemia, and peripheral vascular disease with positive claudication. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: The patient's family history is negative for coronary artery disease. SOCIAL HISTORY: Retired dentist who has a remote tobacco history. Last use was over 50 years ago. Social alcohol use with 1 to 4 drinks per day. ### Response: {'Aortic valve disorders,Diastolic heart failure, unspecified,Atrial fibrillation,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Fitting and adjustment of cardiac pacemaker,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia'}

CHIEF COMPLAINT: Fever and mental status changes. PRESENT ILLNESS: This is an 83-year-old male with a history of progressive [**Last Name (un) 309**] body dementia and a seizure disorder who was a resident of [**Hospital3 **] with a recent general functional decline (since two months) that has manifested as a decrease interactiveness, recent anorexia (refused orals), and decrease functional ability (activities of daily living). MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Other septicemia due to gram-negative organisms,Other shock without mention of trauma,Acute respiratory failure,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Other convulsions,Defibrination syndrome

Gram-neg septicemia NEC,Shock w/o trauma NEC,Acute respiratry failure,Urin tract infection NOS,Pneumonia, organism NOS,Convulsions NEC,Defibrination syndrome

Admission Date: [**2103-7-4**] Discharge Date: [**2103-7-5**] Service: MICU CHIEF COMPLAINT: Fever and mental status changes. HISTORY OF PRESENT ILLNESS: This is an 83-year-old male with a history of progressive [**Last Name (un) 309**] body dementia and a seizure disorder who was a resident of [**Hospital3 **] with a recent general functional decline (since two months) that has manifested as a decrease interactiveness, recent anorexia (refused orals), and decrease functional ability (activities of daily living). He was noted by his neurologist to be likely progressing with his dementia, as recently as [**2103-6-21**]. He was started on Sinemet at that time. HOSPITAL COURSE: He presented to [**Hospital1 190**] with fevers of 102 degrees Fahrenheit, a heart rate of 112, and a blood pressure that was 90/palp, and a respiratory rate of 36, and saturating 100% on 15 liters with decreased urine output. He was also noted to be unresponsive on admission. A chest x-ray was consistent with a right middle lobe infiltrate. He was given levofloxacin, and vancomycin, as well as Flagyl for presumed pneumonia versus urinary tract sepsis. He was hypotensive with a poor response to fluid boluses (he was given a total of 8 liters in the Emergency Department). He was started on a dopamine drip with no response. He was switched to Neo-Synephrine with an increased blood pressure and arousability. He was transferred to the Medical Intensive Care Unit where his hypotension worsened, requiring a second pressor (Vasopressin), plus fluid boluses. He became increasingly acidotic with lactate initially at 8 that increased to 20.7 during the evening of [**7-4**]. He also had worsening bicarbonate levels from 25 initially, decreasing to 6. He was intubated with a pre-intubation arterial blood gas that was 7.04/22/122. Post intubation, his arterial blood gas was 7.11/23/215 on 50% oxygen. He was given sodium bicarbonate followed by a sodium bicarbonate drip. His antibiotics were continued, and he was given stress-dose steroids for presumptive adrenal insufficiency in the setting of sepsis. Levophed was added on as another pressor for hypotension. Blood cultures from earlier that day in the Emergency Department grew gram-negative rods, and the patient was started on ceftazidime. He was also noted to have severe coagulopathy and was treated aggressively with fresh frozen plasma and vitamin K. He was also transfused several units of packed red blood cells for a rapidly decreasing hematocrit in the setting of fluid restriction. Despite all of these aggressive interventions (including triple pressors), the patient's mean arterial pressure remained in the 40s, and his heart rate started to drop. At 5:45 p.m., on [**2103-7-6**], he became asystolic on the monitor. His pupils became fixed and dilated, and he expired. His sister was present and refused the autopsy at that time. The attending, as well as the [**Hospital3 1761**], were notified of his death. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 968**] Dictated By:[**Name8 (MD) 17844**] MEDQUIST36 D: [**2103-10-9**] 14:37 T: [**2103-10-11**] 20:52 JOB#: [**Job Number **]

038,785,518,599,486,780,286

{'Other septicemia due to gram-negative organisms,Other shock without mention of trauma,Acute respiratory failure,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Other convulsions,Defibrination syndrome'}

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: Fever and mental status changes. PRESENT ILLNESS: This is an 83-year-old male with a history of progressive [**Last Name (un) 309**] body dementia and a seizure disorder who was a resident of [**Hospital3 **] with a recent general functional decline (since two months) that has manifested as a decrease interactiveness, recent anorexia (refused orals), and decrease functional ability (activities of daily living). MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Other septicemia due to gram-negative organisms,Other shock without mention of trauma,Acute respiratory failure,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Other convulsions,Defibrination syndrome'}

CHIEF COMPLAINT: lower extremity weakness, paralysis, back pain PRESENT ILLNESS: Pt intubated and sedated on arrival to MICU, history obtained from ED record and girlfriend. 61 yo male diabetic x 15 years who presents to ED with bilateral lower extremity weakness and back pain for the past 2 days. According to his girlfriend, pt had been in his usual state of health except for a flare of his neuropathy and gout on [**Hospital1 107**] day weekend, who developed right sided back pain about two days ago after heavy lifting. Yesterday the patient was unable to lie down and had to sit at the side of his bed for about 24 hours. He was able to ambulate to the bathroom at 9 am, but complained of "pain all over". He had been prescribed Percocets following removal of a R callus by podiatry, and took four of the percocet yesterday for pain relief. This morning he was unable to get out of bed secondary to loss of sensation in his feet, legs, and buttock region. Typically ambulates limited distance with cane. His girlfriend called 911 and he was taken to [**Hospital1 **] and transferred to ED for further evaluation. . In the [**Name (NI) **], pt found to have a leukocytosis, febrile to 100.3 max. Concern for epidural abscess was raised given history of diabetes. Neurosurgery and neurology were consulted, patient found to have flaccid paraplegia, poor rectal tone, absent reflexes in the legs, T4-T6 sensation level, and weak cough; rec stat imaging at [**Hospital6 **] as pt body habitus too large to fit into CT/MRI scanner here. Pt was electively intubated for CT, sent to [**Hospital6 1708**], however, because of his obesity, this was unable to be done as he could not fit on the fluoro table, and a regular CT was done instead. The patient was started on Vanc/ Zosyn along with 2 liters of IVF and transferred to the MICU with plans to undergo an open MRI at Shields MRI in [**Location (un) 583**]. MEDICAL HISTORY: Diabetes- insulin dependent x 15 years MI 5 yrs ago CABG x 4 5 years ago Chronic back pain neuropathy- unable to feel the bottom of his feet gout MEDICATION ON ADMISSION: Percocet, ASA, Zantac, Avapro. Atenolol 25mg daily Avapro 300mg qday lasix 80mg daily glucophage 100mg [**Hospital1 **] lantus 90 units daily lipitor 40mg daily ASA Percocet 5mg daily/prn Talwin i tab daily ALLERGIES: Macrolide Antibiotics / Ambien PHYSICAL EXAM: vitals: 179 kg/temp 99.4/bp 109/51/ hr 76/ 100% vent settings: AC/ 100% FiO2/ 14/ 650-698/ PEEP 15 GEN: sedated, will respond to some questions, intubated, obese HEENT: atraumatic, anicteric, pupils constricted but equal and reactive NECK: unable to appreciate JVP, no LAD CV: soft precordium, RRR, no murmurs. CABG scar on chest LUNGS: CTA B/L, distant BS ABD: soft, nt, NABS, no organomegaly appreciated EXT: warm, dry. DP pulses dopplerable. Lower extremities with chronic venous stasis changes, dry, cracked skin. Hyperpigmentation. Right callous on great toe, appears clean, no frank pus NEURO: arousable, responsive to some commands, no myoclonus, toes mute bilaterally, unable to move extremities FAMILY HISTORY: brother died of cancer, unknown cause SOCIAL HISTORY: quit ETOH after CABG, 2 PPD smoker x 5 years, retired [**Hospital1 **] rep, has two sons but limited contact. Widowed 15 years ago, now lives with his girlfriend.

Methicillin susceptible Staphylococcus aureus septicemia,Intraspinal abscess,Acute respiratory failure,Chronic kidney disease, unspecified,Acute kidney failure with lesion of tubular necrosis,Septic shock,Methicillin susceptible pneumonia due to Staphylococcus aureus,Congestive heart failure, unspecified,Severe sepsis,Morbid obesity,Aortocoronary bypass status,Old myocardial infarction,Gout, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Paraplegia,Altered mental status,Other opiates and related narcotics causing adverse effects in therapeutic use,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Foreign body in larynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation

Meth susc Staph aur sept,Intraspinal abscess,Acute respiratry failure,Chronic kidney dis NOS,Ac kidny fail, tubr necr,Septic shock,Meth sus pneum d/t Staph,CHF NOS,Severe sepsis,Morbid obesity,Aortocoronary bypass,Old myocardial infarct,Gout NOS,Idio periph neurpthy NOS,Paraplegia NOS,Altered mental status,Adv eff opiates,DMII renl nt st uncntrld,Foreign body in larynx,Resp obstr-inhal obj NEC

Admission Date: [**2179-7-13**] Discharge Date: [**2179-7-27**] Date of Birth: [**2118-2-26**] Sex: M Service: MEDICINE Allergies: Macrolide Antibiotics / Ambien Attending:[**First Name3 (LF) 398**] Chief Complaint: lower extremity weakness, paralysis, back pain Major Surgical or Invasive Procedure: C7-T10 laminectomy with washout [**2179-7-21**] Intubation Left trauma IJ central line Right subclavian central line Right arm arterial line History of Present Illness: Pt intubated and sedated on arrival to MICU, history obtained from ED record and girlfriend. 61 yo male diabetic x 15 years who presents to ED with bilateral lower extremity weakness and back pain for the past 2 days. According to his girlfriend, pt had been in his usual state of health except for a flare of his neuropathy and gout on [**Hospital1 107**] day weekend, who developed right sided back pain about two days ago after heavy lifting. Yesterday the patient was unable to lie down and had to sit at the side of his bed for about 24 hours. He was able to ambulate to the bathroom at 9 am, but complained of "pain all over". He had been prescribed Percocets following removal of a R callus by podiatry, and took four of the percocet yesterday for pain relief. This morning he was unable to get out of bed secondary to loss of sensation in his feet, legs, and buttock region. Typically ambulates limited distance with cane. His girlfriend called 911 and he was taken to [**Hospital1 **] and transferred to ED for further evaluation. . In the [**Name (NI) **], pt found to have a leukocytosis, febrile to 100.3 max. Concern for epidural abscess was raised given history of diabetes. Neurosurgery and neurology were consulted, patient found to have flaccid paraplegia, poor rectal tone, absent reflexes in the legs, T4-T6 sensation level, and weak cough; rec stat imaging at [**Hospital6 **] as pt body habitus too large to fit into CT/MRI scanner here. Pt was electively intubated for CT, sent to [**Hospital6 1708**], however, because of his obesity, this was unable to be done as he could not fit on the fluoro table, and a regular CT was done instead. The patient was started on Vanc/ Zosyn along with 2 liters of IVF and transferred to the MICU with plans to undergo an open MRI at Shields MRI in [**Location (un) 583**]. Past Medical History: Diabetes- insulin dependent x 15 years MI 5 yrs ago CABG x 4 5 years ago Chronic back pain neuropathy- unable to feel the bottom of his feet gout Social History: quit ETOH after CABG, 2 PPD smoker x 5 years, retired [**Hospital1 **] rep, has two sons but limited contact. Widowed 15 years ago, now lives with his girlfriend. Family History: brother died of cancer, unknown cause Physical Exam: vitals: 179 kg/temp 99.4/bp 109/51/ hr 76/ 100% vent settings: AC/ 100% FiO2/ 14/ 650-698/ PEEP 15 GEN: sedated, will respond to some questions, intubated, obese HEENT: atraumatic, anicteric, pupils constricted but equal and reactive NECK: unable to appreciate JVP, no LAD CV: soft precordium, RRR, no murmurs. CABG scar on chest LUNGS: CTA B/L, distant BS ABD: soft, nt, NABS, no organomegaly appreciated EXT: warm, dry. DP pulses dopplerable. Lower extremities with chronic venous stasis changes, dry, cracked skin. Hyperpigmentation. Right callous on great toe, appears clean, no frank pus NEURO: arousable, responsive to some commands, no myoclonus, toes mute bilaterally, unable to move extremities Pertinent Results: [**2179-7-13**] 09:55PM TYPE-ART TEMP-37.4 RATES-14/22 PEEP-15 O2-80 PO2-90 PCO2-51* PH-7.34* TOTAL CO2-29 BASE XS-0 AADO2-433 REQ O2-74 INTUBATED-INTUBATED VENT-CONTROLLED [**2179-7-13**] 09:10PM GLUCOSE-167* UREA N-34* CREAT-2.0* SODIUM-137 POTASSIUM-5.5* CHLORIDE-99 TOTAL CO2-26 ANION GAP-18 [**2179-7-13**] 09:10PM ALT(SGPT)-24 AST(SGOT)-49* LD(LDH)-239 CK(CPK)-3981* ALK PHOS-97 AMYLASE-27 TOT BILI-0.4 [**2179-7-13**] 09:10PM LIPASE-27 [**2179-7-13**] 09:10PM CK-MB-27* MB INDX-0.7 cTropnT-0.02* [**2179-7-13**] 05:17AM LACTATE-1.6 [**2179-7-13**] 04:15AM GLUCOSE-167* UREA N-28* CREAT-1.5* SODIUM-136 POTASSIUM-5.3* CHLORIDE-102 TOTAL CO2-24 ANION GAP-15 [**2179-7-13**] 04:15AM proBNP-950* [**2179-7-13**] 04:15AM WBC-27.7* RBC-4.84 HGB-13.5* HCT-40.7 MCV-84 MCH-27.9 MCHC-33.2 RDW-17.5* [**2179-7-13**] 04:15AM PLT COUNT-385 [**2179-7-13**] 09:10PM WBC-26.0* RBC-4.52* HGB-12.7* HCT-38.0* MCV-84 MCH-28.0 MCHC-33.3 RDW-17.5* [**2179-7-27**] 04:39AM BLOOD WBC-16.9* RBC-3.30* Hgb-9.6* Hct-27.8* MCV-84 MCH-29.1 MCHC-34.4 RDW-17.3* Plt Ct-374 [**2179-7-23**] 03:44AM BLOOD Neuts-87.4* Lymphs-7.3* Monos-2.8 Eos-1.9 Baso-0.6 [**2179-7-27**] 04:39AM BLOOD Plt Ct-374 [**2179-7-21**] 11:28AM BLOOD Fibrino-732* [**2179-7-27**] 04:39AM BLOOD UreaN-23* Creat-1.1 K-3.6 [**2179-7-26**] 12:01AM BLOOD CK(CPK)-157 [**2179-7-13**] 09:10PM BLOOD ALT-24 AST-49* LD(LDH)-239 CK(CPK)-3981* AlkPhos-97 Amylase-27 TotBili-0.4 [**2179-7-25**] 04:19PM BLOOD CK-MB-4 [**2179-7-25**] 03:34AM BLOOD cTropnT-0.11* [**2179-7-20**] 01:52PM BLOOD CK-MB-3 cTropnT-0.30* [**2179-7-20**] 05:30AM BLOOD CK-MB-3 cTropnT-0.33* [**2179-7-14**] 05:09AM BLOOD calTIBC-209* Hapto-417* Ferritn-293 TRF-161* [**2179-7-16**] 10:40AM BLOOD Cortsol-49.6* [**2179-7-25**] 04:01AM BLOOD Type-ART Temp-36.6 O2 Flow-4 pO2-60* pCO2-39 pH-7.42 calTCO2-26 Base XS-0 Intubat-NOT INTUBA Vent-SPONTANEOU [**2179-7-21**] 12:22PM BLOOD freeCa-1.10* . PICC LINE PLACMENT SCH [**2179-7-26**] 2:34 PM IMPRESSION: Uncomplicated ultrasound-guided dual-lumen PICC line placement via the right basilic venous approach. Final internal length is 45 cm, with the tip positioned in the SVC seen on portable chest radiograph. The line is ready to use. . Cardiology Report ECG Study Date of [**2179-7-22**] 1:11:52 PM . Sinus rhythm. Frequent ventricular premature beats. Left atrial abnormality. Left axis deviation with left anterior fascicular block. Right bundle-branch block. Low QRS voltage in the precordial leads. Compared to the previous tracing of [**2179-7-20**] frequent ventricular premature beats are more prominent. . CHEST (PORTABLE AP) [**2179-7-22**] 7:36 AM . Patient is markedly rotated. Endotracheal tube, left internal jugular vein line, right subclavian line, and nasogastric tube are probably unchanged; tip of nasogastric tube is not visualized on this study. Vertical staple line, probably down pt's back. Changes of CABG, with multiple broken cerclage wires. Both extreme costophrenic angles are excluded from the study, however, appearance of cardiomegaly and pulmonary vascular congestion is similar to the previous study. No definite pneumothorax. Probable small layering left pleural effusion. . ECHO Study Date of [**2179-7-16**] : . Conclusions: Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is normal (LVEF>55%). Extremely limited study. . IMPRESSION: Unable to exclude endocarditis given extremely limited views. If clinically indicated, a transesophageal study could be done. . Brief Hospital Course: A/P: 61 yo male with lower extremity paralysis and back pain with C7-T8 epidural abscess s/p washout, laminectomy T2-T10 on [**2179-7-21**]. . # Epidural abscess. The patient underwent a T2-T10 washout, laminectomy on [**2179-7-21**] by our neurosurgery service. He will follow up with Dr. [**Last Name (STitle) **] in 4 weeks. He will need an outpatient CT of his spine to assess interval improvement before his follow up appointment with Dr. [**Last Name (STitle) **]. - Surveillance blood cultures have been negative since [**2179-7-13**] and kast grew MSSA growth on [**7-13**]. On discharge, the patient was on Nafcillin day 9 of antibiotics on [**2179-7-26**]. Total 6 weeks of antibiotics. - The patient remains afebrile, however, WBC still elevated but stable at 16 on discharge. . # Respiratory failure: - The patient was intubated electively for transport to his MRI at Shields. He remained on the ventilator with a large PEEP requirement whichw as felt to be secondary to his body habitus. - He remained intubated for the OR on [**2179-7-21**]. Subsequently, he was quickly extubated without further events. - He has intermittent shortness of breath at baseline which was felt to be secondary to atelectasis. He has a known diagnosis of obstructive sleep apnea but did not use his BIPAP at home. He may benefit from intermittent BIPAP at night at the rehab. - On discharge, the patient was sat'ing 93% on 2 liters O2 with a productive cough with no signs of CHF or infiltrate on chest xray. . # Hypotension, unresponsive episode while intubated - The patient had an episode of hypotension on [**2179-7-19**] while intubated from SBP 130 to 80s that required IV bolus of fluid and short run of neosynephrine to maintain his pressures. The patient was intubated and sedated during this time. His fentanyl and versed were immediately discontinued and narcan was administered with good effect. It was felt that this episode was secondary to oversedation with depots of sedatives in subcutaneous fat that contributed to a cumulative overdose despite the fact that the patient had not received additional sedation during this time. EKG was unremarkable but the patient did have a bump in his cardiac enzymes to 0.33 which remained flat. He was not treated for ACS as this was felt to be secondary to demand in the setting of hypotension that an acute plaque burden. . # Leukocytosis- Felt to be secondary to his epidural abscess. WBC 16-17 on discharge. . # Diabetes- insulin dependent x 15 years. Initially was on lantus and HSSI which was later switched to insulin gtt while in the ICU for tight blood sugar control. - BS mid 100s on insulin gtt. [**Month (only) 116**] maintain peri-operatively for now. - He was continued on a sliding scale insulin and his lantus was increased to 50 units glargine on [**2179-7-25**] with stable blood sugars on discharge. . # Cardiac 1. Vessels- history of MI/ CABG x4. In the setting of a hypotensive, unresponsive episode related to oversedation, the patient was found to have an elevated troponin with no EKG changes and flat at 0.33, 0.3. He had an episode of atypical bilateral chest pain on [**2179-7-25**] with no associated symptoms that was reproducible with palpation and worse with movement. - [**Month (only) 116**] restart ASA 325 mg on 60-23-07 per neurosurgery. - . 2. Pump- EF >55%. - The patient was diuresed towards the end of his stay with 20 mg IV lasix per day with -500 to 1 liter negative. - Lasix 40 mg PO QD was restarted on [**2179-7-26**] upon discharge. . # FEN- diabetic, cardiac, monitor lytes. . # Proph- hep SQ TID, H2 blocker . # Access- A line- d/c'd, right subclavian central line dc'd, left IJ double lumen placed [**2179-7-21**] - Dc'd on [**2179-7-26**]. PICC placed by IR on [**2179-7-26**]. . # Code- full, however, the patient expressed the desire with [**State 622**] present to not experience a prolonged intubation . # [**Name (NI) 2638**] Brother [**Name (NI) **] [**Telephone/Fax (1) 92805**] and girlfriend [**Name (NI) 622**] [**Telephone/Fax (1) 92806**] (HCP) Medications on Admission: Percocet, ASA, Zantac, Avapro. Atenolol 25mg daily Avapro 300mg qday lasix 80mg daily glucophage 100mg [**Hospital1 **] lantus 90 units daily lipitor 40mg daily ASA Percocet 5mg daily/prn Talwin i tab daily Discharge Medications: 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 2. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 3. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every 8 hours) as needed. 4. Nicotine 21 mg/24 hr Patch 24 hr Sig: [**2-9**] Patch 24 hrs Transdermal DAILY (Daily). 5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 6. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day). 7. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Losartan 25 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 9. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed). 10. Morphine 30 mg Tablet Sustained Release Sig: Two (2) Tablet Sustained Release PO Q12H (every 12 hours). 11. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 12. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. Heparin Flush CVL (100 units/ml) 1 ml IV DAILY:PRN 10ml NS followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen QD and PRN. Inspect site every shift 14. Nafcillin 2 gm IV Q4H Day 1 [**7-17**] 15. Sodium Chloride 0.9% Flush 3 ml IV DAILY:PRN Peripheral IV - Inspect site every shift 16. Heparin (Porcine) 10,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 17. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 18. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as needed. 19. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). 20. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1) Inhalation Q4H (every 4 hours). 21. Ipratropium Bromide 0.02 % Solution Sig: [**2-9**] Inhalation Q4-6H (every 4 to 6 hours). 22. insulin Sliding scale and lantus 50 QHS Discharge Disposition: Extended Care Facility: [**Hospital1 **] [**Hospital1 **] Discharge Diagnosis: C7-T8 epidural abscess Paraplegia Discharge Condition: Stable. On 2 liters O2 with sats of 93-97% Discharge Instructions: [**Month (only) 116**] resume aspirin 325 mg 7-14 days post-operative [**2179-7-21**]. Will continue IV nafcillin for at least a total of 6 weeks. Follow up with Dr. [**Last Name (STitle) **] in 4 weeks. Followup Instructions: The patient should have his staples removed on [**2179-8-4**]. He should follow up with Dr. [**Last Name (STitle) **] in 4 weeks. Please call [**Telephone/Fax (1) 92807**] to schedule this appointment. The patient should have a CT of his spine prior to seeing Dr. [**Last Name (STitle) **].

038,324,518,585,584,785,482,428,995,278,V458,412,274,356,344,780,E935,250,933,E912

{'Methicillin susceptible Staphylococcus aureus septicemia,Intraspinal abscess,Acute respiratory failure,Chronic kidney disease, unspecified,Acute kidney failure with lesion of tubular necrosis,Septic shock,Methicillin susceptible pneumonia due to Staphylococcus aureus,Congestive heart failure, unspecified,Severe sepsis,Morbid obesity,Aortocoronary bypass status,Old myocardial infarction,Gout, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Paraplegia,Altered mental status,Other opiates and related narcotics causing adverse effects in therapeutic use,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Foreign body in larynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation'}

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: lower extremity weakness, paralysis, back pain PRESENT ILLNESS: Pt intubated and sedated on arrival to MICU, history obtained from ED record and girlfriend. 61 yo male diabetic x 15 years who presents to ED with bilateral lower extremity weakness and back pain for the past 2 days. According to his girlfriend, pt had been in his usual state of health except for a flare of his neuropathy and gout on [**Hospital1 107**] day weekend, who developed right sided back pain about two days ago after heavy lifting. Yesterday the patient was unable to lie down and had to sit at the side of his bed for about 24 hours. He was able to ambulate to the bathroom at 9 am, but complained of "pain all over". He had been prescribed Percocets following removal of a R callus by podiatry, and took four of the percocet yesterday for pain relief. This morning he was unable to get out of bed secondary to loss of sensation in his feet, legs, and buttock region. Typically ambulates limited distance with cane. His girlfriend called 911 and he was taken to [**Hospital1 **] and transferred to ED for further evaluation. . In the [**Name (NI) **], pt found to have a leukocytosis, febrile to 100.3 max. Concern for epidural abscess was raised given history of diabetes. Neurosurgery and neurology were consulted, patient found to have flaccid paraplegia, poor rectal tone, absent reflexes in the legs, T4-T6 sensation level, and weak cough; rec stat imaging at [**Hospital6 **] as pt body habitus too large to fit into CT/MRI scanner here. Pt was electively intubated for CT, sent to [**Hospital6 1708**], however, because of his obesity, this was unable to be done as he could not fit on the fluoro table, and a regular CT was done instead. The patient was started on Vanc/ Zosyn along with 2 liters of IVF and transferred to the MICU with plans to undergo an open MRI at Shields MRI in [**Location (un) 583**]. MEDICAL HISTORY: Diabetes- insulin dependent x 15 years MI 5 yrs ago CABG x 4 5 years ago Chronic back pain neuropathy- unable to feel the bottom of his feet gout MEDICATION ON ADMISSION: Percocet, ASA, Zantac, Avapro. Atenolol 25mg daily Avapro 300mg qday lasix 80mg daily glucophage 100mg [**Hospital1 **] lantus 90 units daily lipitor 40mg daily ASA Percocet 5mg daily/prn Talwin i tab daily ALLERGIES: Macrolide Antibiotics / Ambien PHYSICAL EXAM: vitals: 179 kg/temp 99.4/bp 109/51/ hr 76/ 100% vent settings: AC/ 100% FiO2/ 14/ 650-698/ PEEP 15 GEN: sedated, will respond to some questions, intubated, obese HEENT: atraumatic, anicteric, pupils constricted but equal and reactive NECK: unable to appreciate JVP, no LAD CV: soft precordium, RRR, no murmurs. CABG scar on chest LUNGS: CTA B/L, distant BS ABD: soft, nt, NABS, no organomegaly appreciated EXT: warm, dry. DP pulses dopplerable. Lower extremities with chronic venous stasis changes, dry, cracked skin. Hyperpigmentation. Right callous on great toe, appears clean, no frank pus NEURO: arousable, responsive to some commands, no myoclonus, toes mute bilaterally, unable to move extremities FAMILY HISTORY: brother died of cancer, unknown cause SOCIAL HISTORY: quit ETOH after CABG, 2 PPD smoker x 5 years, retired [**Hospital1 **] rep, has two sons but limited contact. Widowed 15 years ago, now lives with his girlfriend. ### Response: {'Methicillin susceptible Staphylococcus aureus septicemia,Intraspinal abscess,Acute respiratory failure,Chronic kidney disease, unspecified,Acute kidney failure with lesion of tubular necrosis,Septic shock,Methicillin susceptible pneumonia due to Staphylococcus aureus,Congestive heart failure, unspecified,Severe sepsis,Morbid obesity,Aortocoronary bypass status,Old myocardial infarction,Gout, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Paraplegia,Altered mental status,Other opiates and related narcotics causing adverse effects in therapeutic use,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Foreign body in larynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation'}

CHIEF COMPLAINT: Admitted due to failure of out-pt treatment of Pneumonia w/ levaquin. PRESENT ILLNESS: Mr. [**Known lastname **] is a [**Age over 90 **] yo male with dementia, admitted from a NH b/c he is failing out-patient management of a pneumonia. It is unclear where and when he was diagnosed with this pneumonia, but per the ED's coversation with the NH, he has "failed" tx with levaquin. He was also reportedly dehydrated. In the ED, VS were T 99.8, BP , HR and satting 99% 5L. He received doses of ceftriaxone and flagyl. . In addition, he had right-sided rib fractures noted on CXR; NH said he had a fall three weeks ago. CT chest done in ED showed acute fractures that appeared less than three weeks, but there is no other history documenting a more recent fall. He has spine films that were clear, and trauma saw him and recommended an epidural for pain control. MEDICAL HISTORY: Aspiration PNA Hiatal hernia Pneumonia GERD Dementia Anemia MEDICATION ON ADMISSION: prilosec 20mg daily levofloxacin 500mg daily prozac 10mg qday risperdal 0.125mg daily (decreased from 0.25 on [**7-4**]) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VITAL SIGNS: T = 96.3, BP = 125/71:, P = 73:, RR= 20:, O2Sat= 93% on RA confirmed myself:, BM - unclear when his last BM was : FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Lives at [**Location **], widowed, no living children. He has a nephew, [**Name (NI) **] and a brother. [**Name (NI) **] is actively involved in caring for him and has been making his health care decisions.

Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Closed fracture of multiple ribs, unspecified,Unspecified fall,Other persistent mental disorders due to conditions classified elsewhere,Esophageal reflux,Personal history of noncompliance with medical treatment, presenting hazards to health

Food/vomit pneumonitis,Acute kidney failure NOS,Hyperosmolality,Fx mult ribs NOS-closed,Fall NOS,Mental disor NEC oth dis,Esophageal reflux,Hx of past noncompliance

Admission Date: [**2152-7-6**] Discharge Date: [**2152-7-11**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2167**] Chief Complaint: Admitted due to failure of out-pt treatment of Pneumonia w/ levaquin. Major Surgical or Invasive Procedure: none History of Present Illness: Mr. [**Known lastname **] is a [**Age over 90 **] yo male with dementia, admitted from a NH b/c he is failing out-patient management of a pneumonia. It is unclear where and when he was diagnosed with this pneumonia, but per the ED's coversation with the NH, he has "failed" tx with levaquin. He was also reportedly dehydrated. In the ED, VS were T 99.8, BP , HR and satting 99% 5L. He received doses of ceftriaxone and flagyl. . In addition, he had right-sided rib fractures noted on CXR; NH said he had a fall three weeks ago. CT chest done in ED showed acute fractures that appeared less than three weeks, but there is no other history documenting a more recent fall. He has spine films that were clear, and trauma saw him and recommended an epidural for pain control. Past Medical History: Aspiration PNA Hiatal hernia Pneumonia GERD Dementia Anemia Social History: Lives at [**Location **], widowed, no living children. He has a nephew, [**Name (NI) **] and a brother. [**Name (NI) **] is actively involved in caring for him and has been making his health care decisions. Family History: Noncontributory Physical Exam: VITAL SIGNS: T = 96.3, BP = 125/71:, P = 73:, RR= 20:, O2Sat= 93% on RA confirmed myself:, BM - unclear when his last BM was : GENERAL: grooming OK, hygiene- OK , mentation- alert, somnolent but can be aroused. HEENT: NCAT,EOMI,PERRL, dry oral mucosa with crusted dried crusted secretions. Cerumen impacted with wax b/l. NECK: thyroid not palpable, no cervical LAD, carotid pulse 2+B, no JVD RESP: Decreased BS througout but poor exam as patient could not consistently obey commands to take deep breaths. He coughs up thick secretions which I am able to suction but he is unable to completely expectorate. COR: S1S2, rrr, no murmur ABD: +BS, soft, nontender, non-distended, no HSM Rectal: vault full of soft stool. Guiac negative. PULSES: 1 R DPP, none appreicated on the right. EXT: no cyanosis, clubbing or edema. SKIN: no rash, lesion or ulceration NEURO: A an O to self only. Simple one word answers, inattentive, Cranial nerve II through XII: grossly nonfocal, - increased cogwheeling of the upper extremities - brisk 2+ biceps reflexes b/l. No reflexes in lower extremities. - muscle strength 5/5 in bilateral upper and lower extremities Pertinent Results: Imaging: CXR [**7-6**]: Acute fractures involving the anterolateral right eighth through tenth ribs. Bibasilar atelectasis with no definite pneumonia. CT HEAD [**7-6**]: 1.No evidence of acute intracranial hemorrhage or fracture. 2. Cerebral atrophy consistent with stated age and small vessel angiopathy. CT chest/abdomen/pelvis: 1. Multiple right-sided rib fractures extending from 8th through 12th ribs as described above without pneumothorax, pulmonary contusion or pleural effusion. 2. Bibasilar consolidations more dense on the right side could reflect atelectasis, however, acute on chronic aspiration/pneumonia cannot be excluded. 3. Stable enlargement of the prostate gland. . [**2152-7-6**] GLUCOSE-136* UREA N-40* CREAT-2.3* SODIUM-147* POTASSIUM-4.2 CHLORIDE-114* TOTAL CO2-20* ANION GAP-17 [**2152-7-6**] ALT(SGPT)-14 AST(SGOT)-25 ALK PHOS-110 TOT BILI-0.5 [**2152-7-6**] LIPASE-38 [**2152-7-6**] ALBUMIN-3.3* CALCIUM-8.9 PHOSPHATE-3.8 MAGNESIUM-2.7* [**2152-7-6**] WBC-19.9*# RBC-5.13 HGB-14.3 HCT-43.0 MCV-84 MCH-27.9 MCHC-33.3 RDW-14.2 [**2152-7-6**] NEUTS-92.4* LYMPHS-5.8* MONOS-1.7* EOS-0.1 BASOS-0.1 [**2152-7-6**] PLT COUNT-534*# Brief Hospital Course: [**Known firstname **] [**Known lastname **] is a [**Age over 90 **] yo male who is a nursing home resident with dementia who was admitted with bilat lower lobe infiltrates after failed out-patient treatment of PNA. Patient was found to have bibasilar consolidation on chest CT with an oxygen requirement, and was on levofloxacin as an outpatient. He had a leukocytosis to 18 prior to admission, and was given vancomycin and ceftriaxone, with improvement in his symptoms. He was initially admitted to the [**Hospital Unit Name 153**], and was then transferred to the floor for continuation of antibiotics. His blood cultures were negative, and he will need to complete a 7 day course of antibiotics. A PICC line was placed for this indication. He was seen by speech and swallow due to concern for aspiration. He had a video swallow evaluation performed, which showed silent aspiration. A discussion with the health care proxy confirmed that a feeding tube was not something that the patient would wish for, and he was given nectar thickened liquids and a pureed diet with aspiration precautions with the understanding that he is at risk to aspirate. He was noted to have multiple acute rib fractures on chest CT. He denied any pain. He was given pain control with tylenol, and encouraged to use an incentive spirometer and placed on falls precautions. He was asymptomatic, on room air, at discharge. He was evaluated by trauma surgery, who recommended conservative management. He was hypernatremic and had acute renal failure which resolved, which resolved with IV fluids. He remained DNR/DNI during his admission. Medications on Admission: prilosec 20mg daily levofloxacin 500mg daily prozac 10mg qday risperdal 0.125mg daily (decreased from 0.25 on [**7-4**]) Discharge Medications: 1. Fluoxetine 10 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 2. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours). 3. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 4. Acetaminophen 160 mg/5 mL Solution Sig: Six [**Age over 90 1230**]y (650) mg PO Q 8H (Every 8 Hours): until no further pain from rib fractures. Disp:*100 cc* Refills:*2* 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal HS (at bedtime) as needed. 7. Vancomycin 500 mg Recon Soln Sig: One (1) Recon Soln Intravenous Q48H (every 48 hours) for 2 doses. 8. Ceftriaxone 1 gram Recon Soln Sig: One (1) injection Intravenous once a day for 4 doses. 9. PICC line care PICC line care per protocol. D/C PICC line after four days when antibiotics are complete. 10. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 11. Risperdal 0.25 mg Tablet Sig: [**1-5**] Tablet PO once a day. 12. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) injection Injection three times a day. Discharge Disposition: Extended Care Facility: [**Hospital **] [**Hospital **] Nursing Home - [**Location (un) **] Discharge Diagnosis: Aspiration Pneumonia Multiple rib fractures Acute renal failure Hypernatremia Aspiration, silent Discharge Condition: Stable Discharge Instructions: You were admitted to the hospital with pneumonia. You were treated with intravenous antibiotics, O2 and nebulizer breathing treatments. If you develop shortness of breath, fevers, chills, or chest pain, please call your primary care doctor or go to the emergency room. Followup Instructions: Provider: [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2152-7-17**] 3:30

507,584,276,807,E888,294,530,V158

{'Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Closed fracture of multiple ribs, unspecified,Unspecified fall,Other persistent mental disorders due to conditions classified elsewhere,Esophageal reflux,Personal history of noncompliance with medical treatment, presenting hazards to health'}

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: Admitted due to failure of out-pt treatment of Pneumonia w/ levaquin. PRESENT ILLNESS: Mr. [**Known lastname **] is a [**Age over 90 **] yo male with dementia, admitted from a NH b/c he is failing out-patient management of a pneumonia. It is unclear where and when he was diagnosed with this pneumonia, but per the ED's coversation with the NH, he has "failed" tx with levaquin. He was also reportedly dehydrated. In the ED, VS were T 99.8, BP , HR and satting 99% 5L. He received doses of ceftriaxone and flagyl. . In addition, he had right-sided rib fractures noted on CXR; NH said he had a fall three weeks ago. CT chest done in ED showed acute fractures that appeared less than three weeks, but there is no other history documenting a more recent fall. He has spine films that were clear, and trauma saw him and recommended an epidural for pain control. MEDICAL HISTORY: Aspiration PNA Hiatal hernia Pneumonia GERD Dementia Anemia MEDICATION ON ADMISSION: prilosec 20mg daily levofloxacin 500mg daily prozac 10mg qday risperdal 0.125mg daily (decreased from 0.25 on [**7-4**]) ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VITAL SIGNS: T = 96.3, BP = 125/71:, P = 73:, RR= 20:, O2Sat= 93% on RA confirmed myself:, BM - unclear when his last BM was : FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Lives at [**Location **], widowed, no living children. He has a nephew, [**Name (NI) **] and a brother. [**Name (NI) **] is actively involved in caring for him and has been making his health care decisions. ### Response: {'Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Closed fracture of multiple ribs, unspecified,Unspecified fall,Other persistent mental disorders due to conditions classified elsewhere,Esophageal reflux,Personal history of noncompliance with medical treatment, presenting hazards to health'}

CHIEF COMPLAINT: worsening SOB, cough PRESENT ILLNESS: 80 year old male with history of PE ([**2-28**], on lovenox), recurrent PNA, and COPD requring home O2 with a chief complaint of worsening shortness of breath with acute respiratory distress at 5am. Due to pt's recurrent PNA he had been treated with suppressive bactrim therapy until 10 days ago when his pulmonologist (Dr. [**Last Name (STitle) **] tried a trial off Bactrim. Then, 5 days prior to admission he noted increased mucous production, which was thick and white, not purulent or blood streaked. He had some worsening cough with eating, but refuses any coughing with eating at baseline, denies any known aspiration prior to this, states he had a normal barium swallow in [**Month (only) 359**]. On the morning of admission he was very dyspneic, and felt similar to previous times he had PNA. He called an ambulance, and EMS found the pt tachypneic and diaphoretic with BP 200/p. He was given two SL NG and 80mg Lasix en route to [**Hospital3 **]. At [**Name (NI) 620**] pt found to have pneumonia and CHF. Pt has a h/o klebsiella, MRSA, [**Name (NI) **] and pseudomonas in sputum. Given azith, ceftriax, levo, solumedrol. Then transferred from [**Location (un) 620**] secondary to no in patient beds. . He had a PNA vaccine and influenza vaccine this year. He had no sick contacts. he denies fever, [**Last Name (un) 9507**], HA, myalgia, CP, nausea, vommiting, diarrhea, abdominal pain. He has a good appetite. At baseline he can only walk a few steps before becoming SOB. He uses 3L O2 at home at rest. He requires a wheelchair to get around. . In the [**Hospital1 18**] ED VS: 97.9, 158/69, 97, 99% on Neb. Found to have a large L infiltrate, gave nebs, lasix, Vanc, and his dose of lovenox. He continued to be dyspneic and was started on bipap with much improvement in dyspnea. He was then transfered to the [**Hospital Unit Name 153**] for continued management of resp distress and PNA. . MEDICAL HISTORY: `PE - dx [**2106-2-21**], on coumadin `COPD - per patient was severe based on PFTs at [**Hospital1 **] 3 yrs ago, on 3L O2 at home. States he is unable to walk 100 ft without becoming SOB. `CAD (per records, no h/o MI or cardiac cath) `Atrial fibrillation `HTN `BPH `Hypothyroidism s/p partial thyroidectomy `h/o Klebsiella, MRSA, Pseudomonas, and [**Hospital1 **] infections `s/p appy `s/p laminectomy `s/p right partial hip replacement `s/p bowel obstruction s/p SB resection MEDICATION ON ADMISSION: mucinex 600 [**Hospital1 **] zocor 40 flomax 0.4 mg singular 10 mg protonix 40 mg [**Hospital1 **] Proscar 5 mg Vit D 400 units Lisinopril 20 mg Synthroid 0.075 Albuterol neb tiazac 360 mg prednisone 30 mg lovenox 40 mg ALLERGIES: Amoxicillin PHYSICAL EXAM: ON ADMISSION: VS: Temp:98.3 BP: 163/57 HR:93 RR:22 O2sat 95% 4LNC GEN: pleasant, tachypneic, NAD HEENT: PERRL, EOMI, anicteric, dry MM, op without lesions NECK: obese, supple, unable to appreciate jvp, no carotid bruits, no thyromegaly or thyroid nodules RESP: +End Exp wheeze throughout with coarse crackles at bil bases R>L with good air movement throughout CV: RR, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: 3+ pitting edema of bil LE and RUE. +skin breakdown on dorsal aspect of Right hand. SKIN: no rashes/no jaundice NEURO: AAOx3. Cn II-XII intact. FAMILY HISTORY: Father with lung CA. Mother with HTN, [**Name (NI) 10322**], and CVA. Sister with ovarian CA. Brother with brain CA. SOCIAL HISTORY: Tobacco: 67 yrs, 1.5 ppd Alcohol: Denies Retired child psychiatrist and member of Army.

Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants

Pneumonia, organism NOS,Obs chr bronc w(ac) exac,Obstructive sleep apnea,BPH w/o urinary obs/LUTS,Atrial fibrillation,Hypertension NOS,Hypothyroidism NOS,Esophageal reflux,Hx-ven thrombosis/embols,Long-term use anticoagul

Admission Date: [**2106-12-12**] Discharge Date: [**2106-12-16**] Date of Birth: [**2026-7-24**] Sex: M Service: MEDICINE Allergies: Amoxicillin Attending:[**First Name3 (LF) 1674**] Chief Complaint: worsening SOB, cough Major Surgical or Invasive Procedure: none History of Present Illness: 80 year old male with history of PE ([**2-28**], on lovenox), recurrent PNA, and COPD requring home O2 with a chief complaint of worsening shortness of breath with acute respiratory distress at 5am. Due to pt's recurrent PNA he had been treated with suppressive bactrim therapy until 10 days ago when his pulmonologist (Dr. [**Last Name (STitle) **] tried a trial off Bactrim. Then, 5 days prior to admission he noted increased mucous production, which was thick and white, not purulent or blood streaked. He had some worsening cough with eating, but refuses any coughing with eating at baseline, denies any known aspiration prior to this, states he had a normal barium swallow in [**Month (only) 359**]. On the morning of admission he was very dyspneic, and felt similar to previous times he had PNA. He called an ambulance, and EMS found the pt tachypneic and diaphoretic with BP 200/p. He was given two SL NG and 80mg Lasix en route to [**Hospital3 **]. At [**Name (NI) 620**] pt found to have pneumonia and CHF. Pt has a h/o klebsiella, MRSA, [**Name (NI) **] and pseudomonas in sputum. Given azith, ceftriax, levo, solumedrol. Then transferred from [**Location (un) 620**] secondary to no in patient beds. . He had a PNA vaccine and influenza vaccine this year. He had no sick contacts. he denies fever, [**Last Name (un) 9507**], HA, myalgia, CP, nausea, vommiting, diarrhea, abdominal pain. He has a good appetite. At baseline he can only walk a few steps before becoming SOB. He uses 3L O2 at home at rest. He requires a wheelchair to get around. . In the [**Hospital1 18**] ED VS: 97.9, 158/69, 97, 99% on Neb. Found to have a large L infiltrate, gave nebs, lasix, Vanc, and his dose of lovenox. He continued to be dyspneic and was started on bipap with much improvement in dyspnea. He was then transfered to the [**Hospital Unit Name 153**] for continued management of resp distress and PNA. . Past Medical History: `PE - dx [**2106-2-21**], on coumadin `COPD - per patient was severe based on PFTs at [**Hospital1 **] 3 yrs ago, on 3L O2 at home. States he is unable to walk 100 ft without becoming SOB. `CAD (per records, no h/o MI or cardiac cath) `Atrial fibrillation `HTN `BPH `Hypothyroidism s/p partial thyroidectomy `h/o Klebsiella, MRSA, Pseudomonas, and [**Hospital1 **] infections `s/p appy `s/p laminectomy `s/p right partial hip replacement `s/p bowel obstruction s/p SB resection Social History: Tobacco: 67 yrs, 1.5 ppd Alcohol: Denies Retired child psychiatrist and member of Army. Family History: Father with lung CA. Mother with HTN, [**Name (NI) 10322**], and CVA. Sister with ovarian CA. Brother with brain CA. Physical Exam: ON ADMISSION: VS: Temp:98.3 BP: 163/57 HR:93 RR:22 O2sat 95% 4LNC GEN: pleasant, tachypneic, NAD HEENT: PERRL, EOMI, anicteric, dry MM, op without lesions NECK: obese, supple, unable to appreciate jvp, no carotid bruits, no thyromegaly or thyroid nodules RESP: +End Exp wheeze throughout with coarse crackles at bil bases R>L with good air movement throughout CV: RR, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: 3+ pitting edema of bil LE and RUE. +skin breakdown on dorsal aspect of Right hand. SKIN: no rashes/no jaundice NEURO: AAOx3. Cn II-XII intact. Pertinent Results: LABS ON ADMISSION [**2106-12-12**] 01:15PM WBC-12.2*# RBC-3.16* HGB-9.3* HCT-29.4* MCV-93 MCH-29.5 MCHC-31.7 RDW-17.2* [**2106-12-12**] 01:15PM NEUTS-94.9* BANDS-0 LYMPHS-1.9* MONOS-2.8 EOS-0.3 BASOS-0.1 [**2106-12-12**] 01:15PM PLT SMR-NORMAL PLT COUNT-152 [**2106-12-12**] 01:15PM PT-12.0 PTT-20.7* INR(PT)-1.0 [**2106-12-12**] 01:15PM GLUCOSE-160* UREA N-25* CREAT-0.9 SODIUM-143 POTASSIUM-4.1 CHLORIDE-99 TOTAL CO2-33* ANION GAP-15 [**2106-12-12**] 11:24PM TYPE-ART PO2-121* PCO2-59* PH-7.46* TOTAL CO2-43* BASE XS-15 INTUBATED-NOT INTUBA [**2106-12-12**] 12:55PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.006 [**2106-12-12**] 12:55PM URINE BLOOD-LG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-TR [**2106-12-12**] 12:55PM URINE RBC-[**10-13**]* WBC-[**1-26**] BACTERIA-RARE YEAST-NONE EPI-0 [**2106-12-12**] 12:55PM URINE WBCCLUMP-OCC IMAGING Port CXR [**12-12**] - Large dense right lower lobe opacity with less dense surrounding opacity. Given the density of this lesion, the two most likely considerations are dense pneumonia or an underlying mass. Both entities could also be a possibility. Recommend further evaluation with chest CT. RUE US [**12-13**] - Grayscale, color, and pulsed wave Doppler son[**Name (NI) 1417**] were performed on the right internal jugular, subclavian, axillary, brachial, and cephalic veins. Evaluation is slightly limited as the patient is not able to lie flat, and exam was performed with the patient sitting in a chair. The right arm is diffusely edematous, with 3+ pitting edema on physical exam. IMPRESSION: No DVT in the right upper extremity. TTE [**12-13**] - The left atrium is mildly dilated. The right atrial pressure is indeterminate. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal for the patient's body size. Regional left ventricular wall motion is normal. Left ventricular systolic function is hyperdynamic (EF>75%). The estimated cardiac index is normal (>=2.5L/min/m2). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened. There is no valvular aortic stenosis. The increased transaortic velocity is likely related to high cardiac output. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. Compared with the prior study (images reviewed) of [**2106-3-22**], the moderate left ventricular hypertrophy and mild estimated pulmonary arterial hypertension are now better appreciated. Chest CTA [**12-14**] - 1. No evidence of pulmonary embolism. 2. Consolidation within the posterior right upper lobe, with debris seen within the central airways, and right hilar adenopathy. These findings are most suspicious for aspiration pneumonia atop underlying emphysema. 3. Moderately severe centrilobular emphysema. 4. Dependent atelectasis in both lower lobes, with small bilateral pleural effusions. Regions of superimposed infection cannot be excluded. 5. No underlying lung mass seen, although portions of the lungs may be masked by the consolidation and atelectasis. 6. Coronary artery calcifications. 7. Enlarged thyroid as previously described Brief Hospital Course: The patient was admitted to the [**Hospital Unit Name 153**] for RLL PNA and COPD flare. #) Dyspnea, RLL opacity - On arrival, he was initially on BIPAP for dyspnea and hypoxia, which was weaned off to oxygen via nasal cannula on the day of admission. He was given a dose of solumedrol IV in the emergency room and was started on a slow prednisone taper as well as standing nebs. The patient was also started on levofloxacin to cover for CAP with improvement in his symptoms and O2 requirement. He was also restarted on CPAP at night for likely OSA. A speech and swallow evaluation was concerning for aspiration and suggested soft pureed foods only. A chest CTA was obtained due to the patient's relatively [**Name2 (NI) 61519**] consolidation seen on admission CXR to rule out an underlying lung mass showed likely consolidation pneumonia. He was discharged to continue a total 14 day course of levofloxacin, told to take prednisone 40 mg for the next 3 days, then reduce to Prednisone 30 mg per day until he sees his pulmonologist. He was told to restart his Bactrim as suggested by his primary pulmonologist, Dr. [**Last Name (STitle) **]. # OSA: Sleep study from [**2097**] obtained from Dr.[**Name (NI) 61520**] office showed OSA with recommendations of CPAP at night with 9cm H2O. He was restarted on CPAP and told to continue this at home with nasal delivery device. # PE - Diagnosed in [**2106-2-21**]. Continued on lovenox at prophylactic home dose given pt's relative immobility. #. Paroxysmal Atrial fibrillation: Not currently being anticoagulated with warfarin as he is only on lovenox at prophylactic dose. Was rate controlled with diltiazem during [**Hospital Unit Name 153**] course. #. HTN: Continued home doses of lisinopril and diltiazem. #. BPH: Continued proscar and flomax. #. Hypothyroidism s/p partial thyroidectomy - Continued home dose of synthroid. #. Bilateral LE lymphedema and RUE lyphedema: Pt had a repeat TTE showing no signs of systolic failure but signs of diastolic failure and mild PA systolic HTN. He also had a RUE U/S that ruled out RUE DVT given R > L upper extremity edema. He was continued on compression stockings. #. Hyperlipidemia: Continued zocor. #. GERD: Continued home PPI. Medications on Admission: mucinex 600 [**Hospital1 **] zocor 40 flomax 0.4 mg singular 10 mg protonix 40 mg [**Hospital1 **] Proscar 5 mg Vit D 400 units Lisinopril 20 mg Synthroid 0.075 Albuterol neb tiazac 360 mg prednisone 30 mg lovenox 40 mg Discharge Medications: 1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 9 days. [**Hospital1 **]:*9 Tablet(s)* Refills:*0* 2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Guaifenesin 600 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO BID (2 times a day). 4. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 7. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 9. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation Q6H (every 6 hours). 11. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO DAILY (Daily). 12. Vitamin D 400 unit Tablet Sig: One (1) Tablet PO twice a day. 13. Lovenox Continue the same dose you are on as prior to admission. 14. Prednisone 10 mg Tablet Sig: 3-4 tablets Tablets PO once a day: Start 4 tablets a day on [**12-17**] for 3 days then 3 tablets a day until you see your PCP. [**Name Initial (NameIs) **]:*72 Tablet(s)* Refills:*0* 15. CPAP Please provide CPAP with nasal delivery mask at 9cm H2O at bedtime. Discharge Disposition: Home With Service Facility: [**Hospital 2255**] [**Name (NI) **] Discharge Diagnosis: pneumonia COPD flare Discharge Condition: stable Discharge Instructions: Please call your PCP or pulmonologist with any shortness of breath, chest pain, or fever. Please use the albuterol inhaler prior to any exertion. Use the Levofloxacin for a total of 14 days. Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3833**], MD Phone:[**Telephone/Fax (1) 3965**] Date/Time:[**2107-2-22**] 8:45 . Please follow up with Dr. [**Last Name (STitle) **] to discuss chronic antibiotic suppressive treatment. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 1677**] Completed by:[**2106-12-16**]

486,491,327,600,427,401,244,530,V125,V586

{'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}

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: worsening SOB, cough PRESENT ILLNESS: 80 year old male with history of PE ([**2-28**], on lovenox), recurrent PNA, and COPD requring home O2 with a chief complaint of worsening shortness of breath with acute respiratory distress at 5am. Due to pt's recurrent PNA he had been treated with suppressive bactrim therapy until 10 days ago when his pulmonologist (Dr. [**Last Name (STitle) **] tried a trial off Bactrim. Then, 5 days prior to admission he noted increased mucous production, which was thick and white, not purulent or blood streaked. He had some worsening cough with eating, but refuses any coughing with eating at baseline, denies any known aspiration prior to this, states he had a normal barium swallow in [**Month (only) 359**]. On the morning of admission he was very dyspneic, and felt similar to previous times he had PNA. He called an ambulance, and EMS found the pt tachypneic and diaphoretic with BP 200/p. He was given two SL NG and 80mg Lasix en route to [**Hospital3 **]. At [**Name (NI) 620**] pt found to have pneumonia and CHF. Pt has a h/o klebsiella, MRSA, [**Name (NI) **] and pseudomonas in sputum. Given azith, ceftriax, levo, solumedrol. Then transferred from [**Location (un) 620**] secondary to no in patient beds. . He had a PNA vaccine and influenza vaccine this year. He had no sick contacts. he denies fever, [**Last Name (un) 9507**], HA, myalgia, CP, nausea, vommiting, diarrhea, abdominal pain. He has a good appetite. At baseline he can only walk a few steps before becoming SOB. He uses 3L O2 at home at rest. He requires a wheelchair to get around. . In the [**Hospital1 18**] ED VS: 97.9, 158/69, 97, 99% on Neb. Found to have a large L infiltrate, gave nebs, lasix, Vanc, and his dose of lovenox. He continued to be dyspneic and was started on bipap with much improvement in dyspnea. He was then transfered to the [**Hospital Unit Name 153**] for continued management of resp distress and PNA. . MEDICAL HISTORY: `PE - dx [**2106-2-21**], on coumadin `COPD - per patient was severe based on PFTs at [**Hospital1 **] 3 yrs ago, on 3L O2 at home. States he is unable to walk 100 ft without becoming SOB. `CAD (per records, no h/o MI or cardiac cath) `Atrial fibrillation `HTN `BPH `Hypothyroidism s/p partial thyroidectomy `h/o Klebsiella, MRSA, Pseudomonas, and [**Hospital1 **] infections `s/p appy `s/p laminectomy `s/p right partial hip replacement `s/p bowel obstruction s/p SB resection MEDICATION ON ADMISSION: mucinex 600 [**Hospital1 **] zocor 40 flomax 0.4 mg singular 10 mg protonix 40 mg [**Hospital1 **] Proscar 5 mg Vit D 400 units Lisinopril 20 mg Synthroid 0.075 Albuterol neb tiazac 360 mg prednisone 30 mg lovenox 40 mg ALLERGIES: Amoxicillin PHYSICAL EXAM: ON ADMISSION: VS: Temp:98.3 BP: 163/57 HR:93 RR:22 O2sat 95% 4LNC GEN: pleasant, tachypneic, NAD HEENT: PERRL, EOMI, anicteric, dry MM, op without lesions NECK: obese, supple, unable to appreciate jvp, no carotid bruits, no thyromegaly or thyroid nodules RESP: +End Exp wheeze throughout with coarse crackles at bil bases R>L with good air movement throughout CV: RR, S1 and S2 wnl, no m/r/g ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly EXT: 3+ pitting edema of bil LE and RUE. +skin breakdown on dorsal aspect of Right hand. SKIN: no rashes/no jaundice NEURO: AAOx3. Cn II-XII intact. FAMILY HISTORY: Father with lung CA. Mother with HTN, [**Name (NI) 10322**], and CVA. Sister with ovarian CA. Brother with brain CA. SOCIAL HISTORY: Tobacco: 67 yrs, 1.5 ppd Alcohol: Denies Retired child psychiatrist and member of Army. ### Response: {'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}

CHIEF COMPLAINT: hypotension, AMS PRESENT ILLNESS: 79yo woman with h/o HTN, hypertrophic CMY (LVEF 45%, septal HK), PPM for SSS, steroid-dependent asthma, adrenal insufficiency, erosive esophagitis, sliding hiatal hernia, diverticulosis, L SFV thrombus, who was transferred from [**Hospital 1562**] Hospital for further management of sepsis and concern for perforated esophagus. The patient was in her USOH until around [**2137-1-29**] when she presented to [**Hospital 1562**] Hospital with dyspnea of 2d progression. She noted a 4 lbs wt gain over this period. She was found to have BNP>[**2131**], worsened LE edema, was diagnosed with a CHF exacerbation as well as a RLL pna, was diuresed and started on Levaquin x 7d. The patient was doing well, but on the AM of transfer was noted to have AMS, fever to 101.5F, and hypotension. She was started on Zyvox (linezolid) and [**Hospital 64952**] transferred to the ICU at the OSH. There, her SBP dropped to 60s, she developed hypercarbic resp failure and she was intubated, L fem line placed and pressors were started. She underwent a CT of her neck, chest, abd, pelvis, which revealed a large RLL infiltrate, and a thickened gallbladder. She was also noted to have small air in her biliary tree and portal vein. . Of note, the pt had been admitted in late [**2136-12-11**] with UGIB, requiring three units PRBCs, and with EGD showing erosive esophagitis. During her current admission, the patient had an EGD done which revealed severe esophagitis with biopsies showing granulomatous changes. Concern was raised that her esoph may have ruptured. Also of note, patient was diagnosed with a DVT in her LLE during her admit to the OSH, and had a IVC filter placed [**2-1**]. She was continued on stress dose steroids given her underlying adrenal insufficiency. MEDICAL HISTORY: HTN hypertrophic CMY (LVEF 45%, septal HK) chronic LE edema PPM for SSS steroid-dependent asthma adrenal insufficiency erosive esophagitis sliding hiatal hernia GERD diverticulosis L SFV thrombus s/p ventral hernia repair at [**Hospital1 112**] s/p fall and humeral fx in [**7-15**] in setting of NSVT MEDICATION ON ADMISSION: ipitor 20mg qd Carvedilol 3.125mg [**Hospital1 **] Vasopressin 0.02 units/hr Hydrocortisone 100mg q8h Prednisone 30mg qd Imipenem with cilastin 500mg q8h (start [**2-4**]) Linezolid 600mg q12h (start [**2-4**]) Levophed 0.5mg/kg/min Protonix 80mg IV q12h Paxil Cr 12.5mg qd KCl 20mEq PO tid Spironolactone 25mg qd Sucralfate 1gm tid Torsemide 40mg qd Tylenol prn Percocet prn Ativan prn Zofran prn ALLERGIES: Demerol / Sulfa (Sulfonamides) PHYSICAL EXAM: Vitals: T 97.8 HR 85 (AV-paced) BP 107/42 AC 500 x 12, 40% FiO2, PEEP 5 Gen: intubated, sedated caucasian woman with multiple areas of ecchymosis over chest, upper extremtities, neck HEENT: pupils small but responsive to light, no icterus, ETT in place, dried blood in nares bilaterally and around ETT Neck: swollen, 2+ carotids bilaterally, unable to assess JVP, R cerv region with old needle puncture site, no LAD palpable CV: distant HS, unable to appreciate murmur, no S3 Lungs: rales throughout L lung field, exp wheeze throughout R lung field Abd: obese, nondistended, multiple well-healed scars, no ecchymosis, Ext: 3+ pitting edema in b/l LE to mid-thigh; feet cool and dusky b/l but with 2+ DP and PT pulses Neuro: sedated, unarousable FAMILY HISTORY: N/A SOCIAL HISTORY: lives on [**Hospital3 **], was recently in [**Location (un) **] [**Hospital **] Rehab facility, no tobacco, rare etoh

Methicillin susceptible Staphylococcus aureus septicemia,Septic shock,Other primary cardiomyopathies,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Chronic obstructive asthma, unspecified,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute kidney failure, unspecified,Severe sepsis,Diaphragmatic hernia without mention of obstruction or gangrene,Other esophagitis,Long-term (current) use of steroids,Adrenal cortical steroids causing adverse effects in therapeutic use

Meth susc Staph aur sept,Septic shock,Prim cardiomyopathy NEC,Ac posthemorrhag anemia,Food/vomit pneumonitis,Chronic obst asthma NOS,CHF NOS,Urin tract infection NOS,Acute respiratry failure,Acute kidney failure NOS,Severe sepsis,Diaphragmatic hernia,Other esophagitis,Long-term use steroids,Adv eff corticosteroids

Admission Date: [**2137-2-4**] Discharge Date: [**2137-2-6**] Date of Birth: [**2057-11-28**] Sex: F Service: MEDICINE Allergies: Demerol / Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 330**] Chief Complaint: hypotension, AMS Major Surgical or Invasive Procedure: N/A History of Present Illness: 79yo woman with h/o HTN, hypertrophic CMY (LVEF 45%, septal HK), PPM for SSS, steroid-dependent asthma, adrenal insufficiency, erosive esophagitis, sliding hiatal hernia, diverticulosis, L SFV thrombus, who was transferred from [**Hospital 1562**] Hospital for further management of sepsis and concern for perforated esophagus. The patient was in her USOH until around [**2137-1-29**] when she presented to [**Hospital 1562**] Hospital with dyspnea of 2d progression. She noted a 4 lbs wt gain over this period. She was found to have BNP>[**2131**], worsened LE edema, was diagnosed with a CHF exacerbation as well as a RLL pna, was diuresed and started on Levaquin x 7d. The patient was doing well, but on the AM of transfer was noted to have AMS, fever to 101.5F, and hypotension. She was started on Zyvox (linezolid) and [**Hospital 64952**] transferred to the ICU at the OSH. There, her SBP dropped to 60s, she developed hypercarbic resp failure and she was intubated, L fem line placed and pressors were started. She underwent a CT of her neck, chest, abd, pelvis, which revealed a large RLL infiltrate, and a thickened gallbladder. She was also noted to have small air in her biliary tree and portal vein. . Of note, the pt had been admitted in late [**2136-12-11**] with UGIB, requiring three units PRBCs, and with EGD showing erosive esophagitis. During her current admission, the patient had an EGD done which revealed severe esophagitis with biopsies showing granulomatous changes. Concern was raised that her esoph may have ruptured. Also of note, patient was diagnosed with a DVT in her LLE during her admit to the OSH, and had a IVC filter placed [**2-1**]. She was continued on stress dose steroids given her underlying adrenal insufficiency. Past Medical History: HTN hypertrophic CMY (LVEF 45%, septal HK) chronic LE edema PPM for SSS steroid-dependent asthma adrenal insufficiency erosive esophagitis sliding hiatal hernia GERD diverticulosis L SFV thrombus s/p ventral hernia repair at [**Hospital1 112**] s/p fall and humeral fx in [**7-15**] in setting of NSVT Social History: lives on [**Hospital3 **], was recently in [**Location (un) **] [**Hospital **] Rehab facility, no tobacco, rare etoh Family History: N/A Physical Exam: Vitals: T 97.8 HR 85 (AV-paced) BP 107/42 AC 500 x 12, 40% FiO2, PEEP 5 Gen: intubated, sedated caucasian woman with multiple areas of ecchymosis over chest, upper extremtities, neck HEENT: pupils small but responsive to light, no icterus, ETT in place, dried blood in nares bilaterally and around ETT Neck: swollen, 2+ carotids bilaterally, unable to assess JVP, R cerv region with old needle puncture site, no LAD palpable CV: distant HS, unable to appreciate murmur, no S3 Lungs: rales throughout L lung field, exp wheeze throughout R lung field Abd: obese, nondistended, multiple well-healed scars, no ecchymosis, Ext: 3+ pitting edema in b/l LE to mid-thigh; feet cool and dusky b/l but with 2+ DP and PT pulses Neuro: sedated, unarousable Brief Hospital Course: 79yo woman who was transferred from [**Hospital 1562**] Hospital for further management of septic shock, with 4/4 blood culture bottles with MRSA and >100,000 MRSA in urine at OSH. Patient was intubated and sedated, requiring pressors at the time of transfer. She continued to require pressors after 24 hours and given her limited quality of life prior to this event, her family made the decision to make her comfort measures only. She was extubated and pressors were stopped. She died on [**2137-2-6**]. Cardiology came to turn off her pacer. Family was present and declined autopsy. Attending was notified. Medications on Admission: ipitor 20mg qd Carvedilol 3.125mg [**Hospital1 **] Vasopressin 0.02 units/hr Hydrocortisone 100mg q8h Prednisone 30mg qd Imipenem with cilastin 500mg q8h (start [**2-4**]) Linezolid 600mg q12h (start [**2-4**]) Levophed 0.5mg/kg/min Protonix 80mg IV q12h Paxil Cr 12.5mg qd KCl 20mEq PO tid Spironolactone 25mg qd Sucralfate 1gm tid Torsemide 40mg qd Tylenol prn Percocet prn Ativan prn Zofran prn Discharge Medications: N/A Discharge Disposition: Expired Discharge Diagnosis: Sepsis Discharge Condition: Deceased Followup Instructions: N/A Completed by:[**2137-2-17**]

038,785,425,285,507,493,428,599,518,584,995,553,530,V586,E932

{'Methicillin susceptible Staphylococcus aureus septicemia,Septic shock,Other primary cardiomyopathies,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Chronic obstructive asthma, unspecified,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute kidney failure, unspecified,Severe sepsis,Diaphragmatic hernia without mention of obstruction or gangrene,Other esophagitis,Long-term (current) use of steroids,Adrenal cortical steroids causing adverse effects in therapeutic use'}

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: hypotension, AMS PRESENT ILLNESS: 79yo woman with h/o HTN, hypertrophic CMY (LVEF 45%, septal HK), PPM for SSS, steroid-dependent asthma, adrenal insufficiency, erosive esophagitis, sliding hiatal hernia, diverticulosis, L SFV thrombus, who was transferred from [**Hospital 1562**] Hospital for further management of sepsis and concern for perforated esophagus. The patient was in her USOH until around [**2137-1-29**] when she presented to [**Hospital 1562**] Hospital with dyspnea of 2d progression. She noted a 4 lbs wt gain over this period. She was found to have BNP>[**2131**], worsened LE edema, was diagnosed with a CHF exacerbation as well as a RLL pna, was diuresed and started on Levaquin x 7d. The patient was doing well, but on the AM of transfer was noted to have AMS, fever to 101.5F, and hypotension. She was started on Zyvox (linezolid) and [**Hospital 64952**] transferred to the ICU at the OSH. There, her SBP dropped to 60s, she developed hypercarbic resp failure and she was intubated, L fem line placed and pressors were started. She underwent a CT of her neck, chest, abd, pelvis, which revealed a large RLL infiltrate, and a thickened gallbladder. She was also noted to have small air in her biliary tree and portal vein. . Of note, the pt had been admitted in late [**2136-12-11**] with UGIB, requiring three units PRBCs, and with EGD showing erosive esophagitis. During her current admission, the patient had an EGD done which revealed severe esophagitis with biopsies showing granulomatous changes. Concern was raised that her esoph may have ruptured. Also of note, patient was diagnosed with a DVT in her LLE during her admit to the OSH, and had a IVC filter placed [**2-1**]. She was continued on stress dose steroids given her underlying adrenal insufficiency. MEDICAL HISTORY: HTN hypertrophic CMY (LVEF 45%, septal HK) chronic LE edema PPM for SSS steroid-dependent asthma adrenal insufficiency erosive esophagitis sliding hiatal hernia GERD diverticulosis L SFV thrombus s/p ventral hernia repair at [**Hospital1 112**] s/p fall and humeral fx in [**7-15**] in setting of NSVT MEDICATION ON ADMISSION: ipitor 20mg qd Carvedilol 3.125mg [**Hospital1 **] Vasopressin 0.02 units/hr Hydrocortisone 100mg q8h Prednisone 30mg qd Imipenem with cilastin 500mg q8h (start [**2-4**]) Linezolid 600mg q12h (start [**2-4**]) Levophed 0.5mg/kg/min Protonix 80mg IV q12h Paxil Cr 12.5mg qd KCl 20mEq PO tid Spironolactone 25mg qd Sucralfate 1gm tid Torsemide 40mg qd Tylenol prn Percocet prn Ativan prn Zofran prn ALLERGIES: Demerol / Sulfa (Sulfonamides) PHYSICAL EXAM: Vitals: T 97.8 HR 85 (AV-paced) BP 107/42 AC 500 x 12, 40% FiO2, PEEP 5 Gen: intubated, sedated caucasian woman with multiple areas of ecchymosis over chest, upper extremtities, neck HEENT: pupils small but responsive to light, no icterus, ETT in place, dried blood in nares bilaterally and around ETT Neck: swollen, 2+ carotids bilaterally, unable to assess JVP, R cerv region with old needle puncture site, no LAD palpable CV: distant HS, unable to appreciate murmur, no S3 Lungs: rales throughout L lung field, exp wheeze throughout R lung field Abd: obese, nondistended, multiple well-healed scars, no ecchymosis, Ext: 3+ pitting edema in b/l LE to mid-thigh; feet cool and dusky b/l but with 2+ DP and PT pulses Neuro: sedated, unarousable FAMILY HISTORY: N/A SOCIAL HISTORY: lives on [**Hospital3 **], was recently in [**Location (un) **] [**Hospital **] Rehab facility, no tobacco, rare etoh ### Response: {'Methicillin susceptible Staphylococcus aureus septicemia,Septic shock,Other primary cardiomyopathies,Acute posthemorrhagic anemia,Pneumonitis due to inhalation of food or vomitus,Chronic obstructive asthma, unspecified,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Acute respiratory failure,Acute kidney failure, unspecified,Severe sepsis,Diaphragmatic hernia without mention of obstruction or gangrene,Other esophagitis,Long-term (current) use of steroids,Adrenal cortical steroids causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: Tertiary hyperparathyrodism PRESENT ILLNESS: Ms [**Known lastname 13551**] is a 59 year-old female with history of ESRD on HD, HIV on HARRT, Hep C cirrhosis, and tertiary hyperparathyroidism who was admitted for subtotal parathyroidectomy. MEDICAL HISTORY: - ESRD due to HIV nephropathy on HD TuThSa - HIV, diagnosed [**2165**]; last CD4 246, VL: [**2165**] - Hepatitis C with cirrhosis and portal hypertension - Zoster [**2177**] - Bronchitis - GIB - chronic, thought to be due to AVM - Thrombocytopenia - Tertiary hyperparathyroidism MEDICATION ON ADMISSION: Etravirine 100'', lamivudine 50', sevelamer 1600''', and tenofovir 300 once a week, metoprolol 25', nephrocaps qd ALLERGIES: Ampicillin PHYSICAL EXAM: Physical Exam on Discharge: Vitals: 98.5, 111, 160/70, 20, 99RA Gen: AOx3 HEENT: Surgical horizontal neck incision c/d/i with steri strips in place and without signs of infection or hematoma CV: RRR, no m/r/g Resp: CTA bilaterally Abd: Soft, NT/ND Ext: No c/c/e FAMILY HISTORY: Mother with DM and HTN; died from brain aneurysm. GM with DM, HTN; died from diabetic coma. Older sister died of liver cancer. [**Name (NI) **] sister w/ breast cancer; in remission No history of colon cancer. No history of bleeding disorders or GIB. SOCIAL HISTORY: Patient is on disability. Lives with adult son; has 5 adult children. Tob: >25 pack-year tobacco history, currently smokes few cigarrettes/day. EtOH: Denies EtOH use. None for several years since diagnosis of cirrhosis. Drugs: History of crack cocaine use and IVDU (last use 10 yrs ago); stopped since starting dialysis ~[**2171**]. Family aware of HIV diagnosis.

Acute and subacute necrosis of liver,Acute pancreatitis,End stage renal disease,Human immunodeficiency virus [HIV] disease,Portal hypertension,Other complications due to renal dialysis device, implant, and graft,Atrial flutter,Acidosis,Hepatitis, unspecified,Other gaseous anesthetics causing adverse effects in therapeutic use,Renal dialysis status,Chronic hepatitis C without mention of hepatic coma,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Cirrhosis of liver without mention of alcohol,Thrombocytopenia, unspecified,Abdominal pain, unspecified site,Aortic valve disorders,Other alteration of consciousness,Other hyperparathyroidism,Hypoglycemia, unspecified,Hypotension of hemodialysis,Other chronic pulmonary heart diseases,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation

Acute necrosis of liver,Acute pancreatitis,End stage renal disease,Human immuno virus dis,Portal hypertension,Comp-ren dialys dev/grft,Atrial flutter,Acidosis,Hepatitis NOS,Adv eff gas anesthet NEC,Renal dialysis status,Chrnc hpt C wo hpat coma,Nephritis NOS,Cirrhosis of liver NOS,Thrombocytopenia NOS,Abdmnal pain unspcf site,Aortic valve disorder,Other alter consciousnes,Hyperparathyroidism NEC,Hypoglycemia NOS,Hemododialysis hypotensn,Chr pulmon heart dis NEC,Abn react-renal dialysis,Depressive disorder NEC,Abn react-anastom/graft

Admission Date: [**2182-11-1**] Discharge Date: [**2182-11-3**] Date of Birth: [**2123-7-24**] Sex: F Service: SURGERY Allergies: Ampicillin Attending:[**First Name3 (LF) 1**] Chief Complaint: Tertiary hyperparathyrodism Major Surgical or Invasive Procedure: [**2182-11-1**]: Subtotaled parathyroidectomy. History of Present Illness: Ms [**Known lastname 13551**] is a 59 year-old female with history of ESRD on HD, HIV on HARRT, Hep C cirrhosis, and tertiary hyperparathyroidism who was admitted for subtotal parathyroidectomy. Past Medical History: - ESRD due to HIV nephropathy on HD TuThSa - HIV, diagnosed [**2165**]; last CD4 246, VL: [**2165**] - Hepatitis C with cirrhosis and portal hypertension - Zoster [**2177**] - Bronchitis - GIB - chronic, thought to be due to AVM - Thrombocytopenia - Tertiary hyperparathyroidism Social History: Patient is on disability. Lives with adult son; has 5 adult children. Tob: >25 pack-year tobacco history, currently smokes few cigarrettes/day. EtOH: Denies EtOH use. None for several years since diagnosis of cirrhosis. Drugs: History of crack cocaine use and IVDU (last use 10 yrs ago); stopped since starting dialysis ~[**2171**]. Family aware of HIV diagnosis. Family History: Mother with DM and HTN; died from brain aneurysm. GM with DM, HTN; died from diabetic coma. Older sister died of liver cancer. [**Name (NI) **] sister w/ breast cancer; in remission No history of colon cancer. No history of bleeding disorders or GIB. Physical Exam: Physical Exam on Discharge: Vitals: 98.5, 111, 160/70, 20, 99RA Gen: AOx3 HEENT: Surgical horizontal neck incision c/d/i with steri strips in place and without signs of infection or hematoma CV: RRR, no m/r/g Resp: CTA bilaterally Abd: Soft, NT/ND Ext: No c/c/e Pertinent Results: [**2182-11-2**] 06:05AM BLOOD Glucose-201* UreaN-31* Creat-7.7* Na-134 K-4.8 Cl-94* HCO3-19* AnGap-26* [**2182-11-3**] 05:35AM BLOOD Glucose-34* UreaN-19 Creat-5.5*# Na-138 K-4.5 Cl-86* HCO3-22 AnGap-35* [**2182-11-1**] 10:30AM BLOOD Calcium-11.1* Phos-5.6* Mg-1.8 [**2182-11-2**] 02:00PM BLOOD Calcium-9.1 [**2182-11-3**] 05:35AM BLOOD Calcium-9.5 Phos-6.4*# Mg-2.0 [**2182-11-1**] 10:30AM BLOOD PTH-463* [**2182-11-2**] 06:05AM BLOOD PTH-7* [**2182-11-1**] 10:30AM BLOOD WBC-3.3* RBC-4.47 Hgb-13.1 Hct-41.8 MCV-93 MCH-29.2 MCHC-31.3 RDW-17.9* Plt Ct-67* [**2182-11-2**] 06:05AM BLOOD WBC-3.9* RBC-4.53 Hgb-13.8 Hct-42.3 MCV-93 MCH-30.4 MCHC-32.5 RDW-18.0* Plt Ct-61* [**2182-11-1**] 10:30AM BLOOD PT-20.0* PTT-32.0 INR(PT)-1.8* Brief Hospital Course: The patient was admitted to the East 1 Surgical Service for evaluation and treatment for tertiary hyperparathyroidism . On [**2182-11-1**] the patient underwent subtotal parathyroidectomy (the right inferior was left as a partial remnant) which went well without complication (reader referred to the Operative Notes for details). After a brief, uneventful stay in the PACU, the patient arrived on the floor tolerating clears, on maintenance IV fluids, and PO pain medication for pain control. The patient was hemodynamically normal. . Neuro: The patient received PO pain medications with good effect and adequate pain control. . HEENT: Neck monitored for signs of hematoma of which there were none. Pt demonstrated excellent phonation, no stridor and denied dyspnea. . Endocrine: Denied perioral numbness/tingling, parathesias/tingling in hands and fingers. POD 1 calcium demonstrated normocalcemia. The patient was evaluated by the renal team, who recommended 1 g of TUMS TID on discharge, and follow up labs to be drawn with the patient's next HD treatment. There was no need for additional calcitriol or calcium supplementation. . At the time of discharge, the patient was doing well, afebrile with stable vital signs. The patient was tolerating a regular diet, ambulating, voiding without assistance, and pain was well controlled. The patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. Medications on Admission: Etravirine 100'', lamivudine 50', sevelamer 1600''', and tenofovir 300 once a week, metoprolol 25', nephrocaps qd Discharge Medications: 1. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 2. lamivudine 10 mg/mL Solution Sig: Five (5) mL PO DAILY (Daily). 3. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 5. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*25 Tablet(s)* Refills:*0* 6. tenofovir disoproxil fumarate 300 mg Tablet Sig: One (1) Tablet PO QFRI (every Friday). 7. etravirine 100 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 8. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 9. calcium carbonate 1,177 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO three times a day for 4 weeks. Disp:*84 Tablet, Chewable(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: -Tertiary hyperparathyroidism -HIV -Hepatitis C with cirrhosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: You were admitted to the hospital for a parathyroidectomy for tertiary hyperparathyroidism. The procedure went well, and you were kept in the hospital overnight for observation. Following the procedure, you were taken to dialysis to keep your normal schedule. On discharge, you can resume your normal diet and activity without restriction. You may shower, but do not scrub or soak your incision. You should plan to follow up with Dr. [**Last Name (STitle) **] in [**2-10**] weeks, and should call his office to schedule an appointment. Please also bring a copy of your discharge paperwork to your next [**Date Range 13241**] appointment as well as to your next appointment with your primary care doctor. [**First Name (Titles) 2172**] [**Last Name (Titles) 13241**] providers should continue to follow you calcium after this procedure. Please call or return to the hospital if you experience any nausea/vomiting, fevers/chills, numbness or tingling in your face or arms, or worsening swelling/redness around your incision site. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) **] in [**2-10**] weeks. You can call ([**Telephone/Fax (1) 9011**] to make an appointment. Please plan to continue your [**Telephone/Fax (1) 13241**] on your normal schedule and plan to make an appointment to see your primary care provider in the next few weeks. Completed by:[**2182-11-3**] Admission Date: [**2182-11-4**] Discharge Date: [**2182-11-23**] Date of Birth: [**2123-7-24**] Sex: F Service: MEDICINE Allergies: Ampicillin Attending:[**First Name3 (LF) 4393**] Chief Complaint: Abdominal pain, nausea, vomiting Major Surgical or Invasive Procedure: transjugular liver biopsy [**2182-11-8**] History of Present Illness: 59 ESRD on HD, HIV, HCV not being treated. s/p parathyroidectomy [**11-1**], d/c'ed today [**11-3**]. Pt reports that today she went home and felt weak, had abdominal pain, and was nauseated, vomited non-bilious non-bloody material then came to the ER. The pt reports that she hasn't eaten anything all day, has no appetite, and hasn't had a BM since before the surgery. The pt reports that she may have felt this way while in the hospital this recent admission. On arrival to the ED her FSBG was 30, and in the ED they administered D50 ampule and raised the FSBS to 72, which was then followed and trended to be 130, 155, to 108. In the ER the pt also received approximately 300ml of D5 1/2 NS, and was put on a drip of 50cc/hr. Pt reports that her last dialysis administration was the day before yesterday. . On arrival to the MICU, the pt is lethargic and generally slow to respond to questions. The pt continued to endose abdominal pain, but said that she wasn't particularly nauseated. The pt repeatedly would say that she's "not long for this world". . In discussion with the surgeons who performed the procedure, they could not identify any connection between the surgery and liver failure. The noted that the surgery was uncomplicated. Past Medical History: - ESRD due to HIV nephropathy on HD TuThSa - HIV, diagnosed [**2165**]; last CD4 246, VL: [**2165**] - Hepatitis C with cirrhosis and portal hypertension - Zoster [**2177**] - Bronchitis - GIB - chronic, thought to be due to AVM - Thrombocytopenia - Tertiary hyperparathyroidism s/p parathyroidectomy Social History: Patient is on disability. Lives with adult son; has 5 adult children. Tob: >25 pack-year tobacco history, currently smokes few cigarrettes/day. EtOH: Denies EtOH use. None for several years since diagnosis of cirrhosis. Drugs: History of crack cocaine use and IVDU (last use 10 yrs ago); stopped since starting dialysis ~[**2171**]. Family aware of HIV diagnosis. Family History: Mother with DM and HTN; died from brain aneurysm. GM with DM, HTN; died from diabetic coma. Older sister died of liver cancer. [**Name (NI) **] sister w/ breast cancer; in remission No history of colon cancer. No history of bleeding disorders or GIB. Physical Exam: ADMISSION EXAM: VS: 83, 98/62, 98%RA on 2L NC, r22 General: Middle-aged female laying in bed in NAD. Alert and appropriate. HEENT: Sclera anicteric, mucous membranes dry, oropharynx clear. Surgical horizontal neck incision c/d/i with steri strips in place and without signs of infection or hematoma. Neck: supple, JVP not elevated, no LAD Lungs: Breathing comfortably, crackles bilaterally at the bases. CV: RRR, + 3/6 systolic murmur present. Abdomen: +BS, soft, no guarding, no rebound, but TTP in the RUQ, noted hepatomegaly. Ext: warm, well perfused, trace edema bilaterally Access: RUE AVF with aneurysms, + bruit, + thrill DISCHARGE EXAM VSS, afebrile General: AOX3 HEENT: Sclera anicteric, mucous membranes moist, oropharynx clear. Surgical horizontal neck incision c/d/i with steri strips in place and without signs of infection or hematoma. Neck: supple, JVP not elevated, no LAD Lungs: Breathing comfortably, crackles bilaterally at the bases. CV: RRR, 4/6 systolic murmur palpable best at the LLSB,with radiation to axilla Abdomen: +BS, soft, nontender, nondistended, no guarding, no rebound, Ext: warm, well perfused, right UE edema Access: RUE AVF with aneurysms, + bruit, + thrill, Pertinent Results: ADMISSION LABS [**2182-11-3**] 11:05PM BLOOD WBC-10.8# RBC-5.12 Hgb-15.2 Hct-49.4* MCV-97 MCH-29.7 MCHC-30.7* RDW-21.5* Plt Ct-62* [**2182-11-3**] 11:05PM BLOOD Neuts-92.0* Lymphs-4.9* Monos-2.5 Eos-0.3 Baso-0.3 [**2182-11-4**] 03:50AM BLOOD PT-30.9* PTT-36.0* INR(PT)-3.0* [**2182-11-3**] 05:35AM BLOOD Glucose-34* UreaN-19 Creat-5.5*# Na-138 K-4.5 Cl-86* HCO3-22 AnGap-35* [**2182-11-3**] 11:05PM BLOOD ALT-544* AST-854* AlkPhos-58 Amylase-180* TotBili-3.7* DirBili-2.5* IndBili-1.2 [**2182-11-3**] 05:35AM BLOOD Calcium-9.5 Phos-6.4*# Mg-2.0 [**2182-11-3**] 11:12PM BLOOD Lactate-11.6* [**2182-11-3**] 11:12PM BLOOD freeCa-0.82* PERTINENT LABS [**2182-11-3**] 11:05PM BLOOD ALT-544* AST-854* AlkPhos-58 Amylase-180* TotBili-3.7* DirBili-2.5* IndBili-1.2 [**2182-11-4**] 06:00AM BLOOD ALT-541* AST-799* LD(LDH)-748* CK(CPK)-59 AlkPhos-51 Amylase-168* TotBili-3.6* DirBili-2.7* IndBili-0.9 [**2182-11-5**] 05:10AM BLOOD ALT-544* AST-723* AlkPhos-61 Amylase-192* TotBili-4.9* [**2182-11-6**] 02:48AM BLOOD ALT-504* AST-514* AlkPhos-68 Amylase-278* TotBili-8.0* DirBili-5.9* IndBili-2.1 [**2182-11-7**] 04:39AM BLOOD ALT-379* AST-298* AlkPhos-78 Amylase-161* TotBili-10.3* DirBili-7.5* IndBili-2.8 [**2182-11-8**] 04:19AM BLOOD ALT-247* AST-134* AlkPhos-70 TotBili-12.5* DirBili-9.1* IndBili-3.4 [**2182-11-9**] 03:57AM BLOOD ALT-181* AST-89* LD(LDH)-293* AlkPhos-74 TotBili-15.3* [**2182-11-10**] 03:40AM BLOOD ALT-136* AST-92* LD(LDH)-414* AlkPhos-80 TotBili-15.3* [**2182-11-11**] 03:15AM BLOOD ALT-128* AST-111* AlkPhos-91 TotBili-18.4* [**2182-11-12**] 02:00AM BLOOD ALT-96* AST-94* LD(LDH)-328* AlkPhos-72 Amylase-321* TotBili-17.8* [**2182-11-13**] 03:50AM BLOOD ALT-78* AST-67* AlkPhos-70 Amylase-150* TotBili-19.0* DirBili-14.2* IndBili-4.8 [**2182-11-7**] 04:39AM BLOOD calTIBC-229* Ferritn-862* TRF-176* [**2182-11-5**] 10:10AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE IgM HAV-NEGATIVE [**2182-11-5**] 10:10AM BLOOD Smooth-POSITIVE * [**2182-11-5**] 10:10AM BLOOD [**Doctor First Name **]-NEGATIVE [**2182-11-5**] 10:10AM BLOOD IgG-2794* [**2182-11-3**] 11:05PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG DISCHARGE LABS [**2182-11-23**] 07:30AM BLOOD WBC-5.0 RBC-3.32* Hgb-10.6* Hct-34.7* MCV-105* MCH-31.9 MCHC-30.5* RDW-24.4* Plt Ct-63* [**2182-11-23**] 07:30AM BLOOD PT-16.0* PTT-28.0 INR(PT)-1.4* [**2182-11-23**] 07:30AM BLOOD Glucose-112* UreaN-30* Creat-5.5*# Na-134 K-4.2 Cl-96 HCO3-26 AnGap-16 [**2182-11-23**] 07:30AM BLOOD ALT-42* AST-55* AlkPhos-56 TotBili-12.5* [**2182-11-23**] 07:30AM BLOOD Calcium-9.5 Phos-4.5 Mg-2.4 MICROBIOLOGY HIV Viral Load: 252 copies/ml HCV viral load: 1,280,000 IU/mL. CMV: IgG pos, IgM neg VZV: IgG pos, IgM pos 1.22 (nl range 0-0.9) EBV: Ig HSV1: IgG pos HSV2: IgG pos Blood Culture: no growth PERTINENT STUDIES [**11-8**] Transjugular liver bx: Liver, transjugular needle core biopsies: Fragmented core biopsies of liver demonstrating: 1. Established cirrhosis (confirmed with Trichrome stain), Stage 4 fibrosis, with delicate sinusoidal fibrosis. 2. Moderate predominantly microvesicular steatosis without associated ballooning degeneration or intracytoplasmic hyalin. 3. Moderate canalicular cholestasis with occasional associated lobular neutrophils. 4. Scattered focal areas of hepatocyte dropout/necrosis and parenchymal collapse (confirmed with reticulin stain). 5. Iron stain shows marked Kupffer cell and mild hepatocellular iron deposition. [**11-8**] ABD US 1. Patent portal vein with antegrade flow. 2. Small amount of ascites, unchanged. 3. Small amount of gallbladder sludge, but no cholelithiasis or acute cholecystitis. [**11-6**] MRCP IMPRESSION: 1. Hepatic and splenic iron deposition without pancreatic involvement, consistent with hemosiderosis. 2. Cirrhosis of the liver, without evidence of focal lesions or biliary dilation. 3. Small ascites and bilateral pleural effusions with basal atelectasis. Brief Hospital Course: 59F with HIV, ESRD, Hep C cirrhosis, pHTN, Calciphylaxis-related valvular disease s/p subtotal parathyroidectomy on [**11-1**] presents hours after discharge from surgical service who was admitted with acute hepatitis secondary to sevoflurane used in anesthesia. #.Acute liver failure: Pt developed acute liver failure with transaminitis, hyperbilirubinemia, elevated INR, decreasing albumin and altered mental status. Pt was ruled out for obstructive or infectious etiology. Liver biopsy showed microvesicular steatosis and focal necrosis consistent with drug induced hepatitis. Leading diagnosis is desflourane induced hepatitis. Pt was initially treated with Vancomycin, Cefetazidime and Flagyl for concerns of cholangitis. Antibiotics were withdrawn upon clinical improvement and finding on liver biopsy. Her HAART therapy was stopped due to her acute liver failure and will need to be restarted as an outpatient (which per ID should be [**12-4**] and not sooner). Her LFTs trended down, however her Bilirbuin remained elevated at the time of discharge and the patient was still jaundiced. SHe was being treated with urosdiol while inpatient however due to attempt to decrease the amount of medications the patient takes for medication compliance this was discontinued, as was her lactulose and rifaximin. On discharge, pt is alert and oriented X3, with no asterixis. She is not on the liver transplant list because she took herself off. #. Hypotension - Patient required IV pressors while in the MICU, This was felt to be multifactorial due to her MR, MS, and AS as well as her fistula. Her baseline systolic blood pressures are generally in the 90s, and once out of the ICU her blood pressures ranged from high 70s-90s. Because of her low blood pressures her metoprolol succinate 25mg po once a day was changed to metoprolol tartate 12.5mg po BID. The hope was that by slowly her heartrate down would increase her preload and help with her systolic blood pressure. # Pancreatitis- the patient also developed pancreatitis in the setting of her acute liver failure as her lipase was elevated. This trended down and she was able to tolerate a regular diet #.Thrombocytopenia: Seems to be baseline low, likely secondary to liver dysfunction. She did not require any interventions for her low platlets. #. ESRD: The patient was continued on her normal HD schedule, until she developed hypotension. She was on CVVHD from [**Date range (1) 22564**] for hypotension, and then resumed her normal HD schedule starting on [**11-13**]. She had a temporary IJ dialysis line placed, however this was removed as her Rsided fistula was working. It was felt that her right arm swelling was due to a blockage in the fistula. She was scheduled for a fistulagram, multiple times however due to noncompliance with being NPO this did not happen as an inpatient. The fistula continued to function well prior to discharge. She will need to have the fistulagram done as an outpatient. The IR department will contact the rehab facility on [**2182-11-25**] in order to coordinate a date and time. #.HIV: The pt's HIV medications were initially held in the setting of her acute liver failure. ID was consulted who recommended that she not restart them until 30 days after her inpatient, which was on [**2182-11-3**]. She will need to discuss restarting these medications with her outpatient providers. She was given one dose of pantamidine inh prior to discharge. Her HIV viral load was no longer undetectable on this admission #.HCV: Pt is currently not on any antivirals for her HCV. Her HCV viral load is not undetectable. The patient will need to flow up with ID and hepatology what should be done about HCV management. #.s/p parathyroidectomy: The patient's ionized calcium and phosphorus were monitored daily and was given calcium prn. The patient's free-calcium was discharged in the normal range. #Depression- after the patient was transferred to the medical floor, she expressed many concerns about her goals of care, which were waxing and [**Doctor Last Name 688**]. Multiple family meetings took place to discuss what medications she was interested in continuing and any barriers to taking her medications. As she mentioned wanting to give up, and not wanting to eat and having problems sleeping, psychiatry was consulted and they recommended Mirtazipine 7.5mg po qhs to help with her appetitie and sleep. At the time of discharge she was eating well and her sleeping had improved. Transitional Issues: Pending labs: Blood cultures [**2182-11-19**] Medications started: 1. Mirtazpine 7.5mg by mouth at bedtime (for mood/sleep) Medications changed: 1. Metoprolol- changed from long acting version of 25mg once a day to short acting (tartate) 12.5 mg by mouth twice a day Medicaiton stopped: Lamivudine 10 mg/mL 5ml daily Sevelamer carbonate 1600 mg TIDQAC Omeprazole 20 mg daily Oxycodone 5-10 mg Q4H:PRN pain Tenofovir disoproxil fumarate 300 mg QFIR Etravirine 200 mg [**Hospital1 **] Follow-up: 1. Continue dialysis 2. Outpatient fistulogram pending scheduling, IR will call rehab to schedule date and time of procedure 3. Discuss when to restart HAART with outpatient [**Provider Number 22565**]. Will need follow-up with surgery about parathyroidectomy post op treatment Medications on Admission: B complex-vitamin C-folic acid 1 mg daily Lamivudine 10 mg/mL 5ml daily Sevelamer carbonate 1600 mg TIDQAC Omeprazole 20 mg daily Oxycodone 5-10 mg Q4H:PRN pain Tenofovir disoproxil fumarate 300 mg QFIR Etravirine 200 mg [**Hospital1 **] Metoprolol succinate 25 mg daily Calcium carbonate 1,177 mg TID x 4 weeks Discharge Medications: 1. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) as needed for pain. 2. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 3. mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime). 4. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO QID (4 times a day). Discharge Disposition: Extended Care Facility: [**Hospital3 **] Discharge Diagnosis: Primary: Acute liver failure, Drug induced hepatitis, Secondary: HIV, HCV cirrhosis, End stage renal disease, Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Dear Ms. [**Known lastname 13551**], You were admitted to our hospital because you had worsening liver function and were feeling very sick after you had been discharged from your parathyroidectomy. You were found to have acute liver failure. You underwent a liver biopsy to determine the cause of the liver biopsy as all of your blood tests were negative for cuases. THe changes that were seen in the biopsy were consistent with a medication caused liver toxicity, of the medications that you had received during your previous hospital stay it is most likely from the anesthesia that you had, and this is a very very rare possible side effect. You were originally monitored and taken care of in the ICU. Your liver function was improving and you were transferred to the regular medical [**Hospital1 **] for continued monitoring Your HIV medications were held because they can affect the liver. You will need to discuss restarting these after [**12-4**] (1 month after the liver injury) with your outpatient provider. [**Name10 (NameIs) **] mood was very low while you were here and you were seen by psychiatry who felt that you would benefit from an antidepressant called Mirtazipine which were you started on and seemed to help with your sleeping and your appetite. You continued to undergo dialysis while you were inpatient. Your right arm was swollen and it was felt that this was most likely due to a small blockage in your fistula, however your fistula was still working prior to your discharge. We tried to have this fixed while you were inpatient with a fistulagram, however this was not done and will need to be done as an outpatient. The Interventional Radiology department will contact your rehab facility on [**Name (NI) 766**] [**2182-11-25**] to coordinate the date and time of your fistulogram. You CANNOT eat or drink anything the morning of the date of your fistulogram. Transitional Issues: Pending labs: Blood cultures [**2182-11-19**] Medications started: 1. Mirtazpine 7.5mg by mouth at bedtime (for mood/sleep) 2. Tramadol for pain Medications changed: 1. Metoprolol- changed from long acting version of 25mg once a day to short acting (tartate) 12.5 mg by mouth twice a day Medicaiton stopped: Lamivudine 10 mg/mL 5ml daily Sevelamer carbonate 1600 mg TIDQAC Omeprazole 20 mg daily Oxycodone 5-10 mg Q4H:PRN pain Tenofovir disoproxil fumarate 300 mg QFIR Etravirine 200 mg [**Hospital1 **] Follow-up: 1. Continue dialysis 2. Fistulagram still needed 3. Discuss when to restart HAART with outpatient [**Provider Number 22565**]. Will need follow-up with surgery about parathyroidectomy post op treatment Followup Instructions: Name: [**Name6 (MD) 3577**] [**Last Name (NamePattern4) 11407**], MD Specialty: Internal Medicine Location: [**Hospital 3578**] COMMUNITY HEALTH CENTER Address: [**Hospital1 3579**], [**Location (un) **],[**Numeric Identifier 3580**] Phone: [**Telephone/Fax (1) 3581**] We are working on a follow up appointment for you to see Dr. [**Last Name (STitle) **] within 2 weeks of your discharge from the hospital. You will be called at home with the appt. If you have not heard within 2 business days, please call the number above. Department: ADVANCED VASC. CARE CNT When: WEDNESDAY [**2182-12-4**] at 9:30 AM With: [**Name6 (MD) 5536**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 5537**] Building: [**Street Address(2) 7298**] ([**Location (un) 583**], MA) [**Location (un) **] Campus: OFF CAMPUS Best Parking: Free Parking on Site You will be contact[**Name (NI) **] by the interventional radiology department on [**Name (NI) 766**] [**2182-11-25**] to coordinate the date and time of your fistulogram [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 4407**]

570,577,585,042,572,996,427,276,573,E938,V451,070,583,571,287,789,424,780,252,251,458,416,E879,311,E878

{'Acute and subacute necrosis of liver,Acute pancreatitis,End stage renal disease,Human immunodeficiency virus [HIV] disease,Portal hypertension,Other complications due to renal dialysis device, implant, and graft,Atrial flutter,Acidosis,Hepatitis, unspecified,Other gaseous anesthetics causing adverse effects in therapeutic use,Renal dialysis status,Chronic hepatitis C without mention of hepatic coma,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Cirrhosis of liver without mention of alcohol,Thrombocytopenia, unspecified,Abdominal pain, unspecified site,Aortic valve disorders,Other alteration of consciousness,Other hyperparathyroidism,Hypoglycemia, unspecified,Hypotension of hemodialysis,Other chronic pulmonary heart diseases,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant 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: Tertiary hyperparathyrodism PRESENT ILLNESS: Ms [**Known lastname 13551**] is a 59 year-old female with history of ESRD on HD, HIV on HARRT, Hep C cirrhosis, and tertiary hyperparathyroidism who was admitted for subtotal parathyroidectomy. MEDICAL HISTORY: - ESRD due to HIV nephropathy on HD TuThSa - HIV, diagnosed [**2165**]; last CD4 246, VL: [**2165**] - Hepatitis C with cirrhosis and portal hypertension - Zoster [**2177**] - Bronchitis - GIB - chronic, thought to be due to AVM - Thrombocytopenia - Tertiary hyperparathyroidism MEDICATION ON ADMISSION: Etravirine 100'', lamivudine 50', sevelamer 1600''', and tenofovir 300 once a week, metoprolol 25', nephrocaps qd ALLERGIES: Ampicillin PHYSICAL EXAM: Physical Exam on Discharge: Vitals: 98.5, 111, 160/70, 20, 99RA Gen: AOx3 HEENT: Surgical horizontal neck incision c/d/i with steri strips in place and without signs of infection or hematoma CV: RRR, no m/r/g Resp: CTA bilaterally Abd: Soft, NT/ND Ext: No c/c/e FAMILY HISTORY: Mother with DM and HTN; died from brain aneurysm. GM with DM, HTN; died from diabetic coma. Older sister died of liver cancer. [**Name (NI) **] sister w/ breast cancer; in remission No history of colon cancer. No history of bleeding disorders or GIB. SOCIAL HISTORY: Patient is on disability. Lives with adult son; has 5 adult children. Tob: >25 pack-year tobacco history, currently smokes few cigarrettes/day. EtOH: Denies EtOH use. None for several years since diagnosis of cirrhosis. Drugs: History of crack cocaine use and IVDU (last use 10 yrs ago); stopped since starting dialysis ~[**2171**]. Family aware of HIV diagnosis. ### Response: {'Acute and subacute necrosis of liver,Acute pancreatitis,End stage renal disease,Human immunodeficiency virus [HIV] disease,Portal hypertension,Other complications due to renal dialysis device, implant, and graft,Atrial flutter,Acidosis,Hepatitis, unspecified,Other gaseous anesthetics causing adverse effects in therapeutic use,Renal dialysis status,Chronic hepatitis C without mention of hepatic coma,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Cirrhosis of liver without mention of alcohol,Thrombocytopenia, unspecified,Abdominal pain, unspecified site,Aortic valve disorders,Other alteration of consciousness,Other hyperparathyroidism,Hypoglycemia, unspecified,Hypotension of hemodialysis,Other chronic pulmonary heart diseases,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Depressive disorder, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

CHIEF COMPLAINT: nausea/vomiting, s/p fall PRESENT ILLNESS: 89 yo F with Alzheimer's and recent admit for GI bleed from gastritis and metaplastic pyloric mass presented with an episode of nausea / vomiting / and a fall from her bed. She is a poor historian, but records from [**Location (un) **] indicate that she had vomited w/o blood x 1 around 2 pm on [**2113-9-23**], and possibly fell/slid from bed. Pt denies F/C/abd pain/diarrhea/melena / BRBPR. In ED, she had episode of vomiting with SBP 60's, bradycardia to 30's --> given atropine.She was transferred to the MICU for further mgmt. MEDICAL HISTORY: Alzheimer's dementia HTN OCD h/o recent GIB w/ EGD revealing high grade duodenal dysplasia and intestinal metaplasia ([**8-9**]) EGD [**9-9**] with ulcerating pyloric mass increased in size. MEDICATION ON ADMISSION: home meds:pantoprazole 40 mg PO BID, B-12 1000 mcg PO QD, ferrous sulfate 5 g PO TID, folic acid 0.4 mg PO BID, diltiazem (Tiazac) 240 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: O: V: T96.4 BP 114/84 P74 R20 94% 2L Gen: NAD HEENT: OP clear, NG tube in place Resp: lungs coarse bilaterally CV: distant, RRR Abd: soft NTND +BS Ext: no edema Neuro: A+Ox1 (to person), oriented to season and general place FAMILY HISTORY: NC SOCIAL HISTORY: She lives at [**Hospital3 **] facility). Has a remote history of tobacco use, quit 40 years ago. No EtOH.

Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of pylorus,Iron deficiency anemia secondary to blood loss (chronic),Subendocardial infarction, initial episode of care,Nausea with vomiting,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Accidental fall from bed,Unspecified essential hypertension

Gastrointest hemorr NOS,Malignant neo pylorus,Chr blood loss anemia,Subendo infarct, initial,Nausea with vomiting,Alzheimer's disease,Dementia w/o behav dist,Fall from bed,Hypertension NOS

Admission Date: [**2113-9-23**] Discharge Date: [**2113-9-28**] Service: MED Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2972**] Chief Complaint: nausea/vomiting, s/p fall Major Surgical or Invasive Procedure: none History of Present Illness: 89 yo F with Alzheimer's and recent admit for GI bleed from gastritis and metaplastic pyloric mass presented with an episode of nausea / vomiting / and a fall from her bed. She is a poor historian, but records from [**Location (un) **] indicate that she had vomited w/o blood x 1 around 2 pm on [**2113-9-23**], and possibly fell/slid from bed. Pt denies F/C/abd pain/diarrhea/melena / BRBPR. In ED, she had episode of vomiting with SBP 60's, bradycardia to 30's --> given atropine.She was transferred to the MICU for further mgmt. Past Medical History: Alzheimer's dementia HTN OCD h/o recent GIB w/ EGD revealing high grade duodenal dysplasia and intestinal metaplasia ([**8-9**]) EGD [**9-9**] with ulcerating pyloric mass increased in size. Social History: She lives at [**Hospital3 **] facility). Has a remote history of tobacco use, quit 40 years ago. No EtOH. Family History: NC Physical Exam: O: V: T96.4 BP 114/84 P74 R20 94% 2L Gen: NAD HEENT: OP clear, NG tube in place Resp: lungs coarse bilaterally CV: distant, RRR Abd: soft NTND +BS Ext: no edema Neuro: A+Ox1 (to person), oriented to season and general place Pertinent Results: [**2113-9-23**] 03:45PM BLOOD WBC-7.7 RBC-2.07*# Hgb-6.4*# Hct-20.5*# MCV-99*# MCH-31.1 MCHC-31.4 RDW-18.9* Plt Ct-371# [**2113-9-24**] 01:16AM BLOOD WBC-12.4*# RBC-3.01*# Hgb-9.5*# Hct-28.7*# MCV-95 MCH-31.4 MCHC-33.0 RDW-18.7* Plt Ct-318 [**2113-9-24**] 05:59AM BLOOD Hct-29.0* [**2113-9-24**] 02:54PM BLOOD Hct-31.7* [**2113-9-24**] 09:05PM BLOOD Hct-35.9* [**2113-9-25**] 05:35AM BLOOD WBC-14.7* RBC-3.63* Hgb-11.2* Hct-34.1* MCV-94 MCH-30.8 MCHC-32.9 RDW-19.5* Plt Ct-264 [**2113-9-25**] 03:15PM BLOOD Hct-35.2* [**2113-9-26**] 06:00AM BLOOD Hct-33.8* [**2113-9-27**] 05:30AM BLOOD Hct-33.3* [**2113-9-24**] 01:16AM BLOOD CK-MB-86* MB Indx-18.5* cTropnT-1.62* [**2113-9-24**] 02:54PM BLOOD CK-MB-135* MB Indx-16.2* cTropnT-3.06* [**2113-9-24**] 09:05PM BLOOD CK-MB-97* MB Indx-13.3* [**9-23**] CT head - negative [**9-23**] CXR - unremarkable Brief Hospital Course: 1. Anemia - on admission her Hct was 20.3 so she received total of 3 units PRBCs with an appropriate Hct bump to around 33-35. She was given 2 L NS in ED. This was felt to be secondary to bleeding from the pre-pyloric mass. GI was consulted and felt that she would benefit from stent placement only if she was nauseated/vomiting, but that it would not control the bleeding, so she was tried on food and tolerated all foods well. Her PPI was continued twice a day. It was discussed with her family that a conservative/palliative approach will be pursued, with symptomatic control with PPI twice a day, biweekly hct checks, and likely no readmission if she has a massive GI bleed. This will be conveyed to her [**Hospital3 **] facility, where she is to return. 2. Cardiac ischemia: Her troponins/CK were elevated during admission, likely secondary to ischemia from low hematocrit. As pt has history of bleeding, anticoagulation with heparing was contraindicated anyway. A betal blocker was added to her regimen instead of her calcium channel blocker. She was monitored on telemetry without any adverse events. As she is DNR/DNI, no further enzymes will be drawn. 3. HTN: A beta blocker was substituted for her calcium channnel blocker for its cardioprotective effects. Her BP was stable. 4. s/p fall: She was noted to have had a fall at the outside hospital, but her head CT was negative for bleed and her mental statyus 5. Nausea/vomiting: She tolerated clears then solid food in the hospital without aspiration or vomiting. She did not need antiemetics. 6. Code status: DNR/DNI - This was discussed with the family and palliative care. Also no invasive procedures (i.e. cath, EGD for massive GI bleed) should be done but will consider EGD/stent as outpatient if gastric outlet obstruction develops. The family will clarify her status further, with possible CMO, as an outpatient, and may fill out a do not hospitalize plan. Medications on Admission: home meds:pantoprazole 40 mg PO BID, B-12 1000 mcg PO QD, ferrous sulfate 5 g PO TID, folic acid 0.4 mg PO BID, diltiazem (Tiazac) 240 Discharge Medications: 1. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 2. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 3. Fluoxetine HCl 10 mg Capsule Sig: One (1) Capsule PO once a day. Disp:*30 Capsule(s)* Refills:*2* 4. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 5. B Complex-C Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day. 6. Multi-Vit 55 Plus Tablet Sig: One (1) Tablet PO once a day. 7. Outpatient Lab Work Please draw HCT every Monday and Thursday and send results to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. [**0-0-**] 8. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. Disp:*60 Capsule(s)* Refills:*2* 9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as needed for constipation. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: Homecare Solutions Discharge Diagnosis: Pyloric mass with subacute bleeding dementia cardiac ischemia Discharge Condition: Pt was eating and drinking well. She was ambulating, and had no complaints of pain. Discharge Instructions: Please administer her current medications, and give colace and senna if constipated. She may resume a normal diet. Please have the nurse or laboratory draw her blood Monday [**10-2**], and each Thursday and Monday after that, with results sent to Dr. [**Last Name (STitle) **]. If she has vomiting, nausea, bleeding or dark stools, please contact Dr. [**Last Name (STitle) **]. Please do not hospitalize without contacting her daughter first. Followup Instructions: Follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] early next week for check of your blood count ([**0-0-**]). Follow up with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3815**] (GI) as needed, ([**Telephone/Fax (1) 8892**].

578,151,280,410,787,331,294,E884,401

{"Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of pylorus,Iron deficiency anemia secondary to blood loss (chronic),Subendocardial infarction, initial episode of care,Nausea with vomiting,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Accidental fall from bed,Unspecified essential hypertension"}

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: nausea/vomiting, s/p fall PRESENT ILLNESS: 89 yo F with Alzheimer's and recent admit for GI bleed from gastritis and metaplastic pyloric mass presented with an episode of nausea / vomiting / and a fall from her bed. She is a poor historian, but records from [**Location (un) **] indicate that she had vomited w/o blood x 1 around 2 pm on [**2113-9-23**], and possibly fell/slid from bed. Pt denies F/C/abd pain/diarrhea/melena / BRBPR. In ED, she had episode of vomiting with SBP 60's, bradycardia to 30's --> given atropine.She was transferred to the MICU for further mgmt. MEDICAL HISTORY: Alzheimer's dementia HTN OCD h/o recent GIB w/ EGD revealing high grade duodenal dysplasia and intestinal metaplasia ([**8-9**]) EGD [**9-9**] with ulcerating pyloric mass increased in size. MEDICATION ON ADMISSION: home meds:pantoprazole 40 mg PO BID, B-12 1000 mcg PO QD, ferrous sulfate 5 g PO TID, folic acid 0.4 mg PO BID, diltiazem (Tiazac) 240 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: O: V: T96.4 BP 114/84 P74 R20 94% 2L Gen: NAD HEENT: OP clear, NG tube in place Resp: lungs coarse bilaterally CV: distant, RRR Abd: soft NTND +BS Ext: no edema Neuro: A+Ox1 (to person), oriented to season and general place FAMILY HISTORY: NC SOCIAL HISTORY: She lives at [**Hospital3 **] facility). Has a remote history of tobacco use, quit 40 years ago. No EtOH. ### Response: {"Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of pylorus,Iron deficiency anemia secondary to blood loss (chronic),Subendocardial infarction, initial episode of care,Nausea with vomiting,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Accidental fall from bed,Unspecified essential hypertension"}

CHIEF COMPLAINT: fevers PRESENT ILLNESS: 72 yo male with HTN who arrived on the floor from the emergency department with respiratory distress. . He presented to the ED with fevers, chills and weakness for 48 hrs. Per ED notes, spike at home to 104. Of note, ha had a prostate biopsy 5 days prior to presentation and reported hematuria but no clots in the urine. He also reports 2 episodes of diarrhea over last couple of days. No sick contacts. Denied any cough, runny nose, headaches, abdominal pain. . In the ED, VS 102.7, hr 120, 153/91, RR 20, Sats 99% on RA. He was diaphoretic and febrile in the Ed. He received ceftriaxone 1gm (22:00), levofloxacine 500 iv x1 (2100). BP's into the 181/118. He received 10 mg IV diltiazem (00:10) . On arrival to the floor, T 101.8, patient found tachypneic 32-33, BP 180/114, tachycardic 130's, sats 97% 3 L. + wheezing. Per nursing report at some point his HR went into the 170's. He received atrovent nevs, albuterol, racemic epinephyrine, epi sub q, 25 mg IV benadryl, 125mg solumedrol, demerol and 650 tylenol after concern for allergic reaction. Initial ABG: 73.36/36/239, 2nd ABG 7.48/25/183. he never drop his BP while on the floor. MEDICAL HISTORY: HTN s/p prostate biopsy secondary to abnormal exam MEDICATION ON ADMISSION: valsartan amlodipine ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 101.8 P 124: R:28 BP:149/97 SaO2: 100% NRB General: Awake, alert HEENT: dry oral mucose, ? thursh, Neck: no JVD. supple. Pulmonary: Lungs ocassional expiratory wheezing. Cardiac: RRR, nl. S1S2, tachycardic, holosystolic murmur to the apex Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: no edema. Lymphatics: No cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. Skin: no rashes or lesions noted. Neurologic: alert, oriented x 3. movilizing all extremities spontaneously FAMILY HISTORY: non contributory SOCIAL HISTORY: Lives with his wife. Retired bus driver. + smoking. Alcohol + .

Other postoperative infection,Unspecified septicemia,Severe sepsis,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Malignant neoplasm of prostate,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation

Other postop infection,Septicemia NOS,Severe sepsis,Urin tract infection NOS,Acute kidney failure NOS,Subendo infarct, initial,Malign neopl prostate,Hypertension NOS,Hyperlipidemia NEC/NOS,Abn react-surg proc NEC

Admission Date: [**2178-4-17**] Discharge Date: [**2178-4-22**] Date of Birth: [**2106-2-21**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1042**] Chief Complaint: fevers Major Surgical or Invasive Procedure: None History of Present Illness: 72 yo male with HTN who arrived on the floor from the emergency department with respiratory distress. . He presented to the ED with fevers, chills and weakness for 48 hrs. Per ED notes, spike at home to 104. Of note, ha had a prostate biopsy 5 days prior to presentation and reported hematuria but no clots in the urine. He also reports 2 episodes of diarrhea over last couple of days. No sick contacts. Denied any cough, runny nose, headaches, abdominal pain. . In the ED, VS 102.7, hr 120, 153/91, RR 20, Sats 99% on RA. He was diaphoretic and febrile in the Ed. He received ceftriaxone 1gm (22:00), levofloxacine 500 iv x1 (2100). BP's into the 181/118. He received 10 mg IV diltiazem (00:10) . On arrival to the floor, T 101.8, patient found tachypneic 32-33, BP 180/114, tachycardic 130's, sats 97% 3 L. + wheezing. Per nursing report at some point his HR went into the 170's. He received atrovent nevs, albuterol, racemic epinephyrine, epi sub q, 25 mg IV benadryl, 125mg solumedrol, demerol and 650 tylenol after concern for allergic reaction. Initial ABG: 73.36/36/239, 2nd ABG 7.48/25/183. he never drop his BP while on the floor. Past Medical History: HTN s/p prostate biopsy secondary to abnormal exam Social History: Lives with his wife. Retired bus driver. + smoking. Alcohol + . Family History: non contributory Physical Exam: Vitals: T: 101.8 P 124: R:28 BP:149/97 SaO2: 100% NRB General: Awake, alert HEENT: dry oral mucose, ? thursh, Neck: no JVD. supple. Pulmonary: Lungs ocassional expiratory wheezing. Cardiac: RRR, nl. S1S2, tachycardic, holosystolic murmur to the apex Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: no edema. Lymphatics: No cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. Skin: no rashes or lesions noted. Neurologic: alert, oriented x 3. movilizing all extremities spontaneously Pertinent Results: [**2178-4-17**] 08:45PM WBC-11.6* RBC-4.41* HGB-13.4* HCT-39.2* MCV-89 MCH-30.5 MCHC-34.3 RDW-13.7 [**2178-4-17**] 08:45PM NEUTS-89.1* LYMPHS-6.9* MONOS-3.7 EOS-0.2 BASOS-0.1 [**2178-4-17**] 08:45PM PLT COUNT-286 [**2178-4-17**] 08:45PM GLUCOSE-154* UREA N-18 CREAT-1.5* SODIUM-135 POTASSIUM-3.8 CHLORIDE-101 TOTAL CO2-23 ANION GAP-15 [**2178-4-17**] 11:08PM URINE COLOR-Yellow APPEAR-Hazy SP [**Last Name (un) 155**]-1.024 [**2178-4-17**] 11:08PM URINE BLOOD-LGE NITRITE-POS PROTEIN-100 GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-4* PH-5.0 LEUK-SM [**2178-4-17**] 11:08PM URINE RBC-21-50* WBC-21-50* BACTERIA-MOD YEAST-NONE EPI-1 ECG [**4-17**] Sinus tachycardia. Non-specific ST-T wave changes. Consider ischemia. Compared to the previous tracing of [**2178-4-17**] no change. CTA CHEST W&W/O C&RECONS, NON-CORONARY [**2178-4-18**] 10:55 AM CTA CHEST W&W/O C&RECONS, NON- Reason: please assess for PE [**Hospital 93**] MEDICAL CONDITION: 72 year old man with hx HTN, recent prostate bx here with fevers, SOB, tachycardia REASON FOR THIS EXAMINATION: please assess for PE CONTRAINDICATIONS for IV CONTRAST: None. INDICATION: Recent prostate biopsy here with fevers, shortness of breath, tachycardia, please assess for PE. COMPARISON: Chest x-ray of [**2178-4-18**]. TECHNIQUE: Multiple MDCT images were obtained before and after the administration of intravenous Optiray. No enteric contrast was administered and coronal and sagittal reformatted were than derived. FINDINGS: There is no CT evidence for pulmonary emboli. No aortic dissection is demonstrated and there is no evidence for intramural hematoma. There are vascular, including coronary, artery calcifications. There are calcified pleural plaques. Emphysematous changes are seen, and there is bibasilar dependent atelectasis with a small right pleural effusion. Heart size is normal. There is no abnormal bowing of intraventricular septum or enlargement of the right heart. Three hypodensities are seen in the liver, the largest measuring 1.2 cm in the dome of the liver and two in the in the left lobe of the liver, too small to characterize, likely cysts. The visualized portion of the spleen and right kidney appear normal. OSSEOUS STRUCTURES: Mild degenerative changes are seen at numerous levels in the spine with some symmetric sclerosis of the posterior elements superiorly. IMPRESSION: 1. No pulmonary embolus or aortic dissection. 2. Hepatic hypodense nodules of undetermined nature, for which ultrasound is recommended for characterization. ABDOMEN U.S. (COMPLETE STUDY) [**2178-4-20**] 3:56 PM ABDOMEN U.S. (COMPLETE STUDY) Reason: please further evaluate hypodensities in liver [**Hospital 93**] MEDICAL CONDITION: 72 year old man with SOB, recent prostate biopsy and now here with NSTEMI with liver densities on CT chest REASON FOR THIS EXAMINATION: please further evaluate hypodensities in liver HISTORY: 72-year-old male with recent prostate biopsy, now with hypodensities in the liver on CT chest. COMPARISON: CTA chest of [**2178-4-18**]. ABDOMINAL ULTRASOUND: Multiple cysts are seen within the liver, the largest one measuring 1.9 x 1.7 x 1.6 cm. These correspond to the hypodensities that were seen on the CT chest performed 2 days prior. Otherwise, the liver demonstrates normal echogenicity and no other focal lesions. Portal venous flow is normal and hepatopetal. The common duct is not dilated and measures 6 mm. The gallbladder appears normal without evidence of stones. The pancreatic tail is not well visualized due to overlying bowel gas; the visualized portions of pancreas appear normal. The spleen is not enlarged. The right kidney measures 12.0 cm and the left kidney measures 11.47 cm; there is no hydronephrosis, stones, or masses. There is no ascites. While the distalmost aorta is obscured by overlying bowel gas there is focal aneurysmal dilatation of the distal aorta measuring 3.3 cm, compared to the aorta directly above it which measures 2.2 cm. IMPRESSION: 1. Hypodense lesions on the CT chest correspond to hepatic cysts. Otherwise, liver appears normal. 2. Focal aneurysmal dilatation of distal aorta measuring 3.3 cm. Aortic bifurcantion not seen due to overlying bowel gas. Echo ([**4-20**]) The left atrium is moderately dilated. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is an inferobasal left ventricular aneurysm. There is moderate regional left ventricular systolic dysfunction with akinesis of the basal inferior and inferolateral segments, severe hypokinesis of the mid inferior and inferolateral segments and mild hypokinesis of all other segments. Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The remaining left ventricular segments are hypokinetic. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. IMPRESSION: Global LV systolic dysfunction with the inferior wall being worst affected. Inferobasal aneurysm. Diastolic dysfunction. Mild mitral regurgitation. Brief Hospital Course: The patient was admitted to the MICU for respiratory distress which responded to stress dose steroids and inhaler therapy. During a period of high blood pressure and tachycardia, the patient was noted to have a mild NSTEMI which was medically managed. He was also noted to be in acute renal failure, which resonded to gentle hydration. He was also noted to have a pyuria and started empirically on cefepime and ciprofloxacin. He was subsequently transferred to the floor with reasonable control of blood pressure and heart rate. He was started on high dose simvastatin. Cardiology consult recommended 4 week outpatient follow up. His urine culture and sensitivities returned, and his antibiotic regimen was converted to sulfamethoxazole/trimethoprim twice daily for a total of 4 weeks given the reduced tissue penetration to the prostate of sulfa antibiotics. Outpatient follow up for his new diagnosis of prostate cancer was to be arranged by his spouse. On discharge, the patient was feeling at baseline without any significant symptoms. Medications on Admission: valsartan amlodipine Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. Metoprolol Succinate 200 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO twice a day. Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*1* 5. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*1* 6. Septra DS 160-800 mg Tablet Sig: One (1) Tablet PO twice a day for 4 weeks: For urinary tract infection. Disp:*56 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: 1. Prostate adenocarcinoma 2. Non-ST elevation myocardial infarction 3. Acute renal failure, resolved 4. Sepsis, resolved 5. Urinary tract infection following prostate biopsy 6. Hypertension 7. Hyperlipidemia Discharge Condition: Stable Discharge Instructions: Please contact your primary care physician if you develop shortness of breath, chest pain, palpitations, increasing edema in your legs, or difficulty urinating. Followup Instructions: 1. Please schedule a follow up appointment with Urology 2. Cardiology Clinic Monday [**5-18**] with Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] at 2:20pm located on [**Hospital Ward Name 23**] 7 3. Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 14290**], OD Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2178-7-22**] 1:00

998,038,995,599,584,410,185,401,272,E878

{'Other postoperative infection,Unspecified septicemia,Severe sepsis,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Malignant neoplasm of prostate,Unspecified essential hypertension,Other and unspecified hyperlipidemia,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: fevers PRESENT ILLNESS: 72 yo male with HTN who arrived on the floor from the emergency department with respiratory distress. . He presented to the ED with fevers, chills and weakness for 48 hrs. Per ED notes, spike at home to 104. Of note, ha had a prostate biopsy 5 days prior to presentation and reported hematuria but no clots in the urine. He also reports 2 episodes of diarrhea over last couple of days. No sick contacts. Denied any cough, runny nose, headaches, abdominal pain. . In the ED, VS 102.7, hr 120, 153/91, RR 20, Sats 99% on RA. He was diaphoretic and febrile in the Ed. He received ceftriaxone 1gm (22:00), levofloxacine 500 iv x1 (2100). BP's into the 181/118. He received 10 mg IV diltiazem (00:10) . On arrival to the floor, T 101.8, patient found tachypneic 32-33, BP 180/114, tachycardic 130's, sats 97% 3 L. + wheezing. Per nursing report at some point his HR went into the 170's. He received atrovent nevs, albuterol, racemic epinephyrine, epi sub q, 25 mg IV benadryl, 125mg solumedrol, demerol and 650 tylenol after concern for allergic reaction. Initial ABG: 73.36/36/239, 2nd ABG 7.48/25/183. he never drop his BP while on the floor. MEDICAL HISTORY: HTN s/p prostate biopsy secondary to abnormal exam MEDICATION ON ADMISSION: valsartan amlodipine ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 101.8 P 124: R:28 BP:149/97 SaO2: 100% NRB General: Awake, alert HEENT: dry oral mucose, ? thursh, Neck: no JVD. supple. Pulmonary: Lungs ocassional expiratory wheezing. Cardiac: RRR, nl. S1S2, tachycardic, holosystolic murmur to the apex Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: no edema. Lymphatics: No cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. Skin: no rashes or lesions noted. Neurologic: alert, oriented x 3. movilizing all extremities spontaneously FAMILY HISTORY: non contributory SOCIAL HISTORY: Lives with his wife. Retired bus driver. + smoking. Alcohol + . ### Response: {'Other postoperative infection,Unspecified septicemia,Severe sepsis,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Subendocardial infarction, initial episode of care,Malignant neoplasm of prostate,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

CHIEF COMPLAINT: R hip pain PRESENT ILLNESS: 62 year old man with [**First Name9 (NamePattern2) 3262**] [**Last Name (un) 3263**] cirrhosis c/b Grade 1 esophageal varices and past GIB's, Crohn's s/p ileostomy, COPD, HTN, pancytopenia, GERD, depression, avascular necrosis [**1-7**] chronic prednisone use s/p L hip replacement with massive osteolysis of pelvis/acetabulum and proximal femur, extended femoral osteotomy (clamshell) with multiple open reduction and internal fixations who is admitted to the ICU for monitoring after 3rd attempt of total hip replacement. . The patient was previously discharged on [**2201-4-20**] s/p total resection arthroplasty on [**2201-4-2**]. Post-operatively, the patient was noted to be confused coming out of the OR and overnight. He was initially transferred to ICU post surgery because of hypotension and was on pressors with subsequent normalization of blood pressures. Post-op course was also complicated by hepatic/toxic-metabolic encephalopathy, cleared with rifaximin and lactulose, and by acute kidney injury. MEDICAL HISTORY: Past Medical History: - HTN - dyslipidemia - ascending aortic aneurysm, not involving the coronary vessels - bicuspid aortic valve - EtOH cirrhosis c/b esophageal varices and bleeding: baseline liver enzymes ALT 21, AST 30, ALK 190, TBili 1.2 - pancytopenia: baseline WBC 1.7, Hgb 12.3, Hct 35.8, Plt 54 - thrombocytopenia - Crohn's disease s/p ileostomy - prostate cancer - kyphosis - COPD - GERD - squamous cell carcinoma s/p resection - avascular necrosis of left hip secondary to prednisone - depression - baseline BUN 15, Cr 1.0 . Past Surgical History: - squamous cell carcinoma excisions x 3 forehead ([**10/2199**]) - L distal radius ORIF ([**2196**]) - partial colectomy with transverse colostomy and mucous fistula MEDICATION ON ADMISSION: MEDICATIONS AT HOME: AZATHIOPRINE - (Prescribed by Other Provider) - 50 mg Tablet - 2-1/2 Tablet(s) by mouth once daily DULOXETINE [CYMBALTA] - (Prescribed by Other Provider) - 60 mg Capsule, Delayed Release(E.C.) - one Capsule(s) by mouth daily FOLIC ACID - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth once daily LISINOPRIL - (Prescribed by Other Provider) - 10 mg Tablet - one Tablet(s) by mouth daily NADOLOL - (Prescribed by Other Provider) - 40 mg Tablet - one Tablet(s) by mouth daily OXYCODONE [OXYCONTIN] - (Prescribed by Other Provider) - 20 mg Tablet Extended Release 12 hr - 1 Tablet(s) by mouth twice daily OXYCODONE-ACETAMINOPHEN [ROXICET] - (Prescribed by Other Provider) - 5 mg-325 mg Tablet - 1 Tablet(s) by mouth every 4-6 hours as needed for pain SODIUM CHLORIDE - (Prescribed by Other Provider) - - 4 mg daily TRAZODONE - (Prescribed by Other Provider) - 50 mg Tablet - 1 Tablet(s) by mouth once a day . Medications - OTC CALCIUM - (Prescribed by Other Provider) - Dosage uncertain CYANOCOBALAMIN (VITAMIN B-12) [VITAMIN B-12] - (Prescribed by Other Provider) - Dosage uncertain MAGNESIUM OXIDE - (Prescribed by Other Provider) - 400 mg Tablet - 6 Tablet(s) by mouth three times a day MULTIVITAMIN - (Prescribed by Other Provider) - Dosage uncertain OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - (Prescribed by Other Provider) - 20 mg Tablet, Delayed Release (E.C.) - two Tablet(s) by mouth daily . Medications on transfer to ICU: -Lisinopril 10 mg PO/NG DAILY -Acetaminophen 650 mg PO Q6H -Milk of Magnesia 30 ml PO BID:PRN Constipation -Bisacodyl 10 mg PO/PR DAILY:PRN Constipation -Multivitamins 1 CAP PO DAILY -CefazoLIN 2 g IV Q8H (2 hrs post-op) -Nadolol 40 mg PO DAILY -Calcium Carbonate 500 mg PO TID -OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN Pain Start: In am Begin after PCA has been d/c [**6-24**] -Docusate Sodium 100 mg PO BID -Ondansetron 4 mg IV Q8H:PRN nausea/vomiting -Duloxetine 60 mg PO DAILY -Omeprazole 20 mg PO DAILY -Enoxaparin Sodium 40 mg SC DAILY Start: In am Begin on [**6-24**] wednesday -Senna 1 TAB PO BID -FoLIC Acid 1 mg PO/NG DAILY -Vitamin D 400 UNIT PO DAILY Order date: [**6-23**] @ 1103 -HYDROmorphone (Dilaudid) 0.12 mg IVPCA Lockout Interval: 6 minutes Basal Rate: 0 mg(s)/hour 1-hr Max Limit: 1.2 mg(s) ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Well appearing in no acute distress Afebrile with stable vital signs Pain well-controlled Respiratory: CTAB Cardiovascular: RRR Gastrointestinal: NT/ND, ostomy RLQ, hernia LLQ Genitourinary: Voiding independently Neurologic: Intact with no focal deficits Psychiatric: Pleasant, A&O x3 Musculoskeletal Lower Extremity: * Incision healing well with staples * Scant serosanguinous drainage * Thigh full but soft * No calf tenderness * 5/5 strength * SILT, NVI distally * Toes warm FAMILY HISTORY: Positive for hemophilia but not affecting this patient, although he does have thrombocytopenia. SOCIAL HISTORY: He is retired from the Department of Social Services, former widower, has a girlfriend. - Tobacco: Previous use - Alcohol: Prior history of alcohol abuse, no longer drinking in 22 months per pt, family and PCP. [**Name Initial (NameIs) **] [**Name11 (NameIs) 3264**]: denies

Peri-prosthetic osteolysis,Regional enteritis of unspecified site,Acute posthemorrhagic anemia,Esophageal varices without mention of bleeding,Congenital insufficiency of aortic valve,Alcoholic cirrhosis of liver,Unspecified essential hypertension,Thoracic aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Esophageal reflux,Alcohol abuse, in remission,Depressive disorder, not elsewhere classified,Long-term (current) use of steroids,Ileostomy status,Hip joint replacement,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin,Family history of other blood disorders,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation

Periprosthetc osteolysis,Regional enteritis NOS,Ac posthemorrhag anemia,Esoph varices w/o bleed,Cong aorta valv insuffic,Alcohol cirrhosis liver,Hypertension NOS,Thoracic aortic aneurysm,Hyperlipidemia NEC/NOS,Chr airway obstruct NEC,Thrombocytopenia NOS,Esophageal reflux,Alcohol abuse-in remiss,Depressive disorder NEC,Long-term use steroids,Ileostomy status,Joint replaced hip,Hx-prostatic malignancy,Hx-skin malignancy NEC,Fam hx-blood disord NEC,Abn react-artif implant

Admission Date: [**2201-6-23**] Discharge Date: [**2201-6-29**] Date of Birth: [**2138-12-24**] Sex: M Service: ORTHOPAEDICS Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 64**] Chief Complaint: R hip pain Major Surgical or Invasive Procedure: [**2201-6-23**]: s/p left total hip revision History of Present Illness: 62 year old man with [**First Name9 (NamePattern2) 3262**] [**Last Name (un) 3263**] cirrhosis c/b Grade 1 esophageal varices and past GIB's, Crohn's s/p ileostomy, COPD, HTN, pancytopenia, GERD, depression, avascular necrosis [**1-7**] chronic prednisone use s/p L hip replacement with massive osteolysis of pelvis/acetabulum and proximal femur, extended femoral osteotomy (clamshell) with multiple open reduction and internal fixations who is admitted to the ICU for monitoring after 3rd attempt of total hip replacement. . The patient was previously discharged on [**2201-4-20**] s/p total resection arthroplasty on [**2201-4-2**]. Post-operatively, the patient was noted to be confused coming out of the OR and overnight. He was initially transferred to ICU post surgery because of hypotension and was on pressors with subsequent normalization of blood pressures. Post-op course was also complicated by hepatic/toxic-metabolic encephalopathy, cleared with rifaximin and lactulose, and by acute kidney injury. Past Medical History: Past Medical History: - HTN - dyslipidemia - ascending aortic aneurysm, not involving the coronary vessels - bicuspid aortic valve - EtOH cirrhosis c/b esophageal varices and bleeding: baseline liver enzymes ALT 21, AST 30, ALK 190, TBili 1.2 - pancytopenia: baseline WBC 1.7, Hgb 12.3, Hct 35.8, Plt 54 - thrombocytopenia - Crohn's disease s/p ileostomy - prostate cancer - kyphosis - COPD - GERD - squamous cell carcinoma s/p resection - avascular necrosis of left hip secondary to prednisone - depression - baseline BUN 15, Cr 1.0 . Past Surgical History: - squamous cell carcinoma excisions x 3 forehead ([**10/2199**]) - L distal radius ORIF ([**2196**]) - partial colectomy with transverse colostomy and mucous fistula - mucous fistula takedown - left wrist surgery - left hip replacement (20 years ago) - avascular necrosis of left hip secondary to Crohn's/prednisone, - Complex complete resection arthroplasty of failed left total hip replacement; extended femoral osteotomy (clamshell) with multiple open reduction and internal fixation cerclage wires Social History: He is retired from the Department of Social Services, former widower, has a girlfriend. - Tobacco: Previous use - Alcohol: Prior history of alcohol abuse, no longer drinking in 22 months per pt, family and PCP. [**Name Initial (NameIs) **] [**Name11 (NameIs) 3264**]: denies Family History: Positive for hemophilia but not affecting this patient, although he does have thrombocytopenia. Physical Exam: Well appearing in no acute distress Afebrile with stable vital signs Pain well-controlled Respiratory: CTAB Cardiovascular: RRR Gastrointestinal: NT/ND, ostomy RLQ, hernia LLQ Genitourinary: Voiding independently Neurologic: Intact with no focal deficits Psychiatric: Pleasant, A&O x3 Musculoskeletal Lower Extremity: * Incision healing well with staples * Scant serosanguinous drainage * Thigh full but soft * No calf tenderness * 5/5 strength * SILT, NVI distally * Toes warm Pertinent Results: [**2201-6-23**] 11:30AM BLOOD Hgb-12.5* Hct-34.4* Plt Ct-53* [**2201-6-23**] 06:00PM BLOOD Hgb-9.7* Hct-27.6* Plt Ct-85*# [**2201-6-23**] 08:43PM BLOOD WBC-1.9* RBC-3.36* Hgb-11.5* Hct-33.2* MCV-99* MCH-34.2* MCHC-34.6 RDW-18.3* Plt Ct-62* [**2201-6-24**] 03:39AM BLOOD WBC-3.4*# RBC-3.01* Hgb-10.6* Hct-29.3* MCV-97 MCH-35.2* MCHC-36.2* RDW-19.2* Plt Ct-84* [**2201-6-24**] 04:07PM BLOOD WBC-3.7* RBC-2.66* Hgb-9.2* Hct-25.5* MCV-96 MCH-34.8* MCHC-36.2* RDW-18.9* Plt Ct-83* [**2201-6-25**] 06:20AM BLOOD WBC-1.5*# RBC-2.15* Hgb-7.5* Hct-21.1* MCV-98 MCH-35.0* MCHC-35.6* RDW-19.3* Plt Ct-51* [**2201-6-26**] 12:30AM BLOOD WBC-1.8* RBC-2.68* Hgb-9.0* Hct-25.4* MCV-95 MCH-33.7* MCHC-35.5* RDW-18.6* Plt Ct-43* [**2201-6-26**] 06:25AM BLOOD WBC-1.2* RBC-2.71* Hgb-9.2* Hct-26.1* MCV-97 MCH-33.9* MCHC-35.1* RDW-18.6* Plt Ct-42* [**2201-6-27**] 07:20AM BLOOD WBC-1.3* RBC-2.79* Hgb-9.6* Hct-26.8* MCV-96 MCH-34.3* MCHC-35.7* RDW-18.3* Plt Ct-43* [**2201-6-27**] 07:20AM BLOOD WBC-1.3* RBC-2.79* Hgb-9.6* Hct-26.8* MCV-96 MCH-34.3* MCHC-35.7* RDW-18.3* Plt Ct-43* [**2201-6-28**] 06:05AM BLOOD WBC-1.3* RBC-2.79* Hgb-9.7* Hct-27.5* MCV-99* MCH-34.9* MCHC-35.4* RDW-18.8* Plt Ct-42* [**2201-6-23**] 08:43PM BLOOD Neuts-88.5* Bands-0 Lymphs-3.9* Monos-7.0 Eos-0.5 Baso-0.1 [**2201-6-24**] 03:39AM BLOOD Neuts-89.0* Bands-0 Lymphs-4.2* Monos-6.2 Eos-0.1 Baso-0.5 [**2201-6-27**] 07:20AM BLOOD Neuts-80.2* Lymphs-9.1* Monos-7.6 Eos-2.5 Baso-0.5 [**2201-6-23**] 08:43PM BLOOD Glucose-140* UreaN-14 Creat-0.7 Na-138 K-4.6 Cl-113* HCO3-19* AnGap-11 [**2201-6-24**] 03:39AM BLOOD Glucose-119* UreaN-16 Creat-0.8 Na-138 K-4.4 Cl-112* HCO3-19* AnGap-11 [**2201-6-25**] 06:20AM BLOOD Glucose-135* UreaN-17 Creat-0.9 Na-140 K-3.6 Cl-109* HCO3-24 AnGap-11 [**2201-6-26**] 06:25AM BLOOD Glucose-94 UreaN-13 Creat-0.7 Na-141 K-3.3 Cl-109* HCO3-25 AnGap-10 [**2201-6-27**] 07:20AM BLOOD Glucose-98 UreaN-11 Creat-0.7 Na-142 K-3.4 Cl-108 HCO3-24 AnGap-13 [**2201-6-28**] 06:05AM BLOOD Glucose-134* UreaN-12 Creat-0.9 Na-140 K-3.6 Cl-108 HCO3-24 AnGap-12 Brief Hospital Course: The patient was admitted to the orthopaedic surgery service and was taken to the operating room for above described procedure. Please see separately dictated operative report for details. The surgery was uncomplicated and the patient tolerated the procedure well. Patient received perioperative IV antibiotics. Postoperative course was remarkable for the following: 1. ICU Course: # s/p left hip replacement: Patient tolerated the procedure well per Ortho although he did have significant blood loss and fluid shifts. He had a RIJ placed in the OR the postition of which was confirmed on presentation to the [**Hospital Unit Name 153**]. Post-op Hct stable at 33.2. He received ancef for 24 hours after the procedure. Was intubated on admission to unit. He was cautiously weaned from the vent and from Propofol given his prior history of difficulty with extubation and altered mental status. Opiods were avoided in management of the patient's pain. He was given small fentanyl boluses for pain through the night. He was extubated in the morning without difficulty. The JP drains contained serosanginous fluid, and on POD1 the patient was started on enoxaparin 40mg Sc daily. Pain management was an issue given the patient's underlying hepatic dysfunction. The acute pain and the chronic pain services were consulted regarding a lumbosacral block. It was decided that in place of a lumbosacral block, the patient's Dilaudid PCA would be increased to dose to .24/6m and his long-acting oxycontin PO 10 mg Q6H. The patient was successfully extubated upon leaving the [**Hospital Unit Name 153**]. . # EtOH Cirrhosis - Blood transfusions and insult of surgery would contribute to higher likelihood of post-op hepatic encephalopathy. Patient does have history of grade 1 varices as well. Mental status was monitored through [**Hospital Unit Name 153**] course and the patient did not have hepatic encephalopathy on exam. Lactulose was started after the patient was extubated. His home nadolol was initially held [**1-7**] low BP, but this was restarted after extubation. . # Pancytopenia - History of thrombocytopenia [**1-7**] cirrhosis as well as pancytopenia, (which on previous workup by Heme/Onc was felt to medication, portal sequestration). Macrocytic anemia consistent with history of alcohol and cirrhosis. CBC was monitored with a goal of keeping platelets > 10 or 50 if acute bleeding. Through his course in the [**Hospital Unit Name 153**], the patient had an active type and screen. No transfusions were required post-operatively in the [**Hospital Unit Name 153**]. . # Crohn's disease - Stable, not having diarrhea. Continued with azathioprine when taking POs. . # HTN - Initially held lisinopril for now pending fluid shifts and post op hypotension. . # COPD - Documented h/o COPD in OMR but on no home medications. # Ascending aortic aneurysm: Stable on recent Echo. VS were monitored. . # Depression: Home duloxitine was continued. 2. Asymptomatic post-operative anemia - POD 2 Hct 21.1 -> Transfused 2 units PRBCs 3. Medicine consult for co-management Otherwise, pain was initially controlled with a PCA followed by a transition to oral pain medications on POD#2. The patient received lovenox for DVT prophylaxis starting on the morning of POD#1. The foley was removed on POD#2 and the patient was voiding independently thereafter. The surgical dressing was changed on POD#2 and the surgical incision was found to be clean and intact without erythema or abnormal drainage. The patient was seen daily by physical therapy. Labs were checked throughout the hospital course and repleted accordingly. At the time of discharge the patient was tolerating a regular diet and feeling well. The patient was afebrile with stable vital signs. The patient's hematocrit was acceptable and pain was adequately controlled on an oral regimen. The operative extremity was neurovascularly intact and the wound was benign. The patient's weight-bearing status is TOUCHDOWN weight bearing on the operative extremity with POSTERIOR and TROCHANTER OFF precautions. Mr. [**Known lastname 3265**] is discharged to rehab in stable condition. Medications on Admission: MEDICATIONS AT HOME: AZATHIOPRINE - (Prescribed by Other Provider) - 50 mg Tablet - 2-1/2 Tablet(s) by mouth once daily DULOXETINE [CYMBALTA] - (Prescribed by Other Provider) - 60 mg Capsule, Delayed Release(E.C.) - one Capsule(s) by mouth daily FOLIC ACID - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth once daily LISINOPRIL - (Prescribed by Other Provider) - 10 mg Tablet - one Tablet(s) by mouth daily NADOLOL - (Prescribed by Other Provider) - 40 mg Tablet - one Tablet(s) by mouth daily OXYCODONE [OXYCONTIN] - (Prescribed by Other Provider) - 20 mg Tablet Extended Release 12 hr - 1 Tablet(s) by mouth twice daily OXYCODONE-ACETAMINOPHEN [ROXICET] - (Prescribed by Other Provider) - 5 mg-325 mg Tablet - 1 Tablet(s) by mouth every 4-6 hours as needed for pain SODIUM CHLORIDE - (Prescribed by Other Provider) - - 4 mg daily TRAZODONE - (Prescribed by Other Provider) - 50 mg Tablet - 1 Tablet(s) by mouth once a day . Medications - OTC CALCIUM - (Prescribed by Other Provider) - Dosage uncertain CYANOCOBALAMIN (VITAMIN B-12) [VITAMIN B-12] - (Prescribed by Other Provider) - Dosage uncertain MAGNESIUM OXIDE - (Prescribed by Other Provider) - 400 mg Tablet - 6 Tablet(s) by mouth three times a day MULTIVITAMIN - (Prescribed by Other Provider) - Dosage uncertain OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - (Prescribed by Other Provider) - 20 mg Tablet, Delayed Release (E.C.) - two Tablet(s) by mouth daily . Medications on transfer to ICU: -Lisinopril 10 mg PO/NG DAILY -Acetaminophen 650 mg PO Q6H -Milk of Magnesia 30 ml PO BID:PRN Constipation -Bisacodyl 10 mg PO/PR DAILY:PRN Constipation -Multivitamins 1 CAP PO DAILY -CefazoLIN 2 g IV Q8H (2 hrs post-op) -Nadolol 40 mg PO DAILY -Calcium Carbonate 500 mg PO TID -OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN Pain Start: In am Begin after PCA has been d/c [**6-24**] -Docusate Sodium 100 mg PO BID -Ondansetron 4 mg IV Q8H:PRN nausea/vomiting -Duloxetine 60 mg PO DAILY -Omeprazole 20 mg PO DAILY -Enoxaparin Sodium 40 mg SC DAILY Start: In am Begin on [**6-24**] wednesday -Senna 1 TAB PO BID -FoLIC Acid 1 mg PO/NG DAILY -Vitamin D 400 UNIT PO DAILY Order date: [**6-23**] @ 1103 -HYDROmorphone (Dilaudid) 0.12 mg IVPCA Lockout Interval: 6 minutes Basal Rate: 0 mg(s)/hour 1-hr Max Limit: 1.2 mg(s) Discharge Medications: 1. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. multivitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 3. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 4. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 5. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. nadolol 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours). 10. azathioprine 50 mg Tablet Sig: 2.5 Tablets PO DAILY (Daily). 11. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe Subcutaneous DAILY (Daily) for 3 weeks. Disp:*21 syringe* Refills:*0* 12. aspirin, buffered 325 mg Tablet Sig: One (1) Tablet PO twice a day for 3 weeks: AFTER completing Lovenox, take as directed with food. Disp:*42 Tablet(s)* Refills:*0* 13. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day): Take while on strong pain medication. Disp:*2700 ML(s)* Refills:*2* 14. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain: Hold for confusion. Disp:*50 Tablet(s)* Refills:*0* 15. Outpatient Lab Work daily CBC with diff at rehab until his WBC counts increase. If he were to become neutropenic or show signs of infection, would recommend stopping Azathioprine. Would transfuse PRN for goal plt >10 and Hct > 21. Discharge Disposition: Extended Care Facility: [**Hospital 2971**] Rehabilitation and Nursing Center - [**Hospital1 1474**] Discharge Diagnosis: Failed left total hip replacement Post-operative anemia due to blood loss Chronic pancytopenia *Anticipated length of stay < 30 days* Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: 1. Please return to the emergency department or notify your physician if you experience any of the following: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers greater than 101.5, shaking chills, increasing redness or drainage from the incision site, chest pain, shortness of breath or any other concerns. 2. Please follow up with your primary physician regarding this admission and any new medications and refills. 3. Resume your home medications unless otherwise instructed. 4. You have been given medications for pain control. Please do not drive, operate heavy machinery, or drink alcohol while taking these medications. As your pain decreases, take fewer tablets and increase the time between doses. This medication can cause constipation, so you should drink plenty of water daily to prevent this side effect. Call your surgeons office 3 days before you are out of medication so that it can be refilled. These medications cannot be called into your pharmacy and must be picked up in the clinic or mailed to your house. Please allow an extra 2 days if you would like your medication mailed to your home. 5. You may not drive a car until cleared to do so by your surgeon. 6. Please keep your wounds clean. You may shower starting five (5) days after surgery, but no tub baths or swimming for at least four (4) weeks. No dressing is needed if wound continues to be non-draining. Any stitches or staples that need to be removed will be taken out by the visiting nurse (VNA) or rehab facility two weeks after your surgery. 7. Please call your surgeon's office to schedule or confirm your follow-up appointment in four (4) weeks. 8. Please DO NOT take any non-steroidal anti-inflammatory medications (NSAIDs such as celebrex, ibuprofen, advil, aleve, motrin, etc). 9. ANTICOAGULATION: Please continue your lovenox for three (3) weeks to help prevent deep vein thrombosis (blood clots). After completing the lovenox, please take Aspirin 325mg TWICE daily for three weeks. [**Male First Name (un) **] STOCKINGS x 6 WEEKS. 10. WOUND CARE: Please keep your incision clean and dry. It is okay to shower five days after surgery but no tub baths, swimming, or submerging your incision until after your four (4) week checkup. Please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. Check wound regularly for signs of infection such as redness or thick yellow drainage. Staples will be removed by the visiting nurse or rehab facility in two (2) weeks. 11. VNA (once at home): Home PT/OT, dressing changes as instructed, wound checks, and staple removal at two weeks after surgery. 12. ACTIVITY: TOUCHDOWN weight bearing on the operative extremity. POSTERIOR and TROCHANTER OFF precautions. No strenuous exercise or heavy lifting until follow up appointment. Physical Therapy: LLE TOUCHDOWN weight bearing Posterior AND trochanter off precautions Mobilize Treatments Frequency: Dry sterile dressing daily as needed for drainage Wound checks Ice as tolerated Staple removal POD 17 - replace with steristrips TEDs Followup Instructions: Provider: [**First Name11 (Name Pattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3260**], [**MD Number(3) 3261**]:[**Telephone/Fax (1) 1228**] Date/Time:[**2201-7-24**] 11:00 Completed by:[**2201-6-28**] Name: [**Known lastname 368**],[**Known firstname **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) 201**]. Unit [**Name2 (NI) **]: [**Numeric Identifier 369**] Admission Date: [**2201-6-23**] Discharge Date: [**2201-6-29**] Date of Birth: [**2138-12-24**] Sex: M Service: ORTHOPAEDICS Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 370**] Addendum: Patient was stable for discharge on Sunday [**2201-6-28**], but rehab was unable to admit secondary to power outage at facility. Patient was discharged to rehab in stable condition on [**2201-6-29**]. Pertinent Results: [**2201-6-29**] 06:20AM BLOOD WBC-1.3* RBC-2.76* Hgb-9.3* Hct-27.0* MCV-98 MCH-33.8* MCHC-34.6 RDW-18.6* Plt Ct-46* [**2201-6-29**] 06:20AM BLOOD Glucose-109* UreaN-13 Creat-0.6 Na-138 K-3.7 Cl-108 HCO3-24 AnGap-10 [**2201-6-29**] 06:20AM BLOOD Calcium-8.4 Phos-2.9 Mg-1.4* Discharge Disposition: Extended Care Facility: [**Hospital 371**] Rehabilitation and Nursing Center - [**Hospital1 328**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 372**] MD [**MD Number(2) 373**] Completed by:[**2201-6-29**]

996,555,285,456,746,571,401,441,272,496,287,530,305,311,V586,V442,V436,V104,V108,V183,E878

{'Peri-prosthetic osteolysis,Regional enteritis of unspecified site,Acute posthemorrhagic anemia,Esophageal varices without mention of bleeding,Congenital insufficiency of aortic valve,Alcoholic cirrhosis of liver,Unspecified essential hypertension,Thoracic aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Esophageal reflux,Alcohol abuse, in remission,Depressive disorder, not elsewhere classified,Long-term (current) use of steroids,Ileostomy status,Hip joint replacement,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin,Family history of other blood disorders,Surgical operation with implant of artificial internal device 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: R hip pain PRESENT ILLNESS: 62 year old man with [**First Name9 (NamePattern2) 3262**] [**Last Name (un) 3263**] cirrhosis c/b Grade 1 esophageal varices and past GIB's, Crohn's s/p ileostomy, COPD, HTN, pancytopenia, GERD, depression, avascular necrosis [**1-7**] chronic prednisone use s/p L hip replacement with massive osteolysis of pelvis/acetabulum and proximal femur, extended femoral osteotomy (clamshell) with multiple open reduction and internal fixations who is admitted to the ICU for monitoring after 3rd attempt of total hip replacement. . The patient was previously discharged on [**2201-4-20**] s/p total resection arthroplasty on [**2201-4-2**]. Post-operatively, the patient was noted to be confused coming out of the OR and overnight. He was initially transferred to ICU post surgery because of hypotension and was on pressors with subsequent normalization of blood pressures. Post-op course was also complicated by hepatic/toxic-metabolic encephalopathy, cleared with rifaximin and lactulose, and by acute kidney injury. MEDICAL HISTORY: Past Medical History: - HTN - dyslipidemia - ascending aortic aneurysm, not involving the coronary vessels - bicuspid aortic valve - EtOH cirrhosis c/b esophageal varices and bleeding: baseline liver enzymes ALT 21, AST 30, ALK 190, TBili 1.2 - pancytopenia: baseline WBC 1.7, Hgb 12.3, Hct 35.8, Plt 54 - thrombocytopenia - Crohn's disease s/p ileostomy - prostate cancer - kyphosis - COPD - GERD - squamous cell carcinoma s/p resection - avascular necrosis of left hip secondary to prednisone - depression - baseline BUN 15, Cr 1.0 . Past Surgical History: - squamous cell carcinoma excisions x 3 forehead ([**10/2199**]) - L distal radius ORIF ([**2196**]) - partial colectomy with transverse colostomy and mucous fistula MEDICATION ON ADMISSION: MEDICATIONS AT HOME: AZATHIOPRINE - (Prescribed by Other Provider) - 50 mg Tablet - 2-1/2 Tablet(s) by mouth once daily DULOXETINE [CYMBALTA] - (Prescribed by Other Provider) - 60 mg Capsule, Delayed Release(E.C.) - one Capsule(s) by mouth daily FOLIC ACID - (Prescribed by Other Provider) - 1 mg Tablet - 1 Tablet(s) by mouth once daily LISINOPRIL - (Prescribed by Other Provider) - 10 mg Tablet - one Tablet(s) by mouth daily NADOLOL - (Prescribed by Other Provider) - 40 mg Tablet - one Tablet(s) by mouth daily OXYCODONE [OXYCONTIN] - (Prescribed by Other Provider) - 20 mg Tablet Extended Release 12 hr - 1 Tablet(s) by mouth twice daily OXYCODONE-ACETAMINOPHEN [ROXICET] - (Prescribed by Other Provider) - 5 mg-325 mg Tablet - 1 Tablet(s) by mouth every 4-6 hours as needed for pain SODIUM CHLORIDE - (Prescribed by Other Provider) - - 4 mg daily TRAZODONE - (Prescribed by Other Provider) - 50 mg Tablet - 1 Tablet(s) by mouth once a day . Medications - OTC CALCIUM - (Prescribed by Other Provider) - Dosage uncertain CYANOCOBALAMIN (VITAMIN B-12) [VITAMIN B-12] - (Prescribed by Other Provider) - Dosage uncertain MAGNESIUM OXIDE - (Prescribed by Other Provider) - 400 mg Tablet - 6 Tablet(s) by mouth three times a day MULTIVITAMIN - (Prescribed by Other Provider) - Dosage uncertain OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - (Prescribed by Other Provider) - 20 mg Tablet, Delayed Release (E.C.) - two Tablet(s) by mouth daily . Medications on transfer to ICU: -Lisinopril 10 mg PO/NG DAILY -Acetaminophen 650 mg PO Q6H -Milk of Magnesia 30 ml PO BID:PRN Constipation -Bisacodyl 10 mg PO/PR DAILY:PRN Constipation -Multivitamins 1 CAP PO DAILY -CefazoLIN 2 g IV Q8H (2 hrs post-op) -Nadolol 40 mg PO DAILY -Calcium Carbonate 500 mg PO TID -OxycoDONE (Immediate Release) 5-10 mg PO Q4H:PRN Pain Start: In am Begin after PCA has been d/c [**6-24**] -Docusate Sodium 100 mg PO BID -Ondansetron 4 mg IV Q8H:PRN nausea/vomiting -Duloxetine 60 mg PO DAILY -Omeprazole 20 mg PO DAILY -Enoxaparin Sodium 40 mg SC DAILY Start: In am Begin on [**6-24**] wednesday -Senna 1 TAB PO BID -FoLIC Acid 1 mg PO/NG DAILY -Vitamin D 400 UNIT PO DAILY Order date: [**6-23**] @ 1103 -HYDROmorphone (Dilaudid) 0.12 mg IVPCA Lockout Interval: 6 minutes Basal Rate: 0 mg(s)/hour 1-hr Max Limit: 1.2 mg(s) ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Well appearing in no acute distress Afebrile with stable vital signs Pain well-controlled Respiratory: CTAB Cardiovascular: RRR Gastrointestinal: NT/ND, ostomy RLQ, hernia LLQ Genitourinary: Voiding independently Neurologic: Intact with no focal deficits Psychiatric: Pleasant, A&O x3 Musculoskeletal Lower Extremity: * Incision healing well with staples * Scant serosanguinous drainage * Thigh full but soft * No calf tenderness * 5/5 strength * SILT, NVI distally * Toes warm FAMILY HISTORY: Positive for hemophilia but not affecting this patient, although he does have thrombocytopenia. SOCIAL HISTORY: He is retired from the Department of Social Services, former widower, has a girlfriend. - Tobacco: Previous use - Alcohol: Prior history of alcohol abuse, no longer drinking in 22 months per pt, family and PCP. [**Name Initial (NameIs) **] [**Name11 (NameIs) 3264**]: denies ### Response: {'Peri-prosthetic osteolysis,Regional enteritis of unspecified site,Acute posthemorrhagic anemia,Esophageal varices without mention of bleeding,Congenital insufficiency of aortic valve,Alcoholic cirrhosis of liver,Unspecified essential hypertension,Thoracic aneurysm without mention of rupture,Other and unspecified hyperlipidemia,Chronic airway obstruction, not elsewhere classified,Thrombocytopenia, unspecified,Esophageal reflux,Alcohol abuse, in remission,Depressive disorder, not elsewhere classified,Long-term (current) use of steroids,Ileostomy status,Hip joint replacement,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin,Family history of other blood disorders,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}

CHIEF COMPLAINT: acidosis PRESENT ILLNESS: HPI: 61 yoM w/ h/o Type II DM and EtOH abuse p/w N/V X 1 day. Pt reports N/V starting this a.m. (no hematemesis), vomiting 2X/hr. He also notes intermittent central chest pain, [**3-20**] without radiation, associated with SOB since this a.m. Non-exertional, non-pleuritic without associated LH, palpitations. He also notes intermittent, non-productive cough. (+) chills, no fever. No abdominal pain, diarrhea, BRBPR, melena, dysuria, hematuria, polyuria, polydipsia. He reports that he drinks 5-6 EtOH drinks (brandy)/day (last drink yesterday). He reports he has not been taking his medications (including insulin) for several weeks. In the ED, ABG 6.94/11/165 with lactate 23.4. He received lopressor 5 mg IV X 1, Ceftriaxone 2 g IV X 1, 2L NS. * ROS: Pt denies headache, rhinorrhea, recent weight loss, LE edema, increased abdominal girth, orthopnea, PND. (+) poor PO intake. MEDICAL HISTORY: 1) EtOH abuse: denies prior DTs/seizures 2) Type II DM 3) Hyperlipidemia 4) Hypertension 5) Abnl LFTs: suspected secondary to EtOH abuse MEDICATION ON ADMISSION: lipitor 70/30 viagra cartia lisinopril ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 92.7, 97, 140/94, 23, 100% 2L NC tachypnic, speaking in short sentances PERRL, EOMI, icteric, nl conjunctiva, OMM dry, OP clear, neck supple, no LAD, no JVD RRR II/VI SM at apex CTAB hypoactive BS, soft, NT, liver edge 7cm below RCM, no splenomegaly no c/c/e, 2+ DP b/l CN II-XII intact, 5/5 strength, sensation intact, 2+ DTRs, no asterixis FAMILY HISTORY: M MI in 60s SOCIAL HISTORY: EtOH 5 drinks per day. (+) tob [**4-11**] cig /day x 40yr, no other drug use

Unspecified septicemia,Acute pancreatitis,Alcohol abuse, unspecified,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acidosis,Defibrination syndrome,Shock, unspecified,Unspecified protein-calorie malnutrition,Acute respiratory failure,Severe sepsis,Anemia, unspecified,Acute alcoholic hepatitis,Personal history of noncompliance with medical treatment, presenting hazards to health,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Abdominal pain, other specified site

Septicemia NOS,Acute pancreatitis,Alcohol abuse-unspec,Acute kidney failure NOS,Acute necrosis of liver,Acidosis,Defibrination syndrome,Shock NOS,Protein-cal malnutr NOS,Acute respiratry failure,Severe sepsis,Anemia NOS,Ac alcoholic hepatitis,Hx of past noncompliance,DMII wo cmp nt st uncntr,Long-term use of insulin,Abdmnal pain oth spcf st

Admission Date: [**2127-4-29**] Discharge Date: [**2127-4-30**] Date of Birth: [**2065-9-9**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 398**] Chief Complaint: acidosis Major Surgical or Invasive Procedure: Intubation History of Present Illness: HPI: 61 yoM w/ h/o Type II DM and EtOH abuse p/w N/V X 1 day. Pt reports N/V starting this a.m. (no hematemesis), vomiting 2X/hr. He also notes intermittent central chest pain, [**3-20**] without radiation, associated with SOB since this a.m. Non-exertional, non-pleuritic without associated LH, palpitations. He also notes intermittent, non-productive cough. (+) chills, no fever. No abdominal pain, diarrhea, BRBPR, melena, dysuria, hematuria, polyuria, polydipsia. He reports that he drinks 5-6 EtOH drinks (brandy)/day (last drink yesterday). He reports he has not been taking his medications (including insulin) for several weeks. In the ED, ABG 6.94/11/165 with lactate 23.4. He received lopressor 5 mg IV X 1, Ceftriaxone 2 g IV X 1, 2L NS. * ROS: Pt denies headache, rhinorrhea, recent weight loss, LE edema, increased abdominal girth, orthopnea, PND. (+) poor PO intake. Past Medical History: 1) EtOH abuse: denies prior DTs/seizures 2) Type II DM 3) Hyperlipidemia 4) Hypertension 5) Abnl LFTs: suspected secondary to EtOH abuse Social History: EtOH 5 drinks per day. (+) tob [**4-11**] cig /day x 40yr, no other drug use Family History: M MI in 60s Physical Exam: 92.7, 97, 140/94, 23, 100% 2L NC tachypnic, speaking in short sentances PERRL, EOMI, icteric, nl conjunctiva, OMM dry, OP clear, neck supple, no LAD, no JVD RRR II/VI SM at apex CTAB hypoactive BS, soft, NT, liver edge 7cm below RCM, no splenomegaly no c/c/e, 2+ DP b/l CN II-XII intact, 5/5 strength, sensation intact, 2+ DTRs, no asterixis Pertinent Results: [**2127-4-29**] 11:30PM GLUCOSE-153* UREA N-18 CREAT-1.5* SODIUM-137 POTASSIUM-4.7 CHLORIDE-103 TOTAL CO2-5* ANION GAP-34* [**2127-4-29**] 11:30PM ALT(SGPT)-94* AST(SGOT)-331* LD(LDH)-321* CK(CPK)-143 ALK PHOS-82 AMYLASE-430* TOT BILI-6.3* [**2127-4-29**] 11:30PM LIPASE-1333* [**2127-4-29**] 11:30PM CK-MB-4 cTropnT-<0.01 [**2127-4-29**] 11:30PM ALBUMIN-3.3* CALCIUM-6.9* PHOSPHATE-6.8* MAGNESIUM-1.6 [**2127-4-29**] 11:30PM TSH-0.66 [**2127-4-29**] 11:30PM WBC-10.3 RBC-3.12* HGB-9.9* HCT-31.9* MCV-102* MCH-31.8 MCHC-31.1 RDW-13.5 [**2127-4-29**] 11:30PM NEUTS-85* BANDS-3 LYMPHS-11* MONOS-1* EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 NUC RBCS-1* [**2127-4-29**] 11:30PM PLT COUNT-105* [**2127-4-29**] 11:30PM PT-21.2* PTT-57.0* INR(PT)-2.8 [**2127-4-29**] 11:30PM FIBRINOGE-106* [**2127-4-29**] 10:49PM GLUCOSE-145* LACTATE-12.7* [**2127-4-29**] 10:30PM GLUCOSE-147* UREA N-17 CREAT-1.4* SODIUM-139 POTASSIUM-4.6 CHLORIDE-106 TOTAL CO2-<5* [**2127-4-29**] 10:30PM ALT(SGPT)-75* AST(SGOT)-272* LD(LDH)-277* ALK PHOS-70 AMYLASE-366* TOT BILI-5.4* [**2127-4-29**] 10:30PM LIPASE-1190* [**2127-4-29**] 10:30PM ALBUMIN-2.9* CALCIUM-6.5* PHOSPHATE-6.8*# MAGNESIUM-1.5* [**2127-4-29**] 10:30PM TRIGLYCER-265* [**2127-4-29**] 10:30PM WBC-10.6 RBC-2.79*# HGB-8.6*# HCT-28.8*# MCV-103* MCH-30.9 MCHC-30.0* RDW-13.4 [**2127-4-29**] 10:30PM NEUTS-85* BANDS-1 LYMPHS-13* MONOS-1* EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 NUC RBCS-2* [**2127-4-29**] 10:30PM PLT SMR-LOW PLT COUNT-95* [**2127-4-29**] 10:30PM PT-19.1* PTT-91.9* INR(PT)-2.3 [**2127-4-29**] 08:35PM URINE HOURS-RANDOM [**2127-4-29**] 08:35PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2127-4-29**] 08:35PM URINE COLOR-Amber APPEAR-Clear SP [**Last Name (un) 155**]-1.015 [**2127-4-29**] 08:35PM URINE BLOOD-TR NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-150 BILIRUBIN-SM UROBILNGN-8* PH-6.5 LEUK-NEG [**2127-4-29**] 08:35PM URINE RBC-[**4-12**]* WBC-0-2 BACTERIA-OCC YEAST-NONE EPI-[**4-12**] [**2127-4-29**] 07:58PM TYPE-ART TEMP-36.7 O2 FLOW-2 PO2-165* PCO2-11* PH-6.94* TOTAL CO2-3* BASE XS--29 INTUBATED-NOT INTUBA COMMENTS-NASAL [**Last Name (un) 154**] [**2127-4-29**] 07:58PM LACTATE-23.4* [**2127-4-29**] 07:58PM freeCa-1.20 [**2127-4-29**] 07:44PM LACTATE-22.0* [**2127-4-29**] 07:27PM GLUCOSE-179* LACTATE-24.4* K+-5.3 [**2127-4-29**] 07:15PM GLUCOSE-170* UREA N-19 CREAT-2.1*# SODIUM-134 POTASSIUM-5.4* CHLORIDE-82* TOTAL CO2-5* ANION GAP-52* [**2127-4-29**] 07:15PM ALT(SGPT)-98* AST(SGOT)-250* LD(LDH)-277* CK(CPK)-87 ALK PHOS-111 AMYLASE-483* TOT BILI-7.8* [**2127-4-29**] 07:15PM LIPASE-1642* [**2127-4-29**] 07:15PM cTropnT-<0.01 [**2127-4-29**] 07:15PM CK-MB-NotDone [**2127-4-29**] 07:15PM IRON-269* [**2127-4-29**] 07:15PM ALBUMIN-4.9* CALCIUM-10.2 PHOSPHATE-12.1*# MAGNESIUM-2.6 [**2127-4-29**] 07:15PM calTIBC-274 VIT B12-1031* FOLATE-11.4 FERRITIN-GREATER TH TRF-211 [**2127-4-29**] 07:15PM ASA-4 ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2127-4-29**] 07:15PM ASA-5 ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2127-4-29**] 07:15PM WBC-10.4# RBC-3.84* HGB-12.0* HCT-39.4* MCV-103* MCH-31.3 MCHC-30.5*# RDW-13.5 [**2127-4-29**] 07:15PM NEUTS-82.9* BANDS-0 LYMPHS-12.2* MONOS-4.6 EOS-0.1 BASOS-0.2 [**2127-4-29**] 07:15PM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL [**2127-4-29**] 07:15PM PLT SMR-LOW PLT COUNT-125* [**2127-4-29**] 07:15PM PT-17.8* PTT-42.6* INR(PT)-2.0 [**2127-4-29**] 07:15PM FIBRINOGE-158 D-DIMER-2354* [**2127-4-29**] 07:14PM cTropnT-<0.01 . EKG: ST @ 108 bpm, TWF I, avL [**Street Address(2) 4793**] depressions V3-V6 Brief Hospital Course: A: 61 year old male w/ h/o alcohol abuse, Type II DM presents with AG acidosis, pancreatitis, liver failure, and acute renal failure. . The patient was brought to the MICU and intubated for airway protection. Over the course of the next 24 hours the patient's condition rapidly deteriorated. His blood pressure continued to decline despite the administration of large quantities of IVFs (+15L), levophed, and vasopressin. He developed acute liver failure and pancreatitis which was accompanied by gross abdominal distension, bladder pressure as high as 50 and respiratory distress requiring an FiO2 100% & PEEP 35. . The famiy was advised that the patient would need an abdominal fasciotomy to decrease the abdominal pressures, and they were informed of the risks associated with this procedure. They chose to change management goals of DNR & no surgery. The patient expired at 6:50PM on [**2127-4-30**] from respiratory arrest. Medications on Admission: lipitor 70/30 viagra cartia lisinopril Discharge Medications: none Discharge Disposition: Expired Discharge Diagnosis: Respiratory arrest . Pancreatitis Liver failure Sepsis Acidosis Acute renal failure Discharge Condition: Dead Discharge Instructions: . Followup Instructions: .

038,577,305,584,570,276,286,785,263,518,995,285,571,V158,250,V586,789

{'Unspecified septicemia,Acute pancreatitis,Alcohol abuse, unspecified,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acidosis,Defibrination syndrome,Shock, unspecified,Unspecified protein-calorie malnutrition,Acute respiratory failure,Severe sepsis,Anemia, unspecified,Acute alcoholic hepatitis,Personal history of noncompliance with medical treatment, presenting hazards to health,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Abdominal pain, other specified site'}

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: acidosis PRESENT ILLNESS: HPI: 61 yoM w/ h/o Type II DM and EtOH abuse p/w N/V X 1 day. Pt reports N/V starting this a.m. (no hematemesis), vomiting 2X/hr. He also notes intermittent central chest pain, [**3-20**] without radiation, associated with SOB since this a.m. Non-exertional, non-pleuritic without associated LH, palpitations. He also notes intermittent, non-productive cough. (+) chills, no fever. No abdominal pain, diarrhea, BRBPR, melena, dysuria, hematuria, polyuria, polydipsia. He reports that he drinks 5-6 EtOH drinks (brandy)/day (last drink yesterday). He reports he has not been taking his medications (including insulin) for several weeks. In the ED, ABG 6.94/11/165 with lactate 23.4. He received lopressor 5 mg IV X 1, Ceftriaxone 2 g IV X 1, 2L NS. * ROS: Pt denies headache, rhinorrhea, recent weight loss, LE edema, increased abdominal girth, orthopnea, PND. (+) poor PO intake. MEDICAL HISTORY: 1) EtOH abuse: denies prior DTs/seizures 2) Type II DM 3) Hyperlipidemia 4) Hypertension 5) Abnl LFTs: suspected secondary to EtOH abuse MEDICATION ON ADMISSION: lipitor 70/30 viagra cartia lisinopril ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 92.7, 97, 140/94, 23, 100% 2L NC tachypnic, speaking in short sentances PERRL, EOMI, icteric, nl conjunctiva, OMM dry, OP clear, neck supple, no LAD, no JVD RRR II/VI SM at apex CTAB hypoactive BS, soft, NT, liver edge 7cm below RCM, no splenomegaly no c/c/e, 2+ DP b/l CN II-XII intact, 5/5 strength, sensation intact, 2+ DTRs, no asterixis FAMILY HISTORY: M MI in 60s SOCIAL HISTORY: EtOH 5 drinks per day. (+) tob [**4-11**] cig /day x 40yr, no other drug use ### Response: {'Unspecified septicemia,Acute pancreatitis,Alcohol abuse, unspecified,Acute kidney failure, unspecified,Acute and subacute necrosis of liver,Acidosis,Defibrination syndrome,Shock, unspecified,Unspecified protein-calorie malnutrition,Acute respiratory failure,Severe sepsis,Anemia, unspecified,Acute alcoholic hepatitis,Personal history of noncompliance with medical treatment, presenting hazards to health,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Abdominal pain, other specified site'}

CHIEF COMPLAINT: vertigo PRESENT ILLNESS: This is an 83 y/o female who presented to an OSH yesterday evening around 7 pm with c/o dizziness and nausea with vomiting x 1. There, she was given 25 mg IV of phenergan and 25 mg meclizine which resulted in restlessness and leg dyskinesias. She was given 50 mg IV benadryl for the reaction, which resulted in further agitation. She was given another dose of 50 mg IV Benadryl and a dose of Ativan (unknown amount). Shortly after that, she became stridorous and was electively intubated for airway protection at midnight. . In the ED, VS on arrival were T 99.7 (rectal), BP 175/119, HR 75, RR 22, SaO2 98% on AC/500 x 12/FiO2 0.5, PEEP 5. She was given one bolus of fentanyl and two boluses of propofol for sedation. Labs were significant for an elevated troponin of 0.21 with flat CK's and no EKG changes. She was also noted to have a leukocytosis with a left shift, no bands. She is being transferred to the MICU for further management. MEDICAL HISTORY: PMHx: HTN Hypothyroidism Uterine CA s/p TAH Osteoarthritis (spine, hips) . PSHx: Kidney stone removal Cholecystectomy Benign breast mass removal MEDICATION ON ADMISSION: 1. ASA 2. Toprol XL 3. Cozaar 4. Levoxyl ALLERGIES: Morphine / Codeine PHYSICAL EXAM: VS: T 97.7, BP 119/78, HR 81, RR 17, SaO2 99%/AC 500 x 12/FiO2 0.5/PEEP 5 General: Intubated and partially sedated elderly female. Withdraws to pain. HEENT: NC/AT, PERRL. ETT at 19cm at lips. MMM, OP clear. OG in place. Neck: supple, no JVD appreciated Chest: CTA-B, no w/r/r CV: RRR, s1 s2 normal, no m/g/r Abd: soft, NT/ND, NABS Ext: no c/c/e, pulses 2+ b/l Neuro: FROM, withdraws to pain, downgoing Babinski's b/l FAMILY HISTORY: Non contributory. SOCIAL HISTORY: Lives at home alone, husband in [**Name (NI) **]. Son lives close by, involved in her care. Ambulates at baseline. Non-smoker. No EtOH, no illicits.

Other pulmonary insufficiency, not elsewhere classified,Subendocardial infarction, initial episode of care,Stridor,Peripheral vertigo, unspecified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics causing adverse effects in therapeutic use

Other pulmonary insuff,Subendo infarct, initial,Stridor,Peripheral vertigo NOS,Hypothyroidism NOS,Hypertension NOS,Adv eff parasympatholytc

Admission Date: [**2123-7-19**] Discharge Date: [**2123-7-21**] Service: MEDICINE Allergies: Morphine / Codeine Attending:[**First Name3 (LF) 1973**] Chief Complaint: vertigo Major Surgical or Invasive Procedure: Intubation History of Present Illness: This is an 83 y/o female who presented to an OSH yesterday evening around 7 pm with c/o dizziness and nausea with vomiting x 1. There, she was given 25 mg IV of phenergan and 25 mg meclizine which resulted in restlessness and leg dyskinesias. She was given 50 mg IV benadryl for the reaction, which resulted in further agitation. She was given another dose of 50 mg IV Benadryl and a dose of Ativan (unknown amount). Shortly after that, she became stridorous and was electively intubated for airway protection at midnight. . In the ED, VS on arrival were T 99.7 (rectal), BP 175/119, HR 75, RR 22, SaO2 98% on AC/500 x 12/FiO2 0.5, PEEP 5. She was given one bolus of fentanyl and two boluses of propofol for sedation. Labs were significant for an elevated troponin of 0.21 with flat CK's and no EKG changes. She was also noted to have a leukocytosis with a left shift, no bands. She is being transferred to the MICU for further management. Past Medical History: PMHx: HTN Hypothyroidism Uterine CA s/p TAH Osteoarthritis (spine, hips) . PSHx: Kidney stone removal Cholecystectomy Benign breast mass removal Social History: Lives at home alone, husband in [**Name (NI) **]. Son lives close by, involved in her care. Ambulates at baseline. Non-smoker. No EtOH, no illicits. Family History: Non contributory. Physical Exam: VS: T 97.7, BP 119/78, HR 81, RR 17, SaO2 99%/AC 500 x 12/FiO2 0.5/PEEP 5 General: Intubated and partially sedated elderly female. Withdraws to pain. HEENT: NC/AT, PERRL. ETT at 19cm at lips. MMM, OP clear. OG in place. Neck: supple, no JVD appreciated Chest: CTA-B, no w/r/r CV: RRR, s1 s2 normal, no m/g/r Abd: soft, NT/ND, NABS Ext: no c/c/e, pulses 2+ b/l Neuro: FROM, withdraws to pain, downgoing Babinski's b/l Pertinent Results: Head CT [**2123-7-19**] (at OSH) - reportedly negative . CXR [**2123-7-19**] - Mild pulmonary edema, ETT 2.3 cm above carina, NGT in place. . EKG [**2123-7-19**] - NSR, rate at 60 bpm. Normal axis and normal intervals. No acute ST-T wave changes. No comparison. . [**2123-7-19**] 11:14PM CK(CPK)-239* [**2123-7-19**] 11:14PM CK-MB-6 cTropnT-0.12* [**2123-7-19**] 02:35PM GLUCOSE-92 UREA N-13 CREAT-0.8 SODIUM-139 POTASSIUM-3.6 CHLORIDE-104 TOTAL CO2-26 ANION GAP-13 [**2123-7-19**] 02:35PM CK(CPK)-310* [**2123-7-19**] 02:35PM cTropnT-0.16* [**2123-7-19**] 02:35PM CK-MB-9 [**2123-7-19**] 02:35PM CALCIUM-9.2 PHOSPHATE-2.6* MAGNESIUM-1.9 CHOLEST-154 [**2123-7-19**] 02:35PM TRIGLYCER-58 HDL CHOL-60 CHOL/HDL-2.6 LDL(CALC)-82 [**2123-7-19**] 02:35PM WBC-11.7* RBC-3.71* HGB-11.9* HCT-33.4* MCV-90 MCH-32.0 MCHC-35.5* RDW-13.2 [**2123-7-19**] 02:35PM NEUTS-82.8* LYMPHS-14.5* MONOS-2.4 EOS-0.2 BASOS-0.2 [**2123-7-19**] 02:35PM PLT COUNT-155 [**2123-7-19**] 02:35PM PT-13.6* PTT-25.7 INR(PT)-1.2* [**2123-7-19**] 06:41AM TYPE-ART TEMP-36.5 O2-50 PO2-122* PCO2-42 PH-7.40 TOTAL CO2-27 BASE XS-1 INTUBATED-INTUBATED [**2123-7-19**] 06:41AM LACTATE-1.0 [**2123-7-19**] 03:15AM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.021 [**2123-7-19**] 03:15AM URINE BLOOD-LGE NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG [**2123-7-19**] 03:15AM URINE RBC-21-50* WBC-0 BACTERIA-RARE YEAST-NONE EPI-0-2 TRANS EPI-0-2 Brief Hospital Course: Ms. [**Known lastname 69693**] is an 83 y/o female s/p multiple sedating medications p/w stridor leading to intubation, s/p NSTEMI, self extubated, satting well and transferred t. . Respiratory distress: Ms. [**Known lastname 69693**] developed stridor after receiving benadryl and ativan which was given for dystonia believed to be a result of phenergan and/or meclizine. The etiology of the respiratory distress is believed to be secondary to these sedating anticholinergic medications. The patient was intubated for airway protection. A CXR was done which showed only mild pulmonary edema and it was felt that this was unlikely to be the cause of respiratory distress. An ABG was completely normal. The patient was continued on vent support with plan to extubate, however the patient self-extubated. She complained of a cough following the extubation, however, satted well on 2L and quickly weaned to RA. On the day of discharge the patient was satting well on room air. . Vertigo: The patient has a history of vertigo (worked up in past and told she has a "problem with her ears") and developed acute onset of vertigo while bending over. The vertigo worsened with head movements. She went to an outside hospital for evaluation and according to outside hospital ED reports, the patient exhibited no other posterior circulation symptoms. According to her son, her speech was normal, without facial droop or asymmetry. She had no focal weakness. Neurology was consulted and felt that her symptoms were most consistent with peripheral vestibulopathy given her history of similar symptoms in the past and a non focal exam. MRI of the head showed no acute ischemic infarct, findings consistent with chronic microvascular infarcts in the supratentorial area and no definite occlusions or aneurysms were seen. The patient's nausea and dizziness subsided and she denied dizziness on the day of discharge. . NSTEMI: On admission the patient had elevated troponins (0.21, 0.16, 0.12) which were felt to be secondary to demand ischemia peri-intubation from stress and possibly transient tachycardia. Her EKG was unremarkable. She was continued on her aspirin and metoprolol. She did not have any episodes of chest pain. The patient should have a cardiac evaluation as an outpatient. . Leukocytosis: On admission the patient had an elevated WBC count of unclear etiology. The patient has no clear source of infection and the WBC elevation is likely secondary to stress. WBC trended down and the patient remained afebrile. Urine culture was negative. . Hematuria: The patient had positive RBCs in UA which was felt to be secondary to foley placement. Urine culture was negative. . Hypothyroidism: The patient takes levoxyl at home and was continued on this dose while in the hospital. She was asymptomatic. . HTN: The patient is on toprol and cozaar but she does not know what doses she takes at home. On admission she was given metoprolol. Once discharged she will restart her home medications. Medications on Admission: 1. ASA 2. Toprol XL 3. Cozaar 4. Levoxyl Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: Primary: Vertigo Anticholinergic reaction NSTEMI Respiratory distress --------- Secondary: HTN Hypothyroidism Discharge Condition: Stable. Patient is breathing well on room air, hemodynamically stable. Discharge Instructions: Please take all medications as prescribed. . You had a reaction to Meclizine and/or Phenergan. You should avoid these medications. In addition, you developed respiratory distress with benadryl. You should avoid this medication as well. Instead of Benadryl you may take Claritin instead. . If you begin to have increasing dizziness, chest pain, shortness of breath or any other concerning symptoms please [**Name6 (MD) 138**] your MD. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) 69694**] [**Telephone/Fax (1) 69695**] on [**Last Name (LF) 2974**], [**7-23**] at 4:15PM.

518,410,786,386,244,401,E941

{'Other pulmonary insufficiency, not elsewhere classified,Subendocardial infarction, initial episode of care,Stridor,Peripheral vertigo, unspecified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics causing adverse effects in therapeutic use'}

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: vertigo PRESENT ILLNESS: This is an 83 y/o female who presented to an OSH yesterday evening around 7 pm with c/o dizziness and nausea with vomiting x 1. There, she was given 25 mg IV of phenergan and 25 mg meclizine which resulted in restlessness and leg dyskinesias. She was given 50 mg IV benadryl for the reaction, which resulted in further agitation. She was given another dose of 50 mg IV Benadryl and a dose of Ativan (unknown amount). Shortly after that, she became stridorous and was electively intubated for airway protection at midnight. . In the ED, VS on arrival were T 99.7 (rectal), BP 175/119, HR 75, RR 22, SaO2 98% on AC/500 x 12/FiO2 0.5, PEEP 5. She was given one bolus of fentanyl and two boluses of propofol for sedation. Labs were significant for an elevated troponin of 0.21 with flat CK's and no EKG changes. She was also noted to have a leukocytosis with a left shift, no bands. She is being transferred to the MICU for further management. MEDICAL HISTORY: PMHx: HTN Hypothyroidism Uterine CA s/p TAH Osteoarthritis (spine, hips) . PSHx: Kidney stone removal Cholecystectomy Benign breast mass removal MEDICATION ON ADMISSION: 1. ASA 2. Toprol XL 3. Cozaar 4. Levoxyl ALLERGIES: Morphine / Codeine PHYSICAL EXAM: VS: T 97.7, BP 119/78, HR 81, RR 17, SaO2 99%/AC 500 x 12/FiO2 0.5/PEEP 5 General: Intubated and partially sedated elderly female. Withdraws to pain. HEENT: NC/AT, PERRL. ETT at 19cm at lips. MMM, OP clear. OG in place. Neck: supple, no JVD appreciated Chest: CTA-B, no w/r/r CV: RRR, s1 s2 normal, no m/g/r Abd: soft, NT/ND, NABS Ext: no c/c/e, pulses 2+ b/l Neuro: FROM, withdraws to pain, downgoing Babinski's b/l FAMILY HISTORY: Non contributory. SOCIAL HISTORY: Lives at home alone, husband in [**Name (NI) **]. Son lives close by, involved in her care. Ambulates at baseline. Non-smoker. No EtOH, no illicits. ### Response: {'Other pulmonary insufficiency, not elsewhere classified,Subendocardial infarction, initial episode of care,Stridor,Peripheral vertigo, unspecified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: Post-PEG placement PRESENT ILLNESS: 83 year old woman with history significant for bronchiectasis complicated by indolent Mycobacterium abscessus infection for which she is on azithromycin and linezolid. Her course has been complicated by anorexia and failure to thrive and she was referred for elective percutaneous gastrostomy tube for feeding. MEDICAL HISTORY: Bronchiectasis Atypical mycobacteria infection (mycobacterium abscessus) Hypertension Hypercholesterolemia Weight loss Osteoporosis MEDICATION ON ADMISSION: Albuterol Inhaler 2 PUFF IH Q6H Alendronate Sodium 5 mg PO 1X/WEEK HydrALAzine 50 mg PO BID Linezolid 600 mg PO QD Lisinopril 40 mg PO DAILY Mevacor *NF* 20 mg Oral QD Nadolol 100 mg PO DAILY Aspirin 325 mg PO DAILY Azithromycin 250 mg PO DAILY PANTOPRAZOLE 40 mg Tablet DAILY CALCIUM CITRATE-VITAMIN D3 [CITRACAL + D] DEXTROMETHORPHAN 30mg/5 mL Liquid - [**Hospital1 **] PRN MULTI-VITAMIN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL: Thin, ill appearing, VITALS: 97 170/80 65 94RA HEENT: WNL COR: Regular S1 and S2 CHEST: Coarse breath sounds/soft crackles left. ABD: Soft, thin, PEG CDI EXT: Cool, no rash. NEURO: Alert, interactive, gross strenght normal and symmetrical FAMILY HISTORY: Father died of heart attack at age 70. Mother died at age [**Age over 90 **]. Older sister had diabetes and died at age [**Age over 90 **]. [**Name (NI) **] sister had breast cancer and died at age 85. No history of sudden death in family. No other contributory family history. SOCIAL HISTORY: Lives independently with husband. [**Name (NI) **] pets. Tobacco: Past smoking history of approximately [**1-23**] cigarettes/day over 33 years, though quit 32 years ago. EtOH: Denies Illicits: Denies

Malnutrition of moderate degree,Abscess of lung,Pneumonia due to Pseudomonas,Acute respiratory failure,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Other specified mycobacterial diseases,Bronchiectasis with acute exacerbation,Body Mass Index less than 19, adult,Dehydration,Unspecified essential hypertension,Intravenous anesthetics causing adverse effects in therapeutic use,Anemia, unspecified,Other esophagitis,Other specified gastritis, without mention of hemorrhage,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Encounter for palliative care,Hypoxemia,Other and unspecified special symptoms or syndromes, not elsewhere classified,Loss of weight,Gastrostomy status,Personal history of tobacco use

Malnutrition mod degree,Abscess of lung,Pseudomonal pneumonia,Acute respiratry failure,Acute kidney failure NOS,Septicemia NOS,Severe sepsis,Mycobacterial dis NEC,Bronchiectasis w ac exac,BMI less than 19,adult,Dehydration,Hypertension NOS,Adv eff intraven anesth,Anemia NOS,Other esophagitis,Oth spf gstrt w/o hmrhg,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Encountr palliative care,Hypoxemia,Special symptom NEC/NOS,Abnormal loss of weight,Gastrostomy status,History of tobacco use

Admission Date: [**2132-8-7**] Discharge Date: [**2132-8-27**] Date of Birth: [**2049-2-4**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3326**] Chief Complaint: Post-PEG placement Major Surgical or Invasive Procedure: PEG History of Present Illness: 83 year old woman with history significant for bronchiectasis complicated by indolent Mycobacterium abscessus infection for which she is on azithromycin and linezolid. Her course has been complicated by anorexia and failure to thrive and she was referred for elective percutaneous gastrostomy tube for feeding. She is presently in bed, she complains of extreme fatigue, nausea, and mild abdominal pain. She denies fevers, chills, chest pain, shortness of breath - she does have a chronic cough productive of sputum. ROS otherwise negative/ Past Medical History: Bronchiectasis Atypical mycobacteria infection (mycobacterium abscessus) Hypertension Hypercholesterolemia Weight loss Osteoporosis Social History: Lives independently with husband. [**Name (NI) **] pets. Tobacco: Past smoking history of approximately [**1-23**] cigarettes/day over 33 years, though quit 32 years ago. EtOH: Denies Illicits: Denies Family History: Father died of heart attack at age 70. Mother died at age [**Age over 90 **]. Older sister had diabetes and died at age [**Age over 90 **]. [**Name (NI) **] sister had breast cancer and died at age 85. No history of sudden death in family. No other contributory family history. Physical Exam: GENERAL: Thin, ill appearing, VITALS: 97 170/80 65 94RA HEENT: WNL COR: Regular S1 and S2 CHEST: Coarse breath sounds/soft crackles left. ABD: Soft, thin, PEG CDI EXT: Cool, no rash. NEURO: Alert, interactive, gross strenght normal and symmetrical Pertinent Results: None available Brief Hospital Course: #.ANOREXIA/MODERATE MALNUTRITION: Patient initially admitted for PEG placemen. Tube feeds were advanced to a goal of 45cc/hr on [**2132-8-9**]. Abdominal pain and nausea slowly resolved. Diet advanced to full liquids on [**2132-8-10**]. . #.Dyspnea: On the floor, patient became acutely dyspneic on the morning of [**2132-8-10**], thought to be [**12-24**] pulmonary edema in the setting of IVF. Pt received Hydralazine 10mg IV x 2, 2 inches of nitropaste, Lasix 20mg IV x 1, and Cefepime with improvement in her blood pressure and dyspnea. She was weaned from 5L of O2 to RA by 5pm. CXR was read as asymmetric pulmonary edema vs. multifocal pneumonia. On [**8-11**], the patient had a similar episode of acute shortness of breath. Her BP was >200/100. She again receive hydralazine, nitropaste and lasix. Though her BP came down to 180s she was unable to wean from 02 and required NRB. She was transferred to the MICU for respiratory distress. She was initially managed on non-invasive positive pressure ventilation. However, she had icreasing work of breathing, rising CO2 and was intubated for respiratory failure. CT of the lungs showed new multifocal pneumonia on top of the patient's existing cavitary lung disease. The patient was initially treated with Vanco/Cefepime/Cipro and she was continued on her home regimen of linezolid/azithromycin for her mycobaterium abscessus. Sputum culture and mini-BAL grew pseudomonas and the patient was continued on Cefepime/Cipro. The patient's pneumonia initially did not clinically improve (no improvement in ventilation and worsening in imaging). Repeat sputum cultures grew pseudomonas that was intermediate sensitivity to cefepime and ID was consulted. The patient was then switched to meropenem and inhaled tobramycin for a planned 21 day course. The patient's respiratory status clinically improved over the next week and she was weaned from the ventilator. A family meeting was held on [**8-25**] to decide about goals of care and future need for tracheostomy. The patient's primary pulmonologist, primary infectious disease doctor, ICU team, case manager, husband and daughter were all present. The patient was intubated but not sedated. A decision was made to extubate the patient, make her DNR/DNI and send her home with hospice care. After extubation the patient remained with 02 sats >90% on 5-6L 02. Her meropenem and inhaled tobramycin were stopped on discharge. . #Hypotension: Thought [**12-24**] sepsis/pneumonia and sedation. Patient became hypotensive peri-intubation and levophed was started to maintain MAPs>65. Access was initially difficult so a femoral line was initially placed. This was replaced by a central line the next morning. A line was also placed. The patient required levophed intermittently during the first week she was intubated. As her infection was treated and her sedation was weaned off, the patient was able to maintain her blood pressure on her own and became hypertensive. She required fluid boluses on 2 mornings for MAPs<65 and she responded quickly. She was started back on a lower dose of her hydralazine which was titrated up throughout her ICU stay. . # Acute Renal Failure: Pt's creatinine increased to a peak of 1.3 on [**2132-8-9**]; she was started on IVF with resolution of her renal failure. IVF were stopped on [**2132-8-10**] due to acute dyspneic episode, and electrolytes and creatinine remained stable. . # MYCOBACTERIAL ABSCESSUS INFECTION: Pt was continued on Linezolid/Azithromycin throughout her hospital stay. Her primary infectious disease doctor [**First Name (Titles) **] [**Name (NI) 653**] and agreed with this plan. She will continue these medications on discharge. . Medications on Admission: Albuterol Inhaler 2 PUFF IH Q6H Alendronate Sodium 5 mg PO 1X/WEEK HydrALAzine 50 mg PO BID Linezolid 600 mg PO QD Lisinopril 40 mg PO DAILY Mevacor *NF* 20 mg Oral QD Nadolol 100 mg PO DAILY Aspirin 325 mg PO DAILY Azithromycin 250 mg PO DAILY PANTOPRAZOLE 40 mg Tablet DAILY CALCIUM CITRATE-VITAMIN D3 [CITRACAL + D] DEXTROMETHORPHAN 30mg/5 mL Liquid - [**Hospital1 **] PRN MULTI-VITAMIN Discharge Medications: Per hospice protocol, including linezolid and azithromycin for M.abscessus and home 02. Discharge Disposition: Home With Service Facility: [**Hospital 269**] Hospice Care Discharge Diagnosis: Pseudomonal Pneumonia Chronic atypical mycobacterial pneumonia Sepsis requiring intubation and vasopressors Hypertension . Discharge Condition: Stable, 02 sats >90% on6L Discharge Instructions: You came to the hospital with shortness of breath and you were found to have pneumonia. You required a breathing tube and were in the ICU for several weeks. You were able to come off the breathing tube and together with your family it was decided that you would go home with hospice care. . Please take medications per hospice protocol. You should also continued to take the following medications: Azithromycin Linezolid Hydralazine Lisinopril . If you have any concerns about medications please feel free to call your hospice nurse or any of your doctors. . If you have any symptoms that are uncomfortable or concerning to you please call your hospice nurse first. If you are unable to reach your hospice nurse please call your primary care doctor. . Followup Instructions: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 724**], Infectious Disease, Thursday [**9-11**], 2:30 PM in [**Hospital Unit Name **], basement. . Otherwise, as needed

263,513,482,518,584,038,995,031,494,V850,276,401,E938,285,530,535,272,733,V667,799,307,783,V441,V158

{'Malnutrition of moderate degree,Abscess of lung,Pneumonia due to Pseudomonas,Acute respiratory failure,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Other specified mycobacterial diseases,Bronchiectasis with acute exacerbation,Body Mass Index less than 19, adult,Dehydration,Unspecified essential hypertension,Intravenous anesthetics causing adverse effects in therapeutic use,Anemia, unspecified,Other esophagitis,Other specified gastritis, without mention of hemorrhage,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Encounter for palliative care,Hypoxemia,Other and unspecified special symptoms or syndromes, not elsewhere classified,Loss of weight,Gastrostomy status,Personal history of tobacco use'}

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: Post-PEG placement PRESENT ILLNESS: 83 year old woman with history significant for bronchiectasis complicated by indolent Mycobacterium abscessus infection for which she is on azithromycin and linezolid. Her course has been complicated by anorexia and failure to thrive and she was referred for elective percutaneous gastrostomy tube for feeding. MEDICAL HISTORY: Bronchiectasis Atypical mycobacteria infection (mycobacterium abscessus) Hypertension Hypercholesterolemia Weight loss Osteoporosis MEDICATION ON ADMISSION: Albuterol Inhaler 2 PUFF IH Q6H Alendronate Sodium 5 mg PO 1X/WEEK HydrALAzine 50 mg PO BID Linezolid 600 mg PO QD Lisinopril 40 mg PO DAILY Mevacor *NF* 20 mg Oral QD Nadolol 100 mg PO DAILY Aspirin 325 mg PO DAILY Azithromycin 250 mg PO DAILY PANTOPRAZOLE 40 mg Tablet DAILY CALCIUM CITRATE-VITAMIN D3 [CITRACAL + D] DEXTROMETHORPHAN 30mg/5 mL Liquid - [**Hospital1 **] PRN MULTI-VITAMIN ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GENERAL: Thin, ill appearing, VITALS: 97 170/80 65 94RA HEENT: WNL COR: Regular S1 and S2 CHEST: Coarse breath sounds/soft crackles left. ABD: Soft, thin, PEG CDI EXT: Cool, no rash. NEURO: Alert, interactive, gross strenght normal and symmetrical FAMILY HISTORY: Father died of heart attack at age 70. Mother died at age [**Age over 90 **]. Older sister had diabetes and died at age [**Age over 90 **]. [**Name (NI) **] sister had breast cancer and died at age 85. No history of sudden death in family. No other contributory family history. SOCIAL HISTORY: Lives independently with husband. [**Name (NI) **] pets. Tobacco: Past smoking history of approximately [**1-23**] cigarettes/day over 33 years, though quit 32 years ago. EtOH: Denies Illicits: Denies ### Response: {'Malnutrition of moderate degree,Abscess of lung,Pneumonia due to Pseudomonas,Acute respiratory failure,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Other specified mycobacterial diseases,Bronchiectasis with acute exacerbation,Body Mass Index less than 19, adult,Dehydration,Unspecified essential hypertension,Intravenous anesthetics causing adverse effects in therapeutic use,Anemia, unspecified,Other esophagitis,Other specified gastritis, without mention of hemorrhage,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Encounter for palliative care,Hypoxemia,Other and unspecified special symptoms or syndromes, not elsewhere classified,Loss of weight,Gastrostomy status,Personal history of tobacco use'}

CHIEF COMPLAINT: Pancreatic Cancer PRESENT ILLNESS: This is a 76M s/p multiple recent admissions for pancreatitis at MEDICAL HISTORY: Pancreatic Cancer CAD s/p NSTEMI, s/p R circumflex stent [**12-27**], TIA, HTN, hypercholesterolemia, COPD, DM (diet controlled), hemorrhoids, recurrent UTIs, nephrolithiasis, arthritis, bladder ca s/p radical cystectomy & urostomy, s/p parastomal hernia repair, s/p L hip ORIF, s/p L CEA [**1-27**] MEDICATION ON ADMISSION: Metamucil, Senna, gabapentin 300', Plavix 75', loratadine 10', Cartia XT 180', folic acid ?, ASA 325', Tylenol, MVI, simvastatin 40', temazepam 15 qhs, Advair 500/50", Combivent"", Prilosec 20' ALLERGIES: Demerol / Morphine / Sulfa (Sulfonamides) PHYSICAL EXAM: Vitals- T 97.9, HR 87, BP 118/56, RR 18, O2sat 96% RA Gen- NAD, alert Head and neck- AT, NC, soft, supple, no masses Heart- RRR, no murmurs Lungs- CTAB, no rhonchi, no crackles Abd- RLQ ileal conduit with hernia, moderate epigastric pain, no peritoneal signs Rectal- deferred Ext- warm, well-perfused, no edema FAMILY HISTORY: Father: cancer. Mother: cerebral hemorrhage after fall, ?stroke. 1 sister with CAD s/p triple bypass, 2 sisters s/p MI, 1 sister still living. Brother: leukemia. SOCIAL HISTORY: Former truck driver. Married and divorced 3x, no children. 150+ pack-year smoking history. No EtOH.

Malignant neoplasm of head of pancreas,Unspecified septicemia,Malignant neoplasm of liver, secondary,Infection and inflammatory reaction due to other vascular device, implant, and graft,Severe sepsis,Pneumonia, organism unspecified,Obstruction of bile duct,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status

Mal neo pancreas head,Septicemia NOS,Second malig neo liver,React-oth vasc dev/graft,Severe sepsis,Pneumonia, organism NOS,Obstruction of bile duct,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Status-post ptca

Admission Date: [**2119-7-19**] Discharge Date: [**2119-8-3**] Date of Birth: [**2042-10-29**] Sex: M Service: SURGERY Allergies: Demerol / Morphine / Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 473**] Chief Complaint: Pancreatic Cancer Major Surgical or Invasive Procedure: Exploratory Laparoscopy ERCP with Metal Stent EUS with Celiac Plexus Block History of Present Illness: This is a 76M s/p multiple recent admissions for pancreatitis at an OSH. Work-up at the OSH included CT demonstrating a pancreatic head mass and EUS with biopsy demonstrating pancreatic adenocarcinoma. He presented to Dr.[**Name (NI) 9886**] clinic on [**2119-6-19**] for further management. On presentation, he complained of severe epigastric pain radiating to the back, and was actively retching/vomiting. He was recently discharged [**2119-6-29**] on TPN to rehab. He is now a transfer from rehab for pre-op work-up in preparation for Whipple procedure. Review of systems: denies chest pain, denies shortness of breath, denies headaches, all other systems WNL Past Medical History: Pancreatic Cancer CAD s/p NSTEMI, s/p R circumflex stent [**12-27**], TIA, HTN, hypercholesterolemia, COPD, DM (diet controlled), hemorrhoids, recurrent UTIs, nephrolithiasis, arthritis, bladder ca s/p radical cystectomy & urostomy, s/p parastomal hernia repair, s/p L hip ORIF, s/p L CEA [**1-27**] Social History: Former truck driver. Married and divorced 3x, no children. 150+ pack-year smoking history. No EtOH. Family History: Father: cancer. Mother: cerebral hemorrhage after fall, ?stroke. 1 sister with CAD s/p triple bypass, 2 sisters s/p MI, 1 sister still living. Brother: leukemia. Physical Exam: Vitals- T 97.9, HR 87, BP 118/56, RR 18, O2sat 96% RA Gen- NAD, alert Head and neck- AT, NC, soft, supple, no masses Heart- RRR, no murmurs Lungs- CTAB, no rhonchi, no crackles Abd- RLQ ileal conduit with hernia, moderate epigastric pain, no peritoneal signs Rectal- deferred Ext- warm, well-perfused, no edema Pertinent Results: [**2119-7-19**] 05:45PM BLOOD WBC-7.4 RBC-3.24* Hgb-9.3* Hct-28.3* MCV-87# MCH-28.8 MCHC-33.0 RDW-17.0* Plt Ct-333 [**2119-7-23**] 06:30AM BLOOD WBC-11.9* RBC-3.24* Hgb-9.2* Hct-28.2* MCV-87 MCH-28.5 MCHC-32.7 RDW-18.2* Plt Ct-556* [**2119-7-24**] 03:56AM BLOOD WBC-10.8 RBC-3.50* Hgb-10.0* Hct-30.6* MCV-87 MCH-28.6 MCHC-32.7 RDW-18.3* Plt Ct-533* [**2119-7-24**] 03:56AM BLOOD Glucose-125* UreaN-25* Creat-0.8 Na-138 K-4.3 Cl-104 HCO3-26 AnGap-12 [**2119-7-21**] 05:04AM BLOOD ALT-508* AST-203* AlkPhos-980* Amylase-25 TotBili-10.7* [**2119-7-24**] 03:56AM BLOOD ALT-218* AST-42* AlkPhos-627* Amylase-25 TotBili-2.6* [**2119-7-24**] 03:56AM BLOOD Lipase-10 [**2119-7-23**] 06:30AM BLOOD Albumin-3.1* Calcium-8.5 Phos-3.1 Mg-2.0 . Radiology Report CTA PANCREAS W/ CTCP Study Date of [**2119-7-19**] 10:35 PM Preliminary Report !! PFI !! Comparison to CT [**2119-6-19**]. An Ill-defined low attenuation mass within the head of the pancreas measures 1.8 x 1.6 cm. There is new moderately severe intra and extrahepatic biliary dilatation as well as pancreatic dilatation. The pancreatic duct measures 9 mm near the level of the mass. There is peripancreatic stranding centered around the head. There is a para-aortic lymph node with a necrotic appearing center measuring 15x7mm (3b:173). New hazy soft tissue density encases the SMA as it courses near the pancreatic head (3b:164-168). The normal contour of the SMV is maintained as it courses anterior to the pancreas. New low attenuation areas including: segment VI 8 mm (3b:177), 7mm IVB (3b:175), 7 mm and 6 mm in [**Doctor First Name **] are suspicious for metastasis but are too small to definitely characterize. A ventral hernia contains a loop of small bowel and a abdominal defect in the RLQ contains a loop of colon and several loops of small bowel. There is no obstruction. . ERCP Procedures: A small sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. A 6cm covered wall stent biliary stent was placed successfully (Ref: 6971 / LOT [**Numeric Identifier 78701**]). Good drainage of white bile was noted. Impression: The major papilla was buldging and distorted. Tight 3 cm malignant looking distal biliary stricture Small sphincterotomy performed. A 6 cm covered wallstent was placed successfully in bile duct. . EUS EUS findings: Celiac Plexus Neurolysis: EUS was performed using a linear echoendoscope at 7.5 Mhz frequency and Celiac Plexus Neurolysis was performed: The take-off of the celiac artery was identified. A 22 gauge needle was primed with saline and advanced adjacent to the Aorta, just superior to the celiac artery take-off. This was aspirated to assess for vascular injection. No blood was noted. Buipuvacaine 0.25% X 10 cc was injected. Dehydrated 98% alcohol X 10 cc was injected. Saline 3 cc was injected. The needle was then withdrawn. Mass: A > 1.5 cm ill-defined mass was noted in the head of the pancreas. The mass was hypoechoic and heterogenous in echotexture. The borders of the mass were irregular and poorly defined. Impression: EUS guided Celiac Plexus Neurolysis was performed. Ill-defined mass in the head of the pancreas. Brief Hospital Course: This is a 76 year old male with pancreatic cancer who was recently discharged to rehab on TPN and tolerating sips. He returned to go to the OR. A CT pancreas protocol was obtained and showed New low attenuation areas including: segment VI 8 mm (3b:177), 7mm IVB (3b:175), 7 mm and 6 mm in [**Doctor First Name **] are suspicious for metastasis but are too small to definitely characterize. On [**7-20**], he went to the OR for Exploratory Laparoscopy, aborted Whipple due to liver mets. Pain: He still complained of lots of abdominal pain. A Chronic pain consult was obtained and helped manage his medications. He then went EUS for celiac plexus block on [**2119-7-25**]. His pain was improved. Obstructive Jaundice: Due to the mass effect, his Tbili was 10. He then went for ERCP with placement of 6cm covered stent. His Tbili trended down and his jaundice improved. FEN: He continued on TPN. He was then started on a diet and his diet can be advanced as tolerated. UTI: He had a positive UA and was on Cipro/Flagyl. Oncology: He was seen by Oncology and will follow-up as outpatient. Medications on Admission: Metamucil, Senna, gabapentin 300', Plavix 75', loratadine 10', Cartia XT 180', folic acid ?, ASA 325', Tylenol, MVI, simvastatin 40', temazepam 15 qhs, Advair 500/50", Combivent"", Prilosec 20' Discharge Medications: 1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 2. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). 4. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain. 5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 6. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO twice a day. 7. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day) as needed. 8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 9. Hydromorphone 4 mg Tablet Sig: 1-3 Tablets PO Q3H (every 3 hours) as needed. 10. Insulin Regular Human 100 unit/mL Solution Sig: sliding scale Injection four times a day. 11. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 12. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Fentanyl 50 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr Transdermal Q72H (every 72 hours). Discharge Disposition: Extended Care Facility: Life Care Center, [**Location (un) 2199**] Discharge Diagnosis: Pancreatic Cancer - Metastatic Acute on Chronic Pain UTI Obstructive Jaundice Discharge Condition: good Discharge Instructions: Please call your doctor or return to the ER for any of the following: * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. * Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * Your skin, or the whites of your eyes become yellow. * Your pain is not improving within 8-12 hours or not gone within 24 hours. Call or return immediately if your pain is getting worse or is changing location or moving to your chest or back. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. . * Please resume all regular home medications and take any new meds as ordered. * Do not drive or operate heavy machinery while taking any narcotic pain medication. You may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue to take a stool softener. * Continue to ambulate several times per day. * No heavy lifting (>[**10-4**] lbs) until your follow up appointment. * Continue with TPN as ordered. You may also eat and advance your diet as tolerated. Once taking in adequate POs, the TPN cn stop. sted daily. Followup Instructions: Please follow-up with Oncology Provider: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2119-7-31**] 3:00 Completed by:[**2119-7-28**] Name: [**Known lastname 12676**],[**Known firstname 326**] F. Unit No: [**Numeric Identifier 12677**] Admission Date: [**2119-7-19**] Discharge Date: [**2119-8-3**] Date of Birth: [**2042-10-29**] Sex: M Service: SURGERY Allergies: Demerol / Morphine / Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 4987**] Addendum: Mr. [**Known lastname 12679**] discharge was unfortunately delayed beyond the anticipated day of discharge due to a placement issue, and he stayed through the weekend of [**7-25**] receiving pain control. On [**7-30**] at night, he developed fever to 104F and shaking chills, with hypotension to 70/40. He was triggered, and promptly transferred to the SICU, and a sepsis work up was initiated, including a CXR, ECG, CBC, cardiac enzymes, Blood Cx. It was postulated that his indwelling PICC line may be the cause of his sepsis, so it was removed and culture tip sent. He received 1U of PRBCs in the ICU and required pressors to maintain BP. He was started on Zosyn. Over the next few days, he began to stabilize, and in a meeting with his niece [**Name (NI) **] (his medical proxy) and other family members, the decision was made to change his code status to DNR. He was seen by Palliative Care, and the ultimate decision was made with the family to change his status to CMO, and was transferred to the floor. He was discharged to Hospice Care on [**2117-8-2**] in stable condition. Major Surgical or Invasive Procedure: Exploratory Laparoscopy ERCP with Metal Stent EUS with Celiac Plexus Block Discharge Medications: 1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain. 2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 3. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO twice a day. 4. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 5. Hydromorphone 2 mg Tablet Sig: 1-3 Tablets PO Q2H (every 2 hours) as needed. 6. Fentanyl 50 mcg/hr Patch 72 hr Sig: Three (3) Patch 72 hr Transdermal Q72H (every 72 hours). 7. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: 0.5-1 Tablet, Rapid Dissolve PO TID (3 times a day) as needed. 8. Haloperidol Lactate 5 mg/mL Solution Sig: 1-5 mg Injection TID (3 times a day) as needed. 9. Haloperidol 1 mg Tablet Sig: 0.5-2 mg PO TID (3 times a day) as needed. 10. Hydromorphone 2 mg/mL Solution Sig: 0.5-2 mg Injection Q2H (every 2 hours) as needed for pain. Discharge Disposition: Extended Care Facility: Life Care Center, [**Location (un) 654**] Discharge Diagnosis: Pancreatic Cancer - Metastatic Acute on Chronic Pain UTI Obstructive Jaundice Pneumonia Sepsis Discharge Instructions: Continue with comfort measures. Followup Instructions: None [**Name6 (MD) 116**] [**Last Name (NamePattern4) 4988**] MD [**MD Number(1) 4989**] Completed by:[**2119-8-3**]

157,038,197,996,995,486,576,496,250,414,V458

{'Malignant neoplasm of head of pancreas,Unspecified septicemia,Malignant neoplasm of liver, secondary,Infection and inflammatory reaction due to other vascular device, implant, and graft,Severe sepsis,Pneumonia, organism unspecified,Obstruction of bile duct,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}

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: Pancreatic Cancer PRESENT ILLNESS: This is a 76M s/p multiple recent admissions for pancreatitis at MEDICAL HISTORY: Pancreatic Cancer CAD s/p NSTEMI, s/p R circumflex stent [**12-27**], TIA, HTN, hypercholesterolemia, COPD, DM (diet controlled), hemorrhoids, recurrent UTIs, nephrolithiasis, arthritis, bladder ca s/p radical cystectomy & urostomy, s/p parastomal hernia repair, s/p L hip ORIF, s/p L CEA [**1-27**] MEDICATION ON ADMISSION: Metamucil, Senna, gabapentin 300', Plavix 75', loratadine 10', Cartia XT 180', folic acid ?, ASA 325', Tylenol, MVI, simvastatin 40', temazepam 15 qhs, Advair 500/50", Combivent"", Prilosec 20' ALLERGIES: Demerol / Morphine / Sulfa (Sulfonamides) PHYSICAL EXAM: Vitals- T 97.9, HR 87, BP 118/56, RR 18, O2sat 96% RA Gen- NAD, alert Head and neck- AT, NC, soft, supple, no masses Heart- RRR, no murmurs Lungs- CTAB, no rhonchi, no crackles Abd- RLQ ileal conduit with hernia, moderate epigastric pain, no peritoneal signs Rectal- deferred Ext- warm, well-perfused, no edema FAMILY HISTORY: Father: cancer. Mother: cerebral hemorrhage after fall, ?stroke. 1 sister with CAD s/p triple bypass, 2 sisters s/p MI, 1 sister still living. Brother: leukemia. SOCIAL HISTORY: Former truck driver. Married and divorced 3x, no children. 150+ pack-year smoking history. No EtOH. ### Response: {'Malignant neoplasm of head of pancreas,Unspecified septicemia,Malignant neoplasm of liver, secondary,Infection and inflammatory reaction due to other vascular device, implant, and graft,Severe sepsis,Pneumonia, organism unspecified,Obstruction of bile duct,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}

CHIEF COMPLAINT: CC:[**CC Contact Info 75221**] Major Surgical or Invasive Procedure: EGD ([**8-9**]) Blood Transfusion PRESENT ILLNESS: HPI: 44 y.o. male with PMHx of hypercholesterolemia, transferred from [**Hospital6 302**] with likely upper GI bleed. Patient was in his normal state of good health until he noticed left leg swelling and pain approximately two weeks ago. He reported to his PCP who referred him to [**Hospital6 302**] for a LE doppler, which ruled out a DVT. He was then started on Naproxyn 500 mg [**Hospital1 **] on [**2170-7-26**]. Six days later, he began experiencing frequent black, formed stools and dizziness. He denied hematemesis, coffee-ground emesis or hematochezia. He additionally denied abdominal pain/cramping. He had never experienced symptoms like these previously. He presented to his PCP again on [**2170-8-3**] because of these symptoms at which time he was found to be hypotensive, orthostatic and guaiac positive. He was rushed to [**Hospital6 302**] where an urgent EGD showed old blood in the stomach, but no active bleed. He was then hospitalized in the ICU where serial hematocrits revealed a continuously dropping Hct (lowest being 23), despite transfusion. He was thus taken back for repeat EGD, which again showed no active bleed, but was significant for gastric varices. A subsequent RUQ US showed normal liver with patent vasculature. An abdominal CT showed diverticulosis, with no signs of inflammation. The patient was treated with IV PPI [**Hospital1 **] and Octreotide and received a minimum of 13 units of PRBCs before ultimately being transferred to [**Hospital1 18**] for further evaluation. . MEDICAL HISTORY: Hypercholesterolemia MEDICATION ON ADMISSION: Medications: Naproxen 500 mg [**Hospital1 **] Aspirin 81 mg QD Lipitor 10 mg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T - 97.6, BP - 91/63, HR - 51, RR - 11, O2 - 100% RA General: Awake, alert, NAD HEENT: NC/AT; PERRLA, EOMI, anicteric sclera with no pallor; OP clear, nonerythematous Neck: Supple, No LAD Chest/CV: S1, S2 nl, no m/r/g appreciated Lungs: CTAB Abd: Soft, NT, ND, + BS, no organomegaly Rectal: Maroon-colored, guaiac positive stool Ext: No c/c/e Neuro: Grossly intact Skin: No lesions FAMILY HISTORY: Mother with GERD and second degree relatives with esophageal cancer. SOCIAL HISTORY: Patient reports current tobacco use - [**11-28**] ppd x 15 years. He also reports alcohol use, up to 1 beer/week, occasionally. He denies any illicit drug use, intravenous or intranasal and has no tattoos or history of hepatitis that he knows of.

Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Pure hypercholesterolemia

Chr stomach ulc w hem,Chr blood loss anemia,Pure hypercholesterolem

Admission Date: [**2170-8-8**] Discharge Date: [**2170-8-12**] Date of Birth: [**2125-11-8**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 545**] Chief Complaint: CC:[**CC Contact Info 75221**] Major Surgical or Invasive Procedure: EGD ([**8-9**]) Blood Transfusion History of Present Illness: HPI: 44 y.o. male with PMHx of hypercholesterolemia, transferred from [**Hospital6 302**] with likely upper GI bleed. Patient was in his normal state of good health until he noticed left leg swelling and pain approximately two weeks ago. He reported to his PCP who referred him to [**Hospital6 302**] for a LE doppler, which ruled out a DVT. He was then started on Naproxyn 500 mg [**Hospital1 **] on [**2170-7-26**]. Six days later, he began experiencing frequent black, formed stools and dizziness. He denied hematemesis, coffee-ground emesis or hematochezia. He additionally denied abdominal pain/cramping. He had never experienced symptoms like these previously. He presented to his PCP again on [**2170-8-3**] because of these symptoms at which time he was found to be hypotensive, orthostatic and guaiac positive. He was rushed to [**Hospital6 302**] where an urgent EGD showed old blood in the stomach, but no active bleed. He was then hospitalized in the ICU where serial hematocrits revealed a continuously dropping Hct (lowest being 23), despite transfusion. He was thus taken back for repeat EGD, which again showed no active bleed, but was significant for gastric varices. A subsequent RUQ US showed normal liver with patent vasculature. An abdominal CT showed diverticulosis, with no signs of inflammation. The patient was treated with IV PPI [**Hospital1 **] and Octreotide and received a minimum of 13 units of PRBCs before ultimately being transferred to [**Hospital1 18**] for further evaluation. . Past Medical History: Hypercholesterolemia Social History: Patient reports current tobacco use - [**11-28**] ppd x 15 years. He also reports alcohol use, up to 1 beer/week, occasionally. He denies any illicit drug use, intravenous or intranasal and has no tattoos or history of hepatitis that he knows of. Family History: Mother with GERD and second degree relatives with esophageal cancer. Physical Exam: Vitals: T - 97.6, BP - 91/63, HR - 51, RR - 11, O2 - 100% RA General: Awake, alert, NAD HEENT: NC/AT; PERRLA, EOMI, anicteric sclera with no pallor; OP clear, nonerythematous Neck: Supple, No LAD Chest/CV: S1, S2 nl, no m/r/g appreciated Lungs: CTAB Abd: Soft, NT, ND, + BS, no organomegaly Rectal: Maroon-colored, guaiac positive stool Ext: No c/c/e Neuro: Grossly intact Skin: No lesions Pertinent Results: <b>Admit Labs:</b> [**2170-8-8**] 05:32PM BLOOD WBC-9.1 RBC-3.18* Hgb-10.1* Hct-28.2* MCV-89 MCH-31.7 MCHC-35.7* RDW-16.8* Plt Ct-153 [**2170-8-8**] 05:32PM BLOOD Glucose-96 UreaN-14 Creat-0.9 Na-139 K-4.0 Cl-111* HCO3-24 AnGap-8 [**2170-8-8**] 05:32PM BLOOD Calcium-7.6* Phos-3.2 Mg-1.8 <br> <b>Other Labs:</b> H. Pylori Serology ([**8-9**]) - Negative [**2170-8-8**] 11:13PM BLOOD Hct-23.0* [**2170-8-9**] 06:22AM BLOOD WBC-10.1 RBC-2.95* Hgb-9.7* Hct-26.4* MCV-89 MCH-32.9* MCHC-36.8* RDW-15.8* Plt Ct-122* [**2170-8-9**] 03:02PM BLOOD Hct-26.1* [**2170-8-9**] 06:23PM BLOOD Hct-27.6* [**2170-8-9**] 11:54PM BLOOD Hct-29.0* [**2170-8-10**] 05:22AM BLOOD WBC-13.7* RBC-3.03* Hgb-9.7* Hct-27.4* MCV-90 MCH-32.1* MCHC-35.5* RDW-16.0* Plt Ct-162 [**2170-8-10**] 02:04PM BLOOD Hct-27.0* [**2170-8-10**] 08:40PM BLOOD WBC-8.8 RBC-2.96* Hgb-9.5* Hct-26.7* MCV-90 MCH-32.0 MCHC-35.5* RDW-16.9* Plt Ct-189 [**2170-8-11**] 06:05AM BLOOD WBC-7.5 RBC-2.84* Hgb-9.0* Hct-26.0* MCV-91 MCH-31.8 MCHC-34.8 RDW-16.3* Plt Ct-188 [**2170-8-11**] 09:20PM BLOOD Hct-27.0* <br> <b>Discharge Labs:</b> [**2170-8-12**] 06:00AM BLOOD WBC-6.8 RBC-2.79* Hgb-8.9* Hct-25.7* MCV-92 MCH-31.9 MCHC-34.6 RDW-16.4* Plt Ct-220 [**2170-8-12**] 06:00AM BLOOD Plt Ct-220 [**2170-8-12**] 06:00AM BLOOD Glucose-88 UreaN-10 Creat-0.8 Na-141 K-3.4 Cl-108 HCO3-26 AnGap-10 [**2170-8-12**] 06:00AM BLOOD Calcium-7.3* Phos-4.2 Mg-2.1 <br> <b>Procedures:</b> EGD ([**8-9**]): Findings: Esophagus: Normal esophagus. Stomach: Excavated Lesions A single ulcer with a visible vessel and surrounding edema and edematous folds was found in the antrum. On manipulation it started oozing and hemostasis was successfully achieved by a combination [**Hospital1 **]-CAP electrocautery, 24cc epinephrine 1:10,000, and 4 Resolution clips. Duodenum: Normal duodenum. Impression: Ulcer in the antrum (injection, thermal therapy, clipping) Brief Hospital Course: 1. GI bleed. Patient was transferred from an outside hospital for GI bleed. He was initially transfused 2 units PRBCs and giveen IVF. An endoscopy on [**8-9**] showed an antral ulcer, which was cauterized and clipped. Serial crits were followed for concern for re-bleed. Hcts were found to be stable, though they did not show a significant elevation. Patient will have to follow up with GI in 8 weeks for repeat endoscopy and should avoid NSAIDs. Prior to discharge, patient did not have any further BRBPR. He did report slightly dark stool, though decreased vs. previous. No lightheadedness or dizziness. Blood pressure and heart rate were stable. H. pylori antigen was sent and was negative. Patient was initially on Protonix 40mg IV bid. This was subsequently changed to 40mg PO bid. This should be continued for one week. After that, he can change to Protonix 40mg daily. Patient instructed to have his Hct checked as an outpatient this week (3-4 days after discharge) to make sure it is stable. Hct on discharge was 25.7. <br> 2. Hypercholesterolemia Continued on outpatient Lipitor. Medications on Admission: Medications: Naproxen 500 mg [**Hospital1 **] Aspirin 81 mg QD Lipitor 10 mg QD Discharge Medications: 1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours): Take one tab twice daily for one week. Then take one tablet daily until EGD done. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 3. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 4. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) patch Transdermal once a day for 14 days: Use for 2 weeks, then use 7mg patch for 2 weeks. Disp:*14 patches* Refills:*0* 5. Nicotine 7 mg/24 hr Patch 24 hr Sig: One (1) Patch Transdermal once a day for 14 days: Use for 2 weeks after using 14mg patch for 2 weeks. Disp:*14 patches* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Gastric antral ulcer Discharge Condition: Afebrile, vital signs stable. Discharge Instructions: You were admitted for gastrointestinal bleeding. An endoscopy showed a bleeding gastric ulcer. Please follow up with your primary care doctor this week (on Wednesday [**8-15**] or Thursday [**8-16**]) to have your CBC (blood count) checked. Hct on discharge was 25.7. You should also follow up with gastroenterology in 8 weeks for a repeat endoscopy. You will need to continue to take Protonix 40mg twice daily for 1 week, and then change to 40mg daily after that. . Please return to the ER or call your primary care doctor if you have: Blood in your stool Increased black stools Feel lightheaded or dizzy Abdominal pain Vomiting of blood or coffee-ground-like material Followup Instructions: Provider: [**Name Initial (NameIs) **] SUITE GI ROOMS Date/Time:[**2170-10-3**] 12:00 (endoscopy) Provider: [**First Name4 (NamePattern1) 3520**] [**Last Name (NamePattern1) 3521**], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2170-10-3**] 12:00 PCP: [**Name10 (NameIs) 357**] call primary care doctor, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 75222**].

531,280,272

{'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Pure hypercholesterolemia'}

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: CC:[**CC Contact Info 75221**] Major Surgical or Invasive Procedure: EGD ([**8-9**]) Blood Transfusion PRESENT ILLNESS: HPI: 44 y.o. male with PMHx of hypercholesterolemia, transferred from [**Hospital6 302**] with likely upper GI bleed. Patient was in his normal state of good health until he noticed left leg swelling and pain approximately two weeks ago. He reported to his PCP who referred him to [**Hospital6 302**] for a LE doppler, which ruled out a DVT. He was then started on Naproxyn 500 mg [**Hospital1 **] on [**2170-7-26**]. Six days later, he began experiencing frequent black, formed stools and dizziness. He denied hematemesis, coffee-ground emesis or hematochezia. He additionally denied abdominal pain/cramping. He had never experienced symptoms like these previously. He presented to his PCP again on [**2170-8-3**] because of these symptoms at which time he was found to be hypotensive, orthostatic and guaiac positive. He was rushed to [**Hospital6 302**] where an urgent EGD showed old blood in the stomach, but no active bleed. He was then hospitalized in the ICU where serial hematocrits revealed a continuously dropping Hct (lowest being 23), despite transfusion. He was thus taken back for repeat EGD, which again showed no active bleed, but was significant for gastric varices. A subsequent RUQ US showed normal liver with patent vasculature. An abdominal CT showed diverticulosis, with no signs of inflammation. The patient was treated with IV PPI [**Hospital1 **] and Octreotide and received a minimum of 13 units of PRBCs before ultimately being transferred to [**Hospital1 18**] for further evaluation. . MEDICAL HISTORY: Hypercholesterolemia MEDICATION ON ADMISSION: Medications: Naproxen 500 mg [**Hospital1 **] Aspirin 81 mg QD Lipitor 10 mg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T - 97.6, BP - 91/63, HR - 51, RR - 11, O2 - 100% RA General: Awake, alert, NAD HEENT: NC/AT; PERRLA, EOMI, anicteric sclera with no pallor; OP clear, nonerythematous Neck: Supple, No LAD Chest/CV: S1, S2 nl, no m/r/g appreciated Lungs: CTAB Abd: Soft, NT, ND, + BS, no organomegaly Rectal: Maroon-colored, guaiac positive stool Ext: No c/c/e Neuro: Grossly intact Skin: No lesions FAMILY HISTORY: Mother with GERD and second degree relatives with esophageal cancer. SOCIAL HISTORY: Patient reports current tobacco use - [**11-28**] ppd x 15 years. He also reports alcohol use, up to 1 beer/week, occasionally. He denies any illicit drug use, intravenous or intranasal and has no tattoos or history of hepatitis that he knows of. ### Response: {'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Iron deficiency anemia secondary to blood loss (chronic),Pure hypercholesterolemia'}

CHIEF COMPLAINT: Back pain PRESENT ILLNESS: Patient is a 47 yo man who has a h/o of UC and PSC s/p Whipple c/b pouchitis who was transferred from [**Hospital 47**] Hospital with leg/arm parathesias, had MRI which showed cord compression at T7 from mets of unknown source. He had a month long history of back pain, near R shoulder blade. This was followed by numbness/tingling in the R hand, mostly the last 3 digits. Two weeks ago, he saw his PCP. [**Name10 (NameIs) **] was referred to physical therapy. Saturday, pt started to feel tingling in the R leg. Sunday, he had R leg weakness, affecting his gait. On Monday, he felt malaise. By Tuesday, he needed assistance with walking due to weakness in both legs, R>L. No urinary or fecal incontinece, no perianal numbness. MEDICAL HISTORY: Ulcerative colitis, s/p colectomy and ileo-anal pull through Primary sclerosing chlangitis, s/p Whipple Chronic pouchitis, usually on rifaxmin as maintenance, takes cipro/flagyl for rescue Complex renal cyst Asthma Eczema MEDICATION ON ADMISSION: Pls see attached. ALLERGIES: Tylenol 8 Hr PHYSICAL EXAM: VS: 97.7, 100/66, 106, 20, 96RA Gen: NAD, AOX3 HEENT: PERRLA, EOMI, MMM, sclera anicteric, not injected Neck: no LAD, no JVD Cardiovascular: RRR normal s1, s2, no murmurs appreciated Respiratory: Clear to auscultation bilaterally, no crackles, wheeze in LLL Abd: normoactive bowel sounds, soft, non-tender, mildly distended Extremities: No edema, 2+ DP pulses Neurological: MS [**6-12**] in BUEs, mild numbness along ulnar distribution bilaterally, MS 5-/5 in BLEs, no numbness in legs, upgoing babinski on R, equivocal on L, DTR's brisk but equal throughout Back: no TTP or percussion along spine Integument: Warm, moist, no rash or ulceration Psychiatric: appropriate, pleasant, not anxious FAMILY HISTORY: Aunt with rectal cancer, dx in her 50s. Uncle with renal cancer. SOCIAL HISTORY: Patient lives with wife and daughter. [**Name (NI) **] is a database administrator. Quit tobacco use in [**2184**], 1ppd x 10years. 6 pack on a weekend. No recreationsl drugs since college, marijuana, cocaine.

Pathologic fracture of vertebrae,Myelopathy in other diseases classified elsewhere,Cholangitis,Secondary malignant neoplasm of bone and bone marrow,Pouchitis,Spinal stenosis, thoracic region,Other malignant neoplasm without specification of site,Personal history of other diseases of digestive system,Asthma, unspecified type, unspecified,Neoplasm related pain (acute) (chronic),Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation

Path fx vertebrae,Myelopathy in oth dis,Cholangitis,Secondary malig neo bone,Pouchitis,Spinal stenosis-thoracic,Malignant neoplasm NOS,Prsnl hst ot spf dgst ds,Asthma NOS,Neoplasm related pain,Abn react-anastom/graft

Admission Date: [**2199-9-18**] Discharge Date: [**2199-9-28**] Date of Birth: [**2151-11-14**] Sex: M Service: ORTHOPAEDICS Allergies: Tylenol 8 Hr Attending:[**First Name3 (LF) 3645**] Chief Complaint: Back pain Major Surgical or Invasive Procedure: T1, T5, T7 decompression, fusion C5-T10 History of Present Illness: Patient is a 47 yo man who has a h/o of UC and PSC s/p Whipple c/b pouchitis who was transferred from [**Hospital 47**] Hospital with leg/arm parathesias, had MRI which showed cord compression at T7 from mets of unknown source. He had a month long history of back pain, near R shoulder blade. This was followed by numbness/tingling in the R hand, mostly the last 3 digits. Two weeks ago, he saw his PCP. [**Name10 (NameIs) **] was referred to physical therapy. Saturday, pt started to feel tingling in the R leg. Sunday, he had R leg weakness, affecting his gait. On Monday, he felt malaise. By Tuesday, he needed assistance with walking due to weakness in both legs, R>L. No urinary or fecal incontinece, no perianal numbness. MRI at [**Location (un) 47**] showed mets were noted at C7, T1, T2, T5, T7 with cord compression at T7. He received morphine and decadron. In the ED, initial VS were: 97.8 114 126/78 18 97. Labs were notable for AP 707, WBC 13.3. The patient received cipro & flagyl for pouchitis. Ortho-spine was consulted and rec. head of bed <30, bedrest. Review of Systems: (+) Per HPI: He has lost 10 lbs in the last 6 months. Chronic diarrhea, stable. Intermittent pain in LIQ. (-) Denies fever, chills, night sweats. Denies headache, vision problems. Denies chest pain or tightness, palpitations. Denies cough, shortness of breath, or wheezes. Denies nausea, vomiting, constipation, BRBPR, melena. Past Medical History: Ulcerative colitis, s/p colectomy and ileo-anal pull through Primary sclerosing chlangitis, s/p Whipple Chronic pouchitis, usually on rifaxmin as maintenance, takes cipro/flagyl for rescue Complex renal cyst Asthma Eczema Social History: Patient lives with wife and daughter. [**Name (NI) **] is a database administrator. Quit tobacco use in [**2184**], 1ppd x 10years. 6 pack on a weekend. No recreationsl drugs since college, marijuana, cocaine. Family History: Aunt with rectal cancer, dx in her 50s. Uncle with renal cancer. Physical Exam: VS: 97.7, 100/66, 106, 20, 96RA Gen: NAD, AOX3 HEENT: PERRLA, EOMI, MMM, sclera anicteric, not injected Neck: no LAD, no JVD Cardiovascular: RRR normal s1, s2, no murmurs appreciated Respiratory: Clear to auscultation bilaterally, no crackles, wheeze in LLL Abd: normoactive bowel sounds, soft, non-tender, mildly distended Extremities: No edema, 2+ DP pulses Neurological: MS [**6-12**] in BUEs, mild numbness along ulnar distribution bilaterally, MS 5-/5 in BLEs, no numbness in legs, upgoing babinski on R, equivocal on L, DTR's brisk but equal throughout Back: no TTP or percussion along spine Integument: Warm, moist, no rash or ulceration Psychiatric: appropriate, pleasant, not anxious Pertinent Results: Admission labs: [**2199-9-17**] 11:00PM WBC-13.3*# RBC-4.36* HGB-12.3* HCT-37.0* MCV-85# MCH-28.2# MCHC-33.2 RDW-13.9 [**2199-9-17**] 11:00PM NEUTS-96.2* LYMPHS-3.2* MONOS-0.3* EOS-0.1 BASOS-0.1 [**2199-9-17**] 11:00PM PLT COUNT-317 [**2199-9-17**] 11:00PM GLUCOSE-129* UREA N-13 CREAT-0.6 SODIUM-141 POTASSIUM-3.9 CHLORIDE-104 TOTAL CO2-24 ANION GAP-17 [**2199-9-17**] 11:00PM ALT(SGPT)-52* AST(SGOT)-50* ALK PHOS-707* TOT BILI-1.4 [**2199-9-17**] 11:00PM ALBUMIN-3.6 OSH MRI: There are mets involving the C7, T1, T2, T5, and T7 vertebrae. Tumor extends into the canal at the T1, T5, and T7 levels. There may be minimal extension into the anterior aspect of the cancal on the left at the T2 level. Tumor surrounds the cord and causes mild to moderate cord compression at the T7 level. There is only a very small impression on the anterior aspect of the cord by tumor at the T5 level. Brief Hospital Course: 47 yo man who has a h/o of UC and PSC s/p Whipple who presented to OSH with 1 month of back pain and increasing numbness/weakness of extremities, found to have metastatic spine disease and cord compression on MRI. # Spinal cord compression with metastatic bone disease: - Onc to see in AM - Ortho spine - see below # Primary sclerosing cholangitis: - cont. ursodiol # Chronic pouchitis: H/o UC s/p colectomy - cont. cipro, flagyl # Asthma: stable. - albuterol prn FEN: regular diet PPx: HSQ Access: PIV CONTACT: [**First Name4 (NamePattern1) **] [**Known lastname 34751**] cell [**Telephone/Fax (1) 34752**], home [**Telephone/Fax (1) 34753**] Following pre-operative staging and medical optimization, patient presented for decompression and stabilization. He underwent the procedure, tolerating it well. Given duration of anesthesia and blood loss, he was transferred intubated to the TICU in stable condition. He was extubated uneventfully. Patient was transferred to the floor once critical care issues were resolved. Pain was controlled with IV followed by PO medications. Foley was discontinued. PT was consulted for assistance with the patient's care. He progressed with therapy and was fully ambulatory at the time of discharge. Oncology was contact[**Name (NI) **] to arrange follow-up. At the time of discharge, final path was pending. Once pain was well controlled, PO diet was tolerated, and once pt had passed PT, he was deemed stable for D/C to home. Medications on Admission: Pls see attached. Discharge Medications: 1. Loperamide 2 mg Capsule Sig: Two (2) Capsule PO QID (4 times a day) as needed for diarrhea. 2. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 4. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours). 7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 8. Ursodiol 300 mg Capsule Sig: Two (2) Capsule PO QAM (once a day (in the morning)). 9. Ursodiol 300 mg Capsule Sig: Three (3) Capsule PO QPM (once a day (in the evening)). 10. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours) as needed for Pain. Disp:*80 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 **] VNA, [**Hospital1 1559**] Discharge Diagnosis: Metastatic disease to thoracic spine, s/p decompression and fusion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: 1. Keep incision clean and dry, daily dressing change until dry for 24hr, then may leave open to air and may shower - no bath 2. Continue PT exercises at home 3. No lifting > 10 lbs Physical Therapy: Activity as tolerated. Maintain C-collar at all times, no neck ROM Assist with mobilization, ADL training, proprioceptive training; home-exercise program. Treatments Frequency: Keep incision clean and dry. Daily dressing changes until dry for 24 hours, then leave open to air and may shower. Followup Instructions: Test for consideration post-discharge: CA [**08**]-9 1. follow-up with Dr. [**Last Name (STitle) 1352**] in [**8-17**] days, call for appointment 2. follow-up with oncology, call office for appointment Completed by:[**2199-10-1**]

733,336,576,198,569,724,199,V127,493,338,E878

{'Pathologic fracture of vertebrae,Myelopathy in other diseases classified elsewhere,Cholangitis,Secondary malignant neoplasm of bone and bone marrow,Pouchitis,Spinal stenosis, thoracic region,Other malignant neoplasm without specification of site,Personal history of other diseases of digestive system,Asthma, unspecified type, unspecified,Neoplasm related pain (acute) (chronic),Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant 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: Back pain PRESENT ILLNESS: Patient is a 47 yo man who has a h/o of UC and PSC s/p Whipple c/b pouchitis who was transferred from [**Hospital 47**] Hospital with leg/arm parathesias, had MRI which showed cord compression at T7 from mets of unknown source. He had a month long history of back pain, near R shoulder blade. This was followed by numbness/tingling in the R hand, mostly the last 3 digits. Two weeks ago, he saw his PCP. [**Name10 (NameIs) **] was referred to physical therapy. Saturday, pt started to feel tingling in the R leg. Sunday, he had R leg weakness, affecting his gait. On Monday, he felt malaise. By Tuesday, he needed assistance with walking due to weakness in both legs, R>L. No urinary or fecal incontinece, no perianal numbness. MEDICAL HISTORY: Ulcerative colitis, s/p colectomy and ileo-anal pull through Primary sclerosing chlangitis, s/p Whipple Chronic pouchitis, usually on rifaxmin as maintenance, takes cipro/flagyl for rescue Complex renal cyst Asthma Eczema MEDICATION ON ADMISSION: Pls see attached. ALLERGIES: Tylenol 8 Hr PHYSICAL EXAM: VS: 97.7, 100/66, 106, 20, 96RA Gen: NAD, AOX3 HEENT: PERRLA, EOMI, MMM, sclera anicteric, not injected Neck: no LAD, no JVD Cardiovascular: RRR normal s1, s2, no murmurs appreciated Respiratory: Clear to auscultation bilaterally, no crackles, wheeze in LLL Abd: normoactive bowel sounds, soft, non-tender, mildly distended Extremities: No edema, 2+ DP pulses Neurological: MS [**6-12**] in BUEs, mild numbness along ulnar distribution bilaterally, MS 5-/5 in BLEs, no numbness in legs, upgoing babinski on R, equivocal on L, DTR's brisk but equal throughout Back: no TTP or percussion along spine Integument: Warm, moist, no rash or ulceration Psychiatric: appropriate, pleasant, not anxious FAMILY HISTORY: Aunt with rectal cancer, dx in her 50s. Uncle with renal cancer. SOCIAL HISTORY: Patient lives with wife and daughter. [**Name (NI) **] is a database administrator. Quit tobacco use in [**2184**], 1ppd x 10years. 6 pack on a weekend. No recreationsl drugs since college, marijuana, cocaine. ### Response: {'Pathologic fracture of vertebrae,Myelopathy in other diseases classified elsewhere,Cholangitis,Secondary malignant neoplasm of bone and bone marrow,Pouchitis,Spinal stenosis, thoracic region,Other malignant neoplasm without specification of site,Personal history of other diseases of digestive system,Asthma, unspecified type, unspecified,Neoplasm related pain (acute) (chronic),Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Mrs. [**Known lastname 46303**] is a 59 year old female who presented to the Emergency Room at the Cruritis [**Hospital3 417**] Medical Center with complaints of a 2 1/2 hour history of substernal chest pain which radiated to her jaws bilaterally and to her left arm. She stated that she had a transient episode of similar pain approximately 24 hours earlier which had spontaneously remitted after approximately one to two hours. Her chest pain at the time she was seen in the Emergency Room was rated at an 8 out of 10 on the pain scale. MEDICAL HISTORY: 1. Cerebrovascular disease, status post a cerebrovascular accidents; 2. Pulmonary embolus in [**2135**]. MEDICATION ON ADMISSION: The following medications were started in the Emergency Room at the outside hospital - 1. Nitrodur; 2. Lopressor; 3. Heparin; 4. Plavix; 5. Integrilin. The patient stated that at home she took: 1. Aspirin; 2. Imipramine. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Significant for family members who have suffered myocardial infarction in the past. SOCIAL HISTORY:

Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension

AMI NOS, initial,Crnry athrscl natve vssl,Hypertension NOS

Admission Date: [**2170-1-30**] Discharge Date: [**2170-2-4**] Date of Birth: [**2111-1-27**] Sex: F Service: Cardiothoracic Surgery CHIEF COMPLAINT: Chest pain HISTORY OF PRESENT ILLNESS: Mrs. [**Known lastname 46303**] is a 59 year old female who presented to the Emergency Room at the Cruritis [**Hospital3 417**] Medical Center with complaints of a 2 1/2 hour history of substernal chest pain which radiated to her jaws bilaterally and to her left arm. She stated that she had a transient episode of similar pain approximately 24 hours earlier which had spontaneously remitted after approximately one to two hours. Her chest pain at the time she was seen in the Emergency Room was rated at an 8 out of 10 on the pain scale. PAST MEDICAL HISTORY: 1. Cerebrovascular disease, status post a cerebrovascular accidents; 2. Pulmonary embolus in [**2135**]. MEDICATIONS ON ADMISSION: The following medications were started in the Emergency Room at the outside hospital - 1. Nitrodur; 2. Lopressor; 3. Heparin; 4. Plavix; 5. Integrilin. The patient stated that at home she took: 1. Aspirin; 2. Imipramine. ALLERGIES: The patient has no known drug allergies. FAMILY HISTORY: Significant for family members who have suffered myocardial infarction in the past. PHYSICAL EXAMINATION: The patient's temperature was 96.5, heartrate was 133 with a blood pressure of 201/95 and a respiratory rate of 20. The patient was alert and uncomfortable. Skin was warm and dry with no significant lesions. The heart showed a regular rhythm with tachycardia and a systolic murmur. The lungs were clear to auscultation bilaterally. There was no significant peripheral edema. Gross neurologic and motor examinations were intact. HOSPITAL COURSE: The patient was transferred to the [**Hospital6 1760**] later on [**2170-1-30**], when she was admitted to the Operating Room and underwent coronary artery bypass graft times four. Please refer the dictated operative note for full details of this procedure. In summary the left internal mammary artery was anastomosed to the left anterior descending with saphenous vein grafts to the posterior descending, obtuse marginal and diagonal arteries. The patient tolerated the procedure well and was transferred to the Cardiac Intensive Care Unit with intra-aortic balloon pump in place with normal sinus rhythm at 192 beats/minute. On transfer, the patient was on a Propofol drip at 50 mcg/kg/min. The patient remained intubated in the Cardiac Intensive Care Unit with the intra-aortic balloon pump at 1:1, and Propofol at 50 mcg/kg/min. She had huge volume losses via urine output, and was repleted with 4 liters of lactated ringer's and 1 liter of Hespan, as well as one unit of packed red blood cells. Her electrolytes were also repleted at this time. She soon began to require some nitroglycerin drip for control of her blood pressure. Early on postoperative day #1, the patient was weaned from the ventilator and extubated without issue. Her post extubation arterial blood gas was excellent. Her intra-aortic balloon pump at this time was weaned to 1 to 3 with a good cardiac output and index. She did describe a brief run of atrial fibrillation, which resolved with electrolyte repletion and intravenous Lopressor. Her extremities were warm and she had dopplerable pedal pulses bilaterally as well palpable dorsalis pedis pulses bilaterally. Later on postoperative day #1, the intra-aortic balloon pump was removed, and she maintained an excellent cardiac index and output greater than 2. At this time, nitroglycerin drip was titrated to keep her mean arterial pressure at around 90. On postoperative day #2, the nitroglycerin drip was weaned off, and Lopressor was started in the form of beta blockade at 25 mg twice per day. At this time adequate diuresis was also begun using Lasix. Later on postoperative day #2, the patient was deemed stable and ready for transfer to the floor from the Cardiac Surgical Intensive Care Unit. Once on the floor, she continued to do well, increasing her degree of mobility steadily. During the evening of postoperative day #2, she was given an extra dose of 25 mg of oral Lopressor due to some slight sinus tachycardia. Due to this fact, the standing dose of Lopressor was titrated up to better control heartrate and blood pressure. By postoperative day #3, physical therapy evaluation had deemed that she was safe for discharge to home, and had discontinued an acute level physical therapy in the hospital. On postoperative day #4, the patient's remaining issue was a slight oxygen requirement, requiring 2 liters of nasal cannula with an oxygen saturation of approximately 96%. Otherwise she was doing quite well, and her external pacing wires were removed. By postoperative day #5 the patient had been weaned off of nasal cannula oxygen altogether, and at this time was deemed stable and safe and ready to be discharged home. She was discharged home with visiting nurses in order that they would do some cardiopulmonary and wound checks. PHYSICAL EXAMINATION ON DISCHARGE: The patient had a temperature of 100.1 degrees F with a heartrate of 92 in sinus rhythm and a blood pressure of 122/65. Her oxygen saturation was 94% on room air. Her heart showed a regular rate and rhythm with normal S1 and S2 and no murmurs. Lungs were clear to auscultation bilaterally. Her sternal incision was healing nicely with no erythema or drainage. Her sternum was stable. Her abdomen was soft, nontender, nondistended with no hepatosplenomegaly or other palpable masses. She had shown significant decrease in peripheral edema with 1+ peripheral edema remaining around the lower legs and ankles. MEDICATIONS ON DISCHARGE: 1. Lasix 20 mg p.o. b.i.d. times 10 days 2. Potassium chloride 20 mEq p.o. b.i.d. times 10 days 3. Enteric coated Aspirin 325 mg p.o. q. day 4. Zantac 150 mg p.o. b.i.d. 5. Lopressor 75 mg p.o. b.i.d. 6. Percocet 1 to 2 tablets every 4-6 hours as needed for pain 7. Colace 100 mg p.o. b.i.d. CONDITION ON DISCHARGE: The patient was stable. DISCHARGE DIAGNOSIS: 1. Coronary artery disease and unstable angina status post coronary artery bypass graft times four on [**2170-1-30**]. 2. History of cerebrovascular disease and transient ischemic attacks. 3. Pulmonary embolus in [**2135**]. DISCHARGE INSTRUCTIONS: Activity was as tolerated. Diet was a cardiac heart healthy diet. FOLLOW UP: The patient was to follow up with her cardiologist in approximately the next one to two weeks, or her primary care physician in the next one to two weeks, and to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] in approximately five time. Dictated By:[**Name8 (MD) 11089**] MEDQUIST36 D: [**2170-2-17**] 15:56 T: [**2170-2-17**] 19:40 JOB#: [**Job Number **]

410,414,401

{'Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}

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: Chest pain PRESENT ILLNESS: Mrs. [**Known lastname 46303**] is a 59 year old female who presented to the Emergency Room at the Cruritis [**Hospital3 417**] Medical Center with complaints of a 2 1/2 hour history of substernal chest pain which radiated to her jaws bilaterally and to her left arm. She stated that she had a transient episode of similar pain approximately 24 hours earlier which had spontaneously remitted after approximately one to two hours. Her chest pain at the time she was seen in the Emergency Room was rated at an 8 out of 10 on the pain scale. MEDICAL HISTORY: 1. Cerebrovascular disease, status post a cerebrovascular accidents; 2. Pulmonary embolus in [**2135**]. MEDICATION ON ADMISSION: The following medications were started in the Emergency Room at the outside hospital - 1. Nitrodur; 2. Lopressor; 3. Heparin; 4. Plavix; 5. Integrilin. The patient stated that at home she took: 1. Aspirin; 2. Imipramine. ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: Significant for family members who have suffered myocardial infarction in the past. SOCIAL HISTORY: ### Response: {'Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}

CHIEF COMPLAINT: Headache, Nausea, vomiting PRESENT ILLNESS: 81M with known lung mass for which was reportedly refused workup for greater than 1 year, PET +, likely adenocarcinoma, recent admission for post obstructive pneumonia with increasing size of mass seen on chest CT scan, to undergo bronch next month. Was complaining of headache, some n/v last week, now resolved, seen in office this morning, head CT today showed a preliminary read of Left cerebellar mass with mass effect on the 4th ventricle and possible tonsillar herniation. He was then urged by his PCP to come to the ED for evaluation MEDICAL HISTORY: -AAA status post repair in [**2143**] -right renal mass status post nephrectomy in [**2145**] in the USSR -bladder cell CA -CHF --> systolic dysfn w/ EF 35-40% -BPH s/p TURP -coronary artery disease -hyperlipidemia -hypertension -bilateral claudication -status post bilateral iliac stents -chronic renal insufficiency - baseline Cr 1.7 -MGUS. MEDICATION ON ADMISSION: Cyanocobalamin 1,000 mcg/mL Solution 1cc q month Folic Acid 1 mg Tablet QD Furosemide 40 mg Tablet QD Ipratropium Bromide [Atrovent HFA] 2 puffs inhaled every six (6) hours Isosorbide Mononitrate [Imdur] 30 mg Tablet QD Lisinopril 40 mg Tablet QD Metoprolol Succinate 50 mg Tablet [**Hospital1 **] Nicotine 14 mg/24 hour Patch QD Nifedipine [Nifedical XL] 60 mg Tab QPM Nitroglycerin 0.4 mg Tablet, Sublingual prn CP Trazodone 50 mg Tablet [**1-7**] - 1 Tablet(s)(s) HS Aspirin [Aspirin EC] 81 mg Tablet QD ALLERGIES: Zetia PHYSICAL EXAM: On Admission: Gen: WD/WN, comfortable, NAD. HEENT: Pupils:4->2 B/L EOMs intact Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: -Mother has DM -Father with HTN, CAD, PVD. -Sibling w/DM SOCIAL HISTORY: 62 current pack year smoker. Engineer, occasional vodka use, no IVDU.

Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Obstructive hydrocephalus,Malignant neoplasm of main bronchus,Other nervous system complications,Chronic systolic heart failure,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Pulmonary collapse,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of bladder,Hyperpotassemia,Other and unspecified angina pectoris,Other emphysema,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Chronic kidney disease, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication

Sec mal neo brain/spine,Cerebral edema,Obstructiv hydrocephalus,Malig neo main bronchus,Surg comp nerv systm NEC,Chr systolic hrt failure,Mal neo lymph-intrathor,Pulmonary collapse,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Ben hy kid w cr kid I-IV,Hx of bladder malignancy,Hyperpotassemia,Angina pectoris NEC/NOS,Emphysema NEC,BPH w/o urinary obs/LUTS,Chronic kidney dis NOS,Ath ext ntv at w claudct

Admission Date: [**2161-10-21**] Discharge Date: [**2161-11-6**] Date of Birth: [**2080-1-9**] Sex: M Service: NEUROSURGERY Allergies: Zetia Attending:[**First Name3 (LF) 1854**] Chief Complaint: Headache, Nausea, vomiting Major Surgical or Invasive Procedure: 3rd ventriculosotmy [**10-29**] Bronchoscopy with fine needle biopsy [**10-29**] [**11-5**]: Cranial Wound revision [**11-5**]: Replacement of Pulmonary Stent History of Present Illness: 81M with known lung mass for which was reportedly refused workup for greater than 1 year, PET +, likely adenocarcinoma, recent admission for post obstructive pneumonia with increasing size of mass seen on chest CT scan, to undergo bronch next month. Was complaining of headache, some n/v last week, now resolved, seen in office this morning, head CT today showed a preliminary read of Left cerebellar mass with mass effect on the 4th ventricle and possible tonsillar herniation. He was then urged by his PCP to come to the ED for evaluation Past Medical History: -AAA status post repair in [**2143**] -right renal mass status post nephrectomy in [**2145**] in the USSR -bladder cell CA -CHF --> systolic dysfn w/ EF 35-40% -BPH s/p TURP -coronary artery disease -hyperlipidemia -hypertension -bilateral claudication -status post bilateral iliac stents -chronic renal insufficiency - baseline Cr 1.7 -MGUS. Social History: 62 current pack year smoker. Engineer, occasional vodka use, no IVDU. Family History: -Mother has DM -Father with HTN, CAD, PVD. -Sibling w/DM Physical Exam: On Admission: Gen: WD/WN, comfortable, NAD. HEENT: Pupils:4->2 B/L EOMs intact Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. Cranial Nerves: I: Not tested II: Pupils equally round and reactive to light, to 4->2 mm bilaterally. Visual fields are full to confrontation. III, IV, VI: Extraocular movements intact bilaterally without nystagmus. V, VII: Facial strength and sensation intact and symmetric. VIII: Hearing intact to voice. IX, X: Palatal elevation symmetrical. [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations. Motor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power [**5-11**] throughout. No pronator drift Sensation: Intact to light touch. Toes downgoing bilaterally Coordination: normal on finger-nose-finger On Discharge: He is alert/oriented, follows all commands. No focal neurodeficits are appreciated. Pertinent Results: Labs on Admission: [**2161-10-21**] 04:30PM BLOOD WBC-8.8 RBC-2.98* Hgb-10.7* Hct-29.5* MCV-99* MCH-35.9* MCHC-36.3* RDW-14.1 Plt Ct-243 [**2161-10-21**] 04:30PM BLOOD Neuts-67.3 Lymphs-23.9 Monos-7.0 Eos-1.6 Baso-0.3 [**2161-10-21**] 04:50PM BLOOD PT-13.0 PTT-26.2 INR(PT)-1.1 [**2161-10-21**] 04:30PM BLOOD Glucose-104 UreaN-32* Creat-2.0* Na-137 K-4.7 Cl-106 HCO3-22 AnGap-14 [**2161-10-22**] 02:41AM BLOOD Calcium-9.5 Phos-3.7 Mg-2.5 [**2161-10-23**] 05:24AM BLOOD Triglyc-119 HDL-46 CHOL/HD-4.7 LDLcalc-147* Labs on Discharge: [**2161-11-6**] 09:20AM BLOOD WBC-21.1* RBC-2.84* Hgb-10.0* Hct-29.7* MCV-104* MCH-35.1* MCHC-33.6 RDW-14.9 Plt Ct-146* [**2161-11-6**] 09:20AM BLOOD Plt Ct-146* [**2161-11-6**] 09:20AM BLOOD Glucose-273* UreaN-45* Creat-1.5* Na-137 K-5.4* Cl-103 HCO3-24 AnGap-15 [**2161-11-6**] 09:20AM BLOOD Calcium-8.7 Phos-3.5 Mg-2.3 Imaging: Head CT [**10-21**]: IMPRESSION: 1. New left cerebellar mass with possible hemorrhage. 2. Midline shift and tonsillar herniation. Head CT [**11-2**]: IMPRESSION: 1. 2.4 x 1.5 cm left cerebellar mass. No significant change in mass effect. 2. Right frontal ventriculostomy tract. Head CT [**11-4**]: IMPRESSION: 1. Stable size of ventricles since yesterday's scan. 2. Well-circumscribed hypdodense area in right frontal gyrus immediately adjacent to burr hole, slightly more prominent today, most likely related to tract of ventriculostomy. Abdominal Plain Film [**10-22**]: A SINGLE VIEW OF THE ABDOMEN demonstrates surgical clips, likely related to prior vascular procedure, projecting over the L3 vertebral body. Bowel gas pattern is unremarkable. Soft tissues and osseous structures are otherwise unremarkable. CT Torso [**10-23**]: IMPRESSION: 1. Large paraesophageal/subcarinal mass, with mass effect on the left mainstem bronchus, and associated post-obstructive atelectasis of the left lower lobe, progressed from [**2161-9-28**], concerning for either a malignancy of bronchial or esophageal origin as noted previously. Lymphoma is less likely. 2. Interval increase in size of numerous mediastinal nodes, compatible with disease progression. 3. Right lower lobe ground-glass opacities, with scattered nodular ground- glass opacities bilaterally, slightly improved from prior study. 4. Small pericardial effusion. 5. Cholelithiasis. 6. Left renal cysts. 7. Left adrenal fullness, unchanged from as far back as [**2158-9-15**]. 8. Diverticulosis without diverticulitis. MRI [**10-23**]: Left cerebellar 2-cm enhancing lesion, most likely due to metastasis. Mass effect on the fourth ventricle. No hydrocephalus. Mild-to-moderate brain atrophy. EKG [**10-23**]: Sinus tachycardia. Left atrial abnormality. Low limb lead voltage. ST segment depressions in leads I, aVL and V5-V6 suggest the possibility of anterolateral ischemia. Compared to the previous tracing of [**2161-10-21**] the lateral ST segment depressions are new. Brief Hospital Course: 81M with known lung mass for which was reportedly refused workup for greater than 1 year, PET +, likely adenocarcinoma, recent admission for post obstructive pneumonia with increasing size of mass seen on chest CT scan, to undergo bronch next month. Was complaining of headache, some n/v last week, now resolved, seen in office this morning, head CT today showed a preliminary read of Left cerebellar mass with mass effect on the 4th ventricle and possible tonsillar herniation. Neurosurgery consulted to evaluate mass. He was admitted to the NSURG ICU for a period of time for close monitoring. He underwent MRI imaging with further identified the lesion within the cerebellum. He uneventfully underwent Stereotactic third ventriculostomy to facilitate CSF drainage and avoid progressing obstructive hydrocephalus. He also had a CT of the torso which identified a hilar mass causing some degree of stenosis on the pulmonary system. He underwent a bronchoscopy for biopsy of said lesion and pulmonary stent placement. Pathology of the bronchoscopy has revealed small cell carcinoma. In subsequent days, there was some drainage noted around the third ventric site. This was initially conservatively managed, but later came to require perioperative wound revision. On [**11-4**], Mr. [**Known lastname 75361**] had an excessively prolonged coughing fit, and subsequently coughed up his stent. When he was taken back to the OR for cranial wound revision, interventional pulmonology concurrently replaced the pulmonary stent. Post operatively, he is completely stable, without any focal neurological deficits. he is scheduled for whole brain radiation to be conducted on an outpatient basis with follow up scheduled in the brain tumor clinic and with Dr. [**Last Name (STitle) **]. He was also given instruction to follow up with interventional pulmonology with regards to the stent. Medications on Admission: Cyanocobalamin 1,000 mcg/mL Solution 1cc q month Folic Acid 1 mg Tablet QD Furosemide 40 mg Tablet QD Ipratropium Bromide [Atrovent HFA] 2 puffs inhaled every six (6) hours Isosorbide Mononitrate [Imdur] 30 mg Tablet QD Lisinopril 40 mg Tablet QD Metoprolol Succinate 50 mg Tablet [**Hospital1 **] Nicotine 14 mg/24 hour Patch QD Nifedipine [Nifedical XL] 60 mg Tab QPM Nitroglycerin 0.4 mg Tablet, Sublingual prn CP Trazodone 50 mg Tablet [**1-7**] - 1 Tablet(s)(s) HS Aspirin [Aspirin EC] 81 mg Tablet QD Discharge Medications: 1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation QID (4 times a day). 3. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 4. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). 5. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed. 6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 8. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for angina. 10. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO HS (at bedtime). 11. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 13. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for Headache: caution not to exceed more than 4gm APAP in 24 h. Disp:*40 Tablet(s)* Refills:*0* 14. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). Disp:*120 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Left Cerebellar Mass Large paraesophageal/subcarinal mass Discharge Condition: Neurologically Stable Discharge Instructions: General Instructions ??????Have a friend/family member check your incision daily for signs of infection. ??????Take your pain medicine as prescribed. ??????Exercise should be limited to walking; no lifting, straining, or excessive bending. ??????You may wash your hair only after sutures and/or staples have been removed. ??????You may shower before this time using a shower cap to cover your head. ??????Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ??????Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. ??????Clearance to drive and return to work will be addressed at your post-operative office visit. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ??????New onset of tremors or seizures. ??????Any confusion or change in mental status. ??????Any numbness, tingling, weakness in your extremities. ??????Pain or headache that is continually increasing, or not relieved by pain medication. ??????Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. ??????Fever greater than or equal to 101?????? F. Completed by:[**2161-11-6**]

198,348,331,162,997,428,196,518,272,414,403,V105,276,413,492,600,585,440

{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Obstructive hydrocephalus,Malignant neoplasm of main bronchus,Other nervous system complications,Chronic systolic heart failure,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Pulmonary collapse,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of bladder,Hyperpotassemia,Other and unspecified angina pectoris,Other emphysema,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Chronic kidney disease, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication'}

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: Headache, Nausea, vomiting PRESENT ILLNESS: 81M with known lung mass for which was reportedly refused workup for greater than 1 year, PET +, likely adenocarcinoma, recent admission for post obstructive pneumonia with increasing size of mass seen on chest CT scan, to undergo bronch next month. Was complaining of headache, some n/v last week, now resolved, seen in office this morning, head CT today showed a preliminary read of Left cerebellar mass with mass effect on the 4th ventricle and possible tonsillar herniation. He was then urged by his PCP to come to the ED for evaluation MEDICAL HISTORY: -AAA status post repair in [**2143**] -right renal mass status post nephrectomy in [**2145**] in the USSR -bladder cell CA -CHF --> systolic dysfn w/ EF 35-40% -BPH s/p TURP -coronary artery disease -hyperlipidemia -hypertension -bilateral claudication -status post bilateral iliac stents -chronic renal insufficiency - baseline Cr 1.7 -MGUS. MEDICATION ON ADMISSION: Cyanocobalamin 1,000 mcg/mL Solution 1cc q month Folic Acid 1 mg Tablet QD Furosemide 40 mg Tablet QD Ipratropium Bromide [Atrovent HFA] 2 puffs inhaled every six (6) hours Isosorbide Mononitrate [Imdur] 30 mg Tablet QD Lisinopril 40 mg Tablet QD Metoprolol Succinate 50 mg Tablet [**Hospital1 **] Nicotine 14 mg/24 hour Patch QD Nifedipine [Nifedical XL] 60 mg Tab QPM Nitroglycerin 0.4 mg Tablet, Sublingual prn CP Trazodone 50 mg Tablet [**1-7**] - 1 Tablet(s)(s) HS Aspirin [Aspirin EC] 81 mg Tablet QD ALLERGIES: Zetia PHYSICAL EXAM: On Admission: Gen: WD/WN, comfortable, NAD. HEENT: Pupils:4->2 B/L EOMs intact Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Awake and alert, cooperative with exam, normal affect. Orientation: Oriented to person, place, and date. Language: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors. FAMILY HISTORY: -Mother has DM -Father with HTN, CAD, PVD. -Sibling w/DM SOCIAL HISTORY: 62 current pack year smoker. Engineer, occasional vodka use, no IVDU. ### Response: {'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Obstructive hydrocephalus,Malignant neoplasm of main bronchus,Other nervous system complications,Chronic systolic heart failure,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Pulmonary collapse,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of bladder,Hyperpotassemia,Other and unspecified angina pectoris,Other emphysema,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Chronic kidney disease, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication'}

CHIEF COMPLAINT: weakness PRESENT ILLNESS: 72 yo M with DM2, HTN, h/o L carotid artery stenosis now p/w shortness of breath. The patient was in his usual state of health until yesterday when he had poor PO intake due to anorexia. He was driving when he noted marked weakness. States his vision has been fluctuating recently (due to L cataract) but seemed worse. Upon returning to his house he had significant difficulty ambulating up a flight of stairs. The patient had to sit on the steps and states it was difficult for him to raise his head up or his arms. States he tried to "scoot" up the stairs but felt that he pulled a muscle in his L side. . On ROS he notes that he took antibiotics a couple of months ago for an upper resp infection. States this initially improved, but then for the last month he has noted some yellow sputum production. He denies any abdominal complaints, including no nausea, vomiting or diarrhea. At baseline he has severe DOE and it takes him "awhile" to get up his stairs to his apartment. Denies PND, orthopnea, chest pain. No LE edema. No fevers, chills, night sweats. . In the ED, T 98.4 at presentation with a spike to 101.4, hr 78, bp 81/40, rr 22, 94% RA improving to 99% 3L. He received aspirin 325mg po, levofloxacin 500mg IV, flagyl 500mg IV, Acetominophen 1g, and was started on Norepinephrine for persistent hypotension. MEDICAL HISTORY: -HTN -Carotid artery disease, prior TIA's. -DM2 -COPD -R cataract surgery -L cataract - states no one wants to take him off of plavix and ASA to operate. -Glaucoma -R wrist tendon injury -CAD - 3VD seen on cath in [**10-31**] after NSTEMI. Referred for CABG - was supposed to see surgeon at [**Hospital3 **] on [**5-24**] - hasn't f/u x 2 despite preop work-up -PVD MEDICATION ON ADMISSION: Aspirin 325 mg PO DAILY Atorvastatin 80 mg PO DAILY Clopidogrel 75 mg PO DAILY Nitroglycerin 0.4 mg PRN Metoprolol Succinate 50 mg Sustained Release PO DAILY Lisinopril 5 mg PO DAILY Glyburide 10 mg PO twice a day ALLERGIES: Novocain PHYSICAL EXAM: VS: 97.8 80 140/64 16 100% 3L CVP 12 GEN: Lying in bed, talkative, NAD HEENT: PERRL, EOMI, MM dry, OP clear CV: Distant heart sounds [**1-29**] to habitus but RRR without m/r/g. Pulm: Small amount of basilar crackles L>R. Otherwise clear to auscultation. Abd: Obese, soft, NT, ND, +bs. Ext: No edema/cyanosis. Distal pulses intact. Neuro: A&Ox3. FAMILY HISTORY: Mother DM, HTN. Never knew father. Brother ?cancer SOCIAL HISTORY: Used to work for school busing contract and also was a gang leader when younger. Lives alone but has a girlfriend. Quit smoking 20 years ago. Prior to that held cig in hand 5 packs/day for 20 years. Social drinker. Past marijuana use but quit 45 years ago.

Unspecified septicemia,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Hypovolemia,Chronic airway obstruction, not elsewhere classified,Severe sepsis,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Peripheral vascular disease, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction

Septicemia NOS,Acute kidney failure NOS,Pneumonia, organism NOS,Hypovolemia,Chr airway obstruct NEC,Severe sepsis,Crnry athrscl natve vssl,Old myocardial infarct,Hypertension NOS,DMII wo cmp nt st uncntr,Anemia NOS,Periph vascular dis NOS,Ocl crtd art wo infrct

Admission Date: [**2168-5-21**] Discharge Date: [**2168-5-25**] Date of Birth: [**2095-6-10**] Sex: M Service: MEDICINE Allergies: Novocain Attending:[**First Name3 (LF) 5755**] Chief Complaint: weakness Major Surgical or Invasive Procedure: central line History of Present Illness: 72 yo M with DM2, HTN, h/o L carotid artery stenosis now p/w shortness of breath. The patient was in his usual state of health until yesterday when he had poor PO intake due to anorexia. He was driving when he noted marked weakness. States his vision has been fluctuating recently (due to L cataract) but seemed worse. Upon returning to his house he had significant difficulty ambulating up a flight of stairs. The patient had to sit on the steps and states it was difficult for him to raise his head up or his arms. States he tried to "scoot" up the stairs but felt that he pulled a muscle in his L side. . On ROS he notes that he took antibiotics a couple of months ago for an upper resp infection. States this initially improved, but then for the last month he has noted some yellow sputum production. He denies any abdominal complaints, including no nausea, vomiting or diarrhea. At baseline he has severe DOE and it takes him "awhile" to get up his stairs to his apartment. Denies PND, orthopnea, chest pain. No LE edema. No fevers, chills, night sweats. . In the ED, T 98.4 at presentation with a spike to 101.4, hr 78, bp 81/40, rr 22, 94% RA improving to 99% 3L. He received aspirin 325mg po, levofloxacin 500mg IV, flagyl 500mg IV, Acetominophen 1g, and was started on Norepinephrine for persistent hypotension. Past Medical History: -HTN -Carotid artery disease, prior TIA's. -DM2 -COPD -R cataract surgery -L cataract - states no one wants to take him off of plavix and ASA to operate. -Glaucoma -R wrist tendon injury -CAD - 3VD seen on cath in [**10-31**] after NSTEMI. Referred for CABG - was supposed to see surgeon at [**Hospital3 **] on [**5-24**] - hasn't f/u x 2 despite preop work-up -PVD Social History: Used to work for school busing contract and also was a gang leader when younger. Lives alone but has a girlfriend. Quit smoking 20 years ago. Prior to that held cig in hand 5 packs/day for 20 years. Social drinker. Past marijuana use but quit 45 years ago. Family History: Mother DM, HTN. Never knew father. Brother ?cancer Physical Exam: VS: 97.8 80 140/64 16 100% 3L CVP 12 GEN: Lying in bed, talkative, NAD HEENT: PERRL, EOMI, MM dry, OP clear CV: Distant heart sounds [**1-29**] to habitus but RRR without m/r/g. Pulm: Small amount of basilar crackles L>R. Otherwise clear to auscultation. Abd: Obese, soft, NT, ND, +bs. Ext: No edema/cyanosis. Distal pulses intact. Neuro: A&Ox3. Pertinent Results: admission WBC 17.5, 85% N 10% L, Hct 44.1, Lactate 2.4. Most recent WBC 11.1, Hct 37.1, Lactate 1.1, LFT's within normal limits. Na 146, BUN/Cr 30/2.5. iron 54, tibc 231, ferritin 200, folate > 20, b12 629 cortisol 13.0 . Micro: Blood culture ([**2168-5-21**]) x2 sets: no growth Urine culture ([**2168-5-21**]): no growth . EKG ([**2168-5-21**]): Sinus rhythm with a rate of 78. Normal axis. Less than 1mm ST depressions in V4-6, unchanged from prior. . Imaging: CXR ([**2168-5-21**]) x2: Linear atelectasis at left lung base. Emphysema. Comparison is made to the study from five hours earlier. New left subclavian central venous line tip is in the upper SVC. No pneumothorax is identified. Cardiac size, mediastinal contours, and pulmonary vessels are within normal limits. . CT abd/pelvis ([**2168-5-21**]): 1. Limited examination without intravenous contrast. No intra-abdominal or pelvic fluid collection or abscess. Normal appendix. Diverticulosis without evidence of diverticulitis. 2. Anterior wedging and superior endplate depression in the L3 vertebral body likely represents a compression deformity of unknown chronicity. Clinical correlation is requested. . Echo ([**2166-10-31**]): The left atrium is elongated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is moderately depressed. Resting regional wall motion abnormalities include anterior, lateral, and inferior hypokinesis. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild to moderate ([**12-29**]+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is a trivial/physiologic pericardial effusion. Brief Hospital Course: # Hypotension/bacterial pneumonia. Low bp and lactate elevation on presentation were concerning for sirs/sepsis physiology. Most likely source was pulmonary given complaints of cough with sputum production, though imaging not conclusive. Unlikely abdominal source given negative CT. Urine culture was negative. Patient was quickly weaned off levophed. Of note, cortisol showed no evidence of underlying adrenal insufficiency. He completed a 5 day course of high dose levofloxacin for treatment and is stable on room air. . # Acute renal failure. Likely hypovolemia, resolved with IVF. . # CAD: Patient has known 3 vessel CAD and has been referred for CABG but does not follow-up. Most recently he completed the preop work-up at [**Hospital1 756**] but then did not follow through, per his surgeon Dr. [**Last Name (STitle) 66293**], with the surgery. He now states he is finally ready to go through with the surgery given he is scooter-bound due to his baseline dyspnea. No evidence that patient's hypotension was cardiac in origin. ECHO shows improved EF from prior and patient ruled out with serial enzymes. He reports stable exertional dyspnea which has not recently changed. He was thus referred back to his surgeon, Dr. [**Last Name (STitle) 66293**], to pursue CABG. He was urged to avoid significant exertion in the interim but is scooter-bound at baseline due to his dyspnea. He is on an ASA, statin, BB, and ACEI. . # Visual changes: Patient described pre-syncope like visual changes (blacking out of both eyes) in the setting of an extreme urge to pass a bowel movement prior to admission with no recurrence of these symptoms in house. Given a history of carotid disease Carotid ultrasounds were pursued and show 60-70% bilateral disease. No clear indication for surgical intervention at this time. Patient instructed to follow-up with his primary if he develops monocular vision loss or any TIA symptoms. He was continued on his ASA, plavix, and statin. . # PVD. No acute issues. Outpatient follow-up. . # COPD. Stable on room air. Patient encouraged to take his albuterol and atrovent inhalers. Incentive spirometry was reviewed and encouraged in anticipation of future surgery. He does not smoke. . # DM2: Patient covered with insulin in house but was restarted on his home glyburide prior to discharge. . # Opthalmic. History of glaucoma and s/p right sided cataract surgery. - outpatient follow up. . # Anemia: Labs unrevealing. Needs continued work-up outpatient. . # Hematuria: Likely due to trauma from foley placed in ED. Needs repeat urinalysis outpatient and cystoscopy if this persists. . # Access: Left subclavian placed in ED for pressors . # Code: DNR/DNI . # Dispo: discharged to home Medications on Admission: Aspirin 325 mg PO DAILY Atorvastatin 80 mg PO DAILY Clopidogrel 75 mg PO DAILY Nitroglycerin 0.4 mg PRN Metoprolol Succinate 50 mg Sustained Release PO DAILY Lisinopril 5 mg PO DAILY Glyburide 10 mg PO twice a day Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. 5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO twice a day. 7. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation QID (4 times a day). 8. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation every 4-6 hours as needed for shortness of breath or wheezing. Discharge Disposition: Home Discharge Diagnosis: primary: community acquired pneumonia CAD with known 3 vessel disease, noncompliant with follow-up for CABG acute renal failure dehydration with hypotension secondary: chronic obstructive pulmonary disease carotid disease, seen by [**Last Name (un) 60919**] in the past type 2 diabetes, well controlled without insulin Discharge Condition: good: hemodynamically stable, afebrile, 90-92% on room air with ambulation, stable exertional dyspnea w/ improved EF from [**10-31**] by ECHO Discharge Instructions: Please call your doctor or go to the emergency room if you experience chest pain, worsening shortness of breath with walking or other exertion, dizziness, change in your vision, or other concerning symptoms. Please be sure to follow-up with Dr. [**First Name4 (NamePattern1) 12584**] [**Last Name (NamePattern1) 66293**] who will be coordinating your bypass surgery preparation. You will need to have a cardiac catheterization before undergoing his surgery. His office will contact you with an appointment with Dr. [**First Name8 (NamePattern2) 1022**] [**Last Name (NamePattern1) **] who will do your cardiac catheterization. Please follow-up with Dr. [**Last Name (STitle) 28549**], as scheduled below, to have your urine rechecked for blood. If there is still blood, he may wish to refer you for a cystoscopy for bladder cancer screening. Please avoid significant exertion including sexual intercourse or vigorous exercise until you have your bypass surgery. Please continue to use the atrovent and albuterol inhalers, as prescribed. Followup Instructions: Please follow-up with Dr. [**Last Name (STitle) 28549**] on [**Last Name (LF) 2974**], [**2168-6-3**] at 8:40 AM to discuss a possible re-referral to Dr. [**Last Name (STitle) 60919**], to have your urine rechecked for blood, and to continue management of your diabetes. Location: [**Street Address(2) 34126**], [**Location 1268**] [**Numeric Identifier **]. Dr.[**Name (NI) 66294**] office will be contacting you with an appointment for a cardiac catheterization which will need to be done prior to your bypass surgery. If you do not hear from his office by Thursday, please call on [**Name (NI) 2974**] to confirm the time and date of your appointment. Phone: [**Telephone/Fax (1) 66295**]

038,584,486,276,496,995,414,412,401,250,285,443,433

{'Unspecified septicemia,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Hypovolemia,Chronic airway obstruction, not elsewhere classified,Severe sepsis,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Peripheral vascular disease, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}

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: weakness PRESENT ILLNESS: 72 yo M with DM2, HTN, h/o L carotid artery stenosis now p/w shortness of breath. The patient was in his usual state of health until yesterday when he had poor PO intake due to anorexia. He was driving when he noted marked weakness. States his vision has been fluctuating recently (due to L cataract) but seemed worse. Upon returning to his house he had significant difficulty ambulating up a flight of stairs. The patient had to sit on the steps and states it was difficult for him to raise his head up or his arms. States he tried to "scoot" up the stairs but felt that he pulled a muscle in his L side. . On ROS he notes that he took antibiotics a couple of months ago for an upper resp infection. States this initially improved, but then for the last month he has noted some yellow sputum production. He denies any abdominal complaints, including no nausea, vomiting or diarrhea. At baseline he has severe DOE and it takes him "awhile" to get up his stairs to his apartment. Denies PND, orthopnea, chest pain. No LE edema. No fevers, chills, night sweats. . In the ED, T 98.4 at presentation with a spike to 101.4, hr 78, bp 81/40, rr 22, 94% RA improving to 99% 3L. He received aspirin 325mg po, levofloxacin 500mg IV, flagyl 500mg IV, Acetominophen 1g, and was started on Norepinephrine for persistent hypotension. MEDICAL HISTORY: -HTN -Carotid artery disease, prior TIA's. -DM2 -COPD -R cataract surgery -L cataract - states no one wants to take him off of plavix and ASA to operate. -Glaucoma -R wrist tendon injury -CAD - 3VD seen on cath in [**10-31**] after NSTEMI. Referred for CABG - was supposed to see surgeon at [**Hospital3 **] on [**5-24**] - hasn't f/u x 2 despite preop work-up -PVD MEDICATION ON ADMISSION: Aspirin 325 mg PO DAILY Atorvastatin 80 mg PO DAILY Clopidogrel 75 mg PO DAILY Nitroglycerin 0.4 mg PRN Metoprolol Succinate 50 mg Sustained Release PO DAILY Lisinopril 5 mg PO DAILY Glyburide 10 mg PO twice a day ALLERGIES: Novocain PHYSICAL EXAM: VS: 97.8 80 140/64 16 100% 3L CVP 12 GEN: Lying in bed, talkative, NAD HEENT: PERRL, EOMI, MM dry, OP clear CV: Distant heart sounds [**1-29**] to habitus but RRR without m/r/g. Pulm: Small amount of basilar crackles L>R. Otherwise clear to auscultation. Abd: Obese, soft, NT, ND, +bs. Ext: No edema/cyanosis. Distal pulses intact. Neuro: A&Ox3. FAMILY HISTORY: Mother DM, HTN. Never knew father. Brother ?cancer SOCIAL HISTORY: Used to work for school busing contract and also was a gang leader when younger. Lives alone but has a girlfriend. Quit smoking 20 years ago. Prior to that held cig in hand 5 packs/day for 20 years. Social drinker. Past marijuana use but quit 45 years ago. ### Response: {'Unspecified septicemia,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Hypovolemia,Chronic airway obstruction, not elsewhere classified,Severe sepsis,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Peripheral vascular disease, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}

CHIEF COMPLAINT: s/p total thyroidectomy PRESENT ILLNESS: Patient is a 36 year old female whose history of hyperthyroidism, [**Doctor Last Name 933**] Disease, began approximately one year ago when she began feeling tremulous, heat intolerant, palpatations, dysmenorrhea (2 menses/month), chest pressure, and weight loss (20 lbs over 2 mos). At first, this was attributed to panic attacks. She then moved to [**Location (un) 86**] from [**State **] (in [**4-13**]) and presented to the [**Hospital1 18**] E.D. on [**2104-5-28**] from her PCP's office with significant tachycardia, "bugs crawling over her." At that time, her TSH was less than 0.02 with T4 24.8, free T4 7.7, a calculated TBG of less than 0.2, T3 uptake of 2, t3>[**2100**]. She was admitted [**Date range (1) 11621**] and propranolol was titrated upwards w/ good symptom relief. She was seen by enocrinology, thought to have Graves' disease, and was set up for close outpt follow up. MEDICAL HISTORY: NSVD [**2088**] Left ovarian cyst excision right mouth abscess MEDICATION ON ADMISSION: propranolol 60 mg q6 hr PTU 150 mg qid ALLERGIES: Shellfish / Gadolinium-Containing Agents PHYSICAL EXAM: No tetany, no Chvostek's sign FAMILY HISTORY: PER OMR: mother committed suicide at age 25, maternal aunt w/ DM, maternal aunt and grandmother with thyroid disease. SOCIAL HISTORY: PER OMR: Lives w/ mother-in-law. Divorced since [**2090**]. Has 16 year-old son; Had abusive boyfriend (per medical record) who was threatening to kill her, so she left her home in [**State **] in [**4-13**] and came to [**Location (un) 86**]. Denies tobacco use, rare alcohol, no illicit drug use

Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Bilateral paralysis of vocal cords or larynx, complete,Urinary tract infection, site not specified,Hypocalcemia,Other specified cardiac dysrhythmias

Tox dif goiter no crisis,Vocal paral bilat total,Urin tract infection NOS,Hypocalcemia,Cardiac dysrhythmias NEC

Admission Date: [**2104-10-14**] Discharge Date: [**2104-10-25**] Date of Birth: [**2068-4-6**] Sex: F Service: [**Doctor First Name 147**] Allergies: Shellfish / Gadolinium-Containing Agents Attending:[**Doctor First Name 5188**] Chief Complaint: s/p total thyroidectomy Major Surgical or Invasive Procedure: [**2104-10-14**]- Total thyroidectomy with auto transplantation of left upper parathyroid gland into the right sternocleidomastoid muscle [**2104-10-17**]- Tracheotomy, Direct laryngoscopy [**2104-10-23**]- Laryngovideostroboscopy History of Present Illness: Patient is a 36 year old female whose history of hyperthyroidism, [**Doctor Last Name 933**] Disease, began approximately one year ago when she began feeling tremulous, heat intolerant, palpatations, dysmenorrhea (2 menses/month), chest pressure, and weight loss (20 lbs over 2 mos). At first, this was attributed to panic attacks. She then moved to [**Location (un) 86**] from [**State **] (in [**4-13**]) and presented to the [**Hospital1 18**] E.D. on [**2104-5-28**] from her PCP's office with significant tachycardia, "bugs crawling over her." At that time, her TSH was less than 0.02 with T4 24.8, free T4 7.7, a calculated TBG of less than 0.2, T3 uptake of 2, t3>[**2100**]. She was admitted [**Date range (1) 11621**] and propranolol was titrated upwards w/ good symptom relief. She was seen by enocrinology, thought to have Graves' disease, and was set up for close outpt follow up. She presented to endocrine clinic for evaluation on [**6-1**]. She was started on propylthiouracil (in addition to propranolol), but there was some concern about medicine compliance. Her symptoms had initially improved but returned. Since that time, she has been followed closely by Dr [**Last Name (STitle) 6467**] and Dr [**Last Name (STitle) **]. Radioactive iodine was initially the long-term plan, but it was not an option, given her iodine allergy. She was then sent for surgical evaluation to Dr [**Last Name (STitle) 5182**] on [**2104-9-16**]. At that time, he increased her PTU and propranolol dosing. It was noted that she felt improved on her return visit on [**9-23**] and an elective thyroidectomy was planned for [**2104-10-14**]. Interim history is unclear. [**Name2 (NI) **] FreeT4 3.2 on [**2104-10-6**]. Past Medical History: NSVD [**2088**] Left ovarian cyst excision right mouth abscess Social History: PER OMR: Lives w/ mother-in-law. Divorced since [**2090**]. Has 16 year-old son; Had abusive boyfriend (per medical record) who was threatening to kill her, so she left her home in [**State **] in [**4-13**] and came to [**Location (un) 86**]. Denies tobacco use, rare alcohol, no illicit drug use Family History: PER OMR: mother committed suicide at age 25, maternal aunt w/ DM, maternal aunt and grandmother with thyroid disease. Physical Exam: No tetany, no Chvostek's sign Pertinent Results: [**2104-10-14**] 08:24PM TYPE-[**Last Name (un) **] PH-7.26* [**2104-10-14**] 08:24PM freeCa-1.01* [**2104-10-14**] 08:15PM GLUCOSE-99 UREA N-12 CREAT-0.4 SODIUM-142 POTASSIUM-4.3 CHLORIDE-106 TOTAL CO2-27 ANION GAP-13 [**2104-10-14**] 08:15PM ALBUMIN-3.4 CALCIUM-8.1* PHOSPHATE-4.9* MAGNESIUM-1.6 [**2104-10-14**] 08:15PM WBC-11.2*# RBC-4.79 HGB-11.9* HCT-36.8 MCV-77* MCH-24.8* MCHC-32.3 RDW-14.7 [**2104-10-14**] 08:15PM PLT COUNT-225 Brief Hospital Course: Patient was taken to the operating room for the above stated procedure on the day of admission. Patient had to be reintubated in the OR secondary to stridor. She was transferred intubated to the intensive care unit postoperatively. On post operative day 1, patient was extubated by ENT in the intensive care unit. Patient again had to be reintubated secondary to stridor. Supraglottic edema was noted with median positioning of both cords. Patient was started on high dose dexamethasone for 48 hours and then taken back to the OR for a Tracheotomy. Patient began trach collar on post operative day [**4-10**] which she tolerated well. Patient was transferred to the floor on postoperative day [**5-11**]. On post operative day [**6-12**] patient underwent a bedside swallow assessement and a videoswallow study was reccommended. This was performed on [**10-23**] and revealed only trace aspiration and she was started on regular house diet and oral medications. A laryngovideostroboscopy on the same date, revealed bilateral true vocal fold immmobility. Patient was discharged on postoperative day [**11-17**] tolerating diet and oral medications. [**Hospital **] hospital course was also significant for urinary tract infection for which she was started on levoflox a 10 day course which began [**2104-10-17**]. Medications on Admission: propranolol 60 mg q6 hr PTU 150 mg qid Discharge Medications: 1. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable PO TID (3 times a day). Disp:*180 Tablet, Chewable(s)* Refills:*2* 2. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO QD (once a day). Disp:*30 Tablet(s)* Refills:*2* 3. Calcitriol 0.5 mcg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 4. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day for 3 days. Disp:*3 Tablet(s)* Refills:*0* 5. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO three times a day. Disp:*120 Tablet(s)* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: Follicular papillary hyperplasia, consistent with Grave's disease Bilateral vocal fold immobility Discharge Condition: good Discharge Instructions: continue with trachestomy care Followup Instructions: Patient to call and make appointment with Dr. [**Last Name (STitle) 111198**] to be seen in approximately 1 week from discharge [**Telephone/Fax (1) 41**] Patient to call and make appointment with Dr. [**Last Name (STitle) 5182**] [**Telephone/Fax (1) 5189**] [**Name6 (MD) **] [**Last Name (NamePattern4) **] MD, [**MD Number(3) 5190**] Name: [**Known lastname 2717**] [**Known lastname **],[**Known firstname **] J Unit No: [**Numeric Identifier 18242**] Admission Date: [**2104-10-14**] Discharge Date: [**2104-10-25**] Date of Birth: [**2068-4-6**] Sex: F Service: [**Doctor First Name 1379**] Allergies: Shellfish / Gadolinium-Containing Agents Attending:[**Doctor First Name 10794**] Chief Complaint: grave's disease Major Surgical or Invasive Procedure: [**2104-10-14**]- Total thyroidectomy with auto transplantation of left upper parathyroid gland into the right sternocleidomastoid muscle [**2104-10-17**]- Tracheotomy, Direct laryngoscopy [**2104-10-23**]- Laryngovideostroboscopy History of Present Illness: Patient is a 36 year old female whose history of hyperthyroidism, [**Doctor Last Name 12879**] Disease, began approximately one year ago when she began feeling tremulous, heat intolerant, palpatations, dysmenorrhea (2 menses/month), chest pressure, and weight loss (20 lbs over 2 mos). At first, this was attributed to panic attacks. She then moved to [**Location (un) 42**] from [**State 17051**] (in [**4-13**]) and presented to the [**Hospital1 8**] E.D. on [**2104-5-28**] from her PCP's office with significant tachycardia, "bugs crawling over her." At that time, her TSH was less than 0.02 with T4 24.8, free T4 7.7, a calculated TBG of less than 0.2, T3 uptake of 2, t3>[**2100**]. She was admitted [**Date range (1) 18243**] and propranolol was titrated upwards w/ good symptom relief. She was seen by enocrinology, thought to have Graves' disease, and was set up for close outpt follow up. She presented to endocrine clinic for evaluation on [**6-1**]. She was started on propylthiouracil (in addition to propranolol), but there was some concern about medicine compliance. Her symptoms had initially improved but returned. Since that time, she has been followed closely by Dr [**Last Name (STitle) 18244**] and Dr [**Last Name (STitle) 18245**]. Radioactive iodine was initially the long-term plan, but it was not an option, given her iodine allergy. She was then sent for surgical evaluation to Dr [**Last Name (STitle) **] on [**2104-9-16**]. At that time, he increased her PTU and propranolol dosing. It was noted that she felt improved on her return visit on [**9-23**] and an elective thyroidectomy was planned for [**2104-10-14**]. Interim history is unclear. [**Name2 (NI) **] FreeT4 3.2 on [**2104-10-6**]. Past Medical History: NSVD [**2088**] Left ovarian cyst excision right mouth abscess Social History: PER OMR:Lives w/ mother-in-law. Divorced since [**2090**]. Has 16 year-old son; Had abusive boyfriend (per medical record) who was threatening to kill her, so she left her home in [**State 17051**] in [**4-13**] and came to [**Location (un) 42**]. Denies tobacco use, rare alcohol, no illicit drug use Family History: PER OMR: mother committed suicide at age 25, maternal aunt w/ DM, maternal aunt and grandmother with thyroid disease. Physical Exam: On discharge, patient is afebrile with stable vital signs. She is satting well on humidified oxygen. Trach site is clean, with no signs of infection. Surgical incision also has no sign of infection. No tetany or Chvostek's sign is present. Pertinent Results: [**2104-10-14**] 11:58PM TYPE-ART RATES-[**12-11**] TIDAL VOL-500 O2-100 PO2-207* PCO2-49* PH-7.36 TOTAL CO2-29 BASE XS-1 AADO2-479 REQ O2-79 -ASSIST/CON [**2104-10-14**] 11:58PM O2 SAT-98 [**2104-10-14**] 11:58PM freeCa-1.12 [**2104-10-14**] 08:24PM TYPE-[**Last Name (un) **] PH-7.26* [**2104-10-14**] 08:24PM freeCa-1.01* [**2104-10-14**] 08:15PM GLUCOSE-99 UREA N-12 CREAT-0.4 SODIUM-142 POTASSIUM-4.3 CHLORIDE-106 TOTAL CO2-27 ANION GAP-13 [**2104-10-14**] 08:15PM WBC-11.2*# RBC-4.79 HGB-11.9* HCT-36.8 MCV-77* MCH-24.8* MCHC-32.3 RDW-14.7 [**2104-10-14**] 08:15PM PLT COUNT-225 Brief Hospital Course: Patient was taken to the operating room for the above stated procedure on the day of admission. Patient had to be reintubated in the OR secondary to stridor. She was transferred intubated to the intensive care unit postoperatively. On post operative day 1, patient was extubated by ENT in the intensive care unit. Patient again had to be reintubated secondary to stridor. Supraglottic edema was noted with median positioning of both cords. Patient was started on high dose dexamethasone for 48 hours and then taken back to the OR for a Tracheotomy. Patient began trach collar on post operative day [**4-10**] which she tolerated well. Patient was transferred to the floor on postoperative day [**5-11**]. On post operative day [**6-12**] patient underwent a bedside swallow assessement and a videoswallow study was reccommended. This was performed on [**10-23**] and revealed only trace aspiration and she was started on regular house diet and oral medications. A laryngovideostroboscopy on the same date, revealed bilateral true vocal fold immmobility. Patient was discharged on postoperative day [**11-17**] tolerating diet and oral medications. [**Hospital **] hospital course was also significant for urinary tract infection for which she was started on levoflox a 10 day course which began [**2104-10-17**]. Medications on Admission: propranolol 60 mg q6 hr PTU 150 mg qid Discharge Medications: 1. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2) Tablet, Chewable PO TID (3 times a day). Disp:*180 Tablet, Chewable(s)* Refills:*2* 2. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO QD (once a day). Disp:*30 Tablet(s)* Refills:*2* 3. Calcitriol 0.5 mcg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 4. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day for 3 days. Disp:*3 Tablet(s)* Refills:*0* 5. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO three times a day. Disp:*120 Tablet(s)* Refills:*2* Discharge Disposition: Extended Care Facility: [**Hospital6 41**] - [**Location (un) 42**] Discharge Diagnosis: Follicular papillary hyperplasia, consistent with Grave's disease Bilateral vocal fold immobility Discharge Condition: good Discharge Instructions: tracheostomy care Followup Instructions: Patient to call and make appointment with Dr. [**Last Name (STitle) 18246**] to be seen in approximately 1 week from discharge [**Telephone/Fax (1) 1848**] Patient to call and make appointment with Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 14264**] [**Name6 (MD) **] [**Last Name (NamePattern4) 10795**] MD, [**MD Number(3) 10796**] Completed by:[**2104-10-24**]

242,478,599,275,427

{'Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Bilateral paralysis of vocal cords or larynx, complete,Urinary tract infection, site not specified,Hypocalcemia,Other specified cardiac dysrhythmias'}

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: s/p total thyroidectomy PRESENT ILLNESS: Patient is a 36 year old female whose history of hyperthyroidism, [**Doctor Last Name 933**] Disease, began approximately one year ago when she began feeling tremulous, heat intolerant, palpatations, dysmenorrhea (2 menses/month), chest pressure, and weight loss (20 lbs over 2 mos). At first, this was attributed to panic attacks. She then moved to [**Location (un) 86**] from [**State **] (in [**4-13**]) and presented to the [**Hospital1 18**] E.D. on [**2104-5-28**] from her PCP's office with significant tachycardia, "bugs crawling over her." At that time, her TSH was less than 0.02 with T4 24.8, free T4 7.7, a calculated TBG of less than 0.2, T3 uptake of 2, t3>[**2100**]. She was admitted [**Date range (1) 11621**] and propranolol was titrated upwards w/ good symptom relief. She was seen by enocrinology, thought to have Graves' disease, and was set up for close outpt follow up. MEDICAL HISTORY: NSVD [**2088**] Left ovarian cyst excision right mouth abscess MEDICATION ON ADMISSION: propranolol 60 mg q6 hr PTU 150 mg qid ALLERGIES: Shellfish / Gadolinium-Containing Agents PHYSICAL EXAM: No tetany, no Chvostek's sign FAMILY HISTORY: PER OMR: mother committed suicide at age 25, maternal aunt w/ DM, maternal aunt and grandmother with thyroid disease. SOCIAL HISTORY: PER OMR: Lives w/ mother-in-law. Divorced since [**2090**]. Has 16 year-old son; Had abusive boyfriend (per medical record) who was threatening to kill her, so she left her home in [**State **] in [**4-13**] and came to [**Location (un) 86**]. Denies tobacco use, rare alcohol, no illicit drug use ### Response: {'Toxic diffuse goiter without mention of thyrotoxic crisis or storm,Bilateral paralysis of vocal cords or larynx, complete,Urinary tract infection, site not specified,Hypocalcemia,Other specified cardiac dysrhythmias'}

CHIEF COMPLAINT: hypotension PRESENT ILLNESS: 54 y/o F w/ PMH of lithium-induced ESRD on PD, hemorrhoids, tracheal stenosis, and hypertension recently discharged on [**9-24**] after transplant [**Doctor First Name **] admit for diverticulitis (treated conservatively w/ levo flagyl) who p/w fever to 101 at home and four episodes of BRBPR over the past two days. Denies melena. She also reports some light-headedness. On presentation to the ED she was found to be hypotensive to 77/38 (SBp 130's baseline), after 1L IVF bolus her BP increased to the 100's. She was afebrile upon presentation; after sending cultures she was given levo/[**Last Name (un) 2830**]/vanc for broad spectrum coverage in the ED. She denies N/V, denies changes in bladder or bowel habits, denies abdominal pain. She reports that her PO intake has been normal. Her sister who is her primary caregiver [**First Name (Titles) **] [**Last Name (Titles) 66407**] her today and states that the dwells have been clear for her peritoneal [**Last Name (Titles) 2286**], however given the episode of fever 2 days ago her [**Last Name (Titles) 2286**] nurse did start her on vancomycin with PD. She recieved one dose of this prior to presentation. Infectious ROS neg for headaches, neg stiffness, cough, chest pain, diarrhea, abdominal pain, + for dysuria, calf swelling nor rashes. . ED was also concerned about Hct slight drop from 25.4 last week to 23 in context of guaic + marroon stool. They ordered her for 2 units of blood and hung the 2nd unit up in ICU. In the ED, a CXR showed new cardiomegaly and bedside u/s: no cardiac effusion. Transplant surgery felt no surgical indications and that repeat imaging of abdomen was not needed. . Renal consulted: "Please send fluid from PD catheter for cell counts, gram stain and culture. Document what the fluid looks like. Is there abdominal pain? If the fluid returns positive for infection (>100 WBCs), call me again and we can discuss IP antibiotics." . In ED VS were 98.0 95 102/58 21 100 on transfer Labs were remarkable for WBC WNL, lactate 2.9, Interventions: Vanc, [**Last Name (un) **], Levo, UCx, Blood Cx, CXR . ROS: (+) Per HPI MEDICAL HISTORY: tracheostomy [**5-/2198**] for prolonged respiratory failure hyponatremic seizure following GoLytely prep [**5-/2198**] ESRD for lithium toxicity on HD bipolar GERD HTN breast cancer diverticulosis . PSH: parathyroidectomy with reimplantation in left arm left foot surgery in [**2180**] right knee surgery in [**2191**] lumpectomy for breast cancer (DCIS) status post radiation repeat mammograms were all negative history of tonsillectomy in the past MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from webOMR. 1. Docusate Sodium 100 mg PO BID 2. Fluoxetine 20 mg PO DAILY 3. Lithium Carbonate 150 mg PO DAILY 4. OLANZapine 10 mg PO DAILY 5. Calcitriol 0.25 mcg PO DAILY 6. Heparin Dwell (1000 Units/mL) 1000 UNIT DWELL UNDEFINED each 1 liter dwell IP for fibrin 7. Lactulose 30 mL PO BID 8. Lorazepam 1 mg PO HS:PRN insomnia 9. Miconazole Powder 2% 1 Appl TP [**Hospital1 **] 10. Tucks Hemorrhoidal Oint 1% 1 Appl PR PRN hemorrhoidal pain 11. Vitamin D 50,000 UNIT PO 1X/WEEK (TU) 12. Epoetin Alfa 40,000 units SC Q MONDAY 13. Senna 1 TAB PO BID:PRN constipation 14. OLANZapine 5 mg PO ASDIR Please assess patient for leg tingling, restlessness and give this additional dose. Will likely need while doing CAPD 15. Topiramate (Topamax) 25 mg PO DAILY 16. DIALYVITE 800 *NF* (B complex-C-folic acid-Zn) 0.8 mg Oral daily 17. Ferrous Sulfate 325 mg PO DAILY ALLERGIES: Ativan / Amoxicillin / Bactrim / Codeine / ibuprofen / Lamictal / naproxen / Tetanus Toxoid,Fluid / Cephalexin / Peanuts / Sulfa (Sulfonamide Antibiotics) / golytely / citrate of magnesia / Lithium PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: 97.6 96 105/65 21 98% 2L GENERAL: AOx3, NAD HEENT: MMM. no LAD. no JVD. neck supple. HEART: RRR S1/S2 heard. no murmurs/gallops/rubs. LUNGS: mild crackles at bases B/L ABDOMEN: soft, PD catheter in place, no erythema around site, nontender. Foley in place w/ pus in tube. Rectal deferred by patient. Stated she already received on in the ED. EXT: wwp, 2+ pitting edema B/L to knees NEURO/PSYCH: CNs II-XII intact. strength and sensation in U/L extremities grossly intact. gait not assessed. . DISCHARGE PHYSICAL EXAM: Gen: awake, alert, NAD CV: RRR, no m/r/g LUNGS: CTAB ABDOMEN: +BS, soft, NT, distended EXT: WWP, 1+ bilateral edema FAMILY HISTORY: Mother with ovarian CA Father with CAD SOCIAL HISTORY: - Tobacco: Never - Alcohol: Previously occasionally - Illicits: Denies - Occupation/Recent travel/sick contacts: denies

Unspecified septicemia,End stage renal disease,Septic shock,Urinary tract infection, site not specified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyposmolality and/or hyponatremia,Hemorrhage of gastrointestinal tract, unspecified,Intestinal infection due to Clostridium difficile,Bipolar disorder, unspecified,Other psychotropic agents causing adverse effects in therapeutic use,Other and unspecified Escherichia coli [E. coli],Esophageal reflux,Anemia in chronic kidney disease,Severe sepsis,Candidiasis of vulva and vagina

Septicemia NOS,End stage renal disease,Septic shock,Urin tract infection NOS,Hyp kid NOS w cr kid V,Hyposmolality,Gastrointest hemorr NOS,Int inf clstrdium dfcile,Bipolar disorder NOS,Adv eff psychotropic NEC,E.coli infection NEC/NOS,Esophageal reflux,Anemia in chr kidney dis,Severe sepsis,Candidal vulvovaginitis

Admission Date: [**2199-10-3**] Discharge Date: [**2199-10-10**] Date of Birth: [**2144-10-4**] Sex: F Service: MEDICINE Allergies: Ativan / Amoxicillin / Bactrim / Codeine / ibuprofen / Lamictal / naproxen / Tetanus Toxoid,Fluid / Cephalexin / Peanuts / Sulfa (Sulfonamide Antibiotics) / golytely / citrate of magnesia / Lithium Attending:[**First Name3 (LF) 15397**] Chief Complaint: hypotension Major Surgical or Invasive Procedure: none History of Present Illness: 54 y/o F w/ PMH of lithium-induced ESRD on PD, hemorrhoids, tracheal stenosis, and hypertension recently discharged on [**9-24**] after transplant [**Doctor First Name **] admit for diverticulitis (treated conservatively w/ levo flagyl) who p/w fever to 101 at home and four episodes of BRBPR over the past two days. Denies melena. She also reports some light-headedness. On presentation to the ED she was found to be hypotensive to 77/38 (SBp 130's baseline), after 1L IVF bolus her BP increased to the 100's. She was afebrile upon presentation; after sending cultures she was given levo/[**Last Name (un) 2830**]/vanc for broad spectrum coverage in the ED. She denies N/V, denies changes in bladder or bowel habits, denies abdominal pain. She reports that her PO intake has been normal. Her sister who is her primary caregiver [**First Name (Titles) **] [**Last Name (Titles) 66407**] her today and states that the dwells have been clear for her peritoneal [**Last Name (Titles) 2286**], however given the episode of fever 2 days ago her [**Last Name (Titles) 2286**] nurse did start her on vancomycin with PD. She recieved one dose of this prior to presentation. Infectious ROS neg for headaches, neg stiffness, cough, chest pain, diarrhea, abdominal pain, + for dysuria, calf swelling nor rashes. . ED was also concerned about Hct slight drop from 25.4 last week to 23 in context of guaic + marroon stool. They ordered her for 2 units of blood and hung the 2nd unit up in ICU. In the ED, a CXR showed new cardiomegaly and bedside u/s: no cardiac effusion. Transplant surgery felt no surgical indications and that repeat imaging of abdomen was not needed. . Renal consulted: "Please send fluid from PD catheter for cell counts, gram stain and culture. Document what the fluid looks like. Is there abdominal pain? If the fluid returns positive for infection (>100 WBCs), call me again and we can discuss IP antibiotics." . In ED VS were 98.0 95 102/58 21 100 on transfer Labs were remarkable for WBC WNL, lactate 2.9, Interventions: Vanc, [**Last Name (un) **], Levo, UCx, Blood Cx, CXR . ROS: (+) Per HPI Past Medical History: tracheostomy [**5-/2198**] for prolonged respiratory failure hyponatremic seizure following GoLytely prep [**5-/2198**] ESRD for lithium toxicity on HD bipolar GERD HTN breast cancer diverticulosis . PSH: parathyroidectomy with reimplantation in left arm left foot surgery in [**2180**] right knee surgery in [**2191**] lumpectomy for breast cancer (DCIS) status post radiation repeat mammograms were all negative history of tonsillectomy in the past Social History: - Tobacco: Never - Alcohol: Previously occasionally - Illicits: Denies - Occupation/Recent travel/sick contacts: denies Family History: Mother with ovarian CA Father with CAD Physical Exam: ADMISSION PHYSICAL EXAM: VS: 97.6 96 105/65 21 98% 2L GENERAL: AOx3, NAD HEENT: MMM. no LAD. no JVD. neck supple. HEART: RRR S1/S2 heard. no murmurs/gallops/rubs. LUNGS: mild crackles at bases B/L ABDOMEN: soft, PD catheter in place, no erythema around site, nontender. Foley in place w/ pus in tube. Rectal deferred by patient. Stated she already received on in the ED. EXT: wwp, 2+ pitting edema B/L to knees NEURO/PSYCH: CNs II-XII intact. strength and sensation in U/L extremities grossly intact. gait not assessed. . DISCHARGE PHYSICAL EXAM: Gen: awake, alert, NAD CV: RRR, no m/r/g LUNGS: CTAB ABDOMEN: +BS, soft, NT, distended EXT: WWP, 1+ bilateral edema Pertinent Results: ADMISSION LABS: [**2199-10-2**] 11:00PM BLOOD WBC-9.6# RBC-2.08* Hgb-6.8* Hct-22.8* MCV-109* MCH-32.6* MCHC-29.8* RDW-19.9* Plt Ct-172 [**2199-10-2**] 11:00PM BLOOD Neuts-92.1* Lymphs-3.9* Monos-3.6 Eos-0.2 Baso-0.1 [**2199-10-3**] 09:24AM BLOOD PT-17.8* PTT-34.2 INR(PT)-1.7* [**2199-10-2**] 11:00PM BLOOD Glucose-116* UreaN-45* Creat-7.4*# Na-132* K-3.8 Cl-94* HCO3-28 AnGap-14 [**2199-10-2**] 11:00PM BLOOD ALT-8 AST-14 AlkPhos-334* TotBili-0.1 [**2199-10-2**] 11:00PM BLOOD Lipase-14 [**2199-10-2**] 11:00PM BLOOD Albumin-2.3* [**2199-10-3**] 09:24AM BLOOD Calcium-7.9* Phos-3.9 Mg-1.7 [**2199-10-2**] 11:41PM BLOOD Lactate-2.9* MICRO: [**10-2**] Blood culture x 2 - No growth FINAL URINE CULTURE (Final [**2199-10-6**]): ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. PRESUMPTIVE IDENTIFICATION. OF TWO COLONIAL MORPHOLOGIES. Cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. Piperacillin/tazobactam sensitivity testing available on request. AMPICILLIN SENSITIVITIES PERFORMED ON REQUEST.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ESCHERICHIA COLI | AMPICILLIN/SULBACTAM-- 4 S CEFAZOLIN------------- <=4 S CEFEPIME-------------- <=1 S CEFTAZIDIME----------- <=1 S CEFTRIAXONE----------- <=1 S CIPROFLOXACIN--------- =>4 R GENTAMICIN------------ <=1 S MEROPENEM-------------<=0.25 S NITROFURANTOIN-------- <=16 S TOBRAMYCIN------------ <=1 S TRIMETHOPRIM/SULFA---- <=1 S C. difficile DNA amplification assay (Final [**2199-10-9**]): Reported to and read back by DR. [**Last Name (STitle) 13212**],[**Last Name (un) **] PAGER [**Numeric Identifier 13213**] @ 09:40 [**2199-10-9**]. CLOSTRIDIUM DIFFICILE. Positive for toxigenic C. difficile by the Illumigene DNA amplification. (Reference Range-Negative). IMAGING: [**10-2**] CXR: FINDINGS: The lungs are poorly inflated. There is vascular cephalization but no focal opacities concerning for pneumonia. Assessment of the left lung field is limited by stable severe cardiomegaly. A large, fluid filled Morgagni hernia at the right cardiophrenic angle is unchanged. Two tiny locules of air within the hernia are seen in the lateral radiograph which were also present in the CT abdomen from [**2199-9-18**]. There is no pleural effusion or pneumothorax. IMPRESSION: Vascular cephalization but no evidence of acute cardiopulmonary process. Stable large Morgagni hernias with locules of air, unchanged from [**2199-9-18**]. [**10-4**] ECHO: Left ventricular wall thicknesses and cavity size are normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. There is no valvular aortic stenosis. The increased transaortic velocity is likely related to high cardiac output. No aortic regurgitation is seen. Trivial mitral regurgitation is seen. There is no pericardial effusion. IMPRESSION: No pericardial effusion. Grossly normal biventricular systolic function. Compared with the prior study (images reviewed) of [**2193-6-17**], comparable findings are similar. \ DISCHARGE LABS: [**2199-10-10**] 07:45AM BLOOD WBC-5.6 RBC-2.77* Hgb-9.0* Hct-28.5* MCV-103* MCH-32.4* MCHC-31.5 RDW-18.9* Plt Ct-148* [**2199-10-7**] 08:05AM BLOOD PT-12.6* INR(PT)-1.2* [**2199-10-10**] 07:45AM BLOOD Glucose-98 UreaN-52* Creat-6.8* Na-131* K-3.4 Cl-91* HCO3-29 AnGap-14 [**2199-10-10**] 07:45AM BLOOD Calcium-7.8* Phos-4.8* Mg-1.6 [**2199-10-3**] 03:30AM URINE Color-YELLOW Appear-Cloudy Sp [**Last Name (un) **]-1.022 [**2199-10-3**] 03:30AM URINE Blood-SM Nitrite-NEG Protein-100 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG Urine: [**2199-10-3**] 03:30AM URINE RBC-114* WBC->182* Bacteri-MOD Yeast-NONE Epi-0 [**2199-10-3**] 03:30AM URINE WBC Clm-OCC Ascites: [**2199-10-3**] 06:50PM ASCITES WBC-4* RBC-1* Polys-53* Lymphs-4* Monos-39* Eos-1* Mesothe-3* [**2199-10-3**] 06:12PM OTHER BODY FLUID TotProt-0.2 Na-132 K-3.5 Amylase-4 Albumin-LESS THAN GRAM STAIN (Final [**2199-10-3**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. This is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. FLUID CULTURE (Final [**2199-10-6**]): NO GROWTH. Brief Hospital Course: 54 yo female with PMH of lithium-induced ESRD on PD, recently discharged on [**9-24**] admit for diverticulitis (treated conservatively w/ levo and flagyl) p/w fevers, BRBPR and hypotension found to have UTI. No recurrence of BRBPR. Active issues: # Hypotension: Patient was initially hypotensive to the 70s/30s (tachy to 100s) in the ED. Antibiotics were started, she was fluid resuscitated and transferred to the ICU where she was briefly on pressors. Pressors were quickly weaned and she was found to have frank pus in her urine (see below). She was soon transferred out to the floor and remained hemodynamically stable through the rest of the admission. Work-up for other infectious sources was negative (blood cultures, CXR, [**Month/Year (2) 2286**] fluid). # BRBPR: Patient had episode of bright red blood per rectum prompting her initial presentation to the ED. Patient's hematocrit remained stable, she did not require transfusion and had no recurrence of bleeding. # UTI: Patient noted to have frank pus in her urine. Culture was sent and she was started on meropenem due to recent hospitalizations and penicillin allergy. Culture reveal E.coli. Due to patient allergies, she completed a 7 day course of meropenem in the hospital. # C. diff colitis: Prior to discharge, patient had several episodes of diarrhea and was found to be positive for C. diff. She was discharged with a 14 day course of flagyl. Chronic issues: # ESRD: [**2-7**] lithium toxicity. Continued peritoneal [**Month/Day (2) 2286**] with support from renal fellow. Continued MVI, calcitriol. # Hyponatremia: Subacute. Peritoneal [**Month/Day (2) 2286**] adjusted per renal team. # Elevated INR: Unclear etiology: ?nutrition vs. intrinsic liver vs. abx effect. Received vitamin K. # Bipolar disorder: Continued lithium, olanzapine, SSRI # GERD: continued PPI Transitional issues: -WIll complete 14 day course of flagyl for C.diff. Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from webOMR. 1. Docusate Sodium 100 mg PO BID 2. Fluoxetine 20 mg PO DAILY 3. Lithium Carbonate 150 mg PO DAILY 4. OLANZapine 10 mg PO DAILY 5. Calcitriol 0.25 mcg PO DAILY 6. Heparin Dwell (1000 Units/mL) 1000 UNIT DWELL UNDEFINED each 1 liter dwell IP for fibrin 7. Lactulose 30 mL PO BID 8. Lorazepam 1 mg PO HS:PRN insomnia 9. Miconazole Powder 2% 1 Appl TP [**Hospital1 **] 10. Tucks Hemorrhoidal Oint 1% 1 Appl PR PRN hemorrhoidal pain 11. Vitamin D 50,000 UNIT PO 1X/WEEK (TU) 12. Epoetin Alfa 40,000 units SC Q MONDAY 13. Senna 1 TAB PO BID:PRN constipation 14. OLANZapine 5 mg PO ASDIR Please assess patient for leg tingling, restlessness and give this additional dose. Will likely need while doing CAPD 15. Topiramate (Topamax) 25 mg PO DAILY 16. DIALYVITE 800 *NF* (B complex-C-folic acid-Zn) 0.8 mg Oral daily 17. Ferrous Sulfate 325 mg PO DAILY Discharge Medications: 1. Calcitriol 0.25 mcg PO DAILY 2. Docusate Sodium 100 mg PO BID 3. Ferrous Sulfate 325 mg PO DAILY 4. Fluoxetine 20 mg PO DAILY 5. Lactulose 30 mL PO BID Please hold for loose stools. [**Month (only) 116**] need to be held in the setting of C. diff colitis. 6. Lithium Carbonate 150 mg PO DAILY 7. OLANZapine 10 mg PO DAILY 8. Senna 1 TAB PO BID:PRN constipation 9. Topiramate (Topamax) 25 mg PO DAILY 10. DIALYVITE 800 *NF* (B complex-C-folic acid-Zn) 0.8 mg Oral daily 11. Epoetin Alfa 40,000 units SC Q MONDAY 12. Lorazepam 1 mg PO HS:PRN insomnia 13. Miconazole Powder 2% 1 Appl TP [**Hospital1 **] 14. OLANZapine 5 mg PO ASDIR Please assess patient for leg tingling, restlessness and give this additional dose. Will likely need while doing CAPD 15. Tucks Hemorrhoidal Oint 1% 1 Appl PR PRN hemorrhoidal pain 16. Vitamin D 50,000 UNIT PO 1X/WEEK (TU) 17. Heparin Dwell (1000 Units/mL) 1000 UNIT DWELL UNDEFINED each 1 liter dwell IP for fibrin 18. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H Duration: 14 Days Start date [**10-9**] RX *metronidazole 500 mg 1 tablet(s) by mouth every 8 hours Disp #*42 Tablet Refills:*0 19. Outpatient Lab Work Please check Chem 10 on Monday [**10-14**] at [**Month/Day (4) 2286**] unit. Results to be faxed to: Name: [**Last Name (LF) **],[**First Name3 (LF) 177**] A. (MD) Phone: [**Telephone/Fax (1) 66403**] Fax: [**Telephone/Fax (1) 66408**] Discharge Disposition: Home With Service Facility: [**Location (un) 1110**] VNA Discharge Diagnosis: Urinary tract infection Bright red blood per rectum C. difficile colitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Ms. [**Known lastname 66401**], It was a pleasure taking care of you at [**Hospital1 827**]. You were admitted with feeling fatigue and after passing blood while trying to have a bowel movement. When you came to the emergency department your blood pressure was low and you were admitted to the Intensive Care Unit. We gave you IV fluids and medications to support your blood pressure and you got better. We found that you had a urinary tract infection and started you on antibiotics. You continued to get better with treatment of your infection. You finished your antibiotics for the urinary tract infection, but were found to have developed an infection in your bowels, leading to diarrhea. You will need to take a different antibiotic for two weeks to treat this infection. Followup Instructions: Name: [**Last Name (LF) **],[**First Name3 (LF) 177**] A. Location: [**Location (un) **] INTERNAL MEDICAL ASSOC. Address: [**Street Address(2) 66404**], [**Location (un) **],[**Numeric Identifier 66405**] Phone: [**Telephone/Fax (1) 66403**] ** Please call your PCP above to make a follow up appointment for this hospitalization for sometime in the next week. Department: TRANSPLANT CENTER When: THURSDAY [**2199-10-24**] at 1 PM With: [**First Name11 (Name Pattern1) 674**] [**Last Name (NamePattern4) 675**], MD [**Telephone/Fax (1) 673**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage **Please follow-up with your [**Hospital Ward Name 2286**] center on Monday [**10-14**] at your regularly scheduled appointment.

038,585,785,599,403,276,578,008,296,E939,041,530,285,995,112

{'Unspecified septicemia,End stage renal disease,Septic shock,Urinary tract infection, site not specified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyposmolality and/or hyponatremia,Hemorrhage of gastrointestinal tract, unspecified,Intestinal infection due to Clostridium difficile,Bipolar disorder, unspecified,Other psychotropic agents causing adverse effects in therapeutic use,Other and unspecified Escherichia coli [E. coli],Esophageal reflux,Anemia in chronic kidney disease,Severe sepsis,Candidiasis of vulva and vagina'}

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: hypotension PRESENT ILLNESS: 54 y/o F w/ PMH of lithium-induced ESRD on PD, hemorrhoids, tracheal stenosis, and hypertension recently discharged on [**9-24**] after transplant [**Doctor First Name **] admit for diverticulitis (treated conservatively w/ levo flagyl) who p/w fever to 101 at home and four episodes of BRBPR over the past two days. Denies melena. She also reports some light-headedness. On presentation to the ED she was found to be hypotensive to 77/38 (SBp 130's baseline), after 1L IVF bolus her BP increased to the 100's. She was afebrile upon presentation; after sending cultures she was given levo/[**Last Name (un) 2830**]/vanc for broad spectrum coverage in the ED. She denies N/V, denies changes in bladder or bowel habits, denies abdominal pain. She reports that her PO intake has been normal. Her sister who is her primary caregiver [**First Name (Titles) **] [**Last Name (Titles) 66407**] her today and states that the dwells have been clear for her peritoneal [**Last Name (Titles) 2286**], however given the episode of fever 2 days ago her [**Last Name (Titles) 2286**] nurse did start her on vancomycin with PD. She recieved one dose of this prior to presentation. Infectious ROS neg for headaches, neg stiffness, cough, chest pain, diarrhea, abdominal pain, + for dysuria, calf swelling nor rashes. . ED was also concerned about Hct slight drop from 25.4 last week to 23 in context of guaic + marroon stool. They ordered her for 2 units of blood and hung the 2nd unit up in ICU. In the ED, a CXR showed new cardiomegaly and bedside u/s: no cardiac effusion. Transplant surgery felt no surgical indications and that repeat imaging of abdomen was not needed. . Renal consulted: "Please send fluid from PD catheter for cell counts, gram stain and culture. Document what the fluid looks like. Is there abdominal pain? If the fluid returns positive for infection (>100 WBCs), call me again and we can discuss IP antibiotics." . In ED VS were 98.0 95 102/58 21 100 on transfer Labs were remarkable for WBC WNL, lactate 2.9, Interventions: Vanc, [**Last Name (un) **], Levo, UCx, Blood Cx, CXR . ROS: (+) Per HPI MEDICAL HISTORY: tracheostomy [**5-/2198**] for prolonged respiratory failure hyponatremic seizure following GoLytely prep [**5-/2198**] ESRD for lithium toxicity on HD bipolar GERD HTN breast cancer diverticulosis . PSH: parathyroidectomy with reimplantation in left arm left foot surgery in [**2180**] right knee surgery in [**2191**] lumpectomy for breast cancer (DCIS) status post radiation repeat mammograms were all negative history of tonsillectomy in the past MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from webOMR. 1. Docusate Sodium 100 mg PO BID 2. Fluoxetine 20 mg PO DAILY 3. Lithium Carbonate 150 mg PO DAILY 4. OLANZapine 10 mg PO DAILY 5. Calcitriol 0.25 mcg PO DAILY 6. Heparin Dwell (1000 Units/mL) 1000 UNIT DWELL UNDEFINED each 1 liter dwell IP for fibrin 7. Lactulose 30 mL PO BID 8. Lorazepam 1 mg PO HS:PRN insomnia 9. Miconazole Powder 2% 1 Appl TP [**Hospital1 **] 10. Tucks Hemorrhoidal Oint 1% 1 Appl PR PRN hemorrhoidal pain 11. Vitamin D 50,000 UNIT PO 1X/WEEK (TU) 12. Epoetin Alfa 40,000 units SC Q MONDAY 13. Senna 1 TAB PO BID:PRN constipation 14. OLANZapine 5 mg PO ASDIR Please assess patient for leg tingling, restlessness and give this additional dose. Will likely need while doing CAPD 15. Topiramate (Topamax) 25 mg PO DAILY 16. DIALYVITE 800 *NF* (B complex-C-folic acid-Zn) 0.8 mg Oral daily 17. Ferrous Sulfate 325 mg PO DAILY ALLERGIES: Ativan / Amoxicillin / Bactrim / Codeine / ibuprofen / Lamictal / naproxen / Tetanus Toxoid,Fluid / Cephalexin / Peanuts / Sulfa (Sulfonamide Antibiotics) / golytely / citrate of magnesia / Lithium PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS: 97.6 96 105/65 21 98% 2L GENERAL: AOx3, NAD HEENT: MMM. no LAD. no JVD. neck supple. HEART: RRR S1/S2 heard. no murmurs/gallops/rubs. LUNGS: mild crackles at bases B/L ABDOMEN: soft, PD catheter in place, no erythema around site, nontender. Foley in place w/ pus in tube. Rectal deferred by patient. Stated she already received on in the ED. EXT: wwp, 2+ pitting edema B/L to knees NEURO/PSYCH: CNs II-XII intact. strength and sensation in U/L extremities grossly intact. gait not assessed. . DISCHARGE PHYSICAL EXAM: Gen: awake, alert, NAD CV: RRR, no m/r/g LUNGS: CTAB ABDOMEN: +BS, soft, NT, distended EXT: WWP, 1+ bilateral edema FAMILY HISTORY: Mother with ovarian CA Father with CAD SOCIAL HISTORY: - Tobacco: Never - Alcohol: Previously occasionally - Illicits: Denies - Occupation/Recent travel/sick contacts: denies ### Response: {'Unspecified septicemia,End stage renal disease,Septic shock,Urinary tract infection, site not specified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hyposmolality and/or hyponatremia,Hemorrhage of gastrointestinal tract, unspecified,Intestinal infection due to Clostridium difficile,Bipolar disorder, unspecified,Other psychotropic agents causing adverse effects in therapeutic use,Other and unspecified Escherichia coli [E. coli],Esophageal reflux,Anemia in chronic kidney disease,Severe sepsis,Candidiasis of vulva and vagina'}

CHIEF COMPLAINT: PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname 71222**] is a 50 year old female with a long history of valvular disease. The patient has been very active until recently. She recently began to notice a decrease in her activity tolerance as well as lower extremity swelling and also episodes of orthopnea and paroxysmal nocturnal dyspnea. The patient also complained of the recent onset of left sided stabbing type chest pain which would last several seconds as well as dyspnea on exertion. MEDICAL HISTORY: 1. Depression. 2. Migraines. 3. Congestive heart failure. 4. Hypertension. 5. Herpes simplex. 6. Hepatitis C. 7. Mitral regurgitation. 8. Aortic regurgitation. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: History of prior alcohol abuse.

Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Rheumatic heart failure (congestive),Chronic hepatitis C without mention of hepatic coma,Unspecified essential hypertension,Depressive disorder, not elsewhere classified

Mitral/aortic val insuff,Tricuspid valve disease,Rheumatic heart failure,Chrnc hpt C wo hpat coma,Hypertension NOS,Depressive disorder NEC

Admission Date: [**2123-11-15**] Discharge Date: [**2123-11-26**] Date of Birth: [**2073-8-19**] Sex: F Service: CARD [**Doctor First Name 147**] HISTORY OF PRESENT ILLNESS: [**First Name8 (NamePattern2) **] [**Known lastname 71222**] is a 50 year old female with a long history of valvular disease. The patient has been very active until recently. She recently began to notice a decrease in her activity tolerance as well as lower extremity swelling and also episodes of orthopnea and paroxysmal nocturnal dyspnea. The patient also complained of the recent onset of left sided stabbing type chest pain which would last several seconds as well as dyspnea on exertion. The patient had an echocardiogram performed on [**2123-10-8**], which showed mitral valve to be rheumatically deformed with mild thickening, commissural fusion, mild chordal thickening and four plus mitral regurgitation. In addition, the aortic valve was also noted to be mildly thickened with two plus regurgitation. The left ventricle appeared slightly enlarged with end-diastolic dimension of 5.5 and ejection fraction of approximately 60%. In addition, the patient had cardiac catheterization performed on [**2123-10-22**], which showed normal coronary arteries, but severe mitral regurgitation, moderate aortic regurgitation, as well as moderate diastolic ventricular dysfunction. In addition, the patient was noted to have new small bilateral pleural effusions on the chest x-ray as well as small patchy and linear basilar opacities which were confirmed by the CT scan. PAST MEDICAL HISTORY: 1. Depression. 2. Migraines. 3. Congestive heart failure. 4. Hypertension. 5. Herpes simplex. 6. Hepatitis C. 7. Mitral regurgitation. 8. Aortic regurgitation. PAST SURGICAL HISTORY: Transabdominal hysterectomy in [**2104**]. SOCIAL HISTORY: History of prior alcohol abuse. MEDICATIONS 1. Effexor 30 mg p.o. q. day. 2. Trazodone 300 mg p.o. q. day h.s. 3. Lisinopril 2.5 mg p.o. q. day. 4. Ditropan. 5. Acyclovir p.r.n. ALLERGIES: No known drug allergies. PHYSICAL EXAMINATION: Afebrile; heart rate 84; blood pressure 128/78; respiratory rate 12; 98% on room air. In general, a thin female in no apparent distress. HEENT examination within normal limits. No jugular venous distention, no bruits. Murmur present which radiates to the neck bilaterally. Chest examination clear to auscultation bilaterally. Heart examination is regular rate and rhythm. Normal S1 and S2. III/VI systolic ejection murmur. Abdomen soft, nontender, nondistended, no hepatosplenomegaly. Extremities are warm and well perfused. Distal pulses present bilaterally. Varicosities none. Neurologic examination grossly non-focal with excellent strength and sensation in extremities. LABORATORY STUDIES: White blood cell count 4.8, hematocrit 35, platelet count 260, PT 12.3, INR 1.1. Sodium 140, potassium 3.4, BUN 18, creatinine 0.9, glucose 105. ALT 52, AST 75, alkaline phosphatase 76. Total bilirubin 0.3. SUMMARY OF HOSPITAL COURSE: Given symptomatic rheumatic valve disease with severe mitral regurgitation, moderate aortic regurgitation and mild to moderate tricuspid regurgitation, the decision was made to have the patient undergo a surgical procedure. On [**2123-11-15**], the patient underwent aortic valve replacement with a [**Street Address(2) 63249**]. [**Male First Name (un) 923**] Regent valve as well as mitral valve replacement with a [**Street Address(2) 105944**]. [**Male First Name (un) 923**] prosthetic valve. The patient tolerated the procedure well. There were no complications. Please see the full operative report for details. The patient remained intubated and was transferred to the Intensive Care Unit in stable condition. Postoperatively, the patient was transfused with one unit of packed red blood cells for a hematocrit of 22.0. The patient remained in sinus rhythm with stable blood pressure and slightly tachycardic. Her sternum remained stable with no drainage or erythema. Her urine catheter was removed on postoperative day one. She was maintained on a beta blocker and Captopril. The patient had good cardiac output and index. She was extubated on postoperative day zero. Her chest tube was removed on postoperative day two. She was continued on Coumadin. The patient originally required Nipride to control her blood pressure which was eventually weaned. On postoperative days two and three, the patient was noted to be quite agitated while in the Intensive Care Unit. A chest x-ray was obtained on [**2123-11-17**], which showed postoperative cardiomegaly, possibly due to a combination of cardiac dilatation and effusion. Some atelectasis/infiltrate of the left lower lobe was also suggested. The patient was transferred to the Regular Floor on postoperative day three in stable condition. The patient was continued on anti-coagulation. Adequate anti-coagulation with Coumadin was difficult to obtain due to baseline mild coagulopathy. Physical Therapy was consulted which followed the patient during her hospitalization and eventually cleared her to go home. The patient continued to do well. She remained in sinus rhythm without any ectopy. She was showing good saturation on room air. Her pacing wires were discontinued on postoperative day four and anti-coagulation restarted. The patient remained afebrile with stable blood pressure and heart rate. She was discharged to home on [**2123-11-26**], in stable condition. INR upon discharge was 2.8. CONDITION ON DISCHARGE: Good. DISCHARGE DISPOSITION: Home. DISCHARGE DIAGNOSES: 1. Severe mitral regurgitation and aortic insufficiency status post aortic valve replacement with mechanical valve (St. Jude's valve), and mitral valve replacement with a prosthetic valve (St. Jude's valve). 2. Hypertension. 3. Depression. 4. Hepatitis C. 5. Congestive heart failure. DISCHARGE MEDICATIONS: 1. Coumadin, the patient is to take 3 mg on the day of discharge. Coumadin dose is to be adjusted daily based on the INR level. The INR goal is 3.0 to 3.5. 2. Captopril 50 mg p.o. three times a day. 3. Lopressor 75 mg p.o. twice a day. 4. Colace 100 mg p.o. twice a day. 5. Percocet one to two tablets p.o. q. four to six hours p.r.n. pain. 6. Acyclovir p.r.n. 7. Ditropan. 8. Trazodone 300 mg p.o. h.s. 9. Effexor 30 mg p.o. q. day. DISCHARGE INSTRUCTIONS: 1. The patient is to see her surgeon, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in approximately four weeks. 2. The patient is to see her Cardiologist, Dr. [**Last Name (STitle) **]. The patient needs to follow-up in the [**Hospital 197**] Clinic (the office of Dr. [**Last Name (STitle) **], for blood draw and Coumadin dosing. This issue was discussed with the patient in detail. 3. The patient is to follow-up with her primary care physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) **], in approximately one to two weeks. [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D. [**MD Number(1) 414**] Dictated By:[**Last Name (NamePattern1) 1741**] MEDQUIST36 D: [**2123-11-28**] 19:38 T: [**2123-11-28**] 21:26 JOB#: [**Job Number **]

396,397,398,070,401,311

{'Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Rheumatic heart failure (congestive),Chronic hepatitis C without mention of hepatic coma,Unspecified essential hypertension,Depressive disorder, not elsewhere classified'}

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: [**First Name8 (NamePattern2) **] [**Known lastname 71222**] is a 50 year old female with a long history of valvular disease. The patient has been very active until recently. She recently began to notice a decrease in her activity tolerance as well as lower extremity swelling and also episodes of orthopnea and paroxysmal nocturnal dyspnea. The patient also complained of the recent onset of left sided stabbing type chest pain which would last several seconds as well as dyspnea on exertion. MEDICAL HISTORY: 1. Depression. 2. Migraines. 3. Congestive heart failure. 4. Hypertension. 5. Herpes simplex. 6. Hepatitis C. 7. Mitral regurgitation. 8. Aortic regurgitation. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: History of prior alcohol abuse. ### Response: {'Mitral valve insufficiency and aortic valve insufficiency,Diseases of tricuspid valve,Rheumatic heart failure (congestive),Chronic hepatitis C without mention of hepatic coma,Unspecified essential hypertension,Depressive disorder, not elsewhere classified'}

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 84 yo M with h/o CAD s/p CABG 22yrs ago, s/p multiple PCI's, CHF w/ EF 20%, s/p ICD, DM, HTN, Hypercholesterolemia, prostate ca, diverticulitis. Presented to OSH with non-radiating CP at rest/N/diaphoresis/SOB. ECG w/ 1mm STE in inferior leads in setting of LBBB. Transfered from [**Hospital1 34**] to [**Hospital1 18**] for PCI and further medical management. MEDICAL HISTORY: 1.CAD s/p CABG 22yrs ago, 2.s/p multiple PCI's, 3.CHF w/ EF 20%, 4.s/p ICD, 5.DM, 6.HTN, 7.Hypercholesterolemia, 8.prostate ca, 9.diverticulitis. MEDICATION ON ADMISSION: Lopressor, digoxin, lasix, aspirin, lisinopril, oral hypoglycemic [**Doctor Last Name 360**]. ALLERGIES: Lidocaine (Anesthetic) / Procanbid / Quinidine / Relafen PHYSICAL EXAM: T98 BP101-107/63-78 P77 98%RA Gen-looks weel HEENT-unremarkable CVS-nl S1/S2, no S3/S4/murmur, no pedal edema, JVP flat, DP 1+ bilaterally resp-CTAB GI-nl BS, benign FAMILY HISTORY: SOCIAL HISTORY: no tob, no etoh, no ivdu

Acute myocardial infarction of other inferior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Cardiogenic shock,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Diarrhea

AMI inferior wall, init,Comp-oth cardiac device,Cardiogenic shock,CHF NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Diarrhea

Admission Date: [**2125-8-3**] Discharge Date: [**2125-8-13**] Service: [**Hospital Unit Name 196**] Allergies: Lidocaine (Anesthetic) / Procanbid / Quinidine / Relafen Attending:[**First Name3 (LF) 317**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: cardiac catheterization History of Present Illness: 84 yo M with h/o CAD s/p CABG 22yrs ago, s/p multiple PCI's, CHF w/ EF 20%, s/p ICD, DM, HTN, Hypercholesterolemia, prostate ca, diverticulitis. Presented to OSH with non-radiating CP at rest/N/diaphoresis/SOB. ECG w/ 1mm STE in inferior leads in setting of LBBB. Transfered from [**Hospital1 34**] to [**Hospital1 18**] for PCI and further medical management. Past Medical History: 1.CAD s/p CABG 22yrs ago, 2.s/p multiple PCI's, 3.CHF w/ EF 20%, 4.s/p ICD, 5.DM, 6.HTN, 7.Hypercholesterolemia, 8.prostate ca, 9.diverticulitis. Social History: no tob, no etoh, no ivdu Physical Exam: T98 BP101-107/63-78 P77 98%RA Gen-looks weel HEENT-unremarkable CVS-nl S1/S2, no S3/S4/murmur, no pedal edema, JVP flat, DP 1+ bilaterally resp-CTAB GI-nl BS, benign Pertinent Results: [**2125-8-13**] 07:30AM BLOOD WBC-13.3* RBC-3.56* Hgb-11.3* Hct-34.8* MCV-98 MCH-31.7 MCHC-32.4 RDW-14.3 Plt Ct-290 [**2125-8-11**] 07:59AM BLOOD Hypochr-1+ Anisocy-OCCASIONAL Poiklo-2+ Macrocy-2+ Microcy-NORMAL Polychr-NORMAL Burr-2+ Acantho-1+ [**2125-8-13**] 07:30AM BLOOD Plt Ct-290 [**2125-8-13**] 07:30AM BLOOD PT-14.0* PTT-25.5 INR(PT)-1.2 [**2125-8-13**] 07:30AM BLOOD Glucose-90 UreaN-47* Creat-1.5* Na-140 K-5.0 Cl-105 HCO3-25 AnGap-15 [**2125-8-5**] 03:27AM BLOOD CK(CPK)-324* [**2125-8-5**] 03:27AM BLOOD CK-MB-19* MB Indx-5.9 [**2125-8-4**] 03:30AM BLOOD CK-MB-82* MB Indx-7.8* [**2125-8-3**] 06:45PM BLOOD CK-MB-184* MB Indx-11.3* [**2125-8-3**] 10:00AM BLOOD CK-MB-279* MB Indx-17.3* cTropnT-8.12* [**2125-8-13**] 07:30AM BLOOD Mg-2.4 [**2125-8-9**] 08:45AM BLOOD VitB12-1230* Folate-19.9 [**2125-8-3**] 10:00AM BLOOD Triglyc-59 HDL-45 CHOL/HD-3.4 LDLcalc-98 [**2125-8-6**] 02:36PM BLOOD Type-MIX pO2-31* pCO2-43 pH-7.41 calHCO3-28 Base XS-0 [**2125-8-6**] 02:36PM BLOOD Lactate-1.8 Brief Hospital Course: 1. CAD On admission, Mr. [**Known lastname **] was taken to cardiac cath on [**2125-8-3**] showed three vessel CAD. The left main stent was widely patent. The LAD was chronically occluded proximally. The left circumflex stent was widely patent. The large lower pole of the OM1 was totally occluded by thrombus. The RCA had 60% proximal ISR which appeared unchanged from one year ago. The RCA was chronically totally occluded distally and appeared unchanged. The SVG-LAD was known to be occluded and was not injected. Successful PTCA/stenting of the large OM1 (lower pole). Resting hemodynamics demonstrated markedly elevated filling pressures and low cardiac output, conistent with cardiogenic shock. Mean RA pressure was 16 mm Hg and mean PCW pressure was 37 mm Hg. Moderate pulmonary hypertension was present. An intra-aortic balloon pump was placed and patinet observed in CCU. He was weaned off balloon pump within 24 hours.He initially required dobutamine but was weaned on [**8-6**]. He was subsequently transferred to the floor with stable vitals.He was continued on ASA, plavix, statin, ACEI and lipitor 2. CHF Echocardiogram done on [**2125-8-6**] showed EF 15-20%, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 3841**] dilated and elongated, RA mod dilated, akinesis of most of the wall with relative sparing of the lateral wall, RV mildly dilated, trace AR, mod TR, mod PAH Patient was on ACE and decreased Digoxin to 0.0625. His digoxin level was 1.1 3. rhythm Patient has runs of VT with ICD in place. These episodes were not associated with symptoms. 4.GI He initially had some diarrhea. C diff toxin was sent and was negative 5. pscyh According to patient, he has suicidal ideation eg. taking whole bottle of digoxin and has very sad affect. In house psychiatry evaluation did not show the need for sitter. However, they recommended psychiatry evaluation at the rehabilitation center. Patient also refuses to take plavix although the importance had been repeatedly stressed Medications on Admission: Lopressor, digoxin, lasix, aspirin, lisinopril, oral hypoglycemic [**Doctor Last Name 360**]. Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO QD (once a day). 2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD (once a day) for 30 days. 3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO QD (once a day). 5. Digoxin 125 mcg Tablet Sig: 0.5 Tablet PO QD (once a day). 6. Betaxolol HCl 0.25 % Drops, Suspension Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2 times a day). 7. Captopril 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 8. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Glipizide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 12. Mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime). Discharge Disposition: Extended Care Facility: [**Hospital3 23439**] of [**Location (un) 5087**] Discharge Diagnosis: unstable angina CHF Discharge Condition: chest pain free Discharge Instructions: please return to the hospital or call your doctor if you have chest pain or if there are any cnoncerns at all Please take all the medication prescribed to you especially the medication called "PLAVIX". It is absolutely critical that you do not stop plavix in order to prevent the stent in your heart from forming clots. Followup Instructions: Provider: [**Name10 (NameIs) 676**] CLINIC Where: [**Hospital6 29**] CARDIAC SERVICES Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2125-12-4**] 2:30 please call Dr. [**First Name8 (NamePattern2) **] [**Known lastname **] at [**Telephone/Fax (1) 10012**] to make an appointment upon your discharge from rehab Completed by:[**2125-8-13**]

410,996,785,428,414,250,401,787

{'Acute myocardial infarction of other inferior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Cardiogenic shock,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Diarrhea'}

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: chest pain PRESENT ILLNESS: 84 yo M with h/o CAD s/p CABG 22yrs ago, s/p multiple PCI's, CHF w/ EF 20%, s/p ICD, DM, HTN, Hypercholesterolemia, prostate ca, diverticulitis. Presented to OSH with non-radiating CP at rest/N/diaphoresis/SOB. ECG w/ 1mm STE in inferior leads in setting of LBBB. Transfered from [**Hospital1 34**] to [**Hospital1 18**] for PCI and further medical management. MEDICAL HISTORY: 1.CAD s/p CABG 22yrs ago, 2.s/p multiple PCI's, 3.CHF w/ EF 20%, 4.s/p ICD, 5.DM, 6.HTN, 7.Hypercholesterolemia, 8.prostate ca, 9.diverticulitis. MEDICATION ON ADMISSION: Lopressor, digoxin, lasix, aspirin, lisinopril, oral hypoglycemic [**Doctor Last Name 360**]. ALLERGIES: Lidocaine (Anesthetic) / Procanbid / Quinidine / Relafen PHYSICAL EXAM: T98 BP101-107/63-78 P77 98%RA Gen-looks weel HEENT-unremarkable CVS-nl S1/S2, no S3/S4/murmur, no pedal edema, JVP flat, DP 1+ bilaterally resp-CTAB GI-nl BS, benign FAMILY HISTORY: SOCIAL HISTORY: no tob, no etoh, no ivdu ### Response: {'Acute myocardial infarction of other inferior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Cardiogenic shock,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Diarrhea'}

CHIEF COMPLAINT: GI bleed . PRESENT ILLNESS: Mr. [**Known lastname 102989**] is a 53 year-old man with a history of alcoholic cirrhosis with known grade II esophageal varices and portal gastropathy who was transferred from the [**Hospital 882**] Hospital MICU last night for continued management of variceal bleeding. Of note, he was recently hospitalized here at [**Hospital1 18**] from [**Date range (1) 102992**] with hematemesis; EGD at that time showed two cords of nonbleeding grade II esophageal varices and nonbleeding portal gastropathy. He was discharged on [**4-11**] to [**Hospital 100**] Rehab and then began having acute hematemesis on [**4-12**] requiring intubation prior to even the arrival of EMS; by report, he had no palpable BP or pulse, but was moving and breathing spontaneously. He was taken to the [**Hospital 882**] Hospital ED where his BP was initially recorded at 60/palp. An NGT returned bright red blood and he underwent emergent EGD with placement of 7 bands to his varices. He was put on octreotide and pantoprazole continuous infusions, as well as ceftazidime and metronidazole for bactermia prophylaxis. His admission labs were notable for a WBC 18.1 (93% PMNs), Hct 27.4 (unclear how many pRBCs he had received at that time), platelets 96, an INR of 1.9 (peaked at 2.1 during admission), and a creatinine of 1.3; he also had transaminases in the [**2100**], which gradually trended downwards down to 800s on the day of transfer. He received 7 units of pRBCs as well as FFP and platelets. He was extubated the following day ([**4-13**]), taken off of the continuous infusions, transferred to PO medications, and transferred to the floor. On [**4-16**], he acutely vomitted bright red blood and received an additional 4 units of pRBCs, 1 unit of platelets, and 2 units of FFP; his octreotide infusion was resumed. He returned to the MICU and underwent repeat EGD; this failed to show the prior bands, and he received 5 new bands to his varices; no evidence of active bleeding was seen. . Review of Systems: Denies fevers, chills, sweats, abdominal pain. Has had a productive cough and intermittent dyspnea for several days. He denies any confusion. . MEDICAL HISTORY: alcoholic cirrhosis, listed for transplant - prior ascites - prior hepatorenal syndrome requiring several sessions of hemodialysis - known grade II esophageal varices and portal gastropathy by EGD [**2109-4-9**] - history of candidal and bacterial (SBP) peritonitis - colorectal cancer (stage unknown) s/p colectomy in [**11/2108**] - cervical stenosis - hyperlipidemia - hypertension - history of C Diff colitis - anemia with baseline Hct 27-30 - history of Torsades while on ciprofloxacin - depression - history of positive PF4 antibody - BPH MEDICATION ON ADMISSION: Ceftazidime 2gm IV TID Pantoprazole 10mg IV BID Oxycodone IR 15mg PO Q6H PRN Spironolactone 50mg PO daily Rifaximin 400mg PO TID Folate 1mg PO daily Colace 100mg PO BID Albuterol MDI Lactulose 30cc Q6H Nadolol 20mg PO daily Octreotride 500mg IV Q10H ALLERGIES: Heparin Agents / Penicillins / Aspirin / Ibuprofen / Ciprofloxacin PHYSICAL EXAM: Tc 97.9 Tm 97.9 BP 126/85 HR 81 RR 13 Sat 95% 4 L/min Weight: 82.7 kg General: comfortable, lying upright in bed HEENT: no oral lesions; (+) icterus Neck: biphasic JVP to 8cm Chest: significantly decreased breath sounds at both bases; (+) loud ronchi in anterior lung fields CV: regular rate/rhythm, Abdomen: distended, nontender, (+) BS, unable to palpate liver/spleen due to distension; (+) shifting dullness and fluid wave; no caput Extremities: 2+ edema to lower shins bilaterally Skin: (+) jaundice Neuro: alert, appropriate, oriented x3; CN 2-12 intact, [**4-1**] strength in both UEs/LEs; no asterixis . FAMILY HISTORY: Denies fhx of early MI, stroke, cancer. . SOCIAL HISTORY: Home: Lived with wife and daughter in [**Name2 (NI) **] prior to hospitalization in [**Month (only) 958**]. Has since been at [**Hospital1 100**]/[**Hospital 8218**] rehab Occupation: used to work as construction worker. EtOH: denies ETOH for past 5 years, extensive in the past Drugs: denies h/o IVDA Tobacco: Tobacco: [**Date range (1) 61126**] PPD x 30 years; quit in 2/[**2108**]. .

Alcoholic cirrhosis of liver,Portal vein thrombosis,Esophageal varices in diseases classified elsewhere, with bleeding,Other ascites,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Portal hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified disorders of stomach and duodenum,Hypoxemia,Unspecified essential hypertension,Other specified retention of urine,Spinal stenosis in cervical region,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus

Alcohol cirrhosis liver,Portal vein thrombosis,Bleed esoph var oth dis,Ascites NEC,Urin tract infection NOS,Acute kidney failure NOS,Protein-cal malnutr NOS,Portal hypertension,Enterococcus group d,Gastroduodenal dis NEC,Hypoxemia,Hypertension NOS,Oth spcf retention urine,Cervical spinal stenosis,Hyperlipidemia NEC/NOS,Hx-rectal & anal malign

Admission Date: [**2109-4-16**] Discharge Date: [**2109-5-1**] Date of Birth: [**2055-11-20**] Sex: M Service: MEDICINE Allergies: Heparin Agents / Penicillins / Aspirin / Ibuprofen / Ciprofloxacin Attending:[**First Name3 (LF) 943**] Chief Complaint: GI bleed . Major Surgical or Invasive Procedure: Paracenteses Thoracenteses . History of Present Illness: Mr. [**Known lastname 102989**] is a 53 year-old man with a history of alcoholic cirrhosis with known grade II esophageal varices and portal gastropathy who was transferred from the [**Hospital 882**] Hospital MICU last night for continued management of variceal bleeding. Of note, he was recently hospitalized here at [**Hospital1 18**] from [**Date range (1) 102992**] with hematemesis; EGD at that time showed two cords of nonbleeding grade II esophageal varices and nonbleeding portal gastropathy. He was discharged on [**4-11**] to [**Hospital 100**] Rehab and then began having acute hematemesis on [**4-12**] requiring intubation prior to even the arrival of EMS; by report, he had no palpable BP or pulse, but was moving and breathing spontaneously. He was taken to the [**Hospital 882**] Hospital ED where his BP was initially recorded at 60/palp. An NGT returned bright red blood and he underwent emergent EGD with placement of 7 bands to his varices. He was put on octreotide and pantoprazole continuous infusions, as well as ceftazidime and metronidazole for bactermia prophylaxis. His admission labs were notable for a WBC 18.1 (93% PMNs), Hct 27.4 (unclear how many pRBCs he had received at that time), platelets 96, an INR of 1.9 (peaked at 2.1 during admission), and a creatinine of 1.3; he also had transaminases in the [**2100**], which gradually trended downwards down to 800s on the day of transfer. He received 7 units of pRBCs as well as FFP and platelets. He was extubated the following day ([**4-13**]), taken off of the continuous infusions, transferred to PO medications, and transferred to the floor. On [**4-16**], he acutely vomitted bright red blood and received an additional 4 units of pRBCs, 1 unit of platelets, and 2 units of FFP; his octreotide infusion was resumed. He returned to the MICU and underwent repeat EGD; this failed to show the prior bands, and he received 5 new bands to his varices; no evidence of active bleeding was seen. . Review of Systems: Denies fevers, chills, sweats, abdominal pain. Has had a productive cough and intermittent dyspnea for several days. He denies any confusion. . Past Medical History: alcoholic cirrhosis, listed for transplant - prior ascites - prior hepatorenal syndrome requiring several sessions of hemodialysis - known grade II esophageal varices and portal gastropathy by EGD [**2109-4-9**] - history of candidal and bacterial (SBP) peritonitis - colorectal cancer (stage unknown) s/p colectomy in [**11/2108**] - cervical stenosis - hyperlipidemia - hypertension - history of C Diff colitis - anemia with baseline Hct 27-30 - history of Torsades while on ciprofloxacin - depression - history of positive PF4 antibody - BPH Social History: Home: Lived with wife and daughter in [**Name2 (NI) **] prior to hospitalization in [**Month (only) 958**]. Has since been at [**Hospital1 100**]/[**Hospital 8218**] rehab Occupation: used to work as construction worker. EtOH: denies ETOH for past 5 years, extensive in the past Drugs: denies h/o IVDA Tobacco: Tobacco: [**Date range (1) 61126**] PPD x 30 years; quit in 2/[**2108**]. . Family History: Denies fhx of early MI, stroke, cancer. . Physical Exam: Tc 97.9 Tm 97.9 BP 126/85 HR 81 RR 13 Sat 95% 4 L/min Weight: 82.7 kg General: comfortable, lying upright in bed HEENT: no oral lesions; (+) icterus Neck: biphasic JVP to 8cm Chest: significantly decreased breath sounds at both bases; (+) loud ronchi in anterior lung fields CV: regular rate/rhythm, Abdomen: distended, nontender, (+) BS, unable to palpate liver/spleen due to distension; (+) shifting dullness and fluid wave; no caput Extremities: 2+ edema to lower shins bilaterally Skin: (+) jaundice Neuro: alert, appropriate, oriented x3; CN 2-12 intact, [**4-1**] strength in both UEs/LEs; no asterixis . Pertinent Results: PERTINENT LABS: [**2109-4-16**] WBC-8.7 HGB-13.2 HCT-37.1 MCV-85# PLT SMR-LOW PLT COUNT-105* [**2109-4-16**] PT-18.4* PTT-34.1 INR(PT)-1.7* [**2109-4-16**] GLUCOSE-129* UREA N-35* CREAT-1.0 SODIUM-140 POTASSIUM-4.0 CHLORIDE-99 TOTAL CO2-28 [**2109-4-16**] ALT-511* AST-302* LDH-214 ALK PHOS-113 AMYLASE-28 TOT BILI-13.3 [**2109-4-16**] ALBUMIN-3.7 CALCIUM-9.2 PHOSPHATE-3.9 MAGNESIUM-2.5 . Pleural fluid [**4-17**]: GRAM STAIN (Final [**2109-4-17**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. This is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. FLUID CULTURE (Final [**2109-4-20**]): NO GROWTH. ANAEROBIC CULTURE (Final [**2109-4-23**]): NO GROWTH. . NEGATIVE FOR MALIGNANT CELLS. . Peritoneal Fluid [**4-23**]: GRAM STAIN (Final [**2109-4-23**]): 2+ (1-5 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. This is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. FLUID CULTURE (Final [**2109-4-26**]): NO GROWTH. ANAEROBIC CULTURE (Final [**2109-4-29**]): NO GROWTH. . [**4-26**] URINE CX: URINE CULTURE (Final [**2109-4-29**]): ENTEROCOCCUS SP.. >100,000 ORGANISMS/ML.. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ ENTEROCOCCUS SP. | AMPICILLIN------------ =>32 R LINEZOLID------------- 2 S NITROFURANTOIN-------- 128 R TETRACYCLINE---------- =>16 R VANCOMYCIN------------ =>32 R . [**4-28**] BLOOD CX: pending [**4-29**] URINE CX: pending . . STUDIES: CXR [**4-17**]: In comparison with study of [**4-4**], there is extensive opacification causing generalized haziness of the left hemithorax with opacification along the left lateral chest wall. This is consistent with a substantial left pleural effusion. Obliquity of the patient to the right may account for much of the apparent shift of the mediastinum to the contralateral side. . TTE [**4-17**]: The left atrium is normal in size. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%) There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are mildly thickened. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. . RUQ U/S [**4-18**]: 1. Interval development of the partially-occluding thrombus of the right portal vein. 2. Findings compatible with cirrhosis and portal hypertension and splenomegaly. Large volume of ascites is noted. No focal liver lesion is detected . Brief Hospital Course: Mr. [**Known lastname 102989**] is a 53 yo male with PMH significant for ETOH cirrhosis on liver transplant list who is being transferred from OSH for management of variceal bleed with possible TIPS evalation. 1)Upper GI bleed: Patient presents with significant variceal bleed. He was discharged from [**Hospital1 18**] on [**4-11**] and underwent an endoscopy during this admission which showed stable, non-bleeding grade 2 varices. No intervention was done at this time. He presented to [**Hospital 882**] Hospital with several episodes of hematemesis requiring endoscopy x 2. Seven bands were placed on the first endoscopy followed by 5 bands during the second endoscopy. He received approximately 11 units pRBCs at OSH along with FFPs, platelets, and vitamin K. He does not appear to be actively bleeding at this time. He maintained adequate IV access. During his ICU stay, he required no blood transfusions. He received an octretide drip. He received ceftriaxone for SBP prophylaxis for 5 days then converted to oral antibiotics. He had a TTE to eval for TIPS that could not measure PA pressures. He had a liver ultrasound that showed a partially occlusive portal vein thrombus that was thought not prohibitive for a TIPS. On the floor, his Hct remained stable off the octreotide gtt and patient had no hematemesis. He had repeat EGD which revealed 3 grade II varices that were banded. He was started on sucralfate for a 2 week course and will require repeat EGD one week after discharge. Nadolol was held in the setting of UGI bleed and re-started on the day of discharge. . 2)ETOH cirrhosis: Patient currently listed for liver transplantation. He has a history of ascites requiring paracenteses, pleural effusions, and esophageal varices. Per OMR he does not have significant history of hepatic encephalopathy. He is currently awake and alert. Per OSH records pt had elevated LFTs in 1000's which then returned to baseline. His transaminase elevation was thought to be secondary to ischemic hepatopathy from the cardiac arrest. His transaminase levels improved steadily. He continued on Lactulose PO TID, Aldactone, and Rifaximin. His nadolol was held briefly then resumed. The patient had a paracentesis for ascites and thoracentesis for left hepatic hydrothorax on [**2109-4-17**]. His respiratory status remained stable on the floor. Diuretics were held briefly for a rise in creatinine and then resumed. Had paracentesis x 2 on the floor with 5L and then 8L removed. Will need to consider TIPS evaluation, although he has a partial PVT (not an absolute contraindication). He will need a paracentesis next week in clinic. If creatinine remains stable on re-check on [**5-2**], would increase lasix to 40mg daily and spironolactone to 100mg daily. . 3) Hypoxia: The patient had an episode of hypoxia that was most likely related to a large left sided pleural effusion. The pleural effusion was drained. The fluid was most likely related to trans-diaphragmatic translocation of peritoneal ascites. His supplemental oxygen was weaned steadily. On the floor, the patient remained stable on RA. . 4) Partial L portal vein thrombosis - seen on RUQ US on [**4-18**] but patient definitely not a candidate for anticoagulation given his recent bleeding . 5) Urinary retention: On [**4-28**], the patient developed urinary retention requiring a foley. He failed a spontaneous voiding trial the following 2 days with up to 1L of retained urine. This was attributed to increased ascites, though did not improve s/p paracentesis and the patient had to be discharged with a foley in place. No anti-cholinergic medications. No intra-abdominal mass or BPH. Urine culture on [**4-26**] had >100K VRE ([**Last Name (un) 36**] to linezolid). Repeat UA was unremarkable so no antibiotics were initiated. He will need repeated voiding trials as an outpatient with goal of discontinuing the foley as soon as possible. If continues to have urinary retention, would consider urology consult. . 6)Cervical stenosis: Patient has chronic upper extremity and back pain. s/p fall and cervical vertebral fracture requiring surgical repair/stabilization with chronic neuropathic pain. He remained on his home pain medicine regimen. . 7) Nutrition: Calorie count revealed that the patient was not taking adequate POs. A dobhoff tube was placed and tube feeds initiated. . Medications on Admission: Ceftazidime 2gm IV TID Pantoprazole 10mg IV BID Oxycodone IR 15mg PO Q6H PRN Spironolactone 50mg PO daily Rifaximin 400mg PO TID Folate 1mg PO daily Colace 100mg PO BID Albuterol MDI Lactulose 30cc Q6H Nadolol 20mg PO daily Octreotride 500mg IV Q10H Discharge Medications: 1. Rifaximin 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day) as needed. 4. Multivitamin Tablet Sig: One (1) Tablet PO once a day. 5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 6. Cephalexin 250 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours) for 4 days. 7. Sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times a day) for 7 days. 8. Lactulose 10 gram/15 mL Syrup Sig: Five (5) ML PO TID (3 times a day): titrate to maintain 4 documented BMs per day. 9. Spironolactone 25 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily): hold for SBP<100. 10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): hold for SBP<100. 11. Nadolol 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily): hold for SBP<95. 12. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. . Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: Final diagnosis Upper gastrointestinal bleed Bleeding esophageal varices . Secondary diagnosis Alcoholic cirrhosis . Discharge Condition: Stable . Discharge Instructions: You were admitted to the [**Hospital 882**] hospital as you were noted have large amounts of bloody vomitus requiring intubation, multiple transfusions, and 2 episodes of banding there. Your heart also had stopped briefly and you were successfully resuscitated. When you were stable, you were transferred to the [**Hospital1 **] ICU and improved so you were transferred to the medicine floor. You had fluid taken out of your lung and abdomen for comfort. . Please continue all medications as prescribed. . Please keep all your appointments below. . Please call your physician or return to the hospital if you experience any continued bloody vomitus, have active bleeding, palpitations, chest pain, shortness of breath, fever, chills, or any new or worrisome symptoms. . Followup Instructions: You will need EGD and paracentesis next week. You also need to be scheduled for liver orientation. The liver center will call your rehab tomorrow to facilitate this. . Scheduled Appointments : Provider TRANSPLANT [**Hospital 1389**] CLINIC Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2109-5-22**] 1:00 . Provider [**Name9 (PRE) 1382**] [**Name9 (PRE) 1383**], MD Phone:[**Telephone/Fax (1) 2422**] Date/Time:[**2109-6-3**] 9:30 .

571,452,456,789,599,584,263,572,041,537,799,401,788,723,272,V100

{'Alcoholic cirrhosis of liver,Portal vein thrombosis,Esophageal varices in diseases classified elsewhere, with bleeding,Other ascites,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Portal hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified disorders of stomach and duodenum,Hypoxemia,Unspecified essential hypertension,Other specified retention of urine,Spinal stenosis in cervical region,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus'}

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: GI bleed . PRESENT ILLNESS: Mr. [**Known lastname 102989**] is a 53 year-old man with a history of alcoholic cirrhosis with known grade II esophageal varices and portal gastropathy who was transferred from the [**Hospital 882**] Hospital MICU last night for continued management of variceal bleeding. Of note, he was recently hospitalized here at [**Hospital1 18**] from [**Date range (1) 102992**] with hematemesis; EGD at that time showed two cords of nonbleeding grade II esophageal varices and nonbleeding portal gastropathy. He was discharged on [**4-11**] to [**Hospital 100**] Rehab and then began having acute hematemesis on [**4-12**] requiring intubation prior to even the arrival of EMS; by report, he had no palpable BP or pulse, but was moving and breathing spontaneously. He was taken to the [**Hospital 882**] Hospital ED where his BP was initially recorded at 60/palp. An NGT returned bright red blood and he underwent emergent EGD with placement of 7 bands to his varices. He was put on octreotide and pantoprazole continuous infusions, as well as ceftazidime and metronidazole for bactermia prophylaxis. His admission labs were notable for a WBC 18.1 (93% PMNs), Hct 27.4 (unclear how many pRBCs he had received at that time), platelets 96, an INR of 1.9 (peaked at 2.1 during admission), and a creatinine of 1.3; he also had transaminases in the [**2100**], which gradually trended downwards down to 800s on the day of transfer. He received 7 units of pRBCs as well as FFP and platelets. He was extubated the following day ([**4-13**]), taken off of the continuous infusions, transferred to PO medications, and transferred to the floor. On [**4-16**], he acutely vomitted bright red blood and received an additional 4 units of pRBCs, 1 unit of platelets, and 2 units of FFP; his octreotide infusion was resumed. He returned to the MICU and underwent repeat EGD; this failed to show the prior bands, and he received 5 new bands to his varices; no evidence of active bleeding was seen. . Review of Systems: Denies fevers, chills, sweats, abdominal pain. Has had a productive cough and intermittent dyspnea for several days. He denies any confusion. . MEDICAL HISTORY: alcoholic cirrhosis, listed for transplant - prior ascites - prior hepatorenal syndrome requiring several sessions of hemodialysis - known grade II esophageal varices and portal gastropathy by EGD [**2109-4-9**] - history of candidal and bacterial (SBP) peritonitis - colorectal cancer (stage unknown) s/p colectomy in [**11/2108**] - cervical stenosis - hyperlipidemia - hypertension - history of C Diff colitis - anemia with baseline Hct 27-30 - history of Torsades while on ciprofloxacin - depression - history of positive PF4 antibody - BPH MEDICATION ON ADMISSION: Ceftazidime 2gm IV TID Pantoprazole 10mg IV BID Oxycodone IR 15mg PO Q6H PRN Spironolactone 50mg PO daily Rifaximin 400mg PO TID Folate 1mg PO daily Colace 100mg PO BID Albuterol MDI Lactulose 30cc Q6H Nadolol 20mg PO daily Octreotride 500mg IV Q10H ALLERGIES: Heparin Agents / Penicillins / Aspirin / Ibuprofen / Ciprofloxacin PHYSICAL EXAM: Tc 97.9 Tm 97.9 BP 126/85 HR 81 RR 13 Sat 95% 4 L/min Weight: 82.7 kg General: comfortable, lying upright in bed HEENT: no oral lesions; (+) icterus Neck: biphasic JVP to 8cm Chest: significantly decreased breath sounds at both bases; (+) loud ronchi in anterior lung fields CV: regular rate/rhythm, Abdomen: distended, nontender, (+) BS, unable to palpate liver/spleen due to distension; (+) shifting dullness and fluid wave; no caput Extremities: 2+ edema to lower shins bilaterally Skin: (+) jaundice Neuro: alert, appropriate, oriented x3; CN 2-12 intact, [**4-1**] strength in both UEs/LEs; no asterixis . FAMILY HISTORY: Denies fhx of early MI, stroke, cancer. . SOCIAL HISTORY: Home: Lived with wife and daughter in [**Name2 (NI) **] prior to hospitalization in [**Month (only) 958**]. Has since been at [**Hospital1 100**]/[**Hospital 8218**] rehab Occupation: used to work as construction worker. EtOH: denies ETOH for past 5 years, extensive in the past Drugs: denies h/o IVDA Tobacco: Tobacco: [**Date range (1) 61126**] PPD x 30 years; quit in 2/[**2108**]. . ### Response: {'Alcoholic cirrhosis of liver,Portal vein thrombosis,Esophageal varices in diseases classified elsewhere, with bleeding,Other ascites,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Unspecified protein-calorie malnutrition,Portal hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other specified disorders of stomach and duodenum,Hypoxemia,Unspecified essential hypertension,Other specified retention of urine,Spinal stenosis in cervical region,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 66-year-old male with known coronary artery disease (status post left anterior descending stent in [**2098**]) who reported a mild burning sensation in his chest with yard work which resolved with rest. MEDICAL HISTORY: 1. Coronary artery disease; status post left anterior descending stent in [**2098**]. 2. Hypertension. 3. Hyperlipidemia. 4. Ring worm of his left leg - now at approximately 30 to 40 days of treatment. 5. Colitis. 6. Renal calculi. 7. History of deep venous thrombosis in the [**2091**]. MEDICATION ON ADMISSION: Medications at the time he was seen preoperatively were Crestor 20 mg by mouth once daily, Accupril 20 mg by mouth once daily, aspirin 325 mg by mouth once daily, and Polycitra twice daily. ALLERGIES: He is allergic to BETA BLOCKERS (which he stated gave him exhaustion). PHYSICAL EXAM: FAMILY HISTORY: He has a significant family history with his father deceased of a myocardial infarction at the age of 55 and mother with coronary artery disease. SOCIAL HISTORY: The patient is retired. He lives in [**Location **] with his wife. [**Name (NI) **] quit smoking 35 years ago with a 30-pack- year history. He also admitted to three alcoholic drinks per day.

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acute idiopathic pericarditis,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia

Crnry athrscl natve vssl,Intermed coronary synd,Ac idiopath pericarditis,Surg compl-heart,Hypertension NOS,Pure hypercholesterolem

Admission Date: [**2106-11-1**] Discharge Date: [**2106-11-8**] Date of Birth: [**2039-11-18**] Sex: M Service: CSU HISTORY OF PRESENT ILLNESS: This is a 66-year-old male with known coronary artery disease (status post left anterior descending stent in [**2098**]) who reported a mild burning sensation in his chest with yard work which resolved with rest. He had an exercise tolerance test on [**2106-10-20**] which produced chest pain as well as ST depressions. It also revealed a mild inferior wall myocardial infarction and mild anterior wall hypokinesis with an ejection fraction of 54 percent. He was brought into [**Hospital1 188**] for cardiac catheterization on [**2106-10-26**] when he was initially seen by the cardiac surgery team. His ejection fraction was 48 percent at catheterization with a proximal right coronary artery lesion of 100 percent, a left anterior descending 60 percent proximal lesion, an 80 percent mid lesion, and 90 percent lesion, and a ramus intermedius lesion of 90 percent. He was referred for coronary artery bypass grafting to Dr. [**First Name (STitle) **] [**Name (STitle) **], at that time. PAST MEDICAL HISTORY: 1. Coronary artery disease; status post left anterior descending stent in [**2098**]. 2. Hypertension. 3. Hyperlipidemia. 4. Ring worm of his left leg - now at approximately 30 to 40 days of treatment. 5. Colitis. 6. Renal calculi. 7. History of deep venous thrombosis in the [**2091**]. PAST SURGICAL HISTORY: 1. Bilateral hip replacements for avascular necrosis in [**2088**]. 2. Ileostomy. 3. Hernia repair. 4. Kidney stone removal. ALLERGIES: He is allergic to BETA BLOCKERS (which he stated gave him exhaustion). MEDICATIONS ON ADMISSION: Medications at the time he was seen preoperatively were Crestor 20 mg by mouth once daily, Accupril 20 mg by mouth once daily, aspirin 325 mg by mouth once daily, and Polycitra twice daily. SOCIAL HISTORY: The patient is retired. He lives in [**Location **] with his wife. [**Name (NI) **] quit smoking 35 years ago with a 30-pack- year history. He also admitted to three alcoholic drinks per day. FAMILY HISTORY: He has a significant family history with his father deceased of a myocardial infarction at the age of 55 and mother with coronary artery disease. PHYSICAL EXAMINATION ON ADMISSION: The patient was 6 feet 2 inches tall, weight was 205 pounds, in sinus rhythm at 75, respiratory rate was 17, blood pressure was 167/79, and he was saturating 97 percent on room air. He was lying flat in bed status post catheterization. In no apparent distress. He was alert and oriented times three and appropriate. He had no carotid bruits. His lungs were clear bilaterally/anteriorly. His heart was regular in rate and rhythm. S1 and S2 tones. No murmurs, rubs, or gallops. His abdomen was flat, soft, nontender, and nondistended. There were positive bowel sounds and an ileostomy present. His left groin area was reddened with a small 1.5-cm round reddened area. His extremities were warm and well perfused. There was no edema. No varicosities. The right was dressed at his cardiac catheterization site with no apparent hematoma. He had 2 plus bilateral radial pulses and 1 plus bilateral dorsalis pedis pulses. There was a 2 plus posterior tibial pulse on the right and a 1 plus posterior tibial pulse on the left. PREOPERATIVE LABORATORY DATA: White blood cell count was 5.9, hematocrit was 34, and platelet count was 309,000. Sodium was 136, potassium was 4.3, chloride was 101, bicarbonate was 23, blood urea nitrogen was 20, creatinine was 1, and blood sugar was 146. Prothrombin time was 12.7, partial thromboplastin time was 30.4, and INR was 1. ALT was 17, AST was 21, alkaline phosphatase was 84, total bilirubin was 0.5, and albumin was 4.2. Urinalysis was unremarkable. RADIOLOGY: A preoperative chest x-ray showed no acute cardiopulmonary process. Please refer to the official chest x-ray report dated [**2106-10-27**]. A preoperative electrocardiogram dated [**2106-9-25**] showed a sinus rhythm at 68 with an apparent normal ECG. SUMMARY OF HOSPITAL COURSE: The patient was discharged with instructions to come back the same day. The patient was admitted on [**2106-11-1**]. The patient was admitted on that day and underwent coronary artery bypass grafting times four by Dr. [**First Name (STitle) **] [**Name (STitle) **] with a left internal mammary artery to the left anterior descending, vein graft to the left anterior descending distally, a vein graft to the ramus, and a vein graft to the posterior descending artery. He was transferred to the Cardiothoracic Intensive Care Unit in stable condition on a titrated propofol drip. On postoperative day one, the patient was hemodynamically stable. His blood pressure was 116/53 and a heart rate of 83 (in sinus rhythm). He was on no drips at that time. Postoperative laboratories were as follows. White count was 7.5, hematocrit was 25.4, potassium was 4.5, blood urea nitrogen was 14, and creatinine was 1. He was extubated overnight and was saturating 97 percent on 2 liters nasal cannula. He was alert and oriented. He was moving all extremities. He had some ST elevations which were unchanged since the prior evening. His arterial line was discontinued. He was started on his beta blockade with metoprolol. Chest tubes were removed that morning. He was increased his increased diet and activity well. His pacing wires were also removed on postoperative day two. He also began aspirin therapy. His beta blockade was at 12.5 mg per daily. His hematocrit rose slightly to 27.8. He had no events overnight. He was doing well. He also started his oral iron and vitamin C. He was transferred out to the floor on [**2106-11-3**] (postoperative day two). He began to work with nursing and physical therapist, and his activity level was advanced appropriately. On postoperative day three, his creatinine rose slightly to 1.2. He was restarted on his cholesterol medication. His sternum was stable. He was alert and oriented, and his examination was nonfocal. The incisions were clean, dry, and intact with a functioning ileostomy in place. He was transfused one unit of packed red blood cells for a hematocrit of 22.8. He was also seen and evaluated by Case Management, and an evaluation was done by Physical Therapy. He was taking Percocet as an as needed pain management. He was encouraged to use his incentive spirometer and to increase his activity level. On [**11-5**], it was noted that the patient had a 3-cm pericardial effusion with some tamponade physiology. He was taken to the Cardiac Catheterization Laboratory for this to be tapped. His blood pressure was 168/86 with a central venous pressure of 16 at that time. The patient was stable and was taken for an elective pericardiocentesis by Cardiology. There was 450 cc of bloody fluid removed. The patient felt much better and was able to increase his activity level after the transfusion and pericardiocentesis. On postoperative day four, his lungs were a little rhonchorous. He did complain of feeling a little bit jittery and anxious. His examination was otherwise unremarkable. He had trace peripheral edema. The incisions were clean, dry, and intact. He was transferred back to the Intensive Care Unit for monitoring that night after his pericardiocentesis and a pericardial drain had been placed. His cortis was discontinued on postoperative day five, and the pericardial drain was removed on day six. His hematocrit rose to 29.9. He was hemodynamically stable. He was saturating 97 percent on room air. He was transferred back to the floor. His Lopressor was increased. He was evaluated by Physical Therapy again. On postoperative day seven - [**11-8**] - he was discharged to home with VNA services. His examination was unremarkable. He was hemodynamically stable with a blood pressure of 140/90, in a sinus rhythm at 93. Discharge laboratories were as follows. White count was 8.5, hematocrit was 28.7, and platelet count was 433,000. Potassium was 4.4, blood urea nitrogen was 12, and creatinine was 1. The patient was also given albuterol inhaler as needed. DISCHARGE DISPOSITION: His incisions were clean, dry, and intact. He was discharged to home with VNA services with the following discharge diagnoses. DISCHARGE DIAGNOSES: 1. Status post coronary artery bypass grafting times four. 2. Status post pericardiocentesis. 3. Coronary artery disease; status post left anterior descending stent in [**2098**]. 4. Hypertension. 5. Hyperlipidemia. 6. Ring worm of left leg. 7. Colitis. 8. Kidney stones. 9. Deep venous thrombosis. MEDICATIONS ON DISCHARGE: 1. Vitamin C 500 mg by mouth twice daily. 2. Crestor 20 mg by mouth once daily. 3. Enteric coated aspirin 81 mg by mouth once daily. 4. Ferrous sulfate 325 mg by mouth once daily 5. Lasix 20 mg by mouth twice daily (for seven days). 6. Dilaudid 2 mg by mouth q.6h. as needed (for pain). 7. Ibuprofen 400 mg by mouth q.8h. as needed (for pain). 8. Metoprolol 50 mg by mouth once daily. 9. Zantac 150 mg by mouth twice daily. 10. Potassium chloride 20 mEq by mouth twice daily (for seven days). DISCHARGE INSTRUCTIONS: 1. The patient was instructed to follow up with Dr. [**First Name (STitle) **] [**Name (STitle) **] (his surgeon) for a postoperative surgical visit in the office in one months. 2. The patient was instructed to follow up with his primary care physician (Dr. [**Last Name (STitle) 1637**] in approximately two to three weeks post discharge. DISCHARGE STATUS: The patient was discharged to home on [**2106-11-8**]. CONDITION ON DISCHARGE: Stable. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 5897**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2106-12-20**] 11:45:33 T: [**2106-12-20**] 12:42:41 Job#: [**Job Number 41996**]

414,411,420,997,401,272

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acute idiopathic pericarditis,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia'}

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: This is a 66-year-old male with known coronary artery disease (status post left anterior descending stent in [**2098**]) who reported a mild burning sensation in his chest with yard work which resolved with rest. MEDICAL HISTORY: 1. Coronary artery disease; status post left anterior descending stent in [**2098**]. 2. Hypertension. 3. Hyperlipidemia. 4. Ring worm of his left leg - now at approximately 30 to 40 days of treatment. 5. Colitis. 6. Renal calculi. 7. History of deep venous thrombosis in the [**2091**]. MEDICATION ON ADMISSION: Medications at the time he was seen preoperatively were Crestor 20 mg by mouth once daily, Accupril 20 mg by mouth once daily, aspirin 325 mg by mouth once daily, and Polycitra twice daily. ALLERGIES: He is allergic to BETA BLOCKERS (which he stated gave him exhaustion). PHYSICAL EXAM: FAMILY HISTORY: He has a significant family history with his father deceased of a myocardial infarction at the age of 55 and mother with coronary artery disease. SOCIAL HISTORY: The patient is retired. He lives in [**Location **] with his wife. [**Name (NI) **] quit smoking 35 years ago with a 30-pack- year history. He also admitted to three alcoholic drinks per day. ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acute idiopathic pericarditis,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 73-year-old gentleman with a history of atrial fibrillation on Coumadin and chronic EtOH abuse, who fell walking his dog. Patient was transferred from an outside hospital to [**Hospital1 346**] for further management of a large parietal-temporal hemorrhage. MEDICAL HISTORY: 1. Atrial fibrillation. 2. Prostate cancer status post prostatectomy. 3. Asthma. 4. Myocardial infarction. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Closed fracture of vault of skull with cerebral laceration and contusion, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Cardiac arrest,Acute alcoholic intoxication in alcoholism, unspecified,Pneumonitis due to inhalation of food or vomitus,Bacteremia,Fall from other slipping, tripping, or stumbling

Cl skul vlt fx-deep coma,Cardiac arrest,Ac alcohol intox-unspec,Food/vomit pneumonitis,Bacteremia,Fall from slipping NEC

Admission Date: [**2123-9-14**] Discharge Date: [**2123-10-6**] Date of Birth: [**2050-8-12**] Sex: M Service: HISTORY OF PRESENT ILLNESS: The patient is a 73-year-old gentleman with a history of atrial fibrillation on Coumadin and chronic EtOH abuse, who fell walking his dog. Patient was transferred from an outside hospital to [**Hospital1 346**] for further management of a large parietal-temporal hemorrhage. PAST MEDICAL HISTORY: 1. Atrial fibrillation. 2. Prostate cancer status post prostatectomy. 3. Asthma. 4. Myocardial infarction. PHYSICAL EXAMINATION: On physical examination, the patient is not following commands. Draws upper and lower extremities on the right side. Left lower and left upper withdraws to pain. Pupils are equal and 3 mm and brisk. Has swelling over the right eye. He had an immediate repeat head CT scan on admission which showed bifrontal subarachnoid hemorrhage and continued right parietal-temporal hemorrhage with no midline shift. The patient was intubated and transferred to the Intensive Care Unit for close monitoring. Patient on [**2123-9-15**] opened his eyes. Pupils are 5 down to 3 mm, briskly reactive, following commands in the right upper extremity and bilateral lower extremities. No movement of the left upper extremity. The patient received fresh-frozen plasma to correct his INR to keep it below 1.3. On [**2123-9-17**], the patient was extubated. Neurologically, awake and attentive. Pupils 5 down to 4 mm and brisk, following commands in all extremities except for the left upper extremity which was weak from admission without change. The patient is being treated with Levaquin for Klebsiella in his urine. Patient was transferred to the regular floor on [**2123-9-18**], continued to require no significant respiratory care. Was awake, moving all extremities except for the left upper extremity, following commands. He was seen by Physical Therapy and Occupational Therapy, and was planning for discharge to rehabilitation once medically stable. On [**2123-9-20**], the patient was in respiratory distress. The patient was given nebulizer treatments and respiratory status stabilized. The patient had a swallow evaluation which he failed and had to have PEG placement. GI was consulted, and patient had ultrasound to rule out ascites prior to PEG placement due to his long EtOH history. The patient was found to have no evidence of ascites and a PEG was placed by the GI service without complication. The patient had a repeat MRI scan on [**2123-9-25**] which showed a small new thalamic hemorrhage. The patient had flaccid left upper extremity moving the right upper extremity better than previous day, and the patient was perseverating. Continued to have respiratory distress, and requiring multiple breathing treatments as well as chest PT. On [**2123-9-26**], the patient was transferred to the Intensive Care Unit due to decreased O2 sats down to 92%. Patient requiring aggressive pulmonary toilet. The patient remained in the Intensive Care Unit until [**2123-9-28**], the patient became unresponsive. A repeat scan shows a complete left PCA stroke and left new frontal stroke. The previous scan from [**9-23**] showed a thalamic and left PCA stroke. MRA at that time showed a worsening of the left MCA and distal left P2 stenosis. The patient was open his eyes to verbal stimuli, following commands in the upper extremity. Continues to be weak in the left upper extremity as before. Right upper extremity was moving spontaneously. Pupils were 5 down to 2 mm. The patient continued to have problems with respiratory distress and was diagnosed with methicillin-resistant Staphylococcus aureus from a line on [**2123-10-5**], and was being treated with Vancomycin and Cipro. On [**2123-10-6**], a code was called for patient and respiratory arrest. The patient was coded at approximately 4:20 am, the code proceeded until 4:42 am when the patient was pronounced dead at 4:42 am. [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 1133**] Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2124-3-2**] 10:10 T: [**2124-3-2**] 10:31 JOB#: [**Job Number **]

800,427,303,507,790,E885

{'Closed fracture of vault of skull with cerebral laceration and contusion, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Cardiac arrest,Acute alcoholic intoxication in alcoholism, unspecified,Pneumonitis due to inhalation of food or vomitus,Bacteremia,Fall from other slipping, tripping, or stumbling'}

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 73-year-old gentleman with a history of atrial fibrillation on Coumadin and chronic EtOH abuse, who fell walking his dog. Patient was transferred from an outside hospital to [**Hospital1 346**] for further management of a large parietal-temporal hemorrhage. MEDICAL HISTORY: 1. Atrial fibrillation. 2. Prostate cancer status post prostatectomy. 3. Asthma. 4. Myocardial infarction. MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Closed fracture of vault of skull with cerebral laceration and contusion, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Cardiac arrest,Acute alcoholic intoxication in alcoholism, unspecified,Pneumonitis due to inhalation of food or vomitus,Bacteremia,Fall from other slipping, tripping, or stumbling'}

CHIEF COMPLAINT: Bright red blood per rectum. PRESENT ILLNESS: The patient is a 37-year-old gentleman with C6-C7 quadriplegia, hemorrhoids, and a 3-month history of rectal bleeding who reportedly awoke in a pool of bright red blood per rectum around his wheelchair on the day prior to admission. MEDICAL HISTORY: 1. C6-C7 quadriplegia complicated by a neurogenic bladder and bowel following a motor vehicle crash in [**2119**]. 2. Stage IV chronic decubitus ulcerations. 3. Recurrent urinary tract infections. 4. Peptic ulcer disease. 5. Substance abuse. 6. Positive purified protein derivative treated in the past. 7. Hemorrhoids. 8. Labile blood pressures. 9. Chronic osteomyelitis of the right ischial tuberosity treated with six weeks of levofloxacin and metronidazole in [**2140-5-31**]. 10. Depression and impulse control disorder. MEDICATION ON ADMISSION: 1. Docusate 200 mg by mouth twice per day. 2. Bupropion 150 mg by mouth twice per day. 3. Gabapentin 100 mg by mouth three times per day. 4. Milk of Magnesia 30 cc by mouth at hour of sleep. 5. Senna two tablets by mouth at hour of sleep. 6. Baclofen 10 mg by mouth four times per day. 7. Combivent 1 to 2 puffs inhaled q.6h. as needed (for wheezing). 8. Diazepam 5 mg by mouth q.6h. as needed (for anxiety). 9. Ensure one can by mouth three times per day. 10. Super Cereal by mouth every other day. 11. Hydromorphone 3 mg subcutaneously before dressing changes. 12. Iron sulfate 325 mg by mouth once per day. 13. Multivitamin one tablet by mouth once per day. 14. Pantoprazole 40 mg by mouth once per day. 15. Anusol suppositories per rectum once per day. ALLERGIES: 1. PENICILLIN (causes angioedema). 2. VANCOMYCIN (causes a rash). 3. GENTAMICIN (causes urticaria). PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives at the [**Hospital **]. He smokes one pack of cigarettes per day. He denies alcohol or illicit drug abuse.

Ulcer of anus and rectum,Hemorrhage of gastrointestinal tract, unspecified,Cocaine abuse, unspecified,Quadriplegia, unspecified,Depressive disorder, not elsewhere classified,Neurogenic bladder NOS,Constipation, unspecified

Rectal & anal ulcer,Gastrointest hemorr NOS,Cocaine abuse-unspec,Quadriplegia, unspecifd,Depressive disorder NEC,Neurogenic bladder NOS,Constipation NOS

Admission Date: [**2140-9-16**] Discharge Date: [**2140-9-17**] Date of Birth: [**2102-8-24**] Sex: M Service: ICU CHIEF COMPLAINT: Bright red blood per rectum. HISTORY OF PRESENT ILLNESS: The patient is a 37-year-old gentleman with C6-C7 quadriplegia, hemorrhoids, and a 3-month history of rectal bleeding who reportedly awoke in a pool of bright red blood per rectum around his wheelchair on the day prior to admission. The patient went to the commode to clean himself, and he reports that he sustained a syncopal episode at that time. The emergency medical technicians reportedly found the patient unresponsive on the commode with a blood pressure of 90/50 and a heart rate of 82. On arrival to the [**Hospital1 69**] Emergency Department, the patient's blood pressure was 88/74 which subsequently increased to the 110 range systolically but then decreased to the 60s to 70s systolically soon thereafter. He received 4 liters to 5 liters of normal saline in the Emergency Department with only 250 cc of urine output. He refused a blood transfusion. He had guaiac-positive brown stool in the Emergency Department where he also complained of lightheadedness, mild dyspnea, and rectal pain. The patient denied abdominal pain, nausea, vomiting, or cloudy/foul smelling urine. He denied recent substance abuse. Of note, the patient performs daily manual rectal disimpactions. PAST MEDICAL HISTORY: 1. C6-C7 quadriplegia complicated by a neurogenic bladder and bowel following a motor vehicle crash in [**2119**]. 2. Stage IV chronic decubitus ulcerations. 3. Recurrent urinary tract infections. 4. Peptic ulcer disease. 5. Substance abuse. 6. Positive purified protein derivative treated in the past. 7. Hemorrhoids. 8. Labile blood pressures. 9. Chronic osteomyelitis of the right ischial tuberosity treated with six weeks of levofloxacin and metronidazole in [**2140-5-31**]. 10. Depression and impulse control disorder. ALLERGIES: 1. PENICILLIN (causes angioedema). 2. VANCOMYCIN (causes a rash). 3. GENTAMICIN (causes urticaria). MEDICATIONS ON ADMISSION: 1. Docusate 200 mg by mouth twice per day. 2. Bupropion 150 mg by mouth twice per day. 3. Gabapentin 100 mg by mouth three times per day. 4. Milk of Magnesia 30 cc by mouth at hour of sleep. 5. Senna two tablets by mouth at hour of sleep. 6. Baclofen 10 mg by mouth four times per day. 7. Combivent 1 to 2 puffs inhaled q.6h. as needed (for wheezing). 8. Diazepam 5 mg by mouth q.6h. as needed (for anxiety). 9. Ensure one can by mouth three times per day. 10. Super Cereal by mouth every other day. 11. Hydromorphone 3 mg subcutaneously before dressing changes. 12. Iron sulfate 325 mg by mouth once per day. 13. Multivitamin one tablet by mouth once per day. 14. Pantoprazole 40 mg by mouth once per day. 15. Anusol suppositories per rectum once per day. SOCIAL HISTORY: The patient lives at the [**Hospital **]. He smokes one pack of cigarettes per day. He denies alcohol or illicit drug abuse. PHYSICAL EXAMINATION ON PRESENTATION: On initial physical examination, the patient's temperature was 96.1 degrees Fahrenheit, his blood pressure was 52/27, his heart rate was 63, his respiratory rate was 18, and his oxygen saturation was 99% on room air. The patient was awake, alert, and oriented times three. He was in no acute distress. He had slightly dry oral mucosa, and his oropharynx was clear. His neck was supple without meningismus. His heart was regular in rate and rhythm. There were normal first heart sounds and second heart sounds. There were no murmurs, rubs, or gallops. The lung examination revealed trace left-sided basilar crackles but were otherwise clear to auscultation bilaterally. The abdomen was soft. There was mild right upper quadrant tenderness in the context of globally decreased sensation. There was a normal liver span. [**Doctor Last Name **] sign was not present. Extremity examination revealed there was no peripheral edema. There were healed bilateral lower extremity ulcerations and abrasions. The extremities were warm and dry. Rectal examination demonstrated reddish brown guaiac-positive stool (per the Emergency Department). There was a mildly foul-smelling well granulated sacral decubitus ulceration without obvious abscess, drainage, or fluid collection. PERTINENT LABORATORY VALUES ON PRESENTATION: Initial laboratory values demonstrated a white blood cell count of 8.6 (58% neutrophils, 35% lymphocytes, and 3% monocytes), his hematocrit was 38.7, and his platelets were 275,000. His mean cell volume was 83. Serum chemistries were unremarkable. Initial urinalysis was negative. Initial urine toxicology screen was positive for cocaine. PERTINENT RADIOLOGY/IMAGING: Electrocardiogram demonstrated a normal sinus rhythm at 58 beats per minute. Normal axis and intervals. A 0.5-mm J-point elevation in leads V4 through V6 that were also seen on an old electrocardiogram. There were no acute ST segment or T wave changes. A chest x-ray demonstrated tall lung field, poor visualization of the left retrocardiac area, and no pulmonary edema. CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM: 1. GASTROINTESTINAL ISSUES: There was no further gastrointestinal bleeding following admission. A colonoscopy done on hospital day two demonstrated ulcerations in the distal rectum but was otherwise normal to the hepatic flexure with no blood or other bleeding site noted. The patient was started on daily Anusol HC suppositories and should treat his constipation with other techniques (such as bisacodyl suppositories or MiraLax) to avoid rectal trauma. 2. CARDIOVASCULAR ISSUES: After aggressive resuscitation with intravenous fluids, the patient's blood pressure remained stable. Of note, he has a labile blood pressure at baseline and typically runs in the 80s to 90s systolic. He was initially started on broad spectrum antibiotics (levofloxacin and metronidazole) out of concern for possible septic shock, but these were discontinued once his blood pressure stabilized, and he remained afebrile without leukocytosis. His hematocrit stabilized at his baseline at the time of discharge. All of his culture data were negative at the time of discharge. CONDITION AT DISCHARGE: Condition on discharge was stable. DISCHARGE STATUS: The patient was to be returned to the [**Hospital **] in [**Location 1268**], [**State 350**]. MEDICATIONS ON DISCHARGE: 1. Docusate 200 mg by mouth twice per day. 2. Bupropion 150 mg by mouth twice per day. 3. Gabapentin 100 mg by mouth three times per day. 4. Milk of Magnesia 30 cc by mouth at hour of sleep. 5. Senna two tablets by mouth at hour of sleep. 6. Baclofen 10 mg by mouth four times per day. 7. Combivent 1 to 2 puffs inhaled q.6h. as needed (for wheezing). 8. Diazepam 5 mg by mouth q.6h. as needed (for anxiety). 9. Ensure one can by mouth three times per day. 10. Super Cereal by mouth every other day. 11. Hydromorphone 3 mg subcutaneously before dressing changes. 12. Iron sulfate 325 mg by mouth once per day. 13. Multivitamin one tablet by mouth once per day. 14. Pantoprazole 40 mg by mouth once per day. 15. Anusol HC suppositories per rectum once per day. 16. Bisacodyl suppository 10 mg per rectum once per day. DISCHARGE DIAGNOSES: 1. Lower gastrointestinal bleed. 2. Rectal ulceration. 3. Substance abuse. DISCHARGE INSTRUCTIONS/FOLLOWUP: 1. The [**Hospital3 4262**] nurse practitioner was to see the patient at his nursing home on the day following discharge. 2. The patient's primary care physician (Dr. [**First Name8 (NamePattern2) 402**] [**Last Name (NamePattern1) 7461**]) was to make arrangements to follow up with the patient next week. [**Name6 (MD) **] [**Last Name (NamePattern4) 5837**], M.D. [**MD Number(1) 5838**] Dictated By:[**Name8 (MD) 2507**] MEDQUIST36 D: [**2140-9-17**] 17:02 T: [**2140-9-20**] 09:22 JOB#: [**Job Number 107409**]

569,578,305,344,311,596,564

{'Ulcer of anus and rectum,Hemorrhage of gastrointestinal tract, unspecified,Cocaine abuse, unspecified,Quadriplegia, unspecified,Depressive disorder, not elsewhere classified,Neurogenic bladder NOS,Constipation, unspecified'}

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: Bright red blood per rectum. PRESENT ILLNESS: The patient is a 37-year-old gentleman with C6-C7 quadriplegia, hemorrhoids, and a 3-month history of rectal bleeding who reportedly awoke in a pool of bright red blood per rectum around his wheelchair on the day prior to admission. MEDICAL HISTORY: 1. C6-C7 quadriplegia complicated by a neurogenic bladder and bowel following a motor vehicle crash in [**2119**]. 2. Stage IV chronic decubitus ulcerations. 3. Recurrent urinary tract infections. 4. Peptic ulcer disease. 5. Substance abuse. 6. Positive purified protein derivative treated in the past. 7. Hemorrhoids. 8. Labile blood pressures. 9. Chronic osteomyelitis of the right ischial tuberosity treated with six weeks of levofloxacin and metronidazole in [**2140-5-31**]. 10. Depression and impulse control disorder. MEDICATION ON ADMISSION: 1. Docusate 200 mg by mouth twice per day. 2. Bupropion 150 mg by mouth twice per day. 3. Gabapentin 100 mg by mouth three times per day. 4. Milk of Magnesia 30 cc by mouth at hour of sleep. 5. Senna two tablets by mouth at hour of sleep. 6. Baclofen 10 mg by mouth four times per day. 7. Combivent 1 to 2 puffs inhaled q.6h. as needed (for wheezing). 8. Diazepam 5 mg by mouth q.6h. as needed (for anxiety). 9. Ensure one can by mouth three times per day. 10. Super Cereal by mouth every other day. 11. Hydromorphone 3 mg subcutaneously before dressing changes. 12. Iron sulfate 325 mg by mouth once per day. 13. Multivitamin one tablet by mouth once per day. 14. Pantoprazole 40 mg by mouth once per day. 15. Anusol suppositories per rectum once per day. ALLERGIES: 1. PENICILLIN (causes angioedema). 2. VANCOMYCIN (causes a rash). 3. GENTAMICIN (causes urticaria). PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives at the [**Hospital **]. He smokes one pack of cigarettes per day. He denies alcohol or illicit drug abuse. ### Response: {'Ulcer of anus and rectum,Hemorrhage of gastrointestinal tract, unspecified,Cocaine abuse, unspecified,Quadriplegia, unspecified,Depressive disorder, not elsewhere classified,Neurogenic bladder NOS,Constipation, unspecified'}

CHIEF COMPLAINT: Urosepsis PRESENT ILLNESS: 51F with hx of DM, ESRD s/p kidney/pancreas transplant in [**2159**] presents with no urine output x 12 hours. Pt states that she typically urinates 4-5 times per day but not much each time. This morning, she awoke at 4am and urinated only a few drops and none since that time. She reports some low back pain for the past 2 days for which she has been taking tylenol. No other med changes; has been taking anti-rejection meds as prescribed. Also this am, developed right foot pain, described as a sharp electric pain on the lateral side of her foot. This is typical for her neuropathic pain which she gets every 2-3 months. When she gets the pain, she has been told there is nothing she can do and it resolves on its own. When she has the pain, she cannot walk. She also notes some chills this am, no fevers. She denies any cough, chest pain, shortness of breath, dysuria, joint pains, URI sx. No sick contacts, no recent travel. Pt admits that she does not drink as much fluid as she should. MEDICAL HISTORY: Insulin dependent diabetes mellitus. Hypertension. Cataract surgery. C section times two. h/o End Stage Renal Disease s/p kidney/pancreas tx [**2-11**] s/p ventral hernia repair [**2161-8-7**] MEDICATION ON ADMISSION: Tacrolimus 3mg [**Hospital1 **] Azithioprine 50 mg qd Ranitidine Bactrim qMWF ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam: 98.8, BP 118/80, HR 100, R 24, O2 98%RA Gen: in moderate distress from foot pain HEENT: dry MM, JVD flat CV: tachycardic, regular, no murmurs Chest: clear Abd: +BS, healing scar midline, mildly tender to palpation in LLQ, no rebound or guarding Ext: no edema, right foot exquisitely tender along lateral edge, no podagra noted, no joint tenderness, no erythema or swelling FAMILY HISTORY: Diabetes on the mother's side SOCIAL HISTORY: non-contributory

Complications of transplanted kidney,Other septicemia due to gram-negative organisms,Acute kidney failure with lesion of tubular necrosis,Dehydration,Retention of urine, unspecified,Pancreas replaced by transplant,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Polyneuropathy in diabetes,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled

Compl kidney transplant,Gram-neg septicemia NEC,Ac kidny fail, tubr necr,Dehydration,Retention urine NOS,Trnspl status-pancreas,Hyp kid NOS w cr kid V,Sepsis,Abn react-org transplant,Neuropathy in diabetes,DMII neuro nt st uncntrl

Admission Date: [**2162-4-2**] Discharge Date: [**2162-4-7**] Date of Birth: [**2110-4-24**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3624**] Chief Complaint: Urosepsis Major Surgical or Invasive Procedure: Central line placement History of Present Illness: 51F with hx of DM, ESRD s/p kidney/pancreas transplant in [**2159**] presents with no urine output x 12 hours. Pt states that she typically urinates 4-5 times per day but not much each time. This morning, she awoke at 4am and urinated only a few drops and none since that time. She reports some low back pain for the past 2 days for which she has been taking tylenol. No other med changes; has been taking anti-rejection meds as prescribed. Also this am, developed right foot pain, described as a sharp electric pain on the lateral side of her foot. This is typical for her neuropathic pain which she gets every 2-3 months. When she gets the pain, she has been told there is nothing she can do and it resolves on its own. When she has the pain, she cannot walk. She also notes some chills this am, no fevers. She denies any cough, chest pain, shortness of breath, dysuria, joint pains, URI sx. No sick contacts, no recent travel. Pt admits that she does not drink as much fluid as she should. In ED, foley was placed with return of 10cc of urine. In the MICU, urine and blood cultures were positive for pan-[**Last Name (un) 36**] Klebsiella, and patient was started on Cipro. Patient was anuric for 12 hrs, but urine output increased in MICU. Prograf level was high, so was held when being called out from MICU. Past Medical History: Insulin dependent diabetes mellitus. Hypertension. Cataract surgery. C section times two. h/o End Stage Renal Disease s/p kidney/pancreas tx [**2-11**] s/p ventral hernia repair [**2161-8-7**] Social History: non-contributory Family History: Diabetes on the mother's side Physical Exam: Exam: 98.8, BP 118/80, HR 100, R 24, O2 98%RA Gen: in moderate distress from foot pain HEENT: dry MM, JVD flat CV: tachycardic, regular, no murmurs Chest: clear Abd: +BS, healing scar midline, mildly tender to palpation in LLQ, no rebound or guarding Ext: no edema, right foot exquisitely tender along lateral edge, no podagra noted, no joint tenderness, no erythema or swelling Pertinent Results: [**2162-4-2**] 02:20PM BLOOD WBC-10.2# RBC-4.96 Hgb-16.8* Hct-50.0* MCV-101* MCH-33.8* MCHC-33.5 RDW-14.6 Plt Ct-235 [**2162-4-3**] 06:50AM BLOOD WBC-28.3*# RBC-3.78* Hgb-12.9# Hct-38.5# MCV-102* MCH-34.1* MCHC-33.5 RDW-15.1 Plt Ct-153 [**2162-4-3**] 03:38PM BLOOD WBC-34.6* RBC-4.09* Hgb-13.9 Hct-41.1 MCV-101* MCH-34.1* MCHC-33.9 RDW-15.1 Plt Ct-162 [**2162-4-4**] 06:06AM BLOOD WBC-21.7* RBC-3.51* Hgb-12.0 Hct-36.4 MCV-104* MCH-34.3* MCHC-33.0 RDW-14.9 Plt Ct-112* [**2162-4-5**] 05:26AM BLOOD WBC-23.8* RBC-3.85* Hgb-12.9 Hct-39.5 MCV-103* MCH-33.6* MCHC-32.8 RDW-14.9 Plt Ct-110* [**2162-4-6**] 05:40AM BLOOD WBC-16.6* RBC-4.06* Hgb-13.8 Hct-40.8 MCV-100* MCH-33.9* MCHC-33.7 RDW-15.0 Plt Ct-118* [**2162-4-7**] 05:35AM BLOOD WBC-11.6* RBC-4.37 Hgb-14.9 Hct-42.7 MCV-98 MCH-34.2* MCHC-34.9 RDW-15.4 Plt Ct-78* [**2162-4-2**] 03:30PM BLOOD Glucose-78 UreaN-22* Creat-1.8*# Na-139 K-3.9 Cl-106 HCO3-19* AnGap-18 [**2162-4-3**] 06:50AM BLOOD Glucose-70 UreaN-33* Creat-3.2*# Na-137 K-4.8 Cl-110* HCO3-16* AnGap-16 [**2162-4-3**] 03:38PM BLOOD Glucose-92 UreaN-40* Creat-2.8* Na-138 K-4.4 Cl-111* HCO3-17* AnGap-14 [**2162-4-4**] 06:06AM BLOOD Glucose-76 UreaN-45* Creat-3.1* Na-140 K-5.0 Cl-115* HCO3-15* AnGap-15 [**2162-4-5**] 05:26AM BLOOD Glucose-86 UreaN-60* Creat-4.0* Na-139 K-5.4* Cl-114* HCO3-13* AnGap-17 [**2162-4-6**] 05:40AM BLOOD Glucose-109* UreaN-62* Creat-2.4*# Na-142 K-4.2 Cl-118* HCO3-16* AnGap-12 [**2162-4-7**] 05:35AM BLOOD Glucose-110* UreaN-55* Creat-1.5* Na-144 K-3.3 Cl-117* HCO3-16* AnGap-14 Renal tx U/S: 1) Mild hydronephrosis. 2) Trace amount of perinephric fluid. 3) Resistive indices within normal limits. CXR ([**4-3**]): Single portable radiograph of the chest demonstrates normal cardiomediastinal contour. Lungs are clear. No effusion. Trachea is midline. Brief Hospital Course: 51 F with hx of DM, ESRD requiring kidney/pancreas transplant in [**2159**] admited with renal failure, then developed Klebsiella urosepsis. # Klebsiella urosepsis: Pt initially admitted to hepatorenal service, then transferred to MICU for hypotension, where she responded well to goal-directed therapy. Urine and blood cultures were positive for pansensitive Klebsiella pneumoniae, and she was treated with ciprofloxacin and discharged to complete a 21-day course. # Anuria/ARF: Likely secondary to urosepsis and subsequent prerenal physiology/ATN. Responded to aggressive fluid resuscitation . # s/p Kidney/pancreas transplant: as above, no signs of rejection on renal ultrasound. Tacrolimus decreased to 2 mg [**Hospital1 **], azathioprine was D/C'ed per renal recommendations given thrombocytopenia. She will follow up with her primary transplant nephrologist one week after completing her course of ciprofloxacin. Medications on Admission: Tacrolimus 3mg [**Hospital1 **] Azithioprine 50 mg qd Ranitidine Bactrim qMWF Discharge Medications: 1. Tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO BID (2 times a day). 2. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO twice a day for 16 days. Disp:*32 Tablet(s)* Refills:*0* 3. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) Tablet PO MWF (Monday-Wednesday-Friday). 4. Famotidine 20 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Home Discharge Diagnosis: Klebsiella urosepsis Secondary: DM ESRD s/p kidney and pancreas transplant HTN Discharge Condition: Stable tolerating PO and ambulating Discharge Instructions: Please keep your follow-up appointments Please take your medications as directed Please call your doctor or return to the ER for: 1. chest pain 2. shortness of breath 3. fever to 100.4 4. weight gain of more than 3 pounds 5. dizziness or fainting 6. other concerning symptoms Followup Instructions: Provider: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2162-5-3**] 10:10 Please go to the [**Hospital Ward Name 23**] clinical center at [**Hospital1 18**] to have your labs checked in 1 week (chem 7, prograf, CBC) [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**] MD [**MD Number(1) 3629**]

996,038,584,276,788,V428,403,995,E878,357,250

{'Complications of transplanted kidney,Other septicemia due to gram-negative organisms,Acute kidney failure with lesion of tubular necrosis,Dehydration,Retention of urine, unspecified,Pancreas replaced by transplant,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Polyneuropathy in diabetes,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled'}

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: Urosepsis PRESENT ILLNESS: 51F with hx of DM, ESRD s/p kidney/pancreas transplant in [**2159**] presents with no urine output x 12 hours. Pt states that she typically urinates 4-5 times per day but not much each time. This morning, she awoke at 4am and urinated only a few drops and none since that time. She reports some low back pain for the past 2 days for which she has been taking tylenol. No other med changes; has been taking anti-rejection meds as prescribed. Also this am, developed right foot pain, described as a sharp electric pain on the lateral side of her foot. This is typical for her neuropathic pain which she gets every 2-3 months. When she gets the pain, she has been told there is nothing she can do and it resolves on its own. When she has the pain, she cannot walk. She also notes some chills this am, no fevers. She denies any cough, chest pain, shortness of breath, dysuria, joint pains, URI sx. No sick contacts, no recent travel. Pt admits that she does not drink as much fluid as she should. MEDICAL HISTORY: Insulin dependent diabetes mellitus. Hypertension. Cataract surgery. C section times two. h/o End Stage Renal Disease s/p kidney/pancreas tx [**2-11**] s/p ventral hernia repair [**2161-8-7**] MEDICATION ON ADMISSION: Tacrolimus 3mg [**Hospital1 **] Azithioprine 50 mg qd Ranitidine Bactrim qMWF ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam: 98.8, BP 118/80, HR 100, R 24, O2 98%RA Gen: in moderate distress from foot pain HEENT: dry MM, JVD flat CV: tachycardic, regular, no murmurs Chest: clear Abd: +BS, healing scar midline, mildly tender to palpation in LLQ, no rebound or guarding Ext: no edema, right foot exquisitely tender along lateral edge, no podagra noted, no joint tenderness, no erythema or swelling FAMILY HISTORY: Diabetes on the mother's side SOCIAL HISTORY: non-contributory ### Response: {'Complications of transplanted kidney,Other septicemia due to gram-negative organisms,Acute kidney failure with lesion of tubular necrosis,Dehydration,Retention of urine, unspecified,Pancreas replaced by transplant,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Polyneuropathy in diabetes,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: ESRD [**1-28**] nephritis, hypertension PRESENT ILLNESS: MEDICAL HISTORY: 1. ESRD 2. Nephritis 3. HTN 4. afib with pleurodesis surgery [**1-31**] 5. insertion of peritoneal dialysis catheter [**5-30**] 6. gerd 7. enlarged thyroid, no meds 8. pleuroperitoneal fistula [**1-31**] with thoracoscopy/pleurodesis 9. MEDICATION ON ADMISSION: nephrocap 1 cap qd, protonix 40 qd, labetolol 200 [**Hospital1 **], renalgel with meals ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: alert, healthy appearing, NAD upper/lower dentures, mallampati (classIII), Cor: Nl S1S2,HR 69, no murmurs, no carotid bruits. 136/88 Lungs clear. 97% RA. EKG sinus brady abd: soft, non-tender, umbilical hernia, peritoneal dialysis cath exit. LLQ ext: no edema, +dp bilat FAMILY HISTORY: SOCIAL HISTORY: denies smoking. drinks etoh x1/week. Lives alone. Self-employed designer. Protestant.

Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Cardiac complications, not elsewhere classified,Atrial fibrillation,Retention of urine, unspecified,Umbilical hernia without mention of obstruction or gangrene

Hyp kid NOS w cr kid V,Surg compl-heart,Atrial fibrillation,Retention urine NOS,Umbilical hernia

Admission Date: [**2195-6-2**] Discharge Date: [**2195-6-9**] Date of Birth: [**2128-7-13**] Sex: F Service: [**Last Name (un) **] REASON FOR ADMISSION: Living related kidney transplant. ADMISSION DIAGNOSIS: End stage renal disease. DETAILS OF HOSPITAL COURSE: [**Known firstname 48299**] is a 66 year-old female with end stage renal disease who presented to the transplant team after completing a pretest and workup with a suitable donor who has also completed a pretransplant workup, was cross match negative for transplantation. They were taken to the operating room and underwent a living related kidney transplant [**2195-6-2**] where they received a standard course of induction of immunosuppression, which includes 4 doses of Thymoglobulin followed by Prograf and CellCept and rapid steroid withdraw. Her initial hospital course was essentially uncomplicated. She had excellent early graft function. The Foley catheter was removed on postoperative day 3. She advanced to a regular diet on postoperative day 3. Patient controlled anesthesia was also discontinued on postoperative day 3. Postoperative day 4 the [**First Name8 (NamePattern2) 1661**] [**Last Name (NamePattern1) 1662**] drain was removed from her retroperitoneum. Despite this we had difficulty maintaining keeping adequate Prograf levels, which we target in 10 to 15 range and prior to discharge were in the 6.5 on the 13th and 7.4 on the 14th. Thus prolonging her hospital stay by at least 2 days. Eventually she was able to get satisfactory levels and was discharged home on the 14th. The patient will follow up with the transplant team in 1 week. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], MD Dictated By:[**Last Name (NamePattern4) 3433**] MEDQUIST36 D: [**2195-7-6**] 08:17:16 T: [**2195-7-6**] 08:31:56 Job#: [**Job Number 52770**] Admission Date: [**2195-6-2**] Discharge Date: [**2195-6-9**] Date of Birth: [**2128-7-13**] Sex: F Service: SURGERY Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 668**] Chief Complaint: ESRD [**1-28**] nephritis, hypertension Major Surgical or Invasive Procedure: living related kidney transplant [**2195-6-2**] Past Medical History: 1. ESRD 2. Nephritis 3. HTN 4. afib with pleurodesis surgery [**1-31**] 5. insertion of peritoneal dialysis catheter [**5-30**] 6. gerd 7. enlarged thyroid, no meds 8. pleuroperitoneal fistula [**1-31**] with thoracoscopy/pleurodesis 9. Social History: denies smoking. drinks etoh x1/week. Lives alone. Self-employed designer. Protestant. Physical Exam: alert, healthy appearing, NAD upper/lower dentures, mallampati (classIII), Cor: Nl S1S2,HR 69, no murmurs, no carotid bruits. 136/88 Lungs clear. 97% RA. EKG sinus brady abd: soft, non-tender, umbilical hernia, peritoneal dialysis cath exit. LLQ ext: no edema, +dp bilat Pertinent Results: [**2195-6-2**] 01:00PM GLUCOSE-142* UREA N-47* CREAT-7.1* SODIUM-134 POTASSIUM-4.5 CHLORIDE-96 TOTAL CO2-22 ANION GAP-21* [**2195-6-2**] 01:00PM CALCIUM-9.2 PHOSPHATE-5.0*# MAGNESIUM-1.7 [**2195-6-2**] 01:00PM WBC-13.8* RBC-3.08* HGB-10.7* HCT-31.1* MCV-101* MCH-34.7* MCHC-34.3 RDW-14.5 [**2195-6-2**] 01:00PM PLT COUNT-283 [**2195-6-2**] 01:00PM PT-12.4 PTT-26.7 INR(PT)-1.0 [**2195-6-2**] 10:45AM TYPE-ART PO2-234* PCO2-42 PH-7.40 TOTAL CO2-27 BASE XS-1 [**2195-6-2**] 10:45AM GLUCOSE-153* LACTATE-1.3 NA+-131* K+-4.9 CL--95* [**2195-6-2**] 10:45AM HGB-10.2* calcHCT-31 [**2195-6-2**] 10:45AM freeCa-1.2 Brief Hospital Course: Taken to OR [**2195-6-2**] for living related kidney transplant and repair of umbilical hernia. She was stable intraop. See operative report for details. She produced urine immediately via foley. She received induction immunosuppression therapy with ATG, Cellcelpt and solumedrol. EBL was 100cc. She was monitored in the PACU then transferrred out to the transplant unit where she was given IV fluid replacement matching of urine output. Post op creatinine was 7.1 and hematocrit 31.1. She was started on prograf 2mg [**Hospital1 **] pod 0. POD 1, she produced 8 liters of urine on pod 1. Creatinine dropped to 1.8. She received maintenance and replacement IV fluid via a right central line. PCA morphine was used for pain control and diet was slowly advanced. JP drained 200cc of serosang fluid. Nephrology followed along closely during this hospitalization. BP was 139/75 with heart rate of 85. POD 2 BP was 160/100. IV replacement was decreased to 1/2 cc/cc urine output. Patient complained of heart pounding. An ekg revealed rapid afib. Lopressor 5mg IV was given with BP decreasing to 120-130/80 and heartrate 140's. IV diltiazem 15mg was given once. Heart rate was irregularly irregular. Troponin and cpk were done. These were normal. Hematocrit was 29.7. She was transferred to the CCU. She was started on a diltiazem drip. This was later changed to an amiodarone drip. On POD 2, bp was 136/75 and hR 97. Cardiology was consulted. Labetolol was changed to lopressor 150mg [**Hospital1 **] and po diltiazem was started. EKG was repeated. She was in Aflutter. She was placed on a Heparin drip. A TSH was checked. This was 0.59. Foley catheter was removed. She received ATG and tapering solumedrol dose. Prograf level was 5.9. On POD 3, creatinine was 0.9, potassium 3.8, hct 28.9 adn urine output was 2050cc. Heart rate was RRR. BP was 109-127/60's. She was off diltiazem. Phosphorus was replaced for a low phosphorus. Valcyte was increased to 900mg qd as creatinine was normal. Troponins and CKs were negative x3. On POD 4, she was ruled out for MI. Lopressor was increased to 150mg tid and transferred back to the transplant unit where she was monitored by telemetry. Coumadin 4mg was initiated. Heart rate continued to run in 50-70 range. Urine output was stable. ATG was stopped. Solumedrol was decreased to prednisone, cellcept and prograf continued. She remained in sinus rhythm. POD 5, JP continued to drain ~ 110cc of serosanguinous fluid. Hematocrit was 29. Foley was removed. She was voiding in small frequent amounts and she complained of incision pain. She was given po percocets. She was passing flatus and was tolerating a regular diet. She continued to have sharp bladder pains. On POD 6, A bladder scan revealed a 750ml residual. The foley catheter was replaced and a ua/c&s was sent. Coumadin was continued at 2mg qd. Her cardiologist Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**Name (NI) 653**]. [**Name2 (NI) **] will see her [**6-10**] at 12:30, as an outpatient, and will check holter monitor/ekg to determine if she is in PAF to determine if she will need coumadin long term . On POD, 6, the foley catheter was removed. She was able to void with a post void residual of 100cc. Labs were as follows:Hematology COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct [**2195-6-9**] 06:10AM 11.8* 2.91* 10.0* 29.6* 102* 34.5* 33.9 15.8* 270 BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT) [**2195-6-9**] 06:10AM 270 [**2195-6-9**] 06:10AM 12.71 29.4 1.1 1 NOTE NEW NORMAL RANGE AS OF 12 AM [**2195-4-25**] Chemistry RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap [**2195-6-9**] 06:10AM 95 16 0.8 135 4.9 105 24 11 TOXICOLOGY, SERUM AND OTHER DRUGS FK506 [**2195-6-9**] 06:10AM 7.41 1 TARGET 12-HR TROUGH (EARLY POST-TX): [**5-15**] [24-HR TROUGH 33-50% LOWER] Medications on Admission: nephrocap 1 cap qd, protonix 40 qd, labetolol 200 [**Hospital1 **], renalgel with meals Discharge Medications: 1. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 2. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day). 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed: tylenol. 5. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 7. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 9. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*30 Tablet(s)* Refills:*0* 10. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 11. Warfarin Sodium 2 mg Tablet Sig: One (1) Tablet PO HS (at bedtime): follow up with Cardiologist as soon as possible. Disp:*7 Tablet(s)* Refills:*0* 12. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 1. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 2. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day). 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed: tylenol. 5. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 7. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 9. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed. Disp:*30 Tablet(s)* Refills:*0* 10. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 11. Warfarin Sodium 2 mg Tablet Sig: One (1) Tablet PO HS (at bedtime): follow up with Cardiologist as soon as possible. Disp:*7 Tablet(s)* Refills:*0* 12. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Discharge Disposition: Home With Service Facility: [**Hospital1 1474**] VNA Discharge Diagnosis: Living related right kidney transplant and repair of umbilical hernia [**2195-6-2**] Paroxysmal a fib hypertension h/o nephritis Discharge Condition: stable Discharge Instructions: call [**Telephone/Fax (1) 673**] if fevers, chills, nausea, vomiting, inability to take medications, decreased urine output, bladder distension, or ankle swelling. No driving while taking pain medication [**Month (only) 116**] shower Empty JP drain and record amount and color of drainage. Bring JP Followup Instructions: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Where: LM [**Hospital Unit Name 3126**] CENTER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2195-6-11**] 10:10 Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Where: LM [**Hospital Unit Name 3126**] CENTER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2195-6-19**] 8:10 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Where: LM [**Hospital Unit Name 3126**] CENTER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2195-6-22**] 3:00 [**2195-6-10**] 12:30 Dr. [**Last Name (STitle) **] -[**Hospital1 1474**] office Completed by:[**2195-6-9**]

403,997,427,788,553

{'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Cardiac complications, not elsewhere classified,Atrial fibrillation,Retention of urine, unspecified,Umbilical hernia without mention of obstruction or gangrene'}

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: ESRD [**1-28**] nephritis, hypertension PRESENT ILLNESS: MEDICAL HISTORY: 1. ESRD 2. Nephritis 3. HTN 4. afib with pleurodesis surgery [**1-31**] 5. insertion of peritoneal dialysis catheter [**5-30**] 6. gerd 7. enlarged thyroid, no meds 8. pleuroperitoneal fistula [**1-31**] with thoracoscopy/pleurodesis 9. MEDICATION ON ADMISSION: nephrocap 1 cap qd, protonix 40 qd, labetolol 200 [**Hospital1 **], renalgel with meals ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: alert, healthy appearing, NAD upper/lower dentures, mallampati (classIII), Cor: Nl S1S2,HR 69, no murmurs, no carotid bruits. 136/88 Lungs clear. 97% RA. EKG sinus brady abd: soft, non-tender, umbilical hernia, peritoneal dialysis cath exit. LLQ ext: no edema, +dp bilat FAMILY HISTORY: SOCIAL HISTORY: denies smoking. drinks etoh x1/week. Lives alone. Self-employed designer. Protestant. ### Response: {'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Cardiac complications, not elsewhere classified,Atrial fibrillation,Retention of urine, unspecified,Umbilical hernia without mention of obstruction or gangrene'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 76 year old white female with a history of coronary artery disease, status post coronary artery bypass graft in [**2195**], congestive heart failure, hypertension, peripheral vascular disease, atrial fibrillation, Graves' disease, on Coumadin therapy, who presents with a two day history of melena and light-headedness. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Blood in stool,Benign neoplasm of colon,Iron deficiency anemia secondary to blood loss (chronic),Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Aortocoronary bypass status

Blood in stool,Benign neoplasm lg bowel,Chr blood loss anemia,Crnry athrscl natve vssl,Atrial fibrillation,CHF NOS,Chr airway obstruct NEC,Long-term use anticoagul,Aortocoronary bypass

Admission Date: [**2195-7-23**] Discharge Date: [**2195-7-29**] Service: MEDICINE HISTORY OF PRESENT ILLNESS: The patient is a 76 year old white female with a history of coronary artery disease, status post coronary artery bypass graft in [**2195**], congestive heart failure, hypertension, peripheral vascular disease, atrial fibrillation, Graves' disease, on Coumadin therapy, who presents with a two day history of melena and light-headedness. The patient was in her usual state of health until two days ago when she had her first bout of formed black tarry stools accompanied by light-headedness and fatigue. No nausea, vomiting, diarrhea or abdominal pain. No prior history of gastrointestinal bleeding, peptic ulcer disease, varices or melena. Weakness and fatigue was progressive. Two further episodes of melena yesterday. On the day of admission, the patient was very pale with severe light-headedness and orthostasis. The patient had another episode of loose melena and felt "like I was going to die". She was very weak and had shortness of breath and dyspnea on exertion. The patient also has a history of chronic sternal chest pain. The patient has previously been admitted in [**2195-3-19**], for massive epistaxis after starting on Coumadin. The patient has never had an esophagogastroduodenoscopy and her last colonoscopy was over ten years ago and was negative per the patient. No history of alcohol abuse or hepatitis. In the Emergency Department, her rectum was positive for melena. Hematocrit was 18.5 which is down from a baseline of 30.0 to 33.0. She had an INR of 1.7. Blood pressure was 103/53, heart rate 77, respiratory rate 16, 93% in room air. Nasogastric lavage was clear. The patient was started on blood transfusions. PHYSICAL EXAMINATION: Temperature 98.9, heart rate 92, blood pressure 140/44, respiratory rate 20, 100% on two liters. In general, a pleasant elderly white female in no acute distress. Head, eyes, ears, nose and throat - The oropharynx is clear, no retropharyngeal blood or blood in nares. The neck was supple with no lymphadenopathy. Faint left carotid bruit was heard. Cardiac examination - The patient was tachycardic with regular rhythm, no murmurs, rubs or gallops. The lungs were clear to auscultation bilaterally. The abdomen was soft with mild tenderness in the epigastrium, no rebound and no guarding. Positive bowel sounds, no hepatosplenomegaly, no costovertebral angle tenderness. Extremities - capillary refill less than two seconds. Dorsalis pedis pulses were not palpable. LABORATORY DATA: Esophagogastroduodenoscopy showed a hiatal hernia, antral gastritis and was otherwise normal. Colonoscopy revealed multiple polyps in the ascending colon. The polyps were removed. There was oozing blood from one polyp, no additional polyps were taken and the bleeding polyp was electrocauterized. Small bowel follow through showed no masses or lesions in the small bowel noted. HOSPITAL COURSE: The patient was admitted to the Medical Intensive Care Unit where she was transfused four units of blood. The patient's Coumadin and Aspirin were held. The patient was ruled out for myocardial infarction with negative enzymes times three. The patient was transferred to the floor in stable condition. The patient's hematocrit stabilized to 32.0 to 34.0 range. DISCHARGE MEDICATIONS: 1. Lipitor 40 mg p.o. q.d. 2. Zestril 20 p.o. q.d. 3. Lopressor 50 mg p.o. b.i.d. 4. Zantac 150 mg p.o. b.i.d. 5. Lasix 40 mg p.o. q.d. 6. Colace 100 mg p.o. b.i.d. 7. Combivent MDI. 8. K-Dur 20 meq p.o. q.d. 9. Synthroid 100 mcg p.o. q.d. 10. Multivitamins. 11. TUMS. The patient is to have follow-up colonoscopy with either Dr. [**Last Name (STitle) 6861**] or Dr. [**Last Name (STitle) **] in three months. The patient is to hold Coumadin and Aspirin for at least seven days. The patient is to follow-up with primary care physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) 216**], within one week. CONDITION ON DISCHARGE: Stable. DISCHARGE STATUS: The patient is discharged to home. DISCHARGE DIAGNOSES: 1. Lower gastrointestinal bleed likely secondary to polyps. 2. Coronary artery disease, status post coronary artery bypass graft in [**2195-1-19**]. 3. Congestive heart failure with an ejection fraction of 55%. 4. Chronic obstructive pulmonary disease. 5. Graves' disease, status post thyroidectomy. 6. Hypertension. 7. Peripheral vascular disease. 8. Hypercholesterolemia. 9. Atrial fibrillation. 10. Gastroesophageal reflux disease. 11. History of pneumothorax. 12. Status post cholecystectomy. 13. Status post total abdominal hysterectomy. 14. Status post pulmonary wedge resection for hamartoma in [**2193**]. 15. Status post carotid endarterectomy times two. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1211**], M.D. [**MD Number(1) 1212**] Dictated By:[**Name8 (MD) 7112**] MEDQUIST36 D: [**2195-7-29**] 17:31 T: [**2195-7-29**] 21:03 JOB#: [**Job Number **]

578,211,280,414,427,428,496,V586,V458

{'Blood in stool,Benign neoplasm of colon,Iron deficiency anemia secondary to blood loss (chronic),Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Aortocoronary bypass status'}

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 76 year old white female with a history of coronary artery disease, status post coronary artery bypass graft in [**2195**], congestive heart failure, hypertension, peripheral vascular disease, atrial fibrillation, Graves' disease, on Coumadin therapy, who presents with a two day history of melena and light-headedness. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Blood in stool,Benign neoplasm of colon,Iron deficiency anemia secondary to blood loss (chronic),Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Aortocoronary bypass status'}

CHIEF COMPLAINT: Dysarthria, Confusion PRESENT ILLNESS: This 81 year old woman has a history of hypertension and a prior MEDICAL HISTORY: Hypertension Hyperlipidemia Paroxysmal atrial fibrillation TIA in the early [**2095**]??????s [**2109**] CVA (initiated on Coumadin) ASD Anxiety Left breast cancer s/p lumpectomy and axillary lymph node removal in [**2094**], s/p radiation Recent rupture of a sebaceous cyst on the back. Seen at primary MEDICATION ON ADMISSION: Warfarin 2.5mg tablets on Saturday/Sunday/Tuesday/Thursday, half ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: Discharge: Pleasant, answers questions appropriately Chest: lungs clear to auscultation bilaterally. Sternum Stable Sternal Incision: dry and non-erythematous. COR: regular rate and rhythm Abdmomen: soft and nontender with normoactive bowel sounds Extremities: warm with 1+ edema Neuro: grossly intact FAMILY HISTORY: FH: Father died of a heart attack at age 62, two brothers and a SOCIAL HISTORY: Patient is widowed with four children. Lives with: alone in an apartment attached to her daughter??????s house ETOH: two glasses of wine per day. Denies tobacco use. Contact person upon discharge: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 45417**] (daughter): [**Telephone/Fax (1) 80374**]

Mitral valve disorders,Ostium secundum type atrial septal defect,Atrioventricular block, complete,Diseases of tricuspid valve,Other chronic pulmonary heart diseases,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Dental caries, unspecified,Anxiety state, unspecified,Personal history of malignant neoplasm of breast,Osteoarthrosis, localized, not specified whether primary or secondary, hand

Mitral valve disorder,Secundum atrial sept def,Atriovent block complete,Tricuspid valve disease,Chr pulmon heart dis NEC,Atrial fibrillation,Hyperlipidemia NEC/NOS,Hypertension NOS,Hx TIA/stroke w/o resid,Dental caries NOS,Anxiety state NOS,Hx of breast malignancy,Loc osteoarth NOS-hand

Admission Date: [**2113-12-11**] Discharge Date: [**2113-12-24**] Date of Birth: [**2032-4-10**] Sex: F Service: CARDIOTHORACIC Allergies: Sulfa (Sulfonamide Antibiotics) Attending:[**First Name3 (LF) 922**] Chief Complaint: Dysarthria, Confusion Major Surgical or Invasive Procedure: [**2113-12-18**] - 1. Valve sparing mitral valve replacement with a 29-mm St. [**Male First Name (un) 923**] Epic bioprosthesis. The valve data is the following: St. Jude valve, serial number [**Serial Number 80372**], reference number [**Serial Number 10859**]. 2. Tricuspid valvuloplasty with a 30 mm [**Doctor Last Name **] MC cubed tricuspid valvuloplasty ring. The ring data is the following: It is model number [**Doctor Last Name **] ring model number 4900, serial number [**Serial Number 80373**]. 3. Patent foramen ovale closure. 4. Left atrial appendage resection. [**2113-12-11**] - Cardiac Catheterization [**2113-12-11**] - Surgical extraction of tooth 14 in preparation for valvular heart surgery on Monday the 17th. History of Present Illness: This 81 year old woman has a history of hypertension and a prior CVA that was diagnosed in [**2109**] when she presented to an outside hospital with symptoms of dysarthria and confusion. She was subsequently started on Coumadin and around the same time diagnosed with atrial fibrillation and a PFO on echo imaging. Since that time she has not had any additional neurologic symptoms. . Over the years she has had serial echocardiograms, the most recent in [**2113-10-2**]. Further review of this testing has been notable for a progressive increase in pulmonary artery pressures from 30mm HG to about 60 mmHG on her most recent echo, with significant mitral and tricuspid regurgitation. . Because of these findings, she was referred to Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] regarding evaluation and further treatment of the PFO. Notes from Dr. [**Last Name (STitle) **] mention that upon review of her echo, it appeared that her ??????PFO?????? was more likely an ASD. Plans are for diagnostic cardiac catheterization to assess the significance of the ASD as relates to her pulmonary hypertension. Based upon these results, the patient will be given recommendations regarding best treatment options. Past Medical History: Hypertension Hyperlipidemia Paroxysmal atrial fibrillation TIA in the early [**2095**]??????s [**2109**] CVA (initiated on Coumadin) ASD Anxiety Left breast cancer s/p lumpectomy and axillary lymph node removal in [**2094**], s/p radiation Recent rupture of a sebaceous cyst on the back. Seen at primary MD??????s office yesterday where she was given antibiotics due to mild inflammation and redness. No fever. Osteoarthritis of the hands Tonsillectomy Recent epistaxis in the setting of a supratheraputic INR Social History: Patient is widowed with four children. Lives with: alone in an apartment attached to her daughter??????s house ETOH: two glasses of wine per day. Denies tobacco use. Contact person upon discharge: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 45417**] (daughter): [**Telephone/Fax (1) 80374**] Family History: FH: Father died of a heart attack at age 62, two brothers and a sister with heart attacks in their 50??????s. (+) TIA (+) CVA (-) Melena/GIB Pneumovax status: Vaccinated within the past five years Ht: 5 feet 6 inches Wt: 150 lbs Physical Exam: Discharge: Pleasant, answers questions appropriately Chest: lungs clear to auscultation bilaterally. Sternum Stable Sternal Incision: dry and non-erythematous. COR: regular rate and rhythm Abdmomen: soft and nontender with normoactive bowel sounds Extremities: warm with 1+ edema Neuro: grossly intact Pertinent Results: [**2113-12-11**] 01:30PM WBC-5.7 RBC-3.38* HGB-11.3* HCT-33.5* MCV-99* MCH-33.6* MCHC-33.8 RDW-15.2 [**2113-12-11**] 01:30PM ALT(SGPT)-125* AST(SGOT)-81* CK(CPK)-76 AMYLASE-31 TOT BILI-1.3 [**2113-12-11**] 01:30PM GLUCOSE-121* UREA N-20 CREAT-1.0 SODIUM-140 POTASSIUM-4.4 CHLORIDE-105 TOTAL CO2-26 ANION GAP-13 [**2113-12-11**] 06:28PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-NEG BILIRUBIN-LG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2113-12-11**] - Cardiac Catheterization 1. Selective angiography of this right dominant system single vessel coronary artery disease. The left main demonstrated no angiographically apparent flow limiting lesions. The left anterior descending artery demonstrated a mid-distal focal 60% lesion with excellent flow distal to the lesion. The left circumflex demonstrated only mild luminal irregularities. The right coronary artery demonstrated a 30% proximal lesion. 2. Lv ventriculography demonstrated a preserved left ventricular ejection fraction of approximately 50%. The anterolateral wall demonstrated mild hypokinesis. The LV gram demonstrated a calcified mitral valve with 3+ regurgitation. 3. Hemodynamic evaluation demonstrated elevated right (RVEDP = 18 mm Hg) and left heart (LVEDP = 23mm Hg) filling pressures. There was no significant pressure gradient across the aortic valve upon pullback from the left ventricle to the aorta. There was moderate pulmonary artery hypertension (48/30 mm Hg; mean 38 mm Hg). There was moderate central hypertension (148/97 mm Hg). 4. Following a bolus of IV heparin, the PFO was engaged and crossed into the left atrium. A sizing balloon was inflated and occluded the PFO with continuous monitoring of the pulmonary artery pressure. No significant change in the pulmonary artery pressure was noted Resting oximetry was 92% and improved to 100% with the administration of oxygen ruling out a significant right to left shunt. [**2113-12-18**] ECHO PREBYPASS 1. The left atrium is markedly dilated. The right atrium is moderately dilated. A patent foramen ovale is present with a left-to-right shunt across the interatrial septum is seen at rest. 2. Left ventricular wall thicknesses and cavity size are normal. Overall left ventricular systolic function is normal (LVEF>55%). 3. Right ventricular chamber size and free wall motion are normal. 4. There are three aortic valve leaflets. Trace aortic regurgitation is seen. 5. The mitral valve leaflets are mildly thickened. Moderate to severe (3+) mitral regurgitation is seen. 6. Moderate to severe [3+] tricuspid regurgitation is seen. 7. There is no pericardial effusion. 8. Dr. [**Last Name (STitle) 914**] was notified in person of the results on [**2113-12-18**] at 1250. POSTBYPASS 1. Pt is on epinephrine infusion 2. A well seated, well functioning bioprostetic valve is seen in the mitral position. No leaks are seen 3. A well seated, well functioning annuloplasty ring is seen around the tricuspid valve. 4. No color flow is seen across the intraatrial septum 5. The left atrial appendage has been ligated. 6. LV wall motion is similar. [**2113-12-12**] - Carotid Ultrasound Bilateral less than 40% carotid stenosis. Brief Hospital Course: Ms. [**Known lastname 80375**] was admitted to the [**Hospital1 18**] on [**2113-12-11**] for a cardiac catheterization. This revealed severe mitral regurgitation, a patent foramen ovale and single vessel cornary artery disease. An echo was obtained which again showed severe mitral regurgitation but also showed severe tricuspid regurgitation. Given the severity of her disease, the cardiac surgical service was consulted for surgical management.Ms. [**Known lastname 80375**] was worked-up in the usual preoperative manner including a carootid duplex ultrasound which showed [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 40% bilateral internal carotid artery stenosis. The oral surgery service was consulted for oral clearance for valve surgery. It was found that she needed a tooth extracted prior to having her valve surgery which was performed on [**2113-12-15**]. Please see separate dictated operative note for details. She was then cleared for surgery. On [**2113-12-18**], Ms. [**Known lastname 80375**] was taken to the operating room where she underwent a mitral valve replacement, a tricuspind valve repair, a patent foramen ovale closure and ligation of a left atrial appendage. Postoperatively she was taken to the intensive care unit for monitoring. On postoperative day one, Ms. [**Known lastname 80375**] [**Last Name (Titles) 5058**] and was extubated. Beta blockade, a statin and aspirin were resumed. On postoperative day two, she was transferred to the step down unit for further recovery. She was gently diuresed towards her preoperative weight. Coumadin was resumed for her paroxysmal atrial fibrillation. The physical therapy service was consulted for assistance with her postoperative strength and mobility. There was some serosanguenous drainage from the sternal incision noted on POD 4 and she was started on IV cefazolin. The sternal incision remained dry for the next 2 days and she was discharged home on POD 6 with a total 10 day course of oral Keflex. Medications on Admission: Warfarin 2.5mg tablets on Saturday/Sunday/Tuesday/Thursday, half a tablet on Mondays, Wednesdays and Friday??????s. Last dose [**2113-12-6**] [**Name6 (MD) **] primary MD??????s instructions. Atenolol 50mg two tablets every morning Paroxetine 20mg one tablet every morning Vitamin C 500mg one tablet every morning Calcium 600mg + D one tablet twice a day Cephalexin 500mg one capsule t.i.d. x 5 days (started [**2113-12-7**]) Niacin 500mg one tablet every morning Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) for 7 days. Disp:*14 Capsule(s)* Refills:*0* 2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 3. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. Niacin 250 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO BID (2 times a day). Disp:*60 Capsule, Sustained Release(s)* Refills:*0* 5. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 7 days. Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day for 7 days: take one pill twice daily for 4 days, then one pill once daily for 3 days. Disp:*14 Tablet(s)* Refills:*0* 7. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 8. Warfarin 1 mg Tablet Sig: [**2-1**] Tablet PO ONCE (Once). Disp:*30 Tablet(s)* Refills:*0* 9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 10. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a day for 8 days. Disp:*32 Capsule(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 1474**] VNA Discharge Diagnosis: mitral reguritation hypertension dyslipidemia paroxysmal atrial fibrillation s/p transient ischemic attack s/p stroke Discharge Condition: Stable Discharge Instructions: 1) Monitor wounds for signs of infection. These include redness, drainage or increased pain. In the event that you have drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at ([**Telephone/Fax (1) 1504**]. 2) Report any fever greater then 100.5. 3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in 1 week. 4) No lotions, creams or powders to incision until it has healed. You may shower and wash incision. Gently pat the wound dry. Please shower daily. No bathing or swimming for 1 month. Use sunscreen on incision if exposed to sun. 5) No lifting greater then 10 pounds for 10 weeks. 6) No driving for 1 month or while taking narcotics for pain. 7) Call with any questions or concerns. Followup Instructions: Dr. [**Last Name (STitle) 914**] [**Telephone/Fax (1) 170**] Date/Time:[**2114-1-23**] 1:00PM Please follow-up with Dr. [**Last Name (STitle) **] in 2 weeks. [**Telephone/Fax (1) 62**] Please follow-up with Dr. [**Last Name (STitle) 3321**] in [**3-5**] weeks. ([**Telephone/Fax (1) 80376**] INR to be drawn on Monday [**2113-12-25**] with results sent to the office of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3321**] at [**Location (un) **]. Plan confirmed with [**Initials (NamePattern5) **] [**Last Name (NamePattern5) 3321**] Completed by:[**2113-12-24**]

424,745,426,397,416,427,272,401,V125,521,300,V103,715

{'Mitral valve disorders,Ostium secundum type atrial septal defect,Atrioventricular block, complete,Diseases of tricuspid valve,Other chronic pulmonary heart diseases,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Dental caries, unspecified,Anxiety state, unspecified,Personal history of malignant neoplasm of breast,Osteoarthrosis, localized, not specified whether primary or secondary, hand'}

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: Dysarthria, Confusion PRESENT ILLNESS: This 81 year old woman has a history of hypertension and a prior MEDICAL HISTORY: Hypertension Hyperlipidemia Paroxysmal atrial fibrillation TIA in the early [**2095**]??????s [**2109**] CVA (initiated on Coumadin) ASD Anxiety Left breast cancer s/p lumpectomy and axillary lymph node removal in [**2094**], s/p radiation Recent rupture of a sebaceous cyst on the back. Seen at primary MEDICATION ON ADMISSION: Warfarin 2.5mg tablets on Saturday/Sunday/Tuesday/Thursday, half ALLERGIES: Sulfa (Sulfonamide Antibiotics) PHYSICAL EXAM: Discharge: Pleasant, answers questions appropriately Chest: lungs clear to auscultation bilaterally. Sternum Stable Sternal Incision: dry and non-erythematous. COR: regular rate and rhythm Abdmomen: soft and nontender with normoactive bowel sounds Extremities: warm with 1+ edema Neuro: grossly intact FAMILY HISTORY: FH: Father died of a heart attack at age 62, two brothers and a SOCIAL HISTORY: Patient is widowed with four children. Lives with: alone in an apartment attached to her daughter??????s house ETOH: two glasses of wine per day. Denies tobacco use. Contact person upon discharge: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 45417**] (daughter): [**Telephone/Fax (1) 80374**] ### Response: {'Mitral valve disorders,Ostium secundum type atrial septal defect,Atrioventricular block, complete,Diseases of tricuspid valve,Other chronic pulmonary heart diseases,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Dental caries, unspecified,Anxiety state, unspecified,Personal history of malignant neoplasm of breast,Osteoarthrosis, localized, not specified whether primary or secondary, hand'}

CHIEF COMPLAINT: hypoxia and diarrhea PRESENT ILLNESS: Per MICU Admission Note 80 yo male with PMH of brain tumor, recently admitted after intracranial hemorrhage. Was at rehab today when found unresponsive with O2 sat of 50%. Recently has been on trach collar during day and vent at night. Initial workup at OSH ED. He was briefly placed back on vent and transferred to [**Hospital1 18**].He was normotensive here and not hypoxic on 100% but with altered mental status. Narcan did not help and no new focal findings. Head CT was unchanged. CTA torso - no PE, belly ok. WBC of 33. Transiently hypotensive. 2L NS ok. Got a-line and semi clean groin line. Vanc, cefepime, flagyl. A little more awake upon admission. VS: 99.8 R, 63 122/73, 550 x 16 on 5 peep 100% fio2 - satting 100%. MEDICAL HISTORY: Brain tumor: MR c/w low grade glioma; has been followed since [**8-/2169**] Hemorrhagic stroke [**8-/2171**] at site of biopsy CAD s/p CABG x 4 (LIMA->LAD, SVG->OM1, OM2, PDA) [**2168**]. HTN AFib no longer on coumadin (has been on amiodarone) Dyslipidemia Myelodysplastic Syndrome: BM Bx [**8-1**] MDS vs CML, followed by [**Month/Year (2) 2539**] Prostate Cancer s/p radictal prostatectomy and simultaneous penile implant [**2155**] Hyperparathyroidism h/o DVT, no CTA done b/c of CKD--treated w/ IVC filter and lovenox, filter has since been removed. Was on warfarin until hemorrhagic stroke. Gout Subclinical Hypothyroidism Allergic Rhinitis Reflux Pharyngitis Colonic Polyps ? Essential Tremor Anhedonia, attempted celexa but became lightheaded Low back pain, ? spinal stenosis Peripheral neuropathy h/o Fen/Phen use MEDICATION ON ADMISSION: 1. Senna 8.6 mg Tablet [**Month/Year (2) **]: 1-2 Tablets PO BID 2. Docusate Sodium 50 mg/5 mL Liquid 3. Metoprolol Tartrate 25 mg PO BID 4. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY. 5. Allopurinol 100 mg Tablet 2 Tablet PO DAILY 6. Simvastatin 40 mg Tablet PO DAILY 7. Acetaminophen 325 mg PO Q6H PRN for pain. 8. Nystatin 100,000 unit/g Cream [**Last Name (STitle) **]: Apply to affected areas. 9. Levetiracetam 500 mg PO BID 10. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Six (6) Puff Inhalation QID (4 times a day). 11. Oxycodone-Acetaminophen 5-325 5-10 MLs PO Q6H PRN for pain. 12. Ascorbic Acid 90 mg/mL Drops PO DAILY 13. Zinc Sulfate 220 mg 14. Insulin Regular Human 100 unit/mL SS ALLERGIES: Univasc / Celexa / Heparin Agents PHYSICAL EXAM: Initial MICU PE GEN: NAD, interactive, though non-verbal. HEENT: AT, scar present over right pariatal area, trancheostomy in place with very mild skin breakdown. CV: RRR, nl S1 and S2, no MRG - sounds are distant. PULM: Course mechanical BS throughout. No true rhonchi or crackles. ABD: PEG in place and site is c/d/i, NT/ND, obese, with present BS. EXT: No pitting edema, pale nail beds, no wounds, no cyanosis. NEURO: Moderate left sided hemiparesis (at baseline), non-verbal but able to answer with simple questions. FAMILY HISTORY: NC SOCIAL HISTORY: Soc Hx: Married. Has been in nursing home. No tobacco, ETOH, drug use

Acute respiratory failure,Pneumonia, organism unspecified,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Malignant neoplasm of frontal lobe,Other diseases of trachea and bronchus,Attention to tracheostomy,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Gout, unspecified,Myelodysplastic syndrome, unspecified,Personal history of malignant neoplasm of prostate,Hyperparathyroidism, unspecified,Heparin-induced thrombocytopenia (HIT),Pressure ulcer, lower back,Diarrhea

Acute respiratry failure,Pneumonia, organism NOS,Late ef-hemplga side NOS,Malig neo frontal lobe,Trachea & bronch dis NEC,Atten to tracheostomy,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hypertension NOS,Hyperlipidemia NEC/NOS,Atrial fibrillation,Gout NOS,Myelodysplastic synd NOS,Hx-prostatic malignancy,Hyperparathyroidism NOS,Heparin-indu thrombocyto,Pressure ulcer, low back,Diarrhea

Admission Date: [**2171-10-31**] Discharge Date: [**2171-11-6**] Date of Birth: [**2091-3-9**] Sex: M Service: MEDICINE Allergies: Univasc / Celexa / Heparin Agents Attending:[**First Name3 (LF) 348**] Chief Complaint: hypoxia and diarrhea Major Surgical or Invasive Procedure: intubation, arterial line insertion History of Present Illness: Per MICU Admission Note 80 yo male with PMH of brain tumor, recently admitted after intracranial hemorrhage. Was at rehab today when found unresponsive with O2 sat of 50%. Recently has been on trach collar during day and vent at night. Initial workup at OSH ED. He was briefly placed back on vent and transferred to [**Hospital1 18**].He was normotensive here and not hypoxic on 100% but with altered mental status. Narcan did not help and no new focal findings. Head CT was unchanged. CTA torso - no PE, belly ok. WBC of 33. Transiently hypotensive. 2L NS ok. Got a-line and semi clean groin line. Vanc, cefepime, flagyl. A little more awake upon admission. VS: 99.8 R, 63 122/73, 550 x 16 on 5 peep 100% fio2 - satting 100%. Past Medical History: Brain tumor: MR c/w low grade glioma; has been followed since [**8-/2169**] Hemorrhagic stroke [**8-/2171**] at site of biopsy CAD s/p CABG x 4 (LIMA->LAD, SVG->OM1, OM2, PDA) [**2168**]. HTN AFib no longer on coumadin (has been on amiodarone) Dyslipidemia Myelodysplastic Syndrome: BM Bx [**8-1**] MDS vs CML, followed by [**Month/Year (2) 2539**] Prostate Cancer s/p radictal prostatectomy and simultaneous penile implant [**2155**] Hyperparathyroidism h/o DVT, no CTA done b/c of CKD--treated w/ IVC filter and lovenox, filter has since been removed. Was on warfarin until hemorrhagic stroke. Gout Subclinical Hypothyroidism Allergic Rhinitis Reflux Pharyngitis Colonic Polyps ? Essential Tremor Anhedonia, attempted celexa but became lightheaded Low back pain, ? spinal stenosis Peripheral neuropathy h/o Fen/Phen use Social History: Soc Hx: Married. Has been in nursing home. No tobacco, ETOH, drug use Family History: NC Physical Exam: Initial MICU PE GEN: NAD, interactive, though non-verbal. HEENT: AT, scar present over right pariatal area, trancheostomy in place with very mild skin breakdown. CV: RRR, nl S1 and S2, no MRG - sounds are distant. PULM: Course mechanical BS throughout. No true rhonchi or crackles. ABD: PEG in place and site is c/d/i, NT/ND, obese, with present BS. EXT: No pitting edema, pale nail beds, no wounds, no cyanosis. NEURO: Moderate left sided hemiparesis (at baseline), non-verbal but able to answer with simple questions. PE on transfer to floor PE: T 96.9 102-120/52-62 HR 69 RR22 95% 50% FM GEN: NAD, interactive, though non-verbal. HEENT: AT, scar present over right parietal area, trancheostomy in place with very minimal skin breakdown and erythema. CV: RRR, nl S1 and S2, no MRG - sounds are distant and difficult to auscultate over coarse BS. PULM: Course BS throughout and transmitted upper airway sounds. No crackles. ABD: PEG in place and site is c/d/i, NT/ND, obese, with present BS. EXT: No pitting edema, pale nail beds, no wounds, no cyanosis. Left foot with nonpitting edema NEURO: Moderate left sided hemiparesis (at baseline), non-verbal but able to answer with simple questions, nods head. Pertinent Results: [**2171-10-31**] 04:22PM BLOOD WBC-33.5*# RBC-3.11* Hgb-9.2* Hct-29.3* MCV-94 MCH-29.4 MCHC-31.2 RDW-14.0 Plt Ct-67* [**2171-11-2**] 04:27AM BLOOD WBC-18.0* RBC-2.76* Hgb-8.2* Hct-25.0* MCV-90 MCH-29.6 MCHC-32.8 RDW-14.9 Plt Ct-60* [**2171-11-6**] 07:49AM BLOOD WBC-19.0* RBC-2.81* Hgb-8.3* Hct-25.2* MCV-90 MCH-29.5 MCHC-32.9 RDW-15.1 Plt Ct-67* [**2171-10-31**] 04:22PM BLOOD Neuts-18* Bands-2 Lymphs-10* Monos-61* Eos-3 Baso-0 Atyps-0 Metas-2* Myelos-4* [**2171-11-4**] 03:54AM BLOOD Neuts-22* Bands-1 Lymphs-8* Monos-60* Eos-5* Baso-1 Atyps-1* Metas-1* Myelos-1* [**2171-10-31**] 04:22PM BLOOD Glucose-169* UreaN-86* Creat-1.1 Na-149* K-4.6 Cl-111* HCO3-32 AnGap-11 [**2171-11-2**] 03:38PM BLOOD Glucose-130* UreaN-56* Creat-0.7 Na-148* K-3.9 Cl-118* HCO3-26 AnGap-8 [**2171-11-6**] 07:49AM BLOOD Glucose-113* UreaN-45* Creat-0.8 Na-142 K-4.3 Cl-107 HCO3-30 AnGap-9 [**2171-10-31**] 04:22PM BLOOD ALT-13 AST-18 CK(CPK)-7* AlkPhos-101 TotBili-0.2 [**2171-11-1**] 04:10AM BLOOD LD(LDH)-119 CK(CPK)-3* [**2171-11-1**] 03:18PM BLOOD CK(CPK)-7* [**2171-10-31**] 04:22PM BLOOD cTropnT-0.07* [**2171-11-1**] 04:10AM BLOOD CK-MB-NotDone cTropnT-0.05* [**2171-11-1**] 03:18PM BLOOD CK-MB-NotDone cTropnT-0.06* [**2171-11-1**] 04:10AM BLOOD Calcium-11.2* Phos-3.3 Mg-1.8 [**2171-11-4**] 03:54AM BLOOD Albumin-2.9* Calcium-10.9* Phos-2.5* Mg-1.8 [**2171-10-31**] 04:43PM BLOOD Lactate-1.3 CXR [**11-3**]: IMPRESSION: Bibasilar opacities, suspicious for pneumonia. Interval improvement on the left. Evidence for small left effusion unchanged CXR [**11-5**] REASON FOR EXAM: 80-year-old man with hypoxia and respiratory distress and elevated white blood count, please evaluate for pneumonia. Since [**2171-11-3**], sternotomy wires are still intact. A tracheostomy is in unchanged position. Right PICC tip is not seen. Bibasilar opacity increased could be atelectasis, pneumonia or aspiration. Standard PA and lateral views or better inspiration AP could further characterize this. Minimal blunting of the left costophrenic angle is unchanged, altough it was partly excluded on this study. . CT HEAD [**10-31**]: IMPRESSION: Unchanged right frontal lobe heterogeneous mass with resolution of post-biopsy hemorrhage and pneumocephalus. No acute intracranial hemorrhage. CT Torso [**10-31**]: IMPRESSION: 1. Limited study for assessment of pulmonary embolism secondary to technical factors. No central PE. 2. Enlarged pulmonary artery reflective of pulmonary hypertension. 3. Moderate cardiomegaly. 4. Peritracheostomy secretions and debris. 5. Cholelithiasis. No evidence of acute cholecystitis. 6. Innumerable cysts of the kidneys bilaterally, stable compared to [**2168**]. MICRO: Blood cx NGTD Urine cx NG Sputum RESPIRATORY CULTURE (Preliminary): OROPHARYNGEAL FLORA ABSENT. YEAST. SPARSE GROWTH. STAPH AUREUS COAG +. RARE GROWTH. C diff negative x 2 [**2171-11-1**] 11:35AM BLOOD Lactate-0.6 Brief Hospital Course: For details regarding previous prolonged hospital course at [**Hospital 792**]Hospital and [**Hospital1 18**], please see prior discharge summary [**2171-10-25**]. MICU Course: Mr. [**Known lastname **] was admitted to the MICU for a hypoxic episode at rehab. Flexible bronchoscopy was performed on arrival and showed focal tracheomalacia with airway occlusion. Tracheostomy tube change performed. He was not hypoxic upon arrival and was quickly weaned to trach mask which he tolerated for 48 hours prior to transfer to the floor. He was treated with broad-spectrum antibiotics including Zosyn, Vancomycin and Flagyl for possible HCAP/VAP and C. Diff. Antibiotics were weaned quickly as pt was not hypoxic, not febrile, and had a negative chest x-ray. The flagyl was stopped after 3 C. Diff stool studies came back negative. The patient was briefly on pressors overnight the night of admission but these were discontinued in the morning and he remained hemodynamically stable. He was kept in the MICU for thick secretions requiring frequent suctioning but was transferred to the floor as he was off the vent for over 48 hours and secretions thinning. For his brain tumor, Keppra was continued for seizure prophylaxis and his neuro-oncologist was contact[**Name (NI) **]. The family was also requesting a new rehab placement and this process was started with case management. Floor Course On the floor, he remained hemodynamically stable and afebrile. Vancomycin was restarted [**11-5**] since pt was having increased sputum production, sputum cultures grew MRSA, he had an elevated WBC of 20, and ? bibasilar infiltrates on CXR [**2171-11-5**]. He should continue for total 10 day course of vancomycin. He was not continued on Zosyn since MRSA was felt to cause of pneumonia given sputum culture results. If he develops fever, increase in WBC, or increased sputum production, would consider broadening coverage but it was not felt to be neccessary at the time of discharge. He continued to have diarrhea with rectal tube in place but had 3 negative C. difficile toxins, most recently [**11-5**]. His AFib was well controlled on metoprolol 12.5 mg PO BID. This dose may need to be titrated based on BP and HR. Insulin was stopped since he was not requiring any in house and does not carry diagnosis of diabetes. He was continued on all of his outpatient medications for his chronic medical problems. ASA 81mg daily was added given his history of MI and he is now approx. 2 months out from his hemorrhage. We continued to hold Coumadin given recent hemorrhagic CVA [**9-2**]. Medications on Admission: 1. Senna 8.6 mg Tablet [**Month/Year (2) **]: 1-2 Tablets PO BID 2. Docusate Sodium 50 mg/5 mL Liquid 3. Metoprolol Tartrate 25 mg PO BID 4. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY. 5. Allopurinol 100 mg Tablet 2 Tablet PO DAILY 6. Simvastatin 40 mg Tablet PO DAILY 7. Acetaminophen 325 mg PO Q6H PRN for pain. 8. Nystatin 100,000 unit/g Cream [**Last Name (STitle) **]: Apply to affected areas. 9. Levetiracetam 500 mg PO BID 10. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Six (6) Puff Inhalation QID (4 times a day). 11. Oxycodone-Acetaminophen 5-325 5-10 MLs PO Q6H PRN for pain. 12. Ascorbic Acid 90 mg/mL Drops PO DAILY 13. Zinc Sulfate 220 mg 14. Insulin Regular Human 100 unit/mL SS Discharge Medications: 1. Vancomycin in Dextrose 1 gram/200 mL Piggyback [**Last Name (STitle) **]: One (1) gram Intravenous Q 12H (Every 12 Hours) for 6 days. 2. Senna 8.6 mg Tablet [**Last Name (STitle) **]: 1-2 Tablets PO BID (2 times a day) as needed. 3. Colace 50 mg/5 mL Liquid [**Last Name (STitle) **]: Five (5) ml PO twice a day as needed for constipation. 4. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO BID (2 times a day). 5. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] once a day. 6. Allopurinol 100 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO DAILY (Daily). 7. Simvastatin 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 8. Acetaminophen 325 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 9. Levetiracetam 500 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO BID (2 times a day). 10. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Two (2) Puff Inhalation QID (4 times a day). 11. Aspirin 81 mg Tablet, Chewable [**Last Name (STitle) **]: One (1) Tablet, Chewable PO DAILY (Daily). 12. Acetylcysteine 20 % (200 mg/mL) Solution [**Last Name (STitle) **]: One (1) neb Miscellaneous Q8H (every 8 hours) as needed for thick secretions. 13. Zinc Sulfate 220 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO once a day. 14. Ascorbic Acid 90 mg/mL Drops [**Last Name (STitle) **]: One (1) ml PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: Primary Diagnosis 1. Hypoxemic Respiratory Failure 2. Health Care Associated Pneumonia Secondary Diagnosis Brain tumor, likely low grade glioma AFib Stage 2 sacral decubitus ulcer CAD HTN MDS HIT Discharge Condition: Hemodynamically stable, satting high 90s on 50% trach mask, afebrile Discharge Instructions: You were admitted to the hospital because you had low oxygen saturations at your rehab facility. You had your trachesostomy tube changed on admission [**2171-10-31**]. We started antibiotics to treat you for pneumonia and you should complete a 10 day course. We made the following changes to your medications 1. We added Vancomycin which you should continue for 6 more days 2. We added ASA 81 mg 3. We decreased the dose of your Metoprolol in half since your BP was on the lower side 4. We stopped your insulin since you were not requiring this medication and did not have high blood sugars Please return to the ER or call your primary care physician if you develop shortness of breath, cough, fever, chills, chest pain, numbness or weakness or any other concerning symptoms. Followup Instructions: Provider: [**Name10 (NameIs) 5005**] [**Last Name (NamePattern4) 5342**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2171-11-11**] 1:00 Provider: [**Name10 (NameIs) 706**] [**Name10 (NameIs) 4338**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2171-11-11**] 11:55 Please also call your primary care doctor at 617 [**Telephone/Fax (1) 110725**] to make an appointment in the next 1-2 weeks.

518,486,438,191,519,V550,414,V458,401,272,427,274,238,V104,252,289,707,787

{'Acute respiratory failure,Pneumonia, organism unspecified,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Malignant neoplasm of frontal lobe,Other diseases of trachea and bronchus,Attention to tracheostomy,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Gout, unspecified,Myelodysplastic syndrome, unspecified,Personal history of malignant neoplasm of prostate,Hyperparathyroidism, unspecified,Heparin-induced thrombocytopenia (HIT),Pressure ulcer, lower back,Diarrhea'}

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: hypoxia and diarrhea PRESENT ILLNESS: Per MICU Admission Note 80 yo male with PMH of brain tumor, recently admitted after intracranial hemorrhage. Was at rehab today when found unresponsive with O2 sat of 50%. Recently has been on trach collar during day and vent at night. Initial workup at OSH ED. He was briefly placed back on vent and transferred to [**Hospital1 18**].He was normotensive here and not hypoxic on 100% but with altered mental status. Narcan did not help and no new focal findings. Head CT was unchanged. CTA torso - no PE, belly ok. WBC of 33. Transiently hypotensive. 2L NS ok. Got a-line and semi clean groin line. Vanc, cefepime, flagyl. A little more awake upon admission. VS: 99.8 R, 63 122/73, 550 x 16 on 5 peep 100% fio2 - satting 100%. MEDICAL HISTORY: Brain tumor: MR c/w low grade glioma; has been followed since [**8-/2169**] Hemorrhagic stroke [**8-/2171**] at site of biopsy CAD s/p CABG x 4 (LIMA->LAD, SVG->OM1, OM2, PDA) [**2168**]. HTN AFib no longer on coumadin (has been on amiodarone) Dyslipidemia Myelodysplastic Syndrome: BM Bx [**8-1**] MDS vs CML, followed by [**Month/Year (2) 2539**] Prostate Cancer s/p radictal prostatectomy and simultaneous penile implant [**2155**] Hyperparathyroidism h/o DVT, no CTA done b/c of CKD--treated w/ IVC filter and lovenox, filter has since been removed. Was on warfarin until hemorrhagic stroke. Gout Subclinical Hypothyroidism Allergic Rhinitis Reflux Pharyngitis Colonic Polyps ? Essential Tremor Anhedonia, attempted celexa but became lightheaded Low back pain, ? spinal stenosis Peripheral neuropathy h/o Fen/Phen use MEDICATION ON ADMISSION: 1. Senna 8.6 mg Tablet [**Month/Year (2) **]: 1-2 Tablets PO BID 2. Docusate Sodium 50 mg/5 mL Liquid 3. Metoprolol Tartrate 25 mg PO BID 4. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY. 5. Allopurinol 100 mg Tablet 2 Tablet PO DAILY 6. Simvastatin 40 mg Tablet PO DAILY 7. Acetaminophen 325 mg PO Q6H PRN for pain. 8. Nystatin 100,000 unit/g Cream [**Last Name (STitle) **]: Apply to affected areas. 9. Levetiracetam 500 mg PO BID 10. Ipratropium Bromide 17 mcg/Actuation Aerosol [**Last Name (STitle) **]: Six (6) Puff Inhalation QID (4 times a day). 11. Oxycodone-Acetaminophen 5-325 5-10 MLs PO Q6H PRN for pain. 12. Ascorbic Acid 90 mg/mL Drops PO DAILY 13. Zinc Sulfate 220 mg 14. Insulin Regular Human 100 unit/mL SS ALLERGIES: Univasc / Celexa / Heparin Agents PHYSICAL EXAM: Initial MICU PE GEN: NAD, interactive, though non-verbal. HEENT: AT, scar present over right pariatal area, trancheostomy in place with very mild skin breakdown. CV: RRR, nl S1 and S2, no MRG - sounds are distant. PULM: Course mechanical BS throughout. No true rhonchi or crackles. ABD: PEG in place and site is c/d/i, NT/ND, obese, with present BS. EXT: No pitting edema, pale nail beds, no wounds, no cyanosis. NEURO: Moderate left sided hemiparesis (at baseline), non-verbal but able to answer with simple questions. FAMILY HISTORY: NC SOCIAL HISTORY: Soc Hx: Married. Has been in nursing home. No tobacco, ETOH, drug use ### Response: {'Acute respiratory failure,Pneumonia, organism unspecified,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Malignant neoplasm of frontal lobe,Other diseases of trachea and bronchus,Attention to tracheostomy,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Gout, unspecified,Myelodysplastic syndrome, unspecified,Personal history of malignant neoplasm of prostate,Hyperparathyroidism, unspecified,Heparin-induced thrombocytopenia (HIT),Pressure ulcer, lower back,Diarrhea'}

CHIEF COMPLAINT: shoulder pain PRESENT ILLNESS: Ms. [**Known lastname 105089**] is a 58 year oldfemale with a history of type 2 DM, hyperlipidemia, obesity and pericardial effusion requiring a tap in [**2141**] of unclear etiology. Within the past month she has complained of left shoulder and scapular pain worse with activity. She states for the past couple of years she has had bilateral shoulder pain that has occurred shortly after radiation treatment. She had PT for a couple of years without relief of should pain. Patient recently went back to PT for left shoulder and scapular pain and was then referred for a stress test. Patient denies shortness of breath or chest discomfort. Patient states she has had bilateral LE edema for the past couple of years. She denies claudication, edema, orthopnea, PND and lightheadedness. MEDICAL HISTORY: Hyperlipidemia DM type 2 Lymphoma (retroperitoneal mass did not respond to chemo but good result to xrt x 22- last time was 5 yrs ago) Esophageal Reflux Spinal Disorder (Para spinal mass) Vertigo Hypothyroidism Obesity Hernia repaired x2 umbilical Pericardial Effusion [**8-12**] (TAP) Appendectomy as an adult Cholecystectomy C-section x2 MEDICATION ON ADMISSION: GLIPIZIDE 10 mg Tablet - 1 (One) Tablet(s) by mouth twice a day INSULIN GLARGINE [LANTUS] 100unit/mL Solution - 34 units before bedtime once daily LEVOTHYROXINE 75 mcg Tablet -one Tablet(s) by mouth daily MECLIZINE Dosage uncertain METFORMIN 1,000 mg Tablet - 0.5-1 Tablet(s) by mouth 1000mg in am, 500mg in afternoon and 1000mg in pm PANTOPRAZOLE 40 mg Tablet, Delayed Release (E.C.) - one Tablet(s) by mouth daily ROSUVASTATIN [CRESTOR] 5 mg Tablet - one Tablet(s) by mouth daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: Resp:18 O2 sat: 100 B/P Right:147/75 Left: Height:5'3" Weight:210 FAMILY HISTORY: Father had CABG and a couple of MI's, and cancer. Mother has diabetes SOCIAL HISTORY: Last Dental Exam:one month ago, no problems Lives with:alone Occupation:patient is an engineer Tobacco: quit 20 years ago, [**2-8**] pack for 20 years EtOH: a couple of drinks per month

Coronary atherosclerosis of native coronary artery,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Esophageal reflux,Obesity, unspecified,Unspecified acquired hypothyroidism,Personal history of antineoplastic chemotherapy,Personal history of tobacco use,Personal history of irradiation, presenting hazards to health,Body Mass Index 37.0-37.9, adult

Crnry athrscl natve vssl,Oth lymp unsp xtrndl org,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Esophageal reflux,Obesity NOS,Hypothyroidism NOS,Hx antineoplastic chemo,History of tobacco use,Hx of irradiation,BMI 37.0-37.9,adult

Admission Date: [**2144-11-6**] Discharge Date: [**2144-11-10**] Date of Birth: [**2086-5-10**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: shoulder pain Major Surgical or Invasive Procedure: CABGx3(LIMA->LAD, SVG->OM1, OM2) [**2144-11-6**] History of Present Illness: Ms. [**Known lastname 105089**] is a 58 year oldfemale with a history of type 2 DM, hyperlipidemia, obesity and pericardial effusion requiring a tap in [**2141**] of unclear etiology. Within the past month she has complained of left shoulder and scapular pain worse with activity. She states for the past couple of years she has had bilateral shoulder pain that has occurred shortly after radiation treatment. She had PT for a couple of years without relief of should pain. Patient recently went back to PT for left shoulder and scapular pain and was then referred for a stress test. Patient denies shortness of breath or chest discomfort. Patient states she has had bilateral LE edema for the past couple of years. She denies claudication, edema, orthopnea, PND and lightheadedness. Past Medical History: Hyperlipidemia DM type 2 Lymphoma (retroperitoneal mass did not respond to chemo but good result to xrt x 22- last time was 5 yrs ago) Esophageal Reflux Spinal Disorder (Para spinal mass) Vertigo Hypothyroidism Obesity Hernia repaired x2 umbilical Pericardial Effusion [**8-12**] (TAP) Appendectomy as an adult Cholecystectomy C-section x2 Social History: Last Dental Exam:one month ago, no problems Lives with:alone Occupation:patient is an engineer Tobacco: quit 20 years ago, [**2-8**] pack for 20 years EtOH: a couple of drinks per month Family History: Father had CABG and a couple of MI's, and cancer. Mother has diabetes Physical Exam: Pulse: Resp:18 O2 sat: 100 B/P Right:147/75 Left: Height:5'3" Weight:210 General: Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [x] Irregular [] Murmur Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema Varicosities: Yes Neuro: Grossly intact [x] Pulses: Femoral Right:2+ Left:2+ DP Right:2+ Left:2+ PT [**Name (NI) 167**]:2+ Left:2+ Radial Right:2+ Left:2+ Carotid Bruit Right:- Left:- Pertinent Results: [**2144-11-9**] 06:23AM BLOOD WBC-12.3* RBC-3.46* Hgb-9.9* Hct-28.6* MCV-83 MCH-28.7 MCHC-34.7 RDW-15.6* Plt Ct-178 [**2144-11-8**] 03:30AM BLOOD PT-14.2* PTT-26.2 INR(PT)-1.2* [**2144-11-9**] 06:23AM BLOOD Glucose-130* UreaN-23* Creat-0.9 Na-138 K-4.0 Cl-101 HCO3-30 AnGap-11 [**Known lastname **],[**Known firstname 105090**] [**Medical Record Number 105091**] F 58 [**2086-5-10**] Radiology Report CHEST (PORTABLE AP) Study Date of [**2144-11-8**] 12:23 PM [**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG CSRU [**2144-11-8**] 12:23 PM CHEST (PORTABLE AP) Clip # [**Clip Number (Radiology) 105092**] Reason: please check for hemothorax, hemomediastinum Final Report CHEST RADIOGRAPH INDICATION: Drop in hematocrit, questionable mediastinal changes. COMPARISON: [**2144-11-8**], 5:24 a.m. Unchanged extent of the retrocardiac and left lower lobe atelectasis. Unchanged width and appearance of the mediastinum, without evidence of mediastinal density increase or diameter increase. No pleural effusions. Unchanged size of the cardiac silhouette. Unchanged course of the right central venous access line. DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**] Approved: SUN [**2144-11-8**] 4:04 PM Brief Hospital Course: The patient was admitted and underwent CABGx3(LIMA->LAD, SVG->OM1, OM2) on [**2144-11-6**]. The cross clamp time was 63 minutes and total bypass time was 79 minutes. She tolerated the procedure well and was transferred to the CVICU in stable condition on Neo, Propofol, and insulin. She was extubated and her chest tubes were discontinued on POD#1. She had some hyperglycemia post op but the insulin drip was eventually weaned off and she was transferred to the floor on POD#2. Her epicardial pacing wires were discontinued on POD#3 and she was discharged to home in stable condition on POD#4. Medications on Admission: GLIPIZIDE 10 mg Tablet - 1 (One) Tablet(s) by mouth twice a day INSULIN GLARGINE [LANTUS] 100unit/mL Solution - 34 units before bedtime once daily LEVOTHYROXINE 75 mcg Tablet -one Tablet(s) by mouth daily MECLIZINE Dosage uncertain METFORMIN 1,000 mg Tablet - 0.5-1 Tablet(s) by mouth 1000mg in am, 500mg in afternoon and 1000mg in pm PANTOPRAZOLE 40 mg Tablet, Delayed Release (E.C.) - one Tablet(s) by mouth daily ROSUVASTATIN [CRESTOR] 5 mg Tablet - one Tablet(s) by mouth daily Discharge Medications: 1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 3. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 5. metformin 500 mg Tablet Sig: One (1) Tablet PO LUNCH (Lunch). Disp:*30 Tablet(s)* Refills:*2* 6. insulin glargine 100 unit/mL Solution Sig: Thirty Four (34) units Subcutaneous at bedtime. Disp:*11 unit* Refills:*2* 7. rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 8. glipizide 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 9. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 10. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 11. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 12. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7 days. Disp:*14 Tablet(s)* Refills:*0* 13. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 7 days. Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* Discharge Disposition: Home With Service Facility: tba Discharge Diagnosis: Hyperlipidemia DM type 2 Lymphoma (retroperitoneal mass did not respond to chemo but good result to xrt x 22- last time was 5 yrs ago) Esophageal Reflux Spinal Disorder (Para spinal mass) Vertigo Hypothyroidism Obesity Coronary artery disease-s/p CABGx3 [**2144-11-6**] Discharge Condition: Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Ultram Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Followup Instructions: Recommended Follow-up: You are scheduled for the following appointments Surgeon: Dr. [**Last Name (STitle) **] on [**12-3**] @ 1:15 PM Cardiologist: Dr. [**Last Name (STitle) **] on [**12-21**] @ 10:00 AM Please call to schedule appointments with your Primary Care Dr. [**First Name (STitle) 1356**] in [**5-11**] weeks **Please call cardiac surgery office with any questions or concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call person during off hours** Completed by:[**2144-11-10**]

414,202,250,272,530,278,244,V874,V158,V153,V853

{'Coronary atherosclerosis of native coronary artery,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Esophageal reflux,Obesity, unspecified,Unspecified acquired hypothyroidism,Personal history of antineoplastic chemotherapy,Personal history of tobacco use,Personal history of irradiation, presenting hazards to health,Body Mass Index 37.0-37.9, adult'}

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: shoulder pain PRESENT ILLNESS: Ms. [**Known lastname 105089**] is a 58 year oldfemale with a history of type 2 DM, hyperlipidemia, obesity and pericardial effusion requiring a tap in [**2141**] of unclear etiology. Within the past month she has complained of left shoulder and scapular pain worse with activity. She states for the past couple of years she has had bilateral shoulder pain that has occurred shortly after radiation treatment. She had PT for a couple of years without relief of should pain. Patient recently went back to PT for left shoulder and scapular pain and was then referred for a stress test. Patient denies shortness of breath or chest discomfort. Patient states she has had bilateral LE edema for the past couple of years. She denies claudication, edema, orthopnea, PND and lightheadedness. MEDICAL HISTORY: Hyperlipidemia DM type 2 Lymphoma (retroperitoneal mass did not respond to chemo but good result to xrt x 22- last time was 5 yrs ago) Esophageal Reflux Spinal Disorder (Para spinal mass) Vertigo Hypothyroidism Obesity Hernia repaired x2 umbilical Pericardial Effusion [**8-12**] (TAP) Appendectomy as an adult Cholecystectomy C-section x2 MEDICATION ON ADMISSION: GLIPIZIDE 10 mg Tablet - 1 (One) Tablet(s) by mouth twice a day INSULIN GLARGINE [LANTUS] 100unit/mL Solution - 34 units before bedtime once daily LEVOTHYROXINE 75 mcg Tablet -one Tablet(s) by mouth daily MECLIZINE Dosage uncertain METFORMIN 1,000 mg Tablet - 0.5-1 Tablet(s) by mouth 1000mg in am, 500mg in afternoon and 1000mg in pm PANTOPRAZOLE 40 mg Tablet, Delayed Release (E.C.) - one Tablet(s) by mouth daily ROSUVASTATIN [CRESTOR] 5 mg Tablet - one Tablet(s) by mouth daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: Resp:18 O2 sat: 100 B/P Right:147/75 Left: Height:5'3" Weight:210 FAMILY HISTORY: Father had CABG and a couple of MI's, and cancer. Mother has diabetes SOCIAL HISTORY: Last Dental Exam:one month ago, no problems Lives with:alone Occupation:patient is an engineer Tobacco: quit 20 years ago, [**2-8**] pack for 20 years EtOH: a couple of drinks per month ### Response: {'Coronary atherosclerosis of native coronary artery,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Esophageal reflux,Obesity, unspecified,Unspecified acquired hypothyroidism,Personal history of antineoplastic chemotherapy,Personal history of tobacco use,Personal history of irradiation, presenting hazards to health,Body Mass Index 37.0-37.9, adult'}

CHIEF COMPLAINT: back pain PRESENT ILLNESS: This 58-year-old gentleman had been diagnosed with L2 metastasis at the time of his renal cell diagnosis.He had been treated with radiation therapy and symptoms did not improve. He continued to have intractable back pain. His imaging and history were consistent with instability as well.He had some left lower extremity symptoms but the etiology of this was somewhat confused with a left shin lesion. MEDICAL HISTORY: Metastatic renal cell carcinoma with metastases to lungs, spleen, L2 vertebra, left leg MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: pleasant wdwn male in nad Airway Mallampati [Class II] Mouth Opening [Adequate (> 3 cm)] Thyromental Distance [>6 cm] Hyomental Distance [>3 cm] Mandibular Prognatism [Adequate] Dental Good Head/Neck Range of Motion Free Range of Motion ht rrr lungs cta neuro weak LLE FAMILY HISTORY: nc SOCIAL HISTORY: quit tobacco [**2124**]

Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Pathologic fracture of tibia or fibula,Unspecified pleural effusion,Hypovolemia,Myelopathy in other diseases classified elsewhere,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of kidney,Personal history of irradiation, presenting hazards to health,Other joint derangement, not elsewhere classified, other specified sites,Neoplasm related pain (acute) (chronic),Other iatrogenic hypotension

Secondary malig neo bone,Secondary malig neo lung,Path fx tibia fibula,Pleural effusion NOS,Hypovolemia,Myelopathy in oth dis,Hypertension NOS,History of tobacco use,Hx of kidney malignancy,Hx of irradiation,Jt derangment NEC-oth jt,Neoplasm related pain,Iatrogenc hypotnsion NEC

Admission Date: [**2146-11-17**] Discharge Date: [**2146-11-26**] Date of Birth: [**2088-7-18**] Sex: M Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2724**] Chief Complaint: back pain Major Surgical or Invasive Procedure: L2 vertebrectomy and fusion blood transfusions History of Present Illness: This 58-year-old gentleman had been diagnosed with L2 metastasis at the time of his renal cell diagnosis.He had been treated with radiation therapy and symptoms did not improve. He continued to have intractable back pain. His imaging and history were consistent with instability as well.He had some left lower extremity symptoms but the etiology of this was somewhat confused with a left shin lesion. Past Medical History: Metastatic renal cell carcinoma with metastases to lungs, spleen, L2 vertebra, left leg Social History: quit tobacco [**2124**] Family History: nc Physical Exam: pleasant wdwn male in nad Airway Mallampati [Class II] Mouth Opening [Adequate (> 3 cm)] Thyromental Distance [>6 cm] Hyomental Distance [>3 cm] Mandibular Prognatism [Adequate] Dental Good Head/Neck Range of Motion Free Range of Motion ht rrr lungs cta neuro weak LLE Pertinent Results: [**2146-11-17**] 05:37PM GLUCOSE-136* UREA N-22* CREAT-1.3* SODIUM-140 POTASSIUM-5.6* CHLORIDE-109* TOTAL CO2-25 ANION GAP-12 [**2146-11-17**] 05:37PM WBC-11.8* RBC-3.60* HGB-10.2* HCT-30.2* MCV-84 MCH-28.3 MCHC-33.8 RDW-15.3 [**2146-11-17**] 05:37PM PLT COUNT-199 [**2146-11-17**] 05:37PM PT-12.7 PTT-26.7 INR(PT)-1.1 Brief Hospital Course: Pt was admitted to the hospital electively and brought ot the OR where under general anesthesia he underwent L2 vertebrectomy with fusion. Vascular surgery did the approach and and placed CT post op. He was kept intubated, transferred to the ICU. The first post op morning he was extubated without difficulty. The CT was put to waterseal and ultimately removed. His hematocrit was followed due to large intra-op blood loss and he did require blood transfusions. His diet and activity were advanced although he was kept non-weight bearing on left leg as pre-op. He was transferred to the floor. His foley was removed. His incision was clean and dry with staples. He did have post op pain management issues and different medications and dosages were titrated. He did have some confusion on the overnight of the [**11-23**] and had LLE pain in the am which was imaged, showing Large destructive lesion in the proximal tibia causing non-displaced pathological fracture through the tibial eminence and through the medial cortex of the tibia. He was evaluated by PT and recommended for home pt visits. His pain is currently well controlled with Discharge Disposition: Home With Service Facility: VNS [**Location (un) 30700**] Discharge Diagnosis: metastatic renal cell cancer to lumbar spine Discharge Condition: neurologically stable Discharge Instructions: ?????? Do not smoke ?????? Keep wound clean / No tub baths or pools until seen in follow up/ begin daily showers at home ?????? No pulling up, lifting> 10 lbs., excessive bending or twisting for two weeks. ?????? Limit your use of stairs to 2-3 times per day ?????? Have a family member check your incision daily for signs of infection ?????? Take pain medication as instructed; you may find it best if taken in the a.m. when you wake for morning stiffness and before bed for sleeping discomfort ?????? Do not take any anti-inflammatory medications such as Motrin, Advil, aspirin, Ibuprofen etc. for one week. ?????? Increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING: ?????? Pain that is continually increasing or not relieved by pain medicine ?????? Any weakness, numbness, tingling in your extremities ?????? Any signs of infection at the wound site: redness, swelling, tenderness, drainage ?????? Fever greater than or equal to 101?????? F ?????? Any change in your bowel or bladder habits Followup Instructions: PLEASE RETURN TO THE OFFICE IN 7 DAYS FOR REMOVAL OF YOUR STAPLES PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR. [**Last Name (STitle) **] TO BE SEEN IN 6 WEEKS. YOU WILL NEED XRAYS PRIOR TO YOUR APPOINTMENT Completed by:[**2146-11-26**]

198,197,733,511,276,336,401,V158,V105,V153,718,338,458

{'Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Pathologic fracture of tibia or fibula,Unspecified pleural effusion,Hypovolemia,Myelopathy in other diseases classified elsewhere,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of kidney,Personal history of irradiation, presenting hazards to health,Other joint derangement, not elsewhere classified, other specified sites,Neoplasm related pain (acute) (chronic),Other iatrogenic hypotension'}

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: back pain PRESENT ILLNESS: This 58-year-old gentleman had been diagnosed with L2 metastasis at the time of his renal cell diagnosis.He had been treated with radiation therapy and symptoms did not improve. He continued to have intractable back pain. His imaging and history were consistent with instability as well.He had some left lower extremity symptoms but the etiology of this was somewhat confused with a left shin lesion. MEDICAL HISTORY: Metastatic renal cell carcinoma with metastases to lungs, spleen, L2 vertebra, left leg MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: pleasant wdwn male in nad Airway Mallampati [Class II] Mouth Opening [Adequate (> 3 cm)] Thyromental Distance [>6 cm] Hyomental Distance [>3 cm] Mandibular Prognatism [Adequate] Dental Good Head/Neck Range of Motion Free Range of Motion ht rrr lungs cta neuro weak LLE FAMILY HISTORY: nc SOCIAL HISTORY: quit tobacco [**2124**] ### Response: {'Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Pathologic fracture of tibia or fibula,Unspecified pleural effusion,Hypovolemia,Myelopathy in other diseases classified elsewhere,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of kidney,Personal history of irradiation, presenting hazards to health,Other joint derangement, not elsewhere classified, other specified sites,Neoplasm related pain (acute) (chronic),Other iatrogenic hypotension'}

CHIEF COMPLAINT: Tetany muscle spasms. PRESENT ILLNESS: The patient is a 52-year-old female who awoke on the morning of admission with body tingling. She felt numb and felt as though she had trouble moving her arms and legs. At 8 o'clock on the morning of admission the patient called the EMS. She was, otherwise, in her usual state of health. She has noticed over the past several day constipation, which was treated with PO Dulcolax with several watery stools the day before admission. MEDICAL HISTORY: 1. History of seizure disorder. 2. Hypotension. 3. Fibromyalgia. 4. Hypoxic brain injury secondary to overdose. 5. Depression with several suicide attempts. MEDICATION ON ADMISSION: 1. Prozac 40 mg PO b.i.d. 2. Klonopin 2 mg PO q.i.d. 3. Flexeril 10 mg PO t.i.d. 4. Ibuprofen 600 mg PO q.i.d. 5. [**Doctor First Name **] 60 mg PO b.i.d. 6. Risperdal 2 mg PO b.i.d. 7. Colace 100 mg PO b.i.d. 8. Albuterol/Atrovent MDIs p.r.n. ALLERGIES: The patient is allergic to PENICILLIN AND CODEINE. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Hypocalcemia,Tetany,Other, mixed, or unspecified drug abuse, unspecified,Other convulsions,Hypotension, unspecified,Constipation, unspecified,Hypopotassemia,Myalgia and myositis, unspecified

Hypocalcemia,Tetany,Drug abuse NEC-unspec,Convulsions NEC,Hypotension NOS,Constipation NOS,Hypopotassemia,Myalgia and myositis NOS

Service: Date: [**2129-10-12**] Date of Birth: [**2077-7-1**] Sex: F Surgeon: [**Name6 (MD) 3661**] [**Name8 (MD) 3662**], M.D. PREOPERATIVE DIAGNOSIS: POSTOPERATIVE DIAGNOSIS: CHIEF COMPLAINT: Tetany muscle spasms. HISTORY OF THE PRESENT ILLNESS: The patient is a 52-year-old female who awoke on the morning of admission with body tingling. She felt numb and felt as though she had trouble moving her arms and legs. At 8 o'clock on the morning of admission the patient called the EMS. She was, otherwise, in her usual state of health. She has noticed over the past several day constipation, which was treated with PO Dulcolax with several watery stools the day before admission. PAST MEDICAL HISTORY: 1. History of seizure disorder. 2. Hypotension. 3. Fibromyalgia. 4. Hypoxic brain injury secondary to overdose. 5. Depression with several suicide attempts. MEDICATIONS ON ADMISSION: 1. Prozac 40 mg PO b.i.d. 2. Klonopin 2 mg PO q.i.d. 3. Flexeril 10 mg PO t.i.d. 4. Ibuprofen 600 mg PO q.i.d. 5. [**Doctor First Name **] 60 mg PO b.i.d. 6. Risperdal 2 mg PO b.i.d. 7. Colace 100 mg PO b.i.d. 8. Albuterol/Atrovent MDIs p.r.n. ALLERGIES: The patient is allergic to PENICILLIN AND CODEINE. REVIEW OF SYSTEMS: The patient has no headache, no visual changes, no nausea, no vomiting, no fever, no chills, no seisure, no changes in diet, no abdominal pain, no shortness of breath, no chest pain, no changes in medications recently. SOCIAL HISTORY: The patient has positive tobacco use. No alcohol use. PAST MEDICAL HISTORY: The patient has history of multiple recreational drug use. PHYSICAL EXAMINATION: Examination on admission revealed the following: Temperature 96.9, blood pressure 108/48, heart rate 80s, respiratory rate 20. Oxygen saturation 98% on two liters. GENERAL: The patient was alert, oriented times three. Oropharynx was dry. Neck was supple with jugulovenous distention. CARDIOVASCULAR: Regular rate and rhythm normal S1 and S2. LUNGS: Bibasilar crackles. ABDOMEN: Soft, nontender, nondistended, normoactive bowel sounds. No hepatosplenomegaly. EXTREMITIES: Warm with good pulses, no edema. NEUROLOGICAL: Extraocular muscles are intact. Pupils equal, round, reactive to light and accommodation. MOUTH: Clenched, closed tongue, midline. SENSORY: Sensory examination was normal. Strength 5/5 in all muscle groups. Reflexes: 0 through 1 throughout. LABORATORY DATA: Labs on admission revealed the following: White blood count 8.0, hematocrit 32.8, platelet count 287,000, INR 1.2, PTT 23.5, sodium 137, potassium 2.4, chloride 92, bicarbonate 29, BUN 13, creatinine 0.9, glucose 74, magnesium 1.0, free calcium 0.78, CK 128, troponin less than 0.3. ABG: The pH was 7.51, CO2 40, pO2 45, toxicology screen negative. Chest x-ray revealed mild congestive heart failure. Echocardiogram: Mild MR, normal left ventricular ejection fraction greater than 55%. EKG: Normal sinus rhythm, PR of 0.174. QTC: 476 milliseconds, slightly prolonged compared to previous. HOSPITAL COURSE: In the ED, the patient received one ampule of calcium, 2 grams of magnesium, 6 liters of fluid. The patient was treated with Levofloxacin, Flagyl, and Hydrocortisone. The patient was admitted to the Medical Intensive Care Unit for management of electrolytes. The patient was given several ampules of calcium gluconate with improvement of the free calcium, as well as the total calcium. On [**10-11**], in the morning, the patient admitted to using Dulcolax on a daily basis and also frequent use of Fleet Phospho-Soda enemas and wanted to make sure that the staff knew that this could be the possible etiology of her current symptoms. The patient was continued to be hydrated with IV fluids. Electrolytes were repleted. Calcium continued to improve. The patient was transferred to the floor for management. Calcium was then repleted with one gram PO calcium carbonate with improvement of free calcium to a normal range. All other electrolytes were repleted as well. The Department of Psychiatry was consulted for evaluation of the patient laxative abuse. It was felt that the use was secondary to constipation and not likely due to body dysmorphic disorder or attempts to lose weight. However, recommend follow up as an outpatient, which the patient will do through her outpatient therapist, as well as her primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **]. The patient agrees to use nonstimulant bowel regimen, which included Milk of Magnesia, Colace, and Senna. The patient will follow up with the primary care physician for better bowel regimen management and possible gastrointestinal follow up. At the time of discharge, the patient's symptoms of tetany and muscle spasms had completely resolved and the electrolytes were normalized. DISCHARGE DIAGNOSES: 1. Hypocalcemia. 2. Laxative abuse. CONDITION ON DISCHARGE: Good. MEDICATIONS ON DISCHARGE: 1. Prozac 40 mg PO b.i.d. 2. Klonopin 2 mg PO q.i.d. 3. Flexeril 10 mg PO t.i.d. 4. Ibuprofen 600 mg PO q.i.d. 5. [**Doctor First Name **] 60 mg PO b.i.d. 6. Risperdal 2 mg PO b.i.d. 7. Colace 100 mg PO b.i.d. 8. Albuterol/Atrovent MDI p.r.n. 9. Senna one tablet PO q.h.s. 10. Milk of Magnesia PO p.r.n. constipation. 11. Calcium carbonate one gram PO b.i.d. FOLLOW-UP CARE: The patient is to follow up with her primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] who was Emailed. The patient will see Dr. [**Last Name (STitle) **] later this week or possibly the week after. [**Name6 (MD) 251**] [**Name8 (MD) **], M.D. Dictated By:[**Doctor Last Name 3663**] MEDQUIST36 D: [**2129-10-12**] 16:07 T: [**2129-10-13**] 15:05 JOB#: [**Job Number 3664**]

275,781,305,780,458,564,276,729

{'Hypocalcemia,Tetany,Other, mixed, or unspecified drug abuse, unspecified,Other convulsions,Hypotension, unspecified,Constipation, unspecified,Hypopotassemia,Myalgia and myositis, unspecified'}

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: Tetany muscle spasms. PRESENT ILLNESS: The patient is a 52-year-old female who awoke on the morning of admission with body tingling. She felt numb and felt as though she had trouble moving her arms and legs. At 8 o'clock on the morning of admission the patient called the EMS. She was, otherwise, in her usual state of health. She has noticed over the past several day constipation, which was treated with PO Dulcolax with several watery stools the day before admission. MEDICAL HISTORY: 1. History of seizure disorder. 2. Hypotension. 3. Fibromyalgia. 4. Hypoxic brain injury secondary to overdose. 5. Depression with several suicide attempts. MEDICATION ON ADMISSION: 1. Prozac 40 mg PO b.i.d. 2. Klonopin 2 mg PO q.i.d. 3. Flexeril 10 mg PO t.i.d. 4. Ibuprofen 600 mg PO q.i.d. 5. [**Doctor First Name **] 60 mg PO b.i.d. 6. Risperdal 2 mg PO b.i.d. 7. Colace 100 mg PO b.i.d. 8. Albuterol/Atrovent MDIs p.r.n. ALLERGIES: The patient is allergic to PENICILLIN AND CODEINE. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Hypocalcemia,Tetany,Other, mixed, or unspecified drug abuse, unspecified,Other convulsions,Hypotension, unspecified,Constipation, unspecified,Hypopotassemia,Myalgia and myositis, unspecified'}

CHIEF COMPLAINT: Headache x 2 days PRESENT ILLNESS: Patient is a 50 yo F with PMHx significant for current tobacco use, hypothyroidism, hyperlipidemia, hx CVA [**2175**] who presented to OSH this morning complaining of severe headache. The patient reports that the headache woke her from sleep at 1 am on the day prior to presentation. She describes it as bitemporal, radiating to the back of her head, throbbing and associated with nausea, sensitivity to light and sound. No aura, blurry vision or other neurologic symptoms. She does have a history of migraine headaches, for which she takes excedrine migraine once every few months - describes this headache as significantly different, and the "worst headache of her life." She remained at home for one day without any relief. She also experienced fever to 101 and shaking chills at home last night prior to presentation at [**Hospital3 **], as well as right-sided pleuritic chest pain. She denies any SOB, cough, or sick contacts. On arrival to OSH, initial vitals were T 98.1, BP 113/71, HR 111, 96% on RA. She had CT head, which was unremarkable, and LP which was normal. CXR showed a RUL PNA and she became progressively more hypotensive, with a nadir at 62/35 around 1300. She received 3 L IVF, CTX 2 grams IV, azithromycin 500 mg PO, Morphine 4 mg IV x 2 , Dilaudid IV (total of 4 mg IV), reglan 10 IV, and zofran 4 IV x2 and and BP improved to 90s/30s. She was transferred to [**Hospital1 18**] as there were no ICU beds available at the OSH - en route she reportedly received another 1L NS (although not documented). . In the ED, initial vs were: T 97.7 P 93 BP 78/p R 18 O2 sat 98% on 4L NC, pain 4/10 intensity. CXR showed a RUL pneumonia, labs were significant for WBC 24 with a left shift (88% pmns, 5% bands), Hct 34, lactate of 1.6. She was given levofloxacin 750 mg IV, acetaminophin 1gm PO, toradol 30 mg IV and 500cc NS. Blood and urine cultures were sent, and she was admitted to the MICU service for further management. . On arrival to the MICU, patient reported improvement in her headache, with intensity down to 5/10. She denied SOB, chest pain, cough, abd pain or other new complaints. Did report feeling thirsty and hungry. . Review of systems: (+) Per HPI. Also reports recent 50 lb intentional weight loss, accomplished through weight watchers. (-) Denies cough, shortness of breath, or wheezing. Denies palpitations, or weakness. Denies 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: -Hypothyroidism -Hyperlipidemia -Hx of CVA in [**2175**] - affect L optic nerve, has some residual left peripheral vision loss -OSA - was on CPAP at home, but discontinued use after significant recent weight loss -Migraines, typically monthly - s/p hysterectomy - s/p L kidney removal 5-6 years ago (reports it was removed b/c of a benign tumor) - remote hx of left knee surgery (in high school) MEDICATION ON ADMISSION: -Levothyroxane 137 mcg daily -Zetia 10 mg daily -Simvastatin 5 mg daily -ASA 325 mg daily -Excedrine migraine prn -Claritin prn allergies -zofarax prn cold sores ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 97.8, BP: 132/74, P: 86, RR: 20, 97% on RA Gen: well-nourished, well-appearing female HEENT: MMM, clear oropharynx, no LAD CV: RRR, no m/r/g PULM: decreased breath sounds over right upper lobe, clear at bases and over left side ABD: soft, non-tender, non-distended, BS+, EXT: warm, well-perfused, radial, DP, PT pulses 2+ bilaterally FAMILY HISTORY: Father with lung and bone cancer, died age 57. Mother with breast Ca diagnosed in her 40s. No family history of MI or CVA. SOCIAL HISTORY: Lives at home with husband of 30 years. Had been unemployed for 14 months, and then recently started a new job. Has smoked since the age of 18 - at least 30 pack years. Currently smokes [**2-12**] ppd. EtOH [**1-14**] drinks most friday and saturday nights. No increase in EtOH use lately. Denies illicit drug use.

Pneumonia, organism unspecified,Other diseases of lung, not elsewhere classified,Enlargement of lymph nodes,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Anxiety state, unspecified,Other late effects of cerebrovascular disease,Tobacco use disorder

Pneumonia, organism NOS,Other lung disease NEC,Enlargement lymph nodes,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Obstructive sleep apnea,Migrne unsp wo ntrc mgrn,Anxiety state NOS,Late effect CV dis NEC,Tobacco use disorder

Admission Date: [**2178-8-29**] Discharge Date: [**2178-9-1**] Date of Birth: [**2128-1-1**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 20146**] Chief Complaint: Headache x 2 days Major Surgical or Invasive Procedure: Bronschoscopy and biopsy History of Present Illness: Patient is a 50 yo F with PMHx significant for current tobacco use, hypothyroidism, hyperlipidemia, hx CVA [**2175**] who presented to OSH this morning complaining of severe headache. The patient reports that the headache woke her from sleep at 1 am on the day prior to presentation. She describes it as bitemporal, radiating to the back of her head, throbbing and associated with nausea, sensitivity to light and sound. No aura, blurry vision or other neurologic symptoms. She does have a history of migraine headaches, for which she takes excedrine migraine once every few months - describes this headache as significantly different, and the "worst headache of her life." She remained at home for one day without any relief. She also experienced fever to 101 and shaking chills at home last night prior to presentation at [**Hospital3 **], as well as right-sided pleuritic chest pain. She denies any SOB, cough, or sick contacts. On arrival to OSH, initial vitals were T 98.1, BP 113/71, HR 111, 96% on RA. She had CT head, which was unremarkable, and LP which was normal. CXR showed a RUL PNA and she became progressively more hypotensive, with a nadir at 62/35 around 1300. She received 3 L IVF, CTX 2 grams IV, azithromycin 500 mg PO, Morphine 4 mg IV x 2 , Dilaudid IV (total of 4 mg IV), reglan 10 IV, and zofran 4 IV x2 and and BP improved to 90s/30s. She was transferred to [**Hospital1 18**] as there were no ICU beds available at the OSH - en route she reportedly received another 1L NS (although not documented). . In the ED, initial vs were: T 97.7 P 93 BP 78/p R 18 O2 sat 98% on 4L NC, pain 4/10 intensity. CXR showed a RUL pneumonia, labs were significant for WBC 24 with a left shift (88% pmns, 5% bands), Hct 34, lactate of 1.6. She was given levofloxacin 750 mg IV, acetaminophin 1gm PO, toradol 30 mg IV and 500cc NS. Blood and urine cultures were sent, and she was admitted to the MICU service for further management. . On arrival to the MICU, patient reported improvement in her headache, with intensity down to 5/10. She denied SOB, chest pain, cough, abd pain or other new complaints. Did report feeling thirsty and hungry. . Review of systems: (+) Per HPI. Also reports recent 50 lb intentional weight loss, accomplished through weight watchers. (-) Denies cough, shortness of breath, or wheezing. Denies palpitations, or weakness. Denies 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: -Hypothyroidism -Hyperlipidemia -Hx of CVA in [**2175**] - affect L optic nerve, has some residual left peripheral vision loss -OSA - was on CPAP at home, but discontinued use after significant recent weight loss -Migraines, typically monthly - s/p hysterectomy - s/p L kidney removal 5-6 years ago (reports it was removed b/c of a benign tumor) - remote hx of left knee surgery (in high school) Social History: Lives at home with husband of 30 years. Had been unemployed for 14 months, and then recently started a new job. Has smoked since the age of 18 - at least 30 pack years. Currently smokes [**2-12**] ppd. EtOH [**1-14**] drinks most friday and saturday nights. No increase in EtOH use lately. Denies illicit drug use. Family History: Father with lung and bone cancer, died age 57. Mother with breast Ca diagnosed in her 40s. No family history of MI or CVA. Physical Exam: VS: 97.8, BP: 132/74, P: 86, RR: 20, 97% on RA Gen: well-nourished, well-appearing female HEENT: MMM, clear oropharynx, no LAD CV: RRR, no m/r/g PULM: decreased breath sounds over right upper lobe, clear at bases and over left side ABD: soft, non-tender, non-distended, BS+, EXT: warm, well-perfused, radial, DP, PT pulses 2+ bilaterally Pertinent Results: [**2178-9-1**] 06:00AM BLOOD WBC-11.4* RBC-3.69* Hgb-12.1 Hct-34.4* MCV-93 MCH-32.9* MCHC-35.2* RDW-14.0 Plt Ct-284 [**2178-8-31**] 06:28AM BLOOD WBC-15.7* RBC-3.41* Hgb-11.3* Hct-33.3* MCV-98 MCH-33.1* MCHC-33.9 RDW-13.9 Plt Ct-294 [**2178-8-30**] 05:00AM BLOOD WBC-19.7* RBC-3.05* Hgb-10.0* Hct-29.7* MCV-97 MCH-32.8* MCHC-33.7 RDW-13.9 Plt Ct-259 [**2178-8-29**] 06:00PM BLOOD WBC-24.3* RBC-3.45* Hgb-11.4* Hct-34.2* MCV-99* MCH-33.2* MCHC-33.5 RDW-13.8 Plt Ct-277 [**2178-8-29**] 06:00PM BLOOD Neuts-88* Bands-5 Lymphs-3* Monos-4 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2178-8-29**] 06:00PM BLOOD PT-14.5* PTT-29.3 INR(PT)-1.3* [**2178-8-31**] 06:28AM BLOOD PT-11.8 PTT-24.2 INR(PT)-1.0 [**2178-9-1**] 06:00AM BLOOD Glucose-114* UreaN-3* Creat-0.7 Na-139 K-3.6 Cl-106 HCO3-25 AnGap-12 [**2178-8-31**] 06:28AM BLOOD Glucose-83 UreaN-11 Creat-0.9 Na-142 K-4.2 Cl-111* HCO3-23 AnGap-12 [**2178-8-30**] 05:00AM BLOOD Glucose-90 UreaN-16 Creat-0.9 Na-138 K-3.7 Cl-111* HCO3-20* AnGap-11 [**2178-8-29**] 06:00PM BLOOD Glucose-90 UreaN-18 Creat-1.0 Na-137 K-4.7 Cl-108 HCO3-19* AnGap-15 [**2178-8-29**] 06:00PM BLOOD ALT-15 AST-17 AlkPhos-87 TotBili-0.2 [**2178-8-29**] 06:00PM BLOOD Lipase-13 [**2178-8-30**] 05:00AM BLOOD cTropnT-<0.01 [**2178-8-29**] 06:00PM BLOOD cTropnT-<0.01 [**2178-9-1**] 06:00AM BLOOD Calcium-8.4 Phos-4.4 Mg-1.6 [**2178-8-31**] 06:28AM BLOOD Calcium-8.6 Phos-3.0 Mg-2.0 [**2178-8-30**] 05:00AM BLOOD Calcium-7.8* Phos-2.8 Mg-1.8 [**2178-8-29**] 06:00PM BLOOD Calcium-7.3* Phos-3.8 Mg-1.7 [**2178-8-29**] 06:13PM BLOOD Lactate-1.6 CXR: [**2178-8-31**]: FINDINGS: Portable AP upright view of the chest is obtained. There is dense consolidation in the right upper lobe with air bronchograms again noted, which could represent right upper lobe pneumonia. Although, followup to resolution is advised as an underlying malignancy cannot be excluded at this time. The left lung remains clear. No pleural effusion is seen. Clips in the upper abdomen are noted. Heart size remains normal. IMPRESSION: Right upper lobe consolidation with air bronchograms, most likely representing pneumonia, although followup to resolution is advised to exclude underlying malignancy. CT Abdomen [**2178-8-31**]: IMPRESSION: 1. Probable right upper lobe/right suprahilar mass with postobstructive pneumonia. Right sided mediastinal and right hilar lymphadenopathy and contralateral mediastinal nodal enlargement. If this is a mass such as from malignancy, this is probable T3 N3 M0. However this may represent dense right upper lobe consolidation from infection, but less likely. 2. Homogenous enlargement of the left adrenal gland may relate to a nephrectomy as no focal adrenal lesion is shown. 3. Possible right first rib invasion, this can be confirmed with a PET-CT or limited MRI of the chest wall, if clinically appropriate. Result communicated by telephone to Dr [**Last Name (STitle) 86984**] medical resident, at 3.44 PM [**2178-8-30**]. Cytology: [**2178-8-31**] -Transbronchial FNA of 3 lymph nodes: negative for malignant cells. -Bronchial Washings: negative for malignant cells -unable to biopsy dominant mass via bronchoscopy Brief Hospital Course: 50 yo F tobacco user with hx of stroke, hyperlipidemia and hypotension who presents with RUL pneumonia and hypotension concerning for septic shock. # Hypotension/sepsis: Differential included sepsis, medication effect, hypovolemia. The patient was stablizied with fluid boluses. A CXR showed a consolidation in the RUL more consistent with a mass than infiltrate. She was initially started on ceftriaxone and levofloxacin to cover for community acquired pneumonia. She was continued on levofloxacin alone for a 14 day total course. # RUL opacity - A CT Chest was obtained which was consistent with a pancoast tumor of the right lung with mediastinal nodes on the opposite mediastinum. The pulmonary team performed a bronchoscopy with endoscopic ultrasound. They were unable to biopsy the dominant mass. FNAs were obtained from 3 lymph nodes and bronchial alveolar lavage was also performed. The cytology results were negative for malignant cells. Patient will follow-up with her primary care physician regarding further [**Name9 (PRE) 8019**] of this mass, including possible IR-guided transthoracic biopsy. Patient wanted to follow-up at [**Hospital 5871**] Hospital which is a [**Hospital3 328**] Cancer Institute affliate. # Headache - Unclear etiology, possibly initially a migraine HA that may have been complicated by post-LP, positional component. Resolved with pain medication. #Anxiety: Patient appropriately anxious regarding her diagnosis of a lung mass. Patient received lorazepam 1 mg po qHS while hospitalized. She was given a prescription for ambien. She will follow up with outpatient social work. # Tobacco Use: patient with current history of tobacco use, ~30 pack year history. She was given nicotine patch 14 mg daily and nicotine gum 2 mg po q4h prn nicotine craving and was given nicotine replacement prescriptions. #Hx of CVA: residual left side peripheral vision loss. Continued on asa 325 mg po qDay. #Hypothyroidism: continued on levothyroxine. #Hyperlipidemia: continued on simvastatin and eztimibe. Medications on Admission: -Levothyroxane 137 mcg daily -Zetia 10 mg daily -Simvastatin 5 mg daily -ASA 325 mg daily -Excedrine migraine prn -Claritin prn allergies -zofarax prn cold sores Discharge Medications: 1. Levothyroxine 137 mcg Capsule Sig: One (1) Capsule PO DAILY (Daily). 2. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Simvastatin 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). Disp:*14 Patch 24 hr(s)* Refills:*0* 6. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day for 10 days. Disp:*10 Tablet(s)* Refills:*0* 7. Claritin Oral 8. Zovirax Topical 9. Fioricet 50-325-40 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for headache. Disp:*10 Tablet(s)* Refills:*0* 10. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO three times a day as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 11. Cepacol Sore Throat 15-2 mg Lozenge Sig: One (1) lozenge Mucous membrane four times a day as needed for sore throat. Disp:*30 lozenges* Refills:*0* 12. Ambien 10 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia for 10 days. Disp:*10 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Pneumonia Lung Mass Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: 1. Pneumonia: you were admitted to the hospital with high fevers, headache and chest pain. You were found to have a pneumonia. Your infection caused your blood pressure to become low. You were given intravenous fluids to bring up your blood pressure. You were given antibiotics to treat your infection. You will continue to take antibiotics. The instructions for this are: -Levofloxacin 750 mg once a day until [**2178-9-12**] 2. Lung Mass: We found a mass in your lung on your chest x-ray. We got a CT scan to further evaluate the mass. We also performed a brochoscopy to obtain a biopsy of the mass. The results of the biopsy are not available yet. You will review these results with your primary care physician. [**Name10 (NameIs) **] were given a CD with the images from your CT scan. Your PCP will set up follow-up care with oncology at [**Hospital 5871**] Hospital which is an affiliate of [**Hospital 10596**] Cancer Institute 3. The following changes were made to your medications: -Added Levofloxacin 750 mg once a day until [**9-12**] -Added nicotine patch- apply daily -Added nicotine gum as needed for nicotine cravings -Added fioricet as needed for headache -Added ambien as needed for sleep Followup Instructions: Name: [**Last Name (LF) **],[**First Name3 (LF) **] L. Location: TRI-RIVER FAMILY HEALTH CENTER Address: [**Location (un) **], [**Location (un) **],[**Numeric Identifier 63010**] Phone: [**Telephone/Fax (1) 47884**] **Dr. [**Last Name (STitle) 86985**] office will contact you to schedule an appointment. If you dont hear by Wednesday, [**9-2**], please call the number above. Dr.[**Name (NI) 86986**] office will assist you in setting up a follow-up appointment at [**Hospital 5871**] Hospital.

486,518,785,244,272,327,346,300,438,305

{'Pneumonia, organism unspecified,Other diseases of lung, not elsewhere classified,Enlargement of lymph nodes,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Anxiety state, unspecified,Other late effects of cerebrovascular disease,Tobacco use disorder'}

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: Headache x 2 days PRESENT ILLNESS: Patient is a 50 yo F with PMHx significant for current tobacco use, hypothyroidism, hyperlipidemia, hx CVA [**2175**] who presented to OSH this morning complaining of severe headache. The patient reports that the headache woke her from sleep at 1 am on the day prior to presentation. She describes it as bitemporal, radiating to the back of her head, throbbing and associated with nausea, sensitivity to light and sound. No aura, blurry vision or other neurologic symptoms. She does have a history of migraine headaches, for which she takes excedrine migraine once every few months - describes this headache as significantly different, and the "worst headache of her life." She remained at home for one day without any relief. She also experienced fever to 101 and shaking chills at home last night prior to presentation at [**Hospital3 **], as well as right-sided pleuritic chest pain. She denies any SOB, cough, or sick contacts. On arrival to OSH, initial vitals were T 98.1, BP 113/71, HR 111, 96% on RA. She had CT head, which was unremarkable, and LP which was normal. CXR showed a RUL PNA and she became progressively more hypotensive, with a nadir at 62/35 around 1300. She received 3 L IVF, CTX 2 grams IV, azithromycin 500 mg PO, Morphine 4 mg IV x 2 , Dilaudid IV (total of 4 mg IV), reglan 10 IV, and zofran 4 IV x2 and and BP improved to 90s/30s. She was transferred to [**Hospital1 18**] as there were no ICU beds available at the OSH - en route she reportedly received another 1L NS (although not documented). . In the ED, initial vs were: T 97.7 P 93 BP 78/p R 18 O2 sat 98% on 4L NC, pain 4/10 intensity. CXR showed a RUL pneumonia, labs were significant for WBC 24 with a left shift (88% pmns, 5% bands), Hct 34, lactate of 1.6. She was given levofloxacin 750 mg IV, acetaminophin 1gm PO, toradol 30 mg IV and 500cc NS. Blood and urine cultures were sent, and she was admitted to the MICU service for further management. . On arrival to the MICU, patient reported improvement in her headache, with intensity down to 5/10. She denied SOB, chest pain, cough, abd pain or other new complaints. Did report feeling thirsty and hungry. . Review of systems: (+) Per HPI. Also reports recent 50 lb intentional weight loss, accomplished through weight watchers. (-) Denies cough, shortness of breath, or wheezing. Denies palpitations, or weakness. Denies 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: -Hypothyroidism -Hyperlipidemia -Hx of CVA in [**2175**] - affect L optic nerve, has some residual left peripheral vision loss -OSA - was on CPAP at home, but discontinued use after significant recent weight loss -Migraines, typically monthly - s/p hysterectomy - s/p L kidney removal 5-6 years ago (reports it was removed b/c of a benign tumor) - remote hx of left knee surgery (in high school) MEDICATION ON ADMISSION: -Levothyroxane 137 mcg daily -Zetia 10 mg daily -Simvastatin 5 mg daily -ASA 325 mg daily -Excedrine migraine prn -Claritin prn allergies -zofarax prn cold sores ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 97.8, BP: 132/74, P: 86, RR: 20, 97% on RA Gen: well-nourished, well-appearing female HEENT: MMM, clear oropharynx, no LAD CV: RRR, no m/r/g PULM: decreased breath sounds over right upper lobe, clear at bases and over left side ABD: soft, non-tender, non-distended, BS+, EXT: warm, well-perfused, radial, DP, PT pulses 2+ bilaterally FAMILY HISTORY: Father with lung and bone cancer, died age 57. Mother with breast Ca diagnosed in her 40s. No family history of MI or CVA. SOCIAL HISTORY: Lives at home with husband of 30 years. Had been unemployed for 14 months, and then recently started a new job. Has smoked since the age of 18 - at least 30 pack years. Currently smokes [**2-12**] ppd. EtOH [**1-14**] drinks most friday and saturday nights. No increase in EtOH use lately. Denies illicit drug use. ### Response: {'Pneumonia, organism unspecified,Other diseases of lung, not elsewhere classified,Enlargement of lymph nodes,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Anxiety state, unspecified,Other late effects of cerebrovascular disease,Tobacco use disorder'}

CHIEF COMPLAINT: [**Hospital 15305**] transfer from outside hospital PRESENT ILLNESS: Pt is a 70 yo M w/ h/o CAD, CHF (EF 5-10% from recent ECHO), s/p rigth right nephrectomy who presents from outside hospital with sepsis. Pt was originally admitted to [**Hospital1 2436**] on [**2162-11-23**] with fevers, and [**Location (un) 2452**] colored urine. Initially felt to have a UTI and treated with levoquin. Also had elevated LFT's but RUQ US was normal at this point. Continued to spike fevers, and changed abx to Zosyn out of concern for biliary sepsis. However Ct chest,abd pelvis unremarkable. He then had worsening acute renal failure. He was given fluids and then developed respiratory compromise. Ultimately he required intubation. Blood pressures continued to drop and required pressors. [**Last Name (un) **] stim was 60 with no response. Ultimately required 3 pressors. Repeat RUQ US showed GB thickening. A percutaneous cholecystectomy was placed. Found to have gram negative bacilli in biliary fluid. Despite aggressive care continued to have worsening renal failure, required pressors, became anuric, and difficulty to oxygenate on vent. Therefore transferred to [**Hospital1 18**] for possible CVVH and further intensive care. MEDICAL HISTORY: MI s/p 3 stents Right nephrectomy Hiatal hernia MEDICATION ON ADMISSION: Meds on admission to OSH:lescol, zetia, effexor, terazosin, flomax, mavik, cardia, percocet . Meds on admission to [**Hospital1 18**]: Levophed 0.5 Dopamine 20 Vasopressin 2.4 cefepime, gent, heparin sc, protonix, propofol, fentanyl, alb, atrovent ALLERGIES: Lipitor PHYSICAL EXAM: T 101.3 BP 134/70 HR 140 RR 21 O2sats 95% Vent settings: AC TV 600 RR 20 FiO2 100% PEEP 10 Gen: Sedated, non-responsive HEENT: Pupils constricted but reactive, equal. + scleral icterus, + scleral edema, + ETT Neck: no LAD Lungs: Crackles at bases Heart: Tachy, no m/r/g Abd: Distended, hypoactive bowel sounds, + biliary drain w/ dark gree bile Ext: no edema, ext. cool, + mottling Neuro: non-resposive Lines: Left subclavian, right femoral Aline FAMILY HISTORY: NC SOCIAL HISTORY: Lives with wife. Former [**Name2 (NI) 1818**]

Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Cardiogenic shock,Congestive heart failure, unspecified,Mixed acid-base balance disorder,Cholangitis,Cardiac arrest,Severe sepsis,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Acquired absence of kidney,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of kidney

Septicemia NOS,Acute respiratry failure,Acute kidney failure NOS,Cardiogenic shock,CHF NOS,Mixed acid-base bal dis,Cholangitis,Cardiac arrest,Severe sepsis,Hypotension NOS,Crnry athrscl natve vssl,Old myocardial infarct,Acquired absence kidney,Status-post ptca,Hx of kidney malignancy

Admission Date: [**2162-11-26**] Discharge Date: [**2162-11-26**] Date of Birth: [**2092-3-3**] Sex: M Service: MEDICINE Allergies: Lipitor Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: [**Hospital 15305**] transfer from outside hospital Major Surgical or Invasive Procedure: None History of Present Illness: Pt is a 70 yo M w/ h/o CAD, CHF (EF 5-10% from recent ECHO), s/p rigth right nephrectomy who presents from outside hospital with sepsis. Pt was originally admitted to [**Hospital1 2436**] on [**2162-11-23**] with fevers, and [**Location (un) 2452**] colored urine. Initially felt to have a UTI and treated with levoquin. Also had elevated LFT's but RUQ US was normal at this point. Continued to spike fevers, and changed abx to Zosyn out of concern for biliary sepsis. However Ct chest,abd pelvis unremarkable. He then had worsening acute renal failure. He was given fluids and then developed respiratory compromise. Ultimately he required intubation. Blood pressures continued to drop and required pressors. [**Last Name (un) **] stim was 60 with no response. Ultimately required 3 pressors. Repeat RUQ US showed GB thickening. A percutaneous cholecystectomy was placed. Found to have gram negative bacilli in biliary fluid. Despite aggressive care continued to have worsening renal failure, required pressors, became anuric, and difficulty to oxygenate on vent. Therefore transferred to [**Hospital1 18**] for possible CVVH and further intensive care. Past Medical History: MI s/p 3 stents Right nephrectomy Hiatal hernia Social History: Lives with wife. Former [**Name2 (NI) 1818**] Family History: NC Physical Exam: T 101.3 BP 134/70 HR 140 RR 21 O2sats 95% Vent settings: AC TV 600 RR 20 FiO2 100% PEEP 10 Gen: Sedated, non-responsive HEENT: Pupils constricted but reactive, equal. + scleral icterus, + scleral edema, + ETT Neck: no LAD Lungs: Crackles at bases Heart: Tachy, no m/r/g Abd: Distended, hypoactive bowel sounds, + biliary drain w/ dark gree bile Ext: no edema, ext. cool, + mottling Neuro: non-resposive Lines: Left subclavian, right femoral Aline Pertinent Results: [**2162-11-26**] 08:31PM TYPE-ART TEMP-37.2 PEEP-10 PO2-105 PCO2-39 PH-7.18* TOTAL CO2-15* BASE XS--13 INTUBATED-INTUBATED VENT-CONTROLLED [**2162-11-26**] 08:22PM GLUCOSE-121* UREA N-40* CREAT-5.2* SODIUM-135 POTASSIUM-4.0 CHLORIDE-103 TOTAL CO2-14* ANION GAP-22* [**2162-11-26**] 08:22PM ALT(SGPT)-145* AST(SGOT)-120* LD(LDH)-294* CK(CPK)-127 ALK PHOS-114 AMYLASE-297* TOT BILI-2.1* [**2162-11-26**] 08:22PM LIPASE-125* [**2162-11-26**] 08:22PM CK-MB-15* MB INDX-11.8* cTropnT-1.38* [**2162-11-26**] 08:22PM ALBUMIN-2.4* CALCIUM-6.3* PHOSPHATE-4.8* MAGNESIUM-1.6 [**2162-11-26**] 08:22PM WBC-21.6* RBC-3.40* HGB-10.9* HCT-30.7* MCV-90 MCH-32.2* MCHC-35.6* RDW-15.1 [**2162-11-26**] 08:22PM PT-13.7* PTT-30.0 INR(PT)-1.3 [**2162-11-26**] 08:22PM FIBRINOGE-622* Brief Hospital Course: When patient arrived to floor he was on three pressors at max dosages. He was required full ventilatory support with FiO2 of 100%. On attempting to transition him from transort meds to our meds his BP would drop from the low 100's to 60's. During this time we bolused him 2 L of IVF and continued pressor support. Initially ABG should acidosis of 7.18 and Bicarb of 15. His pressors returned to low 100's after fluid boluses but then would have transient episodes of hypotension. Initially labs came back with worsening renal failure, elevated trop, hypoca, hyperphos, leukocytosis. A discussion was held with family given poor prognosis as patient was in sepsis with multi-organ failure including heart, lungs, lkidneys, liver. He was anuric. EF at OSH was 5-10%. Contact[**Name (NI) **] renal about possible CVVH> They recommended trying lasix, zaroxyln, bicarb gtt. Pt was given bicarb and calcium and increased his minute ventilation to blow off CO2. However despite this patient worsened. His BP dropped into the 50's despite maximizing three pressors. HE then went into PEA arrest. CPR started. He was given epineprine 1mg times 2 and atropine 1mg times 2 with no response. After 11 minutes of CPR and coding the patient he was pronounced dead at 2221 (1021pm). Medications on Admission: Meds on admission to OSH:lescol, zetia, effexor, terazosin, flomax, mavik, cardia, percocet . Meds on admission to [**Hospital1 18**]: Levophed 0.5 Dopamine 20 Vasopressin 2.4 cefepime, gent, heparin sc, protonix, propofol, fentanyl, alb, atrovent Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: Sepsis Hypotension Heart Failure Cholangitis Respiratory Failure Cardiac Arrest Discharge Condition: Expired [**2162-11-26**] at 2221 Discharge Instructions: NA Followup Instructions: NA [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

038,518,584,785,428,276,576,427,995,458,414,412,V457,V458,V105

{'Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Cardiogenic shock,Congestive heart failure, unspecified,Mixed acid-base balance disorder,Cholangitis,Cardiac arrest,Severe sepsis,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Acquired absence of kidney,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of kidney'}

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: [**Hospital 15305**] transfer from outside hospital PRESENT ILLNESS: Pt is a 70 yo M w/ h/o CAD, CHF (EF 5-10% from recent ECHO), s/p rigth right nephrectomy who presents from outside hospital with sepsis. Pt was originally admitted to [**Hospital1 2436**] on [**2162-11-23**] with fevers, and [**Location (un) 2452**] colored urine. Initially felt to have a UTI and treated with levoquin. Also had elevated LFT's but RUQ US was normal at this point. Continued to spike fevers, and changed abx to Zosyn out of concern for biliary sepsis. However Ct chest,abd pelvis unremarkable. He then had worsening acute renal failure. He was given fluids and then developed respiratory compromise. Ultimately he required intubation. Blood pressures continued to drop and required pressors. [**Last Name (un) **] stim was 60 with no response. Ultimately required 3 pressors. Repeat RUQ US showed GB thickening. A percutaneous cholecystectomy was placed. Found to have gram negative bacilli in biliary fluid. Despite aggressive care continued to have worsening renal failure, required pressors, became anuric, and difficulty to oxygenate on vent. Therefore transferred to [**Hospital1 18**] for possible CVVH and further intensive care. MEDICAL HISTORY: MI s/p 3 stents Right nephrectomy Hiatal hernia MEDICATION ON ADMISSION: Meds on admission to OSH:lescol, zetia, effexor, terazosin, flomax, mavik, cardia, percocet . Meds on admission to [**Hospital1 18**]: Levophed 0.5 Dopamine 20 Vasopressin 2.4 cefepime, gent, heparin sc, protonix, propofol, fentanyl, alb, atrovent ALLERGIES: Lipitor PHYSICAL EXAM: T 101.3 BP 134/70 HR 140 RR 21 O2sats 95% Vent settings: AC TV 600 RR 20 FiO2 100% PEEP 10 Gen: Sedated, non-responsive HEENT: Pupils constricted but reactive, equal. + scleral icterus, + scleral edema, + ETT Neck: no LAD Lungs: Crackles at bases Heart: Tachy, no m/r/g Abd: Distended, hypoactive bowel sounds, + biliary drain w/ dark gree bile Ext: no edema, ext. cool, + mottling Neuro: non-resposive Lines: Left subclavian, right femoral Aline FAMILY HISTORY: NC SOCIAL HISTORY: Lives with wife. Former [**Name2 (NI) 1818**] ### Response: {'Unspecified septicemia,Acute respiratory failure,Acute kidney failure, unspecified,Cardiogenic shock,Congestive heart failure, unspecified,Mixed acid-base balance disorder,Cholangitis,Cardiac arrest,Severe sepsis,Hypotension, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Acquired absence of kidney,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of kidney'}

CHIEF COMPLAINT: Chief Complaint: Cough, fever, shortness of breath Reason for MICU admission: transient hypotension in the ED (fluid responsive) PRESENT ILLNESS: Patient is a 79 yo woman with complex past medical history (asthma, diastolic heart failure, anemia, thrombocytopenia ?[**2-2**] MDS) now p/w SOB, cough and fevers (up to 101.5) for 24-48h. Cough is non-productive. No chest pain, abdominal pain, palpitations, N/V/D. SOB increased from baseline but responding to home nebs. Patient also endorsed generalized weakness/fatigue, to the point where she was unable to reach the bathroom this am because she could not get out of bed. Also notes ? LBP with radiation to buttocks/legs, but denies urine/stool incontinence and loss of sensation. No recent h/o trauma per daughter. MEDICAL HISTORY: # thrombocytopenia: treated with steroids in the past in setting of asthma exacerbation with clinical response -> likely myelodysplastic disorder as per outpatient heme-onc Dr. [**Last Name (STitle) 2148**] MEDICATION ON ADMISSION: ALLERGIES: Celecoxib PHYSICAL EXAM: Vitals: BP 124/56, HR 93 (sinus), sat 100% RA General: awake, alert and oriented, no distress, breathing comfortably HEENT: non-icteric sclera, PERRLA Neck: supple, no LAD Lungs: diffuse wheezes bilaterally Cardiovascular: RRR, normal s1/s2 Abdomen: soft, non-tender, obese Extremities: non-edematous, warm/well-perfused FAMILY HISTORY: Her sister had diabetes, brother has heart disease and stroke in sister. SOCIAL HISTORY: From [**Male First Name (un) 1056**] (immigrated ~20yr ago). Lives with her son and has a daughter close by. Supportive family. Has VNA coming into the house with rotating family members taking care of her. She does not smoke, does not drink, and does not use drugs.

Immune thrombocytopenic purpura,Chronic combined systolic and diastolic heart failure,Cough,Myelodysplastic syndrome, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Asthma, unspecified type, unspecified,Eosinophilia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Nonspecific low blood pressure reading,Cyst of kidney, acquired,Diverticulosis of colon (without mention of hemorrhage),Unspecified glaucoma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,Fever, unspecified,Acute kidney failure, unspecified

Immune thrombocyt purpra,Chr syst/diastl hrt fail,Cough,Myelodysplastic synd NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,DMII wo cmp nt st uncntr,Anemia NOS,Asthma NOS,Eosinophilia,Cholelithiasis NOS,Low blood press reading,Cyst of kidney, acquired,Dvrtclo colon w/o hmrhg,Glaucoma NOS,Osteoarthros NOS-unspec,Depressive disorder NEC,Fever NOS,Acute kidney failure NOS

Admission Date: [**2123-5-16**] Discharge Date: [**2123-5-18**] Date of Birth: [**2043-10-28**] Sex: F Service: MEDICINE Allergies: Celecoxib Attending:[**First Name3 (LF) 17865**] Chief Complaint: Chief Complaint: Cough, fever, shortness of breath Reason for MICU admission: transient hypotension in the ED (fluid responsive) Major Surgical or Invasive Procedure: None. History of Present Illness: Patient is a 79 yo woman with complex past medical history (asthma, diastolic heart failure, anemia, thrombocytopenia ?[**2-2**] MDS) now p/w SOB, cough and fevers (up to 101.5) for 24-48h. Cough is non-productive. No chest pain, abdominal pain, palpitations, N/V/D. SOB increased from baseline but responding to home nebs. Patient also endorsed generalized weakness/fatigue, to the point where she was unable to reach the bathroom this am because she could not get out of bed. Also notes ? LBP with radiation to buttocks/legs, but denies urine/stool incontinence and loss of sensation. No recent h/o trauma per daughter. In the ED, initial vital signs were: T 101.8, P 108, BP 171/72, RR 24, sat 100% room air. Patient was given acetaminophen, aspirin, albuterol nebs x3, ipratropium Bromide nebs x3, vancomycin 1g, piperacillin-tazob 4.5 mg and 2L IVF. On exam, diffuse wheezes bilaterally > at expiration. CXR and l-spine/pelvis X-ray showed no PNA, no fractures. CT abdomen showed no acute intra-abdominal or pelvic abnormalities, cholelithiasis w/o e/o acute cholecystitis, renal cysts, diverticulosis w/o e/o diverticulitis. UA was negative. Laboratory showed a white count of 9.8 with 84% neutrophils, lipase of 80, lactate of 2.6. EKG showed NSR [**Street Address(2) 35482**] depressions in the lateral leads (and TWIs - unchanged from prior [**2123-2-15**]) that resolved to near baseline without intervention. Cardiac enzymes were negative x2 - six hours apart. Vitals at time of transfer were T 98, BP 120/65, HR 104, satting 100% RA. Access includes 2 PIVs. Of note, patient was recently admitted [**Date range (1) 35483**] to general medicine service for thrombocytopenia (platelets nadired at 9). The cause was felt to be ITP secondary to MDS. She was started on prednisone 60 mg daily with plan to taper over a 15-day course (this taper ended on [**5-15**]). Patient was to follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2148**] in hematology clinic on [**5-27**]. Other events during that admission were a dropping hct (seen by GI who recommended outpatient follow-up), fevers with no clear source (she was treated broadly with vancomycin, Zosyn, and levofloxacin which were all stopped after negative infectious work-up), and acute on chronic renal failure (improved with IVF). Review of systems: Patient currently denies headache, photophobia, stiff neck, chest pain or tightness, shortness of breath, difficulty breathing, abdominal pain or discomfort, diarrhea or constipation, nausea/vomiting, or leg pain. Review of systems is positive for dry cough, which she says started last night. Past Medical History: # thrombocytopenia: treated with steroids in the past in setting of asthma exacerbation with clinical response -> likely myelodysplastic disorder as per outpatient heme-onc Dr. [**Last Name (STitle) 2148**] # asthma # diabetes type II dx'd ~[**2116**] # hypothyroidism # hypertension # chronic kidney disease- baseline crt ~1.1; likely secondary to hypertensive nephrosclerosis # systolic congestive heart failure, EF 45% # anemia # eosinophilia # depression # glaucoma # osteoarthritis # h/o [**First Name8 (NamePattern2) **] [**Location (un) **] syndrome w/ celecoxib # facial cellulitis tx w/ Bactrim in [**5-7**] # history of atrial fibrillation (uncertain to [**Hospital1 18**] cardiologist) Social History: From [**Male First Name (un) 1056**] (immigrated ~20yr ago). Lives with her son and has a daughter close by. Supportive family. Has VNA coming into the house with rotating family members taking care of her. She does not smoke, does not drink, and does not use drugs. Family History: Her sister had diabetes, brother has heart disease and stroke in sister. Physical Exam: Vitals: BP 124/56, HR 93 (sinus), sat 100% RA General: awake, alert and oriented, no distress, breathing comfortably HEENT: non-icteric sclera, PERRLA Neck: supple, no LAD Lungs: diffuse wheezes bilaterally Cardiovascular: RRR, normal s1/s2 Abdomen: soft, non-tender, obese Extremities: non-edematous, warm/well-perfused Pertinent Results: Labs at Admission: [**2123-5-16**] 07:30AM BLOOD WBC-9.8 RBC-3.27* Hgb-10.0* Hct-30.9* MCV-95 MCH-30.8 MCHC-32.5 RDW-15.2 Plt Ct-111* [**2123-5-16**] 07:30AM BLOOD Neuts-84.4* Lymphs-7.2* Monos-3.1 Eos-5.2* Baso-0.1 [**2123-5-16**] 07:30AM BLOOD PT-11.2 PTT-22.6 INR(PT)-0.9 [**2123-5-16**] 07:30AM BLOOD Glucose-110* UreaN-45* Creat-1.6* Na-135 K-5.1 Cl-99 HCO3-24 AnGap-17 [**2123-5-16**] 07:30AM BLOOD ALT-37 AST-39 AlkPhos-48 TotBili-0.3 [**2123-5-16**] 07:30AM BLOOD CK-MB-1 cTropnT-0.01 [**2123-5-16**] 02:10PM BLOOD cTropnT-<0.01 proBNP-3649* [**2123-5-16**] 07:30AM BLOOD Lipase-80* [**2123-5-16**] 07:30AM BLOOD Calcium-8.7 Phos-3.0 Mg-2.1 [**2123-5-16**] 08:26AM BLOOD Glucose-112* Lactate-2.6* K-5.0 [**2123-5-16**] 10:37AM BLOOD Glucose-121* . [**2123-5-16**] 02:10PM BLOOD cTropnT-<0.01 proBNP-3649* [**2123-5-16**] 02:10PM BLOOD TSH-1.9 [**2123-5-17**] 05:25AM BLOOD Cortsol-14.3 . Micro Data: Flu swab neagtive Urine culture negative Blood cultures no growth by discharge (>48 hours) . Images/Studies: CXR ([**5-16**]): IMPRESSION: No evidence of pneumonia. . L-spine and pelvis plain film ([**5-16**]): IMPRESSION: 1. No fracture or dislocation. 2. Possible transitional anatomy with pseudoarthrosis of L5 on S1 with degenerative changes at the articular surfaces. . CT A/P with contrast ([**5-16**]): No acute intra-abd or pelvic abnl. Cholelithiasis w/o e/o acute cholecystitis. Renal cysts. Diverticulosis w/o e/o diverticulitis. . Discharge Labs: [**2123-5-18**] 02:50AM BLOOD WBC-7.4 RBC-3.01* Hgb-9.8* Hct-28.4* MCV-95 MCH-32.5* MCHC-34.4 RDW-15.5 Plt Ct-106* [**2123-5-18**] 02:50AM BLOOD Glucose-248* UreaN-34* Creat-1.5* Na-131* K-5.1 Cl-102 HCO3-20* AnGap-14 [**2123-5-18**] 02:50AM BLOOD Calcium-8.5 Phos-3.2 Mg-2.2 Brief Hospital Course: A 79-year-old woman with past medical history of thrombocytopenia, anemia, asthma, systolic CHF, and chronic renal insufficiency, recent admission for GIB and ITP, who now p/w fever and cough. # Fever/cough: The patient had fevers of an unclear source. CXR clear. U/A and urine cx negative. Blood cx with no growth. She was empirically treated with Vancomycin/Zosyn in ED, but these were not continued after admission, and she never had any further fevers. She was ruled out for influenza with viral DFA. She was kept on bronchodilator nebs given the wheezes on exam. Additionally, she was started back on high-dose prednisone with plan for continued course of 40mg daily until she sees her hematologist in 10 days. # Hypotension: The patient had transient hypotension in the emergency room that was fluid responsive. Given that she just finished a 15-day course of high-dose steroids, adrenal insufficiency was considered, but was ruled out with a normal AM cortisol of 15. TSH was also normal. Infectious workup negative as above. Patient was given small boluses of IVF on the first hospital day and her hypotension resolved, with no further interventions needed. As above, predisone was restarted at high dose (60 mg daily), and she was discharged on 40mg daily until outpt followup. # Thrombocytopenia: In the setting of myelodysplastic syndrome and recent admission for ITP, her plt counts have improved. She had a recent course on prednisone 60 mg daily, with last dose approx [**5-14**]. Her platelets had nadired at 9 and were 27 at the time of discharge [**2123-4-29**], but rebounded to over 100 during this admission. Steroids continued. # Eosinophilia: Patient with diagnosis of ?myelodysplastic syndrome (see heme/onc note from [**2123-1-19**]) and worsening eosinophilia despite treatment for two weeks with high-dose steroids. She is also an asthmatic. No further workup was pursued in the acute inpatient setting. # Anemia: The patient's Hct was at baseline. # Acute on chronic renal failure: The patient's creatinine was up to 1.6 on admission from baseline of 1.3. She reutrned to 1.3 with IVF, and was discharged with a creatinine of 1.5, within her baseline. # Diabetes: We continued ISS and home dose Lantus, with qid fingersticks. # H/o Atrial Fibrillation: She remained in sinus. She is not on anti-coagulation given her thrombocytopenia. # Depression: continued on her home Paxil. . # Prophylaxis: with pneumoboots given thrombocytopenia, PPI per home regimen, bowel regimen prn # Code: full # Communication: - [**Doctor First Name 794**] (dtr): [**Telephone/Fax (1) 35484**] # Disposition: was admitted to ICU given transient hypotension, but improved dramatically and was quickly called out. However, no bed was available for over 2 days, and so she was discharged to home from the ICU. She was evaluated by the RN staff for stability with her walker, and no formal PT consult was deemed necessary. [**Telephone/Fax (1) **] on Admission: (per most recent discharge summary): 1. Latanoprost 0.005 % Drops One (1) Drop Ophthalmic HS. 2. Lorazepam 0.5 mg Tablet One (1) Tablet PO HS PRN insomnia. 3. Levothyroxine 50 mcg Tablet One (1) Tablet PO DAILY. 4. Ferrous Sulfate 300 mg (60 mg Iron) Tablet PO DAILY. 5. Multivitamin Tablet One (1) Tablet PO DAILY. 6. Cyanocobalamin 500 mcg one Tablet PO DAILY. 7. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: [**1-2**] Inhalation every six (6) hours as needed for shortness of breath or wheezing. 8. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 9. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 10. Prednisone 60 mg Tablet PO DAILY for 15 days. 11. Paroxetine HCl 20 mg Tablet PO DAILY. 12. Fexofenadine 60 mg Tablet PO BID. 13. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**1-2**] Drops Ophthalmic PRN (as needed) as needed for burning/dry eyes. 14. Senna 8.6 mg one Tablet PO DAILY. 15. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. Pantoprazole 40 mg Tablet PO Q12H. 17. Docusate Sodium 100 mg Capsule PO BID. 18. Lantus 100 unit/mL Solution Sig: Twenty Five (25) units Subcutaneous at bedtime. 19. Insulin Lispro 100 unit/mL Solution Sig: One (1) injection Subcutaneous before meals and at bed time: As per insulin sliding scale. 20. Lancets One (1) five times a day. Insulin Glargine: 25U at night Insulin Humolog Sliding Scale Discharge [**Month/Day (2) **]: 1. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 2. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia. 3. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Cyanocobalamin 500 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 8. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation three times a day as needed for shortness of breath or wheezing. 9. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 10. Prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily) for 10 days. Disp:*20 Tablet(s)* Refills:*0* 11. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 13. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**1-2**] drops Ophthalmic as directed as needed for burning/dry eyes. 14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO once a day as needed for constipation. 15. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 16. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 17. Insulin Glargine 100 unit/mL Solution Sig: Twenty Five (25) units Subcutaneous at bedtime. 18. Insulin Lispro 100 unit/mL Solution Sig: One (1) injection Subcutaneous before meals and at bed time: As per insulin sliding scale. . 19. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Primary: Fever Shortness of breath . Secondary: ITP possibly due to MDS asthma chronic systolic and diastolic heart failure type 2 diabetes CKD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Dear Ms. [**Known lastname 35479**], You were admitted to the hospital for shortness of breath. You were also found to have a fever and low blood pressure. However, all of these problems quickly resolved. There was no evidence of any infection in your urine, blood, or lungs. Your blood pressure normalized quickly, with only some IV fluids. You had no further fevers, even while off of any antibiotics. It is possible that your symptoms were due to a flare-up of your autoimmune process, since you had just finished your steroids a couple of days prior to admission. For this reason, we are discharging you home with a continued course of steroids, until you see you blood doctor, Dr. [**Last Name (STitle) 2148**]. . Please note the following changes to your [**Last Name (STitle) 4982**]: START prednisone 40mg daily, until you see Dr. [**Last Name (STitle) 2148**] on [**2123-5-27**] . No other changes were made to your [**Date Range 4982**]. Followup Instructions: Hematology (platelets): [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9561**], M.D. Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2123-5-27**] 3:00 . Gastroenterology: [**Name6 (MD) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2123-6-2**] 1:30 . Puilmonology (asthma) Dr. [**First Name (STitle) 437**], MD. PULMONARY FUNCTION LAB Phone:[**Telephone/Fax (1) 609**] Date/Time:[**2123-6-18**] 10:40

287,428,786,238,403,585,250,285,493,288,574,796,593,562,365,715,311,780,584

{'Immune thrombocytopenic purpura,Chronic combined systolic and diastolic heart failure,Cough,Myelodysplastic syndrome, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Asthma, unspecified type, unspecified,Eosinophilia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Nonspecific low blood pressure reading,Cyst of kidney, acquired,Diverticulosis of colon (without mention of hemorrhage),Unspecified glaucoma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,Fever, unspecified,Acute kidney failure, unspecified'}

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: Chief Complaint: Cough, fever, shortness of breath Reason for MICU admission: transient hypotension in the ED (fluid responsive) PRESENT ILLNESS: Patient is a 79 yo woman with complex past medical history (asthma, diastolic heart failure, anemia, thrombocytopenia ?[**2-2**] MDS) now p/w SOB, cough and fevers (up to 101.5) for 24-48h. Cough is non-productive. No chest pain, abdominal pain, palpitations, N/V/D. SOB increased from baseline but responding to home nebs. Patient also endorsed generalized weakness/fatigue, to the point where she was unable to reach the bathroom this am because she could not get out of bed. Also notes ? LBP with radiation to buttocks/legs, but denies urine/stool incontinence and loss of sensation. No recent h/o trauma per daughter. MEDICAL HISTORY: # thrombocytopenia: treated with steroids in the past in setting of asthma exacerbation with clinical response -> likely myelodysplastic disorder as per outpatient heme-onc Dr. [**Last Name (STitle) 2148**] MEDICATION ON ADMISSION: ALLERGIES: Celecoxib PHYSICAL EXAM: Vitals: BP 124/56, HR 93 (sinus), sat 100% RA General: awake, alert and oriented, no distress, breathing comfortably HEENT: non-icteric sclera, PERRLA Neck: supple, no LAD Lungs: diffuse wheezes bilaterally Cardiovascular: RRR, normal s1/s2 Abdomen: soft, non-tender, obese Extremities: non-edematous, warm/well-perfused FAMILY HISTORY: Her sister had diabetes, brother has heart disease and stroke in sister. SOCIAL HISTORY: From [**Male First Name (un) 1056**] (immigrated ~20yr ago). Lives with her son and has a daughter close by. Supportive family. Has VNA coming into the house with rotating family members taking care of her. She does not smoke, does not drink, and does not use drugs. ### Response: {'Immune thrombocytopenic purpura,Chronic combined systolic and diastolic heart failure,Cough,Myelodysplastic syndrome, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Asthma, unspecified type, unspecified,Eosinophilia,Calculus of gallbladder without mention of cholecystitis, without mention of obstruction,Nonspecific low blood pressure reading,Cyst of kidney, acquired,Diverticulosis of colon (without mention of hemorrhage),Unspecified glaucoma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified,Fever, unspecified,Acute kidney failure, unspecified'}

CHIEF COMPLAINT: Fever, tachypnea PRESENT ILLNESS: Patient only able to provide limited history; details below taken from records on transfer, medical record, and history obtained in emergency room. Patient is a 44M with PMH of mental retardation, seizure disorder, [**Last Name (un) 3696**] syndrome, autism and recurrent aspiration pneumonias presenting with fever and tachycardia. Patient was recently admitted to [**Hospital1 18**] from an OSH for evaluation of mental status changes in the setting of [**Last Name (un) 3696**] and an aspiration pneumonia. He was treated with Vancomycin and Zosyn from [**Date range (1) 87807**]. His respiratory status was back to baseline and his mental status was improving at the time of discharge on [**2110-11-14**]. MEDICAL HISTORY: Autism [**Last Name (un) 3696**] Seizure disorder Recurrent aspiration pneumonias Hypertension Asthma Schizoaffective disorder GERD MEDICATION ON ADMISSION: 1. Quetiapine 100mg PO QHS 2. Lorazepam 0.5mg PO Q6H PRN agitation. 3. Nexium 20mg PO BID 4. Keppra 750mg PO BID 5. Lactulose 20g PO BID PRN constipation: titrate to [**2-5**] bowel movements per day. 6. Sucralfate 1g PO QID 7. Acetaminophen 325-650mg PO Q6H PRN pain or fever. 8. Advair Diskus 250-50 1 Inhalation twice a day. 9. Niacin 500mg PO at bedtime. 10. MVI PO once a day. 11. Singulair 10mg PO once a day. 12. Miconazole nitrate 2 % Powder Topical [**Hospital1 **] 13. Hydrocortisone Topical 14. Flonase 50 mcg/Actuation Spray at bedtime: once in each nostril. 15. Albuterol sulfate 90 mcg 1 Inhalation PRN shortness of breath or wheezing. 16. Calcium carbonate 500 mg (1,250 mg) Tablet, [**1-4**] Tablet, Chewables PO twice a day: 1000mg (2 tablets) in AM, and 500mg (1 tablet) in PM. 17. Prochlorperazine 10mg IM QID PRN Nausea ALLERGIES: Erythromycin / IV Dye, Iodine Containing / Haldol PHYSICAL EXAM: VS: T=99.4 BP=128/80 HR=115 RR=18 O2 Sat=97% on 4L Gen: Awake, alert, NAD HEENT: NCAT, EOMI, anicteric CV: RR, no m/r/g Pulm: Crackles bilaterally; bowel sounds audible Abd: Soft, distended, high-pitched bowel sounds throughout, non-tender Ext: No edema or calf tenderness Psych: Smiling, responding to questions, dysarthric FAMILY HISTORY: Patient unable to report. SOCIAL HISTORY: Per prior records, patient is independent with ADL's at baseline, lives in a group home.

Other specified intestinal obstruction,Acute venous embolism and thrombosis of axillary veins,Acute posthemorrhagic anemia,Autistic disorder, current or active state,Hematemesis,Hemorrhage complicating a procedure,Thrombocytopenia, unspecified,Other esophagitis,Hypopotassemia,Hematuria, unspecified,Retention of urine, unspecified,Pressure ulcer, lower back,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified intellectual disabilities,Unspecified essential hypertension,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pneumonitis due to inhalation of food or vomitus

Intestinal obstruct NEC,Ac emblsm axillary veins,Ac posthemorrhag anemia,Autistic disord-current,Hematemesis,Hemorrhage complic proc,Thrombocytopenia NOS,Other esophagitis,Hypopotassemia,Hematuria NOS,Retention urine NOS,Pressure ulcer, low back,Epilep NOS w/o intr epil,Intellect disability NOS,Hypertension NOS,Abn react-urinary cath,Food/vomit pneumonitis

Admission Date: [**2110-11-18**] Discharge Date: [**2110-12-12**] Date of Birth: [**2065-11-19**] Sex: M Service: MEDICINE Allergies: Erythromycin / IV Dye, Iodine Containing / Haldol Attending:[**First Name3 (LF) 633**] Chief Complaint: Fever, tachypnea Major Surgical or Invasive Procedure: NG tube placement femoral line placement History of Present Illness: Patient only able to provide limited history; details below taken from records on transfer, medical record, and history obtained in emergency room. Patient is a 44M with PMH of mental retardation, seizure disorder, [**Last Name (un) 3696**] syndrome, autism and recurrent aspiration pneumonias presenting with fever and tachycardia. Patient was recently admitted to [**Hospital1 18**] from an OSH for evaluation of mental status changes in the setting of [**Last Name (un) 3696**] and an aspiration pneumonia. He was treated with Vancomycin and Zosyn from [**Date range (1) 87807**]. His respiratory status was back to baseline and his mental status was improving at the time of discharge on [**2110-11-14**]. On the day of admission, patient was noted at his outside facility to be tachypneic to 32 with a HR=130 and oxygen saturation of 90% on room air. For these reasons he was transferred to the emergency room. On arrival vital signs were significant for T=101.6, HR=140 151/98, 96% on 4L. Exam was notable for rales on left and abdominal distention but no abdominal pain. Preliminary read of the CXR showed no clear focal consolidation but suggestion of a possible consolidation on the left, with low lung volumes. Also seen were dilated bowel loops, but without fluid levels and similar to prior X-rays. Initial labs were significant for WBC=16.8. Patient received Vancomycin, Flagyl, Tylenol, and 2-3L of IVF. HR improved in that setting to the 110's. He was then transferred to the general medicine service. ROS: All other systems reviewed and negative except as noted above. Past Medical History: Autism [**Last Name (un) 3696**] Seizure disorder Recurrent aspiration pneumonias Hypertension Asthma Schizoaffective disorder GERD Social History: Per prior records, patient is independent with ADL's at baseline, lives in a group home. Family History: Patient unable to report. Physical Exam: VS: T=99.4 BP=128/80 HR=115 RR=18 O2 Sat=97% on 4L Gen: Awake, alert, NAD HEENT: NCAT, EOMI, anicteric CV: RR, no m/r/g Pulm: Crackles bilaterally; bowel sounds audible Abd: Soft, distended, high-pitched bowel sounds throughout, non-tender Ext: No edema or calf tenderness Psych: Smiling, responding to questions, dysarthric Pertinent Results: CT ABD/PELVIS ([**2110-11-19**]): 1. Markedly dilated colon with no evidence for mechanical obstruction or stricture; significant stool burden in the rectum and cecum, most compatible with fecal impaction as there is no bowel wall thickening or pneumatosis. Differential considerations include moderate obstruction due to stool but pseudo-obstruction is suspected. 2. Foley balloon inflated within the urethra. 3. Mild bibasilar pulmonary consolidations which may represent atelectasis, but aspiration or infection cannot be excluded. CT ABD/PELVIS ([**2110-11-28**]): 1. No evidence of retroperitoneal hemorrhage. 2. Hyperdensity in the right colon may represent accidental ingestion of metallic foreign body as it seems to dense for metallic salts in pills;correlate with clinical or treatment history. 3. Bilateral pulmonary ground-glass opacifications again noted, relatively stable since [**2110-11-19**] and may represent aspiration/pneumonia, however, alveolar hemorrhage or edema cannot be completely excluded and should be considered in the correct clinical setting. 4. Calcified prostate noted. UNILAT UP EXT VEINS US LEFT IMPRESSION: Deep venous thrombosis seen within the left axillary vein extending to the basilic vein. . [**2110-12-3**] KUB-FINDINGS: One portable abdominal radiograph shows unchanged air-filled loops of colon. The study is again noted to be slightly underpenetrated. There is stable dilation of the likely mobile redundant cecum in a more anatomically appropriate postion comparted to prior. There is no evidence of free air or pneumatosis. Osseous structures appear unremarkable. IMPRESSION: Essentially unchanged distended cecum . CXR [**12-1**]-IMPRESSION: AP chest compared to [**11-30**]: New region of vague opacification in the right mid lung could represent early aspiration. No free subdiaphragmatic gas. Mild-to-moderate cardiomegaly has increased. No pneumothorax. . Head CT [**12-11**]-FINDINGS: There is no intracranial hemorrhage, mass effect, edema, or shift of normally midline structures. There is no major vascular territorial infarct. The [**Doctor Last Name 352**]-white matter differentiation is preserved. Ventricles and sulci are mildly prominent, indicating volume loss. Suprasellar and basilar cisterns are patent. There is mucosal thickening and aerosolized secretions within the frontal and bilateral maxillary sinuses. A few ethmoidal air cells are opacified. Layering fluid within the maxillary sinuses may indicate ongoing inflammation. Mastoid air cells are well aerated. Globes and soft tissues are unremarkable. . IMPRESSION: 1. No acute intracranial process, including hemorrhage or infarct. 2. Mild cerebral volume loss. 3. Moderate paranasal sinus disease. . EKG [**12-11**]-Sinus tachycardia. Delayed precordial R wave transition. Compared to the previous tracing of [**2110-11-22**] there is variation in precordial lead placement. No diagnostic interim change. Read by: [**Last Name (LF) 578**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 579**] Intervals Axes Rate PR QRS QT/QTc P QRS T 107 152 64 312/394 29 0 -1 . BLood cultures were all negative. C.diff negative x6 . [**2110-12-11**] 8:48 am URINE Source: Catheter. **FINAL REPORT [**2110-12-12**]** URINE CULTURE (Final [**2110-12-12**]): NO GROWTH. Brief Hospital Course: 44 y/oM with PMH of MR, schizoaffective d/o, seizure d/o, recent admission for [**Last Name (un) **] Syndrome c/b delerium and aspiration PNA who was initially readmitted to the hospital with presumed aspiration pneumonitis. . In brief, the patient was initially admitted on [**11-18**] with tachycardia, hypoxia and abdominal distension. Initial evaluation revealed leukocytosis to 20, dilated bowel loops, electrolyte abnormalities, and pulmonary consolidations. His presentation was felt to be consistent with aspiration pneumonitis and an exacerbation of his [**Last Name (un) 3696**] syndrome and he was treated conservatively with monitoring serial KUB and an aggressive bowel regimen. He was also started empirically on IV vanco (stopped on [**11-19**]) and PO vanco/ flagyl for presumed cdiff, but this eventually returned negative. . Of note, his hospital course was c/b traumatic foley insertion on [**11-20**] causing gross hematuria. Urology was consulted and recommended watchful waiting with placement of a coude foley catheter. Hospital course also c/b slow development of thrombocytopenia with platelets trending from 248 on admission to a nadir of 97. Evaluation was with HIT antibody was negative and PPI, flagyl were discontinued due to concern that this could be a medication side effect. . On the evening of presentation, patient developed hypotension to 80/60, tachycardia to 160s and fever to 103 and was noted to have approx 1 cp blood surrounding his penis. Stat labs were obtained and showed a Hct of 18 from 27. He was bolused with IVF (approx 2L), emergency blood was hung at bedside, zosyn x 1 was given. Transfer to unit was initiated for further resuscitation and hemodynamic monitoring. A 22Fr Coude foley catheter was placed urgently, with resulting hemostasis. There was no further bleeding noted. . At the time of transfer to the ICU, his BP was 80/50s with tachycardia to the 150's and elevated lactate in the setting of fever and frank hemorrhage. Etiology was unclear: evolving sepsis vs hypotension from hemorrhage. CXR showed possible aspiration pneumonia vs. pneumonitis. Placed on empiric meropenem, iv flagyl, iv vancomycin, and po vancomycin as pt was having diarrhea. Rec'd 2 U emergency transfusion. Electroylte abnormalites with hypokalemia in the low 2's as well as potential hemodynamic instability prompted sterile placement of right femoral line for rapid electrolyte repletion. Pt. stabilized and femoral line was removed. Was aggressively fluid repleted, and also given additional transfusions of PRBC's. Po vanco and Iv flagyl were discontinued after c.diff negative x3. Continued IV vancomycin 1000mg IV q12hr and meropenem 500 IV q6hr were continued, and he completed 8 days of empiric therapy for HAP. Last day [**12-4**] . During this time, there was concern for evolving severe sepsis given hypotension and elevated lactate. Possible sources included HAP from possible aspiration or an intra-abdominal process such as c.diff with dilated colon, diarrhea/loose stool and recent broad spectrum abx. Elevated coags on admission to ICU concerning for DIC. Started abx's per above. As pt was thrombocytopenic with fevers, DIC labs were checked for possible HUS, but came back negative. He became afebrile with above treatment, and his platelet count improved. HAP treatment completed during admission. . # Hematuria: secondary to traumatic foley placement with prostatic urethral tear. Resolved with placement of a 22fr Coude foley catheter. Pt had development of tea-colored urine [**12-11**] that resolved with clear urine in the foley and [**12-12**] with clear urine in foley. Urology came to evaluate the patient and foley flushed without difficulty there was no hematuria or clots seen. Given that foley had been in place for 2 weeks, urology recommended, DC foley and voiding trial. Pt was able to urinate after foley removal and no hematuria was noted. Recommend follow up with Urology 1-2 weeks after discharge. . # LUE DVT: During the admission, he was noted to develop a significantly swollen left arm. Ultrasound confirmed a non-occlusive DVT in his axillary vein, and a totally occluded basilic vein. Notably, the patient did NOT have a line (eg PICC) in the left arm, so the cause of his DVT is not clear. The risk-benefit of anticoagulation in this patient with recent bleeding episodes was considered, and anticoagulation was discussed with Urology, who felt that with a foley in place he is a low bleed risk. His recent hematuria was not felt to be a contraindication for anticoagulation. His recent GI bleed was felt due to erosive esophagitis, which is being aggressively treated with ppi and sucralfate, and GI bleeding appeared to have resolved. Therefore, he was started on a cautious heparin drip, with transition to warfarin. Considering his history of bleeding, would recommend treating with warfarin for short term/such as one month, with reevaluation for discontinuation of anticoagulation at that time. Pt with supertherapeutic INR up to 5.6, now 3.1. Would hold dose tonight, check INR tomorrow and consider resuming coumadin at 1mg. Goal is [**2-5**] INR but would prefer close to 2 given the above. . # Ogilvies Syndrome: profound colonic dilitation on x-ray in setting of known ogilvies thought to be due to fecal impaction, hypokalemia. Followed by GI on floor with serial KUB's and aggressive bowel regimen resulting in copious loose stool on admission. Empirically started on C.Diff coverage per above, but was negative x 3 so d/c'd. Colonic dilatiation appeared to be stable via KUB. It is important to make sure that pt continues to have at least daily bowel movements, and that he does not become constipated. . #?coffee ground emesis upon initial admission-some concern of this in notes. Pt had not had any further episodes during this admission. GI evaluated the patient for Ogilvies syndrome as above. There is report of patient having "erosive esophagitis" at OSH and pt was placed on [**Hospital1 **] PPI. He will need an EGD as an outpatient after colonic issues and acute issues pertinent to this hospitalization have resolved. Pt noted to be guaiac negative with stable hematocrits aside from gross hematuria as above. . # Schizoaffective d/o, MR: He was followed by Psychiatry, who assisted with management of his periods of agitation. Recommend maintaining sleep-weak cycle as possible, judicious use of anti-psychotics given recent hx of tardive dyskinesia. Consider need for 1:1 sitter. His agitation was treated with ativan and seroquel with benefit. Patient was also often redirectable, by taking him for walks. Pt did become agitated [**12-10**] evening and did suffer a fall. Head CT was negative for acute injury. - seoquel 25-50 mg hs prn or ativan 0.25 mg q6hr prn per Psychiatry - add seroquel 25 mg [**Hospital1 **] prn agitation per Psych . # Seizure d/o: stable, continued lamictal . Erosive esophagitis - continued sucralfate for erosive gastritis - changed IV pantoprazole to lansoprazole Medications on Admission: 1. Quetiapine 100mg PO QHS 2. Lorazepam 0.5mg PO Q6H PRN agitation. 3. Nexium 20mg PO BID 4. Keppra 750mg PO BID 5. Lactulose 20g PO BID PRN constipation: titrate to [**2-5**] bowel movements per day. 6. Sucralfate 1g PO QID 7. Acetaminophen 325-650mg PO Q6H PRN pain or fever. 8. Advair Diskus 250-50 1 Inhalation twice a day. 9. Niacin 500mg PO at bedtime. 10. MVI PO once a day. 11. Singulair 10mg PO once a day. 12. Miconazole nitrate 2 % Powder Topical [**Hospital1 **] 13. Hydrocortisone Topical 14. Flonase 50 mcg/Actuation Spray at bedtime: once in each nostril. 15. Albuterol sulfate 90 mcg 1 Inhalation PRN shortness of breath or wheezing. 16. Calcium carbonate 500 mg (1,250 mg) Tablet, [**1-4**] Tablet, Chewables PO twice a day: 1000mg (2 tablets) in AM, and 500mg (1 tablet) in PM. 17. Prochlorperazine 10mg IM QID PRN Nausea Discharge Medications: 1. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR PO BID (2 times a day). 2. alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension [**Last Name (STitle) **]: 15-30 MLs PO QID (4 times a day) as needed for dyspepsia. 3. quetiapine 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO HS (at bedtime) as needed for insomnia/agitation. 4. Ativan 0.5 mg Tablet [**Last Name (STitle) **]: 0.5 Tablet PO every six (6) hours as needed for agitation. 5. terbinafine 1 % Cream [**Last Name (STitle) **]: One (1) Appl Topical [**Hospital1 **] (2 times a day). 6. calcium carbonate 200 mg (500 mg) Tablet, Chewable [**Hospital1 **]: One (1) Tablet, Chewable PO TID (3 times a day). 7. niacin 500 mg Capsule, Sustained Release [**Hospital1 **]: One (1) Capsule, Sustained Release PO BID (2 times a day). 8. levetiracetam 250 mg Tablet [**Hospital1 **]: Three (3) Tablet PO BID (2 times a day). 9. montelukast 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 10. sucralfate 1 gram Tablet [**Hospital1 **]: One (1) Tablet PO QID (4 times a day). 11. acetaminophen 325 mg Tablet [**Hospital1 **]: 1-2 Tablets PO Q6H (every 6 hours) as needed for fever or pain. 12. Advair Diskus 250-50 mcg/dose Disk with Device [**Hospital1 **]: One (1) Inhalation twice a day. 13. multivitamin Tablet [**Hospital1 **]: One (1) Tablet PO once a day. 14. Flonase 50 mcg/Actuation Spray, Suspension [**Hospital1 **]: One (1) Nasal once a day. 15. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler [**Hospital1 **]: One (1) Inhalation every 6-8 hours as needed for shortness of breath or wheezing. 16. lactulose 10 gram/15 mL Solution [**Hospital1 **]: One (1) PO once a day as needed for constipation. 17. quetiapine 25 mg Tablet [**Hospital1 **]: 1-2 Tablets PO BID (2 times a day) as needed for insomnia/agitation. 18. senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day) as needed for constipation: prn. 19. docusate sodium 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID (2 times a day) as needed for constip. 20. warfarin 1 mg Tablet [**Hospital1 **]: One (1) Tablet PO Once Daily at 4 PM: to start [**12-13**] after checking INR. 21. Calcium 500 500 mg (1,250 mg) Tablet [**Month/Year (2) **]: 2 tabs qam, 1 tab qpm Tablets PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital 671**] [**Hospital 4094**] Hospital - [**Location (un) 86**] Discharge Diagnosis: # Abdominal distension - [**Last Name (un) 3696**] Syndrome # Thrombocytopenia # Urinary retention # Hematemesis # aspiration/healthcare associated pneumonia # Acute blood loss anemia # Hematuria # Erosive esophagitis # schizoaffective d/o Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: You were admitted fever and a fast heart rate. During this stay you were treated for abdominal distension, low platelet counts (thrombocytopenia), urinary retention, bloody vomitus, aspiration/healthcare associated pneumonia, anemia, and hematuria (blood from penis). Your fever and pneumonia appear to have resolved. You were evaluated by the urology service and a foley catheter was placed. You no longer had any bleeding and your foley catheter was removed. You were able to urine without difficulty. You were also evaluated by the gastroeintestinal and psychiatric services. . Please take all of your medications as prescribed and follow up with the appointments below. Followup Instructions: Once you are nearing discharge from rehab, please have them schedule an appointment with your primary care provider. Department: SURGICAL SPECIALTIES When: WEDNESDAY [**2110-12-17**] at 8:00 AM With: UROLOGY UNIT [**Telephone/Fax (1) 164**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

560,453,285,299,578,998,287,530,276,599,788,707,345,319,401,E879,507

{'Other specified intestinal obstruction,Acute venous embolism and thrombosis of axillary veins,Acute posthemorrhagic anemia,Autistic disorder, current or active state,Hematemesis,Hemorrhage complicating a procedure,Thrombocytopenia, unspecified,Other esophagitis,Hypopotassemia,Hematuria, unspecified,Retention of urine, unspecified,Pressure ulcer, lower back,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified intellectual disabilities,Unspecified essential hypertension,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pneumonitis due to inhalation of food or vomitus'}

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: Fever, tachypnea PRESENT ILLNESS: Patient only able to provide limited history; details below taken from records on transfer, medical record, and history obtained in emergency room. Patient is a 44M with PMH of mental retardation, seizure disorder, [**Last Name (un) 3696**] syndrome, autism and recurrent aspiration pneumonias presenting with fever and tachycardia. Patient was recently admitted to [**Hospital1 18**] from an OSH for evaluation of mental status changes in the setting of [**Last Name (un) 3696**] and an aspiration pneumonia. He was treated with Vancomycin and Zosyn from [**Date range (1) 87807**]. His respiratory status was back to baseline and his mental status was improving at the time of discharge on [**2110-11-14**]. MEDICAL HISTORY: Autism [**Last Name (un) 3696**] Seizure disorder Recurrent aspiration pneumonias Hypertension Asthma Schizoaffective disorder GERD MEDICATION ON ADMISSION: 1. Quetiapine 100mg PO QHS 2. Lorazepam 0.5mg PO Q6H PRN agitation. 3. Nexium 20mg PO BID 4. Keppra 750mg PO BID 5. Lactulose 20g PO BID PRN constipation: titrate to [**2-5**] bowel movements per day. 6. Sucralfate 1g PO QID 7. Acetaminophen 325-650mg PO Q6H PRN pain or fever. 8. Advair Diskus 250-50 1 Inhalation twice a day. 9. Niacin 500mg PO at bedtime. 10. MVI PO once a day. 11. Singulair 10mg PO once a day. 12. Miconazole nitrate 2 % Powder Topical [**Hospital1 **] 13. Hydrocortisone Topical 14. Flonase 50 mcg/Actuation Spray at bedtime: once in each nostril. 15. Albuterol sulfate 90 mcg 1 Inhalation PRN shortness of breath or wheezing. 16. Calcium carbonate 500 mg (1,250 mg) Tablet, [**1-4**] Tablet, Chewables PO twice a day: 1000mg (2 tablets) in AM, and 500mg (1 tablet) in PM. 17. Prochlorperazine 10mg IM QID PRN Nausea ALLERGIES: Erythromycin / IV Dye, Iodine Containing / Haldol PHYSICAL EXAM: VS: T=99.4 BP=128/80 HR=115 RR=18 O2 Sat=97% on 4L Gen: Awake, alert, NAD HEENT: NCAT, EOMI, anicteric CV: RR, no m/r/g Pulm: Crackles bilaterally; bowel sounds audible Abd: Soft, distended, high-pitched bowel sounds throughout, non-tender Ext: No edema or calf tenderness Psych: Smiling, responding to questions, dysarthric FAMILY HISTORY: Patient unable to report. SOCIAL HISTORY: Per prior records, patient is independent with ADL's at baseline, lives in a group home. ### Response: {'Other specified intestinal obstruction,Acute venous embolism and thrombosis of axillary veins,Acute posthemorrhagic anemia,Autistic disorder, current or active state,Hematemesis,Hemorrhage complicating a procedure,Thrombocytopenia, unspecified,Other esophagitis,Hypopotassemia,Hematuria, unspecified,Retention of urine, unspecified,Pressure ulcer, lower back,Epilepsy, unspecified, without mention of intractable epilepsy,Unspecified intellectual disabilities,Unspecified essential hypertension,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Pneumonitis due to inhalation of food or vomitus'}

CHIEF COMPLAINT: nausea PRESENT ILLNESS: Patient is a 66 year old female with recently diagnosed lung cancer with metastases to the brain who presents tot he ER with nausea. She was feeling well and then on Wednesday of last week she underwent her first of 10 whole brain radiation treatments. She felt well following it but on Thursday morning developed nausea. She underwent her treatments on Thursday and Friday and progressively developed increasing lethargy and gait disturbance. She went to her radiation treatment the morning of admission, but given her gait instability, she was sent to the ER for concern of increased intracranial pressure. She states that her nausea has been progressive and caused her to not be able to eat or drink anyting for the past 5 days except for her pills. It has persisted despite Zofran standing. She complains moderate head "pressure" and some mild vague visual changes. She denies changes in speech or hearing, photophobia, changes in bowel or bladder function. Vitals in the ER: 97.6 100% RA 16 133/83 HR 82. She received Dexamethasone 4mg IV, IV Morphine, Zofran, and 1L NS. . Review of Systems: (+) Per HPI; 9 lb weight loss in 1 week (-) Denies fever, chills, night sweats, Denies blurry vision, diplopia, loss of vision, photophobia. Denies sinus tenderness, rhinorrhea or congestion. Denies chest pain or tightness, palpitations, lower extremity edema. Denies cough, shortness of breath, or wheezes. Denies diarrhea, constipation, abdominal pain, melena, hematemesis, hematochezia. Denies dysuria, stool or urine incontinence. Denies arthralgias or myalgias. Denies rashes or skin breakdown. No numbness/tingling in extremities. All other systems negative. . MEDICAL HISTORY: HTN, Hyperlipidemia, left upper tooth extraction [**7-22**]. She had a cavity and high likelihood that a root canal would be needed so the tooth was extracted and implant was used. MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Family/Caregiver[**Name (NI) 581**]. 1. [**Name2 (NI) **]ide 25 mg PO DAILY 2. Lisinopril 20 mg PO DAILY 3. Acetaminophen 325-650 mg PO Q6H:PRN pain 4. Dexamethasone 4 mg PO Q6H 5. Docusate Sodium 100 mg PO BID 6. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 7. Pantoprazole 40 mg PO Q24H 8. Phenytoin (Suspension) 100 mg PO TID 9. Senna 1 TAB PO DAILY 10. Ondansetron 8 mg PO Q6H standing ALLERGIES: Shellfish / phenytoin sodium extended PHYSICAL EXAM: VS: T T97.6 bp 153/74 HR 87 RR 16 SaO2 97 RA GEN: tired-appearing, awake, alert HEENT: EOMI, sclera anicteric, conjunctivae clear, OP dry and without lesion NECK: Supple, no JVD CV: Reg rate, normal S1, S2. No m/r/g. CHEST: Resp unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABD: Soft, NT, ND, no HSM, bowel sounds present MSK: normal muscle tone and bulk [**Hospital1 **]: No c/c/e, 2+ DP/PT bilaterally SKIN: No rash, warm skin NEURO: oriented x 3, normal attention, no focal deficits, intact sensation to light touch, see neurosurgrty note for details PSYCH: appropriate FAMILY HISTORY: Her mother had lung CA and her father had lymphoma SOCIAL HISTORY: billing manager at [**Hospital1 11900**]. She smoke 1 pack per day for two years and this was over 25 years ago. Social ETOH.

Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Acute venous embolism and thrombosis of superficial veins of upper extremity,Urinary tract infection, site not specified,Obstructive hydrocephalus,Family history of other lymphatic and hematopoietic neoplasms,Family history of malignant neoplasm of trachea, bronchus, and lung,Unspecified essential hypertension,Malnutrition of moderate degree,Other specified gastritis, without mention of hemorrhage,Adrenal cortical steroids causing adverse effects in therapeutic use,Hypovolemia,Bacterial infection, unspecified, in conditions classified elsewhere and of unspecified site,Body Mass Index 26.0-26.9, adult,Personal history of tobacco use

Sec mal neo brain/spine,Cerebral edema,Mal neo bronch/lung NOS,Ac embl suprfcl up ext,Urin tract infection NOS,Obstructiv hydrocephalus,Fam hx-lymph neoplas NEC,Fm hx-trach/bronchog mal,Hypertension NOS,Malnutrition mod degree,Oth spf gstrt w/o hmrhg,Adv eff corticosteroids,Hypovolemia,Bacterial infection NOS,BMI 26.0-26.9,adult,History of tobacco use

Admission Date: [**2151-8-9**] Discharge Date: [**2151-8-18**] Date of Birth: [**2085-7-18**] Sex: F Service: NEUROSURGERY Allergies: Shellfish / phenytoin sodium extended Attending:[**First Name3 (LF) 1835**] Chief Complaint: nausea Major Surgical or Invasive Procedure: [**2151-8-12**] Posterior fossa decompression, placement external ventricular drain [**2151-8-13**] Left frontal craniotomy for tumor History of Present Illness: Patient is a 66 year old female with recently diagnosed lung cancer with metastases to the brain who presents tot he ER with nausea. She was feeling well and then on Wednesday of last week she underwent her first of 10 whole brain radiation treatments. She felt well following it but on Thursday morning developed nausea. She underwent her treatments on Thursday and Friday and progressively developed increasing lethargy and gait disturbance. She went to her radiation treatment the morning of admission, but given her gait instability, she was sent to the ER for concern of increased intracranial pressure. She states that her nausea has been progressive and caused her to not be able to eat or drink anyting for the past 5 days except for her pills. It has persisted despite Zofran standing. She complains moderate head "pressure" and some mild vague visual changes. She denies changes in speech or hearing, photophobia, changes in bowel or bladder function. Vitals in the ER: 97.6 100% RA 16 133/83 HR 82. She received Dexamethasone 4mg IV, IV Morphine, Zofran, and 1L NS. . Review of Systems: (+) Per HPI; 9 lb weight loss in 1 week (-) Denies fever, chills, night sweats, Denies blurry vision, diplopia, loss of vision, photophobia. Denies sinus tenderness, rhinorrhea or congestion. Denies chest pain or tightness, palpitations, lower extremity edema. Denies cough, shortness of breath, or wheezes. Denies diarrhea, constipation, abdominal pain, melena, hematemesis, hematochezia. Denies dysuria, stool or urine incontinence. Denies arthralgias or myalgias. Denies rashes or skin breakdown. No numbness/tingling in extremities. All other systems negative. . Past Medical History: HTN, Hyperlipidemia, left upper tooth extraction [**7-22**]. She had a cavity and high likelihood that a root canal would be needed so the tooth was extracted and implant was used. Social History: billing manager at [**Hospital1 11900**]. She smoke 1 pack per day for two years and this was over 25 years ago. Social ETOH. Family History: Her mother had lung CA and her father had lymphoma Physical Exam: VS: T T97.6 bp 153/74 HR 87 RR 16 SaO2 97 RA GEN: tired-appearing, awake, alert HEENT: EOMI, sclera anicteric, conjunctivae clear, OP dry and without lesion NECK: Supple, no JVD CV: Reg rate, normal S1, S2. No m/r/g. CHEST: Resp unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABD: Soft, NT, ND, no HSM, bowel sounds present MSK: normal muscle tone and bulk [**Hospital1 **]: No c/c/e, 2+ DP/PT bilaterally SKIN: No rash, warm skin NEURO: oriented x 3, normal attention, no focal deficits, intact sensation to light touch, see neurosurgrty note for details PSYCH: appropriate on discharge: AVSS, NAD forehead incision c/d/i; open to air CNII-XII intact; no focal neurologic deficits Full strength UE/LE bilat. Intact to light touch bilat UE/LE extremities wwp Pertinent Results: [**2151-8-18**] 04:30AM BLOOD WBC-7.9 RBC-3.61* Hgb-11.0* Hct-32.3* MCV-89 MCH-30.6 MCHC-34.2 RDW-13.8 Plt Ct-317 [**2151-8-17**] 04:35AM BLOOD WBC-7.9 RBC-3.51* Hgb-10.8* Hct-31.7* MCV-90 MCH-30.7 MCHC-34.0 RDW-13.6 Plt Ct-307 [**2151-8-16**] 04:13AM BLOOD WBC-10.0 RBC-3.47* Hgb-10.6* Hct-30.9* MCV-89 MCH-30.7 MCHC-34.4 RDW-13.4 Plt Ct-281 [**2151-8-18**] 04:30AM BLOOD Plt Ct-317 [**2151-8-18**] 04:30AM BLOOD PT-13.2* PTT-47.3* INR(PT)-1.2* [**2151-8-18**] 12:20AM BLOOD PT-12.6* PTT-39.2* INR(PT)-1.2* [**2151-8-18**] 04:30AM BLOOD Glucose-88 UreaN-13 Creat-0.3* Na-141 K-3.7 Cl-105 HCO3-29 AnGap-11 [**2151-8-16**] 04:13AM BLOOD Glucose-107* UreaN-8 Creat-0.3* Na-138 K-3.9 Cl-104 HCO3-27 AnGap-11 [**2151-8-9**] 09:55AM BLOOD ALT-36 AST-30 AlkPhos-107* TotBili-0.3 [**2151-8-17**] 04:35AM BLOOD Phenyto-14.3 Head CT [**2151-8-9**] FINDINGS: There are multiple supratentorial and infratentorial metastatic lesions as seen on recent MRI. The largest is in the left cerebellar hemisphere. Hyperdense appearance of the left cerebellar lesion as well as the left frontal lobe lesion are likely due to component of hemorrhage. There is a large amount of surrounding vasogenic edema particularly in the left cerebellar hemisphere causing mild compression of the fourth ventricle with increased dilation of the third ventricle, now measuring 8 mm compared to 5 mm on the prior study. This is concerning for development of obstructive hydrocephalus. There is no evidence of large territorial infarct, shift of midline structures or downward herniation. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Bony structures are intact. IMPRESSION: 1. Multiple supratentorial and infratentorial metastatic lesions as seen on recent MR with possible component of hemorrhage in the left cerebellar and left frontal lesions. 2. Compression of the fourth ventricle causing increased dilation of third ventricle and mild hydrocephalus. Consider neurosurgery evaluation for possible shunt placement. MRI brain with contrast [**2151-8-12**] FINDINGS: Again noted are numerous intracranial enhancing lesions, of various sizes, compatible with the known extensive intracranial metastases. The dominant lesion in the posterior fossa measures 3.5 x 3.0 cm (image 2:6) in the left cerebellum, compared to 3.4 x 2.9 cm on [**2151-7-27**], essentially unchanged. The dominant supratentorial lesion is noted in the left frontal lobe, measures 2.6 x 1.9 cm (image 3:13) compared to 2.6 x 1.8 cm, also unchanged. There are also multiple smaller enhancing lesions scattered through the hemispheres and cerebella bilaterally. The ventricles remain normal in size. There is no shift of normally midline structures. IMPRESSION: Unchanged numerous intracranial metastases, with the dominant lesions in the left cerebellum and left frontal lobe. CT head [**2151-8-12**] FINDINGS: Since the previous MRI this morning, the patient is status post cranioplasty in the left posterior fossa. Small amount of blood products and air is seen in the surgical cavity. There is no significant change in the mass effect on the fourth ventricle. There is no hydrocephalus or hematoma. No change in the multiple supratentorial metastatic lesions as seen on the recent MR [**First Name (Titles) **] [**Last Name (Titles) **]. CONCLUSION: No change in the mass effect on the fourth ventricle. Expected post-surgical changes. MRI brain [**2151-8-13**] IMPRESSION: 1. Status post left posterior fossa cranioplasty for resection of left cerebellar mass with air and blood products within the surgical bed and with similar degree of mass effect on the fourth ventricle, left mesencephalic cistern, medulla and left ambient cistern. Intrinsic T1 hyperintensity limits evaluation for residual tumor. Recommend follow up post resolution of blood products. 2. Small focus of slow diffusion along the periphery of the surgical bed may represent infarct. 3. Multiple supratentorial and infratentorial lesions as before, largest in the left frontal lobe is similar in size compared to the most recent prior examination. CT head [**2151-8-13**] IMPRESSION: Status post left frontal and posterior carinal fossa craniotomies with expected post-surgical gas and fluid within the resection bed and middle blood products; stable appearance of mass effect on the fourth ventricle. MRI brain [**2151-8-14**] IMPRESSION: Status post left frontal and posterior cranial fossa craniotomy with expected post-surgical changes and gas, fluid within the resection bed. Small amount of blood products are present in these areas. Stable appearance of mass effect in the fourth ventricle. Unchanged bilateral enhancing lesions consistent with previously known metastatic disease. LUE dopplers [**2151-8-15**] Non-occlusive thrombus of the left axillary and basilic veins. Soft tissue edema. CT Head [**2151-8-16**] Interval improvement of the post-surgical changes at the left frontal lobe. Stable post-surgical changes at the left cerebellar hemisphere with mild to moderate mass effect on the fourth ventricle, unchanged from the prior study on [**8-13**]. Lateral ventricular enlargment stable since [**2151-8-13**], and slightly improved since [**2151-8-9**]. Brief Hospital Course: Ms. [**Known lastname 112303**] was admitted to the Oncology service and after stabilization it was decided that the patient would benefit from surgical resection. She was transferred to the neurosurgery service and on [**8-12**] she underwent a posterior fossa craniotomy for tumor resection, post operatively patient remained intubated and was transferred to the ICU. She remained intubated overnight and returned to the operating room for resection of the left frontal lesion. A left frontal tumor excision using MRI Wand localization was performed. See operative report for full details. A posrtoperative CT scan and MRI scan showed expected post-op changes. The patient was extubated in the N-SICU and remained there through [**8-15**]. On [**8-15**], patient was clinically ready for transfer but new LUE swelling was noted. The patient also had some left sided facial swelling that extended down the face. Patient also was tachycardiac and Lopressor was started. LOS fluid balance was about 1L negative so 500cc NS bolus was given. LUE dopplers were ordered and showed thrombus in the LUE at the axillary/basilic. Vascular was consulted and the patient was started on a heparin drip. On [**8-16**], the patient was transfered to the floor and PTTs were followed (goal 40-60) to ensure therapeutic range for heparin. A dilantin level was checked and was noted to be 15.6. The patient was switched to Keppra antiseizure medication due to the interaction with coumadin. The patient had a CT head which showed improvement. On [**8-17**], the patient was started on coumadin for DVT treatment. The patient continued to work with physical therapy and expressed readiness for discharge. On [**8-18**], the patient was discharged to a rehab facility with instructions to continue the heparin drip until therapaeutic range (INR [**2-5**]) was reached on coumadin. Currently, INR is 1.2. All questions were answered. The patient will require further radiation treatment for her metastasis with Dr. [**Last Name (STitle) 3929**], scheduled for [**2151-8-30**]. Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from Family/Caregiver[**Name (NI) 581**]. 1. [**Name2 (NI) **]ide 25 mg PO DAILY 2. Lisinopril 20 mg PO DAILY 3. Acetaminophen 325-650 mg PO Q6H:PRN pain 4. Dexamethasone 4 mg PO Q6H 5. Docusate Sodium 100 mg PO BID 6. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 7. Pantoprazole 40 mg PO Q24H 8. Phenytoin (Suspension) 100 mg PO TID 9. Senna 1 TAB PO DAILY 10. Ondansetron 8 mg PO Q6H standing 11. Ibuprofen 800 mg PO Q8H:PRN headache Discharge Medications: 1. Dexamethasone 2 mg po q12 Duration: 0000 the patient is to stay on the 2 mg [**Hospital1 **] dosing until follow up 2. Dexamethasone 2 mg PO Q8 Duration: 24 Hours the patient is to stay on the 2 mg [**Hospital1 **] dosing until follow up 3. Dexamethasone 2 mg PO Q6 Duration: 24 Hours the patient is to stay on the 2 mg [**Hospital1 **] dosing until follow up 4. Docusate Sodium 100 mg PO BID 5. Lisinopril 20 mg PO DAILY 6. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 7. Pantoprazole 40 mg PO Q24H 8. Senna 1 TAB PO DAILY 9. Bisacodyl 10 mg PO/PR DAILY 10. Heparin IV No Initial Bolus Initial Infusion Rate: 800 units/hr PTT goal 40-60 11. LeVETiracetam 500 mg PO BID 12. Metoprolol Tartrate 12.5 mg PO BID 13. Nystatin Oral Suspension 10 mL PO BID 14. Phosphorus 500 mg PO BID 15. Prochlorperazine 10 mg PO Q6H:PRN nausea 16. Warfarin 5 mg PO DAILY 17. Hydrochlorothiazide 25 mg PO DAILY Discharge Disposition: Extended Care Facility: [**Hospital6 979**] - [**Location (un) 246**] Discharge Diagnosis: Metastaic Lung Cancer Posterior fossa tumor Left frontal tumor Cerebral Edema UTI LUE thrombus Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Craniotomy for Tumor Excision Dr. [**Last Name (STitle) 14354**] [**Name (STitle) **] ?????? Have a friend/family member check your incision daily for signs of infection. ?????? Take your pain medicine as prescribed. ?????? Exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? Dressing may be removed on Day 2 after surgery. ?????? **You have dissolvable sutures you may wash your hair and get your incision wet day 3 after surgery. You may shower before this time using a shower cap to cover your head. ?????? Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) & Senna while taking narcotic pain medication. ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. ?????? You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. ?????? If you are being sent home on steroid medication, make sure you are taking a medication to protect your stomach (Prilosec, Protonix, or Pepcid), as these medications can cause stomach irritation. Make sure to take your steroid medication with meals, or a glass of milk. ?????? Clearance to drive and return to work will be addressed at your post-operative office visit. ?????? Make sure to continue to use your incentive spirometer while at home. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ?????? New onset of tremors or seizures. ?????? Any confusion or change in mental status. ?????? Any numbness, tingling, weakness in your extremities. ?????? Pain or headache that is continually increasing, or not relieved by pain medication. ?????? Any signs of infection at the wound site: increasing redness, increased swelling, increased tenderness, or drainage. ?????? Fever greater than or equal to 101.5?????? F. Followup Instructions: ??????Please return to the office in [**7-13**] days (from your date of surgery) for a wound check. This appointment can be made with the Physician Assistant or [**Name9 (PRE) **] Practitioner. Please make this appointment by calling [**Telephone/Fax (1) 1669**]. If you live quite a distance from our office, please make arrangements for the same, with your PCP. ??????**You also may have them removed at your rehab facility You have radiation treatment at 8:30am on [**2151-8-30**] for the first of 11 more sessions (through [**2151-9-14**]) with Dr. [**Last Name (STitle) 3929**]. Call [**Telephone/Fax (1) 9710**] with questions. Completed by:[**2151-8-18**]

198,348,162,453,599,331,V167,V161,401,263,535,E932,276,041,V852,V158

{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Acute venous embolism and thrombosis of superficial veins of upper extremity,Urinary tract infection, site not specified,Obstructive hydrocephalus,Family history of other lymphatic and hematopoietic neoplasms,Family history of malignant neoplasm of trachea, bronchus, and lung,Unspecified essential hypertension,Malnutrition of moderate degree,Other specified gastritis, without mention of hemorrhage,Adrenal cortical steroids causing adverse effects in therapeutic use,Hypovolemia,Bacterial infection, unspecified, in conditions classified elsewhere and of unspecified site,Body Mass Index 26.0-26.9, adult,Personal history of tobacco use'}

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: nausea PRESENT ILLNESS: Patient is a 66 year old female with recently diagnosed lung cancer with metastases to the brain who presents tot he ER with nausea. She was feeling well and then on Wednesday of last week she underwent her first of 10 whole brain radiation treatments. She felt well following it but on Thursday morning developed nausea. She underwent her treatments on Thursday and Friday and progressively developed increasing lethargy and gait disturbance. She went to her radiation treatment the morning of admission, but given her gait instability, she was sent to the ER for concern of increased intracranial pressure. She states that her nausea has been progressive and caused her to not be able to eat or drink anyting for the past 5 days except for her pills. It has persisted despite Zofran standing. She complains moderate head "pressure" and some mild vague visual changes. She denies changes in speech or hearing, photophobia, changes in bowel or bladder function. Vitals in the ER: 97.6 100% RA 16 133/83 HR 82. She received Dexamethasone 4mg IV, IV Morphine, Zofran, and 1L NS. . Review of Systems: (+) Per HPI; 9 lb weight loss in 1 week (-) Denies fever, chills, night sweats, Denies blurry vision, diplopia, loss of vision, photophobia. Denies sinus tenderness, rhinorrhea or congestion. Denies chest pain or tightness, palpitations, lower extremity edema. Denies cough, shortness of breath, or wheezes. Denies diarrhea, constipation, abdominal pain, melena, hematemesis, hematochezia. Denies dysuria, stool or urine incontinence. Denies arthralgias or myalgias. Denies rashes or skin breakdown. No numbness/tingling in extremities. All other systems negative. . MEDICAL HISTORY: HTN, Hyperlipidemia, left upper tooth extraction [**7-22**]. She had a cavity and high likelihood that a root canal would be needed so the tooth was extracted and implant was used. MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Family/Caregiver[**Name (NI) 581**]. 1. [**Name2 (NI) **]ide 25 mg PO DAILY 2. Lisinopril 20 mg PO DAILY 3. Acetaminophen 325-650 mg PO Q6H:PRN pain 4. Dexamethasone 4 mg PO Q6H 5. Docusate Sodium 100 mg PO BID 6. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 7. Pantoprazole 40 mg PO Q24H 8. Phenytoin (Suspension) 100 mg PO TID 9. Senna 1 TAB PO DAILY 10. Ondansetron 8 mg PO Q6H standing ALLERGIES: Shellfish / phenytoin sodium extended PHYSICAL EXAM: VS: T T97.6 bp 153/74 HR 87 RR 16 SaO2 97 RA GEN: tired-appearing, awake, alert HEENT: EOMI, sclera anicteric, conjunctivae clear, OP dry and without lesion NECK: Supple, no JVD CV: Reg rate, normal S1, S2. No m/r/g. CHEST: Resp unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABD: Soft, NT, ND, no HSM, bowel sounds present MSK: normal muscle tone and bulk [**Hospital1 **]: No c/c/e, 2+ DP/PT bilaterally SKIN: No rash, warm skin NEURO: oriented x 3, normal attention, no focal deficits, intact sensation to light touch, see neurosurgrty note for details PSYCH: appropriate FAMILY HISTORY: Her mother had lung CA and her father had lymphoma SOCIAL HISTORY: billing manager at [**Hospital1 11900**]. She smoke 1 pack per day for two years and this was over 25 years ago. Social ETOH. ### Response: {'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Malignant neoplasm of bronchus and lung, unspecified,Acute venous embolism and thrombosis of superficial veins of upper extremity,Urinary tract infection, site not specified,Obstructive hydrocephalus,Family history of other lymphatic and hematopoietic neoplasms,Family history of malignant neoplasm of trachea, bronchus, and lung,Unspecified essential hypertension,Malnutrition of moderate degree,Other specified gastritis, without mention of hemorrhage,Adrenal cortical steroids causing adverse effects in therapeutic use,Hypovolemia,Bacterial infection, unspecified, in conditions classified elsewhere and of unspecified site,Body Mass Index 26.0-26.9, adult,Personal history of tobacco use'}

CHIEF COMPLAINT: Worse headache of life / SAH / Brain aneurysms PRESENT ILLNESS: Asked by the ED to see this 59 year old white female s/p PEA arrest with CPR / rescusitation and SAH. Per nursing, EMS reports that the pt was on the phone with her daughter earlier today and was describing WHOL and blurred vision. The daughter called EMS to go to her mothers residence. Upon arrival they found the pt in PEA arrest/ She was rescusitated with CPR and epi and intubated. She was seen at an OSH and transferred to [**Hospital1 18**] after imaging revealed SAH. MEDICAL HISTORY: PMHx: HTN MEDICATION ON ADMISSION: lisinopril hctz tylenol PM per daughters no aspirin or coumadin per daughters ALLERGIES: Sulfa(Sulfonamide Antibiotics) PHYSICAL EXAM: On admission: FAMILY HISTORY: Unknown family hx of aneurysms SOCIAL HISTORY: Social Hx: lives alone / has two daughters [**Name (NI) **] and [**Name2 (NI) **]. + Tobacco

Subarachnoid hemorrhage,Cerebral edema,Acute respiratory failure,Cardiac arrest,Unspecified essential hypertension,Do not resuscitate status,Encounter for palliative care,Other abnormal glucose

Subarachnoid hemorrhage,Cerebral edema,Acute respiratry failure,Cardiac arrest,Hypertension NOS,Do not resusctate status,Encountr palliative care,Abnormal glucose NEC

Admission Date: [**2157-2-24**] Discharge Date: [**2157-2-26**] Date of Birth: [**2097-12-23**] Sex: F Service: NEUROSURGERY Allergies: Sulfa(Sulfonamide Antibiotics) Attending:[**First Name3 (LF) 78**] Chief Complaint: Worse headache of life / SAH / Brain aneurysms Major Surgical or Invasive Procedure: [**2157-2-24**]: L frontal EVD placement History of Present Illness: Asked by the ED to see this 59 year old white female s/p PEA arrest with CPR / rescusitation and SAH. Per nursing, EMS reports that the pt was on the phone with her daughter earlier today and was describing WHOL and blurred vision. The daughter called EMS to go to her mothers residence. Upon arrival they found the pt in PEA arrest/ She was rescusitated with CPR and epi and intubated. She was seen at an OSH and transferred to [**Hospital1 18**] after imaging revealed SAH. Past Medical History: PMHx: HTN Social History: Social Hx: lives alone / has two daughters [**Name (NI) **] and [**Name2 (NI) **]. + Tobacco Family History: Unknown family hx of aneurysms Physical Exam: On admission: PHYSICAL EXAM: Hunt and [**Doctor Last Name 9381**]: 5 [**Doctor Last Name **]: 4 GCS 3T O: T: BP: 130/ 110's Gen: WD/WN, comfortable, NAD. HEENT: Pupils: 2mm hippus pupils conjugate Neck: in a cervical collar Neuro: Intubated / off sedation x at least 10 minutes / Spontaneous spastic type eye opening / Pupils 2mm hippus / conjugate gaze / no corneals / no localization or w/d of extremities to noxious x 4 / there is some spastic type fasciculations noted in LUE / eyelids and chin peridocially / there is no cough or gag / she is biting the tube at times On Discharge: Expired Pertinent Results: [**2157-2-24**] Head CT: Extensive SAH, worsening cerebral edema, interval placement of EVD. [**2157-2-24**] Head CTA: Large right clinoid aneurysm and a smaller left clinoid anuerysm**** Brief Hospital Course: Pt was seen and evaluated in the ED after transfer in to [**Hospital1 18**] intubated after PEA with diffuse SAH. CTA completed and two distinct cerebral aneurysms were noted. An emergent Left frontal EVD was placed without incident and follow up CT was stable. She was transferred to the NICU. She was started on Nimodipine and Keppra. Appropriate line placement was attained. EEG monitoring was initiated after her exam had not improved after EVD placement. Her ICPs elevated to the 40's and the EVD drain was not draining. The catheter was pulled back about 1cm without improvement. Concern that further swelling had occurred that was now compressing the catheter led to initiating cooling. Goal temp was set to 35 degrees. Family expressed maybe not wanting to pursue heroic measures and not wanting to see her "suffer." Family at that time expressed they were not ready to withdraw but understood the current clinical picture. On [**2-25**] at 0400, cooling had not improved the ICPs as they still remained in the 40's, pupils were noted to now be dilated and fixed. Further discussion with the family was held and the decision to move towards CMO was made. On [**2-26**] at 10:10 am patient passed away. Medications on Admission: lisinopril hctz tylenol PM per daughters no aspirin or coumadin per daughters Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: Subarachnoid hemorrhage PEA arrest R and L clinoid brain aneurysm Cerebral edema Discharge Condition: Expired Discharge Instructions: Expired Followup Instructions: Expired Completed by:[**2157-2-26**]

430,348,518,427,401,V498,V667,790

{'Subarachnoid hemorrhage,Cerebral edema,Acute respiratory failure,Cardiac arrest,Unspecified essential hypertension,Do not resuscitate status,Encounter for palliative care,Other abnormal glucose'}

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: Worse headache of life / SAH / Brain aneurysms PRESENT ILLNESS: Asked by the ED to see this 59 year old white female s/p PEA arrest with CPR / rescusitation and SAH. Per nursing, EMS reports that the pt was on the phone with her daughter earlier today and was describing WHOL and blurred vision. The daughter called EMS to go to her mothers residence. Upon arrival they found the pt in PEA arrest/ She was rescusitated with CPR and epi and intubated. She was seen at an OSH and transferred to [**Hospital1 18**] after imaging revealed SAH. MEDICAL HISTORY: PMHx: HTN MEDICATION ON ADMISSION: lisinopril hctz tylenol PM per daughters no aspirin or coumadin per daughters ALLERGIES: Sulfa(Sulfonamide Antibiotics) PHYSICAL EXAM: On admission: FAMILY HISTORY: Unknown family hx of aneurysms SOCIAL HISTORY: Social Hx: lives alone / has two daughters [**Name (NI) **] and [**Name2 (NI) **]. + Tobacco ### Response: {'Subarachnoid hemorrhage,Cerebral edema,Acute respiratory failure,Cardiac arrest,Unspecified essential hypertension,Do not resuscitate status,Encounter for palliative care,Other abnormal glucose'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is an 88 year-old female with a history of coronary artery disease status post coronary artery bypass graft times two, congestive heart failure with ejection fraction of 35%, paroxysmal atrial fibrillation status post DDD pacer placement, admitted [**2185-12-22**] with sudden onset of right eye pain at home. She subsequently developed slurred speech and was taken to the Emergency Department via EMS. In the Emergency Department the patient was noted to have slurred speech and a left hemiparesis. CAT scan was negative for hemorrhage, but positive for a probable embolic right MCA stroke. TPA was administered in the Emergency Department without benefit. The patient developed respiratory distress in the Emergency Department requiring supplemental oxygen, Lasix and a trial of a noninvasive ventilator. MEDICAL HISTORY: 1. Coronary artery disease status post coronary artery bypass graft times two in [**2181**] complicated by a left ventricular aneurysm status post patched graft and third degree heart block. 2. History of paroxysmal atrial fibrillation status post DDD pacer. 3. Congestive heart failure with ejection fraction of 35%. 4. Hypertension. 5. Hyperthyroid. 6. Chronic renal insufficiency with a baseline creatinine of 1.4. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Cerebral embolism with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Atrial fibrillation,Hyperosmolality and/or hypernatremia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Heart valve replaced by transplant

Crbl emblsm w infrct,Food/vomit pneumonitis,Urin tract infection NOS,CHF NOS,Atrial fibrillation,Hyperosmolality,Crnry athrscl natve vssl,Aortocoronary bypass,Heart valve transplant

Admission Date: [**2185-12-22**] Discharge Date: [**2186-1-4**] Service: HISTORY OF PRESENT ILLNESS: The patient is an 88 year-old female with a history of coronary artery disease status post coronary artery bypass graft times two, congestive heart failure with ejection fraction of 35%, paroxysmal atrial fibrillation status post DDD pacer placement, admitted [**2185-12-22**] with sudden onset of right eye pain at home. She subsequently developed slurred speech and was taken to the Emergency Department via EMS. In the Emergency Department the patient was noted to have slurred speech and a left hemiparesis. CAT scan was negative for hemorrhage, but positive for a probable embolic right MCA stroke. TPA was administered in the Emergency Department without benefit. The patient developed respiratory distress in the Emergency Department requiring supplemental oxygen, Lasix and a trial of a noninvasive ventilator. The patient was subsequently transferred to the MICU. Blood pressure was elevated on admission to 160 to 180. Symptoms of congestive heart failure were controlled with a nitroglycerin drip initially. Neurological examination revealed complete left sided hemiplegia with decreased sensation of the left arm and a left facial droop. The patient has required no further diuresis in the MICU. Blood pressures were running in the 120s to 130s. Nitroglycerin drip was discontinued on [**2185-12-22**] upon arrival to the Medical Intensive Care Unit. Speech and swallow evaluation on [**2185-12-23**] recommended nectar thick liquids since the patient was considered to be at aspiration risk. A repeat head CT on [**12-22**] showed a large right MCA stroke unchanged from prior. The patient's creatinine was slightly increased from baseline, but her urine output was good. An increased white blood cell count was noted on [**12-22**] considered to be stress response versus evidence of infection and cultures were sent. On [**12-22**] and [**12-23**] the patient was noted to have increased alertness complaining of a headache with an unchanged neurological examination. On [**12-23**] systolic blood pressure was running 100 to 110 with the head of the bed at 30 degrees elevation. The patient was alert and interactive though not opening her eyes. She was subsequently transferred to the floor. PAST MEDICAL HISTORY: 1. Coronary artery disease status post coronary artery bypass graft times two in [**2181**] complicated by a left ventricular aneurysm status post patched graft and third degree heart block. 2. History of paroxysmal atrial fibrillation status post DDD pacer. 3. Congestive heart failure with ejection fraction of 35%. 4. Hypertension. 5. Hyperthyroid. 6. Chronic renal insufficiency with a baseline creatinine of 1.4. MEDICATIONS AT HOME: Cozaar 25 mg po q.d., Lasix 40 mg po q.d., enteric coated aspirin, Ambien, Lipitor, Levoxyl. MEDICATIONS AT MICU: Protonix 40 mg q.d., Tylenol, subQ heparin and enteric coated aspirin. ALLERGIES: No known drug allergies. PHYSICAL EXAMINATION ON TRANSFER FROM THE MICU: Vital signs temperature 98.2. Pulse 61. Blood pressure 121/56. Respiratory rate 20. Pulse ox 100% on room air. Examination, the patient is lying in bed with her eyes closed, unable to open them, but is interactive and responds to questions and commands. Mental status, the patient is oriented to hospital, state, but not year. She is oriented to the reason for her hospitalization and answers questions appropriately. HEENT she has dry oral mucosa. The tongue is midline. She is unable to raise her eyelids. The pupils are poorly reactive bilaterally, but the patient does respond to light stimuli. There is poor response to threat bilaterally. We were unable to assess visual fields and extraocular movements at this time. Neck was supple with no bruits. Cardiovascular, regular, 2 out of 6 systolic murmur best at the right upper sternal border. Lungs were with rhoncerous breath sounds bilaterally in the anterior lung fields. Abdomen is soft, mild, diffuse tenderness to palpation with no rebound or guarding and active bowel sounds. Extremities no edema. There are several small raised red lesions on the distal lower extremities. Neurological examination the patient's sensation is intact. The patient is able to open her jaw against resistance and shrug her shoulders. She has a left sided visual field defect/neglect. Sensation, there is no response to light touch to the left arm. She does sense touch on the right arm. Light touch sensation is intact bilaterally in the lower extremities. Strength of the left arm is flaccid with 0 out of 5 strength. The left leg is also flaccid. The right arm shows 5 out of 5 biceps and triceps. The right leg 3 out of 5 hip extension, 5 out of 5 ankle flexion and extension. Reflexes, biceps 2+ bilaterally, brachial radialis 2+ bilaterally, patellar 1+ bilaterally. Toes are down going on the right and up going on the left. LABORATORY STUDIES ON TRANSFER FROM INTENSIVE CARE UNIT: Hematocrit 34.9, white blood cell count 10.4, INR 1.1. Urinalysis showed large blood, negative nitrite, greater then 50 red blood cells, 3 to 5 white blood cells, few bacteria and no epithelial cells. Sodium 150, potassium 3.5, chloride 110, bicarbonate 32, BUN 39, creatinine 1.5, glucose 350, calcium 8.0, phosphate 32.6, magnesium 2.2, albumin 3.2. Blood cultures and urine cultures were negative at that time. HOSPITAL COURSE: 1. Neurological: The patient is admitted with a large right MCA stroke of embolic origin. The patient was administered tissue plasminogen activator in the Emergency Room without benefit. The patient's residual defects were a left facial droop, left hemiparesis and left hemisensory deficits. The patient's mental status seemed to fluctuate at intervals during the course of the hospitalization with intermittent periods of somnolence. However, the patient was generally awake and easily oriented. There were no new focal neurological findings during this admission and there was no reimaging of the head after transfer to the floor on [**2185-12-23**]. The blood pressure goal on transfer to the floor was 130s to 140s to maintain adequate cerebral perfusion. The patient remained intermittently hypotensive and had to be bolused with fluids in order to maintain a blood pressure in the low 100s. Despite periods of hypotension the patient's mental status remained largely unchanged. For the latter portion of the patient's admission blood pressure remained stable in the 110s to 120s. The patient will follow up with the stroke service in several weeks following discharge. 2. Cardiovascular: Patient with a history of coronary artery disease. She was continued on aspirin during this admission. Captopril was added shortly after the [**Hospital 228**] transfer to the floor for treatment of congestive heart failure. The patient was known to be prone to flash pulmonary edema as she had experienced in the Emergency Department. After her transfer to the floor she developed increased respiratory distress over several days. Pulmonary examination and x-ray were consistent with moderate congestive heart failure. The patient was initially gently diuresed with Lasix. Following diuresis the patient became transiently hypotensive to the 70s and 80s with mildly depressed level of alertness and responsiveness. At that time the patient was bolused with 250 cc boluses of normal saline to elevate the blood pressure to the low 100s. Despite these boluses, the patient did not drop her O2 saturation. As the patient's po intake improved over the course of the admission. She was ultimately taken off of maintenance hydration and required no further fluid boluses to maintain a blood pressure in the 110s to 120s. She also maintained good urine output and was considered to be essentially euvolemic with a creatinine at or near baseline of 1.6 at the time of discharge. On [**2185-12-27**] during one period of relative hypotension the patient was noted to be in atrial fibrillation/flutter. On further review of the patient's vital signs and telemetry it was clear that the patient may have been in flutter at least intermittently over the course of two to three days. It was felt that this might be contributing to her difficulty breathing and to her congestive heart failure. She was initially loaded on Amiodarone 400 mg po b.i.d. and this dose was continued up until discharge. On [**2185-12-27**] electrophysiology was consulted for adjustment of the patient's pacemaker as she was conducting her atrial rate at approximately 120 beats per minute to the ventricle. After adjustment of the pacemaker, the patient was in continued atrial fibrillation/flutter, but ventricularly paced at 60 beats per minute. Cardioversion was considered, but will be deferred. We also discussed the possibility with anticoagulation with the neurology service given the patient's atrial fibrillation/flutter and risk for further embolic stroke. Given the patient's recent stroke, this was held off. However, after the patient was more then ten days out from the stroke on the day of discharge [**2186-1-4**] the patient was initiated on Coumadin anticoagulation at a low dose. After the patient achieves a goal INR of 2 to 3 the patient will be considered for reattempt at cardioversion. This will be done after a therapeutic INR for three to four weeks by the electrophysiology service. Will attempt an interruption of the flutter with overdrive atrial pacing. 3. Pulmonary: As noted the patient experienced mild congestive heart failure early in this admission. She was effectively diuresed and became transiently hypotensive. She then responded to fluid boluses and continuous intravenous fluids for several days. During the latter several days of the admission the patient was taken off intravenous fluids and maintained good po intake to support her blood pressures. She was essentially euvolemic at the time of discharge. The patient also spiked a fever and while she did grow out positive blood cultures or have positive sputum specimens, chest x-ray was suggestive of a retrocardiac opacity perhaps most consistent with an aspiration pneumonia. The patient was started on Levaquin and Flagyl for a fourteen day course. Although chest x-ray revealed a persistent left lower lobe opacity at the time of discharge, the patient was afebrile with no new respiratory complaints. She should complete a fourteen day course of Levaquin and Flagyl and should be reimaged if she becomes febrile or new respiratory complaints develop. 4. Infectious disease: As noted the patient was treated for a possible aspiration pneumonia with Levaquin and Flagyl. The patient was also noted to have a urinary tract infection positive for both proteus and enterococcus. Both organisms were sensitive to Levaquin. Hematuria noted during the initial presentation to the floor resolved over time and was attributed to Foley trauma. 5. Hematologic: The patient's hematocrit remained stable throughout this admission after initial drop in the MICU. 6. Fluids, electrolytes and nutrition: The patient's fluid status was essentially euvolemic at the time of discharge. She was requiring no supplemental intravenous fluids and was maintaining good urine output. She should be continued on her prior dose of Lasix, however, should she become hypovolemic, Lasix should be discontinued and the patient should be further hydrated especially if her po intake should taper off. From an electrolyte standpoint the patient's magnesium and potassium should be closely followed especially given current Amiodarone use. The patient should be maintained on a diet of pureed foods and thickened liquids. These should be administered to the right side of the mouth. Thin liquids should be avoided for the most part. The patient should be sitting upright for her meals. 7. Gastrointestinal: The patient was maintained on Protonix during this admission for ulcer prophylaxis. She had multiple repeated loose stools. Stool cultures were negative for clostridium difficile. 8. Endocrine: Patient with a history of hypothyroidism. Her TSH was seemed to be elevated with a low T4 and her Levoxyl dose was subsequently increased from 50 to 75 mcg po q.d. DISCHARGE DIAGNOSES: 1. Middle cerebrovascular artery stroke with left hemiparesis. 2. Atrial fibrillation/flutter. 3. Congestive heart failure. 4. Aspiration pneumonia. 5. Urinary tract infection. DISCHARGE MEDICATIONS: 1. Coumadin 2.5 mg po q.d. as starting dose with a goal INR of 2 to 3. This dose can be adjusted upward to attain this goal, but should be initiated at the low current dose. 2. Protonix 40 mg po q.d. 3. Enteric coated aspirin 325 mg po q.d. 4. Senokot one tab po q.h.s. prn constipation. 5. Colace 100 mg po b.i.d. prn constipation. 6. Lipitor 10 mg po q.d. 7. Captopril 3.25 mg po b.i.d. held for systolic blood pressure less then 100. 8. Flagyl 500 mg po t.i.d. until [**1-8**]. 9. Levaquin 250 mg po q.d. until [**1-8**]. 10. Levoxyl 75 micrograms po q.d. 11. Lasix 40 mg po q.d. 12. Amiodarone 400 mg po q.d. This dose should be changed to 200 mg po t.i.d. on [**1-6**]. It should be then changed to 200 mg po b.i.d. on [**2186-1-13**]. 200 mg b.i.d. will then remain as a maintenance dose. 13. Tylenol 650 mg po q 4 to 6 hours prn pain. INSTRUCTIONS: 1. Diet: The patient should be maintained on pureed food and thickened liquids only diet. Food should be placed on the right side of the patient's mouth. Thin liquids should be avoided. The patient should be seated upright for all meals to avoid aspiration. 2. The patient's left hand and arm should be put through passive range of motion and elevated periodically from an IV pole. 3. INR should be maintained at a goal of 2 to 3. Coumadin is just being initiated at the time of discharge at 2.5 mg q.d. Low dose Coumadin should be continued with potential further adjustment to achieve goal INR of 2 to 3. Follow up will be scheduled with the electrophysiology cardiology team in several weeks for evaluation of pacemaker and potential override atrial pacing. The patient will also be scheduled for follow up with the neurological stroke team. Please see discharge page one for the dates of these follow up appointments. At her skilled nursing facility the patient should receive a repeat swallow evaluation as well as physical and occupational therapy. [**First Name11 (Name Pattern1) 312**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 313**], M.D. [**MD Number(1) 314**] Dictated By:[**Last Name (NamePattern4) 4689**] MEDQUIST36 D: [**2186-1-4**] 07:00 T: [**2186-1-4**] 07:07 JOB#: [**Job Number 4690**] Name: [**Known lastname 552**], [**Known firstname 553**] Unit No: [**Numeric Identifier 554**] Admission Date: [**2185-12-22**] Discharge Date: [**2186-1-13**] Date of Birth: [**2097-4-27**] Sex: F Service: DATE OF DEATH: [**2186-1-13**]. ADDENDUM TO HOSPITAL COURSE: While previously considered possible candidate for skilled nursing facility the patient then took a turn for the worst over the latter days of her hospitalization. She became increasing dyspneic and less responsive. Her fluid status was difficult to manage in the absence of aggressive re-intervention. In accordance with the patient's wishes and following extensive discussions with the family the patient was made comfort measures only. Preparations were made to transition the patient home with Hospice care. On [**2186-1-12**] the patient was noted to be minimally responsive with evidence of continued clinical deterioration. On the morning of [**2186-1-13**] the patient was noted not to be responding to verbal or physical stimuli. She had no respirations or heart sounds. Her pupils were fixed and dilated. The patient was declared dead at 08:30 A.M. The attending and family were notified. No autopsy was requested by the family. DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-766 Dictated By:[**Last Name (NamePattern4) 555**] MEDQUIST36 D: [**2186-2-15**] 20:38 T: [**2186-2-17**] 10:15 JOB#: [**Job Number 556**]

434,507,599,428,427,276,414,V458,V422

{'Cerebral embolism with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Atrial fibrillation,Hyperosmolality and/or hypernatremia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Heart valve replaced by transplant'}

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 an 88 year-old female with a history of coronary artery disease status post coronary artery bypass graft times two, congestive heart failure with ejection fraction of 35%, paroxysmal atrial fibrillation status post DDD pacer placement, admitted [**2185-12-22**] with sudden onset of right eye pain at home. She subsequently developed slurred speech and was taken to the Emergency Department via EMS. In the Emergency Department the patient was noted to have slurred speech and a left hemiparesis. CAT scan was negative for hemorrhage, but positive for a probable embolic right MCA stroke. TPA was administered in the Emergency Department without benefit. The patient developed respiratory distress in the Emergency Department requiring supplemental oxygen, Lasix and a trial of a noninvasive ventilator. MEDICAL HISTORY: 1. Coronary artery disease status post coronary artery bypass graft times two in [**2181**] complicated by a left ventricular aneurysm status post patched graft and third degree heart block. 2. History of paroxysmal atrial fibrillation status post DDD pacer. 3. Congestive heart failure with ejection fraction of 35%. 4. Hypertension. 5. Hyperthyroid. 6. Chronic renal insufficiency with a baseline creatinine of 1.4. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Cerebral embolism with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Atrial fibrillation,Hyperosmolality and/or hypernatremia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Heart valve replaced by transplant'}

CHIEF COMPLAINT: s/p fall down stairs PRESENT ILLNESS: 62 yo female with multiple medical problems including venous stasis and recalcitrant pyoderma gangrenosum of the right leg, taking prednisone, mycophenalate mofetil and infliximab. She was receiving hyperbaric O2 therapy at an area hospital and fell down the stairs sustaining an open right tib-fib fracture grade IIIB, likely contaminated and exposed to the old presumably infected ulcer site (large 10 x 10 medial tibial open ulcer for the last three years). She was the transported to [**Hospital1 18**] Pt had difficult access with unsuccessful attempt and femoral, subclavian and internal jugular central line placement. R brachial cutdown was eventually performed. MEDICAL HISTORY: Pyoderman gangrenosum Venous stasis ulcers Bilateral DVT Pulmonary embolus s/p IVC filter Crohn's disease s/p total colectomy/ileostomy Splenectomy [**12-27**] hemorrahge Right oophorectomy Multiple skin grafts and vascular grafts MEDICATION ON ADMISSION: Medications - Prescription ATENOLOL - (Prescribed by Other Provider) - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a day BUPROPION - (Prescribed by Other Provider) - 150 mg Tablet Sustained Release - 1 (One) Tablet(s) by mouth twice a day CITALOPRAM - (Prescribed by Other Provider) - 40 mg Tablet - 1 (One) Tablet(s) by mouth once a day FUROSEMIDE [LASIX] - (Prescribed by Other Provider) - 20 mg Tablet - [**1-27**] Tablet(s) by mouth once a day INFLIXIMAB [REMICADE] - (Prescribed by Other Provider) - Dosage uncertain LEVOTHYROXINE - (Prescribed by Other Provider) - 100 mcg Tablet - 1 (One) Tablet(s) by mouth once a day METHADONE - (Prescribed by Other Provider) - 10 mg Tablet - [**12-28**] Tablet(s) by mouth twice a day METHYLPREDNISOLONE - (Prescribed by Other Provider) - 8 mg Tablet - 4 (Four) Tablet(s) by mouth once a day MINOCYCLINE - (Prescribed by Other Provider) - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a day MYCOPHENOLATE MOFETIL [CELLCEPT] - (Prescribed by Other Provider) - 500 mg Tablet - 2 (Two) Tablet(s) by mouth twice a day OMEPRAZOLE [PRILOSEC] - (Prescribed by Other Provider) - 20 mg Capsule, Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth twice a day OXYCODONE - (Prescribed by Other Provider) - 5 mg Tablet - 3 (Three) Tablet(s) by mouth every 4-6 hours SULFASALAZINE - (Prescribed by Other Provider) - 500 mg Tablet, Delayed Release (E.C.) - 2 (Two) Tablet(s) by mouth twice a day and one tab at lunch ALLERGIES: Imuran / Cyclosporine / IV Dye, Iodine Containing PHYSICAL EXAM: Upon exam: BP: 130/83 HR: 92 Patient is intubated, sedated; Pupils are equal and reactive bilat. Motor: upon holding sedation, patient able to move both LE to command: she is able to lift her left leg of the bed, bending the knee (4-/5), and can move both feet/toes distally. Exam of the right LE severly limited by post surgical condition. Patient able to confirm feeling light touch in both LE. Quad and achilleus rx are trace bilat. Toes are downgoing. FAMILY HISTORY: Mother died of breast cancer at the age of 86 and father died of pulmonary hypertension complications at the age of 79 SOCIAL HISTORY: She drinks wine on occasion. Denies any illicit drug use or smoking history. Her domestic violence screen is negative

Closed fracture of lumbar vertebra without mention of spinal cord injury,Open fracture of shaft of tibia alone,Acute respiratory failure,Pyoderma gangrenosum,Acute posthemorrhagic anemia,Alkalosis,Regional enteritis of unspecified site,Fracture of lateral malleolus, closed,Abrasion or friction burn of elbow, forearm, and wrist, without mention of infection,Accidental fall on or from other stairs or steps,Ulcer of other part of foot,Venous (peripheral) insufficiency, unspecified,Hypotension, unspecified,Other specified cardiac dysrhythmias,Colostomy status,Ileostomy status,Personal history of venous thrombosis and embolism,Other postprocedural status

Fx lumbar vertebra-close,Fx tibia shaft-open,Acute respiratry failure,Pyoderma gangrenosum,Ac posthemorrhag anemia,Alkalosis,Regional enteritis NOS,Fx lateral malleolus-cl,Abrasion forearm,Fall on stair/step NEC,Ulcer other part of foot,Venous insufficiency NOS,Hypotension NOS,Cardiac dysrhythmias NEC,Colostomy status,Ileostomy status,Hx-ven thrombosis/embols,Post-proc states NEC

Admission Date: [**2195-7-30**] Discharge Date: [**2195-8-13**] Date of Birth: [**2133-7-10**] Sex: F Service: SURGERY Allergies: Imuran / Cyclosporine / IV Dye, Iodine Containing Attending:[**First Name3 (LF) 2534**] Chief Complaint: s/p fall down stairs Major Surgical or Invasive Procedure: Irrigation and debridement of grade 3B open tibia fracture, open reduction, internal fixation grade IIIB open tibial fracture, placement of external fixator Lumbar fusion L1-L5 Laminectomy L4 History of Present Illness: 62 yo female with multiple medical problems including venous stasis and recalcitrant pyoderma gangrenosum of the right leg, taking prednisone, mycophenalate mofetil and infliximab. She was receiving hyperbaric O2 therapy at an area hospital and fell down the stairs sustaining an open right tib-fib fracture grade IIIB, likely contaminated and exposed to the old presumably infected ulcer site (large 10 x 10 medial tibial open ulcer for the last three years). She was the transported to [**Hospital1 18**] Pt had difficult access with unsuccessful attempt and femoral, subclavian and internal jugular central line placement. R brachial cutdown was eventually performed. Past Medical History: Pyoderman gangrenosum Venous stasis ulcers Bilateral DVT Pulmonary embolus s/p IVC filter Crohn's disease s/p total colectomy/ileostomy Splenectomy [**12-27**] hemorrahge Right oophorectomy Multiple skin grafts and vascular grafts Social History: She drinks wine on occasion. Denies any illicit drug use or smoking history. Her domestic violence screen is negative Family History: Mother died of breast cancer at the age of 86 and father died of pulmonary hypertension complications at the age of 79 Physical Exam: Upon exam: BP: 130/83 HR: 92 Patient is intubated, sedated; Pupils are equal and reactive bilat. Motor: upon holding sedation, patient able to move both LE to command: she is able to lift her left leg of the bed, bending the knee (4-/5), and can move both feet/toes distally. Exam of the right LE severly limited by post surgical condition. Patient able to confirm feeling light touch in both LE. Quad and achilleus rx are trace bilat. Toes are downgoing. Pertinent Results: [**2195-7-30**] 05:49PM BLOOD WBC-17.2* RBC-2.46* Hgb-6.9* Hct-21.8* MCV-89 MCH-28.2 MCHC-31.7 RDW-16.4* Plt Ct-145* [**2195-7-31**] 02:47AM BLOOD PT-13.0 PTT-23.5 INR(PT)-1.1 [**2195-7-30**] 05:49PM BLOOD Glucose-254* UreaN-31* Creat-1.2* Na-137 K-4.5 Cl-107 HCO3-20* AnGap-15 [**2195-7-31**] 11:32AM BLOOD CK(CPK)-23* [**2195-7-31**] 11:32AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2195-7-30**] 05:49PM BLOOD Calcium-8.4 Phos-4.6* Mg-1.8 [**2195-7-30**] 08:07PM BLOOD Type-ART Temp-37.2 Rates-14/ FiO2-100 pO2-375* pCO2-34* pH-7.37 calTCO2-20* Base XS--4 AADO2-320 REQ O2-58 Intubat-INTUBATED Vent-CONTROLLED [**2195-7-30**] 09:48AM BLOOD Glucose-207* Lactate-7.7* Na-136 K-4.6 Cl-100 calHCO3-20* [**2195-7-30**] 09:48AM BLOOD Hgb-9.5* calcHCT-29 O2 Sat-78 COHgb-2 MetHgb-0 [**2195-7-30**] 3:40 pm TISSUE RIGHT TIBIA. **FINAL REPORT [**2195-8-3**]** GRAM STAIN (Final [**2195-7-30**]): 3+ (5-10 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. TISSUE (Final [**2195-8-3**]): REPORTED BY PHONE TO OLUSEKON [**2195-7-31**] @11:54 AM. Due to mixed bacterial types (>=3) an abbreviated workup is performed; P.aeruginosa, S.aureus and beta strep. are reported if present. Susceptibility will be performed on P.aeruginosa and S.aureus if sparse growth or greater.. STAPH AUREUS COAG +. SPARSE GROWTH OF TWO COLONIAL MORPHOLOGIES. Please contact the Microbiology Laboratory ([**5-/2493**]) immediately if sensitivity to clindamycin is required on this patient's isolate. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ STAPH AUREUS COAG + | GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- =>8 R OXACILLIN-------------<=0.25 S PENICILLIN G----------<=0.03 S TRIMETHOPRIM/SULFA---- <=0.5 S ANAEROBIC CULTURE (Final [**2195-8-3**]): NO ANAEROBES ISOLATED. [**2195-7-30**] TIB/FIB (AP & LAT) RIGHT 1. Displaced tibial and fibular fractures. Probable lateral malleolar fracture, but the ankle is not well evaluated for on this study. 2. Sclerotic lesions within the distal femoral and proximal tibia, compatible with bone infarcts. [**2195-7-30**] CT CHEST W/O CONTRAST; CT ABDOMEN W/O CONTRAST; CT PELVIS W/O CONTRAST 1. L4 compression fracture with mild narrowing of the central canal at this level, age indeterminant. MRI of the L-spine is recommended for further evaluation of the cord at this level. 2. No evidence of solid organ injury. [**2195-7-31**] CT L-SPINE/MYELOGRAM 1. Moderate-to-severe canal stenosis seen at L4-L5 secondary to retropulsed bone fragments from a compression deformity. A small amount of contrast is seen accumulating distal to this level. Please note that the contrast was injected at the level of L3. 2. Superior endplate fracture seen at L3 with roughly 20% loss of height. Brief Hospital Course: She was admitted to the Trauma Service; Orthopedics and Neurosurgery were consulted initially given her injuries. She was taken on the day of admission to the operating room for irrigation and debridement of her grade IIIB open tibia fracture, as well as open reduction, internal fixation and placement of an external fixator. There were no intraoperative complications. She has maintained palpable pulses that were confirmed with Doppler throughout the hospital admission. She was taken to the operating room on [**8-7**] for lumbar fusion of L1-L5 and laminectomy of L4. Plastics, Vascular and Dermatology were also consulted for discussion surrounding the utility and possibility of right leg amputation. It was decided by the family, team and consultants that given that the leg had adequate vasculature at that amputation would not be performed during this hospital stay. The plan is for her to follow up the week after discharge in orthopedics clinic for further evaluation of her RLE and discussion regarding possible removal of the external fixation device. Initially Dermatology recommended keeping steroids, mycophenolate and infliximab for her pyoderma; however because of the recent surgeries to the her leg and back necessitated tapering of her steroids and discontinuance of the infliximab for optimal post-operative healing. This decision was discussed with Dermatology. Her steroids are being tapered daily by 2 mg, she is being discharged on 20 mg with instructions for tapering. Her pain is now being controlled with longa acting narcotics; shorter acting ones are prescribed for breakthrough pain. Her home medications were restarted as well. She was followed by the wound ostomy care nursing team throughout her hospital stay. Physical and Occupational therapy have evaluated her and have recommended rehab. Medications on Admission: Medications - Prescription ATENOLOL - (Prescribed by Other Provider) - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a day BUPROPION - (Prescribed by Other Provider) - 150 mg Tablet Sustained Release - 1 (One) Tablet(s) by mouth twice a day CITALOPRAM - (Prescribed by Other Provider) - 40 mg Tablet - 1 (One) Tablet(s) by mouth once a day FUROSEMIDE [LASIX] - (Prescribed by Other Provider) - 20 mg Tablet - [**1-27**] Tablet(s) by mouth once a day INFLIXIMAB [REMICADE] - (Prescribed by Other Provider) - Dosage uncertain LEVOTHYROXINE - (Prescribed by Other Provider) - 100 mcg Tablet - 1 (One) Tablet(s) by mouth once a day METHADONE - (Prescribed by Other Provider) - 10 mg Tablet - [**12-28**] Tablet(s) by mouth twice a day METHYLPREDNISOLONE - (Prescribed by Other Provider) - 8 mg Tablet - 4 (Four) Tablet(s) by mouth once a day MINOCYCLINE - (Prescribed by Other Provider) - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a day MYCOPHENOLATE MOFETIL [CELLCEPT] - (Prescribed by Other Provider) - 500 mg Tablet - 2 (Two) Tablet(s) by mouth twice a day OMEPRAZOLE [PRILOSEC] - (Prescribed by Other Provider) - 20 mg Capsule, Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth twice a day OXYCODONE - (Prescribed by Other Provider) - 5 mg Tablet - 3 (Three) Tablet(s) by mouth every 4-6 hours SULFASALAZINE - (Prescribed by Other Provider) - 500 mg Tablet, Delayed Release (E.C.) - 2 (Two) Tablet(s) by mouth twice a day and one tab at lunch Medications - OTC CALCIUM CARB-MAG OXIDE-VIT D3 - (Prescribed by Other Provider) - Dosage uncertain CALCIUM CARBONATE [TUMS] - (Prescribed by Other Provider) - 500 mg Tablet, Chewable - 3 (Three) Tablet(s) by mouth twice a day MULTIVITAMIN - (Prescribed by Other Provider) - Dosage uncertain ZINC SULFATE - (Prescribed by Other Provider) - Dosage uncertain Discharge Medications: 1. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 2. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 3. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for insomnia. 4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 5. Bupropion 150 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO BID (2 times a day). 6. Citalopram 20 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 7. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Minocycline 50 mg Capsule Sig: Two (2) Capsule PO Q24H (every 24 hours). 9. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 10. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ML Injection TID (3 times a day). 11. Morphine 15 mg Tablet Sustained Release Sig: Three (3) Tablet Sustained Release PO Q12H (every 12 hours). 12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 13. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 14. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed for constipation. 15. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 16. Vitamin A 10,000 unit Capsule Sig: Two (2) Capsule PO DAILY (Daily) for 7 days. 17. Ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO Q8H (every 8 hours) as needed for nausea. 18. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 5 days. 19. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q3H (every 3 hours) as needed for breakthrough pain. 20. Insulin Regular Human 100 unit/mL Solution Sig: One (1) DOSE Injection four times a day as needed for per slidng scale. 21. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for anxiety. 22. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 23. Methylprednisolone 4 mg Tablet Sig: Five (5) Tablet PO DAILY (Daily): *Tapering dose: Decrease by 2 mg daily until stopped. Discharge Disposition: Extended Care Facility: [**Hospital6 85**] - [**Location (un) 86**] Discharge Diagnosis: s/p Fall Right distal tibia/fibula fracture Old L3/L4 compression fracture Secondary diagnosis: Pyoderma gangrenosum w/ chronic ulcer RLE Discharge Condition: Hemodynamically stable, tolerating a regular diet, pain adequately controlled. Discharge Instructions: DO NOT bear any weight on your right leg at all. The TLSO brace must be worn at all times when out of bed. Followup Instructions: Follow up next Tuesday in [**Hospital 5498**] Clinic with Dr. [**Last Name (STitle) 1005**]. call [**Telephone/Fax (1) 1228**] for an appoinmtent. Follow up with Dr. [**Last Name (STitle) **], Vascular surgery for any concerns or questions related to prior discussions surrounding your right leg. Call [**Telephone/Fax (1) 1237**]. Follow up with Dr. [**Last Name (STitle) 63264**], Neurosurgery in [**1-27**] weeks; call [**Telephone/Fax (1) 1669**] for an appointment. Completed by:[**2195-8-18**]

805,823,518,686,285,276,555,824,913,E880,707,459,458,427,V443,V442,V125,V458

{'Closed fracture of lumbar vertebra without mention of spinal cord injury,Open fracture of shaft of tibia alone,Acute respiratory failure,Pyoderma gangrenosum,Acute posthemorrhagic anemia,Alkalosis,Regional enteritis of unspecified site,Fracture of lateral malleolus, closed,Abrasion or friction burn of elbow, forearm, and wrist, without mention of infection,Accidental fall on or from other stairs or steps,Ulcer of other part of foot,Venous (peripheral) insufficiency, unspecified,Hypotension, unspecified,Other specified cardiac dysrhythmias,Colostomy status,Ileostomy status,Personal history of venous thrombosis and embolism,Other postprocedural status'}

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: s/p fall down stairs PRESENT ILLNESS: 62 yo female with multiple medical problems including venous stasis and recalcitrant pyoderma gangrenosum of the right leg, taking prednisone, mycophenalate mofetil and infliximab. She was receiving hyperbaric O2 therapy at an area hospital and fell down the stairs sustaining an open right tib-fib fracture grade IIIB, likely contaminated and exposed to the old presumably infected ulcer site (large 10 x 10 medial tibial open ulcer for the last three years). She was the transported to [**Hospital1 18**] Pt had difficult access with unsuccessful attempt and femoral, subclavian and internal jugular central line placement. R brachial cutdown was eventually performed. MEDICAL HISTORY: Pyoderman gangrenosum Venous stasis ulcers Bilateral DVT Pulmonary embolus s/p IVC filter Crohn's disease s/p total colectomy/ileostomy Splenectomy [**12-27**] hemorrahge Right oophorectomy Multiple skin grafts and vascular grafts MEDICATION ON ADMISSION: Medications - Prescription ATENOLOL - (Prescribed by Other Provider) - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a day BUPROPION - (Prescribed by Other Provider) - 150 mg Tablet Sustained Release - 1 (One) Tablet(s) by mouth twice a day CITALOPRAM - (Prescribed by Other Provider) - 40 mg Tablet - 1 (One) Tablet(s) by mouth once a day FUROSEMIDE [LASIX] - (Prescribed by Other Provider) - 20 mg Tablet - [**1-27**] Tablet(s) by mouth once a day INFLIXIMAB [REMICADE] - (Prescribed by Other Provider) - Dosage uncertain LEVOTHYROXINE - (Prescribed by Other Provider) - 100 mcg Tablet - 1 (One) Tablet(s) by mouth once a day METHADONE - (Prescribed by Other Provider) - 10 mg Tablet - [**12-28**] Tablet(s) by mouth twice a day METHYLPREDNISOLONE - (Prescribed by Other Provider) - 8 mg Tablet - 4 (Four) Tablet(s) by mouth once a day MINOCYCLINE - (Prescribed by Other Provider) - 100 mg Tablet - 1 (One) Tablet(s) by mouth once a day MYCOPHENOLATE MOFETIL [CELLCEPT] - (Prescribed by Other Provider) - 500 mg Tablet - 2 (Two) Tablet(s) by mouth twice a day OMEPRAZOLE [PRILOSEC] - (Prescribed by Other Provider) - 20 mg Capsule, Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth twice a day OXYCODONE - (Prescribed by Other Provider) - 5 mg Tablet - 3 (Three) Tablet(s) by mouth every 4-6 hours SULFASALAZINE - (Prescribed by Other Provider) - 500 mg Tablet, Delayed Release (E.C.) - 2 (Two) Tablet(s) by mouth twice a day and one tab at lunch ALLERGIES: Imuran / Cyclosporine / IV Dye, Iodine Containing PHYSICAL EXAM: Upon exam: BP: 130/83 HR: 92 Patient is intubated, sedated; Pupils are equal and reactive bilat. Motor: upon holding sedation, patient able to move both LE to command: she is able to lift her left leg of the bed, bending the knee (4-/5), and can move both feet/toes distally. Exam of the right LE severly limited by post surgical condition. Patient able to confirm feeling light touch in both LE. Quad and achilleus rx are trace bilat. Toes are downgoing. FAMILY HISTORY: Mother died of breast cancer at the age of 86 and father died of pulmonary hypertension complications at the age of 79 SOCIAL HISTORY: She drinks wine on occasion. Denies any illicit drug use or smoking history. Her domestic violence screen is negative ### Response: {'Closed fracture of lumbar vertebra without mention of spinal cord injury,Open fracture of shaft of tibia alone,Acute respiratory failure,Pyoderma gangrenosum,Acute posthemorrhagic anemia,Alkalosis,Regional enteritis of unspecified site,Fracture of lateral malleolus, closed,Abrasion or friction burn of elbow, forearm, and wrist, without mention of infection,Accidental fall on or from other stairs or steps,Ulcer of other part of foot,Venous (peripheral) insufficiency, unspecified,Hypotension, unspecified,Other specified cardiac dysrhythmias,Colostomy status,Ileostomy status,Personal history of venous thrombosis and embolism,Other postprocedural status'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 73 year-old female with a history of systemic lupus erythematosus and atrial fibrillation who complains of a five day history of a cough productive of white sputum. She reports that yesterday she developed increasing shortness of breath (gradual) along with subjective fevers with chills and sweats. The patient therefore called EMS. MEDICAL HISTORY: Systemic lupus erythematosus, atrial fibrillation, osteoarthritis, status post bilateral total knee replacements, peripheral neuropathy, status post venous stripping, status post hiatal hernia repair, status post cataract surgery, question of coronary artery disease (this is according to a discharge summary, the patient denies history of heart disease). History of deep venous thrombosis (occurred postop from the total knee replacement). Osteoporosis. MEDICATION ON ADMISSION: ALLERGIES: The patient has allergies recorded to aspirin, sulfa, Penicillin, percocet and Codeine. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Congestive heart failure, unspecified,Acute bronchitis,Systemic lupus erythematosus,Atrial fibrillation,Unspecified hereditary and idiopathic peripheral neuropathy,Osteoporosis, unspecified

CHF NOS,Acute bronchitis,Syst lupus erythematosus,Atrial fibrillation,Idio periph neurpthy NOS,Osteoporosis NOS

Admission Date: [**2140-6-9**] Discharge Date: [**2140-6-9**] Date of Birth: [**2067-7-11**] Sex: F Service: [**Last Name (un) 18171**] ICU HISTORY OF PRESENT ILLNESS: This is a 73 year-old female with a history of systemic lupus erythematosus and atrial fibrillation who complains of a five day history of a cough productive of white sputum. She reports that yesterday she developed increasing shortness of breath (gradual) along with subjective fevers with chills and sweats. The patient therefore called EMS. She states that she returned from a vacation in the Catskills approximately one week prior to admission and had a sore throat that subsequently resolved. REVIEW OF SYSTEMS: Negative for chest pain, shortness of breath, emesis, diarrhea, bright red blood per rectum or melena. She reports recent nausea with dry heaves. She has had chronic leg pain and edema (secondary to venostasis and peripheral neuropathy), but denies increase above baseline. The patient denies orthopnea or paroxysmal nocturnal dyspnea. She does report some palpitations and racing heart. EMS gave the patient a Lasix dose times one and sublingual nitroglycerin times three and brought the patient to the [**Hospital1 1444**] Emergency Department. In the Emergency Department her temperature was 100.0. Heart rate 100 to 117. Blood pressure 160/110. Her oxygen saturation was 85% on room air, which increased to 95% on a 100% nonrebreather. The patient's electrocardiogram showed minimal lateral nonspecific ST changes. Her chest x-ray (after the Lasix dose) showed no congestive heart failure, pneumothorax or pneumonia. An arterial blood gas done on 100% nonrebreather was 7.49, PCO2 of 37, and PO2 of 75. Significant examination findings in the Emergency Department included bibasilar crackles, jugulovenous distention and peripheral edema. With the patient's history of deep venous thrombosis and PE there was a concern for pulmonary embolus. The CT angiogram was performed, which was negative for pulmonary emboli or for any pulmonary parenchymal process. The patient was then transferred to the MICU due to her elevated oxygen requirement. On arrival to the MICU the patient reported feeling much better. Her oxygen saturations were in the mid 90s on 6 liters nasal cannula. PAST MEDICAL HISTORY: Systemic lupus erythematosus, atrial fibrillation, osteoarthritis, status post bilateral total knee replacements, peripheral neuropathy, status post venous stripping, status post hiatal hernia repair, status post cataract surgery, question of coronary artery disease (this is according to a discharge summary, the patient denies history of heart disease). History of deep venous thrombosis (occurred postop from the total knee replacement). Osteoporosis. HOME MEDICATIONS: Lasix 40 mg po every other day, Digoxin 0.125 mg p q day, Protonix, Coumadin 7.5 mg q Monday through Saturday and 10 mg q Sunday, Prednisone 10 mg po q day, Neurontin 600 mg q.i.d., Fosamax 70 mg q week, Duragesic patch 75 micrograms q 72 hours, Miacalcin nasal spray one spray q.d., Cardizem 80 mg q day. ALLERGIES: The patient has allergies recorded to aspirin, sulfa, Penicillin, percocet and Codeine. LABORATORIES ON ADMISSION: White blood cell count of 11.2 with 73% neutrophils and 15% lymphocytes, hematocrit 43.9 and platelets of 273, PT 17.0, PTT 41.1, INR 2.0. chem 7 sodium 1356, potassium 3.7, chloride 95, bicarb 29, BUN 12, creatinine 0.9, glucose 101, calcium 9.2, magnesium 1.7, phos 3.3. Urinalysis showed small blood, negative nitrite or leukocyte, 0 to 2 red blood cell and 0 to 2 white blood cell, occasional bacteria and no epithelial cells. A Digoxin level was subtherapeutic at 0.3. Electrocardiogram showed atrial fibrillation at a rate of 100 with normal axis, normal intervals, 1.[**Street Address(2) 1755**] depression in V4 through V5 compared with prior in 5 of [**2135**] (the prior also showed normal sinus rhythm). CT angiogram was negative for pulmonary embolus. It showed no consolidation and only minimal bibasilar atelectasis. HOSPITAL COURSE: The patient was admitted to the MICU at 3:00 a.m. on [**2140-6-9**]. This patient usually receives her care at [**Hospital6 2910**]. Later that morning contact was made with her primary physicians and the arrangements were made for transfer to that institution. Pulmonary: The patient reported subjective improvement in her shortness of breath after her diuresis. The patient's oxygen requirement at the time of this dictation is 5 liters nasal cannula to maintain oxygen saturations in the mid 90s. Cardiovascular: 1. Ischemia, the patient's records record a history of coronary artery disease, which is not further documented. The patient's electrocardiogram on admission showed nonspecific ST changes, which were resolved by repeat electrocardiogram this morning. The patient denies any history of chest pain associated with this shortness of breath. Serial enzymes are being obtained to rule out myocardial infarction. At the time of this dictation the first two sets are negative and the patient was maintained on telemetry and a low dose beta blocker was started during the rule out protocol. No aspirin was started as the patient reports an aspirin allergy. 2. Pump, the patient has no history of congestive heart failure and her ejection fraction is unknown. Her presentation examination was consistent with congestive heart failure and she did have subjective improvement with diuresis. 3. Rate/rhythm, the patient has chronic atrial fibrillation and is currently reasonably rate controlled on her home dose of Cardizem (heart rates have been in the 90s). The patient is on anticoagulation with Coumadin. Infectious disease: The patient presented with a low grade temperature. She had a mildly increased white blood cell count with a left shift. It was felt that this patient likely has tracheobronchitis. She did receive one dose of Levofloxacin in the Emergency Department. Sputum cultures were obtained. Endocrine: 1. The patient has a history of chronic Prednisone use. The patient received one dose of Hydrocortisone as stress dosed steroids in the Emergency Department. In the Intensive Care Unit the patient was mildly hypertensive. It was therefore felt the stress dose steroids were not necessary. She was continued on her home dose of Prednisone. 2. Osteoporosis the patient is treated with Miacalcin spray and Fosamax. Rheumatology: History of systemic lupus erythematosus. The patient will be continued on her usual Prednisone dose. Neurology: The patient has a history of peripheral neuropathy and is treated with Neurontin. The patient has a history of chronic pain and is treated with a Fentanyl patch. DISCHARGE STATUS: The patient is medically stable for [**Hospital 18172**] transfer to the [**Hospital6 2910**]. DISCHARGE DIAGNOSES: 1. Congestive heart failure. 2. Tracheobronchitis. DISCHARGE MEDICATIONS: Protonix 40 mg po q day, Coumadin 7.5 mg po q day on Monday through Saturday and 10 mg on Sunday. Neurontin 600 mg po q.i.d., Prednisone 10 mg po q day, Fosamax 70 mg po q week, Duragesic patch 75 micrograms q 72 hours, Miacalcin one spray q.d., Cardizem 180 mg po q day, Lopressor 12.5 mg po b.i.d., Lasix 40 mg intravenous q.d. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 5587**] Dictated By:[**Last Name (NamePattern1) 15468**] MEDQUIST36 D: [**2140-6-9**] 12:44 T: [**2140-6-9**] 12:54 JOB#: [**Job Number 18173**]

428,466,710,427,356,733

{'Congestive heart failure, unspecified,Acute bronchitis,Systemic lupus erythematosus,Atrial fibrillation,Unspecified hereditary and idiopathic peripheral neuropathy,Osteoporosis, unspecified'}

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: This is a 73 year-old female with a history of systemic lupus erythematosus and atrial fibrillation who complains of a five day history of a cough productive of white sputum. She reports that yesterday she developed increasing shortness of breath (gradual) along with subjective fevers with chills and sweats. The patient therefore called EMS. MEDICAL HISTORY: Systemic lupus erythematosus, atrial fibrillation, osteoarthritis, status post bilateral total knee replacements, peripheral neuropathy, status post venous stripping, status post hiatal hernia repair, status post cataract surgery, question of coronary artery disease (this is according to a discharge summary, the patient denies history of heart disease). History of deep venous thrombosis (occurred postop from the total knee replacement). Osteoporosis. MEDICATION ON ADMISSION: ALLERGIES: The patient has allergies recorded to aspirin, sulfa, Penicillin, percocet and Codeine. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Congestive heart failure, unspecified,Acute bronchitis,Systemic lupus erythematosus,Atrial fibrillation,Unspecified hereditary and idiopathic peripheral neuropathy,Osteoporosis, unspecified'}

CHIEF COMPLAINT: hypotension and ascites PRESENT ILLNESS: Mr. [**Known lastname 59304**] is a 46-year-old male with metastatic renal cell carcinoma now on axitinib therapy for ~5 weeks, admitted [**Date range (1) 91600**] with anemia, malignant ascites and treated with 3L therapeutic paracentesis 2 wks ago and noted to have disease progression on CT. Patient presented from cliic with hypotension (SBP 70s). He had acutely worsening sharp diffuse abdominal pain that is worse with movement the night prior to admission. The morning of admission he felt weak and dizzy. He had two episoes of vomiting; one prior to admission which was bilious and one while in the ED that had small amount of blood. He also reports decreased PO intake over the past several days secondary to feeling consipated and bloated. His last bowel movement was two days prior to admission. He denies any fever, cough, dyspnea, chest pain, rash. MEDICAL HISTORY: Oncologic History: Mr. [**Known lastname 59304**] presented to his PCP in [**2100-10-30**] for routine physical exam and reported he had some left lower quadrant abdominal discomfort. He was referred to a surgeon for questionable hernia with CT scan on [**2100-11-18**] revealing a left kidney mass measuring 9 x 7.5 cm, with a larger exophytic component measuring approximately 12 cm abutting the abdominal wall. He also had periaortic lymphadenopathy and pulmonary nodules. He was referred here for further management. Plain film of the left femur was done due to pain, revealing a lytic lesion. He was referred to Dr. [**First Name (STitle) 4223**] in orthopedics with plan for left femur surgery in the future. She obtained plain films of the right wrist due to pain and another lytic lesion was noted in the distal ulna. Bone scan on [**2100-12-6**] revealed widespread bony disease. Zometa was initiated on [**2100-12-7**]. He underwent open radical left nephrectomy on [**2100-12-17**] by Dr. [**Last Name (STitle) 3748**]. At the time of surgery, there was significant progression of disease with extension of tumor into the colon and mesentery, requiring left colectomy and small bowel resection. Pathology confirmed renal cell carcinoma, clear cell histology, [**Last Name (un) 19076**] grade 2 with lymphovascular invasion and 4 positive lymph nodes. He underwent excision and curettage of left distal femur lesion and prophylactic fixation with a combination of cement, plate, and screws on [**2101-1-5**] by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4223**]. He developed increased right wrist pain and was found to have a pathologic fracture of the distal ulna on [**2101-1-17**]. He underwent radiation therapy to the right wrist, left shoulder and left femur at the [**Location (un) **] [**Hospital 5028**] Cancer Center. Right heel MRI on [**2101-2-28**] demonstrated a metastatic bony lesion and he received radiation to that site, completing on [**2101-3-18**]. He also had radiation to the left tibia and L3 region. He developed a pathologic fracture of the left proximal humerus on [**2101-4-25**], managed with splinting. He was admitted [**Date range (3) 91600**] with anemia, ascites and disease progression noted on CT including lung/liver/peritoneam metastases. MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientwebOMR. 1. Dexamethasone 0.5 mg PO EVERY OTHER DAY 2. Lisinopril 20 mg PO DAILY 3. Metoprolol Tartrate 50 mg PO DAILY PRN SBP>110 4. HYDROmorphone (Dilaudid) 2-6 mg PO Q3H:PRN pain hold for sedation, RR<10 5. Oxycodone SR (OxyconTIN) 60 mg PO Q8H 6. Sertraline 50 mg PO DAILY ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMITTING EXAM 97.2 103 87/57 20 99% 4L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: tachycardic regular rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: distended, flank dullness to percusion, bowel sounds present, diffusely tender to palpation, no rebound or guarding GU: no foley Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, gait deferred, no asterixis FAMILY HISTORY: No history of renal cell carcinoma or other cancers. His mother died of a cardiac arrest with no significant cardiac history at age 66. Grandmother died of a stroke and coronary artery disease in her 80s. He has a brother who is alive and well. His biological father died when he was age 12 and he does not know his medical history. SOCIAL HISTORY: Divorced and lives in [**Location **]. He has two daughters ages 8 and 11. He works as a firefighter and EMT. No smoking. He drinks alcohol socially. Denies illicit drug use. Brother [**Name (NI) **] is HCP.

Unspecified septicemia,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Malignant ascites,Acidosis,Secondary malignant neoplasm of lung,Paralytic ileus,Secondary malignant neoplasm of bone and bone marrow,Severe sepsis,Other opiates and related narcotics causing adverse effects in therapeutic use,Encounter for palliative care,Depressive disorder, not elsewhere classified,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Physical restraints status,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of kidney

Septicemia NOS,Septic shock,Acute respiratry failure,Acute kidney failure NOS,Malignant ascites,Acidosis,Secondary malig neo lung,Paralytic ileus,Secondary malig neo bone,Severe sepsis,Adv eff opiates,Encountr palliative care,Depressive disorder NEC,Anemia NOS,Hypertension NOS,Pure hypercholesterolem,Migrne unsp wo ntrc mgrn,Physical restrain status,Hx antineoplastic chemo,Hx of irradiation,Hx of kidney malignancy

Admission Date: [**2101-9-6**] Discharge Date: [**2101-9-13**] Date of Birth: [**2055-6-1**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 3565**] Chief Complaint: hypotension and ascites Major Surgical or Invasive Procedure: Abdominal Paracentesis (8.8 and 8.11) History of Present Illness: Mr. [**Known lastname 59304**] is a 46-year-old male with metastatic renal cell carcinoma now on axitinib therapy for ~5 weeks, admitted [**Date range (1) 91600**] with anemia, malignant ascites and treated with 3L therapeutic paracentesis 2 wks ago and noted to have disease progression on CT. Patient presented from cliic with hypotension (SBP 70s). He had acutely worsening sharp diffuse abdominal pain that is worse with movement the night prior to admission. The morning of admission he felt weak and dizzy. He had two episoes of vomiting; one prior to admission which was bilious and one while in the ED that had small amount of blood. He also reports decreased PO intake over the past several days secondary to feeling consipated and bloated. His last bowel movement was two days prior to admission. He denies any fever, cough, dyspnea, chest pain, rash. Of note, has also been on steroid taper (previously on dex 1 mg qdaily, now tapered to 0.5mg every other day). In the ED, initial VS were: 97.7 104 94/54 17 97%RA. Examination was notable for a distended, tender, non-rigid abdomen with guarding. Got 100 hydrocortisone, 2L NS, and Albumin 5% (12.5g / 250mL) x1. Dilaudid 1mg x3 given for pain control. Bladder scan showed > 800 cc and patient unable to void; foley placed with 35 cc UOP, likely that bladder saw ascites not urine. Foley placement verified by ultrasound. Diagnostic paracentesis performed. Patient was started on ceftriaxone 1g, vancomycin 1g, azithromycin 500mg and blood, urine, ascites cx sent. On transfer, VS were: 97.2 103 87/57 20 99% 4L On arrival to the MICU, patient's VS. 98.1, 100, 96/59, 18, 98% RA Review of systems: (+) Per HPI (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies shortness of breath, cough, dyspnea or wheezing. Denies chest pain, chest pressure, palpitations. Denies diarrhea, dark or bloody stools. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. Past Medical History: Oncologic History: Mr. [**Known lastname 59304**] presented to his PCP in [**2100-10-30**] for routine physical exam and reported he had some left lower quadrant abdominal discomfort. He was referred to a surgeon for questionable hernia with CT scan on [**2100-11-18**] revealing a left kidney mass measuring 9 x 7.5 cm, with a larger exophytic component measuring approximately 12 cm abutting the abdominal wall. He also had periaortic lymphadenopathy and pulmonary nodules. He was referred here for further management. Plain film of the left femur was done due to pain, revealing a lytic lesion. He was referred to Dr. [**First Name (STitle) 4223**] in orthopedics with plan for left femur surgery in the future. She obtained plain films of the right wrist due to pain and another lytic lesion was noted in the distal ulna. Bone scan on [**2100-12-6**] revealed widespread bony disease. Zometa was initiated on [**2100-12-7**]. He underwent open radical left nephrectomy on [**2100-12-17**] by Dr. [**Last Name (STitle) 3748**]. At the time of surgery, there was significant progression of disease with extension of tumor into the colon and mesentery, requiring left colectomy and small bowel resection. Pathology confirmed renal cell carcinoma, clear cell histology, [**Last Name (un) 19076**] grade 2 with lymphovascular invasion and 4 positive lymph nodes. He underwent excision and curettage of left distal femur lesion and prophylactic fixation with a combination of cement, plate, and screws on [**2101-1-5**] by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4223**]. He developed increased right wrist pain and was found to have a pathologic fracture of the distal ulna on [**2101-1-17**]. He underwent radiation therapy to the right wrist, left shoulder and left femur at the [**Location (un) **] [**Hospital 5028**] Cancer Center. Right heel MRI on [**2101-2-28**] demonstrated a metastatic bony lesion and he received radiation to that site, completing on [**2101-3-18**]. He also had radiation to the left tibia and L3 region. He developed a pathologic fracture of the left proximal humerus on [**2101-4-25**], managed with splinting. He was admitted [**Date range (3) 91600**] with anemia, ascites and disease progression noted on CT including lung/liver/peritoneam metastases. 1. RCC - as above 2. Hypertension. 3. Hypercholesterolemia. 4. Anxiety -- has prior history of panic attacks. 5. Migraines. 6. Seasonal allergies. 7. s/p XRT to L3 lesion 8. Right humerus pathologic fracture Social History: Divorced and lives in [**Location **]. He has two daughters ages 8 and 11. He works as a firefighter and EMT. No smoking. He drinks alcohol socially. Denies illicit drug use. Brother [**Name (NI) **] is HCP. Family History: No history of renal cell carcinoma or other cancers. His mother died of a cardiac arrest with no significant cardiac history at age 66. Grandmother died of a stroke and coronary artery disease in her 80s. He has a brother who is alive and well. His biological father died when he was age 12 and he does not know his medical history. Physical Exam: ADMITTING EXAM 97.2 103 87/57 20 99% 4L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: tachycardic regular rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: distended, flank dullness to percusion, bowel sounds present, diffusely tender to palpation, no rebound or guarding GU: no foley Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, gait deferred, no asterixis Pertinent Results: ADMITTING LABS [**2101-9-6**] 02:10PM UREA N-44* CREAT-2.9*# SODIUM-132* POTASSIUM-5.8* CHLORIDE-91* TOTAL CO2-24 ANION GAP-23* [**2101-9-6**] 02:10PM ALT(SGPT)-17 AST(SGOT)-19 LD(LDH)-205 ALK PHOS-162* TOT BILI-0.3 [**2101-9-6**] 02:10PM LIPASE-7 [**2101-9-6**] 02:10PM ALBUMIN-2.5* CALCIUM-9.0 PHOSPHATE-5.4*# MAGNESIUM-2.1 [**2101-9-6**] 02:10PM TSH-6.8* [**2101-9-6**] 02:10PM WBC-10.2# RBC-4.90# HGB-13.2*# HCT-42.5# MCV-87 MCH-27.0 MCHC-31.1 RDW-17.0* [**2101-9-6**] 02:10PM NEUTS-78* BANDS-0 LYMPHS-18 MONOS-3 EOS-0 BASOS-0 ATYPS-1* METAS-0 MYELOS-0 PERTINENT LABS [**2101-9-12**] 04:08AM BLOOD Glucose-146* UreaN-61* Creat-3.4* Na-137 K-4.8 Cl-103 HCO3-14* AnGap-25* [**2101-9-12**] 04:08AM BLOOD Calcium-8.5 Phos-5.8* Mg-2.4 [**2101-9-12**] 01:25AM BLOOD Type-ART pO2-87 pCO2-31* pH-7.26* calTCO2-15* Base XS--11 Intubat-NOT INTUBA [**2101-9-12**] 11:11AM BLOOD Lactate-3.7* MICRO [**2101-9-10**] 1:36 pm PERITONEAL FLUID PERITONEAL FLUID. GRAM STAIN (Final [**2101-9-10**]): 2+ (1-5 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. This is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. FLUID CULTURE (Preliminary): NO GROWTH. ANAEROBIC CULTURE (Preliminary): NO GROWTH. [**2101-9-7**] 2:23 pm PERITONEAL FLUID PERITONEAL FLUID. GRAM STAIN (Final [**2101-9-7**]): 2+ (1-5 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. This is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. FLUID CULTURE (Final [**2101-9-10**]): NO GROWTH. ANAEROBIC CULTURE (Preliminary): NO GROWTH. IMAGING . Radiology Report RENAL U.S. Study Date of [**2101-9-7**] 9:30 AM IMPRESSION: 1. Prior left nephrectomy. No evidence of hydronephrosis or renal vascular occlusion involving the right kidney to explain the patient's acute renal failure. 2. Large amount of ascites with diffuse intraperitoneal metastatic disease. . ECHO [**2101-9-8**] at 9:30:00 AM The left atrium is normal in size. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Left ventricular systolic function is hyperdynamic (EF = 75%) M-mode analysis of the aortic valve suggests premature systolic closure. A left ventricular outflow tract obstruction cannot be excluded with certainty due to the technically suboptimal nature of this study. Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). The right ventricular free wall thickness is normal. Right ventricular chamber size is normal. with depressed free wall contractility. The aortic valve leaflets are mildly thickened (?#). There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is mild posterior leaflet mitral valve prolapse. Trivial mitral regurgitation is seen. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion. . ECHO Portable TTE (Complete) Done [**2101-9-12**] at 2:20:00 PM FINAL Poor image quality.The left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. Left ventricular systolic function is hyperdynamic (EF>75%). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are probably normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. Tricuspid regurgitation is present but cannot be quantified. There is mild pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. There are no echocardiographic signs of tamponade. . CXR 8.9 As compared to the previous radiograph, there is a newly appeared moderate left pleural effusion. There is unchanged evidence of low lung volumes and known nodular opacities in both lungs. No evidence of pulmonary edema. Unchanged appearance of the cardiac silhouette. Brief Hospital Course: # Shock: The patient presented with hypotension with systolics in the 70s-80s compared to his baseline of 120s-130s in the outpatient setting. His pressures did not respond adequately to fluid boluses. A PICC line was placed and he was started on dopamine initially. Dopamine was switched to vasopressin given concern for his recurrent ascites. His shock was thought to be due to a combination of sepsis and intravascular volume depletion [**3-3**] recurrent malignant ascites. A definitive infectious source was never identified, though SBP was excluded with 2 large volume paracenteses. The patient was placed on vancomycin, cefepime, and flagyl. He was also given stress dose steroids. Fluid resuscitation was performed with crystalloid and colloid without success. The patient continued to rapidly reaccumulate fluid in his abdomen. The patient remained oliguric to anuric during his admission. Norepinephrine was added on the day of intubation added without improvement in urine output. After a family meeting, the patient was made CMO and vasoactive medications were discontinued. The patient expired shortly thereafter. # Respiratory failure: The patient developed tachypnea and increased work of breathing on the morning of his expiration while undergoing a CT head. He was intubated for respiratory distress, self-extubated, and was reintubated for continuing respiratory distress. Versed, fentanyl, and propofol were used for sedation. A CXR did not show any acute intrapulmonary process. Bilateral LENIs were negative for DVTs. An ECHO did not show any RV strain. Most likely etiology was worsening lung function in the setting of extensive RCC lung metastases and worsening metabolic acidoses due to renal failure. A family meeting was held in the afternoon and the decision was made to make him CMO given his poor prognosis. The patient was terminally extubated on the afternoon of [**9-12**] and expired shortly thereafter. # Acute renal failure: The patient was oliguric on presentation. A renal ultrasound did not show impaired renal flow. Bladder pressures were consistently below 20. Etiology was likely secondary to intraarterial volume depletion due to massive 3rd spacing of fluids secondary to ascites. Urine output did not improve after large volume paracentesis or after fluid resuscitation with crystalloid or colloid. Patient became increasingly acidemic. Dialysis was discussed and not considered appropriate given his poor prognosis. # Metastatic renal cell carcinoma: The patient required 2 large volume paracenteses to manage his malignant ascites. His pain was managed with a dilaudid PCA. Patient's outpatient oncologist was contact[**Name (NI) **] and informed of worsening status and the decision was made to not be aggressive with interventions given his worsening prognosis and lack of tumor response to multiple biologic therapies. # Comfort care: Patient's Oncologist was contact[**Name (NI) **] regarding transitioning to comfort care. As noted above, his prognosis was poor given his lack of response to biologic therapies. Palliative care service was consulted. Patient's family was called on the day of intubation and arrived in the afternoon. Discussion was had with the family as well as Oncologist NP and Palliative care and decision was made to terminally extubate. Patient expired peacefully in the evening. Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from PatientwebOMR. 1. Dexamethasone 0.5 mg PO EVERY OTHER DAY 2. Lisinopril 20 mg PO DAILY 3. Metoprolol Tartrate 50 mg PO DAILY PRN SBP>110 4. HYDROmorphone (Dilaudid) 2-6 mg PO Q3H:PRN pain hold for sedation, RR<10 5. Oxycodone SR (OxyconTIN) 60 mg PO Q8H 6. Sertraline 50 mg PO DAILY Discharge Medications: expired Discharge Disposition: Expired Discharge Diagnosis: Metastatic renal cell carcinoma Malignant ascites Respiratory failure Discharge Condition: Expired. Discharge Instructions: Expired. Followup Instructions: Expired. Completed by:[**2101-9-13**]

038,785,518,584,789,276,197,560,198,995,E935,V667,311,285,401,272,346,V498,V874,V153,V105

{'Unspecified septicemia,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Malignant ascites,Acidosis,Secondary malignant neoplasm of lung,Paralytic ileus,Secondary malignant neoplasm of bone and bone marrow,Severe sepsis,Other opiates and related narcotics causing adverse effects in therapeutic use,Encounter for palliative care,Depressive disorder, not elsewhere classified,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Physical restraints status,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of kidney'}

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: hypotension and ascites PRESENT ILLNESS: Mr. [**Known lastname 59304**] is a 46-year-old male with metastatic renal cell carcinoma now on axitinib therapy for ~5 weeks, admitted [**Date range (1) 91600**] with anemia, malignant ascites and treated with 3L therapeutic paracentesis 2 wks ago and noted to have disease progression on CT. Patient presented from cliic with hypotension (SBP 70s). He had acutely worsening sharp diffuse abdominal pain that is worse with movement the night prior to admission. The morning of admission he felt weak and dizzy. He had two episoes of vomiting; one prior to admission which was bilious and one while in the ED that had small amount of blood. He also reports decreased PO intake over the past several days secondary to feeling consipated and bloated. His last bowel movement was two days prior to admission. He denies any fever, cough, dyspnea, chest pain, rash. MEDICAL HISTORY: Oncologic History: Mr. [**Known lastname 59304**] presented to his PCP in [**2100-10-30**] for routine physical exam and reported he had some left lower quadrant abdominal discomfort. He was referred to a surgeon for questionable hernia with CT scan on [**2100-11-18**] revealing a left kidney mass measuring 9 x 7.5 cm, with a larger exophytic component measuring approximately 12 cm abutting the abdominal wall. He also had periaortic lymphadenopathy and pulmonary nodules. He was referred here for further management. Plain film of the left femur was done due to pain, revealing a lytic lesion. He was referred to Dr. [**First Name (STitle) 4223**] in orthopedics with plan for left femur surgery in the future. She obtained plain films of the right wrist due to pain and another lytic lesion was noted in the distal ulna. Bone scan on [**2100-12-6**] revealed widespread bony disease. Zometa was initiated on [**2100-12-7**]. He underwent open radical left nephrectomy on [**2100-12-17**] by Dr. [**Last Name (STitle) 3748**]. At the time of surgery, there was significant progression of disease with extension of tumor into the colon and mesentery, requiring left colectomy and small bowel resection. Pathology confirmed renal cell carcinoma, clear cell histology, [**Last Name (un) 19076**] grade 2 with lymphovascular invasion and 4 positive lymph nodes. He underwent excision and curettage of left distal femur lesion and prophylactic fixation with a combination of cement, plate, and screws on [**2101-1-5**] by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4223**]. He developed increased right wrist pain and was found to have a pathologic fracture of the distal ulna on [**2101-1-17**]. He underwent radiation therapy to the right wrist, left shoulder and left femur at the [**Location (un) **] [**Hospital 5028**] Cancer Center. Right heel MRI on [**2101-2-28**] demonstrated a metastatic bony lesion and he received radiation to that site, completing on [**2101-3-18**]. He also had radiation to the left tibia and L3 region. He developed a pathologic fracture of the left proximal humerus on [**2101-4-25**], managed with splinting. He was admitted [**Date range (3) 91600**] with anemia, ascites and disease progression noted on CT including lung/liver/peritoneam metastases. MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientwebOMR. 1. Dexamethasone 0.5 mg PO EVERY OTHER DAY 2. Lisinopril 20 mg PO DAILY 3. Metoprolol Tartrate 50 mg PO DAILY PRN SBP>110 4. HYDROmorphone (Dilaudid) 2-6 mg PO Q3H:PRN pain hold for sedation, RR<10 5. Oxycodone SR (OxyconTIN) 60 mg PO Q8H 6. Sertraline 50 mg PO DAILY ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMITTING EXAM 97.2 103 87/57 20 99% 4L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: tachycardic regular rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: distended, flank dullness to percusion, bowel sounds present, diffusely tender to palpation, no rebound or guarding GU: no foley Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, gait deferred, no asterixis FAMILY HISTORY: No history of renal cell carcinoma or other cancers. His mother died of a cardiac arrest with no significant cardiac history at age 66. Grandmother died of a stroke and coronary artery disease in her 80s. He has a brother who is alive and well. His biological father died when he was age 12 and he does not know his medical history. SOCIAL HISTORY: Divorced and lives in [**Location **]. He has two daughters ages 8 and 11. He works as a firefighter and EMT. No smoking. He drinks alcohol socially. Denies illicit drug use. Brother [**Name (NI) **] is HCP. ### Response: {'Unspecified septicemia,Septic shock,Acute respiratory failure,Acute kidney failure, unspecified,Malignant ascites,Acidosis,Secondary malignant neoplasm of lung,Paralytic ileus,Secondary malignant neoplasm of bone and bone marrow,Severe sepsis,Other opiates and related narcotics causing adverse effects in therapeutic use,Encounter for palliative care,Depressive disorder, not elsewhere classified,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Physical restraints status,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of kidney'}

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: The patient is an 83-year-old woman with chronic diastolic CHF (LVH, EF 75%), chronic atrial fibrillation on anticoagulation, severe pulmonary hypertension, diabetes, hypertension, dyslipidemia, and metastatic thyroid cancer undergoing cyberknife therapy, who presents to the ED today with complaints of 20-pound weight gain over the last two weeks and increasing shortness of breath, dyspnea on exertion, orthopnea, and PND. She denies any palpitations, presyncope, or syncope. She was evaluated by Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 437**] on [**2175-11-6**], at which point her digoxin was stopped due to her normal EF and her Lopressor was changed to Toprol XL and the dose was doubled. She subsequently has been undergoing CyberKnife therapy for her metastatic thyroid cancer, completing treatment [**4-16**] today. She complained of progressive symptoms and was referred in to the ED for further evaluation. . In the ED: VS - HR 130s, BP 80/54, Weight 148lbs (up from 124lbs). Her baseline SBPs are known to be in the 100s. ECG showed AFib w/ RVR. CXR showed no significant effusion, pneumothorax, or focal consolidation. She had a shock ultrasound that was negative and was started on Neosynephrine for her hypotension. She received Ceftriaxone as empiric coverage given concern for sepsis contributing to her hypotension and possible underlying pneumonia. She was seen by the CCU team in the ED and started on an Esmolol drip and IV Digoxin. Esmolol and Neosynephrine were titrated up and she received 1 more dose of IV Digoxin. She was also hypoxic, with room air ABG 7.35/51/61. She did not tolerate BiPAP so she was transitioned to NRB. She is being admitted to the CCU for further care. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. MEDICAL HISTORY: PAST CARDIAC HISTORY: 1. Chronic Diastolic Heart Failure: EF 75% 2. Atrial Fibrillation on Coumadin 3. Severe pulmonary hypertension . OTHER PAST MEDICAL HISTORY: 4. Type 2 DM: complicated by diabetic retinopathy and peripheral neuropathy 5. Hyperlipidemia 6. Chronic Lymphedema with multiple lower extremity ulcers 7. Goiter: prior Radioiodine therapy, followed Dr. [**Last Name (STitle) 80040**] 8. GERD 9. Crohn's Disease 10. Cholelithiasis - seen on U/S in past, no previous sx. 11. Achalasia 12. Sleep Apnea: h/o abnormal overnight pulse oximetry, but large thryoid goiter obstructs depending upon patient position . PAST SURGICAL HISTORY: 1. TAH-BSO 2. Tonsillectomy 3. Cataract surgery MEDICATION ON ADMISSION: - Lasix 60mg PO daily - Glyburide 2.5mg PO daily - Lisinopril 2.5mg PO daily - Lorazepam 0.5mg PO daily - Pentasa 1000mg PO BID - Toprol XL 200mg PO daily - Omeprazole 40mg PO daily - Spironolactone 25mg PO daily - Warfarin 5mg PO daily ALLERGIES: Atorvastatin / Celebrex PHYSICAL EXAM: VS: afeb, BP= 90s/40s, HR= 110s-130s, RR= 14-18, O2 sat= 96-99% NRB GENERAL: WD/WN elderly woman in moderate respiratory distress. HEENT: NC/AT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with significant JVD to just below the angle of the jaw. Large firm multinodular mass in the thyroid area. Carotid upstrokes normal in volume and contour, without bruits. Trachea is midline but not highly mobile. Tachycardia sensitive to Carotid Sinus Massage. CARDIAC: PMI located in 5th intercostal space, anterior axillary line. Irregularly irregular. Normal S1, widely split S2 w/ prominent P2, no S3 or S4. +[**2-16**] HSM at apex. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp tachypneic but unlabored, mild accessory muscle use. +Crackles and decreased breath sounds at the bases bilaterally. No rhonchi or wheezes. ABDOMEN: +BS, soft/NT/ND. Mildly obese. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: WWP, 2+ pedal edema bilaterally, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] in compressive wrappings. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. NEURO: Awake, A&Ox3, mood and affect appropriate. Fluently conversant w/ no focal neurologic abnormalities. PULSES: Right: Carotid 2+ DP 2+ PT 2+ Radial 2+ Left: Carotid 2+ DP 2+ PT 2+ Radial 2+ FAMILY HISTORY: Father with coronary artery disease, Two children and five grandchildren alive and healthy Daughter with hyperthyroidism SOCIAL HISTORY: Widowed. Lives in [**Location 3915**], MA in an apartment by herself. Her son, [**Name (NI) **] leaves nearby, as do multiple grandchildren. Remote smoking history, occasional alcohol consumption, no illicit drugs.

Acute on chronic diastolic heart failure,Acute respiratory failure,Acute kidney failure, unspecified,Regional enteritis of unspecified site,Pneumonia, organism unspecified,Atrial fibrillation,Malignant neoplasm of thyroid gland,Hypotension, unspecified,Abnormal coagulation profile,Other chronic pulmonary heart diseases,Pressure ulcer, lower back,Obstructive sleep apnea (adult)(pediatric),Achalasia and cardiospasm,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Background diabetic retinopathy,Nontoxic uninodular goiter,Anticoagulants causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Other diseases of trachea and bronchus

Ac on chr diast hrt fail,Acute respiratry failure,Acute kidney failure NOS,Regional enteritis NOS,Pneumonia, organism NOS,Atrial fibrillation,Malign neopl thyroid,Hypotension NOS,Abnrml coagultion prfile,Chr pulmon heart dis NEC,Pressure ulcer, low back,Obstructive sleep apnea,Achalasia & cardiospasm,DMII neuro nt st uncntrl,Long-term use anticoagul,Hyperlipidemia NEC/NOS,Neuropathy in diabetes,Diabetic retinopathy NOS,Nontox uninodular goiter,Adv eff anticoagulants,Crnry athrscl natve vssl,Trachea & bronch dis NEC

Admission Date: [**2175-12-11**] Discharge Date: [**2175-12-23**] Date of Birth: [**2092-8-31**] Sex: F Service: MEDICINE Allergies: Atorvastatin / Celebrex Attending:[**Last Name (NamePattern4) 290**] Chief Complaint: shortness of breath Major Surgical or Invasive Procedure: none History of Present Illness: The patient is an 83-year-old woman with chronic diastolic CHF (LVH, EF 75%), chronic atrial fibrillation on anticoagulation, severe pulmonary hypertension, diabetes, hypertension, dyslipidemia, and metastatic thyroid cancer undergoing cyberknife therapy, who presents to the ED today with complaints of 20-pound weight gain over the last two weeks and increasing shortness of breath, dyspnea on exertion, orthopnea, and PND. She denies any palpitations, presyncope, or syncope. She was evaluated by Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 437**] on [**2175-11-6**], at which point her digoxin was stopped due to her normal EF and her Lopressor was changed to Toprol XL and the dose was doubled. She subsequently has been undergoing CyberKnife therapy for her metastatic thyroid cancer, completing treatment [**4-16**] today. She complained of progressive symptoms and was referred in to the ED for further evaluation. . In the ED: VS - HR 130s, BP 80/54, Weight 148lbs (up from 124lbs). Her baseline SBPs are known to be in the 100s. ECG showed AFib w/ RVR. CXR showed no significant effusion, pneumothorax, or focal consolidation. She had a shock ultrasound that was negative and was started on Neosynephrine for her hypotension. She received Ceftriaxone as empiric coverage given concern for sepsis contributing to her hypotension and possible underlying pneumonia. She was seen by the CCU team in the ED and started on an Esmolol drip and IV Digoxin. Esmolol and Neosynephrine were titrated up and she received 1 more dose of IV Digoxin. She was also hypoxic, with room air ABG 7.35/51/61. She did not tolerate BiPAP so she was transitioned to NRB. She is being admitted to the CCU for further care. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. Past Medical History: PAST CARDIAC HISTORY: 1. Chronic Diastolic Heart Failure: EF 75% 2. Atrial Fibrillation on Coumadin 3. Severe pulmonary hypertension . OTHER PAST MEDICAL HISTORY: 4. Type 2 DM: complicated by diabetic retinopathy and peripheral neuropathy 5. Hyperlipidemia 6. Chronic Lymphedema with multiple lower extremity ulcers 7. Goiter: prior Radioiodine therapy, followed Dr. [**Last Name (STitle) 80040**] 8. GERD 9. Crohn's Disease 10. Cholelithiasis - seen on U/S in past, no previous sx. 11. Achalasia 12. Sleep Apnea: h/o abnormal overnight pulse oximetry, but large thryoid goiter obstructs depending upon patient position . PAST SURGICAL HISTORY: 1. TAH-BSO 2. Tonsillectomy 3. Cataract surgery Social History: Widowed. Lives in [**Location 3915**], MA in an apartment by herself. Her son, [**Name (NI) **] leaves nearby, as do multiple grandchildren. Remote smoking history, occasional alcohol consumption, no illicit drugs. Family History: Father with coronary artery disease, Two children and five grandchildren alive and healthy Daughter with hyperthyroidism Physical Exam: VS: afeb, BP= 90s/40s, HR= 110s-130s, RR= 14-18, O2 sat= 96-99% NRB GENERAL: WD/WN elderly woman in moderate respiratory distress. HEENT: NC/AT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with significant JVD to just below the angle of the jaw. Large firm multinodular mass in the thyroid area. Carotid upstrokes normal in volume and contour, without bruits. Trachea is midline but not highly mobile. Tachycardia sensitive to Carotid Sinus Massage. CARDIAC: PMI located in 5th intercostal space, anterior axillary line. Irregularly irregular. Normal S1, widely split S2 w/ prominent P2, no S3 or S4. +[**2-16**] HSM at apex. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp tachypneic but unlabored, mild accessory muscle use. +Crackles and decreased breath sounds at the bases bilaterally. No rhonchi or wheezes. ABDOMEN: +BS, soft/NT/ND. Mildly obese. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: WWP, 2+ pedal edema bilaterally, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] in compressive wrappings. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. NEURO: Awake, A&Ox3, mood and affect appropriate. Fluently conversant w/ no focal neurologic abnormalities. PULSES: Right: Carotid 2+ DP 2+ PT 2+ Radial 2+ Left: Carotid 2+ DP 2+ PT 2+ Radial 2+ Pertinent Results: ADMISSION LABS: [**2175-12-11**] 11:30AM WBC-4.6 RBC-4.15* HGB-10.5* HCT-33.0* MCV-79* MCH-25.3*# MCHC-31.8 RDW-17.5* [**2175-12-11**] 11:30AM GLUCOSE-82 UREA N-72* CREAT-1.4* SODIUM-139 POTASSIUM-5.5* CHLORIDE-102 TOTAL CO2-27 ANION GAP-16 [**2175-12-11**] 11:45AM PT-26.2* PTT-32.8 INR(PT)-2.6* . Cardiac enzymes: [**2175-12-11**] 11:45AM CK(CPK)-62 [**2175-12-11**] 11:45AM cTropnT-<0.01 [**2175-12-11**] 08:00PM cTropnT-<0.01 [**2175-12-11**] 08:00PM CK(CPK)-49 . Thyroid labs: [**2175-12-11**] 08:00PM T4-9.2 FREE T4-1.7 [**2175-12-11**] 08:00PM TSH-0.067* . . Labs on Transfer: [**2175-12-21**] 05:31AM BLOOD PT-55.3* PTT-37.2* INR(PT)-6.5* [**2175-12-21**] 05:31AM BLOOD Glucose-177* UreaN-86* Creat-1.5* Na-143 K-4.4 Cl-95* HCO3-38* AnGap-14 . . CARDIOLOGY: . EKG [**2175-12-11**] Atrial fibrillation with rapid ventricular response. Right axis deviation. Low limb lead QRS voltage. RSR' pattern in lead VI. Persistent prominent S waves in the left precordial leads. Modest right precordial lead T wave changes. Findings are consistent with right ventricular hypertrophy/right ventricular overload. Clinical correlation is suggested. No previous tracing available for comparison. . TTE [**2175-12-12**] IMPRESSION: Markedly dilated right ventricle with moderate global hypokinesis and relative sparing of the basal right ventricular segments. Preserved left ventricular regional and global systolic function. Severe diastolic dysfunction. Moderate to severe pulmonary hypertension. Mild aortic and moderate mitral regurgitation. . . RADIOLOGY: CXR ([**2175-12-12**]): FINDINGS: Large right thyroid masses again appreciated with calcification and leftward deviation of the trachea. Numerous rounded masses within the chest bilaterally are again depicted consistent with known metastatic disease. No significant effusion or pneumothorax is detected. Double density with regard to the cardiac shadow is consistent with a large hiatal hernia. No focal consolidation to suggest pneumonia is detected. . CTA Chest ([**2175-12-13**]): IMPRESSION: 1. No pulmonary embolism. Large pulmonary artery measuring 3.4 cm, greater than the aorta. The heart is enlarged with large atria bilaterally, right ventricle greater than the left, although this has not changed in appearance since [**8-14**]. Septal thickening consistent with fluid overload. 3. Large pleural effusions, right greater than left, much worse than in [**Month (only) **]. Significant right and left lower lobe atelectasis. 4. Numerous metastatic pulmonary nodules as before. 5. Hiatal hernia. . CT Chest ([**12-21**]): pending Brief Hospital Course: ASSESSMENT AND PLAN: 83-yo woman w/ chronic dCHF (LVH, EF 75%), chronic A-fib on anticoagulation, severe pulm HTN, DM, HTN, HL, and metastatic thyroid Ca s/p CyberKnife therapy, p/w 20-pound weight gain x2 weeks and progressively worsening SOB and DOE, found to be in A-fib w/ RVR in the ED, hypotensive, and hypoxic, admitted to the CCU, improved w diuresis and transferred temporarily to regular floor. Readmitted to CCU for hypercarbic respiratory failure improved on BiPaP. Diltiazem had been used for rate control - beta blockers were discontinued given concern for ?contribution to respiratory decompensation on the floor. She was empirically started on vancomycin and zosyn for possible HAP on [**12-20**]. She was transfered to the MICU at the request of the patient's family. . # Hypercarbic/hypoxemic respiratory failure: Multiple potential etiologies, in part secondary to her hypervolemia as well as known pulmonary hypertension, cardiogenic pulmonary edema. Pulmonary consult was following the patient, then the patient was transfered to the MICU. Considered tapping pleural effusions, but determined to be technically difficult as the patient had elevated INR. The patient was aggressively diuresed with lasix drip. The patient was continued on BiPAP and was able to be weaned to NC only. Neurology was consulted, paradoxical breathing could be result of myopathy. However, the patient decided after much discussion that she desired to have comfort measures only. The patient was made comfortable, underwent respiratory arrest and cardiac arrest in minutes following. . #. PUMP: Pt w/ known chronic dCHF (LVH and EF 75%), p/w acute exacerbation in the setting of afib with RVR. She was overloaded on exam and was responsive to a lasix drip with improvement in volume status. TTE showed EF 70-75%, markedly dilated RV w/ moderate global HK, preserved LV regional and global systolic function, severe diastolic dysfunction, moderate to severe pulmonary hypertenion. Given hypotension and mild acute renal failure, lasix drip was continued with 1-1.5 L net diuresis daily. Spironolactone was also continued at home dose. With improvement in her volume status, she was transferred to the regular floor, however, readmitted to CCU for hypercarbic/hypoxemic respiratory failure. Pt i/o slightly net negative, but unable to adequately diurese secondary to hypotension. Nonetheless, the patient appears volume overloaded, restarted on lasix gtt yesterday. Continued lasix gtt, then switched to bolus lasix. . # RHYTHM: Pt was noted to have chronic atrial fibrillation, no previous attempts at cardioversion. She was in a-Fib w/ RVR on presentation to ED, w/ hypotension as below, in setting of worsening symptoms since stopping Digoxin and uptitrating Toprol XL. Low TSH also suggested a contribution of thyrotoxicity secondary to CyberKnife therapy for thyroid cancer. She was started on Esmolol gtt which was titrated to max in ED. Also given IV Digoxin 250mg x 2 in ED. Upon arrival to CCU, Diltiazem bolus + gtt were started with good effect, and esmolol was titrated off. No more digoxin was given. Rate was subsequently well controlled on PO and diltiazem, which were increased for goal HR <80. Coumadin was continued but INR became supratherapeutic. Now s/p diltiazem and esmolol drips on PO diltiazem and metoprolol with HR 90-100. Low TSH suggests probable contribution from thyrotoxicity likely from CyberKnife therapy to thyroid cancer. Due to supratherapeutic INR, coumadin was d/c'd. . # CORONARIES: No known CAD, but w/ many risk factors. . # HYPOTENSION: Pt w/ SBP 80s-90s in ED in the setting of RVR, and neosynephrine was started for BP support while on rate-controlling agents. She continued to mentate well even though hypotensive. She was briefly febrile, but no infection was identified and sepsis was considered unlikely. Random cortisol was high, ruling out adrenal insufficiency as a cause. Hypotension was attributed to poor forward flow from acute on chronic diastolic CHF and A-Fib/RVR. Blood pressure improved with rate control and diuresis. Now low normal BP with fluctuating mentation. Low UOP on lasix drip, ultrafiltration was considered. . # ACUTE RENAL FAILURE: Likely [**1-15**] poor forward flow from A-Fib/RVR. Will likely improve with HR control and diuresis. Urine lytes c/w prerenal physiology. Renal following. . # DIABETES: On oral meds at home for glycemic control. ISS while inpatient. . # CROHN'S DISEASE: continued home Pentasa, PPI. . # SUPRATHERAPEUTIC INR: Pt on coumadin for a-fib, but INR now > 6, unclear etiology. . # ETHICS: Pt was DNR/DNI, but family says pt confused. Patient says "I want to die" but son wants full code. Had family meeting with PCP and endocrinology. Ethics following. She has a tortuous trachea - ENT has eval'd think intubation would not be problem[**Name (NI) 115**]. Family meetings- pt to remain full code for now and aggrees to trial intubation if needed. Pt eventually CMO. Medications on Admission: - Lasix 60mg PO daily - Glyburide 2.5mg PO daily - Lisinopril 2.5mg PO daily - Lorazepam 0.5mg PO daily - Pentasa 1000mg PO BID - Toprol XL 200mg PO daily - Omeprazole 40mg PO daily - Spironolactone 25mg PO daily - Warfarin 5mg PO daily Discharge Medications: expired Discharge Disposition: Expired Discharge Diagnosis: expired Discharge Condition: expired Discharge Instructions: expired Followup Instructions: expired [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**] Completed by:[**2175-12-26**]

428,518,584,555,486,427,193,458,790,416,707,327,530,250,V586,272,357,362,241,E934,414,519

{'Acute on chronic diastolic heart failure,Acute respiratory failure,Acute kidney failure, unspecified,Regional enteritis of unspecified site,Pneumonia, organism unspecified,Atrial fibrillation,Malignant neoplasm of thyroid gland,Hypotension, unspecified,Abnormal coagulation profile,Other chronic pulmonary heart diseases,Pressure ulcer, lower back,Obstructive sleep apnea (adult)(pediatric),Achalasia and cardiospasm,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Background diabetic retinopathy,Nontoxic uninodular goiter,Anticoagulants causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Other diseases of trachea and bronchus'}

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: The patient is an 83-year-old woman with chronic diastolic CHF (LVH, EF 75%), chronic atrial fibrillation on anticoagulation, severe pulmonary hypertension, diabetes, hypertension, dyslipidemia, and metastatic thyroid cancer undergoing cyberknife therapy, who presents to the ED today with complaints of 20-pound weight gain over the last two weeks and increasing shortness of breath, dyspnea on exertion, orthopnea, and PND. She denies any palpitations, presyncope, or syncope. She was evaluated by Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 437**] on [**2175-11-6**], at which point her digoxin was stopped due to her normal EF and her Lopressor was changed to Toprol XL and the dose was doubled. She subsequently has been undergoing CyberKnife therapy for her metastatic thyroid cancer, completing treatment [**4-16**] today. She complained of progressive symptoms and was referred in to the ED for further evaluation. . In the ED: VS - HR 130s, BP 80/54, Weight 148lbs (up from 124lbs). Her baseline SBPs are known to be in the 100s. ECG showed AFib w/ RVR. CXR showed no significant effusion, pneumothorax, or focal consolidation. She had a shock ultrasound that was negative and was started on Neosynephrine for her hypotension. She received Ceftriaxone as empiric coverage given concern for sepsis contributing to her hypotension and possible underlying pneumonia. She was seen by the CCU team in the ED and started on an Esmolol drip and IV Digoxin. Esmolol and Neosynephrine were titrated up and she received 1 more dose of IV Digoxin. She was also hypoxic, with room air ABG 7.35/51/61. She did not tolerate BiPAP so she was transitioned to NRB. She is being admitted to the CCU for further care. . On review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. MEDICAL HISTORY: PAST CARDIAC HISTORY: 1. Chronic Diastolic Heart Failure: EF 75% 2. Atrial Fibrillation on Coumadin 3. Severe pulmonary hypertension . OTHER PAST MEDICAL HISTORY: 4. Type 2 DM: complicated by diabetic retinopathy and peripheral neuropathy 5. Hyperlipidemia 6. Chronic Lymphedema with multiple lower extremity ulcers 7. Goiter: prior Radioiodine therapy, followed Dr. [**Last Name (STitle) 80040**] 8. GERD 9. Crohn's Disease 10. Cholelithiasis - seen on U/S in past, no previous sx. 11. Achalasia 12. Sleep Apnea: h/o abnormal overnight pulse oximetry, but large thryoid goiter obstructs depending upon patient position . PAST SURGICAL HISTORY: 1. TAH-BSO 2. Tonsillectomy 3. Cataract surgery MEDICATION ON ADMISSION: - Lasix 60mg PO daily - Glyburide 2.5mg PO daily - Lisinopril 2.5mg PO daily - Lorazepam 0.5mg PO daily - Pentasa 1000mg PO BID - Toprol XL 200mg PO daily - Omeprazole 40mg PO daily - Spironolactone 25mg PO daily - Warfarin 5mg PO daily ALLERGIES: Atorvastatin / Celebrex PHYSICAL EXAM: VS: afeb, BP= 90s/40s, HR= 110s-130s, RR= 14-18, O2 sat= 96-99% NRB GENERAL: WD/WN elderly woman in moderate respiratory distress. HEENT: NC/AT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple with significant JVD to just below the angle of the jaw. Large firm multinodular mass in the thyroid area. Carotid upstrokes normal in volume and contour, without bruits. Trachea is midline but not highly mobile. Tachycardia sensitive to Carotid Sinus Massage. CARDIAC: PMI located in 5th intercostal space, anterior axillary line. Irregularly irregular. Normal S1, widely split S2 w/ prominent P2, no S3 or S4. +[**2-16**] HSM at apex. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp tachypneic but unlabored, mild accessory muscle use. +Crackles and decreased breath sounds at the bases bilaterally. No rhonchi or wheezes. ABDOMEN: +BS, soft/NT/ND. Mildly obese. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: WWP, 2+ pedal edema bilaterally, [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] in compressive wrappings. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. NEURO: Awake, A&Ox3, mood and affect appropriate. Fluently conversant w/ no focal neurologic abnormalities. PULSES: Right: Carotid 2+ DP 2+ PT 2+ Radial 2+ Left: Carotid 2+ DP 2+ PT 2+ Radial 2+ FAMILY HISTORY: Father with coronary artery disease, Two children and five grandchildren alive and healthy Daughter with hyperthyroidism SOCIAL HISTORY: Widowed. Lives in [**Location 3915**], MA in an apartment by herself. Her son, [**Name (NI) **] leaves nearby, as do multiple grandchildren. Remote smoking history, occasional alcohol consumption, no illicit drugs. ### Response: {'Acute on chronic diastolic heart failure,Acute respiratory failure,Acute kidney failure, unspecified,Regional enteritis of unspecified site,Pneumonia, organism unspecified,Atrial fibrillation,Malignant neoplasm of thyroid gland,Hypotension, unspecified,Abnormal coagulation profile,Other chronic pulmonary heart diseases,Pressure ulcer, lower back,Obstructive sleep apnea (adult)(pediatric),Achalasia and cardiospasm,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of anticoagulants,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Background diabetic retinopathy,Nontoxic uninodular goiter,Anticoagulants causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Other diseases of trachea and bronchus'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 70-year-old female who presents with a four-day history of pressure and headache and in the last 12 hours prior to admission it was an unbearable headache. Denied any changes in vision currently but states that there was a period where she had a decreased visual field in the right eye this morning. Denied photophobia. Denied LOC. Denied nausea, vomiting, or meningeal signs. No decreases in hearing. MEDICAL HISTORY: 1. Mechanical fall in [**2112-4-17**]. 2. Denied stroke. 3. History of hypertension. MEDICATION ON ADMISSION: ALLERGIES: Penicillin and Percocet. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Subarachnoid hemorrhage,Unspecified essential hypertension

Subarachnoid hemorrhage,Hypertension NOS

Admission Date: [**2112-5-17**] Discharge Date: [**2112-5-26**] Date of Birth: [**2041-12-28**] Sex: F Service: Neurosurgery HISTORY OF THE PRESENT ILLNESS: The patient is a 70-year-old female who presents with a four-day history of pressure and headache and in the last 12 hours prior to admission it was an unbearable headache. Denied any changes in vision currently but states that there was a period where she had a decreased visual field in the right eye this morning. Denied photophobia. Denied LOC. Denied nausea, vomiting, or meningeal signs. No decreases in hearing. PAST MEDICAL HISTORY: 1. Mechanical fall in [**2112-4-17**]. 2. Denied stroke. 3. History of hypertension. ALLERGIES: Penicillin and Percocet. CURRENT ADMISSION MEDICATIONS: 1. Aspirin 81 mg q.d. 2. Hydralazine for high blood pressure. LABORATORY/RADIOLOGIC DATA: CT of the head showed cerebellar AVM, a small subdural bleed. White count 9.6, hematocrit 39.9, 271,000 platelets. PHYSICAL EXAMINATION ON ADMISSION: Vital signs: Blood pressure 164/80, pulse 118. Neurologic: EOMs were full. No nystagmus. Cranial nerves II through XII intact. Pupils, right [**2-18**], left [**2-18**]. No papilledema noted. Hypoglossus was intact. Palate was symmetric. Visual fields had some peripheral color discrimination deterioration, left greater than right. No pronator drift. The patient's muscle strength was [**3-21**] in all upper and lower extremities. Fine finger movements were intact. Finger-to-nose was intact bilaterally. No dyskinesia. [**Location (un) **] was intact. Language was intact with some perseveration. HOSPITAL COURSE: The patient was admitted to the Intensive Care Unit where she was sent for a MRI/MRA/MRV and was preopped to have an angiogram. MRI of the brain on [**2112-5-17**] showed a large left cerebellar hemispheric subacute subdural hemorrhage, a left occipital lobe hemorrhage with a moderate amount surrounding edema. MRA showed no definite vascular abnormality was appreciated. MRV showed that there was some displacement of venous tributaries of the superior sagittal sinus in the proximity of the hemorrhage. On [**2112-5-18**], the patient continued to have a headache and nausea which was relieved with some Tylenol and Lorazepam. The vital signs were stable. The patient was brought to the Angio Suite on [**2112-5-18**] where she was diagnosed with a left occipital dural arteriovenous fistula with a feeder coming from the left MMA. The patient tolerated the procedure without any problems and was transferred back to the ICU. Her right groin insertion site was fine with no hematoma or swelling and she was stable postprocedure. The patient was monitored in the ICU setting until [**2112-5-19**] when she was transferred to the floor to await further neurosurgical intervention. Her laboratories were monitored on the floor and she was preopped to have an embolization done. Her laboratories were all within normal limits. Chest x-ray was normal. An EKG showed a normal sinus rhythm. There was a question of a possible old infarct, nonspecific ST flattening. Neurologically, the patient remained intact with no neurological deficits appreciated. On [**2112-5-23**], the patient had her dural AV fistula embolized to greater than 90% with a faint persistent flow from a posterior meningeal vessel the actual arteriovenous malformation. On her second postoperative day, her vital signs remained stable. Her blood pressure was in the 90s/40s. Her hematocrit was 35, sodium 140, potassium 4.0. The patient was awake, alert, followed commands. Pupils were 2 and trace bilaterally. The patient was moving all extremities. The patient was intubated at this time. The patient was extubated on the first postoperative day, [**2112-5-24**]. The orders were to keep her blood pressure less than 140 and to advance her diet. The patient was transferred to the floor on [**2112-5-24**], awake, alert, and moving all extremities and following commands. On [**2112-5-25**], a Physical Therapy consult was done and the patient was found to be safe to go home. The patient is going to be discharged on [**2112-5-26**]. DISCHARGE INSTRUCTIONS: To gradually increase activity back to baseline, watch the angio insertion site for redness and swelling. FOLLOW-UP: The patient has a follow-up appointment on [**2112-6-27**] at 9:00 that will be to have a follow-up angiogram to assess the one vessel that was not able to be embolized. Also, the patient is not being sent home on blood pressure medications at this time due to systolic blood pressures in the 90s to low 100s. We are asking that she follow-up with her primary care physician to asses the need for further blood pressure medication. She was discharged neurologically intact. [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 1133**] Dictated By:[**Last Name (NamePattern4) 36958**] MEDQUIST36 D: [**2112-5-26**] 09:01 T: [**2112-5-29**] 20:40 JOB#: [**Job Number 51935**]

430,401

{'Subarachnoid hemorrhage,Unspecified essential hypertension'}

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 70-year-old female who presents with a four-day history of pressure and headache and in the last 12 hours prior to admission it was an unbearable headache. Denied any changes in vision currently but states that there was a period where she had a decreased visual field in the right eye this morning. Denied photophobia. Denied LOC. Denied nausea, vomiting, or meningeal signs. No decreases in hearing. MEDICAL HISTORY: 1. Mechanical fall in [**2112-4-17**]. 2. Denied stroke. 3. History of hypertension. MEDICATION ON ADMISSION: ALLERGIES: Penicillin and Percocet. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Subarachnoid hemorrhage,Unspecified essential hypertension'}

CHIEF COMPLAINT: PRESENT ILLNESS: Patient is an 83-year-old male with past medical history significant for CAD status post CABG, Class IV CHF with an EF of 35%, AFib status post ICD pacer and chronic renal insufficiency, transferred to [**Hospital1 18**] from nursing home facility due to increased respiratory rate and lethargy on day of admission. Patient had a recent hospital admission for pneumonia, and had just completed a seven day course of Augmentin, which was finished on the day of this current admission. Patient had been noticed to be increasingly lethargic with decreased p.o. intake by the nursing home staff. He also notes diffuse achiness and feeling chilly. Patient is a poor historian. MEDICAL HISTORY: 1. Coronary artery disease status post CABG x3 in [**2096**] with redo in [**2108**]. P-MIBI in [**2115-4-16**] showing moderate reversible inferior defect, status post dual lead pacer and defibrillator placed in [**2114-8-16**], bilateral pleural effusions. 2. Class IV CHF with EF of 35%. 3. AFib. 4. Chronic renal insufficiency with baseline creatinine of 2.2. 5. Hyperlipidemia. 6. Hypertension. 7. Monoclonal gammopathy. 8. Prostate cancer status post prostatectomy. 9. Tophaceous gout. 10. Cervical spondylosis. 11. Status post appendectomy. 12. GAVE syndrome. 13. Status post knee surgery. 14. Status post spinal cyst removal. 15. History of lower gastrointestinal bleed. MEDICATION ON ADMISSION: ALLERGIES: Morphine. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Currently residing at [**Hospital 33092**] Rehab. Lives alone. Daughter in [**Name2 (NI) 4565**]. Quit tobacco 40 years ago. No current alcohol use.

Congestive heart failure, unspecified,Cardiogenic shock,Acute and chronic respiratory failure,Hyperosmolality and/or hypernatremia,Urinary tract infection, site not specified,Atrial fibrillation

CHF NOS,Cardiogenic shock,Acute & chronc resp fail,Hyperosmolality,Urin tract infection NOS,Atrial fibrillation

Admission Date: [**2115-9-28**] Discharge Date: [**2115-10-20**] Date of Birth: Sex: F Service: MICU HISTORY OF PRESENT ILLNESS: Patient is an 83-year-old male with past medical history significant for CAD status post CABG, Class IV CHF with an EF of 35%, AFib status post ICD pacer and chronic renal insufficiency, transferred to [**Hospital1 18**] from nursing home facility due to increased respiratory rate and lethargy on day of admission. Patient had a recent hospital admission for pneumonia, and had just completed a seven day course of Augmentin, which was finished on the day of this current admission. Patient had been noticed to be increasingly lethargic with decreased p.o. intake by the nursing home staff. He also notes diffuse achiness and feeling chilly. Patient is a poor historian. Upon arrival to [**Hospital1 18**], his blood pressure was 167/68, heart rate of 60, respiratory rate of 30, and satting 86% on 5 liters. He was placed on 100% nonrebreather with his sats improving to the 90s. He received 80 mg of IV Lasix, and his oxygen requirement then decreased to 4 liters. He also received a dose of Levaquin and was started on a nitroglycerin drip. PAST MEDICAL HISTORY: 1. Coronary artery disease status post CABG x3 in [**2096**] with redo in [**2108**]. P-MIBI in [**2115-4-16**] showing moderate reversible inferior defect, status post dual lead pacer and defibrillator placed in [**2114-8-16**], bilateral pleural effusions. 2. Class IV CHF with EF of 35%. 3. AFib. 4. Chronic renal insufficiency with baseline creatinine of 2.2. 5. Hyperlipidemia. 6. Hypertension. 7. Monoclonal gammopathy. 8. Prostate cancer status post prostatectomy. 9. Tophaceous gout. 10. Cervical spondylosis. 11. Status post appendectomy. 12. GAVE syndrome. 13. Status post knee surgery. 14. Status post spinal cyst removal. 15. History of lower gastrointestinal bleed. MEDICATIONS: 1. Protonix. 2. Digoxin. 3. Colace. 4. Isosorbide mononitrate. 5. Epogen. 6. Hydralazine. 7. Toprol XL. 8. Bumetanide. 9. Timoptic eyedrops. 10. Senna. 11. Allopurinol. 12. Remeron. 13. Multivitamin. ALLERGIES: Morphine. SOCIAL HISTORY: Currently residing at [**Hospital 33092**] Rehab. Lives alone. Daughter in [**Name2 (NI) 4565**]. Quit tobacco 40 years ago. No current alcohol use. FAMILY HISTORY: Noncontributory. LABORATORIES ON ADMISSION: White count 11.2, hematocrit 34.7. Sodium 154, potassium 4.9, chloride 116, bicarb 24, BUN 106, creatinine 2.6. Urinalysis: 100 protein, 21-50 RBC, and few bacteria. Chest x-ray: Cardiomegaly, bilateral basilar dense opacities with air bronchograms in the right middle lobe and right lower lobe consistent with pneumonia with superimposed pulmonary edema. EKG: Paced rhythm, left bundle branch block. HOSPITAL COURSE: 1. Cardiovascular: Pump: Patient with Class IV CHF admitted with acute CHF exacerbation. At initial presentation in the ED, patient in acute respiratory distress, received Lasix with good diuresis, and subsequent improved respiratory status. He initially went to the floor, where he was weaned down to 4 liters nasal cannula of oxygen. However, the day following admission, patient developed worsening respiratory distress and was markedly tachypneic with decreased urine output and abdominal pain. He was then transferred to the MICU for closer monitoring. Upon arrival in the MICU, there was concern that patient might be intervascularly dry given his hypernatremia, acute renal failure, and free water deficit, and low CVPs. He received several free water and normal saline boluses. Although his chest x-ray did show bilateral pleural effusions, these were thought to be chronic. However, on [**10-4**], the patient continued to have significant respiratory distress and difficulty weaning off the ventilator. A CAT scan was obtained, which showed bilateral layering effusions, pulmonary edema, and patient was thought to be in CHF. At this point, he was then diuresed with Zaroxolyn and Bumex for several days without response. Cardiology was then consulted for evaluation of his CHF at which point he was started on a Natrecor drip. Initially, Bumex and Zaroxolyn were D/C'd. Patient had minimal diuresis. Review of the record showed patient has had multiple episodes of CHF refractory to diuresis. Bumex and Zaroxolyn were added back. In addition, patient was started on a Lasix drip. He did have an adequate diuretic response on this regimen. He also required the addition of dobutamine given his poor cardiac function. A Swan was placed to monitor patient's hemodynamics throughout this. Multiple attempts were made to wean him off of his drips, which were unsuccessful. After several days, his Lasix drip was stopped, and he was maintained on Natrecor and dobutamine. However, patient had significant ectopy with dobutamine, so this was slowly weaned down. The CHF service was also consulted, but no further progress was able to be made in the management of patient's CHF. Rhythm: Patient with biventricular pacer and defibrillator. He was V paced throughout the hospitalization. He was seen by EP and his pacer rate was increased to 95 in order to optimize his cardiac function given his severe CHF. He had marked ectopy on dobutamine drip, which had been added as per his CHF. Coronary: Patient had no active ischemia during the hospitalization. 2. ID: Patient admitted having just completed treatment for a pneumonia. He was started on Levaquin and Cipro on admission to cover for community acquired and aspiration pneumonia. When he was transferred to the MICU, his antibiotic coverage was brought in to ceftaz, Flagyl, and Vancomycin to cover for pneumonia. He was treated for seven days. Given his continued respiratory issues, patient was bronched with BAL cultures obtained. These grew out only sparse MRSA which was thought to be colonization. Patient remained off antibiotics for many days. He then subsequently developed a Pseudomonas UTI for which he was started on cefepime. 3. Pulmonary: Patient admitted with mild respiratory distress thought to be CHF exacerbation and pneumonia. Following diuresis, his respiratory status initially improved, but then upon day of transfer to the MICU, he was markedly tachypneic with abdominal pain and decreased urine output. In this setting, he was electively intubated to allow for better workup of his other issues. Following this, multiple attempts to wean him off the ventilator were unsuccessful. He was then started on an aggressive diuresis regimen. He was finally extubated on [**10-10**]. He had been intubated for a total of 12 days. He did well for several days following extubation, but in the setting of his worsening CHF, developed progressive respiratory distress. Following lengthy discussions with the patient and the family, decided that patient would not be reintubated. He was briefly placed on BiPAP, which he did not tolerate well and which had minimal effect on his respiratory distress. 4. Heme: Several days into admission, the patient developed left lower upper edema. An ultrasound showed a new left subclavian vein thrombus in addition to an old right IJ clot. Patient was then started on Heparin. Given patient's history of GAVE syndrome, GI was consulted prior to initiation of Heparin. There was also concern given a recent EGD, which showed gastritis and a few AVMs. Following lengthy discussion with the GI team, it was decided that the patient would benefit from Heparin. Serial hematocrits were followed on this regimen. Patient with baseline anemia due to chronic renal insufficiency, he was maintained on Epogen and iron per his outpatient regimen. 5. Renal: Patient with chronic renal insufficiency and baseline creatinine of approximately 2.2. His creatinine remained essentially stable. His medications were renally dosed. Patient did have symptoms with urinary obstruction. The day following admission, he developed acute abdominal pain. A CAT scan of the abdomen showed a distended bladder. Following catheterization, his abdominal pain resolved. Patient had multiple issues with Foley catheter placement thought to be due to his prostatectomy and unusual anatomy. Multiple episodes of Foley catheter clogging and with large bladder residuals measuring 100 cc. Urology was consulted, and several catheters were placed including finally a catheter placed under cystoscopy. Patient then had multiple blood clots and hematuria thought to be due to Foley catheter trauma in the setting of Heparin. He was briefly placed on continuous bowel irrigation and his symptoms resolved. 6. GI: Patient with dysphagia. He had a PEG tube placed and tube feeds were started, which he tolerated well. He has a history of GAVE syndrome for which GI followed him. He had no active exacerbations of this. 7. Fluids, electrolytes, and nutrition: Patient initially dry on admission and rehydrated. He subsequently developed a severe CHF exacerbation and was fluid restricted. His electrolytes were followed throughout the hospitalization and patient was started on tube feeds, which he tolerated well. A PEG was placed for tube feed delivery. 8. Disposition: Patient continued to have progressive CHF refractory to diuretic or other treatments. He developed progressive respiratory distress, but did not wish to be reintubated. Multiple discussions regarding codes and interventions were discussed with patient and his daughter. [**Name (NI) 227**] patient's extremely poor prognosis and medical futility treatment, it was decided that he would not benefit from intubation. Patient had progressive symptoms related to his CHF. He was briefly placed on BiPAP, which he did not tolerate. He was given Morphine to make him comfortable and in an attempt to facilitate BiPAP. Patient developed progressive respiratory distress and died secondary to cardiopulmonary failure on [**2115-10-20**] at 4:10 p.m. Patient's daughter was [**Name (NI) 653**] and made aware. She declined any postmortem examination. The patient was actually transferred to the CCU service with the attending, Dr. [**Last Name (STitle) **], although it is still listed in the computer under MICU, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], just as to clarify who the attending of record is to be. DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-932 Dictated By:[**Last Name (NamePattern1) 5212**] MEDQUIST36 D: [**2116-1-23**] 23:36 T: [**2116-1-24**] 12:10 JOB#: [**Job Number 96378**] cc:[**Last Name (NamePattern4) 96379**]

428,785,518,276,599,427

{'Congestive heart failure, unspecified,Cardiogenic shock,Acute and chronic respiratory failure,Hyperosmolality and/or hypernatremia,Urinary tract infection, site not specified,Atrial fibrillation'}

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: Patient is an 83-year-old male with past medical history significant for CAD status post CABG, Class IV CHF with an EF of 35%, AFib status post ICD pacer and chronic renal insufficiency, transferred to [**Hospital1 18**] from nursing home facility due to increased respiratory rate and lethargy on day of admission. Patient had a recent hospital admission for pneumonia, and had just completed a seven day course of Augmentin, which was finished on the day of this current admission. Patient had been noticed to be increasingly lethargic with decreased p.o. intake by the nursing home staff. He also notes diffuse achiness and feeling chilly. Patient is a poor historian. MEDICAL HISTORY: 1. Coronary artery disease status post CABG x3 in [**2096**] with redo in [**2108**]. P-MIBI in [**2115-4-16**] showing moderate reversible inferior defect, status post dual lead pacer and defibrillator placed in [**2114-8-16**], bilateral pleural effusions. 2. Class IV CHF with EF of 35%. 3. AFib. 4. Chronic renal insufficiency with baseline creatinine of 2.2. 5. Hyperlipidemia. 6. Hypertension. 7. Monoclonal gammopathy. 8. Prostate cancer status post prostatectomy. 9. Tophaceous gout. 10. Cervical spondylosis. 11. Status post appendectomy. 12. GAVE syndrome. 13. Status post knee surgery. 14. Status post spinal cyst removal. 15. History of lower gastrointestinal bleed. MEDICATION ON ADMISSION: ALLERGIES: Morphine. PHYSICAL EXAM: FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Currently residing at [**Hospital 33092**] Rehab. Lives alone. Daughter in [**Name2 (NI) 4565**]. Quit tobacco 40 years ago. No current alcohol use. ### Response: {'Congestive heart failure, unspecified,Cardiogenic shock,Acute and chronic respiratory failure,Hyperosmolality and/or hypernatremia,Urinary tract infection, site not specified,Atrial fibrillation'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: 83 year old female with PMH significant for CAD and aortic stenosis s/p hybrid procedure including mid LAD stenting and subsequent open heart surgery with AVR with bioprosthesis in [**2124**]. In [**Month (only) **]/[**2131**] the patient was treated at [**Hospital3 **] for an episode of recurrent clinical angina for which she ruled out for an MI. She describes this as chest and throat "pressure." She underwent diagnostic cardiac catheterization [**2132-1-1**] at NEBH which revealed an eccentric smooth bordered 80% mid LAD stenosis immediately prior to the origin of a very large major diagonal branch and a focal eccentric 95% mid LAD stenosis just after the origin of the same diagonal vessel. The patient is now referred for planned LAD-Diagonal branch PCI of these lesions. During the procedure, a [**Month/Day/Year **] was placed into a large diagonal off of the mid LAD. A severely retroflexed smaller LAD was found to be jailed, slow flow, and they were unable to rescue. After the procedure the patient was transfered to the CCU. Was hemodynamically stable, feeling fine. Denies chest pain and SOB. . Cardiac review of systems is notable for presence of chest pain. Negative for dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: negative for diabetes. Positive for dyslipidemia and hypertension. 2. CARDIAC HISTORY: - severe aortic stenosis - CAD s/p MI in setting of post op hip surgery. Underwent hybrid procedure involving stenting of the mid LAD with a Cyper stent as well as subsequent open heart surgery involving replacement of her aortic valve with a 21mm CE Magna pericardial bioprosthesis AVR in [**2124**] MEDICATION ON ADMISSION: ATORVASTATIN - 20 mg Tablet PO daily LISINOPRIL - 20 mg Tablet PO daily METOPROLOL SUCCINATE - 25 mg PO daily CLOPIDOGREL [PLAVIX] - 75 mg PO daily ASPIRIN - 81 mg Tablet PO daily CITALOPRAM - 20 mg TabletPO daily NITROGLYCERIN - 0.4 mg Tablet SL PRN chest pain. OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - 20 mg Tablet PO daily. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. - Mother: Died of an MI age 67. - Father: Died of cancer. SOCIAL HISTORY: Lives alone. Retired from [**Location (un) **] of [**State 350**] in personnel department. Uses cane and walker at home. Uses wheelchair outside.

Coronary atherosclerosis of native coronary artery,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Knee joint replacement,Old myocardial infarction

Crnry athrscl natve vssl,Heart valve transplant,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx TIA/stroke w/o resid,Joint replaced knee,Old myocardial infarct

Admission Date: [**2132-1-24**] Discharge Date: [**2132-1-25**] Date of Birth: [**2048-8-24**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1145**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: Percutaneous Coronary Intervention with drug eluting stent placement. History of Present Illness: 83 year old female with PMH significant for CAD and aortic stenosis s/p hybrid procedure including mid LAD stenting and subsequent open heart surgery with AVR with bioprosthesis in [**2124**]. In [**Month (only) **]/[**2131**] the patient was treated at [**Hospital3 **] for an episode of recurrent clinical angina for which she ruled out for an MI. She describes this as chest and throat "pressure." She underwent diagnostic cardiac catheterization [**2132-1-1**] at NEBH which revealed an eccentric smooth bordered 80% mid LAD stenosis immediately prior to the origin of a very large major diagonal branch and a focal eccentric 95% mid LAD stenosis just after the origin of the same diagonal vessel. The patient is now referred for planned LAD-Diagonal branch PCI of these lesions. During the procedure, a [**Month/Day/Year **] was placed into a large diagonal off of the mid LAD. A severely retroflexed smaller LAD was found to be jailed, slow flow, and they were unable to rescue. After the procedure the patient was transfered to the CCU. Was hemodynamically stable, feeling fine. Denies chest pain and SOB. . Cardiac review of systems is notable for presence of chest pain. Negative for dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. Past Medical History: 1. CARDIAC RISK FACTORS: negative for diabetes. Positive for dyslipidemia and hypertension. 2. CARDIAC HISTORY: - severe aortic stenosis - CAD s/p MI in setting of post op hip surgery. Underwent hybrid procedure involving stenting of the mid LAD with a Cyper stent as well as subsequent open heart surgery involving replacement of her aortic valve with a 21mm CE Magna pericardial bioprosthesis AVR in [**2124**] 3. OTHER PAST MEDICAL HISTORY: Mild stroke per pt report History of adult onset asthma Peptic ulcer Gall bladder surgery Bilateral knee replacements Hip replacement, left Cataracts, bilateral Tonsillectomy Appendectomy Hysterectomy Hemorrhoidectomy Skin cancer lesions removed s/p typhoid fever as a child Social History: Lives alone. Retired from [**Location (un) **] of [**State 350**] in personnel department. Uses cane and walker at home. Uses wheelchair outside. Family History: - No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. - Mother: Died of an MI age 67. - Father: Died of cancer. Physical Exam: GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. NECK: Supple. No JVP appreciated. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, sistolic murmur best heard at right upper sternal border. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No edema. Groin site with good pulse, no hematoma and no bruit appreciated. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Pertinent Results: [**2132-1-24**] 05:52PM BLOOD WBC-6.3 RBC-3.89* Hgb-12.0 Hct-35.5* MCV-91 MCH-30.7 MCHC-33.7 RDW-13.2 Plt Ct-195 [**2132-1-25**] 05:16AM BLOOD WBC-6.6 RBC-3.84* Hgb-12.0 Hct-35.5* MCV-92 MCH-31.2 MCHC-33.8 RDW-12.9 Plt Ct-191 [**2132-1-24**] 05:52PM BLOOD PT-11.6 PTT-97.2* INR(PT)-1.1 [**2132-1-24**] 05:52PM BLOOD Glucose-109* UreaN-18 Creat-0.8 Na-140 K-4.4 Cl-105 HCO3-28 AnGap-11 [**2132-1-25**] 05:16AM BLOOD Glucose-110* UreaN-18 Creat-0.9 Na-140 K-3.9 Cl-105 HCO3-28 AnGap-11 [**2132-1-24**] 10:50PM BLOOD CK-MB-2 [**2132-1-25**] 05:16AM BLOOD CK-MB-2 1. Coronary angiography in this right dominant system demonstrated 80% mid LAD stenosis into a diagonal branch. The continuation of the LAD was retroflexed and had a 90% stenosis at its origin, and was a small caliber vessel that was likley intramyocardial. The diagonal branch was the larger parent vessel. The LMCA had no angiographically apparent disease. The LCx was widely patent. The RCA was not injected. 2. Limited resting hemodynamics reveal systemic arterial normotension with SBP 126 mmHg. 3. Successful PCI of the LAD into a large diagonal branch with 3.5x12mm Promus [**Month/Day/Year **] (see PTCA comments). 4. Unable to cross into the LAD with TIMI 2 flow at the end of the procedure (see PTCA comments). Brief Hospital Course: 83 y/o female with PMH of CAD and aortic stenosis s/p mid LAD stenting and AVR with bioprosthesis in [**2124**]. Underwent diagnostic cath on [**Month (only) **]/11 which revealed 80% mid LAD stenosis and a focal eccentric 95% mid LAD stenosis. Patient was referred for planned LAD-Diagonal branch PCI. . #CAD s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) 5175**] into mid LAD large diagonal: During the procedure, the diagonal [**Last Name (Prefixes) **] resulted in a jailed LAD which was unable to be rescued but showed TIMI 2 flow. The LAD was small and thought to not be a dominant vessel. She was admitted to the CCU for further monitoring. Her cardiac enzymes did not increase and she remained chest pain free throughout the short hospitalization. She was maintained on integrillin for 18hrs post-catheterization, and discharged on her home medications for CAD. . #HTN: her blood pressure medications were restarted and no changes were made as her BP was well controlled. Medications on Admission: ATORVASTATIN - 20 mg Tablet PO daily LISINOPRIL - 20 mg Tablet PO daily METOPROLOL SUCCINATE - 25 mg PO daily CLOPIDOGREL [PLAVIX] - 75 mg PO daily ASPIRIN - 81 mg Tablet PO daily CITALOPRAM - 20 mg TabletPO daily NITROGLYCERIN - 0.4 mg Tablet SL PRN chest pain. OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - 20 mg Tablet PO daily. Discharge Medications: 1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily) for 1 months. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*3* 3. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 5. lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day. 6. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 7. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Sublingual once a day as needed for chest pain. 8. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home With Service Facility: [**Hospital3 **] VNA Discharge Diagnosis: Coronary artery disease s/p drug-eluting stent placement Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: It was a pleasure to take care of you at [**Hospital1 827**]. During your hospital stay you had a procedure done to reverse two heart vessel narrowings. One of the narrowings was successfully reversed with a stent and for that you will need to take a medication for 1 year to prevent the wire from reocluding. The other narrowing you had could not be repaired. You were transfered to the CCU to be better watched following the procedure. You had no complications during your CCU stay. We are making the following changes in your home medications: -Aspirin from 81mg to 325mg for 1 month, daily by mouth. After 1 month you can likely resume taking aspirin 81mg as before. Please speak with your cardiologist about this medication change first. -Start Plavix 75mg daily by mouth. You should take this medication for at least 1 year to prevent reoclusion of the wire that was placed in one of your heart vessels. You should continue to take all the other medications as usual. Followup Instructions: Name: [**Last Name (LF) **],[**First Name3 (LF) **] Location: [**Location (un) **] CARDIOVASCULAR ASSOCIATES [**Hospital6 **] Address: [**Apartment Address(1) 14524**], [**Location (un) **],[**Numeric Identifier 9749**] Phone: [**Telephone/Fax (1) 14525**] Appt: [**2-15**] at 1pm **IF you are having any issues before this appt, please call Dr [**Last Name (STitle) 30280**] office to see him sooner. Department: CARDIAC SERVICES When: FRIDAY [**2132-3-14**] at 10:40 AM With: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

414,V422,401,272,V125,V436,412

{'Coronary atherosclerosis of native coronary artery,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Knee joint replacement,Old myocardial infarction'}

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: Chest pain PRESENT ILLNESS: 83 year old female with PMH significant for CAD and aortic stenosis s/p hybrid procedure including mid LAD stenting and subsequent open heart surgery with AVR with bioprosthesis in [**2124**]. In [**Month (only) **]/[**2131**] the patient was treated at [**Hospital3 **] for an episode of recurrent clinical angina for which she ruled out for an MI. She describes this as chest and throat "pressure." She underwent diagnostic cardiac catheterization [**2132-1-1**] at NEBH which revealed an eccentric smooth bordered 80% mid LAD stenosis immediately prior to the origin of a very large major diagonal branch and a focal eccentric 95% mid LAD stenosis just after the origin of the same diagonal vessel. The patient is now referred for planned LAD-Diagonal branch PCI of these lesions. During the procedure, a [**Month/Day/Year **] was placed into a large diagonal off of the mid LAD. A severely retroflexed smaller LAD was found to be jailed, slow flow, and they were unable to rescue. After the procedure the patient was transfered to the CCU. Was hemodynamically stable, feeling fine. Denies chest pain and SOB. . Cardiac review of systems is notable for presence of chest pain. Negative for dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: negative for diabetes. Positive for dyslipidemia and hypertension. 2. CARDIAC HISTORY: - severe aortic stenosis - CAD s/p MI in setting of post op hip surgery. Underwent hybrid procedure involving stenting of the mid LAD with a Cyper stent as well as subsequent open heart surgery involving replacement of her aortic valve with a 21mm CE Magna pericardial bioprosthesis AVR in [**2124**] MEDICATION ON ADMISSION: ATORVASTATIN - 20 mg Tablet PO daily LISINOPRIL - 20 mg Tablet PO daily METOPROLOL SUCCINATE - 25 mg PO daily CLOPIDOGREL [PLAVIX] - 75 mg PO daily ASPIRIN - 81 mg Tablet PO daily CITALOPRAM - 20 mg TabletPO daily NITROGLYCERIN - 0.4 mg Tablet SL PRN chest pain. OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] - 20 mg Tablet PO daily. ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: GENERAL: NAD. Oriented x3. Mood, affect appropriate. HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. - Mother: Died of an MI age 67. - Father: Died of cancer. SOCIAL HISTORY: Lives alone. Retired from [**Location (un) **] of [**State 350**] in personnel department. Uses cane and walker at home. Uses wheelchair outside. ### Response: {'Coronary atherosclerosis of native coronary artery,Heart valve replaced by transplant,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Knee joint replacement,Old myocardial infarction'}

CHIEF COMPLAINT: Unresponsive PRESENT ILLNESS: Pt is a [**Age over 90 **] year old woman with PMH of stage IV NSCLC, CVA, and a recurrent malignant right sided pleural effusion who presented after attempted IP procedure on day of admission with altered mental status and an unresponsive episode. Pt was scheduled for outpatient pleuroscopy, pleurodesis, and PleurX Catheter placement today. She was prepped and received 75Mcg of Fentanyl and 1.5 mg total of Midazolam. An incision was made, but at that time the patient became unresponsive with bradycardia into the 30s and hypotension with SBPs in the 60s. She required ventilatory support with a BVM briefly, got Atropine 0.5mg x 2 and the procedure was aborted (and small incision sutured closed). MEDICAL HISTORY: 1. CVA 2. Right-sided breast cancer: This was about 30 years ago and treated with mastectomy and radiation therapy. 3. Type 2 diabetes: Diet controlled. 4. Hypertension. 5. Atrial fibrillation. 6. Gout. 7. Hypothyroidism. 8. Osteopenia/osteoporosis. 9. Glaucoma. 10. NSCLC as below: -[**10-7**] CXR for cough showed R-sided opacity, chest CT which showed a nodular lesions in superior RLL and mod/large R pleural MEDICATION ON ADMISSION: ALLKARE PROTECTIVE BARRIER WIPES - - use to cleanse area around your feeding tube twice a day or as needed Convatec ALLOPURINOL - 100 mg Tablet - 2 Tablet(s) by mouth once a day ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth once a day COLCHICINE - 0.6 mg Tablet - 1 Tablet(s) by mouth as directed take only with gout flare. do not take on regular basis FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth twice a day as needed for volume overload as directed HYDROCHLOROTHIAZIDE - 12.5 mg Capsule - 1 Capsule(s) by mouth qam for blood pressure IPRATROPIUM-ALBUTEROL - 0.5 mg-2.5 mg/3 mL Solution for Nebulization - 1 neb(s) inh every four (4) hours as needed for wheeze ICD9: 496 LEVOTHYROXINE - 75 mcg Tablet - 1 Tablet(s) by mouth once a day SALINE BULLETS - - 1 neb inh every four (4) hours as needed for wheeze Use with nebulizer machine TIMOLOL MALEATE - 0.5 % Drops - 1 drop(s) both eyes twice a day TRAZODONE - 50 mg Tablet - 1.5 Tablet(s) by mouth at bedtime Dose= 75 mg nightly ALLERGIES: Penicillins PHYSICAL EXAM: Vitals: T: 95.6 (axillary) BP:97/62 P: 62 R: 20 O2: 99% 2 L General: Withdraws to painful stimuli only, no posturing. HEENT: No evidence of trauma. Sclera anicteric, MMM, oropharynx clear, PERRL Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, limited air movement at apices only (decreased breath sounds bilateral bases) CV: irregularly irregular normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: withdraws all extremities to painful stimuli only, 1+ LE reflexes, toes downgoing bilaterally. FAMILY HISTORY: No family history of lung disease. However, note that her husband who is a long time smoker died of lung cancer. SOCIAL HISTORY: The patient currently lives with her family in [**Location (un) 2312**], she has VNA 2X/week. She is originally from the [**Country 31115**] but moved here in [**2081**] and has not been back there recently. She previously lived in [**Location 86**] and then moved to [**State 108**] and has now been back up in [**Location (un) 86**] for the last 2 years. She denies any other areas of residence. She denies any alcohol use and she denies any past or present cigarette smoking. However, her husband was a significant smoker. The patient previously worked for the Red Cross and had no occupational exposures. Family very involved in her care.

Malignant pleural effusion,Malignant neoplasm of lower lobe, bronchus or lung,Other alteration of consciousness,Hypotension, unspecified,Unspecified essential hypertension,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Disorder of bone and cartilage, unspecified,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use

Malignant pleural effusn,Mal neo lower lobe lung,Other alter consciousnes,Hypotension NOS,Hypertension NOS,Atrial fibrillation,DMII wo cmp nt st uncntr,Hypothyroidism NOS,Bone & cartilage dis NOS,Adv eff sedat/hypnot NOS

Admission Date: [**2119-4-6**] Discharge Date: [**2119-4-8**] Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 2297**] Chief Complaint: Unresponsive Major Surgical or Invasive Procedure: Pleurex catheter History of Present Illness: Pt is a [**Age over 90 **] year old woman with PMH of stage IV NSCLC, CVA, and a recurrent malignant right sided pleural effusion who presented after attempted IP procedure on day of admission with altered mental status and an unresponsive episode. Pt was scheduled for outpatient pleuroscopy, pleurodesis, and PleurX Catheter placement today. She was prepped and received 75Mcg of Fentanyl and 1.5 mg total of Midazolam. An incision was made, but at that time the patient became unresponsive with bradycardia into the 30s and hypotension with SBPs in the 60s. She required ventilatory support with a BVM briefly, got Atropine 0.5mg x 2 and the procedure was aborted (and small incision sutured closed). She was given flumazenil 0.5mg as well as narcan 0.4mg with minimal response. She was not responding verbally/appropriately. She was withdrawing to painful stimuli and moving all extremities. At the time of this incident, an EKG was performed that showed atrial fibrillation and ST depressions (reportedly in V2-V3). Repeat EKG 30 minutes later showed normalization of these abnormalities. Prior to the procedure she reported cough, dyspnea, and weight loss. She specifically denied orthopnea, PND or leg edema. Of note, she has had thoracentesis x 2 on [**1-26**] and [**2-27**] draining 850ml and 1300ml respectively. Post procedure her dyspnea improved and there was complete lung expansion. On the floor, the patient is responsive to painful stimuli only. Review of systems: Unable to obtain due to patient's mental status. Past Medical History: 1. CVA 2. Right-sided breast cancer: This was about 30 years ago and treated with mastectomy and radiation therapy. 3. Type 2 diabetes: Diet controlled. 4. Hypertension. 5. Atrial fibrillation. 6. Gout. 7. Hypothyroidism. 8. Osteopenia/osteoporosis. 9. Glaucoma. 10. NSCLC as below: -[**10-7**] CXR for cough showed R-sided opacity, chest CT which showed a nodular lesions in superior RLL and mod/large R pleural effusion - [**2118-11-2**] pleural effusion tapped and negative for malignancy Pt then developed hoarseness and was seen by ENT [**1-8**] and determined to have recurrent nerve paralysis, highly concerning for malignancy. - [**2119-1-13**] repeat imaging disclosed a smaller LUL nodule and paratracheal mass, likely a lymph node conglomerage - [**2119-1-26**] EBUS with FNA sampled paratracheal mass and lymph node, both positive for poorly differentiated adenocarcinoma. Brochial brushings of the right lobar bronchi were atypical - [**2119-2-9**]: C1D1 09-018: irreversible EGFR/ErbB2 TKI PF-[**Numeric Identifier 108198**] Social History: The patient currently lives with her family in [**Location (un) 2312**], she has VNA 2X/week. She is originally from the [**Country 31115**] but moved here in [**2081**] and has not been back there recently. She previously lived in [**Location 86**] and then moved to [**State 108**] and has now been back up in [**Location (un) 86**] for the last 2 years. She denies any other areas of residence. She denies any alcohol use and she denies any past or present cigarette smoking. However, her husband was a significant smoker. The patient previously worked for the Red Cross and had no occupational exposures. Family very involved in her care. Family History: No family history of lung disease. However, note that her husband who is a long time smoker died of lung cancer. Physical Exam: Vitals: T: 95.6 (axillary) BP:97/62 P: 62 R: 20 O2: 99% 2 L General: Withdraws to painful stimuli only, no posturing. HEENT: No evidence of trauma. Sclera anicteric, MMM, oropharynx clear, PERRL Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, limited air movement at apices only (decreased breath sounds bilateral bases) CV: irregularly irregular normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: withdraws all extremities to painful stimuli only, 1+ LE reflexes, toes downgoing bilaterally. Pertinent Results: [**2119-4-6**] 09:08PM TYPE-ART TEMP-35.0 PO2-127* PCO2-65* PH-7.40 TOTAL CO2-42* BASE XS-12 INTUBATED-NOT INTUBA [**2119-4-6**] 09:08PM GLUCOSE-157* LACTATE-0.7 K+-3.8 [**2119-4-6**] 09:08PM freeCa-1.13 [**2119-4-6**] 05:06PM GLUCOSE-219* UREA N-50* CREAT-1.1 SODIUM-139 CHLORIDE-92* TOTAL CO2-41* [**2119-4-6**] 05:06PM CK(CPK)-79 [**2119-4-6**] 05:06PM CK-MB-NotDone cTropnT-<0.01 [**2119-4-6**] 05:06PM CALCIUM-8.9 PHOSPHATE-5.2* MAGNESIUM-2.4 [**2119-4-6**] 05:06PM TSH-7.8* [**2119-4-6**] 05:06PM FREE T4-1.6 [**2119-4-6**] 05:06PM WBC-8.2 RBC-3.71* HGB-11.7* HCT-37.8 MCV-102* MCH-31.5 MCHC-30.9* RDW-16.4* [**2119-4-6**] 05:06PM PLT COUNT-249 [**2119-4-6**] 05:04PM TYPE-ART RATES-/18 PO2-413* PCO2-78* PH-7.34* TOTAL CO2-44* BASE XS-12 INTUBATED-NOT INTUBA VENT-SPONTANEOU [**2119-4-6**] 05:04PM GLUCOSE-266* LACTATE-2.3* NA+-137 K+-3.6 CL--85* [**2119-4-6**] 05:04PM HGB-12.4 calcHCT-37 O2 SAT-98 [**2119-4-6**] 05:04PM freeCa-1.11* [**2119-4-6**] 11:20AM GLUCOSE-151* [**2119-4-6**] 11:20AM UREA N-52* CREAT-1.1 SODIUM-138 POTASSIUM-3.2* CHLORIDE-90* [**2119-4-6**] 11:20AM estGFR-Using this [**2119-4-6**] 11:20AM ALT(SGPT)-27 AST(SGOT)-32 LD(LDH)-201 ALK PHOS-86 TOT BILI-0.7 [**2119-4-6**] 11:20AM TOT PROT-6.7 ALBUMIN-3.7 GLOBULIN-3.0 CALCIUM-9.4 PHOSPHATE-3.7 MAGNESIUM-2.3 [**2119-4-6**] 11:20AM WBC-8.1 RBC-3.61* HGB-11.8* HCT-36.9 MCV-102* MCH-32.8* MCHC-32.1 RDW-15.9* [**2119-4-6**] 11:20AM NEUTS-71.9* LYMPHS-18.3 MONOS-6.2 EOS-3.3 BASOS-0.4 [**2119-4-6**] 11:20AM PLT COUNT-217 [**2119-4-6**] 11:20AM PT-13.9* PTT-24.6 INR(PT)-1.2* [**2119-4-8**] 06:50AM BLOOD WBC-8.7 RBC-3.54* Hgb-11.0* Hct-35.1* MCV-99* MCH-31.1 MCHC-31.3 RDW-17.3* Plt Ct-183 [**2119-4-8**] 06:50AM BLOOD Glucose-139* UreaN-60* Creat-1.3* Na-144 K-4.4 Cl-100 HCO3-39* AnGap-9 . CXR (portable): [**2119-4-6**] CHEST, AP: Lung volumes are low, with increased left lower lobe atelectasis and a tiny left apical pneumothorax. Right lower lobe atelectasis and subpulmonic effusion persist. Hazy opacity in the right upper lobe corresponds to known primary tumor. Left upper lobe nodule is vaguely seen overlying the second anterior and fourth posterior ribs. Mild-to-moderate cardiomegaly and aortic tortuosity persist. The stomach is markedly distended, with PEG tube in place. IMPRESSION: 1. Bibasilar atelectasis, tiny left pneumothorax. 2. Distended stomach, please decompress through PEG tube. CT Head w/o Contrast [**2119-4-6**]: IMPRESSION: 1. No acute intracranial process. 2. 1.4 cm calcified left paraclinoid lesion most consistent with meningioma without associated edema. 3. Areas of hypodensity within the right parietal and right frontal regions corresponding to FLAIR abnormalities on prior MRI and consistent with remote infarcts. . MRI Head [**2119-4-7**]: No acute pathology (prelim) . CXR [**2119-4-7**] (post Pleurex): No evidence of residual pneumothorax. Brief Hospital Course: # Altered Mental Status: The patient's unresponsiveness/altered mental status was possibly due to versed/fentanyl with slow metabolism, but also possibly due to hypoxia and resultant CNS insult that occurred as a result of her hypoperfusion with low HR and blood pressure. Alternative explanations include CVA and other toxic/metabolic abnormalities. Glucose level was normal. As this change in level of consciousness was so acute, less likely due to infection/sepsis. Patient also with long history of atrial fibrillation, not currently on anticoagulation with an INR of 1.2. The patient was admitted to the SICU under the care of the MICU team. Her airway was monitored closely and she had a repeat ABG that showed 7.4/65/127. She did not receive any further opiates/benzodiazepines. Her mental status was waxing and [**Doctor Last Name 688**], and she would have periods throughout the night where she would open her eyes and follow simple commands (squeeze hands). Otherwise, she was responsive only to painful stimuli. An MRI of her brain was performed due to concern for embolic CVA which showed no acute pathology. She did receive flumazenil 0.5mg again along with narcan 0.4mg. Approximately one hour after the administration of these medicines, the patient was fully awake, alert and oriented. On the day following admission, she was able to converse with her family (present at bedside) although she frequently reported feeling "tired." She later tolerated her IP procedure well and was alert on discharge. # Hypotension: When the patient first arrived to the ICU, her blood pressures were in the high 90s and low 100s systolic. Over the subsequent several hours, her blood pressures drifted down to a nadir of 70s systolic. She received 2 IV fluid boluses of 500ml. She showed improvement in her blood pressure to 90s-100s. A central line set up was at bed side in case pressors were needed, but her blood pressure remained stable and then increased to 120s systolic when she became fully awake. During this time her UOP remained satisfactory, averaging 30ml/hour. # EKG changes: The patient had EKG changes during her initial bradycardic/hypotensive episode with new RBBB and minimal ST depressions in V2-V3. A repeat EKG 30 minutes later showed resolution of these findings and only showed atrial fibrillation with no ST/T wave abnormalities. The patient does not carry the diagnosis of CAD, but is a diabetic and is predisposed to vascular abnormalities. As a result cardiac enzymes were cycled. A second set did show a small increase in troponin T to 0.02, but no MB component. Third set of enzymes was negative. # NSCLC with pleural effusion: Patient is now status post 2 cycles with investigatory drug, now with reaccumulation of pleural effusion. The reaccumulation likely represents progression of tumor. On the day following admission, she was seen by IP and a PleurX catheter was placed at bedside with drainage of 1100 cc of fluid. After the procedure, the patient reported feelling "much better." F/U chest x-ray showed no PTX. She was called out to the general medical wards after this procedure. She was discharged the following day with no acute issues. # DM 2: The patient's diabetes was generally diet controlled, here with glucose range 150-250. She was maintained on a RISS. # Afib: Atenolol was discontinued given her hypotension. Pt's heart rate was stable prior to discharge. # Hypothyroidism: A TSH was sent and was elevated at 7.8, however, a free T4 was normal at 1.6. Te patient was maintained on her home dose levothyroxine via PEG daily. # Code status: The patient expressed wishes to be DNR/DNI during this admission. This decision was discussed with her daughter at bedside. The patient was provided with a DNR/DNI form to complete should she require future documentation of this decision. Patient was discharged home with VNA. The family did not want hospice but VNA will be there to assist them and help make the patient comfortable. Palliative care was also consulted this admission to help with planning. Medications on Admission: ALLKARE PROTECTIVE BARRIER WIPES - - use to cleanse area around your feeding tube twice a day or as needed Convatec ALLOPURINOL - 100 mg Tablet - 2 Tablet(s) by mouth once a day ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth once a day COLCHICINE - 0.6 mg Tablet - 1 Tablet(s) by mouth as directed take only with gout flare. do not take on regular basis FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth twice a day as needed for volume overload as directed HYDROCHLOROTHIAZIDE - 12.5 mg Capsule - 1 Capsule(s) by mouth qam for blood pressure IPRATROPIUM-ALBUTEROL - 0.5 mg-2.5 mg/3 mL Solution for Nebulization - 1 neb(s) inh every four (4) hours as needed for wheeze ICD9: 496 LEVOTHYROXINE - 75 mcg Tablet - 1 Tablet(s) by mouth once a day SALINE BULLETS - - 1 neb inh every four (4) hours as needed for wheeze Use with nebulizer machine TIMOLOL MALEATE - 0.5 % Drops - 1 drop(s) both eyes twice a day TRAZODONE - 50 mg Tablet - 1.5 Tablet(s) by mouth at bedtime Dose= 75 mg nightly Medications - OTC LACTOSE-FREE FOOD WITH FIBER [ISOSOURCE 1.5 CAL] - Liquid - 4 can via feeding tube daily Bolus feedings , 4 cans daily, URGENT delivery please LOPERAMIDE - 2 mg Tablet - 1 Tablet(s) by mouth q3h as needed for diarrhea Take after each episode of diarrhea, maximum 8 pills per day. NUTRITIONAL SUPPLEMENT - FIBER [FIBERSOURCE HN] - Liquid - 50 mL PEG 50 mL/hour continuous over 24 hours modify as directed by Nutritionist Discharge Medications: 1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Doctor Last Name **]: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 2. Senna 8.6 mg Tablet [**Doctor Last Name **]: One (1) Tablet PO BID (2 times a day) as needed for Constipation. Disp:*60 Tablet(s)* Refills:*0* 3. Levothyroxine 75 mcg Tablet [**Doctor Last Name **]: One (1) Tablet PO DAILY (Daily). 4. Ipratropium-Albuterol 0.5-2.5 mg/3 mL Solution for Nebulization [**Doctor Last Name **]: One (1) Inhalation four times a day as needed for shortness of breath or wheezing. 5. Trazodone 50 mg Tablet [**Doctor Last Name **]: 1.5 Tablets PO at bedtime as needed for insomnia. 6. Loperamide 2 mg Tablet [**Doctor Last Name **]: One (1) Tablet PO once a day as needed for constipation. 7. Nutritional Supplement - Fiber Liquid [**Doctor Last Name **]: Fifty (50) ml/hr PO once a day: ASDIR BY NUTRITIONIST. 8. Morphine Concentrate 20 mg/mL Solution [**Doctor Last Name **]: 5-10 mg PO q 15 min as needed for shortness of breath or wheezing. Disp:*20 ml* Refills:*0* 9. Allopurinol 100 mg Tablet [**Doctor Last Name **]: One (1) Tablet PO once a day. 10. Docusate Sodium 50 mg/5 mL Liquid [**Doctor Last Name **]: Five (5) ml PO once a day as needed for constipation. Disp:*150 ml* Refills:*0* Discharge Disposition: Home With Service Facility: Caregroup VNA Discharge Diagnosis: Primary: (1) Unresponsiveness (2) Hypotension Secondary: (1) Non-Small cell lung cancer (2) Diabetes Mellitus (3) CVA (4) Hypothyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Discharge Instructions: Ms. [**Known lastname 108197**], You were seen and evaluated for low blood pressure and a period of unresponsiveness in the hospital after a planned pulmonary procedure. Your unresponsiveness was likely due to the medications you received for sedation in the procedure, and you are probably an individual who breaks down these medicines very slowly. You were monitored closely in the intensive care unit and received fluid resuscitation for your low blood pressure. You also underwent the planned procedure, which involved placing a tube in your chest to drain the fluid. You tolerated the procedure well. As you may be aware, you had a discussion with our palliative care team, and decided that you did not want to be recussitated. You also indicated that your goals of care were geared towards comfort, but did not want to be set up with home hospice care. We made the following changes to your medication regimen: We stopped you blood pressure medications, including atenolol and hydrochlorothiazide, since you had low blood pressure. Should your blood pressure at home be elevated, and should you choose to treat this condition, you may contact your regular doctor to restart these medications. We also are giving you medication in case you develop constipation, i.e. loperamide, or diarrhea, i.e. colace, senna, bisacodyl; all of which may be taken on an as needed basis. Finally we are giving you morphine, to take sublingually, in case you have shortness of breath or pain. It was a pleasure taking care of you. Followup Instructions: Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], M.D. Date/Time:[**2119-4-13**] 11:20 Provider: [**Name10 (NameIs) 251**] [**Last Name (NamePattern4) 252**], M.D. Phone:[**Telephone/Fax (1) 253**] Date/Time:[**2119-5-31**] 10:00 Completed by:[**2119-4-8**]

511,162,780,458,401,427,250,244,733,E937

{'Malignant pleural effusion,Malignant neoplasm of lower lobe, bronchus or lung,Other alteration of consciousness,Hypotension, unspecified,Unspecified essential hypertension,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Disorder of bone and cartilage, unspecified,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use'}

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: Unresponsive PRESENT ILLNESS: Pt is a [**Age over 90 **] year old woman with PMH of stage IV NSCLC, CVA, and a recurrent malignant right sided pleural effusion who presented after attempted IP procedure on day of admission with altered mental status and an unresponsive episode. Pt was scheduled for outpatient pleuroscopy, pleurodesis, and PleurX Catheter placement today. She was prepped and received 75Mcg of Fentanyl and 1.5 mg total of Midazolam. An incision was made, but at that time the patient became unresponsive with bradycardia into the 30s and hypotension with SBPs in the 60s. She required ventilatory support with a BVM briefly, got Atropine 0.5mg x 2 and the procedure was aborted (and small incision sutured closed). MEDICAL HISTORY: 1. CVA 2. Right-sided breast cancer: This was about 30 years ago and treated with mastectomy and radiation therapy. 3. Type 2 diabetes: Diet controlled. 4. Hypertension. 5. Atrial fibrillation. 6. Gout. 7. Hypothyroidism. 8. Osteopenia/osteoporosis. 9. Glaucoma. 10. NSCLC as below: -[**10-7**] CXR for cough showed R-sided opacity, chest CT which showed a nodular lesions in superior RLL and mod/large R pleural MEDICATION ON ADMISSION: ALLKARE PROTECTIVE BARRIER WIPES - - use to cleanse area around your feeding tube twice a day or as needed Convatec ALLOPURINOL - 100 mg Tablet - 2 Tablet(s) by mouth once a day ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth once a day COLCHICINE - 0.6 mg Tablet - 1 Tablet(s) by mouth as directed take only with gout flare. do not take on regular basis FUROSEMIDE - 40 mg Tablet - 1 Tablet(s) by mouth twice a day as needed for volume overload as directed HYDROCHLOROTHIAZIDE - 12.5 mg Capsule - 1 Capsule(s) by mouth qam for blood pressure IPRATROPIUM-ALBUTEROL - 0.5 mg-2.5 mg/3 mL Solution for Nebulization - 1 neb(s) inh every four (4) hours as needed for wheeze ICD9: 496 LEVOTHYROXINE - 75 mcg Tablet - 1 Tablet(s) by mouth once a day SALINE BULLETS - - 1 neb inh every four (4) hours as needed for wheeze Use with nebulizer machine TIMOLOL MALEATE - 0.5 % Drops - 1 drop(s) both eyes twice a day TRAZODONE - 50 mg Tablet - 1.5 Tablet(s) by mouth at bedtime Dose= 75 mg nightly ALLERGIES: Penicillins PHYSICAL EXAM: Vitals: T: 95.6 (axillary) BP:97/62 P: 62 R: 20 O2: 99% 2 L General: Withdraws to painful stimuli only, no posturing. HEENT: No evidence of trauma. Sclera anicteric, MMM, oropharynx clear, PERRL Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, limited air movement at apices only (decreased breath sounds bilateral bases) CV: irregularly irregular normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: withdraws all extremities to painful stimuli only, 1+ LE reflexes, toes downgoing bilaterally. FAMILY HISTORY: No family history of lung disease. However, note that her husband who is a long time smoker died of lung cancer. SOCIAL HISTORY: The patient currently lives with her family in [**Location (un) 2312**], she has VNA 2X/week. She is originally from the [**Country 31115**] but moved here in [**2081**] and has not been back there recently. She previously lived in [**Location 86**] and then moved to [**State 108**] and has now been back up in [**Location (un) 86**] for the last 2 years. She denies any other areas of residence. She denies any alcohol use and she denies any past or present cigarette smoking. However, her husband was a significant smoker. The patient previously worked for the Red Cross and had no occupational exposures. Family very involved in her care. ### Response: {'Malignant pleural effusion,Malignant neoplasm of lower lobe, bronchus or lung,Other alteration of consciousness,Hypotension, unspecified,Unspecified essential hypertension,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Disorder of bone and cartilage, unspecified,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: Hematemesis PRESENT ILLNESS: This is a 69 year old semi-retired male orthopedic surgeon with a history of peptic ulcer disease, alcoholic cirrhosis and hepatic encephalopathy with a [**2169-12-24**] admission for an upper gastrointestinal bleed for Grade 3 esophageal varix banded on [**2170-1-3**] and discharged that month with subsequent banding as an outpatient in [**Month (only) 956**]. On this particular visit the patient had two episodes of hematemesis on the night of admission with accompanying dizziness, lightheadedness and diaphoresis but no complaints of abdominal pain, shortness of breath and cough, no bright red blood per rectum and no loss of consciousness. Emergency Medical Services were called and they estimated his blood loss approximately 1 liter. Blood pressure at the time was 53/33 and heartrate was 60. He was given Octreotide 15 mcg bolus and given Trippa 25 mcg/hr. He was admitted to the Medicine Intensive Care Unit on [**2170-1-12**]. Esophagogastroduodenoscopy was performed that day and showed presence of esophageal varices. The procedure was complicated by active bleeding into intubation. Transfusion of four units of packed red blood cells. Central line was placed. Emergent transjugular intrahepatic portocaval shunt was performed because of continued gastrointestinal bleed. Systolic blood pressure was in the 60s to 70s and also he had failed attempt at [**Last Name (un) **] tube placement on [**2170-1-13**]. The patient will need 26 units of packed red blood cells on [**1-17**]. By [**1-14**], he received one additional unit of packed red blood cells and gastrointestinal bleed had stabilized with hematocrit in the 26 to 29% range. On [**1-15**], he underwent a paracentesis for ascites, approximately 2.5 liters was aspirated. At that time he was also able to be transferred to the floor on [**2170-1-18**]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Iron deficiency anemia secondary to blood loss (chronic),Hematemesis,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Cachexia,Portal hypertension

Alcohol cirrhosis liver,Bleed esoph var oth dis,Chr blood loss anemia,Hematemesis,Other pulmonary insuff,CHF NOS,Cachexia,Portal hypertension

Admission Date: [**2170-1-12**] Discharge Date: [**2170-1-26**] Date of Birth: [**2100-10-23**] Sex: M Service: [**Hospital **] [**Hospital Ward Name 46602**] CHIEF COMPLAINT: Hematemesis HISTORY OF PRESENT ILLNESS: This is a 69 year old semi-retired male orthopedic surgeon with a history of peptic ulcer disease, alcoholic cirrhosis and hepatic encephalopathy with a [**2169-12-24**] admission for an upper gastrointestinal bleed for Grade 3 esophageal varix banded on [**2170-1-3**] and discharged that month with subsequent banding as an outpatient in [**Month (only) 956**]. On this particular visit the patient had two episodes of hematemesis on the night of admission with accompanying dizziness, lightheadedness and diaphoresis but no complaints of abdominal pain, shortness of breath and cough, no bright red blood per rectum and no loss of consciousness. Emergency Medical Services were called and they estimated his blood loss approximately 1 liter. Blood pressure at the time was 53/33 and heartrate was 60. He was given Octreotide 15 mcg bolus and given Trippa 25 mcg/hr. He was admitted to the Medicine Intensive Care Unit on [**2170-1-12**]. Esophagogastroduodenoscopy was performed that day and showed presence of esophageal varices. The procedure was complicated by active bleeding into intubation. Transfusion of four units of packed red blood cells. Central line was placed. Emergent transjugular intrahepatic portocaval shunt was performed because of continued gastrointestinal bleed. Systolic blood pressure was in the 60s to 70s and also he had failed attempt at [**Last Name (un) **] tube placement on [**2170-1-13**]. The patient will need 26 units of packed red blood cells on [**1-17**]. By [**1-14**], he received one additional unit of packed red blood cells and gastrointestinal bleed had stabilized with hematocrit in the 26 to 29% range. On [**1-15**], he underwent a paracentesis for ascites, approximately 2.5 liters was aspirated. At that time he was also able to be transferred to the floor on [**2170-1-18**]. On transfer to the floor vital signs were as follows - Temperature 98.4, blood pressure 112/72, heartrate 90, respirations 24 and oxygen saturation 94% on 2 liters. On presentation he was well with no jaundice noted in no apparent distress. Mucous membranes were moist. Extraocular movements intact. Lungs were bilaterally clear. Cardiovascular, regular rate and rhythm, no murmurs, rubs or gallops. Abdomen was distended and soft. There was, however, presence of fluid wave on percussion, nontender, liver is not palpable. Extremities notable for 5+ bilateral and there was 3+ lower extremity edema. Dorsalis pedis pulses were palpable. Radial pulses were 1+. Hematocrit at the time he was transferred to the floor was 30. BUN and creatinine were 21/0.5 respectively. At this point the [**Hospital 228**] hospital course was that of management for evaluation for getting the patient on the transplant liver list. Work included the bone densitometry which was normal and also the patient was scheduled for pulmonary function tests which were still pending. The patient had an abdominal computerized tomography scan to evaluate his liver. A questionable liver mass was found but follow up on magnetic resonance imaging scan revealed only presence of the hepatic cyst. Also found on the ultrasound evaluation was the patient's proximal portion of the transjugular intrahepatic portocaval shunt was not in adequate position and so Interventional Radiology went in again to place a stent within the stent, proximal portion, to link that part of the catheter. At this point, the patient is being screened now and being evaluated by physical therapy and will be evaluated by occupational therapy for placement either in a rehabilitation center or home with rehabilitation services. Plan to discharge most likely will be [**2170-1-26**]. DISCHARGE MEDICATIONS: To be added as an addendum. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 13467**] Dictated By:[**Last Name (NamePattern1) 31134**] MEDQUIST36 D: [**2170-1-25**] 16:52 T: [**2170-1-25**] 17:50 JOB#: [**Job Number 46603**] Admission Date: [**2170-1-12**] Discharge Date: [**2170-1-29**] Date of Birth: [**2100-10-23**] Sex: M Service: ADDENDUM DISCHARGE INSTRUCTIONS: The Spironolactone should be changed from 200 mg in the morning, 100 mg in the evening to just 400 mg p.o. q.d. In addition, diet on discharge will be 1.5 g sodium with Boost with each meal. DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-ACD Dictated By:[**Doctor Last Name 46604**] MEDQUIST36 D: [**2170-1-29**] 10:47 T: [**2170-1-29**] 10:47 JOB#: [**Job Number 46605**] Name: [**Known lastname 8559**], [**Known firstname 140**] JR Unit [**Name2 (NI) **]: [**Numeric Identifier 8560**] Admission Date: [**2170-1-12**] Discharge Date: 03/08/0303 Date of Birth: [**2100-10-23**] Sex: M Service: ADDENDUM: The plan is to see the patient to rehabilitation, short term, before return home. DISCHARGE DIAGNOSES: 1. Cirrhosis. 2. Upper gastrointestinal bleed. MEDICATIONS ON DISCHARGE: 1. Lasix 120 mg p.o. daily. 2. Spironolactone 200 mg q.a.m. and 100 mg p.o. q.p.m. 3. Lactulose 30 ml four times a day. 4. Protonix 40 mg p.o. once daily. 5. Folate 1 mg p.o. once daily. 6. Multivitamin one capsule p.o. once daily. 7. Thiamine 100 mg p.o. once daily. 8. Levofloxacin 500 mg p.o. once daily times seven days. Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2170-1-27**] 02:09 T: [**2170-1-27**] 14:58 JOB#: [**Job Number 8561**]

571,456,280,578,518,428,799,572

{'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Iron deficiency anemia secondary to blood loss (chronic),Hematemesis,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Cachexia,Portal hypertension'}

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: Hematemesis PRESENT ILLNESS: This is a 69 year old semi-retired male orthopedic surgeon with a history of peptic ulcer disease, alcoholic cirrhosis and hepatic encephalopathy with a [**2169-12-24**] admission for an upper gastrointestinal bleed for Grade 3 esophageal varix banded on [**2170-1-3**] and discharged that month with subsequent banding as an outpatient in [**Month (only) 956**]. On this particular visit the patient had two episodes of hematemesis on the night of admission with accompanying dizziness, lightheadedness and diaphoresis but no complaints of abdominal pain, shortness of breath and cough, no bright red blood per rectum and no loss of consciousness. Emergency Medical Services were called and they estimated his blood loss approximately 1 liter. Blood pressure at the time was 53/33 and heartrate was 60. He was given Octreotide 15 mcg bolus and given Trippa 25 mcg/hr. He was admitted to the Medicine Intensive Care Unit on [**2170-1-12**]. Esophagogastroduodenoscopy was performed that day and showed presence of esophageal varices. The procedure was complicated by active bleeding into intubation. Transfusion of four units of packed red blood cells. Central line was placed. Emergent transjugular intrahepatic portocaval shunt was performed because of continued gastrointestinal bleed. Systolic blood pressure was in the 60s to 70s and also he had failed attempt at [**Last Name (un) **] tube placement on [**2170-1-13**]. The patient will need 26 units of packed red blood cells on [**1-17**]. By [**1-14**], he received one additional unit of packed red blood cells and gastrointestinal bleed had stabilized with hematocrit in the 26 to 29% range. On [**1-15**], he underwent a paracentesis for ascites, approximately 2.5 liters was aspirated. At that time he was also able to be transferred to the floor on [**2170-1-18**]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Alcoholic cirrhosis of liver,Esophageal varices in diseases classified elsewhere, with bleeding,Iron deficiency anemia secondary to blood loss (chronic),Hematemesis,Other pulmonary insufficiency, not elsewhere classified,Congestive heart failure, unspecified,Cachexia,Portal hypertension'}

CHIEF COMPLAINT: ESRD PRESENT ILLNESS: Patient is 71 year old male with ESKD stage 5 secondary to hypertension and history of MI and PCI in [**2167**], presenting for renal transplant. Patient has been stable with minimal uremic symptoms and minimal edema, never had a requirement for hemodialysis. He reports good appetite, but does not eat much [**2-5**] dysgeusia. He denies any nausea, vomiting, diarrhea, constipation, headaches, chest pain, SOB. He denies insomnia, muscle weakness or cramping. He denies any pruritus. He denies any recent infections, has not taken any antibiotics recently. Patient had a LUE AV fistula placed in [**Month (only) 404**] of this year, but it failed to mature. In [**2176-4-3**] he had fistulogram with an 8mm baloon angioplasty of a segment of vein just beyond the arterial anastomosis, side branch was ligated. Fistula has subsequently matured and may be used if needed. . MEDICAL HISTORY: HTN - Mild/moderate left distal SFA stenosis ([**2176-8-8**]) - MI in [**2167**] s/p PCI - CAD. stable chronic angina (no chest pain or nitro use for almost 10 years) - questionable stent in iliac vessels - per pt report, is uncertain - left upper extremity AV fistula - [**2176-1-4**] [**2176-8-16**] renal transplant NSTEMI [**2176-8-19**] Hematoma, wash out [**2176-8-21**] MEDICATION ON ADMISSION: diovan 320mg qd aspirin 325mg qd isosorbide mononitrate 30mg qd pravistan 40mg qd sodium bicarbonate 650mg 6xday gemfibrozil 60mg [**Hospital1 **] allopurinol 100mg [**Hospital1 **] calcacetate 667mg 6xday calcitrol 0.25mg [**Hospital1 **] nifedepine 60mg [**Hospital1 **] metoprolol 100mg [**Hospital1 **] folic acid 1mg qd aranesp injection qweek ALLERGIES: Lipitor / Lisinopril PHYSICAL EXAM: 99.9kg 96.3 56 123/66 18 98%RA gen: WA/WD, NAD pleasant HEENT: EOMI, PERRL CV: RRR, nl S1, S2 pulm: CTAB abdominal: NBS, ND/NT, mildly obese extremities: palpable DP bilaterally, minimal edema . FAMILY HISTORY: n/c SOCIAL HISTORY: lives alone, is divorced - has 2 children and 5 grandchildren - denies etoh, stopped cigarettes 20 years ago .

Urinary complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia,Other constipation,Gout, unspecified,Obesity, unspecified,Anemia in chronic kidney disease,Old myocardial infarction,Arthrodesis status,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of steroids,Personal history of tobacco use,Anticoagulants causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Chronic kidney disease, Stage V

Surg compl-urinary tract,Parox ventric tachycard,Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Ath ext ntv at w claudct,Hyperlipidemia NEC/NOS,Constipation NEC,Gout NOS,Obesity NOS,Anemia in chr kidney dis,Old myocardial infarct,Arthrodesis status,Status-post ptca,Long-term use steroids,History of tobacco use,Adv eff anticoagulants,Abn react-org transplant,Hyp kid NOS w cr kid V,Subendo infarct, initial,Hematoma complic proc,Ac kidny fail, tubr necr,Chron kidney dis stage V

Admission Date: [**2176-8-16**] Discharge Date: [**2176-8-26**] Date of Birth: [**2104-10-10**] Sex: M Service: SURGERY Allergies: Lipitor / Lisinopril Attending:[**First Name3 (LF) 5569**] Chief Complaint: ESRD Major Surgical or Invasive Procedure: [**2176-8-16**] renal transplant [**2176-8-20**] washout of hematoma History of Present Illness: Patient is 71 year old male with ESKD stage 5 secondary to hypertension and history of MI and PCI in [**2167**], presenting for renal transplant. Patient has been stable with minimal uremic symptoms and minimal edema, never had a requirement for hemodialysis. He reports good appetite, but does not eat much [**2-5**] dysgeusia. He denies any nausea, vomiting, diarrhea, constipation, headaches, chest pain, SOB. He denies insomnia, muscle weakness or cramping. He denies any pruritus. He denies any recent infections, has not taken any antibiotics recently. Patient had a LUE AV fistula placed in [**Month (only) 404**] of this year, but it failed to mature. In [**2176-4-3**] he had fistulogram with an 8mm baloon angioplasty of a segment of vein just beyond the arterial anastomosis, side branch was ligated. Fistula has subsequently matured and may be used if needed. . Past Medical History: HTN - Mild/moderate left distal SFA stenosis ([**2176-8-8**]) - MI in [**2167**] s/p PCI - CAD. stable chronic angina (no chest pain or nitro use for almost 10 years) - questionable stent in iliac vessels - per pt report, is uncertain - left upper extremity AV fistula - [**2176-1-4**] [**2176-8-16**] renal transplant NSTEMI [**2176-8-19**] Hematoma, wash out [**2176-8-21**] Social History: lives alone, is divorced - has 2 children and 5 grandchildren - denies etoh, stopped cigarettes 20 years ago . Family History: n/c Physical Exam: 99.9kg 96.3 56 123/66 18 98%RA gen: WA/WD, NAD pleasant HEENT: EOMI, PERRL CV: RRR, nl S1, S2 pulm: CTAB abdominal: NBS, ND/NT, mildly obese extremities: palpable DP bilaterally, minimal edema . Pertinent Results: [**2176-8-26**] 05:00AM BLOOD WBC-9.6 RBC-2.86* Hgb-7.8* Hct-24.4* MCV-85 MCH-27.3 MCHC-32.0 RDW-16.3* Plt Ct-176 [**2176-8-26**] 09:05AM BLOOD Hct-28.2* [**2176-8-24**] 05:13AM BLOOD PT-16.0* PTT-26.2 INR(PT)-1.4* [**2176-8-26**] 05:00AM BLOOD Glucose-99 UreaN-55* Creat-3.2* Na-140 K-4.0 Cl-111* HCO3-16* AnGap-17 [**2176-8-26**] 05:00AM BLOOD Calcium-7.2* Phos-3.6 Mg-2.3 [**2176-8-26**] 05:00AM BLOOD tacroFK-7.0 Brief Hospital Course: On [**2176-8-16**], he had an ECD kidney transplant into left iliac fossa. Surgeon was Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**]. Per operative note, there was severe calcification of the iliac artery making anastomosis quite difficult and requiring a much more extensive dissection into the femoral canal than usually done. The anastomosis was done like a live donor transplant. Induction immunosuppresion was administered (cellcept, simulect, and solumedrol) Postop, urine output averaged between 360 and 525cc per hour. Creatinine started to trend down. He developed chest pain on postop day 2, at 6am with ST changes in the lateral leads. Chest pain was relieved with NTG SL and paste. EKG normalized. Enzymes were cycled. Chest pain recurred at 10pm. SBP was elevated to 180s. This was treated with NTG paste and SL nitro with relief of chest pain. Cardiology was consulted and Lopressor was increased. Enzymes continued to be cycled. Troponin increased from baseline of 0.02 to 0.12. Cariology felt that he had suffered a NSTEMI and recommended ASA, IV heparin drip, pravastatin and BP control. A cardiac catheterization was anticipated. IV heparin drip was initiated on [**8-19**]. On [**8-20**], ptt was supratherapeutic and heparin was held then restarted at a lower rate. During the day he complained of increased incision pain. A repeat hematocrit was checked and noted to be decreased to 22.5 from 25.6. IV heparin was stopped. Two units of PRBC were ordered and a stat renal transplant duplex was done without visualization of the renal transplant kidney. Vasculature was unable to be assessed secondary to a large amount of blood in the LLQ. Urine output was stopped and a foley was placed. He was transferred to the SICU. Cardiology was contact[**Name (NI) **] and planned catheterization for [**8-21**] was deferred. Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**] took him to the OR on the PM of [**8-20**] for exploratory lap due to concern for compromise of renal vasculature of the kidney and control of hemorrhage. A number of small bleeding points were controlled with argon beam. There were no large activevessels that were bleeding. A drain was placed. Postop, he went to the SICU where he received further PRBC and FFP. Hematocrit stablized. Urine output increased. Creatinine continued to decrease with good urine output into the 3 liter range. He was transferred out of the SICU after several days. Diet was advanced and tolerated. Incision had a small amount of serosanuinous drainage. The JP drainage decreased and was dark, old bloody fluid averaging 50cc/day by [**8-26**]. Immunosuppression consisted of cellcept 1 gram [**Hospital1 **] which was well tolerated. Steroids were tapered off per protocol. Simulect was repeated on postop day 4 and prograf was initiated on postop day 1 and adjusted by daily trough levels which ranged between 8.5-11.3 on 3mg [**Hospital1 **]. Trough level decreased to 7.0 on [**8-26**]. Prograf was increased to 4mg [**Hospital1 **]. Blood sugars were mildly increased to 140s. Minimal sliding scale insulin was used and he was taught how to check his glucose at home twice daily and record. Cardiology continued to follow throughout this hospital course recommending that hydralazine be added. Aspirin continued. Lopressor was increased and pravastatin was continued. Of note, he did complain of some bilateral leg/thigh discomfort with movement that requires monitoring for SE of pravastatin. On [**8-23**], he experienced a junctional bradycardia/arrythmia. Lopressor was decreased. No further episodes occured. CXR showed improvement with only a tiny left pleural effusion noted. He denied any further chest pain. On [**8-26**], he was discharged to home with Care Group VNA services ([**Telephone/Fax (1) 13046**]). Medication teaching was reviewed. PT cleared him for home without further PT. Although, cardiac rehab should be investigated. Cardiology followup was scheduled for [**9-12**] with Dr. [**Last Name (STitle) 5543**] to determine cardiac risk stratification (ie. stress test vs. cardiac catheterization). Of note, hematocrit was 24.4 on [**8-26**]. This was repeated and found to be 28.2. He was discharged to home on [**8-26**]. Medications on Admission: diovan 320mg qd aspirin 325mg qd isosorbide mononitrate 30mg qd pravistan 40mg qd sodium bicarbonate 650mg 6xday gemfibrozil 60mg [**Hospital1 **] allopurinol 100mg [**Hospital1 **] calcacetate 667mg 6xday calcitrol 0.25mg [**Hospital1 **] nifedepine 60mg [**Hospital1 **] metoprolol 100mg [**Hospital1 **] folic acid 1mg qd aranesp injection qweek Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 2. One Touch Ultra System Kit Kit Sig: One (1) Miscellaneous twice a day. Disp:*1 * Refills:*0* 3. One Touch UltraSoft Lancets Misc Sig: One (1) Miscellaneous twice a day. Disp:*1 box* Refills:*0* 4. One Touch Ultra Test Strip Sig: One (1) In [**Last Name (un) 5153**] twice a day. Disp:*1 box* Refills:*1* 5. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day). 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 10. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day). 11. Pravastatin 20 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily). 12. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 13. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily). 14. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 15. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 16. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 17. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 18. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 19. Tacrolimus 1 mg Capsule Sig: Four (4) Capsule PO Q12H (every 12 hours). Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: esrd renal transplant NSTEMI hematoma Discharge Condition: good Discharge Instructions: please call the Transplant office [**Telephone/Fax (1) 673**] if fever, chills, nausea, vomiting, inability to take any of your medications, chest pain/shortness of breath, increased abdominal pain, incision redness/bleeding/drainage, decreased urine output, JP drainage stops or any concerns Labs at [**Last Name (NamePattern1) 439**] [**Location (un) 86**] every Monday and Thursday empty JP drain and record output. bring record of output to next appointment check blood sugar before breakfast and supper and record. bring record of glucoses to next appointment Followup Instructions: Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2176-9-2**] 1:10 Provider: [**Name10 (NameIs) 2105**] [**Name11 (NameIs) 2106**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2176-9-12**] 8:40 Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2176-9-12**] 2:40 Completed by:[**2176-8-26**]

997,427,414,413,440,272,564,274,278,285,412,V454,V458,V586,V158,E934,E878,403,410,998,584,585

{'Urinary complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia,Other constipation,Gout, unspecified,Obesity, unspecified,Anemia in chronic kidney disease,Old myocardial infarction,Arthrodesis status,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of steroids,Personal history of tobacco use,Anticoagulants causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Chronic kidney disease, Stage V'}

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: ESRD PRESENT ILLNESS: Patient is 71 year old male with ESKD stage 5 secondary to hypertension and history of MI and PCI in [**2167**], presenting for renal transplant. Patient has been stable with minimal uremic symptoms and minimal edema, never had a requirement for hemodialysis. He reports good appetite, but does not eat much [**2-5**] dysgeusia. He denies any nausea, vomiting, diarrhea, constipation, headaches, chest pain, SOB. He denies insomnia, muscle weakness or cramping. He denies any pruritus. He denies any recent infections, has not taken any antibiotics recently. Patient had a LUE AV fistula placed in [**Month (only) 404**] of this year, but it failed to mature. In [**2176-4-3**] he had fistulogram with an 8mm baloon angioplasty of a segment of vein just beyond the arterial anastomosis, side branch was ligated. Fistula has subsequently matured and may be used if needed. . MEDICAL HISTORY: HTN - Mild/moderate left distal SFA stenosis ([**2176-8-8**]) - MI in [**2167**] s/p PCI - CAD. stable chronic angina (no chest pain or nitro use for almost 10 years) - questionable stent in iliac vessels - per pt report, is uncertain - left upper extremity AV fistula - [**2176-1-4**] [**2176-8-16**] renal transplant NSTEMI [**2176-8-19**] Hematoma, wash out [**2176-8-21**] MEDICATION ON ADMISSION: diovan 320mg qd aspirin 325mg qd isosorbide mononitrate 30mg qd pravistan 40mg qd sodium bicarbonate 650mg 6xday gemfibrozil 60mg [**Hospital1 **] allopurinol 100mg [**Hospital1 **] calcacetate 667mg 6xday calcitrol 0.25mg [**Hospital1 **] nifedepine 60mg [**Hospital1 **] metoprolol 100mg [**Hospital1 **] folic acid 1mg qd aranesp injection qweek ALLERGIES: Lipitor / Lisinopril PHYSICAL EXAM: 99.9kg 96.3 56 123/66 18 98%RA gen: WA/WD, NAD pleasant HEENT: EOMI, PERRL CV: RRR, nl S1, S2 pulm: CTAB abdominal: NBS, ND/NT, mildly obese extremities: palpable DP bilaterally, minimal edema . FAMILY HISTORY: n/c SOCIAL HISTORY: lives alone, is divorced - has 2 children and 5 grandchildren - denies etoh, stopped cigarettes 20 years ago . ### Response: {'Urinary complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia,Other constipation,Gout, unspecified,Obesity, unspecified,Anemia in chronic kidney disease,Old myocardial infarction,Arthrodesis status,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of steroids,Personal history of tobacco use,Anticoagulants causing adverse effects in therapeutic use,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Chronic kidney disease, Stage V'}

CHIEF COMPLAINT: DOE and dyspnea after dialysis PRESENT ILLNESS: 61 yo male first seen on [**2137-4-10**] for DOE, and dyspnea after dialysis. He has had routine echos to follow his worsening EF. Echo in [**2-15**] showed EF 25% , mild MR [**First Name (Titles) **] [**Last Name (Titles) **]. Cath done in [**4-15**] showed 30% ostial LM, 95% ostial CX, 90% LAD, PAP 71/31, LVEDP 37, 70% ostial RCA, EF 19%. Referred for surgical revascularization after re-evaluation in late [**5-16**]. Pre-op vein mapping showed bilat. severe reflux in greater saphs above knees and mult. varicosities bilat. calves, no thrombosis. Carotid US [**5-16**] showed no significant stenoses with bilat. antegrade vertebral flow. MEDICAL HISTORY: CRF with HD (T-TH-Sat) elev. chol. cardiomyopathy retinopathy IDDM HTN left forearm AV fistula right subclavian dialysis catheter large right inguinal hernia diverticulosis with GI bleed 4 years ago appendectomy tonsillectomy ORIF right femur 2 years ago cataract surgery laser eye surgery MEDICATION ON ADMISSION: coreg 25 mg [**Hospital1 **] nephrocaps one daily cortef 10 qAM, 5 qPM lisinopril 40 mg daily folate daily lovastatin 20 mg daily phoslo 662 TID flomax 0.4 mg daily omeprazole 20 mg daily fludrocortisone 0.1 [**Hospital1 **] gemfibrozil 600 mg [**Hospital1 **] lantus 12 units qPM ASA 81 mg daily epogen at dialysis ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ambulates with walker; very weak HR 78 RR 14 124/79 6'1" 175# fatigued, NAD keratoses anterior chest PERRL, EOMI, OP benign, poor dentition neck supple with no JVD or carotid bruits, full ROM RRR no murmur abd soft, NT, ND with large inguinal hernia left forearm fistula in place rubor bilat. [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **], well-perfused with no edema and bilat. varicosities neuro grossly intact right-handed 1+ bilat. DP/PT/radials 1+ right femoral, 2+ left femoral FAMILY HISTORY: grandfather died of MI at age 50 SOCIAL HISTORY: retired maintenance worker for the military lives with wife smokes [**Name2 (NI) **]. cigar rare ETOH

Congestive heart failure, unspecified,Cardiac arrest,Anoxic brain damage,End stage renal disease,Septicemia due to serratia,Pneumonia due to other gram-negative bacteria,Hemopericardium,Pressure ulcer, buttock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Severe sepsis,Inguinal hernia, with obstruction, without mention of gangrene, bilateral (not specified as recurrent),Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Laparoscopic surgical procedure converted to open procedure,Long-term (current) use of insulin

CHF NOS,Cardiac arrest,Anoxic brain damage,End stage renal disease,Serratia septicemia,Pneumo oth grm-neg bact,Hemopericardium,Pressure ulcer, buttock,Hyp kid NOS w cr kid V,Severe sepsis,Bilat ing hernia w obst,Crnry athrscl natve vssl,DMII renl nt st uncntrld,Lap surg convert to open,Long-term use of insulin

Admission Date: [**2137-6-19**] Discharge Date: [**2137-7-15**] Date of Birth: [**2075-10-22**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: DOE and dyspnea after dialysis Major Surgical or Invasive Procedure: cabg x5 on [**2137-6-19**] (LIMA to LAD, SVG to OM1, sequenced to OM2, sequenced to OM3; SVG to PDA) exploratory laparotomy [**2137-6-24**] History of Present Illness: 61 yo male first seen on [**2137-4-10**] for DOE, and dyspnea after dialysis. He has had routine echos to follow his worsening EF. Echo in [**2-15**] showed EF 25% , mild MR [**First Name (Titles) **] [**Last Name (Titles) **]. Cath done in [**4-15**] showed 30% ostial LM, 95% ostial CX, 90% LAD, PAP 71/31, LVEDP 37, 70% ostial RCA, EF 19%. Referred for surgical revascularization after re-evaluation in late [**5-16**]. Pre-op vein mapping showed bilat. severe reflux in greater saphs above knees and mult. varicosities bilat. calves, no thrombosis. Carotid US [**5-16**] showed no significant stenoses with bilat. antegrade vertebral flow. Past Medical History: CRF with HD (T-TH-Sat) elev. chol. cardiomyopathy retinopathy IDDM HTN left forearm AV fistula right subclavian dialysis catheter large right inguinal hernia diverticulosis with GI bleed 4 years ago appendectomy tonsillectomy ORIF right femur 2 years ago cataract surgery laser eye surgery Social History: retired maintenance worker for the military lives with wife smokes [**Name2 (NI) **]. cigar rare ETOH Family History: grandfather died of MI at age 50 Physical Exam: ambulates with walker; very weak HR 78 RR 14 124/79 6'1" 175# fatigued, NAD keratoses anterior chest PERRL, EOMI, OP benign, poor dentition neck supple with no JVD or carotid bruits, full ROM RRR no murmur abd soft, NT, ND with large inguinal hernia left forearm fistula in place rubor bilat. [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **], well-perfused with no edema and bilat. varicosities neuro grossly intact right-handed 1+ bilat. DP/PT/radials 1+ right femoral, 2+ left femoral Pertinent Results: [**2137-7-15**] 02:12AM BLOOD WBC-13.5*# RBC-2.83* Hgb-8.2* Hct-25.4* MCV-90 MCH-29.1 MCHC-32.4 RDW-16.9* Plt Ct-185 [**2137-7-15**] 03:47PM BLOOD Hgb-7.8* Hct-23.4* [**2137-7-15**] 02:12AM BLOOD PT-13.2* PTT-30.2 INR(PT)-1.2* [**2137-7-15**] 02:12AM BLOOD Plt Ct-185 [**2137-7-15**] 02:12AM BLOOD Fibrino-440* [**2137-7-15**] 02:12AM BLOOD Glucose-65* UreaN-14 Creat-1.7* Na-136 K-4.2 Cl-99 HCO3-24 AnGap-17 [**2137-7-15**] 02:12AM BLOOD Calcium-8.2* Phos-3.7 Mg-2.2 [**2137-7-15**] 02:12AM BLOOD Vanco-22.6* [**2137-7-15**] 04:01PM BLOOD Type-ART pO2-121* pCO2-47* pH-7.37 calTCO2-28 Base XS-1 [**2137-7-15**] 04:01PM BLOOD freeCa-0.91* Brief Hospital Course: Admitted [**6-19**] and underwent cabg x5 with Dr. [**Last Name (STitle) 914**]. Transferred to the CSRU in stable condition on epinephrine, neosynephrine and propofol drips. Seen by renal service for management of HD issues. Extubated on POD #2 and off all drips. Transferred to the floor to begin to increase his activity level. Suffered an acute respiratory arrest on the morning of POD #3 and reintubated and transferred back to the CSRU with continued hypotension. Bedside echo done urgently which confirmed cardiac arrest. ACLS protocol done and pressor support/steroids given.Ruled out for PE by CT scan when stabilized with suggestion of right heart failure. Bilat. atelectasis and severely elevated PA pressures treated per Dr. [**Last Name (STitle) **]. General surgery consulted on POD #4 for GNR serratia sepsis, and probable shock liver due to hypotension. Exploratory lap done by general surgery on POD #5 for ? mesenteric ischemia. ID and neurology consults done with noted probable anoxic insult. CVVH, epinephrine, pitressin and milrinone added for further support. On vancomycin, meropenem, and flagyl for coverage. Cardioverted for Afib multiple times on amiodarone. He remained critically ill with marginal CO/CI. Clinical nutrition consulted as pt. could not tolerate tube feeds. Chest tubes and pacing wires removed on POD #13/8. Flagyl stopped on [**7-3**] as C. diff. negative. CT scan showed mediastinal /retrosternal fluid collection,pleural effusion and loculated left hydropneumothorax. Head CT was negative. Pericardial drain placed and 500 cc of old blood removed.Heparin was held as indicated. Bronchoscopy done on [**7-4**] which revealed RML and RLL thick secretions. Swan removed and CVL changed on POD #17/12. Re- bronchoscopied on [**7-10**] with clear right lung, and thick secretions from LUL. MRI and EEG done which were both consistent with severe diffuse anoxic injury. Renal, ID, and neuro services followed the pt. daily. On [**7-12**],social work team consulted with family and Dr. [**Last Name (STitle) 914**] regarding the pt's poor prognosis. DNR/DNI order in effect on [**7-13**]. Comfort measures only instituted on [**7-13**]. Stroke attending neurologist consulted on [**7-15**] for second opinion on prognosis and confirmed extremely poor prognosis for a meaningful neurological recovery. Family discussion had with team, and they elected to have him extubated. Pt. expired in the CSRU at 8:08 PM on [**7-15**]. Medications on Admission: coreg 25 mg [**Hospital1 **] nephrocaps one daily cortef 10 qAM, 5 qPM lisinopril 40 mg daily folate daily lovastatin 20 mg daily phoslo 662 TID flomax 0.4 mg daily omeprazole 20 mg daily fludrocortisone 0.1 [**Hospital1 **] gemfibrozil 600 mg [**Hospital1 **] lantus 12 units qPM ASA 81 mg daily epogen at dialysis Discharge Disposition: Expired Discharge Diagnosis: s/p cabg x5 [**6-19**] s/p exploratory laparotomy [**6-24**] IDDM ESRD/CRF on HD cardiomyopathy HTN BLE varicosities cardiopulmonary arrest elev. chol. diverticulosis with GI bleed 4 years ago retinopathy Discharge Condition: expired Completed by:[**2137-8-16**]

428,427,348,585,038,482,423,707,403,995,550,414,250,V644,V586

{'Congestive heart failure, unspecified,Cardiac arrest,Anoxic brain damage,End stage renal disease,Septicemia due to serratia,Pneumonia due to other gram-negative bacteria,Hemopericardium,Pressure ulcer, buttock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Severe sepsis,Inguinal hernia, with obstruction, without mention of gangrene, bilateral (not specified as recurrent),Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Laparoscopic surgical procedure converted to open procedure,Long-term (current) use of insulin'}

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: DOE and dyspnea after dialysis PRESENT ILLNESS: 61 yo male first seen on [**2137-4-10**] for DOE, and dyspnea after dialysis. He has had routine echos to follow his worsening EF. Echo in [**2-15**] showed EF 25% , mild MR [**First Name (Titles) **] [**Last Name (Titles) **]. Cath done in [**4-15**] showed 30% ostial LM, 95% ostial CX, 90% LAD, PAP 71/31, LVEDP 37, 70% ostial RCA, EF 19%. Referred for surgical revascularization after re-evaluation in late [**5-16**]. Pre-op vein mapping showed bilat. severe reflux in greater saphs above knees and mult. varicosities bilat. calves, no thrombosis. Carotid US [**5-16**] showed no significant stenoses with bilat. antegrade vertebral flow. MEDICAL HISTORY: CRF with HD (T-TH-Sat) elev. chol. cardiomyopathy retinopathy IDDM HTN left forearm AV fistula right subclavian dialysis catheter large right inguinal hernia diverticulosis with GI bleed 4 years ago appendectomy tonsillectomy ORIF right femur 2 years ago cataract surgery laser eye surgery MEDICATION ON ADMISSION: coreg 25 mg [**Hospital1 **] nephrocaps one daily cortef 10 qAM, 5 qPM lisinopril 40 mg daily folate daily lovastatin 20 mg daily phoslo 662 TID flomax 0.4 mg daily omeprazole 20 mg daily fludrocortisone 0.1 [**Hospital1 **] gemfibrozil 600 mg [**Hospital1 **] lantus 12 units qPM ASA 81 mg daily epogen at dialysis ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ambulates with walker; very weak HR 78 RR 14 124/79 6'1" 175# fatigued, NAD keratoses anterior chest PERRL, EOMI, OP benign, poor dentition neck supple with no JVD or carotid bruits, full ROM RRR no murmur abd soft, NT, ND with large inguinal hernia left forearm fistula in place rubor bilat. [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **], well-perfused with no edema and bilat. varicosities neuro grossly intact right-handed 1+ bilat. DP/PT/radials 1+ right femoral, 2+ left femoral FAMILY HISTORY: grandfather died of MI at age 50 SOCIAL HISTORY: retired maintenance worker for the military lives with wife smokes [**Name2 (NI) **]. cigar rare ETOH ### Response: {'Congestive heart failure, unspecified,Cardiac arrest,Anoxic brain damage,End stage renal disease,Septicemia due to serratia,Pneumonia due to other gram-negative bacteria,Hemopericardium,Pressure ulcer, buttock,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Severe sepsis,Inguinal hernia, with obstruction, without mention of gangrene, bilateral (not specified as recurrent),Coronary atherosclerosis of native coronary artery,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Laparoscopic surgical procedure converted to open procedure,Long-term (current) use of insulin'}

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: 68 yo M with history of CAD and abnormal stress test referred for cardiac cath which showed 3VD. Referred for surgery. MEDICAL HISTORY: Atrial fibrillation s/p cardioversion [**3-17**] and [**4-15**], on coumadin Tonsillectomy Hypertension Hyperlipidemia Gout Low back pain Bilateral carpal tunnel release ? sleep apnea MEDICATION ON ADMISSION: Coumadin 5 ([**2-9**] tab daily), ASA 81(1), Allopurinol 300(1), Amiodarone 200(1), Doxazosin 4(1), Zocor 40(1), Diovan 80(1) ALLERGIES: Percocet / Vicodin PHYSICAL EXAM: HR 84 RR 14 BP 146/68 NAD Lungs CTAB Heart irregular Abdomen Soft, NT, obese No varicosities Neuro grossly intact 1+ femoral pulses, dp/pt non-palp, 1+ radial pulses no carotid bruits FAMILY HISTORY: Father died of heart failure ~68. SOCIAL HISTORY: He is married with five grown children. He is a retired sheet metal worker. He smokes cigars and drinks alcohol on occasion. Prior smoking history of ~ 80 pack-years, quit 20 years ago

Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Atrial flutter,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Pneumonia due to Hemophilus influenzae [H. influenzae],Unspecified pleural effusion,Unspecified sleep apnea,Anemia, unspecified,Thrombocytopenia, unspecified,Other and unspecified complications of medical care, not elsewhere classified,Other abnormal glucose,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Family history of ischemic heart disease,Old myocardial infarction,Retention of urine, unspecified

Crnry athrscl natve vssl,Acute kidney failure NOS,Atrial flutter,Disrup-external op wound,Urin tract infection NOS,H.influenzae pneumonia,Pleural effusion NOS,Sleep apnea NOS,Anemia NOS,Thrombocytopenia NOS,Complic med care NEC/NOS,Abnormal glucose NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Fam hx-ischem heart dis,Old myocardial infarct,Retention urine NOS

Admission Date: [**2124-6-5**] Discharge Date: [**2124-6-30**] Date of Birth: [**2055-10-21**] Sex: M Service: CARDIOTHORACIC Allergies: Percocet / Vicodin Attending:[**First Name3 (LF) 1267**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: s/p CABGx2(LIMA->LAD, SVG->OM)/MAZE [**2124-6-5**] History of Present Illness: 68 yo M with history of CAD and abnormal stress test referred for cardiac cath which showed 3VD. Referred for surgery. Past Medical History: Atrial fibrillation s/p cardioversion [**3-17**] and [**4-15**], on coumadin Tonsillectomy Hypertension Hyperlipidemia Gout Low back pain Bilateral carpal tunnel release ? sleep apnea Social History: He is married with five grown children. He is a retired sheet metal worker. He smokes cigars and drinks alcohol on occasion. Prior smoking history of ~ 80 pack-years, quit 20 years ago Family History: Father died of heart failure ~68. Physical Exam: HR 84 RR 14 BP 146/68 NAD Lungs CTAB Heart irregular Abdomen Soft, NT, obese No varicosities Neuro grossly intact 1+ femoral pulses, dp/pt non-palp, 1+ radial pulses no carotid bruits Pertinent Results: [**2124-6-26**] 04:52AM BLOOD WBC-7.6 RBC-2.95* Hgb-9.3* Hct-28.1* MCV-95 MCH-31.4 MCHC-33.0 RDW-14.1 Plt Ct-354 [**2124-6-26**] 01:10AM BLOOD WBC-8.7 RBC-3.01* Hgb-9.3* Hct-28.3* MCV-94 MCH-30.9 MCHC-32.8 RDW-14.3 Plt Ct-360 [**2124-6-26**] 04:52AM BLOOD Glucose-123* UreaN-21* Creat-1.0 Na-136 K-4.6 Cl-99 HCO3-35* AnGap-7* [**2124-6-26**] 01:10AM BLOOD Glucose-123* UreaN-21* Creat-0.9 Na-136 K-4.7 Cl-99 HCO3-34* AnGap-8 **FINAL REPORT [**2124-6-17**]** GRAM STAIN (Final [**2124-6-12**]): >25 PMNs and <10 epithelial cells/100X field. NO MICROORGANISMS SEEN. RESPIRATORY CULTURE (Final [**2124-6-17**]): SPARSE GROWTH OROPHARYNGEAL FLORA. GRAM NEGATIVE ROD(S). RARE GROWTH. HAEMOPHILUS INFLUENZAE, BETA-LACTAMASE NEGATIVE. RARE GROWTH. Beta-lactamse negative: presumptively sensitive to ampicillin. Confirmation should be requested in cases of treatment failure in life-threatening infections.. RADIOLOGY Final Report CHEST (PA & LAT) [**2124-6-25**] 9:30 AM CHEST (PA & LAT) Reason: r/o inf, eff [**Hospital 93**] MEDICAL CONDITION: 68 year old man with REASON FOR THIS EXAMINATION: r/o inf, eff AP CHEST, 9:38 A.M., [**6-25**] HISTORY: Status post CABG. IMPRESSION: AP chest compared to [**6-20**]: Moderate left pleural effusion has increased, and new obscuration of the left heart border could be due either to that effusion surrounding the heart or co-existent abnormality in the lingula, probably collapse. Small right pleural effusion is unchanged. Right-sided cardiac shadow is unchanged, and mediastinal vascular engorgement has cleared, but I cannot comment heart size. No pneumothorax. Right PICC line tip projects low over the SVC. DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**] Approved: SUN [**2124-6-25**] 9:24 PM RADIOLOGY Final Report UNILAT LOWER EXT VEINS LEFT [**2124-6-21**] 7:52 PM UNILAT LOWER EXT VEINS LEFT Reason: R/O DVT SWELLING [**Hospital 93**] MEDICAL CONDITION: 68 year old man with s/p cabg REASON FOR THIS EXAMINATION: r/o dvt HISTORY: 68-year-old male status post CABG. COMPARISON: Bilateral lower extremity venous ultrasound of [**2124-4-25**]. LEFT LOWER EXTREMITY VENOUS ULTRASOUND: [**Doctor Last Name **]-scale and Doppler ultrasound examination of the left common femoral, superficial femoral, and popliteal veins demonstrate normal compressibility, flow, and augmentation. No intraluminal thrombus is seen. The patient is status post harvest of greater saphenous vein for CABG; a small amount of fluid is seen in the soft tissues along the expected course of the greater saphenous vein. Lymph nodes measuring up to 1 cm in short axis and demonstrating fatty hila are noted in both groins. IMPRESSION: No evidence of deep venous thrombosis in the left lower extremity. The study and the report were reviewed by the staff radiologist. DR. [**First Name8 (NamePattern2) 95**] [**Last Name (NamePattern1) **] DR. [**First Name8 (NamePattern2) 814**] [**Name (STitle) 815**] Approved: FRI [**2124-6-23**] 9:32 AM RADIOLOGY Final Report CT CHEST W/O CONTRAST [**2124-6-19**] 11:14 AM CT CHEST W/O CONTRAST Reason: r/o consolidation vs. pleural effusion [**Hospital 93**] MEDICAL CONDITION: 68 year old man with REASON FOR THIS EXAMINATION: r/o consolidation vs. pleural effusion CONTRAINDICATIONS for IV CONTRAST: None. PROCEDURE: CT chest without contrast on [**2124-6-19**]. COMPARISON: Multiple previous chest radiographs and a chest CT scan examination on [**2124-4-26**]. TECHNIQUE: Contiguous axial images were obtained from the thoracic inlet to the subdiaphragmatic area without contrast. Thinner slice 5 mm and 1.25 mm images were reconstructed in the axial plane at different window algorithms. Sagittal/coronal reformatted images were also obtained for further evaluation. HISTORY: 68-year-old man status post CABG procedure on [**5-30**]. Rule out consolidation versus pleural effusion. FINDINGS: Lower most three sternal wires are off line to the left, better seen on the scanogram with sternal dehiscence, which is most pronounced at the inferior most sternal wire (3:29) and measures 1.6 cm in width. Extending through this wide dehiscence into the anterior inferior mediastinal compartment is a collection of high attenuation, which measures 3.5 x 6.5 cm. Postoperative changes in the mediastinal fat pad anteriorly is seen from a CABG procedure. Moderate cardiomegaly is stable. Multiple extensively atherosclerotic coronary vasculature are seen. The lungs are clear with the exception of the bases where there is minimal bilateral pleural effusion and adjacent basilar atelectasis. There are no pathologically enlarged lymph nodes according to CT criteria in the mediastinum or in the hilar area. The limited evaluation of the abdomen show hyperdense stones or sludge in the gallbladder. No other abnormality is seen. IMPRESSION: 1. Sternal dehiscence involving the three inferior wires most pronounced with a 1.6 cm bony separation and a collection extending from that site into the anterior left mediastinal compartment suggestive of a potentially inflammated fluid collection. 2. Small bibasilar atelectasis and effusion are seen. Without a contrast examination, no pneumonia can be excluded at these sites; however, the remainder of the lungs are relatively clear. 3. Sludge/stones in the gallbladder, which do not show any signs of inflammation. The content of this report has been discussed with the referring physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**Name (STitle) **], at approximately 12 p.m. The study and the report were reviewed by the staff radiologist. DR. [**First Name (STitle) 11004**] [**Name (STitle) 11005**] DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**] [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 111590**] (Complete) Done [**2124-6-5**] at 1:16:28 PM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) 1112**] W. [**Hospital Unit Name 927**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2055-10-21**] Age (years): 68 M Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: Intraoperative TEE for CABG, MAZE Procedure ICD-9 Codes: 427.31, 440.0 Test Information Date/Time: [**2124-6-5**] at 13:16 Interpret MD: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Name Initial (MD) **] [**Name8 (MD) 4901**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Suboptimal Tape #: 2008AW4-: Machine: AW5 Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: *5.2 cm <= 4.0 cm Left Atrium - Four Chamber Length: *5.8 cm <= 5.2 cm Left Ventricle - Ejection Fraction: 50% to 55% >= 55% Aorta - Ascending: 2.9 cm <= 3.4 cm Aorta - Descending Thoracic: 2.5 cm <= 2.5 cm Findings LEFT ATRIUM: Moderate LA enlargement. Elongated LA. Mild spontaneous echo contrast in the body of the LA. Good (>20 cm/s) LAA ejection velocity. Cannot exclude LAA thrombus. RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is seen in the RA and extending into the RV. No ASD by 2D or color Doppler. LEFT VENTRICLE: Suboptimal technical quality, a focal LV wall motion abnormality cannot be fully excluded. Low normal LVEF. RIGHT VENTRICLE: Normal RV systolic function. AORTA: Normal ascending aorta diameter. Simple atheroma in ascending aorta. Focal calcifications in ascending aorta. Mildly dilated descending aorta. Complex (>4mm) atheroma in the descending thoracic aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. Trace AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild mitral annular calcification. Trivial MR. TRICUSPID VALVE: Tricuspid valve not well visualized. Physiologic TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. The patient was under general anesthesia throughout the procedure. No TEE related complications. Suboptimal image quality - poor echo windows. The patient appears to be in sinus the patient. Conclusions PRE CPB Poor image quality secodary to poor echo windows. The left atrium is moderately dilated. The left atrium is elongated. Mild spontaneous echo contrast is seen in the body of the left atrium. A left atrial appendage thrombus cannot be excluded secondary to poor imaging. No atrial septal defect is seen by 2D or color Doppler. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is low normal (LVEF 50-55%). The right ventricle displays normal free wall contractility. There are simple atheroma in the ascending aorta. The descending thoracic aorta is mildly dilated. There are complex (>4mm) atheroma in the descending thoracic aorta. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room at the time of the procedure. POST CPB The patient is being atrially paced. Normal overall biventricular systolic function although a focal wall motion abnormality cannot be fully excluded due to poor image quality. No significant changes from the pre bypass findings. I certify that I was present for this procedure in compliance with HCFA regulations. Brief Hospital Course: He was taken to the operating room on [**6-5**] where he underwent a CABG x 2 and MAZE with LAA ligation. He was transferred to the ICU in stable condition. He was initally hypotensive with low CI and SVO2, and hypoxic. He was transfused. He was started on amiodarone for atrial fibrillation. His urine output decreased, however bladder scan showed retention and his foley was changed. He developed hematuria and was seen by urology who replaced his foley and started CBI and his hematuria cleared. He was started on tube feeds. He was pancultured for fever, and started on cipro for a UTI. He was cardioverted on [**6-10**] for atrial flutter. EP was consulted for arrythmias. He was started on cefepime for potential pseudomonas pneumonia. He continued to have fevers, and remained on the ventilator. He underwent left thoracentesis on [**6-14**] for 150 cc. He began to improve and vent weaning which he was extubated. All antibiotics were discontinued, he remained afebrile. He developed some sternal drainage and CT scan revealed dehiscence of distal sternal wires but sternum remains stable and the drainage resolved. He continued to progress and was transferred to the floor for the remained of his care. He was noted to have sleep apnea accompanied by bradycardia with pauses. He underwent a modified sleep study and was placed on CPAP. He will require a follow up sleep study after discharge from rehab. EP was reconsulted and his beta blockers were discontinued, he will be transferred to rehab telemetry unit with CPAP at night. Medications on Admission: Coumadin 5 ([**2-9**] tab daily), ASA 81(1), Allopurinol 300(1), Amiodarone 200(1), Doxazosin 4(1), Zocor 40(1), Diovan 80(1) Discharge Medications: 1. Respiratory Auto CPAP [**5-28**] with heated humidifier to treat obstructive sleep apnea 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a day. 5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. 6. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q4H (every 4 hours). 7. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day. 8. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day: please give 2mg coumadin sat and sun - please check pt/inr on mon-wed-fri and dose for goal INR 2.0-2.5 for atrial fibrillation . 9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day: please evaluate edema and weights and titrate lasix. 11. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 13. Doxazosin 4 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 14. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO once a day. 15. Potassium Chloride 10 mEq Tablet Sustained Release Sig: Two (2) Tablet Sustained Release PO twice a day: with lasix. Discharge Disposition: Extended Care Facility: [**Hospital3 105**] - [**Location (un) 86**] Discharge Diagnosis: Coronary artery disease Atrial fibrillation gout HTN sleep apnea respiratory failure Discharge Condition: Good Discharge Instructions: Follow medications in discharge instructions. Do not drive for 4 weeks. Do not lift more than 10 lbs for 2 months. Shower daily, let water flow over wounds, pat dry with a towel. Do not use lotions, powders, or creams on wounds. Call our office for temp >101.5, sternal drainage [**Telephone/Fax (1) 170**]. Beta blockers were discontinued for pauses - please follow up with cardiology prior to restarting, he continues on amiodarone Followup Instructions: please call to schedule appointments Dr. [**Last Name (STitle) 172**] after discharge from rehab [**Telephone/Fax (1) 133**] Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] See Dr. [**Last Name (STitle) **] on [**2128-8-25**]:20 ([**Telephone/Fax (1) 22784**].Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. Phone:[**Telephone/Fax (1) 285**] Date/Time:[**2124-11-14**] 2:20 Completed by:[**2124-6-30**]

414,584,427,998,599,482,511,780,285,287,999,790,401,272,V173,412,788

{'Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Atrial flutter,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Pneumonia due to Hemophilus influenzae [H. influenzae],Unspecified pleural effusion,Unspecified sleep apnea,Anemia, unspecified,Thrombocytopenia, unspecified,Other and unspecified complications of medical care, not elsewhere classified,Other abnormal glucose,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Family history of ischemic heart disease,Old myocardial infarction,Retention of urine, unspecified'}

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: chest pain PRESENT ILLNESS: 68 yo M with history of CAD and abnormal stress test referred for cardiac cath which showed 3VD. Referred for surgery. MEDICAL HISTORY: Atrial fibrillation s/p cardioversion [**3-17**] and [**4-15**], on coumadin Tonsillectomy Hypertension Hyperlipidemia Gout Low back pain Bilateral carpal tunnel release ? sleep apnea MEDICATION ON ADMISSION: Coumadin 5 ([**2-9**] tab daily), ASA 81(1), Allopurinol 300(1), Amiodarone 200(1), Doxazosin 4(1), Zocor 40(1), Diovan 80(1) ALLERGIES: Percocet / Vicodin PHYSICAL EXAM: HR 84 RR 14 BP 146/68 NAD Lungs CTAB Heart irregular Abdomen Soft, NT, obese No varicosities Neuro grossly intact 1+ femoral pulses, dp/pt non-palp, 1+ radial pulses no carotid bruits FAMILY HISTORY: Father died of heart failure ~68. SOCIAL HISTORY: He is married with five grown children. He is a retired sheet metal worker. He smokes cigars and drinks alcohol on occasion. Prior smoking history of ~ 80 pack-years, quit 20 years ago ### Response: {'Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Atrial flutter,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Pneumonia due to Hemophilus influenzae [H. influenzae],Unspecified pleural effusion,Unspecified sleep apnea,Anemia, unspecified,Thrombocytopenia, unspecified,Other and unspecified complications of medical care, not elsewhere classified,Other abnormal glucose,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Family history of ischemic heart disease,Old myocardial infarction,Retention of urine, unspecified'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 58-year-old woman who was 8 years status post repair of an atrial septal defect at [**Location (un) 511**] [**Hospital **] Hospital. She was recently admitted with rapid atrial fibrillation and echocardiogram revealed moderate to severe tricuspid regurgitation and evidence of right heart failure. She had increased leg swelling and increased abdominal girth. She was treated with diuretics with a good result. She has no other serious medical problems. MEDICAL HISTORY: MEDICATION ON ADMISSION: 1. Coumadin. 2. Synthroid. 3. Toprol. 4. Cardizem. 5. Potassium chloride. 6. Lasix. ALLERGIES: She is allergic to SULFA. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Diseases of tricuspid valve,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified acquired hypothyroidism,Pure hypercholesterolemia

Tricuspid valve disease,Atrial fibrillation,CHF NOS,Hypothyroidism NOS,Pure hypercholesterolem

Admission Date: [**2142-8-14**] Discharge Date: [**2142-8-21**] Date of Birth: [**2085-9-13**] Sex: F Service: CSU HISTORY OF PRESENT ILLNESS: The patient is a 58-year-old woman who was 8 years status post repair of an atrial septal defect at [**Location (un) 511**] [**Hospital **] Hospital. She was recently admitted with rapid atrial fibrillation and echocardiogram revealed moderate to severe tricuspid regurgitation and evidence of right heart failure. She had increased leg swelling and increased abdominal girth. She was treated with diuretics with a good result. She has no other serious medical problems. ALLERGIES: She is allergic to SULFA. PAST SURGICAL HISTORY: She is status post breast biopsy for benign disease. MEDICATIONS ON ADMISSION: 1. Coumadin. 2. Synthroid. 3. Toprol. 4. Cardizem. 5. Potassium chloride. 6. Lasix. PHYSICAL EXAMINATION: She has mild lower extremity edema. Mild jugular venous distention. No carotid bruits. Cardiac exam reveals a 2/6 systolic murmur. Lungs are clear bilaterally. Neurological exam is normal. Abdomen is soft and nontender. No masses palpable. She has distal lower extremity pulses. LABORATORY DATA: Hemoglobin was 11.7, hematocrit was 35.4 percent, platelet count 169,000. Urinalysis was normal. HOSPITAL COURSE: The patient was admitted. During which time, catheterization was performed. This revealed normal coronary arteries. Ejection fraction was 50 percent. She underwent a tricuspid valve repair with a placement of a 32 mm adverse tricuspid ring on [**2142-8-15**]. Postoperatively, she did well. She did have atrial fibrillation postoperatively. For this reason was restarted on her Coumadin. Otherwise, she did well and was discharged to home on [**2142-8-21**]. DISCHARGE DIAGNOSES: Right heart failure. Tricuspid regurgitation. Status post repair of atrial septal defect. Hypothyroidism. DISCHARGE MEDICATIONS: 1. Coumadin. 2. Synthroid. 3. Lasix. 4. Potassium chloride. FOLLOW-UP: The patient is scheduled to see Dr. [**Last Name (STitle) **] in 3 weeks for follow-up and to follow up with her cardiologist Dr. [**Last Name (STitle) 5686**] in 2 to 3 weeks. In addition, she is to see Dr. [**First Name (STitle) **] [**Name (STitle) 1911**] for treatment of atrial fibrillation. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**] Dictated By:[**Last Name (NamePattern1) 5297**] MEDQUIST36 D: [**2142-9-7**] 16:26:53 T: [**2142-9-7**] 19:43:35 Job#: [**Job Number 41832**]

397,427,428,244,272

{'Diseases of tricuspid valve,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified acquired hypothyroidism,Pure hypercholesterolemia'}

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 58-year-old woman who was 8 years status post repair of an atrial septal defect at [**Location (un) 511**] [**Hospital **] Hospital. She was recently admitted with rapid atrial fibrillation and echocardiogram revealed moderate to severe tricuspid regurgitation and evidence of right heart failure. She had increased leg swelling and increased abdominal girth. She was treated with diuretics with a good result. She has no other serious medical problems. MEDICAL HISTORY: MEDICATION ON ADMISSION: 1. Coumadin. 2. Synthroid. 3. Toprol. 4. Cardizem. 5. Potassium chloride. 6. Lasix. ALLERGIES: She is allergic to SULFA. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Diseases of tricuspid valve,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified acquired hypothyroidism,Pure hypercholesterolemia'}

CHIEF COMPLAINT: Mental status change, abdominal distention. PRESENT ILLNESS: This is a 70 year-old woman with h/o obesity, DM, MS x40 years, but mobile without walker and independent with ADLs. She fell on [**12-7**], suffered rib fractures and a non-displaced left pubic ramus pelvic fracture. After her first hospitalization she was discharged to rehab on ciprofloxacin for UTI. She returned to the hospital from rehab with metnal status change, confusion, and abdominal distention. MEDICAL HISTORY: MS (with gait disturbance and urinary incontinence) DM HTN Hyperlipid Hypothyroidism MEDICATION ON ADMISSION: MEDS (at time of transfer): 1. Levothyroxine Sodium 100 mcg PO DAILY 2. Losartan Potassium 100 mg PO DAILY 3. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H 4. Acetaminophen 650 mg PO Q6H 5. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 6. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN 7. Pantoprazole 40 mg PO Q24H 8. Amlodipine 5 mg PO DAILY 9. Pioglitazone 30 mg PO DAILY 10.Atorvastatin 40 mg PO DAILY 11.Bisacodyl 10 mg PR DAILY 12.GlyBURIDE 5 mg PO DAILY 13.Heparin 5000 UNIT SC TID 14.TraMADOL (Ultram) 25 mg PO Q6H 15.Vancomycin Oral Liquid 125 mg PO Q6H 16.Insulin SC (per Insulin Flowsheet) . MEDS (at time of admission/per recent d/c summary): 1. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY 2. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY 3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY 4. Pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY 5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY 6. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY 7. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY 8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) inj Injection [**Hospital1 **] (2 times a day): For DVT prophylaxis 9. Metformin 500 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY 10. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1) Tablet Sustained Release 12 hr PO Q12H 11. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed 12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID 13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID 14. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H PRN 15. Insulin Regular Human 100 unit/mL Solution Sig: One (1) inj Injection ASDIR (AS DIRECTED): Per sliding scale protocol. 16. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 17. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 5 days. ALLERGIES: Penicillins PHYSICAL EXAM: Physical exam at time of transfer to medicine service: Vitals Tm96.7, Bp 140/70, Hr 84, Rr 30, 96% RA General elderly-appearing female in NAD, breathing and speaking comfortably on RA; however, she becomes dyspneic with minimal movements in bed HEENT PERRLA, EOMI, no scleral icterus, MMM, oropharynx clear Neck no JVD appreciated, supple, non-tender Chest clear to auscultation bilaterally anterior fields; no wheezes Heart RRR, normal s1/s2, no murmurs or extra heart sounds appreciated [**Last Name (un) **] obese, soft, no tenderness; bruising over lower abdomen c/w heparin injections; no guarding or rebound; no percussion or cough tenderness; not hypertympanic; normal to slightly hypoactive bs; rectal tube in place, draining loose brown yellow stool Extremities trace pitting edema to mid shins; feet warm and well-perfused bilaterally FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Lives in [**State 3706**], takes care of husband who is in hospice.

Urinary tract infection, site not specified,Acute kidney failure, unspecified,Infectious colitis, enteritis, and gastroenteritis,Paralytic ileus,Other constipation,Dehydration,Multiple sclerosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Morbid obesity

Urin tract infection NOS,Acute kidney failure NOS,Infectious enteritis NOS,Paralytic ileus,Constipation NEC,Dehydration,Multiple sclerosis,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Oth specf bacteria,DMII wo cmp uncntrld,Morbid obesity

Admission Date: [**2159-12-17**] Discharge Date: [**2159-12-31**] Date of Birth: [**2089-1-19**] Sex: F Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 4654**] Chief Complaint: Mental status change, abdominal distention. Major Surgical or Invasive Procedure: None. History of Present Illness: This is a 70 year-old woman with h/o obesity, DM, MS x40 years, but mobile without walker and independent with ADLs. She fell on [**12-7**], suffered rib fractures and a non-displaced left pubic ramus pelvic fracture. After her first hospitalization she was discharged to rehab on ciprofloxacin for UTI. She returned to the hospital from rehab with metnal status change, confusion, and abdominal distention. Past Medical History: MS (with gait disturbance and urinary incontinence) DM HTN Hyperlipid Hypothyroidism Social History: Lives in [**State 3706**], takes care of husband who is in hospice. Family History: Noncontributory. Physical Exam: Physical exam at time of transfer to medicine service: Vitals Tm96.7, Bp 140/70, Hr 84, Rr 30, 96% RA General elderly-appearing female in NAD, breathing and speaking comfortably on RA; however, she becomes dyspneic with minimal movements in bed HEENT PERRLA, EOMI, no scleral icterus, MMM, oropharynx clear Neck no JVD appreciated, supple, non-tender Chest clear to auscultation bilaterally anterior fields; no wheezes Heart RRR, normal s1/s2, no murmurs or extra heart sounds appreciated [**Last Name (un) **] obese, soft, no tenderness; bruising over lower abdomen c/w heparin injections; no guarding or rebound; no percussion or cough tenderness; not hypertympanic; normal to slightly hypoactive bs; rectal tube in place, draining loose brown yellow stool Extremities trace pitting edema to mid shins; feet warm and well-perfused bilaterally Pertinent Results: Labs at Admission: [**2159-12-17**] 03:36PM BLOOD WBC-35.2*# RBC-3.91* Hgb-11.9* Hct-34.2* MCV-88 MCH-30.3 MCHC-34.7 RDW-14.9 Plt Ct-584*# [**2159-12-17**] 03:36PM BLOOD Neuts-83* Bands-6* Lymphs-3* Monos-6 Eos-0 Baso-0 Atyps-0 Metas-2* Myelos-0 [**2159-12-17**] 03:36PM BLOOD PT-13.4 PTT-36.2* INR(PT)-1.2* [**2159-12-17**] 03:36PM BLOOD Glucose-343* UreaN-50* Creat-1.6* Na-133 K-4.3 Cl-101 HCO3-17* AnGap-19 [**2159-12-17**] 03:36PM BLOOD ALT-25 AST-24 CK(CPK)-107 AlkPhos-108 TotBili-0.5 [**2159-12-17**] 03:36PM BLOOD Albumin-3.3* Calcium-9.8 Phos-5.0*# Mg-2.0 . Labs at Discharge: [**2159-12-31**] 05:13AM BLOOD WBC-7.9 RBC-3.49* Hgb-10.5* Hct-30.1* MCV-86 MCH-30.0 MCHC-34.9 RDW-16.5* Plt Ct-358 [**2159-12-31**] 05:13AM BLOOD Glucose-81 UreaN-11 Creat-0.8 Na-140 K-3.9 Cl-112* HCO3-22 AnGap-10 [**2159-12-31**] 05:13AM BLOOD Calcium-8.2* Phos-2.6* Mg-1.8 . Miscellaneous Labs: [**2159-12-28**] 06:40AM BLOOD Folate-5.3 [**2159-12-28**] 06:40AM BLOOD %HbA1c-7.5* [**2159-12-27**] 10:02AM BLOOD TSH-24* [**2159-12-27**] 10:02AM BLOOD T4-4.9 T3-50* calcTBG-1.04 TUptake-0.96 T4Index-4.7 [**2159-12-28**] 06:40AM BLOOD CRP-25.8* [**2159-12-28**] 06:40AM BLOOD PEP-PND [**2159-12-28**] 06:40AM BLOOD ESR-95* . IMAGING [**12-7**]: CT C/A/P: 1. Undisplaced acute left lower rib fractures and nondisplaced fracture through the left inferior pubic ramus as described above. There is no pneumothorax. 2. Up to 4 mm pulmonary nodules in the right lower lobe need followup with a chest CT in three months to ensure stability. 3. A filling defect in the upper pole calyx of the left kidney could represent a blood clot; however, the possibility of an urothelial neoplasm cannot be excluded and a renal MRI is recommended for further assessment. [**12-17**] CTOH: no hemorrhage [**12-17**] CT ABD: Distended large bowel, cecum @ 9.8cm, inflammatory changes and fluid surrounding cecum and proximal asc colon, no transition point. No abscess, free air or pneumatosis. Fracture of left posterior [**10-20**] ribs. Fracture of the left sacrum. Fracture of the left inferior and superior pubic rami. [**12-18**] CXR: No evidence of pneumoperitoneum. Markedly dilated loops of large bowel. [**12-19**] KUB: unchanged [**12-20**] KUB: increased LOB, mainly colon [**12-21**] CTABD: Colonic wall thickening in the ascending and proximal transverse colon, no free air, b/l pleural effusions L>R, fractures unchanged [**12-29**] KUB: Compared to the study from [**2159-12-20**] the colon is no longer as distended. The stomach is distended with a large amount of material within it and gas seen crossing midline. Gas is seen in loops of small bowel and large bowel. On the supine view there is no evidence of free air but this would be better assessed on the upright or lateral decubitus film. IMPRESSION: Distended stomach. . MICRO [**12-7**] UCx: E. coli, 10,000-100,000 ORGANISMS/ML - pan-sensitive [**12-17**] UCx: Alpha strep or Lactobacillus [**12-21**] Stool O+P negative [**12-25**] UCx: Pending [**Date range (1) 54629**]: CDiff negative x3 [**12-25**]: UCx negative [**12-25**]: Stool culture negative [**12-28**]: RPR negative [**12-29**]: CDiff negative x1 Brief Hospital Course: 70 yo woman h/o hypertension, DMII, hyperlipid, hypothyroid, recent admission after fall for left non-displaced pubic ramus fracture, presenting from rehab on [**12-17**] with abdominal distention, concern of C dif colitis in setting of recent cipro for UTI. . Hospital Course on Surgical Service ([**Date range (1) 81918**]): . Patient presented from rehab dehydrated with mental status changes and abdominal distention, probable C diff (toxin negative). Her white count was 30 at time of admission (see labs above). She had a dilated R colon (?opiate induced vs C.diff) and initially had no bowel movements or flatus. . She was seen by GI service who recommended for decompression with rectal tube and NGT, and continued avoidance of narcotics. She was switched to IV flagyl and po vanco and improved. However, she began having copious diarrhea, requiring up to 100-120 mEq IV potassium daily. She never developed hypotension and her HR remained stable 70-80s. She was tranferred to the medicine service on [**12-25**] for management of diarrhea. . . Hospital Course on Medicine Service ([**Date range (1) 81919**]): . At time of transfer, she had no significant complaints. She had mild low right back pain, persisting from her fall. She denied abdominal pain, nausea or vomiting, dizziness or lightheadedness. She denied subjective fevers or chills. Her hospital course by problem is below: . 1. Diarrhea. Our differential diagnosis for her diarrhea included infectious (C. dif versus bacterial), poor sphincter tone from deconditioning, or exacerbation of MS. Stool cultures and C dif were re-sent, and these returned negative. We consulted neurology who felt that her fecal incontinence was unlikely related to MS flare and more likely related to dementia and deconditioning. They noted that she likely suffers from mild chronic dementia, with acute worsening in the setting of infection, narcotic use, and metabolic abnormalities. They recommended against MRI as they had a low index of suspicion for spinal cord involvement. . We contined Flagyl to complete a 14-day course and we removed her rectal tube. We reinvolved physical therapy as we felt that her incontinence was most likely related to deconditioning. With these conservative interventions the frequency of her loose stools decreased. Furthermore, her stools are becoming more formed at discharge and we suspect that this will aid her ability to sense when she needs to void. . 2. Pain control. We held all narcotics given our concern that narcotic-related constipation was largely to blame for her abdominal distention at time of admission. We treated her pain with standing doses of ibuprofen (with meals) and tylenol as needed. . 3. Wound care. Nurses have noticed that there is reddening of the skin in the sacral area, although no ulceration. They have been regularly treating the area with antifungal powder, cleaning and drying. She should continue to receive this care in rehab to prevent skin breakdown and decubitus ulceration. . 4. Hypertension. We continued her outpatient Losartan and increased her amlodipine to a dose of 10 mg once daily. We added hydrochlorothiazide at a dose of 12.5 mg once daily. . 5. Hyperlipid. We continued her outpatient statin. . 6. Hypothyroid. We increased her levothyroxine to 112 mcg when TFTs showed slight hypothyroidism. . 7. Diabetes. Endocrinology was consulted for management of hyperglycemia during this admission. With their recommendations, we increased her dose of pioglitazone to 30 mg once daily, increased glyburide to 5 mg twice daily, and kept the metformin at 500 mg twice daily. Her standing insulin dose has also been adjusted to 33U of glargine at bed time, with sliding scale humalog insulin as outlined in the medications. . 7. Lung nodules. She will need outpatient follow-up imaging for lung nodules noted on chest CT [**12-7**]. . 8. Left renal mass. She will need outpatient f/u MRI for urothelial neoplasm vs clot noted in the left kidney from CT abdomen [**12-7**]. . She was kept on a diabetic diet. Subcutaneous heparin was used for venous thrombosis prophylaxis. Her code status is full code. Medications on Admission: MEDS (at time of transfer): 1. Levothyroxine Sodium 100 mcg PO DAILY 2. Losartan Potassium 100 mg PO DAILY 3. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H 4. Acetaminophen 650 mg PO Q6H 5. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 6. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN 7. Pantoprazole 40 mg PO Q24H 8. Amlodipine 5 mg PO DAILY 9. Pioglitazone 30 mg PO DAILY 10.Atorvastatin 40 mg PO DAILY 11.Bisacodyl 10 mg PR DAILY 12.GlyBURIDE 5 mg PO DAILY 13.Heparin 5000 UNIT SC TID 14.TraMADOL (Ultram) 25 mg PO Q6H 15.Vancomycin Oral Liquid 125 mg PO Q6H 16.Insulin SC (per Insulin Flowsheet) . MEDS (at time of admission/per recent d/c summary): 1. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY 2. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY 3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY 4. Pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY 5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY 6. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY 7. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY 8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) inj Injection [**Hospital1 **] (2 times a day): For DVT prophylaxis 9. Metformin 500 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY 10. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1) Tablet Sustained Release 12 hr PO Q12H 11. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed 12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID 13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID 14. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H PRN 15. Insulin Regular Human 100 unit/mL Solution Sig: One (1) inj Injection ASDIR (AS DIRECTED): Per sliding scale protocol. 16. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 17. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 5 days. Discharge Medications: 1. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 2. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 7. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): Take one dose in morning and one dose before dinner. 10. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed. 12. Insulin Lispro 100 unit/mL Cartridge Sig: [**1-24**] U Subcutaneous four times a day: For blood sugar 0-80 mg/dL, give 4 oz. juice and 15 gm crackers; for blood sugar 81-100 mg/dL, give 4 units (or give 0 units at bedtime); for blood sugar 101-150 mg/dL give 6 units (or 0 units at bedtime); for blood sugar 151-200 mg/dL, give 8 units (or 3 units at bedtime); for blood sugar 201-250 mg/dL, give 10 units (or 5 units at bedtime); for blood sugar 251-300 mg/dL, give 12 units (or 7 units at bedtime); for blood sugar 301-350 mg/dL, give 14 units (or 9 units at bedtime); for blood sugar 351-400 mg/dL, give 16 units (or 11 units at bedtime); for blood sugar >400, give 16 units (or 11 units at bedtime) and notify MD. [**Last Name (Titles) **]:*qs qs* Refills:*2* 13. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 14. Insulin Glargine 100 unit/mL Cartridge Sig: Thirty Three (33) units Subcutaneous at bedtime. 15. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO once a day. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - MACU Discharge Diagnosis: Primary Diagnoses Infectious colitis Constipation and ileus secondary to narcotic use . Secondary Diagnoses Diabetes mellitus Hypothyroidism Hypertension Hyperlipidemia Recent non-displaced left-sided pelvic fracture Discharge Condition: Vital signs stable. Afebrile. Discharge Instructions: You were hospitalized for treatment of abdominal distention and diarrhea. We were concerned that you had an infection of the gastrointestinal tract. We were not able to confirm this infection because all of the culture data was negative. However, we treated you presumptively with a 14-day course of antibiotics to help clear infection if present. We also involved physical therapy in your care. With these treatments, your abdominal distention resolved and your diarrhea improved. . We have made several changes to your medications. They are as follows: 1. We increased the glyburide to 5 mg twice dialy. 2. We increased the amlodipine to 10 mg once daily. 3. We added hydrochlorothiazide at a dose of 12.5 mg once daily. 4. We changed the insulin regimen. 5. We incresed levothyroxine to 112 mcg once daily. 6. We stopped the lidocaine patch. 7. We stopped the oxycodone. . You have been seen by physical therapists during this admission who recommend discharge to rehab. Please follow-up with your primary physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1924**], after you leave rehab. Followup Instructions: Please follow-up with your primary physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1924**] ([**2159**]. [**First Name8 (NamePattern2) **] [**Name8 (MD) 474**] MD [**MD Number(2) 4658**] Completed by:[**2159-12-31**]

599,584,009,560,564,276,340,401,272,244,041,250,278

{'Urinary tract infection, site not specified,Acute kidney failure, unspecified,Infectious colitis, enteritis, and gastroenteritis,Paralytic ileus,Other constipation,Dehydration,Multiple sclerosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Morbid obesity'}

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: Mental status change, abdominal distention. PRESENT ILLNESS: This is a 70 year-old woman with h/o obesity, DM, MS x40 years, but mobile without walker and independent with ADLs. She fell on [**12-7**], suffered rib fractures and a non-displaced left pubic ramus pelvic fracture. After her first hospitalization she was discharged to rehab on ciprofloxacin for UTI. She returned to the hospital from rehab with metnal status change, confusion, and abdominal distention. MEDICAL HISTORY: MS (with gait disturbance and urinary incontinence) DM HTN Hyperlipid Hypothyroidism MEDICATION ON ADMISSION: MEDS (at time of transfer): 1. Levothyroxine Sodium 100 mcg PO DAILY 2. Losartan Potassium 100 mg PO DAILY 3. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H 4. Acetaminophen 650 mg PO Q6H 5. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 6. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN 7. Pantoprazole 40 mg PO Q24H 8. Amlodipine 5 mg PO DAILY 9. Pioglitazone 30 mg PO DAILY 10.Atorvastatin 40 mg PO DAILY 11.Bisacodyl 10 mg PR DAILY 12.GlyBURIDE 5 mg PO DAILY 13.Heparin 5000 UNIT SC TID 14.TraMADOL (Ultram) 25 mg PO Q6H 15.Vancomycin Oral Liquid 125 mg PO Q6H 16.Insulin SC (per Insulin Flowsheet) . MEDS (at time of admission/per recent d/c summary): 1. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY 2. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY 3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY 4. Pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY 5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY 6. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY 7. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY 8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) inj Injection [**Hospital1 **] (2 times a day): For DVT prophylaxis 9. Metformin 500 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY 10. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1) Tablet Sustained Release 12 hr PO Q12H 11. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed 12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID 13. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID 14. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H PRN 15. Insulin Regular Human 100 unit/mL Solution Sig: One (1) inj Injection ASDIR (AS DIRECTED): Per sliding scale protocol. 16. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 17. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 5 days. ALLERGIES: Penicillins PHYSICAL EXAM: Physical exam at time of transfer to medicine service: Vitals Tm96.7, Bp 140/70, Hr 84, Rr 30, 96% RA General elderly-appearing female in NAD, breathing and speaking comfortably on RA; however, she becomes dyspneic with minimal movements in bed HEENT PERRLA, EOMI, no scleral icterus, MMM, oropharynx clear Neck no JVD appreciated, supple, non-tender Chest clear to auscultation bilaterally anterior fields; no wheezes Heart RRR, normal s1/s2, no murmurs or extra heart sounds appreciated [**Last Name (un) **] obese, soft, no tenderness; bruising over lower abdomen c/w heparin injections; no guarding or rebound; no percussion or cough tenderness; not hypertympanic; normal to slightly hypoactive bs; rectal tube in place, draining loose brown yellow stool Extremities trace pitting edema to mid shins; feet warm and well-perfused bilaterally FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Lives in [**State 3706**], takes care of husband who is in hospice. ### Response: {'Urinary tract infection, site not specified,Acute kidney failure, unspecified,Infectious colitis, enteritis, and gastroenteritis,Paralytic ileus,Other constipation,Dehydration,Multiple sclerosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Morbid obesity'}

CHIEF COMPLAINT: PRESENT ILLNESS: Ms. [**Known lastname **] has a history of small cell lung cancer. She was admitted to the medical intensive care unit after being found with hypoxic respiratory failure at her nursing home. At the time of presentation to [**Hospital1 69**] she was febrile with an absolute neutrophil count of 40. She required large amounts of intravenous fluid and hemodynamic support from her time of presentation. On arrival in the NICU she was on Neo-Synephrine and Levophed. She was also on mechanical ventilation at that time. She reached maximum doses on Neo-Synephrine and Levophed. At that point Vasopressin was added. Despite these measures, it was difficult to maintain her blood pressure. Her oxygenation and ventilation continued to decline over several hours. Despite numerous interventions on the mode of ventilation and numerous boluses of intravenous fluid, the patient was unable to maintain a blood pressure sufficient to profuse her vital organs. She passed away on the evening of [**2109-9-27**]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Methicillin susceptible pneumonia due to Staphylococcus aureus,Other shock without mention of trauma,Malignant neoplasm of bronchus and lung, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Congestive heart failure, unspecified,Unspecified essential hypertension

Meth sus pneum d/t Staph,Shock w/o trauma NEC,Mal neo bronch/lung NOS,DMII wo cmp nt st uncntr,CHF NOS,Hypertension NOS

Admission Date: [**2109-9-27**] Discharge Date: [**2109-9-27**] Date of Birth: [**2037-6-26**] Sex: F Service: HISTORY OF PRESENT ILLNESS: Ms. [**Known lastname **] has a history of small cell lung cancer. She was admitted to the medical intensive care unit after being found with hypoxic respiratory failure at her nursing home. At the time of presentation to [**Hospital1 69**] she was febrile with an absolute neutrophil count of 40. She required large amounts of intravenous fluid and hemodynamic support from her time of presentation. On arrival in the NICU she was on Neo-Synephrine and Levophed. She was also on mechanical ventilation at that time. She reached maximum doses on Neo-Synephrine and Levophed. At that point Vasopressin was added. Despite these measures, it was difficult to maintain her blood pressure. Her oxygenation and ventilation continued to decline over several hours. Despite numerous interventions on the mode of ventilation and numerous boluses of intravenous fluid, the patient was unable to maintain a blood pressure sufficient to profuse her vital organs. She passed away on the evening of [**2109-9-27**]. FINAL DIAGNOSES: 1. Septic shock, secondary to MRSA pneumonia. 2. Small cell lung cancer. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 4561**] Dictated By:[**Last Name (NamePattern1) 15710**] MEDQUIST36 D: [**2109-9-30**] 22:18 T: [**2109-10-1**] 19:54 JOB#: [**Job Number 36269**]

482,785,162,250,428,401

{'Methicillin susceptible pneumonia due to Staphylococcus aureus,Other shock without mention of trauma,Malignant neoplasm of bronchus and lung, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Congestive heart failure, unspecified,Unspecified essential hypertension'}

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: Ms. [**Known lastname **] has a history of small cell lung cancer. She was admitted to the medical intensive care unit after being found with hypoxic respiratory failure at her nursing home. At the time of presentation to [**Hospital1 69**] she was febrile with an absolute neutrophil count of 40. She required large amounts of intravenous fluid and hemodynamic support from her time of presentation. On arrival in the NICU she was on Neo-Synephrine and Levophed. She was also on mechanical ventilation at that time. She reached maximum doses on Neo-Synephrine and Levophed. At that point Vasopressin was added. Despite these measures, it was difficult to maintain her blood pressure. Her oxygenation and ventilation continued to decline over several hours. Despite numerous interventions on the mode of ventilation and numerous boluses of intravenous fluid, the patient was unable to maintain a blood pressure sufficient to profuse her vital organs. She passed away on the evening of [**2109-9-27**]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Methicillin susceptible pneumonia due to Staphylococcus aureus,Other shock without mention of trauma,Malignant neoplasm of bronchus and lung, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Congestive heart failure, unspecified,Unspecified essential hypertension'}

CHIEF COMPLAINT: dyspnea and cough PRESENT ILLNESS: Mr. [**Known lastname **] is a 66 y/o male with a history of CAD (VF arrest post CABG with ICD/PPM inserted), systolic CHF (EF 20%), PVD s/p bilat fem-[**Doctor Last Name **] bypasses, AF s/p DC cardioversion [**2120**], DM2 on insulin and gout post recent admission with gout flare and prednisone course in [**2121-10-15**] presents with one week of shortness of breath with associated cough. He notes subjective fevers and chills with associated night sweats. Over the past day he has developed confusion and difficulty with concentration which was noticed by his daughter. [**Name (NI) **] has been having associated headaches and chest pain. The chest pain was described as squeezing in nature and without radiation. He also notes some increased lower exteremity swelling which has been increasing over the past week. . Of note, recently saw his rheumatologist who started him on methylprednisone as well as increased his allopurinol due to an elevated uric acid. He was also admitted in [**Month (only) 1096**] for about a week for a significant gout flare. . In the ED, initial vs were: T 102.9 P 100 BP 131/69 R 20 O2 sat 100% RA. Labs were noteable for a WBC of 26.8 and a glucose of 45. Patient was given an amp of D50, levofloxacin, ceftriaxone and vancomycin. Vitals upon transfer were Temp 100.3, HR 100, 100% 2L. . On the floor, he appeared comfortable but in no acute distress. He was oriented to self, place and time however he appeared to have difficulty answering questions. He was complaining of left sided chest pain which his wife noted had been occurring over the past 2 weeks. The pain was nonradiating and was relieved with nitro tab x1. . Review of systems: (+) Per HPI (-) Denies recent weight loss or gain. Denies sinus tenderness, rhinorrhea or congestion. Denies 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: 1. Severe CAD s/p 4vCABG [**2107**] 2. V-Fib arrest 4-days post-CABG s/p pacemaker/ICD [**2107**] - Generator change and pocket revision in [**2120-1-14**] to right side of chest secondary to pain 3. Ischemic cardiomypoathy / systolic CHF, EF 25% 4. Peripheral vascular disease s/p bilateral femoral-popliteal bypass 5. multiple lower extremity catheterizations 6. Diabetes Type II - followed at [**Last Name (un) **] 7. Obstructive sleep apnea 8. Gout 9. Asthma 10. Mild sigmoid colonic thickening on recent CT-Abd/Plv, colonoscopy showing sessile polyps, biopsy will have to happen off plavix 11. Esophagitis, gastritis, peptic ulcer disease 12. Afib s/p TTE cardioversion [**1-/2121**] MEDICATION ON ADMISSION: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: General: patient appeared uncomfortable but in NAD AAOx3 HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP unable to be appreciated, no LAD Lungs: bibasilar crackles noted bilaterally, no wheezing or rhonchi CV: Irregular, SEM in the LUSB no rubs or gallops Abdomen: distended abdomen GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Mother with kidney problems. Father died of unknown causes. One sister died of stomach cancer, another sister also with stomach cancer. Diabetes is prevalent throughout the family. There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Married, lives at home with wife. Former 70 pack years tobacco use but quit in [**2107**]. Denies alcohol or IVDA.

Acute on chronic systolic heart failure,Pneumonia, organism unspecified,Encephalopathy, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Cardiac pacemaker in situ,Gout, unspecified,Long-term (current) use of insulin,Personal history of tobacco use,Asthma, unspecified type, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Pain in joint, upper arm,Accidental fall from bed,Malnutrition of moderate degree,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled

Ac on chr syst hrt fail,Pneumonia, organism NOS,Encephalopathy NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Status cardiac pacemaker,Gout NOS,Long-term use of insulin,History of tobacco use,Asthma NOS,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Joint pain-up/arm,Fall from bed,Malnutrition mod degree,DMII wo cmp uncntrld

Admission Date: [**2122-1-6**] Discharge Date: [**2122-1-14**] Date of Birth: [**2055-10-31**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1115**] Chief Complaint: dyspnea and cough Major Surgical or Invasive Procedure: None History of Present Illness: Mr. [**Known lastname **] is a 66 y/o male with a history of CAD (VF arrest post CABG with ICD/PPM inserted), systolic CHF (EF 20%), PVD s/p bilat fem-[**Doctor Last Name **] bypasses, AF s/p DC cardioversion [**2120**], DM2 on insulin and gout post recent admission with gout flare and prednisone course in [**2121-10-15**] presents with one week of shortness of breath with associated cough. He notes subjective fevers and chills with associated night sweats. Over the past day he has developed confusion and difficulty with concentration which was noticed by his daughter. [**Name (NI) **] has been having associated headaches and chest pain. The chest pain was described as squeezing in nature and without radiation. He also notes some increased lower exteremity swelling which has been increasing over the past week. . Of note, recently saw his rheumatologist who started him on methylprednisone as well as increased his allopurinol due to an elevated uric acid. He was also admitted in [**Month (only) 1096**] for about a week for a significant gout flare. . In the ED, initial vs were: T 102.9 P 100 BP 131/69 R 20 O2 sat 100% RA. Labs were noteable for a WBC of 26.8 and a glucose of 45. Patient was given an amp of D50, levofloxacin, ceftriaxone and vancomycin. Vitals upon transfer were Temp 100.3, HR 100, 100% 2L. . On the floor, he appeared comfortable but in no acute distress. He was oriented to self, place and time however he appeared to have difficulty answering questions. He was complaining of left sided chest pain which his wife noted had been occurring over the past 2 weeks. The pain was nonradiating and was relieved with nitro tab x1. . Review of systems: (+) Per HPI (-) Denies recent weight loss or gain. Denies sinus tenderness, rhinorrhea or congestion. Denies 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: 1. Severe CAD s/p 4vCABG [**2107**] 2. V-Fib arrest 4-days post-CABG s/p pacemaker/ICD [**2107**] - Generator change and pocket revision in [**2120-1-14**] to right side of chest secondary to pain 3. Ischemic cardiomypoathy / systolic CHF, EF 25% 4. Peripheral vascular disease s/p bilateral femoral-popliteal bypass 5. multiple lower extremity catheterizations 6. Diabetes Type II - followed at [**Last Name (un) **] 7. Obstructive sleep apnea 8. Gout 9. Asthma 10. Mild sigmoid colonic thickening on recent CT-Abd/Plv, colonoscopy showing sessile polyps, biopsy will have to happen off plavix 11. Esophagitis, gastritis, peptic ulcer disease 12. Afib s/p TTE cardioversion [**1-/2121**] Social History: Married, lives at home with wife. Former 70 pack years tobacco use but quit in [**2107**]. Denies alcohol or IVDA. Family History: Mother with kidney problems. Father died of unknown causes. One sister died of stomach cancer, another sister also with stomach cancer. Diabetes is prevalent throughout the family. There is no family history of premature coronary artery disease or sudden death. Physical Exam: General: patient appeared uncomfortable but in NAD AAOx3 HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP unable to be appreciated, no LAD Lungs: bibasilar crackles noted bilaterally, no wheezing or rhonchi CV: Irregular, SEM in the LUSB no rubs or gallops Abdomen: distended abdomen GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: ADMISSION LABS: [**2122-1-6**] 07:30PM WBC-26.8*# RBC-3.93* HGB-8.8* HCT-28.3* MCV-72* MCH-22.5*# MCHC-31.2 RDW-17.5* [**2122-1-6**] 07:30PM NEUTS-90* BANDS-5 LYMPHS-0 MONOS-5 EOS-0 BASOS-0 ATYPS-0 METAS-0 MYELOS-0 [**2122-1-6**] 07:30PM PLT COUNT-358 [**2122-1-6**] 07:30PM HYPOCHROM-2+ ANISOCYT-1+ POIKILOCY-OCCASIONAL MACROCYT-NORMAL MICROCYT-2+ POLYCHROM-1+ OVALOCYT-OCCASIONAL STIPPLED-OCCASIONAL ACANTHOCY-OCCASIONAL [**2122-1-6**] 07:30PM PT-15.5* PTT-24.6 INR(PT)-1.4* [**2122-1-6**] 07:30PM GLUCOSE-45* UREA N-44* CREAT-1.3* SODIUM-139 POTASSIUM-3.7 CHLORIDE-101 TOTAL CO2-27 ANION GAP-15 [**2122-1-6**] 07:30PM CALCIUM-8.1* PHOSPHATE-2.6*# MAGNESIUM-1.7 [**2122-1-6**] 07:30PM cTropnT-0.17* [**2122-1-6**] 07:30PM CK-MB-4 [**2122-1-6**] 07:30PM CK(CPK)-85 [**2122-1-6**] 07:34PM GLUCOSE-44* LACTATE-1.9 K+-3.6 [**2122-1-6**] 08:00PM URINE HOURS-RANDOM [**2122-1-6**] 08:00PM URINE GR HOLD-HOLD [**2122-1-6**] 08:00PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.009 [**2122-1-6**] 08:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG DISCHARGE LABS: [**2122-1-14**] 06:15AM BLOOD WBC-7.6 RBC-4.12* Hgb-8.9* Hct-30.6* MCV-74* MCH-21.6* MCHC-29.1* RDW-18.2* Plt Ct-301 [**2122-1-14**] 06:15AM BLOOD PT-28.9* INR(PT)-2.9* [**2122-1-14**] 06:15AM BLOOD Glucose-221* UreaN-40* Creat-1.4* Na-133 K-4.6 Cl-97 HCO3-27 AnGap-14 [**2122-1-14**] 06:15AM BLOOD Calcium-8.3* Phos-3.5 Mg-2.1 MICRO: [**2122-1-9**] URINE URINE CULTURE-FINAL {YEAST} INPATIENT [**2122-1-7**] Influenza A/B by DFA DIRECT INFLUENZA A ANTIGEN TEST-FINAL; DIRECT INFLUENZA B ANTIGEN TEST-FINAL INPATIENT [**2122-1-7**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2122-1-7**] BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT [**2122-1-6**] MRSA SCREEN MRSA SCREEN-FINAL INPATIENT [**2122-1-6**] BLOOD CULTURE Blood Culture, Routine-FINAL EMERGENCY [**Hospital1 **] [**2122-1-6**] BLOOD CULTURE Blood Culture, Routine-FINAL EMERGENCY [**Hospital1 **] STUDIES: [**2122-1-8**] CXR: Study is limited due to patient's respiratory motion and the superior aspect of the lung apices excluded from the field of view. The patient is status post median sternotomy and CABG. Right-sided AICD/pacemaker device is noted with lead terminating in the right ventricle. Abandoned pacer leads are also noted within the left chest wall, with the tip from one of these abandoned leads terminating in the region of the right ventricle. The cardiac silhouette remains moderately enlarged. There are low inspiratory lung volumes. This likely causes accentuation and crowding of the pulmonary vascular markings, but mild pulmonary vascular congestion is likely present. No focal consolidation is seen. There are no large pleural effusions. Assessment for pneumothorax is limited. Abdominal clips are seen in the right upper quadrant of the abdomen. There are no acute osseous findings. [**2122-1-8**] ECHO: Conclusions The left atrium is moderately dilated. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity is moderately dilated. Overall left ventricular systolic function is severely depressed (LVEF= 20-25 %). [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] A left ventricular mass/thrombus cannot be excluded. Diastolic function could not be assessed. Right ventricular chamber size is normal with borderline normal free wall function. [Intrinsic right ventricular systolic function is likely more depressed given the severity of tricuspid regurgitation.] There are three aortic valve leaflets. The aortic valve leaflets are moderately thickened. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. [In the setting of at least moderate to severe tricuspid regurgitation, the estimated pulmonary artery systolic pressure may be underestimated due to a very high right atrial pressure.] There is no pericardial effusion. IMPRESSION: Dilated left ventricle with severely depressed systolic function secondary to septal and anterior akinesis and hypokinesis of the remaining segments. Depressed RV systolic function. Mild mitral and moderate tricuspid regurgitation. At least moderate pulmonary artery systolic hypertension. Compared with the prior study (TEE - images reviewed) of [**2121-4-8**], regional LV wall motion abnormalities can be better appreciated on the current study. Valvular abnormalities are similar. IMPRESSION: Limited exam. Probable mild pulmonary vascular congestion. Low lung volumes. [**2122-1-8**]: LENI IMPRESSION: Negative Doppler ultrasound of both lower extremities, no evidence for DVT. Incidental left popliteal fossa [**Hospital Ward Name 4675**] cyst with internal hemorrhage. [**2122-1-11**]: CT LE (left) IMPRESSION: 1. No fracture detected. 2. Moderately severe diffuse soft tissue swelling. Small joint effusion and [**Hospital Ward Name 4675**] cyst. 3. Mild tricompartmental degenerative change. 4. Atherosclerotic vascular calcification. 5. Unusual cystic change in the superolateral aspect of the [**Last Name (LF) 15219**], [**First Name3 (LF) **] be degenerative, but could also be seen in the setting of gout. Clinical correlation requested. 6. Faint calcification along popliteus tendon - ? chondrocalcinosis. [**2122-1-11**]: US Extremity Nonvascular Left INDICATION: Fell on to left arm with painful fluid pouch. COMPARISON: None. FINDINGS: Grayscale, and color ultrasound imaging was performed over the area of tenderness in the left elbow. Within the superficial soft tissues, there is a 3.0 x 1.2 x 2.0 cm ovoid heterogeneously hypoechoic collection with enhanced through transmission and multiple internal septations, but no internal vascularity. Additionally, there is mild internal echogenicity noted in this collection. IMPRESSION: Multiseptated fluid collection overlying the left elbow within the subcutaneous tissues, likely representing a hematoma. Brief Hospital Course: Mr. [**Known lastname **] is a 66-year-old male with a history of CAD (VF arrest post CABG with ICD/PPM inserted), systolic CHF (EF 20%), PVD s/p bilateral fem-[**Doctor Last Name **] bypasses, AF s/p DC cardioversion [**2120**], DM2 on insulin and gout post recent admission with gout flare and prednisone course in [**2121-10-15**] who presented with one week of shortness of breath with associated cough with primary diagnoses of acute on chronic systolic heart failure with demand ischemia and health-care acquired pneumonia. Secondary issues during hospitalization were gout flare and hyperglycemia. # Acute on chronic systolic heart failure (EF 20 %) The patient's admission weight was 202 lbs, which is above his last dry weight in clinic in [**2121-10-15**] (181.6 lbs). Decompensation is likely secondary to infectious process with possible contribution of medication non-adherence. He had predominantly had right-sided heart failure pathophysiology given relatively clear lung exam and preponderance of lower extremity edema. He underwent diuresis with IV furosemide with discharge weight of 200.2 lbs. His creatinine fluctuated throughout hospitalization from 1.3 to 1.6 notably with diuresis with baseline Cr of 1.3. He was converted to his home furosemide 120 mg PO BID. He was continued on metoprolol succinate 50 mg PO qD. His spironolactone was discontinued, and his lisinopril was decreased from 10 mg to 5 mg given past issues with hyperkalemia and concurrent usage of digoxin. He was also continued on statin for CAD. He has a pacemaker for primary prevention. His diuretic regimen should continued to be optimized on an outpatient basis. If the patient does not maintain a stable weight on oral furosemide, torsemide could be considered. He will follow-up with Dr. [**Last Name (STitle) **], his primary cardiologist. In addition, the patient likely had demand ischemia given troponin elevation from 0.17 to 0.24 (baseline troponin T appears to be 0.03 based on measurement on [**2121-4-5**]) with negative CK-MB fraction and troponin downtrend to 0.14. He was treated for NSTEMI briefly with a heparin gtt, which was discontinued given low clinical suspicion. ECG showed only non-specific ST-T changes. ECHO did not show any new regional or global wall motion abnormalities. # Health-care acquired pneumonia Patient was noted to have an elevated WBC with a left shift, fever up to 102.9 and a RR >20 fulfilling SIRS criteria in addition to new cough. CURB-65 score was 3 based on confusion, BUN > 19, and Age > 65 with brief MICU course. Chest radiography did not show a definitive infiltrate. The patient was initially started on treatment for health-care acquired pneumonia with cefepime, vancomycin, and azithromycin. Influenza test was negative. Blood cultures did not suggest bacteremia. He was transitioned to room air with adequate oxygen saturation and completed an 8-day course of vancomycin, cefepime, and azithromycin for presumed pneumonia ([**2122-1-7**] to [**2122-1-14**]). . # Altered Mental Status: According to his family he developed confusion prior to admission, which has now resolved. Etiology was likely encephalopathy / delerium in the setting of acute infection. His sensorium cleared within a day. His insulin regimen was optimized by [**Last Name (un) **] as discussed below. . #. Type 2 Diabetes (A1c 9.8), controlled with complications: Home regimen on admission was Lantus 88 units qAM and lispro SSI. [**Last Name (un) **] was consulted secondary to hypoglycemia on admission (glucose 45) with secondary issue of persistent hyperglycemia after regimen was changed to glargine 10 units. There was some question about the etiology of hypoglycemia on admission as steroid usage and counter-regulatory hormones from infection would cause hyperglycemia. Consideration of adrenal axis testing should be considered based on pattern of steroid usage. [**Last Name (un) **] followed closely and his later hospital course was complicated by persistant hyperglycemia. His insulin regimen at discharge with insulin glargine 40 units SC qAM and insulin lispro 10 units SC AC. He will keep a log of blood glucose measurements at home and call [**Last Name (un) **] if his blood glucose is greater than 400. He will require ongoing close follow up for this. . #. Atrial Fibrillation: He remained in normal sinus rhythm during hospitalization. He was continued on metoprolol. His INR (1.4) was sub-therapeutic on admission consistent with known non-adherence to regimen. He was treated with warfarin during hospitalization, which was discontinued after supra-therapeutic INR with discharge INR of 2.9. Per his primary cardiologist, he was recently changed to pradaxa. He will have an INR check on [**2122-1-16**], which Dr. [**Last Name (STitle) **] will follow-up. When his INR is below 2, he will start pradaxa. . #. Gout with fall He was recently seen by rheumatology, and his allopurinol was increased to 600mg daily given hyperuricemia. During his hospitalization, he experienced a fall with trauma to his left elbow and knee. US of left elbow suggested a hematoma given supratherapeutic INR at time of fall. Imaging of left knee showed known [**Hospital Ward Name 4675**] cyst, degenerative changes, faint calcification suggestive of chondrocalcinosis, and effusion. Arthrocentesis of the left knee was considered but was deferred in setting of his INR. Septic joint was a consideration but unlikely given concurrent therapy with broad spectrum antimicrobials. Clinically, he had a convincing story for gout flare given trauma and recent withdrawal of corticosteroids. He was treated with colchicine 1.2 mg PO x 1, naproxen x 1, and colchicine 0.6 mg PO BID from [**1-12**] to [**1-16**] with return to home dosage on [**1-17**]. He improved rapidly on this regimen with resolution of flare by discharge. Prednisone and standing NSAIDs were not utilized given comorbid conditions including diabetes and congestive heart failure. He will follow-up with rheumatology. # Chronic kidney disease, Stage 3 His creatinine experienced fluctuations during hospitalization as mentioned above. His renal function should be assessed within one week of discharge. # Microcytic Anemia Admission Hgb was 9.5 with discharge Hgb of 8.5. Iron studies should be performed on outpatient basis. Some component may be from CKD. # Nutrition His albumin was 2.8 with normal synthetic function given liver function tests. He should be assessed for nutritional status. # Communication: HCP [**Name (NI) 17380**],[**Name (NI) **] (HCP) [**Telephone/Fax (1) 17381**] # Code: Full # Transitions of care 1. For his acute on chronic systolic heart failure, assess maintenance of discharge weight (200.2 lbs) and volume status. Further optimization of cardiovascular regimen such as diuretic conversion from furosemide to torsemide if not maintaining weight on oral furosemide and conversion of metoprolol to carvedilol given depressed ejection fraction. 2. Although he did not have a discrete infiltrate on chest radiography, repeat PA and Lateral CXR in [**2-18**] weeks may be judicious given likely pulmonary process. 3. His outpatient insulin regimen needs continual optimization from [**Last Name (un) **] given changes made during hospitalization. His blood glucose measurement log should be reviewed. He will call [**Last Name (un) **] for blood glucose > 400 or low glucose readings. 4. Given hypoglycemia on admission in the setting of infection and steroid usage, consider testing for relative or absolute adrenal insufficiency. 5. Patient will have INR check followed by Dr. [**Last Name (STitle) **] on [**2122-1-16**] and will need to start Pradaxa once INR < 2. 6. For gout, he will follow-up with rheumatology for further assessment and optimization of gout therapy. NSAIDs and corticosteroids should be used sparingly in a patient with heart failure and diabetes given fluid retention, aforementioned labile blood glucose measurements, and confusion. 7. Patient will need chemistry panel including creatinine to assess for stability of renal function on home furosemide regimen within one week of discharge. 8. He should be assessed for nutrition given albumin. 9. He should have iron studies to work-up his microcytic anemia. Medications on Admission: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 5. metoprolol succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). 6. furosemide 40 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 7. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 8. spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. warfarin 7.5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*5 Tablet(s)* Refills:*0* 10. pregabalin 75 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 11. Lantus 88 units at morning 12. Lispro sliding scale Discharge Medications: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 4. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for Pain/Fever. 5. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 6. Lasix 80 mg Tablet Sig: 1.5 Tablets PO twice a day. Disp:*90 Tablet(s)* Refills:*0* 7. pregabalin 75 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. allopurinol 300 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 9. colchicine 0.6 mg Tablet Sig: One (1) Tablet PO twice a day for 2 days: Take on [**1-15**] and [**1-16**]. On [**1-17**], return to your normal home dose. 10. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 11. colchicine 0.6 mg Tablet Sig: One (1) Tablet PO once a day: start your normal colchicine dose on [**1-17**]. 12. Pradaxa 75 mg Capsule Sig: One (1) Capsule PO twice a day: You will get an INR test. Do NOT start this medication now. Dr. [**Last Name (STitle) **] will call by next Tuesday to tell you when to start this medication. Disp:*60 Capsule(s)* Refills:*2* 13. Outpatient Lab Work Check INR on [**2122-1-16**] (FRIDAY) at [**Hospital6 **] laboratory. LAB: Please fax results to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] office (cardiology), fax # [**Telephone/Fax (1) 17382**] 14. insulin glargine 100 unit/mL Solution Sig: Forty (40) units Subcutaneous qAM. Disp:*[**2110**] units* Refills:*2* 15. insulin lispro 100 unit/mL Solution Sig: Ten (10) units Subcutaneous AC. Disp:*1000 units* Refills:*0* 16. digoxin 125 mcg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary: pneumonia, acute on chronic heart failure exacerbation, gout Secondary: Diabetes, chronic kidney disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname **], It was a pleasure taking care of you in the hospital. You were admitted with cough and shortness of breath. We were concerned that you had a pneumonia and treated you with antibiotics for which you have completed a course. You also were given lasix to remove some excess fluid from your body. It is very important to follow a LOW SALT diet, or you will develop more fluid and have heart problems. Your gout worsened during hospitalization, and you were started on a higher dosage of colchicine for the next few days for your gout. Medication changes: -STOP coumadin -STOP spironolactone -START pradaxa when Dr. [**Last Name (STitle) **] instructs you to start this medication. You will need to have your *INR* checked on [**2122-1-16**]. This result will be faxed to Dr.[**Name (NI) 5452**] office. If you do not hear from Dr. [**Last Name (STitle) **] by [**2122-1-19**], please call his office and ask when to start the pradaxa. - START Colchicine 0.6 mg by mouth TWICE daily for 2(two) days on [**1-15**] and [**1-16**] for your gout flare. - THEN on [**1-17**], START your regular home dose (colchicine 0.6 mg by mouth ONCE daily) - CHANGE lisinopril from 10 mg to 5 mg - CHANGE your insulin regimen: Take lantus 40 units in the morning Take humalog 10 units before meals *** Your blood sugar was high during hospitalization. Please continue to check your blood sugars three times per day and bring a record of them to your [**Last Name (un) **] visit. If your glucose level is > 400, please call [**Hospital **] clinic. Please go to the followup appointment scheduled below. ***Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: INR check at [**Hospital6 **] lab on [**2122-1-16**]. Department: [**Hospital3 249**] When: THURSDAY [**2122-1-22**] at 9:10 AM With: [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage This is a follow up of your hospitalization. You will become established with your primary care physician after this visit. Department: [**Hospital3 249**] When: MONDAY [**2122-2-2**] at 3:25 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13530**], MD [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage This will be your new primary care physician within [**Name9 (PRE) 191**]. Department: RHEUMATOLOGY When: THURSDAY [**2122-1-29**] at 12:30 PM With: [**First Name8 (NamePattern2) 11595**] [**Last Name (NamePattern1) 11596**], MD [**Telephone/Fax (1) 2226**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 861**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Name: [**Last Name (LF) 11712**], [**First Name3 (LF) **] Location: [**Last Name (un) **] DIABETES CENTER Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 2378**] When: Monday, [**2-2**], 11AM Name: [**Last Name (LF) **], [**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] Location: [**Doctor Last Name **] BLDG, [**Apartment Address(1) 17383**] Address: [**Last Name (NamePattern1) 8541**], [**Location (un) **],[**Numeric Identifier 8542**] Phone: [**Telephone/Fax (1) 7960**] When: Wednesday, [**2-4**], 1:30PM

428,486,348,414,V458,V450,274,V586,V158,493,403,585,719,E884,263,250

{'Acute on chronic systolic heart failure,Pneumonia, organism unspecified,Encephalopathy, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Cardiac pacemaker in situ,Gout, unspecified,Long-term (current) use of insulin,Personal history of tobacco use,Asthma, unspecified type, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Pain in joint, upper arm,Accidental fall from bed,Malnutrition of moderate degree,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}

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 and cough PRESENT ILLNESS: Mr. [**Known lastname **] is a 66 y/o male with a history of CAD (VF arrest post CABG with ICD/PPM inserted), systolic CHF (EF 20%), PVD s/p bilat fem-[**Doctor Last Name **] bypasses, AF s/p DC cardioversion [**2120**], DM2 on insulin and gout post recent admission with gout flare and prednisone course in [**2121-10-15**] presents with one week of shortness of breath with associated cough. He notes subjective fevers and chills with associated night sweats. Over the past day he has developed confusion and difficulty with concentration which was noticed by his daughter. [**Name (NI) **] has been having associated headaches and chest pain. The chest pain was described as squeezing in nature and without radiation. He also notes some increased lower exteremity swelling which has been increasing over the past week. . Of note, recently saw his rheumatologist who started him on methylprednisone as well as increased his allopurinol due to an elevated uric acid. He was also admitted in [**Month (only) 1096**] for about a week for a significant gout flare. . In the ED, initial vs were: T 102.9 P 100 BP 131/69 R 20 O2 sat 100% RA. Labs were noteable for a WBC of 26.8 and a glucose of 45. Patient was given an amp of D50, levofloxacin, ceftriaxone and vancomycin. Vitals upon transfer were Temp 100.3, HR 100, 100% 2L. . On the floor, he appeared comfortable but in no acute distress. He was oriented to self, place and time however he appeared to have difficulty answering questions. He was complaining of left sided chest pain which his wife noted had been occurring over the past 2 weeks. The pain was nonradiating and was relieved with nitro tab x1. . Review of systems: (+) Per HPI (-) Denies recent weight loss or gain. Denies sinus tenderness, rhinorrhea or congestion. Denies 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: 1. Severe CAD s/p 4vCABG [**2107**] 2. V-Fib arrest 4-days post-CABG s/p pacemaker/ICD [**2107**] - Generator change and pocket revision in [**2120-1-14**] to right side of chest secondary to pain 3. Ischemic cardiomypoathy / systolic CHF, EF 25% 4. Peripheral vascular disease s/p bilateral femoral-popliteal bypass 5. multiple lower extremity catheterizations 6. Diabetes Type II - followed at [**Last Name (un) **] 7. Obstructive sleep apnea 8. Gout 9. Asthma 10. Mild sigmoid colonic thickening on recent CT-Abd/Plv, colonoscopy showing sessile polyps, biopsy will have to happen off plavix 11. Esophagitis, gastritis, peptic ulcer disease 12. Afib s/p TTE cardioversion [**1-/2121**] MEDICATION ON ADMISSION: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: General: patient appeared uncomfortable but in NAD AAOx3 HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP unable to be appreciated, no LAD Lungs: bibasilar crackles noted bilaterally, no wheezing or rhonchi CV: Irregular, SEM in the LUSB no rubs or gallops Abdomen: distended abdomen GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Mother with kidney problems. Father died of unknown causes. One sister died of stomach cancer, another sister also with stomach cancer. Diabetes is prevalent throughout the family. There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Married, lives at home with wife. Former 70 pack years tobacco use but quit in [**2107**]. Denies alcohol or IVDA. ### Response: {'Acute on chronic systolic heart failure,Pneumonia, organism unspecified,Encephalopathy, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Cardiac pacemaker in situ,Gout, unspecified,Long-term (current) use of insulin,Personal history of tobacco use,Asthma, unspecified type, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Pain in joint, upper arm,Accidental fall from bed,Malnutrition of moderate degree,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 79-year-old male, with a history of coronary artery disease and known left carotid artery blockage, hyperlipidemia, and hypertension, who was seen in the [**Hospital1 18**] Emergency Department on [**2119-1-7**]. The patient states that he had had chest pain last evening lasting approximating 5 minutes after exertion. The patient describes the chest pain as burning, substernal, no radiation, no nausea, vomiting, no diaphoresis, no shortness of breath. The patient stated that the pain was relieved after 5 minutes after taking a Nitroglycerin tablet. The patient states that he has often had this pain at night after exerting himself. The patient states that this pain has been unchanged. The patient denies orthopnea or lower extremity swelling. MEDICAL HISTORY: 1. Coronary artery disease. 2. Hyperlipidemia. 3. Hypertension. 4. Benign prostatic hypertrophy. 5. Gastroesophageal reflux disease. 6. Asthma. 7. Allergic rhinitis. 8. Left carotid blockage. MEDICATION ON ADMISSION: 1. Enteric-coated aspirin 325 mg po bid. 2. Atenolol 50 mg qd. 3. Nitroglycerin sublingual. ALLERGIES: No known drug allergies. PHYSICAL EXAM: The patient was afebrile, 98.3, pulse 57, blood pressure 165/72, respiratory rate 20, 95% on room air. In general, he was alert and oriented, in no apparent distress, very pleasant. Cardiovascular - regular rate and rhythm, II/VI systolic ejection murmur noted at the left lower sternal border. Lung exam was clear to auscultation bilaterally with a long expiratory phase. Abdominal exam - soft, nontender, nondistended, positive bowel sounds. Extremities - no edema. Distal pulses were palpated. Neck exam - no JVP, no bruits, no masses were discernible. Rectal exam - guaiac negative, enlarged prostate. FAMILY HISTORY: SOCIAL HISTORY: The patient lives with his wife, is a nonsmoker, heavy alcohol usage.

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Atrial fibrillation,Pneumonia, organism unspecified,Postherpetic polyneuropathy,Pulmonary collapse,Chronic obstructive asthma, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction

Crnry athrscl natve vssl,Intermed coronary synd,CHF NOS,Atrial fibrillation,Pneumonia, organism NOS,Postherpes polyneuropath,Pulmonary collapse,Chronic obst asthma NOS,Ocl crtd art wo infrct

Admission Date: [**2119-1-7**] Discharge Date: [**2119-1-24**] Service: CARDIOTHORACIC SURGERY ADMITTING DIAGNOSIS: Rule out myocardial infarction. HISTORY OF PRESENT ILLNESS: This is a 79-year-old male, with a history of coronary artery disease and known left carotid artery blockage, hyperlipidemia, and hypertension, who was seen in the [**Hospital1 18**] Emergency Department on [**2119-1-7**]. The patient states that he had had chest pain last evening lasting approximating 5 minutes after exertion. The patient describes the chest pain as burning, substernal, no radiation, no nausea, vomiting, no diaphoresis, no shortness of breath. The patient stated that the pain was relieved after 5 minutes after taking a Nitroglycerin tablet. The patient states that he has often had this pain at night after exerting himself. The patient states that this pain has been unchanged. The patient denies orthopnea or lower extremity swelling. The patient reports that he has had a stress test in the past. Upon review, it was noticed that the patient was exercised for 10 minutes using a modified [**Doctor First Name **] protocol and was stopped due to fatigue. At peak exercise, there was approximately 2.0-2.5 mm down-sloping ST depression in anterior and lateral leads, and slightly less in the inferior leads. These changes were noted in the presence of a baseline abnormal ECG of right bundle branch block and left ventricular hypertrophy with prominent T wave abnormalities. This exercise stress test was essentially unchanged from an earlier test performed in [**2114-3-19**]. PREVIOUS MEDICAL HISTORY: 1. Coronary artery disease. 2. Hyperlipidemia. 3. Hypertension. 4. Benign prostatic hypertrophy. 5. Gastroesophageal reflux disease. 6. Asthma. 7. Allergic rhinitis. 8. Left carotid blockage. MEDICATIONS ON ADMISSION: 1. Enteric-coated aspirin 325 mg po bid. 2. Atenolol 50 mg qd. 3. Nitroglycerin sublingual. ALLERGIES: No known drug allergies. SOCIAL HISTORY: The patient lives with his wife, is a nonsmoker, heavy alcohol usage. PHYSICAL EXAM: The patient was afebrile, 98.3, pulse 57, blood pressure 165/72, respiratory rate 20, 95% on room air. In general, he was alert and oriented, in no apparent distress, very pleasant. Cardiovascular - regular rate and rhythm, II/VI systolic ejection murmur noted at the left lower sternal border. Lung exam was clear to auscultation bilaterally with a long expiratory phase. Abdominal exam - soft, nontender, nondistended, positive bowel sounds. Extremities - no edema. Distal pulses were palpated. Neck exam - no JVP, no bruits, no masses were discernible. Rectal exam - guaiac negative, enlarged prostate. LABS ON ADMISSION: CBC - white count 7.7, hematocrit 47.2, platelets 189. Chemistry - sodium 141, potassium 4.5, chloride 104, bicarb 31, BUN 23, creatinine 1.2, PT 13.2, PTT 25.2, INR 1.1. The patient had a set of cardiac enzymes sent off. CK was 106, troponin 0.02. CHEST X-RAY: Cardiomegaly, no consolidation, flattened diaphragm, no CHF noted. EKG: Sinus rhythm in the 50s, left ventricular hypertrophy, right bundle branch block, normal axis. HOSPITAL COURSE: The patient was admitted to the medicine service for a rule out evaluation for myocardial infarction. The patient had serial enzymes done with the CK decreasing from 106 to 80 to 72. His troponin initially at 0.02 decreased to 0.01. The patient was planned to have a stress test and follow-up the results. On hospital day #3, the patient complained of having chest pain, [**5-29**], with substernal tightness. An EKG done at that time showed ST depression in V1 and V2. The patient's pain was relieved after 3 sublingual nitrogen tablets and 1 mg morphine. The patient's blood pressure was systolic 120s-140. Heart rate 80. After this episode, the patient was evaluated by the Department of Cardiology which noted that the patient was now with unstable angina. It was advised that the patient undergo angiography, carotid duplex, and cardiac catheterization. A set of enzymes was sent-off following this episode. CK came back at 102, CK-MB 6, troponin 0.17. On [**2119-1-10**], the patient underwent an MIBI stress test, during which the patient developed chest pain. The patient's chest pain was resolved status post 3 sublingual nitrogen tablets and IV morphine. Stress test showed ST depression in leads V1 through V3. The patient was started on a heparin drip and referred to cardiothoracic surgery service. Also on [**1-11**], the patient underwent a carotid duplex which showed a right internal carotid stenosis of 70-79%, and a left internal stenosis of less than 40%. The patient underwent a cardiac catheterization which noted that the patient had three-vessel disease. On [**2119-1-11**], the patient underwent coronary artery bypass grafting x 4 with the LIMA to the left anterior descending, SVG to O1, SVG to the PDA to the OM1. The surgery was performed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**], and there were on complications noted, and the patient tolerated the procedure well. Postoperatively, the patient remained intubated, was A-paced, and placed on a Levophed drip for pressure support. Following a brief stay in the PACU, the patient went to the CSRU where the patient arrived at a paced rate of approximately 90 beats per minute. The patient was noted to have labile blood pressure requiring IV Nitroglycerin and IV Levophed drips in order to keep his systolic blood pressure between 120 and 140. The patient remained intubated with plans to extubate when the patient was stable. Initial attempts to extubate were unsuccessful, but the patient was weaned to a pressure support of 5 and 5, with 40% FIO2. On postoperative day #1, another attempt was made to extubate the patient, but the patient went into pulmonary edema, and subsequently was placed on SIMV. The patient was noted to have rales and rhonchi bilaterally, and had symptoms of a frothy pink sputum, with a respiratory acidosis. Cardiovascularly, the patient was noted to have frequent PVCs with runs of bigeminy. A Swan catheter was placed with no effects. The patient continued to be maintained on Levophed and Nitroglycerin to maintain his systolic blood pressure between 120 and 140. The patient also underwent several episodes of ectopy, though his cardiac index remained greater than 2.0. From a respiratory standpoint, the patient continued to have thick yellow secretions and rhonchorous-sounding lungs. His SP02 was maintained at 95%, and the vent was able to correct his respiratory acidosis. His secretions improved after administration of 40 mg IV lasix. The decision was made to keep the patient on the vent overnight with plans to extubate on [**1-14**]. A chest x-ray was done to evaluate the patient's increased secretions and decreased breath sounds. This revealed no pulmonary edema, but questionable developing consolidation. As a precaution, the patient was placed on Levofloxacin for a questionable developing nosocomial pneumonia. The patient was also evaluated by electrophysiology for the patient's continued ventricular ectopy and sinus node dysfunction. It was determined at that time that the patient did not need a permanent pacemaker placed at that time. On postoperative day #2, the patient was weaned off SIMV down to CPAP with his initial pressure support at 15 which was weaned down to 5. As a result of this successful weaning, the patient was extubated and placed on a face mask of 40% FIO2. The patient was able to maintain his O2 saturations at 99% with no stridor, but still slightly coarse breath sounds. From a cardiovascular standpoint, the patient went back into a ST rate of 150s, with a stable blood pressure. The patient continued to have frequent PVCs, bigeminy, trigeminy, occasional couplets. The patient was started on Lopressor 12.5 mg po, and bolused with amiodarone, and placed on an amiodarone drip. The patient's blood pressure remained labile, still requiring a Nitroglycerin drip. Additionally, the patient received 1 unit of packed red blood cells for a low hematocrit. Additionally on this day, the patient was evaluated by physical therapy who was able to successfully get the patient out of bed which he tolerated well. The patient was continued to be weaned off his oxygen, and was able to maintain O2 sats greater than 94% on 4 liters nasal cannula. On postoperative day #3, the patient continued to do well with a continued weaning of his Nitroglycerin support while able to maintain his blood pressure between 120 and 140. The patient was also diuresed with IV lasix and remained on an amiodarone drip. The patient went into atrial fibrillation with his pulse reaching as high as into the 140s, but later went down to 106-118 with a stable systolic blood pressure. The patient denied any discomfort at this time. The patient was continued on his IV amiodarone which later converted his arrhythmia into normal sinus rhythm. This amiodarone was switched from IV to PO without any difficulty. From a respiratory standpoint, the patient was able to be weaned down to 2 liters nasal cannula and was able to maintain his saturation at greater than 98%. His breath sounds had begun to clear-up though still remained slightly diminished in the bases. No nebulizers were needed today. The patient's activity was increased. He was out of bed and was able to ambulate with assistance. On postoperative day #4, [**1-16**], the patient did very well from a cardiovascular standpoint. He remained in normal sinus rhythm with rare PVCs. The patient's systolic blood pressure remained greater than 100. On postoperative day #6, the patient was transferred from the CSRU down to FAR-2. The patient did very well and was continued to be anticoagulated for his atrial fibrillation. The patient was placed on Coumadin at this time. The patient's amiodarone was decreased from 400 [**Hospital1 **] to 400 qd. The patient was encouraged to be out of bed and ambulate. The patient was continued to be on a heparin infusion of 1,150 U/h and given 3 mg of Coumadin q hs. Despite this, the patient did go into atrial fibrillation on [**1-19**], but the patient remained asymptomatic and maintained his blood pressure at 116/66. The patient was given 50 mg po Lopressor and 400 mg po amiodarone at that time. Following the administration of medication, the patient converted out of atrial fibrillation to a normal sinus rhythm. During the patient's further postoperative course, the patient continued to do well. He remained in normal sinus rhythm without a need for further pharmaceutical intervention. The patient was maintained on his heparin drip to keep a VTT of approximately 40-60. The patient's Coumadin doses ranged between 3 and 5 mg per evening. The patient worked extensively with physical therapy. It was noted that the patient, while he had good mobility and good flexibility, was in very poor condition and was easily desaturating down to the 88-89% O2 while on room air and exercising. The patient had a steady gait and could balance, but was easily winded. As a result of this, it was determined that the patient would need to go to a rehabilitation facility following discharge for further conditioning. This dictation will be continued in a further addendum when final placement of the patient has been determined. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 75**] Dictated By:[**Name8 (MD) 846**] MEDQUIST36 D: [**2119-1-23**] 12:13 T: [**2119-1-23**] 12:35 JOB#: [**Job Number 17674**] Name: [**Known lastname **], [**Known firstname **] T Unit No: [**Numeric Identifier 2818**] Admission Date: [**2119-1-7**] Discharge Date: [**2119-1-24**] Date of Birth: [**2039-11-11**] Sex: M Service: Addendum to hospital course: Patient will be discharged to rehabilitation facility today. His discharge exam shows his lungs to be clear to auscultation bilaterally. His heart is regular rate and rhythm. His abdomen is soft, nontender, nondistended and extremities show 1+ bilateral pitting edema. His incisions are clean, dry, and intact, and his sternum is stable. His laboratories included a white count of 11.9, hematocrit 28.6% and platelet count of 324,000. Sodium of 138, potassium of 4.8, chloride 101, CO2 29, BUN 37, creatinine 1.4, and a glucose of 119. His PT on discharge was 18.5 with an INR of 2.3, and a PTT of 28.3. His chest x-ray for discharged showed a small left effusion, otherwise chest x-ray was clear. DISCHARGE MEDICATIONS: 1. Enteric coated aspirin 325 mg p.o. q.d. 2. Percocet 1-2 tablets p.o. q.4h. prn. 3. Iron sulfate 325 mg p.o. q.d. x3 months. 4. Protonix 40 mg p.o. q.d. 5. Lasix 40 mg p.o. b.i.d. x7 days. 6. Potassium chloride 20 mEq p.o. b.i.d. x7 days. 7. Colace 100 mg p.o. b.i.d. 8. Flovent 110 mcg MDI two puffs b.i.d. 9. Lopressor 75 mg p.o. b.i.d. 10. Albuterol MDI 1-2 puffs q.6h. prn. 11. Amiodarone 400 mg p.o. q.d. x1 month, then to be re-evaluated by his primary care physician or cardiologist as this was started for postoperative atrial fibrillation. 12. Coumadin as directed to maintain a goal INR of [**2-20**].5 and again he is being anticoagulated for postoperative atrial fibrillation. FOLLOW-UP INSTRUCTIONS: He should follow up with Dr. [**Last Name (STitle) 2819**] in [**1-20**] weeks after discharge from rehab and with Dr. [**Last Name (STitle) 71**] in six weeks. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 224**], M.D. [**MD Number(1) 225**] Dictated By:[**Last Name (NamePattern1) 2820**] MEDQUIST36 D: [**2119-1-24**] 10:41 T: [**2119-1-24**] 10:53 JOB#: [**Job Number 2821**]

414,411,428,427,486,053,518,493,433

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Atrial fibrillation,Pneumonia, organism unspecified,Postherpetic polyneuropathy,Pulmonary collapse,Chronic obstructive asthma, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}

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: This is a 79-year-old male, with a history of coronary artery disease and known left carotid artery blockage, hyperlipidemia, and hypertension, who was seen in the [**Hospital1 18**] Emergency Department on [**2119-1-7**]. The patient states that he had had chest pain last evening lasting approximating 5 minutes after exertion. The patient describes the chest pain as burning, substernal, no radiation, no nausea, vomiting, no diaphoresis, no shortness of breath. The patient stated that the pain was relieved after 5 minutes after taking a Nitroglycerin tablet. The patient states that he has often had this pain at night after exerting himself. The patient states that this pain has been unchanged. The patient denies orthopnea or lower extremity swelling. MEDICAL HISTORY: 1. Coronary artery disease. 2. Hyperlipidemia. 3. Hypertension. 4. Benign prostatic hypertrophy. 5. Gastroesophageal reflux disease. 6. Asthma. 7. Allergic rhinitis. 8. Left carotid blockage. MEDICATION ON ADMISSION: 1. Enteric-coated aspirin 325 mg po bid. 2. Atenolol 50 mg qd. 3. Nitroglycerin sublingual. ALLERGIES: No known drug allergies. PHYSICAL EXAM: The patient was afebrile, 98.3, pulse 57, blood pressure 165/72, respiratory rate 20, 95% on room air. In general, he was alert and oriented, in no apparent distress, very pleasant. Cardiovascular - regular rate and rhythm, II/VI systolic ejection murmur noted at the left lower sternal border. Lung exam was clear to auscultation bilaterally with a long expiratory phase. Abdominal exam - soft, nontender, nondistended, positive bowel sounds. Extremities - no edema. Distal pulses were palpated. Neck exam - no JVP, no bruits, no masses were discernible. Rectal exam - guaiac negative, enlarged prostate. FAMILY HISTORY: SOCIAL HISTORY: The patient lives with his wife, is a nonsmoker, heavy alcohol usage. ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Atrial fibrillation,Pneumonia, organism unspecified,Postherpetic polyneuropathy,Pulmonary collapse,Chronic obstructive asthma, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}

CHIEF COMPLAINT: altered mental status PRESENT ILLNESS: 39M found walking in and out of traffic on the street by EMS, with periods of combativeness and lethargy on scene, who was brought to the ED. . In ED VS= 98.4 146/95 56 17 100%RA. He was found to have a graduation certificate from [**Doctor First Name **] street treatment resources step down services in his backpack. He was intermittently combative and lethargic. He had bottles of his own clonidine, neurontin, and xanax with him, and by report, a slip saying he was on methadone 85mg qdaily. . Labs were essentially unremarkable (INR 1.3, UA with few bacteria). ECG revealed sinus bradycardia. Head CT was attempted, but cancelled as pt would not sit still. . He presentation was concerning for clonidine toxicity given bradycardia, hypertension. He was given narcan 0.5 mg without response, but improved after receiving a second 0.5mg dose. He became lethargic again, and received another 0.5mg of narcan and was started on narcan gtt at 1.25mg/hr. . Upon arrival to the MICU the patient is lethargic, and minimally responsive to sternal rub. He withdraws to pain, PERRL. He is minimally responsive to ABG, but does withdraw to the pain. ABG 7.45/80/45 on 3L. There is no improvement with narca 0.5mg x 2. MEDICAL HISTORY: - hep C positive - bilateral sciatica - anxiety disorder vs. personality disorder - h/o heroin dependence and cocaine abuse Previous psychiatric history: - h/o panic attacks tx'd by an outpatient psychiatrist Dr. [**Last Name (STitle) 24051**] - h/o multiple psychiatric and detox admissions - h/o several suicide attempts including with heroin OD >2 y ago Per his ICM at MBHP [**First Name8 (NamePattern2) 55644**] [**Last Name (NamePattern1) 5448**] [**Telephone/Fax (1) 55645**] she reports that: - [**Hospital **] hospital [**Date range (1) 42060**] - CAB detox [**Date range (1) 19139**] - Brounweed [**4-21**], steped down to eATS [**4-25**] - CAB [**5-1**] for detox for two days - Bournwood [**Date range (1) 1261**] - [**2117-5-18**] step down to EATS [**Doctor Last Name **] [**Date range (1) 55646**], extended to [**6-9**] MEDICATION ON ADMISSION: Medications: (filled at CVS [**Telephone/Fax (1) 55649**], Rx by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 24051**]) - neurontin 800mg po tid - clonidine 0.1 mg po tid - cvs stool softener 100mg po bid - alprazolam 4mg po qdaily Per [**Doctor Last Name **]: - clonidine 0.1 mg tid - colace 100mg [**Hospital1 **] - abilify 5 mg at hs - vistaril 50 mg tid - methadone 85 mg a day ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: 60 140/90 29 99% on 3L General: lethargic, withdraws to pain. HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation anteriorly, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: obsese, +striaea, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema NEURO: PERRL, occulocephalic reflex intact, toes downgoing. withdraws to pain in all four extremities. FAMILY HISTORY: No family h/o of dx'd psychiatric disorders SOCIAL HISTORY: Pt reports a good family, finished HS, family is in law enforcemtn; brother is a homicide investigator; pt reports receving a $100,000 inheritance several years ago and using cocaine and drugs until he ran through the money; estranged from his family

Poisoning by other antihypertensive agents,Opioid type dependence, continuous,Chronic hepatitis C without mention of hepatic coma,Aortocoronary bypass status,Sciatica,Other specified cardiac dysrhythmias,Anxiety state, unspecified,Unspecified personality disorder,Accidental poisoning by agents primarily affecting cardiovascular system

Pois-antihyperten agent,Opioid dependence-contin,Chrnc hpt C wo hpat coma,Aortocoronary bypass,Sciatica,Cardiac dysrhythmias NEC,Anxiety state NOS,Personality disorder NOS,Acc poisn-cardiovasc agt

Admission Date: [**2200-6-9**] Discharge Date: [**2200-6-10**] Date of Birth: [**2160-12-30**] Sex: M Service: MEDICINE Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 2297**] Chief Complaint: altered mental status Major Surgical or Invasive Procedure: None History of Present Illness: 39M found walking in and out of traffic on the street by EMS, with periods of combativeness and lethargy on scene, who was brought to the ED. . In ED VS= 98.4 146/95 56 17 100%RA. He was found to have a graduation certificate from [**Doctor First Name **] street treatment resources step down services in his backpack. He was intermittently combative and lethargic. He had bottles of his own clonidine, neurontin, and xanax with him, and by report, a slip saying he was on methadone 85mg qdaily. . Labs were essentially unremarkable (INR 1.3, UA with few bacteria). ECG revealed sinus bradycardia. Head CT was attempted, but cancelled as pt would not sit still. . He presentation was concerning for clonidine toxicity given bradycardia, hypertension. He was given narcan 0.5 mg without response, but improved after receiving a second 0.5mg dose. He became lethargic again, and received another 0.5mg of narcan and was started on narcan gtt at 1.25mg/hr. . Upon arrival to the MICU the patient is lethargic, and minimally responsive to sternal rub. He withdraws to pain, PERRL. He is minimally responsive to ABG, but does withdraw to the pain. ABG 7.45/80/45 on 3L. There is no improvement with narca 0.5mg x 2. . Review of systems: unable to obtain [**2-3**] lethargy. Past Medical History: - hep C positive - bilateral sciatica - anxiety disorder vs. personality disorder - h/o heroin dependence and cocaine abuse Previous psychiatric history: - h/o panic attacks tx'd by an outpatient psychiatrist Dr. [**Last Name (STitle) 24051**] - h/o multiple psychiatric and detox admissions - h/o several suicide attempts including with heroin OD >2 y ago Per his ICM at MBHP [**First Name8 (NamePattern2) 55644**] [**Last Name (NamePattern1) 5448**] [**Telephone/Fax (1) 55645**] she reports that: - [**Hospital **] hospital [**Date range (1) 42060**] - CAB detox [**Date range (1) 19139**] - Brounweed [**4-21**], steped down to eATS [**4-25**] - CAB [**5-1**] for detox for two days - Bournwood [**Date range (1) 1261**] - [**2117-5-18**] step down to EATS [**Doctor Last Name **] [**Date range (1) 55646**], extended to [**6-9**] Social History: Pt reports a good family, finished HS, family is in law enforcemtn; brother is a homicide investigator; pt reports receving a $100,000 inheritance several years ago and using cocaine and drugs until he ran through the money; estranged from his family Family History: No family h/o of dx'd psychiatric disorders Physical Exam: Vitals: 60 140/90 29 99% on 3L General: lethargic, withdraws to pain. HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation anteriorly, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: obsese, +striaea, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema NEURO: PERRL, occulocephalic reflex intact, toes downgoing. withdraws to pain in all four extremities. Pertinent Results: On admission: [**2200-6-9**] 07:15PM BLOOD WBC-6.3 RBC-4.78 Hgb-13.7* Hct-39.1* MCV-82 MCH-28.7 MCHC-35.1* RDW-14.3 Plt Ct-221 [**2200-6-9**] 07:15PM BLOOD Glucose-116* UreaN-12 Creat-1.1 Na-139 K-4.2 Cl-101 HCO3-30 AnGap-12 [**2200-6-9**] 07:15PM BLOOD Calcium-9.6 Phos-3.7 Mg-2.0 [**2200-6-9**] 07:15PM BLOOD ALT-39 AST-37 LD(LDH)-195 AlkPhos-98 TotBili-0.7 [**2200-6-9**] 07:15PM BLOOD PT-14.4* PTT-31.5 INR(PT)-1.3* . [**2200-6-10**] 12:08AM BLOOD Type-ART Temp-36.5 O2 Flow-3 pO2-84* pCO2-40 pH-7.45 calTCO2-29 Base XS-3 Intubat-NOT INTUBA Comment-O2 DELIVER [**2200-6-10**] 12:08AM BLOOD Lactate-0.8 [**2200-6-10**] 05:34AM BLOOD TSH-0.67 [**2200-6-9**] 07:15PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2200-6-9**] 08:13PM URINE bnzodzp-POS barbitr-POS opiates-NEG cocaine-NEG amphetm-NEG mthdone-POS . [**2200-6-9**] 08:13PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.015 [**2200-6-9**] 08:13PM URINE Blood-NEG Nitrite-NEG Protein-TR Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-1 pH-7.0 Leuks-NEG [**2200-6-9**] 08:13PM URINE RBC-0-2 WBC-0-2 Bacteri-FEW Yeast-NONE Epi-0-2 . On discharge: [**2200-6-10**] 05:34AM BLOOD WBC-9.4 RBC-4.74 Hgb-13.7* Hct-38.7* MCV-82 MCH-28.9 MCHC-35.4* RDW-14.3 Plt Ct-237 [**2200-6-10**] 05:34AM BLOOD Glucose-129* UreaN-12 Creat-0.8 Na-137 K-4.3 Cl-104 HCO3-26 AnGap-11 [**2200-6-10**] 05:34AM BLOOD Calcium-9.5 Phos-4.1 Mg-2.0 Brief Hospital Course: 39M found wandering in traffic admitted with altered mental status [**2-3**] substance abuse. . # Altered mental status: Discharged from detox program on day of admission, presenting with altered mental status. Given prescribed medications found with him, mostly likely [**2-3**] benzo and clonidine abuse although also taking higher doses of gabapentin than prescribed. Denied suicidal ideation but noted to have very impulsive behavior on psych eval. Was to be discharged on same medication regimen and f/u with outpatient prescribing psychiatrist. However, later called mother threatening suicide. Given this new information, made Section 12 with plan to discharge pt to dual diagnosis facility. Pt continued on home clonidine and gabapentin; recommended ativan 2mg tid prn agitation and zyprexa 5mg tid prn agitation by Psych. . # Sinus bradycardia: [**Month (only) 116**] be [**2-3**] to medication intoxication although pt also reports bradycardia at baseline. No evidence of infarct on ECG. . # Code: Presumed full . # Communication: With patient and mother, [**Name (NI) **] [**Name (NI) 55647**] ([**Telephone/Fax (1) 55648**]). Medications on Admission: Medications: (filled at CVS [**Telephone/Fax (1) 55649**], Rx by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 24051**]) - neurontin 800mg po tid - clonidine 0.1 mg po tid - cvs stool softener 100mg po bid - alprazolam 4mg po qdaily Per [**Doctor Last Name **]: - clonidine 0.1 mg tid - colace 100mg [**Hospital1 **] - abilify 5 mg at hs - vistaril 50 mg tid - methadone 85 mg a day Discharge Medications: 1. Methadone 5 mg Tablet Sig: Seventeen (17) Tablet PO DAILY (Daily). 2. Neurontin 800 mg Tablet Sig: One (1) Tablet PO three times a day. 3. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO three times a day. 4. Lorazepam 1 mg Tablet Sig: Two (2) Tablet PO three times a day as needed for agitation. 5. Zyprexa 5 mg Tablet Sig: One (1) Tablet PO three times a day as needed for agitation. 6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital 1680**] Hospital - [**Location (un) 538**] Discharge Diagnosis: Clonidine overdose Intoxication Discharge Condition: Medical issues stable for transfer to dual diagnosis facility Discharge Instructions: You were evaluated for your unusual behavior which was felt related to your overuse of drugs such as xanax, clonidine, methadone, and neurontin. You were evaluated by Psychiatry here and are being discharged to a dual diagnosis facility. No changes were made to your medications, and you should take all medications as prescribed. Many of your medications can cause drowsiness or impaired judgment. Taking more than prescribed can be harmful to your health and to those around you. Please review your medication regimen further with a physician. Seek immediate medical attention if you develop chest pain, difficulty breathing, confusion, thoughts about hurting yourself or others, or any other concerning symptoms. Followup Instructions: Please follow up with your outpatient psychiatrist after your discharge from your dual diagnosis facility. Completed by:[**2200-6-11**]

972,304,070,V458,724,427,300,301,E858

{'Poisoning by other antihypertensive agents,Opioid type dependence, continuous,Chronic hepatitis C without mention of hepatic coma,Aortocoronary bypass status,Sciatica,Other specified cardiac dysrhythmias,Anxiety state, unspecified,Unspecified personality disorder,Accidental poisoning by agents primarily affecting cardiovascular system'}

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: altered mental status PRESENT ILLNESS: 39M found walking in and out of traffic on the street by EMS, with periods of combativeness and lethargy on scene, who was brought to the ED. . In ED VS= 98.4 146/95 56 17 100%RA. He was found to have a graduation certificate from [**Doctor First Name **] street treatment resources step down services in his backpack. He was intermittently combative and lethargic. He had bottles of his own clonidine, neurontin, and xanax with him, and by report, a slip saying he was on methadone 85mg qdaily. . Labs were essentially unremarkable (INR 1.3, UA with few bacteria). ECG revealed sinus bradycardia. Head CT was attempted, but cancelled as pt would not sit still. . He presentation was concerning for clonidine toxicity given bradycardia, hypertension. He was given narcan 0.5 mg without response, but improved after receiving a second 0.5mg dose. He became lethargic again, and received another 0.5mg of narcan and was started on narcan gtt at 1.25mg/hr. . Upon arrival to the MICU the patient is lethargic, and minimally responsive to sternal rub. He withdraws to pain, PERRL. He is minimally responsive to ABG, but does withdraw to the pain. ABG 7.45/80/45 on 3L. There is no improvement with narca 0.5mg x 2. MEDICAL HISTORY: - hep C positive - bilateral sciatica - anxiety disorder vs. personality disorder - h/o heroin dependence and cocaine abuse Previous psychiatric history: - h/o panic attacks tx'd by an outpatient psychiatrist Dr. [**Last Name (STitle) 24051**] - h/o multiple psychiatric and detox admissions - h/o several suicide attempts including with heroin OD >2 y ago Per his ICM at MBHP [**First Name8 (NamePattern2) 55644**] [**Last Name (NamePattern1) 5448**] [**Telephone/Fax (1) 55645**] she reports that: - [**Hospital **] hospital [**Date range (1) 42060**] - CAB detox [**Date range (1) 19139**] - Brounweed [**4-21**], steped down to eATS [**4-25**] - CAB [**5-1**] for detox for two days - Bournwood [**Date range (1) 1261**] - [**2117-5-18**] step down to EATS [**Doctor Last Name **] [**Date range (1) 55646**], extended to [**6-9**] MEDICATION ON ADMISSION: Medications: (filled at CVS [**Telephone/Fax (1) 55649**], Rx by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 24051**]) - neurontin 800mg po tid - clonidine 0.1 mg po tid - cvs stool softener 100mg po bid - alprazolam 4mg po qdaily Per [**Doctor Last Name **]: - clonidine 0.1 mg tid - colace 100mg [**Hospital1 **] - abilify 5 mg at hs - vistaril 50 mg tid - methadone 85 mg a day ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals: 60 140/90 29 99% on 3L General: lethargic, withdraws to pain. HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation anteriorly, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: obsese, +striaea, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema NEURO: PERRL, occulocephalic reflex intact, toes downgoing. withdraws to pain in all four extremities. FAMILY HISTORY: No family h/o of dx'd psychiatric disorders SOCIAL HISTORY: Pt reports a good family, finished HS, family is in law enforcemtn; brother is a homicide investigator; pt reports receving a $100,000 inheritance several years ago and using cocaine and drugs until he ran through the money; estranged from his family ### Response: {'Poisoning by other antihypertensive agents,Opioid type dependence, continuous,Chronic hepatitis C without mention of hepatic coma,Aortocoronary bypass status,Sciatica,Other specified cardiac dysrhythmias,Anxiety state, unspecified,Unspecified personality disorder,Accidental poisoning by agents primarily affecting cardiovascular system'}