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CHIEF COMPLAINT: PRESENT ILLNESS: This is a 62-year-old male with a history of metastatic malignant melanoma metastatic to liver, lungs, and brain and small bowel who was admitted with right flank pain times two days and shortness of breath times two days. The patient had woken up from sleep four days ago with right flank pain which was pleuritic and radiated to the chest and arm. He became short of breath two days prior to admission. The patient had two recent car trips, had no leg swelling, and the review of systems was otherwise negative. MEDICAL HISTORY: 1. Malignancy melanoma diagnosed in [**2107**]. 2. Brain metastases status post XRT whole-brain radiation in the spring and summer of [**2120**]. 3. Cranial bleed in 12/[**2119**]. 4. Seizure in 12/[**2119**]. 5. Stereotactic radiosurgery to the frontal lobe. 6. Lung and small bowel metastases. MEDICATION ON ADMISSION: ALLERGIES: 1. Reglan. 2. Iodine although he can take contrast. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Patient is a former urologist and his oncologist fellow is [**First Name5 (NamePattern1) 402**] [**Last Name (NamePattern1) 41157**].

Other pulmonary embolism and infarction,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Other convulsions,Personal history of malignant melanoma of skin

Pulm embol/infarct NEC,Secondary malig neo lung,Sec mal neo brain/spine,Convulsions NEC,Hx-malig skin melanoma

Admission Date: [**2120-9-23**] Discharge Date: [**2120-9-28**] Date of Birth: [**2058-6-2**] Sex: M Service: [**Company 191**] PRESENT ILLNESS: This is a 62-year-old male with a history of metastatic malignant melanoma metastatic to liver, lungs, and brain and small bowel who was admitted with right flank pain times two days and shortness of breath times two days. The patient had woken up from sleep four days ago with right flank pain which was pleuritic and radiated to the chest and arm. He became short of breath two days prior to admission. The patient had two recent car trips, had no leg swelling, and the review of systems was otherwise negative. Patient was first diagnosed in [**2107**] with melanoma and has been complicated by cerebral hemorrhage in [**12/2119**] with associated seizures status post craniotomy and also by the aforementioned metastases to liver and small bowel. Patient most recently has been treated on Dilantin, thalidomide, Temozolomide. This patient is status post numbers of years of chemotherapy and adjuvant treatment, including Interferon, IL2, and the most recent therapy listed above. Patient was enrolled in the current clinical trial in [**2120-6-30**], which has included whole-brain radiation, Temozolomide, and thalidomide. He recently completed the first 10-week cycle two weeks ago, and repeat CT scans and the brain MRI, which were done on [**9-12**], revealed significant regression in his ............ abdominal and pelvic disease, undetectable pulmonary nodules, and regression of the lesions in his brain. Patient had numerous risk factors for a clot, which included his known malignancy, his treatment with thalidomide, which can be prothrombotic, his long car rides, which were greater than three hours times two. In the Emergency Room the patient had a CT angiogram which showed 1) bilateral large pulmonary emboli with clot in the left main pulmonary artery bifurcation of the left and right main pulmonary arteries, 2) right-sided pulmonary effusion, and 3) collaterals of left chest wall suggesting a left subclavian clot. Patient was not started on anticoagulation given his past medical history of spontaneous bleeding and his melanoma metastases to the brain. Patient was admitted from the Emergency Room to the [**Hospital Unit Name 153**]. PAST MEDICAL HISTORY: 1. Malignancy melanoma diagnosed in [**2107**]. 2. Brain metastases status post XRT whole-brain radiation in the spring and summer of [**2120**]. 3. Cranial bleed in 12/[**2119**]. 4. Seizure in 12/[**2119**]. 5. Stereotactic radiosurgery to the frontal lobe. 6. Lung and small bowel metastases. ALLERGIES: 1. Reglan. 2. Iodine although he can take contrast. SOCIAL HISTORY: Patient is a former urologist and his oncologist fellow is [**First Name5 (NamePattern1) 402**] [**Last Name (NamePattern1) 41157**]. OUTPATIENT MEDICATIONS: 1. Dilantin 300 b.i.d. 2. Chemotherapy with Temozolomide and thalidomide, as mentioned before. EXAM ON ADMISSION: Vital signs: 94% Oxygen saturation on two liters nasal cannula. Blood pressure was 140/76. Heart rate 65. In general this was a middle-aged man lying flat post procedure. Pain with movements. HEENT showed alopecia, plethora of the head and face. Oropharynx: Clear, PERRL and bilateral nystagmus. Jugular venous distention lying flat 4 cm from clavicular line. No carotid bruits. Lungs: Right-sided one-third up reduced breath sounds, rales at the edge of the base, reduced breath sounds bilaterally, reduced fremita. Cardiovascular: Regular rate, S1, S2, elevated T2, no murmurs, gallops, rubs. Abdomen: Nontender, soft, positive bowel sounds. Extremities: No clubbing, cyanosis, edema, [**3-3**] dorsalis pedis and posterior tibial. Neuro: Alert and oriented, pleasant. There are no significant laboratory abnormalities on admission. HOSPITAL COURSE: Patient was admitted from the Emergency Room where he had a CT angiogram showing 1) bilateral large pulmonary embolus with the largest embolus seen in the left main pulmonary artery; saddle embolus is present, 2) right-sided pleural effusion, 3) collateral vessels seen within the left chest wall suggesting occlusion of the left subclavian. Patient also went directly to Interventional Radiology as he was not a candidate for coagulation for aforementioned spontaneous intracranial bleed. In [**2119-12-31**] patient had IVC filter placed as well as an echocardiogram to evaluate the hemodynamic effects of the pulmonary embolism and to guide IV fluid therapy. Patient had successful placement of Gunther-Tulip vena cava filter just below the level of the renal vein from the common femoral approach. Patient also had bilateral lower extremity Dopplers performed on [**2120-9-24**]. The results were 1) nonocclusive thrombus at the right common femoral vein which has extensions to the greater saphenous vein and the deep femoral vein, 2) no evidence of left lower extremity deep venous thrombosis. Patient also had echocardiogram on [**2120-9-23**]. The conclusions were left atrium normal in size. Left ventricular wall thickness is normal. Left ventricular cavity size is normal. Overall ventricular systolic size is normal with left ventricular ejection fraction of 50 to 70%. No masses or thrombi are seen in the left ventricle. The aortic root is moderately dilated. The mitral valve appears structurally normal, a trivial mitral regurgitation. The tricuspid leaflets are mildly thickened. Moderate 2+ TR regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion compared with the findings of prior report of [**2120-4-19**], left ventricular enlargement is no longer apparent. Given this result, deemed that right ventricular failure was not present, patient was transferred from the [**Hospital Unit Name 153**] to the floor on [**2120-9-24**] in good condition. Patient was satting approximately 95 to 96% on transfer on room air but was continuously short on breath with any walking or activity such as brushing teeth. Again, the issue of anticoagulation was addressed on [**2120-9-25**] with differing specialists suggesting alternative approaches. To better assess the patient's risk, a head CT without contrast was performed. The results of the CT were no acute hemorrhage or mass effect, stable appearance of the right frontal lobe resection bed, and left cerebral hemorrhage likely due to punctate left cerebellar tonsillar metastases. The finding of small focus of hyperdensity within the left cerebellum was consistent with the finding of susceptibility within the same region on a prior MRI and likely represented an area of old hemorrhage into a metastatic lesion. This result like the issue of anticoagulation remaining complex. There was the issue of recent hemorrhage into the cerebellar metastases. In addition, patient had large pulmonary embolus. Patient was loathed to begin anticoagulation and wanted to wait and see if he had more sequelae from clotting before addressing anticoagulation, especially given that he had a filter placed to prevent further pulmonary embolus from the lower extremities. The issue of propagation of the existing clot was discussed at length with Oncology as well as the Pulmonary team. Pulmonology does not recommend anticoagulation with the idea that Heparin would not significantly affect propagation of the existing clot and the clot would eventually be reabsorbed and the patient would still have significant risk of bleeding into his metastatic lesion. On [**2120-9-27**] the patient had sudden onset chest pain with pleuritic component. His blood pressure was unchanged. His heart rate was stable. Patient was not short of breath, and his oxygen saturation remained at 96% on room air. Patient was much worse with inspiration. EKG showed no S-T depressions, no T-wave inversions, no new Q-waves and was relatively unchanged from his admission EKG. A stat portable chest x-ray was performed on [**2120-9-27**] showing 1) improving right lower lobe atelectasis versus consolidation, 2) patchy opacity of the left lateral lung field corresponding to area of pulmonary embolus on recent CT scan. Exam was otherwise unchanged from prior study and was negative for pneumothorax or new pneumonia. Given these results pain was attributed to the existing pulmonary embolus, and pain was eventually controlled on intravenous Dilaudid. On [**2120-9-28**] patient awoke with pain relieved, intermittent nausea. Patient was otherwise stable with normal blood pressure, heart rate, oxygen saturation on room air, and desire to go home. The coverage Oncology attending agreed that the patient should be discharged. Patient was discharged home in good condition. DISCHARGE DIAGNOSES: 1. Pulmonary embolism. 2. Melanoma. DISCHARGE INSTRUCTIONS: Patient was recommended to follow up with Dr. [**Last Name (STitle) 1729**] within one week. DISCHARGE MEDICATIONS: 1. Phenytoin 300 mg p.o. b.i.d. 2. Colace 200 mg p.o. b.i.d. 3. Benadryl 25 mg p.o. q. six hours p.r.n. itching. 4. Dilaudid 4 mg tablets, three to five tablets p.o. q. four hours p.r.n. pain. 5. Zofran 8 mg tablets, one tablet p.o. t.i.d. p.r.n. nausea. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. Dictated By:[**Name8 (MD) 41158**] MEDQUIST36 D: [**2120-9-28**] 14:04 T: [**2120-9-29**] 17:12 JOB#: [**Job Number 41159**]

415,197,198,780,V108

{'Other pulmonary embolism and infarction,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Other convulsions,Personal history of malignant melanoma of skin'}

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 62-year-old male with a history of metastatic malignant melanoma metastatic to liver, lungs, and brain and small bowel who was admitted with right flank pain times two days and shortness of breath times two days. The patient had woken up from sleep four days ago with right flank pain which was pleuritic and radiated to the chest and arm. He became short of breath two days prior to admission. The patient had two recent car trips, had no leg swelling, and the review of systems was otherwise negative. MEDICAL HISTORY: 1. Malignancy melanoma diagnosed in [**2107**]. 2. Brain metastases status post XRT whole-brain radiation in the spring and summer of [**2120**]. 3. Cranial bleed in 12/[**2119**]. 4. Seizure in 12/[**2119**]. 5. Stereotactic radiosurgery to the frontal lobe. 6. Lung and small bowel metastases. MEDICATION ON ADMISSION: ALLERGIES: 1. Reglan. 2. Iodine although he can take contrast. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: Patient is a former urologist and his oncologist fellow is [**First Name5 (NamePattern1) 402**] [**Last Name (NamePattern1) 41157**]. ### Response: {'Other pulmonary embolism and infarction,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Other convulsions,Personal history of malignant melanoma of skin'}

CHIEF COMPLAINT: chest pain PRESENT ILLNESS: Pt is a 47 yo caucasian male w/ PMHx significant for HTN, PAF who p/w chest pain. Pt works as a police officer and recalls one week earlier experiencing chest pain when arresting a felon. He states that the pain was sharp in the middle of his chest and he had not experienced these symptoms before. This afternoon the patient was riding on an exercise bike at home when he experienced similar 8/10 chest pain that radiated to his arms. He stopped biking and felt sweaty and nauseated. The pain was constant and not relieved by rest. He states that he climbed stairs in his house with great difficulty and rested on the floor of a room feeling extremely fatigued. Pt does not report heart palpitaions, pleuritic chest pain, or fever. An ambulance was called and the patient was taken to [**Hospital1 3325**]. In the ambulance the patient received SL nitroglycerin w/o relief. . In ED, EKG showed [**Street Address(2) 1766**] elevations in II, III, aVF and 3mm elevations in V3-V4. R sided EKG showed .[**Street Address(2) **] elevation in V4. Pt was given ASA, morphine, lopressor, heparin gtt, aggrestat gtt, and nitro gtt - his pain came down to 4/10. He was then transferred to [**Hospital1 18**] for catheterization. . In cath lab, pt found to 100% stenosis in the mid RCA s/p stent placement. He was transferred to CCU for further observation on aggrenox gtt and nitro gtt to prevent vasospasm. MEDICAL HISTORY: HTN diagnosed in 20's, pt took lopressor for 10 years and then stopped due to hypotension. . Questionable atrial fibrillation - pt states that he has been hospitalized previously due to a-fib. . Tonsillectomy MEDICATION ON ADMISSION: none ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals - Temp 98.7 BP 119/77 P 82 RR 14 O2sat 99% RA FAMILY HISTORY: Father - MI, atrial fibrillation, stroke. SOCIAL HISTORY: Pt is a police officer, lives at home with wife and two children. He has never smoked. He drinks 3 drinks/week.

Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension

AMI inferior wall, init,Crnry athrscl natve vssl,Atrial fibrillation,Pure hypercholesterolem,Hypertension NOS

Admission Date: [**2151-12-22**] Discharge Date: [**2151-12-24**] Date of Birth: [**2104-4-12**] Sex: M Service: MEDICINE Allergies: No Drug Allergy Information on File Attending:[**First Name3 (LF) 425**] Chief Complaint: chest pain Major Surgical or Invasive Procedure: Cardiac catheterization History of Present Illness: Pt is a 47 yo caucasian male w/ PMHx significant for HTN, PAF who p/w chest pain. Pt works as a police officer and recalls one week earlier experiencing chest pain when arresting a felon. He states that the pain was sharp in the middle of his chest and he had not experienced these symptoms before. This afternoon the patient was riding on an exercise bike at home when he experienced similar 8/10 chest pain that radiated to his arms. He stopped biking and felt sweaty and nauseated. The pain was constant and not relieved by rest. He states that he climbed stairs in his house with great difficulty and rested on the floor of a room feeling extremely fatigued. Pt does not report heart palpitaions, pleuritic chest pain, or fever. An ambulance was called and the patient was taken to [**Hospital1 3325**]. In the ambulance the patient received SL nitroglycerin w/o relief. . In ED, EKG showed [**Street Address(2) 1766**] elevations in II, III, aVF and 3mm elevations in V3-V4. R sided EKG showed .[**Street Address(2) **] elevation in V4. Pt was given ASA, morphine, lopressor, heparin gtt, aggrestat gtt, and nitro gtt - his pain came down to 4/10. He was then transferred to [**Hospital1 18**] for catheterization. . In cath lab, pt found to 100% stenosis in the mid RCA s/p stent placement. He was transferred to CCU for further observation on aggrenox gtt and nitro gtt to prevent vasospasm. Past Medical History: HTN diagnosed in 20's, pt took lopressor for 10 years and then stopped due to hypotension. . Questionable atrial fibrillation - pt states that he has been hospitalized previously due to a-fib. . Tonsillectomy Social History: Pt is a police officer, lives at home with wife and two children. He has never smoked. He drinks 3 drinks/week. Family History: Father - MI, atrial fibrillation, stroke. Physical Exam: Vitals - Temp 98.7 BP 119/77 P 82 RR 14 O2sat 99% RA Gen - lying in bed comfortable, NAD HEENT - dry mmm, PERRL, EOMI, no JVD CV - RRR nl S1 S2 no m/r/g Resp - CTA b/l Abd - soft NT ND + BS Ext - no c/c/e Groin - c/d/i Neuro - A&O x3, CN II-XII intact Pertinent Results: TTE - The left atrium is normal in size. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Resting regional wall motion abnormalities include mild interior/inferolateral hypokinesis. Right ventricular chamber size is normal; cannot exclude free wall hypokinesis. The ascending aorta is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. . Catheterization report - R dominant system. LAD 50% proximal stenosis. RCA 50% proximal stenosis, 100% stenosis of mid vessel. RA 16. PAP 34/24. PCW 18. CI 2.5. . [**2151-12-22**] 10:03PM GLUCOSE-114* UREA N-12 CREAT-0.9 SODIUM-140 POTASSIUM-4.4 CHLORIDE-107 TOTAL CO2-20* ANION GAP-17 [**2151-12-22**] 10:03PM CK(CPK)-250* [**2151-12-22**] 10:03PM CK-MB-30* MB INDX-12.0* cTropnT-0.40* [**2151-12-22**] 10:03PM CALCIUM-8.4 PHOSPHATE-2.5* MAGNESIUM-1.6 CHOLEST-211* [**2151-12-22**] 10:03PM TRIGLYCER-123 HDL CHOL-49 CHOL/HDL-4.3 LDL(CALC)-137* [**2151-12-22**] 10:03PM WBC-10.6 RBC-4.25* HGB-14.2 HCT-38.3* MCV-90 MCH-33.5* MCHC-37.2* RDW-12.4 [**2151-12-22**] 10:03PM PLT COUNT-165 [**2151-12-22**] 10:03PM PT-13.2 PTT-31.1 INR(PT)-1.1 Brief Hospital Course: CAD - The patient was admitted to the CCU post-catheterization in stable condition. He was continued on aggrenox 18 hours post-catheterization. He was maintained with light hydration, aspirin, statin, plavix, beta blocker, and ACE inhibitor. He tolerated his CCU stay without complications. . Pump - TTE was obtained following catheterization and showed an EF of 55% w/ mild interior/inferolateral hypokinesis. He was d/c home on an ACE inhibitor. . Rhythm - Patient was in normal sinus rhythm upon d/c. . [**Name (NI) **] - Pt was d/c to home on aspirin, plavix, toprol xl, lisinopril, and lipitor. He was instructed to follow up with his primary care physician [**Last Name (NamePattern4) **] [**1-1**] weeks with cardiology follow up in one month. Medications on Admission: none Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). [**Date Range **]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Date Range **]:*30 Tablet(s)* Refills:*2* 3. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). [**Date Range **]:*60 Tablet(s)* Refills:*2* 4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). [**Date Range **]:*30 Tablet(s)* Refills:*2* 5. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO once a day. [**Date Range **]:*30 Tablet Sustained Release 24HR(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Inferior Myocardial Infarction s/p RCA stent Secondary Diagnoses: 1. Hypertension 2. h/o Paroxysml Atrial Fibrillation Discharge Condition: Stable Discharge Instructions: Please contact your primary care doctor or call 911 should you have any chest pain, shortness of breath, palpitations, or any other worrisome symptoms. Take all of your medications as prescribed. Followup Instructions: Please follow up with your primary care doctor in [**1-1**] weeks and ask him to refer you to cardiac rehabilitation. Please call [**Hospital3 **] Cardiology ([**0-0-**]) when you are discharged to make an appointment with Dr. [**Last Name (STitle) **] or Dr. [**Last Name (STitle) 13175**] (to follow up within one month).

410,414,427,272,401

{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Pure hypercholesterolemia,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: Pt is a 47 yo caucasian male w/ PMHx significant for HTN, PAF who p/w chest pain. Pt works as a police officer and recalls one week earlier experiencing chest pain when arresting a felon. He states that the pain was sharp in the middle of his chest and he had not experienced these symptoms before. This afternoon the patient was riding on an exercise bike at home when he experienced similar 8/10 chest pain that radiated to his arms. He stopped biking and felt sweaty and nauseated. The pain was constant and not relieved by rest. He states that he climbed stairs in his house with great difficulty and rested on the floor of a room feeling extremely fatigued. Pt does not report heart palpitaions, pleuritic chest pain, or fever. An ambulance was called and the patient was taken to [**Hospital1 3325**]. In the ambulance the patient received SL nitroglycerin w/o relief. . In ED, EKG showed [**Street Address(2) 1766**] elevations in II, III, aVF and 3mm elevations in V3-V4. R sided EKG showed .[**Street Address(2) **] elevation in V4. Pt was given ASA, morphine, lopressor, heparin gtt, aggrestat gtt, and nitro gtt - his pain came down to 4/10. He was then transferred to [**Hospital1 18**] for catheterization. . In cath lab, pt found to 100% stenosis in the mid RCA s/p stent placement. He was transferred to CCU for further observation on aggrenox gtt and nitro gtt to prevent vasospasm. MEDICAL HISTORY: HTN diagnosed in 20's, pt took lopressor for 10 years and then stopped due to hypotension. . Questionable atrial fibrillation - pt states that he has been hospitalized previously due to a-fib. . Tonsillectomy MEDICATION ON ADMISSION: none ALLERGIES: No Drug Allergy Information on File PHYSICAL EXAM: Vitals - Temp 98.7 BP 119/77 P 82 RR 14 O2sat 99% RA FAMILY HISTORY: Father - MI, atrial fibrillation, stroke. SOCIAL HISTORY: Pt is a police officer, lives at home with wife and two children. He has never smoked. He drinks 3 drinks/week. ### Response: {'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension'}

CHIEF COMPLAINT: This patient presented with what he described as weakness in his legs and headaches. PRESENT ILLNESS: This patient presented with what he described as weakness in his legs and headaches. The MRI scan showed a homogeneously enhancing lesion in the left parietal lobe para medially which completely occluded the sagittal sinus. There is very little para focal edema. The tumor has a maximum diameter of 3.4 cm already. The situation was discussed with him and clearly primary radiosurgery is inappropriate due to the size of the tumor. Also wait and see strategy given the size and the inhomogeneity of the contrast enhancement, which was suspicious for atypical features was not advisable. Mr. [**Known lastname **] [**Last Name (Titles) 54345**] for an at least partial resection to obtain histological diagnosis and provide conditions that make radiosurgery of the tumor parts and the sinus a possibility. MEDICAL HISTORY: unknown MEDICATION ON ADMISSION: pioglitazone, glimepiride, atorvastatin, metoprolol tartrate, omeprazole ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam upon discharge: The patient was oriented x 3. PERRL, EOMs intact. Face symmetric, tongue midline. He was moving all 4 extremities spontaneously and was walking on his own. His sensation was intact. No pronator drift. FAMILY HISTORY: non-contributory SOCIAL HISTORY: lives with wife

Benign neoplasm of cerebral meninges,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Asthma, unspecified type, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

Ben neo cerebr meninges,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Asthma NOS,DMII wo cmp nt st uncntr

Admission Date: [**2140-3-3**] Discharge Date: [**2140-3-6**] Date of Birth: [**2069-6-7**] Sex: M Service: NEUROSURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1854**] Chief Complaint: This patient presented with what he described as weakness in his legs and headaches. Major Surgical or Invasive Procedure: left craniotomy for tumor resection [**2140-3-3**] History of Present Illness: This patient presented with what he described as weakness in his legs and headaches. The MRI scan showed a homogeneously enhancing lesion in the left parietal lobe para medially which completely occluded the sagittal sinus. There is very little para focal edema. The tumor has a maximum diameter of 3.4 cm already. The situation was discussed with him and clearly primary radiosurgery is inappropriate due to the size of the tumor. Also wait and see strategy given the size and the inhomogeneity of the contrast enhancement, which was suspicious for atypical features was not advisable. Mr. [**Known lastname **] [**Last Name (Titles) 54345**] for an at least partial resection to obtain histological diagnosis and provide conditions that make radiosurgery of the tumor parts and the sinus a possibility. Past Medical History: unknown Social History: lives with wife Family History: non-contributory Physical Exam: Exam upon discharge: The patient was oriented x 3. PERRL, EOMs intact. Face symmetric, tongue midline. He was moving all 4 extremities spontaneously and was walking on his own. His sensation was intact. No pronator drift. Pertinent Results: Post-op MRI [**2140-3-4**]: FINDINGS: Postoperative changes are seen in the area of partially resected meningioma in the high left occipital lobe adjacent to the sagittal sinus. There are small foci of blood products in the operative bed, and a tiny amount of left subdural blood. Some residual enhancing mass remains adjacent to the superior sagittal sinus. Signal change within the sinus itself is not significantly changed from prior exam, allowing for technical factors. There is high signal on T2W images within the portions of the sagittal sinus inferior to the resection site suggestive of slow flow, but normal enhancement within these areas on post-contrast images, and no increased signal on precontrast T1W images to suggest thrombus. Ventricular size and configuration is unchanged. There is no evidence of acute ischemia. Mildly restricted diffusion signal at the operative bed is compatible with postsurgical change. Old infarct in the brainstem is unchanged. IMPRESSION: 1. Postoperative change at the site of recently resected meningioma, with some residual enhancing tumor, and unchanged signal abnormality within the adjacent superior sagittal sinus which may represent tumoral invasion or thrombus. CTV or phase-contrast MRV could be performed to further evaluate this area if clinically indicated. 2. Findings most consistent with slow flow within the sagittal sinus inferior to the resection site. No additional evidence of sinus thrombosis. 3. No evidence of acute infarction. CT Head [**2140-3-3**]: FINDINGS: High left parietal meningioma has been resected via left parietal craniotomy. Expected postsurgical change is seen in the resection bed. There is no sign of large intracranial hemorrhage. Moderate amount of pneumocephalus is present. There is no sign of mass effect, or vascular territorial infarction. Ventricles and sulci are unchanged in size and configuration, allowing for differences in modality. IMPRESSION: Expected post-surgical change status post resection of left parietal meningioma. No large intracranial hemorrhage. Pathology: pending at time of discharge but the frozen section showed meningioma with atypical features Brief Hospital Course: The patient underwent elective craniotomy for tumor resection on [**2140-3-3**]. The surgery went well. He did require intra-operative platelets due to some bleeding. He had previously been on aspirin but discontinued it 10 days before the surgery. The patient went to the ICU post-operatively. His CT scan showed no large hemorrhage with expected post-surgical changes in the operative bed. The MRI showed some residual tumor as well as some blood in the surgical bed and small amount of SDH. Neurologically the patient was doing very well. He was transferred to the floor on [**3-4**]. The patient was evaluated by PT and was deemed safe to be discharged with his family. He was ambulating, voiding, and taking in food without difficulty. He was discharged on [**2140-3-6**]. Medications on Admission: pioglitazone, glimepiride, atorvastatin, metoprolol tartrate, omeprazole Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. Pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Tablet(s) 4. Glimepiride 2 mg Tablet Sig: One (1) Tablet PO daily (). 5. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 8. Dexamethasone 1 mg Tablet Sig: One (1) Tablet PO every eight (8) hours for 1 days. Disp:*3 Tablet(s)* Refills:*0* 9. 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:*1* 10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO every eight (8) hours: Please follow up with pcp for BP monitoring. Disp:*30 Tablet(s)* Refills:*1* Discharge Disposition: Home Discharge Diagnosis: meningioma with atypical features Discharge Condition: neurologically stable Discharge 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 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. ?????? 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 haven been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. ?????? 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, unless you have been instructed not to. 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. Followup Instructions: ??????Please return to the office in [**6-24**] days(from your date of surgery) for removal of your sutures and/or a wound check. This appointment can be made with the Nurse 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 have a Brain [**Hospital 341**] Clinic appointment with [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 4861**], MD Phone:[**Telephone/Fax (1) 1844**] Date/Time:[**2140-3-21**] 4:00 pm on [**Hospital Ward Name 23**] 8 on the [**Hospital Ward Name 516**]. Completed by:[**2140-3-9**]

225,403,585,493,250

{'Benign neoplasm of cerebral meninges,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Asthma, unspecified type, 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: This patient presented with what he described as weakness in his legs and headaches. PRESENT ILLNESS: This patient presented with what he described as weakness in his legs and headaches. The MRI scan showed a homogeneously enhancing lesion in the left parietal lobe para medially which completely occluded the sagittal sinus. There is very little para focal edema. The tumor has a maximum diameter of 3.4 cm already. The situation was discussed with him and clearly primary radiosurgery is inappropriate due to the size of the tumor. Also wait and see strategy given the size and the inhomogeneity of the contrast enhancement, which was suspicious for atypical features was not advisable. Mr. [**Known lastname **] [**Last Name (Titles) 54345**] for an at least partial resection to obtain histological diagnosis and provide conditions that make radiosurgery of the tumor parts and the sinus a possibility. MEDICAL HISTORY: unknown MEDICATION ON ADMISSION: pioglitazone, glimepiride, atorvastatin, metoprolol tartrate, omeprazole ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam upon discharge: The patient was oriented x 3. PERRL, EOMs intact. Face symmetric, tongue midline. He was moving all 4 extremities spontaneously and was walking on his own. His sensation was intact. No pronator drift. FAMILY HISTORY: non-contributory SOCIAL HISTORY: lives with wife ### Response: {'Benign neoplasm of cerebral meninges,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Asthma, unspecified type, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: Hematemesis PRESENT ILLNESS: 61 year old with cryptogenic cirrhosis, CAD s/p CABG, and DMII who has had a general sense of being unwell over the past few days. He had some mild epigastric pain and dark stool, though not like his previous episodes of melena. He saw his PCP today for the dark stools. While at the office he vomited blood. He was sent to the ED and a hematocrit was 29. He was taken to EGD where a large amount of blood was seen in the stomach (fresh and clots). A steady stream of blood was seen and he vomited a large amount of blood. The scope was removed, he was intubated and he was rescoped. An injection of epinephrine was made at the site of bleeding and apparent stoppage in active bleeding. He received 5 units of blood and HCT returned at 24. He received an additional 2 units of blood and his HCT at transfer was 31. During intubation he became hypotensive, a cordis was placed in his RIJ and right femoral. Levophed was started. He has continued to put out blood from his NG tube. At time of transfer to [**Hospital1 18**] he was on octreotide, pantoprazole ([**Hospital1 **]), levophed and propofol. MEDICAL HISTORY: Cryptogenic Cirrhosis, c/b grade 2 esophageal varices, banded in [**4-/2145**] CAD s/p CABG DMII Depression MEDICATION ON ADMISSION: tylenol [**Telephone/Fax (1) 1999**] Q4prn ASA 81 mg daily citalopram 60mg daily iron 325mg PO TID glyburide 6mg PO daily lipoic acid 200mg PO daily Lisinopril 2.5mg PO daily Loratidine 10mg PO daily prn Mag gluconate 250mg PO daily Metformin 1000mg PO BID Multivitamin 1 tab daily Nadolol 20mg daily Pravachol 20mg daily Zantac 150mg PO BID ALLERGIES: Codeine PHYSICAL EXAM: Admission physical exam General: Intubated and sedated HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Normal rate and regular rhythm, soft SEM at upper sternal border, distant heart sounds Abdomen: soft, non-tender, non-distended, decreased bowel sounds, though present, Liver tip at 2 FB BCM. No rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: Not responding, sedated. PERRL. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Salesman at [**Last Name (LF) 90456**], [**First Name3 (LF) **] OSH record. Denies tobacco, occassional alcohol use.

Portal hypertension,Esophageal varices in diseases classified elsewhere, with bleeding,Other shock without mention of trauma,Other and unspecified coagulation defects,Hyperosmolality and/or hypernatremia,Acute venous embolism and thrombosis of superficial veins of upper extremity,Hematemesis,Cirrhosis of liver without mention of alcohol,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Heart valve replaced by transplant,Physical restraints status,Iron deficiency anemia secondary to blood loss (chronic),Hepatitis, unspecified,Thrombocytopenia, unspecified

Portal hypertension,Bleed esoph var oth dis,Shock w/o trauma NEC,Coagulat defect NEC/NOS,Hyperosmolality,Ac embl suprfcl up ext,Hematemesis,Cirrhosis of liver NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,DMII wo cmp nt st uncntr,Depressive disorder NEC,Heart valve transplant,Physical restrain status,Chr blood loss anemia,Hepatitis NOS,Thrombocytopenia NOS

Admission Date: [**2146-8-6**] Discharge Date: [**2146-8-14**] Date of Birth: [**2085-6-17**] Sex: M Service: MEDICINE Allergies: Codeine Attending:[**First Name3 (LF) 8388**] Chief Complaint: Hematemesis Major Surgical or Invasive Procedure: Transjugular intrahepatic portosystemic shunt Esophagogastroduodenoscopy with dermabond placement Intubation (at outside hospital) Central venous catheter (internal jugular and femoral at outside hospital) History of Present Illness: 61 year old with cryptogenic cirrhosis, CAD s/p CABG, and DMII who has had a general sense of being unwell over the past few days. He had some mild epigastric pain and dark stool, though not like his previous episodes of melena. He saw his PCP today for the dark stools. While at the office he vomited blood. He was sent to the ED and a hematocrit was 29. He was taken to EGD where a large amount of blood was seen in the stomach (fresh and clots). A steady stream of blood was seen and he vomited a large amount of blood. The scope was removed, he was intubated and he was rescoped. An injection of epinephrine was made at the site of bleeding and apparent stoppage in active bleeding. He received 5 units of blood and HCT returned at 24. He received an additional 2 units of blood and his HCT at transfer was 31. During intubation he became hypotensive, a cordis was placed in his RIJ and right femoral. Levophed was started. He has continued to put out blood from his NG tube. At time of transfer to [**Hospital1 18**] he was on octreotide, pantoprazole ([**Hospital1 **]), levophed and propofol. Past Medical History: Cryptogenic Cirrhosis, c/b grade 2 esophageal varices, banded in [**4-/2145**] CAD s/p CABG DMII Depression Social History: Salesman at [**Last Name (LF) 90456**], [**First Name3 (LF) **] OSH record. Denies tobacco, occassional alcohol use. Family History: Noncontributory Physical Exam: Admission physical exam General: Intubated and sedated HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Normal rate and regular rhythm, soft SEM at upper sternal border, distant heart sounds Abdomen: soft, non-tender, non-distended, decreased bowel sounds, though present, Liver tip at 2 FB BCM. No rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: Not responding, sedated. PERRL. Transfer physical exam Vitals: T:98.1 BP:132/55 P:79 R:18 O2:98%RA General: obese comfortable appearing man in NAD HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: no wheezes, rales, ronchi CV: Normal rate and regular rhythm, soft SEM at upper sternal border, distant heart sounds Abdomen: soft, non-tender, non-distended, decreased bowel sounds, though present, Liver tip at 2 FB BCM. No rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: A&Ox3. Nonfocal. Moving all extremities. Pertinent Results: Admission labs: [**2146-8-6**] 01:34AM BLOOD WBC-9.1 RBC-3.78* Hgb-11.8* Hct-33.7* MCV-89 MCH-31.1 MCHC-34.9 RDW-15.6* Plt Ct-119* [**2146-8-6**] 01:34AM BLOOD Neuts-75.3* Lymphs-18.8 Monos-3.8 Eos-1.9 Baso-0.2 [**2146-8-6**] 01:34AM BLOOD PT-14.9* PTT-29.7 INR(PT)-1.3* [**2146-8-9**] 11:08AM BLOOD Fibrino-471* [**2146-8-9**] 11:08AM BLOOD FDP-0-10 [**2146-8-6**] 01:34AM BLOOD Glucose-323* UreaN-49* Creat-0.9 Na-140 K-5.0 Cl-113* HCO3-20* AnGap-12 [**2146-8-6**] 01:34AM BLOOD ALT-15 AST-19 AlkPhos-56 TotBili-1.7* [**2146-8-6**] 01:34AM BLOOD Calcium-6.9* Phos-3.8 Mg-1.8 [**2146-8-9**] 11:08AM BLOOD Hapto-56 [**2146-8-8**] 12:51PM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HBcAb-NEGATIVE IgM HAV-NEGATIVE [**2146-8-8**] 12:51PM BLOOD HCV Ab-NEGATIVE [**2146-8-6**] 04:57PM BLOOD Type-ART Temp-37.6 pO2-189* pCO2-32* pH-7.39 calTCO2-20* Base XS--4 [**2146-8-6**] 04:57PM BLOOD Lactate-1.8 Transfer Labs: [**2146-8-9**] 03:14AM BLOOD WBC-5.9 RBC-3.00* Hgb-9.7* Hct-26.1* MCV-87 MCH-32.5* MCHC-37.4* RDW-17.3* Plt Ct-52* [**2146-8-10**] 04:15AM BLOOD WBC-6.5 RBC-3.16* Hgb-9.8* Hct-28.2* MCV-89 MCH-31.1 MCHC-34.8 RDW-16.7* Plt Ct-63* [**2146-8-11**] 04:43AM BLOOD WBC-5.3 RBC-2.88* Hgb-9.0* Hct-26.0* MCV-90 MCH-31.2 MCHC-34.5 RDW-16.5* Plt Ct-58* [**2146-8-12**] 05:00AM BLOOD WBC-5.3 RBC-2.86* Hgb-9.1* Hct-25.9* MCV-91 MCH-31.7 MCHC-35.0 RDW-17.3* Plt Ct-68* [**2146-8-13**] 05:20AM BLOOD WBC-4.9 RBC-2.62* Hgb-8.4* Hct-23.4* MCV-89 MCH-32.2* MCHC-36.1* RDW-17.6* Plt Ct-61* [**2146-8-14**] 04:45AM BLOOD WBC-5.9 RBC-2.44* Hgb-7.8* Hct-21.9* MCV-90 MCH-31.9 MCHC-35.6* RDW-18.0* Plt Ct-68* [**2146-8-14**] 04:45AM BLOOD PT-16.0* PTT-31.1 INR(PT)-1.4* [**2146-8-14**] 04:45AM BLOOD Glucose-235* UreaN-18 Creat-0.8 Na-134 K-3.7 Cl-105 HCO3-24 AnGap-9 [**2146-8-9**] 03:14AM BLOOD ALT-1232* AST-1485* AlkPhos-218* TotBili-1.7* [**2146-8-10**] 04:15AM BLOOD ALT-849* AST-481* AlkPhos-250* TotBili-2.4* [**2146-8-11**] 04:43AM BLOOD ALT-551* AST-186* AlkPhos-258* TotBili-1.7* [**2146-8-12**] 05:00AM BLOOD ALT-355* AST-101* AlkPhos-285* TotBili-1.4 [**2146-8-13**] 05:20AM BLOOD ALT-236* AST-56* AlkPhos-259* TotBili-1.5 [**2146-8-14**] 04:45AM BLOOD ALT-164* AST-48* AlkPhos-244* TotBili-1.3 [**2146-8-14**] 04:45AM BLOOD PT-16.0* PTT-31.1 INR(PT)-1.4* Microbiology: blood 8/30 pending negative urine [**8-9**] final negative blood 8/30 pending negative Imaging: [**8-6**] TTE The left atrium is mildly dilated. There is probably symmetric left ventricular hypertrophy (views are suboptimal). The left ventricular cavity size is normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is probably normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic valve is not well seen. There is mild aortic valve stenosis (valve area 1.2-1.9cm2). No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. The pulmonary artery systolic pressure could not be determined. There is a trivial pericardial effusion. There is an anterior space which most likely represents a prominent fat pad. UE U/S [**8-7**] FINDINGS: Grayscale and color Doppler ultrasonography of the right upper extremity demonstrates normal flow and compressibility of the right IJ, axillary, and both brachial veins. There is wall-to-wall flow demonstrated within the right subclavian vein. An occlusive thrombus is present within the right mid to distal cephalic vein, without extension into the deep veins. No fluid collections are seen. IMPRESSION: Occlusive thrombus within the right cephalic vein. No deep venous thrombosis. TIPS [**8-7**] FINDINGS: 1. Patent right hepatic vein. 2. Initial portal venography demonstrated a patent portal venous system, SMV, and splenic vein. Two prominent gastric variceal collaterals were seen. Initial portosystemic gradient of 20-25 mmHg. 3. Successful placement of a right hepatic vein to right posterior portal vein TIPS, using a 10 mm x 6 cm x 2 cm Viatorr stent, extended into the right hepatic vein with a 12 mm x 6 cm Luminexx stent. The TIPS shunt was dilated to 10 mm. The post-TIPS portosystemic gradient was 7-8 mmHg. 4. Post-TIPS venography demonstrated preferential flow through the portal vein and TIPS with reduced filling of the gastric varices (no targeted embolization was required). IMPRESSION: Successful TIPS placement, as described above. CXR [**8-7**] REASON FOR EXAM: Assess NG tube. NG tube tip is difficult to visualize. In the prior study performed a day earlier was in the stomach. ET tube is in standard position. Cardiomediastinal contours are unchanged. There are persistent low lung volumes. There is no evidence of pneumothorax or pleural effusion. Vascular congestion has resolved. Left lower lobe atelectasis is unchanged. There are no new lung abnormalities. TIPS project in the right upper quadrant. [**8-9**] ultrasound abd INDICATION: Post-TIPS, now with drop in hematocrit. Evaluate for hemorrhage, clot or stent thrombosis. COMPARISON: No prior ultrasound. TECHNIQUE: Right upper quadrant ultrasound with duplex son[**Name (NI) 493**] evaluation of the liver. FINDINGS: The liver shows a nodular contour consistent with cirrhosis. A TIPS stent is in place. The main portal vein is patent with antegrade flow of 52.6 cm/sec. Visualization of the most distal portion of the TIPS is limited by acoustic window. Wall-to-wall flow is demonstrated within the TIPS, although note is made of slow flow within the proximal TIPS at 53.2 cm/sec, and higher velocity flow within the mid and distal portions of the TIPS measuring 161 and 187 cm/sec, respectively. The left portal vein shows reversed flow towards the direction of the TIPS. The hepatic arteries are patent with normal waveforms. Hepatic veins show normal color flow. The gallbladder is moderately distended with mural thickening consistent with underlying liver disease. There is trace ascites in the right upper quadrant and no free fluid throughout the remainder of the abdomen. No evidence of hematoma as questioned. Spleen is enlarged measuring 18.1 cm. No hydronephrosis in either kidney. IMPRESSION: 1. Grossly patent TIPS, though with low velocities in its proximal portion and elevated velocities in its distal portion. Short-interval followup is suggested with repeat ultrasound. 2. Reversed flow in left portal vein consistent with presence of TIPS. Patent main portal vein with antegrade flow. 3. No evidence of right upper quadrant hematoma as questioned. 4. Findings consistent with cirrhosis; splenomegaly and trace right upper quadrant ascites. [**8-12**] Ultrasound of Abdomen FINDINGS: Liver again shows a nodular contour consistent with known cirrhosis. A TIPS is in place. Wall-to-wall flow is again visualized throughout the TIPS; Velocities in the proximal, mid, and distal TIPS are approximately 94, 154, and 183 cm/sec respectively. Since the previous examination, this represents an increase in the velocity in the proximal TIPS and a decreased gradient overall across the TIPS. Main portal vein remains patent with antegrade flow of 73 cm/sec. There is persistent reversal of flow in the left and anterior right portal veins towards the TIPS. The hepatic veins and IVC remain patent. There is antegrade flow within the splenic vein. Gallbladder remains distended with intraluminal sludge. There is no intra- or extra-hepatic biliary ductal dilation. Common hepatic duct measures 3 mm. IMPRESSION: Patent TIPS, with increased velocity in the proximal TIPS compared to [**2146-8-9**] compatible with improved intra-TIPS flow. Patent and antegrade main portal vein and reversed flow in the left and anterior right portal veins towards the TIPS. Brief Hospital Course: 61 year old male with a pmh of cryptogenic cirrhosis complicated by grade 2 esophageal varices, banded in [**4-19**], CAD s/p CABG, DM2 and depression who presented with an UGIB at the GE junction. . # UGIB: The patient arrived to the MICU intubated for airway protection. He underwent upper endoscopy by the liver service and was found to have varices at the gastroesophageal junction, large blood clots in the gastric fundus, but no active bleeding. It was thought most likely the patient had bled from gastric fundic varices. He went back for repeat EGD later in the day and was found to have fresh blood clots in the fundus, secondary to gastric variceal bleed. These were injected with dermabond. TIPS was recommended. His Hct was monitored and slowly trended down from 35 to 28 and he was transfused one unit of RBCs prior to going for TIPS on [**8-7**] given his history of coronary artery disease. He subsequently has melena attributed to passage of old blood without drops in his Hct. His hct remained stable on serial checks and melena stopped after 2 days. He was continued on protonix IV BID, octreotide drip, and ceftriaxone 1 gm daily for SBP prophylaxis. He required the use of pressors (levophed) for blood pressure initially. The TIPS procedure was uncomplicated and afterwards ultrasound showed patent stent though with poor flow. LFTs increased and peaked to 1200/1400 on [**8-9**] and then subsequently decreased. LFT abnormality was attributed to poor perfusion during TIPS and shock hepatitis. Viral hepatitis serologies were negative. He was transfered to the hepatology service on [**8-11**]. Ultrasound was repeated and again revealed patent TIPS with improved intra-TIPS flow. LFTs were noted to downtrend consistent with stabilization of TIPS. His hematocrit post TIPS initially stabilized around 26% from [**8-9**] to [**8-12**]. On the two days prior transfer, his his hematocrit had trended down to 23.4% on [**8-13**] and 21.9% on [**8-14**] prompting transfusion of 1 unit of PRBC. He remained hemodynamically stable since transfer to hepatology service on [**8-11**] and was hemodyncamically stable prior to transfer. # Hepatic Encephalopathy: Post extubation patient experienced agitation and delirium thought multifactorial due to hypernatremia, ICU delirium and hepatic encephalopathy. He was given free water in his tube feeds and was started on lactulose. His MS improved considerably and lactulose was continued with goal 500cc soft stool daily. He did not manifest with signs of infection. Following transfer to the hepatology service on [**8-11**] he was maintained on lactulose and rifaxamin and had no recurrence of hepatic encephalopathy. # Respiratory/intubation: The patient was intubated for airway protection. He was maintained on minimal vent settings and was extubated successfully on [**8-8**]. # DMII: The patient was noted to on oral diabetes management at home. He was covered with insulin sliding scale throughout admission. . # CAD: S/p CABG. The patient's aspirin and lisinopril were both held in the setting of bleed. These may be resumed once extended stability is ascertained. # RUE thrombus: RUE US was noted to be swollen so a LENI was obtained and revealed occlusive thrombus within the mid and distal right cephalic vein. No deep venous thrombus. He was not started on anticoagulation. This was managed with warm compresses and elevation of RUE. # HTN: Patient was changed from home ace-i to carvedilol for inpatient blood pressure management. He may be discharged on home lisinopril as appropriate. Medications on Admission: tylenol [**Telephone/Fax (1) 1999**] Q4prn ASA 81 mg daily citalopram 60mg daily iron 325mg PO TID glyburide 6mg PO daily lipoic acid 200mg PO daily Lisinopril 2.5mg PO daily Loratidine 10mg PO daily prn Mag gluconate 250mg PO daily Metformin 1000mg PO BID Multivitamin 1 tab daily Nadolol 20mg daily Pravachol 20mg daily Zantac 150mg PO BID Discharge Medications: 1. rifaximin 550 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every 8 hours) as needed for constipation. 4. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 5. Humalog 100 unit/mL Solution Sig: 0-10 units Subcutaneous four times a day: per attached sliding scale. 6. Pantoprazole 40 mg IV Q12H Discharge Disposition: Extended Care Discharge Diagnosis: Gastroesophageal Junction Variceal Bleed Hepatic Encephalopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname 62209**], You were transfered to [**Hospital1 69**] for emergent treatment of bleeding from blood vessels in your stomach. You arrived intubated and with a central venous catheter. You were evaluated and treated by the medicine service. You received an evaluation of this bleeding with endoscopy. You then needed an emergent procedure called a transjugular intrahepatic portosystemic shunt to allow some blood to bypass your your liver. This procedure allowed for better control of your bleeding. On the day of your hospital transfer, you received one unit of packed red blood cells for a blood level that had slowly decreased over two days. You were comfortable and had stable vital signs before transfering. Followup Instructions: As recommended at the time of discharge from [**Hospital 8641**] Hospital

572,456,785,286,276,453,578,571,414,V458,250,311,V422,V498,280,573,287

{'Portal hypertension,Esophageal varices in diseases classified elsewhere, with bleeding,Other shock without mention of trauma,Other and unspecified coagulation defects,Hyperosmolality and/or hypernatremia,Acute venous embolism and thrombosis of superficial veins of upper extremity,Hematemesis,Cirrhosis of liver without mention of alcohol,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Heart valve replaced by transplant,Physical restraints status,Iron deficiency anemia secondary to blood loss (chronic),Hepatitis, unspecified,Thrombocytopenia, 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: Hematemesis PRESENT ILLNESS: 61 year old with cryptogenic cirrhosis, CAD s/p CABG, and DMII who has had a general sense of being unwell over the past few days. He had some mild epigastric pain and dark stool, though not like his previous episodes of melena. He saw his PCP today for the dark stools. While at the office he vomited blood. He was sent to the ED and a hematocrit was 29. He was taken to EGD where a large amount of blood was seen in the stomach (fresh and clots). A steady stream of blood was seen and he vomited a large amount of blood. The scope was removed, he was intubated and he was rescoped. An injection of epinephrine was made at the site of bleeding and apparent stoppage in active bleeding. He received 5 units of blood and HCT returned at 24. He received an additional 2 units of blood and his HCT at transfer was 31. During intubation he became hypotensive, a cordis was placed in his RIJ and right femoral. Levophed was started. He has continued to put out blood from his NG tube. At time of transfer to [**Hospital1 18**] he was on octreotide, pantoprazole ([**Hospital1 **]), levophed and propofol. MEDICAL HISTORY: Cryptogenic Cirrhosis, c/b grade 2 esophageal varices, banded in [**4-/2145**] CAD s/p CABG DMII Depression MEDICATION ON ADMISSION: tylenol [**Telephone/Fax (1) 1999**] Q4prn ASA 81 mg daily citalopram 60mg daily iron 325mg PO TID glyburide 6mg PO daily lipoic acid 200mg PO daily Lisinopril 2.5mg PO daily Loratidine 10mg PO daily prn Mag gluconate 250mg PO daily Metformin 1000mg PO BID Multivitamin 1 tab daily Nadolol 20mg daily Pravachol 20mg daily Zantac 150mg PO BID ALLERGIES: Codeine PHYSICAL EXAM: Admission physical exam General: Intubated and sedated HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Normal rate and regular rhythm, soft SEM at upper sternal border, distant heart sounds Abdomen: soft, non-tender, non-distended, decreased bowel sounds, though present, Liver tip at 2 FB BCM. No rebound tenderness or guarding, no organomegaly GU: foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: Not responding, sedated. PERRL. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Salesman at [**Last Name (LF) 90456**], [**First Name3 (LF) **] OSH record. Denies tobacco, occassional alcohol use. ### Response: {'Portal hypertension,Esophageal varices in diseases classified elsewhere, with bleeding,Other shock without mention of trauma,Other and unspecified coagulation defects,Hyperosmolality and/or hypernatremia,Acute venous embolism and thrombosis of superficial veins of upper extremity,Hematemesis,Cirrhosis of liver without mention of alcohol,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Heart valve replaced by transplant,Physical restraints status,Iron deficiency anemia secondary to blood loss (chronic),Hepatitis, unspecified,Thrombocytopenia, unspecified'}

CHIEF COMPLAINT: Headache PRESENT ILLNESS: 59 year old with a history of lower back pain s/p lumbar laminectomy who was at Dr.[**Name (NI) 12040**] office for follow up today and developed a sudden onset of headache. Her husband says that she had a sudden onset of severe headache, felt very flushed ("red as a lobster"). Her blood pressure was taken and found to be elevated. MEDICAL HISTORY: Followed by cardiologist for elevated blood pressures (Toprol was recently increased to [**Hospital1 **] and HCTZ was added), herniated disks at C4 anc C5 with increased neck pain in the past few months, s/p hysterectomy, appendectomy, lumbar disk surgery in [**2088**]. MEDICATION ON ADMISSION: Allergies: Erythromycin ALLERGIES: Erythromycin Base PHYSICAL EXAM: Vitals: T 94.9 HR 80 RR 10 BP 172/74 100% pm RA General: Sleepy but arousable, NAD HEENT: No conjunctivitis, nares clear, OP clear, mucous membranes moist. CV: Normal S1 and S2, no murmur Pulm: Clear bilaterally, good aeration Abdomen: Soft, nondistended, nontender, NABS Extremities: Warm and well perfused. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Home with husband, on disability since her back sugery, used to work in HR for [**Location (un) 86**] Visiting Nurses. Denies any smoking.

Subarachnoid hemorrhage,Unspecified essential hypertension

Subarachnoid hemorrhage,Hypertension NOS

Admission Date: [**2124-2-3**] Discharge Date: [**2124-2-3**] Date of Birth: [**2064-3-6**] Sex: F Service: NEUROSURGERY Allergies: Erythromycin Base Attending:[**First Name3 (LF) 1271**] Chief Complaint: Headache Major Surgical or Invasive Procedure: Cerebral angiogram History of Present Illness: 59 year old with a history of lower back pain s/p lumbar laminectomy who was at Dr.[**Name (NI) 12040**] office for follow up today and developed a sudden onset of headache. Her husband says that she had a sudden onset of severe headache, felt very flushed ("red as a lobster"). Her blood pressure was taken and found to be elevated. ROS: Over the past few months, she has had instances of elevated blood pressure with systolics up to 215. She also has some neck pain that over the past few months has worsened so that it's now radiating up her neck to the back of her head and has pain in her shoulders. She has not had any fevers, + URI symptoms mainly with cough for the past week, +nausea, no vomiting, no abdominal pain, diarrhea, dysuria. Past Medical History: Followed by cardiologist for elevated blood pressures (Toprol was recently increased to [**Hospital1 **] and HCTZ was added), herniated disks at C4 anc C5 with increased neck pain in the past few months, s/p hysterectomy, appendectomy, lumbar disk surgery in [**2088**]. Social History: Home with husband, on disability since her back sugery, used to work in HR for [**Location (un) 86**] Visiting Nurses. Denies any smoking. Family History: Noncontributory Physical Exam: Vitals: T 94.9 HR 80 RR 10 BP 172/74 100% pm RA General: Sleepy but arousable, NAD HEENT: No conjunctivitis, nares clear, OP clear, mucous membranes moist. CV: Normal S1 and S2, no murmur Pulm: Clear bilaterally, good aeration Abdomen: Soft, nondistended, nontender, NABS Extremities: Warm and well perfused. Neuro Exam: Mental status: Inattentive, able to follow commands. CN: Pupils 2.5 to 2mm bilaterally, no RAPD, EOMI without nystagmus or ptosis, facial sensation intact to V1 to V3, symmetric eyelid closure and smile, palate elevates symmetrically, tongue midline. Motor: Normal bulk and tone, has some giveway weakness diffusely during the examination. Delt Tri Bic WE FE IP Q H DF PF R 4 5 5 5 5 4+ 5 5 4+ 5 L 4 5 5 5 5 4+ 5 5 4+ 5 Sensory: Light touch grossly intact in upper and lower extremities. Reflexes: Bic [**Last Name (un) 1035**] Pat Achilles Toes R 2+ 2+ 2+ Clonus Mute L 2+ 2+ 2+ Clonus Up Reflexes were brisk throughout. Coordination: Finger to nose slowed (likely due to weakness) but not ataxic. Gait: Deferred. Pertinent Results: [**2124-2-3**] 01:30PM BLOOD WBC-7.4 RBC-4.33 Hgb-11.6* Hct-33.0* MCV-76* MCH-26.9* MCHC-35.2* RDW-14.8 Plt Ct-225# [**2124-2-3**] 01:30PM BLOOD Neuts-63.3 Lymphs-31.2 Monos-3.6 Eos-1.5 Baso-0.4 [**2124-2-3**] 01:30PM BLOOD Plt Ct-225# [**2124-2-3**] 01:30PM BLOOD PT-11.8 PTT-22.4 INR(PT)-1.0 [**2124-2-3**] 01:30PM BLOOD Glucose-129* UreaN-29* Creat-1.2* Na-141 K-4.3 Cl-106 HCO3-22 AnGap-17 [**2124-2-3**] 01:30PM BLOOD Calcium-9.7 Phos-2.6* Mg-2.3 Head CT: There is large subarachnoid hemorrhage present throughout the suprasellar cistern and probably also present within the insular regions bilaterally. There is subarachnoid hemorrhage surrounding the brainstem, also surrounding the upper cervical spinal cord. There is hemorrhage within the fourth ventricle. There is possible mild, subtle hypodensity of the left frontal and parietal white matter. No previous studies are available to evaluate for change in the size of the ventricles. There is possible very mild dilatation of the temporal [**Doctor Last Name 534**] of the right lateral ventricle. There is no shift of normally midline structures. There are multiple soft tissue nodules, one at the posterior vertex measuring 8 mm that appears to have associated calcification, and one measuring 10 mm at the right high lateral soft tissues (series 2, image 26), and a third located more posteriorly at the lower level on the right measuring 11 mm (series 2, image 15). No fractures are seen. The visualized portions of the paranasal sinuses are well aerated. IMPRESSION: 1. Extensive subarachnoid hemorrhage. Intraventricular hemorrhage. 2. Possible very mild dilatation of the temporal [**Doctor Last Name 534**] of the right lateral ventricle, although no previous studies are available for comparison. Angiogram: Aneurysm and AVM of right PICA Brief Hospital Course: Patient was brought directly from the ED to the neurointerventional suite. She was found to have a PICA aneurysm and AVM. Embolization of PICA was attempted but failed due to the tortuous vessels. Dr. [**Last Name (STitle) 739**] has discussed the case with Dr. [**Last Name (STitle) **] - patient will be transferred to [**Hospital1 756**] for further care. Medications on Admission: Allergies: Erythromycin Medications: Toprol 100mg [**Hospital1 **], Lisinopril 40mg QD, HCTZ 12.5mg QD, Simvastatin 20mg QD, Premarin 3.25mg QM,W,F, Zelnorm 3mg [**Hospital1 **], ASA 325mg QD, Centrum MVI, Calcium 500mg QD, Vitamin C 1000mg QD, Fibercon 2 per day, Ativan 2mg QHS Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for Pain. 2. Nimodipine 30 mg Capsule Sig: One (1) Capsule PO Q2H (every 2 hours). 3. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 4. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 6. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 8. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QD (). 9. Ascorbic Acid 500 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 10. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 11. Conjugated Estrogens 0.3 mg Tablet Sig: One (1) Tablet PO 3X/WEEK (MO,WE,FR). 12. Hydromorphone 2 mg/mL Syringe Sig: 0.5-2mg Injection Q3-4H (Every 3 to 4 Hours) as needed for Pain. 13. Dolasetron 12.5 mg/0.625 mL Solution Sig: One (1) Intravenous Q8H (every 8 hours) as needed for Nausea. Discharge Disposition: Extended Care Discharge Diagnosis: AVM and aneurysm Discharge Condition: Stable Discharge Instructions: Patient is being transferred to [**Hospital1 756**] under the care of Dr. [**Last Name (STitle) **]. Followup Instructions: Per [**Hospital1 756**]. Attempted to contact film library for copies of imaging studies but they could not be reached, their phone number is [**Telephone/Fax (1) 98784**]. [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

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: Headache PRESENT ILLNESS: 59 year old with a history of lower back pain s/p lumbar laminectomy who was at Dr.[**Name (NI) 12040**] office for follow up today and developed a sudden onset of headache. Her husband says that she had a sudden onset of severe headache, felt very flushed ("red as a lobster"). Her blood pressure was taken and found to be elevated. MEDICAL HISTORY: Followed by cardiologist for elevated blood pressures (Toprol was recently increased to [**Hospital1 **] and HCTZ was added), herniated disks at C4 anc C5 with increased neck pain in the past few months, s/p hysterectomy, appendectomy, lumbar disk surgery in [**2088**]. MEDICATION ON ADMISSION: Allergies: Erythromycin ALLERGIES: Erythromycin Base PHYSICAL EXAM: Vitals: T 94.9 HR 80 RR 10 BP 172/74 100% pm RA General: Sleepy but arousable, NAD HEENT: No conjunctivitis, nares clear, OP clear, mucous membranes moist. CV: Normal S1 and S2, no murmur Pulm: Clear bilaterally, good aeration Abdomen: Soft, nondistended, nontender, NABS Extremities: Warm and well perfused. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Home with husband, on disability since her back sugery, used to work in HR for [**Location (un) 86**] Visiting Nurses. Denies any smoking. ### Response: {'Subarachnoid hemorrhage,Unspecified essential hypertension'}

CHIEF COMPLAINT: coronary artery disease PRESENT ILLNESS: This 80 year old white male with a history of chronic angina with exertion and negative stress tests. His angina has crescendoed over a two day period to having angina with climbing one flight of stairs.. He was admitted for elective catheterization at [**Hospital6 1109**]. This revealed 3 vessel disease with preserved LV function and he was transferred for revascularization. MEDICAL HISTORY: Prostate cancer- XRT Diverticulitis colectomy for diverticular disease hyperlipidemia peripheral neuropathy prostatism s/p dual chamber pacemaker implant MEDICATION ON ADMISSION: Atenolol 25mg/D NTG 0.1 mg/hr TD Vytorin 110/10 QD Prilosec 20mg [**Hospital1 **] Flomax 0.4 mg/D Lyrica 75mg [**Hospital1 **] Quinine 324mggg/D ASA81 mg/D Celebrex 200mg/D MVI ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Discharge: 98.1 124/64 76 18 No acute distress, oriented, and awake Heart of regular rate and rhythm Lungs clear to auscultation bilaterally Abdomen soft, non-tender, non-distended Extremities warm with 1+ edema Mediastinal incision clean, dry, and intact Sternum stable Left vein harvest sites clean, dry, and intact FAMILY HISTORY: noncontributory SOCIAL HISTORY: remote smoker. rare ETOH use. lives with his wife

Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Intermediate coronary syndrome,Atrial fibrillation,Syncope and collapse,Personal history of malignant neoplasm of prostate,Unspecified hereditary and idiopathic peripheral neuropathy,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ

Crnry athrscl natve vssl,Ac on chr syst hrt fail,Intermed coronary synd,Atrial fibrillation,Syncope and collapse,Hx-prostatic malignancy,Idio periph neurpthy NOS,Hyperlipidemia NEC/NOS,Status cardiac pacemaker

Admission Date: [**2111-11-14**] Discharge Date: [**2111-11-23**] Date of Birth: [**2031-8-16**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: coronary artery disease Major Surgical or Invasive Procedure: Coronary artery bypass grafts x 3(LIMA-LAD, SVG-DG,SVG-RCA)[**11-17**] History of Present Illness: This 80 year old white male with a history of chronic angina with exertion and negative stress tests. His angina has crescendoed over a two day period to having angina with climbing one flight of stairs.. He was admitted for elective catheterization at [**Hospital6 1109**]. This revealed 3 vessel disease with preserved LV function and he was transferred for revascularization. Past Medical History: Prostate cancer- XRT Diverticulitis colectomy for diverticular disease hyperlipidemia peripheral neuropathy prostatism s/p dual chamber pacemaker implant Social History: remote smoker. rare ETOH use. lives with his wife Family History: noncontributory Physical Exam: Discharge: 98.1 124/64 76 18 No acute distress, oriented, and awake Heart of regular rate and rhythm Lungs clear to auscultation bilaterally Abdomen soft, non-tender, non-distended Extremities warm with 1+ edema Mediastinal incision clean, dry, and intact Sternum stable Left vein harvest sites clean, dry, and intact Pertinent Results: [**2111-11-22**] 07:15AM BLOOD WBC-6.8 RBC-3.37* Hgb-10.6* Hct-30.4* MCV-90 MCH-31.6 MCHC-35.0 RDW-13.8 Plt Ct-263 [**2111-11-22**] 07:15AM BLOOD Plt Ct-263 [**2111-11-22**] 07:15AM BLOOD Glucose-94 UreaN-22* Creat-1.3* Na-135 K-3.9 Cl-97 HCO3-32 AnGap-10 [**2111-11-21**] 03:14AM BLOOD ALT-21 AST-34 LD(LDH)-303* AlkPhos-62 Amylase-32 TotBili-0.6 [**2111-11-22**] 07:15AM BLOOD WBC-6.8 RBC-3.37* Hgb-10.6* Hct-30.4* MCV-90 MCH-31.6 MCHC-35.0 RDW-13.8 Plt Ct-263 [**2111-11-21**] 03:14AM BLOOD WBC-9.0 RBC-3.88*# Hgb-12.1*# Hct-34.5* MCV-89 MCH-31.2 MCHC-35.1* RDW-14.5 Plt Ct-209# [**2111-11-17**] 02:29PM BLOOD WBC-6.7 RBC-2.64*# Hgb-8.3*# Hct-23.7*# MCV-90 MCH-31.6 MCHC-35.2* RDW-13.8 Plt Ct-147* [**2111-11-14**] 07:15PM BLOOD WBC-6.5 RBC-4.08* Hgb-13.0* Hct-37.7* MCV-92 MCH-31.9 MCHC-34.5 RDW-13.2 Plt Ct-235 [**2111-11-21**] 03:14AM BLOOD PT-12.7 PTT-30.8 INR(PT)-1.1 [**2111-11-14**] 07:15PM BLOOD PT-12.2 PTT-27.0 INR(PT)-1.0 [**2111-11-22**] 07:15AM BLOOD Glucose-94 UreaN-22* Creat-1.3* Na-135 K-3.9 Cl-97 HCO3-32 AnGap-10 [**2111-11-14**] 07:15PM BLOOD Glucose-136* UreaN-20 Creat-1.4* Na-139 K-4.4 Cl-104 HCO3-28 AnGap-11 [**2111-11-21**] 03:14AM BLOOD ALT-21 AST-34 LD(LDH)-303* AlkPhos-62 Amylase-32 TotBili-0.6 [**2111-11-14**] 07:15PM BLOOD ALT-18 AST-21 AlkPhos-68 Amylase-56 TotBili-0.2 [**2111-11-22**] 07:15AM BLOOD Mg-2.4 [**2111-11-14**] 07:15PM BLOOD Albumin-4.1 Mg-2.1 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname 105287**], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 105288**] (Complete) Done [**2111-11-17**] at 12:14:43 PM FINAL Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) **] R. [**Hospital1 18**], Division of Cardiothorac [**Hospital Unit Name 4081**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2031-8-16**] Age (years): 80 M Hgt (in): BP (mm Hg): / Wgt (lb): HR (bpm): BSA (m2): Indication: Abnormal ECG. Aortic valve disease. Chest pain. Coronary artery disease. Hypertension. ICD-9 Codes: 402.90, 786.51, 440.0, 424.1 Test Information Date/Time: [**2111-11-17**] at 12:14 Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5209**], MD Doppler: Full Doppler and color Doppler Test Location: Anesthesia West OR cardiac Contrast: None Tech Quality: Adequate Tape #: 2008AW5-: Machine: Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: *5.7 cm <= 4.0 cm Right Atrium - Four Chamber Length: *5.7 cm <= 5.0 cm Left Ventricle - Ejection Fraction: 40% to 45% >= 55% Aortic Valve - Peak Gradient: 2 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 1 mm Hg Findings LEFT ATRIUM: Moderate LA enlargement. No spontaneous echo contrast or thrombus in the LA/LAA or the RA/RAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. No spontaneous echo contrast in the body of the RA. A catheter or pacing wire is seen in the RA and extending into the RV. Dynamic interatrial septum. No ASD by 2D or color Doppler. LEFT VENTRICLE: Normal LV wall thickness and cavity size. Normal LV wall thickness. Normal LV cavity size. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. Simple atheroma in aortic root. Normal ascending aorta diameter. Simple atheroma in ascending aorta. Normal aortic arch diameter. Simple atheroma in aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. AORTIC VALVE: Three aortic valve leaflets. Mildly thickened aortic valve leaflets. No AS. Mild to moderate ([**12-24**]+) AR. MITRAL VALVE: Normal mitral valve leaflets with trivial MR. Mildly thickened mitral valve leaflets. Trivial MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. PERICARDIUM: Trivial/physiologic pericardial effusion. 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. The patient received antibiotic prophylaxis. The TEE probe was passed with assistance from the anesthesioology staff using a laryngoscope. No TEE related complications. patient. REGIONAL LEFT VENTRICULAR WALL MOTION: N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic Conclusions PRE-CPB:1. The left atrium is moderately dilated. 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 spontaneous echo contrast is seen in the body of the right atrium. 2. No atrial septal defect is seen by 2D or color Doppler. 3. Left ventricular wall thicknesses and cavity size are normal. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. 4. Right ventricular chamber size and free wall motion are normal. 5. There are simple atheroma in the aortic root. There are simple atheroma in the ascending aorta. There are simple atheroma in the aortic arch. There are simple atheroma in the descending thoracic aorta. 6. There are three aortic valve leaflets. The aortic valve leaflets are mildly thickened. There is no aortic valve stenosis. Mild to moderate ([**12-24**]+) aortic regurgitation is seen. 7. The mitral valve appears structurally normal with trivial mitral regurgitation. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. 8. There is a trivial/physiologic pericardial effusion. Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) **] were notified in person of the results. POST-CPB: On infusion of phenylephrine. AV pacing. Well-preserved LV systolic function with improvement of the anteroapical and anteroseptal walls. LVEF is now 45%. 1+ AI, trace MR. Aortic contour is normal post decannulation. I certify that I was present for this procedure in compliance with HCFA regulations. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting physician [**Last Name (NamePattern4) **] Brief Hospital Course: The patient was transferred her from [**Hospital **] Hospital for surgery following his catheterization. He remained stable and on [**11-17**] was taken to the operating room where triple bypass grafting was performed as noted. Please see operative note for complete details. He weaned from bypass on neosynephrine and Propofol. Epinephrine was begun after surgery for low cardiac outputs and volume was required for low urine output. He was extubated and his permanent pacemaker was interogated on post-operative day one and was found to be functioning normally. His chest tubes and wires were removed. On post-op day 3 he was noted to have orthostatic hypotension. He was given several fluid boluses with improvement in his blood pressure and was transferred to the step down floor. Once on the floor he was noted to be hypotensive, had an episode of syncope and also had word finding difficulty. His hematocrit had dropped from 29 to 23 compared to the previous day. He was brought back to the CVICU. A stat bedside echo was performed and did not find hemopericadium. He was transfused one unit packed red blood cells and his symptoms resolved. Also on post-op day 3 his abdomen became distended and his bowel regimen was increased. By post-operative day 4 his abdomen improved, he was hemodynamically stable and he was transferred to the surgical step down floor. That evening he had atrial fibrillation which converted with lopressor. He worked with physical therapy on strength and balance. He continued to be gently diuresed towards his pre-operative weight and by post-operative day 5 he was ready for discharge to home. Medications on Admission: Atenolol 25mg/D NTG 0.1 mg/hr TD Vytorin 110/10 QD Prilosec 20mg [**Hospital1 **] Flomax 0.4 mg/D Lyrica 75mg [**Hospital1 **] Quinine 324mggg/D ASA81 mg/D Celebrex 200mg/D MVI Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*0* 3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*0* 5. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 6. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0* 7. Pregabalin 75 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 8. Quinine Sulfate 324 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). Disp:*30 Capsule(s)* Refills:*0* 9. 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* 10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. Disp:*5 Tablet(s)* Refills:*0* 11. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 5 days. Disp:*5 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 12. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital **] Hospice and VNA Discharge Diagnosis: coronary artery disease s/p coronary artery bypass grafts x 3 (LIMA-LAD, SVG-DG,SVG-RCA) s/p permanent dual chamber pacemaker implant h/o prostate cancer hyperlipidemia s/p colectomy peripheral neuropathy h/o diverticulitis Discharge Condition: good Discharge Instructions: shower daily, no baths or swimming no lotions, creams or powders to incisions no lifting more than 10 pounds for 10 weeks no driving for 4 weeks and off all narcotics report any fever greater than 100.5 report any redness of, or drainage from incisions report any weight gain greater than 2 pounds a day or 5 pounds a week take all medications as directed Followup Instructions: Dr. [**Last Name (STitle) **] in 2 weeks ([**Telephone/Fax (1) 6256**]) at [**Hospital1 **] Heart Center. Dr. [**First Name8 (NamePattern2) 8516**] [**Last Name (NamePattern1) **] in 2 weeks ([**Telephone/Fax (1) 36609**]) Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in 2 weeks ([**Telephone/Fax (1) 6256**]) at [**Hospital1 **] Heart Center Please call for appointments Please have your creatinine checked in one week with results to go to Dr [**Last Name (STitle) **] and Dr [**First Name (STitle) **]. Completed by:[**2111-11-23**]

414,428,411,427,780,V104,356,272,V450

{'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Intermediate coronary syndrome,Atrial fibrillation,Syncope and collapse,Personal history of malignant neoplasm of prostate,Unspecified hereditary and idiopathic peripheral neuropathy,Other and unspecified hyperlipidemia,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: coronary artery disease PRESENT ILLNESS: This 80 year old white male with a history of chronic angina with exertion and negative stress tests. His angina has crescendoed over a two day period to having angina with climbing one flight of stairs.. He was admitted for elective catheterization at [**Hospital6 1109**]. This revealed 3 vessel disease with preserved LV function and he was transferred for revascularization. MEDICAL HISTORY: Prostate cancer- XRT Diverticulitis colectomy for diverticular disease hyperlipidemia peripheral neuropathy prostatism s/p dual chamber pacemaker implant MEDICATION ON ADMISSION: Atenolol 25mg/D NTG 0.1 mg/hr TD Vytorin 110/10 QD Prilosec 20mg [**Hospital1 **] Flomax 0.4 mg/D Lyrica 75mg [**Hospital1 **] Quinine 324mggg/D ASA81 mg/D Celebrex 200mg/D MVI ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Discharge: 98.1 124/64 76 18 No acute distress, oriented, and awake Heart of regular rate and rhythm Lungs clear to auscultation bilaterally Abdomen soft, non-tender, non-distended Extremities warm with 1+ edema Mediastinal incision clean, dry, and intact Sternum stable Left vein harvest sites clean, dry, and intact FAMILY HISTORY: noncontributory SOCIAL HISTORY: remote smoker. rare ETOH use. lives with his wife ### Response: {'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Intermediate coronary syndrome,Atrial fibrillation,Syncope and collapse,Personal history of malignant neoplasm of prostate,Unspecified hereditary and idiopathic peripheral neuropathy,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ'}

CHIEF COMPLAINT: Admission for hyperkalemia and transferred to the Coronary Care Unit for fluid overload. PRESENT ILLNESS: This is a 66-year-old Russian male with a past medical history for known coronary artery disease and chronic renal insufficiency with a creatinine between 2 and 2.5, recently admitted for [**11-9**] for asymptomatic hyperkalemia after increase in Aldactone as an outpatient. MEDICAL HISTORY: 1. Coronary artery disease, status post inferior myocardial infarction in [**2116-3-26**]. Status post coronary artery bypass graft in [**2116-3-26**] with saphenous vein graft to left internal mammary artery, saphenous vein graft to diagonal with sequential graft to the first obtuse marginal, and saphenous vein graft to the posterior descending artery. Operation was complicated by cardiogenic shock requiring intra-aortic balloon pump. Postoperative course complicated by sepsis requiring bilateral below-knee amputations. He suffered stump infections with pseudomonas and methicillin-resistant Staphylococcus aureus. 2. Hypothyroidism. 3. Chronic renal insufficiency with creatinine between 2 and 2.5. 4. Upper gastrointestinal bleed. 5. Gout. 6. Congestive heart failure with an ejection fraction of 20%. 7. Heparin-induced thrombocytopenia. 8. Severe mitral regurgitation. 9. History of ascites. MEDICATION ON ADMISSION: 1. Allopurinol 200 mg p.o. q.d. 2. Aldactone. 3. Levoxyl 175 mcg p.o. q.d. 4. Isordil 10 mg p.o. t.i.d. 5. Zoloft 100 mg p.o. q.d. 6. Digoxin 0.125 mg p.o. q.d. 7. Hydralazine 25 mg p.o. q.i.d. ALLERGIES: Allergy to KEFLEX and HEPARIN (heparin-induced thrombocytopenia). PHYSICAL EXAM: FAMILY HISTORY: Family history is noncontributory. SOCIAL HISTORY: The patient denies tobacco or alcohol use. His is a Russian immigrant.

Congestive heart failure, unspecified,Hyperpotassemia,Acute kidney failure, unspecified,Other specified cardiac dysrhythmias,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Old myocardial infarction

CHF NOS,Hyperpotassemia,Acute kidney failure NOS,Cardiac dysrhythmias NEC,Mitral valve disorder,Crnry athrscl natve vssl,Hypothyroidism NOS,Old myocardial infarct

Admission Date: [**2118-11-9**] Discharge Date: [**2118-11-16**] Date of Birth: [**2052-8-26**] Sex: M Service: CCU CHIEF COMPLAINT: Admission for hyperkalemia and transferred to the Coronary Care Unit for fluid overload. HISTORY OF PRESENT ILLNESS: This is a 66-year-old Russian male with a past medical history for known coronary artery disease and chronic renal insufficiency with a creatinine between 2 and 2.5, recently admitted for [**11-9**] for asymptomatic hyperkalemia after increase in Aldactone as an outpatient. The patient had been admitted to the hospital in [**Month (only) 216**] on Lasix but had creatinine bumps and therefore was discharged without Lasix. During the interim time he was restarted on Lasix, potassium, and spironolactone. Approximately one week prior to admission he was seen by his primary care physician who discontinued Lasix and increased Aldactone from one-half pill to three pills. On the day of admission he was seen by his primary care physician with laboratories showing potassium of 7.4, but was asymptomatic. At the time he decided to go to the Emergency Department. Electrocardiogram showed minimally peaked T waves, left axis deviation, and sinus bradycardia. He was given 30 g of Kayexalate, lactulose, calcium, and bicarbonate in the Emergency Department. In the intervening day, he received additional doses of Kayexalate and lactulose times three with potassium decreasing to 5.1. On [**2118-11-10**], he [**Year (4 digits) 1834**] 4-liter large volume paracentesis with supplemental albumin. On the day of transfer (on [**11-11**]) another 3.5 liters of fluid was removed. Mr. [**Known lastname 105732**] has a history of severe ascites which tested hepatitis B and hepatitis C negative. It was thought to be secondary to severe right heart failure. He was without complaints of shortness of breath or other discomforts. Prior to large-volume paracentesis he did have some mild abdominal distention which is much improved. He is being transferred to the Coronary Care Unit for right heart catheterization and aggressive diuresis and blood pressure management. Of note, the patient's history is significant for creatinine bumps to 3 with diuresis with Lasix and increased potassium with Aldactone. PAST MEDICAL HISTORY: 1. Coronary artery disease, status post inferior myocardial infarction in [**2116-3-26**]. Status post coronary artery bypass graft in [**2116-3-26**] with saphenous vein graft to left internal mammary artery, saphenous vein graft to diagonal with sequential graft to the first obtuse marginal, and saphenous vein graft to the posterior descending artery. Operation was complicated by cardiogenic shock requiring intra-aortic balloon pump. Postoperative course complicated by sepsis requiring bilateral below-knee amputations. He suffered stump infections with pseudomonas and methicillin-resistant Staphylococcus aureus. 2. Hypothyroidism. 3. Chronic renal insufficiency with creatinine between 2 and 2.5. 4. Upper gastrointestinal bleed. 5. Gout. 6. Congestive heart failure with an ejection fraction of 20%. 7. Heparin-induced thrombocytopenia. 8. Severe mitral regurgitation. 9. History of ascites. MEDICATIONS ON ADMISSION: 1. Allopurinol 200 mg p.o. q.d. 2. Aldactone. 3. Levoxyl 175 mcg p.o. q.d. 4. Isordil 10 mg p.o. t.i.d. 5. Zoloft 100 mg p.o. q.d. 6. Digoxin 0.125 mg p.o. q.d. 7. Hydralazine 25 mg p.o. q.i.d. MEDICATIONS ON TRANSFER: Medications on transfer to the Coronary Care Unit included all of the above in addition to Lasix 40 mg p.o. b.i.d. and Tylenol p.r.n. ALLERGIES: Allergy to KEFLEX and HEPARIN (heparin-induced thrombocytopenia). SOCIAL HISTORY: The patient denies tobacco or alcohol use. His is a Russian immigrant. FAMILY HISTORY: Family history is noncontributory. PHYSICAL EXAMINATION ON PRESENTATION: On admission temperature was 98.4, blood pressure 110/72, pulse 72, respiratory rate 20, satting 95% on room air. In general, he was a moderately obese male with protruding abdomen, lying in bed, in no acute distress. HEENT revealed jugular venous distention elevated beyond the angle of the jaw of approximately 20 cm. Cardiovascular revealed there was a [**3-1**] quiet systolic murmur at the apex. Lungs on anterior examination were clear to auscultation. The abdomen had normal active bowel sounds, nontender, distended with fluid. No masses. Extremities were clean, dry, and intact. Bilateral below-knee amputations, no swelling. LABORATORY DATA ON PRESENTATION: Laboratories on transfer, Chem-7 showed the following: Sodium 140, potassium 5.1, chloride 113, bicarbonate 18, BUN 39, creatinine 2.4, sugar 86. Albumin 2.6, calcium 8.1, phosphate 3.7, magnesium 2.1. Digoxin level of 0.7. Of note, potassium had decreased from 7.4 to 7.1 to 6 to 5.8 to 5.1 times three consecutive times. RADIOLOGY/IMAGING: Electrocardiogram on [**11-9**] showed evidence for old inferior myocardial infarction with Q waves in leads III and aVF; first-degree heart block, poor R wave progression. On [**11-10**], there was evidence for first-degree heart block with occasional sinus nodal block with a junctional escape. Echocardiogram from [**2117-7-27**] showed mildly dilated left atrium, markedly dilated right atrium, left ventricular systolic function markedly decreased with dyskinesis of the basal anteroseptal, middle anteroseptal, and basal and middle inferoseptal regions. There was also akinesis of the basal inferior, middle inferior, basal and middle inferolateral, and inferoapical regions. There was also evidence for 1+ aortic regurgitation, 4+ mitral regurgitation, and 4+ tricuspid regurgitation. Ejection fraction at that time was 20%. HOSPITAL COURSE: 1. FLUIDS/ELECTROLYTES/NUTRITION: As stated above, Mr. [**Known lastname 105734**] potassium elevation was likely secondary to Aldactone. In the future he should no longer receive Aldactone or ACE inhibitors, much less any medication that would elevate potassium, as Mr. [**Known lastname 105732**] seems particularly sensitive to these medications. He was placed on a low-sodium/low-potassium diet. 2. CARDIOVASCULAR: (a) Coronary artery disease: Mr. [**Known lastname 105732**] has a history of coronary artery disease but was not on aspirin on admission. He was placed on aspirin. (b) Pump: Mr. [**Known lastname 105732**] had an ejection fraction of 20% and ischemic cardiomyopathy. He has signs of right-sided failure without symptoms except for his tense ascites. Liver function tests were checked for possible passive congestion but were within normal limits. They were only significant for alkaline phosphatase of around 200. On transfer to the Coronary Care Unit, he [**Known lastname 1834**] right internal jugular introduction with Swan placement soon after. Initial Swan numbers were the following: INCOMPLETE DICTATION [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D. [**MD Number(1) 1014**] Dictated By:[**Name8 (MD) 8073**] MEDQUIST36 D: [**2118-11-15**] 10:37 T: [**2118-11-18**] 09:34 JOB#: [**Job Number 105735**] Admission Date: [**2118-11-9**] Discharge Date: [**2118-11-16**] Date of Birth: [**2052-8-26**] Sex: M Service: CCU CHIEF COMPLAINT: Hyperkalemia. HISTORY OF PRESENT ILLNESS: This is a 66 year-old Russian, but English speaking male with a past medical history of known coronary artery disease and chronic renal insufficiency with a creatinine between 2 and 2.5 recently admitted on [**2118-11-9**] for asymptomatic hyperkalemia after increase in outpatient diuretic regimen. The patient had been discharged from [**Hospital1 **] [**First Name (Titles) **] [**Last Name (Titles) 216**] without Lasix, which was restarted in the interim. Approximately one week he was seen by his primary care physician and Lasix was discontinued and his normal Aldactone dose was changed from one half pill to three pills q.d. On the day of admission the patient was seen again by primary care physician with laboratories showing potassium 7.4. At this time he was advised to go to the Emergency Department. Electrocardiogram showed minimally peaked T waves, left axis deviation, sinus bradycardia. However, he was asymptomatic throughout. In the Emergency Department he received 30 grams of Kayexalate, Lactulose, calcium and bicarb. He was admitted to Far Six where he received additional doses of Kayexalate and Lactulose with good results on potassium. On [**2118-11-10**] he [**Year (4 digits) 1834**] 4 liter large volume paracentesis for intractable ascites with supplemental albumin. This was repeated on [**2118-11-11**] when 3.5 liters of fluid was removed. Of note, Mr. [**Known lastname 105732**] had only moderate abdominal distention, which was much improved after paracentesis. He was without complaints or shortness of breath or other discomfort. He was transferred to the Coronary Care Unit for right heart catheterization and aggressive diuresis with pressure management. Of note, the patient's history is notable for a creatinine bump to 3 with Lasix and potassium increases with Aldactone. PAST MEDICAL HISTORY: 1. Coronary artery disease status post inferior myocardial infarction in 4/99 status post coronary artery bypass graft in 4/99 with saphenous vein graft to the left internal mammary coronary artery, diagonal with sequential graft to the obtuse marginal, and finally to the posterior descending coronary artery. Coronary artery bypass graft was complicated by cardiogenic shock requiring intra-aortic balloon pump. Postoperative course complicated by sepsis requiring bilateral below the knee amputations. He also suffers from stump infections with Pseudomonas and MRSA. 2. Hyperthyroid. 3. Chronic renal insufficiency. 4. Upper GI bleed. 5. Gout. 6. Congestive heart failure, EF of 20%. 7. Heparin induced thrombocytopenia. 8. Severe mitral regurgitation. 9. History of severe ascites, which known to be HBV and HCV negative. This is likely secondary to severe right heart failure. MEDICATIONS ON ADMISSION: 1. Allopurinol 200 mg po q.d. 2. Aldactone. 3. Levoxyl 175 micrograms po q.d. 4. Isordil 10 mg po t.i.d. 5. Zoloft 100 mg po q day. 6. Digoxin 0.125 mg po qd. 7. Hydralazine 25 mg po q.i.d. MEDICATIONS ON TRANSFER: Include all the previous medications in addition to Lasix 40 mg po q.d. and Tylenol prn. ALLERGIES: Keflex and heparin induce thrombocytopenia. SOCIAL HISTORY: Negative for tobacco or alcohol. He is a Russian immigrant. FAMILY HISTORY: Noncontributory. PHYSICAL EXAMINATION ON ADMISSION: Vital signs temperature 98.4. Blood pressure 110/72. Pulse 72. Respiratory rate 20. Sating 95% on room air. In general, this is a moderately obese Caucasian male with a protruding abdomen lying in bed and in no acute distress. HEENT JVP is approximately 20 cm. Cardiovascular is just a quiet 3 out 6 systolic murmur best heard at the apex. Lungs anterior examination is clear. Abdomen normoactive bowel sounds, nontender, distended with fluid. Extremities clean, dry and intact, below the knee amputations bilaterally. No swelling. LABORATORIES ON TRANSFER TO THE CORONARY CARE UNIT: Chem 7 with a sodium 140, potassium 5.1, chloride 113, bicarb 18, BUN 39, creatinine 2.4, blood sugar 86, albumin 3.6, calcium 8.1, phosphate 3.7, magnesium 2.1, digoxin 0.7. Potassium on admission noted to decrease from 7.4 to 7.1 to 6 to 5.8 to 5.1 times three consecutive times. Electrocardiogram on [**11-9**] showed evidence for old inferior myocardial infarction with Qs in leads 3 and AVF. There is also evidence for first degree heart block and poor R wave progression. Repeat electrocardiogram on [**2118-11-10**] showed first degree heart block with occasional sinus nodal block with junctional escape. Echocardiogram from [**7-/2117**] showed mildly dilated left atrium, markedly dilated right atrium, left ventricular systolic function markedly decreased. There is dyskinesia in the basal anteroseptal, mid anteroseptal, basal and mid inferoseptal regions. There is also akinesis of the basal inferior, mid inferior, basal and mid inferolateral and inferior apices area. There is also evidence for 1+ aortic regurgitation, 4+ mitral regurgitation and 4+ tricuspid regurgitation. EF at that time was noted to be 20%. HOSPITAL COURSE: Mr. [**Known lastname 105732**] was transferred from the Kurlind Service to the Coronary Care Unit on [**2118-11-11**]. 1. FEN: As stated above, Mr. [**Known lastname 105732**] received aggressive treatment for asymptomatic hyperkalemia without electrocardiogram changes. Potassium since that time has been stable approximately 4.7 to 4.8. This has been followed carefully. He has received low potassium and low sodium diet without problems. 2. Cardiovascular/coronary artery disease: Mr. [**Known lastname 105732**] was not on aspirin prior to transfer despite his history of coronary artery disease. He was placed on aspirin on [**2118-11-11**] without problems. Pumps, Mr. [**Known lastname 105732**] was known to have an EF of 20% with ischemic cardiomyopathy. These symptoms are mostly right sided consisting entirely of ascites and no lower extremity edema. Liver function tests were checked on transfer to look for evidence of passive congestion. Alkaline phosphatase was noted to be elevated at 208, otherwise liver function tests within normal limits. Mr. [**Known lastname 105732**] [**Last Name (Titles) 1834**] right heart catheterization in the Coronary Care Unit showing a wedge of approximately 17 to 20, SVR of [**2057**], cardiac output around 3 with cardiac index around 2.1. CVP was known to be elevated secondary to tricuspid regurgitation. Hydralazine and Isordil were held initially and he was placed on Dobutamine for better renal perfusion. On the first night he received 40 mg of intravenous Lasix with approximately 2 liters diuresis. In the intervening days he was diuresed well with Metolazone and prn Lasix with approximately 2 liter diuresis for the next three days. On [**2118-11-13**] he was placed back on Hydralazine 25 mg po q.i.d. His cardiac output was noted to decrease from 5 to 4 and his Hydralazine was increased to 50 mg po q.i.d. The next day he received Isordil 10 mg po t.i.d. and tolerated this very well. On [**2118-11-14**], right heart catheterization was removed without further problems. Of note, wedge pressure was unable to be evaluated on [**11-13**] and 19 secondary to severe mitral regurgitation. 3. Renal: As stated above, Mr. [**Known lastname 105732**] has had trouble with diuresis in the past secondary to creatinine elevation and hyperkalemia as side effects of diuretic therapy. Renal was consulted who thought that ultrafiltration/dialysis was not an option at this time. They felt that the trade off between elevating creatinine and fluid reduction was unnecessary at this time. He was diuresed well with Lasix and Metolazone. Creatinine on [**2118-11-13**] was 2.5 up from 2.4. On [**2118-11-14**] his BUN had bumped from 45 to 55 showing some evidence for intravascular depletion. Finally on [**2118-11-15**] creatinine was shown to be 2.6. At that time dry weight was noted to be 162.6 pounds with prostheses in place. 4. Gastrointestinal: As stated above Mr. [**Known lastname 105732**] received two large volume paracenteses first on [**11-10**] and then again on [**2118-11-11**]. He continued to have a distended belly and ultrasound was used to evaluate left over fluid. Of note, there was no fluid in the right lower quadrant or left lower quadrant. There was still a mild to moderate degree of fluid in the right upper quadrant next to the liver. It was decided at that time not to remove any further fluid for fear of injury to the liver. 5. Pulmonary: On the day of transfer Mr. [**Known lastname 105732**] [**Last Name (Titles) 1834**] chest x-ray showing small right pleural effusion and possible evidence of consolidation in that area. However, because he was asymptomatic and afebrile no further treatment was undergone. 6. Rheumatology: Mr. [**Known lastname 105732**] has a history of gout. Allopurinol was continued. 7. Endocrine: TSH at admission was 2.0. He was continued on his normal dose of Levoxyl without problems. 8. Prophylaxis: Mr. [**Known lastname 105732**] was started on Protonix secondary to heparin induced thrombocytopenia. He was not a candidate for heparin. Secondary to his bilateral below the knee amputations he was not a candidate for pneumoboots. DISPOSITION: Mr. [**Known lastname 105732**] was full code. He will be discharged home without further services. He was seen by physical therapy who thought that he was at baseline. DISCHARGE MEDICATIONS: 1. Allopurinol 200 mg po q.d. 2. Digoxin 0.125 mg po q.d. 3. Levoxyl 0.175 mg po q.d. 4. Zoloft 100 mg po q.d. 5. Hydralazine 50 mg po q.i.d. 6. Isordil 10 mg po t.i.d. 7. Lasix 20 mg po q.d. 8. Metolazone 2.5 mg po q.d. FOLLOW UP: He will follow up with Dr. [**Last Name (STitle) **] his cardiologist at a later time. Of note, Mr. [**Known lastname 105732**] had three episodes of asymptomatic nonsustained ventricular tachycardia including a 6 beat, 10 beat and 11 beat run. EP will be consulted at a later time. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D. [**MD Number(1) 1014**] Dictated By:[**Name8 (MD) 8073**] MEDQUIST36 D: [**2118-11-15**] 10:54 T: [**2118-11-18**] 09:47 JOB#: [**Job Number 105733**] Name: [**Known lastname 17208**],[**Known firstname 17209**] Unit No: [**Unit Number 17210**] Admission Date: [**2118-11-9**] Discharge Date: [**2118-11-18**] Date of Birth: [**2052-8-26**] Sex: M Service: CCU ADDENDUM: On the previous day of discharge, [**2118-11-15**], Mr. [**Known lastname **] felt not back to baseline and requested one day further of hospitalization. The following day, his rhythm which had previously been first degree heart block with occasional junctional escape rhythm, changed to paroxysmal atrial tachycardia with variable block. He was asymptomatic. Ventricular response rate ranged from 40 while sleeping to 70s-80s. Serial electrocardiograms were taken. The following day Mr. [**Known lastname **] had converted to the previous first degree heart block with occasional junctional escape rhythm; however, that day, creatinine was found to be 3.3, BUN 83, with dry weight at goal of 163 pounds with prosthetic legs. He was kept one day further for monitoring. Repeat creatinine at that time was 3.0 with BUN 85. On the day of discharge, [**2118-11-18**], AM BUN was 80 with creatinine of 3.2. He was feeling well. The previous day at 04:00 PM he had converted back into the paroxysmal atrial tachycardia with a variable block, sometimes [**12-28**], sometimes [**12-29**]. Amiodarone was started on the first day of this rhythm, on [**2118-11-16**] with the following load: 400 mg po tid times five days which will then be changed to 400 mg po bid times two weeks, which will then be changed to 400 mg po q day. When BUN and creatinine started to indicate overdiuresis, further diuretics were held. He will be discharged on the following diuretic regimen: Lasix 20 mg po q day. Metolazone will be held until seen by Dr. [**Last Name (STitle) 1426**] in one week. Of note, Digoxin was also discontinued on [**2118-11-16**] secondary to possible Digoxin toxicity, especially with these passive pneumonic rhythms of first degree heart block, junctional escape rhythm, and paroxysmal atrial tachycardia with variable block. DISCHARGE MEDICATIONS: 1) Levoxyl 0.175 mg po q day, 2) Zoloft 100 mg po q day, 3) allopurinol 200 mg po q day, 4) Lasix 20 mg po q day, 5) aspirin 325 mg po q day, 6) Hydralazine 25 mg po qid, 7) Isordil 10 mg po tid, 8) amiodarone 400 mg po tid for an additional three days, 400 mg po bid times two weeks, and then change to 400 mg po q day. Of note, Mr. [**Known lastname **] will follow up with Nurse [**First Name8 (NamePattern2) **] [**Last Name (Titles) 17211**] in one week. Cardiology Clinic will contact Mr. [**Known lastname **] with the exact time and date. He has been instructed to check his daily weights with a goal of 163 pounds. He was also outfitted with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts monitor for further monitoring during the load of amiodarone and also the most recent arrhythmias. Electrophysiology study for non-sustained ventricular tachycardia will be done at a later time. Furthermore, nasal swabs and perirectal swabs were sent to help change Mr. [**Known lastname **] to non-MRSA precautions; however, nasal and rectal swabs showed continual methicillin - resistant Staphylococcus aureus carriage. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1729**], M.D. [**MD Number(1) 6268**] Dictated By:[**Name8 (MD) 1037**] MEDQUIST36 D: [**2118-11-18**] 13:20 T: [**2118-11-21**] 10:36 JOB#: [**Job Number 17212**]

428,276,584,427,424,414,244,412

{'Congestive heart failure, unspecified,Hyperpotassemia,Acute kidney failure, unspecified,Other specified cardiac dysrhythmias,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,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: Admission for hyperkalemia and transferred to the Coronary Care Unit for fluid overload. PRESENT ILLNESS: This is a 66-year-old Russian male with a past medical history for known coronary artery disease and chronic renal insufficiency with a creatinine between 2 and 2.5, recently admitted for [**11-9**] for asymptomatic hyperkalemia after increase in Aldactone as an outpatient. MEDICAL HISTORY: 1. Coronary artery disease, status post inferior myocardial infarction in [**2116-3-26**]. Status post coronary artery bypass graft in [**2116-3-26**] with saphenous vein graft to left internal mammary artery, saphenous vein graft to diagonal with sequential graft to the first obtuse marginal, and saphenous vein graft to the posterior descending artery. Operation was complicated by cardiogenic shock requiring intra-aortic balloon pump. Postoperative course complicated by sepsis requiring bilateral below-knee amputations. He suffered stump infections with pseudomonas and methicillin-resistant Staphylococcus aureus. 2. Hypothyroidism. 3. Chronic renal insufficiency with creatinine between 2 and 2.5. 4. Upper gastrointestinal bleed. 5. Gout. 6. Congestive heart failure with an ejection fraction of 20%. 7. Heparin-induced thrombocytopenia. 8. Severe mitral regurgitation. 9. History of ascites. MEDICATION ON ADMISSION: 1. Allopurinol 200 mg p.o. q.d. 2. Aldactone. 3. Levoxyl 175 mcg p.o. q.d. 4. Isordil 10 mg p.o. t.i.d. 5. Zoloft 100 mg p.o. q.d. 6. Digoxin 0.125 mg p.o. q.d. 7. Hydralazine 25 mg p.o. q.i.d. ALLERGIES: Allergy to KEFLEX and HEPARIN (heparin-induced thrombocytopenia). PHYSICAL EXAM: FAMILY HISTORY: Family history is noncontributory. SOCIAL HISTORY: The patient denies tobacco or alcohol use. His is a Russian immigrant. ### Response: {'Congestive heart failure, unspecified,Hyperpotassemia,Acute kidney failure, unspecified,Other specified cardiac dysrhythmias,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Old myocardial infarction'}

CHIEF COMPLAINT: Dyspnea PRESENT ILLNESS: This is a 40 year-old man with AIDS diagnosed in [**2171**] last CD4 count of 27 and viral load of [**Numeric Identifier **] re-started on HAART salvage this month who activated EMS today for shortness of breath. He is admitted to [**Hospital Unit Name 153**] after being intubated for airway protection due to altered mental status and on pressors for hypotension. History is obtained from family and partner, [**Name (NI) **] notes and [**Name (NI) **] notes/doctors. MEDICAL HISTORY: 1. HIV disease- HIV/AIDS since [**2172**] off HAART since [**4-/2190**],(Absolute CD4 count 27, CD4 1%, HIV viral load was 41,800 copies per mL) Prior HIV regimens -monotherapy with AZT [**2173**]-[**2178**], and complicated by nausea -monotherapy with DDI, complicated by neuropathy in [**2181**] Combivir/Indinavir on 5/96-8/96, nausea to AZT -D4T, 3TC, Crixivan from 11/96-4/04. 2. History of "hepatitis" unclear as to what type. 3. History of nephrolithiasis. 4. History of prostatitis. 5. Arthroscopic knee surgery. 6. History of depression, briefly on SSRI. 7. Eczema. 8. Tension headaches. 9. Positive hep B core antibody and surface antibody. 10. [**2191-12-11**] admission for MRSA finger infection, transaminitis, pancytopenia/leukopenia, fevers MEDICATION ON ADMISSION: abicavir, kaletra, bactrim, truvada, azithromycin--although unclear which of these he was taking recently ALLERGIES: Zantac / Tagamet / Megace / Zyban / Iodine; Iodine Containing / Zoloft / Ceftriaxone / Cefepime / Abacavir PHYSICAL EXAM: VS: Temp:98.5 BP: 112/65 HR:99 RR:20 100% O2sat VENT 650 x 20 fio2100 peep 5 ABG:7.30/35/377 general: intubated, sedated HEENT: pupils equal 4mm, round, sluggish but reactive, no scleral icterus, MMM, op without lesions, no supraclavicular or cervical lymphadenopathy, no thyromegaly or thyroid nodules lungs: Coarse anteriorly heart: tachy, S1 and S2 wnl, no murmurs, rubs or gallops appreciated abdomen: nd, +b/s, soft, nt, no masses or hepatosplenomegaly extremities: 1+edema skin/nails: rash over lower extremities neuro: intubated, sedated, responds to pain FAMILY HISTORY: FH - He reports his mother is alive and well but has diabetes. Father is alive and obese, also with diabetes and coronary artery disease. SOCIAL HISTORY: Per [**Last Name (LF) **], [**First Name3 (LF) **] h/o smoking, social ETOH only, no illicit drug use; lives in JP with long-time partner, also HIV+; they are sexually active and use condoms 100% of the time per pt; he was born and raised in [**University/College **] and came to the US in [**2172**], first living in [**State 108**] for 4 months and then moving to [**Location (un) 538**], where he has lived ever since; works as a florist doing visual displays; he has 1 adult cat at home; travels frequently to [**Country 5976**], [**Country 12649**], [**Country 74323**], S.America, but denies ever traveling to [**Country 480**]/[**Female First Name (un) 8489**]. Toxo IgG negative in [**2188**].

Human immunodeficiency virus [HIV] disease,Cryptococcosis,Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Opioid abuse, unspecified,Poisoning by methadone,Accidental poisoning by methadone

Human immuno virus dis,Cryptococcosis,Pneumonia, organism NOS,Acute respiratry failure,Acidosis,Opioid abuse-unspec,Poisoning-methadone,Acc poison-methadone

Admission Date: [**2192-3-1**] Discharge Date: [**2192-3-7**] Date of Birth: [**2151-8-28**] Sex: M Service: MEDICINE Allergies: Zantac / Tagamet / Megace / Zyban / Iodine; Iodine Containing / Zoloft / Ceftriaxone / Cefepime / Abacavir Attending:[**First Name3 (LF) 613**] Chief Complaint: Dyspnea Major Surgical or Invasive Procedure: Intubated History of Present Illness: This is a 40 year-old man with AIDS diagnosed in [**2171**] last CD4 count of 27 and viral load of [**Numeric Identifier **] re-started on HAART salvage this month who activated EMS today for shortness of breath. He is admitted to [**Hospital Unit Name 153**] after being intubated for airway protection due to altered mental status and on pressors for hypotension. History is obtained from family and partner, [**Name (NI) **] notes and [**Name (NI) **] notes/doctors. As per his family and partner, he was feeling well until this afternoon. He was at work and apparently felt he had an "anxiety attack". He felt short of breath and palpitations and was brought to the ED by EMS. Family also notes that last friday he started a new HIV medication and subsequently developed chills, diarrhea, fever to 103 and some new red "bumps" appeared on his legs. The following day felt better. As per Dr.[**Initials (NamePattern4) 42346**] [**Last Name (NamePattern4) **] notes confirm initiation of abacivir, truvada and kaletra. A [**2-17**] telephone contact notes initiation of all meds at that time without significant complication. The patient's family thinks he may have been staggering initiation of meds. As per ED physician and [**Name9 (PRE) 9168**] notes, patient reported that he started a new medication today before his shortness of breath started. History obtained in ED from patient documents that patient became short of breath after using crystal meth today. Of note, recent hospitalization in [**2191-12-11**] with fevers, MRSA finger infection, pancytopenia, transaminitis. Treated for MRSA infection and had seeming resolution of other issues. At that time had AFB sent--was positive but no TB as per state lab--thought was it could be MAC but state lab results still outstanding. In the ED, T 99.2 at 12 noon-->102.4 at 4:30PM Hr 128 BP 138/76 at 12 noon-->72sbp by about 4:30PM RR 25 Sats 98%. He received 5 liters of fluid, significant amount of ativan, was noted to have altered mental status with bizarre behavior, intubated for airway protection, given cefipime and vancomycin, started on pressors. Past Medical History: 1. HIV disease- HIV/AIDS since [**2172**] off HAART since [**4-/2190**],(Absolute CD4 count 27, CD4 1%, HIV viral load was 41,800 copies per mL) Prior HIV regimens -monotherapy with AZT [**2173**]-[**2178**], and complicated by nausea -monotherapy with DDI, complicated by neuropathy in [**2181**] Combivir/Indinavir on 5/96-8/96, nausea to AZT -D4T, 3TC, Crixivan from 11/96-4/04. 2. History of "hepatitis" unclear as to what type. 3. History of nephrolithiasis. 4. History of prostatitis. 5. Arthroscopic knee surgery. 6. History of depression, briefly on SSRI. 7. Eczema. 8. Tension headaches. 9. Positive hep B core antibody and surface antibody. 10. [**2191-12-11**] admission for MRSA finger infection, transaminitis, pancytopenia/leukopenia, fevers Social History: Per [**Last Name (LF) **], [**First Name3 (LF) **] h/o smoking, social ETOH only, no illicit drug use; lives in JP with long-time partner, also HIV+; they are sexually active and use condoms 100% of the time per pt; he was born and raised in [**University/College **] and came to the US in [**2172**], first living in [**State 108**] for 4 months and then moving to [**Location (un) 538**], where he has lived ever since; works as a florist doing visual displays; he has 1 adult cat at home; travels frequently to [**Country 5976**], [**Country 12649**], [**Country 74323**], S.America, but denies ever traveling to [**Country 480**]/[**Female First Name (un) 8489**]. Toxo IgG negative in [**2188**]. Family History: FH - He reports his mother is alive and well but has diabetes. Father is alive and obese, also with diabetes and coronary artery disease. Physical Exam: VS: Temp:98.5 BP: 112/65 HR:99 RR:20 100% O2sat VENT 650 x 20 fio2100 peep 5 ABG:7.30/35/377 general: intubated, sedated HEENT: pupils equal 4mm, round, sluggish but reactive, no scleral icterus, MMM, op without lesions, no supraclavicular or cervical lymphadenopathy, no thyromegaly or thyroid nodules lungs: Coarse anteriorly heart: tachy, S1 and S2 wnl, no murmurs, rubs or gallops appreciated abdomen: nd, +b/s, soft, nt, no masses or hepatosplenomegaly extremities: 1+edema skin/nails: rash over lower extremities neuro: intubated, sedated, responds to pain Pertinent Results: [**2192-3-1**] CT Head - No evidence of hemorrhage or mass defect. Sinus findings as described above. Apparent fullness of the nasopharynx. Correlation with clinical exam is recommended. [**2192-3-1**] CXR - No acute cardiopulmonary process [**2192-3-5**] RUQ U/S - Two small hemangiomas in the liver, otherwise normal right upper quadrant ultrasound. [**2192-3-6**] CT Chest - Multifocal patchy consolidation in both lower lobes and peripheral ground- glass opacities in the upper lobes with bronchocentric nodules in the right lower lobe and enlarging noncalcified pulmonary nodule in the right middle lobe. Bilateral small pleural effusions. The findings are consistent with an infectious process but are not specific for a particular organism. Differential diagnosis includes fungal infection such as cryptococcus or bacterial or mycobacterial infection. [**2192-3-6**] MR [**Name13 (STitle) 430**] - Unremarkable examination of the brain. Diffuse paranasal sinus disease as indicated on the CT examination. Bilateral changes of mild mastoiditis of uncertain chronicity. Brief Hospital Course: Mr. [**Known lastname **] [**Known lastname 92744**] is a 40 year-old man with history of AIDS recently started on salvage HAART as an outpatient who initially presented with shortness of breath in the setting of crystal methamphetamine use. He was noted to have bizarre behavior in the ER and was intubated for airway protection. He was not hypoxic and had a clear CXR. Notably, in the ER he was also found to have neutropenia and was given one dose of cefepime. The patient has a cephalosporin allergy (reaction being hypotension) and in this setting he became hypotensive, briefly requiring pressors. He was also noted to be febrile, however this was in the setting of having already received the cefepime. He was intubated only briefly, and did well post-extubation in the ICU. Reportedly his fevers did not start until after receiving the cefepime in the ED suggesting a medication reaction. However he was febrile up to 104 overnight [**2111-3-3**]. He is certainly susceptible to multiple infections given his HIV status and at least transient neutropenia. All cultures, with the exception of a positive serum cryptococcal antigen, were negative. With CD4=29 the differential was broad. He was followed by infectious disease during his stay. Head MRI was unremarkable and chest CT was unrevealing. cultures remained negative. The patient was initially treated with broad spectrum antibiotics, including antibacterials, acyclovir and fluconazole. Acyclovir was discontinued after HSV PR from CSF was negative. AFB x 3 was sent from induced sputum. The patient has a positive AFB culture at the state lab for 2 months that returned MYCOBACTERIUM FORTUITUM. The patient was discharged on levo/flagyl to complete a 10 day course (today is day #5) and was continued on fluconazole indefinately until seen by Dr. [**Last Name (STitle) **]. At the time of discharge all HIV meds were being held. He will be restarted on a new regimen by Dr. [**Last Name (STitle) **]. There was a question as to whether some of his symptoms were abacavir hypersensitivity. Medications on Admission: abicavir, kaletra, bactrim, truvada, azithromycin--although unclear which of these he was taking recently Discharge Medications: 1. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) Tablet PO MWF (Monday-Wednesday-Friday). Disp:*15 Tablet(s)* Refills:*2* 2. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 5 days. Disp:*5 Tablet(s)* Refills:*0* 3. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 5 days. Disp:*15 Tablet(s)* Refills:*0* 4. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO once a day. Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Cryptococcal Infection Crystal Meth OD Abacavir Hypersensitivity Cefepime Allergy Discharge Condition: Stable Discharge Instructions: --Please take all medications as prescribed. You will be taking levofloxacin and Flagyl for the next 5 days (to complete a 10 day course). You need to continue the fluconazole until Dr. [**Last Name (STitle) **] tells you to stop. Please notify your doctors [**First Name (Titles) **] [**Last Name (Titles) 2449**] [**Name5 (PTitle) **] numbness or weakness. -- Do NOT take your HIV medicines --Please return to the ER for any shortness of breath, difficulty breathing, fevers, or chills. Followup Instructions: ** You have an appointment with Dr. [**Last Name (STitle) **] on [**3-21**] at 11AM. She is located on the [**Location (un) **] of the [**Hospital Ward Name 23**] Building. Please call [**Telephone/Fax (1) 250**] if you need to reschedule. ***You have an appointment with Dr. [**Last Name (STitle) **]/Dr. [**Last Name (STitle) **] (Pulmonary) at 3:15 on [**4-2**]. They are located on the [**Location (un) **] of the [**Hospital Ward Name 23**] Building. Check in at the Medical Specilities Desk. [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

042,117,486,518,276,305,965,E850

{'Human immunodeficiency virus [HIV] disease,Cryptococcosis,Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Opioid abuse, unspecified,Poisoning by methadone,Accidental poisoning by methadone'}

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 PRESENT ILLNESS: This is a 40 year-old man with AIDS diagnosed in [**2171**] last CD4 count of 27 and viral load of [**Numeric Identifier **] re-started on HAART salvage this month who activated EMS today for shortness of breath. He is admitted to [**Hospital Unit Name 153**] after being intubated for airway protection due to altered mental status and on pressors for hypotension. History is obtained from family and partner, [**Name (NI) **] notes and [**Name (NI) **] notes/doctors. MEDICAL HISTORY: 1. HIV disease- HIV/AIDS since [**2172**] off HAART since [**4-/2190**],(Absolute CD4 count 27, CD4 1%, HIV viral load was 41,800 copies per mL) Prior HIV regimens -monotherapy with AZT [**2173**]-[**2178**], and complicated by nausea -monotherapy with DDI, complicated by neuropathy in [**2181**] Combivir/Indinavir on 5/96-8/96, nausea to AZT -D4T, 3TC, Crixivan from 11/96-4/04. 2. History of "hepatitis" unclear as to what type. 3. History of nephrolithiasis. 4. History of prostatitis. 5. Arthroscopic knee surgery. 6. History of depression, briefly on SSRI. 7. Eczema. 8. Tension headaches. 9. Positive hep B core antibody and surface antibody. 10. [**2191-12-11**] admission for MRSA finger infection, transaminitis, pancytopenia/leukopenia, fevers MEDICATION ON ADMISSION: abicavir, kaletra, bactrim, truvada, azithromycin--although unclear which of these he was taking recently ALLERGIES: Zantac / Tagamet / Megace / Zyban / Iodine; Iodine Containing / Zoloft / Ceftriaxone / Cefepime / Abacavir PHYSICAL EXAM: VS: Temp:98.5 BP: 112/65 HR:99 RR:20 100% O2sat VENT 650 x 20 fio2100 peep 5 ABG:7.30/35/377 general: intubated, sedated HEENT: pupils equal 4mm, round, sluggish but reactive, no scleral icterus, MMM, op without lesions, no supraclavicular or cervical lymphadenopathy, no thyromegaly or thyroid nodules lungs: Coarse anteriorly heart: tachy, S1 and S2 wnl, no murmurs, rubs or gallops appreciated abdomen: nd, +b/s, soft, nt, no masses or hepatosplenomegaly extremities: 1+edema skin/nails: rash over lower extremities neuro: intubated, sedated, responds to pain FAMILY HISTORY: FH - He reports his mother is alive and well but has diabetes. Father is alive and obese, also with diabetes and coronary artery disease. SOCIAL HISTORY: Per [**Last Name (LF) **], [**First Name3 (LF) **] h/o smoking, social ETOH only, no illicit drug use; lives in JP with long-time partner, also HIV+; they are sexually active and use condoms 100% of the time per pt; he was born and raised in [**University/College **] and came to the US in [**2172**], first living in [**State 108**] for 4 months and then moving to [**Location (un) 538**], where he has lived ever since; works as a florist doing visual displays; he has 1 adult cat at home; travels frequently to [**Country 5976**], [**Country 12649**], [**Country 74323**], S.America, but denies ever traveling to [**Country 480**]/[**Female First Name (un) 8489**]. Toxo IgG negative in [**2188**]. ### Response: {'Human immunodeficiency virus [HIV] disease,Cryptococcosis,Pneumonia, organism unspecified,Acute respiratory failure,Acidosis,Opioid abuse, unspecified,Poisoning by methadone,Accidental poisoning by methadone'}

CHIEF COMPLAINT: Right hydrothorax, fluid overload, fever PRESENT ILLNESS: Mr. [**Known lastname 75713**] is a 71 year-old male with history of right upper lobe lung cancer s/p right thoracotomy with right upper lobectomy and en-block chest wall resection with decortication of the middle and lower lobes. The procedure was difficult procedure and complicated by prolonged hospital stay due to bronchopleural fistula. He returned for followup on [**2101-1-13**] with improving postoperative chest discomfort, yet reported shortness of breath, nonproductive cough, and bilateral lower extremity edema, despite being recently placed on lasix by his PCP. [**Name10 (NameIs) **] had a low-grade fever to 100.1 the evening prior to his followup appointment. CXR ([**2101-1-13**]) revealed right hydropneumothorax. He was subsequently admitted to the Thoracic Surgery service for further workup and management. MEDICAL HISTORY: PMH: Traumatic blindness (left eye) Hypertension Alcohol-induced gastric ulcers (alcohol-free x20yr) Lung CA, R chest wall ([**4-11**]), s/p carboplatin, taxol with avastin h/o serratia marascens VAP MEDICATION ON ADMISSION: Atenolol 100 mg daily Oxycodone-Acetaminophen 5-325 mg, 1-2 tabs po q4-6hr prn pain Docusate Sodium 100 mg [**Hospital1 **] Lisinopril 20 mg [**Hospital1 **] Hydrochlorothiazide 25 mg daily Doxazosin 6mg qhs Lasix 40mg daily ALLERGIES: Penicillins PHYSICAL EXAM: General: NAD, thin-appearing male, awake, alert HEENT: NC/AT, mucous membranes moist, OP clear, no lesions Neck: Supple, no lymphadenopathy Cardiovascular: RRR no murmurs Respiratory: Significantly decreased right base, slightly decreased on left base. Empyema tubes x3. Back: Well-healed thoracotomy scar Gastrointestinal: soft, nontender, nondistended, normoactive bowel sounds Musculoskeletal: [**2-6**]+ pitting edema LE bilaterally Skin: Right port without erythema, bilateral splinter hemorrhages FAMILY HISTORY: Notable for cerebral hemorrhage. Father with lung cancer. Brother with gastric cancer and another brother with emphysema. Sister with cystic fibrosis. SOCIAL HISTORY: Lives with wife EtOH: {x}N { }Y Quit Tobacco: {x}N { }Y Quit 20 years ago Drugs: {x}N { }Y Amount: Married: { } N {x}Y Occupations: Construction worker Exposures: Asbestos, chemical / construction materials Diabetes: N Immunodeficiency: N Cancer: Y

Empyema without mention of fistula,Other and unspecified mycoses,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of bronchus and lung

Empyema w/o fistula,Mycoses NEC & NOS,Acute kidney failure NOS,Chronic kidney dis NOS,Chr airway obstruct NEC,Hy kid NOS w cr kid I-IV,Hx-bronchogenic malignan

Admission Date: [**2101-1-13**] Discharge Date: [**2101-2-11**] Date of Birth: [**2030-1-26**] Sex: M Service: CARDIOTHORACIC Allergies: Penicillins Attending:[**First Name3 (LF) 2969**] Chief Complaint: Right hydrothorax, fluid overload, fever Major Surgical or Invasive Procedure: [**2101-1-13**]: right ultrasound-guided thoracentesis [**2101-1-14**]: flexible bronchoscopy [**2101-1-18**]: bronchoscopy, thorascoscopy video-assisted right drainage of effusion, decortication, removal of gortex mesh History of Present Illness: Mr. [**Known lastname 75713**] is a 71 year-old male with history of right upper lobe lung cancer s/p right thoracotomy with right upper lobectomy and en-block chest wall resection with decortication of the middle and lower lobes. The procedure was difficult procedure and complicated by prolonged hospital stay due to bronchopleural fistula. He returned for followup on [**2101-1-13**] with improving postoperative chest discomfort, yet reported shortness of breath, nonproductive cough, and bilateral lower extremity edema, despite being recently placed on lasix by his PCP. [**Name10 (NameIs) **] had a low-grade fever to 100.1 the evening prior to his followup appointment. CXR ([**2101-1-13**]) revealed right hydropneumothorax. He was subsequently admitted to the Thoracic Surgery service for further workup and management. Past Medical History: PMH: Traumatic blindness (left eye) Hypertension Alcohol-induced gastric ulcers (alcohol-free x20yr) Lung CA, R chest wall ([**4-11**]), s/p carboplatin, taxol with avastin h/o serratia marascens VAP PSH: s/p appendectomy, date unknown [**2100-12-22**]: Bronchoscopy, Reoperative right thoracotomy with right upper lobectomy and en bloc right chest wall resection (ribs 3,4 and 5) with [**Doctor Last Name 4726**]-Tex chest wall reconstruction and decortication of right middle and right lower lobes. . [**2100-12-25**]: Flexible bronchoscopy with therapeutic aspiration and bronchoalveolar lavage. . [**2100-12-26**], [**2100-12-27**], [**2100-12-28**], [**2101-1-19**]: Flexible bronchoscopy with therapeutic aspiration. . [**2101-1-13**]: Right sided thoracentesis under ultrasound guidance. Social History: Lives with wife EtOH: {x}N { }Y Quit Tobacco: {x}N { }Y Quit 20 years ago Drugs: {x}N { }Y Amount: Married: { } N {x}Y Occupations: Construction worker Exposures: Asbestos, chemical / construction materials Diabetes: N Immunodeficiency: N Cancer: Y Family History: Notable for cerebral hemorrhage. Father with lung cancer. Brother with gastric cancer and another brother with emphysema. Sister with cystic fibrosis. Physical Exam: General: NAD, thin-appearing male, awake, alert HEENT: NC/AT, mucous membranes moist, OP clear, no lesions Neck: Supple, no lymphadenopathy Cardiovascular: RRR no murmurs Respiratory: Significantly decreased right base, slightly decreased on left base. Empyema tubes x3. Back: Well-healed thoracotomy scar Gastrointestinal: soft, nontender, nondistended, normoactive bowel sounds Musculoskeletal: [**2-6**]+ pitting edema LE bilaterally Skin: Right port without erythema, bilateral splinter hemorrhages Pertinent Results: [**2101-1-13**]: CXR (on admit) No evidence of remaining aerated pulmonary tissue in right-sided hemithorax and central right-sided airways only followed 2-3 cm distal to the bifurcation. A hydropneumothorax is present on the right side with an air-fluid level above thoracic arch. Multiple right-sided upper rib defects consistent with chest wall reconstruction. Mild-to-moderate mediastinal shift towards right side indicative of volume loss. The left-sided hemithorax shows grossly normal appearance of the lung without evidence of acute infiltrates or congestive pattern. . [**2101-1-13**]: Pleural fluid: NEGATIVE FOR MALIGNANT CELLS . [**2101-1-25**]: ECHO: Left atrium is mildly dilated. Mild symmetric left ventricular hypertrophy. Left ventricular systolic function is normal (LVEF>55%). 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. There is a small pericardial effusion. . [**2101-1-27**]: CT Chest IMPRESSION: 1. New, large hematoma in the right upper chest, predominantly pleural, despite two apical pleural tubes; new submuscular, R chest wall hematoma. 2. Persistent right pleural thickening and worsening atelectasis. 3. New small left pleural effusion. . [**2101-2-3**]: CT Chest IMPRESSION: 1. Resolving large hematoma in the right upper chest with reexpansion of the right upper lobe volume. 2. Persistent right extrathoracic hematoma with less gas. 3. Resolving left pleural effusion. . [**2101-2-9**]: Renal U/S: No evidence of hydronephrosis . [**2101-2-10**]: CXR (prior to discharge) IMPRESSION: No relevant changes in right hemithorax. Minimal increase in a subtle perihilar, but diffuse opacity in the left lung. Brief Hospital Course: Neuro: On admit, the patient was given oral pain medication, on which he reported adequate pain relief. Following right VATS and post-operative intubation, he was placed on propofol gtt and given dilaudid IV until extubated. When able to tolerate po, he was placed on oral pain medication. Prior to discharge, his pain was adequately controlled on tylenol. . Cardiopulmonary: Following admission, the patient underwent a bronchoscopy on [**2101-1-14**] which revealed a small amount of granulation tissue at the base of cords c/w prior intubation trauma, healthy appearing surgical stump, mucous in RLL, and edematous RML/RLL bronchi. Based on the right hydropneumothorax revealed on CXR, a right apical chest tube was inserted (drained ~1000cc serosanginous) at the bedside and pleural fluid cultures were obtained. tPA was placed through the tube prior to obtaining CT Chest on [**2101-1-17**]. On [**2101-1-18**], due to the persistent right effusion, the patient underwent a flexible bronchoscopy, right video-assisted thoracoscopy with drainage, and decortication. Two additional right chest tubes were placed while in the operating room. The patient tolerated the procedure well, yet post-operatively, was electively intubated following right hemithorax whiteout demonstrated on CXR. He was subsequently transferred to the ICU and underwent bronchoscopy which revealed moderate inflammation and edema in the distal trachea and mainstem bronchi with a mucous plug in the bronchus intermedius and right middle lobe takeoff. Repeat bronchoscopy on [**2101-1-19**] revealed a small amount thick mucoid secretions in the LLL, with an intact RUL stump. Following bronchoscopy, he was weaned to extubate without incident. On [**2101-1-20**], he was transferred to [**Hospital Ward Name 121**] 7. He had multiple CT scans during the remainder of the hospitalization, results aforementioned. On [**2101-1-26**] he was transferred to the TICU for hypotension and decreased hemocrit. After stabilization of hemocrit (received 6 units pRBCs) and blood pressure stabilization, he was transferred to [**Hospital Ward Name 121**] 7 on [**2101-1-28**]. Once on the floor, tPA was placed through the chest tubes. He became hypertensive (SBP 180s) intermittently, and was administered hydralazine IV prn in addition to atenolol and lisinopril (home medications). On [**2101-2-7**], all three chest tubes were placed to waterseal. The anterior CT was subsequently converted to an empyema tube. Prior to discharge, the posterior and basilar tubes were converted to empyema tubes. CXR on [**2101-2-11**] revealed no relevant changes in the right hemithorax. . FEN/GI: Following admit, the patient tolerated a regular diet. He was given Ensure supplements and calorie counts were initiated per nutritional recommendations. Over 3 days, calorie were 1403 and protein 47 grams. Lasix 40mg daily was continued for diuresis and electrolytes were repleted as appropriate. On discharge, he was tolerating a regular diet; denied nausea or vomiting. . ID: On admit, patient had temperature of 101.2, WBC=8.5. He was initially placed on vancomycin and levofloxacin IV while awaiting culture results. Diflucan was started on [**2101-1-15**] due to [**Female First Name (un) **] albicans growth in pleural fluid from [**2101-1-13**] and subsequently [**2101-1-18**]. Levofloxacin was discontinued on [**2101-1-24**]. Infectious disease was consulted for antibiotic management. Recommendations included: checking TEE to r/o endocarditis, continuing diflucan from [**Date range (1) 75840**], checking LFTs every 2weeks while on diflucan, and obtaining f/u CT scan at end of treatment course to determine resolution of effusion. On discharge, the patient was afebrile, WBC=9.9. He was discharged on vancomycin, to continue until all empyema tubes removed, and fluconazole, to continue until [**2101-2-28**]. . Renal: On [**2101-2-9**], the patient's creatinine increased to 1.7 (from 1.3 on admit). Fractional excretion of sodium was 0.9. Renal ultrasound revealed right kidney 11.6 cm, left kidney 10.7 cm, with no evidence of hydronephrosis, nephrolithiasis, or renal mass. Urinalysis was negative; no eosinophils. Renal team was consulted and thought acute renal failure was likely drug-related. Renal recommmendations included holding lisinopril and renally dosing antibiotics. Creatinine was closely followed; on discharge, creatinine was 1.9. . Endo: Blood sugars were closely monitored. The patient was placed on an insulin sliding scale. On [**2101-2-4**], the patient was triggered for a blood sugar of 26. He was confused and disoriented, yet improved with 1/2 amp D50 x2 and [**Location (un) 2452**] juice. He subsequently received D10W, insulin was held, and fingersticks were closely monitoring. He did not have any further low blood sugars during the remainder of his hospitalization. . Heme: He was given heparin SQ 5000U TID for DVT prophylaxis. He received 2 units pRBC on [**2101-1-26**] for Hct drop (28.6 to 23.8). Post-tranfusion Hct was 25.9, and he subsequently received 4 more units pRBC, with resulting Hct of 33.0. On discharge, Hct was 26.6. Medications on Admission: Atenolol 100 mg daily Oxycodone-Acetaminophen 5-325 mg, 1-2 tabs po q4-6hr prn pain Docusate Sodium 100 mg [**Hospital1 **] Lisinopril 20 mg [**Hospital1 **] Hydrochlorothiazide 25 mg daily Doxazosin 6mg qhs Lasix 40mg daily Discharge Medications: 1. Docusate Sodium 50 mg/5 mL Liquid [**Hospital1 **]: One (1) PO BID (2 times a day). 2. Doxazosin 4 mg Tablet [**Hospital1 **]: 1.5 Tablets PO HS (at bedtime). 3. Ferrous Sulfate 325 mg (65 mg Iron) Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily). 4. Senna 8.6 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day) as needed. 5. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 6. Fluconazole 200 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO Q24H (every 24 hours): Dr. [**Doctor Last Name 75841**] disease will stop this medication. Disp:*30 Tablet(s)* Refills:*1* 7. Atenolol 100 mg Tablet [**Doctor Last Name **]: One (1) Tablet PO once a day: Hold for SBP<100, HR<60. 8. Diazepam 5 mg Tablet [**Doctor Last Name **]: [**1-5**] to 1 [**1-5**] Tablet PO Q12H (every 12 hours) as needed. 9. Vancomycin in Dextrose 1 gram/200 mL Piggyback [**Month/Day (2) **]: One (1) gm Intravenous Q 24H (Every 24 Hours). Disp:*30 gm* Refills:*1* 10. Atenolol 50 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO q pm. 11. Outpatient Lab Work check vanco level, liver function tests, and bun/creat on monday [**2101-2-14**] and call to Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 170**] 12. Heparin Lock Flush (Porcine) 10 unit/mL Solution [**Telephone/Fax (1) **]: One (1) ML Intravenous DAILY (Daily) as needed. Disp:*qs unit/ml* Refills:*0* 13. Tylenol 325 mg Tablet [**Telephone/Fax (1) **]: 1-2 Tablets PO every four (4) hours. 14. Saline Flush 0.9 % Syringe [**Telephone/Fax (1) **]: One (1) Injection prn. Disp:*qs syringe* Refills:*0* Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Primary: Lung CA, right chest wall s/p carboplatin, taxol with avastin, s/p right thoracotomy with right upper lobectomy and enblock right chest wall resection with [**Doctor Last Name 4726**]-Tex chest wall reconstruction Secondary: Hypertension Gastric Ulcers COPD CRI (baseline Cr 1.5) Traumatic blindness L eye Discharge Condition: Good Discharge Instructions: Call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 170**] if experience: -Fever > 101 or chills -Increased shortness of breath, cough or sputum production -Chest pain -Incision develops discharge Cover chest tube site with a clean dry dressing daily. The gauze at the end of the chest tubes can changed as often as needed. If the chest tube falls out- cover the site with a gauze and call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 170**] immediately. Complete Diflucan through [**2101-2-28**] LFT's every 2 weeks while on Diflucan: Fax results to Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 432**] You may only [**Last Name (un) 41829**] bathe until the chest tubes are removed. Followup Instructions: Follow-up with Dr. [**Last Name (STitle) **] on thursday [**2101-2-17**] at 3pm in the [**Hospital Ward Name **] clinical center [**Location (un) **]. Please arrive 45 minutes prior to your follow up appointment and report to the [**Location (un) **] radiology for a chest xray. Follow-up with [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 22367**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2101-2-28**] 11:00 in the [**Last Name (un) 2577**] Building basement [**Last Name (NamePattern1) 10357**]

510,117,584,585,496,403,V101

{'Empyema without mention of fistula,Other and unspecified mycoses,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of bronchus and lung'}

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: Right hydrothorax, fluid overload, fever PRESENT ILLNESS: Mr. [**Known lastname 75713**] is a 71 year-old male with history of right upper lobe lung cancer s/p right thoracotomy with right upper lobectomy and en-block chest wall resection with decortication of the middle and lower lobes. The procedure was difficult procedure and complicated by prolonged hospital stay due to bronchopleural fistula. He returned for followup on [**2101-1-13**] with improving postoperative chest discomfort, yet reported shortness of breath, nonproductive cough, and bilateral lower extremity edema, despite being recently placed on lasix by his PCP. [**Name10 (NameIs) **] had a low-grade fever to 100.1 the evening prior to his followup appointment. CXR ([**2101-1-13**]) revealed right hydropneumothorax. He was subsequently admitted to the Thoracic Surgery service for further workup and management. MEDICAL HISTORY: PMH: Traumatic blindness (left eye) Hypertension Alcohol-induced gastric ulcers (alcohol-free x20yr) Lung CA, R chest wall ([**4-11**]), s/p carboplatin, taxol with avastin h/o serratia marascens VAP MEDICATION ON ADMISSION: Atenolol 100 mg daily Oxycodone-Acetaminophen 5-325 mg, 1-2 tabs po q4-6hr prn pain Docusate Sodium 100 mg [**Hospital1 **] Lisinopril 20 mg [**Hospital1 **] Hydrochlorothiazide 25 mg daily Doxazosin 6mg qhs Lasix 40mg daily ALLERGIES: Penicillins PHYSICAL EXAM: General: NAD, thin-appearing male, awake, alert HEENT: NC/AT, mucous membranes moist, OP clear, no lesions Neck: Supple, no lymphadenopathy Cardiovascular: RRR no murmurs Respiratory: Significantly decreased right base, slightly decreased on left base. Empyema tubes x3. Back: Well-healed thoracotomy scar Gastrointestinal: soft, nontender, nondistended, normoactive bowel sounds Musculoskeletal: [**2-6**]+ pitting edema LE bilaterally Skin: Right port without erythema, bilateral splinter hemorrhages FAMILY HISTORY: Notable for cerebral hemorrhage. Father with lung cancer. Brother with gastric cancer and another brother with emphysema. Sister with cystic fibrosis. SOCIAL HISTORY: Lives with wife EtOH: {x}N { }Y Quit Tobacco: {x}N { }Y Quit 20 years ago Drugs: {x}N { }Y Amount: Married: { } N {x}Y Occupations: Construction worker Exposures: Asbestos, chemical / construction materials Diabetes: N Immunodeficiency: N Cancer: Y ### Response: {'Empyema without mention of fistula,Other and unspecified mycoses,Acute kidney failure, unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of bronchus and lung'}

CHIEF COMPLAINT: chest tightness with exertion PRESENT ILLNESS: 57 y/o Cantonese speaking F with known 3V CAD, medically managed with recent 2 day episode of exertional angina. Underwent cardiac cath which again revealed severe three vessel coronary artery disease. Referred for surgical revascularization. MEDICAL HISTORY: Coronary Artery Disease s/p Myocardial Infarction [**8-9**], Hypertension, Hypercholesterolemia, Diabetes, melodysplastic syndrome, Peripheral Vawscular Disease s/p R com Fem to [**Doctor Last Name **] BPG, Retinopathy, GERD, Chronic Renal Insufficiency(1.3-1.8) MEDICATION ON ADMISSION: Aspirin 81mg qd, Norvasc 5mg qd, Lipitor 80mg qd, Plavix 75mg qd, Iron, Folic Acid, Glyburide 5mg [**Hospital1 **], Lisinopril 10mg, MVI, Pyridoxine25mg qd, Zantac 150mg qd, Toprol XL 100mg qd, Lantus ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: HR 66 RR 16 BP 177/92 WDWN Asian F in NAD Lungs CTAB Heart RRR no Murmur Abdomen benign Extrem warm, no edema FAMILY HISTORY: n/c SOCIAL HISTORY: no alcohol non smoker

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Pure hypercholesterolemia,Myelodysplastic syndrome, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Esophageal reflux,Anemia of other chronic disease

Crnry athrscl natve vssl,Intermed coronary synd,DMII ophth nt st uncntrl,Diabetic retinopathy NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Pure hypercholesterolem,Myelodysplastic synd NOS,Ath ext ntv at w claudct,Esophageal reflux,Anemia-other chronic dis

Admission Date: [**2138-11-28**] Discharge Date: [**2138-12-3**] Date of Birth: [**2081-1-1**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1267**] Chief Complaint: chest tightness with exertion Major Surgical or Invasive Procedure: CABGx4(LIMA-LAD,SVG-Diag,SVG-OM,SVG-PDA)[**11-29**] History of Present Illness: 57 y/o Cantonese speaking F with known 3V CAD, medically managed with recent 2 day episode of exertional angina. Underwent cardiac cath which again revealed severe three vessel coronary artery disease. Referred for surgical revascularization. Past Medical History: Coronary Artery Disease s/p Myocardial Infarction [**8-9**], Hypertension, Hypercholesterolemia, Diabetes, melodysplastic syndrome, Peripheral Vawscular Disease s/p R com Fem to [**Doctor Last Name **] BPG, Retinopathy, GERD, Chronic Renal Insufficiency(1.3-1.8) Social History: no alcohol non smoker Family History: n/c Physical Exam: HR 66 RR 16 BP 177/92 WDWN Asian F in NAD Lungs CTAB Heart RRR no Murmur Abdomen benign Extrem warm, no edema Pertinent Results: [**2138-11-28**] Echo: 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 and regional/global systolic function (LVEF>55%). Right ventricular chamber size and free wall motion are normal. There are focal calcifications 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. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no pericardial effusion. Post_Bypass: Preserved biventricular systolic function. LVEF 55%. Thoracic aortic contour is intact. Trivial MR< TR Brief Hospital Course: Ms. [**Known lastname **] was a same day admit and on the day of admission she was brought directly to the operating room where she underwent a coronary artery bypass graft x 4. Please see operative report for surgical details. Following surgery she was transferred to the CVICU for invasive monitoring in stable condition. On post-op day one she was weaned from sedation, awoke neurologically intact and extubated. Chest tubes were removed and she was started on beta blockers and diuretics. She was gently diuresed towards her pre-op weight. On post-op day two she was transferred to the telemetry floor for further care and her pre-op medications were restarted. On post-op day three her epicardial pacing wires were removed. Over the next several days her medications were titrated and she worked with physical therapy for strength and mobility. On post-op day 5 she was discharged to home with VNA services and the appropriate follow-up appointments. Medications on Admission: Aspirin 81mg qd, Norvasc 5mg qd, Lipitor 80mg qd, Plavix 75mg qd, Iron, Folic Acid, Glyburide 5mg [**Hospital1 **], Lisinopril 10mg, MVI, Pyridoxine25mg qd, Zantac 150mg qd, Toprol XL 100mg qd, Lantus 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:*0* 2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 5. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day for 5 days. Disp:*10 Tablet(s)* Refills:*0* 6. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 8. Pyridoxine 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 9. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours) for 5 days. Disp:*20 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 11. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed. Disp:*30 Tablet(s)* Refills:*0* 12. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 13. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0* 14. Norvasc 5 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4 PMH: Hypertension, Hypercholesterolemia, Diabetes, melodysplastic syndrome, Peripheral Vawscular Disease s/p R com Fem to [**Doctor Last Name **] BPG, Retinopathy, GERD, Chronic Renal Insufficiency(1.3-1.8) Discharge Condition: Good Discharge Instructions: Call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. Shower, no baths, no lotions, creams or powders to incisions. No lifting more than 10 pounds or driving until follow up with surgeon. Followup Instructions: Dr. [**First Name (STitle) **] 2 weeks Dr. [**Last Name (STitle) **] 4 weeks Dr. [**Last Name (STitle) 1016**] 2 weeks Already scheduled apppointments: Provider: [**Name10 (NameIs) 26**] [**Name8 (MD) 28**], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2138-12-4**] 2:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 647**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2139-1-1**] 1:30 Provider: [**Name10 (NameIs) 26**] [**Name8 (MD) 28**], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2139-1-1**] 2:30 Completed by:[**2138-12-3**]

414,411,250,362,403,585,272,238,440,530,285

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Pure hypercholesterolemia,Myelodysplastic syndrome, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Esophageal reflux,Anemia of other chronic disease'}

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 tightness with exertion PRESENT ILLNESS: 57 y/o Cantonese speaking F with known 3V CAD, medically managed with recent 2 day episode of exertional angina. Underwent cardiac cath which again revealed severe three vessel coronary artery disease. Referred for surgical revascularization. MEDICAL HISTORY: Coronary Artery Disease s/p Myocardial Infarction [**8-9**], Hypertension, Hypercholesterolemia, Diabetes, melodysplastic syndrome, Peripheral Vawscular Disease s/p R com Fem to [**Doctor Last Name **] BPG, Retinopathy, GERD, Chronic Renal Insufficiency(1.3-1.8) MEDICATION ON ADMISSION: Aspirin 81mg qd, Norvasc 5mg qd, Lipitor 80mg qd, Plavix 75mg qd, Iron, Folic Acid, Glyburide 5mg [**Hospital1 **], Lisinopril 10mg, MVI, Pyridoxine25mg qd, Zantac 150mg qd, Toprol XL 100mg qd, Lantus ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: HR 66 RR 16 BP 177/92 WDWN Asian F in NAD Lungs CTAB Heart RRR no Murmur Abdomen benign Extrem warm, no edema FAMILY HISTORY: n/c SOCIAL HISTORY: no alcohol non smoker ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Pure hypercholesterolemia,Myelodysplastic syndrome, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Esophageal reflux,Anemia of other chronic disease'}

CHIEF COMPLAINT: respiratory distress, hemoptysis transferred from OSH PRESENT ILLNESS: [**Age over 90 **] yo male with PMH large right thyroid cystic mass eroding into trachea, who presented to [**Hospital6 **] [**2120-3-24**] with hemoptysis and respiratory distress, now diagnosed with anaplastic thyroid carcinoma. . Pt reports that he noticed a right neck mass last [**Month (only) 359**]. The mass grew larger, to the size of a baseball. It appears that FNA was performed but was non-diagnostic (probably because anaplastic tumors tend to be necrotic). The mass appears to be cystic in nature and has been aspirated at least 3 times, which decrease in size each time. Now size is 6.5cm*6.5cm. Plan for surgery in [**Month (only) **] was deferred [**3-7**] syncope and pacer placement for SSS; again deferred 2 weeks ago [**3-7**] URI; was planned for surgery this Thurday. . Pt was o/w in his USOH until 2-3 weeks ago when he developed a URI with symptoms of dry cough; no fever, chills, sore throat, myalgias. Pt was treated with 3 days of an antibiotics, followed by a 10 day course of levaquin (completed 2 days PTA). Per pt and son, no [**Name2 (NI) 66025**] pna. 2 days prior to admission, pt developed hemoptysis; states he coughed up 4 tsp of blood. 1 day PTA, pt developed stridorous breathing and respiratory distress. Pt was initially seen at [**Hospital1 **], where he was given steroids, with improvement in respiratory status. Pt was transferred to [**Hospital6 2561**], where his surgeon is located. There he was admitted to the MICU. Thyroid cyst was aspirated with removal of 300cc of fluid. Pt was given racemic epinephrine and Decadron 10mg IV x1. CT neck showed tracheal mass per nursing s/o (pt brought CT). . Pt now breathing more comfortably. He has not had fever and night sweats but reports weakness and weight loss for several months recently. MEDICAL HISTORY: R thyroid cyst (as above) Goiter CRI HTN SSS (s/p pacer [**First Name8 (NamePattern2) **] [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 66026**]) prostate cancer -dx 10 years ago; received monthly shots which were discontinued recently. anemia Afib (19 episodes since [**2119-11-4**], as documented on pacer interogation [**2120-3-6**]) MEDICATION ON ADMISSION: ALLERGIES: Penicillins PHYSICAL EXAM: VS: T 99.4, BP 119/59, HR 76, RR 18, 99%RA Gen: NAD HEENT: PERRL, EOMI, clear OP, MMM Neck: Large ~6 x 6 cm sized right thyroid mass, soft, possibly cystic, non-tender. L lobe of the thyroid gland also prominent. FAMILY HISTORY: No history of thyroid disease. Sister with lung ca. Brother with gastric ca. sister with unknown ca. Father with stroke. SOCIAL HISTORY: Was living alone in ALF. Walks with walker. Able to take care of himself; home health aide visits once a week. Denies history of tobacco, etoh, drugs. Used to work as hat manufacturer.

Malignant neoplasm of thyroid gland,Acute respiratory failure,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Secondary malignant neoplasm of other respiratory organs,Cardiac pacemaker in situ,Personal history of malignant neoplasm of prostate

Malign neopl thyroid,Acute respiratry failure,Atrial fibrillation,Hyp kid NOS w cr kid V,Sec malig neo resp NEC,Status cardiac pacemaker,Hx-prostatic malignancy

Admission Date: [**2120-3-25**] Discharge Date: [**2120-4-2**] Service: MEDICINE Allergies: Penicillins Attending:[**First Name3 (LF) 2186**] Chief Complaint: respiratory distress, hemoptysis transferred from OSH Major Surgical or Invasive Procedure: debridement of mass from tracheal lumen by interventional pulmonary History of Present Illness: [**Age over 90 **] yo male with PMH large right thyroid cystic mass eroding into trachea, who presented to [**Hospital6 **] [**2120-3-24**] with hemoptysis and respiratory distress, now diagnosed with anaplastic thyroid carcinoma. . Pt reports that he noticed a right neck mass last [**Month (only) 359**]. The mass grew larger, to the size of a baseball. It appears that FNA was performed but was non-diagnostic (probably because anaplastic tumors tend to be necrotic). The mass appears to be cystic in nature and has been aspirated at least 3 times, which decrease in size each time. Now size is 6.5cm*6.5cm. Plan for surgery in [**Month (only) **] was deferred [**3-7**] syncope and pacer placement for SSS; again deferred 2 weeks ago [**3-7**] URI; was planned for surgery this Thurday. . Pt was o/w in his USOH until 2-3 weeks ago when he developed a URI with symptoms of dry cough; no fever, chills, sore throat, myalgias. Pt was treated with 3 days of an antibiotics, followed by a 10 day course of levaquin (completed 2 days PTA). Per pt and son, no [**Name2 (NI) 66025**] pna. 2 days prior to admission, pt developed hemoptysis; states he coughed up 4 tsp of blood. 1 day PTA, pt developed stridorous breathing and respiratory distress. Pt was initially seen at [**Hospital1 **], where he was given steroids, with improvement in respiratory status. Pt was transferred to [**Hospital6 2561**], where his surgeon is located. There he was admitted to the MICU. Thyroid cyst was aspirated with removal of 300cc of fluid. Pt was given racemic epinephrine and Decadron 10mg IV x1. CT neck showed tracheal mass per nursing s/o (pt brought CT). . Pt now breathing more comfortably. He has not had fever and night sweats but reports weakness and weight loss for several months recently. Past Medical History: R thyroid cyst (as above) Goiter CRI HTN SSS (s/p pacer [**First Name8 (NamePattern2) **] [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 66026**]) prostate cancer -dx 10 years ago; received monthly shots which were discontinued recently. anemia Afib (19 episodes since [**2119-11-4**], as documented on pacer interogation [**2120-3-6**]) Social History: Was living alone in ALF. Walks with walker. Able to take care of himself; home health aide visits once a week. Denies history of tobacco, etoh, drugs. Used to work as hat manufacturer. Family History: No history of thyroid disease. Sister with lung ca. Brother with gastric ca. sister with unknown ca. Father with stroke. Physical Exam: VS: T 99.4, BP 119/59, HR 76, RR 18, 99%RA Gen: NAD HEENT: PERRL, EOMI, clear OP, MMM Neck: Large ~6 x 6 cm sized right thyroid mass, soft, possibly cystic, non-tender. L lobe of the thyroid gland also prominent. CVS: RRR, nl s1 s2, no m/g/r Lungs: transmitted upper airway stridor; otherwise clear Abd: soft, NT, ND, +BS Ext: no edema Neuro: CN 2-12 intact, [**6-7**] bilateral upper and lower extremity strength. Pertinent Results: CT Neck-IMPRESSION: 1. 7-cm diameter right neck mass, with direct invasion of the subglottic, cervical and proximal thoracic trachea. The mass is reportedly thyroid in origin. Differential diagnosis includes primary head/neck cancer and lymphoma. 2. Left lobe thyroid enlargement with heterogeneous appearance. 3. Right upper paratracheal and prevascular lymphadenopathy as well as additional nodes in the right side of the neck. Dedicated MR of the neck may be helpful for more complete assessment of the neck mass and lymphadenopathy if warranted clinically. . Pathology: The tumor is composed of a relatively monotonous proliferation of spindle cells which grow in sheets with a prominent vascular pattern. Immunostains for cytokeratin AE1/3 and CAM 5.2, CD-68, CD-79a, CD-138, S-100, LCA absorbed CEA, EMA, CD34, CD31, TTF-1, actin, desmin, MNF-116, calcitonin, and thyroglobulin are negative. These results exclude both melanoma and hematopoietic neoplasms. The differential diagnosis includes, but is not limited to, sarcoma, spindle cell carcinomas (sarcomatoid carcinoma of the upper aerodigestive tract and anaplastic thyroid carcinoma), and malignant salivary gland neoplasms. Brief Hospital Course: Pt was transferred here for further mgmt of airway and large thyroid mass by our IP team. IP found endotracheal obstructing tumor and extrinsic compression of the high trachea by thyroid mass. After rigid bronchoscopy with removal of the intratracheal tumor component on [**2120-3-26**], stat pathology showed anaplastic tumor. He was tranferred to the MICU. Subsequently extubated and his respiratory Sx are now improved. Pt was seen by Rad Onc, who recommended transfer to the [**Hospital Ward Name 516**] for XRT. On the morning of possible radiation, patient and family met with interventional pulmonary team who explained that the most recent CT showed further invasion of the tumor into the trachea. After a long discussion, patient and family asked to be made CMO. Patient was started on morphine drip and palliative care team was consulted with recommendations to ensure comfort. Mr. [**Known lastname 66027**] died approximately 24 hours after decision to be CMO, on [**2120-4-2**]. Discharge Disposition: Expired Discharge Diagnosis: NC Discharge Condition: NC Discharge Instructions: NC Followup Instructions: NC Completed by:[**2120-4-7**]

193,518,427,403,197,V450,V104

{'Malignant neoplasm of thyroid gland,Acute respiratory failure,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Secondary malignant neoplasm of other respiratory organs,Cardiac pacemaker in situ,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: respiratory distress, hemoptysis transferred from OSH PRESENT ILLNESS: [**Age over 90 **] yo male with PMH large right thyroid cystic mass eroding into trachea, who presented to [**Hospital6 **] [**2120-3-24**] with hemoptysis and respiratory distress, now diagnosed with anaplastic thyroid carcinoma. . Pt reports that he noticed a right neck mass last [**Month (only) 359**]. The mass grew larger, to the size of a baseball. It appears that FNA was performed but was non-diagnostic (probably because anaplastic tumors tend to be necrotic). The mass appears to be cystic in nature and has been aspirated at least 3 times, which decrease in size each time. Now size is 6.5cm*6.5cm. Plan for surgery in [**Month (only) **] was deferred [**3-7**] syncope and pacer placement for SSS; again deferred 2 weeks ago [**3-7**] URI; was planned for surgery this Thurday. . Pt was o/w in his USOH until 2-3 weeks ago when he developed a URI with symptoms of dry cough; no fever, chills, sore throat, myalgias. Pt was treated with 3 days of an antibiotics, followed by a 10 day course of levaquin (completed 2 days PTA). Per pt and son, no [**Name2 (NI) 66025**] pna. 2 days prior to admission, pt developed hemoptysis; states he coughed up 4 tsp of blood. 1 day PTA, pt developed stridorous breathing and respiratory distress. Pt was initially seen at [**Hospital1 **], where he was given steroids, with improvement in respiratory status. Pt was transferred to [**Hospital6 2561**], where his surgeon is located. There he was admitted to the MICU. Thyroid cyst was aspirated with removal of 300cc of fluid. Pt was given racemic epinephrine and Decadron 10mg IV x1. CT neck showed tracheal mass per nursing s/o (pt brought CT). . Pt now breathing more comfortably. He has not had fever and night sweats but reports weakness and weight loss for several months recently. MEDICAL HISTORY: R thyroid cyst (as above) Goiter CRI HTN SSS (s/p pacer [**First Name8 (NamePattern2) **] [**First Name5 (NamePattern1) 923**] [**Last Name (NamePattern1) 66026**]) prostate cancer -dx 10 years ago; received monthly shots which were discontinued recently. anemia Afib (19 episodes since [**2119-11-4**], as documented on pacer interogation [**2120-3-6**]) MEDICATION ON ADMISSION: ALLERGIES: Penicillins PHYSICAL EXAM: VS: T 99.4, BP 119/59, HR 76, RR 18, 99%RA Gen: NAD HEENT: PERRL, EOMI, clear OP, MMM Neck: Large ~6 x 6 cm sized right thyroid mass, soft, possibly cystic, non-tender. L lobe of the thyroid gland also prominent. FAMILY HISTORY: No history of thyroid disease. Sister with lung ca. Brother with gastric ca. sister with unknown ca. Father with stroke. SOCIAL HISTORY: Was living alone in ALF. Walks with walker. Able to take care of himself; home health aide visits once a week. Denies history of tobacco, etoh, drugs. Used to work as hat manufacturer. ### Response: {'Malignant neoplasm of thyroid gland,Acute respiratory failure,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Secondary malignant neoplasm of other respiratory organs,Cardiac pacemaker in situ,Personal history of malignant neoplasm of prostate'}

CHIEF COMPLAINT: Angina, Shortness of breath PRESENT ILLNESS: 54F with hx of CAD s/p CABG x 2, prior stents, CHF, and severe MR referred here by her primary cardiologist for one month of intermittent chest pain and increasing shortness of breath. Patient states that for the past month she has had increasingly severe DOE with occasional pre-syncopal symptoms and light-headedness. She also describes experiencing a dull, squeezing sensation in her chest about a month ago and since has had intermittent sharp central chest pain that has crescendo quality with exertion and resolves after seconds with rest. She also describes occasional onset of chills without fevers, 3-pillow orthopnea, PND, frequent bedtime urination, and waxing and [**Doctor Last Name 688**] LE swelling. She was to undergo coronary cath today for evaluation primarily of her MV as she has been undergoing outpatient planning for possible MVR but is thought to be higher risk given her past history of bleeding (nose bleeds requiring ED visit and cautery) and prior CABG prompting a trial of medical management. Of note, she does not take aspirin or plavix currently due to her history of bleeding. Her baseline creatinine is in the high 1.0's per report but was 2.0 this AM so his cath was deferred and she was transferred. Goal of transfer also include coronary cath, C-[**Doctor First Name **] evaluation, diuresis, and ACS rule-out. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: - Albuterol Neb Q4-6hrs PRN - Clonazepam 1mg TID - Rosuvastatin 5 mg PO DAILY - Fluticasone 220 mcg inhaler 2 puffs [**Hospital1 **] - Furosemide 80mg PO daily - Lamotrigine 100mg Tab PO DAILY - Lamotrigine 100mg Tab x 2 PO QHS - Levothyroxine 88 mcg PO DAILY - Lisinopril 20mg PO daily - Metoprolol Succinate 25mg PO BID - Protonix 40mg PO BID - Albuterol Inhaler 2 puffs Q4hrs PRN - Serevent Diskus 50mcg 1 puff [**Hospital1 **] - Singulair 10mg PO daily - Colace 100mg PO daily - Ascorbic Acid 1000mg PO DAILY - Sertraline 150mg PO daily - Glipizide 10mg PO daily - Quetiapine 25 mg PO BID - Quetiapine 50 mg PO QHS - Insulin (Humalog) 75/25 15units [**Hospital1 **] ALLERGIES: Latex / Morphine / bee sting PHYSICAL EXAM: ADMISSION PHYSICAL EXAMINATION: VS- T= 97.8 BP= 132/76 HR= 67 RR= 16 O2 sat= 99RA GENERAL- WDWN woman in NAD, AOx3, tearful when recounting PMHx HEENT- NCAT. Sclera anicteric. PERRL, EOMI. NECK- Supple without JVD. CARDIAC- RRR, normal S1, S2. [**1-29**] holosystolic mumur loudest lower left sternal border. No thrills, lifts. No S3 or S4. Some tenderness to palpation of her sternum which she describes as reproducing her sharp chest pain LUNGS- Soft expiratory wheezes diffusely, no rales appreciated on exam ABDOMEN- Soft, obese, ND, mildly tender to palpation in epigastrium. EXTREMITIES- 1+ pitting in BLE's. Non-tender. 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+ . DISCHARGE PHYSICAL EXAM: FAMILY HISTORY: Father died of MI at 47 Brother with PTCA at 50 SOCIAL HISTORY: Lives with boyfriend, 20 pack-year smoking history, quit a few years ago, prior modest ETOH but none now, no illicts.

Acute kidney failure, unspecified,Chronic and other pulmonary manifestations due to radiation,Congestive heart failure, unspecified,Other chronic pulmonary heart diseases,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Acquired partial absence of pancreas,Personal history of antineoplastic chemotherapy,Chronic obstructive asthma, unspecified,Personal history of other lymphatic and hematopoietic neoplasms,Barrett's esophagus,Atherosclerosis of other specified arteries,Changes in vascular appearance of retina,Unspecified acquired hypothyroidism,Family history of ischemic heart disease,Personal history of tobacco use,Personal history of other diseases of circulatory system,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Accidental cut, puncture, perforation or hemorrhage during surgical operation,Personal history of other specified diseases,Abnormal coagulation profile,Leukocytosis, unspecified,Anticoagulants causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Lumbago,Fall resulting in striking against other object,Home accidents,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Multiple involvement of mitral and aortic valves,Postoperative shock, cardiogenic,Coronary atherosclerosis of autologous vein bypass graft,Intermediate coronary syndrome

Acute kidney failure NOS,Chr pul manif d/t radiat,CHF NOS,Chr pulmon heart dis NEC,Status-post ptca,Acq absence of organ NEC,Acq part absnce pancreas,Hx antineoplastic chemo,Chronic obst asthma NOS,Hx-lymphatic malign NEC,Barrett's esophagus,Atherosclerosis NEC,Retinal vascular changes,Hypothyroidism NOS,Fam hx-ischem heart dis,History of tobacco use,Hx-circulatory dis NEC,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Acc cut/hem in surgery,Hx diseases NEC,Abnrml coagultion prfile,Leukocytosis NOS,Adv eff anticoagulants,Adv eff cardiovasc NEC,Lumbago,Fall striking object NEC,Accident in home,Late effect of radiation,Abn react-radiotherapy,DMII oth nt st uncntrld,Long-term use of insulin,Adv eff insulin/antidiab,Mitr/aortic mult involv,Postop shock,cardiogenic,Crn ath atlg vn bps grft,Intermed coronary synd

Admission Date: [**2205-5-2**] Discharge Date: [**2205-5-15**] Date of Birth: [**2150-7-11**] Sex: F Service: CARDIOTHORACIC Allergies: Latex / Morphine / bee sting Attending:[**First Name3 (LF) 1406**] Chief Complaint: Angina, Shortness of breath Major Surgical or Invasive Procedure: [**2205-5-8**] Re-do sternotomy. Coronary artery bypass grafting x1 with saphenous vein graft to the right coronary artery. Mitral valve replacement with a 25/33 On-X mechanical valve, serial #[**Serial Number 107678**], reference #[**Serial Number 101277**]. Aortic valve replacement with a 19 mm On-X mechanical valve, serial #[**Serial Number 107679**], reference #[**Serial Number 42227**]. History of Present Illness: 54F with hx of CAD s/p CABG x 2, prior stents, CHF, and severe MR referred here by her primary cardiologist for one month of intermittent chest pain and increasing shortness of breath. Patient states that for the past month she has had increasingly severe DOE with occasional pre-syncopal symptoms and light-headedness. She also describes experiencing a dull, squeezing sensation in her chest about a month ago and since has had intermittent sharp central chest pain that has crescendo quality with exertion and resolves after seconds with rest. She also describes occasional onset of chills without fevers, 3-pillow orthopnea, PND, frequent bedtime urination, and waxing and [**Doctor Last Name 688**] LE swelling. She was to undergo coronary cath today for evaluation primarily of her MV as she has been undergoing outpatient planning for possible MVR but is thought to be higher risk given her past history of bleeding (nose bleeds requiring ED visit and cautery) and prior CABG prompting a trial of medical management. Of note, she does not take aspirin or plavix currently due to her history of bleeding. Her baseline creatinine is in the high 1.0's per report but was 2.0 this AM so his cath was deferred and she was transferred. Goal of transfer also include coronary cath, C-[**Doctor First Name **] evaluation, diuresis, and ACS rule-out. In the ED, initial vitals were 98.5 71 130/66 18 100% Labs and imaging significant for negative troponin, creatinine 2.0, BNP of 2374, HCT of 33.7, UA negative, CXR c/w mild fluid overload ECG showed SR @ 70, NA, NI, TWI in V1-V2 Patient given Aspirin 325mg PO x 1, Hydromorphone 0.5 mg IV x 1, humalog 14units x 1 for fingerstick of 300. Vitals on transfer were P 66, BP: 114/93, RR: 12, 95% on RA On arrival to the floor, patient initially feeling well and recounting her history as above but became acutely diaphoretic, anxious, described chest pressure and shortness of breath. Vital signs unchanged, satting 100%RA, EKG unchanged, FSBS 54 following 1 glass of juice 10 minutes prior. REVIEW OF SYSTEMS: Cardiac review of systems is notable for intermittent chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, but no palpitations, Also denies fevers, abdominal pain, N/V/D, urinary symptoms, or localized numbness, weakness, or tingling. Past Medical History: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: -CABG: CABG x2 [**2199-7-26**] (LIMA-LAD, SVG-OM) -PERCUTANEOUS CORONARY INTERVENTIONS: Prior stenting (anatomy not presently known) -PACING/ICD: None 3. OTHER PAST MEDICAL HISTORY: -Non-Hodgkin's lymphoma dx [**2175**] s/p splenectomy/partial pancreatectomy along with XRT/chemotherapy -COPD/asthma -Heliohepatitis -Hyperlipidemia -NIDDM -GERD c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] esophagus -Bipolar disorder, depression/anxiety -Retinal artery stenoses -Hypothyroidism -Prior shoulder injury -3+ Mitral valve regurgitation Past Surgical History: -CABG -shoulder surgery -splenectomy -distal pancreatectomy '[**94**] for duct stricture Social History: Lives with boyfriend, 20 pack-year smoking history, quit a few years ago, prior modest ETOH but none now, no illicts. Family History: Father died of MI at 47 Brother with PTCA at 50 Physical Exam: ADMISSION PHYSICAL EXAMINATION: VS- T= 97.8 BP= 132/76 HR= 67 RR= 16 O2 sat= 99RA GENERAL- WDWN woman in NAD, AOx3, tearful when recounting PMHx HEENT- NCAT. Sclera anicteric. PERRL, EOMI. NECK- Supple without JVD. CARDIAC- RRR, normal S1, S2. [**1-29**] holosystolic mumur loudest lower left sternal border. No thrills, lifts. No S3 or S4. Some tenderness to palpation of her sternum which she describes as reproducing her sharp chest pain LUNGS- Soft expiratory wheezes diffusely, no rales appreciated on exam ABDOMEN- Soft, obese, ND, mildly tender to palpation in epigastrium. EXTREMITIES- 1+ pitting in BLE's. Non-tender. 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+ . DISCHARGE PHYSICAL EXAM: Pertinent Results: ADMISSION LABS: --------------- [**2205-5-2**] 10:15AM BLOOD WBC-9.3 RBC-3.58* Hgb-10.9* Hct-33.7* MCV-94# MCH-30.3# MCHC-32.2 RDW-14.7 Plt Ct-354 [**2205-5-2**] 10:15AM BLOOD Neuts-74.0* Lymphs-14.0* Monos-5.1 Eos-5.9* Baso-1.1 [**2205-5-2**] 10:15AM BLOOD PT-11.3 PTT-34.8 INR(PT)-1.0 [**2205-5-2**] 10:15AM BLOOD Glucose-252* UreaN-64* Creat-2.0* Na-138 K-5.1 Cl-101 HCO3-24 AnGap-18 [**2205-5-2**] 10:15AM BLOOD CK-MB-2 proBNP-2374* [**2205-5-2**] 10:15AM BLOOD Calcium-9.3 Phos-4.8* Mg-2.6 [**2205-5-2**] 10:45AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.009 [**2205-5-2**] 10:45AM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG [**2205-5-2**] 10:45AM URINE Hours-RANDOM UreaN-557 Creat-49 Na-45 K-51 Cl-39 [**2205-5-2**] 10:45AM URINE Osmolal-392 DISCHARGE LABS: --------------- MICRO/PATH: ----------- -MRSA SCREEN (Final [**2205-5-6**]): No MRSA isolated. -URINE CULTURE (Final [**2205-5-4**]): MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT WITH SKIN AND/OR GENITAL CONTAMINATION. IMAGING/STUDIES: ---------------- ECG [**2205-5-2**]: Sinus rhythm. Mild P-R interval pro0longation. RSR' pattern in leads VI-V2 is likely a normal variant. Minor non-specific ST-T wave abnormalities. Compared to the previous tracing of [**2202-6-5**] no significant changes. . CXR PA/LAT [**2205-5-2**]: IMPRESSION: Unchanged, small right pleural effusion with mild pulmonary edema. . TTE [**2205-5-3**]: Conclusions The left atrium is normal in size. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF 70%). The right ventricular free wall is hypertrophied. The right ventricular cavity is dilated with borderline normal free wall function. The aortic valve leaflets (3) are mildly thickened. There is a minimally increased gradient consistent with minimal aortic valve stenosis. Mild to moderate ([**11-26**]+) aortic regurgitation is seen. The mitral valve leaflets are moderately thickened and mildly retracted. There is no mitral valve prolapse. There is moderate thickening of the mitral valve chordae. There is a minimally increased gradient consistent with trivial mitral stenosis. An eccentric, posteriorly directed jet of moderate (2+) mitral regurgitation is seen. Due to the eccentric nature of the regurgitant jet, its severity may be significantly underestimated (Coanda effect). The tricuspid valve leaflets are mildly thickened and mildly retracted. Moderate [2+] tricuspid regurgitation is seen (may be significantly underestimated due to the technically suboptimal nature of this study). There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the findings of the prior study (images reviewed) of [**2202-4-26**], the pulmonary artery pressure is increased. IMPRESSION: Suboptimal image quality. The multiplicity and morphology of valve lesions suggests radiation-induced or, less likely, rheumatic valve disease . L-Spine XR AP/LAT [**2205-5-3**]: FINDINGS: Comparison is made to the CT scan of the abdomen and pelvis from [**2199-8-1**]. There is slight scoliosis of lumbar spine convexity to the left side centered at L3-L4. There are no compression deformities. There are degenerative changes of the lower facet joints. No compression deformities or antero- or retrolisthesis is seen. There are abdominal aortic calcifications. The sacroiliac joints and bilateral hip joints are grossly preserved. . CT CHEST Non-Con [**2205-5-4**]: IMPRESSION: 1. Status post CABG and median sternotomy with intact sternotomy wires. 2. Several stable pulmonary nodules, some of which are calcified. 3. Hepatomegaly, similar to prior. 4. Status post splenectomy with splenules. . TEE [**2205-5-6**]: Conclusions The left atrium is minimally enlarged. 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. Overall left ventricular systolic function is normal (LVEF>55%). [Intrinsic function may be depressed given the severity of mitral regurgitation and aortic regurgitation.] Right ventricular chamber size and free wall motion are normal. There are simple atheroma in the aortic arch and descending thoracic aorta. The aortic valve leaflets (3) are moderately thickened. No masses or vegetations are seen on the aortic valve. At least moderate (2+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse or mass/vegetation Systolic flow reversal is seen in the pulmonary veins. Moderate to severe (3+) mitral regurgitation is seen. No vegetation/mass is seen on the pulmonic valve. There is no pericardial effusion. IMPRESSION: Moderate to severe mitral regurgitation without discrete vegetation or systolic prolapse. At least moderate aortic regurgitation. Preserved global left ventricular systolic function. If clinically indicated, cardiac MR would be better able to quantify the severity of valvular regurgitation and to assess effective left ventricular ejection fraction. . C. Cath [**2205-5-6**]: COMMENTS: 1. Selective angiography of this right dominant system demonstrated native LMCA and three-vessel coronary artery disease. The LMCA is diffusely diseased with distal haziness; caliber of LMCA similar to LCx so likely 70% ostial lesion with diffuse disease throughout. The LAD had a mid total occlusion after S1 and branching D2; D2 proximal 50%. The LCx had a mid AV groove CX lesion of 80% supplying grafted tortuous LPL. The RCA had stent(s) ostially and proximally; difficult to engage RCA selectively, likely severe ostial in-stent restenosis with unequivocal diffuse 60% in-stent restenosis with diffuse mid 60% stenosis beyond with TIMI 2 flow. 2. Selective arterial conduit angiography demonstrated a patent LIMA to LAD graft. 3. Selective venous conduit angiography demonstrated patent SVG to OM graft with tapering at the distal anastamosis (but taper approximates the caliber of the grafted LPL/OM). 4. Subclavian artery angiography showed no obvious proximal subclavian artery stenosis. 5. Although not imaged in detail, the left vertebral artery is tortuous at its origin and significant stenosis cannot be excluded. FINAL DIAGNOSIS: 1. Native LMCA and three vessel coronary artery disease with severe in-stent restenois. 2. Prominent PCW v waves consistent with significant mitral regurgitation. 3. Moderate to severe pulmonary arterial hypertension. 4. Moderate to severe left and severe right ventricular diastolic heart failure. 5. Sheaths to be removed in holding. 6. Additional plans per Dr. [**Last Name (STitle) **], Dr. [**Last Name (STitle) **], and Dr. [**Last Name (STitle) **]; likely benefit from MVR+CABG (SVG-RPDA). 7. Reinforce secondary preventative measures against CAD. Brief Hospital Course: 54F with hx of CAD s/p CABG x 2, prior stents, dCHF, and severe MR referred here by her primary cardiologist for one month of intermittent chest pain and increasing shortness of breath concerning for ACS overlying diastolic CHF exacerbation. ACTIVE DIAGNOSES: ----------------- # Subacute Diastolic CHF Exacerbation/Severe Aortic and Mitral Regurg: Patient was admitted following a month of severe CHF symptoms such as orthopnea, PND, frequent night time urination and was found to have an elevated BNP and evidence of fluid overload on admission CXR concerning for worsening CHF likely related to her severe known MR. [**First Name (Titles) **] [**Last Name (Titles) 1834**] TTE and then TEE which showed moderate to severe mitral regurgitation without discrete vegetation or systolic prolapse and at least moderate aortic regurgitation with preserved global left ventricular systolic function. She was diuresed with IV lasix and maintained on metoprolol (lisnipril initially held given need for contrast with C. cath and fear of precipitating CIN). She had a coronary catheterization which showed in-stent restenosis with a 60% ostial RCA lesions. She was evaluated by cardiac surgery who felt she would benefit from AVR/MVR/RCA CABG. On [**5-8**] she [**Month/Year (2) 1834**] a redo sternotomy, aortic valve replacement, mitral valve replacement, and coronary artery bypass grafting times one. This procedure was performed by Dr. [**Last Name (STitle) **], please see the operative note for details. She tolerated the procedure well and was transferred in critical but stable condition to the surgical intensive care unit. She was extubated by the following day and weaned from vasopressor and inotropic support over the next two days. Her chest tubes were removed. On post-operative day three she transferred to the step down unit and coumadin was begun for her double mechanical valves. She quickly became supertherapeutic so her epicardial wires were cut at the skin and several doses of coumadin were held. She was discharged to home on post-operative day seven with low dose coumadin and INR/CBC follow-up arranged with VNA and Dr. [**Last Name (STitle) 29478**], her PCP. . # Unstable Angina/CAD/HTN/HLD: Patient with increasing anginal symptoms at home over the past month. Chest pain has features of classic angina but also has aytpical features including reproducibility on palpation and sharp nature. EKG with TWI in V1-V2 which are minimally changed from her prior EKG's in our system 3 years ago. She ruled-out for MI with CE's x 3 which were negative. CXR without significant thoracic process other than mild fluid overload. CT chest non-con without significant findings that may explain cause. Cardiac cath showing 60% ostial RCA in-stent restenosis. She was initially treated with aspirin 325mg daily but then switched to 81mg daily following rule-out. She was continued on her crestor and metoprolol (switched to tartrate in-house) with holding of her lisinopril prior to and following catheterization given concerns for [**Last Name (un) **] and CIN. . # Acute on Chronic Kidney Injury: Patient with CKD Stage III at baseline. She was admitted with a Cr of 2.0 with FENa and FEUrea in indeterminant ranges. Her Cr improved to 1.5 with initial diuresis and witholding her lisinopril. Following surgery her creatinine stabilized and lisinopril was restarted. . # Low Back Pain: Patient with a couple weeks of low back pain localized mostly to the low lumber paraspinal muscles but also including the central back. No radiculopathy, localized weakness, or other concerning symptoms. She recounts history of falling when getting out of bath tub which may correlate. L-spine XR 2 views was without significant pathology. Her pain was managed with tylenol and dilaudid PO PRN. Post operatively her pain was adequately managed with percocet. . CHRONIC DIAGNOSES: ------------------ # COPD/Radiation-related Lung Disease: Patient with history of COPD related to smoking and radiation relatd lung disease from non-hodgkins lymphoma treatment 30 years ago. She had intermittent diffuse expiratory wheezes on exam which improved with nebs. Her CT non-con of her chest showed parenchymal scarring and volume loss within the medial portion of both lungs, likely related to previous radiation therapy as well as post-CABG, post-sternotomy, and post-splenectomy changes. She was maintained on nebs PRN as well as her home montelukast, inhaled steroid, and [**Last Name (un) **] regimen. # DM2: A1c 7.5. She was hyperglycemic on admission to 300's for which she recieved 14 units of humalog which percipitated a hypoglycemic episode with significant symptoms at a BSL of 49. She was started on her home regimen of humalog 75/25 with improved control in her BSL's. Her home glipizide was held while in-house given [**Last Name (un) **]. It was restarted at discharge with stablilization of her creatinine. # Anemia: Chronic anemia with prior workup 4 years ago with normal iron studies and B12/folate. Likely related to CKD and stable. Further workup was deferred to the outpatient setting. Her hematocrit was 27 on the day of discharge, she will have a CBC drawn the day after discharge. # Bipolar Disorder: Stable. She was continued on her home sertraline 150mg PO daily, seroquel 25 mg PO bid, and 50mg PO QHS. She was followed by social work in-house. Medications on Admission: - Albuterol Neb Q4-6hrs PRN - Clonazepam 1mg TID - Rosuvastatin 5 mg PO DAILY - Fluticasone 220 mcg inhaler 2 puffs [**Hospital1 **] - Furosemide 80mg PO daily - Lamotrigine 100mg Tab PO DAILY - Lamotrigine 100mg Tab x 2 PO QHS - Levothyroxine 88 mcg PO DAILY - Lisinopril 20mg PO daily - Metoprolol Succinate 25mg PO BID - Protonix 40mg PO BID - Albuterol Inhaler 2 puffs Q4hrs PRN - Serevent Diskus 50mcg 1 puff [**Hospital1 **] - Singulair 10mg PO daily - Colace 100mg PO daily - Ascorbic Acid 1000mg PO DAILY - Sertraline 150mg PO daily - Glipizide 10mg PO daily - Quetiapine 25 mg PO BID - Quetiapine 50 mg PO QHS - Insulin (Humalog) 75/25 15units [**Hospital1 **] Discharge Medications: 1. Furosemide 80 mg PO DAILY 2. Rosuvastatin Calcium 5 mg PO DAILY 3. Levothyroxine Sodium 88 mcg PO DAILY 4. Quetiapine Fumarate 25 mg PO BID 5. GlipiZIDE 10 mg PO DAILY 6. fluticasone *NF* 220 mcg Inhalation 2 puffs [**Hospital1 **] 7. Albuterol 0.083% Neb Soln 1 NEB IH Q4-6H PRN wheezing/dyspnea 8. Clonazepam 1 mg PO TID 9. LaMOTrigine 100 mg PO DAILY 10. LaMOTrigine 200 mg PO QHS 11. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing/dyspnea 12. Docusate Sodium 100 mg PO DAILY 13. Ascorbic Acid 1000 mg PO DAILY 14. Montelukast Sodium 10 mg PO DAILY 15. Pantoprazole 40 mg PO Q12H 16. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H 17. Sertraline 150 mg PO DAILY 18. Aspirin EC 81 mg PO DAILY RX *Adult Low Dose Aspirin 81 mg daily Disp #*30 Tablet Refills:*2 19. Metoprolol Tartrate 6.25 mg PO BID Hold for HR <60 or SBP <95 RX *metoprolol tartrate 25 mg two times daily Disp #*30 Tablet Refills:*2 20. Oxycodone-Acetaminophen (5mg-325mg) [**11-26**] TAB PO Q4H:PRN pain RX *Percocet 5 mg-325 mg every four hours Disp #*40 Tablet Refills:*0 21. Warfarin 0.5 mg PO ONCE Duration: 1 Doses do not take until as directed by the office of Dr. [**Last Name (STitle) 29478**] RX *Coumadin 1 mg once Disp #*30 Tablet Refills:*2 Discharge Disposition: Home With Service Facility: [**Location (un) 2203**] VNA Discharge Diagnosis: mitral regurgitation coronary artery disease Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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** Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge Followup Instructions: You are scheduled for the following appointments: Wound check [**2205-5-23**] at 10:00am at Cardiac Surgery Office [**Telephone/Fax (1) 170**] Surgeon Dr. [**Last Name (STitle) **] [**2205-6-20**] at 1:00pm [**Telephone/Fax (1) 170**] Cardiologist Dr. [**Last Name (STitle) **] [**2205-6-3**] 2:20p Please call to schedule the following: Primary Care Dr. [**Last Name (STitle) 29478**] in [**2-28**] 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** Labs: PT/INR/CBC Coumadin for mechanical aortic and mitral valves Goal INR 2.5-3.5 First draw day after discharge Thursday [**2205-5-16**] Then please do INR checks daily until stablized and then Monday, Wednesday, and Friday for 2 weeks then decrease frequency as directed by Dr. [**Last Name (STitle) 29478**] ([**Telephone/Fax (1) 35953**]. Check a CBC during the first INR check. Plan confirmed with Dr. [**Last Name (STitle) 29478**] on [**2205-5-15**]. Results to phone fax ([**Telephone/Fax (1) 107680**] Completed by:[**2205-5-15**]

584,508,428,416,V458,V457,V881,V874,493,V107,530,440,362,244,V173,V158,V125,403,585,E870,V138,790,288,E934,E942,724,E888,E849,909,E879,250,V586,E932,396,998,414,411

{"Acute kidney failure, unspecified,Chronic and other pulmonary manifestations due to radiation,Congestive heart failure, unspecified,Other chronic pulmonary heart diseases,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Acquired partial absence of pancreas,Personal history of antineoplastic chemotherapy,Chronic obstructive asthma, unspecified,Personal history of other lymphatic and hematopoietic neoplasms,Barrett's esophagus,Atherosclerosis of other specified arteries,Changes in vascular appearance of retina,Unspecified acquired hypothyroidism,Family history of ischemic heart disease,Personal history of tobacco use,Personal history of other diseases of circulatory system,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Accidental cut, puncture, perforation or hemorrhage during surgical operation,Personal history of other specified diseases,Abnormal coagulation profile,Leukocytosis, unspecified,Anticoagulants causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Lumbago,Fall resulting in striking against other object,Home accidents,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Multiple involvement of mitral and aortic valves,Postoperative shock, cardiogenic,Coronary atherosclerosis of autologous vein bypass graft,Intermediate coronary 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: Angina, Shortness of breath PRESENT ILLNESS: 54F with hx of CAD s/p CABG x 2, prior stents, CHF, and severe MR referred here by her primary cardiologist for one month of intermittent chest pain and increasing shortness of breath. Patient states that for the past month she has had increasingly severe DOE with occasional pre-syncopal symptoms and light-headedness. She also describes experiencing a dull, squeezing sensation in her chest about a month ago and since has had intermittent sharp central chest pain that has crescendo quality with exertion and resolves after seconds with rest. She also describes occasional onset of chills without fevers, 3-pillow orthopnea, PND, frequent bedtime urination, and waxing and [**Doctor Last Name 688**] LE swelling. She was to undergo coronary cath today for evaluation primarily of her MV as she has been undergoing outpatient planning for possible MVR but is thought to be higher risk given her past history of bleeding (nose bleeds requiring ED visit and cautery) and prior CABG prompting a trial of medical management. Of note, she does not take aspirin or plavix currently due to her history of bleeding. Her baseline creatinine is in the high 1.0's per report but was 2.0 this AM so his cath was deferred and she was transferred. Goal of transfer also include coronary cath, C-[**Doctor First Name **] evaluation, diuresis, and ACS rule-out. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: - Albuterol Neb Q4-6hrs PRN - Clonazepam 1mg TID - Rosuvastatin 5 mg PO DAILY - Fluticasone 220 mcg inhaler 2 puffs [**Hospital1 **] - Furosemide 80mg PO daily - Lamotrigine 100mg Tab PO DAILY - Lamotrigine 100mg Tab x 2 PO QHS - Levothyroxine 88 mcg PO DAILY - Lisinopril 20mg PO daily - Metoprolol Succinate 25mg PO BID - Protonix 40mg PO BID - Albuterol Inhaler 2 puffs Q4hrs PRN - Serevent Diskus 50mcg 1 puff [**Hospital1 **] - Singulair 10mg PO daily - Colace 100mg PO daily - Ascorbic Acid 1000mg PO DAILY - Sertraline 150mg PO daily - Glipizide 10mg PO daily - Quetiapine 25 mg PO BID - Quetiapine 50 mg PO QHS - Insulin (Humalog) 75/25 15units [**Hospital1 **] ALLERGIES: Latex / Morphine / bee sting PHYSICAL EXAM: ADMISSION PHYSICAL EXAMINATION: VS- T= 97.8 BP= 132/76 HR= 67 RR= 16 O2 sat= 99RA GENERAL- WDWN woman in NAD, AOx3, tearful when recounting PMHx HEENT- NCAT. Sclera anicteric. PERRL, EOMI. NECK- Supple without JVD. CARDIAC- RRR, normal S1, S2. [**1-29**] holosystolic mumur loudest lower left sternal border. No thrills, lifts. No S3 or S4. Some tenderness to palpation of her sternum which she describes as reproducing her sharp chest pain LUNGS- Soft expiratory wheezes diffusely, no rales appreciated on exam ABDOMEN- Soft, obese, ND, mildly tender to palpation in epigastrium. EXTREMITIES- 1+ pitting in BLE's. Non-tender. 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+ . DISCHARGE PHYSICAL EXAM: FAMILY HISTORY: Father died of MI at 47 Brother with PTCA at 50 SOCIAL HISTORY: Lives with boyfriend, 20 pack-year smoking history, quit a few years ago, prior modest ETOH but none now, no illicts. ### Response: {"Acute kidney failure, unspecified,Chronic and other pulmonary manifestations due to radiation,Congestive heart failure, unspecified,Other chronic pulmonary heart diseases,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Acquired partial absence of pancreas,Personal history of antineoplastic chemotherapy,Chronic obstructive asthma, unspecified,Personal history of other lymphatic and hematopoietic neoplasms,Barrett's esophagus,Atherosclerosis of other specified arteries,Changes in vascular appearance of retina,Unspecified acquired hypothyroidism,Family history of ischemic heart disease,Personal history of tobacco use,Personal history of other diseases of circulatory system,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Accidental cut, puncture, perforation or hemorrhage during surgical operation,Personal history of other specified diseases,Abnormal coagulation profile,Leukocytosis, unspecified,Anticoagulants causing adverse effects in therapeutic use,Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use,Lumbago,Fall resulting in striking against other object,Home accidents,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Multiple involvement of mitral and aortic valves,Postoperative shock, cardiogenic,Coronary atherosclerosis of autologous vein bypass graft,Intermediate coronary syndrome"}

CHIEF COMPLAINT: PRESENT ILLNESS: This 79-year-old with history of coronary artery disease, chronic low back pain, and constipation was transferred from [**Hospital 6138**] Hospital for development of hyponatremia and mental status changes. He had been admitted there on [**8-25**] for malaise and weakness, as well as lightheadedness, with an episode of supraventricular tachycardia in the Emergency Department which was converted to a paced rhythm with Lopressor. The patient ruled out for myocardial infarction. The patient continued to have difficulty with lower back pain, severe constipation associated with narcotic usage including phentanyl and OxyContin. Over the course of the patient's admission, he was noted to have a drop in his sodium over a course of days from 130 to as low at 117. This had been difficult to correct and recently the patient had been started on 3% saline. The patient's urine sodium had been measured as high as 133. The patient was diagnosed with a pneumonia. MEDICAL HISTORY: 1. Chronic lower back pain with lumbar spine spondylosis. 2. Hypertension. 3. Reactive airway disease. 4. Benign prostatic hypertrophy, status post transurethral resection of prostate. 5. Coronary artery disease with three vessel disease, status post stent in [**2192-3-15**]. 6. Status post DDD pacer in [**2191-10-16**] for complete heart block. 7. Peptic ulcer disease. 8. B12 deficiency. 9. Dysphasia. 10. Status post CVA. 11. Constipation. 12. Depression. MEDICATION ON ADMISSION: ALLERGIES: Codeine and morphine. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives in [**Location 29897**] with his friend, [**Name (NI) 26196**] [**Name (NI) 5108**]. He denies alcohol or tobacco use.

Pneumonia due to Pseudomonas,Hyposmolality and/or hyponatremia,Acute respiratory failure,Other specified cardiac dysrhythmias,Unspecified protein-calorie malnutrition,Lumbosacral spondylosis without myelopathy,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery

Pseudomonal pneumonia,Hyposmolality,Acute respiratry failure,Cardiac dysrhythmias NEC,Protein-cal malnutr NOS,Lumbosacral spondylosis,Hypertension NOS,Crnry athrscl natve vssl

Admission Date: [**2192-9-5**] Discharge Date: Service: HISTORY OF PRESENT ILLNESS: This 79-year-old with history of coronary artery disease, chronic low back pain, and constipation was transferred from [**Hospital 6138**] Hospital for development of hyponatremia and mental status changes. He had been admitted there on [**8-25**] for malaise and weakness, as well as lightheadedness, with an episode of supraventricular tachycardia in the Emergency Department which was converted to a paced rhythm with Lopressor. The patient ruled out for myocardial infarction. The patient continued to have difficulty with lower back pain, severe constipation associated with narcotic usage including phentanyl and OxyContin. Over the course of the patient's admission, he was noted to have a drop in his sodium over a course of days from 130 to as low at 117. This had been difficult to correct and recently the patient had been started on 3% saline. The patient's urine sodium had been measured as high as 133. The patient was diagnosed with a pneumonia. PAST MEDICAL HISTORY: 1. Chronic lower back pain with lumbar spine spondylosis. 2. Hypertension. 3. Reactive airway disease. 4. Benign prostatic hypertrophy, status post transurethral resection of prostate. 5. Coronary artery disease with three vessel disease, status post stent in [**2192-3-15**]. 6. Status post DDD pacer in [**2191-10-16**] for complete heart block. 7. Peptic ulcer disease. 8. B12 deficiency. 9. Dysphasia. 10. Status post CVA. 11. Constipation. 12. Depression. MEDICATIONS: Paxil 40 mg q.d., Protonix 40 mg q.d., aspirin 325 mg q.d., OxyContin 5 mg prn for pain, folate 1 mg q.d., amoxicillin 500 mg b.i.d., Imdur 30 mg q.d., Atrovent nebulizers, senna, Atenolol 25 mg b.i.d., BuSpar 10 mg b.i.d., phentanyl 25 mcg transdermally 3-72 hours. ALLERGIES: Codeine and morphine. SOCIAL HISTORY: The patient lives in [**Location 29897**] with his friend, [**Name (NI) 26196**] [**Name (NI) 5108**]. He denies alcohol or tobacco use. PHYSICAL EXAMINATION: On physical examination, the patient had a temperature of 97. Pulse of 60. Blood pressure of 100/70, saturating 96% on two liters. Patient was elderly appearing male in no apparent distress. On skin examination, patient's skin was warm, dry and anicteric. Head, eyes, ears, nose and throat revealed extraocular movements intact. No sinus tenderness and an oropharynx that was clear. On neck examination, patient's neck was supple with no jugular venous distention. Lung examination revealed lungs that were clear to auscultation bilaterally. Cardiovascular exam revealed distant heart sounds with normal S1, S2 and no murmurs, rubs or gallops appreciated. Abdominal exam revealed a belly that was soft, nontender with normal bowel sounds. Rectal exam revealed brown stool that was guaiac negative. Extremity exam revealed no edema and no calf tenderness. Neurological exam revealed cranial nerves grossly intact, nonfocal exam. PERTINENT LABORATORY FINDINGS: White blood cell count 7.3 with a hematocrit of 34.2 and platelets of 288,000. Patient's sodium was 125 with a potassium of 4.6, a chloride of 85, bicarbonate of 34, BUN of 19, creatinine of 0.4 and glucose of 110. Electrocardiogram was read as A/B paced at 60 beats per minute. Chest x-ray: Left lower lobe opacification consistent with consolidation versus atelectasis. HOSPITAL COURSE: This 79-year-old male with history of coronary artery disease, hypertension, chronic low back pain, and constipation presented with likely pneumonia and hyponatremia leading to mental status changes. 1. Pulmonary: The patient was admitted with a suspected pneumonia. He was started on levofloxacin 500 mg po q.d. Patient also with history of asthma and was maintained on a regimen of albuterol and Atrovent MDIs. The patient's respiratory status worsened over his admission with oxygen saturations requiring increasing amounts of supplemental oxygen in order to maintain levels greater than 92%. Patient was arranged to undergo a CT scan of the chest. CT scan of the chest with contrast was performed, however, the patient was found to be unresponsive and pulseless in Radiology after the exam. The patient was found to be in ventricular fibrillation. CPR was initiated. The patient was intubated and spontaneously converted into a paced rhythm. The patient was transferred to the Medical Intensive Care Unit where he underwent bronchoscopy with a significant amount of mucus removed from the left main bronchus, left lower lobe, left upper lobe lingula. The patient was treated for what was considered to be a hospital acquired pneumonia with ceftazidime 1 gram q. 8 hours. Sputum cultures and Gram stains were sent. The patient failed three trials of extubation. He eventually required a bedside tracheostomy placed by Pulmonary. He experienced some episodes of desaturation related to mucus plugging. These episodes resolved to frequent suctioning. The patient recuperated a great deal of his respiratory function over the admission. The patient benefited from several occasions of bronchoscopy with suctioning. Status post tracheostomy, the patient experienced some bleeding around the collar but this seemed to resolve on its own. 2. Cardiovascular: Patient with episodes of paroxysmal supraventricular tachycardia. The patient experienced a few isolated episodes of paroxysmal supraventricular tachycardia. Cardiology was consulted and felt that the patient was at risk for a worsening coronary artery disease because of baseline vessel disease given the recent stress. Patient was started on Lopressor 50 mg po b.i.d. The patient had been on telemetry and had experienced only a few isolated episodes. Cardiology felt that he could see an electrophysiology attending in two to four months after discharge to discuss possible AV nodule ablation for what appeared to be atrioventricular node reentry tachycardia. 3. Renal: Patient presented with hyponatremia that was believed to be related to syndrome of inappropriate diuretic hormone. The patient was given very careful fluid repletion with hypertonic saline. The patient was able to produce urine. 4. Infectious Disease: The patient eventually was found to have a pseudomonal pneumonia with negative blood cultures requiring treatment with ceftazidime 1 gram t.i.d. and levofloxacin 500 mg q.d. for 14 days of a course of antibiotics. 5. Fluid, electrolytes and nutrition: The patient was eventually arranged to undergo a percutaneous endoscopic gastrostomy procedure by Gastroenterology. They were not able to place a PEG tube secondary to distortion of the patient's abdomen related to postsurgical changes. The patient was maintained on ceftazidime and levofloxacin for double coverage for 14 days. The patient remained afebrile after being stabilized in the Intensive Care Unit. CONDITION AT DISCHARGE: Good. DISCHARGE STATUS: The patient was discharged to rehabilitation. He was discharged to rehabilitation with follow-up with his primary care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 140**] [**Last Name (NamePattern1) **], within one to two weeks of discharge. The patient should also follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in two to four months after discharge to discuss possible AV nodule ablation. The patient was discharged on the following medications: DISCHARGE MEDICATIONS: 1. Colace 100 mg b.i.d. 2. Enteric coated aspirin 325 mg q.d. 3. Senna 2 tablets b.i.d. 4. Albuterol MDI q. 8 hours prn shortness of breath. 5. Atrovent MDI q. 8 hours prn shortness of breath. 6. Lopressor 75 mg b.i.d. 7. Folate 1 mg q.d. 8. Protonix 40 mg q.d. 9. Ativan 1-2 mg q. 4-6 hours prn. 10. Percocet 1-2 tablets q. 4-6 hours prn pain. DISCHARGE DIAGNOSES: 1. Pneumonia. 2. Chronic low back pain with lumbar spine spondylosis. 3. Hypertension. 4. Reactive airway disease. 5. Benign prostatic hypertrophy, status post transurethral resection of prostate. 6. Coronary artery disease with three vessel disease status post stent in [**2192-3-15**], status post DDD pacer for complete heart block. 7. Peptic ulcer disease. 8. B12 deficiency. 9. Dysphasia, status post cerebral vascular accident. 10. Constipation. 11. Depression. 12. Hyponatremia. [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 968**] Dictated By:[**Last Name (NamePattern1) 5246**] MEDQUIST36 D: [**2192-9-25**] 13:33 T: [**2192-9-25**] 13:33 JOB#: [**Job Number 29898**] cc:[**Last Name (NamePattern1) 29899**] Admission Date: [**2192-9-5**] Discharge Date: [**2192-9-26**] Service: ADDENDUM: This Discharge Summary addendum is from [**2192-9-23**] to [**2192-9-26**]. HOSPITAL COURSE CONTINUED: The patient completed a 14-day course of levofloxacin and ceftazidime on [**9-23**]. He was subsequently monitored off antibiotics and remained afebrile and clinically stable. Additionally, he was bronched for clearing of secretions on [**9-23**] and tolerated that well. On [**9-24**], he had a percutaneous J-tube placed by Interventional Radiology without complications, and his tube feeds were resumed on [**9-25**]. The patient's wean to tracheostomy mask was continued without event. His Lopressor was increased given some ectopy on telemetry; however, he had no further episodes of his supraventricular tachycardia. MEDICATIONS ON DISCHARGE: 1. Colace 100 mg p.o. b.i.d. 2. Aspirin 325 mg p.o. q.d. 3. Senna 2 tablets p.o. b.i.d. 4. Albuterol MDI. 5. Atrovent MDI. 6. Lopressor 100 mg p.o. b.i.d. 7. Folate 1 mg p.o. q.d. 8. Tube feeds with ProMod with fiber. 9. Dulcolax 10 mg p.r. q.d. and p.r.n. DR.[**First Name (STitle) 8560**],[**First Name3 (LF) 1569**] 12-985 Dictated By:[**Name8 (MD) 29900**] MEDQUIST36 D: [**2192-9-25**] 15:09 T: [**2192-9-25**] 15:21 JOB#: [**Job Number **]

482,276,518,427,263,721,401,414

{'Pneumonia due to Pseudomonas,Hyposmolality and/or hyponatremia,Acute respiratory failure,Other specified cardiac dysrhythmias,Unspecified protein-calorie malnutrition,Lumbosacral spondylosis without myelopathy,Unspecified essential hypertension,Coronary atherosclerosis of native coronary 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 79-year-old with history of coronary artery disease, chronic low back pain, and constipation was transferred from [**Hospital 6138**] Hospital for development of hyponatremia and mental status changes. He had been admitted there on [**8-25**] for malaise and weakness, as well as lightheadedness, with an episode of supraventricular tachycardia in the Emergency Department which was converted to a paced rhythm with Lopressor. The patient ruled out for myocardial infarction. The patient continued to have difficulty with lower back pain, severe constipation associated with narcotic usage including phentanyl and OxyContin. Over the course of the patient's admission, he was noted to have a drop in his sodium over a course of days from 130 to as low at 117. This had been difficult to correct and recently the patient had been started on 3% saline. The patient's urine sodium had been measured as high as 133. The patient was diagnosed with a pneumonia. MEDICAL HISTORY: 1. Chronic lower back pain with lumbar spine spondylosis. 2. Hypertension. 3. Reactive airway disease. 4. Benign prostatic hypertrophy, status post transurethral resection of prostate. 5. Coronary artery disease with three vessel disease, status post stent in [**2192-3-15**]. 6. Status post DDD pacer in [**2191-10-16**] for complete heart block. 7. Peptic ulcer disease. 8. B12 deficiency. 9. Dysphasia. 10. Status post CVA. 11. Constipation. 12. Depression. MEDICATION ON ADMISSION: ALLERGIES: Codeine and morphine. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives in [**Location 29897**] with his friend, [**Name (NI) 26196**] [**Name (NI) 5108**]. He denies alcohol or tobacco use. ### Response: {'Pneumonia due to Pseudomonas,Hyposmolality and/or hyponatremia,Acute respiratory failure,Other specified cardiac dysrhythmias,Unspecified protein-calorie malnutrition,Lumbosacral spondylosis without myelopathy,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery'}

CHIEF COMPLAINT: AMS and generalized weakness PRESENT ILLNESS: Mr. [**Known lastname 78835**] is an 80 yoM with ESRD on HD and recent E. coli bacteremia, who presented to the ED after dialysis today with delta MS. The patient reportedly had symptoms of confusion and difficulty speaking, as well as generalized weakness, beginning around 11 am. Per his daughter, he began to exhibit an expressive aphasia on the way to the car, and they returned to the HD unit where he had an EKG with ? afib/flutter. He was brought to [**Hospital6 33**] via EMS from the HD unit where he had a neg NCHCT and nml FSG. He was then brought to [**Hospital1 18**] for further stroke workup and possible CTA. Neurology felt he was severely inattentive, but had no focal deficits, c/w a toxic-metabolic derrangement rather than a stroke. . In the ED, VS were initially Tmax 98.0, SBP 89-132, HR 76-95, RR 18-24, 100% 2LNC. Lactate was noted to be 3.4, and UA was [**12-31**] WBC, + LE, neg nit. He was given 1LNS over several hours (fluids given at a gentler rate b/c of his dialysis status), at which point his SBP dropped to the 90's. His SBP then fell to the 80's and he was given another 500 cc bolus, with improvement of his SBP to the 100's. HR remained in the 70's and he was never tachycardic. He was given vanco/ceftriaxone for presumed urosepsis. . He was also c/o abdominal pain (of several weeks duration) and an A/P CT was obtained that showed a large, complex ventral hernia w/o evidence of incarceration, but no other acute pathology. . On arrival to the [**Hospital Unit Name 153**], he says he is feeling "much better," "much less dizzy." He appears to have no word-finding or speech production difficulties and feels these sx have resolved. He denies HA, change in vision, stiff neck, SOB, chest and skeletal pain; he has had no fevers and was feeling well throughout the week prior to HD on [**8-28**]. Per the patient, he had no episodes of hypotension at HD. . Patient was transferred to the floor after he was found to be stable in the [**Hospital Unit Name 153**]. Mr. [**Known lastname 78835**] stated that he felt well and no longer had any of the symptoms that had originally brought him to the hospital. MEDICAL HISTORY: # ESRD on HD-- recently started on HD in [**6-18**] # Ascending Cholangitis with E. coli bacteremia in [**7-19**]. Had ERCP with stone/sludge removal. Completed 10 day course of ampicillin. # HTN # Dementia # s/p B/L hip replacement # Abdominal hernia repair # Prostate resection # TIA-- per [**Hospital1 34**] records, in [**4-/2115**] had TIA with some speech impediment # Atrial fibrillation with history of RVR while bacteremic/septic from ascending cholangitis. Converted back to NSR prior to discharge. # Anemia--iron deficiency and anemia of chronic disease # Systolic CHF with EF 40% in [**7-19**] MEDICATION ON ADMISSION: renal Caps softgel CYP- 1 capsule daily metoprolol 12.5 mg PO qHS Renagel 2400 mg PO TID Lactulose 10 g/15 ml - 2 tbls PO PRN constipation colace 100 mg PO BID acid controller 20 mg PO BID gas relief 80 mg q6h ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS in the ED: Tmax 98.0, SBP 89-132, HR 76-95, RR 18-24, 100% 2LNC VS on arrival to the floor: 96.2, 72/39 (though as high as 100 SBP on repeat measurements), 77, RR 20, 97% 3L GEN: Well-appearing, NAD HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM NECK: Supple, no LAD CV: II/VI SM at b/l USB, no rubs PULM: pt not cooperative with siting up so unable to obtain full lung exam; crackles at bases anteriorly ABD: Soft, obese, slight TTP midline/suprapubic, small hernia palpated in region but does not buldge with valsalva EXT: No C/C/E NEURO: AAOx3, language fluent, no word finding difficulties, fully attentive, CN II-XII intact, 5/5 strength throughout, reflexes 2+ throughout FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lines at home alone in his apartment No ETOH, smoking, or drug use. Has a fiance and 2 daughters who are also his HCP.

Altered mental status,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic systolic heart failure,Hypotension, unspecified,Atrial fibrillation,Other persistent mental disorders due to conditions classified elsewhere,Iron deficiency anemia, unspecified,Ventral, unspecified, hernia without mention of obstruction or gangrene,Nontoxic uninodular goiter,Anemia in chronic kidney disease,Other specified disorders of adrenal glands,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Hip joint replacement

Altered mental status,End stage renal disease,Hyp kid NOS w cr kid V,Chr systolic hrt failure,Hypotension NOS,Atrial fibrillation,Mental disor NEC oth dis,Iron defic anemia NOS,Ventral hernia NOS,Nontox uninodular goiter,Anemia in chr kidney dis,Adrenal disorder NEC,Hx TIA/stroke w/o resid,Joint replaced hip

Admission Date: [**2116-8-29**] Discharge Date: [**2116-9-1**] Date of Birth: [**2036-3-20**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**Known firstname 2181**] Chief Complaint: AMS and generalized weakness Major Surgical or Invasive Procedure: none History of Present Illness: Mr. [**Known lastname 78835**] is an 80 yoM with ESRD on HD and recent E. coli bacteremia, who presented to the ED after dialysis today with delta MS. The patient reportedly had symptoms of confusion and difficulty speaking, as well as generalized weakness, beginning around 11 am. Per his daughter, he began to exhibit an expressive aphasia on the way to the car, and they returned to the HD unit where he had an EKG with ? afib/flutter. He was brought to [**Hospital6 33**] via EMS from the HD unit where he had a neg NCHCT and nml FSG. He was then brought to [**Hospital1 18**] for further stroke workup and possible CTA. Neurology felt he was severely inattentive, but had no focal deficits, c/w a toxic-metabolic derrangement rather than a stroke. . In the ED, VS were initially Tmax 98.0, SBP 89-132, HR 76-95, RR 18-24, 100% 2LNC. Lactate was noted to be 3.4, and UA was [**12-31**] WBC, + LE, neg nit. He was given 1LNS over several hours (fluids given at a gentler rate b/c of his dialysis status), at which point his SBP dropped to the 90's. His SBP then fell to the 80's and he was given another 500 cc bolus, with improvement of his SBP to the 100's. HR remained in the 70's and he was never tachycardic. He was given vanco/ceftriaxone for presumed urosepsis. . He was also c/o abdominal pain (of several weeks duration) and an A/P CT was obtained that showed a large, complex ventral hernia w/o evidence of incarceration, but no other acute pathology. . On arrival to the [**Hospital Unit Name 153**], he says he is feeling "much better," "much less dizzy." He appears to have no word-finding or speech production difficulties and feels these sx have resolved. He denies HA, change in vision, stiff neck, SOB, chest and skeletal pain; he has had no fevers and was feeling well throughout the week prior to HD on [**8-28**]. Per the patient, he had no episodes of hypotension at HD. . Patient was transferred to the floor after he was found to be stable in the [**Hospital Unit Name 153**]. Mr. [**Known lastname 78835**] stated that he felt well and no longer had any of the symptoms that had originally brought him to the hospital. Past Medical History: # ESRD on HD-- recently started on HD in [**6-18**] # Ascending Cholangitis with E. coli bacteremia in [**7-19**]. Had ERCP with stone/sludge removal. Completed 10 day course of ampicillin. # HTN # Dementia # s/p B/L hip replacement # Abdominal hernia repair # Prostate resection # TIA-- per [**Hospital1 34**] records, in [**4-/2115**] had TIA with some speech impediment # Atrial fibrillation with history of RVR while bacteremic/septic from ascending cholangitis. Converted back to NSR prior to discharge. # Anemia--iron deficiency and anemia of chronic disease # Systolic CHF with EF 40% in [**7-19**] Social History: Lines at home alone in his apartment No ETOH, smoking, or drug use. Has a fiance and 2 daughters who are also his HCP. Family History: Non-contributory Physical Exam: ADMISSION PHYSICAL EXAM: VS in the ED: Tmax 98.0, SBP 89-132, HR 76-95, RR 18-24, 100% 2LNC VS on arrival to the floor: 96.2, 72/39 (though as high as 100 SBP on repeat measurements), 77, RR 20, 97% 3L GEN: Well-appearing, NAD HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM NECK: Supple, no LAD CV: II/VI SM at b/l USB, no rubs PULM: pt not cooperative with siting up so unable to obtain full lung exam; crackles at bases anteriorly ABD: Soft, obese, slight TTP midline/suprapubic, small hernia palpated in region but does not buldge with valsalva EXT: No C/C/E NEURO: AAOx3, language fluent, no word finding difficulties, fully attentive, CN II-XII intact, 5/5 strength throughout, reflexes 2+ throughout Pertinent Results: ADMISSION LABS: [**2116-8-28**] 11:20AM BLOOD WBC-10.1 RBC-4.23*# Hgb-11.6*# Hct-37.1*# MCV-88# MCH-27.4 MCHC-31.2 RDW-18.7* Plt Ct-129* [**2116-8-28**] 11:20AM BLOOD Neuts-85.1* Bands-0 Lymphs-8.8* Monos-5.3 Eos-0.3 Baso-0.5 [**2116-8-28**] 11:20AM BLOOD PT-14.0* PTT-24.1 INR(PT)-1.2* [**2116-8-28**] 11:20AM BLOOD Glucose-84 UreaN-22* Creat-4.5*# Na-139 K-3.8 Cl-99 HCO3-21* AnGap-23* [**2116-8-28**] 11:20AM BLOOD ALT-22 AST-22 CK(CPK)-17* AlkPhos-115 TotBili-0.8 [**2116-8-28**] 11:20AM BLOOD cTropnT-0.05* [**2116-8-28**] 11:20AM BLOOD Lipase-51 [**2116-8-28**] 11:20AM BLOOD Calcium-8.9 Phos-1.3*# Mg-1.7 [**2116-8-28**] 04:24PM BLOOD Lactate-3.4* URINALYSIS [**2116-8-28**] 05:05PM URINE Color-Amber Appear-Hazy Sp [**Last Name (un) **]-1.018 [**2116-8-28**] 05:05PM URINE Blood-MOD Nitrite-NEG Protein-30 Glucose-NEG Ketone-TR Bilirub-MOD Urobiln-NEG pH-5.0 Leuks-MOD [**2116-8-28**] 05:05PM URINE RBC-[**7-21**]* WBC-[**12-31**]* Bacteri-MOD Yeast-NONE Epi-0 MICRO: [**2116-8-28**] BCx x 3: pending, at least one set drawn off the line [**2116-8-28**] UCx: pending --> he has no record of positive UCx in [**Hospital1 18**] system (only yeast) [**2116-8-28**] EKG: regular, at ~90 bpm, nml axis, < [**Street Address(2) 4793**] dep in V2/V3 IMAGING: [**2116-8-28**] Admission CXR: The lungs are clear without focal consolidation. There is no pulmonary edema. There is no pleural effusion or pneumothorax. Heart size is normal. Left subclavian catheter terminating at the brachiocephalic confluence is noted. The osseous structures are unremarkable. IMPRESSION: No acute cardiopulmonary process. . [**8-28**] CTA head/neck: No hemorrhage or mass effect. Chronic microvascular ischemia. MRI with DWI should be performed if there is concern for acute infarct. Complete recons and perfusion images are not available. There is no flow limiting stenosis. There is mild atherosclerotic calcifications at the carotid bifurcations. No flow limiting stenosis. . [**8-29**] CT Abd/Pelvis (prelim read): No acute process. Large complex ventral hernia, but no sign of incarceration. Brief Hospital Course: Mr. [**Known lastname 78835**] is an 80-year-old man with a history of ESRD, recent bacteremia, and possible prior TIA who presented with confusion. . #. AMS: Mr [**Known lastname 78837**] initial neuro exam is non focal, with only global inattention which has resolved by arrival to [**Hospital Unit Name 153**]. DDx included encephalopathy secondary to fluid shifts duing HD, infarction, and infection. Imaging was negative, with no evidence of acute infarct or vessel cutoff; there was no report of hypotension during dialysis. There are no gross electrolyte abnormalities aside from his baseline uremia. Patient had positive UA at OSH for which he was initially treated for w/ cipro, but then stopped once cultures grew diptheroids. Patient afebrile and w/o a leukocytosis. No evidence of recurrent cholangitis currently given nml LFT's. The etiology was unclear at discharge as Mr. [**Known lastname 78835**] was AO x3 and sharp in his judgement. . # h/o TIA and CHF: Patient was started on full dose ASA and started on Zocor. Additionally, patient is on low dose metoprolol. #. ESRD on HD: Patient on MWF schedule; patient to resume HD on discharge. Of note, his dose of Renagel has been reduced to 800mg TID. . #. HTN: Patient's BP initially during course was persistently low, but was likely secondary to HD prior to admission. BP meds were initially held, but BP at discharge was 110/70. Given his other comorbidities, Mr. [**Known lastname 78835**] was discharged on Metoprolol Tartrate 12.5mg po qHS. #. Indicental findings: During course, patient's latate was found to be elevated and CT abdomen was obtained and a small 3.2 cm right adrenal nodule found that needs to be followed up as outpatient. Additionally, on CT head/neck a thyroid nodule was found that will need follow up. Unknown clinical significance. Medications on Admission: renal Caps softgel CYP- 1 capsule daily metoprolol 12.5 mg PO qHS Renagel 2400 mg PO TID Lactulose 10 g/15 ml - 2 tbls PO PRN constipation colace 100 mg PO BID acid controller 20 mg PO BID gas relief 80 mg q6h Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*90 Tablet(s)* Refills:*2* 3. Renal Caps 1 mg Capsule Sig: One (1) Capsule PO once a day. 4. Lactulose 10 gram/15 mL Solution Sig: One (1) PO twice a day. 5. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. 6. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 7. Omeprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day: Please continue to take the acid med you have at home. 8. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO at bedtime. Discharge Disposition: Home Discharge Diagnosis: Primary: 1) Altered Mental Status, resolved. Unknown etiology. 2) Hypotension, resolved. Secondary: - ESRD on HD-- recently started on HD in [**6-18**] - Ascending Cholangitis with E. coli bacteremia in [**7-19**]. - HTN - Dementia - h/o TIA -- per [**Hospital1 34**] records, in [**4-/2115**] had TIA with some speech impediment - Anemia - Systolic CHF with EF 40% in [**7-19**] Discharge Condition: Afebrile, vitals stable. Discharge Instructions: You were hospitalized because you had altered mental status and had trouble uttering your words. Initally, our concern was that you were having another stroke. After a thorough work up to make sure that you didn't have a stroke or an infection, it is unclear what caused your episode altered mental status. Additionally, your blood pressure was a little low when you arrived at the hospital, although that has now resolved. . We will be continuing your home medications on discharge with a few additions and changes. We are starting you on Simvastatin (Zocor) to control your cholesterol, and Aspirin 325mg (full strength) for secondary prevention of stroke. Additionally, your dose of Renagel has been reduced to 800mg, three times a day. . Of note, on your CT scan of the abdomen, we found a small 3.2 cm right adrenal nodule, that we would like your PCP to follow up on in 6 months. You also had a thyroid nodule on your CT head/neck that needs to be followed up by your PCP. . Please return to the ED if your symptoms return. Followup Instructions: Please follow up w/ Dr. [**First Name (STitle) 19961**] on Thurs at 9AM. Completed by:[**2116-10-1**]

780,585,403,428,458,427,294,280,553,241,285,255,V125,V436

{'Altered mental status,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic systolic heart failure,Hypotension, unspecified,Atrial fibrillation,Other persistent mental disorders due to conditions classified elsewhere,Iron deficiency anemia, unspecified,Ventral, unspecified, hernia without mention of obstruction or gangrene,Nontoxic uninodular goiter,Anemia in chronic kidney disease,Other specified disorders of adrenal glands,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Hip joint replacement'}

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: AMS and generalized weakness PRESENT ILLNESS: Mr. [**Known lastname 78835**] is an 80 yoM with ESRD on HD and recent E. coli bacteremia, who presented to the ED after dialysis today with delta MS. The patient reportedly had symptoms of confusion and difficulty speaking, as well as generalized weakness, beginning around 11 am. Per his daughter, he began to exhibit an expressive aphasia on the way to the car, and they returned to the HD unit where he had an EKG with ? afib/flutter. He was brought to [**Hospital6 33**] via EMS from the HD unit where he had a neg NCHCT and nml FSG. He was then brought to [**Hospital1 18**] for further stroke workup and possible CTA. Neurology felt he was severely inattentive, but had no focal deficits, c/w a toxic-metabolic derrangement rather than a stroke. . In the ED, VS were initially Tmax 98.0, SBP 89-132, HR 76-95, RR 18-24, 100% 2LNC. Lactate was noted to be 3.4, and UA was [**12-31**] WBC, + LE, neg nit. He was given 1LNS over several hours (fluids given at a gentler rate b/c of his dialysis status), at which point his SBP dropped to the 90's. His SBP then fell to the 80's and he was given another 500 cc bolus, with improvement of his SBP to the 100's. HR remained in the 70's and he was never tachycardic. He was given vanco/ceftriaxone for presumed urosepsis. . He was also c/o abdominal pain (of several weeks duration) and an A/P CT was obtained that showed a large, complex ventral hernia w/o evidence of incarceration, but no other acute pathology. . On arrival to the [**Hospital Unit Name 153**], he says he is feeling "much better," "much less dizzy." He appears to have no word-finding or speech production difficulties and feels these sx have resolved. He denies HA, change in vision, stiff neck, SOB, chest and skeletal pain; he has had no fevers and was feeling well throughout the week prior to HD on [**8-28**]. Per the patient, he had no episodes of hypotension at HD. . Patient was transferred to the floor after he was found to be stable in the [**Hospital Unit Name 153**]. Mr. [**Known lastname 78835**] stated that he felt well and no longer had any of the symptoms that had originally brought him to the hospital. MEDICAL HISTORY: # ESRD on HD-- recently started on HD in [**6-18**] # Ascending Cholangitis with E. coli bacteremia in [**7-19**]. Had ERCP with stone/sludge removal. Completed 10 day course of ampicillin. # HTN # Dementia # s/p B/L hip replacement # Abdominal hernia repair # Prostate resection # TIA-- per [**Hospital1 34**] records, in [**4-/2115**] had TIA with some speech impediment # Atrial fibrillation with history of RVR while bacteremic/septic from ascending cholangitis. Converted back to NSR prior to discharge. # Anemia--iron deficiency and anemia of chronic disease # Systolic CHF with EF 40% in [**7-19**] MEDICATION ON ADMISSION: renal Caps softgel CYP- 1 capsule daily metoprolol 12.5 mg PO qHS Renagel 2400 mg PO TID Lactulose 10 g/15 ml - 2 tbls PO PRN constipation colace 100 mg PO BID acid controller 20 mg PO BID gas relief 80 mg q6h ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: ADMISSION PHYSICAL EXAM: VS in the ED: Tmax 98.0, SBP 89-132, HR 76-95, RR 18-24, 100% 2LNC VS on arrival to the floor: 96.2, 72/39 (though as high as 100 SBP on repeat measurements), 77, RR 20, 97% 3L GEN: Well-appearing, NAD HEENT: Sclera anicteric, PERRL, EOMI, OP clear, MMM NECK: Supple, no LAD CV: II/VI SM at b/l USB, no rubs PULM: pt not cooperative with siting up so unable to obtain full lung exam; crackles at bases anteriorly ABD: Soft, obese, slight TTP midline/suprapubic, small hernia palpated in region but does not buldge with valsalva EXT: No C/C/E NEURO: AAOx3, language fluent, no word finding difficulties, fully attentive, CN II-XII intact, 5/5 strength throughout, reflexes 2+ throughout FAMILY HISTORY: Non-contributory SOCIAL HISTORY: Lines at home alone in his apartment No ETOH, smoking, or drug use. Has a fiance and 2 daughters who are also his HCP. ### Response: {'Altered mental status,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic systolic heart failure,Hypotension, unspecified,Atrial fibrillation,Other persistent mental disorders due to conditions classified elsewhere,Iron deficiency anemia, unspecified,Ventral, unspecified, hernia without mention of obstruction or gangrene,Nontoxic uninodular goiter,Anemia in chronic kidney disease,Other specified disorders of adrenal glands,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Hip joint replacement'}

CHIEF COMPLAINT: hypotension PRESENT ILLNESS: 76 yo M with ESRD on HD, CAD, AAA repair, Aflutter, AVR, COPD, [**Hospital **] transferred from [**Hospital **] hospital with sepsis. and weak. He was dialysed 5 times in the past 1 week as patient had gained around 9 kg. He also noted to have diarrhea, decreased PO intake. He also complained of left flank pain for the last 1-2 weeks. On the morning od admission, he felt really weak and slumped to the ground. His daughter checked his BP which was SBP of 30's. He was immediately taken to [**Location (un) **]. In the EMS, his SBP was in 60's. At [**Location (un) **], he got Fluid boluses and was started on pressors. They tried SCL but were not successful. He was then transferred to [**Hospital1 18**] for further management. In the ED, he got a fem line (under sterile precautions) and was started intially on Neo and then switched to Levo. His UA was dirty, he had leukocytosis and elevated CKs. He also received Vanc, Cefepime. MEDICAL HISTORY: atrial fibrillation/atrial flutter CAD s/p CABG thoracic ascending aortic aneurysm s/p AVR HTN CKD - on HD MWF s/p pacer s/p AAA repair ??????01 AF ?????? s/p cardioversion ??????03 COPD hypothyroid carotid stenosis possible renal artery stenosis kyphosis asthma asbestosis restless leg MEDICATION ON ADMISSION: ASA 81 mg Carbidopa-Levodopa 10-100 mg Tablet TID Atorvastatin 40 mg QD Morphine 15 mg [**Hospital1 **] Fluticasone-Salmeterol 250-50 mcg/Dose [**Hospital1 **] Metoprolol Succinate 25 mg Tablet SR QD Pantoprazole 40 mg Ipratropium Bromide Q6H Docusate Sodium 100 mg [**Hospital1 **] Ropinirole 1 mg [**Hospital1 **] Nephrocaps QD Levothyroxine 75 mcg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 97.8, 91/71, 66, 14, 100%/3L NC Gen: alert, oriented, in no acute distress HEENT: furrowed tongue, mild glossitis Neck: thick neck, no JVD appreciable Heart: S1/S2, many ectopic beats, 3/6 SEM at LUSB Lungs: bilateral wheezes, no crackles Abdomen: tense, no tenderness/guarding/rigidity, normoactive BS Flank: no tenderness Ext: no edema Neuro: no focal deficits FAMILY HISTORY: no h/o DM, HTN, no Cancer Mother died of heart disease at 90 SOCIAL HISTORY: Patient lives with his wife and one of his 3 children. He quit smoking 40 years ago ([**2090**]), smoked for 18 years. Retired salesman. Asbestos exposure in submarines 50 yrs ago. Denies any EtOH, no IVDU.

Infection and inflammatory reaction due to other vascular device, implant, and graft,Chronic airway obstruction, not elsewhere classified,Atrial flutter,End stage renal disease,Heart valve replaced by transplant,Congestive heart failure, unspecified,Hypotension of hemodialysis,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Swelling of limb,Profound impairment, one eye, impairment level not further specified,Asbestosis,Other specified forms of chronic ischemic heart disease,Fitting and adjustment of cardiac pacemaker

React-oth vasc dev/graft,Chr airway obstruct NEC,Atrial flutter,End stage renal disease,Heart valve transplant,CHF NOS,Hemododialysis hypotensn,Hypothyroidism NOS,Aortocoronary bypass,Swelling of limb,Blindness, one eye,Asbestosis,Chr ischemic hrt dis NEC,Ftng cardiac pacemaker

Admission Date: [**2129-1-17**] Discharge Date: [**2129-1-28**] Date of Birth: [**2052-8-6**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2387**] Chief Complaint: hypotension Major Surgical or Invasive Procedure: Left femoral line History of Present Illness: 76 yo M with ESRD on HD, CAD, AAA repair, Aflutter, AVR, COPD, [**Hospital **] transferred from [**Hospital **] hospital with sepsis. and weak. He was dialysed 5 times in the past 1 week as patient had gained around 9 kg. He also noted to have diarrhea, decreased PO intake. He also complained of left flank pain for the last 1-2 weeks. On the morning od admission, he felt really weak and slumped to the ground. His daughter checked his BP which was SBP of 30's. He was immediately taken to [**Location (un) **]. In the EMS, his SBP was in 60's. At [**Location (un) **], he got Fluid boluses and was started on pressors. They tried SCL but were not successful. He was then transferred to [**Hospital1 18**] for further management. In the ED, he got a fem line (under sterile precautions) and was started intially on Neo and then switched to Levo. His UA was dirty, he had leukocytosis and elevated CKs. He also received Vanc, Cefepime. Past Medical History: atrial fibrillation/atrial flutter CAD s/p CABG thoracic ascending aortic aneurysm s/p AVR HTN CKD - on HD MWF s/p pacer s/p AAA repair ??????01 AF ?????? s/p cardioversion ??????03 COPD hypothyroid carotid stenosis possible renal artery stenosis kyphosis asthma asbestosis restless leg Social History: Patient lives with his wife and one of his 3 children. He quit smoking 40 years ago ([**2090**]), smoked for 18 years. Retired salesman. Asbestos exposure in submarines 50 yrs ago. Denies any EtOH, no IVDU. Family History: no h/o DM, HTN, no Cancer Mother died of heart disease at 90 Physical Exam: Vitals: 97.8, 91/71, 66, 14, 100%/3L NC Gen: alert, oriented, in no acute distress HEENT: furrowed tongue, mild glossitis Neck: thick neck, no JVD appreciable Heart: S1/S2, many ectopic beats, 3/6 SEM at LUSB Lungs: bilateral wheezes, no crackles Abdomen: tense, no tenderness/guarding/rigidity, normoactive BS Flank: no tenderness Ext: no edema Neuro: no focal deficits Pertinent Results: [**2129-1-17**] 05:20PM BLOOD CK(CPK)-1598* [**2129-1-18**] 02:18AM BLOOD CK(CPK)-1143* [**2129-1-18**] 05:57PM BLOOD CK(CPK)-696* [**2129-1-18**] 02:18AM BLOOD CK-MB-24* MB Indx-2.1 cTropnT-0.30* [**2129-1-17**] 05:20PM BLOOD Cortsol-29.1* [**2129-1-18**] 12:25AM BLOOD Cortsol-39.1* [**2129-1-18**] 01:00AM BLOOD Cortsol-44.5* [**2129-1-17**] 05:20PM WBC-19.5* RBC-3.34* HGB-11.2* HCT-33.6* MCV-101* MCH-33.5* MCHC-33.3 RDW-17.9* [**2129-1-17**] 05:20PM GLUCOSE-76 UREA N-41* CREAT-5.1*# SODIUM-138 POTASSIUM-5.5* CHLORIDE-102 TOTAL CO2-24 ANION GAP-18 . EKG: Aflutter with 4:1 block, no acute ST-T wave changes . Chest Xray: Overall improvement in the congestive heart failure seen in early [**Month (only) 216**]. Likely there is still a mild degree of pulmonary edema. Stable appearance to the mediastinum. . LUE U/S [**2128-1-19**]: 1. Nonvisualization of left upper extremity veins with multiple collateral vessels identified, suggestive of a chronic obstruction. This can be further evaluated with an MR examination. 2. No evidence of deep venous thrombosis in the right upper extremity. 3. Fistula graft within the left forearm which is widely patent, however, it appears to be anastomosed to arterial vessels. No venous flow is noted within the region of the fistula graft anastomoses. . Echo [**2128-1-22**]: 1.The left atrium is mildly dilated. The right atrium is moderately dilated. 2.There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] Left ventricular systolic function is hyperdynamic (EF>75%). 3. Right ventricular chamber size is normal. 4.A bioprosthetic aortic valve prosthesis is present. The aortic prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. Trace aortic regurgitation is seen. [The amount of regurgitation present is normal for this prosthetic aortic valve.] 5. The mitral valve leaflets are mildly thickened. There is severe mitral annular calcification. Moderate to severe (3+) mitral regurgitation is seen. 6. Severe [4+] tricuspid regurgitation is seen. There is mild pulmonary artery systolic hypertension. 7.There is no pericardial effusion. Compared with the findings of the prior report (images unavailable for review) of [**2128-8-25**], the MR [**First Name (Titles) **] [**Last Name (Titles) 28495**] significantly. An accurate assessment of the aorta could not be made on the present study. . [**1-24**] Fistulography L arm: Angiography of the arterialized L brachial vein showed an occluded L subclavian vein. The L subclavian vein was occluded. The procedure was abandoned in favor of surgical intervention. FINAL DIAGNOSIS: 1. thrombosed L AV fistula 2. occluded L subclavian vein . [**1-25**] HD catheter exchange by IR: Uneventful exchange of right IJ dialysis catheter, as above. The tip of the catheter, which was removed, was sent for cultures. The line is ready to use. . [**1-27**] Left fistula ligation without any major complications. Brief Hospital Course: 76 yo M with ESRD on HD, CAD, AAA repair, Aflutter, AVR, COPD with hypotension from urosepsis vs overdialyzing, requiring MICU stay. He was transiently on pressors. Broad spectrum antibiotics were started in the ICU, as well as a Heparin gtt for Aflutter and L UE clot. He was transferred to the floor with stable BP, off pressors, on Vancomycin and Cefepime. . 1) Hypotension: ? line sepsis vs. pneumonia vs hypovolemia [**2-18**] aggressive HD and decreased PO intake. Cortstim test was negative for adrenal insufficiency. Likely sources of infection are HD catheter, PNA, less likely urine. Off Levophed gtt after 24h, BP was stable, then transferred to floor. Patient received IV fluids as needed. Vancomycin (started [**1-19**]) and Cefepime (started [**1-17**]) were continued. A total course of 21 days should be given. Multiple blood and urine cultures from [**1-17**] through [**1-19**] came back negative. HD catheter cultures were sent off on [**1-25**] and also came back negative. Pt was hemodynamically stable on discharge and afebrile. . 2) CAD s/ CABG: Pt developed elevation of troponin to 0.3 (from 0.14 from [**August 2128**]), CPK elevated to 1598 although no elevation of CK-MD index. EKG no evidence of any acute ST-T wave changes. This could represent demand ischemia in the setting of sepsis, hypotension. Cardiac enzymes were cycled x3 and remained stable. Pt was continued on Lipitor. ASA was held on Heparin gtt. Pt was continued on toprol XL with holding parameters once his blood pressure was stable after transfer from the ICU. An Echo from [**1-21**] to assess LV function showed EF of 75%, but [**Month/Day (1) 28495**] MR. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]p appointment with cardiologist Dr. [**Last Name (STitle) **] should be scheduled for 1-2 weeks after discharge. . 3) Atrial flutter: His rate was controlled in 4:1 bloc. It was therefore unlikely that this was contributing to the hypotension. Pt was continued on his BB. Anticoagulation was started. A heparin gtt was initiated which was discontinued shortly pior discharge since he went for an AV fistula ligation. He also developed guaiac positive stools on two occasions during his hospital stay. The first time, the heparin gtt has been held transiently (see below). The second time, Coumadin was just started at 3mg qHS and was held as well for guaiac positive stools. A hematocrit should be checked at rehab. It should be decided after further Hematocrits whether anticoagulation with Coumadin is being continued as an outpatient. . 4) L UE clot: Present since fistula operation in [**11-22**]. The patient was on a heparin gtt for the majority of his hospital stay. However, the drip has been discontinued shortly prior discharge. A fistulogram on [**1-24**] was performed and showed a large clot that could not be cleared during the procedure. Transplant surgery ligated the fistula on [**1-27**] without any major complications. Swelling of his arm improved soon thereafter. An outpatient followup appointment has been scheduled by transplant surgery in order to follow up on his ligated AV fistula. . 5) ESRD: Pt received routine HD on M/W/F or as needed. Pt was continued on Nephrocaps and PhosLo. HD catheter was exchanged over wire on [**1-25**] by IR. HD catheter tip was sent for culture and came back negative. He should resume his regular outpatient HD. Vancomycin should be given with hemodialysis. Levels should be checked prior each Vanco dose. . 6) Anemia: Likely secondary ESRD. Iron studies consistant with ACD. HCT baseline of 34-40. Hct was trending down to 31. Pt received Epo with HD and dose was increased on [**1-26**]. . 7) Guaiac positive stools: Pt had Guaiac pos stool on [**1-21**]. Heparin gtt was transiently held and pt was briefly on PPI IV BID, but repeat hct remained stable at a lower baseline. One unit of PRBC were transfused on [**1-26**]. The heparin drip was restarted but discontinued shortly prior discharge for an AV fistula ligation. Coumadin was started after the procedure at 3mg qHS but was held as well because of another guaiac positive stool. A hematocrit should be checked at rehab. It should be decided after further Hematocrits whether anticoagulation with Coumadin is being continued as an outpatient. It is recommended that the patient is undergoing an outpatient GI workup for this GI bleed. . 8) Dizziness: The patient developed intermittent, mild dizziness when moving. These symptoms appeared shortly prior discharge. One likely diagnosis would be BPPV among others, and should be further worked up as an outpatient. His VS remained stable. . 9) HTN: Continued BB after transfer to the floor. . 10) COPD: Continued nebs. Xopenex (Levalbuterol) to be considered if tachycardic. . 11) Hypothyroid: Continued levothyroxine; initial elevated CK could be from hypothyroidism. TSH was 64, Free T4 was 0.57 while patient was still in the ICU. Synthroid dose was increased from 75 mcg to 100 mcg daily. Patient was discharge on this higher dose. . 12) PPX: heparin gtt (for majority of hosptial stay), one dose of Coumadin, held after guaiac positive stools, Heparin sc for the remainder, pneumoboots, protonix, HOB elevation . 13) FEN: heart healthy diet . 13) Access: L Femoral line discontinued on [**1-19**], HD catheter, PICC, PIV . 15) Code: DNR/I Medications on Admission: ASA 81 mg Carbidopa-Levodopa 10-100 mg Tablet TID Atorvastatin 40 mg QD Morphine 15 mg [**Hospital1 **] Fluticasone-Salmeterol 250-50 mcg/Dose [**Hospital1 **] Metoprolol Succinate 25 mg Tablet SR QD Pantoprazole 40 mg Ipratropium Bromide Q6H Docusate Sodium 100 mg [**Hospital1 **] Ropinirole 1 mg [**Hospital1 **] Nephrocaps QD Levothyroxine 75 mcg QD Discharge Medications: 1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 4. Carbidopa-Levodopa 10-100 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 5. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 6. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Inhalation every six (6) hours as needed for shortness of breath or wheezing. 7. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 9. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 13. Ropinirole 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 14. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1) Intravenous QHD (each hemodialysis) for 10 days: Started [**2129-1-19**]. Complete 21 day course. Check Vanco level prior each HD. 15. Cefepime 1 g Recon Soln Sig: One (1) Recon Soln Intravenous Q24H (every 24 hours) for 8 days: Started [**2129-1-17**]. Complete 21 day course. 16. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1) ML Intravenous DAILY (Daily) as needed. Discharge Disposition: Extended Care Facility: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] - [**Location (un) **] Discharge Diagnosis: Primary Diagnosis: 1. ? Sepsis 2. Atrial flutter 3. L Upper extremity clot . Secondary Diagnosis: 1. CAD s/p CABG 2. Hypertension 3. COPD 4. Hypothyroid Discharge Condition: Afebrile. Hemodynamically stable. Tolerating PO. Discharge Instructions: Please call your primary doctor or return to the ED with fever, chills, chest pain, shortness of breath, nausea/vomiting, spontaneous bleeding or any other concerning symptoms. . Please take all your medications as directed. Your coumadin has been held. . Please keep you follow up appointments as below. Followup Instructions: Please follow up with your primary care doctor ([**Last Name (LF) **],[**First Name3 (LF) **] M. [**Telephone/Fax (1) 14895**]) as needed. Please schedule a followup appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 2394**]) in [**1-18**] weeks from now. . [**First Name8 (NamePattern2) 5969**] [**Last Name (NamePattern1) 5970**] from transplant surgery has scheduled an oupatient appointment for you. Her phone number is [**Telephone/Fax (1) 7207**]. The appointment is: Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2129-2-10**] 9:10 . Vancomycin and Cefepime to be continued until 21 day course is completed or for one week after discharge. Vancomycin levels should be checked prior each Hemodialysis. . *******Patient had guaiac positive stools during hospitalization. Outpatient GI workup is necessary.********His Hematocrit should be checked at rehab. His last Hct at discharge was 26.5.********* Coumadin (3mg qHS) was started during the hospitalization but has been held prior discharge. It should be decided as an outpatient when to restart.*********

996,496,427,585,V422,428,458,244,V458,729,369,501,414,V533

{'Infection and inflammatory reaction due to other vascular device, implant, and graft,Chronic airway obstruction, not elsewhere classified,Atrial flutter,End stage renal disease,Heart valve replaced by transplant,Congestive heart failure, unspecified,Hypotension of hemodialysis,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Swelling of limb,Profound impairment, one eye, impairment level not further specified,Asbestosis,Other specified forms of chronic ischemic heart disease,Fitting and adjustment of cardiac pacemaker'}

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: 76 yo M with ESRD on HD, CAD, AAA repair, Aflutter, AVR, COPD, [**Hospital **] transferred from [**Hospital **] hospital with sepsis. and weak. He was dialysed 5 times in the past 1 week as patient had gained around 9 kg. He also noted to have diarrhea, decreased PO intake. He also complained of left flank pain for the last 1-2 weeks. On the morning od admission, he felt really weak and slumped to the ground. His daughter checked his BP which was SBP of 30's. He was immediately taken to [**Location (un) **]. In the EMS, his SBP was in 60's. At [**Location (un) **], he got Fluid boluses and was started on pressors. They tried SCL but were not successful. He was then transferred to [**Hospital1 18**] for further management. In the ED, he got a fem line (under sterile precautions) and was started intially on Neo and then switched to Levo. His UA was dirty, he had leukocytosis and elevated CKs. He also received Vanc, Cefepime. MEDICAL HISTORY: atrial fibrillation/atrial flutter CAD s/p CABG thoracic ascending aortic aneurysm s/p AVR HTN CKD - on HD MWF s/p pacer s/p AAA repair ??????01 AF ?????? s/p cardioversion ??????03 COPD hypothyroid carotid stenosis possible renal artery stenosis kyphosis asthma asbestosis restless leg MEDICATION ON ADMISSION: ASA 81 mg Carbidopa-Levodopa 10-100 mg Tablet TID Atorvastatin 40 mg QD Morphine 15 mg [**Hospital1 **] Fluticasone-Salmeterol 250-50 mcg/Dose [**Hospital1 **] Metoprolol Succinate 25 mg Tablet SR QD Pantoprazole 40 mg Ipratropium Bromide Q6H Docusate Sodium 100 mg [**Hospital1 **] Ropinirole 1 mg [**Hospital1 **] Nephrocaps QD Levothyroxine 75 mcg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: 97.8, 91/71, 66, 14, 100%/3L NC Gen: alert, oriented, in no acute distress HEENT: furrowed tongue, mild glossitis Neck: thick neck, no JVD appreciable Heart: S1/S2, many ectopic beats, 3/6 SEM at LUSB Lungs: bilateral wheezes, no crackles Abdomen: tense, no tenderness/guarding/rigidity, normoactive BS Flank: no tenderness Ext: no edema Neuro: no focal deficits FAMILY HISTORY: no h/o DM, HTN, no Cancer Mother died of heart disease at 90 SOCIAL HISTORY: Patient lives with his wife and one of his 3 children. He quit smoking 40 years ago ([**2090**]), smoked for 18 years. Retired salesman. Asbestos exposure in submarines 50 yrs ago. Denies any EtOH, no IVDU. ### Response: {'Infection and inflammatory reaction due to other vascular device, implant, and graft,Chronic airway obstruction, not elsewhere classified,Atrial flutter,End stage renal disease,Heart valve replaced by transplant,Congestive heart failure, unspecified,Hypotension of hemodialysis,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Swelling of limb,Profound impairment, one eye, impairment level not further specified,Asbestosis,Other specified forms of chronic ischemic heart disease,Fitting and adjustment of cardiac pacemaker'}

CHIEF COMPLAINT: Increasing shortness of breath at rest and dyspnea on exertion. Chest pain and increasing fatigue. PRESENT ILLNESS: The patient is a 64 year old gentleman with a questionable history of a myocardial infarction in his 40s, which was medically managed. Over the past three months, he has developed worsening shortness of breath and anginal symptoms. In [**2188-6-11**], the patient underwent an exercise tolerance thallium test which revealed a left ventricular ejection fraction of 32%, down from a left ventricular ejection fraction of 60% in [**2181**]. MEDICAL HISTORY: 1. Myocardial infarction. 2. Insulin dependent diabetes mellitus. 3. Hypertension. 4. Hyperlipidemia. 5. Chronic obstructive pulmonary disease. 6. Chronic right sided headache. 7. Gastroesophageal reflux disease. 8. Peripheral vascular disease. 9. Bilateral carotid endarterectomies. 10. Removal of penile implant status post infection. 11. Left total knee replacement. 12. Colonoscopy with polyp removal. 13. Cataract, right eye. MEDICATION ON ADMISSION: Aspirin 81 mg p.o.q.d., Prevacid 30 mg p.o.b.i.d., Zocor 20 mg p.o.q.d., Zestril 10 mg p.o.q.d., atenolol 50 mg p.o.q.d., Procardia 60 mg p.o.q.d., and insulin Novolin 70/30 15 units q.a.m. and 16 units q.p.m. ALLERGIES: Naprosyn and Vioxx (gastrointestinal distress). PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient has a remote history of alcohol abuse. He has an 80 pack year history of smoking.

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Old myocardial infarction,Personal history of tobacco use

Crnry athrscl natve vssl,Intermed coronary synd,DMI wo cmp nt st uncntrl,Hypertension NOS,Esophageal reflux,Periph vascular dis NOS,Pure hypercholesterolem,Old myocardial infarct,History of tobacco use

Admission Date: [**2188-8-19**] Discharge Date: [**2188-8-22**] Date of Birth: [**2124-2-3**] Sex: M Service: Cardiothoracic Surgery CHIEF COMPLAINT: Increasing shortness of breath at rest and dyspnea on exertion. Chest pain and increasing fatigue. HISTORY OF PRESENT ILLNESS: The patient is a 64 year old gentleman with a questionable history of a myocardial infarction in his 40s, which was medically managed. Over the past three months, he has developed worsening shortness of breath and anginal symptoms. In [**2188-6-11**], the patient underwent an exercise tolerance thallium test which revealed a left ventricular ejection fraction of 32%, down from a left ventricular ejection fraction of 60% in [**2181**]. The patient was subsequently evaluated with a cardiac catheterization on [**2188-7-23**], which revealed left main 20%, left anterior descending artery 50%, diagonal 50%, diagonal two 80%, circumflex 100%, right coronary artery 100%, and left ventricular ejection fraction 41%. He was subsequently evaluated for cardiac surgery. PAST MEDICAL HISTORY: 1. Myocardial infarction. 2. Insulin dependent diabetes mellitus. 3. Hypertension. 4. Hyperlipidemia. 5. Chronic obstructive pulmonary disease. 6. Chronic right sided headache. 7. Gastroesophageal reflux disease. 8. Peripheral vascular disease. 9. Bilateral carotid endarterectomies. 10. Removal of penile implant status post infection. 11. Left total knee replacement. 12. Colonoscopy with polyp removal. 13. Cataract, right eye. SOCIAL HISTORY: The patient has a remote history of alcohol abuse. He has an 80 pack year history of smoking. MEDICATIONS ON ADMISSION: Aspirin 81 mg p.o.q.d., Prevacid 30 mg p.o.b.i.d., Zocor 20 mg p.o.q.d., Zestril 10 mg p.o.q.d., atenolol 50 mg p.o.q.d., Procardia 60 mg p.o.q.d., and insulin Novolin 70/30 15 units q.a.m. and 16 units q.p.m. ALLERGIES: Naprosyn and Vioxx (gastrointestinal distress). REVIEW OF SYSTEMS: The patient denies weight loss, rash, sinusitis. He has chronic obstructive pulmonary disease, palpitations, orthopnea and paroxysmal nocturnal dyspnea. He has no gastrointestinal symptoms. He has chronic left knee pain, status post total knee replacement. He has bilateral claudication in his legs and a history of bilateral carotid disease. He has no history of cerebrovascular accident. He has insulin dependent diabetes mellitus, no thyroid or psychiatric history. PHYSICAL EXAMINATION: On physical examination, the patient had a heart rate of 54, respiratory rate 10, blood pressure 148/82. General: Well nourished gentleman appearing his stated age, in no acute distress. Head, eyes, ears, nose and throat: Normocephalic, atraumatic, pupils equal, round, and reactive to light and accommodation. Neck: Supple, no jugular venous distention. Lungs: Clear to auscultation bilaterally. Cardiovascular: Occasionally irregular without murmur, rub or gallop. Abdomen: Soft, nontender, nondistended, positive bowel sounds. Extremities: Well perfused with no cyanosis, clubbing or edema. HOSPITAL COURSE: The patient was taken to the Operating Room on [**2188-8-19**] for coronary artery bypass grafting times four. Grafts included a left internal mammary artery to the left anterior descending artery, saphenous vein graft to the diagonal, saphenous vein graft to the ramus and saphenous vein graft to the posterior descending coronary artery. The operation was performed without complication and the patient was subsequently transferred to the Cardiothoracic Intensive Care Unit. The patient was weaned off drips and extubated. He was adequately fluid resuscitated. On postoperative day number one, the patient was felt stable for transfer to the floor. The patient recovered well and uneventfully on the floor. His Foley catheter and chest tubes were discontinued on postoperative day number two. He was tolerating an oral diet. He was ambulating well and his pain was under good control on oral medications. On [**2188-8-22**], the patient was felt stable for discharge to home. Physical examination on discharge: Vital signs: Temperature 99.3, pulse 80, blood pressure 139/66, respiratory rate 20 and oxygen saturation 93% on three liters. Cardiovascular: Regular rate and rhythm. Lungs: Clear to auscultation bilaterally. Incision: Clean, dry and intact. Abdomen: Soft, nontender, nondistended, positive bowel sounds. Extremities: Without cyanosis, clubbing or edema. DISCHARGE MEDICATIONS: Simvastatin 20 mg p.o.q.d. Atenolol 50 mg p.o.q.d. Aspirin 325 mg p.o.q.d. Prevacid 30 mg p.o.b.i.d. Percocet one to two tablets p.o.q.4-6h.p.r.n. Docusate 100 mg p.o.b.i.d. Zestril 10 mg p.o.q.d. Novolin insulin 70/30 15 units q.a.m. and 15 units q.p.m. CONDITION ON DISCHARGE: Stable. DISCHARGE STATUS: The patient was discharged to home. FOLLOW-UP: The patient was instructed to follow up with Dr. [**Last Name (STitle) **] in four weeks and with Dr. [**Last Name (STitle) **] in three to four weeks. DISCHARGE DIAGNOSIS: Status post coronary artery bypass grafting times four. [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 3113**] Dictated By:[**Name8 (MD) 11235**] MEDQUIST36 D: [**2188-8-22**] 17:45 T: [**2188-8-22**] 18:59 JOB#: [**Job Number **]

414,411,250,401,530,443,272,412,V158

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Old myocardial infarction,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: Increasing shortness of breath at rest and dyspnea on exertion. Chest pain and increasing fatigue. PRESENT ILLNESS: The patient is a 64 year old gentleman with a questionable history of a myocardial infarction in his 40s, which was medically managed. Over the past three months, he has developed worsening shortness of breath and anginal symptoms. In [**2188-6-11**], the patient underwent an exercise tolerance thallium test which revealed a left ventricular ejection fraction of 32%, down from a left ventricular ejection fraction of 60% in [**2181**]. MEDICAL HISTORY: 1. Myocardial infarction. 2. Insulin dependent diabetes mellitus. 3. Hypertension. 4. Hyperlipidemia. 5. Chronic obstructive pulmonary disease. 6. Chronic right sided headache. 7. Gastroesophageal reflux disease. 8. Peripheral vascular disease. 9. Bilateral carotid endarterectomies. 10. Removal of penile implant status post infection. 11. Left total knee replacement. 12. Colonoscopy with polyp removal. 13. Cataract, right eye. MEDICATION ON ADMISSION: Aspirin 81 mg p.o.q.d., Prevacid 30 mg p.o.b.i.d., Zocor 20 mg p.o.q.d., Zestril 10 mg p.o.q.d., atenolol 50 mg p.o.q.d., Procardia 60 mg p.o.q.d., and insulin Novolin 70/30 15 units q.a.m. and 16 units q.p.m. ALLERGIES: Naprosyn and Vioxx (gastrointestinal distress). PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient has a remote history of alcohol abuse. He has an 80 pack year history of smoking. ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Esophageal reflux,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Old myocardial infarction,Personal history of tobacco use'}

CHIEF COMPLAINT: left sided weakness PRESENT ILLNESS: 71 year old RH man with history of atrial fibrillation, hypertension, and cad who presents with acute onset of left sided weakness at 10:30 PM yesterday. His wife was with him in the living room when she noticed acute onset of left side facial droop. She then tried to get him up but he fell over due to left arm/leg weakness. He then complained that he had a headache and felt dizzy. His wife gave him 5 mg coumadin but when he did not feel better, she called EMS. He was taking coumadin but then stopped it 3 days ago for a tooth extraction yesterday morning. MEDICAL HISTORY: atrial fibrillation cad htn lupus chf gi bleed fe deficiency MEDICATION ON ADMISSION: verapamil 360 lopressor 100 coumadin 2.5-not taking for dental procedure ativan 2 folate ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Mental status: Awake and alert, cooperative with exam, normal affect Orientation: oriented to person, place Language: fluent with good comprehension and repetition; naming intact. + dysarthria but no paraphasic errors Left sided neglect with eyes deviated to right FAMILY HISTORY: SOCIAL HISTORY: He is an owner of a printing shop who lives with wife. no tobacco, occasional etoh, no ivdu.

Cerebral embolism with cerebral infarction,Atrial fibrillation,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Systemic lupus erythematosus,Hemiplegia, unspecified, affecting nondominant side,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Acquired absence of teeth, unspecified,Other postprocedural status

Crbl emblsm w infrct,Atrial fibrillation,Pneumonia, organism NOS,Urin tract infection NOS,Syst lupus erythematosus,Unsp hmiplga nondmnt sde,Crnry athrscl natve vssl,Hypertension NOS,Acq absence of teeth NOS,Post-proc states NEC

Admission Date: [**2175-11-7**] Discharge Date: [**2175-11-10**] Date of Birth: [**2104-7-1**] Sex: M Service: NEUROLOGY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5018**] Chief Complaint: left sided weakness Major Surgical or Invasive Procedure: IV t-PA History of Present Illness: 71 year old RH man with history of atrial fibrillation, hypertension, and cad who presents with acute onset of left sided weakness at 10:30 PM yesterday. His wife was with him in the living room when she noticed acute onset of left side facial droop. She then tried to get him up but he fell over due to left arm/leg weakness. He then complained that he had a headache and felt dizzy. His wife gave him 5 mg coumadin but when he did not feel better, she called EMS. He was taking coumadin but then stopped it 3 days ago for a tooth extraction yesterday morning. Past Medical History: atrial fibrillation cad htn lupus chf gi bleed fe deficiency Social History: He is an owner of a printing shop who lives with wife. no tobacco, occasional etoh, no ivdu. Physical Exam: Mental status: Awake and alert, cooperative with exam, normal affect Orientation: oriented to person, place Language: fluent with good comprehension and repetition; naming intact. + dysarthria but no paraphasic errors Left sided neglect with eyes deviated to right Cranial Nerves: I: not tested II: Pupils equally round and reactive to light, 4 to 3 mm bilaterally. Left homonymous hemanopsia III, IV, VI: Eyes deviated to right but Extraocular movements intact bilaterally without nystagmus. V, VII: Facial sensation intact and symmetric. left facial droop VIII: Hearing intact to finger rub bilaterally. IX, X: Palatal elevation symmetrical [**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally. XII: Tongue midline without fasciculations, intact movements Motor: Normal bulk bilaterally. decreased tone on left arm No tremor D T B WF WE FiF [**Last Name (un) **] IP Gl Q H AF AE TF TE Left leg raised against gravity for 5 seconds and no movement of left arm Sensation: localizes noxious stimuli on right side and withdraws at left leg. no movement of left arm to stimuli Reflexes: 2+/4 throughout Grasp reflex absent Toes were downgoing on right and upgoing on left Coordination: normal on finger-nose-finger on right but unable to test on left due to weakness Gait was not assessed as he was unable to wa Pertinent Results: [**2175-11-10**] 05:05AM BLOOD WBC-12.0* RBC-5.59 Hgb-15.2 Hct-45.2 MCV-81* MCH-27.1 MCHC-33.6 RDW-14.1 Plt Ct-174 [**2175-11-7**] 12:25AM BLOOD WBC-11.7* RBC-5.45 Hgb-14.8 Hct-43.7 MCV-80* MCH-27.1 MCHC-33.8 RDW-14.2 Plt Ct-164 [**2175-11-8**] 04:21AM BLOOD PT-15.0* PTT-29.8 INR(PT)-1.4 [**2175-11-10**] 05:05AM BLOOD Glucose-95 UreaN-20 Creat-0.7 Na-139 K-4.0 Cl-104 HCO3-24 AnGap-15 [**2175-11-7**] 03:00AM BLOOD ALT-14 AST-16 CK(CPK)-94 [**2175-11-10**] 05:05AM BLOOD Calcium-9.3 Phos-3.4 Mg-1.9 [**2175-11-7**] 08:56AM BLOOD %HbA1c-5.8 [**2175-11-7**] 03:00AM BLOOD Triglyc-84 HDL-39 CHOL/HD-4.1 LDLcalc-103 [**2175-11-9**] 11:45AM URINE Blood-LGE Nitrite-NEG Protein-100 Glucose-NEG Ketone-50 Bilirub-NEG Urobiln-NEG pH-9.0* Leuks-MOD CT HEAD: 1. Findings consistent with acute right MCA infarction and thrombus in the proximal right middle cerebral artery. 2. No intracranial hemorrhage or masss effect CTA: 1. Asymmetry of branching of right MCA artery, vessels otherwise patent Carotid duplex; No carotid stenosis ECHO: The left atrium is moderately dilated. The right atrium is moderately dilated. No atrial septal defect is seen by 2D or color Doppler. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF 70%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is moderately dilated. The aortic arch is mildly dilated. There are focal calcifications in the aortic arch. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion. Brief Hospital Course: Pt was found to have a right MCA stroke (cardioembolic in setting of stopping Coumadin for dental procedure) and was given IV-tPA in the ER and admitted to the neurology service. He was registered at [**Hospital1 18**] at 0015. Labs were drawn at 0025 and his INR was 1.2. CT scan at 0050 showed a dense rt mca, loss of the insular ribbon and grey white junction elsewhere in the rtmca territory. Exam at that time was reported to show a NIHscale of 16 primarily due to left sided weakness, sensory deficit and neglect. He recieved a bolus of 8.2 mg IV tPA at 0135. The rest of the 73.6 mg was given as a drip. He was admitted to the N-ICU for observation, neuro checks and BP montioring. Post-t-PA course was complicated by dental bleeding (s/p extraction) which resolved spontaneously. He had a CTA and rpt CT post IV t-[**MD Number(3) 24709**] showed patenet proximal Right MCA with decreased MCA branching. CT also showed petechial hemorrhage within infarct. He was started on aspirin [**11-8**]. Because of the small hemorrhage seen on follow up CT, his Coumadin should be held for one week and restarted on [**11-15**]. He should continue to take ASA until his INR is therapeutic. Echo showed no evidence of intracardiac thrombus. Carotid duplex showed patenet carotids. His blood pressure was initially controlled with labetalol drip which was converted to oral metoprolol. ACEI was added for improved BP control. On [**11-9**] he had an episode of rapid Afib which responded to diltiazem, Metoprolol dose was increased for better rate control with good results. On [**11-9**] he was found to have a UTI and left LL PNA. He was started on Levoquin and has remained afebrile. He had a video swallow evaluation on [**11-10**]. Diet recommendations for pureed solids, nectar thick liquids. Maintain aspiration precautions, alternate between taking bites and sips. He was seen be PT and OT during his admission and was felt to be an excellent candidate for rehab. He is now being discharged to acute rehab facility for continued care. Medications on Admission: verapamil 360 lopressor 100 coumadin 2.5-not taking for dental procedure ativan 2 folate Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Tablet(s) 2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* 6. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day for 7 days. Discharge Disposition: Extended Care Facility: [**Hospital6 979**] - [**Location (un) 246**] Discharge Diagnosis: Right MCA stroke Discharge Condition: Improved: Left hemiparesis, improving Discharge Instructions: Please keep appointments as outlined below. You should resume taking Coumadin on [**11-15**]. Please follow up with your primary care doctor to have your INR monitored after re-starting Coumadin. You should continue to take Aspirin until your INR is therapeutic. Please return to the Emergency room for worsening visual symptoms, weakness, numbness, or any other worrisome symptoms. Followup Instructions: 1. [**Hospital 4038**] Clinic: Dr. [**First Name (STitle) **] [**Name (STitle) 21421**] call to make an appointment [**Telephone/Fax (1) 657**] 2. PCP: [**Last Name (NamePattern4) **]. [**Doctor Last Name 110148**] follow up with after discharge from Rehab [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]

434,427,486,599,710,342,414,401,525,V458

{'Cerebral embolism with cerebral infarction,Atrial fibrillation,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Systemic lupus erythematosus,Hemiplegia, unspecified, affecting nondominant side,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Acquired absence of teeth, unspecified,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: left sided weakness PRESENT ILLNESS: 71 year old RH man with history of atrial fibrillation, hypertension, and cad who presents with acute onset of left sided weakness at 10:30 PM yesterday. His wife was with him in the living room when she noticed acute onset of left side facial droop. She then tried to get him up but he fell over due to left arm/leg weakness. He then complained that he had a headache and felt dizzy. His wife gave him 5 mg coumadin but when he did not feel better, she called EMS. He was taking coumadin but then stopped it 3 days ago for a tooth extraction yesterday morning. MEDICAL HISTORY: atrial fibrillation cad htn lupus chf gi bleed fe deficiency MEDICATION ON ADMISSION: verapamil 360 lopressor 100 coumadin 2.5-not taking for dental procedure ativan 2 folate ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Mental status: Awake and alert, cooperative with exam, normal affect Orientation: oriented to person, place Language: fluent with good comprehension and repetition; naming intact. + dysarthria but no paraphasic errors Left sided neglect with eyes deviated to right FAMILY HISTORY: SOCIAL HISTORY: He is an owner of a printing shop who lives with wife. no tobacco, occasional etoh, no ivdu. ### Response: {'Cerebral embolism with cerebral infarction,Atrial fibrillation,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Systemic lupus erythematosus,Hemiplegia, unspecified, affecting nondominant side,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Acquired absence of teeth, unspecified,Other postprocedural status'}

CHIEF COMPLAINT: new onset diabetes, confusion PRESENT ILLNESS: Pt is a 72 yo M with HTN, hyperlipidemia, who presents with altered mental status. According to his son, he has not been feeling very well over the last week; he later recalled that his father had been polyuric, polydipsic. There were no no obvious fever, chills, HA, cardiopulmonary symptoms, or abd pain n/v. He had not traveled anywhere recently. He works in [**Location (un) **] and lives with his family. . On the day of admission, he was taking the bus when he was found to be mumbling and not making sense, repeatedly stating his wife's name and telephone number. He was found to be 220/110 with HR 80s and blood sugar 575. On arrival to the [**Name (NI) **], Pts BP improved to the 140s-150s. Pt spiked a temp to 101. He was pan cultured. CT head neg. LP neg (elevated protein). Pt given 2g CTX and labetolol and started on insulin gtt for FSBG ibn 500s. Pt also with hyponatremia and renal failure. Despite a translator, he continued to repeat his name and wife's phone number. . In the unit, Insulin drip was continued. MRI of the head was done with no findings on preliminary report. MEDICAL HISTORY: HTN Hyperlipidemia MEDICATION ON ADMISSION: HCTZ 25mg daily Atenolol 25mg daily Simvatatin 40mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 99.0, 59, 121/76, 17, 96%ra Gen: awake and alert, creole speaking. states his name HEENT: EOMI, PERRL, anicteric sclera, MMM, OP clear. Poor dentition Neck: supple, no LAD Heart: RRR no m/r/g Lungs: CTAB no wheezes, rales, or crackles Abd: soft, NT/ND +BS no rebound or guarding Ext: warm, well perfused, no pitting edema Skin: no obvious rashes Neuro: awake and alert. Speaks in creole. States name. Fully responsive. CNII-XII intact. strength preserved in all extremities. gross sensation intact. No nystagmus ================================ Not significantly changed at time of discharge FAMILY HISTORY: Non-contributory SOCIAL HISTORY: married with 2 children. From [**Country **] originally. Works at garage. No smoking, EtOH, or recreational drugs

Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild),Other and unspecified hyperlipidemia,Other alteration of consciousness

Acute kidney failure NOS,Hyposmolality,DMII renl nt st uncntrld,Hy kid NOS w cr kid I-IV,Chro kidney dis stage II,Hyperlipidemia NEC/NOS,Other alter consciousnes

Admission Date: [**2194-3-21**] Discharge Date: [**2194-3-25**] Date of Birth: [**2121-11-4**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1253**] Chief Complaint: new onset diabetes, confusion Major Surgical or Invasive Procedure: none History of Present Illness: Pt is a 72 yo M with HTN, hyperlipidemia, who presents with altered mental status. According to his son, he has not been feeling very well over the last week; he later recalled that his father had been polyuric, polydipsic. There were no no obvious fever, chills, HA, cardiopulmonary symptoms, or abd pain n/v. He had not traveled anywhere recently. He works in [**Location (un) **] and lives with his family. . On the day of admission, he was taking the bus when he was found to be mumbling and not making sense, repeatedly stating his wife's name and telephone number. He was found to be 220/110 with HR 80s and blood sugar 575. On arrival to the [**Name (NI) **], Pts BP improved to the 140s-150s. Pt spiked a temp to 101. He was pan cultured. CT head neg. LP neg (elevated protein). Pt given 2g CTX and labetolol and started on insulin gtt for FSBG ibn 500s. Pt also with hyponatremia and renal failure. Despite a translator, he continued to repeat his name and wife's phone number. . In the unit, Insulin drip was continued. MRI of the head was done with no findings on preliminary report. Past Medical History: HTN Hyperlipidemia Social History: married with 2 children. From [**Country **] originally. Works at garage. No smoking, EtOH, or recreational drugs Family History: Non-contributory Physical Exam: VS: 99.0, 59, 121/76, 17, 96%ra Gen: awake and alert, creole speaking. states his name HEENT: EOMI, PERRL, anicteric sclera, MMM, OP clear. Poor dentition Neck: supple, no LAD Heart: RRR no m/r/g Lungs: CTAB no wheezes, rales, or crackles Abd: soft, NT/ND +BS no rebound or guarding Ext: warm, well perfused, no pitting edema Skin: no obvious rashes Neuro: awake and alert. Speaks in creole. States name. Fully responsive. CNII-XII intact. strength preserved in all extremities. gross sensation intact. No nystagmus ================================ Not significantly changed at time of discharge Pertinent Results: admission: . [**2194-3-21**] 05:43PM BLOOD WBC-5.4 RBC-5.76 Hgb-16.2 Hct-50.0 MCV-87 MCH-28.1 MCHC-32.4 RDW-13.8 Plt Ct-230 [**2194-3-21**] 05:43PM BLOOD PT-13.9* PTT-24.0 INR(PT)-1.2* [**2194-3-21**] 05:43PM BLOOD Fibrino-448* [**2194-3-21**] 08:00PM BLOOD Glucose-549* UreaN-20 Creat-1.6* Na-127* K-4.3 Cl-89* HCO3-23 AnGap-19 [**2194-3-22**] 04:03AM BLOOD ALT-20 AST-21 LD(LDH)-254* CK(CPK)-331* AlkPhos-121* TotBili-0.5 [**2194-3-22**] 04:03AM BLOOD CK-MB-7 cTropnT-<0.01 [**2194-3-22**] 03:12PM BLOOD CK-MB-6 cTropnT-<0.01 [**2194-3-22**] 04:03AM BLOOD Calcium-10.1 Phos-3.9 Mg-1.9 [**2194-3-21**] 05:43PM BLOOD Lipase-29 [**2194-3-22**] 04:03AM BLOOD VitB12-510 Folate-7.6 [**2194-3-22**] 09:29AM BLOOD %HbA1c-14.7* [**2194-3-22**] 04:03AM BLOOD TSH-0.56 [**2194-3-23**] 07:05AM BLOOD Cortsol-2.8 [**2194-3-21**] 05:53PM BLOOD Glucose-GREATER TH Lactate-2.3* Na-130* K-4.3 Cl-87* calHCO3-24 . MRI/MRA: No significant abnormalities on MRA of the head . NCHCT: Chronic small vessel ischemic changes without intracranial hemorrhage or edema. . discharge: [**2194-3-25**] 06:35AM BLOOD WBC-5.2 RBC-5.16 Hgb-14.7 Hct-43.7 MCV-85 MCH-28.4 MCHC-33.6 RDW-13.9 Plt Ct-241 [**2194-3-25**] 06:35AM BLOOD Glucose-100 UreaN-23* Creat-1.3* Na-138 K-4.2 Cl-101 HCO3-29 AnGap-12 Brief Hospital Course: 72 yo M with HTN, hyperlipidemia, who presents with altered mental status, hyperglycemia, and hyponatremia. Initially managed with insulin drip in the MICU. Presentation c/w new-onset DM. Discharged on Lantus 20mg qam and a QID sliding scale with close follow-up scheduled at the [**Hospital **] clinic. . NEW ONSET DMII: Presentation c/w new-onset DMII. Good BS control on the day of discharge with a weight-based regimen (50% long acting, 50% SSI). We have had difficulty with insulin teaching [**1-6**] language barrier & poor vision. Pt's daughter was also taught and [**Name (NI) 269**] was provided for further teaching. - Lantus 20 daily + SSI ([**7-26**] with meals & [**1-12**] qhs) - consider initiating oral hypoglycemics in outpt setting - follow-up arranged within 2 days of discharge at [**Last Name (un) **] - lisinopril 5mg daily started - A1C= 14 . Altered Mental Status: Unclear etiology. Pt fully alert and oriented now, but was initially confused while in the MICU. No focal signs to suggest stroke, and head CT/MRI/MRA unremarkable. He did have a low-grade fever in ED. LP unremarkable. No growth on urine or blood cultures. CXR unremarkable. [**Month (only) 116**] have been HHS vs/ DKA given high glucose and initial ketones. Was very HTNive initially, raising concern for hypertensive encephalopathy. Hyponatremia mostly pseudohyponatremia which soon resolved. Initial Tox screen negative. No obvious offenders on home medication list. - TSH, B12, folate all normal; RPR negative - at the time of d/c, family said he was at his baseline mental status . HTN: Came in extremely HTNive, but this largely resolved and BP in the 140-150/80 range. Cont HCTZ, metoprolol. Added lisinopril. . Renal Failure NOS: Unclear baseline. U/A negative for protein. No obvious infection. Cr= 1.3 at the time of d/c. . --FOLLOW UP: Appointments made for pt at [**Last Name (un) **] w/in two days of d/c. Message left for PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1355**] at [**Hospital 8**] Hospital. Medications on Admission: HCTZ 25mg daily Atenolol 25mg daily Simvatatin 40mg daily Discharge Medications: 1. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day. 2. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. 3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 4. FreeStyle Lite Strips Strip Sig: One (1) strip In [**Last Name (un) 5153**] four times a day. Disp:*1 month supply* Refills:*3* 5. Insulin Syringe 1 mL 28 X 1 Syringe Sig: One (1) syringe Miscellaneous four times a day. Disp:*1 month supply* Refills:*2* 6. Lantus 100 unit/mL Solution Sig: Twenty (20) units Subcutaneous once a day: at breakfast. Disp:*1 month supply* Refills:*2* 7. Humalog 100 unit/mL Solution Sig: 8-20 units Subcutaneous four times a day: as per sliding scale. Disp:*1 month supply* Refills:*2* 8. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: New Onset Diabetes Mellitus ============= Hypertension Hyperlipidemia Discharge Condition: Medically stable for discharge. Discharge Instructions: Dear Mr. [**Known lastname **], You were admitted directly to the Intensive Care Unit at [**Hospital1 18**] for confusion. You were diagnosed with Diabetes. We have started you on insulin and you and your family members have been taught how to administer it. It is very important that you take all of the insulin which you prescribe because you will become very ill if you do not do this. You will be provided with instructions for your insulin. None of your previous medications have been changed. You should continue to take them as you did previously. The only new medications you should take are insulin and lisinopril. Appointments have been made for you at the [**Hospital **] clinic (listed below). Please keep these appointments and try to attend with an english-speaking family member. Followup Instructions: The following appointment have been made for you at the [**Hospital **] Clinic: [**3-28**], 3pm with a Clinical Educator at the [**Hospital **] Clinic ([**Last Name (un) 19749**]) [**Telephone/Fax (1) 2384**]. You will then have an appointment immediately after with Dr. [**Last Name (STitle) 3617**]. Please call and make an appointment with your PCP within one week. Completed by:[**2194-3-25**]

584,276,250,403,585,272,780

{'Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild),Other and unspecified hyperlipidemia,Other alteration of consciousness'}

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: new onset diabetes, confusion PRESENT ILLNESS: Pt is a 72 yo M with HTN, hyperlipidemia, who presents with altered mental status. According to his son, he has not been feeling very well over the last week; he later recalled that his father had been polyuric, polydipsic. There were no no obvious fever, chills, HA, cardiopulmonary symptoms, or abd pain n/v. He had not traveled anywhere recently. He works in [**Location (un) **] and lives with his family. . On the day of admission, he was taking the bus when he was found to be mumbling and not making sense, repeatedly stating his wife's name and telephone number. He was found to be 220/110 with HR 80s and blood sugar 575. On arrival to the [**Name (NI) **], Pts BP improved to the 140s-150s. Pt spiked a temp to 101. He was pan cultured. CT head neg. LP neg (elevated protein). Pt given 2g CTX and labetolol and started on insulin gtt for FSBG ibn 500s. Pt also with hyponatremia and renal failure. Despite a translator, he continued to repeat his name and wife's phone number. . In the unit, Insulin drip was continued. MRI of the head was done with no findings on preliminary report. MEDICAL HISTORY: HTN Hyperlipidemia MEDICATION ON ADMISSION: HCTZ 25mg daily Atenolol 25mg daily Simvatatin 40mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: 99.0, 59, 121/76, 17, 96%ra Gen: awake and alert, creole speaking. states his name HEENT: EOMI, PERRL, anicteric sclera, MMM, OP clear. Poor dentition Neck: supple, no LAD Heart: RRR no m/r/g Lungs: CTAB no wheezes, rales, or crackles Abd: soft, NT/ND +BS no rebound or guarding Ext: warm, well perfused, no pitting edema Skin: no obvious rashes Neuro: awake and alert. Speaks in creole. States name. Fully responsive. CNII-XII intact. strength preserved in all extremities. gross sensation intact. No nystagmus ================================ Not significantly changed at time of discharge FAMILY HISTORY: Non-contributory SOCIAL HISTORY: married with 2 children. From [**Country **] originally. Works at garage. No smoking, EtOH, or recreational drugs ### Response: {'Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage II (mild),Other and unspecified hyperlipidemia,Other alteration of consciousness'}

CHIEF COMPLAINT: Vocal hoarseness and dysphagia. PRESENT ILLNESS: Mr. [**Known lastname 107587**] is an 84-year-old man with hoarseness and left vocal cord paralysis. Chest x- ray revealed a mediastinal mass. A CT showed density at the aortic arch just distal to the left subclavian consistent with a thoracic aneurysm. He had a catheterization done in [**2177-5-10**] that showed an EF of 60%, a 40% LAD, 95% RCA ostial and 60% distal. Aortogram showed an irregular arch with an aneurysm which was not well seen. MEDICAL HISTORY: Significant for hypertension, depression, syncope, vocal hoarseness with left cord paralysis, and sinus surgery. MEDICATION ON ADMISSION: ALLERGIES: He is intolerant to indapamide and atenolol. PHYSICAL EXAM: Pulse is 54, blood pressure is 165/79, respiratory rate 20. Height is 5 feet, 8 inches, weight is 122 pounds. General: Is in no acute distress. Skin is scattered excoriated areas in the right leg and foot. HEENT is unremarkable. Neck is supple. Chest is clear to auscultation bilaterally. Heart is regular rate and rhythm without murmur. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities are warm and well perfused with no edema, no varicosities. Neuro is grossly intact on focal exam. Pulses: Femoral 2+ bilaterally, dorsalis pedis and posterior tibial 1+ bilaterally, and radial is 2+ bilaterally. No carotid bruits. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Tobacco: Quit at age 50. Smoked for 20 years prior to that. Lives alone. No heavy alcohol use.

Thoracic aneurysm without mention of rupture,Mechanical complication of other vascular device, implant, and graft,Acute pericarditis, unspecified,Cardiac arrest,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Pneumonia due to Pseudomonas,Unilateral paralysis of vocal cords or larynx, partial,Coronary atherosclerosis of native coronary artery,Other specified congenital anomalies of heart,Infection with microorganisms resistant to penicillins

Thoracic aortic aneurysm,Malfunc vasc device/graf,Acute pericarditis NOS,Cardiac arrest,Ac posthemorrhag anemia,Hemorrhage complic proc,Ac kidny fail, tubr necr,Pseudomonal pneumonia,Vocal paral unilat part,Crnry athrscl natve vssl,Cong heart anomaly NEC,Inf mcrg rstn pncllins

Unit No: [**Numeric Identifier 107586**] Admission Date: [**2177-6-24**] Discharge Date: [**2177-8-4**] Sex: M Service: CSU CHIEF COMPLAINT: Vocal hoarseness and dysphagia. HISTORY OF PRESENT ILLNESS: Mr. [**Known lastname 107587**] is an 84-year-old man with hoarseness and left vocal cord paralysis. Chest x- ray revealed a mediastinal mass. A CT showed density at the aortic arch just distal to the left subclavian consistent with a thoracic aneurysm. He had a catheterization done in [**2177-5-10**] that showed an EF of 60%, a 40% LAD, 95% RCA ostial and 60% distal. Aortogram showed an irregular arch with an aneurysm which was not well seen. PAST MEDICAL HISTORY: Significant for hypertension, depression, syncope, vocal hoarseness with left cord paralysis, and sinus surgery. MEDICATIONS AT HOME: Hydrochlorothiazide 25 daily, enalapril 20 daily. ALLERGIES: He is intolerant to indapamide and atenolol. FAMILY HISTORY: Noncontributory. OCCUPATION: Retired small engine mechanic. SOCIAL HISTORY: Tobacco: Quit at age 50. Smoked for 20 years prior to that. Lives alone. No heavy alcohol use. PHYSICAL EXAM: Pulse is 54, blood pressure is 165/79, respiratory rate 20. Height is 5 feet, 8 inches, weight is 122 pounds. General: Is in no acute distress. Skin is scattered excoriated areas in the right leg and foot. HEENT is unremarkable. Neck is supple. Chest is clear to auscultation bilaterally. Heart is regular rate and rhythm without murmur. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities are warm and well perfused with no edema, no varicosities. Neuro is grossly intact on focal exam. Pulses: Femoral 2+ bilaterally, dorsalis pedis and posterior tibial 1+ bilaterally, and radial is 2+ bilaterally. No carotid bruits. LABS: White count 8.8, hematocrit 41.9, platelets 339. INR is 1.0. Sodium 135, potassium 4.8, chloride 97, CO2 25, BUN 20, creatinine 1.1. AST 22, alkaline phosphatase 68, total bilirubin 1, albumin 3.8. EKG is sinus rhythm at a rate of 61 with LVH. Chest x-ray: With a known thoracic aneurysm, no CHF. UA is negative. Echocardiogram showed a normal EF with 1+ AR, no MR, 1+ TR, aortic root that was mildly dilated, ascending aorta that is also mildly dilated with [**Doctor First Name **] PA pressures, no pericardial effusion. Carotid studies showed less than 40% stenosis on the right and less than 40% stenosis on the left with antegrade flow in both vertebrals. HOSPITAL COURSE: Patient was a direct admission to the operating room on [**6-24**] where he underwent an aortic-to- innominate bypass with a 12 mm Dacron graft, a TAG stent placed across the aortic arch, and a coronary artery bypass with saphenous vein graft to the LAD. The bypass time was 99 minutes with a crossclamp time of 66 minutes. Patient tolerated the procedure and was transferred from the operating room to the cardiothoracic intensive care unit with a mean arterial pressure of 82 in a sinus rhythm at 88 beats per minute. At that time, he was on Neo-Synephrine and propofol infusion. He also had a lumbar drain placed that was kept at the time of transfer. Patient did well in the immediate postoperative period. He remained hemodynamically stable throughout the day of surgery, but did remain sedated throughout that 1st operative day. On the morning of postoperative day 1, the patient continued to be hemodynamically stable. His sedation was discontinued, and he was weaned from the ventilator, unsuccessfully extubated. Additionally, the patient's lumbar drain was also removed. Throughout the day the patient was noted to have frequent periods of atrial fibrillation which required continued Neo- Synephrine drip to maintain adequate blood pressure. Patient remained hemodynamically stable on postoperative day 2; although, did continue to require Neo-Synephrine for his blood pressure. He had a bedside swallow evaluation on bed 2 and failed; and therefore, was kept NPO at that time. Additionally, the patient's chest tubes were removed on postoperative day 2. On day 3, the patient was hemodynamically stable. By then, he had weaned off his Neo-Synephrine drip. He remained in sinus rhythm, and he was transferred from the ICU to the cardiac stepdown floor for continuing postoperative care and cardiac rehabilitation. It should be noted that the patient was placed on amiodarone for his intermittent episodes of atrial fibrillation. Over the next several days, the patient did well. His activity level was increased with the assistance of the nursing staff. Patient did well once on the floor. It was noted on postoperative day 5 that the patient had an edematous left upper arm. He had a duplex scan that showed a DVT and therefore, he was begun on heparin as well as Coumadin at that time. On postoperative day 7, the patient complained of acute onset chest pain as well as tachypnea and diaphoresis with associated hypotension. His physical exam at the time was unremarkable. He was given a liter of saline which helped to improve his blood pressure. Cardiology consult was obtained at that time. An echocardiogram done showed a lateral hypokinesis with a pericardial effusion. He, additionally, had some lateral EKG changes. He was brought to the catheterization lab, where a cardiac catheterization showed that his coronaries were all patent and his pericardial effusion was drained following which he was transferred to the cardiothoracic ICU for continued monitoring. During the night of postoperative day 7, the patient went into a cardiac arrest with a rhythm that was PEA. He was intubated and resuscitated with multiple shocks ultimately ending up on dobutamine, epinephrine, and Neo-Synephrine. The following morning the patient was brought to CAT scan, where it was discovered that the patient had a leak at the anastomosis of his aortic-to-innominate bypass graft, and he was brought emergently to the operating room where he underwent a mediastinal exploration and repair of the proximal aortic-to-innominate anastomosis as well as evacuation of right and left pleural hematomas. He tolerated this well and was transferred from the operating room to the cardiothoracic intensive care unit. At the time of transfer, he was on Neo-Synephrine at 0.3, dobutamine at 5 mcg per kilogram per minute, and propofol at 30 mcg per kilogram per minute with a heart rate of 62, sinus rhythm and a mean arterial pressure of 54. Patient remained hemodynamically stable throughout that surgical day. On postoperative day 1, he continued to be hemodynamically stable. His dobutamine wean was begun. His propofol was weaned to off. The ventilator was weaned, and the patient was successfully extubated. Patient did go back into atrial fibrillation during the course of postoperative day 1 from his 2nd surgery. On day 2, he was begun to be diuresed. Over the next several days, the patient struggled from a pulmonary standpoint working to bring up thick secretions and ultimately on postoperative days 13 and 5, he was reintubated for respiratory distress. It should be noted that following the patient's 2nd surgery, he also had worsening renal function with a creatinine that got as high as 2.7 and a BUN in the 70s. The renal service was consulted. Patient was gently hydrated and ultimately diuresed. Additionally, he was treated for a Pseudomonas pneumonia at that time. By postoperative days 17 and 9, it was felt that the patient may be able to be weaned again from the ventilator which was therefore weaned, and patient was again extubated on postoperative days 20 and 12. He, again, struggled from a pulmonary standpoint for several days. On postoperative days 22 and 14, the patient had a PEG placed. Again, for several days, the patient struggled from a pulmonary standpoint, but remained extubated. He did not tolerate his tube feeds during this period of time. On postoperative day 27, he was brought to the interventional radiology suite to have a Dobbhoff placed through his existing PEG to try to advance to a postpyloric tube. This maneuver failed and ultimately, his PEG was lost during the procedure following which he was brought emergently to the operating room where he underwent an exploratory laparotomy as well as an open G-J tube placement and an open tracheostomy. Patient tolerated the surgery well and was transferred from the operating room back to the cardiothoracic intensive care unit. The patient recovered from his open laparotomy and the G-J tube was attempted to be used. However, the patient, again, did not tolerate his tube feeds. Several days was spent waiting for the patient's bowel function to return. Was able to wean to tracheostomy collar during this period. After several days, nursing staff was noting that they were getting tube feeds back in the gastric residual. A KUB showed that the jejunostomy tube had recoiled and this was sitting in the stomach. Patient was, again, brought to interventional radiology where he had advancement of the jejunostomy tube back to a postpyloric position. Additionally on the [**6-28**], the patient underwent a thoracentesis for 1.2 liters of serosanguineous fluid. At this time, the patient is tolerating tube feeds at full strength, and he has weaned from the ventilator having gone on tracheostomy collar for greater than 24 hours; however, he continues to have ventilator backup in his room incase there is any need for pressure-support ventilation at night or during periods of respiratory distress. It is felt that the patient is ready and stable for transfer to a rehabilitation facility for continuing respiratory care as well as nutrition management. At the time of this dictation, the patient's physical exam is as follows: Temperature 98.7, heart rate 88 sinus rhythm, blood pressure 106/52, respiratory rate 22, O2 saturation 99% on 40% tracheostomy mask. Lab data: White count 16, hematocrit 32, platelets 99. Sodium 136, potassium 4.1, chloride 104, CO2 26, BUN 32, creatinine 1.2, glucose 147. ABG: pH 7.44, CO2 40, PO2 90. General: In no acute distress. Alert and responsive to voice. Chest is regular rate and rhythm. Lungs are coarse with bilateral rhonchi. Abdomen is soft, nontender with active bowel sounds and a G-J tube in place that is clean and dry. Extremities are warm. They are well perfused with 1+ lower extremity edema. Patient is to be discharged to rehabilitation. DISCHARGE DIAGNOSES: Aortic aneurysm status post endovascular stent with aortic-to-innominate bypass status post coronary artery bypass grafting x1 with a saphenous vein graft to the posterior descending artery, pericardial tamponade status post pericardial drain, status post re- exploration with repair of aortic-to-innominate anastomosis leak, respiratory failure status post tracheostomy, exploratory laparoscopy with an open gastrostomy-jejunostomy tube placement, hypertension, depression, and vocal cord paralysis. FO[**Last Name (STitle) 996**]P: Patient is to have followup with Dr. [**Last Name (Prefixes) **] 2 weeks after his discharge from rehabilitation. Follow up with Dr. [**Last Name (STitle) 1391**] in [**3-14**] weeks and follow up with Dr. [**Last Name (STitle) 35888**] 1 month following his discharge from rehabilitation. DISCHARGE MEDICATIONS: Heparin 5000 units subcutaneously t.i.d., Atrovent nebulizer q.4h. as needed, albuterol nebulizers q.4h. as needed, lansoprazole suspension 30 mg daily, ferrous gluconate 300 mg daily, ascorbic acid 500 mg b.i.d., cefepime 2 grams every 24 hours x3 weeks with the last dose being on [**8-21**], and Roxicet elixir 5 mL every 4-6 hours as needed for pain 1 b.i.d. Patient is currently tolerating tube feeds with ProBalance at 55 cc per hour. ACTIVITY: Restrictions for the next 6 weeks include 10 pound lifting limit. [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**] Dictated By:[**Last Name (NamePattern4) 1718**] MEDQUIST36 D: [**2177-8-4**] 12:48:57 T: [**2177-8-4**] 13:30:58 Job#: [**Job Number 107588**]

441,996,420,427,285,998,584,482,478,414,746,V090

{'Thoracic aneurysm without mention of rupture,Mechanical complication of other vascular device, implant, and graft,Acute pericarditis, unspecified,Cardiac arrest,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Pneumonia due to Pseudomonas,Unilateral paralysis of vocal cords or larynx, partial,Coronary atherosclerosis of native coronary artery,Other specified congenital anomalies of heart,Infection with microorganisms resistant to penicillins'}

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: Vocal hoarseness and dysphagia. PRESENT ILLNESS: Mr. [**Known lastname 107587**] is an 84-year-old man with hoarseness and left vocal cord paralysis. Chest x- ray revealed a mediastinal mass. A CT showed density at the aortic arch just distal to the left subclavian consistent with a thoracic aneurysm. He had a catheterization done in [**2177-5-10**] that showed an EF of 60%, a 40% LAD, 95% RCA ostial and 60% distal. Aortogram showed an irregular arch with an aneurysm which was not well seen. MEDICAL HISTORY: Significant for hypertension, depression, syncope, vocal hoarseness with left cord paralysis, and sinus surgery. MEDICATION ON ADMISSION: ALLERGIES: He is intolerant to indapamide and atenolol. PHYSICAL EXAM: Pulse is 54, blood pressure is 165/79, respiratory rate 20. Height is 5 feet, 8 inches, weight is 122 pounds. General: Is in no acute distress. Skin is scattered excoriated areas in the right leg and foot. HEENT is unremarkable. Neck is supple. Chest is clear to auscultation bilaterally. Heart is regular rate and rhythm without murmur. Abdomen is soft, nontender, nondistended with normoactive bowel sounds. Extremities are warm and well perfused with no edema, no varicosities. Neuro is grossly intact on focal exam. Pulses: Femoral 2+ bilaterally, dorsalis pedis and posterior tibial 1+ bilaterally, and radial is 2+ bilaterally. No carotid bruits. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Tobacco: Quit at age 50. Smoked for 20 years prior to that. Lives alone. No heavy alcohol use. ### Response: {'Thoracic aneurysm without mention of rupture,Mechanical complication of other vascular device, implant, and graft,Acute pericarditis, unspecified,Cardiac arrest,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Pneumonia due to Pseudomonas,Unilateral paralysis of vocal cords or larynx, partial,Coronary atherosclerosis of native coronary artery,Other specified congenital anomalies of heart,Infection with microorganisms resistant to penicillins'}

CHIEF COMPLAINT: Cellulitis/fever PRESENT ILLNESS: 38 yo with known hypertension/hyperlipidemia/Diabetes Mellitus presents with a 4 day history of cellulitis RLE, started cephalexin and bactrim the day prior to presentation without improvement. On the day of admission, the temperature increased to 101.4 at home and he called PCP who advised to go to ER. Temperature at ED: 101, wbc 24, creat 2.7 (baseline 1.7). Pan cultured, started iv vanco and unasyn, iv rehydration. u/s and xray of RLE prelim were negative. The patient was admitted after discussion with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. . ROS MEDICAL HISTORY: DIABETES TYPE 2 ([**First Name8 (NamePattern2) **] [**Last Name (un) **]; in [**Last Name **] problem list says type 1) HYPERCHOLESTEROLEMIA HYPERTENSION OBESITY ASTHMA; never been intubated TOBACCO ABUSE S/P APPY TO THE ER Chronic RENAL INSUFFICIENCY OTITIS Obesity MEDICATION ON ADMISSION: Bupropion 100" keflex, bactrim insulin NPH - 62u in AM, 52 in PM HCTZ 50' Cartia 180' Lisinopril 40' question other meds? ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T: 98.0 BP: 126/72 P: 86 RR: 22 O2 sats: 92RA FS: 181 Gen: NAD HEENT: NC/AT, EOMI Neck: supple, no [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]: RRR, no m/r/g Resp: CTAB Abd: obese, soft, NT/ND Ext: - RLE with areas of blanching erythema bordered with pen on anterior aspect. No erythema over posterior aspect. Warm and tender on palpation. Proximal leg with trace erythema/swelling. - LLE wnl. Neuro: grossly wnl Sensation: wnl Strength: [**2-22**] dorsi/plantar flexion of R foot; 5/5 strength on L Reflexes: 1+ b/l DTR FAMILY HISTORY: Diabetes SOCIAL HISTORY: He lives in [**Location 686**] with his wife, their 11 [**Name2 (NI) **] son and two step sons. Pt states he is a long-time smoker, but has quit several times in the past and does not see smoking as a problem for him. Occasional EtOH at parties, no IVDU.

Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Cellulitis and abscess of leg, except foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonia, organism unspecified,Hypoxemia,Obesity, unspecified,Asthma, unspecified type, unspecified,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Personal history of tobacco use,Long-term (current) use of insulin,Other dependence on machines, supplemental oxygen

Pulm embol/infarct NEC,Acute kidney failure NOS,Cellulitis of leg,Hyp kid NOS w cr kid V,Pneumonia, organism NOS,Hypoxemia,Obesity NOS,Asthma NOS,Obstructive sleep apnea,Pure hypercholesterolem,DMI wo cmp nt st uncntrl,History of tobacco use,Long-term use of insulin,Depend-supplement oxygen

Admission Date: [**2187-2-17**] Discharge Date: [**2187-2-25**] Date of Birth: [**2148-11-12**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2160**] Chief Complaint: Cellulitis/fever Major Surgical or Invasive Procedure: None History of Present Illness: 38 yo with known hypertension/hyperlipidemia/Diabetes Mellitus presents with a 4 day history of cellulitis RLE, started cephalexin and bactrim the day prior to presentation without improvement. On the day of admission, the temperature increased to 101.4 at home and he called PCP who advised to go to ER. Temperature at ED: 101, wbc 24, creat 2.7 (baseline 1.7). Pan cultured, started iv vanco and unasyn, iv rehydration. u/s and xray of RLE prelim were negative. The patient was admitted after discussion with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. . ROS Denied any precipitant of cellulitis; no falls/abrasion, trauma. No other complaints: No CP, SOB, palpitations. No GI/GU complaints. Past Medical History: DIABETES TYPE 2 ([**First Name8 (NamePattern2) **] [**Last Name (un) **]; in [**Last Name **] problem list says type 1) HYPERCHOLESTEROLEMIA HYPERTENSION OBESITY ASTHMA; never been intubated TOBACCO ABUSE S/P APPY TO THE ER Chronic RENAL INSUFFICIENCY OTITIS Obesity Social History: He lives in [**Location 686**] with his wife, their 11 [**Name2 (NI) **] son and two step sons. Pt states he is a long-time smoker, but has quit several times in the past and does not see smoking as a problem for him. Occasional EtOH at parties, no IVDU. Family History: Diabetes Physical Exam: T: 98.0 BP: 126/72 P: 86 RR: 22 O2 sats: 92RA FS: 181 Gen: NAD HEENT: NC/AT, EOMI Neck: supple, no [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]: RRR, no m/r/g Resp: CTAB Abd: obese, soft, NT/ND Ext: - RLE with areas of blanching erythema bordered with pen on anterior aspect. No erythema over posterior aspect. Warm and tender on palpation. Proximal leg with trace erythema/swelling. - LLE wnl. Neuro: grossly wnl Sensation: wnl Strength: [**2-22**] dorsi/plantar flexion of R foot; 5/5 strength on L Reflexes: 1+ b/l DTR Pertinent Results: [**2187-2-16**] 03:45PM BLOOD WBC-12.9* RBC-4.83 Hgb-13.1* Hct-38.9* MCV-81* MCH-27.1 MCHC-33.7 RDW-13.8 Plt Ct-308 [**2187-2-17**] 01:30PM BLOOD WBC-23.6*# RBC-4.48* Hgb-12.4* Hct-35.7* MCV-80* MCH-27.7 MCHC-34.8 RDW-14.5 Plt Ct-256 [**2187-2-18**] 06:55AM BLOOD WBC-15.9* RBC-4.04* Hgb-11.0* Hct-32.4* MCV-80* MCH-27.3 MCHC-34.1 RDW-14.5 Plt Ct-261 [**2187-2-19**] 07:35AM BLOOD WBC-15.8* RBC-4.00* Hgb-10.4* Hct-32.4* MCV-81* MCH-26.0* MCHC-32.1 RDW-14.4 Plt Ct-262 [**2187-2-17**] 01:30PM BLOOD Neuts-83.7* Lymphs-11.4* Monos-4.4 Eos-0.3 Baso-0.2 [**2187-2-19**] 01:05PM BLOOD PT-12.0 PTT-45.7* INR(PT)-1.0 [**2187-2-17**] 01:30PM BLOOD Glucose-186* UreaN-37* Creat-2.7* Na-135 K-4.1 Cl-96 HCO3-30 AnGap-13 [**2187-2-18**] 06:55AM BLOOD Glucose-172* UreaN-48* Creat-3.7* Na-136 K-4.1 Cl-97 HCO3-27 AnGap-16 [**2187-2-19**] 07:35AM BLOOD Glucose-133* UreaN-59* Creat-4.0* Na-137 K-4.3 Cl-100 HCO3-27 AnGap-14 [**2187-2-18**] 06:55AM BLOOD Calcium-8.3* Phos-4.3 Mg-1.9 Cholest-207* [**2187-2-19**] 07:35AM BLOOD calTIBC-225* VitB12-440 Ferritn-269 TRF-173* [**2187-2-18**] 06:55AM BLOOD Triglyc-201* HDL-42 CHOL/HD-4.9 LDLcalc-125 [**2187-2-19**] 07:35AM BLOOD Vanco-8.8* [**2187-2-19**] 03:59AM BLOOD Type-ART pO2-62* pCO2-56* pH-7.34* calTCO2-32* Base XS-2 Intubat-NOT INTUBA Comment-NON-REBREA [**2187-2-17**] 01:32PM BLOOD Lactate-1.1 - UNILAT LOWER EXT VEINS RIGHT [**2187-2-17**] 3:48 PM FINDINGS: Color Doppler son[**Name (NI) 1417**] of the right common femoral, superficial femoral, and popliteal veins were performed. There was normal flow, augmentation, and waveforms demonstrated. There was no intraluminal thrombus identified. Due to the patient body habitus, compression images of the common and superficial femoral arteries could not be obtained. IMPRESSION: No evidence of right lower extremity deep vein thrombosis. Somewhat limited study. - RADIOLOGY TIB/FIB (AP & LAT) RIGHT [**2187-2-17**] FINDINGS: There is a marked soft tissue edema and density, in the proximal right lower extremity. There is no gas noted in the subcutaneous tissue. There is no sign of fracture or dislocation or degenerative change. There is no underlying cortical reaction. There are no radiopaque foreign bodies. IMPRESSION: Marked density and edema of soft tissues of the proximal right lower extremity. Please note that absence of gas does not rule out necrotizing fasciitis. - RADIOLOGY CHEST (PA & LAT) [**2187-2-17**] PA AND LATERAL CHEST RADIOGRAPH: The lung volumes are low. Cardiomediastinal silhouette is unchanged. There is no evidence of central lymphadenopathy. Lungs are clear, with the exception of bibasilar atelectasis. There is no pleural effusion. Pulmonary vascularity is normal. IMPRESSION: No acute cardiopulmonary process - RADIOLOGY Final Report CHEST (PORTABLE AP) [**2187-2-18**] IMPRESSION: Stable appearance to the chest with no acute process seen. - RENAL U.S. [**2187-2-18**] FINDINGS: Study is very limited secondary to large body habitus. The left kidney measures 11.9 cm. The right kidney measures 10.7 cm. No hydronephrosis identified within the kidneys. No definite mass lesion or stones identified. IMPRESSION: Limited study secondary to increased body habitus. No hydronephrosis identified and no definite mass lesion or renal stones identified. - LUNG SCAN [**2187-2-19**] INTERPRETATION: Ventilation images obtained with Tc-[**Age over 90 **]m aerosol in 8 views demonstrate mild decrease in tracer uptake in the posterobasilar segment of the right lower lobe. Perfusion images in the same 8 views show a matched defect in the posterior right lower lobe. No other perfusion defects are identified. Chest x-ray shows an air space opacity in the right lower lobe corresponding to the area of matched tracer defect. IMPRESSION: Decreased perfusion and ventilation in the posterior right lower lobe corresponding to an infiltrate on CXR. These findings would be entirely compatible with air space disease, but in the face of CXR findings, the possibility of pulmonary embolism can not be fully excluded. No other segmental perfusion defects are present. - BILAT LOWER EXT VEINS [**2187-2-19**] BILATERAL LOWER EXTREMITY ULTRASOUND: Compared to DVT study of just two days prior. Grayscale and Doppler son[**Name (NI) 867**] were performed of the bilateral lower extremity veins including the greater saphenous, common femoral, superficial femoral, popliteal, and deep tibial veins. Venous structures demonstrate normal compression, flow, waveforms, and augmentation without intraluminal thrombus. Note is made of large right groin lymph nodes measuring up to 2.8 cm in long axis, demonstrating a benign-appearing fatty hila, likely reactive given history of cellulitis. IMPRESSION: 1) No evidence of DVT. 2) Right groin adenopathy, likely reactive. - CHEST (PORTABLE AP) [**2187-2-19**] PORTABLE AP CHEST RADIOGRAPH: There is a new area of faint opacity within the right lower lobe in comparison to the prior study. The cardiac and mediastinal contours are stable. The remainder of lungs are clear. There is no pulmonary vascular congestion. No pleural effusions or pneumothorax seen. IMPRESSION: New faint opacity in the right lower lobe may represent an area of aspiration and/or consolidation. LIVER OR GALLBLADDER US (SINGLE ORGAN) [**2187-2-24**] 3:52 PM LIVER OR GALLBLADDER US (SINGL; DUPLEX DOP ABD/PEL LIMITED Reason: evaluate for evidence of hepatitis, gallbladder disease, por [**Hospital 93**] MEDICAL CONDITION: 38 year old man with diabetes, hypercholesterolemia, HTN, CRI admitted for PE and ? cellulitis, now with elevated LFTs (new since [**2187-2-15**]). REASON FOR THIS EXAMINATION: evaluate for evidence of hepatitis, gallbladder disease, portal vein thrombosis INDICATION: Diabetes, chronic renal failure, and admitted for PE. Now with elevated LFTs. Evaluate for hepatitis, gallbladder disease, portal vein thrombosis. COMPARISON: [**2185-6-17**]. ABDOMINAL ULTRASOUND: The liver is diffusely echogenic consistent with fatty infiltration. No focal lesions are seen. The gallbladder is unremarkable with no stones or wall thickening. The common hepatic duct measures 4 mm. There is no intrahepatic biliary dilatation. The portal vein is patent with anterograde flow. There is no ascites. The pancreas was not well visualized due to overlying bowel gas. Limited views of the right kidney demonstrate no hydronephrosis. IMPRESSION: Echogenic liver consistent with fatty infiltration. Other forms of liver disease including significant fibrosis/cirrhosis cannot be excluded. Additionally, ultrasound is not very sensitive for detection of hepatitis. Please correlate clinically. TIB/FIB (AP & LAT) RIGHT [**2187-2-24**] 1:39 PM TIB/FIB (AP & LAT) RIGHT Reason: eval for evidence of osteomyelitis [**Hospital 93**] MEDICAL CONDITION: 38 year old diabetic male with cellulitis, pain on RLE (anterior shin). REASON FOR THIS EXAMINATION: eval for evidence of osteomyelitis EXAMINATION: Tibia and fibular, right. INDICATION: Diabetes. Pain. Possible osteomyelitis. Views of the right tibia and fibula show normal bony alignment with no acute bony injury. No plain film findings are seen to suggest osteomyelitis. No soft tissue gas or foreign material is visualized. There is mild soft tissues swelling anterior to the proximal tibia. IMPRESSION: No plain final film findings to suggest osteomyelitis. If this remains a clinical concern, then a nuclear medicine study or MRI would be more sensitive. Brief Hospital Course: # Cellulitis Pt was started on keflex and bactrim as an outpatient on the day prior to admission, but had called PCP because of fevers on day of admission. On arrival to [**Name (NI) **], pt had LENIs, R TIB/FIB XR, and CXR performed, which were all negative. He received vanco and unasyn in ED and continued on floor. Temperatures were monitored, and noted to spike despite antibiotics. Blood cultures were drawn for each spike. His wbc trended downwards from 26->15. Pt received dilaudid for pain control. Subsequently he was switched to a regimen of vancomycin, levofloxacin and flagyl. He was discharged on keflex x one week and asked to finish his course of levo and flagyl. # Hypoxia Pt had desaturated to the 66% on RA while sleeping on routine vital sign check on HD#2. Pt's lungs were clear, without wheeze/rales/crackles. Given his asthma hx, albuterol/atrovent nebs were provided. An EKG and CXR were also performed which showed no change from prior. His temperature was also elevated at the time, and thus another set of blood culture was sent. Blood cultures from [**2-19**] were again negative, and ASO negative as well. The patient then had an episode of shortness of breath early morning of HD#3. Pt was noted to be saturating at 76% on RA when he ambulated to the use the bathroom. Pt was placed on NC, and was 85%. Thus, was placed on NRB and saturating 93%. He was without CP, palpitations, or any other complaints. SOB was improved on NRB. His vitals at the time of incident was: 102.3 108 118/70 22. Another CXR and LENIs were ordered, which were negative, ABG was done: 7.34/56/62. Repeat EKG showed no acute changes. Moreover, his creatinine had increased up to 4.0. On exam, the patient's lungs had crackles, and thus lasix was given with renal consult. Pt had a V/Q scan performed and he was found to have decreased perfusion and ventilation in the posterior right lower lobe corresponding to an infiltrate on CXR. These findings would be entirely compatible with air space disease, but in the face of CXR findings, the possibility of pulmonary embolism could not be fully excluded. No other segmental perfusion defects were present. Pt remaind on NRB and was achieving low 90s. MICU consult was obtained, and the patient was transferred to the MICU for persistent hypoxia. Because the patient had remained relatively immobile with his cellulitis, clinical suspicion for PE warranted the initiation of anticoagulation with heparin bridge to coumadin. Heparin was d/c on [**2-23**]. Coumadin was initially given at 7.5 mg, then 5 mg, and he was discharged on 3 mg with instructions to see his PCP within [**Name Initial (PRE) **] day or two to address the need for continued anticoagulation. The patient was put on BIPAP for OSA in the ICU, and prior to discharge it was arranged that he would get a BIPAP machine that same day. He did not like the BIPAP but it was explained to him that he required it for sleep apnea. Prior to discharge, he ambulated on the floor and maintained his oxygen sats >95% at all times. . # Acute renal failure The patient has known chronic renal insufficiency with bsl creatinine of 1.7-2.1. On admission at [**Name (NI) **], pt's creatinine was elevated to 2.7. It was remeasured on the following day and showed an increase to 3.7. Urinary Na, creatinine, osm, protein, eos were measured, and results were suggestive of prerenal picture. Renal U/S was performed, which was a limited study secondary to increased body habitus, but no hydronephrosis identified and no definite mass lesion or renal stones identified. IVF was started overnight of HD#2. Renal consult was obtained. Recommendations included: Holding ACE-I, continuing to Vanco dose was obtained was 8.8. Vancomycin was continued until the day of discharge, at which time he was put on Keflex for one week. # DIABETES TYPE II, followed at [**Last Name (un) **], the patient's sugars were well controlled on sliding scale insulin. . # HYPERCHOLESTEROLEMIA - Stable; Pt was continue on Lipitor. Fasting lipids were drawn which were reasonable. . # HYPERTENSION - Stable; Pt was initiated on HCTZ, Cardia, Lisinopril. Lisinopril was later held. . # TOBACCO ABUSE - offer nicotine patch prn . #. # FEN: The patient was maintained on a regular - diabetic diet. . # PPX: SC hep . # CODE: FC Medications on Admission: Bupropion 100" keflex, bactrim insulin NPH - 62u in AM, 52 in PM HCTZ 50' Cartia 180' Lisinopril 40' question other meds? Discharge Medications: 1. Bupropion 100 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO BID (2 times a day). 2. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO DAILY (Daily). 3. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 5 days: Last doses on [**3-1**]. Disp:*14 Tablet(s)* Refills:*0* 4. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 4 days: Last dose 4/12. Disp:*4 Tablet(s)* Refills:*0* 7. Coumadin 3 mg Tablet Sig: Three (3) Tablet PO at bedtime: Please take 3 mg daily, follow-up with your PCP on [**Month/Year (2) 3816**] for dose adjustment. . Disp:*5 Tablet(s)* Refills:*0* 8. Keflex 500 mg Tablet Sig: One (1) Tablet PO every six (6) hours for 7 days: Last doses on [**2187-3-3**]. Disp:*28 Tablet(s)* Refills:*0* 9. Please continue to take insulin as you were prior to admission Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Acute respiratory failure - Possible Pulmonary Embolism/ pneumonia Right Lower Extremity Cellulitis Acute on Chronic Renal Failure Secondary Diagnosis: DM type II Hypercholesterolemia Hypertension Obesity Asthma Discharge Condition: Good. Ambulatory and no need for oxygen. Discharge Instructions: You were in the hospital for an infection in your right leg. We also were unable to exclude a blood clot in your lungs, and are treating you for this condition. You were given medicine to make your blood thinner and antibiotics. It is ESSENTIAL that you see your doctor [**First Name (Titles) **] [**Last Name (Titles) 3816**] [**2-27**] at the latest as your blood can get too thin and not thin enough and this can cause very serious health problems. You need to complete the course of antibiotics as prescribed. Flagyl and Levofloxacin until [**3-1**], and Keflex until [**3-4**]. You need to use a CPAP machine at home for your obstructive sleep apnea (breathing problems at home). You also need to discuss this problem with your PCP during your next visit. Please note that we have stopped hydrochlorothiazide, and started a new blood pressure medication called Metoprolol. Please take it as prescribed. Please note that we have also stopped Lisinopril. Please discuss this with your PCP when you see him on [**Month/Year (2) 3816**]. Followup Instructions: With Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5377**], MD Phone:[**Telephone/Fax (1) 250**]. Please call and schedule an appointment with him for Monday or [**Telephone/Fax (1) 3816**] ([**2-27**]) at the latest. Should he not be available, please schedule an appointment with a different provider in the clinic (episodic), but it is ESSENTIAL that you be seen within the next two days.

415,584,682,403,486,799,278,493,327,272,250,V158,V586,V462

{'Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Cellulitis and abscess of leg, except foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonia, organism unspecified,Hypoxemia,Obesity, unspecified,Asthma, unspecified type, unspecified,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Personal history of tobacco use,Long-term (current) use of insulin,Other dependence on machines, supplemental oxygen'}

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: Cellulitis/fever PRESENT ILLNESS: 38 yo with known hypertension/hyperlipidemia/Diabetes Mellitus presents with a 4 day history of cellulitis RLE, started cephalexin and bactrim the day prior to presentation without improvement. On the day of admission, the temperature increased to 101.4 at home and he called PCP who advised to go to ER. Temperature at ED: 101, wbc 24, creat 2.7 (baseline 1.7). Pan cultured, started iv vanco and unasyn, iv rehydration. u/s and xray of RLE prelim were negative. The patient was admitted after discussion with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. . ROS MEDICAL HISTORY: DIABETES TYPE 2 ([**First Name8 (NamePattern2) **] [**Last Name (un) **]; in [**Last Name **] problem list says type 1) HYPERCHOLESTEROLEMIA HYPERTENSION OBESITY ASTHMA; never been intubated TOBACCO ABUSE S/P APPY TO THE ER Chronic RENAL INSUFFICIENCY OTITIS Obesity MEDICATION ON ADMISSION: Bupropion 100" keflex, bactrim insulin NPH - 62u in AM, 52 in PM HCTZ 50' Cartia 180' Lisinopril 40' question other meds? ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T: 98.0 BP: 126/72 P: 86 RR: 22 O2 sats: 92RA FS: 181 Gen: NAD HEENT: NC/AT, EOMI Neck: supple, no [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]: RRR, no m/r/g Resp: CTAB Abd: obese, soft, NT/ND Ext: - RLE with areas of blanching erythema bordered with pen on anterior aspect. No erythema over posterior aspect. Warm and tender on palpation. Proximal leg with trace erythema/swelling. - LLE wnl. Neuro: grossly wnl Sensation: wnl Strength: [**2-22**] dorsi/plantar flexion of R foot; 5/5 strength on L Reflexes: 1+ b/l DTR FAMILY HISTORY: Diabetes SOCIAL HISTORY: He lives in [**Location 686**] with his wife, their 11 [**Name2 (NI) **] son and two step sons. Pt states he is a long-time smoker, but has quit several times in the past and does not see smoking as a problem for him. Occasional EtOH at parties, no IVDU. ### Response: {'Other pulmonary embolism and infarction,Acute kidney failure, unspecified,Cellulitis and abscess of leg, except foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonia, organism unspecified,Hypoxemia,Obesity, unspecified,Asthma, unspecified type, unspecified,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Personal history of tobacco use,Long-term (current) use of insulin,Other dependence on machines, supplemental oxygen'}

CHIEF COMPLAINT: Fatigue, weakness. PRESENT ILLNESS: The pt. is a 57 year-old female with a h/o "borderline" DM and HTN who presented to ED c/o fatigue and weakness. The pt. was in her USOH until 3 days PTA when she developed fatigue, weakness, dry mouth, sore throat and blurred vision. These symptoms, particularly the blurred vision and fatigue worsened 2 days PTA and the pt. began to develop difficulty ambulating. Throughout the course of her illness, she denied lightheadedness, vertigo, numbness or tingling in extremities, fevers or chills, cough, shortness of breath, chest pain, nausea or vomiting, diarrhea, or abdominal pain. She also denied dysuria but c/o urinary frequency and increased thirst. She called her PCP on the day of admission who advised her to go to the ED for evaluation. In the ED, she was discovered to have a serum glucose of 1290 and an anion gap of 19 with positive urine ketones (minimal). She was subsequently admitted to the MICU for treatment of suspected hyperosmolar non-ketotic coma. MEDICAL HISTORY: HTN, S/p TAH/BSO [**4-/2158**] for fibroids, borderline DM (HbA1C 6.5% 9/03), L shoulder impingement s/p athroscopic capsular release, knee pain, back pain, gallstones MEDICATION ON ADMISSION: -metoprolol XL 50mg once daily -tylenol #3 1 tablet q6hours prn pain -naprosyn 500mg po once daily -estrogen 0.625mg po once daily -HCTZ 25mg po once daily ALLERGIES: Penicillins PHYSICAL EXAM: Vitals: T: 97.5F BP: 154/75 P: 77 R: 18 SaO2: 98% General: appears fatigued, in NAD HEENT: PERRL, EOMI, dry mucous membranes, white plaques noted on bilateral buccal mucosa, erythematous oropharynx, no sinus tenderness, no hemorrhages or exudates appreciated on fundoscopic exam. Neck: supple, FROM Lungs: CTA B Cardiac: RRR, nl. S1S2, no m/r/g noted Abdomen: soft, NT/ND, nl. bowel sounds Extremeties: no edema noted. FAMILY HISTORY: Remarkable for diabetes mellitus in her father and son. SOCIAL HISTORY: The pt. lives in [**Location 686**] with her daughter. She is on disability. She denied use of tobacco, EtOH or IV drugs.

Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Candidiasis of mouth,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Unspecified essential hypertension

DMII hprosmlr uncontrold,Thrush,Acute kidney failure NOS,Urin tract infection NOS,Hypertension NOS

Admission Date: [**2165-7-2**] Discharge Date: [**2165-7-10**] Date of Birth: [**2107-12-1**] Sex: F Service: MED Allergies: Penicillins Attending:[**First Name3 (LF) 2181**] Chief Complaint: Fatigue, weakness. Major Surgical or Invasive Procedure: None. History of Present Illness: The pt. is a 57 year-old female with a h/o "borderline" DM and HTN who presented to ED c/o fatigue and weakness. The pt. was in her USOH until 3 days PTA when she developed fatigue, weakness, dry mouth, sore throat and blurred vision. These symptoms, particularly the blurred vision and fatigue worsened 2 days PTA and the pt. began to develop difficulty ambulating. Throughout the course of her illness, she denied lightheadedness, vertigo, numbness or tingling in extremities, fevers or chills, cough, shortness of breath, chest pain, nausea or vomiting, diarrhea, or abdominal pain. She also denied dysuria but c/o urinary frequency and increased thirst. She called her PCP on the day of admission who advised her to go to the ED for evaluation. In the ED, she was discovered to have a serum glucose of 1290 and an anion gap of 19 with positive urine ketones (minimal). She was subsequently admitted to the MICU for treatment of suspected hyperosmolar non-ketotic coma. Past Medical History: HTN, S/p TAH/BSO [**4-/2158**] for fibroids, borderline DM (HbA1C 6.5% 9/03), L shoulder impingement s/p athroscopic capsular release, knee pain, back pain, gallstones Social History: The pt. lives in [**Location 686**] with her daughter. She is on disability. She denied use of tobacco, EtOH or IV drugs. Family History: Remarkable for diabetes mellitus in her father and son. Physical Exam: Vitals: T: 97.5F BP: 154/75 P: 77 R: 18 SaO2: 98% General: appears fatigued, in NAD HEENT: PERRL, EOMI, dry mucous membranes, white plaques noted on bilateral buccal mucosa, erythematous oropharynx, no sinus tenderness, no hemorrhages or exudates appreciated on fundoscopic exam. Neck: supple, FROM Lungs: CTA B Cardiac: RRR, nl. S1S2, no m/r/g noted Abdomen: soft, NT/ND, nl. bowel sounds Extremeties: no edema noted. Pertinent Results: [**2165-7-2**] 11:52PM GLUCOSE-864* [**2165-7-2**] 10:21PM GLUCOSE-1079* NA+-120* K+-5.3 CL--82* TCO2-23 [**2165-7-2**] 10:15PM UREA N-47* CREAT-1.8* [**2165-7-2**] 10:15PM OSMOLAL-346* [**2165-7-2**] 09:24PM GLUCOSE-1282* [**2165-7-2**] 09:04PM URINE HOURS-RANDOM [**2165-7-2**] 09:04PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-1000 KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2165-7-2**] 08:47PM GLUCOSE-1290* UREA N-50* CREAT-2.0* SODIUM-110* POTASSIUM-5.7* CHLORIDE-70* TOTAL CO2-21* ANION GAP-25* [**2165-7-2**] 08:47PM ACETONE-LARGE [**2165-7-2**] 08:47PM WBC-11.3* RBC-3.96* HGB-12.1 HCT-38.2 MCV-97# MCH-30.7 MCHC-31.8 RDW-12.1 [**2165-7-2**] 08:47PM NEUTS-78.8* LYMPHS-16.4* MONOS-3.7 EOS-0.8 BASOS-0.3 Brief Hospital Course: 1. Hyperosmolar nonketotic coma/DM: The etiology of the presentation was unclear with no obvious precipitant such as infection or ischemia. The pt. was admitted to the MICU on presentation. She was started on insulin gtt and aggressively hydrated. Her hyperglycemia began to resolve quickly and she was transitioned to insulin sliding scale and Lantus on the second hospital day. Insulin drip was completely discontinued by the second hospital day. [**Last Name (un) **] diabetes service consult was obtained and followed the patient, making adjustments to her insulin regimen. They had opined that the pt. may suffer from the Flatbush variant of diabetes mellitus. She was transferred to the floor on hospital day number 5. There her fingerstick glucose levels were noted to be in acceptable ranges on 70 units of glargine in the evenings and insulin sliding scale. The pt. was counselled as to the need to continue to check her fingerstick glucose levels and administer insulin to herself upon discharge. She was noted by the nursing staff to be competent as obtaining her fingersticks and administering subcutaneous insulin. The pt. did complain of blurred vision upon presentation which resolved somewhat over the course of her hospitalization. She was advised to follow up with [**Last Name (un) **] ophthalmology as an outpatient. 2. HTN: The patient's blood pressure was noted to be stable for the duration of her hospital stay. HCTZ was discontinued on admission as this drug is known to cause hyperglycemia. She was maintained on lisinopril and metoprolol XL with good effect. She was discharged on these medications. 3. ARF: The pt. was noted to have a creatinine of 2.0 on admission. This quickly resolved with the administration of IV fluids. Her creatinine remained stable for the remaineder of her hospitalization. 4. Oral thrush: This was treated with nystatin oral suspension and sore throat was treated with cepacol lozenges. Upon dishcarge, the oral thrush was noted to be improved and she was continued on nystatin. 5. UTI: The pt. was discovered to have a possible UTI on U/A on hospital day #5. She was given a three day course of bactrim DS. She remained asymptomatic for the duration of the course of treatment. Medications on Admission: -metoprolol XL 50mg once daily -tylenol #3 1 tablet q6hours prn pain -naprosyn 500mg po once daily -estrogen 0.625mg po once daily -HCTZ 25mg po once daily Discharge Medications: 1. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day) as needed for 7 days. Disp:*150 ML(s)* Refills:*0* 2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a day). Disp:*30 Tablet(s)* Refills:*2* 3. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig: Two (2) Tablet Sustained Release 24HR PO QD (once a day). Disp:*60 Tablet Sustained Release 24HR(s)* Refills:*2* 4. Insulin Glargine 100 unit/mL Solution Sig: Seventy (70) Units Subcutaneous at bedtime: please only take 70 units. Disp:*qs Units* Refills:*3* 5. Insulin Syringe-Needle U-100 Syringe Sig: One (1) Miscell. once a day. Disp:*30 * Refills:*2* 6. Insulin Lispro (Human) 100 unit/mL Solution Sig: per sliding scale Subcutaneous four times a day: per sliding scale. Disp:*qs * Refills:*2* 7. Insulin Admin Suppl. w/Lancets Misc Sig: Four (4) Miscell. once a day: use as needed for daily fingersticks. Disp:*100 * Refills:*2* Discharge Disposition: Home Discharge Diagnosis: 1. Diabetes mellitus 2. HTN 3. ARF, resolved 4. Oral thrush Discharge Condition: Stable, blood sugars 135-228 for 24 hrs prior to d/c (but overall much better controlled over hospitalization) Discharge Instructions: Please take your insulin as prescribed. You will have to check your blood sugars very carefully at least 4 times per day. Please keep a log of your morning, lunch, dinner and nightime sugars and if possible, what types of food you ate and exercise. If you are urinating very frequently, feel lightheaded, dizzy, sweaty, have chest pain, have a headache or feel as though you are going to pass out, please call your doctor (Dr.[**Last Name (STitle) 2450**]) or call 911 to come to the hospital. Followup Instructions: 1. Please follow-up with your PCP [**Last Name (NamePattern4) **].[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2450**]. You have an appointment on [**2165-7-15**]. 2. Please schedule an appointment with [**Last Name (un) **] ophthalmology.

250,112,584,599,401

{'Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Candidiasis of mouth,Acute kidney failure, unspecified,Urinary tract infection, site not specified,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: Fatigue, weakness. PRESENT ILLNESS: The pt. is a 57 year-old female with a h/o "borderline" DM and HTN who presented to ED c/o fatigue and weakness. The pt. was in her USOH until 3 days PTA when she developed fatigue, weakness, dry mouth, sore throat and blurred vision. These symptoms, particularly the blurred vision and fatigue worsened 2 days PTA and the pt. began to develop difficulty ambulating. Throughout the course of her illness, she denied lightheadedness, vertigo, numbness or tingling in extremities, fevers or chills, cough, shortness of breath, chest pain, nausea or vomiting, diarrhea, or abdominal pain. She also denied dysuria but c/o urinary frequency and increased thirst. She called her PCP on the day of admission who advised her to go to the ED for evaluation. In the ED, she was discovered to have a serum glucose of 1290 and an anion gap of 19 with positive urine ketones (minimal). She was subsequently admitted to the MICU for treatment of suspected hyperosmolar non-ketotic coma. MEDICAL HISTORY: HTN, S/p TAH/BSO [**4-/2158**] for fibroids, borderline DM (HbA1C 6.5% 9/03), L shoulder impingement s/p athroscopic capsular release, knee pain, back pain, gallstones MEDICATION ON ADMISSION: -metoprolol XL 50mg once daily -tylenol #3 1 tablet q6hours prn pain -naprosyn 500mg po once daily -estrogen 0.625mg po once daily -HCTZ 25mg po once daily ALLERGIES: Penicillins PHYSICAL EXAM: Vitals: T: 97.5F BP: 154/75 P: 77 R: 18 SaO2: 98% General: appears fatigued, in NAD HEENT: PERRL, EOMI, dry mucous membranes, white plaques noted on bilateral buccal mucosa, erythematous oropharynx, no sinus tenderness, no hemorrhages or exudates appreciated on fundoscopic exam. Neck: supple, FROM Lungs: CTA B Cardiac: RRR, nl. S1S2, no m/r/g noted Abdomen: soft, NT/ND, nl. bowel sounds Extremeties: no edema noted. FAMILY HISTORY: Remarkable for diabetes mellitus in her father and son. SOCIAL HISTORY: The pt. lives in [**Location 686**] with her daughter. She is on disability. She denied use of tobacco, EtOH or IV drugs. ### Response: {'Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Candidiasis of mouth,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Unspecified essential hypertension'}

CHIEF COMPLAINT: + ETT PRESENT ILLNESS: This 66-year-old patient with a recent onset of chest pain was investigated and he had a positive stress test and a subsequent angiogram showed significant disease in the LAD and diagonal and obtuse marginal arteries, with some irregularities, noncritical, in the right coronary system. The ejection fraction was about 40%. He was electively admitted for coronary artery bypass grafting. His preoperative echocardiogram showed 1+ mitral regurgitation which was confirmed by transesophageal echo on the table. This was left alone. MEDICAL HISTORY: Hyperlipidemia HTN GERD MEDICATION ON ADMISSION: Toprol XL 50mg QD Crestor 20mg QD Lisinopril 20mg QD Aspirin 81mg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse 84 BR: 160/80 67" 180 lbs GEN: Healthy appearing man in NAD SKIN: Unremarkable HEENT: Unremarkable NECK: Supple, full ROM HEART: RRR, Nl S1-S2 LUNGS: Clear ABD: Benign EXT: Warm, no edema, no varicosities. NEURO: Nonfocal. FAMILY HISTORY: Father died of MI at age 52. Brother s/p PCI. SOCIAL HISTORY: Works as a hairdresser. Lives alone. Drinks 1-2 drinks weekly.

Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Family history of ischemic heart disease

Crnry athrscl natve vssl,Mitral valve disorder,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Fam hx-ischem heart dis

Admission Date: [**2182-4-8**] Discharge Date: [**2182-4-12**] Date of Birth: [**2115-4-26**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1283**] Chief Complaint: + ETT Major Surgical or Invasive Procedure: [**2182-4-8**] - CABGx3(LIMA-left Anterior Descending artery, SVG->Obtuse Marginal artery, SVG->Diagonal artery) History of Present Illness: This 66-year-old patient with a recent onset of chest pain was investigated and he had a positive stress test and a subsequent angiogram showed significant disease in the LAD and diagonal and obtuse marginal arteries, with some irregularities, noncritical, in the right coronary system. The ejection fraction was about 40%. He was electively admitted for coronary artery bypass grafting. His preoperative echocardiogram showed 1+ mitral regurgitation which was confirmed by transesophageal echo on the table. This was left alone. Past Medical History: Hyperlipidemia HTN GERD Social History: Works as a hairdresser. Lives alone. Drinks 1-2 drinks weekly. Family History: Father died of MI at age 52. Brother s/p PCI. Physical Exam: Pulse 84 BR: 160/80 67" 180 lbs GEN: Healthy appearing man in NAD SKIN: Unremarkable HEENT: Unremarkable NECK: Supple, full ROM HEART: RRR, Nl S1-S2 LUNGS: Clear ABD: Benign EXT: Warm, no edema, no varicosities. NEURO: Nonfocal. Pertinent Results: [**2182-4-12**] 06:30AM BLOOD Hct-27.5* [**2182-4-10**] 07:25AM BLOOD Plt Ct-111* [**2182-4-12**] 06:30AM BLOOD UreaN-26* Creat-1.0 K-4.4 [**2182-4-10**] CXR There has been interval removal of the endotracheal tube, right IJ line, NG tube and the chest tubes. There is evidence of CABG with median sternotomy sutures and cardiovascular clips. There is no pneumothorax. Small bilateral pleural effusions are noted. Linear atelectasis is visualized at the left lung base and right lung mid zone. [**2182-4-8**] ECHO 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 bdy of the right atrium/right atrial appendage. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses and cavity size are normal. There is moderate regional left ventricular systolic dysfunction. Resting regional wall motion abnormalities include mid and apical anterior, anteroseptal and lateral walls.. Right ventricular chamber size and free wall motion are normal. There are simple atheroma in the descending thoracic aorta. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not resent. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild to moderate ([**1-14**]+) mitral regurgitation is seen. There is no pericardial effusion. Post bypass: Preserved RV systolic function. LVEF 45-50%. There is improvement of wall motion abnormalities in all the wallmotions. MR is mild. Ascending aorta is okay. Brief Hospital Course: Mr. [**Known lastname 100425**] was admitted to the [**Hospital1 18**] on [**2182-4-8**] for surgical management of his coronary artery disease. He was taken directly to the operating room where he underwent coronary artery bypass grafting to three vessels. Postoperatively he was taken to the cardiac intensive care unit for monitoring. By postoperative day one, Mr. [**Known lastname 100425**] [**Last Name (Titles) 5058**] neurologically intact and was extubated. Beta blockade, a statin and aspirin were started. He was then transferred to the step down unit for further recovery. Mr. [**Known lastname 100425**] was gently diuresed towards his preoperative weight. The physical therapy service was consulted for assistance with his postoperative strength and mobility. His drains and wires were removed per protocol without complication. Mr. [**Known lastname 100425**] continued to make steady progress and was discharged home on postoperative day four. He has been instructed to follow-up with Dr. [**Last Name (Prefixes) **], his cardiologist and his primary care physician as an outpatient. If he seeks a new or local primary care physician, [**Name10 (NameIs) **] has been instructed to contact his insurance provider to be assigned a primary care physician. Medications on Admission: Toprol XL 50mg QD Crestor 20mg QD Lisinopril 20mg QD Aspirin 81mg QD Discharge Medications: 1. Rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*4* 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): [**Month (only) 116**] stop when off pain medicine. Disp:*60 Capsule(s)* Refills:*0* 5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*45 Tablet(s)* Refills:*0* 6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 4 days. Disp:*8 Tablet(s)* Refills:*0* 7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 4 days. Disp:*8 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 9. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*1* Discharge Disposition: Home With Service Facility: [**Hospital **] Hospice and VNA Discharge Diagnosis: HTN Hyperlipidemia GERD Discharge Condition: Good Discharge Instructions: 1) Monitor wounds for signs of infection. These include redness, drainage or increased pain. 2) You may wash your incision and pat dry. No bathing or swimming until it has healed. 3) No lotions, creams or powders to wound until it has healed. 4) Report any fever greater then 100.5. 5) No lifting greater then 10 pounds for 10 weeks. 6) No driving for 1 month. 7) Report any weight gain greater then 2 pounds in 24 hours or 5 pounds in 1 week. 8) Take lasix and potassium twice daily for 4 days then stop. 9) Please follow-up with all providers as instructed. If you do not have a local primary care provider you must call you insurance company and be assigned one. 10) Please call with any questions or concerns. [**Last Name (NamePattern4) 2138**]p Instructions: Follow-up with Dr. [**Last Name (Prefixes) **] in 1 month. ([**Telephone/Fax (1) 1504**] Follow-up with Dr. [**Last Name (STitle) 6254**] in [**1-14**] weeks. ([**Telephone/Fax (1) 20259**] Follow-up with your primary care physician [**Last Name (NamePattern4) **] 2 weeks. Call all providers for appointments. Completed by:[**2182-4-12**]

414,424,401,272,530,V173

{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Family history of ischemic heart disease'}

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: + ETT PRESENT ILLNESS: This 66-year-old patient with a recent onset of chest pain was investigated and he had a positive stress test and a subsequent angiogram showed significant disease in the LAD and diagonal and obtuse marginal arteries, with some irregularities, noncritical, in the right coronary system. The ejection fraction was about 40%. He was electively admitted for coronary artery bypass grafting. His preoperative echocardiogram showed 1+ mitral regurgitation which was confirmed by transesophageal echo on the table. This was left alone. MEDICAL HISTORY: Hyperlipidemia HTN GERD MEDICATION ON ADMISSION: Toprol XL 50mg QD Crestor 20mg QD Lisinopril 20mg QD Aspirin 81mg QD ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse 84 BR: 160/80 67" 180 lbs GEN: Healthy appearing man in NAD SKIN: Unremarkable HEENT: Unremarkable NECK: Supple, full ROM HEART: RRR, Nl S1-S2 LUNGS: Clear ABD: Benign EXT: Warm, no edema, no varicosities. NEURO: Nonfocal. FAMILY HISTORY: Father died of MI at age 52. Brother s/p PCI. SOCIAL HISTORY: Works as a hairdresser. Lives alone. Drinks 1-2 drinks weekly. ### Response: {'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Family history of ischemic heart disease'}

CHIEF COMPLAINT: Post-operative hypotension, bleed PRESENT ILLNESS: 72 y/o M with history of hypertension, GERD, stage III colon cancer s/p right colectomy in [**5-/2105**], now POD #1 s/p elective incisonal hernia repair on [**5-26**] with component separatin and mesh. The patient was in his usual state of health and presented to the hospital for elective surgery. MEDICAL HISTORY: HTN arthritis GERD legally blind [**2-9**] retinitis pigmentosa S/p R colectomy ([**2105**]) S/p hiatal hernia repair ([**2091**]) S/p surgical removal shrapnel ([**2056**]) Dermatologic cquamous cell carcinoma, anterior abdominal wall ([**2106**]) MEDICATION ON ADMISSION: Allopurinol 300 mg PO daily Atorvastatin 5 mg PO QHS HCTZ 25 mg PO daily Verapamil 240 mg PO daily Ascorbic acid 500 mg PO daily Aspirin 81 mg PO daily (last taken on [**5-21**]) Fish oil Vitamin A 15,000 units daily Vit B6 100 mg PO BID Spironolactone 25 mg PO BID ALLERGIES: Ceftriaxone PHYSICAL EXAM: T: 97.5 BP: 114/63 P: 73 R:13 O2:96% RA General: Alert, oriented, NAD, pleasant HEENT: Sclera anicteric, MMM, OP clear Neck: supple, no JVD or LAD Lungs: CTAB, no wheezes, rales, rhonchi CV: RRR, normal S1 + S2, no M/R/G Abdomen: softly distended. +hypoactive bowel sounds throughout. Vertical midline incision scar underneath C/D/I dressing. No rebound tenderness or guarding, mildly tender to deep palpation around epigastrium GU: Foley catheter in place Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Father passed away from stroke at age 51. Sister with blindness. No known cardiovascular disease or diabetes. No children. SOCIAL HISTORY: Lives at home with wife. Is a retired military historian and a psychologist in the federal court system. Is physically active, participating in regular running, spinning, and water exercises. Remote etoh abuse, last drink 22 years ago. Denies current or past tobacco abuse.

Incisional hernia without mention of obstruction or gangrene,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure,Precipitous drop in hematocrit,Hyposmolality and/or hyponatremia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other iatrogenic hypotension,Oliguria and anuria,Thrombocytopenia, unspecified,Unspecified essential hypertension,Esophageal reflux,Pigmentary retinal dystrophy,Legal blindness, as defined in U.S.A.,Personal history of other malignant neoplasm of skin

Incisional hernia,Ac kidny fail, tubr necr,Hemorrhage complic proc,Drop, hematocrit, precip,Hyposmolality,Abn react-surg proc NEC,Iatrogenc hypotnsion NEC,Oliguria & anuria,Thrombocytopenia NOS,Hypertension NOS,Esophageal reflux,Pigment retina dystrophy,Legal blindness-usa def,Hx-skin malignancy NEC

Admission Date: [**2106-5-26**] Discharge Date: [**2106-6-1**] Date of Birth: [**2032-11-16**] Sex: M Service: SURGERY Allergies: Ceftriaxone Attending:[**First Name3 (LF) 1**] Chief Complaint: Post-operative hypotension, bleed Major Surgical or Invasive Procedure: Elective incisonal hernia repair. History of Present Illness: 72 y/o M with history of hypertension, GERD, stage III colon cancer s/p right colectomy in [**5-/2105**], now POD #1 s/p elective incisonal hernia repair on [**5-26**] with component separatin and mesh. The patient was in his usual state of health and presented to the hospital for elective surgery. Past Medical History: HTN arthritis GERD legally blind [**2-9**] retinitis pigmentosa S/p R colectomy ([**2105**]) S/p hiatal hernia repair ([**2091**]) S/p surgical removal shrapnel ([**2056**]) Dermatologic cquamous cell carcinoma, anterior abdominal wall ([**2106**]) Social History: Lives at home with wife. Is a retired military historian and a psychologist in the federal court system. Is physically active, participating in regular running, spinning, and water exercises. Remote etoh abuse, last drink 22 years ago. Denies current or past tobacco abuse. Family History: Father passed away from stroke at age 51. Sister with blindness. No known cardiovascular disease or diabetes. No children. Physical Exam: T: 97.5 BP: 114/63 P: 73 R:13 O2:96% RA General: Alert, oriented, NAD, pleasant HEENT: Sclera anicteric, MMM, OP clear Neck: supple, no JVD or LAD Lungs: CTAB, no wheezes, rales, rhonchi CV: RRR, normal S1 + S2, no M/R/G Abdomen: softly distended. +hypoactive bowel sounds throughout. Vertical midline incision scar underneath C/D/I dressing. No rebound tenderness or guarding, mildly tender to deep palpation around epigastrium GU: Foley catheter in place Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: [**2106-5-27**] 01:00PM BLOOD WBC-10.1# RBC-3.38* Hgb-10.7* Hct-32.1* MCV-95 MCH-31.6 MCHC-33.2 RDW-14.8 Plt Ct-218 [**2106-5-28**] 05:10AM BLOOD WBC-6.7 RBC-2.88* Hgb-9.0* Hct-25.8*# MCV-90 MCH-31.2 MCHC-34.9 RDW-15.0 Plt Ct-125* [**2106-5-29**] 02:44AM BLOOD WBC-6.7 RBC-3.17* Hgb-10.5* Hct-28.3* MCV-89 MCH-32.9* MCHC-37.1* RDW-15.4 Plt Ct-118* [**2106-5-29**] 08:44AM BLOOD WBC-5.4 RBC-3.18* Hgb-9.9* Hct-27.8* MCV-87 MCH-31.2 MCHC-35.7* RDW-15.4 Plt Ct-118* [**2106-5-29**] 02:44AM BLOOD PT-13.7* INR(PT)-1.2* [**2106-5-28**] 09:26PM BLOOD PT-13.3 PTT-26.0 INR(PT)-1.1 [**2106-5-28**] 12:06AM BLOOD PT-15.5* PTT-26.1 INR(PT)-1.4* [**2106-5-28**] 05:10AM BLOOD Calcium-7.8* Phos-3.0 Mg-1.5* [**2106-5-28**] 12:06AM BLOOD Hapto-110 [**2106-5-27**] 01:00PM BLOOD Osmolal-290 KUB [**2106-5-27**]: Multiple loops of dilated small and large bowel may be compatible with an ileus in the setting of recent surgery. Brief Hospital Course: The patient was admitted to the inpatient [**Hospital1 **] status post incisional hernia repair with mesh and component separation. The patient tolerated the procedure well however post-operative day 1 developed hypotension, low urine output, with a dropping hematocrit, increased serous drainage from the [**Location (un) 1661**]-[**Location (un) 1662**] drains placed in either side of the abdomen.On day of admission to ICU, patient was noted to have BP of 87/61, at 4:25 pm. Hct dropped from 32 to 26. He was also noted to have a moderate amount of bloody JP drain output (328 cc R drain, 131 cc L drain) over 24 hours. His urine output had also dropped to 0-10 cc/hr for most of the day. Got 3500 cc lactated ringers, and 1uPRBC ordered prior to transfer to [**Hospital Unit Name 153**]. Patient has one peripheral IV. Has been off his home aspirin since [**5-21**]. Was on subcu heparin.On the floor, the patient denied any symptoms, including dizziness, lightheadedness, abdominal pain, nausea, vomiting, palpations, dyspnea, or chest pain. Also denies fevers, chills, or sweats. The patient was transferred from the inpatient floor to the intensive care unit for further monitoring. [**Hospital Unit Name 153**] course: # HYPOTENSION: BP stabilized after significant IVF resuscitation and blood transfusions. Patient displayed no signs or symptoms of sepsis. Good IV access was maintained throughout entire [**Hospital Unit Name 153**] course. Home HCTZ, verapamil, and spironolactone were held. Two units of blood were eventually transfused, and patient did well; he was transferred back to the surgical floor without complications. # POST-OPERATIVE BLEED: Per attending surgeon, no blood loss intra-operatively, no visceral organs punctured and no significant blood vessels injured. Patient without known past or current bleeding disorders. Hct dropped 32 -> 26; then dropped further to 24 in setting of aggressive IVF resuscitation. No recent coagulation studies seen in medical records. Platelet count normal. As above, patient received 2 units of PRBCs. Coags were normal. ASA was held. On morning after [**Hospital Unit Name 153**] transfer, patient had no signs or symptoms of bleeds and blood pressure had normalized. Patient was transferred to surgery floor. # ACUTE KIDNEY INJURY/OLIGURIA: Given history of hypotension and bleeding, concerning for perfusion-related kidney injury. [**Month (only) 116**] also be in oliguric phase of ATN, given hypotension earlier during admission and BUN:creatinine ratio < 20. FeNa 0.5 consistent with perfusion-related [**Last Name (un) **]. Patient was given IVF and anti-hypertensives were held. Creatinine trended down to 1.1 after fluid resuscitation. # HYPONATREMIA: Likely hypoosomolar, hypovolemic. Resolved with IVF. After the patient was medically stabilized he was transferred to the inpatient [**Hospital1 **]. The remaining post-operative coarse was uneventful and this laboratory values remained stable with a hematocrit of 28.7 at discharge. 2 JP drains were removed from right and left side of the midline incision and dressed appropriately. The midline incision was intact with staples, triple antibiotic ointment was applied and the area was covered with a dry sterile gauze dressing. The patient was discharged home with close visiting nurse follow-up. Medications on Admission: Allopurinol 300 mg PO daily Atorvastatin 5 mg PO QHS HCTZ 25 mg PO daily Verapamil 240 mg PO daily Ascorbic acid 500 mg PO daily Aspirin 81 mg PO daily (last taken on [**5-21**]) Fish oil Vitamin A 15,000 units daily Vit B6 100 mg PO BID Spironolactone 25 mg PO BID Discharge Medications: 1. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H (Every 8 Hours). 2. Atorvastatin 10 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 4. Verapamil 240 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day. 5. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. 6. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO twice a day. 7. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. 8. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Incisional hernia following midline incision. 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 after your repair of incisional hernia with mesh and component separation technique. The first day after your surgery you had some bleeding and you were admitted to the intesive care unit for replacement of this blood loss. You recovered well from this and the two drains in your abdomen will be removed prior to your discharge. The drain sites will be covered with bulky sterile gauze dressings and tegaderms. These can be left in place until your follow-up or be changed as needed by the visiting nurses. Because of your vision impairment it is very important that you have the visiting nurses look at the dressings on your abdomen daily and a family member glance at these dressings throughout the day to be sure that these dressings are clean dry and intact. If you notice that the dressings become saturated with drainage or blood please call Dr [**Last Name (STitle) 11639**] with any quesstions related to the dressings. The midline incision line will be covered with triple antibiotic ointment and covered with a protective dry sterile gauze dressing. This should be left in place until your follow up appointment with Dr. [**Last Name (STitle) **] which should be in 1 week. If the gauze becomes dirty or soaked with drainage it may be changed. Please monitor your bowel function. If you notice that you are unable to pass stool, become nauseated, vomit, or you notice that your abdomen becomes more distended please seek medical attention or if severe come to the emergency room. Please eat small frequent meals and take adequate fluids. Please watch for symptoms of dehydration such as dizziness, nausea, loss of conciousness, dry mouth, rapid heart rate, or fatigue. These could also be signs of bleeding, which we do not expect, but you should watch for. Please call or go to the emergency room if these symptoms are severe. You may resume the medications your were taking prior to your surgery. You have not been having pain, however if you do have pain you may take extra strength Tylenol as written on the over the counter bottle but do not take more than 4000mg of Tylenol daily. Followup Instructions: Please call Dr.[**Name (NI) 10946**] office at ([**Telephone/Fax (1) 9011**] to make a follow up appointment within one week. Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2106-7-2**] 10:00 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 593**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2106-7-14**] 9:00 Provider: [**First Name4 (NamePattern1) 488**] [**Last Name (NamePattern1) 6401**], MD Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2106-7-14**] 9:00 Completed by:[**2106-6-8**]

553,584,998,790,276,E878,458,788,287,401,530,362,369,V108

{'Incisional hernia without mention of obstruction or gangrene,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure,Precipitous drop in hematocrit,Hyposmolality and/or hyponatremia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other iatrogenic hypotension,Oliguria and anuria,Thrombocytopenia, unspecified,Unspecified essential hypertension,Esophageal reflux,Pigmentary retinal dystrophy,Legal blindness, as defined in U.S.A.,Personal history of other malignant neoplasm of skin'}

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-operative hypotension, bleed PRESENT ILLNESS: 72 y/o M with history of hypertension, GERD, stage III colon cancer s/p right colectomy in [**5-/2105**], now POD #1 s/p elective incisonal hernia repair on [**5-26**] with component separatin and mesh. The patient was in his usual state of health and presented to the hospital for elective surgery. MEDICAL HISTORY: HTN arthritis GERD legally blind [**2-9**] retinitis pigmentosa S/p R colectomy ([**2105**]) S/p hiatal hernia repair ([**2091**]) S/p surgical removal shrapnel ([**2056**]) Dermatologic cquamous cell carcinoma, anterior abdominal wall ([**2106**]) MEDICATION ON ADMISSION: Allopurinol 300 mg PO daily Atorvastatin 5 mg PO QHS HCTZ 25 mg PO daily Verapamil 240 mg PO daily Ascorbic acid 500 mg PO daily Aspirin 81 mg PO daily (last taken on [**5-21**]) Fish oil Vitamin A 15,000 units daily Vit B6 100 mg PO BID Spironolactone 25 mg PO BID ALLERGIES: Ceftriaxone PHYSICAL EXAM: T: 97.5 BP: 114/63 P: 73 R:13 O2:96% RA General: Alert, oriented, NAD, pleasant HEENT: Sclera anicteric, MMM, OP clear Neck: supple, no JVD or LAD Lungs: CTAB, no wheezes, rales, rhonchi CV: RRR, normal S1 + S2, no M/R/G Abdomen: softly distended. +hypoactive bowel sounds throughout. Vertical midline incision scar underneath C/D/I dressing. No rebound tenderness or guarding, mildly tender to deep palpation around epigastrium GU: Foley catheter in place Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Father passed away from stroke at age 51. Sister with blindness. No known cardiovascular disease or diabetes. No children. SOCIAL HISTORY: Lives at home with wife. Is a retired military historian and a psychologist in the federal court system. Is physically active, participating in regular running, spinning, and water exercises. Remote etoh abuse, last drink 22 years ago. Denies current or past tobacco abuse. ### Response: {'Incisional hernia without mention of obstruction or gangrene,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure,Precipitous drop in hematocrit,Hyposmolality and/or hyponatremia,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other iatrogenic hypotension,Oliguria and anuria,Thrombocytopenia, unspecified,Unspecified essential hypertension,Esophageal reflux,Pigmentary retinal dystrophy,Legal blindness, as defined in U.S.A.,Personal history of other malignant neoplasm of skin'}

CHIEF COMPLAINT: altered mental status PRESENT ILLNESS: 80 yo F with history of hypertension and HCV, presented to the ED today with acutely altered mental status this AM in the setting of two weeks of nausea, abdominal pain, and malaise. [**Name (NI) **] son reports that the patient had been more weak than normal in last several weeks and that she had been eating small bland meals. Last night she asked for tea and bread and then went to bed early. Her son reports finding her this morning slumped over next to the toilet. Patient had soiled herself, though no visible blood was seen by patient's son. . At presentation to ED vitals were: HR 86, BP 174/74, RR 14, O2Sat 100% RA. Patient was hypothermic (34C) upon arrival. Was initially alert with eyes open, though was not responding to commands. Initial labs showed a HCT down to 27 from a baseline of 38 in 5/[**2165**]. Also had lactate of 2.6. On exam, patient had dark brown, guaiac positive stools. Patient triggered for hypotension twice during ED course and was subsequently given a femoral CVC and 2L fluid and 2 units PRBC with stabilization of BP. GI consult saw patient in the ED and initially agreed with CT scan of abd/pelvis. Patient then was sent up to the ICU via radiology, where she received head CT, CT c-spine, and CT abd/pelvis. Prior to transfer to MICU vitals were: T afebrile, HR 90, BP 150/48, RR 16, 100% RA. MEDICAL HISTORY: 1) Hypertension 2) Hepatitis C 3) Aortic insufficiency 4) Eosinophilia 5) Strongyloidiasis 6) Low back pain 7) History of PPD positive MEDICATION ON ADMISSION: 1) Atenolol 50 mg Tablet by mouth daily 2) Lisinopril 40 mg Tablet by mouth daily 3) Spironolactone-hydrochlorothiazide 25 mg-25 mg by mouth daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission Exam: VS: T 97.8, HR 110, BP 158/76, RR 18, O2Sat 100% RA GEN: Flat in bed, asleep HEENT: PERRL, does not spontaneously open eyes, oral mucosa slightly dry NECK: In C-collar PULM: CTAB anteriorly CARD: Tachycardic, nl S1, no S2, no M/R/G ABD: BS+, soft, NT, ND, slightly tympanitic EXT: Scars along BLE, though no edema SKIN: no rashes seen NEURO: Obtunded, does not arouse to her name or sternal rub, grimace during ABG though did not withdraw . Discharge Exam: VS: 98.1 164/74 66 18 99% RA GENERAL: elderly woman, sleeping but easily arousable, NAD HEENT: sclera anicteric, MMM NECK: supple, no JVD appreciated CARDIAC: RRR, normal S1, S2, slight systolic murmur at LUSB LUNGS: CTAB, no crackles, wheezes or rhonchi appreciated ABDOMEN: bowel sounds present, soft, NT, ND, no guarding or rebound tenderness EXTREMITIES: warm, well-perfused, DP pulses 2+, no edema NEURO: oriented to person/place, not time (baseline per son), no asterixis FAMILY HISTORY: No family history of cancers, heart disease, hypertension, or diabetes. SOCIAL HISTORY: The patient is originally from [**Country 4812**] and moved here approximately three years ago. She denies any current or history of tobacco use, has an occasional alcoholic drink, and denies any drug use. She currently lives with her son and his two kids.

Hemorrhage of gastrointestinal tract, unspecified,Acidosis,Portal hypertension,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Acute posthemorrhagic anemia,Esophageal varices without mention of bleeding,Other specified gastritis, without mention of hemorrhage,Hypothermia not associated with low environmental temperature,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Aortic valve disorders,Apnea,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Other opiates and related narcotics causing adverse effects in therapeutic use,Accidents occurring in residential institution

Gastrointest hemorr NOS,Acidosis,Portal hypertension,Chrnc hpt C wo hpat coma,Cirrhosis of liver NOS,Ac posthemorrhag anemia,Esoph varices w/o bleed,Oth spf gstrt w/o hmrhg,Hypothrm-wo low env tmp,Hypertension NOS,Mental disor NEC oth dis,Aortic valve disorder,Apnea,Adv eff benzodiaz tranq,Adv eff opiates,Accid in resident instit

Admission Date: [**2166-10-24**] Discharge Date: [**2166-10-29**] Date of Birth: [**2086-5-17**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 613**] Chief Complaint: altered mental status Major Surgical or Invasive Procedure: Endoscopy [**2166-10-27**] History of Present Illness: 80 yo F with history of hypertension and HCV, presented to the ED today with acutely altered mental status this AM in the setting of two weeks of nausea, abdominal pain, and malaise. [**Name (NI) **] son reports that the patient had been more weak than normal in last several weeks and that she had been eating small bland meals. Last night she asked for tea and bread and then went to bed early. Her son reports finding her this morning slumped over next to the toilet. Patient had soiled herself, though no visible blood was seen by patient's son. . At presentation to ED vitals were: HR 86, BP 174/74, RR 14, O2Sat 100% RA. Patient was hypothermic (34C) upon arrival. Was initially alert with eyes open, though was not responding to commands. Initial labs showed a HCT down to 27 from a baseline of 38 in 5/[**2165**]. Also had lactate of 2.6. On exam, patient had dark brown, guaiac positive stools. Patient triggered for hypotension twice during ED course and was subsequently given a femoral CVC and 2L fluid and 2 units PRBC with stabilization of BP. GI consult saw patient in the ED and initially agreed with CT scan of abd/pelvis. Patient then was sent up to the ICU via radiology, where she received head CT, CT c-spine, and CT abd/pelvis. Prior to transfer to MICU vitals were: T afebrile, HR 90, BP 150/48, RR 16, 100% RA. Past Medical History: 1) Hypertension 2) Hepatitis C 3) Aortic insufficiency 4) Eosinophilia 5) Strongyloidiasis 6) Low back pain 7) History of PPD positive Social History: The patient is originally from [**Country 4812**] and moved here approximately three years ago. She denies any current or history of tobacco use, has an occasional alcoholic drink, and denies any drug use. She currently lives with her son and his two kids. Family History: No family history of cancers, heart disease, hypertension, or diabetes. Physical Exam: Admission Exam: VS: T 97.8, HR 110, BP 158/76, RR 18, O2Sat 100% RA GEN: Flat in bed, asleep HEENT: PERRL, does not spontaneously open eyes, oral mucosa slightly dry NECK: In C-collar PULM: CTAB anteriorly CARD: Tachycardic, nl S1, no S2, no M/R/G ABD: BS+, soft, NT, ND, slightly tympanitic EXT: Scars along BLE, though no edema SKIN: no rashes seen NEURO: Obtunded, does not arouse to her name or sternal rub, grimace during ABG though did not withdraw . Discharge Exam: VS: 98.1 164/74 66 18 99% RA GENERAL: elderly woman, sleeping but easily arousable, NAD HEENT: sclera anicteric, MMM NECK: supple, no JVD appreciated CARDIAC: RRR, normal S1, S2, slight systolic murmur at LUSB LUNGS: CTAB, no crackles, wheezes or rhonchi appreciated ABDOMEN: bowel sounds present, soft, NT, ND, no guarding or rebound tenderness EXTREMITIES: warm, well-perfused, DP pulses 2+, no edema NEURO: oriented to person/place, not time (baseline per son), no asterixis Pertinent Results: Admission Labs: [**2166-10-24**] 11:30AM BLOOD WBC-5.7 RBC-2.96*# Hgb-9.6* Hct-27.9*# MCV-94 MCH-32.5* MCHC-34.5 RDW-13.4 Plt Ct-172 [**2166-10-24**] 11:30AM BLOOD Neuts-81.6* Lymphs-16.2* Monos-1.9* Eos-0.2 Baso-0.2 [**2166-10-24**] 11:30AM BLOOD PT-14.3* PTT-21.2* INR(PT)-1.2* [**2166-10-24**] 11:30AM BLOOD Glucose-171* UreaN-41* Creat-1.2* Na-141 K-4.0 Cl-110* HCO3-18* AnGap-17 [**2166-10-24**] 11:30AM BLOOD ALT-53* AST-91* LD(LDH)-268* CK(CPK)-425* AlkPhos-80 TotBili-0.9 [**2166-10-24**] 11:30AM BLOOD Lipase-53 [**2166-10-24**] 11:30AM BLOOD CK-MB-8 cTropnT-<0.01 [**2166-10-24**] 11:30AM BLOOD Calcium-9.6 Phos-3.0 Mg-2.4 [**2166-10-24**] 07:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2166-10-24**] 08:27PM BLOOD Type-ART pO2-99 pCO2-24* pH-7.49* calTCO2-19* Base XS--2 Intubat-NOT INTUBA [**2166-10-24**] 11:45AM BLOOD Glucose-160* Lactate-2.6* . Other Pertinent Labs: [**2166-10-24**] 08:01PM BLOOD Lactate-1.2 [**2166-10-24**] 07:30PM BLOOD TSH-0.40 [**2166-10-28**] 05:25AM BLOOD Ammonia-58 . [**2166-10-24**] 11:30AM BLOOD CK-MB-8 cTropnT-<0.01 [**2166-10-24**] 07:30PM BLOOD CK-MB-9 cTropnT-<0.01 [**2166-10-25**] 03:08AM BLOOD CK-MB-10 MB Indx-1.2 cTropnT-0.02* [**2166-10-25**] 11:15AM BLOOD CK-MB-11* MB Indx-1.0 cTropnT-0.01 . [**2166-10-24**] 11:30AM BLOOD CK(CPK)-425* [**2166-10-24**] 07:30PM BLOOD CK(CPK)-546* [**2166-10-25**] 03:08AM BLOOD CK(CPK)-810* [**2166-10-25**] 11:15AM BLOOD CK(CPK)-1059* [**2166-10-26**] 06:05AM BLOOD CK(CPK)-743* [**2166-10-27**] 06:28AM BLOOD CK(CPK)-635* . Discharge Labs: [**2166-10-29**] 05:48AM BLOOD WBC-5.4 RBC-3.52* Hgb-11.1* Hct-32.4* MCV-92 MCH-31.4 MCHC-34.1 RDW-15.6* Plt Ct-159 [**2166-10-29**] 05:48AM BLOOD Glucose-86 UreaN-12 Creat-0.9 Na-138 K-3.9 Cl-110* HCO3-22 AnGap-10 [**2166-10-29**] 05:48AM BLOOD Albumin-2.9* Calcium-8.3* Phos-1.8* Mg-1.8 . Urine: [**2166-10-24**] 12:05PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.013 [**2166-10-24**] 12:05PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG . Micro: [**2166-10-24**] Urine culture: negative [**2166-10-24**] Blood cultures: pending, no growth to date at time of discharge . Imaging: [**2166-10-24**] EKG: Sinus rhythm. Left ventricular hypertrophy. . [**2166-10-24**] CXR: No acute intrathoracic process. . [**2166-10-24**] CT Head w/o Contrast: No acute intracranial pathology. . [**2166-10-24**] CT C-Spine w/o Contrast: 1. No acute fracture. Multilevel degenerative changes. 2. Diffusely heterogenous bones which could be related to osteopenia, but if patient has history of malignancy, or other concern for metastatic disease, consider outpatient MRI for further evaluation. 3. Prominent proximal innominate artery as well as minimal prominence of the right common carotid and subclavian arteries, not fully imaged on this study and may be secondary to tortuosity. However, if there is clinical concern or this has not been previously evaluated, then this can be further evaluated on a dedicated chest CT with contrast. 4. Calcification in the right thyroid lobe can be further evaluated with ultrasound. . [**2166-10-24**] CT Abd/Pelvis: 1. No acute CT findings to explain patient's symptoms. No bowel wall thickening. 2. Nodular contour of the liver suggests cirrhosis. Upper abdominal varices. Subtle hypodensity in the liver adjacent to the falciform ligament on axial images was not substantiated on reformats and may be artifactual. 3. Prominence of the endometrial cavity is not optimally evaluated on this study. Given postmenopausal status of the patient consider an nonemergent pelvic ultrasound for further evaluation. 4. Abundant fecal loading in the rectosigmoid, could relate to constipation in the appropriate clinical setting. . [**2166-10-27**] EGD: Varices at the lower third of the esophagus and gastroesophageal junction Varices at the gastroesophageal junction Erosion in the stomach body Otherwise normal EGD to third part of the duodenum Brief Hospital Course: 80yo female with h/o HTN, HCV, who presents after being found down at home by family in setting of two weeks of nausea, abdominal pain and malaise, was found to have decreased HCT (38.3 in [**4-/2166**] to 27.9) and guiac positive stools, and who was initially admitted to MICU given concern for GI bleeding. . #. Altered Mental Status: Patient had relatively undifferentiated AMS on admission, and appeared somnolent and non-verbal. Infectious work-up was negative, including unremarkable CXR, UA, and blood cultures that remained negative to date at time of discharge. Hypoglycemia unlikely given normal sugars at presentation and no history of diabetes. CT head was negative for any acute intracranial process. AMS may have been secondary to hypovolemia/hypotension, and the patient's hypotension (see below) responded to IV fluids. Patient later noted to be oriented to person and place, not time, and was able to answer questions appropriately. Per son, this is her baseline mental status. She continued to mentate well throughout rest of hospital course. . #. GI bleed: On arrival, patient noted to have decrease in HCT from 38 in [**4-/2166**] to 27, and had guiac positive dark brown stool. Patient had hypotensive episode in ED requiring IVF, and was also transfused 4 units PRBCs with subsequent stabilization of HCT and hemodynamics. She was seen by gasteroenterology, and had endoscopy on [**2166-10-27**] which revealed varices at the lower third of the esophagus and gastroesophageal junction, as well as an erosion in the stomach body. No active bleeding was noted. The patient was started on a PPI, and should continue taking a PPI after discharge. Aspirin was held, and patient should discuss restarting with PCP. [**Name10 (NameIs) 227**] presence of varices, likely in setting of HCV cirrhosis, the patient should have outpatient liver follow-up. The patient will also need a colonoscopy as an outpatient, though study will likely need to be done under general anesthesia as patient had brief episode of apnea during EGD after receiving fentanyl/versed, and required narcan and NRB to stabilize respiratory status. . #. Hepatitis C: Patient has h/o HCV, genotype 5. Transaminases mildly elevated, and CT abd/pelvis shows nodular cirrhosis and upper abdominal varices. EGD confirmed grade I and grade II varices in esophagus and gastroesophageal junction, with no evidence of active bleeding. Of note, the patient's AFP checked this admission was 5.1. The patient has outpatient liver follow-up scheduled. . #. Hypotension: Patient initially hypotensive in ED; which may have been multifactorial in setting of GI bleed and recent decreased PO intake. Patient received IVF and total transfusion of 4 units pRBCs, with resultant improvement in BP. Patient remained hemodynamically stable throughout rest of hospital course. . #. Hypertension: Once BP stabilized, patient returned to baseline level of hypertension. She was continued on outpatient regimen of HCTZ, spironolactone, lisinopril, and beta blocker was switched from atenolol to metoprolol during hospital course. If BP remains persistently elevated in outpatient setting, she may benefit from dose increase in her lisinopril or other antihypertensive [**Doctor Last Name 360**]. . #. Fall: Patient was found on ground at home from unwitnessed fall, which may have been mechanical or related to orthostatic hypotension. Was placed in c-collar in ED, and was cleared after CT head and C-spine were negative. As above, infectious work-up negative. No evidence of cardiac etiology, and cardiac enzymes were negative. Patient was monitored on telemetry. BP stabilized, and she was seen by PT prior to discharge home. . Transitional Issues: -Code Status: The patient was a full code during this admission. -Imaging findings: CT abd/pelvis revealed possible endometrial wall thickening, and patient may benefit from pelvic ultrasound for further evaluation. CT C-spine showed calcification in the right thyroid lobe which could be evaluated with ultrasound in outpatient setting. -Patient needs outpatient colonoscopy and liver follow-up. Medications on Admission: 1) Atenolol 50 mg Tablet by mouth daily 2) Lisinopril 40 mg Tablet by mouth daily 3) Spironolactone-hydrochlorothiazide 25 mg-25 mg by mouth daily 4) Acetaminophen 500 mg Tablet by mouth Q6H:PRN Discharge Medications: 1. atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day. 2. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO QAM (once a day (in the morning)). 3. spironolactone 25 mg Tablet Sig: One (1) Tablet PO once a day. 4. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 5. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain. 6. calcium carbonate-vitamin D3 500 mg(1,250mg) -400 unit Tablet, Chewable Sig: One (1) Tablet, Chewable PO twice a day. Disp:*60 Tablet, Chewable(s)* Refills:*2* 7. omeprazole 40 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* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: GI bleeding of undetermined origin acute blood loss anemia Secondary Diagnosis: Hepatitis C Esophageal Varices Hypertension Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Ms. [**Known lastname 75684**], You were admitted to the hospital after you fell at home. You were found to have anemia, and received a blood transfusion. The anemia is likely from bleeding in your gastrointestinal tract. The gastroenterology doctors saw [**Name5 (PTitle) **], and they performed a procedure in which they looked in your esophagus and stomach with a camera. They saw some enlarged blood vessels, which may have been bleeding at some point, but there was no active bleeding while you were here. Your blood counts were stable after the transfusion. It is very important that you follow-up with primary care after you leave the hospital. You will need a colonoscopy, and should discuss this with your primary care doctor. You should also follow-up with the liver doctors next week. Your hepatitis C infection can cause damage to the liver over time, and will be important for the liver doctors to [**Name5 (PTitle) 788**] [**Name5 (PTitle) **]. The enlarged blood vessels in your esophagus can be related to the liver disease. We made the following changes to your medications: 1. STARTED omeprazole 2. STOPPED aspirin We did not make any other changes to your medications. Please continue to take them as you have been doing. Please discuss your medication list and blood pressure with your doctor at your follow-up appointment. Also, your imaging studies showed some thickening of your uterus which you should have followed up by your primary care physician. Followup Instructions: Please follow-up in the [**Hospital6 733**] Clinic next Wednesday, and with your new primary care doctor, Dr. [**Last Name (STitle) 12933**], in [**Month (only) 956**]. You will also need to have a colonoscopy done once you leave the hospital. Please follow-up in the liver clinic on Friday, [**2166-11-7**]. Department: [**Hospital3 249**] When: WEDNESDAY [**2166-11-5**] at 10:10 AM With: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Location: [**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 appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. [**Name10 (NameIs) 616**] this visit, you will see your regular primary care doctor in follow up. Department: LIVER CENTER When: FRIDAY [**2166-11-7**] at 8:20 AM With: [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) **], MD [**Telephone/Fax (1) 2422**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 858**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: [**Hospital3 249**] When: TUESDAY [**2167-1-6**] at 2:45 PM With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

578,276,572,070,571,285,456,535,780,401,294,424,786,E939,E935,E849

{'Hemorrhage of gastrointestinal tract, unspecified,Acidosis,Portal hypertension,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Acute posthemorrhagic anemia,Esophageal varices without mention of bleeding,Other specified gastritis, without mention of hemorrhage,Hypothermia not associated with low environmental temperature,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Aortic valve disorders,Apnea,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Other opiates and related narcotics causing adverse effects in therapeutic use,Accidents occurring in residential institution'}

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: 80 yo F with history of hypertension and HCV, presented to the ED today with acutely altered mental status this AM in the setting of two weeks of nausea, abdominal pain, and malaise. [**Name (NI) **] son reports that the patient had been more weak than normal in last several weeks and that she had been eating small bland meals. Last night she asked for tea and bread and then went to bed early. Her son reports finding her this morning slumped over next to the toilet. Patient had soiled herself, though no visible blood was seen by patient's son. . At presentation to ED vitals were: HR 86, BP 174/74, RR 14, O2Sat 100% RA. Patient was hypothermic (34C) upon arrival. Was initially alert with eyes open, though was not responding to commands. Initial labs showed a HCT down to 27 from a baseline of 38 in 5/[**2165**]. Also had lactate of 2.6. On exam, patient had dark brown, guaiac positive stools. Patient triggered for hypotension twice during ED course and was subsequently given a femoral CVC and 2L fluid and 2 units PRBC with stabilization of BP. GI consult saw patient in the ED and initially agreed with CT scan of abd/pelvis. Patient then was sent up to the ICU via radiology, where she received head CT, CT c-spine, and CT abd/pelvis. Prior to transfer to MICU vitals were: T afebrile, HR 90, BP 150/48, RR 16, 100% RA. MEDICAL HISTORY: 1) Hypertension 2) Hepatitis C 3) Aortic insufficiency 4) Eosinophilia 5) Strongyloidiasis 6) Low back pain 7) History of PPD positive MEDICATION ON ADMISSION: 1) Atenolol 50 mg Tablet by mouth daily 2) Lisinopril 40 mg Tablet by mouth daily 3) Spironolactone-hydrochlorothiazide 25 mg-25 mg by mouth daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission Exam: VS: T 97.8, HR 110, BP 158/76, RR 18, O2Sat 100% RA GEN: Flat in bed, asleep HEENT: PERRL, does not spontaneously open eyes, oral mucosa slightly dry NECK: In C-collar PULM: CTAB anteriorly CARD: Tachycardic, nl S1, no S2, no M/R/G ABD: BS+, soft, NT, ND, slightly tympanitic EXT: Scars along BLE, though no edema SKIN: no rashes seen NEURO: Obtunded, does not arouse to her name or sternal rub, grimace during ABG though did not withdraw . Discharge Exam: VS: 98.1 164/74 66 18 99% RA GENERAL: elderly woman, sleeping but easily arousable, NAD HEENT: sclera anicteric, MMM NECK: supple, no JVD appreciated CARDIAC: RRR, normal S1, S2, slight systolic murmur at LUSB LUNGS: CTAB, no crackles, wheezes or rhonchi appreciated ABDOMEN: bowel sounds present, soft, NT, ND, no guarding or rebound tenderness EXTREMITIES: warm, well-perfused, DP pulses 2+, no edema NEURO: oriented to person/place, not time (baseline per son), no asterixis FAMILY HISTORY: No family history of cancers, heart disease, hypertension, or diabetes. SOCIAL HISTORY: The patient is originally from [**Country 4812**] and moved here approximately three years ago. She denies any current or history of tobacco use, has an occasional alcoholic drink, and denies any drug use. She currently lives with her son and his two kids. ### Response: {'Hemorrhage of gastrointestinal tract, unspecified,Acidosis,Portal hypertension,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Acute posthemorrhagic anemia,Esophageal varices without mention of bleeding,Other specified gastritis, without mention of hemorrhage,Hypothermia not associated with low environmental temperature,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Aortic valve disorders,Apnea,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Other opiates and related narcotics causing adverse effects in therapeutic use,Accidents occurring in residential institution'}

CHIEF COMPLAINT: RLQ pain PRESENT ILLNESS: The patient is an 82 yo female who presented with a history of abdominal pain. She was residing at the [**Hospital 100**] Rehab facility, and her caregivers there reported that she complained of pain in the right lower quadrant area over a period of one day and that she had a low blood pressure. No fever or chills were reported, and the patient was having normal bowel function. MEDICAL HISTORY: Large obstructing pelvic hematoma, dementia, depression, osteoporosis, s/p compression fracture, chronic anemia, s/p TAH BSO, hypercholesterolemia, CHF (30-35% EF) MEDICATION ON ADMISSION: subQ heparin, zoloft, lidoderm, fosamax, colace, iron, FA ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: Vitals: 97.5, 89, 96/54, 16, 100% (RA) PE: Awake, alert, slightly confused, NAD; lungs clear to auscultation bilaterally, heart regular rate and rhythm, no murmurs, rubs or gallops; abdomen firm, distended, tender in the right lower quadrant, echymoses present, tympanitic, with guarding; rectal exam guaic negative, no lesions or masses appreciated; extremities warm, no peripheral edema. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: No tobacco, alcohol or drugs. Prior to her stay at the rehab facility she lived independently. She moved to the rehab facility after she suffered a fall earlier this year.

Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Injury to gastric artery,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hyperpotassemia,Thrombocytopenia, unspecified,Unspecified fall,Osteoporosis, unspecified,Other persistent mental disorders due to conditions classified elsewhere

Peritoneum injury-closed,Injury gastric artery,CHF NOS,Chr blood loss anemia,Hyperpotassemia,Thrombocytopenia NOS,Fall NOS,Osteoporosis NOS,Mental disor NEC oth dis

Admission Date: [**2117-5-20**] Discharge Date: [**2117-6-1**] Service: [**Doctor First Name 147**] Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 974**] Chief Complaint: RLQ pain Major Surgical or Invasive Procedure: Laparoscopic hematoma evacuation History of Present Illness: The patient is an 82 yo female who presented with a history of abdominal pain. She was residing at the [**Hospital 100**] Rehab facility, and her caregivers there reported that she complained of pain in the right lower quadrant area over a period of one day and that she had a low blood pressure. No fever or chills were reported, and the patient was having normal bowel function. Past Medical History: Large obstructing pelvic hematoma, dementia, depression, osteoporosis, s/p compression fracture, chronic anemia, s/p TAH BSO, hypercholesterolemia, CHF (30-35% EF) Social History: No tobacco, alcohol or drugs. Prior to her stay at the rehab facility she lived independently. She moved to the rehab facility after she suffered a fall earlier this year. Family History: Noncontributory Physical Exam: Vitals: 97.5, 89, 96/54, 16, 100% (RA) PE: Awake, alert, slightly confused, NAD; lungs clear to auscultation bilaterally, heart regular rate and rhythm, no murmurs, rubs or gallops; abdomen firm, distended, tender in the right lower quadrant, echymoses present, tympanitic, with guarding; rectal exam guaic negative, no lesions or masses appreciated; extremities warm, no peripheral edema. Pertinent Results: Labs: WBC - 16.4, Hct - 25.1, Plts - 179, Na - 137, K 4.4, Cl 103, HCO3 - 24, BUN - 35, Crt - 1, Gluc - 154, UA negative, LFTs and amylase normal, INR - 1.2, PT - 13.5, PTT - 50.5 - CT scan revealed a large fluid collection within the right pelvis c/w a hematoma - obstruction of the urinary outflow tract was noted Brief Hospital Course: The patient was admitted to the Blue Medicine service under the care of Dr.[**Last Name (STitle) **]. She was made NPO and started on IVF for resuscitation. Blood was typed and crossed in preparation for surgery. Appropriate consent was obtained. She did well during the procedure. A central venous line was placed prior to surgery and after the evacuation she was initially transferred to the ICU. Her pain was treated with dilaudid and po pain meds. She was transferred to the floor on POD#2. On the floor, the patient's diet was advanced and she was ordered for a PT consult. She underwent periods of confusion during this time, requiring restraints on POD#6. Her nutritional status was a primary focus during her post-op recovery. Her diet was advanced, but she did not eat independently and required continued intravenous fluids and encouragement and feeding from nursing staff. By the time of discharge, she was tolerating po with assistance in feeding from nursing staff. She was passing gas and having regular bowel movements. She was incontinent and required placement of a foley catheter in order to keep track of her ins/outs. Her peripheral IV was discontinued prior to discharge. Medications on Admission: subQ heparin, zoloft, lidoderm, fosamax, colace, iron, FA Discharge Medications: Metoprolol 50 mg PO BID Ranitidine 150 mg PO BID Acetaminophen 650 mg PR Q4-6H:PRN Docusate Sodium 100 mg PO BID Alendronate Sodium 10 mg PO QD Sertraline HCl 50 mg PO QD Insulin SC Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: s/p exploratory laparotomy and evacuation of pelvic hematoma Discharge Condition: Good Discharge Instructions: No subcutaneous heparin. Extreme care with any subcutaneous injections. Call Dr.[**Name (NI) 18535**] office with fever over 101.5 degrees. Ensure adequate oral intake

868,902,428,280,276,287,E888,733,294

{'Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Injury to gastric artery,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hyperpotassemia,Thrombocytopenia, unspecified,Unspecified fall,Osteoporosis, unspecified,Other persistent mental disorders due to conditions classified elsewhere'}

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: RLQ pain PRESENT ILLNESS: The patient is an 82 yo female who presented with a history of abdominal pain. She was residing at the [**Hospital 100**] Rehab facility, and her caregivers there reported that she complained of pain in the right lower quadrant area over a period of one day and that she had a low blood pressure. No fever or chills were reported, and the patient was having normal bowel function. MEDICAL HISTORY: Large obstructing pelvic hematoma, dementia, depression, osteoporosis, s/p compression fracture, chronic anemia, s/p TAH BSO, hypercholesterolemia, CHF (30-35% EF) MEDICATION ON ADMISSION: subQ heparin, zoloft, lidoderm, fosamax, colace, iron, FA ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: Vitals: 97.5, 89, 96/54, 16, 100% (RA) PE: Awake, alert, slightly confused, NAD; lungs clear to auscultation bilaterally, heart regular rate and rhythm, no murmurs, rubs or gallops; abdomen firm, distended, tender in the right lower quadrant, echymoses present, tympanitic, with guarding; rectal exam guaic negative, no lesions or masses appreciated; extremities warm, no peripheral edema. FAMILY HISTORY: Noncontributory SOCIAL HISTORY: No tobacco, alcohol or drugs. Prior to her stay at the rehab facility she lived independently. She moved to the rehab facility after she suffered a fall earlier this year. ### Response: {'Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum,Injury to gastric artery,Congestive heart failure, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Hyperpotassemia,Thrombocytopenia, unspecified,Unspecified fall,Osteoporosis, unspecified,Other persistent mental disorders due to conditions classified elsewhere'}

CHIEF COMPLAINT: Endometrial cancer PRESENT ILLNESS: 76 yo GO found to have thickened endometrium on CT done for surveillance due to history of breast cancer. CT also showed bilateral ovarian cysts. Pt's CA-125 was elevated at 22 in [**2-23**] in [**4-24**]. D&C [**2127-5-26**] revealed endometrial adenocarcinoma. Pt presents now for TAH/BSO/staging for endometrial CA. MEDICAL HISTORY: Past Surgical History: -R hip replacement -shoulder replacement -lumpectomy in [**2121**] for breast CA -D&C for menorrhagia in [**2071**]'s MEDICATION ON ADMISSION: -Lasix 40mg PO qd -Toprol XL 100mg PO qd -Omeprazole 40 mg PO qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pre-admission PE GENERAL: She appeared well and was moderately overweight. She was in no acute distress. SKIN: Sclerae anicteric. Lymph node survey was negative. ABDOMEN: Soft, nondistended and without palpable masses. EXTREMITIES: Without edema. PELVIC: The vulva and vagina were normal. The cervix was very difficult to visualize, as the vagina was quite narrow and the apex was quite high. In addition, the patient had a great deal of difficulty in fully relaxing. Despite several attempts, the speculum could not be positioned such that the cervix was exposed. Any attempt at endometrial biopsy was therefore abandoned. Bimanual examination was similarly limited. The vaginal walls were smooth, and the cervix was normal to palpation. There were no palpable pelvic masses. RECTAL: Examination was confirmatory. There was no cul-de-sac nodularity and the rectum was intrinsically normal. FAMILY HISTORY: Niece-breast CA, No endometrial/ovarian/colon CA SOCIAL HISTORY: Lives at [**Location **], not married. Remote Hx tobacco, occassional wine, no other drugs.

Malignant neoplasm of corpus uteri, except isthmus,Atrial fibrillation,Pathologic fracture of vertebrae,Urinary tract infection, site not specified,Pulmonary collapse,Pneumonitis due to inhalation of food or vomitus,Acute posthemorrhagic anemia,Diastolic heart failure, unspecified,Unspecified pleural effusion,Personal history of malignant neoplasm of breast,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Constipation, unspecified,Cardiac pacemaker in situ,Benign neoplasm of ovary

Malig neo corpus uteri,Atrial fibrillation,Path fx vertebrae,Urin tract infection NOS,Pulmonary collapse,Food/vomit pneumonitis,Ac posthemorrhag anemia,Diastolc hrt failure NOS,Pleural effusion NOS,Hx of breast malignancy,Klebsiella pneumoniae,Iatrogenc hypotnsion NEC,Abn react-surg proc NEC,Accident in place NEC,Constipation NOS,Status cardiac pacemaker,Benign neoplasm ovary

Admission Date: [**2127-6-23**] Discharge Date: [**2127-7-8**] Date of Birth: [**2051-2-12**] Sex: F Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 898**] Chief Complaint: Endometrial cancer Major Surgical or Invasive Procedure: TAH/BSO/staging for endometrial CA Central Line placement History of Present Illness: 76 yo GO found to have thickened endometrium on CT done for surveillance due to history of breast cancer. CT also showed bilateral ovarian cysts. Pt's CA-125 was elevated at 22 in [**2-23**] in [**4-24**]. D&C [**2127-5-26**] revealed endometrial adenocarcinoma. Pt presents now for TAH/BSO/staging for endometrial CA. Past Medical History: Past Surgical History: -R hip replacement -shoulder replacement -lumpectomy in [**2121**] for breast CA -D&C for menorrhagia in [**2071**]'s Past Medical History: 1. Breast CA s/p radiation therapy [**2121**], on adjuvant chemo 2. Osteoporosis with mult compression fx of vertebrae 3. OA of shoulder, hip s/p R hip replacement 4. A Fib, parox, on amio but no anticoag given fall hx and risk 5. Tachy-brady Synd, s/p PPM 6. Chronic hypoxia, followed by Pulm 7. Chronic recurrent b/l pleural effusions, s/p taps and biopsies with no evid of malignancy Social History: Lives at [**Location **], not married. Remote Hx tobacco, occassional wine, no other drugs. Family History: Niece-breast CA, No endometrial/ovarian/colon CA Physical Exam: Pre-admission PE GENERAL: She appeared well and was moderately overweight. She was in no acute distress. SKIN: Sclerae anicteric. Lymph node survey was negative. ABDOMEN: Soft, nondistended and without palpable masses. EXTREMITIES: Without edema. PELVIC: The vulva and vagina were normal. The cervix was very difficult to visualize, as the vagina was quite narrow and the apex was quite high. In addition, the patient had a great deal of difficulty in fully relaxing. Despite several attempts, the speculum could not be positioned such that the cervix was exposed. Any attempt at endometrial biopsy was therefore abandoned. Bimanual examination was similarly limited. The vaginal walls were smooth, and the cervix was normal to palpation. There were no palpable pelvic masses. RECTAL: Examination was confirmatory. There was no cul-de-sac nodularity and the rectum was intrinsically normal. Pertinent Results: [**2127-6-23**] 06:23PM BLOOD WBC-16.1* RBC-3.29* Hgb-11.2* Hct-33.2*# MCV-101* MCH-33.9* MCHC-33.6 RDW-13.4 Plt Ct-260 [**2127-6-24**] 04:40PM BLOOD WBC-11.2* RBC-3.05* Hgb-10.3* Hct-31.2* MCV-102* MCH-33.8* MCHC-33.0 RDW-13.6 Plt Ct-234 [**2127-6-27**] 07:01AM BLOOD WBC-6.0 RBC-2.67* Hgb-9.1* Hct-26.4* MCV-99* MCH-34.2* MCHC-34.6 RDW-13.2 Plt Ct-217 [**2127-7-2**] 06:00AM BLOOD WBC-14.3* RBC-3.52* Hgb-11.2* Hct-33.7* MCV-96 MCH-31.9 MCHC-33.4 RDW-19.0* Plt Ct-356 [**2127-7-6**] 05:50AM BLOOD WBC-19.5* RBC-3.93* Hgb-12.2 Hct-37.4 MCV-95 MCH-30.9 MCHC-32.5 RDW-18.7* Plt Ct-543* [**2127-7-8**] 07:00AM BLOOD WBC-14.5* RBC-3.75* Hgb-11.8* Hct-36.0 MCV-96 MCH-31.3 MCHC-32.7 RDW-18.3* Plt Ct-431 [**2127-6-29**] 09:29AM BLOOD Neuts-90.6* Bands-0 Lymphs-5.2* Monos-2.5 Eos-1.4 Baso-0.4 [**2127-7-2**] 01:31PM BLOOD Neuts-74* Bands-1 Lymphs-11* Monos-4 Eos-6* Baso-1 Atyps-1* Metas-1* Myelos-1* [**2127-6-29**] 09:29AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-1+ Macrocy-NORMAL Microcy-NORMAL Polychr-1+ Ovalocy-1+ [**2127-7-2**] 01:31PM BLOOD Hypochr-NORMAL Anisocy-2+ Poiklo-NORMAL Macrocy-2+ Microcy-1+ Polychr-NORMAL [**2127-6-23**] 06:23PM BLOOD Plt Ct-260 [**2127-6-25**] 03:57AM BLOOD PT-12.3 PTT-28.1 INR(PT)-1.1 [**2127-7-8**] 07:00AM BLOOD Plt Ct-431 [**2127-6-23**] 06:23PM BLOOD Glucose-268* UreaN-19 Creat-0.9 Na-139 K-4.3 Cl-107 HCO3-22 AnGap-14 [**2127-7-7**] 06:40AM BLOOD Glucose-100 UreaN-13 Creat-0.7 Na-136 K-4.3 Cl-100 HCO3-24 AnGap-16 [**2127-6-24**] 12:44AM BLOOD CK(CPK)-59 [**2127-7-6**] 05:50AM BLOOD ALT-14 AST-16 LD(LDH)-245 AlkPhos-53 Amylase-133* TotBili-0.3 [**2127-7-7**] 06:40AM BLOOD ALT-12 AST-18 AlkPhos-50 Amylase-85 TotBili-0.4 [**2127-7-6**] 05:50AM BLOOD Lipase-153* [**2127-7-7**] 06:40AM BLOOD Lipase-77* [**2127-6-24**] 12:44AM BLOOD CK-MB-3 cTropnT-<0.01 [**2127-6-30**] 05:55AM BLOOD proBNP-6339* [**2127-6-23**] 06:23PM BLOOD Calcium-7.8* Phos-4.2 Mg-1.6 [**2127-6-29**] 09:29AM BLOOD Albumin-2.9* Calcium-7.5* Phos-2.3* Mg-1.9 [**2127-7-4**] 07:30AM BLOOD TotProt-5.0* Mg-1.9 [**2127-7-6**] 05:50AM BLOOD Albumin-3.3* Mg-2.0 [**2127-6-24**] 04:40PM BLOOD Cortsol-29.2* [**2127-7-3**] 04:02PM BLOOD [**Doctor First Name **]-NEGATIVE [**2127-6-24**] 04:16AM BLOOD Lactate-1.9 Na-134* K-4.0 Cl-106 calHCO3-24 [**2127-6-24**] 04:16AM BLOOD Hgb-10.0* calcHCT-30 [**2127-7-6**] 10:31AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.010 [**2127-7-2**] 12:18PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.005 [**2127-6-24**] 02:36AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.030 [**2127-7-6**] 10:31AM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-MOD [**2127-7-2**] 12:18PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG [**2127-6-24**] 02:36AM URINE Blood-LG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG [**2127-7-6**] 10:31AM URINE RBC-13* WBC-99* Bacteri-MOD Yeast-NONE Epi-<1 [**2127-6-24**] 02:36AM URINE RBC-52* WBC-11* Bacteri-NONE Yeast-NONE Epi-<1 RenalEp-2 [**2127-6-24**] 02:36AM URINE CastGr-2* CastHy-4* [**2127-7-6**] 10:31AM URINE AmorphX-RARE . Microbiology [**2127-6-24**] 2:36 am URINE **FINAL REPORT [**2127-6-25**]** URINE CULTURE (Final [**2127-6-25**]): NO GROWTH. [**2127-7-2**] 12:18 pm URINE **FINAL REPORT [**2127-7-6**]** URINE CULTURE (Final [**2127-7-6**]): KLEBSIELLA PNEUMONIAE. >100,000 ORGANISMS/ML.. ESCHERICHIA COLI. 10,000-100,000 ORGANISMS/ML. PRESUMPTIVE IDENTIFICATION. SENSITIVITIES: MIC expressed in MCG/ML _________________________________________________________ KLEBSIELLA PNEUMONIAE | ESCHERICHIA COLI | | AMPICILLIN------------ 4 S AMPICILLIN/SULBACTAM-- 4 S 4 S CEFAZOLIN------------- <=4 S <=4 S CEFEPIME-------------- <=1 S <=1 S CEFTAZIDIME----------- <=1 S <=1 S CEFTRIAXONE----------- <=1 S <=1 S CEFUROXIME------------ <=1 S 4 S CIPROFLOXACIN---------<=0.25 S <=0.25 S GENTAMICIN------------ <=1 S <=1 S IMIPENEM-------------- <=1 S <=1 S LEVOFLOXACIN----------<=0.25 S <=0.25 S MEROPENEM-------------<=0.25 S <=0.25 S NITROFURANTOIN-------- 64 I <=16 S PIPERACILLIN---------- <=4 S PIPERACILLIN/TAZO----- <=4 S <=4 S TOBRAMYCIN------------ <=1 S <=1 S TRIMETHOPRIM/SULFA---- <=1 S <=1 S . [**2127-7-2**] 1:54 pm PLEURAL FLUID **FINAL REPORT [**2127-7-8**]** GRAM STAIN (Final [**2127-7-2**]): 2+ (1-5 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2127-7-5**]): NO GROWTH. ANAEROBIC CULTURE (Final [**2127-7-8**]): NO GROWTH. . [**2127-7-6**] 10:31 am URINE **FINAL REPORT [**2127-7-7**]** URINE CULTURE (Final [**2127-7-7**]): KLEBSIELLA PNEUMONIAE. >100,000 ORGANISMS/ML.. IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # 210-1766H([**2127-7-2**]). ESCHERICHIA COLI. 10,000-100,000 ORGANISMS/ML.. IDENTIFICATION AND SENSITIVITIES PERFORMED ON CULTURE # 210-1766H([**2127-7-2**]). Imaging: . CHEST PORT. LINE PLACEMENT [**2127-6-24**] 4:27 PM Portable chest radiograph compared to the previous one done the same day at 5:01 a.m. IMPRESSION: The right internal jugular line tip was inserted with its tip projecting over the distal portion of superior vena cava. There is no pneumothorax or enlarged pleural effusion. The heart size is enlarged but stable. Bilateral small amount of pleural effusion is unchanged, more on the right. The prosthesis in the left humerus and severe changes in the right humerus are stable as well. . CHEST (PORTABLE AP) [**2127-6-24**] 5:43 AM UPRIGHT AP VIEW OF THE CHEST: Mild cardiomegaly is unchanged. Left-sided dual chamber [**Month/Day/Year 4448**] with leads terminating in the right atrium and right ventricle is unchanged. Increased prominence of the azygos contour and increased right basilar hazy opacity reflect increasing asymmetric pulmonary edema, right greater than left. Small right pleural effusion has increased in size, and a small left pleural effusion is stable. Hiatal hernia is unchanged. There is no pneumothorax. Severe degenerative changes are present in the right shoulder, and the patient is status post left shoulder hemiarthroplasty. IMPRESSION: Increasing mild asymmetric pulmonary edema, right greater than left, with increasing small right pleural effusion. . TTE [**2127-6-24**] 1. The left atrium is markedly dilated. The right atrium is moderately dilated. 2. Left ventricular wall thickness, cavity size, and systolic function are normal (LVEF>55%). Regional left ventricular wall motion is normal. 3. The aortic valve leaflets (3) are mildly thickened. 4. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. 5. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. 6. There is a moderate sized pericardial effusion. The effusion is echo dense, consistent with blood, inflammation or other cellular elements. There are no echocardiographic signs of tamponade. 7. Compared with the report of the prior study (images unavailable for review)of [**2126-5-17**], the pulmonary hypertension is worse. . EKG [**2127-6-24**] Atrial fibrillation with a rapid ventricular response. No change since the previous tracing of [**2127-5-22**]. Diffuse non-specific ST-T wave abnormalities persist. . EKG [**2127-6-26**] Atrial fibrillation with rapid ventricular response RSR' in V1 Generalized low QRS voltages Since previous tracing of [**2127-6-25**], no significant change . CHEST (PA & LAT) [**2127-6-29**] 10:20 AM FINDINGS: Comparison is made to the previous study from [**2127-6-24**]. There is a left humeral prosthesis. There is a left-sided dual-lead [**Year (4 digits) 4448**]. There is a right IJ central venous catheter with the distal tip in the proximal SVC. There is cardiomegaly, unchanged. There are persistent bilateral pleural effusions which are unchanged, right greater than left. Mild interstitial prominence is seen, which is stable. IMPRESSION: No interval change. Persistent cardiomegaly with bilateral pleural effusions and slight interstitial pulmonary prominence. . CTA CHEST W&W/O C &RECONS [**2127-6-30**] 7:46 PM COMPARISONS: Comparison is made to [**2127-2-25**]. CTA OF THE CHEST: There is significant interval worsening of bilateral pleural effusions, now moderate in size and right greater than left. There is bilateral basilar atelectasis. Again seen is a 1.7-mm lung nodule in the right lower lobe. This appears to be stable since [**2125**] suggesting benignancy. There is cardiomegaly. The great vessels appear unremarkable. The pulmonary vasculature is opacified without evidence of intraluminal filling defects to suggest the presence of pulmonary embolism. No mediastinal or hilar lymphadenopathy is seen. Several medistinal lymph nodes do not meet size criteria for pathologic enlargement. There are bilateral nodules within the thyroid lobes. The partially visualized upper abdominal organs are notable for abdominal ascites around the liver. Bone windows demonstrate severe degenerative changes in the thoracic spine, but no evidence of suspicious lytic or sclerotic lesions. IMPRESSION: 1. No evidence of pulmonary embolism. 2. Interval increase in bilateral pleural effusions and bilateral basilar atelectasis. 3. Stable right lower lobe lung nodule. 4. Abdominal ascites. . ABDOMEN (SUPINE ONLY) [**2127-7-2**] 10:19 AM SUPINE ABDOMINAL RADIOGRAPH: There are mildly dilated loops of small bowel as well as air seen in the ascending, descending, and transverse colon. There is no evidence of obstruction. Clips are seen overlying the abdomen. The patient is status post prior vertebroplasty of a lower thoracic vertebra. There is a right-sided bipolar hemiarthroplasty. No bilateral pleural effusions. IMPRESSION: No evidence of obstruction. . [**2127-7-3**] ECHO with bubble study 1. The left atrium is markedly dilated. The right atrium is moderately dilated. 2. No atrial septal defect or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers. 3. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). 4. The right ventricular cavity is moderately dilated. 5. The aortic valve leaflets (3) are mildly thickened. 6. The mitral valve leaflets are mildly thickened. Moderate [2+] tricuspid regurgitation is seen. 7. There is a moderate sized pericardial effusion. The effusion is echo dense, consistent with blood, inflammation or other cellular elements. . CHEST (PA & LAT) [**2127-7-6**] 11:08 AM IMPRESSION: PA and lateral chest compared to [**6-29**] and 14: Small left and moderate right pleural effusion have improved since [**6-29**]. Now more heterogeneous opacification in the right and mid and lower lung than there was on [**7-2**]. Although this could be asymmetric edema, the simultaneous improvement in effusions suggest that this is pneumonia instead, quite likely aspiration. Right internal jugular line and transvenous right atrial and right ventricular pacer leads are unchanged in their standard positions. No pneumothorax. Brief Hospital Course: Ms. [**Known lastname 109973**] is a 76 yo lady with multiple medical problems admitted to the GYN service for TAH/BSO and transferred to the medicine service initially for hypotension post op and later for A.fib with RVR and CHF. Her hospital course is summarized below. . [**Hospital Unit Name 153**] course: The pt was admitted to the [**Hospital Unit Name 153**] for management of post-op (s/p TAH/BSO for endometrial ca) hypotension in the setting of post-op sedation. Ms. [**Known lastname 109973**] was treated with a pressor and boluses of LR with no significant improvement of BP (remained in low 100). She was noted to have a HCT drop (43->35) after fluid resuscitation. She was gradually weaned off pressors. The pt had very poor peripheral access so a R IJ was placed for fluid resuscitation. Her repeat HCT showed a further drop. The patient was noted to be in Afib on admission, consistent with her past medical history. Her cardiac enzymes were negative. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 104**] stim test was negative for adrenal insufficiency. . On the day after admission, the pt's EKG was significant for uniformly low voltages in all leads. A cardiac ECHO showed moderate pulmonary artery systolic hypertension, a moderate sized pericardial effusion (echo dense, consistent with blood, inflammation or other cellular elements) with no evidence of tamponade; these findings have been noted on previous ECHO dating back to 10/[**2125**]. The pt's CXR was significant for increased mild asymmetric pulmonary edema (R>L), with increasing small R pleural effusion. It was noted that her BPs would fall with each administration of narcotics; these were weaned off and her BPs remained stable. It was thought that her hypotension was likely due to iatrogenic narcotic use, and these were tapered off as tolerated. . Patient improved and transferred back to gyn service on [**2127-6-25**]. Patient remained in A.fib with transient episodes of RVR. Cardiology was consulted who suggested increase standing dose to Toprol 100mg qd + IV Lopressor 5mg prn. Patient had tachy episodes to 150s-170s x 2 on [**6-25**] & [**6-26**], EKGs showing afib w/RVR. [**Month/Day (4) **] interrogated [**6-26**], functioning fine and only V-paces when bradycardic. Patient remained tachy to 120s on [**6-28**], per cards changed Toprol to Lopressor 50mg PO TID, titrate to 75 mg TID for adequate beta blockade. CXR on [**6-29**] CXR showing effusion and cardiomegaly unchanged from prior. . The medicine service continued to follow the patient while on the GYN service. The patient noted to be wheezing, desated transiently to 75% RA while ambulating. Patient known to have restrictive lung dz [**2-20**] to b/l pleural effusions and DOE and is followed in [**Hospital **] clinic, who recommended home O2 w/exertion, however pt declined use of home O2 in the past. Patient continued sating mid 90s on RA (baseline). ROS negative aside from audible wheezing (new per patient)and dyspnea at rest "can't get enough air". Patient reported being able to walk to the door and back but develops palpitations and SOB. Prior was living in apartment and was able to do ADLs without similar limitations. The decision was made to transfer the patient to the medicine service for further management of her shortness of breath as well as difficult to control A.fib with RVR. Her hospital course on the medicine service is summarized below. . # Sob/Hypoxia: Likely Multifactorial given patient with known lung disease, b/l pleural effusions, stable pericardial effusion, CHF and volume overload, A.fib with RVR and platypnea-orthodeoxia (see below). PE was ruled out with CTA given patient was post op with tachycardia and SOB. On exam, patient was wheezing primarily upper airway with intermittent stridor. ENT was consulted who performed laryngoscopy which was non revealing. Patient was treated symtomatically with diuresis, Albuterol/Atrovent nebs prn, incentive spirometry. Thoracentesis was also performed for for syptom relief. This was negative for infection and was consistent with a transudative process. Patient improved gradually with ongoing diuresis and control of her A.fib with RVR. Upon discharge she was able to ambulate the floor while maintaining her saturations in the low 90s. Patient is to have close flow up after discharge for ongoing management. Patient would also benefit from home O2 however she continues to refuse this option since she does not feel the need for oxygen. She is discharged home to her assissted living. . # UTI: Pansensitive UTI with leukocytosis. Treated with cipro po for 7 day course. Patient remained afebrile. . # Platypnea-Orthodeoxia: Very unclear etiology. Patient noted to desat to low 80s upon sitting up on bed with improvement in her sats to mid 90's when lying supine. Patient also experience dyspnea with air hunger when sitting up. A positional echo was performed however it was negative for ASD/PFO. Patient then improved with ongoing diuresis. Patient was evaluated by the pulmonary service who recommended the above echo as well as [**Doctor First Name **] to r/out CT disease. Other potential work up as an outpatient may include [**Name (NI) 5283**] son[**Name (NI) **] or V/Q scan to assess for cirrhosis (unlikely) or vascular shunts. Given that the patient improved and was ambulating the pod while mataining her sats in the low 90s, the medicine team did not feel that she should remain in hospital for ongoing workup. # CVS: PUMP: EF >55%, transient hypotension s/p sedation and narcotic use s/p stay in ICU requiring transient pressors. Upon transfer to the medicine service the patient was clearly volume overloaded post op and after receiving fluids in the ICU. Her BNP significantly elevated. Patient was diuresed with IV lasix with goal I/Os negative 1L daily. She diuresed significantly to lasix with dramatic improvement in her symptoms. Patient was discharged home on 40 mg po lasix. She was continued on an ACEI and BB/CCB for rate control. She will need close PCP follow up for adjustment in her medications if needed. . RHYTHM: A.fib with RVR, SSS s/p PPM. Patient with chronic A.fib not on anticoagulation due to fall risk. Her HR has been relatively well controlled as an outpatient however patient went into RVR post op. Patient did not experience any chest discomfort but did have baseline shortness of breath. Her HR was controlled with lopressor which was uptitrated to 100 mg TID. Diltiazem was them added for further control. She was monitored on telemetry throughout with improvement in HR ranging 80-90s. Patient was discharged on 50 mg lopressor TID with 120 mg long acting CCB. She is followed by the cardiology clinic as an outpatient. . ISCHEMIA. No evidence of ischemia, no CP although patient has dyspnea on exertion likely secondary to her above pulmonary disease. CE negative x neg x 1 on [**6-24**]. Continued ASA, BB. . # Anemia: Stable at 33. On [**6-27**] transfused for Hct 26.4 likely [**2-20**] to post op blood loss. . # Endometrial CA: s/p tab/bso and lymph node dissection, followed by GYN service. The patient's wound remained clean, dry and intact. Staples removed prior to discharge. Patient scheduled with close GYN follow up as an outpatient. . # Access: poor PIV access; central line in RIJ - d/ced day prior to discharge. . # Prophylaxis: Pneumoboots, TEDS, Heparin SC TID, ambulation, po diet . Nutrition. Patient's diet was advanced as tolerated post surgery. She was eating well upon discharge. Her electrolytes remained stable. . Patient remained a full code throughout this admission. Medications on Admission: -Lasix 40mg PO qd -Toprol XL 100mg PO qd -Omeprazole 40 mg PO qd Discharge Medications: 1. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO every [**6-26**] hours as needed for constipation. Disp:*qs ML(s)* Refills:*0* 2. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1) Capsule, Sustained Release PO DAILY (Daily). Disp:*30 Capsule, Sustained Release(s)* Refills:*2* 3. Simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for for gas and bloating. Disp:*30 Tablet, Chewable(s)* Refills:*0* 4. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). Disp:*180 Tablet(s)* Refills:*2* 5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed. Disp:*30 Tablet(s)* Refills:*2* 6. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 7. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 5 days. Disp:*10 Tablet(s)* Refills:*0* 8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO DAILY (Daily) as needed. Disp:*30 Capsule(s)* Refills:*2* 9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 10. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed. Disp:*30 Tablet(s)* Refills:*0* 11. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). Disp:*240 Tablet(s)* Refills:*2* 12. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*2* 13. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for 10 days. Disp:*30 Tablet(s)* Refills:*0* 14. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: [**1-20**] Inhalation every 6-8 hours as needed for shortness of breath or wheezing. Disp:*qs 1* Refills:*0* 15. Omeprazole 40 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* 16. Cepacol 2 mg Lozenge Sig: One (1) Lozenge Mucous membrane PRN (as needed). Disp:*30 Lozenge(s)* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Endometrial cancer Discharge Condition: Stable Discharge Instructions: Pelvic rest x 6 wks (2 for laparoscopy) No heavy lifting x 6 wks Call for fevers >101o No driving while taking narcotics Followup Instructions: You have the following appointments scheduled: 1. Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] B. GYN ONC PPS (SB) Date/Time:[**2127-7-24**] 1:00 Provider: [**Name10 (NameIs) **],[**First Name3 (LF) **] B. [**Telephone/Fax (1) 5777**] 2. Provider: [**Name10 (NameIs) **] CALL Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2127-8-26**] 10:30 3. Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2127-10-29**] 4:00 Completed by:[**2127-7-19**]

182,427,733,599,518,507,285,428,511,V103,041,458,E878,E849,564,V450,220

{"Malignant neoplasm of corpus uteri, except isthmus,Atrial fibrillation,Pathologic fracture of vertebrae,Urinary tract infection, site not specified,Pulmonary collapse,Pneumonitis due to inhalation of food or vomitus,Acute posthemorrhagic anemia,Diastolic heart failure, unspecified,Unspecified pleural effusion,Personal history of malignant neoplasm of breast,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Constipation, unspecified,Cardiac pacemaker in situ,Benign neoplasm of ovary"}

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: Endometrial cancer PRESENT ILLNESS: 76 yo GO found to have thickened endometrium on CT done for surveillance due to history of breast cancer. CT also showed bilateral ovarian cysts. Pt's CA-125 was elevated at 22 in [**2-23**] in [**4-24**]. D&C [**2127-5-26**] revealed endometrial adenocarcinoma. Pt presents now for TAH/BSO/staging for endometrial CA. MEDICAL HISTORY: Past Surgical History: -R hip replacement -shoulder replacement -lumpectomy in [**2121**] for breast CA -D&C for menorrhagia in [**2071**]'s MEDICATION ON ADMISSION: -Lasix 40mg PO qd -Toprol XL 100mg PO qd -Omeprazole 40 mg PO qd ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pre-admission PE GENERAL: She appeared well and was moderately overweight. She was in no acute distress. SKIN: Sclerae anicteric. Lymph node survey was negative. ABDOMEN: Soft, nondistended and without palpable masses. EXTREMITIES: Without edema. PELVIC: The vulva and vagina were normal. The cervix was very difficult to visualize, as the vagina was quite narrow and the apex was quite high. In addition, the patient had a great deal of difficulty in fully relaxing. Despite several attempts, the speculum could not be positioned such that the cervix was exposed. Any attempt at endometrial biopsy was therefore abandoned. Bimanual examination was similarly limited. The vaginal walls were smooth, and the cervix was normal to palpation. There were no palpable pelvic masses. RECTAL: Examination was confirmatory. There was no cul-de-sac nodularity and the rectum was intrinsically normal. FAMILY HISTORY: Niece-breast CA, No endometrial/ovarian/colon CA SOCIAL HISTORY: Lives at [**Location **], not married. Remote Hx tobacco, occassional wine, no other drugs. ### Response: {"Malignant neoplasm of corpus uteri, except isthmus,Atrial fibrillation,Pathologic fracture of vertebrae,Urinary tract infection, site not specified,Pulmonary collapse,Pneumonitis due to inhalation of food or vomitus,Acute posthemorrhagic anemia,Diastolic heart failure, unspecified,Unspecified pleural effusion,Personal history of malignant neoplasm of breast,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Constipation, unspecified,Cardiac pacemaker in situ,Benign neoplasm of ovary"}

CHIEF COMPLAINT: Left rib pain/LUQ pain PRESENT ILLNESS: 67 yo M s/p CABG/MVR [**2-23**] with complicated post op course, dc'd home3/16, returned to [**Location **] [**3-21**] c/o LUQ/chest pain. Also c/o some SOB secondary to pain. MEDICAL HISTORY: CAD s/p CABGx2 [**2124**], PPM, multiple PCI, NIDDM, GERD s/p dilation of esophageal stricture, proxysmal A.fib, HTN MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 98.0 [**Telephone/Fax (1) 2488**] 16 NAD Lungs with decreased breath sounds bilaterally with crackles at both bases CV RRR Sternum C/D/I Abd benign Extrem without edema Pain to palpation at left rib cage FAMILY HISTORY: NC SOCIAL HISTORY: retired communications technician

Unspecified pleural effusion,Atrial fibrillation,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,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Aortocoronary bypass status

Pleural effusion NOS,Atrial fibrillation,Abn react-anastom/graft,Mth sus Stph aur els/NOS,DMII wo cmp nt st uncntr,Esophageal reflux,Hypertension NOS,Hyperlipidemia NEC/NOS,Aortocoronary bypass

Admission Date: [**2151-3-21**] Discharge Date: [**2151-3-29**] Date of Birth: [**2084-2-28**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1283**] Chief Complaint: Left rib pain/LUQ pain Major Surgical or Invasive Procedure: [**3-21**] Left Thoracentesis [**3-22**] Left Chest tube insertion History of Present Illness: 67 yo M s/p CABG/MVR [**2-23**] with complicated post op course, dc'd home3/16, returned to [**Location **] [**3-21**] c/o LUQ/chest pain. Also c/o some SOB secondary to pain. Past Medical History: CAD s/p CABGx2 [**2124**], PPM, multiple PCI, NIDDM, GERD s/p dilation of esophageal stricture, proxysmal A.fib, HTN Social History: retired communications technician Family History: NC Physical Exam: 98.0 [**Telephone/Fax (1) 2488**] 16 NAD Lungs with decreased breath sounds bilaterally with crackles at both bases CV RRR Sternum C/D/I Abd benign Extrem without edema Pain to palpation at left rib cage Pertinent Results: [**2151-3-29**] 07:10AM BLOOD WBC-4.7 RBC-3.39* Hgb-9.5* Hct-29.9* MCV-88 MCH-27.9 MCHC-31.7 RDW-14.6 Plt Ct-183 [**2151-3-29**] 07:10AM BLOOD Plt Ct-183 [**2151-3-25**] 02:54AM BLOOD PT-14.0* PTT-37.3* INR(PT)-1.2* [**2151-3-29**] 07:10AM BLOOD Glucose-126* UreaN-23* Creat-1.3* Na-136 K-4.1 Cl-104 HCO3-26 AnGap-10 [**2151-3-27**] 05:45AM BLOOD Glucose-112* UreaN-32* Creat-1.5* Na-136 K-3.6 Cl-99 HCO3-29 AnGap-12 [**2151-3-26**] 04:45AM BLOOD UreaN-46* Creat-1.6* K-3.8 [**2151-3-25**] 02:54AM BLOOD Creat-2.0* Na-131* K-4.1 Cl-96 HCO3-27 AnGap-12 Brief Hospital Course: Mr. [**Known lastname 2487**] was admitted to Cardiac surgery. Interventional pulmonology performed a left thoracentesis for 750 cc serosanguinous fluid.Thoracic surgery was consulted and recommended a left chest tube and TPA which was performed. Pleural fluid cultures showed MSSA for which he was placed on nafcillin. Infectious diseases recommended 6 weeks of Nafcillin. CT scan on [**3-26**] showed imporved effusion and VATS was cancelled. Chest tube was dc'd without incident on [**3-27**]. CXR on [**3-29**] showed no increase in the effusions, and he was ready for discharge on [**2151-3-29**]. Discharge Medications: 1. Nafcillin in D2.4W 2 g/100 mL Piggyback Sig: Two (2) grams Intravenous Q6H (every 6 hours). Disp:*240 grams* Refills:*2* 2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*0* 3. 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:*0* 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 6. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Tablet(s) 7. Pioglitazone 15 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed. Disp:*40 Tablet(s)* Refills:*0* 10. 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:*0* 11. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day: Until dc'd by Dr. [**Last Name (STitle) 1295**]. 12. Lantus Subcutaneous 13. Outpatient Lab Work Weekly CBC, Bun/Creatinine, LFTs while on Nafcillin Results to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 432**] 14. Heparin Lock Flush 100 unit/mL Solution Sig: PICC flush per protocol Intravenous DAILY (Daily) as needed. Disp:*1 vial* Refills:*2* Discharge Disposition: Home With Service Facility: [**Hospital1 **] VNA Discharge Diagnosis: Left pleural effusion s/p Redo sternotomy, CABG x 2, MVRepair [**2151-2-23**] PMH: CAD s/p CABGx2 [**2124**], PPM, multiple PCI, NIDDM, GERD s/p dilation of esophageal stricture, proxysmal A.fib, HTN, HLD Discharge Condition: Good. Discharge Instructions: Call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. No lifting more than 10 pounds for 10 weeks from surgery. No driving while taking narcotic pain medicine. [**Last Name (NamePattern4) 2138**]p Instructions: Dr. [**Last Name (STitle) 1295**] as prior to admission Dr. [**Last Name (Prefixes) **] in 2 weeks [**Hospital **] clinic with nurse practitioner ([**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2489**] if possible) [**Telephone/Fax (1) 2490**] Dr. [**Last Name (STitle) 931**] in [**4-9**] weeks DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (Infectious Disease) Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2151-5-3**] 9:00 Completed by:[**2151-3-30**]

511,427,E878,041,250,530,401,272,V458

{'Unspecified pleural effusion,Atrial fibrillation,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,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,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: Left rib pain/LUQ pain PRESENT ILLNESS: 67 yo M s/p CABG/MVR [**2-23**] with complicated post op course, dc'd home3/16, returned to [**Location **] [**3-21**] c/o LUQ/chest pain. Also c/o some SOB secondary to pain. MEDICAL HISTORY: CAD s/p CABGx2 [**2124**], PPM, multiple PCI, NIDDM, GERD s/p dilation of esophageal stricture, proxysmal A.fib, HTN MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: 98.0 [**Telephone/Fax (1) 2488**] 16 NAD Lungs with decreased breath sounds bilaterally with crackles at both bases CV RRR Sternum C/D/I Abd benign Extrem without edema Pain to palpation at left rib cage FAMILY HISTORY: NC SOCIAL HISTORY: retired communications technician ### Response: {'Unspecified pleural effusion,Atrial fibrillation,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,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Aortocoronary bypass status'}

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 55 year old male h/o CAD, DM, HTN, CKD who presents to ER with acute SOB. Patient states he was feeling his normal self until approximately 6:00pm today when he began to experience nausea, diaphoresis and SOB. His children were concerned and called 911. The symptoms resolved in the ER. Patient denies any chest discomfort or dizziness during the episode. Patient reports 4 weeks of sub-sternal "heart burn" with exertion, which he thought could also be musculoskeletal related to climbing into his new truck. He describes this pain as a band-like tightness [**4-13**]. Of note patient discontinued all of his home medications (other than insulin) because he felt they caused his weight gain. Patient has baseline 2 pillow orthopnea and intermittent lower extremity edema (not worsened recently). Denies PND, syncope, pre-syncope. . On review of systems, denies stroke, TIA, deep venous thrombosis, pulmonary embolism, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. . In the ED, initial vitals were HR 121, BP 240/110, RR 38, 97% RA. Patient continued to be hypertensive in ER and was started on Nitro ggt. Glucose was 603, no ketones. Patient received ASA, Lasix 40 mg IV, Nitro ggt, Lopressor 5mg IV, Ativan 1 mg and Insulin 10 Units. Admitted to CCU. . MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: + Diabetes x 15 years complicated by neuropathy, nephropathy, and retinopathy. Most recent HgA1C 9.[**9-11**]/27/[**2185**]. + Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: -CABG: None -PERCUTANEOUS CORONARY INTERVENTIONS: CAD s/p PCI and stent placement to LAD in [**2179**] -PACING/ICD: None. 3. OTHER PAST MEDICAL HISTORY: Obesity gout kidney stones appendectomy R knee arthoplasty MEDICATION ON ADMISSION: patient unsure of medications - states Dr. [**Last Name (STitle) 1576**] reviewed and last note should be correct. As below: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission VS: BP=149/85 HR=100 RR=24 O2 sat=94% GENERAL: Obese male 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 and maternal GM with DM mother died of [**Name (NI) **] (thinks brain) father passed away in 60s secondary to trauma and alcohol use SOCIAL HISTORY: No tobacco use (smoked cigars in [**2148**]. [**Name (NI) **] wife and children smoke). No EtOH, no illicits. Married, lives with wife. Owns a construction company.

Subendocardial infarction, initial episode of care,Acute on chronic diastolic heart failure,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified,Acidosis,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Personal history of noncompliance with medical treatment, presenting hazards to health,Morbid obesity,Gout, unspecified,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Background diabetic retinopathy

Subendo infarct, initial,Ac on chr diast hrt fail,Mal hyp ht/kd I-IV w hf,Acidosis,Chronic kidney dis NOS,DMII neuro uncntrld,Crnry athrscl natve vssl,Hx of past noncompliance,Morbid obesity,Gout NOS,Hyperlipidemia NEC/NOS,Neuropathy in diabetes,Diabetic retinopathy NOS

Admission Date: [**2186-10-26**] Discharge Date: [**2186-11-3**] Date of Birth: [**2131-5-12**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 922**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: [**2186-10-30**] - Coronary artery bypass grafting x4 with left internal mammary artery to the left anterior descending coronary artery; reverse saphenous vein single graft from the aorta to the first diagonal coronary artery; reverse saphenous vein single graft from the aorta to the second obtuse marginal coronary artery; as well as reverse saphenous vein graft from the aorta to the posterior descending coronary artery. [**2186-10-27**] - Cardiac Catheterization History of Present Illness: 55 year old male h/o CAD, DM, HTN, CKD who presents to ER with acute SOB. Patient states he was feeling his normal self until approximately 6:00pm today when he began to experience nausea, diaphoresis and SOB. His children were concerned and called 911. The symptoms resolved in the ER. Patient denies any chest discomfort or dizziness during the episode. Patient reports 4 weeks of sub-sternal "heart burn" with exertion, which he thought could also be musculoskeletal related to climbing into his new truck. He describes this pain as a band-like tightness [**4-13**]. Of note patient discontinued all of his home medications (other than insulin) because he felt they caused his weight gain. Patient has baseline 2 pillow orthopnea and intermittent lower extremity edema (not worsened recently). Denies PND, syncope, pre-syncope. . On review of systems, denies stroke, TIA, deep venous thrombosis, pulmonary embolism, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. . In the ED, initial vitals were HR 121, BP 240/110, RR 38, 97% RA. Patient continued to be hypertensive in ER and was started on Nitro ggt. Glucose was 603, no ketones. Patient received ASA, Lasix 40 mg IV, Nitro ggt, Lopressor 5mg IV, Ativan 1 mg and Insulin 10 Units. Admitted to CCU. . Past Medical History: 1. CARDIAC RISK FACTORS:: + Diabetes x 15 years complicated by neuropathy, nephropathy, and retinopathy. Most recent HgA1C 9.[**9-11**]/27/[**2185**]. + Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: -CABG: None -PERCUTANEOUS CORONARY INTERVENTIONS: CAD s/p PCI and stent placement to LAD in [**2179**] -PACING/ICD: None. 3. OTHER PAST MEDICAL HISTORY: Obesity gout kidney stones appendectomy R knee arthoplasty Social History: No tobacco use (smoked cigars in [**2148**]. [**Name (NI) **] wife and children smoke). No EtOH, no illicits. Married, lives with wife. Owns a construction company. Family History: brother and maternal GM with DM mother died of [**Name (NI) **] (thinks brain) father passed away in 60s secondary to trauma and alcohol use Physical Exam: Admission VS: BP=149/85 HR=100 RR=24 O2 sat=94% GENERAL: Obese male 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: Unable to detect JVD due to obesity. CARDIAC: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. Distant heart sounds due to body habitus. 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. Distant lung sounds due to body habitus. CTAB, no crackles, wheezes or rhonchi. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: Edema 1+ posterior calves b/l. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: DP 2+ PT 2+ Left: DP 2+ PT 2+ Discharge VS T 98.0 BP 113/61 HR 80SR RR 20 O2sat 95%-RA Gen NAD Neuro A&Ox3, nonfocal exam Pulm CTA-bilat CV RRR, no murmur. Sternum stable, incision CDI Abdm soft, NT/+BS Ext warm, 1+ pedal edema Pertinent Results: Discharge [**2186-11-3**] 01:50PM BLOOD Hct-24.2* [**2186-11-3**] 06:00AM BLOOD Plt Ct-151 [**2186-10-30**] 05:09PM BLOOD PT-14.8* PTT-32.2 INR(PT)-1.3* [**2186-11-3**] 06:00AM BLOOD Glucose-97 UreaN-54* Creat-2.9* Na-136 K-3.7 Cl-103 HCO3-25 AnGap-12 [**2186-10-27**] 11:35AM BLOOD %HbA1c-9.5* Admission [**2186-10-26**] 06:50PM BLOOD WBC-8.7 RBC-4.84 Hgb-15.6 Hct-43.9 MCV-91 MCH-32.2* MCHC-35.5* RDW-14.0 Plt Ct-128* [**2186-10-26**] 06:50PM BLOOD Neuts-74.1* Lymphs-18.3 Monos-2.9 Eos-3.7 Baso-1.0 [**2186-10-26**] 06:50PM BLOOD PT-12.6 PTT-23.9 INR(PT)-1.1 [**2186-10-26**] 06:50PM BLOOD Glucose-603* UreaN-37* Creat-2.5* Na-135 K-4.8 Cl-100 HCO3-25 AnGap-15 [**2186-10-26**] 06:50PM BLOOD CK(CPK)-221* [**2186-10-26**] 06:50PM BLOOD CK-MB-11* MB Indx-5.0 proBNP-1621* [**2186-10-26**] 06:50PM BLOOD Calcium-9.3 Phos-4.6* Mg-1.9 [**2186-10-27**] 06:18AM BLOOD %HbA1c-9.2* [**2186-10-27**] 06:18AM BLOOD Triglyc-206* HDL-38 CHOL/HD-6.2 LDLcalc-157* . Cardiac Cath [**2186-10-27**] 1. Coronary angiography of this right dominant system revealed 3 vessel and left main disease unsuitable for PCI. The LMCA had an 80% stenosis distally at the bifurcation of the LAD and LCX. The LAD had mild disease in the previously placed proximal stent and moderate mid-segment disease. The LCX had an 80% ostial stenosis with an 80% stenosis proximally in a high OM1. The RCA had a 50% stenosis in the mid-segment and an 80% stenosis in the proximal right posterolateral branch. 2. Limited resting hemodynamics revealed severely elevated systemic arterial pressure despite a nitroglyercine IV drip with an SBP of 181 mm Hg. The LVEDP was also elevated at 25 mm Hg suggestive of severe diastolic dysfunction. There was no gradient suggestive of aortic stenosis with pullback across the aortic valve. 3. Left ventriculography given renal insufficiency. FINAL DIAGNOSIS: 1. Three vessel coronary artery disease. 2. Severe diastolic ventricular dysfunction. ECHO [**2186-10-27**]: The left atrium and right atrium are normal in cavity size. There is moderate symmetric left ventricular hypertrophy with normal cavity size and global systolic function (LVEF>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 root is moderately dilated at the sinus level. 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 appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. IMPRESSION: Suboptimal image quality. Prominent symmetric left ventricular hypertrophy with preserved global biventricular systolic function. Dilated thoracic aorta. These findings are c/w hypertensive heart. Compared with the prior report (images unavailable for review) of [**2179-6-22**], prominent left ventricular hypertrophy is now identified. [**2186-10-30**] ECHO PRE BYPASS: The left atrium is mildly dilated. No atrial septal defect is seen by 2D or color Doppler. There is moderate symmetric left ventricular hypertrophy. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic root is moderately dilated at the sinus level. There are simple atheroma in the descending thoracic aorta. There are three aortic valve leaflets. 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. Trivial mitral regurgitation is seen. There is no pericardial effusion. POST BYPASS: Left and right ventricular function is preserved. The aorta is intact. The study is unchanged. [**2186-10-30**] Carotid Ultrasound Minimal plaque with bilateral less than 40% carotid stenosis. CHEST (PA & LAT) Clip # [**Clip Number (Radiology) 29794**] [**Hospital 93**] MEDICAL CONDITION: 55 year old man with s/p cabg REASON FOR THIS EXAMINATION: f/u atx, effusions Final Report CHEST, PA AND LATERAL REASON FOR EXAM: Status post CABG, follow up effusion. Since [**2186-11-1**], all tubes and catheters were removed except right internal jugular catheter ending into the cavoatrial junction. Minimal bilateral pleural effusions are associated with small left basilar atelectasis. There is no volume overload. Lungs are otherwise clear. The cardiomediastinal silhouette is unchanged. The study and the report were reviewed by the staff radiologist. DR. [**First Name8 (NamePattern2) 4078**] [**Name (STitle) 4079**] DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**] Brief Hospital Course: Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2186-10-27**] for management of his dyspnea and chest pain. A cardiac catheterization was performed which revealed severe left main and three vessel coronary artery disease. Heparin, beta blockade, a statin and aspirin were started. He ruled in for a myocardial infarction by enzymes. Given the severity of his disease, the cardiac surgical service was consulted. Mr. [**Known lastname **] was worked-up in the usual preoperative manner including a carotid duplex ultrasound which showed no significant internal carotid artery disease. On [**2186-10-30**], Mr. [**Known lastname **] was taken to the operating room where he underwent coronary artery bypass grafting to four vessels. Please see operative note for details. In summary he had a CABG x4 with LIMA-LAD,SVG-OM,SVG-Diag,SVG-PDA. His bypass time was 113 minutes with a crossclamp of 90 minutes. He tolerated the operation well and was transferred to the intensive care unit for monitoring in stable condition. He did well in the immediate postoperative period, however he did have a metabolic acidosis and therefore remained intubated until the morning of POD1 at 6AM. He continued to do well and was transferred from the ICU to the stepdown unit on POD2. The remainder of his post-operative course was uneventful. Once on the floor his chest tubes and epicardial wires were removed. His activity progressed and on POD 4 he was discharged home with visiting nurses. Medications on Admission: patient unsure of medications - states Dr. [**Last Name (STitle) 1576**] reviewed and last note should be correct. As below: ALLOPURINOL - 300 mg Tablet - 1 Tablet(s) by mouth twice a day to prevent gout kidney stones ALPRAZOLAM - 0.5MG Tablet - TAKE ONE BY MOUTH AT BEDTIME FOR ANXIETY, INSOMNIA AMLODIPINE - 10 mg Tablet - 1 Tablet(s) by mouth once a day bp ATENOLOL - 100 mg Tablet - 1 Tablet(s) by mouth once a day bp DOXAZOSIN - 2 mg Tablet - 1 Tablet(s) by mouth at bedtime bp FENOFIBRATE MICRONIZED - 160 mg Tablet - 1 Tablet(s) by mouth once a day with food for triglycerides HYDROCHLOROTHIAZIDE - 25 mg Tablet - 1 by mouth once a day bp, unk dose IBUPROFEN - 800MG Tablet - TAKE ONE BY MOUTH TWICE A DAY AS NEEDED FOR FOR PAIN KIDNEY STONES, KNEE, BACK, INSULIN LISPRO PROTAM & LISPRO [HUMALOG MIX 75-25] - 100 unit/mL (75-25) Suspension - inject twice a day 100units per dose, dm LABETALOL - 200 mg Tablet - 1 Tablet(s) by mouth twice a day bp POTASSIUM BICARB-CITRIC ACID - 25 mEq Tablet, Effervescent - 1 Tablet, Effervescent(s) by mouth once a day uncertain dose, instructions. Dr. [**First Name (STitle) 805**] POTASSIUM CITRATE [UROCIT-K 10] - 10 mEq (1,080 mg) Tablet Sustained Release - 1 Tablet Sustained Release(s) by mouth three times a day for balance, hx stones PRAVASTATIN - 10 mg Tablet - 1 Tablet(s) by mouth once a day cholesterol SYRINGE-NDL,INS DISPOSABLE - - 40-60 untis twice a day dm u-100 . Medications - OTC ASPIRIN - 325MG Tablet, Delayed Release (E.C.) - TAKE ONE BY MOUTH EVERY DAY FOR PREVENTION ONE TOUCH ULTRA TEST STRIPS - Strip - FOUR TIMES A DAY TERBINAFINE - 1 % Cream - Apply to feet twice daily Discharge Medications: 1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(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. 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* 4. Pravastatin 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 5. Doxazosin 2 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 6. Fenofibrate Micronized 160 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed. 8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 2 weeks. Disp:*30 Tablet(s)* Refills:*0* 9. Insulin Glargine 100 unit/mL Solution Sig: 40u QAM/45u QPM Subcutaneous twice a day: 40 units QAM 45 units QPM. Disp:*1 vial* Refills:*2* 10. Humalog 100 unit/mL Solution Sig: sliding scale Subcutaneous QAC&HS: as directed. Disp:*1 vial* Refills:*2* 11. Potassium Chloride 10 mEq Tablet Sustained Release Sig: Two (2) Tablet Sustained Release PO once a day for 2 weeks. Disp:*28 Tablet Sustained Release(s)* Refills:*0* Discharge Disposition: Home With Service Facility: vna of greater [**Location (un) **] Discharge Diagnosis: CAD s/p CABGx4 (LIMA-LAD,SVG-Diag,SVG-OM,SVG-PDA)[**2186-10-30**] LAD stent in [**8-4**] IDDM with retinopathy and neuropathy Hyperlipidemia HTN Gout Nephrolithiasis Chronic kidney disease Anxiety Myocardial infarction Discharge Condition: good 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 6 weeksor while taking narcotics for pain. 7) Call with any questions or concerns. Followup Instructions: [**Hospital 409**] clinic in 2 weeks Dr. [**Last Name (STitle) 914**] in 1 month. ([**Telephone/Fax (1) 1504**] Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 1579**] Patient to call for all appointments Completed by:[**2186-11-3**]

410,428,404,276,585,250,414,V158,278,274,272,357,362

{'Subendocardial infarction, initial episode of care,Acute on chronic diastolic heart failure,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified,Acidosis,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Personal history of noncompliance with medical treatment, presenting hazards to health,Morbid obesity,Gout, unspecified,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Background diabetic retinopathy'}

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: 55 year old male h/o CAD, DM, HTN, CKD who presents to ER with acute SOB. Patient states he was feeling his normal self until approximately 6:00pm today when he began to experience nausea, diaphoresis and SOB. His children were concerned and called 911. The symptoms resolved in the ER. Patient denies any chest discomfort or dizziness during the episode. Patient reports 4 weeks of sub-sternal "heart burn" with exertion, which he thought could also be musculoskeletal related to climbing into his new truck. He describes this pain as a band-like tightness [**4-13**]. Of note patient discontinued all of his home medications (other than insulin) because he felt they caused his weight gain. Patient has baseline 2 pillow orthopnea and intermittent lower extremity edema (not worsened recently). Denies PND, syncope, pre-syncope. . On review of systems, denies stroke, TIA, deep venous thrombosis, pulmonary embolism, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. . In the ED, initial vitals were HR 121, BP 240/110, RR 38, 97% RA. Patient continued to be hypertensive in ER and was started on Nitro ggt. Glucose was 603, no ketones. Patient received ASA, Lasix 40 mg IV, Nitro ggt, Lopressor 5mg IV, Ativan 1 mg and Insulin 10 Units. Admitted to CCU. . MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: + Diabetes x 15 years complicated by neuropathy, nephropathy, and retinopathy. Most recent HgA1C 9.[**9-11**]/27/[**2185**]. + Dyslipidemia, + Hypertension 2. CARDIAC HISTORY: -CABG: None -PERCUTANEOUS CORONARY INTERVENTIONS: CAD s/p PCI and stent placement to LAD in [**2179**] -PACING/ICD: None. 3. OTHER PAST MEDICAL HISTORY: Obesity gout kidney stones appendectomy R knee arthoplasty MEDICATION ON ADMISSION: patient unsure of medications - states Dr. [**Last Name (STitle) 1576**] reviewed and last note should be correct. As below: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission VS: BP=149/85 HR=100 RR=24 O2 sat=94% GENERAL: Obese male 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 and maternal GM with DM mother died of [**Name (NI) **] (thinks brain) father passed away in 60s secondary to trauma and alcohol use SOCIAL HISTORY: No tobacco use (smoked cigars in [**2148**]. [**Name (NI) **] wife and children smoke). No EtOH, no illicits. Married, lives with wife. Owns a construction company. ### Response: {'Subendocardial infarction, initial episode of care,Acute on chronic diastolic heart failure,Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified,Acidosis,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Personal history of noncompliance with medical treatment, presenting hazards to health,Morbid obesity,Gout, unspecified,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Background diabetic retinopathy'}

CHIEF COMPLAINT: s/p fall, ear bleed, L shoulder pain PRESENT ILLNESS: 31 yo male who awoke with stabbing left shoulder pain and incidentally found that his left ear was bleeding. Reports came home from work and drank 7 beers, went to sleep and awoke with the pain described. Works in construction and reports frequent head trauma's, today at work sustained minor hit to vertex of his head, there was no LOC; reports headache X 1 wk. Multiple falls, cable to back the week prior. He went to an area hospital where CT scan performed revealed right SDH, pneumocephalus above right petrous bone; xrays revealed left scapula fracture. MEDICAL HISTORY: None MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE on admission: T 99.8 HR 114 BP 123/80 RR 18 room air Sats 99% Gen-thin male, boarded and collared, calm Skin-no ecchymoses, no visible skin breaks HEENT-NCAT, 4 mm bilat pupils, PERRL, EOMI, MMM, left ear canal with dried blood,midline trachea Cor-ST, no m/r/g Chest- CTA bilat Abd- Soft ,NT, ND Extr-2+ pulses, no edema Musculosk-FROM x4 Neuro-A & ) x3, appropriate speech and affect; CN II-XII intact [**Last Name (un) **]- intact to light touch Motor-[**4-25**] str x4 FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Works in construction. 20 pack/year tobacco Drinks ETOH in binges

Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of glenoid cavity and neck of scapula,Closed fracture of two ribs,Other otorrhea,Tobacco use disorder,Unspecified accident

Traumatic subdural hem,Fx dorsal vertebra-close,Fx scap, glen cav/nck-cl,Fracture two ribs-closed,Otorrhea NEC,Tobacco use disorder,Accident NOS

Admission Date: [**2110-1-3**] Discharge Date: [**2110-1-8**] Date of Birth: [**2078-1-21**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 371**] Chief Complaint: s/p fall, ear bleed, L shoulder pain Major Surgical or Invasive Procedure: None History of Present Illness: 31 yo male who awoke with stabbing left shoulder pain and incidentally found that his left ear was bleeding. Reports came home from work and drank 7 beers, went to sleep and awoke with the pain described. Works in construction and reports frequent head trauma's, today at work sustained minor hit to vertex of his head, there was no LOC; reports headache X 1 wk. Multiple falls, cable to back the week prior. He went to an area hospital where CT scan performed revealed right SDH, pneumocephalus above right petrous bone; xrays revealed left scapula fracture. Past Medical History: None Social History: Works in construction. 20 pack/year tobacco Drinks ETOH in binges Family History: Noncontributory Physical Exam: PE on admission: T 99.8 HR 114 BP 123/80 RR 18 room air Sats 99% Gen-thin male, boarded and collared, calm Skin-no ecchymoses, no visible skin breaks HEENT-NCAT, 4 mm bilat pupils, PERRL, EOMI, MMM, left ear canal with dried blood,midline trachea Cor-ST, no m/r/g Chest- CTA bilat Abd- Soft ,NT, ND Extr-2+ pulses, no edema Musculosk-FROM x4 Neuro-A & ) x3, appropriate speech and affect; CN II-XII intact [**Last Name (un) **]- intact to light touch Motor-[**4-25**] str x4 Pertinent Results: [**2110-1-3**] 07:53PM GLUCOSE-99 UREA N-6 CREAT-0.7 SODIUM-139 POTASSIUM-3.7 CHLORIDE-104 TOTAL CO2-28 ANION GAP-11 [**2110-1-3**] 07:53PM CALCIUM-8.6 PHOSPHATE-3.5 MAGNESIUM-1.9 [**2110-1-3**] 07:53PM WBC-11.1* RBC-4.42* HGB-14.7 HCT-41.2 MCV-93 MCH-33.4* MCHC-35.8* RDW-12.1 [**2110-1-3**] 07:53PM PLT COUNT-197 [**2110-1-3**] 06:07AM PHENYTOIN-14.9 MR THORACIC SPINE [**2110-1-4**] 7:15 PM MR CERVICAL SPINE; MR THORACIC SPINE Reason: ? ligamentus injury [**Hospital 93**] MEDICAL CONDITION: 31 year old man with T12 compression fracture REASON FOR THIS EXAMINATION: ? ligamentus injury CONTRAINDICATIONS for IV CONTRAST: None. EXAM: MRI cervical and thoracic spine. CLINICAL INFORMATION: Patient with T12 compression fracture, rule out ligamentous injury. TECHNIQUE: T1 and T2 sagittal and inversion recovery sagittal images of the cervical spine were obtained. T1 sagittal images of the thoracic spine were obtained. The patient was unable to continue and therefore exam was not completed. FINDINGS: In the cervical region no evidence of fracture or marrow edema is seen. There is no evidence of ligamentous disruption seen. The alignment is normal. The spinal cord demonstrates normal signal. There is disk bulging at C6-7 level. In the visualized upper thoracic region marrow edema is seen at the superior endplate of T3 which could be due to mild compression. Limited evaluation of the thoracic spine on the scout images of the thoracic spine demonstrates compression of T10 vertebra as seen on the CT of [**2110-1-4**]. There is no abnormal widening of the intrapinous distances seen. However, evaluation is limited for ligamentous injury. IMPRESSION: Mild compression of the superior endplate of T3 and compression of T10 vertebral bodies. Thoracic spine could not be evaluated as patient was unable to continue. No evidence of epidural hematoma or spinal cord compression in the cervical region. CT T-SPINE W/O CONTRAST [**2110-1-4**] 3:47 PM CT T-SPINE W/O CONTRAST Reason: S/P MVC ASSESS FOR FX,BACK PAIN [**Hospital 93**] MEDICAL CONDITION: 31 year old man s/p mvc REASON FOR THIS EXAMINATION: assess for fx CONTRAINDICATIONS for IV CONTRAST: None. INDICATION: History of MVC, evaluate for fracture. COMPARISON: None. TECHNIQUE: Contiguous axial images of the thoracic spine were obtained with coronal and sagittal reconstructions. CT T-SPINE: There is a fracture of the superior anterior endplate of T10, with slight wedging. There is no evidence of retropulsion of fragments. Additionally, there are associated fractures of several left ribs adjacent to their articulation with thoracic vertebral bodies, at the T2, T4-7, and T10-12 levels. No right-sided rib fracture is seen. There is no evidence of spondylolisthesis. MR provides better evaluation of intrathecal contents; however, the contour of the thecal sac appears to be within normal limits. There is a left pleural effusion with associated atelectasis. There is a small right pleural effusion. On the limited portions of the lungs, no definite pneumothorax is seen. IMPRESSION: There is a fracture of the anterior portion of the superior endplate of T10. Additionally, there are fractures of the left ribs posteriorly at the T2, T4-7, and T10-12 levels. There are bilateral pleural effusions, greater on the left. These results were discussed with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3035**] at 4:30 p.m. on [**2110-1-4**]. MR L SPINE SCAN [**2110-1-5**] 2:13 AM MR L SPINE SCAN Reason: ? ligamentus injury [**Hospital 93**] MEDICAL CONDITION: 31 year old man with T12 compression fracture REASON FOR THIS EXAMINATION: ? ligamentus injury MR LUMBAR SPINE, [**2110-1-5**] HISTORY: T12 compression fracture. Is there evidence of ligamentous injury? Sagittal and axial imaging was performed with long TR, long TE fast spin echo and short TR, short TE spin echo technique. No contrast was administered. No prior lumbar spine imaging studies are available for comparison. FINDINGS: This is a preliminary report. Although all of the images appear to have been acquired, the exam is still marked in "arrived" status, indicating that there are further images or processing to be done. Based on the available information, there is no evidence of encroachment on the spinal canal, injury to the conus medullaris, or vertebral body fractures from T11 to the sacrum. There is loss of signal at the L4-5 intervertebral disc with a focal tear in the posterior anulus. These are manifestations of degenerative disc disease. There is a markedly enlarged bladder. CONCLUSION: Preliminary study still in "arrived" status. There are degenerative changes at L4-5 without evidence of fracture, subluxation, or encroachment upon the spinal canal. Brief Hospital Course: Patient admitted to the trauma service. Neurosurgery consulted and recommended Dilantin and serial head CT scans. Orthopedics consulted because of scapular fracture; non operative management with Physical therapy and CT imaging. Neurosurgery Spine consulted for his T10 fracture and have recommended TLSO brace to be worn while OOB. He was fitted for the brace on [**2110-1-4**]. ENT evaluated left ear canal, no fractures of the bones identified. Patient will need to follow up with ENT after discharge. Physical therapy consulted and have recommended outpatient PT after discharge. Discharge Medications: 1. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*90 Capsule(s)* Refills:*1* 2. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4 to 6 hours) as needed for pain. Disp:*45 Tablet(s)* Refills:*0* 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: s/p Fall Subdural hematoma Pneumocephalus Left scapula fracture T10 fracture Discharge Condition: Stable Discharge Instructions: You must wear your TLSO brace while out of bed. Follow up with Neurosurgery in [**5-29**] weeks. Follow up with Orthopedics in 2 weeks. Followup Instructions: Call [**Telephone/Fax (1) 9986**] for an appointment with Dr. [**Last Name (STitle) **] in [**5-29**] weeks. Inform his office that you will need a repeat head CT scan for this appointment. Call [**Telephone/Fax (1) 1228**] for an appointment in [**Hospital **] Clinic in 2 weeks. Call [**Telephone/Fax (1) 64521**] to schedule an appointment with Dr. [**First Name (STitle) **], Otolaryngology, for your left ear. Completed by:[**2110-1-8**]

852,805,811,807,388,305,E928

{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of glenoid cavity and neck of scapula,Closed fracture of two ribs,Other otorrhea,Tobacco use disorder,Unspecified accident'}

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, ear bleed, L shoulder pain PRESENT ILLNESS: 31 yo male who awoke with stabbing left shoulder pain and incidentally found that his left ear was bleeding. Reports came home from work and drank 7 beers, went to sleep and awoke with the pain described. Works in construction and reports frequent head trauma's, today at work sustained minor hit to vertex of his head, there was no LOC; reports headache X 1 wk. Multiple falls, cable to back the week prior. He went to an area hospital where CT scan performed revealed right SDH, pneumocephalus above right petrous bone; xrays revealed left scapula fracture. MEDICAL HISTORY: None MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE on admission: T 99.8 HR 114 BP 123/80 RR 18 room air Sats 99% Gen-thin male, boarded and collared, calm Skin-no ecchymoses, no visible skin breaks HEENT-NCAT, 4 mm bilat pupils, PERRL, EOMI, MMM, left ear canal with dried blood,midline trachea Cor-ST, no m/r/g Chest- CTA bilat Abd- Soft ,NT, ND Extr-2+ pulses, no edema Musculosk-FROM x4 Neuro-A & ) x3, appropriate speech and affect; CN II-XII intact [**Last Name (un) **]- intact to light touch Motor-[**4-25**] str x4 FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Works in construction. 20 pack/year tobacco Drinks ETOH in binges ### Response: {'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Closed fracture of glenoid cavity and neck of scapula,Closed fracture of two ribs,Other otorrhea,Tobacco use disorder,Unspecified accident'}

CHIEF COMPLAINT: Nausea and Tachypnea PRESENT ILLNESS: 24 year old female with IDDM complicated by recurrent DKA from withholding insulin presenting with nausea and tachypnea with concern for DKA in the setting of a known eating disorder with 2 days of refusal to use insulin. Per past discharge summary, patient is seen weekly in [**Hospital **] clinic for labs and for counseling. She was seen by [**Last Name (un) **] on [**8-18**] and thought to have mild DKA and hypokalemia and refused admission. She was taking some insulin and PO fluids at that time. Repeat labs on [**8-19**] showed mild improvement. She was noted at that time to have tachycardia to 120 and DOE and again refused admission. On [**8-24**], she returned with nausea, underwent stat labs and was advised to go to the hospital for admission. Since [**8-24**], nausea and shortness of breath have progressively worsened. She presented to the hospital today due to profound tachypnea at rest. MEDICAL HISTORY: - Type I diabetes (diagnosed age 3; no h/o eye or kidney problems, no peripheral neuropathy; no insulin pump; 2 prior hospitalizations for DKA) - Depression (since high school) - Eating disorder - No surgeries MEDICATION ON ADMISSION: Citalopram Hbr 40 Mg [**1-25**] to 1 po qam Levothyroxine Sodium 50 Mcg take 1 tablet (50MCG) by oral route every day and on sunday take 2 pills (patient has not taken for 2 months, against medical advice) Lorazepam 0.5 Mg [**1-25**] po qhs Levemir 100 Unit/ml using up to 20 units daily Humalog 100 Unit/ml using up to 30 units daily - 1 unit to 10 carbs, 1 unit for every 25 points above blood glucose of 100 Symlinpen 60 1,500 Mcg/1.5 Ml inject 0.02 milliliter (15MCG) by Subcutaneous route before meals Glucagon Emergency Kit 1mg use as directed Jolessa 0.15 Mg-30 Mcg take 1 tablet by oral route every day ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Physical Exam: Vitals: T: 37.8 BP: 108/63 P: 75 R: 15 O2: 99%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachycardic S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no edema FAMILY HISTORY: - Hypertension: mother, maternal aunt - [**Name (NI) **] cancer: maternal grandparent - Esophageal cancer: maternal grandparent SOCIAL HISTORY: Works as a teacher in an afterschool program. Graduated from college in spring [**2148**] with a degree in neurobiology. No smoking, no recreational drug use, "rare" alcohol.

Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Hyposmolality and/or hyponatremia,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Disorders of phosphorus metabolism,Unspecified acquired hypothyroidism,Eating disorder, unspecified

DMI ketoacd uncontrold,Hyposmolality,Long-term use of insulin,Hx of past noncompliance,Dis phosphorus metabol,Hypothyroidism NOS,Eating disorder NOS

Name: [**Known lastname 7208**],[**Known firstname 7209**] L Unit No: [**Numeric Identifier 7210**] Admission Date: [**2150-8-26**] Discharge Date: [**2150-8-28**] Date of Birth: [**2126-6-2**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 417**] Addendum: Blood cultures from [**2150-8-26**] were no growth. Discharge Disposition: Home [**Name6 (MD) **] [**Last Name (NamePattern4) 424**] MD [**MD Number(1) 425**] Completed by:[**2150-9-1**] Admission Date: [**2150-8-26**] Discharge Date: [**2150-8-28**] Date of Birth: [**2126-6-2**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2641**] Chief Complaint: Nausea and Tachypnea Major Surgical or Invasive Procedure: None History of Present Illness: 24 year old female with IDDM complicated by recurrent DKA from withholding insulin presenting with nausea and tachypnea with concern for DKA in the setting of a known eating disorder with 2 days of refusal to use insulin. Per past discharge summary, patient is seen weekly in [**Hospital **] clinic for labs and for counseling. She was seen by [**Last Name (un) **] on [**8-18**] and thought to have mild DKA and hypokalemia and refused admission. She was taking some insulin and PO fluids at that time. Repeat labs on [**8-19**] showed mild improvement. She was noted at that time to have tachycardia to 120 and DOE and again refused admission. On [**8-24**], she returned with nausea, underwent stat labs and was advised to go to the hospital for admission. Since [**8-24**], nausea and shortness of breath have progressively worsened. She presented to the hospital today due to profound tachypnea at rest. In the ED, initial vs were: 1 99.8 122 136/82 27 100% ra. The patient had a blood glucose of 446 and an anion gap of 30. K+ on admission was less than 5.5. The patient was bolused with 2L of normal saline, followed by D5W with K+ at 250/hr when glucose was less than 250. The patient received 5 units of IV insulin followed by 5 units per hour On the floor, admission vital signs were 99.6 100 111/60 18 100RA. The patient endorses feeling much better. She denies pain, shortness of breath. She states that she has had a worsening vaginal yeast infection for the past 3-4 days. Review of systems: (+) Per HPI (-) Denies fever, chills, headache, rhinorrhea or congestion. Denies cough, shortness of breath, or wheezing. Denies chest pain, 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: - Type I diabetes (diagnosed age 3; no h/o eye or kidney problems, no peripheral neuropathy; no insulin pump; 2 prior hospitalizations for DKA) - Depression (since high school) - Eating disorder - No surgeries Social History: Works as a teacher in an afterschool program. Graduated from college in spring [**2148**] with a degree in neurobiology. No smoking, no recreational drug use, "rare" alcohol. Family History: - Hypertension: mother, maternal aunt - [**Name (NI) **] cancer: maternal grandparent - Esophageal cancer: maternal grandparent Physical Exam: Admission Physical Exam: Vitals: T: 37.8 BP: 108/63 P: 75 R: 15 O2: 99%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachycardic S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no edema Discharge Physical Exam: Vitals: 97-98.6, 100-60s, 79-90s, 18 98-100% on RA I/O: NR General: Pleasant, stable, lying comfortably in bed HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachycardic S1 + S2, 2/6 systolic flow murmur heard. Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no edema. Pertinent Results: [**2150-8-26**] 01:15PM BLOOD WBC-11.7*# RBC-5.59*# Hgb-14.5 Hct-48.4*# MCV-87 MCH-25.9* MCHC-30.0* RDW-16.0* Plt Ct-486*# [**2150-8-27**] 04:00AM BLOOD WBC-7.5 RBC-4.26 Hgb-11.1*# Hct-35.8*# MCV-84 MCH-26.2* MCHC-31.1 RDW-16.5* Plt Ct-353 [**2150-8-26**] 01:15PM BLOOD Neuts-78.1* Lymphs-18.2 Monos-2.6 Eos-0.5 Baso-0.6 [**2150-8-26**] 01:15PM BLOOD Glucose-583* UreaN-12 Creat-0.9 Na-130* K-5.1 Cl-90* HCO3-8* AnGap-37* [**2150-8-26**] 06:32PM BLOOD Glucose-174* UreaN-6 Creat-0.6 Na-131* K-4.0 Cl-105 HCO3-15* AnGap-15 [**2150-8-26**] 11:04PM BLOOD Glucose-186* UreaN-5* Creat-0.5 Na-133 K-3.3 Cl-108 HCO3-14* AnGap-14 [**2150-8-27**] 04:00AM BLOOD Glucose-306* UreaN-5* Creat-0.6 Na-132* K-4.1 Cl-106 HCO3-14* AnGap-16 [**2150-8-27**] 11:05AM BLOOD Glucose-230* UreaN-3* Creat-0.5 Na-136 K-3.8 Cl-109* HCO3-18* AnGap-13 [**2150-8-26**] 06:32PM BLOOD Calcium-7.6* Phos-1.2*# Mg-1.5* [**2150-8-26**] 11:04PM BLOOD Calcium-7.4* Phos-1.8* Mg-1.5* [**2150-8-27**] 04:00AM BLOOD Calcium-8.0* Phos-1.9* Mg-2.2 [**2150-8-27**] 11:05AM BLOOD Calcium-8.3* Phos-2.2* Mg-1.9 [**2150-8-26**] 07:21PM BLOOD Type-[**Last Name (un) **] pH-7.27* Comment-GREEN TOP [**2150-8-26**] 11:12PM BLOOD Type-[**Last Name (un) **] pH-7.32* Comment-GREEN TOP [**2150-8-27**] 11:16AM BLOOD Type-[**Last Name (un) **] pH-7.36 [**2150-8-28**] 06:35AM BLOOD Glucose-290* UreaN-10 Creat-0.5 Na-136 K-3.9 Cl-105 HCO3-21* AnGap-14 [**2150-8-28**] 06:35AM BLOOD Calcium-8.2* Phos-3.1 Mg-1.7 DIPSTICK URINALYSIS [**2150-8-26**] Blood SM Nitrite NEG Protein TR mg/dL Glucose 1000 mg/dL Ketone 150 mg/dL Bilirubin NEG mg/dL Urobilinogen NEG 0.2 - 1 mg/dL pH 5.0 5 - 8 units Leukocytes NEG Blood cultures x2 [**2150-8-26**] Peding CXR [**2150-8-26**] IMPRESSION: No acute cardiopulmonary process. EKG [**2150-8-26**] Sinus tachycardia with non-specific ST-T wave abnormalities. Compared to the previous tracing of [**2150-1-27**] no diagnostic interval change. Blood Cultures No Growth to date from [**2150-8-26**]. Not Final*** Brief Hospital Course: 24-year-old woman with type I diabetes and a history of eating disorder with recent insulin non-adherence admitted with diabetic ketoacidosis. #DIABETIC KETOACIDOSIS: The patient was admitted with a fasting blood glucose of 583 and an anion gap of 32 in the setting of 3 days of nausea and tachypnea in the context of withholding her insulin. EKG and CXR were unremarkable. The patient was started on an insulin drip and given 2 liters normal saline in th ED followed by D51/2NS with 40 of K at 250/hr once glucose had decreased to 250. On admission to floor, fasting glucose had improved to 174. Insulin drip was tapered and patient was started on home regimen of SC insulin on the evening of admission. Her anion gap closed and her acidosis normalized. She was started on a diabetic diet and tolerated it without difficulty. [**Last Name (un) **] was consulted regarding further management of her diabetes and recommended reducing home insulin doses to prevent episodes of hypoglycemia following previous non-adherence. Blood cultures were pending #HYPONATREMIA: A result of dilution and osmotic drag from hyperglycemia. Improved with normalization of hyperglycemia. #HYPOPHOSPHOTEMIA: Depleted due to osmotic drag and phosphate movement out of cells. Improved without intervention with normalization of hyperglycemia. #EATING DISORDER: The patient is seen weekly by her psychologist, Dr. [**Doctor Last Name 39995**], at [**Last Name (un) **]. The patient's outpatient psychologist was contact[**Name (NI) **] regarding her admission. Upon discharge, the plan is for the patient to go to a program in MN for further co-management of her diabetes and eating disorder. #HYPOTHYROIDISM: Patient non-adherent to levothyroxine at home. She was continued on prescribed dose of levothyroxine in house. #FOLLOW UP: Patient has a history of repeat admissions in DKA for non-adherence to her home insulin dose. She is currently going to seek help at a program in MN, and is scheduled to leave at [**2150-9-1**] to initiate treatment. Medications on Admission: Citalopram Hbr 40 Mg [**1-25**] to 1 po qam Levothyroxine Sodium 50 Mcg take 1 tablet (50MCG) by oral route every day and on sunday take 2 pills (patient has not taken for 2 months, against medical advice) Lorazepam 0.5 Mg [**1-25**] po qhs Levemir 100 Unit/ml using up to 20 units daily Humalog 100 Unit/ml using up to 30 units daily - 1 unit to 10 carbs, 1 unit for every 25 points above blood glucose of 100 Symlinpen 60 1,500 Mcg/1.5 Ml inject 0.02 milliliter (15MCG) by Subcutaneous route before meals Glucagon Emergency Kit 1mg use as directed Jolessa 0.15 Mg-30 Mcg take 1 tablet by oral route every day Discharge Medications: 1. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Jolessa 0.15-30 mg-mcg Tablet, Dose Pack, 3 Months Sig: One (1) Tablet, Dose Pack, 3 Months PO daily () as needed for oral contraception. 3. Glucagon Emergency 1 mg Kit Sig: One (1) kit Injection use as directed. 4. insulin glargine 100 unit/mL Solution Sig: Eighteen (18) units Subcutaneous once a day. 5. lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO at bedtime as needed for anxiety. 6. Humalog 100 unit/mL Solution Sig: One (1) insulin sliding scale Subcutaneous QACHS: follow sliding scale provided in discharge paperwork . Discharge Disposition: Home Discharge Diagnosis: Diabetic ketoacidosis Eating disorder - restrictive use of insulin Discharge Condition: 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 at [**Hospital1 18**]. You were admitted to the hospital in diabetic ketoacidosis. You were admitted to the ICU for an insulin drip and your anion gap closed shortly thereafter. You were transferred to the floor once you were medically stable. Psychiatry evaluated you and cleared you for safe discharge to home with plan for outpatient monitoring. You expressed agreement with plan to live with your mother and attend the eating disorder program at the [**Location (un) **] Institute. The following changes were made to your medications: ADJUSTED insulin regimen: Lantus 18units in AM, and Humalog insulin sliding scale included in your discharge paperwork. Followup Instructions: Name: [**Last Name (LF) 3240**],[**First Name3 (LF) **] F. Location: [**Hospital3 39996**] CLINIC Address: [**Hospital1 **], [**Location (un) **],[**Numeric Identifier 8235**] Phone: [**Telephone/Fax (1) 39997**] **We were unable to schedule a follow up appointment with your PCP due to the office being closed on Fridays. Please contact your PCP office to schedule a follow up appointment within a week of your discharge from the hospital.** Name: [**Last Name (LF) **], [**Name8 (MD) **] NP Location: [**Last Name (un) **] DIABETES CENTER Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 16420**] Appointment: Friday [**9-4**] at 11AM Your [**Last Name (un) **] psychologist [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Doctor Last Name **] was aware of your hospitalization and will be seeing you as an outpatient.

250,276,V586,V158,275,244,307

{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Hyposmolality and/or hyponatremia,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Disorders of phosphorus metabolism,Unspecified acquired hypothyroidism,Eating disorder, 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: Nausea and Tachypnea PRESENT ILLNESS: 24 year old female with IDDM complicated by recurrent DKA from withholding insulin presenting with nausea and tachypnea with concern for DKA in the setting of a known eating disorder with 2 days of refusal to use insulin. Per past discharge summary, patient is seen weekly in [**Hospital **] clinic for labs and for counseling. She was seen by [**Last Name (un) **] on [**8-18**] and thought to have mild DKA and hypokalemia and refused admission. She was taking some insulin and PO fluids at that time. Repeat labs on [**8-19**] showed mild improvement. She was noted at that time to have tachycardia to 120 and DOE and again refused admission. On [**8-24**], she returned with nausea, underwent stat labs and was advised to go to the hospital for admission. Since [**8-24**], nausea and shortness of breath have progressively worsened. She presented to the hospital today due to profound tachypnea at rest. MEDICAL HISTORY: - Type I diabetes (diagnosed age 3; no h/o eye or kidney problems, no peripheral neuropathy; no insulin pump; 2 prior hospitalizations for DKA) - Depression (since high school) - Eating disorder - No surgeries MEDICATION ON ADMISSION: Citalopram Hbr 40 Mg [**1-25**] to 1 po qam Levothyroxine Sodium 50 Mcg take 1 tablet (50MCG) by oral route every day and on sunday take 2 pills (patient has not taken for 2 months, against medical advice) Lorazepam 0.5 Mg [**1-25**] po qhs Levemir 100 Unit/ml using up to 20 units daily Humalog 100 Unit/ml using up to 30 units daily - 1 unit to 10 carbs, 1 unit for every 25 points above blood glucose of 100 Symlinpen 60 1,500 Mcg/1.5 Ml inject 0.02 milliliter (15MCG) by Subcutaneous route before meals Glucagon Emergency Kit 1mg use as directed Jolessa 0.15 Mg-30 Mcg take 1 tablet by oral route every day ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission Physical Exam: Vitals: T: 37.8 BP: 108/63 P: 75 R: 15 O2: 99%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachycardic S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no edema FAMILY HISTORY: - Hypertension: mother, maternal aunt - [**Name (NI) **] cancer: maternal grandparent - Esophageal cancer: maternal grandparent SOCIAL HISTORY: Works as a teacher in an afterschool program. Graduated from college in spring [**2148**] with a degree in neurobiology. No smoking, no recreational drug use, "rare" alcohol. ### Response: {'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Hyposmolality and/or hyponatremia,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Disorders of phosphorus metabolism,Unspecified acquired hypothyroidism,Eating disorder, unspecified'}

CHIEF COMPLAINT: Nausea/vomiting PRESENT ILLNESS: This is a 59 year old woman with DM, and known CAD. Last [**Month (only) 1096**] patient had a NSTEMI at [**Hospital3 **]. Found to have three vessel CAD. Transferred to [**Hospital3 **] where she was to have CABG. Upon intubation, she had airway perforation, left pneumothorax and cardiopulmonary arrest. CABG cancelled. Subsequently came to [**Hospital1 18**] in [**2141-1-9**] for flex bronchoscopy with debridement of necrotic tissue. TTE at the time showed normal LVEF. Decision was made to pursue CABG as elective procedure at a later date. Patient has been at rehab for the past months and has had repetitive admissions for nausea/vomiting which was felt to be due to gastroparesis. MEDICAL HISTORY: 1. CAD with 3 vessel disease (70% LAD, 80% RCA, 80% Circ) 2. HTN 3. CHF 4. Obstructive sleep apnea 5. Morbid obesity 6. DM 7. Rheumatoid arthritis 8. Psoriasis 9. Hyperlipidemia 10. Cholelithiasis 11. Spinal stenosis 12. s/p airway perforation, left pneumothorax, and cardiopulmonary arrest ([**12-14**]) during intubation attempt (OSH) MEDICATION ON ADMISSION: 1. Labetalol 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Imdur 30 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. 5. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 7. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed. 12. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 13. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) ALLERGIES: Codeine / Morphine / Percocet PHYSICAL EXAM: Vitals - T 100.2, BP 132/58, HR 91, 16, 94% ra, wt 119 kg General - sitting in bed, eating, breathing comfortably HEENT - sclera anicteric, JVP difficult to appreciate given body habitus CV - RRR, S1, S2, no murmurs Chest - bibasilar crackles Abdomen - obese, soft, non-tender, +BS Neuro - AAOx3 Extermities-LE edema to mid leg, no venous stasis changes Pulses: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: The patient is adopted; FH unknown. SOCIAL HISTORY: The patient lives alone, but her daughter ([**Name (NI) **]) lives nearby with her 3 children; they have a very close relationship. The patient has homemaker services. Fiance- Mark. 15 pack year smoking history, she quit 2 years ago. Denies alcohol use.

Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acquired cardiac septal defect,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Other impaction of intestine,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Gastroparesis,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Rheumatoid arthritis,Other and unspecified hyperlipidemia,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Candidiasis of other urogenital sites

Subendo infarct, initial,CHF NOS,Acq cardiac septl defect,Urin tract infection NOS,Hyposmolality,Retention urine NOS,Impaction intestine NEC,Crnry athrscl natve vssl,Hypertension NOS,DMII neuro nt st uncntrl,Gastroparesis,Obstructive sleep apnea,Morbid obesity,Rheumatoid arthritis,Hyperlipidemia NEC/NOS,Klebsiella pneumoniae,Candidias urogenital NEC

Admission Date: [**2141-8-8**] Discharge Date: [**2141-8-22**] Date of Birth: [**2082-3-19**] Sex: F Service: CARDIOTHORACIC Allergies: Codeine / Morphine / Percocet Attending:[**First Name3 (LF) 165**] Chief Complaint: Nausea/vomiting Major Surgical or Invasive Procedure: [**2141-8-9**] Cardiac Catheterization [**2141-8-11**] Four Vessel Coronary Artery Bypass Grafting(left internal mammary artery to left anterior descending, with vein grafts to diagonal, obtuse marginal, and PDA) and Closure of Atrial Septal Defect. [**2141-8-14**] Placement of Single Lumen PICC Line History of Present Illness: This is a 59 year old woman with DM, and known CAD. Last [**Month (only) 1096**] patient had a NSTEMI at [**Hospital3 **]. Found to have three vessel CAD. Transferred to [**Hospital3 **] where she was to have CABG. Upon intubation, she had airway perforation, left pneumothorax and cardiopulmonary arrest. CABG cancelled. Subsequently came to [**Hospital1 18**] in [**2141-1-9**] for flex bronchoscopy with debridement of necrotic tissue. TTE at the time showed normal LVEF. Decision was made to pursue CABG as elective procedure at a later date. Patient has been at rehab for the past months and has had repetitive admissions for nausea/vomiting which was felt to be due to gastroparesis. Admitted to [**Hospital3 **] on [**2141-8-4**] with nausea/vomiting and abdominal pain associated with chest tightness. Patient's last chest discomfort was the morning of admission, described as a "twinge", which was relieved with SL nitroglycerin. She subsequently ruled in for an acute myocardial infarction as her troponin came back at 3.38. Repeat echocardiogram has shown an LVEF of 50%. Stress testing today reportedly "extremely positive" for anterior/anteroapical ischemia. LVEF 44%. Patient transferred to the [**Hospital1 18**] for further evaluation. Of note, patient currently undergoing treatment for UTI. Past Medical History: 1. CAD with 3 vessel disease (70% LAD, 80% RCA, 80% Circ) 2. HTN 3. CHF 4. Obstructive sleep apnea 5. Morbid obesity 6. DM 7. Rheumatoid arthritis 8. Psoriasis 9. Hyperlipidemia 10. Cholelithiasis 11. Spinal stenosis 12. s/p airway perforation, left pneumothorax, and cardiopulmonary arrest ([**12-14**]) during intubation attempt (OSH) Social History: The patient lives alone, but her daughter ([**Name (NI) **]) lives nearby with her 3 children; they have a very close relationship. The patient has homemaker services. Fiance- Mark. 15 pack year smoking history, she quit 2 years ago. Denies alcohol use. Family History: The patient is adopted; FH unknown. Physical Exam: Vitals - T 100.2, BP 132/58, HR 91, 16, 94% ra, wt 119 kg General - sitting in bed, eating, breathing comfortably HEENT - sclera anicteric, JVP difficult to appreciate given body habitus CV - RRR, S1, S2, no murmurs Chest - bibasilar crackles Abdomen - obese, soft, non-tender, +BS Neuro - AAOx3 Extermities-LE edema to mid leg, no venous stasis changes Pulses: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Pertinent Results: [**2141-8-22**] 05:27AM BLOOD WBC-11.4*# RBC-3.41* Hgb-9.6* Hct-29.3* MCV-86 MCH-28.0 MCHC-32.7 RDW-17.6* Plt Ct-485* [**2141-8-13**] 12:57AM BLOOD WBC-22.9*# RBC-3.39* Hgb-9.6* Hct-28.3* MCV-84 MCH-28.3 MCHC-33.9 RDW-16.9* Plt Ct-418 [**2141-8-8**] 10:40PM BLOOD WBC-8.1 RBC-4.03* Hgb-10.5* Hct-30.8* MCV-76*# MCH-26.0* MCHC-34.1 RDW-15.0 Plt Ct-307 [**2141-8-22**] 05:27AM BLOOD Plt Ct-485* [**2141-8-12**] 04:17AM BLOOD PT-12.9 PTT-32.3 INR(PT)-1.1 [**2141-8-8**] 10:40PM BLOOD Plt Ct-307 [**2141-8-8**] 10:40PM BLOOD PT-11.2 PTT-27.5 INR(PT)-0.9 [**2141-8-22**] 05:27AM BLOOD Glucose-79 UreaN-14 Creat-0.4 Na-137 K-4.0 Cl-98 HCO3-33* AnGap-10 [**2141-8-8**] 10:40PM BLOOD Glucose-339* UreaN-17 Creat-0.7 Na-132* K-4.5 Cl-97 HCO3-27 AnGap-13 [**2141-8-19**] 12:13PM BLOOD ALT-22 AST-20 LD(LDH)-205 AlkPhos-170* Amylase-37 TotBili-0.3 [**2141-8-9**] 05:30PM BLOOD ALT-9 AST-10 AlkPhos-67 Amylase-25 TotBili-0.3 [**2141-8-9**] 09:30AM BLOOD cTropnT-0.22* [**2141-8-19**] 12:13PM BLOOD Lipase-33 [**2141-8-21**] 08:57AM BLOOD Calcium-8.5 Phos-3.6 Mg-2.1 [**2141-8-18**] 9:16 pm URINE Source: Catheter. **FINAL REPORT [**2141-8-20**]** URINE CULTURE (Final [**2141-8-20**]): YEAST. 10,000-100,000 ORGANISMS/ML.. GRAM NEGATIVE ROD(S). ~1000 ORG/ML RADIOLOGY Final Report CHEST (PA & LAT) [**2141-8-21**] 9:22 AM CHEST (PA & LAT) Reason: evaluate lll [**Hospital 93**] MEDICAL CONDITION: 59 year old woman s/p CABG. REASON FOR THIS EXAMINATION: evaluate lll Upright Frontal and lateral films of the chest on [**8-21**]. This is compared with the previous films. Sternal sutures and changes from cardiac surgery are seen. The right lung is clear. There is obviously some fluid and atelectasis adjacent to the heart and at the left base. No pneumothorax is seen. The overall appearance is good when compared to the previous films. CONCLUSION: The postoperative appearance of the chest at this point in time appears good. No pneumothorax. There are no large effusions. DR. [**First Name8 (NamePattern2) **] [**Doctor Last Name **] Approved: MON [**2141-8-21**] 10:23 AM Cardiology Report ECG Study Date of [**2141-8-18**] 9:46:46 AM Normal sinus rhythm, rate 71. ST segment elevations in the mid-precordium consistent with acute myocardial infarction. T wave inversions laterally consistent with ischemia. Compared to the previous tracing of [**2141-8-11**] the sinus rate is marginally slower. Otherwise, no significant change. Read by: [**Last Name (LF) **],[**First Name3 (LF) **] S. Intervals Axes Rate PR QRS QT/QTc P QRS T 71 0 84 426/448.14 0 4 96 RADIOLOGY Final Report [**Numeric Identifier **] PICC W/O PORT [**2141-8-14**] 4:20 PM Reason: needs picc line placed [**Hospital 93**] MEDICAL CONDITION: 59 year old woman with REASON FOR THIS EXAMINATION: needs picc line placed PICC LINE PLACEMENT INDICATION: Needs PICC for IV access . The procedure was explained to the patient. A timeout was performed. RADIOLOGIST: Drs. [**Last Name (STitle) 380**], [**Name5 (PTitle) **] and [**Doctor Last Name **] Dr. [**Last Name (STitle) 380**], the attending radiologist, was present and supervising throughout. TECHNIQUE: Using sterile technique and local anesthesia, the right brachial vein was punctured under direct ultrasound guidance using a micropuncture set. Hard copies of ultrasound images were obtained before and immediately after establishing intravenous access. A peel-away sheath was then placed over a guidewire and a single lumen PICC line measuring 39 cm in length was then placed through the peel-away sheath with its tip positioned in the SVC under fluoroscopic guidance. Position of the catheter was confirmed by a fluoroscopic spot film of the chest. The peel-away sheath and guidewire were then removed. The catheter was secured to the skin, flushed, and a sterile dressing applied. The patient tolerated the procedure well. There were no immediate complications. IMPRESSION: Uncomplicated ultrasound and fluoroscopically guided single lumen PICC line placement via the right brachial venous approach. Final internal length is 39 cm, with the tip positioned in SVC. The line is ready to use. The study and the report were reviewed by the staff radiologist. DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **] DR. [**First Name (STitle) **] [**Doctor Last Name 4391**] DR. [**First Name (STitle) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Approved: TUE [**2141-8-15**] 6:51 PM Cardiology Report ECHO Study Date of [**2141-8-11**] PATIENT/TEST INFORMATION: Indication: Intraoperative TEE for CABG, ?MVR Status: Inpatient Date/Time: [**2141-8-11**] at 13:00 Test: TEE (Complete) Doppler: Full Doppler and color Doppler Contrast: None Tape Number: 2007AW2-: Test Location: Anesthesia West OR cardiac Technical Quality: Suboptimal REFERRING DOCTOR: DR. [**First Name (STitle) **] [**Name (STitle) **] MEASUREMENTS: Left Atrium - Long Axis Dimension: *6.0 cm (nl <= 4.0 cm) Left Atrium - Four Chamber Length: *6.3 cm (nl <= 5.2 cm) Left Ventricle - Inferolateral Thickness: *1.2 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 3.5 cm (nl <= 5.6 cm) Left Ventricle - Ejection Fraction: 55% (nl >=55%) Aorta - Ascending: 3.2 cm (nl <= 3.4 cm) Aorta - Descending Thoracic: 1.9 cm (nl <= 2.5 cm) Aortic Valve - LVOT Diam: 1.9 cm Mitral Valve - MVA (P [**1-10**] T): 2.3 cm2 INTERPRETATION: Findings: LEFT ATRIUM: Moderate LA enlargement. Elongated LA. No spontaneous echo contrast in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good (>20 cm/s) LAA ejection velocity. All four pulmonary veins identified and enter the left atrium. RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is seen in the RA and extending into the RV. Left-to-right shunt across the interatrial septum at rest. Small secundum ASD. LEFT VENTRICLE: Wall thickness and cavity dimensions were obtained from 2D images. Mild symmetric LVH. Normal LV cavity size. Mild regional LV systolic dysfunction. Overall normal LVEF (>55%). RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Focal calcifications in aortic root. Normal ascending aorta diameter. Focal calcifications in ascending aorta. Simple atheroma in aortic arch. Focal calcifications in aortic arch. Normal descending aorta diameter. Simple atheroma in descending aorta. Focal calcifications in descending aorta. AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. Trace AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild mitral annular calcification. No MS. Mild (1+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen. Physiologic (normal) PR. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. No TEE related complications. The patient was under general anesthesia throughout the procedure. Suboptimal image quality. The patient appears to be in sinus the patient. Conclusions: PRE CPB The left atrium is moderately dilated. The left atrium is elongated. No spontaneous echo contrast is seen in the body of the left atrium or left atrial appendage. A left-to-right shunt across the interatrial septum is seen at rest. A small secundum atrial septal defect is present. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with mild hypokinesis of the apex and distal anterior wall. . Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. There are simple atheroma in the aortic arch. There are focal calcifications 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. POST CPB Normal right ventricular systolic function. Left ventricle with normal systolic function. Apical function improved from pre-CPB. Interatrial septum s/p pledgeted ASD closure. Small, pin-hole flow seen across septum, consistent with this kind of closure. No other changes seen from pre-CPB study Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD on [**2141-8-11**] 15:58. [**Location (un) **] PHYSICIAN: Brief Hospital Course: Ms. [**Known lastname **] was transferred to [**Hospital1 18**] for cardiac catheterization after presenting to OSH with an NSTEMI. She was referred for CABG. She was seen by interventional pulmonology for clearance given her history of traumatic intubation and tracheal debridement. Recommendation was for airway CT, which showed no evidence of tracheomalacia and resolved mild stenosis in the subglottic trachea, and fiberoptic bronchoscopy. She was taken to the operating room on [**2141-8-11**] where she underwent a CABG x 4 and ASD closure. Please see operative report for surgical details. Following surgery she was transferred to the CSRU for invasive monitoring in stable condition. Later on op day she was weaned from sedation, awoke neurologically intact and extubated. On post-op day one her chest tubes were removed. Beta blockers and diuretics were started and she was gently diuresed towards her pre-op weight. She was seen by infectious diseases on post-op day three d/t fever, increased WBC and preoperative klebsiella UTI. Her urine culture had no growth and imipenium was stopped. Her fevers resolved and WBC returned to [**Location 213**].Also on post-op day three a PICC line was placed due to poor IV access. Aggressive diuresis continued for hyponatremia and post op volume overload with low urine output and she was eventually transferred to the floor later on post-op day three. Epicardial pacing wires were removed on post-op day four. Post-operatively she worked with physical for strength and mobility, but would continue to require assistance with ambulation and feeding in rehab facility. She remained in house while awaiting rehab placement and on post-op day eight complained of abdominal pain which abdominal xray revelaed fecal impaction. She received medications and after several bowel movements her abdominal pain resolved. Urine culture from several days ago revealed yeast in urine and foley was removed. Due to failure to void the foley was reinserted and she was started on diflucan. She was ready and discharged to rehab on POD 11. Medications on Admission: 1. Labetalol 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Imdur 30 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. 5. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 7. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed. 12. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 13. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 14. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 15. Methocarbamol 500 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day) as needed. 16. Loperamide 2 mg Capsule Sig: One (1) Capsule PO QID (4 times a day) as needed for diarrhea/loose stools. 17. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. 18. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for anxiety. 19. Triamcinolone Acetonide 0.1 % Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed. 20. Insulin Lispro (Human) 100 unit/mL Cartridge Sig: SLIDING SCALE Subcutaneous AS DIRECTED. 21. Lantus 100 unit/mL Cartridge Sig: 30 units Subcutaneous at bedtime. 22. Ondansetron 4 mg IV Q8H:PRN 23. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 24. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 25. 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. 26. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed. 27. Prochlorperazine 10 mg IV Q6H:PRN Discharge Medications: 1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) mL Injection TID (3 times a day). 5. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours). 6. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 7. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 12. Methocarbamol 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 13. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 14. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q4H (every 4 hours). 15. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation [**Hospital1 **] (2 times a day). 16. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. 17. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day. 18. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours) for 2 days. 19. Cephalexin 250 mg Capsule Sig: Two (2) Capsule PO Q6H (every 6 hours) for 7 days. 20. Lantus 100 unit/mL Cartridge Sig: Twenty (20) units Subcutaneous once a day. Discharge Disposition: Extended Care Facility: Guardian [**Name (NI) **] - [**Name (NI) 1474**] Discharge Diagnosis: Coronary Artery Disease - s/p Coronary Artery Bypass Graft x 4 Atrial Septal Defect - s/p closure Congestive Heart Failure(Systolic) Recent NSTEMI PMH: Hypertension, Hyperlipidemia, Diabetes Mellitus, Morbid Obesity, Obstructive Sleep Apnea, Rheumatoid Arthritis Discharge Condition: Good Discharge Instructions: Please shower daily including washing incisions, no baths or swimming Monitor wounds for infection - redness, drainage, or increased pain Report any fever greater than 101 Report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week No creams, lotions, powders, or ointments to incisions No driving for approximately one month No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: Please call to schedule all appointments Dr. [**First Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] Dr. [**Last Name (STitle) 5310**] in 3 weeks [**Telephone/Fax (1) 5315**] Dr. [**Last Name (STitle) **] after discharge from rehab [**Telephone/Fax (1) 23520**] [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**] Completed by:[**2141-8-22**]

410,428,429,599,276,788,560,414,401,250,536,327,278,714,272,041,112

{"Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acquired cardiac septal defect,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Other impaction of intestine,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Gastroparesis,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Rheumatoid arthritis,Other and unspecified hyperlipidemia,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Candidiasis of other urogenital sites"}

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 PRESENT ILLNESS: This is a 59 year old woman with DM, and known CAD. Last [**Month (only) 1096**] patient had a NSTEMI at [**Hospital3 **]. Found to have three vessel CAD. Transferred to [**Hospital3 **] where she was to have CABG. Upon intubation, she had airway perforation, left pneumothorax and cardiopulmonary arrest. CABG cancelled. Subsequently came to [**Hospital1 18**] in [**2141-1-9**] for flex bronchoscopy with debridement of necrotic tissue. TTE at the time showed normal LVEF. Decision was made to pursue CABG as elective procedure at a later date. Patient has been at rehab for the past months and has had repetitive admissions for nausea/vomiting which was felt to be due to gastroparesis. MEDICAL HISTORY: 1. CAD with 3 vessel disease (70% LAD, 80% RCA, 80% Circ) 2. HTN 3. CHF 4. Obstructive sleep apnea 5. Morbid obesity 6. DM 7. Rheumatoid arthritis 8. Psoriasis 9. Hyperlipidemia 10. Cholelithiasis 11. Spinal stenosis 12. s/p airway perforation, left pneumothorax, and cardiopulmonary arrest ([**12-14**]) during intubation attempt (OSH) MEDICATION ON ADMISSION: 1. Labetalol 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 4. Imdur 30 mg Tablet Sustained Release 24 hr Sig: One (1) Tablet Sustained Release 24 hr PO once a day. 5. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed. 7. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed. 12. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 13. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) ALLERGIES: Codeine / Morphine / Percocet PHYSICAL EXAM: Vitals - T 100.2, BP 132/58, HR 91, 16, 94% ra, wt 119 kg General - sitting in bed, eating, breathing comfortably HEENT - sclera anicteric, JVP difficult to appreciate given body habitus CV - RRR, S1, S2, no murmurs Chest - bibasilar crackles Abdomen - obese, soft, non-tender, +BS Neuro - AAOx3 Extermities-LE edema to mid leg, no venous stasis changes Pulses: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+ FAMILY HISTORY: The patient is adopted; FH unknown. SOCIAL HISTORY: The patient lives alone, but her daughter ([**Name (NI) **]) lives nearby with her 3 children; they have a very close relationship. The patient has homemaker services. Fiance- Mark. 15 pack year smoking history, she quit 2 years ago. Denies alcohol use. ### Response: {"Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Acquired cardiac septal defect,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Retention of urine, unspecified,Other impaction of intestine,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Gastroparesis,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Rheumatoid arthritis,Other and unspecified hyperlipidemia,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Candidiasis of other urogenital sites"}

CHIEF COMPLAINT: Pulseless cold leg PRESENT ILLNESS: [**Age over 90 **] y/o female with hx of breast cancer s/p mastectomy (no chemotherapy), hypothyroidism, ? MAT, depression, EF > 55% on echo [**2156**], presenting from nursing home to [**Hospital1 18**] [**Location (un) 620**] today with LLQ pain, nausea, vomiting, diarrhea x 1 day. . EMS was initially called for LLQ pain and diarrhea and found her to be in AFib w/ RVR and her left foot to be blue and pulseless (non-dopplerable pulses). HR in 170's in transport to [**Hospital1 **] [**Location (un) 620**] and hypotensive so no meds given; not cardioverted en route. Of note, no prior hx of AFIB. Upon arrival, was alert and conversive. Complaining of LLQ abdominal pain and Lt foot pain (cold, bluest extremity). . At [**Location (un) 620**], she was found to be in rapid a-fib and hypotensive. There were three unsuccessful attempts of electric cardioversion (360 J). She was then placed on a diltiazem drip with BP drop to 70s-80s, a heparin drip (700 Units/hr with no Bolus) and transferred to [**Hospital1 18**] [**Location (un) 86**]. Diltiazem gtt d/c's upon arrival here [**2-4**] hypotension with SBP 80's. Vascular surgery consulted for cold, ischemic left foot. They felt that etiology is less likely embolic, given her known popliteal stenosis bilaterally, and more likely hypoperfusion. They will consider additional w/u and possibly stenting once more stable. Cariology consulted for AFIB with RVR. . In our ED, initial VS - 8, 97.0, 134, 122/74, 18, 96% 4L Nasal. Exam notable for cold, pulseless foot on the right, decreased signals on the left. Here, labs notable for WBC 8.5 with left shift, INR 1.2, U/A wnl, lactate 2.1. EKG showing AFIB with HR with non-specific ST changes. CTA AORTA/BIFEM/ILIAC RUNOFF W/W&WO C AND RECONS showing, "Patent abdominal aorta and major branches. Right leg: chronic occlusion of the rt popliteal artery with distal reconstitution on delays. Left leg: chronic occlusion of the popliteal artery with partial distal reconstitution on delays (segment of [**Doctor Last Name **] does not reconstitute) - lt ant tibial artery with equivocal reconstitution distally." . CT abd/pelvis showing, "bilat pl. effusions, basilar atelectasis. trace ascites, thickened descending colon though mucosal enhancement is noted - may reflect colitis." . She was changed from diltiazem to esmolol gtt, with digoxin load of 0.5 mg at 17:30 hrs per cardiology recommendations. She also received magnesium, continued on heparin gtt, and phenylephrine. Subsequently, SBP dropped to 80s, and esmolol gtt turned off. . She is admitted for AFIB with RVR, associated hypoperfusion of foot, ? infectious vs. ischemic colitis. She was given cipro/flagyl, and magnesium en route. CVL was placed prior to transfer. . Vitals on transfer - HR 80-104, BP 88/58, RR 12, 97% 2L NC Access - CVL, PIV . On arrival to the MICU, pt denies concerns but when prompted, she reports pain in left foot. . 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. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. . After evaluation by the vascular surgery team it as determined that the patient had a cold left extremity and would need immediate surgical intervention to revascularize the leg. MEDICAL HISTORY: Breast cancer s/p mastectomy 15 years ago (no systemic chemotx) MEDICATION ON ADMISSION: Medications (unable to confirm): - MVI - ASA 325 - Lasix 20 - Prilosec 20 - Mirtazapine 15 QHS - Dulcolax PR PRN - Levothyroxine 100mcg - Spironolactone 12.5 - HCTZ 12.5 - Acetaminophen PRN - Ultram PRN ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Vitals: 96.3, HR 110-140, BP 97/52, 18, 96% 2L NC General: Alert, oriented, no distress HEENT: Sclera anicteric, MM dry, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: rapid irregular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops appreciated Lungs: mild crackles and rhonchi R base, no wheezes Abdomen: soft, mild tenderness to deep palpation LLQ, non-distended, bowel sounds present, no organomegaly GU: foley Ext: cool, mottled, non-palpable DP pulses bilaterally; however, able to obtain L DP pulse with doppler Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 1+ reflexes bilaterally, gait deferred, finger-to-nose intact FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Pt lives in a nursing home where she is essentially non-ambulatory. Per daughter, has had difficulty with eating and drinking adequately. She uses a wheelchair as her primary mode transport and is able to use a walker for only very short distances with the help of others.

Arterial embolism and thrombosis of lower extremity,Acute respiratory failure,Acute posthemorrhagic anemia,Infectious colitis, enteritis, and gastroenteritis,Blood in stool,Atrial fibrillation,Personal history of malignant neoplasm of breast,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Depressive disorder, not elsewhere classified,Nausea with vomiting,Wheelchair dependence,Esophageal reflux,Hypoxemia

Lower extremity embolism,Acute respiratry failure,Ac posthemorrhag anemia,Infectious enteritis NOS,Blood in stool,Atrial fibrillation,Hx of breast malignancy,Hypothyroidism NOS,Osteoporosis NOS,Depressive disorder NEC,Nausea with vomiting,Wheelchair dependence,Esophageal reflux,Hypoxemia

Admission Date: [**2156-11-20**] Discharge Date: [**2156-11-28**] Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2777**] Chief Complaint: Pulseless cold leg Major Surgical or Invasive Procedure: 11/20/111 Left popliteal cutdown and thrombectomy 11/22/111 Re-do Left popliteal cutdown and thrombectomy History of Present Illness: [**Age over 90 **] y/o female with hx of breast cancer s/p mastectomy (no chemotherapy), hypothyroidism, ? MAT, depression, EF > 55% on echo [**2156**], presenting from nursing home to [**Hospital1 18**] [**Location (un) 620**] today with LLQ pain, nausea, vomiting, diarrhea x 1 day. . EMS was initially called for LLQ pain and diarrhea and found her to be in AFib w/ RVR and her left foot to be blue and pulseless (non-dopplerable pulses). HR in 170's in transport to [**Hospital1 **] [**Location (un) 620**] and hypotensive so no meds given; not cardioverted en route. Of note, no prior hx of AFIB. Upon arrival, was alert and conversive. Complaining of LLQ abdominal pain and Lt foot pain (cold, bluest extremity). . At [**Location (un) 620**], she was found to be in rapid a-fib and hypotensive. There were three unsuccessful attempts of electric cardioversion (360 J). She was then placed on a diltiazem drip with BP drop to 70s-80s, a heparin drip (700 Units/hr with no Bolus) and transferred to [**Hospital1 18**] [**Location (un) 86**]. Diltiazem gtt d/c's upon arrival here [**2-4**] hypotension with SBP 80's. Vascular surgery consulted for cold, ischemic left foot. They felt that etiology is less likely embolic, given her known popliteal stenosis bilaterally, and more likely hypoperfusion. They will consider additional w/u and possibly stenting once more stable. Cariology consulted for AFIB with RVR. . In our ED, initial VS - 8, 97.0, 134, 122/74, 18, 96% 4L Nasal. Exam notable for cold, pulseless foot on the right, decreased signals on the left. Here, labs notable for WBC 8.5 with left shift, INR 1.2, U/A wnl, lactate 2.1. EKG showing AFIB with HR with non-specific ST changes. CTA AORTA/BIFEM/ILIAC RUNOFF W/W&WO C AND RECONS showing, "Patent abdominal aorta and major branches. Right leg: chronic occlusion of the rt popliteal artery with distal reconstitution on delays. Left leg: chronic occlusion of the popliteal artery with partial distal reconstitution on delays (segment of [**Doctor Last Name **] does not reconstitute) - lt ant tibial artery with equivocal reconstitution distally." . CT abd/pelvis showing, "bilat pl. effusions, basilar atelectasis. trace ascites, thickened descending colon though mucosal enhancement is noted - may reflect colitis." . She was changed from diltiazem to esmolol gtt, with digoxin load of 0.5 mg at 17:30 hrs per cardiology recommendations. She also received magnesium, continued on heparin gtt, and phenylephrine. Subsequently, SBP dropped to 80s, and esmolol gtt turned off. . She is admitted for AFIB with RVR, associated hypoperfusion of foot, ? infectious vs. ischemic colitis. She was given cipro/flagyl, and magnesium en route. CVL was placed prior to transfer. . Vitals on transfer - HR 80-104, BP 88/58, RR 12, 97% 2L NC Access - CVL, PIV . On arrival to the MICU, pt denies concerns but when prompted, she reports pain in left foot. . 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. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. . After evaluation by the vascular surgery team it as determined that the patient had a cold left extremity and would need immediate surgical intervention to revascularize the leg. Past Medical History: Breast cancer s/p mastectomy 15 years ago (no systemic chemotx) Hypothyroidism s/p thyroidectomy 4 years ago Osteoperosis Depression Back pain Cardiac Risk Factors: - Diabetes, - Dyslipidemia, + Hypertension Cardiac History: No prior CABG, ICD, or PCI . Social History: Pt lives in a nursing home where she is essentially non-ambulatory. Per daughter, has had difficulty with eating and drinking adequately. She uses a wheelchair as her primary mode transport and is able to use a walker for only very short distances with the help of others. Family History: There is no family history of premature coronary artery disease or sudden death. Physical Exam: Vitals: 96.3, HR 110-140, BP 97/52, 18, 96% 2L NC General: Alert, oriented, no distress HEENT: Sclera anicteric, MM dry, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: rapid irregular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops appreciated Lungs: mild crackles and rhonchi R base, no wheezes Abdomen: soft, mild tenderness to deep palpation LLQ, non-distended, bowel sounds present, no organomegaly GU: foley Ext: cool, mottled, non-palpable DP pulses bilaterally; however, able to obtain L DP pulse with doppler Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 1+ reflexes bilaterally, gait deferred, finger-to-nose intact Pertinent Results: [**2156-11-20**] 08:21PM LACTATE-1.6 [**2156-11-20**] 05:20PM URINE HOURS-RANDOM [**2156-11-20**] 05:20PM URINE UHOLD-HOLD [**2156-11-20**] 05:20PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.012 [**2156-11-20**] 05:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-5.0 LEUK-NEG [**2156-11-20**] 03:50PM GLUCOSE-92 UREA N-33* CREAT-0.6 SODIUM-140 POTASSIUM-3.1* CHLORIDE-103 TOTAL CO2-24 ANION GAP-16 [**2156-11-20**] 03:50PM estGFR-Using this [**2156-11-20**] 03:50PM ALT(SGPT)-32 AST(SGOT)-28 LD(LDH)-233 CK(CPK)-22* ALK PHOS-124* TOT BILI-0.9 [**2156-11-20**] 03:50PM CK-MB-2 cTropnT-<0.01 [**2156-11-20**] 03:50PM ALBUMIN-1.9* CALCIUM-6.6* PHOSPHATE-4.1 MAGNESIUM-1.5* [**2156-11-20**] 03:50PM TSH-0.67 [**2156-11-20**] 02:35PM WBC-8.5# RBC-4.32# HGB-13.3# HCT-41.9# MCV-97 MCH-30.7 MCHC-31.7 RDW-14.6 [**2156-11-20**] 02:35PM NEUTS-91* BANDS-3 LYMPHS-2* MONOS-3 EOS-0 BASOS-0 ATYPS-0 METAS-1* MYELOS-0 [**2156-11-20**] 02:35PM HYPOCHROM-OCCASIONAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL [**2156-11-28**] 12:21AM BLOOD WBC-6.0 RBC-2.77* Hgb-8.4* Hct-24.9* MCV-90 MCH-30.2 MCHC-33.6 RDW-16.0* Plt Ct-41* [**2156-11-23**] 01:42AM BLOOD Neuts-91* Bands-1 Lymphs-3* Monos-2 Eos-0 Baso-0 Atyps-0 Metas-3* Myelos-0 [**2156-11-23**] 01:42AM BLOOD Hypochr-1+ Anisocy-1+ Poiklo-2+ Macrocy-OCCASIONAL Microcy-1+ Polychr-OCCASIONAL Schisto-OCCASIONAL Burr-2+ Tear Dr[**Last Name (STitle) **]1+ [**2156-11-28**] 12:21AM BLOOD Plt Ct-41* [**2156-11-28**] 12:21AM BLOOD PT-23.5* PTT-120.6* INR(PT)-2.2* [**2156-11-28**] 12:21AM BLOOD Glucose-93 UreaN-15 Creat-0.5 Na-136 K-3.3 Cl-108 HCO3-22 AnGap-9 [**2156-11-27**] 03:12AM BLOOD Glucose-71 UreaN-16 Creat-0.5 Na-135 K-4.9 Cl-107 HCO3-21* AnGap-12 [**2156-11-26**] 01:47PM BLOOD UreaN-16 Creat-0.5 [**2156-11-26**] 03:27AM BLOOD Glucose-112* UreaN-16 Creat-0.5 Na-134 K-5.0 Cl-108 HCO3-17* AnGap-14 [**2156-11-27**] 03:12AM BLOOD ALT-4 AST-14 LD(LDH)-111 AlkPhos-33* Amylase-137* TotBili-2.5* [**2156-11-26**] 03:27AM BLOOD ALT-7 AST-14 LD(LDH)-129 AlkPhos-40 Amylase-59 TotBili-2.3* [**2156-11-25**] 04:26PM BLOOD ALT-10 AST-23 LD(LDH)-148 AlkPhos-41 Amylase-107* TotBili-2.5* [**2156-11-28**] 12:21AM BLOOD Calcium-7.4* Phos-1.9* Mg-1.8 [**2156-11-27**] 03:12AM BLOOD Albumin-3.9 Calcium-8.2* Phos-2.2* Mg-1.7 [**2156-11-26**] 03:27AM BLOOD Albumin-3.4* Calcium-8.0* Phos-2.7 Mg-1.7 [**2156-11-28**] 12:37AM BLOOD Type-ART pO2-168* pCO2-28* pH-7.49* calTCO2-22 Base XS-0 Intubat-INTUBATED [**2156-11-27**] 03:26AM BLOOD Type-ART pO2-137* pCO2-26* pH-7.52* calTCO2-22 Base XS-0 [**2156-11-26**] 11:12PM BLOOD Type-ART pO2-145* pCO2-23* pH-7.52* calTCO2-19* Base XS--1 [**2156-11-25**] 12:00PM BLOOD HEPARIN DEPENDENT ANTIBODIES- Brief Hospital Course: [**Age over 90 **] y/o female with hx of breast cancer s/p mastectomy (no chemotherapy), hypothyroidism, ? MAT, depression, presenting from nursing home to [**Hospital1 18**] [**Location (un) 620**] with LLQ pain, nausea, vomiting, diarrhea x 1 day, transferred to [**Hospital1 **] [**Location (un) 86**] with unstable news onset AFIB with RVR, hypoperfusion and cool left lower extremity, and ? colitis on CT abdomen/pelvis. She underwent two operations for revascularization of her left lower extremity. Her foot became ischemic again on POD [**4-3**] and the family declined further intervention. On POD [**7-6**] the family decided to make the patient CMO and the patient was started on a Morphine drip and all other care was suspended. The patient expired on [**2156-11-28**]. . # Atrial fibrillation with rapid ventricular response: hemodynamically unstable. She dropped pressures with diltiazem gtt and esmolol gtt, and failed cardioversion x 3 at OSH. Etiology was unclear, but most likely related to infection, specifically ischemic vs. inflammatory vs. infectious colitis, as seen on CT abdomen and pelvis. Cardiology consulted in ED, and was loaded with digoxin and on esmolol gtt with phenylephrine however, dig was discontinued and Amiodarone loading was begun. TTE showed normal EF. Patient was maintained on Amiodarone drip for afib control postoperatively. Patient maintained HR's between 80-100 for the majority of her hospital course. # Ischemic, cool, non-dopplerable left lower extremity: hypoperfusion vs. embolic. Per vascular, etiology is less likely embolic, given her known popliteal stenosis bilaterally and lack of clot on CTA imaging. ? hypoperfusion. However, embolic phenomenon very possible given new onset atrial fibrillation. On doppler exam, right sided dorsalis pedis and posterior tibial were audible. However, on left side, pulses not audible. +1 pedal edema. Per vascular surgery suspicion of left popliteal clot, patient was taken to the OR for thrombectomy and was thence transferred to the CVICU. The procedure was without complication and upon transfer to the CVICU the patient's foot has a dopplarable PT signal. However on POD 1 the foot began appearing ischemic and the patient was taken back to the operating room to have a repeat popliteal cutdown and reexploration and thrombectomy to revascularize the foot. Postoperatively the foot began showing signs of adequate perfusion. Her pulses were dopplarable and on POD4 there was a palpable DP pulse. The perfusion to her foot was maintained by keep her systolic blood pressure elevated to >120 which required repeat boluses with fluid, albumin and repeat blood transfusions to maintain a Hct of 30. On POD [**3-2**] she was started on Dobutamine secondary to systolic blood pressures in the 80s and 90s. In addition to maintaining her SBP she was also started on a heparin drip to prevent further thrombosis of her lower extremity. She was maintained on heparin drip with a goal PTT of 60-80. On POD [**4-3**] she was changed to Bivalirudin given her decrease in platelets and suspicion for HITT. A HITT panel was sent and she was maintained therapeutic on the Bivalirudin. On POD [**4-3**] overnight her left foot lost dopplarable signals and began appearing ischemic. She was normotensive and therapeutic on her anticoagulation at the time. Her family was called and was told that without intervention her left foot would not be salvageable. The family declined any further intervention and the patient was continued on full medical support. The foot never regained pulses and continued to worsen in appearance. # Hypotension: etiology suspected to be from rapid atrial fibrillation with rapid ventricular response but also need to consider sepsis given tachycardia, hypotension, and suspected source of colitis. DDx also includes cardiogenic shock, although echo early this year without wall motion abnormalities or systolic dysfunction. We added Meropenam and Linezolid for empiric HCAP coverage. Sputum cultures, and sputum and urine legionella were ordered. Patient was started on dopamine in the MICU and responded well. This was continued postoperatively along with maintained a Hct of 30 and additional fluid and albumin as needed. . # ? colitis: infectious vs. inflammatory vs. ischemic colitis on CT abdomen and pelvis. Consistent with her reported history of LLQ pain, N/V/D. We sent stool cultures, C.diff toxin and added cipro/flagyl for Abx. The transplant service was contact postoperatively who recommended serial exams and antibiotics. Postoperatively she developed a firm abdomen, however bladder pressures were 20-24 with normal urine output and peak airway pressures. The transplant service did not feel the need for any urgent intervention and the patient was maintained on antibiotics and her abdominal exam was monitored closely. . # HTN: We held lasix, aldactone, HCTZ in setting of hypotension. . # Hypothyroidism: Synthroid was held upon admission, however was restarted postoperatively; sent TSH and FT4, Fingersticks were checked regularly and blood sugars were maintained with prn Insulin. . # Depression: we continued remeron. . # GERD: We continued omeprazole. . # Code: Patient was DNR/DNI initially upon admission, however the order was suspended to allow the patient to go to the operating room. This was reinstated postoperatively, however when it was apparent the patient would need an additional procedure the order was once again suspended. The order was then reinstated postoperatively. After it was apparent that her foot was no longer viable the patient was managed with full medical support until the patient's family made the decision to make the patient CMO on [**2156-11-28**]. The patient then expired several hours later on [**2156-11-28**] secondary to cardiopulmonary arrest. . Medications on Admission: Medications (unable to confirm): - MVI - ASA 325 - Lasix 20 - Prilosec 20 - Mirtazapine 15 QHS - Dulcolax PR PRN - Levothyroxine 100mcg - Spironolactone 12.5 - HCTZ 12.5 - Acetaminophen PRN - Ultram PRN Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: Atrial fibrillation Left leg ischemia Discharge Condition: Expired Discharge Instructions: None Followup Instructions: None

444,518,285,009,578,427,V103,244,733,311,787,V463,530,799

{'Arterial embolism and thrombosis of lower extremity,Acute respiratory failure,Acute posthemorrhagic anemia,Infectious colitis, enteritis, and gastroenteritis,Blood in stool,Atrial fibrillation,Personal history of malignant neoplasm of breast,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Depressive disorder, not elsewhere classified,Nausea with vomiting,Wheelchair dependence,Esophageal reflux,Hypoxemia'}

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: Pulseless cold leg PRESENT ILLNESS: [**Age over 90 **] y/o female with hx of breast cancer s/p mastectomy (no chemotherapy), hypothyroidism, ? MAT, depression, EF > 55% on echo [**2156**], presenting from nursing home to [**Hospital1 18**] [**Location (un) 620**] today with LLQ pain, nausea, vomiting, diarrhea x 1 day. . EMS was initially called for LLQ pain and diarrhea and found her to be in AFib w/ RVR and her left foot to be blue and pulseless (non-dopplerable pulses). HR in 170's in transport to [**Hospital1 **] [**Location (un) 620**] and hypotensive so no meds given; not cardioverted en route. Of note, no prior hx of AFIB. Upon arrival, was alert and conversive. Complaining of LLQ abdominal pain and Lt foot pain (cold, bluest extremity). . At [**Location (un) 620**], she was found to be in rapid a-fib and hypotensive. There were three unsuccessful attempts of electric cardioversion (360 J). She was then placed on a diltiazem drip with BP drop to 70s-80s, a heparin drip (700 Units/hr with no Bolus) and transferred to [**Hospital1 18**] [**Location (un) 86**]. Diltiazem gtt d/c's upon arrival here [**2-4**] hypotension with SBP 80's. Vascular surgery consulted for cold, ischemic left foot. They felt that etiology is less likely embolic, given her known popliteal stenosis bilaterally, and more likely hypoperfusion. They will consider additional w/u and possibly stenting once more stable. Cariology consulted for AFIB with RVR. . In our ED, initial VS - 8, 97.0, 134, 122/74, 18, 96% 4L Nasal. Exam notable for cold, pulseless foot on the right, decreased signals on the left. Here, labs notable for WBC 8.5 with left shift, INR 1.2, U/A wnl, lactate 2.1. EKG showing AFIB with HR with non-specific ST changes. CTA AORTA/BIFEM/ILIAC RUNOFF W/W&WO C AND RECONS showing, "Patent abdominal aorta and major branches. Right leg: chronic occlusion of the rt popliteal artery with distal reconstitution on delays. Left leg: chronic occlusion of the popliteal artery with partial distal reconstitution on delays (segment of [**Doctor Last Name **] does not reconstitute) - lt ant tibial artery with equivocal reconstitution distally." . CT abd/pelvis showing, "bilat pl. effusions, basilar atelectasis. trace ascites, thickened descending colon though mucosal enhancement is noted - may reflect colitis." . She was changed from diltiazem to esmolol gtt, with digoxin load of 0.5 mg at 17:30 hrs per cardiology recommendations. She also received magnesium, continued on heparin gtt, and phenylephrine. Subsequently, SBP dropped to 80s, and esmolol gtt turned off. . She is admitted for AFIB with RVR, associated hypoperfusion of foot, ? infectious vs. ischemic colitis. She was given cipro/flagyl, and magnesium en route. CVL was placed prior to transfer. . Vitals on transfer - HR 80-104, BP 88/58, RR 12, 97% 2L NC Access - CVL, PIV . On arrival to the MICU, pt denies concerns but when prompted, she reports pain in left foot. . 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. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. . After evaluation by the vascular surgery team it as determined that the patient had a cold left extremity and would need immediate surgical intervention to revascularize the leg. MEDICAL HISTORY: Breast cancer s/p mastectomy 15 years ago (no systemic chemotx) MEDICATION ON ADMISSION: Medications (unable to confirm): - MVI - ASA 325 - Lasix 20 - Prilosec 20 - Mirtazapine 15 QHS - Dulcolax PR PRN - Levothyroxine 100mcg - Spironolactone 12.5 - HCTZ 12.5 - Acetaminophen PRN - Ultram PRN ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Vitals: 96.3, HR 110-140, BP 97/52, 18, 96% 2L NC General: Alert, oriented, no distress HEENT: Sclera anicteric, MM dry, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: rapid irregular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops appreciated Lungs: mild crackles and rhonchi R base, no wheezes Abdomen: soft, mild tenderness to deep palpation LLQ, non-distended, bowel sounds present, no organomegaly GU: foley Ext: cool, mottled, non-palpable DP pulses bilaterally; however, able to obtain L DP pulse with doppler Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 1+ reflexes bilaterally, gait deferred, finger-to-nose intact FAMILY HISTORY: There is no family history of premature coronary artery disease or sudden death. SOCIAL HISTORY: Pt lives in a nursing home where she is essentially non-ambulatory. Per daughter, has had difficulty with eating and drinking adequately. She uses a wheelchair as her primary mode transport and is able to use a walker for only very short distances with the help of others. ### Response: {'Arterial embolism and thrombosis of lower extremity,Acute respiratory failure,Acute posthemorrhagic anemia,Infectious colitis, enteritis, and gastroenteritis,Blood in stool,Atrial fibrillation,Personal history of malignant neoplasm of breast,Unspecified acquired hypothyroidism,Osteoporosis, unspecified,Depressive disorder, not elsewhere classified,Nausea with vomiting,Wheelchair dependence,Esophageal reflux,Hypoxemia'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: This patient is a 62 year old male with CAD s/p MI in [**2100**], T2DM, HTN and HLD who is BIBEMS for chest pain. He was in his usual state of health today when he started to have left sided chest pressure after having a bowel movement. He has intermittent chest pain when he plays [**Doctor First Name 13792**] [**Doctor Last Name 13793**] each week, the pain always resolves with rest and he is able to play for [**3-22**] hours at a time taking only intermittent breaks. He does note that the pain was worse than usual last week. The discomfort he experienced today was located just to the left of the sternum, radiated down his left arm and escalated to a [**11-26**] in severity. He states that the pain felt the same as the pain he had with his prior MI in [**Location (un) 2848**] in [**2100**]. He also describes feeling short of breath at this time. EMS arrived and gave him SL nitro x2 which brought his pain down to a [**2102-9-25**]. He was taken to the [**Hospital1 18**] ED. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: -Plavix 75mg PO daily -Diovan 40mg PO daily -Metoprolol 25mg PO bid -Metformin 1000mg PO bid -ASA 81mg PO daily -Lipitor 10mg PO qHS -Colchicine 0.6mg PO daily -Detrol 2mg PO bid -Advil PRN ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission exam: VS: T 95.6 HR 68 BP 139/77 RR 15 SpO2 100%/2L NC 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: - Mother: Died of "old age" at 97 - Father: DM, died from CVA at age 86 - Brother and sister both with CAD and MIs, brother reportedly has 13 stents SOCIAL HISTORY: He lives in CT with his wife, was visiting his daughter and new granddaughter in [**Name2 (NI) **] when the CP started. He is a retired technician for Pfizer. - Tobacco history: Remote smoking, quit 40 years ago - ETOH: Rare social alcohol use - Illicit drugs: None

Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Gout, unspecified

AMI anterior wall, init,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Gout NOS

Admission Date: [**2104-1-27**] Discharge Date: [**2104-1-30**] Date of Birth: [**2041-9-3**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 425**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: [**2104-1-27**] - Cardiac catheterization with DES placed in LAD History of Present Illness: This patient is a 62 year old male with CAD s/p MI in [**2100**], T2DM, HTN and HLD who is BIBEMS for chest pain. He was in his usual state of health today when he started to have left sided chest pressure after having a bowel movement. He has intermittent chest pain when he plays [**Doctor First Name 13792**] [**Doctor Last Name 13793**] each week, the pain always resolves with rest and he is able to play for [**3-22**] hours at a time taking only intermittent breaks. He does note that the pain was worse than usual last week. The discomfort he experienced today was located just to the left of the sternum, radiated down his left arm and escalated to a [**11-26**] in severity. He states that the pain felt the same as the pain he had with his prior MI in [**Location (un) 2848**] in [**2100**]. He also describes feeling short of breath at this time. EMS arrived and gave him SL nitro x2 which brought his pain down to a [**2102-9-25**]. He was taken to the [**Hospital1 18**] ED. In the [**Hospital1 18**] ED, he still had [**2102-9-25**] pain and received Plavix 600mg, ASA 325mg, and a heparin gtt. An EKG was obtained which showed ST elevations in V2-V5. A code STEMI was activated and he was taken to the cath lab. He was found to have a 90% stenosis in the LAD, 40% mid-LCx lesion and minimal disease in the RCA. He received a 3.0x23mm DES to the LAD and was started on integrilin while in the cath lab. Upon arrival to the CCU, his pain had improved to [**2102-4-20**] and he describes it more as a pain than the pressure he felt earlier today. Repeat EKG post-cath was improved with only 1mm STEs in V2-V3. On review of systems, s/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. S/he denies recent fevers, chills or rigors. S/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 dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. Past Medical History: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension 2. CARDIAC HISTORY: - CABG: None - PERCUTANEOUS CORONARY INTERVENTIONS: Stent at [**Hospital1 1872**] in [**Location (un) 2848**], FL in [**2100**], not sure which artery it was placed in - PACING/ICD: None 3. OTHER PAST MEDICAL HISTORY: -CAD s/p MI and stent in [**2100**] -HTN -DM -Gout -Arthritis -Sciatica with 2 prior back surgeries (not sure what procedure) Social History: He lives in CT with his wife, was visiting his daughter and new granddaughter in [**Name2 (NI) **] when the CP started. He is a retired technician for Pfizer. - Tobacco history: Remote smoking, quit 40 years ago - ETOH: Rare social alcohol use - Illicit drugs: None Family History: - Mother: Died of "old age" at 97 - Father: DM, died from CVA at age 86 - Brother and sister both with CAD and MIs, brother reportedly has 13 stents Physical Exam: Admission exam: VS: T 95.6 HR 68 BP 139/77 RR 15 SpO2 100%/2L NC 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, JVD difficult to assess because pt lying flat after procedure. 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, 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. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ Discharge exam: Unchanged from above Pertinent Results: Admission labs: [**2104-1-27**] 01:10PM BLOOD WBC-7.2 RBC-4.81 Hgb-14.5 Hct-42.4 MCV-88 MCH-30.1 MCHC-34.1 RDW-12.6 Plt Ct-222 [**2104-1-27**] 01:10PM BLOOD Neuts-42.5* Lymphs-46.1* Monos-5.8 Eos-4.9* Baso-0.8 [**2104-1-27**] 01:10PM BLOOD PT-10.5 PTT-30.4 INR(PT)-1.0 [**2104-1-27**] 01:10PM BLOOD Glucose-219* UreaN-17 Creat-0.9 Na-137 K-3.9 Cl-102 HCO3-22 AnGap-17 [**2104-1-27**] 01:10PM BLOOD CK-MB-4 [**2104-1-27**] 01:10PM BLOOD cTropnT-<0.01 [**2104-1-27**] 01:10PM BLOOD Calcium-8.8 Phos-2.2* Mg-1.9 Studies: Left heart cath ([**2104-1-27**]) - COMMENTS: 1. Selective coronary angiography of this right-dominant system demonstrated severe single-vessel CAD. The LMCA had no angiographically significant lesions. The LAD had a long 90% thrombotic lesion in the mid-vessel. There was 50% ostial stenosis of the diagonal branch. The LCX had a 40% stenosis in the mid-vessel. The dominant RCA was a large caliber vessel with minimal disease. 2. Limited resting hemodynamics revealed severely elevated systemic arterial pressures with a central aortic pressure of 157/83. 3. Successful direct stenting of the LAD with a 3.0 x 23 Promus DES (see PTCA comments). 4. Successful RFA AngioSeal (see PTCA comments). FINAL DIAGNOSIS: 1. One-vessel coronary artery disease. 2. Successful PCI of the mid LAD with a 3.0 x 23 mm Promus DES. 3. Successful RFA AngioSeal. CXR ([**2104-1-28**]) - Lungs clear. Heart size normal. No pleural effusion. TTE ([**2104-1-28**]) - The left atrium and right atrium are normal in cavity size. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses and cavity size are normal. There is mild to moderate regional left ventricular systolic dysfunction with severe hypokinesis of the distal half of the anterior septum and anterior walls, and apex. There is a small apical left ventricular aneurysm. The remaining segments contract normally (LVEF = 40 %). The estimated cardiac index is normal (>=2.5L/min/m2). No masses or thrombi are seen in the left ventricle. Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are 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. The pulmonary artery systolic pressure could not be determined. There is an anterior space which most likely represents a prominent fat pad. IMPRESSION: Normal left ventricular cavity size with regional systolic dysfunction c/w CAD (mid-LAD distribution). Discharge labs: [**2104-1-30**] 06:35AM BLOOD WBC-7.3 RBC-4.91 Hgb-14.7 Hct-43.0 MCV-88 MCH-30.0 MCHC-34.3 RDW-12.5 Plt Ct-231 [**2104-1-30**] 06:35AM BLOOD PT-12.2 PTT-38.2* INR(PT)-1.1 [**2104-1-30**] 06:35AM BLOOD Glucose-127* UreaN-15 Creat-0.9 Na-138 K-4.1 Cl-99 HCO3-30 AnGap-13 [**2104-1-30**] 06:35AM BLOOD Calcium-9.5 Phos-4.5 Mg-2.0 Brief Hospital Course: 62M with CAD s/p MI in [**2100**], HTN, HLD and DM who presents with chest pain and was found to have a STEMI, now s/p PCI. # STEMI: The patient presented to [**Hospital1 18**] ED with chest pain similar to prior MI. There were anterior ST elevations on EKG. He was given aspirin, plavix 600mg, and heparin and taken urgently to the cardiac catheterization lab. There he was found to have single vessel coronary artery disease with the LAD having a long 90% thrombotic lesion in the mid-vessel. One drug eluting stent was successfully placed in the LAD. He received integrillin for 18 hours after the procedure. His metoprolol and diovan were restarted. His atorvastatin was increased to 80mg daily. His metoprolol was uptitrated to 50mg [**Hospital1 **] with improvement in blood pressure and heart rate. He was continued on plavix 75mg daily and aspirin was increased to 325mg daily. His troponin-T peaked at 2.45. Trans-thoracic echocardiogram on the second day of admission showed LVEF of 40% with a small apical left ventricular aneurysm and hypokinesis of the distal-anterior septum. At discharge, his cheat pain had improved. He has been arranged for follow-up with his cardiologist and PCP. . #ISCHEMIC CARDIOMYOPATHY/STUNNED MYOCARDIUM: Trans-thoracic echocardiogram revealed an ejection fraction of 40% with small apical left ventricular aneurysm and hypokinesis of the distal-anterior septum. He was started on lovenox and coumadin (5mg on [**2104-1-29**]) for prevention of left ventricular thrombus. INR on discharge was 1.1 (he had only received 1 dose of Coumadin). We communicated with PCP office who will follow INR as outpatient. He will need repeat echocardiogram in [**2-19**] months to assess degree of LV dysfunction and continued need for anticoagulation. . # HYPERTENSION: - He was restarted on his home dose metoprolol and diovan with suboptimal control of blood pressure. His metoprolol was uptitrated to 50mg PO bid with improvement in heart rate and blood pressure. . # HYPERLIPIDEMIA - His atorvastatin was increased to 80mg daily. Lipid panel at admission showed good control of his cholesterol with LDL <70. . # Diabetes - A1c at admission was 6.3%, suggesting good control at home. Metformin was held during this admission and he was covered with a Humalog sliding scale. AT discharge, he will restart metformin. . # Gout - Continued on colchicine 0.6mg PO daily, did not have any pain consistent with a gout flare during this admission. . # Code status this admission - FULL #Transitional issues -Started on Coumadin 5mg daily at discharge, spoke with PCP's office about following INR and adjusting Coumadin. He is scheduled for next INR check on Friday [**2104-2-1**]. -Will be bridged with Lovenox 80mg q12h until INR is therapeutic -Will need follow-up TTE after discharge to reassess EF and apical akinesis Medications on Admission: -Plavix 75mg PO daily -Diovan 40mg PO daily -Metoprolol 25mg PO bid -Metformin 1000mg PO bid -ASA 81mg PO daily -Lipitor 10mg PO qHS -Colchicine 0.6mg PO daily -Detrol 2mg PO bid -Advil PRN Discharge Medications: 1. valsartan 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 3. 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:*0* 4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 5. colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. tolterodine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: Take at the same time every day. Disp:*30 Tablet(s)* Refills:*0* 8. Lovenox 80 mg/0.8 mL Syringe Sig: Eighty (80) mg Subcutaneous every twelve (12) hours: Continue to take until your PCP tells you to stop. Disp:*20 doses* Refills:*0* 9. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day. 10. Outpatient Lab Work INR check on Friday [**2104-2-1**]. Please fax results to Dr. [**Last Name (STitle) 91374**] at [**0-0-**]. 11. metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*0* Discharge Disposition: Home With Service Facility: VNA of Southeastern [**State 2748**] Discharge Diagnosis: Primary Diagnoses: 1. Acute ST-segment elevation myocardial infarction (STEMI) 2. Chest pain Secondary Diagnoses: 1. Hypertension 2. Hyperlipidemia 3. Diabetes mellitus, type 2 4. Gout Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Patient Discharge Instructions: You were admitted to the Coronary Care Unit (CCU) at [**Hospital1 771**] on [**Hospital Ward Name 121**] 6 regarding management of your acute myocardial infarction (heart attack). Your presented with chest pain and were urgently taken to the cardiac catheterization lab where a drug-eluting stent was placed in your left anterior descending coronary (heart) artery. Following the procedure your pain improved, your cardiac medications were changed and you were feeling better at the time of discharge. You should have your INR checked on Friday [**2104-2-1**], this monitors how thin your blood while you are on Coumadin. You can take the attached prescription to any lab, have the results faxed to Dr. [**Last Name (STitle) 91374**] at [**0-0-**]. Please call your doctor or go to the emergency department if: * You experience new chest pain, pressure, squeezing or tightness. * You develop new or worsening cough, shortness of breath, or wheezing. * You are vomiting and cannot keep down fluids, or your medications. * If 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. * You experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * Your pain is not improving within 12 hours or is not under control within 24 hours. * Your pain worsens or changes location. * You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. * You develop any other concerning symptoms. The following changes were made to your medications: CHANGE atorvastatin 80mg by mough daily CHANGE metoprolol 100mg by mouth daily CHANGE aspirin 325mg by mouth daily START Warfarin 5mg by mouth daily - Dr. [**Last Name (STitle) 91375**] office will advise you on adjusring the dose of this medication START Lovenox 80mg subcutaneous every 12 hours - take until Dr. [**Last Name (STitle) 91374**] tells you that your INR is therapeutic Followup Instructions: Name: [**Last Name (LF) **],[**Name8 (MD) **] MD Location: [**Hospital **] MEDICAL GROUP, P.C. Address: [**Street Address(2) 91376**]., [**Location (un) 25465**],[**Numeric Identifier 91377**] Phone: [**Telephone/Fax (1) 91378**] Appt: [**2-13**] at 10:30am Name: [**Last Name (LF) 91379**], [**Name8 (MD) **] MD Location: Eastern [**State 2748**] Cardiology Address: 196 Parkway South [**Apartment Address(1) **], [**Location (un) 48511**], CT Phone: [**Telephone/Fax (1) 91380**] Appt: Monday [**2-4**] at 1:20pm

410,414,250,272,401,274

{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Gout, 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: This patient is a 62 year old male with CAD s/p MI in [**2100**], T2DM, HTN and HLD who is BIBEMS for chest pain. He was in his usual state of health today when he started to have left sided chest pressure after having a bowel movement. He has intermittent chest pain when he plays [**Doctor First Name 13792**] [**Doctor Last Name 13793**] each week, the pain always resolves with rest and he is able to play for [**3-22**] hours at a time taking only intermittent breaks. He does note that the pain was worse than usual last week. The discomfort he experienced today was located just to the left of the sternum, radiated down his left arm and escalated to a [**11-26**] in severity. He states that the pain felt the same as the pain he had with his prior MI in [**Location (un) 2848**] in [**2100**]. He also describes feeling short of breath at this time. EMS arrived and gave him SL nitro x2 which brought his pain down to a [**2102-9-25**]. He was taken to the [**Hospital1 18**] ED. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes, +Dyslipidemia, +Hypertension MEDICATION ON ADMISSION: -Plavix 75mg PO daily -Diovan 40mg PO daily -Metoprolol 25mg PO bid -Metformin 1000mg PO bid -ASA 81mg PO daily -Lipitor 10mg PO qHS -Colchicine 0.6mg PO daily -Detrol 2mg PO bid -Advil PRN ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Admission exam: VS: T 95.6 HR 68 BP 139/77 RR 15 SpO2 100%/2L NC 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: - Mother: Died of "old age" at 97 - Father: DM, died from CVA at age 86 - Brother and sister both with CAD and MIs, brother reportedly has 13 stents SOCIAL HISTORY: He lives in CT with his wife, was visiting his daughter and new granddaughter in [**Name2 (NI) **] when the CP started. He is a retired technician for Pfizer. - Tobacco history: Remote smoking, quit 40 years ago - ETOH: Rare social alcohol use - Illicit drugs: None ### Response: {'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Gout, unspecified'}

CHIEF COMPLAINT: Stage III-a squamous cell carcinoma left lower lobe. PRESENT ILLNESS: This is a 50-year-old woman with biopsy-proven squamous cell carcinoma of the left lower lobe. She underwent induction of neoadjuvant chemoradiation therapy completed on [**2169-8-31**]. She had previously undergone a mediastinal and left VATS lymph node sampling of pleural fluid biopsy that demonstrated a positive AP window node for metastatic carcinoma. All other nodal stations sampled and the pleural fluid were negative for malignancy. She now presents for definitive resection. MEDICAL HISTORY: hyperlipidemia Stage III NSCL squamous lung cell cancer MEDICATION ON ADMISSION: FAMOTIDINE 20 mg [**Hospital1 **], HYDROCODONE-HOMATROPINE [HYDROMET]QID PRN Cough, HYDROCORTISONE cream, LORAZEPAM 0.5-1 mg QID PRN, Maalox PRN, ONDANSETRON HCL 8 Q8h PRN, ROXICET PRN PAIN, PROTONIX 40 mg [**Hospital1 **], SUCRALFATE - 1 gram/10 mL PRN Dysphagia, Colace 100 [**Hospital1 **] ALLERGIES: Penicillins / Erythromycin / Etoposide PHYSICAL EXAM: 98.5 93 126/76 20 96% RA Gen: Alert and oriented x 3, NAD Cardiac: RRR no murmers, rubs, gallops Pulm: R lung CTA Abdomen: soft, nontender, no masses +BS, nondistended Ext: no edema + pulses FAMILY HISTORY: notable for breast cancer in four aunts, mostly premenopausal. Also notable for gastric cancer in her grandmother, and throat cancer in her father, who was also a heavy smoker. SOCIAL HISTORY: lives alone, works for a flooring company. Smoked 1 ppd for 30 years, quit 3-4 years ago. Drink wine occasionally. Arrives today with her sister.

Malignant neoplasm of lower lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Unspecified pleural effusion,Anemia, unspecified,Personal history of tobacco use,Other and unspecified hyperlipidemia,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Other iatrogenic hypotension

Mal neo lower lobe lung,Mal neo lymph-intrathor,Pleural effusion NOS,Anemia NOS,History of tobacco use,Hyperlipidemia NEC/NOS,Hx of irradiation,Hx antineoplastic chemo,Iatrogenc hypotnsion NEC

Admission Date: [**2169-10-2**] Discharge Date: [**2169-10-8**] Date of Birth: [**2119-9-30**] Sex: F Service: CARDIOTHORACIC Allergies: Penicillins / Erythromycin / Etoposide Attending:[**First Name3 (LF) 2969**] Chief Complaint: Stage III-a squamous cell carcinoma left lower lobe. Major Surgical or Invasive Procedure: [**2169-10-2**] Left thoracotomy, left pneumonectomy, mediastinal lymph node sampling and therapeutic bronchoscopic aspiration of secretions. History of Present Illness: This is a 50-year-old woman with biopsy-proven squamous cell carcinoma of the left lower lobe. She underwent induction of neoadjuvant chemoradiation therapy completed on [**2169-8-31**]. She had previously undergone a mediastinal and left VATS lymph node sampling of pleural fluid biopsy that demonstrated a positive AP window node for metastatic carcinoma. All other nodal stations sampled and the pleural fluid were negative for malignancy. She now presents for definitive resection. Past Medical History: hyperlipidemia Stage III NSCL squamous lung cell cancer Social History: lives alone, works for a flooring company. Smoked 1 ppd for 30 years, quit 3-4 years ago. Drink wine occasionally. Arrives today with her sister. Family History: notable for breast cancer in four aunts, mostly premenopausal. Also notable for gastric cancer in her grandmother, and throat cancer in her father, who was also a heavy smoker. Physical Exam: 98.5 93 126/76 20 96% RA Gen: Alert and oriented x 3, NAD Cardiac: RRR no murmers, rubs, gallops Pulm: R lung CTA Abdomen: soft, nontender, no masses +BS, nondistended Ext: no edema + pulses Pertinent Results: [**2169-10-7**] 04:28PM BLOOD Hct-31.1* [**2169-10-7**] 04:23AM BLOOD WBC-5.0 RBC-3.00* Hgb-8.9* Hct-26.3* MCV-88 MCH-29.8 MCHC-34.0 RDW-17.3* Plt Ct-282 [**2169-10-7**] 04:23AM BLOOD Glucose-96 UreaN-20 Creat-0.8 Na-138 K-4.0 Cl-101 HCO3-31 AnGap-10 [**2169-10-7**] 04:23AM BLOOD Calcium-9.2 Phos-4.2 Mg-2.2 Brief Hospital Course: Ms. [**Known lastname 36653**] was admitted on [**2169-10-2**] for Left Pneumonectomy. She was extubated in the operating room and transferred to the SICU for further management. Respiratory: left chest removed POD1. Chest X-ray revealed right pleural effusion which lasix was given. Cardiac: she responded to fluid challenges to maintain MAPs > 60. She remained in sinus rhythm. Low dose beta-blocker was started prophylaxis for atrial fibrillation. She occasinally had sinus tachycardia which responded to fluid and betablockade. GI: bowel function returned. Prophlyaxtic PPI was started. Nutrition: She was seen by Speech and Swallow for bedside swallow evaluation. They felt she was safe for a diet of regular consistency solids and thin liquid. She was started on a clear liquid diet advanced as tolerated. Renal: normal renal function. Initially low urine output which responded to fluids. Heme: developed post-op anemia and had 1 Unit of blood which brought her hct up to 31. Pain: Epidural was removed POD1. PO pain medication and toradol was initated with good pain control. Wound: Left thoracotomy site clean intact, no erythema or discharge Neuro: no deficiits Medications on Admission: FAMOTIDINE 20 mg [**Hospital1 **], HYDROCODONE-HOMATROPINE [HYDROMET]QID PRN Cough, HYDROCORTISONE cream, LORAZEPAM 0.5-1 mg QID PRN, Maalox PRN, ONDANSETRON HCL 8 Q8h PRN, ROXICET PRN PAIN, PROTONIX 40 mg [**Hospital1 **], SUCRALFATE - 1 gram/10 mL PRN Dysphagia, Colace 100 [**Hospital1 **] Discharge Medications: 1. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours) as needed for pain. Disp:*45 Tablet(s)* Refills:*0* 2. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*90 Capsule(s)* Refills:*0* 3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). Disp:*90 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Squamous Cell CA post-induction chemo/XRT Discharge Condition: stable Discharge Instructions: Call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 4741**] if experience: -Fever > 101 or chills -Increased shortness of breath,cough or sputum production -Chest pain -Incision develops drainage or increased redness -You may shower. No tub bathing or swimming for 6 weeks -No driving until seen in follow-up -No lifting more than 10 pounds Followup Instructions: Follow-up with Dr.[**Name8 (MD) 4738**] NP [**10-24**] at 11:30 am in the Chest Disease Center, [**Hospital Ward Name 121**] Building [**Hospital1 **] I Chest X-Ray 45 minutes before your appointment in the [**Hospital Ward Name 12837**] Clinical Center [**Location (un) **] Radiology

162,196,511,285,V158,272,V153,V874,458

{'Malignant neoplasm of lower lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Unspecified pleural effusion,Anemia, unspecified,Personal history of tobacco use,Other and unspecified hyperlipidemia,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,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: Stage III-a squamous cell carcinoma left lower lobe. PRESENT ILLNESS: This is a 50-year-old woman with biopsy-proven squamous cell carcinoma of the left lower lobe. She underwent induction of neoadjuvant chemoradiation therapy completed on [**2169-8-31**]. She had previously undergone a mediastinal and left VATS lymph node sampling of pleural fluid biopsy that demonstrated a positive AP window node for metastatic carcinoma. All other nodal stations sampled and the pleural fluid were negative for malignancy. She now presents for definitive resection. MEDICAL HISTORY: hyperlipidemia Stage III NSCL squamous lung cell cancer MEDICATION ON ADMISSION: FAMOTIDINE 20 mg [**Hospital1 **], HYDROCODONE-HOMATROPINE [HYDROMET]QID PRN Cough, HYDROCORTISONE cream, LORAZEPAM 0.5-1 mg QID PRN, Maalox PRN, ONDANSETRON HCL 8 Q8h PRN, ROXICET PRN PAIN, PROTONIX 40 mg [**Hospital1 **], SUCRALFATE - 1 gram/10 mL PRN Dysphagia, Colace 100 [**Hospital1 **] ALLERGIES: Penicillins / Erythromycin / Etoposide PHYSICAL EXAM: 98.5 93 126/76 20 96% RA Gen: Alert and oriented x 3, NAD Cardiac: RRR no murmers, rubs, gallops Pulm: R lung CTA Abdomen: soft, nontender, no masses +BS, nondistended Ext: no edema + pulses FAMILY HISTORY: notable for breast cancer in four aunts, mostly premenopausal. Also notable for gastric cancer in her grandmother, and throat cancer in her father, who was also a heavy smoker. SOCIAL HISTORY: lives alone, works for a flooring company. Smoked 1 ppd for 30 years, quit 3-4 years ago. Drink wine occasionally. Arrives today with her sister. ### Response: {'Malignant neoplasm of lower lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Unspecified pleural effusion,Anemia, unspecified,Personal history of tobacco use,Other and unspecified hyperlipidemia,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Other iatrogenic hypotension'}

CHIEF COMPLAINT: sudden onset severe headache PRESENT ILLNESS: Pt is a 51 yo RH woman with HTN and Type I DM who presents after sudden onset HA. She was in her USOH yesterday talking to a friend when she had sudden onset of posterior HA bilaterally, with spread down her neck as far as her upper scapulae. She had associated diaphoresis and later developed N/V. She also reports ~10 minutes of very muffled hearing, which resolved. She denies other neurologic symptoms including dysarthria, dysphagia, weakness, numbness, tingling(other than baseline neuropathy), visual changes, diplopia, ataxia, or vertigo. She did have some lightheadedness with standing. She continued to have the HA and came to the ED. MEDICAL HISTORY: mild HTN Type I DM since [**2090**] (uses insulin pump) s/p Splenectomy [**2108**] secondary ITP Trauma with T12 crush fracture managed conservatively; L pelvic, R ulna, L tibia, R fibula. s/p Cholecystectomy MEDICATION ON ADMISSION: Insulin via pump Lisinopril 5mg qhs incr to 10mg today Clarynex 5mg qd Low dose OCP for menopausal symptoms ALLERGIES: Penicillins PHYSICAL EXAM: T-97.1 BP-154-155/67-80 HR-94 RR-16-18 O2Sat 99% RA Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck;tender with movement and nuchal rigidity present CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender , no masses; insulin pump in situ ext: no edema FAMILY HISTORY: Father and mother both have HTN and hyperlipidemia Father with prostate ca. Mother and sister have migraines, but not patient. SOCIAL HISTORY: Married, no children; retired. No EtOH, tobacco, or drugs

Subarachnoid hemorrhage,Bacteremia,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Other acquired absence of organ

Subarachnoid hemorrhage,Bacteremia,Urin tract infection NOS,Hypertension NOS,DMI wo cmp nt st uncntrl,Acq absence of organ NEC

Admission Date: [**2126-5-11**] Discharge Date: [**2126-5-24**] Date of Birth: [**2074-11-14**] Sex: F Service: NEUROSURGERY Allergies: Penicillins Attending:[**First Name3 (LF) 1835**] Chief Complaint: sudden onset severe headache Major Surgical or Invasive Procedure: angiogram History of Present Illness: Pt is a 51 yo RH woman with HTN and Type I DM who presents after sudden onset HA. She was in her USOH yesterday talking to a friend when she had sudden onset of posterior HA bilaterally, with spread down her neck as far as her upper scapulae. She had associated diaphoresis and later developed N/V. She also reports ~10 minutes of very muffled hearing, which resolved. She denies other neurologic symptoms including dysarthria, dysphagia, weakness, numbness, tingling(other than baseline neuropathy), visual changes, diplopia, ataxia, or vertigo. She did have some lightheadedness with standing. She continued to have the HA and came to the ED. ROS: Patient denies any fever, chills, dysarthria, dysphagia, weakness, numbness, tingling, dizziness, visual changes, diplopia, chest pain, shortness of breath. Past Medical History: mild HTN Type I DM since [**2090**] (uses insulin pump) s/p Splenectomy [**2108**] secondary ITP Trauma with T12 crush fracture managed conservatively; L pelvic, R ulna, L tibia, R fibula. s/p Cholecystectomy ALL:PCN Social History: Married, no children; retired. No EtOH, tobacco, or drugs Family History: Father and mother both have HTN and hyperlipidemia Father with prostate ca. Mother and sister have migraines, but not patient. Physical Exam: T-97.1 BP-154-155/67-80 HR-94 RR-16-18 O2Sat 99% RA Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck;tender with movement and nuchal rigidity present CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender , no masses; insulin pump in situ ext: no edema Neurologic examination: Mental status: Awake and alert, cooperative with exam, normal affect. Oriented to person, place, and date. Speech is fluent with normal comprehension. No dysarthria. No right left confusion. No evidence of apraxia or neglect. Cranial Nerves: Pupils equally round and reactive to light, 4 to 2 mm bilaterally. Visual fields are full to confrontation. Fundi NAD. Extraocular movements intact bilaterally, no nystagmus. Sensation intact V1-V3. Facial movement symmetric. Hearing intact to finger rub bilaterally. Palate elevation symmetrical. Sternocleidomastoid and trapezius normal bilaterally. Tongue midline, movements intact Motor: Normal bulk bilaterally. Tone normal. No observed myoclonus or tremor No pronator drift [**Doctor First Name **] Tri [**Hospital1 **] WF WE FE FF IP H Q DF PF TE TF R 5 5 5 5 5 5 5 5 5 5 5 5 5 5 L 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Sensation: Intact to light touch, vibration and proprioception throughout. No extinction to DSS. Reflexes: +2 and symmetric throughout. Toes downgoing bilaterally Coordination: finger-nose-finger normal, heel to shin normal, RAMs normal. Gait: Deferred Romberg: Deferred Pertinent Results: Admission labs: CSF Protein 372 Glucose 127 TUBE #4 CSF WBC 56 RBC [**Numeric Identifier 20939**] Poly Pnd Lymph Pnd Mono Pnd EOs TUBE #1 CSF WBC 70 RBC [**Numeric Identifier 40813**] Poly Pnd Lymph Pnd Mono Pnd EOs 137 101 16 243 AGap=16 4.7 25 1.0 99 8.9 14.5 430 42.5 N:55.8 L:34.2 M:7.2 E:2.4 Bas:0.4 PT: 11.0 PTT: 18.3 INR: 0.9 Brief Hospital Course: Pt was admitted to neurosurgery service and had close neurologic monitoring. She was followed by [**Last Name (un) **] service for her diabetes (has insulin pump). She was found to have a UTI and treated with antibiotics. She underwent LP, CTA (Normal CTA of the head with no evidence of aneurysm or stenosis), and cerebral angiogram (negative for aneurysm) all in workup for her subarachnoid hemmorrhage. She had fevers and infectious disease consult was obtained. Catheter tip culture showed coag. negative staph. Blood cultures from [**5-19**] showed coag. negative staph also. She still has pending cultures from [**5-23**] at time of discharge. The patient will be sent home on linezolid. The patient's fever has resolved. She did have much nausea and vomiting and received medication for that. At the time of discharge her nausea is much better and she has no headache. On [**5-23**] the patient had elevated blood pressure with SBP into the 160s. She was given lisinopril and metoprolol and will follow-up with her PCP for continued BP management. Medications on Admission: Insulin via pump Lisinopril 5mg qhs incr to 10mg today Clarynex 5mg qd Low dose OCP for menopausal symptoms Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4-6H (every 4 to 6 hours) as needed for fever, pain. 3. Lisinopril 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). Disp:*60 Tablet(s)* Refills:*0* 4. Linezolid 600 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 10 days. Disp:*20 Tablet(s)* Refills:*0* 5. Lorazepam 0.5 mg Tablet Sig: [**1-1**] tablet Tablet PO Q4-6H (every 4 to 6 hours) as needed for nausea for 2 weeks. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Subarachnoid hemorrhage Discharge Condition: Neurologically stable Discharge Instructions: DISCHARGE INSTRUCTIONS FOR HEAD INJURY ?????? Take your pain medicine as prescribed ?????? Exercise should be limited to walking; no lifting, straining, excessive bending ?????? Increase your intake of fluids and fiber as pain medicine (narcotics) can cause constipation ?????? Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, aspirin, Advil, Ibuprofen etc. ?????? If you have been prescribed an anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing as ordered ?????? 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, drainage ?????? Fever greater than or equal to 101?????? F IF YOU EXPERIENCE SIMILAR SYMPTOMS, YOU SHOULD GO TO A LOCAL HOSPITAL AND HAVE A CT SCAN PERFORMED. Followup Instructions: You should follow up with your primary care doctor when you return to [**State 2690**] to manage your blood pressure. Completed by:[**2126-5-24**]

430,790,599,401,250,V457

{'Subarachnoid hemorrhage,Bacteremia,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Other acquired absence of organ'}

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: sudden onset severe headache PRESENT ILLNESS: Pt is a 51 yo RH woman with HTN and Type I DM who presents after sudden onset HA. She was in her USOH yesterday talking to a friend when she had sudden onset of posterior HA bilaterally, with spread down her neck as far as her upper scapulae. She had associated diaphoresis and later developed N/V. She also reports ~10 minutes of very muffled hearing, which resolved. She denies other neurologic symptoms including dysarthria, dysphagia, weakness, numbness, tingling(other than baseline neuropathy), visual changes, diplopia, ataxia, or vertigo. She did have some lightheadedness with standing. She continued to have the HA and came to the ED. MEDICAL HISTORY: mild HTN Type I DM since [**2090**] (uses insulin pump) s/p Splenectomy [**2108**] secondary ITP Trauma with T12 crush fracture managed conservatively; L pelvic, R ulna, L tibia, R fibula. s/p Cholecystectomy MEDICATION ON ADMISSION: Insulin via pump Lisinopril 5mg qhs incr to 10mg today Clarynex 5mg qd Low dose OCP for menopausal symptoms ALLERGIES: Penicillins PHYSICAL EXAM: T-97.1 BP-154-155/67-80 HR-94 RR-16-18 O2Sat 99% RA Gen: Lying in bed, NAD HEENT: NC/AT, moist oral mucosa Neck;tender with movement and nuchal rigidity present CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs Lung: Clear to auscultation bilaterally aBd: +BS soft, nontender , no masses; insulin pump in situ ext: no edema FAMILY HISTORY: Father and mother both have HTN and hyperlipidemia Father with prostate ca. Mother and sister have migraines, but not patient. SOCIAL HISTORY: Married, no children; retired. No EtOH, tobacco, or drugs ### Response: {'Subarachnoid hemorrhage,Bacteremia,Urinary tract infection, site not specified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Other acquired absence of organ'}

CHIEF COMPLAINT: Hypotension PRESENT ILLNESS: 71 yo female with severe diastolic dysfunction, afib on coumadin, CAD, severe PVD with chronic LE ulcer and infection with MRSA who was recent admitted to [**Hospital1 18**] ([**2123-3-30**] - [**2123-4-6**]) for diastolic CHF and COPD excerbation where she was diuresed with Lasix gtt, and also just completed 14 day course of Vanc/Levo/Flagyl for her LE infection who was admitted for hypotension. . Prior to this admission, she was eating dinner at [**Hospital 100**] Rehab and vomited at 6 pm. At that time, she was noted to be lethargic and somnolent without respiratory distress. She had received an extra dose of Lasix that morning since her weight was up 3 lbs over the past 3 days. She reports no SOB, CP, dysuria, cough, only states feeling sleepy and "tired". She reports increased in her bliteral LE over the past few days. MEDICAL HISTORY: 1. CHF diastolic dysfunction (EF 65% 1/05 MIBI normal) DRY WEIGHT 194 lbs 2. DM 2 on insulin 3. Atrial Fibrillation 4. Anemia 5. CAD s/p PTCA x 3 (RCA '[**09**], LCx '[**10**], RCA '[**13**]) 6. Pulmonary HTN 7. Hypercholesterolemia 8. COPD/[**Year (2 digits) 105496**] on home O2 (sometimes on home O2) 9. Thyroid CA s/p resection/now hypothryoid 10. Myoclonic tremors 11. H/O PE 12. OSA on CPAP (started last admission) 13. Depression/Anxiety 14. h/o MRSA/VRE. ICU admit x 2 for MRSA aortic valve endocarditis and pseudomonal sepsis (secondary to wound infection), status post intubation x 2. 15. S/p laproscopic cholecystectomy [**34**]. s/p right throcoscopy and decortication. Right lung bx. 17. s/p right hip ORIF 18. s/p right ankle ORIF MEDICATION ON ADMISSION: tylenol amiodarone 200mg po q24h - d/c'd by pulmonary clinic [**4-16**]. ASA 325mg po q24h citalopram 60mg po q24h dulcolax 10mg po q24h colace 100mg po bid fentanyl 50mcg TP q72h FeSO4 325mg po q24h lasix 40mg po q24h lasix 40mg po q MWF am for wt > 200lbs neurontin 300mg po bid lansoprazole 30mg po q24h levoxyl 200mcg po q24h lisinopril 5mg po q24h methylphenidate 10mg po q24h metoprolol 25mg po tid multivit olanzapine 5mg po qhs oxycodone 10mg po q4h simvastatin 20mg po qhs topiramate 25mg po q24h warfarin miconazole glargine 18U qhs insulin SS 150-200 - 6U 200-250 8U 250-300 10U 300-350 12U 350-400 14U ALLERGIES: Penicillins / Tegretol / Insulin,Beef / Insulin,Pork / Zaroxolyn PHYSICAL EXAM: On transfer to the floor [**4-26**]: VS: Tm/Tc 99.9/97.5 BP 122/51 HR 118 RR 14 O2sat 97-99% RA GEN: Awake, pleasant, NAD HEENT: NC/AT, PERRL, EOMI, MMM, neck supple, no cervical LAD COR: Irregular, S1, S2, no M/R/G LUNGS: Crackles at the bases R>L ABD: +BS, soft, NTND, no hepatosplenomegaly EXT: R foot ulcer on plantar medial heel with black eschar, necortic. L foot with erythema/scab at the hallux lateral nail border. Heel with black eschar. L heel ulcer with necrosis, not probable to bone by [**Month/Year (2) **]. bilateral LE venous stasis change and weeping serosanguinous fluid from the shin. NEURO: Alert and oriented x 3, CN II-XII intact. Strengths grossly [**6-10**]. Sensation intact to light touch. FAMILY HISTORY: F: Died at 47 of MI; M: Colon CA; brother with DM SOCIAL HISTORY: Pt is divorced with three children. Former CPA. Quit smoking in [**2104**] after a history of 1 ppd x 15 years. No etoh. No drugs.Lives at [**Hospital 100**] Rehab

Unspecified septicemia,Septic shock,Cellulitis and abscess of leg, except foot,Chronic diastolic heart failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Ulcer of heel and midfoot,Severe sepsis,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Venous (peripheral) insufficiency, unspecified,Anemia of other chronic disease,Atherosclerosis of native arteries of the extremities with ulceration,Personal history of malignant neoplasm of thyroid

Septicemia NOS,Septic shock,Cellulitis of leg,Chr diastolic hrt fail,Atrial fibrillation,Chr airway obstruct NEC,Ulcer of heel & midfoot,Severe sepsis,Long-term use anticoagul,DMII wo cmp nt st uncntr,Venous insufficiency NOS,Anemia-other chronic dis,Ath ext ntv art ulcrtion,Hx of thyroid malignancy

Name: [**Known lastname 17151**],[**Known firstname **] Unit No: [**Numeric Identifier 17152**] Admission Date: [**2123-4-22**] Discharge Date: [**2123-4-29**] Date of Birth: [**2052-2-14**] Sex: F Service: MEDICINE Allergies: Penicillins / Tegretol / Insulin,Beef / Insulin,Pork / Zaroxolyn Attending:[**First Name3 (LF) 11586**] Addendum: 1)Pain: Patient ended up staying additional night since her lower extremity pain was intolerable. She was seen by the Pain service, and her Fentanyl patch was increased to 75 mcg/hr q72hr, Oxycodone was increased to 10-15 mg Q3-4HR PRN, and IV Morphine 2 mg Q4:PRN was also added. Her pain is not much better controlled and she appears comfortable without oversedation. 2)LE ulcers: She had a long discussion with the team regarding the option of amputation as her prognosis of LE ulcer recovery is poor given her severe PVD and that she is not a surgical candidate. She states that she "would rather die before getting the amputation." 3)Diarrhea: She developed diarrhea the last 2 days of hospitalization. Stool C.diff was sent but the result is still pending. This needs to to be followed up. 4)A-fib: Her metoprolol was increased to 50 mg tid with better rate control. She is still on coumading, and needs to have her INR checked in [**3-11**] days. Discharge Disposition: Extended Care Facility: [**Hospital6 609**] for the Aged - Acute Rehab [**First Name11 (Name Pattern1) 2197**] [**Last Name (NamePattern4) 2198**] MD [**MD Number(1) 2199**] Completed by:[**2123-4-29**] Admission Date: [**2123-4-22**] Discharge Date: [**2123-4-29**] Date of Birth: [**2052-2-14**] Sex: F Service: MEDICINE Allergies: Penicillins / Tegretol / Insulin,Beef / Insulin,Pork / Zaroxolyn Attending:[**First Name3 (LF) 4980**] Chief Complaint: Hypotension Major Surgical or Invasive Procedure: PICC line placement History of Present Illness: 71 yo female with severe diastolic dysfunction, afib on coumadin, CAD, severe PVD with chronic LE ulcer and infection with MRSA who was recent admitted to [**Hospital1 18**] ([**2123-3-30**] - [**2123-4-6**]) for diastolic CHF and COPD excerbation where she was diuresed with Lasix gtt, and also just completed 14 day course of Vanc/Levo/Flagyl for her LE infection who was admitted for hypotension. . Prior to this admission, she was eating dinner at [**Hospital 100**] Rehab and vomited at 6 pm. At that time, she was noted to be lethargic and somnolent without respiratory distress. She had received an extra dose of Lasix that morning since her weight was up 3 lbs over the past 3 days. She reports no SOB, CP, dysuria, cough, only states feeling sleepy and "tired". She reports increased in her bliteral LE over the past few days. In ED, she had a temp of 101.1, WBC 16, lactate 1.9, and hypotensive in 70's/40's. She got a stress dose hyrdocortisone 50 mg IV x1, Vancomycin 1 gm IV x1, Ceftazidime 2 gm IV x1, Flagyl 500 mg IV x1, and 3 L NS bolus with BP response from 70's/40's to 90-100/50's. MUST protocol was initiated and pt was transferred to [**Hospital Unit Name 153**] for sepsis treatment. In the [**Hospital Unit Name 153**], she got a right subclavian line, and was briefly on Dopamine gtt from [**Date range (1) **], and her BP has been stable off Dopa since. She got about 2.5 L of IVF in the ICU. She was started on Vanco/Ceftaz/Flagyl for her presumed sepsis from LE cellulitis/questionable osteo. Past Medical History: 1. CHF diastolic dysfunction (EF 65% 1/05 MIBI normal) DRY WEIGHT 194 lbs 2. DM 2 on insulin 3. Atrial Fibrillation 4. Anemia 5. CAD s/p PTCA x 3 (RCA '[**09**], LCx '[**10**], RCA '[**13**]) 6. Pulmonary HTN 7. Hypercholesterolemia 8. COPD/[**Year (2 digits) 105496**] on home O2 (sometimes on home O2) 9. Thyroid CA s/p resection/now hypothryoid 10. Myoclonic tremors 11. H/O PE 12. OSA on CPAP (started last admission) 13. Depression/Anxiety 14. h/o MRSA/VRE. ICU admit x 2 for MRSA aortic valve endocarditis and pseudomonal sepsis (secondary to wound infection), status post intubation x 2. 15. S/p laproscopic cholecystectomy [**34**]. s/p right throcoscopy and decortication. Right lung bx. 17. s/p right hip ORIF 18. s/p right ankle ORIF Social History: Pt is divorced with three children. Former CPA. Quit smoking in [**2104**] after a history of 1 ppd x 15 years. No etoh. No drugs.Lives at [**Hospital 100**] Rehab Family History: F: Died at 47 of MI; M: Colon CA; brother with DM Physical Exam: On transfer to the floor [**4-26**]: VS: Tm/Tc 99.9/97.5 BP 122/51 HR 118 RR 14 O2sat 97-99% RA GEN: Awake, pleasant, NAD HEENT: NC/AT, PERRL, EOMI, MMM, neck supple, no cervical LAD COR: Irregular, S1, S2, no M/R/G LUNGS: Crackles at the bases R>L ABD: +BS, soft, NTND, no hepatosplenomegaly EXT: R foot ulcer on plantar medial heel with black eschar, necortic. L foot with erythema/scab at the hallux lateral nail border. Heel with black eschar. L heel ulcer with necrosis, not probable to bone by [**Month/Year (2) **]. bilateral LE venous stasis change and weeping serosanguinous fluid from the shin. NEURO: Alert and oriented x 3, CN II-XII intact. Strengths grossly [**6-10**]. Sensation intact to light touch. Pertinent Results: Micro: BCx: ([**4-23**])-NGTD, ([**4-22**])-NGTD x2 Sputum Cx: ([**4-23**])-Staph Aureus coag + Swab ([**4-23**]): Heels, tibial wounds: MRSA L great toe: Proteus sp ([**Last Name (un) 36**] ceftriax, ceftaz, cefepime) Cath tip: ([**4-23**])-Coag negative Staph (oxacillin resistant) Urine Cx: ([**4-23**])-NGTD Radiology: -MRI Foot ([**4-26**]): 1. Right calcaneal intraosseous lesion, most consistent with a bone infarct. Chronic osteomyelitis is less likely, but continued followup is recommended. 2. Diffuse subcutaneous edema of both feet and visualized portions of both calves, a nonspecific finding, but possibly related to cellulitis -CXR ([**4-25**]): +PICC placement, L linear atelectasis, small right side pleural effusion -Left foot film ([**4-23**]): diffuse dimineralization; no new fracure, no local bony destruction, possible dislocation of the second metatarsophalangeal joint. -NIAS ([**4-23**]):significant SFA and tibial dz bilaterally Brief Hospital Course: 71 yo F with severe diastolic dysfuntion, a-fib on coumadin, CAD, pulmonary fibrosis, severe PVD with chronic LE ulcer who presented with septic shock likely from LE ulcers secondarily infected. . MICU course: subclavian line placed and briefly on Dopamine gtt from [**Date range (1) **]. She was presumed to be in septic shock secondary to L shifted elevated WBC. Other etiology would be over-diuresis and hypovolemia (but elev WBC does not fit this etiology). The source of sepsis was unclear but felt to be LE ulcers, as blood cx, CXR and UA were not revealing. She received 2.5 L of IVF in the ICU. She was continued on Vanco/Ceftaz/Flagyl for her presumed sepsis from LE cellulitis/questionable osteomyeltis. No Blood Cx or Urine Cx grew an organism. . 1)Foot ulcer/infection: Pt likely had re-infection of the LE wound after completing a 14 day course of Vanc/Levo/Flagyl. Pt got a non-invasive art studies this hospitalization with sigfnificant SFA and tibial dz. [**Date range (1) **] and [**Date range (1) **] surgery followed in house. Recommendations were for local wound care, with systemic antibiotics, and outpatient follow-up for continued discussions of re-vascularization/angiogram. Swabs of L and R heel and L great toe and tibial wounds revealed MRSA and Proteus species (sensitive to 3rd/4th gen cephalosporins, but resistant to FQ, gent). [**Date range (1) **] was unable to probe to bone on their exam. An x-ray of the L foot showed no evidence of osteomyelitis. An MRI was also obtained which showed possible intraosseus bone infarct of L calcaneus but no clear evidence for osteomyelitis. A follow-up xray should be obtained after patient finishes course of antibiotics. -- patient will finish 2 week course of Vanc/Ceftaz/Flagyl, PICC line placed. -- Vanc trough sl elevated (25), changed to 750 mg q24. -- all blood cx were NGTD. . 2)Hemodynamics: Pt was briefly (< 36hrs) on pressors (dopamine) for BP support in MICU. She remained basically euvolemic on the medical [**Hospital1 **] requiring no pressors and just her maintenance diuresis. -- In the past, she required Lasix gtt for diuresis as she is very sensitive to lasix. . 3)Cardiovascular: Pump: Pt with severe diastolic dysfunction and very sensitve to lasix bolus. Goal was BP/HR control. -- Patient did not require IV lasix in and was restarted on her oupatient dose prior to discharge. She was euvolemic on physical exam. -- Her lisinopril 5 mg po daily was also restarted prior to discharge for optimum BP control. -- Metoprolol was titrated up throughout her stay for better HR control (see below) . Ischemia: -- She was continued on BB, ASA, simvastatin. . Rhythm: -- Afib throughout stay. -- Her dose of metoprolol was titrated up for better HR control, she was d/c'd on 37.5 mg tid with HR in 80's. -- For anti-coag the patient was placed on warfarin 5 mg po qhs (goal INR [**3-11**]), she should have INR checked in [**3-11**] days after discharge. -- amiodarone has been discontinued during the last admission for concern of pulmonary toxicity. . 5)Pulm: Pt h/o COPD/[**Date Range 105496**]/pulmonary fibrosis. Some wheezing noted in ICU but was treated successfully withn Albuterol and Ipratropium nebs PRN . 6)DM: The patient's glargine 14 units was stopped and she was switched to NPH 14 units in AM as she had low sugars in AM and high at night. She was maintained on HISS prior to meals and at bedtime. . 7)Pain: The patient had escalating pain on medical [**Hospital1 **] and her doses of fentanyl patch was increased to 75mcg/q72hrs and her neurontin was also changed back to her dosing during her most recent hospital stay [**Telephone/Fax (3) 105497**]). She was receiving oxycodone 10mg every 4hrs prn for breakthrough pain and standing tylenol 1g tid. The patient was not somnolent or lethargic on this regimen. She should be monitored closely as she has had changes in her mental status before due to over-sedation with narcotics. . 8)Psych: Continue citalopram, methylphenadate, Topamax. . 9)Anemia: Anemia of chronic illness. Hct low but at baseline throughout stay (28-30). -- She was continued on iron supplements. . 10)Hypothyroid: -- Continued Levoxyl at outpatient dosing. TSH 1.1. Medications on Admission: tylenol amiodarone 200mg po q24h - d/c'd by pulmonary clinic [**4-16**]. ASA 325mg po q24h citalopram 60mg po q24h dulcolax 10mg po q24h colace 100mg po bid fentanyl 50mcg TP q72h FeSO4 325mg po q24h lasix 40mg po q24h lasix 40mg po q MWF am for wt > 200lbs neurontin 300mg po bid lansoprazole 30mg po q24h levoxyl 200mcg po q24h lisinopril 5mg po q24h methylphenidate 10mg po q24h metoprolol 25mg po tid multivit olanzapine 5mg po qhs oxycodone 10mg po q4h simvastatin 20mg po qhs topiramate 25mg po q24h warfarin miconazole glargine 18U qhs insulin SS 150-200 - 6U 200-250 8U 250-300 10U 300-350 12U 350-400 14U Discharge Medications: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 2. Citalopram Hydrobromide 20 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 6. Levothyroxine Sodium 200 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily): please give 2 hrs before or after iron pill is taken. 7. Olanzapine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 9. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 10 days. 10. Albuterol Sulfate 0.083 % Solution Sig: One (1) neb Inhalation Q4H (every 4 hours) as needed. 11. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours) as needed. 12. Oxycodone HCl 5 mg Tablet Sig: Two (2) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 13. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 14. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day). 15. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO twice a day. 16. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 17. Topiramate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 18. Methylphenidate HCl 10 mg Tablet Sig: One (1) Tablet PO QAM (once a day (in the morning)). 19. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Vaginal HS (at bedtime) for 7 days. 20. Insulin NPH Human Recomb 100 unit/mL Syringe Sig: Fourteen (14) units Subcutaneous qAM. 21. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 22. Insulin Regular Human 100 unit/mL Solution Sig: sliding scale Injection four times a day. 23. Fentanyl 75 mcg/hr Patch 72HR Sig: One (1) patch Transdermal Q72H (every 72 hours). 24. Gabapentin 300 mg Tablet Sig: Three (3) Tablet PO HS (at bedtime): please give 600mg [**Hospital1 **] and 900mg at bedtime. 25. Ceftazidime 2 g Recon Soln Sig: Two (2) grams Intravenous twice a day for 10 days. 26. Vancomycin HCl 1,000 mg Recon Soln Sig: Seven [**Age over 90 1230**]y (750) mg Intravenous once a day for 10 days. Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - Acute Rehab Discharge Diagnosis: Primary: -- presumed septic shock -- infected venous stasis ulcers Secondary: diastolic CHF Afib CAD DMII COPD vs [**Hospital6 105496**] vs pulm fibrosis h/o thyroid ca pulm HTN Discharge Condition: stable, tolerating room air, afebrile Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet Fluid Restriction: 1500ml --If you experience any chest pain, shortness of breath, fevers > 101.5, [**Name6 (MD) 138**] primary MD or go to ER. --please continue Antibiotics for 10 days. --please have INR checked in [**3-11**] days. Followup Instructions: --Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4582**], M.D. Where: [**Hospital6 29**] CARDIAC SERVICES Phone:[**Telephone/Fax (1) 3512**] Date/Time:[**2123-5-6**] 2:30 --Provider: [**Name10 (NameIs) **] SCAN Where: [**Hospital6 29**] RADIOLOGY Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2123-7-1**] 2:00 --Provider: [**Name10 (NameIs) 1571**] BREATHING TESTS Where: [**Hospital6 29**] PULMONARY FUNCTION LAB Phone:[**Telephone/Fax (1) 612**] Date/Time:[**2123-7-16**] 11:35 --Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY Where: [**Last Name (NamePattern4) **] SURGERY Date/Time:[**2123-5-13**] 11:00 Completed by:[**2123-4-28**]

038,785,682,428,427,496,707,995,V586,250,459,285,440,V108

{'Unspecified septicemia,Septic shock,Cellulitis and abscess of leg, except foot,Chronic diastolic heart failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Ulcer of heel and midfoot,Severe sepsis,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Venous (peripheral) insufficiency, unspecified,Anemia of other chronic disease,Atherosclerosis of native arteries of the extremities with ulceration,Personal history of malignant neoplasm of thyroid'}

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: 71 yo female with severe diastolic dysfunction, afib on coumadin, CAD, severe PVD with chronic LE ulcer and infection with MRSA who was recent admitted to [**Hospital1 18**] ([**2123-3-30**] - [**2123-4-6**]) for diastolic CHF and COPD excerbation where she was diuresed with Lasix gtt, and also just completed 14 day course of Vanc/Levo/Flagyl for her LE infection who was admitted for hypotension. . Prior to this admission, she was eating dinner at [**Hospital 100**] Rehab and vomited at 6 pm. At that time, she was noted to be lethargic and somnolent without respiratory distress. She had received an extra dose of Lasix that morning since her weight was up 3 lbs over the past 3 days. She reports no SOB, CP, dysuria, cough, only states feeling sleepy and "tired". She reports increased in her bliteral LE over the past few days. MEDICAL HISTORY: 1. CHF diastolic dysfunction (EF 65% 1/05 MIBI normal) DRY WEIGHT 194 lbs 2. DM 2 on insulin 3. Atrial Fibrillation 4. Anemia 5. CAD s/p PTCA x 3 (RCA '[**09**], LCx '[**10**], RCA '[**13**]) 6. Pulmonary HTN 7. Hypercholesterolemia 8. COPD/[**Year (2 digits) 105496**] on home O2 (sometimes on home O2) 9. Thyroid CA s/p resection/now hypothryoid 10. Myoclonic tremors 11. H/O PE 12. OSA on CPAP (started last admission) 13. Depression/Anxiety 14. h/o MRSA/VRE. ICU admit x 2 for MRSA aortic valve endocarditis and pseudomonal sepsis (secondary to wound infection), status post intubation x 2. 15. S/p laproscopic cholecystectomy [**34**]. s/p right throcoscopy and decortication. Right lung bx. 17. s/p right hip ORIF 18. s/p right ankle ORIF MEDICATION ON ADMISSION: tylenol amiodarone 200mg po q24h - d/c'd by pulmonary clinic [**4-16**]. ASA 325mg po q24h citalopram 60mg po q24h dulcolax 10mg po q24h colace 100mg po bid fentanyl 50mcg TP q72h FeSO4 325mg po q24h lasix 40mg po q24h lasix 40mg po q MWF am for wt > 200lbs neurontin 300mg po bid lansoprazole 30mg po q24h levoxyl 200mcg po q24h lisinopril 5mg po q24h methylphenidate 10mg po q24h metoprolol 25mg po tid multivit olanzapine 5mg po qhs oxycodone 10mg po q4h simvastatin 20mg po qhs topiramate 25mg po q24h warfarin miconazole glargine 18U qhs insulin SS 150-200 - 6U 200-250 8U 250-300 10U 300-350 12U 350-400 14U ALLERGIES: Penicillins / Tegretol / Insulin,Beef / Insulin,Pork / Zaroxolyn PHYSICAL EXAM: On transfer to the floor [**4-26**]: VS: Tm/Tc 99.9/97.5 BP 122/51 HR 118 RR 14 O2sat 97-99% RA GEN: Awake, pleasant, NAD HEENT: NC/AT, PERRL, EOMI, MMM, neck supple, no cervical LAD COR: Irregular, S1, S2, no M/R/G LUNGS: Crackles at the bases R>L ABD: +BS, soft, NTND, no hepatosplenomegaly EXT: R foot ulcer on plantar medial heel with black eschar, necortic. L foot with erythema/scab at the hallux lateral nail border. Heel with black eschar. L heel ulcer with necrosis, not probable to bone by [**Month/Year (2) **]. bilateral LE venous stasis change and weeping serosanguinous fluid from the shin. NEURO: Alert and oriented x 3, CN II-XII intact. Strengths grossly [**6-10**]. Sensation intact to light touch. FAMILY HISTORY: F: Died at 47 of MI; M: Colon CA; brother with DM SOCIAL HISTORY: Pt is divorced with three children. Former CPA. Quit smoking in [**2104**] after a history of 1 ppd x 15 years. No etoh. No drugs.Lives at [**Hospital 100**] Rehab ### Response: {'Unspecified septicemia,Septic shock,Cellulitis and abscess of leg, except foot,Chronic diastolic heart failure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Ulcer of heel and midfoot,Severe sepsis,Long-term (current) use of anticoagulants,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Venous (peripheral) insufficiency, unspecified,Anemia of other chronic disease,Atherosclerosis of native arteries of the extremities with ulceration,Personal history of malignant neoplasm of thyroid'}

CHIEF COMPLAINT: Shortness of breath; hematuria; urinary frequency and urgency; back pain. PRESENT ILLNESS: This is a 76 year old female in her usual state of health which includes having to ambulate with assistance who saw her podiatrist and dentist on [**5-25**] without any difficulty. That evening she had hematuria noticed by her daughter who obtained a clean catch at home and took urinalysis and culture to her primary care physician. [**Last Name (NamePattern4) **] 3 AM on the day of admission she developed her first symptoms which included rigors, a fever of 100.7, nausea, vomiting, diaphoresis, left flank pain as well as dizziness and cough, dyspnea on exertion and lower extremity edema which was slightly worse than her baseline. Her daughter took her to [**Name (NI) **] [**Name (NI) **]/[**Hospital **] Hospital where she was afebrile with a heartrate of 127, blood pressure 130/61 and respiratory rate of 36 sating 97% on room air. At the outside hospital her lungs were described as clear. She was developing a metabolic acidosis and mild hypoxia and underwent a V/Q scan which was low probability. She received Levofloxacin and intravenous fluids as well as Lasix. Over the course of her Emergency Room stay there, she became confused and febrile. She was given Ativan for anxiety and her lungs gradually developed a crackle and wheeze. Anemia, elevated troponin, elevated creatinine and BUN were noted on her laboratory data. The team recommended transfer to [**Hospital6 1760**]. She was intubated for transfer for Life Flight as she was apparently have worsening respiratory distress. On arrival her temperature was 102.6, blood pressure was 105/55, then dropping to 88 systolic for which she received 3 liters of intravenous fluid. The patient was fighting FIMV mode of ventilation and she was given Ativan, Morphine and Vecuronium times one and switched to assist control. PH improved from 7.17 to 7.34 with a pCO2 improving from 58 to 38. Endotracheal tube was repositioned secondary to right main stem location. Ceftriaxone was given secondary to the concern about the p.o. Levofloxacin absorption given at the outside hospital. Troponin was noticed to be 11. Her CKs were negative. She was treated with Aspirin 5 mg intravenously and Lopressor in the Emergency Room. She was noted to be heme positive with a decreased hematocrit and heparin was held. She had a right internal jugular central line placed in the Emergency Room and she was transferred to the Medicine Intensive Care Unit. MEDICAL HISTORY: 1. Diabetes Type 2 with chronic renal failure with proteinuria and history of foot ulcer; 2. Bilateral mastectomy for comfort, no history of cancer; 3. Cerebrovascular accident with a residual left hemiparesis in [**2099**], also some memory impairment; 4. Hypercholesterolemia; 5. Hysterectomy and appendectomy. MEDICATION ON ADMISSION: ALLERGIES: Penicillin? as well as to Sulfa, Erythromycin and Ciprofloxacin which reportedly cause gastrointestinal upset, one of these but it is not known which one caused a rash according to the daughter. PHYSICAL EXAM: FAMILY HISTORY: Not available. SOCIAL HISTORY: The patient does not drink or smoke.

Other septicemia due to gram-negative organisms,Other shock without mention of trauma,Acute respiratory failure,Subendocardial infarction, initial episode of care,Acute pyelonephritis without lesion of renal medullary necrosis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Calculus of kidney

Gram-neg septicemia NEC,Shock w/o trauma NEC,Acute respiratry failure,Subendo infarct, initial,Ac pyelonephritis NOS,Acute kidney failure NOS,CHF NOS,DMII wo cmp nt st uncntr,Calculus of kidney

Admission Date: [**2103-5-26**] Discharge Date: Date of Birth: [**2026-8-11**] Sex: F Service: MICU CHIEF COMPLAINT: Shortness of breath; hematuria; urinary frequency and urgency; back pain. HISTORY OF PRESENT ILLNESS: This is a 76 year old female in her usual state of health which includes having to ambulate with assistance who saw her podiatrist and dentist on [**5-25**] without any difficulty. That evening she had hematuria noticed by her daughter who obtained a clean catch at home and took urinalysis and culture to her primary care physician. [**Last Name (NamePattern4) **] 3 AM on the day of admission she developed her first symptoms which included rigors, a fever of 100.7, nausea, vomiting, diaphoresis, left flank pain as well as dizziness and cough, dyspnea on exertion and lower extremity edema which was slightly worse than her baseline. Her daughter took her to [**Name (NI) **] [**Name (NI) **]/[**Hospital **] Hospital where she was afebrile with a heartrate of 127, blood pressure 130/61 and respiratory rate of 36 sating 97% on room air. At the outside hospital her lungs were described as clear. She was developing a metabolic acidosis and mild hypoxia and underwent a V/Q scan which was low probability. She received Levofloxacin and intravenous fluids as well as Lasix. Over the course of her Emergency Room stay there, she became confused and febrile. She was given Ativan for anxiety and her lungs gradually developed a crackle and wheeze. Anemia, elevated troponin, elevated creatinine and BUN were noted on her laboratory data. The team recommended transfer to [**Hospital6 1760**]. She was intubated for transfer for Life Flight as she was apparently have worsening respiratory distress. On arrival her temperature was 102.6, blood pressure was 105/55, then dropping to 88 systolic for which she received 3 liters of intravenous fluid. The patient was fighting FIMV mode of ventilation and she was given Ativan, Morphine and Vecuronium times one and switched to assist control. PH improved from 7.17 to 7.34 with a pCO2 improving from 58 to 38. Endotracheal tube was repositioned secondary to right main stem location. Ceftriaxone was given secondary to the concern about the p.o. Levofloxacin absorption given at the outside hospital. Troponin was noticed to be 11. Her CKs were negative. She was treated with Aspirin 5 mg intravenously and Lopressor in the Emergency Room. She was noted to be heme positive with a decreased hematocrit and heparin was held. She had a right internal jugular central line placed in the Emergency Room and she was transferred to the Medicine Intensive Care Unit. PAST MEDICAL HISTORY: 1. Diabetes Type 2 with chronic renal failure with proteinuria and history of foot ulcer; 2. Bilateral mastectomy for comfort, no history of cancer; 3. Cerebrovascular accident with a residual left hemiparesis in [**2099**], also some memory impairment; 4. Hypercholesterolemia; 5. Hysterectomy and appendectomy. FAMILY HISTORY: Not available. SOCIAL HISTORY: The patient does not drink or smoke. ALLERGIES: Penicillin? as well as to Sulfa, Erythromycin and Ciprofloxacin which reportedly cause gastrointestinal upset, one of these but it is not known which one caused a rash according to the daughter. MEDICATIONS AT HOME: Avandia 4 q.d.; Amaryl 4 q.d.; Lasix 40 q.d.; Avalide 6.25/25 q.d.; Celebrex 200 prn; Plavix 75; Lipitor 20; Aspirin 81; Gemfibrozil 600 b.i.d. BASELINE LABORATORY DATA: Baseline laboratory data obtained from her primary care physician on [**5-29**], showed a BUN of 45 and creatinine of 1.3 at baseline, microalbumin to creatinine ratio of 1,667 with normal being less than 30, cholesterol of 182, HDL 46, LDL 117, triglyceride 124, hematocrit 35.4, no history of gastrointestinal bleed and a panculture in primary care physician's office growing Proteus mirabilis sensitive to Bactrim, Ampicillin, Gentamicin, Cefuroxime, Cephalothin and Ceftriaxone. PHYSICAL EXAMINATION: Physical examination on arrival revealed temperature up to 103.8, pulse in the 60s to 110s, blood pressure 120 systolic climbing to 70s after 5 mg of Lopressor, respiratory rate 16 on assist control. In general she is intubated to date, is paralyzed, no reaction to sternal rub after Vecuronium. Pupils were slightly reactive and equal. She had no coronal reflex, no Doll's eye, no evident jugulovenous distension, however, she does have a thick neck. Endotracheal tube was in place. She was regular with a mild tachycardia, distant heartsounds but S1 and S2 appreciated. She had bilateral mastectomy scars. Lung examination showed rhonchi and wheezes bilaterally. She had crackles, left greater than right. Abdomen had faint bowel sounds, soft, obese without masses. There was a hysterectomy scar. Extremities had mild pitting edema but not excessively warm or cold. She had decreased pulses distally. There were no foot ulcers. Nasogastric aspirate showed clear mucous with some blood streaks that cleared. There was no rash. LABORATORY DATA: Laboratory data on admission, white blood count 9.3, it was 3 at the outside hospital, hematocrit 23.1, 27 at the outside hospital, platelets 192. Differential, 59 neutrophils, 28 bands, 5 monos, 3 atypicals, 6 metas. Chem-7 notable for a potassium of 3.5, creatinine of 2.5, BUN 70, bicarbonate of 21, INR 1.3, normal liver function tests, moderate leukocyte esterase on urinalysis with greater than 50 white blood cells and many bacteria. Troponin was 11 which climbs to 28.5, Phena .3% despite Lasix and arterial blood gases 7.17, 58, 246, improving to 734, 38 and 350, after ventilator changes. Chest x-ray showed endotracheal tube in right main stem which was pulled back to a good position as well as carotid vasculature due to low lung volumes but no evidence of pneumonia. Electrocardiogram showed sinus rhythm at 80 with normal axis, a Q in 3 and question of slight ST depression laterally and some T wave flattening. HOSPITAL COURSE: 1. Infectious disease - The patient was continued on her Ceftriaxone. Starting the evening of admission she required Dopamine to support her blood pressure through her sepsis, as well as vigorous intravenous fluids. After we received the results of her urine culture at her primary care physician's office her antibiotics were briefly changed to Cefuroxime, however, that evening she became septic again with a low blood pressure and recurrent fever on the evening of [**5-29**]. On the morning of [**5-30**], she was back on pressors and her antibiotics were broadened to Ceftazidime and Vancomycin. Workup for her current fever included chest x-ray which reportedly showed a layering effusion, however, there was no effusion by ultrasound and the appearance was attributed to soft tissues. A computerized tomography scan of her chest and abdomen was performed next which showed left obstruction of the renal pelvis with stones. The Urology consult was obtained and she was stented by Urology on the morning of [**6-2**] with release of pus under pressure. Afterwards her antibiotics were changed back to Ceftriaxone and she improved thereafter. She did have one brief period of DIC which resolved around the time of [**5-30**]. She also had blood cultures from her arterial line growing Methicillin-resistant Staphylococcus epidermidis and Vancomycin-resistant enterococcus in one bottle and was treated initially with Vancomycin and then Laniazid when her Vancomycin-resistant enterococcus results returned. She also had one bottle growing Methicillin-resistant Staphylococcus epidermidis from her triple lumen catheter which was recited first in her groin and then to the subclavian site. She was given a ten day course of Laniazid which was discontinued on [**6-11**]. Her Ceftriaxone for Proteus was discontinued on [**6-10**]. 2. Cardiovascular - She was given Aspirin, Plavix and Lipitor. Her troponin climbed to 28.5. Cardiology was curb-sided which said this could be attributed to sepsis only. Heparin was deferred because of her gastrointestinal bleed. She underwent an echocardiogram which showed a 60 to 65% ejection fraction and lipomatous intraatrial septum, normal wall motion. Her troponin declined and she was stable thereafter. 3. Endocrine - She had initial episodes of hypoglycemia requiring multiple infusions of D50. This was attributed to persistent action of oral hypoglycemics. Liver function was checked and was normal by INR and normal liver function tests at the time. She then began to require NPH and regular insulin sliding scale. This was changed to an insulin drip with good results when tube feeds were started and blood sugar became elevated. She was changed back to NPH and sliding scale with good control as of [**6-11**]. 4. Gastrointestinal - She was treated for probable gastrointestinal bleed with proton pump inhibitors. She did not undergo any endoscopy during her stay as she was ill in the Intensive Care Unit and her hematocrit was stable after her initial decline prior to admission. This issue needs to be followed up either before or after discharge. 5. Heme - With her recurrent sepsis around the time of [**5-30**], she was briefly in DIC. This was resolved with antibiotic changes and relief of her obstructive renal pelvis. Her INR was still elevated after other parameters returned to [**Location 213**] and she was given Vitamin K, given continuous nutrition status and prolonged antibiotic course and her INR normalized. 6. Pulmonary - The patient was initially on assist-control. She was weaned to pressor support ventilation. She had episodes of tachypnea and agitation during weans and had to be placed back on assist control with heavy sedation. She was, however, eventually changed back to pressor support and weaned with steady diuresis as she was greater than 10 liters from fluid boluses for hypotension early in her stay. On [**6-9**], the patient extubated herself from ventilator settings of 15 and 5. She did well thereafter with a compensatory respiratory acidosis to compensate for a metabolic alkalosis from her diuresis. 7. Fluids, electrolytes and nutrition - Electrolytes were repleted as needed. She was given tube feeds while intubated and changed to a liquid diet on [**6-11**] after she was extubated, tolerating p.o. medications with a good cough. She developed substantial edema because of fluid boluses and was diuresed vigorously with Lasix and a Lasix drip as well as Zaroxolyn. This was discontinued on [**6-10**] with an increasing metabolic alkalosis and she continued to have good urine output thereafter. At this point her ins and outs goals are about 500 cc negative a day. 8. Vascular - She developed left upper extremity edema, out of proportion to her other extremities and ultrasound was ordered on [**6-11**]. This issue needs to be followed up after she is transferred out of the unit. She has a left subclavian line at this point and she may need to have a PICC placed in her right arm and be heparinized if there is a clot at the subclavian line site. 9. Prophylaxis - Prophylaxis throughout was with a proton pump inhibitor and pneumaboots. The patient is a full code. This discharge summary will be addended by the Medicine Team that picks up her after her transfer out of the Intensive Care Unit. [**Last Name (LF) **],[**First Name3 (LF) **] N. M.D. [**MD Number(1) 39096**] Dictated By:[**Last Name (NamePattern1) **] MEDQUIST36 D: [**2103-6-11**] 13:25 T: [**2103-6-13**] 17:14 JOB#: [**Job Number 43323**] Name: [**Known lastname 6510**], [**Known firstname 3485**] Unit No: [**Numeric Identifier 7905**] Admission Date: [**2103-5-26**] Discharge Date: [**2103-6-14**] Date of Birth: [**2026-8-11**] Sex: F Service: ACOVE DISCHARGE SUMMARY ADDENDUM: This is an addendum to the previous dictation from [**2103-5-26**] to [**2103-6-11**] by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. Continuation of hospital course is as follows: On [**2103-6-11**] the patient was transferred from the Medical Intensive Care Unit to the ACOVE Medicine Service for further care. As previously noted in the prior dictation portion the patient had a question of a left subclavian thrombus. As such the patient was transiently anticoagulated with Lovenox and then the line was removed. A venogram was subsequently performed which showed no evidence of thrombus in the left anticoagulation was discontinued. The patient continued to recover well and by [**2103-6-14**] was ready to be discharged to rehabilitation. The patient is tentatively accepted at [**Location (un) 3653**] in [**Location (un) 4415**] where the patient's primary care physician is the medical director. DISCHARGE MEDICATIONS: The patient's discharge medications are as follows: 1. Enteric coated aspirin 81 mg po q day. 2. Plavix 75 mg po q day to complete a one month course on [**2103-6-25**]. 3. Lopressor 50 mg po tid. 4. Captopril 6.25 mg po tid to be titrated up as tolerated while at rehabilitation. 5. Lipitor 20 mg po q HS. 6. NPH insulin 15 units sub q [**Hospital1 **] to be given one half if the patient has poor po intake. 7. Regular sliding scale insulin 2 units for every 50 over 150. 8. Protonix 40 mg po q day. 9. Colace 100 mg po bid. 10. Heparin 5000 units sub q [**Hospital1 **]. The patient is to be transitioned back to oral [**Doctor Last Name 932**] for diabetes once her diet and renal function stabilize. The patient had a left ureteral stent placed on [**2103-6-2**] which needs to be changed within three months. The patient will also need outpatient ESWL and should follow up with Dr. [**First Name (STitle) 1185**] [**Name (STitle) 7906**], [**Telephone/Fax (1) 7907**], for this continued care. The patient may also benefit from outpatient EGD and colonoscopy given her probable GI bleed during this admission. DISCHARGE DIAGNOSIS: Primary Diagnosis: 1. Proteus urosepsis. 2. Left ureteral obstruction. 3. Myocardial infarction. 4. GI bleed. Secondary Diagnosis: 1. Type II diabetes. 2. Hypertension. 3. Hypercholesterolemia. DISCHARGE DISPOSITION: The patient is to be discharged to [**Location (un) 3653**] in [**Hospital 4415**] Rehabilitation in stable condition. [**Name6 (MD) 1034**] [**Name8 (MD) 1035**], M.D. [**MD Number(1) 1036**] Dictated By:[**Last Name (NamePattern1) 4070**] MEDQUIST36 D: [**2103-6-14**] 08:11 T: [**2103-6-14**] 08:18 JOB#: [**Job Number **]

038,785,518,410,590,584,428,250,592

{'Other septicemia due to gram-negative organisms,Other shock without mention of trauma,Acute respiratory failure,Subendocardial infarction, initial episode of care,Acute pyelonephritis without lesion of renal medullary necrosis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Calculus 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: Shortness of breath; hematuria; urinary frequency and urgency; back pain. PRESENT ILLNESS: This is a 76 year old female in her usual state of health which includes having to ambulate with assistance who saw her podiatrist and dentist on [**5-25**] without any difficulty. That evening she had hematuria noticed by her daughter who obtained a clean catch at home and took urinalysis and culture to her primary care physician. [**Last Name (NamePattern4) **] 3 AM on the day of admission she developed her first symptoms which included rigors, a fever of 100.7, nausea, vomiting, diaphoresis, left flank pain as well as dizziness and cough, dyspnea on exertion and lower extremity edema which was slightly worse than her baseline. Her daughter took her to [**Name (NI) **] [**Name (NI) **]/[**Hospital **] Hospital where she was afebrile with a heartrate of 127, blood pressure 130/61 and respiratory rate of 36 sating 97% on room air. At the outside hospital her lungs were described as clear. She was developing a metabolic acidosis and mild hypoxia and underwent a V/Q scan which was low probability. She received Levofloxacin and intravenous fluids as well as Lasix. Over the course of her Emergency Room stay there, she became confused and febrile. She was given Ativan for anxiety and her lungs gradually developed a crackle and wheeze. Anemia, elevated troponin, elevated creatinine and BUN were noted on her laboratory data. The team recommended transfer to [**Hospital6 1760**]. She was intubated for transfer for Life Flight as she was apparently have worsening respiratory distress. On arrival her temperature was 102.6, blood pressure was 105/55, then dropping to 88 systolic for which she received 3 liters of intravenous fluid. The patient was fighting FIMV mode of ventilation and she was given Ativan, Morphine and Vecuronium times one and switched to assist control. PH improved from 7.17 to 7.34 with a pCO2 improving from 58 to 38. Endotracheal tube was repositioned secondary to right main stem location. Ceftriaxone was given secondary to the concern about the p.o. Levofloxacin absorption given at the outside hospital. Troponin was noticed to be 11. Her CKs were negative. She was treated with Aspirin 5 mg intravenously and Lopressor in the Emergency Room. She was noted to be heme positive with a decreased hematocrit and heparin was held. She had a right internal jugular central line placed in the Emergency Room and she was transferred to the Medicine Intensive Care Unit. MEDICAL HISTORY: 1. Diabetes Type 2 with chronic renal failure with proteinuria and history of foot ulcer; 2. Bilateral mastectomy for comfort, no history of cancer; 3. Cerebrovascular accident with a residual left hemiparesis in [**2099**], also some memory impairment; 4. Hypercholesterolemia; 5. Hysterectomy and appendectomy. MEDICATION ON ADMISSION: ALLERGIES: Penicillin? as well as to Sulfa, Erythromycin and Ciprofloxacin which reportedly cause gastrointestinal upset, one of these but it is not known which one caused a rash according to the daughter. PHYSICAL EXAM: FAMILY HISTORY: Not available. SOCIAL HISTORY: The patient does not drink or smoke. ### Response: {'Other septicemia due to gram-negative organisms,Other shock without mention of trauma,Acute respiratory failure,Subendocardial infarction, initial episode of care,Acute pyelonephritis without lesion of renal medullary necrosis,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Calculus of kidney'}

CHIEF COMPLAINT: shortness of breath PRESENT ILLNESS: This is an 87 year old male with PMH of ischemic cardiomyopathy with an EF of 45% s/p PPM/AICD placement in [**2113**] for AV block, HTN, recently diagnosed sarcoidosis after a [**Year (4 digits) **] biopsy, and recent brief admission for bronchiectasis/UTI with discharge on [**1-14**] now returning with shortness of breath. He was discharged on a course of ciprofloxacin for UTI/bronchiectasis. He was doing well at home until a few day ago when he developed gradually worsening shortness of breath and [**Month/Year (2) **] productive of clear sputum. His symptoms were exacerbated by activity. He reports no fevers or chills, no headache, change in vision or neck pain. He continues to have burning with urination since his recent diagnosis of UTI, difficulty starting urinary stream. Denies any abdominal pain, no focal numbness tingling or weakness, no rash. This episode of shortness ofbreath was more severe than his previous. MEDICAL HISTORY: bradycardia - with primary AV block s/p AICD and pacer placement Recurrent urethral strictures [**12-29**] childhood infection Mild systolic dysfunction - EF of 40-45% on Echo in [**2110**] Chronic [**Year (4 digits) **], congestion and hoarseness with referral for possible sarcoidosis. Chronic sinusitis. Osteoarthritis. Right knee surgery. Defibrillator/pacemaker. MEDICATION ON ADMISSION: Medications (confirmed w/ wife): -Finasteride 5 mg PO once a day. -Furosemide 40 mg PO daily. -Metoprolol tartrate 12.5 mg PO BID. -Rosuvastatin 40 mg once a day. -Potassium chloride 20 mEq Tablet PO every other day. -Sertraline 12.5 mg PO daily. -Tamsulosin 0.4 mg PO HS. -Aspirin 81 mg PO daily. -Multivitamin PO daily. -Calcium carbonate-vitamin D3 600 mg-400 unit PO twice a day. -Aleve 220 mg PO twice a day as needed for pain. -[**Last Name (un) 14822**] [**Last Name (un) 97884**] with steroid. -Terazosin 5 mg PO daily -Ofloxacin 0.3% One drop four times a day into both eyes. -Ciprofloxacin 500 mg PO Q12H until [**1-23**] -fluticasone nasal spray ALLERGIES: sulfa or amoxicillin PHYSICAL EXAM: ON ADMISSION: Vitals: T: 98.5, BP: 110s-130s/60s-70s, P: 90s-100s, R: 35, O2: 96% on bipap General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry MM, EOMI, PERRL Neck: supple, JVP not elevated CV: Regular rate and rhythm, difficult to auscultate heart sounds over bipap Lungs: Clear to auscultation anteriorly Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, trace LE edema bilaterally Neuro: motor strength and sensory grossly equal and intact bilaterally, gait deferred FAMILY HISTORY: Father died of CVA; sister has [**Name (NI) 4278**]. SOCIAL HISTORY: Denies smoking, alcohol use, recreational drug use. Lives at home with wife.

Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Bronchiectasis with acute exacerbation,Urinary tract infection, site not specified,Chronic systolic heart failure,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Other specified forms of chronic ischemic heart disease,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ,Sarcoidosis,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Conjunctivitis, unspecified,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Other and unspecified Escherichia coli [E. coli]

Pulm embol/infarct NEC,Pneumonia, organism NOS,Bronchiectasis w ac exac,Urin tract infection NOS,Chr systolic hrt failure,Ac DVT/emb prox low ext,Chr ischemic hrt dis NEC,Hypertension NOS,Status autm crd dfbrltr,Sarcoidosis,BPH w/o urinary obs/LUTS,Conjunctivitis NOS,Anxiety state NOS,Depressive disorder NEC,E.coli infection NEC/NOS

Admission Date: [**2119-1-19**] Discharge Date: [**2119-1-23**] Service: MEDICINE Allergies: sulfa or amoxicillin Attending:[**First Name3 (LF) 2291**] Chief Complaint: shortness of breath Major Surgical or Invasive Procedure: none History of Present Illness: This is an 87 year old male with PMH of ischemic cardiomyopathy with an EF of 45% s/p PPM/AICD placement in [**2113**] for AV block, HTN, recently diagnosed sarcoidosis after a [**Year (4 digits) **] biopsy, and recent brief admission for bronchiectasis/UTI with discharge on [**1-14**] now returning with shortness of breath. He was discharged on a course of ciprofloxacin for UTI/bronchiectasis. He was doing well at home until a few day ago when he developed gradually worsening shortness of breath and [**Month/Year (2) **] productive of clear sputum. His symptoms were exacerbated by activity. He reports no fevers or chills, no headache, change in vision or neck pain. He continues to have burning with urination since his recent diagnosis of UTI, difficulty starting urinary stream. Denies any abdominal pain, no focal numbness tingling or weakness, no rash. This episode of shortness ofbreath was more severe than his previous. On admission from [**1-13**] to [**1-14**], patient presented with acute onset shortness of breath with [**Month/Year (2) **] productive of whitish sputum without fever or leukocytosis, felt to be consistent with bronchiectasis flare. Sxs resolved overnight so pt was discharged on ciprofloxacin to be completed on [**1-23**]. In the ED, initial VS were: 98.0, 86, 107/50, 22, 100% 4L Nasal Cannula. He then became hypoxic to the 80s and tachypneic to the 30s, but was never hypotensive. Exam was notable for diffuse rhonchi, no JVD, trace LE edema, and patient was placed on non-rebreather to maintain sats in the low 90s. He was then placed on BiPap and unable to be weaned. EKG was at baseline. Labs notable for a lactate of 2. CXR was unremarkable. He received Combivent, albuterol nebs x 2, 125mg of IV solumedrol, 40mg IV lasix, and 750mg IV levofloxacin. On arrival to the MICU, patient was breathing comfortably on bipap which was placed in the ED in the late afternoon. He reports improvement since arrival on bipap. He soon became tachypneic to 50s and uncomfortable. ABG was obtained at 1AM and showed 7.46/45/57/bicarb=33 with no previous comparison. He was transitioned to high flow oxygen shortly after arriving. He continues to have burning with urination despite treatment for his UTI with cipro. Past Medical History: bradycardia - with primary AV block s/p AICD and pacer placement Recurrent urethral strictures [**12-29**] childhood infection Mild systolic dysfunction - EF of 40-45% on Echo in [**2110**] Chronic [**Year (4 digits) **], congestion and hoarseness with referral for possible sarcoidosis. Chronic sinusitis. Osteoarthritis. Right knee surgery. Defibrillator/pacemaker. Social History: Denies smoking, alcohol use, recreational drug use. Lives at home with wife. Family History: Father died of CVA; sister has [**Name (NI) 4278**]. Physical Exam: ON ADMISSION: Vitals: T: 98.5, BP: 110s-130s/60s-70s, P: 90s-100s, R: 35, O2: 96% on bipap General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry MM, EOMI, PERRL Neck: supple, JVP not elevated CV: Regular rate and rhythm, difficult to auscultate heart sounds over bipap Lungs: Clear to auscultation anteriorly Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, trace LE edema bilaterally Neuro: motor strength and sensory grossly equal and intact bilaterally, gait deferred AT DISCHARGE: VS: Tmax/Tc 97.7/97.7; 110/80; 90; 18; 97%RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry MM, EOMI, PERRL Neck: supple, JVP not elevated CV: RRR, nl S1, S2, no MRG Lungs: CTAB, respirations unlabored Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, no edema Neuro: motor strength and sensory grossly equal and intact bilaterally, gait deferred Pertinent Results: Admission Labs: [**2119-1-19**] 03:55PM BLOOD WBC-7.4 RBC-3.82* Hgb-12.0* Hct-35.8* MCV-94 MCH-31.5 MCHC-33.6 RDW-14.3 Plt Ct-235 [**2119-1-19**] 03:55PM BLOOD Neuts-70.4* Lymphs-18.7 Monos-6.5 Eos-2.8 Baso-1.7 [**2119-1-19**] 03:55PM BLOOD Glucose-115* UreaN-11 Creat-1.1 Na-139 K-4.1 Cl-98 HCO3-32 AnGap-13 [**2119-1-19**] 06:59PM BLOOD Lactate-2.0 PT/PTT/INR [**2119-1-20**] 05:36PM BLOOD PT-13.6* PTT-150* INR(PT)-1.3* [**2119-1-21**] 02:22AM BLOOD PT-13.0* PTT-150* INR(PT)-1.2* [**2119-1-22**] 07:00AM BLOOD PT-12.4 PTT-56.3* INR(PT)-1.1 [**2119-1-22**] 07:15PM BLOOD PT-13.2* PTT-71.9* INR(PT)-1.2* [**2119-1-23**] 06:33AM BLOOD PT-13.2* PTT-69.8* INR(PT)-1.2* Discharge labs: [**2119-1-23**] 06:33AM BLOOD WBC-9.0 RBC-3.67* Hgb-11.6* Hct-33.8* MCV-92 MCH-31.5 MCHC-34.2 RDW-14.8 Plt Ct-190 [**2119-1-23**] 06:33AM BLOOD Glucose-99 UreaN-11 Creat-0.9 Na-140 K-3.9 Cl-103 HCO3-31 AnGap-10 [**2119-1-21**] 02:22AM BLOOD ALT-22 AST-47* LD(LDH)-246 AlkPhos-53 TotBili-0.4 [**2119-1-19**] 03:55PM BLOOD proBNP-379 [**2119-1-23**] 06:33AM BLOOD Calcium-9.3 Phos-2.1* Mg-2.3 [**2119-1-23**] 06:33AM BLOOD Vanco-36.7* IMAGING: ECHO [**2119-1-23**]: The left atrium is elongated. No right-to-left shunt is seen on intravenous saline injection at rest. Left ventricular wall thicknesses and cavity size are normal. There is mild to moderate regional left ventricular systolic dysfunction with hypokinesis of the inferior and inferolateral walls. The remaining segments contract normally (LVEF = 35-40 %), but the apical half of the ventricle is not well seen. The estimated cardiac index is normal (>=2.5L/min/m2). No masses or thrombi are seen in the left ventricle. Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the [**Month/Day/Year **] level. 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. There is no pericardial effusion. IMPRESSION: Suboptimal image quality. Normal left ventricular cavity size with regional systolic dysfunction c/w CAD. Mild mitral regurgitation. No right-to-left intracardiac shunt identified. Dilated ascending aorta. Compared with the prior report (images unavailable for review) of [**2111-6-12**], the severeity of mitral regurgitation may be somewhat reduced and global systolic function is slightly worse. CXR [**2119-1-21**] MPRESSION: Increased retrocardiac density consistent with left lower lobe collapse and/or consolidation, worse compared with [**2119-1-19**]. Bilateral LENIS [**2119-1-19**]: IMPRESSION: Nonocclusive thrombus within the distal left common femoral vein extending to the proximal superficial femoral vein. CT Chest [**1-13**]: Bilateral bronchiectasis with bronchial wall thickening consistent with a bronchial inflammatory process. Again noted is right middle lobe loss of volume with a peripheral consolidation which may represent atelectasis, but malignancy cannot be excluded. Dedicated chest CT is again recommended in 3 months. Stable lung nodules Microbiology: Blood cultures [**2119-1-19**]: pending URINE CULTURE ([**2119-1-19**]): <10,000 organisms/ml. Urine culture [**2119-1-21**]: no growth Speech and Swallow Eval [**2119-1-23**]: This swallowing pattern correlates to a Functional Oral Intake Scale (FOIS) rating of 5. RECOMMENDATIONS: 1. Ground consistency solids with thin liquids. 2. Meds whole with water. 3. TID oral care. 4. Recommended video swallow and barium swallow as outpatient for further evaluation of symptoms. To schedule, please call ([**Telephone/Fax (1) 97885**]. Brief Hospital Course: 87 year old male with PMH of ischemic cardiomyopathy s/p PPM/AICD placement, HTN, recently diagnosed sarcoidosis after a [**Telephone/Fax (1) **] biopsy, and recent brief admission for bronchiectasis/UTI with discharge on [**1-14**], who presented with shortness of breath. # DVT/presumed PE: Pt presented with SOB, with LENIS positive for DVT of LLE. Pt is highly immobile at home, although no recent surgery or known history of malignancy. Last colonoscopy in [**2114**] with polypectomy, plan repeat in 5 years. Given sob/respiratory distress (see below), presumed to have PE. No evidence of RH strain. Started on hep gtt on [**2119-1-19**]. Respiratory status improved: initially required BiPAP in MICU but quickly transferred to the floor, where he remained stable, satting mid-high 90s on 3L NC, O2 sat high 90s on room air and mid 90s on ambulation at the time of discharge. Pt was started on warfarin 2.5 on [**1-21**].5 on [**1-22**], and 4mg on [**1-23**], DC [**Last Name (un) **] on 4mg daily. Heparin drip DCed on [**1-23**], and started Lovenox 1.5mg/kg daily (110mg daily) to bridge. Likely will need 6 months anticoagulation for provoked DVT/PE. Contact[**Name (NI) **] Dr. [**Name (NI) 97886**] office to follow Lovenox/Coumadin bridging and future INR. # Respiratory distress/hypoxia - Rapidly resolved after BIPAP in MICU. Suspicion for PE given DVT and new O2 requirement/hypoxia and pt was started on anticoagulation (see DVT/PE above). On admission, BNP was <400 pointing away from a cardiac etiology. ECHO on [**1-23**] showed slightly worse global dysfunction compared to [**2110**], now EF 35%. Out of concern for possible pneumonia (HCAP as pt was recently hospitalized)and pt was started on levoquin in the ED, transitioned to vanc/cefepime in the MICU. Pt was also given steroids in the ED on arrival. CXR initially did not suggest acute infection. CT scan from prior admission showed bronchiectasis, and it was felt some of his SOB/hypoxia could be related to superinfection or bronchiectasis flare. On [**2119-1-21**] WBC was elevated but pt afebrile and with improving respiratory status. Leukocytosis thought to be from steroids received in ED. However on [**1-21**] showed retrocardiac opacity which could represent consolidation, and pt was continued on antibiotics. Pt was administered respiratory therapy - chest PT treatments, acapella, pulmonary toilet. Patient switched back to Levaquin on [**1-23**] and planned for total 7-day course for CAP. Blood culture pending at time of discharge. # UTI/[**Name (NI) 30294**] pt sent home on cipro from last admission, had not yet finished his course. Cipro was DCd, pt placed on vanc/cefepime c/f CAP. Pt has history of recurrent UTIs likely [**12-29**] BPH. Continued home regimen of finasteride, terazosin, and tamsulosin. Urine culture on [**1-19**] grew <10,000 organisms. DC home on 7-day course of levaquin to cover CAP which also covers UTI. # Possible Sarcoid. Patient has chronic sinusitis, Chronic [**Month/Year (2) **], congestion and hoarseness with a [**Month/Year (2) **] bx in [**2118-11-27**] c/w sarcoidosis, however definitive diagnosis remains unclear. Continued home nasal saline. Steroids, after the 1 time dose in the ED, were not continued. # Ischemic cardiomyopathy. ECHO on [**1-23**] showed slightly worse global dysfunction compared to [**2110**], now EF 35%. BNP on admission <400. Pt did not appear fluid overloaded on exam. Furosemide initially held in the setting of presumed PE. Restarted on discharge. Continued home metoprolol, ASA, rosuvasatin. Patient has previously been on lisinopril, but was discontinued for unclear reason. Please address this on follow up. # Conjunctivitis. Continued outpatient ofloxacin. # Depression/anxiety - Patient was recently started on sertraline which was continued. # Aspiration risk- [**Name (NI) **] wife expressed concern about patient choking on his food. Speech and swallow eval reveals a swallowing pattern correlates to a Functional Oral Intake Scale (FOIS) rating of 5. Recommended Ground consistency solids with thin liquids (which patient is already doing at home), meds whole with water. Also recommended video swallow and barium swallow as outpatient for further evaluation of symptoms. PT WAS MAINTAINED AS FULL CODE THROUGHOUT THE COURSE OF THIS HOSPITALIZATION. # Transitional issues: 1. Anticoagulation: Dr.[**Name (NI) 2935**] office was contact[**Name (NI) **] regarding management of anticoagulation with Lovenox to coumadin bridge. VNA to help administer daily lovenox. VNA to draw PT/INR on [**2119-1-26**] and fax results to Dr.[**Name (NI) 2935**] office. 2. Follow up final blood culture results 3. Address restarting ACE-I/[**Last Name (un) **] given repeat ECHO findings. 4. Outpatient video swallow Medications on Admission: Medications (confirmed w/ wife): -Finasteride 5 mg PO once a day. -Furosemide 40 mg PO daily. -Metoprolol tartrate 12.5 mg PO BID. -Rosuvastatin 40 mg once a day. -Potassium chloride 20 mEq Tablet PO every other day. -Sertraline 12.5 mg PO daily. -Tamsulosin 0.4 mg PO HS. -Aspirin 81 mg PO daily. -Multivitamin PO daily. -Calcium carbonate-vitamin D3 600 mg-400 unit PO twice a day. -Aleve 220 mg PO twice a day as needed for pain. -[**Last Name (un) 14822**] [**Last Name (un) 97884**] with steroid. -Terazosin 5 mg PO daily -Ofloxacin 0.3% One drop four times a day into both eyes. -Ciprofloxacin 500 mg PO Q12H until [**1-23**] -fluticasone nasal spray Discharge Medications: 1. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 4. rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig: One (1) Tablet, ER Particles/Crystals PO every other day. 6. sertraline 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 7. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). 8. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 9. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 11. Aleve 220 mg Capsule Sig: One (1) Capsule PO twice a day as needed for pain. 12. terazosin 5 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 13. sodium chloride 0.65 % Aerosol, Spray Sig: [**11-28**] Sprays Nasal QID (4 times a day) as needed for nasal congestion. Disp:*1 unit* Refills:*0* 14. ofloxacin 0.3 % Drops Sig: One (1) Drop Ophthalmic QID (4 times a day). 15. fluticasone 50 mcg/actuation Spray, Suspension Sig: Two (2) Spray Nasal DAILY (Daily). 16. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 6 days: last day [**1-30**]. Disp:*6 Tablet(s)* Refills:*0* 17. warfarin 4 mg Tablet Sig: One (1) Tablet PO q4pm: as instructed by Dr. [**Last Name (STitle) 2204**]. Disp:*30 tablets* Refills:*0* 18. Lovenox 120 mg/0.8 mL Syringe Sig: One Hundred-Ten (110) mg Subcutaneous once a day: unless otherwise instructed by Dr. [**Last Name (STitle) 2204**]. Disp:*7 units* Refills:*0* 19. Outpatient Lab Work Please have VNA check INR on [**2119-1-26**]. Please fax results to patient's PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2204**] MD at [**Telephone/Fax (1) 7922**] 20. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation every six (6) hours as needed for shortness of breath or wheezing. Disp:*qs qs* Refills:*0* 21. guaifenesin 50 mg/5 mL Liquid Sig: Five (5) mL PO every six (6) hours as needed for [**Telephone/Fax (1) **]. Disp:*1 bottle* Refills:*1* 22. nebulizer & compressor Device Sig: One (1) unit Miscellaneous every 4-6 hours as needed for shortness of breath or wheezing: dx: pneumonia. Disp:*1 unit* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 **] Family & [**Hospital1 1926**] Services Discharge Diagnosis: Primary: -Deep vein thrombosis -Suspected pulmonary embolism -Community acquired pneumonia Secondary: -Ischemic cardiomyopathy -Bronchiectasis PE 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: Mr. [**Known lastname 97883**], It was a pleasure taking care of you during your hospitalization. You were admitted because of difficulty breathing. We think this is caused by a clot in your left leg that travelled up to your lungs. We treated you with blood thinners, which you will continue and be monitored by Dr. [**Last Name (STitle) 2204**]. We are also treating you with, levofloxacin, an antibiotic for pneumonia (last day will be [**1-30**]). You were also evaluated by our speech and swallow specialists, who recommended that you continue a normal diet, but you should have an outpatient video swallow evaluation which you PCP can coordinate We made the following changes to your medications: STARTED Lovenox (injection blood thinner, will stop once your coumadin level is in good range) STARTED Coumadin (you should have your INR checked by your VNA on [**1-26**]) STARTED Levofloxacin (last day [**1-30**]) STARTED Albuterol nebulizers as needed for shortness of breath STARTED Guaifenesin 5-10mL every 6 hours as needed for [**Month (only) **] Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: We are working on a follow up appointment with your primary care physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2204**] within 1 week of discharge. The office will contact you at home with an appointment. If you have not heard within 2 business days please call the office at [**Telephone/Fax (1) 2205**]. Department: [**State **]When: WEDNESDAY [**2119-2-8**] at 2:00 PM With: [**First Name11 (Name Pattern1) 2946**] [**Last Name (NamePattern4) 6564**], MD [**Telephone/Fax (1) 2205**] Building: [**State **] ([**Location (un) **], MA) [**Location (un) **] Campus: OFF CAMPUS Best Parking: On Street Parking Department: RHEUMATOLOGY When: THURSDAY [**2119-3-16**] at 2:00 PM With: [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **], 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 Department: CARDIAC SERVICES When: FRIDAY [**2119-6-23**] at 11:30 AM With: DEVICE CLINIC [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Completed by:[**2119-1-23**]

415,486,494,599,428,453,414,401,V450,135,600,372,300,311,041

{'Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Bronchiectasis with acute exacerbation,Urinary tract infection, site not specified,Chronic systolic heart failure,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Other specified forms of chronic ischemic heart disease,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ,Sarcoidosis,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Conjunctivitis, unspecified,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,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: shortness of breath PRESENT ILLNESS: This is an 87 year old male with PMH of ischemic cardiomyopathy with an EF of 45% s/p PPM/AICD placement in [**2113**] for AV block, HTN, recently diagnosed sarcoidosis after a [**Year (4 digits) **] biopsy, and recent brief admission for bronchiectasis/UTI with discharge on [**1-14**] now returning with shortness of breath. He was discharged on a course of ciprofloxacin for UTI/bronchiectasis. He was doing well at home until a few day ago when he developed gradually worsening shortness of breath and [**Month/Year (2) **] productive of clear sputum. His symptoms were exacerbated by activity. He reports no fevers or chills, no headache, change in vision or neck pain. He continues to have burning with urination since his recent diagnosis of UTI, difficulty starting urinary stream. Denies any abdominal pain, no focal numbness tingling or weakness, no rash. This episode of shortness ofbreath was more severe than his previous. MEDICAL HISTORY: bradycardia - with primary AV block s/p AICD and pacer placement Recurrent urethral strictures [**12-29**] childhood infection Mild systolic dysfunction - EF of 40-45% on Echo in [**2110**] Chronic [**Year (4 digits) **], congestion and hoarseness with referral for possible sarcoidosis. Chronic sinusitis. Osteoarthritis. Right knee surgery. Defibrillator/pacemaker. MEDICATION ON ADMISSION: Medications (confirmed w/ wife): -Finasteride 5 mg PO once a day. -Furosemide 40 mg PO daily. -Metoprolol tartrate 12.5 mg PO BID. -Rosuvastatin 40 mg once a day. -Potassium chloride 20 mEq Tablet PO every other day. -Sertraline 12.5 mg PO daily. -Tamsulosin 0.4 mg PO HS. -Aspirin 81 mg PO daily. -Multivitamin PO daily. -Calcium carbonate-vitamin D3 600 mg-400 unit PO twice a day. -Aleve 220 mg PO twice a day as needed for pain. -[**Last Name (un) 14822**] [**Last Name (un) 97884**] with steroid. -Terazosin 5 mg PO daily -Ofloxacin 0.3% One drop four times a day into both eyes. -Ciprofloxacin 500 mg PO Q12H until [**1-23**] -fluticasone nasal spray ALLERGIES: sulfa or amoxicillin PHYSICAL EXAM: ON ADMISSION: Vitals: T: 98.5, BP: 110s-130s/60s-70s, P: 90s-100s, R: 35, O2: 96% on bipap General: Alert, oriented, no acute distress HEENT: Sclera anicteric, dry MM, EOMI, PERRL Neck: supple, JVP not elevated CV: Regular rate and rhythm, difficult to auscultate heart sounds over bipap Lungs: Clear to auscultation anteriorly Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, trace LE edema bilaterally Neuro: motor strength and sensory grossly equal and intact bilaterally, gait deferred FAMILY HISTORY: Father died of CVA; sister has [**Name (NI) 4278**]. SOCIAL HISTORY: Denies smoking, alcohol use, recreational drug use. Lives at home with wife. ### Response: {'Other pulmonary embolism and infarction,Pneumonia, organism unspecified,Bronchiectasis with acute exacerbation,Urinary tract infection, site not specified,Chronic systolic heart failure,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Other specified forms of chronic ischemic heart disease,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ,Sarcoidosis,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Conjunctivitis, unspecified,Anxiety state, unspecified,Depressive disorder, not elsewhere classified,Other and unspecified Escherichia coli [E. coli]'}

CHIEF COMPLAINT: Altered Mental Status PRESENT ILLNESS: 72 F with insulin dependent diabetes having refused fingersticks lately and her daughter reportedly refusing to administer insulin went to OSH with altered mental status. She was intubated and found to have glucose > 1000 and hyperkalemia without an anion gap. She was transferred to the [**Hospital1 18**] for further management. In our ED, she was noted to have HR 83, 124/68, 14, 100%, cvp 11 and possible pancreatitis. A left IJ was placed, an insulin drip was begun at 6 units per hours, and 750 mg of levaquin with IVF was administered. Blood and urine cultures were obtained and she was sent to the [**Hospital Unit Name 153**]. Of note, no paperwork was delivered with patient so initial history was per OMR notes from [**2181**]. Later, in the [**Hospital Unit Name 153**], her daughter would expand on the presentation and would state that the patient had become agressive, scratching her caregivers (family) and throwing diapers at them. MEDICAL HISTORY: 1. Coronary artery disease, status post myocardial infarction in [**2177**]. 2. Chronic atrial fibrillation. 3. History of CVA in [**2181-3-6**] with left arm paralysis 4. Insulin dependent diabetes with neuropathy and retinopathy. 5. Patient is legally blind. 6. Hypertension. 7. History of gastrointestinal bleed secondary to ulcers. 8. History of a scull fracture as a child. 9. History of chronic anemia. 10. History of urinary tract infection. 11. History of depression anxiety. 12. superficial femoral perineal artery bypass with nonreversible saphenous vein graft [**2181**]. 13. s/p left BKA [**2180**] for nonhealing heel ulcer and 14. Dyslipidemia. MEDICATION ON ADMISSION: Unknown ALLERGIES: All drug allergies previously recorded have been deleted PHYSICAL EXAM: T 97.4 BP 87/65 with HR 65 O2 100% on AC PEEP 5 TV 400 RR 14 overbreathing by 4 FIO2 0.6 Gen: obtunded, moaning, intubated HEENT: dry mm, eyes deviated up and to left, minimally reactive pupils Neck: supple, no bruits, left IJ in place without erythema Cor: irreg irreg, no murmurs Chest: CTAB no crackles, right nipple inverted Abd: soft NT ND decreased bowel sounds Ext: s/p bilateral BKAs, moving arms, right brachial reflex 2+ left diminished. Skin: multiple escars, 3x4 cm over right hip, 4x6 under left pannus, 2x3 on back, 6x8 cm erosions under left breast FAMILY HISTORY: unknown SOCIAL HISTORY: The patient is a married female. She usually lives with her daughter. She does not smoke. She does not drink. She has had blood transfusions in the past.

Other septicemia due to gram-negative organisms,Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Acute respiratory failure,Pressure ulcer, hip,Acute kidney failure, unspecified,Acute pancreatitis,Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Acidosis,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Congestive heart failure, unspecified,Candidiasis of other urogenital sites,Severe sepsis,Below knee amputation status,Foreign body in larynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Personal history of noncompliance with medical treatment, presenting hazards to health,Polyneuropathy in diabetes,Profound impairment, both eyes, impairment level not further specified,Anemia of other chronic disease,Aortocoronary bypass status,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Bed confinement status,Other specified antibiotics causing adverse effects in therapeutic use,Long-term (current) use of insulin

Gram-neg septicemia NEC,DMII hprosmlr uncontrold,Urin tract infection NOS,Acute respiratry failure,Pressure ulcer, hip,Acute kidney failure NOS,Acute pancreatitis,Cardiac arrest,Food/vomit pneumonitis,Acidosis,Proteus infection NOS,CHF NOS,Candidias urogenital NEC,Severe sepsis,Status amput below knee,Foreign body in larynx,Resp obstr-inhal obj NEC,Hx of past noncompliance,Neuropathy in diabetes,Both eyes blind-who def,Anemia-other chronic dis,Aortocoronary bypass,Late ef-hemplga side NOS,Bed confinement status,Adv eff antibiotics NEC,Long-term use of insulin

Admission Date: [**2185-3-16**] Discharge Date: [**2185-4-6**] Date of Birth: [**2112-5-1**] Sex: F Service: MEDICINE Allergies: All drug allergies previously recorded have been deleted Attending:[**First Name3 (LF) 3556**] Chief Complaint: Altered Mental Status Major Surgical or Invasive Procedure: Tracheostomy PICC line History of Present Illness: 72 F with insulin dependent diabetes having refused fingersticks lately and her daughter reportedly refusing to administer insulin went to OSH with altered mental status. She was intubated and found to have glucose > 1000 and hyperkalemia without an anion gap. She was transferred to the [**Hospital1 18**] for further management. In our ED, she was noted to have HR 83, 124/68, 14, 100%, cvp 11 and possible pancreatitis. A left IJ was placed, an insulin drip was begun at 6 units per hours, and 750 mg of levaquin with IVF was administered. Blood and urine cultures were obtained and she was sent to the [**Hospital Unit Name 153**]. Of note, no paperwork was delivered with patient so initial history was per OMR notes from [**2181**]. Later, in the [**Hospital Unit Name 153**], her daughter would expand on the presentation and would state that the patient had become agressive, scratching her caregivers (family) and throwing diapers at them. Past Medical History: 1. Coronary artery disease, status post myocardial infarction in [**2177**]. 2. Chronic atrial fibrillation. 3. History of CVA in [**2181-3-6**] with left arm paralysis 4. Insulin dependent diabetes with neuropathy and retinopathy. 5. Patient is legally blind. 6. Hypertension. 7. History of gastrointestinal bleed secondary to ulcers. 8. History of a scull fracture as a child. 9. History of chronic anemia. 10. History of urinary tract infection. 11. History of depression anxiety. 12. superficial femoral perineal artery bypass with nonreversible saphenous vein graft [**2181**]. 13. s/p left BKA [**2180**] for nonhealing heel ulcer and 14. Dyslipidemia. PAST SURGICAL HISTORY: Significant for: 1. Coronary artery bypass graft at [**Hospital6 54007**] in the year [**2177**]. 2. Cataract surgery with loss of vision. 3. Right below the knee amputation in [**2181-11-5**]. Social History: The patient is a married female. She usually lives with her daughter. She does not smoke. She does not drink. She has had blood transfusions in the past. Family History: unknown Physical Exam: T 97.4 BP 87/65 with HR 65 O2 100% on AC PEEP 5 TV 400 RR 14 overbreathing by 4 FIO2 0.6 Gen: obtunded, moaning, intubated HEENT: dry mm, eyes deviated up and to left, minimally reactive pupils Neck: supple, no bruits, left IJ in place without erythema Cor: irreg irreg, no murmurs Chest: CTAB no crackles, right nipple inverted Abd: soft NT ND decreased bowel sounds Ext: s/p bilateral BKAs, moving arms, right brachial reflex 2+ left diminished. Skin: multiple escars, 3x4 cm over right hip, 4x6 under left pannus, 2x3 on back, 6x8 cm erosions under left breast Pertinent Results: EKG: low voltage a.fib at 80, left axis, poor R wave progression, TWI V3-v6, no ST changes. . CHEST (PORTABLE AP) [**2185-3-16**] 4:02 AM Portable AP chest dated [**2185-3-16**] is compared to the prior from [**2181-12-25**]. The patient is intubated. The endotracheal tube terminates 3.9 cm above the carina. The heart size is normal. There is no pulmonary vascular congestion. There is stable elevation of the left hemidiaphragm. There is patchy opacity in the left retrocardiac region, which could represent atelectasis and/or aspiration. There is no pleural effusion or pneumothorax. IMPRESSION: Endotracheal tube is appropriately positioned. Left lower lung lobe patchy airspace opacity likely represents atelectasis and/or aspiration. CT HEAD WITHOUT CONTRAST [**3-16**] CONCLUSION: Extensive areas of diminished density within the cerebral hemispheres suggesting prior infarcts. If a new infarct is suspected, MR is a more sensitive imaging modality to detect acute brain ischemia. CT SCAN ABDOMEN/PELVIS [**3-22**] IMPRESSION: 1. Left parapelvic cyst, with no evidence of renal abscess or hydronephrosis. 2. Bilateral moderate pleural effusions with adjacent compressive atelectasis. 3. Large ascites, generalized anasarca. 4. Fluid and stranding surrounding the pancreatic head, with heterogeneous enhancement, consistent with pancreatitis; there is no evidence of complication. 5. Abnormal appearance of the sigmoid and distal descending colon with hausrtral edema, a non-specific finding in a setting of ascites; however, this may be seen in pseudomembranous and other colitis, and should be correlated clinically. 6. Mildly distended gallbladder with enhancing borderline wall thickening. This, too, is non-specific, and follow-up son[**Name (NI) 867**] should be considered, if there is clinical concern for cholecystitis. 7. Multiple splenic infarcts [**2185-3-16**] ECHO Conclusions: The left atrium is normal in size. The estimated right atrial pressure is 11-15mmHg. There is moderate regional left ventricular systolic dysfunction with hypokinesis of the anterior septum, anterior wall, and apex (EF ~ 35%). The remaining segments contract well. 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. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPRESSION: Regional left ventricular dysfunction consistent with coronary artery disease. Mild mitral regurgitation. [**2185-3-16**] 05:46PM TYPE-MIX TEMP-36.2 RATES-/25 TIDAL VOL-330 PEEP-12 O2-40 PO2-42* PCO2-41 PH-7.33* TOTAL CO2-23 BASE XS--4 INTUBATED-INTUBATED [**2185-3-16**] 05:24PM GLUCOSE-34* UREA N-65* CREAT-1.0 SODIUM-137 POTASSIUM-4.7 CHLORIDE-109* TOTAL CO2-20* ANION GAP-13 [**2185-3-16**] 05:24PM ALBUMIN-1.7* CALCIUM-6.8* PHOSPHATE-1.6* MAGNESIUM-1.5* [**2185-3-16**] 05:24PM WBC-14.7* RBC-3.91* HGB-10.9* HCT-32.3* MCV-83 MCH-27.9 MCHC-33.8 RDW-14.0 [**2185-3-16**] 05:24PM PLT COUNT-217 [**2185-3-16**] 08:10AM TYPE-MIX TEMP-36.3 RATES-18/4 TIDAL VOL-360 PEEP-5 PO2-40* PCO2-46* PH-7.34* TOTAL CO2-26 BASE XS--1 INTUBATED-INTUBATED [**2185-3-16**] 08:10AM LACTATE-4.2* [**2185-3-16**] 07:55AM GLUCOSE-363* UREA N-71* CREAT-1.3* SODIUM-148* POTASSIUM-3.5 CHLORIDE-113* TOTAL CO2-22 ANION GAP-17 [**2185-3-16**] 07:55AM LD(LDH)-243 AMYLASE-606* [**2185-3-16**] 07:55AM LIPASE-864* [**2185-3-16**] 07:55AM CALCIUM-7.5* PHOSPHATE-2.1* MAGNESIUM-1.9 IRON-20* [**2185-3-16**] 07:55AM calTIBC-120 FERRITIN-GREATER TH TRF-92* [**2185-3-16**] 07:55AM TRIGLYCER-170* [**2185-3-16**] 07:55AM TSH-5.7* [**2185-3-16**] 07:55AM T4-3.7* FREE T4-0.89* [**2185-3-16**] 07:55AM URINE HOURS-RANDOM UREA N-531 CREAT-47 SODIUM-43 [**2185-3-16**] 07:55AM WBC-13.8* RBC-4.07* HGB-11.5* HCT-34.2* MCV-84 MCH-28.2 MCHC-33.6 RDW-13.9 [**2185-3-16**] 07:55AM PLT COUNT-257 [**2185-3-16**] 07:55AM RET AUT-1.5 [**2185-3-16**] 05:20AM URINE COLOR-Red APPEAR-Cloudy SP [**Last Name (un) 155**]-1.024 [**2185-3-16**] 05:20AM URINE BLOOD-LG NITRITE-NEG PROTEIN-30 GLUCOSE-TR KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-MOD [**2185-3-16**] 05:20AM URINE RBC->50 WBC->50 BACTERIA-MANY YEAST-MANY EPI-0-2 [**2185-3-16**] 04:47AM GLUCOSE-572* UREA N-75* CREAT-1.4* SODIUM-145 POTASSIUM-3.4 CHLORIDE-110* TOTAL CO2-22 ANION GAP-16 [**2185-3-16**] 04:47AM ALT(SGPT)-12 AST(SGOT)-24 LD(LDH)-235 CK(CPK)-342* ALK PHOS-108 AMYLASE-590* TOT BILI-0.4 [**2185-3-16**] 04:47AM LIPASE-1096* [**2185-3-16**] 04:47AM CK-MB-8 [**2185-3-16**] 04:47AM ALBUMIN-1.9* CALCIUM-7.2* PHOSPHATE-2.7 MAGNESIUM-1.9 [**2185-3-16**] 04:47AM OSMOLAL-352* [**2185-3-16**] 04:47AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2185-3-16**] 04:47AM WBC-15.2*# RBC-3.86* HGB-10.9* HCT-33.2* MCV-86 MCH-28.1 MCHC-32.7 RDW-14.4 [**2185-3-16**] 04:47AM NEUTS-92.8* BANDS-0 LYMPHS-4.2* MONOS-2.7 EOS-0.1 BASOS-0.3 [**2185-3-16**] 04:47AM PLT SMR-NORMAL PLT COUNT-226# LPLT-1+ [**2185-3-16**] 04:47AM PT-13.9* PTT-32.5 INR(PT)-1.2* [**2185-3-16**] 04:45AM LACTATE-5.4* K+-3.5 Brief Hospital Course: Ms. [**Known lastname 634**] is a 72 year old woman with with HHNK and pancreatitis with a hospital course complicated by respiratory failure requiring intubation now s/p tracheostomy. MICU events: [**3-21**]: Respiratory arrest, bradycardic, hypotensive, with desat to 15%. Intubated at 9:30am. Atropine given. Started on dopamine. Bronchoscopy showed secretions, no evidence of tube feed aspiration or plugs. [**3-18**]: Asystolic arrest. recovered after one dose of epinephrine and atropine. Was intubated. No EKG changes. . # Hypoxic respiratory failure: The etiology was thought to be multifactorial, with an infectious component, possibly aspiration pneumonia, as well as mucous plugging. A tracheostomy was performed at the bedside on [**3-28**]. The patient remained ventilator dependent, transitioning from A/C to Pressure Support, until [**3-30**], when she had a successful trach collar trial. She was put back on CPAP during the night and again on trach collar [**3-31**]. She had abundant secretions during her course which were treated with suction and mucomyst. She completed a 10 day course of meropenem for aspiration pneumonia. However, because fever and hypotension persisted transiently on abx, as well as diarrhea, she has also to complete a course of Flagyl (last day [**4-5**]), Ceftriaxone (last day [**4-5**]) and Fluconazole (last day [**4-4**]). At the time of discharge the patient was saturating well on 12L/min trach collar with FiO2 40%. She was successfully fitted for Passy-Muir valve. . # Altered mental status: Initially thought to be from HHNK but she had persistently deviated eyes to left concerning for new CVA, and she has h/o CVA. Head CT showed old stroke. She also had evidence of proteus UTI. TSH was normal. Her urine grew yeast, besides proteus, and a beta glucan was positive. Her AMS was multifactorial, due to hyperglycemia, sepsis, and uremia. MS resolved and returned at baseline with aggressive antibiotic and antifungal treatment, and resolution of metabolic imbalance and ARF. . # AG metabolic acidosis resolved gradually as her sugars were brought under control. Successive urine analysis showed no ketones. . # HHNK: Now resolved. Initially with serum glucose >1000 at OSH with osms > 350 in setting of no insulin administration. Her sugars remained between 100 and 200 and the sliding scale was tightened and [**Last Name (un) **] consult obtained. [**Last Name (un) **] started her on lantus 8 units daily, then increased to 12 units daily on [**3-31**]. At the time of discharge she showed good blood sugar control, ranging from 80-170 on the 24 hours prior to discharge. . # Pancreatitis: Pancreatic enzymes trended down and normalized paralleling resolution of renal failure, so this might not have been a true pancreatitis. The patient did not have epigastric pain. . # UTI: She grew proteus in blood and urine, sensitive to meropenem and ceftriaxone. She completed a ten day course of meropenem and a 14 day course of ceftriaxone, last dose on [**4-5**]. Later she grew yeast. She also had a positive beta glucan. She was started on caspofungin and then switched to fluconazole, last dose 4/30. . # Renal failure. ARF of pre-renal etiology, low urinary output. The patient was severely dehydrated on presentation, and the renal failure resolved with fluids. All medications were renally dosed, and nephrotoxins were avoided. Her creatinine is at baseline now. . # Skin breakdown/eschars over dermatomal distribution: concerning for osteomyelitis and also for zoster. She was put on zoster precautions, and briefly on vancomycin. Most of these lesions were consistent with pressure sores. Wound consult and plastics consult was obtained and, with accuzyme, air mattress, frequent position changes, optimization of nutrition, and zinc/vitamin C x 14 days (ongoing, last dose [**2185-4-12**]), the wounds began to heal. However, on [**3-28**] her edema became worse and she had true anasarca, as a result of which new skin lesions started to develop. Lasix was started and her extremities were apropriately dressed to avoid moisture. The patient was negative >1L in the 24 hours prior to discharge. She requires more diuresis. This must be followed further at her rehab facility. . # History of CAD: The patient had Atrial Fibrillation but no RVR. Plavix and aspirin were held initially. Aspirin was restarted early in the course and plavix was restarted on [**3-29**]. She was felt not to be a candidate for systemic anticoagulation as this would exacerbate her poor wound healing. The question of systemic anticoagulation can be readdressed as an outpatient at a later date. The patient was initially on lopressor but this was d/ced due to bradycardia and hypotension. . # Anemia: appears to be at baseline, likely anemia of chronic disease. Iron studies were not consistent with iron deficiency and hemolysis labs were not consistent with lysis. . # Pain: The patient has significant pain. She became oversedated on a fentanyl patch. She was treated with morphine and tylenol PRN. She stil endorsed pain on questioning and may require uptitration of her pain medications. . # Hemiparesis: the patient has L hemiparesis and bilateral BKA. A PT consult was obtained. . # Thrombocytopenia: HIT negative. The most likely etiology was vancomycin as thrombocytopenia resolved once Vancomycin was stopped. . # Social issues: per signout, patient has been refusing fingersticks and daughter has been refusing to administer insulin. Currently being investigated for possible neglect. This issue needs to be clarified before the patient can be made DNR/DNI. The patient stated that her health care proxy is her daughter. . # Nutrition: The patient was severely malnourished at presentation. Nutrition consult was obtained early on and followed the patient until discharge. Tube feeds were aimed at maximizing protein intake, and the patient tolerated well. A Dubhoff feeding tube was placed under bronchoscopy on [**3-28**]. Zinc and vitamin supplements were started for a course of 14 days (last dose 5/8). The patient was thought not to be a PEG candidate due to poor wound healing. . # Prophylaxis: hep SQ, PPI. . # Access: left IJ d/c on [**3-29**], PICC line placed [**3-29**]. . # FULL CODE. Medications on Admission: Unknown Discharge Medications: 1. Heparin (Porcine) 5,000 unit/mL Solution [**Month/Year (2) **]: One (1) Injection TID (3 times a day). 2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Month/Year (2) **]: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 3. Miconazole Nitrate 2 % Powder [**Month/Year (2) **]: One (1) Appl Topical [**Hospital1 **] (2 times a day). 4. Lactulose 10 g/15 mL Syrup [**Hospital1 **]: Thirty (30) ML PO Q8H (every 8 hours) as needed. 5. Bacitracin Zinc 500 unit/g Ointment [**Hospital1 **]: One (1) Appl Topical [**Hospital1 **] (2 times a day). 6. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1) Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily). 7. Atorvastatin 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 8. Citalopram 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 9. Levothyroxine 25 mcg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily). 10. Nystatin 100,000 unit/g Cream [**Last Name (STitle) **]: One (1) Appl Topical [**Hospital1 **] (2 times a day). 11. Acetylcysteine 10 % (100 mg/mL) Solution [**Hospital1 **]: 1-2 MLs Miscellaneous Q4-6H (every 4 to 6 hours) as needed. 12. Ascorbic Acid 500 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times a day) for 14 days: Last dose [**2185-4-12**]. 13. Zinc Sulfate 220 (50) mg Capsule [**Month/Day/Year **]: One (1) Capsule PO DAILY (Daily) for 14 days: Last dose [**2185-4-12**]. 14. Clopidogrel 75 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO DAILY (Daily). 15. Insulin Glargine 100 unit/mL Cartridge [**Month/Day/Year **]: One (1) 12 Subcutaneous at bedtime. 16. Morphine 10 mg/5 mL Solution [**Month/Day/Year **]: 1-2 mg PO Q3-4H (Every 3 to 4 Hours) as needed for pain. 17. 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. 18. Aspirin 325 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO DAILY (Daily). 19. Albuterol Sulfate 0.083 % Solution [**Month/Day/Year **]: One (1) Inhalation Q6H (every 6 hours) as needed. 20. Furosemide 10 mg/mL Solution [**Month/Day/Year **]: Sixty (60) mg Injection once a day as needed for For fluid overload for 2 days: As needed for fluid overload. Patient still requires several liters diuresis at goal negative 1L/day. To be reassessed by a physician [**Name Initial (PRE) **] 2 days. 21. Papain-Urea 830,000-10 unit/g-% Spray, Non-Aerosol [**Name Initial (PRE) **]: One (1) Appl Topical [**Hospital1 **] (2 times a day). 22. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) Inhalation Q6H (every 6 hours) as needed. 23. Acetaminophen 325 mg Tablet [**Hospital1 **]: 1-2 Tablets PO every [**3-11**] hours as needed for Pain or fever. 24. Docusate Sodium 50 mg/5 mL Liquid [**Month/Day (3) **]: Two (2) PO twice a day. 25. Insulin sliding scale Four times daily fingerstick glucose with humalog insulin correction sliding scale. Discharge Disposition: Extended Care Facility: [**Hospital3 105**] Northeast - [**Location (un) 1110**] Discharge Diagnosis: hyperosmolar nonketotic coma hypoxic respiratory failure s/p trach proteus UTI sepsis bradycardia pancreatitis anemia thrombocytopenia multiple pressure ulcers hypoxic cardiac arrest following intubation, twice Discharge Condition: Stable, breathing comfortably on trach collar. Discharge Instructions: Please administer all medications and do trach care as indicated. . Continue trach collar: 12L/min, FiO2 40% . Continue 4 times daily blood sugar monitoring with standing insulin (glargine 12U at bedtime) and humalog sliding scale. Followup Instructions: Please have the patient follow up with her PCP 1-2 weeks after discharge from rehab: [**Last Name (LF) 54008**],[**First Name3 (LF) 247**] O. [**Telephone/Fax (1) 54009**] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3559**] MD, [**MD Number(3) 3560**]

038,250,599,518,707,584,577,427,507,276,041,428,112,995,V497,933,E912,V158,357,369,285,V458,438,V498,E930,V586

{'Other septicemia due to gram-negative organisms,Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Acute respiratory failure,Pressure ulcer, hip,Acute kidney failure, unspecified,Acute pancreatitis,Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Acidosis,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Congestive heart failure, unspecified,Candidiasis of other urogenital sites,Severe sepsis,Below knee amputation status,Foreign body in larynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Personal history of noncompliance with medical treatment, presenting hazards to health,Polyneuropathy in diabetes,Profound impairment, both eyes, impairment level not further specified,Anemia of other chronic disease,Aortocoronary bypass status,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Bed confinement status,Other specified antibiotics causing adverse effects in therapeutic use,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: Altered Mental Status PRESENT ILLNESS: 72 F with insulin dependent diabetes having refused fingersticks lately and her daughter reportedly refusing to administer insulin went to OSH with altered mental status. She was intubated and found to have glucose > 1000 and hyperkalemia without an anion gap. She was transferred to the [**Hospital1 18**] for further management. In our ED, she was noted to have HR 83, 124/68, 14, 100%, cvp 11 and possible pancreatitis. A left IJ was placed, an insulin drip was begun at 6 units per hours, and 750 mg of levaquin with IVF was administered. Blood and urine cultures were obtained and she was sent to the [**Hospital Unit Name 153**]. Of note, no paperwork was delivered with patient so initial history was per OMR notes from [**2181**]. Later, in the [**Hospital Unit Name 153**], her daughter would expand on the presentation and would state that the patient had become agressive, scratching her caregivers (family) and throwing diapers at them. MEDICAL HISTORY: 1. Coronary artery disease, status post myocardial infarction in [**2177**]. 2. Chronic atrial fibrillation. 3. History of CVA in [**2181-3-6**] with left arm paralysis 4. Insulin dependent diabetes with neuropathy and retinopathy. 5. Patient is legally blind. 6. Hypertension. 7. History of gastrointestinal bleed secondary to ulcers. 8. History of a scull fracture as a child. 9. History of chronic anemia. 10. History of urinary tract infection. 11. History of depression anxiety. 12. superficial femoral perineal artery bypass with nonreversible saphenous vein graft [**2181**]. 13. s/p left BKA [**2180**] for nonhealing heel ulcer and 14. Dyslipidemia. MEDICATION ON ADMISSION: Unknown ALLERGIES: All drug allergies previously recorded have been deleted PHYSICAL EXAM: T 97.4 BP 87/65 with HR 65 O2 100% on AC PEEP 5 TV 400 RR 14 overbreathing by 4 FIO2 0.6 Gen: obtunded, moaning, intubated HEENT: dry mm, eyes deviated up and to left, minimally reactive pupils Neck: supple, no bruits, left IJ in place without erythema Cor: irreg irreg, no murmurs Chest: CTAB no crackles, right nipple inverted Abd: soft NT ND decreased bowel sounds Ext: s/p bilateral BKAs, moving arms, right brachial reflex 2+ left diminished. Skin: multiple escars, 3x4 cm over right hip, 4x6 under left pannus, 2x3 on back, 6x8 cm erosions under left breast FAMILY HISTORY: unknown SOCIAL HISTORY: The patient is a married female. She usually lives with her daughter. She does not smoke. She does not drink. She has had blood transfusions in the past. ### Response: {'Other septicemia due to gram-negative organisms,Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Acute respiratory failure,Pressure ulcer, hip,Acute kidney failure, unspecified,Acute pancreatitis,Cardiac arrest,Pneumonitis due to inhalation of food or vomitus,Acidosis,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Congestive heart failure, unspecified,Candidiasis of other urogenital sites,Severe sepsis,Below knee amputation status,Foreign body in larynx,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Personal history of noncompliance with medical treatment, presenting hazards to health,Polyneuropathy in diabetes,Profound impairment, both eyes, impairment level not further specified,Anemia of other chronic disease,Aortocoronary bypass status,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Bed confinement status,Other specified antibiotics causing adverse effects in therapeutic use,Long-term (current) use of insulin'}

CHIEF COMPLAINT: Unwitnessed fall PRESENT ILLNESS: 79 y.o. female found down in them bathroom per family. Famly heard her fall down in the bathroom. It was unwitnessed fall. Unresponsive and intubated but per EMS was MAEs before arrival to [**Hospital6 1597**]. Head CT shows extensive SAH, [**Doctor Last Name **] grade V, and likely a right MCA rupture with ICH. Neurosurgery consult for further management. MEDICAL HISTORY: HTN, HLD MEDICATION ON ADMISSION: unk ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: O: T: af BP: 166/100 HR:60 R 12 O2Sats 1005 Gen: intubated, chemically paralyzed HEENT: atraumatic, eyes: clear Pupils: blown bilaterally Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. FAMILY HISTORY: NC SOCIAL HISTORY: unk

Subarachnoid hemorrhage,Cerebral edema,Subdural hemorrhage,Coma,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Do not resuscitate status

Subarachnoid hemorrhage,Cerebral edema,Subdural hemorrhage,Coma,Hypertension NOS,Hyperlipidemia NEC/NOS,Do not resusctate status

Admission Date: [**2188-7-19**] Discharge Date: [**2188-7-19**] Date of Birth: [**2108-10-5**] Sex: F Service: NEUROSURGERY Allergies: No Allergies/ADRs on File Attending:[**First Name3 (LF) 1271**] Chief Complaint: Unwitnessed fall Major Surgical or Invasive Procedure: None History of Present Illness: 79 y.o. female found down in them bathroom per family. Famly heard her fall down in the bathroom. It was unwitnessed fall. Unresponsive and intubated but per EMS was MAEs before arrival to [**Hospital6 1597**]. Head CT shows extensive SAH, [**Doctor Last Name **] grade V, and likely a right MCA rupture with ICH. Neurosurgery consult for further management. Past Medical History: HTN, HLD Social History: unk Family History: NC Physical Exam: O: T: af BP: 166/100 HR:60 R 12 O2Sats 1005 Gen: intubated, chemically paralyzed HEENT: atraumatic, eyes: clear Pupils: blown bilaterally Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: intubated Pupils fixed and dilated at 6mm, No corneals, no gag reflex No movement to noxious stimuli Grade V [**Doctor Last Name **], HH 5 On Discharge: Expired Pertinent Results: CT HEad from [**Hospital6 2561**] massive intracranial SAH bilaterally right greater than left with right SDH, and right temporal ICH likely consistent with right MCA rupture. There is global cerebral edema with right to left shift 1cm. There is compressionon midbrain throughout. brainstem appear hypodense consistent with infarct. There is trapping of right ventricle with impending hydrocephalus Brief Hospital Course: Patient presented to [**Hospital1 18**] from [**Hospital6 **] after found to have severe intracranial hemorrhage. Patient was seen and examined in the ED and due to imaging findings and physical exam withdrawl of care was discussed with the family. The decision was made to make the patient DNR/DNI but to admit to Neuro ICU while awaiting other family members prior to extubation and making patient CMO. Once all family arrived, the patient was extubated and passed away peacefully soon after with her family at her bedside. Medications on Admission: unk Discharge Medications: None Discharge Disposition: Expired Discharge Diagnosis: Subdural hematoma Subarachnoid Hemorrhage Discharge Condition: Expired Discharge Instructions: Expired Followup Instructions: Expired [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**] Completed by:[**2188-7-19**]

430,348,432,780,401,272,V498

{'Subarachnoid hemorrhage,Cerebral edema,Subdural hemorrhage,Coma,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Do not resuscitate 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: Unwitnessed fall PRESENT ILLNESS: 79 y.o. female found down in them bathroom per family. Famly heard her fall down in the bathroom. It was unwitnessed fall. Unresponsive and intubated but per EMS was MAEs before arrival to [**Hospital6 1597**]. Head CT shows extensive SAH, [**Doctor Last Name **] grade V, and likely a right MCA rupture with ICH. Neurosurgery consult for further management. MEDICAL HISTORY: HTN, HLD MEDICATION ON ADMISSION: unk ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: O: T: af BP: 166/100 HR:60 R 12 O2Sats 1005 Gen: intubated, chemically paralyzed HEENT: atraumatic, eyes: clear Pupils: blown bilaterally Neck: Supple. Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. FAMILY HISTORY: NC SOCIAL HISTORY: unk ### Response: {'Subarachnoid hemorrhage,Cerebral edema,Subdural hemorrhage,Coma,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Do not resuscitate status'}

CHIEF COMPLAINT: altered mental status, unresponsiveness PRESENT ILLNESS: [**Age over 90 **]-year-old white female with a recent PPM for CHB, history of CAD, hyperlipidemia, hypertension and arthritis who presented to [**Hospital6 33**] with altered mental status and failure of RV capture. . Per ED report, the patient had a syncopal episode at her nursing facility today. The patient just had a pacemaker placed on [**2161-2-17**] at [**Hospital3 **] after prolonged episodes of complete heart block with asystole and no escape rhythm. The patient's family subsequently reports that the patient had been complaining of some discomfort in the left lower chest/ left upper abdomen over the past 2 days. They report this is worse when the patient takes a deep breath. . EMS reports that the patient's pacemaker did not appear to be functioning adequately as they found the patient's heart rate to be between the 30's and 70's. EMS was not able to obtan IV access and an IO was placed. There are no reports of any recent chest pain, shortness of breath, abdominal pain, new back pain, or trauma. The patient was not able to answer review of systems questions or identify exacerbating or alleviating factors. The patient did have some eccymosis about the left side of her head. . In the [**Hospital3 **], the patient was successfully intubated with versed, fentanyl, and succinylcholine out of concerns that she could not protect her airway and hypotension. A temporary pacing wire was placed via the right IJ. The patient was bradycardic and a CXR demonstrated a displaced right ventricular pacer wire. After consultation with the family, the patient was transferred to [**Hospital1 18**] for further evaluation and management. . At [**Hospital1 18**], we noted complete loss of capture of the pacemaker RV lead, and intermittent or absent capture of the temporary pacing wire. During periods of her complete paroxysmal heart block, she was completely pacer dependent. Given the tenuous situation, she was taken to the OR emergently. On Echo, there was concern for RV lead displacement but no evidence of tamponade or effusion. She was taken to the OR and had the RV lead repositioned to the RVOT. She was intubated and sedated and on dopamine. A repeat ECHO demonstrated no effusion or complication of lead placement. Access is PIV, femoral 7-french central line. . ROS: unable to obtain due to intubation/sedation. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension, diabetes mellitus 2. CARDIAC HISTORY: CAD. s/p inferior microinfarction - PACING/ICD: complete heart block s/p pacemaker placement in [**1-/2161**] 3. OTHER PAST MEDICAL HISTORY: 1. Gastroesophageal reflux disease. 2. Colon cancer. 3. Insulin dependent-diabetes mellitus. 4. History of duodenal ulcer. 5. COPD. 6. Asthma. 7. History of cataracts. 8. Osteoarthritis. 9. History of ventral hernia. 10. History of abdominal wall abscess. 11. Depression. 12. History of colocutaneous fistula. 13. History of diverticulitis. 14. Hyperlipidemia 15. CAD. s/p inferior microinfarction 16. Pulmonary edema, diastolic dysfunction 17. complete heart block. . PAST SURGICAL HISTORY: 1. Right colectomy for colon cancer. 2. Ventral hernia repair with mesh. 3. Bilateral hip replacements. 4. Antrectomy and vagotomy with [**Doctor First Name 892**]-[**Doctor Last Name **] II reconstruction with splenectomy and partial pancreatectomy for duodenal ulcer. 5. Duodenostomy tube. 6. Feeding jejunostomy. 7. Exploration of abdominal abscess. MEDICATION ON ADMISSION: HOME MEDICATIONS: From D/C summary from [**Hospital1 **] on [**2161-2-22**]; unable to confirm as pt intubated and sedated Lactobacillus 1 tab [**Hospital1 **] Metoprolol Tartrate 25 mg [**Hospital1 **] Aspirin 325 mg DAILY Enoxaparin Sodium 30 mg DAILY Fluticasone [**Hospital1 **] Salmeterol INH Acetaminophen 650mg Q4H PRN Oxycodone 1 tab Q4H PRN Magnesium Hydroxide Nitroglycerin 0.4 mg Q5M PRN ALLERGIES: Percocet / Dilaudid (PF) PHYSICAL EXAM: VITAL SIGNS: 95.1 60 111/53 100% CMV assist control 400/14 PEEP 5 GENERAL: Intubated w/ RASS of -5. HEENT: Conjunctiva were pale. Pupils reactive to light. No xanthalesma. NECK: Supple with JVP flat 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. Pt intubated CTAB, no crackles, wheezes or rhonchi on anterior lung exam. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. NEURO: Intubated with RASS of -5, 2+ reflexes biceps, brachioradialis, patellar, ankle. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ FAMILY HISTORY: NC SOCIAL HISTORY: - Tobacco history: ex-smoker - ETOH: no - Illicit drugs: no

Esophageal reflux,Personal history of malignant neoplasm of large intestine,Chronic obstructive asthma, unspecified,Hip joint replacement,Congestive heart failure, unspecified,Other and unspecified Escherichia coli [E. coli],Diarrhea,Do not resuscitate status,Mechanical complication due to cardiac pacemaker (electrode),Atrioventricular block, complete,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

Esophageal reflux,Hx of colonic malignancy,Chronic obst asthma NOS,Joint replaced hip,CHF NOS,E.coli infection NEC/NOS,Diarrhea,Do not resusctate status,Malfunc cardiac pacemake,Atriovent block complete,Acute kidney failure NOS,Urin tract infection NOS,Abn react-artif implant,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Hypertension NOS,Osteoarthros NOS-unspec,DMII wo cmp nt st uncntr

Admission Date: [**2161-3-2**] Discharge Date: [**2161-3-4**] Service: MEDICINE Allergies: Percocet / Dilaudid (PF) Attending:[**Attending Info 11308**] Chief Complaint: altered mental status, unresponsiveness Major Surgical or Invasive Procedure: Right ventricular lead revision History of Present Illness: [**Age over 90 **]-year-old white female with a recent PPM for CHB, history of CAD, hyperlipidemia, hypertension and arthritis who presented to [**Hospital6 33**] with altered mental status and failure of RV capture. . Per ED report, the patient had a syncopal episode at her nursing facility today. The patient just had a pacemaker placed on [**2161-2-17**] at [**Hospital3 **] after prolonged episodes of complete heart block with asystole and no escape rhythm. The patient's family subsequently reports that the patient had been complaining of some discomfort in the left lower chest/ left upper abdomen over the past 2 days. They report this is worse when the patient takes a deep breath. . EMS reports that the patient's pacemaker did not appear to be functioning adequately as they found the patient's heart rate to be between the 30's and 70's. EMS was not able to obtan IV access and an IO was placed. There are no reports of any recent chest pain, shortness of breath, abdominal pain, new back pain, or trauma. The patient was not able to answer review of systems questions or identify exacerbating or alleviating factors. The patient did have some eccymosis about the left side of her head. . In the [**Hospital3 **], the patient was successfully intubated with versed, fentanyl, and succinylcholine out of concerns that she could not protect her airway and hypotension. A temporary pacing wire was placed via the right IJ. The patient was bradycardic and a CXR demonstrated a displaced right ventricular pacer wire. After consultation with the family, the patient was transferred to [**Hospital1 18**] for further evaluation and management. . At [**Hospital1 18**], we noted complete loss of capture of the pacemaker RV lead, and intermittent or absent capture of the temporary pacing wire. During periods of her complete paroxysmal heart block, she was completely pacer dependent. Given the tenuous situation, she was taken to the OR emergently. On Echo, there was concern for RV lead displacement but no evidence of tamponade or effusion. She was taken to the OR and had the RV lead repositioned to the RVOT. She was intubated and sedated and on dopamine. A repeat ECHO demonstrated no effusion or complication of lead placement. Access is PIV, femoral 7-french central line. . ROS: unable to obtain due to intubation/sedation. Past Medical History: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension, diabetes mellitus 2. CARDIAC HISTORY: CAD. s/p inferior microinfarction - PACING/ICD: complete heart block s/p pacemaker placement in [**1-/2161**] 3. OTHER PAST MEDICAL HISTORY: 1. Gastroesophageal reflux disease. 2. Colon cancer. 3. Insulin dependent-diabetes mellitus. 4. History of duodenal ulcer. 5. COPD. 6. Asthma. 7. History of cataracts. 8. Osteoarthritis. 9. History of ventral hernia. 10. History of abdominal wall abscess. 11. Depression. 12. History of colocutaneous fistula. 13. History of diverticulitis. 14. Hyperlipidemia 15. CAD. s/p inferior microinfarction 16. Pulmonary edema, diastolic dysfunction 17. complete heart block. . PAST SURGICAL HISTORY: 1. Right colectomy for colon cancer. 2. Ventral hernia repair with mesh. 3. Bilateral hip replacements. 4. Antrectomy and vagotomy with [**Doctor First Name 892**]-[**Doctor Last Name **] II reconstruction with splenectomy and partial pancreatectomy for duodenal ulcer. 5. Duodenostomy tube. 6. Feeding jejunostomy. 7. Exploration of abdominal abscess. Social History: - Tobacco history: ex-smoker - ETOH: no - Illicit drugs: no Family History: NC Physical Exam: VITAL SIGNS: 95.1 60 111/53 100% CMV assist control 400/14 PEEP 5 GENERAL: Intubated w/ RASS of -5. HEENT: Conjunctiva were pale. Pupils reactive to light. No xanthalesma. NECK: Supple with JVP flat 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. Pt intubated CTAB, no crackles, wheezes or rhonchi on anterior lung exam. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. NEURO: Intubated with RASS of -5, 2+ reflexes biceps, brachioradialis, patellar, ankle. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Discharge: VITAL SIGNS: 98.8 71 110/38 26 99%2L GENERAL: NAD, AxOx1, agitated. HEENT: Conjunctiva were pale. Pupils reactive to light. No xanthalesma. NECK: Supple with JVP flat CARDIAC: irregular RR, normal S1, S2. 1/6 systolic flow murmur . LUNGS: No chest wall deformities, scoliosis or kyphosis. Pt intubated CTAB, no crackles, wheezes or rhonchi on anterior lung exam. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. Pertinent Results: LABS ON ADMISSION: [**2161-3-2**] 04:30PM BLOOD WBC-15.7* RBC-3.39* Hgb-10.1* Hct-30.8* MCV-91 MCH-29.7 MCHC-32.6 RDW-14.1 Plt Ct-232 [**2161-3-2**] 04:30PM BLOOD Neuts-83.7* Lymphs-11.3* Monos-3.7 Eos-0.9 Baso-0.4 [**2161-3-2**] 04:30PM BLOOD Plt Ct-232 [**2161-3-2**] 04:30PM BLOOD Glucose-103* UreaN-49* Creat-1.7* Na-145 K-5.3* Cl-117* HCO3-22 AnGap-11 [**2161-3-2**] 04:30PM BLOOD CK(CPK)-89 [**2161-3-3**] 04:38AM BLOOD Calcium-8.1* Phos-5.3* Mg-1.8 [**2161-3-2**] 04:21PM BLOOD Type-ART Rates-16/ Tidal V-400 PEEP-5 FiO2-100 pO2-472* pCO2-35 pH-7.36 calTCO2-21 Base XS--4 AADO2-206 REQ O2-43 Intubat-INTUBATED Vent-CONTROLLED . LABS ON DISCHARGE: [**2161-3-4**] 04:22AM BLOOD WBC-12.3* RBC-2.88* Hgb-8.8* Hct-26.3* MCV-92 MCH-30.6 MCHC-33.5 RDW-14.5 Plt Ct-191 [**2161-3-4**] 04:22AM BLOOD Plt Ct-191 [**2161-3-4**] 04:22AM BLOOD Glucose-93 UreaN-41* Creat-1.6* Na-145 K-4.3 Cl-116* HCO3-22 AnGap-11 [**2161-3-4**] 04:22AM BLOOD Calcium-7.8* Phos-4.2 Mg-2.9* [**2161-3-3**] 01:25AM BLOOD Lactate-1.1 [**2161-3-3**] 01:25AM BLOOD O2 Sat-98 [**2161-3-3**] 01:25AM BLOOD freeCa-1.14 . [**2161-3-3**] pCXR IMPRESSION: 1. ETT approximately 1.7cm above the carina and should be repositioned. 2. New right ventricular lead projects medial to the ventricular apex, however it's exact position cannot be completely assessed without a lateral view. . [**2161-3-2**] pCXR FINDINGS: In comparison with the study of [**3-2**], the new right ventricular lead appears to be in good position, substantially less peripheral than on the previous study. Endotracheal tube tip lies approximately 2 cm above the carina. Small layering pleural effusion persists on the left and there is mild bilateral basilar atelectasis. . ECHO [**2161-3-2**] Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The right ventricular pacing lead is identified in the right ventricular cavity. It does not appear to extend beyond the free wall (but images are focused). There is a trivial pericardial effusion with no echocardiographic signs of tamponade. . Compared with the prior study of earlier in the day, the right ventricular pacing lead no longer appears to extend beyond the free wall (though views are focused). . ECHO [**2161-3-1**] Normal right ventricular cavity size and free wall motino. In some views (clips [**4-7**]), the right ventricular pacing lead appears to extend beyond the right ventricular free wall. There is no pericardial effusion. . MICROBIOLOGY: [**2161-3-2**] 4:30 pm URINE Site: NOT SPECIFIED HEM# 1646E [**3-2**]. URINE CULTURE (Preliminary): ESCHERICHIA COLI. >100,000 ORGANISMS/ML.. PRESUMPTIVE IDENTIFICATION. . 3/6/012 [**2161-3-3**] 2:43 am STOOL CONSISTENCY: SOFT Source: Stool. **FINAL REPORT [**2161-3-3**]** CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2161-3-3**]): Feces negative for C.difficile toxin A & B by EIA. (Reference Range-Negative). Brief Hospital Course: [**Age over 90 **]-year-old white female with a history of CAD, hyperlipidemia, hypertension, DM, and arthritis with recent PPM placement at [**Hospital1 **] on [**2-18**] for complete heart block (?paroxysmal av block) and syncope who presented to [**Hospital6 33**] with altered mental status and a displaced RV pacerlead with bradycardia now s/p pacer lead revision. . # COMPLETE HEART BLOCK/RV LEAD DISPLACEMENT: The patient had a DDD pacemaker placed at [**Hospital1 **] on approximately [**2161-2-22**] for symptomatic (syncope) bradycardia. She was transferred to [**Hospital1 18**] today after being found unresponsive; it was found that her RV pacer lead had perforated her RV apex. A temporary pacing wire was placed [**2161-3-2**] at [**Hospital3 **] without complication and she was transferred to [**Hospital1 18**]. An echo here demonstrated no pericardial effusion, but showed clear perforation of the RV lead. She underwent RV lead revision, with post-operative echo showing no complication. Repeat Echo demonstrates only minimal pericardial fluid, but no evidence of tamponade. Patient was monitored on telemetry and with serial EKG without additional complication. She received a one time dose of vancomycin, and then on discharge, will continue keflex, renally dosed, for a total of 7 day of Abx coverage for lead revision. She will have follow-up at device clinic on Tuesday, [**2161-3-10**]. . # CHF: diastolic dysfunction. Patient was continued on her home BB, ASA. . # [**Last Name (un) **]: Pt's Cr baseline appears to be near 1.2 as per discharge from [**Hospital1 **] on [**2161-2-22**]. Cr was 1.7 on admission. DDx included prerenal vs intrinsic. Cr remained stable during admission, and on discharge was 1.6. . # COPD - known history of COPD. She was continued on albuterol and ipratropium, and discharged on her home fluticasone and salmeterol. . # E. Coli UTI - UA suggestive of urinary tract infection. Culture grew > 100k E.coli with sensitivities pending. She received a dose of ceftriaxone, and then was changed to ciprofloxacin x 5 days on discharge. She remained afebrile, with resolving wbc. She denied urinary symptoms while here. If sensitivities are cephalosporin positive, ciprofloxacin could be discontinued, as she is on keflex x 5 days for lead revision. . # Diarrhea: resolved. Cdiff was checked and negative. . # Code: DNR/DNI, confirmed with HCP . # Transitions: - E.coli sensitivities from urine culture pending - spoke with PCP, [**Last Name (NamePattern4) **]. [**First Name (STitle) 15532**] at [**Hospital1 **] and updated on patient's admission. Medications on Admission: HOME MEDICATIONS: From D/C summary from [**Hospital1 **] on [**2161-2-22**]; unable to confirm as pt intubated and sedated Lactobacillus 1 tab [**Hospital1 **] Metoprolol Tartrate 25 mg [**Hospital1 **] Aspirin 325 mg DAILY Enoxaparin Sodium 30 mg DAILY Fluticasone [**Hospital1 **] Salmeterol INH Acetaminophen 650mg Q4H PRN Oxycodone 1 tab Q4H PRN Magnesium Hydroxide Nitroglycerin 0.4 mg Q5M PRN Discharge Medications: 1. lactobacillus acidophilus Tablet, Chewable Sig: One (1) Tablet, Chewable PO twice a day. 2. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) syringe Subcutaneous once a day. 5. fluticasone 110 mcg/actuation Aerosol Sig: One (1) puff Inhalation twice a day. 6. salmeterol 50 mcg/dose Disk with Device Sig: One (1) puff Inhalation once a day. 7. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 9. senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as needed for constipation. 10. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q8H (every 8 hours) for 5 days. 11. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Sublingual prn as needed for chest pain: Can take 3 in 15 minutes. 12. ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. Discharge Disposition: Extended Care Facility: [**Hospital 4470**] HealthCare Center at [**Location (un) 38**] Discharge Diagnosis: Primary: 1. Right ventricular lead revision Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Discharge Instructions: Dear Ms. [**Known lastname **], . It was a pleasure taking care of you at [**Hospital1 18**]. You were admitted for malfunction and displacement of your pacer lead. This was fixed with good results. You had an echocardiogram which showed no complication. . You were noted to have a urinary tract infection. You will take antibiotics for this, and also for the pacer lead revision. . MEDICATION CHANGES: - START keflex 500 mg every 8 hours for 5 more days . Please seek medical attention for any concerns. Please attend your follow-up appointments below. Followup Instructions: Department: CARDIAC SERVICES When: TUESDAY [**2161-3-10**] at 10:00 AM With: DEVICE CLINIC [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage [**Name6 (MD) **] [**Name8 (MD) 163**] MD [**MD Number(2) 11313**] Completed by:[**2161-3-4**]

530,V100,493,V436,428,041,787,V498,996,426,584,599,E878,414,272,401,715,250

{'Esophageal reflux,Personal history of malignant neoplasm of large intestine,Chronic obstructive asthma, unspecified,Hip joint replacement,Congestive heart failure, unspecified,Other and unspecified Escherichia coli [E. coli],Diarrhea,Do not resuscitate status,Mechanical complication due to cardiac pacemaker (electrode),Atrioventricular block, complete,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site 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: altered mental status, unresponsiveness PRESENT ILLNESS: [**Age over 90 **]-year-old white female with a recent PPM for CHB, history of CAD, hyperlipidemia, hypertension and arthritis who presented to [**Hospital6 33**] with altered mental status and failure of RV capture. . Per ED report, the patient had a syncopal episode at her nursing facility today. The patient just had a pacemaker placed on [**2161-2-17**] at [**Hospital3 **] after prolonged episodes of complete heart block with asystole and no escape rhythm. The patient's family subsequently reports that the patient had been complaining of some discomfort in the left lower chest/ left upper abdomen over the past 2 days. They report this is worse when the patient takes a deep breath. . EMS reports that the patient's pacemaker did not appear to be functioning adequately as they found the patient's heart rate to be between the 30's and 70's. EMS was not able to obtan IV access and an IO was placed. There are no reports of any recent chest pain, shortness of breath, abdominal pain, new back pain, or trauma. The patient was not able to answer review of systems questions or identify exacerbating or alleviating factors. The patient did have some eccymosis about the left side of her head. . In the [**Hospital3 **], the patient was successfully intubated with versed, fentanyl, and succinylcholine out of concerns that she could not protect her airway and hypotension. A temporary pacing wire was placed via the right IJ. The patient was bradycardic and a CXR demonstrated a displaced right ventricular pacer wire. After consultation with the family, the patient was transferred to [**Hospital1 18**] for further evaluation and management. . At [**Hospital1 18**], we noted complete loss of capture of the pacemaker RV lead, and intermittent or absent capture of the temporary pacing wire. During periods of her complete paroxysmal heart block, she was completely pacer dependent. Given the tenuous situation, she was taken to the OR emergently. On Echo, there was concern for RV lead displacement but no evidence of tamponade or effusion. She was taken to the OR and had the RV lead repositioned to the RVOT. She was intubated and sedated and on dopamine. A repeat ECHO demonstrated no effusion or complication of lead placement. Access is PIV, femoral 7-french central line. . ROS: unable to obtain due to intubation/sedation. MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension, diabetes mellitus 2. CARDIAC HISTORY: CAD. s/p inferior microinfarction - PACING/ICD: complete heart block s/p pacemaker placement in [**1-/2161**] 3. OTHER PAST MEDICAL HISTORY: 1. Gastroesophageal reflux disease. 2. Colon cancer. 3. Insulin dependent-diabetes mellitus. 4. History of duodenal ulcer. 5. COPD. 6. Asthma. 7. History of cataracts. 8. Osteoarthritis. 9. History of ventral hernia. 10. History of abdominal wall abscess. 11. Depression. 12. History of colocutaneous fistula. 13. History of diverticulitis. 14. Hyperlipidemia 15. CAD. s/p inferior microinfarction 16. Pulmonary edema, diastolic dysfunction 17. complete heart block. . PAST SURGICAL HISTORY: 1. Right colectomy for colon cancer. 2. Ventral hernia repair with mesh. 3. Bilateral hip replacements. 4. Antrectomy and vagotomy with [**Doctor First Name 892**]-[**Doctor Last Name **] II reconstruction with splenectomy and partial pancreatectomy for duodenal ulcer. 5. Duodenostomy tube. 6. Feeding jejunostomy. 7. Exploration of abdominal abscess. MEDICATION ON ADMISSION: HOME MEDICATIONS: From D/C summary from [**Hospital1 **] on [**2161-2-22**]; unable to confirm as pt intubated and sedated Lactobacillus 1 tab [**Hospital1 **] Metoprolol Tartrate 25 mg [**Hospital1 **] Aspirin 325 mg DAILY Enoxaparin Sodium 30 mg DAILY Fluticasone [**Hospital1 **] Salmeterol INH Acetaminophen 650mg Q4H PRN Oxycodone 1 tab Q4H PRN Magnesium Hydroxide Nitroglycerin 0.4 mg Q5M PRN ALLERGIES: Percocet / Dilaudid (PF) PHYSICAL EXAM: VITAL SIGNS: 95.1 60 111/53 100% CMV assist control 400/14 PEEP 5 GENERAL: Intubated w/ RASS of -5. HEENT: Conjunctiva were pale. Pupils reactive to light. No xanthalesma. NECK: Supple with JVP flat 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. Pt intubated CTAB, no crackles, wheezes or rhonchi on anterior lung exam. ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. EXTREMITIES: No c/c/e. No femoral bruits. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. NEURO: Intubated with RASS of -5, 2+ reflexes biceps, brachioradialis, patellar, ankle. PULSES: Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 1+ PT 1+ FAMILY HISTORY: NC SOCIAL HISTORY: - Tobacco history: ex-smoker - ETOH: no - Illicit drugs: no ### Response: {'Esophageal reflux,Personal history of malignant neoplasm of large intestine,Chronic obstructive asthma, unspecified,Hip joint replacement,Congestive heart failure, unspecified,Other and unspecified Escherichia coli [E. coli],Diarrhea,Do not resuscitate status,Mechanical complication due to cardiac pacemaker (electrode),Atrioventricular block, complete,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: Chest pain with NSTEMI PRESENT ILLNESS: 76 year old male s/p Right total hip arthroplasty [**2196-6-2**] that developed atrial fibrillation and ruled in for and NSTEMI with troponin peak to 11, with post operative anemia (hct 27 dropped from 34.9) on post operative day two. He did develop chest pain but unable to describe and is now transferred to [**Hospital1 18**] for cardiac workup including catheterization that revealed coronary artery disease and referred for surgical evaluation. MEDICAL HISTORY: Right hip fracture [**2-/2194**] Atrial Fibrillation - new after arthroplasty Prostate cancer - seed implants [**2190**] Benign prostatic hypertrophy Tobacco abuse Past Surgical History Right hip fixation [**2-/2194**] Right Total hip arthroplasty [**2196-6-2**] Bilateral shoulder surgery appendectomy Discectomy [**2160**] Laminectomy [**2180**] and [**2181**] MEDICATION ON ADMISSION: Vancomycin 1 gram IV q12h Atrovent 0.5 mg nebulizer inhaled q6h p.r.n. shortness of breath aspirin 325 mg by mouth daily Celebrex 200 mg by mouth daily for four weeks Dilaudid 2-4 mg by mouth every three hours as needed for pain Flomax 0.4 mg by mouth daily Lopressor 50 mg by mouth every eight hours Lovenox 40 mg subcutaneous injection daily until last dose 7/10/2011multivitamin one tab by mouth daily Nexium 40 mg by mouth daily Senokot 2 tabs by mouth at bedtime Tylenol 975 mg by mouth every six hours as needed for pain ALLERGIES: Percocet PHYSICAL EXAM: Pulse: 95 Resp: 16 O2 sat: 93% B/P Right: 112/76 Left: 118/72 Height: 183 cm Weight: 73.9 kg FAMILY HISTORY: Father died at age 82 of "old age" Mother died at age 54 of stomach cancer. No known family h/o of CAD, Stroke, CKD in parents, sister, or grandparents. SOCIAL HISTORY: Race: caucasian Last Dental Exam: edentulous Lives with: Spouse Contact: [**Name (NI) 8214**] Phone # [**Telephone/Fax (1) 88727**] Occupation: retired maintenance worker Cigarettes: Smoked no [] yes [x] last cigarette - currentHx: 30 pack year history ETOH: < 1 drink/week [] [**1-18**] drinks/week [x] >8 drinks/week [] Illicit drug use denies

Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Unspecified pleural effusion,Acute posthemorrhagic anemia,Pulmonary collapse,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Hip joint replacement,Tobacco use disorder,Phlebitis and thrombophlebitis of superficial veins of upper extremities

Surg compl-heart,Subendo infarct, initial,Pneumonia, organism NOS,Pleural effusion NOS,Ac posthemorrhag anemia,Pulmonary collapse,Abn react-artif implant,Atrial fibrillation,Crnry athrscl natve vssl,Joint replaced hip,Tobacco use disorder,Phlbts sprfc vn up extrm

Admission Date: [**2196-6-6**] Discharge Date: [**2196-6-22**] Date of Birth: [**2119-7-17**] Sex: M Service: CARDIOTHORACIC Allergies: Percocet Attending:[**First Name3 (LF) 1505**] Chief Complaint: Chest pain with NSTEMI Major Surgical or Invasive Procedure: [**2196-6-7**] Cardiac Cath [**2196-6-17**] Coronary [**Last Name (un) **] bypass graft x 5 (left internal mammary artery to left anterior descending, saphenous vein graft to diagonal, saphenous vein graft to obtuse marginal, saphenous vein graft to posterior descending with y-graft to posterior lateral) History of Present Illness: 76 year old male s/p Right total hip arthroplasty [**2196-6-2**] that developed atrial fibrillation and ruled in for and NSTEMI with troponin peak to 11, with post operative anemia (hct 27 dropped from 34.9) on post operative day two. He did develop chest pain but unable to describe and is now transferred to [**Hospital1 18**] for cardiac workup including catheterization that revealed coronary artery disease and referred for surgical evaluation. Past Medical History: Right hip fracture [**2-/2194**] Atrial Fibrillation - new after arthroplasty Prostate cancer - seed implants [**2190**] Benign prostatic hypertrophy Tobacco abuse Past Surgical History Right hip fixation [**2-/2194**] Right Total hip arthroplasty [**2196-6-2**] Bilateral shoulder surgery appendectomy Discectomy [**2160**] Laminectomy [**2180**] and [**2181**] Social History: Race: caucasian Last Dental Exam: edentulous Lives with: Spouse Contact: [**Name (NI) 8214**] Phone # [**Telephone/Fax (1) 88727**] Occupation: retired maintenance worker Cigarettes: Smoked no [] yes [x] last cigarette - currentHx: 30 pack year history ETOH: < 1 drink/week [] [**1-18**] drinks/week [x] >8 drinks/week [] Illicit drug use denies Family History: Father died at age 82 of "old age" Mother died at age 54 of stomach cancer. No known family h/o of CAD, Stroke, CKD in parents, sister, or grandparents. Physical Exam: Pulse: 95 Resp: 16 O2 sat: 93% B/P Right: 112/76 Left: 118/72 Height: 183 cm Weight: 73.9 kg General: No acute distress sitting up in bed Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Expiratory wheezes throughout no rhonchi Heart: RRR [] Irregular [x] Murmur none Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema none Varicosities: spider veins bilateral lower extremities Neuro: Alert and oriented x3 non focal Pulses: Femoral Right: +1 Left: cath site DP Right: +2 Left: +2 PT [**Name (NI) 167**]: +2 Left: +2 Radial Right: +2 Left: +2 Carotid Bruit Right: ? bruit Left: no bruit Right forearm with PIV noted for phlebitis - warm red non tender Pertinent Results: [**6-22**] CXR: Pending [**6-7**] Cath: 1. Coronary angiography in this right-dominant system demonstrated three-vessel and left main disease. The LMCA had an ostial 80% stenosis. The LAD was heavily calcified and had a 80% proximal stenosis. The LCx had moderate diffuse disease with an 80% stenosis in its first obtuse marginal branch. The RCA was totally occluded and filled via collaterals. 2. Resting hemodynamics revealed elevated right- and left-sided filling pressures, with an RVEDP of 13 mm Hg and a PCWP of 20 mm Hg. There was moderate pulmonary arterial systolic hypertension, with a PASP of 49 mm Hg. The cardiac index was preserved at 2.7 L/min/m2. The systemic arterial blood pressure was normal. There was no gradient upon pullback of the catheter from the left ventricle to the aorta. [**6-8**] Carotid U/S: There is less than 40% stenosis within the internal carotid arteries bilaterally. [**6-8**] Chest CT: 1. Complete left upper lobe atelectasis with central obstructing lesion that potentially may represent obstructing tumor versus plaque and should be correlated with bronchoscopy. 2. Multiple mediastinal lymph nodes, but none of them specifically enlarged. 3. Right upper lobe and to a lesser extent right middle lobe opacity that most likely represent area of infection or aspiration and less likely asymmetric edema. 4. Bilateral moderate pleural effusion. 5. Extensive involvement of thoracic spine by multiple wedge compression fractures. Old fracture of the right humerus. Multiple rib fractures. [**6-17**] Echo: PREBYPASS: The interatrial septum is aneurysmal. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with mild inferior hypokinesis. Overall left ventricular systolic function is mildly depressed (LVEF= 45-50 %). The right ventricular cavity is mildly dilated with borderline normal free wall function. The ascending aorta is mildly dilated. 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. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. POSTBYPASS: LV systolic function remains unchanged. MR remains mild. Study otherwise unchanged from prebypass. [**6-20**] CXR: Moderate-to-large left pleural effusion has increased since [**2196-6-18**]. Generalized mediastinal widening, which developed between 7:30 a.m. and 10:45 a.m. on [**2196-6-18**] has changed in distribution but not in overall severity, concerning for mediastinal blood or other focal fluid accumulation. No pneumothorax. Mild pulmonary edema and small right pleural effusion have increased. Findings were discussed with the clinical care team member responsible for this patient, at the time of dictation. [**2196-6-6**] 09:40PM BLOOD WBC-5.9 RBC-3.59* Hgb-10.8* Hct-31.5* MCV-88 MCH-30.2 MCHC-34.4 RDW-14.1 Plt Ct-199 [**2196-6-16**] 08:05AM BLOOD WBC-6.1 RBC-3.54* Hgb-10.2* Hct-30.6* MCV-86 MCH-28.9 MCHC-33.5 RDW-13.5 Plt Ct-437 [**2196-6-17**] 12:14PM BLOOD WBC-8.1 RBC-2.69* Hgb-8.1* Hct-23.8* MCV-89 MCH-30.2 MCHC-34.2 RDW-13.7 Plt Ct-306 [**2196-6-22**] 04:55AM BLOOD WBC-7.0 RBC-3.14* Hgb-9.4* Hct-27.1* MCV-86 MCH-30.0 MCHC-34.9 RDW-13.7 Plt Ct-353 [**2196-6-6**] 09:40PM BLOOD PT-13.2 PTT-42.0* INR(PT)-1.1 [**2196-6-19**] 01:59AM BLOOD PT-16.6* PTT-35.0 INR(PT)-1.5* [**2196-6-20**] 08:30AM BLOOD PT-62.4* PTT-38.5* INR(PT)-6.9* [**2196-6-21**] 04:45AM BLOOD PT-33.8* PTT-39.9* INR(PT)-3.4* [**2196-6-22**] 04:55AM BLOOD PT-17.8* PTT-32.0 INR(PT)-1.6* [**2196-6-6**] 09:40PM BLOOD Glucose-166* UreaN-17 Creat-0.7 Na-136 K-3.9 Cl-103 HCO3-24 AnGap-13 [**2196-6-21**] 04:45AM BLOOD Glucose-105* UreaN-18 Creat-0.6 Na-137 K-4.5 Cl-101 HCO3-27 AnGap-14 [**2196-6-22**] 04:55AM BLOOD Glucose-130* UreaN-18 Creat-0.7 Na-139 K-4.6 Cl-102 HCO3-29 AnGap-13 [**2196-6-6**] 09:40PM BLOOD Calcium-8.0* Phos-2.5* Mg-1.9 Iron-14* [**2196-6-22**] 04:55AM BLOOD Calcium-8.8 Phos-3.7 Mg-2.2 [**2196-6-20**] 08:30AM BLOOD ALT-14 AST-20 LD(LDH)-272* AlkPhos-68 Amylase-17 TotBili-0.8 [**2196-6-9**] 07:30AM BLOOD %HbA1c-5.6 eAG-114 [**2196-6-9**] 07:30AM BLOOD Triglyc-66 HDL-28 CHOL/HD-4.0 LDLcalc-72 Brief Hospital Course: Mr. [**Known lastname 22627**] is a 76 year old gentleman status post total hip arthroplasty ([**2196-6-2**]) at [**Hospital6 **] who presents with Atrial fibrillation (HR 90-100)and post-op NSTEMI. He was found to have 3 vessel coronary disease demonstrated by catheterization ([**2196-6-7**]) and is on day [**4-14**] of empiric treatment for hospital acquired pneumonitis. Cardiac surgery was consulted and he was worked-up in the usual manner for coronary artery bypass grafting. He was noted to have left forearm phlebitis. An ultrasound revealed no evidence of deep vein thrombosis. Pulmonary function testing was obtained which showed an FEV1 of 1.57L. A carotid duplex ultrasound was also obtained which showed less than 40% stenosis within the internal carotid arteries bilaterally. Chest CT revealed new infiltrates and he developed a fever. Cefepime and vancomycin were started and surgery was delayed. In addition there was complete left upper lobe atelectasis with central obstructing lesion that potentially may represent obstructing tumor. Pulmonary was consulted and bronchoscopy was performed in the operating room at the end surgery. No official report but initial statement was mass seen in LUL/bronchus. On [**2196-6-17**], Mr. [**Known lastname 22627**] was taken to the operating room where he underwent coronary artery bypass grafting to five vessels. Please see operative note for details. Following surgery he was transferred to the CVICU for invasive monitoring in stable condition. He remained intubated overnight and on post-op day one was weaned from sedation, awoke neurologically intact and extubated. Chest x-ray prior to extubation showed LUL open. Chest tubes and epicardial pacing wires were removed per protocol. Beta-blockers and diuretics were initiated and he was gently diuresed towards his pre-op weight. On post-op day two he was transferred to the step-down unit for further recovery. He required blood transfusion for anemia, HCT 21 and had increase to 26. He also developed a brief episode of atrial fibrillation and was given amiodarone and beta-blockers. Given his pre-op history, he was also started on Coumadin. His INR quickly jumped to 6.3, Coumadin was stopped and FFP was given. Coumadin will continue on discharge given atrial fibrillation and recent right hip surgery (goal INR 2). He continued to make good progress while working with physical therapy for strength and mobility (decreased given recent hip surgery). On post-op day five he appeared to be doing well and was discharged to rehab with the appropriate medications and follow-up appointments. IV Lasix will continue given 10+ kg above pre-op weight and moderate-large left pleural effusion. He has multiple appointments in the beginning of [**Month (only) 216**] for further work-up of lung lesion. Dr. [**Last Name (STitle) **] has asked to wait for cardiology clearance prior to undergoing any procedure by pulm/thoracic. Dr. [**Last Name (STitle) **] will see him on [**7-20**] and will most likely clear him if he is doing well. Medications on Admission: Vancomycin 1 gram IV q12h Atrovent 0.5 mg nebulizer inhaled q6h p.r.n. shortness of breath aspirin 325 mg by mouth daily Celebrex 200 mg by mouth daily for four weeks Dilaudid 2-4 mg by mouth every three hours as needed for pain Flomax 0.4 mg by mouth daily Lopressor 50 mg by mouth every eight hours Lovenox 40 mg subcutaneous injection daily until last dose 7/10/2011multivitamin one tab by mouth daily Nexium 40 mg by mouth daily Senokot 2 tabs by mouth at bedtime Tylenol 975 mg by mouth every six hours as needed for pain Discharge Medications: 1. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). 2. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime). 6. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). 7. montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day). 9. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours). 10. ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). 11. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q2H (every 2 hours) as needed for wheezing and sob . 12. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 13. hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q3H (every 3 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 14. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. metoprolol tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 17. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily): Please take 400mg daily for 7 days then decrease to 200mg daily until stopped by cardiologist. 18. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day) as needed for groin . 19. Coumadin 1 mg Tablet Sig: One (1) Tablet PO once a day: Please titrate for goal INR of 2 for AF and recent right hip surgery. INR [**6-22**] 1.6. 20. furosemide 10 mg/mL Solution Sig: Forty (40) mg Injection Q12H (every 12 hours): Please switch to PO once at pre-op weight of 73.9kg. 21. potassium chloride 10 mEq Tablet Extended Release Sig: Two (2) Tablet Extended Release PO Q12H (every 12 hours). Discharge Disposition: Extended Care Facility: [**Hospital1 15331**] TCU Discharge Diagnosis: Coronary artery disease s/p Coronary artery bypass graft x 5 Myocardial infarction Atrial Fibrillation - new after arthroplasty Left upper lobe pulmonary nodule Past medical history: Right hip fracture [**2-/2194**] Prostate cancer - seed implants [**2190**] Benign prostatic hypertrophy Tobacco abuse Past Surgical History s/p Right hip fixation [**2-/2194**] s/p Right Total hip arthroplasty [**2196-6-2**] s/p Bilateral shoulder surgery s/p Appendectomy s/p Discectomy [**2160**] s/p Laminectomy [**2180**] and [**2181**] Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Dilaudid/Tylenol Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema trace 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. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] on [**7-14**] at 1:00pm Cardiologist: Dr. [**First Name4 (NamePattern1) 3979**] [**Last Name (NamePattern1) **] [**7-20**] at 12:30pm Pulmonary: Dr. [**Last Name (STitle) **] [**0-0-**] on [**2196-7-12**] at 1:30pm in [**Hospital Ward Name 23**] 9A Thoracic: Dr. [**Last Name (STitle) **] on [**2196-7-12**] at 2:30pm in [**Hospital Ward Name 23**] 9A CT of Head with Contrast on [**2196-7-6**] at 10:15AM in [**Hospital Ward Name 23**] 4 Please call to schedule appointments with your Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 19219**] in [**3-15**] weeks To be scheduled by Chest disease center: Body PET/CT **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 Coumadin ?????? indication: AF/recent R hip arthroplasty Goal INR 2 First draw, 1 day after discharge, [**6-23**] Completed by:[**2196-6-22**]

997,410,486,511,285,518,E878,427,414,V436,305,451

{'Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Unspecified pleural effusion,Acute posthemorrhagic anemia,Pulmonary collapse,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Hip joint replacement,Tobacco use disorder,Phlebitis and thrombophlebitis of superficial veins of upper extremities'}

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 with NSTEMI PRESENT ILLNESS: 76 year old male s/p Right total hip arthroplasty [**2196-6-2**] that developed atrial fibrillation and ruled in for and NSTEMI with troponin peak to 11, with post operative anemia (hct 27 dropped from 34.9) on post operative day two. He did develop chest pain but unable to describe and is now transferred to [**Hospital1 18**] for cardiac workup including catheterization that revealed coronary artery disease and referred for surgical evaluation. MEDICAL HISTORY: Right hip fracture [**2-/2194**] Atrial Fibrillation - new after arthroplasty Prostate cancer - seed implants [**2190**] Benign prostatic hypertrophy Tobacco abuse Past Surgical History Right hip fixation [**2-/2194**] Right Total hip arthroplasty [**2196-6-2**] Bilateral shoulder surgery appendectomy Discectomy [**2160**] Laminectomy [**2180**] and [**2181**] MEDICATION ON ADMISSION: Vancomycin 1 gram IV q12h Atrovent 0.5 mg nebulizer inhaled q6h p.r.n. shortness of breath aspirin 325 mg by mouth daily Celebrex 200 mg by mouth daily for four weeks Dilaudid 2-4 mg by mouth every three hours as needed for pain Flomax 0.4 mg by mouth daily Lopressor 50 mg by mouth every eight hours Lovenox 40 mg subcutaneous injection daily until last dose 7/10/2011multivitamin one tab by mouth daily Nexium 40 mg by mouth daily Senokot 2 tabs by mouth at bedtime Tylenol 975 mg by mouth every six hours as needed for pain ALLERGIES: Percocet PHYSICAL EXAM: Pulse: 95 Resp: 16 O2 sat: 93% B/P Right: 112/76 Left: 118/72 Height: 183 cm Weight: 73.9 kg FAMILY HISTORY: Father died at age 82 of "old age" Mother died at age 54 of stomach cancer. No known family h/o of CAD, Stroke, CKD in parents, sister, or grandparents. SOCIAL HISTORY: Race: caucasian Last Dental Exam: edentulous Lives with: Spouse Contact: [**Name (NI) 8214**] Phone # [**Telephone/Fax (1) 88727**] Occupation: retired maintenance worker Cigarettes: Smoked no [] yes [x] last cigarette - currentHx: 30 pack year history ETOH: < 1 drink/week [] [**1-18**] drinks/week [x] >8 drinks/week [] Illicit drug use denies ### Response: {'Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Pneumonia, organism unspecified,Unspecified pleural effusion,Acute posthemorrhagic anemia,Pulmonary collapse,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Hip joint replacement,Tobacco use disorder,Phlebitis and thrombophlebitis of superficial veins of upper extremities'}

CHIEF COMPLAINT: 57 M s/p fall on [**2119-12-23**] backwards, hit a table and presented at 04:30a.m. c/o subscapular pain, difficulty breathing, severe right chest pain. PRESENT ILLNESS: 57 M s/p fall on [**2119-12-23**] backwards, hit a table and presented at 04:30a.m. c/o subscapular pain, difficulty breathing, severe right chest pain. Right sided hemothorax seen on CXR, after unsuccessful attempts at chest tube placement at OSH, BP dropped to 80's. Resuscitated with 2 units PRBC, crystolloid (500cc) and transfered to [**Hospital1 18**] by [**Location (un) **]. MEDICAL HISTORY: s/p MI ETOH abuse s/p right thoracotomy, and partial pneumonectomy s/p trauma s/p posterior cervical spine surgery s/p splenectomy s/p appy MEDICATION ON ADMISSION: Lipitor Toprol Baclofen ASA ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Per hospital chart "101.4 133 113/74 intubated & sedated TM's clear Regular decrease breath sounds over R lower chest abdomen soft extremities warm and well perfused guiac negative pelvis stable palpable DP pulses bilaterally" FAMILY HISTORY: non-contributory SOCIAL HISTORY: 3 drinks/day

Traumatic hemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Unspecified fall,Contusion of chest wall,Other diseases of lung, not elsewhere classified

Traum hemothorax-closed,Fx mult ribs NOS-closed,Fall NOS,Contusion of chest wall,Other lung disease NEC

Admission Date: [**2119-12-24**] Discharge Date: [**2120-1-4**] Date of Birth: [**2062-7-30**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 3223**] Chief Complaint: 57 M s/p fall on [**2119-12-23**] backwards, hit a table and presented at 04:30a.m. c/o subscapular pain, difficulty breathing, severe right chest pain. Major Surgical or Invasive Procedure: Exploratory thoracoscopy, evacuation of clotted blood, right thoracotomy and ligation of bleeding chest wall vessel, partial pleurectomy, flexible bronchoscopy. History of Present Illness: 57 M s/p fall on [**2119-12-23**] backwards, hit a table and presented at 04:30a.m. c/o subscapular pain, difficulty breathing, severe right chest pain. Right sided hemothorax seen on CXR, after unsuccessful attempts at chest tube placement at OSH, BP dropped to 80's. Resuscitated with 2 units PRBC, crystolloid (500cc) and transfered to [**Hospital1 18**] by [**Location (un) **]. Past Medical History: s/p MI ETOH abuse s/p right thoracotomy, and partial pneumonectomy s/p trauma s/p posterior cervical spine surgery s/p splenectomy s/p appy Social History: 3 drinks/day Family History: non-contributory Physical Exam: Per hospital chart "101.4 133 113/74 intubated & sedated TM's clear Regular decrease breath sounds over R lower chest abdomen soft extremities warm and well perfused guiac negative pelvis stable palpable DP pulses bilaterally" Pertinent Results: [**2119-12-24**] 08:52AM BLOOD WBC-16.0* RBC-3.65* Hgb-11.4* Hct-32.0* MCV-88 MCH-31.3 MCHC-35.7* RDW-13.8 Plt Ct-262 [**2119-12-24**] 11:18AM BLOOD WBC-18.9* RBC-4.67# Hgb-14.1 Hct-40.7# MCV-87 MCH-30.2 MCHC-34.6 RDW-13.7 Plt Ct-236 [**2119-12-24**] 03:50PM BLOOD WBC-13.2* RBC-3.96* Hgb-11.9* Hct-33.4* MCV-84 MCH-30.1 MCHC-35.7* RDW-13.7 Plt Ct-172 [**2119-12-24**] 05:50PM BLOOD WBC-13.7* RBC-3.89* Hgb-11.7* Hct-32.8* MCV-84 MCH-30.1 MCHC-35.7* RDW-13.8 Plt Ct-193 [**2119-12-25**] 02:23AM BLOOD WBC-9.2 RBC-3.55* Hgb-11.0* Hct-29.7* MCV-84 MCH-31.1 MCHC-37.2* RDW-14.0 Plt Ct-149* [**2119-12-25**] 07:23PM BLOOD WBC-12.8* RBC-3.28* Hgb-10.0* Hct-27.2* MCV-83 MCH-30.4 MCHC-36.7* RDW-13.6 Plt Ct-128* [**2119-12-26**] 02:24AM BLOOD WBC-11.2* RBC-3.28* Hgb-10.3* Hct-27.7* MCV-84 MCH-31.4 MCHC-37.2* RDW-14.1 Plt Ct-131* [**2119-12-27**] 02:16AM BLOOD WBC-9.9 RBC-3.05* Hgb-9.6* Hct-26.1* MCV-85 MCH-31.4 MCHC-36.8* RDW-14.2 Plt Ct-144* [**2119-12-28**] 02:24AM BLOOD WBC-9.1 RBC-3.07* Hgb-9.4* Hct-26.1* MCV-85 MCH-30.5 MCHC-35.9* RDW-14.3 Plt Ct-159 [**2119-12-29**] 02:07AM BLOOD WBC-6.9 RBC-2.69* Hgb-8.4* Hct-23.5* MCV-88 MCH-31.4 MCHC-35.8* RDW-14.4 Plt Ct-223 [**2119-12-30**] 03:17AM BLOOD WBC-7.4 RBC-2.78* Hgb-8.7* Hct-25.0* MCV-90 MCH-31.5 MCHC-34.9 RDW-14.4 Plt Ct-297 [**2120-1-3**] 06:18AM BLOOD WBC-8.9 RBC-3.41* Hgb-10.1* Hct-28.8* MCV-84 MCH-29.6 MCHC-35.0 RDW-13.6 Plt Ct-622* Brief Hospital Course: 57 M transferred to [**Hospital1 18**] from Southern [**Hospital **] medical center. He sustained a fall injuring his right chest on [**2119-12-23**]. He presented to OSH where he was found to have a CXR consistent w/ right hemothorax. He was intubated and transferred to [**Hospital1 18**]. On arrival to [**Hospital1 18**] a right chest tube was placed and approximately 800 CC of serosanguinous fluid was drained. A CT chest revealed a large right extra-pleural posterior hemothorax extending into the upper abdomen. He received 2 units PRBC at the OSH and 2 FFP in the [**Hospital1 18**] ED. Then transfered to the TSICU. -[**2119-12-25**] Taken to OR for Exploratory thoracoscopy, evacuation of clotted blood, right thoracotomy and ligation of bleeding intercostal vessel, partial pleurectomy, flexible bronchoscopy. He received 3 units PRBC intra-operatively and [**2114**] crystalloid. See operative report for full details. Postoperatively he remained intubated and sedated on vasoactive pressors for BP control. -[**2119-12-26**] A left chest tube was placed for increase in size of left effusion. He was transfused an additional 2 units of PRBC. Failed extubation attempt. -[**2119-12-28**] Right chest tube discontinued. Tube feeds advanced to goal. 7 day course of zosyn added for sputum culture: GRAM STAIN (Final [**2119-12-26**]): >25 PMNs and <10 epithelial cells/100X field. 2+ (1-5 per 1000X FIELD): GRAM NEGATIVE ROD(S). 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS AND CLUSTERS. 1+ (<1 per 1000X FIELD): GRAM POSITIVE ROD(S). [**2119-12-29**] antibiotics continued on levofloxaxin. Left chest tube d/c'd. Received 2 units of PRBC, off pressors. Continued on ventilator CPAP and PS. [**2120-1-1**] continued to improve, extubated. [**2120-1-2**] Tolerating regular diet, continued on home pain meds. Transfered to floor. [**2120-1-3**] Worked with PT/OT, was OOBTC, continued to improve, bowel regimen, and heparin SC for DVT prophylaxis. Medications on Admission: Lipitor Toprol Baclofen ASA Discharge Medications: 1. Oxycodone 40 mg Tablet Sustained Release 12HR Sig: One (1) Tablet Sustained Release 12HR PO Q12H (every 12 hours). 2. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily). 3. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q2H (every 2 hours) as needed. 4. Heparin (Porcine) 5,000 unit/mL Solution Sig: [**1-15**] Injection TID (3 times a day). 5. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Baclofen 10 mg Tablet Sig: Six (6) Tablet PO HS (at bedtime). 7. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed. 8. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). 9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed. 10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed. 11. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed. Discharge Disposition: Extended Care Facility: St [**Hospital **] Healthcare Center - [**Hospital1 189**] Discharge Diagnosis: s/p [**2119**]0,11,12 rib fractures Large extrapleural hematoma compressing right lung s/p thoracotomy, evacuation Discharge Condition: stable tolerating regular diet ambulating pain well controlled Discharge Instructions: [**Name8 (MD) **] M.D. for increase in pain, increase in severity of symptoms, shortness of breath, chest pain, fever, dizziness, drainage or redness at surgical site, questions or concerns. Follow-up with thoracic surgery. Please call clinic to schedule [**Telephone/Fax (1) 64925**]. Followup Instructions: Follow-up with thoracic surgery clinic in 2 weeks, please call clinic to schedule [**Telephone/Fax (1) 64925**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**] Completed by:[**2120-1-4**]

860,807,E888,922,518

{'Traumatic hemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Unspecified fall,Contusion of chest wall,Other diseases of lung, 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: 57 M s/p fall on [**2119-12-23**] backwards, hit a table and presented at 04:30a.m. c/o subscapular pain, difficulty breathing, severe right chest pain. PRESENT ILLNESS: 57 M s/p fall on [**2119-12-23**] backwards, hit a table and presented at 04:30a.m. c/o subscapular pain, difficulty breathing, severe right chest pain. Right sided hemothorax seen on CXR, after unsuccessful attempts at chest tube placement at OSH, BP dropped to 80's. Resuscitated with 2 units PRBC, crystolloid (500cc) and transfered to [**Hospital1 18**] by [**Location (un) **]. MEDICAL HISTORY: s/p MI ETOH abuse s/p right thoracotomy, and partial pneumonectomy s/p trauma s/p posterior cervical spine surgery s/p splenectomy s/p appy MEDICATION ON ADMISSION: Lipitor Toprol Baclofen ASA ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Per hospital chart "101.4 133 113/74 intubated & sedated TM's clear Regular decrease breath sounds over R lower chest abdomen soft extremities warm and well perfused guiac negative pelvis stable palpable DP pulses bilaterally" FAMILY HISTORY: non-contributory SOCIAL HISTORY: 3 drinks/day ### Response: {'Traumatic hemothorax without mention of open wound into thorax,Closed fracture of multiple ribs, unspecified,Unspecified fall,Contusion of chest wall,Other diseases of lung, not elsewhere classified'}

CHIEF COMPLAINT: SOB PRESENT ILLNESS: [**Known firstname **] [**Known lastname 86028**] is an 84-year-old woman recently diagnosed with stage 4 renal papillary carcinoma (not yet started treatment) and at that time found to have bilateral PEs. On [**9-7**] she had a staging CTs which showed significant disease (stage 4 with mets to liver, bone metastases in the L1 and T12 vertebrae) as well as bilateral basal PEs. She was admitted to [**Hospital1 18**] for anticoagulation with lovenox. Further work up demonstrated extensive bilateral lower extermity DVTs. She is scheduled to begin SUNITINIB trial for her advanced . On [**9-14**] the patient reported urinary vs vaginal bleeding on anticoagulation. At this point anticoagulation was stopped and her bleeding resolved. There is no note as the the amount of bleeding that prompted the stopping of the anticoagulation. On [**9-20**] she underwent IVC filter placement with interventional radiology as an outpatient. The procedure was felt to be a success but the patient was experiencing increasing exertional SOB since the procedure ans so she presented to the ED today. . In the ED, initial vitals were 97.3 94 111/68 20 97% 2L Labs and imaging significant for a CXR - IVC filter has migrated to the right ventricle. Patient was placed on a heparin ggt and sent to the cardiac cath lab for percutanous removal of the IVC filter. Vitals on transfer were 98.0, 113/54,90, 27, 98%2LNC . In the cath lab they were able to retrieve the filter without issue. . On arrival to the floor, she is comfortable without concerns. MEDICAL HISTORY: . Past Oncologic History: [**Known firstname **] [**Known lastname 86028**] is an 84-year-old healthy woman who presented approximately 2 years ago for a 2-cm right complex renal cysts. She was referred to [**Hospital1 18**] in [**7-25**] and underwent CT imaging which reportedly revealed 2.2 cm right kidney cyst with no central enhancement, multiple pulmonary nodules and a L5 lucent lesion. Repeat CT scan in [**7-27**] was then performed and showed infiltrating mass involving most of right kidney with extensive retroperitoneal lymphadenopathy. Radiology report stated that findings were C/W possible lymphoma, small lesions in liver. . [**2151-7-23**] Abd/Pelvis CT: Previously in the right kidney, there was a focal exophytic slightly complex lesion, but there is now a diffuse infiltrative mass of much of the right kidney. The previously identified lesion, exophytic at the interpolar region, measures 18 x 25 mm, previously perhaps 20 x 18 mm. The diffuse infiltrative component, which extends through the cortex of the renal hilum and involves the hilar fat as well as circumferential the vessels of the renal hilum, is new. Also new is extensive retroperitoneal and retrocrural lymphadenopathy. A left adrenal lesion is stable. The liver contains new lesions. The findings are unusual for renal cell carcinoma, the presumptive pretest pathology. The appearances would be much more suggestive of lymphoma, possibly a transitional cell carcinoma, with atypical infection considered extremely unlikely. [**2151-8-12**] Bx of right kidney mass showed papillary carcinoma diffusing infiltrating into the renal cortex and medulla. Tumor is CK903, CK7, P504S positive. Negative for CK20, CDX2 and p63. Focally positive for CAIX. . Past Medical History: Osteoporosis Arthritis - s/p TKR bilaterally Pacemaker Right sided breast cancer [**2131**] - Underwent lumpectomy, treated with XRT and TAM x 5 years on ajuvant trial - Surveillance mammography is normal . MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientwebOMR. 1. Amlodipine 5 mg PO BID 2. CloniDINE 0.1 mg PO BID 3. Lisinopril 20 mg PO BID 4. Acetaminophen 500 mg PO Q6H:PRN Pain 5. Lorazepam 0.5 mg PO QHS ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: GENERAL: WDWN female 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: Mother: died of CHF at age [**Age over 90 **] Father: died of MI at age 59 Has other family members with heart disease. Has no children. SOCIAL HISTORY: Gen: Works part time at a law office. Has worked at attorney's office x 50 years. She was forced to retire in [**2134**] and that lasted 3 weeks. Tobacco: Smokes 6 cigarettes a day since age 18 (x 66 years). EtOH: 1 glass of wine daily and occasionally more on the weekends Illicits: none Occupation: Works as admin assistant. Living situation: Lives with cousin Exercise: [**Name2 (NI) 6934**] daily

Mechanical complication of other vascular device, implant, and graft,Malignant neoplasm of kidney, except pelvis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Osteoporosis, unspecified,Tobacco use disorder,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Knee joint replacement,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health

Malfunc vasc device/graf,Malig neopl kidney,Second malig neo liver,Secondary malig neo bone,Osteoporosis NOS,Tobacco use disorder,Abn react-procedure NEC,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Joint replaced knee,Hx of breast malignancy,Hx of irradiation

Admission Date: [**2151-9-23**] Discharge Date: [**2151-9-26**] Date of Birth: [**2067-4-11**] Sex: F Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 106**] Chief Complaint: SOB Major Surgical or Invasive Procedure: IVC filter removal History of Present Illness: [**Known firstname **] [**Known lastname 86028**] is an 84-year-old woman recently diagnosed with stage 4 renal papillary carcinoma (not yet started treatment) and at that time found to have bilateral PEs. On [**9-7**] she had a staging CTs which showed significant disease (stage 4 with mets to liver, bone metastases in the L1 and T12 vertebrae) as well as bilateral basal PEs. She was admitted to [**Hospital1 18**] for anticoagulation with lovenox. Further work up demonstrated extensive bilateral lower extermity DVTs. She is scheduled to begin SUNITINIB trial for her advanced . On [**9-14**] the patient reported urinary vs vaginal bleeding on anticoagulation. At this point anticoagulation was stopped and her bleeding resolved. There is no note as the the amount of bleeding that prompted the stopping of the anticoagulation. On [**9-20**] she underwent IVC filter placement with interventional radiology as an outpatient. The procedure was felt to be a success but the patient was experiencing increasing exertional SOB since the procedure ans so she presented to the ED today. . In the ED, initial vitals were 97.3 94 111/68 20 97% 2L Labs and imaging significant for a CXR - IVC filter has migrated to the right ventricle. Patient was placed on a heparin ggt and sent to the cardiac cath lab for percutanous removal of the IVC filter. Vitals on transfer were 98.0, 113/54,90, 27, 98%2LNC . In the cath lab they were able to retrieve the filter without issue. . On arrival to the floor, she is comfortable without concerns. Past Medical History: . Past Oncologic History: [**Known firstname **] [**Known lastname 86028**] is an 84-year-old healthy woman who presented approximately 2 years ago for a 2-cm right complex renal cysts. She was referred to [**Hospital1 18**] in [**7-25**] and underwent CT imaging which reportedly revealed 2.2 cm right kidney cyst with no central enhancement, multiple pulmonary nodules and a L5 lucent lesion. Repeat CT scan in [**7-27**] was then performed and showed infiltrating mass involving most of right kidney with extensive retroperitoneal lymphadenopathy. Radiology report stated that findings were C/W possible lymphoma, small lesions in liver. . [**2151-7-23**] Abd/Pelvis CT: Previously in the right kidney, there was a focal exophytic slightly complex lesion, but there is now a diffuse infiltrative mass of much of the right kidney. The previously identified lesion, exophytic at the interpolar region, measures 18 x 25 mm, previously perhaps 20 x 18 mm. The diffuse infiltrative component, which extends through the cortex of the renal hilum and involves the hilar fat as well as circumferential the vessels of the renal hilum, is new. Also new is extensive retroperitoneal and retrocrural lymphadenopathy. A left adrenal lesion is stable. The liver contains new lesions. The findings are unusual for renal cell carcinoma, the presumptive pretest pathology. The appearances would be much more suggestive of lymphoma, possibly a transitional cell carcinoma, with atypical infection considered extremely unlikely. [**2151-8-12**] Bx of right kidney mass showed papillary carcinoma diffusing infiltrating into the renal cortex and medulla. Tumor is CK903, CK7, P504S positive. Negative for CK20, CDX2 and p63. Focally positive for CAIX. . Past Medical History: Osteoporosis Arthritis - s/p TKR bilaterally Pacemaker Right sided breast cancer [**2131**] - Underwent lumpectomy, treated with XRT and TAM x 5 years on ajuvant trial - Surveillance mammography is normal . Social History: Gen: Works part time at a law office. Has worked at attorney's office x 50 years. She was forced to retire in [**2134**] and that lasted 3 weeks. Tobacco: Smokes 6 cigarettes a day since age 18 (x 66 years). EtOH: 1 glass of wine daily and occasionally more on the weekends Illicits: none Occupation: Works as admin assistant. Living situation: Lives with cousin Exercise: [**Name2 (NI) 6934**] daily Family History: Mother: died of CHF at age [**Age over 90 **] Father: died of MI at age 59 Has other family members with heart disease. Has no children. Physical Exam: GENERAL: WDWN female 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 7 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, 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. SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. PULSES: Right: Carotid 2+ DP 2+ PT 2+ Left: Carotid 2+ DP 2+ PT 2+ Pertinent Results: [**2151-9-23**] 12:05PM BLOOD WBC-15.4* RBC-3.60* Hgb-10.2* Hct-32.1* MCV-89 MCH-28.3 MCHC-31.8 RDW-15.0 Plt Ct-171 [**2151-9-23**] 12:05PM BLOOD Glucose-134* UreaN-53* Creat-2.4* Na-139 K-5.3* Cl-102 HCO3-19* AnGap-23* [**2151-9-23**] 12:05PM BLOOD proBNP-[**Numeric Identifier **]* [**2151-9-23**] 12:11PM BLOOD Lactate-2.0 Echo: There is a number of metal densities in the right ventricle, some likely representing the migrated IVC filter, however no further comments can be made regarding its precise position or interaction with the RV pacemaker lead. The transtricuspid inflow gradient is slightly abnormal, although the patient is tachycardic at this time. There is no unusual metallic objects seen in the visualized portions of the IVC, RA (besides the pacer leads), or the proximal pulmonary artery. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). Left ventricular wall thicknesses are normal. Right ventricular chamber size and free wall motion are normal. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. Mild (1+) mitral regurgitation is seen. Moderate [2+] tricuspid regurgitation is seen. There is no pericardial effusion CXR: IMPRESSION: 1. Displaced IVC filter likely in the right ventricle. 2. Small bilateral pleural effusions. Brief Hospital Course: 84F w/ renal papillary CA and known bilateral PEs not on anticoagulation [**3-18**] to hematuria s/p IVC filter placement on [**9-20**] presented with SOB and was found to have migration of IVC filter to RV. # Pulmonary embolism/IVC filter migration - Patient has known bilateral PEs and had anticoagulation stopped due to hematuria with IVC filter placed on [**9-20**]. CXR on admission identified migration of IVC filter to right ventricle. The IVC filter was able to be removed percutanously. She had resolution of her symptoms following the procedure. She had a cardiac echo that did not show any valvular damage and her pacemaker was interogated and found to be adequetly working. She was anticagulated with heparin and transitioned to lovenox 70mg daily at time of discharge. While in the hospital she had no active bleeding. Pt refused IR placement of another IVC filter. # Chronic Kidney Disease - The patients creatinine was elevated to 2.4 on admission. She was given IV hydration in the setting of dye load at time of admission for retrival of the IVC and had recieved contrast 3 days prior for placement of the filter. Her creatinine trended down and was 1.1 at time of discharge. Her lisinopril was held while in the hospital but as her creatinine normalized it was felt that she could resume her home dose at time of discharge. # Renal Cell Carcinoma - Not active during this hospitalization. She will follow up with Hematology/Onoclongy as an outpatient. # HTN - The patient has a history of this. She was continued on her home medications with the exception of her home lisinopril while in the hospital with no episodes of hypertension. Transitional Issues: -Restarted on Lovenox 70mg Daily. She will need to have factor Xa level checked after for 3rd-5th dose. Results faxed to her oncologists at ([**Telephone/Fax (1) 86029**]. She will also need to have a CBC drawn at that time. -She will have follow up for her RCC with her oncologists as scheduled. Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from PatientwebOMR. 1. Amlodipine 5 mg PO BID 2. CloniDINE 0.1 mg PO BID 3. Lisinopril 20 mg PO BID 4. Acetaminophen 500 mg PO Q6H:PRN Pain 5. Lorazepam 0.5 mg PO QHS Discharge Medications: 1. Outpatient Lab Work Dx: Pulmonary embolism Please check:1) Factor Xa level 2) Complete blood count (CBC)Fax results to ([**Telephone/Fax (1) 28908**]. Please fax results to Dr. [**First Name (STitle) **] and Dr. [**Last Name (STitle) **] at ([**Telephone/Fax (1) 86029**] 2. Acetaminophen 500 mg PO Q6H:PRN Pain 3. Amlodipine 5 mg PO BID 4. CloniDINE 0.1 mg PO BID 5. Lorazepam 0.5 mg PO QHS 6. Lisinopril 20 mg PO BID 7. Enoxaparin Sodium 70 mg SC Q24H RX *enoxaparin 80 mg/0.8 mL daily Disp #*28 Syringe Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Migration of IVC filter to Right Ventricle Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Ms. [**Known lastname 86028**], It was a pleasure taking care of you during your hospitalization. You came to the hospital because you were feeling short of breath. It was found that your IVC filter had migrated into the right ventricle of your heart. We were able to remove it percutanously. You were placed on heparin for anticoagulation and monitored for several days. Your blood count initally fell but then stablized without signs of bleeding. You were discharged home without any of the shortness of breath. Please Start: Lovenox 70mg daily Followup Instructions: Please follow up with Dr. [**First Name (STitle) **] and Dr. [**Last Name (STitle) **] as scheduled for oncology. Please have your labs drawn on Tuesday or Wednesday ([**Date range (1) 19038**]) at your PCPs office with the results faxed to ([**Telephone/Fax (1) 86030**].

996,189,197,198,733,305,E879,403,585,V436,V103,V153

{'Mechanical complication of other vascular device, implant, and graft,Malignant neoplasm of kidney, except pelvis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Osteoporosis, unspecified,Tobacco use disorder,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Knee joint replacement,Personal history of malignant neoplasm of breast,Personal history of irradiation, 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: SOB PRESENT ILLNESS: [**Known firstname **] [**Known lastname 86028**] is an 84-year-old woman recently diagnosed with stage 4 renal papillary carcinoma (not yet started treatment) and at that time found to have bilateral PEs. On [**9-7**] she had a staging CTs which showed significant disease (stage 4 with mets to liver, bone metastases in the L1 and T12 vertebrae) as well as bilateral basal PEs. She was admitted to [**Hospital1 18**] for anticoagulation with lovenox. Further work up demonstrated extensive bilateral lower extermity DVTs. She is scheduled to begin SUNITINIB trial for her advanced . On [**9-14**] the patient reported urinary vs vaginal bleeding on anticoagulation. At this point anticoagulation was stopped and her bleeding resolved. There is no note as the the amount of bleeding that prompted the stopping of the anticoagulation. On [**9-20**] she underwent IVC filter placement with interventional radiology as an outpatient. The procedure was felt to be a success but the patient was experiencing increasing exertional SOB since the procedure ans so she presented to the ED today. . In the ED, initial vitals were 97.3 94 111/68 20 97% 2L Labs and imaging significant for a CXR - IVC filter has migrated to the right ventricle. Patient was placed on a heparin ggt and sent to the cardiac cath lab for percutanous removal of the IVC filter. Vitals on transfer were 98.0, 113/54,90, 27, 98%2LNC . In the cath lab they were able to retrieve the filter without issue. . On arrival to the floor, she is comfortable without concerns. MEDICAL HISTORY: . Past Oncologic History: [**Known firstname **] [**Known lastname 86028**] is an 84-year-old healthy woman who presented approximately 2 years ago for a 2-cm right complex renal cysts. She was referred to [**Hospital1 18**] in [**7-25**] and underwent CT imaging which reportedly revealed 2.2 cm right kidney cyst with no central enhancement, multiple pulmonary nodules and a L5 lucent lesion. Repeat CT scan in [**7-27**] was then performed and showed infiltrating mass involving most of right kidney with extensive retroperitoneal lymphadenopathy. Radiology report stated that findings were C/W possible lymphoma, small lesions in liver. . [**2151-7-23**] Abd/Pelvis CT: Previously in the right kidney, there was a focal exophytic slightly complex lesion, but there is now a diffuse infiltrative mass of much of the right kidney. The previously identified lesion, exophytic at the interpolar region, measures 18 x 25 mm, previously perhaps 20 x 18 mm. The diffuse infiltrative component, which extends through the cortex of the renal hilum and involves the hilar fat as well as circumferential the vessels of the renal hilum, is new. Also new is extensive retroperitoneal and retrocrural lymphadenopathy. A left adrenal lesion is stable. The liver contains new lesions. The findings are unusual for renal cell carcinoma, the presumptive pretest pathology. The appearances would be much more suggestive of lymphoma, possibly a transitional cell carcinoma, with atypical infection considered extremely unlikely. [**2151-8-12**] Bx of right kidney mass showed papillary carcinoma diffusing infiltrating into the renal cortex and medulla. Tumor is CK903, CK7, P504S positive. Negative for CK20, CDX2 and p63. Focally positive for CAIX. . Past Medical History: Osteoporosis Arthritis - s/p TKR bilaterally Pacemaker Right sided breast cancer [**2131**] - Underwent lumpectomy, treated with XRT and TAM x 5 years on ajuvant trial - Surveillance mammography is normal . MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from PatientwebOMR. 1. Amlodipine 5 mg PO BID 2. CloniDINE 0.1 mg PO BID 3. Lisinopril 20 mg PO BID 4. Acetaminophen 500 mg PO Q6H:PRN Pain 5. Lorazepam 0.5 mg PO QHS ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: GENERAL: WDWN female 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: Mother: died of CHF at age [**Age over 90 **] Father: died of MI at age 59 Has other family members with heart disease. Has no children. SOCIAL HISTORY: Gen: Works part time at a law office. Has worked at attorney's office x 50 years. She was forced to retire in [**2134**] and that lasted 3 weeks. Tobacco: Smokes 6 cigarettes a day since age 18 (x 66 years). EtOH: 1 glass of wine daily and occasionally more on the weekends Illicits: none Occupation: Works as admin assistant. Living situation: Lives with cousin Exercise: [**Name2 (NI) 6934**] daily ### Response: {'Mechanical complication of other vascular device, implant, and graft,Malignant neoplasm of kidney, except pelvis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Osteoporosis, unspecified,Tobacco use disorder,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Knee joint replacement,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health'}

CHIEF COMPLAINT: Fever and hypotension PRESENT ILLNESS: The pt is an 84 yo female with past hx significant for DM type II, CHF, HTN, hypothyroidism, A-fib, chronic leg ulcers, and chronic renal insufficiency who presented to the ED on [**10-21**] with fever to 102 F and hypotension. She was transferred to the ICU where the hospital course was as follows: Sepsis protocol was initiated. Coverage of multiple possible sources was begun with vancomycin, levofloxacin, and metronidazole. Pt was aggressively fluid resuscitated. Norepinephrine drip was required to maintain blood pressure in adequate range. Urine culture was positive for Klebsiella pneumoniae, and the patient also had stool positive for C. diff toxin. Vancomyin was discontinued after osteomyelitis was ruled out as a possible infection in this patient. The patient's blood pressure was stable and the norepinephrine drip was discontinued. She was transferred to 12R on the am of [**2179-10-26**]. On arrival to the floor her temp was 100, hr 90-110, bp 100/60. MEDICAL HISTORY: - Hypertension - DM II - Atrial Fibrillation - Gastroesophageal Reflux Disease - Total abdominal hysterectomy, bilateral salpingoophorectomy - Anemia - Chronic renal insufficiency (baseline 1.4 - 1.5) - Chronic leg ulcers - Anemia - Hypothyroidism MEDICATION ON ADMISSION: citalopram 20 mg po daily mirtazapine 15 mg qhs docusate 100 mg po senna po bid bisacodyl 2 mg daily prn levothyroxine 125 mcg daily glipizide 25 mg daily regular insulin protonix 40 mg daily albuterol MDI q6 prn simethicone qid prn metoprolol 75 mg tid tylenol750 mg q6 tramadol 25 mg q6 prn coumadin 1 mg qhs enalapril 10 mg daily lasix 40 mg po daily oxycodone/APAP fentanyl zinc keflex MVI ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam on arrival to the floors: VS: 97.8, 110/80, 78, 18, 98% on 4L NC Gen: lying in bed moaning, leaning to the right side, with preferential right gaze, difficult to understand speech HEENT: NC/AT, perrl, mmd, o/p clear Neck: L IJ CVL in place CV: irreg irreg, s1 and s2, no m/r/g Pulm: crackles bilaterally Abd: obese, soft, nt, nd, active bs Extr: 2+ edema throughout arms, legs, eye-lids; multiple deep ulcers bilaterally that are bandaged, bandages c/d/i FAMILY HISTORY: Non-contributory SOCIAL HISTORY: - Denies smoking, EtOH, or drinking history. - Pt was independent until recent stay at [**Hospital3 2558**] - POA is [**Name (NI) **] [**Name (NI) 71227**]

Unspecified septicemia,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Atrial fibrillation,Ulcer of heel and midfoot,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis,Venous (peripheral) insufficiency, unspecified,Unspecified acquired hypothyroidism,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Esophageal reflux,Anemia of other chronic disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

Septicemia NOS,Urin tract infection NOS,Int inf clstrdium dfcile,Atrial fibrillation,Ulcer of heel & midfoot,Hyperosmolality,Acute kidney failure NOS,Food/vomit pneumonitis,Hyp kid NOS w cr kid V,Sepsis,Venous insufficiency NOS,Hypothyroidism NOS,Klebsiella pneumoniae,Esophageal reflux,Anemia-other chronic dis,DMII wo cmp nt st uncntr

Admission Date: [**2179-10-21**] Discharge Date: [**2179-11-5**] Service: MED Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2840**] Chief Complaint: Fever and hypotension Major Surgical or Invasive Procedure: none History of Present Illness: The pt is an 84 yo female with past hx significant for DM type II, CHF, HTN, hypothyroidism, A-fib, chronic leg ulcers, and chronic renal insufficiency who presented to the ED on [**10-21**] with fever to 102 F and hypotension. She was transferred to the ICU where the hospital course was as follows: Sepsis protocol was initiated. Coverage of multiple possible sources was begun with vancomycin, levofloxacin, and metronidazole. Pt was aggressively fluid resuscitated. Norepinephrine drip was required to maintain blood pressure in adequate range. Urine culture was positive for Klebsiella pneumoniae, and the patient also had stool positive for C. diff toxin. Vancomyin was discontinued after osteomyelitis was ruled out as a possible infection in this patient. The patient's blood pressure was stable and the norepinephrine drip was discontinued. She was transferred to 12R on the am of [**2179-10-26**]. On arrival to the floor her temp was 100, hr 90-110, bp 100/60. Past Medical History: - Hypertension - DM II - Atrial Fibrillation - Gastroesophageal Reflux Disease - Total abdominal hysterectomy, bilateral salpingoophorectomy - Anemia - Chronic renal insufficiency (baseline 1.4 - 1.5) - Chronic leg ulcers - Anemia - Hypothyroidism Social History: - Denies smoking, EtOH, or drinking history. - Pt was independent until recent stay at [**Hospital3 2558**] - POA is [**Name (NI) **] [**Name (NI) 71227**] Family History: Non-contributory Physical Exam: Exam on arrival to the floors: VS: 97.8, 110/80, 78, 18, 98% on 4L NC Gen: lying in bed moaning, leaning to the right side, with preferential right gaze, difficult to understand speech HEENT: NC/AT, perrl, mmd, o/p clear Neck: L IJ CVL in place CV: irreg irreg, s1 and s2, no m/r/g Pulm: crackles bilaterally Abd: obese, soft, nt, nd, active bs Extr: 2+ edema throughout arms, legs, eye-lids; multiple deep ulcers bilaterally that are bandaged, bandages c/d/i Pertinent Results: [**2179-10-21**] 05:00PM GLUCOSE-98 UREA N-89* CREAT-2.9*# SODIUM-153* POTASSIUM-4.9 CHLORIDE-113* TOTAL CO2-25 ANION GAP-20 [**2179-10-21**] 05:00PM WBC-21.7*# RBC-5.41* HGB-13.4 HCT-43.0 MCV-79* MCH-24.7* MCHC-31.2 RDW-18.9* [**2179-10-21**] 05:00PM NEUTS-87.9* BANDS-0 LYMPHS-7.1* MONOS-3.1 EOS-1.3 BASOS-0.4 [**2179-10-21**] 05:00PM PLT SMR-NORMAL PLT COUNT-323 [**2179-10-21**] 05:00PM PT-13.8* PTT-25.7 INR(PT)-1.2 [**2179-10-21**] 05:00PM ALT(SGPT)-13 AST(SGOT)-18 CK(CPK)-35 ALK PHOS-110 AMYLASE-69 TOT BILI-0.4 [**2179-10-21**] 05:18PM LACTATE-3.8* [**2179-10-21**] 05:55PM URINE BLOOD-LG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD [**2179-10-21**] 05:55PM URINE RBC-[**3-19**]* WBC->50 BACTERIA-MANY YEAST-NONE EPI-0 [**2179-10-21**] 06:55PM DIGOXIN-1.7 [**2179-10-21**] 06:55PM CORTISOL-24.9* [**2179-10-21**] 11:15PM CK-MB-3 cTropnT-0.03* [**2179-10-21**] 05:00PM cTropnT-0.02* [**2179-10-22**] 12:00AM CORTISOL-42.9* On discharge: [**2179-11-5**] 05:49AM BLOOD WBC-12.5* RBC-3.59* Hgb-9.2* Hct-28.6* MCV-80* MCH-25.6* MCHC-32.1 RDW-26.4* Plt Ct-316 [**2179-11-5**] 05:49AM BLOOD PT-13.0 PTT-31.8 INR(PT)-1.1 [**2179-11-5**] 05:49AM BLOOD Glucose-147* UreaN-29* Creat-0.6 Na-143 K-3.7 Cl-110* HCO3-28 AnGap-9 [**2179-10-27**] 10:45AM BLOOD calTIBC-131* Ferritn-196* TRF-101* TSH: [**2179-10-21**] 09:16PM BLOOD TSH-8.0* [**2179-10-27**] 10:45AM BLOOD TSH-16* [**2179-11-3**] 06:19AM BLOOD TSH-30* [**2179-10-27**] 10:45AM BLOOD Free T4-0.6* Digoxin: [**2179-10-21**] 06:55PM BLOOD Digoxin-1.7 [**2179-11-3**] 06:19AM BLOOD Digoxin-0.9 CXR [**11-2**]: A left internal jugular vascular catheter remains in satisfactory position. The cardiac silhouette is enlarged but stable. There is some degree of respiratory motion present, resulting in blurring of the pulmonary vasculature. This limits assessment for mild congestive heart failure. Bilateral pleural effusions are present and are partially layering on this semi-erect study. Increased opacity persists in the left retrocardiac region. AXR [**11-2**]: Gas present in colon. No abnormalities. Brief Hospital Course: 84 yo F presented with sepsis, transfered to ICU on arrival. In the ICU, a sepsis protocol was initiated. Coverage of multiple possible sources was begun with vancomycin, levofloxacin, and metronidazole. She was aggressively fluid resuscitated. A norepinephrine drip was required to maintain blood pressure in adequate range. Urine culture was positive for Klebsiella pneumoniae, and the patient also had stool positive for C. diff toxin. Vancomyin was discontinued after osteomyelitis was ruled out as a possible infection in this patient. The patient's blood pressure was stable and the norepinephrine drip was discontinued. She was transferred to 12R on the am of [**2179-10-26**]. On arrival to the floor her temp was 100, hr 90-110, bp 100/60. 1) ID: On the floors she completed 14 day courses of both flagyl and meropenem, and remained afebrile and hemodynamically stable throughout the remainder of her hospital course. 2) Leg Ulcers: The patient was seen by vascular surgery who felt that her ulcers were a combination of venous stasis and pressure ulcers. ABIs were not done as it would cause the patient too much pain, and the patient was not felt to be a surgical candidate regardless in light of her condition and comorbidities. Her dressings were changed once a day, however this was causing her extreme pain, despite morphine and ativan premedication, and dressing changes were decreased to every three days, and then not at all. She should not have any further dressing changes, as the pain is excrutiating for her. 3) Anasarca/fluid balance/hypernatremia: Ms. [**Known lastname 97599**] was found to be intravascularly depleted (high sodium), but total body fluid overloaded. We attempted diuresis, but this only elevated her sodium. We therefore fluid resuscitated her to lower her sodium, and then began diuresis once her hypernatremia had resolved. We had hoped that her fluid balance would improve with initiation of TPN to raise her albumin, however, after a week of TPN, her albumin continues to decrease, and she is not eating anything. Her anasarca persists. She will get maintenance IVF at [**Hospital3 2558**] with D5, in the absence of other forms of nutrition. 4) Nutrition: TPN was initiated through her central line on [**10-29**]. Her albumin was 2.6 on [**10-21**], declining to 1.9 on [**11-3**]. She occasionally ate spoonfulls of pudding, however largely refused food and PO medications. 5) Anemia: The patient had a baseline hct ranging from 35-43 prior to admission, while declined to 29-31 for much of her stay. Her iron studies indicated anemia of chronic disease, and her stool was guaiac negative. She did not receive any transfusions. 6) Hypothyroidism: Ms. [**Known lastname 95808**] was profoundly hypothyroid, with a TSH of 8 on admission, increasing to 16 and then 30 at discharge despite increasing her thyroxine dose (it takes [**6-22**] weeks for the new dose to take effect, however the TSH should not continue to rise to such an extent). 7) Pain: Ms. [**Known lastname 95808**] [**Last Name (Titles) 97600**] anytime she was touched. She persistenly denied pain, only admitting to pain during her dressing changes. Despite this, she [**Last Name (Titles) 97600**] anytime anyone touched her. We decreased the frequency of her dressing changes secondary to her extreme pain, and used morphine concentrated solution 4 mg Q 4 hours for pain. She should be given tylenol 1000 mg PR Q 6 hours as needed for pain, as well as morphine concentrated solution 5 mg Q 4 hours around the clock. 8) Atrial fibrillation: Her a-fib was poorly controlled with digoxin in the unit, and not responsive to amiodarone. On the floors her rate was well-controlled in the 60s, though her pulse was irregularly irregular. She was therefore maintained on digoxin and coumadin for anticoagulation. Her coumadin was maintained at 1 mg qhs and INR was therapeutic for the most part. 9) Mental status: The patient had waxing and [**Doctor Last Name 688**] mental status, but mostly was delirious. She leaned to the right side, with R lateral gaze preference. A head CT was performed due to concern for stroke, and was negative for any acute intracranial process. 10) Code status: She was DNR/DNI during the hospitalization. During a family meeting with her long-time boyfriend [**Name (NI) **], for whom she cares a lot, and who cares for her, on her last day of hospitalization it was decided that in light of her failure to demonstrate any improvement, persistent refusal to eat and worsening albumin in spite of TPN, along with continued extreme pain and incredibly poor prognosis, the best thing for her would be comfort care only. She should be given pain medications, with PRN zyprexa for aggitation for the next 3 weeks. Her boyfriend, [**Name (NI) **], would like her to receive fluids for the time being, in order to try to buy her a little bit more time to see if she will eat. It has been explained that this may only prolong her life for a little while, and he will consider stopping the fluids in the future. She will get maintenance fluids through her central line, which can be flushed with heparin to keep it patent. Medications on Admission: citalopram 20 mg po daily mirtazapine 15 mg qhs docusate 100 mg po senna po bid bisacodyl 2 mg daily prn levothyroxine 125 mcg daily glipizide 25 mg daily regular insulin protonix 40 mg daily albuterol MDI q6 prn simethicone qid prn metoprolol 75 mg tid tylenol750 mg q6 tramadol 25 mg q6 prn coumadin 1 mg qhs enalapril 10 mg daily lasix 40 mg po daily oxycodone/APAP fentanyl zinc keflex MVI Discharge Medications: 1. Morphine Concentrate 20 mg/mL Solution Sig: Five (5) mg PO Q4H (every 4 hours). 2. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One (1) ML Intravenous QD (once a day) as needed: 10ml NS followed by 1ml of 100 Units/ml heparin (100 units heparin) each lumen QD and PRN. . 3. Olanzapine 5 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO three times a day as needed for aggitation for 3 weeks. 4. Acetaminophen 650 mg Suppository Sig: 1-2 tabs Rectal Q6H (every 6 hours) as needed for pain. 5. IV fluids Please give IVF: D5, [**1-15**] normal saline at a rate of 50 cc/hr continuously. Discharge Disposition: Extended Care Facility: [**Hospital3 2558**] - [**Location (un) **] Discharge Diagnosis: urosepsis c. difficile colitis venous stasis/pressure ulcers on legs b/l Anasarca DM type 2 Hypothyroidism A-fib Hypertension Discharge Condition: poor Discharge Instructions: Comfort care only. Followup Instructions: none

038,599,008,427,707,276,584,507,403,995,459,244,041,530,285,250

{"Unspecified septicemia,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Atrial fibrillation,Ulcer of heel and midfoot,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis,Venous (peripheral) insufficiency, unspecified,Unspecified acquired hypothyroidism,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Esophageal reflux,Anemia of other chronic disease,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: Fever and hypotension PRESENT ILLNESS: The pt is an 84 yo female with past hx significant for DM type II, CHF, HTN, hypothyroidism, A-fib, chronic leg ulcers, and chronic renal insufficiency who presented to the ED on [**10-21**] with fever to 102 F and hypotension. She was transferred to the ICU where the hospital course was as follows: Sepsis protocol was initiated. Coverage of multiple possible sources was begun with vancomycin, levofloxacin, and metronidazole. Pt was aggressively fluid resuscitated. Norepinephrine drip was required to maintain blood pressure in adequate range. Urine culture was positive for Klebsiella pneumoniae, and the patient also had stool positive for C. diff toxin. Vancomyin was discontinued after osteomyelitis was ruled out as a possible infection in this patient. The patient's blood pressure was stable and the norepinephrine drip was discontinued. She was transferred to 12R on the am of [**2179-10-26**]. On arrival to the floor her temp was 100, hr 90-110, bp 100/60. MEDICAL HISTORY: - Hypertension - DM II - Atrial Fibrillation - Gastroesophageal Reflux Disease - Total abdominal hysterectomy, bilateral salpingoophorectomy - Anemia - Chronic renal insufficiency (baseline 1.4 - 1.5) - Chronic leg ulcers - Anemia - Hypothyroidism MEDICATION ON ADMISSION: citalopram 20 mg po daily mirtazapine 15 mg qhs docusate 100 mg po senna po bid bisacodyl 2 mg daily prn levothyroxine 125 mcg daily glipizide 25 mg daily regular insulin protonix 40 mg daily albuterol MDI q6 prn simethicone qid prn metoprolol 75 mg tid tylenol750 mg q6 tramadol 25 mg q6 prn coumadin 1 mg qhs enalapril 10 mg daily lasix 40 mg po daily oxycodone/APAP fentanyl zinc keflex MVI ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Exam on arrival to the floors: VS: 97.8, 110/80, 78, 18, 98% on 4L NC Gen: lying in bed moaning, leaning to the right side, with preferential right gaze, difficult to understand speech HEENT: NC/AT, perrl, mmd, o/p clear Neck: L IJ CVL in place CV: irreg irreg, s1 and s2, no m/r/g Pulm: crackles bilaterally Abd: obese, soft, nt, nd, active bs Extr: 2+ edema throughout arms, legs, eye-lids; multiple deep ulcers bilaterally that are bandaged, bandages c/d/i FAMILY HISTORY: Non-contributory SOCIAL HISTORY: - Denies smoking, EtOH, or drinking history. - Pt was independent until recent stay at [**Hospital3 2558**] - POA is [**Name (NI) **] [**Name (NI) 71227**] ### Response: {"Unspecified septicemia,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Atrial fibrillation,Ulcer of heel and midfoot,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Sepsis,Venous (peripheral) insufficiency, unspecified,Unspecified acquired hypothyroidism,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Esophageal reflux,Anemia of other chronic disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled"}

CHIEF COMPLAINT: IPH, SDH, SAH, IVH PRESENT ILLNESS: [**Age over 90 **]M s/p WHOL -> fall and head strike -> LOC. Apparently had a 15 minute lucid interval before LOC. Intubated at scene and brought to ED. MEDICAL HISTORY: HTN BPH PAF on Coumadin CKD bl 1.6 Chronic anemia S/p exlap, bowel resection, colostomy and reversal in setting of wooden skewer ingestion in [**2137**] S/p CCY MEDICATION ON ADMISSION: Unknown ALLERGIES: Levaquin PHYSICAL EXAM: Upon admission: FAMILY HISTORY: Daughter with Crohn's disease. SOCIAL HISTORY: Pathology professor [**First Name (Titles) **] [**Last Name (Titles) **], still working. Independant in all ADL's, still driving. Lives with his daughter. Former [**Name2 (NI) 1818**] more than 20 years ago, no EtOH or drugs. Widowed

Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Acute respiratory failure,Unspecified fall,Do not resuscitate status,Long-term (current) use of anticoagulants,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified

Cl skul fx NEC-deep coma,Acute respiratry failure,Fall NOS,Do not resusctate status,Long-term use anticoagul,Atrial fibrillation,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS

Admission Date: [**2153-9-30**] Discharge Date: [**2153-9-30**] Service: NEUROSURGERY Allergies: Levaquin Attending:[**First Name3 (LF) 5084**] Chief Complaint: IPH, SDH, SAH, IVH Major Surgical or Invasive Procedure: None History of Present Illness: [**Age over 90 **]M s/p WHOL -> fall and head strike -> LOC. Apparently had a 15 minute lucid interval before LOC. Intubated at scene and brought to ED. Past Medical History: HTN BPH PAF on Coumadin CKD bl 1.6 Chronic anemia S/p exlap, bowel resection, colostomy and reversal in setting of wooden skewer ingestion in [**2137**] S/p CCY Social History: Pathology professor [**First Name (Titles) **] [**Last Name (Titles) **], still working. Independant in all ADL's, still driving. Lives with his daughter. Former [**Name2 (NI) 1818**] more than 20 years ago, no EtOH or drugs. Widowed Family History: Daughter with Crohn's disease. Physical Exam: Upon admission: PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD. HEENT: Pupils: 5mm, sluggish R periorbital ecchymosis Neck: C-collar Lungs: CTA bilaterally. Cardiac: RRR. S1/S2. Abd: Soft, NT, BS+ Extrem: Warm and well-perfused. Neuro: Mental status: Intubated Orientation: Intubated Recall: Intubated Language: Intubated Cranial Nerves: I: Not tested II: Pupils as above Motor: Withdraws LE to pain Toes downgoing bilaterally Pertinent Results: CT Head [**2153-9-30**]: FINDINGS: There is a large right-sided subdural hematoma overlying the whole right hemispheric convexity, with area of the largest thickness measuring 2.9 cm (2A:19) at the level of the right frontal lobe. There is also an intraparenchymal hemorrhagic focus measuring 3.8 x 2.8 cm (2A:13) extending from the temporal lobe into the parietal lobe with a thin rim of surrounding edema. This large hemorrhagic focus overlies a fracture of the squamous portion of the right tmporal bone. There is associated shift of midline structures up to 2.2 cm (2a:16), with complete effacement of the right lateral ventricle and compression of the left lateral ventricle. A thin line of hyperdense material is noted in the compressed right lateral ventricle (2a:15) suggesting intraventricular extension of the intraparenchymal hemorrhage. There is hyperdense material in the basal cisterns as well, complete effacement of the suparasellar cisterns is consistent with uncal herniation. Blood is also seen in the thecal sac at the level of C1 without tonsillar herniation. A 0.6 cm hypodensity in the right midbrain (2a:10) might represent an old infarct vs. volume averaging artifact. Multiple fractures are observed, including: 1. Fracture of the squamous portion of the temporal bone. 2. Fracture of the lateral wall (2A:10), , roof (400b:26), floor (400b:18) and medial wall (400b:15) of the right orbit. There is associated maxillary and ethmoidal sinus hemorrhage as well as subperiostial hemorrhage in the roof of the orbit. There is stranding surrounding the inferior rectus muscle (400b:20) suggesting entrapment. 3. Fracture of the right zygoma. 4. Possible fracture of the right pterygoid process (3a:7), correlation with maxillo-facial CT is advised. There is a large soft tissue hematoma in the facial tissues of the right with some soft tissue laceration and subcutaneous gas. IMPRESSION: 1. Large right temporal lobe intraparenchymal hemorrhage extending into the parietal lobe, associated with a fracture of the squamous portion of the temporal bone. Blood within the basal cisterns with possible intraventricular extension. Effacement of the suprasellar cistern suggest uncal herniation. 2. Large subarachnoid hemorrhage with subfalcine herniation. 3. Multiple fractures as described above, including fracture of all the walls of the right orbit with associated subperiostial hematoma in the right orbit, right maxillary and ethmoidal sinuses hemorrhage and probable entrapment of the inferior rectus muscle. Clinical correlation recommended. 4. Large rigth sided facial soft tissue laceration. Brief Hospital Course: [**Age over 90 **]M who was admitted to [**Hospital1 18**] after experiencing the WHOL, CT showed a SDH, IPH, SAH, and IVH with a question of aneurysm. Patient was DNR and given his poor exam and imaging, he was made CMO and extubated. He passed away on [**2153-9-30**]. Medications on Admission: Unknown Discharge Medications: Expired Discharge Disposition: Expired Discharge Diagnosis: R temporal IPH SAH SDH IVH Multiple skull fractures Respiratory failure Discharge Condition: Expired Discharge Instructions: Expired Followup Instructions: Expired Completed by:[**2153-10-1**]

803,518,E888,V498,V586,427,403,585

{'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Acute respiratory failure,Unspecified fall,Do not resuscitate status,Long-term (current) use of anticoagulants,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, 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: IPH, SDH, SAH, IVH PRESENT ILLNESS: [**Age over 90 **]M s/p WHOL -> fall and head strike -> LOC. Apparently had a 15 minute lucid interval before LOC. Intubated at scene and brought to ED. MEDICAL HISTORY: HTN BPH PAF on Coumadin CKD bl 1.6 Chronic anemia S/p exlap, bowel resection, colostomy and reversal in setting of wooden skewer ingestion in [**2137**] S/p CCY MEDICATION ON ADMISSION: Unknown ALLERGIES: Levaquin PHYSICAL EXAM: Upon admission: FAMILY HISTORY: Daughter with Crohn's disease. SOCIAL HISTORY: Pathology professor [**First Name (Titles) **] [**Last Name (Titles) **], still working. Independant in all ADL's, still driving. Lives with his daughter. Former [**Name2 (NI) 1818**] more than 20 years ago, no EtOH or drugs. Widowed ### Response: {'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level,Acute respiratory failure,Unspecified fall,Do not resuscitate status,Long-term (current) use of anticoagulants,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 64-year-old Spanish speaking insulin and hemodialysis dependent woman who presents as a transfer from [**Hospital3 417**] Hospital for chest pain and short of breath. The patient initially presented on [**2191-9-26**] with dyspnea and leg pain which apparently was chronic. Upon admission it was thought she was volume overloaded and therefore the next day she was dialyzed and 6 kilograms were removed. At that time she was also started on Heparin and ruled out for pulmonary embolism with a CT angiogram which was negative. After she was dialyzed her oxygenation improved but shortly afterwards her oxygenation saturation dropped to 70% on room air and she became hypotensive to the 70's. She was volume resuscitated and started on Dopamine. Afterwards the cardiac enzymes were positive for Troponin of 13, CK of 116 and MB of 13.5. At that time she developed mild neck pain while patient's Heparin was restarted and the patient was prepared for transfer to the [**Hospital1 69**] for cardiac catheterization. MEDICAL HISTORY: 1. Coronary artery disease. Echo in [**2191-5-27**] showed EF of 65% with evidence of left ventricular hypertrophy, right atrial enlargement, mild ASA, pulmonary artery pressure of 77 mm of mercury. She has a MIBI in [**2191-5-27**] that showed ejection fraction of 75% with a fixed lateral wall defect and dilated RV with no reversibility. MEDICATION ON ADMISSION: ALLERGIES: Penicillin. PHYSICAL EXAM: FAMILY HISTORY: Insulin dependent diabetes mellitus. SOCIAL HISTORY: No tobacco use.

Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Primary pulmonary hypertension,Congestive heart failure, unspecified,Subarachnoid hemorrhage,Mitral valve insufficiency and aortic valve stenosis,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic hepatitis C without mention of hepatic coma

Subendo infarct, initial,Crnry athrscl natve vssl,Prim pulm hypertension,CHF NOS,Subarachnoid hemorrhage,Mitral insuf/aort stenos,DMI renl nt st uncntrld,Hyp kid NOS w cr kid V,Chrnc hpt C wo hpat coma

Admission Date: [**2191-9-28**] Discharge Date: [**2191-10-7**] Date of Birth: [**2127-3-21**] Sex: F Service: HISTORY OF PRESENT ILLNESS: This is a 64-year-old Spanish speaking insulin and hemodialysis dependent woman who presents as a transfer from [**Hospital3 417**] Hospital for chest pain and short of breath. The patient initially presented on [**2191-9-26**] with dyspnea and leg pain which apparently was chronic. Upon admission it was thought she was volume overloaded and therefore the next day she was dialyzed and 6 kilograms were removed. At that time she was also started on Heparin and ruled out for pulmonary embolism with a CT angiogram which was negative. After she was dialyzed her oxygenation improved but shortly afterwards her oxygenation saturation dropped to 70% on room air and she became hypotensive to the 70's. She was volume resuscitated and started on Dopamine. Afterwards the cardiac enzymes were positive for Troponin of 13, CK of 116 and MB of 13.5. At that time she developed mild neck pain while patient's Heparin was restarted and the patient was prepared for transfer to the [**Hospital1 69**] for cardiac catheterization. During the entire admission there were no significant electrocardiogram changes. After speaking to the family the patient has a long history of chronic pain from her diabetes. PAST MEDICAL HISTORY: 1. Coronary artery disease. Echo in [**2191-5-27**] showed EF of 65% with evidence of left ventricular hypertrophy, right atrial enlargement, mild ASA, pulmonary artery pressure of 77 mm of mercury. She has a MIBI in [**2191-5-27**] that showed ejection fraction of 75% with a fixed lateral wall defect and dilated RV with no reversibility. 2. History of atrial fibrillation. 3. Asthma. 4. Hypertension. 5. Insulin dependent diabetes mellitus consistent with nephropathy, retinopathy and neuropathy. 6. End-stage renal disease on hemodialysis for four years. 7. Hepatitis C. SOCIAL HISTORY: No tobacco use. FAMILY HISTORY: Insulin dependent diabetes mellitus. OUTPATIENT MEDICATIONS: 1. Nifedipine SR 60 mg p.o. q day. 2. Insulin 3. Nephrocaps two caps p.o. q day. 4. Percocet. 5. Coumadin. 6. Epogen. ALLERGIES: Penicillin. PHYSICAL EXAMINATION: Temperature 98.2, pulse 83, blood pressure 94/58. Respiratory rate 20. Oxygen sats 85% on room air and 96% on six liters. HENT: Extraocular movements intact. Pupils are equal and reactive to light. Anicteric sclera. Neck supple. Increased jugular venous distention to 30 degrees, no carotid bruits bilaterally. Cardiovascular is regular rate with a crescendo decrescendo mid to late peaking systolic ejection murmur at the right sided systolic murmur that increased with inspiration and a right sided S3. The patient also had a large right sided heave that is sustained. Lungs clear to auscultation bilaterally except some crackles at the basis. Abdomen soft, distended, positive bowel sounds and enlarged liver to 8 cm below the ribcage. No spleen is palpable. Extremities: Exquisite tenderness bilaterally with palpation palpable worse on the right. Guaiac negative stool. Chest x-ray showed pulmonary edema with cephalization. Electrocardiogram: Normal sinus rhythm at 85 beats per minute with an axis of 80 with normal intervals and no ST-T changes when compared to prior electrocardiogram. White blood count 9.7, hematocrit 37.5, platelets 212, coags, PTT 58.1, INR 3.6, sodium 129, potassium 5.1, chloride 91, bicarbonate 23, BUN 74, creatinine 7.5, glucose 166. Calcium 8.1, magnesium 2.4. CK 157. Troponin pending. HOSPITAL COURSE: The patient's hypotension was attributed to excessive loss of fluid during dialysis at outside hospital. The patient underwent a cardiac catheterization which showed pulmonary hypertension, moderate MR with a left ventricular ejection fraction of 50% Coronary arteries showed left anterior descending 80% mid-segmental focal stenosis at bifurcation of D2 and proximal portion of the left anterior descending was stented. CT angiogram showed no pulmonary embolism, large heart with subcutaneous pleural effusion right greater than left, no calcification of the parenchymals. A Swann-Ganz catheter was placed to assess pulmonary capillary wedge pressure which was initially elevated to 55. It was felt that the degree of pulmonary hypertension was still out of proportion to the degree of left ventricular failure as well as mitral regurg. She was diuresed with Lasix and given her increased wedge pressure however, it was thought that the pulmonary hypertension workup needs to be pursued once she is adequately diuresed. However, on [**10-4**] the patient developed right arm weakness, Stat head CT showed subarachnoid hemorrhage. Neurosurgery was consulted. Her Heparin was turned off. She was administered Protamine. She was given several units of FFP to bring her INR down. Aspirin and Plavix were stopped. Despite over 20 units of FFP her INR could not be lowered below 1.4 secondary to her liver disease from Hepatitis C and right heart failure. Over the course of the day the patient's neurological status deteriorated. A follow-up CT showed markedly enlarged plaque. Neurosurgery suggested conservative therapy since surgically there was no indication for evacuation of hemorrhage because of the location of the hemorrhage. The patient's bleeding was probably worsened by underlying platelet dysfunction secondary to uremia. Gastroenterology was consulted and they felt an esophagogastroduodenoscopy is emergent however, given the patient's "Do Not Resuscitate" status she could not be scoped. Given the patient's poor prognosis and worsening bleeding status as per the patient's family the patient was made CMO and started on Morphine drip on [**2191-10-6**]. The patient expired on [**2191-10-6**] at 2:51 AM. [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 4786**] Dictated By:[**Name8 (MD) 5753**] MEDQUIST36 D: [**2191-11-23**] 15:32 T: [**2191-11-24**] 08:18 JOB#: [**Job Number 29664**]

410,414,416,428,430,396,250,403,070

{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Primary pulmonary hypertension,Congestive heart failure, unspecified,Subarachnoid hemorrhage,Mitral valve insufficiency and aortic valve stenosis,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic hepatitis C without mention of hepatic coma'}

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 64-year-old Spanish speaking insulin and hemodialysis dependent woman who presents as a transfer from [**Hospital3 417**] Hospital for chest pain and short of breath. The patient initially presented on [**2191-9-26**] with dyspnea and leg pain which apparently was chronic. Upon admission it was thought she was volume overloaded and therefore the next day she was dialyzed and 6 kilograms were removed. At that time she was also started on Heparin and ruled out for pulmonary embolism with a CT angiogram which was negative. After she was dialyzed her oxygenation improved but shortly afterwards her oxygenation saturation dropped to 70% on room air and she became hypotensive to the 70's. She was volume resuscitated and started on Dopamine. Afterwards the cardiac enzymes were positive for Troponin of 13, CK of 116 and MB of 13.5. At that time she developed mild neck pain while patient's Heparin was restarted and the patient was prepared for transfer to the [**Hospital1 69**] for cardiac catheterization. MEDICAL HISTORY: 1. Coronary artery disease. Echo in [**2191-5-27**] showed EF of 65% with evidence of left ventricular hypertrophy, right atrial enlargement, mild ASA, pulmonary artery pressure of 77 mm of mercury. She has a MIBI in [**2191-5-27**] that showed ejection fraction of 75% with a fixed lateral wall defect and dilated RV with no reversibility. MEDICATION ON ADMISSION: ALLERGIES: Penicillin. PHYSICAL EXAM: FAMILY HISTORY: Insulin dependent diabetes mellitus. SOCIAL HISTORY: No tobacco use. ### Response: {'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Primary pulmonary hypertension,Congestive heart failure, unspecified,Subarachnoid hemorrhage,Mitral valve insufficiency and aortic valve stenosis,Diabetes with renal manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Chronic hepatitis C without mention of hepatic coma'}

CHIEF COMPLAINT: s/p fall off bicycle RUQ pain PRESENT ILLNESS: 26-year-old male who was injured in a bicycle crash this afternoon. On CT scan of the abdomen he had a grade V rupture of the spleen with greater than 1 liter of blood in the peritoneal cavity. He had fresh extravasation in the hilum suggesting this was a non salvageable circumstance. The patient had not yet become hypotensive, but while being brought up to the preoperative holding area he dropped his pressure. The patient was taken to the operating room emergently for splenectomy. MEDICAL HISTORY: Depression MEDICATION ON ADMISSION: Wellbutrin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Married

Injury to spleen without mention of open wound into cavity, massive parenchymal disruption,Pedal cycle accident injuring pedal cyclist

Spleen disruption-clos,Ped cycl acc-ped cyclist

Admission Date: [**2111-1-26**] Discharge Date: [**2111-1-30**] Date of Birth: [**2084-5-1**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4691**] Chief Complaint: s/p fall off bicycle RUQ pain Major Surgical or Invasive Procedure: [**2111-1-26**] Splenectomy History of Present Illness: 26-year-old male who was injured in a bicycle crash this afternoon. On CT scan of the abdomen he had a grade V rupture of the spleen with greater than 1 liter of blood in the peritoneal cavity. He had fresh extravasation in the hilum suggesting this was a non salvageable circumstance. The patient had not yet become hypotensive, but while being brought up to the preoperative holding area he dropped his pressure. The patient was taken to the operating room emergently for splenectomy. Past Medical History: Depression Social History: Married Family History: Noncontributory Pertinent Results: [**2111-1-26**] 09:24PM GLUCOSE-180* UREA N-14 CREAT-0.7 SODIUM-141 POTASSIUM-4.3 CHLORIDE-113* TOTAL CO2-22 ANION GAP-10 [**2111-1-26**] 09:24PM WBC-13.7* RBC-3.93*# HGB-11.9*# HCT-34.4*# MCV-88 MCH-30.3 MCHC-34.6 RDW-13.0 [**2111-1-26**] 09:24PM PLT SMR-NORMAL PLT COUNT-276# [**2111-1-26**] 09:24PM PT-13.9* PTT-28.4 INR(PT)-1.2* [**2111-1-26**] 07:47PM GLUCOSE-169* LACTATE-2.4* NA+-134* K+-4.5 CL--106 [**2111-1-26**] 07:46PM WBC-10.5 RBC-2.22*# HGB-6.8*# HCT-19.7*# MCV-89 MCH-30.7 MCHC-34.5 RDW-13.1 [**2111-1-26**] 05:00PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG CT ABDOMEN W/CONTRAST; CT PELVIS W/CONTRAST Reason: evaluate for spleen injury, rib fx, other injury Field of view: 36 Contrast: OPTIRAY [**Hospital 93**] MEDICAL CONDITION: 26 year old man with significant LUQ tenderness/pain after bicycle accident REASON FOR THIS EXAMINATION: evaluate for spleen injury, rib fx, other injury CONTRAINDICATIONS for IV CONTRAST: None. CT OF THE ABDOMEN AND PELVIS WITH CONTRAST DATED [**2111-1-26**]. HISTORY: 26-year-old man with significant left upper quadrant tenderness, following bicycle accident; evaluate for splenic injury or rib fracture. TECHNIQUE: Helical 5-mm axial MDCT sections were obtained from the lung bases through the pubic symphysis without oral but during dynamic intravenous contrast administration; coronal and sagittal reformations were also obtained, and all images are viewed in soft tissue, lung and bone window on a workstation. Additional delayed images were also obtained through the abdomen and pelvis, at thirteen minutes. FINDINGS: There is a large amount of dense ascites throughout the upper abdomen, particularly around the spleen. There is an extensive laceration involving virtually the entire splenic lower and mid-pole, with appearance of fragmentation and large areas of hypoperfusion, representing a so-called "shattered spleen." While there is a slightly prominent vascular blush at the splenic hilum (2:18-20), there is no definite contrast pooling to specifically suggest active arterial extravasation. However, though follow-up imaging was, unfortunately, obtained with a protracted, 13 minute delay, there is significantly increased attenuation (up to 90-100 [**Doctor Last Name **]) within and immediately adjacent to the spleen, particularly anteriorly, strongly suggestive of extravasated contrast material; similar relatively high-attenuation material is not seen adjacent to the liver, in the right pericolic gutter or in the dependent pelvis, where there is abundant ascites measuring 40-60 [**Doctor Last Name **], representing further hemoperitoneum. Other than dependent atelectasis, the lung bases are clear, with no pleural effusion, and no lower rib fracture is identified. The limited included portion of the heart and pericardium is grossly unremarkable. No hepatic laceration, or other visceral injury is seen. The stomach (with abundant retained fluid and debris), pancreas, gallbladder, and both adrenal glands are unremarkable, and both kidneys enhance and excrete contrast normally. Of note although the abdominal aorta appears normal in caliber and opacification, the IVC appears relatively flat and slit-like, with marked renal parenchymal and intestinal mucosal enhancement, as may be seen in the post-traumatic "hypoperfusion complex." There is no evident vascular, bowel, or mesenteric injury in the abdomen or pelvis. The bladder, prostate gland, and seminal vesicles are grossly unremarkable. No vertebral, sacral, pelvic or proximal femoral fracture is identified. IMPRESSION: 1. Extensive, grade V splenic injury with the appearance of a "shattered spleen." 2. Associated large hemoperitoneum with some evidence of contrast extravasation on delayed imaging. 3. Renal parenchymal and bowel mucosal hyperenhancement with relatively collapsed IVC; in this context, the findings are worrisome for "hypoperfusion complex." 4. No other visceral injury. 5. Unremarkable lung bases, with no basilar pneumothorax. 6. No rib or other fracture identified. Brief Hospital Course: He was admitted to the Trauma service and taken emergently to the operating room for splenectomy. There were no intraoperative complications; postoperatively he was taken to the Trauma ICU where he remained for several days. He was later transferred to the regular nursing unit. He initially required intravenous narcotics for pain control and was later changed to oral narcotics with adequate response. His diet was advanced and he was ambulating independently at time of discharge. The appropriate vaccinations were administered prior to discharge. He was discharged to home on hospital day 5. Medications on Admission: Wellbutrin Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*75 Tablet(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Bupropion 150 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO Q 24H (Every 24 Hours). 4. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical [**Hospital1 **] (2 times a day). 5. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 6. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day) as needed for constipation. 8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: s/p Fall from bicycle Splenic rupture - Grade V injury Discharge Condition: Good Discharge Instructions: Return to the Emergency room if you develop any fevers, chills, headache, dizziness, increased pain, redness or drainage from your incision, nausea, vomiting, diarrhea and/or any other symptoms that are concerning to you. Because of your spleen being removed you were given vaccines to protect you against certain diseases. Followup Instructions: Follow up next week with Dr. [**Last Name (STitle) **] for removal of your staples; call [**Telephone/Fax (1) 6429**] for an appointment. Completed by:[**2111-7-10**]

865,E826

{'Injury to spleen without mention of open wound into cavity, massive parenchymal disruption,Pedal cycle accident injuring pedal cyclist'}

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 off bicycle RUQ pain PRESENT ILLNESS: 26-year-old male who was injured in a bicycle crash this afternoon. On CT scan of the abdomen he had a grade V rupture of the spleen with greater than 1 liter of blood in the peritoneal cavity. He had fresh extravasation in the hilum suggesting this was a non salvageable circumstance. The patient had not yet become hypotensive, but while being brought up to the preoperative holding area he dropped his pressure. The patient was taken to the operating room emergently for splenectomy. MEDICAL HISTORY: Depression MEDICATION ON ADMISSION: Wellbutrin ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Married ### Response: {'Injury to spleen without mention of open wound into cavity, massive parenchymal disruption,Pedal cycle accident injuring pedal cyclist'}

CHIEF COMPLAINT: dyspnea on exertion PRESENT ILLNESS: This 80 year old man with a history of polymyalgia rheumatica on chronic steroids and aortic stenosis that has been followed by serial echocardiograms for many years. He has noted a decline in his activity tolerance over the past six months. Dyspnea with limited amounts of activity and several episodes of exertional lightheadedness with no syncope. He is now being referred for cardiac catheterization to assess his aortic valve. MEDICAL HISTORY: Severe Aortic stenosis Hypertension Hyperlipidemia Polymyalgia rheumatica on chronic steroids Recent nose bleeds requiring cauterization (aspirin since d/c'd) Thrombocytopenia GERD Right sided sciatica Gout Hard of hearing (right sided hearing aid) Carpal tunnel syndrome bilaterally (wearing splints at night) Arthritis Right shoulder surgery for a "separation" MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Allopurinol 100 mg PO DAILY 2. Fluticasone-Salmeterol Diskus (250/50) 2 INH IH [**Hospital1 **] 3. Hydrochlorothiazide 25 mg PO DAILY 4. Lisinopril 20 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Pravastatin 10 mg PO DAILY 7. PredniSONE 6 mg PO DAILY 8. Calcium Carbonate 500 mg PO DAILY 9. Vitamin D [**2183**] UNIT PO DAILY ALLERGIES: Lipitor / lovastatin / furosemide PHYSICAL EXAM: Admission exam: Pulse:58 B/P Right: Left:138/62 Resp:20 O2 sat:100% RA Height:175cm Weight:93.4kg General:NAD, AAOx3,No focal deficits Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [] Irregular [x] Murmur [] grade _3/6_____ 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:+2 Left:+2 DP Right:+1 Left:+1 PT [**Name (NI) 167**]:+2 Left:+2 Radial Right:Cath site Left:+2 Carotid Bruit: None Discahrge exam: VS 98.9 76 120/62 18 97% RA wt 102.1kg Gen: NAD Neuro: A&O x3, MAE. nonfocal exam Pulm: CTA-bilat CV: RRR, no murmur. Sternum stable-incision CDI Abdm: soft, NT/ND/+BS Ext: warm, well perfused. 2+ pedal edema bilat FAMILY HISTORY: Father died at age 77 from unknown causes, might have had a stroke. Mother with "cardiac disease", dying in her 50's from a "giant embolism" SOCIAL HISTORY: lives with his wife and is retied. He does not smoke cigarettes. Consumes [**3-17**] alcoholic beverages per week. He denies use of illigal drugs.

Aortic valve disorders,Atrial flutter,Hemorrhage complicating a procedure,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Polymyalgia rheumatica,Gout, unspecified,Thrombocytopenia, unspecified,Esophageal reflux,Unspecified hearing loss,Arthropathy, unspecified, site unspecified,Long-term (current) use of steroids,Carpal tunnel syndrome,Other iatrogenic hypotension,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,Accidents occurring in residential institution,Anemia, unspecified

Aortic valve disorder,Atrial flutter,Hemorrhage complic proc,Pleural effusion NOS,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Polymyalgia rheumatica,Gout NOS,Thrombocytopenia NOS,Esophageal reflux,Hearing loss NOS,Arthropathy NOS-unspec,Long-term use steroids,Carpal tunnel syndrome,Iatrogenc hypotnsion NEC,Abn react-anastom/graft,Accid in resident instit,Anemia NOS

Admission Date: [**2195-10-2**] Discharge Date: [**2195-10-8**] Date of Birth: [**2114-9-24**] Sex: M Service: CARDIOTHORACIC Allergies: Lipitor / lovastatin / furosemide Attending:[**First Name3 (LF) 1505**] Chief Complaint: dyspnea on exertion Major Surgical or Invasive Procedure: [**2195-10-2**] aortic valve replacement(tissue 25mm), coronary artery bypass grafting times two with Left Internal Mammary Artery to Left Anterior Descending artery and reverse Saphenous Vein Graft to Obtuse Marginal artery. History of Present Illness: This 80 year old man with a history of polymyalgia rheumatica on chronic steroids and aortic stenosis that has been followed by serial echocardiograms for many years. He has noted a decline in his activity tolerance over the past six months. Dyspnea with limited amounts of activity and several episodes of exertional lightheadedness with no syncope. He is now being referred for cardiac catheterization to assess his aortic valve. Past Medical History: Severe Aortic stenosis Hypertension Hyperlipidemia Polymyalgia rheumatica on chronic steroids Recent nose bleeds requiring cauterization (aspirin since d/c'd) Thrombocytopenia GERD Right sided sciatica Gout Hard of hearing (right sided hearing aid) Carpal tunnel syndrome bilaterally (wearing splints at night) Arthritis Right shoulder surgery for a "separation" Social History: lives with his wife and is retied. He does not smoke cigarettes. Consumes [**3-17**] alcoholic beverages per week. He denies use of illigal drugs. Family History: Father died at age 77 from unknown causes, might have had a stroke. Mother with "cardiac disease", dying in her 50's from a "giant embolism" Physical Exam: Admission exam: Pulse:58 B/P Right: Left:138/62 Resp:20 O2 sat:100% RA Height:175cm Weight:93.4kg General:NAD, AAOx3,No focal deficits Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [] Irregular [x] Murmur [] grade _3/6_____ 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:+2 Left:+2 DP Right:+1 Left:+1 PT [**Name (NI) 167**]:+2 Left:+2 Radial Right:Cath site Left:+2 Carotid Bruit: None Discahrge exam: VS 98.9 76 120/62 18 97% RA wt 102.1kg Gen: NAD Neuro: A&O x3, MAE. nonfocal exam Pulm: CTA-bilat CV: RRR, no murmur. Sternum stable-incision CDI Abdm: soft, NT/ND/+BS Ext: warm, well perfused. 2+ pedal edema bilat Pertinent Results: [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT BP (mm Hg): 129/69 Wgt (lb): 207 HR (bpm): 56 BSA (m2): 2.10 m2 Indication: Aortic valve disease. Coronary artery disease. Left ventricular function. Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: *5.2 cm <= 4.0 cm Left Atrium - Four Chamber Length: 4.7 cm <= 5.2 cm Right Atrium - Four Chamber Length: 4.7 cm <= 5.0 cm 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: 4.3 cm <= 5.6 cm Left Ventricle - Systolic Dimension: 2.4 cm Left Ventricle - Fractional Shortening: 0.44 >= 0.29 Left Ventricle - Ejection Fraction: >= 65% >= 55% Left Ventricle - Stroke Volume: 125 ml/beat Left Ventricle - Cardiac Output: 7.02 L/min Left Ventricle - Cardiac Index: 3.35 >= 2.0 L/min/M2 Left Ventricle - Lateral Peak E': *0.03 m/s > 0.08 m/s Left Ventricle - Septal Peak E': *0.04 m/s > 0.08 m/s Left Ventricle - Ratio E/E': *26 < 15 Aorta - Sinus Level: 3.6 cm <= 3.6 cm Aorta - Ascending: *3.6 cm <= 3.4 cm Aorta - Arch: 3.0 cm <= 3.0 cm Aortic Valve - Peak Velocity: *5.1 m/sec <= 2.0 m/sec Aortic Valve - Peak Gradient: *106 mm Hg < 20 mm Hg Aortic Valve - Mean Gradient: 67 mm Hg Aortic Valve - LVOT pk vel: 1.19 m/sec Aortic Valve - LVOT VTI: 33 Aortic Valve - LVOT diam: 2.2 cm Aortic Valve - Valve Area: *0.8 cm2 >= 3.0 cm2 Mitral Valve - E Wave: 0.9 m/sec Mitral Valve - A Wave: 1.3 m/sec Mitral Valve - E/A ratio: 0.69 Mitral Valve - E Wave deceleration time: *343 ms 140-250 ms Pulmonic Valve - Peak Velocity: 1.1 m/sec <= 1.5 m/sec Findings This study was compared to the prior study of [**2195-2-6**]. LEFT ATRIUM: Mild LA enlargement. RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. LEFT VENTRICLE: Mild symmetric LVH with normal cavity size and regional/global systolic function (LVEF>55%). TDI E/e' >15, suggesting PCWP>18mmHg. No resting or Valsalva inducible LVOT gradient. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. Mildly dilated ascending aorta. Normal aortic arch diameter. No 2D or Doppler evidence of distal arch coarctation. AORTIC VALVE: Severely thickened/deformed aortic valve leaflets. Severe AS (area 0.8-1.0cm2). No AR. MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP. Mild mitral annular calcification. Calcified tips of papillary muscles. Trivial MR. TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial TR. Indeterminate PA systolic pressure. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. PERICARDIUM: No pericardial effusion. GENERAL COMMENTS: Suboptimal image quality - poor subcostal views. Conclusions The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>65%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). There is no left ventricular outflow obstruction at rest or with Valsalva. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets are severely thickened/deformed. There is severe aortic valve stenosis (valve area 0.8cm2). No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. IMPRESSION: Severe aortic valve stenosis. Mild symmetric left ventricular hypertrophy with preserved regional and excellent global biventricular systolic function. Increased PCWP. Compared with the prior study (images reviewed) of [**2195-2-6**], the aortic valve gradient is slightly higher. Admission labs: [**2195-10-2**] 11:21AM PT-15.3* PTT-29.9 INR(PT)-1.4* [**2195-10-2**] 11:21AM PLT SMR-LOW PLT COUNT-88* [**2195-10-2**] 01:45PM UREA N-17 CREAT-0.7 SODIUM-141 POTASSIUM-3.9 CHLORIDE-113* TOTAL CO2-21* ANION GAP-11 [**2195-10-2**] 01:46PM freeCa-1.05* [**2195-10-2**] 01:03PM WBC-15.9*# RBC-2.81* HGB-8.4* HCT-25.1*# MCV-89 MCH-29.7 MCHC-33.4 RDW-15.1 Discharge Labs: [**2195-10-8**] 06:09AM BLOOD WBC-8.0 RBC-3.06* Hgb-9.1* Hct-27.7* MCV-91 MCH-29.9 MCHC-33.0 RDW-14.5 Plt Ct-171 [**2195-10-8**] 06:09AM BLOOD Plt Ct-171 [**2195-10-6**] 05:23AM BLOOD PT-13.2* PTT-29.4 INR(PT)-1.2* [**2195-10-8**] 06:09AM BLOOD Glucose-117* UreaN-24* Creat-0.7 Na-135 K-4.2 Cl-96 HCO3-31 AnGap-12 Radiology Report CHEST (PA & LAT) Study Date of [**2195-10-7**] 1:38 PM Final Report: A small right and moderate-to-large left pleural effusion are unchanged since the prior exam yesterday. Central pulmonary vascular congestion has significantly improved. Sternotomy wires are intact and mediastinal clips are in unchanged position. A right-sided internal jugular catheter tip remains in the low SVC. IMPRESSION: Stable small right and moderate-to-large left effusions. Brief Hospital Course: The patient was a same day admission and was brought to the Operating Room on [**2195-10-2**] where the patient underwent an Aortic Valve Rreplacement(tissue 25mm) and Coronary artery bypass grafting times two with Left Internal Mammary Artery to Left Anterior Descending artery and reverse Saphenous Vein Graft to Obtuse Marginal artery. His cardiopulmonary bypass time was 90 minutes with a crossclamp of 73 minutes. Overall the patient tolerated the procedure well and post-operatively was transferred to the CVICU in stable condition for recovery and invasive monitoring. He had some post-operative bleeding and was transfused with several units of packed red blood cells, fresh frozen plasma and received Protamine with resolution of bleeding. Post-operative day one found the patient extubated, alert and oriented and breathing comfortably. The patient was neurologically intact and hemodynamically stable. Over the next 48hours he was weaned from pressor support and beta blockers were initiated, the patient was gently diuresed toward his preoperative weight. On POD3 the patient was transferred to the telemetry floor for further recovery. Chest tubes and pacing wires were discontinued per cardiac surgery guidelines without complication. The patient worked with the physical therapy service for assistance with strength and mobility. By the time of discharge on post-operative day 6 the patient was ambulating with assistance, the wound was healing and pain was controlled with oral analgesics. The patient was discharged to Life Care Center of [**Location 15289**] in good condition with appropriate follow up instructions. Medications on Admission: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Allopurinol 100 mg PO DAILY 2. Fluticasone-Salmeterol Diskus (250/50) 2 INH IH [**Hospital1 **] 3. Hydrochlorothiazide 25 mg PO DAILY 4. Lisinopril 20 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Pravastatin 10 mg PO DAILY 7. PredniSONE 6 mg PO DAILY 8. Calcium Carbonate 500 mg PO DAILY 9. Vitamin D [**2183**] UNIT PO DAILY Discharge Medications: 1. Acetaminophen 650 mg PO/PR Q4H:PRN temperature >38.0 2. Aspirin EC 81 mg PO DAILY if extubated 3. Docusate Sodium 100 mg PO BID 4. Milk of Magnesia 30 mL PO DAILY:PRN constipation 5. Omeprazole 20 mg PO DAILY 6. Fluticasone-Salmeterol Diskus (250/50) 2 INH IH [**Hospital1 **] 7. Vitamin D [**2183**] UNIT PO DAILY 8. Calcium Carbonate 500 mg PO DAILY 9. Allopurinol 100 mg PO DAILY 10. Pravastatin 10 mg PO DAILY 11. PredniSONE 6 mg PO DAILY 12. Metoprolol Tartrate 12.5 mg PO BID hold HR<55 SBP<100 13. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth every six (6) hours Disp #*50 Tablet Refills:*0 14. Metolazone 5 mg PO BID 15. Furosemide 40 mg PO BID 16. Potassium Chloride 20 mEq PO BID Hold for K > 4.5 Discharge Disposition: Extended Care Facility: Life Care Center of [**Location 15289**] Discharge Diagnosis: aortic stenosis coronary artery disease Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with Ultram Sternal Incision - healing well, no erythema or drainage Edema- 2+ bilat Discharge Instructions: Please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 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 one month or while taking narcotics. Driving will be discussed at follow up appointment with surgeon. No lifting more than 10 pounds for 10 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** Followup Instructions: You are scheduled for the following appointments: Wound Check-Cardiac Surgery Office Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2195-10-20**] 10:30 Surgeon- Dr. [**First Name (STitle) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2195-11-4**] 1:15 Cardiologist- [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D. Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2195-11-5**] 7:40 Please call to schedule the following: Primary Care Dr.[**Last Name (STitle) **],[**First Name3 (LF) **] D. [**Telephone/Fax (1) 3329**] in [**5-14**] 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:[**2195-10-8**]

424,427,998,511,414,401,272,725,274,287,530,389,716,V586,354,458,E878,E849,285

{'Aortic valve disorders,Atrial flutter,Hemorrhage complicating a procedure,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Polymyalgia rheumatica,Gout, unspecified,Thrombocytopenia, unspecified,Esophageal reflux,Unspecified hearing loss,Arthropathy, unspecified, site unspecified,Long-term (current) use of steroids,Carpal tunnel syndrome,Other iatrogenic hypotension,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,Accidents occurring in residential institution,Anemia, 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: dyspnea on exertion PRESENT ILLNESS: This 80 year old man with a history of polymyalgia rheumatica on chronic steroids and aortic stenosis that has been followed by serial echocardiograms for many years. He has noted a decline in his activity tolerance over the past six months. Dyspnea with limited amounts of activity and several episodes of exertional lightheadedness with no syncope. He is now being referred for cardiac catheterization to assess his aortic valve. MEDICAL HISTORY: Severe Aortic stenosis Hypertension Hyperlipidemia Polymyalgia rheumatica on chronic steroids Recent nose bleeds requiring cauterization (aspirin since d/c'd) Thrombocytopenia GERD Right sided sciatica Gout Hard of hearing (right sided hearing aid) Carpal tunnel syndrome bilaterally (wearing splints at night) Arthritis Right shoulder surgery for a "separation" MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete. Information was obtained from Patient. 1. Allopurinol 100 mg PO DAILY 2. Fluticasone-Salmeterol Diskus (250/50) 2 INH IH [**Hospital1 **] 3. Hydrochlorothiazide 25 mg PO DAILY 4. Lisinopril 20 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Pravastatin 10 mg PO DAILY 7. PredniSONE 6 mg PO DAILY 8. Calcium Carbonate 500 mg PO DAILY 9. Vitamin D [**2183**] UNIT PO DAILY ALLERGIES: Lipitor / lovastatin / furosemide PHYSICAL EXAM: Admission exam: Pulse:58 B/P Right: Left:138/62 Resp:20 O2 sat:100% RA Height:175cm Weight:93.4kg General:NAD, AAOx3,No focal deficits Skin: Dry [x] intact [x] HEENT: PERRLA [x] EOMI [x] Neck: Supple [x] Full ROM [x] Chest: Lungs clear bilaterally [x] Heart: RRR [] Irregular [x] Murmur [] grade _3/6_____ 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:+2 Left:+2 DP Right:+1 Left:+1 PT [**Name (NI) 167**]:+2 Left:+2 Radial Right:Cath site Left:+2 Carotid Bruit: None Discahrge exam: VS 98.9 76 120/62 18 97% RA wt 102.1kg Gen: NAD Neuro: A&O x3, MAE. nonfocal exam Pulm: CTA-bilat CV: RRR, no murmur. Sternum stable-incision CDI Abdm: soft, NT/ND/+BS Ext: warm, well perfused. 2+ pedal edema bilat FAMILY HISTORY: Father died at age 77 from unknown causes, might have had a stroke. Mother with "cardiac disease", dying in her 50's from a "giant embolism" SOCIAL HISTORY: lives with his wife and is retied. He does not smoke cigarettes. Consumes [**3-17**] alcoholic beverages per week. He denies use of illigal drugs. ### Response: {'Aortic valve disorders,Atrial flutter,Hemorrhage complicating a procedure,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Polymyalgia rheumatica,Gout, unspecified,Thrombocytopenia, unspecified,Esophageal reflux,Unspecified hearing loss,Arthropathy, unspecified, site unspecified,Long-term (current) use of steroids,Carpal tunnel syndrome,Other iatrogenic hypotension,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,Accidents occurring in residential institution,Anemia, unspecified'}

CHIEF COMPLAINT: Abdominal pain PRESENT ILLNESS: 72 year old female with history significant only for hypothyroidism, who has been experiencing abdominal pain, nausea and vomiting since about 1 pm on [**5-23**]. The emesis worsened as did the groin pain over the course of the next several hours and patient decided to come to the ED. She reports last bowel movement at greater than 24 hours ago and denies passing any flatus since the pain began, approximately 12 hours ago. Patient has never experienced this before. She denies any fevers, chills, hematemesis. MEDICAL HISTORY: Hypothyroidism MEDICATION ON ADMISSION: levothyroxine 50 mcg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Upon admission to [**Hospital1 18**]: Temp: 97.7 HR: 63 BP: 132/55 Resp: 16 O(2)Sat: 100 Normal FAMILY HISTORY: Noncontibutory SOCIAL HISTORY:

Femoral hernia with gangrene, unilateral or unspecified (not specified as recurrent),Other ascites,Unspecified acquired hypothyroidism,Atrial fibrillation,Other iatrogenic hypotension,Other antihypertensive agents causing adverse effects in therapeutic use

Unil femoral hern w gang,Ascites NEC,Hypothyroidism NOS,Atrial fibrillation,Iatrogenc hypotnsion NEC,Adv eff antihyperten agt

Admission Date: [**2122-5-24**] Discharge Date: [**2122-5-28**] Date of Birth: [**2049-11-29**] Sex: F Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 4691**] Chief Complaint: Abdominal pain Major Surgical or Invasive Procedure: [**2122-5-24**] Exploratory Laparotomy, Small Bowel Resection, Right Femoral Hernia Repair History of Present Illness: 72 year old female with history significant only for hypothyroidism, who has been experiencing abdominal pain, nausea and vomiting since about 1 pm on [**5-23**]. The emesis worsened as did the groin pain over the course of the next several hours and patient decided to come to the ED. She reports last bowel movement at greater than 24 hours ago and denies passing any flatus since the pain began, approximately 12 hours ago. Patient has never experienced this before. She denies any fevers, chills, hematemesis. Past Medical History: Hypothyroidism Family History: Noncontibutory Physical Exam: Upon admission to [**Hospital1 18**]: Temp: 97.7 HR: 63 BP: 132/55 Resp: 16 O(2)Sat: 100 Normal Constitutional: Comfortable HEENT: Extraocular muscles intact, Normocephalic, atraumatic Oropharynx within normal limits Chest: Clear to auscultation Cardiovascular: Regular Rate and Rhythm, Normal first and second heart sounds Abdominal: Soft, Nontender, firm 5 cm mass in the right inguinal area, nontender. GU/Flank: No costovertebral angle tenderness Extr/Back: No cyanosis, clubbing or edema Skin: No rash, Warm and dry Neuro: Speech fluent Psych: Normal mood, Normal mentation Pertinent Results: [**2122-5-24**] 02:16PM GLUCOSE-157* UREA N-9 CREAT-0.6 SODIUM-139 POTASSIUM-3.6 CHLORIDE-105 TOTAL CO2-24 ANION GAP-14 [**2122-5-24**] 02:16PM CALCIUM-8.3* PHOSPHATE-3.1 MAGNESIUM-1.7 [**2122-5-24**] 02:16PM WBC-12.6* RBC-3.95* HGB-12.2 HCT-35.3* MCV-89 MCH-31.0 MCHC-34.7 RDW-13.1 [**2122-5-24**] 02:16PM PLT COUNT-298 [**2122-5-24**] 09:10AM CALCIUM-8.6 PHOSPHATE-2.8 MAGNESIUM-1.9 [**2122-5-23**] 10:10PM ALT(SGPT)-31 AST(SGOT)-24 ALK PHOS-78 TOT BILI-0.6 [**2122-5-23**] 10:10PM LIPASE-25 [**2122-5-23**] 10:10PM ALBUMIN-3.9 CT Abd/pelvis: IMPRESSION: 1. Right femoral hernia with mild dilatation of bowel loops proximal and collapse of bowel loops distally consistent with mechanical small bowel obstruction. 2. Significant dilatation of the stomach. 3. Sigmoid colon diverticulosis without diverticulitis. 4. Small segment VII liver lesion might be further worked up with ultrasound. Brief Hospital Course: She was admitted to the Acute Care Service where she underwent CT imaging of her abdomen and pelvis showing right femoral hernia with mild dilatation of bowel loops proximal and collapse of bowel loops distally consistent with mechanical small bowel obstruction. She was taken to the operating room for repair of her hernia. There were no complications. Postoperatively her NG tube remained in place for a little over 24 hours. Her serial abdominal exams were followed very closely and remained stable. She had little NG output and began passing flatus and the NG was removed. Overnight on [**5-25**] she reported feeling "heart racing" but denied chest pain or shortness of breath. She was found to be in atrial fibrillation. 5mg Lopressor x2 and 5mg diltiazem x3 did not break the rhythm, however she remained hemodynamically stable. EKG showed rapid afib with RVR, 1st set of cardiac enzymes with negative troponin. She was transferred to the ICU and placed on a Diltiazem drip; the drip was turned off when she converted to NSR. She was started on 2.5mg Lopressor q6h but became hypotensive and the Lopressor was stopped. She remained in the ICU for 24 hours and in NSR. Her TSH was checked and was 5.1; at home she takes 50 mcg levothyroxine. She was given IV Levothyroxine while NPO and later changed back to her oral home dose. We are recommending that she follow up with her primary care doctor within the next week for ongoing evaluation of this. Once stable she was transferred back to the regular nursing unit. Once back to the regular nursing unit her diet was advanced for which she was able to tolerate. She was passing flatus and had a bowel movement on day of discharge. Her pain was well controlled and she was ambulating independently. Medications on Admission: levothyroxine 50 mcg daily Discharge Medications: 1. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Tylenol 325 mg Tablet Sig: Two (2) Tablet PO every 4-6 hours as needed for pain. 3. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*20 Tablet(s)* Refills:*0* 4. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 5. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: Right femoral hernia with incarcerated small bowel Atrial fibrillation 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 with an incarcerated hernia in your right groin which required an operation to repair. Following your operation you experienced an irregular heart rhythm called atrial fibrillation whcih was felt likley a reflection of your fluid volume status associated with your surgery. You were given medications to correct this irregularity which has now resolved. It is improtnat that you follow up with your PCP within the next week for ongoing follow up of this. You may resume your home medications as prescribed. You are being discharged on medications to treat the pain from your operation. These medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. You MUST refrain from such activities while taking these medications. Please call your doctor or return to the emergency room if you have any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * 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. * 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. Activity: No heavy lifting of items [**10-3**] pounds for 6 weeks. You may resume moderate exercise at your discretion, no abdominal exercises. Wound Care: You may shower, no tub baths or swimming. If there is clear drainage from your incisions, cover with clean, dry gauze. Your steri-strips will fall off on their own. Please remove any remaining strips 7-10 days after surgery. Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. Followup Instructions: Follow up in Acute Care Surgery clinic in [**1-22**] weeks, call [**Telephone/Fax (1) 600**] for an appointment. Follow up with your primary care doctor in the next 1-2 weeks for a general physical and for follow up of the irregular heart rhythm you experienced while in the hospital. Provider: [**Name10 (NameIs) **] DENSITY TESTING Phone:[**Telephone/Fax (1) 4586**] Date/Time:[**2122-8-20**] 9:00 Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2164**], MD Phone:[**Telephone/Fax (1) 1803**] Date/Time:[**2122-8-20**] 10:00 Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) 13532**], MD Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2122-8-20**] 11:20 Completed by:[**2122-5-28**]

551,789,244,427,458,E942

{'Femoral hernia with gangrene, unilateral or unspecified (not specified as recurrent),Other ascites,Unspecified acquired hypothyroidism,Atrial fibrillation,Other iatrogenic hypotension,Other antihypertensive agents 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: Abdominal pain PRESENT ILLNESS: 72 year old female with history significant only for hypothyroidism, who has been experiencing abdominal pain, nausea and vomiting since about 1 pm on [**5-23**]. The emesis worsened as did the groin pain over the course of the next several hours and patient decided to come to the ED. She reports last bowel movement at greater than 24 hours ago and denies passing any flatus since the pain began, approximately 12 hours ago. Patient has never experienced this before. She denies any fevers, chills, hematemesis. MEDICAL HISTORY: Hypothyroidism MEDICATION ON ADMISSION: levothyroxine 50 mcg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Upon admission to [**Hospital1 18**]: Temp: 97.7 HR: 63 BP: 132/55 Resp: 16 O(2)Sat: 100 Normal FAMILY HISTORY: Noncontibutory SOCIAL HISTORY: ### Response: {'Femoral hernia with gangrene, unilateral or unspecified (not specified as recurrent),Other ascites,Unspecified acquired hypothyroidism,Atrial fibrillation,Other iatrogenic hypotension,Other antihypertensive agents causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: Fibula/tibia fracture, alcohol detoxification and atrial fibrillation with rapid ventricular response. PRESENT ILLNESS: This is a 60 year old male who fell down some stairs while carrying a mattress after drinking alcohol. He was taken to an OSH ED where he was noted to have an ankle fracture which was splinted and then transferred to [**Hospital1 18**]. MEDICAL HISTORY: obtained from patient and OSH records -PUD, with history of significant GI bleed -Anxiety -Afib, ? PAF, no coumadin -Anemia -ETOH abuse -Denies any other medical problems including heart failure/CAD -Thrombocytopenia ? related to ETOH -h/o Calculus of kidney in [**2171**] -Arthritis MEDICATION ON ADMISSION: omeprazole 20 mg daily metoprolol 50 mg twice a day ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Transfer: Vitals: 99.7, 125/84, 168, 20, 98%2L General: sleepy but responds to questions. Oriented x2, having ankle pain, mildly tremulous. HEENT: Sclera anicteric, Pupils 1.5 mm with minimally reactive to light b/l, MMM, oropharynx clear, Neck: supple no elevation of JVP noted. Lungs: CTA b/l Heart: tachycardic, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses in LLE, RLE in wrapped Neuro: Awake, oriented x 2, unable to recall the name of the hospital. Pupils 1.5 mm with minimally reactive to light b/l. Spontaneously moves all 3 ext except RLE. Unable to perform complete Neuro exam due to patient's discomfort. FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: More than six beers per day. Last drink [**2176-12-21**] at noon. Approx 1 pk of cig per day. Denies street drugs. Lives alone with son and son's wife nearby. Is estranged from wife for many years. Sees son and has grandson of six years.

Closed fracture of unspecified part of fibula with tibia,Atrial flutter,Alcohol withdrawal delirium,Accidental fall on or from other stairs or steps,Thrombocytopenia, unspecified,Other vitamin B12 deficiency anemia

Fx tibia w fibula NOS-cl,Atrial flutter,Delirium tremens,Fall on stair/step NEC,Thrombocytopenia NOS,B12 defic anemia NEC

Admission Date: [**2176-12-22**] Discharge Date: [**2176-12-24**] Date of Birth: [**2116-10-5**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: Fibula/tibia fracture, alcohol detoxification and atrial fibrillation with rapid ventricular response. Major Surgical or Invasive Procedure: Closed reduction fibula fracture, open reduction internal fixation right distal tibia pilon fracture with external fixation in order to restore anatomical length. History of Present Illness: This is a 60 year old male who fell down some stairs while carrying a mattress after drinking alcohol. He was taken to an OSH ED where he was noted to have an ankle fracture which was splinted and then transferred to [**Hospital1 18**]. In the ED, initial VS were 96.2 78 136/74 14 100. EKG showed afib. After manipulating the ankle, the patient had an episode of RVR, BP remained stable. Patient given diltiazem IV 10mg x2 and IVF (? 2LNS). His rate then came down to 90s. Night float resident has asked the ED to give the patient his morning dose of 50 po metoprolol. He also recieved 2mg ativan once for possible ETOH withdrawl. CT ankle showed comminuted fractures of the tibia and the fibula. Patient seen by ortho who will take the patient to surgery when his afib w/RVR is under control. Pre-op U/A, CXR, EKG labs all finished. On the floor, patient was still in pain. His HR increased to 160s (appeared aflutter with 2:1 block) with BP to 130/102. He recieved 10 mg IV dilt soon after his arrival and HR improved to 100s (approx 9am on [**2176-12-22**]) His heart rate improved for approx 30-45 minutes. He then went back to a heart rate of 160s. At 10:30 on same day he was given metoprolol 10mg IV and again his heart rate responded to the 100s for about 30-45 minutes. He was then started on lopressor 10mg IV q6 as he was having some emesis and it was unclear if he would keep down PO medication. He is in significant amount of ankle pain especially with transfer. He denies any chest pain, shortness of breath, headache, change in vision/hearing, fever, chills, nightsweats, cough, cold, abdominal pain, bleeding. No other complaints. Past Medical History: obtained from patient and OSH records -PUD, with history of significant GI bleed -Anxiety -Afib, ? PAF, no coumadin -Anemia -ETOH abuse -Denies any other medical problems including heart failure/CAD -Thrombocytopenia ? related to ETOH -h/o Calculus of kidney in [**2171**] -Arthritis Social History: More than six beers per day. Last drink [**2176-12-21**] at noon. Approx 1 pk of cig per day. Denies street drugs. Lives alone with son and son's wife nearby. Is estranged from wife for many years. Sees son and has grandson of six years. Family History: Non-contributory. Physical Exam: On Transfer: Vitals: 99.7, 125/84, 168, 20, 98%2L General: sleepy but responds to questions. Oriented x2, having ankle pain, mildly tremulous. HEENT: Sclera anicteric, Pupils 1.5 mm with minimally reactive to light b/l, MMM, oropharynx clear, Neck: supple no elevation of JVP noted. Lungs: CTA b/l Heart: tachycardic, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses in LLE, RLE in wrapped Neuro: Awake, oriented x 2, unable to recall the name of the hospital. Pupils 1.5 mm with minimally reactive to light b/l. Spontaneously moves all 3 ext except RLE. Unable to perform complete Neuro exam due to patient's discomfort. At discharge: Vitals: 99.1 , 165/70, 107, 21, 93% RA General: Aggitated and non-compliant (had also removed leads and PIV, refusing meds). Oriented to person and place, year. HEENT: Sclera anicteric, PEARL, OP clear. Neck: supple, no elevation of JVP Lungs: CTA b/l Heart: tachycardic and irregular, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses in LLE, RLE in wrapped Pertinent Results: 139 104 11 AGap=18 --------------111 ALT: 35 AP: 93 Tbili: 0.3 Alb: 4.1 AST: 46 LDH: 189 Lip: 23 Serum EtOH 33 Serum Benzo Pos Serum ASA, Acetmnphn, Barb, Tricyc Negative TSH:2.7 Vit-B12:248 Folate:13.0 Iron: 72 calTIBC: 315 Ferritn: 240 TRF: 242 12.4 4.3-----92 36.9 Diff: N:66.5 L:23.9 M:7.8 E:1.2 Bas:0.6 PT: 11.4 PTT: 27.7 INR: 0.9 On discharge: [**2176-12-24**] WBC-6.1 RBC-3.00* Hgb-10.8* Hct-31.9* MCV-107* MCH-36.1* MCHC-33.8 RDW-13.0 Plt Ct-98* Glucose-226* UreaN-8 Creat-0.8 Na-136 K-4.7 Cl-102 HCO3-24 AnGap-15 Calcium-8.6 Phos-2.1* Mg-1.9 Images: Comminuted fracture of the distal right fibula with medial angulation of the apex. Comminuted fx of the tibia with lateral displacement of the distal fragment by approx 7 mm. Fx involve bilateral malleoli. Soft tissue edema. ECG [**2176-12-22**] 0425: Aflutter with 2:1 block rate in 140s, left axis deviation, no concerning ischemic changes however no prior ECG to compare. ECG [**2176-12-22**] 0448: Afib with rate in 80s, left axis deviation, no other significant change compared to earlier tracing. Brief Hospital Course: 60 y/o M s/p fall during EtOH intoxication found to have comminuted fractures of the right tibia and the fibula. Afib/flutter with RVR Patient with first ECG that looked like 2:1 flutter and repeat after slowing down in ED that looked like A-fib. Likely RVR in setting of pain and EtOH intox as well as questionable intake of medications. After trial with PO medications, patient was started on Diltiazem drip for rate control. On [**12-23**] patient, went to OR for Ex-Fix of right ankle. Post-op patient experienced a brief and isolated run of ansymptomatic 14 beat VT. He was slowly transitioned to PO diltiazem and remained largely in normal sinus rhythm at the time of transfer to the floor. Diltiazem increased to 90 mg PO QID on the day of discharge. Ankle fracture After medical clearance, patient taken to OR on [**12-23**] for Ex-Fix of right ankle fracture. Post-operatively patient was started on dilaudid PCA for pain control. Patient began four weeks of anticoagulation with Lovenox per Orthopedics. ETOH Withdrawal Patient initially reported last drink on [**2176-12-21**] in the afternoon, but later said was on [**12-19**]. Patient was given thiamine, folate and multivitamin for ETOH. Patient was started on CIWA scale for ETOH withdrawal with his symptoms largely controlled by PO valium. On the final day, aggitation was most prominent with no other autonomic or motoric signs of withdrawal. On this final day CIWA was changed to 5-10 mg diazepam PO Q4H PRN. Anemia Macrocytic anemia felt to be [**1-29**] nutritional deficiency, primarily B12 with normal Fe and folate levels. Thrombocytopenia Thought to be due to alcoholism. Platelets were trended and remained stable. Psychiatric Mental Status Patient was aggitated and beligerant during the admission, particularly on the last day. We thought, as a team, that he had capacity, but that his judgement was very poor. He was not interested in anything but the most immediate of concerns, refusing medication stubbornly because he wanted to sleep, etc. He and his son both wanted him to leave AMA. His son was resigned to his father's non-compliance and threatened that his father would need to drink again if he was not given sufficient pain medications (he was given just six Percocet to cover him until seeing his doctor tomorrow). The son had been drinking when he arrived, so we were concerned that he might drive he, his six year-old son and father home. [**Name2 (NI) **] stated that his friend or wife could drive - security followed him to the car. Medications on Admission: omeprazole 20 mg daily metoprolol 50 mg twice a day Discharge Medications: 1. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) Subcutaneous DAILY (Daily). Disp:*14 14* Refills:*0* 2. Diltiazem HCl 30 mg Tablet Sig: Three (3) Tablet PO QID (4 times a day). Disp:*360 Tablet(s)* Refills:*2* 3. 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* 4. Percocet 2.5-325 mg Tablet Sig: 1-2 Tablets PO three times a day for 1 days. Disp:*6 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Ankle fracture (of both tibia/fibula). Atrial fibrillation. Alcohol withdrawal. Discharge Condition: Left against medical advice. Risks were explained to him, including those of uncontrolled atrial fibrillation - stroke, myocardial infarction - and those of poor care of the external fixation device and incision - including infection, sepsis. He was somewhat rate-controlled on discharge, moderately hypertensive.

823,427,291,E880,287,281

{'Closed fracture of unspecified part of fibula with tibia,Atrial flutter,Alcohol withdrawal delirium,Accidental fall on or from other stairs or steps,Thrombocytopenia, unspecified,Other vitamin B12 deficiency 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: Fibula/tibia fracture, alcohol detoxification and atrial fibrillation with rapid ventricular response. PRESENT ILLNESS: This is a 60 year old male who fell down some stairs while carrying a mattress after drinking alcohol. He was taken to an OSH ED where he was noted to have an ankle fracture which was splinted and then transferred to [**Hospital1 18**]. MEDICAL HISTORY: obtained from patient and OSH records -PUD, with history of significant GI bleed -Anxiety -Afib, ? PAF, no coumadin -Anemia -ETOH abuse -Denies any other medical problems including heart failure/CAD -Thrombocytopenia ? related to ETOH -h/o Calculus of kidney in [**2171**] -Arthritis MEDICATION ON ADMISSION: omeprazole 20 mg daily metoprolol 50 mg twice a day ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Transfer: Vitals: 99.7, 125/84, 168, 20, 98%2L General: sleepy but responds to questions. Oriented x2, having ankle pain, mildly tremulous. HEENT: Sclera anicteric, Pupils 1.5 mm with minimally reactive to light b/l, MMM, oropharynx clear, Neck: supple no elevation of JVP noted. Lungs: CTA b/l Heart: tachycardic, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding, no organomegaly Ext: Warm, well perfused, 2+ pulses in LLE, RLE in wrapped Neuro: Awake, oriented x 2, unable to recall the name of the hospital. Pupils 1.5 mm with minimally reactive to light b/l. Spontaneously moves all 3 ext except RLE. Unable to perform complete Neuro exam due to patient's discomfort. FAMILY HISTORY: Non-contributory. SOCIAL HISTORY: More than six beers per day. Last drink [**2176-12-21**] at noon. Approx 1 pk of cig per day. Denies street drugs. Lives alone with son and son's wife nearby. Is estranged from wife for many years. Sees son and has grandson of six years. ### Response: {'Closed fracture of unspecified part of fibula with tibia,Atrial flutter,Alcohol withdrawal delirium,Accidental fall on or from other stairs or steps,Thrombocytopenia, unspecified,Other vitamin B12 deficiency anemia'}

CHIEF COMPLAINT: Neutropenic fever, diffuse large B-cell lymphoma. PRESENT ILLNESS: Mr. [**Known lastname **] is a 59 year-old man with a history of diffuse large B-cell lymphoma s/p IVAC D11 who presents with fever, nausea and vomiting of 1 day duration. He was feeling overall well until this morning when he developed a fever of 102. He vomited twice (bilious, non-bloody). Denies abdominal pain or diarrhea. Denies cough, sore throat, rhinorrhea or headache. Denies sick contacts though was concerned his milk was old. Denies shortness of breath or chest pain. Denies rashes. Does report increased urinary frequency but no dysuria. Yesterday he went to his outpatient oncology appointment, received 1 unit platelets with no complications and felt well enough to walk home. . In the ED, initial vitals were T 100.3, BP 112/89, HR 94, RR 18, 100% NRB. During ED course Tmax 102.7. He was noted to be in AFib at a rate of 135-160 which improved without intervention. O2 sat 98-100% 2L. BP dropped to 76 and he was given 5L NS and started on levophed. He received vancomycin and cefepime before being transferred to the ICU. On arrival to the ICU patient was actively rigoring. . Patient recently admitted [**Date range (3) 21959**] and treated with IVAC chemotherapy x 5 days which was complicated by neutropenia, thrombocytopenia, dizziness and diarrhea. Hospital stay was also complicated by Atrial Fibrillation treated with metoprolol and digoxin. Patient also has history of pulmonary embolism ([**10-15**] admission) felt to be secondary to right atrial catheter-associated thrombus complicated by likely TIA/amaurosis fugax. Patient was treated with fondaparinux but this was then stopped last admission due to thrombocytopenia. . ROS: The patient denies melena, hematochezia, chest pain, shortness of breath, orthopnea, PND, lower extremity edema, cough, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. MEDICAL HISTORY: ONCOLOGIC HISTORY: Mr. [**Known lastname **] initially presented in early [**6-/2197**] with fever, weight loss, and muscle and joint aches. He was diagnosed with PMR and started on prednisone with improvement in his symptoms. During the preceding six months, he reported a history of the generalized body pain as well as fatigue, weakness, and poor appetite. He also reported periodic fevers, drenching night sweats, and a 25-pound weight loss also over the same six months. Marked improvement of both his musculoskeletal and constitutional symptoms after prednisone treatment. He then presented to the emergency room on [**2197-7-17**] with palpitations and dizziness and was found to be in atrial fibrillation. He has had a history of PAF in the past. He was febrile to 101.6 with a heart rate of 126. CT scan of the chest, abdomen, and pelvis on showed multiple low-attenuation lesions within the liver, spleen, and kidneys with characteristics felt atypical for lymphoma. A follow-up MRI of the abdomen showed hypovascular masses in both kidneys and spleen of various sizes consistent with lymphoma. Mr. [**Known lastname **] then underwent bone marrow aspirate and biopsy on [**2197-7-26**], which showed extensive necrosis with focal involvement by a high-grade B-cell lymphoma, diffuse large B-cell type. FISH translocation was notable for c-Myc and Bcl-2 indicating a "double hit" lymphoma characterized by a Burkitt's-like lymphoma. . Mr. [**Known lastname **] has overall tolerated his chemotherapy relatively well. He has continued on his Fondaparinux daily when on [**2197-11-16**], he noted sudden onset sudden of a dark cover in the lower half of the visual field in his right eye, which lasted [**10-20**] minutes, then self-resolved. He presented to the emergency room for evaluation. TEE revealed thrombus at the tip of his right atrial catheter, with no PFO. Ophthalmology work up was negative and the episode was attributed to TIA with recommendation to continue fondaparinux. He was discharged on [**2197-11-18**] with no further episodes. . TREATMENT HISTORY: 1. Initiated treatment with [**Hospital1 **] chemotherapy on [**2197-7-29**] with two doses of Rituxan on [**2197-8-2**] and [**2197-8-3**]. Follow up CT imaging on [**2197-8-5**] showed stable lymphomatous lesions in the kidney, spleen, and abdominal nodes. 2. Rituxan 500 mg given on [**2197-8-10**] with a fever that evening and admission for neutropenia. During admission, noted for atrial fibrillation with RVR and was started on digoxin at 0.125 mg daily along with metoprolol 200 mg daily. 3. Readmitted on [**2197-8-18**] for his second cycle of [**Hospital1 **] chemotherapy, which was delayed for two days due to hypotension and cough. A CT of the chest showed bilateral lower lobe opacities, right greater than left, concerning for infection and he was treated with a course of Levaquin. 4. On [**2197-8-30**], received Rituxan at 375 mg/m2. 5. Follow up PET scan on [**2194-9-6**] showed no evidence for lymphoma but was notable for multiple peripheral base pulmonary opacities with rims of soft tissue density and relative central lucencies most of which were new. He underwent CT of the chest for further evaluation, which showed multiple filling defects within the segmental and subsegmental branches of the right lower lobe arteries compatible with pulmonary emboli. 6. Admitted on [**2197-9-7**] for initiation of anticoagulation with fondaparinux and began third cycle of treatment with [**Hospital1 **] on [**2197-9-8**](dose level 2) 7. Received Rituxan 375 mg/m2 on [**2197-9-25**]. 8. Admitted on [**2197-9-29**] for fourth cycle of treatment with [**Hospital1 **](dose level 3). 9. Received Rituxan 375 mg/m2 on [**2197-10-17**]. 10. Admitted on [**2197-10-20**] for fifth cycle of treatment with [**Hospital1 **](dose level 3 with Adriamycin at dose level 2. Received Rituxan on [**2197-11-7**]. 11. Admitted on [**2197-11-23**] for high-dose cyclophosphamide. 12. Admitted on [**2198-1-15**] for IVAC (originally admitted for high-dose MTX, but PET scan showed progressive disease). . OTHER MEDICAL HISTORY: 1. Diffuse large B-cell lymphoma, Burkitt's like with c-Myc and Bcl-2 positivity s/p [**Hospital1 **] x 5 cycles and multiple rituxan infusions. He has had recurrent disease within 2 - 3 months of his last treatment. Patient recently admitted [**Date range (3) 21959**] for CNS prophylaxis with high-dose MTX for his aggressive lymphoma. However, PET scan prior to admission was concerning for rapidly progressive disease and CT torso on admission agreed with these findings and his LDH continued to rise. He was therefore started on IVAC chemotherapy x5 days and discharged on neupogen. 2. PAF diagnosed in [**2180**] with now chronic atrial fibrillation in the past several months. He had no history of treatment with anti-arrhythmia or anticoagulation prior to his admission in [**8-/2197**], currently receiving treatment with metoprolol and digoxin. 3. Pulmonary embolism, currently receiving treatment with fondaparinux. 4. Polymyalgia rheumatica diagnosed in [**2197**] and managed by Dr. [**Last Name (STitle) **], although further treatment on hold while getting treatment for lymphoma and unclear if his symptoms were related to lymphoma and not PMR. 5. Remote history of syphilis, gonorrhea, and genital herpes in [**2160**]. 6. Tonsillectomy and adenoidectomy in the [**2137**]. 7. Myopia. 8. Recent probable TIA with from thrombus on right atrial catheter tip MEDICATION ON ADMISSION: 1. G-CSF (Neupogen) 300mcg SC daily 2. Levofloxacin 500mg PO daily 3. Acyclovir 400mg PO Q8H 4. Sulfamethoxazole-trimethoprim 800-160mg PO MWF 5. Digoxin 125mcg PO DAILY 6. Metoprolol succinate 100mg PO HS 7. Fondaparinux 7.5mg/0.6mL Syringe SC daily, on hold since [**2198-1-25**] 8. Oxycodone 5-10mg PO Q4H prn pain 9. Calcium carbonate 200 mg (500 mg) PO TID 10. Cholecalciferol (vitamin D3) 400 unit PO DAILY 11. Famotidine 20mg PO Q12H 12. MVI one Tablet PO DAILY 13. Ondansetron 4mg PO TID prn ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: Vitals: T: 98.8 BP: 100/53 HR: 64 RR: 18 O2Sat: 94% 2L GEN: Pale, thin, no acute distress. HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, OP Clear, pale conjunctiva NECK: No JVD, COR: Irregular rate, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, ND, +BS, mild tenderness on LLQ and RUQ but described as "tightness" and not overt abdominal pain, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: alert, oriented to person, place, and time. Moves all 4 extremities. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. . DISCHARGE EXAM: GEN: Cachectic, NAD CV: RRR, nl s1 and s2, no m/r/g Chest: CTAB ABD: Soft, NTND, +BS FAMILY HISTORY: Father had an MI in his 70s and his paternal grandfather had an MI in his 40s. His mother is status post aortic valve replacement. His younger brother had probable schizophrenia and died from suicide at age 18. There is no family history of cancer. SOCIAL HISTORY: Mr. [**Known lastname **] is married and lives in [**Location **]. He previously worked as a software engineer, but now works without pay from home contributing to open source software projects. He gas two adult children but has minimal contact with them. He is a nonsmoker, drinks alcohol on occasion, and denies any history of illicit drugs.

Abscess of lung,Pneumonitis due to inhalation of food or vomitus,Burkitt's tumor or lymphoma, unspecified site, extranodal and solid organ sites,Iatrogenic pneumothorax,Acute kidney failure, unspecified,Other ascites,Chronic pulmonary embolism,Delirium due to conditions classified elsewhere,Gastrointestinal mucositis (ulcerative),Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Atrial fibrillation,Polymyalgia rheumatica,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Awaiting organ transplant status,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Other fluid overload,Pain in limb

Abscess of lung,Food/vomit pneumonitis,Brkt tmr unsp xtrndl org,Iatrogenic pneumothorax,Acute kidney failure NOS,Ascites NEC,Chr pulmonary embolism,Delirium d/t other cond,GI mucositis (ulceratve),Hemorrhage complic proc,Effusion NEC exc tb,Atrial fibrillation,Polymyalgia rheumatica,Abn reac-organ rem NEC,Await organ transplnt st,Adv eff antineoplastic,Fluid overload NEC,Pain in limb

Admission Date: [**2198-1-26**] Discharge Date: [**2198-3-5**] Date of Birth: [**2138-11-8**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Last Name (NamePattern1) 4377**] Chief Complaint: Neutropenic fever, diffuse large B-cell lymphoma. Major Surgical or Invasive Procedure: None History of Present Illness: Mr. [**Known lastname **] is a 59 year-old man with a history of diffuse large B-cell lymphoma s/p IVAC D11 who presents with fever, nausea and vomiting of 1 day duration. He was feeling overall well until this morning when he developed a fever of 102. He vomited twice (bilious, non-bloody). Denies abdominal pain or diarrhea. Denies cough, sore throat, rhinorrhea or headache. Denies sick contacts though was concerned his milk was old. Denies shortness of breath or chest pain. Denies rashes. Does report increased urinary frequency but no dysuria. Yesterday he went to his outpatient oncology appointment, received 1 unit platelets with no complications and felt well enough to walk home. . In the ED, initial vitals were T 100.3, BP 112/89, HR 94, RR 18, 100% NRB. During ED course Tmax 102.7. He was noted to be in AFib at a rate of 135-160 which improved without intervention. O2 sat 98-100% 2L. BP dropped to 76 and he was given 5L NS and started on levophed. He received vancomycin and cefepime before being transferred to the ICU. On arrival to the ICU patient was actively rigoring. . Patient recently admitted [**Date range (3) 21959**] and treated with IVAC chemotherapy x 5 days which was complicated by neutropenia, thrombocytopenia, dizziness and diarrhea. Hospital stay was also complicated by Atrial Fibrillation treated with metoprolol and digoxin. Patient also has history of pulmonary embolism ([**10-15**] admission) felt to be secondary to right atrial catheter-associated thrombus complicated by likely TIA/amaurosis fugax. Patient was treated with fondaparinux but this was then stopped last admission due to thrombocytopenia. . ROS: The patient denies melena, hematochezia, chest pain, shortness of breath, orthopnea, PND, lower extremity edema, cough, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. Past Medical History: ONCOLOGIC HISTORY: Mr. [**Known lastname **] initially presented in early [**6-/2197**] with fever, weight loss, and muscle and joint aches. He was diagnosed with PMR and started on prednisone with improvement in his symptoms. During the preceding six months, he reported a history of the generalized body pain as well as fatigue, weakness, and poor appetite. He also reported periodic fevers, drenching night sweats, and a 25-pound weight loss also over the same six months. Marked improvement of both his musculoskeletal and constitutional symptoms after prednisone treatment. He then presented to the emergency room on [**2197-7-17**] with palpitations and dizziness and was found to be in atrial fibrillation. He has had a history of PAF in the past. He was febrile to 101.6 with a heart rate of 126. CT scan of the chest, abdomen, and pelvis on showed multiple low-attenuation lesions within the liver, spleen, and kidneys with characteristics felt atypical for lymphoma. A follow-up MRI of the abdomen showed hypovascular masses in both kidneys and spleen of various sizes consistent with lymphoma. Mr. [**Known lastname **] then underwent bone marrow aspirate and biopsy on [**2197-7-26**], which showed extensive necrosis with focal involvement by a high-grade B-cell lymphoma, diffuse large B-cell type. FISH translocation was notable for c-Myc and Bcl-2 indicating a "double hit" lymphoma characterized by a Burkitt's-like lymphoma. . Mr. [**Known lastname **] has overall tolerated his chemotherapy relatively well. He has continued on his Fondaparinux daily when on [**2197-11-16**], he noted sudden onset sudden of a dark cover in the lower half of the visual field in his right eye, which lasted [**10-20**] minutes, then self-resolved. He presented to the emergency room for evaluation. TEE revealed thrombus at the tip of his right atrial catheter, with no PFO. Ophthalmology work up was negative and the episode was attributed to TIA with recommendation to continue fondaparinux. He was discharged on [**2197-11-18**] with no further episodes. . TREATMENT HISTORY: 1. Initiated treatment with [**Hospital1 **] chemotherapy on [**2197-7-29**] with two doses of Rituxan on [**2197-8-2**] and [**2197-8-3**]. Follow up CT imaging on [**2197-8-5**] showed stable lymphomatous lesions in the kidney, spleen, and abdominal nodes. 2. Rituxan 500 mg given on [**2197-8-10**] with a fever that evening and admission for neutropenia. During admission, noted for atrial fibrillation with RVR and was started on digoxin at 0.125 mg daily along with metoprolol 200 mg daily. 3. Readmitted on [**2197-8-18**] for his second cycle of [**Hospital1 **] chemotherapy, which was delayed for two days due to hypotension and cough. A CT of the chest showed bilateral lower lobe opacities, right greater than left, concerning for infection and he was treated with a course of Levaquin. 4. On [**2197-8-30**], received Rituxan at 375 mg/m2. 5. Follow up PET scan on [**2194-9-6**] showed no evidence for lymphoma but was notable for multiple peripheral base pulmonary opacities with rims of soft tissue density and relative central lucencies most of which were new. He underwent CT of the chest for further evaluation, which showed multiple filling defects within the segmental and subsegmental branches of the right lower lobe arteries compatible with pulmonary emboli. 6. Admitted on [**2197-9-7**] for initiation of anticoagulation with fondaparinux and began third cycle of treatment with [**Hospital1 **] on [**2197-9-8**](dose level 2) 7. Received Rituxan 375 mg/m2 on [**2197-9-25**]. 8. Admitted on [**2197-9-29**] for fourth cycle of treatment with [**Hospital1 **](dose level 3). 9. Received Rituxan 375 mg/m2 on [**2197-10-17**]. 10. Admitted on [**2197-10-20**] for fifth cycle of treatment with [**Hospital1 **](dose level 3 with Adriamycin at dose level 2. Received Rituxan on [**2197-11-7**]. 11. Admitted on [**2197-11-23**] for high-dose cyclophosphamide. 12. Admitted on [**2198-1-15**] for IVAC (originally admitted for high-dose MTX, but PET scan showed progressive disease). . OTHER MEDICAL HISTORY: 1. Diffuse large B-cell lymphoma, Burkitt's like with c-Myc and Bcl-2 positivity s/p [**Hospital1 **] x 5 cycles and multiple rituxan infusions. He has had recurrent disease within 2 - 3 months of his last treatment. Patient recently admitted [**Date range (3) 21959**] for CNS prophylaxis with high-dose MTX for his aggressive lymphoma. However, PET scan prior to admission was concerning for rapidly progressive disease and CT torso on admission agreed with these findings and his LDH continued to rise. He was therefore started on IVAC chemotherapy x5 days and discharged on neupogen. 2. PAF diagnosed in [**2180**] with now chronic atrial fibrillation in the past several months. He had no history of treatment with anti-arrhythmia or anticoagulation prior to his admission in [**8-/2197**], currently receiving treatment with metoprolol and digoxin. 3. Pulmonary embolism, currently receiving treatment with fondaparinux. 4. Polymyalgia rheumatica diagnosed in [**2197**] and managed by Dr. [**Last Name (STitle) **], although further treatment on hold while getting treatment for lymphoma and unclear if his symptoms were related to lymphoma and not PMR. 5. Remote history of syphilis, gonorrhea, and genital herpes in [**2160**]. 6. Tonsillectomy and adenoidectomy in the [**2137**]. 7. Myopia. 8. Recent probable TIA with from thrombus on right atrial catheter tip Social History: Mr. [**Known lastname **] is married and lives in [**Location **]. He previously worked as a software engineer, but now works without pay from home contributing to open source software projects. He gas two adult children but has minimal contact with them. He is a nonsmoker, drinks alcohol on occasion, and denies any history of illicit drugs. Family History: Father had an MI in his 70s and his paternal grandfather had an MI in his 40s. His mother is status post aortic valve replacement. His younger brother had probable schizophrenia and died from suicide at age 18. There is no family history of cancer. Physical Exam: ADMISSION EXAM: Vitals: T: 98.8 BP: 100/53 HR: 64 RR: 18 O2Sat: 94% 2L GEN: Pale, thin, no acute distress. HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, OP Clear, pale conjunctiva NECK: No JVD, COR: Irregular rate, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, ND, +BS, mild tenderness on LLQ and RUQ but described as "tightness" and not overt abdominal pain, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: alert, oriented to person, place, and time. Moves all 4 extremities. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. . DISCHARGE EXAM: GEN: Cachectic, NAD CV: RRR, nl s1 and s2, no m/r/g Chest: CTAB ABD: Soft, NTND, +BS Pertinent Results: ADMISSION LABS: [**2198-1-25**] 12:20PM BLOOD WBC-<0.1* RBC-3.32* Hgb-10.0* Hct-29.0* MCV-87 MCH-30.2 MCHC-34.5 RDW-14.8 Plt Ct-13*# [**2198-1-26**] 01:30PM BLOOD WBC-0.1* RBC-3.17* Hgb-9.5* Hct-26.4* MCV-83 MCH-29.8 MCHC-35.8* RDW-14.9 Plt Ct-21* [**2198-1-25**] 12:20PM BLOOD Neuts-53 Bands-0 Lymphs-40 Monos-0 Eos-7* Baso-0 Atyps-0 Metas-0 Myelos-0 [**2198-1-26**] 01:30PM BLOOD Neuts-0* Bands-0 Lymphs-100* Monos-0 Eos-0 Baso-0 Atyps-0 Metas-0 Myelos-0 [**2198-1-26**] 01:30PM BLOOD PT-14.5* PTT-29.5 INR(PT)-1.3* [**2198-1-26**] 01:30PM BLOOD Glucose-134* UreaN-19 Creat-1.0 Na-134 K-3.6 Cl-104 HCO3-20* AnGap-14 [**2198-1-25**] 12:20PM BLOOD Albumin-4.2 Calcium-8.9 [**2198-1-25**] 12:20PM BLOOD ALT-15 AST-19 LD(LDH)-161 AlkPhos-94 TotBili-0.5 [**2198-1-26**] 01:30PM BLOOD Digoxin-0.7* [**2198-1-26**] 01:38PM BLOOD Lactate-1.9 . PERTINENT LABS: [**2198-2-9**], [**2198-1-29**] Aspergillus Galactommanan Ag: negative [**2198-2-9**], [**2198-1-28**] B-Glucan: negative . DISCHARGE LABS: [**2198-3-5**] 05:47AM BLOOD WBC-6.1 RBC-3.01* Hgb-8.4* Hct-25.9* MCV-86 MCH-27.9 MCHC-32.5 RDW-17.8* Plt Ct-201 [**2198-3-5**] 05:47AM BLOOD Neuts-61.1 Lymphs-28.4 Monos-9.4 Eos-0.8 Baso-0.2 [**2198-3-5**] 05:47AM BLOOD PT-15.0* PTT-40.3* INR(PT)-1.3* [**2198-3-5**] 05:47AM BLOOD Glucose-99 UreaN-21* Creat-1.1 Na-141 K-4.2 Cl-107 HCO3-27 AnGap-11 [**2198-3-5**] 05:47AM BLOOD ALT-55* AST-49* LD(LDH)-209 AlkPhos-81 TotBili-0.2 [**2198-3-5**] 05:47AM BLOOD Albumin-3.3* Calcium-8.6 Phos-3.2 Mg-2.0 ................................................................ MICROBIOLOGY: [**2198-2-12**] BAL: no growth [**2198-2-12**] Lung tissue: no bacterial, fungal, AFB, or mycobacterial growth **All blood, urine, and stool cultures were negative** ................................................................ PATHOLOGY: [**2198-2-12**] Right 6th rib biopsy: Unremarkable bone, cartilage and soft tissue . [**2198-2-12**] Right lower lobe biopsy: Acute and organizing pneumonia with abscess formation. No fungal organisms identified on GMS and PAS stains. . [**2198-2-12**] Lymph node biopsy right, level 12: No carcinoma identified in three examined lymph nodes. ................................................................ IMAGING: [**2197-1-27**] CXR: As compared to the previous radiograph, there is a newly appeared right basal and perihilar opacity with subtle air bronchograms, in continuation with the inferior hilar structures. In the setting of neutropenia and fever, a newly appeared pneumonia must be suspected. . [**2198-1-29**] CT Chest w/ con: 1. Right lower lobe pneumonia. 2. Small-to-moderate bilateral pleural effusions. 3. Mesenteric edema and ascites may reflect third spacing. . [**2198-2-3**] CXR: AP chest compared to chest radiograph since [**1-28**], and a chest CT scan [**1-29**]. Sequence of radiographic findings to suggest pneumonia present on [**1-28**] worsened in the right lower lobe on [**1-29**] and then the patient subsequently developed pulmonary edema. Since [**1-31**] nearly all of these abnormalities have resolved. Small bilateral pleural effusions remain. . [**2198-2-8**] CT Chest/Abd/Pelvis w/ con: Large area of consolidation within the right lower lobe now has a new area of cavitation. This could represent progression of known pneumonic consolidation or be representative of fungal disease. Clinical correlation recommended. No lymphomatous involvement noted. . [**2198-2-13**]: CXR: Moderate right pneumothorax has changed in distribution, with a change in posture from supine to erect, now visible in the upper hemithorax. Two right pleural tubes are also in place. There is substantial atelectasis at the base of the postoperative right lung and perihilar consolidation which could be atelectasis. Obviously follow up will be careful for possibility of postoperative pneumonia. Left lung is clear. Heart size is normal. A right subclavian infusion port ends in the right atrium. Brief Hospital Course: 59M with Burkitt's-like DLBCL s/p R-[**Hospital1 **], high-dose cytoxan, and recent IVAC for progressive disease, initially admitted to the ICU for febrile neutropenia, found to have pneumonia. . # Neutropenic Fever: The patient presented on [**1-26**] with neutropenic fever to 102 and nausea/vomiting. He became hypoxic requiring oxygen, and hypotensive requiring Levophed, and was admitted to the [**Hospital Unit Name 153**]. He had diarrhea, so the source was thought to be GI. He was empirically treated with vanc/cefepime/flagyl. Urine and stool cultures (including multiple C.diff's), and urine Legionella antigen were negative. CXR and CT showed RML/RLL pneumonia (management of pneumonia is discussed below) and micafungin was added. He was eventually weaned off pressors and had improved oxygenation. The micafungin was d/c'd and he was transferred to the floor on [**1-31**]. All blood cultures were negative. G-CSF was continued post-chemo and his counts improved markedly, so it was stopped on [**2-1**]. . # Pneumonia: Patient was found to have a RML/RLL pneumonia on CXR, confirmed by CT chest. He was initially treated broadly with vanc/cefepime/flagyl/micafungin, which was later tapered to vanc/cefepime. He improved clinically, though continued to have intermittent low-grade fevers and productive cough. There was concern for aspiration so he underwent a video-assisted swallowing study which did not reveal any aspiration, though he was switched to thin liquids and soft solids with aspiration precautions. A repeat CT chest on [**2-8**] showed new cavitary lesion within the pneumonia. Pulmonary was consulted but felt that they would be unable to reach the area via bronchoscopy. Antibiotics were switched to vanc/zosyn for better anaerobic coverage out of concern for aspiration pneumonia. At this point the patient was due for another round of chemotherapy, which could not be initiated in the setting of active pneumonia. Therefore, CT surgery was consulted to evaluate for possible lobectomy. Dr. [**First Name (STitle) **] took the patient to the operating room on [**2-12**] where he underwent right thoracotomy and right lower lobectomy with buttressing of bronchial staple line with intercostal muscle, and bronchoscopy with BAL. The patient remained in the ICU POD 1, to monitor atrial fibrillation. He had afib with RVR POD 1, which stopped after metoprolol 7.5mg IV was given. The anterior chest tube was removed on [**2-14**], and he was transferred to the floor. The last chest tube was discontinued on [**2-16**]. Post-op course was complicated by a hydropneumothorax which required placement of a pigtail catheter on [**2-22**] which was later removed. . # Increased stool output: Unclear etiology, but all of his stool studies negative, including numerous C. diff toxins. Symptomatic control with Imodium QID PRN. The diarrhea eventually resolved. . # DLBCL: Burkitt's-type lymphoma, previously on R-[**Hospital1 **], high-dose cytoxan, and IVAC with continued anemia and thrombocytopenia s/p chemo. He was transfused with goal Plt>10, Hct>24. He was continued on acyclovir and Bactrim for viral and PCP [**Name Initial (PRE) 1102**]. Rituxan was given on [**2198-2-11**], but complicated by a reaction [**2-8**] of the way through the dose, and the dose was not restarted. He was given another dose of Rituxan on [**2198-3-4**]. He is scheduled for a follow-up PET scan on [**2198-3-12**]. . # Atrial fibrillation: His HR was poorly controlled despite uptitrating the digoxin and metoprolol. Cardiology was consulted and a TEE with cardioversion was performed on [**2198-2-28**]. Digoxin was stopped. He was started on amiodarone 40mg TID for 1 week, then 400mg [**Hospital1 **] for 1 week, then 400mg daily. He was continued on anticoagulation with Fondaparinux. His metroprolol succinate was decreased to 100 mg daily from 200 mg daily. He will follow-up with Dr. [**Last Name (STitle) **] from cardiology. Medications on Admission: 1. G-CSF (Neupogen) 300mcg SC daily 2. Levofloxacin 500mg PO daily 3. Acyclovir 400mg PO Q8H 4. Sulfamethoxazole-trimethoprim 800-160mg PO MWF 5. Digoxin 125mcg PO DAILY 6. Metoprolol succinate 100mg PO HS 7. Fondaparinux 7.5mg/0.6mL Syringe SC daily, on hold since [**2198-1-25**] 8. Oxycodone 5-10mg PO Q4H prn pain 9. Calcium carbonate 200 mg (500 mg) PO TID 10. Cholecalciferol (vitamin D3) 400 unit PO DAILY 11. Famotidine 20mg PO Q12H 12. MVI one Tablet PO DAILY 13. Ondansetron 4mg PO TID prn Discharge Medications: 1. acyclovir 200 mg Capsule Sig: Two (2) Capsule PO Q8H (every 8 hours). 2. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) Tablet PO MWF ([**Month/Day/Year 766**]-Wednesday-Friday). 3. famotidine 20 mg Tablet Sig: One (1) Tablet PO once a day. 4. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every four (4) hours as needed for pain. 5. multivitamin Tablet Sig: One (1) Tablet PO once a day. 6. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO see below: take 400 mg three times per day until [**2198-3-6**], then two times per day until [**2198-3-13**], then once per day after that. Disp:*60 Tablet(s)* Refills:*2* 7. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Calcium 500 500 mg (1,250 mg) Tablet Sig: One (1) Tablet PO three times a day. 9. metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO at bedtime. 10. Guaifenesin-DM NR 10-100 mg/5 mL Liquid Sig: Five (5) mL PO twice a day as needed for cough for 5 days. Disp:*1 bottle* Refills:*0* 11. fondaparinux 7.5 mg/0.6 mL Syringe Sig: One (1) injection Subcutaneous once a day. Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: - Pneumonia - Atrial fibrillation . Secondary diagnosis: - Diffuse large B-cell lymphoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname **], It was a pleasure taking part in your care at the [**Hospital1 771**]. You were initially admitted to the intensive care unit after becoming quite ill after your recent chemotherapy treatment. You were found to have a pneumonia which was treated with antibiotics and the surgeons then removed part of your infected right lung. We also converted your heart back to a normal rhythm and started medication for this. . The following changes were made to your medications: -STOP digoxin. -DECREASE metoprolol succinate. -START amiodarone. . For your incisions: Call Dr. [**First Name (STitle) **] at [**Telephone/Fax (1) 2348**] if these become red, swollen, or drain. Keep chest tube sites covered with gauze and bandages, changing daily, until healed. . You may shower but do not tub bath for 6 weeks. Followup Instructions: Department: Radiology - PET scan When: [**Telephone/Fax (1) 766**] [**2198-3-12**] at 1:45 p.m. Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital3 249**] When: [**Hospital3 **] [**2198-3-26**] at 11:20 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15675**], MD [**Telephone/Fax (1) 250**] Building: [**Hospital6 29**] [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage . Department: CARDIAC SERVICES When: WEDNESDAY [**2198-4-4**] at 2:00 PM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. [**Telephone/Fax (1) 62**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage

513,507,200,512,584,789,416,293,538,998,511,427,725,E878,V498,E933,276,729

{"Abscess of lung,Pneumonitis due to inhalation of food or vomitus,Burkitt's tumor or lymphoma, unspecified site, extranodal and solid organ sites,Iatrogenic pneumothorax,Acute kidney failure, unspecified,Other ascites,Chronic pulmonary embolism,Delirium due to conditions classified elsewhere,Gastrointestinal mucositis (ulcerative),Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Atrial fibrillation,Polymyalgia rheumatica,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Awaiting organ transplant status,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Other fluid overload,Pain in limb"}

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: Neutropenic fever, diffuse large B-cell lymphoma. PRESENT ILLNESS: Mr. [**Known lastname **] is a 59 year-old man with a history of diffuse large B-cell lymphoma s/p IVAC D11 who presents with fever, nausea and vomiting of 1 day duration. He was feeling overall well until this morning when he developed a fever of 102. He vomited twice (bilious, non-bloody). Denies abdominal pain or diarrhea. Denies cough, sore throat, rhinorrhea or headache. Denies sick contacts though was concerned his milk was old. Denies shortness of breath or chest pain. Denies rashes. Does report increased urinary frequency but no dysuria. Yesterday he went to his outpatient oncology appointment, received 1 unit platelets with no complications and felt well enough to walk home. . In the ED, initial vitals were T 100.3, BP 112/89, HR 94, RR 18, 100% NRB. During ED course Tmax 102.7. He was noted to be in AFib at a rate of 135-160 which improved without intervention. O2 sat 98-100% 2L. BP dropped to 76 and he was given 5L NS and started on levophed. He received vancomycin and cefepime before being transferred to the ICU. On arrival to the ICU patient was actively rigoring. . Patient recently admitted [**Date range (3) 21959**] and treated with IVAC chemotherapy x 5 days which was complicated by neutropenia, thrombocytopenia, dizziness and diarrhea. Hospital stay was also complicated by Atrial Fibrillation treated with metoprolol and digoxin. Patient also has history of pulmonary embolism ([**10-15**] admission) felt to be secondary to right atrial catheter-associated thrombus complicated by likely TIA/amaurosis fugax. Patient was treated with fondaparinux but this was then stopped last admission due to thrombocytopenia. . ROS: The patient denies melena, hematochezia, chest pain, shortness of breath, orthopnea, PND, lower extremity edema, cough, lightheadedness, gait unsteadiness, focal weakness, vision changes, headache, rash or skin changes. MEDICAL HISTORY: ONCOLOGIC HISTORY: Mr. [**Known lastname **] initially presented in early [**6-/2197**] with fever, weight loss, and muscle and joint aches. He was diagnosed with PMR and started on prednisone with improvement in his symptoms. During the preceding six months, he reported a history of the generalized body pain as well as fatigue, weakness, and poor appetite. He also reported periodic fevers, drenching night sweats, and a 25-pound weight loss also over the same six months. Marked improvement of both his musculoskeletal and constitutional symptoms after prednisone treatment. He then presented to the emergency room on [**2197-7-17**] with palpitations and dizziness and was found to be in atrial fibrillation. He has had a history of PAF in the past. He was febrile to 101.6 with a heart rate of 126. CT scan of the chest, abdomen, and pelvis on showed multiple low-attenuation lesions within the liver, spleen, and kidneys with characteristics felt atypical for lymphoma. A follow-up MRI of the abdomen showed hypovascular masses in both kidneys and spleen of various sizes consistent with lymphoma. Mr. [**Known lastname **] then underwent bone marrow aspirate and biopsy on [**2197-7-26**], which showed extensive necrosis with focal involvement by a high-grade B-cell lymphoma, diffuse large B-cell type. FISH translocation was notable for c-Myc and Bcl-2 indicating a "double hit" lymphoma characterized by a Burkitt's-like lymphoma. . Mr. [**Known lastname **] has overall tolerated his chemotherapy relatively well. He has continued on his Fondaparinux daily when on [**2197-11-16**], he noted sudden onset sudden of a dark cover in the lower half of the visual field in his right eye, which lasted [**10-20**] minutes, then self-resolved. He presented to the emergency room for evaluation. TEE revealed thrombus at the tip of his right atrial catheter, with no PFO. Ophthalmology work up was negative and the episode was attributed to TIA with recommendation to continue fondaparinux. He was discharged on [**2197-11-18**] with no further episodes. . TREATMENT HISTORY: 1. Initiated treatment with [**Hospital1 **] chemotherapy on [**2197-7-29**] with two doses of Rituxan on [**2197-8-2**] and [**2197-8-3**]. Follow up CT imaging on [**2197-8-5**] showed stable lymphomatous lesions in the kidney, spleen, and abdominal nodes. 2. Rituxan 500 mg given on [**2197-8-10**] with a fever that evening and admission for neutropenia. During admission, noted for atrial fibrillation with RVR and was started on digoxin at 0.125 mg daily along with metoprolol 200 mg daily. 3. Readmitted on [**2197-8-18**] for his second cycle of [**Hospital1 **] chemotherapy, which was delayed for two days due to hypotension and cough. A CT of the chest showed bilateral lower lobe opacities, right greater than left, concerning for infection and he was treated with a course of Levaquin. 4. On [**2197-8-30**], received Rituxan at 375 mg/m2. 5. Follow up PET scan on [**2194-9-6**] showed no evidence for lymphoma but was notable for multiple peripheral base pulmonary opacities with rims of soft tissue density and relative central lucencies most of which were new. He underwent CT of the chest for further evaluation, which showed multiple filling defects within the segmental and subsegmental branches of the right lower lobe arteries compatible with pulmonary emboli. 6. Admitted on [**2197-9-7**] for initiation of anticoagulation with fondaparinux and began third cycle of treatment with [**Hospital1 **] on [**2197-9-8**](dose level 2) 7. Received Rituxan 375 mg/m2 on [**2197-9-25**]. 8. Admitted on [**2197-9-29**] for fourth cycle of treatment with [**Hospital1 **](dose level 3). 9. Received Rituxan 375 mg/m2 on [**2197-10-17**]. 10. Admitted on [**2197-10-20**] for fifth cycle of treatment with [**Hospital1 **](dose level 3 with Adriamycin at dose level 2. Received Rituxan on [**2197-11-7**]. 11. Admitted on [**2197-11-23**] for high-dose cyclophosphamide. 12. Admitted on [**2198-1-15**] for IVAC (originally admitted for high-dose MTX, but PET scan showed progressive disease). . OTHER MEDICAL HISTORY: 1. Diffuse large B-cell lymphoma, Burkitt's like with c-Myc and Bcl-2 positivity s/p [**Hospital1 **] x 5 cycles and multiple rituxan infusions. He has had recurrent disease within 2 - 3 months of his last treatment. Patient recently admitted [**Date range (3) 21959**] for CNS prophylaxis with high-dose MTX for his aggressive lymphoma. However, PET scan prior to admission was concerning for rapidly progressive disease and CT torso on admission agreed with these findings and his LDH continued to rise. He was therefore started on IVAC chemotherapy x5 days and discharged on neupogen. 2. PAF diagnosed in [**2180**] with now chronic atrial fibrillation in the past several months. He had no history of treatment with anti-arrhythmia or anticoagulation prior to his admission in [**8-/2197**], currently receiving treatment with metoprolol and digoxin. 3. Pulmonary embolism, currently receiving treatment with fondaparinux. 4. Polymyalgia rheumatica diagnosed in [**2197**] and managed by Dr. [**Last Name (STitle) **], although further treatment on hold while getting treatment for lymphoma and unclear if his symptoms were related to lymphoma and not PMR. 5. Remote history of syphilis, gonorrhea, and genital herpes in [**2160**]. 6. Tonsillectomy and adenoidectomy in the [**2137**]. 7. Myopia. 8. Recent probable TIA with from thrombus on right atrial catheter tip MEDICATION ON ADMISSION: 1. G-CSF (Neupogen) 300mcg SC daily 2. Levofloxacin 500mg PO daily 3. Acyclovir 400mg PO Q8H 4. Sulfamethoxazole-trimethoprim 800-160mg PO MWF 5. Digoxin 125mcg PO DAILY 6. Metoprolol succinate 100mg PO HS 7. Fondaparinux 7.5mg/0.6mL Syringe SC daily, on hold since [**2198-1-25**] 8. Oxycodone 5-10mg PO Q4H prn pain 9. Calcium carbonate 200 mg (500 mg) PO TID 10. Cholecalciferol (vitamin D3) 400 unit PO DAILY 11. Famotidine 20mg PO Q12H 12. MVI one Tablet PO DAILY 13. Ondansetron 4mg PO TID prn ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: Vitals: T: 98.8 BP: 100/53 HR: 64 RR: 18 O2Sat: 94% 2L GEN: Pale, thin, no acute distress. HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or rhinorrhea, MMM, OP Clear, pale conjunctiva NECK: No JVD, COR: Irregular rate, no M/G/R, normal S1 S2, radial pulses +2 PULM: Lungs CTAB, no W/R/R ABD: Soft, ND, +BS, mild tenderness on LLQ and RUQ but described as "tightness" and not overt abdominal pain, no HSM, no masses EXT: No C/C/E, no palpable cords NEURO: alert, oriented to person, place, and time. Moves all 4 extremities. SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses. . DISCHARGE EXAM: GEN: Cachectic, NAD CV: RRR, nl s1 and s2, no m/r/g Chest: CTAB ABD: Soft, NTND, +BS FAMILY HISTORY: Father had an MI in his 70s and his paternal grandfather had an MI in his 40s. His mother is status post aortic valve replacement. His younger brother had probable schizophrenia and died from suicide at age 18. There is no family history of cancer. SOCIAL HISTORY: Mr. [**Known lastname **] is married and lives in [**Location **]. He previously worked as a software engineer, but now works without pay from home contributing to open source software projects. He gas two adult children but has minimal contact with them. He is a nonsmoker, drinks alcohol on occasion, and denies any history of illicit drugs. ### Response: {"Abscess of lung,Pneumonitis due to inhalation of food or vomitus,Burkitt's tumor or lymphoma, unspecified site, extranodal and solid organ sites,Iatrogenic pneumothorax,Acute kidney failure, unspecified,Other ascites,Chronic pulmonary embolism,Delirium due to conditions classified elsewhere,Gastrointestinal mucositis (ulcerative),Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Atrial fibrillation,Polymyalgia rheumatica,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Awaiting organ transplant status,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Other fluid overload,Pain in limb"}

CHIEF COMPLAINT: dyspnea on exertion PRESENT ILLNESS: Ms. [**Known lastname **] is a 72 year old woman who over the past year experienced dyspnea on exertion. Over the past month or so she has also been experiencing palpitations and was recently diagnosed with atrial fibrillation. During her work-up for dyspnea she was also found to have 3+ mitral regurgitation. Dr.[**Last Name (STitle) **] was consulted for Coronary artery revascularization/Mitral Valve replacement. MEDICAL HISTORY: Afib, IDDM, HTN, L breast cancer with lymph node removal dx on [**10-4**] on arimidex, 3+ MR, prior history of stage 2 hodgkin's lymphoma s/p CHOP x 9 in [**2117**], hysterectomy, L lung abscess removal,hysterectomy, B knee replacement, h/o blood clot in stomach MEDICATION ON ADMISSION: lasix 20, KCL 20, digoxin 0.125, arimedex 1, zocor 40, propoxy 150 QID, glargine 20 units QPM, SS novolog, coumadin 5, lisinopril 10, ASA 81, gabapentin 300, toprol XL 100 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 71 Resp: 18 O2 sat: 96 RA B/P Right: Left: 127/65 Height: 5'5" Weight:228lbs FAMILY HISTORY: non-contributory SOCIAL HISTORY: Last Dental Exam:edentulous Lives with:son Occupation:attendant at laundrymat Tobacco:60yrs x 3ppd ETOH:none

Mitral valve disorders,Chronic systolic heart failure,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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,Long-term (current) use of insulin,Tobacco use disorder,Personal history of malignant neoplasm of breast,Personal history of hodgkin's disease,Personal history of antineoplastic chemotherapy,Knee joint replacement

Mitral valve disorder,Chr systolic hrt failure,Intermed coronary synd,Surg compl-heart,Crnry athrscl natve vssl,Iatrogenc hypotnsion NEC,Cardiac dysrhythmias NEC,Anemia NOS,DMII wo cmp nt st uncntr,Abn react-anastom/graft,Long-term use of insulin,Tobacco use disorder,Hx of breast malignancy,Hx-hodgkin's disease,Hx antineoplastic chemo,Joint replaced knee

Admission Date: [**2122-11-18**] Discharge Date: [**2122-11-25**] Date of Birth: [**2050-7-5**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: dyspnea on exertion Major Surgical or Invasive Procedure: -Coronary artery bypass grafting x3 with left internal mammary artery graft to left anterior descending, reverse saphenous vein graft to the marginal branch of the posterior descending artery. - Mitral valve repair with a 26-mm annuloplasty ring (Future CG).-[**11-20**] History of Present Illness: Ms. [**Known lastname **] is a 72 year old woman who over the past year experienced dyspnea on exertion. Over the past month or so she has also been experiencing palpitations and was recently diagnosed with atrial fibrillation. During her work-up for dyspnea she was also found to have 3+ mitral regurgitation. Dr.[**Last Name (STitle) **] was consulted for Coronary artery revascularization/Mitral Valve replacement. Past Medical History: Afib, IDDM, HTN, L breast cancer with lymph node removal dx on [**10-4**] on arimidex, 3+ MR, prior history of stage 2 hodgkin's lymphoma s/p CHOP x 9 in [**2117**], hysterectomy, L lung abscess removal,hysterectomy, B knee replacement, h/o blood clot in stomach Social History: Last Dental Exam:edentulous Lives with:son Occupation:attendant at laundrymat Tobacco:60yrs x 3ppd ETOH:none Family History: non-contributory Physical Exam: Pulse: 71 Resp: 18 O2 sat: 96 RA B/P Right: Left: 127/65 Height: 5'5" Weight:228lbs 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[x] II/VI SEM Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + [x] Extremities: Warm [x], well-perfused [x] Edema Varicosities [x] Neuro: Grossly intact [x] Pulses: Femoral Right: 1+ Left: 1+ DP Right: 1+ Left: 1+ PT [**Name (NI) 167**]: 1+ Left: 1+ Radial Right: 2+ Left: 2+ Carotid Bruit Right: - Left: - Pertinent Results: [**2122-11-23**] 02:21AM BLOOD WBC-10.3 RBC-3.08* Hgb-9.9* Hct-27.5* MCV-89 MCH-32.1* MCHC-36.0* RDW-13.9 Plt Ct-132* [**2122-11-18**] 07:21PM BLOOD WBC-10.1 RBC-4.12* Hgb-12.5 Hct-37.2 MCV-90 MCH-30.4 MCHC-33.6 RDW-14.1 Plt Ct-219 [**2122-11-23**] 02:21AM BLOOD PT-15.1* PTT-31.2 INR(PT)-1.3* [**2122-11-18**] 07:21PM BLOOD PT-13.0 PTT-24.6 INR(PT)-1.1 [**2122-11-23**] 02:21AM BLOOD Glucose-63* UreaN-28* Creat-0.9 Na-135 K-4.3 Cl-100 HCO3-29 AnGap-10 [**2122-11-18**] 07:21PM BLOOD Glucose-150* UreaN-19 Creat-1.0 Na-136 K-4.6 Cl-97 HCO3-28 AnGap-16 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT [**Known lastname **], [**Known firstname **] [**Hospital1 18**] [**Numeric Identifier 94681**] (Complete) Done [**2122-11-20**] at 11:44:19 AM PRELIMINARY Referring Physician [**Name9 (PRE) **] Information [**Name9 (PRE) **], [**First Name3 (LF) **] R. [**Hospital1 18**], Division of Cardiothorac [**Hospital Unit Name 4081**] [**Location (un) 86**], [**Numeric Identifier 718**] Status: Inpatient DOB: [**2050-7-5**] Age (years): 72 F Hgt (in): 64 BP (mm Hg): 110/70 Wgt (lb): 228 HR (bpm): 70 BSA (m2): 2.07 m2 Indication: Coronary artery disease and mitral regurgitation ICD-9 Codes: 424.0, 424.2, 427.31, 440.0 Test Information Date/Time: [**2122-11-20**] at 11:44 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 #: 2009AW04-: Machine: Echocardiographic Measurements Results Measurements Normal Range Left Atrium - Long Axis Dimension: *5.8 cm <= 4.0 cm Left Atrium - Four Chamber Length: *5.3 cm <= 5.2 cm 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: 5.4 cm <= 5.6 cm Left Ventricle - Ejection Fraction: 40% >= 55% Aorta - Sinus Level: 3.4 cm <= 3.6 cm Aorta - Ascending: *3.6 cm <= 3.4 cm Aortic Valve - Peak Velocity: 1.2 m/sec <= 2.0 m/sec Findings LEFT ATRIUM: Dilated LA. 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. Normal LV cavity size. Mild regional LV systolic dysfunction. Mildly depressed LVEF. RIGHT VENTRICLE: Normal RV chamber size and free wall motion. AORTA: Normal aortic diameter at the sinus level. Mildly dilated ascending aorta. Simple atheroma in ascending aorta. Focal calcifications in ascending aorta. Normal aortic arch diameter. Normal descending aorta diameter. 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. No MVP. Moderate to severe (3+) MR. TRICUSPID VALVE: Moderate [2+] TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. No PS. Physiologic PR. PERICARDIUM: No pericardial effusion. 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. The rhythm appears to be atrial fibrillation. Results were personally reviewed with the MD caring for the patient. See Conclusions for post-bypass data The post-bypass study was performed while the patient was receiving vasoactive infusions (see Conclusions for listing of medications). REGIONAL LEFT VENTRICULAR WALL MOTION: N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic Conclusions PRE-BYPASS: The left atrium is dilated. 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. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with focalities in the septal wall added to the mild global hypokinesis. Overall left ventricular systolic function is mildly depressed (LVEF= 40 %). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. There are simple atheroma in the ascending aorta. 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. There is no mitral valve prolapse. Moderate to severe (3+) mitral regurgitation is seen. Moderate [2+] tricuspid regurgitation is seen. There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results on [**Known lastname **], [**Last Name (un) **] at 9:50AM. POST-BYPASS: For the post-bypass study, the patient was receiving vasoactive infusions including epinephrine 0.02 mcg/kg/min and phenylephrine 0.5 mcg/kg/min. There is mild residula MR across the mitral valve. There is a mitral ring well seated. Intact thoracic aorta. There is moderate TR as before. RV has mild global dysfunction. LVEF 40%. The septal wall is severely hypokiunetic as before. . I certify that I was present for this procedure in compliance with HCFA regulations. Interpretation assigned to [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting physician Brief Hospital Course: [**11-20**] Ms.[**Known lastname **] was taken to the operating room and underwent Coronary artery bypass grafting x3(left internal mammary artery graft to left anterior descending, reverse saphenous vein graft to the marginal branch of the posterior descending artery)/Mitral valve repair (#26-mm CG future annuloplasty ring)with Dr.[**Last Name (STitle) **]. Cross clamp time was 82 minutes. Cardiopulmonary bypass time was 98 minutes. Please refer to Dr[**Last Name (STitle) **] operative note for further surgical details. She tolerated the procedure well and was transferred to the CVICU intubated and sedated, requiring pressors to optimize hemodynamics, in critical but stable condition. She was extubated and weaned from her pressors. A post-operative anemia was noted and her hematocrit responded to transfusions. Her chest tubes and wires were removed. Coumadin was restarted for her history of atrial fibrillation. Post-operatively she experienced bradycardia, but it abated after her digoxin was discontinued. She was seen in consultation by physical therapy. By post-operative day five she was ready for discharge to rehab per Dr. [**Last Name (STitle) **]. All follow-up appointments were advised. Medications on Admission: lasix 20, KCL 20, digoxin 0.125, arimedex 1, zocor 40, propoxy 150 QID, glargine 20 units QPM, SS novolog, coumadin 5, lisinopril 10, ASA 81, gabapentin 300, toprol XL 100 Discharge Medications: 1. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 14 days: adjust dose to fit clinical assessment. Disp:*14 Tablet(s)* Refills:*0* 2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. 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* 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 8. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 9. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO HS (at bedtime) as needed for constipation. Disp:*30 ML(s)* Refills:*0* 10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for 14 days. Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0* 11. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day for 1 doses: titrate for INR of [**3-3**] for atrial fibrillation. Disp:*1 Tablet(s)* Refills:*0* 12. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Extended Care Facility: Geriatric Authority of [**Location (un) 5871**] Discharge Diagnosis: Coronary disease with mitral regurgitation, unstable angina and congestive heart failureAfib, IDDM, HTN, L breast cancer with lymph node removal dx on [**10-4**] on arimidex, 3+ MR, prior history of stage 2 hodgkin's lymphoma s/p CHOP x 9 in [**2117**], hysterectomy, L lung abscess removal,B knee replacement, h/o blood clot in stomach Discharge Condition: good Discharge Instructions: Please shower daily including washing incisions, no baths or swimming Monitor wounds for infection - redness, drainage, or increased pain Report any fever greater than 101 Report any weight gain of greater than 2 pounds in 24 hours or 5 pounds in a week No creams, lotions, powders, or ointments to incisions No driving for approximately one month, and while taking narcotics No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns [**Telephone/Fax (1) 170**] Followup Instructions: Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 911**] in [**3-3**] weeks ([**Telephone/Fax (1) 59456**]) Please call for appointments Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse ([**Telephone/Fax (1) 3071**]) Completed by:[**2122-11-25**] Name: [**Known lastname 1585**],[**Known firstname **] A Unit No: [**Numeric Identifier 14937**] Admission Date: [**2122-11-18**] Discharge Date: [**2122-11-25**] Date of Birth: [**2050-7-5**] Sex: F Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 741**] Addendum: On her last day of admission she was placed on Keflex for an erythematous vein harvest site. Discharge Disposition: Extended Care Facility: Geriatric Authority of [**Location (un) 745**] [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**] Completed by:[**2122-11-25**]

424,428,411,997,414,458,427,285,250,E878,V586,305,V103,V107,V874,V436

{"Mitral valve disorders,Chronic systolic heart failure,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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,Long-term (current) use of insulin,Tobacco use disorder,Personal history of malignant neoplasm of breast,Personal history of hodgkin's disease,Personal history of antineoplastic chemotherapy,Knee joint replacement"}

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 on exertion PRESENT ILLNESS: Ms. [**Known lastname **] is a 72 year old woman who over the past year experienced dyspnea on exertion. Over the past month or so she has also been experiencing palpitations and was recently diagnosed with atrial fibrillation. During her work-up for dyspnea she was also found to have 3+ mitral regurgitation. Dr.[**Last Name (STitle) **] was consulted for Coronary artery revascularization/Mitral Valve replacement. MEDICAL HISTORY: Afib, IDDM, HTN, L breast cancer with lymph node removal dx on [**10-4**] on arimidex, 3+ MR, prior history of stage 2 hodgkin's lymphoma s/p CHOP x 9 in [**2117**], hysterectomy, L lung abscess removal,hysterectomy, B knee replacement, h/o blood clot in stomach MEDICATION ON ADMISSION: lasix 20, KCL 20, digoxin 0.125, arimedex 1, zocor 40, propoxy 150 QID, glargine 20 units QPM, SS novolog, coumadin 5, lisinopril 10, ASA 81, gabapentin 300, toprol XL 100 ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Pulse: 71 Resp: 18 O2 sat: 96 RA B/P Right: Left: 127/65 Height: 5'5" Weight:228lbs FAMILY HISTORY: non-contributory SOCIAL HISTORY: Last Dental Exam:edentulous Lives with:son Occupation:attendant at laundrymat Tobacco:60yrs x 3ppd ETOH:none ### Response: {"Mitral valve disorders,Chronic systolic heart failure,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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,Long-term (current) use of insulin,Tobacco use disorder,Personal history of malignant neoplasm of breast,Personal history of hodgkin's disease,Personal history of antineoplastic chemotherapy,Knee joint replacement"}

CHIEF COMPLAINT: Hyperglycemia PRESENT ILLNESS: HPI from [**Hospital Unit Name 153**]: 64 y/o F w/ type 1 DM who came to the ED for elevated Glu readings over the past 2 days. She is a poor historian. She denies missing recent insulin doses, but does relate 2-3 days of mild orthostasis, fatigue, and DOE. She also relates polyuria and increased thirst, but denies CP or cough. She may have had 1 episode of N/V, but currently is asymptomatic and denies abdominal pain. She denies other symptoms. Of note she was recently treated for a UTI on [**12-10**], treated with Bactrim X 10 days(?). . In the ED she was noted to have a K of 81, with peaked T waves on EKG. She received insulin, Calcium, and 1 amp of bicarb. An EJ was placed, and she received a total of 2L of IVF's. There was also concern for possible STE's on EKG, but after d/w cardiology this was felt to be related to hyperkalemia. The pateint was felt to likely be in DKA with superimposed ARF (Cr 8.1 from baseline of 2.0), and was transferred to the [**Hospital Unit Name 153**] for furher management. . IN [**Hospital Unit Name 153**]: SHe was aggressively fluid rehydrated, placed on insulin gtt, corrected potassium, and renal and [**Last Name (un) 387**] were following. There was no indication for hemodialysis, although vein mapping was planned for potential access in the future. Her gap closed and she began to feel better. She was treated with cipro for a UTI, to stop on [**12-30**]. She was allowed to eat and tolerated PO diet. Her atenolol was changed to metoprolol. MEDICAL HISTORY: 1. DM type 1 x 35 years. Previous admissions for DKA and hypoglycemic episodes. Her DM is complicated by peripheral neuropathy, proliferative retinopathy (left eye blindness), and nephropathy. Followed at [**Last Name (un) **]. 2. Hypertension 3. History of osteomyelitis, status post left transmetatarsal amputation. 4. History of herpes zoster of left chest in [**2163**]. 5. Bezoar, disclosed on UGI series [**7-/2166**]. 6. No documented CAD. Nuclear stress test [**4-21**]: P-MIBI, without fixed or reversible defects, normal wall motion. EF 61%. MEDICATION ON ADMISSION: Home Meds: Atenolol 12.5 mg PO QD ASA 325 mg Po QD Nifedipine 60 mg PO QD Protonix 40 mg PO QD Diovan 80 mg PO BID Lumigan 0.03% 1 drop OD QD Timolol 0.5% 1 drop OD QD Lantus 12 units QHS with Novolog sliding scale. ALLERGIES: Gantrisin PHYSICAL EXAM: VITALS: 97.0, 112/58 70 18 99% RA GEN: Pt comfortable in NAD HEENT: MMM, no JVD noted; cataract in left eye, depigmented. Right eye reacts to light. EOMI right eye. CHEST: CTA bilaterally, no CVA tenderness CV: RRR, I/VI SEM noted, no gallop or rub GI: soft, NT, ND , pos BS EXT: no LE edema, dry skin, warm, equal pulses NEURO: AAO x 3, no focal findings other than left eye blindness FAMILY HISTORY: Per OMR records, mother with DM. Father with AD. Sister with DM and breast cancer. SOCIAL HISTORY: She lives at home with her son, who is mentally retarded. Past history of EtOH use. Ex-smoker, quit in [**2154**]. No history of illicit drug use.

Acute kidney failure, unspecified,Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Urinary tract infection, site not specified,Unspecified essential hypertension,Polyneuropathy in diabetes,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere

Acute kidney failure NOS,DMI ketoacd uncontrold,Dehydration,Urin tract infection NOS,Hypertension NOS,Neuropathy in diabetes,Diabetic retinopathy NOS,Nephritis NOS in oth dis

Admission Date: [**2171-12-23**] Discharge Date: [**2171-12-27**] Date of Birth: [**2107-9-11**] Sex: F Service: MEDICINE Allergies: Gantrisin Attending:[**First Name3 (LF) 348**] Chief Complaint: Hyperglycemia Major Surgical or Invasive Procedure: Insertion of external jugular line Insertion of left subclavian line History of Present Illness: HPI from [**Hospital Unit Name 153**]: 64 y/o F w/ type 1 DM who came to the ED for elevated Glu readings over the past 2 days. She is a poor historian. She denies missing recent insulin doses, but does relate 2-3 days of mild orthostasis, fatigue, and DOE. She also relates polyuria and increased thirst, but denies CP or cough. She may have had 1 episode of N/V, but currently is asymptomatic and denies abdominal pain. She denies other symptoms. Of note she was recently treated for a UTI on [**12-10**], treated with Bactrim X 10 days(?). . In the ED she was noted to have a K of 81, with peaked T waves on EKG. She received insulin, Calcium, and 1 amp of bicarb. An EJ was placed, and she received a total of 2L of IVF's. There was also concern for possible STE's on EKG, but after d/w cardiology this was felt to be related to hyperkalemia. The pateint was felt to likely be in DKA with superimposed ARF (Cr 8.1 from baseline of 2.0), and was transferred to the [**Hospital Unit Name 153**] for furher management. . IN [**Hospital Unit Name 153**]: SHe was aggressively fluid rehydrated, placed on insulin gtt, corrected potassium, and renal and [**Last Name (un) 387**] were following. There was no indication for hemodialysis, although vein mapping was planned for potential access in the future. Her gap closed and she began to feel better. She was treated with cipro for a UTI, to stop on [**12-30**]. She was allowed to eat and tolerated PO diet. Her atenolol was changed to metoprolol. Past Medical History: 1. DM type 1 x 35 years. Previous admissions for DKA and hypoglycemic episodes. Her DM is complicated by peripheral neuropathy, proliferative retinopathy (left eye blindness), and nephropathy. Followed at [**Last Name (un) **]. 2. Hypertension 3. History of osteomyelitis, status post left transmetatarsal amputation. 4. History of herpes zoster of left chest in [**2163**]. 5. Bezoar, disclosed on UGI series [**7-/2166**]. 6. No documented CAD. Nuclear stress test [**4-21**]: P-MIBI, without fixed or reversible defects, normal wall motion. EF 61%. Social History: She lives at home with her son, who is mentally retarded. Past history of EtOH use. Ex-smoker, quit in [**2154**]. No history of illicit drug use. Family History: Per OMR records, mother with DM. Father with AD. Sister with DM and breast cancer. Physical Exam: VITALS: 97.0, 112/58 70 18 99% RA GEN: Pt comfortable in NAD HEENT: MMM, no JVD noted; cataract in left eye, depigmented. Right eye reacts to light. EOMI right eye. CHEST: CTA bilaterally, no CVA tenderness CV: RRR, I/VI SEM noted, no gallop or rub GI: soft, NT, ND , pos BS EXT: no LE edema, dry skin, warm, equal pulses NEURO: AAO x 3, no focal findings other than left eye blindness Pertinent Results: HEME . [**2171-12-23**] 03:50PM BLOOD WBC-9.3# RBC-3.66* Hgb-9.7* Hct-32.3* MCV-88 MCH-26.4* MCHC-30.0* RDW-13.5 Plt Ct-343 [**2171-12-23**] 07:56PM BLOOD WBC-11.4* RBC-3.16* Hgb-8.4* Hct-26.5* MCV-84 MCH-26.5* MCHC-31.6 RDW-15.0 Plt Ct-315 [**2171-12-23**] 10:56PM BLOOD WBC-10.0 RBC-3.00* Hgb-7.7* Hct-24.9* MCV-83 MCH-25.5* MCHC-30.7* RDW-13.5 Plt Ct-273 [**2171-12-26**] 05:00AM BLOOD WBC-8.0 RBC-3.19* Hgb-8.3* Hct-26.2* MCV-82 MCH-26.0* MCHC-31.6 RDW-14.4 Plt Ct-240 [**2171-12-23**] 04:35PM BLOOD PT-12.7 PTT-24.1 INR(PT)-1.1 [**2171-12-24**] 08:12AM BLOOD PT-13.6* PTT-29.1 INR(PT)-1.2 [**2171-12-27**] 06:40AM BLOOD Plt Ct-231 . CHEM . [**2171-12-23**] 03:50PM BLOOD Glucose-1065* UreaN-79* Creat-8.1*# Na-123* K-8.1* Cl-86* HCO3-11* AnGap-34* [**2171-12-23**] 07:56PM BLOOD Glucose-874* UreaN-76* Creat-7.9* Na-125* K-5.5* Cl-93* HCO3-16* AnGap-22* [**2171-12-23**] 10:56PM BLOOD Glucose-717* UreaN-75* Creat-7.8* Na-127* K-4.9 Cl-99 HCO3-18* AnGap-15 [**2171-12-25**] 04:58PM BLOOD Glucose-134* UreaN-51* Creat-5.9* Na-138 K-4.4 Cl-110* HCO3-17* AnGap-15 [**2171-12-26**] 05:00AM BLOOD Glucose-207* UreaN-47* Creat-5.5* Na-136 K-4.8 Cl-110* HCO3-17* AnGap-14 [**2171-12-27**] 06:40AM BLOOD Glucose-102 UreaN-39* Creat-4.4*# Na-140 K-4.3 Cl-112* HCO3-18* AnGap-14 . ENZYMES . [**2171-12-23**] 03:50PM BLOOD CK-MB-NotDone cTropnT-0.02* . CA,MG,PH . [**2171-12-23**] 07:56PM BLOOD Calcium-8.7 Phos-6.0*# Mg-2.3 [**2171-12-23**] 10:56PM BLOOD Calcium-8.5 Phos-4.5 Mg-2.2 [**2171-12-24**] 01:44AM BLOOD Calcium-8.1* Phos-3.7 Mg-2.2 [**2171-12-27**] 06:40AM BLOOD Calcium-8.5 Phos-3.7 Mg-2.1 . IRON . [**2171-12-24**] 03:29PM BLOOD calTIBC-168* Ferritn-45 TRF-129* . RENAL . [**2171-12-27**] 06:40AM BLOOD Acetone-NEGATIVE [**2171-12-24**] 12:06PM BLOOD PTH-158* [**2171-12-23**] 04:33PM BLOOD Glucose-1096* K-7.6* [**2171-12-23**] 09:38PM BLOOD Glucose-693* Lactate-2.4* K-5.4* calHCO3-17* . ABG . [**2171-12-23**] 09:38PM BLOOD Type-ART pO2-57* pCO2-34* pH-7.29* calHCO3-17* Base XS--8 . VENOUS mAPPING . HISTORY: Pre-assessment for AV fistula creation. FINDINGS: Duplex color Doppler demonstrate patency of the cephalic veins bilaterally as well as the left basilic vein. The right basilic vein appears patent at the antecubital fossa, but it cannot be followed more centrally. The subclavian veins appear widely patent bilaterally and demonstrate normal phasicity, excluding any high-grade central venous stenosis. The brachial arteries bilaterally show normal triphasic waveforms. IMPRESSION: 1. Patent bilateral cephalic and left basilic vein, please see PACS digitized image for formal measurements. 2. Right basilic vein cannot be followed centrally beyond the antecubital fossa. 3. No indirect evidence to suggest a high-grade central venous stenosis bilaterally. 4. No evidence of arterial insufficiency to either upper extremity. . RENAL US . FINDINGS: The kidneys are normal in size and echogenicity. There are no kidney stones, hydronephrosis or renal masses. The right kidney measures 9.1 cm in length. The left kidney measures 9.9 cm in length. There is no free fluid. The gallbladder is distended with sludge in its lumen. There is no pericholecystic fluid. The gallbladder wall is normal. The CBD measures 2 mm. IMPRESSION: 1. There is no hydronephrosis, kidney stones or renal masses. 2. Sludge in the gallbladder lumen. . PA AND LATERAL CHEST RADIOGRAPHS: The lung fields are clear. The heart size and mediastinal contours are within normal limits. No pleural effusions or pneumothorax are seen. Soft tissue and osseous structures are within normal limits. IMPRESSION: No evidence of pneumonia. Brief Hospital Course: 64 y/o F w/o h/o Type 1 DM and CRI, who now presents with Glucose of 1096 and ARF. SHe was intially treated in the [**Hospital Unit Name 153**], and she was transferred to the floor for continued observation. The acetone level in her blood remained normal, her acute renal failure began to improve. SHe was followed by [**Last Name (un) **] and renal during her entire stay. She began to have good PO intake, and she was discharged to home in stable condition. . HYPERGLYCEMIA: Pt presented with DKA / HONK. Contributing factor may have been the UTI, or generalized dehydration and medication non-compliance. She had moderate serum ketones. She presented with an AG acidosis, that has closed nicely. She has been transitioned off of insulin gtt to NPH regimen, and is beginning to tolerate PO diet. [**Last Name (un) **] followed her during her stay. She remained difficult to control blood sugars. She was discharged to home on her previous regimen. It was likely noncompliance or UTI that instigated this episode. She was limited in the supplies she can use due to her blindness and difficulty administering insulin. Her oral diet improved during her stay. She was adequately fluid resucitated. . ARF: This was likely a pre-renal exacerbation of CKD. It is unclear what her true baseline has been recently. Her creatinine slowly came down, and was at 4.4 on discharge. She began the evaluation for dialysis during this hospitalization. She had vein mapping studies done, and follow up was arranged. Her atenolol was changed to metoprolol because of renal excretion. . ODYNOPHAGIA: She has been complaining of pain / burning while swallowing. She has h/o candidal esophagitis in [**2170**] based on EGD. SHe is not sure if this is similar to the pain she was experiencing that led to this scope. She assured us that the symptoms leading to her original investigation were much different. SHe was given nystatin s&S with decent releif. There was no need to re-scope her during this admission, although could be considered as an outpateint. . ANEMIA: Appears to be anemia of chronic disease / CKD. Will transfuse prn. She is to start getting erythropoietin as an outpatient. Her prescription will need to be written by PCP and forms signed to get coverage with mass health. . HTN: atenolol changed to metoprolol in setting of acute on chronic renal failure. Remained in decent control once on the floor. . UTI: treat with cipro x 3 days to complete on [**12-27**]. . FEN: Aggressive IVF while in [**Hospital Unit Name 153**], nearly 8L positive. Was given gentle fluids on floor until tolerating good PO, at which time fluids were stopped, she still had good urine output, and she was stable for discharge. . PPx: pneumoboots, place on PPI, bowel regimen. . Access: L subclavian placed [**12-23**], L EJ pulled . Code Status: FULL . Medications on Admission: Home Meds: Atenolol 12.5 mg PO QD ASA 325 mg Po QD Nifedipine 60 mg PO QD Protonix 40 mg PO QD Diovan 80 mg PO BID Lumigan 0.03% 1 drop OD QD Timolol 0.5% 1 drop OD QD Lantus 12 units QHS with Novolog sliding scale. Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Nifedipine 60 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO DAILY (Daily). 3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 5. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY (Daily). 7. Sodium Bicarbonate 650 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 8. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1) injection Injection QMOWEFR (Monday -Wednesday-Friday). Disp:*qs injection* Refills:*2* 9. Timolol 0.5 % Drops Sig: One (1) drop Ophthalmic once a day. 10. Lumigan 0.03 % Drops Sig: One (1) drop Ophthalmic once a day. 11. Insulin Aspart 100 unit/mL Cartridge Sig: One (1) pen Subcutaneous four times a day. 12. Insulin Glargine 100 unit/mL Cartridge Sig: One (1) cartridge Subcutaneous at bedtime: 10 units. Discharge Disposition: Home Discharge Diagnosis: Diabetic ketoacidosis Acute renal failure Dehydration Urinary tract infection Discharge Condition: GOod, ambulating, tolerating PO, afebrile Discharge Instructions: Please continue to take all medications as prescribed. Please keep all follow up appointments. If you experience any chest pain, difficulty breathing, lightheadedness, passing out, or any other concerning symptom, please seek immediate medical attention. You will need to see [**Doctor Last Name **] Brain on Monday [**12-30**] at 2:40 to fill out the forms in order to get your approval for the epogen, which your kidney doctors feel that [**Name5 (PTitle) **] need to be on. THen you will see Dr. [**Last Name (STitle) 3029**] on Friday to discuss your hospitalization. Your atenolol has been changed to metoprolol, so you should stop taking the atenolol. You have a prescription for your metoprolol. Followup Instructions: Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2172-1-2**] 11:00 Provider: [**First Name8 (NamePattern2) 278**] [**Last Name (NamePattern1) 279**], [**Name12 (NameIs) 280**] Date/Time:[**2172-4-8**] 11:20 Provider: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 720**], M.D. Date/Time:[**2172-1-7**] 3:30 Provider: [**First Name11 (Name Pattern1) 674**] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. Date/Time:[**2172-1-3**] 10:30 Provider: [**First Name8 (NamePattern2) 1238**] [**Last Name (NamePattern1) 1239**] [**Name8 (MD) **], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 250**] Date/Time:[**2171-12-30**] 2:40

584,250,276,599,401,357,362,583

{'Acute kidney failure, unspecified,Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Urinary tract infection, site not specified,Unspecified essential hypertension,Polyneuropathy in diabetes,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}

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: Hyperglycemia PRESENT ILLNESS: HPI from [**Hospital Unit Name 153**]: 64 y/o F w/ type 1 DM who came to the ED for elevated Glu readings over the past 2 days. She is a poor historian. She denies missing recent insulin doses, but does relate 2-3 days of mild orthostasis, fatigue, and DOE. She also relates polyuria and increased thirst, but denies CP or cough. She may have had 1 episode of N/V, but currently is asymptomatic and denies abdominal pain. She denies other symptoms. Of note she was recently treated for a UTI on [**12-10**], treated with Bactrim X 10 days(?). . In the ED she was noted to have a K of 81, with peaked T waves on EKG. She received insulin, Calcium, and 1 amp of bicarb. An EJ was placed, and she received a total of 2L of IVF's. There was also concern for possible STE's on EKG, but after d/w cardiology this was felt to be related to hyperkalemia. The pateint was felt to likely be in DKA with superimposed ARF (Cr 8.1 from baseline of 2.0), and was transferred to the [**Hospital Unit Name 153**] for furher management. . IN [**Hospital Unit Name 153**]: SHe was aggressively fluid rehydrated, placed on insulin gtt, corrected potassium, and renal and [**Last Name (un) 387**] were following. There was no indication for hemodialysis, although vein mapping was planned for potential access in the future. Her gap closed and she began to feel better. She was treated with cipro for a UTI, to stop on [**12-30**]. She was allowed to eat and tolerated PO diet. Her atenolol was changed to metoprolol. MEDICAL HISTORY: 1. DM type 1 x 35 years. Previous admissions for DKA and hypoglycemic episodes. Her DM is complicated by peripheral neuropathy, proliferative retinopathy (left eye blindness), and nephropathy. Followed at [**Last Name (un) **]. 2. Hypertension 3. History of osteomyelitis, status post left transmetatarsal amputation. 4. History of herpes zoster of left chest in [**2163**]. 5. Bezoar, disclosed on UGI series [**7-/2166**]. 6. No documented CAD. Nuclear stress test [**4-21**]: P-MIBI, without fixed or reversible defects, normal wall motion. EF 61%. MEDICATION ON ADMISSION: Home Meds: Atenolol 12.5 mg PO QD ASA 325 mg Po QD Nifedipine 60 mg PO QD Protonix 40 mg PO QD Diovan 80 mg PO BID Lumigan 0.03% 1 drop OD QD Timolol 0.5% 1 drop OD QD Lantus 12 units QHS with Novolog sliding scale. ALLERGIES: Gantrisin PHYSICAL EXAM: VITALS: 97.0, 112/58 70 18 99% RA GEN: Pt comfortable in NAD HEENT: MMM, no JVD noted; cataract in left eye, depigmented. Right eye reacts to light. EOMI right eye. CHEST: CTA bilaterally, no CVA tenderness CV: RRR, I/VI SEM noted, no gallop or rub GI: soft, NT, ND , pos BS EXT: no LE edema, dry skin, warm, equal pulses NEURO: AAO x 3, no focal findings other than left eye blindness FAMILY HISTORY: Per OMR records, mother with DM. Father with AD. Sister with DM and breast cancer. SOCIAL HISTORY: She lives at home with her son, who is mentally retarded. Past history of EtOH use. Ex-smoker, quit in [**2154**]. No history of illicit drug use. ### Response: {'Acute kidney failure, unspecified,Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Urinary tract infection, site not specified,Unspecified essential hypertension,Polyneuropathy in diabetes,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}

CHIEF COMPLAINT: Lower Gastrointestinal Bleeding PRESENT ILLNESS: 81 year old female with hx of Atemeir procedure for rectal prolapse on [**1-18**], dilated cardiomyopathy (EF 45%), h/o complete heart block s/p pacer, CKD (Cr 1.2-1.4) presenting with hematochezia. No overt complications by procedure and patient was sent to rehab on [**2130-1-23**]. Starting sunday patient noted diarrhea which turned to large amount of bright red blood per rectum with large clots. Of note she was initiated on levaquin two days prior for diarrhea of potential infectious origin. Hgb was 8.7 and she got 2 units PRBC and was returned to rehab. Re presented yesterday with continued bleeding and transferred to [**Hospital1 18**]. NG lavage with bilious output. She was taken to the operating room with a flexible sigmoidoscopy to 70cm under general with diverticula, stable anastamosis as that was initially a concern as to etiology of bleeding. MEDICAL HISTORY: - congestive heart failure with dilated cardiomyopathy. LVEF 45% in 4/[**2127**]. She has mitral regurgitation. She has a history of alcohol use and is thought to have an alcohol-related cardiomyopathy - DDD Pacemaker - [**Company 1543**] Sigma SDR 303 dual-chamber pacemaker implanted in 7/00 for complete heart block - peptic ulcer disease - history of esophageal stricture - hypertension - s/p hysterectomy - s/p excision of localized melanoma from arm and face in [**2122**], from tip of finger in [**2125-7-27**], and from shin in [**2128**] - stage III chronic kidney disease MEDICATION ON ADMISSION: Betimol 0.5 % Eye Drops 1 gtt ou daily Xalatan 0.005 % Eye Drops 1 gtt ou HS Carvedilol 25 mg Tab twice daily Nexium 20mg daily Aspirin 81 mg daily Diltiazem SR 120mg daily, Acular 0.5 % Eye Drops one drop OS daily Furosemide 2mg twice daily Simvastatin 20mg dialy ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: General: Doing well, appearance much improved since admission, no distress VS: 97.7, 67, 138/77, 20, 93% RA Neuro: A&OX3 Cardiac: RRR, no MRG, NL S1S2 Lungs: CTA bil, no respiratory Abdomen: Normal Bowel Sounds, nontender, soft, nondistended, no rebound GU: No issues Lower Extremities: No significant edema FAMILY HISTORY: Not relavent to the current admission. SOCIAL HISTORY: Lives with her husband and has 12 children. No smoking. She reports little current alcohol use but her daughter told the [**Name (NI) **] staff she continues to drink heavily at home.

Diverticulosis of colon with hemorrhage,Other primary cardiomyopathies,Unspecified glaucoma,Iron deficiency anemia secondary to blood loss (chronic),Congestive heart failure, unspecified,Cardiac pacemaker in situ

Dvrtclo colon w hmrhg,Prim cardiomyopathy NEC,Glaucoma NOS,Chr blood loss anemia,CHF NOS,Status cardiac pacemaker

Admission Date: [**2130-1-31**] Discharge Date: [**2130-2-3**] Date of Birth: [**2048-7-30**] Sex: F Service: SURGERY Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 158**] Chief Complaint: Lower Gastrointestinal Bleeding Major Surgical or Invasive Procedure: None History of Present Illness: 81 year old female with hx of Atemeir procedure for rectal prolapse on [**1-18**], dilated cardiomyopathy (EF 45%), h/o complete heart block s/p pacer, CKD (Cr 1.2-1.4) presenting with hematochezia. No overt complications by procedure and patient was sent to rehab on [**2130-1-23**]. Starting sunday patient noted diarrhea which turned to large amount of bright red blood per rectum with large clots. Of note she was initiated on levaquin two days prior for diarrhea of potential infectious origin. Hgb was 8.7 and she got 2 units PRBC and was returned to rehab. Re presented yesterday with continued bleeding and transferred to [**Hospital1 18**]. NG lavage with bilious output. She was taken to the operating room with a flexible sigmoidoscopy to 70cm under general with diverticula, stable anastamosis as that was initially a concern as to etiology of bleeding. Past Medical History: - congestive heart failure with dilated cardiomyopathy. LVEF 45% in 4/[**2127**]. She has mitral regurgitation. She has a history of alcohol use and is thought to have an alcohol-related cardiomyopathy - DDD Pacemaker - [**Company 1543**] Sigma SDR 303 dual-chamber pacemaker implanted in 7/00 for complete heart block - peptic ulcer disease - history of esophageal stricture - hypertension - s/p hysterectomy - s/p excision of localized melanoma from arm and face in [**2122**], from tip of finger in [**2125-7-27**], and from shin in [**2128**] - stage III chronic kidney disease Social History: Lives with her husband and has 12 children. No smoking. She reports little current alcohol use but her daughter told the [**Name (NI) **] staff she continues to drink heavily at home. Family History: Not relavent to the current admission. Physical Exam: General: Doing well, appearance much improved since admission, no distress VS: 97.7, 67, 138/77, 20, 93% RA Neuro: A&OX3 Cardiac: RRR, no MRG, NL S1S2 Lungs: CTA bil, no respiratory Abdomen: Normal Bowel Sounds, nontender, soft, nondistended, no rebound GU: No issues Lower Extremities: No significant edema Pertinent Results: [**2130-2-3**] 07:15AM BLOOD WBC-7.7 RBC-3.18* Hgb-10.2* Hct-29.8* MCV-94 MCH-32.0 MCHC-34.1 RDW-14.5 Plt Ct-196 [**2130-2-2**] 03:50AM BLOOD WBC-10.3 RBC-3.18* Hgb-10.1* Hct-31.5* MCV-99* MCH-31.6 MCHC-32.0 RDW-15.0 Plt Ct-192 [**2130-2-1**] 03:36PM BLOOD Hct-31.6* [**2130-2-1**] 09:32AM BLOOD WBC-10.0 RBC-3.51* Hgb-11.3* Hct-32.9* MCV-94 MCH-32.1* MCHC-34.3 RDW-14.8 Plt Ct-207 [**2130-2-1**] 04:12AM BLOOD WBC-10.3 RBC-3.40* Hgb-11.1* Hct-31.9* MCV-94 MCH-32.6* MCHC-34.7 RDW-15.0 Plt Ct-205 [**2130-2-1**] 12:06AM BLOOD WBC-12.4* RBC-3.75* Hgb-11.9* Hct-35.0* MCV-94 MCH-31.8 MCHC-34.0 RDW-15.0 Plt Ct-222 [**2130-1-31**] 07:34PM BLOOD Hct-33.4* [**2130-1-31**] 04:01PM BLOOD WBC-13.6* RBC-3.87* Hgb-12.5 Hct-35.9* MCV-93 MCH-32.4* MCHC-34.9 RDW-14.9 Plt Ct-224 [**2130-1-31**] 08:45AM BLOOD WBC-10.6# RBC-3.77*# Hgb-12.0# Hct-35.6*# MCV-95 MCH-31.9 MCHC-33.7 RDW-15.2 Plt Ct-271# [**2130-2-1**] 04:12AM BLOOD Neuts-76.4* Lymphs-11.1* Monos-9.9 Eos-1.9 Baso-0.7 [**2130-1-31**] 08:45AM BLOOD Neuts-81.1* Lymphs-10.1* Monos-6.1 Eos-1.8 Baso-0.9 [**2130-2-3**] 07:15AM BLOOD Plt Ct-196 [**2130-2-2**] 03:50AM BLOOD Plt Ct-192 [**2130-2-2**] 03:50AM BLOOD PT-14.4* PTT-24.8 INR(PT)-1.2* [**2130-2-1**] 09:32AM BLOOD Plt Ct-207 [**2130-2-1**] 04:12AM BLOOD Plt Ct-205 [**2130-2-1**] 12:06AM BLOOD PT-14.6* PTT-27.0 INR(PT)-1.3* [**2130-1-31**] 04:01PM BLOOD Plt Ct-224 [**2130-1-31**] 04:01PM BLOOD PT-13.8* PTT-20.7* INR(PT)-1.2* [**2130-1-31**] 08:45AM BLOOD Plt Ct-271# [**2130-1-31**] 08:45AM BLOOD PT-13.9* PTT-21.3* INR(PT)-1.2* [**2130-2-1**] 04:12AM BLOOD Glucose-99 UreaN-22* Creat-1.0 Na-140 K-3.9 Cl-106 HCO3-24 AnGap-14 [**2130-1-31**] 04:01PM BLOOD Glucose-102* UreaN-30* Creat-1.4* Na-140 K-3.4 Cl-100 HCO3-27 AnGap-16 [**2130-2-2**] 03:50AM BLOOD Amylase-281* [**2130-2-1**] 04:12AM BLOOD ALT-9 AST-21 AlkPhos-89 Amylase-304* TotBili-0.9 [**2130-2-1**] 12:06AM BLOOD Amylase-310* [**2130-1-31**] 08:45AM BLOOD ALT-20 AST-38 CK(CPK)-14* AlkPhos-123* TotBili-1.0 [**2130-2-2**] 03:50AM BLOOD Lipase-399* [**2130-2-1**] 04:12AM BLOOD Lipase-576* [**2130-2-1**] 12:06AM BLOOD Lipase-574* [**2130-1-31**] 08:45AM BLOOD Lipase-427* [**2130-2-1**] 12:06AM BLOOD cTropnT-<0.01 [**2130-1-31**] 04:01PM BLOOD cTropnT-<0.01 [**2130-1-31**] 08:45AM BLOOD CK-MB-1 [**2130-1-31**] 08:40AM BLOOD cTropnT-0.01 [**2130-2-2**] 03:50AM BLOOD Calcium-7.7* Phos-2.5* Mg-2.0 [**2130-2-1**] 04:12AM BLOOD Albumin-3.1* Calcium-7.7* Phos-3.0 Mg-2.7* [**2130-1-31**] 04:01PM BLOOD Calcium-8.3* Phos-3.2 Mg-1.6 [**2130-1-31**] 08:47AM BLOOD Comment-GREEN TOP [**2130-1-31**] 08:47AM BLOOD Lactate-1.2 K-3.6 [**2130-1-31**] 08:47AM BLOOD Hgb-12.2 calcHCT-37 CHEST (PA & LAT) Study Date of [**2130-1-31**] 11:27 AM FINDINGS: In comparison with the study of [**1-20**], there is little interval change. Continued enlargement of the cardiac silhouette without vascular congestion in a patient with a dual-channel pacemaker device in place. The left hemidiaphragm is more sharply seen, suggesting some improvement in pleural fluid and atelectasis. Similarly, the right costophrenic angle is more sharply visualized. No evidence of acute focal pneumonia. Cardiology Report ECG Study Date of [**2130-1-31**] 8:35:48 AM Sinus rhythm with first degree atrio-ventricular conduction delay. Non-specific QRS widening. Diffuse non-diagnostic repolarization abnormalities. Compared to the previous tracing of [**2130-1-12**] there is no diagnostic change. Brief Hospital Course: The patient was taken to the operating room from the emergency department for a flexible sigmoidoscopy to 70cm under general with diverticula, stable anastamosis as that was initially a concern as to etiology of bleeding. Report of a little ulceration posterior to anastomosis. Because of ST depressions seen on monitor during the operative case and concern for continued bleeding, a surgicel packing was placed in the rectum and the patient was transfered to the intensive care unit from the operating room. The patient remained stable in the intensive care unit, her laboratory values and urine output were monitored carefully. On hospital day two, her hematocrit was 31.6, cardiac enzymes were negative, and the patient was stable in the ICU and ready for transfer to the inpatient floor for further monitoring. NEURO/PAIN: The patient had minimal pain throughout this hospitalization. CARDIOVASCULAR: The patient continued on her home blood pressure medications once tolerating a clear liquid diet. She remained hemodynamically stable and cardiac enzymes were negative. RESPIRATORY: Lungs were clear to ascultation and respiratory status was stable. GASTROINTESTINAL: A flexible sigmoidoscopy was done in the operating room which showed evidence of a diverticular bleed. Gastroenterology was involved with and the interdisiplinary team plan was that if her hematocrit dropped she would be studied further however her hematocrit remained stable. On hospital say two, the patient tolerated a clear liquid diet. The patient had minimal old bloody stool drianage per rectum however there was no evidence of further lower GI bleeding. She was passing flatus and tolerating a regular diet on discharge. GENITOURINARY: A foley catheter was placed on admission however was removed on hospital day three and the patient was able to urinate on her own without any issue. HEME: On admission, the patient's hematocrit was stable at 35.6, however the patient had recieved a blood transfusion at an outside facility. The patients hematocrit was not below 29.8 throughout this hospital stay and she remained hemodynamically stable. ID: No evidence of infection during this hospital admission. ENDOCRINE: No issues. PROPHYLAXIS: The patient was maintained on heparin 5000 units SQ TID for DVT/PE prophylaxis and encouraged to ambulate. The patient also had sequential compression boot devices in place during immobilization to promote circulation. The patient had improved greatly by hospital day three and she was ready for discharge. Medications on Admission: Betimol 0.5 % Eye Drops 1 gtt ou daily Xalatan 0.005 % Eye Drops 1 gtt ou HS Carvedilol 25 mg Tab twice daily Nexium 20mg daily Aspirin 81 mg daily Diltiazem SR 120mg daily, Acular 0.5 % Eye Drops one drop OS daily Furosemide 2mg twice daily Simvastatin 20mg dialy Discharge Medications: 1. Acular 0.5 % Drops Sig: One (1) drop Ophthalmic Daily (): 1 drop in Left Eye dialy. 2. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime): 1 drop in both eyes at bedtime. 3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 4. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. timolol maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic DAILY (Daily): 1 drop in both eyes daily. . 6. diltiazem HCl 120 mg Capsule, Extended Release Sig: One (1) Capsule, Extended Release PO DAILY (Daily). 7. carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 10. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection TID (3 times a day): Continue DVT prophylactics per facility protocol. 11. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day. 12. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. Discharge Disposition: Extended Care Facility: [**Hospital 4542**] Rehabilitation of [**Hospital3 **] Discharge Diagnosis: Likely Diverticular Bleeding. 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: You were admitted to the hospital with a lower GI bleed from an outside hospital. You were monitored very closely here, and this bleeding was related to a section of your colon that has diverticular disease and not related to your recent altmier procedure. The gastroenterology department also followed you closely and they are comfortable with you returning to rehab as your blood counts are now stable. Please continue to monitor your bowel function call the office if you develop: nausea, vomiting, increased abdominal pain, increased abdominal distension, pain in your rectal area, or constipation. You have has a small amount of old bloodly discharge from your rectum which is ok, however, if you have any more bright red blood from your rectum or with bowel movements please notify the staff at your rehabilitation hospital and have them seek medical attention for you. Please monitor yourself for signs and symptoms of bleeing including: lightheadedness, dizziness, low blood pressure, or fast heart rate. You may continue a low residue diet to prevent food particals from becoming stuck in these areas of your colon. Please continue to participate in physical therapy and working your way to getting home. Please drink nutrtional supplements like ensure or boost to supplement your nutrition. You have improved greatly and you are ready to go back to rehab. Followup Instructions: Please call the colorectal surgery office with questions, concerns and to make a follow-up appointment with Dr. [**Last Name (STitle) **] in 2 weeks, [**Telephone/Fax (1) 160**]. Provider: [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2130-2-28**] 11:00 Provider: [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 126**], M.D. Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2130-2-28**] 11:30 Completed by:[**2130-2-3**]

562,425,365,280,428,V450

{'Diverticulosis of colon with hemorrhage,Other primary cardiomyopathies,Unspecified glaucoma,Iron deficiency anemia secondary to blood loss (chronic),Congestive heart failure, unspecified,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: Lower Gastrointestinal Bleeding PRESENT ILLNESS: 81 year old female with hx of Atemeir procedure for rectal prolapse on [**1-18**], dilated cardiomyopathy (EF 45%), h/o complete heart block s/p pacer, CKD (Cr 1.2-1.4) presenting with hematochezia. No overt complications by procedure and patient was sent to rehab on [**2130-1-23**]. Starting sunday patient noted diarrhea which turned to large amount of bright red blood per rectum with large clots. Of note she was initiated on levaquin two days prior for diarrhea of potential infectious origin. Hgb was 8.7 and she got 2 units PRBC and was returned to rehab. Re presented yesterday with continued bleeding and transferred to [**Hospital1 18**]. NG lavage with bilious output. She was taken to the operating room with a flexible sigmoidoscopy to 70cm under general with diverticula, stable anastamosis as that was initially a concern as to etiology of bleeding. MEDICAL HISTORY: - congestive heart failure with dilated cardiomyopathy. LVEF 45% in 4/[**2127**]. She has mitral regurgitation. She has a history of alcohol use and is thought to have an alcohol-related cardiomyopathy - DDD Pacemaker - [**Company 1543**] Sigma SDR 303 dual-chamber pacemaker implanted in 7/00 for complete heart block - peptic ulcer disease - history of esophageal stricture - hypertension - s/p hysterectomy - s/p excision of localized melanoma from arm and face in [**2122**], from tip of finger in [**2125-7-27**], and from shin in [**2128**] - stage III chronic kidney disease MEDICATION ON ADMISSION: Betimol 0.5 % Eye Drops 1 gtt ou daily Xalatan 0.005 % Eye Drops 1 gtt ou HS Carvedilol 25 mg Tab twice daily Nexium 20mg daily Aspirin 81 mg daily Diltiazem SR 120mg daily, Acular 0.5 % Eye Drops one drop OS daily Furosemide 2mg twice daily Simvastatin 20mg dialy ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: General: Doing well, appearance much improved since admission, no distress VS: 97.7, 67, 138/77, 20, 93% RA Neuro: A&OX3 Cardiac: RRR, no MRG, NL S1S2 Lungs: CTA bil, no respiratory Abdomen: Normal Bowel Sounds, nontender, soft, nondistended, no rebound GU: No issues Lower Extremities: No significant edema FAMILY HISTORY: Not relavent to the current admission. SOCIAL HISTORY: Lives with her husband and has 12 children. No smoking. She reports little current alcohol use but her daughter told the [**Name (NI) **] staff she continues to drink heavily at home. ### Response: {'Diverticulosis of colon with hemorrhage,Other primary cardiomyopathies,Unspecified glaucoma,Iron deficiency anemia secondary to blood loss (chronic),Congestive heart failure, unspecified,Cardiac pacemaker in situ'}

CHIEF COMPLAINT: gait instability PRESENT ILLNESS: Dr [**Known lastname 3271**] is a 84y/o M with recently dx right frontal glioblastoma who presented to Dr[**Name (NI) 6767**] onc clinic today with increased giat instability. The patient was had worsening weakness and psychomotor slowing since monday. He presented to clinic on monday and recieved a avastin infusion with some improvement in symptoms. Starting [**11-25**] his Decadron was decreased from 8mg to 4mg daily. MEDICAL HISTORY: Onc Hx: -In end of [**2183-9-29**] presented with imbalance, short-term [**Last Name **] problem, flat affect, and urinary urgency. -[**2183-11-3**] MRI showed Large heterogeneous infiltrative mass in the right frontal lobe, extending into the left anterior corpus callosum -a stereotaxic brain biopsy by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D., Ph.D. on [**2183-11-5**] confirming Glioblastoma -started temozolomide chemo-irradiation on [**2183-11-18**]. -started C1D1 bevacizumab on [**2183-11-24**] - pt opted not to persume debulking MEDICATION ON ADMISSION: Dexamethasone 4mg Tablet [**Hospital1 **] (recently decreased from TID) Fluoxetine 10mg PO daily Keppra 750mg [**Hospital1 **] Lisinpril 5mg daily lorazepam 1mg q6h prn anxiety/hiccups pantoprazole 40mg daily prochlorperazine 5mg prn nausa ambien 6.25mg hs prn Temodar 125mg PO daily Cyanocobalamin 1000mcg PO daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: VS: T95.4, BP 147/93, R 16, P 75, 95%RA, wt 129lb GEN: elderly man apearing frail HEENT: erythematous scalp. Left eye is prostetic. R pupil post surgical and non-responsive. EOMI impaired superior rightward gaze in left eye. Retina exam, optic disk not clearly visualized. Throat erythematous dry MM. multiple 1cm brown ulceration on chin. Slight R periorbital swelling. neck: supple CV: RRR, no m/r/g nl S1 and S2 lungs: CTA BL abd: ND, NT +BS, no HSM ext: no edema neuro: Pt speech is slow but appropriate, however not responding to all questions. Eye exam as above. Left facial droop. weakness in L SCM. no tongue deviation. Strength 5/5 on right, [**5-3**] diffusely on Left. DTR 3+ LUE, 2+ RUE. 2+ DTRs in [**Name2 (NI) **]. normal babinski. Pt to weak to safely access gait. FAMILY HISTORY: noncontributory SOCIAL HISTORY: He is a physician, [**Name10 (NameIs) **] Chief of Medicine; married with adult children (a cardiologist and a psychiatrist). He drinks 2 glasses of wine per night; he does not smoke cigarettes or use illicit drugs.

Malignant neoplasm of frontal lobe,Encephalopathy, unspecified,Atrial flutter,Other disorders of neurohypophysis,Malignant neoplasm of kidney, except pelvis,Herpes simplex without mention of complication,Anemia, unspecified,Personal history of malignant melanoma of skin,Body Mass Index between 19-24, adult,Acquired absence of organ, eye

Malig neo frontal lobe,Encephalopathy NOS,Atrial flutter,Neurohypophysis dis NEC,Malig neopl kidney,Herpes simplex NOS,Anemia NOS,Hx-malig skin melanoma,BMI between 19-24,adult,Acquired absence of eye

Admission Date: [**2183-11-27**] Discharge Date: [**2183-12-3**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 8487**] Chief Complaint: gait instability Major Surgical or Invasive Procedure: none History of Present Illness: Dr [**Known lastname 3271**] is a 84y/o M with recently dx right frontal glioblastoma who presented to Dr[**Name (NI) 6767**] onc clinic today with increased giat instability. The patient was had worsening weakness and psychomotor slowing since monday. He presented to clinic on monday and recieved a avastin infusion with some improvement in symptoms. Starting [**11-25**] his Decadron was decreased from 8mg to 4mg daily. Since monday he has had intermittant diarrhea. Per family he did recieve abx around brain bx on [**2183-11-5**]. This am he had difficulty swallowing his pills. Pt reports hiccups partially controled with ativan. Dr [**Known lastname 3271**] also has swelling of his R eye lid and new lesions on his chin noted today. No trauma noted. He denies F/C/S, HA, visual changes. No cough, sorethroat, sob, abd pain, N/V. No urinary symptoms. In clinic VS, T 99.8, BP 90/60, p 72, R 18. PT noted to have magnetic gait and abulia on neuro exam. He was sent for further evaluation including MRI of the brain. Past Medical History: Onc Hx: -In end of [**2183-9-29**] presented with imbalance, short-term [**Last Name **] problem, flat affect, and urinary urgency. -[**2183-11-3**] MRI showed Large heterogeneous infiltrative mass in the right frontal lobe, extending into the left anterior corpus callosum -a stereotaxic brain biopsy by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D., Ph.D. on [**2183-11-5**] confirming Glioblastoma -started temozolomide chemo-irradiation on [**2183-11-18**]. -started C1D1 bevacizumab on [**2183-11-24**] - pt opted not to persume debulking PMHx: presumed small renal cell ca followed by Dr [**Last Name (STitle) 261**] melanoma of his left eye s/p enucleation in [**2181**] retinal detachment in OD. cataractsurgery in right eye hypertension typical values of 150/80. Social History: He is a physician, [**Name10 (NameIs) **] Chief of Medicine; married with adult children (a cardiologist and a psychiatrist). He drinks 2 glasses of wine per night; he does not smoke cigarettes or use illicit drugs. Family History: noncontributory Physical Exam: PE: VS: T95.4, BP 147/93, R 16, P 75, 95%RA, wt 129lb GEN: elderly man apearing frail HEENT: erythematous scalp. Left eye is prostetic. R pupil post surgical and non-responsive. EOMI impaired superior rightward gaze in left eye. Retina exam, optic disk not clearly visualized. Throat erythematous dry MM. multiple 1cm brown ulceration on chin. Slight R periorbital swelling. neck: supple CV: RRR, no m/r/g nl S1 and S2 lungs: CTA BL abd: ND, NT +BS, no HSM ext: no edema neuro: Pt speech is slow but appropriate, however not responding to all questions. Eye exam as above. Left facial droop. weakness in L SCM. no tongue deviation. Strength 5/5 on right, [**5-3**] diffusely on Left. DTR 3+ LUE, 2+ RUE. 2+ DTRs in [**Name2 (NI) **]. normal babinski. Pt to weak to safely access gait. Pertinent Results: [**2183-11-27**] 02:45PM PLT COUNT-244 [**2183-11-27**] 02:45PM NEUTS-92.6* LYMPHS-3.3* MONOS-3.9 EOS-0.1 BASOS-0.1 [**2183-11-27**] 02:45PM WBC-17.2* RBC-4.89 HGB-15.1 HCT-42.8 MCV-88 MCH-31.0 MCHC-35.4* RDW-13.1 [**2183-11-27**] 02:45PM OSMOLAL-277 [**2183-11-27**] 02:45PM ALT(SGPT)-104* AST(SGOT)-27 ALK PHOS-67 TOT BILI-0.7 [**2183-11-27**] 02:45PM UREA N-37* CREAT-1.1 SODIUM-129* POTASSIUM-4.8 CHLORIDE-88* TOTAL CO2-25 ANION GAP-21* [**2183-11-27**] 02:45PM GLUCOSE-151* . [**2183-11-27**]: MRI head: 1. Infiltrative right frontal mass lesion consistent with glioblastoma multiforme as suggested in the history. 2. New areas of slow diffusion in the posterior [**Doctor Last Name 534**] of the right lateral ventricle and in the subarachnoid space along the falx of the right vertex (which appears to be associated with enhancement) may represent tumor seeding, however, these findings are concerning for infection and clinical correlation is recommended. . [**2183-11-28**]: EEG: This is an abnormal portable EEG due to the slow and disorganized background and the multifocal intermittent slowing. The first abnormality suggests a mild encephalopathy, whereas the second one suggests multifocal subcortical dysfunction. There were no epileptiform features seen. Note is incidentally made of occasional PVC's. . [**2183-11-28**] CXR: Since [**2183-11-25**], lungs remain clear. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion. . [**11-29**] CT head: No interval change from [**2183-11-24**], with a large right frontal lobe necrotic mass, extending into the corpus callosum with associated vasogenic edema. Brief Hospital Course: Dr [**Known lastname 3271**] is a 84 y/o with a h/o of suspected renal cell ca, L eye melenoma s/p enucleation, recent dx of GBM s/p temozolomide chemo-irradiation on [**2183-11-18**], bevacizumab on [**2183-11-24**] presents with giat instability, dyspahagia, diarrhea, left sided weakness. . #. Glioblastoma: Presenting with evidence of frontal lobe dysfunction, magnetic gait and slowed speech. In additiona diffuse left weakness concerning for worsening brain edema. Edema may be worsening in setting of recent decrease in decadron. s/p recent becacizumab making hemmorhage likely although [**11-24**] ct without evidence of bleed. MRI brain prelim showed no hemmorhage, edema similar to previous imaging. He was put on increased ICP precautions, head bed > 30 degrees, ppx zofran, autoreg bp, serum na goal > 130. He received decadron IV 10mgx1 and 4mg [**Hospital1 **], later increased to 4mg q6h. He MS continued to deteriate. An EEG was obtained which did not show any seizure activity but had evidence of encephalopathy. The encephalopathy could be radiation induced vs herpes vs [**3-1**] hyponatremia. Despite high dose acyclovir and correction of his hyponatremia Dr.[**Known lastname 87904**] MS deteriorated to the point that he could no longer protect his airway. When reversible causes of his altered MS had all but been corrected, it was determined that he should be made comfortable. However, upon [**Location (un) 1131**] his article entitled "The Role of the Physician in the Preservation of Life", vital signs were monitored, physical exams were performed and labs were measured in a tribute to this great teacher of the art of medicine. On [**2183-12-3**], Dr. [**Known lastname 3271**] expired. . #. Hyponatremia: differential includes SIADH or hypovolemic hyponatremia [**3-1**] poor po intake. Urine lytes consistant with SIADH. He was placed on fluid restriction. Started on hypertonic saline, transfered to [**Hospital Unit Name 153**] for worsening hyponatremia. As above, correction of his sodium did not correct his mental status and Dr. [**Known lastname 3271**] expired on [**2183-12-3**]. Medications on Admission: Dexamethasone 4mg Tablet [**Hospital1 **] (recently decreased from TID) Fluoxetine 10mg PO daily Keppra 750mg [**Hospital1 **] Lisinpril 5mg daily lorazepam 1mg q6h prn anxiety/hiccups pantoprazole 40mg daily prochlorperazine 5mg prn nausa ambien 6.25mg hs prn Temodar 125mg PO daily Cyanocobalamin 1000mcg PO daily Allergies: NKDA Discharge Medications: Patient expired. Discharge Disposition: Expired Discharge Diagnosis: Glioblastoma Multiforme. Patient expired. Discharge Condition: Patient expired. Discharge Instructions: Patient expired. Followup Instructions: Patient expired. Completed by:[**2183-12-6**]

191,348,427,253,189,054,285,V108,V851,V457

{'Malignant neoplasm of frontal lobe,Encephalopathy, unspecified,Atrial flutter,Other disorders of neurohypophysis,Malignant neoplasm of kidney, except pelvis,Herpes simplex without mention of complication,Anemia, unspecified,Personal history of malignant melanoma of skin,Body Mass Index between 19-24, adult,Acquired absence of organ, eye'}

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: gait instability PRESENT ILLNESS: Dr [**Known lastname 3271**] is a 84y/o M with recently dx right frontal glioblastoma who presented to Dr[**Name (NI) 6767**] onc clinic today with increased giat instability. The patient was had worsening weakness and psychomotor slowing since monday. He presented to clinic on monday and recieved a avastin infusion with some improvement in symptoms. Starting [**11-25**] his Decadron was decreased from 8mg to 4mg daily. MEDICAL HISTORY: Onc Hx: -In end of [**2183-9-29**] presented with imbalance, short-term [**Last Name **] problem, flat affect, and urinary urgency. -[**2183-11-3**] MRI showed Large heterogeneous infiltrative mass in the right frontal lobe, extending into the left anterior corpus callosum -a stereotaxic brain biopsy by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D., Ph.D. on [**2183-11-5**] confirming Glioblastoma -started temozolomide chemo-irradiation on [**2183-11-18**]. -started C1D1 bevacizumab on [**2183-11-24**] - pt opted not to persume debulking MEDICATION ON ADMISSION: Dexamethasone 4mg Tablet [**Hospital1 **] (recently decreased from TID) Fluoxetine 10mg PO daily Keppra 750mg [**Hospital1 **] Lisinpril 5mg daily lorazepam 1mg q6h prn anxiety/hiccups pantoprazole 40mg daily prochlorperazine 5mg prn nausa ambien 6.25mg hs prn Temodar 125mg PO daily Cyanocobalamin 1000mcg PO daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: VS: T95.4, BP 147/93, R 16, P 75, 95%RA, wt 129lb GEN: elderly man apearing frail HEENT: erythematous scalp. Left eye is prostetic. R pupil post surgical and non-responsive. EOMI impaired superior rightward gaze in left eye. Retina exam, optic disk not clearly visualized. Throat erythematous dry MM. multiple 1cm brown ulceration on chin. Slight R periorbital swelling. neck: supple CV: RRR, no m/r/g nl S1 and S2 lungs: CTA BL abd: ND, NT +BS, no HSM ext: no edema neuro: Pt speech is slow but appropriate, however not responding to all questions. Eye exam as above. Left facial droop. weakness in L SCM. no tongue deviation. Strength 5/5 on right, [**5-3**] diffusely on Left. DTR 3+ LUE, 2+ RUE. 2+ DTRs in [**Name2 (NI) **]. normal babinski. Pt to weak to safely access gait. FAMILY HISTORY: noncontributory SOCIAL HISTORY: He is a physician, [**Name10 (NameIs) **] Chief of Medicine; married with adult children (a cardiologist and a psychiatrist). He drinks 2 glasses of wine per night; he does not smoke cigarettes or use illicit drugs. ### Response: {'Malignant neoplasm of frontal lobe,Encephalopathy, unspecified,Atrial flutter,Other disorders of neurohypophysis,Malignant neoplasm of kidney, except pelvis,Herpes simplex without mention of complication,Anemia, unspecified,Personal history of malignant melanoma of skin,Body Mass Index between 19-24, adult,Acquired absence of organ, eye'}

CHIEF COMPLAINT: Confusion, decreased po intake PRESENT ILLNESS: Ms. [**Known lastname 105149**] is an 88 year old female with recurrent UTIs, nephrolithiasis, CAD, AF on coumadin, s/p AVR and CAD who presented to [**Hospital1 **] [**Location (un) 620**] on [**11-16**] with fatigue and altered mental status. She was found to have a urinary tract infection as well as acute on chronic renal failure. She was started on Meropenem given history of MDR UTIs in past. She also had a CT head which showed a new subacute right parietal infarct. She was transferred to [**Hospital1 18**] for further care. . Here, renal US showed moderate to severe left hydronephrosis. CT Abd/pelvis showed a proximal renal stone with perinephric stranding. Urology was consulted and recommended IR precutaneous nephrostomy tubes. She received 4units of FFP to reverse INR prior to procedure. Following the procedure she required 3L NC and was noted to have an oxygen saturation of 60% on room air. She was transferred to MICU for closer monitoring. . In the MICU, ABG notable for A-a gradient and CXR with bilateral infiltrates. She was continued on meropenem and vancomycin was added for empiric PNA coverage. She was quickly weaned from NRB back to NC and has continued good oxygenation. She was also briefly hypotensive after receiving IV and PO metoprolol for AF with RVR. BP responded to fluids. She was also seen by neurology based on CT findings and had MRI/MRA which showed a small hemorrhage in the area of the parietal infarct. INR was 1.7 on admission, ie subtherapeutic INR. Carotid US was done which was unchanged from 4/[**2139**]. Based on this, neurology felt that infarct was likely cardioembolic in origin and less likely to be [**Country **] related. They recommended restarting heparin bridge, aspirin and aggrenox. . Of note, she was recently discharged [**2140-11-13**] for UTI with left ureteral stent removal [**2140-11-1**] and was treated with IV Meropenum for 10 days. . This AM, patient denies complaints. She continues to be confused, oriented to person only. MEDICAL HISTORY: 1. Opthalmic artery infact [**2-22**] - thought to be secondary to a high grade rt carotid artery stenosis. Discussed surgery during admission, but chose medical therapy for treatment. 2. Rheumatic heart disease-Prosthetic AVR-[**2126**] 3. Atrial Fibrillation 4. CAD-[**2126**] LIMA to LAD for 80%lesion, at time of AVR 5. Chronic Kidney Disease Stage IV-baseline creatinine ~2 6. MVA in [**2128**]-residual colostomy 7. MSSA bacteremia/discitis 8. Left heel ulcer 9. Recurrent UTI's 10. History of urosepsis [**6-/2139**]-managed at [**Hospital1 18**] [**Location (un) **]. 11. History of C. difficile colitis 12. Anemia 13. history of Herpes Zoster MEDICATION ON ADMISSION: Aghgrenox 200/25 [**Hospital1 **] Coumadin 2mg daily Lopressor 12.5 [**Hospital1 **] Zoloft 200 daily Neurontin 300 q48h aspirin 325 daily Simvastatin 20mg ALLERGIES: Ciprofloxacin / Levaquin PHYSICAL EXAM: PHYSICAL EXAMINATION: VS: Tm: 98.0 Tc: 97.8 BP 11/64 HR 76 RR 18 O2 sat 98 RA GEN: pleasant, awake, alert, not oriented HEENT: sclera anicteric, conjunctivae clear, OP dry and without lesion NECK: Supple, no JVD CV: irregularly irregular, normal S1, S2. No m/r/g. CHEST: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABD: Soft, positive BS, tenderness throughout however, unable to specific exact location, no gaurding or rebound. EXT: No c/c/e SKIN: No rash FAMILY HISTORY: Mother died of colon cancer at the age of 62. Father died of "old age" at the age of 84. Brother died of testicular cancer at the age of 72. Her children are all alive and in good health. SOCIAL HISTORY: Patient lives with her son, daughter-in-law, and grandchildren. At baseline, she uses a walker for ambulation. She has several visiting home health aids that help with her ADLs. Husband passed away about 30 years ago.

Acute kidney failure, unspecified,Cerebral embolism with cerebral infarction,Intracerebral hemorrhage,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Diseases of tricuspid valve,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Congestive heart failure, unspecified,Calculus of kidney,Hydronephrosis,Atrial fibrillation,Heart valve replaced by transplant,Anemia in chronic kidney disease,Ileostomy status,Coronary atherosclerosis of native coronary artery,Acute pyelonephritis without lesion of renal medullary necrosis,Long-term (current) use of anticoagulants,Chronic kidney disease, Stage IV (severe)

Acute kidney failure NOS,Crbl emblsm w infrct,Intracerebral hemorrhage,Acute respiratry failure,Food/vomit pneumonitis,Tricuspid valve disease,Proteus infection NOS,CHF NOS,Calculus of kidney,Hydronephrosis,Atrial fibrillation,Heart valve transplant,Anemia in chr kidney dis,Ileostomy status,Crnry athrscl natve vssl,Ac pyelonephritis NOS,Long-term use anticoagul,Chr kidney dis stage IV

Admission Date: [**2140-11-16**] Discharge Date: [**2140-11-24**] Service: MEDICINE Allergies: Ciprofloxacin / Levaquin Attending:[**First Name3 (LF) 800**] Chief Complaint: Confusion, decreased po intake Major Surgical or Invasive Procedure: Percutaneous nephrostomy tube on the left History of Present Illness: Ms. [**Known lastname 105149**] is an 88 year old female with recurrent UTIs, nephrolithiasis, CAD, AF on coumadin, s/p AVR and CAD who presented to [**Hospital1 **] [**Location (un) 620**] on [**11-16**] with fatigue and altered mental status. She was found to have a urinary tract infection as well as acute on chronic renal failure. She was started on Meropenem given history of MDR UTIs in past. She also had a CT head which showed a new subacute right parietal infarct. She was transferred to [**Hospital1 18**] for further care. . Here, renal US showed moderate to severe left hydronephrosis. CT Abd/pelvis showed a proximal renal stone with perinephric stranding. Urology was consulted and recommended IR precutaneous nephrostomy tubes. She received 4units of FFP to reverse INR prior to procedure. Following the procedure she required 3L NC and was noted to have an oxygen saturation of 60% on room air. She was transferred to MICU for closer monitoring. . In the MICU, ABG notable for A-a gradient and CXR with bilateral infiltrates. She was continued on meropenem and vancomycin was added for empiric PNA coverage. She was quickly weaned from NRB back to NC and has continued good oxygenation. She was also briefly hypotensive after receiving IV and PO metoprolol for AF with RVR. BP responded to fluids. She was also seen by neurology based on CT findings and had MRI/MRA which showed a small hemorrhage in the area of the parietal infarct. INR was 1.7 on admission, ie subtherapeutic INR. Carotid US was done which was unchanged from 4/[**2139**]. Based on this, neurology felt that infarct was likely cardioembolic in origin and less likely to be [**Country **] related. They recommended restarting heparin bridge, aspirin and aggrenox. . Of note, she was recently discharged [**2140-11-13**] for UTI with left ureteral stent removal [**2140-11-1**] and was treated with IV Meropenum for 10 days. . This AM, patient denies complaints. She continues to be confused, oriented to person only. Past Medical History: 1. Opthalmic artery infact [**2-22**] - thought to be secondary to a high grade rt carotid artery stenosis. Discussed surgery during admission, but chose medical therapy for treatment. 2. Rheumatic heart disease-Prosthetic AVR-[**2126**] 3. Atrial Fibrillation 4. CAD-[**2126**] LIMA to LAD for 80%lesion, at time of AVR 5. Chronic Kidney Disease Stage IV-baseline creatinine ~2 6. MVA in [**2128**]-residual colostomy 7. MSSA bacteremia/discitis 8. Left heel ulcer 9. Recurrent UTI's 10. History of urosepsis [**6-/2139**]-managed at [**Hospital1 18**] [**Location (un) **]. 11. History of C. difficile colitis 12. Anemia 13. history of Herpes Zoster Social History: Patient lives with her son, daughter-in-law, and grandchildren. At baseline, she uses a walker for ambulation. She has several visiting home health aids that help with her ADLs. Husband passed away about 30 years ago. Quit smoking many years ago. Denies drug use, occasional alcohol use (wine)at social events a few times a year. Family History: Mother died of colon cancer at the age of 62. Father died of "old age" at the age of 84. Brother died of testicular cancer at the age of 72. Her children are all alive and in good health. Physical Exam: PHYSICAL EXAMINATION: VS: Tm: 98.0 Tc: 97.8 BP 11/64 HR 76 RR 18 O2 sat 98 RA GEN: pleasant, awake, alert, not oriented HEENT: sclera anicteric, conjunctivae clear, OP dry and without lesion NECK: Supple, no JVD CV: irregularly irregular, normal S1, S2. No m/r/g. CHEST: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABD: Soft, positive BS, tenderness throughout however, unable to specific exact location, no gaurding or rebound. EXT: No c/c/e SKIN: No rash Pertinent Results: On Admission: [**2140-11-16**] 09:40AM BLOOD WBC-9.2 RBC-3.59* Hgb-11.1* Hct-33.2* MCV-93 MCH-31.0 MCHC-33.5 RDW-14.8 Plt Ct-230 [**2140-11-16**] 09:40AM BLOOD Neuts-67.9 Lymphs-26.6 Monos-4.1 Eos-1.0 Baso-0.4 [**2140-11-16**] 09:40AM BLOOD PT-21.1* PTT-36.1* INR(PT)-2.0* [**2140-11-16**] 09:40AM BLOOD Glucose-96 UreaN-41* Creat-2.4* Na-140 K-4.8 Cl-111* HCO3-23 AnGap-11 [**2140-11-16**] 09:40AM BLOOD Calcium-9.7 Phos-3.1 Mg-1.7 . Imaging: [**Location (un) 620**] Head CT: per verbal report: Acute R superior parietal infarct suggestive of MCA lesion. Suggest MRI. . [**11-16**] CXR: There has been no radiographic change. The right lung is particularly hyperinflated suggesting emphysema or chronic small airways obstruction. No focal pulmonary abnormality is seen. The patient has had median sternotomy, coronary bypass grafting and aortic valve replacement. Heart size is normal. There is no pulmonary vascular engorgement, edema or pleural effusion. . [**11-16**] Renal US: Interval development of moderate-to-severe left hydronephrosis. No evidence of right hydronephrosis. Prominent debris or hemorrhage layers dependently within the urinary bladder. . [**11-16**] CT Abd/Pelvis: 1. New obstructing 7-mm calculus within the proximal left ureter with resultant moderate hydronephrosis and perinephric stranding. 2. Nonobstructing renal stone within the left renal pelvis. 3. Little change in 2.2 cm left adnexal cyst over two-year period. Further evaluation with pelvic ultrasound may be obtained to exclude low- grade genitourinary malignancy given postmenaupausal status. 4. Cholelithiasis without acute cholecystitis. 5. Extensive spinal degenerative changes and atherosclerotic plaque within the abdominal aorta and major branches. . [**11-16**] MR/MRA head: The right posterior parietal infarction noted on the head CT of [**2140-11-15**] is again identified and there is a small amount of hemorrhage associated with it. The MRA examination demonstrates no occlusions, but there is possible narrowing in the inferior division of the right middle cerebral artery. No other infarction is detected. . [**11-18**]: Echo: The left atrial volume is markedly increased (>32ml/m2). There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is unusually small. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. A bioprosthetic aortic valve prosthesis is present. The aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. The transaortic gradient is normal for this prosthesis. Trace aortic regurgitation is seen. [The amount of regurgitation present is normal for this prosthetic aortic valve.] The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. There is no systolic anterior motion of the mitral valve leaflets. Moderate (2+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] The tricuspid valve leaflets are mildly thickened. Moderate to severe [3+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. IMPRESSION: No left atrial thrombus seen. However, transthoracic echo is NOT accurate at determining presence or absence of atrial thrombus. Symmetric LVH with a small cavity and near-hyperdynamic systolic function. At least moderate mitral regurgitation. Moderate to severe tricuspid regurgitation. Moderate pulmonary artery systolic hypertension. The aortic arch probably has atheromatous plaque. . [**11-18**] Carotid US: Findings as stated above which indicate an approximately 70% right ICA stenosis, unchanged from the exam of [**2140-3-14**]. There is approximately 40% left ICA stenosis, also unchanged. Possibility of cardiac disease. Brief Hospital Course: Mrs. [**Known lastname 105149**] is an 88-year-old female with a PMH significant for a recurrent UTIs, recent discharged [**2140-11-13**] for UTI with left stent removal [**2140-11-1**] and was treated with IV Meropenum for 10 days. She returned with an Per daughter, patient had an 8 day history of wax-[**Doctor Last Name 688**] confusion, poor po intake, nausea, vomiting. . # Urinary tract infection with hydronephrosis: On arrival to the ED, patient was noted to be in acute renal failure. Renal US and CT Abd/Pelvis demonstrated 7 mm obstructing renal calculus within the proximal left ureter with resultant moderate hydronephrosis and perinephric stranding. UA significantly positive. She was started on Meropenem while awaiting culture results. A left percutaneous nephrostomy tube was placed to relieve obstruction. Urine culture grew Proteus and Klebsiella. Urine culture from nephrostomy tube grew proteus and enterococcus. Both the Klebsiella and Proteus were sensitive to Meropenem and plan is for 14 day course via PICC line. She remained afebrile. A repeat urine culture was sent on [**11-23**] prior to discharge to evaluate for resolution. This should be followed by the rehab. . # Sub-acute CVA: CT without contrast [**First Name8 (NamePattern2) **] [**Location (un) 620**] verbal report R superior parietal infarct suggestive of MCA lesion. No focal neuro deficits, some waxing and [**Doctor Last Name 688**] confusion. Patient history of A Fib and aortic prosthetic valve ([**Last Name (un) 5487**] type), INR sub-therapeutic 1.7 at [**Location (un) 620**] (here INR 2). Neurology was consulted and recommended MRI/MRA which demonstrated a small hemorrhage at CVA site. A repeat CT scan was done which did not show evidence of bleeding and therefore the recommendation was to restart heparin, coumadin, ASA and aggrenox which was done on [**11-18**]. An echo was done which did not show a left atrial thrombus. Carotid dopplers were unchanged from prior and therefore neurology felt that CVA was likely cardioembolic source. Anticoagulation with coumadin was continued. . # Respiratory distress: On the evening of nephrostomy tube placement patient became acutely hypoxic requiring a non-rebreather. CXR showed volume overload and ABG with large A-a gradient. The desaturation was attributed to TRALI vs aspiration PNA. She did have an elevated WBC count and infiltrates on CXR. She was given 1 dose of vancomycin in addition to Meropenem she was on for UTI. She was weaned to 3L the day following the event. An echocardiogram was done which showed worsening tricuspid regurgitation. She was on Meropenem as above. At the time of discharge she was oxygenating well on room air. . # Acute renal failure: Creatinine on admission increased to 2.4 from 1.3 likely related to obstruction, infection and perhaps dehydration. After placement of percutaneous nephrostomy tube, creatinine improved throughout stay and returned to baseline. She should follow up with Dr. [**Last Name (STitle) 770**] in 1 week from discharge from hospital. Interventional radiology is also available if there are any questions regarding nephrostomy tube, [**Telephone/Fax (1) 53983**]. . # Afib, prosthetic valve: The patient's valve was reportedly placed in [**2128**] per daughter. Coumadin was held initially for IR procedure and patient was given FFP. Subsequently, patient had MRI which demonstrated small hemorrhage at CVA so heparin was held for another day. On repeat head CT no evidence of bleeding so hpearing restarted on [**11-18**]. On [**11-19**] nephrostomy tube noted to have increasingly bloody output and so per IR heparin/coumadin held again. Beta blocker was continued with good rate control. On [**11-22**] coumadin was held for a supratherapeutic INR, restarted on 2mg daily on [**11-23**]. She should have daily INR for the next several days until INR has stabilized. . # CAD: Patient was continued on BB and aspirin, aggrenox. . # Generalized arthritis pains: Continued on her usual home regimen of gabapentin for joint related pains/arthritis. . # Anemia: At baseline 27-28. Hematocrit dropped slightly over last several days of hospitalization. Guaiac was negative. Iron was started. Would recommend every other day monitoring of hematocrit while at rehab to ensure this is stable. . # Depression: Continued on her usual home regimen of sertraline. Medications on Admission: Aghgrenox 200/25 [**Hospital1 **] Coumadin 2mg daily Lopressor 12.5 [**Hospital1 **] Zoloft 200 daily Neurontin 300 q48h aspirin 325 daily Simvastatin 20mg Discharge Medications: 1. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Sertraline 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. Dipyridamole-Aspirin 200-25 mg Cap, Multiphasic Release 12 hr Sig: One (1) Cap PO BID (2 times a day). 4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). 5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) nwb Inhalation Q2H (every 2 hours) as needed. 7. Ipratropium Bromide 0.02 % Solution Sig: One (1) neb Inhalation Q6H (every 6 hours) as needed. 8. Meropenem 1 gram Recon Soln Sig: Five Hundred (500) mg Intravenous Q12H (every 12 hours) for 7 days: day 1 = [**11-16**], to complete 14 day course on [**11-29**]. 9. Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. 10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 11. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed. 12. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Extended Care Facility: [**Doctor First Name 3548**] [**Doctor Last Name 3549**] Nursing & Rehabilitation Center - [**Location (un) 1110**] Discharge Diagnosis: Acute renal failure [**12-19**] obstruction Urinary tract infection Subacute parietal infarct Aspiration pneumonia Tricuspid regurgitation Congestive heart failure Atrial fibrillation on coumadin Aortic valve replacement - bioprosthetic Anemia of chronic disease Discharge Condition: Stable. Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet You were admitted with a urinary tract infection and acute renal failure. This was felt to be due to blockage from a stone. A percutaneous nephrostomy tube was placed to help relieve the blockage. Your kidney function improved following this intervention. If you have any difficulties with the nephrostomy tube, please call Dr.[**Name (NI) 825**] office, otherwise you can call Interventional Radiology at [**Telephone/Fax (1) 53983**]. Your urinary tract infection was treated with Meropenem. You will need to continue the antibiotics for 14 days total. A PICC line was placed for administration of antibiotics. You were also found to have a small stroke. You were seen by the neurologist in the hospital who felt that it was safe to restart your coumadin. You are also taking aspirin and aggrenox. Your coumadin was held initially for the nephrostomy placement. When it was restarted, it was noted that you had a supratherapeutic INR and it was held briefly. While at rehab, they should be checking your INR daily until it has stabilized. You were also noted to be anemic. The low red blood cell level was stable, but this should also be checked at rehab every other day. The following changes were made to your medical regimen. 1. You will continue on Meropenem. Day 1 of antibiotics was [**11-16**]. Your course will be completed on [**11-29**]. If you have any fevers, chills, abdominal pain, chest pain, shortness of breath or other concerning symptoms please call your doctor or return to the Emergency Room. Followup Instructions: You have the following appointments: 1. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8244**], MD Phone:[**Telephone/Fax (1) 4775**] Date/Time:[**2141-1-4**] 11:00 2. [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], M.D. Phone:[**Telephone/Fax (1) 1694**] Date/Time:[**2141-5-8**] 2:00 You should also see Dr. [**Last Name (STitle) 770**] in one week's time for follow up. His phone number is [**Telephone/Fax (1) 5727**]. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**]

584,434,431,518,507,397,041,428,592,591,427,V422,285,V442,414,590,V586,585

{'Acute kidney failure, unspecified,Cerebral embolism with cerebral infarction,Intracerebral hemorrhage,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Diseases of tricuspid valve,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Congestive heart failure, unspecified,Calculus of kidney,Hydronephrosis,Atrial fibrillation,Heart valve replaced by transplant,Anemia in chronic kidney disease,Ileostomy status,Coronary atherosclerosis of native coronary artery,Acute pyelonephritis without lesion of renal medullary necrosis,Long-term (current) use of anticoagulants,Chronic kidney disease, Stage IV (severe)'}

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: Confusion, decreased po intake PRESENT ILLNESS: Ms. [**Known lastname 105149**] is an 88 year old female with recurrent UTIs, nephrolithiasis, CAD, AF on coumadin, s/p AVR and CAD who presented to [**Hospital1 **] [**Location (un) 620**] on [**11-16**] with fatigue and altered mental status. She was found to have a urinary tract infection as well as acute on chronic renal failure. She was started on Meropenem given history of MDR UTIs in past. She also had a CT head which showed a new subacute right parietal infarct. She was transferred to [**Hospital1 18**] for further care. . Here, renal US showed moderate to severe left hydronephrosis. CT Abd/pelvis showed a proximal renal stone with perinephric stranding. Urology was consulted and recommended IR precutaneous nephrostomy tubes. She received 4units of FFP to reverse INR prior to procedure. Following the procedure she required 3L NC and was noted to have an oxygen saturation of 60% on room air. She was transferred to MICU for closer monitoring. . In the MICU, ABG notable for A-a gradient and CXR with bilateral infiltrates. She was continued on meropenem and vancomycin was added for empiric PNA coverage. She was quickly weaned from NRB back to NC and has continued good oxygenation. She was also briefly hypotensive after receiving IV and PO metoprolol for AF with RVR. BP responded to fluids. She was also seen by neurology based on CT findings and had MRI/MRA which showed a small hemorrhage in the area of the parietal infarct. INR was 1.7 on admission, ie subtherapeutic INR. Carotid US was done which was unchanged from 4/[**2139**]. Based on this, neurology felt that infarct was likely cardioembolic in origin and less likely to be [**Country **] related. They recommended restarting heparin bridge, aspirin and aggrenox. . Of note, she was recently discharged [**2140-11-13**] for UTI with left ureteral stent removal [**2140-11-1**] and was treated with IV Meropenum for 10 days. . This AM, patient denies complaints. She continues to be confused, oriented to person only. MEDICAL HISTORY: 1. Opthalmic artery infact [**2-22**] - thought to be secondary to a high grade rt carotid artery stenosis. Discussed surgery during admission, but chose medical therapy for treatment. 2. Rheumatic heart disease-Prosthetic AVR-[**2126**] 3. Atrial Fibrillation 4. CAD-[**2126**] LIMA to LAD for 80%lesion, at time of AVR 5. Chronic Kidney Disease Stage IV-baseline creatinine ~2 6. MVA in [**2128**]-residual colostomy 7. MSSA bacteremia/discitis 8. Left heel ulcer 9. Recurrent UTI's 10. History of urosepsis [**6-/2139**]-managed at [**Hospital1 18**] [**Location (un) **]. 11. History of C. difficile colitis 12. Anemia 13. history of Herpes Zoster MEDICATION ON ADMISSION: Aghgrenox 200/25 [**Hospital1 **] Coumadin 2mg daily Lopressor 12.5 [**Hospital1 **] Zoloft 200 daily Neurontin 300 q48h aspirin 325 daily Simvastatin 20mg ALLERGIES: Ciprofloxacin / Levaquin PHYSICAL EXAM: PHYSICAL EXAMINATION: VS: Tm: 98.0 Tc: 97.8 BP 11/64 HR 76 RR 18 O2 sat 98 RA GEN: pleasant, awake, alert, not oriented HEENT: sclera anicteric, conjunctivae clear, OP dry and without lesion NECK: Supple, no JVD CV: irregularly irregular, normal S1, S2. No m/r/g. CHEST: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. ABD: Soft, positive BS, tenderness throughout however, unable to specific exact location, no gaurding or rebound. EXT: No c/c/e SKIN: No rash FAMILY HISTORY: Mother died of colon cancer at the age of 62. Father died of "old age" at the age of 84. Brother died of testicular cancer at the age of 72. Her children are all alive and in good health. SOCIAL HISTORY: Patient lives with her son, daughter-in-law, and grandchildren. At baseline, she uses a walker for ambulation. She has several visiting home health aids that help with her ADLs. Husband passed away about 30 years ago. ### Response: {'Acute kidney failure, unspecified,Cerebral embolism with cerebral infarction,Intracerebral hemorrhage,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Diseases of tricuspid valve,Proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site,Congestive heart failure, unspecified,Calculus of kidney,Hydronephrosis,Atrial fibrillation,Heart valve replaced by transplant,Anemia in chronic kidney disease,Ileostomy status,Coronary atherosclerosis of native coronary artery,Acute pyelonephritis without lesion of renal medullary necrosis,Long-term (current) use of anticoagulants,Chronic kidney disease, Stage IV (severe)'}

CHIEF COMPLAINT: transfer from [**Hospital1 18**] [**Location (un) 620**] for thrombocytopenia and lymphadenopathy of unclear origen PRESENT ILLNESS: This is 51 y/o M with history of hyperlipidemia who presented to OSH on [**2114-9-13**] complaining of shortness of breath and palpitations. MEDICAL HISTORY: [**2114-9-14**] Bone Marrow biopsy MEDICATION ON ADMISSION: Lipitor ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 100.1 P:114 R: BP:113/83 SaO2:94%on RA General: Awake, alert, NAD. HEENT: NC/AT, PERRL, EOMI without nystagmus, mild icteric sclera Neck: supple, no JVD or carotid bruits appreciated Pulmonary: Decrease breath soudns in the bases. No crackles. Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No edema 2+ radial, DP and PT pulses b/l. Lymphatics: No cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. Skin: + petechia in lower extremitis and abdomen. Neurologic: AxO times three. CN II-xII normal. DT reflexes 2+/4+. Normal gait. FAMILY HISTORY: Mother and Father with [**Name2 (NI) **] Cancer ~ age 50's. Brother Melanoma. Brother [**Name (NI) **]. SOCIAL HISTORY: Lives with wife and two dauthers. He is IT manager in a Bank. Denied iv drug use. No smoking, Alcohol 3 glass of wine a week. beer every three weeks. No ocuppational exposures.

Secondary malignant neoplasm of other specified sites,Acute and subacute necrosis of liver,Other pulmonary insufficiency, not elsewhere classified,Acidosis,Cardiac arrest,Other malignant neoplasm without specification of site,Hypotension, unspecified,Anemia in neoplastic disease,Other and unspecified hyperlipidemia,Diarrhea,Anxiety state, unspecified

Secondary malig neo NEC,Acute necrosis of liver,Other pulmonary insuff,Acidosis,Cardiac arrest,Malignant neoplasm NOS,Hypotension NOS,Anemia in neoplastic dis,Hyperlipidemia NEC/NOS,Diarrhea,Anxiety state NOS

Admission Date: [**2114-9-14**] Discharge Date: [**2114-9-21**] Date of Birth: [**2063-4-6**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: transfer from [**Hospital1 18**] [**Location (un) 620**] for thrombocytopenia and lymphadenopathy of unclear origen Major Surgical or Invasive Procedure: none History of Present Illness: This is 51 y/o M with history of hyperlipidemia who presented to OSH on [**2114-9-13**] complaining of shortness of breath and palpitations. He refers that in [**Month (only) **] he started having increase urinary frequency. No clear burnin on urination or decrease in the caliber of the stream. After the [**9-1**], he started having dry cough, night sweats, fevers and general malaise. No pariticular pattern of his fevers. Low appetite as well. No abdominal sympotms. He felt that it was a viral infection. After 3 weeks of this sympotms he developed more urinary sympotms, burning on urination, bilateral frank pain. He felt that his urinary symptoms had came back. . He went to see his PCP on [**9-1**]. he was started on ciprofloxacine 500 daily for 10 days. He continue to have persistent urinary symptoms, malaise and fatigue. he felt that he coudl not doo as much work as he wanted. he was then refered to the Urologist. He was seen on [**9-3**], (Dr [**Last Name (STitle) 24934**] who felt that his prostate was enlarged and tender. His dose of ciprofloxacine was increase to 500 [**Hospital1 **]. He also ordered a CT Abdomen and checked labs. His CT revealed cystic strucuture in the lower portion of left kidney and also numerous periaortic, celiac and pelvic lymph node. Also enlarged prostate. Platelets were noted to be [**Numeric Identifier 38500**] . Over the next week, he developed Right upper quadrant abdominal pain, constant, and also over his right chest wall. He started taking some Ibuprofen as per his report aroudn 600mg ~ q3h. A week prior to admission he developed increasing shortness of breath specially on exertion, extreme fatigue, palpitations, nausea and vomit. Also increase in night sweats. . After talking to PCP coverage he was refered to the ED. . In OSH ED, VS T 98.6, Hr 113, Bp 94/75, RR 16 Sats 98% 2L. + petechial lesion over extremities and abdomen. U/a had WBC 2 to 5. EKG with sinus tachycardia. CT Abdomen was done that showed new pockets of ascitis, pelvic lymphadenopathy worse thatn prior, cirrhotic liver, enlarged portoahepatis and portocaval notes and heterogeneus prostate. A CTA was done that was negative for PE - altough states that a suboptima IV bolus was given-. Subpleural node 2.9 mm RML noted, 3mm focal opacity along RM fisure. His labs were notable for WBC 5.6, HCT 41.6 Platelets of [**Numeric Identifier 961**], INR 1.0, PTT 25.8, elevated bili 2.63 Direct 1.66, and elevated transaminases ALT 225, AST 184, alk phosphatase 165LDH 2163.normal Creatinine 1.0 Peripheral smear was reviewed with no evidence of schistocytes. . Upon transfer to [**Hospital1 18**], the patient was evaluated by Hem/Onc who reviewed smear - negative schistocytes. Platelet transfusion was recomended with increase to 12. Bone marrow biopsy performed on Friday showed findings consistent with neuroendocrine tumor. Surgery was consulted for possible biopsy of lymph nodes but felt it was unsafe to do it with thrombocytopenia. . On the evening of [**2114-9-17**], he developed acute respiratory distress. He became more tachycardic, hypoxic, and tachypnic. He was given Lasix 20 mg IV x 1 with good response. STAT CXR revealed worsening B/L pleural effusions. CT chest concerning for new opacities. He was started on Zosyn. ABG revealed hypoxia and he was switched to a NRB and transferred to the MICU for closer respiratory monitoring. In MICU he was treated with morphine for SOB and continued on zosyn. Heme/onc recommended initiating chemotherapy and due to his worsening respiratory status with increased oxygen requirement he was transferred to the [**Hospital Unit Name 153**] for close monitoring. He was placed on BiPAP for increased SOB prior to transfer on [**9-19**]. . On arrival to the [**Hospital Unit Name 153**] the patient was complaining of some mild SOB, however reported that his breathing was better on BIPAP. He denied CP, N/V, abdominal pain. He expressed that he was anxious about his new diagnosis and the upcoming chemotherapy. Past Medical History: [**2114-9-14**] Bone Marrow biopsy Social History: Lives with wife and two dauthers. He is IT manager in a Bank. Denied iv drug use. No smoking, Alcohol 3 glass of wine a week. beer every three weeks. No ocuppational exposures. Family History: Mother and Father with [**Name2 (NI) **] Cancer ~ age 50's. Brother Melanoma. Brother [**Name (NI) **]. Physical Exam: Vitals: T: 100.1 P:114 R: BP:113/83 SaO2:94%on RA General: Awake, alert, NAD. HEENT: NC/AT, PERRL, EOMI without nystagmus, mild icteric sclera Neck: supple, no JVD or carotid bruits appreciated Pulmonary: Decrease breath soudns in the bases. No crackles. Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No edema 2+ radial, DP and PT pulses b/l. Lymphatics: No cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. Skin: + petechia in lower extremitis and abdomen. Neurologic: AxO times three. CN II-xII normal. DT reflexes 2+/4+. Normal gait. Pertinent Results: CT Abdomen [**2114-9-13**] PELVIS: There is minimal interval enlargement of prominent retroperitoneaL lymph nodes; a representative left parailiac node measures 1.6 cm (image 59 series 2), previously measuring 11 mm. There is a 3.3 x 2.3 cm lymph node noted along the right external iliac vessels. In addition, there is a stable 1.8 cm lymph node along the left pelvic side wall. An additional represenatative enlarged measures 2.9 x 2.9 cm left common iliac lymph node. A 1.2 cm node is seen within the perirectal fat. The prostate gland is slightly heterogeneous. Rectal fat right of midline. The bony structures are grossly unremarkable. IMPRESSION: 1. NEW POCKETS OF ASCITES OF UNCERTAIN ETIOLOGY. 2. PELVIC LYMPHADENOPATHY CONCERNING FOR AN UNDERLYING MALIGNANCY, SPECIFICALLY [**Month (only) **] REFLECT UNDERLYING LYMPHOMA. 3. LIKELY CIRRHOTIC LIVER. 4. ENLARGED PORTAHEPATIS AND PORTOCAVAL NODES [**Month (only) **] BE INFLAMMATORY IN NATURE. 5. HETEROGENEOUS PROSTATE GLAND [**Month (only) **] REFLECT A HISTORY OF PROSTATITIS. . CT PE [**2114-7-14**]: negative for PE . TTE [**2114-9-17**] Small left ventricular cavity with hyperdynamic function, tachycardia, moderate outflow tract gradient and systolic anterior motion of the mitral valve leaflet in the absence of left ventricular hypertrophy (suggestive of intravascular volume depletion with high catecholamine state). No intracardiac shunt identified. . CT Chest [**2114-9-17**] No pulmonary embolism. Diffuse tree-in-[**Male First Name (un) 239**] opacities predominating within the lower lobes bilaterally representing an acute infectious process. Multiple hypoattenuating lesions diffusely throughout the liver of varying sizes. While most of the opacities in the lung are tree-in-[**Male First Name (un) 239**], some are morenodular and repeat chest CT may be indicated if further abdominal workup reveals underlying malignancy to rule out lung metastases. . CXR [**2114-9-19**]: No new focal consolidations are identified with increased obscuration of the right hemidiaphragm likely related to underlying atelectasis. There is persistent left lower lobe linear atelectasis and low lung volumes. The cardiomediastinal silhouette, contours and pleural surfaces are unchanged. . Single organ US (liver) [**2114-9-20**]: CONCLUSION: Small amount of ascites. Brief Hospital Course: Assessment and Plan: The patient is a 51 y/o M who was transferred from OSH with thrombocytopenia, newly dx cirrotic liver, and worsening lymphadenopathy. Preliminary BM biopsy showed evidence of neuroendocrine tumor, complicated by respiratory distress. The patient was transferred to the [**Hospital Unit Name 153**] for initiation of chemotherapy, s/p intubation on [**9-20**] for worsening respiratory distress. ICU course by problem is as follows: . # Neuroendocrine tumor: Preliminary BM biopsy was consistent with neuroendocrine tumor, not lymphoma. The patient had diffuse LAD and hepatic nodules concerning for metastatic disease. Chemotherapy was initiated on [**2114-9-20**]; however, due to the patient's rapid clinical decline chemotherapy was felt to be unlikely to produce an effect. These findings were discussed with the family during a family meeting. . # New onset liver failure/ lactic acidosis: felt to be secondary to metastatic disease. There was no plan for biopsy given low platelets; however MR of the abdomen showed several diffuse nodules in liver with necrosis - infectious vs lymphoma, less likely HCC. Transaminitis continued to rise during the hospital course. On [**2114-9-20**] there was a dramatic rise in lactate secondary to liver failure with a steady increase throughout the day from 7 to >18. . # Thrombocytopenia/ Anemia: Most likely [**3-2**] cancer. Preliminary BM biopsy showed infiltrating carcinoma of bone marrow consistent with neuroendocrine tumor. Hct progressively declined, as below, but there was no clinical evidence of active bleeding. An autoimmune process was also considered given that platelets did not bump appropriately to transfusion. . # Anemia: The patient was at risk of bleeding given thrombocytopenia, but did not show any active signs of bleeding. Hct steadily declined from baseline 43 at OSH with values slowly trending down into the mid-20s. B12 and folate were normal. Hemolysis labs negative. Anemia was also thought to be related to malignancy and BM process. . # SOB/tachypnea/hypoxia: Etiology was not entirely clear, but most likely related to worsening acidemia and/or lymphangitic spread of his tumor. CTA was negative for PE. CT chest with opacities and concern for possible infectious process, and the patient was broadly covered with vancomycin and zosyn for possible PNA. Echo with bubble study negative for shunt. No clinical evidence of volume overload currently with flat JVP. Anemia may have also been contributing. During the ICU course the patient was intubated on AC for increased work of breathing and increasing O2 requirement. The patients O2 requirement dramatically increased as lactate levels increased and pH decreased. . # Hypotension: The patient became increasingly hypotensive as acidosis worsened and ventilation and sedation were increased. An arterial line was placed without complication and the patient was started on levophed, which was uptitrated to maximal settings, and vasopressin which produced temporary increases in SBP. Pressors failed to maintain BPs as the patient became more acidemic, and despite receiving multiple crystalloid boluses with LR, the patient's MAPs began to steadily decline. . # PEA/ arrest: On the morning of [**9-21**] in the above setting, the patient had an episode of PEA arrest for which he temporarily responded to epinephrine. His wife, [**Name (NI) **], was contact[**Name (NI) **] with this information, and chose not to rescusitate any further. Later that morning the patient had steadily declining BPs and entered a period of asystole. The patient was pronounced at 7:10am on [**2114-9-21**]. The attending was notified. The family was at the bedside, and chose to pursue a limited autopsy. . # Communication was with [**Name (NI) **] (wife) home [**Telephone/Fax (1) 74072**] cell [**Telephone/Fax (1) 74073**] . Medications on Admission: Lipitor Discharge Medications: none Discharge Disposition: Expired Discharge Diagnosis: neuroendocrine tumor, metastatic liver failure lactic acidosis Discharge Condition: Expired.

198,570,518,276,427,199,458,285,272,787,300

{'Secondary malignant neoplasm of other specified sites,Acute and subacute necrosis of liver,Other pulmonary insufficiency, not elsewhere classified,Acidosis,Cardiac arrest,Other malignant neoplasm without specification of site,Hypotension, unspecified,Anemia in neoplastic disease,Other and unspecified hyperlipidemia,Diarrhea,Anxiety state, 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: transfer from [**Hospital1 18**] [**Location (un) 620**] for thrombocytopenia and lymphadenopathy of unclear origen PRESENT ILLNESS: This is 51 y/o M with history of hyperlipidemia who presented to OSH on [**2114-9-13**] complaining of shortness of breath and palpitations. MEDICAL HISTORY: [**2114-9-14**] Bone Marrow biopsy MEDICATION ON ADMISSION: Lipitor ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Vitals: T: 100.1 P:114 R: BP:113/83 SaO2:94%on RA General: Awake, alert, NAD. HEENT: NC/AT, PERRL, EOMI without nystagmus, mild icteric sclera Neck: supple, no JVD or carotid bruits appreciated Pulmonary: Decrease breath soudns in the bases. No crackles. Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No edema 2+ radial, DP and PT pulses b/l. Lymphatics: No cervical, supraclavicular, axillary or inguinal lymphadenopathy noted. Skin: + petechia in lower extremitis and abdomen. Neurologic: AxO times three. CN II-xII normal. DT reflexes 2+/4+. Normal gait. FAMILY HISTORY: Mother and Father with [**Name2 (NI) **] Cancer ~ age 50's. Brother Melanoma. Brother [**Name (NI) **]. SOCIAL HISTORY: Lives with wife and two dauthers. He is IT manager in a Bank. Denied iv drug use. No smoking, Alcohol 3 glass of wine a week. beer every three weeks. No ocuppational exposures. ### Response: {'Secondary malignant neoplasm of other specified sites,Acute and subacute necrosis of liver,Other pulmonary insufficiency, not elsewhere classified,Acidosis,Cardiac arrest,Other malignant neoplasm without specification of site,Hypotension, unspecified,Anemia in neoplastic disease,Other and unspecified hyperlipidemia,Diarrhea,Anxiety state, unspecified'}

CHIEF COMPLAINT: Hematemesis PRESENT ILLNESS: (Amended ICU admission HPI) .. Ms. [**Known lastname 13224**] is a 69yo F with ESRD on HD, CAD, DM, HTN, CHF (EF 60-70%, 3+ MR) and GAVE who presents following an episode of hematemesis and maroon stools at home. She was recently admitted to [**Hospital1 18**] [**2-17**] - [**2-22**] after developing "dark" BM that were guaiac positive. At that time, she was found to be more anemic than usual and was given IVF and 2u pRBC in the ER, after which she developed flash pulmonary edema and required intubation and a short stay in the MICU. She was then scoped and underwent an Argon plasma coagulation procedure after which she did very well. Hct upon d/c on [**2-22**] was 31%. At that time, the plan per GI was to repeat EGD on [**2154-3-7**]. Of note, during her last hospital stay, she was noted to have lateral TW depressions and + troponins which were felt to be due to demand ischemia. .. Reports that she felt well after discharge until this past Monday ([**2-25**]), when she reports she had to be taken off of her dialysis treatment b/c she didn't feel well. She states that she first felt tingling and pain in her fingers and toes, to the point where she was unable to put her feet on the ground. She felt generally weak and tired following dialysis and needed to be assisted back to her apartment. She spent the evening and most of the next morning in bed. Her nurse came to assist her the next day and offered her an oxycodone which she took, but then vomited what she described as brown liquid w/ white specks in it. No nausea prior to her vomiting. Her nurse said that it looked like blood, but denied that it was coffee ground emesis. After vomiting, Ms. [**Known lastname 13224**] immediately felt better. The nurse then called the pt's PCP who advised the pt to come to the ER. 15-20 mins later, Ms. [**Known lastname 13224**] then felt the sudden urge to have a BM and had a liquid maroon stool which was guaiac positive. She denies any abdominal pain associated w/ the BM. At that point, EMS arrived and transported her to the ER. On ROS, Ms. [**Known lastname 13224**] [**Last Name (Titles) 13230**]d any lightheadedness, dizziness, CP, SOB, or diaphoresis. + persistent burping, but that has actually decreased in frequency since her last admission. Between her last discharge and now, she had been eating normally and having normal brown, formed stools. She has never had an episode of hematemesis before. .. In the ED, she was tachycardic but normotensive. Her NG lavage showed brown fluid that cleared with 200 cc and her rectal exam revealed guaiac negative brown stool. Her Hct on admsiion was 38% and she received lL of NS and 1u pRBCs. She also received Anzemet 12.5 mg IV X 1 and pantoprazole 40 mg IV X 1. She was evaluated by GI and taken for an EGD which showed findings c/w GAVE. Her angiodysplasias were coagulated w/ an argon laser and the pt was transfered to the [**Hospital Unit Name 153**] for monitoring of fluid status and serial Hct's. She remained hemodynamically stable in the [**Hospital Unit Name 153**] w/o any further episodes of hematemesis or melena, and her Hct remained stable, so she was transferred to the medical floor for futher monitoring. . MEDICAL HISTORY: 1. DM type II - c/b nephropathy and neuropathy 2. ESRD - on HD since [**11-30**] 3. CAD - suspected by stress test ([**Doctor Last Name 4001**]) in [**2153-5-22**]: Mild global hypokinesis. LVEF 43%. Normal myocardial perfusion at the level of stress achieved. 4. CHF: TTE [**2153-11-1**] showed LVEF 60-70% with 3+ MR and 2+ TR 5. Anemia: multifactorial (ESRD + iron deficiency [**12-27**] GIB) - colonoscopy on [**2153-8-7**] -> two nonbleeding polyps in sigmoid - EGD [**2153-8-7**] -> sig for erythema, edema, and erosion in the antrum c/w gastritis in addition to erythema in the proximal bulb c/w duodenitis - EGD [**12-31**] demonstated GAVE 6. Occult GI bleed [**7-/2153**] with studies as above 7. Gout MEDICATION ON ADMISSION: Allopurinol 100 mg PO QD Atorvastatin 80 mg PO QD Toprol XL 50mg PO QD Nystatin 100,000 unit/mL Suspension 10 ML PO QID Protonix 40mg PO QD Glipizide 2.5mg PO QD PhosLo 667mg PO TID Folic Acid 1mg PO QD Multivitamin 1 tab PO QD Vitamin B Complex 1 tab PO QD Colace 100mg PO BID Senna 8.6mg PO BID Tylenol 325-650 PO Q4-6 prn Oxycodone 5mg PO Q6 prn ALLERGIES: Aspirin / Aleve PHYSICAL EXAM: PE (on transfer to the floor): VS: Tm + Tc 98.9, BP 118/62 (127-147/51-101), HR 88 (94-110), RR 20, sats 98% on RA FS 57 I/O: none recorded yet GEN: Pleasant, elderly AfAm female in NAD. Moving around bed very comfortably. HEENT: NCAT, sclera anicteric, PERRL, EOMI. MMM w/ thrush on tongue, improved since last admission. Has dark circles around her eyes, nonpuffy. NECK: Neck supple, no JVD. CV: RR, normal S1, S2. III/VI soft systolic murmur heard at RUSB, II/VI holosystolic murmur heard at LLSB. CHEST: CTAB, except for few crackles at bases bilaterally. ABD: Soft, protuberant abdomen, no fluid wave, no ascites; + BS; obvious ventral hernia, otherwise no masses; no hepatomegaly. EXT: 2+ radial/PT pulses bilaterally. At tips of index fingers bilaterally, skin is cool, [**Doctor Last Name 352**]. R index finger has ? necrotic vs. blood blister on tip. Nontender. No edema. Skin dry, warm, wrinkled. NEURO: CN II-XII grossly intact. FAMILY HISTORY: [**Name (NI) 1094**] son and daughter have DM. Her son also has HTN. She has no family history of CAD. SOCIAL HISTORY: Pt lives alone in an [**Hospital3 **] community. She has a visiting nurse [**First Name (Titles) **] [**Last Name (Titles) 13222**]. Son lives close by and helps mother. [**Name (NI) **] ETOH, tobacco, or drugs.

Angiodysplasia of stomach and duodenum with hemorrhage,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Gout, unspecified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Anemia in chronic kidney disease

Angio stm/dudn w hmrhg,Hyp kid NOS w cr kid V,End stage renal disease,CHF NOS,Gout NOS,DMII renl nt st uncntrld,Neuropathy in diabetes,Anemia in chr kidney dis

Admission Date: [**2154-2-26**] Discharge Date: [**2154-3-1**] Date of Birth: [**2084-3-11**] Sex: F Service: MEDICINE Allergies: Aspirin / Aleve Attending:[**First Name3 (LF) 4219**] Chief Complaint: Hematemesis Major Surgical or Invasive Procedure: EGD with APC of angioectasias Hemodialysis History of Present Illness: (Amended ICU admission HPI) .. Ms. [**Known lastname 13224**] is a 69yo F with ESRD on HD, CAD, DM, HTN, CHF (EF 60-70%, 3+ MR) and GAVE who presents following an episode of hematemesis and maroon stools at home. She was recently admitted to [**Hospital1 18**] [**2-17**] - [**2-22**] after developing "dark" BM that were guaiac positive. At that time, she was found to be more anemic than usual and was given IVF and 2u pRBC in the ER, after which she developed flash pulmonary edema and required intubation and a short stay in the MICU. She was then scoped and underwent an Argon plasma coagulation procedure after which she did very well. Hct upon d/c on [**2-22**] was 31%. At that time, the plan per GI was to repeat EGD on [**2154-3-7**]. Of note, during her last hospital stay, she was noted to have lateral TW depressions and + troponins which were felt to be due to demand ischemia. .. Reports that she felt well after discharge until this past Monday ([**2-25**]), when she reports she had to be taken off of her dialysis treatment b/c she didn't feel well. She states that she first felt tingling and pain in her fingers and toes, to the point where she was unable to put her feet on the ground. She felt generally weak and tired following dialysis and needed to be assisted back to her apartment. She spent the evening and most of the next morning in bed. Her nurse came to assist her the next day and offered her an oxycodone which she took, but then vomited what she described as brown liquid w/ white specks in it. No nausea prior to her vomiting. Her nurse said that it looked like blood, but denied that it was coffee ground emesis. After vomiting, Ms. [**Known lastname 13224**] immediately felt better. The nurse then called the pt's PCP who advised the pt to come to the ER. 15-20 mins later, Ms. [**Known lastname 13224**] then felt the sudden urge to have a BM and had a liquid maroon stool which was guaiac positive. She denies any abdominal pain associated w/ the BM. At that point, EMS arrived and transported her to the ER. On ROS, Ms. [**Known lastname 13224**] [**Last Name (Titles) 13230**]d any lightheadedness, dizziness, CP, SOB, or diaphoresis. + persistent burping, but that has actually decreased in frequency since her last admission. Between her last discharge and now, she had been eating normally and having normal brown, formed stools. She has never had an episode of hematemesis before. .. In the ED, she was tachycardic but normotensive. Her NG lavage showed brown fluid that cleared with 200 cc and her rectal exam revealed guaiac negative brown stool. Her Hct on admsiion was 38% and she received lL of NS and 1u pRBCs. She also received Anzemet 12.5 mg IV X 1 and pantoprazole 40 mg IV X 1. She was evaluated by GI and taken for an EGD which showed findings c/w GAVE. Her angiodysplasias were coagulated w/ an argon laser and the pt was transfered to the [**Hospital Unit Name 153**] for monitoring of fluid status and serial Hct's. She remained hemodynamically stable in the [**Hospital Unit Name 153**] w/o any further episodes of hematemesis or melena, and her Hct remained stable, so she was transferred to the medical floor for futher monitoring. . Past Medical History: 1. DM type II - c/b nephropathy and neuropathy 2. ESRD - on HD since [**11-30**] 3. CAD - suspected by stress test ([**Doctor Last Name 4001**]) in [**2153-5-22**]: Mild global hypokinesis. LVEF 43%. Normal myocardial perfusion at the level of stress achieved. 4. CHF: TTE [**2153-11-1**] showed LVEF 60-70% with 3+ MR and 2+ TR 5. Anemia: multifactorial (ESRD + iron deficiency [**12-27**] GIB) - colonoscopy on [**2153-8-7**] -> two nonbleeding polyps in sigmoid - EGD [**2153-8-7**] -> sig for erythema, edema, and erosion in the antrum c/w gastritis in addition to erythema in the proximal bulb c/w duodenitis - EGD [**12-31**] demonstated GAVE 6. Occult GI bleed [**7-/2153**] with studies as above 7. Gout Social History: Pt lives alone in an [**Hospital3 **] community. She has a visiting nurse [**First Name (Titles) **] [**Last Name (Titles) 13222**]. Son lives close by and helps mother. [**Name (NI) **] ETOH, tobacco, or drugs. Family History: [**Name (NI) 1094**] son and daughter have DM. Her son also has HTN. She has no family history of CAD. Physical Exam: PE (on transfer to the floor): VS: Tm + Tc 98.9, BP 118/62 (127-147/51-101), HR 88 (94-110), RR 20, sats 98% on RA FS 57 I/O: none recorded yet GEN: Pleasant, elderly AfAm female in NAD. Moving around bed very comfortably. HEENT: NCAT, sclera anicteric, PERRL, EOMI. MMM w/ thrush on tongue, improved since last admission. Has dark circles around her eyes, nonpuffy. NECK: Neck supple, no JVD. CV: RR, normal S1, S2. III/VI soft systolic murmur heard at RUSB, II/VI holosystolic murmur heard at LLSB. CHEST: CTAB, except for few crackles at bases bilaterally. ABD: Soft, protuberant abdomen, no fluid wave, no ascites; + BS; obvious ventral hernia, otherwise no masses; no hepatomegaly. EXT: 2+ radial/PT pulses bilaterally. At tips of index fingers bilaterally, skin is cool, [**Doctor Last Name 352**]. R index finger has ? necrotic vs. blood blister on tip. Nontender. No edema. Skin dry, warm, wrinkled. NEURO: CN II-XII grossly intact. Pertinent Results: Labs on admission: WBC 7.8, Hct 38.5, MCV 94, Plt 229 (DIFF: Neuts-89.1* Bands-0 Lymphs-7.2* Monos-2.4 Eos-1.2 Baso-0.1) PT 12.2, PTT 27.1, INR 1.0 Na 139, K 4.9, Cl 98, HCO3 23, BUN 53, Cr 5.9 . Labs on discharge: WBC 7.7, Hct 33.5, MCV 93, Plt 239 PT 12.2, PTT 29.8, INR 1.0 Na 139, K 3.9, Cl 104, HCO3 24, BUN 33, Cr 5.0, Glu 78 Calcium 8.1, Phos 3.1, Mg 1.7 calTIBC 161, Ferritin 437, TRF 124* PTH 81* . Urinalysis: [**2154-2-26**] 08:45PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.019 Blood-NEG Nitrite-NEG Protein-30 Glucose-NEG Ketone-15 Bilirub-SM Urobiln-NEG pH-8.0 Leuks-NEG RBC-0-2 WBC-[**5-4**]* Bacteri-FEW Yeast-NONE Epi-[**10-14**] . Micro: none . Imaging: EGD [**2154-2-21**]: - Normal esophagus. - Stomach: Flat Lesions Multiple angiodysplasias/watermelon stomach was seen in the antrum compatible with GAVE. An Argon-Plasma Coagulator was applied for hemostasis successfully. - Duodenum: Angiodysplasias distributed in a linear pattern was noted in the first part of the duodenum. - Impression: Watermelon stomach in the antrum, Angiodysplasias in the first part of the duodenum, Otherwise normal egd to second part of the duodenum . CXR [**2154-2-26**]: No evidence of CHF or other acute cardiopulmonary process. . EGD [**2154-2-27**]: Mild erythema in the first part of the duodenum Angioectasia in the antrum Erosion in the cardia Otherwise normal egd to second part of the duodenum .. Brief Hospital Course: 69yo F with ESRD on HD, CAD, DM, HTN, CHF and h/o UGIB/GAVE, now presenting with hematemesis and melena. . # UGIB: Her NG lavage in the ER was positive, but cleared with 200cc. She was placed on protonix IV for UGIB and 2 large bore IVs were placed. She was given 1L NS as well as 1u pRBCs. An EGD was performed which showed bleeding in gastric antrum, likely due to GAVE. The angioectasias were cauterized with Argon laser and she had no further episodes of bleeding. Her Hct remained stable at 36. She was discharged with plans for a repeat elective EGD and Argon laser cauterization on [**2154-3-7**]. . # THRUSH: Ms. [**Known lastname 13224**] has thrush, but it appeared improved since her last hospitalization. She was continued on nystatin swish and swallow. . # CAD: Ms. [**Known lastname 13224**] [**Last Name (Titles) 13231**] has CAD, given that she had a stress MIBI that showed EKG changes but no perfusion defects at normal workload. She has no h/o of MI, but does have elevated troponins at baseline. During her last admission, she experienced lateral TW depressions as well as a troponin leak felt to be due to demand ischemia. She was continued on a beta-blocker and statin, but was not given an aspirin due to her UGIB. . # CHF: Her CHF appeared stable during this admission. She had crackles at her L lung base on exam but no shortness of breath or hypoxia. She was continued on her regular HD schedule and her volume status was managed by renal. The team discussed whether an ACE-inhibitor would be beneficial in her, but it was discontinued for unclear reasons in [**2145**]. The team decided to defer this decision to her PCP. . # DM II: Her fingersticks were monitored QID and she originally was on her regular glipizde dose as well as a regular insulin sliding scale for additional coverage. However, she actually was hypoglycemic and her glipizide does was held. She was not put on glipizide upon discharge, as she continued to be hypoglycemic. . # ESRD: Ms. [**Known lastname 13224**] has been receiving HD since [**2153-11-25**]. She was continued on HD per her regular M/W/F schedule. Renal consulted on her while she was in-house. She was continued on phoslo and nephrocaps daily. . # GOUT: She was continued on allopurinol. . # FINGER LESIONS: It was noted prior to discharge that Ms. [**Known lastname 13224**] has some lesions on the tips of her fingers. Our differential diagnosis included gout (less likely given appearance, lack of warmth or effusion), vascular (though has strong bilateral radial pulses), or a CTD (like lupus or Raynaud's, though unusual to present for first time at her age). Further workup was deferred to the outpatient setting as it was not acute, per the patient. . # FEN: She was given a regular [**Doctor First Name **] diet. No IVF were needed. Her electrolytes were checked daily and were repleted to keep K>4, Mg>2. . # PPX: She was given a PPI for GI prophylaxis, pneumoboots for DVT ppx, and a bowel regimen to prevent constipation. . # ACCESS: Peripheral IV . # COMM: with her son, [**Name (NI) **] at #[**Telephone/Fax (1) 13227**] . # DISPO: To home with services. Medications on Admission: Allopurinol 100 mg PO QD Atorvastatin 80 mg PO QD Toprol XL 50mg PO QD Nystatin 100,000 unit/mL Suspension 10 ML PO QID Protonix 40mg PO QD Glipizide 2.5mg PO QD PhosLo 667mg PO TID Folic Acid 1mg PO QD Multivitamin 1 tab PO QD Vitamin B Complex 1 tab PO QD Colace 100mg PO BID Senna 8.6mg PO BID Tylenol 325-650 PO Q4-6 prn Oxycodone 5mg PO Q6 prn Discharge Medications: 1. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day). 2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 5. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 6. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 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. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. 10. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID (4 times a day) as needed. 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Primary diagnosis: 1. GIB . Secondary diagnosis: 1. ESRD on HD 2. Diabetes 3. HTN Discharge Condition: Afebrile, Hct stable, BP stable Discharge Instructions: Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs. Adhere to 2 gm sodium diet Fluid Restriction: 1.5 L . Please call your PCP or go to the nearest ER if you develop any of the following symptoms: fever, chills, chest pain, dizziness, lightheadhedness, dark, tarry or bloody stools, burning on urination, abdominal pain or tenderness, or any other worrisome symptoms. . You should take all your medications as prescribed. The only change in your medications is to take Toprol XL 50mg daily. . You should follow-up with the GI department as previously scheduled for a repeat EGD on [**2154-3-7**]. . Please have a hematocrit (a measure of your red blood cells) checked at each hemodialysis session. Per your GI doctors, you should be transfused for any hematocrit less than 25. Followup Instructions: Already scheduled: Provider: [**Name10 (NameIs) 13228**] [**Name11 (NameIs) 13229**], [**First Name3 (LF) **] Phone:[**Telephone/Fax (1) 2226**] Date/Time:[**2154-3-5**] 12:00 Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1982**], MD Phone:[**Telephone/Fax (1) 1983**] Date/Time:[**2154-3-7**] 8:00 Provider: [**Name10 (NameIs) **] WEST,ROOM ONE GI ROOMS Date/Time:[**2154-3-7**] 8:00 . Please call your PCP [**Last Name (NamePattern4) **] [**11-26**] weeks for f/u from this admission. . Please continue dialysis as reccomended by your nephrologist. [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 4231**]

537,403,585,428,274,250,357,285

{'Angiodysplasia of stomach and duodenum with hemorrhage,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Gout, unspecified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Anemia in chronic kidney disease'}

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: (Amended ICU admission HPI) .. Ms. [**Known lastname 13224**] is a 69yo F with ESRD on HD, CAD, DM, HTN, CHF (EF 60-70%, 3+ MR) and GAVE who presents following an episode of hematemesis and maroon stools at home. She was recently admitted to [**Hospital1 18**] [**2-17**] - [**2-22**] after developing "dark" BM that were guaiac positive. At that time, she was found to be more anemic than usual and was given IVF and 2u pRBC in the ER, after which she developed flash pulmonary edema and required intubation and a short stay in the MICU. She was then scoped and underwent an Argon plasma coagulation procedure after which she did very well. Hct upon d/c on [**2-22**] was 31%. At that time, the plan per GI was to repeat EGD on [**2154-3-7**]. Of note, during her last hospital stay, she was noted to have lateral TW depressions and + troponins which were felt to be due to demand ischemia. .. Reports that she felt well after discharge until this past Monday ([**2-25**]), when she reports she had to be taken off of her dialysis treatment b/c she didn't feel well. She states that she first felt tingling and pain in her fingers and toes, to the point where she was unable to put her feet on the ground. She felt generally weak and tired following dialysis and needed to be assisted back to her apartment. She spent the evening and most of the next morning in bed. Her nurse came to assist her the next day and offered her an oxycodone which she took, but then vomited what she described as brown liquid w/ white specks in it. No nausea prior to her vomiting. Her nurse said that it looked like blood, but denied that it was coffee ground emesis. After vomiting, Ms. [**Known lastname 13224**] immediately felt better. The nurse then called the pt's PCP who advised the pt to come to the ER. 15-20 mins later, Ms. [**Known lastname 13224**] then felt the sudden urge to have a BM and had a liquid maroon stool which was guaiac positive. She denies any abdominal pain associated w/ the BM. At that point, EMS arrived and transported her to the ER. On ROS, Ms. [**Known lastname 13224**] [**Last Name (Titles) 13230**]d any lightheadedness, dizziness, CP, SOB, or diaphoresis. + persistent burping, but that has actually decreased in frequency since her last admission. Between her last discharge and now, she had been eating normally and having normal brown, formed stools. She has never had an episode of hematemesis before. .. In the ED, she was tachycardic but normotensive. Her NG lavage showed brown fluid that cleared with 200 cc and her rectal exam revealed guaiac negative brown stool. Her Hct on admsiion was 38% and she received lL of NS and 1u pRBCs. She also received Anzemet 12.5 mg IV X 1 and pantoprazole 40 mg IV X 1. She was evaluated by GI and taken for an EGD which showed findings c/w GAVE. Her angiodysplasias were coagulated w/ an argon laser and the pt was transfered to the [**Hospital Unit Name 153**] for monitoring of fluid status and serial Hct's. She remained hemodynamically stable in the [**Hospital Unit Name 153**] w/o any further episodes of hematemesis or melena, and her Hct remained stable, so she was transferred to the medical floor for futher monitoring. . MEDICAL HISTORY: 1. DM type II - c/b nephropathy and neuropathy 2. ESRD - on HD since [**11-30**] 3. CAD - suspected by stress test ([**Doctor Last Name 4001**]) in [**2153-5-22**]: Mild global hypokinesis. LVEF 43%. Normal myocardial perfusion at the level of stress achieved. 4. CHF: TTE [**2153-11-1**] showed LVEF 60-70% with 3+ MR and 2+ TR 5. Anemia: multifactorial (ESRD + iron deficiency [**12-27**] GIB) - colonoscopy on [**2153-8-7**] -> two nonbleeding polyps in sigmoid - EGD [**2153-8-7**] -> sig for erythema, edema, and erosion in the antrum c/w gastritis in addition to erythema in the proximal bulb c/w duodenitis - EGD [**12-31**] demonstated GAVE 6. Occult GI bleed [**7-/2153**] with studies as above 7. Gout MEDICATION ON ADMISSION: Allopurinol 100 mg PO QD Atorvastatin 80 mg PO QD Toprol XL 50mg PO QD Nystatin 100,000 unit/mL Suspension 10 ML PO QID Protonix 40mg PO QD Glipizide 2.5mg PO QD PhosLo 667mg PO TID Folic Acid 1mg PO QD Multivitamin 1 tab PO QD Vitamin B Complex 1 tab PO QD Colace 100mg PO BID Senna 8.6mg PO BID Tylenol 325-650 PO Q4-6 prn Oxycodone 5mg PO Q6 prn ALLERGIES: Aspirin / Aleve PHYSICAL EXAM: PE (on transfer to the floor): VS: Tm + Tc 98.9, BP 118/62 (127-147/51-101), HR 88 (94-110), RR 20, sats 98% on RA FS 57 I/O: none recorded yet GEN: Pleasant, elderly AfAm female in NAD. Moving around bed very comfortably. HEENT: NCAT, sclera anicteric, PERRL, EOMI. MMM w/ thrush on tongue, improved since last admission. Has dark circles around her eyes, nonpuffy. NECK: Neck supple, no JVD. CV: RR, normal S1, S2. III/VI soft systolic murmur heard at RUSB, II/VI holosystolic murmur heard at LLSB. CHEST: CTAB, except for few crackles at bases bilaterally. ABD: Soft, protuberant abdomen, no fluid wave, no ascites; + BS; obvious ventral hernia, otherwise no masses; no hepatomegaly. EXT: 2+ radial/PT pulses bilaterally. At tips of index fingers bilaterally, skin is cool, [**Doctor Last Name 352**]. R index finger has ? necrotic vs. blood blister on tip. Nontender. No edema. Skin dry, warm, wrinkled. NEURO: CN II-XII grossly intact. FAMILY HISTORY: [**Name (NI) 1094**] son and daughter have DM. Her son also has HTN. She has no family history of CAD. SOCIAL HISTORY: Pt lives alone in an [**Hospital3 **] community. She has a visiting nurse [**First Name (Titles) **] [**Last Name (Titles) 13222**]. Son lives close by and helps mother. [**Name (NI) **] ETOH, tobacco, or drugs. ### Response: {'Angiodysplasia of stomach and duodenum with hemorrhage,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Gout, unspecified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Anemia in chronic kidney disease'}

CHIEF COMPLAINT: Leg cramps PRESENT ILLNESS: 43 yo M with history of rhabdomyolysis related to mitochondrial d/o comes w/ cramping in legs. Pt reports he's been feeling somewhat unwell since 2 days ago when he nausea after eating chicken panini from [**Company **]. However, his symptom resolved by the end of the day. No diarrhea/abdominal pain/fevers or chills. Yesterday, he was moving boxes because he's moving to a different apt and felt tired and took a nap. After taking a nap, he woke up with calf muscle cramping and checked urine myoglobin at home which was positive. He then came to the ED. Otherwise, he denies any chest pain, sob, cough, diarrhea, abdominal pain, or constipation. He reports some HA and nasal congestion but no vision changes, stiff neck, neck pain or rhinorrhea. . In the Emergency Department, his CK was noted to be in 50,000s and received 1L NS. 1L of bicarb was started. Initially, for close monitor of urine output hourly and 'lytes in the setting of aggressive IVF, there was a consideration for MICU admission. However, MICU attending did not feel that he warranted MICU admission, thus floor admission was decided. However, from the [**Name (NI) **], pt went to MICU. Upon arrival to MICU, pt's VS was 98.3, 144/90, 102, 11, 99% on RA. Upon hearing that pt's moving again to CC7 again, pt became upset and tachycardic to 120-130s and hypertensive to 182/105. Currently, pt's BP 144/98, HR 94, 16, sat 98% on RA. Pt had uop of 500cc of tea-colored urine while in MICU. While in MICU, pt finished 1L bicarb and received 2 L of NS. 4th NS is running currently. Pt is refusing foley. MEDICAL HISTORY: 1. Mitochondrial myopathy with recurrent rhabdomyolysis; this myopathy is secondary to a cytochrome c-oxidase mutation; in the past, his rhabdomyolysis has been precipitated by exercise, warm weather, dehydration, viral and sinus infections. He is followed by Dr. [**Last Name (STitle) **] in Neurology. The pt's case has been studied and published in the journal NEUROLOGY [**2158**];55:644??????649. 2. Obstructive sleep apnea. 3. Recurrent sinusitis. MEDICATION ON ADMISSION: None. ALLERGIES: Compazine PHYSICAL EXAM: VS T 98.3 BP 144/98, HR 94, 16, sat 98% on RA GEN: well-appearing male, NAD HEENT: PERRL, EOMI, MMM. OP clear. NECK: supple Lungs: CTAB. CV: RRR, No MRG. Abd: S/NT/ND. Extr: No c/c/e. Neuro: CNs II-XII intact. Strength was [**3-23**] bilaterally in both upper and lower extremities. No tremor or asterixis. FAMILY HISTORY: There is no family history of mitochondrial or neuromuscular disease. His parents are both alive and well. Factor V Leiden. SOCIAL HISTORY: Software engineer, lives in [**Hospital1 **]. Not married. No tob, occ EtOH.

Rhabdomyolysis,Other and unspecified infection due to central venous catheter,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Disorders of mitochondrial metabolism,Other myopathies,Conditions due to anomaly of unspecified chromosome,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Obstructive sleep apnea (adult)(pediatric),Unspecified sinusitis (chronic),Painful respiration,Other specified cardiac dysrhythmias,Anemia, unspecified,Headache,Abdominal pain, left lower quadrant,Other chronic pain,Hypocalcemia,Enlargement of lymph nodes,Lymphocytosis (symptomatic)

Rhabdomyolysis,Oth/uns inf-cen ven cath,Phlbts sprfc vn up extrm,Dis mitochondrial metab,Myopathies NEC,Chromosome anomaly NOS,Abn react-procedure NEC,Obstructive sleep apnea,Chronic sinusitis NOS,Painful respiration,Cardiac dysrhythmias NEC,Anemia NOS,Headache,Abdmnal pain lt lwr quad,Chronic pain NEC,Hypocalcemia,Enlargement lymph nodes,Lymphocytosis-symptomatc

Admission Date: [**2167-4-11**] Discharge Date: [**2167-4-19**] Date of Birth: [**2124-2-10**] Sex: M Service: MEDICINE Allergies: Compazine Attending:[**First Name3 (LF) 905**] Chief Complaint: Leg cramps Major Surgical or Invasive Procedure: Lumbar puncture History of Present Illness: 43 yo M with history of rhabdomyolysis related to mitochondrial d/o comes w/ cramping in legs. Pt reports he's been feeling somewhat unwell since 2 days ago when he nausea after eating chicken panini from [**Company **]. However, his symptom resolved by the end of the day. No diarrhea/abdominal pain/fevers or chills. Yesterday, he was moving boxes because he's moving to a different apt and felt tired and took a nap. After taking a nap, he woke up with calf muscle cramping and checked urine myoglobin at home which was positive. He then came to the ED. Otherwise, he denies any chest pain, sob, cough, diarrhea, abdominal pain, or constipation. He reports some HA and nasal congestion but no vision changes, stiff neck, neck pain or rhinorrhea. . In the Emergency Department, his CK was noted to be in 50,000s and received 1L NS. 1L of bicarb was started. Initially, for close monitor of urine output hourly and 'lytes in the setting of aggressive IVF, there was a consideration for MICU admission. However, MICU attending did not feel that he warranted MICU admission, thus floor admission was decided. However, from the [**Name (NI) **], pt went to MICU. Upon arrival to MICU, pt's VS was 98.3, 144/90, 102, 11, 99% on RA. Upon hearing that pt's moving again to CC7 again, pt became upset and tachycardic to 120-130s and hypertensive to 182/105. Currently, pt's BP 144/98, HR 94, 16, sat 98% on RA. Pt had uop of 500cc of tea-colored urine while in MICU. While in MICU, pt finished 1L bicarb and received 2 L of NS. 4th NS is running currently. Pt is refusing foley. Past Medical History: 1. Mitochondrial myopathy with recurrent rhabdomyolysis; this myopathy is secondary to a cytochrome c-oxidase mutation; in the past, his rhabdomyolysis has been precipitated by exercise, warm weather, dehydration, viral and sinus infections. He is followed by Dr. [**Last Name (STitle) **] in Neurology. The pt's case has been studied and published in the journal NEUROLOGY [**2158**];55:644??????649. 2. Obstructive sleep apnea. 3. Recurrent sinusitis. Social History: Software engineer, lives in [**Hospital1 **]. Not married. No tob, occ EtOH. Family History: There is no family history of mitochondrial or neuromuscular disease. His parents are both alive and well. Factor V Leiden. Physical Exam: VS T 98.3 BP 144/98, HR 94, 16, sat 98% on RA GEN: well-appearing male, NAD HEENT: PERRL, EOMI, MMM. OP clear. NECK: supple Lungs: CTAB. CV: RRR, No MRG. Abd: S/NT/ND. Extr: No c/c/e. Neuro: CNs II-XII intact. Strength was [**3-23**] bilaterally in both upper and lower extremities. No tremor or asterixis. Pertinent Results: ADMISSION LABS: =============== 137 99 19 -----|-----|-----< 108 3.9 25 1.0 Ca 8.7 Phos 2.5 Mg 2.1 CK 51,291 UA: BLOOD-LG NITRITE-NEG PROTEIN-100 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG; RBC-0-2 WBC-0-2 BACTERIA-FEW YEAST-NONE EPI-<1 PERTINENT LABS DURING HOSPITALIZATION: ====================================== CK peaked at 55,950 then decreased to 1484 upon discharge WBC trend: 9.8 - 9.8 - 12.2 - 14.7 - 11.2 - 11.3 - 12.1 - 9.7 [**4-13**] D-dimer: 304 [**4-17**] ESR: 58 [**4-17**] CRP: 97.3 MICROBIOLOGY: ============= [**4-13**] UCx: negative [**4-13**] BCx: negative [**4-14**] BCx x 2: negative [**2167-4-15**] 4:09 pm CSF;SPINAL FLUID Source: LP. **FINAL REPORT [**2167-4-18**]** GRAM STAIN (Final [**2167-4-15**]): NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. NO MICROORGANISMS SEEN. FLUID CULTURE (Final [**2167-4-18**]): NO GROWTH. [**4-16**] UCx: negative [**4-17**] BCx x 2: negative [**4-18**] Lyme: negative STUDIES: ======== CHEST (PORTABLE AP) [**2167-4-13**] FINDINGS: In comparison with the study of [**2161-7-2**], there are lower lung volumes, but no evidence of acute pneumonia or vascular congestion. EKG [**2167-4-13**] Sinus rhythm. Diffuse non-specific ST-T wave changes. Compared to the previous tracing of [**2158-3-31**] the rate is increased and there are non-specific ST-T wave changes. Otherwise, no diagnostic interim change EKG [**2167-4-14**] Sinus rhythm Inferior T wave changes are nonspecific Since previous tracing of [**2167-4-13**], no significant change CHEST (PORTABLE AP) [**2167-4-15**] FINDINGS: In comparison with study of [**4-13**], there is some increasing prominence of interstitial markings that are less well defined, consistent with the clinical concern of some volume overload. No acute focal pneumonia. CHEST (PA & LAT) [**2167-4-16**] FINDINGS: In comparison with the study of [**4-15**], the degree of pulmonary vascular congestion has substantially decreased. There is still some increased opacification at the bases, which on lateral views seen to represent bilateral pleural effusions. Atelectatic change is seen at the bases. The upper lungs are free of acute pneumonia. CTA CHEST W&W/O C&RECONS, NON-CORONARY [**2167-4-17**] 1:47 PM There are several scattered ground-glass opacities in both lungs, predominantly in a bronchovascular distribution. There are bibasal effusions with atelectasis in the lower lobes. There are scattered mediastinal lymph nodes with the largest measuring 14 x 12 mm in a subcarinal location. There is no aortic dissection or pulmonary embolism. The coronary arteries arise from the normal expected anatomical location. The visualized liver and spleen appear unremarkable. MUSCULOSKELETAL: There are no worrisome bone lesions. CONCLUSION: 1. No pulmonary embolism or aortic dissection. The coronary arteries arise from the normal expected anatomical location. 2. Multifocal ground-glass opacities predominantly in a bronchovascular distribution. There is a wide differential for this appearance, including but not limited to infection, aspiration or pulmonary hemorrhage. UNILAT UP EXT VEINS US LEFT [**2167-4-17**] IMPRESSION: Acute short segment distal basilic vein clot, just superior to the antecubital fossa, corresponding to the palpable abnormality. THYROID U.S. [**2167-4-17**] 2:06 PM The right lobe measures 4.9 x 1.6 x 1.5 cm and left lobe measures 4.4 x 1.6 x 1.3 cm. Both lobes demonstrate normal echogenicity and vascularity. There are no discrete nodules. No cervical lymphadenopathy. IMPRESSION: Normal thyroid ultrasound. EKG [**2167-4-17**] Sinus tachycardia. Diffuse non-specific ST-T wave changes. Compared to the previous tracing of [**2167-4-14**] the rate has increased and there is inferolateral ST-T wave flattening. Otherwise, no diagnostic interim change. Brief Hospital Course: Mr. [**Known lastname 6852**] is a 43-year-old man with a history of rhabdomyolysis due to mitochondrial myopathy presenting with muscle pain and myoglobin in the urine due to rhabdomyolysis. #) Rhabdomyolysis: The patient presented with muscle aches and home urine test that showed myoglobin. He was treated with aggressive hydration with NS at 1L/hour, which was then decreased as he started to increase po intake. While on IV fluids, his urine output was monitored to keep UOP>200 cc/hour. His CKs trended down. Electrolytes were monitored, especially his renal function for signs of renal involvement. He was also monitored for hyperkalemia (due to release of cellular K) and metabolic acidosis (due to release of cellular phosphate and sulfate) but none of these occurred. #) Chest Pain: On [**4-13**], the pt reported that he has had chest pain in past episodes of rhabdomyolysis, and again, he had mild chest pain. CK-MB and troponin were checked and were flat. EKG showed only nonspecific TW flattening. Therefore, there was little concern for myocardial ischemia. More likely that this was [**12-20**] muscle pain in the chest wall. Other concern was for PE because he also had sinus tachycardia. However, he was oxygenating well, and D-Dimer was found to be normal making PE much less likely. He reports that during past admissions he has became tachycardic for unclear reasons. #) Sinus Tachycardia: Unclear etiology, as described above, much less likely to be due to PE due to normal saturation and nml D-Dimer. He has some pain, which may be underlying the tachycardia, though unclear. Please also see below. #) Shortness of Breath: During hospitalization, he did have an episode of shortness of breath and continued tachycardia, and he also continued to spike fevers for a few days. A CTA was obtained to rule out pulmonary embolism, which it did. His shortness of breath was likely due to volume overload from aggressive IVF hydration, which was also seen on CTA. This resolved as IVFs were decreased. A follow up CT chest should be performed in [**11-19**] months. #) Abdominal Pain: The patient complained of LLQ abdominal pain while hospitalized. This pain had been occurring for about 2 months prior to hospitalization. There was no rebound or guarding on exam. A CT of the abdomen was ordered, but the patient refused due to the oral contrast. His abdominal pain improved, and due to its chronicity, it was felt that he could follow up with his PCP for this chronic issue. #) Basilic Vein Clot: The patient developed a L basilic vein clot towards the end of his hospitalization. Anticoagulation was initiated with Lovenox bridge to coumadin. He will need to be anticoagulated for 3 months. His goal INR is [**12-21**]. He was set up with lab checks. Of important note, the patient has a family history of Factor V Leiden. He will need further workup of this history. #) Fevers of Unknown Origin: Hospitalization was complicated by fevers. The patient began to spike temperatures of 101-102. All urine cultures and blood cultures were negative to date. Lyme negative. CXR negative for infiltrates. CTA showed some ground glass opacities. LP negative. Thyroid U/S showed no cervical lymphadenopathy. ID was consulted, and he was followed clinically. Pt did endorse several weeks of lymphadenopathy and fevers as outpatient that had once been treated with a Z-pak. He also had a leukocytosis that then resolved upon discharge. #) Headache: Pt c/o headache in setting of fever and nausea/vomiting. LP performed that was negative. Headache resolved s/p LP. #) L upper extremity cellulitis: After clot developed (which was after fevers were occurring), pt had cellulitis overlying it. Pt was started on IV vancomycin, which was switched to Keflex and Bactrim per ID. The patient discharged with instructions to take 7 days of these medications, see his PCP, [**Name10 (NameIs) **] should it not have improved, to take an extra 7 days of Keflex/Bactrim. #) Anemia: likely [**12-20**] hemodilution from large volume IVF. However, pt reports that at outside hospital he was also found to have a low hct. Iron studies were checked, and are not c/w Iron def anemia, nevertheless pt reports that his PCP scheduled [**Name9 (PRE) 3782**] colonoscopy for him prior to admission. Medications on Admission: None. Discharge Medications: 1. Enoxaparin 80 mg/0.8 mL Syringe Sig: Eighty (80) Enoxaparin (Subcutaneous) 80 mg Subcutaneous Q12H (every 12 hours). Disp:*20 80 mg/0.8 mL Syringe* Refills:*0* 2. Amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 4. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 PM. Disp:*30 Tablet(s)* Refills:*2* 5. Bactrim DS 160-800 mg Tablet Sig: Two (2) Tablet PO twice a day for 7 days. Disp:*28 Tablet(s)* Refills:*0* 6. Keflex 500 mg Capsule Sig: One (1) Capsule PO every six (6) hours for 7 days. Disp:*28 Capsule(s)* Refills:*0* 7. Outpatient Lab Work Have blood work for INR checked on Tuesday [**4-21**], and faxed to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 6853**] office. Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Rhabdomyolysis Fevers R arm basilic vein thrombus Cellulitis Discharge Condition: CK trending down, muscle aches improved, cellulitis improved, ambulating. Discharge Instructions: You were admitted with rhabdomyolysis. This occured because of your mitochondiral disorder. You were treated with large volumes of IV fluids to help protect your kidneys. Your kidney function remained good throughout your stay. Your hospitalization was complicated by fevers of unknown origin. A CT scan was done of your lungs which showed that you had some fluid in your lungs, most likely due to the IV fluids and no pneumonia. You will need a repeat CT Chest in [**11-19**] months to make sure the changes have ressolved. The Infectious Disease doctors were involved in your care for your fevers. Also, you had a clot in one of your veins in your left arm, which we started anticoagulation for with both Lovenox and Coumadin. You will need to be on anticoagulation for 3 months. You told us that there is a clotting disorder in your family, and this can be worked up in you with blood tests as an outpatient. Lastly, the the area on your left arm appeared infected (cellulitis), so you were started on an IV antibiotic, which was changed to antibiotics that you can take by mouth. If you are still having redness in your arm after 7 days of antibiotics, call your primary care physician [**Name Initial (PRE) **] 7 more days of antibiotics. Your blood pressures were elevated in the hospital and you have been given prescriptions for anti-hypertensives. . Please keep your follow up appointments as written below. . Please take all your medications as prescribed. You have been started on metoprolol and amlodipine for elevated blood pressures. You have been started on coumadin and lovenox for anticoagulation. . You will need to follow up your INR levels to make sure you are getting adequately anti-coagulated for your clot. Your PCP should follow these levels and change your dose accordingly. . If you have any symptoms of worsening muscle aches, pains, dark urine, or any other concerning symptoms you should call your doctor or go to the ER immediately. Followup Instructions: Please follow up with your PCP, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 3393**]) in the next 1 week. You should have blood work done for an INR on Tuesday [**4-21**], and this should be faxed to Dr.[**Name (NI) 6854**] office. . Provider [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6855**], M.D. Phone:[**Telephone/Fax (1) 6856**] Date/Time:[**2167-5-14**] 9:30 [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**] Completed by:[**2167-4-21**]

728,999,451,277,359,758,E879,327,473,786,427,285,784,789,338,275,785,288

{'Rhabdomyolysis,Other and unspecified infection due to central venous catheter,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Disorders of mitochondrial metabolism,Other myopathies,Conditions due to anomaly of unspecified chromosome,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Obstructive sleep apnea (adult)(pediatric),Unspecified sinusitis (chronic),Painful respiration,Other specified cardiac dysrhythmias,Anemia, unspecified,Headache,Abdominal pain, left lower quadrant,Other chronic pain,Hypocalcemia,Enlargement of lymph nodes,Lymphocytosis (symptomatic)'}

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: Leg cramps PRESENT ILLNESS: 43 yo M with history of rhabdomyolysis related to mitochondrial d/o comes w/ cramping in legs. Pt reports he's been feeling somewhat unwell since 2 days ago when he nausea after eating chicken panini from [**Company **]. However, his symptom resolved by the end of the day. No diarrhea/abdominal pain/fevers or chills. Yesterday, he was moving boxes because he's moving to a different apt and felt tired and took a nap. After taking a nap, he woke up with calf muscle cramping and checked urine myoglobin at home which was positive. He then came to the ED. Otherwise, he denies any chest pain, sob, cough, diarrhea, abdominal pain, or constipation. He reports some HA and nasal congestion but no vision changes, stiff neck, neck pain or rhinorrhea. . In the Emergency Department, his CK was noted to be in 50,000s and received 1L NS. 1L of bicarb was started. Initially, for close monitor of urine output hourly and 'lytes in the setting of aggressive IVF, there was a consideration for MICU admission. However, MICU attending did not feel that he warranted MICU admission, thus floor admission was decided. However, from the [**Name (NI) **], pt went to MICU. Upon arrival to MICU, pt's VS was 98.3, 144/90, 102, 11, 99% on RA. Upon hearing that pt's moving again to CC7 again, pt became upset and tachycardic to 120-130s and hypertensive to 182/105. Currently, pt's BP 144/98, HR 94, 16, sat 98% on RA. Pt had uop of 500cc of tea-colored urine while in MICU. While in MICU, pt finished 1L bicarb and received 2 L of NS. 4th NS is running currently. Pt is refusing foley. MEDICAL HISTORY: 1. Mitochondrial myopathy with recurrent rhabdomyolysis; this myopathy is secondary to a cytochrome c-oxidase mutation; in the past, his rhabdomyolysis has been precipitated by exercise, warm weather, dehydration, viral and sinus infections. He is followed by Dr. [**Last Name (STitle) **] in Neurology. The pt's case has been studied and published in the journal NEUROLOGY [**2158**];55:644??????649. 2. Obstructive sleep apnea. 3. Recurrent sinusitis. MEDICATION ON ADMISSION: None. ALLERGIES: Compazine PHYSICAL EXAM: VS T 98.3 BP 144/98, HR 94, 16, sat 98% on RA GEN: well-appearing male, NAD HEENT: PERRL, EOMI, MMM. OP clear. NECK: supple Lungs: CTAB. CV: RRR, No MRG. Abd: S/NT/ND. Extr: No c/c/e. Neuro: CNs II-XII intact. Strength was [**3-23**] bilaterally in both upper and lower extremities. No tremor or asterixis. FAMILY HISTORY: There is no family history of mitochondrial or neuromuscular disease. His parents are both alive and well. Factor V Leiden. SOCIAL HISTORY: Software engineer, lives in [**Hospital1 **]. Not married. No tob, occ EtOH. ### Response: {'Rhabdomyolysis,Other and unspecified infection due to central venous catheter,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Disorders of mitochondrial metabolism,Other myopathies,Conditions due to anomaly of unspecified chromosome,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Obstructive sleep apnea (adult)(pediatric),Unspecified sinusitis (chronic),Painful respiration,Other specified cardiac dysrhythmias,Anemia, unspecified,Headache,Abdominal pain, left lower quadrant,Other chronic pain,Hypocalcemia,Enlargement of lymph nodes,Lymphocytosis (symptomatic)'}

CHIEF COMPLAINT: Trauma - Fall PRESENT ILLNESS: This patient is a 43 year old male transferred for 20 foot fall onto a pole that impaled his R thigh. Imaging at OSH (including a CT pan scan) found a depressed skull fx, L humerus fx/dislocation. Initial GCS 13. Then developed projectile vomiting and became more somnolent, so he was intubated by RSI. Received PTA 250 mcg fentanyl, 4 mg versed, 10 mg vecuronium (40 minutes prior to arrival), TD, and 2 g of ancef. MEDICAL HISTORY: PMH: none PSH: none MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission (per ED note) Temp:96.7 HR:124 BP:186/75 Resp:12 O(2)Sat:100 normal FAMILY HISTORY: non contributory SOCIAL HISTORY: construction worker, lives with wife and one son

Open fracture of base of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Injury to kidney without mention of open wound into cavity, unspecified injury,Closed fracture of two ribs,Closed fracture of shaft of tibia alone,Closed fracture of greater tuberosity of humerus,Acute posthemorrhagic anemia,Open fracture of vault of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Rotator cuff (capsule) sprain,Closed anterior dislocation of humerus,Closed fracture of other facial bones,Open wound of hip and thigh, without mention of complication,Open wound of forehead, without mention of complication,Other specified cardiac dysrhythmias,Other antihypertensive agents causing adverse effects in therapeutic use,Enophthalmos due to trauma or surgery,Accidental fall into other hole or other opening in surface,Accidents occurring in industrial places and premises

Opn skul base fx/hem NEC,Kidney injury NOS-closed,Fracture two ribs-closed,Fx shaft tibia-closed,Fx gr tuberos humerus-cl,Ac posthemorrhag anemia,Opn skull vlt fx/hem NEC,Sprain rotator cuff,Ant disloc humerus-close,Fx facial bone NEC-close,Open wound of hip/thigh,Open wound of forehead,Cardiac dysrhythmias NEC,Adv eff antihyperten agt,Enophthalmos d/t trauma,Fall into other hole,Acc on industr premises

Admission Date: [**2172-7-21**] Discharge Date: [**2172-8-5**] Date of Birth: [**2128-10-4**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 371**] Chief Complaint: Trauma - Fall Major Surgical or Invasive Procedure: [**2172-7-22**] Ortho: - Intramedullary nail, right tibia. - Closed treatment, left glenohumeral dislocation, with manipulation. - Washout and closure, right thigh wound, with debridement to muscle. ENT: - Surgical preparation of the frontal area (area debrided and irrigated 80 cm2) - Cranialization of frontal sinus. - Removal of nasal frontal duct mucosa bilaterally. - Obliteration of nasal frontal duct bilateral. - Anterior frontal sinus bony reconstruction. - Complex wound closure of 15 cm Neurosurgery: - Elevation of depressed fractures of the left frontal sinus and the left frontal area. [**2172-7-30**] Orthopedics: - Open reduction internal fixation greater tuberosity fracture - Repair rotator cuff History of Present Illness: This patient is a 43 year old male transferred for 20 foot fall onto a pole that impaled his R thigh. Imaging at OSH (including a CT pan scan) found a depressed skull fx, L humerus fx/dislocation. Initial GCS 13. Then developed projectile vomiting and became more somnolent, so he was intubated by RSI. Received PTA 250 mcg fentanyl, 4 mg versed, 10 mg vecuronium (40 minutes prior to arrival), TD, and 2 g of ancef. Past Medical History: PMH: none PSH: none Social History: construction worker, lives with wife and one son Family History: non contributory Physical Exam: On Admission (per ED note) Temp:96.7 HR:124 BP:186/75 Resp:12 O(2)Sat:100 normal Constitutional: Intubated HEENT: Pupils 2 mm NR, + facial laceration, bilateral periorbital ecchymoses C-collar, midline trachea Chest: Equal bs with bagging Cardiovascular: Regular Rate and Rhythm, tachycardic Abdominal: Soft, stable pelvis GU/Flank: No stepoffs on log roll Extr/Back: Warm extremities, No palpable DP in RLE, + palpable PT/femoral pulses in RLE and normal pulses in other extremities Skin: Very large laceration to medial R thigh oozing blood, but no arterial bleeding, + abrasions Neuro: Limited neuro exam, + spontaneous inspiratory effort and extremity movement in UEs Pertinent Results: CT torso OSH [**7-21**]: Air tracking along right groin through iliopsoas, no active extrav from SFA or profunda. Left renal interpolar hypodensity concerning for laceration. No hematoma/extravasation. SQ gas along the right thigh with sm gas to RP R iliopsoas. No pneumoperitoneum. Minimally displaced left 11th and 10th rib fractures. Left humeral head dislocation and Fx. Hepatic steatosis. Ct Head [**7-22**]: Depressed left anterior skull fracture, no associated hemmorhage. Skull fracture with extension to the L frontal sinus. Cspine [**7-22**]: Negative Tib/ Fib Xray [**7-21**]: Right tibial fracture Femur xray right [**7-21**]: No fx [**2172-7-25**] head CT : 1. Evolving bifrontal edema related to known parenchymal contusions. The volume of intracranial hemorrhage has minimally decreased, and there is no new focus of intracranial hemorrhage. 2. Mild increase in the size of a small extra-axial fluid and gas collection overlying the left frontal lobe. [**2172-7-30**] Left shoulder : ORIF of the left proximal comminuted humerus fracture with interval placement of metallic fixation devices CT head [**8-2**]: 1. No new intracranial hemorrhage. 2. Interval mild decrease of parenchymal edema and its mass effect in the left frontral lobe. 3. No definite new fracture. Unchanged comminuted frontal calvarial fracture and left lateral orbital wall fx with metallic clips. Brief Hospital Course: Trauma team evaluated the patient and after primary/secondary surveys and imaging the following injuries were noted: Injuries: Depressed skull fx without associated hemorrhage scalp lac L shoulder dislocation comminuted left humeral fracture R thigh lac R tib fx Pt was admitted to the TSICU for further management. [**7-22**] - admitted with multiple lesions/fractures, hypotensive. Received 7L crystalloids and 1U pRBC. to OR for elevation of depressed skull fracture ORIF right tibia fracture; closed reduction left proximal humerus, lumbar drain [**7-23**] - New right CVL placed; increased dilantin dosing and gave one time additional dose of 500mg IV as level was sub-therapeutic. Removed potentially dirty left groin trauma line. Plan for OR on [**7-24**] for left humerus greater tuberousity repair. NPO after midnight. [**7-24**] - Restarted TFs goal 70. Changed right a.line to left a.line. Discontinued vanc/ceftaz/flagyl and started only unasyn per Nsurg and Plastics. Transfused 1U pRBC for Hct 22.0. Extubated succesfully. [**7-25**] - interval head CT with evolving bifrontal edema, MRI L-spine done, C-spine clear [**7-26**] - ordered arterial non-invasives bilateral lower extremities. minimally improving neuro exam (patient now able to say his name). Will likely require PEG on [**2172-7-27**]. [**7-27**] - Pt spiked to 101.9 at 8 am, then afebrile during the day. Bcx and lumbar drain cx's were sent. CSF with 2575 RBC, 119 protein, gram stain negative, cx's pending. Neurosurgery to pull the lumbar drain in am after clamp trial overnight to monitor for CSF leak. Currently on cefazolin. No need for NIAS per vascular, pt now with palpable pulses. Diuresed with lasix 20', -3L for the day. [**Month (only) 116**] have PEG when availability if WBC going down. Stopped standing lopressor, due to bradycardia episodes during night [**7-28**] - Continues to have elevated WBC of 13.6 with no obvious source of infection. Lumbar drain pulled. Still waiting on PEG given leukocytosis. Facial sutures dc'd by plastics. [**7-29**] - Passed speech/swallow eval for diet of thin liquids and pureed solids [**7-30**] - Pt transferred to floor. Taken to OR with orthopedics for ORIF L humerus greater tuberosity, rotator cuff repair. [**8-2**] - Evaluated by ophthalmology, no acute issues. Pt can follow up with outpatient ophthalmologist. In the evening, pt had mechanical fall while attempting to move from commode to bed. Struck right side of head on wall. No other injuries. No head bleeding, neuro exam at baseline. CT head showed no acute bleed or fracture. [**8-4**] - Right thigh sutures and knee staples removed. At the time of discharge, pt working with Physical Therapy to increase mobility but still required a maximal assist. His appetite was slowly improving but still on calorie counts. He remained free of any pulmonary complications post op and remained afebrile. he was transferred to rehab on [**2172-8-5**] with the hopes of returning home independently. Medications on Admission: none Discharge Medications: 1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for fever or pain. 2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 3. Docusate Sodium 50 mg/5 mL Liquid Sig: Ten (10) ml PO BID (2 times a day) as needed for constipation. 4. White Petrolatum-Mineral Oil 56.8-42.5 % Ointment Sig: One (1) Appl Ophthalmic PRN (as needed) as needed for dry eyes. 5. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection TID (3 times a day). 6. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. Discharge Disposition: Extended Care Facility: [**Hospital6 979**] Discharge Diagnosis: S/P [**2172**]0 ft. 1. Depressed skull fracture 2. Scalp laceration 3. Left shoulder proximal fracture and dislocation 4. Right thigh laceration 5. Right tibial fracture 6. Acute blood loss anemia 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: * You were admitted to the Acute Care Service after your traumatic fall with multiple injuries requiring evaluation by Plastic Surgery, Orthopedic Surgery, Neurosurgery< Opthamology and Rehab Services. * You have made great strides but you still have room to improve thus necessitating this transfer to rehab. * Your mental status is improving daily and should continue to do so. * Participation in physical therapy with gait training, balance and range of motion will help you in your goal to return home. * Continue to eat and stay hydrated to help with healing and stamina. Followup Instructions: 1. During business hours, please have patient call the office of Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 6742**] to schedule a follow-up appointment for [**Last Name (LF) 2974**], [**8-7**]. ( Plastic Surgery) 2. Please call/or have the patient call ([**Telephone/Fax (1) 88**] to schedule a follow- up appointment in 4 weeks with a Non-contrast CT scan of the head. Our office is located in the [**Hospital **] Medical Building, [**Hospital Unit Name 12193**]. ( Neurosurgery) Call [**Telephone/Fax (1) 1228**] for a follow up appointment in 1 week at the [**Hospital **] Clinic Call your eye doctor for a follow up appointment when you return home from from rehab. Completed by:[**2172-8-5**]

801,866,807,823,812,285,800,840,831,802,890,873,427,E942,376,E883,E849

{'Open fracture of base of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Injury to kidney without mention of open wound into cavity, unspecified injury,Closed fracture of two ribs,Closed fracture of shaft of tibia alone,Closed fracture of greater tuberosity of humerus,Acute posthemorrhagic anemia,Open fracture of vault of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Rotator cuff (capsule) sprain,Closed anterior dislocation of humerus,Closed fracture of other facial bones,Open wound of hip and thigh, without mention of complication,Open wound of forehead, without mention of complication,Other specified cardiac dysrhythmias,Other antihypertensive agents causing adverse effects in therapeutic use,Enophthalmos due to trauma or surgery,Accidental fall into other hole or other opening in surface,Accidents occurring in industrial places and premises'}

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: Trauma - Fall PRESENT ILLNESS: This patient is a 43 year old male transferred for 20 foot fall onto a pole that impaled his R thigh. Imaging at OSH (including a CT pan scan) found a depressed skull fx, L humerus fx/dislocation. Initial GCS 13. Then developed projectile vomiting and became more somnolent, so he was intubated by RSI. Received PTA 250 mcg fentanyl, 4 mg versed, 10 mg vecuronium (40 minutes prior to arrival), TD, and 2 g of ancef. MEDICAL HISTORY: PMH: none PSH: none MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On Admission (per ED note) Temp:96.7 HR:124 BP:186/75 Resp:12 O(2)Sat:100 normal FAMILY HISTORY: non contributory SOCIAL HISTORY: construction worker, lives with wife and one son ### Response: {'Open fracture of base of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Injury to kidney without mention of open wound into cavity, unspecified injury,Closed fracture of two ribs,Closed fracture of shaft of tibia alone,Closed fracture of greater tuberosity of humerus,Acute posthemorrhagic anemia,Open fracture of vault of skull with other and unspecified intracranial hemorrhage, unspecified state of consciousness,Rotator cuff (capsule) sprain,Closed anterior dislocation of humerus,Closed fracture of other facial bones,Open wound of hip and thigh, without mention of complication,Open wound of forehead, without mention of complication,Other specified cardiac dysrhythmias,Other antihypertensive agents causing adverse effects in therapeutic use,Enophthalmos due to trauma or surgery,Accidental fall into other hole or other opening in surface,Accidents occurring in industrial places and premises'}

CHIEF COMPLAINT: L. pleural effusion PRESENT ILLNESS: The patient is a delightful, 77-year-old gentleman who has developed progressive dyspnea. He has been found to have a left-sided pleural effusion. Thoracentesis demonstrated no evidence of malignancy or infection on pathological and microbiological examination. He has not had any documented episodes of infections recently to suggest that this was a parapneumonic effusion. He did have a few small, relatively superficial lung nodules in the left lower and left upper lobe. He was admitted for thoracoscopy with evacuation of pleural effusion, takedown of adhesions and partial lung decortication. MEDICAL HISTORY: glaucoma, BPH, total knee replacement, loss of hearing right ear, bronchitis. MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Lisinopril 40', Lasix 40', Combivent, Claritin 10', eyedrops Travatan one drop right eye, Trisopt one drop right eye both daily ALLERGIES: Penicillins PHYSICAL EXAM: AF, VSS NAD RRR CTAB CT incisions dressed warm no edema FAMILY HISTORY: SOCIAL HISTORY:

Pleurisy without mention of effusion or current tuberculosis,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Knee joint replacement

Pleurisy w/o effus or TB,Hypertension NOS,BPH w/o urinary obs/LUTS,Joint replaced knee

Admission Date: [**2115-2-15**] Discharge Date: [**2115-2-17**] Date of Birth: [**2037-5-2**] Sex: M Service: CARDIOTHORACIC Allergies: Penicillins Attending:[**Last Name (NamePattern1) 1561**] Chief Complaint: L. pleural effusion Major Surgical or Invasive Procedure: s/p VATS decortication History of Present Illness: The patient is a delightful, 77-year-old gentleman who has developed progressive dyspnea. He has been found to have a left-sided pleural effusion. Thoracentesis demonstrated no evidence of malignancy or infection on pathological and microbiological examination. He has not had any documented episodes of infections recently to suggest that this was a parapneumonic effusion. He did have a few small, relatively superficial lung nodules in the left lower and left upper lobe. He was admitted for thoracoscopy with evacuation of pleural effusion, takedown of adhesions and partial lung decortication. Past Medical History: glaucoma, BPH, total knee replacement, loss of hearing right ear, bronchitis. Physical Exam: AF, VSS NAD RRR CTAB CT incisions dressed warm no edema Pertinent Results: [**2115-2-17**] 01:53AM BLOOD WBC-8.0 RBC-2.99* Hgb-9.4* Hct-26.6* MCV-89 MCH-31.5 MCHC-35.5* RDW-13.4 Plt Ct-338 [**2115-2-17**] 01:53AM BLOOD Plt Ct-338 [**2115-2-17**] 01:53AM BLOOD Glucose-106* UreaN-11 Creat-0.7 Na-130* K-4.6 Cl-99 HCO3-23 AnGap-13 [**2115-2-17**] 01:53AM BLOOD Calcium-8.3* Phos-3.3 Mg-1.8 Brief Hospital Course: The pt was taken to the operating room where a VATS drainage and decortication was preformed. The pt tolerated the procedure well. The pt remained intubated overnight and was transfered to the CSRU in stable condition at the end of the procedure. There were no complications. The pt's post operative course was uncomplicated. He was extubated POD #1. On POD# 2 his chest tubes were removed. At the time of discharge he was ambulating on his own with out difficulty, had good pain control on oral pain medications, had O2 sats greater then 92 % on Room air, had return of bowel and baldder function and was tolerating a regular diet. Medications on Admission: [**Last Name (un) 1724**]: Lisinopril 40', Lasix 40', Combivent, Claritin 10', eyedrops Travatan one drop right eye, Trisopt one drop right eye both daily Discharge Medications: 1. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every four (4) hours as needed for pain. Disp:*80 Tablet(s)* Refills:*0* 2. Home Meds OK to resume home medications Take a stool sofener while taking pain medications Discharge Disposition: Home Discharge Diagnosis: s/p VATS decortication Discharge Condition: good Discharge Instructions: Call Clinic or return to the ED for T>101.5. Any redness or drainage from the wound. Shortness of breath or anything else that is of concern to you. Followup Instructions: Follow up with Dr. [**Last Name (STitle) 952**] in Clinic in [**2-16**] weeks. Call for an appointment on Monday. [**Telephone/Fax (1) 170**] Completed by:[**2115-2-18**]

511,401,600,V436

{'Pleurisy without mention of effusion or current tuberculosis,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Knee joint replacement'}

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: L. pleural effusion PRESENT ILLNESS: The patient is a delightful, 77-year-old gentleman who has developed progressive dyspnea. He has been found to have a left-sided pleural effusion. Thoracentesis demonstrated no evidence of malignancy or infection on pathological and microbiological examination. He has not had any documented episodes of infections recently to suggest that this was a parapneumonic effusion. He did have a few small, relatively superficial lung nodules in the left lower and left upper lobe. He was admitted for thoracoscopy with evacuation of pleural effusion, takedown of adhesions and partial lung decortication. MEDICAL HISTORY: glaucoma, BPH, total knee replacement, loss of hearing right ear, bronchitis. MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Lisinopril 40', Lasix 40', Combivent, Claritin 10', eyedrops Travatan one drop right eye, Trisopt one drop right eye both daily ALLERGIES: Penicillins PHYSICAL EXAM: AF, VSS NAD RRR CTAB CT incisions dressed warm no edema FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Pleurisy without mention of effusion or current tuberculosis,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Knee joint replacement'}

CHIEF COMPLAINT: CC: Resp Failure PRESENT ILLNESS: HPI: 83 M with h/o thyroid CA s/p resection, MDS txn dependent, bronchomalacia, with recent admission for [**Doctor First Name **] pneumonia. Pt was recently discharged on chlarithromycin/ethambutol in [**10-9**]. Pt was not taking ethambutol. Since d/c has been having orthopnea, poor appetite, and progressive weight loss. Has had DOE and in AM of admission had acute sob with tachypnea. No cough or sputum production. No fever/chills. Had isolated episode of hemoptysis shortly after and increasing lethargy. Came to ED. In ED, was tachypneic (40's), diaphoretic, hypertensive (SBP's 220)and febrile. Initial ABG: 7.35/42/277 on NRB but pt intubated for impending fatigue. Given levoquin/ceftazidime/lasix/solumedrol and nitro gtt, and admitted to MICU for further care. In MICU, pt continued to be transfusion dependent and received prbc's for a hct<25 & platelet transfusions for a count of <20. Ceftaz was switched to zosyn for pneumonia treatment. He continued to have copious secretions. He was weaned off mechanical ventilation on [**11-16**] and subsequently transferred to medicine for further management. Given pt's improving respiratory function, no bronchoscopy was performed to further evaluate pt's airway infection issues. MEDICAL HISTORY: 1.Papillary thyroid CA resected in [**5-7**] and then radioablated. 2.MDS dx by BMB in [**6-8**]. He??????s transfusion dependent at baseline. MEDICATION ON ADMISSION: levothyroxine Clarithromycin Ethambutol Protonix Danazol Fe MVI Folic acid Flonase Duonebs Erythropoietin ALLERGIES: Oxycodone / [**Doctor First Name **]-D / Pletal / Atenolol PHYSICAL EXAM: PHYSICAL EXAM VS: 97.4 120/60 84 20 99%3L Gen: asleep and in NAD HEENT: NC/AT, MMM CV: RRR, S1/S2 nml, no m/r/g Pulm: + crackles at left base, otherwise CTA Abd: soft, NT/ND, NABS, no HSM Extr: no c/c/e Neuro: CN II-XII were nonfocal. FAMILY HISTORY: No known h/o blood disorders in his family. 2 sisters with CAD. SOCIAL HISTORY: Mr [**Known lastname **] came to the US about 15 years ago. He smoked for most of his life, but stopped 15 years ago. He was a teacher when he lived in [**Location 27654**]. He lives alone with his wife in subsidized housing here in [**Location (un) 86**]. He has 3 children. He has occassional alcohol.

Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Acute bronchitis,Esophageal reflux,Personal history of malignant neoplasm of thyroid,Coronary atherosclerosis of native coronary artery,Personal history of noncompliance with medical treatment, presenting hazards to health,Other chronic pulmonary heart diseases

Pneumonia, organism NOS,Obs chr bronc w(ac) exac,Acute respiratry failure,CHF NOS,Acute kidney failure NOS,Acute bronchitis,Esophageal reflux,Hx of thyroid malignancy,Crnry athrscl natve vssl,Hx of past noncompliance,Chr pulmon heart dis NEC

Admission Date: [**2184-11-13**] Discharge Date: [**2184-11-25**] Service: MED Allergies: Oxycodone / [**Doctor First Name **]-D / Pletal / Atenolol Attending:[**First Name3 (LF) 11754**] Chief Complaint: CC: Resp Failure Major Surgical or Invasive Procedure: bronchoscopy History of Present Illness: HPI: 83 M with h/o thyroid CA s/p resection, MDS txn dependent, bronchomalacia, with recent admission for [**Doctor First Name **] pneumonia. Pt was recently discharged on chlarithromycin/ethambutol in [**10-9**]. Pt was not taking ethambutol. Since d/c has been having orthopnea, poor appetite, and progressive weight loss. Has had DOE and in AM of admission had acute sob with tachypnea. No cough or sputum production. No fever/chills. Had isolated episode of hemoptysis shortly after and increasing lethargy. Came to ED. In ED, was tachypneic (40's), diaphoretic, hypertensive (SBP's 220)and febrile. Initial ABG: 7.35/42/277 on NRB but pt intubated for impending fatigue. Given levoquin/ceftazidime/lasix/solumedrol and nitro gtt, and admitted to MICU for further care. In MICU, pt continued to be transfusion dependent and received prbc's for a hct<25 & platelet transfusions for a count of <20. Ceftaz was switched to zosyn for pneumonia treatment. He continued to have copious secretions. He was weaned off mechanical ventilation on [**11-16**] and subsequently transferred to medicine for further management. Given pt's improving respiratory function, no bronchoscopy was performed to further evaluate pt's airway infection issues. Past Medical History: 1.Papillary thyroid CA resected in [**5-7**] and then radioablated. 2.MDS dx by BMB in [**6-8**]. He??????s transfusion dependent at baseline. 3.Recently admitted with probable pneumonia and treated initially with cefepime and azithro, then transitioned to levaquin and azithro. 4.Recent negative AFB x3 and neg stianing for pneumocysts. 5. bronchomalacia 6. h/o 25 pk-years of smoking 7. EF 50% PASP 38 ([**9-8**]) 8. Chest CT ([**9-8**]): calcified pleural plaque, bronchomalacia, mediastinal lymphadenopathy Social History: Mr [**Known lastname **] came to the US about 15 years ago. He smoked for most of his life, but stopped 15 years ago. He was a teacher when he lived in [**Location 27654**]. He lives alone with his wife in subsidized housing here in [**Location (un) 86**]. He has 3 children. He has occassional alcohol. Family History: No known h/o blood disorders in his family. 2 sisters with CAD. Physical Exam: PHYSICAL EXAM VS: 97.4 120/60 84 20 99%3L Gen: asleep and in NAD HEENT: NC/AT, MMM CV: RRR, S1/S2 nml, no m/r/g Pulm: + crackles at left base, otherwise CTA Abd: soft, NT/ND, NABS, no HSM Extr: no c/c/e Neuro: CN II-XII were nonfocal. Pertinent Results: + [**2184-11-13**] 07:33PM TYPE-ART PO2-277* PCO2-42 PH-7.35 TOTAL CO2-24 BASE XS--2 [**2184-11-13**] 07:21PM URINE HOURS-RANDOM [**2184-11-13**] 07:21PM URINE GR HOLD-HOLD [**2184-11-13**] 07:21PM URINE COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.009 [**2184-11-13**] 07:21PM URINE BLOOD-MOD NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2184-11-13**] 07:21PM URINE RBC-<1 WBC-0-2 BACTERIA-RARE YEAST-NONE EPI-<1 [**2184-11-13**] 07:21PM URINE AMORPH-FEW URIC ACID-FEW [**2184-11-13**] 07:00PM COMMENTS-GREEN TOP [**2184-11-13**] 07:00PM LACTATE-1.9 [**2184-11-13**] 06:54PM GLUCOSE-123* UREA N-24* CREAT-1.6* SODIUM-133 POTASSIUM-5.3* CHLORIDE-101 TOTAL CO2-22 ANION GAP-15 [**2184-11-13**] 06:54PM ALT(SGPT)-46* AST(SGOT)-36 CK(CPK)-88 ALK PHOS-90 AMYLASE-39 TOT BILI-0.6 [**2184-11-13**] 06:54PM LIPASE-25 [**2184-11-13**] 06:54PM CK-MB-NotDone cTropnT-<0.01 [**2184-11-13**] 06:54PM ALBUMIN-3.2* [**2184-11-13**] 06:54PM WBC-7.2# RBC-2.40* HGB-6.7* HCT-20.1* MCV-84 MCH-27.8 MCHC-33.2 RDW-16.9* [**2184-11-13**] 06:54PM NEUTS-33* BANDS-1 LYMPHS-42 MONOS-2 EOS-1 BASOS-0 ATYPS-3* METAS-4* MYELOS-14* NUC RBCS-6* [**2184-11-13**] 06:54PM PLT SMR-VERY LOW PLT COUNT-38* LPLT-3+ [**2184-11-13**] 06:54PM PT-13.0 PTT-27.5 INR(PT)-1.1 [**2184-11-13**] 06:52PM cTropnT-<0.01 Brief Hospital Course: ASSESSMENT/PLAN: 83 M with pancytopenia [**3-8**] MDS, h/o smoking, bronchomalacia, chf, pulm htn, and recent [**Doctor First Name **] infection admitted with respiratory failure. After a 48 hour period of mechanical ventilation, he was weaned from the ventilator and transferred out of the ICU. 1. Respiratory Failure: multifactorial --> COPD, pneumonia due to MAC and possibly other pathogens, possible CHF -He was continued on antibiotics and nebulizer treatmetns. Pt had a bronchoscopy to further evaluate his bronchomalacia. The interventional pulmonologists found severe bronchitis upon broncoscopy but nothing amenable to pulmonary stenting. 2. MAC Infection -continue ethambutol/claritrhomycin 3. Other bacterial pneumonia -continued on levofloxacin for 7 day course 4. ARF: likely pre-renal azotemia [**3-8**] diuresis -diuretics were held, urine output was followed, and steadily improved 5. MDS: transfusion dependent but stable -Pt was transfused two units of platelets for bronchoscopy -transfused for hct < 25 -continued on danazol and erythropoietin 6. FEN: fluid goal even; QD lytes; low sodium/heart healthy diet 7. PPX: protonix, bowel regimen as needed, pneumoboots (NO HEPARIN GIVEN MDS) 8. Code status: full --> had extensive discussions with family, social work, and consultants. Patient wished to receive aggressive care. 9. Disposition: Rehabilitation stay was arranged. Medications on Admission: levothyroxine Clarithromycin Ethambutol Protonix Danazol Fe MVI Folic acid Flonase Duonebs Erythropoietin Discharge Medications: 1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO QD (once a day). 2. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Six (6) Puff Inhalation Q4H (every 4 hours). 3. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 3 days. 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Six (6) Puff Inhalation [**Hospital1 **] (2 times a day). 6. Danazol 200 mg Capsule Sig: One (1) Capsule PO TID (). 7. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical PRN (as needed). 8. Levothyroxine Sodium 175 mcg Tablet Sig: One (1) Tablet PO QD (once a day). 9. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 10. Trazodone HCl 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed. 11. Menthol-Cetylpyridinium Cl 2 mg Lozenge Sig: One (1) Lozenge Mucous membrane PRN (as needed). 12. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection ASDIR (AS DIRECTED). 13. Ethambutol HCl 400 mg Tablet Sig: Four (4) Tablet PO QD (once a day). 14. Clarithromycin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 15. Procrit 20,000 unit/mL Solution Sig: Three (3) ml Injection once a week: 60,000 units SC every monday. 16. Albuterol Sulfate 5 mg/mL Nebu Soln Sig: One (1) Inhalation q 6h:prn as needed for shortness of breath or wheezing. 17. Atrovent 18 mcg/Actuation Aerosol Sig: One (1) Inhalation q 6:prn as needed for shortness of breath or wheezing. Discharge Disposition: Extended Care Facility: [**Hospital3 7**] & Rehab Center - [**Hospital1 8**] Discharge Diagnosis: Bronchitis Discharge Condition: Stable Discharge Instructions: Please follow up with Dr. [**Last Name (STitle) 3638**] Hematology/[**Hospital **] Clinic on [**11-29**] and with translator have full PFTs. If PFTs normal then consider d/c flovent and albuterol. Please have liver function tests (AST/ALT) drawn every two weeks. Please have your blood count checked every week. You should get a blood transfusion to keep your HCT > 26 and platelets >10 unless for a procedure. Please call your doctor for difficulty breathing, coughing up blood or colored sputum, heart palpitations, chest pain, high fever. Followup Instructions: Provider: [**Name10 (NameIs) 17515**] CHAIR 1A Date/Time:[**2184-11-29**] 9:00 Provider: [**First Name4 (NamePattern1) 2747**] [**Last Name (NamePattern1) 5780**], RN Where: [**Hospital6 29**] HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2184-11-29**] 9:00

486,491,518,428,584,466,530,V108,414,V158,416

{'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Acute bronchitis,Esophageal reflux,Personal history of malignant neoplasm of thyroid,Coronary atherosclerosis of native coronary artery,Personal history of noncompliance with medical treatment, presenting hazards to health,Other chronic pulmonary heart diseases'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: CC: Resp Failure PRESENT ILLNESS: HPI: 83 M with h/o thyroid CA s/p resection, MDS txn dependent, bronchomalacia, with recent admission for [**Doctor First Name **] pneumonia. Pt was recently discharged on chlarithromycin/ethambutol in [**10-9**]. Pt was not taking ethambutol. Since d/c has been having orthopnea, poor appetite, and progressive weight loss. Has had DOE and in AM of admission had acute sob with tachypnea. No cough or sputum production. No fever/chills. Had isolated episode of hemoptysis shortly after and increasing lethargy. Came to ED. In ED, was tachypneic (40's), diaphoretic, hypertensive (SBP's 220)and febrile. Initial ABG: 7.35/42/277 on NRB but pt intubated for impending fatigue. Given levoquin/ceftazidime/lasix/solumedrol and nitro gtt, and admitted to MICU for further care. In MICU, pt continued to be transfusion dependent and received prbc's for a hct<25 & platelet transfusions for a count of <20. Ceftaz was switched to zosyn for pneumonia treatment. He continued to have copious secretions. He was weaned off mechanical ventilation on [**11-16**] and subsequently transferred to medicine for further management. Given pt's improving respiratory function, no bronchoscopy was performed to further evaluate pt's airway infection issues. MEDICAL HISTORY: 1.Papillary thyroid CA resected in [**5-7**] and then radioablated. 2.MDS dx by BMB in [**6-8**]. He??????s transfusion dependent at baseline. MEDICATION ON ADMISSION: levothyroxine Clarithromycin Ethambutol Protonix Danazol Fe MVI Folic acid Flonase Duonebs Erythropoietin ALLERGIES: Oxycodone / [**Doctor First Name **]-D / Pletal / Atenolol PHYSICAL EXAM: PHYSICAL EXAM VS: 97.4 120/60 84 20 99%3L Gen: asleep and in NAD HEENT: NC/AT, MMM CV: RRR, S1/S2 nml, no m/r/g Pulm: + crackles at left base, otherwise CTA Abd: soft, NT/ND, NABS, no HSM Extr: no c/c/e Neuro: CN II-XII were nonfocal. FAMILY HISTORY: No known h/o blood disorders in his family. 2 sisters with CAD. SOCIAL HISTORY: Mr [**Known lastname **] came to the US about 15 years ago. He smoked for most of his life, but stopped 15 years ago. He was a teacher when he lived in [**Location 27654**]. He lives alone with his wife in subsidized housing here in [**Location (un) 86**]. He has 3 children. He has occassional alcohol. ### Response: {'Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Acute respiratory failure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Acute bronchitis,Esophageal reflux,Personal history of malignant neoplasm of thyroid,Coronary atherosclerosis of native coronary artery,Personal history of noncompliance with medical treatment, presenting hazards to health,Other chronic pulmonary heart diseases'}

CHIEF COMPLAINT: Chest pain PRESENT ILLNESS: Pt is an 87 yo woman with h/o HTN, hypercholesterolemia who presented to OSH with chest pain. The patient was in her USOH the day prior to admission when she started feeling R-sided chest pain, rated [**11-22**], as well as nausea. Pain developed while she was doing her laundry. Pain persisted throughout the night with minimal improvement. Then this AM due to persistent pain she decided to go to hospital. She denied any SOB, diaphoresis, vomiting, LH, syncope, or palpitations. At the OSH, her vitals were T 98.7, HR 72, BP 178/93, O2 sat 96% RA. EKG was notable for ST elevation in anterolateral leads. She received SL nitroglycerin, heparin, ASA 325, metoprolol 5 mg IV x 2, Integrillin bolus and drip, atorvastatin 80 mg PO x 1, Plavix 600 mg PO x 1, and morphine. On arrival to [**Hospital1 18**], her ABG was 7.37/45/107. She underwent cath with stenting of LAD. MEDICAL HISTORY: HTN Hyperlipidemia Vestibular dysfuntion- Vertigo MEDICATION ON ADMISSION: Reports no medications at home ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T BP 127/75 HR 85 RR 16 O2sats 96% Wt 64kg Gen: Elderly female in NAD HEENT: PERRL, EOMI, anicteric, dry mm Neck: No JVD Lungs: CTAB anteriorly Heart: Irregular due to multiple PVC's seen on tele, S1/S2, no m/r/g Abd: Soft, NT, ND, normoactive Ext: No edema, 2+ DP bilaterall, no bruit in right groin Neuro: A&O times 3, grossly intact FAMILY HISTORY: NC SOCIAL HISTORY: Lives with husband. 4 children. Denies any T/A/D use.

Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Delirium due to conditions classified elsewhere,Dizziness and giddiness

AMI anterior wall, init,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Delirium d/t other cond,Dizziness and giddiness

Admission Date: [**2140-10-30**] Discharge Date: [**2140-11-3**] Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 4765**] Chief Complaint: Chest pain Major Surgical or Invasive Procedure: Cardiac Catheterization with stenting of the LAD History of Present Illness: Pt is an 87 yo woman with h/o HTN, hypercholesterolemia who presented to OSH with chest pain. The patient was in her USOH the day prior to admission when she started feeling R-sided chest pain, rated [**11-22**], as well as nausea. Pain developed while she was doing her laundry. Pain persisted throughout the night with minimal improvement. Then this AM due to persistent pain she decided to go to hospital. She denied any SOB, diaphoresis, vomiting, LH, syncope, or palpitations. At the OSH, her vitals were T 98.7, HR 72, BP 178/93, O2 sat 96% RA. EKG was notable for ST elevation in anterolateral leads. She received SL nitroglycerin, heparin, ASA 325, metoprolol 5 mg IV x 2, Integrillin bolus and drip, atorvastatin 80 mg PO x 1, Plavix 600 mg PO x 1, and morphine. On arrival to [**Hospital1 18**], her ABG was 7.37/45/107. She underwent cath with stenting of LAD. Past Medical History: HTN Hyperlipidemia Vestibular dysfuntion- Vertigo Social History: Lives with husband. 4 children. Denies any T/A/D use. Family History: NC Physical Exam: T BP 127/75 HR 85 RR 16 O2sats 96% Wt 64kg Gen: Elderly female in NAD HEENT: PERRL, EOMI, anicteric, dry mm Neck: No JVD Lungs: CTAB anteriorly Heart: Irregular due to multiple PVC's seen on tele, S1/S2, no m/r/g Abd: Soft, NT, ND, normoactive Ext: No edema, 2+ DP bilaterall, no bruit in right groin Neuro: A&O times 3, grossly intact Pertinent Results: Admission Labs: [**2140-10-30**] 12:34PM GLUCOSE-176* LACTATE-1.5 K+-4.1 [**2140-10-30**] 12:34PM TYPE-ART O2 FLOW-4 PO2-107* PCO2-45 PH-7.37 TOTAL CO2-27 BASE XS-0 INTUBATED-NOT INTUBA COMMENTS-NASAL [**Last Name (un) 154**] [**2140-10-30**] 12:35PM PT-13.2* PTT-100.7* INR(PT)-1.2* [**2140-10-30**] 12:35PM CK-MB-49* MB INDX-13.3* cTropnT-0.49* [**2140-10-30**] 12:35PM CK(CPK)-369* [**2140-10-30**] 12:35PM GLUCOSE-181* UREA N-12 CREAT-1.0 SODIUM-138 POTASSIUM-5.0 CHLORIDE-108 TOTAL CO2-19* ANION GAP-16 [**2140-10-30**] 01:15PM PLT COUNT-311 [**2140-10-30**] 01:15PM WBC-10.2 RBC-3.69* HGB-11.2* HCT-32.3* MCV-88 MCH-30.4 MCHC-34.8 RDW-15.2 [**2140-10-30**] 08:51PM PLT COUNT-297 [**2140-10-30**] 08:51PM HCT-36.1 [**2140-10-30**] 08:51PM MAGNESIUM-1.7 [**2140-10-30**] 08:51PM CK-MB-348* MB INDX-14.6* [**2140-10-30**] 08:51PM CK(CPK)-2380* [**2140-10-30**] 08:51PM UREA N-13 CREAT-0.7 POTASSIUM-4.5 . DISCHARGE LABS: [**2140-11-3**] 07:12AM BLOOD WBC-8.1 RBC-3.46* Hgb-10.5* Hct-30.8* MCV-89 MCH-30.4 MCHC-34.2 RDW-15.5 Plt Ct-310 [**2140-11-3**] 07:12AM BLOOD Plt Ct-310 [**2140-11-3**] 07:12AM BLOOD Glucose-87 UreaN-20 Creat-0.8 Na-139 K-4.1 Cl-104 HCO3-27 AnGap-12 [**2140-11-3**] 07:12AM BLOOD Calcium-8.3* Phos-3.1 Mg-1.9 . STUDIES: EKG [**10-30**] (OSH): NSR @ 68 bpm, ST elevation in I, aVL, V2-V5; ST depression in II, III, aVF EKG [**10-30**] ([**Hospital1 18**]): 87 bpm, ST elevations in V2-V6, TWI in aVL, V1, V2, Q waves in I, II, aVF, V1-V6. . [**2140-10-30**] Cardiac Cath: 1. Selective coronary angiography of this left dominant system demonstrated single vessel coronary artery disease. The LMCA revealed no angiographically apparent coronary artery disease. The LAD had 40% ostial stenosis at its origin. There was further 95% stenosis in the proximal vessel. This was followed by serial 70-80% stenoses throughout the mid and distal vessel. The LCX was a large vessel and widely patent. The RCA was a small non-dominant vessel with no angiographically apparent coronary artery disease. 2. Resting hemodynamics were performed. The right sided filling pressures were elevated (mean RA pressure was 13 mmHg and RVEDP was 15 mmHg). The pulmonary artery pressures were elveated (PA pressure was 39/18 mmHg). The left sided filling pressures were elevated (mean PCW pressure was 21 mmHg). The cardiac index was depressed measuring 1.7 l/min/m2). 3. Successful primary PTCA and stenting of the proximal LAD with a 3.0 Cypher DES. There was no residual stenosis at the stent site, however 70-80% stenoses in the mid and distal LAD were left untreated. The final angiography showed TIMI III flow in the distal vessel and no evidence of dissection, embolization or peforation. . [**2140-11-2**] ECHO: LVEF 35%; [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 3841**] dilated; nl LV wall thickness; nl LV cavity size; tissue velocity imaging E/e' is elevated (>15) suggesting increased LV filling pressure (PCWP>18mmHg); mid to distal anterior, anteroseptal and apical akinesis/hypokinesis; AV leaflets(3) are mildly thickened; no AR; MV leaflets mildly thickened; mild MR; mod pulmonary artery systolic hypertension Brief Hospital Course: INITIAL IMPPRESSION: 87 yo F with h/o HTN, hyperlipidemia p/w chest pain, EKG c/w anterolateral STEMI, now s/p LAD stenting. . HOSPITAL COURSE BY SYSTEM: . * Cardiovascular: The patient underwent stenting of her LAD. She was started on ASA 325 qd, Plavix 75 qd, atorvastatin 80, metoprolol 12.5 mg q6h and captopril 12.5 q8h. With her BP and HR stable, metoprolol was titrated up to metoprolol XL 200 mg qd and captopril to lisinopril 5 mg qd. Her echocardiogram suggested increased LV filling pressure; therefore, furosemide 10 mg qd was started. Telemetry revealed frequent PVCs. She was asymptomatic and clinically stable during the CCU course. She did not experience any more chest pain or other symptoms during admission. . * Psych: The patient experienced confusion and agitation during the first night in the CCU. She was started on olanzapine 5 mg qhs and had no more periods of confusion or agitation. . * Code: DNR/DNI per patient . Medications on Admission: Reports no medications at home 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:*6* 2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*11* 3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*11* 4. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR Sig: Two (2) Tablet Sustained Release 24HR PO DAILY (Daily). Disp:*60 Tablet Sustained Release 24HR(s)* Refills:*11* 5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*11* 6. Furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*6* Discharge Disposition: Home With Service Facility: [**Hospital 119**] Homecare Discharge Diagnosis: Primary Diagnsois: 1. Coronary Artery Disease s/p ST Elevation Myocardial Infarction, s/p cardiac cath with stent to Left Anterior Descending coronary artery . Secondary Diagnoses: 1. Hypertension 2. Hyperlipidemia 3. Vestibular dysfuntion- Vertigo Discharge Condition: Stable, pain free, stable on medication regimen, appropriate followup arranged. Discharge Instructions: Take all medications as prescribed. It is especially important to take the Plavix and aspirin to protect your heart. You have also been started on medications for your blood pressure. Please keep all follow up appointments. Please return to the hospital if you develop chest pain, shortness of breath, or any other symptoms that concern you. Followup Instructions: An appointment has been made for you with your PCP/Cardiologist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 10543**] on Monday, [**11-14**], at 4:00 PM ([**Telephone/Fax (1) 40360**]

410,414,401,272,293,780

{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Delirium due to conditions classified elsewhere,Dizziness and giddiness'}

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: Pt is an 87 yo woman with h/o HTN, hypercholesterolemia who presented to OSH with chest pain. The patient was in her USOH the day prior to admission when she started feeling R-sided chest pain, rated [**11-22**], as well as nausea. Pain developed while she was doing her laundry. Pain persisted throughout the night with minimal improvement. Then this AM due to persistent pain she decided to go to hospital. She denied any SOB, diaphoresis, vomiting, LH, syncope, or palpitations. At the OSH, her vitals were T 98.7, HR 72, BP 178/93, O2 sat 96% RA. EKG was notable for ST elevation in anterolateral leads. She received SL nitroglycerin, heparin, ASA 325, metoprolol 5 mg IV x 2, Integrillin bolus and drip, atorvastatin 80 mg PO x 1, Plavix 600 mg PO x 1, and morphine. On arrival to [**Hospital1 18**], her ABG was 7.37/45/107. She underwent cath with stenting of LAD. MEDICAL HISTORY: HTN Hyperlipidemia Vestibular dysfuntion- Vertigo MEDICATION ON ADMISSION: Reports no medications at home ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: T BP 127/75 HR 85 RR 16 O2sats 96% Wt 64kg Gen: Elderly female in NAD HEENT: PERRL, EOMI, anicteric, dry mm Neck: No JVD Lungs: CTAB anteriorly Heart: Irregular due to multiple PVC's seen on tele, S1/S2, no m/r/g Abd: Soft, NT, ND, normoactive Ext: No edema, 2+ DP bilaterall, no bruit in right groin Neuro: A&O times 3, grossly intact FAMILY HISTORY: NC SOCIAL HISTORY: Lives with husband. 4 children. Denies any T/A/D use. ### Response: {'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Delirium due to conditions classified elsewhere,Dizziness and giddiness'}

CHIEF COMPLAINT: abdominal pain, some nausea PRESENT ILLNESS: Patient is a 84 year old male transferred from [**Hospital3 **] for management of undetermined biliary tree injury. Patient was originally admitted on [**2151-6-23**] with chest pain. Cardiac cath revealed LAD and LCX disease. Pain continued and patient was diagnosed with acute cholecystitis. Patient underwent a laproscopic cholecystectomy [**2151-7-1**] which was complicated by small bowel enterotomy. The procedure was converted to open, with repair of the enterotomy and completion of the cholecystectomy. Postoperatively, a intrabdominal bile collection was diagnosed and a 7mm stent was placed on [**2151-7-14**]. Patient presented again to [**Hospital3 15402**] on [**2151-8-28**], and underwent a CT guided percutaneous drain placement for a RUQ abscess. At that time patient was still having seropurulent drainage. MEDICAL HISTORY: 1. status post cholecystectomy complicated by right upper quadrant abcess 2. coronary artery disease, status post myocardial infarction: [**5-28**] c. cath showed 99% dLAD, pLAD stenosis, mLCX stenosis, mild RCA stenosis; ejection fraction 25-30% with anteroapical AK. 3. COPD 4. Depression 5. anxiety 6. htn 7. chronic back pain MEDICATION ON ADMISSION: zozyn digoxin metoprolol ecitalopram protonix senna/colace percocet moprhine coumadin ALLERGIES: Aspirin / Vioxx / Celebrex PHYSICAL EXAM: PE: V- 98.8, 182/77, 76, 18, 99% on RA gen - NAD HEENT - PERRLA, EOMI, anicteric. O/P clear, MMM neck - supple, no JVD, minimal L sided carotid upstroke, no bruits lungs - CTAB c/v - RRR, II/VI SEM at base abd - s/nt/nd, NABS, no HSM, AAA incision is c/d/i extr - no c/c/e neuro - A+Ox3, no focal signs FAMILY HISTORY: SOCIAL HISTORY: resident at [**First Name8 (NamePattern2) 636**] [**Last Name (NamePattern1) 57090**] NH, previous heavy smoker, no history of excessive drug abuse

Other postoperative infection,Chronic airway obstruction, not elsewhere classified,Other specified disorders of biliary tract,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Dysthymic disorder

Other postop infection,Chr airway obstruct NEC,Dis of biliary tract NEC,Abn react-surg proc NEC,Crnry athrscl natve vssl,Dysthymic disorder

Admission Date: [**2151-9-16**] Discharge Date: [**2151-9-29**] Service: [**Doctor First Name 147**] Allergies: Aspirin / Vioxx / Celebrex Attending:[**First Name3 (LF) 148**] Chief Complaint: abdominal pain, some nausea Major Surgical or Invasive Procedure: none History of Present Illness: Patient is a 84 year old male transferred from [**Hospital3 **] for management of undetermined biliary tree injury. Patient was originally admitted on [**2151-6-23**] with chest pain. Cardiac cath revealed LAD and LCX disease. Pain continued and patient was diagnosed with acute cholecystitis. Patient underwent a laproscopic cholecystectomy [**2151-7-1**] which was complicated by small bowel enterotomy. The procedure was converted to open, with repair of the enterotomy and completion of the cholecystectomy. Postoperatively, a intrabdominal bile collection was diagnosed and a 7mm stent was placed on [**2151-7-14**]. Patient presented again to [**Hospital3 15402**] on [**2151-8-28**], and underwent a CT guided percutaneous drain placement for a RUQ abscess. At that time patient was still having seropurulent drainage. Patient was readmitted to [**Hospital3 15402**] a third time on [**2151-9-12**] with low grade fevers, and RUQ pain. He was found to have a WBC count of 26.2 with a left shift. Abdominal/pelvic CT showed no fluid collection or free air, but some slight inflammatory changes around the drain. The stent was in place, with no duodenal erosion. Patient was placed on unasyn and flagyl empirically. Patient underwent an ERCP to remove the biliary stent on [**2151-9-14**]. Following this, he had copious drainage from the pigtail catheter, suggesting an ongoing bile leak, possibly from the R hepatic duct. Patient was transferred to [**Hospital3 **] Deconess for further evaluation and treatment. Urinalysis and culture was negative, chest xray revealed bibasilar atelectasis vs scarring. Blood cultures remained negative after 48 hrs. Past Medical History: 1. status post cholecystectomy complicated by right upper quadrant abcess 2. coronary artery disease, status post myocardial infarction: [**5-28**] c. cath showed 99% dLAD, pLAD stenosis, mLCX stenosis, mild RCA stenosis; ejection fraction 25-30% with anteroapical AK. 3. COPD 4. Depression 5. anxiety 6. htn 7. chronic back pain Social History: resident at [**First Name8 (NamePattern2) 636**] [**Last Name (NamePattern1) 57090**] NH, previous heavy smoker, no history of excessive drug abuse Physical Exam: PE: V- 98.8, 182/77, 76, 18, 99% on RA gen - NAD HEENT - PERRLA, EOMI, anicteric. O/P clear, MMM neck - supple, no JVD, minimal L sided carotid upstroke, no bruits lungs - CTAB c/v - RRR, II/VI SEM at base abd - s/nt/nd, NABS, no HSM, AAA incision is c/d/i extr - no c/c/e neuro - A+Ox3, no focal signs Pertinent Results: [**2151-9-16**] 11:08PM GLUCOSE-74 UREA N-6 CREAT-0.7 SODIUM-139 POTASSIUM-3.6 CHLORIDE-106 TOTAL CO2-25 ANION GAP-12 [**2151-9-16**] 11:08PM ALT(SGPT)-8 AST(SGOT)-13 LD(LDH)-198 ALK PHOS-95 AMYLASE-17 TOT BILI-0.3 [**2151-9-16**] 11:08PM LIPASE-12 [**2151-9-16**] 11:08PM ALBUMIN-2.6* CALCIUM-8.5 PHOSPHATE-3.3 MAGNESIUM-1.7 IRON-13* [**2151-9-16**] 11:08PM calTIBC-133* VIT B12-418 FOLATE-15.8 FERRITIN-440* TRF-102* [**2151-9-16**] 11:08PM DIGOXIN-1.0 [**2151-9-16**] 11:08PM WBC-12.2* RBC-3.51* HGB-9.6* HCT-31.2* MCV-89 MCH-27.2 MCHC-30.6* RDW-15.7* [**2151-9-16**] 11:08PM NEUTS-76.4* LYMPHS-15.0* MONOS-6.7 EOS-1.7 BASOS-0.2 [**2151-9-16**] 11:08PM HYPOCHROM-2+ [**2151-9-16**] 11:08PM PLT COUNT-346 [**2151-9-16**] 11:08PM PT-16.9* PTT-31.2 INR(PT)-1.8 [**2151-9-16**] 11:08PM FIBRINOGE-728* Brief Hospital Course: Patient was admitted to [**Hospital1 **] [**First Name (Titles) **] [**2151-9-16**] with the above complaints. Patient was started on zosyn for bilary coverage. CT on [**2151-9-17**] demonstrated small residual fluid/air collection in the gallbladder fossa around the pigtail catheter. The plan itially was repeat the ERCP, but the patient improved clinically. Repeat CT on [**9-23**] showed no change. The pigtail cathater was pulled the next day and the zozyn was discontinued. Throughout admission, patient consistantly refused to eat. He is without his dentures and although a soft mechanical diet was ordered, he ate very little A picc line was placed on [**9-20**] and the patient has been getting his daily caloric needs with peripheral nutrition. Towards the end of the admission, with encouragement he does drink some of his boost shakes. His dentures and glasses, turns out, are in pocession by a friend/family member. Patient also was followed by pyschiatry during this admission for symptoms of depression/anxiety. Patient was started on Risperdal for these symptoms. Medications on Admission: zozyn digoxin metoprolol ecitalopram protonix senna/colace percocet moprhine coumadin Discharge Medications: 1. Ipratropium Bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). Disp:*1 inhalation* Refills:*2* 2. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO QD (once a day). Disp:*30 Tablet(s)* Refills:*2* 3. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours). Disp:*1 inhalation* Refills:*2* 4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*2* 5. Pantoprazole Sodium 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* 6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed. Disp:*60 Tablet(s)* Refills:*0* 8. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. Disp:*30 Tablet(s)* Refills:*0* 9. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal QD (once a day). Disp:*30 Suppository(s)* Refills:*2* 10. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical PRN (as needed). Disp:*1 application* Refills:*2* 11. Risperidone 0.5 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime). Disp:*1 Tablet(s)* Refills:*2* 12. Morphine Sulfate 10 mg/5 mL Solution Sig: One (1) 10mg/5ml PO Q4H (every 4 hours) as needed. Disp:*60 10mg/5ml* Refills:*0* Discharge Disposition: Extended Care Facility: [**Hospital6 54351**] - [**Location (un) 5503**] Discharge Diagnosis: bilary sepsis depression coronary artery disease history of myocardial infarction hypertension Discharge Condition: good Discharge Instructions: increase food intake Followup Instructions: Patient to follow up with Dr. [**Last Name (STitle) 57091**]

998,496,576,E878,414,300

{'Other postoperative infection,Chronic airway obstruction, not elsewhere classified,Other specified disorders of biliary tract,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,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: abdominal pain, some nausea PRESENT ILLNESS: Patient is a 84 year old male transferred from [**Hospital3 **] for management of undetermined biliary tree injury. Patient was originally admitted on [**2151-6-23**] with chest pain. Cardiac cath revealed LAD and LCX disease. Pain continued and patient was diagnosed with acute cholecystitis. Patient underwent a laproscopic cholecystectomy [**2151-7-1**] which was complicated by small bowel enterotomy. The procedure was converted to open, with repair of the enterotomy and completion of the cholecystectomy. Postoperatively, a intrabdominal bile collection was diagnosed and a 7mm stent was placed on [**2151-7-14**]. Patient presented again to [**Hospital3 15402**] on [**2151-8-28**], and underwent a CT guided percutaneous drain placement for a RUQ abscess. At that time patient was still having seropurulent drainage. MEDICAL HISTORY: 1. status post cholecystectomy complicated by right upper quadrant abcess 2. coronary artery disease, status post myocardial infarction: [**5-28**] c. cath showed 99% dLAD, pLAD stenosis, mLCX stenosis, mild RCA stenosis; ejection fraction 25-30% with anteroapical AK. 3. COPD 4. Depression 5. anxiety 6. htn 7. chronic back pain MEDICATION ON ADMISSION: zozyn digoxin metoprolol ecitalopram protonix senna/colace percocet moprhine coumadin ALLERGIES: Aspirin / Vioxx / Celebrex PHYSICAL EXAM: PE: V- 98.8, 182/77, 76, 18, 99% on RA gen - NAD HEENT - PERRLA, EOMI, anicteric. O/P clear, MMM neck - supple, no JVD, minimal L sided carotid upstroke, no bruits lungs - CTAB c/v - RRR, II/VI SEM at base abd - s/nt/nd, NABS, no HSM, AAA incision is c/d/i extr - no c/c/e neuro - A+Ox3, no focal signs FAMILY HISTORY: SOCIAL HISTORY: resident at [**First Name8 (NamePattern2) 636**] [**Last Name (NamePattern1) 57090**] NH, previous heavy smoker, no history of excessive drug abuse ### Response: {'Other postoperative infection,Chronic airway obstruction, not elsewhere classified,Other specified disorders of biliary tract,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Coronary atherosclerosis of native coronary artery,Dysthymic disorder'}

CHIEF COMPLAINT: Trazodone overdose, EtOH intoxication PRESENT ILLNESS: Ms. [**Known lastname **] is a 32 yoF with h/o prior suicide attempts, who presents after taking trazodone in an attempt to kill herself. Around noon this afternoon, she drank "five drinks" (not "shots") of vodka, and then around 2 pm, she ingested 30 pills of 50 mg trazodone. Within the next hour, she called the ambulance herself. This was done at her apartment, and she reports that she did this because she was upset about her boyfriend. MEDICAL HISTORY: Depression MEDICATION ON ADMISSION: Celexa 40 mg QD Trazodone 50 mg QHS PRN (takes about two per month) ALLERGIES: Erythromycin PHYSICAL EXAM: VS 99.5, 80, 101/52, 64, 16, 99/RA General: Alert sitting upright in bed, friendly and conversant [**Name (NI) 4459**]: [**Name (NI) 5674**], 1 mm pupils R=L (PEERL) Lungs: CTA b/l, no wheezes or crackles Cardio: RRR, no m/r/g Abd: Active bowel tones, soft, NT/ND without masses Extremities: no LE edema Skin: no rash Neuro: Alert & O x 3; CN II - XII intact; normal muscle tone, normal strength throughout FAMILY HISTORY: -- mother: breast CA, Bipolar disorder -- father: [**Name (NI) 81855**], diet controlled -- older sister: MS -- older brother: healthy SOCIAL HISTORY: -- has lived with her boyfriend 4 years; readily admits to emotional and physical abuse by boyfriend (he has put out cigarettes on her in the past; has been hit in the face before)

Other adult abuse and neglect,Suicidal ideation,Other iatrogenic hypotension,Alcohol abuse, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Assault by other specified means,Perpetrator of child and adult abuse, by father, stepfather, or boyfriend,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Nonspecific abnormal electrocardiogram [ECG] [EKG]

Oth adult abuse/neglect,Suicidal ideation,Iatrogenc hypotnsion NEC,Alcohol abuse-unspec,Poison-psychotropic agt,Assault NEC,Abuse by fther/stpfth/bf,Depressive disorder NEC,Iron defic anemia NOS,Abnorm electrocardiogram

Admission Date: [**2200-1-23**] Discharge Date: [**2200-1-28**] Date of Birth: [**2167-5-30**] Sex: F Service: MEDICINE Allergies: Erythromycin Attending:[**First Name3 (LF) 348**] Chief Complaint: Trazodone overdose, EtOH intoxication Major Surgical or Invasive Procedure: None History of Present Illness: Ms. [**Known lastname **] is a 32 yoF with h/o prior suicide attempts, who presents after taking trazodone in an attempt to kill herself. Around noon this afternoon, she drank "five drinks" (not "shots") of vodka, and then around 2 pm, she ingested 30 pills of 50 mg trazodone. Within the next hour, she called the ambulance herself. This was done at her apartment, and she reports that she did this because she was upset about her boyfriend. Of note, she has had three prior SA since [**2199-11-9**], two of which resulted in hospitalization at [**Hospital3 **], at which point she was put on Celexa. She has a PCP (Dr. [**First Name4 (NamePattern1) 1399**] [**Last Name (NamePattern1) 81854**]?) but no psychiatrist or psychologist currently. In the ED, VS were T 98.0, HR 94, BP 133/97, RR 22, 99 % RA. The toxicology team saw her; she was considered out fo the time window for activated charcoal; no stomach pumping was performed. while she was wiating for a bed, she became hypotensive with BP 70-80, which improved with 2 L NS. On arrival to the MICU, VS were T 97.6, HR 86, BP 90/51, 100% RA, RR 19. She denied nausea, HA, F/C, CP, SOB, abd pain; she was somnolent but easily arousable and conversant. Past Medical History: Depression Social History: -- has lived with her boyfriend 4 years; readily admits to emotional and physical abuse by boyfriend (he has put out cigarettes on her in the past; has been hit in the face before) -- drinks occ on weekends; denies having a "drinking problems" in the past; denies drinking daily; no h/o withdrawal symptoms -- smokes cigarettes socially when she drinks; does not smoke daily -- denied IVDU, snorting drugs -- originally from Western Mass -- works as an ESL instructor Family History: -- mother: breast CA, Bipolar disorder -- father: [**Name (NI) 81855**], diet controlled -- older sister: MS -- older brother: healthy Physical Exam: VS 99.5, 80, 101/52, 64, 16, 99/RA General: Alert sitting upright in bed, friendly and conversant [**Name (NI) 4459**]: [**Name (NI) 5674**], 1 mm pupils R=L (PEERL) Lungs: CTA b/l, no wheezes or crackles Cardio: RRR, no m/r/g Abd: Active bowel tones, soft, NT/ND without masses Extremities: no LE edema Skin: no rash Neuro: Alert & O x 3; CN II - XII intact; normal muscle tone, normal strength throughout Pertinent Results: ADMISSION LABS: [**2200-1-23**] 03:00PM BLOOD WBC-4.7 RBC-4.34 Hgb-12.7 Hct-36.7 MCV-85 MCH-29.3 MCHC-34.6 RDW-17.0* Plt Ct-290 [**2200-1-23**] 03:00PM BLOOD Neuts-65.0 Lymphs-27.7 Monos-5.8 Eos-1.1 Baso-0.5 [**2200-1-23**] 03:00PM BLOOD Glucose-92 UreaN-11 Creat-0.7 Na-145 K-3.8 Cl-110* HCO3-21* AnGap-18 [**2200-1-24**] 04:32AM BLOOD ALT-10 AST-13 AlkPhos-35* TotBili-0.4 [**2200-1-24**] 04:32AM BLOOD Albumin-3.5 Calcium-6.9* Phos-3.2 Mg-1.5* TOX SCREENS: [**2200-1-23**] 03:00PM BLOOD ASA-NEG Ethanol-281* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2200-1-23**] 03:00PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG URINALYSIS: [**2200-1-23**] 03:00PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-<=1.005 [**2200-1-23**] 03:00PM URINE Blood-TR Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-0.2 pH-5.5 Leuks-SM [**2200-1-23**] 03:00PM URINE RBC-0-2 WBC-[**3-13**] Bacteri-FEW Yeast-NONE Epi-0 ECG Study Date of [**2200-1-24**] 12:35:14 AM Sinus rhythm. Minor non-diagnostic T wave flattening. Compared to the previous tracing no major change. Rate 80, PR 112, QRS 78, QT/QTc 404/439, P 31, QRS 57, T 29 IRON STUDIES: [**2200-1-25**] 06:22AM BLOOD calTIBC-345 Ferritn-9.7* TRF-265 Brief Hospital Course: 32 yo F w/ depression hx and prior SA, admitted to the MICU for trazodone OD with EtOH intoxication; now transferred to the floor for further monitoring and recovery. # TRAZODONE OVERDOSE: Risk of hypotension with anti-alpha 1 effects; no evidence of serotonin syndrome since admission. Tox fellow notified upon admission, who advised monitoring for hypotension, CNS depression and Qtc prolongation. Once medically stable, she was transferred to the floor for further monitoring. EKG notable for TWI V1/2, no QT prolongation. EKG rechecked with only T-wave inversions in V1. Remained hemodynamically stable and repeat orthostatics were negative. By hospital day #2, patient with no remaining sypmtoms of overdose. # SUICIDE ATTTEMPT, DEPRESSION: Patient states this been worsened in recent past by abusive relationship with boyfriend (living partner). Initially continued to hold Celexa for given trazodone OD. Consults included Social Work, Center for Violence Prevention consult given domestic abuse and Psychiatry. She was also kept on a 1:1 Sitter and had a safety tray for all meals. On hospital day #2, Citalopram was restarted at prior dosing. Psychiatry considered her a danger to herself under section 12. She was then discharged to a inpatient psychiatric facility once one became available for further monitoring and improvement. # DOMESTIC ABUSE: As above, closely related to depression. Requested consultation from the Center for Violence Prevention. While inpatient, she was on a safety alert / privacy alert to avoid further contact with her abusive partner. # EKG CHANGES: Patient with TWI in V1/2 on repeat EKG early [**1-24**] AM. Patient denied any symptoms of CP, SOB or other anginal equivalents. No known correlation with Trazodone overdose. Repeat EKG with resolution of inversion in V2, remaining T-waves nonspecific. Further EKG were not clinically indicated. # ANEMIA: The patient had a 9 pt Hct drop in the setting of aggressive volume resuscitation. There was no evidence of bleeding, chronic disease or infection/process to cause hemolysis. Repeat HCTs revealed stable blood counts. Her trend was 36.7 --> 27.4 --> 29.4 --> 28.4. Iron studies were consistent with iron deficiency with a normal TIBS, low ferritin and low-normal iron. She was started on iron therapy. Medications on Admission: Celexa 40 mg QD Trazodone 50 mg QHS PRN (takes about two per month) Discharge Medications: 1. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 4. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed. Discharge Disposition: Extended Care Discharge Diagnosis: Primary: Trazodone overdose, alcohol intoxication Secondary: Depression, history of suicide attempt, Iron-deficiency anemia. Discharge Condition: Hemodynamically stable and afebrile. Discharge Instructions: You were admitted after drinking alcohol and overdosing on Trazodone. You were evaluated for toxic effects including altered thinking or heart problems. Once stable, you were transfered to the floor. You are now discharged to a psychiatric facility for further recovery. Please take all medication as prescribed. Please seek medical assistance if you notice fevers, chills, difficulty breathing, chest pain or any other symptom which is concerning to you. Followup Instructions: To be followed in psychiatry facility until safe to discharge. Upon discharge, follow-up should be scheduled with Dr. [**First Name4 (NamePattern1) 1399**] [**Last Name (NamePattern1) 71206**] [**Telephone/Fax (1) 67474**] for outpatient primary care follow-up. Completed by:[**2200-2-4**]

995,V628,458,305,E950,E968,E967,311,280,794

{'Other adult abuse and neglect,Suicidal ideation,Other iatrogenic hypotension,Alcohol abuse, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Assault by other specified means,Perpetrator of child and adult abuse, by father, stepfather, or boyfriend,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Nonspecific abnormal electrocardiogram [ECG] [EKG]'}

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: Trazodone overdose, EtOH intoxication PRESENT ILLNESS: Ms. [**Known lastname **] is a 32 yoF with h/o prior suicide attempts, who presents after taking trazodone in an attempt to kill herself. Around noon this afternoon, she drank "five drinks" (not "shots") of vodka, and then around 2 pm, she ingested 30 pills of 50 mg trazodone. Within the next hour, she called the ambulance herself. This was done at her apartment, and she reports that she did this because she was upset about her boyfriend. MEDICAL HISTORY: Depression MEDICATION ON ADMISSION: Celexa 40 mg QD Trazodone 50 mg QHS PRN (takes about two per month) ALLERGIES: Erythromycin PHYSICAL EXAM: VS 99.5, 80, 101/52, 64, 16, 99/RA General: Alert sitting upright in bed, friendly and conversant [**Name (NI) 4459**]: [**Name (NI) 5674**], 1 mm pupils R=L (PEERL) Lungs: CTA b/l, no wheezes or crackles Cardio: RRR, no m/r/g Abd: Active bowel tones, soft, NT/ND without masses Extremities: no LE edema Skin: no rash Neuro: Alert & O x 3; CN II - XII intact; normal muscle tone, normal strength throughout FAMILY HISTORY: -- mother: breast CA, Bipolar disorder -- father: [**Name (NI) 81855**], diet controlled -- older sister: MS -- older brother: healthy SOCIAL HISTORY: -- has lived with her boyfriend 4 years; readily admits to emotional and physical abuse by boyfriend (he has put out cigarettes on her in the past; has been hit in the face before) ### Response: {'Other adult abuse and neglect,Suicidal ideation,Other iatrogenic hypotension,Alcohol abuse, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Assault by other specified means,Perpetrator of child and adult abuse, by father, stepfather, or boyfriend,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Nonspecific abnormal electrocardiogram [ECG] [EKG]'}

CHIEF COMPLAINT: abdominal pain PRESENT ILLNESS: HPI: Vitals on arrival to the ED were 98.8 71 117/66 16 100. In ED she complained of [**9-12**] abd pain and nausea/vomiting. Her FS was 698. K returned at 7.3 but was hemolyzed and was 4 on repeat. WBC nl at 8.8 NA 127, cl 85, bicarb 19, and gap=23. + ktones in urine 150. Urine tox + for opiates. She had a lactate of 2.4. She received zofran 4mg IV for her nausea, a total of morphine 8mg IV x1 for her pain, and question of receiving dilaudid 1mg x1. She later asked for a diet despite complaining of [**9-12**] abd pain. She was difficilt to obtain access on initially but eventually a 18 guage and a 20 guage was placed and she was started on her first L of IVF. She was given 10 units of regular insulin IV and then started on an insulin gtt at 7units/hr at 1600. Vitals prior to transfer were T99 HR 72 BP 177/72 RR16 100% RA. . She reports that her BS have been greater than assay since she left [**Hospital3 26615**] on [**2100-10-14**]. She has been taking glargine 10 units qhs and novologu 30 units TID. She reports blurry vision and a few seoncds of blacking out while in the ED. . She reports severe [**9-12**] abd pain that can be sharp or a constant ache. She's had abdominal pain for many yrs but it has been much worse in the last few weeks. The pain is in the upper abd and radiates to the back. It occurs without eating but is worse with eating. It does not feel like her gastroparesis pain. It was worked up at [**Hospital3 26615**] and no etiology was found. She became very upset when they changed her from morphine 4mg IV q2hrs to po morphine. She has not had a BM for weeks and lost 20 lbs over the last [**3-9**] wks. . She also reports 10/10 chest pain that she's had since being at [**Hospital3 26615**]. She describes it as "firey, acidy, and sharp pain." She also gets a feeling of numbness in her entire left arm. The pain is worse with inspiration. . At [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], the patient ruled out for PE, had a negative HIDA scan, had a neg lead level, had an abdominal u/s that showed ascities, had an unremarkable CT abd/pelvis, TSH was 4.3, pt refused in pt tx for narcotic abuse, and was reluctant to switch from IV to po pain meds. The d/c summary reports she set an alarm to wake up to take her pain meds. . She reports pain in her head x1 week. The pain is in the back of the right head behind the right ear and behind the right eye. The pain is [**2100-6-10**] and comes and goes. It does go away completely and does not feel like a migraine. MEDICAL HISTORY: DDM and DKA Chronic abdominal pain and discomfort on daily basis and occasional nausea. Last hospitalized in [**10-13**] and in [**2096**] for upper abd pain. Anxiety Depression PSA ? currently abusing narcotics mild pancreatitis in [**2095**] h/o bipolar and personality d/o h/o TIA Possible h/o eating d/o DKA h/o MI at age 22 [**1-5**] cocaine use paranoid schizoid personality d/o h/o depression s/p ECT LBP [**1-5**] ruptured disc hepatomegaly [**1-5**] NASH MEDICATION ON ADMISSION: Glargine novolog sliding scale trazodone 300 mg qhs ALLERGIES: Penicillins / Compazine PHYSICAL EXAM: VS: Temp: BP:111/70 HR: 75 RR: 15 O2sat 100% GEN: pleasant, comfortable, NAD HEENT: PERRL, EOMI, anicteric, mildly dry mm RESP: CTA b/l with good air movement throughout CV: RR, S1 and S2 wnl, no m/r/g ABD: + epigastric tenderness, mildly distracting, no rebound, no HSM EXT: Dp pulses intact, no edema NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. UE reflexes +2. FAMILY HISTORY: Adopted SOCIAL HISTORY: h/o cocaine abuse, tobacco use, occ etoh, h/o benzo abuse; divorced, remarried presented from psychiatric hospital

Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Long-term (current) use of insulin,Abdominal pain, generalized,Dysthymic disorder

DMI ketoacd uncontrold,Acute kidney failure NOS,Long-term use of insulin,Abdmnal pain generalized,Dysthymic disorder

Admission Date: [**2100-10-16**] Discharge Date: [**2100-10-20**] Date of Birth: [**2062-9-19**] Sex: F Service: MEDICINE Allergies: Penicillins / Compazine Attending:[**First Name3 (LF) 2009**] Chief Complaint: abdominal pain Major Surgical or Invasive Procedure: none History of Present Illness: HPI: Vitals on arrival to the ED were 98.8 71 117/66 16 100. In ED she complained of [**9-12**] abd pain and nausea/vomiting. Her FS was 698. K returned at 7.3 but was hemolyzed and was 4 on repeat. WBC nl at 8.8 NA 127, cl 85, bicarb 19, and gap=23. + ktones in urine 150. Urine tox + for opiates. She had a lactate of 2.4. She received zofran 4mg IV for her nausea, a total of morphine 8mg IV x1 for her pain, and question of receiving dilaudid 1mg x1. She later asked for a diet despite complaining of [**9-12**] abd pain. She was difficilt to obtain access on initially but eventually a 18 guage and a 20 guage was placed and she was started on her first L of IVF. She was given 10 units of regular insulin IV and then started on an insulin gtt at 7units/hr at 1600. Vitals prior to transfer were T99 HR 72 BP 177/72 RR16 100% RA. . She reports that her BS have been greater than assay since she left [**Hospital3 26615**] on [**2100-10-14**]. She has been taking glargine 10 units qhs and novologu 30 units TID. She reports blurry vision and a few seoncds of blacking out while in the ED. . She reports severe [**9-12**] abd pain that can be sharp or a constant ache. She's had abdominal pain for many yrs but it has been much worse in the last few weeks. The pain is in the upper abd and radiates to the back. It occurs without eating but is worse with eating. It does not feel like her gastroparesis pain. It was worked up at [**Hospital3 26615**] and no etiology was found. She became very upset when they changed her from morphine 4mg IV q2hrs to po morphine. She has not had a BM for weeks and lost 20 lbs over the last [**3-9**] wks. . She also reports 10/10 chest pain that she's had since being at [**Hospital3 26615**]. She describes it as "firey, acidy, and sharp pain." She also gets a feeling of numbness in her entire left arm. The pain is worse with inspiration. . At [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], the patient ruled out for PE, had a negative HIDA scan, had a neg lead level, had an abdominal u/s that showed ascities, had an unremarkable CT abd/pelvis, TSH was 4.3, pt refused in pt tx for narcotic abuse, and was reluctant to switch from IV to po pain meds. The d/c summary reports she set an alarm to wake up to take her pain meds. . She reports pain in her head x1 week. The pain is in the back of the right head behind the right ear and behind the right eye. The pain is [**2100-6-10**] and comes and goes. It does go away completely and does not feel like a migraine. Past Medical History: DDM and DKA Chronic abdominal pain and discomfort on daily basis and occasional nausea. Last hospitalized in [**10-13**] and in [**2096**] for upper abd pain. Anxiety Depression PSA ? currently abusing narcotics mild pancreatitis in [**2095**] h/o bipolar and personality d/o h/o TIA Possible h/o eating d/o DKA h/o MI at age 22 [**1-5**] cocaine use paranoid schizoid personality d/o h/o depression s/p ECT LBP [**1-5**] ruptured disc hepatomegaly [**1-5**] NASH Social History: h/o cocaine abuse, tobacco use, occ etoh, h/o benzo abuse; divorced, remarried presented from psychiatric hospital Family History: Adopted Physical Exam: VS: Temp: BP:111/70 HR: 75 RR: 15 O2sat 100% GEN: pleasant, comfortable, NAD HEENT: PERRL, EOMI, anicteric, mildly dry mm RESP: CTA b/l with good air movement throughout CV: RR, S1 and S2 wnl, no m/r/g ABD: + epigastric tenderness, mildly distracting, no rebound, no HSM EXT: Dp pulses intact, no edema NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. UE reflexes +2. Pertinent Results: Admission labs: [**2100-10-16**] 05:00PM WBC-8.8 RBC-4.42 HGB-13.6 HCT-40.2 MCV-91 MCH-30.8 MCHC-33.9 RDW-13.7 [**2100-10-16**] 05:00PM NEUTS-74.7* LYMPHS-20.5 MONOS-3.2 EOS-0.9 BASOS-0.7 [**2100-10-16**] 05:00PM GLUCOSE-698* UREA N-28* CREAT-1.0 SODIUM-127* POTASSIUM-7.3* CHLORIDE-85* TOTAL CO2-19* ANION GAP-30* [**2100-10-16**] 04:55PM URINE BLOOD-SM NITRITE-NEG PROTEIN-25 GLUCOSE-1000 KETONE-150 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG [**2100-10-16**] 04:55PM URINE RBC-0-2 WBC-0 BACTERIA-RARE YEAST-NONE EPI-0-2 [**2100-10-16**] 04:55PM URINE bnzodzpn-NEG barbitrt-NEG opiates-POS cocaine-NEG amphetmn-NEG mthdone-NEG [**2100-10-16**] 05:00PM ALT(SGPT)-15 AST(SGOT)-28 ALK PHOS-69 TOT BILI-0.6 [**2100-10-16**] 05:00PM LIPASE-23 [**2100-10-16**] 05:00PM cTropnT-<0.01 CXR [**10-16**]: no acute processes Microbiology: Blood cx [**10-16**]: negative Urine cx [**10-16**]: 10-100k GPC, either streptococcus A or lactobacilli (returned after discharge, no action necessary) Discharge labs: [**2100-10-19**] 05:09AM BLOOD WBC-4.8 RBC-3.87* Hgb-11.6* Hct-33.7* MCV-87 MCH-30.1 MCHC-34.5 RDW-13.3 Plt Ct-241 [**2100-10-19**] 05:09AM BLOOD Glucose-127* UreaN-10 Creat-0.4 Na-138 K-3.9 Cl-102 HCO3-27 AnGap-13 [**2100-10-19**] 05:09AM BLOOD Calcium-8.6 Phos-3.3 Mg-1.6 Brief Hospital Course: A/P: 38 yo female with h/o IDDM who presented to the ED with a BS of 698 in DKA with a gap of 23 and also complaining of chest pain and abdominal pain. DKA: Etiology of DKA unknown. UA was negative for infection. Gap in the ED was 23 and bicarb was 19. BS 698 on arrival. She was started on insulin gtt at 7 U/h. BS was checked q1h. NS was given initially and changed to D5 1/2 NS when FSBG fell below 200. She was given phosporus and potassium repletion. Anion gap closed within 36 hours of admission. She was given 10 U SC Lantus and insulin gtt turned off several hours later. She was subsequently covered with humalog SS. [**Last Name (un) **] was consulted to assist with outpatient planning. Lantus was increased to 13 units and continued on sliding scale. Patient was discharged to follow-up with PCP. Abdominal pain: Records from outside hospital revealed extensive prior work-up for her chronic abdominal pain including negative workup for gastroparesis. Here, LFTs, lipase were all WNL. She was treated with small doses of morphine. Bowel regimen was started for constipation component. On transfer to floor, she was transitioned to PO pain medication and ultimately tolerated a PO diet prior to discharge. Patient requested discharge on hospital day 4. Follow-up was arranged for patient with PCP the day after discharge. Acute Renal Failure: Creatinine initially elevated to 1.1, fell to .5 with IV fluids. Medications on Admission: Glargine novolog sliding scale trazodone 300 mg qhs Discharge Medications: 1. insulin glargine 100 unit/mL Solution Sig: Thirteen (13) units Subcutaneous at bedtime. 2. Novolog 100 unit/mL Solution Sig: 1-12 units Subcutaneous four times a day: Per sliding scale, as previously prescribed. 3. trazodone 300 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for insomnia. Discharge Disposition: Home Discharge Diagnosis: Diabetic Ketoacidosis Chronic Abdominal Pain Discharge Condition: Mental Status: Clear and coherent. Discharge Instructions: You were admitted to the hospital due to uncontrolled diabetes - a state called diabetic ketoacidosis. You were in the intensive care until your blood sugars were well controlled. You were given medications to control your abdominal pain. At discharge, you were tolerating an normal diet. It is very important that you take your insulin as prescribed to keep your sugars at a safe level. Even if you aren't eating, it is important that you take your LANTUS becuase your body always needs insulin. Changes in Medication: Increase Lantus (glargine) to 13 units at night. Followup Instructions: The following appointment has been arranged for you at your PCP's office. It is VERY important that you go to this appointment. PCP [**Name Initial (PRE) 648**]: Thursday, [**10-21**] at 2:45pm With [**First Name4 (NamePattern1) 803**] [**Last Name (NamePattern1) 34086**], NP(who works with Dr. [**First Name4 (NamePattern1) 333**] [**Last Name (NamePattern1) 958**]) Location: HOLISTIC FAMILY PRACTICE Address: 65 [**Location (un) **] TURNPIKE, [**Location (un) **],[**Numeric Identifier 34087**] Phone: [**Telephone/Fax (1) 34088**]

250,584,V586,789,300

{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Long-term (current) use of insulin,Abdominal pain, generalized,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: abdominal pain PRESENT ILLNESS: HPI: Vitals on arrival to the ED were 98.8 71 117/66 16 100. In ED she complained of [**9-12**] abd pain and nausea/vomiting. Her FS was 698. K returned at 7.3 but was hemolyzed and was 4 on repeat. WBC nl at 8.8 NA 127, cl 85, bicarb 19, and gap=23. + ktones in urine 150. Urine tox + for opiates. She had a lactate of 2.4. She received zofran 4mg IV for her nausea, a total of morphine 8mg IV x1 for her pain, and question of receiving dilaudid 1mg x1. She later asked for a diet despite complaining of [**9-12**] abd pain. She was difficilt to obtain access on initially but eventually a 18 guage and a 20 guage was placed and she was started on her first L of IVF. She was given 10 units of regular insulin IV and then started on an insulin gtt at 7units/hr at 1600. Vitals prior to transfer were T99 HR 72 BP 177/72 RR16 100% RA. . She reports that her BS have been greater than assay since she left [**Hospital3 26615**] on [**2100-10-14**]. She has been taking glargine 10 units qhs and novologu 30 units TID. She reports blurry vision and a few seoncds of blacking out while in the ED. . She reports severe [**9-12**] abd pain that can be sharp or a constant ache. She's had abdominal pain for many yrs but it has been much worse in the last few weeks. The pain is in the upper abd and radiates to the back. It occurs without eating but is worse with eating. It does not feel like her gastroparesis pain. It was worked up at [**Hospital3 26615**] and no etiology was found. She became very upset when they changed her from morphine 4mg IV q2hrs to po morphine. She has not had a BM for weeks and lost 20 lbs over the last [**3-9**] wks. . She also reports 10/10 chest pain that she's had since being at [**Hospital3 26615**]. She describes it as "firey, acidy, and sharp pain." She also gets a feeling of numbness in her entire left arm. The pain is worse with inspiration. . At [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], the patient ruled out for PE, had a negative HIDA scan, had a neg lead level, had an abdominal u/s that showed ascities, had an unremarkable CT abd/pelvis, TSH was 4.3, pt refused in pt tx for narcotic abuse, and was reluctant to switch from IV to po pain meds. The d/c summary reports she set an alarm to wake up to take her pain meds. . She reports pain in her head x1 week. The pain is in the back of the right head behind the right ear and behind the right eye. The pain is [**2100-6-10**] and comes and goes. It does go away completely and does not feel like a migraine. MEDICAL HISTORY: DDM and DKA Chronic abdominal pain and discomfort on daily basis and occasional nausea. Last hospitalized in [**10-13**] and in [**2096**] for upper abd pain. Anxiety Depression PSA ? currently abusing narcotics mild pancreatitis in [**2095**] h/o bipolar and personality d/o h/o TIA Possible h/o eating d/o DKA h/o MI at age 22 [**1-5**] cocaine use paranoid schizoid personality d/o h/o depression s/p ECT LBP [**1-5**] ruptured disc hepatomegaly [**1-5**] NASH MEDICATION ON ADMISSION: Glargine novolog sliding scale trazodone 300 mg qhs ALLERGIES: Penicillins / Compazine PHYSICAL EXAM: VS: Temp: BP:111/70 HR: 75 RR: 15 O2sat 100% GEN: pleasant, comfortable, NAD HEENT: PERRL, EOMI, anicteric, mildly dry mm RESP: CTA b/l with good air movement throughout CV: RR, S1 and S2 wnl, no m/r/g ABD: + epigastric tenderness, mildly distracting, no rebound, no HSM EXT: Dp pulses intact, no edema NEURO: AAOx3. Cn II-XII intact. 5/5 strength throughout. UE reflexes +2. FAMILY HISTORY: Adopted SOCIAL HISTORY: h/o cocaine abuse, tobacco use, occ etoh, h/o benzo abuse; divorced, remarried presented from psychiatric hospital ### Response: {'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Long-term (current) use of insulin,Abdominal pain, generalized,Dysthymic disorder'}

CHIEF COMPLAINT: atrial flutter RVR, possible GIB, leukocytosis, fever PRESENT ILLNESS: 55yo M previously unknown to this hospital presented initially to OSH with progressive low back pain. In [**2119-1-12**] pt underwent L3L4 laminectomy for epidural abcess. Pain recurred after discontinuation of 6 week post-op course of antibiotics (organism and Abx unknown at this time). Pt apparently admitted to OSH for similar back pain prior to transfer. Pt was prepared for discharge at OSH, but then collapsed, became lethargic, was found to be in flutter vs fib w/ RVR, with WBC of 40, and producing copious dark stools. Sequence of events and chronicity not entirely clear. Prior to transfer to [**Hospital1 18**] for further evaluation, pt received vanco, zosyn, and dilt 35mg. 4L NS were given by EMS in transit, per their flowsheet, pt was never hypotensive (all SBP>120). . In the ED, initial vs were: T98.7 P114 BP114/67 R40 O2 sat99 on 4L. Pt continued to produced dark stools (guiaic +). Patient was given 4L NS with total UOP of 1200cc. His Hct remained stable. 3 peripheral IVs were placed. Tachycardia did not resolve with fluids--interpreted as flutter with variable block. NSGY eval in the ED for low back pain as they thought he had a laminectomy in [**2121-1-12**] for epidural abcess, if fact, laminectomy was in [**2118**]. Pt seen by GI in ED and considering EGD. . Pt markedly tachypneic, initial ABG in ED 7.47, 28, 96 on 2L. Repeat ABG five hours later showed 7.47, 27, 67 on room air. . Review of systems: (+) Per HPI (-) unable to provide reliable ROS MEDICAL HISTORY: -Prior PNA -septic shock [**1-13**] septic shoulder [**2120-2-10**] (MRSA) -Epidural abcess (organism unknown) tx with 6 weeks Abx post-laminectomy in [**2119-1-12**] -Hep C -A fib not on coumadin MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Discharge exam: FAMILY HISTORY: UNABLE TO ELICIT SOCIAL HISTORY: Hx of IVDU; no use per pt for several months. Denies ETOH abuse.

Methicillin susceptible Staphylococcus aureus septicemia,Other encephalopathy,Cocaine dependence, continuous,Cellulitis and abscess of trunk,Atrial flutter,Acidosis,Hemorrhage of gastrointestinal tract, unspecified,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Pyogenic arthritis, shoulder region,Unspecified osteomyelitis, upper arm,Sepsis,Other disorders of muscle, ligament, and fascia,Hemangioma of other sites,Scar conditions and fibrosis of skin,Unspecified viral hepatitis C without hepatic coma,Tachycardia, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dental caries, unspecified

Meth susc Staph aur sept,Encephalopathy NEC,Cocaine depend-contin,Cellulitis of trunk,Atrial flutter,Acidosis,Gastrointest hemorr NOS,Ac DVT/embl low ext NOS,Pyogen arthritis-shlder,Osteomyelitis NOS-up/arm,Sepsis,Muscle/ligament dis NEC,Hemangioma NEC,Scar & fibrosis of skin,Hpt C w/o hepat coma NOS,Tachycardia NOS,Chr blood loss anemia,Dental caries NOS

Admission Date: [**2121-6-17**] Discharge Date: [**2121-7-2**] Date of Birth: [**2065-7-15**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 30**] Chief Complaint: atrial flutter RVR, possible GIB, leukocytosis, fever Major Surgical or Invasive Procedure: intubated [**2121-6-21**] central venous line [**2121-6-21**] History of Present Illness: 55yo M previously unknown to this hospital presented initially to OSH with progressive low back pain. In [**2119-1-12**] pt underwent L3L4 laminectomy for epidural abcess. Pain recurred after discontinuation of 6 week post-op course of antibiotics (organism and Abx unknown at this time). Pt apparently admitted to OSH for similar back pain prior to transfer. Pt was prepared for discharge at OSH, but then collapsed, became lethargic, was found to be in flutter vs fib w/ RVR, with WBC of 40, and producing copious dark stools. Sequence of events and chronicity not entirely clear. Prior to transfer to [**Hospital1 18**] for further evaluation, pt received vanco, zosyn, and dilt 35mg. 4L NS were given by EMS in transit, per their flowsheet, pt was never hypotensive (all SBP>120). . In the ED, initial vs were: T98.7 P114 BP114/67 R40 O2 sat99 on 4L. Pt continued to produced dark stools (guiaic +). Patient was given 4L NS with total UOP of 1200cc. His Hct remained stable. 3 peripheral IVs were placed. Tachycardia did not resolve with fluids--interpreted as flutter with variable block. NSGY eval in the ED for low back pain as they thought he had a laminectomy in [**2121-1-12**] for epidural abcess, if fact, laminectomy was in [**2118**]. Pt seen by GI in ED and considering EGD. . Pt markedly tachypneic, initial ABG in ED 7.47, 28, 96 on 2L. Repeat ABG five hours later showed 7.47, 27, 67 on room air. . Review of systems: (+) Per HPI (-) unable to provide reliable ROS Past Medical History: -Prior PNA -septic shock [**1-13**] septic shoulder [**2120-2-10**] (MRSA) -Epidural abcess (organism unknown) tx with 6 weeks Abx post-laminectomy in [**2119-1-12**] -Hep C -A fib not on coumadin Social History: Hx of IVDU; no use per pt for several months. Denies ETOH abuse. Family History: UNABLE TO ELICIT Physical Exam: Discharge exam: Vitals: T: 99.4 BP: 120/80 P: 88 R: 20 O2: 98% on RA General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Slightly decreased lung sounds throughout. Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly Back: large healing surgical incision in lumbar sign, some erythema but no swelling or discharge. Ext: Warm, well perfused, 2+ pulses throughout, no clubbing, cyanosis or edema. Limited ROM in right shoulder and elbow [**1-13**] pain. Small cut in left foot from incision in drainage expressing serosanguinous fluid, no frank pus. Dressing clean/dry/intact. Neuro: aaox3, 5/5 strength b/l and throughout, sensation intact. Able to transfer himself from chair to walker, but requires arm assistance. Pertinent Results: Labs on Admission: [**2121-6-17**] WBC-35.2* RBC-3.79* Hgb-11.9* Hct-34.5* MCV-91 MCH-31.3 Plt Ct-185 Neuts-87* Bands-5 Lymphs-2* Monos-3 Eos-0 Baso-0 Atyps-0 Metas-2* Myelos-1* PT-16.0* PTT-27.9 INR(PT)-1.4* Glucose-110* UreaN-65* Creat-1.3* Na-138 K-3.6 Cl-109* HCO3-19* AnGap-14 ALT-16 AST-30 LD(LDH)-306* CK(CPK)-42 AlkPhos-192* TotBili-1.5 Albumin-2.0* Calcium-7.2* Phos-3.0 Mg-1.7 Hapto-328* HIV Ab-NEGATIVE freeCa-1.09* Lactate-1.2 . [**2121-6-17**] 09:11AM BLOOD CK-MB-NotDone cTropnT-<0.01 [**2121-6-17**] 02:45AM BLOOD CK-MB-NotDone cTropnT-<0.01 . [**2121-6-17**] Blood culture STAPH AUREUS COAG + ERYTHROMYCIN---------- =>8 R GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- 4 R OXACILLIN------------- =>4 R RIFAMPIN-------------- <=0.5 S TETRACYCLINE---------- <=1 S TRIMETHOPRIM/SULFA---- <=0.5 S VANCOMYCIN------------ <=1 S . [**2121-6-22**] 11:40 pm SWAB Site: BACK DEEP LUMBAR. . **FINAL REPORT [**2121-6-27**]** . GRAM STAIN (Final [**2121-6-23**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. SMEAR REVIEWED; RESULTS CONFIRMED. . WOUND CULTURE (Final [**2121-6-25**]): STAPH AUREUS COAG +. MODERATE GROWTH. SENSITIVITIES PERFORMED ON CULTURE # 277-2104F [**2121-6-23**]. . ANAEROBIC CULTURE (Final [**2121-6-27**]): NO ANAEROBES ISOLATED. . [**2121-6-23**] 1:02 pm SWAB Source: L 2nd toe. . **FINAL REPORT [**2121-6-27**]** . GRAM STAIN (Final [**2121-6-23**]): 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. IN PAIRS. . WOUND CULTURE (Final [**2121-6-25**]): STAPH AUREUS COAG +. SPARSE GROWTH. SENSITIVITIES PERFORMED ON CULTURE # 277-1942F [**2121-6-22**]. . ANAEROBIC CULTURE (Final [**2121-6-27**]): NO ANAEROBES ISOLATED. . [**2121-6-22**] 11:49 pm TISSUE LAMINA AND EPIDURAL PHLEGMON. . GRAM STAIN (Final [**2121-6-23**]): 2+ (1-5 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO MICROORGANISMS SEEN. . TISSUE (Final [**2121-6-26**]): STAPH AUREUS COAG +. SPARSE GROWTH. Oxacillin RESISTANT Staphylococci MUST be reported as also RESISTANT to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. Rifampin should not be used alone for therapy. Please contact the Microbiology Laboratory ([**6-/2418**]) immediately if sensitivity to clindamycin is required on this patient's isolate. . SENSITIVITIES: MIC expressed in MCG/ML . _________________________________________________________ STAPH AUREUS COAG + | ERYTHROMYCIN---------- =>8 R GENTAMICIN------------ <=0.5 S LEVOFLOXACIN---------- 4 R OXACILLIN------------- =>4 R RIFAMPIN-------------- <=0.5 S TETRACYCLINE---------- <=1 S TRIMETHOPRIM/SULFA---- <=0.5 S VANCOMYCIN------------ <=1 S . ANAEROBIC CULTURE (Final [**2121-6-27**]): NO ANAEROBES ISOLATED. . FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. . Blood Cultures [**Date range (1) 34617**] - No Growth . MRI Lumber Spine [**2121-6-19**] 1. Abnormal STIR hyperintense collection within the ventral epidural space tracking along the posterior margin of the L5 vertebral body and sacrum resulting in complete effacement of the ventral sac with abnormal clumping of the nerve roots at these levels. Given the patient's clinical history and adjacent right-sided paravertebral collections, findings are suspicious for epidural phlegmon or abscess. Distinction cannot be made on this limited non-contrast enhanced examination. 2. Limited evaluation of multilevel degenerative disc disease with disc bulges as detailed above. Slightly elevated signal within multiple endplates and discs are likely degenerative, but underlying discitis/osteomyelitis cannot be excluded by this limited imaging. There remains high clinical concern, repeat MRI with increased sedation or correlation with nuclear scintigraphy exam should be considered. . MRI Left Foot [**2121-6-21**] Dorsal dislocation of the second metatarsophalangeal joint, extensive, loculated and enhancing fluid collections centered at the second metatarsophalangeal joint, extending proximally to the second metatarsal base and first tarsometatarsal joint, consistent with the second metatarsophalangeal septic arthritis and associated abscesses in the more proximal forefoot. Mild edema in the distal second metatarsal without definitive changes of osteomyelitis. . [**2121-6-21**] TEE Valves are very well visualized. No valvular vegetations, abscess or pathologic regurgitation seen. . [**2121-6-27**] CT head IMPRESSION: Small vessel ischemic disease, no sign of abscess. . [**2121-6-29**] MRI Shoulder INDICATION: 55-year-old man with history of MRSA of right shoulder, question septic arthritis and osteomyelitis. . COMPARISON: None. . TECHNIQUE: Imaging was performed at 1.5 Tesla using the shoulder coil. Sequences include true axial and coronal T1, STIR, and post-gadolinium images of the right shoulder. . FINDINGS: There is a massive effusion extending through a torn rotator cuff from the joint to the subdeltoid/subacromial bursa and subscapularis recess containing debris and septations. There is marked edema within the head and neck of the humerus as well as the glenoid with loss of cortical definition. A focal area of T2 hyperintensity measuring 12 (AP) x 12 (TV) x 16 (CC) mm with thick peripheral enhancement (series 15:25) located in the proximal humeral metadiaphysis is consistent with an intraosseous abscess. There is edema within the muscles of the rotator cuff, especially the subscapularis muscle. A peripherally enhancing 12 x 8 mm abscess (series 13:38) is seen in the subscapularis muscle. . While not dedicated to evaluation of the rotator cuff, there is a complete tear of the supraspinatus tendon, as well as tears of the infraspinatus and subscapularis tendons. There is a tear of the superior labrum (series 11:16). The biceps labral anchor complex is destroyed. . IMPRESSION: 1. Complex fluid collection in the shoulder joint communicating with the subacromial/subdeltoid bursae and subscapularis recess with diffuse marrow edema and loss of cortical definition of the humeral head, proximal humeral metadiaphysis and glenoid. . 2. Discrete peripherally enhancing interosseous abscess. . 3. Small intramuscular abscess within the subscapularis muscle. Overall, the findings are concerning for osteomyelitis, interosseous abscess, and septic joint. . Brief Hospital Course: 1. MRSA Sepsis: Was initially placed on broad covg with vanco/zosyn/cipro. Blood cx showed MRSA bacteremia on [**2121-6-17**]. Pt placed on vancomycin and zosyn/cipro stopped. TTE and TEE without vegetation. Pt also developed back pain and L toe pain which were felt to be likely seeded from MRSA bacteremia. He was electively intubated for MRI, which showed epidural abscess. MR of the foot also showed septic arthritis. Patient had a Lumbar laminectomy to drain an epidural abscess, L4-S1 on [**2121-6-22**] which he tolerated well. Podiatry did an incision and drainage at the bedside which he tolerated well. After these procedures the patient had occasional temperature spikes. Each time he was recultured (no growth on cultures after [**6-22**]). MRSA sepsis has cleared with foci of infection in left foot, pelvis, lumbar spine, and right shoulder. MR shoulder showed osteomyelitis, septic joint and interosseous abscess. Orthopedics did a tap of the shoulder that was dry, and their assessment was that there was no discrete abscess that would benefit from an open shoulder washout. Will continue vancomycin 1000mg Q12H to complete an 8 week course. He will follow up with ID and orthopedics as an outpatient for continued management. . 2. DVT Right UE: presented with a painful and increasingly swollen elbow. Initial UE u/s did not show DVT. Initial elbow tap by [**Month/Year (2) **] was dry. Pt states pain is improving, but clinically edema is worsened. CT elbow showed small (<1cm) fluid in biceps and small joint effusion without osteo. Clinical suspicion high for clot given degree of swelling on exam. Repeat u/s [**6-26**] showed brachial vein clot with 8x10cm complex cyst in shoulder, concerning for an abscess. Did not start coumadin in setting of recent laminectomy and ?GI bleed, started heparin gtt goal PTT 50-60. Discharged with lovenox 120mg daily. . 3. Swollen right shoulder: as per patient report, he went to OSH for shoulder pain, on discharge for OSH he collapsed and was transfered here. He has a history of MRSA in the joint with chronic swelling. MRI showed osteomyelitis, septic joint and abscess. Will follow up with orthopedics in the outpatient setting for further management of the shoulder. See above for orthopedics assessment of shoulder. . 4. Guiaic positive stools: Guiaic positive but not melena, especially considering that Hct has [**Doctor First Name **] stable despite large amounts of dark stool. Given marked leukocytosis, concern for CDIFF. However, toxin neg here. Empiric po vanco stopped once toxin neg. Patient refused colonoscopy and EGD and understood the risks of not working up a guiaic positive stool. His hct has been stable for >1 week . 5. Anemia: Patient had iron studies consistent with anemia of chronic inflammation/disease. Pt reticulocyte count 3.9%, corrected retic index ~1%, which is not appropriate with his anemia and consistent with this diagnosis. The patient had guiaic positive stools and the original plan was to perform an EGD and colonoscopy, however the patient declined the procedure. He was informed of the risk that he was undertaking of continued bleeding from declining the procedures. . 6. Tachycardia: Atrial tachyarrhtymia. Hemodynamically tolerating elevated rate. Rate not indicative of intravascular depletion. Was rate controlled, as this was felt to be separate physiology from his sepsis. Corrected to normal sinus rhythm after sepsis resolved. Discharged on metoprolol extended release 50mg daily. . 7. Hypoalbuminemia: urine negative for protein, probably not a liver synthesis problem as [**Name (NI) 3539**] not elevated and only slight INR increase. Most likely malnutrition, nutrition consulted. Eating a regular diet. . 8. Poor dentition: has ~3 teeth, very loose and discolored. Dental consult earlier in course to eval for source of infection, they rec panorex and likely oral surgery. Given outpatient information for follow up. Medications on Admission: none Discharge Medications: 1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 2. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily). 3. 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. 4. Enoxaparin 120 mg/0.8 mL Syringe Sig: One (1) syringe Subcutaneous Q24H (every 24 hours): discontinue upon discharge from rehab. Check platelets weekly. 5. Vancomycin 1,000 mg Recon Soln Sig: One (1) 1000 mg Intravenous every twelve (12) hours: day1 = [**6-22**] total 8 week duration. 6. Oxycodone 5 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 7. Morphine 10 mg/mL Solution Sig: 2-4 mg Intravenous Q4H (every 4 hours) as needed for pain. 8. Outpatient Lab Work Please draw weekly BUN, creatinine, CBC with differential to monitor renal function and treatment response to vancomycin, and platelets to monitor for acute marked drop from lovenox. Discharge Disposition: Extended Care Facility: [**Hospital 5503**] [**Hospital **] Hospital Discharge Diagnosis: Primary: MRSA sepsis, septic toe, septic shoulder, epidural abscess, pelvic soft tissue infection, DVT right brachial vein, atrial fibrillation with rapid ventricular response Secondary: hepatitis C, IV drug abuse, prior epidural abscess, prior septic shoulder Discharge Condition: Hemodynamically stable. MRSA controled and no evidence of bacteremia. Discharge Instructions: You were admitted with a MRSA infection in your blood. MRSA is a bacteria that can cause severe infections, and is difficult to treat because it is resistant to many antibiotics. As a result of this you also got MRSA infections in your foot, shoulder, pelvis and lumbar spine. You were treated with IV vancomycin, and will continue to need IV vancomycin for at least 8 weeks, with antibiotics by mouth after that. Your stool was positive for blood was tested. This is concerning for a possibly bleed in your stomach or bowels. You refused to have a colonoscopy or upper scope. You understood the risk of not getting these procedures and were comfortable with not having them done. You also developed a clot in the vein of your right arm. As a result of this you had swelling and pain your right elbow. You were treated for this with heparin, which was an medicine that you recieved in the hospital through an IV. This has been discontinued, but you will continue to need shots for anticoagulation at rehab as well as after you are discharged from rehab. This is for your safety and to dissolve the clot, and you will need to have these shots for 3 months. When you came from the outside hospital your heart was beating in an irregular rhythm - atrial fibrillation with rapid ventricular response. This was caused by the MRSA infection in your blood. You were given metoprolol to help with control your heart rate. We are adding a new medication metoprolol XL, please be sure to take this everyday. During your stay a dentist saw you and thought your teeth needed to be pulled. Please call one of the following numbers to make an appointment for continued dental care and treatment. If you experience chest pain, shortness of breath, fevers, chills, tremors, abdominal pain, swollen red joints, dizzyness or any other symptom that is concerning to you, please call your doctor or go to the nearest emergency room. Followup Instructions: You are scheduled to follow up with orthopedic surgery at the [**Hospital3 **] Hospital [**Hospital Ward Name 23**] Building on [**7-30**] at the times below: 1. Provider: [**Name10 (NameIs) **] XRAY (SCC 2) Phone:[**Telephone/Fax (1) 1228**] Date/Time:[**2121-7-30**] 11:55AM [**Hospital Ward Name 516**], [**Hospital Ward Name 23**] Building, [**Location (un) **] 2. Provider: [**Name10 (NameIs) 8741**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 1228**] Date/Time:[**2121-7-30**] 12:15PM [**Hospital Ward Name 516**], [**Hospital Ward Name 23**] Building, [**Location (un) **] You are also scheduled to follow up with infectious disease clinic at the time below: 1. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13896**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2121-7-16**] 2:30PM at [**Hospital Ward Name 517**], [**Last Name (NamePattern1) 439**], Basement 2. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13896**], MD Phone:[**Telephone/Fax (1) 457**] Date/Time:[**2121-8-5**] 9:00 at [**Hospital Ward Name 517**], [**Last Name (NamePattern1) 439**], basement Completed by:[**2121-7-2**]

038,348,304,682,427,276,578,453,711,730,995,728,228,709,070,785,280,521

{'Methicillin susceptible Staphylococcus aureus septicemia,Other encephalopathy,Cocaine dependence, continuous,Cellulitis and abscess of trunk,Atrial flutter,Acidosis,Hemorrhage of gastrointestinal tract, unspecified,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Pyogenic arthritis, shoulder region,Unspecified osteomyelitis, upper arm,Sepsis,Other disorders of muscle, ligament, and fascia,Hemangioma of other sites,Scar conditions and fibrosis of skin,Unspecified viral hepatitis C without hepatic coma,Tachycardia, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dental caries, 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: atrial flutter RVR, possible GIB, leukocytosis, fever PRESENT ILLNESS: 55yo M previously unknown to this hospital presented initially to OSH with progressive low back pain. In [**2119-1-12**] pt underwent L3L4 laminectomy for epidural abcess. Pain recurred after discontinuation of 6 week post-op course of antibiotics (organism and Abx unknown at this time). Pt apparently admitted to OSH for similar back pain prior to transfer. Pt was prepared for discharge at OSH, but then collapsed, became lethargic, was found to be in flutter vs fib w/ RVR, with WBC of 40, and producing copious dark stools. Sequence of events and chronicity not entirely clear. Prior to transfer to [**Hospital1 18**] for further evaluation, pt received vanco, zosyn, and dilt 35mg. 4L NS were given by EMS in transit, per their flowsheet, pt was never hypotensive (all SBP>120). . In the ED, initial vs were: T98.7 P114 BP114/67 R40 O2 sat99 on 4L. Pt continued to produced dark stools (guiaic +). Patient was given 4L NS with total UOP of 1200cc. His Hct remained stable. 3 peripheral IVs were placed. Tachycardia did not resolve with fluids--interpreted as flutter with variable block. NSGY eval in the ED for low back pain as they thought he had a laminectomy in [**2121-1-12**] for epidural abcess, if fact, laminectomy was in [**2118**]. Pt seen by GI in ED and considering EGD. . Pt markedly tachypneic, initial ABG in ED 7.47, 28, 96 on 2L. Repeat ABG five hours later showed 7.47, 27, 67 on room air. . Review of systems: (+) Per HPI (-) unable to provide reliable ROS MEDICAL HISTORY: -Prior PNA -septic shock [**1-13**] septic shoulder [**2120-2-10**] (MRSA) -Epidural abcess (organism unknown) tx with 6 weeks Abx post-laminectomy in [**2119-1-12**] -Hep C -A fib not on coumadin MEDICATION ON ADMISSION: none ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Discharge exam: FAMILY HISTORY: UNABLE TO ELICIT SOCIAL HISTORY: Hx of IVDU; no use per pt for several months. Denies ETOH abuse. ### Response: {'Methicillin susceptible Staphylococcus aureus septicemia,Other encephalopathy,Cocaine dependence, continuous,Cellulitis and abscess of trunk,Atrial flutter,Acidosis,Hemorrhage of gastrointestinal tract, unspecified,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Pyogenic arthritis, shoulder region,Unspecified osteomyelitis, upper arm,Sepsis,Other disorders of muscle, ligament, and fascia,Hemangioma of other sites,Scar conditions and fibrosis of skin,Unspecified viral hepatitis C without hepatic coma,Tachycardia, unspecified,Iron deficiency anemia secondary to blood loss (chronic),Dental caries, unspecified'}

CHIEF COMPLAINT: Tx for hypotension/ sepsis PRESENT ILLNESS: Pt is a 68 yo male with DM, HTN, deep brain stimulator, who is being transferred from the floor from hypotension. Pt says that he has been having fevers off and on for 5 weeks. Max temp reached 104. No weight loss, night sweats with this but pt does endorses rigors/chills. He states that some nights he would have fever and sometimes his temperature would be 98.5 (fevers generally occured at night). Pt did not go to his [**First Name3 (LF) 3390**] until this past Tuesday. Blood cultures were drawn and grew out GPC in clusters and pt was told to come to the ED. In the ED, lactate was 4.7 (attributed to rigors as lactate was lower previously) but patient did not meet strict criteria for sepsis then and was admitted to the floor and started on vancomycin. MEDICAL HISTORY: 1. DM 2 x 11 years 2. Essential tremor followed by Dr [**Last Name (STitle) **], w/ DBS placed in [**2117**] MEDICATION ON ADMISSION: lantus 80 u qhs amaryl 4 mg tricor 48 mg daily lisinopril 40 mg daily ASA lasix 40 mg daily b12 q mth novolog scale paxil 20 mg daily glyburide 5 mg [**Hospital1 **] verapamil 180 mg daily KCL ALLERGIES: Codeine / Heparin Agents / Vancomycin PHYSICAL EXAM: Temp 101.7 BP 114/74 Pulse 106 Resp 20 O2 sat 96% RA Gen - Alert, no acute distress, arousable from sleep HEENT - PERRL, extraocular motions intact, anicteric, mucous membranes dry Neck - no JVD, no cervical lymphadenopathy Lymph: no axiallr LAD Chest - Clear to auscultation bilaterally CV - Normal S1/S2, RRR, 2/6 SEM at LUSB Abd - Soft, nontender, nondistended, with normoactive bowel sounds, RUQ surgical scar Back - No costovertebral angle tendernes Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally FAMILY HISTORY: Mother died of pancreatitis. Sister died of pancreatic cancer; father died of bone cancer and another sister died of ovarian cancer. SOCIAL HISTORY: former physics instructor at [**University/College **]. Nonmarried no children. Lives with sister in [**Name (NI) 745**]. No smoking. former heavy EtOH, none now.

Other staphylococcal septicemia,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Severe sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hyperglyceridemia,Unspecified essential hypertension,Essential and other specified forms of tremor,Dysthymic disorder,History of fall,Personal history of malignant melanoma of skin,Hypotension, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Alcohol abuse, in remission,Long-term (current) use of insulin,Anticoagulants causing adverse effects in therapeutic use,Other specified antibiotics causing adverse effects in therapeutic use

Staphylcocc septicem NEC,Acute kidney failure NOS,CHF NOS,Severe sepsis,DMII wo cmp nt st uncntr,Pure hyperglyceridemia,Hypertension NOS,Tremor NEC,Dysthymic disorder,Personal history of fall,Hx-malig skin melanoma,Hypotension NOS,Idio periph neurpthy NOS,Alcohol abuse-in remiss,Long-term use of insulin,Adv eff anticoagulants,Adv eff antibiotics NEC

Admission Date: [**2119-5-18**] Discharge Date: [**2119-5-27**] Date of Birth: [**2050-10-17**] Sex: M Service: MEDICINE Allergies: Codeine / Heparin Agents / Vancomycin Attending:[**First Name3 (LF) 905**] Chief Complaint: Tx for hypotension/ sepsis Major Surgical or Invasive Procedure: Transesophageal echocardiogram History of Present Illness: Pt is a 68 yo male with DM, HTN, deep brain stimulator, who is being transferred from the floor from hypotension. Pt says that he has been having fevers off and on for 5 weeks. Max temp reached 104. No weight loss, night sweats with this but pt does endorses rigors/chills. He states that some nights he would have fever and sometimes his temperature would be 98.5 (fevers generally occured at night). Pt did not go to his [**First Name3 (LF) 3390**] until this past Tuesday. Blood cultures were drawn and grew out GPC in clusters and pt was told to come to the ED. In the ED, lactate was 4.7 (attributed to rigors as lactate was lower previously) but patient did not meet strict criteria for sepsis then and was admitted to the floor and started on vancomycin. Past Medical History: 1. DM 2 x 11 years 2. Essential tremor followed by Dr [**Last Name (STitle) **], w/ DBS placed in [**2117**] 3. HTN 4. melanoma of ear 15 years ago 5. h/o falls, admitted in [**2115**] 6. hypertTG leading to pancreatitis in [**2107**] 7. ETOH hepatitis 8. s/p CCY in [**2106**] 9. h/o peripheral neruopathy 10. hx of CHF 11. depression/anxiety Social History: former physics instructor at [**University/College **]. Nonmarried no children. Lives with sister in [**Name (NI) 745**]. No smoking. former heavy EtOH, none now. Family History: Mother died of pancreatitis. Sister died of pancreatic cancer; father died of bone cancer and another sister died of ovarian cancer. Physical Exam: Temp 101.7 BP 114/74 Pulse 106 Resp 20 O2 sat 96% RA Gen - Alert, no acute distress, arousable from sleep HEENT - PERRL, extraocular motions intact, anicteric, mucous membranes dry Neck - no JVD, no cervical lymphadenopathy Lymph: no axiallr LAD Chest - Clear to auscultation bilaterally CV - Normal S1/S2, RRR, 2/6 SEM at LUSB Abd - Soft, nontender, nondistended, with normoactive bowel sounds, RUQ surgical scar Back - No costovertebral angle tendernes Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally Neuro - Alert and oriented x 3, cranial nerves [**2-20**] intact, upper and lower extremity strength 5/5 bilaterally, sensation grossly intact Skin - red papularmacular rash over chest wall and arms, AK's on neck, no osler nodes or [**Last Name (un) **] lesions, no skin breaks Pertinent Results: [**2119-5-18**] 02:35PM BLOOD WBC-6.7 RBC-4.62 Hgb-15.8 Hct-43.8 MCV-95 MCH-34.1* MCHC-36.0* RDW-14.2 Plt Ct-131* [**2119-5-19**] 08:00AM BLOOD WBC-19.8*# RBC-4.29* Hgb-14.7 Hct-41.5 MCV-97 MCH-34.3* MCHC-35.4* RDW-14.2 Plt Ct-145* [**2119-5-19**] 07:43PM BLOOD WBC-19.4* RBC-4.23* Hgb-14.3 Hct-40.2 MCV-95 MCH-33.8* MCHC-35.5* RDW-14.2 Plt Ct-136* [**2119-5-27**] 05:30AM BLOOD WBC-5.6 RBC-3.48* Hgb-11.8* Hct-33.8* MCV-97 MCH-34.0* MCHC-35.0 RDW-14.0 Plt Ct-117* . [**2119-5-18**] 02:35PM BLOOD PT-13.6* PTT-24.1 INR(PT)-1.2* [**2119-5-24**] 05:54AM BLOOD PT-14.5* PTT-37.1* INR(PT)-1.3* . [**2119-5-20**] 04:24AM BLOOD Fibrino-250 D-Dimer-642* [**2119-5-18**] 02:35PM BLOOD ESR-0 [**2119-5-25**] 05:56AM BLOOD ESR-28* . [**2119-5-18**] 02:35PM BLOOD Glucose-148* UreaN-18 Creat-1.0 Na-143 K-3.5 Cl-107 HCO3-27 AnGap-13 [**2119-5-27**] 05:30AM BLOOD Glucose-104 UreaN-12 Creat-1.1 Na-142 K-3.5 Cl-108 HCO3-26 AnGap-12 [**2119-5-18**] 02:35PM BLOOD ALT-54* AST-50* LD(LDH)-204 AlkPhos-65 [**2119-5-21**] 03:14AM BLOOD ALT-54* AST-37 LD(LDH)-212 AlkPhos-42 Amylase-20 TotBili-0.8 [**2119-5-26**] 07:07AM BLOOD ALT-41* AST-56* AlkPhos-48 Amylase-17 TotBili-0.9 [**2119-5-20**] 04:24AM BLOOD Calcium-7.7* Phos-3.0 Mg-1.9 [**2119-5-27**] 05:30AM BLOOD Calcium-8.4 Phos-3.3 Mg-2.2 [**2119-5-19**] 08:00AM BLOOD TSH-2.0 [**2119-5-18**] 02:35PM BLOOD RheuFac-6 CRP-0.8 [**2119-5-25**] 05:56AM BLOOD CRP-61.8* [**2119-5-18**] 02:43PM BLOOD Lactate-1.3 [**2119-5-18**] 09:42PM BLOOD Lactate-4.7* [**2119-5-19**] 11:51AM BLOOD Lactate-2.8* [**2119-5-19**] 09:39PM BLOOD Lactate-1.6 . [**2119-5-25**] 08:04AM BLOOD HIV Ab-NEGATIVE [**2119-5-19**] 07:43PM BLOOD Parst S-NEG [**2119-5-23**] 05:00AM BLOOD Parst S-NEGATIVE . [**2119-5-26**] URINE URINE CULTURE-FINAL INPATIENT [**2119-5-25**] BLOOD CULTURE ISOLATE FOR MIC-FINAL {STAPHYLOCOCCUS, COAGULASE NEGATIVE} INPATIENT - this culture are bacteria sent from the [**Location (un) **] blood culture of [**2119-5-16**]. [**2119-5-25**] BLOOD CULTURE AEROBIC BOTTLE-PENDING; ANAEROBIC BOTTLE-PENDING INPATIENT [**2119-5-25**] Blood (Toxo) TOXOPLASMA IgG ANTIBODY-FINAL; TOXOPLASMA IgM ANTIBODY-FINAL INPATIENT [**2119-5-24**] BLOOD CULTURE AEROBIC BOTTLE-PENDING; ANAEROBIC BOTTLE-PENDING INPATIENT [**2119-5-24**] SEROLOGY/BLOOD LYME SEROLOGY-FINAL INPATIENT [**2119-5-23**] URINE URINE CULTURE-FINAL INPATIENT [**2119-5-23**] BLOOD CULTURE AEROBIC BOTTLE-FINAL; ANAEROBIC BOTTLE-FINAL INPATIENT [**2119-5-21**] BLOOD CULTURE AEROBIC BOTTLE-FINAL; ANAEROBIC BOTTLE-FINAL INPATIENT [**2119-5-20**] BLOOD CULTURE AEROBIC BOTTLE-FINAL; ANAEROBIC BOTTLE-FINAL INPATIENT [**2119-5-20**] URINE URINE CULTURE-FINAL INPATIENT [**2119-5-20**] BLOOD CULTURE AEROBIC BOTTLE-FINAL; ANAEROBIC BOTTLE-FINAL INPATIENT [**2119-5-19**] ABSCESS GRAM STAIN-FINAL; FLUID CULTURE-FINAL {STAPH AUREUS COAG +, STAPHYLOCOCCUS, COAGULASE NEGATIVE}; ANAEROBIC CULTURE-FINAL; FUNGAL CULTURE-PRELIMINARY INPATIENT [**2119-5-19**] BLOOD CULTURE AEROBIC BOTTLE-FINAL; ANAEROBIC BOTTLE-FINAL INPATIENT [**2119-5-19**] BLOOD CULTURE AEROBIC BOTTLE-FINAL; ANAEROBIC BOTTLE-FINAL INPATIENT [**2119-5-19**] BLOOD CULTURE AEROBIC BOTTLE-FINAL; ANAEROBIC BOTTLE-FINAL INPATIENT [**2119-5-18**] BLOOD CULTURE ANAEROBIC BOTTLE-FINAL; BRUCELLA BLOOD CULTURE-PRELIMINARY INPATIENT [**2119-5-18**] URINE URINE CULTURE-FINAL EMERGENCY [**Hospital1 **] [**2119-5-18**] BLOOD CULTURE ANAEROBIC BOTTLE-FINAL; BRUCELLA BLOOD CULTURE-PRELIMINARY EMERGENCY [**Hospital1 **] [**2119-5-18**] BLOOD CULTURE ANAEROBIC BOTTLE-FINAL; BRUCELLA BLOOD CULTURE-PENDING EMERGENCY [**Hospital1 **] . [**2119-5-18**] CXR - IMPRESSION: No acute cardiopulmonary process. . [**2119-5-19**] chest ultrasound - ordered to examine deep brain stimulator for infection. IMPRESSION: No soft tissue fluid collection. . [**2119-5-21**] CXR - IMPRESSION: No acute pulmonary process. . [**2119-5-22**] - CT-torso with contrast. IMPRESSION: 1. Enlarged caudate and left lobes of liver with secondary signs of portal hypertension, including perigastric and periesophageal varices suggesting cirrhosis. Splenomegaly has also progressed since [**2115**]. Small amount of perihepatic ascites. 2. Diverticulosis without evidence of diverticulitis. 3. Mediastinal lymph nodes measuring up to 13mm in short-axis diameter, not significantly changed. . [**2119-5-22**] - Transesophageal Echocardiogram. IMPRESSION: Mildly thickened mitral and aortic valves with no vegetations or abscess seen. Mild mitral regurgitation. . [**2119-5-25**] - Tagged white blood cell nuclear scan. IMPRESSION: No source of fever or bacteremia is identified. Brief Hospital Course: This is a 68 year old male with DM, HTN, a deep brain stimulator, who presented with 5 weeks of fever, and 2 of 4 positive blood cultures at [**Location (un) 620**] for Staph. lugdunensis on [**2119-5-16**]. 1. Fever - The patient was febrile on admission and on [**2119-5-19**] began to have difficulty with hypotension. Despite nearly 1.5 liters in bolus normal saline his systolic blood pressure was persistently in the low 70s in the setting of recieving his anti-hypertensive medication (lasix, verapamil, lisinopril). He was asymptomatic and his heart rate remaind within normal limits. He was transferred to the intensive care unit where he recieved another 3.5 liters of normal saline and was on a peripheral dopamine drip for 24 hours. A central venous catheter was not placed. The patient was transferred back to the floor on [**10-21**]. His pressure remained stable for the rest of his stay, but he was presistently febrile. A vigorous attempt was made to identify the source of the fever. Blood cultures, urinalysis, urine cultures, two parasite smears, Chest x-rays, CT-torso, trans thoracic and esophageal echocardiograms, chest ultrasound of his deep brain stimulator, panorex and tagged white blood cell scan were all negative. Blood tests for HIV, brucella and lyme were negative. Blood tests for ehlichia, bartonella and babesia were pending at the time of discharge. The patient was covered on a variety of antibiotics during his stay including vancomycin, doxycycline, ceftriaxone, and nafcillin. Concern arose that the patient's fever was intially caused by an infectious [**Doctor Last Name 360**] (possibly staph. lugdenensis), which had been treated, but then continued due to drug fever. At the time that this hypothesis arose the patient was on doxycycline and vancomycin. The vancomycin was exchanged for nafcillin and the patient defervesced. A PICC line was placed and the patient was sent home on a course of PO and IV antibiotics (see discharge plan). . 2. Acute renal failure - This was attributed to the patient's episode of hypotension that was likley related to his Staph. lugdenensis bacteremia. The renal failure resolved with volume resucitation and treatment of the bacteremia. Mucomyst was given for nephroprotection before and after the CT-torso. . 3. Diabetes - We held the patient's sulfonylurea and biguanide in setting of IV contrast. We covered the patient with lantus and a tight humalog insulin sliding scale. . 4. Hypertriglyceridemia - we held the patient's tricor, as he had reported that he recently started this medication and though this is not classically associated with fever, we held the medication based on the following monograph: Diabetes Metab. [**2113**] [**Month (only) **];27(1):66-8. Rare side-effects of fenofibrate. Rabasa-Lhoret R, Rasamisoa M, Avignon A, [**Last Name (un) 3391**] L. See copy of abstract in the chart. . 5. Other Medical Issues - managaed with outpatient regimen. Medications on Admission: lantus 80 u qhs amaryl 4 mg tricor 48 mg daily lisinopril 40 mg daily ASA lasix 40 mg daily b12 q mth novolog scale paxil 20 mg daily glyburide 5 mg [**Hospital1 **] verapamil 180 mg daily KCL Discharge Medications: 1. Nafcillin in D2.4W 2 g/100 mL Piggyback Sig: Two (2) g Intravenous Q6H (every 6 hours) for 5 days. Disp:*40 g* Refills:*0* 2. Insulin Glargine 100 unit/mL Solution Sig: Eighty (80) units Subcutaneous at bedtime. 3. Amaryl 4 mg Tablet Sig: One (1) Tablet PO once a day. 4. PICC Care by VNA PICC line care per NEHT protocol. Please don't use heparin. 5. Discussion Please discuss your discontinuing tricor with your primary care physician. [**Name10 (NameIs) 357**] inform him that we discontinued this medication because of your fever. 6. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 7. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. 8. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. 9. Cyanocobalamin Oral 10. Novolog 100 unit/mL Solution Sig: per sliding scale. units Subcutaneous once a day. 11. Doxycycline Hyclate 100 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours) for 3 days. Disp:*6 Capsule(s)* Refills:*0* 12. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. Glyburide 5 mg Tablet Sig: One (1) Tablet PO twice a day. 14. Verapamil 180 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day. 15. Potassium Chloride 8 mEq Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO once a day: Please take potassium as you were prior to admission. Discharge Disposition: Home With Service Facility: [**Location (un) 511**] Home Therpies Discharge Diagnosis: Fever Sepsis secondary to Staph Lugdunensis Drug induced fever - Vancomycin ? Heparin induced thrombocytopenia Discharge Condition: Vital signs stable. Fever resolved for greater than 24 hours. Ambulating. Tollerating POs. Toileting independently. Still requiring IV antibiotics. Discharge Instructions: Please take your medications as prescribed. Please follow up with your primary care doctor within 1 to 2 weeks of discharge. For now, you should avoid heparin products until you talk to your [**Location (un) 3390**]. [**Name10 (NameIs) **] will be doing further studies in collaboration with our blood bank to verify this dx. Followup Instructions: Provider: [**Name Initial (NameIs) 1220**]. [**Last Name (STitle) 1941**] AND [**Name5 (PTitle) 3392**] Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2119-10-2**] 11:00 Provider: [**Name Initial (NameIs) 3390**]: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 3393**] Date/Time: [**2119-6-1**] 1:00pm Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) 3394**] [**2119-6-6**] 8:30 am Phone [**Telephone/Fax (1) 3395**] [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**] Completed by:[**2119-5-29**] Name: [**Known lastname 388**],[**Known firstname 389**] Unit No: [**Numeric Identifier 390**] Admission Date: [**2119-5-18**] Discharge Date: [**2119-5-27**] Date of Birth: [**2050-10-17**] Sex: M Service: MEDICINE Allergies: Codeine / Heparin Agents / Vancomycin Attending:[**First Name3 (LF) 391**] Addendum: The patient was noted to have thrombocytopenia. Test for heparin induced antibodies were sent. This came back positive. Heme/onc was informally consulted and felt that the probability of a true positive result was unlikely given the less than 50% drop in the PLT and partial recovery prior to discharge, no thrombosis, and infection as possible etiology for the patient's platelet drop. Nevertheless, a plan was put into place to consult with the pathology lab regarding this test and to follow up with the PCP if they felt that this was a true positive. Discharge Disposition: Home With Service Facility: [**Location (un) **] Home Therpies [**Name6 (MD) 116**] [**Name8 (MD) 117**] MD [**MD Number(1) 392**] Completed by:[**2119-5-29**]

038,584,428,995,250,272,401,333,300,V158,V108,458,356,305,V586,E934,E930

{'Other staphylococcal septicemia,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Severe sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hyperglyceridemia,Unspecified essential hypertension,Essential and other specified forms of tremor,Dysthymic disorder,History of fall,Personal history of malignant melanoma of skin,Hypotension, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Alcohol abuse, in remission,Long-term (current) use of insulin,Anticoagulants causing adverse effects in therapeutic use,Other specified antibiotics 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: Tx for hypotension/ sepsis PRESENT ILLNESS: Pt is a 68 yo male with DM, HTN, deep brain stimulator, who is being transferred from the floor from hypotension. Pt says that he has been having fevers off and on for 5 weeks. Max temp reached 104. No weight loss, night sweats with this but pt does endorses rigors/chills. He states that some nights he would have fever and sometimes his temperature would be 98.5 (fevers generally occured at night). Pt did not go to his [**First Name3 (LF) 3390**] until this past Tuesday. Blood cultures were drawn and grew out GPC in clusters and pt was told to come to the ED. In the ED, lactate was 4.7 (attributed to rigors as lactate was lower previously) but patient did not meet strict criteria for sepsis then and was admitted to the floor and started on vancomycin. MEDICAL HISTORY: 1. DM 2 x 11 years 2. Essential tremor followed by Dr [**Last Name (STitle) **], w/ DBS placed in [**2117**] MEDICATION ON ADMISSION: lantus 80 u qhs amaryl 4 mg tricor 48 mg daily lisinopril 40 mg daily ASA lasix 40 mg daily b12 q mth novolog scale paxil 20 mg daily glyburide 5 mg [**Hospital1 **] verapamil 180 mg daily KCL ALLERGIES: Codeine / Heparin Agents / Vancomycin PHYSICAL EXAM: Temp 101.7 BP 114/74 Pulse 106 Resp 20 O2 sat 96% RA Gen - Alert, no acute distress, arousable from sleep HEENT - PERRL, extraocular motions intact, anicteric, mucous membranes dry Neck - no JVD, no cervical lymphadenopathy Lymph: no axiallr LAD Chest - Clear to auscultation bilaterally CV - Normal S1/S2, RRR, 2/6 SEM at LUSB Abd - Soft, nontender, nondistended, with normoactive bowel sounds, RUQ surgical scar Back - No costovertebral angle tendernes Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally FAMILY HISTORY: Mother died of pancreatitis. Sister died of pancreatic cancer; father died of bone cancer and another sister died of ovarian cancer. SOCIAL HISTORY: former physics instructor at [**University/College **]. Nonmarried no children. Lives with sister in [**Name (NI) 745**]. No smoking. former heavy EtOH, none now. ### Response: {'Other staphylococcal septicemia,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Severe sepsis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hyperglyceridemia,Unspecified essential hypertension,Essential and other specified forms of tremor,Dysthymic disorder,History of fall,Personal history of malignant melanoma of skin,Hypotension, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Alcohol abuse, in remission,Long-term (current) use of insulin,Anticoagulants causing adverse effects in therapeutic use,Other specified antibiotics causing adverse effects in therapeutic use'}

CHIEF COMPLAINT: L hip fracture PRESENT ILLNESS: 68 year old femal with hx of Afib presents to ED after falling in front of her house while walking with her mother. On presentation to ED was found to be in A-fib with ventricular rate of 120-[**Street Address(2) 19795**] depressions in the inferior and lateral leads. At no time did the pt experience CP, SOB, N/V/diaphoresis. Pt is active at baseline, denies orthopnea, and climbs multiple flights of stairs without SOB. Hip pain currently well controlled. MEDICAL HISTORY: Afib Hyperlipidemia Osteoporosis Depression Benign spindle cell CA of stomach s/p resection in [**2185**] S/p resection of benign posterior fossa tumor Lifelong hx of hemoptysis [**12-21**] bronchiectasis from childhood infection MEDICATION ON ADMISSION: 1. Atenolol 25 mg Tablet Sig: One (1) Tablet PO QD (once a day). ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GEN: NAD HEENT: perrl, eomi, MMM PULM: cta b/l CVS: RRR no m/g/r ABD: soft, NT, ND EXT: LLE shortened, externally rotated. No c/c/e NEURO: CN 2-12 intact. AAOx3 FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Pt lives at home, takes care of elderly mother. Denies EtOH, tobacco, drugs. Daughter is [**Name2 (NI) 595**] interpreter here at [**Hospital1 18**].

Closed fracture of unspecified part of neck of femur,Atrial fibrillation,Fall from other slipping, tripping, or stumbling,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Depressive disorder, not elsewhere classified

Fx neck of femur NOS-cl,Atrial fibrillation,Fall from slipping NEC,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Depressive disorder NEC

Admission Date: [**2190-8-25**] Discharge Date: [**2190-9-1**] Date of Birth: [**2121-4-29**] Sex: F Service: MED Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2181**] Chief Complaint: L hip fracture Major Surgical or Invasive Procedure: Left Hip ORIF History of Present Illness: 68 year old femal with hx of Afib presents to ED after falling in front of her house while walking with her mother. On presentation to ED was found to be in A-fib with ventricular rate of 120-[**Street Address(2) 19795**] depressions in the inferior and lateral leads. At no time did the pt experience CP, SOB, N/V/diaphoresis. Pt is active at baseline, denies orthopnea, and climbs multiple flights of stairs without SOB. Hip pain currently well controlled. In the [**Name (NI) **], pt was given IV Lopressor 5mg x3 with minimal effect. Pt was then given IV Diltiazem 15mg, then 25mg followed by PO Atenolol 25mg x1. Pt currently in NSR at 60. Past Medical History: Afib Hyperlipidemia Osteoporosis Depression Benign spindle cell CA of stomach s/p resection in [**2185**] S/p resection of benign posterior fossa tumor Lifelong hx of hemoptysis [**12-21**] bronchiectasis from childhood infection Social History: Pt lives at home, takes care of elderly mother. Denies EtOH, tobacco, drugs. Daughter is [**Name2 (NI) 595**] interpreter here at [**Hospital1 18**]. Family History: Noncontributory Physical Exam: GEN: NAD HEENT: perrl, eomi, MMM PULM: cta b/l CVS: RRR no m/g/r ABD: soft, NT, ND EXT: LLE shortened, externally rotated. No c/c/e NEURO: CN 2-12 intact. AAOx3 Pertinent Results: [**2190-8-25**] 03:15PM PT-21.1* PTT-29.2 INR(PT)-2.8 [**2190-8-25**] 04:57AM GLUCOSE-162* UREA N-14 CREAT-0.7 SODIUM-137 POTASSIUM-3.9 CHLORIDE-100 TOTAL CO2-28 ANION GAP-13 [**2190-8-25**] 04:57AM CK(CPK)-140 [**2190-8-25**] 04:57AM CK-MB-3 cTropnT-<0.01 [**2190-8-25**] 04:57AM WBC-8.4 RBC-4.00* HGB-12.4 HCT-36.2 MCV-91 MCH-31.1 MCHC-34.3 RDW-12.6 [**2190-8-25**] 04:57AM PLT COUNT-253 [**2190-8-25**] 04:57AM PT-18.4* PTT-26.9 INR(PT)-2.1 [**2190-8-24**] 08:50PM GLUCOSE-143* UREA N-19 CREAT-0.7 SODIUM-137 POTASSIUM-3.5 CHLORIDE-99 TOTAL CO2-25 ANION GAP-17 [**2190-8-24**] 08:50PM CK(CPK)-138 [**2190-8-24**] 08:50PM CK-MB-2 cTropnT-<0.01 [**2190-8-24**] 08:50PM WBC-10.3# RBC-4.07* HGB-12.6 HCT-35.8* MCV-88 MCH-31.0 MCHC-35.2* RDW-12.4 [**2190-8-24**] 08:50PM NEUTS-85.0* BANDS-0 LYMPHS-11.7* MONOS-2.8 EOS-0.4 BASOS-0.2 [**2190-8-24**] 08:50PM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL [**2190-8-24**] 08:50PM PLT COUNT-236 [**2190-8-24**] 08:50PM PT-17.4* PTT-24.9 INR(PT)-1.9 Brief Hospital Course: Pt admitted on [**8-25**] after fall and found to have L femoral neck fx. Pt went into Rapid Afib in the ED, which responded to IV diltiazem. Pt was then admitted to the floor pending ORIF. Pt was found to have a supertherapeutic INR of 2.6 on admission, and was given 3 units FFP prior to surgery on [**8-26**]. Pt had uncomplicated ORIF late in the evening to [**8-26**] to the [**Doctor Last Name **] hours of [**8-27**]. Pt required 1 unit PRBC intraoperatively. Post operatively, pt was noted to be hypoxic, with ABG showing 7.35/52/57 with new onset bilateral opacities noted on CXR. Pt was given Lasix, reintubated, and transferred to the MICU. In the MICU, pt was started on Lovenox and given 4 doses Ancef. Her respiratory status quickly improved and she was extubated on the evening of [**8-27**]. However, while in the unit she once again developed rapid Afib that responded to a Diltiazem drip. Pt was transferred to the floor in the evening of [**8-28**], where the Diltiazem drip was changed to a loading dose of Amiodarone 400mg tid. Pt hct was noted to be low (23.3) during the night of [**10-25**] and two units PRBCs were transfused without incident. Pt was cleared for rehab from ortho standpoint on [**8-30**]. Hct dropped slightly on [**8-31**] and Lovenox dose was decreased. Throught the evening of [**8-31**] onto [**9-1**] Hct was observed to be stable and pt was discharged to [**Hospital 100**] Rehab with plans for close followup and continuing physical therapy, as well as plans to switch Lovenox back to coumadin while at rehab. Medications on Admission: 1. Atenolol 25 mg Tablet Sig: One (1) Tablet PO QD (once a day). 2. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 3. Citalopram Hydrobromide 20 mg Tablet Sig: 0.5 Tablet PO QD (once a day). 4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO QD (once a day). 6. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. Coumadin 5mg qTuesday, 2.5mg all other days once per day Discharge Medications: 1. Atenolol 25 mg Tablet Sig: One (1) Tablet PO QD (once a day). 2. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 3. Citalopram Hydrobromide 20 mg Tablet Sig: 0.5 Tablet PO QD (once a day). 4. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO QD (once a day). 6. Oxycodone HCl 5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain uncontrolled by acetaminophen. 7. Amiodarone HCl 400 mg Tablet Sig: One (1) Tablet PO three times a day for 4 days. Tablet(s) 8. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 9. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. 10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 12. Enoxaparin Sodium 40 mg/0.4mL Syringe Sig: Forty (40) mg Subcutaneous QAM (once a day (in the morning)). Discharge Disposition: Extended Care Facility: [**Hospital6 459**] for the Aged - [**Location (un) 550**] Discharge Diagnosis: L Hip facture Afib Osteoporosis Depression Discharge Condition: Good Discharge Instructions: Take all medications as directed, follow physical therapy recommendations closely. Followup Instructions: Please follow up with your primary care doctor within one week. Follow up with Dr. [**First Name (STitle) **] from orthopedics within 10 days at [**Telephone/Fax (1) 1113**].

820,427,E885,272,733,311

{'Closed fracture of unspecified part of neck of femur,Atrial fibrillation,Fall from other slipping, tripping, or stumbling,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,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: L hip fracture PRESENT ILLNESS: 68 year old femal with hx of Afib presents to ED after falling in front of her house while walking with her mother. On presentation to ED was found to be in A-fib with ventricular rate of 120-[**Street Address(2) 19795**] depressions in the inferior and lateral leads. At no time did the pt experience CP, SOB, N/V/diaphoresis. Pt is active at baseline, denies orthopnea, and climbs multiple flights of stairs without SOB. Hip pain currently well controlled. MEDICAL HISTORY: Afib Hyperlipidemia Osteoporosis Depression Benign spindle cell CA of stomach s/p resection in [**2185**] S/p resection of benign posterior fossa tumor Lifelong hx of hemoptysis [**12-21**] bronchiectasis from childhood infection MEDICATION ON ADMISSION: 1. Atenolol 25 mg Tablet Sig: One (1) Tablet PO QD (once a day). ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: GEN: NAD HEENT: perrl, eomi, MMM PULM: cta b/l CVS: RRR no m/g/r ABD: soft, NT, ND EXT: LLE shortened, externally rotated. No c/c/e NEURO: CN 2-12 intact. AAOx3 FAMILY HISTORY: Noncontributory SOCIAL HISTORY: Pt lives at home, takes care of elderly mother. Denies EtOH, tobacco, drugs. Daughter is [**Name2 (NI) 595**] interpreter here at [**Hospital1 18**]. ### Response: {'Closed fracture of unspecified part of neck of femur,Atrial fibrillation,Fall from other slipping, tripping, or stumbling,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Depressive disorder, not elsewhere classified'}

CHIEF COMPLAINT: nausea PRESENT ILLNESS: Mr. [**Known lastname 60118**] is a 48 year old man with a history of pancreatitis, alcohol abuse, and type II diabetes. He drinks about 1 pint of brandy every other day (although sometimes everyday). He reports his family wants him to stop drinking alcohol. He initially stopped two days prior to presentation. Yesterday afternoon around four PM he developed nausea and emesis (non-bloody). He states that he thought it was related to not drinking. He then tried to drink some alcohol, but was unable to do so. He denied any pain, but reports that he felt slightly unstable on his feet. He reports not sleeping very well throughout the night. This morning he was able to drink some soda and V8. However, he continued to feel very bad and his wife brought him to the [**Name (NI) **]. He reports his main symptoms are feeling his heart go fast, "high blood bressure," and "high cholesterol." He did not take his heart rate or blood pressure. He generally has poor glucose control. He takes glargine 16 units [**Name (NI) **] along with 10 units of humalog with meals. His blood glucose generally ranges in the 150's-300's. His glucose the day prior to presentation was 324-194-284. Initial vitals in the ED were: 98.2 135 153/87 18 99%. In the ED he received two liters of normal saline. His initial labs were significant for a glucose of 360, creatinine of 2.2, and anion gap of 40. He was started on an insulin gtt and his glucose prior to leaving the ED was 203. He was switched over to D5NS with 40 mEq of KCl. Vitals on transfer were: 20 g 110 155/85 20 100% RA. On arrival to the MICU, he appeared comfortable. He had a slight headache (denied any trauma). He denied any other pain, shortness of breath, cough, dysuria, back pain, fever, chills, night sweats, recent weight loss or gain. Denies sinus tenderness, rhinorrhea, jaw pain, or congestion. Denies chest pain, chest pressure, palpitations. Denies constipation, abdominal pain. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. He also denies any over the counter medications or ingestions such as methanol, ethylene glycol, etc. MEDICAL HISTORY: Anxiety DM II on insulin Alcohol abuse Hypertension Hyperlipidemia Acute-on-Chronic pancreatitis MEDICATION ON ADMISSION: CITALOPRAM - 20 mg Tablet FOLIC ACID - 1 mg GABAPENTIN - 100 mg Capsule 3 Capsule(s) by mouth three times per day INSULIN GLARGINE 16 units [**Last Name (un) **] INSULIN LISPRO [HUMALOG] - (Prescribed by Other Provider) - 100 unit/mL Solution - per sliding scale protocol per sliding scale protocol LISINOPRIL - 20 mg Tablet SIMVASTATIN - 40 mg Tablet ASPIRIN - 325 mg Tablet MULTIVITAMIN WITH MINERALS THIAMINE HCL - 100 mg Tablet ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: Vitals: T: BP: P: R: 18 O2: General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley [**Month/Day (3) **]: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . DISCHARGE EXAM: VS: 98.2 106/70-144/93 80-101 18 100% RA GENERAL - well-appearing man in NAD, comfortable, appropriate HEENT - sclerae anicteric, MMM, OP clear NECK - supple, no JVD, no cervical lymphadenopathy LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - RRR, no MRG, nl S1-S2 ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) FAMILY HISTORY: Reports hypertension and anxiety in multiple family members. SOCIAL HISTORY: He lives at home with his wife, daughter, and three grand children. Reports cigarette use 15 years ago (about [**2-17**] cigarettes per day). Denies drug use. Drinks 1 pint of brandy every 1-2 days.

Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Alcohol withdrawal,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension,Dysphagia, unspecified,Other and unspecified hyperlipidemia,Mononeuritis of unspecified site,Anxiety state, unspecified,Long-term (current) use of insulin,Personal history of tobacco use

DMII ketoacd uncontrold,Acute kidney failure NOS,Alcohol withdrawal,Alcoh dep NEC/NOS-contin,Hypertension NOS,Dysphagia NOS,Hyperlipidemia NEC/NOS,Mononeuritis NOS,Anxiety state NOS,Long-term use of insulin,History of tobacco use

Admission Date: [**2175-6-24**] Discharge Date: [**2175-6-27**] Date of Birth: [**2127-2-19**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**Doctor First Name 2080**] Chief Complaint: nausea Major Surgical or Invasive Procedure: None History of Present Illness: Mr. [**Known lastname 60118**] is a 48 year old man with a history of pancreatitis, alcohol abuse, and type II diabetes. He drinks about 1 pint of brandy every other day (although sometimes everyday). He reports his family wants him to stop drinking alcohol. He initially stopped two days prior to presentation. Yesterday afternoon around four PM he developed nausea and emesis (non-bloody). He states that he thought it was related to not drinking. He then tried to drink some alcohol, but was unable to do so. He denied any pain, but reports that he felt slightly unstable on his feet. He reports not sleeping very well throughout the night. This morning he was able to drink some soda and V8. However, he continued to feel very bad and his wife brought him to the [**Name (NI) **]. He reports his main symptoms are feeling his heart go fast, "high blood bressure," and "high cholesterol." He did not take his heart rate or blood pressure. He generally has poor glucose control. He takes glargine 16 units [**Name (NI) **] along with 10 units of humalog with meals. His blood glucose generally ranges in the 150's-300's. His glucose the day prior to presentation was 324-194-284. Initial vitals in the ED were: 98.2 135 153/87 18 99%. In the ED he received two liters of normal saline. His initial labs were significant for a glucose of 360, creatinine of 2.2, and anion gap of 40. He was started on an insulin gtt and his glucose prior to leaving the ED was 203. He was switched over to D5NS with 40 mEq of KCl. Vitals on transfer were: 20 g 110 155/85 20 100% RA. On arrival to the MICU, he appeared comfortable. He had a slight headache (denied any trauma). He denied any other pain, shortness of breath, cough, dysuria, back pain, fever, chills, night sweats, recent weight loss or gain. Denies sinus tenderness, rhinorrhea, jaw pain, or congestion. Denies chest pain, chest pressure, palpitations. Denies constipation, abdominal pain. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. He also denies any over the counter medications or ingestions such as methanol, ethylene glycol, etc. Past Medical History: Anxiety DM II on insulin Alcohol abuse Hypertension Hyperlipidemia Acute-on-Chronic pancreatitis Social History: He lives at home with his wife, daughter, and three grand children. Reports cigarette use 15 years ago (about [**2-17**] cigarettes per day). Denies drug use. Drinks 1 pint of brandy every 1-2 days. Family History: Reports hypertension and anxiety in multiple family members. Physical Exam: ADMISSION EXAM: Vitals: T: BP: P: R: 18 O2: General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley [**Month/Day (3) **]: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . DISCHARGE EXAM: VS: 98.2 106/70-144/93 80-101 18 100% RA GENERAL - well-appearing man in NAD, comfortable, appropriate HEENT - sclerae anicteric, MMM, OP clear NECK - supple, no JVD, no cervical lymphadenopathy LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - RRR, no MRG, nl S1-S2 ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) NEURO - awake, A&Ox3 Pertinent Results: admission labs [**2175-6-24**] 12:25PM BLOOD WBC-13.5*# RBC-4.68 Hgb-13.4* Hct-41.9 MCV-90 MCH-28.7 MCHC-32.1 RDW-13.2 Plt Ct-231 [**2175-6-24**] 12:25PM BLOOD Neuts-89.1* Lymphs-6.1* Monos-4.2 Eos-0.5 Baso-0.2 [**2175-6-25**] 01:48AM BLOOD PT-11.2 PTT-27.4 INR(PT)-1.0 [**2175-6-24**] 12:25PM BLOOD Glucose-360* UreaN-32* Creat-2.2*# Na-131* K-4.2 Cl-81* HCO3-10* AnGap-44* [**2175-6-24**] 12:25PM BLOOD ALT-89* AST-145* AlkPhos-99 TotBili-0.6 [**2175-6-24**] 12:25PM BLOOD Lipase-15 [**2175-6-24**] 12:25PM BLOOD CK-MB-4 [**2175-6-24**] 12:25PM BLOOD cTropnT-<0.01 [**2175-6-25**] 11:45AM BLOOD CK-MB-3 cTropnT-<0.01 [**2175-6-24**] 12:25PM BLOOD Albumin-5.4* Calcium-10.5* Phos-2.3* Mg-2.6 [**2175-6-24**] 12:25PM BLOOD ASA-4.0 Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2175-6-24**] 06:49PM BLOOD Type-ART pO2-108* pCO2-31* pH-7.39 calTCO2-19* Base XS--4 [**2175-6-24**] 06:49PM BLOOD Glucose-127* Lactate-1.0 Na-137 K-4.2 Cl-103 . discharge labs [**2175-6-27**] 06:00AM BLOOD WBC-4.3 RBC-3.86* Hgb-10.7* Hct-33.6* MCV-87 MCH-27.7 MCHC-31.8 RDW-12.8 Plt Ct-176 [**2175-6-27**] 06:00AM BLOOD Glucose-289* UreaN-4* Creat-0.9 Na-134 K-3.3 Cl-99 HCO3-27 AnGap-11 [**2175-6-27**] 06:00AM BLOOD Calcium-9.1 Phos-2.3* Mg-1.4* . urine [**2175-6-25**] 12:58PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.010 [**2175-6-25**] 12:58PM URINE Blood-SM Nitrite-NEG Protein-NEG Glucose-1000 Ketone-40 Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-SM [**2175-6-25**] 12:58PM URINE RBC-5* WBC-1 Bacteri-NONE Yeast-NONE Epi-<1 TransE-<1 . micro URINE CULTURE (Final [**2175-6-27**]): MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT WITH SKIN AND/OR GENITAL CONTAMINATION. . blood culture pending at time of discharge . studies CXR: No acute cardiopulmonary process. . Brief Hospital Course: Mr. [**Known lastname 60118**] is a 48 year old man with a history of alcohol abuse presenting with with anion gap metabolic acidosis now improved . # Anion gap metabolic acidosis: Likely multifactorial and related to DKA vs starvation vs ETOH. Gap closed with IV fluids and improved blood glucose control. Workup for inciting events including ischemia and infection were negative (final blood cultures pending at time of discharge). [**Last Name (un) **] was consulted and adjusted his insulin regimen. His blood sugars improved to low 200s. He was discharged with plans to take 24 units of lantus every evening and sliding scale humalog QACHS. He is [**Last Name (un) 1988**] for PCP and [**Name9 (PRE) **] follow up. . # Alcohol Dependence with Withdrawal: Given significant abuse history, he was at high risk for withdrawal. Patient was placed on valium CIWA scale and required only 1 dose while in the ICU but did not require any further benzodiazepines while on the floor. Patient reported motivation to stop drinking. He met with the social worker who provided him with resources to help him stop drinking. He was continued on multivitamin, thiamine, and folate. . # Acute Kidney Injury: Creatinine up to 2.2 on admission likely prerenal in etiology. Creatinine improved with intravenous fluids. . # Hypertension: Initially held lisinopril in the setting of [**Last Name (un) **]. This was restarted when creatinine improved to baseline. . # Elevated LFT's: likely in the setting of ETOH use as AST/ALT 2:1 ratio. LFTs should be rechecked at outpatient follow up. . # difficulty with swallowing: On day of transfer from the MICU to the floor, the patient reported some discomfort with swallowing. This was thought to be due to irritation from frequent vomiting the day prior to presentation. He was started on a PPI and underwent a speech and swallow evaluation which was unrevealing. Symptoms improved and patient was able to tolerate full diet without difficulty prior to discharge. . # Hx of Pancreatitis: Lipase within normal limits. Denied pain consistent with his prior episodes. . # depression - continued citalopram, gabapentin. Gabapentin was renally dosed. . # HLD - held simvastatin in the setting of elevated LFTs. Patient will need to have his LFTs checked at follow up with his PCP and discuss whether it is safe to restart this medication. . transitional issues: -statin held at discharge for elevated LFTs. patient will need to have LFTs checked at follow up. -patient provided with information regarding the Choices group for his alcohol abuse -patient will need to monitor and record blood sugars after discharge, and insulin regimen may need further alteration Medications on Admission: CITALOPRAM - 20 mg Tablet FOLIC ACID - 1 mg GABAPENTIN - 100 mg Capsule 3 Capsule(s) by mouth three times per day INSULIN GLARGINE 16 units [**Last Name (un) **] INSULIN LISPRO [HUMALOG] - (Prescribed by Other Provider) - 100 unit/mL Solution - per sliding scale protocol per sliding scale protocol LISINOPRIL - 20 mg Tablet SIMVASTATIN - 40 mg Tablet ASPIRIN - 325 mg Tablet MULTIVITAMIN WITH MINERALS THIAMINE HCL - 100 mg Tablet Discharge Medications: 1. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. gabapentin 300 mg Capsule Sig: One (1) Capsule PO every twelve (12) hours. 4. Lantus 100 unit/mL Solution Sig: Twenty Four (24) units Subcutaneous at bedtime. 5. Humalog 100 unit/mL Solution Sig: as directed by sliding scale units Subcutaneous four times a day: please take as directed by sliding scale . 6. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 8. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. omeprazole 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* 1. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. gabapentin 300 mg Capsule Sig: One (1) Capsule PO every twelve (12) hours. 4. Lantus 100 unit/mL Solution Sig: Twenty Four (24) units Subcutaneous at bedtime. 5. Humalog 100 unit/mL Solution Sig: as directed by sliding scale units Subcutaneous four times a day: please take as directed by sliding scale . 6. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 8. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. omeprazole 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* Discharge Disposition: Home Discharge Diagnosis: primary diagnosis: diabetic ketoacidosis, acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Dear Mr. [**Known lastname 60118**], It was a pleasure caring for you while you were admitted to the hospital. You were admitted because you were having nausea and vomiting and were unable to tolerate oral intake. You were found to have high sugars and concern for diabetic ketoacidosis. You were given intravenous fluids and insulin to improve your blood sugars. You were evaluated by the [**Last Name (un) 387**] team who helped modify your insulin regimen. . The following changes were made to your medication regimen. Please START taking - omeprazole 20 mg daily . Please CHANGE - lantus to 24 units at bedtime (on evening of [**6-27**] take 4 units of lantus, start 24 units at bedtime on [**6-28**]) - humalog before meals and bedtime according to sliding scale - gabapentin from 300 mg three times daily to twice daily - aspirin from 325 to 81 mg daily . Please STOP taking your simvastatin as your liver function is abnormal. This is likely related to your alcohol use. You should stop drinking alcohol. Please have your liver function checked at follow up and discuss if it is safe to restart this medication. . Please take the rest of your medications as prescribed and follow up with your doctors [**First Name (Titles) 3**] [**Last Name (Titles) 1988**]. Followup Instructions: Name:[**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3640**], NP Location: [**Hospital **] CLINIC Address: ONE [**Last Name (un) **] PLACE, SECOND FL, [**Location (un) **],[**Numeric Identifier 718**] Phone: [**Telephone/Fax (1) 60119**] When:Thursday, [**6-29**] at 8:30am Department: [**Hospital3 249**] When: THURSDAY [**2175-7-3**] at 1:00 PM With: [**Company 191**] POST [**Hospital 894**] CLINIC with Dr [**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 1520**] Phone:[**Telephone/Fax (1) 2010**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage This appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. [**Name10 (NameIs) 616**] this visit, you will see your regular primary care doctor in follow up. Completed by:[**2175-6-27**]

250,584,291,303,401,787,272,355,300,V586,V158

{'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Alcohol withdrawal,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension,Dysphagia, unspecified,Other and unspecified hyperlipidemia,Mononeuritis of unspecified site,Anxiety state, unspecified,Long-term (current) use of insulin,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: Mr. [**Known lastname 60118**] is a 48 year old man with a history of pancreatitis, alcohol abuse, and type II diabetes. He drinks about 1 pint of brandy every other day (although sometimes everyday). He reports his family wants him to stop drinking alcohol. He initially stopped two days prior to presentation. Yesterday afternoon around four PM he developed nausea and emesis (non-bloody). He states that he thought it was related to not drinking. He then tried to drink some alcohol, but was unable to do so. He denied any pain, but reports that he felt slightly unstable on his feet. He reports not sleeping very well throughout the night. This morning he was able to drink some soda and V8. However, he continued to feel very bad and his wife brought him to the [**Name (NI) **]. He reports his main symptoms are feeling his heart go fast, "high blood bressure," and "high cholesterol." He did not take his heart rate or blood pressure. He generally has poor glucose control. He takes glargine 16 units [**Name (NI) **] along with 10 units of humalog with meals. His blood glucose generally ranges in the 150's-300's. His glucose the day prior to presentation was 324-194-284. Initial vitals in the ED were: 98.2 135 153/87 18 99%. In the ED he received two liters of normal saline. His initial labs were significant for a glucose of 360, creatinine of 2.2, and anion gap of 40. He was started on an insulin gtt and his glucose prior to leaving the ED was 203. He was switched over to D5NS with 40 mEq of KCl. Vitals on transfer were: 20 g 110 155/85 20 100% RA. On arrival to the MICU, he appeared comfortable. He had a slight headache (denied any trauma). He denied any other pain, shortness of breath, cough, dysuria, back pain, fever, chills, night sweats, recent weight loss or gain. Denies sinus tenderness, rhinorrhea, jaw pain, or congestion. Denies chest pain, chest pressure, palpitations. Denies constipation, abdominal pain. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. He also denies any over the counter medications or ingestions such as methanol, ethylene glycol, etc. MEDICAL HISTORY: Anxiety DM II on insulin Alcohol abuse Hypertension Hyperlipidemia Acute-on-Chronic pancreatitis MEDICATION ON ADMISSION: CITALOPRAM - 20 mg Tablet FOLIC ACID - 1 mg GABAPENTIN - 100 mg Capsule 3 Capsule(s) by mouth three times per day INSULIN GLARGINE 16 units [**Last Name (un) **] INSULIN LISPRO [HUMALOG] - (Prescribed by Other Provider) - 100 unit/mL Solution - per sliding scale protocol per sliding scale protocol LISINOPRIL - 20 mg Tablet SIMVASTATIN - 40 mg Tablet ASPIRIN - 325 mg Tablet MULTIVITAMIN WITH MINERALS THIAMINE HCL - 100 mg Tablet ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: Vitals: T: BP: P: R: 18 O2: General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi Abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly GU: no foley [**Month/Day (3) **]: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Neuro: CNII-XII intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact . DISCHARGE EXAM: VS: 98.2 106/70-144/93 80-101 18 100% RA GENERAL - well-appearing man in NAD, comfortable, appropriate HEENT - sclerae anicteric, MMM, OP clear NECK - supple, no JVD, no cervical lymphadenopathy LUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use HEART - RRR, no MRG, nl S1-S2 ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) FAMILY HISTORY: Reports hypertension and anxiety in multiple family members. SOCIAL HISTORY: He lives at home with his wife, daughter, and three grand children. Reports cigarette use 15 years ago (about [**2-17**] cigarettes per day). Denies drug use. Drinks 1 pint of brandy every 1-2 days. ### Response: {'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Alcohol withdrawal,Other and unspecified alcohol dependence, continuous,Unspecified essential hypertension,Dysphagia, unspecified,Other and unspecified hyperlipidemia,Mononeuritis of unspecified site,Anxiety state, unspecified,Long-term (current) use of insulin,Personal history of tobacco use'}

CHIEF COMPLAINT: Dysnpea, dysphagia PRESENT ILLNESS: 84F s/p TEVAR for ruptured thoracic aortic aneurysm [**2170-10-30**]. She was discharged on [**2170-11-5**] in good condition. She presents [**11-12**] with a four day history of weakness, low grade fevers. She has developed worsening cough over the last 3 days associated with shortness of breath and dysphagia/odynophagia. The cough is mostly nonproductive (white phlegm). She also has abdominal pain and nausea and diarrhea. She denies, melena, BRBPR, hematemesis, or hemoptysis. She was started on antibiotics for pneumonia. Imaging at [**Hospital3 52206**] showed that she had a left side pleural effusion and atelectasis concerning for re-rupture with mass effect on trachea and esophagus. She was transfered to [**Hospital 61**] for further management. MEDICAL HISTORY: Hypertension Hypercholesterol Sciatica Cold feet MEDICATION ON ADMISSION: lovastatin 10, motrin 400 tid, premarin, enalapril 10, HCTZ 25 ALLERGIES: Influenza Virus Vaccine PHYSICAL EXAM: On admission: Temp 99.2 HR: 74 BP: 124/58 RR: 21 O2 Sat: 94% 2L Gen: alert and oriented x 3, NAD Card: RRR no murmer, rubs, gallops, clicks Pulm: CTA on R, decreased breath sounds on L. Dull to percussion on L. Abd: Soft, nontender, nondistended Ext: Palp DP, PT, radial FAMILY HISTORY: No CAD SOCIAL HISTORY: lives with husband. active and independent in ADLs. no tobacco (husband was a smoker in the house). no etoh

Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Other iatrogenic hypotension,Dysphagia, unspecified,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,Accidental cut, puncture, perforation or hemorrhage during other specified medical care,Other diseases of trachea and bronchus,Unspecified essential hypertension,Pure hypercholesterolemia,Sciatica

Hemorrhage complic proc,Effusion NEC exc tb,Iatrogenc hypotnsion NEC,Dysphagia NOS,Abn react-anastom/graft,Acc cut in med care NEC,Trachea & bronch dis NEC,Hypertension NOS,Pure hypercholesterolem,Sciatica

Admission Date: [**2170-11-12**] Discharge Date: [**2170-11-23**] Date of Birth: [**2086-4-8**] Sex: F Service: CARDIOTHORACIC Allergies: Influenza Virus Vaccine Attending:[**First Name3 (LF) 5790**] Chief Complaint: Dysnpea, dysphagia Major Surgical or Invasive Procedure: [**2170-11-14**]: Left thoracotomy. Repair of proximal left main stem bronchus laceration,intercostal muscle flap buttress, drainage of hemothorax. [**2170-11-14**]: Rigid bronchoscopy and flexible bronchoscopy. [**2170-11-12**] Placement of an 18-French chest tube into the left hemithorax. History of Present Illness: 84F s/p TEVAR for ruptured thoracic aortic aneurysm [**2170-10-30**]. She was discharged on [**2170-11-5**] in good condition. She presents [**11-12**] with a four day history of weakness, low grade fevers. She has developed worsening cough over the last 3 days associated with shortness of breath and dysphagia/odynophagia. The cough is mostly nonproductive (white phlegm). She also has abdominal pain and nausea and diarrhea. She denies, melena, BRBPR, hematemesis, or hemoptysis. She was started on antibiotics for pneumonia. Imaging at [**Hospital3 52206**] showed that she had a left side pleural effusion and atelectasis concerning for re-rupture with mass effect on trachea and esophagus. She was transfered to [**Hospital 61**] for further management. CTA chest was performed [**2170-11-12**] demonstrating evidence of endoleak and increased left pleural effusion. An interventional pulmonary consult was obtained, they placed a chest tube and drained 250cc of dark blood. Past Medical History: Hypertension Hypercholesterol Sciatica Cold feet PSH: Hysterectomy Social History: lives with husband. active and independent in ADLs. no tobacco (husband was a smoker in the house). no etoh Family History: No CAD Physical Exam: On admission: Temp 99.2 HR: 74 BP: 124/58 RR: 21 O2 Sat: 94% 2L Gen: alert and oriented x 3, NAD Card: RRR no murmer, rubs, gallops, clicks Pulm: CTA on R, decreased breath sounds on L. Dull to percussion on L. Abd: Soft, nontender, nondistended Ext: Palp DP, PT, radial Pertinent Results: [**2170-11-12**] 06:03PM PLEURAL WBC-750* Polys-17* Bands-1* Lymphs-72* Monos-5* Eos-5* Metas-0 [**2170-11-12**] 06:03PM PLEURAL Hct,Fl-5.5* Pleural Fluid negative [**2170-11-14**] 08:04PM BLOOD WBC-10.4 RBC-3.40* Hgb-10.4* Hct-30.4* MCV-90 MCH-30.6 MCHC-34.2 RDW-13.8 Plt Ct-487* [**2170-11-14**] 08:04PM BLOOD Plt Ct-487* [**2170-11-14**] 08:04PM BLOOD Glucose-128* UreaN-17 Creat-0.7 Na-139 K-3.9 Cl-109* HCO3-22 AnGap-12 [**2170-11-14**] 08:04PM BLOOD Calcium-8.8 Phos-4.8*# Mg-1.9 [**2170-11-14**] 08:19PM BLOOD Type-ART pO2-83* pCO2-44 pH-7.32* calTCO2-24 Base XS--3 [**2170-11-14**] 08:19PM BLOOD freeCa-1.26 [**2170-11-14**] 04:05PM BLOOD Glucose-117* Lactate-1.4 Na-136 K-3.6 Cl-107 [**2170-11-18**] 01:43AM BLOOD WBC-12.3* RBC-3.79* Hgb-11.3* Hct-33.4* MCV-88 MCH-29.9 MCHC-34.0 RDW-13.9 Plt Ct-633* [**2170-11-18**] 01:43AM BLOOD Plt Ct-633* [**2170-11-17**] 01:31AM BLOOD Glucose-108* UreaN-17 Creat-0.6 Na-138 K-3.8 Cl-105 HCO3-23 AnGap-14 [**2170-11-18**] 01:43AM BLOOD Calcium-8.1* Phos-2.7 Mg-2.0 CXR [**10/2570**] Left fourth posterior rib fracture is difficult to visualize on the upright prior study probably post surgical. Extensive subcutaneous emphysema, otherwise unchanged. [**2170-11-22**] 09:27PM BLOOD WBC-13.2* RBC-3.73* Hgb-11.2* Hct-33.9* MCV-91 MCH-30.0 MCHC-33.1 RDW-14.7 Plt Ct-386 [**2170-11-22**] 09:27PM BLOOD Plt Ct-386 [**2170-11-22**] 09:27PM BLOOD Glucose-111* UreaN-30* Creat-0.9 Na-143 K-4.2 Cl-105 HCO3-31 AnGap-11 [**2170-11-22**] 09:27PM BLOOD Calcium-8.3* Phos-3.1 Mg-2.1 Brief Hospital Course: The patient was admitted to the vascular service on [**2170-11-12**]. Interventional pulmonary was consulted for thoracentesis. They placed an 18Fr chest tube to drain the left collection which was of dark bloody consistency. She was taken to the operating room on [**2170-11-14**] for planned left VATS, washout and chest tube placement. However, after the patient was intubated in the OR, the anesthesiologist was checking tube position with the bronchoscope, it was noted that there was a laceration of the proximal left main stem bronchus. A rigid bronchoscopy was then performed demonstrating a 1.5 cm full thickness tear. The patient then proceeded to have a left thoracotomy and primary repair. See operative note for full details. The patient remained intubated following the procedure and was transferred to the TSICU. She was treated prophylactically with vanco/levo, was intubated, NG tube in place, 2 chest tubes and one [**Doctor Last Name **] drain in place, foley in place. She was extubated on [**11-15**] without any issues, her chest tubes were placed to water [**Last Name (LF) **], [**First Name3 (LF) **] epidural was placed for pain control. [**11-16**] - NG tube was removed, speech and swallow assessed the patient and she started thin liquids and ground solids. [**11-18**] - due to poor intake, a dobhoff tube was placed and tube feeds were started [**11-19**] - the patient was transferred to the floor for continued monitoring, she removed her dobhoff overnight, PO intake was encouraged, chest tubes removed [**11-20**] - antibiotics discontinued, chest drain removed [**11-21**] - physical therapy continued working with the patient and recommended rehab [**11-22**]- Physical therapy continued working with the patient. Patient over night got moderate respiratory depression, with ABG showed hypoxemia. 1 time dose naloxone was administrated with good response. We change pain management to Tylenol and Ibuprofen, no narcotics. [**2170-11-23**]- Patient was stable , doing fine, VS stable , afebrile. Patient was discharge to rehab. Medications on Admission: lovastatin 10, motrin 400 tid, premarin, enalapril 10, HCTZ 25 Discharge Medications: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 3. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**12-29**] Puffs Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 4. Enalapril Maleate 10 mg Tablet Sig: One (1) Tablet PO once a day: hold SBP < 100. 5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 6. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day) as needed for constipation. 7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) SC Injection TID (3 times a day). 9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours) as needed for pain. 10. Mirtazapine 7.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 11. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6 hours) as needed for mucoltytic. 12. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3 times a day) as needed for hold hr<55, SBP<100. 13. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Discharge Disposition: Extended Care Facility: Catholic [**Hospital1 107**] Home Discharge Diagnosis: Left hemothorax s/p TEVAR for ruptured thoracic aortic aneurysm [**2170-10-30**] Hypertension Hypercholesterol Sciatica Cold feet Discharge Condition: stable Discharge Instructions: Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if experience: -Fever > 101 or chills. -Increased shortness of breath, cough or sputum production -Chest pain Followup Instructions: Follow-up with Dr. [**Last Name (STitle) **] [**12-6**] 3:30 pm on the [**Hospital Ward Name 5074**] [**Hospital Ward Name 23**] Clinical Center, [**Location (un) 24**]. CXR on the [**Location (un) 861**] Radiology Department 45 minutes before your appointment Completed by:[**2170-11-23**]

998,511,458,787,E878,E870,519,401,272,724

{'Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Other iatrogenic hypotension,Dysphagia, unspecified,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,Accidental cut, puncture, perforation or hemorrhage during other specified medical care,Other diseases of trachea and bronchus,Unspecified essential hypertension,Pure hypercholesterolemia,Sciatica'}

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: Dysnpea, dysphagia PRESENT ILLNESS: 84F s/p TEVAR for ruptured thoracic aortic aneurysm [**2170-10-30**]. She was discharged on [**2170-11-5**] in good condition. She presents [**11-12**] with a four day history of weakness, low grade fevers. She has developed worsening cough over the last 3 days associated with shortness of breath and dysphagia/odynophagia. The cough is mostly nonproductive (white phlegm). She also has abdominal pain and nausea and diarrhea. She denies, melena, BRBPR, hematemesis, or hemoptysis. She was started on antibiotics for pneumonia. Imaging at [**Hospital3 52206**] showed that she had a left side pleural effusion and atelectasis concerning for re-rupture with mass effect on trachea and esophagus. She was transfered to [**Hospital 61**] for further management. MEDICAL HISTORY: Hypertension Hypercholesterol Sciatica Cold feet MEDICATION ON ADMISSION: lovastatin 10, motrin 400 tid, premarin, enalapril 10, HCTZ 25 ALLERGIES: Influenza Virus Vaccine PHYSICAL EXAM: On admission: Temp 99.2 HR: 74 BP: 124/58 RR: 21 O2 Sat: 94% 2L Gen: alert and oriented x 3, NAD Card: RRR no murmer, rubs, gallops, clicks Pulm: CTA on R, decreased breath sounds on L. Dull to percussion on L. Abd: Soft, nontender, nondistended Ext: Palp DP, PT, radial FAMILY HISTORY: No CAD SOCIAL HISTORY: lives with husband. active and independent in ADLs. no tobacco (husband was a smoker in the house). no etoh ### Response: {'Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Other iatrogenic hypotension,Dysphagia, unspecified,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,Accidental cut, puncture, perforation or hemorrhage during other specified medical care,Other diseases of trachea and bronchus,Unspecified essential hypertension,Pure hypercholesterolemia,Sciatica'}

CHIEF COMPLAINT: PRESENT ILLNESS: This patient is a 55-year-old man status post cadaveric renal transplant on [**2145-4-21**], complicated by wound hematoma and opening of the wound. The patient has been managed on an outpatient basis with a VAC dressing and has been discharged to rehabilitation prior to this admission. The patient presented today to the Clinic where an exposed renal graft was noted in the wound. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Complications of transplanted kidney,Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Disruption of external operation (surgical) wound,Acute hepatitis C without mention of hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other staphylococcal septicemia,Sepsis

Compl kidney transplant,Subendo infarct, initial,CHF NOS,Disrup-external op wound,Hpt C acute wo hpat coma,Hyp kid NOS w cr kid V,Staphylcocc septicem NEC,Sepsis

Admission Date: [**2145-6-25**] Discharge Date: [**2145-7-13**] Date of Birth: [**2090-12-8**] Sex: M Service: [**Last Name (un) **] HISTORY OF PRESENT ILLNESS: This patient is a 55-year-old man status post cadaveric renal transplant on [**2145-4-21**], complicated by wound hematoma and opening of the wound. The patient has been managed on an outpatient basis with a VAC dressing and has been discharged to rehabilitation prior to this admission. The patient presented today to the Clinic where an exposed renal graft was noted in the wound. PHYSICAL EXAMINATION: Temperature 97.9 degrees Fahrenheit, heart rate 83, blood pressure 182/86, respiratory rate 20 and oxygen saturation 100 percent on room air. The patient was awake and alert in no apparent distress. The patient's heart was in regular rate and rhythm with no murmurs, rubs or gallops. His lungs were clear to auscultation bilaterally. His abdomen was noted to have a wound VAC dressing in place; otherwise, it was soft, non-tender, non-distended, normoactive bowel sounds. His extremities were warm. Distal pulses were two plus and he had no peripheral edema in both lower extremities and slight peripheral edema in his left upper extremity at the site of where he had a prior fistula for hemodialysis. HOSPITAL COURSE: At this point the patient was admitted to [**Hospital1 69**] and was continued on his prior medications from a recent discharge medicine list and his VAC was placed to continuous suction. The patient was also followed by the Renal Transplant Service who also noted his creatinine to reveal excellent graft function. The patient was on vancomycin during this time one gram q. 48h. to protect against potential wound pathogens. The plan at this time was to have Plastic Surgery to see the patient to evaluate a possible wound flap to cover the exposed graft. On [**2145-6-29**], hospital day five, the patient continued to progress well. Was voiding without complaint and the service was waiting for Plastic Surgery evaluation at this time for potential wound flap coverage. The patient's vital signs were stable during this time. The patient was afebrile throughout his hospital stay up until this point. The patient was given nutritional supplements with meals, Boost three times a day, and on [**2145-6-30**], the patient was visited by the Plastic Surgery service. On [**2145-6-30**], the patient was found in his room to be complaining of feeling hot and generally "not well." Vital signs were taken revealing a blood pressure of 204/109 with a heart rate of 144, breathing at 70 percent on room air. The patient received 5 mg of intravenous push Lopressor. Blood pressure at this point was 208/111, heart rate 137. Blood gases were drawn. Electrolytes and blood cultures were sent and Foley catheter was inserted. A second dose of intravenous Lopressor was given and his blood pressure was 206/90 at this point, heart rate of 137 and at this point 10 mg of intravenous Lopressor was hung and 10 mg was pushed. The patient continued to have labored breathing. Was alert and oriented but sleepy and arousable. Chest x-ray revealed what looked like a likely pneumonia. Electrocardiogram showed sinus tachycardia. His blood gases at this point were pO2 of 82, pCO2 of 54 and a pH of 7.19. The patient at this point was transferred to the Surgical Intensive Care Unit. A central venous line was also placed at this point without complications with the patient having insufficient peripheral access for the purpose of ABG drawing, hemodynamic monitoring. The patient at this point was on metoprolol on hydralazine 25 mg q. 6h. The plan was for serial ABG's. The patient was placed on nonrebreathable oxygen mask. On the same day Plastic Surgery saw the patient and recommended that patient would likely benefit from right gracilis flap to protect and cover the open wound with kidney graft exposed. The patient was then consulted to see Cardiology after this bout of respiratory distress and sinus tachycardia who recommended tighter blood pressure control and metoprolol was thus restarted at a dose of 150 mg p.o. b.i.d. and aspirin was continued 325 mg q. day. On SICU day two, the patient was noted to be significantly improved and vital signs were within normal limits. His blood pressure was 161/82 at this point and he was saturating at 95 percent on room air with a heart rate of 83. The patient at this point was on vancomycin, Zosyn and Bactrim. This was the second day of Zosyn. At this point the plan was for Plastic Surgery, after seeing the patient on hospital day eight, [**2145-7-2**], to bring the patient to the Operating Room on Monday for likely gracilis flap, possible rectus flap and they would pre-op the patient for surgery. The patient then was transferred back to the floor later in the day after noted to be doing very well. His vital signs were stable. The patient was saturating well and his heart rate and blood pressure were within normal limits. Blood pressure at this point was 115/68. He had no complaints of shortness of breath or chest pain at this time. On the 17th day of [**Month (only) 30676**] hospital day nine, the patient continued to progress well and the patient was scheduled for stress echocardiogram as preoperative evaluation after events that led to the patient being transferred to the Surgical Intensive Care Unit. Echocardiogram revealed moderate inferior wall hypokinesis with an ejection fraction of approximately 27-28 percent and it was determined at this point that the patient would likely benefit from cardiac catheterization. The patient, however, required two negative sets of blood cultures which were drawn on the 16th and [**7-3**] which eventually came back negative and the patient was brought to cardiac catheterization on [**7-9**] revealing that the patient had normal coronary arteries. No signs of stenosis. Ejection fraction at this point was noted to be in the mid 30's, approximately 35 percent. The patient continued to progress well during his hospital stay, was afebrile and without complaint and at this point was awaiting possible of Plastic Surgery flap closure for his open wound. The patient was also followed by Physical Therapy and Occupational Therapy who suggested that the patient would likely benefit from a stint in rehabilitation before being discharged to home and, upon learning that the patient would not be able to be scheduled for plastic surgery closure until the following week, likely to occur on [**7-20**] or 4th of [**2144**], it was determined that the patient could be discharged to rehabilitation on the wound VAC. The patient was stable on the day of discharge. The patient was afebrile. The rest of his vital signs were within normal limits. DISCHARGE DIAGNOSES: Status post cadaveric renal transplant [**2145-4-17**] with open wound and exposed kidney. End-stage renal disease. Diabetes mellitus type 2. Hypertension. Hepatitis C virus. CONDITION ON DISCHARGE: Stable. DISPOSITION: The patient was to be discharged to rehabilitation facility where patient would have wound VAC changes every fourth day, to [**Name8 (MD) 138**] M.D. if patient had any increasing fevers, chills, nausea, vomiting, decreased urine output, excessive blood coming from site of wound VAC or if there were any other questions. DISCHARGE MEDICATIONS: 1. Bactrim one tab q. day. 2. Metoclopramide 10 mg p.o. q.i.d. 3. Protonix 40 mg p.o. q. day. 4. Percocet 5/325 one to two tablets p.o. q. 4-6h. as needed pain. 5. Regular insulin sliding scale as directed per sliding scale. 6. Colace 100 mg p.o. b.i.d. 7. Prednisone 10 mg p.o. q. day. 8. ____________ 450 mg p.o. q. day. 9. Epogen 20,000 units three times per week, Monday, Wednesday and [**Name8 (MD) 2974**]. 10. Nystatin 5 mL p.o. q.i.d. 11. Metoprolol 150 mg p.o. b.i.d. 12. Heparin 5000 units one injection three times a day. 13. Azathioprine 75 mg p.o. q. day. 14. Furosemide 40 mg p.o. q. day. 15. Clonidine 0.2 mg p.o. t.i.d. 16. Aspirin 325 mg p.o. q. day. 17. Cyclosporin 125 mg p.o. b.i.d. 18. Hydralazine 37.5 mg q.i.d. DISPOSITION: Patient stable and to be discharged to rehabilitation facility. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 816**], M.D. [**MD Number(2) 6727**] Dictated By:[**Last Name (NamePattern1) 15912**] MEDQUIST36 D: [**2145-7-13**] 12:49:02 T: [**2145-7-13**] 14:01:07 Job#: [**Job Number 19457**]

996,410,428,998,070,403,038,995

{'Complications of transplanted kidney,Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Disruption of external operation (surgical) wound,Acute hepatitis C without mention of hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other staphylococcal septicemia,Sepsis'}

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 is a 55-year-old man status post cadaveric renal transplant on [**2145-4-21**], complicated by wound hematoma and opening of the wound. The patient has been managed on an outpatient basis with a VAC dressing and has been discharged to rehabilitation prior to this admission. The patient presented today to the Clinic where an exposed renal graft was noted in the wound. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Complications of transplanted kidney,Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Disruption of external operation (surgical) wound,Acute hepatitis C without mention of hepatic coma,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other staphylococcal septicemia,Sepsis'}

CHIEF COMPLAINT: Left lower extremity ischemia with ulceration. PRESENT ILLNESS: This is a 60-year-old man who has left leg ulceration in the heel. Arteriogram showed occlusion of the above-knee popliteal artery with reconstitution of the below-knee popliteal artery and a single-vessel runoff via the peroneal which had a patent posterior tibial artery. Given these findings, the patient was consented for a femoral to tibial bypass to help assist him with wound healing MEDICAL HISTORY: CHF with EF < 20%, global right and left ventricle hypokinesis DM2 on insulin HTN CAD: CABG [**2187**], on asa, plavix; MIBI in [**1-31**] w/out rev [**First Name (Titles) 110951**] [**Last Name (Titles) 110952**] MEDICATION ON ADMISSION: xanax 1mg TID, Amlodipine 5 mg Tablet QD, Coreg 25 QD, Clonidine 0.2 mg Tablet TID, Plavix 75, Lasix 80mg [**Hospital1 **], Hydralazine 25 mg Tablet TID, Vicodin prn, Lantus 55 units in a.m., 22 units at night, Lisinopril 2.5 mg Tablet QD, zocor ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: FAMILY HISTORY: non-contributory SOCIAL HISTORY: - no current etoh - no cigarette smoking, no illegal drug use - blood transfusion once before, at hospitalization at [**Hospital1 18**] in [**1-/2193**]

Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Cardiac complications, not elsewhere classified,Systolic heart failure, unspecified,Paroxysmal ventricular tachycardia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Polyneuropathy in diabetes,Aortocoronary bypass status,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

DMII circ nt st uncntrld,Ath ext ntv art gngrene,Ulcer of heel & midfoot,Surg compl-heart,Systolic hrt failure NOS,Parox ventric tachycard,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Neuropathy in diabetes,Aortocoronary bypass,Abn react-anastom/graft

Admission Date: [**2195-7-13**] Discharge Date: [**2195-7-18**] Date of Birth: [**2134-9-18**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2777**] Chief Complaint: Left lower extremity ischemia with ulceration. Major Surgical or Invasive Procedure: Left SFA to TPT bypass with NRGSV History of Present Illness: This is a 60-year-old man who has left leg ulceration in the heel. Arteriogram showed occlusion of the above-knee popliteal artery with reconstitution of the below-knee popliteal artery and a single-vessel runoff via the peroneal which had a patent posterior tibial artery. Given these findings, the patient was consented for a femoral to tibial bypass to help assist him with wound healing Past Medical History: CHF with EF < 20%, global right and left ventricle hypokinesis DM2 on insulin HTN CAD: CABG [**2187**], on asa, plavix; MIBI in [**1-31**] w/out rev [**First Name (Titles) 110951**] [**Last Name (Titles) 110952**] Social History: - no current etoh - no cigarette smoking, no illegal drug use - blood transfusion once before, at hospitalization at [**Hospital1 18**] in [**1-/2193**] Family History: non-contributory Physical Exam: PE: AFVSS NEURO: PERRL / EOMI MAE equally Answers simple commands Neg pronator drift Sensation intact to ST 2 plus DTR Neg Babinski HEENT: NCAT Neg lesions nares, oral pharnyx, auditory Supple / FAROM neg lyphandopathy, supra clavicular nodes LUNGS: CTA b/l CARDIAC: 2/6 SEM ABDOMEN: Soft, NTTP, ND, pos BS, neg CVA tenderness EXT: rle - palp fem, [**Doctor Last Name **], dop pt lle - palp fem, [**Doctor Last Name **], dop pt, dp ulcer on the left heel, debrided bedside graft palp Pertinent Results: [**2195-7-17**] 07:10AM BLOOD WBC-11.7* RBC-3.39* Hgb-10.3* Hct-29.2* MCV-86 MCH-30.3 MCHC-35.1* RDW-14.2 Plt Ct-276 [**2195-7-17**] 07:10AM BLOOD Glucose-61* UreaN-32* Creat-2.4* Na-140 K-3.7 Cl-103 HCO3-25 AnGap-16 [**2195-7-17**] 07:10AM BLOOD Calcium-8.3* Phos-4.2 Mg-2.2 [**2195-7-13**] 06:00PM BLOOD Glucose-255* Lactate-2.2* Na-134* K-4.8 Cl-108 [**Known lastname **],[**Known firstname **] I [**Medical Record Number 110955**] M 60 [**2134-9-18**] Cardiology Report ECG Study Date of [**2195-7-13**] 7:33:08 PM Baseline artifact. Sinus rhythm. P-R interval prolongation. Left bundle-branch block. Compared to the previous tracing of [**2195-7-8**] there is no significant diagnostic change. Intervals Axes Rate PR QRS QT/QTc P QRS T 60 186 150 490/490 75 -26 -179 Brief Hospital Course: Patient is a 60 year old male with multiple medical problems including severe peripheral vascular disease and a non-healing left foot ulcer on which an angiogram was performed on previous admission [**2195-7-7**] without complication. Patient was scheduled for surgery [**2195-7-13**] and discharged home. Patient was found to have chronic renal insufficiency on previous admission and was discharged with stable Cr. On this admission patient underwent a Left superficial femoral artery to dorsalis pedis trunk bypass with reverse greater saphenous vein. The operation was uncomplicated. Patient returned to the floor. During his post-operative recovery patient experienced an episode of tachycardia for which he was followed by cardiology. ECG and cardiac enzymes were found to be negative and the patient was asymptomatic. Cardiology was consulted and it was determined no further workup was necessary. During his hospital admission patient's creatinine rose to 2.5. He was given IV bicarbonate and at discharge his creatinine has stabilized. Patient was discharged home on POD5 with visiting nurse to monitor his leg incision for signs of infection and with PT to help patient ambulate. Medications on Admission: xanax 1mg TID, Amlodipine 5 mg Tablet QD, Coreg 25 QD, Clonidine 0.2 mg Tablet TID, Plavix 75, Lasix 80mg [**Hospital1 **], Hydralazine 25 mg Tablet TID, Vicodin prn, Lantus 55 units in a.m., 22 units at night, Lisinopril 2.5 mg Tablet QD, zocor Discharge Medications: 1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Alprazolam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for anxiety. 3. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Tablet(s) 4. Carvedilol 25 mg Tablet Sig: One (1) Tablet PO twice a day. 5. Clonidine 0.2 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 6. Furosemide 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. Insulin Sliding Scale & Fixed Dose Fingerstick QACHS Insulin SC Fixed Dose Orders Breakfast Bedtime Glargine 55 Units Glargine 22 Units Insulin SC Sliding Scale Breakfast Lunch Dinner Bedtime Regular Glucose Insulin Dose 0-50 mg/dL 4 oz. Juice 51-150 mg/dL 0 Units 0 Units 0 Units 0 Units 151-200 mg/dL 2 Units 2 Units 2 Units 2 Units 201-250 mg/dL 4 Units 4 Units 4 Units 4 Units 251-300 mg/dL 6 Units 6 Units 6 Units 6 Units 301-350 mg/dL 8 Units 8 Units 8 Units 8 Units 351-400 mg/dL 10 Units 10 Units 10 Units 10 Units > 400 mg/dL Notify M.D. 10. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO four times a day for 10 days: prn. Disp:*31 Tablet(s)* Refills:*0* 11. [**Last Name (un) 1724**] xanax 1mg TID, Amlodipine 5 mg Tablet QD, Coreg 25 QD, Clonidine 0.2 mg Tablet TID, Plavix 75, Lasix 80mg [**Hospital1 **], Hydralazine 25 mg Tablet TID, Vicodin prn, Lantus 55 units in a.m., 22 units at night, Lisinopril 2.5 mg Tablet QD, zocor 40mg QD 12. Hydralazine 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 13. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day: On Hold check with PCP before taking. Discharge Disposition: Home With Service Facility: caritas home care Discharge Diagnosis: Peripheral Vascular Disease Gangrenous ulcer left heel CRI Low HCT post op requiring PRBC Bedside debridement of leftheel ulcer Diabetes mellitus type 2, HTN, coronary artery disease, CHF Discharge Condition: Stable Discharge Instructions: Incision Care: Keep clean and dry. -You may shower, and wash surgical incisions. -Avoid swimming and baths until your follow-up appointment. -Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites. -If you have staples, they will be removed during at your follow up appointment. . Please call your doctor or return to the ER for any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * 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 drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. * Continue to ambulate several times per day. * No heavy ([**10-8**] lbs) until your follow up appointment. What to expect when you go home: 1. It is normal to feel tired, this will last for 4-6 weeks ?????? You should get up out of bed every day and gradually increase your activity each day ?????? Unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs ?????? Increase your activities as you can tolerate- do not do too much right away! 2. It is normal to have swelling of the leg you were operated on: ?????? Elevate your leg above the level of your heart (use [**1-27**] pillows or a recliner) every 2-3 hours throughout the day and at night ?????? Avoid prolonged periods of standing or sitting without your legs elevated 3. It is normal to have a decreased appetite, your appetite will return with time ?????? You will probably lose your taste for food and lose some weight ?????? Eat small frequent meals ?????? It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication What activities you can and cannot do: ?????? No driving until post-op visit and you are no longer taking pain medications ?????? Unless you were told not to bear any weight on operative foot: ?????? You should get up every day, get dressed and walk ?????? You should gradually increase your activity ?????? You may up and down stairs, go outside and/or ride in a car ?????? Increase your activities as you can tolerate- do not do too much right away! ?????? No heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit ?????? You may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over 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 over the area that is draining, as needed ?????? Take all the medications you were taking before surgery, unless otherwise directed ?????? Take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed ?????? Call and schedule an appointment to be seen in 2 weeks for staple/suture removal What to report to office: ?????? Redness that extends away from your incision ?????? A sudden increase in pain that is not controlled with pain medication ?????? A sudden change in the ability to move or use your leg or the ability to feel your leg ?????? Temperature greater than 100.5F for 24 hours ?????? Bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions Followup Instructions: Followup with Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2195-8-6**] 11:30 Follow-up with Podiatry: Dr. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name (STitle) **] for appt. Phone: ([**Telephone/Fax (1) 19882**]

250,440,707,997,428,427,403,585,357,V458,E878

{'Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Cardiac complications, not elsewhere classified,Systolic heart failure, unspecified,Paroxysmal ventricular tachycardia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Polyneuropathy in diabetes,Aortocoronary bypass status,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: Left lower extremity ischemia with ulceration. PRESENT ILLNESS: This is a 60-year-old man who has left leg ulceration in the heel. Arteriogram showed occlusion of the above-knee popliteal artery with reconstitution of the below-knee popliteal artery and a single-vessel runoff via the peroneal which had a patent posterior tibial artery. Given these findings, the patient was consented for a femoral to tibial bypass to help assist him with wound healing MEDICAL HISTORY: CHF with EF < 20%, global right and left ventricle hypokinesis DM2 on insulin HTN CAD: CABG [**2187**], on asa, plavix; MIBI in [**1-31**] w/out rev [**First Name (Titles) 110951**] [**Last Name (Titles) 110952**] MEDICATION ON ADMISSION: xanax 1mg TID, Amlodipine 5 mg Tablet QD, Coreg 25 QD, Clonidine 0.2 mg Tablet TID, Plavix 75, Lasix 80mg [**Hospital1 **], Hydralazine 25 mg Tablet TID, Vicodin prn, Lantus 55 units in a.m., 22 units at night, Lisinopril 2.5 mg Tablet QD, zocor ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: PE: FAMILY HISTORY: non-contributory SOCIAL HISTORY: - no current etoh - no cigarette smoking, no illegal drug use - blood transfusion once before, at hospitalization at [**Hospital1 18**] in [**1-/2193**] ### Response: {'Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with gangrene,Ulcer of heel and midfoot,Cardiac complications, not elsewhere classified,Systolic heart failure, unspecified,Paroxysmal ventricular tachycardia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Polyneuropathy in diabetes,Aortocoronary bypass status,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: sepsis PRESENT ILLNESS: Ms. [**Known lastname **] is a 71 year old female with previous medical history significant for DM2, HTN/HL, and diverticulosis. She initially presented to [**Hospital6 19155**] on [**12-27**] with 3 weeks of crampy abdominal pain. Initial pain control with Dilaudid and nausea control with Zofran + Reglan. CT abdomen showed ?diverticular abscess and he was started on Levaquin/Flagyl initially. She had a leukocytosis to 25 and hypotension requiring neosyneprhine. Given her worsening picture, she was brought to the OR for an exploratory laparotomy. . A necrotic uterus was found and Ob-Gyn was called in for a sub-total hysterectomy and bilateral salpingo-oopherectomy and omentectomy were performed. They found a pocket of pus/abscess adjacent to uterus (walled off). No fistula, no diverticulitis. Omentectomy done "just in case it was cancer". They closed the fascia, placed a JP, left SQ tissue open. She was given FFP and 10mg vitamin K IV intra-op for an INR of 1.6-->1.4. Peri-operative EBL~500cc and follow-up hematocrit went from 26 to 24. She no longer required pressors post-operatively, but remained intubated due desaturation to 85% on 4L, corrected to 100% on NRB presumably secondary to pulmonary edema (confirmed by CXR) so she was given lasix 100mg IV with 1650cc output. Prior to transfer, she was reportedly given 1 unit pRBCs followed by Lasix. Antibiotic coverage broadened with Zosyn/Flagyl/Levaquin with blood cultures growing GNRs and GPCs in [**4-17**] bottles and GNRs in urine culture. An arterial line is in place with a right double-lumen PICC. She was sedated on propofol. She has a partially open abdomen, packed with betadine/gauze and with a JP drain in place (drained 20cc of serosanguinous fluid to date). . On arrival to the MICU, she was breathing spontaneously on pressure support and ABG showed 7.37/37/152. She was in significant pain, so she was bolused with Fentanyl for comfort and started back on AC for rest. . Review of systems: Unable to perform secondary to sedation MEDICAL HISTORY: type 2 diabetes mellitus - HTN (diagnosed in [**2164**]) - HL - diverticulosis - right hydronephrosis on CT abdomen in [**2164**], ?etiology - s/p carpal tunnel release - "disc surgery" - tubal ligation MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Lisinopril 10', Glyburide 5 qAM, 2.5mg qPM, Metformin 1000'', Fish Oil 300'', Glucosamine-chondroitin 1', Simvastatin ALLERGIES: epinephrine PHYSICAL EXAM: Admission PE: Vitals: T: 97.7, BP: 93/50, P: 93/50, R: 15 O2: 86% on PS [**10-23**] General: opens eyes to voice, sleepy HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Relatively clear to auscultation bilaterally, no wheezes, rales, rhonchi Abdomen: protuberant, soft, diffusely tender with vertically-sutured wound packed with gauze and abdominal binder in place. Bowel sounds quiet, no organomegaly appreciated GU: foley in place Ext: warm, well perfused, 2+ pulses, no clubbing, [**1-15**]+ edema Neuro: opens eyes to voice, painful to palpation of abdomen FAMILY HISTORY: No reported history of cancers, blood disorders, or GU issues. Mother had breast "lump". One of her daughter had a hysterectomy for unknown reasons. SOCIAL HISTORY: Lives independently in [**Location (un) **] - Tobacco: none - Alcohol: none - Illicits: none

Septicemia due to escherichia coli [E. coli],Peritoneal abscess,Acute kidney failure with lesion of tubular necrosis,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute or unspecified pelvic peritonitis, female,Acute edema of lung, unspecified,Acute inflammatory diseases of uterus, except cervix,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Diverticulitis of colon (without mention of hemorrhage),Abscess of intestine,Severe sepsis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other alteration of consciousness,Acquired absence of both cervix and uterus,Leukocytosis, unspecified

E coli septicemia,Peritoneal abscess,Ac kidny fail, tubr necr,Septic shock,Food/vomit pneumonitis,Ac pelv peritonitis-fem,Acute lung edema NOS,Ac uterine inflammation,Urin tract infection NOS,Ac posthemorrhag anemia,Dvrtcli colon w/o hmrhg,Intestinal abscess,Severe sepsis,Streptococcus group b,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Other alter consciousnes,Acq absnce cervix/uterus,Leukocytosis NOS

Admission Date: [**2169-12-28**] Discharge Date: [**2170-1-9**] Date of Birth: [**2098-3-23**] Sex: F Service: SURGERY Allergies: epinephrine Attending:[**First Name3 (LF) 1390**] Chief Complaint: sepsis Major Surgical or Invasive Procedure: [**2170-1-2**] [**Doctor Last Name 3379**] colostomy Vac dressing placed [**1-4**] History of Present Illness: Ms. [**Known lastname **] is a 71 year old female with previous medical history significant for DM2, HTN/HL, and diverticulosis. She initially presented to [**Hospital6 19155**] on [**12-27**] with 3 weeks of crampy abdominal pain. Initial pain control with Dilaudid and nausea control with Zofran + Reglan. CT abdomen showed ?diverticular abscess and he was started on Levaquin/Flagyl initially. She had a leukocytosis to 25 and hypotension requiring neosyneprhine. Given her worsening picture, she was brought to the OR for an exploratory laparotomy. . A necrotic uterus was found and Ob-Gyn was called in for a sub-total hysterectomy and bilateral salpingo-oopherectomy and omentectomy were performed. They found a pocket of pus/abscess adjacent to uterus (walled off). No fistula, no diverticulitis. Omentectomy done "just in case it was cancer". They closed the fascia, placed a JP, left SQ tissue open. She was given FFP and 10mg vitamin K IV intra-op for an INR of 1.6-->1.4. Peri-operative EBL~500cc and follow-up hematocrit went from 26 to 24. She no longer required pressors post-operatively, but remained intubated due desaturation to 85% on 4L, corrected to 100% on NRB presumably secondary to pulmonary edema (confirmed by CXR) so she was given lasix 100mg IV with 1650cc output. Prior to transfer, she was reportedly given 1 unit pRBCs followed by Lasix. Antibiotic coverage broadened with Zosyn/Flagyl/Levaquin with blood cultures growing GNRs and GPCs in [**4-17**] bottles and GNRs in urine culture. An arterial line is in place with a right double-lumen PICC. She was sedated on propofol. She has a partially open abdomen, packed with betadine/gauze and with a JP drain in place (drained 20cc of serosanguinous fluid to date). . On arrival to the MICU, she was breathing spontaneously on pressure support and ABG showed 7.37/37/152. She was in significant pain, so she was bolused with Fentanyl for comfort and started back on AC for rest. . Review of systems: Unable to perform secondary to sedation Past Medical History: type 2 diabetes mellitus - HTN (diagnosed in [**2164**]) - HL - diverticulosis - right hydronephrosis on CT abdomen in [**2164**], ?etiology - s/p carpal tunnel release - "disc surgery" - tubal ligation Social History: Lives independently in [**Location (un) **] - Tobacco: none - Alcohol: none - Illicits: none Family History: No reported history of cancers, blood disorders, or GU issues. Mother had breast "lump". One of her daughter had a hysterectomy for unknown reasons. Physical Exam: Admission PE: Vitals: T: 97.7, BP: 93/50, P: 93/50, R: 15 O2: 86% on PS [**10-23**] General: opens eyes to voice, sleepy HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Relatively clear to auscultation bilaterally, no wheezes, rales, rhonchi Abdomen: protuberant, soft, diffusely tender with vertically-sutured wound packed with gauze and abdominal binder in place. Bowel sounds quiet, no organomegaly appreciated GU: foley in place Ext: warm, well perfused, 2+ pulses, no clubbing, [**1-15**]+ edema Neuro: opens eyes to voice, painful to palpation of abdomen Pertinent Results: Admission Labs: [**2169-12-28**] 09:00PM BLOOD WBC-15.0* RBC-3.11* Hgb-9.3* Hct-28.3* MCV-91 MCH-29.8 MCHC-32.7 RDW-13.7 Plt Ct-164 [**2169-12-28**] 09:00PM BLOOD Neuts-82* Bands-8* Lymphs-7* Monos-1* Eos-0 Baso-0 Atyps-2* Metas-0 Myelos-0 [**2169-12-28**] 09:00PM BLOOD PT-18.5* PTT-31.3 INR(PT)-1.7* [**2169-12-29**] 03:24AM BLOOD PT-16.6* PTT-28.2 INR(PT)-1.6* [**2169-12-28**] 09:00PM BLOOD Glucose-143* UreaN-52* Creat-2.4* Na-140 K-4.6 Cl-109* HCO3-20* AnGap-16 [**2169-12-29**] 03:24AM BLOOD Glucose-85 UreaN-55* Creat-2.5* Na-141 K-4.2 Cl-108 HCO3-23 AnGap-14 [**2169-12-29**] 04:27PM BLOOD Glucose-67* UreaN-51* Creat-2.2* Na-145 K-4.0 Cl-109* HCO3-27 AnGap-13 [**2169-12-30**] 04:02AM BLOOD ALT-45* AST-77* LD(LDH)-312* AlkPhos-141* TotBili-0.9 [**2169-12-28**] 09:00PM BLOOD Calcium-7.2* Phos-4.6* Mg-1.9 [**2169-12-29**] 03:24AM BLOOD Calcium-7.8* Phos-4.7* Mg-1.9 [**2169-12-29**] 03:24AM BLOOD CEA-1.9 CA125-50* [**2169-12-28**] 09:07PM BLOOD Lactate-2.2* [**2169-12-29**] 03:42AM BLOOD Lactate-1.3 [**2169-12-29**] 12:20PM BLOOD Lactate-1.4 K-4.2 [**2169-12-28**] 09:07PM BLOOD freeCa-0.99* [**2169-12-29**] 03:42AM BLOOD freeCa-1.07* [**2170-1-1**]: Blood-bank: DIAGNOSIS, ASSESSMENT AND RECOMMENDATIONS: Ms. [**Known lastname **] has a confirmed diagnosis of Anti-D antibody. D-antigen is a member of the Rhesus blood group system. Anti-D antibody is clinically significant and capable of causing hemolytic transfusion reactions. In the future, Ms. [**Known lastname **] should receive D-antigen negative products for all red cell transfusions. Approximately 15% of ABO compatible blood will be D-antigen negative. [**2169-12-28**]: EKG: Probable ectopic atrial rhythm. Slight upsloping ST segment elevation in lead aVF which does not meet diagnostic criteria for myocardial infarction. Low amplitude QRS voltage in the limb leads and precordial leads. No previous tracing available for comparison. [**2169-12-29**]: ECHO: IMPRESSION: No valvular vegetations seen. Mild mitral regurgitation. Normal global and regional biventricular systolic function [**2169-12-31**]: cat scan of the head: IMPRESSION: No acute intracranial process. [**2169-12-31**]: chest x-ray: Still mild-to-moderate pulmonary edema has markedly improved. NG tube tip is out of view below the diaphragm. Cardiomediastinal contours areunchanged. There is no pneumothorax. If any, there is a small left pleural effusion. [**2170-1-1**]: ekg: Sinus rhythm. Possible inferior myocardial infarction. Borderline low voltage. Since the previous tracing of [**2169-12-28**] there is probably no significant change [**2170-1-1**]: chest x-ray: IMPRESSION: Retrocardiac atelectasis and improving pulmonary edema with small left pleural effusion. [**2170-1-1**]: chest x-ray: IMPRESSION: Right PICC tip in the right atrium, retraction by 5 cm should be considered [**2170-1-1**]: chest x-ray: The ET tube tip is 3.2 cm above the carina. The NG tube tip is in the stomach. The right PICC line tip has been adjusted, currently being at the level of mid SVC. There is interval improvement of pulmonary edema. Left retrocardiac consolidation is still present, most likely representing atelectasis, attention to this area is highly recommended to exclude the possibility of developing infection. Small amount of pleural effusion is seen bilaterally. The NG tube tip is in the stomach. [**2170-1-2**]: chest x-ray: FINDINGS: In comparison with the study of [**1-1**], the monitoring and support devices remain in place. Continued opacification in the retrocardiac region is consistent with atelectasis and effusion, in the appropriate clinical setting, superimposed pneumonia would have to be considered. Pulmonary vascularity is essentially within normal limits. [**2170-1-4**]: chest x-ray: FINDINGS: In comparison with the study of [**1-3**], the endotracheal tube has been removed. Some retrocardiac opacification persists consistent with volume loss and effusion. Prominence of pulmonary markings is consistent with elevated pulmonary venous pressure. Brief Hospital Course: 71 year old female with history of DM2, HL, and diverticulitis s/p subtotal hysterectomy and bilateral oopherectomy for a necrotic uterus and associated abscess, presenting with GNR/GPC bacteremia concerning for polymicrobial sepsis. # GNR/GPC sepsis: The patient was admitted to the MICU for polymicrobial sepsis, initially was on phenylephrine while at OSH, but on transfer to [**Hospital1 18**], the patient was off pressors. At OSH, she was s/p hysterectomy and bilateral oopherectomy with observed walled-off abscess adjacent to a necrotic uterus, with blood cultures in [**4-17**] bottles with GNRs + GPCs as well as urine cultures with GNRs. The patient was transferred over on Levoflox, Flagyl, and Zosyn and on arrival to [**Hospital1 18**], she was broaded to Vanc/Zosyn. Her a-line and PICC line placed at OSH were pulled. The patient was bolused cautiously for MAPs <65. The patient had an elevated white count, which persisted after starting empiric antibiotics. ID was consulted and they suggested that her white count was likely lagging and based on sensitivies from OSH, her abx were changed to Ceftriaxone/Flagyl. A new PICC line was placed. On transfer out of the MICU, here pressures were stable in 140-160s systolic. The patient remained afebrile throughout. . # Respiratory failure: Patient was intubated for the OR and remained intubate post operative; was found to have extensive pulmonary edema and was started on diuresis on tranfer to the [**Hospital1 18**]. While in the MICU diueresis was continued and the patient ultimately self extubated herself. Post extubation, she was satting in the high 90s on shovel mask. . # s/p exlap: Pt had exlap at OSH, found to have disintegrating uterus, with evidence of ?extrauterine abscess. As per operative note, the bowel was run and no evidence of perforation was seen. A JP was placed and the fascia was closed, but the skin and subcutaneous tissue was left open. On arrival to the MICU, JP was draining serosanginous fluid. However, a few days into the hospitalization, the JP started draining feculent material. Surgery was consulted re: possible fistula and patient was taken to the OR and then to the SICU postoperatively. . # altered mental status: S/p self-extubation, the patient was altered, lethargic, and not very responsive. Thought likely due to residual sedatives from being intubated, possibly hypomanic delirium. A CT head was done to rule out any intracranial pathology, which was negative for any acute intracranial process. The patient's mental status continually cleared while she was in the unit. . # Blood pressure: The patient was on neo at OSH, but on arrival to [**Hospital1 18**], her pressures stabilized. She had some episodes of hypotension into the low 80s, however, that responded to fluid boluses. Her home lisinopril was held while in the MICU. . # Acute kidney injury: On transfer to [**Hospital1 18**], the patient's creat up to 2.4, baseline 1.0-1.4. Likely related to hypotension and possible ATN, but no casts seen on urine sediment. Also could be related to contrast nephropathy, as pt had CT at OSH. Fena 5.2% consistent with an acute tubular necrosis picture. Her creat was trended while in the MICU, and on transfer out of the unit, her urine output was improving and creat trended down to 1.4. . # Acute blood loss anemia: Pt was transferred over from OSH with crit of 24, as per report, received 1U PRBC on transfer. Repeat crit was 28 and her crits remained stable while she was in the MICU. . # DM2: The patient's home oral hypoglycemics were held in patient, and she was started on ISS. # Hyperlipidemia: continue simvastatin ***Surgery consultation was placed [**1-2**] for feculent drainage from JP drain. On surgical evaluation patient was somnolent with mild lower abdominal tenderness on physical exam. Despite this, patient had frank stool from lower abdominal JP drain. Risks/benefits of surgical intervention were discussed with patient's family (healthcare proxy). During process of surgical evaluation patient had aspiration event requiring intubation. Patient was then taken to operating room for exploratory laparotomy. Intra-operative findings were consistent with sigmoid diverticulitis with extensive inflammation. Sigmoid colon was resected with Hartmann's procedure and washout. Patient tolerated procedure well and was tranferred to TSICU intubated/sedated for further management. Remainder of hospital course as follows: Neuro: Post-operatively, the patient was left intubated/sedated. Following extubation, analgesia administered via intermittent IV narcotics and acetaminophen with good effect and adequate pain control. Mental status cleared significantly with return to near baseline (A&Ox3) by POD1. When tolerating oral intake, the patient was transitioned to oral pain medications. CV: Patient did not require pressors postop. Had intermittent hypertension managed w prn hydralazine IV. When tolerating po intake patient was started on home CV medications. vital signs were routinely monitored. Pulmonary: Patient was left intubated postop and successfully extubated POD1 ([**1-3**]). Supplemental oxygen was weaned effectively. Pulmonary toilet including incentive spirometry and early ambulation were encouraged. The patient was stable from a pulmonary standpoint; vital signs were routinely monitored. GI/GU: Post-operatively, the patient was NPO w IVF hydration and NGT. NGT removed [**1-4**] w positive gas and stool per ostomy. Her diet was advanced to sips [**1-4**], regular diet [**1-5**], which was tolerated well. She was also started on a bowel regimen to encourage bowel movement. JP drain was removed [**1-5**] as output decreased to less than 30cc/day. Lower midline abdominal wound had been left open to close by secondary intention following initial OSH surgery. Lower midline was used for Hartmann's and left open to close by secondary intention. With wound base clean and fascia intact, vac was placed [**1-4**]. This was changed at 3 day intervals with good result and healthy granulation tissue seen to be forming. Patient had manifested [**Last Name (un) **] w creatinine bump as per above. This returned to [**Location 213**] as patient recovered. Foley was removed on [**1-5**] and patient voided appropriately. Intake and output were closely monitored. ID: At time of transfer from medical service patient was on CTX/flagyl per ID recs. Leukocytosis and fever curve were followed. Intra-operative findings and persistent leukocytosis prompted switch to vanco/zosyn per ID [**1-3**]. This was continued until [**1-8**]. All BCx at [**Hospital1 18**] were returned negative as of this report. HEME: Patient admitted with baseline anemia from OSH. Postoperatively hct drifted from 25-28 range to low 20s though no bleeding source suspected. Transfused 1u pRBC [**1-5**] and 25 w appropriate bump in hct. Hct was trended and found to be stable following this. ENDO: Insulin sliding scale was utilized for glucose control postop with good effect. Transitioned to home po regimen when tolerating po. Prophylaxis: The patient received subcutaneous heparin during this stay, and was encouraged to get up and ambulate as early as possible. DISPO: Patient evaluated by PT who recommended dispo to rehab for continued recovery. This was arranged and patient prepared for d/c [**1-9**]. At the time of discharge on [**1-9**], the patient was doing well, afebrile with stable vital signs, tolerating a regular diet, ambulating w assistance, voiding without assistance, and pain was well controlled. Medications on Admission: [**Last Name (un) 1724**]: Lisinopril 10', Glyburide 5 qAM, 2.5mg qPM, Metformin 1000'', Fish Oil 300'', Glucosamine-chondroitin 1', Simvastatin 40' Discharge Medications: 1. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. glyburide 5 mg Tablet Sig: One (1) Tablet PO MORNING (). 4. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO EVENING (). 5. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush PICC, non-heparin dependent: Flush with 10 mL Normal Saline daily and PRN per lumen. Discharge Disposition: Extended Care Facility: [**Hospital3 7665**] Discharge Diagnosis: sepsis perforated diverticulitis 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 after you had an exploratory lapartomy for a ? ruptured uterus. You developed an abscess near your surgery site and became very ill. You were transferred here for further managment. You were takne to the operating room where you found to have a perforated diverticulitis with pelvic peritonitis. You had a section of your colon resected and had a colostomy placed. You are slowly getting better. You vital signs are stable and your white blood cell count is decreasing. You are now on intravenous antibiotics. You had a special dressing called a VAC dressing over the incision to help with wound healing. You are now preparing for discharge. Completed by:[**2170-1-9**]

038,567,584,785,507,614,518,615,599,285,562,569,995,041,250,401,272,780,V880,288

{'Septicemia due to escherichia coli [E. coli],Peritoneal abscess,Acute kidney failure with lesion of tubular necrosis,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute or unspecified pelvic peritonitis, female,Acute edema of lung, unspecified,Acute inflammatory diseases of uterus, except cervix,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Diverticulitis of colon (without mention of hemorrhage),Abscess of intestine,Severe sepsis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other alteration of consciousness,Acquired absence of both cervix and uterus,Leukocytosis, 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: sepsis PRESENT ILLNESS: Ms. [**Known lastname **] is a 71 year old female with previous medical history significant for DM2, HTN/HL, and diverticulosis. She initially presented to [**Hospital6 19155**] on [**12-27**] with 3 weeks of crampy abdominal pain. Initial pain control with Dilaudid and nausea control with Zofran + Reglan. CT abdomen showed ?diverticular abscess and he was started on Levaquin/Flagyl initially. She had a leukocytosis to 25 and hypotension requiring neosyneprhine. Given her worsening picture, she was brought to the OR for an exploratory laparotomy. . A necrotic uterus was found and Ob-Gyn was called in for a sub-total hysterectomy and bilateral salpingo-oopherectomy and omentectomy were performed. They found a pocket of pus/abscess adjacent to uterus (walled off). No fistula, no diverticulitis. Omentectomy done "just in case it was cancer". They closed the fascia, placed a JP, left SQ tissue open. She was given FFP and 10mg vitamin K IV intra-op for an INR of 1.6-->1.4. Peri-operative EBL~500cc and follow-up hematocrit went from 26 to 24. She no longer required pressors post-operatively, but remained intubated due desaturation to 85% on 4L, corrected to 100% on NRB presumably secondary to pulmonary edema (confirmed by CXR) so she was given lasix 100mg IV with 1650cc output. Prior to transfer, she was reportedly given 1 unit pRBCs followed by Lasix. Antibiotic coverage broadened with Zosyn/Flagyl/Levaquin with blood cultures growing GNRs and GPCs in [**4-17**] bottles and GNRs in urine culture. An arterial line is in place with a right double-lumen PICC. She was sedated on propofol. She has a partially open abdomen, packed with betadine/gauze and with a JP drain in place (drained 20cc of serosanguinous fluid to date). . On arrival to the MICU, she was breathing spontaneously on pressure support and ABG showed 7.37/37/152. She was in significant pain, so she was bolused with Fentanyl for comfort and started back on AC for rest. . Review of systems: Unable to perform secondary to sedation MEDICAL HISTORY: type 2 diabetes mellitus - HTN (diagnosed in [**2164**]) - HL - diverticulosis - right hydronephrosis on CT abdomen in [**2164**], ?etiology - s/p carpal tunnel release - "disc surgery" - tubal ligation MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: Lisinopril 10', Glyburide 5 qAM, 2.5mg qPM, Metformin 1000'', Fish Oil 300'', Glucosamine-chondroitin 1', Simvastatin ALLERGIES: epinephrine PHYSICAL EXAM: Admission PE: Vitals: T: 97.7, BP: 93/50, P: 93/50, R: 15 O2: 86% on PS [**10-23**] General: opens eyes to voice, sleepy HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL Neck: supple, JVP not elevated, no LAD CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Lungs: Relatively clear to auscultation bilaterally, no wheezes, rales, rhonchi Abdomen: protuberant, soft, diffusely tender with vertically-sutured wound packed with gauze and abdominal binder in place. Bowel sounds quiet, no organomegaly appreciated GU: foley in place Ext: warm, well perfused, 2+ pulses, no clubbing, [**1-15**]+ edema Neuro: opens eyes to voice, painful to palpation of abdomen FAMILY HISTORY: No reported history of cancers, blood disorders, or GU issues. Mother had breast "lump". One of her daughter had a hysterectomy for unknown reasons. SOCIAL HISTORY: Lives independently in [**Location (un) **] - Tobacco: none - Alcohol: none - Illicits: none ### Response: {'Septicemia due to escherichia coli [E. coli],Peritoneal abscess,Acute kidney failure with lesion of tubular necrosis,Septic shock,Pneumonitis due to inhalation of food or vomitus,Acute or unspecified pelvic peritonitis, female,Acute edema of lung, unspecified,Acute inflammatory diseases of uterus, except cervix,Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Diverticulitis of colon (without mention of hemorrhage),Abscess of intestine,Severe sepsis,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group B,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other alteration of consciousness,Acquired absence of both cervix and uterus,Leukocytosis, unspecified'}

CHIEF COMPLAINT: septic shock pnemonia PRESENT ILLNESS: Chief Complaint: Respiratory failure . History of Present Illness (Of note, much of the hx is obtained from family as the pt was intubated): Mr. [**Known lastname **] is a 83 yo M with HLD, CAD s/p MI (unknown intervention hx), and RCC metastatic to liver and ?bone, who presented this morning to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] hospital complaining of 1 day of nausea and vomiting. As per the patient's family, the pt was found in the AM having had vomitted numerous times O/N. The pt denied any cough or fever, but did endorse chills, fatigue, and recent loss of appetite. The friend that found the pt noted him to be quite pale, and brought him to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **]. At the OSH ED, he was found to have a WBC of 14 with 40% bands, CXR showed PNA. He was given levofloxacin 750 mg, azithromycin 500 mg, subsequently developed respiratory failure, was intubated, given 4L NS and transfered to [**Hospital1 18**]. During his transfer his SBP was low and he was started on norepinephrine. . In the ED, initial VS were: T 97, HR 73, BP 85/73, on a vent. Patient's antibiotics were broadened to vanc/zosyn, a RIJ was placed, he was given 500 mL NS and admitted to the CCU. . On the floor, the patient is intubated and unable to answer questions. MEDICAL HISTORY: Past Medical History: HLD CAD s/p MI (before the age of 40) RCC metastatic to liver/bone marrow MEDICATION ON ADMISSION: Crestor Sutent (sunitinib) 25 mg PO daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical Exam: Vitals: T: BP: 98/59 P:93 R: 31 O2: 96% on vent General: Intubated and sedated HEENT: NCAT Neck: RIJ c/d/i Lungs: Coarse breath sounds and crackles noted R>L, no wheezes CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present Ext: cold, poorly perfused, 2+ pulses in femorals, unable to feel pulses in radials and DPs, no edema Neuro: Intubated and sedated, no response to noxious stimuli FAMILY HISTORY: Family History (unable to obtain): Unknown SOCIAL HISTORY: Social History (unable to obtain): - Tobacco: Unknown - Alcohol: Unknown - Illicits: Unknown

Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Septic shock,Acute kidney failure with lesion of tubular necrosis,Malignant neoplasm of kidney, except pelvis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Acidosis,Severe sepsis,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Examination of participant in clinical trial

Septicemia NOS,Acute respiratry failure,Pneumonia, organism NOS,Septic shock,Ac kidny fail, tubr necr,Malig neopl kidney,Second malig neo liver,Secondary malig neo bone,Acidosis,Severe sepsis,Cardiac arrest,Crnry athrscl natve vssl,Old myocardial infarct,Hyperlipidemia NEC/NOS,Exam-clincal trial

Admission Date: [**2179-6-3**] Discharge Date: [**2179-6-4**] Date of Birth: [**2095-9-22**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5608**] Chief Complaint: septic shock pnemonia Major Surgical or Invasive Procedure: none, arrived intubated with CVL in place from OSH History of Present Illness: Chief Complaint: Respiratory failure . History of Present Illness (Of note, much of the hx is obtained from family as the pt was intubated): Mr. [**Known lastname **] is a 83 yo M with HLD, CAD s/p MI (unknown intervention hx), and RCC metastatic to liver and ?bone, who presented this morning to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] hospital complaining of 1 day of nausea and vomiting. As per the patient's family, the pt was found in the AM having had vomitted numerous times O/N. The pt denied any cough or fever, but did endorse chills, fatigue, and recent loss of appetite. The friend that found the pt noted him to be quite pale, and brought him to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **]. At the OSH ED, he was found to have a WBC of 14 with 40% bands, CXR showed PNA. He was given levofloxacin 750 mg, azithromycin 500 mg, subsequently developed respiratory failure, was intubated, given 4L NS and transfered to [**Hospital1 18**]. During his transfer his SBP was low and he was started on norepinephrine. . In the ED, initial VS were: T 97, HR 73, BP 85/73, on a vent. Patient's antibiotics were broadened to vanc/zosyn, a RIJ was placed, he was given 500 mL NS and admitted to the CCU. . On the floor, the patient is intubated and unable to answer questions. Past Medical History: Past Medical History: HLD CAD s/p MI (before the age of 40) RCC metastatic to liver/bone marrow Social History: Social History (unable to obtain): - Tobacco: Unknown - Alcohol: Unknown - Illicits: Unknown Family History: Family History (unable to obtain): Unknown Physical Exam: Physical Exam: Vitals: T: BP: 98/59 P:93 R: 31 O2: 96% on vent General: Intubated and sedated HEENT: NCAT Neck: RIJ c/d/i Lungs: Coarse breath sounds and crackles noted R>L, no wheezes CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present Ext: cold, poorly perfused, 2+ pulses in femorals, unable to feel pulses in radials and DPs, no edema Neuro: Intubated and sedated, no response to noxious stimuli Pertinent Results: [**2179-6-3**] 10:23PM TYPE-ART RATES-24/16 TIDAL VOL-500 PEEP-5 O2-100 PO2-224* PCO2-45 PH-7.16* TOTAL CO2-17* BASE XS--12 AADO2-464 REQ O2-77 -ASSIST/CON INTUBATED-INTUBATED [**2179-6-3**] 10:23PM GLUCOSE-156* LACTATE-6.0* NA+-134* K+-3.9 CL--106 [**2179-6-3**] 10:23PM HGB-9.0* calcHCT-27 O2 SAT-99 CARBOXYHB-0.9 MET HGB-0.3 [**2179-6-3**] 10:23PM freeCa-0.98* [**2179-6-3**] 09:59PM PH-6.97* COMMENTS-GREEN TOP [**2179-6-3**] 09:59PM GLUCOSE-60* LACTATE-7.8* NA+-141 K+-3.9 CL--108 TCO2-16* [**2179-6-3**] 09:59PM HGB-9.8* calcHCT-29 O2 SAT-74 CARBOXYHB-1.8 MET HGB-0.2 [**2179-6-3**] 09:59PM freeCa-0.92* [**2179-6-3**] 09:45PM UREA N-26* CREAT-2.6* [**2179-6-3**] 09:45PM estGFR-Using this [**2179-6-3**] 09:45PM ALT(SGPT)-38 AST(SGOT)-96* ALK PHOS-77 TOT BILI-0.8 [**2179-6-3**] 09:45PM LIPASE-8 [**2179-6-3**] 09:45PM cTropnT-0.47* [**2179-6-3**] 09:45PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG [**2179-6-3**] 09:45PM WBC-19.8* RBC-3.44* HGB-9.1* HCT-30.0* MCV-87 MCH-26.5* MCHC-30.5* RDW-23.8* [**2179-6-3**] 09:45PM NEUTS-68 BANDS-13* LYMPHS-7* MONOS-8 EOS-0 BASOS-0 ATYPS-0 METAS-3* MYELOS-1* [**2179-6-3**] 09:45PM HYPOCHROM-2+ ANISOCYT-2+ POIKILOCY-2+ MACROCYT-1+ MICROCYT-1+ POLYCHROM-1+ OVALOCYT-1+ TARGET-1+ SCHISTOCY-1+ BURR-2+ [**2179-6-3**] 09:45PM PT-20.1* PTT-54.4* INR(PT)-1.9* [**2179-6-3**] 09:45PM PLT COUNT-207 [**2179-6-3**] 09:45PM FIBRINOGE-319 Brief Hospital Course: Mr. [**Known lastname **] is a 83 yo M with HLD, CAD s/p MI (unknown intervention hx), and RCC metastatic to liver and bone marrow, who presented to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] hospital complaining of 2 days of nausea and vomiting found to have PNA, who was transferred to [**Hospital1 18**] for further management after developing respiratory failure. His family arrived the following morning and goals of care were shifted to comfort. Pressors [**Last Name (un) 8966**] discontinued and the pt expired shortly thereafter. His family declined a post-mortem examination. . #. PNA/ Respiratory failure: Patient found to have PNA at OSH, subsequently developed respiratory failure, was intubated and started on norepinephrine on transfer. Admission CXR revealed large right mid-lower lobe consolidation. He was treated with Vanco/Zosyn and mechanical ventilation was continued until he expired. . #. Septic shock: Patient presented developed hypotension on transfer from the OSH and started on norepinephrine. On admission pH 7.16 and lactate of 7.8. Lactate improved with fluid resuscitation. Pressors discontinued when goals of care were focused on comfort. . #. Metastic RCC: Prior to pursuing comfort, confirmed pt's previously guarded prognosis from an oncologic perspective with his onocologist, Dr. [**Last Name (STitle) 1492**]. Medications on Admission: Crestor Sutent (sunitinib) 25 mg PO daily Discharge Medications: n/a Discharge Disposition: Expired Discharge Diagnosis: Lobar Pneumonia Hypoxic Resp Failure Septic Shock Metastatic Renal Cell Carcinoma Discharge Condition: Deceased Discharge Instructions: n/a Followup Instructions: n/a Completed by:[**2179-6-7**]

038,518,486,785,584,189,197,198,276,995,427,414,412,272,V707

{'Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Septic shock,Acute kidney failure with lesion of tubular necrosis,Malignant neoplasm of kidney, except pelvis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Acidosis,Severe sepsis,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Examination of participant in clinical trial'}

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: septic shock pnemonia PRESENT ILLNESS: Chief Complaint: Respiratory failure . History of Present Illness (Of note, much of the hx is obtained from family as the pt was intubated): Mr. [**Known lastname **] is a 83 yo M with HLD, CAD s/p MI (unknown intervention hx), and RCC metastatic to liver and ?bone, who presented this morning to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] hospital complaining of 1 day of nausea and vomiting. As per the patient's family, the pt was found in the AM having had vomitted numerous times O/N. The pt denied any cough or fever, but did endorse chills, fatigue, and recent loss of appetite. The friend that found the pt noted him to be quite pale, and brought him to the [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **]. At the OSH ED, he was found to have a WBC of 14 with 40% bands, CXR showed PNA. He was given levofloxacin 750 mg, azithromycin 500 mg, subsequently developed respiratory failure, was intubated, given 4L NS and transfered to [**Hospital1 18**]. During his transfer his SBP was low and he was started on norepinephrine. . In the ED, initial VS were: T 97, HR 73, BP 85/73, on a vent. Patient's antibiotics were broadened to vanc/zosyn, a RIJ was placed, he was given 500 mL NS and admitted to the CCU. . On the floor, the patient is intubated and unable to answer questions. MEDICAL HISTORY: Past Medical History: HLD CAD s/p MI (before the age of 40) RCC metastatic to liver/bone marrow MEDICATION ON ADMISSION: Crestor Sutent (sunitinib) 25 mg PO daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Physical Exam: Vitals: T: BP: 98/59 P:93 R: 31 O2: 96% on vent General: Intubated and sedated HEENT: NCAT Neck: RIJ c/d/i Lungs: Coarse breath sounds and crackles noted R>L, no wheezes CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: soft, non-tender, non-distended, bowel sounds present Ext: cold, poorly perfused, 2+ pulses in femorals, unable to feel pulses in radials and DPs, no edema Neuro: Intubated and sedated, no response to noxious stimuli FAMILY HISTORY: Family History (unable to obtain): Unknown SOCIAL HISTORY: Social History (unable to obtain): - Tobacco: Unknown - Alcohol: Unknown - Illicits: Unknown ### Response: {'Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Septic shock,Acute kidney failure with lesion of tubular necrosis,Malignant neoplasm of kidney, except pelvis,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Acidosis,Severe sepsis,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Examination of participant in clinical trial'}

CHIEF COMPLAINT: Motobike vs. car, thrown for bike, significant left sided injuries PRESENT ILLNESS: Pt was a helmeted motorcycle rider that was hit by SUV at high rate of speed. EtOH negative. Combative at sceen, Left sided chest pain, and SOB Unknown LOC. Intubated by [**Location (un) 7622**]. MEDICAL HISTORY: None MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission: VS:100.8, 111, 127/74, 100% Gen: Intubated GCS 3t (paralyzed en route) HEENT: PEERL, facial lacerations, TMs clear B Neck: trachea Midline Chest decrease BS on Left, otherwise CTA Abd: soft NT/ND Pelvis: stable Rectal: heme neg, good tone Back: no stepoffs no lacs Ext: Left humerus with open fracture, Left shoulder deformity, Ecchymosis over Left thigh FAMILY HISTORY: SOCIAL HISTORY:

Open fracture of shaft of humerus,Traumatic pneumothorax without mention of open wound into thorax,Injury to spleen without mention of open wound into cavity, unspecified injury,Open fracture of metacarpal bone(s), site unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Open wound of hand except finger(s) alone, without mention of complication,Contusion of lung without mention of open wound into thorax,Abrasion or friction burn of hip, thigh, leg, and ankle, without mention of infection

Fx humerus shaft-open,Traum pneumothorax-close,Spleen injury NOS-closed,Fx metacarpal NOS-open,Mv collis NOS-motorcycl,Open wound of hand,Lung contusion-closed,Abrasion hip & leg

Admission Date: [**2100-8-2**] Discharge Date: [**2100-8-9**] Date of Birth: [**2081-12-31**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5880**] Chief Complaint: Motobike vs. car, thrown for bike, significant left sided injuries Major Surgical or Invasive Procedure: Left Humerus ORIF Chest tube placement History of Present Illness: Pt was a helmeted motorcycle rider that was hit by SUV at high rate of speed. EtOH negative. Combative at sceen, Left sided chest pain, and SOB Unknown LOC. Intubated by [**Location (un) 7622**]. Past Medical History: None Physical Exam: On admission: VS:100.8, 111, 127/74, 100% Gen: Intubated GCS 3t (paralyzed en route) HEENT: PEERL, facial lacerations, TMs clear B Neck: trachea Midline Chest decrease BS on Left, otherwise CTA Abd: soft NT/ND Pelvis: stable Rectal: heme neg, good tone Back: no stepoffs no lacs Ext: Left humerus with open fracture, Left shoulder deformity, Ecchymosis over Left thigh Pertinent Results: [**8-2**]: CT head and neck: negative [**8-2**]: L Arm XR: Left humerus mid shaft compound comminuted fracture with medial angulation of the distal fracture fragments. [**8-2**]: CT chest/Abd/Pelvis 1. Extensive splenic lacerations with perisplenic hematoma and a moderate amount of blood within the abdomen and pelvis. 2. Moderate-sized left pneumothorax, without evidence of midline shift. Small peripheral opacities within the lungs bilaterally, which likely represent contusions. Small left pleural effusion. [**2100-8-9**] 05:25AM BLOOD WBC-13.2* RBC-3.31* Hgb-10.2* Hct-30.0* MCV-91 MCH-30.9 MCHC-34.1 RDW-13.3 Plt Ct-451* [**2100-8-8**] 07:10PM BLOOD Hct-27.9* [**2100-8-8**] 01:00PM BLOOD Hct-28.8* [**2100-8-2**] 09:50PM BLOOD WBC-21.4* RBC-4.01* Hgb-12.5* Hct-36.6* MCV-91 MCH-31.1 MCHC-34.1 RDW-12.4 Plt Ct-275 [**2100-8-3**] 04:55AM BLOOD WBC-9.0# RBC-3.00*# Hgb-9.2*# Hct-26.5*# MCV-88 MCH-30.6 MCHC-34.6 RDW-12.3 Plt Ct-193 [**2100-8-3**] 10:22AM BLOOD Hct-26.3* [**2100-8-8**] 08:54AM BLOOD Glucose-94 UreaN-20 Creat-0.7 Na-136 K-4.2 Cl-99 HCO3-28 AnGap-13 [**2100-8-3**] 04:55AM BLOOD Glucose-121* UreaN-19 Creat-1.0 Na-141 K-4.1 Cl-109* HCO3-24 AnGap-12 [**2100-8-9**] 05:25AM BLOOD ALT-46* AST-41* AlkPhos-47 TotBili-1.0 [**2100-8-3**] 04:55AM BLOOD ALT-55* AST-108* AlkPhos-41 Amylase-72 TotBili-0.9 [**2100-8-8**] 08:54AM BLOOD Calcium-8.7 Phos-4.5 Mg-2.0 [**2100-8-3**] 04:55AM BLOOD Calcium-8.6 Phos-5.3* Mg-1.5 [**2100-8-2**] 09:50PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG [**2100-8-2**] 10:13PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG Brief Hospital Course: Pt is a 19yo Man s/p motorbike vs SUV, pt helmeted, Trauma transfer via [**Location (un) **]. On presentation pt presented with and open humerus fracture and On Ct was found to have a significant splenic laceration. Pt was also found to have small Left sided PNX which was treated via Chest Tube. As VS were stable patient was taken to the OR for ORIF of his humerus fracture. Superficial cuts to the hands were sutured and a Left sided abrasion at the hip was dressed. The splenic laceration was managed conservatively. Pt was admitted to the TSICU, and was transferred to the floor with stable Hcts. On the floor the Patient's Hct decreased slightly prompting a reinstitution of strict bedrest. Pts Hcts stabilized once more and patient was discharged with follow up. Discharge Medications: 1. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: [**1-24**] Tablets PO Q4-6H (every 4 to 6 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Discharge Disposition: Home Discharge Diagnosis: Splenic Laceration Left Humerus fracture, repaired Left hip abrasion Hand lacerations, repaired Left Pneumothorax, resolved status post chest Tube Discharge Condition: Stable Discharge Instructions: Take medications as perscribed, follow up as directed. Avoid all contact sports, avoid lifting anything heavier than a phone book. It you feel extremely light headed or faint, return to the emergency department as soon as possible. Also retuyrn to the emergency department if you develop fevers > 101.5, severe abdominal pain, or increasing pain that is not controlled with pain medication. Take medications as perscribed, follow up as directed. Avoid all contact sports, avoid lifting anything heavier than a phone book. It you feel extremely light headed or faint, return to the emergency department as soon as possible. Also retuyrn to the emergency department if you develop fevers > 101.5, severe abdominal pain, or increasing pain that is not controlled with pain medication. Followup Instructions: Follow up with Dr. [**Last Name (STitle) 2719**] in 2 weeks regarding your arm fracture, call for appointment at ([**Telephone/Fax (1) 47479**] Contact the Trauma Surgery office at [**Telephone/Fax (1) 2359**] to arrange a follow up appointment in about 1 month. Schedule an abdominal CT scan prior to this appointment to evaluate your splenic laceration. X ray scheduling [**Telephone/Fax (1) 327**].

812,860,865,815,E812,882,861,916

{'Open fracture of shaft of humerus,Traumatic pneumothorax without mention of open wound into thorax,Injury to spleen without mention of open wound into cavity, unspecified injury,Open fracture of metacarpal bone(s), site unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Open wound of hand except finger(s) alone, without mention of complication,Contusion of lung without mention of open wound into thorax,Abrasion or friction burn of hip, thigh, leg, and ankle, without mention of infection'}

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: Motobike vs. car, thrown for bike, significant left sided injuries PRESENT ILLNESS: Pt was a helmeted motorcycle rider that was hit by SUV at high rate of speed. EtOH negative. Combative at sceen, Left sided chest pain, and SOB Unknown LOC. Intubated by [**Location (un) 7622**]. MEDICAL HISTORY: None MEDICATION ON ADMISSION: ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On admission: VS:100.8, 111, 127/74, 100% Gen: Intubated GCS 3t (paralyzed en route) HEENT: PEERL, facial lacerations, TMs clear B Neck: trachea Midline Chest decrease BS on Left, otherwise CTA Abd: soft NT/ND Pelvis: stable Rectal: heme neg, good tone Back: no stepoffs no lacs Ext: Left humerus with open fracture, Left shoulder deformity, Ecchymosis over Left thigh FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Open fracture of shaft of humerus,Traumatic pneumothorax without mention of open wound into thorax,Injury to spleen without mention of open wound into cavity, unspecified injury,Open fracture of metacarpal bone(s), site unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring motorcyclist,Open wound of hand except finger(s) alone, without mention of complication,Contusion of lung without mention of open wound into thorax,Abrasion or friction burn of hip, thigh, leg, and ankle, without mention of infection'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 42 year old man with a past medical history of HIV and depression, who intentionally took approximately 16 Nortriptyline pills and 20 Klonopin pills on the day of admission, [**2170-11-5**]. He was originally admitted to the Intensive Care Unit for care. He was in a coma with dilated pupils on presentation. MEDICAL HISTORY: 1. Human Immunodeficiency Virus diagnosed in [**2156**]. The patient was on HAART from [**2161**] until [**2165**]. He states that he had two episodes of PCP [**Last Name (NamePattern4) **] [**2163**] and in [**2164**], when his CD4 count was approximately 50. He was restarted on his HAART in [**2169**] and he self-discontinued his HAART in [**2170-5-23**] when his CD4 count was 900. He is currently followed for his HIV at the [**Hospital1 778**]. 2. Depression. 3. History of substance abuse in the past with cocaine and currently with Klonopin. 4. Chronic back pain. 5. Sleep disturbance. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives in [**Location (un) 44698**] which is a group home for HIV males with substance abuse histories. He admits to occasional alcohol use but denies intravenous drug use at this time. He does smoke cigarettes.

Coma,Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior,Pneumonia, organism unspecified,Human immunodeficiency virus [HIV] disease,Other, mixed, or unspecified drug abuse, unspecified,Retention of urine, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents

Coma,Rec depr psych-psychotic,Pneumonia, organism NOS,Human immuno virus dis,Drug abuse NEC-unspec,Retention urine NOS,Poison-psychotropic agt

Admission Date: [**2170-11-5**] Discharge Date: [**2170-11-10**] Date of Birth: [**2128-10-7**] Sex: M Service: [**Company 191**]-MED REASON FOR ADMISSION: This patient was a call-out from the Intensive Care Unit after a TCA overdose who is now stable but still needs monitoring and psychiatric follow-up. HISTORY OF PRESENT ILLNESS: This is a 42 year old man with a past medical history of HIV and depression, who intentionally took approximately 16 Nortriptyline pills and 20 Klonopin pills on the day of admission, [**2170-11-5**]. He was originally admitted to the Intensive Care Unit for care. He was in a coma with dilated pupils on presentation. EMERGENCY ROOM COURSE: The patient was intubated and he received three ampules of sodium bicarbonate in D5W at 250 cc. per hour. He was given 100 grams of activated charcoal and admitted to the SICU. His EKG was notable for a prolonged QRS. INTENSIVE CARE UNIT COURSE, [**11-5**] until [**11-7**]: The patient was seen by Psychiatry and given more bicarbonate, potassium and magnesium. On [**11-7**], he spiked a temperature to 101.4 F. He was extubated and the central line was discontinued on [**11-7**]. He was started on Levofloxacin for a presumed pneumonia and he was sent stable to the floor on [**2170-11-7**]. REVIEW OF SYSTEMS: Positive for productive cough, pleuritic chest pain. No nausea, vomiting or abdominal pain. PAST MEDICAL HISTORY: 1. Human Immunodeficiency Virus diagnosed in [**2156**]. The patient was on HAART from [**2161**] until [**2165**]. He states that he had two episodes of PCP [**Last Name (NamePattern4) **] [**2163**] and in [**2164**], when his CD4 count was approximately 50. He was restarted on his HAART in [**2169**] and he self-discontinued his HAART in [**2170-5-23**] when his CD4 count was 900. He is currently followed for his HIV at the [**Hospital1 778**]. 2. Depression. 3. History of substance abuse in the past with cocaine and currently with Klonopin. 4. Chronic back pain. 5. Sleep disturbance. SOCIAL HISTORY: The patient lives in [**Location (un) 44698**] which is a group home for HIV males with substance abuse histories. He admits to occasional alcohol use but denies intravenous drug use at this time. He does smoke cigarettes. ALLERGIES: No known drug allergies. MEDICATIONS ON TRANSFER TO THE FLOOR: 1. Levofloxacin 500 mg q. day started on [**11-7**]. 2. Tylenol p.r.n. OUTPATIENT MEDICINES: 1. Klonopin 3 mg q. h.s. 2. Motrin 400 mg three times a day. 3. Seroquel 75 mg q. h.s. 4. Combivir one tablet twice a day. 5. Nortriptyline 100 to 150 mg q. h.s. 6. Viramune 500 mg twice a day. 7. [**Doctor First Name **] D one tablet twice a day. 8. Tramadol 50 mg q. six hours p.r.n. 9. Chloral hydrate 500 mg q. h.s. 10. Kenalog 5 mg three times a day. PHYSICAL EXAMINATION: Vital signs were heart rate 92; saturation 96% on room air and otherwise stable. In general, in no acute distress. HEENT: Mucous membranes are moist. Pupils are equal, round and reactive to light. There is no jugular venous distention. Chest: Clear to auscultation bilaterally. Cardiovascular: Regular rate and rhythm, normal S1 and S2. No murmurs, rubs or gallops. Abdomen with positive bowel sounds, soft, nontender, nondistended, obese. Extremities with no cyanosis, clubbing or edema. Plus two dorsalis pedis bilaterally. Neurological: Flat affect and alert and oriented times three, non-focal. LABORATORY: On transfer to the floor, hematocrit 37.6, white count of 10.3, potassium of 3.2, magnesium of 1.4, TSH 1.6. A urine toxicology screen on the day of admission was positive for benzodiazepines. A serum toxicology screen on the day of admission was positive for tricyclic anti-depressants. A chest x-ray on [**11-7**] showed right diaphragm elevated and a right lower lobe atelectasis versus consolidation. EKG on [**11-7**], sinus at a rate of 93; normal axis, PR 160, QRS of 110. QTC 412. No ST or T wave changes. IMPRESSION: This is a 42 year old male call out from the Intensive Care Unit after intentional TCA overdose, no extubated and EKG abnormalities are resolving. HOSPITAL COURSE (SINCE DISCHARGE FROM THE INTENSIVE CARE UNIT TO THE FLOOR): 1. TOXICOLOGY: The QRS remained narrow on the floor for over two days (QRS less than 100). There were no events on Telemetry and it was discontinued on [**11-9**]. His electrolytes were aggressively repleted and normalized by [**11-9**]. From a cardiac standpoint he was stable for discharge to a psychiatric facility on [**11-9**], however, patient was unable to void, likely secondary to anti-cholinergic side effects of his TCA overdose. He was straight cathed on the night of [**11-8**] with a total residual urine of 1,600 cc. At that time, his Foley was replaced. On the morning of [**11-9**], the Foley was removed and we began a trial of bethanechol, 10 mg q. one hour times five until the patient voids. At the time of this discharge summary, the patient had not yet voided and had just received his third dose. Please see the discharge addendum. The patient was unable to transfer to Psychiatry from a psychiatric standpoint until he voids, however, he is medically stable for transfer. 2. HEMATOLOGIC: Deep vein thrombosis prophylaxis with subcutaneous heparin. 3. INFECTIOUS DISEASE: A CD4 count was 355. Viral load was pending at the time of this dictation. There was no need to start HAART or prophylaxis at this time. [**Month (only) 116**] want to consider starting HAART treatment in the future once the acute psychiatric issues have resolved if the patient can adhere to this treatment. He received topical Kenalog for oral hairy leukoplakia. Treatment was initiated with Levofloxacin for a fever, cough and a question of a right lower lobe consolidation (on chest x-ray, atelectasis versus consolidation) on [**11-7**]. The patient improved by [**11-9**] on Levaquin and should complete a seven day course for bronchitis versus question of pneumonia. 4. PSYCHIATRIC: Psychiatry continued to follow the patient on the floor for ongoing issues of depression, sleep disturbance and status post overdose. He was restarted on Prozac 10 q. a.m. and Seroquel 25 q. h.s. on [**11-8**]. The one-to-one sitter was continued throughout this admission. The patient is to be transferred to an inpatient psychiatric unit from here. CONDITION ON DISCHARGE: Fair. DISCHARGE STATUS: The patient is to be discharged to an inpatient psychiatric facility. DISCHARGE MEDICATIONS: 1. Levaquin 500 mg q. day to complete a seven day course. 2. Tylenol p.r.n. 3. Prozac 10 mg q. a.m. 4. Motrin 400 to 800 q. six hours p.r.n. back pain. 5. Kenalog Topical Ointment q. six hours p.r.n. 6. Seroquel 25 mg q. h.s. DISCHARGE DIAGNOSES: 1. Status post TCA (also Klonopin) overdose, suicide attempt. 2. Human Immunodeficiency Virus. 3. Depression/sleep disturbance. 4. Substance abuse (recently with Klonopin and in the past with cocaine). [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2667**], M.D. [**MD Number(1) 2668**] Dictated By:[**Name8 (MD) 210**] MEDQUIST36 D: [**2170-11-9**] 15:58 T: [**2170-11-9**] 22:51 JOB#: [**Job Number 44699**] Name: [**Known lastname 8180**], [**Known firstname **] Unit No: [**Numeric Identifier 8181**] Admission Date: [**2170-11-5**] Discharge Date: [**2170-11-10**] Date of Birth: [**2128-10-7**] Sex: M Service: [**Company 112**] MEDICINE CONTINUATION OF HOSPITAL COURSE: Mr. [**Known lastname **] was able to void by [**2170-11-10**] after treatment with Bethanechol. However, he still had a postvoid residual of 400 cc; therefore, the Foley was put back in place and should remain for two days. He was discharged to a psychiatric inpatient hospital and in addition to his discharge medications he will also be on Bethanechol 10 mg t.i.d. for a total of two days until the Foley is removed. Then, he will need to have his urine output monitored carefully. Of note, there was an error in the discharge summary in that the patient intentionally took 60 nortriptyline pills not 16. Of note, the patient's primary care physician is [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 8182**] at the [**Hospital1 8183**] and his psychiatrist is Dr. [**Last Name (STitle) 8184**]. [**First Name11 (Name Pattern1) 126**] [**Last Name (NamePattern4) 290**], M.D. [**MD Number(1) 291**] Dictated By:[**Name8 (MD) 6984**] MEDQUIST36 D: [**2170-11-11**] 14:54 T: [**2170-11-11**] 15:21 JOB#: [**Job Number 8185**] cc:[**Last Name (NamePattern4) 8186**]

780,296,486,042,305,788,E950

{'Coma,Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior,Pneumonia, organism unspecified,Human immunodeficiency virus [HIV] disease,Other, mixed, or unspecified drug abuse, unspecified,Retention of urine, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents'}

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 42 year old man with a past medical history of HIV and depression, who intentionally took approximately 16 Nortriptyline pills and 20 Klonopin pills on the day of admission, [**2170-11-5**]. He was originally admitted to the Intensive Care Unit for care. He was in a coma with dilated pupils on presentation. MEDICAL HISTORY: 1. Human Immunodeficiency Virus diagnosed in [**2156**]. The patient was on HAART from [**2161**] until [**2165**]. He states that he had two episodes of PCP [**Last Name (NamePattern4) **] [**2163**] and in [**2164**], when his CD4 count was approximately 50. He was restarted on his HAART in [**2169**] and he self-discontinued his HAART in [**2170-5-23**] when his CD4 count was 900. He is currently followed for his HIV at the [**Hospital1 778**]. 2. Depression. 3. History of substance abuse in the past with cocaine and currently with Klonopin. 4. Chronic back pain. 5. Sleep disturbance. MEDICATION ON ADMISSION: ALLERGIES: No known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: The patient lives in [**Location (un) 44698**] which is a group home for HIV males with substance abuse histories. He admits to occasional alcohol use but denies intravenous drug use at this time. He does smoke cigarettes. ### Response: {'Coma,Major depressive affective disorder, recurrent episode, severe, specified as with psychotic behavior,Pneumonia, organism unspecified,Human immunodeficiency virus [HIV] disease,Other, mixed, or unspecified drug abuse, unspecified,Retention of urine, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents'}

CHIEF COMPLAINT: Dyspnea on exertion PRESENT ILLNESS: Mr. [**Known lastname 5784**] is an 81 year old male with known atrial fibrillation and atrial myxoma for approximately 9 years. Serial echocardiograms have revealed worsening aortic insufficiency and mitral regurgitation. He concomitantly has complained of progressive dyspnea on exertion, [**1-3**] pillow orthopnea and worsening cough. Cardiac catheterization in [**2194-5-31**] showed normal coronary arteries and an LVEF of 50%. A transesophogeal echocardiogram in [**2194-10-31**] confirmed 3+ AI, 3+MR, with a 3x3 centimeter right atrial mass. LVEF was estimated at 65%. In preperation for cardiac surgery, he also underwent chest CT scan which revealed a dilated ascending aorta. After extensive preoperative evaluation, he was admitted for cardiac surgical intervention. MEDICAL HISTORY: Congestive Heart Failure(diastolic), Aortic Insufficiency, Mitral Regurgitation, Atrial Myxoma, Dilated Ascending Aorta, Atrial Fibrillation, Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy, Sleep Apnea - on CPAP, Obesity MEDICATION ON ADMISSION: Flonase K-Dur 60 meq [**Hospital1 **] Proscar 5 qd Lasix 40 qam Detrol LA 4 qam Procardia 30 qpm Fexofenadine 180 qpm Hytrin 10 qd Benicar 40 qpm Lipitor 20 qd Toprol XL 20 qd Singulair 10 qd Warfarin 6mg qd - stopped 5 days prior to admission ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: Admission Vitals: BP 140/90, HR 90, RR 14, SAT 94% on room air General: well developed elderly male in no acute distress HEENT: oropharynx benign, voice hoarse Neck: supple, no JVD, transmitted murmurs over carotid regions Heart: irregular rate, normal s1s2, mixed diastolic and systolic murmurs Lungs: clear bilaterally Abdomen: soft, nontender, normoactive bowel sounds, mild hepatomegaly Ext: warm, 2+ edema, no varicosities Pulses: 2+ distally Neuro: nonfocal FAMILY HISTORY: Denies premature coronary disease(before age 55) SOCIAL HISTORY: Retired, lives with wife in [**Name (NI) 108**]. Quit cigars over 10 years ago. Admits to social ETOH consumption.

Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Thoracic aneurysm without mention of rupture,Benign neoplasm of heart,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Long-term (current) use of anticoagulants

Rheumatic heart failure,Mitral/aortic val insuff,Atrial fibrillation,Ac kidny fail, tubr necr,Thoracic aortic aneurysm,Benign neoplasm heart,Hypertension NOS,Obstructive sleep apnea,BPH w/o urinary obs/LUTS,Long-term use anticoagul

Admission Date: [**2195-3-23**] Discharge Date: [**2195-4-1**] Date of Birth: [**2112-12-21**] Sex: M Service: CARDIOTHORACIC Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 1283**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: [**2195-3-23**] Aortic Valve Replacement(25mm Mosaic Porcine Valve), Mitral Valve Replacement(29mm Mosaic Porcine Valve), Replacement of Ascending Aorta(26mm Gelweave) and Atrial Myxoma Removal History of Present Illness: Mr. [**Known lastname 5784**] is an 81 year old male with known atrial fibrillation and atrial myxoma for approximately 9 years. Serial echocardiograms have revealed worsening aortic insufficiency and mitral regurgitation. He concomitantly has complained of progressive dyspnea on exertion, [**1-3**] pillow orthopnea and worsening cough. Cardiac catheterization in [**2194-5-31**] showed normal coronary arteries and an LVEF of 50%. A transesophogeal echocardiogram in [**2194-10-31**] confirmed 3+ AI, 3+MR, with a 3x3 centimeter right atrial mass. LVEF was estimated at 65%. In preperation for cardiac surgery, he also underwent chest CT scan which revealed a dilated ascending aorta. After extensive preoperative evaluation, he was admitted for cardiac surgical intervention. Past Medical History: Congestive Heart Failure(diastolic), Aortic Insufficiency, Mitral Regurgitation, Atrial Myxoma, Dilated Ascending Aorta, Atrial Fibrillation, Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy, Sleep Apnea - on CPAP, Obesity Social History: Retired, lives with wife in [**Name (NI) 108**]. Quit cigars over 10 years ago. Admits to social ETOH consumption. Family History: Denies premature coronary disease(before age 55) Physical Exam: Admission Vitals: BP 140/90, HR 90, RR 14, SAT 94% on room air General: well developed elderly male in no acute distress HEENT: oropharynx benign, voice hoarse Neck: supple, no JVD, transmitted murmurs over carotid regions Heart: irregular rate, normal s1s2, mixed diastolic and systolic murmurs Lungs: clear bilaterally Abdomen: soft, nontender, normoactive bowel sounds, mild hepatomegaly Ext: warm, 2+ edema, no varicosities Pulses: 2+ distally Neuro: nonfocal Discharge Gen NAD Neuro A&Ox3, nonfocal exam Pulm decreased bases, otherwise clear CV RRR S1-S2. Sternum stable, incision w/steris CDI Abdm soft, NT/ND/+BS Ext warm [**1-3**]+ pedal edema-bilat Pertinent Results: [**2195-3-23**] 04:42PM UREA N-17 CREAT-0.7 CHLORIDE-112* TOTAL CO2-25 [**2195-3-23**] 04:42PM WBC-12.3* RBC-3.55* HGB-11.2* HCT-31.0* MCV-87 MCH-31.5 MCHC-36.1* RDW-14.5 [**2195-3-23**] 04:42PM PLT COUNT-141* [**2195-3-23**] 04:42PM PT-14.0* PTT-56.5* INR(PT)-1.2* [**2195-3-31**] 06:05AM BLOOD WBC-7.2 RBC-3.24* Hgb-10.1* Hct-30.3* MCV-94 MCH-31.1 MCHC-33.2 RDW-14.6 Plt Ct-337# [**2195-4-1**] 06:38AM BLOOD PT-14.2* INR(PT)-1.3* [**2195-3-31**] 06:05AM BLOOD Plt Ct-337# [**2195-3-29**] 05:25AM BLOOD Glucose-115* UreaN-26* Creat-1.0 Na-143 K-3.3 Cl-102 HCO3-34* AnGap-10 CHEST (PA & LAT) [**2195-3-28**] 11:00 AM CHEST (PA & LAT) Reason: post op evaluation, SOB [**Hospital 93**] MEDICAL CONDITION: 82 year old man with AVR/MVR/AscAorta Replacement and ct removal REASON FOR THIS EXAMINATION: post op evaluation, SOB TWO-VIEW CHEST X-RAY, [**2195-3-28**]. COMPARISON: [**2195-3-24**]. Cardiology Report ECHO Study Date of [**2195-3-23**] PATIENT/TEST INFORMATION: Indication: Intraop AVR, MVR, Ascending Aorta replacement. Evaluate Aorta, valves, binventricular function Height: (in) 65 Weight (lb): 206 BSA (m2): 2.01 m2 BP (mm Hg): 165/85 HR (bpm): 80 Status: Inpatient Date/Time: [**2195-3-23**] at 13:20 Test: TEE (Complete) Doppler: Full Doppler and color Doppler Contrast: None Tape Number: 2007AW1-: Test Location: Anesthesia West OR cardiac Technical Quality: Adequate REFERRING DOCTOR: DR. [**First Name (STitle) 412**] [**Last Name (Prefixes) 413**] MEASUREMENTS: Left Atrium - Long Axis Dimension: *7.5 cm (nl <= 4.0 cm) Left Atrium - Four Chamber Length: *5.7 cm (nl <= 5.2 cm) Left Ventricle - Inferolateral Thickness: *1.4 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 5.6 cm (nl <= 5.6 cm) Left Ventricle - Systolic Dimension: 4.8 cm Left Ventricle - Fractional Shortening: *0.14 (nl >= 0.29) Left Ventricle - Ejection Fraction: 50% to 55% (nl >=55%) Aorta - Valve Level: *4.1 cm (nl <= 3.6 cm) Aorta - Ascending: *4.5 cm (nl <= 3.4 cm) Aorta - Arch: *3.6 cm (nl <= 3.0 cm) Aorta - Descending Thoracic: *3.8 cm (nl <= 2.5 cm) Aortic Valve - Peak Velocity: 1.5 m/sec (nl <= 2.0 m/sec) Aortic Valve - Peak Gradient: 9 mm Hg Aortic Valve - Mean Gradient: 4 mm Hg Aortic Valve - Valve Area: 3.7 cm2 (nl >= 3.0 cm2) Mitral Valve - MVA (2D): 4.9 cm2 Pulmonary Artery - Main Diameter: *3.5 cm Pericardium - Effusion Size: 0.5 cm INTERPRETATION: Findings: LEFT ATRIUM: Marked LA enlargement. Elongated LA. No mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Mild spontaneous echo contrast in the LAA. No thrombus in the LAA. RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. LEFT VENTRICLE: Wall thickness and cavity dimensions were obtained from 2D images. Mild symmetric LVH. Top normal/borderline dilated LV cavity size. Low normal LVEF. [Intrinsic LV systolic function likely depressed given the severity of valvular regurgitation.] LV WALL MOTION: Regional LV wall motion abnormalities include: mid inferolateral - hypo; remaining LV segments contract normally. RIGHT VENTRICLE: Moderately dilated RV cavity. AORTA: Moderately dilated aortic sinus. Moderately dilated ascending aorta. Mildly dilated aortic arch. Simple atheroma in aortic arch. Moderately dilated descending aorta Complex (>4mm) atheroma in the descending thoracic aorta. AORTIC VALVE: Normal aortic valve leaflets (3). No AS. Moderate to severe (3+)AR. Eccentric AR jet. MITRAL VALVE: Mildly thickened mitral valve leaflets. Moderate to severe (3+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets. No PR. PERICARDIUM: Small pericardial effusion. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. No TEE related complications. The patient was under general anesthesia throughout the procedure. Conclusions: Pre Bypass: The left atrium is markedly dilated. The left atrium is elongated. No mass/thrombus is seen in the left atrium or left atrial appendage. Mild spontaneous echo contrast is present in the left atrial appendage. No thrombus is seen in the left atrial appendage. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is top normal/borderline dilated. Overall left ventricular systolic function is low normal (LVEF 50-55%). [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] The remaining left ventricular segments contract normally. The right ventricular cavity is moderately dilated. The aortic root is moderately dilated athe sinus level. The ascending aorta is moderately dilated. The aortic arch is mildly dilated. There are simple atheroma in the aortic arch. The descending thoracic aorta is moderately dilated. There are complex (>4mm) atheroma in the descending thoracic aorta. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Moderate to severe (3+) aortic regurgitation is seen. The aortic regurgitation jet is eccentric. The mitral valve leaflets are mildly thickened. Moderate to severe (3+) mitral regurgitation is seen. There is a right atrial mass just above the svc inlet. It is rounded and almost reaches the interatrial septum. There is a small pericardial effusion. Post Bypass: Perserved biventricular function, LVEF >55%. An Aortic bioprostesis is insitu. No AI or AS, no perivalvular leaks. A mitral bioprosthesis is insitu, no MR, no MS, no perivalvular leaks. An prosthetic graft is seen in the proximal ascending aorta above the sinus of valsalva. The remaing aortic contours are intact. There is no longer a right atrial masss or pericardial effusion. The remainder of the exam is unchanged. All findings are discussed with surgeons at the time of the exam. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD on [**2195-3-23**] 15:54. CXR INDICATION: Shortness of breath. Right internal jugular vascular sheath has been removed with no pneumothorax. Lung volumes remain low, and cardiac and mediastinal contours are stable in appearance. Bibasilar atelectasis and small pleural effusions are again demonstrated. IMPRESSION: Persistent bibasilar atelectasis and small pleural effusions. DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**] Brief Hospital Course: Mr. [**Known lastname 5784**] was admitted and underwent aortic and mitral valve replacments, along with replacement of ascending aorta and excision of atrial myxoma. For surgical details, please see seperate dictated operative note. Following the operation, he was brought to the CSRU for invasive monitoring. Within 24 hours, he awoke neurologically intact and was extubated without incident. He maintained stable hemodynamics and weaned from inotropic support. On postoperative day two, he experienced oliguria with rise in creatinine. Volume and intravenous fluids were administered while diuretics and beta-blockers were initially withheld. He was started on Neosynephrine to maintain MAPs > 70 mmHg and renal perfusion. His creatinine peaked to 1.7 on postoperative day two. Over several days, his urine output and renal function improved. Neosynephrine was gradually weaned without difficulty. Diuretics and beta blockade were gradually resumed. On postoperative day four, he transferred to the SDU for further care and recovery. Despite remaining in a normal sinus rhythm(with first degree AV block)postoperatively, Warfarin anticoagulation was eventually resumed given his history of atrial fibrillation and myxoma resection. He continued to make clinical improvements with diuresis and was eventually cleared for discharge to home on postoperative day 9. His INR was to be followed by Dr [**Last Name (STitle) 911**] until his return to [**State 108**]. Medications on Admission: Flonase K-Dur 60 meq [**Hospital1 **] Proscar 5 qd Lasix 40 qam Detrol LA 4 qam Procardia 30 qpm Fexofenadine 180 qpm Hytrin 10 qd Benicar 40 qpm Lipitor 20 qd Toprol XL 20 qd Singulair 10 qd Warfarin 6mg qd - stopped 5 days prior to admission Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) Capsule, Sust. Release 24 hr PO HS (at bedtime). 4. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Fexofenadine 60 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 6. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed. Disp:*20 Tablet(s)* Refills:*0* 10. Outpatient Lab Work Please check INR Friday [**2195-4-3**]. Send result to Dr.[**Name (NI) 5786**] office at F([**Telephone/Fax (1) 5787**]. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Congestive Heart Failure(diastolic), Aortic Insufficiency, Mitral Regurgitation, Atrial Myxoma, Dilated Ascending Aorta - s/p Aortic Valve Replacement, Mitral Valve Replacement, Replacement of Ascending Aorta and Atrial Myxoma Removal, Postop Acute Renal Insufficiency, Atrial Fibrillation, Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy, Sleep Apnea - on CPAP Discharge Condition: Good Discharge Instructions: Patient may shower, no baths. No creams, lotions or ointments to incisions. No driving for at least one month. No lifting more than 10 lbs for at least 10 weeks from the date of surgery. Monitor wounds for signs of infection. Please call with any concerns or questions. Followup Instructions: Dr. [**Last Name (STitle) 1290**] in [**3-5**] weeks, call for appt Dr. [**Last Name (STitle) 911**] in [**1-3**] weeks, call for appt Dr. [**Last Name (STitle) 5788**], call for appt Completed by:[**2195-4-2**] Name: [**Known lastname 671**],[**Known firstname 672**] Unit No: [**Numeric Identifier 673**] Admission Date: [**2195-3-23**] Discharge Date: [**2195-4-1**] Date of Birth: [**2112-12-21**] Sex: M Service: CARDIOTHORACIC Allergies: Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 674**] Addendum: the patient was also discharged with the following medication: Warfarin 5 mg QD Metoprolol 25 mg [**Hospital1 **] Lasix 40 mg [**Hospital1 **] KCL 20 meq [**Hospital1 **] Chief Complaint: per previous d/c summary Major Surgical or Invasive Procedure: [**2195-3-23**] Aortic Valve Replacement(25mm Mosaic Porcine Valve), Mitral Valve Replacement(29mm Mosaic Porcine Valve), Replacement of Ascending Aorta(26mm Gelweave) and Atrial Myxoma Removal History of Present Illness: as per previous d/c summary Past Medical History: Congestive Heart Failure(diastolic), Aortic Insufficiency, Mitral Regurgitation, Atrial Myxoma, Dilated Ascending Aorta, Atrial Fibrillation, Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy, Sleep Apnea - on CPAP, Obesity Social History: Retired, lives with wife in [**Name (NI) 675**]. Quit cigars over 10 years ago. Admits to social ETOH consumption. Family History: Denies premature coronary disease(before age 55) Physical Exam: none Pertinent Results: none Brief Hospital Course: none Medications on Admission: none Discharge Medications: In addition to above medication the patient was also discharged with: 1. Warfarin 5 mg daily 2. Metoprolol 25mg Twice a day 3. Lasix 40 mg Twice a day 4. Potassium Chloride 20 meq twice a day Discharge Disposition: Home With Service Facility: [**Location (un) 42**] VNA Discharge Diagnosis: Congestive Heart Failure(diastolic), Aortic Insufficiency, Mitral Regurgitation, Atrial Myxoma, Dilated Ascending Aorta - s/p Aortic Valve Replacement, Mitral Valve Replacement, Replacement of Ascending Aorta and Atrial Myxoma Removal, Postop Acute Renal Insufficiency, Atrial Fibrillation, Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy, Sleep Apnea - on CPAP Discharge Condition: Good Discharge Instructions: Patient may shower, no baths. No creams, lotions or ointments to incisions. No driving for at least one month. No lifting more than 10 lbs for at least 10 weeks from the date of surgery. Monitor wounds for signs of infection. Please call with any concerns or questions. Followup Instructions: Dr. [**Last Name (STitle) 676**] in [**3-5**] weeks, call for appt Dr. [**Last Name (STitle) 677**] in [**1-3**] weeks, call for appt. Please send INRs to Dr. [**Name (NI) 678**] office at F([**Telephone/Fax (1) 679**]. He will need INR check Friday. Dr. [**Last Name (STitle) 680**], call for appt [**Doctor Last Name **] [**Last Name (Prefixes) **] MD [**MD Number(1) 681**] Completed by:[**2195-4-2**]

398,396,427,584,441,212,401,327,600,V586

{'Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Thoracic aneurysm without mention of rupture,Benign neoplasm of heart,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),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: Dyspnea on exertion PRESENT ILLNESS: Mr. [**Known lastname 5784**] is an 81 year old male with known atrial fibrillation and atrial myxoma for approximately 9 years. Serial echocardiograms have revealed worsening aortic insufficiency and mitral regurgitation. He concomitantly has complained of progressive dyspnea on exertion, [**1-3**] pillow orthopnea and worsening cough. Cardiac catheterization in [**2194-5-31**] showed normal coronary arteries and an LVEF of 50%. A transesophogeal echocardiogram in [**2194-10-31**] confirmed 3+ AI, 3+MR, with a 3x3 centimeter right atrial mass. LVEF was estimated at 65%. In preperation for cardiac surgery, he also underwent chest CT scan which revealed a dilated ascending aorta. After extensive preoperative evaluation, he was admitted for cardiac surgical intervention. MEDICAL HISTORY: Congestive Heart Failure(diastolic), Aortic Insufficiency, Mitral Regurgitation, Atrial Myxoma, Dilated Ascending Aorta, Atrial Fibrillation, Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy, Sleep Apnea - on CPAP, Obesity MEDICATION ON ADMISSION: Flonase K-Dur 60 meq [**Hospital1 **] Proscar 5 qd Lasix 40 qam Detrol LA 4 qam Procardia 30 qpm Fexofenadine 180 qpm Hytrin 10 qd Benicar 40 qpm Lipitor 20 qd Toprol XL 20 qd Singulair 10 qd Warfarin 6mg qd - stopped 5 days prior to admission ALLERGIES: Sulfa (Sulfonamides) PHYSICAL EXAM: Admission Vitals: BP 140/90, HR 90, RR 14, SAT 94% on room air General: well developed elderly male in no acute distress HEENT: oropharynx benign, voice hoarse Neck: supple, no JVD, transmitted murmurs over carotid regions Heart: irregular rate, normal s1s2, mixed diastolic and systolic murmurs Lungs: clear bilaterally Abdomen: soft, nontender, normoactive bowel sounds, mild hepatomegaly Ext: warm, 2+ edema, no varicosities Pulses: 2+ distally Neuro: nonfocal FAMILY HISTORY: Denies premature coronary disease(before age 55) SOCIAL HISTORY: Retired, lives with wife in [**Name (NI) 108**]. Quit cigars over 10 years ago. Admits to social ETOH consumption. ### Response: {'Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve insufficiency,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Thoracic aneurysm without mention of rupture,Benign neoplasm of heart,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Long-term (current) use of anticoagulants'}

CHIEF COMPLAINT: C2 dens complicated fracture involving arch of C1, extending into arch with L vertebral artery dissection, thrombosis with reconstitution PRESENT ILLNESS: This patient is a 57 year old male who complains of FALL. Patient was mulching when had an unclear fall and awoke at the bottom of a [**Doctor Last Name **]. Patient went to an outside hospital and was found to have C1, C2, C3 fracture. Patient is not moving his arms bilaterally. Patient states pain is [**9-14**] in his neck. Patient is able to move his legs. Patient was transferred to [**Hospital1 69**] for further evaluation. MEDICAL HISTORY: DM II, HTN, CKD on HD (R chest catheter), b/l LE neuropathy MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: humalog, lisinopril, carvedilol, neurontin, lipitor, calcium, folic acid, ASA 81', percocet ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On discharge FAMILY HISTORY: NC SOCIAL HISTORY: currently smokes 1 ppd for past 30 yrs

Closed fracture of C1-C4 level with central cord syndrome,End stage renal disease,Dissection of vertebral artery,Pneumonia due to other gram-negative bacteria,Unspecified protein-calorie malnutrition,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Infection and inflammatory reaction due to other vascular device, implant, and graft,Other accidental fall from one level to another,Tobacco use disorder,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Anemia in chronic kidney disease,Syncope and collapse

C1-c4 fx-cl/cen cord syn,End stage renal disease,Dissect vertebral artery,Pneumo oth grm-neg bact,Protein-cal malnutr NOS,Hyp kid NOS w cr kid V,React-oth vasc dev/graft,Fall-1 level to oth NEC,Tobacco use disorder,DMII neuro nt st uncntrl,Neuropathy in diabetes,Abn react-renal dialysis,Other staphylococcus,Nephritis NOS in oth dis,Anemia in chr kidney dis,Syncope and collapse

Admission Date: [**2151-7-9**] Discharge Date: [**2151-7-27**] Date of Birth: [**2093-8-2**] Sex: M Service: SURGERY Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 598**] Chief Complaint: C2 dens complicated fracture involving arch of C1, extending into arch with L vertebral artery dissection, thrombosis with reconstitution Major Surgical or Invasive Procedure: [**2151-7-13**] Percutaneous tracheostomy. [**2151-7-13**] Insertion of percutaneous endoscopic gastrostomy tube. [**2151-7-9**] ORIF C1 fracture and C2 fracture.Occiput to T1 posterior instrumented spinal fusion with iliac crest bone grafting. C3-C7 laminectomy. History of Present Illness: This patient is a 57 year old male who complains of FALL. Patient was mulching when had an unclear fall and awoke at the bottom of a [**Doctor Last Name **]. Patient went to an outside hospital and was found to have C1, C2, C3 fracture. Patient is not moving his arms bilaterally. Patient states pain is [**9-14**] in his neck. Patient is able to move his legs. Patient was transferred to [**Hospital1 69**] for further evaluation. Past Medical History: DM II, HTN, CKD on HD (R chest catheter), b/l LE neuropathy Social History: currently smokes 1 ppd for past 30 yrs Family History: NC Physical Exam: On discharge Temp 99.6 Pulse 63 BP 108/51 RR 12 SATS 100 trach/CMV General cooperative, not in distress NEURO Oriented awake alert, [**4-8**] Bilt extremities HEENT no thyromegaly, no lymphadenopathy, no carotid bruit. CHEST Bilateral basal crackles. CARDIAC S1 S2 audible no murmurs appreciated. ABDOMEN soft, non tender, non distended, BS+, no masses no herniation, guaic not done. EXTREM No edema, distal pulses palpable +1 R tunneled Scl HD access: No evidence of cellulitis, no active purulent infective process. No regional lymphadenopathy. Pertinent Results: [**2151-7-27**] 06:00AM BLOOD WBC-9.4 RBC-3.06* Hgb-9.8* Hct-29.9* MCV-98 MCH-31.9 MCHC-32.7 RDW-16.4* Plt Ct-622* [**2151-7-26**] 04:40AM BLOOD WBC-9.1 RBC-2.87* Hgb-8.8* Hct-27.7* MCV-96 MCH-30.6 MCHC-31.7 RDW-15.6* Plt Ct-613* [**2151-7-25**] 08:10AM BLOOD WBC-10.8 RBC-3.06* Hgb-9.1* Hct-29.1* MCV-95 MCH-29.9 MCHC-31.4 RDW-15.4 Plt Ct-701* [**2151-7-24**] 02:03AM BLOOD WBC-11.7* RBC-2.64* Hgb-8.4* Hct-25.4* MCV-96 MCH-31.6 MCHC-32.9 RDW-15.5 Plt Ct-608* [**2151-7-23**] 02:11AM BLOOD WBC-13.3* RBC-2.64* Hgb-8.5* Hct-25.8* MCV-97 MCH-32.0 MCHC-32.8 RDW-15.3 Plt Ct-684* [**2151-7-22**] 02:13AM BLOOD WBC-16.3* RBC-2.93* Hgb-8.7* Hct-28.2* MCV-96 MCH-29.8 MCHC-30.9* RDW-14.8 Plt Ct-796* [**2151-7-20**] 03:18AM BLOOD WBC-14.6* RBC-2.74* Hgb-8.5* Hct-26.4* MCV-97 MCH-31.0 MCHC-32.1 RDW-15.0 Plt Ct-563* [**2151-7-19**] 01:51AM BLOOD WBC-11.4* RBC-2.57* Hgb-7.9* Hct-24.5* MCV-95 MCH-30.7 MCHC-32.3 RDW-14.8 Plt Ct-539* [**2151-7-14**] 01:08AM BLOOD WBC-8.5 RBC-2.43* Hgb-7.7* Hct-23.2* MCV-95 MCH-31.6 MCHC-33.2 RDW-15.0 Plt Ct-280 [**2151-7-13**] 01:19AM BLOOD WBC-8.4 RBC-2.75* Hgb-8.4* Hct-25.8* MCV-94 MCH-30.5 MCHC-32.5 RDW-15.1 Plt Ct-275 [**2151-7-11**] 02:24AM BLOOD WBC-8.1 RBC-2.95* Hgb-9.2* Hct-27.8* MCV-95 MCH-31.2 MCHC-33.0 RDW-15.4 Plt Ct-187 [**2151-7-26**] 04:40AM BLOOD Glucose-68* UreaN-39* Creat-2.6* Na-137 K-4.6 Cl-104 HCO3-28 AnGap-10 [**2151-7-25**] 08:10AM BLOOD Glucose-78 UreaN-31* Creat-2.3* Na-139 K-4.5 Cl-106 HCO3-27 AnGap-11 [**2151-7-23**] 02:11AM BLOOD Glucose-93 UreaN-99* Creat-5.0* Na-141 K-3.9 Cl-104 HCO3-25 AnGap-16 [**2151-7-20**] 10:37AM BLOOD Glucose-209* UreaN-48* Creat-3.1* Na-141 K-4.3 Cl-107 HCO3-29 AnGap-9 [**2151-7-18**] 02:30AM BLOOD Glucose-172* UreaN-54* Creat-3.5* Na-139 K-4.0 Cl-104 HCO3-26 AnGap-13 [**2151-7-15**] 04:40AM BLOOD Glucose-219* UreaN-27* Creat-2.6* Na-135 K-3.8 Cl-102 HCO3-25 AnGap-12 [**2151-7-21**] 12:52AM BLOOD ALT-21 AST-27 AlkPhos-422* TotBili-0.5 DirBili-0.3 IndBili-0.2 Brief Hospital Course: Upon arrive pt noted to have neck pain radiating down the back and arms, numbness in arms, exam - loss of motor function arms b/l + intact sensation to touch. However in [**Name (NI) **], pt developed rapid ascending paralysis/weaknes requiring intubation. Injuries: C2 dens complicated fracture involving arch of C1, extending into arch with L vertebral artery dissection, thrombosis with reconstitution [**2151-7-13**] Percutaneous tracheostomy. [**2151-7-13**] Insertion of percutaneous endoscopic gastrostomy tube. [**2151-7-9**] ORIF C1 fracture and C2 fracture.Occiput to T1 posterior instrumented spinal fusion with iliac crest bone grafting. C3-C7 laminectomy. MICRO: [**7-12**] swab: Staph coag + [**7-12**] Bcx: NGTD x2 [**7-13**] Ucx: NGTD [**7-14**] Bl Cx: NGTD x2 [**7-14**] Ucx: NGTD [**7-15**] Sputum: enterobacter [**7-16**] Ucx: NGTD [**7-16**] Bcx: NGTD x2 [**7-17**] Ucx: NGTD [**7-20**] Sputum: MSSA, enterobacter [**7-20**] Bl CX: NGTD [**7-20**] Ucx: Neg [**7-20**] Cath tip: NGTD [**7-21**] c Diff neg [**7-21**] Bcx: NGTD [**7-21**] Ucx: NGTD [**7-22**] C diff: P [**7-23**] UCX: P . IMAGING: [**7-8**] CT C-spine (OSH): fractures of C1, C2, and C3 [**7-8**] CTA neck: complex fracture of C2 with anterior displacement of body of C2. This fracture extends into the L TP. Linear fracture of ant arch of C1. Complete thrombosis of L. vert artery at the level C3 and C4 and partially at C2. There is reconstitution at C1 level. [**7-8**] CT T/L spine: no fracture [**7-9**] MRI:Traumatic injury to the C2 vertebral body with a comminuted fracture. Multilevel high-grade canal narrowing with associated cord signal abnormality extending from the C2 through the C7 levels [**7-10**] CXR: clear. ETT. [**7-13**] CXR: tracheostomy tube well positioned with no evidence of pneumothorax or pneumomediastinum [**7-14**] CXR: No DVT [**7-14**] U/S:No read or images [**7-14**] Lenis: No DVT [**7-16**] CXR: improved inilt on left, not on the right. [**7-21**] Lenis: No DVT [**7-22**] RUQ: no cholecystitis. . EVENTS: [**7-9**]: Admitted TSICU. Intubated fiber optically , aline. OR with Ortho spine s/p decompression and occiput to T1 fusion. [**7-10**]: Improving neuro exam, can move LE, RUE. HD done. H2B. Spine recs no ASA or heparin until 4d post-op. [**7-11**] Started patient on asa 81 mg and hsq. Tf started. Po pain meds via ogt. [**7-12**]:TTE done->no etiology syncope. pus noted from the exit site of the tunneled HD catheter.swab and blood culture sent.1 dose of vanco [**7-13**]: trach/peg done in ICU, post-CXR no PTX. Spiked 101.8. [**7-14**]: Duplex carotid performed. Culture from HD line coag + staph Continued Vancomycin, Peg loosened by 1 cm. Lenis no dvt. Febrile overnight dispite tylenol. [**7-16**]: Vanco 500 c HD. Renal recs IV iron, no epo for now. PRBC 2u. MOM. Hemolysis [**Name2 (NI) **] sent. Spiked 101.3, sputum cx with GNR, started on zosyn. [**7-17**]: Changed to cefepime per ID recs for suspected PNA. Neurontin increased to [**Hospital1 **]. Patient now moving his fingers. Soft BP to high 70-80s. Patient asymtp, given 12.5 grams albumin in 50 ml x 1 [**7-19**]: vanco (last dose), d/c cefepime. Cipro po. NPH 15/10. HD off 1L. Temp to 100.7, kept for another 24hrs. Some ?gastric contents leakage from PEG site. [**7-20**] HD catherter removed adn culturesd fue to persistant leukocystosis to 14.6. Pan cultured [**7-22**]: inc WBC 14->16. Started flagyl. RUQ US neg. S/S eval recs thin liquids. Plan HD tomorrow. [**7-23**] HD line placement L groin temp line. HD performed. [**7-25**] Tunnel line placement in IR . Assessment and Plan: 57 male s/p ?syncopal fall with C1-3 fracture and associated L.vertebral artery thrombosis. s/p cervical fusion occiput to T1 Neurologic: C2 fracture involving C1 and Vertebral artery on the Left with dissection and thrombosis now on asa and hsq. - needs hard collar for 3 months Pain - percocet, Neurontin 300 [**Hospital1 **] Cardiovascular: No active cardiac issues. - cont asa, carvedilol, lisinopril Pulmonary: Trach mask w/ Passy-Muir valve Gastrointestinal / Abdomen: PEG placed [**7-13**]. Slight drainage at peg site. Cont to monitor. - bowel regimen - H2B Nutrition: DM diet. Renal: Foley, HD, Dialysis dependent although makes urine. Hematology: L Vertebral artery thrombosis and dissection. On ASA 81 and hsq. Endocrine: RISS, NPH 15 q am and qpm Wounds: Dry dressings Fluids: HLIV Medications on Admission: [**Last Name (un) 1724**]: humalog, lisinopril, carvedilol, neurontin, lipitor, calcium, folic acid, ASA 81', percocet Discharge Medications: 1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. Glucagon (Human Recombinant) 1 mg Recon Soln Sig: One (1) Recon Soln Injection Q15MIN () as needed for hypoglycemia protocol. 3. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: One (1) ML Mucous membrane [**Hospital1 **] (2 times a day). 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) as needed for constipation. 6. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 7. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. Carvedilol 3.125 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 9. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 10. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 11. Insulin Regular Human Injection 12. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol 13. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) Injection [**Hospital1 **] (2 times a day). 14. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain: Take with stool softeners. Disp:*30 Tablet(s)* Refills:*0* 15. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). Discharge Disposition: Extended Care Facility: [**Hospital3 105**] Northeast - [**Location (un) 1110**] Discharge Diagnosis: C1, C2 fractures with central cord syndrome and cervical myelopathy Discharge Condition: Stable, alert and oriented. Discharge Instructions: You have undergone the following operation: Posterior Cervical Decompression and Fusion from occiput to T1 vertebra Immediately after the operation: - Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit in a car or chair for more than ~45 minutes without getting up and walking around. - Rehabilitation/ Physical Therapy: o 2-3 times a day you should go for a walk for 15-30 minutes as part of your recovery. You can walk as much as you can tolerate. o Isometric Extension Exercise in the collar: 2x/day x 10 times perform extension exercises as instructed. - Cervical Collar / Neck Brace: You need to wear the brace at all times until your follow-up appointment which should be in 2 weeks. You may remove the collar to take a shower. Limit your motion of your neck while the collar is off. Place the collar back on your neck immediately after the shower. - Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually 2-3 days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. If you have an incision on your hip please follow the same instructions in terms of wound care. - You should resume taking your normal home medications. - You have also been given Additional Medications to control your pain. . Please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. You can either have them mailed to your home or pick them up at the clinic located on [**Hospital Ward Name 23**] 2. We are not allowed to call in narcotic prescriptions (oxycontin, oxycodone, percocet) to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - Follow up: o Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. o At the 2-week visit we will check your incision, take baseline x rays and answer any questions. o We will then see you at 6 weeks from the day of the operation. At that time we will most likely obtain Flexion/Extension X-rays and often able to place you in a soft collar which you will wean out of over 1 week. Please call the office if you have a fever>101.5 degrees Fahrenheit, drainage from your wound, or have any question Followup Instructions: Follow up in 2 weeks with Dr [**Last Name (STitle) 1352**]. Please call [**Telephone/Fax (1) 9769**] to make an appointment. Follow up with Dr [**Last Name (STitle) **] in 3 weeks ([**Telephone/Fax (1) 27603**] [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 601**] Completed by:[**2151-7-27**]

806,585,443,482,263,403,996,E884,305,250,357,E879,041,583,285,780

{'Closed fracture of C1-C4 level with central cord syndrome,End stage renal disease,Dissection of vertebral artery,Pneumonia due to other gram-negative bacteria,Unspecified protein-calorie malnutrition,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Infection and inflammatory reaction due to other vascular device, implant, and graft,Other accidental fall from one level to another,Tobacco use disorder,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Anemia in chronic kidney disease,Syncope and collapse'}

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: C2 dens complicated fracture involving arch of C1, extending into arch with L vertebral artery dissection, thrombosis with reconstitution PRESENT ILLNESS: This patient is a 57 year old male who complains of FALL. Patient was mulching when had an unclear fall and awoke at the bottom of a [**Doctor Last Name **]. Patient went to an outside hospital and was found to have C1, C2, C3 fracture. Patient is not moving his arms bilaterally. Patient states pain is [**9-14**] in his neck. Patient is able to move his legs. Patient was transferred to [**Hospital1 69**] for further evaluation. MEDICAL HISTORY: DM II, HTN, CKD on HD (R chest catheter), b/l LE neuropathy MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: humalog, lisinopril, carvedilol, neurontin, lipitor, calcium, folic acid, ASA 81', percocet ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: On discharge FAMILY HISTORY: NC SOCIAL HISTORY: currently smokes 1 ppd for past 30 yrs ### Response: {'Closed fracture of C1-C4 level with central cord syndrome,End stage renal disease,Dissection of vertebral artery,Pneumonia due to other gram-negative bacteria,Unspecified protein-calorie malnutrition,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Infection and inflammatory reaction due to other vascular device, implant, and graft,Other accidental fall from one level to another,Tobacco use disorder,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Anemia in chronic kidney disease,Syncope and collapse'}

CHIEF COMPLAINT: left sided weakness/slurred speech PRESENT ILLNESS: HPI: Ms. [**Known lastname **] is a 79-year-old right-handed woman with a history of HTN, hyperlipidemia who presents with acute onset dysarthria and left-sided weakness. MEDICAL HISTORY: -Hypertension. -Hyperlipidemia. -COPD. -"borderline" diabetes mellitus -Osteoporosis. -Depression. -History of alcohol use. -History of pyloric stenosis. -Dizziness with a TTE in [**11-28**] with an LVEF greater than 55 percent, 1 plus AR, 1 plus MR, 1 plus TR. MEDICATION ON ADMISSION: Albuterol/Atrovent INH 2 puffs tid prn SOB Fosamax 70 mg weekly Lipitor 20 mg daily Beconase AQ 1 spray [**Hospital1 **] prn Calcium 600/D 600/200 daily Fluoxetine 20 daily T,TH,[**Last Name (LF) **],[**First Name3 (LF) **]; 40 mg MWF Nifedipine SR 30 mg daily ASA 325 daily Prilosec 20 mg daily ALLERGIES: Codeine / Ace Inhibitors PHYSICAL EXAM: Physical Exam: (Full exam performed at 6:30 AM) Vitals: T: 98.0 P: 89 R: 16 BP: 156/73 SaO2: 99%2L General: Awake, cooperative, NAD. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. Skin: no rashes or lesions noted. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Pt. smokes one pack of cigarettes per day x over 50 years, and continues to smoke. Denied recent alcohol use.

Cerebral embolism with cerebral infarction,Homonymous bilateral field defects,Aortic valve disorders,Other and unspecified hyperlipidemia,Tobacco use disorder,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,Depressive disorder, not elsewhere classified

Crbl emblsm w infrct,Homonymous hemianopsia,Aortic valve disorder,Hyperlipidemia NEC/NOS,Tobacco use disorder,Hypertension NOS,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Osteoporosis NOS,Depressive disorder NEC

Admission Date: [**2201-1-16**] Discharge Date: [**2201-1-19**] Date of Birth: [**2121-5-26**] Sex: F Service: NEUROLOGY Allergies: Codeine / Ace Inhibitors Attending:[**First Name3 (LF) 2569**] Chief Complaint: left sided weakness/slurred speech Major Surgical or Invasive Procedure: none History of Present Illness: HPI: Ms. [**Known lastname **] is a 79-year-old right-handed woman with a history of HTN, hyperlipidemia who presents with acute onset dysarthria and left-sided weakness. She was last seen normal by her grandson at 3:30 AM. He took a nap, and when he awoke at about 4 AM, he found her on the couch speaking incomprehensibly. He thought she was moving her left side less. He didn't notice any other deficits. He called 911, and EMS brought her to [**Hospital1 18**]. Code Stroke was called at 5:04 AM. Neurology Resident was at the bedside by 5:09 AM. Initial NIH Stroke Scale (begun at 5:11 AM) score was 17: 1a. Level of Consciousness: 0 1b. LOC Question: 1 (incorrect month) 1c. LOC Commands: 0 2. Best gaze: 2 (forced deviation to right) 3. Visual fields: 2 (left homonymous hemianopia) 4. Facial palsy: 1 (left NLF flattening) 5a. Motor arm, left: 4 (no movement) 5b. Motor arm, right: 0 6a. Motor leg, left: 4 6b. Motor leg, right: 1 (drift) 7. Limb Ataxia: 0 8. Sensory: 1 (loss of light touch in left arm) 9. Language: 0 10. Dysarthria: 1 (mild) 11. Extinction and Neglect: 2 (profound neglect of left side, extinction to DSS with both tactile and visual input) TOTAL: 17 She was taken emergently to the CT scanner, where evidence of a Right M1 occlusion was seen. There was no evidence of intracranial hemorrhage. On return from CT, she showed some clinical improvement. Her repeat NIH Stroke Scale (begun at 5:45 AM) score was 5: 1a. Level of Consciousness: 0 1b. LOC Question: 0 1c. LOC Commands: 0 2. Best gaze: 0 3. Visual fields: 2 (left homonymous hemianopia) 4. Facial palsy: 0 5a. Motor arm, left: 0 5b. Motor arm, right: 0 6a. Motor leg, left: 1 (drift) 6b. Motor leg, right: 0 7. Limb Ataxia: 0 8. Sensory: 1 (loss of light touch in left arm) 9. Language: 0 10. Dysarthria: 0 (mild) 11. Extinction and Neglect: 2 (profound neglect of left side, extinction to DSS with both tactile and visual input) TOTAL: 5 As she had become oriented, further history was obtained from her directly. She recalls going into the kitchen to make breakfast at 3:30 AM (which is routine for her). She does not have a specific recall of the onset of her symptoms. In fact, she was unaware of having anything wrong, and says she came to the hospital because her grandson said she was slurring her speech. She denies having a history of intracranial or subarachnoid hemorrhage; she denies any neurosurgery, head trauma, and prior stroke; she denies a history of internal bleeding; and she denies a history of intracranial neoplasm or vascular malformation. On neuro ROS, she reports a headache, but still denies having any other deficit, including loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denies difficulties producing or comprehending speech. Denies focal weakness, numbness, parasthesiae. No bowel or bladder incontinence or retention. Denies difficulty with gait. On general review of systems, she denies recent fever or chills. No night sweats or recent weight loss or gain. Denies cough, shortness of breath. Denies chest pain or tightness, palpitations. Denies nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denies arthralgias or myalgias. Denies rash. Because she still had significant deficits and had evidence of occlusion on CT, tPA at a dose of 0.9 mg/kg was administered (61 kg; 6 mg given as IV push, 55 mg infused over 60 minutes). Past Medical History: -Hypertension. -Hyperlipidemia. -COPD. -"borderline" diabetes mellitus -Osteoporosis. -Depression. -History of alcohol use. -History of pyloric stenosis. -Dizziness with a TTE in [**11-28**] with an LVEF greater than 55 percent, 1 plus AR, 1 plus MR, 1 plus TR. Social History: Pt. smokes one pack of cigarettes per day x over 50 years, and continues to smoke. Denied recent alcohol use. Family History: Noncontributory. Physical Exam: Physical Exam: (Full exam performed at 6:30 AM) Vitals: T: 98.0 P: 89 R: 16 BP: 156/73 SaO2: 99%2L General: Awake, cooperative, NAD. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. Skin: no rashes or lesions noted. Neurologic: -Mental Status: Alert, oriented x 3. Able to relate the events she was a part of but is not able to site reason for coming to hospital. Mildly inattentive, able to name DOW backward to Tuesday. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency objects. Unable to read either due to neglect of hemianopsia. Speech was mildly dysarthric. Able to follow both midline and appendicular commands. Pt. was able to register 3 objects and recall [**1-26**] at 5 minutes. She had modest knowledge of current events. There was evidence of left hemi-neglect. Significant anosognosia. -Cranial Nerves: I: Olfaction not tested. II: PERRL 3 to 1mm and brisk. Left homonymous hemianopia by visual threat. Funduscopic exam revealed no papilledema, exudates, or hemorrhages. III, IV, VI: Forced rightward eye deviation (returned, after having apparently resolved immediately after CT scan). V: Facial sensation intact to pinprick. VII: No facial droop, facial musculature symmetric. VIII: Hearing intact to voice bilaterally. IX, X: Palate elevates symmetrically. [**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally. XII: Tongue protrudes in midline. -Motor: Normal bulk, tone throughout. No pronator drift bilaterally. No adventitious movements noted. No asterixis noted. Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB L 4 5 4+ 5- 5 5- 5 4+ 4+ 4- 4 5 5 5 R 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -Sensory: No deficits to light touch, pinprick, proprioception throughout. Has extinction to tactile DSS on the left. -DTRs: [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach L 2 2 2 0 0 R 2 2 2 0 0 Plantar response was flexor bilaterally. -Coordination: No intention tremor, no dysdiadochokinesia noted. No dysmetria on FNF or HKS bilaterally. -Gait: Deferred. Pertinent Results: [**2201-1-16**] 05:21AM GLUCOSE-117* NA+-138 K+-4.0 CL--99* TCO2-24 [**2201-1-16**] 05:15AM UREA N-9 CREAT-0.7 [**2201-1-16**] 05:15AM CK(CPK)-27 [**2201-1-16**] 05:15AM CK-MB-NotDone cTropnT-<0.01 [**2201-1-16**] 05:15AM WBC-8.8 RBC-5.22 HGB-13.7 HCT-42.8 MCV-82 MCH-26.2* MCHC-32.0 RDW-15.3 [**2201-1-16**] 05:15AM PT-12.9 PTT-30.7 INR(PT)-1.1 [**1-16**]: CTH: noncontrast head without evidence of acute ich. [**1-16**]:CTA demonstrates apparent filling defect in right mca (3:212, 213) concerning for thrombus. [**1-16**]: MRA: Focal area of narrowing and signal loss near the bifurcation of right middle cerebral artery, indicative of a thrombus seen on the earlier CT. MRI: Findings indicative of acute infarct in the distribution of right middle cerebral artery. Echo: The left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is unusually small. Overall left ventricular systolic function is normal (LVEF 70%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve is bicuspid. The aortic valve leaflets are moderately thickened. There is moderate to severe aortic valve stenosis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] The left ventricular inflow pattern suggests impaired relaxation. The tricuspid valve leaflets are mildly thickened. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. Brief Hospital Course: After arrival to the SICU, pt with stable exam with L sided weakness 4+-5- in UMN pattern with L neglect both visual and sensory with right sided gaze preference. MRI confirmed right MCA infarct. The patient recieved IV TPA in the ED. The patient's deficits decreased dramatically from initial presentation to discharge. By the time of discharge the patient merely had a left visual field cut, but was otherwise doing very well. Speech and Swallow evaluated patient on [**1-16**]. Patientt did well and was cleared for soft solids with thin liquids. Cardiac enzymes were negative. ECHO revealed moderate to severe stenosis of the aortic valve. There was no clear cardioembolic source. The aortic stenosis was not hemodynamically significant during this admission, but the patient was notified of the abnormality and the need for follow up. The patient's PCP will be notified by the chief resident. Physical therapists here felt that the patient was doing well enough to go home, with home physical therapy. The patient was noted to have an elevated LDL and was started on lipitor 80. Hemolglobin A1C was negative. The patient denied being on daily full dose aspirin (despite what was recorded in the admission note). Her secondary prevention therapy will thus be lipitor and full dose daily aspirin. Medications on Admission: Albuterol/Atrovent INH 2 puffs tid prn SOB Fosamax 70 mg weekly Lipitor 20 mg daily Beconase AQ 1 spray [**Hospital1 **] prn Calcium 600/D 600/200 daily Fluoxetine 20 daily T,TH,[**Last Name (LF) **],[**First Name3 (LF) **]; 40 mg MWF Nifedipine SR 30 mg daily ASA 325 daily Prilosec 20 mg daily Discharge Medications: 1. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QSUN (every Sunday). 3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 4. Combivent 18-103 mcg/Actuation Aerosol Sig: Two (2) puffs Inhalation three times a day as needed for shortness of breath or wheezing. 5. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO 4X/WEEK ([**Doctor First Name **],TU,TH,SA). 6. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO 3X/WEEK (MO,WE,FR). 7. Beconase AQ 42 mcg (0.042 %) Aerosol, Spray Sig: One (1) spray Nasal twice a day as needed for allergy symptoms. 8. Calcium 600 + D 600 (1,500)-200 mg-unit Tablet Sig: One (1) Tablet PO once a day. 9. Nifedipine 30 mg Tab,Sust Rel Osmotic Push 24hr Sig: One (1) Tab,Sust Rel Osmotic Push 24hr PO once a day. 10. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Discharge Disposition: Home With Service Facility: [**Location (un) 86**] VNA Discharge Diagnosis: Right MCA stroke. Discharge Condition: Vital signs stable. The patient still has a left homonymous hemianopsia. Discharge Instructions: Please take your medications as prescribed. Please follow up with your appointments as documented below. Please return to the hospital if you should have any concerning symptoms. These include, but are not limited to, weakness, numbness, slurred speech and vision changes. Be aware that though the echocardiogram of your hear did not find a reason for your stroke, it did find severe dysfunction of your aortic valve. You should discuss this with your primary care doctor Followup Instructions: Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2201-3-6**] 10:30 Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10134**], MD Phone:[**Telephone/Fax (1) 7980**] Date/Time:[**2201-2-13**] 12:00 [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**] Completed by:[**2201-1-19**]

434,368,424,272,305,401,496,250,733,311

{'Cerebral embolism with cerebral infarction,Homonymous bilateral field defects,Aortic valve disorders,Other and unspecified hyperlipidemia,Tobacco use disorder,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,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: left sided weakness/slurred speech PRESENT ILLNESS: HPI: Ms. [**Known lastname **] is a 79-year-old right-handed woman with a history of HTN, hyperlipidemia who presents with acute onset dysarthria and left-sided weakness. MEDICAL HISTORY: -Hypertension. -Hyperlipidemia. -COPD. -"borderline" diabetes mellitus -Osteoporosis. -Depression. -History of alcohol use. -History of pyloric stenosis. -Dizziness with a TTE in [**11-28**] with an LVEF greater than 55 percent, 1 plus AR, 1 plus MR, 1 plus TR. MEDICATION ON ADMISSION: Albuterol/Atrovent INH 2 puffs tid prn SOB Fosamax 70 mg weekly Lipitor 20 mg daily Beconase AQ 1 spray [**Hospital1 **] prn Calcium 600/D 600/200 daily Fluoxetine 20 daily T,TH,[**Last Name (LF) **],[**First Name3 (LF) **]; 40 mg MWF Nifedipine SR 30 mg daily ASA 325 daily Prilosec 20 mg daily ALLERGIES: Codeine / Ace Inhibitors PHYSICAL EXAM: Physical Exam: (Full exam performed at 6:30 AM) Vitals: T: 98.0 P: 89 R: 16 BP: 156/73 SaO2: 99%2L General: Awake, cooperative, NAD. HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx Neck: Supple, no carotid bruits appreciated. No nuchal rigidity Pulmonary: Lungs CTA bilaterally without R/R/W Cardiac: RRR, nl. S1S2, no M/R/G noted Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. Extremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. Skin: no rashes or lesions noted. FAMILY HISTORY: Noncontributory. SOCIAL HISTORY: Pt. smokes one pack of cigarettes per day x over 50 years, and continues to smoke. Denied recent alcohol use. ### Response: {'Cerebral embolism with cerebral infarction,Homonymous bilateral field defects,Aortic valve disorders,Other and unspecified hyperlipidemia,Tobacco use disorder,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Osteoporosis, unspecified,Depressive disorder, not elsewhere classified'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient was born at 1390 g at 32-2/7 weeks' gestation to a 33-year-old, G3, P1, now 2, mother, with a pregnancy complicated by hypertension and diet- controlled gestational diabetes. The mother received a single dose of betamethasone prior to delivery. Prenatal labs revealed B+, antibody negative, RPR nonreactive, hepatitis B surface antigen positive, rubella immune. The baby did receive hepatitis B vaccine as per staff at [**Hospital3 **] [**Hospital **] [**First Name (Titles) **] [**Last Name (Titles) **]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Primary apnea of newborn,Other preterm infants, 1,250-1,499 grams,Atresia and stenosis of large intestine, rectum, and anal canal,Neonatal jaundice associated with preterm delivery,Other specified congenital anomalies of heart,Neonatal conjunctivitis and dacryocystitis,Need for prophylactic vaccination and inoculation against viral hepatitis

Primary apnea of newborn,Preterm NEC 1250-1499g,Atresia large intestine,Neonat jaund preterm del,Cong heart anomaly NEC,Neonatal conjunctivitis,Need prphyl vc vrl hepat

Admission Date: [**2163-11-27**] Discharge Date: [**2163-12-21**] Date of Birth: [**2163-11-18**] Sex: F Service: NBB HISTORY OF PRESENT ILLNESS: The patient was born at 1390 g at 32-2/7 weeks' gestation to a 33-year-old, G3, P1, now 2, mother, with a pregnancy complicated by hypertension and diet- controlled gestational diabetes. The mother received a single dose of betamethasone prior to delivery. Prenatal labs revealed B+, antibody negative, RPR nonreactive, hepatitis B surface antigen positive, rubella immune. The baby did receive hepatitis B vaccine as per staff at [**Hospital3 **] [**Hospital **] [**First Name (Titles) **] [**Last Name (Titles) **]. Initial exam was notable for an imperforate anus and the baby was transferred to [**Hospital3 1810**] where she remained from [**2163-11-18**], until [**2163-11-27**], for surgical management of [**Last Name **] problem. The infant had an unremarkable course at [**Hospital3 1810**] that just consisted of sequential dilations and a further work-up for Vater syndrome, the reports of which are listed in the individual systems of the total NICU course. Please refer to the original discharge summary from [**2163-11-19**], by Dr. [**First Name (STitle) **] that was initially done prior to the patient leaving the [**Hospital3 1810**]. The mother went into preterm labor with concern for vaginal bleeding and possible abruption. Apgar scores were 8 and 9 and initial weight was 1390 g, 10th percentile, length 40 cm, 10-20th percentile, and head circumference was less than 25th percentile. SUMMARY OF NICU COURSE: 1. Respiratory: The patient was always stable on room air. She never required any respiratory support. She did have some apnea of prematurity for which she was treated with caffeine which was stopped at approximately 35 weeks corrected gestational age and the infant did not have any spells for over a week prior to being discharged home. 2. Cardiovascular: The patient was stable from a cardiovascular standpoint. As part of the work-up for Vader's syndrome because of the imperforate anus, the infant had an echocardiogram which was significant for an ASD, TDA, a left-sided SVC to the coronary sinus and a normal right-sided SVC. The echocardiogram was repeated again on [**2163-12-20**], which was stable. The plan is to follow-up with cardiology as an outpatient. No active issues were involved. 3. Fluids, electrolytes and nutrition: The patient was advanced on feeds per standard protocol, was worked all the way to 30 calories premature Enfamil and breast milk with Beneprotein because of small for gestational age. The patient was gaining weight well and will be discharged on EnfaCare 26 or Mom's milk 26 to be home on for at least several months following discharge. 4. GI: The patient has an imperforate anus. She required dilations with a 7, 8 and 9 dilator twice a day. She did have some intermittent bleeding that was due to the external irritation of the posterior fourchette of the vagina with a rectovaginal fistula present. The patient was stooling spontaneously through that fistula and there were no issues regarding that. 5. Hematology: The patient has been hemodynamically stable. She did receive some phototherapy for hyperbilirubinemia. Her last hematocrit was 57.4 which was on [**2163-11-20**]. The patient was discharged home on 4 mg/kg/day of iron. 6. Infectious disease: The patient was born to a hepatitis B surface antigen positive mother. She received HBIG and had hepatitis B vaccine both at birth and then again received a second dose of hepatitis B vaccine at 1 month of age with plan to receive the rest of her hepatitis B immunizations and test for hepatitis B surface antigen and surface antibody per protocol between 9 and 15 months. The patient also received rule out sepsis on initial admission and did not have any problems with infections throughout her stay. 7. Neurology: The patient did have a head ultrasound . The patient had bilateral periventricular cysts of the caudothalamic area that were noted on [**12-6**]. It was of unclear significance. The urine CMV was done and was negative. Other causes of TORCH infections such as toxoplasmosis and rubella and syphilis were all negative on the prenatals and the newborn screen. The patient will have a brain MRI at 3-6 months of age as part of the follow- up; however, the significance of the cysts are unclear and could potentially represent an old grade 1 hemorrhage. Also from a neurologic standpoint, the patient had a spinal ultrasound at [**Hospital3 1810**] as part of the Vater work-up. She was noted to have a low-lying spine cord and possible concern for cord tethering. As a part of the follow-up, the patient will also have a spine MRI at approximately 3-6 months of age which will be scheduled as an outpatient at [**Hospital1 62374**]. For follow-up of the MRI and the periventricular cysts that were noted in the caudothalamic area, the patient will have a follow-up arranged with neonatal and neurology as an outpatient. 8. Eyes: The patient was treated with 10 days of gentamicin drops which ended on [**2163-12-14**], for conjunctivitis. Culture from that was pansensitive pseudomonas. The patient had resolution of eye drainage. 9. Genetics: As part of the Vater work-up, as mentioned, the patient had an echocardiograph as noted above, a renal ultrasound that was normal, a spinal ultrasound as noted above, and all the x-rays of the spine have been noted to be normal without having any abnormalities of the vertebral bodies. 10.Endocrinology: The patient had an initial low T4 noted on the newborn screen. A repeat newborn screen on [**2163-12-3**], was normal, as well as TFTs that were done on [**11-30**] were noted to be normal. 11.Sensory: Part A: Audiology hearing screen was performed with automated auditory brain stem responses. The results were negative. The patient passed both ears. Part B Ophthalmology: The patient had an initial ophthalmology exam on [**12-5**] that noted an immature zone 2,and on [**12-19**] for follow-up, the patient was noted to have mature retina. The eyes were examined most recently on [**2163-12-19**], revealing mature retinal vessels. A follow-up exam is recommended at 9 months or at approximately 1 year of age. 12.Psychosocial: The family had weekly meetings with a Chinese interpreter at which they were given updates, as well as received their teaching. CONDITION ON DISCHARGE: Stable. DISCHARGE PHYSICAL EXAMINATION: The last head circumference was noted to be 32 cm, the length was 42 cm and the weight was 2085 g. In general she is well-appearing in no acute distress. On HEENT exam her anterior fontanels are open and flat. The red reflux is present bilaterally. There is no cleft lip or palate. Her lungs are clear to auscultation bilaterally. On heart exam there is regular rate and rhythm. There is an intermittent 1 out of 6 systolic ejection murmur that is present best heard at the upper sternal border. Her abdomen is soft, nontender, nondistended. No hepatosplenomegaly. There is no hernias noted. On GU exam she has normal female genitalia. There is an imperforate anus. There is a fistula that is present and a posterior fourchette of the vagina with spontaneous stool coming from it. Her extremity are warm and well perfused. Her capillary refill is less than 2 seconds. On neurologic exam she has normal tone for age and normal Moro reflex and a normal grasp. PRIMARY CARE PEDIATRICIAN: Dr. [**First Name (STitle) 437**] at [**Hospital3 **] Health Center, [**Telephone/Fax (1) 8236**]. CARES AND RECOMMENDATIONS: Part A: Feeds at discharge: EnfaCare 26 cal/oz or breast milk 26 cal/oz. Part B: Medications: 1. Iron as ferrous sulfate 4 mg/kg/day once daily. 2. Multivitamins, Goldline baby multivitamins 1 ml p.o. once daily. Part C: Iron and vitamin D supplementation: 1. Iron supplementation is recommended for preterm and low birth weight infants until 12 months corrected age. 2. All infant's that predominantly breast milk should receive vitamin D supplementation at 200 international units and may be provided as a multivitamin preparation daily until 12 months corrected age. Part D: Car seat screening was done and normal. DUe tothe child's small size and ill-fit for the car seat purchased by her parents, she is to be discharged home in a car bed until such time as a car seat of appropriate size is available. Part E: Newborn screen was done on [**12-3**] as a repeat and was normal. Part F: Immunizations received: 1. Hepatitis B vaccine was given on [**11-19**] and [**12-19**], [**2163**]. The HBeAg immunoglobulin was given on [**11-19**], [**2163**]. Synagis vaccine was given on [**2163-12-20**]. Part G: Immunizations recommended: 1. Synagis RSV prophylaxis should be considered from [**Month (only) **] through [**Month (only) 958**] for infants who meet any of the following 4 criteria: 1) born at less than 32 weeks, 2) born between 32 and 35 weeks with 2 of the following: Day care during RSV season, a smoker in the household, neuromuscular disease, airway abnormalities, or school- age siblings, 3) chronic lung disease, or 4) hemodynamically significant congenital heart disease. 2. Influenza immunization is recommended annually in the Fall for all infants once they reach 6 months of age. Before this age (and for the first 24 months of the child's life), immunization against influenza is recommended for household contacts and out-of-home caregivers. 3. This infant has not received Rotavirus vaccine. The American Academy of Pediatrics recommends initial vaccination of preterm infants at or following discharge from the hospital if they are clinically stable and at least 6 weeks but fewer than 12 weeks of age. Part H: Follow-up appointments: 1. Primary care pediatrician at [**Hospital3 **] 1-2 days after discharge. 2. Neonatal neurology will follow-up with an appointment. 3. MRI at [**Hospital3 1810**] of the Brain and Spine. Information was faxed and they will contact the family at the appropriate time 3 months from now. 4. Cardiology follow-up will be arranged as an outpatient. 5. The patient will follow-up with the general surgery service, Dr. [**Last Name (STitle) 7860**], 2 weeks after discharge with a plan for repair of the fistula at least 3-6 months of age. DISCHARGE DIAGNOSIS: 1. Prematurity at 32-2/7 weeks. 2. Imperforate anus with fistula in the posterior fourchette of the vagina. 3. Apnea of prematurity. 4. Feeding immaturity. 5. Minor congenital heart disease including ASD, PDA, left SVC to the coronary sinus. 6. Low lying spinal cord, concern for cord tethering. 7. Born to hepatitis B positive mother. Received HBIG and HBV [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern1) **], [**MD Number(1) 54604**] Dictated By:[**Doctor Last Name 74580**] MEDQUIST36 D: [**2163-12-20**] 15:37:57 T: [**2163-12-20**] 16:53:10 Job#: [**Job Number 75360**]

770,765,751,774,746,771,V053

{'Primary apnea of newborn,Other preterm infants, 1,250-1,499 grams,Atresia and stenosis of large intestine, rectum, and anal canal,Neonatal jaundice associated with preterm delivery,Other specified congenital anomalies of heart,Neonatal conjunctivitis and dacryocystitis,Need for prophylactic vaccination and inoculation against viral hepatitis'}

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 was born at 1390 g at 32-2/7 weeks' gestation to a 33-year-old, G3, P1, now 2, mother, with a pregnancy complicated by hypertension and diet- controlled gestational diabetes. The mother received a single dose of betamethasone prior to delivery. Prenatal labs revealed B+, antibody negative, RPR nonreactive, hepatitis B surface antigen positive, rubella immune. The baby did receive hepatitis B vaccine as per staff at [**Hospital3 **] [**Hospital **] [**First Name (Titles) **] [**Last Name (Titles) **]. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Primary apnea of newborn,Other preterm infants, 1,250-1,499 grams,Atresia and stenosis of large intestine, rectum, and anal canal,Neonatal jaundice associated with preterm delivery,Other specified congenital anomalies of heart,Neonatal conjunctivitis and dacryocystitis,Need for prophylactic vaccination and inoculation against viral hepatitis'}

CHIEF COMPLAINT: Left Sided Pleuritic Chest Pain PRESENT ILLNESS: 87F with history of HTN, HLD, memory impairment presented to ED with dyspnea and chest pain, found to have large almost saddle emboli. Per pt and OMR, had recent URI [**7-20**] with associated mild hypoxia at adult daycare. Underwent PCP [**Name9 (PRE) **] at that time, completed azithromycin course, treated symptommatically with nebulizer treatments. Symptoms initially improved. 5 Days ago started having pain in left side, worse with inspiration and presing on abdomen. SOB unchanged in past 2 weeks. Last night unable to sleep [**3-8**] cough. Home VNA found her with O2 sat of 89% on RA today, administered nebs with improvement. No recent surgeries, immobilizations. Presented to ED today with worsening shortness of breath, pleuritic chest pain and hypoxia of 89% on RA at home. Mild cough, non-productive. . In the ED, initial vitals: 98.4 90 143/77 18 98% 4L Nasal Cannula. Chest x-ray concerning for possible atelectasis vs. pneumonia, BNP elevated 2368. EKG sinus rhythm, TWI in inferior and V2-V6 leads, no ST changes. CTA showed large saddle PE. Guaic negative, startd heparin gtt. Admitted to ICU for further management, transfer vitals HR 89 BP 100/p RR 19 97%4L. . On the floor, patient is comfortable, no real complaints except for left sided pleuritic pain. cough improving. no swelling or pain in legs. headache today. All of this was communicated via translator MEDICAL HISTORY: -hypertension -hyperlipidemia -shoulder pain -R kidney stones status lithotripsy and ureteral stent MEDICATION ON ADMISSION: Atorvastatin 20 mg daily Fluticasone 50 mcg 2 sprays each nostril daily HCTZ 25 mg daily Lactulose [**3-9**] tsp daily prn constipation Memantine (Namenda) 5 mg [**Hospital1 **] Mirtazapine 15 mg qhs Nifedipine ER 30 mg daily Valsartan 160 mg daily Tylenol prn Colace 100 mg [**Hospital1 **] ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam: Vitals: T: 97 BP: 148/71 P: 95 R: 14 O2: 95%4L General: alert, no acute distress, in bed HEENT: Sclera anicteric, MMM, oropharynx clear, no thrush Neck: supple, JVP not elevated with patient at 60 degrees, no thyromegally, no lad, no carotid bruits Lungs: bibasilar crackles, decreased BS at left posterior lung base with no rhonchi. no wheeze. no splinting, symmetric excursion. Pain to palpation over axial aspect of left lower rib cage. CV: Regular rate and rhythm, normal s1, fixed split p2, no appreciable murmurs, no gallops Abdomen: slight distension. soft, minimal tenderness in LUQ over rib cage, bowel sounds present, no rebound tenderness or guarding. Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. + vericose veins. no palpable cords or other e/o DVT. FAMILY HISTORY: Daughter with LUE DVT on Warfarin Unknown if patient has family history for cardiac sudden deaths. There is no known history of renal disease or renal stones in her family. SOCIAL HISTORY: She has 8 children (3 of whom have passed away), and lives in [**Location 686**] with her daughter, [**Telephone/Fax (1) 7971**]. She is [**Location 7972**] and does not speak English. She attends a daycare. Denies tobacco, alcohol and recreational drug use.

Other pulmonary embolism and infarction,Other chronic pulmonary heart diseases,Other persistent mental disorders due to conditions classified elsewhere,Other constipation,Benign essential hypertension,Abdominal pain, other specified site,Other and unspecified hyperlipidemia,Personal history of urinary calculi,Aortic aneurysm of unspecified site without mention of rupture

Pulm embol/infarct NEC,Chr pulmon heart dis NEC,Mental disor NEC oth dis,Constipation NEC,Benign hypertension,Abdmnal pain oth spcf st,Hyperlipidemia NEC/NOS,Prsnl hst urnr dsrd calc,Aortic aneurysm NOS

Admission Date: [**2102-8-3**] Discharge Date: [**2102-8-10**] Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1253**] Chief Complaint: Left Sided Pleuritic Chest Pain Major Surgical or Invasive Procedure: None History of Present Illness: 87F with history of HTN, HLD, memory impairment presented to ED with dyspnea and chest pain, found to have large almost saddle emboli. Per pt and OMR, had recent URI [**7-20**] with associated mild hypoxia at adult daycare. Underwent PCP [**Name9 (PRE) **] at that time, completed azithromycin course, treated symptommatically with nebulizer treatments. Symptoms initially improved. 5 Days ago started having pain in left side, worse with inspiration and presing on abdomen. SOB unchanged in past 2 weeks. Last night unable to sleep [**3-8**] cough. Home VNA found her with O2 sat of 89% on RA today, administered nebs with improvement. No recent surgeries, immobilizations. Presented to ED today with worsening shortness of breath, pleuritic chest pain and hypoxia of 89% on RA at home. Mild cough, non-productive. . In the ED, initial vitals: 98.4 90 143/77 18 98% 4L Nasal Cannula. Chest x-ray concerning for possible atelectasis vs. pneumonia, BNP elevated 2368. EKG sinus rhythm, TWI in inferior and V2-V6 leads, no ST changes. CTA showed large saddle PE. Guaic negative, startd heparin gtt. Admitted to ICU for further management, transfer vitals HR 89 BP 100/p RR 19 97%4L. . On the floor, patient is comfortable, no real complaints except for left sided pleuritic pain. cough improving. no swelling or pain in legs. headache today. All of this was communicated via translator Past Medical History: -hypertension -hyperlipidemia -shoulder pain -R kidney stones status lithotripsy and ureteral stent Social History: She has 8 children (3 of whom have passed away), and lives in [**Location 686**] with her daughter, [**Telephone/Fax (1) 7971**]. She is [**Location 7972**] and does not speak English. She attends a daycare. Denies tobacco, alcohol and recreational drug use. Family History: Daughter with LUE DVT on Warfarin Unknown if patient has family history for cardiac sudden deaths. There is no known history of renal disease or renal stones in her family. Physical Exam: Physical Exam: Vitals: T: 97 BP: 148/71 P: 95 R: 14 O2: 95%4L General: alert, no acute distress, in bed HEENT: Sclera anicteric, MMM, oropharynx clear, no thrush Neck: supple, JVP not elevated with patient at 60 degrees, no thyromegally, no lad, no carotid bruits Lungs: bibasilar crackles, decreased BS at left posterior lung base with no rhonchi. no wheeze. no splinting, symmetric excursion. Pain to palpation over axial aspect of left lower rib cage. CV: Regular rate and rhythm, normal s1, fixed split p2, no appreciable murmurs, no gallops Abdomen: slight distension. soft, minimal tenderness in LUQ over rib cage, bowel sounds present, no rebound tenderness or guarding. Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. + vericose veins. no palpable cords or other e/o DVT. Discharge: Afebrile 124/90 P65 R24 96%RA Breathing comfortably. Minimal bibasilar rales. good AE. Pertinent Results: [**2102-8-3**] 12:50PM BLOOD WBC-8.0 RBC-4.49 Hgb-14.9 Hct-42.8 MCV-95 MCH-33.1* MCHC-34.7 RDW-14.0 Plt Ct-254 [**2102-8-8**] 04:45AM BLOOD WBC-6.2 RBC-4.10* Hgb-13.9 Hct-39.3 MCV-96 MCH-33.8* MCHC-35.3* RDW-13.4 Plt Ct-248 [**2102-8-3**] 12:50PM BLOOD Glucose-106* UreaN-21* Creat-0.9 Na-137 K-3.1* Cl-98 HCO3-27 AnGap-15 [**2102-8-7**] 05:33AM BLOOD Glucose-86 UreaN-13 Creat-0.7 Na-141 K-3.9 Cl-107 HCO3-26 AnGap-12 [**2102-8-4**] 10:34PM BLOOD ALT-18 AST-30 AlkPhos-48 TotBili-0.3 [**2102-8-4**] 10:34PM BLOOD Lipase-39 [**2102-8-3**] 12:50PM BLOOD cTropnT-<0.01 [**2102-8-3**] 10:00PM BLOOD cTropnT-<0.01 [**2102-8-4**] 05:43AM BLOOD cTropnT-<0.01 [**2102-8-3**] 12:50PM BLOOD proBNP-2368* [**2102-8-6**] 09:30AM BLOOD Calcium-9.2 Phos-2.4* Mg-1.7 [**2102-8-4**] 10:46PM BLOOD Type-[**Last Name (un) **] pO2-112* pCO2-37 pH-7.43 calTCO2-25 Base XS-0 ECG Study Date of [**2102-8-3**] Sinus rhythm. Left ventricular hypertrophy. Right bundle-branch block. Compared to the previous tracing of [**2100-2-10**] right bundle-branch block has appeared. The ST-T wave changes in the anterolateral leads appear to exceed the repolarization abnormalities associated with right bundle-branch block and there is T wave inversion in leads II, III and aVF. These findings suggest acute anterolateral ischemic process. The rate has increased. Clinical correlation is suggested. CTA CHEST W&W/O C&RECONS, NON-CORONARY Study Date of [**2102-8-3**] IMPRESSION: 1. Massive PE with evidence with evidence of right heart strain. 2. Significant eccentric plaque along the thoracic aorta. 3. 2-mm right upper lobe nodule is visualized. One-year followup CT is recommended if elevated risk factors (smoking, malignancy) are present. TTE (Complete) Done [**2102-8-4**] IMPRESSION: Moderate to severe pulmonary hypertension with dilated and hypokinetic right ventricle. Normal global and regional left ventricular systolic function. Mild aortic and mitral regurgitation. _ _ ________________________________________________________________ Anticoagulation Warfarin Dose [**2102-8-6**] 09:30AM INR(PT)-1.4* 5 mg [**2102-8-7**] 05:33AM INR(PT)-1.7* 5 mg [**2102-8-8**] 04:45AM INR(PT)-2.0* 5 mg [**2102-8-9**] 04:45AM INR(PT)-2.4* 3 mg [**2102-8-10**] 04:40AM INR(PT)-2.8* 3 mg (pending after discharge) _ _ _ ________________________________________________________________ Brief Hospital Course: Ms. [**Known lastname 7973**] is an 87 year old portugese speaking woman with a PMHx significant for HLD and HTN who presented on [**8-3**] to the ED with a chief complaint of dyspnea associated with pleuritic flank pain. # Pulmonary embolism--As mentioned in the HPI, pt denied any antecedent trauma, surgeries, cancer diagnoses, or immobilization. She denies recent weight loss or rectal/vaginal bleeding. She felt asymmetric leg swelling 3-4 weeks ago and prior to presentation, she experienced 3 weeks of gradually improving rhinorrhea, cough, and SOB. For this she had been treated with a 5 day course of Azithromycin per her PCP 3 weeks prior to presention. Upon presentation to the [**Name (NI) **], pt was found to have an SpO2 of 89%, but was hemodynamically stable with BP 120's-130's/50's-60's. On EKG she demonstrated symptoms of right heart strain with S1,T3 and a new RBBB. A CTA was performed which demonstrated a saddle pulmonary embolus. She was begun on a heparin gtt and transferred to the [**Hospital Unit Name 153**]. Throughout her stay in the ICU, her BP remained stable in the range of 140-170/70-90's. A TTE performed on the second day of admission demonstrated normal LV function, severe pulmonary hypertension with a dilated and hypokinetic right ventricle. Hemodynamically, however, Ms. [**Known lastname 7973**] remained stable without hypotension or tachycardia. Given her advanced age and lack of hemodynamic instability the decision was made not to administer tPA. Ms. [**Known lastname 7973**] was begun on warfarin in anticipation of long-term anticoagulation. Her INR was followed closely, and a therapeutic INR (goal [**3-9**]) was overlapped with the heparin gtt x 48 hours. She will follow up closely with her PCP, [**Name10 (NameIs) **] she has an [**Hospital3 **] appointment the day following discharge. Please see results section for recent INR's and warfarin dosing. Of note, Ms. [**Known lastname 7973**] has not had a colonoscopy since [**2091**] (which was normal), and has not had a mammogram since [**2094**] (which was normal). The cessation of these cancer screens was age appropriate, however the PCP may elect to repeat these tests in light of her PE. In addition, given that this PE was unprovoked, the patient should have a hypercoag work-up as an outpt given that this may impact her length of therapy as well as screening for her family. Per report, her daughter has a history of DVt. # HTN, benign-- her blood pressure medications were initially held due to acute pulmonary embolism, but these were resumed, and her blood pressure remained well controlled. - continued Valsartan 160 mg PO/NG DAILY - continued HCTZ 25 mg po q day - continued Nifedipine 30 mg po q day # Hyperlipidemia Continued atorvastatin. # Memory impairment/likely early dementia - continued Namenda (MEMAntine) 5 mg Medications on Admission: Atorvastatin 20 mg daily Fluticasone 50 mcg 2 sprays each nostril daily HCTZ 25 mg daily Lactulose [**3-9**] tsp daily prn constipation Memantine (Namenda) 5 mg [**Hospital1 **] Mirtazapine 15 mg qhs Nifedipine ER 30 mg daily Valsartan 160 mg daily Tylenol prn Colace 100 mg [**Hospital1 **] Discharge Medications: 1. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2) sprays each nostril Nasal once a day as needed for allergy symptoms. 3. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. 4. lactulose 10 gram/15 mL Solution Sig: [**3-9**] teaspoons PO once a day as needed for constipation. 5. memantine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 7. nifedipine 30 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO DAILY (Daily). 8. valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every six (6) hours as needed for pain. 10. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. 11. warfarin 3 mg Tablet Sig: One (1) Tablet PO daily at 4 pm: Please follow up with your PCP [**Name Initial (PRE) 7974**]. Disp:*5 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Pulmonary Embolism Hypertension Hyperlipidemia 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 with shortness of breath and were found to have a large blood clot in your lungs. Since this was a large clot, you were admitted to the intensive care unit for monitoring. You needed a blood thinner in your IV called heparin, this was continued until the oral medication, coumadin was at the right level. It is VERY important that you keep your follow up appointments because this medication needs frequent monitoring and dose adjustments. Followup Instructions: Department: [**Hospital1 7975**] INTERNAL MEDICINE When: FRIDAY [**2102-8-11**] at 10:00 AM [**Telephone/Fax (1) 7976**] Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **] Campus: OFF CAMPUS Best Parking: Free Parking on Site Department: [**Hospital1 7975**] INTERNAL MEDICINE When: THURSDAY [**2102-8-17**] at 11:00 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7978**], MD [**Telephone/Fax (1) 7976**] Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **] Campus: OFF CAMPUS Best Parking: Free Parking on Site

415,416,294,564,401,789,272,V130,441

{'Other pulmonary embolism and infarction,Other chronic pulmonary heart diseases,Other persistent mental disorders due to conditions classified elsewhere,Other constipation,Benign essential hypertension,Abdominal pain, other specified site,Other and unspecified hyperlipidemia,Personal history of urinary calculi,Aortic aneurysm of unspecified site without mention of rupture'}

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: Left Sided Pleuritic Chest Pain PRESENT ILLNESS: 87F with history of HTN, HLD, memory impairment presented to ED with dyspnea and chest pain, found to have large almost saddle emboli. Per pt and OMR, had recent URI [**7-20**] with associated mild hypoxia at adult daycare. Underwent PCP [**Name9 (PRE) **] at that time, completed azithromycin course, treated symptommatically with nebulizer treatments. Symptoms initially improved. 5 Days ago started having pain in left side, worse with inspiration and presing on abdomen. SOB unchanged in past 2 weeks. Last night unable to sleep [**3-8**] cough. Home VNA found her with O2 sat of 89% on RA today, administered nebs with improvement. No recent surgeries, immobilizations. Presented to ED today with worsening shortness of breath, pleuritic chest pain and hypoxia of 89% on RA at home. Mild cough, non-productive. . In the ED, initial vitals: 98.4 90 143/77 18 98% 4L Nasal Cannula. Chest x-ray concerning for possible atelectasis vs. pneumonia, BNP elevated 2368. EKG sinus rhythm, TWI in inferior and V2-V6 leads, no ST changes. CTA showed large saddle PE. Guaic negative, startd heparin gtt. Admitted to ICU for further management, transfer vitals HR 89 BP 100/p RR 19 97%4L. . On the floor, patient is comfortable, no real complaints except for left sided pleuritic pain. cough improving. no swelling or pain in legs. headache today. All of this was communicated via translator MEDICAL HISTORY: -hypertension -hyperlipidemia -shoulder pain -R kidney stones status lithotripsy and ureteral stent MEDICATION ON ADMISSION: Atorvastatin 20 mg daily Fluticasone 50 mcg 2 sprays each nostril daily HCTZ 25 mg daily Lactulose [**3-9**] tsp daily prn constipation Memantine (Namenda) 5 mg [**Hospital1 **] Mirtazapine 15 mg qhs Nifedipine ER 30 mg daily Valsartan 160 mg daily Tylenol prn Colace 100 mg [**Hospital1 **] ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Physical Exam: Vitals: T: 97 BP: 148/71 P: 95 R: 14 O2: 95%4L General: alert, no acute distress, in bed HEENT: Sclera anicteric, MMM, oropharynx clear, no thrush Neck: supple, JVP not elevated with patient at 60 degrees, no thyromegally, no lad, no carotid bruits Lungs: bibasilar crackles, decreased BS at left posterior lung base with no rhonchi. no wheeze. no splinting, symmetric excursion. Pain to palpation over axial aspect of left lower rib cage. CV: Regular rate and rhythm, normal s1, fixed split p2, no appreciable murmurs, no gallops Abdomen: slight distension. soft, minimal tenderness in LUQ over rib cage, bowel sounds present, no rebound tenderness or guarding. Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. + vericose veins. no palpable cords or other e/o DVT. FAMILY HISTORY: Daughter with LUE DVT on Warfarin Unknown if patient has family history for cardiac sudden deaths. There is no known history of renal disease or renal stones in her family. SOCIAL HISTORY: She has 8 children (3 of whom have passed away), and lives in [**Location 686**] with her daughter, [**Telephone/Fax (1) 7971**]. She is [**Location 7972**] and does not speak English. She attends a daycare. Denies tobacco, alcohol and recreational drug use. ### Response: {'Other pulmonary embolism and infarction,Other chronic pulmonary heart diseases,Other persistent mental disorders due to conditions classified elsewhere,Other constipation,Benign essential hypertension,Abdominal pain, other specified site,Other and unspecified hyperlipidemia,Personal history of urinary calculi,Aortic aneurysm of unspecified site without mention of rupture'}

CHIEF COMPLAINT: elective carotid stenting PRESENT ILLNESS: 70 yo male with PMH DM, HTN, hyperlipid, smoking, mult strokes admitted for elective carotid angiography/intervention. * Carotid ultrasound in [**Month (only) **] found occlusion of right internal carotid artery and a high grade stenosis of the origin of the left internal cartoid artery. * Pt denies any neurologic symptoms (visual, slurred speech, numbness, weakness, other stroke-like sx. * In cath lab found occluded [**Country **], focal 90% stenosis of [**Doctor First Name 3098**]. Successful stenting of the [**Doctor First Name 3098**] was performed. MEDICAL HISTORY: NIDDM (diet control) Non small cell lung cancer 16 yrs ago s/p chemo and XRT 2-3 years ago had EMPYEMA rx??????d with decortication & chest tube Hematuria 2 weeks ago, now resolved S/P IVP/cystourethrogram on [**2138-9-24**] COPD s/p cardiac stent h/o pseudomona sepsis [**4-29**] hypercholesterolemia HTN MEDICATION ON ADMISSION: NIDDM, HTN, CAD ([**4-29**]:s/p PCI x 2,cypher to LAD and taxus to RCA), hyperlipid,COPD, hematuria 2 weeks ago (s/p IVP/cystourethrogram), non-small cell lung cancer ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: t98, p80, 120/80 Gen: NAD, pleasant HEENT: PERRL, EOMI, clear OP Neck: supple, no LAD CVS: RRR, nl s1 s2, no m/g/r, distant heart sounds Lungs: CTAB, no c/w/r Abd: soft, NT, ND, +BS Ext: no c/e/e Neuro: CN2-12 intact, [**4-30**] upper and lower extremity strength, sensation intact to light touch FAMILY HISTORY: dad ?; mom died of pneumonia, (+) HTN; daughter- HTN SOCIAL HISTORY: + Cigs (now smokes 1/2ppd (previously [**1-28**])for 50years) still smoking, occasional alcohol, no illicit drugs. lives with wife on farm, owns bed and bkfst.

Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bronchus and lung,Percutaneous transluminal coronary angioplasty status,Tobacco use disorder

Ocl mlt bi art wo infrct,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx-bronchogenic malignan,Status-post ptca,Tobacco use disorder

Admission Date: [**2138-10-22**] Discharge Date: [**2138-10-24**] Date of Birth: [**2068-5-13**] Sex: M Service: [**Hospital Unit Name 196**] Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2704**] Chief Complaint: elective carotid stenting Major Surgical or Invasive Procedure: [**Doctor First Name 3098**] stenting History of Present Illness: 70 yo male with PMH DM, HTN, hyperlipid, smoking, mult strokes admitted for elective carotid angiography/intervention. * Carotid ultrasound in [**Month (only) **] found occlusion of right internal carotid artery and a high grade stenosis of the origin of the left internal cartoid artery. * Pt denies any neurologic symptoms (visual, slurred speech, numbness, weakness, other stroke-like sx. * In cath lab found occluded [**Country **], focal 90% stenosis of [**Doctor First Name 3098**]. Successful stenting of the [**Doctor First Name 3098**] was performed. Past Medical History: NIDDM (diet control) Non small cell lung cancer 16 yrs ago s/p chemo and XRT 2-3 years ago had EMPYEMA rx??????d with decortication & chest tube Hematuria 2 weeks ago, now resolved S/P IVP/cystourethrogram on [**2138-9-24**] COPD s/p cardiac stent h/o pseudomona sepsis [**4-29**] hypercholesterolemia HTN Social History: + Cigs (now smokes 1/2ppd (previously [**1-28**])for 50years) still smoking, occasional alcohol, no illicit drugs. lives with wife on farm, owns bed and bkfst. Family History: dad ?; mom died of pneumonia, (+) HTN; daughter- HTN Physical Exam: VS: t98, p80, 120/80 Gen: NAD, pleasant HEENT: PERRL, EOMI, clear OP Neck: supple, no LAD CVS: RRR, nl s1 s2, no m/g/r, distant heart sounds Lungs: CTAB, no c/w/r Abd: soft, NT, ND, +BS Ext: no c/e/e Neuro: CN2-12 intact, [**4-30**] upper and lower extremity strength, sensation intact to light touch Pertinent Results: [**2138-10-23**] 05:57AM BLOOD WBC-8.4 RBC-4.15* Hgb-12.3* Hct-35.4* MCV-85 MCH-29.6 MCHC-34.7 RDW-14.4 Plt Ct-196 [**2138-10-23**] 05:57AM BLOOD PT-12.6 PTT-25.9 INR(PT)-1.0 . [**2138-10-22**] 08:56PM GLUCOSE-84 UREA N-26* CREAT-0.9 SODIUM-135 POTASSIUM-4.3 CHLORIDE-100 TOTAL CO2-27 ANION GAP-12 [**2138-10-22**] 08:56PM CALCIUM-8.9 PHOSPHATE-3.2 MAGNESIUM-1.8 . [**2138-10-22**] Cardiac cath: 1. Access was retrograde via the right CFA to the selective subclavian, carotid, and vertebral arteries. 2. The thoracic arch was Type I without significant disease. 3. Subclavian arteries: The RSC was normal. The LSC had mild disease without lesions. 4. Carotid/vertebrals: The RCCA was normal. The [**Country **] was occluded. The right vertebral was normal. The right vertebral filled the cerebellar and basilar sytems and the right MCA via the PCOM. The left vertebral was without lesions. The [**Doctor First Name 3098**] had a focal 90% lesion. The ICA filled the ACA/MCA with contralateral filling of the ACA. 5. Successful stenting of the [**Doctor First Name 3098**] was performed with a tapered [**10-2**] x 30 mm Acculink stent. 6. Angioseal of the right groin was performed. FINAL DIAGNOSIS: 1. Occluded [**Country **]. 2. Severe stenosis of [**Doctor First Name 3098**]. 3. Stenting of the [**Doctor First Name 3098**]. 4. Angioseal of groin. Brief Hospital Course: 1. [**Doctor First Name 3098**] stenosis. Pt had a left carotid stent placed without any complications. He was initially started on neosynephrine given risk of hypotension with disruption of baroreceptors. He was gradually weaned off of neo for SBP between 95-140. Serial neuro checks were normal. Pt was continued on Plavix. * 2. CAD: No active issues. Pt was continued on asa, bb, ace, statin. * 3. DM: No active issues. Pt was continued on amaryl * 4. COPD: Pt was continued on home inhalers. Medications on Admission: NIDDM, HTN, CAD ([**4-29**]:s/p PCI x 2,cypher to LAD and taxus to RCA), hyperlipid,COPD, hematuria 2 weeks ago (s/p IVP/cystourethrogram), non-small cell lung cancer Discharge Medications: 1. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. 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* 4. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-27**] Puffs Inhalation Q6H (every 6 hours) as needed. Disp:*1 1* Refills:*3* 5. Clonazepam 0.5 mg Tablet Sig: Two (2) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 6. Advair Diskus 500-50 mcg/Dose Disk with Device Sig: One (1) puff Inhalation twice a day. Disp:*1 1* Refills:*3* 7. Amaryl 1 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 8. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 9. Lasix 20 mg Tablet Sig: One (1) Tablet PO at bedtime. Disp:*30 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: L internal carotid artery stenosis Discharge Condition: Stable Discharge Instructions: Restart your home medications. call Dr. [**First Name (STitle) **] to schedule a follow-up appointment Followup Instructions: Follow-up with Dr. [**First Name (STitle) **]

433,496,250,401,272,V101,V458,305

{'Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bronchus and lung,Percutaneous transluminal coronary angioplasty status,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: elective carotid stenting PRESENT ILLNESS: 70 yo male with PMH DM, HTN, hyperlipid, smoking, mult strokes admitted for elective carotid angiography/intervention. * Carotid ultrasound in [**Month (only) **] found occlusion of right internal carotid artery and a high grade stenosis of the origin of the left internal cartoid artery. * Pt denies any neurologic symptoms (visual, slurred speech, numbness, weakness, other stroke-like sx. * In cath lab found occluded [**Country **], focal 90% stenosis of [**Doctor First Name 3098**]. Successful stenting of the [**Doctor First Name 3098**] was performed. MEDICAL HISTORY: NIDDM (diet control) Non small cell lung cancer 16 yrs ago s/p chemo and XRT 2-3 years ago had EMPYEMA rx??????d with decortication & chest tube Hematuria 2 weeks ago, now resolved S/P IVP/cystourethrogram on [**2138-9-24**] COPD s/p cardiac stent h/o pseudomona sepsis [**4-29**] hypercholesterolemia HTN MEDICATION ON ADMISSION: NIDDM, HTN, CAD ([**4-29**]:s/p PCI x 2,cypher to LAD and taxus to RCA), hyperlipid,COPD, hematuria 2 weeks ago (s/p IVP/cystourethrogram), non-small cell lung cancer ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: t98, p80, 120/80 Gen: NAD, pleasant HEENT: PERRL, EOMI, clear OP Neck: supple, no LAD CVS: RRR, nl s1 s2, no m/g/r, distant heart sounds Lungs: CTAB, no c/w/r Abd: soft, NT, ND, +BS Ext: no c/e/e Neuro: CN2-12 intact, [**4-30**] upper and lower extremity strength, sensation intact to light touch FAMILY HISTORY: dad ?; mom died of pneumonia, (+) HTN; daughter- HTN SOCIAL HISTORY: + Cigs (now smokes 1/2ppd (previously [**1-28**])for 50years) still smoking, occasional alcohol, no illicit drugs. lives with wife on farm, owns bed and bkfst. ### Response: {'Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of bronchus and lung,Percutaneous transluminal coronary angioplasty status,Tobacco use disorder'}

CHIEF COMPLAINT: transferred for biliary sepsis/acalculous cholecystitis PRESENT ILLNESS: This is a 56yo M who was transferred for acalculous cholecystitis. He had prolonged recent hospitalization with recent C diff with toxic megacolon in [**4-13**](surgery deferred because patient refused ostomy), sepsis with pseudomonas from urine, respiratory failure secondary to pneumonia requiring intubation, fungal septicemia. PEG tube was palced at that time. He was eventually discharged to [**Hospital1 41724**] rehabilitation after one month of hospitalization on [**2126-5-23**]. He developed abdominal discomfort in rehab and was sent to [**First Name4 (NamePattern1) 46**] [**Last Name (NamePattern1) **] outpatient CT scan raised suspiciaon of cholecystitis. Patient had ALP and direct bili elevation since [**4-13**]. Ultrasound demonstarted sludge in GB, CT showed ??cholecystitis with some pericholecystic fluid and HIDA scan abnormal. He was given cefotetan and zosyn. He was in ICU and given IVF for mild hypotension. He was also given IVF for mild hypotention (per d/c summary). Transferred to [**Hospital1 18**] for futher care and ? biliary drainage. MEDICAL HISTORY: major depression with recent hospitalization under section 12 seizure disorder osteoporosis C diff colitis VRE from rectal swab anemia chronic constipation colonic polyp osteoporosis bilateral pneumonia MEDICATION ON ADMISSION: cymbalta lamictal 50 Q8 zonegran flagyl vanco 250 Q6 valproic acid 375 QID hydrocortisone 5 QD sc heparin cymbalta 60 QAM zantac potassium 20 [**Hospital1 **] lidoderm for left hip morphine prn guainefesin ALLERGIES: Compazine / Phenobarbital / Nsaids / Aspirin / Dilantin / Heparin Agents PHYSICAL EXAM: Gen-sleepy, NAD, A+O x3 HEENT-anicteric, oral mucosa dry, neck supple CV-rrr, no r/m/g resp-CTAb from anterior exam [**Last Name (un) 103**]-mild tenderness on right side, no rebound, no guarding, active bowel sounds, soft, PEG tube site clean ext-1+pitting edema FAMILY HISTORY: SOCIAL HISTORY: He denies smoking/ETOH, prior to all this he was living home alone

Hepatitis, unspecified,Other convulsions,Intestinal infection due to Clostridium difficile,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acquired coagulation factor deficiency,Unspecified protein-calorie malnutrition,Arterial embolism and thrombosis of lower extremity,Unspecified accident,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Unspecified septicemia,Anticoagulants causing adverse effects in therapeutic use,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Pain in joint, pelvic region and thigh,Major depressive affective disorder, single episode, unspecified,Critical illness polyneuropathy,Hypertrophy of breast,Hypopotassemia

Hepatitis NOS,Convulsions NEC,Int inf clstrdium dfcile,Fx lumbar vertebra-close,Acq coagul factor defic,Protein-cal malnutr NOS,Lower extremity embolism,Accident NOS,SIRS-noninf w ac org dys,Septicemia NOS,Adv eff anticoagulants,Adv eff antconvl NEC/NOS,Cardiac dysrhythmias NEC,Joint pain-pelvis,Depress psychosis-unspec,Crit illness neuropathy,Hypertrophy of breast,Hypopotassemia

Admission Date: [**2126-6-1**] Discharge Date: [**2126-7-6**] Date of Birth: [**2070-1-8**] Sex: M Service: MEDICINE Allergies: Compazine / Phenobarbital / Nsaids / Aspirin / Dilantin / Heparin Agents Attending:[**First Name3 (LF) 5644**] Chief Complaint: transferred for biliary sepsis/acalculous cholecystitis Major Surgical or Invasive Procedure: subclavian line placement History of Present Illness: This is a 56yo M who was transferred for acalculous cholecystitis. He had prolonged recent hospitalization with recent C diff with toxic megacolon in [**4-13**](surgery deferred because patient refused ostomy), sepsis with pseudomonas from urine, respiratory failure secondary to pneumonia requiring intubation, fungal septicemia. PEG tube was palced at that time. He was eventually discharged to [**Hospital1 41724**] rehabilitation after one month of hospitalization on [**2126-5-23**]. He developed abdominal discomfort in rehab and was sent to [**First Name4 (NamePattern1) 46**] [**Last Name (NamePattern1) **] outpatient CT scan raised suspiciaon of cholecystitis. Patient had ALP and direct bili elevation since [**4-13**]. Ultrasound demonstarted sludge in GB, CT showed ??cholecystitis with some pericholecystic fluid and HIDA scan abnormal. He was given cefotetan and zosyn. He was in ICU and given IVF for mild hypotension. He was also given IVF for mild hypotention (per d/c summary). Transferred to [**Hospital1 18**] for futher care and ? biliary drainage. Past Medical History: major depression with recent hospitalization under section 12 seizure disorder osteoporosis C diff colitis VRE from rectal swab anemia chronic constipation colonic polyp osteoporosis bilateral pneumonia Social History: He denies smoking/ETOH, prior to all this he was living home alone Physical Exam: Gen-sleepy, NAD, A+O x3 HEENT-anicteric, oral mucosa dry, neck supple CV-rrr, no r/m/g resp-CTAb from anterior exam [**Last Name (un) 103**]-mild tenderness on right side, no rebound, no guarding, active bowel sounds, soft, PEG tube site clean ext-1+pitting edema Pertinent Results: CT Pelvis: Limited portable exam demonstrating no gross evidence of left hip fracture or dislocation. Dedicated radiographs of the hip within the department may be helpful for more comprehensive assessment given concern for fracture. . MRCP: 1) Minimal central intrahepatic biliary ductal dilatation, with a normal appearing common bile duct. There is no evidence of intraductal filling defects or central obstructing lesions. 2) Gallbladder sludge with a small amount of gallbladder wall edema. Given the presence of abdominal ascites and third spacing of fluid within the visualized subcutaneous soft tissues, the significance of this gallbladder wall edema is non-specific. Clinical correlation is recommended. 3) Bibasilar consolidations, consistent with the patient's stated history of aspiration pneumonia. 4) Gynecomastia. . liver U/S: 1) Gallbladder sludge, without calculi or evidence of acute cholecytitis. 2) No evidence of biliary tract obstruction to explain cholestasis. . CXR: increased opacity at the right lung base likely represents developing pneumonia versus aspiration. Increased atelectasis at the left lung base. . CT Head: No evidence of acute intracranial hemorrhage or mass effect. . MR [**Name13 (STitle) **]: There is an acute compression fracture of the L2 vertebral body, which likely represents an insufficiency fracture, though a pathologic fracture cannot be entirely excluded. A chronic compression fracture of L1 is also noted. There is no evidence of cord impingement . MR [**Name13 (STitle) 2854**]: Chronic compression fracture of T10 vertebral body. No epidural abscesses are seen . Liver core biopsy: The specimen is small and fragmented but shows changes consistent with submassive hepatic necrosis. The changes include parenchymal collapse, bile duct proliferation with portal mixed inflammatory cell infiltrate and cholestasis. No fatty change is seen. Trichrome stain shows mild portal fibrosis and collapse. The etiology of these changes includes a drug reaction, among others. . Knee plain film - PA and lateral views of the left knee show mild degree of degenerative changes involving the left knee manifested by mild degree of joint space narrowing involving the medial and the patellofemoral compartments. There is no evidence of joint effusion. There is mild degree of hypertrophic changes involving the superior aspect of the patella.the bony structures show normal bone density and no evidence of fractures or destructive changes or erosions . [**2126-6-1**] 11:47PM LACTATE-1.8 [**2126-6-1**] 11:37PM GLUCOSE-151* UREA N-11 CREAT-0.4* SODIUM-142 POTASSIUM-3.9 CHLORIDE-107 TOTAL CO2-29 ANION GAP-10 [**2126-6-1**] 11:37PM ALT(SGPT)-736* AST(SGOT)-1850* LD(LDH)-451* ALK PHOS-1752* AMYLASE-107* TOT BILI-4.6* [**2126-6-1**] 11:37PM LIPASE-139* [**2126-6-1**] 11:37PM ALBUMIN-2.3* CALCIUM-8.4 PHOSPHATE-3.2 MAGNESIUM-1.6 [**2126-6-1**] 11:37PM HBsAg-NEGATIVE HBs Ab-NEGATIVE HBc Ab-NEGATIVE HAV Ab-NEGATIVE [**2126-6-1**] 11:37PM HCV Ab-NEGATIVE [**2126-6-1**] 11:37PM WBC-11.3* RBC-3.85* HGB-12.9* HCT-40.3 MCV-105* MCH-33.5* MCHC-32.0 RDW-16.5* [**2126-6-1**] 11:37PM NEUTS-79.7* LYMPHS-13.6* MONOS-5.9 EOS-0.1 BASOS-0.6 [**2126-6-1**] 11:37PM ANISOCYT-1+ MACROCYT-3+ [**2126-6-1**] 11:37PM PLT COUNT-354 [**2126-6-1**] 11:37PM PT-16.3* PTT-33.0 INR(PT)-1.7 Brief Hospital Course: C diff colitis - the patient was initially placed on metronidazole due to his prior history of prolonged C diff colitis. This was stopped after three days after it was determined that the he had completed a full course of metronidazole at the outside hospital. On hospital day 15 the patient spiked to 104 w/ rigors and tachycardia to the 170's. He was transferred to the MICU for a second time for further monitoring. His white count rose to 33. He was pancultured and emprically started on vancomycin, levaquin, and flagyl. His stool eventually came back positive for C difficile. Vancomycin and levaquin were stopped and the patient was maintained on flagyl and po vancomycin. His white count returned to [**Location 213**] and he was no longer febrile. The patient was eventually given a 14 day course of flagyl for C diff colitis. Since the patient had a prior history of C diff toxic megacolon and a history of prior C diff infections was unknown he was treated as a second relapse. He will be d/c on pulsed taper of po vancomycin for a total six week course. . Elevated LFTs - The patient was initially admitted to the ICU for sepsis. He was started on broad spectrum abx due to concern for cholecystitis. Pt had RUQ US and MRCP that illustrated sludging withing the gallbladder but no evidence for acute cholecystitis. Since the patient did not have a fever and no cholecystitis zosyn was stopped after five days. Due to concern for hepatotoxicity of his regular anticonvulsants lamictal and valproate, both known to be hepatotoxic, and conversation with neurology the patients regular anticonvulsants were held and he was started on keppra. His LFTs then began to normalize. However, after the patient was called out of the MICU for a second time for a recurrence of his c diff colitis, his LFTs began to rise again. Hepatology was re-consulted and recommended ruling out fungal infections. Fungal isolator blood cx were sent and found to be negative. The patient also had a negative HIV test. The patient eventually had a transjugular liver biopsy that showed submassive hepatic necrosis that was most consistent with a drug reaction. The patient was not on any hepatotoxic medications during his second episode of transaminitis, however this will felt to represent a residual finding from his anti-epileptic medications. His LFTs again began to trend down at the time of d/c and the patient was instructed to follow up with hepatology in the next month. . Atrial tachycardia - The patient was noted on telemetry to have intermittent bursts of tachycardia to the 120's and then he would slowly return to a rhythm in the 80's. ECG [**Last Name (un) **] p waves of a different morphology than his baseline when he became tachycardic. On one occasion the patient experienced bradycardia to the 30's. EP was called to see the patient. They felt the patient had an episodic atrial atchycardia that emerged due to his acute illness. They felt his bradycardia was due to a vagal episode. As a result he was placed on a beta blocker for prophylaxis against other vagal episodes as well as a tachycardia induced cardiomyopathy. . Seizures - depakote, lemectil and zonegram was discontinued due to concern of hepatotpxicity. Per conversation with neurology the patient was started on Keppra for prophylaxis and prn ativan. [**6-22**] the patient was noted to have a generalized shaking of all extremities which lasted for 1-2 minutes and resolved with the administration of ativan. Neurology was consulted and advised that the patient's keppra dose be increased. On the morning of [**7-5**] the patient had a staring spell and had decreased responsiveness. This was felt to be another seizure and neurology advised to increase the keppra again. Neurology also felt that the patient should be given a sleep aid as abnormal sleep cycles could contribute to breakthrough seizures. Neurontin was recommended as an additional [**Doctor Last Name 360**] if needed but was not started as the patient did not have another episode at the time of d/c. Right foot ischemia - On hospital day # 7, the pt was noted to have a cold right foot with nonpalpable pulse. Pulse was present by doppler. He was started on heparin drip. Vascular surgery was consulted. Per their recommendation, workup was initiated to rule out source of emboli. Echocardiogram showed normal EF with no thrombus, duplex fem/[**Doctor Last Name **] arteries was negative for aneurysm, abd U/S to r/o AAA was negative. Heparin was eventually changed to lovenox and the patient was started on coumadin with anticipated treatment for six months. The patient's platelet count began to steadily decline. As a result all heparin products were stopped and a heparin induced thrombocytopenia (HIT) antibody was sent and was found to be positive. The patient was placed on lepirudin for his HIT. This was stopped temporarily for liver biopsy and then started again. Once the patient's coumadin was therapeutic ([**3-14**]) lepirudin was stopped. He was instructed to see vascular surgery in 3 months time. Serotonin release antibody ultimately returned negative so this anticoagulation can likely be discontinued. This information was communicated with the rehabilitation facility. . Tube feeds - The patient was given Resplor tube feeds and encouraged to take po's as tolerated. . Lower extremity weakness - the patient was felt to be deconditioned due to prolonged hospitalization. Neurology was consulted and recommended an MRI spine to evaluate for epidural abscess. He was found to have a lumbar compression fracture with no cord compression and no abscess. The patient was given calcium and vitamin D. Medications on Admission: cymbalta lamictal 50 Q8 zonegran flagyl vanco 250 Q6 valproic acid 375 QID hydrocortisone 5 QD sc heparin cymbalta 60 QAM zantac potassium 20 [**Hospital1 **] lidoderm for left hip morphine prn guainefesin all:compazine, aspirin, dilantin, phenobarbital, NSAIDS, tricyclics, tegretol, succinylcholine Discharge Medications: 1. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical Q24H (every 24 hours): right hip. 4. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical Q24 (): left hip. 5. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID (3 times a day). 6. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One (1) PO DAILY (Daily). 7. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO QAM (once a day (in the morning)). 8. Levetiracetam 500 mg Tablet Sig: Four (4) Tablet PO QPM (once a day (in the evening)). 9. Trazodone HCl 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed. 10. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig: 15-30 MLs PO QID (4 times a day) as needed. 11. Zinc Oxide-Cod Liver Oil 40 % Ointment Sig: One (1) Appl Topical QD (). 12. Oxycodone HCl 5 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4 to 6 hours) as needed. 13. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. Calcium Carbonate 1,250 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 15. Lorazepam 2 mg/mL Syringe Sig: 1-2 mg Injection Q4H (every 4 hours) as needed for seizure activity. 16. Vancomycin HCl 125 mg Capsule Sig: One (1) Capsule PO see instructions: 1 pill [**Hospital1 **] x 2 days 1 pill qd x 7 days 1 pill qod x 7 days 1 pill q 3 days x 14 days. 17. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO once a day for 6 months: Please start again when INR between [**3-14**]. Discharge Disposition: Extended Care Facility: [**Hospital1 700**] - [**Location (un) 701**] Discharge Diagnosis: drug induced hepatitis heparin induced thrombocytopenia seizures C diff colitis atrial tachycardia depression ischemic foot Discharge Condition: Fair Discharge Instructions: Please notify a physician or return to the emergency room if you experience fevers, chills, uncontrolled nausea or vomiting, continuous foul smelling diarrhea, limb shaking, shortness of breath, chest pain, abdominal pain, bloody stool, confusion. . You will take coumadin for the next six months and then follow up with Dr. [**Last Name (STitle) **] of vascular surgery in 3 months time. Your coumadin is being held for two days until your INR returns between [**3-14**]. . You should have your LFTs checked daily in rehab to make sure they normalize. Followup Instructions: Please follow up with Dr. [**Last Name (STitle) **] of vascular surgery in 3 months for your ischemic foot - ([**Telephone/Fax (1) 1798**] . Please make an appointment to be seen in the hepatology clinic in the next month ([**Telephone/Fax (1) 1582**] . Please make an appointment to see your neurologist Dr. [**Last Name (STitle) 40860**] within a week of discharge from rehab.

573,780,008,805,286,263,444,E928,995,038,E934,E936,427,719,296,357,611,276

{'Hepatitis, unspecified,Other convulsions,Intestinal infection due to Clostridium difficile,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acquired coagulation factor deficiency,Unspecified protein-calorie malnutrition,Arterial embolism and thrombosis of lower extremity,Unspecified accident,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Unspecified septicemia,Anticoagulants causing adverse effects in therapeutic use,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Pain in joint, pelvic region and thigh,Major depressive affective disorder, single episode, unspecified,Critical illness polyneuropathy,Hypertrophy of breast,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: transferred for biliary sepsis/acalculous cholecystitis PRESENT ILLNESS: This is a 56yo M who was transferred for acalculous cholecystitis. He had prolonged recent hospitalization with recent C diff with toxic megacolon in [**4-13**](surgery deferred because patient refused ostomy), sepsis with pseudomonas from urine, respiratory failure secondary to pneumonia requiring intubation, fungal septicemia. PEG tube was palced at that time. He was eventually discharged to [**Hospital1 41724**] rehabilitation after one month of hospitalization on [**2126-5-23**]. He developed abdominal discomfort in rehab and was sent to [**First Name4 (NamePattern1) 46**] [**Last Name (NamePattern1) **] outpatient CT scan raised suspiciaon of cholecystitis. Patient had ALP and direct bili elevation since [**4-13**]. Ultrasound demonstarted sludge in GB, CT showed ??cholecystitis with some pericholecystic fluid and HIDA scan abnormal. He was given cefotetan and zosyn. He was in ICU and given IVF for mild hypotension. He was also given IVF for mild hypotention (per d/c summary). Transferred to [**Hospital1 18**] for futher care and ? biliary drainage. MEDICAL HISTORY: major depression with recent hospitalization under section 12 seizure disorder osteoporosis C diff colitis VRE from rectal swab anemia chronic constipation colonic polyp osteoporosis bilateral pneumonia MEDICATION ON ADMISSION: cymbalta lamictal 50 Q8 zonegran flagyl vanco 250 Q6 valproic acid 375 QID hydrocortisone 5 QD sc heparin cymbalta 60 QAM zantac potassium 20 [**Hospital1 **] lidoderm for left hip morphine prn guainefesin ALLERGIES: Compazine / Phenobarbital / Nsaids / Aspirin / Dilantin / Heparin Agents PHYSICAL EXAM: Gen-sleepy, NAD, A+O x3 HEENT-anicteric, oral mucosa dry, neck supple CV-rrr, no r/m/g resp-CTAb from anterior exam [**Last Name (un) 103**]-mild tenderness on right side, no rebound, no guarding, active bowel sounds, soft, PEG tube site clean ext-1+pitting edema FAMILY HISTORY: SOCIAL HISTORY: He denies smoking/ETOH, prior to all this he was living home alone ### Response: {'Hepatitis, unspecified,Other convulsions,Intestinal infection due to Clostridium difficile,Closed fracture of lumbar vertebra without mention of spinal cord injury,Acquired coagulation factor deficiency,Unspecified protein-calorie malnutrition,Arterial embolism and thrombosis of lower extremity,Unspecified accident,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Unspecified septicemia,Anticoagulants causing adverse effects in therapeutic use,Other and unspecified anticonvulsants causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Pain in joint, pelvic region and thigh,Major depressive affective disorder, single episode, unspecified,Critical illness polyneuropathy,Hypertrophy of breast,Hypopotassemia'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 61 year-old female with multiple medical problems including end stage renal disease on hemodialysis, congestive heart failure with an EF of 45 to 50%, coronary artery disease, hypertension and repeat admissions for congestive heart failure secondary to hypovolemia who presents with shortness of breath on the morning of admission. The patient reports a hard time sleeping on the night prior to admission and then at 5:00 a.m. developed dyspnea without chest pain, nausea, vomiting or diaphoresis or other symptoms. She denies fevers or chills, night sweats, dietary indiscretions, and noncompliance that would explain failure. She is typically dialyzed Monday, Wednesday and Friday. Her blood pressure in the Emergency Department was 210/100 and given intravenous Hydralazine before being seen by the medicine team. MEDICAL HISTORY: 1. End stage renal disease on hemodialysis. 2. Type 2 diabetes. 3. Congestive heart failure with an EF of 45 to 50% with mild regional left ventricular systolic dysfunction. 4. Coronary artery disease with a stress MIBI in [**5-22**], measured moderate distal anterior apical fixed perfusion deficits. 5. Hypertension. 6. Anemia. 7. Gastroparesis. 8. Right thalamic infarct in [**8-22**]. MEDICATION ON ADMISSION: 1. Clonidine q Sunday. 2. Aspirin 81 q.d. 3. Norvasc 10 q.d. 4. Metoprolol 50 on Monday, Wednesday and Friday. 5. Lisinopril 40 q day. 6. Atorvastatin 20 q.d. 7. Protonix 40 q.d. 8. Nitro patch .4 q 24. 9. Insulin NPH and sliding scale. ALLERGIES: Reglan. PHYSICAL EXAM: FAMILY HISTORY: Notable for diabetes. SOCIAL HISTORY: The patient lives in [**Location 686**] originally from [**Location (un) 4708**]. She denies tobacco and alcohol use. She has six children.

Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonia, organism unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere

CHF NOS,Hyp kid NOS w cr kid V,Pneumonia, organism NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Nephritis NOS in oth dis

Admission Date: [**2179-10-24**] Discharge Date: [**2179-10-29**] Date of Birth: [**2118-4-29**] Sex: F Service: [**Doctor Last Name 1181**]/MEDICINE HISTORY OF PRESENT ILLNESS: The patient is a 61 year-old female with multiple medical problems including end stage renal disease on hemodialysis, congestive heart failure with an EF of 45 to 50%, coronary artery disease, hypertension and repeat admissions for congestive heart failure secondary to hypovolemia who presents with shortness of breath on the morning of admission. The patient reports a hard time sleeping on the night prior to admission and then at 5:00 a.m. developed dyspnea without chest pain, nausea, vomiting or diaphoresis or other symptoms. She denies fevers or chills, night sweats, dietary indiscretions, and noncompliance that would explain failure. She is typically dialyzed Monday, Wednesday and Friday. Her blood pressure in the Emergency Department was 210/100 and given intravenous Hydralazine before being seen by the medicine team. PAST MEDICAL HISTORY: 1. End stage renal disease on hemodialysis. 2. Type 2 diabetes. 3. Congestive heart failure with an EF of 45 to 50% with mild regional left ventricular systolic dysfunction. 4. Coronary artery disease with a stress MIBI in [**5-22**], measured moderate distal anterior apical fixed perfusion deficits. 5. Hypertension. 6. Anemia. 7. Gastroparesis. 8. Right thalamic infarct in [**8-22**]. ALLERGIES: Reglan. MEDICATIONS ON ADMISSION: 1. Clonidine q Sunday. 2. Aspirin 81 q.d. 3. Norvasc 10 q.d. 4. Metoprolol 50 on Monday, Wednesday and Friday. 5. Lisinopril 40 q day. 6. Atorvastatin 20 q.d. 7. Protonix 40 q.d. 8. Nitro patch .4 q 24. 9. Insulin NPH and sliding scale. SOCIAL HISTORY: The patient lives in [**Location 686**] originally from [**Location (un) 4708**]. She denies tobacco and alcohol use. She has six children. FAMILY HISTORY: Notable for diabetes. PHYSICAL EXAMINATION: On examination the patient's temperature was 99.5, pulse 85, blood pressure 198/72. Respiratory rate 15. 98% on 4 liters. General, this is a somnolent woman in no acute distress. Neck examination she had JVD to the angle of the jaw. Lungs had decreased breath sounds bilaterally. There is bibasilar crackles. She was dull to percussion at the bases. Heart examination regular rate and rhythm with occasional premature beats. No murmurs, rubs or gallops. Abdomen was soft, nontender, nondistended. Positive bowel sounds. Extremities no clubbing, cyanosis or edema. LABORATORY: White blood cell count was 18.9 with 89% polys, hematocrit 29.1, platelets 265. Her chem 7 she had a sodium of 138, potassium 4.3, chloride 90, bicarb 32, BUN 42, creatinine 7.2, glucose 211. She had a CK of 99, troponin of .09. Chest film she had bilateral pulmonary infiltrates, cardiomegaly consistent with congestive heart failure. HOSPITAL COURSE: 1. Later on the day of admission while being previously stable she developed significant hypoxia consistent with flash pulmonary edema. Her blood pressure escalated to approximately 260/110 with crackles throughout her lung examination. She developed pink frothy sputum and sating at the mid 80s on 6 liters ultimately requiring a face mask and sating better. At this time there are several therapies undergone. She was given 80 mg of Lasix with poor diuretic response. Because the patient makes very little urine as well as started on a nitroglycerin drip to lower blood pressure. She was also given a total of 8 mg of morphine with significant improvement. After these symptoms began the Intensive Care Unit team was called and the decision was made to put the patient on BiPAP and transferred to the Intensive Care Unit. During this time she was still hypertensive and the patient was given intravenous Metoprolol. ............ Service who had earlier consulted on the patient was consulted again and they deferred emergent dialysis pending more medical management. After increase in the nitroglycerin drip the patient's blood pressure finally responded going under 180 to 190 with significant improvement in her symptoms and oxygen saturation at this point. She was transferred to the Intensive Care Unit and given BiPAP overnight. Over the next several days the patient underwent several rounds of hemodialysis with ultra filtration prior to that to take off more volume. The plan was to over the next week and in coming times to take off more fluid with dialysis likely having an ultra filtration prior to actually initiating hemodialysis. By discharge the patient was in much better respiratory shape with sating in the mid to high 90s on room air without any dyspnea. 2. Hypertension: The patient presented with hypertensive emergency. She was started on Metoprolol q.d. instead of three times a week and was discharged with Toprol XL 50 due to heart failure. Further cardiac workup was postponed for several reasons. For one she had a cardiac consult in [**Month (only) 116**], which suggested that her previous MIBI scan was interpretable and further study would require an MRI, which we did not have at this institution. In addition, the patient deferred cardiac catheterization and so further ischemic workup was not indicated. The Clonidine patch, which she had been on admission was discontinued and was replaced with Metoprolol. This was in [**Location (un) **] the Renal Service who would like more room with her blood pressure to take off fluid during dialysis and ultra filtration. CONDITION ON DISCHARGE: Stable. DISCHARGE STATUS: To home. DISCHARGE MEDICATIONS: 1. Aspirin 81 q.d. 2. Lipitor 20 q.d. 3. Amlodipine 10 q.d. 4. Lisinopril 40 q.d. 5. Protonix 40 q.d. 6. Nitroglycerin tab prn. 7. Toprol 50 q.d. DISCHARGE DIAGNOSES: 1. Hypertensive emergency. 2. Congestive heart failure. 3. End stage renal disease. FOLLOW UP PLANS: The patient will follow up with her outpatient nephrologist and her primary care physician within one week. She will have outpatient VNA for physical therapy and other services. [**Doctor Last Name **] [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(1) 5712**] Dictated By:[**Last Name (NamePattern1) 7693**] MEDQUIST36 D: [**2179-10-31**] 10:46 T: [**2179-11-1**] 11:01 JOB#: [**Job Number 12546**]

428,403,486,250,357,583

{'Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonia, organism unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}

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 61 year-old female with multiple medical problems including end stage renal disease on hemodialysis, congestive heart failure with an EF of 45 to 50%, coronary artery disease, hypertension and repeat admissions for congestive heart failure secondary to hypovolemia who presents with shortness of breath on the morning of admission. The patient reports a hard time sleeping on the night prior to admission and then at 5:00 a.m. developed dyspnea without chest pain, nausea, vomiting or diaphoresis or other symptoms. She denies fevers or chills, night sweats, dietary indiscretions, and noncompliance that would explain failure. She is typically dialyzed Monday, Wednesday and Friday. Her blood pressure in the Emergency Department was 210/100 and given intravenous Hydralazine before being seen by the medicine team. MEDICAL HISTORY: 1. End stage renal disease on hemodialysis. 2. Type 2 diabetes. 3. Congestive heart failure with an EF of 45 to 50% with mild regional left ventricular systolic dysfunction. 4. Coronary artery disease with a stress MIBI in [**5-22**], measured moderate distal anterior apical fixed perfusion deficits. 5. Hypertension. 6. Anemia. 7. Gastroparesis. 8. Right thalamic infarct in [**8-22**]. MEDICATION ON ADMISSION: 1. Clonidine q Sunday. 2. Aspirin 81 q.d. 3. Norvasc 10 q.d. 4. Metoprolol 50 on Monday, Wednesday and Friday. 5. Lisinopril 40 q day. 6. Atorvastatin 20 q.d. 7. Protonix 40 q.d. 8. Nitro patch .4 q 24. 9. Insulin NPH and sliding scale. ALLERGIES: Reglan. PHYSICAL EXAM: FAMILY HISTORY: Notable for diabetes. SOCIAL HISTORY: The patient lives in [**Location 686**] originally from [**Location (un) 4708**]. She denies tobacco and alcohol use. She has six children. ### Response: {'Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Pneumonia, organism unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}

CHIEF COMPLAINT: Elective CABG PRESENT ILLNESS: Patient is a 75 y/o man with hx of HTN, hyperlipidemia, CAD (BMS to RCA in [**2173**] with in-stent occlusion in [**2184**]), recent GI bleed likely from ulcer in stomach, and atrial fibrillation, who presented for EGD prior to CABG. The patient was admitted to [**Hospital1 18**] in [**2185-9-28**] for STEMI in the setting of a GI bleed. He had a cardiac cath where he was found to have an in-stent stenosis of his RCA and diffuse 3VD. The patient also had an EGD performed prior to his admission in [**Month (only) 359**], which demonstrated a sliding type hiatal hernia, mild gastritis and an antral ulcer which had a white, healing base with no active clots or active bleeding. It was decided at the time of discharge that the patient would have an ECG performed before elective CABG. The patient states that he has not experienced any recent chest pain, and he is no longer having melena. He has been off Plavix and Coumadin since Monday before this admission date. . On ROS, the patient denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, myalgias, joint pains, cough, hemoptysis. He denies 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: -Coronary Artery Disease/Ischemic Cardiomyopathy -Prior Thrombectomy/Stenting of RCA [**2173**] -Prior ICD Placement -Dyslipidemia -Hypertension -COPD -Atrial fibrillation -Recent hospitalization for a GI bleed -Diverticulosis -Grade I internal hemorrhoids -Osteoarthritis -Healing antral ulcer -Hiatal hernia MEDICATION ON ADMISSION: 1. Aspirin 325 mg daily 2. Clopidogrel 75 mg daily 3. Warfarin 4. Atorvastatin 80 mg daily 5. Acetaminophen 500 mg as needed 6. Dofetilide 250 mcg twice daily 7. Furosemide 20 mg daily 8. Metoprolol Succinate 100 mg [**Hospital1 **] 9. Lisinopril 5 mg daily 10. Pantoprazole 40 mg twice daily 11. Glucosamine 500 mg daily 12. Chondroitin Sulfate-Vit C-Mn 400-60-2.5 mg daily 13. Multiple Vitamin daily 14. Calcium 600 + D(3) 600 mg(1,500mg) daily 15. Meloxicam 22.5 mg daily 16. Tikosyn 0.5 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission VS - T 98.1, BP 135/87, P 66, R 18, O2 100% on RA Gen: Elderly man in NAD. Oriented x3. Mood, affect appropriate. FAMILY HISTORY: Both parents died of coronary artery disease in their 60s SOCIAL HISTORY: Mr. [**Known lastname **] is married and lives at home with his wife in [**Name (NI) 2498**], MA. He considers himself to be an active person for his age. He is a retired supervisor of [**State 20475**]. He quit smoking on [**2158**] after a history of 1PPD x 30 years. He denies any alcohol use and denies any history of illicit drug use.

Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Other iatrogenic hypotension,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ,Atrial fibrillation,Long-term (current) use of anticoagulants,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Helicobacter pylori [H. pylori],Percutaneous transluminal coronary angioplasty status,Acute myocardial infarction of other anterior wall, subsequent episode of care,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Internal hemorrhoids without mention of complication

Crnry athrscl natve vssl,Chr systolic hrt failure,Iatrogenc hypotnsion NEC,Hypertension NOS,Status autm crd dfbrltr,Atrial fibrillation,Long-term use anticoagul,Stomach ulcer NOS,Helicobacter pylori,Status-post ptca,AMI anterior wall,subseq,Chr airway obstruct NEC,Hyperlipidemia NEC/NOS,Int hemorrhoid w/o compl

Admission Date: [**2185-12-8**] Discharge Date: [**2185-12-19**] Date of Birth: [**2110-9-8**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 1505**] Chief Complaint: Elective CABG Major Surgical or Invasive Procedure: [**2185-12-13**] Two Vessel Coronary Artery Bypass Grafting utilizing the left internal mammary artery to left anterior descending, saphenous vein graft to posterior lateral branch History of Present Illness: Patient is a 75 y/o man with hx of HTN, hyperlipidemia, CAD (BMS to RCA in [**2173**] with in-stent occlusion in [**2184**]), recent GI bleed likely from ulcer in stomach, and atrial fibrillation, who presented for EGD prior to CABG. The patient was admitted to [**Hospital1 18**] in [**2185-9-28**] for STEMI in the setting of a GI bleed. He had a cardiac cath where he was found to have an in-stent stenosis of his RCA and diffuse 3VD. The patient also had an EGD performed prior to his admission in [**Month (only) 359**], which demonstrated a sliding type hiatal hernia, mild gastritis and an antral ulcer which had a white, healing base with no active clots or active bleeding. It was decided at the time of discharge that the patient would have an ECG performed before elective CABG. The patient states that he has not experienced any recent chest pain, and he is no longer having melena. He has been off Plavix and Coumadin since Monday before this admission date. . On ROS, the patient denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, myalgias, joint pains, cough, hemoptysis. He denies 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: -Coronary Artery Disease/Ischemic Cardiomyopathy -Prior Thrombectomy/Stenting of RCA [**2173**] -Prior ICD Placement -Dyslipidemia -Hypertension -COPD -Atrial fibrillation -Recent hospitalization for a GI bleed -Diverticulosis -Grade I internal hemorrhoids -Osteoarthritis -Healing antral ulcer -Hiatal hernia Social History: Mr. [**Known lastname **] is married and lives at home with his wife in [**Name (NI) 2498**], MA. He considers himself to be an active person for his age. He is a retired supervisor of [**State 20475**]. He quit smoking on [**2158**] after a history of 1PPD x 30 years. He denies any alcohol use and denies any history of illicit drug use. Family History: Both parents died of coronary artery disease in their 60s Physical Exam: Admission VS - T 98.1, BP 135/87, P 66, R 18, O2 100% on RA Gen: Elderly man in NAD. Oriented x3. Mood, affect appropriate. HEENT: PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. Neck: Supple, No JVD appreciated. No LAD CV: PMI located in 5th intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. Chest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. Abd: Soft, NTND. No HSM or tenderness. Ext: No c/c/e. No femoral bruits. Skin: No stasis dermatitis, ulcers, scars, or xanthomas. Pulses: Right: DP 2+ PT 2+ / Left: DP 2+ PT 2+ At discharge: Exam mostly same than amission, except: Chest: Sternal wound healing, clean and dry, -clicks Ext: Warm, 1+ edema incision healing well Pertinent Results: [**2185-12-8**] BLOOD WBC-4.8 RBC-3.71* Hgb-8.8* Hct-27.2* MCV-73*# MCH-23.7*# MCHC-32.2 RDW-15.9* Plt Ct-246 [**2185-12-8**] BLOOD PT-16.3* PTT-28.7 INR(PT)-1.5* [**2185-12-8**] BLOOD Glucose-125* UreaN-24* Creat-1.3* Na-137 K-4.4 Cl-104 HCO3-25 AnGap-12 [**2185-12-9**] BLOOD ALT-11 AST-18 LD(LDH)-164 AlkPhos-60 TotBili-0.5 [**2185-12-9**] BLOOD Albumin-3.7 Calcium-8.4 Phos-3.3 Mg-2.1 [**2185-12-9**] BLOOD %HbA1c-6.2* [**2185-12-9**] ECHO: The left atrium is markedly dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is severely dilated. LV systolic function appears moderately-to-severely depressed (ejection fraction 30 percent) secondary to a large posterobasal aneurysm, severe hypokinesis of the inferior septum, akinesis of the inferior free wall, and hypokinesis of the lateral wall. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic root is moderately dilated at the sinus level. 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. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] The left ventricular inflow pattern suggests impaired relaxation. The tricuspid valve leaflets are mildly thickened. There is no pericardial effusion. [**2185-12-9**] Carotid Ultrasound: Right ICA 1-39% stenosis. Tortuous left ICA with a low end, 40-59% stenosis. Normal vertebral flow. Brief Hospital Course: Mr. [**Known lastname **] was admitted to the [**Hospital Unit Name 196**] service. Prior to surgical revascularization and given his history of GI bleed, he underwent EGD which found 8mm ulcer in the antrum and only mild gastritis. EGD was otherwise normal. He remained stable on medical therapy, and was maintained on Lovenox bridge. Preoperative course was otherwise uneventful and he was cleared for surgery. On [**12-13**], Dr. [**Last Name (STitle) **] performed coronary artery bypass grafting. For surgical details, please see operative note. Following surgery, he was brought to the CVICU for invasive monitoring. Within 24 hours, he awoke neurologically intact and was extubated. He initially experienced some hypotension but gradually weaned from Neo-Synephrine over several days. He remained in atrial fibrillation. His preoperative medications were resumed and was eventually restarted on Warfarin. Antibiotics(Amoxicillin and Clarithromycin) were initiated for positive H. pylori antibodies on serology. On postoperative day four, he transferred to the SDU. Cardiology service was consulted given poorly controlled atrial fibrillation. Recommendations were to increase beta blockade as tolerated as Verapamil in contraindicated in the setting of Dofetilide. Over several days medical therapy was optimized. He continued to make clinical improvements and was eventually cleared for discharge to rehab on postoperative day six. Warfarin should be dosed for goal INR between 2.0 - 3.0. Medications on Admission: 1. Aspirin 325 mg daily 2. Clopidogrel 75 mg daily 3. Warfarin 4. Atorvastatin 80 mg daily 5. Acetaminophen 500 mg as needed 6. Dofetilide 250 mcg twice daily 7. Furosemide 20 mg daily 8. Metoprolol Succinate 100 mg [**Hospital1 **] 9. Lisinopril 5 mg daily 10. Pantoprazole 40 mg twice daily 11. Glucosamine 500 mg daily 12. Chondroitin Sulfate-Vit C-Mn 400-60-2.5 mg daily 13. Multiple Vitamin daily 14. Calcium 600 + D(3) 600 mg(1,500mg) daily 15. Meloxicam 22.5 mg daily 16. Tikosyn 0.5 mg daily Discharge Medications: 1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Atorvastatin 80 mg Tablet Sig: One (1) 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. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). 7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours as needed for pain. 8. Dofetilide 500 mcg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). 9. Clarithromycin 250 mg Tablet Sig: Two (2) Tablet PO Q12H (every 12 hours). 10. Amoxicillin 250 mg Capsule Sig: Four (4) Capsule PO Q12H (every 12 hours). 11. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours): can reduce to 20mg daily once at pre-op weight or per cardiologist. 12. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H (every 12 hours): can reduce to 20mEq daily once at pre-op weight or per cardiologist. . 13. Warfarin 1 mg Tablet Sig: 3.5 Tablets PO DAILY (Daily): goal INR between 2.0 - 3.0. Discharge Disposition: Extended Care Facility: Life Care Center of [**Location 15289**] Discharge Diagnosis: Coronary Artery Disease - s/p Coronary Artery Bypass Graft x 2 Ischemic Cardiomyopathy/Chronic Systolic Congestive Heart Failure History of Atrial Fibrillation Hypertension Dyslipidemia Chronic Obstructive Pulmonary Disease Prior ICD Placement History of GI Bleed Mild to moderate Carotid Disease Discharge Condition: Good Discharge Instructions: No driving for 4 weeks. No lifting more than 10 pounds for 10 weeks. Shower daily, no baths. Report any temperature greater than 100.5. Report any weight gain greater than 2 pounds a day or 5 pounds a week. Report any redness of, or drainage from incisions. No lotions, creams or powders to incisions. Followup Instructions: Dr. [**Last Name (STitle) **] in [**4-2**] weeks, call for appt Dr. [**Last Name (STitle) 8098**] in [**1-30**] weeks, call for appt Dr. [**Last Name (STitle) 20478**] in [**1-30**] weeks, call for appt Completed by:[**2185-12-19**]

414,428,458,401,V450,427,V586,531,041,V458,410,496,272,455

{'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Other iatrogenic hypotension,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ,Atrial fibrillation,Long-term (current) use of anticoagulants,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Helicobacter pylori [H. pylori],Percutaneous transluminal coronary angioplasty status,Acute myocardial infarction of other anterior wall, subsequent episode of care,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Internal hemorrhoids without mention of complication'}

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: Elective CABG PRESENT ILLNESS: Patient is a 75 y/o man with hx of HTN, hyperlipidemia, CAD (BMS to RCA in [**2173**] with in-stent occlusion in [**2184**]), recent GI bleed likely from ulcer in stomach, and atrial fibrillation, who presented for EGD prior to CABG. The patient was admitted to [**Hospital1 18**] in [**2185-9-28**] for STEMI in the setting of a GI bleed. He had a cardiac cath where he was found to have an in-stent stenosis of his RCA and diffuse 3VD. The patient also had an EGD performed prior to his admission in [**Month (only) 359**], which demonstrated a sliding type hiatal hernia, mild gastritis and an antral ulcer which had a white, healing base with no active clots or active bleeding. It was decided at the time of discharge that the patient would have an ECG performed before elective CABG. The patient states that he has not experienced any recent chest pain, and he is no longer having melena. He has been off Plavix and Coumadin since Monday before this admission date. . On ROS, the patient denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, myalgias, joint pains, cough, hemoptysis. He denies 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: -Coronary Artery Disease/Ischemic Cardiomyopathy -Prior Thrombectomy/Stenting of RCA [**2173**] -Prior ICD Placement -Dyslipidemia -Hypertension -COPD -Atrial fibrillation -Recent hospitalization for a GI bleed -Diverticulosis -Grade I internal hemorrhoids -Osteoarthritis -Healing antral ulcer -Hiatal hernia MEDICATION ON ADMISSION: 1. Aspirin 325 mg daily 2. Clopidogrel 75 mg daily 3. Warfarin 4. Atorvastatin 80 mg daily 5. Acetaminophen 500 mg as needed 6. Dofetilide 250 mcg twice daily 7. Furosemide 20 mg daily 8. Metoprolol Succinate 100 mg [**Hospital1 **] 9. Lisinopril 5 mg daily 10. Pantoprazole 40 mg twice daily 11. Glucosamine 500 mg daily 12. Chondroitin Sulfate-Vit C-Mn 400-60-2.5 mg daily 13. Multiple Vitamin daily 14. Calcium 600 + D(3) 600 mg(1,500mg) daily 15. Meloxicam 22.5 mg daily 16. Tikosyn 0.5 mg daily ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: Admission VS - T 98.1, BP 135/87, P 66, R 18, O2 100% on RA Gen: Elderly man in NAD. Oriented x3. Mood, affect appropriate. FAMILY HISTORY: Both parents died of coronary artery disease in their 60s SOCIAL HISTORY: Mr. [**Known lastname **] is married and lives at home with his wife in [**Name (NI) 2498**], MA. He considers himself to be an active person for his age. He is a retired supervisor of [**State 20475**]. He quit smoking on [**2158**] after a history of 1PPD x 30 years. He denies any alcohol use and denies any history of illicit drug use. ### Response: {'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Other iatrogenic hypotension,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ,Atrial fibrillation,Long-term (current) use of anticoagulants,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Helicobacter pylori [H. pylori],Percutaneous transluminal coronary angioplasty status,Acute myocardial infarction of other anterior wall, subsequent episode of care,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Internal hemorrhoids without mention of complication'}

CHIEF COMPLAINT: Left upper lobe lung cancer. PRESENT ILLNESS: Mr. [**Known lastname **] is a 62-year-old gentleman with a biopsy-proven left upper lobe lung cancer. His mediastinoscopy and mediastinal lymph node staging by VATS AP window dissection was negative for nodal spread. MEDICAL HISTORY: Prostate cancer, status post radical prostatectomy and XRT Status post appendectomy Status post cholecystectomy Skin cancer MEDICATION ON ADMISSION: Randitine ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: General: no apparent distress HEENT: normocephalic, mucus membranes moist Neck: supple Resp: clear breath sounds right, left absent Card: RRR GI: benign Extr: warm no edema Incision: Left thoracotomy site clean dry intact Neuro: non-focal FAMILY HISTORY: Father deceased MI. Mother deceased emphysema. Sister and brother had AAA repairs. SOCIAL HISTORY: Married. Works as a swimming pool service contractor. Drinks 10 drinks/week. Quit smoking 20 years ago and had been a 60ppy smoker. No smokes cigars.

Malignant neoplasm of upper lobe, bronchus or lung,Pneumonia, organism unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Emphysema (subcutaneous) (surgical) resulting from procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension,Atrial fibrillation,Hypoxemia,Tobacco use disorder,Constipation, unspecified

Mal neo upper lobe lung,Pneumonia, organism NOS,Mal neo lymph-intrathor,Emphysema rsult frm proc,Abn react-surg proc NEC,Accid in resident instit,Hx-prostatic malignancy,Iatrogenc hypotnsion NEC,Atrial fibrillation,Hypoxemia,Tobacco use disorder,Constipation NOS

Admission Date: [**2109-11-13**] Discharge Date: [**2109-11-21**] Date of Birth: [**2047-1-19**] Sex: M Service: CARDIOTHORACIC Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 5790**] Chief Complaint: Left upper lobe lung cancer. Major Surgical or Invasive Procedure: [**2109-11-13**] Left intrapericardial pneumonectomy and intercostal muscle flap buttress to the pneumonectomy [**Last Name (LF) **], [**First Name3 (LF) **] lymphadenectomy, bronchoscopy with aspiration. History of Present Illness: Mr. [**Known lastname **] is a 62-year-old gentleman with a biopsy-proven left upper lobe lung cancer. His mediastinoscopy and mediastinal lymph node staging by VATS AP window dissection was negative for nodal spread. The patient had marginal pulmonary function tests and we did try to clarify this further with both VQ testing which revealed passable reserves following a left upper lobectomy with an expected predicted postoperative FEV1 of 48% and DLCO of 41%. He had a predicted postoperative FEV1 of closer to 39% and 34% following pneumonectomy. He was admitted for resection with possible pneumonectomy. Past Medical History: Prostate cancer, status post radical prostatectomy and XRT Status post appendectomy Status post cholecystectomy Skin cancer Social History: Married. Works as a swimming pool service contractor. Drinks 10 drinks/week. Quit smoking 20 years ago and had been a 60ppy smoker. No smokes cigars. Family History: Father deceased MI. Mother deceased emphysema. Sister and brother had AAA repairs. Physical Exam: VS: General: no apparent distress HEENT: normocephalic, mucus membranes moist Neck: supple Resp: clear breath sounds right, left absent Card: RRR GI: benign Extr: warm no edema Incision: Left thoracotomy site clean dry intact Neuro: non-focal Pertinent Results: [**2109-11-20**] WBC-11.0 RBC-3.25* Hgb-10.6* Hct-30.9* Plt Ct-268 [**2109-11-19**] WBC-10.6 RBC-3.25* Hgb-10.7* Hct-30.8* Plt Ct-258 [**2109-11-14**] WBC-20.1*# RBC-4.03* Hgb-12.7* Hct-37.5 Plt Ct-274 [**2109-11-20**] Glucose-91 UreaN-16 Creat-1.0 Na-139 K-3.5 Cl-100 HCO3-31 [**2109-11-19**] Glucose-95 UreaN-23* Creat-1.0 Na-139 K-4.2 Cl-102 HCO3-31 [**2109-11-14**] Glucose-112* UreaN-19 Creat-2.1*# Na-139 K-6.6* Cl-105 HCO3-27 [**2109-11-14**] Glucose-110* UreaN-21* Creat-2.0* Na-141 K-6.0* Cl-106 HCO3-24 [**2109-11-16**] CK-MB-4 cTropnT-0.04* [**2109-11-18**] CK-MB-3 cTropnT-0.01 [**2109-11-19**] CK-MB-3 cTropnT-<0.01 CXR: [**2109-11-19**]: There is no change in the appearance of the chest, compared to the prior study, including status post left pneumonectomy with surgical clips at the left hilus, near opacification of the left hemithorax, with small amount of air remaining in the pneumonectomy cavity and elevation of the left hemidiaphragm. Mild rightward mediastinal shift has stabilized. The right lung remains relatively clear. Thoracotomy changes are seen on the left. Left chest wall emphysema has decreased. [**2109-11-18**]: A small amount of air is still present in the left hemithorax. The left post- pneumonectomy cavity is mainly occupied by fluid. There is stable shifting of the cardiomediastinal silhouette towards the right. The right lung is grossly clear. Left subcutaneous emphysema has minimally decreased. [**2109-11-17**]: interval increased opacification of the left hemithorax. Right lung is relatively clear. There is subcutaneous emphysema in the left chest wall extending into the neck. Small foci of air remain in the left upper thorax. Surgical clips are present at the left hilum. [**2109-11-15**]: Post-surgical changes including resolution of the left pleural air cavity and increasing fluid. Persistent subcutaneous air as described. [**2109-11-13**]: Status post pneumonectomy with two round areas of opacity in the left hemithorax, which may represent loculated fluid collections and/or postoperative hematoma. PICC: [**2109-11-18**] Right PICC tip is in the lower SVC. Brief Hospital Course: Mr. [**Known lastname **] was admitted on [**2109-11-13**] and had successful left pneumonectomy. He was extubated in the operating room, transferred to the TSICU for further management. Respiratory: He required aggressive pulmonary toilet, nebs and chest PT to Right lung to maintain oxygen saturations in the high 90's. He eventually weaned off oxygen with saturations 97% on Room air. Chest-tube was removed on POD 1. Serial chest films showed opacification of the left hemithorax, right clear lung. Cardiac: He required a small amount of pressures for hypotension. On POD4 he had an episode or rapid afibrillation and hypotension after lopressor & diltiazem IV. He was transferred back to the TSICU converted to sinus rhythm with amiodarone and beta-blocker. Electrolytes were repleted as needed. Cardiac enzymes were negative x 3. He remained in sinus rhythm with heart rate in the 50-60's. His amiodarone was titrated to maintance dose and beta-blocker changed to toprol daily. GI: PPI's were given for prophylaxis. Normal bowel funtion returned. Renal: Immediately postoperative the Creatinine level peaked to 2.2 with low urine output. His potassium level was also elevated to 6.6 and was normalized with insulin, and Kayexalate. With gental hydration his creatinine level improved to his base of 1.0 and good urine output. The foley was removed Incision: Left thoracotomy site clean Pain: Epidural managed by the acute pain service. On POD1 the epidural was replaced. The epidural was removed on POD5. He converted to PO Dilaudid and tylenol with good pain control. IV access: [**2109-11-18**] A right PICC line was placed in the Right Basilic vein and terminated in the distal SVC. Neuro: non-focal Medications on Admission: Randitine Discharge Disposition: Home With Service Facility: [**Hospital **] Home Health Care Discharge Diagnosis: Left upper lobe mass Prostate cancer, status post radical prostatectomy and XRT Status post appendectomy Status post cholecystectomy Skin cancer Discharge Condition: stable Discharge Instructions: Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if experience: -Fever > 101 or chills -Increased shortness of breath, cough or sputum production -Chest pain -Incision develops drainage -You may shower. No tub bathing or swimming for 4 weeks -No driving while taking narcotics. Completed by:[**2109-11-26**]

162,486,196,998,E878,E849,V104,458,427,799,305,564

{'Malignant neoplasm of upper lobe, bronchus or lung,Pneumonia, organism unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Emphysema (subcutaneous) (surgical) resulting from procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension,Atrial fibrillation,Hypoxemia,Tobacco use disorder,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: Left upper lobe lung cancer. PRESENT ILLNESS: Mr. [**Known lastname **] is a 62-year-old gentleman with a biopsy-proven left upper lobe lung cancer. His mediastinoscopy and mediastinal lymph node staging by VATS AP window dissection was negative for nodal spread. MEDICAL HISTORY: Prostate cancer, status post radical prostatectomy and XRT Status post appendectomy Status post cholecystectomy Skin cancer MEDICATION ON ADMISSION: Randitine ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS: General: no apparent distress HEENT: normocephalic, mucus membranes moist Neck: supple Resp: clear breath sounds right, left absent Card: RRR GI: benign Extr: warm no edema Incision: Left thoracotomy site clean dry intact Neuro: non-focal FAMILY HISTORY: Father deceased MI. Mother deceased emphysema. Sister and brother had AAA repairs. SOCIAL HISTORY: Married. Works as a swimming pool service contractor. Drinks 10 drinks/week. Quit smoking 20 years ago and had been a 60ppy smoker. No smokes cigars. ### Response: {'Malignant neoplasm of upper lobe, bronchus or lung,Pneumonia, organism unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Emphysema (subcutaneous) (surgical) resulting from procedure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension,Atrial fibrillation,Hypoxemia,Tobacco use disorder,Constipation, unspecified'}

CHIEF COMPLAINT: PRESENT ILLNESS: The patient is a 35-year-old male with multiple intracranial aneurysms, including a bilateral internal carotid bifurcation aneurysms and an anterior communicating aneurysm all of which have been surgically clipped. He has in addition a proximal right supraclinoid internal carotid artery which was too proximal to undergo clipping during the previous operation. He underwent a subsequent attempt at endovascular coiling of the latter aneurysm which could not be performed because of its wide neck. He is now undergoing a repeat surgery with proximal carotid control of the cervical ICA. In addition, he harbors an unclippable fusiform aneurysmal dilatation of the right ICA at the level of the origin of the anterior choroidal artery. PAST MEDICAL HISTORY: 1. Hypertension. 2. Peptic ulcer disease. 3. Asthma as a child. 4. Bells palsy in [**2119-8-12**]. MEDICAL HISTORY: 1. Hypertension. 2. Peptic ulcer disease. 3. Asthma as a child. 4. Bells palsy in [**2119-8-12**]. MEDICATION ON ADMISSION: ALLERGIES: The patient is allergic to CODEINE. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Subarachnoid hemorrhage,Unspecified essential hypertension

Subarachnoid hemorrhage,Hypertension NOS

Admission Date: [**2120-2-13**] Discharge Date: [**2120-2-19**] Date of Birth: [**2084-10-6**] Sex: M Service: HISTORY OF THE PRESENT ILLNESS: The patient is a 35-year-old male with multiple intracranial aneurysms, including a bilateral internal carotid bifurcation aneurysms and an anterior communicating aneurysm all of which have been surgically clipped. He has in addition a proximal right supraclinoid internal carotid artery which was too proximal to undergo clipping during the previous operation. He underwent a subsequent attempt at endovascular coiling of the latter aneurysm which could not be performed because of its wide neck. He is now undergoing a repeat surgery with proximal carotid control of the cervical ICA. In addition, he harbors an unclippable fusiform aneurysmal dilatation of the right ICA at the level of the origin of the anterior choroidal artery. PAST MEDICAL HISTORY: 1. Hypertension. 2. Peptic ulcer disease. 3. Asthma as a child. 4. Bells palsy in [**2119-8-12**]. PAST SURGICAL HISTORY: History revealed left carotid bifurcation aneurysm clipping via a pterional craniotomy. ALLERGIES: The patient is allergic to CODEINE. MEDICATIONS: 1. Tagamet. 2. Tylenol. PHYSICAL EXAMINATION: On physical examination, the patient was afebrile with a blood pressure of 151/94, pulse 80. NEUROLOGICAL: Examination demonstrated left sided craniotomy with increased sensation in the left frontoparietal and left temporal regions. Pupils equal, round, and reactive to light and accommodation. Extraocular muscles are intact. There was no motor drift with equal strength bilaterally. HOSPITAL COURSE: The patient was admitted to the Surgical Intensive Care Unit status post a right ICA aneurysm for clipping of ICA aneurysm. Intraoperative course was complicated by aneurysmal rupture which was controlled and he underwent succesful clip placement on the target aneurysm. Postoperatively, the patient was monitored in the Surgical Intensive Care Unit. The mental status was awake, alert, and oriented times three. He was moving all extremities, withdrawing to pain, following simple commands. The patient was extubated on postoperative day #1. The patient was in stable condition. He was weaned off his sedation and his blood pressure medications. He had an angiogram repeated on [**2120-2-14**], which showed no aneurysmal filling on the post clipping angiogram. The patient remained neurologically stable. The patient was transferred to the regular floor on postoperative day #2. Vital signs were stable. The patient was afebrile. The patient was moving all extremities strongly. There was no complaint of headache. Groin was clean, dry, and intact. Pulse was intact. He had no drift. He was out of bed and ambulating. He was medicated with Percocet and Dilaudid for pain. He was discharged home on [**2120-2-19**] in stable condition with followup with Dr. [**Last Name (STitle) 1132**] in two to four weeks and followup for staple removal on the 14th. The patient was stable at the time of discharge. [**Location (un) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. Dictated By:[**Last Name (NamePattern1) 344**] MEDQUIST36 D: [**2120-2-19**] 14:02 T: [**2120-2-19**] 14:10 JOB#: [**Job Number 1778**]

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 35-year-old male with multiple intracranial aneurysms, including a bilateral internal carotid bifurcation aneurysms and an anterior communicating aneurysm all of which have been surgically clipped. He has in addition a proximal right supraclinoid internal carotid artery which was too proximal to undergo clipping during the previous operation. He underwent a subsequent attempt at endovascular coiling of the latter aneurysm which could not be performed because of its wide neck. He is now undergoing a repeat surgery with proximal carotid control of the cervical ICA. In addition, he harbors an unclippable fusiform aneurysmal dilatation of the right ICA at the level of the origin of the anterior choroidal artery. PAST MEDICAL HISTORY: 1. Hypertension. 2. Peptic ulcer disease. 3. Asthma as a child. 4. Bells palsy in [**2119-8-12**]. MEDICAL HISTORY: 1. Hypertension. 2. Peptic ulcer disease. 3. Asthma as a child. 4. Bells palsy in [**2119-8-12**]. MEDICATION ON ADMISSION: ALLERGIES: The patient is allergic to CODEINE. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Subarachnoid hemorrhage,Unspecified essential hypertension'}

CHIEF COMPLAINT: syncope, chills, nausea, vomiting, diarrhea PRESENT ILLNESS: 75 yo M with metastatic gallbladder cancer on gemzar/cisplatinum (last dose [**2167-1-16**]), bladder cancer s/p cystectomy, recent admissions for partial SBO ([**1-5**] - [**1-7**]) and for biliary obstruction ([**1-20**] - [**1-22**]) now presenting with hypotension, nausea, vomiting. . The patient was admitted [**Date range (1) 30498**]/12 following ERCP, performed due to biliary obstruction. During the ERCP, diffuse ulceration was noted in the distal esophagus, at the GE junction, and in the body of the stomach. Cannulation of the biliary duct was initially difficult but was successful and deep after placement of a 5 mm x 5 FR pancreatic stent. A 12 mm long segment of severe narrowing was noted at the level of the hilum consistent with a stricture. A sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. A WallFlex TM biliary RX uncovered 8 mm x 80 mm stent (REF: 7062, LOT: [**Numeric Identifier 93920**]) was placed successfully. The pancratic stent was removed after placement of the metal stent. . ERCP was complicated by nausea, vomiting, and elevated lipase. The patient was treated with bowel rest and IV fluids, and his diet was advanced prior to discharge on [**2167-1-22**]. Hospital course was also notable for new diagnosis of bilateral DVTs for which patient was started on lovenox treatment. . Yesterday, the patient developed weakness, nausea, and vomiting. He estimates that he had 10 episodes of non-bloody emesis. He also had some black diarrhea overnight last night. Then, at 3 a.m., the patient awoke with nausea and vomiting. He spent the next couple of hours sitting on a couch, during which time he experienced shaking chills and also syncopized for a couple of minutes. He regained consciousness and his family helped him to the toilet, at which point he had no BM had more syncope, and his family called EMS. When EMS arrived, initial BP was 70s/40s. . The patient also complains of cough and the sensation fo being unable to take a deep breath, which started during his recent admission. He has had hiccups for several weeks now, and has been taking baclofen twice daily for this. . In the ED, initial vitals signs were T 98.4 BP 73/37 HR 122 RR 16 Sat 93%. Exam was significant for AOx2, course breath sounds bilaterally. Patient was bolused with IVF. Labs were notable for WBC 6.9 (73N, 15bands), Hct 34 (27 at discharge), platelets 1000 (588 at discharge), Cr 1.4 (0.7 at discharge), ALT 16, AST 15, AP 675 (627 at discharge), Tbili 2.5 (2.2 at discharge), lactate 5.1, UA w 83 WBCs, positive nitrites, few bacteria. CXR demonstrated new L basilar infiltrate and bilateral pleural effusion. Patient was started on vanco/cefepime for presumed HCAP. LIJ was placed for fluid resuscitation. Patient remained hypotensive in SBP 80s, requiring initiation of levophed. ED course otherwise notable for patient reporting abdominal pain. CT abd/pelvis demonstrated known tumor, mildly distended stomach, with some fluid in the lower esophagus, could relate to partial gastric antral obstruction in the presence of symptoms. CT abd/pelvis also showed pleural effusion, ascites, improved left hydronephrosis. Repeat lactate returned 2.1. At time of transfer, patient had received 4L IVF and had a LIJ and two peripheral 18 gauge IVs. Vital signs on transfer were 98.5 HR119 BP85/50, RR34 98%3L. . On arrival to the ICU, the patient complained of heartburn and abdominal bloating. His nausea had resolved. He had the sensation of needing to defecate. However, he did not pass any stool. . Review of systems: No fever. +chills. +cough and dyspnea. No chest pain. +syncope. +abdominal discomfort and bloating, increased from baseline. Urine has been darker than usual. Has urinary ostomy. +hiccups. No rash. No focal weakness. +Chronic bilateral toe tingling L>R. No visual changes. MEDICAL HISTORY: ONCOLOGY HISTORY - [**2158**] - cystoprostatectomy by Dr. [**Last Name (STitle) 7391**] revealed bladder TCC invading the lamina propria involving intravesicular portion of the left ureter - [**2165**] - resection for local recurrence. - [**10/2166**] - CT abdomen w hypodense liver lesion and mesenteric band-like nodularity in the right upper quadrant concerning for peritoneal carcinomatosis, pleural thickening along the ascending colon. - [**11/2166**] - colonoscopy w severe narrowing at the hepatic flexure [**12-25**] extrinsic compression, CT torso and MRCP demonstrated regular hypoenhancing mass centered within the gallbladder fossa and infiltrating portions of the right and left hepatic lobes, extending to hepatic flexure most c/w gallbladder cancer, also w loss of intervening fat plane between the extension of the tumor out of the liver and the hepatic flexure and duodenal bulb, intrahepatic bile duct dilation, extrinsic compression of the hepatic duct, and enhancing soft tissue nodules in the greater omentum consistent with peritoneal carcinomatosis. - [**2166-12-30**] - CT-guided liver biopsy carcinoma with clear cell features diffusely positive for cytokeratin cocktail and cytokeratin 7 and negative for Hep Par 1 packs 2 TTF-1, cytokeratin 20 and P63 most compatible with a tumor of biliary pancreatic or upper gastrointestinal origin - [**2167-1-5**] - KUB partial small-bowel obstruction - [**2167-1-9**] - Gemzar/cisplatin started - [**2167-1-20**] - Presentation w abd pain and elevated bilirubin, ERCP w 12mm long segment of severe narrowing, sphincterotomy and placement of WallFlex TM biliary RX uncovered stent . PAST MEDICAL HISTORY - Metastatic gallbladder cancer - Recurrent bladder CA s/p primary resection ([**2159**]), penile/urethral metastatsis resection ([**2165**]) - HTN - HLD - LVH w mild LVOT obstruction and mildly dilated thoracic aorta - h/o cystectomy - h/o resection penile recurrence MEDICATION ON ADMISSION: Medications (per recent discharge summary) - enoxaparin 70mg q12hrs - metoprolol succinate 50mg daily - verapamil 120mg Extended Release daily - docusate sodium 100mg [**Hospital1 **] - senna [**Hospital1 **] - polyethylene glycol daily - oxycodone 5mg q6hrs prn - omeprazole 20mg daily - lisinopril 20mg daily - baclofen 10mg [**Hospital1 **] prn hiccups ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: . General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, LIJ in place Lungs: Coarse breath sounds bilaterally CV: Tachycardic, regular, normal S1 + S2, no murmurs, rubs, gallops Abdomen: distended, diffusely tender, especially in RUQ, very quiet bowel sounds, +guarding in RUQ, urinary ostomy bag in place with yellow urine. Ext: warm, well perfused, 2+ pulses, 3+ bilateral lower extremity edema Neuro: CN II-XII intact. Moving all extremities . DISCHARGE EXAM: . FAMILY HISTORY: Father with bladder cancer. Mother with either CVA or MI. SOCIAL HISTORY: Lives with wife in [**Name (NI) 86**]. Emigrated from [**Country 532**] remotely. Retired engineer. Quit tobacco 20+ years ago, 36 pack years. Denies EtOH, denies illicits.

Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Obstruction of bile duct,Acute kidney failure with lesion of tubular necrosis,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Unspecified pleural effusion,Hydronephrosis,Malignant neoplasm of liver, secondary,Jaundice, unspecified, not of newborn,Acquired hypertrophic pyloric stenosis,Malignant ascites,Malignant neoplasm of gallbladder,Urinary tract infection, site not specified,Personal history of malignant neoplasm of bladder,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Severe sepsis

Septicemia NOS,Pneumonia, organism NOS,Acute respiratry failure,Septic shock,Obstruction of bile duct,Ac kidny fail, tubr necr,Ac DVT/emb distl low ext,Pleural effusion NOS,Hydronephrosis,Second malig neo liver,Jaundice NOS,Acq pyloric stenosis,Malignant ascites,Malig neo gallbladder,Urin tract infection NOS,Hx of bladder malignancy,Hypertension NOS,Hyperlipidemia NEC/NOS,Severe sepsis

Admission Date: [**2167-1-24**] Discharge Date: [**2167-1-27**] Date of Birth: [**2091-4-11**] Sex: M Service: MEDICINE Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 2297**] Chief Complaint: syncope, chills, nausea, vomiting, diarrhea Major Surgical or Invasive Procedure: [**2167-1-24**] - Arterial line placement History of Present Illness: 75 yo M with metastatic gallbladder cancer on gemzar/cisplatinum (last dose [**2167-1-16**]), bladder cancer s/p cystectomy, recent admissions for partial SBO ([**1-5**] - [**1-7**]) and for biliary obstruction ([**1-20**] - [**1-22**]) now presenting with hypotension, nausea, vomiting. . The patient was admitted [**Date range (1) 30498**]/12 following ERCP, performed due to biliary obstruction. During the ERCP, diffuse ulceration was noted in the distal esophagus, at the GE junction, and in the body of the stomach. Cannulation of the biliary duct was initially difficult but was successful and deep after placement of a 5 mm x 5 FR pancreatic stent. A 12 mm long segment of severe narrowing was noted at the level of the hilum consistent with a stricture. A sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. A WallFlex TM biliary RX uncovered 8 mm x 80 mm stent (REF: 7062, LOT: [**Numeric Identifier 93920**]) was placed successfully. The pancratic stent was removed after placement of the metal stent. . ERCP was complicated by nausea, vomiting, and elevated lipase. The patient was treated with bowel rest and IV fluids, and his diet was advanced prior to discharge on [**2167-1-22**]. Hospital course was also notable for new diagnosis of bilateral DVTs for which patient was started on lovenox treatment. . Yesterday, the patient developed weakness, nausea, and vomiting. He estimates that he had 10 episodes of non-bloody emesis. He also had some black diarrhea overnight last night. Then, at 3 a.m., the patient awoke with nausea and vomiting. He spent the next couple of hours sitting on a couch, during which time he experienced shaking chills and also syncopized for a couple of minutes. He regained consciousness and his family helped him to the toilet, at which point he had no BM had more syncope, and his family called EMS. When EMS arrived, initial BP was 70s/40s. . The patient also complains of cough and the sensation fo being unable to take a deep breath, which started during his recent admission. He has had hiccups for several weeks now, and has been taking baclofen twice daily for this. . In the ED, initial vitals signs were T 98.4 BP 73/37 HR 122 RR 16 Sat 93%. Exam was significant for AOx2, course breath sounds bilaterally. Patient was bolused with IVF. Labs were notable for WBC 6.9 (73N, 15bands), Hct 34 (27 at discharge), platelets 1000 (588 at discharge), Cr 1.4 (0.7 at discharge), ALT 16, AST 15, AP 675 (627 at discharge), Tbili 2.5 (2.2 at discharge), lactate 5.1, UA w 83 WBCs, positive nitrites, few bacteria. CXR demonstrated new L basilar infiltrate and bilateral pleural effusion. Patient was started on vanco/cefepime for presumed HCAP. LIJ was placed for fluid resuscitation. Patient remained hypotensive in SBP 80s, requiring initiation of levophed. ED course otherwise notable for patient reporting abdominal pain. CT abd/pelvis demonstrated known tumor, mildly distended stomach, with some fluid in the lower esophagus, could relate to partial gastric antral obstruction in the presence of symptoms. CT abd/pelvis also showed pleural effusion, ascites, improved left hydronephrosis. Repeat lactate returned 2.1. At time of transfer, patient had received 4L IVF and had a LIJ and two peripheral 18 gauge IVs. Vital signs on transfer were 98.5 HR119 BP85/50, RR34 98%3L. . On arrival to the ICU, the patient complained of heartburn and abdominal bloating. His nausea had resolved. He had the sensation of needing to defecate. However, he did not pass any stool. . Review of systems: No fever. +chills. +cough and dyspnea. No chest pain. +syncope. +abdominal discomfort and bloating, increased from baseline. Urine has been darker than usual. Has urinary ostomy. +hiccups. No rash. No focal weakness. +Chronic bilateral toe tingling L>R. No visual changes. Past Medical History: ONCOLOGY HISTORY - [**2158**] - cystoprostatectomy by Dr. [**Last Name (STitle) 7391**] revealed bladder TCC invading the lamina propria involving intravesicular portion of the left ureter - [**2165**] - resection for local recurrence. - [**10/2166**] - CT abdomen w hypodense liver lesion and mesenteric band-like nodularity in the right upper quadrant concerning for peritoneal carcinomatosis, pleural thickening along the ascending colon. - [**11/2166**] - colonoscopy w severe narrowing at the hepatic flexure [**12-25**] extrinsic compression, CT torso and MRCP demonstrated regular hypoenhancing mass centered within the gallbladder fossa and infiltrating portions of the right and left hepatic lobes, extending to hepatic flexure most c/w gallbladder cancer, also w loss of intervening fat plane between the extension of the tumor out of the liver and the hepatic flexure and duodenal bulb, intrahepatic bile duct dilation, extrinsic compression of the hepatic duct, and enhancing soft tissue nodules in the greater omentum consistent with peritoneal carcinomatosis. - [**2166-12-30**] - CT-guided liver biopsy carcinoma with clear cell features diffusely positive for cytokeratin cocktail and cytokeratin 7 and negative for Hep Par 1 packs 2 TTF-1, cytokeratin 20 and P63 most compatible with a tumor of biliary pancreatic or upper gastrointestinal origin - [**2167-1-5**] - KUB partial small-bowel obstruction - [**2167-1-9**] - Gemzar/cisplatin started - [**2167-1-20**] - Presentation w abd pain and elevated bilirubin, ERCP w 12mm long segment of severe narrowing, sphincterotomy and placement of WallFlex TM biliary RX uncovered stent . PAST MEDICAL HISTORY - Metastatic gallbladder cancer - Recurrent bladder CA s/p primary resection ([**2159**]), penile/urethral metastatsis resection ([**2165**]) - HTN - HLD - LVH w mild LVOT obstruction and mildly dilated thoracic aorta - h/o cystectomy - h/o resection penile recurrence Social History: Lives with wife in [**Name (NI) 86**]. Emigrated from [**Country 532**] remotely. Retired engineer. Quit tobacco 20+ years ago, 36 pack years. Denies EtOH, denies illicits. Family History: Father with bladder cancer. Mother with either CVA or MI. Physical Exam: ADMISSION EXAM: . General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, LIJ in place Lungs: Coarse breath sounds bilaterally CV: Tachycardic, regular, normal S1 + S2, no murmurs, rubs, gallops Abdomen: distended, diffusely tender, especially in RUQ, very quiet bowel sounds, +guarding in RUQ, urinary ostomy bag in place with yellow urine. Ext: warm, well perfused, 2+ pulses, 3+ bilateral lower extremity edema Neuro: CN II-XII intact. Moving all extremities . DISCHARGE EXAM: . Pertinent Results: ADMISSION LABS: . [**2167-1-24**] 07:30AM BLOOD WBC-6.9# RBC-5.02 Hgb-11.3* Hct-34.4* MCV-69* MCH-22.5* MCHC-32.8 RDW-17.1* Plt Ct-1000*# [**2167-1-24**] 07:30AM BLOOD Hypochr-1+ Anisocy-1+ Poiklo-2+ Macrocy-NORMAL Microcy-1+ Polychr-NORMAL Ovalocy-2+ Acantho-2+ Ellipto-2+ [**2167-1-24**] 07:30AM BLOOD PT-15.2* PTT-28.1 INR(PT)-1.4* [**2167-1-24**] 07:30AM BLOOD Glucose-110* UreaN-23* Creat-1.4* Na-136 K-4.1 Cl-97 HCO3-23 AnGap-20 [**2167-1-24**] 07:30AM BLOOD ALT-16 AST-15 AlkPhos-675* TotBili-2.5* [**2167-1-24**] 07:30AM BLOOD proBNP-1532* [**2167-1-24**] 07:30AM BLOOD cTropnT-<0.01 [**2167-1-24**] 12:44PM BLOOD CK-MB-1 cTropnT-<0.01 [**2167-1-24**] 05:17PM BLOOD CK-MB-1 cTropnT-<0.01 [**2167-1-24**] 07:30AM BLOOD Albumin-2.6* [**2167-1-24**] 07:49AM BLOOD Lactate-5.1* [**2167-1-24**] 01:05PM BLOOD freeCa-1.03* . MICROBIOLOGY: . [**2167-1-24**] Urine culture - pending [**2167-1-24**] Blood culture (x 2) - pending [**2167-1-24**] MRSA screen - pending . IMAGING STUDIES: . [**2167-1-24**] CHEST (PORTABLE AP) - Slight prominence of the hila, could be due to vascular engorgement. Bibasilar opacities could represent atelectasis, aspiration, or infection in the appropriate clinical setting. . [**2167-1-24**] CT ABD & PELVIS W/O CON - Moderate-sized right and a small left pleural effusion, with bibasilar compressive atelectasis. Patchy opacities in the left lower lobe, concerning for acute infection/aspiration. known infiltrating gallbladder fossa mass, allowing for differences in Technique is similar to the prior study. Infiltration of the gastric antrum and ascending colon, with resultant gastric outlet obstruction. Moderate-to-large volume ascites, consistent with worsening omental metastatic disease, which is suboptimally assessed in this non-contrast study. Additional hypodense liver lesion, likely cysts. Lack of air within the biliary stent and left lobe of liver suggests stent occlusion. Interval improvement in the previously noted left hydroureteronephrosis in this patient status post urinary diversion and ileal conduit. . [**2167-1-24**] DUPLEX DOPP ABD/PEL POR AND LIVER OR GALLBLADDER US - Please note, patient had difficulty remaining in left lateral decubitus after obtaining only sagittal images, at which point the decision was made to transfer to the right lateral decubitus position. After obtaining left-sided images, patient was able to again return to left lateral decubitus position, at which point the right-sided transverse images were acquired. The right kidney measures 11.5 cm. The left kidney measures 10 cm. There is no evidence of hydronephrosis, stones, or masses. Patient is status post urinary diversion and ileal conduit. No bladder assessment performed. Significant ascites idenitifed throughout the abdomen. Brief Hospital Course: IMPRESSION: 75M with PMH significant for metastatic gallbladder carcinoma, bladder carcinoma (s/p primary resection with ileal conduit formation), hypertension and hyperlipidemia with recent hospitalization for ERCP in the setting of biliary stricture with metal stent deployment complicated by post-procedural pancreatitis and evidence of DVTs who now presents with nausea, emesis and hypotension concerning for septic shock requiring pressor support with evolving pneumonia, acute renal insufficiency and hyperbilirubinemia. Given worsening clinical status despite aggressive resuscitation and pressors, patient was transitioned to comfort measures only and expired on [**2167-1-27**]. . # ACUTE HYPOXIC RESPIRATORY FAILURE - Following volume resuscitation needs given his septic shock, the patient developed worsening respiratory concerns and hypoxia with an increased oxygen requirement. His CXR imaging demonstrated marked pleural effusions. After discussion with the family, it was clarified that he would not want to be intubated, thus he was made comfortable on supportive oxygen. . # SHOCK - Presented with hypotension and evidence of volume depletion with leukocytosis and bandemia in the setting of metastatic gallbladder carcinoma, with acute renal insufficiency and hyperbilirubinemia. Shock appears distributive or vasodilatory in the setting of sepsis. Possible sources of infection include: biliary obstruction or stent obstruction with gram negative or anaerobic enteric seeding vs. aspiration pneumonitis (CT imaging showed LLL opacification) or pneumonia vs. urinary tract infection. Patient was empirically antibiosed with Vancomycin, Levofloxacin and Zosyn. Lactate 5.1 on admission, trending downward with IV fluid resuscitation. Following aggressive volume resuscitation, his hypotension and tachycardia improved and his pressor support was weaned. His serial lactate and central venous oxygen saturations improved with broad spectrum antibiotics - Vancomycin, Levofloxacin and Zosyn (started [**2167-1-24**]). ACS surgery had been consulted given his evidence of delayed emptying and possible gastric obstruction with known biliary obstruction and felt no surgical intervention was feasible. They recommended palliation with possible duodental stent placement in discussion with the gastroenterology team based on his imaging findings. His imaging showed evidence of gastric antral obstruction. Given his overall poor prognosis, the family opted to enagage comfort measures only and a Dilaudid infusion was started. . # NAUSEA, EMESIS AND GASTRIC OUTLET OBSTRUCTION - CT imaging revealed tumor that extends to the gastric antrum and hepatic flexure with mildly distended stomach and some fluid in the lower esophagus; possibly related to partial gastric antral obstruction vs. delayed transit and slow emptying given his nausea and bilious emesis concerns. NGT remains in place. Evidence of tumor causing obstruction without definable surgical options - would likely require palliative stenting. ERCP 2-days prior allowed passage of endoscope to the level of the duodenum for biliary stenting, now with evidence of on-going obstruction. ACS surgery had been consulted given his evidence of delayed emptying and possible gastric obstruction with known biliary obstruction and felt no surgical intervention was feasible. ERCP team was also notified. Given his overall poor prognosis, the family opted to enagage comfort measures only and a Dilaudid infusion was started. . # ACUTE RENAL INSUFFICIENCY - Patient presents with baseline creatinine of 0.7-0.9 now with admission creatinine of 1.4 in the setting of septic shock, hypotension and low urine output. This likely represents poor forward flow and hypoperfusion with pre-renal azotemia in the setting of vasodilation and sepsis physiology generating hypotension. ATN certainly could have developed in the this time frame. Following fluid resuscitation, his creatinine continued to worsen. . # ASCITES - Likely malignant in the setting of know gallbladder carcinoma with metastatic involvement. Now with septic shock picture in the setting of multiple sources of infection. His RUQ ultrasound showed concern for no pneumobilia with possble obstruction at the level of his biliary stent. . # METASTATIC GALLBLADDER CARCINOMA, BLADDER CANCER - Metastatic gallbladder carcinoma currently receiving Gemzar/Cisplatinum. Bladder carcinoma treated with primary resection and cystectomy with ileal conduit. His outpatient Oncologist was notified of the admission and discussed with the family the overall very poor prognosis. Comfort measures were employed following that discussion. . # DEEP VENOUS THROMBOSES - DVT in both posterior tibial veins on the right and one posterior tibial vein on the left in 2/29. Heparin gtt started this admission (switched from Lovenox given renal dysfunction). He was maintained on a heparin gtt until comfort measures were established. . # HYPERTENSION - Hypotensive in the setting of sepsis, as noted above. Holding Metoprolol, Verapamil, Lisinopril. . Medications on Admission: Medications (per recent discharge summary) - enoxaparin 70mg q12hrs - metoprolol succinate 50mg daily - verapamil 120mg Extended Release daily - docusate sodium 100mg [**Hospital1 **] - senna [**Hospital1 **] - polyethylene glycol daily - oxycodone 5mg q6hrs prn - omeprazole 20mg daily - lisinopril 20mg daily - baclofen 10mg [**Hospital1 **] prn hiccups Discharge Medications: none Discharge Disposition: Expired Discharge Diagnosis: septic shock and metastatic gallbladder cancer Discharge Condition: expired Discharge Instructions: patient expired on [**2167-1-27**]. Followup Instructions: none

038,486,518,785,576,584,453,511,591,197,782,537,789,156,599,V105,401,272,995

{'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Obstruction of bile duct,Acute kidney failure with lesion of tubular necrosis,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Unspecified pleural effusion,Hydronephrosis,Malignant neoplasm of liver, secondary,Jaundice, unspecified, not of newborn,Acquired hypertrophic pyloric stenosis,Malignant ascites,Malignant neoplasm of gallbladder,Urinary tract infection, site not specified,Personal history of malignant neoplasm of bladder,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Severe sepsis'}

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, chills, nausea, vomiting, diarrhea PRESENT ILLNESS: 75 yo M with metastatic gallbladder cancer on gemzar/cisplatinum (last dose [**2167-1-16**]), bladder cancer s/p cystectomy, recent admissions for partial SBO ([**1-5**] - [**1-7**]) and for biliary obstruction ([**1-20**] - [**1-22**]) now presenting with hypotension, nausea, vomiting. . The patient was admitted [**Date range (1) 30498**]/12 following ERCP, performed due to biliary obstruction. During the ERCP, diffuse ulceration was noted in the distal esophagus, at the GE junction, and in the body of the stomach. Cannulation of the biliary duct was initially difficult but was successful and deep after placement of a 5 mm x 5 FR pancreatic stent. A 12 mm long segment of severe narrowing was noted at the level of the hilum consistent with a stricture. A sphincterotomy was performed in the 12 o'clock position using a sphincterotome over an existing guidewire. A WallFlex TM biliary RX uncovered 8 mm x 80 mm stent (REF: 7062, LOT: [**Numeric Identifier 93920**]) was placed successfully. The pancratic stent was removed after placement of the metal stent. . ERCP was complicated by nausea, vomiting, and elevated lipase. The patient was treated with bowel rest and IV fluids, and his diet was advanced prior to discharge on [**2167-1-22**]. Hospital course was also notable for new diagnosis of bilateral DVTs for which patient was started on lovenox treatment. . Yesterday, the patient developed weakness, nausea, and vomiting. He estimates that he had 10 episodes of non-bloody emesis. He also had some black diarrhea overnight last night. Then, at 3 a.m., the patient awoke with nausea and vomiting. He spent the next couple of hours sitting on a couch, during which time he experienced shaking chills and also syncopized for a couple of minutes. He regained consciousness and his family helped him to the toilet, at which point he had no BM had more syncope, and his family called EMS. When EMS arrived, initial BP was 70s/40s. . The patient also complains of cough and the sensation fo being unable to take a deep breath, which started during his recent admission. He has had hiccups for several weeks now, and has been taking baclofen twice daily for this. . In the ED, initial vitals signs were T 98.4 BP 73/37 HR 122 RR 16 Sat 93%. Exam was significant for AOx2, course breath sounds bilaterally. Patient was bolused with IVF. Labs were notable for WBC 6.9 (73N, 15bands), Hct 34 (27 at discharge), platelets 1000 (588 at discharge), Cr 1.4 (0.7 at discharge), ALT 16, AST 15, AP 675 (627 at discharge), Tbili 2.5 (2.2 at discharge), lactate 5.1, UA w 83 WBCs, positive nitrites, few bacteria. CXR demonstrated new L basilar infiltrate and bilateral pleural effusion. Patient was started on vanco/cefepime for presumed HCAP. LIJ was placed for fluid resuscitation. Patient remained hypotensive in SBP 80s, requiring initiation of levophed. ED course otherwise notable for patient reporting abdominal pain. CT abd/pelvis demonstrated known tumor, mildly distended stomach, with some fluid in the lower esophagus, could relate to partial gastric antral obstruction in the presence of symptoms. CT abd/pelvis also showed pleural effusion, ascites, improved left hydronephrosis. Repeat lactate returned 2.1. At time of transfer, patient had received 4L IVF and had a LIJ and two peripheral 18 gauge IVs. Vital signs on transfer were 98.5 HR119 BP85/50, RR34 98%3L. . On arrival to the ICU, the patient complained of heartburn and abdominal bloating. His nausea had resolved. He had the sensation of needing to defecate. However, he did not pass any stool. . Review of systems: No fever. +chills. +cough and dyspnea. No chest pain. +syncope. +abdominal discomfort and bloating, increased from baseline. Urine has been darker than usual. Has urinary ostomy. +hiccups. No rash. No focal weakness. +Chronic bilateral toe tingling L>R. No visual changes. MEDICAL HISTORY: ONCOLOGY HISTORY - [**2158**] - cystoprostatectomy by Dr. [**Last Name (STitle) 7391**] revealed bladder TCC invading the lamina propria involving intravesicular portion of the left ureter - [**2165**] - resection for local recurrence. - [**10/2166**] - CT abdomen w hypodense liver lesion and mesenteric band-like nodularity in the right upper quadrant concerning for peritoneal carcinomatosis, pleural thickening along the ascending colon. - [**11/2166**] - colonoscopy w severe narrowing at the hepatic flexure [**12-25**] extrinsic compression, CT torso and MRCP demonstrated regular hypoenhancing mass centered within the gallbladder fossa and infiltrating portions of the right and left hepatic lobes, extending to hepatic flexure most c/w gallbladder cancer, also w loss of intervening fat plane between the extension of the tumor out of the liver and the hepatic flexure and duodenal bulb, intrahepatic bile duct dilation, extrinsic compression of the hepatic duct, and enhancing soft tissue nodules in the greater omentum consistent with peritoneal carcinomatosis. - [**2166-12-30**] - CT-guided liver biopsy carcinoma with clear cell features diffusely positive for cytokeratin cocktail and cytokeratin 7 and negative for Hep Par 1 packs 2 TTF-1, cytokeratin 20 and P63 most compatible with a tumor of biliary pancreatic or upper gastrointestinal origin - [**2167-1-5**] - KUB partial small-bowel obstruction - [**2167-1-9**] - Gemzar/cisplatin started - [**2167-1-20**] - Presentation w abd pain and elevated bilirubin, ERCP w 12mm long segment of severe narrowing, sphincterotomy and placement of WallFlex TM biliary RX uncovered stent . PAST MEDICAL HISTORY - Metastatic gallbladder cancer - Recurrent bladder CA s/p primary resection ([**2159**]), penile/urethral metastatsis resection ([**2165**]) - HTN - HLD - LVH w mild LVOT obstruction and mildly dilated thoracic aorta - h/o cystectomy - h/o resection penile recurrence MEDICATION ON ADMISSION: Medications (per recent discharge summary) - enoxaparin 70mg q12hrs - metoprolol succinate 50mg daily - verapamil 120mg Extended Release daily - docusate sodium 100mg [**Hospital1 **] - senna [**Hospital1 **] - polyethylene glycol daily - oxycodone 5mg q6hrs prn - omeprazole 20mg daily - lisinopril 20mg daily - baclofen 10mg [**Hospital1 **] prn hiccups ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: ADMISSION EXAM: . General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, LIJ in place Lungs: Coarse breath sounds bilaterally CV: Tachycardic, regular, normal S1 + S2, no murmurs, rubs, gallops Abdomen: distended, diffusely tender, especially in RUQ, very quiet bowel sounds, +guarding in RUQ, urinary ostomy bag in place with yellow urine. Ext: warm, well perfused, 2+ pulses, 3+ bilateral lower extremity edema Neuro: CN II-XII intact. Moving all extremities . DISCHARGE EXAM: . FAMILY HISTORY: Father with bladder cancer. Mother with either CVA or MI. SOCIAL HISTORY: Lives with wife in [**Name (NI) 86**]. Emigrated from [**Country 532**] remotely. Retired engineer. Quit tobacco 20+ years ago, 36 pack years. Denies EtOH, denies illicits. ### Response: {'Unspecified septicemia,Pneumonia, organism unspecified,Acute respiratory failure,Septic shock,Obstruction of bile duct,Acute kidney failure with lesion of tubular necrosis,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Unspecified pleural effusion,Hydronephrosis,Malignant neoplasm of liver, secondary,Jaundice, unspecified, not of newborn,Acquired hypertrophic pyloric stenosis,Malignant ascites,Malignant neoplasm of gallbladder,Urinary tract infection, site not specified,Personal history of malignant neoplasm of bladder,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Severe sepsis'}

CHIEF COMPLAINT: Asymptomatic with positive nuclear stress test that showed a fixed inferior prefusion defect PRESENT ILLNESS: 74 year old spanish speaking male who has severe peripheral vascilar disease. He has 1.5 block intermittent claudication and recent peripheral angiogram that demonstrated multiple areas of stenosis that requires surgery. In reparation for this he underwent a nuclear stress test that showed a fixed inferior prefusion defect. He then underwent a cardiac cath which revealed 50% left main lesion, 70% LAD and 100% RCA lesion. He is now referred for surgical revasclarization MEDICAL HISTORY: Hypertension, Hyperlipidemia, Diabetes Mellitus, Peripheral vascular disease s/p left common iliac stent, Right leg fracture, Right hip surgery for foreign body MEDICATION ON ADMISSION: Medications at home: Plavix 75mg daily Hydrochlorothiazide 25mg daily - stopped Enalapril 20mg daily Aspirin 325mg daily Metformin 500mg Amlodipine 5mg daily Lipitor 10mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pulse: 55 Resp: 16 O2 sat: 100% B/P Right: 176/75 Left: 172/65 Height: 66" Weight: 150 lbs FAMILY HISTORY: No premature coronary artery disease SOCIAL HISTORY: Race: Hispanic Last Dental Exam: N/A Lives with: Wife and son Contact: [**Name (NI) 91624**] [**Name (NI) 4890**] - wife Phone #[**Telephone/Fax (1) 91625**] [**Name2 (NI) 27057**]tion: Retired Cigarettes: Smoked [X] last cigarette 5yrs Hx: 1ppd x 50 yrs Other Tobacco use: none ETOH: < 1 drink/week [X] Illicit drug use none

Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled

Crnry athrscl natve vssl,Intermed coronary synd,Ath ext ntv at w claudct,Hyperlipidemia NEC/NOS,Hypertension NOS,DMII wo cmp nt st uncntr

Admission Date: [**2168-9-12**] Discharge Date: [**2168-9-17**] Date of Birth: [**2094-7-20**] Sex: M Service: CARDIOTHORACIC Allergies: No Known Allergies / Adverse Drug Reactions Attending:[**First Name3 (LF) 1505**] Chief Complaint: Asymptomatic with positive nuclear stress test that showed a fixed inferior prefusion defect Major Surgical or Invasive Procedure: [**2168-9-12**] coronary bypass grafting x2 with left internal mamary artery to left anterior descending artery and reverse saphenous vein graft to obtuse marginal artery History of Present Illness: 74 year old spanish speaking male who has severe peripheral vascilar disease. He has 1.5 block intermittent claudication and recent peripheral angiogram that demonstrated multiple areas of stenosis that requires surgery. In reparation for this he underwent a nuclear stress test that showed a fixed inferior prefusion defect. He then underwent a cardiac cath which revealed 50% left main lesion, 70% LAD and 100% RCA lesion. He is now referred for surgical revasclarization Past Medical History: Hypertension, Hyperlipidemia, Diabetes Mellitus, Peripheral vascular disease s/p left common iliac stent, Right leg fracture, Right hip surgery for foreign body Social History: Race: Hispanic Last Dental Exam: N/A Lives with: Wife and son Contact: [**Name (NI) 91624**] [**Name (NI) 4890**] - wife Phone #[**Telephone/Fax (1) 91625**] [**Name2 (NI) 27057**]tion: Retired Cigarettes: Smoked [X] last cigarette 5yrs Hx: 1ppd x 50 yrs Other Tobacco use: none ETOH: < 1 drink/week [X] Illicit drug use none Family History: No premature coronary artery disease Physical Exam: Pulse: 55 Resp: 16 O2 sat: 100% B/P Right: 176/75 Left: 172/65 Height: 66" Weight: 150 lbs General: Well-developed male in no acute distress 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 [] grade ______ Abdomen: Soft [X] non-distended [X] non-tender [X] +BS [X] Extremities: Warm [X], well-perfused [X] Edema [-] Varicosities: mild right Neuro: Grossly intact [X] Pulses: Femoral Right: 1+ Left: 1+ DP Right: 1+ Left: 1+ PT [**Name (NI) 167**]: 2+ Left: 2+ Radial Right: 2+ Left: 2+ Carotid Bruit Right: - Left: - Pertinent Results: Admission labs: [**2168-9-12**] 12:07PM HGB-13.1* calcHCT-39 [**2168-9-12**] 12:07PM GLUCOSE-89 LACTATE-1.3 NA+-135 K+-4.2 CL--103 [**2168-9-12**] 03:07PM FIBRINOGE-148* [**2168-9-12**] 03:07PM PLT COUNT-134* [**2168-9-12**] 03:07PM WBC-13.5*# RBC-2.84*# HGB-8.7*# HCT-25.3*# MCV-89 MCH-30.7 MCHC-34.4 RDW-12.7 [**2168-9-12**] 04:11PM UREA N-14 CREAT-0.8 SODIUM-138 POTASSIUM-4.8 CHLORIDE-108 TOTAL CO2-26 ANION GAP-9 [**2168-9-15**] 04:59AM BLOOD WBC-16.2* RBC-3.74* Hgb-11.2* Hct-32.6* MCV-87 MCH-29.9 MCHC-34.3 RDW-12.8 Plt Ct-193 [**2168-9-15**] 04:59AM BLOOD Glucose-137* UreaN-22* Creat-0.9 Na-140 K-3.9 Cl-103 HCO3-27 AnGap-14 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT Conclusions 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. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). The right ventricular free wall is hypertrophied with normal free wall contractility. There are simple atheroma in the ascending aorta. There are complex (>4mm) atheroma in the aortic arch. The descending thoracic aorta is mildly dilated. There are complex (>4mm) atheroma in the descending thoracic aorta. There are three aortic valve leaflets. The aortic valve leaflets are moderately thickened. The left coronary cusp is immobilized. There is mild aortic valve stenosis (valve area 1.2-1.9cm2). Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the results in the operating room at the time of the study. POST-BYPASS: There is normal biventricular systolic function. The mitral regurgitation is slightly worse - now mild-moderate. The thoracic aorta is intact after decannulation. Radiology Report CHEST (PORTABLE AP) Study Date of [**2168-9-13**] 12:56 PM Final Report: Bilateral lung volumes are low. Following left chest tube removal, there is no evidence of pneumothorax. Right internal jugular line ends at upper SVC. Right lower lung atelectasis and elevation of the right hemidiaphragm have improved. Nodular opacity in the left lower lung near the apex is likely residual edema from the previous chest tube placement. Bilateral lower lung atelectasis is unchanged. The patient is status post median sternotomy with intact sternotomy sutures. Mediastinal and hilar contours are stable. [**2168-9-16**] 05:58AM BLOOD WBC-10.1 RBC-3.35* Hgb-10.1* Hct-29.3* MCV-87 MCH-30.1 MCHC-34.4 RDW-12.7 Plt Ct-201 [**2168-9-17**] 06:55AM BLOOD UreaN-23* Creat-1.0 Na-138 K-4.3 Cl-101 Brief Hospital Course: Mr. [**Known lastname 91626**] [**Last Name (Titles) 91627**] is a 74 year old male who was a direct admission to the operating room for coronary bypass grafting on [**9-12**]. Please see the operative report for details, in summary he had a coronary bypass grafting x2 with left internal mammary artery to left anterior descending artery and reverse saphenous vein graft to obtuse marginal artery. His bypass time was 63 minutes with a cross clamp of 36 minutes. He tolerated the operation well and was transferred from the operating room to the cardiac surgery ICU in stable condition. He remained hemodynamically stable in the immediate post-op period, anesthesia was reversed he woke neurologically intact and was extubated. All tubes lines and drains were removed per cardiac surgery protocol. He remained hemodynamically stable and on post operative day one was transferred from the ICU to the cardiac surgery step-down floor. Once on the floor he worked with nursing and physical therapy to increase his strength and mobility. His antihypertensives were titrated up and additional medications were added for better blood pressure control. The remainder of his hospital course was uneventful and on post operative day five he was discharged home with visiting nurse services in stable condition. All follow up appointments were advised. Medications on Admission: Medications at home: Plavix 75mg daily Hydrochlorothiazide 25mg daily - stopped Enalapril 20mg daily Aspirin 325mg daily Metformin 500mg Amlodipine 5mg daily Lipitor 10mg 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. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 3. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 4. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 5. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 6. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 7. metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 8. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Disp:*90 Tablet(s)* Refills:*2* 9. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 7 days. Disp:*7 Tablet(s)* Refills:*2* 10. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig: One (1) Tablet, ER Particles/Crystals PO once a day for 7 days. Disp:*7 Tablet, ER Particles/Crystals(s)* Refills:*2* 11. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* Discharge Disposition: Home With Service Facility: Multicultural VNA Discharge Diagnosis: s/p CABGx2(LIMA-LAD,SVG-OM) PMH: Hypertension, Hyperlipidemia, Diabetes Mellitus, Peripheral vascular disease s/p left common iliac stent, Right leg fracture, ?Right hip surgery for foreign body Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Percocet Incisions: Sternal - healing well, no erythema or drainage Leg 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**] **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: [**Name6 (MD) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**] [**2168-10-19**] @1:15P [**Hospital 409**] Clinic: Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2168-9-27**] @10:45A Cardiologist: [**Doctor First Name 29069**] Kvaternick on [**10-4**] at 1:15pm Please call to schedule appointments with your Vascular: Mark Iafrati Primary Care Dr.[**Last Name (STitle) 91628**],[**First Name3 (LF) 58427**] [**Telephone/Fax (1) 63099**] in [**3-29**] 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:[**2168-9-17**]

414,411,440,272,401,250

{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia,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: Asymptomatic with positive nuclear stress test that showed a fixed inferior prefusion defect PRESENT ILLNESS: 74 year old spanish speaking male who has severe peripheral vascilar disease. He has 1.5 block intermittent claudication and recent peripheral angiogram that demonstrated multiple areas of stenosis that requires surgery. In reparation for this he underwent a nuclear stress test that showed a fixed inferior prefusion defect. He then underwent a cardiac cath which revealed 50% left main lesion, 70% LAD and 100% RCA lesion. He is now referred for surgical revasclarization MEDICAL HISTORY: Hypertension, Hyperlipidemia, Diabetes Mellitus, Peripheral vascular disease s/p left common iliac stent, Right leg fracture, Right hip surgery for foreign body MEDICATION ON ADMISSION: Medications at home: Plavix 75mg daily Hydrochlorothiazide 25mg daily - stopped Enalapril 20mg daily Aspirin 325mg daily Metformin 500mg Amlodipine 5mg daily Lipitor 10mg daily ALLERGIES: No Known Allergies / Adverse Drug Reactions PHYSICAL EXAM: Pulse: 55 Resp: 16 O2 sat: 100% B/P Right: 176/75 Left: 172/65 Height: 66" Weight: 150 lbs FAMILY HISTORY: No premature coronary artery disease SOCIAL HISTORY: Race: Hispanic Last Dental Exam: N/A Lives with: Wife and son Contact: [**Name (NI) 91624**] [**Name (NI) 4890**] - wife Phone #[**Telephone/Fax (1) 91625**] [**Name2 (NI) 27057**]tion: Retired Cigarettes: Smoked [X] last cigarette 5yrs Hx: 1ppd x 50 yrs Other Tobacco use: none ETOH: < 1 drink/week [X] Illicit drug use none ### Response: {'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atherosclerosis of native arteries of the extremities with intermittent claudication,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}

CHIEF COMPLAINT: Dyspnea on exertion PRESENT ILLNESS: This is an 81-year-old male who had increasing shortness of breath. His workup revealed that he had a positive exercise stress test. He underwent a cardiac catheterization, and this demonstrated 3-vessel coronary artery disease. It was recommended that he undergo coronary bypass grafting and, after risks and benefits were explained to him, he agreed to proceed. MEDICAL HISTORY: PVD COPD Hyperlipidemia HTN MRSA Pneumonia Emphysema Prostate Cancer Prostatectomy MEDICATION ON ADMISSION: Albuterol/Atrovent Nebs Spiriva Inhaler daily Mucinex 600mg twice daily Diltiazem 120mg daily Aspirin 81mg daily Zocor 10mg daily Atrovent nasal spray ALLERGIES: Prednisone / Sulfa (Sulfonamides) PHYSICAL EXAM: 64 sr 129/76 (R) 153/81 (L) GEN: Elderly man in NAD but mildly SOB with talking HEENT: Unremarkable NECK: Supple, FROM LUNGS: Diminished BS throughout with mild exp wheeze HEART: RRR, Nl S1-S2 ABD: Ventral hernia noted, S/NT/ND/NABS EXT: Pulses [**1-12**]+ throughout. Warm, well perfused. NO varicosities noted NEURO: No carotid bruits. Nonfocal FAMILY HISTORY: Father died of ? MI at age 54. SOCIAL HISTORY: Retired. Quit smoking [**2143**] 45 pk/yrs. Does not drink. Lives with fiance. Edentulous.

Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Mitral valve disorders,Bladder neck obstruction,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Personal history of malignant neoplasm of prostate,Personal history of tobacco use

Crnry athrscl natve vssl,Chr airway obstruct NEC,Pneumonia, organism NOS,Mitral valve disorder,Bladder neck obstruction,Hyperlipidemia NEC/NOS,Periph vascular dis NOS,Hx-prostatic malignancy,History of tobacco use

Admission Date: [**2168-4-12**] Discharge Date: [**2168-4-18**] Date of Birth: [**2087-2-1**] Sex: M Service: CARDIOTHORACIC Allergies: Prednisone / Sulfa (Sulfonamides) Attending:[**First Name3 (LF) 1283**] Chief Complaint: Dyspnea on exertion Major Surgical or Invasive Procedure: [**2168-4-12**] - CABGx3 (Mammary artery to left anterior descending artery, vein to ramus and vein graft to obtsue marginal artery); Mitral valve Repair (26mm Annuloplasty Band) [**2168-4-12**] - Flexible cystoscopy with wire placement and Foley catheter introduction to bladder. History of Present Illness: This is an 81-year-old male who had increasing shortness of breath. His workup revealed that he had a positive exercise stress test. He underwent a cardiac catheterization, and this demonstrated 3-vessel coronary artery disease. It was recommended that he undergo coronary bypass grafting and, after risks and benefits were explained to him, he agreed to proceed. Past Medical History: PVD COPD Hyperlipidemia HTN MRSA Pneumonia Emphysema Prostate Cancer Prostatectomy Social History: Retired. Quit smoking [**2143**] 45 pk/yrs. Does not drink. Lives with fiance. Edentulous. Family History: Father died of ? MI at age 54. Physical Exam: 64 sr 129/76 (R) 153/81 (L) GEN: Elderly man in NAD but mildly SOB with talking HEENT: Unremarkable NECK: Supple, FROM LUNGS: Diminished BS throughout with mild exp wheeze HEART: RRR, Nl S1-S2 ABD: Ventral hernia noted, S/NT/ND/NABS EXT: Pulses [**1-12**]+ throughout. Warm, well perfused. NO varicosities noted NEURO: No carotid bruits. Nonfocal Discharge Vitals 99, 80 SR, 121/63, 20 Sat 2l NC 98% RA 84% wt 71.4kg Neuro A/O x3 nonfocal Cardiac RRR no m/r/g Pulm CTA bilat Abd soft, NT, ND, +BS Ext warm pulses palpable +1 LE edema Sternal inc CDI no erythema no drainage sternum stable Left EVH thigh ecchymotic, no erythema Pertinent Results: [**2168-4-17**] 04:15AM BLOOD WBC-7.7 RBC-3.37* Hgb-10.7* Hct-30.4* MCV-90 MCH-31.7 MCHC-35.2* RDW-13.7 Plt Ct-174 [**2168-4-12**] 01:38PM BLOOD WBC-8.1 RBC-3.05*# Hgb-9.9*# Hct-28.6*# MCV-94 MCH-32.5* MCHC-34.7 RDW-13.0 Plt Ct-128* [**2168-4-17**] 04:15AM BLOOD Plt Ct-174 [**2168-4-13**] 03:10AM BLOOD PT-13.5* PTT-32.3 INR(PT)-1.2* [**2168-4-12**] 01:38PM BLOOD PT-16.3* PTT-44.3* INR(PT)-1.5* [**2168-4-12**] 01:38PM BLOOD Plt Ct-128* [**2168-4-18**] 05:45AM BLOOD K-4.2 [**2168-4-17**] 04:15AM BLOOD Glucose-106* UreaN-29* Creat-1.0 Na-135 K-3.4 Cl-94* HCO3-37* AnGap-7* [**2168-4-12**] 02:42PM BLOOD UreaN-15 Creat-0.8 Cl-111* HCO3-25 [**2168-4-17**] 04:15AM BLOOD Calcium-8.3* Phos-3.1 Mg-2.3 CXR RADIOLOGY Final Report CHEST (PA & LAT) [**2168-4-17**] 3:56 PM CHEST (PA & LAT) Reason: Eval. for interval change [**Hospital 93**] MEDICAL CONDITION: 81 year old man with CAD, pre-op for CABGpt currently in cath lab HA, [**Hospital Ward Name **] 4. plse do after 3:45 pm REASON FOR THIS EXAMINATION: Eval. for interval change CHEST, TWO VIEWS, ON [**4-17**] HISTORY: Preop CABG. REFERENCE EXAM: [**4-16**]. FINDINGS: There are bilateral pleural effusions that are slightly larger than on the prior study. There is bilateral lower lobe volume loss. The cardiac and mediastinal silhouettes are unchanged. DR. [**First Name (STitle) **] [**Doctor Last Name **] Approved: MON [**2168-4-18**] 8:37 AM TEE PATIENT/TEST INFORMATION: Indication: Intraop CABG. Evaluate valves, ventricular function, aortic atheroma/contours. Height: (in) 66 Weight (lb): 144 BSA (m2): 1.74 m2 BP (mm Hg): 165/65 HR (bpm): 63 Status: Inpatient Date/Time: [**2168-4-12**] at 11:36 Test: TEE (Complete) Doppler: Full Doppler and color Doppler Contrast: None Tape Number: 2007AW1-: Test Location: Anesthesia West OR cardiac Technical Quality: Adequate REFERRING DOCTOR: DR. [**First Name (STitle) 412**] [**Last Name (Prefixes) 413**] MEASUREMENTS: Left Atrium - Long Axis Dimension: *5.1 cm (nl <= 4.0 cm) Left Atrium - Four Chamber Length: 4.2 cm (nl <= 5.2 cm) Left Ventricle - Inferolateral Thickness: 1.1 cm (nl 0.6 - 1.1 cm) Left Ventricle - Diastolic Dimension: 5.1 cm (nl <= 5.6 cm) Left Ventricle - Systolic Dimension: 4.3 cm Left Ventricle - Fractional Shortening: *0.16 (nl >= 0.29) Left Ventricle - Ejection Fraction: 45% to 50% (nl >=55%) Aorta - Valve Level: 3.5 cm (nl <= 3.6 cm) Aorta - Ascending: 3.3 cm (nl <= 3.4 cm) Aorta - Arch: 2.3 cm (nl <= 3.0 cm) Aorta - Descending Thoracic: *2.7 cm (nl <= 2.5 cm) Aortic Valve - Peak Velocity: 1.3 m/sec (nl <= 2.0 m/sec) Aortic Valve - Peak Gradient: 7 mm Hg Aortic Valve - Mean Gradient: 4 mm Hg Aortic Valve - Valve Area: *2.0 cm2 (nl >= 3.0 cm2) Mitral Valve - Peak Velocity: 0.8 m/sec Mitral Valve - Mean Gradient: 1 mm Hg Mitral Valve - E Wave: 0.6 m/sec Mitral Valve - A Wave: 0.8 m/sec Mitral Valve - E/A Ratio: 0.75 INTERPRETATION: Findings: LEFT ATRIUM: Moderate LA enlargement. RIGHT ATRIUM/INTERATRIAL SEPTUM: Lipomatous hypertrophy of the interatrial septum. No ASD by 2D or color Doppler. Prominent Eustachian valve (normal variant). LEFT VENTRICLE: Wall thickness and cavity dimensions were obtained from 2D images. Normal LV wall thickness. Normal LV cavity size. Mild regional LV systolic dysfunction. Mildly depressed LVEF. 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. Complex (>4mm) atheroma in the aortic arch. Mildly dilated descending aorta. Complex (>4mm) atheroma in the descending thoracic aorta. AORTIC VALVE: Three aortic valve leaflets. Minimally increased gradient c/w minimal AS. No AR. MITRAL VALVE: Moderately thickened mitral valve leaflets. No MS. Moderate (2+) MR. TRICUSPID VALVE: Normal tricuspid valve leaflets. Physiologic TR. PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets. Physiologic (normal) PR. PERICARDIUM: Trivial/physiologic pericardial effusion. Pericardial calcifications. GENERAL COMMENTS: A TEE was performed in the location listed above. I certify I was present in compliance with HCFA regulations. No TEE related complications. Conclusions: Pre Bypass: 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 size is normal. There is mild regional left ventricular systolic dysfunction with mild to moderate mid inferior hypokinesis. LVEF 45-50%. The descending thoracic aorta is mildly dilated. There are complex (>4mm) atheroma in the arch and descending thoracic aorta. There are three aortic valve leaflets.The left coronary cusp may have decreased mobility. There is minimal aortic valve stenosis. Aortic valve area 1.94 cm2 averaged on continuity, 2.24 cm2 averaged on plainemetry. No aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. Moderate (2+) mitral regurgitation is seen. The jet is posteriorly directed with a vena contracta from 4-6 mm in diameter. There is partial restrictioin of the postierior leaflet, most likely involving P2. There is a trivial/physiologic pericardial effusion. There are pericardial calcifications. Post Bypass: Patient is AV paced on epinepherine and phenylepherine gtt. LV function is improved with LVEF >55%. Septal wall motion is consistent with av pacing. Inferior wall motion is improved. There is a partial mitral ring prosthesis insitu. Peak and mean gradients are 3 mm Hg. There is no residual mitral regurgitation. Aortic contours are intact. Remaining exam is unchanged. All findings discussed with surgeons at the time of the exam. Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD on [**2168-4-12**] 13:48. [**Location (un) **] PHYSICIAN: EKG Sinus rhythm. No significant change compared to the previous tracing of [**2168-4-12**]. Read by: [**Last Name (LF) **],[**First Name3 (LF) **] B. Intervals Axes Rate PR QRS QT/QTc P QRS T 75 186 134 [**Telephone/Fax (2) 27518**] 79 37 Brief Hospital Course: Mr. [**Known lastname 27519**] was admitted to the [**Hospital1 18**] on [**2168-4-12**] for surgical management of his coronary artery disease. He was taken to the operating room where he underwent coronary artery bypass grafting to three vessels and a mitral valve repair. Please see operative note for details. Of note, he was a difficult foley placement due to a stricture. The urology service was consulted who performed a cystoscopy and foley placement. Gentamicin, ciprofloxacin and ancef were given for prophylactic coverage. Postoperatively he was taken to the intensive care unit for monitoring. On postoperative day one, Mr. [**Known lastname 27519**] [**Last Name (Titles) 5058**] neurologically intact and was extubated. Beta blockade, aspirin and statins were resumed. On postoperative day two, 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 was ready for discharge to rehab on POD 6. Medications on Admission: Albuterol/Atrovent Nebs Spiriva Inhaler daily Mucinex 600mg twice daily Diltiazem 120mg daily Aspirin 81mg daily Zocor 10mg daily Atrovent nasal spray 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. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 4. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 5. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for SOB. 6. Albuterol Sulfate 0.083 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed for SOB. 7. Guaifenesin 600 mg Tablet Sustained Release Sig: One (1) Tablet Sustained Release PO BID (2 times a day). 8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as needed for pain. 9. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two (2) Capsule, Sustained Release PO BID (2 times a day). 12. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). Discharge Disposition: Extended Care Facility: Greenbriar Terrace Discharge Diagnosis: CAD Hyperlipidemia HTN COPD Pneumonia Prostate Cancer Prostatectomy Emphysema PVD Discharge Condition: Good. Discharge Instructions: 1) Monitor wounds for signs of infection. These include redness, drainage or increased pain. 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. 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. Followup Instructions: Please follow-up with Dr. [**Last Name (STitle) 1290**] in 1 month. [**Telephone/Fax (1) 170**] Please follow-up with Dr. [**Last Name (STitle) 11493**] in 2 weeks. [**Telephone/Fax (1) 11650**] Please follow-up with Dr. [**Last Name (STitle) **] after discharge from rehab Completed by:[**2168-4-18**]

414,496,486,424,596,272,443,V104,V158

{'Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Mitral valve disorders,Bladder neck obstruction,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Personal history of malignant neoplasm of prostate,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: Dyspnea on exertion PRESENT ILLNESS: This is an 81-year-old male who had increasing shortness of breath. His workup revealed that he had a positive exercise stress test. He underwent a cardiac catheterization, and this demonstrated 3-vessel coronary artery disease. It was recommended that he undergo coronary bypass grafting and, after risks and benefits were explained to him, he agreed to proceed. MEDICAL HISTORY: PVD COPD Hyperlipidemia HTN MRSA Pneumonia Emphysema Prostate Cancer Prostatectomy MEDICATION ON ADMISSION: Albuterol/Atrovent Nebs Spiriva Inhaler daily Mucinex 600mg twice daily Diltiazem 120mg daily Aspirin 81mg daily Zocor 10mg daily Atrovent nasal spray ALLERGIES: Prednisone / Sulfa (Sulfonamides) PHYSICAL EXAM: 64 sr 129/76 (R) 153/81 (L) GEN: Elderly man in NAD but mildly SOB with talking HEENT: Unremarkable NECK: Supple, FROM LUNGS: Diminished BS throughout with mild exp wheeze HEART: RRR, Nl S1-S2 ABD: Ventral hernia noted, S/NT/ND/NABS EXT: Pulses [**1-12**]+ throughout. Warm, well perfused. NO varicosities noted NEURO: No carotid bruits. Nonfocal FAMILY HISTORY: Father died of ? MI at age 54. SOCIAL HISTORY: Retired. Quit smoking [**2143**] 45 pk/yrs. Does not drink. Lives with fiance. Edentulous. ### Response: {'Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Mitral valve disorders,Bladder neck obstruction,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Personal history of malignant neoplasm of prostate,Personal history of tobacco use'}

CHIEF COMPLAINT: Gastrointestinal bleed. PRESENT ILLNESS: The patient is an 84-year-old male with a history of diverticular bleed in the past and mantle cell lymphoma who was in his usual state of bright red blood per rectum and was admitted to [**Hospital 1474**] Hospital. He had a large hematocrit drop of 12 points from 38 down to 26 without any hemodynamic instability. Nevertheless, he was transferred to the outside hospital ICU. The bleeding scan there revealed bleeding of the hepatic flexure making this largely a large bowel bleed. MEDICAL HISTORY: 1. Mantle cell lymphoma diagnosed in [**2132**], status post XRT and chemotherapy, recently diagnosed with radiation pneumonitis, started on prednisone. This was complicated by herpes labialis. He is followed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] from the [**Hospital1 18**] Dept. of Heme/Onc. 2. Hypertension. 3. Diabetes mellitus, currently diet-controlled. 4. Atrial fibrillation, two episodes, always in the context of surgery. 5. Diverticulosis with the previous GI bleed in [**2124**]. The patient had a sigmoidoscopy with no sources localized. 6. Hypothyroidism. 7. Status post TURP. 8. Status post appendectomy. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: No history of colon cancer or diverticulosis. SOCIAL HISTORY: He is married. He is a retired aircraft engineer. Smoked about 45 packs per year but quit about 15 years ago. No alcohol.

Diverticulosis of colon with hemorrhage,Acute pulmonary manifestations due to radiation,Other malignant lymphomas, lymph nodes of multiple sites,Acute posthemorrhagic anemia,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Personal history of tobacco use

Dvrtclo colon w hmrhg,Ac pul manif d/t radiat,Lymphomas NEC mult,Ac posthemorrhag anemia,Atrial fibrillation,Hypertension NOS,DMII wo cmp nt st uncntr,Hypothyroidism NOS,History of tobacco use

Admission Date: [**2137-12-15**] Discharge Date: [**2137-12-19**] Service: MEDICINE CHIEF COMPLAINT: Gastrointestinal bleed. HISTORY OF THE PRESENT ILLNESS: The patient is an 84-year-old male with a history of diverticular bleed in the past and mantle cell lymphoma who was in his usual state of bright red blood per rectum and was admitted to [**Hospital 1474**] Hospital. He had a large hematocrit drop of 12 points from 38 down to 26 without any hemodynamic instability. Nevertheless, he was transferred to the outside hospital ICU. The bleeding scan there revealed bleeding of the hepatic flexure making this largely a large bowel bleed. was eventually transferred to our Medical Intensive Care Unit after he received 4 units of packed red blood cells and 2 units of FFP. Upon arrival in the [**Hospital 18**] Medical Intensive Care Unit, the patient was hemodynamically stable. He complained of no abdominal pain, no nausea, no vomiting, no hematemesis, and most importantly no bright red blood per rectum. He continued to have bowel movements. He had no shortness of breath, chest pain, or palpitations. An angiogram was performed which revealed no bleeding and, therefore, he had no embolization. He received a further 2 units of packed red blood cells and given that he was stable was transferred to the regular medical floor. PAST MEDICAL HISTORY: 1. Mantle cell lymphoma diagnosed in [**2132**], status post XRT and chemotherapy, recently diagnosed with radiation pneumonitis, started on prednisone. This was complicated by herpes labialis. He is followed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] from the [**Hospital1 18**] Dept. of Heme/Onc. 2. Hypertension. 3. Diabetes mellitus, currently diet-controlled. 4. Atrial fibrillation, two episodes, always in the context of surgery. 5. Diverticulosis with the previous GI bleed in [**2124**]. The patient had a sigmoidoscopy with no sources localized. 6. Hypothyroidism. 7. Status post TURP. 8. Status post appendectomy. MEDICATIONS AT HOME: 1. Protonix 40 q.d. 2. Acyclovir 400 p.o. t.i.d. 3. Bactrim double-strength Monday, Wednesday, and Friday. 4. Prednisone 60 q.d. 5. Potassium chloride 20 mg p.o. q.d. 6. Ambien 5 q.d. 7. Aspirin 81 p.o. q.d. 8. Synthroid 175 p.o. q.d. 9. Captopril 50 t.i.d. 10. Nifedipine 30 p.o. q.d. 11. Demodex, unknown dose, q.o.d. ALLERGIES: The patient has no known drug allergies. SOCIAL HISTORY: He is married. He is a retired aircraft engineer. Smoked about 45 packs per year but quit about 15 years ago. No alcohol. FAMILY HISTORY: No history of colon cancer or diverticulosis. PHYSICAL EXAMINATION UPON TRANSFER TO THE MEDICAL FLOOR: Vital signs: Temperature 98.4, heart rate 78, blood pressure 150/80, respiratory rate 20, saturating 93 on 2 liters. General: The patient was a comfortable gentleman in no acute distress. HEENT: No icterus. Moist mucous membranes. Neck: Supple with no lymphadenopathy. No JVD. Respiratory: Good air movement. Occasional wheezes. No crackles. Cardiovascular: S1, S2, with no murmurs, rubs, or gallops. Abdomen: Soft, nontender, nondistended with normoactive bowel sounds. Extremities: Trace edema, 1+ pulses. LABORATORY DATA ON TRANSFER TO THE MEDICAL FLOOR: White count 6.6, hematocrit 25.2, platelets 139,000. Chem-7 142, 4.0, 109, 24, 28, 1.0. He had unremarkable LFTs. HOSPITAL COURSE: 1. GASTROINTESTINAL: A consultation with the GI Service was obtained and given that there was no bleeding seen on angiography their recommendations were to proceed with colonoscopy. This was done and the colonoscopy revealed multiple diverticuli but no evidence of active GI bleed. We, therefore, obtained an upper GI, small bowel follow through which was completely unremarkable. His hematocrit in the meantime has stabilized even though he required a couple of additional units of packed red blood cells. He remained consistently stable above 29 and upon discharge was 32. He continued to have several Guaiac positive bowel movements per day but no episodes of frank blood in his stool. Of note, he had absolutely no episodes of hemodynamic instability. 2. PULMONARY: The patient carries the diagnosis of radiation pneumonitis. He has been on almost four weeks of prednisone 60 mg p.o. q.d. apparently. The dose was changed currently to 40 mg p.o. q.d. and an appointment was made with the Pulmonary Service in which he will follow-up next week regarding his radiation pneumonitis. His 02 saturations on 2 liters was 93 and 94% and without oxygen would drop to 90-91. Upon ambulation, however, his sats dropped to 84 and, therefore, the patient is being discharged on home oxygen. 3. HEMATOLOGY: The patient was closely followed by Hematology/Oncology regarding his mantle cell lymphoma. His therapy is apparently on hold given the radiation pneumonitis exacerbation. Of note, platelets dropped from a baseline of about 350 to 115 upon admission and then to as low as 99. In the context of this, his Bactrim was withheld. We also withheld his aspirin in the context of a GI bleed and decreasing platelets. DISCHARGE CONDITION: Stable. Discharged to home with 02 and VNA. DISCHARGE DIAGNOSIS: 1. Lower gastrointestinal bleed, most likely from diverticulosis. 2. Mantle cell lymphoma. 3. Radiation pneumonitis. DISCHARGE MEDICATIONS: 1. Protonix 40 p.o. q.d. 2. Acyclovir 400 mg p.o. t.i.d. 3. Synthroid 175 p.o. q.d. 4. Captopril 50 t.i.d. 5. Nifedipine 30 p.o. q.d. 6. K-Dur 20 mg p.o. q.d. 7. Flonase inhaler 110 micrograms b.i.d. 8. Prednisone 40 q.d. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D. [**MD Number(1) 2506**] Dictated By:[**Last Name (STitle) 6865**] MEDQUIST36 D: [**2137-12-19**] 02:37 T: [**2137-12-21**] 10:42 JOB#: [**Job Number 37715**]

562,508,202,285,427,401,250,244,V158

{'Diverticulosis of colon with hemorrhage,Acute pulmonary manifestations due to radiation,Other malignant lymphomas, lymph nodes of multiple sites,Acute posthemorrhagic anemia,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,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: Gastrointestinal bleed. PRESENT ILLNESS: The patient is an 84-year-old male with a history of diverticular bleed in the past and mantle cell lymphoma who was in his usual state of bright red blood per rectum and was admitted to [**Hospital 1474**] Hospital. He had a large hematocrit drop of 12 points from 38 down to 26 without any hemodynamic instability. Nevertheless, he was transferred to the outside hospital ICU. The bleeding scan there revealed bleeding of the hepatic flexure making this largely a large bowel bleed. MEDICAL HISTORY: 1. Mantle cell lymphoma diagnosed in [**2132**], status post XRT and chemotherapy, recently diagnosed with radiation pneumonitis, started on prednisone. This was complicated by herpes labialis. He is followed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] from the [**Hospital1 18**] Dept. of Heme/Onc. 2. Hypertension. 3. Diabetes mellitus, currently diet-controlled. 4. Atrial fibrillation, two episodes, always in the context of surgery. 5. Diverticulosis with the previous GI bleed in [**2124**]. The patient had a sigmoidoscopy with no sources localized. 6. Hypothyroidism. 7. Status post TURP. 8. Status post appendectomy. MEDICATION ON ADMISSION: ALLERGIES: The patient has no known drug allergies. PHYSICAL EXAM: FAMILY HISTORY: No history of colon cancer or diverticulosis. SOCIAL HISTORY: He is married. He is a retired aircraft engineer. Smoked about 45 packs per year but quit about 15 years ago. No alcohol. ### Response: {'Diverticulosis of colon with hemorrhage,Acute pulmonary manifestations due to radiation,Other malignant lymphomas, lymph nodes of multiple sites,Acute posthemorrhagic anemia,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Personal history of tobacco use'}

CHIEF COMPLAINT: Shortness of breath PRESENT ILLNESS: 63 y/o F with hx of severe diastolic CHF, pulm HTN, afib, ulcerative colitis, and recent lower GI bleed who is transferred from [**Hospital1 1774**] with acute dyspnea and hypoxia. Per her daughter, she has been more dypsneic on exertion for the past week with episodes somewhat relieved with albuterol. The pt reports that she awoke at 3:15 AM with acute shortness of breath and wheezing. She denies chest pain, palpitations, fevers, chills, night sweats. She denies cough. An albuterol inhaler did not help, so she went to the [**Hospital1 1774**] ED. . In the [**Hospital1 1774**] ED, she placed on bipap with O2sat 100%. Her BP was initially 104/67, HR 55, RR13. CXR showed R pleural effusion. BNP was 1500, cardiac enzymes negative. HCT was noted to be 24.9 (baseline 24-27). At 6am her blood pressures dropped to 83/44 and she was given a 125cc NS bolus. ABG on bipap was 7.34/60/313/32. At 7:30am, Levophed gtt was started. At 8am she was transitioned to a NRB and was satting 100%. Her levophed was increased at 8:15am. . On arrival to the ICU, she reports comfortable breathing ever since being placed on O2. ROS is otherwise positive for more black stools over the past 2-3 days. . Of note, she was recently admitted [**Date range (3) 13475**] due to lower GI bleed and HCT of 17. She required 6 units PRBCs that admission and bleeding was felt to be due to lower GI angioectasia; colonoscopy was not done due to recent scope [**1-30**] which showed many angioectasias throughout the colon. HCT was stable at 24.7 on discharge and most recent HCT [**3-26**] was 27.4. She was also treated for congestive heart failure exacerbation and acute renal failure on that admission and was discharged on spironolactone, torsemide and metolazone still about 40 lbs above her dry weight. At her follow-up appointments, her weight was still stable, so spironolactone was increased on [**3-15**] by Dr. [**Last Name (STitle) 118**] (weight 199 lbs) and her torsemide on [**3-18**] by Dr. [**First Name (STitle) 437**] (weight 196 lbs). The pt reports medication compliance (does sometimes take medications late) and general diet compliance although "ate more over [**Holiday **]." She does recall an episode of left leg pain two days ago while trying to go up stairs and feels she may have been when she started feeling more short of breath, although the acute episode of dyspnea was not until later. . Review of systems: (+) Per HPI. Ongoing occasional nausea, vomiting with emesis including medications at times. (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough. Denies chest pain, chest pressure, palpitations, or weakness. 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: # Diabetes # Dyslipidemia (TG 53, Chol 145 HDL 71 LDL 63 on [**10/2107**]) # Hypertension # atrial fibrillation off coumadin secondary to GI bleed # severe diastolic dysfunction w/ right sided heart failure # severe pulmonary hypertension # severe tricuspid regurg (eval by card [**Doctor First Name **], not op candidate) MEDICATION ON ADMISSION: Albuterol HFA 90 mcg 2 puffs PO QID PRN Ammonial Lactate 12% lotion [**Hospital1 **] Dicloxacillin 500mg PO QID Folic Acid 1 tab PO qday Gabapentin 200mg PO qHS PRN leg spasm Mesalamine 800mg PO TID Metolazone 5mg PO BID Metoprolol Tartrate 25mg PO BID Metronidazole 0.75% cream [**Hospital1 **] Omeprazole 20mg PO qday Oxycodone 5mg PO 5mg PO q6H Potassium Chloride 20meq with meals Promethazine 12.5-25mg PO q6H PRN Spironolactone 50mg PO qday Torsemide 60mg PO BID Trazodone 25mg PO qHS ASA 81mg PO qday Ferrous Sulfate 325mg PO BID Miconazole 2% cream ALLERGIES: Lisinopril / Kefzol / Sulfa (Sulfonamide Antibiotics) / Shellfish Derived PHYSICAL EXAM: Vitals: T 95.7, P 57, BP 104/71, RR 13, O2sat 100% 5L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: Supple, very promiment EJ, JVP elevated, no LAD Lungs: Mild rales bilaterally, no wheezes, or ronchi CV: Irregular rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Soft, obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GI: Trace guaiac positive hard very dark brown stool GU: Foley in place Ext: warm, well perfused, 2+ pulses, 3+ edema bilateral to knees and up posterior aspects to lower back, LLE more erythematous with hematoma, calf tenderness bilaterally Neuro: AAOx3, mild asterixis b/l, otherwise nonfocal FAMILY HISTORY: -Father with MI at age 68 -Mother breast cancer at age 52 No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: -Married, separated from husband who is mentally ill, living with son and his family currently (supportive) -Tobacco history: No -ETOH: +prior h/o heavy EtOH use, current intermittent EtOH use -Illicit drugs: No

Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Angiodysplasia of intestine with hemorrhage,Ulcerative colitis, unspecified,Unspecified pleural effusion,Chronic kidney disease, Stage IV (severe),Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other chronic pulmonary heart diseases,Atrial fibrillation,Restless legs syndrome (RLS),Diseases of tricuspid valve,Hypotension, unspecified,Anemia in chronic kidney disease

Ac on chr diast hrt fail,Acute kidney failure NOS,Angio intes w hmrhg,Ulceratve colitis unspcf,Pleural effusion NOS,Chr kidney dis stage IV,Urin tract infection NOS,DMII wo cmp nt st uncntr,Hy kid NOS w cr kid I-IV,Chr pulmon heart dis NEC,Atrial fibrillation,Restless legs syndrome,Tricuspid valve disease,Hypotension NOS,Anemia in chr kidney dis

Admission Date: [**2109-4-1**] Discharge Date: [**2109-4-13**] Date of Birth: [**2045-4-2**] Sex: F Service: MEDICINE Allergies: Lisinopril / Kefzol / Sulfa (Sulfonamide Antibiotics) / Shellfish Derived Attending:[**First Name3 (LF) 800**] Chief Complaint: Shortness of breath Major Surgical or Invasive Procedure: Temporary HD line placement Arterial Line Placement CVVH Hemodialysis Subclavean Central Line Placement History of Present Illness: 63 y/o F with hx of severe diastolic CHF, pulm HTN, afib, ulcerative colitis, and recent lower GI bleed who is transferred from [**Hospital1 1774**] with acute dyspnea and hypoxia. Per her daughter, she has been more dypsneic on exertion for the past week with episodes somewhat relieved with albuterol. The pt reports that she awoke at 3:15 AM with acute shortness of breath and wheezing. She denies chest pain, palpitations, fevers, chills, night sweats. She denies cough. An albuterol inhaler did not help, so she went to the [**Hospital1 1774**] ED. . In the [**Hospital1 1774**] ED, she placed on bipap with O2sat 100%. Her BP was initially 104/67, HR 55, RR13. CXR showed R pleural effusion. BNP was 1500, cardiac enzymes negative. HCT was noted to be 24.9 (baseline 24-27). At 6am her blood pressures dropped to 83/44 and she was given a 125cc NS bolus. ABG on bipap was 7.34/60/313/32. At 7:30am, Levophed gtt was started. At 8am she was transitioned to a NRB and was satting 100%. Her levophed was increased at 8:15am. . On arrival to the ICU, she reports comfortable breathing ever since being placed on O2. ROS is otherwise positive for more black stools over the past 2-3 days. . Of note, she was recently admitted [**Date range (3) 13475**] due to lower GI bleed and HCT of 17. She required 6 units PRBCs that admission and bleeding was felt to be due to lower GI angioectasia; colonoscopy was not done due to recent scope [**1-30**] which showed many angioectasias throughout the colon. HCT was stable at 24.7 on discharge and most recent HCT [**3-26**] was 27.4. She was also treated for congestive heart failure exacerbation and acute renal failure on that admission and was discharged on spironolactone, torsemide and metolazone still about 40 lbs above her dry weight. At her follow-up appointments, her weight was still stable, so spironolactone was increased on [**3-15**] by Dr. [**Last Name (STitle) 118**] (weight 199 lbs) and her torsemide on [**3-18**] by Dr. [**First Name (STitle) 437**] (weight 196 lbs). The pt reports medication compliance (does sometimes take medications late) and general diet compliance although "ate more over [**Holiday **]." She does recall an episode of left leg pain two days ago while trying to go up stairs and feels she may have been when she started feeling more short of breath, although the acute episode of dyspnea was not until later. . Review of systems: (+) Per HPI. Ongoing occasional nausea, vomiting with emesis including medications at times. (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough. Denies chest pain, chest pressure, palpitations, or weakness. 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: # Diabetes # Dyslipidemia (TG 53, Chol 145 HDL 71 LDL 63 on [**10/2107**]) # Hypertension # atrial fibrillation off coumadin secondary to GI bleed # severe diastolic dysfunction w/ right sided heart failure # severe pulmonary hypertension # severe tricuspid regurg (eval by card [**Doctor First Name **], not op candidate) # EtOH remote history # PFO closure ([**2108-3-21**]) # ulcerative colitis # intermittent hyponatermia # elevated LFTs # angioectasia of the entire colon seen on colonoscopy [**2109-1-30**] Social History: -Married, separated from husband who is mentally ill, living with son and his family currently (supportive) -Tobacco history: No -ETOH: +prior h/o heavy EtOH use, current intermittent EtOH use -Illicit drugs: No Family History: -Father with MI at age 68 -Mother breast cancer at age 52 No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. Physical Exam: Vitals: T 95.7, P 57, BP 104/71, RR 13, O2sat 100% 5L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: Supple, very promiment EJ, JVP elevated, no LAD Lungs: Mild rales bilaterally, no wheezes, or ronchi CV: Irregular rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Soft, obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GI: Trace guaiac positive hard very dark brown stool GU: Foley in place Ext: warm, well perfused, 2+ pulses, 3+ edema bilateral to knees and up posterior aspects to lower back, LLE more erythematous with hematoma, calf tenderness bilaterally Neuro: AAOx3, mild asterixis b/l, otherwise nonfocal Pertinent Results: [**2109-4-1**] 09:32PM UREA N-102* CREAT-2.4* [**2109-4-1**] 09:32PM CK(CPK)-32 [**2109-4-1**] 09:32PM CK-MB-NotDone cTropnT-<0.01 [**2109-4-1**] 09:32PM HCT-26.8* [**2109-4-1**] 03:32PM URINE HOURS-RANDOM UREA N-335 CREAT-27 SODIUM-84 [**2109-4-1**] 03:32PM URINE OSMOLAL-348 [**2109-4-1**] 03:32PM URINE COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.007 [**2109-4-1**] 03:32PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD [**2109-4-1**] 03:32PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD [**2109-4-1**] 03:32PM URINE RBC-0-2 WBC-[**5-30**]* BACTERIA-FEW YEAST-NONE EPI-0-2 [**2109-4-1**] 03:32PM URINE EOS-POSITIVE [**2109-4-1**] 12:00PM GLUCOSE-109* UREA N-100* CREAT-2.5* SODIUM-134 POTASSIUM-4.5 CHLORIDE-92* TOTAL CO2-26 ANION GAP-21* [**2109-4-1**] 12:00PM ALT(SGPT)-9 AST(SGOT)-44* LD(LDH)-283* CK(CPK)-39 ALK PHOS-194* TOT BILI-1.4 [**2109-4-1**] 12:00PM CK-MB-NotDone cTropnT-0.01 proBNP-6666* [**2109-4-1**] 12:00PM CALCIUM-9.4 PHOSPHATE-6.5*# MAGNESIUM-2.4 [**2109-4-1**] 12:00PM TSH-4.7* [**2109-4-1**] 12:00PM WBC-12.1*# RBC-3.33* HGB-8.9* HCT-28.8* MCV-87 MCH-26.9* MCHC-31.0 RDW-16.3* [**2109-4-1**] 12:00PM NEUTS-94.4* LYMPHS-3.0* MONOS-2.2 EOS-0.3 BASOS-0.1 [**2109-4-1**] 12:00PM PLT COUNT-236 [**2109-4-1**] 12:00PM PT-13.1 PTT-29.4 INR(PT)-1.1 [**2109-4-1**]: Portable CXR INDICATION: 63-year-old female with history of CHF, shortness of breath. [**Month/Day/Year **] for pulmonary edema. COMPARISON: Chest radiograph [**2109-2-26**] and multiple priors. SINGLE PORTABLE SEMI-UPRIGHT VIEW OF THE CHEST: In comparison to the most recent chest radiograph as well as the recent CT, there has been an increase in a right pleural effusion. Lung volumes are low, accentuating the heart size, but even allowing for technique very stable moderate cardiomegaly. The bony thorax is unremarkable. IMPRESSION: Increased right and continued left pleural effusion. [**2109-4-1**]: Portable CXR HISTORY: Central line placement. FINDINGS: In comparison with the earlier study of this date, there has been placement of a right subclavian catheter that extends to the mid-to-lower portion of the SVC. Otherwise, little change. The study and the report were reviewed by the staff radiologist. [**2109-4-2**]: TTE The left atrium is moderately dilated. The right atrium is moderately dilated. A septal occluder device is seen across the interatrial septum. The estimated right atrial pressure is 10-20mmHg. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. 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 ventricular cavity is dilated with borderline normal free wall function. [Intrinsic right ventricular systolic function is likely more depressed given the severity of tricuspid regurgitation.] There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild to moderate ([**12-22**]+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Severe [4+] tricuspid regurgitation is seen. There is probably significant pulmonary hypertension although this could not be adequately quantified. [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.] Significant pulmonic regurgitation is seen. There is a very small pericardial effusion. There are no echocardiographic signs of tamponade. (Echocardiographic signs of tamponade may be absent in the presence of elevated right sided pressures.) Compared with the prior study (images reviewed) of [**2109-2-26**], there is no significant change. [**2109-4-2**]: Renal Ultrasound INDICATION: Patient is a 63-year-old female with longstanding hypertension. [**Month/Day/Year **] for renal artery stenosis. EXAMINATION: Renal ultrasound with Doppler. COMPARISONS: Comparison is made to CT from [**2109-2-27**] and renal ultrasound from [**2109-2-25**]. FINDINGS: The right kidney measures 9.2 cm. Left kidney measures 8.7 cm. Both kidneys are relatively normal in size for patient's stated age. Both kidneys are unremarkable in appearance with no evidence of hydronephrosis, nephrolithiasis, or discrete masses. Note is made of a small amount of pelvic free fluid. The bladder is collapsed about a Foley catheter. DOPPLER EXAMINATION: Both main renal arteries demonstrate a brisk upstroke and good diastolic flow. There is normal venous drainage with normal venous waveforms demonstrated. Resistive indices were measured as ranging from 0.61 to 0.83 within the left and 0.68 to 0.81 on the right. This is compatible with mild to moderately elevated resistive indices. IMPRESSION: 1. No son[**Name (NI) 493**] evidence of renal artery stenosis. Mild to moderately and symmetrically elevated resistive indices bilaterally. 2. Unremarkable appearance of the kidneys. 3. Small amount of pelvic free fluid. [**2109-4-4**]: CHEST RADIOGRAPH INDICATION: Chronic heart failure, shortness of breath, evaluation for interval change. COMPARISON: [**2109-4-3**]. FINDINGS: As compared to the previous radiograph, there is no relevant change. Unchanged moderate cardiomegaly with basal areas of atelectasis and a small right-sided pleural effusion. No newly occurred focal parenchymal opacity in the lung parenchyma. Unchanged course and position of the two right-sided central venous access lines. No pneumothorax. Brief Hospital Course: # Dyspnea/Hypoxia: Pt presented with dyspnea and hypoxia; she was on Bipap and transitioned to NRB. She appeared fluid overloaded clinically and on CXR with a BNP of 6666. Acute onset raised concern for an inciting event, but no clear inciting factor apparent. She did have mild leukocytosis to WBC 12 but no fevers, cough, or clear consolidation suggestive of pneumonia. She is in chronic atrial fibrillation but is rate controlled. She had no chest pain to suggest ACS; EKG was at her baseline and 2 sets of cardiac enzymes were negative. A pulmonary embolus was considered but given no chest pain or tachycardia (on beta blocker) this was not felt to be a concern. Thyroid dysfunction unlikely to provoke acute decompensation. According to the patient's daughter, the presentation may have actually been more subacute over several days and there may have been a component of suboptimal dietary/medication compliance in this patient with baseline diastolic CHF that has been very difficult to manage. She was begun on CVVH on [**2109-4-2**] and diuresis was begun. Her admission weight was 87.6 kg and her maximum weight during admission prior to CVVH was 92 kg. She continued on CVVH with levophed as needed for pressure support until [**2109-4-8**]. She was transferred to the regular floor and continued to receive hemodialysis until discharge. She was discharged on her home regimen of metolazone, torsemide and spironalactone. Permanent transiton to hemodialsis had been discussed with her in detail but she much preferred the option of an oral antidiuretic regimen which she committed to be compliant with. . # Hypotension: The patient was hypotensive to the 80s systolic in the OSH ED and she was started on levophed. She continued requiring levophed for pressure support here in the ED and MICU and a central venous line was placed here in her right subclavian vein. The hypotension was felt to be cardiogenic in the setting of worsening diastolic CHF. There was no evidence for sepsis although the patient was found to have a UTI. Her hematocrit did show a slight drop but blood loss and hypovolemia were not felt to be contributing to her hypotension. Levophed was maintained as needed while diuresing aggressively with CVVH. . # Hematochezia: The patient was recently admitted for anemia and thought to have recurrent lower GI angioectasia bleeding. During this admission she continued to have guaiac positive stools but her hematocrit was relatively stable since her last discharge. Her hematocrit was monitored closely and she was transfused two units of packed red blood cells (one on [**2109-4-3**] and one on [**2109-4-4**]) with an appropriate increase in her hematocrit from 22.9 to 29.8. She continued taking her home pantoprazole, and sub-cutaneous heparin was avoided in the setting of her GI bleed. . # Acute renal failure: The patient was found to have BUN 100 and Cr 2.5 (baseline 1.7). This was thought likely due to decreased renal perfusion in the setting of decompensated heart failure. Creatinine began trending down as patient started on CVVH. Medications were dosed for the patient's creatinine clearance, and the patient was followed by the renal consult team; Dr. [**Last Name (STitle) 118**], the patient's nephrologist, saw her while in-house. She was begun on CVVH on [**2109-4-2**] and diuresis was begun. Her admission weight was 87.6 kg and her maximum weight during admission prior to CVVH was 92 kg. She continued on CVVH with levophed as needed for pressure support until [**2109-4-8**]. She was transferred to the regular floor and continued to receive hemodialysis until discharge. She was discharged on her home regimen of metolazone, torsemide and spironalactone. Permanent transiton to hemodialsis had been discussed with her in detail but she much preferred the option of an oral antidiuretic regimen which she committed to be compliant with. . # Elevated LFTs: The patient was noted to have mild AST and Alkaline phosphate elevation with normal ALT and total bilirubin. She had no abdominal pain and these values were felt to be due to congestive hepatopathy; they resolved with diuresis. . # Nausea: The patient had intermittent nausea, possibly related to uremia. Abdominal exam was benign and the patient was given zofran as needed. . # Atrial fibrillation: The patient remained stable with a slow ventricular response. Her home metoprolol was held in the setting of hypotension and she was not anticoagulated given her history of significant GI bleeding. . # Diarrhea / ulcerative colitis: Dr. [**Last Name (STitle) 2987**], the patient's gastroenterologist, was made aware of the patient's admission. On admission, the patient had no abdominal symptoms such as pain or diarrhea, and she did not seem to be having an acute ulcerative colitis flare. She did develop diarrhea with antibiotic treatment of her UTI that resolved when the antibiotics were stopped. She continued taking her Asacol though had some difficulties tolerating the medication without vomiting due to the size of the pill. Medications on Admission: Albuterol HFA 90 mcg 2 puffs PO QID PRN Ammonial Lactate 12% lotion [**Hospital1 **] Dicloxacillin 500mg PO QID Folic Acid 1 tab PO qday Gabapentin 200mg PO qHS PRN leg spasm Mesalamine 800mg PO TID Metolazone 5mg PO BID Metoprolol Tartrate 25mg PO BID Metronidazole 0.75% cream [**Hospital1 **] Omeprazole 20mg PO qday Oxycodone 5mg PO 5mg PO q6H Potassium Chloride 20meq with meals Promethazine 12.5-25mg PO q6H PRN Spironolactone 50mg PO qday Torsemide 60mg PO BID Trazodone 25mg PO qHS ASA 81mg PO qday Ferrous Sulfate 325mg PO BID Miconazole 2% cream Discharge Medications: 1. Mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO TID (3 times a day). 2. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Ferrous Sulfate 300 mg (60 mg Iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. Torsemide 20 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 6. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for insomnia. 7. Spironolactone 50 mg Tablet Sig: One (1) Tablet PO once a day. 8. Metolazone 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. Methyl Salicylate-Menthol Ointment Sig: One (1) Appl Topical QID (4 times a day) as needed for PRN PAIN. 10. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2) puffs Inhalation four times a day as needed for shortness of breath or wheezing. 11. Gabapentin 100 mg Capsule Sig: Two (2) Capsule PO QHS (once a day (at bedtime)) as needed for leg spasm. 12. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice a day. 13. Promethazine 12.5 mg Tablet Sig: 1-2 Tablets PO every six (6) hours. 14. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home With Service Facility: [**Company 1519**] Discharge Diagnosis: Primary Acute on Chronic Diastolic Heart Failure. . Secondary Acute Renal Failure ulcerative colitis Diabetes Hypertension Discharge Condition: fully ambulatory with walker. Alert and oriented to person, place and time. Discharge Instructions: You were admitted to the hospital because you were having difficulty breathing. This was due to your heart failure which also caused renal failure. You required dialysis to remove all the extra fluid. A decision was made between you and your nephrologist not to pursue permanent dialysis but to continue using the diuretics you had been using at home.It is very important that you minimize salt in your diet to less than 2g/day and that you drink less than 1.5L of fluid a day and take all your medications. We stopped your omeprazole as we think this lowered your platelets. We stopped the potassium for the time being. You can discuss with Dr [**Last Name (STitle) 118**] when you should restart this. We ADDED iron sulphate 325mg daily. Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more than 3 lbs. Followup Instructions: Department: INTERNAL MEDICINE When: WEDNESDAY [**2109-4-17**] at 10:30 am With: [**Last Name (NamePattern5) 6666**], MD, MPH [**Telephone/Fax (1) 4775**] Building: [**Location (un) 2790**] ([**Location (un) **], MA) [**Location (un) 551**] Campus: OFF CAMPUS Best Parking: Free Parking on Site [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**]

428,584,569,556,511,585,599,250,403,416,427,333,397,458,285

{'Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Angiodysplasia of intestine with hemorrhage,Ulcerative colitis, unspecified,Unspecified pleural effusion,Chronic kidney disease, Stage IV (severe),Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other chronic pulmonary heart diseases,Atrial fibrillation,Restless legs syndrome (RLS),Diseases of tricuspid valve,Hypotension, unspecified,Anemia in chronic kidney disease'}

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: 63 y/o F with hx of severe diastolic CHF, pulm HTN, afib, ulcerative colitis, and recent lower GI bleed who is transferred from [**Hospital1 1774**] with acute dyspnea and hypoxia. Per her daughter, she has been more dypsneic on exertion for the past week with episodes somewhat relieved with albuterol. The pt reports that she awoke at 3:15 AM with acute shortness of breath and wheezing. She denies chest pain, palpitations, fevers, chills, night sweats. She denies cough. An albuterol inhaler did not help, so she went to the [**Hospital1 1774**] ED. . In the [**Hospital1 1774**] ED, she placed on bipap with O2sat 100%. Her BP was initially 104/67, HR 55, RR13. CXR showed R pleural effusion. BNP was 1500, cardiac enzymes negative. HCT was noted to be 24.9 (baseline 24-27). At 6am her blood pressures dropped to 83/44 and she was given a 125cc NS bolus. ABG on bipap was 7.34/60/313/32. At 7:30am, Levophed gtt was started. At 8am she was transitioned to a NRB and was satting 100%. Her levophed was increased at 8:15am. . On arrival to the ICU, she reports comfortable breathing ever since being placed on O2. ROS is otherwise positive for more black stools over the past 2-3 days. . Of note, she was recently admitted [**Date range (3) 13475**] due to lower GI bleed and HCT of 17. She required 6 units PRBCs that admission and bleeding was felt to be due to lower GI angioectasia; colonoscopy was not done due to recent scope [**1-30**] which showed many angioectasias throughout the colon. HCT was stable at 24.7 on discharge and most recent HCT [**3-26**] was 27.4. She was also treated for congestive heart failure exacerbation and acute renal failure on that admission and was discharged on spironolactone, torsemide and metolazone still about 40 lbs above her dry weight. At her follow-up appointments, her weight was still stable, so spironolactone was increased on [**3-15**] by Dr. [**Last Name (STitle) 118**] (weight 199 lbs) and her torsemide on [**3-18**] by Dr. [**First Name (STitle) 437**] (weight 196 lbs). The pt reports medication compliance (does sometimes take medications late) and general diet compliance although "ate more over [**Holiday **]." She does recall an episode of left leg pain two days ago while trying to go up stairs and feels she may have been when she started feeling more short of breath, although the acute episode of dyspnea was not until later. . Review of systems: (+) Per HPI. Ongoing occasional nausea, vomiting with emesis including medications at times. (-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough. Denies chest pain, chest pressure, palpitations, or weakness. 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: # Diabetes # Dyslipidemia (TG 53, Chol 145 HDL 71 LDL 63 on [**10/2107**]) # Hypertension # atrial fibrillation off coumadin secondary to GI bleed # severe diastolic dysfunction w/ right sided heart failure # severe pulmonary hypertension # severe tricuspid regurg (eval by card [**Doctor First Name **], not op candidate) MEDICATION ON ADMISSION: Albuterol HFA 90 mcg 2 puffs PO QID PRN Ammonial Lactate 12% lotion [**Hospital1 **] Dicloxacillin 500mg PO QID Folic Acid 1 tab PO qday Gabapentin 200mg PO qHS PRN leg spasm Mesalamine 800mg PO TID Metolazone 5mg PO BID Metoprolol Tartrate 25mg PO BID Metronidazole 0.75% cream [**Hospital1 **] Omeprazole 20mg PO qday Oxycodone 5mg PO 5mg PO q6H Potassium Chloride 20meq with meals Promethazine 12.5-25mg PO q6H PRN Spironolactone 50mg PO qday Torsemide 60mg PO BID Trazodone 25mg PO qHS ASA 81mg PO qday Ferrous Sulfate 325mg PO BID Miconazole 2% cream ALLERGIES: Lisinopril / Kefzol / Sulfa (Sulfonamide Antibiotics) / Shellfish Derived PHYSICAL EXAM: Vitals: T 95.7, P 57, BP 104/71, RR 13, O2sat 100% 5L General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: Supple, very promiment EJ, JVP elevated, no LAD Lungs: Mild rales bilaterally, no wheezes, or ronchi CV: Irregular rhythm, normal S1 + S2, no murmurs, rubs, gallops Abdomen: Soft, obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly GI: Trace guaiac positive hard very dark brown stool GU: Foley in place Ext: warm, well perfused, 2+ pulses, 3+ edema bilateral to knees and up posterior aspects to lower back, LLE more erythematous with hematoma, calf tenderness bilaterally Neuro: AAOx3, mild asterixis b/l, otherwise nonfocal FAMILY HISTORY: -Father with MI at age 68 -Mother breast cancer at age 52 No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. SOCIAL HISTORY: -Married, separated from husband who is mentally ill, living with son and his family currently (supportive) -Tobacco history: No -ETOH: +prior h/o heavy EtOH use, current intermittent EtOH use -Illicit drugs: No ### Response: {'Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Angiodysplasia of intestine with hemorrhage,Ulcerative colitis, unspecified,Unspecified pleural effusion,Chronic kidney disease, Stage IV (severe),Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other chronic pulmonary heart diseases,Atrial fibrillation,Restless legs syndrome (RLS),Diseases of tricuspid valve,Hypotension, unspecified,Anemia in chronic kidney disease'}

CHIEF COMPLAINT: PRESENT ILLNESS: This is a 51-year-old white female patient who is status post coronary artery bypass grafting x3 at [**Hospital3 **] Medical Center in [**2193-3-12**]. Her surgery was complicated by a sternal wound infection requiring multiple courses of antibiotics and three surgical sternal debridements. Patient was subsequently referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], who is a plastic surgeon at [**Hospital1 69**] for flap evaluation. Patient did present for cardiac surgery evaluation as well due to sternal involvement. MEDICAL HISTORY: Coronary artery bypass graft as previously stated. MEDICATION ON ADMISSION: ALLERGIES: The patient states an allergy to Bactrim, which causes a rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Other postoperative infection,Acute posthemorrhagic anemia,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

Other postop infection,Ac posthemorrhag anemia,DMII wo cmp nt st uncntr,Cor ath unsp vsl ntv/gft,Aortocoronary bypass

Admission Date: [**2194-6-23**] Discharge Date: [**2194-7-3**] Date of Birth: [**2142-9-23**] Sex: F Service: CSU HISTORY OF PRESENT ILLNESS: This is a 51-year-old white female patient who is status post coronary artery bypass grafting x3 at [**Hospital3 **] Medical Center in [**2193-3-12**]. Her surgery was complicated by a sternal wound infection requiring multiple courses of antibiotics and three surgical sternal debridements. Patient was subsequently referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], who is a plastic surgeon at [**Hospital1 69**] for flap evaluation. Patient did present for cardiac surgery evaluation as well due to sternal involvement. PAST MEDICAL HISTORY: Coronary artery bypass graft as previously stated. Insulin dependent-diabetes mellitus. Hypertension. Crohn's disease. Osteoarthritis. Hypothyroidism. Depression. PAST SURGICAL HISTORY: Right ear surgery at age 14. PREOPERATIVE EVALUATION: Cardiology workup. Her echocardiogram revealed a normal left ventricular ejection fraction, no mitral regurgitation, and normal pulmonary artery pressures. PREOP MEDICATIONS: 1. Humulin NPH insulin. 2. Glipizide 5 mg p.o. t.i.d. 3. Asacol 400 mg three tablets t.i.d. 4. Celexa 20 mg p.o. t.i.d. 5. Synthroid 88 mcg p.o. q.d. 6. Aspirin 81 mg p.o. q.d. 7. Advil 600-800 mg t.i.d. prn. 8. Lipitor 20 mg p.o. q.d. 9. Lisinopril/hydrochlorothiazide 20 mg/25 mg. 10. Temazepam 15 mg prn. 11. Seroquel 50 mg q.h.s. ALLERGIES: The patient states an allergy to Bactrim, which causes a rash. The patient also underwent a preoperative stress test, which showed no inducible ischemia and good exercise tolerance. HOSPITAL COURSE: The patient was taken to the operating room on [**2194-6-23**], where she underwent a sternal debridement with pectoral advancement flap with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] and Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. Postoperatively, the patient was transported in good condition to the Cardiac Surgery Recovery Unit. She was weaned from mechanical ventilation, extubated the day of surgery. On postoperative day one, she remained hemodynamically stable. She had two [**Location (un) 1661**]-[**Location (un) 1662**] drains in place. She was begun on her preoperative oral medications and transferred out of the Intensive Care Unit to the telemetry floor. Over the next few days the patient began to progress slowly with ambulation. Her cultures from the sternal wound and tissue reviewed coag-negative Staph and the patient has been continued on IV Vancomycin for this. Over the next few days, the patient remained hemodynamically stable. Continued on her IV Vancomycin. Her drains remained in for a number of days due to continued drainage. The patient continued to progress very slowly from Physical Therapy standpoint, very difficult to get her ambulating and physically active. On postoperative day four, her TSH was checked and found to be elevated and her Synthroid was increased to 100 mcg at that time. However, she remained very slow to continue ambulation. On postoperative day four, Hematology consult was obtained due to persistent leukopenia with a white cell count in the 2.6 to 4.9 range. It was their recommendation to check peripheral smears, and folate, and B12 levels and continue to follow her TSH and these are all issues that need to be continued to be addressed as the patient was discharged from rehabilitation facility. On postoperative day five, the [**Location (un) 1661**]-[**Location (un) 1662**] drains were discontinued. Patient continued to progress very slowly from an ambulation standpoint. Therefore it was determined that it would be in the patient's best interest to be discharged to a rehabilitation facility to help with mobility issues. Patient has had fluctuating blood glucose levels high in the 170s, but low in the 40s-50s. Her Glipizide was discontinued as was her NPH insulin, and she was placed on ultimately a sliding scale coverage of regular insulin for that reason. Ultimately, the patient will need to be resumed on her preoperative dose of NPH insulin as well as her oral hypoglycemic [**Doctor Last Name 360**] Glipizide when she is able to tolerate p.o. intake more adequately. The patient remains hemodynamically stable and will be discharged to a rehabilitation facility today, postoperative day 10. CONDITION TODAY: Temperature is 96.5, pulse 72 in normal sinus rhythm, blood pressure 130/50, respiratory rate 18, and on room air oxygen saturation was 99 percent. Her intakes and output for today have not been reported. PHYSICAL EXAMINATION: Neurologically: The patient is intact. Pulmonary: Her lungs are clear to auscultation bilaterally. She has a regular, rate, and rhythm. Her incision is clean and healing well with no erythema or drainage. She has no peripheral edema. DISCHARGE MEDICATIONS: 1. Colace 100 mg p.o. b.i.d. 2. Aspirin 325 mg p.o. q.d. 3. Tylenol 650 mg p.o. q.4h. prn pain. 4. Percocet 1-2 tablets p.o. q.4h prn pain. 5. Milk of magnesia 30 mL p.o. q.d. prn constipation. 6. Mesalamine DR 1200 mg p.o. t.i.d. 7. Celexa 20 mg p.o. t.i.d. 8. Lipitor 20 mg p.o. q.d. 9. Temazepam 15 mg p.o. q.h.s. prn. 10. Seroquel 50 mg p.o. q.h.s. 11. Synthroid 100 mcg p.o. q.d. 12. Lisinopril 20 mg p.o. q.d. 13. Hydrochlorothiazide 25 mg p.o. q.d. 14. Vancomycin 750 mg IV q.12h. for 10 more days after discharge to be discontinued about the [**2105-7-12**]. Folic acid 1 mg p.o. q.d. 16. Ascorbic acid 500 mg p.o. b.i.d. 17. Ferrous sulfate 325 mg p.o. q.d. 18. Multivitamin one capsule p.o. q.d. 19. Ibuprofen 400-600 mg q.8h. prn pain. 20. Sliding scale regular insulin coverage before meals and at bedtime for blood glucose of 120-150, she is to receive 3 units subcutaneously. For a glucose of 151-200, she is to receive 5 units. Blood glucose of 201-250 7 units. Glucose greater than 250 10 units. The patient should continue to be re-evaluated on a daily basis for resumption of her preoperative NPH insulin, which is 8 units at bedtime as well as her Glipizide, which was 5 mg p.o. t.i.d. DISCHARGE INSTRUCTIONS: Patient also needs to be followed up as an outpatient for her leukopenia through her primary care physician, [**Name10 (NameIs) **] she should also be monitored for her thyroid replacement and have another TSH level checked in approximately four more weeks since her Synthroid was recently increased to 100 mcg. The patient needs to followup with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] in approximately four weeks after discharge from the hospital. She needs to call for an appointment at [**Telephone/Fax (1) 170**]. Patient is to followup with her primary care physician, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 14328**], and she should call for an appointment to be seen upon discharge from rehabilitation. The patient also needs to be seen by Plastic Surgery service, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 1416**], and she should follow up in approximately one week from now and call to make an appointment. DISCHARGE DIAGNOSIS: Postoperative sternal wound infection status post sternal wound debridement and pectoral flaps. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**] Dictated By:[**Last Name (NamePattern1) 5664**] MEDQUIST36 D: [**2194-7-3**] 07:55:24 T: [**2194-7-3**] 08:46:13 Job#: [**Job Number 55686**]

998,285,250,414,V458

{'Other postoperative infection,Acute posthemorrhagic anemia,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: PRESENT ILLNESS: This is a 51-year-old white female patient who is status post coronary artery bypass grafting x3 at [**Hospital3 **] Medical Center in [**2193-3-12**]. Her surgery was complicated by a sternal wound infection requiring multiple courses of antibiotics and three surgical sternal debridements. Patient was subsequently referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], who is a plastic surgeon at [**Hospital1 69**] for flap evaluation. Patient did present for cardiac surgery evaluation as well due to sternal involvement. MEDICAL HISTORY: Coronary artery bypass graft as previously stated. MEDICATION ON ADMISSION: ALLERGIES: The patient states an allergy to Bactrim, which causes a rash. PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Other postoperative infection,Acute posthemorrhagic anemia,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: ?TCA overdose, AMS PRESENT ILLNESS: 56y/o male with a PMH of possible ETOH abuse, gastric bypass who is transferred from OSH for further management of AMS and likely overdose. Per OSH report, he was found slumped over a picnic table by friends unresponsive after partying. Arrived to OSH with decoriticate posturing. There, he received CT head which was negative. Alcohol level 25. Received zosyn, rocephin, and bicarb gtt for prolonged QRS on EKG to 126. Transferred intubated and sedated to [**Hospital1 18**] ED. . At [**Hospital1 18**] ED, a toxicology panel tested positive for serum tricyclics, but negative for Serum ASA, EtOH, Acetmnphn, Benzo, Barb. Urine was positive for benzos but was negative for Barbs, Opiates, Cocaine, Amphet, Mthdne. QRS was initially wide on arrival (120s), so toxicology was consulted. They agreed upon treating as a likely TCA overdose with bicarb gtt, though serum tox for TCA has low specificity and may detect benadryl, seroquel, carbamazepine, and other meds. Due to spontaneous narrowing of the QRS, ED discontinued bicarb gtt. Neuro involved for ?seizures and AMS, recommended a CTA head and neck which revealed no new pathology, as well as an EEG. He remained afebrile and hemodynamically stable with BP in the 130s, sats in 100s on the vent, and HR in the 80s. Psych consulted -- pt denied SI initially but may be endorsing to certain member of conuslting teams. Per psych note [**11-8**], patient's partner is concerned re multiple comments about suicide, patient was upset at partner. [**Name (NI) **] sister pt seemed fine earlier in the day. . MICU course notable for: [**11-8**] > extubated, active SI; seen by psych and section 12'd, stayed in unit to monitor for withdrawl; placed on ciwa as well as home klonipin. . In transfer to floor, patient denied suicidal ideation during time of Transfer. Vitals 96.3 (ax), 108, 130/81, 17, 97% on RA. MEDICAL HISTORY: pancreatitis gallstones gastric bypass alcohol abuse and withdrawal MEDICATION ON ADMISSION: citalopram levothyroxine; lisinopril; clonazepma 1mg tid; tirazola 2mg 3 at hs; pantoprazole percocet ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: EXAM ON TRANSFER TO FLOOR: Vitals: Vitals 96.3 (ax), 108, 130/81, 17, 97% on RA. General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: crackles at bases B/L, mild expiratory wheezes CV: regular, tachycardic Abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Family psych hx; sister with bipolar disorder, otherwise noncontributory. SOCIAL HISTORY: Social history: youngest of 6, lives with partner [**Name (NI) 401**], lost 11 year job as bus driver, worked in the past as hairdresser and lived in [**Location **]. Parents deaceased.

Poisoning by tricyclic antidepressants,Acute respiratory failure,Accidental poisoning by antidepressants,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, unspecified,Dysthymic disorder,Esophageal reflux,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Bariatric surgery status

Pois tricyclc antidepres,Acute respiratry failure,Acc poison-antidepressnt,Alcoh dep NEC/NOS-unspec,Drug abuse NEC-unspec,Dysthymic disorder,Esophageal reflux,Hypothyroidism NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Bariatric surgery status

Admission Date: [**2130-11-8**] Discharge Date: [**2130-11-10**] Date of Birth: [**2074-2-21**] Sex: M Service: MEDICINE Allergies: No Allergies/ADRs on File Attending:[**First Name3 (LF) 613**] Chief Complaint: ?TCA overdose, AMS Major Surgical or Invasive Procedure: extubation [**2041-11-7**] (intubated prior to arrival) History of Present Illness: 56y/o male with a PMH of possible ETOH abuse, gastric bypass who is transferred from OSH for further management of AMS and likely overdose. Per OSH report, he was found slumped over a picnic table by friends unresponsive after partying. Arrived to OSH with decoriticate posturing. There, he received CT head which was negative. Alcohol level 25. Received zosyn, rocephin, and bicarb gtt for prolonged QRS on EKG to 126. Transferred intubated and sedated to [**Hospital1 18**] ED. . At [**Hospital1 18**] ED, a toxicology panel tested positive for serum tricyclics, but negative for Serum ASA, EtOH, Acetmnphn, Benzo, Barb. Urine was positive for benzos but was negative for Barbs, Opiates, Cocaine, Amphet, Mthdne. QRS was initially wide on arrival (120s), so toxicology was consulted. They agreed upon treating as a likely TCA overdose with bicarb gtt, though serum tox for TCA has low specificity and may detect benadryl, seroquel, carbamazepine, and other meds. Due to spontaneous narrowing of the QRS, ED discontinued bicarb gtt. Neuro involved for ?seizures and AMS, recommended a CTA head and neck which revealed no new pathology, as well as an EEG. He remained afebrile and hemodynamically stable with BP in the 130s, sats in 100s on the vent, and HR in the 80s. Psych consulted -- pt denied SI initially but may be endorsing to certain member of conuslting teams. Per psych note [**11-8**], patient's partner is concerned re multiple comments about suicide, patient was upset at partner. [**Name (NI) **] sister pt seemed fine earlier in the day. . MICU course notable for: [**11-8**] > extubated, active SI; seen by psych and section 12'd, stayed in unit to monitor for withdrawl; placed on ciwa as well as home klonipin. . In transfer to floor, patient denied suicidal ideation during time of Transfer. Vitals 96.3 (ax), 108, 130/81, 17, 97% on RA. Past Medical History: pancreatitis gallstones gastric bypass alcohol abuse and withdrawal Social History: Social history: youngest of 6, lives with partner [**Name (NI) 401**], lost 11 year job as bus driver, worked in the past as hairdresser and lived in [**Location **]. Parents deaceased. Family History: Family psych hx; sister with bipolar disorder, otherwise noncontributory. Physical Exam: EXAM ON TRANSFER TO FLOOR: Vitals: Vitals 96.3 (ax), 108, 130/81, 17, 97% on RA. General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: crackles at bases B/L, mild expiratory wheezes CV: regular, tachycardic Abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Pertinent Results: Admission Labs: [**2130-11-8**] 10:21AM TYPE-ART RATES-14/4 TIDAL VOL-500 PEEP-5 O2-100 PO2-353* PCO2-43 PH-7.43 TOTAL CO2-29 BASE XS-4 AADO2-322 REQ O2-59 [**2130-11-8**] 09:27AM TYPE-ART TEMP-36.3 RATES-14/4 TIDAL VOL-500 PEEP-5 O2-100 -ASSIST/CON [**2130-11-8**] 09:27AM VoidSpec-QNS TO RUN [**2130-11-8**] 03:11AM GLUCOSE-111* LACTATE-3.5* NA+-142 K+-3.9 CL--102 TCO2-26 [**2130-11-8**] 03:09AM TYPE-ART PO2-146* PCO2-45 PH-7.37 TOTAL CO2-27 BASE XS-0 COMMENTS-SPECIMEN R [**2130-11-8**] 03:05AM UREA N-6 CREAT-0.6 [**2130-11-8**] 03:05AM estGFR-Using this [**2130-11-8**] 03:05AM ALT(SGPT)-30 AST(SGOT)-42* LD(LDH)-175 CK(CPK)-740* ALK PHOS-69 TOT BILI-0.4 [**2130-11-8**] 03:05AM LIPASE-15 [**2130-11-8**] 03:05AM CK-MB-20* MB INDX-2.7 [**2130-11-8**] 03:05AM ALBUMIN-4.0 [**2130-11-8**] 03:05AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-POS [**2130-11-8**] 03:05AM WBC-8.0 RBC-3.80* HGB-13.7* HCT-38.6* MCV-101* MCH-36.1* MCHC-35.6* RDW-14.8 [**2130-11-8**] 03:05AM PLT COUNT-154 [**2130-11-8**] 03:05AM PT-12.5 PTT-24.3 INR(PT)-1.1 [**2130-11-8**] 03:05AM FIBRINOGE-195 [**2130-11-8**] 02:49AM URINE HOURS-RANDOM [**2130-11-8**] 02:49AM URINE bnzodzpn-POS barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG [**2130-11-8**] 02:49AM URINE COLOR-Straw APPEAR-Hazy SP [**Last Name (un) 155**]-1.005 [**2130-11-8**] 02:49AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG CXR [**2130-11-8**]: The endotracheal tube terminates approximately 4.5 cm above the carina. There is no pneumothorax or large pleural effusion. Linear opacity in the lung bases are compatible with bibasilar atelectasis. There is no definite focal airspace consolidation. The cardiomediastinal silhouette, hilar contours, and pulmonary vasculature are within normal limits. Multilevel degenerative changes are mild-to-moderate. IMPRESSION: The endotracheal tube terminates approximately 4.5 cm above the carina. CTA HEAD NECK [**2130-11-8**] 1. No evidence of acute intracranial hemorrhage or acute territorial infarction. 2. No evidence of focal flow-limiting stenosis, occlusion, or aneurysm greater than 3 mm in arteries of neck. 3. A small protuberance is noted along the superior aspect of anterior communicating artery. However, no discrete aneurysm is identified. Brief Hospital Course: Patient is a 56YO M found down with decorticate posturing at OSH and + TCA on serum tox at [**Hospital1 18**], intubated and sedated with QRS widening on EKG. . #. ALTERED MENTAL STATUS: Patient arrived intubated and sedated on a bicarbonate gtt with suspicion for polysubstance abuse including TCA overdose based on a positive blood serum screen and an initially prolonged QRS segment on OSH EKG. Toxicology was consulted in the ED, who felt that in the abscense of the typical hemodyanmic compromise that accompanies these patients, his TCA screen was possibly a false positive induced by substances like benadryl, flexeril, and others. By the time of arrival, his QRS was normal and remained closed on repeat EKG, so bicarbonate was not restarted. His mental status was not clearing with sedation holiday in the ED, prompting neuro consult. CTA of the head and neck showed no structural or vascular causes for his AMS. He cleared considerably in the MICU and was promptly extubated with return to his baseline mental status. #. ?SUICIDE ATTEMPT: Psychiatry consulted upon extubation, per their interview: Pt has no recollection of what happened the day PTA. He reports that he went to visit his sister, he had lunch with her. His sister says that he was fine forward looking, and did not drink at lunch. Pt went home. Per the sister pt partner not there, the pt had made dinner, but when the partner called and spoke with his pt, the partner [**Name (NI) 91660**] that he was already slurring his speech. The partner went home, so the pt slumped over the picnic table still breathing, and then the partner watched him, about two hour laters he noted that the pt had stopped breathing, he called 911 and went to the outside hospital. Reportedly the alcohol level was not very high 26, the ct of the head was negative, and the patient was sent here for concern re stroke. Pt QRS was wide at the time. Pt sister doesn't think he was suicidal, appeared forward looking. Pt partner reports several months of very heavy drinking and several months of worry abou this work. 11 days ago the patient lost his job driving a bus because of 4 minor accidents in a year. Since that time and before per the partner the patient made statements suggestive of suicide. About a month ago, made statements to partner suggestive of intending to end his life. His partner has been upset about the patient's drinking. He was placed on a section 12 with plan for psychiatric hospitalization following medical stabilization. [**Hospital1 18**] Psych ulimately felt him safe for home with close watching by his partner and they reversed their section 12 statement that so that he could go home to follow up with his outpatient psychiatrist. . #. ALCOHOL WITHDRAWAL: An escalating pattern of intoxication emerged through multiple conversations with his sister and partner. [**Name (NI) **] was placed on CIWA scale with occasional diazepam requirement only during his first hospital night. . # Anxiety/Depression: continued clonazapam, held triazolam. Continued citalopram. . # ?GERD: continued protonix . # Hypothyroid: continued levothyroxine. . # Hypertension: contintued carvedolol . # Hyperlipidemia: continued lipitor. . Transitions of care: substance abuse counseling with outpatient psych. Medications on Admission: citalopram levothyroxine; lisinopril; clonazepma 1mg tid; tirazola 2mg 3 at hs; pantoprazole percocet Discharge Medications: 1. clonazepam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 2. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. 3. ergocalciferol (vitamin D2) 50,000 unit Capsule Sig: One (1) Capsule PO 2X/WEEK (TU,TH). 4. lisinopril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. Testim 50 mg/5 gram (1 %) Gel Sig: Two (2) tubes Transdermal once a day. 8. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Discharge Disposition: Home Discharge Diagnosis: Primary: Respiratory failure Substance overdose . Secondary: Anxiety / Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Discharge Instructions: Mr. [**Known lastname **]: . You were admitted to [**Hospital1 69**] with concern for a drug overdose. You were initially admitted to the ICU but were subsequently transferred to the medicine floor once you were stabilized. The psychiatry service saw you as an inpatient and felt that you were safe to return home. It is very important that you follow up with your outpatient psychiatrist. It is also very important that you do not drink alcohol or while your are taking benzodiazepines (Clonazepam and Triazolam). . The following changes were made to your medications: - You did not receive Triazolam during this hospitalization. You should NOT resume taking this medication after discharge. We strongly encourage you to stop taking this medication. - You also did not receive Oxycodone-Acetaminophen (Percocet) during this hospitalization. Please do not take this medication until you follow up with your primary care doctor. - You did not receive Flexeril (Cyclobenzaprine) during this hospitalization. Please do not take this medication until you follow up with your primary care physician. . The reason many of these medications were held or discontinued is because of the potential for interaction between the drugs and with alcohol and their side-effects, especially sedation. Followup Instructions: Please followup with your primary care physician [**Name Initial (PRE) 176**] [**8-20**] days regarding the course of this hospitalization. . Please call your outpatient psychiatrist on Monday, [**2130-11-13**], to schedule an appointment. [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**] Completed by:[**2130-11-13**]

969,518,E854,303,305,300,530,244,401,272,V458

{'Poisoning by tricyclic antidepressants,Acute respiratory failure,Accidental poisoning by antidepressants,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, unspecified,Dysthymic disorder,Esophageal reflux,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Bariatric surgery 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: ?TCA overdose, AMS PRESENT ILLNESS: 56y/o male with a PMH of possible ETOH abuse, gastric bypass who is transferred from OSH for further management of AMS and likely overdose. Per OSH report, he was found slumped over a picnic table by friends unresponsive after partying. Arrived to OSH with decoriticate posturing. There, he received CT head which was negative. Alcohol level 25. Received zosyn, rocephin, and bicarb gtt for prolonged QRS on EKG to 126. Transferred intubated and sedated to [**Hospital1 18**] ED. . At [**Hospital1 18**] ED, a toxicology panel tested positive for serum tricyclics, but negative for Serum ASA, EtOH, Acetmnphn, Benzo, Barb. Urine was positive for benzos but was negative for Barbs, Opiates, Cocaine, Amphet, Mthdne. QRS was initially wide on arrival (120s), so toxicology was consulted. They agreed upon treating as a likely TCA overdose with bicarb gtt, though serum tox for TCA has low specificity and may detect benadryl, seroquel, carbamazepine, and other meds. Due to spontaneous narrowing of the QRS, ED discontinued bicarb gtt. Neuro involved for ?seizures and AMS, recommended a CTA head and neck which revealed no new pathology, as well as an EEG. He remained afebrile and hemodynamically stable with BP in the 130s, sats in 100s on the vent, and HR in the 80s. Psych consulted -- pt denied SI initially but may be endorsing to certain member of conuslting teams. Per psych note [**11-8**], patient's partner is concerned re multiple comments about suicide, patient was upset at partner. [**Name (NI) **] sister pt seemed fine earlier in the day. . MICU course notable for: [**11-8**] > extubated, active SI; seen by psych and section 12'd, stayed in unit to monitor for withdrawl; placed on ciwa as well as home klonipin. . In transfer to floor, patient denied suicidal ideation during time of Transfer. Vitals 96.3 (ax), 108, 130/81, 17, 97% on RA. MEDICAL HISTORY: pancreatitis gallstones gastric bypass alcohol abuse and withdrawal MEDICATION ON ADMISSION: citalopram levothyroxine; lisinopril; clonazepma 1mg tid; tirazola 2mg 3 at hs; pantoprazole percocet ALLERGIES: No Allergies/ADRs on File PHYSICAL EXAM: EXAM ON TRANSFER TO FLOOR: Vitals: Vitals 96.3 (ax), 108, 130/81, 17, 97% on RA. General: Alert, oriented, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: crackles at bases B/L, mild expiratory wheezes CV: regular, tachycardic Abdomen: soft, non-tender, non-distended, no rebound tenderness or guarding GU: no foley Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema FAMILY HISTORY: Family psych hx; sister with bipolar disorder, otherwise noncontributory. SOCIAL HISTORY: Social history: youngest of 6, lives with partner [**Name (NI) 401**], lost 11 year job as bus driver, worked in the past as hairdresser and lived in [**Location **]. Parents deaceased. ### Response: {'Poisoning by tricyclic antidepressants,Acute respiratory failure,Accidental poisoning by antidepressants,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, unspecified,Dysthymic disorder,Esophageal reflux,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Bariatric surgery status'}

CHIEF COMPLAINT: Nausea; abdominal pain PRESENT ILLNESS: 64y/o gentleman with DM, HTN, CAD and recent [**Hospital Unit Name 153**] admission for necrotizing pancreatitis and pseudocyst is now admitted to the [**Hospital Unit Name 153**] for IR-guided drainage of enlarging pseudocyst. MEDICAL HISTORY: 1. Necrotizing pancreatitis ([**2142-3-29**]) - complicated by Enterococcus bacteremia, septic shock, hypoxic respiratory failure requiring intubation/trach (which was removed at rehab) 2. CABG [**2139**] 3. DM II with neuropathy 4. CHF (EF 35-40% [**8-5**] TTE) 5. Hypertension 6. Hyperlipidemia 7. MSSA epidural abscess s/p laminectomy - [**2133**] MEDICATION ON ADMISSION: -Aspirin 325 mg PO/NG DAILY -Diltiazem 120 mg PO/NG QID -Humalog Sliding Scale & Fixed Dose Lantus -Acetaminophen 325-650 mg PO/NG Q4H:PRN pain -Miconazole Powder 2% 1 Appl TP QID:PRN to folds -Citalopram Hydrobromide 10 mg PO/NG DAILY -Multivitamins W/minerals 1 TAB PO DAILY -Docusate Sodium 100 mg PO BID -Pancrelipase 5000 2 CAP PO TID W/MEALS -Famotidine 20 mg PO/NG Q24H -Heparin 5000 UNIT SC TID ALLERGIES: Penicillins / Vancomycin / Levofloxacin / Unasyn / Tigecycline / Meropenem / Metoprolol PHYSICAL EXAM: Vitals: T:96.9 BP:119/76 P:102 R: 17 O2:98%2L NC General: Alert, oriented x3, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachycardic, normal S1 and S2, regular, no murmurs Abdomen: obese but nondistended; bowel sounds present; soft; non-tender; tenderness to very deep palpation of epigastrium; no rebound tenderness or guarding Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Skin: rash on back near costal angles bilaterally - raised erythematous plaques with scale and satellite lesions FAMILY HISTORY: Dad passed away from complications of CAD (MI in 60s) and CHF. Mother had an MI in her 50s. Sister with obesity, DM. SOCIAL HISTORY: Divorced, retired high school english teacher. Former cigar smoker, [**12-30**] cigars/day, quit 8 years ago. Rare ETOH use, no illicits.

Cyst and pseudocyst of pancreas,Acute kidney failure, unspecified,Chronic systolic heart failure,Unspecified pleural effusion,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,Unspecified essential hypertension,Aortocoronary bypass status,Long-term (current) use of aspirin

Pancreat cyst/pseudocyst,Acute kidney failure NOS,Chr systolic hrt failure,Pleural effusion NOS,DMII wo cmp nt st uncntr,Cor ath unsp vsl ntv/gft,Hypertension NOS,Aortocoronary bypass,Long-term use of aspirin

Admission Date: [**2142-9-7**] Discharge Date: [**2142-9-14**] Date of Birth: [**2078-1-27**] Sex: M Service: MEDICINE Allergies: Penicillins / Vancomycin / Levofloxacin / Unasyn / Tigecycline / Meropenem / Metoprolol Attending:[**First Name3 (LF) 1828**] Chief Complaint: Nausea; abdominal pain Major Surgical or Invasive Procedure: none History of Present Illness: 64y/o gentleman with DM, HTN, CAD and recent [**Hospital Unit Name 153**] admission for necrotizing pancreatitis and pseudocyst is now admitted to the [**Hospital Unit Name 153**] for IR-guided drainage of enlarging pseudocyst. He was admitted from [**Date range (1) 79527**] for necrotizing pancreatitis that began in [**2142-4-28**] and was complicated by shock, bacteremia, VAP, hypoxic respiratory failure requiring intubation and eventually tracheostomy. He had been discharged to rehab, and 2 days later his trach was removed and he was breathing fine on RA during the day, 1L NC st night. He [**Year (4 digits) 5058**] on the morning of presentation with nausea and abdominal pain, so he presented to the ED. It is epigastric, moving horizontally but not to the back, and is a deep pain. His pain is very similar to prior pancreatitis pain, but the nausea is new. No vomiting, no fever/chills. In the ED, initial vs were: T 97.1, HR 100, BP 122/62, RR 14, SaO2100%RA By the time of presentation his abdominal pain had subsided, and his exam was benign. He had a mild leukocytosis (11.1) and amylase was 112. His Cr was 1.6 (baseline 1.3) so he was hydrated with 1200cc IVF and Mucomyst (slowly, as patient has history of CHF), then sent for abdomen CT with contrast. This showed enlarging pancreatic pseudocyst, pelvic fluid collection smaller than on previous imaging, new small fluid collection anterior to pancreas as well as new small pseudocyst in pancreatic head. Upon returning from CT, he complained of [**5-7**] abdominal pain and he was given a total of 8mg IV morphine, and Zofran. He is tachycardic, but his blood pressures have been stable and he has no fever. Surgery is aware of the patient; they feel that there is no need for surgical intervention at this time. He is being admitted to the [**Hospital Unit Name 153**] with plans for IR drainage of the pseudocyst. On the floor, the patient is without complaints. He has no abdominal pain. Not nauseous currently, but has no appetite. Does have an itchy rash that he has had since his last hospitalization that has been treated at rehab with antifungal powder and Benadryl. Review of systems: (+) Per HPI (nausea, abdominal pain, rash) (-) Denies fever, chills. Denies cough, shortness of breath, or wheezing. Denies chest pain, chest pressure, palpitations, or weakness. Denies vomiting, diarrhea, constipation, or changes in bowel habits. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Past Medical History: 1. Necrotizing pancreatitis ([**2142-3-29**]) - complicated by Enterococcus bacteremia, septic shock, hypoxic respiratory failure requiring intubation/trach (which was removed at rehab) 2. CABG [**2139**] 3. DM II with neuropathy 4. CHF (EF 35-40% [**8-5**] TTE) 5. Hypertension 6. Hyperlipidemia 7. MSSA epidural abscess s/p laminectomy - [**2133**] Social History: Divorced, retired high school english teacher. Former cigar smoker, [**12-30**] cigars/day, quit 8 years ago. Rare ETOH use, no illicits. Family History: Dad passed away from complications of CAD (MI in 60s) and CHF. Mother had an MI in her 50s. Sister with obesity, DM. Physical Exam: Vitals: T:96.9 BP:119/76 P:102 R: 17 O2:98%2L NC General: Alert, oriented x3, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachycardic, normal S1 and S2, regular, no murmurs Abdomen: obese but nondistended; bowel sounds present; soft; non-tender; tenderness to very deep palpation of epigastrium; no rebound tenderness or guarding Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Skin: rash on back near costal angles bilaterally - raised erythematous plaques with scale and satellite lesions Pertinent Results: [**2142-9-7**] 01:40PM WBC-11.1* RBC-4.02*# HGB-11.7*# HCT-34.9*# MCV-87 MCH-29.0 MCHC-33.4 RDW-17.7* [**2142-9-7**] 01:40PM NEUTS-82.9* LYMPHS-11.5* MONOS-3.7 EOS-1.4 BASOS-0.5 [**2142-9-7**] 01:40PM PLT COUNT-372 [**2142-9-7**] 01:40PM PT-13.5* PTT-22.8 INR(PT)-1.2* [**2142-9-7**] 01:40PM ALT(SGPT)-13 AST(SGOT)-14 ALK PHOS-74 AMYLASE-112* TOT BILI-0.4 [**2142-9-7**] 01:40PM LIPASE-40 [**2142-9-7**] 01:40PM GLUCOSE-119* UREA N-39* CREAT-1.6* SODIUM-137 POTASSIUM-3.8 CHLORIDE-94* TOTAL CO2-31 ANION GAP-16 [**2142-9-7**] 01:45PM LACTATE-1.1 [**2142-9-6**] UA - rare bacteria [**2142-9-6**] Urine Cx - pending [**2142-9-7**] CT Abdomen/Pelvis with Contrast: IMPRESSION: 1. The large pancreatic body pseudocyst has continued to enlarge further across multiple prior studies. There is now possibly development of a satellite pseudocyst and/or adjacent small peripancreatic fluid collections as detailed above. 2. There is a relatively eccentric but traumatic wall thickening of the adjoining gastric body, pylorus, and proximal duodenum. This may be reactiv in nature if pancreatic enzymes continue to leach or also may represent a coincident gastritis. Correlate clinically. This may account for an acute pain as described. Not mentioned above, there may be a minimal amount of fluid tracking within the gastrohepatic ligament. 3. The relatively wide [**Name (NI) 79528**] pelvic collection previously described has decreased in size from the prior exam. The previously noted pigtail percutaneous drain is no longer present. 4. Persistent right pleural effusion with bibasilar atelectasis. Brief Hospital Course: 1. Pancreatic pseudocyst. CT imaging showed enlarging pancreatic pseudocyst. GI and surgery (Dr. [**Last Name (STitle) **] discussed options for drainage and initially determined that the best course was endoscopic drainage. However, during the hospitalization his pain improved and he remained stable, with no laboratory evidence of worsened pancreatitis. After discussion with patient, it was agreed to postpone the drainage, given risks involved, and reassess in about 1-2 weeks. Outpatient follow-up with CT, followed by appointment in Gastroenterology, was arranged. 2. Acute renal failure. Baseline is 1.3. It was felt that acute renal failure was likely prerenal on admission. He improved to baseline with hyudration. 3. Pleural effusion. Previously attributed to trans-diaphragmatic ascites. Not felt to represent CHF/cardiogenic volume overload. 4. Depression-- contniued on SSRI On [**9-14**] he was deemed appropriate for transfer to a rehab facility and this was arranged. Medications on Admission: -Aspirin 325 mg PO/NG DAILY -Diltiazem 120 mg PO/NG QID -Humalog Sliding Scale & Fixed Dose Lantus -Acetaminophen 325-650 mg PO/NG Q4H:PRN pain -Miconazole Powder 2% 1 Appl TP QID:PRN to folds -Citalopram Hydrobromide 10 mg PO/NG DAILY -Multivitamins W/minerals 1 TAB PO DAILY -Docusate Sodium 100 mg PO BID -Pancrelipase 5000 2 CAP PO TID W/MEALS -Famotidine 20 mg PO/NG Q24H -Heparin 5000 UNIT SC TID Discharge Medications: 1. Diltiazem HCl 120 mg Tablet Sig: One (1) Tablet PO four times a day. 2. Citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 3. Multivitamin,Tx-Minerals Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 5. Lipase-Protease-Amylase 5,000-17,000 -27,000 unit Capsule, Delayed Release(E.C.) Sig: Two (2) Cap PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 6. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 7. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical QID (4 times a day) as needed for itching. 8. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID (4 times a day) as needed for to folds. 9. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 10. insulin per previous regimen Discharge Disposition: Extended Care Facility: Port Health Care Center Discharge Diagnosis: Pancreatic pseudocyst Discharge Condition: Fevers, worsened abdominal pain, nausea/vomiting Discharge Instructions: You were admitted with abdominal pain and found to have an enlarging pseudocyst. Initial plan was to drain this by a percutaneous (needle) procedure, but over the course of hospitalization your pain has improved and you have remained clinically stable, so the decision was made to postpone the procedure and reassess in approximately 10-14 days Followup Instructions: Department: [**Month/Year (2) **] DISEASE When: MONDAY [**2142-9-10**] at 11:00 AM With: [**First Name4 (NamePattern1) 2482**] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 457**] Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Hospital 1422**] Campus: WEST Best Parking: [**Hospital Ward Name **] Garage Department: RADIOLOGY When: FRIDAY [**2142-9-21**] at 10:30 AM With: CAT SCAN [**Telephone/Fax (1) 327**] Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) **] Campus: EAST Best Parking: Main Garage Department: SURGICAL SPECIALTIES When: FRIDAY [**2142-9-21**] at 11:15 AM With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2832**], MD [**Telephone/Fax (1) 1231**] Building: [**Hospital6 29**] [**Location (un) **] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Department: [**Hospital3 249**] When: MONDAY [**2142-9-24**] at 3:25 PM With: [**Doctor First Name **] [**Name6 (MD) 79525**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 250**] Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**] Campus: EAST Best Parking: [**Hospital Ward Name 23**] Garage Will also receive a call from office of Dr. [**First Name (STitle) **] [**Name (STitle) **]/Gastroenterology for follow-up

577,584,428,511,250,414,401,V458,V586

{'Cyst and pseudocyst of pancreas,Acute kidney failure, unspecified,Chronic systolic heart failure,Unspecified pleural effusion,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,Unspecified essential hypertension,Aortocoronary bypass status,Long-term (current) use of aspirin'}

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; abdominal pain PRESENT ILLNESS: 64y/o gentleman with DM, HTN, CAD and recent [**Hospital Unit Name 153**] admission for necrotizing pancreatitis and pseudocyst is now admitted to the [**Hospital Unit Name 153**] for IR-guided drainage of enlarging pseudocyst. MEDICAL HISTORY: 1. Necrotizing pancreatitis ([**2142-3-29**]) - complicated by Enterococcus bacteremia, septic shock, hypoxic respiratory failure requiring intubation/trach (which was removed at rehab) 2. CABG [**2139**] 3. DM II with neuropathy 4. CHF (EF 35-40% [**8-5**] TTE) 5. Hypertension 6. Hyperlipidemia 7. MSSA epidural abscess s/p laminectomy - [**2133**] MEDICATION ON ADMISSION: -Aspirin 325 mg PO/NG DAILY -Diltiazem 120 mg PO/NG QID -Humalog Sliding Scale & Fixed Dose Lantus -Acetaminophen 325-650 mg PO/NG Q4H:PRN pain -Miconazole Powder 2% 1 Appl TP QID:PRN to folds -Citalopram Hydrobromide 10 mg PO/NG DAILY -Multivitamins W/minerals 1 TAB PO DAILY -Docusate Sodium 100 mg PO BID -Pancrelipase 5000 2 CAP PO TID W/MEALS -Famotidine 20 mg PO/NG Q24H -Heparin 5000 UNIT SC TID ALLERGIES: Penicillins / Vancomycin / Levofloxacin / Unasyn / Tigecycline / Meropenem / Metoprolol PHYSICAL EXAM: Vitals: T:96.9 BP:119/76 P:102 R: 17 O2:98%2L NC General: Alert, oriented x3, no acute distress HEENT: Sclera anicteric, MMM, oropharynx clear Neck: supple, JVP not elevated, no LAD Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi CV: Tachycardic, normal S1 and S2, regular, no murmurs Abdomen: obese but nondistended; bowel sounds present; soft; non-tender; tenderness to very deep palpation of epigastrium; no rebound tenderness or guarding Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema Skin: rash on back near costal angles bilaterally - raised erythematous plaques with scale and satellite lesions FAMILY HISTORY: Dad passed away from complications of CAD (MI in 60s) and CHF. Mother had an MI in her 50s. Sister with obesity, DM. SOCIAL HISTORY: Divorced, retired high school english teacher. Former cigar smoker, [**12-30**] cigars/day, quit 8 years ago. Rare ETOH use, no illicits. ### Response: {'Cyst and pseudocyst of pancreas,Acute kidney failure, unspecified,Chronic systolic heart failure,Unspecified pleural effusion,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,Unspecified essential hypertension,Aortocoronary bypass status,Long-term (current) use of aspirin'}

CHIEF COMPLAINT: PRESENT ILLNESS: On [**2136-5-29**] the patient presented to the hospital with a small bowel obstruction. This patient is a 76-year-old man who had a prior partial colectomy with an ileostomy who presented to [**Hospital1 346**] with a parastomal hernia. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY:

Other colostomy and enterostomy complication,Unspecified intestinal obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Personal history of malignant neoplasm of large intestine,Attention to ileostomy,Peritoneal adhesions (postoperative) (postinfection),Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation

Colstmy/enteros comp NEC,Intestinal obstruct NOS,Accidental op laceration,Hx of colonic malignancy,Atten to ileostomy,Peritoneal adhesions,Abn reac-organ rem NEC

Admission Date: [**2136-5-28**] Discharge Date: [**2136-6-19**] Date of Birth: [**2058-8-29**] Sex: M Service: Blue Surgery. HISTORY OF PRESENT ILLNESS: On [**2136-5-29**] the patient presented to the hospital with a small bowel obstruction. This patient is a 76-year-old man who had a prior partial colectomy with an ileostomy who presented to [**Hospital1 346**] with a parastomal hernia. HOSPITAL COURSE: The patient's physical examination on admission was notable that he was afebrile and also hypotensive with a blood pressure 190/100, a distended abdomen, which was diffusely tender to palpation. An incarcerated, parastomal hernia was identified in the right lower quadrant. It was decided that the patient was going to go to the operating room for repair of this hernia. The patient was taken to the operating room and repair of the parastomal hernia was performed. The ileostomy that he had prior had was taken down and a new ileostomy was created. Intraoperatively, the patient also had a PA catheter placed. A peritoneal culture at this time subsequently revealed [**Female First Name (un) 564**] albicans and Clostridium perfringens and other gastrointestinal flora. The patient was sent to the surgical ICU after the surgery, where he was given multiple fluid boluses and had a difficult time keeping up his blood pressures and his urine output. He was intubated this entire time as well. He also, unfortunately suffered from tachycardia and a number of high spiking fevers and a CT scan on [**6-2**] revealed no leak. On [**6-4**], the patient underwent a second operation because of his recurrent tachycardia and spiking fevers. During this operation, it was noted that the patient had a small bowel enterotomy, basically a hole in the small bowel right close to the previous anastomotic site. Please refer the OP note from [**2136-6-4**] for a further description of the discovery. This enterotomy was repaired and afterwards the patient was sent back to the intensive care unit. The patient was intubated after the surgery and remained intubated in the intensive care unit for the next eight days. During this time it was noted he had several fevers and during one fever he was cultured and had a positive sputum culture for methicillin resistant Staphylococcus aureus. He continued to improve in the intensive care unit and on [**6-13**] he was transferred to the floor from the intensive care unit. A swallowing study before he left the SICU showed a normal swallowing ability. The recommendations said that he was able to be advanced to a regular diet. While on the floor, the patient was slowly weaned off his total parenteral nutrition and advanced slowly to a regular diet. As of now, he is tolerating a regular diet and has been weaned off of his parenteral nutrition. He is also able to ambulate with assistance from his family members, although physical therapy has recommended that the patient should remain at a rehab facility. The patient and his family adamantly refuse this option and would much prefer to have him return home. As a result, he is being discharged home with services on [**2136-6-18**]. In addition, the [**Hospital 228**] hospital course is significant for the placement of a vacuum assisted closure device to help with granulation of the previous ostomy site. He will go home on this vacuum drainage and have services assist with his management. His condition on discharge is good. The patient's diagnoses while admitted on this admission are: 1. A parastomal hernia, status post exploratory laparotomy with a parastomal hernia repair and creation of a new ileostomy. 2. He was intubated. 3. Enterostomy closure. 4. Methicillin resistant Staphylococcus aureus sputum infection. 5. Hypertension. 6. Diabetes mellitus. 7. Vacuum drain placement. DISCHARGE MEDICATIONS: Percocet, metoprolol 150 mg twice a day, Protonix 40 mg once a day, insulin, Avandia 4 mg once a day. The insulin is NPH 2 x a day and sliding scale. Combivent as needed and Metamucil 2 packets 3 x a day. FOLLOWUP: The patient's followup plans are to arrange to contact Dr.[**Name (NI) 22019**] office to arrange an appointment in one to two weeks. He is also expected to have visiting nursing assistance come and maintain the drain and assist with his activities of daily living. [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D. [**MD Number(1) 845**] Dictated By:[**First Name3 (LF) 33295**] MEDQUIST36 D: [**2136-6-18**] 15:10 T: [**2136-6-24**] 19:44 JOB#: [**Job Number 33296**]

569,560,998,V100,V552,568,E878

{'Other colostomy and enterostomy complication,Unspecified intestinal obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Personal history of malignant neoplasm of large intestine,Attention to ileostomy,Peritoneal adhesions (postoperative) (postinfection),Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT. ### Clinical text : CHIEF COMPLAINT: PRESENT ILLNESS: On [**2136-5-29**] the patient presented to the hospital with a small bowel obstruction. This patient is a 76-year-old man who had a prior partial colectomy with an ileostomy who presented to [**Hospital1 346**] with a parastomal hernia. MEDICAL HISTORY: MEDICATION ON ADMISSION: ALLERGIES: PHYSICAL EXAM: FAMILY HISTORY: SOCIAL HISTORY: ### Response: {'Other colostomy and enterostomy complication,Unspecified intestinal obstruction,Accidental puncture or laceration during a procedure, not elsewhere classified,Personal history of malignant neoplasm of large intestine,Attention to ileostomy,Peritoneal adhesions (postoperative) (postinfection),Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}

CHIEF COMPLAINT: acute kidney injury PRESENT ILLNESS: Mr. [**Known lastname **] is a 49 y.o. M with Hep C cirrhosis who presents for acute renal failure. He had a recent hospitalization at [**Hospital1 18**] [**Date range (1) 80556**] for renal failure with creatinine of 3.0 on admission and urine Na<10. Felt to be due to hepatorenal syndrome due to failed response to fluid challenge. His diuretics were held and he was treated with octreotide, midodrine, and albumin. His creatinine improved to 1.5 upon discharge. . He was seen last week by Dr. [**Name (NI) **] and noted to have increased creatinine to 2.7, as well as new cough with green mucus and hemoptysis (clots). CXR was normal and he was given azithromycin. His sx persisted, so he was seen by his VA provider yesterday, who rx'd him doxycycline. He also had labs redone this week in [**Location (un) 5583**] that showed further increase in creatinine (value not available at this time), which prompted him to be directly admitted from home. . On the floor, he notes increased abd soreness from baseline x1 week, worse with deep breath, although not as severe as his prior SBP. Also notes increased dyspnea from baseline, that he associates with concurrent abd pain. Has has had poor PO intake over the past week. Also notes intermittent sore throat, chronic nausea, chronic diarrhea from lactulose. He denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, chest pain, vomiting, BRBPR, melena, hematochezia, dysuria, hematuria. MEDICAL HISTORY: HCV Cirrhosis, genotype 1 (with 3.9 x 2.7 mass in the segment VI of the liver could be perfusion abnormality versus a hepatoma seen on [**2185**]) SBP [**6-15**], currently on norfloxacin prophylaxis Esophageal Varicies (distal) [**12-9**]+ noted [**1-15**] endoscopy at OSH Depression/Anxiety Hypertension h/o infectious colitis [**8-/2184**] to [**12/2184**] Nephrolithiasis - prior lithiotripsy MEDICATION ON ADMISSION: Lactulose 30 mL po QID Midodrine 5 mg po TID Nadolol 10 mg po daily (held per Dr. [**Name (STitle) 23173**]) Norfloxacin 400 mg po daily Phytonadione 5 mg po daily Potassium Chloride SR 20 meq po daily Sertraline 50 mg po daily Doxycycline 100mg daily x10 days (started [**10-12**]) Motrin prn Benadryl prn ALLERGIES: Latex PHYSICAL EXAM: Vitals - T: 97.3 BP: 124/71 HR: 73 RR: 16 02 sat: 95RA UOP 1090 FAMILY HISTORY: He has one brother who has genetic hemochromatosis. He has one sister with thyroid disease and diabetes, and a second sister who has cholesterolemia and hypertension. Both of his parents have had coronary artery disease. His mother succumbed to complications of her coronary artery disease. SOCIAL HISTORY: His HCV thought to be [**1-9**] to occupational exposure, patient used to work as dialysis nurse and had a needle stick. Past alcohol use described as occasional wine/cocktail, has not drunk since [**2175**]. He is an ex-cigarette smoker for the last eight years, but prior to this has a 20-pack year history. Denies any illicit drug use, marijuana, intravenous drug use, tattoos, or body piercing. He is married with two children.

Hepatorenal syndrome,Acute kidney failure, unspecified,Unspecified viral hepatitis C with hepatic coma,Urinary tract infection, site not specified,Esophageal varices without mention of bleeding,Other ascites,Hemorrhage complicating a procedure,Unspecified transient mental disorder in conditions classified elsewhere,Cirrhosis of liver without mention of alcohol,Bronchitis, not specified as acute or chronic,Thrombocytopenia, unspecified,Failure in suture and ligature during surgical operation,Unspecified essential hypertension,Anemia of other chronic disease,Dysthymic disorder,Personal history of tobacco use

Hepatorenal syndrome,Acute kidney failure NOS,Hpt C w hepatic coma NOS,Urin tract infection NOS,Esoph varices w/o bleed,Ascites NEC,Hemorrhage complic proc,Transient mental dis NOS,Cirrhosis of liver NOS,Bronchitis NOS,Thrombocytopenia NOS,Failure in suture,Hypertension NOS,Anemia-other chronic dis,Dysthymic disorder,History of tobacco use

Admission Date: [**2186-10-13**] Discharge Date: [**2186-11-10**] Date of Birth: [**2137-2-18**] Sex: M Service: SURGERY Allergies: Latex Attending:[**First Name3 (LF) 668**] Chief Complaint: acute kidney injury Major Surgical or Invasive Procedure: [**2186-11-4**]: orthotopic liver transplant History of Present Illness: Mr. [**Known lastname **] is a 49 y.o. M with Hep C cirrhosis who presents for acute renal failure. He had a recent hospitalization at [**Hospital1 18**] [**Date range (1) 80556**] for renal failure with creatinine of 3.0 on admission and urine Na<10. Felt to be due to hepatorenal syndrome due to failed response to fluid challenge. His diuretics were held and he was treated with octreotide, midodrine, and albumin. His creatinine improved to 1.5 upon discharge. . He was seen last week by Dr. [**Name (NI) **] and noted to have increased creatinine to 2.7, as well as new cough with green mucus and hemoptysis (clots). CXR was normal and he was given azithromycin. His sx persisted, so he was seen by his VA provider yesterday, who rx'd him doxycycline. He also had labs redone this week in [**Location (un) 5583**] that showed further increase in creatinine (value not available at this time), which prompted him to be directly admitted from home. . On the floor, he notes increased abd soreness from baseline x1 week, worse with deep breath, although not as severe as his prior SBP. Also notes increased dyspnea from baseline, that he associates with concurrent abd pain. Has has had poor PO intake over the past week. Also notes intermittent sore throat, chronic nausea, chronic diarrhea from lactulose. He denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, chest pain, vomiting, BRBPR, melena, hematochezia, dysuria, hematuria. Past Medical History: HCV Cirrhosis, genotype 1 (with 3.9 x 2.7 mass in the segment VI of the liver could be perfusion abnormality versus a hepatoma seen on [**2185**]) SBP [**6-15**], currently on norfloxacin prophylaxis Esophageal Varicies (distal) [**12-9**]+ noted [**1-15**] endoscopy at OSH Depression/Anxiety Hypertension h/o infectious colitis [**8-/2184**] to [**12/2184**] Nephrolithiasis - prior lithiotripsy Social History: His HCV thought to be [**1-9**] to occupational exposure, patient used to work as dialysis nurse and had a needle stick. Past alcohol use described as occasional wine/cocktail, has not drunk since [**2175**]. He is an ex-cigarette smoker for the last eight years, but prior to this has a 20-pack year history. Denies any illicit drug use, marijuana, intravenous drug use, tattoos, or body piercing. He is married with two children. Family History: He has one brother who has genetic hemochromatosis. He has one sister with thyroid disease and diabetes, and a second sister who has cholesterolemia and hypertension. Both of his parents have had coronary artery disease. His mother succumbed to complications of her coronary artery disease. Physical Exam: Vitals - T: 97.3 BP: 124/71 HR: 73 RR: 16 02 sat: 95RA UOP 1090 GENERAL: Well appearing, NAD HEENT: No icterus, MM dry, neck supple CARDIAC: RRR no m/r/g LUNG: CTAB, except slight crackles at right base ABDOMEN: Soft, distended with ascites. Nontender. +fluid wave. No organomegaly. NABS. EXT: 1+ ankle edema. WWP. NEURO: A+Ox3. CN 2-12 grossly intact. No asterixis. Pertinent Results: On Admission: [**2186-10-14**] WBC-5.3# RBC-2.51* Hgb-8.5* Hct-25.0* MCV-100* MCH-33.8* MCHC-33.9 RDW-17.6* Plt Ct-59* PT-21.4* PTT-59.4* INR(PT)-2.0* Glucose-86 UreaN-46* Creat-3.5* Na-135 K-4.2 Cl-112* HCO3-17* AnGap-10 ALT-33 AST-55* LD(LDH)-174 AlkPhos-93 TotBili-3.9* Albumin-2.1* Calcium-8.0* Phos-3.8 Mg-2.3 On Discharge: [**2186-11-10**] WBC-4.3 RBC-3.19* Hgb-10.0* Hct-27.4* MCV-86 MCH-31.3 MCHC-36.4* RDW-17.5* Plt Ct-38* PT-12.7 PTT-26.4 INR(PT)-1.1 Glucose-84 UreaN-59* Creat-2.1* Na-137 K-3.1* Cl-103 HCO3-26 AnGap-11 ALT-63* AST-31 AlkPhos-32* TotBili-1.2 Albumin-3.4 Calcium-8.7 Phos-3.8 Mg-1.8 tacroFK-4.8* Brief Hospital Course: [**Last Name (un) **]: Creatinine decreased to 2.4. Upon discharge in [**8-16**], was 1.5. Urine Na was less than 10 now 17. Concerning for HRS physiology. s/p blood transfusion. Currently on daily midodrine and octreotide. Anti-GBM negative. Good UOP and high blood pressures. He was diagnosed with a UTI pre surgery. The UA is consistent with infection. Treated with CTX. Received a seven day course . Confusion: This is new as of [**2186-10-31**]. Concern for encephalopathy and asterixis. He was placed on lactulose and rifaxamin until the time of the liver transplant. . HCV Cirrhosis: MELD on admission was 36. H/o decompensation with SBP, encephalopathy, varices, ascites and thrombocytopenia. Para negative for SBP this admission. The patient stayed hospitalized until the time of his liver transplant due to his decompensation. On [**2186-11-4**] the patient received and orthotopic liver transplant. He was taken to the OR with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. He received routine induction immunosuppresion to include cellcept, solumedrol with taper and prograf which was started on the evening of POD 0. The surgery went well with the only issue recorded as the bile ducts were taken down and re-anastomosed due to evidence of a bile leak. In the post op period the drain output was minimal and the lateral drain was d/c'd prior to discharge. His LFTs never really were elevated and his creatinine came down to 2.1 by day of discharge and his urine output was excellent between one and two liters. POD 1 ultrasound was WNL His prograf was dose adjusted daily based on trough levels. The level was initially high in the mid teens. Labs will be recehecked Monday [**11-13**]. He was ambulating without difficulty although he had c/o pitting leg edema for which he received IV lasix with good response. He will go home on 20 PO daily x three days with re-assessment in clinic of his fluid status. Patient was reminded to only use the lasix for the three days to avoid dehydration. He was tolerating diet and using supplements PRN. He was not sent on insulin as blood sugars were never elevated and fasting levels were excellent. Medications on Admission: Lactulose 30 mL po QID Midodrine 5 mg po TID Nadolol 10 mg po daily (held per Dr. [**Name (STitle) 23173**]) Norfloxacin 400 mg po daily Phytonadione 5 mg po daily Potassium Chloride SR 20 meq po daily Sertraline 50 mg po daily Doxycycline 100mg daily x10 days (started [**10-12**]) Motrin prn Benadryl prn Discharge Medications: 1. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours). 2. Prednisone 5 mg Tablet Sig: Four (4) Tablet PO once a day: Follow transplant clinic taper. 3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 7. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 9. Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. Valganciclovir 450 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. Tacrolimus 1 mg Capsule Sig: Three (3) Capsule PO twice a day. 12. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 3 days. Disp:*3 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: [**Hospital1 **] VNA & Hospice Services Discharge Diagnosis: s/p liver transplant Hepatorenal syndrome with acute kidney failure: resolved Discharge Condition: Stable Ambulatory A+Ox3 Discharge Instructions: Please call the transplant clinic at [**Telephone/Fax (1) 673**] for fever, chills, nausea, vomiting, diarrhea, constipation, increased abdominal pain, yellowing of skin or eyes, or other concerning symptoms. Drain and record JP bulb output three times daily and more often as necessary. Bring copy of record with you to transplant clinic appointments. Place a new drain sponge around the drain site daily and as needed. Please call the transplant clinic if the drain output increases significantly, turns bloody, green or develops a foul odor. Drink enough fluids to keep your urine light yellow in color Monitor the incision for redness, drainage or bleeding. [**Month (only) 116**] leave the incision open to air. You may shower. Pat incision dry and place a new drain sponge daily No heavy lifting No driving if taking narcotic pain medication. Driving should only be resumed with your surgeons permission Labs every Monday and Thursday at [**Hospital **] Medical Office Building Lab Followup Instructions: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2186-11-17**] 1:50 [**Last Name (LF) **],[**First Name3 (LF) 156**] TRANSPLANT SOCIAL WORK Date/Time:[**2186-11-17**] 2:30 [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1330**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2186-11-24**] 12:50 Completed by:[**2186-11-10**]

572,584,070,599,456,789,998,293,571,490,287,E876,401,285,300,V158

{'Hepatorenal syndrome,Acute kidney failure, unspecified,Unspecified viral hepatitis C with hepatic coma,Urinary tract infection, site not specified,Esophageal varices without mention of bleeding,Other ascites,Hemorrhage complicating a procedure,Unspecified transient mental disorder in conditions classified elsewhere,Cirrhosis of liver without mention of alcohol,Bronchitis, not specified as acute or chronic,Thrombocytopenia, unspecified,Failure in suture and ligature during surgical operation,Unspecified essential hypertension,Anemia of other chronic disease,Dysthymic disorder,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: acute kidney injury PRESENT ILLNESS: Mr. [**Known lastname **] is a 49 y.o. M with Hep C cirrhosis who presents for acute renal failure. He had a recent hospitalization at [**Hospital1 18**] [**Date range (1) 80556**] for renal failure with creatinine of 3.0 on admission and urine Na<10. Felt to be due to hepatorenal syndrome due to failed response to fluid challenge. His diuretics were held and he was treated with octreotide, midodrine, and albumin. His creatinine improved to 1.5 upon discharge. . He was seen last week by Dr. [**Name (NI) **] and noted to have increased creatinine to 2.7, as well as new cough with green mucus and hemoptysis (clots). CXR was normal and he was given azithromycin. His sx persisted, so he was seen by his VA provider yesterday, who rx'd him doxycycline. He also had labs redone this week in [**Location (un) 5583**] that showed further increase in creatinine (value not available at this time), which prompted him to be directly admitted from home. . On the floor, he notes increased abd soreness from baseline x1 week, worse with deep breath, although not as severe as his prior SBP. Also notes increased dyspnea from baseline, that he associates with concurrent abd pain. Has has had poor PO intake over the past week. Also notes intermittent sore throat, chronic nausea, chronic diarrhea from lactulose. He denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, chest pain, vomiting, BRBPR, melena, hematochezia, dysuria, hematuria. MEDICAL HISTORY: HCV Cirrhosis, genotype 1 (with 3.9 x 2.7 mass in the segment VI of the liver could be perfusion abnormality versus a hepatoma seen on [**2185**]) SBP [**6-15**], currently on norfloxacin prophylaxis Esophageal Varicies (distal) [**12-9**]+ noted [**1-15**] endoscopy at OSH Depression/Anxiety Hypertension h/o infectious colitis [**8-/2184**] to [**12/2184**] Nephrolithiasis - prior lithiotripsy MEDICATION ON ADMISSION: Lactulose 30 mL po QID Midodrine 5 mg po TID Nadolol 10 mg po daily (held per Dr. [**Name (STitle) 23173**]) Norfloxacin 400 mg po daily Phytonadione 5 mg po daily Potassium Chloride SR 20 meq po daily Sertraline 50 mg po daily Doxycycline 100mg daily x10 days (started [**10-12**]) Motrin prn Benadryl prn ALLERGIES: Latex PHYSICAL EXAM: Vitals - T: 97.3 BP: 124/71 HR: 73 RR: 16 02 sat: 95RA UOP 1090 FAMILY HISTORY: He has one brother who has genetic hemochromatosis. He has one sister with thyroid disease and diabetes, and a second sister who has cholesterolemia and hypertension. Both of his parents have had coronary artery disease. His mother succumbed to complications of her coronary artery disease. SOCIAL HISTORY: His HCV thought to be [**1-9**] to occupational exposure, patient used to work as dialysis nurse and had a needle stick. Past alcohol use described as occasional wine/cocktail, has not drunk since [**2175**]. He is an ex-cigarette smoker for the last eight years, but prior to this has a 20-pack year history. Denies any illicit drug use, marijuana, intravenous drug use, tattoos, or body piercing. He is married with two children. ### Response: {'Hepatorenal syndrome,Acute kidney failure, unspecified,Unspecified viral hepatitis C with hepatic coma,Urinary tract infection, site not specified,Esophageal varices without mention of bleeding,Other ascites,Hemorrhage complicating a procedure,Unspecified transient mental disorder in conditions classified elsewhere,Cirrhosis of liver without mention of alcohol,Bronchitis, not specified as acute or chronic,Thrombocytopenia, unspecified,Failure in suture and ligature during surgical operation,Unspecified essential hypertension,Anemia of other chronic disease,Dysthymic disorder,Personal history of tobacco use'}

CHIEF COMPLAINT: hypotension, sepsis, CRF, obesity-hypoventilation syndrome PRESENT ILLNESS: 39 year old man with Prader-Willi syndrome, morbid obesity, obesity hypoventillation (vent. dependent), Renal failure on HD, who was rectently admitted to ICU here with sepsis s/p abdominal abscess debridement ([**Date range (1) 99960**]) and discharged to rehab at the [**Hospital1 **] House - was found to be hypotense at HD today (sbp 55 - came up to 100/40 after HD stopped after 30 min), also noted to have hct. 22. Sent to [**Hospital1 18**] ED. . MEDICAL HISTORY: Prader Willi Syndrome Morbid obesity T2DM CRI with baseline creatinine 1.8-2.0 OSA Mental retardation Hypothyroidism Status post tracheostomy and PEG tube placement MEDICATION ON ADMISSION: Bupropion 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Ascorbic Acid 90 mg/mL Drops Sig: One (1) PO DAILY (Daily). 3. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Four ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS:98.6 86 116/doppler 12 96% (on FiO2 .4 on CMV on vent) HEENT: EOMI, PERRL COR: RRR, [**3-7**] HSM PULM: CTA anteriorly ABD:obese, foley in place as G tube with tube feeds leaking around ostomy, LLQ abscess drainage site with Wet-dry dsg in place. LLQ indurated, erythematous EXT:RLE edema greater than Lt LE, bilateral heel pressure ulceration NEURO:Opens eyes to voice, tracks, nods yes/no in response to questions . FAMILY HISTORY: Family history of diabetes. SOCIAL HISTORY: Resident at [**Hospital 100**] Rehab. No smoking, ethanol or drug use.

Other septicemia due to gram-negative organisms,Chronic respiratory failure,End stage renal disease,Other gastrostomy complications,Cellulitis and abscess of trunk,Pressure ulcer, heel,Hypovolemia,Prader-Willi syndrome,Anemia in chronic kidney disease,Hypotension of hemodialysis,Attention to tracheostomy,Morbid obesity,Unspecified intellectual disabilities,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Severe sepsis

Gram-neg septicemia NEC,Chronic respiratory fail,End stage renal disease,Gastrostomy comp NEC,Cellulitis of trunk,Pressure ulcer, heel,Hypovolemia,Prader-willi syndrome,Anemia in chr kidney dis,Hemododialysis hypotensn,Atten to tracheostomy,Morbid obesity,Intellect disability NOS,DMII wo cmp nt st uncntr,Hypothyroidism NOS,Obstructive sleep apnea,Severe sepsis

Admission Date: [**2185-9-23**] Discharge Date: [**2185-10-5**] Date of Birth: [**2145-10-22**] Sex: M Service: MEDICINE Allergies: Patient recorded as having No Known Allergies to Drugs Attending:[**First Name3 (LF) 2297**] Chief Complaint: hypotension, sepsis, CRF, obesity-hypoventilation syndrome Major Surgical or Invasive Procedure: debridement of abdominal surgical wound History of Present Illness: 39 year old man with Prader-Willi syndrome, morbid obesity, obesity hypoventillation (vent. dependent), Renal failure on HD, who was rectently admitted to ICU here with sepsis s/p abdominal abscess debridement ([**Date range (1) 99960**]) and discharged to rehab at the [**Hospital1 **] House - was found to be hypotense at HD today (sbp 55 - came up to 100/40 after HD stopped after 30 min), also noted to have hct. 22. Sent to [**Hospital1 18**] ED. . Past Medical History: Prader Willi Syndrome Morbid obesity T2DM CRI with baseline creatinine 1.8-2.0 OSA Mental retardation Hypothyroidism Status post tracheostomy and PEG tube placement Social History: Resident at [**Hospital 100**] Rehab. No smoking, ethanol or drug use. Family History: Family history of diabetes. Physical Exam: VS:98.6 86 116/doppler 12 96% (on FiO2 .4 on CMV on vent) HEENT: EOMI, PERRL COR: RRR, [**3-7**] HSM PULM: CTA anteriorly ABD:obese, foley in place as G tube with tube feeds leaking around ostomy, LLQ abscess drainage site with Wet-dry dsg in place. LLQ indurated, erythematous EXT:RLE edema greater than Lt LE, bilateral heel pressure ulceration NEURO:Opens eyes to voice, tracks, nods yes/no in response to questions . Pertinent Results: [**2185-9-23**] 05:09PM HCT-23.3* [**2185-9-23**] 12:48PM WBC-15.8* RBC-2.67* HGB-7.2* HCT-23.8* MCV-89 MCH-27.0 MCHC-30.2* RDW-22.6* [**2185-9-23**] 12:48PM PLT COUNT-265 [**2185-9-23**] 02:30AM GLUCOSE-96 LACTATE-1.7 NA+-143 K+-4.6 CL--105 TCO2-31* [**2185-9-23**] 02:10AM GLUCOSE-95 UREA N-46* CREAT-3.8*# SODIUM-141 POTASSIUM-4.5 CHLORIDE-103 TOTAL CO2-28 ANION GAP-15 [**2185-9-23**] 02:10AM ALT(SGPT)-22 AST(SGOT)-24 ALK PHOS-462* AMYLASE-13 TOT BILI-0.5 [**2185-9-23**] 02:10AM LIPASE-11 [**2185-9-23**] 02:10AM CALCIUM-8.5 PHOSPHATE-2.5* MAGNESIUM-1.8 [**2185-9-23**] 02:10AM WBC-14.1* RBC-2.21* HGB-6.1* HCT-20.3* MCV-92 MCH-27.8 MCHC-30.2* RDW-23.2* [**2185-9-23**] 02:10AM NEUTS-90.1* BANDS-0 LYMPHS-7.3* MONOS-1.2* EOS-1.3 BASOS-0.1 [**2185-9-23**] 02:10AM HYPOCHROM-1+ ANISOCYT-2+ POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-1+ SPHEROCYT-OCCASIONAL [**2185-9-23**] 02:10AM PLT SMR-NORMAL PLT COUNT-261 [**2185-9-23**] 02:10AM PT-15.4* PTT-34.0 INR(PT)-1.4* Brief Hospital Course: 39 y/o with Prader-Willi, morbid obesity, obesity-hypoventilation syndrome (vent dependent), CKD on HD who was found to be hypotense and anemic at HD. The hospital course consisted of chronic hypotension, bacteremia, worsening abdominal abscess, and HD that could not take off fluid. His sister [**Name (NI) 2431**] was involved in his care and health care decision making daily (she is the HCP). After long discussions with family and consulting doctors, [**Doctor First Name 2431**] wished to take him home with hospice care to die at home. HD and all invasive procedures were held in hospital and antibiotics were continued until the day of discharge. [**Doctor First Name 2431**] came in and assisted with [**Known firstname 2979**] care in preparation to care for him at home. Supplies and hospice services were established and in place for the day of discharge. Dr.[**Name (NI) 20819**] (PCP) was called and aksed for an order for Hospice care DNR/DNI/DNH. Medications on Admission: Bupropion 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Ascorbic Acid 90 mg/mL Drops Sig: One (1) PO DAILY (Daily). 3. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Four (4) Puff Inhalation Q6H (every 6 hours). 4. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H as needed. 5. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID as needed. 6. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One (1) PO DAILY 7. Epoetin Alfa 4,000 unit/mL Solution Sig: One (1) Injection QMOWEFR 8. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap PO DAILY 9. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY 10. Insulin Glargine 100 unit/mL Solution Sig: One (1) 60 units Subcutaneous q breakfast. 11. Insulin Regular Human 100 unit/mL Solution Sig: One (1) Injection q ACHS: Please administer insulin according to the following sliding scale. If BG 141-200, please give 8 units. If BG 201-240, give 12 units. If BG 241-280, give 16 units. If BG 281-320, give 20 units. If BG 321-360, give 24 units. If BG 361-400, give 28 units. 12. Levothyroxine 100 mcg Tablet Sig: Three (3) Tablet PO DAILY Discharge Medications: 1. Hydromorphone 2 mg/mL Syringe Sig: 1-2 mg Injection Q6H (every 6 hours) as needed for pain. 2. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**5-5**] Puffs Inhalation Q6H (every 6 hours). 3. Roxanol Concentrate 20 mg/mL Solution Sig: [**1-31**] PO every four (4) hours as needed for pain for 10 days. 4. Ventilator Set Misc Sig: One (1) Miscell. once a day. 5. Oxygen-Air Delivery Systems Device Sig: One (1) Miscell. continuous. 6. Oxygen Tubing Misc Sig: One (1) Miscell. continuous. Discharge Disposition: Home With Service Facility: Vista Care Hospice Discharge Diagnosis: 1. prader willi 2. Anemia 3. obesity hypoventilation syndrome ventilator dependent 4. bacteremia 5. abdominal abscess 6. chronic renal failure Discharge Condition: comfort measures only Discharge Instructions: Follow the suggestions and care of Hospice nurses and doctors. Followup Instructions: Please follow up with your physician as needed

038,518,585,536,682,707,276,759,285,458,V550,278,319,250,244,327,995

{'Other septicemia due to gram-negative organisms,Chronic respiratory failure,End stage renal disease,Other gastrostomy complications,Cellulitis and abscess of trunk,Pressure ulcer, heel,Hypovolemia,Prader-Willi syndrome,Anemia in chronic kidney disease,Hypotension of hemodialysis,Attention to tracheostomy,Morbid obesity,Unspecified intellectual disabilities,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Severe sepsis'}

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, sepsis, CRF, obesity-hypoventilation syndrome PRESENT ILLNESS: 39 year old man with Prader-Willi syndrome, morbid obesity, obesity hypoventillation (vent. dependent), Renal failure on HD, who was rectently admitted to ICU here with sepsis s/p abdominal abscess debridement ([**Date range (1) 99960**]) and discharged to rehab at the [**Hospital1 **] House - was found to be hypotense at HD today (sbp 55 - came up to 100/40 after HD stopped after 30 min), also noted to have hct. 22. Sent to [**Hospital1 18**] ED. . MEDICAL HISTORY: Prader Willi Syndrome Morbid obesity T2DM CRI with baseline creatinine 1.8-2.0 OSA Mental retardation Hypothyroidism Status post tracheostomy and PEG tube placement MEDICATION ON ADMISSION: Bupropion 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Ascorbic Acid 90 mg/mL Drops Sig: One (1) PO DAILY (Daily). 3. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Four ALLERGIES: Patient recorded as having No Known Allergies to Drugs PHYSICAL EXAM: VS:98.6 86 116/doppler 12 96% (on FiO2 .4 on CMV on vent) HEENT: EOMI, PERRL COR: RRR, [**3-7**] HSM PULM: CTA anteriorly ABD:obese, foley in place as G tube with tube feeds leaking around ostomy, LLQ abscess drainage site with Wet-dry dsg in place. LLQ indurated, erythematous EXT:RLE edema greater than Lt LE, bilateral heel pressure ulceration NEURO:Opens eyes to voice, tracks, nods yes/no in response to questions . FAMILY HISTORY: Family history of diabetes. SOCIAL HISTORY: Resident at [**Hospital 100**] Rehab. No smoking, ethanol or drug use. ### Response: {'Other septicemia due to gram-negative organisms,Chronic respiratory failure,End stage renal disease,Other gastrostomy complications,Cellulitis and abscess of trunk,Pressure ulcer, heel,Hypovolemia,Prader-Willi syndrome,Anemia in chronic kidney disease,Hypotension of hemodialysis,Attention to tracheostomy,Morbid obesity,Unspecified intellectual disabilities,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Severe sepsis'}