CHIEF COMPLAINT: Bilateral Pulmonary nodules

PRESENT ILLNESS: 65-year-old woman referred to the thoracic multidisciplinary
clinic by Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 3274**]. Ms. [**Known lastname 104221**] recently completed a
course of chemotherapy and XRT for a small cell lung cancer,
which was in
the right lung. This was treated as a limited stage small cell
lung cancer, with recognition that there were several other
lesions bilaterally. Most notably, there were bilateral apical
nodules as well as multiple other smaller nodules noted both
lungs. Since completion of her chemotherapy and radiation 6
weeks ago, Ms. [**Known lastname 104221**] noted that her energy level has been
increasing. She has some hot flashes on occasion, but denies any
fevers or chills. She has an occasional dry cough, which is not
productive of any purulent sputum or hemoptysis. She has been
gaining weight back. She denies any new bony pain. She can walk
up two flights of stairs and has returned to her activity as a
dressmaker.

MEDICAL HISTORY: Bladder cancer, status post partialcystectomy in [**2186**], orally
treated diabetes, hypertension, bilateral lower extremity leg
fractures with extensive reconstruction being done in the left
ankle region, left breast cancer in [**2182**], status post lumpectomy
and axillary lymph node dissection, status post radiation for
this and tamoxifen for 7 years, status post right vocal cord in
situ squamous cell carcinoma and intraepithelial squamous
neoplasia resected in [**2194**] and [**2195**].

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: Well-nourished, well-developed woman, in no apparent
distress.
HEENT: Alopecic. EOMI. PERRL. Sclerae are anicteric. No
facial asymmetry. Tongue is midline. Palate elevates
symmetrically. No oropharynx or nasopharynx mucosal
abnormalities. Trachea is midline.
NECK: Supple, nontender, and without mass. There is no thyroid
enlargement.
LUNGS: Clear to auscultation and percussion bilaterally. There
is no tactile fremitus or egophony. Chest excursion is symmetric

FAMILY HISTORY: No family history of bleeding dyscrasia

SOCIAL HISTORY: The patient owns a dressmaking shop. She has an
approximately 20-25 pack year smoking history, which was
discontinued in [**2196-1-24**].
Hypoxemia,Chronic airway obstruction, not elsewhere classified,Tachypnea,Other diseases of lung, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Personal history of malignant neoplasm of breast
Hypoxemia,Chr airway obstruct NEC,Tachypnea,Other lung disease NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Hx-bronchogenic malignan,Hx of breast malignancy
Admission Date:  [**2196-8-6**]              Discharge Date:   [**2196-8-9**]

Date of Birth:  [**2131-3-18**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Bilateral Pulmonary nodules

Major Surgical or Invasive Procedure:
VATS
Left Upper Lobe [**First Name3 (LF) **] resection
Mediastinal lymph node dissection


History of Present Illness:
65-year-old woman referred to the thoracic multidisciplinary
clinic by Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 3274**]. Ms. [**Known lastname 104221**] recently completed a
course of chemotherapy and XRT for a small cell lung cancer,
which was in
the right lung. This was treated as a limited stage small cell
lung cancer, with recognition that there were several other
lesions bilaterally. Most notably, there were bilateral apical
nodules as well as multiple other smaller nodules noted both
lungs. Since completion of her chemotherapy and radiation 6
weeks ago, Ms. [**Known lastname 104221**] noted that her energy level has been
increasing. She has some hot flashes on occasion, but denies any
fevers or chills. She has an occasional dry cough, which is not
productive of any purulent sputum or hemoptysis. She has been
gaining weight back. She denies any new bony pain. She can walk
up two flights of stairs and has returned to her activity as a
dressmaker.


Past Medical History:
Bladder cancer, status post partialcystectomy in [**2186**], orally
treated diabetes, hypertension, bilateral lower extremity leg
fractures with extensive reconstruction being done in the left
ankle region, left breast cancer in [**2182**], status post lumpectomy
and axillary lymph node dissection, status post radiation for
this and tamoxifen for 7 years, status post right vocal cord in
situ squamous cell carcinoma and intraepithelial squamous
neoplasia resected in [**2194**] and [**2195**].


Social History:
The patient owns a dressmaking shop. She has an
approximately 20-25 pack year smoking history, which was
discontinued in [**2196-1-24**].


Family History:
 No family history of bleeding dyscrasia

Physical Exam:
GENERAL: Well-nourished, well-developed woman, in no apparent
distress.
HEENT: Alopecic. EOMI. PERRL. Sclerae are anicteric. No
facial asymmetry. Tongue is midline. Palate elevates
symmetrically. No oropharynx or nasopharynx mucosal
abnormalities. Trachea is midline.
NECK: Supple, nontender, and without mass. There is no thyroid
enlargement.
LUNGS: Clear to auscultation and percussion bilaterally. There
is no tactile fremitus or egophony. Chest excursion is symmetric


and good.
BACK: There is no spine or CVA tenderness.
HEART: Regular rate and rhythm without murmur, rub, or gallop.
ABDOMEN: Soft, nontender, and nondistended, without mass or
hepatosplenomegaly.
EXTREMITIES: No clubbing, cyanosis, or edema. There is evidence
of multiple surgical repairs of her bilateral lower extremities.


LYMPH NODES: No inguinal, axillary, cervical, or supraclavicular


lymphadenopathy.


Pertinent Results:
IMPRESSION:

1) Enlarged right hilum with worsening surrounding ground glass
and interstitial opacity. The latter may represent lymphangitic
spread of
tumor, post-radiation changes, drug toxicity or infection.

2) Persistent bilateral nodular opacities.


TECHNIQUE: PA and lateral chest.

FINDINGS: Since the previous examination, the left-sided chest
tube has been
removed and no pneumothorax is identified. Heart size is normal.

There is
decreased prominence of the left upper mediastinum since the
previous
examination. Areas of consolidation within the left upper and
right lower
lobe are probably unchanged although appear less conspicuous due

to marked
increase in interstitial and air space opacity throughout the
remainder of the
lungs. There are small bilateral pleural effusions.

IMPRESSION:
1. No pneumothorax following removal of chest tube.
2. Marked progression of interstitial and air space opacities
bilaterally,
superimposed upon pre-existing left upper and right lower lobe
consolidations.
The findings could reflect pulmonary edema due to transfusion,
drug toxicity,
or less likely cardiogenic causes, or other etiologies such as
diffuse
pulmonary hemorrhage.

HISTORY:  Status post left upper lobe [**Year (4 digits) **] resection and
mediastinal lymph
node dissection.  Short of breath, low sats, evaluate CHF.

CHEST, SINGLE AP PORTABLE UPRIGHT VIEW.

Heart size is at the upper limits of normal.  There are diffuse
patchy
interstitial and alveolar opacities throughout both lungs,
demonstrating
moderate interval improvement compared with [**2196-8-5**].  No
effusions are
identified.  Pleural thickening, focal area of relative lucency,
and surgical
sutures noted at the left lung apex.


Brief Hospital Course:
Early a.m. of [**8-6**]: Patient [**Name (NI) 104222**] to thoracic service
after prior d/c on [**8-5**] with a complaint of hypoxia. Patient
became tachypneic and began to desaturate while on oxygen. She
was tranferred to the CSRU for monitoring of O2 saturation.
Patient was placed on high-flow 02 via face tent while in the
ICU, and monitored.

[**8-7**]: Patient remained in ICU for close monitoring of O2
saturation.

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. Glipizide 5 mg Tab,Sust Rel Osmotic Push 24HR Sig: One (1)
Tab,Sust Rel Osmotic Push 24HR PO DAILY (Daily).
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.
6. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
7. Zestril 20 mg Tablet Sig: One (1) Tablet PO once a day.
8. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H PRN () as
needed for anxiety.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Bilateral pulmonary nodules, Acute Shortness of Breath


Discharge Condition:
Stable


Discharge Instructions:
Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 170**] if you have chest
pain, shortness of breath, productive cough of green/[**Last Name (un) 104223**]
sputum, fever, chills or pain not relieved with pain medicine.
Do not drive while taking narcotic pain medication. You may
shower.


Followup Instructions:
Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) **] for a follow-up
appointment in 2 weeks.



Completed by:[**2196-8-17**]
{'Hypoxemia,Chronic airway obstruction, not elsewhere classified,Tachypnea,Other diseases of lung, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Personal history of malignant neoplasm of breast'}


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: Bilateral Pulmonary nodules

PRESENT ILLNESS: 65-year-old woman referred to the thoracic multidisciplinary
clinic by Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 3274**]. Ms. [**Known lastname 104221**] recently completed a
course of chemotherapy and XRT for a small cell lung cancer,
which was in
the right lung. This was treated as a limited stage small cell
lung cancer, with recognition that there were several other
lesions bilaterally. Most notably, there were bilateral apical
nodules as well as multiple other smaller nodules noted both
lungs. Since completion of her chemotherapy and radiation 6
weeks ago, Ms. [**Known lastname 104221**] noted that her energy level has been
increasing. She has some hot flashes on occasion, but denies any
fevers or chills. She has an occasional dry cough, which is not
productive of any purulent sputum or hemoptysis. She has been
gaining weight back. She denies any new bony pain. She can walk
up two flights of stairs and has returned to her activity as a
dressmaker.

MEDICAL HISTORY: Bladder cancer, status post partialcystectomy in [**2186**], orally
treated diabetes, hypertension, bilateral lower extremity leg
fractures with extensive reconstruction being done in the left
ankle region, left breast cancer in [**2182**], status post lumpectomy
and axillary lymph node dissection, status post radiation for
this and tamoxifen for 7 years, status post right vocal cord in
situ squamous cell carcinoma and intraepithelial squamous
neoplasia resected in [**2194**] and [**2195**].

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: Well-nourished, well-developed woman, in no apparent
distress.
HEENT: Alopecic. EOMI. PERRL. Sclerae are anicteric. No
facial asymmetry. Tongue is midline. Palate elevates
symmetrically. No oropharynx or nasopharynx mucosal
abnormalities. Trachea is midline.
NECK: Supple, nontender, and without mass. There is no thyroid
enlargement.
LUNGS: Clear to auscultation and percussion bilaterally. There
is no tactile fremitus or egophony. Chest excursion is symmetric

FAMILY HISTORY: No family history of bleeding dyscrasia

SOCIAL HISTORY: The patient owns a dressmaking shop. She has an
approximately 20-25 pack year smoking history, which was
discontinued in [**2196-1-24**]. 

### Response:
{'Hypoxemia,Chronic airway obstruction, not elsewhere classified,Tachypnea,Other diseases of lung, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Personal history of malignant neoplasm of breast'}
