CHIEF COMPLAINT: Lung cancer.

PRESENT ILLNESS: The patient is a 75 yo man with biopsy proven RUL NSCL Ca with
FDG-avid right
paratracheal, tracheobronchial and precarinal nodes who was
admitted to [**Hospital1 18**] on [**10-5**] for bronchoscopy and mediastinoscopy
for staging of his NSCLCa.

MEDICAL HISTORY: GERD
Hypertension
Hyperlipidemia
Goug
Skin Cancer
Tonsillectomy

MEDICATION ON ADMISSION: Aspirin 81mg daily, allopurinol 300 mg daily, lisinopril 20 mg
daily, atenolol 50 mg daily, lipitor 20 mg daily, omeprezole 20
mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.3    HR: 97 AFib    BP 90/62  Sats: 93 RA
General: 75 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: irregular
Resp: decreased breath sounds otherwise clear
GI: benign
Extr: warm no edema
Incision: sternal clean dry intact
Neuro: non-focal

FAMILY HISTORY: Positive for hypertension, heart disease and stroke

SOCIAL HISTORY: Married live with wife who has [**Name (NI) 11964**].  5 children
Tobacco: 30 pack-year
ETOH: stopped drinking 13 years ago
Accidental puncture or laceration during a procedure, not elsewhere classified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Malignant neoplasm of upper lobe, bronchus or lung,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Other and unspecified hyperlipidemia,Gout, unspecified,Atrial fibrillation,Benign essential hypertension
Accidental op laceration,Mal neo lymph-intrathor,Mal neo upper lobe lung,Pleural effusion NOS,Abn react-surg proc NEC,Esophageal reflux,Hyperlipidemia NEC/NOS,Gout NOS,Atrial fibrillation,Benign hypertension
Admission Date:  [**2114-10-5**]              Discharge Date:   [**2114-10-11**]

Date of Birth:  [**2038-11-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Lung cancer.


Major Surgical or Invasive Procedure:
[**2114-10-6**] Transthoracic ultrasound. Thoracentesis on the right
side.
[**2114-10-5**] Flexible bronchoscopy with aspiration cervical
mediastinoscopy, median sternotomy and repair of innominate
artery.


History of Present Illness:
The patient is a 75 yo man with biopsy proven RUL NSCL Ca with
FDG-avid right
paratracheal, tracheobronchial and precarinal nodes who was
admitted to [**Hospital1 18**] on [**10-5**] for bronchoscopy and mediastinoscopy
for staging of his NSCLCa.

Past Medical History:
GERD
Hypertension
Hyperlipidemia
Goug
Skin Cancer
Tonsillectomy

Social History:
Married live with wife who has [**Name (NI) 11964**].  5 children
Tobacco: 30 pack-year
ETOH: stopped drinking 13 years ago

Family History:
Positive for hypertension, heart disease and stroke

Physical Exam:
VS: T 97.3    HR: 97 AFib    BP 90/62  Sats: 93 RA
General: 75 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: irregular
Resp: decreased breath sounds otherwise clear
GI: benign
Extr: warm no edema
Incision: sternal clean dry intact
Neuro: non-focal

Pertinent Results:
[**2114-10-10**] WBC-5.2 RBC-3.05* Hgb-9.6* Hct-27.0* Plt Ct-165
[**2114-10-9**] WBC-5.4 RBC-3.22* Hgb-9.9* Hct-28.9* Plt Ct-208
[**2114-10-4**] WBC-5.8 RBC-3.71* Hgb-11.9* Hct-33.4*Plt Ct-213
[**2114-10-10**] Glucose-102 UreaN-27* Creat-1.1 Na-139 K-3.7 Cl-96
HCO3-31
[**2114-10-9**] Glucose-107* UreaN-23* Creat-1.0 Na-137 K-4.0 Cl-96
HCO3-32
[**2114-10-4**] UreaN-24* Creat-1.2 Na-137 K-4.3 Cl-102 HCO3-24
AnGap-15
[**2114-10-7**] CK(CPK)-127 CK(CPK)-128
[**2114-10-4**] ALT-16 AST-24 LD(LDH)-182 AlkPhos-82 Amylase-55
TotBili-0.7
[**2114-10-8**] CK-MB-5 cTropnT-0.07* CK-MB-7 cTropnT-0.08* CK-MB-7
cTropnT-0.07*

[**2114-10-10**]:Echocardiogram: The left atrium is elongated. 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. Regional left ventricular wall motion is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic root is mildly 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. Trivial mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. The estimated pulmonary artery systolic pressure is
normal. There is no pericardial effusion.

[**2114-10-9**] CXR: IMPRESSION: No pneumothorax. No significant
interval change. Stable large right pleural effusion and
adjacent atelectasis and small left pleural effusion.
[**2114-10-8**] CXR: FINDINGS: In comparison with study of [**10-7**], there
is continued opacification at the right base consistent with
pleural effusion and atelectasis. Smaller effusion is seen at
the left base. Pulmonary vascularity is essentially within
normal limits.

Pathology: Right lung tissue & lymph nodes: Metastatic, poorly
differentiated non-small cell carcinoma.


Brief Hospital Course:
OPERATIONS DURING ADMISSION
[**10-5**]  Flexible bronchoscopy with aspiration cervical
mediastinoscopy, median sternotomy and repair of innominate
artery.

CONSULTATIONS DURING ADMISSION
Cardiology, [**10-8**]

PATHOLOGY:  Mediastinal Lymph Nodes
II.  4L (C-D):
Metastatic, poorly differentiated non-small cell carcinoma.
III.  2R (E):
Metastatic, poorly differentiated non-small cell carcinoma.
IV.  Level 1 (F-I):
Metastatic, poorly differentiated non-small cell carcinoma.

# Flexible bronchoscopy with aspiration cervical
mediastinoscopy, median sternotomy and repair of innominate
artery:
The patient is a 75 yo male w/RUL biopsy-proven non small cell
lung ca who was admitted on [**10-5**] for bronchoscopy and
mediastinoscopy for staging purposes.  The patient was taken to
the operating room on [**10-5**]; the mediastinoscopy was complicated
by significant scarring (probably from infiltrative tumorous
process) in pretracheal space with a subsequent tear in the
inominate Artery requiring emergent sternotomy with primary
repair.  Fortuantely, the patient remained hemodynamically
stable throughout the operation with SBP consistently above 100;
he did have EBL 1000, u/o 220, ivf 2500, 5 units of blood were
transfused.

Postoperatively the patient was taken to the SICU and extubated
where he remained in good condition overnight.  His Hct remained
stable at 28.

# Rapid Atrial Fibrillation:
On POD2 the patient went into rapid atrial fibrillation.  He was
placed on a diltiazem drip and converted to sinus rhythm
overnight.  The following day his drip was discontinued, he was
placed back on his home dose of atenolol and started on lasix.
The evening of POD3 he converted back to atrial fibrillation
with regular ventricular rate. He was changed to lopressor and
diltiazem with rate control.
Cardiology was consulted, who recommended lopressor TID and an
Echocardiogram.  The Echo revealed:  EF 55% with normal left
ventricular function. (see report).

# Right sided effusion
The patient was brought to the SICU with a mediastinal [**Doctor Last Name **] in
place; this was discontinued on POD2.  On POD4 the patient was
noted to have a developing right sided effusion.  IP was
consulted for thoracentesis.  They drained 340 ml of bloody
discharge.

# NSCLCA
Unfortunately, the mediastinal lymph nodes were positive for
metastatic disease. He was schedule for follow-up with the
multidisciplinary onocology team as an outpatient.


Medications on Admission:
Aspirin 81mg daily, allopurinol 300 mg daily, lisinopril 20 mg
daily, atenolol 50 mg daily, lipitor 20 mg daily, omeprezole 20
mg daily

Discharge Medications:
1. Allopurinol 100 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
2. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
Disp:*270 Tablet(s)* Refills:*2*
3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*80 Tablet(s)* Refills:*0*
7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
8. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Diltiazem HCl 30 mg Tablet Sig: [**12-13**] Tablet PO TID (3 times a
day).
Disp:*15 Tablet(s)* Refills:*2*
10. Lipitor 20 mg Tablet Sig: One (1) Tablet PO once a day.
11. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
12. 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*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Right upper lobe nodule, GERD, Hypertension, Hyperlipidemia,
Gout, Skin cancer, tonsillectomy


Discharge Condition:
stable


Discharge Instructions:
Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if experience:
-Fever > 101 or chills
-Increased cough, shortness of breath or chest pain
-Sternal incision develops drainage or increased redness
Follow sternal precaution instructions reviewed by physical
therapy.
No lifting greater than 10 pounds for 4 weeks. No driving for 4
weeks
You may shower.  No tub bathing or swimming for 6 weeks
Take stool softners with narcotics

Followup Instructions:
Report to the [**Location (un) 861**] Radiolgoy Department for a Chest X-Ray
45 minutes before your appointment.
Appointment with Dr. [**Last Name (STitle) **] & Dr. [**Last Name (STitle) **] at 11:00am on the
[**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center, [**Location (un) 24**].
Follow-up with Dr. [**Last Name (STitle) **] [**10-16**] at 1:00pm on the
[**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center, [**Location (un) 24**].
Appointment with Dr. [**Last Name (STitle) **] 1:30pm on the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**]
Clinical Center, [**Location (un) 24**].

Provider: [**Name10 (NameIs) 900**] [**Name8 (MD) 901**], M.D. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2114-11-19**] 9:40



Completed by:[**2114-10-11**]
{'Accidental puncture or laceration during a procedure, not elsewhere classified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Malignant neoplasm of upper lobe, bronchus or lung,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Other and unspecified hyperlipidemia,Gout, unspecified,Atrial fibrillation,Benign 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: Lung cancer.

PRESENT ILLNESS: The patient is a 75 yo man with biopsy proven RUL NSCL Ca with
FDG-avid right
paratracheal, tracheobronchial and precarinal nodes who was
admitted to [**Hospital1 18**] on [**10-5**] for bronchoscopy and mediastinoscopy
for staging of his NSCLCa.

MEDICAL HISTORY: GERD
Hypertension
Hyperlipidemia
Goug
Skin Cancer
Tonsillectomy

MEDICATION ON ADMISSION: Aspirin 81mg daily, allopurinol 300 mg daily, lisinopril 20 mg
daily, atenolol 50 mg daily, lipitor 20 mg daily, omeprezole 20
mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.3    HR: 97 AFib    BP 90/62  Sats: 93 RA
General: 75 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: irregular
Resp: decreased breath sounds otherwise clear
GI: benign
Extr: warm no edema
Incision: sternal clean dry intact
Neuro: non-focal

FAMILY HISTORY: Positive for hypertension, heart disease and stroke

SOCIAL HISTORY: Married live with wife who has [**Name (NI) 11964**].  5 children
Tobacco: 30 pack-year
ETOH: stopped drinking 13 years ago 

### Response:
{'Accidental puncture or laceration during a procedure, not elsewhere classified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Malignant neoplasm of upper lobe, bronchus or lung,Unspecified pleural effusion,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Other and unspecified hyperlipidemia,Gout, unspecified,Atrial fibrillation,Benign essential hypertension'}
