CHIEF COMPLAINT: Shortness of breath, Weakness

PRESENT ILLNESS: 50 y/o F with metastatic adenoid cystic carcinoma, GERD, PE,
recent esophageal stent placement presents with increasing
cough. She presented intially to her PCP 2 days back with cough
and was given levoflox. However continued to have worsening
cough with phlegm and difficulty swallowing. Of note, she had
esophageal stents placed twice in the last month.
.
ED: Initial vitals were 99.3, 156, 122/81, 18, 100%/2L. Imaging
showed aspiration PNA and did not show any PE or significant
pericardial effusion. Started on Ceftriaxone, Zithro, Flagyl.
She remained tachycardiac to 120s non-responsive to fluids. She
was admitted to the ICU given her low pulm reserve and likely
semi-urgent esophageal stent placement.

MEDICAL HISTORY: 1. Adenoid cystic carcinoma, diagnosed [**3-/2103**], details below
2. Left vocal cord paralysis
3. GERD
4. History of PE, [**2099**], [**2107**]
5. Cerebral vein thrombosis
6. Depression? (found in ED note)
7. CVA? (found in ED note)
8. Esophogeal stent [**2110-9-30**]
.
Onc Hx:
[**2102**]: diag after work-up 8 months of cough, L pneumonectomy and
carinal resection and postop radiation.
[**2105**]: Recurrent dz in pleural space.
[**2106**]: palliative radiation with concurrent low-dose Taxotere.
[**2107**]: Hepatic involvement --> 4 cycles of cisplatin and
Adriamycin.
[**2107**]: CT showed progression in lungs/liver. 2 cycles of
carboplatin and Taxol given, still with pulm progression. Tx
complicated by thrombocytopenia and PE on CT, started on
Lovenox.
[**2108**]: Brachial plexus MRI showed tumor L paraspinal region from
T2-T5
[**2108**]: 4 cycles of dose-reduced cisplatin, Navelbine
[**2108**]: CT showed renal hepatic progression.
[**2108**]: started on gemcitabine, held sev times for
myelosuppression.
[**2108**]: MRI showed leptomeningeal enhancement L frontal lobe.
[**2109**]: seizure, vein of Trolard thrombosis.
[**2109**]: weekly epirubicin, received 3 cycles, but multiple doses
were held because of poor performance status.
[**2109**]: onc team and pt decided upon symptom managment as CT scan
showed progression, she received single [**Doctor Last Name 360**] cisplatin.

MEDICATION ON ADMISSION: Levoquin
Codeine,couh suppresant
Neurontin
Fentanyl patch

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: T 99, BP 105/80, HR 130, RR 18, 100% 2L
Gen: cachectic, chronically ill-appearing F in moderate
discomfort [**12-27**] neck pain; mostly Spanish speaking.
HEENT: EOMI. dry mucous membranes, clear oropharynx without
thrush.
Neck: flat JVP, tenderness diffusely along right paracervical
muscles without associated LAD, erythema or discrete mass
palpated. full ROM on neck. mild distension of neck veins on
right.
Lungs: good air movement R, decreased left, w/o focal
ronchi,rales, or wheeze
Cardiac: tachycardic, RRR, S1, S2, no murmurs
Abd: SNTND, +bs
Extr: thin, warm, well perfused. no clubbing/cyanosis/edema.
Skin: no rashes or other lesions. port on right chest c/d/i, no

FAMILY HISTORY: Her mother is alive and healthy. Her father died at age 80 from
a stroke and heart attack. She has 5 sisters and 2 brothers, and
some of them have hypertension, hypercholesterolemia, and
diabetes. She has 6 daughters and a
son; they are all healthy.

SOCIAL HISTORY: She does not smoke cigarettes or drink alcohol. She moved from
[**Country 3594**] to [**State 350**] in [**2091**]. She has a daughter who lives
Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of lung,Cachexia,Malignant neoplasm of larynx, unspecified,Esophageal reflux,Personal history of venous thrombosis and embolism,Encounter for palliative care
Food/vomit pneumonitis,Secondary malig neo lung,Cachexia,Malignant neo larynx NOS,Esophageal reflux,Hx-ven thrombosis/embols,Encountr palliative care
Admission Date:  [**2110-10-25**]              Discharge Date:   [**2110-10-27**]

Date of Birth:  [**2060-5-13**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
Shortness of breath, Weakness

Major Surgical or Invasive Procedure:
None

History of Present Illness:
 50 y/o F with metastatic adenoid cystic carcinoma, GERD, PE,
recent esophageal stent placement presents with increasing
cough. She presented intially to her PCP 2 days back with cough
and was given levoflox. However continued to have worsening
cough with phlegm and difficulty swallowing. Of note, she had
esophageal stents placed twice in the last month.
.
ED: Initial vitals were 99.3, 156, 122/81, 18, 100%/2L. Imaging
showed aspiration PNA and did not show any PE or significant
pericardial effusion. Started on Ceftriaxone, Zithro, Flagyl.
She remained tachycardiac to 120s non-responsive to fluids. She
was admitted to the ICU given her low pulm reserve and likely
semi-urgent esophageal stent placement.


Past Medical History:
1. Adenoid cystic carcinoma, diagnosed [**3-/2103**], details below
2. Left vocal cord paralysis
3. GERD
4. History of PE, [**2099**], [**2107**]
5. Cerebral vein thrombosis
6. Depression? (found in ED note)
7. CVA? (found in ED note)
8. Esophogeal stent [**2110-9-30**]
.
Onc Hx:
[**2102**]: diag after work-up 8 months of cough, L pneumonectomy and
carinal resection and postop radiation.
[**2105**]: Recurrent dz in pleural space.
[**2106**]: palliative radiation with concurrent low-dose Taxotere.
[**2107**]: Hepatic involvement --> 4 cycles of cisplatin and
Adriamycin.
[**2107**]: CT showed progression in lungs/liver. 2 cycles of
carboplatin and Taxol given, still with pulm progression. Tx
complicated by thrombocytopenia and PE on CT, started on
Lovenox.
[**2108**]: Brachial plexus MRI showed tumor L paraspinal region from
T2-T5
[**2108**]: 4 cycles of dose-reduced cisplatin, Navelbine
[**2108**]: CT showed renal hepatic progression.
[**2108**]: started on gemcitabine, held sev times for
myelosuppression.
[**2108**]: MRI showed leptomeningeal enhancement L frontal lobe.
[**2109**]: seizure, vein of Trolard thrombosis.
[**2109**]: weekly epirubicin, received 3 cycles, but multiple doses
were held because of poor performance status.
[**2109**]: onc team and pt decided upon symptom managment as CT scan
showed progression, she received single [**Doctor Last Name 360**] cisplatin.


Social History:
She does not smoke cigarettes or drink alcohol. She moved from
[**Country 3594**] to [**State 350**] in [**2091**]. She has a daughter who lives

in [**Location 17065**]. She also has a brother and sister who live in
the Greater [**Name (NI) 86**] area. She denies tobacco or alcohol use and
is currently not working. In the past, she has worked in a
bakery.


Family History:
Her mother is alive and healthy. Her father died at age 80 from
a stroke and heart attack. She has 5 sisters and 2 brothers, and
some of them have hypertension, hypercholesterolemia, and
diabetes. She has 6 daughters and a
son; they are all healthy.

Physical Exam:
PE: T 99, BP 105/80, HR 130, RR 18, 100% 2L
Gen: cachectic, chronically ill-appearing F in moderate
discomfort [**12-27**] neck pain; mostly Spanish speaking.
HEENT: EOMI. dry mucous membranes, clear oropharynx without
thrush.
Neck: flat JVP, tenderness diffusely along right paracervical
muscles without associated LAD, erythema or discrete mass
palpated. full ROM on neck. mild distension of neck veins on
right.
Lungs: good air movement R, decreased left, w/o focal
ronchi,rales, or wheeze
Cardiac: tachycardic, RRR, S1, S2, no murmurs
Abd: SNTND, +bs
Extr: thin, warm, well perfused. no clubbing/cyanosis/edema.
Skin: no rashes or other lesions. port on right chest c/d/i, no

erythema, tenderness to palpation.
Neuro: A&O, CNs grossly intact, no focal deficits
Affect: appropriate


Pertinent Results:
Labs on Admission:
[**2110-10-25**] WBC-11.8* RBC-3.43* Hgb-9.7* Hct-29.1* MCV-85 MCH-28.3
MCHC-33.3 RDW-15.2 Plt Ct-398 Neuts-92.2* Bands-0 Lymphs-4.2*
Monos-3.4 Eos-0.1 Baso-0.1 Hypochr-2+ Anisocy-NORMAL Poiklo-1+
Macrocy-NORMAL Microcy-NORMAL Polychr-OCCASIONAL Ovalocy-1+
Target-1+ Plt Smr-NORMAL Plt Ct-398
[**2110-10-26**] PT-17.3* PTT-60.6* INR(PT)-1.6*
[**2110-10-25**] Glucose-95 UreaN-5* Creat-0.4 Na-139 K-3.5 Cl-98
HCO3-31 AnGap-14 Calcium-7.9* Phos-3.4 Mg-1.0*
[**2110-10-26**] 12:20AM BLOOD Type-ART pO2-84* pCO2-55* pH-7.32*
calTCO2-30 Base XS-0 Intubat-NOT INTUBA
[**2110-10-26**] Lactate-2.2*

Imaging:
[**2110-10-25**] CXR FINDINGS: Single bedside AP examination labeled
"erect, 16:45 hours" is compared with the recent study dated
[**10-23**], as well as previous study, dated [**2110-10-9**]. There has been
progressive opacification of the right hemithorax over the
series of studies, which may represent confluent aspiration
pneumonitis. The patient is s/p left pneumonectomy and tubular-
appearing, presumably pleural, calcifications in the medial left
hemithorax are unchanged. Again demonstrated are esophageal
stent in situ, with slight narrowing at its mid-portion, as
before, as well as right subclavian venous access device with
tip likely at the cavo-atrial junction or high right atrium.

[**2110-10-25**] CTA
IMPRESSION:
1. No PE and no significant pericardial effusion.

2. Patchy airspace disease in the right lower lobe consistent
with aspiration pneumonitis.

3. Study is otherwise overall unchanged since the recent study
dated [**2110-9-25**].


Brief Hospital Course:
50 y/o F w/ h/o adenoid cystic carcinoma, GERD, PE, presented
with aspiration pneumonitis in the setting of likely obstructed
esophageal stent.

# Aspiration PNA: Aspiration from obstructed esophageal stent in
the setting of widely metastatic adenoid cystic carcinoma.
Patient was maintained NPO and started on Ceftriaxone,
Azithromycin, Flagyl for aspiration pneumonia.  Given end-stage
carcinoma and high likelihood of repeated aspiration events in
the setting of esophageal obstruction and stent failure, goals
of care were changed to comfort measures only after discussion
with family on day 2 of admission.  Patient received morphine
for respiratory distress.

# adenoid cystic carcinoma: Patient with known widely metastatic
disease on admission; was home hospice but family reversed it 2
days prior to admission as the service was not helping the
patient to be comfortable. Extensively discussed with patient
and family about goals of care: they would like comfort care and
minimal intervention to help make her comfortable. Patient was
given morphine for pain and comfort.
.
# Code: DNR/DNI on admission, made comfort measures only on day
2 of admission.  The patient died the following day from
respiratory failure.
.
# FEN: The patient was maintained NPO during this hospital
admission.
.
# Dispo: The patient died one day after decision to continue
comfort measure care.


Medications on Admission:
Levoquin
Codeine,couh suppresant
Neurontin
Fentanyl patch


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Aspiration Pneumonitis
Esophageal Stent Occlusion
Adenoid cystic carcinoma, metastatic
Respiratory Failure

Discharge Condition:
Deceased

Discharge Instructions:
None

Followup Instructions:
None
{'Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of lung,Cachexia,Malignant neoplasm of larynx, unspecified,Esophageal reflux,Personal history of venous thrombosis and embolism,Encounter for palliative care'}


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, Weakness

PRESENT ILLNESS: 50 y/o F with metastatic adenoid cystic carcinoma, GERD, PE,
recent esophageal stent placement presents with increasing
cough. She presented intially to her PCP 2 days back with cough
and was given levoflox. However continued to have worsening
cough with phlegm and difficulty swallowing. Of note, she had
esophageal stents placed twice in the last month.
.
ED: Initial vitals were 99.3, 156, 122/81, 18, 100%/2L. Imaging
showed aspiration PNA and did not show any PE or significant
pericardial effusion. Started on Ceftriaxone, Zithro, Flagyl.
She remained tachycardiac to 120s non-responsive to fluids. She
was admitted to the ICU given her low pulm reserve and likely
semi-urgent esophageal stent placement.

MEDICAL HISTORY: 1. Adenoid cystic carcinoma, diagnosed [**3-/2103**], details below
2. Left vocal cord paralysis
3. GERD
4. History of PE, [**2099**], [**2107**]
5. Cerebral vein thrombosis
6. Depression? (found in ED note)
7. CVA? (found in ED note)
8. Esophogeal stent [**2110-9-30**]
.
Onc Hx:
[**2102**]: diag after work-up 8 months of cough, L pneumonectomy and
carinal resection and postop radiation.
[**2105**]: Recurrent dz in pleural space.
[**2106**]: palliative radiation with concurrent low-dose Taxotere.
[**2107**]: Hepatic involvement --> 4 cycles of cisplatin and
Adriamycin.
[**2107**]: CT showed progression in lungs/liver. 2 cycles of
carboplatin and Taxol given, still with pulm progression. Tx
complicated by thrombocytopenia and PE on CT, started on
Lovenox.
[**2108**]: Brachial plexus MRI showed tumor L paraspinal region from
T2-T5
[**2108**]: 4 cycles of dose-reduced cisplatin, Navelbine
[**2108**]: CT showed renal hepatic progression.
[**2108**]: started on gemcitabine, held sev times for
myelosuppression.
[**2108**]: MRI showed leptomeningeal enhancement L frontal lobe.
[**2109**]: seizure, vein of Trolard thrombosis.
[**2109**]: weekly epirubicin, received 3 cycles, but multiple doses
were held because of poor performance status.
[**2109**]: onc team and pt decided upon symptom managment as CT scan
showed progression, she received single [**Doctor Last Name 360**] cisplatin.

MEDICATION ON ADMISSION: Levoquin
Codeine,couh suppresant
Neurontin
Fentanyl patch

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: T 99, BP 105/80, HR 130, RR 18, 100% 2L
Gen: cachectic, chronically ill-appearing F in moderate
discomfort [**12-27**] neck pain; mostly Spanish speaking.
HEENT: EOMI. dry mucous membranes, clear oropharynx without
thrush.
Neck: flat JVP, tenderness diffusely along right paracervical
muscles without associated LAD, erythema or discrete mass
palpated. full ROM on neck. mild distension of neck veins on
right.
Lungs: good air movement R, decreased left, w/o focal
ronchi,rales, or wheeze
Cardiac: tachycardic, RRR, S1, S2, no murmurs
Abd: SNTND, +bs
Extr: thin, warm, well perfused. no clubbing/cyanosis/edema.
Skin: no rashes or other lesions. port on right chest c/d/i, no

FAMILY HISTORY: Her mother is alive and healthy. Her father died at age 80 from
a stroke and heart attack. She has 5 sisters and 2 brothers, and
some of them have hypertension, hypercholesterolemia, and
diabetes. She has 6 daughters and a
son; they are all healthy.

SOCIAL HISTORY: She does not smoke cigarettes or drink alcohol. She moved from
[**Country 3594**] to [**State 350**] in [**2091**]. She has a daughter who lives 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of lung,Cachexia,Malignant neoplasm of larynx, unspecified,Esophageal reflux,Personal history of venous thrombosis and embolism,Encounter for palliative care'}
