CHIEF COMPLAINT: Hemoptysis

PRESENT ILLNESS: Mr. [**Known lastname 33372**] is an 84M with SCLC diagnosed 8 months ago
undergoing 3rd cycle of chemotherapy who presents with
hemoptysis. He began to have blood streaked sputum 1 month ago
which has been progressing in volume over the past week.  On the
day of admission he began to cough up frank blood, approximately
1 tablespoon per cough for a total of one cup of frank blood
with clots.  He had a gurgling sensation in his chest and found
it difficult to breath and called 911.
.
In ED, initial VS:98.9 60 118/68 18 96% RA. He continued to have
frank blood with an intermittent cough but only pea sized
amounts.  CTA was negative for PE but revealed mass abutting
pulm artery. Labs were significant for HCT stable at baseline
28-29. He was seen by IP and underwent flexible bronchoscopy
which revealed large endobronchial vascular oozing mass almost
obstructing RUL bronchus. IR was called and patient underwent
right bronchial artery embolization. During procedure, he
developed oxygen requirement and was  satting mid 90s on NRB. He
was transferred back to the ED, stabilized, and transferred to
[**Hospital Unit Name 153**]. VS prior to transfer: 97.8 76 123/71 25 94% on NRB, not in
any acute distress
.
On the floor, he reports improved SOB and no further hemoptysis.
He reports stable cough for months and denies any CP,
palpitations, fever, chills, LH or dizziness, HA. States he
stopped ASA one month ago and is not on plavix, coumadin or any
other blood thinning medications.

MEDICAL HISTORY: 1. SCLC diagnosed 8 months ago, undergoing 3rd cycle of chemo,
has not receievd XRT. Receives care at Cancer Center in
[**Location (un) 47**]
2.  Coronary artery disease, status post coronary artery bypass
grafting in [**2112-5-13**].
3.  Peptic ulcer disease.
4.  Status post AAA repair in [**2112-1-14**] with
intraoperative myocardial infarction.
5.  Hypercholesterolemia.
6.  Tuberculosis as a child.
7.  Diverticulosis.
8.  Left retinal artery thrombosis with reduced vision on that
side.
9.  Eczema.
10.  Chronic renal insufficiency with a baseline creatinine of
1.3 to 1.6.
11. history of asbestos exposure.
12. Zoster
13. Anemia
14. HTN

MEDICATION ON ADMISSION: Atenolol 25 mg daily
Niacin 500 mg
Nitroglycerin prn
Aspirin 81 mg daily
Crestor 40 mg daily
Amlodipine 5 mg po daily

ALLERGIES: Oxycodone

PHYSICAL EXAM: General: Alert, oriented, slightly agitated, pulling at sheets
in bed
HEENT: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, JVP 8-9cm, no LAD
Lungs: Anteriorly coarse breath sounds throughout R>L with
bibasilar rales
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
GU: no foley
Ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis.
Trace edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Tobacco: 80 pack year ex smoker
Lives with wife of 14 years. Electrician on sick leave
He quit smoking more than 20 years ago,but prior to that was
smoking 3-4 packs per day.  He started smoking in [**2054**].  He also
quit EtOH over 10 years ago.
Malignant neoplasm of upper lobe, bronchus or lung,Acute edema of lung, unspecified,Acute kidney failure, unspecified,Other hemoptysis,Dehydration,Antineoplastic chemotherapy induced anemia,Thrombocytopenia, unspecified,Leukocytopenia, unspecified,Disorders of phosphorus metabolism,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Fever, unspecified,Diverticulosis of colon (without mention of hemorrhage),Contact dermatitis and other eczema, unspecified cause,Personal history of contact with and (suspected) exposure to asbestos,Personal history of peptic ulcer disease,Aortocoronary bypass status,Personal history of tuberculosis,Personal history of antineoplastic chemotherapy,Do not resuscitate status
Mal neo upper lobe lung,Acute lung edema NOS,Acute kidney failure NOS,Hemoptysis NEC,Dehydration,Anemia d/t antineo chemo,Thrombocytopenia NOS,Leukocytopenia NOS,Dis phosphorus metabol,Chr kidney dis stage III,Hy kid NOS w cr kid I-IV,Pure hypercholesterolem,Fever NOS,Dvrtclo colon w/o hmrhg,Dermatitis NOS,Hx-contct/expos asbestos,Prsnl hst peptic ulcr ds,Aortocoronary bypass,Prsnl hst tuberculosis,Hx antineoplastic chemo,Do not resusctate status
Admission Date:  [**2121-9-27**]              Discharge Date:   [**2121-10-4**]

Date of Birth:  [**2037-2-3**]             Sex:   M

Service: MEDICINE

Allergies:
Oxycodone

Attending:[**First Name3 (LF) 11839**]
Chief Complaint:
Hemoptysis


Major Surgical or Invasive Procedure:
arterial embolization


History of Present Illness:
Mr. [**Known lastname 33372**] is an 84M with SCLC diagnosed 8 months ago
undergoing 3rd cycle of chemotherapy who presents with
hemoptysis. He began to have blood streaked sputum 1 month ago
which has been progressing in volume over the past week.  On the
day of admission he began to cough up frank blood, approximately
1 tablespoon per cough for a total of one cup of frank blood
with clots.  He had a gurgling sensation in his chest and found
it difficult to breath and called 911.
.
In ED, initial VS:98.9 60 118/68 18 96% RA. He continued to have
frank blood with an intermittent cough but only pea sized
amounts.  CTA was negative for PE but revealed mass abutting
pulm artery. Labs were significant for HCT stable at baseline
28-29. He was seen by IP and underwent flexible bronchoscopy
which revealed large endobronchial vascular oozing mass almost
obstructing RUL bronchus. IR was called and patient underwent
right bronchial artery embolization. During procedure, he
developed oxygen requirement and was  satting mid 90s on NRB. He
was transferred back to the ED, stabilized, and transferred to
[**Hospital Unit Name 153**]. VS prior to transfer: 97.8 76 123/71 25 94% on NRB, not in
any acute distress
.
On the floor, he reports improved SOB and no further hemoptysis.
He reports stable cough for months and denies any CP,
palpitations, fever, chills, LH or dizziness, HA. States he
stopped ASA one month ago and is not on plavix, coumadin or any
other blood thinning medications.


Past Medical History:
1. SCLC diagnosed 8 months ago, undergoing 3rd cycle of chemo,
has not receievd XRT. Receives care at Cancer Center in
[**Location (un) 47**]
2.  Coronary artery disease, status post coronary artery bypass
grafting in [**2112-5-13**].
3.  Peptic ulcer disease.
4.  Status post AAA repair in [**2112-1-14**] with
intraoperative myocardial infarction.
5.  Hypercholesterolemia.
6.  Tuberculosis as a child.
7.  Diverticulosis.
8.  Left retinal artery thrombosis with reduced vision on that
side.
9.  Eczema.
10.  Chronic renal insufficiency with a baseline creatinine of
1.3 to 1.6.
11. history of asbestos exposure.
12. Zoster
13. Anemia
14. HTN


Social History:
Tobacco: 80 pack year ex smoker
Lives with wife of 14 years. Electrician on sick leave
He quit smoking more than 20 years ago,but prior to that was
smoking 3-4 packs per day.  He started smoking in [**2054**].  He also
quit EtOH over 10 years ago.


Family History:
NC

Physical Exam:
General: Alert, oriented, slightly agitated, pulling at sheets
in bed
HEENT: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, JVP 8-9cm, no LAD
Lungs: Anteriorly coarse breath sounds throughout R>L with
bibasilar rales
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
GU: no foley
Ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis.
Trace edema


Pertinent Results:
[**2121-9-27**] 10:31PM   GLUCOSE-98 UREA N-18 CREAT-1.4* SODIUM-139
POTASSIUM-4.6 CHLORIDE-107 TOTAL CO2-22 ANION GAP-15
[**2121-9-27**] 10:31PM   CALCIUM-7.8* PHOSPHATE-2.3* MAGNESIUM-2.0
[**2121-9-27**] 10:31PM   WBC-19.6*# RBC-3.49* HGB-10.3* HCT-31.1*
MCV-89 MCH-29.4 MCHC-33.0 RDW-14.9
[**2121-9-27**] 10:31PM   NEUTS-95* BANDS-0 LYMPHS-5* MONOS-0 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2121-9-27**] 10:31PM   HYPOCHROM-1+ ANISOCYT-NORMAL POIKILOCY-NORMAL
MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL
SCHISTOCY-OCCASIONAL BITE-OCCASIONAL
[**2121-9-27**] 10:31PM   PLT SMR-LOW PLT COUNT-84*
[**2121-9-27**] 10:31PM   PT-14.4* PTT-31.0 INR(PT)-1.2*
[**2121-9-27**] 10:43AM   PT-13.4 PTT-28.6 INR(PT)-1.1
[**2121-9-27**] 08:10AM   GLUCOSE-84 UREA N-24* CREAT-1.6* SODIUM-142
POTASSIUM-4.5 CHLORIDE-110* TOTAL CO2-27 ANION GAP-10
[**2121-9-27**] 08:10AM   estGFR-Using this
[**2121-9-27**] 08:10AM   CALCIUM-7.9* PHOSPHATE-1.8*# MAGNESIUM-2.3
[**2121-9-27**] 08:10AM   WBC-9.3# RBC-3.29* HGB-9.5* HCT-29.1* MCV-89
MCH-29.0 MCHC-32.7 RDW-15.5
[**2121-9-27**] 08:10AM   NEUTS-79.9* LYMPHS-17.9* MONOS-1.5* EOS-0.4
BASOS-0.3
[**2121-9-27**] 08:10AM   PLT COUNT-84*#
GRAM STAIN (Final [**2121-10-1**]):
      <10 PMNs and >10 epithelial cells/100X field.
      Gram stain indicates extensive contamination with upper
respiratory
      secretions. Bacterial culture results are invalid.
Blood cultures: negative


Brief Hospital Course:
This 84 year old gentleman with SCLC receiving chemo was
admitted with hemoptysis and RUL endobronchial mass and
developed increasing hypoxia after undergoing IR guided
bronchial artery embolization.
.
# Hemoptysis: Presented with hemoptysis and bronchoscopy
consistent with RUL vascular mass and underwent right bronchial
artery embolization. Pt was monitored closely and no recurrent
episodes of [**Female First Name (un) **] hemoptysis. H?H was followed an dreained
stable. Plts were also followed with th eintent to keep level
close to 50k. On the day of discharge plt count was 47 an dpt
did get 1 units of plts.Pt scheduled to return to [**Hospital Ward Name 1826**] 7 for
a cbc to follow plt count.
# SCLC:Pt was started on radiation treatment during the
hospitalization. He completed 1500cgy out of 3000, and scheduled
to return on Monday to radiation oncology fo rcompletion of
treatment. pt to return to primary outside oncologist fo
rfurther treatment of SCLC.
# Hypoxemic respiratory distress: Pt still requiring O2 on
transfer to floor. CXR c/w edema. Pt received lasix po x3 doses
in total with good response. breathing improved an dpt weaned
off oxygen.
# Acute on chronic renal insufficiency: Pt has rising Cr 1.7
from baseline of 1.3-1.4, possibly due to large dye load
received during bronchial artery embolization. FeNa 3%. Patient
had good urine output and crea remained at 1.8. Creatinine shoul
dbe followe dwith priary oncologist..
# Low grade fever: Pt had low grade fevers on th efloor. Blood
and sputu culture sobtained and without growth. CXR also did not
show a clear infiltrate. Fevers resolved and on d/c pt afebrile.
# Leuopenia: Secondary to recent treatment with [**Doctor Last Name **]-etoposide.
Pt was scheduled to get neulasta at primary oncologist but was
admitted fo rhemoptysis. First dose of neupogen was given to pt
on th eday of discharge . Pt scheduled to return to 7 [**Hospital Ward Name 1826**]
to receive 3 additional daily doses.
#. CAD s/p CABG: Pt restarted on a beta-blocker and
rosuvastatin.
Code status: DNR/DNI


Medications on Admission:
Atenolol 25 mg daily
Niacin 500 mg
Nitroglycerin prn
Aspirin 81 mg daily
Crestor 40 mg daily
Amlodipine 5 mg po daily

Discharge Medications:
1. rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
3. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
[**12-14**]  Inhalation every six (6) hours as needed for cough.
Disp:*1 1* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Hemoptysis
Pulmonary edema
Small cell lung cancer


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Mr [**Known lastname 33372**], You were admitted with hemoptysis ( bleeding from
your lungs). A chest CT showed that you have a mass abutting a
pulmonary artery. You underwent an arterial embolization that
was successful and you also started radiation treatment for your
lung mass.You will need to continue follow up with your
oncologist as scheduled as well as completion of teh radiation
treatment at [**Hospital1 **].
Change in medication:
Aspirin held because of bleeding- you should not continue
aspirin for now.
Niacin held-you will need to discuss the continuation of niacin
in the future with your primary physician.

Followup Instructions:
1. F/U with Radiation Oncology on Monday at 2pm at [**Location (un) 3387**] [**Hospital Ward Name 332**]-[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 86**], [**Numeric Identifier 718**]. Phone: [**Telephone/Fax (1) 9710**].
2.Appointment on Monday at 1:30pm Oncology outpt infusion center
[**Hospital Ward Name 1826**] 7 at [**Hospital1 18**], [**Location (un) **], tel [**Numeric Identifier 33374**] for
neupogen shot and CBC.
2. Cont F/U with Primary oncologist at [**Location (un) 47**] cancer
center.If you do not have an appointment, call to schedule an
appointment.
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute edema of lung, unspecified,Acute kidney failure, unspecified,Other hemoptysis,Dehydration,Antineoplastic chemotherapy induced anemia,Thrombocytopenia, unspecified,Leukocytopenia, unspecified,Disorders of phosphorus metabolism,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Fever, unspecified,Diverticulosis of colon (without mention of hemorrhage),Contact dermatitis and other eczema, unspecified cause,Personal history of contact with and (suspected) exposure to asbestos,Personal history of peptic ulcer disease,Aortocoronary bypass status,Personal history of tuberculosis,Personal history of antineoplastic chemotherapy,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: Hemoptysis

PRESENT ILLNESS: Mr. [**Known lastname 33372**] is an 84M with SCLC diagnosed 8 months ago
undergoing 3rd cycle of chemotherapy who presents with
hemoptysis. He began to have blood streaked sputum 1 month ago
which has been progressing in volume over the past week.  On the
day of admission he began to cough up frank blood, approximately
1 tablespoon per cough for a total of one cup of frank blood
with clots.  He had a gurgling sensation in his chest and found
it difficult to breath and called 911.
.
In ED, initial VS:98.9 60 118/68 18 96% RA. He continued to have
frank blood with an intermittent cough but only pea sized
amounts.  CTA was negative for PE but revealed mass abutting
pulm artery. Labs were significant for HCT stable at baseline
28-29. He was seen by IP and underwent flexible bronchoscopy
which revealed large endobronchial vascular oozing mass almost
obstructing RUL bronchus. IR was called and patient underwent
right bronchial artery embolization. During procedure, he
developed oxygen requirement and was  satting mid 90s on NRB. He
was transferred back to the ED, stabilized, and transferred to
[**Hospital Unit Name 153**]. VS prior to transfer: 97.8 76 123/71 25 94% on NRB, not in
any acute distress
.
On the floor, he reports improved SOB and no further hemoptysis.
He reports stable cough for months and denies any CP,
palpitations, fever, chills, LH or dizziness, HA. States he
stopped ASA one month ago and is not on plavix, coumadin or any
other blood thinning medications.

MEDICAL HISTORY: 1. SCLC diagnosed 8 months ago, undergoing 3rd cycle of chemo,
has not receievd XRT. Receives care at Cancer Center in
[**Location (un) 47**]
2.  Coronary artery disease, status post coronary artery bypass
grafting in [**2112-5-13**].
3.  Peptic ulcer disease.
4.  Status post AAA repair in [**2112-1-14**] with
intraoperative myocardial infarction.
5.  Hypercholesterolemia.
6.  Tuberculosis as a child.
7.  Diverticulosis.
8.  Left retinal artery thrombosis with reduced vision on that
side.
9.  Eczema.
10.  Chronic renal insufficiency with a baseline creatinine of
1.3 to 1.6.
11. history of asbestos exposure.
12. Zoster
13. Anemia
14. HTN

MEDICATION ON ADMISSION: Atenolol 25 mg daily
Niacin 500 mg
Nitroglycerin prn
Aspirin 81 mg daily
Crestor 40 mg daily
Amlodipine 5 mg po daily

ALLERGIES: Oxycodone

PHYSICAL EXAM: General: Alert, oriented, slightly agitated, pulling at sheets
in bed
HEENT: Sclera anicteric, MM dry, oropharynx clear
Neck: supple, JVP 8-9cm, no LAD
Lungs: Anteriorly coarse breath sounds throughout R>L with
bibasilar rales
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
GU: no foley
Ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis.
Trace edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Tobacco: 80 pack year ex smoker
Lives with wife of 14 years. Electrician on sick leave
He quit smoking more than 20 years ago,but prior to that was
smoking 3-4 packs per day.  He started smoking in [**2054**].  He also
quit EtOH over 10 years ago. 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute edema of lung, unspecified,Acute kidney failure, unspecified,Other hemoptysis,Dehydration,Antineoplastic chemotherapy induced anemia,Thrombocytopenia, unspecified,Leukocytopenia, unspecified,Disorders of phosphorus metabolism,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Fever, unspecified,Diverticulosis of colon (without mention of hemorrhage),Contact dermatitis and other eczema, unspecified cause,Personal history of contact with and (suspected) exposure to asbestos,Personal history of peptic ulcer disease,Aortocoronary bypass status,Personal history of tuberculosis,Personal history of antineoplastic chemotherapy,Do not resuscitate status'}
