CHIEF COMPLAINT: Multiple, 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,

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: ALBUTEROL 90 mcg/Actuation--2 puffs q 4 h prn
ATIVAN 0.5MG--Take one tablet every 4-6 hours as needed for
nausea, one tablet at night for insomnia
FLOVENT HFA 220 mcg/Actuation--1 puffs twice a day rinse mouth
GLUCOTROL XL 5 mg--1 tab(s) by mouth once a day
LISINOPRIL 20MG--Every day
PRILOSEC 20 mg--1 capsule(s) by mouth once a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temperature 97.7, pulse 96, blood pressure 137/88,
respiratory rate 16, oxygen saturation 96% on room air, and
weight is 169.1 pounds.
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**].
Malignant neoplasm of upper lobe, bronchus or lung,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of breast
Mal neo upper lobe lung,DMII wo cmp nt st uncntr,Hypertension NOS,Hx of breast malignancy
Admission Date:  [**2196-8-3**]              Discharge Date:   [**2196-8-5**]

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:
Multiple, Bilateral Pulmonary Nodules

Major Surgical or Invasive Procedure:
VATS, Left upper lung [**First Name3 (LF) **] resection with 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:
Temperature 97.7, pulse 96, blood pressure 137/88,
respiratory rate 16, oxygen saturation 96% on room air, and
weight is 169.1 pounds.
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:
[**2196-8-3**] 03:03PM   TYPE-ART O2-4 PO2-69* PCO2-57* PH-7.26* TOTAL
CO2-27 BASE XS--2 INTUBATED-NOT INTUBA COMMENTS-NC
[**2196-8-3**] 06:38PM   TYPE-ART TEMP-36.3 RATES-18/ O2-70 PO2-88
PCO2-58* PH-7.28* TOTAL CO2-28 BASE XS-0 INTUBATED-NOT INTUBA

PA and lateral upright chest radiograph compared to previous
chest x-ray from
[**2196-1-26**] and to chest CT from [**2196-6-28**].

The heart size is normal. The aorta is slightly elongated with
no evidence of
focal dilatation. The right hilus is again demonstrated enlarged
with
additional perihilar interstitial density which is worse since
the prior CT.
The bilateral small rounded opacities in the right upper and
left upper lobe
are again demonstrated. The pleural surfaces are smooth with no
pleural
effusion.

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.



CLINICAL HISTORY: Status post left upper lobe [**Year (4 digits) **] resection.
Evaluate for
pneumothorax.

CHEST: A left chest tube is present and a small apical
pneumothorax is seen.
Opacification of the left upper lobe is present and also some
opacities are
seen in the right lower lobe. These opacities could be due to
pneumonic
consolidation or aspiration pneumonia

 INDICATION: Left upper lobe [**Last Name (LF) **], [**First Name3 (LF) 406**] tube removed, evaluate
for
pneumothorax.

COMPARISON: [**2196-8-3**].

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. Findings were discussed with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4129**]
at
approximately 10 a.m. on [**2196-8-4**].


Brief Hospital Course:
Patient was admitted on [**8-3**] for VATS, Left upper lung [**Month/Year (2) **]
resection with mediastinal lymph node dissection.
Post-operatively, the patient was kept in the PACU overnight for
cardiopulmonary monitoring and weening off of pressor
medications; her chest tube was to water seal overnight. On
Post-op day 1, the patient was transferred out of the PACU in
stable condition. Patient's meds were switched to p.o., chest
tube was discontinued as well as her foley. Post-pull x-ray
showed good lung expansion. POD #2, patient was diuresed, given
chest physical therapy and ambulated. PT consult was obtained
which showed an ambulating o2 sat of 79-88%. Based on this, the
patient was arranged to have home o2. Patient was d/c'd to home
on the afternoon of [**8-5**], POD #2.

Medications on Admission:
ALBUTEROL 90 mcg/Actuation--2 puffs q 4 h prn
ATIVAN 0.5MG--Take one tablet every 4-6 hours as needed for
nausea, one tablet at night for insomnia
FLOVENT HFA 220 mcg/Actuation--1 puffs twice a day rinse mouth
GLUCOTROL XL 5 mg--1 tab(s) by mouth once a day
LISINOPRIL 20MG--Every day
PRILOSEC 20 mg--1 capsule(s) by mouth once a day



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. Glipizide 5 mg Tab,Sust Rel Osmotic Push 24HR Sig: One (1)
Tab,Sust Rel Osmotic Push 24HR PO QAM (once a day (in the
morning)).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for pain.
Disp:*80 Tablet(s)* Refills:*0*
7. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
8. Senna 8.6 mg Capsule Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
9. Milk of Magnesia 7.75 % Suspension Sig: Thirty (30) ML PO Q6H
(every 6 hours) as needed.
10. Metoprolol Tartrate 25 mg Tablet Sig: one half Tablet PO BID
(2 times a day).
Disp:*30 Tablet(s)* Refills:*1*
11. oxygen
oxygen
1-2L/min continuous for portability pulse dose system


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
multiple bilat nodules
PMH: Right lung Small cell lung cancer s/p chemo and radiation
thereapy [**6-28**];
R vocal cord squamous cell carcinoma in situ/intraepithelial
squamous neoplasia s/presections in [**2194**]/[**2195**]; Bladder CA s/p
partial cystectomy [**2186**];
Left Breast CAncer s/p lumpectomy/Axilla lymph node disection w/
radiation therapy and tamoxifen [**2182**]; Non insulin dependent
diabetes tupe 2,
Hypertension, BLE fx s/p ORIF, 25pk-yr smoker quit [**1-29**]


Discharge Condition:
good


Discharge Instructions:
Call Dr[**Doctor Last Name **]/ Thoracic Surgery office [**Telephone/Fax (1) 170**])
for: fever, shortness of breath, chest pain, exscessive foul
smelling drainage from incision sites
*Continue new medications as previous to surgery as stated on
discharge instructions
*Take new medications as directed and as needed, stated on
discharge instructions. Presriptions-Dilaudid [**1-25**] pills every
4ours as needed for pain.
*Small white strips on incisions will fall off in time.
You may shower in 2 days, remove chest tube dressing after
showering and place bandaid or guaze daily as needed.
No tub baths or swimming for 3-4 weeks.



Followup Instructions:
CAll Dr[**Doctor Last Name **]/Thoracic office for an appointment-
[**Telephone/Fax (1) 170**]



Completed by:[**2196-8-5**]
{'Malignant neoplasm of upper lobe, bronchus or lung,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,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: Multiple, 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,

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: ALBUTEROL 90 mcg/Actuation--2 puffs q 4 h prn
ATIVAN 0.5MG--Take one tablet every 4-6 hours as needed for
nausea, one tablet at night for insomnia
FLOVENT HFA 220 mcg/Actuation--1 puffs twice a day rinse mouth
GLUCOTROL XL 5 mg--1 tab(s) by mouth once a day
LISINOPRIL 20MG--Every day
PRILOSEC 20 mg--1 capsule(s) by mouth once a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temperature 97.7, pulse 96, blood pressure 137/88,
respiratory rate 16, oxygen saturation 96% on room air, and
weight is 169.1 pounds.
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:
{'Malignant neoplasm of upper lobe, bronchus or lung,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}
