CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: Mr. [**Known lastname 3451**] is a 41yo gentleman with h/o melanoma metastatic to his
lung, liver, heart, skin, and bone recently treated at an OSH
for pneumonia who presents with shortness of breath and fevers.
.
Much of the history was obtained from the patient's wife as the
patient was very sleepy upon arrival to the unit.  The patient
was admitted to a hospital in [**State 2748**] [**Date range (1) 38269**] with
pneumonia.  He was discharged on a course of cefuroxime, flagyl,
and levofloxacin, which he has since completed.  In addition, he
was given a 5 week course of prophylactic PO vancomycin given a
history of severe C diff colitis in the past.  He had been doing
well at home, getting about with a walker or wheelchair and
improving his PO intake.  About two or three days ago, he began
to have increased work of breathing.  He was having some fevers
at home as well but no shaking chills.  In addition, he had a
cough that was productive, at one point of foul-smelling green
sputum.  There were times he had some blood-streaked sputum as
well.
.
In the ED, initial VS were:  101.8 rectal  110/70   119   22
99%.  CTA chest was negative for PE but showed airspace
consolidation suggestive of RLL pneumonia.  He was given
vancomycin, cefepime, and levofloxacin.  In addition, IP was
contact[**Name (NI) **] for possible flexible bronchoscopy in the morning to
help relieve any obstruction.  Because the team was anticipating
the possibility of a PE, they also obtained a non-contrast head
CT, which unfortunately demonstrated likely new brain mets.
Both the patient and his oncologist were informed about this.
.
His ED course was also notable for an episode when his wife
stated he did not respond to verbal or tactile stimuli x 1
minute.  This occurred after 1mg IV dilaudid followed 45 minutes
later by 1mg IV ativan.  When the MD arrived to assess the
patient, he was awake and responsive but somewhat consfused.  He
improved after a dose of narcan.  Finally, he received 2L of NS
and was started on a NS infusion at 150cc/hr.
.
Upon arrival to the ICU, he was pleasant but sleepy.  He did not
feel particularly short of breath.
.
Of note, Mr. [**Known lastname 3451**] was seen by his oncologist on [**2138-6-11**] and
given a 7 day course of levofloxacin for incidentally-noted LUL
infiltrate on staging chest CT.
.
On review of systems, his wife notes that he has had episodes
recently of being unresponsive after getting his fentanyl patch
similar to what happened in the ED.  He also has been having
some loose stool lately.

MEDICAL HISTORY: Melanoma metastatic to lung, liver, heart, skin, and bone
(spine) s/p high-dose IL-2 x 4 cycles, CTLA-4 antibody in [**5-6**] x
2, then EBRT to T7-T12 spine [**3-9**], currently receiving
palliative XRT to hip mets (next dose due [**7-15**])
Hypercholesterolemia
Hypothyroidism
Sinus tachycardia at baseline
Diabetes mellitus [**3-3**] study drug, developed in [**2-7**],
diet-controlled
h/o C diff colitis
h/o severe neuropathy from CR-01 immunotoxin, now improving
s/p Right knee surgery
s/p Tonsillectomy
Recent b/l upper lobe pneumonia treated in CT [**2138-5-30**]
.
Oncologic History:
Pt developed a broken rib in [**2133**],was treated conservatively at
the time, intermittently treated with anti-inflammatory agents.
He then noticed a small bump adjacent to his sternum, which
began to grow through [**2135-4-30**] at which time he was evaluated
at [**Hospital 33316**] Hospital in [**Location (un) **], [**State 2748**]. A surgeon
performed a FNA biopsy of the parasternal mass which showed
metastatic melanoma.  Per his most recent oncology note, his
prior treatments include:
.
1.  Biopsy of a parasternal mass at the site of a pathologic
sternal fracture which revealed metastatic melanoma in 05/[**2135**].
The patient had no prior history of melanoma and no suspicious
skin lesions.
2.  Partial sternectomy with resection of the parasternal mass
in
07/[**2135**].
3.  High-dose IL-2 at the National Cancer Institute Surgery
Branch in 12/[**2135**]. The patient was enrolled in a protocol that
involved the administration of TIL generated from the resected
tumor.  However, no TIL could be grown from the tumor specimen
and the patient therefore received only IL-2.
4.  Medarex anti-CTLA-4 biomarker trial.  Treatment was
complicated by several autoimmune side effects including
colitis,
fever, arthralgias, and elevated transaminases.
5.  CyberKnife treatment to an isolated right medial pulmonary
mass which was at the time the only growing tumor.
6.  Radiation therapy to T7-12.
7.  A second cycle of the CTLA-4 antibody in 06/[**2137**].  This
treatment was complicated by autoimmune colitis and later, the
development of a superimposed C. difficile colitis that failed
to
respond to Flagyl and required oral vancomycin.
8.  Cryoablation of a large LLL mass by Dr. [**First Name (STitle) 4702**] of the
Interventional Pulmonary Department in [**Location (un) **], [**State 2748**].
The procedure was complicated by the development of a
pneumothorax that required the placement of a Pleurx catheter,
which has long since been removed.
9.  Treatment at [**Hospital1 56915**] with the CR-001 immunotoxin.
This treatment gave rise to a severe peripheral neuropathy that
is slowly improving.
10. Off-study Sutent therapy.

MEDICATION ON ADMISSION: Lexapro 10mg daily
Esomeprazole 40mg daily
Fentanyl patch 50 mcg per hour Q48H
Dilaudid 2 mg Q4H prn pain (very rare use)
Maalox, Lidocaine, Benadryl mouthwash
Lorazepam 1mg PO Q4H prn (very rare use)
Metoprolol succinate 50mg [**Hospital1 **]
Sunitinib 50 mg daily currently on day 4 of 10 day course
Albuterol inhaler Q2H prn
Combivent inhaler Q6H
Colace 100mg [**Hospital1 **]
Humalog sliding scale (not getting doses b/c sugar not high
enough)
On vancomycin PO taper:
125mg Q6H x 3 days, then 125mg Q12H x 7 days, then 125mg daily x
7 days

ALLERGIES: Morphine Sulfate / Penicillins / Adhesive Tape

PHYSICAL EXAM: 97.2    110    117/76    38    99% 2L
Very thin, pale man in moderate respiratory distress.  Otherwise
appears comfortable but very sleepy.
+Temporal wasting.  No scleral icterus.  EOMI.
Face symmetric.  OP clear, MMM.
Neck supple, no JVD, no thyroid enlargement, no palpable
cervical adenopathy.
S1, S2, regular tachycardia, hyperdynamic PMI, no murmur.
Lungs with diffuse coarse crackles throughout, expiratory wheeze
R>L.  Tachypneic and appears to be using accessory muscles
although respiratory pattern somewhat affected by history of
excision of part of sternum.
+BS, soft, not tender or distended.  + hepatomegaly.
No LE edema.  Distal pulses palpable and extremities warm.
Skin is very pale without appreciable rash.

FAMILY HISTORY: Father with melanoma in his 30s.

SOCIAL HISTORY: Lives in CT with his wife and daughter.  [**Name (NI) **] cats and dogs.  No
alcohol, smoking, or IV drug use.  Has home health aide.
Acute respiratory failure,Pneumonia, organism unspecified,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Acute posthemorrhagic anemia,Paroxysmal ventricular tachycardia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Hyperpotassemia,Anxiety state, unspecified,Neoplasm related pain (acute) (chronic),Personal history of malignant melanoma of skin,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy
Acute respiratry failure,Pneumonia, organism NOS,Secondary malig neo lung,Sec mal neo brain/spine,Ac posthemorrhag anemia,Parox ventric tachycard,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypothyroidism NOS,Pure hypercholesterolem,Hyperpotassemia,Anxiety state NOS,Neoplasm related pain,Hx-malig skin melanoma,Hx of irradiation,Hx antineoplastic chemo
Admission Date:  [**2138-7-14**]              Discharge Date:   [**2138-7-25**]

Date of Birth:  [**2097-1-9**]             Sex:   M

Service: MEDICINE

Allergies:
Morphine Sulfate / Penicillins / Adhesive Tape

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
Endotracheal Intubation, mechanical ventilation
Bronchoscopy
Insertion of arterial line,
femoral TLC

History of Present Illness:
Mr. [**Known lastname 3451**] is a 41yo gentleman with h/o melanoma metastatic to his
lung, liver, heart, skin, and bone recently treated at an OSH
for pneumonia who presents with shortness of breath and fevers.
.
Much of the history was obtained from the patient's wife as the
patient was very sleepy upon arrival to the unit.  The patient
was admitted to a hospital in [**State 2748**] [**Date range (1) 38269**] with
pneumonia.  He was discharged on a course of cefuroxime, flagyl,
and levofloxacin, which he has since completed.  In addition, he
was given a 5 week course of prophylactic PO vancomycin given a
history of severe C diff colitis in the past.  He had been doing
well at home, getting about with a walker or wheelchair and
improving his PO intake.  About two or three days ago, he began
to have increased work of breathing.  He was having some fevers
at home as well but no shaking chills.  In addition, he had a
cough that was productive, at one point of foul-smelling green
sputum.  There were times he had some blood-streaked sputum as
well.
.
In the ED, initial VS were:  101.8 rectal  110/70   119   22
99%.  CTA chest was negative for PE but showed airspace
consolidation suggestive of RLL pneumonia.  He was given
vancomycin, cefepime, and levofloxacin.  In addition, IP was
contact[**Name (NI) **] for possible flexible bronchoscopy in the morning to
help relieve any obstruction.  Because the team was anticipating
the possibility of a PE, they also obtained a non-contrast head
CT, which unfortunately demonstrated likely new brain mets.
Both the patient and his oncologist were informed about this.
.
His ED course was also notable for an episode when his wife
stated he did not respond to verbal or tactile stimuli x 1
minute.  This occurred after 1mg IV dilaudid followed 45 minutes
later by 1mg IV ativan.  When the MD arrived to assess the
patient, he was awake and responsive but somewhat consfused.  He
improved after a dose of narcan.  Finally, he received 2L of NS
and was started on a NS infusion at 150cc/hr.
.
Upon arrival to the ICU, he was pleasant but sleepy.  He did not
feel particularly short of breath.
.
Of note, Mr. [**Known lastname 3451**] was seen by his oncologist on [**2138-6-11**] and
given a 7 day course of levofloxacin for incidentally-noted LUL
infiltrate on staging chest CT.
.
On review of systems, his wife notes that he has had episodes
recently of being unresponsive after getting his fentanyl patch
similar to what happened in the ED.  He also has been having
some loose stool lately.


Past Medical History:
Melanoma metastatic to lung, liver, heart, skin, and bone
(spine) s/p high-dose IL-2 x 4 cycles, CTLA-4 antibody in [**5-6**] x
2, then EBRT to T7-T12 spine [**3-9**], currently receiving
palliative XRT to hip mets (next dose due [**7-15**])
Hypercholesterolemia
Hypothyroidism
Sinus tachycardia at baseline
Diabetes mellitus [**3-3**] study drug, developed in [**2-7**],
diet-controlled
h/o C diff colitis
h/o severe neuropathy from CR-01 immunotoxin, now improving
s/p Right knee surgery
s/p Tonsillectomy
Recent b/l upper lobe pneumonia treated in CT [**2138-5-30**]
.
Oncologic History:
Pt developed a broken rib in [**2133**],was treated conservatively at
the time, intermittently treated with anti-inflammatory agents.
He then noticed a small bump adjacent to his sternum, which
began to grow through [**2135-4-30**] at which time he was evaluated
at [**Hospital 33316**] Hospital in [**Location (un) **], [**State 2748**]. A surgeon
performed a FNA biopsy of the parasternal mass which showed
metastatic melanoma.  Per his most recent oncology note, his
prior treatments include:
.
1.  Biopsy of a parasternal mass at the site of a pathologic
sternal fracture which revealed metastatic melanoma in 05/[**2135**].
The patient had no prior history of melanoma and no suspicious
skin lesions.
2.  Partial sternectomy with resection of the parasternal mass
in
07/[**2135**].
3.  High-dose IL-2 at the National Cancer Institute Surgery
Branch in 12/[**2135**]. The patient was enrolled in a protocol that
involved the administration of TIL generated from the resected
tumor.  However, no TIL could be grown from the tumor specimen
and the patient therefore received only IL-2.
4.  Medarex anti-CTLA-4 biomarker trial.  Treatment was
complicated by several autoimmune side effects including
colitis,
fever, arthralgias, and elevated transaminases.
5.  CyberKnife treatment to an isolated right medial pulmonary
mass which was at the time the only growing tumor.
6.  Radiation therapy to T7-12.
7.  A second cycle of the CTLA-4 antibody in 06/[**2137**].  This
treatment was complicated by autoimmune colitis and later, the
development of a superimposed C. difficile colitis that failed
to
respond to Flagyl and required oral vancomycin.
8.  Cryoablation of a large LLL mass by Dr. [**First Name (STitle) 4702**] of the
Interventional Pulmonary Department in [**Location (un) **], [**State 2748**].
The procedure was complicated by the development of a
pneumothorax that required the placement of a Pleurx catheter,
which has long since been removed.
9.  Treatment at [**Hospital1 56915**] with the CR-001 immunotoxin.
This treatment gave rise to a severe peripheral neuropathy that
is slowly improving.
10. Off-study Sutent therapy.


Social History:
Lives in CT with his wife and daughter.  [**Name (NI) **] cats and dogs.  No
alcohol, smoking, or IV drug use.  Has home health aide.

Family History:
Father with melanoma in his 30s.

Physical Exam:
97.2    110    117/76    38    99% 2L
Very thin, pale man in moderate respiratory distress.  Otherwise
appears comfortable but very sleepy.
+Temporal wasting.  No scleral icterus.  EOMI.
Face symmetric.  OP clear, MMM.
Neck supple, no JVD, no thyroid enlargement, no palpable
cervical adenopathy.
S1, S2, regular tachycardia, hyperdynamic PMI, no murmur.
Lungs with diffuse coarse crackles throughout, expiratory wheeze
R>L.  Tachypneic and appears to be using accessory muscles
although respiratory pattern somewhat affected by history of
excision of part of sternum.
+BS, soft, not tender or distended.  + hepatomegaly.
No LE edema.  Distal pulses palpable and extremities warm.
Skin is very pale without appreciable rash.


Pertinent Results:
LABS ON ADMISSION:
[**2138-7-14**] 04:30PM BLOOD WBC-9.4 RBC-2.72* Hgb-7.5* Hct-24.2*
MCV-89 MCH-27.5 MCHC-30.9* RDW-19.8* Plt Ct-218
[**2138-7-14**] 04:30PM BLOOD PT-15.3* PTT-28.7 INR(PT)-1.3*
[**2138-7-14**] 04:30PM BLOOD Glucose-102 UreaN-16 Creat-0.5 Na-134
K-5.5* Cl-98 HCO3-23 AnGap-19
[**2138-7-14**] 04:30PM BLOOD ALT-107* AST-174* LD(LDH)-319*
CK(CPK)-29* AlkPhos-503* TotBili-0.5
[**2138-7-14**] 04:30PM BLOOD Albumin-3.0* Calcium-8.3* Phos-4.1 Mg-1.8
.
RADIOLOGY:
CT Head:
IMPRESSION: Interval development of a 12 x 7 mm
hyper-attenuating focus
located in the right occipital lobe given history of metastatic
melanoma is highly concerning for a focus metastasis. This can
be more fully
characterized with MR examination as clinically indicated.
.
CTA Chest:
1. Overall, progression of disease in the diffuse metastatic
disease
involving hilar, mediastinal, and axillary lymphadenopathy,
pulmonary
metastasis, cardiac, osseous, and hepatic metastases.
2. New multifocal parenchymal airspace consolidation involving
the posterior aspect of the right lower lobe, the right middle
lobe, that likely represents in multifocal superimposed
infection.
3. Post-obstructive changes involving the left upper lobe with
associated
collapse.
4. No evidence of pulmonary embolism.

Brief Hospital Course:
Shortness of breath and fevers: Pneumonia.  The patient was
treated with a course of broad spectrum abx for nosocomial PNA.
His fevers improved.  He was noted to have hemoptysis and was
intubated for resp distress as well as for need for
bronchoscpoy.  He had tumor bleeding in the RLL and underwent
rigid bronchoscopy x 3 for argon treatments and
photocoagulation, these were temporarily successful.  Finally
underwent RLL embolization.   This was technically sucessful but
hemoptysis continued, patient was extubated w/ a plan for no
further reintubation and comfort measures.  Patient died on [**7-25**]
at 19:27 secondary to pulmonary hemorrhage causing respiratory
arrest which is all related to his underlying metastatic
melanoma.


Medications on Admission:
Lexapro 10mg daily
Esomeprazole 40mg daily
Fentanyl patch 50 mcg per hour Q48H
Dilaudid 2 mg Q4H prn pain (very rare use)
Maalox, Lidocaine, Benadryl mouthwash
Lorazepam 1mg PO Q4H prn (very rare use)
Metoprolol succinate 50mg [**Hospital1 **]
Sunitinib 50 mg daily currently on day 4 of 10 day course
Albuterol inhaler Q2H prn
Combivent inhaler Q6H
Colace 100mg [**Hospital1 **]
Humalog sliding scale (not getting doses b/c sugar not high
enough)
On vancomycin PO taper:
125mg Q6H x 3 days, then 125mg Q12H x 7 days, then 125mg daily x
7 days

Discharge Medications:
pt expired

Discharge Disposition:
Expired

Discharge Diagnosis:
pt expired

Discharge Condition:
pt expired

Discharge Instructions:
pt expired

Followup Instructions:
pt expired
{'Acute respiratory failure,Pneumonia, organism unspecified,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Acute posthemorrhagic anemia,Paroxysmal ventricular tachycardia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Hyperpotassemia,Anxiety state, unspecified,Neoplasm related pain (acute) (chronic),Personal history of malignant melanoma of skin,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy'}


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: dyspnea

PRESENT ILLNESS: Mr. [**Known lastname 3451**] is a 41yo gentleman with h/o melanoma metastatic to his
lung, liver, heart, skin, and bone recently treated at an OSH
for pneumonia who presents with shortness of breath and fevers.
.
Much of the history was obtained from the patient's wife as the
patient was very sleepy upon arrival to the unit.  The patient
was admitted to a hospital in [**State 2748**] [**Date range (1) 38269**] with
pneumonia.  He was discharged on a course of cefuroxime, flagyl,
and levofloxacin, which he has since completed.  In addition, he
was given a 5 week course of prophylactic PO vancomycin given a
history of severe C diff colitis in the past.  He had been doing
well at home, getting about with a walker or wheelchair and
improving his PO intake.  About two or three days ago, he began
to have increased work of breathing.  He was having some fevers
at home as well but no shaking chills.  In addition, he had a
cough that was productive, at one point of foul-smelling green
sputum.  There were times he had some blood-streaked sputum as
well.
.
In the ED, initial VS were:  101.8 rectal  110/70   119   22
99%.  CTA chest was negative for PE but showed airspace
consolidation suggestive of RLL pneumonia.  He was given
vancomycin, cefepime, and levofloxacin.  In addition, IP was
contact[**Name (NI) **] for possible flexible bronchoscopy in the morning to
help relieve any obstruction.  Because the team was anticipating
the possibility of a PE, they also obtained a non-contrast head
CT, which unfortunately demonstrated likely new brain mets.
Both the patient and his oncologist were informed about this.
.
His ED course was also notable for an episode when his wife
stated he did not respond to verbal or tactile stimuli x 1
minute.  This occurred after 1mg IV dilaudid followed 45 minutes
later by 1mg IV ativan.  When the MD arrived to assess the
patient, he was awake and responsive but somewhat consfused.  He
improved after a dose of narcan.  Finally, he received 2L of NS
and was started on a NS infusion at 150cc/hr.
.
Upon arrival to the ICU, he was pleasant but sleepy.  He did not
feel particularly short of breath.
.
Of note, Mr. [**Known lastname 3451**] was seen by his oncologist on [**2138-6-11**] and
given a 7 day course of levofloxacin for incidentally-noted LUL
infiltrate on staging chest CT.
.
On review of systems, his wife notes that he has had episodes
recently of being unresponsive after getting his fentanyl patch
similar to what happened in the ED.  He also has been having
some loose stool lately.

MEDICAL HISTORY: Melanoma metastatic to lung, liver, heart, skin, and bone
(spine) s/p high-dose IL-2 x 4 cycles, CTLA-4 antibody in [**5-6**] x
2, then EBRT to T7-T12 spine [**3-9**], currently receiving
palliative XRT to hip mets (next dose due [**7-15**])
Hypercholesterolemia
Hypothyroidism
Sinus tachycardia at baseline
Diabetes mellitus [**3-3**] study drug, developed in [**2-7**],
diet-controlled
h/o C diff colitis
h/o severe neuropathy from CR-01 immunotoxin, now improving
s/p Right knee surgery
s/p Tonsillectomy
Recent b/l upper lobe pneumonia treated in CT [**2138-5-30**]
.
Oncologic History:
Pt developed a broken rib in [**2133**],was treated conservatively at
the time, intermittently treated with anti-inflammatory agents.
He then noticed a small bump adjacent to his sternum, which
began to grow through [**2135-4-30**] at which time he was evaluated
at [**Hospital 33316**] Hospital in [**Location (un) **], [**State 2748**]. A surgeon
performed a FNA biopsy of the parasternal mass which showed
metastatic melanoma.  Per his most recent oncology note, his
prior treatments include:
.
1.  Biopsy of a parasternal mass at the site of a pathologic
sternal fracture which revealed metastatic melanoma in 05/[**2135**].
The patient had no prior history of melanoma and no suspicious
skin lesions.
2.  Partial sternectomy with resection of the parasternal mass
in
07/[**2135**].
3.  High-dose IL-2 at the National Cancer Institute Surgery
Branch in 12/[**2135**]. The patient was enrolled in a protocol that
involved the administration of TIL generated from the resected
tumor.  However, no TIL could be grown from the tumor specimen
and the patient therefore received only IL-2.
4.  Medarex anti-CTLA-4 biomarker trial.  Treatment was
complicated by several autoimmune side effects including
colitis,
fever, arthralgias, and elevated transaminases.
5.  CyberKnife treatment to an isolated right medial pulmonary
mass which was at the time the only growing tumor.
6.  Radiation therapy to T7-12.
7.  A second cycle of the CTLA-4 antibody in 06/[**2137**].  This
treatment was complicated by autoimmune colitis and later, the
development of a superimposed C. difficile colitis that failed
to
respond to Flagyl and required oral vancomycin.
8.  Cryoablation of a large LLL mass by Dr. [**First Name (STitle) 4702**] of the
Interventional Pulmonary Department in [**Location (un) **], [**State 2748**].
The procedure was complicated by the development of a
pneumothorax that required the placement of a Pleurx catheter,
which has long since been removed.
9.  Treatment at [**Hospital1 56915**] with the CR-001 immunotoxin.
This treatment gave rise to a severe peripheral neuropathy that
is slowly improving.
10. Off-study Sutent therapy.

MEDICATION ON ADMISSION: Lexapro 10mg daily
Esomeprazole 40mg daily
Fentanyl patch 50 mcg per hour Q48H
Dilaudid 2 mg Q4H prn pain (very rare use)
Maalox, Lidocaine, Benadryl mouthwash
Lorazepam 1mg PO Q4H prn (very rare use)
Metoprolol succinate 50mg [**Hospital1 **]
Sunitinib 50 mg daily currently on day 4 of 10 day course
Albuterol inhaler Q2H prn
Combivent inhaler Q6H
Colace 100mg [**Hospital1 **]
Humalog sliding scale (not getting doses b/c sugar not high
enough)
On vancomycin PO taper:
125mg Q6H x 3 days, then 125mg Q12H x 7 days, then 125mg daily x
7 days

ALLERGIES: Morphine Sulfate / Penicillins / Adhesive Tape

PHYSICAL EXAM: 97.2    110    117/76    38    99% 2L
Very thin, pale man in moderate respiratory distress.  Otherwise
appears comfortable but very sleepy.
+Temporal wasting.  No scleral icterus.  EOMI.
Face symmetric.  OP clear, MMM.
Neck supple, no JVD, no thyroid enlargement, no palpable
cervical adenopathy.
S1, S2, regular tachycardia, hyperdynamic PMI, no murmur.
Lungs with diffuse coarse crackles throughout, expiratory wheeze
R>L.  Tachypneic and appears to be using accessory muscles
although respiratory pattern somewhat affected by history of
excision of part of sternum.
+BS, soft, not tender or distended.  + hepatomegaly.
No LE edema.  Distal pulses palpable and extremities warm.
Skin is very pale without appreciable rash.

FAMILY HISTORY: Father with melanoma in his 30s.

SOCIAL HISTORY: Lives in CT with his wife and daughter.  [**Name (NI) **] cats and dogs.  No
alcohol, smoking, or IV drug use.  Has home health aide. 

### Response:
{'Acute respiratory failure,Pneumonia, organism unspecified,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of brain and spinal cord,Acute posthemorrhagic anemia,Paroxysmal ventricular tachycardia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Hyperpotassemia,Anxiety state, unspecified,Neoplasm related pain (acute) (chronic),Personal history of malignant melanoma of skin,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy'}
