CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 71M w/Lung cancer s/p RUL lobectomy p/w severe sob
improved s/p solumedrol, Banana bag x1, levaquin 750mg IV x1at
[**Last Name (un) 4068**]. Pt presented to OSH for increasing SOB. Since [**Name (NI) 2974**] pt
noticed increasing SOB w/minimal activity, having to stop after
[**5-11**] steps and rest for 30min to recover from SOB. Throughout
sat/sun noticed increasing SOB w/even less activity, increasing
non-productive cough. Pt got concerned and went to local ED. Pt
denies any CP/Palpitation, no diaphoresis. No f/c/sweats. No
N/V/Diarrhea. No LH/Dizziness or confusion. No weight loss,
diminished appetite, no back pain.
Of note, pt stated that he quit smoking and drinking on [**Month/Day (3) 2974**].
Pt had been drinking his usual amount of ETOH, took an ambien
tablet and had a horrible reaction whereby he thought he was
going to die. Pt transferred from OSH to [**Hospital1 18**] for further
management. He receivd steroids and levaquin prior to transfer.

MEDICAL HISTORY: 1. Hypertension.
2. Hypercholesterolemia.
3. History of colon polyp resection
4. Squamous Cell CA of lung s/p RUL lobectomy: [**2133**] done here
5. COPD, Emphysema: [**10-11**] FEV1 0.81L, FVC 1.66, FEV1/FVC 49
DLCO 69%
6. basal cell carcinoma of the chest wall

MEDICATION ON ADMISSION: 1. Lisinopril 40 mg PO q.d.
2. Atenolol 100 mg PO q.d.
3. Lescol
4. Advair
5. Spiriva

ALLERGIES: Penicillins / Ambien

PHYSICAL EXAM: VS: BP 158/88 HR 80 RR 20 98%3LNC
GEN: NAD, speaking in short sentences, lying comfortably in bed

FAMILY HISTORY: -M: died of Alzheimer's
-F: Died of aneurysm
-Brother died of stomach CA w/mets to LN
- denies fam history of heart disease

SOCIAL HISTORY: The patient is a retired engineer. History of smoking (60 pack
years). Quit smoking 2days ago. Extensive ETOH h/o-4 drinks of
Burbon per day for several years-quit [**Month (only) 2974**].
Pneumonitis due to inhalation of food or vomitus,Obstructive chronic bronchitis with (acute) exacerbation,Hyposmolality and/or hyponatremia,Alcohol abuse, continuous,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Pure hypercholesterolemia
Food/vomit pneumonitis,Obs chr bronc w(ac) exac,Hyposmolality,Alcohol abuse-continuous,Hypertension NOS,Hx-bronchogenic malignan,Pure hypercholesterolem
Admission Date:  [**2138-2-3**]              Discharge Date:   [**2138-2-7**]

Date of Birth:  [**2067-1-4**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Ambien

Attending:[**First Name3 (LF) 5301**]
Chief Complaint:
SOB

Major Surgical or Invasive Procedure:
none


History of Present Illness:
71M w/Lung cancer s/p RUL lobectomy p/w severe sob
improved s/p solumedrol, Banana bag x1, levaquin 750mg IV x1at
[**Last Name (un) 4068**]. Pt presented to OSH for increasing SOB. Since [**Name (NI) 2974**] pt
noticed increasing SOB w/minimal activity, having to stop after
[**5-11**] steps and rest for 30min to recover from SOB. Throughout
sat/sun noticed increasing SOB w/even less activity, increasing
non-productive cough. Pt got concerned and went to local ED. Pt
denies any CP/Palpitation, no diaphoresis. No f/c/sweats. No
N/V/Diarrhea. No LH/Dizziness or confusion. No weight loss,
diminished appetite, no back pain.
Of note, pt stated that he quit smoking and drinking on [**Month/Day (3) 2974**].
Pt had been drinking his usual amount of ETOH, took an ambien
tablet and had a horrible reaction whereby he thought he was
going to die. Pt transferred from OSH to [**Hospital1 18**] for further
management. He receivd steroids and levaquin prior to transfer.

.
ED Course: Here HD stable with sats mid 90s on 4L NC. Initial
VSS ASA 325mg x1.



Past Medical History:
1. Hypertension.
2. Hypercholesterolemia.
3. History of colon polyp resection
4. Squamous Cell CA of lung s/p RUL lobectomy: [**2133**] done here
5. COPD, Emphysema: [**10-11**] FEV1 0.81L, FVC 1.66, FEV1/FVC 49
DLCO 69%
6. basal cell carcinoma of the chest wall


Social History:
The patient is a retired engineer. History of smoking (60 pack
years). Quit smoking 2days ago. Extensive ETOH h/o-4 drinks of
Burbon per day for several years-quit [**Month (only) 2974**].



Family History:
-M: died of Alzheimer's
-F: Died of aneurysm
-Brother died of stomach CA w/mets to LN
- denies fam history of heart disease



Physical Exam:
VS: BP 158/88 HR 80 RR 20 98%3LNC
GEN: NAD, speaking in short sentences, lying comfortably in bed

HEENT: MMM, OP clear, no cervical LAD
RESP: Diminished BS, barrel chested, expiratory wheezing and
rhonchi at bases, diminished bs RUL
CV: distant heart sounds, Nml s1,s2, no M/R/G
ABD: Soft ND/NT +BS
EXT: No C/C/E, warm, 2+DP pulses b/l
NEURO: A&O x3, no focal deficits


Pertinent Results:
labs on admission:
[**2138-2-2**] 07:00PM   WBC-16.6* RBC-4.11* HGB-15.0 HCT-42.7
MCV-104* MCH-36.4* MCHC-35.0 RDW-13.6
[**2138-2-2**] 07:00PM   NEUTS-85* BANDS-13* LYMPHS-0 MONOS-1* EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0 PLASMA-1*
[**2138-2-2**] 07:00PM   cTropnT-<0.01
[**2138-2-2**] 07:00PM   CK(CPK)-54
[**2138-2-2**] 07:00PM   GLUCOSE-150* UREA N-26* CREAT-0.9 SODIUM-125*
POTASSIUM-3.9 CHLORIDE-88* TOTAL CO2-28 ANION GAP-13
[**2138-2-2**] 07:12PM   LACTATE-1.8
[**2138-2-3**] 02:25AM   cTropnT-<0.01
[**2138-2-3**] 02:25AM   CK(CPK)-50
.
cta [**2-2**]: IMPRESSION:
1. No evidence of PE.
2. Multifocal consolidative opacities as described with
predominance in the posterior lower lobes bilaterally,
concerning for pneumonia.
3. Right hilar and mediastinal lymphadenopathy.
4. Soft tissue opacity adjacent the lung Ca resection site, and
multifocal opacities along bronchovascular bundles raise the
suspicion for lung Ca recurrence. Comparison to old studies
would be very helpful (none are available at [**Hospital1 18**] on PACS). If
such studies are unavailable, then a PET-CT may be warranted for
further investigation.
5. Collapsed medial segment of the right middle lobe. Bronchial
obstruction by recurrent lung Ca is of concern.
6. Hypoattenuating lesion in the caudate lobe of the liver,
incompletely characterized on this single contrast study.
7. Moderate-severe emphysema.


Brief Hospital Course:
In brief, the patient is a 71 yo M w/ EtOH, COPD, NSCLC s/p RUL
Lobectomy with dyspnea likely [**2-7**] aspiration pneumonia and COPD
flare, c/b by MS change reaction to ambien.
.
1. Dyspnea: This was thought likely secondary to aspiration
pneumonia and COPD flare.  His breathing improved with
aggressive bronchodilator therapy, corticosteroids and
antibiotics.  He will complete a 14 day course of antibiotics.
He was discharged with stable oxygenation with supplemental O2
that will be made available at home. He was referred to
outpatient pulmonary rehab.
.
2. H/o NSCLC s/p RUL lobectomy: A chest CT scan during admission
demonstrated new nodules at previous scar site also with large
mediastinal LN. A pulmonary consult was obtained and discussed
his case in Thoracic Tumor Board regarding the possible relapse
of his lung cancer.  The location of the mediastinal lymph node
was thought most amenable to endoscopic ultrasound guided biopsy
via an esophageal approach.  He was referred to the ERCP group
for biopsy following resolution of his acute illness.
.
3. Mental Changes: The patient had acute MS change on night
after admission following a dose of Ambien which was thought the
likely inciting [**Doctor Last Name 360**].  As the patient has a history of alcohol
abuse there was concern for alcohol withdrawal however his rapid
recovery without specific intervention made this unlikely.
Otherwise his vital signs, chemistries and blood gas were
essentially unchanged from his baseline.
.
4. Hypertension: The patient's baseline hypertension was mildly
exacerbated by steroids, anticipate improvement as steroids
taper. He continued on his home beta-blocker and ACEi.
.
5. EtOH abuse: Pt. has extensive history of abuse, no current
signs of withdrawal. As above, MS [**First Name (Titles) 4245**] [**Last Name (Titles) 4246**]. patient
states that he just quit drinking (as of this admission). He was
monitored per CIWA protocol without incident.
.
6. Blood cx from OSH: Prior to transfer to [**Hospital1 18**], blood cultures
were drawn these resulted as 1/4 bottles w/ coag neg staph. This
was thought likely skin contaminate. Repeat BCx were negative.
.
7. Hyperlipidemia: There were no acute issues. Continue statin.

.
8. PPX: PPI
.
9. FEN: Cardiac diet, moniter and replete lytes PRN. insulin
sliding scale for glucose control while in the hospital. As the
steroids are tapered his blood sugars should normalize.
.
10. CODE: Full


Medications on Admission:
1. Lisinopril 40 mg PO q.d.
2. Atenolol 100 mg PO q.d.
3. Lescol
4. Advair
5. Spiriva


Discharge Medications:
1. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device
Sig: One (1) capsule Inhalation once a day.
2. Advair Diskus 250-50 mcg/Dose Disk with Device Sig: One (1)
puff Inhalation twice a day.
3. Oxygen-Air Delivery Systems     Device Sig: Three (3)
Liters/minute Miscellaneous continuous: Home O2
Portability Post-O System.
Disp:*1 system* Refills:*0*
4. Prednisone 10 mg Tablet Sig: 1-4 Tablets PO once a day: take
4 tablets for 5 days, then 2 tablets for 5 days, then 1 tablet
for 2 days.
Disp:*32 Tablet(s)* Refills:*0*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 9 days.
Disp:*9 Tablet(s)* Refills:*0*
6. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 9 days.
Disp:*27 Tablet(s)* Refills:*0*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours) for
2 weeks.
Disp:*14 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
8. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
9. Lisinopril 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
10. Atenolol 100 mg Tablet Sig: One (1) Tablet PO once a day.
11. Lescol 40 mg Capsule Sig: One (1) Capsule PO once a day.
Disp:*30 Capsule(s)* Refills:*2*
12. Albuterol Sulfate 90 mcg/Actuation Aerosol Sig: Two (2)
puffs Inhalation every six (6) hours for 2 weeks.
Disp:*112 puffs* Refills:*0*
13. Albuterol Sulfate 90 mcg/Actuation Aerosol Sig: 1-2 puffs
Inhalation every 4-6 hours as needed for chest tightness.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Pneumonia
COPD exacerbation
.
Secondary:
Mediastinal Lymphadenopathy
Delirium
Non-small cell lung cancer s/p resection
Hypertension


Discharge Condition:
good. stable on minimal supplemental oxygen by nasal cannula.
ambulating without assist. tolerating oral medications and
nutrition.


Discharge Instructions:
You were evaluated and treated for a pneumonia with exacerbation
of your COPD.  You were given antibiotics, steroids, nebulizers
to improve your breathing.  The CT scan of your chest did show
an enlarged lymph node that would need more evaluation once you
are recovered from this acute illness.
Your course was complicated by marked confusion following a dose
of ambien.  This medicine is now listed in your allergies.
.
Please take all medications as prescribed.
.
Please make and attend all recommended follow-up appointments.
.
If you develop any new or concerning symptoms particularly chest
pain, shortness of breath, new fever; please seek medical
attention.

Followup Instructions:
1. Pulmonary: Dr. [**First Name8 (NamePattern2) 30642**] [**Name (STitle) **] on Thursday [**2138-2-13**] at 12pm.
Please call [**Telephone/Fax (1) 6163**] with questions.
2. Primary Care: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. Please call [**Telephone/Fax (1) 3070**] to
schedule an appointment to be seen within the next 2 weeks. His
office will be expecting your call.
3. Gastroenterology: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for endoscopic biopsy.
Please call ([**Telephone/Fax (1) 2306**] to schedule an appointment within the
next 2-3 weeks.  His office will be expecting your call.
4. Pulmonary Rehab: please call the number provided to you to
set up an outpatient appointment.
{'Pneumonitis due to inhalation of food or vomitus,Obstructive chronic bronchitis with (acute) exacerbation,Hyposmolality and/or hyponatremia,Alcohol abuse, continuous,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Pure hypercholesterolemia'}


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: SOB

PRESENT ILLNESS: 71M w/Lung cancer s/p RUL lobectomy p/w severe sob
improved s/p solumedrol, Banana bag x1, levaquin 750mg IV x1at
[**Last Name (un) 4068**]. Pt presented to OSH for increasing SOB. Since [**Name (NI) 2974**] pt
noticed increasing SOB w/minimal activity, having to stop after
[**5-11**] steps and rest for 30min to recover from SOB. Throughout
sat/sun noticed increasing SOB w/even less activity, increasing
non-productive cough. Pt got concerned and went to local ED. Pt
denies any CP/Palpitation, no diaphoresis. No f/c/sweats. No
N/V/Diarrhea. No LH/Dizziness or confusion. No weight loss,
diminished appetite, no back pain.
Of note, pt stated that he quit smoking and drinking on [**Month/Day (3) 2974**].
Pt had been drinking his usual amount of ETOH, took an ambien
tablet and had a horrible reaction whereby he thought he was
going to die. Pt transferred from OSH to [**Hospital1 18**] for further
management. He receivd steroids and levaquin prior to transfer.

MEDICAL HISTORY: 1. Hypertension.
2. Hypercholesterolemia.
3. History of colon polyp resection
4. Squamous Cell CA of lung s/p RUL lobectomy: [**2133**] done here
5. COPD, Emphysema: [**10-11**] FEV1 0.81L, FVC 1.66, FEV1/FVC 49
DLCO 69%
6. basal cell carcinoma of the chest wall

MEDICATION ON ADMISSION: 1. Lisinopril 40 mg PO q.d.
2. Atenolol 100 mg PO q.d.
3. Lescol
4. Advair
5. Spiriva

ALLERGIES: Penicillins / Ambien

PHYSICAL EXAM: VS: BP 158/88 HR 80 RR 20 98%3LNC
GEN: NAD, speaking in short sentences, lying comfortably in bed

FAMILY HISTORY: -M: died of Alzheimer's
-F: Died of aneurysm
-Brother died of stomach CA w/mets to LN
- denies fam history of heart disease

SOCIAL HISTORY: The patient is a retired engineer. History of smoking (60 pack
years). Quit smoking 2days ago. Extensive ETOH h/o-4 drinks of
Burbon per day for several years-quit [**Month (only) 2974**]. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Obstructive chronic bronchitis with (acute) exacerbation,Hyposmolality and/or hyponatremia,Alcohol abuse, continuous,Unspecified essential hypertension,Personal history of malignant neoplasm of bronchus and lung,Pure hypercholesterolemia'}
