CHIEF COMPLAINT: hemoptysis

PRESENT ILLNESS: 71 year old man w/ multiple medical problems including locally
invasive laryngopharyngeal cancer developed approx. 75cc
hemoptysis while at XRT today. He has been spitting and coughing
up several tsps of blood daily or sometimes multiple times daily
for about one month leading up to this. Daily cough, which does
not seem associated with hemoptysis.
.
He was seen by ENT in the ED, who performed fiberoptic exam
through trach and did not see any active bleeding or friable
tissue. CTA of neck was performed to rule out invasion of
carotid sheath.
Of note, he was seen in the ED on [**2107-8-30**] for similar
hemoptysis, at which point the bleeding was thought to be coming
from his tumor and pt was discharged home.

MEDICAL HISTORY: Diabetes
Hypertension
Coronary Artery Disease, s/p CABG x 5
Permanent Pacemaker for sick sinus
Peripheral Vascular Disease (AAA s/p repair)
COPD
Spontaneous Pneumothorax s/p chest tube
Colon Cancer s/p resection and chemo (pt does not know details
of therapy) in approximately [**2102**]

MEDICATION ON ADMISSION: # Albuterol Sulfate 0.083 % neb Q6H and Q2H prn
# ipratropium neb
# Lisinopril 10 mg DAILY
# Metoprolol Tartrate 25 mg [**Hospital1 **]
# Clonidine 0.2 mg/24 hr Patch QTHUR
# HydrALAzine 20 mg IV Q6H:PRN SBP > 160
# Insulin Glargine 10 units QHS
# Insulin sliding scale
# lasix 20mg daily
# Nitroglycerin 0.3 mg SL prn
# esomeprazole 20 mg daily
# reglan
# ativan 0.5mg prn
# morphine prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: 98.2 194/72 78 20 97% on 35% trach collar
GEN: cachectic male lying comfortably in bed
HEENT: NC/AT, + temporal wasting, OP clear
NECK: trach with button
CARDIAC: heart sounds obscured by lung sounds
LUNG: rhonchorous throughout
ABDOMEN: scaphoid, PEG site clean, dry, healing
EXT: decreased bulk and tone, no c/c/e
NEURO: grossly intact
SKIN: no rashes

FAMILY HISTORY: Aunt with breast cancer and uncle with throat cancer.

SOCIAL HISTORY: Patient is single. He does not have any children. He reports he
has been an alcoholic for the past 45 years and had been
drinking 2 glasses wine per day up to hospitalization in [**Month (only) **].
He has a 59 pack year smoking history.
Malignant neoplasm of pyriform sinus,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Anemia in neoplastic disease,Coronary atherosclerosis of unspecified type of vessel, native or graft,Peripheral vascular disease, unspecified,Unspecified essential hypertension,Aortocoronary bypass status,Personal history of peptic ulcer disease,Cardiac pacemaker in situ,Personal history of malignant neoplasm of large intestine,Tracheostomy status,Personal history of tobacco use
Mal neo pyriform sinus,Chr airway obstruct NEC,Alcohol abuse-unspec,DMII wo cmp nt st uncntr,Abn react-radiotherapy,Anemia in neoplastic dis,Cor ath unsp vsl ntv/gft,Periph vascular dis NOS,Hypertension NOS,Aortocoronary bypass,Prsnl hst peptic ulcr ds,Status cardiac pacemaker,Hx of colonic malignancy,Tracheostomy status,History of tobacco use
Admission Date:  [**2107-9-12**]              Discharge Date:   [**2107-9-15**]

Date of Birth:  [**2036-4-3**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
hemoptysis

Major Surgical or Invasive Procedure:
fiberoptic laryngoscopy
bronchoscopy

History of Present Illness:
71 year old man w/ multiple medical problems including locally
invasive laryngopharyngeal cancer developed approx. 75cc
hemoptysis while at XRT today. He has been spitting and coughing
up several tsps of blood daily or sometimes multiple times daily
for about one month leading up to this. Daily cough, which does
not seem associated with hemoptysis.
.
He was seen by ENT in the ED, who performed fiberoptic exam
through trach and did not see any active bleeding or friable
tissue. CTA of neck was performed to rule out invasion of
carotid sheath.
Of note, he was seen in the ED on [**2107-8-30**] for similar
hemoptysis, at which point the bleeding was thought to be coming
from his tumor and pt was discharged home.


Past Medical History:
Diabetes
Hypertension
Coronary Artery Disease, s/p CABG x 5
Permanent Pacemaker for sick sinus
Peripheral Vascular Disease (AAA s/p repair)
COPD
Spontaneous Pneumothorax s/p chest tube
Colon Cancer s/p resection and chemo (pt does not know details
of therapy) in approximately [**2102**]


Social History:
Patient is single. He does not have any children. He reports he
has been an alcoholic for the past 45 years and had been
drinking 2 glasses wine per day up to hospitalization in [**Month (only) **].
He has a 59 pack year smoking history.


Family History:
Aunt with breast cancer and uncle with throat cancer.

Physical Exam:
VITALS: 98.2 194/72 78 20 97% on 35% trach collar
GEN: cachectic male lying comfortably in bed
HEENT: NC/AT, + temporal wasting, OP clear
NECK: trach with button
CARDIAC: heart sounds obscured by lung sounds
LUNG: rhonchorous throughout
ABDOMEN: scaphoid, PEG site clean, dry, healing
EXT: decreased bulk and tone, no c/c/e
NEURO: grossly intact
SKIN: no rashes


Pertinent Results:
[**2107-9-12**] 03:30PM   WBC-5.8 RBC-3.06* HGB-9.0* HCT-27.4* MCV-90
MCH-29.5 MCHC-32.9 RDW-14.6
[**2107-9-12**] 03:30PM   NEUTS-82.0* LYMPHS-14.1* MONOS-2.1 EOS-1.8
BASOS-0.2
[**2107-9-12**] 03:30PM   PLT COUNT-174
[**2107-9-12**] 03:30PM   PT-13.2* PTT-24.6 INR(PT)-1.1
[**2107-9-12**] 03:30PM   GLUCOSE-93 UREA N-25* CREAT-0.9 SODIUM-140
POTASSIUM-3.6 CHLORIDE-98 TOTAL CO2-38* ANION GAP-8

CXR: Single bedside AP examination labeled "upright at 5:00
p.m." is compared with study dated [**2107-8-30**]. The patient is
status post tracheostomy, median sternotomy with CABG with
left-sided dual-chamber cardiac pacemaker with intact RA and RV
leads, unchanged. There is evidence of underlying hyperinflation
and probable edema. There is persistent moderately large,
posteriorly-layering right pleural effusion with associated
basilar atelectasis. There is a small left pleural effusion with
left basilar atelectasis, as before. The remainder of the lungs
is grossly clear; specifically, there is no new focal airspace
process to specifically suggest pulmonary hemorrhage. Again
demonstrated are numerous surgical clips and gastrostomy tube in
the left upper central abdomen. IMPRESSION: Findings suggestive
of CHF with bilateral pleural effusions, superimposed on
underlying emphysema. However, there is no distinct new airspace
process to suggest pulmonary hemorrhage. The appearance of the
cervicothoracic trachea and tracheostomy site are grossly
unchanged since the [**2107-8-30**] examination.

CTA Neck:
1. There is redemonstration of an ill-defined, heterogeneous
mass that is filling the left piriform sinus, with obliteration
of the airway. Compared to prior study, this lesion appears to
be more extensive.
2. There is no evidence of active extravasation of contrast.
3. There is a right pulmonary parenchymal consolidation that is
partially imaged.

CT Chest:
1. Large right and mild/moderate left pleural effusion, slightly
smaller compared to the previous exam.
2. No lesion seen in the trachea and lobar bronchi.
3. Extensive vascular disease.
4. Please refer to the report from the CTA Neck from one day
prior for description of the known laryngeal mass.

Brief Hospital Course:
71M with head and neck cancer undergoing chemo and XRT with
worsened hemoptysis
# hemoptysis--likely related to necrosis of either primary mass
induced by XRT.
- bronchoscopic exam of lower airways limited by mass, but no
active bleeding seen
- Hct down to 24.9, transfused one unit PRBCs [**9-14**]
- bleeding likely to continue until large enough total dose of
radiation has been delivered to substantially debulk the mass
.
# SCCa--will contact [**Name (NI) **] team in am to let them know
patient is here; undergoing XRT, which we are attempting to
coordinate while patient is in-house.
Oncology fellow saw patient and explained to him that his
performance status and bleeding prevents him from safely
receiving more chemo.
- morphine and tylenol prn for pain
.
# HTN--poorly controlled on admission, increased lisinopril.
Continue metoprolol, lasix, and clonidine.
.
# COPD--nebs
.
# CAD--h/o CABG but no active issues. Holding ASA since
bleeding.
.
# Diabetes--lantus 10 qhs + SSI.
.
# FEN--TF through PEG.
.
# Ppx--heparin sub-q, ppi
.
# Full Code


Medications on Admission:
# Albuterol Sulfate 0.083 % neb Q6H and Q2H prn
# ipratropium neb
# Lisinopril 10 mg DAILY
# Metoprolol Tartrate 25 mg [**Hospital1 **]
# Clonidine 0.2 mg/24 hr Patch QTHUR
# HydrALAzine 20 mg IV Q6H:PRN SBP > 160
# Insulin Glargine 10 units QHS
# Insulin sliding scale
# lasix 20mg daily
# Nitroglycerin 0.3 mg SL prn
# esomeprazole 20 mg daily
# reglan
# ativan 0.5mg prn
# morphine prn


Discharge Medications:
1. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution [**Hospital1 **]: One (1)
neb Inhalation Q4H (every 4 hours) as needed.
2. Ipratropium Bromide 0.02 % Solution [**Hospital1 **]: One (1) neb
Inhalation Q6H (every 6 hours) as needed.
3. Clonidine 0.2 mg/24 hr Patch Weekly [**Hospital1 **]: One (1) Patch Weekly
Transdermal QTHUR (every Thursday).
4. Lisinopril 20 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

5. Metoprolol Tartrate 25 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID
(2 times a day).
6. Insulin Glargine 100 unit/mL Solution [**Hospital1 **]: Ten (10) units
Subcutaneous at bedtime.
7. Insulin Lispro 100 unit/mL Solution [**Hospital1 **]: ASDIR units
Subcutaneous four times a day: 2 units for FS 151-200, 4 units
for FS 201-250, 6 units for FS 251-300, 8 units for FS 301-350,
10 units for FS 351-400.
8. Lorazepam 0.5 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q8H (every 8
hours) as needed.
9. Metoclopramide 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
10. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1)
syringe Injection TID (3 times a day).
11. Docusate Sodium 50 mg/5 mL Liquid [**Hospital1 **]: Ten (10) mL PO BID (2
times a day).
12. Acetaminophen 160 mg/5 mL Solution [**Hospital1 **]: Twenty (20) mL PO
Q6H (every 6 hours) as needed.
13. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
14. Furosemide 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
15. Morphine 10 mg/5 mL Solution [**Last Name (STitle) **]: Five (5) mL PO every four
(4) hours as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Necrotic Left Piriform Sinus Squamous Cell Carcinoma
Diabetes
Hypertension
Coronary Artery Disease, s/p CABG x 5
Permanent Pacemaker for ?sick sinus/tachy brady
Peripheral Vascular Disease (AAA s/p repair)
COPD
Spontaneous Pneumothorax s/p chest tube
Colon Cancer s/p resection in approximately [**2102**]
Esophageal stricture
s/p open gastrostomy [**7-14**]
s/p tracheostomy [**7-14**]


Discharge Condition:
fair

Discharge Instructions:
You were admitted for evaluation of your hemoptysis. The source
of bleeding was from your known throat cancer, which is
undergoing radiation treatment. You may need blood transfusions
while undergoing treatment to make up for blood loss. Please
have your blood counts checked regularly.

Followup Instructions:
You will be undergoing daily radiation therapy at [**Hospital3 **]
for your cancer.
.
Provider: [**First Name8 (NamePattern2) 2191**] [**Last Name (NamePattern1) **], RN Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2107-9-22**]
8:00


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Malignant neoplasm of pyriform sinus,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Anemia in neoplastic disease,Coronary atherosclerosis of unspecified type of vessel, native or graft,Peripheral vascular disease, unspecified,Unspecified essential hypertension,Aortocoronary bypass status,Personal history of peptic ulcer disease,Cardiac pacemaker in situ,Personal history of malignant neoplasm of large intestine,Tracheostomy status,Personal history of tobacco use'}


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: 71 year old man w/ multiple medical problems including locally
invasive laryngopharyngeal cancer developed approx. 75cc
hemoptysis while at XRT today. He has been spitting and coughing
up several tsps of blood daily or sometimes multiple times daily
for about one month leading up to this. Daily cough, which does
not seem associated with hemoptysis.
.
He was seen by ENT in the ED, who performed fiberoptic exam
through trach and did not see any active bleeding or friable
tissue. CTA of neck was performed to rule out invasion of
carotid sheath.
Of note, he was seen in the ED on [**2107-8-30**] for similar
hemoptysis, at which point the bleeding was thought to be coming
from his tumor and pt was discharged home.

MEDICAL HISTORY: Diabetes
Hypertension
Coronary Artery Disease, s/p CABG x 5
Permanent Pacemaker for sick sinus
Peripheral Vascular Disease (AAA s/p repair)
COPD
Spontaneous Pneumothorax s/p chest tube
Colon Cancer s/p resection and chemo (pt does not know details
of therapy) in approximately [**2102**]

MEDICATION ON ADMISSION: # Albuterol Sulfate 0.083 % neb Q6H and Q2H prn
# ipratropium neb
# Lisinopril 10 mg DAILY
# Metoprolol Tartrate 25 mg [**Hospital1 **]
# Clonidine 0.2 mg/24 hr Patch QTHUR
# HydrALAzine 20 mg IV Q6H:PRN SBP > 160
# Insulin Glargine 10 units QHS
# Insulin sliding scale
# lasix 20mg daily
# Nitroglycerin 0.3 mg SL prn
# esomeprazole 20 mg daily
# reglan
# ativan 0.5mg prn
# morphine prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: 98.2 194/72 78 20 97% on 35% trach collar
GEN: cachectic male lying comfortably in bed
HEENT: NC/AT, + temporal wasting, OP clear
NECK: trach with button
CARDIAC: heart sounds obscured by lung sounds
LUNG: rhonchorous throughout
ABDOMEN: scaphoid, PEG site clean, dry, healing
EXT: decreased bulk and tone, no c/c/e
NEURO: grossly intact
SKIN: no rashes

FAMILY HISTORY: Aunt with breast cancer and uncle with throat cancer.

SOCIAL HISTORY: Patient is single. He does not have any children. He reports he
has been an alcoholic for the past 45 years and had been
drinking 2 glasses wine per day up to hospitalization in [**Month (only) **].
He has a 59 pack year smoking history. 

### Response:
{'Malignant neoplasm of pyriform sinus,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Anemia in neoplastic disease,Coronary atherosclerosis of unspecified type of vessel, native or graft,Peripheral vascular disease, unspecified,Unspecified essential hypertension,Aortocoronary bypass status,Personal history of peptic ulcer disease,Cardiac pacemaker in situ,Personal history of malignant neoplasm of large intestine,Tracheostomy status,Personal history of tobacco use'}
