CHIEF COMPLAINT: Lung cancer

PRESENT ILLNESS: The patient is a 71yo gentlman who was admitted to the hospital
on [**7-29**] of this year for dyspnea, cough, and some low
volume hemoptysis.  He underwent an endoscopy by Dr. [**Last Name (STitle) 3373**] on
[**7-31**].  No endobronchial disease was noted, but a radial
EBUS was performed from the superior segment of the left lower
lobe.  Bronchial washings were positive for adenocarcinoma and
the transbronchial biopsy showed atypical cells suspicious for
large cell carcinoma. He has undergone imaging that includes
both CT of the head on
[**2116-6-17**] that shows no metastatic disease.  CTA of the chest
shows a left perihilar mass that is 4.0 x 1.9 cm.  This mass is
centered in the left lower lobe, but does partially encase the
left lower lobe superior segment PA.  There are also two nodules
in the left upper lobe and a 0.9-cm nodule at the right apex.
PET scan performed on [**8-11**] shows the hilar mass to be FDG
avid
with an SUV of 17.  The left upper lobe nodule is non-FDG avid
as are other pulmonary nodules.  There was no metastatic disease
on this study. He subsequently underwent a mediastinoscopy with
lymph node biopsy performed by Dr. [**Last Name (STitle) 7343**] at [**Hospital1 18**] on [**2116-8-25**],
which was negative for malignancy. He now presents for surgical
resection of his lung mass.

MEDICAL HISTORY: - Iron-deficiency anemia
- angioectasias in the distal small bowel
- Hyperlipidemia
- Hypertension
- Diabetes
- Dementia
- COPD
- OSA
- GERD
- Peptic Ulcers

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Losartan Potassium 50 mg PO DAILY
2. Hydrocortisone Cream 2.5% 1 Appl TP TWICE DAILY
3. Tiotropium Bromide 1 CAP IH DAILY
4. Carvedilol 12.5 mg PO BID
5. MetFORMIN (Glucophage) 500 mg PO BID
6. Docusate Sodium 100 mg PO BID
7. MEMAntine *NF* 10 mg Oral twice a day
8. Amlodipine 5 mg PO DAILY
9. Atorvastatin 20 mg PO DAILY
10. Glargine 8 Units Bedtime
11. Ferrous Sulfate 325 mg PO DAILY
12. Donepezil 10 mg PO HS
13. Omeprazole 20 mg PO DAILY
14. Sertraline 100 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS T 98.7, HR 86, BP 150/81, RR 20, O2-sat 95% RA
General: Appears well, NAD
HEENT: MMM, no scleral icterus, trachea and tongue midline, no
palpable lymphadenopathy
Cardiac: RRR, no M/R/G
Pulmonary: CTAB, no rales/rhonchi/wheezes
Abdomen: Soft, NT/ND, positive bowel sounds, no palpable masses
Extremities: no edema

FAMILY HISTORY: Daughter with skin cancer.

SOCIAL HISTORY: Patient is retired, lives with his wife and a daughter lives
nearby, apparently still drives, smokes 1 bag of pipe tobacco a
week with a 60 pack year history (current [**9-24**] cigs per day), no
drugs or alcohol by his wife's report. Reportedly recently
sleeping in bathroom and this is "most comfortable".
Malignant neoplasm of lower lobe, bronchus or lung,Pneumonia due to Pseudomonas,Iatrogenic pneumothorax,Pulmonary collapse,Paroxysmal ventricular tachycardia,Other diseases of trachea and bronchus,Hypoxemia,Emphysema (subcutaneous) (surgical) resulting from procedure,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Tobacco use disorder,Iron deficiency anemia, unspecified,Other and unspecified hyperlipidemia,Venous (peripheral) insufficiency, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric),Angiodysplasia of intestine (without mention of hemorrhage),Esophageal reflux,Personal history of peptic ulcer disease,Physical restraints status
Mal neo lower lobe lung,Pseudomonal pneumonia,Iatrogenic pneumothorax,Pulmonary collapse,Parox ventric tachycard,Trachea & bronch dis NEC,Hypoxemia,Emphysema rsult frm proc,Alzheimer's disease,Dementia w/o behav dist,Tobacco use disorder,Iron defic anemia NOS,Hyperlipidemia NEC/NOS,Venous insufficiency NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Chr airway obstruct NEC,Obstructive sleep apnea,Angio intes w/o hmrhg,Esophageal reflux,Prsnl hst peptic ulcr ds,Physical restrain status
Name:  [**Known lastname 1997**],[**Known firstname 448**] E                Unit No:   [**Numeric Identifier 1998**]

Admission Date:  [**2116-9-18**]              Discharge Date:   [**2116-9-29**]

Date of Birth:  [**2044-9-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1999**]
Addendum:
After a long discussion with his wife and Dr. [**First Name (STitle) **], mr. Blink
preferred to go home with services.  He was re evaluated by
Physical Therapy who felt that he would be safe.

Discharge Disposition:
Home With Service

Facility:
[**Location (un) 42**] VNA

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2000**] MD [**MD Number(2) 2001**]

Completed by:[**2116-9-29**]

Admission Date:  [**2116-9-18**]              Discharge Date:   [**2116-9-29**]

Date of Birth:  [**2044-9-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Lung cancer

Major Surgical or Invasive Procedure:
[**2116-9-18**]
1. Left thoracotomy.
2. Left lower lobectomy.
3. Arterioplasty of lower lobe pulmonary artery.
4. Mediastinal lymphadenectomy.

[**2116-9-21**]
Bronchoscopy

[**2116-9-25**]
Bronchoscopy


History of Present Illness:
The patient is a 71yo gentlman who was admitted to the hospital
on [**7-29**] of this year for dyspnea, cough, and some low
volume hemoptysis.  He underwent an endoscopy by Dr. [**Last Name (STitle) 3373**] on
[**7-31**].  No endobronchial disease was noted, but a radial
EBUS was performed from the superior segment of the left lower
lobe.  Bronchial washings were positive for adenocarcinoma and
the transbronchial biopsy showed atypical cells suspicious for
large cell carcinoma. He has undergone imaging that includes
both CT of the head on
[**2116-6-17**] that shows no metastatic disease.  CTA of the chest
shows a left perihilar mass that is 4.0 x 1.9 cm.  This mass is
centered in the left lower lobe, but does partially encase the
left lower lobe superior segment PA.  There are also two nodules
in the left upper lobe and a 0.9-cm nodule at the right apex.
PET scan performed on [**8-11**] shows the hilar mass to be FDG
avid
with an SUV of 17.  The left upper lobe nodule is non-FDG avid
as are other pulmonary nodules.  There was no metastatic disease
on this study. He subsequently underwent a mediastinoscopy with
lymph node biopsy performed by Dr. [**Last Name (STitle) 7343**] at [**Hospital1 18**] on [**2116-8-25**],
which was negative for malignancy. He now presents for surgical
resection of his lung mass.


Past Medical History:
- Iron-deficiency anemia
- angioectasias in the distal small bowel
- Hyperlipidemia
- Hypertension
- Diabetes
- Dementia
- COPD
- OSA
- GERD
- Peptic Ulcers


Social History:
Patient is retired, lives with his wife and a daughter lives
nearby, apparently still drives, smokes 1 bag of pipe tobacco a
week with a 60 pack year history (current [**9-24**] cigs per day), no
drugs or alcohol by his wife's report. Reportedly recently
sleeping in bathroom and this is "most comfortable".

Family History:
Daughter with skin cancer.

Physical Exam:
VS T 98.7, HR 86, BP 150/81, RR 20, O2-sat 95% RA
General: Appears well, NAD
HEENT: MMM, no scleral icterus, trachea and tongue midline, no
palpable lymphadenopathy
Cardiac: RRR, no M/R/G
Pulmonary: CTAB, no rales/rhonchi/wheezes
Abdomen: Soft, NT/ND, positive bowel sounds, no palpable masses
Extremities: no edema

Pertinent Results:
[**2116-9-18**] 02:10PM   WBC-6.3 RBC-3.22* HGB-8.1* HCT-26.2* MCV-81*
MCH-25.1* MCHC-30.8* RDW-16.5*
[**2116-9-18**] 02:10PM   GLUCOSE-187* UREA N-23* CREAT-1.3* SODIUM-142
POTASSIUM-4.7 CHLORIDE-109* TOTAL CO2-25 ANION GAP-13

[**2116-9-20**] 3:04 pm BRONCHIAL WASHINGS      BRONCHIAL WASH.

                            **FINAL REPORT [**2116-9-23**]**

   GRAM STAIN (Final [**2116-9-20**]):
      4+   (>10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      3+  (5-10 per 1000X FIELD):   GRAM NEGATIVE ROD(S).
      2+   (1-5 per 1000X FIELD):   MULTIPLE ORGANISMS
CONSISTENT WITH
                                    OROPHARYNGEAL FLORA.

   RESPIRATORY CULTURE (Final [**2116-9-23**]):
      10,000-100,000 ORGANISMS/ML. Commensal Respiratory Flora.
      PSEUDOMONAS AERUGINOSA.    >100,000 ORGANISMS/ML..
         Piperacillin/Tazobactam sensitivity testing performed
by [**First Name8 (NamePattern2) 3077**]
         [**Last Name (NamePattern1) 3060**].

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             PSEUDOMONAS AERUGINOSA
                             |
CEFEPIME--------------     4 S
CEFTAZIDIME-----------   <=1 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------     4 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN/TAZO-----       S
TOBRAMYCIN------------   <=1 S

[**2116-9-23**]
CXR :In comparison with study of earlier in this date, there is
little
interval change.  Substantial opacification of the left
hemithorax persists with the right lung being essentially clear.
 No appreciable pneumothorax.  Gas within soft tissues is seen
in the supraclavicular level on the left

[**2116-9-26**]
CXR :
There continues to be elevation of the left hemidiaphragm with
left
effusion and an alveolar infiltrate in the left mid lung.
However, overall the aeration on the left is much improved.  The
right lung is clear.



Brief Hospital Course:
The patient was admitted to the Thoracic Surgery Service for
evaluation and treatment.  On [**2116-9-18**], the patient underwent left
thoracotomy, left lower lobectomy,
arterioplasty of lower lobe pulmonary artery, mediastinal
lymphadenectomy, which went well without complication.  After a
brief, uneventful stay in the PACU, the patient arrived on the
floor NPO, on IV fluids, with a foley catheter, and an epidural
for pain control.  The patient was hemodynamically stable.

Neuro: The patient received the epidural with good effect and
adequate pain control.  When tolerating oral intake, the patient
was transitioned to oral pain medications. He was resumed on his
dementia medications and his narcotics were limited so as not to
promote more confusion.

CV: The patient remained stable from a cardiovascular
standpoint; vital signs were routinely monitored.

Pulmonary: The patient had an episode of desaturation into the
80's when chest physical therapy was being performed. He was
transferred to the ICU where bronchoscopy was performed and
secretions were evacuated. The secretions were sent for gram
stain and culture, which grew pan-sensitive pseudomonas.
Otherwise, the patient remained stable from a pulmonary
standpoint; vital signs were routinely monitored. Good pulmonary
toilet, early ambulation and incentive spirometry were
encouraged throughout hospitalization.

GI/GU/FEN: Post-operatively, the patient was made NPO with IV
fluids. Diet was advanced when appropriate, which was well
tolerated.  Patient's intake and output were closely monitored,
and IV fluid was adjusted when necessary.  Electrolytes were
routinely followed, and repleted when necessary.

ID: The patient's white blood count and fever curves were
closely watched for signs of infection. Secretions from
bronchoscopy were sent for gram stain and culture. The patient
received vancomycin and cefepime for empiric coverage for
possible pneumonia. This regimen was scaled back to
ciprofloxacin once the culture sensitivities returned. He will
remain on Cipro thru [**2116-10-2**].

Endocrine: Patient was maintained on sliding scale insulin to
good effect. His blood sugars were monitored routinely.

Hematology: The patient's complete blood count was examined
routinely; no transfusions were required.

Prophylaxis: The patient received subcutaneous heparin and
venodyne boots were used during this stay; was encouraged to get
up and ambulate as early as possible.

At the time of discharge, the patient was doing well, afebrile
with stable vital signs.  The patient was tolerating a regular
diet, ambulating, voiding without assistance, and pain was well
controlled.  The patient received discharge teaching and
follow-up instructions with understanding verbalized and
agreement with the discharge plan.


Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Losartan Potassium 50 mg PO DAILY
2. Hydrocortisone Cream 2.5% 1 Appl TP TWICE DAILY
3. Tiotropium Bromide 1 CAP IH DAILY
4. Carvedilol 12.5 mg PO BID
5. MetFORMIN (Glucophage) 500 mg PO BID
6. Docusate Sodium 100 mg PO BID
7. MEMAntine *NF* 10 mg Oral twice a day
8. Amlodipine 5 mg PO DAILY
9. Atorvastatin 20 mg PO DAILY
10. Glargine 8 Units Bedtime
11. Ferrous Sulfate 325 mg PO DAILY
12. Donepezil 10 mg PO HS
13. Omeprazole 20 mg PO DAILY
14. Sertraline 100 mg PO DAILY


Discharge Medications:
1. Amlodipine 5 mg PO DAILY
2. Atorvastatin 20 mg PO DAILY
3. Carvedilol 12.5 mg PO BID
4. Docusate Sodium 100 mg PO BID
5. Donepezil 10 mg PO HS
6. Glargine 8 Units Bedtime
7. MEMAntine *NF* 10 mg Oral twice a day
8. Omeprazole 40 mg PO DAILY
9. Sertraline 100 mg PO DAILY
10. Tiotropium Bromide 1 CAP IH DAILY
11. Acetaminophen 650 mg PO Q6H
12. Ciprofloxacin HCl 750 mg PO Q12H
thru [**2116-10-2**]
RX *Cipro 750 mg 1 tablet(s) by mouth twice a day Disp #*8
Tablet Refills:*0
13. OxycoDONE (Immediate Release)  5 mg PO Q4H:PRN pain
RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours
Disp #*20 Tablet Refills:*0
14. Senna 1 TAB PO BID:PRN constipation
RX *senna 8.6 mg 1 tablet by mouth twice a day Disp #*20 Tablet
Refills:*0
15. TraMADOL (Ultram) 25 mg PO QID
RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth four times
a day Disp #*30 Tablet Refills:*0
16. Ferrous Sulfate 325 mg PO DAILY
17. Hydrocortisone Cream 2.5% 1 Appl TP TWICE DAILY
18. Losartan Potassium 50 mg PO DAILY
19. MetFORMIN (Glucophage) 500 mg PO BID


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Left lower lobe lung cancer
Pseudomonas pneumonia


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
* You were admitted to the hospital for lung surgery and you've
recovered well. You are now ready for discharge.
* Continue to use your incentive spirometer 10 times an hour
while awake.
* Check your incisions daily and report any increased redness or
drainage.   Cover the area with a gauze pad if it is draining.
* Your chest tube dressing may be removed in 48 hours.  If it
starts to drain, cover it with a clean dry dressing and change
it  as needed to keep site clean and dry.
* You will continue to need pain medication once you are home
but you can wean it over a few weeks as the discomfort resolves.
 Make sure that you have regular bowel movements while on
narcotic pain medications as they are constipating which can
cause more problems.  Use a stool softener or gentle laxative to
stay regular.
* No driving while taking narcotic pain medication.
* Take Tylenol  650 mg every 6 hours in between your narcotic.
* Continue to stay well hydrated and eat well to heal your
incisions
* Shower daily. Wash incision with mild soap & water, rinse, pat
dry
* No tub bathing, swimming or hot tubs until incision healed
* No lotions or creams to incision site
* Walk 4-5 times a day and gradually increase your activity as
you can tolerate.

Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, chest pain or any other symptoms
that concern you.


Followup Instructions:
Department: HEMATOLOGY/ONCOLOGY
When: TUESDAY [**2116-10-13**] at 9:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3000**], MD [**0-0-**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Please report 30 minutes prior to your appointment to the
Radiology Department on the [**Location (un) **] of the [**Hospital Ward Name 23**] Clinical
Center for a chest xray.

Department: WEST [**Hospital 2002**] CLINIC
When: FRIDAY [**2116-11-6**] at 11:30 AM
With: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5250**], M.D. [**Telephone/Fax (1) 62**]
Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage



Completed by:[**2116-9-29**]
{"Malignant neoplasm of lower lobe, bronchus or lung,Pneumonia due to Pseudomonas,Iatrogenic pneumothorax,Pulmonary collapse,Paroxysmal ventricular tachycardia,Other diseases of trachea and bronchus,Hypoxemia,Emphysema (subcutaneous) (surgical) resulting from procedure,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Tobacco use disorder,Iron deficiency anemia, unspecified,Other and unspecified hyperlipidemia,Venous (peripheral) insufficiency, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric),Angiodysplasia of intestine (without mention of hemorrhage),Esophageal reflux,Personal history of peptic ulcer disease,Physical restraints 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: Lung cancer

PRESENT ILLNESS: The patient is a 71yo gentlman who was admitted to the hospital
on [**7-29**] of this year for dyspnea, cough, and some low
volume hemoptysis.  He underwent an endoscopy by Dr. [**Last Name (STitle) 3373**] on
[**7-31**].  No endobronchial disease was noted, but a radial
EBUS was performed from the superior segment of the left lower
lobe.  Bronchial washings were positive for adenocarcinoma and
the transbronchial biopsy showed atypical cells suspicious for
large cell carcinoma. He has undergone imaging that includes
both CT of the head on
[**2116-6-17**] that shows no metastatic disease.  CTA of the chest
shows a left perihilar mass that is 4.0 x 1.9 cm.  This mass is
centered in the left lower lobe, but does partially encase the
left lower lobe superior segment PA.  There are also two nodules
in the left upper lobe and a 0.9-cm nodule at the right apex.
PET scan performed on [**8-11**] shows the hilar mass to be FDG
avid
with an SUV of 17.  The left upper lobe nodule is non-FDG avid
as are other pulmonary nodules.  There was no metastatic disease
on this study. He subsequently underwent a mediastinoscopy with
lymph node biopsy performed by Dr. [**Last Name (STitle) 7343**] at [**Hospital1 18**] on [**2116-8-25**],
which was negative for malignancy. He now presents for surgical
resection of his lung mass.

MEDICAL HISTORY: - Iron-deficiency anemia
- angioectasias in the distal small bowel
- Hyperlipidemia
- Hypertension
- Diabetes
- Dementia
- COPD
- OSA
- GERD
- Peptic Ulcers

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Losartan Potassium 50 mg PO DAILY
2. Hydrocortisone Cream 2.5% 1 Appl TP TWICE DAILY
3. Tiotropium Bromide 1 CAP IH DAILY
4. Carvedilol 12.5 mg PO BID
5. MetFORMIN (Glucophage) 500 mg PO BID
6. Docusate Sodium 100 mg PO BID
7. MEMAntine *NF* 10 mg Oral twice a day
8. Amlodipine 5 mg PO DAILY
9. Atorvastatin 20 mg PO DAILY
10. Glargine 8 Units Bedtime
11. Ferrous Sulfate 325 mg PO DAILY
12. Donepezil 10 mg PO HS
13. Omeprazole 20 mg PO DAILY
14. Sertraline 100 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS T 98.7, HR 86, BP 150/81, RR 20, O2-sat 95% RA
General: Appears well, NAD
HEENT: MMM, no scleral icterus, trachea and tongue midline, no
palpable lymphadenopathy
Cardiac: RRR, no M/R/G
Pulmonary: CTAB, no rales/rhonchi/wheezes
Abdomen: Soft, NT/ND, positive bowel sounds, no palpable masses
Extremities: no edema

FAMILY HISTORY: Daughter with skin cancer.

SOCIAL HISTORY: Patient is retired, lives with his wife and a daughter lives
nearby, apparently still drives, smokes 1 bag of pipe tobacco a
week with a 60 pack year history (current [**9-24**] cigs per day), no
drugs or alcohol by his wife's report. Reportedly recently
sleeping in bathroom and this is "most comfortable". 

### Response:
{"Malignant neoplasm of lower lobe, bronchus or lung,Pneumonia due to Pseudomonas,Iatrogenic pneumothorax,Pulmonary collapse,Paroxysmal ventricular tachycardia,Other diseases of trachea and bronchus,Hypoxemia,Emphysema (subcutaneous) (surgical) resulting from procedure,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Tobacco use disorder,Iron deficiency anemia, unspecified,Other and unspecified hyperlipidemia,Venous (peripheral) insufficiency, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric),Angiodysplasia of intestine (without mention of hemorrhage),Esophageal reflux,Personal history of peptic ulcer disease,Physical restraints status"}
