CHIEF COMPLAINT: SOB, fever, hemoptysis

PRESENT ILLNESS: Pt is a 68 yo M with history of stage 4 NSCLC w/ mets to the
sternum who presents with fever, hemoptysis and SOB. Pt was
recently hospitalized in [**Month (only) **] at which time he had a talc
pleurodesis done on the left side due to malignant pleural
effusion. He was then discharged home on levofloxacin for
possible PNA for 10 days. Pt states he continued to have
persistent fevers despite the anitbiotics. On [**3-16**] he was seen by
Dr. [**Last Name (STitle) **] and at that time his chemo regimen was changed to
Tarceva after having failed both taxol/carboplatin and taxotere.
He said after starting this chemo he developed some diarrhea, no
N/V. He has had a persistent dry cough up until 2 days ago when
he noted hemoptysis and sputum production from his cough. Also
developed progressive SOB over the past few days with
fevers/chills. Cough is associated with right sided pleuritic
chest pain. He currently denies any N/V, CP, dysuria, focal
weakness, weight loss. Pt does have h/o of TB in right apices 50
yrs ago treated with INH and streptomycin along with chinese
herbal meds.
.
ONC History: Begins in [**2-11**] when pt was visiting his father in
[**Name (NI) 651**] and developed fever/cough.  At that time he had a CT scan
done which found a nodule in the LLL.  Pt then had this nodule
rescanned in [**Location (un) 86**] with subsequent scans that showed interval
increase in size.  He then underwent bronchoscopy and sampling
of pleural effusion  in [**11-11**] which demonstrated poorly
differentiated non-small cell carcinoma.  Staging PET scan
showed lesion in the sternum for metastatic disease.  He then
began chemotherapy with 2 cycles  [**Doctor Last Name **]/taxol with no response.
Switched to Taxotere for 2 cycles and once again no response,
then started on Tarceva on [**2107-3-16**].

MEDICAL HISTORY: -Stage 4 NSCLC- mets to sternum
-R apical TB 50 yrs ago
-s/p appy

MEDICATION ON ADMISSION: colace, oxycodone, toprol xl 50mg qday, guaifenesin-codeine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 102.2 BP 121/65 HR 91 RR 19 O2sats 90% RA 94% 4L
Gen: pleasant, thin Asian male mildly dyspneic on speaking
Skin: warm, no rashes
HEENT: OP clear, dry mm, no JVD
Heart: S1S2 tachy but regular, no murmurs appreciated
Lungs: decrease breath sounds at the left base half way up with
rales, right otherwise clear
Abd: thin, soft, NABS, NT, ND
Extrem: 2+ pulses, no edema, full ROM
Neuro: A&Ox3, fluent speech in broken English,
,strength/sensation, CN2-12 intact.

FAMILY HISTORY: Father with stomach cancer still alive at age [**Age over 90 **].  Mother died
from complications of diabetes in her 70's.

SOCIAL HISTORY: Retired ENT physician originally from [**Name9 (PRE) 651**]. Moved to US 6 yrs
ago. Lives with wife. [**Name (NI) **] tobacco/ETOH use or history
Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of pleura,Acute kidney failure, unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Acidosis,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Unspecified protein-calorie malnutrition,Anemia in neoplastic disease,Diarrhea,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use
Pneumonia, organism NOS,Secondary malig neo bone,Second malig neo pleura,Acute kidney failure NOS,Mal neo lower lobe lung,Acidosis,Septicemia NOS,Severe sepsis,Acute respiratry failure,Protein-cal malnutr NOS,Anemia in neoplastic dis,Diarrhea,Adv eff antineoplastic
Admission Date:  [**2107-3-21**]              Discharge Date:   [**2107-3-30**]

Date of Birth:  [**2038-5-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3326**]
Chief Complaint:
SOB, fever, hemoptysis

Major Surgical or Invasive Procedure:
Intubation
Central line placment
Swan-ganz cath placement

History of Present Illness:
Pt is a 68 yo M with history of stage 4 NSCLC w/ mets to the
sternum who presents with fever, hemoptysis and SOB. Pt was
recently hospitalized in [**Month (only) **] at which time he had a talc
pleurodesis done on the left side due to malignant pleural
effusion. He was then discharged home on levofloxacin for
possible PNA for 10 days. Pt states he continued to have
persistent fevers despite the anitbiotics. On [**3-16**] he was seen by
Dr. [**Last Name (STitle) **] and at that time his chemo regimen was changed to
Tarceva after having failed both taxol/carboplatin and taxotere.
He said after starting this chemo he developed some diarrhea, no
N/V. He has had a persistent dry cough up until 2 days ago when
he noted hemoptysis and sputum production from his cough. Also
developed progressive SOB over the past few days with
fevers/chills. Cough is associated with right sided pleuritic
chest pain. He currently denies any N/V, CP, dysuria, focal
weakness, weight loss. Pt does have h/o of TB in right apices 50
yrs ago treated with INH and streptomycin along with chinese
herbal meds.
.
ONC History: Begins in [**2-11**] when pt was visiting his father in
[**Name (NI) 651**] and developed fever/cough.  At that time he had a CT scan
done which found a nodule in the LLL.  Pt then had this nodule
rescanned in [**Location (un) 86**] with subsequent scans that showed interval
increase in size.  He then underwent bronchoscopy and sampling
of pleural effusion  in [**11-11**] which demonstrated poorly
differentiated non-small cell carcinoma.  Staging PET scan
showed lesion in the sternum for metastatic disease.  He then
began chemotherapy with 2 cycles  [**Doctor Last Name **]/taxol with no response.
Switched to Taxotere for 2 cycles and once again no response,
then started on Tarceva on [**2107-3-16**].

Past Medical History:
-Stage 4 NSCLC- mets to sternum
-R apical TB 50 yrs ago
-s/p appy

Social History:
Retired ENT physician originally from [**Name9 (PRE) 651**]. Moved to US 6 yrs
ago. Lives with wife. [**Name (NI) **] tobacco/ETOH use or history

Family History:
Father with stomach cancer still alive at age [**Age over 90 **].  Mother died
from complications of diabetes in her 70's.

Physical Exam:
T 102.2 BP 121/65 HR 91 RR 19 O2sats 90% RA 94% 4L
Gen: pleasant, thin Asian male mildly dyspneic on speaking
Skin: warm, no rashes
HEENT: OP clear, dry mm, no JVD
Heart: S1S2 tachy but regular, no murmurs appreciated
Lungs: decrease breath sounds at the left base half way up with
rales, right otherwise clear
Abd: thin, soft, NABS, NT, ND
Extrem: 2+ pulses, no edema, full ROM
Neuro: A&Ox3, fluent speech in broken English,
,strength/sensation, CN2-12 intact.


Pertinent Results:
[**2107-3-21**] 05:50PM   GLUCOSE-116* UREA N-22* CREAT-0.9 SODIUM-134
POTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-20* ANION GAP-15
[**2107-3-21**] 05:50PM   WBC-14.4* RBC-3.39* HGB-9.6* HCT-28.5* MCV-84
MCH-28.2 MCHC-33.6 RDW-15.6*
[**2107-3-21**] 05:50PM   NEUTS-79.8* LYMPHS-11.7* MONOS-4.8 EOS-3.4
BASOS-0.4
[**2107-3-21**] 05:50PM   IRON-11*
[**2107-3-21**] 05:50PM   calTIBC-195* VIT B12-810 FOLATE-11.7
FERRITIN-929* TRF-150*

CXR Interval progression of the left lower lobe opacity with
interval progression of bilateral upper lobe interstitial
opacities. These findings may be consistent with pulmonary edema
or changes related to radiation therapy. Lymphangitic spread of
tumor cannot be excluded. If clinically indicated, examination
with CT of the chest may be considered.

CTA Chest
1. Interval development of new extensive ground glass opacities
within the right upper lobe, patchy ground glass opacity within
the right middle lobe, and interval worsening of consolidation
within the left lower lobe with air bronchograms, findings all
of which suggest worsening multifocal pneumonia.
2. Relatively stable appearance of loculated small left pleural
effusion with enhancing and nodular thickening of the pleural
rim.
3. Small right pleural effusion.
4. No CT evidence of pulmonary embolism.

Brief Hospital Course:
Patient was transfered to the ICU on HD #2 secondary to
increased hypoxia.  A chest xray revealed what appeared to be
multifocul pnuemonia.  Patient was kept on NRB mask overnight
however the next day patient continued to fatigue and after
discussion with the patient he was intubated.  Patient was
continued on broad spectrum antibiotics for empiric treatment of
pnuemonia even though no cultures came back positive.  He
continued to deteriorate while intubated and it was felt that he
went into ARDS based on his chest x-ray.  Patient was switched
to ARDSnet vent settings.  At one point patient became
hypotensive and had poor urine output.  He was started on
pressors which were able to be weaned off and his urine output
did improve slightly.  However is oxygenation requirements
continued to increase.  He was proned, and mutiple alveolar
recruitment efforts were tried for better oxygenation which only
produced minimal improvement.  After mutiple discussions with
the family they intitially wanted to continue with aggresive
treatment since the patient had one daughter in [**Name (NI) 651**] who the
family wanted to be present before the patient passed away.
However as the patient's oxygenation continued to deteriorate
even on maximal support his wife decided to stop aggresive
treatment and make patient comfort measures only.  Patient
expired soon after.

Medications on Admission:
colace, oxycodone, toprol xl 50mg qday, guaifenesin-codeine

Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired
{'Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of pleura,Acute kidney failure, unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Acidosis,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Unspecified protein-calorie malnutrition,Anemia in neoplastic disease,Diarrhea,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic 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: SOB, fever, hemoptysis

PRESENT ILLNESS: Pt is a 68 yo M with history of stage 4 NSCLC w/ mets to the
sternum who presents with fever, hemoptysis and SOB. Pt was
recently hospitalized in [**Month (only) **] at which time he had a talc
pleurodesis done on the left side due to malignant pleural
effusion. He was then discharged home on levofloxacin for
possible PNA for 10 days. Pt states he continued to have
persistent fevers despite the anitbiotics. On [**3-16**] he was seen by
Dr. [**Last Name (STitle) **] and at that time his chemo regimen was changed to
Tarceva after having failed both taxol/carboplatin and taxotere.
He said after starting this chemo he developed some diarrhea, no
N/V. He has had a persistent dry cough up until 2 days ago when
he noted hemoptysis and sputum production from his cough. Also
developed progressive SOB over the past few days with
fevers/chills. Cough is associated with right sided pleuritic
chest pain. He currently denies any N/V, CP, dysuria, focal
weakness, weight loss. Pt does have h/o of TB in right apices 50
yrs ago treated with INH and streptomycin along with chinese
herbal meds.
.
ONC History: Begins in [**2-11**] when pt was visiting his father in
[**Name (NI) 651**] and developed fever/cough.  At that time he had a CT scan
done which found a nodule in the LLL.  Pt then had this nodule
rescanned in [**Location (un) 86**] with subsequent scans that showed interval
increase in size.  He then underwent bronchoscopy and sampling
of pleural effusion  in [**11-11**] which demonstrated poorly
differentiated non-small cell carcinoma.  Staging PET scan
showed lesion in the sternum for metastatic disease.  He then
began chemotherapy with 2 cycles  [**Doctor Last Name **]/taxol with no response.
Switched to Taxotere for 2 cycles and once again no response,
then started on Tarceva on [**2107-3-16**].

MEDICAL HISTORY: -Stage 4 NSCLC- mets to sternum
-R apical TB 50 yrs ago
-s/p appy

MEDICATION ON ADMISSION: colace, oxycodone, toprol xl 50mg qday, guaifenesin-codeine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 102.2 BP 121/65 HR 91 RR 19 O2sats 90% RA 94% 4L
Gen: pleasant, thin Asian male mildly dyspneic on speaking
Skin: warm, no rashes
HEENT: OP clear, dry mm, no JVD
Heart: S1S2 tachy but regular, no murmurs appreciated
Lungs: decrease breath sounds at the left base half way up with
rales, right otherwise clear
Abd: thin, soft, NABS, NT, ND
Extrem: 2+ pulses, no edema, full ROM
Neuro: A&Ox3, fluent speech in broken English,
,strength/sensation, CN2-12 intact.

FAMILY HISTORY: Father with stomach cancer still alive at age [**Age over 90 **].  Mother died
from complications of diabetes in her 70's.

SOCIAL HISTORY: Retired ENT physician originally from [**Name9 (PRE) 651**]. Moved to US 6 yrs
ago. Lives with wife. [**Name (NI) **] tobacco/ETOH use or history 

### Response:
{'Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of pleura,Acute kidney failure, unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Acidosis,Unspecified septicemia,Severe sepsis,Acute respiratory failure,Unspecified protein-calorie malnutrition,Anemia in neoplastic disease,Diarrhea,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}
