CHIEF COMPLAINT: Cough and dyspnea on exertion

PRESENT ILLNESS: Mr. [**Known lastname **] is a 61 year old male with no significant past medical
history who presents with a ten day history of cough productive
of blood tinged sputum, right shoulder pain and dyspnea on
exertion. He felt entirely well until ten days ago. He has a
primary care doctor in the United States for the past three
years but has not been followed for any medical problems. [**Name (NI) **] has
not had routine health screening. He is unable to quantify the
amount of sputum production or blood in his sputum. He also was
experiencing pain in his right shoulder which was worsened with
cough or deep inspiration and dyspnea with mild exertion. He was
still able to perform his activities of daily living and go to
work but he was unable to sleep for the past two nights because
of cough and shoulder pain. He presented to his primary care
doctor with these symptoms ten days ago and was treated with
azithromycin without improvement. He presented again on [**2123-2-25**]
and had a CXR performed which showed a large right sided
mediastinal mass. He was seen again today and was referred for a
CT scan of the chest. Preliminary findings on the chest CT were
concerning and he was referred to the emergency room.

MEDICAL HISTORY: Low Back Pain
Latent TB s/p treatment (unknown details)
Gastric Ulcer

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 100.2 HR: 81 BP: 123/85 RR: 20 O2: 99% on 2L
HEENT: PERRL, EOMI, sclera anicteric, MMM, oropharynx clear
Neck: External veins distended, JVP ~ 10 cm, no lymphadenopathy

FAMILY HISTORY: History of hepatitis B in the family. No history of CAD or
diabetes. No history of lung disease or lung cancer.

SOCIAL HISTORY: Originally from [**Country 651**]. Previously worked as a farmer of rice and
corn. Also worked for 2-3 years in the concrete industry. Since
coming to the United States he has worked in a super market. He
lives with his wife. [**Name (NI) **] has five children. He smoked [**12-4**] pack
per day for 40 years and quit 10 years ago. He does not drink or
use illicit drugs.
Malignant neoplasm of lower lobe, bronchus or lung,Pneumonia, organism unspecified,Malignant pleural effusion,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Compression of vein,Anemia of other chronic disease,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Backache, unspecified,Personal history of tuberculosis,Personal history of tobacco use
Mal neo lower lobe lung,Pneumonia, organism NOS,Malignant pleural effusn,Mal neo lymph-intrathor,Compression of vein,Anemia-other chronic dis,Elev transaminase/ldh,Stomach ulcer NOS,Backache NOS,Prsnl hst tuberculosis,History of tobacco use
Admission Date:  [**2123-3-3**]              Discharge Date:   [**2123-3-11**]

Date of Birth:  [**2061-3-2**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
Cough and dyspnea on exertion

Major Surgical or Invasive Procedure:
Thoracentesis with chest tube placement ([**2123-3-4**])

History of Present Illness:
Mr. [**Known lastname **] is a 61 year old male with no significant past medical
history who presents with a ten day history of cough productive
of blood tinged sputum, right shoulder pain and dyspnea on
exertion. He felt entirely well until ten days ago. He has a
primary care doctor in the United States for the past three
years but has not been followed for any medical problems. [**Name (NI) **] has
not had routine health screening. He is unable to quantify the
amount of sputum production or blood in his sputum. He also was
experiencing pain in his right shoulder which was worsened with
cough or deep inspiration and dyspnea with mild exertion. He was
still able to perform his activities of daily living and go to
work but he was unable to sleep for the past two nights because
of cough and shoulder pain. He presented to his primary care
doctor with these symptoms ten days ago and was treated with
azithromycin without improvement. He presented again on [**2123-2-25**]
and had a CXR performed which showed a large right sided
mediastinal mass. He was seen again today and was referred for a
CT scan of the chest. Preliminary findings on the chest CT were
concerning and he was referred to the emergency room.

In the emergency room his initial vitals were T: 97.9 HR: 98 BP:
145/93 RR: 20 O2: 98% on RA. He had a Chest CT which showed a
large right sided lung mass with associated right middle and
right lower lobe collapse and large circumfrential right sided
pleural effusion. The mass is compressing the SVC to a slit.
There is also concern regarding possible involvement of the
pericardium and myocardium. He received 4 mg IV morphine in the
emergency room with resolution of his dyspnea and right sided
shoulder pain.

On review of systems he denies fevers, chills, left sided chest
pain, nausea, vomiting, abdominal pain, diarrhea, constipation,
dysuria, hematuria, leg pain, leg swelling, lightheadedness,
dizziness, numbness or tingling. He has had a 10 lb weight loss
over the past few weeks. All other review of systems negative in
detail.

Past Medical History:
Low Back Pain
Latent TB s/p treatment (unknown details)
Gastric Ulcer


Social History:
Originally from [**Country 651**]. Previously worked as a farmer of rice and
corn. Also worked for 2-3 years in the concrete industry. Since
coming to the United States he has worked in a super market. He
lives with his wife. [**Name (NI) **] has five children. He smoked [**12-4**] pack
per day for 40 years and quit 10 years ago. He does not drink or
use illicit drugs.

Family History:
History of hepatitis B in the family. No history of CAD or
diabetes. No history of lung disease or lung cancer.

Physical Exam:
Vitals: T: 100.2 HR: 81 BP: 123/85 RR: 20 O2: 99% on 2L
HEENT: PERRL, EOMI, sclera anicteric, MMM, oropharynx clear
Neck: External veins distended, JVP ~ 10 cm, no lymphadenopathy

Cardiac: Regular rate and rhythm, s1 + s2, no murmurs, rubs,
gallops
Lungs: Decreased chest wall expansion on right, absent breath
sounds on right, dullness to percussion on right, on left clear
to auscultation
GI: soft, non-tender, non-distended, + BS, no organomegaly
appreciated
GU: no foley
Ext: Warm and well perfused, 2+ pulses, trace clubbing, no
cyanosis or edema
Neurologic: Grossly intact

Pertinent Results:
[**2123-3-8**] 06:20AM BLOOD WBC-8.2 RBC-3.63* Hgb-10.6* Hct-31.9*
MCV-88 MCH-29.3 MCHC-33.4 RDW-12.1 Plt Ct-478*
[**2123-3-3**] 05:45PM BLOOD WBC-8.3 RBC-3.70* Hgb-11.3* Hct-32.0*
MCV-87 MCH-30.4 MCHC-35.2* RDW-12.3 Plt Ct-456*
[**2123-3-3**] 05:45PM BLOOD Neuts-78.7* Lymphs-11.5* Monos-8.6
Eos-0.7 Baso-0.5
[**2123-3-5**] 05:35AM BLOOD PT-14.2* PTT-30.2 INR(PT)-1.2*
[**2123-3-8**] 06:20AM BLOOD Glucose-112* UreaN-11 Creat-0.9 Na-138
K-3.8 Cl-101 HCO3-32 AnGap-9
[**2123-3-3**] 05:45PM BLOOD Glucose-112* UreaN-14 Creat-0.9 Na-134
K-4.2 Cl-99 HCO3-25 AnGap-14
[**2123-3-3**] 05:45PM BLOOD ALT-61* AST-50* LD(LDH)-161 AlkPhos-143*
TotBili-0.3
[**2123-3-3**] 05:45PM BLOOD TotProt-6.5 Albumin-3.3* Globuln-3.2
Calcium-8.7 Phos-3.4 Mg-2.3 Iron-12*
[**2123-3-3**] 05:45PM BLOOD calTIBC-228* Hapto-397* Ferritn-697*
TRF-175*
[**2123-3-4**] 04:00AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE
HBcAb-BORDERLINE
[**2123-3-5**] 05:35AM BLOOD CEA-1.7

[**2123-3-11**]   Radiology FDG TUMOR IMAGING (PET-
[**Last Name (LF) **], [**First Name3 (LF) **] Approved
1. Large FDG-avid right perihilar mass, involving the middle and

upper lobes and associated with extensive right hilar,
mediastinal, retrocrural and right supraclavicular FDG-avid
lymphadenopathy.
2. Extensive multifocal FDG-avid right pleural disease
associated with a moderate sized pleural effusion increased in
volume from the prior study.
3. There is nodular airspace disease in the anterior right upper
lobe having low-level tracer uptake which may be infectious,
inflammatory or neoplastic in nature.
4. There is mild tracer uptake in both adrenal glands, left
slightly greater than right, which may be physiologic but should
be re-evaluated on follow-up imaging.

[**2123-3-5**]   Pathology Tissue: FNA, 4R (Cell Block)   [**2123-3-8**]
[**Last Name (LF) **],[**First Name3 (LF) **] Final
FNA, 4R lymph node, cell block:
Positive for metastatic carcinoma, most consistent with
metastatic small cell carcinoma of the lung.  Note: Immunostains
show the tumor cells are positive for keratin cocktail
(AE1/AE3/CAM5.2), CK7, TTF-1 and synaptophysin; they are weakly
positive for p63, but negative for CK20, chromogranin and LCA.
The findings are most consistent with a metastatic small cell
carcinoma of the lung.

[**2123-3-4**]   Cardiology ECHO   [**2123-3-4**] [**Last Name (LF) **],[**First Name3 (LF) **] F.
The left atrium and right atrium are normal in cavity size. The
estimated right atrial pressure is 0-5 mmHg. Left ventricular
wall thickness, cavity size and regional/global systolic
function are normal (LVEF >55%). Transmitral Doppler and tissue
velocity imaging are consistent with normal LV diastolic
function. Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets (3) are mildly thickened
but aortic stenosis is not present. Trace aortic regurgitation
is seen. The mitral valve leaflets are structurally normal.
There is no mitral valve prolapse. Trivial mitral regurgitation
is seen. The tricuspid valve leaflets are mildly thickened.
There is mild pulmonary artery systolic hypertension. There is a
small pericardial effusion. The effusion appears
circumferential. There are no echocardiographic signs of
tamponade. IMPRESSION: Normal biventricular regional and global
function. Very small pericardial effusion.

[**2123-3-3**]   Radiology CT CHEST W/CONTRAST     [**Last Name (LF) **],[**First Name3 (LF) 10348**] Approved

1. Widespread malignancy in the thorax, most consistent with
advanced lung cancer (likely small cell ca and less likely
agressive nonsmall cell), with associated mediastinal and
pericardial invasion, high- grade narrowing of the superior vena
cava, bronchial obstruction, diffuse lymphadenopathy, and
malignant pleural disease.
2. Indeterminate fullness of left adrenal gland. If a PET CT is
obtained as part of overall staging process, this could be
further assessed at that time.

[**2123-3-3**]   Cardiology ECG   [**2123-3-5**] [**Last Name (LF) **],[**First Name3 (LF) **]
Sinus rhythm  Indeterminate axis Q-Tc interval appears prolonged
but is difficult to measure Low lateral T wave amplitude
Findings are nonspecific and may be within normal limits, but
clinical correlation is suggested

[**2123-3-7**]  BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT

[**2123-3-7**]  URINE URINE CULTURE-FINAL INPATIENT
[**2123-3-7**]  BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT

[**2123-3-6**]  BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT

[**2123-3-6**]  BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT

[**2123-3-5**]  BRONCHOALVEOLAR LAVAGE ACID FAST SMEAR-FINAL; ACID
FAST CULTURE-PRELIMINARY [**Last Name (LF) **],[**First Name3 (LF) **]
[**2123-3-5**]  SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL
INPATIENT
[**2123-3-5**]  BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT

[**2123-3-5**]  BLOOD CULTURE Blood Culture, Routine-FINAL INPATIENT

[**2123-3-4**]  PLEURAL FLUID GRAM STAIN-FINAL; FLUID CULTURE-FINAL;
ANAEROBIC CULTURE-FINAL; ACID FAST SMEAR-FINAL; ACID FAST
CULTURE-PRELIMINARY INPATIENT
[**2123-3-4**]  MRSA SCREEN MRSA SCREEN-FINAL INPATIENT


Brief Hospital Course:
61 year old man remote smoking history presents 10 days cough,
hemoptysis and DOE, with likely malignant right sided lung mass.

.
MICU course:
Following admission, patient had a CT scan showing right-sided
invasive mass with associated large pleural effusion.
Interventional pulmonology team placed chest tube into right
pleural space with greater than two liters of serosanguinous
drainage. Pleural fluid was sent for gram stain, culture, AFB
stain and culture, chems, cell count, and cytology.
Echocardiogram was performed due to invasive vascular appearance
of lung mass and noted "Normal biventricular regional and global
function. Very small pericardial effusion." Given patient's
elevated LFTs at presentation, concerning for metastatic
disease; however, hepatitis serologies pending. Patient was
hemodynamically stable with no respiratory distress throughout
his stay. Was maintained on 2L NC with sats 99%.
.
RIGHT-SIDED LUNG MASS: Patient presented with cough, hemoptysis,
pain, and dyspnea. CT appearence was consistant with small cell
ca vs. agressive nonsmall cell lung cancer of right middle lobe.
He had a thoracentesis during which  2L of serosanguinous fluid
were drained, and a chest tube was placed. Repeat CT showed
extensive thoracic malignancy including evidence of pleural
metastatic disease. This process involved the pulmonary artery,
pulmonary veins, pericardium, and possibly the myocardium.
However, no abnormalities were seen on cardiac echo. Patient was
oxygenating well and hemodynamically stable. Patient had
EBUS/biopsy for tissue diagnosis on [**3-5**], and pathology was found
to be consistent with SCLC.  Chest tube was removed on [**3-8**].
These findings were discussed and reviewed with the patient and
his family with the help of heme-onc consultants and social
work.
.
PNEUMONIA: Patient had progressive fever, spiking to 101.5 on
[**3-5**].  Repeat CT could not exclude infection.  Given his high
risk for post-obstructive pneumonia and chest tube in place, he
was treated with a 7 day course fo levofloxacin for presumed
post-obstructive pneumonia.  Cultures were negative.  His fevers
may have also have been secondary to malignancy.
.
ANEMIA: Stable. Likely related to inflammatory process given
likely malignancy. Normocytic to microcytic. Elevated ferritin
c/w AICD. Could consider EPO if Hb < 10.
.
ELEVATED LFTs: Unclear etiology. Not previously documented.
Likely related to tumor extension across diaphragm. Hep B SAb
(+), core Ab borderline. Consistent with prior vaccination, but
could consider viral load to further eval.

Medications on Admission:
None

Discharge Medications:
1. Codeine Sulfate 30 mg Tablet Sig: 0.5-1 Tablet PO Q4H (every
4 hours) as needed for cough, pain.
Disp:*45 Tablet(s)* Refills:*0*
2. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day) as needed for cough.
Disp:*90 Capsule(s)* Refills:*0*
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
Disp:*60 Capsule(s)* Refills:*2*
4. Wheelchair
5. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release(s)* Refills:*0*
6. Bedside commode
7. Tylenol 325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
8. Lactulose 10 gram/15 mL Solution Sig: One (1) 15 mL dose PO
twice a day.
Disp:*QS 1 mo* Refills:*2*


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
Primary Diagnosis:
small cell lung cancer
malignant pleural effusion
post-obstructive pneumonia
anemia of chronic disease

Discharge Condition:
Stable, normal ambulatory oxygen saturation


Discharge Instructions:
It was a pleasure taking care of you at the [**Hospital1 18**].  You were
admitted with shortness of breath, bloody cough, and back pain.
You had imaging studies done that showed a lung mass and fluid.
This fluid was removed with a chest tube.  You also had a biopsy
done on this tissue that showed Small Cell Lung Cancer.  You had
a PET-CT scan done to determine the extent of this cancer and
what types of treatments would be available.  You should follow
up with your oncologist to discuss these results and possible
treatment options.

You were started on antibiotics to treat a pneumonia that may be
associated with this mass.  You completed 7 days of levofloxacin
while hospitalized.

Please take all your medications as prescribed.  The following
changes were made to your medications:
1. Codeine-Sulfate 30 mg: 1 tablet by mouth every 4 hours as
needed for cough and pain.
2. Ferrous sulfate 325 mg: 1 tablet by mouth daily for iron
deficiency anemia.
3. Benzonatate 100 mg: 1 capsule by mouth three times a day as
needed for cough.
4. Colace 100 mg: 1 capsule by mouth twice daily for
constipation while taking iron.

Please keep all your medical appointments.  The
Hematology-Oncology team will also see you as an outpatient in
their clinic.

If you have any of the following symptoms, please call your
doctor or go to the nearest ED: fever, chest pain, shortness of
breath, coughing up blood, constant nausea/vomiting/diarrhea,
abdominal pain, bright red blood in the toilet bowel, or any
other concerning symptoms.

Followup Instructions:
MD: [**Doctor First Name **] [**Doctor Last Name **]
Specialty: Primary Care Physician
Date and time: [**2123-3-17**] at 1pm
Location: [**Hospital1 392**]
Phone number: [**Telephone/Fax (1) 51633**]

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 593**], MD; [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD
Specialty: Oncology
Date/Time:[**2123-3-16**] 10:30 AM
Phone:[**0-0-**]
Location: [**Hospital Ward Name 23**] 9


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

Completed by:[**2123-4-1**]
{'Malignant neoplasm of lower lobe, bronchus or lung,Pneumonia, organism unspecified,Malignant pleural effusion,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Compression of vein,Anemia of other chronic disease,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Backache, unspecified,Personal history of tuberculosis,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: Cough and dyspnea on exertion

PRESENT ILLNESS: Mr. [**Known lastname **] is a 61 year old male with no significant past medical
history who presents with a ten day history of cough productive
of blood tinged sputum, right shoulder pain and dyspnea on
exertion. He felt entirely well until ten days ago. He has a
primary care doctor in the United States for the past three
years but has not been followed for any medical problems. [**Name (NI) **] has
not had routine health screening. He is unable to quantify the
amount of sputum production or blood in his sputum. He also was
experiencing pain in his right shoulder which was worsened with
cough or deep inspiration and dyspnea with mild exertion. He was
still able to perform his activities of daily living and go to
work but he was unable to sleep for the past two nights because
of cough and shoulder pain. He presented to his primary care
doctor with these symptoms ten days ago and was treated with
azithromycin without improvement. He presented again on [**2123-2-25**]
and had a CXR performed which showed a large right sided
mediastinal mass. He was seen again today and was referred for a
CT scan of the chest. Preliminary findings on the chest CT were
concerning and he was referred to the emergency room.

MEDICAL HISTORY: Low Back Pain
Latent TB s/p treatment (unknown details)
Gastric Ulcer

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 100.2 HR: 81 BP: 123/85 RR: 20 O2: 99% on 2L
HEENT: PERRL, EOMI, sclera anicteric, MMM, oropharynx clear
Neck: External veins distended, JVP ~ 10 cm, no lymphadenopathy

FAMILY HISTORY: History of hepatitis B in the family. No history of CAD or
diabetes. No history of lung disease or lung cancer.

SOCIAL HISTORY: Originally from [**Country 651**]. Previously worked as a farmer of rice and
corn. Also worked for 2-3 years in the concrete industry. Since
coming to the United States he has worked in a super market. He
lives with his wife. [**Name (NI) **] has five children. He smoked [**12-4**] pack
per day for 40 years and quit 10 years ago. He does not drink or
use illicit drugs. 

### Response:
{'Malignant neoplasm of lower lobe, bronchus or lung,Pneumonia, organism unspecified,Malignant pleural effusion,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Compression of vein,Anemia of other chronic disease,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Backache, unspecified,Personal history of tuberculosis,Personal history of tobacco use'}
