CHIEF COMPLAINT: incidental finding of PE on CT

PRESENT ILLNESS: 53-yo-woman w/ MMP including metastatic breast CA was admitted
yesterday w/ PE found incidentally on staging CT of the chest.
She has breast CA metastatic to the liver and lung, complicated
by chronic right pleural effusion, and followed w/ serial chest
CT.  On [**5-6**], chest CT demonstrated pulmonary embolus, prompting
her referral to the ED.  In the ED, she was HD stable but was
tachycardic, leading to admission to the [**Hospital Unit Name 153**] for close
observation during her early treatment.
<BR>
In the [**Hospital Unit Name 153**], she was treated w/ heparin gtt and remained
hemodynamically stable overnight.  She is now transferred to the
OMED service for ongoing care.
<BR>
Currently, she feels at her baseline resp status, w/ mild
dyspnea while talking and walking.  She denies any fever,
chills, cough, chest pain, palpitations.

MEDICAL HISTORY: 1) Metastatic breast cancer: T2-NO, ER/PR + HER-2/neu (-),
diagnosed [**2158**]
-[**2158**]: She was treated with CMF plus tamoxifen and local
radiation.
-[**2162**]: Treated with epirubicin/taxotere after found to have
adrenal met
-[**2162**]-[**2164**]: On Arimidex, then found to have liver mets
-[**2164**]: Started on Xeloda
-[**2165**]: Treated with taxol
-[**2165**]: Phase II study of [**Doctor First Name **] [**Numeric Identifier 99361**] (tyrosine kinase inhibitor)
-[**2165**]: Cancer metastasized to liver and adrenals
-[**2166**]: Has received 2 treatments with gemcitabine
[**2167-8-28**]: thoracentesis with fluid positive for malignant cells
[**2167-10-16**]: Right VATS, talc pleurodesis by Dr. [**Last Name (STitle) 952**] with
placement of pleur-X cath
[**2167-10-30**]: 3rd dose of Gemcitabine
Currently treated w/ Navelbine, last dose 2 wks ago.
2) Malignant pleural effusion s/p pleurex catheter placed [**9-29**]
removed [**3-31**]
3) Asthma
4) Allergic rhinitis
5) GERD

MEDICATION ON ADMISSION: 1) Ativan 1 mg QHS prn
2) Protonix 40 mg daily
3) Zofran 8 mg PO BID
4) Lactulose prn
5) Megace 400 mg PO BID
6) Percocet prn

ALLERGIES: Compazine

PHYSICAL EXAM: Gen: pleasant, conversational woman lying flat in bed, mildly
dyspnic after our interview
HEENT: EOMI, PERRL, OP clear w/ MMM
CV: reg s1/s2, no s3/s4/m/r
Pulm: dullness to percussion w/ decreased BS over right field;
good air movement throughout
Abd: scaphoid, +BS, soft, NT, ND
Ext: warm, 2+ DP B/L, no edema
Neuro: a/o x 3, strength 4/5 throughout LE B/L

FAMILY HISTORY: 1. Breast cancer:  uncle
2. Lung CA:  father, sister

SOCIAL HISTORY: lives with husband, 23 year-old daughter, and 6 month-old
grandson.  [**Name (NI) 4084**] smoked.  No alcohol, cocaine, or IVDU.
Secondary malignant neoplasm of adrenal gland,Esophageal reflux,Hypercalcemia,Personal history of malignant neoplasm of breast,Other pulmonary embolism and infarction,Secondary malignant neoplasm of pleura
Second malig neo adrenal,Esophageal reflux,Hypercalcemia,Hx of breast malignancy,Pulm embol/infarct NEC,Second malig neo pleura
Admission Date:  [**2168-5-9**]              Discharge Date:   [**2168-5-13**]

Date of Birth:  [**2115-2-18**]             Sex:   F

Service: MEDICINE

Allergies:
Compazine

Attending:[**First Name3 (LF) 3276**]
Chief Complaint:
incidental finding of PE on CT

Major Surgical or Invasive Procedure:
none

History of Present Illness:
53-yo-woman w/ MMP including metastatic breast CA was admitted
yesterday w/ PE found incidentally on staging CT of the chest.
She has breast CA metastatic to the liver and lung, complicated
by chronic right pleural effusion, and followed w/ serial chest
CT.  On [**5-6**], chest CT demonstrated pulmonary embolus, prompting
her referral to the ED.  In the ED, she was HD stable but was
tachycardic, leading to admission to the [**Hospital Unit Name 153**] for close
observation during her early treatment.
<BR>
In the [**Hospital Unit Name 153**], she was treated w/ heparin gtt and remained
hemodynamically stable overnight.  She is now transferred to the
OMED service for ongoing care.
<BR>
Currently, she feels at her baseline resp status, w/ mild
dyspnea while talking and walking.  She denies any fever,
chills, cough, chest pain, palpitations.


Past Medical History:
1) Metastatic breast cancer: T2-NO, ER/PR + HER-2/neu (-),
diagnosed [**2158**]
-[**2158**]: She was treated with CMF plus tamoxifen and local
radiation.
-[**2162**]: Treated with epirubicin/taxotere after found to have
adrenal met
-[**2162**]-[**2164**]: On Arimidex, then found to have liver mets
-[**2164**]: Started on Xeloda
-[**2165**]: Treated with taxol
-[**2165**]: Phase II study of [**Doctor First Name **] [**Numeric Identifier 99361**] (tyrosine kinase inhibitor)
-[**2165**]: Cancer metastasized to liver and adrenals
-[**2166**]: Has received 2 treatments with gemcitabine
[**2167-8-28**]: thoracentesis with fluid positive for malignant cells
[**2167-10-16**]: Right VATS, talc pleurodesis by Dr. [**Last Name (STitle) 952**] with
placement of pleur-X cath
[**2167-10-30**]: 3rd dose of Gemcitabine
Currently treated w/ Navelbine, last dose 2 wks ago.
2) Malignant pleural effusion s/p pleurex catheter placed [**9-29**]
removed [**3-31**]
3) Asthma
4) Allergic rhinitis
5) GERD


Social History:
lives with husband, 23 year-old daughter, and 6 month-old
grandson.  [**Name (NI) 4084**] smoked.  No alcohol, cocaine, or IVDU.


Family History:
1. Breast cancer:  uncle
2. Lung CA:  father, sister


Physical Exam:
Gen: pleasant, conversational woman lying flat in bed, mildly
dyspnic after our interview
HEENT: EOMI, PERRL, OP clear w/ MMM
CV: reg s1/s2, no s3/s4/m/r
Pulm: dullness to percussion w/ decreased BS over right field;
good air movement throughout
Abd: scaphoid, +BS, soft, NT, ND
Ext: warm, 2+ DP B/L, no edema
Neuro: a/o x 3, strength 4/5 throughout LE B/L


Pertinent Results:
[**2168-5-9**] 07:10PM   PTT-135.4*
[**2168-5-9**] 12:45PM   GLUCOSE-135* UREA N-7 CREAT-0.6 SODIUM-139
POTASSIUM-3.7 CHLORIDE-103 TOTAL CO2-23 ANION GAP-17
[**2168-5-9**] 12:45PM   ALT(SGPT)-19 AST(SGOT)-49* CK(CPK)-26 ALK
PHOS-301* AMYLASE-63 TOT BILI-0.6
[**2168-5-9**] 12:45PM   LIPASE-16
[**2168-5-9**] 12:45PM   cTropnT-<0.01
[**2168-5-9**] 12:45PM   CK-MB-NotDone
[**2168-5-9**] 12:45PM   ALBUMIN-3.6 CALCIUM-10.4* PHOSPHATE-1.9*
MAGNESIUM-1.7
[**2168-5-9**] 12:45PM   WBC-6.1# RBC-3.87* HGB-11.6* HCT-38.0 MCV-98
MCH-30.1 MCHC-30.7* RDW-19.5*
[**2168-5-9**] 12:45PM   NEUTS-63.3 LYMPHS-28.6 MONOS-6.9 EOS-0.3
BASOS-0.9
[**2168-5-9**] 12:45PM   HYPOCHROM-3+ ANISOCYT-2+ MACROCYT-3+
[**2168-5-9**] 12:45PM   PLT COUNT-357
[**2168-5-9**] 12:45PM   PT-13.6* PTT-29.0 INR(PT)-1.2*
.
CT chest and abdomen [**2167-5-7**]:
1) Interval progression of disease, with [**Month/Day/Year 9140**] of hepatic,
osseous, omental, mesenteric, mediasatinal nodal, and possible
anterior abdominal wall metastases.
2) Pulmonary emboli involving the left main pulmonary artery and
segmental right lower lobe branches.
3) Right-sided concentric pleural thickening with small pleural
effusion. The consolidation and interstitial thickening at the
right base is nonspecific and may relate either to previous
pleurodesis or lymphangitic spread.


Brief Hospital Course:
Briefly, this is a 53-yo-woman w/ breast CA metastatic to liver
and lung, chronic right pleural effusion, and GERD who was found
to have a PE incidentally on CT.  She was managed in the ICU on
a heparin gtt and then transferred to the OMED service.
.
# Bilateral PE:  The pt was found to have pulmonary emboli
involving the left main pulmonary artery and segmental right
lower lobe branches. She was mildly tachycardic up to 120 this
admission. In the ICU she was started on a heparin gtt and then
she was transitioned to Lovenox on the floor.  Her Lovenox will
be managed by Dr. [**Last Name (STitle) 3274**] after discharge. The pt was
instructed several times by nursing on self-injection of
Lovenox.
.
# Breast CA:  The pt has disease metastatic to liver, ab
wall/omentum, and lung. She was continued on Megace for appetite
stimulation, zofran for nausea.
.
# Gait instability/Deconditioning:  The pt worked with pt prior
to discharge, but she was unable to walk very far without having
to stop.  She was satting well on room air.  The pt does not
walk around her house much at baseline, and the pt wished to go
home with the assistance of her husband.  [**Name (NI) **] PT, home saftey
eval, a wheelchair, and home O2 were arranged for the pt.
.
#Hypercalcemia: Likely related to pts osteolytic lesions. PTH
was wnl. The pt received Zometa 4 mg IV x1 while in hospital.
.
#Tachycardia; The pt had sinus tachycardia throughout her
admission.  This did not resolve even after hydration with 1.5 L
NS.  She is likely tachycardic due to her PE.


Medications on Admission:
1) Ativan 1 mg QHS prn
2) Protonix 40 mg daily
3) Zofran 8 mg PO BID
4) Lactulose prn
5) Megace 400 mg PO BID
6) Percocet prn

Discharge Medications:
1. Megestrol 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
2. Ondansetron HCl 4 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO DAILY
(Daily) as needed for constipation.
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4-6H (every 4 to 6 hours) as needed.
6. Enoxaparin 80 mg/0.8 mL Syringe Sig: Seventy (70) mg
Subcutaneous Q12H (every 12 hours).
Disp:*60 syringes* Refills:*2*
7. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
pulmonary embolism


Discharge Condition:
stable


Discharge Instructions:
1.  Please take all medications as prescribed.  You will need to
administer your Lovenox injections twice daily
2. Please follow up with Dr. [**Last Name (STitle) 3274**] next week
3. Return to the ER or call your doctor [**First Name (Titles) **] [**Last Name (Titles) 9140**] shortness
of breath, chest pain, or any other concerning symptoms

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 3274**] at 2:00 PM on Wednesday [**5-18**]. Please come to [**Hospital Ward Name 23**] [**Location (un) **]. [**Telephone/Fax (1) 15512**]


                             [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **] MD [**MD Number(1) 3282**]
{'Secondary malignant neoplasm of adrenal gland,Esophageal reflux,Hypercalcemia,Personal history of malignant neoplasm of breast,Other pulmonary embolism and infarction,Secondary malignant neoplasm of pleura'}


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: incidental finding of PE on CT

PRESENT ILLNESS: 53-yo-woman w/ MMP including metastatic breast CA was admitted
yesterday w/ PE found incidentally on staging CT of the chest.
She has breast CA metastatic to the liver and lung, complicated
by chronic right pleural effusion, and followed w/ serial chest
CT.  On [**5-6**], chest CT demonstrated pulmonary embolus, prompting
her referral to the ED.  In the ED, she was HD stable but was
tachycardic, leading to admission to the [**Hospital Unit Name 153**] for close
observation during her early treatment.
<BR>
In the [**Hospital Unit Name 153**], she was treated w/ heparin gtt and remained
hemodynamically stable overnight.  She is now transferred to the
OMED service for ongoing care.
<BR>
Currently, she feels at her baseline resp status, w/ mild
dyspnea while talking and walking.  She denies any fever,
chills, cough, chest pain, palpitations.

MEDICAL HISTORY: 1) Metastatic breast cancer: T2-NO, ER/PR + HER-2/neu (-),
diagnosed [**2158**]
-[**2158**]: She was treated with CMF plus tamoxifen and local
radiation.
-[**2162**]: Treated with epirubicin/taxotere after found to have
adrenal met
-[**2162**]-[**2164**]: On Arimidex, then found to have liver mets
-[**2164**]: Started on Xeloda
-[**2165**]: Treated with taxol
-[**2165**]: Phase II study of [**Doctor First Name **] [**Numeric Identifier 99361**] (tyrosine kinase inhibitor)
-[**2165**]: Cancer metastasized to liver and adrenals
-[**2166**]: Has received 2 treatments with gemcitabine
[**2167-8-28**]: thoracentesis with fluid positive for malignant cells
[**2167-10-16**]: Right VATS, talc pleurodesis by Dr. [**Last Name (STitle) 952**] with
placement of pleur-X cath
[**2167-10-30**]: 3rd dose of Gemcitabine
Currently treated w/ Navelbine, last dose 2 wks ago.
2) Malignant pleural effusion s/p pleurex catheter placed [**9-29**]
removed [**3-31**]
3) Asthma
4) Allergic rhinitis
5) GERD

MEDICATION ON ADMISSION: 1) Ativan 1 mg QHS prn
2) Protonix 40 mg daily
3) Zofran 8 mg PO BID
4) Lactulose prn
5) Megace 400 mg PO BID
6) Percocet prn

ALLERGIES: Compazine

PHYSICAL EXAM: Gen: pleasant, conversational woman lying flat in bed, mildly
dyspnic after our interview
HEENT: EOMI, PERRL, OP clear w/ MMM
CV: reg s1/s2, no s3/s4/m/r
Pulm: dullness to percussion w/ decreased BS over right field;
good air movement throughout
Abd: scaphoid, +BS, soft, NT, ND
Ext: warm, 2+ DP B/L, no edema
Neuro: a/o x 3, strength 4/5 throughout LE B/L

FAMILY HISTORY: 1. Breast cancer:  uncle
2. Lung CA:  father, sister

SOCIAL HISTORY: lives with husband, 23 year-old daughter, and 6 month-old
grandson.  [**Name (NI) 4084**] smoked.  No alcohol, cocaine, or IVDU. 

### Response:
{'Secondary malignant neoplasm of adrenal gland,Esophageal reflux,Hypercalcemia,Personal history of malignant neoplasm of breast,Other pulmonary embolism and infarction,Secondary malignant neoplasm of pleura'}
