CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 88-year-old female
with history of fully enlarging right upper lobe nodule since
[**2127**], admitted to the Medical Intensive Care Unit after an
elective bronchoscopy today, which was complicated by change
in mental status and hypertension.  Patient had a chest CT on
[**2131-4-27**] revealing 3 x 7 x 3.5 cm spiculated right upper
lobe mass suggestive of bronchogenic carcinoma with
prominence of right hilum.  Patient has a history of
hypertension controlled with nadolol and maxzide.  On arrival
to the Bronchoscopy Suite, the patient's blood pressure was
elevated to 240/100, which persisted despite 50 mcg of
Fentanyl and 1 mg versed.  Bronchoscopy was aborted secondary
to hypertension, yet, Dr. [**Last Name (STitle) 4427**] was able to retrieve
bronchial washings from the right upper lobe and observe a
regular right upper lobe mucosa and narrowing of right upper
lobe bronchus consistent with extrinsic compression.  After
procedure, patient remained lethargic and thus received .2 mg
Narcan with "good results."  She also received 5 mg
intravenous hydralazine which brought the blood pressure down
to 173/88.  She was then transferred to the Medical Intensive
Care Unit for blood pressure control and repeat elective
bronchoscopy in the Intensive Care Unit setting on [**10-4**].  Of note, patient did not take her blood pressure
medications that day as per the instructions for elective
bronchoscopy.

MEDICAL HISTORY: 1.  Rheumatoid arthritis.
2.  Hypertension.
3.  Right upper lobe nodule as per above.
4.  Aortic insufficiency.
5.  Transient ischemic attack [**2131-4-27**].
6.  Status post hysterectomy.
7.  Cataracts bilaterally.
8.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.  Positive allergy to
shellfish.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Unspecified essential hypertension,Swelling, mass, or lump in chest,Aortic valve disorders,Rheumatoid arthritis
Hypertension NOS,Chest swelling/mass/lump,Aortic valve disorder,Rheumatoid arthritis
Admission Date:  [**2131-10-3**]       Discharge Date:


Service:







                       DR.[**Last Name (STitle) **],[**First Name3 (LF) 4514**] 12-424


Dictated By:[**Name8 (MD) 4733**]
MEDQUIST36

D:  [**2131-10-29**]  08:32
T:  [**2131-10-29**]  08:40
JOB#:  [**Job Number **]
1
1
1
R



Admission Date:  [**2131-10-3**]     Discharge Date:  [**2131-10-5**]


Service:

HISTORY OF PRESENT ILLNESS:  This is an 88-year-old female
with history of fully enlarging right upper lobe nodule since
[**2127**], admitted to the Medical Intensive Care Unit after an
elective bronchoscopy today, which was complicated by change
in mental status and hypertension.  Patient had a chest CT on
[**2131-4-27**] revealing 3 x 7 x 3.5 cm spiculated right upper
lobe mass suggestive of bronchogenic carcinoma with
prominence of right hilum.  Patient has a history of
hypertension controlled with nadolol and maxzide.  On arrival
to the Bronchoscopy Suite, the patient's blood pressure was
elevated to 240/100, which persisted despite 50 mcg of
Fentanyl and 1 mg versed.  Bronchoscopy was aborted secondary
to hypertension, yet, Dr. [**Last Name (STitle) 4427**] was able to retrieve
bronchial washings from the right upper lobe and observe a
regular right upper lobe mucosa and narrowing of right upper
lobe bronchus consistent with extrinsic compression.  After
procedure, patient remained lethargic and thus received .2 mg
Narcan with "good results."  She also received 5 mg
intravenous hydralazine which brought the blood pressure down
to 173/88.  She was then transferred to the Medical Intensive
Care Unit for blood pressure control and repeat elective
bronchoscopy in the Intensive Care Unit setting on [**10-4**].  Of note, patient did not take her blood pressure
medications that day as per the instructions for elective
bronchoscopy.

PAST MEDICAL HISTORY:
1.  Rheumatoid arthritis.
2.  Hypertension.
3.  Right upper lobe nodule as per above.
4.  Aortic insufficiency.
5.  Transient ischemic attack [**2131-4-27**].
6.  Status post hysterectomy.
7.  Cataracts bilaterally.
8.  Gastroesophageal reflux disease.

MEDICATIONS AT HOME:  Nadolol 40 mg po q.d., magnesium oxide
240 mg po q.d., maxzide unclear dose.

ALLERGIES:  No known drug allergies.  Positive allergy to
shellfish.

PHYSICAL EXAMINATION UPON ARRIVAL TO THE MEDICAL INTENSIVE
CARE UNIT:  Blood pressure 188/67.  Heart rate 61.
Respiratory rate 16.  Temperature 97.8.  02 saturation 99% on
room air.  General:  Alert and oriented times three in no
acute distress.  Complains of right periorbital headache.
Head, eyes, ears, nose and throat:  No jugular venous
distention.  Oropharynx clear.  Pupils equal, round and
reactive to light.  Extraocular movements intact.  Positive
arcus senilis.  Lungs:  Positive rales at left base,
otherwise clear to auscultation bilaterally.  Cardiovascular:
Regular rate and rhythm, normal S1, S2 with 3+ aortic
insufficiency, diastolic murmur responsive to hand grip.
Abdomen:  Soft, nontender, nondistended, positive bowel
sounds.  Extremities:  1+ pedal edema bilaterally.
Neurologically:  Nonfocal exam.  Extremities also positive
for positive Swan neck and ulnar deviation in the metacarpal
phalangeal, distal interphalangeal joints deformity
consistent with rheumatoid arthritis.

LABORATORIES:  [**9-28**] coags:  PT 12, PTT 27.5, INR 1.0,
platelets 519,000.  [**10-4**]:  Sodium 141, potassium 3.5,
chloride 103, bicarbonate 31, BUN 16, creatinine 0.9, glucose
85, calcium 9.8, magnesium 2.1, phosphorus 3.8.  CPKs 65, 32,
troponin less than 0.3.  White blood cell 14.3, hematocrit
35.6, platelets 389,000.

SUMMARY OF HOSPITAL COURSE:  The patient was admitted to the
Medical Intensive Care Unit and her blood pressure was
controlled with hydralazine 20 mg po q.i.d.  However,
nighttime dose was frequently held to systolic blood pressure
less than 140.  Patient underwent an elective bronchoscopy
without complication on [**2131-10-4**] by Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] under the guidance of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].
Washings were obtained from the right upper lobe, however, a
transbronchial needle biopsy was not performed due to
inability to access appropriate area.  Patient was observed
overnight and maintained stable vital signs and respiratory
status.  Patient was discharged to home on [**2131-10-5**]
after eating breakfast and demonstrating an intact gag
reflex.  Patient is to follow-up with Dr. [**First Name8 (NamePattern2) 24990**] [**Last Name (NamePattern1) 4427**] for
results of bronchoscopy.  Patient is to follow-up with Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 24991**] on [**2131-10-9**] at 2:30 p.m. for blood
pressure check and blood pressure management.  Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] has been notified via E-mail of this upcoming
appointment as he is her primary care physician.  [**Name10 (NameIs) **] was
also sent home with VNA Services for blood pressure control,
monitoring of respiratory status and ambulatory stability, as
patient unable to be seen in Clinic for another three days.

CONDITION AT DISCHARGE:  Stable.

MEDICATIONS AT DISCHARGE:
1.  Hydralazine 20 mg po t.i.d.
2.  Magnesium oxide 400 mg po q.d.






                          DR.[**Last Name (STitle) **],[**First Name3 (LF) 4514**] 12-424

Dictated By:[**Name8 (MD) 10996**]

MEDQUIST36

D:  [**2131-10-7**]  13:42
T:  [**2131-10-7**]  13:42
JOB#:  [**Job Number **]
{'Unspecified essential hypertension,Swelling, mass, or lump in chest,Aortic valve disorders,Rheumatoid arthritis'}


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: 

PRESENT ILLNESS: This is an 88-year-old female
with history of fully enlarging right upper lobe nodule since
[**2127**], admitted to the Medical Intensive Care Unit after an
elective bronchoscopy today, which was complicated by change
in mental status and hypertension.  Patient had a chest CT on
[**2131-4-27**] revealing 3 x 7 x 3.5 cm spiculated right upper
lobe mass suggestive of bronchogenic carcinoma with
prominence of right hilum.  Patient has a history of
hypertension controlled with nadolol and maxzide.  On arrival
to the Bronchoscopy Suite, the patient's blood pressure was
elevated to 240/100, which persisted despite 50 mcg of
Fentanyl and 1 mg versed.  Bronchoscopy was aborted secondary
to hypertension, yet, Dr. [**Last Name (STitle) 4427**] was able to retrieve
bronchial washings from the right upper lobe and observe a
regular right upper lobe mucosa and narrowing of right upper
lobe bronchus consistent with extrinsic compression.  After
procedure, patient remained lethargic and thus received .2 mg
Narcan with "good results."  She also received 5 mg
intravenous hydralazine which brought the blood pressure down
to 173/88.  She was then transferred to the Medical Intensive
Care Unit for blood pressure control and repeat elective
bronchoscopy in the Intensive Care Unit setting on [**10-4**].  Of note, patient did not take her blood pressure
medications that day as per the instructions for elective
bronchoscopy.

MEDICAL HISTORY: 1.  Rheumatoid arthritis.
2.  Hypertension.
3.  Right upper lobe nodule as per above.
4.  Aortic insufficiency.
5.  Transient ischemic attack [**2131-4-27**].
6.  Status post hysterectomy.
7.  Cataracts bilaterally.
8.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.  Positive allergy to
shellfish.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Unspecified essential hypertension,Swelling, mass, or lump in chest,Aortic valve disorders,Rheumatoid arthritis'}
