CHIEF COMPLAINT: hemoptysis

PRESENT ILLNESS: 65 yo male diagnosed with small cell lung cancer s/p chemo and
radiation therapy with increasing tumor burden and left main
obstruction, s/p left mainstem stent placement [**11-30**], presenting
today with submassive hemoptysis.  Patient was recently admitted
for elective rigid bronchocscopy, found to have pulsus, and had
pericardiocentesis for pericardial effusion with tamponade.
Patient then had left main stem stent placed via IP and
discharged on [**2180-12-2**].
.
Per wife, patient was doing well following discharge.  Today,
just after eating breakfast, patient's wife (who is providing
history) heard patient coughing in kitchen.  Wife then found
patient had coughed up bright red blood, covering plate, with
coffee mug half-filled with blood.  Patient then asked wife to
call 911.  Patient had some lightheadedness, no syncope, no
other symptoms.
.
Patient was then transferred to OSH, where patient received 750
cc NS at OSH and tylenol for headache, and was then transferred
to [**Hospital1 18**] ED given recent history.  In the ED, vitals were 97.4
106   113/80  22  100% 4L NC.  He felt well, although continues
to cough teaspoons to tablespoons of bright red blood and clots.
 He denied dyspnea, fever, chills or chest pain.  At baseline on
2 liters supplemental O2, requirements unchanged.  Patient went
to the OR from ED for rigid bronchoscopy and cauterization with
APC.
.
In OR, patient received LR 700 cc, propofol, midazolam 2 mg,
fentanyl 200 mcg, phenylephrine, and rocuronium.  Bronch showed
left main stem medial wall is completely eroded, unclear if
changed from prior bronch.  LLL patent, but with tumor burden
distal to stent.  LUL remains collapsed.  Fresh clot was noted
at carina, no signs of active hemorrhage.  Patient was then
transferred to ICU for further management and angiography,
possible embolization vs. vascular stent.
.
Patient arrived in ICU inubated and sedated.  History provided
by wife.

MEDICAL HISTORY: -SCLC:
[**11-16**] - SCLCA diagnosed, had etoposide/carboplatin with 6th
cycle given [**4-17**] (good tolerance).
[**2-15**] and [**3-18**]: RT done
[**2-15**]: showed regression in most areas.
[**5-18**]: reduction in mass, persistent subtotal central occlusion
of LUL bronchus, reduction in constriction of pulmonary artery
to the LUL and reduction in central adenopathy, reexpansion of
LUL.
[**4-17**]: last chemo
[**2180-6-1**]: PET showed reduction in all areas, no new areas.
[**2180-6-14**]: hemoptysis of teaspoon 5cc BRB. CT scan noted for new
infiltrate showing encasement of artery to LUL and subtotal
occlusion of the bronchus to the LUL. Smoking was continued at
this point 2ppd. Bronchoscopy by Dr [**First Name (STitle) **] was suspiciuous for
tumor.
[**8-18**]: continued worsening of hoarseness, paroxysmal cough, left
anterior chest dsicomfort, increased dyspnea, no other pain or
headache, no addtional bleed.
CT: increasing central adenopathy, narrowing of left mainstem
bronchus to [**12-10**] of the right bronchus, complete obliteration of
the LUL bronchus with collapse of LUL with compromise of left
pulmonary artery. Bronchus to LLL, lingular were compromised.
Started on: Etoposide and carboplatin - 2 cycles, progressive
disease noted, has a pericardial effusion.
- continued to be symptomatic dyspnea, no dysphagia, continued
anorexia. presented for paliative treatment.
Hyperlipidemia
Pacemaker [**2169**]
H/O Hep C untreated [**1-10**] IVDU 30 yrs ago
spontaneous PTX
cigarette addiction
significant alcohol intake
tendon repair 4th finger on the right hand

MEDICATION ON ADMISSION: Guiatuss AC  10-100 mg/5 mL Liquid  Sig: Ten (10) mL PO prn:
cough
levofloxacin  750 mg Tablet  Sig:  One (1) Tablet PO Q24H 8 days
Mucinex  600 mg Tablet Sustained Release Q6H PRN cough
Megace ES  625 mg/5 mL Suspension  Sig:  Five (5) mL PO TID with
meals
hydrocodone-acetaminophen  5-500 mg Tablet Sig: 1-2 Tablets PO
QHS PRN
Colace  100 mg Capsule  Sig:  One (1) Capsule PO BID PRN
constipation
Home oxygen 2 liters continuously, pulse-dose system

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: GEN: comfortable, NAD, intubated and sedated
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: CTA b/l, dimished breath sounds in left axillae
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: pupils 3 mm, minimally responsive to light, but react
equally

FAMILY HISTORY: Father: died in 50's, emphysema
Mother: dies in 100's, Natural causes
Sister 1: 68 yrs
Sister 2: 66 yrs
Has two grown children

SOCIAL HISTORY: 2 Drinks daily, smoke [**12-10**] ppd or more till [**2-/2180**], started a
nicotine patch. married to [**Doctor First Name **]. working 12-14 hr days.
Malignant neoplasm of main bronchus,Bronchopneumonia, organism unspecified,Pulmonary collapse,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Chronic hepatitis C without mention of hepatic coma,Tobacco use disorder
Malig neo main bronchus,Bronchopneumonia org NOS,Pulmonary collapse,Status cardiac pacemaker,Hyperlipidemia NEC/NOS,Chrnc hpt C wo hpat coma,Tobacco use disorder
Admission Date:  [**2180-12-8**]              Discharge Date:   [**2180-12-10**]

Date of Birth:  [**2115-3-19**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3561**]
Chief Complaint:
hemoptysis

Major Surgical or Invasive Procedure:
IR angiogram with stent placement
Rigid bronchoscopy

History of Present Illness:
65 yo male diagnosed with small cell lung cancer s/p chemo and
radiation therapy with increasing tumor burden and left main
obstruction, s/p left mainstem stent placement [**11-30**], presenting
today with submassive hemoptysis.  Patient was recently admitted
for elective rigid bronchocscopy, found to have pulsus, and had
pericardiocentesis for pericardial effusion with tamponade.
Patient then had left main stem stent placed via IP and
discharged on [**2180-12-2**].
.
Per wife, patient was doing well following discharge.  Today,
just after eating breakfast, patient's wife (who is providing
history) heard patient coughing in kitchen.  Wife then found
patient had coughed up bright red blood, covering plate, with
coffee mug half-filled with blood.  Patient then asked wife to
call 911.  Patient had some lightheadedness, no syncope, no
other symptoms.
.
Patient was then transferred to OSH, where patient received 750
cc NS at OSH and tylenol for headache, and was then transferred
to [**Hospital1 18**] ED given recent history.  In the ED, vitals were 97.4
106   113/80  22  100% 4L NC.  He felt well, although continues
to cough teaspoons to tablespoons of bright red blood and clots.
 He denied dyspnea, fever, chills or chest pain.  At baseline on
2 liters supplemental O2, requirements unchanged.  Patient went
to the OR from ED for rigid bronchoscopy and cauterization with
APC.
.
In OR, patient received LR 700 cc, propofol, midazolam 2 mg,
fentanyl 200 mcg, phenylephrine, and rocuronium.  Bronch showed
left main stem medial wall is completely eroded, unclear if
changed from prior bronch.  LLL patent, but with tumor burden
distal to stent.  LUL remains collapsed.  Fresh clot was noted
at carina, no signs of active hemorrhage.  Patient was then
transferred to ICU for further management and angiography,
possible embolization vs. vascular stent.
.
Patient arrived in ICU inubated and sedated.  History provided
by wife.

Past Medical History:
-SCLC:
[**11-16**] - SCLCA diagnosed, had etoposide/carboplatin with 6th
cycle given [**4-17**] (good tolerance).
[**2-15**] and [**3-18**]: RT done
[**2-15**]: showed regression in most areas.
[**5-18**]: reduction in mass, persistent subtotal central occlusion
of LUL bronchus, reduction in constriction of pulmonary artery
to the LUL and reduction in central adenopathy, reexpansion of
LUL.
[**4-17**]: last chemo
[**2180-6-1**]: PET showed reduction in all areas, no new areas.
[**2180-6-14**]: hemoptysis of teaspoon 5cc BRB. CT scan noted for new
infiltrate showing encasement of artery to LUL and subtotal
occlusion of the bronchus to the LUL. Smoking was continued at
this point 2ppd. Bronchoscopy by Dr [**First Name (STitle) **] was suspiciuous for
tumor.
[**8-18**]: continued worsening of hoarseness, paroxysmal cough, left
anterior chest dsicomfort, increased dyspnea, no other pain or
headache, no addtional bleed.
CT: increasing central adenopathy, narrowing of left mainstem
bronchus to [**12-10**] of the right bronchus, complete obliteration of
the LUL bronchus with collapse of LUL with compromise of left
pulmonary artery. Bronchus to LLL, lingular were compromised.
Started on: Etoposide and carboplatin - 2 cycles, progressive
disease noted, has a pericardial effusion.
- continued to be symptomatic dyspnea, no dysphagia, continued
anorexia. presented for paliative treatment.
Hyperlipidemia
Pacemaker [**2169**]
H/O Hep C untreated [**1-10**] IVDU 30 yrs ago
spontaneous PTX
cigarette addiction
significant alcohol intake
tendon repair 4th finger on the right hand

Social History:
2 Drinks daily, smoke [**12-10**] ppd or more till [**2-/2180**], started a
nicotine patch. married to [**Doctor First Name **]. working 12-14 hr days.


Family History:
Father: died in 50's, emphysema
Mother: dies in 100's, Natural causes
Sister 1: 68 yrs
Sister 2: 66 yrs
Has two grown children

Physical Exam:
GEN: comfortable, NAD, intubated and sedated
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: CTA b/l, dimished breath sounds in left axillae
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: pupils 3 mm, minimally responsive to light, but react
equally

Pertinent Results:
[**2180-12-10**] 04:47AM BLOOD WBC-10.3 RBC-2.75* Hgb-9.0* Hct-26.5*
MCV-96 MCH-32.7* MCHC-33.9 RDW-16.1* Plt Ct-150
[**2180-12-10**] 04:47AM BLOOD Glucose-169* UreaN-9 Creat-0.5 Na-138
K-3.4 Cl-104 HCO3-30 AnGap-7*

CXR: There is an endotracheal tube whose distal tip is 5 cm
above the carina. A left-sided tracheal stent is again seen and
without complications. Pacemaker wires are seen. There is again
seen volume loss on the left with increased density within the
left upper lobe. This is unchanged. The right lung is clear. No
pneumothoraces are present. No pneumomediastinum is identified.
Overall, there has been no change.


Brief Hospital Course:
Mr. [**Known lastname 88214**] is a 65 yom with HLD, HCV [**1-10**] IVDU, SCLC complicated
by left main stem obstruction and recent pericardial tamponade
presenting with hemoptysis now s/p IR stending of PA.

1. Hemoptysis: Patient admitted intubated. He underwent rigid
bronchoscopy with no intervention performed, as well as IR
angiogram with [**MD Number(3) 88216**] placement on the first night of
admission. Hct stable s/p IR stenting of PA. Per discussion with
IP and IR, no further interventions possible at this time if
patient rebleeds. Discussed overal situation with patient,
confirmed DNR/DNI status prior to discharge.

2. SCLC: Scheduled for outpatient onc visit on [**2179-12-13**], with
intent to begin palliative chemotherapy on [**2179-12-14**].

3. Post-obstructive pneumonia- patient had been discharged on
course of levofloxacin for 8 days, completed yesterday.  No
evidence of excessive sputum production on on [**12-8**].

CODE: DNR/DNI

Medications on Admission:
Guiatuss AC  10-100 mg/5 mL Liquid  Sig: Ten (10) mL PO prn:
cough
levofloxacin  750 mg Tablet  Sig:  One (1) Tablet PO Q24H 8 days
Mucinex  600 mg Tablet Sustained Release Q6H PRN cough
Megace ES  625 mg/5 mL Suspension  Sig:  Five (5) mL PO TID with
meals
hydrocodone-acetaminophen  5-500 mg Tablet Sig: 1-2 Tablets PO
QHS PRN
Colace  100 mg Capsule  Sig:  One (1) Capsule PO BID PRN
constipation
Home oxygen 2 liters continuously, pulse-dose system

Discharge Medications:
1. nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) patch
Transdermal once a day.
Disp:*30 patches* Refills:*0*
2. benzonatate 100 mg Capsule Sig: One (1) Capsule PO three
times a day.
Disp:*90 Capsule(s)* Refills:*0*
3. Tylenol-Codeine #3 300-30 mg Tablet Sig: One (1) Tablet PO
every six (6) hours for 7 days.
Disp:*28 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Angels at Home

Discharge Diagnosis:
Primary -
Small cell lung cancer
Hemoptysis


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were transferred to [**Hospital1 18**] due to an episode were your
coughed up blood after being evaluated at another hospital.  You
underwent a rigid bronchoscopy with stenting of your left
pulmonary artery (procedure where a camera takes a look into
your lungs).  You completed a course of antibiotics for a
pneumonia.  You have had no further episodes of coughing up
blood.  You need to stop smoking, given your oxygen at home and
your bleeding risk.  Please follow up closely with your
previously scheduled appointments with your oncologist and PCP
this week.

You need to stop smoking.  Please discuss this with your primary
doctor.

Medication changes:
- added nicotine patch to be applied to the skin daily
- added benzonatate to be taken for cough
- tylenol with codeine to be given for cough

Followup Instructions:
Please follow up with your oncologist and primary care doctor.
You stated you already had appointments with them this upcoming
week.

Your PCP is [**Known firstname **] [**Last Name (NamePattern1) 14879**].  Phone number: [**Telephone/Fax (1) 32949**].
{'Malignant neoplasm of main bronchus,Bronchopneumonia, organism unspecified,Pulmonary collapse,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Chronic hepatitis C without mention of hepatic coma,Tobacco use disorder'}


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: hemoptysis

PRESENT ILLNESS: 65 yo male diagnosed with small cell lung cancer s/p chemo and
radiation therapy with increasing tumor burden and left main
obstruction, s/p left mainstem stent placement [**11-30**], presenting
today with submassive hemoptysis.  Patient was recently admitted
for elective rigid bronchocscopy, found to have pulsus, and had
pericardiocentesis for pericardial effusion with tamponade.
Patient then had left main stem stent placed via IP and
discharged on [**2180-12-2**].
.
Per wife, patient was doing well following discharge.  Today,
just after eating breakfast, patient's wife (who is providing
history) heard patient coughing in kitchen.  Wife then found
patient had coughed up bright red blood, covering plate, with
coffee mug half-filled with blood.  Patient then asked wife to
call 911.  Patient had some lightheadedness, no syncope, no
other symptoms.
.
Patient was then transferred to OSH, where patient received 750
cc NS at OSH and tylenol for headache, and was then transferred
to [**Hospital1 18**] ED given recent history.  In the ED, vitals were 97.4
106   113/80  22  100% 4L NC.  He felt well, although continues
to cough teaspoons to tablespoons of bright red blood and clots.
 He denied dyspnea, fever, chills or chest pain.  At baseline on
2 liters supplemental O2, requirements unchanged.  Patient went
to the OR from ED for rigid bronchoscopy and cauterization with
APC.
.
In OR, patient received LR 700 cc, propofol, midazolam 2 mg,
fentanyl 200 mcg, phenylephrine, and rocuronium.  Bronch showed
left main stem medial wall is completely eroded, unclear if
changed from prior bronch.  LLL patent, but with tumor burden
distal to stent.  LUL remains collapsed.  Fresh clot was noted
at carina, no signs of active hemorrhage.  Patient was then
transferred to ICU for further management and angiography,
possible embolization vs. vascular stent.
.
Patient arrived in ICU inubated and sedated.  History provided
by wife.

MEDICAL HISTORY: -SCLC:
[**11-16**] - SCLCA diagnosed, had etoposide/carboplatin with 6th
cycle given [**4-17**] (good tolerance).
[**2-15**] and [**3-18**]: RT done
[**2-15**]: showed regression in most areas.
[**5-18**]: reduction in mass, persistent subtotal central occlusion
of LUL bronchus, reduction in constriction of pulmonary artery
to the LUL and reduction in central adenopathy, reexpansion of
LUL.
[**4-17**]: last chemo
[**2180-6-1**]: PET showed reduction in all areas, no new areas.
[**2180-6-14**]: hemoptysis of teaspoon 5cc BRB. CT scan noted for new
infiltrate showing encasement of artery to LUL and subtotal
occlusion of the bronchus to the LUL. Smoking was continued at
this point 2ppd. Bronchoscopy by Dr [**First Name (STitle) **] was suspiciuous for
tumor.
[**8-18**]: continued worsening of hoarseness, paroxysmal cough, left
anterior chest dsicomfort, increased dyspnea, no other pain or
headache, no addtional bleed.
CT: increasing central adenopathy, narrowing of left mainstem
bronchus to [**12-10**] of the right bronchus, complete obliteration of
the LUL bronchus with collapse of LUL with compromise of left
pulmonary artery. Bronchus to LLL, lingular were compromised.
Started on: Etoposide and carboplatin - 2 cycles, progressive
disease noted, has a pericardial effusion.
- continued to be symptomatic dyspnea, no dysphagia, continued
anorexia. presented for paliative treatment.
Hyperlipidemia
Pacemaker [**2169**]
H/O Hep C untreated [**1-10**] IVDU 30 yrs ago
spontaneous PTX
cigarette addiction
significant alcohol intake
tendon repair 4th finger on the right hand

MEDICATION ON ADMISSION: Guiatuss AC  10-100 mg/5 mL Liquid  Sig: Ten (10) mL PO prn:
cough
levofloxacin  750 mg Tablet  Sig:  One (1) Tablet PO Q24H 8 days
Mucinex  600 mg Tablet Sustained Release Q6H PRN cough
Megace ES  625 mg/5 mL Suspension  Sig:  Five (5) mL PO TID with
meals
hydrocodone-acetaminophen  5-500 mg Tablet Sig: 1-2 Tablets PO
QHS PRN
Colace  100 mg Capsule  Sig:  One (1) Capsule PO BID PRN
constipation
Home oxygen 2 liters continuously, pulse-dose system

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: GEN: comfortable, NAD, intubated and sedated
HEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no
supraclavicular or cervical lymphadenopathy, no jvd, no carotid
bruits, no thyromegaly or thyroid nodules
RESP: CTA b/l, dimished breath sounds in left axillae
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice/no splinters
NEURO: pupils 3 mm, minimally responsive to light, but react
equally

FAMILY HISTORY: Father: died in 50's, emphysema
Mother: dies in 100's, Natural causes
Sister 1: 68 yrs
Sister 2: 66 yrs
Has two grown children

SOCIAL HISTORY: 2 Drinks daily, smoke [**12-10**] ppd or more till [**2-/2180**], started a
nicotine patch. married to [**Doctor First Name **]. working 12-14 hr days. 

### Response:
{'Malignant neoplasm of main bronchus,Bronchopneumonia, organism unspecified,Pulmonary collapse,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Chronic hepatitis C without mention of hepatic coma,Tobacco use disorder'}
