CHIEF COMPLAINT: transferred for further management of tracheal stenosis

PRESENT ILLNESS: 63 y/o F w/hx of breast Ca s/p lumpectomy/chemo [**2135**], who
presented to [**Hospital 531**] [**Hospital 63637**] Hospital on [**2140-7-23**] with
shortness of breath.  Per the pt, she initially noted swelling
in her left neck one year ago.  Her oncologist at [**State 531**]
Presbyterian treated her with Femara which made no difference.
At that point he told her that her tumor was "receptor negative"
and the Femara was likely not helping.  At this point (approx
one month ago) she developed swelling in her right neck as well.
 She then went to The Oasis Center in Tijuana, [**Country 149**] in [**Month (only) **] of
this year, and was treated with a vaccine of some sort, as well
as numerous vitamins.  A week after this, she developed
shortness of breath which progressively worsened, as well as
difficulty speaking/swallowing.  She also has a nonproductive
cough but no fevers.

MEDICAL HISTORY: 1. Breast Ca [**2135**], s/p lumpectomy.  Refused XRT.  s/p
cyclophosphamide and Taxol x 6 months in [**2135**].  Had recurrence
at left supraclavicular node s/p excision, refused chemo.
2. Endometrial Ca s/p hysterectomy [**2136**]

MEDICATION ON ADMISSION: numerous vitamins and herbal supplements

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 99.1  P: 71  BP: 123/56  R: 16  98%RA
Gen: alert and oriented pleasant female in no acute distress,
but with audible inspiratory stridor and frequent coughing
during exam
HEENT:  normocephalic, atraumatic, MM dry, anicteric.
Neck:  matted, firm, nontender massive lymphadenopathy in L>R
cervical and supraclavicular regions.  trachea deviated to left.
Lungs:  bibasilar rhonchi, otherwise no crackles or wheezes
CV: regular rate and rhythm, no murmur/rub/gallop
Breasts: symmetric, no palpable masses
Abd: soft, nontender, nondistended, normoactive bowel sounds.
No hepatomegaly.
Ext: no edema, 2+ distal pulses
Skin: warm and dry

FAMILY HISTORY: Mother & Father w/CVA.  Sister with brain cancer.

SOCIAL HISTORY: Lives alone in [**State 531**], has 3 children who live nearby.  No
history of tobacco use.  No EtOH.   Works as a legal assistant.
Secondary malignant neoplasm of mediastinum,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Iatrogenic pneumothorax,Personal history of malignant neoplasm of breast,Personal history of malignant neoplasm of other parts of uterus
Sec mal neo mediastinum,Mal neo lymph-head/neck,Iatrogenic pneumothorax,Hx of breast malignancy,Hx-uterus malignancy NEC
Admission Date:  [**2140-7-27**]              Discharge Date:   [**2140-8-7**]

Date of Birth:  [**2077-6-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 1561**]
Chief Complaint:
transferred for further management of tracheal stenosis

Major Surgical or Invasive Procedure:
Bronchoscopy with stent placement
Bronchoscopy


History of Present Illness:
63 y/o F w/hx of breast Ca s/p lumpectomy/chemo [**2135**], who
presented to [**Hospital 531**] [**Hospital 63637**] Hospital on [**2140-7-23**] with
shortness of breath.  Per the pt, she initially noted swelling
in her left neck one year ago.  Her oncologist at [**State 531**]
Presbyterian treated her with Femara which made no difference.
At that point he told her that her tumor was "receptor negative"
and the Femara was likely not helping.  At this point (approx
one month ago) she developed swelling in her right neck as well.
 She then went to The Oasis Center in Tijuana, [**Country 149**] in [**Month (only) **] of
this year, and was treated with a vaccine of some sort, as well
as numerous vitamins.  A week after this, she developed
shortness of breath which progressively worsened, as well as
difficulty speaking/swallowing.  She also has a nonproductive
cough but no fevers.

At the outside hospital, CXR demonstrated a mediastinal mass, no
infiltrates or effusions.  LE dopplers were negative for DVT.
She was begun on Solumedrol 60 IV q12h and had a CT scan of her
chest (r/o PE) and neck (eval for tracheal compression).   She
also was placed on ceftriaxone and azithromycin.  She was
evaluated by Pulmonary, Thoracic Surgery, ENT, Heme-Onc, and
Rad-Onc who all agreed that she needed definitive therapy for
her extrinsic tracheal compression and she was transferred to
[**Hospital1 18**] for Interventional Pulmonary evaluation on [**7-27**].  She did
have a lymph node biopsy of her neck prior to transfer.

Past Medical History:
1. Breast Ca [**2135**], s/p lumpectomy.  Refused XRT.  s/p
cyclophosphamide and Taxol x 6 months in [**2135**].  Had recurrence
at left supraclavicular node s/p excision, refused chemo.
2. Endometrial Ca s/p hysterectomy [**2136**]


Social History:
Lives alone in [**State 531**], has 3 children who live nearby.  No
history of tobacco use.  No EtOH.   Works as a legal assistant.

Family History:
Mother & Father w/CVA.  Sister with brain cancer.

Physical Exam:
T: 99.1  P: 71  BP: 123/56  R: 16  98%RA
Gen: alert and oriented pleasant female in no acute distress,
but with audible inspiratory stridor and frequent coughing
during exam
HEENT:  normocephalic, atraumatic, MM dry, anicteric.
Neck:  matted, firm, nontender massive lymphadenopathy in L>R
cervical and supraclavicular regions.  trachea deviated to left.
Lungs:  bibasilar rhonchi, otherwise no crackles or wheezes
CV: regular rate and rhythm, no murmur/rub/gallop
Breasts: symmetric, no palpable masses
Abd: soft, nontender, nondistended, normoactive bowel sounds.
No hepatomegaly.
Ext: no edema, 2+ distal pulses
Skin: warm and dry


Pertinent Results:
Labs from OSH:

WBC 9.3
Hct 29.2
Plt 316

Na 138
K 4.4
Cl 103
HCO3 25
BUN 15
Creat 0.5
Glc 121

PT 11
PTT 27
INR 1.0

Ca 8.7
Alb 4.2
Total protein 8
Tot bili 0.3
Alk phos 59
ALT 12
AST 22
LDH 122

CEA 112.4

CXR [**7-24**]:  large superior mediastinal mass with leftward
tracheal deviation, no infiltrate

CT neck with contrast [**7-23**]:  extensive bilateral cervical
adenopathy up to 4 cm in diameter, some with moderate central
necrosis.  moderate extrinsic compression and displacement of
the cervico thoracic trachea from adjacent nodal enlargement at
this level.  Low attenuation lesion 1 cm in diameter in left
thyroid lobe.

CT chest [**7-23**]:  large 5x7 anterior mediastinal mass continuous
with neck masses, with mixed attenuation and contrast
enhyancement.  extends inferiorly compression the trachea.
multiple subcarinal nodes and few right hilar nodes with largest
at 1.5 cm.  SVC patent and displaced anteriorly.  8 mm
spiculated pulmonary nodule in right apex.  No effusion.

CT abd/pelvis [**7-23**]:  normal, no evidence of metastasis.

Labs on admission:
[**2140-7-27**] 05:57PM BLOOD WBC-10.1 RBC-3.71* Hgb-10.7* Hct-32.1*
MCV-86 MCH-28.8 MCHC-33.3 RDW-13.0 Plt Ct-334
[**2140-7-27**] 05:57PM BLOOD PT-11.8 PTT-24.0 INR(PT)-0.9
[**2140-7-27**] 05:57PM BLOOD Calcium-9.4 Phos-2.5* Mg-2.0

Labs on discharge:
[**2140-8-6**] 06:35AM BLOOD WBC-10.4 RBC-3.78* Hgb-11.3* Hct-33.3*
MCV-88 MCH-29.9 MCHC-34.0 RDW-13.3 Plt Ct-404
[**2140-8-5**] 06:30AM BLOOD Glucose-122* UreaN-14 Creat-0.6 Na-140
K-4.5 Cl-104 HCO3-27 AnGap-14

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2140-8-2**] [**2140-8-2**] [**2140-8-4**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/crxs

DIAGNOSIS:
Excised soft tissue, "Tracheal tumor versus granulation tissue."
Fibrinous exudate with admixed inflammatory and scattered
atypical cells considered to be reactive. No malignancy is
identified.
Clinical: History of breast cancer. Tracheal tumor versus
granulation tissue.
Gross: The specimen is received in formalin-filled container
labeled "[**Initials (NamePattern4) **] [**Known lastname 63638**]" and consists of an irregularly shaped
tan-white piece of soft tissue measuring 1.9 x 1.1 x 0.9 cm with
focal areas of hemorrhage. The specimen is inked in black,
serially sectioned and submitted in total in cassettes A-C.


Brief Hospital Course:
This is a 63 y/o F w/metastatic breast Ca who presents with
airway obstruction. Hospital course was remarkable for the
following issues:

1. Airway obstruction/SOB:  Per review of outside hospital CT
scan, pt's trachea at smallest dimension is 3 mm, and she had
audible stridor on admission exam.  She was admitted to the ICU
and went to the OR tomorrow the following day for rigid bronch
with placement of a Y stent by the interventional pulmonary
staff.  She was monitored in the ICU for 1 day.  She had a
stable airway and was subsequently transferred to the medical
floor on [**2140-7-30**].  Radiation oncology was consulted and the
decision was made to initiate radiation therapy locally in order
to monitor the patient's airway closely during radiation. She
initiated daily radiation treatments on [**2140-8-1**]. She tolerated
radiation treatments well without evidence of stridor or airway
compromise.  She underwent repeat bronchoscopy on [**2140-8-2**] which
revealed boggy/infiltrate arytenoid with narrow glottis and
proximal trachea. A tissue flap partially occluding the proximal
tracheal stent was excised with forceps. Moderate secretions in
the mid-tracheal stent were therapeutically aspirated. Stent
limbs were patent.  The patient was also continued on IV
dexamethasone while undergoing radiation. The patient is to
continue daily radiation therapy to complete a 10 day course.
Radiation oncologists at [**Hospital1 18**] contact[**Name (NI) **] radiation oncology at
[**Name (NI) 531**] [**Hospital 63637**] hospital and communicated the treatment plan.
  The patient was continued on an aggressive anti-tussive
regimen and continued on pain medications prn. Her oxygen
saturations were stable in the mid-upper 90's on room air.  It
is highly recommended that the patient continue to be monitored
by the pulmonary staff at [**State 531**] Methodist (Dr. [**First Name (STitle) **].

2. Metastatic breast cancer:  Hematology/oncology was consulted
and recommended that the patient follow up with oncologists in
[**State 531**].  It was recommended that the patient's HER-2-NEU
status be clarified as to overexpressing or not. If 3+
HER-2-NEU, then herceptin should be considered as an additional
[**Doctor Last Name 360**] in additional to standard chemotherapy after radiation
therapy is completed.

3. FEN:  The patient was was given a pureed diet and tolerated
this very well.

4. Prophylaxis:  The patient was continued on subcutaneous
heparin for DVT prophylaxis and stool softeners while on
narcotic pain medications.

5. Disposition: The patient repeatedly requested transfer to [**Location (un) 5426**] if possible in order to be closer to her family. The
patient was a full code.

Medications on Admission:
numerous vitamins and herbal supplements

Discharge Medications:

1. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: 5000
(5000) units Injection TID (3 times a day).
2. Lidocaine HCl 1 % Solution Sig: 2.5 MLs Injection Q1-2H () as
needed for cough.
3. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed for cough.
4. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Zolpidem Tartrate 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed.
7. Docusate Sodium 150 mg/15 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day) as needed: hold for diarrhea.
8. Acetaminophen-Codeine 120-12 mg/5 mL Elixir Sig: 12.5-25 MLs
PO Q4H (every 4 hours) as needed.
9. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty
(30) mg PO DAILY (Daily).
10. Morphine 2 mg/mL Syringe Sig: Two (2) mg Injection Q4H
(every 4 hours) as needed.
11. Cepacol 2 mg Lozenge Sig: One (1) Lozenge Mucous membrane
Q4H (every 4 hours) as needed.
12. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO TID (3 times a day) as needed.
13. Albuterol Sulfate 0.083 % Solution Sig: One (1) nebulizer
treatment Inhalation Q6H (every 6 hours) as needed.
14. Dexamethasone 4 mg IV Q6H
15. Guaifenesin 1,200 mg Tablet Sustained Release 12HR Sig: One
(1) tablet PO twice a day as needed for cough.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Metastatic breast Cancer
Tracheal stenosis/compression


Discharge Condition:
O2 sats stable on RA, no stridor

Discharge Instructions:
Follow up with your doctors at [**Name5 (PTitle) 531**] Methodist

Followup Instructions:
You are being transferred to an inpatient facility.
{'Secondary malignant neoplasm of mediastinum,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Iatrogenic pneumothorax,Personal history of malignant neoplasm of breast,Personal history of malignant neoplasm of other parts of uterus'}


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: transferred for further management of tracheal stenosis

PRESENT ILLNESS: 63 y/o F w/hx of breast Ca s/p lumpectomy/chemo [**2135**], who
presented to [**Hospital 531**] [**Hospital 63637**] Hospital on [**2140-7-23**] with
shortness of breath.  Per the pt, she initially noted swelling
in her left neck one year ago.  Her oncologist at [**State 531**]
Presbyterian treated her with Femara which made no difference.
At that point he told her that her tumor was "receptor negative"
and the Femara was likely not helping.  At this point (approx
one month ago) she developed swelling in her right neck as well.
 She then went to The Oasis Center in Tijuana, [**Country 149**] in [**Month (only) **] of
this year, and was treated with a vaccine of some sort, as well
as numerous vitamins.  A week after this, she developed
shortness of breath which progressively worsened, as well as
difficulty speaking/swallowing.  She also has a nonproductive
cough but no fevers.

MEDICAL HISTORY: 1. Breast Ca [**2135**], s/p lumpectomy.  Refused XRT.  s/p
cyclophosphamide and Taxol x 6 months in [**2135**].  Had recurrence
at left supraclavicular node s/p excision, refused chemo.
2. Endometrial Ca s/p hysterectomy [**2136**]

MEDICATION ON ADMISSION: numerous vitamins and herbal supplements

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T: 99.1  P: 71  BP: 123/56  R: 16  98%RA
Gen: alert and oriented pleasant female in no acute distress,
but with audible inspiratory stridor and frequent coughing
during exam
HEENT:  normocephalic, atraumatic, MM dry, anicteric.
Neck:  matted, firm, nontender massive lymphadenopathy in L>R
cervical and supraclavicular regions.  trachea deviated to left.
Lungs:  bibasilar rhonchi, otherwise no crackles or wheezes
CV: regular rate and rhythm, no murmur/rub/gallop
Breasts: symmetric, no palpable masses
Abd: soft, nontender, nondistended, normoactive bowel sounds.
No hepatomegaly.
Ext: no edema, 2+ distal pulses
Skin: warm and dry

FAMILY HISTORY: Mother & Father w/CVA.  Sister with brain cancer.

SOCIAL HISTORY: Lives alone in [**State 531**], has 3 children who live nearby.  No
history of tobacco use.  No EtOH.   Works as a legal assistant. 

### Response:
{'Secondary malignant neoplasm of mediastinum,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Iatrogenic pneumothorax,Personal history of malignant neoplasm of breast,Personal history of malignant neoplasm of other parts of uterus'}
