CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: 64M with PMH significant for
right-sided nonsmall celll lung cancer stage IIIb s/p
neoadjuvant
chemoradiation therapy with good response presented today with
dyspnea.  He is s/p right upper lobectomy and wedge resection of
RLL on [**2155-5-23**] performed at [**Hospital **] Hospital.  He was discharged
after an uneventful course but returned to the ED the next day
with dyspnea.  A CXR revealed pneumothorax, and ultimately he
required two weeks of inpatient treatment.  He was then
discharged on a pneumostat, and came up to [**Location (un) 86**] for vacation.
Last evening, he developed acute dyspnea.  In the ED a portable
CXR was ordered and basic labs drawn.

MEDICAL HISTORY: right-sided nonsmall cell lung cancer stage IIIb s/p neoadjuvant
chemoradiation therapy with good response.

MEDICATION ON ADMISSION: 1. Citalopram 20 mg PO DAILY
2. Lorazepam 1 mg PO Q4H:PRN anxiety
3. Oxycodone-Acetaminophen (5mg-325mg) [**12-16**] TAB PO Q4H:PRN pain
RX *oxycodone-acetaminophen 5 mg-325 mg [**12-16**] Tablet(s) by mouth
q4-6 hours Disp #*30 Tablet Refills:*0
4. Symbicort *NF* (budesonide-formoterol) 80-4.5 mcg/actuation
Inhalation 2 puffs [**Hospital1 **]
5. Albuterol Inhaler [**12-16**] PUFF IH Q6H
6. Aspirin 325 mg PO DAILY
7. Docusate Sodium 100 mg PO BID:PRN constipation
RX *docusate sodium 100 mg 1 Capsule(s) by mouth twice a day
Disp #*30 Capsule Refills:*1

ALLERGIES: Penicillins

PHYSICAL EXAM: PHYSICAL EXAM:
T=98.6, HR=119 (sinus), 151/93, 16, 96% on 4L NC

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Tobacco: Quit < 1 year ago, Alcohol: Heavy; beer daily time(s);
Recreational Drugs: None.
Other air leak,Malignant neoplasm of bronchus and lung, unspecified,Pulmonary collapse,Personal history of tobacco use,Acquired absence of organ, lung
Other air leak,Mal neo bronch/lung NOS,Pulmonary collapse,History of tobacco use,Acq absence of lung
Admission Date:  [**2155-6-13**]              Discharge Date:   [**2155-6-15**]

Date of Birth:  [**2091-4-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
bronchoscopy [**2155-6-13**]


History of Present Illness:
64M with PMH significant for
right-sided nonsmall celll lung cancer stage IIIb s/p
neoadjuvant
chemoradiation therapy with good response presented today with
dyspnea.  He is s/p right upper lobectomy and wedge resection of
RLL on [**2155-5-23**] performed at [**Hospital **] Hospital.  He was discharged
after an uneventful course but returned to the ED the next day
with dyspnea.  A CXR revealed pneumothorax, and ultimately he
required two weeks of inpatient treatment.  He was then
discharged on a pneumostat, and came up to [**Location (un) 86**] for vacation.
Last evening, he developed acute dyspnea.  In the ED a portable
CXR was ordered and basic labs drawn.

Past Medical History:
right-sided nonsmall cell lung cancer stage IIIb s/p neoadjuvant
chemoradiation therapy with good response.

Social History:
Tobacco: Quit < 1 year ago, Alcohol: Heavy; beer daily time(s);
Recreational Drugs: None.

Family History:
non-contributory

Physical Exam:
PHYSICAL EXAM:
T=98.6, HR=119 (sinus), 151/93, 16, 96% on 4L NC

GENERAL        [x] All findings normal
[ ] WN/WD  [ ] NAD  [ ] AAO  [ ] abnormal findings:

HEENT          [x] All findings normal
[ ] NC/AT   [ ] EOMI   [ ] PERRL/A   [ ] Anicteric
[ ] OP/NP mucosa normal     [ ] Tongue midline
[ ] Palate symmetric  [ ] Neck supple/NT/without mass
[ ] Trachea midline [ ] Thyroid nl size/contour
[ ] Abnormal findings:

RESPIRATORY    [ ] All findings normal
[ ] CTA/P     [ ] Excursion normal     [ ] No fremitus
[ ] No egophony    [ ] No spine/CVAT
[X] Abnormal findings: decreased respirations on right side

CARDIOVASCULAR [x] All findings normal
[ ] RRR    [ ] No m/r/g    [ ] No JVD   [ ] PMI nl  [ ] No edema
[ ] Peripheral pulses nl    [ ] No abd/carotid bruit
[ ] Abnormal findings:

GI             [x] All findings normal
[ ] Soft    [ ] NT   [ ] ND  [ ] No mass/HSM   [ ] No hernia
[ ] Abnormal findings:

GU             [x] Deferred  [ ] All findings normal
[ ] Nl genitalia    [ ] Nl pelvic/testicular exam    [ ] Nl DRE
[ ] Abnormal findings:

NEURO          [x] All findings normal
[ ] Strength intact/symmetric    [ ] Sensation intact/ symmetric
[ ] Reflexes nl     [ ] No facial asymmetry [ ] Cognition intact
[ ] Cranial nerves intact   [ ] Abnormal findings:

MS             [x] All findings normal
[ ] No clubbing   [ ] No cyanosis   [ ] No edema   [ ] Gait nl
[ ] No tenderness  [ ] Tone/align/ROM nl   [ ] Palpation nl
[ ] Nails nl   [ ] Abnormal findings:

LYMPH NODES    [x] All findings normal
[ ] Cervical nl      [ ] Supraclavicular nl     [ ] Axillary nl
[ ] Inguinal nl   [ ] Abnormal findings:

SKIN           [x] All findings normal
[ ] No rashes/lesions/ulcers
[ ] No induration/nodules/tightening     [ ] Abnormal findings:

PSYCHIATRIC    [x] All findings normal
[ ] Nl judgment/insight    [ ] Nl memory   [ ] Nl mood/affect
[ ] Abnormal findings:

Pertinent Results:
[**2155-6-13**] 11:00AM   WBC-12.3* RBC-4.65 HGB-14.1 HCT-42.4 MCV-91
MCH-30.3 MCHC-33.2 RDW-13.8
[**2155-6-13**] 11:00AM   NEUTS-91.7* LYMPHS-3.2* MONOS-4.8 EOS-0.2
BASOS-0.2
[**2155-6-13**] 11:00AM   PLT COUNT-418
[**2155-6-13**] 11:00AM   PT-10.8 PTT-30.9 INR(PT)-1.0

CXR: subcutaneous emphysema, pneumothorax, right-[**Hospital1 **] tracheal
deviation, no blunting of right costophrenic angle, no evidence
of effusion


Brief Hospital Course:
64M with PMH significant for right-sided nonsmall cell lung
cancer stage IIIb s/p neoadjuvant chemoradiation therapy with
good response presented to the hospital with
dyspnea.  He is s/p right upper lobectomy and wedge resection of
RLL on [**2155-5-23**] performed at [**Hospital **] Hospital.  In the ED a
portable CXR was ordered and basic labs drawn. His pneumostat
was switched to a Pleurovac to suction.  A repeat CXR showing
improvement.

Given given his recent right upper lobectomy, there was concern
for a bronchial stump leak or bronchopleural fistula formation
responsible for his pneumothorax.  So, he underwent bronchoscopy
to rule this out.  The bronchoscopy showed a middle lobe
positional occlusion, likely due to kinking of the middle
bronchial stem as the middle lobe expanded in the absence of the
upper lobe.  There was no evidence to suggest a bronchopleural
fistula or a bronchial stump air leak.

   During his entire course, he was satting well and ambulating
without difficulty.  Attempts to wean him down to waterseal were
successful.  Finally, we placed him on pneumostat again, which
this time showed no air leak.  A final CXR was negative for
increased pneumothorax, and he was discharged to home in stable
condition.

Medications on Admission:
1. Citalopram 20 mg PO DAILY
2. Lorazepam 1 mg PO Q4H:PRN anxiety
3. Oxycodone-Acetaminophen (5mg-325mg) [**12-16**] TAB PO Q4H:PRN pain
RX *oxycodone-acetaminophen 5 mg-325 mg [**12-16**] Tablet(s) by mouth
q4-6 hours Disp #*30 Tablet Refills:*0
4. Symbicort *NF* (budesonide-formoterol) 80-4.5 mcg/actuation
Inhalation 2 puffs [**Hospital1 **]
5. Albuterol Inhaler [**12-16**] PUFF IH Q6H
6. Aspirin 325 mg PO DAILY
7. Docusate Sodium 100 mg PO BID:PRN constipation
RX *docusate sodium 100 mg 1 Capsule(s) by mouth twice a day
Disp #*30 Capsule Refills:*1

Discharge Medications:
1. Citalopram 20 mg PO DAILY
2. Lorazepam 1 mg PO Q4H:PRN anxiety
3. Oxycodone-Acetaminophen (5mg-325mg) [**12-16**] TAB PO Q4H:PRN pain
RX *oxycodone-acetaminophen 5 mg-325 mg [**12-16**] Tablet(s) by mouth
q4-6 hours Disp #*30 Tablet Refills:*0
4. Symbicort *NF* (budesonide-formoterol) 80-4.5 mcg/actuation
Inhalation 2 puffs [**Hospital1 **]
5. Albuterol Inhaler [**12-16**] PUFF IH Q6H
6. Aspirin 325 mg PO DAILY
7. Docusate Sodium 100 mg PO BID:PRN constipation
RX *docusate sodium 100 mg 1 Capsule(s) by mouth twice a day
Disp #*30 Capsule Refills:*1


Discharge Disposition:
Home

Discharge Diagnosis:
small persistent air leak, right middle lobe bronchus collapse


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


Discharge Instructions:
You were admitted to [**Hospital1 18**] after worsening shortness of breath
and right sided chest pain. You are now doing much better with
minimal intermittent sharp pain and no shortness of breath. Your
pigtail catheter is hooked back up to a pneumostat. You will be
seen by your thoracic surgeon in [**State 531**] in follow up tomorrow.

Please call your physician or go to the emergency department if
you develop worsening shortness of breath or chest pain or have
any symptoms that concern you.

Take percocet for pain control as needed.

Take colace as a stool softener as needed while taking
narcotics.

Do not drive while taking percocet.

Shower but do not bathe. Keep the insertion site of the pigtail
catheter clean and dry.

Followup Instructions:
Follow up with your thoracic surgery in [**State 531**].

Follow up with your primary care physician in [**Name9 (PRE) 531**].

Call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] office as needed for follow up.

Division of Thoracic Surgery and Interventional Pulmonology
Department of Surgery
[**Hospital1 69**]
[**Hospital Ward Name 517**], [**Hospital Ward Name 121**] Entrance - [**Hospital1 **] Building, [**Apartment Address(1) **]
[**Street Address(2) 8667**]
[**Location (un) 86**] , [**Telephone/Fax (1) 112527**]
{'Other air leak,Malignant neoplasm of bronchus and lung, unspecified,Pulmonary collapse,Personal history of tobacco use,Acquired absence of organ, lung'}


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: dyspnea

PRESENT ILLNESS: 64M with PMH significant for
right-sided nonsmall celll lung cancer stage IIIb s/p
neoadjuvant
chemoradiation therapy with good response presented today with
dyspnea.  He is s/p right upper lobectomy and wedge resection of
RLL on [**2155-5-23**] performed at [**Hospital **] Hospital.  He was discharged
after an uneventful course but returned to the ED the next day
with dyspnea.  A CXR revealed pneumothorax, and ultimately he
required two weeks of inpatient treatment.  He was then
discharged on a pneumostat, and came up to [**Location (un) 86**] for vacation.
Last evening, he developed acute dyspnea.  In the ED a portable
CXR was ordered and basic labs drawn.

MEDICAL HISTORY: right-sided nonsmall cell lung cancer stage IIIb s/p neoadjuvant
chemoradiation therapy with good response.

MEDICATION ON ADMISSION: 1. Citalopram 20 mg PO DAILY
2. Lorazepam 1 mg PO Q4H:PRN anxiety
3. Oxycodone-Acetaminophen (5mg-325mg) [**12-16**] TAB PO Q4H:PRN pain
RX *oxycodone-acetaminophen 5 mg-325 mg [**12-16**] Tablet(s) by mouth
q4-6 hours Disp #*30 Tablet Refills:*0
4. Symbicort *NF* (budesonide-formoterol) 80-4.5 mcg/actuation
Inhalation 2 puffs [**Hospital1 **]
5. Albuterol Inhaler [**12-16**] PUFF IH Q6H
6. Aspirin 325 mg PO DAILY
7. Docusate Sodium 100 mg PO BID:PRN constipation
RX *docusate sodium 100 mg 1 Capsule(s) by mouth twice a day
Disp #*30 Capsule Refills:*1

ALLERGIES: Penicillins

PHYSICAL EXAM: PHYSICAL EXAM:
T=98.6, HR=119 (sinus), 151/93, 16, 96% on 4L NC

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Tobacco: Quit < 1 year ago, Alcohol: Heavy; beer daily time(s);
Recreational Drugs: None. 

### Response:
{'Other air leak,Malignant neoplasm of bronchus and lung, unspecified,Pulmonary collapse,Personal history of tobacco use,Acquired absence of organ, lung'}
