CHIEF COMPLAINT: Presumed lung cancer, transfer for palliative stenting

PRESENT ILLNESS: Ms. [**Known lastname 4318**] is a 60 y/o f with schizophrenia, htn, chf, copd,
and a 50+ pack year smoking history who presented to
[**Hospital1 18**]-[**Location (un) 620**] on [**2150-11-4**] from [**Location (un) 1036**] NH with sob and
hypoxia, was given a presumptive dx of lung cancer, and is
transferred to [**Hospital1 18**] for palliative stenting.

MEDICAL HISTORY: 1.)Chronic schizophrenia
2.)Bipolar disorder
3.)Seizure disorder
4.)Etoh abuse
5.)Diastolic CHF
6.)Hypertension
7.)COPD
8.)50+ pack year tobacco abuse history

MEDICATION ON ADMISSION: 1.)Risperidone 1mg qHS
2.)Pantoprazole 40mg daily
3.)Furosemide 80mg daily
4.)Prednisone 10mg daily
5.)Docusate 100mg [**Hospital1 **]
6.)Albuterol and ipratropium nebulizers
7.)Verapamil 120mg daily
8.)Lisinopril 5mg daily
9.)Bupropion 100mg [**Hospital1 **]
10.)Depakote 2000mg daily
11.)ASA 325mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical examination on admission:
VITALS: T 97.3, bp 103/57, hr 81, rr 19, spo2 99% 6lnc
GEN: Pleasant female, sitting up in bed, nad
HEENT: Anicteric sclera, op clear with mmm
CV: RRR, s1s2, no m/r/g
PULM: Fair air movement on right with end expr wheeze, diffusely
decreased bs on left
GI: Obese, soft, nt, nd, nabs
EXT: Trace bilateral le edema over shins, warm/dry
NAILS: Minimal clubbing, no pitting/color changes/indentations
NEURO: AXO X3, no focal cn/motor/sensory deficits, finger to
nose normal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives at [**Location **]. She has 50+ pack year smoking history and
a history of etoh abuse.  Brother [**Name (NI) **] [**Name (NI) 12021**] is her hcp.
Malignant neoplasm of other parts of bronchus or lung,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Other convulsions,Other disorders of neurohypophysis,Phlebitis and thrombophlebitis of upper extremities, unspecified
Mal neo bronch/lung NEC,Atrial fibrillation,Chr airway obstruct NEC,Diastolc hrt failure NOS,Vasc comp med care NEC,Convulsions NEC,Neurohypophysis dis NEC,Phlbts vn NOS up extrm
Admission Date:  [**2150-11-7**]              Discharge Date:   [**2150-11-13**]

Date of Birth:  [**2090-5-7**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2186**]
Chief Complaint:
Presumed lung cancer, transfer for palliative stenting

Major Surgical or Invasive Procedure:
Rigid bronchoscopy with stent placement [**2150-11-13**]


History of Present Illness:
Ms. [**Known lastname 4318**] is a 60 y/o f with schizophrenia, htn, chf, copd,
and a 50+ pack year smoking history who presented to
[**Hospital1 18**]-[**Location (un) 620**] on [**2150-11-4**] from [**Location (un) 1036**] NH with sob and
hypoxia, was given a presumptive dx of lung cancer, and is
transferred to [**Hospital1 18**] for palliative stenting.

She began to complain of shortness of breath and was found to be
hypoxic (94% on 2Lnc) at [**Last Name (LF) **], [**First Name3 (LF) **] was sent to [**Hospital1 18**]-[**Location (un) 620**] ED.
During the admission, she was noted to have a left peri-hilar
mass on CXR as well as a left pleural effusion, and a chest CT
revealed a 3.5x5cm left suprahilar mass with impingment on the
LUL bronchus and subsequent LUL collapse. She underwent
bronchoscopy showing a large lesion involving the left mainstem
bronchus and completely obstructing the LUL take-off. On the
following day, a chest x-ray showed total white-out of the left
lung. Her course was also complicated by the onset of new atrial
fibrillation, for which she was treated with diltiazem and sent
over on an IV amiodarone load. She also was hyponatremic and was
fluid restricted for presumed SIADH, and started on sodium tabs.

On admission, she had no complaints. Occasional complaint of
chest tightness that she's been having off and on for days, not
severe, no sob, no f/c. She has a mild productive cough,
unchanged over the past few days.

Past Medical History:
1.)Chronic schizophrenia
2.)Bipolar disorder
3.)Seizure disorder
4.)Etoh abuse
5.)Diastolic CHF
6.)Hypertension
7.)COPD
8.)50+ pack year tobacco abuse history

Social History:
Lives at [**Location **]. She has 50+ pack year smoking history and
a history of etoh abuse.  Brother [**Name (NI) **] [**Name (NI) 12021**] is her hcp.


Family History:
Non-contributory


Physical Exam:
Physical examination on admission:
VITALS: T 97.3, bp 103/57, hr 81, rr 19, spo2 99% 6lnc
GEN: Pleasant female, sitting up in bed, nad
HEENT: Anicteric sclera, op clear with mmm
CV: RRR, s1s2, no m/r/g
PULM: Fair air movement on right with end expr wheeze, diffusely
decreased bs on left
GI: Obese, soft, nt, nd, nabs
EXT: Trace bilateral le edema over shins, warm/dry
NAILS: Minimal clubbing, no pitting/color changes/indentations
NEURO: AXO X3, no focal cn/motor/sensory deficits, finger to
nose normal


Pertinent Results:
Admission Labs:
[**2150-11-8**] 02:28AM BLOOD WBC-12.2* RBC-4.38 Hgb-13.4 Hct-39.3
MCV-90 MCH-30.6 MCHC-34.1 RDW-13.3 Plt Ct-259
[**2150-11-8**] 02:28AM BLOOD Plt Ct-259
[**2150-11-9**] 03:00AM BLOOD PT-13.1 PTT-28.2 INR(PT)-1.2
[**2150-11-8**] 02:28AM BLOOD Glucose-160* UreaN-17 Creat-0.6 Na-129*
K-4.4 Cl-91* HCO3-30 AnGap-12
[**2150-11-8**] 02:28AM BLOOD Calcium-9.4 Mg-2.0 UricAcd-3.4
[**2150-11-10**] 01:49PM BLOOD Osmolal-272*
[**2150-11-10**] 01:49PM BLOOD Cortsol-21.9*
[**2150-11-8**] 02:28AM BLOOD Valproa-73
*
CXR [**11-8**]: IMPRESSION: Collapse left lung
*
CT Chest/Abd/Pelvis [**11-9**]:
IMPRESSION:
1. 3.4 x 2.9 cm peripherally enhancing lobulated mass causing
obstruction of the left upper lobe bronchus and resulting in
complete collapse/consolidation of the left upper lobe. The left
lower lobe bronchus remains patent, and the left lower lobe
remains aerated.
2. Moderate left pleural effusion, with minimal compressive
atelectasis on aerated left lower lobe.
3. Tiny 3 to 4 mm nodular densities within the right lung base.
Attention to this area should be paid on subsequent followup
exams.
4. Low-density lesion adjacent to falciform ligament most likely
represents focal fatty infiltration. Attention to this area
should be paid on followup exams.
5. Bilateral adrenal adenomas.
6. Tiny low-density lesions within both kidneys, which are too
small to adequately characterize.
*
[**2150-11-10**] CXR: IMPRESSION: AP chest compared to [**2150-11-8**]:
Left upper lobe has reexpanded. Left lower lobe still collapsed
around the left hilar mass accompanied by small left pleural
effusion. Mediastinum midline. Heart normal size. Right lung
clear.

Brief Hospital Course:
Ms. [**Known lastname 4318**] is a 60 year-old female with long-standing smoking
history with newly diagnosed lung mass obstructing LUL with
consequent collapse, transferred initially to MICU, then floor
for further work-up and care.

1) Lung mass: Her presentation with long-standing smoking, lung
mass, and presumptive SIADH was highly concerning for
malignancy, and an appropriate work-up was continued. A CT chest
performed on [**11-10**] revealed a 3.4 x 2.9 cm peripherally
enhancing lobulated mass causing obstruction of the left upper
lobe bronchus and resulting in complete collapse/consolidation
of the left upper lobe, with patent LLL bronchus. A moderate
left pleural effusion was also seen. Pleural fluid cytology from
the OSH thoracentesis returned negative for malignancy, although
only a small amount of fluid was obtained at that time. BAL
brushings from the OSH returned highly suspicious for squamous
cell cancer, which was felt diagnostic. She underwent a rigid
bronchoscopy on [**11-12**], with findings significant for tumor
infiltration of the submucosa in left mainstem bronchus, with
LUL/lingula completely obstructed. Stenting of the distal left
main stem bronchus (2mm uncovered stent) was performed.
LUL/lingula completely obstructed and unable to open. She
tolerated the procedure well without immediate complications.
CXR PA/lat post-procedure without complications.

Work-up otherwise remarkable for negative head CT, abdominal CT
without liver mets, bilateral adrenal adenomas. She does have a
pleural effusion, likely malignant, and is awaiting an
out-patient PET scan to complete her metastatic work-up and
assess disease burden. Hematology-Oncology was consulted in
house, with impression of unresectability. She may benefit from
XRT, which will be addressed as an out-patient. Ms. [**Known lastname 4318**] has
a poor understanding of her disease, and as such complicates
matters in trying to obtain consent.

She will follow-up with Hematology/Oncology with Dr. [**Last Name (STitle) **]
or [**Doctor Last Name 3274**] as an out-patient.

2) Dyspnea: Felt secondary to above. She also has a history of
COPD, and was initially placed on a higher dose of Prednisone 40
mg PO QD for possible COPD exacerbation upon admission to the
MICU. COPD was ultimately not felt to be an important
contributor, and quick Prednisone taper was initiated. She is
now down to her usual dose of 10 mg PO QD. We contact[**Name (NI) **] the
patient's PCP, [**Name10 (NameIs) 1023**] indicated that she is on chronic low dose
Prednisone 10 mg PO QD. Continue supportive care with nebulizers
prn, MDIs. NO LASIX.

4) Atrial fibrillation: She was loaded on amiodarone IV at the
OSH, completed at [**Hospital1 18**]. She was subsequently placed on
Amiodarone 200 mg PO TID. she was also on a Diltiazem drip at
the OSH, converted to Verapamil upon transfer. She reverted to
NSR while in the ICU on [**11-10**], then back in afib on [**11-11**] with
RVR with HR in 140s, and borderline low BP. She was given
Diltiazem push IV X 3 doses, then Verapamil was changed to
Diltiazem 60 mg PO QID for easier titration. Amiodarone was also
increased to 400 mg PO TID. She converted back to NSR on [**11-11**],
and has remained in NSR since. She is back on 200 mg PO TID, and
should continue this dose X 1 week ([**11-20**]), then decrease to 200
mg PO BID X 1 week, then daily thereafter. She is back on
Verapamil 120 mg PO Q 12 hours. Decision was made not to
anticoagulate given her lung mass and concern over
friability/bleeding. However, no such evidence on bronch. She
currently remains in NSR, and per discussion with attending, no
anticoagulation at present. Of note, we have been avoiding
Albuterol nebulizers to prevent med-induced tachycardia.

5) Hyponatremia: Urine electrolytes with elevated urine sodium,
high urine osm, and low serum sodium was consistent with SIADH.
Renal was consulted, who confirmed the diagnosis. Her sodium has
improved in the hospital with fluid restriction 1200 cc/day.
Lasix was avoided, and IV fluids were used only sparingly for
lowish BP, now stable. A random cortisol level of 21 ruled out
adrenal insufficiency.

6) Psych: She was continued on her out-patient regiment of
Risperidone, valproic acid (level therapeutic on admission).
Bupropion inadvertently held during admission, restarted at
discharge. Poor grasp of diagnosis.

7) Code: Patient remained full code throughout her hospital
course. Her brother, [**Name (NI) **] [**Name (NI) **] is her HCP.

Medications on Admission:
1.)Risperidone 1mg qHS
2.)Pantoprazole 40mg daily
3.)Furosemide 80mg daily
4.)Prednisone 10mg daily
5.)Docusate 100mg [**Hospital1 **]
6.)Albuterol and ipratropium nebulizers
7.)Verapamil 120mg daily
8.)Lisinopril 5mg daily
9.)Bupropion 100mg [**Hospital1 **]
10.)Depakote 2000mg daily
11.)ASA 325mg daily

Discharge Medications:
1. Risperidone 1 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
4. Prednisone 10 mg Tablet Sig: One (1) Tablet PO QD ().
5. Valproate Sodium 250 mg/5 mL Syrup Sig: 1000 (1000) mg PO
Q12H (every 12 hours).
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Prednisone 10 mg Tablet Sig: One (1) Tablet PO QD ().
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Verapamil 80 mg Tablet Sig: One [**Age over 90 **]y (120) mg PO
Q12H (every 12 hours): Start [**11-13**] PM. Hold for SBO<95 or HR<55.

11. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
12. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
13. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
every six (6) hours as needed for shortness of breath or
wheezing.
14. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
15. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day): Please give 200 mg PO TID until [**11-20**], then 200 mg P0 [**Hospital1 **]
X 1 week, then 200 mg daily thereafter. .
16. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
17. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 5 days: Last doses on [**11-18**].
18. Combivent 103-18 mcg/Actuation Aerosol Sig: Two (2)
inhalation Inhalation twice a day.
19. Bupropion 100 mg Tablet Sig: One (1) Tablet PO twice a day.



Discharge Disposition:
Extended Care

Facility:
[**Location (un) 1036**] - [**Location (un) 620**]

Discharge Diagnosis:
Newly diagnosed lung squamous cell cancer
Atrial fibrillation
Syndrome of inappropriate ADH
Left forearm thrombophlebitis
COPD
Schizophrenia


Discharge Condition:
Patient stable at dishcarge. foley still in place, to be removed
at [**Location (un) 1036**].


Discharge Instructions:
1. If you experience fever, chills, chest pain, shortness of
breath, palpitations, or other concerning symptoms, please call
your doctor or return to the emergency department for
evaluation.

2. Please note that we have made changes to your medications.
Please take all medications as prescribed.

3. You have a scheduled PET scan on [**11-18**] at 0720 AM to rule out
lesions elsewhere in your body. It is extremely important that
you go to this test. You need to be fasting for 6 hours prior to
the test. You can have water with your meds.

4. You will also need to follow-up with Oncology. Please call on
Monday [**0-0-**] to schedule an appointment next week (after
[**11-18**]).

Followup Instructions:
1. You have a scheduled PET scan on Wednesday [**11-18**] [**Hospital Ward Name 23**] [**Location (un) **] at 0720 AM. It is extremely important that you go to this
test. You need to be fasting for 6 hours prior to the test. You
can have water with your meds.

2. Please call [**0-0-**] to schedule an appointment with
Oncology Dr. [**Last Name (STitle) **] or [**Doctor Last Name 3274**] next week after [**11-18**].

3. Please also call your PCP and schedule an appointment to see
him/her within the next 2 weeks.



Completed by:[**2150-11-13**]

Name:  [**Known lastname 1323**],[**Known firstname 1013**]                 Unit No:   [**Numeric Identifier 11254**]

Admission Date:  [**2150-11-7**]              Discharge Date:   [**2150-11-13**]

Date of Birth:  [**2090-5-7**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 406**]
Addendum:
Please note that CXR on [**11-13**] following stenting procedure
revealed aeration in LUL and collapse of LLL and lingula. Plan
nonetheless as above. Please also note that patient has been
requiring supplemental oxygen 2-3 L via NC to maintian
saturation >92%. Continue supplemental oxygen as needed.

She is to complete a 7-day course of Keflex for left forearm
thrombophlebitis, although most likely sterile. Last doses on
[**11-18**].

Patient discharged with foley still in place, please D/C on
arrival to [**Location (un) 1132**].


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 1132**] - [**Location (un) 407**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 408**] MD [**MD Number(2) 409**]

Completed by:[**2150-11-13**]
{'Malignant neoplasm of other parts of bronchus or lung,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Other convulsions,Other disorders of neurohypophysis,Phlebitis and thrombophlebitis of upper extremities, unspecified'}


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: Presumed lung cancer, transfer for palliative stenting

PRESENT ILLNESS: Ms. [**Known lastname 4318**] is a 60 y/o f with schizophrenia, htn, chf, copd,
and a 50+ pack year smoking history who presented to
[**Hospital1 18**]-[**Location (un) 620**] on [**2150-11-4**] from [**Location (un) 1036**] NH with sob and
hypoxia, was given a presumptive dx of lung cancer, and is
transferred to [**Hospital1 18**] for palliative stenting.

MEDICAL HISTORY: 1.)Chronic schizophrenia
2.)Bipolar disorder
3.)Seizure disorder
4.)Etoh abuse
5.)Diastolic CHF
6.)Hypertension
7.)COPD
8.)50+ pack year tobacco abuse history

MEDICATION ON ADMISSION: 1.)Risperidone 1mg qHS
2.)Pantoprazole 40mg daily
3.)Furosemide 80mg daily
4.)Prednisone 10mg daily
5.)Docusate 100mg [**Hospital1 **]
6.)Albuterol and ipratropium nebulizers
7.)Verapamil 120mg daily
8.)Lisinopril 5mg daily
9.)Bupropion 100mg [**Hospital1 **]
10.)Depakote 2000mg daily
11.)ASA 325mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical examination on admission:
VITALS: T 97.3, bp 103/57, hr 81, rr 19, spo2 99% 6lnc
GEN: Pleasant female, sitting up in bed, nad
HEENT: Anicteric sclera, op clear with mmm
CV: RRR, s1s2, no m/r/g
PULM: Fair air movement on right with end expr wheeze, diffusely
decreased bs on left
GI: Obese, soft, nt, nd, nabs
EXT: Trace bilateral le edema over shins, warm/dry
NAILS: Minimal clubbing, no pitting/color changes/indentations
NEURO: AXO X3, no focal cn/motor/sensory deficits, finger to
nose normal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives at [**Location **]. She has 50+ pack year smoking history and
a history of etoh abuse.  Brother [**Name (NI) **] [**Name (NI) 12021**] is her hcp. 

### Response:
{'Malignant neoplasm of other parts of bronchus or lung,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diastolic heart failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Other convulsions,Other disorders of neurohypophysis,Phlebitis and thrombophlebitis of upper extremities, unspecified'}
