CHIEF COMPLAINT: Chest pain, SOB.

PRESENT ILLNESS: 75 year-old man with history of stage IV non-small cell lung ca
with mets to spine diagnosed [**9-22**], HTN, AF, CRI, who presents
with pleuritic chest pain and dyspnea for one day. The patient
states that he received his first round of chemotherapy of
[**Doctor Last Name **]/taxol 4 days prior to admission. He felt well one day
prior to admission, but then began feeling unwell today.  He
stated that he had a productive cough, chills, fatigue and well
as bilateral plerutic CP with taking a deep breath. He denied
dyspnea. He denied N/V/D or poor po intake - eating eggs and
bacon. Temp at home 100.4; referred to ED by heme/onc fellow.
The pt was BIBA. Enroute the patient c/o CP and was given nitro
with drop in BP to 70's.
.
In the ED, the patient vomited once.  He had a chest CT, neg for
PE. CT abd/pelvis neg. Due to the ? of PNA with fever and WBC
16.8, the pt received levo, cefepime - did not yet receive vanc.
The patient remained hypotensive with SBP's 70-90's despite
repeat fluid boluses - total 2L. An IJ was placed and neo was
started. The patient was also found to be in afib with RVR HR
130-170. He received IV diltiazem x  with improvement in HR to
100's. He was then switched to a diltiazem drip. The patient was
not cardioverted as he had been in afib for 10+ years. VS were
temp 99.0 HR 105 SBP 105/50 RR 20 SAo2 100% NC.

MEDICAL HISTORY: # stage IV adenocarcinoma of the lung dx [**2177-10-21**] by
bronchoscopy, MRI [**10-26**] with bony mets to T11, 50-75% narrowing
of spinal canal and mild to moderate spinal cord compression,
s/p radiation on [**10-28**]
- started clinical trial with Pacitaxel, Carboplatin, Anamorelin
vs. placebo at [**Company 2860**], day 1 was [**2177-11-11**]
# DM2
# Atrial fibrillation
# HTN
# chronic renal failure
# Anemia
# Hyperlipidemia
# COPD

MEDICATION ON ADMISSION: Fluticasone-Salmeterol 250/50 mcg disk, 1 disk [**Hospital1 **]
Tiotropium Bromide 18mcg 1 cap qday
Enalapril 10mg PO qday- not taking
Simvastatin 20mg PO qday
Albuterol 90mcg [**1-15**] puff q6hours PRN
Atenolol 75mg PO daily
Colace 100mg PO BID
Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day)
Zofran 8 mg [**Hospital1 **]
Ativan 1mg [**Hospital1 **]
Hydrocodone as needed
Tramadol as needed

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam at Admission
VS: 98.9 HR 92 Bp 112/77 RR 12 SaO2 96%RA
Gen: NAD, flushed, Aox3 easily able to relate history
HEENT: right IJ in place, mild JVD, no LAD, benign OP
CV: RRR, no MRG
PULM: mild bilateral crackles, good air movement, no labored
breathing
ABD: soft, NT/ ND
EXT: warm well perfused
.
Physical Exam at Discharge
VS: 97.7, 112/68, 106, 16, 95%RA
In general patient is alerat and oriented, in NAD
Neck is supple and non-tender with no LAD
Heart exam shows irregular rate and rhythm.  No m/r/g.
Chest exam is clear to auscultation bilaterally in posterior
fields
Abdomen is non-tender with normal bowel sounds
Extremities shows no lower pitting edema; they are warm and well
perfused

FAMILY HISTORY: No family history of lung cancer

SOCIAL HISTORY: -Tob: quit in [**2166**], approx 150 pk yrs, + asbestos exposure
-EtOH: quit in [**2166**]
-Illicits: None
-Living situation: lives alone, no children but his extended
family is very close to him
-Occupation: used to be a [**Doctor Last Name 9808**] operator
Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of lower lobe, bronchus or lung,Unspecified disease of pericardium,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anemia, unspecified,Neutropenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Nausea alone,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Hypotension, unspecified
Pneumonia, organism NOS,Secondary malig neo bone,Mal neo lower lobe lung,Pericardial disease NOS,Pleural effusion NOS,Hyposmolality,Atrial fibrillation,Chr airway obstruct NEC,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Anemia NOS,Neutropenia NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Nausea alone,Adv eff antineoplastic,Hypotension NOS
Admission Date:  [**2177-11-13**]              Discharge Date:   [**2177-11-21**]

Date of Birth:  [**2101-12-31**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3276**]
Chief Complaint:
Chest pain, SOB.

Major Surgical or Invasive Procedure:
Arterial line
Central venous line

History of Present Illness:
75 year-old man with history of stage IV non-small cell lung ca
with mets to spine diagnosed [**9-22**], HTN, AF, CRI, who presents
with pleuritic chest pain and dyspnea for one day. The patient
states that he received his first round of chemotherapy of
[**Doctor Last Name **]/taxol 4 days prior to admission. He felt well one day
prior to admission, but then began feeling unwell today.  He
stated that he had a productive cough, chills, fatigue and well
as bilateral plerutic CP with taking a deep breath. He denied
dyspnea. He denied N/V/D or poor po intake - eating eggs and
bacon. Temp at home 100.4; referred to ED by heme/onc fellow.
The pt was BIBA. Enroute the patient c/o CP and was given nitro
with drop in BP to 70's.
.
In the ED, the patient vomited once.  He had a chest CT, neg for
PE. CT abd/pelvis neg. Due to the ? of PNA with fever and WBC
16.8, the pt received levo, cefepime - did not yet receive vanc.
The patient remained hypotensive with SBP's 70-90's despite
repeat fluid boluses - total 2L. An IJ was placed and neo was
started. The patient was also found to be in afib with RVR HR
130-170. He received IV diltiazem x  with improvement in HR to
100's. He was then switched to a diltiazem drip. The patient was
not cardioverted as he had been in afib for 10+ years. VS were
temp 99.0 HR 105 SBP 105/50 RR 20 SAo2 100% NC.

Past Medical History:
# stage IV adenocarcinoma of the lung dx [**2177-10-21**] by
bronchoscopy, MRI [**10-26**] with bony mets to T11, 50-75% narrowing
of spinal canal and mild to moderate spinal cord compression,
s/p radiation on [**10-28**]
- started clinical trial with Pacitaxel, Carboplatin, Anamorelin
vs. placebo at [**Company 2860**], day 1 was [**2177-11-11**]
# DM2
# Atrial fibrillation
# HTN
# chronic renal failure
# Anemia
# Hyperlipidemia
# COPD

Social History:
-Tob: quit in [**2166**], approx 150 pk yrs, + asbestos exposure
-EtOH: quit in [**2166**]
-Illicits: None
-Living situation: lives alone, no children but his extended
family is very close to him
-Occupation: used to be a [**Doctor Last Name 9808**] operator


Family History:
No family history of lung cancer

Physical Exam:
Physical Exam at Admission
VS: 98.9 HR 92 Bp 112/77 RR 12 SaO2 96%RA
Gen: NAD, flushed, Aox3 easily able to relate history
HEENT: right IJ in place, mild JVD, no LAD, benign OP
CV: RRR, no MRG
PULM: mild bilateral crackles, good air movement, no labored
breathing
ABD: soft, NT/ ND
EXT: warm well perfused
.
Physical Exam at Discharge
VS: 97.7, 112/68, 106, 16, 95%RA
In general patient is alerat and oriented, in NAD
Neck is supple and non-tender with no LAD
Heart exam shows irregular rate and rhythm.  No m/r/g.
Chest exam is clear to auscultation bilaterally in posterior
fields
Abdomen is non-tender with normal bowel sounds
Extremities shows no lower pitting edema; they are warm and well
perfused

Pertinent Results:
[**2177-11-13**] 04:40PM BLOOD WBC-16.8* RBC-3.86* Hgb-11.4* Hct-33.6*
MCV-87 MCH-29.5 MCHC-34.0 RDW-14.0 Plt Ct-313
[**2177-11-13**] 04:40PM BLOOD Neuts-95.4* Lymphs-3.2* Monos-0.7*
Eos-0.7 Baso-0.1
[**2177-11-14**] 05:11AM BLOOD PT-15.5* PTT-31.7 INR(PT)-1.4*
[**2177-11-13**] 05:00PM BLOOD Glucose-163* UreaN-24* Creat-1.4* Na-130*
K-4.8 Cl-95* HCO3-22 AnGap-18
[**2177-11-13**] 05:00PM BLOOD CK(CPK)-31*
[**2177-11-14**] 05:11AM BLOOD LD(LDH)-344* CK(CPK)-34* TotBili-0.9
[**2177-11-13**] 05:00PM BLOOD cTropnT-<0.01
[**2177-11-14**] 05:11AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2177-11-13**] 05:00PM BLOOD Calcium-8.3* Phos-2.9 Mg-1.8
[**2177-11-14**] 05:11AM BLOOD Hapto-345*
.
CXR: Interval worsening of the left upper lobe opacity and left
subpulmonic effusion. There is a large left hilar mass, better
appreciated on prior CT study.
.
Head CT: No acute intracranial process. Lucency involving the
inner table of the left occipital bone may represent venous [**Doctor Last Name **]
or arachnoid granulation, although metastatic disease cannot be
excluded.  Opacification of the left mastoid air cells and
middle ear opacification may represent mastoiditis in the
correct clinical context.
.
CTA Chest: Extensive left hilar tumor masses with lesions
narrowing the left upper segmental branches without evidence of
PE.

Brief Hospital Course:
MICU Course:
Mr. [**Known lastname 1007**] was admitted to the MICU with  likely post-obstructive
PNA with elevated WBCs, productive cough and fever.  A CTA
showed a lung mass but no clear infiltrate and was negative for
PE.  ECGs initially were without ischemic changes and troponins
were negative.  He was started on Vancomycin and Zosyn.  He had
a thoracentesis which showed an exudate, cytology pending at
time of transfer.  He initially required Levophed for blood
pressure but was able to be weaned off on [**2177-11-16**].  He was never
intubated.  He was feeling well the day after admission and
asymptomatic with regards to the hypotension.  Cultures were all
negative.
.
He also had Afib with RVR on presentation.  He was initially
managed with Diltiazem gtt in the ED, then put on standing
Diltiazem in the MICU.  He was transitioned to Metoprolol which
was titrated up to 75 mg PO TID.  He had some occasional
episodes of rapid heart rate which were controlled with
additional doses of Metoprolol.  He was loaded with Digoxin
0.25mg PO X 3 and then put on standing Digoxin of 0.125mg PO
qday.  His rate was better controlled on transfer but
occasionally required additional Metoprolol for HR>120s.  An ECG
showed some T wave inversions compared to admission his cardiac
enzymes were negative.  He never complained of chest pain.  He
had an echocardiogram which showed moderate pericardial effusion
without signs of tamponade.There was possible but not confirmed
pericarditis causing his symptoms and ECG findings.
.
He developed neutropenia with an ANC of 540 on the day of
transfer.  He had been started on Neupogen on [**2177-11-18**].  He was
afebrile at this time and continued on broad-spectrum
antibiotics.  He was transfused 2 units PRBCs over his course in
the ICU for a hematocrit of 23.9 on [**2177-11-14**].  He was continued
on standing Zofran and Ativan for post-chemotherapy nausea and
was continued on his clinical trial medication of anamorelin.
He was put on an insulin sliding scale for a diagnosis of
diabetes for which he was not taking medication.
.
He was transferred to the Oncology service on [**2177-11-19**] with a
controlled heart rate in the 100s-120s, hemodynamically stable
and asymptomatic.
.
FLOOR COURSE:
He was transferred to OMED service and maintained on metoprolol
for rate control.  He was monitored on telemetry and although he
remained in atrial fibrillation, his ventricular rate was
well-controlled on metoprolol 75 mg Q6H.  His antibiotics were
switched to levofloxacin, and he was discharged to complete a
seven day course for presumptive CAP.  He was seen by physical
therapy who recommended discharge to home with home PT.  He
remained on the floor for two nights.  There were no concerning
episodes on telemetry and he was afebrile without chest pain or
cough.  He was no longer neutropenic at time of discharge.
Neupogen was stopped.

Medications on Admission:
Fluticasone-Salmeterol 250/50 mcg disk, 1 disk [**Hospital1 **]
Tiotropium Bromide 18mcg 1 cap qday
Enalapril 10mg PO qday- not taking
Simvastatin 20mg PO qday
Albuterol 90mcg [**1-15**] puff q6hours PRN
Atenolol 75mg PO daily
Colace 100mg PO BID
Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day)
Zofran 8 mg [**Hospital1 **]
Ativan 1mg [**Hospital1 **]
Hydrocodone as needed
Tramadol as needed

Discharge Medications:
1. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed: nausea.
2. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: One (1) Tablet
PO Q6H (every 6 hours) as needed for pain.
3. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Anamorelin  Sig: One (1)   DAILY (Daily) for 3 weeks: study
drug, take as directed.
6. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*2*
11. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) capsule Inhalation once a day.
12. Zofran 8 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for nausea.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:

Pneumonia
Atrial fibrillation with rapid ventricular response
hypotension secondary to afib/dehydration
Neutropenia
.
Secondary:
# Stage IV adenocarcinoma of the lung
# DM2
# Atrial fibrillation
# HTN
# Chronic renal failure
# Anemia
# Hyperlipidemia
# COPD


Discharge Condition:
Vital signs stable, afebrile, tolerating POs, ambulatory


Discharge Instructions:
You presented to the hospital for low blood pressures and
trouble breathing likely due to a pneumonia. You were treated
with antibiotics and pressors in the ICU and your blood pressure
improved. During this time, occasionally you had a rapid heart
rate due to atrial fibrillation and you were started on
medications, digoxin and metoprolol, to control your heart rate.
.
Please take all medications as prescribed.
New medications: digoxin, toprol XL, levofloxacin
Discontinued medications: atenolol
.
Call your doctor or return to the ED immediately if you
experience worsening chest pain, shortness of breath, nausea,
vomiting, abdominal pain, sweating, fevers, chills, bleeding, or
other concerning symptoms.

Followup Instructions:
You should schedule an appointment with Dr. [**Last Name (STitle) 3274**] for next
week on Tuesday or Thursday. You said you had already called his
office to set this up prior to discharge. Call his office at
([**Telephone/Fax (1) 3280**] with any questions.
.
Provider: [**Name10 (NameIs) **] [**Name8 (MD) 831**], MD Phone:[**0-0-**] Date/Time:[**2177-12-2**]
9:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], MD Phone:[**Telephone/Fax (1) 5068**]
Date/Time:[**2177-12-4**] 1:00
Provider: [**First Name4 (NamePattern1) 1575**] [**Last Name (NamePattern1) 1576**], MD Phone:[**Telephone/Fax (1) 1579**]
Date/Time:[**2177-12-24**] 10:10


                             [**First Name8 (NamePattern2) 251**] [**Name8 (MD) **] MD [**MD Number(1) 3282**]

Completed by:[**2177-11-22**]
{'Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of lower lobe, bronchus or lung,Unspecified disease of pericardium,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anemia, unspecified,Neutropenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Nausea alone,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Hypotension, 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: Chest pain, SOB.

PRESENT ILLNESS: 75 year-old man with history of stage IV non-small cell lung ca
with mets to spine diagnosed [**9-22**], HTN, AF, CRI, who presents
with pleuritic chest pain and dyspnea for one day. The patient
states that he received his first round of chemotherapy of
[**Doctor Last Name **]/taxol 4 days prior to admission. He felt well one day
prior to admission, but then began feeling unwell today.  He
stated that he had a productive cough, chills, fatigue and well
as bilateral plerutic CP with taking a deep breath. He denied
dyspnea. He denied N/V/D or poor po intake - eating eggs and
bacon. Temp at home 100.4; referred to ED by heme/onc fellow.
The pt was BIBA. Enroute the patient c/o CP and was given nitro
with drop in BP to 70's.
.
In the ED, the patient vomited once.  He had a chest CT, neg for
PE. CT abd/pelvis neg. Due to the ? of PNA with fever and WBC
16.8, the pt received levo, cefepime - did not yet receive vanc.
The patient remained hypotensive with SBP's 70-90's despite
repeat fluid boluses - total 2L. An IJ was placed and neo was
started. The patient was also found to be in afib with RVR HR
130-170. He received IV diltiazem x  with improvement in HR to
100's. He was then switched to a diltiazem drip. The patient was
not cardioverted as he had been in afib for 10+ years. VS were
temp 99.0 HR 105 SBP 105/50 RR 20 SAo2 100% NC.

MEDICAL HISTORY: # stage IV adenocarcinoma of the lung dx [**2177-10-21**] by
bronchoscopy, MRI [**10-26**] with bony mets to T11, 50-75% narrowing
of spinal canal and mild to moderate spinal cord compression,
s/p radiation on [**10-28**]
- started clinical trial with Pacitaxel, Carboplatin, Anamorelin
vs. placebo at [**Company 2860**], day 1 was [**2177-11-11**]
# DM2
# Atrial fibrillation
# HTN
# chronic renal failure
# Anemia
# Hyperlipidemia
# COPD

MEDICATION ON ADMISSION: Fluticasone-Salmeterol 250/50 mcg disk, 1 disk [**Hospital1 **]
Tiotropium Bromide 18mcg 1 cap qday
Enalapril 10mg PO qday- not taking
Simvastatin 20mg PO qday
Albuterol 90mcg [**1-15**] puff q6hours PRN
Atenolol 75mg PO daily
Colace 100mg PO BID
Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day)
Zofran 8 mg [**Hospital1 **]
Ativan 1mg [**Hospital1 **]
Hydrocodone as needed
Tramadol as needed

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam at Admission
VS: 98.9 HR 92 Bp 112/77 RR 12 SaO2 96%RA
Gen: NAD, flushed, Aox3 easily able to relate history
HEENT: right IJ in place, mild JVD, no LAD, benign OP
CV: RRR, no MRG
PULM: mild bilateral crackles, good air movement, no labored
breathing
ABD: soft, NT/ ND
EXT: warm well perfused
.
Physical Exam at Discharge
VS: 97.7, 112/68, 106, 16, 95%RA
In general patient is alerat and oriented, in NAD
Neck is supple and non-tender with no LAD
Heart exam shows irregular rate and rhythm.  No m/r/g.
Chest exam is clear to auscultation bilaterally in posterior
fields
Abdomen is non-tender with normal bowel sounds
Extremities shows no lower pitting edema; they are warm and well
perfused

FAMILY HISTORY: No family history of lung cancer

SOCIAL HISTORY: -Tob: quit in [**2166**], approx 150 pk yrs, + asbestos exposure
-EtOH: quit in [**2166**]
-Illicits: None
-Living situation: lives alone, no children but his extended
family is very close to him
-Occupation: used to be a [**Doctor Last Name 9808**] operator 

### Response:
{'Pneumonia, organism unspecified,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of lower lobe, bronchus or lung,Unspecified disease of pericardium,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Anemia, unspecified,Neutropenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Nausea alone,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Hypotension, unspecified'}
