CHIEF COMPLAINT: transferred from OSH for possible thoracentesis

PRESENT ILLNESS: 57 yo man w/ h/o non-hodgkins lymphoma s/p CHOP, chronic
lymphedema, and chronic bilateral effusions who initially
presented to an OSH on [**7-28**] after acute onset dyspnea at home.
The patient reports mild dyspnea x 1 month.  On the night before
admission, he experienced acute onset SOB after walking from his
car into his house.  He felt as though he "couldn't catch his
breath."  He called 911, and EMS brought him to OSH ER.
Patient's dyspnea improved after O2 therapy.  Patient then c/o
anterior chest "soreness," worse with inspiration.  CTA was
attempted but patient became SOB in the supine position, so this
study was aborted.  He was admitted to the MICU and was started
on a heparin gtt empirically.  After discussion with the family,
the patient's wife requested that the patient be transferred to
[**Hospital1 18**] for possible therapeutic thoracentesis.
.

MEDICAL HISTORY: Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection

MEDICATION ON ADMISSION: ASA 325 mg PO daily
MVI
Lasix 40 mg PO daily
Rhinocort 2 spray [**Hospital1 **]
Allopurinol 200 mg PO daily
Advair 50/100 mcg 2 puffs [**Hospital1 **]
Atrovent MDI 2 puffs Q6H
Prednisone 100mg PO daily
Keflex 500 mg PO Q6H
Accupril 10mg PO daily
Ambien 5 mg PO QHS prn
Albuterol MDI prn
Claritin 10 mg prn
Dilaudid 2-4 mg PO Q4 prn
.

ALLERGIES: Codeine / Zestril

PHYSICAL EXAM: VS - T 98.8; HR 120; BP 115/56; RR = 30; O2 96% 4L NC
GEN - elderly man, appears older than stated age, tachypneic,
appears dyspneic, coughing
HEENT - NCAT, PERRL bilat, EOMI, OP clear, anicteric
NECK: supple, no LAD, no JVD
CV: RRR, normal S1S2, no M/R/G
PULM: decreased BS [**1-1**] way up bilaterally, no crackles/wheezes
ABD: NABS, soft, NT, ND, obese
EXT: 3+ pitting edema bilat
SKIN: +lichenification of lower ext bilat, +pus drainage from
midline abdominal wound, no erythema
Neuro: CNII-XII intact, strength symmetric

FAMILY HISTORY: Father - PVD
Mother - questionable metastatic ovarian cancer

SOCIAL HISTORY: Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU.
Unspecified pleural effusion,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Acidosis,Urinary tract infection, site not specified,Other postoperative infection,Cellulitis and abscess of trunk,Other pulmonary insufficiency, not elsewhere classified,Unspecified essential hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified,Anemia in neoplastic disease,Other lymphedema,Other specified congenital anomalies,Esophageal reflux,Other and unspecified mycoses,Personal history of malignant neoplasm of testis,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use
Pleural effusion NOS,Oth lymp unsp xtrndl org,Acute kidney failure NOS,Acidosis,Urin tract infection NOS,Other postop infection,Cellulitis of trunk,Other pulmonary insuff,Hypertension NOS,Streptococcus unspecf,Anemia in neoplastic dis,Other lymphedema,Specfied cong anomal NEC,Esophageal reflux,Mycoses NEC & NOS,Hx-testicular malignancy,Adv eff antineoplastic
Admission Date:  [**2175-7-28**]              Discharge Date:   [**2175-8-2**]

Date of Birth:  [**2117-10-10**]             Sex:   M

Service: MEDICINE

Allergies:
Codeine / Zestril

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
transferred from OSH for possible thoracentesis

Major Surgical or Invasive Procedure:
s/p Bilaretal Thoracenteses


History of Present Illness:
57 yo man w/ h/o non-hodgkins lymphoma s/p CHOP, chronic
lymphedema, and chronic bilateral effusions who initially
presented to an OSH on [**7-28**] after acute onset dyspnea at home.
The patient reports mild dyspnea x 1 month.  On the night before
admission, he experienced acute onset SOB after walking from his
car into his house.  He felt as though he "couldn't catch his
breath."  He called 911, and EMS brought him to OSH ER.
Patient's dyspnea improved after O2 therapy.  Patient then c/o
anterior chest "soreness," worse with inspiration.  CTA was
attempted but patient became SOB in the supine position, so this
study was aborted.  He was admitted to the MICU and was started
on a heparin gtt empirically.  After discussion with the family,
the patient's wife requested that the patient be transferred to
[**Hospital1 18**] for possible therapeutic thoracentesis.
.


Past Medical History:
Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection


Social History:
Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU.


Family History:
Father - PVD
Mother - questionable metastatic ovarian cancer

Physical Exam:
VS - T 98.8; HR 120; BP 115/56; RR = 30; O2 96% 4L NC
GEN - elderly man, appears older than stated age, tachypneic,
appears dyspneic, coughing
HEENT - NCAT, PERRL bilat, EOMI, OP clear, anicteric
NECK: supple, no LAD, no JVD
CV: RRR, normal S1S2, no M/R/G
PULM: decreased BS [**1-1**] way up bilaterally, no crackles/wheezes
ABD: NABS, soft, NT, ND, obese
EXT: 3+ pitting edema bilat
SKIN: +lichenification of lower ext bilat, +pus drainage from
midline abdominal wound, no erythema
Neuro: CNII-XII intact, strength symmetric

Brief Hospital Course:
Briefly, this is a 57 yo man with a h/o NHL s/p CHOP x 6 on
[**7-25**], chronic lymphedema/Bilateral pleural effusions who
initially was admitted to the MICU from an OSH for evaluation of
acute worsening dyspnea and worsening pleural effusions.  There
was initial concern at the OSH for pulmonary embolism given the
pts c/o chest pain and pain which worsened with deep
inspiration. The pt was empirically heparinized at the OSH and
transferred to [**Hospital1 18**].  Upon arrival to [**Hospital1 **] the pt was tachy to
the 120s, tachypneic to 30, and satting at 96 on 4L nC.  ABG was
7.41/32/81.  The pt had a lactate of 4.2, WBC count greater than
40,000 and new ST-T wave changes (flattened T waves) in V3-V5
when compared to prior EKG.  The pt was also documented to have
a troponin peak of 0.22.  The pt was initially empirically
started on Vancomycin and Zosyn for suspected urosepsis, but his
UA was negative and his urine culture on [**7-29**] grew out
ampicillin resistant enterococcus. Zosyn was discontinued and
the Vancomycin (started [**7-31**]) is to be completed for a 2 week
course after discharge.  Levofloxacin was started on [**7-29**] for a
possible pneumonia given this could not be ruled out with large
overlying pleural effusions.  CT angiogram on [**7-30**] ruled out
pulmonary embolism and heparin gtt was discontinued at this
time.  The pts R sided pleural effusion was tapped on [**7-29**] with
2 L of output, and his L pleural effusion was tapped on [**7-31**].
The effusion from [**7-29**] was slightly exudative, while the
effusion from [**7-31**] was borderline transudate/exudate.  The pt was
clear that he did not want any evaluation for pleurodesis or
semi-permanent drain.  TTE on [**7-31**] revealed a normal EF, making
CHF an unlikely cause of the pts symptoms.
.
The elevation in the pts troponin was felt to be secondary to
demand ischemia in setting of tachycardia and resp. distress.
Cardiac enzymes trended down, and the pt vehemently refused
CATH. He was continued on ASA and metoprolol 12.5 TID.
.
The pts WBC, platelets, and red cells all dropped over the
course of several days, c/w his recent CHOP regimen.  His WBC
dropped from [**Numeric Identifier 17451**] on admission to as low as 200 with an ANC of
70, and the pt was placed on neutropenic precautions.  He never
spiked a fever.  The pt was advised that we wanted to watch him
in the hospital for a little while given his UTI and abdominal
wall cellulitis, but the pt insisted on discharge.  He was told
to return if he experienced any fevers.  The pts Hct also
dropped from 33 on admission to 25 prior to discharge.  The pt
was transfused 1 unit of PRBC.
.
During his stay the pt was also treated for a small abdominal
wall cellultis with Keflex.  He was discharged home on a 7 day
course of po Keflex.  As UA revealed yeast on [**7-31**], the pt was
discharged home on a 7 day course of fluconazole.  The pts vanc
was changed to linezolid for 11 days to treat the enterococcus
UTI.  The pt was also discharged home on 1 week of levofloxacin
for emperic treatment of pneumonia.
.
The pt was scheduled for follow up with both his PCP for [**Name Initial (PRE) **] wound
check and lab draw in the week following discharge as well as
with BMT on [**8-7**].


Medications on Admission:
ASA 325 mg PO daily
MVI
Lasix 40 mg PO daily
Rhinocort 2 spray [**Hospital1 **]
Allopurinol 200 mg PO daily
Advair 50/100 mcg 2 puffs [**Hospital1 **]
Atrovent MDI 2 puffs Q6H
Prednisone 100mg PO daily
Keflex 500 mg PO Q6H
Accupril 10mg PO daily
Ambien 5 mg PO QHS prn
Albuterol MDI prn
Claritin 10 mg prn
Dilaudid 2-4 mg PO Q4 prn
.


Discharge Medications:
1. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.
Disp:*30 Tablet(s)* Refills:*0*
3. Zolpidem Tartrate 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed.
Disp:*10 Tablet(s)* Refills:*0*
4. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) puff Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 device* Refills:*2*
5. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
Disp:*1 device* Refills:*2*
6. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
Disp:*1 device* Refills:*3*
7. Beclomethasone Diprop Monohyd 0.042 % Aerosol, Spray Sig: One
(1) Spray Nasal [**Hospital1 **] (2 times a day).
Disp:*1 container* Refills:*2*
8. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
Disp:*10 Tablet(s)* Refills:*0*
9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Loratadine 10 mg Tablet Sig: One (1) Tablet PO daily ().
Disp:*30 Tablet(s)* Refills:*2*
11. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
12. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
Disp:*30 Tablet(s)* Refills:*0*
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*2*
14. Psyllium     Packet Sig: One (1) Packet PO BID (2 times a
day) as needed.
Disp:*30 Packet(s)* Refills:*0*
15. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
Disp:*100 ML(s)* Refills:*0*
16. Acyclovir 200 mg Capsule Sig: Two (2) Capsule PO Q12H (every
12 hours).
Disp:*120 Capsule(s)* Refills:*2*
17. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
Disp:*45 Tablet(s)* Refills:*2*
18. Insulin Regular Human 100 unit/mL Solution Sig: One (1) as
directed Injection ASDIR (AS DIRECTED).
Disp:*100 ML* Refills:*2*
19. Linezolid 600 mg Tablet Sig: One (1) Tablet PO twice a day
for 11 days.
Disp:*22 Tablet(s)* Refills:*0*
20. Lasix 20 mg Tablet Sig: Three (3) Tablet PO once a day.
Disp:*90 Tablet(s)* Refills:*2*
21. Keflex 250 mg Capsule Sig: One (1) Capsule PO four times a
day for 7 days.
Disp:*28 Capsule(s)* Refills:*0*
22. Diflucan 200 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **]

Discharge Diagnosis:
Recurrent Pleural Effusion-s/p thoracentesis
Non Hodgkins Disease


Discharge Condition:
stable. Patient stable on rrom air. Tolerating a PO diet.

Discharge Instructions:
Patient is to take all medications as perscribed. Please report
to your primary care physician or to the ED with any
temperatures > 100.5, nausea, vomiting, chills, rigors, dysuria.


Followup Instructions:
Dr. [**Name (NI) 50409**] [**Name (STitle) **] Physician-[**Telephone/Fax (1) 3183**]-[**Street Address(1) 50410**] Office-at 7:50AM-please have a wound check at this visit,
and have your CBC drawn at this visit and results called in to
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Office



Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 50411**]8/8/05-1:30PM-[**Telephone/Fax (1) 3241**]-you Provider: [**First Name11 (Name Pattern1) **]
[**Last Name (NamePattern4) 4380**], MD Where: [**Hospital6 29**] HEMATOLOGY/BMT
Phone:[**Telephone/Fax (1) 3237**] Date/Time:[**2175-8-7**] 1:30

Provider: [**Name Initial (NameIs) **] Where: [**Hospital6 29**] HEMATOLOGY/ONCOLOGY
Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2175-8-7**] 1:30





                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]
{'Unspecified pleural effusion,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Acidosis,Urinary tract infection, site not specified,Other postoperative infection,Cellulitis and abscess of trunk,Other pulmonary insufficiency, not elsewhere classified,Unspecified essential hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified,Anemia in neoplastic disease,Other lymphedema,Other specified congenital anomalies,Esophageal reflux,Other and unspecified mycoses,Personal history of malignant neoplasm of testis,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}


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 from OSH for possible thoracentesis

PRESENT ILLNESS: 57 yo man w/ h/o non-hodgkins lymphoma s/p CHOP, chronic
lymphedema, and chronic bilateral effusions who initially
presented to an OSH on [**7-28**] after acute onset dyspnea at home.
The patient reports mild dyspnea x 1 month.  On the night before
admission, he experienced acute onset SOB after walking from his
car into his house.  He felt as though he "couldn't catch his
breath."  He called 911, and EMS brought him to OSH ER.
Patient's dyspnea improved after O2 therapy.  Patient then c/o
anterior chest "soreness," worse with inspiration.  CTA was
attempted but patient became SOB in the supine position, so this
study was aborted.  He was admitted to the MICU and was started
on a heparin gtt empirically.  After discussion with the family,
the patient's wife requested that the patient be transferred to
[**Hospital1 18**] for possible therapeutic thoracentesis.
.

MEDICAL HISTORY: Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection

MEDICATION ON ADMISSION: ASA 325 mg PO daily
MVI
Lasix 40 mg PO daily
Rhinocort 2 spray [**Hospital1 **]
Allopurinol 200 mg PO daily
Advair 50/100 mcg 2 puffs [**Hospital1 **]
Atrovent MDI 2 puffs Q6H
Prednisone 100mg PO daily
Keflex 500 mg PO Q6H
Accupril 10mg PO daily
Ambien 5 mg PO QHS prn
Albuterol MDI prn
Claritin 10 mg prn
Dilaudid 2-4 mg PO Q4 prn
.

ALLERGIES: Codeine / Zestril

PHYSICAL EXAM: VS - T 98.8; HR 120; BP 115/56; RR = 30; O2 96% 4L NC
GEN - elderly man, appears older than stated age, tachypneic,
appears dyspneic, coughing
HEENT - NCAT, PERRL bilat, EOMI, OP clear, anicteric
NECK: supple, no LAD, no JVD
CV: RRR, normal S1S2, no M/R/G
PULM: decreased BS [**1-1**] way up bilaterally, no crackles/wheezes
ABD: NABS, soft, NT, ND, obese
EXT: 3+ pitting edema bilat
SKIN: +lichenification of lower ext bilat, +pus drainage from
midline abdominal wound, no erythema
Neuro: CNII-XII intact, strength symmetric

FAMILY HISTORY: Father - PVD
Mother - questionable metastatic ovarian cancer

SOCIAL HISTORY: Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU. 

### Response:
{'Unspecified pleural effusion,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Acute kidney failure, unspecified,Acidosis,Urinary tract infection, site not specified,Other postoperative infection,Cellulitis and abscess of trunk,Other pulmonary insufficiency, not elsewhere classified,Unspecified essential hypertension,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, unspecified,Anemia in neoplastic disease,Other lymphedema,Other specified congenital anomalies,Esophageal reflux,Other and unspecified mycoses,Personal history of malignant neoplasm of testis,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}
