CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: Dr. [**Known lastname **] is an 83M with PMN significant for metastatic prostate
CA who presented to the ED with dyspnea after a probable
aspiration event [**2-19**] N/V thought to be due to pain meds. Dr.
[**Known lastname **] notes that he had a bitter sensation in his throat, after
which he began feeling dyspneic. His wife noted that he vomited
earlier in the day and may have aspirated. He noted no cough,
SOB, F/C, or URI symptoms prior to this event. His only other
complaint is a mild sensation of numbness along the right side
of his jaw. He has noted no weakness or numbness in his
extremities, bowel or bladder dysfunction, and his wife has not
noted any facial droop or weakness aside from his generalized
profound fatigue. On arrival to the ED, his vitals were T 99.5F
BP 77/20 HR 70 RR 23, SaO2 100% on 4L. Per clinic notes, Dr. [**Name (NI) 12492**] SBP has been in 80s-90s over the last year, but he was
given 3L NS, which raised his BP to the 90s. He was also found
to have a K elevated to 7.0, with no ivsible peaked T-waves in
setting of AV pacing, and was treated with Calcium gluconate and
10U regular insulin with D50, and was given Kayexylate. CXR
demonstrated opacities in R mid-lung and lingula suspicious for
aspiration. Lactate was elevated to 3.8. UA was negative for LE
and nitrite, though had [**6-27**] wbc and mod bacteria with 0-2 epi.
He was given Levofloxacin and Metronidazole, and blood and urine
cultures were sent. He was admitted to the [**Hospital Unit Name 153**] for further
management.

MEDICAL HISTORY: 1) Prostate CA - Dx around [**2184**]. Rapidly declining functional
status. Last PSA 2813 on [**2189-7-9**]. Has diffuse bony pain in his
extremities that likely reflects metastatic disease, but pt has
refused bone scans and all other imaging. On mitoxantrone and
Lupron, which by report have not lowered PSA recently. Had
originally been on Lupron alone, which briefly suppressed PSAs,
then tx with casodex, which also had positive effects for
several months before PSAs began to rise again. Requires
intermittent blood transfusions for falling hct, most recently
2U PRBC on [**7-30**] for hct 24.
.
2) s/p dual chamber PPM placement for 3rd degree heart block
[**6-22**], AV paced.
.
3) Sacral decub - tx with duoderm
.
4) TIA [**2184**]
.
5) s/p L hip replacement
.
6) Glaucoma
.
7) h/o Lumbar disc herniation [**2143**]
.
8) EF 65% on RVG gated scan [**3-23**]

MEDICATION ON ADMISSION: Mitoxantrone 21mg q3wk, last dose 06/26 (9th cycle) (held [**7-30**]
[**2-19**] weakness)
Lupron 22.5mg SC qmo
Aranesp
Oxycodone 5mg PO prn
Ativan 1mg PO qHS prn
Tylenol prn
Ultram prn

ALLERGIES: Penicillins / Aspirin

PHYSICAL EXAM: T: 99.1F BP: 94/30 HR: 71 RR: 20 SaO2: 100% 4L NC
Gen: Emaciated older gentleman, lying comfortably in bed,
occasional non-productive cough, NAD
HEENT: s/p cataract surgery L eye, sclerae anicteric, MM
slightly dry, poor dentition.
Neck: Supple, no elevated JVP, no LAD
CV: Distant heart sounds, RRR, nl S1 and S2, no m/r/g
Chest: Mild coarse breath sounds throughout, clearing with
coughing, mild R basilar rales
Abd: Soft, mildly distended, no HSM appreciated, +hypoactive BS

FAMILY HISTORY: No family history of prostate cancer. The rest of his
family history is significant for breast cancer in his mother.
His father died at 87 of a stroke. He had no siblings. He has
three children in their 40s, all in good health.

SOCIAL HISTORY: Lives at home with his second wife of 25 years. +cigar smoking
many years ago. No ETOH.
Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of bone and bone marrow,Hyperpotassemia,Pressure ulcer, lower back,Acute kidney failure, unspecified,Severe sepsis,Personal history of malignant neoplasm of prostate,Hip joint replacement,Cardiac pacemaker in situ
Septicemia NOS,Septic shock,Food/vomit pneumonitis,Secondary malig neo bone,Hyperpotassemia,Pressure ulcer, low back,Acute kidney failure NOS,Severe sepsis,Hx-prostatic malignancy,Joint replaced hip,Status cardiac pacemaker
Admission Date:  [**2189-8-12**]              Discharge Date:   [**2189-8-14**]


Service: MEDICINE

Allergies:
Penicillins / Aspirin

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Dr. [**Known lastname **] is an 83M with PMN significant for metastatic prostate
CA who presented to the ED with dyspnea after a probable
aspiration event [**2-19**] N/V thought to be due to pain meds. Dr.
[**Known lastname **] notes that he had a bitter sensation in his throat, after
which he began feeling dyspneic. His wife noted that he vomited
earlier in the day and may have aspirated. He noted no cough,
SOB, F/C, or URI symptoms prior to this event. His only other
complaint is a mild sensation of numbness along the right side
of his jaw. He has noted no weakness or numbness in his
extremities, bowel or bladder dysfunction, and his wife has not
noted any facial droop or weakness aside from his generalized
profound fatigue. On arrival to the ED, his vitals were T 99.5F
BP 77/20 HR 70 RR 23, SaO2 100% on 4L. Per clinic notes, Dr. [**Name (NI) 12492**] SBP has been in 80s-90s over the last year, but he was
given 3L NS, which raised his BP to the 90s. He was also found
to have a K elevated to 7.0, with no ivsible peaked T-waves in
setting of AV pacing, and was treated with Calcium gluconate and
10U regular insulin with D50, and was given Kayexylate. CXR
demonstrated opacities in R mid-lung and lingula suspicious for
aspiration. Lactate was elevated to 3.8. UA was negative for LE
and nitrite, though had [**6-27**] wbc and mod bacteria with 0-2 epi.
He was given Levofloxacin and Metronidazole, and blood and urine
cultures were sent. He was admitted to the [**Hospital Unit Name 153**] for further
management.


Past Medical History:
1) Prostate CA - Dx around [**2184**]. Rapidly declining functional
status. Last PSA 2813 on [**2189-7-9**]. Has diffuse bony pain in his
extremities that likely reflects metastatic disease, but pt has
refused bone scans and all other imaging. On mitoxantrone and
Lupron, which by report have not lowered PSA recently. Had
originally been on Lupron alone, which briefly suppressed PSAs,
then tx with casodex, which also had positive effects for
several months before PSAs began to rise again. Requires
intermittent blood transfusions for falling hct, most recently
2U PRBC on [**7-30**] for hct 24.
.
2) s/p dual chamber PPM placement for 3rd degree heart block
[**6-22**], AV paced.
.
3) Sacral decub - tx with duoderm
.
4) TIA [**2184**]
.
5) s/p L hip replacement
.
6) Glaucoma
.
7) h/o Lumbar disc herniation [**2143**]
.
8) EF 65% on RVG gated scan [**3-23**]


Social History:
Lives at home with his second wife of 25 years. +cigar smoking
many years ago. No ETOH.


Family History:
No family history of prostate cancer. The rest of his
family history is significant for breast cancer in his mother.
His father died at 87 of a stroke. He had no siblings. He has
three children in their 40s, all in good health.

Physical Exam:
T: 99.1F BP: 94/30 HR: 71 RR: 20 SaO2: 100% 4L NC
Gen: Emaciated older gentleman, lying comfortably in bed,
occasional non-productive cough, NAD
HEENT: s/p cataract surgery L eye, sclerae anicteric, MM
slightly dry, poor dentition.
Neck: Supple, no elevated JVP, no LAD
CV: Distant heart sounds, RRR, nl S1 and S2, no m/r/g
Chest: Mild coarse breath sounds throughout, clearing with
coughing, mild R basilar rales
Abd: Soft, mildly distended, no HSM appreciated, +hypoactive BS

Extr: No LE edema, trace DPs bilaterally
Neuro: A&Ox3, reports slightly decreased sensation over left
chin compared to right (pt had earlier reported R numbess), no
other focal deficits, but profound weakness throughout.


Pertinent Results:
[**2189-8-12**] 06:10PM   PLT COUNT-200#
[**2189-8-12**] 06:10PM   HYPOCHROM-OCCASIONAL ANISOCYT-OCCASIONAL
POIKILOCY-1+ MACROCYT-NORMAL MICROCYT-OCCASIONAL
POLYCHROM-OCCASIONAL OVALOCYT-1+ TEARDROP-OCCASIONAL
FRAGMENT-OCCASIONAL
[**2189-8-12**] 06:10PM   NEUTS-56 BANDS-26* LYMPHS-5* MONOS-8 EOS-3
BASOS-0 ATYPS-0 METAS-1* MYELOS-1*
[**2189-8-12**] 06:10PM   WBC-4.0 RBC-2.85* HGB-8.4* HCT-23.8* MCV-83
MCH-29.6 MCHC-35.5* RDW-17.9*
[**2189-8-12**] 06:10PM   calTIBC-133* VIT B12-623 FOLATE-7.4
FERRITIN-GREATER TH TRF-102*
[**2189-8-12**] 06:10PM   CALCIUM-8.1* PHOSPHATE-3.8 MAGNESIUM-1.7
IRON-81
[**2189-8-12**] 06:10PM   GLUCOSE-129* UREA N-58* CREAT-1.9*
SODIUM-132* POTASSIUM-7.0* CHLORIDE-99 TOTAL CO2-19* ANION
GAP-21*
[**2189-8-12**] 06:14PM   LACTATE-3.8*
[**2189-8-12**] 07:56PM   LACTATE-3.2*
[**2189-8-12**] 08:30PM URINE  RBC-[**3-22**]* WBC-[**6-27**]* BACTERIA-MOD
YEAST-NONE EPI-0-2 TRANS EPI-0-2
[**2189-8-12**] 08:30PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-0.2 PH-5.0
LEUK-NEG
[**2189-8-12**] 08:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.018
[**2189-8-12**] 11:25PM   OSMOLAL-294
[**2189-8-12**] 11:25PM   POTASSIUM-6.2*
.
[**8-12**] CXR
IMPRESSION:
1. Airspace opacities within the right mid lung and lingula that
are concerning for pneumonia/aspiration.
2. Sclerosis of the osseous structures.
.
[**8-12**] CXR
Compared to two hours prior, there has been minimal interval
change compared to prior study with airspace opacities again
noted within the right mid lung and left lingula. Findings are
concerning for aspiration or pneumonia.
.
[**8-13**] CXR
IMPRESSION:
1. Short interval development of bilateral pleural effusions and
worsening bilateral air space opacity consistent with worsening
congestive failure.
2. Compared back to [**2188-6-18**] steadily worsening osseous
metastatic disease.


Brief Hospital Course:
Dr. [**Known lastname **] was admitted with probable aspiration pneumonia,
hypotension, and ARF. He was treated with IVF boluses,
levofloxacin and metronidazole for possible aspiration PNA.  12
hours after admission, he experienced falling urine output, and
after administration of fluid boluses, developed substantial
pulmonary edema with dropping sats and tenuous BP. His wife was
kept aware of developments throughout the night, and agreed to
forego intubation and other invasive modalities of treatment. He
was tried on BiPap, but appeared very uncomfortable and become
tachycardic. He passed away early in the morning on [**2189-8-14**]
(48 hours after admission) with his wife at the bedside.

Medications on Admission:
Mitoxantrone 21mg q3wk, last dose 06/26 (9th cycle) (held [**7-30**]
[**2-19**] weakness)
Lupron 22.5mg SC qmo
Aranesp
Oxycodone 5mg PO prn
Ativan 1mg PO qHS prn
Tylenol prn
Ultram prn


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Metastatic Prostate Cancer
Septic Shock

Discharge Condition:
Death

Discharge Instructions:
None

Followup Instructions:
None
{'Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of bone and bone marrow,Hyperpotassemia,Pressure ulcer, lower back,Acute kidney failure, unspecified,Severe sepsis,Personal history of malignant neoplasm of prostate,Hip joint replacement,Cardiac pacemaker in situ'}


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: Dr. [**Known lastname **] is an 83M with PMN significant for metastatic prostate
CA who presented to the ED with dyspnea after a probable
aspiration event [**2-19**] N/V thought to be due to pain meds. Dr.
[**Known lastname **] notes that he had a bitter sensation in his throat, after
which he began feeling dyspneic. His wife noted that he vomited
earlier in the day and may have aspirated. He noted no cough,
SOB, F/C, or URI symptoms prior to this event. His only other
complaint is a mild sensation of numbness along the right side
of his jaw. He has noted no weakness or numbness in his
extremities, bowel or bladder dysfunction, and his wife has not
noted any facial droop or weakness aside from his generalized
profound fatigue. On arrival to the ED, his vitals were T 99.5F
BP 77/20 HR 70 RR 23, SaO2 100% on 4L. Per clinic notes, Dr. [**Name (NI) 12492**] SBP has been in 80s-90s over the last year, but he was
given 3L NS, which raised his BP to the 90s. He was also found
to have a K elevated to 7.0, with no ivsible peaked T-waves in
setting of AV pacing, and was treated with Calcium gluconate and
10U regular insulin with D50, and was given Kayexylate. CXR
demonstrated opacities in R mid-lung and lingula suspicious for
aspiration. Lactate was elevated to 3.8. UA was negative for LE
and nitrite, though had [**6-27**] wbc and mod bacteria with 0-2 epi.
He was given Levofloxacin and Metronidazole, and blood and urine
cultures were sent. He was admitted to the [**Hospital Unit Name 153**] for further
management.

MEDICAL HISTORY: 1) Prostate CA - Dx around [**2184**]. Rapidly declining functional
status. Last PSA 2813 on [**2189-7-9**]. Has diffuse bony pain in his
extremities that likely reflects metastatic disease, but pt has
refused bone scans and all other imaging. On mitoxantrone and
Lupron, which by report have not lowered PSA recently. Had
originally been on Lupron alone, which briefly suppressed PSAs,
then tx with casodex, which also had positive effects for
several months before PSAs began to rise again. Requires
intermittent blood transfusions for falling hct, most recently
2U PRBC on [**7-30**] for hct 24.
.
2) s/p dual chamber PPM placement for 3rd degree heart block
[**6-22**], AV paced.
.
3) Sacral decub - tx with duoderm
.
4) TIA [**2184**]
.
5) s/p L hip replacement
.
6) Glaucoma
.
7) h/o Lumbar disc herniation [**2143**]
.
8) EF 65% on RVG gated scan [**3-23**]

MEDICATION ON ADMISSION: Mitoxantrone 21mg q3wk, last dose 06/26 (9th cycle) (held [**7-30**]
[**2-19**] weakness)
Lupron 22.5mg SC qmo
Aranesp
Oxycodone 5mg PO prn
Ativan 1mg PO qHS prn
Tylenol prn
Ultram prn

ALLERGIES: Penicillins / Aspirin

PHYSICAL EXAM: T: 99.1F BP: 94/30 HR: 71 RR: 20 SaO2: 100% 4L NC
Gen: Emaciated older gentleman, lying comfortably in bed,
occasional non-productive cough, NAD
HEENT: s/p cataract surgery L eye, sclerae anicteric, MM
slightly dry, poor dentition.
Neck: Supple, no elevated JVP, no LAD
CV: Distant heart sounds, RRR, nl S1 and S2, no m/r/g
Chest: Mild coarse breath sounds throughout, clearing with
coughing, mild R basilar rales
Abd: Soft, mildly distended, no HSM appreciated, +hypoactive BS

FAMILY HISTORY: No family history of prostate cancer. The rest of his
family history is significant for breast cancer in his mother.
His father died at 87 of a stroke. He had no siblings. He has
three children in their 40s, all in good health.

SOCIAL HISTORY: Lives at home with his second wife of 25 years. +cigar smoking
many years ago. No ETOH. 

### Response:
{'Unspecified septicemia,Septic shock,Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of bone and bone marrow,Hyperpotassemia,Pressure ulcer, lower back,Acute kidney failure, unspecified,Severe sepsis,Personal history of malignant neoplasm of prostate,Hip joint replacement,Cardiac pacemaker in situ'}
