CHIEF COMPLAINT: Failure to thrive

PRESENT ILLNESS: Pt is an 80 yo female h/o HTN, osteoporosis, and emphysema who
presents with progressive weight loss, early satiety, hoarseness
and pedal edema. Weight loss was unintentional, documented from
113->97 lbs in about one year. Along with this, she has lost
strength, balance, and energy. No fever/chills/NS. She has also
had early satiety which she describes as wanting to eat a meal,
but stopping short [**2-21**] feeling that it will come up. Yesterday,
for example, she only had a little bit of chicken noodle soup
for dinner. The hoarseness has also been progressing over the
last year, with associated production of white "foam" that she
has been coughing up more frequently with no blood or distinct
colors other than white. Of note, no difficulty swallowing, no
constipation/diarrhea, no melena/BRBPR. She had a recent E. coli
UTI [**2143-8-28**] with hematuria which was treated with Bactrim for 3
days and resolved with f/u UA with no RBCs. Finally, she has
also had gradually increasing pedal edema over the past few
weeks. She has no chest pain, but has dyspnea after walking ~1
block that is stable. ROS otherwise negative except for urinary
stress incontinence that she has had for years which is stable.

MEDICAL HISTORY: (1) Hypertension.
(2) Osteoporosis.
(3) Emphysema.
(4) Osteoarthritis.
(5) Ectopic pregnancy.
(6) Uterine prolapse.
(7) Hyperlipidemia. Her triglycerides were elevated in [**2142**].
(8) Gastroesophageal reflux disease and heartburn. An upper GI
in [**2140**] showed hiatal hernia. An EGD in [**2141**] showed moderate
gastritis.
(9) Colonic polyps. A colonoscopy in [**2142**] showed a polyp.
(10) Claudication.
(11) Urinary stress incontinence.
(12) Coronary artery disease. An echo in [**2140**] showed trace MR.
(13) Status post appendectomy.

MEDICATION ON ADMISSION: Fosamax, stopped >1 month ago
Protonix, stopped 1 month ago, felt like it wasn't working
Ditropan, recently changed to unknown med one week ago
Lisinopril unknown dose
Citracal tid
Glucosamine [**Hospital1 **]
ASA 81 mg qd
Vit E qd

ALLERGIES: Ciprofloxacin / Amoxicillin

PHYSICAL EXAM: PE: T 98.3 BP 134/88 HR 100 R 20 95% O2 Sats RA
Gen: Frail, pleasant woman in NAD, hoarse
HEENT: Clear OP, MMM, when speaking has hoarse, gurgly voice,
occasionally bringing up white frothy sputum.
NECK: Supple, No LAD
CV: RR, NL rate. NL S1, S2. III/VI holosystolic murmur best
heard over the apex, radiating to axilla.
LUNGS: Bilateral coarse breath sounds with kyphoscoliotic spine

FAMILY HISTORY: There is no family history of colorectal cancer.

SOCIAL HISTORY: The patient is retired, lives in [**Location (un) 5481**] retirement home in
[**Location (un) 2624**], MA. She quit smoking in [**2137**] after heavy smoking for 20
years. She does not drink. She is a widow with 3 children,
youngest lives close by in [**Location (un) 3786**], MA.
Malignant neoplasm of upper lobe, bronchus or lung,Acute pericarditis in diseases classified elsewhere,Acute posthemorrhagic anemia,Other emphysema,Congestive heart failure, unspecified,Other iatrogenic hypotension,Stricture of artery,Other diseases of larynx, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of tobacco use,Unspecified disease of pericardium,Adult failure to thrive,Urinary incontinence, unspecified
Mal neo upper lobe lung,Ac pericardit in oth dis,Ac posthemorrhag anemia,Emphysema NEC,CHF NOS,Iatrogenc hypotnsion NEC,Stricture of artery,Disease of larynx NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,History of tobacco use,Pericardial disease NOS,Failure to thrive-adult,Urinary incontinence NOS
Admission Date:  [**2143-9-15**]              Discharge Date:   [**2143-9-27**]

Date of Birth:  [**2063-1-6**]             Sex:   F

Service: MEDICINE

Allergies:
Ciprofloxacin / Amoxicillin

Attending:[**First Name3 (LF) 2840**]
Chief Complaint:
Failure to thrive

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Pt is an 80 yo female h/o HTN, osteoporosis, and emphysema who
presents with progressive weight loss, early satiety, hoarseness
and pedal edema. Weight loss was unintentional, documented from
113->97 lbs in about one year. Along with this, she has lost
strength, balance, and energy. No fever/chills/NS. She has also
had early satiety which she describes as wanting to eat a meal,
but stopping short [**2-21**] feeling that it will come up. Yesterday,
for example, she only had a little bit of chicken noodle soup
for dinner. The hoarseness has also been progressing over the
last year, with associated production of white "foam" that she
has been coughing up more frequently with no blood or distinct
colors other than white. Of note, no difficulty swallowing, no
constipation/diarrhea, no melena/BRBPR. She had a recent E. coli
UTI [**2143-8-28**] with hematuria which was treated with Bactrim for 3
days and resolved with f/u UA with no RBCs. Finally, she has
also had gradually increasing pedal edema over the past few
weeks. She has no chest pain, but has dyspnea after walking ~1
block that is stable. ROS otherwise negative except for urinary
stress incontinence that she has had for years which is stable.

Past Medical History:
(1) Hypertension.
(2) Osteoporosis.
(3) Emphysema.
(4) Osteoarthritis.
(5) Ectopic pregnancy.
(6) Uterine prolapse.
(7) Hyperlipidemia. Her triglycerides were elevated in [**2142**].
(8) Gastroesophageal reflux disease and heartburn. An upper GI
in [**2140**] showed hiatal hernia. An EGD in [**2141**] showed moderate
gastritis.
(9) Colonic polyps. A colonoscopy in [**2142**] showed a polyp.
(10) Claudication.
(11) Urinary stress incontinence.
(12) Coronary artery disease. An echo in [**2140**] showed trace MR.
(13) Status post appendectomy.


Social History:
The patient is retired, lives in [**Location (un) 5481**] retirement home in
[**Location (un) 2624**], MA. She quit smoking in [**2137**] after heavy smoking for 20
years. She does not drink. She is a widow with 3 children,
youngest lives close by in [**Location (un) 3786**], MA.

Family History:
There is no family history of colorectal cancer.

Physical Exam:
PE: T 98.3 BP 134/88 HR 100 R 20 95% O2 Sats RA
Gen: Frail, pleasant woman in NAD, hoarse
HEENT: Clear OP, MMM, when speaking has hoarse, gurgly voice,
occasionally bringing up white frothy sputum.
NECK: Supple, No LAD
CV: RR, NL rate. NL S1, S2. III/VI holosystolic murmur best
heard over the apex, radiating to axilla.
LUNGS: Bilateral coarse breath sounds with kyphoscoliotic spine

ABD: Soft, NT, ND. NL BS. No HSM
EXT: No edema. 2+ DP pulses BL
SKIN: No lesions
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact. Preserved
sensation throughout. 5/5 strength throughout with good effort.
Normal coordination. Gait guarded, but stable with cane, stooped
[**2-21**] kyphoscoliosis
PSYCH: Listens and responds to questions appropriately, pleasant

.


Pertinent Results:
Admit WBC 7.9, hgb 11, plt 247.
.
Na 139, K 4.1, Cl 102, bicarb 30, BUN 24, Cr 0.8
.
SPEP: no monoclonal spike. hypogammaglobulinemic at IgG 461* IgA
55* IgM 57 .
Admission CXR: severe cardiomegaly; kyphoscoliosis
.
STUDIES:
.
Laryngoscopy: no vocal cord paralysis, no mass, presbylaryngis
and signs of pharyngeal/laryngeal reflux.
.
CT torso: [**2143-9-18**]:
1. Right apical 2-cm mass, consistent with appearance of
carcinoma.
2. Bilateral pleural effusions, with adjacent atelectasis in
both lower lobes.
3. Small left liver lobe as well as dilated intrahepatic bile
ducts.
4. 37 x 29 mm nonenhancing structure in the left liver lobe, not
present on the MR study of [**2143-4-20**]. The differential
diagnosis includes hematoma and pseudocyst.
5. Free pelvic fluid.
.
[**9-16**] eccho: There is a large pericardial effusion. The effusion
appears circumferential. There is right ventricular diastolic
collapse, consistent with impaired fillling/tamponade
physiology.
.
CXR [**9-18**]: Mild pulmonary edema has improved. Left lower lobe
atelectasis and small left pleural effusion have worsened.
A small collection of pleural air at the base of the right lung
is stable. No pneumothorax is seen elsewhere.
.
Echo [**9-18**]: There is mild symmetric left ventricular hypertrophy
with normal cavity size and systolic function (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets are moderately thickened. There is a small
to moderate sized pericardial effusion most prominent
inferolateral to the left ventricle, but also circumferential.
There is no 2D echocardiographic evidence for tamponade
physiology.
.
[**9-20**] Echo: still with resolution of effusion
.
[**9-20**] PPD negative
.
EKG: NSR @ 93, borderline RAD, nl intervals, low voltages, no
ischemic changes.
.
RUE US: patient with IVC sluggish flow, pre- compression state.

.
[**9-24**] Gastric emptying study: delayed at 1hr; nl at 2.5 hrs


Brief Hospital Course:
Ms [**Known lastname 1104**] is an 80 yo F with h/o HTN and COPD who presented with
failure to thrive, hoarseness, and peripheral edema.  She had
recently had a negative malignancy work-up including mammogram,
colonoscopy, EGD, pap smear, and CT chest abdomen and pelvis
within the preceding 6 months.  She was initially admitted to
facilitate further workup for these problems with plans for a
laryngoscopy, gastric emptying study, and ecchocardiogram.
.
# Hoarseness - Laryngoscopy revealed presbylaryngis (failure of
the vocal cords to completely collapse) and inflammation
suggestive of pharyngeal/laryngeal reflux without any evidence
for cancer or vocal cord paralysis.  She was started on [**Hospital1 **] PPI
treatment with some improvement in her voice.  She should
receive vocal therapy on dishcarge.
.
# Pericardial effusion - patient was found to have new murmur
initially and on subsequently Echo she was found to have a large
circumferential pericardial effusion with tamponade physiology.
She was clinically stable on the floor with 8-10 pulsus pardoxus
and cardiology service was consulted. The effusion was likely
deemed to be chronic since she was tolerating it without
hemodynamic instability.  It was decided that she would benifit
from fluid drainage for symptomatic relief, and also to
facilitate workup for the cause of her effusion and FTT.  She
was transferred to the CCU and underwent pericardiocentesis in
the cath lab with 450cc drained. Opening pressure was 15,
pericardium was thickened. CO 3.14, CI 2.32, mean RA 11, mean
PCW 12. The procedure was complicated by hypotension, which
responded to atropine. This was attributed to the drainage of
500cc of bloody fluid, suspected from a venous structure, likely
the azygous or splenic vein. Post-procedure echo confirmed
evacuation of fluid. She was then transferred to the CCU for
further care and monitoring. The pericardial drain was
discontinued and she transfered from CCU back to the floor.
Repeat eccho the next day on [**9-20**] continued to show no
reaccumulation of fluid.  She continued to remain
hemodynamically stable on the floor and was monitored on
telemetry without evidence of tachycardia.  She has not had
clinical evidence of fluid reaccumulation, however this is very
likely to recurr and she should be seen by cardiology within a
month (Dr.[**Name (NI) 94146**] saw her at [**Hospital1 18**])
.
With regard to the etiology of her pericardial effusion clinical
suspicion was very high for malignancy, especially considering
her extensive smoking history.  A chest CT revealed a 2cm
spiculated RUL lung mass.  Additionally pericardial fluid was +
for CEA+ malignant-appearing cells.  Otherwise, her PPD was
negative, ESR nl, she had no uremia.
.
# Right Apical Mass: CT this admission showed 2cm right apical
mass concerning for malignancy. She has a h/o smoking and
otherwise negative malignancy work up (including colonoscopy,
EGD, pap, mammogram, and CT abdomen/pelvis).  Pericardial fluid
showed malignant appearing cells that were strongly + for CEA
and considered most consistent with adenocarcinoma.  The overall
clinical picture is most concerning for NSCLC.  Dr. [**First Name8 (NamePattern2) **]
[**Name (STitle) 3274**], a lung cancer specialist consulted and agreed with
this assessment.  With this assumption she would be considered
an unresectable lung cancer and Dr. [**Last Name (STitle) 3274**] agreed that she
would likely not be a chemotherapy candidate because of her very
poor performance status.  Nonetheless we had been pursuing a
tissue diagnosis.  Gastroenterology service considered
trans-esophageal biopsy of the mass it was decided that she was
too high risk especially in light of potential pneumothorax.
Interventional pulmonology felt they would not be able to
technically perform a bronchoscopic biopsy.  Interventional
radiology was willing to perform the procedure next week but
cited an approximate 30% risk of pneumothorax with 5-10% risk of
needing a chest tube.  Ultimately patient decided to contemplate
the biopsy further and wished to be have addressed as an
outpatient, leaning towards not proceeding with the biopsy.
.
# Anemia:  ms. [**Known lastname 1104**] was admitted with a normocytic anemia.
Iron studies, B12, folate unrevealing. She had a crit drop with
the bleeding from her pericardiocentesis which stabilized over
one day.  She was none-theless transfused 2 U pRBCs on [**9-20**] with
appropriate rise in hematocrit and has demonstrated stability
since.
.
# Ms [**Known lastname 1104**] developed right arm swelling in the setting of IV
placement.  Doppler did not reveal obvious clot but there was
suggestion of sluggish flow in her R internal jugular vein which
was further evaluated by an MRI.  Unfortunately the patient only
tolerated [**3-23**] of the exam.  The official [**Location (un) 1131**] of the study is
pending upon discharge but will be followed up by PCP.
.
# Constipation: has many prn meds.
.
# Weight loss/Early Satiety: Most likely related to malignancy.
Her pre-albumin was low-normal and her albumin was normal on
admission.  Gastric emptying study revealed delayed emptying and
she was started on tid reglan which she tolerated.  Nutrition
consulted and she was given nutritional suppluments.  Her
appetite has somewhat improved but will need to be monitored.
.
# Hypoxia: Ms. [**Known lastname 1104**] developed hypoxia in the CCU which was
felt to be partly COPD + heart failure, no signs of infection.
CXR revealed pulmonary edema and bilateral pleural effusions.
This improved with diuresis (lasix 20 IV) and with afterload
reduction with lisinopril 10.  [**9-26**] CXR was improved and she is
being discharged on room air.  Patient may also have underlying
restrictive lung component due to kyphoscoliosis that may be
further diagnosed as outpatient but may not change further
managment.
.
# HTN: had been on lisinopril as outpt, was held for decreased
BP in CCU. She was restarted on lisionpril 5 on [**9-24**] which was
increased to lisinopril 10.  She is normotensive on discharge
.
# COPD: Stable inhouse. She received albuterol/ipratropium nebs
prn.
.
# GERD: Pt stopped taking PPI at home as she felt it wasn't
helping. She now has gastritis and evidence of laryngeal
pharyngeal reflux.  She was therefore started on protonix 40mg
po bid with some improvement insymptoms
.
# PPx: Ms [**Known lastname 1104**] received SQ heparin. PPI. Bowel regimen.  PT
consulted and has been working with patient.
.
# Contact: Pt and son [**First Name8 (NamePattern2) **] [**Name (NI) 1104**]). Family mtg held [**9-19**] in
CCU to discuss CT findings. home: [**Telephone/Fax (1) 94147**], work:
[**Telephone/Fax (1) 94148**], would like to be called with updates; PCP: [**Last Name (NamePattern4) **].
[**Last Name (STitle) 4033**] ([**Telephone/Fax (1) 94149**] (pager)


Medications on Admission:
Fosamax, stopped >1 month ago
Protonix, stopped 1 month ago, felt like it wasn't working
Ditropan, recently changed to unknown med one week ago
Lisinopril unknown dose
Citracal tid
Glucosamine [**Hospital1 **]
ASA 81 mg qd
Vit E qd


Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
2. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
4. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
5. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
6. Oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours)
as needed.
7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): hold for loose stool.
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Reglan 10 mg Tablet Sig: One (1) Tablet PO three times a
day: with meals.
12. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 5481**] [**Hospital1 1501**]

Discharge Diagnosis:
1.  Malignant pericardial effusion with tamponade
2.  Malignancy, unspecified
3.  Presbylaryngis, laryngeal/pharyngeal reflux
4.  Emphysema
5.  Hypertension
6.  Urinary incontinence


Discharge Condition:
Fair, Afebrile, Vital signs stable.


Discharge Instructions:
Please continue to take all medications as prescribed.  We have
started you on 1 new medication called Reglan or metaclopramide
to help with your appetite and digestion.  We are started you on
a medicien called protonix to take for your hoarse voice.  You
should take this twice per day.

As you know, you had fluid drained from around your heart.  This
fluid might reaccumulate in the future and you may need to be
seen by a cardiologist about this.  Symptoms of this would be
worsening shortness of breath, leg swelling, or worsening
weakness or light headedness.  Please seek medical attention if
you have any of these symptoms.  You should also seek medical
care if you have fever over 100.4, worsening swelling of your
arm, [**Last Name (un) 2043**] pain, or for any other concerns

Followup Instructions:
Please follow up with your primary care physician within the
next 1-2 weeks.
.
Provider: [**Name10 (NameIs) 475**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 474**], M.D. Phone:[**Telephone/Fax (1) 1989**]
Date/Time:[**2143-10-25**] 10:00.  [**Hospital1 18**] cardiology
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute pericarditis in diseases classified elsewhere,Acute posthemorrhagic anemia,Other emphysema,Congestive heart failure, unspecified,Other iatrogenic hypotension,Stricture of artery,Other diseases of larynx, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of tobacco use,Unspecified disease of pericardium,Adult failure to thrive,Urinary incontinence, 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: Failure to thrive

PRESENT ILLNESS: Pt is an 80 yo female h/o HTN, osteoporosis, and emphysema who
presents with progressive weight loss, early satiety, hoarseness
and pedal edema. Weight loss was unintentional, documented from
113->97 lbs in about one year. Along with this, she has lost
strength, balance, and energy. No fever/chills/NS. She has also
had early satiety which she describes as wanting to eat a meal,
but stopping short [**2-21**] feeling that it will come up. Yesterday,
for example, she only had a little bit of chicken noodle soup
for dinner. The hoarseness has also been progressing over the
last year, with associated production of white "foam" that she
has been coughing up more frequently with no blood or distinct
colors other than white. Of note, no difficulty swallowing, no
constipation/diarrhea, no melena/BRBPR. She had a recent E. coli
UTI [**2143-8-28**] with hematuria which was treated with Bactrim for 3
days and resolved with f/u UA with no RBCs. Finally, she has
also had gradually increasing pedal edema over the past few
weeks. She has no chest pain, but has dyspnea after walking ~1
block that is stable. ROS otherwise negative except for urinary
stress incontinence that she has had for years which is stable.

MEDICAL HISTORY: (1) Hypertension.
(2) Osteoporosis.
(3) Emphysema.
(4) Osteoarthritis.
(5) Ectopic pregnancy.
(6) Uterine prolapse.
(7) Hyperlipidemia. Her triglycerides were elevated in [**2142**].
(8) Gastroesophageal reflux disease and heartburn. An upper GI
in [**2140**] showed hiatal hernia. An EGD in [**2141**] showed moderate
gastritis.
(9) Colonic polyps. A colonoscopy in [**2142**] showed a polyp.
(10) Claudication.
(11) Urinary stress incontinence.
(12) Coronary artery disease. An echo in [**2140**] showed trace MR.
(13) Status post appendectomy.

MEDICATION ON ADMISSION: Fosamax, stopped >1 month ago
Protonix, stopped 1 month ago, felt like it wasn't working
Ditropan, recently changed to unknown med one week ago
Lisinopril unknown dose
Citracal tid
Glucosamine [**Hospital1 **]
ASA 81 mg qd
Vit E qd

ALLERGIES: Ciprofloxacin / Amoxicillin

PHYSICAL EXAM: PE: T 98.3 BP 134/88 HR 100 R 20 95% O2 Sats RA
Gen: Frail, pleasant woman in NAD, hoarse
HEENT: Clear OP, MMM, when speaking has hoarse, gurgly voice,
occasionally bringing up white frothy sputum.
NECK: Supple, No LAD
CV: RR, NL rate. NL S1, S2. III/VI holosystolic murmur best
heard over the apex, radiating to axilla.
LUNGS: Bilateral coarse breath sounds with kyphoscoliotic spine

FAMILY HISTORY: There is no family history of colorectal cancer.

SOCIAL HISTORY: The patient is retired, lives in [**Location (un) 5481**] retirement home in
[**Location (un) 2624**], MA. She quit smoking in [**2137**] after heavy smoking for 20
years. She does not drink. She is a widow with 3 children,
youngest lives close by in [**Location (un) 3786**], MA. 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute pericarditis in diseases classified elsewhere,Acute posthemorrhagic anemia,Other emphysema,Congestive heart failure, unspecified,Other iatrogenic hypotension,Stricture of artery,Other diseases of larynx, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of tobacco use,Unspecified disease of pericardium,Adult failure to thrive,Urinary incontinence, unspecified'}
