CHIEF COMPLAINT: Hematuria, Hemoptysis

PRESENT ILLNESS: ADMIT NOTE
Date: [**2192-3-13**]
Time: 2200

MEDICAL HISTORY: Asthma
COPD
Appendectomy
NSCLC
Oncology TREATMENT HISTORY:
[**8-/2191**] Developed hemoptysis
[**9-/2191**] Saw a doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **], [**Country 5881**] and diagnosed with left
lung mass
[**2192-1-20**] Bronchoscopy
[**2192-1-20**] Pathology showed non small cell lung cancer
[**2192-1-27**] Brain MRI showed two left cerebral lesions with edema
[**2192-2-3**] Stereotactic resection of left parieto-occipital tumor
[**2192-2-14**] Completed radiation to lung
[**2192-3-13**] Completed WBI

MEDICATION ON ADMISSION: dexamethasone 4mg [**Hospital1 **]
famotidine 20mg [**Hospital1 **]
advair
keppra 750 [**Hospital1 **]
oxycodone (not really using)
TMP-SMX
acetaminophen prn

ALLERGIES: Heparin Agents

PHYSICAL EXAM: Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, not date (baseline).
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Three children, one died in an accident.
Maternal uncle with lung cancer.

SOCIAL HISTORY: Originally from [**Country 5881**]. Currently lives in [**Location **]. Patient is
married and has two healthy children. He is retired painter.
He smoked 1.5 packs per day for 55 years and quit a few months
ago.
He was also a heavy drinker but he quit 5 months ago. He denies
any recreational drugs use.
Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Thrombocytopenia, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Hemoptysis, unspecified,Hemiplegia, unspecified, affecting unspecified side,Hematuria, unspecified,Encounter for palliative care,Do not resuscitate status,Backache, unspecified,Chronic obstructive asthma, unspecified,Personal history of irradiation, presenting hazards to health,Personal history of tobacco use
Sec mal neo brain/spine,Cerebral edema,Thrombocytopenia NOS,Mal neo upper lobe lung,Hemoptysis NOS,Unsp hemiplga unspf side,Hematuria NOS,Encountr palliative care,Do not resusctate status,Backache NOS,Chronic obst asthma NOS,Hx of irradiation,History of tobacco use
Admission Date:  [**2192-3-13**]              Discharge Date:   [**2192-3-23**]

Date of Birth:  [**2119-9-4**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Heparin Agents

Attending:[**First Name3 (LF) 14802**]
Chief Complaint:
Hematuria, Hemoptysis

Major Surgical or Invasive Procedure:
[**2192-3-15**] Right craniotomy for tumor resection


History of Present Illness:
ADMIT NOTE
Date: [**2192-3-13**]
Time: 2200

HPI: 72 yo M with NSCLC with brain mets s/p parietal/occipital
crani for tumor resection on [**2192-2-3**], relatively new bilateral
frontal hemorrhagic mets scheduled for neurosurgical resection
next week now s/p WB XRT with progressive weakness now with
hematuria x 1 week, worsening thrombocytopenia. Per patient's
son, his father and mother have been staying with him and he has
been providing much of the care for his father. [**Name (NI) **] was unaware
that his father was having hematuria until yesterday when his
urine was noted to be dark red. He has also had hemoptysis for a
number of months but worsening in the past 1-2 weeks with
tablespoon of hemoptysis nearly every time he coughs. The cough
is associated with right sided chest pain in the front and back.
 Labs are significant for worsening thrombocytopenia of unclear
etiology.

In the ED: 98.8 85 117/71 18 98% RA. foley placed. CT head with
hemorrhagic mets stable from MRI on [**3-12**] but new from [**2192-2-3**].

Currently, he denies any pain but feels very tired.

Past Medical History:
Asthma
COPD
Appendectomy
NSCLC
Oncology TREATMENT HISTORY:
[**8-/2191**] Developed hemoptysis
[**9-/2191**] Saw a doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **], [**Country 5881**] and diagnosed with left
lung mass
[**2192-1-20**] Bronchoscopy
[**2192-1-20**] Pathology showed non small cell lung cancer
[**2192-1-27**] Brain MRI showed two left cerebral lesions with edema
[**2192-2-3**] Stereotactic resection of left parieto-occipital tumor
[**2192-2-14**] Completed radiation to lung
[**2192-3-13**] Completed WBI


Social History:
Originally from [**Country 5881**]. Currently lives in [**Location **]. Patient is
married and has two healthy children. He is retired painter.
He smoked 1.5 packs per day for 55 years and quit a few months
ago.
He was also a heavy drinker but he quit 5 months ago. He denies
any recreational drugs use.


Family History:
Three children, one died in an accident.
Maternal uncle with lung cancer.


Physical Exam:
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, not date (baseline).
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2 mm
bilaterally. R VF deficit.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Baseline left sided weakness. LUE [**1-15**], LLE [**3-15**], RUE and
RLE are full motor.


Pertinent Results:
[**2192-3-13**] 01:10PM   cTropnT-0.014*
[**2192-3-13**] 01:10PM   WBC-10.4 RBC-4.61 HGB-13.2* HCT-41.6 MCV-90
MCH-28.7 MCHC-31.8 RDW-18.0*
[**2192-3-13**] 01:10PM   NEUTS-93* BANDS-4 LYMPHS-2* MONOS-1* EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2192-3-13**] 01:10PM   HYPOCHROM-2+ ANISOCYT-2+ POIKILOCY-1+
MACROCYT-1+ MICROCYT-1+ POLYCHROM-NORMAL OVALOCYT-1+
TEARDROP-OCCASIONAL
[**2192-3-13**] 01:10PM   PT-11.1 PTT-22.0* INR(PT)-1.0
[**2192-3-13**] 01:10PM   PLT SMR-VERY LOW PLT COUNT-69*

[**2192-3-13**] 11:45AM URINE  COLOR-Red APPEAR-Cloudy SP [**Last Name (un) 155**]-1.015
[**2192-3-13**] 11:45AM URINE  BLOOD-LG NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-1 PH-6.0 LEUK-TR
[**2192-3-13**] 11:45AM URINE  RBC->182* WBC-0 BACTERIA-NONE YEAST-NONE
EPI-0

[**3-12**] MRI: Three markedly enlarged hemorrhagic metastases have
progressed
dramatically since the brain MR [**First Name (Titles) **] [**2192-2-4**]. The
largest of these
measures 35 mm in greatest diameter. Other small metastatic
lesions appear
unchanged.

[**3-13**] CT head: One right and two left frontal hemorrhagic lesions
with surrounding edema, concerning for metastasis. These lesions
were seen in the MRI of [**2192-3-12**], but new since the CT of
[**2192-2-3**]. No new hemorrhage. No midline shift. Prominent
bilateral extra-axial spaces, likely subdural hygromas.

[**3-13**] CXR: PRELIM Consolidation in the lingular segment of the
left lung, is
consistent with known diagnosis of lung cancer. No new pulmonary
pathology
identified.

Pathology Report Tissue: RIGHT PARIETAL LESION. Study Date of
[**2192-3-15**] White matter and blood clot. No tumor identified,
levels x3.

[**3-15**] MRI Brain- IMPRESSION: Previously noted enhancing lesions in
the brain on the MRI of [**2182-3-12**] again identified for WAND study
for surgical planning. No midline shift or hydrocephalus. No
change in the size of the lesion seen since the previous study.

[**3-15**] NCHCT: IMPRESSION: Status post right frontal craniotomy and
resection of right frontal hemorrhagic metastasis with expected
intralesional and intracranial post-surgical changes. Stable
appearance of left frontal hemorrhagic metastasis and left
parieto-occipital encephalomalacia from prior resection.  Stable
bilateral subdural hygromas.

[**3-16**] ECG: FINDINGS: The patient has been extubated. Left upper
lobe consolidation has improved. This pattern is consistent with
an obstructive pneumonia consistent with known lingular mass.
There is no pleural effusion or pneumothorax. The heart size is
within normal limits.

[**3-21**] LENI's: IMPRESSION: No evidence of DVT.

Brief Hospital Course:
72 yo M with NSCLC with brain mets s/p parietal/occipital crani
for tumor resection on [**2192-2-3**], relatively new bilateral
frontal hemorrhagic mets scheduled for neurosurgical resection
next week now s/p WB XRT with progressive weakness now with
hematuria x 1 week, worsening thrombocytopenia.

On [**3-13**], The patient completed WBXRT- 3500 cGy over 14 fractions
and was sent to the Emergency Department. He presented with
hematuria,thrombocytopenia, and hemoptysis. The patient had a
Head CT which was consistent with multiple known hemorrhagic
metastases in bifrontal lobes. There was no new intracranial
hemorrhage. The patient was admitted to Oncology with plans to
prepare the patient for surgery on Friday with Dr [**Last Name (STitle) **] for a
craniotomy for resection of brain mass.  The platlet level was
69.

On [**3-15**], The patient went to the Operating Room for an elective
craniotomy for resection of brain mass with Dr [**Last Name (STitle) **]. The
patient tolerated the procedure well and was recovered in the
intensive care unit. The goal systolic blood pressure was < 140.
The post operative Head Ct was consistent with expected post
operative changes.  The patient was alert and oriented to person
and place at baseline the patient never knows date.  He was
moving all extremities and exhibited his baseline level of left
sided weakness. The goal was to keep the patient platlets > 80
for 24 hours post surgery. A blood sample was sent to the lab
and the patient was found to be HEPARIN DEPENDENT ANTIBODIES
  Positive.  The patient was not started on prophylactic SQ
Heparin as a result. Venodyne boots were on at all times and
mobility was encouraged.

On [**3-16**], POD #2 the patient continued to have a production
productive cough/hemoptysis.  He was able to independently raise
secretions and was using a hand held suction independently.  A
CXR was performed in the afternoon which was consistent with
left upper lobe consolidation which had improved. The pattern
was consistent with an obstructive pneumonia consistent with
known lingular mass. There was no pleural effusion or
pneumothorax. The heart size was within normal limits. The
platlets were 67 and the patient was transfused with 1 pack of
platlets and post transfusion platlet count was 136. The
dexamethasone was weaned. The systolic blood pressure goal was <
160. A regular insulin sliding scale was initiated given the
dexamethasone.  The patients diet wa advanced and physical
therapy and occupational therapy was ordered.  The patient was
transferred to the floor.

On [**3-17**], The patient's hematocrit was 21.7 from 27 the day prior
and 2 units of Packed Red Blood Cells were administered with 10
mg IV lasix to avoid fluid volume overload.  The patient
continued have hemoptysis although this was improved. The serum
potassium level was 3.8 and was repleated with 20 meq KCL.  The
foley catheter remained in place to accuratly  moniotr urine
output in the setting of transfusion of blood products and
adminitration of lasix. The platlets count was 63.  Decadron was
weaned to 4mg [**Hospital1 **] per neurology oncology recommendations. The
post transfusion hematocrit was 31.3.  The evening platlet count
was 37.  On exam, the patient is primarily Greek speaking.  He
exhibits improved hemotysis.  The surgical dressing was removed
and the staples at the incision were intact and the incision was
well approximated.  There was no drainage, erythema or edema.
The patient was alert, oriented to person and place.  The pupils
5-4mm bilaterally.  The patient was able to move all
extremitiesand exhibited baseline Left sided weakness.  The left
deltoid strength was [**2-13**], bicep [**1-15**], tricep 4-/5, grip [**1-15**], IP
[**1-15**], quad /ham4-/5, AT/[**Last Name (un) 938**]/[**Last Name (un) **] [**2-13**] RLE full, RUE 5-/5.
HIT markedly positive no heparin.

[**Date range (1) 19033**] The patient remained neurologically stable but
physically continued to become weaker and have increased pain
throughout his body. Palliative Care was consulted and pain
medications were adjusted. Multiple family meetings were held
with the son and daughter in regards to discharge planning.
Their ultimate goal was to send the patient back to [**Country 5881**] which
delayed the patient's discharge in order to figure out how to
best make this happen.
On [**3-23**] the patient continued to appear more weak, refused to
eat and complained of pain. The palliative care team met with
the family again and they all agreed that it would be in the
patient's best interest to be made CMO. Medications except for
pain meds were d/c'd. Patient was kept comfortable and he passed
with family at the bedside on [**2192-3-23**] at 23:30


Medications on Admission:
dexamethasone 4mg [**Hospital1 **]
famotidine 20mg [**Hospital1 **]
advair
keppra 750 [**Hospital1 **]
oxycodone (not really using)
TMP-SMX
acetaminophen prn

Discharge Medications:
Expired

Discharge Disposition:
Expired

Discharge Diagnosis:
NSCLCA with mets to brain
Hematuria
Thrombocytopenia
Hemoptysis
COPD


Discharge Condition:
Expired on [**2192-3-23**] at 23:30


Discharge Instructions:
Expired

Followup Instructions:
N/A



Completed by:[**2192-3-23**]
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Thrombocytopenia, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Hemoptysis, unspecified,Hemiplegia, unspecified, affecting unspecified side,Hematuria, unspecified,Encounter for palliative care,Do not resuscitate status,Backache, unspecified,Chronic obstructive asthma, unspecified,Personal history of irradiation, presenting hazards to health,Personal history of tobacco 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: Hematuria, Hemoptysis

PRESENT ILLNESS: ADMIT NOTE
Date: [**2192-3-13**]
Time: 2200

MEDICAL HISTORY: Asthma
COPD
Appendectomy
NSCLC
Oncology TREATMENT HISTORY:
[**8-/2191**] Developed hemoptysis
[**9-/2191**] Saw a doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **], [**Country 5881**] and diagnosed with left
lung mass
[**2192-1-20**] Bronchoscopy
[**2192-1-20**] Pathology showed non small cell lung cancer
[**2192-1-27**] Brain MRI showed two left cerebral lesions with edema
[**2192-2-3**] Stereotactic resection of left parieto-occipital tumor
[**2192-2-14**] Completed radiation to lung
[**2192-3-13**] Completed WBI

MEDICATION ON ADMISSION: dexamethasone 4mg [**Hospital1 **]
famotidine 20mg [**Hospital1 **]
advair
keppra 750 [**Hospital1 **]
oxycodone (not really using)
TMP-SMX
acetaminophen prn

ALLERGIES: Heparin Agents

PHYSICAL EXAM: Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, not date (baseline).
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Three children, one died in an accident.
Maternal uncle with lung cancer.

SOCIAL HISTORY: Originally from [**Country 5881**]. Currently lives in [**Location **]. Patient is
married and has two healthy children. He is retired painter.
He smoked 1.5 packs per day for 55 years and quit a few months
ago.
He was also a heavy drinker but he quit 5 months ago. He denies
any recreational drugs use. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Thrombocytopenia, unspecified,Malignant neoplasm of upper lobe, bronchus or lung,Hemoptysis, unspecified,Hemiplegia, unspecified, affecting unspecified side,Hematuria, unspecified,Encounter for palliative care,Do not resuscitate status,Backache, unspecified,Chronic obstructive asthma, unspecified,Personal history of irradiation, presenting hazards to health,Personal history of tobacco use'}
