CHIEF COMPLAINT: Dyspnea, hemoptysis

PRESENT ILLNESS: 79 yo M with known metastatic nonsmall cell lung CA (mets to
T-spine) p/w episodes every 2 hours of coughing up blood
starting last night at 2300. Associated with dyspnea over the
past 2 days to the extent that he was unable to get out of bed
yesterday. Also, he had nausea and one episode of post-tussive
emesis. He felt feverish and had chills last night, but did not
take his temperature. He denies chest pain or abdominal pain.
Denies trauma.
.
In the ED, initial vs were: T 94.6F P afib 113 BP 92/50 R 20 O2
sat 90% on 2L NC. Patient was given Levaquin 750mg IV x1 for CXR
showing LLL infiltrate and effusion. The EKG showed afib with
ventricular rate of 113, NA, NI with no STE or changes from
previous tracing. CTA chest negative for PE, but showed tumor
burden in L hilum with likely post-obstructive pneumonia in the
setting of a left-sided pleural effusion.
.
On the floor, the patient had no complaints and was speaking in
full sentences.
.

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.
TREATMENT:
1. Status post palliative thoracic spine radiation to T9-T12
thoracic spine. Total of 800 cGy (1 dose) completed [**2177-10-28**].
2. Status post cycle 1 of carboplatin 6 AUC, paclitaxel 200
mg/m2
and anamorelin vs placebo as part of DFHCC 07-369. C1D1 given on

MEDICATION ON ADMISSION: ALBUTEROL - 90 mcg Aerosol - 2 puffs qday
DEXAMETHASONE - 4 mg Tablet - 1 Tablet(s) by mouth twice a day
day before chemotherapy, and for 2 days following chemotherapy.
DIGOXIN - 125 mcg Tablet - daily
FENTANYL - 25 mcg/hour Patch 72 hr
FLUTICASONE-SALMETEROL [ADVAIR DISKUS] - 250 mcg-50 mcg/Dose
Disk
with Device - 1 puff intraoral twice a day
FOLIC ACID - 1 mg Tablet - daily
HYDROCODONE-ACETAMINOPHEN - 5 mg-500 mg Tablet - [**1-16**] Tablet(s)
by
mouth every 6 hours as needed for pain for cancer-related pain
LORAZEPAM - 1 mg Tablet - 1 Tablet(s)(s) by mouth every 12 hours
chemotherapy-induced nausea or anxiety
METOPROLOL TARTRATE - 100 mg Tablet - twice a day
SIMVASTATIN - 20 mg - daily
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg Capsule,
w/Inhalation Device - 1 capsule orally daily
.
Medications - OTC
ASPIRIN - 325 mg Tablet - daily
BLOOD SUGAR DIAGNOSTIC [SURESTEP TEST] check fs qid as needed
for DM
LANCETS [LIFESCAN FINEPOINT LANCETS] -   Misc - check once a day
NUT.TX.GLUC.INTOL,LAC-FREE,SOY [GLUCERNA] -   Liquid - 2 bottles
by mouth twice a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97 BP: 123/51 P: 113 R: 21 18 O2:  99/4L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, trace dried
blood on lower lip
Neck: supple, JVP not elevated, no LAD
Lungs: Diminish BS L>R, scattered rales and rhonchi heard
throughout
CV: [**Last Name (un) **] [**Last Name (un) 3526**], normal S1 + S2, no murmurs, rubs, gallops
Abdomen:  soft, non-tender, protuberant, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
=====================
Discharge Examination:
Vitals: Tc 96 Tm 96.7 BP 110/66 HR 104 RR 20 O2 Sat 96% on 2L
Gen: well appearing, NAD
Heart: irregularly irregular, s1/s2 present, -mrg
Lungs: diminished breath sounds at bases, scattered wheezes
Abd: +bs, soft, non-tender, non-distended
Ext: [**1-16**]+ LE edema

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
-Occupation: used to be a [**Doctor Last Name 9808**] operator
Malignant neoplasm of upper lobe, bronchus or lung,Pneumonia, organism unspecified,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of bone and bone marrow,Myelopathy in other diseases classified elsewhere,Pulmonary collapse,Unspecified pleural effusion,Other specified aplastic anemias,Pathologic fracture of vertebrae,Acute posthemorrhagic anemia,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Iron deficiency anemia secondary to blood loss (chronic),Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Neoplasm related pain (acute) (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Swelling of limb,Personal history of contact with and (suspected) exposure to asbestos
Mal neo upper lobe lung,Pneumonia, organism NOS,Secondary malig neo lung,Secondary malig neo bone,Myelopathy in oth dis,Pulmonary collapse,Pleural effusion NOS,Aplastic anemias NEC,Path fx vertebrae,Ac posthemorrhag anemia,Atrial fibrillation,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Chr airway obstruct NEC,Hyperlipidemia NEC/NOS,Chr blood loss anemia,Adv eff antineoplastic,Neoplasm related pain,DMII wo cmp nt st uncntr,Swelling of limb,Hx-contct/expos asbestos
Admission Date:  [**2178-3-20**]              Discharge Date:   [**2178-4-1**]

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

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Doctor First Name 16571**]
Chief Complaint:
Dyspnea, hemoptysis

Major Surgical or Invasive Procedure:
ICU monitoring

History of Present Illness:
79 yo M with known metastatic nonsmall cell lung CA (mets to
T-spine) p/w episodes every 2 hours of coughing up blood
starting last night at 2300. Associated with dyspnea over the
past 2 days to the extent that he was unable to get out of bed
yesterday. Also, he had nausea and one episode of post-tussive
emesis. He felt feverish and had chills last night, but did not
take his temperature. He denies chest pain or abdominal pain.
Denies trauma.
.
In the ED, initial vs were: T 94.6F P afib 113 BP 92/50 R 20 O2
sat 90% on 2L NC. Patient was given Levaquin 750mg IV x1 for CXR
showing LLL infiltrate and effusion. The EKG showed afib with
ventricular rate of 113, NA, NI with no STE or changes from
previous tracing. CTA chest negative for PE, but showed tumor
burden in L hilum with likely post-obstructive pneumonia in the
setting of a left-sided pleural effusion.
.
On the floor, the patient had no complaints and was speaking in
full sentences.
.

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.
TREATMENT:
1. Status post palliative thoracic spine radiation to T9-T12
thoracic spine. Total of 800 cGy (1 dose) completed [**2177-10-28**].
2. Status post cycle 1 of carboplatin 6 AUC, paclitaxel 200
mg/m2
and anamorelin vs placebo as part of DFHCC 07-369. C1D1 given on

[**2177-11-11**].
3. Status post cycle 2 of carboplatin 4.5 AUC, paclitaxel 180
mg/m2 and anamorelin vs placebo as part of DFHCC 07-369. C2D1
given on [**2177-12-2**].
# 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
-Occupation: used to be a [**Doctor Last Name 9808**] operator


Family History:
No family history of lung cancer

Physical Exam:
Vitals: T: 97 BP: 123/51 P: 113 R: 21 18 O2:  99/4L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, trace dried
blood on lower lip
Neck: supple, JVP not elevated, no LAD
Lungs: Diminish BS L>R, scattered rales and rhonchi heard
throughout
CV: [**Last Name (un) **] [**Last Name (un) 3526**], normal S1 + S2, no murmurs, rubs, gallops
Abdomen:  soft, non-tender, protuberant, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
=====================
Discharge Examination:
Vitals: Tc 96 Tm 96.7 BP 110/66 HR 104 RR 20 O2 Sat 96% on 2L
Gen: well appearing, NAD
Heart: irregularly irregular, s1/s2 present, -mrg
Lungs: diminished breath sounds at bases, scattered wheezes
Abd: +bs, soft, non-tender, non-distended
Ext: [**1-16**]+ LE edema


Pertinent Results:
ADMISSION LABS:
[**2178-3-20**] 01:40PM BLOOD Glucose-162* UreaN-30* Creat-0.8 Na-134
K-4.6 Cl-99 HCO3-28 AnGap-12
[**2178-3-20**] 01:40PM BLOOD Phos-3.3 Mg-1.7
[**2178-3-20**] 01:49PM BLOOD Lactate-2.0
[**2178-3-20**] 01:40PM BLOOD CK-MB-NotDone proBNP-7277*
[**2178-3-20**] 01:40PM BLOOD CK(CPK)-35*
[**2178-3-20**] 01:40PM BLOOD PT-15.9* PTT-31.7 INR(PT)-1.4*
[**2178-3-20**] 01:40PM BLOOD WBC-4.0# RBC-2.18*# Hgb-7.2*# Hct-21.0*#
MCV-96 MCH-33.1* MCHC-34.3 RDW-17.3* Plt Ct-76*#
[**2178-3-20**] 01:40PM BLOOD Neuts-87.6* Lymphs-9.4* Monos-2.4 Eos-0.4
Baso-0.3
[**2178-3-20**] 09:56PM BLOOD Hct-19.0*
[**2178-3-20**] 09:56PM BLOOD PT-16.4* PTT-32.8 INR(PT)-1.5*
-------
-------
DISCHARGE LABS:
[**2178-4-1**] 06:10AM BLOOD WBC-13.3* RBC-2.77* Hgb-8.6* Hct-24.6*
MCV-89 MCH-31.3 MCHC-35.1* RDW-17.6* Plt Ct-74*
[**2178-4-1**] 06:10AM BLOOD Glucose-101 UreaN-14 Creat-0.6 Na-134
K-4.4 Cl-95* HCO3-34* AnGap-9
.
.
CXR: FINDINGS: Portable upright AP chest radiograph is obtained.
When compared with the prior radiograph there is interval
increase in left basilar opacity compatible with effusion and
likely post-obstructive atelectasis or pneumonia. Increased
vague opacity in the left mid lung is also concerning for post-
obstructive pneumonia. Left hilar mass is suboptimally assessed.
Right lung remains clear.
IMPRESSION: Post-obstructive pneumonia and atelectasis in the
left mid and
lower lung with associated effusion.
.
CTA chest:
IMPRESSION:
1. No pulmonary embolus.
2. Left hilar mass results in total occlusion of the left upper
lobe bronchus and near complete obstruction of the lingular
bronchus. Probable
postobstructive atelectasis and pneumonia is present within the
left upper
lobe with probable lymphangitic carcinomatosis in the left upper
lobe.
3. Increased bilateral pleural effusions.
4. Tree-in-[**Male First Name (un) 239**] opacification in the right lung and left lower
lobe concerning for a small airways disease process including
aspiration and/or infection.
5. Marked attenuation of the pulmonary arteries supplying the
left upper lobe and lingula. Unchanged thrombus in the left
superior pulmonary vein.
6. New T11 pathologic compression fracture with slight
retropulsion of the
vertebral body into the canal. Unchanged T10 metastasis. MR is
recommended to for further evaluation of the spinal cord.
------------
Arterial Embolization Report3/11/09:
Tumor blush was visualized at the left hilar mass. The left
bronchial artery feeding to the tumor at the left hilum, was
embolized with  particles until stagnation of the flow.

CXR [**2178-3-26**]: No pneumothorax. Left pleural effusion decreased


Brief Hospital Course:
This is a 76 year old family who presented from home with
hemoptysis.

# Hemoptysis: This was likely secondary to bleeding from
patient's lung cancer which is now obstructing his left main
bronchus. On admission hematocrit was 19 and patient transfused
two units. He was observed to have continued hemoptysis and
required an additional two units of blood. Patient underwent
flexible bronchoscopy on [**2178-3-23**] by interventional pulmonology
with APC to active bleeding on tumor site. Interventional
pulmonology recommended left pulmonary artery embolization in
order to more effectively prevent tumor bleeding. On [**2178-3-24**]
patient underwent left artery embolization by interventional
radiology with good effect. Patient's hemoptysis has nearly
resolved at time of discharge. Patient's aspirin is being held
given his risk of bleeding.

# Hypoxia/Post-Obstructive Pneumonia/Bilateral Pleural
Effusions: On admission patient determined to have
postobstructive atelectasis and pneumonia on chest CT. PNA
initially treated with unasyn and transitioned to levaquin for a
total of 10 day course. Sputum cultures have grown mixed oral
flora. Hypoxia improved with treatment of PNA. In addition
patient noted to have bilateral pleural effusions. He underwent
therapeutic thoracentesis on [**2178-3-26**] with good effect however
fluid re-accumulated and patient underwent placement of a PleurX
cathether on [**2178-3-30**] which can continue to be drained. Patient
is sating in the mid to high 90's on 2 liters of oxygen at time
of discharge. Oxygen via nasal cannula should continue to be
weaned as tolerated to maintain sats >93%.

# Atrial fibrillation: Patient noted to be in atrial
fibrillation with rapid ventricular response to 150's. Patient
treated with bolus doses of intravenous metoprolol and oral
metoprolol titrated up to 100mg TID (100mg [**Hospital1 **] at home).
Patient was also continued on his outpatient regimen of digoxin.
Heart has stabilized in the high 90's and blood pressure has
remained stable.

# Pancytopenia: Likely secondary to recent treatment with
pemetrexed (last dose [**2178-3-12**]). [**Known lastname 1007**] blood cell count has risen
to normal range. Platelet count is is trending up.  Would
anticipate that platelet would continue to increase.

# Right Arm Swelling: Ulstrasound did NOT indicate a deep venous
thrombosis.

# Non-Small Cell Lung Cancer: Patient followed by Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **]. He is cycle 2 of Pemetrexed on [**2178-3-12**]. He is scheduled
to follow up with Dr. [**Last Name (STitle) **] on [**2178-4-2**].

# Back Pain: Patient has known metastasis to the spine with a
particularly symptomatic lesion at T11 which he has received
palliative radiation and more recently cyberknife therapy in
[**1-23**]. Pain control much improved after patient switched from
fentanyl patch 25 mcg/vicodin to fentanyl patch 50mcg/MSIR
combination. Patient may require continued increased titration
of his current pain medication regimen to achieve comfort.

# Type II Diabetes Mellitus: Patient has diet controlled
diabetes.

#COPD: Patient had increased wheezing at time of discharge. He
will certainly require pulmonary rehab, pulmonary toilet and
incentive spirometry. He was continued on his outpatient regimen
of Fluticasone-Salmeterol. His tiotropium bromide was changed to
ipratropium bromide and Xopenex was added to his regimen for
wheezing/shortness of breath PRN. We prefer he receive Xopenex
rather than albuterol given he has an underlying tachyarrthymia.


Patient was DNR/DNI on this admission. Code status discussed
with patient and family members.

Medications on Admission:
ALBUTEROL - 90 mcg Aerosol - 2 puffs qday
DEXAMETHASONE - 4 mg Tablet - 1 Tablet(s) by mouth twice a day
day before chemotherapy, and for 2 days following chemotherapy.
DIGOXIN - 125 mcg Tablet - daily
FENTANYL - 25 mcg/hour Patch 72 hr
FLUTICASONE-SALMETEROL [ADVAIR DISKUS] - 250 mcg-50 mcg/Dose
Disk
with Device - 1 puff intraoral twice a day
FOLIC ACID - 1 mg Tablet - daily
HYDROCODONE-ACETAMINOPHEN - 5 mg-500 mg Tablet - [**1-16**] Tablet(s)
by
mouth every 6 hours as needed for pain for cancer-related pain
LORAZEPAM - 1 mg Tablet - 1 Tablet(s)(s) by mouth every 12 hours
chemotherapy-induced nausea or anxiety
METOPROLOL TARTRATE - 100 mg Tablet - twice a day
SIMVASTATIN - 20 mg - daily
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg Capsule,
w/Inhalation Device - 1 capsule orally daily
.
Medications - OTC
ASPIRIN - 325 mg Tablet - daily
BLOOD SUGAR DIAGNOSTIC [SURESTEP TEST] check fs qid as needed
for DM
LANCETS [LIFESCAN FINEPOINT LANCETS] -   Misc - check once a day
NUT.TX.GLUC.INTOL,LAC-FREE,SOY [GLUCERNA] -   Liquid - 2 bottles
by mouth twice a day

Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
1 puff Disk with Device Inhalation [**Hospital1 **] (2 times a day).
2. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Simvastatin 40 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
5. Codeine-Guaifenesin 10-100 mg/5 mL Syrup Sig: 5-10mL MLs PO
Q4H (every 4 hours) as needed for cough.
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
9. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily): apply
for 12 hours at a time to lower back.
10. Magnesium Oxide 140 mg Capsule Sig: Two (2) Capsule PO twice
a day.
11. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours): take with food and water.
12. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
13. Polyethylene Glycol 3350 100 % Powder Sig: One (1)  PO DAILY
(Daily) as needed for constipation.
14. Fentanyl 50 mcg/hr Patch 72 hr Sig: One (1)  Transdermal
every seventy-two (72) hours.
15. Levalbuterol HCl 0.63 mg/3 mL Solution for Nebulization Sig:
One (1)  Inhalation QID (4 times a day) as needed for shortness
of breath, wheezing.
16. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).


Discharge Disposition:
Extended Care

Facility:
Bear [**Doctor Last Name **] Nursing Center - [**Location (un) 2199**]

Discharge Diagnosis:
Primary: Hemoptysis secondary to left lung mass bleeding, Atrial
Fibrillation with rapid ventricular response, post obstructive
pneumonia
Secondary: Stage IV non small cell lung cancer, spinal
compression fracture at T11 secondary to lung cancer metastases,
Chronic obstructive pulmonary disease, type II diabetes mellitus
(diet controlled), Hypertension, hyperlipidemia


Discharge Condition:
hemodynamically stable


Discharge Instructions:
You were admitted to the hospital for management of the blood
you were coughing up. We determined that the blood in your lungs
represented active bleeding from your lung tumor. You underwent
two procedures to stop the bleeding, which have been successful.
You were also treated for a pneumonia. Your breathing has
improved though you are still requiring oxygen.

During your hospital stay your heart rate became very fast as a
result of your atrial fibrillation. We have had to increase your
dose of metoprolol to achieve better rate control.

You have also had difficulty urinating which has required foley
catheter placement. We will discharge you with the foley in
place. We have made an appointment for you to follow up with
urology.

Please take all medications as directed and attend all follow up
appointments.

If you begin coughing up blood, experience worsening shortness
of breath or have fevers or chest pain please contact your
primary oncologist or go to the emergency department for
evaluation.

Followup Instructions:
You have an appointment to follow up with Dr. [**First Name (STitle) **] [**Name (STitle) **] in
urology on [**2178-4-13**] at 9:00am. The office is located in [**Hospital Ward Name 23**]
Building [**Location (un) 470**]. The office phone number is ([**Telephone/Fax (1) 4376**].

You will need to follow up in interventional pulmonology clinic
in TWO weeks to have the sutures securing your pleurX catheter
removed. Please call [**Telephone/Fax (1) 7769**] to schedule an appointment.

You will need to schedule an appointment to see Dr. [**Last Name (STitle) **] in 2
weeks. His office phone number is ([**Telephone/Fax (1) 3280**].

You have an MRI scheduled for [**2178-4-13**] at 1:00PM on the [**Hospital Ward Name 12837**], [**Hospital Ward Name 121**] Building [**Location (un) 453**]. The number for MRI scheduling
is ([**Telephone/Fax (1) 6713**].



Completed by:[**2178-4-1**]
{'Malignant neoplasm of upper lobe, bronchus or lung,Pneumonia, organism unspecified,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of bone and bone marrow,Myelopathy in other diseases classified elsewhere,Pulmonary collapse,Unspecified pleural effusion,Other specified aplastic anemias,Pathologic fracture of vertebrae,Acute posthemorrhagic anemia,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Iron deficiency anemia secondary to blood loss (chronic),Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Neoplasm related pain (acute) (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Swelling of limb,Personal history of contact with and (suspected) exposure to asbestos'}


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, hemoptysis

PRESENT ILLNESS: 79 yo M with known metastatic nonsmall cell lung CA (mets to
T-spine) p/w episodes every 2 hours of coughing up blood
starting last night at 2300. Associated with dyspnea over the
past 2 days to the extent that he was unable to get out of bed
yesterday. Also, he had nausea and one episode of post-tussive
emesis. He felt feverish and had chills last night, but did not
take his temperature. He denies chest pain or abdominal pain.
Denies trauma.
.
In the ED, initial vs were: T 94.6F P afib 113 BP 92/50 R 20 O2
sat 90% on 2L NC. Patient was given Levaquin 750mg IV x1 for CXR
showing LLL infiltrate and effusion. The EKG showed afib with
ventricular rate of 113, NA, NI with no STE or changes from
previous tracing. CTA chest negative for PE, but showed tumor
burden in L hilum with likely post-obstructive pneumonia in the
setting of a left-sided pleural effusion.
.
On the floor, the patient had no complaints and was speaking in
full sentences.
.

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.
TREATMENT:
1. Status post palliative thoracic spine radiation to T9-T12
thoracic spine. Total of 800 cGy (1 dose) completed [**2177-10-28**].
2. Status post cycle 1 of carboplatin 6 AUC, paclitaxel 200
mg/m2
and anamorelin vs placebo as part of DFHCC 07-369. C1D1 given on

MEDICATION ON ADMISSION: ALBUTEROL - 90 mcg Aerosol - 2 puffs qday
DEXAMETHASONE - 4 mg Tablet - 1 Tablet(s) by mouth twice a day
day before chemotherapy, and for 2 days following chemotherapy.
DIGOXIN - 125 mcg Tablet - daily
FENTANYL - 25 mcg/hour Patch 72 hr
FLUTICASONE-SALMETEROL [ADVAIR DISKUS] - 250 mcg-50 mcg/Dose
Disk
with Device - 1 puff intraoral twice a day
FOLIC ACID - 1 mg Tablet - daily
HYDROCODONE-ACETAMINOPHEN - 5 mg-500 mg Tablet - [**1-16**] Tablet(s)
by
mouth every 6 hours as needed for pain for cancer-related pain
LORAZEPAM - 1 mg Tablet - 1 Tablet(s)(s) by mouth every 12 hours
chemotherapy-induced nausea or anxiety
METOPROLOL TARTRATE - 100 mg Tablet - twice a day
SIMVASTATIN - 20 mg - daily
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] - 18 mcg Capsule,
w/Inhalation Device - 1 capsule orally daily
.
Medications - OTC
ASPIRIN - 325 mg Tablet - daily
BLOOD SUGAR DIAGNOSTIC [SURESTEP TEST] check fs qid as needed
for DM
LANCETS [LIFESCAN FINEPOINT LANCETS] -   Misc - check once a day
NUT.TX.GLUC.INTOL,LAC-FREE,SOY [GLUCERNA] -   Liquid - 2 bottles
by mouth twice a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97 BP: 123/51 P: 113 R: 21 18 O2:  99/4L NC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, trace dried
blood on lower lip
Neck: supple, JVP not elevated, no LAD
Lungs: Diminish BS L>R, scattered rales and rhonchi heard
throughout
CV: [**Last Name (un) **] [**Last Name (un) 3526**], normal S1 + S2, no murmurs, rubs, gallops
Abdomen:  soft, non-tender, protuberant, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
=====================
Discharge Examination:
Vitals: Tc 96 Tm 96.7 BP 110/66 HR 104 RR 20 O2 Sat 96% on 2L
Gen: well appearing, NAD
Heart: irregularly irregular, s1/s2 present, -mrg
Lungs: diminished breath sounds at bases, scattered wheezes
Abd: +bs, soft, non-tender, non-distended
Ext: [**1-16**]+ LE edema

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
-Occupation: used to be a [**Doctor Last Name 9808**] operator 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Pneumonia, organism unspecified,Secondary malignant neoplasm of lung,Secondary malignant neoplasm of bone and bone marrow,Myelopathy in other diseases classified elsewhere,Pulmonary collapse,Unspecified pleural effusion,Other specified aplastic anemias,Pathologic fracture of vertebrae,Acute posthemorrhagic anemia,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Iron deficiency anemia secondary to blood loss (chronic),Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Neoplasm related pain (acute) (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Swelling of limb,Personal history of contact with and (suspected) exposure to asbestos'}
