CHIEF COMPLAINT: cough and tachycardia

PRESENT ILLNESS: This is a 45 year old male with no past medical history
presenting with 3 - 4 weeks of cough.  His symptoms began about
a month ago when he noted the onset of a dry, paroxysmal, cough
initially associated with one brief post-tussive syncope.  No
hemoptysis or sputum production.  He also states he feels short
of breath and "can't quite fill up his lungs with air."  Deep
breaths tend to set off cough paroxysms.  He has never
experienced symptoms like these in the past, and denies prior
history of asthma, allergies, or any other lung diseases.  No
history of gastroesophageal reflux.  Associated with cough and
shortness of breath, he notes non-drenching night sweats and a
[**11-9**] lb weight loss.  About 5 days prior to admission, he noted
his shortness of breath got appreciably worse: while walking in
his garden he noted significantly dyspnea. Previously he has had
normal exercise tolerance, able to play tennis, significant
exercise. He saw his primary care doctor for these complaints on
[**6-30**], who noted his heart rate to be in the 130s.  His PCP sent
him to the ED at [**Hospital1 **] for these complaints; he had a CXR
there which showed left pleural effusion and widening of his
mediastinum.  CTA showed no PE, but large pericardial effusion,
left pleural effusion, and mediastinal adenopathy.  Vitals at
this time were remarkable for HR in the 130s and Tmax of 101.5.
He had a bedside US done at [**Hospital1 **] which showed mild RV
collapse at diastole but no hypotension was noted.  Pulsus
unknown.  At time of transfer to [**Hospital1 18**], his vitals were 113
114.89 20 100% on 2L NC.  At [**Hospital1 18**], his vitals were 96.3 103
127/77 20 97.  Repeat bedside echo showed no echocardiographic
evidence of tamponade physiology.  There was no evidence of RV
diastolic collapse.
.
ROS:  Positive for non-drenching night sweats, recent weight
loss of [**11-9**] lbs, with no unusual bleeding/bruising, chest
pain, palpitations, PND, orthopnea.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Vancomycin

PHYSICAL EXAM: GEN: Sitting up in bed in NAD
Neck: Palpable left occiptal lymph node, no other adenopathy
noted
Lymph: left occiptal lymph node, no other adenopathy noted
Cardiac: tachycardic, nl s1/s2, no distended neck veins noted,
pulsus ~ 20 compared to pulsus ~ 6 noted in ED
Pulm: decreased breath sounds at left lung base
Abd: +BS, nontender, nondistended, no hepatosplenomegaly noted
Ext: no edema noted
Neuro: moving all extremities, alert + oriented X 3

FAMILY HISTORY: No family history of malignancy, bleeding disorders, thyroid
disease, autoimmune disease.

SOCIAL HISTORY: Just prior to current onset of symptoms, reports recent trip to
St. [**Doctor Last Name **] / Antilles, where he did explore a sea cave.  He also
spent some time in [**Location (un) 18317**] prior to the onset of these symptoms.
 No exposure to pets at home.  No unusual work exposures; works
in IT for a pharmaceutical company. No known exposures to TB.
No IV drug use, tobacco use.  Alcohol use 4 drinks / wk.  Lives
with wife and 8 year old child; no sick contacts.  [**Name (NI) **] than
above travel history, no other recent travel.
Other malignant lymphomas, intrathoracic lymph nodes,Cardiac tamponade,Malignant pleural effusion,Pneumonia, organism unspecified,Neutropenia, unspecified,Other specified cardiac dysrhythmias,Fever presenting with conditions classified elsewhere,Other agents affecting blood constituents causing adverse effects in therapeutic use,Other abnormal blood chemistry
Lymphomas NEC thorax,Cardiac tamponade,Malignant pleural effusn,Pneumonia, organism NOS,Neutropenia NOS,Cardiac dysrhythmias NEC,Fever in other diseases,Adv eff blood agent NEC,Abn blood chemistry NEC
Admission Date:  [**2184-6-30**]              Discharge Date:   [**2184-7-17**]

Date of Birth:  [**2138-9-17**]             Sex:   M

Service: MEDICINE

Allergies:
Vancomycin

Attending:[**Last Name (NamePattern1) 4377**]
Chief Complaint:
cough and tachycardia

Major Surgical or Invasive Procedure:
Lymph node biopsy
pleural drain


History of Present Illness:
This is a 45 year old male with no past medical history
presenting with 3 - 4 weeks of cough.  His symptoms began about
a month ago when he noted the onset of a dry, paroxysmal, cough
initially associated with one brief post-tussive syncope.  No
hemoptysis or sputum production.  He also states he feels short
of breath and "can't quite fill up his lungs with air."  Deep
breaths tend to set off cough paroxysms.  He has never
experienced symptoms like these in the past, and denies prior
history of asthma, allergies, or any other lung diseases.  No
history of gastroesophageal reflux.  Associated with cough and
shortness of breath, he notes non-drenching night sweats and a
[**11-9**] lb weight loss.  About 5 days prior to admission, he noted
his shortness of breath got appreciably worse: while walking in
his garden he noted significantly dyspnea. Previously he has had
normal exercise tolerance, able to play tennis, significant
exercise. He saw his primary care doctor for these complaints on
[**6-30**], who noted his heart rate to be in the 130s.  His PCP sent
him to the ED at [**Hospital1 **] for these complaints; he had a CXR
there which showed left pleural effusion and widening of his
mediastinum.  CTA showed no PE, but large pericardial effusion,
left pleural effusion, and mediastinal adenopathy.  Vitals at
this time were remarkable for HR in the 130s and Tmax of 101.5.
He had a bedside US done at [**Hospital1 **] which showed mild RV
collapse at diastole but no hypotension was noted.  Pulsus
unknown.  At time of transfer to [**Hospital1 18**], his vitals were 113
114.89 20 100% on 2L NC.  At [**Hospital1 18**], his vitals were 96.3 103
127/77 20 97.  Repeat bedside echo showed no echocardiographic
evidence of tamponade physiology.  There was no evidence of RV
diastolic collapse.
.
ROS:  Positive for non-drenching night sweats, recent weight
loss of [**11-9**] lbs, with no unusual bleeding/bruising, chest
pain, palpitations, PND, orthopnea.


Past Medical History:
None


Social History:
 Just prior to current onset of symptoms, reports recent trip to
St. [**Doctor Last Name **] / Antilles, where he did explore a sea cave.  He also
spent some time in [**Location (un) 18317**] prior to the onset of these symptoms.
 No exposure to pets at home.  No unusual work exposures; works
in IT for a pharmaceutical company. No known exposures to TB.
No IV drug use, tobacco use.  Alcohol use 4 drinks / wk.  Lives
with wife and 8 year old child; no sick contacts.  [**Name (NI) **] than
above travel history, no other recent travel.


Family History:
No family history of malignancy, bleeding disorders, thyroid
disease, autoimmune disease.

Physical Exam:
GEN: Sitting up in bed in NAD
Neck: Palpable left occiptal lymph node, no other adenopathy
noted
Lymph: left occiptal lymph node, no other adenopathy noted
Cardiac: tachycardic, nl s1/s2, no distended neck veins noted,
pulsus ~ 20 compared to pulsus ~ 6 noted in ED
Pulm: decreased breath sounds at left lung base
Abd: +BS, nontender, nondistended, no hepatosplenomegaly noted
Ext: no edema noted
Neuro: moving all extremities, alert + oriented X 3

Pertinent Results:
Admission labs:
[**2184-7-1**] 02:45AM BLOOD WBC-7.5 RBC-4.77 Hgb-13.5* Hct-41.1
MCV-86 MCH-28.2 MCHC-32.8 RDW-13.0 Plt Ct-362
[**2184-7-1**] 02:45AM BLOOD Neuts-74.4* Lymphs-14.1* Monos-8.2
Eos-2.9 Baso-0.4
[**2184-7-1**] 02:45AM BLOOD PT-14.7* PTT-26.8 INR(PT)-1.3*
[**2184-7-1**] 02:45AM BLOOD Glucose-110* UreaN-10 Creat-0.8 Na-138
K-4.3 Cl-105 HCO3-19* AnGap-18
[**2184-7-1**] 02:45AM BLOOD ALT-81* AST-68* LD(LDH)-791* AlkPhos-89
TotBili-0.5
[**2184-7-1**] 02:45AM BLOOD Calcium-8.7 Phos-3.7 Mg-2.1 UricAcd-5.9
[**2184-7-1**] 02:45AM BLOOD TSH-4.3*
[**2184-7-1**] 11:30AM BLOOD HCG-<5
[**2184-7-1**] 11:30AM BLOOD AFP-2.3
[**2184-7-1**] 02:45AM BLOOD [**Doctor First Name **]-NEGATIVE
[**2184-7-1**] 02:45AM BLOOD HIV Ab-NEGATIVE
[**2184-7-1**] 02:45AM BLOOD BRUCELLA ANTIBODY, IGG, IGM-PND
.
Pericardial fluid:
[**2184-7-1**] 04:30AM OTHER BODY FLUID WBC-3456* Hct,Fl-4.5* Polys-8*
Lymphs-69* Monos-18* Atyps-5*
[**2184-7-1**] 04:30AM OTHER BODY FLUID TotProt-4.4 Glucose-78
LD(LDH)-3000 Amylase-25 Albumin-2.9
.
Micro:
[**2184-7-1**] blood culture: no growth to date
[**2184-7-1**] pericardial fluid: propionobacterium acnes, BPCs.
[**2184-7-1**] EBV and CMV pending
[**2184-7-6**] 05:25PM BLOOD COCCIDIOIDES ANTIBODY,
IMMUNODIFFUSION-Test
[**2184-7-1**] 02:45AM BLOOD BRUCELLA ANTIBODY, IGG, IGM-Test
[**2184-7-6**] 05:00PM BLOOD HCV Ab-NEGATIVE
.
Discharge Labs:
[**2184-7-9**] 9:01 pm PLEURAL FLUID
   GRAM STAIN (Final [**2184-7-9**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
   FLUID CULTURE (Final [**2184-7-12**]):    NO GROWTH.
   ANAEROBIC CULTURE (Final [**2184-7-15**]):    NO GROWTH.
   ACID FAST SMEAR (Final [**2184-7-10**]):
      NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
   ACID FAST CULTURE (Preliminary):    NO MYCOBACTERIA ISOLATED

Brief Hospital Course:
This is a 45 year old male with no significant past medical
history presenting with 3 weeks of dry cough, tachycardia, and
subjective dyspnea who was found to have cardiac tamponade and
primary mediastinal B cell lymphoma.
.
# Pericardial/pleural effusion - Developed in the setting of 3
weeks of indolent symptoms of cough, non-drenching night sweats,
fevers. He was found on lymph node biopsy to have a primary b
cell lymphoma.   Tamponade was noted and patient had drain
placed in the ICU with subsequent removal once tamponade
physiology resolved. Pt was found to have propionum bacterium
acnes infection of pericardial fluid as well as staph
epidermidis and was started on vancomycin while sensitvities
were being awaited from [**Hospital3 **]. Echo prior to discharge
showed resolution of pericardial fluid. he also had large
pleural effusions which were successfully drained with chest
tube removed prior to discharge. It is recommended that a repeat
Echo is conducted within 1 month of discharge.   Patient will
follow up with oncology and I.D as outpatient. Depending on the
p.acnes sensitivities he may be switched by I.D to penicillin
and ceftriaxone. Labs as recommended by I.D will be followed
whilst on antibiotics.
.
Hypodense Liver lesions.He also had hypodense liver lesions that
had been noted on abdominal CT.Liver MRI was limited, and liver
lesions could not be assessed. Repeat imaging may be considered
as an outpatient.
.
# Tachycardia - Likely in setting of underlying effusion,
resulting in reduction in cardiac output with compensatory
tachycardia.  Patient also has increased insensible water loss
due to night sweats. Patient was given several liters of fluid
this admission. Should continue to drink large amounts of fluid
as outpatient.
.
# Cough - Likely secondary to underlying effusion as noted
above. Patient was managed symptomatically with cough
supressants.
.
# Lymphadenopathy: CT shows extensive mediastinal
lymphadenopathy. Patient also had lymph node in his neck and had
excisional biopsy while in the hospital which showed primary
mediastinal B cell lymphoma.
.


Medications on Admission:
None

Discharge Medications:
1. Vancomycin 1,000 mg Recon Soln Sig: 1500 (1500) mg
Intravenous every twelve (12) hours for 4 weeks.
Disp:*84 recon solns* Refills:*0*
2. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed for cough.
Disp:*100 ML(s)* Refills:*0*
3. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day) as needed for cough.
Disp:*90 Capsule(s)* Refills:*0*
4. Clotrimazole 1 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times
a day) as needed for tinea corporis.
Disp:*1 tube* Refills:*2*
5. ZOFRAN ODT 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO every eight (8) hours as needed for nausea.
Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*2*
6. Outpatient Lab Work
Please check  a CBC/diff, BMP, vancomycin trough, ESR and CRP
every Monday and fax results to ([**Telephone/Fax (1) 1353**], attention Dr
[**Last Name (STitle) 724**]
7. Outpatient Lab Work
Please check CBC/diff twice a week and Fax results to Dr
[**Last Name (STitle) **] at [**Telephone/Fax (1) 13345**]
8. Saline Flush 0.9 % Syringe Sig: [**6-7**] ml flush Injection as
needed : with administration of medications .
Disp:*84 doses * Refills:*1*
9. Heparin Flush 10 unit/mL Kit Sig: Five (5) ml flush
Intravenous as needed : with administration of medications.
Disp:*84 doses * Refills:*1*


Discharge Disposition:
Home With Service

Facility:
Critical Care Systems

Discharge Diagnosis:
Primary Diagnosis:

Primary Mediastinal B cell lymphoma.


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital with tachycardia and cough.
You had fluid that had built up around your heart (pericardial
fluid) that was drained. This fluid was found to be infected and
you were started on antibiotics. CT showed several lymph nodes
as well as pleural and pericardial fluids in your chest and a
biopsy was performed. You were found to have a primary
mediastinal lymphoma and you were treated with chemotherapy and
you improved.
.
The following changes were made to your medications:
We added clotrimazole topical cream.
We added guafenesin as needed for cough
We added benzonatate as needed for cough
We added zofran as needed for nausea.
.
You were started on vancomycin. The infectious diseases doctors
[**Name5 (PTitle) **] contact [**Name5 (PTitle) **] if there needs to be a change made in your
antibiotics.
.
You will need to have another echo to determine if there is any
fluid reaccumulating around your heart. You will be called by
our radiology department with the date and time of your
appointment.


Followup Instructions:
Provider: [**Name Initial (NameIs) 455**] 2-HEM ONC 7F HEMATOLOGY/ONCOLOGY-7F
Date/Time:[**2184-7-23**] 9:00
[**Location (un) 830**], [**Hospital1 69**] [**Hospital Ward Name 5074**]
Tel [**Telephone/Fax (1) 62736**].
.
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 724**]:
Infectious Disease Clinic
[**Last Name (NamePattern1) 439**].
Tel:([**Telephone/Fax (1) 17490**]
You will be contact[**Name (NI) **] with the date and time of your appointment
which will be in the last week of [**Month (only) **]. If you do not hear from
the Clinic by Wednesday next week, please call to determine the
date of your appointment.
.
Echo Suite
Radiology Department
[**Hospital Unit Name 1825**], [**Location (un) **]
[**Location (un) 830**]
[**Hospital1 69**]
Tel [**Telephone/Fax (1) 62**]
You will be called by our radiology department with the date and
time of your appointment. If you do not hear from them on Monday
next week, please call the number above to determine the date
and time of your study.
{'Other malignant lymphomas, intrathoracic lymph nodes,Cardiac tamponade,Malignant pleural effusion,Pneumonia, organism unspecified,Neutropenia, unspecified,Other specified cardiac dysrhythmias,Fever presenting with conditions classified elsewhere,Other agents affecting blood constituents causing adverse effects in therapeutic use,Other abnormal blood chemistry'}


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: cough and tachycardia

PRESENT ILLNESS: This is a 45 year old male with no past medical history
presenting with 3 - 4 weeks of cough.  His symptoms began about
a month ago when he noted the onset of a dry, paroxysmal, cough
initially associated with one brief post-tussive syncope.  No
hemoptysis or sputum production.  He also states he feels short
of breath and "can't quite fill up his lungs with air."  Deep
breaths tend to set off cough paroxysms.  He has never
experienced symptoms like these in the past, and denies prior
history of asthma, allergies, or any other lung diseases.  No
history of gastroesophageal reflux.  Associated with cough and
shortness of breath, he notes non-drenching night sweats and a
[**11-9**] lb weight loss.  About 5 days prior to admission, he noted
his shortness of breath got appreciably worse: while walking in
his garden he noted significantly dyspnea. Previously he has had
normal exercise tolerance, able to play tennis, significant
exercise. He saw his primary care doctor for these complaints on
[**6-30**], who noted his heart rate to be in the 130s.  His PCP sent
him to the ED at [**Hospital1 **] for these complaints; he had a CXR
there which showed left pleural effusion and widening of his
mediastinum.  CTA showed no PE, but large pericardial effusion,
left pleural effusion, and mediastinal adenopathy.  Vitals at
this time were remarkable for HR in the 130s and Tmax of 101.5.
He had a bedside US done at [**Hospital1 **] which showed mild RV
collapse at diastole but no hypotension was noted.  Pulsus
unknown.  At time of transfer to [**Hospital1 18**], his vitals were 113
114.89 20 100% on 2L NC.  At [**Hospital1 18**], his vitals were 96.3 103
127/77 20 97.  Repeat bedside echo showed no echocardiographic
evidence of tamponade physiology.  There was no evidence of RV
diastolic collapse.
.
ROS:  Positive for non-drenching night sweats, recent weight
loss of [**11-9**] lbs, with no unusual bleeding/bruising, chest
pain, palpitations, PND, orthopnea.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Vancomycin

PHYSICAL EXAM: GEN: Sitting up in bed in NAD
Neck: Palpable left occiptal lymph node, no other adenopathy
noted
Lymph: left occiptal lymph node, no other adenopathy noted
Cardiac: tachycardic, nl s1/s2, no distended neck veins noted,
pulsus ~ 20 compared to pulsus ~ 6 noted in ED
Pulm: decreased breath sounds at left lung base
Abd: +BS, nontender, nondistended, no hepatosplenomegaly noted
Ext: no edema noted
Neuro: moving all extremities, alert + oriented X 3

FAMILY HISTORY: No family history of malignancy, bleeding disorders, thyroid
disease, autoimmune disease.

SOCIAL HISTORY: Just prior to current onset of symptoms, reports recent trip to
St. [**Doctor Last Name **] / Antilles, where he did explore a sea cave.  He also
spent some time in [**Location (un) 18317**] prior to the onset of these symptoms.
 No exposure to pets at home.  No unusual work exposures; works
in IT for a pharmaceutical company. No known exposures to TB.
No IV drug use, tobacco use.  Alcohol use 4 drinks / wk.  Lives
with wife and 8 year old child; no sick contacts.  [**Name (NI) **] than
above travel history, no other recent travel. 

### Response:
{'Other malignant lymphomas, intrathoracic lymph nodes,Cardiac tamponade,Malignant pleural effusion,Pneumonia, organism unspecified,Neutropenia, unspecified,Other specified cardiac dysrhythmias,Fever presenting with conditions classified elsewhere,Other agents affecting blood constituents causing adverse effects in therapeutic use,Other abnormal blood chemistry'}
