CHIEF COMPLAINT: FDG avid right upper lobe cavitary lung nodule.

PRESENT ILLNESS: 83 y.o. Italian speaking male being followed for a 3.5 cm RUL
cavitary nodule, suspcious for TB or cavitary tumor, returns for
eval. He preferred observation rather than biopsy at his last
visit. Currently, the pt reports only occas dry cough and some
shortness of breath after climbing two flights of stairs, which
does not require him to sit down. RUL transbronchial biopsy done
in [**2102-7-31**] was negative for malignancy. Currently the
patient has had a repeat CT scan which demonstrated FDG avidity
in the region of the lung nodule and some uptake in T11. He does
come today with an X-ray report of the thoracic and lumbar spine
which demonstrated no abnormality in that region.
.
ROS: otherwise negative

MEDICAL HISTORY: COPD
Hypertension
Inguinal hernia
Renal insufficiency
BPH

MEDICATION ON ADMISSION: pravastatin 40'
symbicort 2 puffs [**Hospital1 **]
losartan 100'
hctz 25'
latanoprost eye gtts 1 ou hs
diltiazem 300'
alendronate 70 mg wk
spiriva 1 inh daily
albut HRA prn
miralax
vit D
multivit
asa 81'
calcium w/ D

ALLERGIES: lisinopril / Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: ON ADMISSION:
------------
BP: 134/60. Heart Rate: 75. Temperature: 96.7. Resp. Rate: 12.
Pain 0. O2 Saturation%: 87% RA.
Gen: AOx3 NAD
Cor: RRR without MRG
Res: Nl WOB, CTAB
Abd: Soft, nt/nd without organomegaly
Ext: w/w/p, no c/c/e, moves all
.
ON DISCHARGE:
-------------
BP: 150/80. Heart Rate: 82. Temperature: 98.0. Resp. Rate: 18.
Pain 0. O2 Saturation%: 87-92% on 2-4L NC.
Gen: AOx3 NAD
Cor: RRR without MRG
Res: Nl WOB, decreased BS on right, expiratory wheezes b/l
Abd: Soft, nt/nd without organomegaly
Ext: w/w/p, no c/c/e, moves all

FAMILY HISTORY: Mother- colon CA, rheumatic heart disease
Father- CVA, HTN
Siblings- one sister w/ lymphoma still alive, HTN

SOCIAL HISTORY: Cigarettes: quit: 17 yrs ago, 40 pk yr hx
ETOH: [x ] Yes  drinks/day: 1 cogniac/day
Drugs: none
Exposure:  [ x] No
Occupation: retired welder
Marital Status: [x ] Married
Lives: [x] w/ wife & 2 girls
Travel history: From [**Country 2559**], last travel a year ago to [**Country 2559**]. USA
x 45 years
Other diseases of lung, not elsewhere classified,Foreign body in main bronchus,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Iatrogenic pneumothorax,Unspecified pleural effusion,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Other lung disease NEC,Foreign body bronchus,Chr airway obstruct NEC,Pneumonia, organism NOS,Iatrogenic pneumothorax,Pleural effusion NOS,Resp obstr-inhal obj NEC,Hypertension NOS,Renal & ureteral dis NOS,BPH w/o urinary obs/LUTS,History of tobacco use,Abn reac-organ rem NEC
Admission Date:  [**2103-3-21**]              Discharge Date:   [**2103-4-4**]

Date of Birth:  [**2020-1-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
lisinopril / Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
FDG avid right upper lobe cavitary lung nodule.


Major Surgical or Invasive Procedure:
[**2103-3-31**] bronchoscopy with interventional pulmonology
[**2103-3-30**] IR drainage of right pleural effusion
[**2103-3-29**] bronchoscopy with interventional pulmonology
[**2103-3-26**] bronchoscopy with interventional pulmonology
[**2103-3-25**] bronchoscopy with mucus plug removal
[**2103-3-23**] bronchoscopy with interventional pulmonology
[**2103-3-21**] VATS right upper lung lobe


History of Present Illness:
83 y.o. Italian speaking male being followed for a 3.5 cm RUL
cavitary nodule, suspcious for TB or cavitary tumor, returns for
eval. He preferred observation rather than biopsy at his last
visit. Currently, the pt reports only occas dry cough and some
shortness of breath after climbing two flights of stairs, which
does not require him to sit down. RUL transbronchial biopsy done
in [**2102-7-31**] was negative for malignancy. Currently the
patient has had a repeat CT scan which demonstrated FDG avidity
in the region of the lung nodule and some uptake in T11. He does
come today with an X-ray report of the thoracic and lumbar spine
which demonstrated no abnormality in that region.
.
ROS: otherwise negative

Past Medical History:
COPD
Hypertension
Inguinal hernia
Renal insufficiency
BPH

Social History:
Cigarettes: quit: 17 yrs ago, 40 pk yr hx
ETOH: [x ] Yes  drinks/day: 1 cogniac/day
Drugs: none
Exposure:  [ x] No
Occupation: retired welder
Marital Status: [x ] Married
Lives: [x] w/ wife & 2 girls
Travel history: From [**Country 2559**], last travel a year ago to [**Country 2559**]. USA
x 45 years

Family History:
Mother- colon CA, rheumatic heart disease
Father- CVA, HTN
Siblings- one sister w/ lymphoma still alive, HTN


Physical Exam:
ON ADMISSION:
------------
BP: 134/60. Heart Rate: 75. Temperature: 96.7. Resp. Rate: 12.
Pain 0. O2 Saturation%: 87% RA.
Gen: AOx3 NAD
Cor: RRR without MRG
Res: Nl WOB, CTAB
Abd: Soft, nt/nd without organomegaly
Ext: w/w/p, no c/c/e, moves all
.
ON DISCHARGE:
-------------
BP: 150/80. Heart Rate: 82. Temperature: 98.0. Resp. Rate: 18.
Pain 0. O2 Saturation%: 87-92% on 2-4L NC.
Gen: AOx3 NAD
Cor: RRR without MRG
Res: Nl WOB, decreased BS on right, expiratory wheezes b/l
Abd: Soft, nt/nd without organomegaly
Ext: w/w/p, no c/c/e, moves all

Pertinent Results:
LABS ON ADMISSION:
------------------
[**2103-3-22**] 07:10AM BLOOD WBC-10.3 RBC-3.63* Hgb-11.6* Hct-35.8*
MCV-99* MCH-31.9 MCHC-32.3 RDW-13.3 Plt Ct-308
[**2103-3-21**] 07:07PM BLOOD Glucose-166* UreaN-31* Creat-1.4* Na-139
K-4.0 Cl-105 HCO3-25 AnGap-13
[**2103-3-21**] 07:07PM BLOOD Calcium-9.3 Phos-4.0 Mg-2.2
[**2103-3-21**] 02:52PM -ART pO2-195* pCO2-34* pH-7.41 calTCO2-22 Base
XS--1
[**2103-3-21**] 02:52PM BLOOD Glucose-97 Lactate-0.9 Na-138 K-2.5*
Cl-114*
[**2103-3-21**] 02:52PM BLOOD Hgb-8.8* calcHCT-26
[**2103-3-21**] 02:52PM BLOOD freeCa-1.00*
.
LABS ON DISCHARGE:
------------------
[**2103-4-4**] 06:55AM BLOOD WBC-12.3* RBC-3.43* Hgb-10.7* Hct-33.8*
MCV-99* MCH-31.1 MCHC-31.6 RDW-13.6 Plt Ct-588*
[**2103-4-4**] 06:55AM Glu-107 BUN-21 Cr-1.1 Na-137 K-4.3 Cl-100
HCO3-27 AG-14
[**2103-4-4**] 06:55AM BLOOD Calcium-9.5 Phos-3.6 Mg-2.1
.
IMAGING & STUDIES:
------------------
[**2103-3-21**] CXR:
There is right chest tube in place. Opacities in the right
perihilar region and right mid lung are postoperative findings.
Cardiomegaly is stable. There is no large pneumothorax or
pleural effusions. There is right subcutaneous emphysema.
.
[**2103-3-24**] CT CHEST NON-CONTRAST:
IMPRESSION:
1. Status post right upper lobectomy, with a small air-fluid
level seen in the resection bed. No evidence of hemorrhage. A
small loculated pneumothorax and small simple effusion in the
right basal pleural space.
2. Partial aeration of the superior segment of the right lower
lobe, with
near complete collapse of the right middle and lower lobes.
Large amount of secretions obstructing the right main and
bronchus intermedius.
3. Large amount of right chest wall emphysema relates to the
recent
procedure.
.
[**2103-3-30**] CT CHEST NON-CONTRAST:
IMPRESSION:
1. Enlarged large right hydrothorax at the right upper lobectomy
bed.
2. Interval complete collapse of the right middle and lower
lobes, with
slightly increased rightward mediastinal shift.
3. Unchanged right lower 4.8 x 4.3 cm extrapulmonary gas-fluid
collection.
4. Large amount of secretions within the bronchus intermedius
and distal
branches.
5. Clear left lung.
.
[**2103-3-30**] BRONCHIAL WASHINGS: PLEURAL FLUID.
GRAM STAIN (Final [**2103-3-30**]):
NO POLYMORPHONUCLEAR LEUKOCYTES SEEN.
NO MICROORGANISMS SEEN.
FLUID CULTURE (Final [**2103-4-2**]):    NO GROWTH.
ANAEROBIC CULTURE (Preliminary):    NO GROWTH.
.
[**2103-4-4**] CXR:
FINDINGS: As compared to the previous radiograph, the right
pigtail catheter has been removed. The extrathoracic air
collection with multiple air-fluid levels is unchanged in size
and appearance. The extent of the right pleural effusion has
minimally increased. As a consequence, the amount of ventilated
lung parenchyma at the lung base has decreased. Unchanged
appearance of the left lung.

Brief Hospital Course:
Mr. [**Known lastname 88903**] is an 83yM who initially presented to the thoracic
surgery clinic in [**2101**] for an incidentally discovered RUL mass
on routine preoperative CXR.  He underwent PET scanning as well
as EBUS which were negative for malignancy.  He was followed
with surveillance CT scans as he desired conservative management
as opposed to VATS biopsy.  The nodule continued to grow on f/u
CT scan [**1-/2103**] and recommendation was made for resection.

He was admitted to [**Hospital1 18**] [**2103-3-21**] at which time he underwent VATS
right upper lobectomy with mediastinal lymphadenectomy.  He was
admitted to the surgical floor postoperatively.  He did well on
POD1 with good pain control and oxygen requirement of 2-4L by
nasal cannula.  On POD2, his chest xray demonstrated progressive
collapse as well as a sizeable pneumothorax.  He underwent
placement of an anterior pigtail for evacuation of the
pneumothorax and was taken to the OR on [**3-23**] for bronchoscopy
for evacuation of mucous plug likely causing lung collapse.

He was admitted to the ICU for aggressive pulmonary toilet and
continued observation.  On [**3-25**], his CXR demonstrated continued
atalectasis and he returned to the OR for a repeat therapeutic
bronchoscopy.

He remained in the ICU receiving 3% normal saline nebulizers as
well as Acapella valve therapy and night-time BiPAP as
tolerated.  His CXRs continued to demonstrated atalectasis with
nearly complete right sided collapse and Interventional
Pulmonology performed two further bedside bronchoscopies for
pulmonary toilet on [**3-27**] and 3.29.  A CT chest was obtained [**3-29**]
and demonstrated an apical pleural effusion which was drained
with a pigtail by Interventional pulmonology.  His last
bronchoscopy was [**3-30**] with IP and resulted in significant
improvement in his CXR with greater aeration.  He was
transferred from the ICU to the surgical floor and began working
with physical therapy.  On his first session, he was noted to
desaturate with ambulation to 75% while on 2L NC.  He continued
to work with physical therapy and his ambulatory saturations
improved.  His pigtail drainage decreased significantly and was
insignificant on [**2103-4-3**] at which time it was removed.  Physical
therapy recommended that he be discharged home with home PT and
home oxygen.

On [**4-3**], his pain was well controlled, he was tolerating a
regular diet and his CXR following pigtail removal was stable.
He was deemed to be stable for discharge with PT recommendations
in place.


Medications on Admission:
pravastatin 40'
symbicort 2 puffs [**Hospital1 **]
losartan 100'
hctz 25'
latanoprost eye gtts 1 ou hs
diltiazem 300'
alendronate 70 mg wk
spiriva 1 inh daily
albut HRA prn
miralax
vit D
multivit
asa 81'
calcium w/ D

Discharge Medications:
1. nasal cannula oxygen
Patient requires supplemental nasal cannula oxygen at home.
2. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
4. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
5. diltiazem HCl 300 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily).
6. guaifenesin 600 mg Tablet Extended Release Sig: Two (2)
Tablet Extended Release PO Q12H (every 12 hours) as needed for
cough/congestion.
Disp:*60 Tablet Extended Release(s)* Refills:*0*
7. tramadol 50 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
8. Symbicort 80-4.5 mcg/actuation HFA Aerosol Inhaler Sig: Two
(2) puffs Inhalation twice a day.
9. latanoprost 0.005 % Drops Sig: One (1) drop Ophthalmic at
bedtime: 1 drop to each eye once daily.
10. alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week.

11. Spiriva with HandiHaler 18 mcg Capsule, w/Inhalation Device
Sig: One (1) inhalation Inhalation once a day.
12. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
Two (2) puffs Inhalation every four (4) hours as needed for
shortness of breath or wheezing.
13. polyethylene glycol 3350 17 gram Powder in Packet Sig: One
(1) packet PO once a day.
14. Vitamin D3 1,000 unit Tablet Sig: One (1) Tablet PO once a
day: Take as prior to admission.
15. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
16. aspirin, buffered 81 mg Tablet Sig: One (1) Tablet PO once a
day.
17. Calcium 500 + D (D3) 500-125 mg-unit Tablet Sig: One (1)
Tablet PO twice a day: Take as prior to admission.


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
FDG avid right upper lobe cavitary lung nodule.


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity: ambulatory w/ assistance or aid (walker or cane).


Discharge Instructions:
Dear Mr. [**Known lastname 88903**],
* You were admitted to the hospital for lung surgery, and you've
recovered well. You are now ready for discharge to home.
* Continue to use incentive spirometer 10 times an hour during
day.
* Check your incisions daily and report any increased redness or
drainage. Cover the area with a gauze pad if it is draining.
* Your chest tube dressing may be removed 48 hours after
discharge from the hospital. If it starts to drain, cover the
site with a clean dry dressing and change it as needed to keep
clean and dry.
* You will likely continue to need pain medication once you are
home, but you can wean off of the Tramadol over a few weeks as
the discomfort resolves. You may begin to take only Tylenol or
ibuprofen for pain whenever you feel that this is reasonable
instead of the Tramadol. Make sure that you have regular bowel
movements while on pain medications as they are constipating
which can cause more medical problems. Use an over the counter
stool softener or gentle laxative to stay regular.
* No driving while taking narcotic pain medication (Tramadol).
* Tylenol 650 mg (as mentioned above) is OK to take every 6
hours in between your Tramadol doses, but do not take more than
4000mg in 24 hours.
* Continue to stay well hydrated and eat well to heal.
* Shower daily. Wash incision with mild soap & water, rinse, &
dry.
* No tub bathing, swimming, or hot tubs until OK given by Dr. [**Last Name (STitle) **].
* No lotions or creams to incision site.
* Walk 4-5 times a day and increase activity as you can
tolerate.
.
Call Dr.[**Name (NI) 2347**] office @ [**Telephone/Fax (1) 3020**] if you experience:
-Fevers > 101 or chills
-Shortness of breath, chest pain, or other concerning symptoms.

Followup Instructions:
Please call Dr.[**Name (NI) 88904**] office at [**Telephone/Fax (1) 3020**] to schedule
a follow-up appointment within 1-2 weeks of discharge from the
hospital.
.
Tentative appt: [**2103-4-17**]



Completed by:[**2103-4-6**]
{'Other diseases of lung, not elsewhere classified,Foreign body in main bronchus,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Iatrogenic pneumothorax,Unspecified pleural effusion,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: FDG avid right upper lobe cavitary lung nodule.

PRESENT ILLNESS: 83 y.o. Italian speaking male being followed for a 3.5 cm RUL
cavitary nodule, suspcious for TB or cavitary tumor, returns for
eval. He preferred observation rather than biopsy at his last
visit. Currently, the pt reports only occas dry cough and some
shortness of breath after climbing two flights of stairs, which
does not require him to sit down. RUL transbronchial biopsy done
in [**2102-7-31**] was negative for malignancy. Currently the
patient has had a repeat CT scan which demonstrated FDG avidity
in the region of the lung nodule and some uptake in T11. He does
come today with an X-ray report of the thoracic and lumbar spine
which demonstrated no abnormality in that region.
.
ROS: otherwise negative

MEDICAL HISTORY: COPD
Hypertension
Inguinal hernia
Renal insufficiency
BPH

MEDICATION ON ADMISSION: pravastatin 40'
symbicort 2 puffs [**Hospital1 **]
losartan 100'
hctz 25'
latanoprost eye gtts 1 ou hs
diltiazem 300'
alendronate 70 mg wk
spiriva 1 inh daily
albut HRA prn
miralax
vit D
multivit
asa 81'
calcium w/ D

ALLERGIES: lisinopril / Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: ON ADMISSION:
------------
BP: 134/60. Heart Rate: 75. Temperature: 96.7. Resp. Rate: 12.
Pain 0. O2 Saturation%: 87% RA.
Gen: AOx3 NAD
Cor: RRR without MRG
Res: Nl WOB, CTAB
Abd: Soft, nt/nd without organomegaly
Ext: w/w/p, no c/c/e, moves all
.
ON DISCHARGE:
-------------
BP: 150/80. Heart Rate: 82. Temperature: 98.0. Resp. Rate: 18.
Pain 0. O2 Saturation%: 87-92% on 2-4L NC.
Gen: AOx3 NAD
Cor: RRR without MRG
Res: Nl WOB, decreased BS on right, expiratory wheezes b/l
Abd: Soft, nt/nd without organomegaly
Ext: w/w/p, no c/c/e, moves all

FAMILY HISTORY: Mother- colon CA, rheumatic heart disease
Father- CVA, HTN
Siblings- one sister w/ lymphoma still alive, HTN

SOCIAL HISTORY: Cigarettes: quit: 17 yrs ago, 40 pk yr hx
ETOH: [x ] Yes  drinks/day: 1 cogniac/day
Drugs: none
Exposure:  [ x] No
Occupation: retired welder
Marital Status: [x ] Married
Lives: [x] w/ wife & 2 girls
Travel history: From [**Country 2559**], last travel a year ago to [**Country 2559**]. USA
x 45 years 

### Response:
{'Other diseases of lung, not elsewhere classified,Foreign body in main bronchus,Chronic airway obstruction, not elsewhere classified,Pneumonia, organism unspecified,Iatrogenic pneumothorax,Unspecified pleural effusion,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Unspecified essential hypertension,Unspecified disorder of kidney and ureter,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
