CHIEF COMPLAINT: Bladder tumor

PRESENT ILLNESS: 83yoM hx htn, dm, chf, presented for anesthesia assisted,
urological transurethreal resection of presumed bladder cancer,
admitted to [**Hospital Unit Name 153**] for post-procedure monitoring given significant
[**Hospital Unit Name 1106**] disease.
Over previous 2 months, pt has had hematuria, in addition to
multiple UTIs, without resolution with abx. Dr. [**Last Name (STitle) 9125**] from
urology performed outpt cystoscopy, showing bladder tumors, c/w
bladder CA; was scheduled for transurethral bx and removal of
tumors with anesthesia assitance, given past hx of [**Last Name (STitle) 1106**] cva.

MEDICAL HISTORY: PMH:
CRI, baseline 2.5-3.5
NIDDM
[**11/2139**] AMI
PVD: s/p RLE bypass [**7-/2143**], [**5-/2148**] left Fem [**Doctor Last Name **] bypass, [**2-4**]
angioplasty of left Fem-AT bypass stenosis
Hyperlipidemia
Gallstones s/p [**2156-1-2**] ERCP w/ CBD [**Month/Day/Year **] placement needs
[**Month/Day/Year 100581**]
AAA (3cm stable sine [**2145**])
Elevated Alk Phos
[**9-/2147**] embolic CVA, seven CVA's since most recently in [**10-8**].
Afib/flutter s/p Ablation [**11-6**], EPS [**11-8**]
Syncope
HTN
renal arteries no stenosis by cath [**2154-5-17**]
[**5-9**] s/p TTE w/ EF to be newly depressed at 30-35% with left
ventricular hypertrophy and [**12-8**]+MR. [**Name14 (STitle) **] w/ reversible defect

MEDICATION ON ADMISSION: Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.1, 57, 142/51, 13, 100%RA
PHYSICAL EXAM
GENERAL: Pleasant, well appearing male in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP=flat
LUNGS: mild exp wheezes
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact.
PSYCH: Listens and responds to questions appropriately, pleasant

FAMILY HISTORY: NC

SOCIAL HISTORY: Married for 53 years with three sons. They have assistance  with
cleaning and cooking at home through elderly affairs assistance.
His son manages all their bills and mail and lives upstairs.
Wife is legally blind and is a care taker for Mr. [**Known lastname 100582**]. The
patient walks unassisted now. He is very hard of hearing. +80
ppy history, quit [**2145**]. No EtOH or illicits.
Malignant neoplasm of lateral wall of urinary bladder,Chronic systolic heart failure,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Abdominal aneurysm without mention of rupture,Long-term (current) use of anticoagulants
Mal neo bladder-lateral,Chr systolic hrt failure,Old myocardial infarct,Crnry athrscl natve vssl,Periph vascular dis NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Atrial fibrillation,Hypothyroidism NOS,Obstructive sleep apnea,Abdom aortic aneurysm,Long-term use anticoagul
Admission Date:  [**2159-2-8**]              Discharge Date:   [**2159-2-10**]

Date of Birth:  [**2075-5-3**]             Sex:   M

Service: UROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name8 (NamePattern2) 19908**]
Chief Complaint:
Bladder tumor

Major Surgical or Invasive Procedure:
Cystoscopy, TURBT [**2159-2-8**] - Dr. [**Last Name (STitle) 9125**]


History of Present Illness:
83yoM hx htn, dm, chf, presented for anesthesia assisted,
urological transurethreal resection of presumed bladder cancer,
admitted to [**Hospital Unit Name 153**] for post-procedure monitoring given significant
[**Hospital Unit Name 1106**] disease.
Over previous 2 months, pt has had hematuria, in addition to
multiple UTIs, without resolution with abx. Dr. [**Last Name (STitle) 9125**] from
urology performed outpt cystoscopy, showing bladder tumors, c/w
bladder CA; was scheduled for transurethral bx and removal of
tumors with anesthesia assitance, given past hx of [**Last Name (STitle) 1106**] cva.

On day of admit to [**Hospital1 18**], pt underwent transurethral resection
of tumour, 45min procedure, stable hemodynamics throughout
procedure. SBP prior to procedure 180, kept on peripheral
phenylephrine throughout procedure to maintain MAPs (unclear if
BPs dropped throughout procedure). Patient was transferred to
PACU with pressor off and stable hemodynamics then transferred
to [**Hospital Unit Name 153**] in stable condition.


Past Medical History:
PMH:
CRI, baseline 2.5-3.5
NIDDM
[**11/2139**] AMI
PVD: s/p RLE bypass [**7-/2143**], [**5-/2148**] left Fem [**Doctor Last Name **] bypass, [**2-4**]
angioplasty of left Fem-AT bypass stenosis
Hyperlipidemia
Gallstones s/p [**2156-1-2**] ERCP w/ CBD [**Month/Day/Year **] placement needs
[**Month/Day/Year 100581**]
AAA (3cm stable sine [**2145**])
Elevated Alk Phos
[**9-/2147**] embolic CVA, seven CVA's since most recently in [**10-8**].
Afib/flutter s/p Ablation [**11-6**], EPS [**11-8**]
Syncope
HTN
renal arteries no stenosis by cath [**2154-5-17**]
[**5-9**] s/p TTE w/ EF to be newly depressed at 30-35% with left
ventricular hypertrophy and [**12-8**]+MR. [**Name14 (STitle) **] w/ reversible defect

PSH:
[**2142**] R Fem [**Doctor Last Name **] in situ
[**2147**] L Fem [**Doctor Last Name **] in situ
[**2150**] vein angioplasty L Fem artery


Social History:
Married for 53 years with three sons. They have assistance  with
cleaning and cooking at home through elderly affairs assistance.
His son manages all their bills and mail and lives upstairs.
Wife is legally blind and is a care taker for Mr. [**Known lastname 100582**]. The
patient walks unassisted now. He is very hard of hearing. +80
ppy history, quit [**2145**]. No EtOH or illicits.


Family History:
NC

Physical Exam:
97.1, 57, 142/51, 13, 100%RA
PHYSICAL EXAM
GENERAL: Pleasant, well appearing male in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP=flat
LUNGS: mild exp wheezes
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact.
PSYCH: Listens and responds to questions appropriately, pleasant



Brief Hospital Course:
83yoM hx htn, dm, chf, presented for anesthesia assisted,
urological transurethreal resection of presumed bladder cancer,
admitted to [**Hospital Unit Name 153**] for post-procedure monitoring given significant
[**Hospital Unit Name 1106**] disease. In [**Hospital Unit Name 153**], he was found to possibly have OSA,
monitored on continous O2 and telemetry, no events. He was
transferred out of ICU POD1. Urine clear off CBI POD2 and foley
removed. He passed voiding trial and discharged home in stable
condition. He will follow-up with Dr. [**Last Name (STitle) **] of sleep clinic
for OSA work-up, per ICU team and respiratory.

Medications on Admission:
Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).


Discharge Medications:
1. Pyridium 100 mg Tablet Sig: One (1) Tablet PO twice a day for
3 days.
Disp:*6 Tablet(s)* Refills:*0*
2. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
7. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
9. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*0 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Bladder tumor


Discharge Condition:
Stable


Discharge Instructions:
--Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet

--The operation you have experienced is a "scraping" operation;
that is to say, the bladder tumor or biopsy sample was "scraped"
off the bladder wall. Bleeding was controlled with
electrocautery which will produce a "scab" in the inside bladder
wall. About 1-2 weeks after the operation, pieces of the scab
will fall off and come out with the urine. As this occurs,
bleeding may be noted which is normal. You should not worry
about this. Simply lie down and increase your fluid intake for a
few hours. In most cases, the urine will clear. Because of this
tendency for bleeding, aspirin (or Advil) must be avoided for 2
weeks following your operation (Tylenol is okay). If bleeding
occurs or persists for more than 12 hours or if clots appear
impairing your stream, call your urologist.

If you develop a fever over 101??????, or have chills, call your
urologist. Although not common, this may indicate infection that
has developed beyond the control of the antibiotics that you
have taken.

It will take 6 weeks from the date of surgery to fully recover
from your operation. This can be divided into two parts -- the
first 2 weeks and the last 4 weeks. During the first 2 weeks
from the date of your surgery, it is important to be "a person
of leisure". You should avoid lifting and straining, which also
means that you should avoid constipation. This can be done by
any of 3 ways: 1) modify your diet, 2) use stool softeners which
have been prescribed for you, and 3) use gentle laxatives such
as Milk of Magnesia which can be purchased at your local drug
store. It is important for you to avoid prolonged sitting. You
should avoid sexual activity during this time. Also, avoid
driving. The danger is not so much the driving, but it may delay
you from urinating if you have the urge; and, "holding" urine
may cause bleeding. If you return to work before 2 weeks, you
may feel fatigued and require a decreased work load.

During the second 4 week period of your recovery, you may begin
regular activity, but only on a graduated basis. For example,
you may feel well enough to return to work, but you may find it
easier to begin on a half-day basis. It is common to become
quite tired in the afternoon, and if such occurs, it is best to
take a nap! Also, you may begin to drive as well as lift objects
such as a briefcase, etc. If you are a golfer, you may begin to
swing a golf club at this time. Sexual activity may be resumed
during this time, but only on a limited basis. In general, your
overall activity may be escalated to normal as you progress
through this second time period, such that by 6-8 weeks
following the date of surgery, you should be back to normal
activity. If you take aspirin as a regular medication, it may be
resumed at this time.

Finally, call your urologist in one week after your surgery for
the results of your biopsy and your next appointment

Followup Instructions:
Please call Dr. [**Last Name (STitle) 9125**] for a f/u appointment.
Call [**Telephone/Fax (1) 55570**] Sleep Medicine for work-up of sleep apnea, Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].
{'Malignant neoplasm of lateral wall of urinary bladder,Chronic systolic heart failure,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Abdominal aneurysm without mention of rupture,Long-term (current) use of anticoagulants'}


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: Bladder tumor

PRESENT ILLNESS: 83yoM hx htn, dm, chf, presented for anesthesia assisted,
urological transurethreal resection of presumed bladder cancer,
admitted to [**Hospital Unit Name 153**] for post-procedure monitoring given significant
[**Hospital Unit Name 1106**] disease.
Over previous 2 months, pt has had hematuria, in addition to
multiple UTIs, without resolution with abx. Dr. [**Last Name (STitle) 9125**] from
urology performed outpt cystoscopy, showing bladder tumors, c/w
bladder CA; was scheduled for transurethral bx and removal of
tumors with anesthesia assitance, given past hx of [**Last Name (STitle) 1106**] cva.

MEDICAL HISTORY: PMH:
CRI, baseline 2.5-3.5
NIDDM
[**11/2139**] AMI
PVD: s/p RLE bypass [**7-/2143**], [**5-/2148**] left Fem [**Doctor Last Name **] bypass, [**2-4**]
angioplasty of left Fem-AT bypass stenosis
Hyperlipidemia
Gallstones s/p [**2156-1-2**] ERCP w/ CBD [**Month/Day/Year **] placement needs
[**Month/Day/Year 100581**]
AAA (3cm stable sine [**2145**])
Elevated Alk Phos
[**9-/2147**] embolic CVA, seven CVA's since most recently in [**10-8**].
Afib/flutter s/p Ablation [**11-6**], EPS [**11-8**]
Syncope
HTN
renal arteries no stenosis by cath [**2154-5-17**]
[**5-9**] s/p TTE w/ EF to be newly depressed at 30-35% with left
ventricular hypertrophy and [**12-8**]+MR. [**Name14 (STitle) **] w/ reversible defect

MEDICATION ON ADMISSION: Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.1, 57, 142/51, 13, 100%RA
PHYSICAL EXAM
GENERAL: Pleasant, well appearing male in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. JVP=flat
LUNGS: mild exp wheezes
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.
NEURO: A&Ox3. Appropriate. CN 2-12 grossly intact.
PSYCH: Listens and responds to questions appropriately, pleasant

FAMILY HISTORY: NC

SOCIAL HISTORY: Married for 53 years with three sons. They have assistance  with
cleaning and cooking at home through elderly affairs assistance.
His son manages all their bills and mail and lives upstairs.
Wife is legally blind and is a care taker for Mr. [**Known lastname 100582**]. The
patient walks unassisted now. He is very hard of hearing. +80
ppy history, quit [**2145**]. No EtOH or illicits. 

### Response:
{'Malignant neoplasm of lateral wall of urinary bladder,Chronic systolic heart failure,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Atrial fibrillation,Unspecified acquired hypothyroidism,Obstructive sleep apnea (adult)(pediatric),Abdominal aneurysm without mention of rupture,Long-term (current) use of anticoagulants'}
