CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: Mr. [**Known lastname **] is a 73 year old man with history of laryngeal
cancer s/p external beam radiation, COPD, and diabetes who
presented to an OSH with worsening shortness of breath, hoarse
voice, inability to lie flat, non-productive cough, and
increasing swelling of his bilateral upper extremities and neck.
He notes for the past 3 weeks or so, he has noticed increasing
shortness of breath and orthopnea, with an increasing number of
pillows at night; he now sleeps only in a sitting position. He
has noticed a change in the quality of his voice. In addition,
his neck and face have been "swelling up". He initially
presented to an OSH in [**State 1727**], where a CT neck demonstrated
mediastinal lymphadenopathy, a 4mm trachea likely secondary to
extrinsic compression, and multiple pulmonary nodules (the
largest of which was 1.5cm in diameter). He was transferred to
[**Hospital 1727**] Medical Center for further workup, where compression of
the SVC was revealed. He was seen by ENT, who noted bilateral
immobile vocal cords fixed in the paramedial/medial position, as
well as an 80% subglottic stenosis. He was noted to have
intraperitoneal air, which was deemed non-surgical and benign by
the consulting surgery team. Radiation oncology was also
consulted, and they recommended XRT after treatment of his SVC
syndrome and tracheal compression. He was referred to [**Hospital1 18**] for
tracheal Y-stenting, SVC stenting, and transbronchial biopsy of
the mediastinal lymphadenopathy.

MEDICAL HISTORY: - Hypertension
- Baseline chronic kidney disease, unknown creatinine; was 1.4
on admission to OSH
- Diabetes mellitus (HgbA1C 9.8)
- Coronary artery disease (sestamibi in [**2-/2175**] with fixed
inferior segment and small reversible defect at apex, EF 68%)
- COPD (on 20mg prednisone daily)
- Bladder CA
- Laryngeal CA (s/p external beam radiation in [**2172**])
- Cataract surgery
- Laser eye surgery

MEDICATION ON ADMISSION: Lantus 35 units QHS
Novalog sliding scale
Glyburide 10mg [**Hospital1 **]
Metformin 1000mg [**Hospital1 **]
Prednisone 20mg daily
HCTZ 25 mg daily
Lisinopril 20mg daily
Metoprolol 50mg TID
Simvastatin 40mg QHS
Precose 100mg TID
ASA 81mg daily
Triamcinolone 100mcg 4 puffs [**Hospital1 **]
Omeprazole 40mg daily
Loratadine 10mg daily
Albulterol 2 puffs q4-6hours

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: T 96.2F, BP 128/55, HR 57, RR 19, O2sat 100%4LNC
GENERAL: Older gentleman in mild respiratory distress, sitting
up in bed
HEENT: Marked facial swelling and plethora, OP clear
NECK: thick, unable to appreciate JVD
CARD: RRR no m/r/g
RESP: Audible inspiratory and expiratory stridor, occasional
wheeze; diffuse rhonchi anteriorly
ABD: Tympanic, soft, non-tender, decreased bowel sounds
BACK: Deferred
UPPER EXT: 2+ pitting edema bilaterally, 2+ radial pulses
LOWER EXT: no clubbing, cyanosis, edema
NEURO: A&O x 3

FAMILY HISTORY: Father died of lung cancer, diabetes; mother with diabetes.

SOCIAL HISTORY: Former smoker, quit 20 years ago, 40 pack-year history.
Secondary malignant neoplasm of other respiratory organs,Acute kidney failure, unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Compression of vein,Hyposmolality and/or hyponatremia,Iatrogenic pneumothorax,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of larynx,Other drugs and medicinal substances causing adverse effects in therapeutic use,Chronic airway obstruction, not elsewhere classified,Personal history of malignant neoplasm of bladder,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Sec malig neo resp NEC,Acute kidney failure NOS,Mal neo lymph-intrathor,Compression of vein,Hyposmolality,Iatrogenic pneumothorax,DMII renl nt st uncntrld,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hx-laryngeal malignancy,Adv eff medicinal NEC,Chr airway obstruct NEC,Hx of bladder malignancy,Abn react-surg proc NEC
Admission Date:  [**2179-12-9**]              Discharge Date:   [**2179-12-13**]

Date of Birth:  [**2106-2-27**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
Tracheal Stent Placement
SVC Stent Placement

History of Present Illness:
Mr. [**Known lastname **] is a 73 year old man with history of laryngeal
cancer s/p external beam radiation, COPD, and diabetes who
presented to an OSH with worsening shortness of breath, hoarse
voice, inability to lie flat, non-productive cough, and
increasing swelling of his bilateral upper extremities and neck.
He notes for the past 3 weeks or so, he has noticed increasing
shortness of breath and orthopnea, with an increasing number of
pillows at night; he now sleeps only in a sitting position. He
has noticed a change in the quality of his voice. In addition,
his neck and face have been "swelling up". He initially
presented to an OSH in [**State 1727**], where a CT neck demonstrated
mediastinal lymphadenopathy, a 4mm trachea likely secondary to
extrinsic compression, and multiple pulmonary nodules (the
largest of which was 1.5cm in diameter). He was transferred to
[**Hospital 1727**] Medical Center for further workup, where compression of
the SVC was revealed. He was seen by ENT, who noted bilateral
immobile vocal cords fixed in the paramedial/medial position, as
well as an 80% subglottic stenosis. He was noted to have
intraperitoneal air, which was deemed non-surgical and benign by
the consulting surgery team. Radiation oncology was also
consulted, and they recommended XRT after treatment of his SVC
syndrome and tracheal compression. He was referred to [**Hospital1 18**] for
tracheal Y-stenting, SVC stenting, and transbronchial biopsy of
the mediastinal lymphadenopathy.

Past Medical History:
- Hypertension
- Baseline chronic kidney disease, unknown creatinine; was 1.4
on admission to OSH
- Diabetes mellitus (HgbA1C 9.8)
- Coronary artery disease (sestamibi in [**2-/2175**] with fixed
inferior segment and small reversible defect at apex, EF 68%)
- COPD (on 20mg prednisone daily)
- Bladder CA
- Laryngeal CA (s/p external beam radiation in [**2172**])
- Cataract surgery
- Laser eye surgery


Social History:
Former smoker, quit 20 years ago, 40 pack-year history.

Family History:
Father died of lung cancer, diabetes; mother with diabetes.

Physical Exam:
VITALS: T 96.2F, BP 128/55, HR 57, RR 19, O2sat 100%4LNC
GENERAL: Older gentleman in mild respiratory distress, sitting
up in bed
HEENT: Marked facial swelling and plethora, OP clear
NECK: thick, unable to appreciate JVD
CARD: RRR no m/r/g
RESP: Audible inspiratory and expiratory stridor, occasional
wheeze; diffuse rhonchi anteriorly
ABD: Tympanic, soft, non-tender, decreased bowel sounds
BACK: Deferred
UPPER EXT: 2+ pitting edema bilaterally, 2+ radial pulses
LOWER EXT: no clubbing, cyanosis, edema
NEURO: A&O x 3


Pertinent Results:
[**2179-12-9**] 01:15PM   PT-12.2 PTT-22.8 INR(PT)-1.0
[**2179-12-9**] 01:15PM   PLT COUNT-371
[**2179-12-9**] 01:15PM   WBC-9.6 RBC-3.65* HGB-10.9* HCT-33.9* MCV-93
MCH-29.9 MCHC-32.2 RDW-13.5
[**2179-12-9**] 01:15PM   CALCIUM-9.3 PHOSPHATE-7.2* MAGNESIUM-2.5
[**2179-12-9**] 01:15PM   LD(LDH)-229
[**2179-12-9**] 01:15PM   estGFR-Using this
[**2179-12-9**] 01:15PM   GLUCOSE-357* UREA N-79* CREAT-2.4*
SODIUM-132* POTASSIUM-5.5* CHLORIDE-94* TOTAL CO2-25 ANION
GAP-19
[**2179-12-9**] 05:24PM URINE  EOS-NEGATIVE

[**2179-12-9**] 05:24PM URINE  OSMOLAL-439
[**2179-12-9**] 05:24PM URINE  HOURS-RANDOM UREA N-456 CREAT-95
SODIUM-52 POTASSIUM-44 TOT PROT-32 CALCIUM-2.8 PROT/CREA-0.3*
[**2179-12-9**] 11:09PM   GLUCOSE-270* UREA N-91* CREAT-3.1* SODIUM-135
POTASSIUM-5.3* CHLORIDE-95* TOTAL CO2-25 ANION GAP-20
[**2179-12-9**] 11:09PM   CALCIUM-9.3 PHOSPHATE-8.0* MAGNESIUM-2.7*
.
[**2179-12-12**]: CXR - FINDINGS:
Compared to the prior study, there is no new consolidation and
the pulmonary vascular markings are within normal limits.
Diminished linear atelectatic changes at left base are noted.
IMPRESSION:
No significant interval change vs. prior.


Brief Hospital Course:
The patient was admitted to the medical ICU on transfer from
[**Hospital 1727**] Medical Center for monitring peri-procedure.
Interventional Pulmonary placed a Y-stent and Interventional
Radiology placed an SVC stent. The procedures went well.  The
Y-stent placement was complicated by a small left lower
pneumothorax. A chest tube with a pig-tail catheter was placed.
This was placed on water seal and showed no re-expansion. The
pigtail catheter was removed and there is no residual PTX and no
leak as evidenced by repeat chest film.

The interventional Pulmonary attending is named [**Name (NI) 828**] [**Name (NI) 829**]

When removing the bialteral femoral lines, there was unexpected
bleeding approx 30 minutes after the right SVC-stent introducer
catheter was removed. The line was pulled, and no bleeding was
noted.  However, upon sitting up and eating, blood was noticed
oozing from the wound site. Pressure was held and his Hct was
stable. No further complications were noted.

The patient suffered acute renal failure felt secondary to
contrast nephropathy as a result of multiple contrast studies.
His Creatinine stabilized @ 3.2 and he continued to make urine.
Renal was consulted and felt dialysis was not needed and that
his kidneys should continue to improve gradually.

Surgery was notified of the CT finding of marked bowel wall gas
and free air under the diaphragm. He was asymptomatic and
tolerating a diet. They felt this was [**Last Name (un) 17066**] issue without clear
etiology. They felt a diet as tolerated and bowel regemine were
indicated and close monitoring.

The following recommendations are made regarding his ongoing
care:
Oncology input once the pathology of the tumor is identified
regarding treatment
Tapering of his steroids
He is to continue on his Aeroslized N-Acetyl Cysteine and normal
saline nebs
continued monitoring of his abdominal exams

Medications on Admission:
Lantus 35 units QHS
Novalog sliding scale
Glyburide 10mg [**Hospital1 **]
Metformin 1000mg [**Hospital1 **]
Prednisone 20mg daily
HCTZ 25 mg daily
Lisinopril 20mg daily
Metoprolol 50mg TID
Simvastatin 40mg QHS
Precose 100mg TID
ASA 81mg daily
Triamcinolone 100mcg 4 puffs [**Hospital1 **]
Omeprazole 40mg daily
Loratadine 10mg daily
Albulterol 2 puffs q4-6hours


Discharge Medications:
1. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
Units Injection TID (3 times a day).
2. Albuterol Sulfate 2.5 mg/3 mL Solution for Nebulization Sig:
[**11-24**] Nebulizers Inhalation Q6H (every 6 hours) as needed.
3. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation [**Hospital1 **] (2 times a day).
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
7. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
8. Ipratropium Bromide 0.02 % Solution Sig: [**11-24**] Nebs Inhalation
Q6H (every 6 hours).
9. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
10. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Please taper as symptoms tolerate.
11. Acetylcysteine 20 % (200 mg/mL) Solution Sig: [**11-24**] Nebs
Miscellaneous Q6H (every 6 hours).
12. MetRONIDAZOLE (FLagyl) 500 mg IV Q8H
13. Ciprofloxacin 400 mg IV Q24H
14. Insulin Glargine 100 unit/mL Solution Sig: Thirty Five (35)
Units Subcutaneous once a day.
15. Insulin Regular Human 100 unit/mL Solution Sig: 2-10 Units
Injection four times a day: As Directed per Sliding Scale.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 1727**] Medical Center

Discharge Diagnosis:
Primary:
1. Tumor of unknown primary
2. Tracheal Encroachment/Invasion.
3. SVC Syndrome from tumor compression
4. Acute on chronic renal failure.
5. Diabetes mellitus type II.

Secondary:
1. Chronic kidney disease.
2. Hypertension
3. Laryngeal CA (s/p external beam radiation in [**2172**])
4. Coronary Artery Disease
5. COPD
6. History of Bladder Cancer


Discharge Condition:
Tolerating 35% facemask, tolerating oral diet, hemodynamically
stable.


Discharge Instructions:
You were transfered to [**Hospital1 18**] from [**Hospital 1727**] Medical Center for
interventional pulmonary and interventional radiology
procedures. These went well.  You are being transfered back to
[**Hospital 1727**] Medical Center for on-going care.

Followup Instructions:
Please follow up with your oncologist and primary care doctors
as directed by the [**Hospital 1727**] Medical Center providers.
{'Secondary malignant neoplasm of other respiratory organs,Acute kidney failure, unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Compression of vein,Hyposmolality and/or hyponatremia,Iatrogenic pneumothorax,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of larynx,Other drugs and medicinal substances causing adverse effects in therapeutic use,Chronic airway obstruction, not elsewhere classified,Personal history of malignant neoplasm of bladder,Other specified surgical operations and procedures 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: Dyspnea

PRESENT ILLNESS: Mr. [**Known lastname **] is a 73 year old man with history of laryngeal
cancer s/p external beam radiation, COPD, and diabetes who
presented to an OSH with worsening shortness of breath, hoarse
voice, inability to lie flat, non-productive cough, and
increasing swelling of his bilateral upper extremities and neck.
He notes for the past 3 weeks or so, he has noticed increasing
shortness of breath and orthopnea, with an increasing number of
pillows at night; he now sleeps only in a sitting position. He
has noticed a change in the quality of his voice. In addition,
his neck and face have been "swelling up". He initially
presented to an OSH in [**State 1727**], where a CT neck demonstrated
mediastinal lymphadenopathy, a 4mm trachea likely secondary to
extrinsic compression, and multiple pulmonary nodules (the
largest of which was 1.5cm in diameter). He was transferred to
[**Hospital 1727**] Medical Center for further workup, where compression of
the SVC was revealed. He was seen by ENT, who noted bilateral
immobile vocal cords fixed in the paramedial/medial position, as
well as an 80% subglottic stenosis. He was noted to have
intraperitoneal air, which was deemed non-surgical and benign by
the consulting surgery team. Radiation oncology was also
consulted, and they recommended XRT after treatment of his SVC
syndrome and tracheal compression. He was referred to [**Hospital1 18**] for
tracheal Y-stenting, SVC stenting, and transbronchial biopsy of
the mediastinal lymphadenopathy.

MEDICAL HISTORY: - Hypertension
- Baseline chronic kidney disease, unknown creatinine; was 1.4
on admission to OSH
- Diabetes mellitus (HgbA1C 9.8)
- Coronary artery disease (sestamibi in [**2-/2175**] with fixed
inferior segment and small reversible defect at apex, EF 68%)
- COPD (on 20mg prednisone daily)
- Bladder CA
- Laryngeal CA (s/p external beam radiation in [**2172**])
- Cataract surgery
- Laser eye surgery

MEDICATION ON ADMISSION: Lantus 35 units QHS
Novalog sliding scale
Glyburide 10mg [**Hospital1 **]
Metformin 1000mg [**Hospital1 **]
Prednisone 20mg daily
HCTZ 25 mg daily
Lisinopril 20mg daily
Metoprolol 50mg TID
Simvastatin 40mg QHS
Precose 100mg TID
ASA 81mg daily
Triamcinolone 100mcg 4 puffs [**Hospital1 **]
Omeprazole 40mg daily
Loratadine 10mg daily
Albulterol 2 puffs q4-6hours

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: T 96.2F, BP 128/55, HR 57, RR 19, O2sat 100%4LNC
GENERAL: Older gentleman in mild respiratory distress, sitting
up in bed
HEENT: Marked facial swelling and plethora, OP clear
NECK: thick, unable to appreciate JVD
CARD: RRR no m/r/g
RESP: Audible inspiratory and expiratory stridor, occasional
wheeze; diffuse rhonchi anteriorly
ABD: Tympanic, soft, non-tender, decreased bowel sounds
BACK: Deferred
UPPER EXT: 2+ pitting edema bilaterally, 2+ radial pulses
LOWER EXT: no clubbing, cyanosis, edema
NEURO: A&O x 3

FAMILY HISTORY: Father died of lung cancer, diabetes; mother with diabetes.

SOCIAL HISTORY: Former smoker, quit 20 years ago, 40 pack-year history. 

### Response:
{'Secondary malignant neoplasm of other respiratory organs,Acute kidney failure, unspecified,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Compression of vein,Hyposmolality and/or hyponatremia,Iatrogenic pneumothorax,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of larynx,Other drugs and medicinal substances causing adverse effects in therapeutic use,Chronic airway obstruction, not elsewhere classified,Personal history of malignant neoplasm of bladder,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
