CHIEF COMPLAINT: asymptomatic RLL mass

PRESENT ILLNESS: Ms [**Known lastname 37080**] is an 83F with FDG avid RLL mass with
positive bronchial washings for NSCLC. Although the biopsies
were
negative, the positive PET scan and positive washings make this
lesion highly suspicious for lung cancer.  She currently denies
cough, SOB, DOE, sweats, chest pain, wt loss, HA or bony pain.

MEDICAL HISTORY: PMH:
syncope/TIA/left facial droop [**2113-5-28**]
hypothyroidism
cavernous angioma dx'd [**2094**]
osteopenia
thyroid cancer, s/p thyroidectomy [**2094**]
RUL lung cancer, s/p RUL lobectomy [**2094**]
BCC
hyperlipidemia
HTN

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Alendronate Sodium 70 mg PO QFRI
2. Donepezil 5 mg PO HS
3. Enalapril Maleate 20 mg PO BID
4. Levothyroxine Sodium 175 mcg PO DAILY
5. Metoprolol Succinate XL 100 mg PO DAILY
6. NiCARdipine 20 mg PO DAILY Start: noon
give at noon
7. NiCARdipine 40 mg PO BID
8. Pravastatin 80 mg PO DAILY
9. Calcium Carbonate 1000 mg PO DAILY
10. Multivitamins 1 TAB PO DAILY

ALLERGIES: Bactrim

PHYSICAL EXAM: BP: 168/81. Heart Rate: 74. Weight: 139.6. Height: 60.5. BMI:
26.8. Temperature: 96.8. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 97.

FAMILY HISTORY: Mother - [**Year (4 digits) 499**] Ca
Father
Siblings - Sister with [**Name2 (NI) 499**] Ca, brother with lung Ca
Offspring
Other

SOCIAL HISTORY: Cigarettes: [x ] never  [ ] ex-smoker   [ ] current
Pack-yrs:____
                       quit: ______
ETOH:       [x] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:
Marital Status: [ ] Married  [x] Single
Lives:          [x] Alone    [ ] w/ family  [ ] Other:
Other pertinent social history:
Travel history: NONE
Malignant neoplasm of lower lobe, bronchus or lung,Foreign body in main bronchus,Urinary tract infection, site not specified,Pulmonary collapse,Cardiac complications, not elsewhere classified,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other specified cardiac dysrhythmias,Orthostatic hypotension,Mild cognitive impairment, so stated,Postsurgical hypothyroidism,Other late effects of cerebrovascular disease, facial weakness,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Disorder of bone and cartilage, unspecified,Personal history of other malignant neoplasm of skin,Family history of malignant neoplasm of gastrointestinal tract
Mal neo lower lobe lung,Foreign body bronchus,Urin tract infection NOS,Pulmonary collapse,Surg compl-heart,Oth gram negatv bacteria,Cardiac dysrhythmias NEC,Orthostatic hypotension,Mild cognitive impairemt,Postsurgical hypothyroid,Facial weakness,Hyperlipidemia NEC/NOS,Hypertension NOS,Bone & cartilage dis NOS,Hx-skin malignancy NEC,Family hx-gi malignancy
Admission Date:  [**2113-10-11**]              Discharge Date:   [**2113-10-19**]

Date of Birth:  [**2030-4-11**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Bactrim

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
asymptomatic RLL mass

Major Surgical or Invasive Procedure:
[**2113-10-11**]
Redo right thoracotomy, lysis of adhesions, right lower
lobectomy, mediastinal lymph node dissection, bronchoscopy with
bronchoalveolar lavage, and pericardial fat pad buttress to the
bronchial stump.

[**2113-10-13**]
Bronchoscopy

[**2113-10-16**]
Flexible bronchoscopy with therapeutic aspiration.


History of Present Illness:
Ms [**Known lastname 37080**] is an 83F with FDG avid RLL mass with
positive bronchial washings for NSCLC. Although the biopsies
were
negative, the positive PET scan and positive washings make this
lesion highly suspicious for lung cancer.  She currently denies
cough, SOB, DOE, sweats, chest pain, wt loss, HA or bony pain.


Past Medical History:
PMH:
syncope/TIA/left facial droop [**2113-5-28**]
hypothyroidism
cavernous angioma dx'd [**2094**]
osteopenia
thyroid cancer, s/p thyroidectomy [**2094**]
RUL lung cancer, s/p RUL lobectomy [**2094**]
BCC
hyperlipidemia
HTN

PSH:
RUL lobectomy [**2094**]
Thyroidectomy [**2094**]


Social History:
Cigarettes: [x ] never  [ ] ex-smoker   [ ] current
Pack-yrs:____
                       quit: ______
ETOH:       [x] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:
Marital Status: [ ] Married  [x] Single
Lives:          [x] Alone    [ ] w/ family  [ ] Other:
Other pertinent social history:
Travel history: NONE


Family History:
Mother - [**Year (4 digits) 499**] Ca
Father
Siblings - Sister with [**Name2 (NI) 499**] Ca, brother with lung Ca
Offspring
Other


Physical Exam:
BP: 168/81. Heart Rate: 74. Weight: 139.6. Height: 60.5. BMI:
26.8. Temperature: 96.8. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 97.

Gen: NAD
Neck: no [**Doctor First Name **]
Chest: clear ausc
Cor: RRR no murmur
Ext: no CCE


Pertinent Results:
[**2113-10-13**] 4:24 pm Mini-BAL      R MAINSTEM.

   GRAM STAIN (Final [**2113-10-13**]):
      3+  (5-10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      3+  (5-10 per 1000X FIELD):   MULTIPLE ORGANISMS
CONSISTENT WITH
                                    OROPHARYNGEAL FLORA.

   RESPIRATORY CULTURE (Preliminary):
      >100,000 ORGANISMS/ML. Commensal Respiratory Flora.
      GRAM NEGATIVE ROD(S).    ~1000/ML.
         Isolates are considered potential pathogens in amounts
>=10,000
         cfu/ml.  WORK-UP PER DR. [**Last Name (STitle) 39463**],[**First Name3 (LF) 39464**] PAGER [**Numeric Identifier 39465**]
[**2113-10-16**].
         Piperacillin/tazobactam sensitivity testing available
on request.
         This organism may develop resistance to third
generation
         cephalosporins during prolonged therapy. Therefore,
isolates that
         are initially susceptible may become resistant within
three to
         four days after initiation of therapy.  For serious
infections,
         repeat culture and sensitivity testing may therefore be
warranted
         if third generation cephalosporins were used.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             GRAM NEGATIVE ROD(S)
                             |
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S

[**2113-10-16**] 7:25 pm BRONCHOALVEOLAR LAVAGE

                            **FINAL REPORT [**2113-10-18**]**

   GRAM STAIN (Final [**2113-10-16**]):
      2+   (1-5 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      1+    (<1 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CHAINS.
      1+    (<1 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

   RESPIRATORY CULTURE (Final [**2113-10-18**]):
      >100,000 ORGANISMS/ML. Commensal Respiratory Flora.

[**2113-10-16**] 4:55 am URINE      Source: Catheter.

                            **FINAL REPORT [**2113-10-18**]**

   URINE CULTURE (Final [**2113-10-18**]):
      CITROBACTER FREUNDII COMPLEX.    >100,000 ORGANISMS/ML..
         This organism may develop resistance to third
generation
         cephalosporins during prolonged therapy. Therefore,
isolates that
         are initially susceptible may become resistant within
three to
         four days after initiation of therapy.  For serious
infections,
         repeat culture and sensitivity testing may therefore be
warranted
         if third generation cephalosporins were used.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             CITROBACTER FREUNDII COMPLEX
                             |
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------    64 I
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S




[**2113-10-11**] 08:02PM   WBC-21.1*# RBC-3.88*# HGB-11.4*# HCT-33.8*#
MCV-87 MCH-29.4 MCHC-33.8 RDW-13.4
[**2113-10-11**] 08:02PM   PLT COUNT-303
[**2113-10-11**] 03:33PM   GLUCOSE-149* LACTATE-1.6 NA+-139 K+-3.5
CL--108

                     WBC  RBC  Hgb   Hct  MCV MCH MCHC RDW Plt
Ct
[**2113-10-19**] 06:45    20.1* 3.17* 9.2* 29.0* 91 28.9 31.6 14.2
481*
DIFFERENTIAL     Neuts Bands Lymphs Monos Eos Baso Atyps Metas
Myelos
[**2113-10-19**] 06:45    77* 0      11*    9    2    1    0    0
0

[**2113-10-18**] CXR :
In comparison with the study of [**10-17**], this upright view shows at

least two air-fluid levels in the right hemithorax.  Presumably,
these are
related to the recent surgery and at least one of these
represents a loculated collection in or adjacent to the
mediastinum.  Extensive post-surgical changes are again seen in
the right hemithorax.  The left lung is clear and hyperexpanded
with blunting of the costophrenic angle.



Brief Hospital Course:
Mrs. [**Known lastname 37080**] was admitted to the hospital and taken to the
Operating Room where she underwent a redo right thoracotomy with
right lower lobectomy.  She tolerated the procedure well and
returned to the PACU in stable condition. She had some sinus
bradycardia intraop therefore had cardiac enzymes cycled post
op.  Her troponin were normal x 3 and she had no EKG changes.

Following transfer to the Surgical floor her chest tubes
remained in place until the drainage decreased and she was
attempting to use her incentive spirometer.  She desaturated on
post op day #2 and was transferred to the ICU for more pulmonary
toilet as her remaining right lung was collapsed.  A
bronchoscopy was done on [**2113-10-13**] to evaluate her airway and
thick tenacious secretions were found in the bronchus
intermedius and removed.  She improved from a respiratory
standpoint thereafter.

She was seen by the Geriatric service as she had some confusion
and dizziness prior to transfer.  They felt that her neuro exam
was that of MCI (mild cognitive impairment) as opposed to
Alzheimer's as she had no functional impairment and was not
dependent.  The Aricept can cause orthostasis and would not be
effective with MCI therefore was stopped.  She gradually
improved and had no more confusion or dizziness.

Her chest xrays were followed daily and she underwent another
bronchoscopy on [**2113-10-16**] and had secretions in both the right and
left main stem which were aspirated.  Her nebulizer treatments
were increased and she remained afebrile.

From an ID standpoint she had some dysuria after the Foley
catheter was removed and was started on Cipro.  Her culture grew
>100K Citrobacter.  She also had BAL's sent with each
bronchoscopy and the antibiotic was changed to Levaquin for more
gram positive coverage.  Her WBC has been as high as 27K and as
low as 15K post op, currently 20K without any bands in her
differential. Her lungs are clearer and her wound is healing
well.  She has no evidence of phlebitis or any skin problems and
the elevated WBC is unclear as she clinically looks well.  She
will complete a 7 day course of antibiotics which will end on
[**2113-10-23**].   She's tolerating a regular diet and working with
physical therapy so that she may return home.

She was discharged to rehab on [**2113-10-19**] and will follow up in the
Thoracic Clinic in 2 weeks or sooner if needed.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Alendronate Sodium 70 mg PO QFRI
2. Donepezil 5 mg PO HS
3. Enalapril Maleate 20 mg PO BID
4. Levothyroxine Sodium 175 mcg PO DAILY
5. Metoprolol Succinate XL 100 mg PO DAILY
6. NiCARdipine 20 mg PO DAILY Start: noon
give at noon
7. NiCARdipine 40 mg PO BID
8. Pravastatin 80 mg PO DAILY
9. Calcium Carbonate 1000 mg PO DAILY
10. Multivitamins 1 TAB PO DAILY


Discharge Medications:
1. Alendronate Sodium 70 mg PO QFRI
2. Levothyroxine Sodium 175 mcg PO DAILY
3. Metoprolol Succinate XL 100 mg PO DAILY
4. Multivitamins 1 TAB PO DAILY
5. Pravastatin 80 mg PO DAILY
6. Acetaminophen 650 mg PO Q6H:PRN pain
7. Albuterol 0.083% Neb Soln [**1-30**] NEB IH Q6H:PRN wheeze
8. Docusate Sodium 100 mg PO BID
9. Guaifenesin ER 600 mg PO Q12H mucus plug
10. Heparin 5000 UNIT SC TID
11. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheeze
12. Bisacodyl 10 mg PO/PR DAILY:PRN constipation
13. Levofloxacin 750 mg PO DAILY
thru [**2113-10-23**]
14. Milk of Magnesia 30 mL PO HS:PRN constipation
15. OxycoDONE (Immediate Release)  2.5-5 mg PO Q4H:PRN pain
16. Senna 1 TAB PO BID
17. TraMADOL (Ultram) 25-50 mg PO Q6H:PRN pain
18. Calcium Carbonate 1000 mg PO DAILY
19. NiCARdipine 20 mg PO DAILY
give at noon
20. NiCARdipine 40 mg PO BID
Hold for SBP < 100


Discharge Disposition:
Extended Care

Facility:
[**Hospital 4470**] HealthCare Center at [**Location (un) 38**]

Discharge Diagnosis:
Lung cancer
Collapse of the right lung with mucus plugging
Right lung atelectesis
Urinary tract infection (Citrobacter)


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
* You were admitted to the hospital for lung surgery and you've
recovered well. You are now ready for discharge.
* Continue to use your incentive spirometer 10 times an hour
while awake.
* 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 in 48 hours.  If it
starts to drain, cover it with a clean dry dressing and change
it  as needed to keep site clean and dry.
* You will continue to need pain medication once you are home
but you can wean it over a few weeks as the discomfort resolves.
 Make sure that you have regular bowel movements while on
narcotic pain medications as they are constipating which can
cause more problems.  Use a stool softener or gentle laxative to
stay regular.
* No driving while taking narcotic pain medication.
* Take Tylenol  650 mg every 6 hours in between your narcotic.
* Continue to stay well hydrated and eat well to heal your
incisions
* Shower daily. Wash incision with mild soap & water, rinse, pat
dry
* No tub bathing, swimming or hot tubs until incision healed
* No lotions or creams to incision site
* Walk 4-5 times a day and gradually increase your activity as
you can tolerate.

Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, chest pain or any other symptoms
that concern you.




Followup Instructions:
Department: HEMATOLOGY/ONCOLOGY
When: TUESDAY [**2113-10-31**] at 2:30 PM
With: [**Name6 (MD) 1532**] [**Name8 (MD) 1533**], MD [**0-0-**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Please report 30 minutes prior to your appointment to the
Radiology Department on the [**Location (un) **] of the [**Hospital Ward Name 23**] Clinical
Center for a chest xray



Completed by:[**2113-10-19**]
{'Malignant neoplasm of lower lobe, bronchus or lung,Foreign body in main bronchus,Urinary tract infection, site not specified,Pulmonary collapse,Cardiac complications, not elsewhere classified,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other specified cardiac dysrhythmias,Orthostatic hypotension,Mild cognitive impairment, so stated,Postsurgical hypothyroidism,Other late effects of cerebrovascular disease, facial weakness,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Disorder of bone and cartilage, unspecified,Personal history of other malignant neoplasm of skin,Family history of malignant neoplasm of gastrointestinal tract'}


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: asymptomatic RLL mass

PRESENT ILLNESS: Ms [**Known lastname 37080**] is an 83F with FDG avid RLL mass with
positive bronchial washings for NSCLC. Although the biopsies
were
negative, the positive PET scan and positive washings make this
lesion highly suspicious for lung cancer.  She currently denies
cough, SOB, DOE, sweats, chest pain, wt loss, HA or bony pain.

MEDICAL HISTORY: PMH:
syncope/TIA/left facial droop [**2113-5-28**]
hypothyroidism
cavernous angioma dx'd [**2094**]
osteopenia
thyroid cancer, s/p thyroidectomy [**2094**]
RUL lung cancer, s/p RUL lobectomy [**2094**]
BCC
hyperlipidemia
HTN

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Alendronate Sodium 70 mg PO QFRI
2. Donepezil 5 mg PO HS
3. Enalapril Maleate 20 mg PO BID
4. Levothyroxine Sodium 175 mcg PO DAILY
5. Metoprolol Succinate XL 100 mg PO DAILY
6. NiCARdipine 20 mg PO DAILY Start: noon
give at noon
7. NiCARdipine 40 mg PO BID
8. Pravastatin 80 mg PO DAILY
9. Calcium Carbonate 1000 mg PO DAILY
10. Multivitamins 1 TAB PO DAILY

ALLERGIES: Bactrim

PHYSICAL EXAM: BP: 168/81. Heart Rate: 74. Weight: 139.6. Height: 60.5. BMI:
26.8. Temperature: 96.8. Resp. Rate: 16. Pain Score: 0. O2
Saturation%: 97.

FAMILY HISTORY: Mother - [**Year (4 digits) 499**] Ca
Father
Siblings - Sister with [**Name2 (NI) 499**] Ca, brother with lung Ca
Offspring
Other

SOCIAL HISTORY: Cigarettes: [x ] never  [ ] ex-smoker   [ ] current
Pack-yrs:____
                       quit: ______
ETOH:       [x] No   [ ] Yes     drinks/day: _____
Drugs:
Exposure:   [x] No   [ ] Yes  [ ] Radiation
                     [ ] Asbestos [ ] Other:
Occupation:
Marital Status: [ ] Married  [x] Single
Lives:          [x] Alone    [ ] w/ family  [ ] Other:
Other pertinent social history:
Travel history: NONE 

### Response:
{'Malignant neoplasm of lower lobe, bronchus or lung,Foreign body in main bronchus,Urinary tract infection, site not specified,Pulmonary collapse,Cardiac complications, not elsewhere classified,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Other specified cardiac dysrhythmias,Orthostatic hypotension,Mild cognitive impairment, so stated,Postsurgical hypothyroidism,Other late effects of cerebrovascular disease, facial weakness,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Disorder of bone and cartilage, unspecified,Personal history of other malignant neoplasm of skin,Family history of malignant neoplasm of gastrointestinal tract'}
