CHIEF COMPLAINT: Enlarged mediastinal lymph nodes

PRESENT ILLNESS: Mr. [**Known lastname 24085**] is a 46 male seen at [**Hospital3 **] for chest pain
in [**2147-3-17**].  CXR revealed abnormal density overlying AP area.
CTA Chest demonstrates multiple enlarged mediastinal lymph nodes
and enlarged AP node.  He is being admitted for cervical
medinstinoscpy.

MEDICAL HISTORY: Hyperlipidemia
GERD

MEDICATION ON ADMISSION: Tricor 145 mg daily, Omeprazole 40 mg daily, Simvastatin 20 mg
daily, Viagra PRN, ASA 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 98.3   HR: 77 SR  BP: 122/66   Sats 94% RA
General: 46 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2 no mumur/gallor or rub
Resp: decreased breath sounds throughout otherwise clear
GI: obese, bowel sounds positive abd soft
non-tender/non-distended
Extr; warm no edema
Incision: sternal and cervical meds site no erythema or
discharge, margins well approximated
Neuro: awake, alert oriented

FAMILY HISTORY: Mother - CAD, MI X 3, TIA
Father - Colitis

SOCIAL HISTORY: Married lives with wife.  [**Name (NI) 1139**]: none.  ETOH yes
Other malignant lymphomas, intrathoracic lymph nodes,Accidental puncture or laceration during a procedure, not elsewhere classified,Esophageal reflux,Other and unspecified hyperlipidemia,Accidental cut, puncture, perforation or hemorrhage during surgical operation
Lymphomas NEC thorax,Accidental op laceration,Esophageal reflux,Hyperlipidemia NEC/NOS,Acc cut/hem in surgery
Admission Date:  [**2147-3-27**]              Discharge Date:   [**2147-3-30**]

Date of Birth:  [**2100-4-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Enlarged mediastinal lymph nodes

Major Surgical or Invasive Procedure:
[**2147-3-27**]: Cervical Medinstinoscopy
[**2147-3-27**]: Repair of innominate artery tear via a median
    sternotomy.


History of Present Illness:
Mr. [**Known lastname 24085**] is a 46 male seen at [**Hospital3 **] for chest pain
in [**2147-3-17**].  CXR revealed abnormal density overlying AP area.
CTA Chest demonstrates multiple enlarged mediastinal lymph nodes
and enlarged AP node.  He is being admitted for cervical
medinstinoscpy.


Past Medical History:
Hyperlipidemia
GERD


Social History:
Married lives with wife.  [**Name (NI) 1139**]: none.  ETOH yes

Family History:
Mother - CAD, MI X 3, TIA
Father - Colitis


Physical Exam:
VS: T: 98.3   HR: 77 SR  BP: 122/66   Sats 94% RA
General: 46 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2 no mumur/gallor or rub
Resp: decreased breath sounds throughout otherwise clear
GI: obese, bowel sounds positive abd soft
non-tender/non-distended
Extr; warm no edema
Incision: sternal and cervical meds site no erythema or
discharge, margins well approximated
Neuro: awake, alert oriented

Pertinent Results:
[**2147-3-27**] 05:15PM BLOOD WBC-13.6* RBC-4.12* Hgb-11.8* Hct-33.9*
MCV-82 MCH-28.6 MCHC-34.7 RDW-13.6 Plt Ct-327
[**2147-3-28**] 04:32AM BLOOD Glucose-139* UreaN-17 Creat-0.9 Na-139
K-4.0 Cl-106 HCO3-25 AnGap-12
[**2147-3-27**] 05:15PM BLOOD UreaN-16 Creat-1.0 Cl-110* HCO3-23

CXR:
[**2147-3-30**]: CHEST, PA AND LATERAL: Stable postoperative widening of
the mediastinum is present. The cardiac and hilar contours are
normal. Lung volumes are low, with increased bibasilar
atelectasis. Small bilateral pleural effusions are present.
There is no pneumothorax
[**2147-3-27**]: Substantial prominence of the superior mediastinum is
again seen. Again, this could reflect either expected
post-surgical changes or be a manifestation of mediastinal
hematoma. There are areas of increased opacification at both
bases in the retrocardiac region, again consistent with
atelectasis. However, in the appropriate clinical scenario, the
possibility of superimposed pneumonia would have to be seriously
considered.
[**2147-3-27**] AP: Median sternotomy wires overlie the chest. The
cardiomediastinal shadow is enlarged, likely due to known
lymphadenopathy and recent instrumentation. There are no pleural
effusions or pneumothorax. A nasogastric tube courses beyond the
film. No radiopaque foreign bodies are seen.


Brief Hospital Course:
Mr. [**Known lastname 24085**] was admitted on [**2147-3-27**] for cervical medstinoscopy
complicated by Innominate artery tear.  Transferred to the CVIC
intubated.

Respiratory: extubated day of surgery.  Aggressive pulmonary
toilet, and nebs were administered.  He initially required 3
Liters oxygen via nasal cannula and weaned to room air with
oxygen saturations 94-95%. He was followed by serial chest films
which remained stable.

Chest tubes: medialstinal chest tube were removed on POD3.

Cardiac: remained in sinus rhythm and hemodynamically stable.

GI: bowel function returned.

Renal: renal function normal.  Foley was removed on POD3.  He
voided without difficulty.

Heme: transfused 3 units of PRBC in the operating room.  HCT
stable at 34

Nutrition: tolerated a regular diet

Pain: good pain control with Toradol and hydromorphone

Neuro: Awake, alert & oriented

Disposition: he was seen by physical therapy for sternal
precaution teaching.  he continued to do well and was discharged
to home with his wife.  he will follow-up with Dr. [**First Name (STitle) **] as an
outpatient.


Medications on Admission:
Tricor 145 mg daily, Omeprazole 40 mg daily, Simvastatin 20 mg
daily, Viagra PRN, ASA 81 mg daily


Discharge Medications:
1. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. Tricor 145 mg Tablet Sig: One (1) Tablet PO once a day.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): take while taking narcotics.
5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*70 Tablet(s)* Refills:*0*
6. Motrin 600 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours: take with food and water.
Disp:*90 Tablet(s)* Refills:*2*
7. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
8. Geriatric Recliner
46 year-old male with Repair of innominate artery tear via a
median sternotomy, [**2147-3-27**]

9. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1)
scoop PO DAILY (Daily).
Disp:*QS can* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Enlarged mediastinal lymph nodes
Innominate artery tear.


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


Discharge Instructions:
Call Dr. [**First Name (STitle) **] office [**Telephone/Fax (1) 3020**] if you experience:
-Fevers > 101 or chills
-Increased cough or sputum production
-Chest pain
-Sternal incision develops drainage
-Chest tube site keep covered with a bandaid
-No lifting greater than 10 pounds
-You may shower.  No tub bathing or swimming for 4 weeks
-No driving for 4 weeks
-Regular diet
-Walk 4-5 times a day for 10-15 minutes

Followup Instructions:
Follow-up with Dr. [**First Name (STitle) **] [**0-0-**] Date/Time:[**2147-4-13**] 9:00
on the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) 24**]
Chest X-Ray in the [**Location (un) 861**] Radiology Department 30 minutes
before your appointment

Follow-up with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] [**Telephone/Fax (1) 9347**]



Completed by:[**2147-3-31**]
{'Other malignant lymphomas, intrathoracic lymph nodes,Accidental puncture or laceration during a procedure, not elsewhere classified,Esophageal reflux,Other and unspecified hyperlipidemia,Accidental cut, puncture, perforation or hemorrhage during surgical 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: Enlarged mediastinal lymph nodes

PRESENT ILLNESS: Mr. [**Known lastname 24085**] is a 46 male seen at [**Hospital3 **] for chest pain
in [**2147-3-17**].  CXR revealed abnormal density overlying AP area.
CTA Chest demonstrates multiple enlarged mediastinal lymph nodes
and enlarged AP node.  He is being admitted for cervical
medinstinoscpy.

MEDICAL HISTORY: Hyperlipidemia
GERD

MEDICATION ON ADMISSION: Tricor 145 mg daily, Omeprazole 40 mg daily, Simvastatin 20 mg
daily, Viagra PRN, ASA 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 98.3   HR: 77 SR  BP: 122/66   Sats 94% RA
General: 46 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2 no mumur/gallor or rub
Resp: decreased breath sounds throughout otherwise clear
GI: obese, bowel sounds positive abd soft
non-tender/non-distended
Extr; warm no edema
Incision: sternal and cervical meds site no erythema or
discharge, margins well approximated
Neuro: awake, alert oriented

FAMILY HISTORY: Mother - CAD, MI X 3, TIA
Father - Colitis

SOCIAL HISTORY: Married lives with wife.  [**Name (NI) 1139**]: none.  ETOH yes 

### Response:
{'Other malignant lymphomas, intrathoracic lymph nodes,Accidental puncture or laceration during a procedure, not elsewhere classified,Esophageal reflux,Other and unspecified hyperlipidemia,Accidental cut, puncture, perforation or hemorrhage during surgical operation'}
