CHIEF COMPLAINT: Dyspnea

PRESENT ILLNESS: 59yo M PMHx Stage IV NSLC s/p L pneumonectomy ([**7-/2147**]), recent
diagnosis of PE ([**3-/2148**]) now on coumadin, CT at time of
diagnosis suggesting cancer recurrence, recently seen in
thoracic clinic with cough and shortness of breath and
prescribed levofloxacin for presumed bronchitis ([**2148-3-28**]), now
presenting with increasing dyspnea and cough.  Patient reports
cough is chronic for past 2 months, although worsening since
hospitalization with yellow, non-bloody sputum production.
Patient denies fevers and chills but states that he is unable to
walk more than a few feet.  Prior to the PE, patient was able to
walk 200 feet but was started on 2L NC at time of discharge.
Patient states that his shortness of breath has been progressive
and not acute.  Of note, patient has been taking levofloxacin
with sputum becoming less yellow and a one time episode of
nausea following dinner last night.

MEDICAL HISTORY: Past Medical History:
- poorly-differentiated carcinoma of the lung
- DM2
- HTN
- HLD
- s/p CVA ([**2140**]) w residual LUE weakness and numbness
.
Onc History
[**1-/2145**] - diagnosed with cardiac tamponade, PET/CT w left upper
lobe
lung mass, multiple enlarged lymph nodes, brain MRI negative for
mets
[**2-/2145**] - s/p 6 cycles carboplatin/alimta, XRT 6000cGy, follwed
by taxol
[**2-/2147**] - Enlarging LUL mass, started on Tarceva
[**7-/2147**] - 1. Left thoracotomy/left pneumonectomy.  2. Buttressing
of bronchial stump with intercostal muscle.

MEDICATION ON ADMISSION: glimepiride 2 mg Tablet daily
levofloxacin 500 mg Tablet daily
lisinopril-hydrochlorothiazide 20 mg-12.5 mg daily
simvastatin 80 mg Tablet
warfarin 5 mg Tablet
aspirin 81 mg Tablet daily
hydromorphone 2mg PRN

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission:
Vitals: T: BP: 99/61 P: 128 R: 30 O2: 99%
General: Alert, oriented, using accessory muscles to breath
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, Left supraclavicular lymphnode
Lungs: No sounds on left, right side with rhonchi throughout
CV: tacyhcardic, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or 1+
edema

FAMILY HISTORY: No family history of lung cancer. His father had
a history of strokes.  His mother had type 2 diabetes.  He has
no
children.

SOCIAL HISTORY: He is married and has no children.  He previously worked in
construction before his diagnosis.  He is originally from
[**Country 6257**] and is accompanied by his friend [**Name (NI) **] [**Name (NI) **] (W:
[**Telephone/Fax (1) 81460**], x16; C: [**Telephone/Fax (1) 81461**]), who he has authorized us to
speak with about his health matters.  He previously smoked [**2-12**]
packs per day x 42 years, quitting in [**2144**]. He drinks 3 bottles
of wine per week.
Pneumonia, organism unspecified,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Hyposmolality and/or hyponatremia,Personal history of malignant neoplasm of bronchus and lung,Long-term (current) use of anticoagulants,Personal history of pulmonary embolism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Personal history of tobacco use,Acquired absence of organ, lung,Do not resuscitate status,Tachycardia, unspecified,Hypoxemia,Abnormal coagulation profile
Pneumonia, organism NOS,Mal neo lymph-head/neck,Hyposmolality,Hx-bronchogenic malignan,Long-term use anticoagul,Hx pulmonary embolism,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Late effect CV dis NEC,Muscskel sympt limb NEC,History of tobacco use,Acq absence of lung,Do not resusctate status,Tachycardia NOS,Hypoxemia,Abnrml coagultion prfile
Name:  [**Known lastname 13046**],[**Known firstname **]                    Unit No:   [**Numeric Identifier 13047**]

Admission Date:  [**2148-3-31**]              Discharge Date:   [**2148-4-7**]

Date of Birth:  [**2088-8-3**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1824**]
Addendum:
Pulmonary Embolism:  Unable to specify whether an acute or
chronic pulmonary embolism was present and/or contributing to
the patient's presentation as this diagnosis was not pursued in
the context of his goals of care.

Discharge Disposition:
Expired

                             [**First Name11 (Name Pattern1) 634**] [**Last Name (NamePattern4) 1837**] MD [**MD Number(2) 1838**]

Completed by:[**2148-4-30**]

Admission Date:  [**2148-3-31**]              Discharge Date:   [**2148-4-7**]

Date of Birth:  [**2088-8-3**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 2195**]
Chief Complaint:
Dyspnea

Major Surgical or Invasive Procedure:
None

History of Present Illness:
59yo M PMHx Stage IV NSLC s/p L pneumonectomy ([**7-/2147**]), recent
diagnosis of PE ([**3-/2148**]) now on coumadin, CT at time of
diagnosis suggesting cancer recurrence, recently seen in
thoracic clinic with cough and shortness of breath and
prescribed levofloxacin for presumed bronchitis ([**2148-3-28**]), now
presenting with increasing dyspnea and cough.  Patient reports
cough is chronic for past 2 months, although worsening since
hospitalization with yellow, non-bloody sputum production.
Patient denies fevers and chills but states that he is unable to
walk more than a few feet.  Prior to the PE, patient was able to
walk 200 feet but was started on 2L NC at time of discharge.
Patient states that his shortness of breath has been progressive
and not acute.  Of note, patient has been taking levofloxacin
with sputum becoming less yellow and a one time episode of
nausea following dinner last night.

Initial vital signs on presentation to [**Hospital1 18**] ED were HR132
84%onRA.  EKG demonstrated sinus tachycardia to 120s.  Labs were
remarkable for WBC 11.7 (90N), Hct 33.6, Plt 171, Na 132, Cr
1.2, BUN 69, INR 4.0, Lactate 1.6, BNP 437.  CXR showed
increased consolidation of RLL suggestive of infection.  Case
was discussed with thoracic surgery, who felt that MICU
admission was warranted. Patient was given vanco, ceftriaxone
for treatment of presumed pnuemonia.

Vital signs on transfer: 97.6 134 36 112/68 95%NRB

On arrival to the ICU patient is tachypnic to 30s and satting
100% on non-rebreather.  He is speaking in 2 word sentences
although does not appear tiring.  Of note, patient endorses 20
pound weight loss over the past 2 months or so.

Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats. Denies headache, sinus
tenderness, rhinorrhea or congestion. Denies chest pain, chest
pressure, palpitations, or weakness. Denies diarrhea,
constipation, abdominal pain, or changes in bowel habits. Denies
dysuria, frequency, or urgency. Denies arthralgias or myalgias.
Denies rashes or skin changes.

Past Medical History:
Past Medical History:
- poorly-differentiated carcinoma of the lung
- DM2
- HTN
- HLD
- s/p CVA ([**2140**]) w residual LUE weakness and numbness
.
Onc History
[**1-/2145**] - diagnosed with cardiac tamponade, PET/CT w left upper
lobe
lung mass, multiple enlarged lymph nodes, brain MRI negative for
mets
[**2-/2145**] - s/p 6 cycles carboplatin/alimta, XRT 6000cGy, follwed
by taxol
[**2-/2147**] - Enlarging LUL mass, started on Tarceva
[**7-/2147**] - 1. Left thoracotomy/left pneumonectomy.  2. Buttressing
of bronchial stump with intercostal muscle.

Social History:
He is married and has no children.  He previously worked in
construction before his diagnosis.  He is originally from
[**Country 6257**] and is accompanied by his friend [**Name (NI) **] [**Name (NI) **] (W:
[**Telephone/Fax (1) 81460**], x16; C: [**Telephone/Fax (1) 81461**]), who he has authorized us to
speak with about his health matters.  He previously smoked [**2-12**]
packs per day x 42 years, quitting in [**2144**]. He drinks 3 bottles
of wine per week.


Family History:
No family history of lung cancer. His father had
a history of strokes.  His mother had type 2 diabetes.  He has
no
children.

Physical Exam:
Admission:
Vitals: T: BP: 99/61 P: 128 R: 30 O2: 99%
General: Alert, oriented, using accessory muscles to breath
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, Left supraclavicular lymphnode
Lungs: No sounds on left, right side with rhonchi throughout
CV: tacyhcardic, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or 1+
edema

Discharge:


Pertinent Results:
[**2148-3-31**] 07:45PM BLOOD WBC-11.7*# RBC-4.43*# Hgb-11.3* Hct-33.6*
MCV-76*# MCH-25.5* MCHC-33.7 RDW-14.7 Plt Ct-171
[**2148-3-31**] 07:45PM BLOOD Neuts-90.0* Lymphs-4.3* Monos-3.4 Eos-1.8
Baso-0.5
[**2148-3-31**] 07:45PM BLOOD PT-41.2* PTT-33.6 INR(PT)-4.0*
[**2148-3-31**] 07:45PM BLOOD Glucose-195* UreaN-69* Creat-1.2 Na-132*
K-3.9 Cl-94* HCO3-26 AnGap-16
[**2148-3-31**] 07:45PM BLOOD cTropnT-0.01 proBNP-437*
[**2148-3-31**] 07:45PM BLOOD Calcium-8.9 Phos-3.9 Mg-2.0
[**2148-3-31**] 11:29PM BLOOD Type-ART Temp-37.7 pO2-298* pCO2-36
pH-7.45 calTCO2-26 Base XS-2 Intubat-NOT INTUBA Comment-AXILLARY
T
[**2148-3-31**] 11:29PM BLOOD Lactate-1.2 K-3.5
[**2148-3-31**] 07:58PM BLOOD Lactate-1.6
[**2148-3-31**] 11:29PM BLOOD O2 Sat-99
[**2148-3-31**] 11:29PM BLOOD freeCa-1.12

Blood cultures pending x2

CHEST (PORTABLE AP) Study Date of [**2148-3-31**] 7:54 PM
FINDINGS: Single frontal view of the chest demonstrates complete

Preliminary Reportopacification of the left hemithorax and
leftward cardiomediastinal shift
Preliminary Reportconsistent with post-pneumonectomy change. The
right lung demonstrates
Preliminary Reportincreased consolidation in the lower lobe and
possibly also the middle lobe
Preliminary Reportsuggestive of infection. This distribution
would be atypical for edema.
Preliminary ReportThere is no pneumothorax or large right
effusion.

Preliminary ReportIMPRESSION:
Preliminary Report1. Stable post-pneumonectomy changes in the
left lung.
Preliminary Report2. Right lower lung consolidation, suggestive
of new infection.


Brief Hospital Course:
59yo M PMHx Stage IV NSLC s/p L pneumonectomy ([**7-/2147**]) with
recurrence in supraclavicular node, recent diagnosis of PE
([**3-/2148**]) on coumadin, and pneumonia.

# Hypoxia
Stage IV lung cancer with nodal recurrance recently s/p L
pneumonectomy, as well as a new right sided pneumonia. Admitted
to the [**Hospital Unit Name 153**] and started on IV vanc/zosyn/levaquin for HCAP.
Anticoag was held for elevated INR, but PE was likely a
contributing factor to hypoxia. Very high oxygen requirements,
with desats with any movement. Vancomycin was stopped with no
evidence of MRSA. Levaquin stopped after 6 days. Zosyn continued
for 10 days. Lasix attempted for diuresis without improvement,
and worsening of congestion. No improvement in oxygenation over
the course of about a week. Palliative care consult was called
and patient and family decided to pursue hospice, while
continuing to treat pneumonia and PE. Lab draws, vitals, and
non-comfort medications were stopped. Patient was called out to
the floor. Overnight he became much less responsive, and his
work of breathing increased. Antibiotics were stopped and a
morphine drip and glycopyrrolate were started. He was seen by
the Catholic chaplain and received the anointing of the sick
with his family present.

Mr.[**Known lastname 32665**] passed away peacefully on the afternoon of [**2148-4-7**]
with his family at his bedside.

Medications on Admission:
glimepiride 2 mg Tablet daily
levofloxacin 500 mg Tablet daily
lisinopril-hydrochlorothiazide 20 mg-12.5 mg daily
simvastatin 80 mg Tablet
warfarin 5 mg Tablet
aspirin 81 mg Tablet daily
hydromorphone 2mg PRN

Discharge Disposition:
Expired

Discharge Diagnosis:
Metastatic lung cancer


Discharge Condition:
Expired.
{'Pneumonia, organism unspecified,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Hyposmolality and/or hyponatremia,Personal history of malignant neoplasm of bronchus and lung,Long-term (current) use of anticoagulants,Personal history of pulmonary embolism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Personal history of tobacco use,Acquired absence of organ, lung,Do not resuscitate status,Tachycardia, unspecified,Hypoxemia,Abnormal coagulation profile'}


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: 59yo M PMHx Stage IV NSLC s/p L pneumonectomy ([**7-/2147**]), recent
diagnosis of PE ([**3-/2148**]) now on coumadin, CT at time of
diagnosis suggesting cancer recurrence, recently seen in
thoracic clinic with cough and shortness of breath and
prescribed levofloxacin for presumed bronchitis ([**2148-3-28**]), now
presenting with increasing dyspnea and cough.  Patient reports
cough is chronic for past 2 months, although worsening since
hospitalization with yellow, non-bloody sputum production.
Patient denies fevers and chills but states that he is unable to
walk more than a few feet.  Prior to the PE, patient was able to
walk 200 feet but was started on 2L NC at time of discharge.
Patient states that his shortness of breath has been progressive
and not acute.  Of note, patient has been taking levofloxacin
with sputum becoming less yellow and a one time episode of
nausea following dinner last night.

MEDICAL HISTORY: Past Medical History:
- poorly-differentiated carcinoma of the lung
- DM2
- HTN
- HLD
- s/p CVA ([**2140**]) w residual LUE weakness and numbness
.
Onc History
[**1-/2145**] - diagnosed with cardiac tamponade, PET/CT w left upper
lobe
lung mass, multiple enlarged lymph nodes, brain MRI negative for
mets
[**2-/2145**] - s/p 6 cycles carboplatin/alimta, XRT 6000cGy, follwed
by taxol
[**2-/2147**] - Enlarging LUL mass, started on Tarceva
[**7-/2147**] - 1. Left thoracotomy/left pneumonectomy.  2. Buttressing
of bronchial stump with intercostal muscle.

MEDICATION ON ADMISSION: glimepiride 2 mg Tablet daily
levofloxacin 500 mg Tablet daily
lisinopril-hydrochlorothiazide 20 mg-12.5 mg daily
simvastatin 80 mg Tablet
warfarin 5 mg Tablet
aspirin 81 mg Tablet daily
hydromorphone 2mg PRN

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission:
Vitals: T: BP: 99/61 P: 128 R: 30 O2: 99%
General: Alert, oriented, using accessory muscles to breath
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, Left supraclavicular lymphnode
Lungs: No sounds on left, right side with rhonchi throughout
CV: tacyhcardic, normal S1 + S2, no murmurs, rubs, gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or 1+
edema

FAMILY HISTORY: No family history of lung cancer. His father had
a history of strokes.  His mother had type 2 diabetes.  He has
no
children.

SOCIAL HISTORY: He is married and has no children.  He previously worked in
construction before his diagnosis.  He is originally from
[**Country 6257**] and is accompanied by his friend [**Name (NI) **] [**Name (NI) **] (W:
[**Telephone/Fax (1) 81460**], x16; C: [**Telephone/Fax (1) 81461**]), who he has authorized us to
speak with about his health matters.  He previously smoked [**2-12**]
packs per day x 42 years, quitting in [**2144**]. He drinks 3 bottles
of wine per week. 

### Response:
{'Pneumonia, organism unspecified,Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck,Hyposmolality and/or hyponatremia,Personal history of malignant neoplasm of bronchus and lung,Long-term (current) use of anticoagulants,Personal history of pulmonary embolism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Personal history of tobacco use,Acquired absence of organ, lung,Do not resuscitate status,Tachycardia, unspecified,Hypoxemia,Abnormal coagulation profile'}
