CHIEF COMPLAINT: Elective LN biopsy

PRESENT ILLNESS: 80 yo M with h/o CAD s/p 3 vessel CABG, afib,
obstructive/restrictive lung dz presents to the medicine service
from the SICU after transbronchial biopsy for hilar mass
complicated by hypercarbic respiratory failure, SOB, and acute
hypertension. Patient originally presented for EBUS with
transbronchial biopsy of known hilar mass. The procedure was
performed without incident. However, the patient's
post-procedure course was complicated by hypercarbia and SOB,
which necessitated observation in the SICU. His pCO2 was 87 at
that time. He was oxygenated with BiPAP eventually weaning him
to to 1L NC. His pCO2 decreased to the mid 50s. He maintained
his oxygenation throughout. However, during this course, the
patient became hypertensive. Given his extensive history of
heart disease, the patient was ruled out for MI. The patient
also has known afib but had not been anticoagulated given the
recent procedure.
.
On transfer to the floor, the patient was in good spirits. He
did not complain of any residual pain, though he did have blood
tinged sputum. His BP was stable at 125/42.

MEDICAL HISTORY: CAD, s/p 3 vessel CABG in [**2122**]
Afib on coumadin
HTN
Type 2 DM
Hyperlipidemia
Obstructive/Restrictive lung dz FEV 1.0
LLL resection prior to [**2113**]
Prostate ca s/p radiation
s/p cholecystectomy

MEDICATION ON ADMISSION: zocor 40mg qd, lasix 20mg [**Hospital1 **], asa 81mg qd, lisinopril 5mg qd,
salsalate 750mg [**Hospital1 **], glipizide 15mg [**Hospital1 **], coumadin 5mg daily (d/c
15 days ago), citalopram 10mg qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T 98, BP 125/42, HR 78, RR 24, 98% 1L
Gen: Alert, talkative, NAD
HEENT: EOMI, PERRL, anicteric sclera, MMM, dentition poor
Neck: supple, no LAD, no JVD, + bruits
Lung: CTAB, no wheezes, rales, or crackles
Heart: Irreg irreg, [**1-29**] sys murmur heard best at base
Abd: soft NT/ND, normoactive BS
Back: No CVA tenderness
GU: deferred
Ext: warm, well perfused, no pitting edema
Skin: warm, no rashes noted
Neuro: CN II-XII grossly intact
.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home with family. Has remote hx of cigar smoking. No
current alcohol or tobacco.
Acute respiratory failure,Atrial fibrillation,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Aortocoronary bypass status,Personal history of malignant neoplasm of prostate,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Enlargement of lymph nodes
Acute respiratry failure,Atrial fibrillation,Ac posthemorrhag anemia,Chr airway obstruct NEC,Long-term use anticoagul,Hypertension NOS,Aortocoronary bypass,Hx-prostatic malignancy,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Enlargement lymph nodes
Admission Date:  [**2125-10-15**]              Discharge Date:   [**2125-10-17**]

Date of Birth:  [**2045-8-22**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
Elective LN biopsy

Major Surgical or Invasive Procedure:
EBUS tracheal lymph node biopsy


History of Present Illness:
80 yo M with h/o CAD s/p 3 vessel CABG, afib,
obstructive/restrictive lung dz presents to the medicine service
from the SICU after transbronchial biopsy for hilar mass
complicated by hypercarbic respiratory failure, SOB, and acute
hypertension. Patient originally presented for EBUS with
transbronchial biopsy of known hilar mass. The procedure was
performed without incident. However, the patient's
post-procedure course was complicated by hypercarbia and SOB,
which necessitated observation in the SICU. His pCO2 was 87 at
that time. He was oxygenated with BiPAP eventually weaning him
to to 1L NC. His pCO2 decreased to the mid 50s. He maintained
his oxygenation throughout. However, during this course, the
patient became hypertensive. Given his extensive history of
heart disease, the patient was ruled out for MI. The patient
also has known afib but had not been anticoagulated given the
recent procedure.
.
On transfer to the floor, the patient was in good spirits. He
did not complain of any residual pain, though he did have blood
tinged sputum. His BP was stable at 125/42.


Past Medical History:
CAD, s/p 3 vessel CABG in [**2122**]
Afib on coumadin
HTN
Type 2 DM
Hyperlipidemia
Obstructive/Restrictive lung dz FEV 1.0
LLL resection prior to [**2113**]
Prostate ca s/p radiation
s/p cholecystectomy


Social History:
Lives at home with family. Has remote hx of cigar smoking. No
current alcohol or tobacco.

Family History:
NC

Physical Exam:
VS: T 98, BP 125/42, HR 78, RR 24, 98% 1L
Gen: Alert, talkative, NAD
HEENT: EOMI, PERRL, anicteric sclera, MMM, dentition poor
Neck: supple, no LAD, no JVD, + bruits
Lung: CTAB, no wheezes, rales, or crackles
Heart: Irreg irreg, [**1-29**] sys murmur heard best at base
Abd: soft NT/ND, normoactive BS
Back: No CVA tenderness
GU: deferred
Ext: warm, well perfused, no pitting edema
Skin: warm, no rashes noted
Neuro: CN II-XII grossly intact
.


Pertinent Results:
13.5 D \ 14.1 / 209
       --------
         40.4
 N:80.8 L:14.1 M:4.1 E:0.8 Bas:0.2
PT: 14.8  PTT: 30.4  INR: 1.3
.
140  99  19  / 199    AGap=13
-------------
4.0  32  0.7 \
MB: 4  Trop-*T*: <0.01
.
Bronchial biopsy: negative for malignant cells.
.
CXR:
FINDINGS: Compared with 11/20, allowing for interval development
of atelectasis at the left base medially, no obvious significant
interval change in the small left pleural effusion is
appreciated. The right lung is clear. The right CPA is not
included on this film.

Brief Hospital Course:
80 yo M with h/o CAD/CABG, afib, HTN, lung dz with perihilar
mass, s/p transbronchial biopsy complicated by hypercarbia and
HTN, who presented from the SICU for post-procedure management
and observation.
.
P:
Nodule s/p biopsy. A bronchoscopy was performed with sampling of
the mediastinal lymph nodes, and bronchial washings were
obtained as well. Patient's biopsy results were still pending at
time of discharge.
.
Anemia: Pt had acute hematocrit drop after the procedure, likely
secondary to acute blood loss anemia. He had an active type and
screen. His hematocrit stabilized two days after the procedure.
He was advised to restart his coumadin on discharge.
.
SOB/hypercarbia/s/p biopsy: Patient likely had hypercarbic
respiratory failure secondary to oversedation, initially but had
persistent hypoxia after discharge to the floor which was felt
to be secondary to baseline restrictive and obstructive lung
disease, with also component of anemia and recent bronchoscopy
with resultant atelectasis. This improved through the course of
the day, and on discharge, patient was oxygenating well on room
air on discharge, although had desaturation to 88-90% with
ambulation. Most recent ABG demonstrated CO2 in the mid 50's. He
had negative cardiac enzymes, and his EKG was unremarkable, as
was his repeat CXR. He was restarted on his home lasix dose on
discharge. He was ruled out for an MI in the SICU with negative
cardiac enzymes and no EKG changes. He was discharged to home
with home oxygen due to patient concern about hypoxia, despite
good oxygen saturations while in the hospital.
.
His atrial fibrillation was rate controlled and stable. His
coumadin dose was held during admission. For his CAD and
hypertension, his lisinopril dose was uptitrated.
.
He was discharged to home with followup.

Medications on Admission:
zocor 40mg qd, lasix 20mg [**Hospital1 **], asa 81mg qd, lisinopril 5mg qd,
salsalate 750mg [**Hospital1 **], glipizide 15mg [**Hospital1 **], coumadin 5mg daily (d/c
15 days ago), citalopram 10mg qd

Discharge Medications:
1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for HTN: This dose is double your home dose. .
2. Salsalate 750 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Glipizide 10 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day) as needed for [**Hospital1 **].
4. Citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day.
8. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily): This
is a new medication for your blood pressure. .
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Lung mass s/p biopsy
Post operative hypercarbic respiratory distress
Acute blood loss anemia
Hypertension


Discharge Condition:
Good


Discharge Instructions:
Please resume your home medications after discharge, including
your home coumadin. You have been started on a new medication
for your blood pressure called Atenolol, which you should take
daily. Your lisinopril dose was increased as well. These
medications can be titrated by your primary care doctor.


You may resume your normal activities.  You may resume your
regular diet.

Please call or return to the ER if you experience:
- Fever (> 101.5)
- Increasing shortness of breath or trouble breathing
- Increasing pain
- Coughing up increased amounts of blood

Followup Instructions:
[**Last Name (LF) **],[**First Name3 (LF) **] [**Telephone/Fax (1) 3020**]. Please follow up with Dr. [**Last Name (STitle) **] for
your lung procedure.

[**Last Name (LF) **],[**First Name8 (NamePattern2) **] [**Doctor First Name **] [**Telephone/Fax (1) 693**]. Please follow up with Dr.
[**Last Name (STitle) **] in [**11-27**] weeks. You can restart your coumadin after
discharge from the hospital. You should have a repeat blood
count checked at that time to make sure that your blood count is
stable.
{'Acute respiratory failure,Atrial fibrillation,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Aortocoronary bypass status,Personal history of malignant neoplasm of prostate,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Enlargement of lymph nodes'}


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: Elective LN biopsy

PRESENT ILLNESS: 80 yo M with h/o CAD s/p 3 vessel CABG, afib,
obstructive/restrictive lung dz presents to the medicine service
from the SICU after transbronchial biopsy for hilar mass
complicated by hypercarbic respiratory failure, SOB, and acute
hypertension. Patient originally presented for EBUS with
transbronchial biopsy of known hilar mass. The procedure was
performed without incident. However, the patient's
post-procedure course was complicated by hypercarbia and SOB,
which necessitated observation in the SICU. His pCO2 was 87 at
that time. He was oxygenated with BiPAP eventually weaning him
to to 1L NC. His pCO2 decreased to the mid 50s. He maintained
his oxygenation throughout. However, during this course, the
patient became hypertensive. Given his extensive history of
heart disease, the patient was ruled out for MI. The patient
also has known afib but had not been anticoagulated given the
recent procedure.
.
On transfer to the floor, the patient was in good spirits. He
did not complain of any residual pain, though he did have blood
tinged sputum. His BP was stable at 125/42.

MEDICAL HISTORY: CAD, s/p 3 vessel CABG in [**2122**]
Afib on coumadin
HTN
Type 2 DM
Hyperlipidemia
Obstructive/Restrictive lung dz FEV 1.0
LLL resection prior to [**2113**]
Prostate ca s/p radiation
s/p cholecystectomy

MEDICATION ON ADMISSION: zocor 40mg qd, lasix 20mg [**Hospital1 **], asa 81mg qd, lisinopril 5mg qd,
salsalate 750mg [**Hospital1 **], glipizide 15mg [**Hospital1 **], coumadin 5mg daily (d/c
15 days ago), citalopram 10mg qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T 98, BP 125/42, HR 78, RR 24, 98% 1L
Gen: Alert, talkative, NAD
HEENT: EOMI, PERRL, anicteric sclera, MMM, dentition poor
Neck: supple, no LAD, no JVD, + bruits
Lung: CTAB, no wheezes, rales, or crackles
Heart: Irreg irreg, [**1-29**] sys murmur heard best at base
Abd: soft NT/ND, normoactive BS
Back: No CVA tenderness
GU: deferred
Ext: warm, well perfused, no pitting edema
Skin: warm, no rashes noted
Neuro: CN II-XII grossly intact
.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home with family. Has remote hx of cigar smoking. No
current alcohol or tobacco. 

### Response:
{'Acute respiratory failure,Atrial fibrillation,Acute posthemorrhagic anemia,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Aortocoronary bypass status,Personal history of malignant neoplasm of prostate,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Enlargement of lymph nodes'}
