CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 65 year old man with a
history of bronchoalveolar carcinoma since [**2109**], status post
right lower lobe lobectomy times two in [**2111**] and [**2117**], who
noted the acute onset of dyspnea on awakening on [**1-4**]
and dyspnea on exertion upon walking 15 feet.  Denied chest
pain, orthopnea, paroxysmal nocturnal dyspnea, fever, chills,
change in sputum production (chronic), lower extremity
swelling or pain.  He was seen in clinic the afternoon of
[**1-4**] by Dr. [**Last Name (STitle) **] and noted to have oxygen
saturation in the mid-80% range in room air.  Patient was
sent to the emergency room.  In the emergency room he was
afebrile with normal white blood cells.  Oxygen saturation
was 88% in room air and 95% on 6 liters of oxygen.  Computer
tomography scan of the chest noted multiple small pulmonary
emboli.  Patient was felt to be safe for anticoagulation as
CT of the head was negative and there was no history of
bright red blood per rectum or melena.

MEDICAL HISTORY: Bronchoalveolar carcinoma diagnosed in
[**2109**], status post right lower lobe lobectomy times two in
[**2111**] and [**2117**].  In [**2117**] received experimental protocol with
lavage of T53 virus.  In [**2121**] started experimental phase two
trials of Iressa until [**2122-6-6**] when this trial was stopped
due to increased dyspnea on exertion and cough.  Started VEGF
inhibitor at this time until [**2122-12-6**] when it was
discontinued secondary to disease progression.  No mets.  No
history of chemotherapy.  Benign prostatic hypertrophy.
Gout.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother died of liver cancer in her 60s.
Father died of a myocardial infarction.  Brother with
alcoholism.  Sister with lupus.  Three children are well.

SOCIAL HISTORY: The patient is married and lives with his
wife in [**Name (NI) 12670**].  He is a retired manager of a computer
company.  He has three children who live locally.  He quit
smoking 35 years ago after a 15 pack year smoking history.
He drinks two to three glasses of wine per day.  No history
of IV drug abuse.
Other pulmonary embolism and infarction,Malignant neoplasm of other parts of bronchus or lung,Pneumonia, organism unspecified,Acute respiratory failure,Personal history of tobacco use,Unspecified essential hypertension,Gout, unspecified
Pulm embol/infarct NEC,Mal neo bronch/lung NEC,Pneumonia, organism NOS,Acute respiratry failure,History of tobacco use,Hypertension NOS,Gout NOS
Admission Date:  [**2123-1-4**]     Discharge Date:  [**2123-1-11**]

Date of Birth:   [**2057-7-30**]     Sex:  M

Service:  ICU

HISTORY OF PRESENT ILLNESS:  This is a 65 year old man with a
history of bronchoalveolar carcinoma since [**2109**], status post
right lower lobe lobectomy times two in [**2111**] and [**2117**], who
noted the acute onset of dyspnea on awakening on [**1-4**]
and dyspnea on exertion upon walking 15 feet.  Denied chest
pain, orthopnea, paroxysmal nocturnal dyspnea, fever, chills,
change in sputum production (chronic), lower extremity
swelling or pain.  He was seen in clinic the afternoon of
[**1-4**] by Dr. [**Last Name (STitle) **] and noted to have oxygen
saturation in the mid-80% range in room air.  Patient was
sent to the emergency room.  In the emergency room he was
afebrile with normal white blood cells.  Oxygen saturation
was 88% in room air and 95% on 6 liters of oxygen.  Computer
tomography scan of the chest noted multiple small pulmonary
emboli.  Patient was felt to be safe for anticoagulation as
CT of the head was negative and there was no history of
bright red blood per rectum or melena.

PAST MEDICAL HISTORY:  Bronchoalveolar carcinoma diagnosed in
[**2109**], status post right lower lobe lobectomy times two in
[**2111**] and [**2117**].  In [**2117**] received experimental protocol with
lavage of T53 virus.  In [**2121**] started experimental phase two
trials of Iressa until [**2122-6-6**] when this trial was stopped
due to increased dyspnea on exertion and cough.  Started VEGF
inhibitor at this time until [**2122-12-6**] when it was
discontinued secondary to disease progression.  No mets.  No
history of chemotherapy.  Benign prostatic hypertrophy.
Gout.  Hypertension.

MEDICATIONS:  Allopurinol 300 mg p.o. q.d., Toprol sustained
release 50 mg p.o. q.d., tolterodine 2 mg p.o. q.d.,
indomethacin 50 mg p.o. q.d., Solu-Medrol inhaler two puffs
inhaled twice daily, Combivent inhaler two puffs inhaled four
times daily.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient is married and lives with his
wife in [**Name (NI) 12670**].  He is a retired manager of a computer
company.  He has three children who live locally.  He quit
smoking 35 years ago after a 15 pack year smoking history.
He drinks two to three glasses of wine per day.  No history
of IV drug abuse.

FAMILY HISTORY:  Mother died of liver cancer in her 60s.
Father died of a myocardial infarction.  Brother with
alcoholism.  Sister with lupus.  Three children are well.

PHYSICAL EXAMINATION:  Pleasant, elderly, white male, mildly
tachypneic, otherwise appeared comfortable.  Temperature
97.7, blood pressure 133/79, heart rate 95, respiratory rate
24, oxygen saturation 88% in room air to 95% on 6 liters
nasal cannula.  Head normocephalic, atraumatic.  Pupils
equal, round and reactive to light.  Extraocular movements
intact.  Sclerae anicteric.  Mucous membranes moist.
Oropharynx clear.  Neck supple, no jugular venous distention,
no lymphadenopathy.  Breathing was mildly labored, but with
no accessory muscle use.  Decreased breath sounds at the
right base and focal wheezes.  Left lung clear to
auscultation.  Heart tachycardiac, but regular with no
murmurs, gallops or rubs, normal S1, S2 heart sounds
appreciated.  Abdomen soft, nondistended, nontender with
normoactive bowel sounds and no hepatosplenomegaly.
Extremities without cyanosis, clubbing or edema, 2+ distal
pulses, no swelling or erythema, negative Homans sign.
Neurologically cranial nerves II-XII were intact.  Patient
was alert and oriented to person, place and time.

LABORATORY DATA:  White blood cell count 1.0, hematocrit
38.2, platelets 315, MCV 96.  Differential 84 neutrophils, 9
lymphocytes, 4 monocytes, 1 eosinophil.  PT 12.8, INR 1.1,
PTT 24.1.  Sodium 138, potassium 4.2, chloride 105, CO2 26,
BUN 17, creatinine 0.9, glucose 105.  ALT 20, AST 28,
alkaline phosphatase 97, LDH 355, total bilirubin 0.6,
albumin 3.5.  C3 159, C4 20.  ESR 74.  Urinalysis amber,
hazy, specific gravity 1.025, 5 red cells, 2 white cells, no
bacteria, less than 1 epithelial cell.  Electrocardiogram
normal sinus rhythm at 85 beats per minute, normal axis,
normal intervals, no Q waves, no ST segment or T wave changes
as compared with [**2122-12-21**].  Chest x-ray showed
worsening bilateral opacities compared with [**2121-3-6**] with
increased tumor burden.  Cannot rule out infectious process.
Computer tomography angiogram protocol of the chest showed
five to six small pulmonary emboli in third order branches of
the left lung.  Right lung difficult to assess due to
extensive tumor burden.  Computer tomography of the head
showed no mass lesions.

HOSPITAL COURSE:  The patient was admitted to oncology
medicine.  He was treated with heparin and supportive care
for hypoxia.  From the beginning of [**Hospital 228**] hospital stay
he and his wife expressed some desire that he be DNR/DNI.
This was discussed further in multiple meetings with
patient's oncologist.  At many times during the hospital stay
patient wished to be full code with resuscitation measures as
necessary; at other times he wished to be do not
resuscitate/do not intubate.  In summary, he wished to have
resuscitation measures taken if reversal of his condition was
likely, but did not wish to be intubated if his decline was
likely to continue.  Unfortunately, his hypoxia never
improved and, in fact, got worse between [**1-4**] and
[**2123-1-8**].  He was empirically treated with IV
methylprednisolone, levofloxacin, trimethoprim sulfamethizole
and nebulizers as well as IV heparin.  He was transferred to
the medical intensive care unit on [**1-8**] in order to give
him the opportunity to try noninvasive positive pressure
ventilation.

Mask ventilation did result in improvement in hypoxia while
patient remained on noninvasive positive pressure
ventilation.  However, he continued to be profoundly hypoxic
with oxygen saturation in the 80s on nonrebreather oxygen
face mask whenever off noninvasive positive pressure
ventilation.  On [**1-10**] it was felt that any improvement
in hypoxia that patient would experience in the acute setting
had already occurred.  That is to say that no further
improvement in severe hypoxia was expected without further
therapy.  Options were discussed with the patient and his
wife, [**Name (NI) **], and all agreed to try thrombolytic therapy with
tissue plasminogen activator in order to attempt to improve
perfusion of the pulmonary capillary bed.  Patient and wife
understood that this therapy might not work to improve
oxygenation and might, in fact, make him worse.  However, it
was felt that in the absence of this therapy, there was no
likelihood of recovery of oxygenation.  Code status was again
addressed with patient and wife.  [**Name (NI) 6419**] felt that if
thrombolytic therapy did not succeed and patient's hypoxia
was likely to be continuous, then he would not wish to be
intubated.  His code status was changed to do not
resuscitate/do not intubate confirmed by Dr. [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **].

Over the course of [**1-10**] patient experienced gradual
worsening of hypoxia and increased work of breathing.
Noninvasive positive pressure ventilation eventually became
quite uncomfortable for him and patient's family agreed to
retreat to nonrebreather face mask therapy for patient's
comfort.  IV morphine was administered, first in boluses and
then by continuous infusion.  Family was present and
supportive throughout the evening.  At 1:30 a.m. patient was
found to have no cardiopulmonary activity on telemetry.
Pupils were fixed and dilated.  Patient had no spontaneous
cardiac or respiratory sounds.  He was unresponsive to verbal
and tactile stimuli.  Patient was pronounced dead at 1:30
a.m. on [**2123-1-11**].  Per patient's wife, [**Name (NI) **] [**Name (NI) **],
patient had always said that he would want an autopsy to
improve medical learning in any way possible.  Wife's written
consent was obtained for post mortem examination.






                          [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3795**]

Dictated By:[**Last Name (NamePattern1) 8352**]

MEDQUIST36

D:  [**2123-1-11**]  02:49
T:  [**2123-1-12**]  14:00
JOB#:  [**Job Number 34288**]
{'Other pulmonary embolism and infarction,Malignant neoplasm of other parts of bronchus or lung,Pneumonia, organism unspecified,Acute respiratory failure,Personal history of tobacco use,Unspecified essential hypertension,Gout, unspecified'}


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: 

PRESENT ILLNESS: This is a 65 year old man with a
history of bronchoalveolar carcinoma since [**2109**], status post
right lower lobe lobectomy times two in [**2111**] and [**2117**], who
noted the acute onset of dyspnea on awakening on [**1-4**]
and dyspnea on exertion upon walking 15 feet.  Denied chest
pain, orthopnea, paroxysmal nocturnal dyspnea, fever, chills,
change in sputum production (chronic), lower extremity
swelling or pain.  He was seen in clinic the afternoon of
[**1-4**] by Dr. [**Last Name (STitle) **] and noted to have oxygen
saturation in the mid-80% range in room air.  Patient was
sent to the emergency room.  In the emergency room he was
afebrile with normal white blood cells.  Oxygen saturation
was 88% in room air and 95% on 6 liters of oxygen.  Computer
tomography scan of the chest noted multiple small pulmonary
emboli.  Patient was felt to be safe for anticoagulation as
CT of the head was negative and there was no history of
bright red blood per rectum or melena.

MEDICAL HISTORY: Bronchoalveolar carcinoma diagnosed in
[**2109**], status post right lower lobe lobectomy times two in
[**2111**] and [**2117**].  In [**2117**] received experimental protocol with
lavage of T53 virus.  In [**2121**] started experimental phase two
trials of Iressa until [**2122-6-6**] when this trial was stopped
due to increased dyspnea on exertion and cough.  Started VEGF
inhibitor at this time until [**2122-12-6**] when it was
discontinued secondary to disease progression.  No mets.  No
history of chemotherapy.  Benign prostatic hypertrophy.
Gout.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother died of liver cancer in her 60s.
Father died of a myocardial infarction.  Brother with
alcoholism.  Sister with lupus.  Three children are well.

SOCIAL HISTORY: The patient is married and lives with his
wife in [**Name (NI) 12670**].  He is a retired manager of a computer
company.  He has three children who live locally.  He quit
smoking 35 years ago after a 15 pack year smoking history.
He drinks two to three glasses of wine per day.  No history
of IV drug abuse. 

### Response:
{'Other pulmonary embolism and infarction,Malignant neoplasm of other parts of bronchus or lung,Pneumonia, organism unspecified,Acute respiratory failure,Personal history of tobacco use,Unspecified essential hypertension,Gout, unspecified'}
