CHIEF COMPLAINT: H/A, N/V x3days

PRESENT ILLNESS: 54F c/o H/A in frontal region of head since Tuesday morning
unrelieved with NSAIDS. She began vomiting Tuesday afternoon and
reports nausea and vomiting since. She denies falls or head
trauma. Denies difficulty walking, dizziness.

MEDICAL HISTORY: 1. Rheumatic heart disease; status post mitral valve replacement
and tricuspid valve replacement in [**2156**] complicated by
postoperative heart block and now status post pacemaker.
2. Dilated cardiomyopathy with an ejection fraction of 40% to
45%.
3. Paroxysmal atrial fibrillation; status post cardioversion.
4. Status post atrial septal defect in [**2133**].
5. Hypertension.
6. Hypothyroidism.
7. Anemia.

MEDICATION ON ADMISSION: Levothyroxine 75mcg', Digoxin 125mcg', Lopressor 50mg", Cartia
XT 120mg', Lisinopril 20mg', Lasix 120mg',Coumadin 5mg', Lipitor
10mg'.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admisson:
Gen: Comfortable, NAD.
HEENT:Atraumatic, Normocephalic Pupils: PERRL     EOMs full
Neck: Supple.
Neuro:
Mental status: Awake and alert x3, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Heart disease

SOCIAL HISTORY: She is a homemaker and lives with husband and children in
[**Name (NI) 1468**].  Quit smoking 3 years ago, 4pack per year history.  No
IVDU, No EtOH
Benign neoplasm of pituitary gland and craniopharyngeal duct,Other optic neuritis,Other primary cardiomyopathies,Other disorders of the pituitary and other syndromes of diencephalohypophyseal origin,Headache,Nausea with vomiting,Heart valve replaced by other means,Cardiac pacemaker in situ,Other chronic pulmonary heart diseases,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Personal history of tobacco use,Rheumatic heart disease, unspecified
Benign neo pituitary,Optic neuritis NEC,Prim cardiomyopathy NEC,Pituitary disorder NEC,Headache,Nausea with vomiting,Heart valve replac NEC,Status cardiac pacemaker,Chr pulmon heart dis NEC,Atrial fibrillation,Hypertension NOS,Hypothyroidism NOS,History of tobacco use,Rheumatic heart dis NOS
Admission Date:  [**2163-9-15**]              Discharge Date:   [**2163-10-2**]

Date of Birth:  [**2109-3-22**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
H/A, N/V x3days


Major Surgical or Invasive Procedure:
Transpenoidal pituitary rsxn([**9-21**])


History of Present Illness:
54F c/o H/A in frontal region of head since Tuesday morning
unrelieved with NSAIDS. She began vomiting Tuesday afternoon and
reports nausea and vomiting since. She denies falls or head
trauma. Denies difficulty walking, dizziness.


Past Medical History:
1. Rheumatic heart disease; status post mitral valve replacement
and tricuspid valve replacement in [**2156**] complicated by
postoperative heart block and now status post pacemaker.
2. Dilated cardiomyopathy with an ejection fraction of 40% to
45%.
3. Paroxysmal atrial fibrillation; status post cardioversion.
4. Status post atrial septal defect in [**2133**].
5. Hypertension.
6. Hypothyroidism.
7. Anemia.


Social History:
She is a homemaker and lives with husband and children in
[**Name (NI) 1468**].  Quit smoking 3 years ago, 4pack per year history.  No
IVDU, No EtOH


Family History:
Heart disease

Physical Exam:
On Admisson:
Gen: Comfortable, NAD.
HEENT:Atraumatic, Normocephalic Pupils: PERRL     EOMs full
Neck: Supple.
Neuro:
Mental status: Awake and alert x3, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3mm to 2mm
bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**4-18**] throughout. No pronator drift

Sensation: Intact to light touch.

Toes downgoing bilaterally

Coordination: Heel to shin

Exam on Discharge:
AOx3, full strength and power throughout all extremities.


Pertinent Results:
Labs on Admission:
[**2163-9-15**] 10:00AM BLOOD WBC-11.0# RBC-4.15* Hgb-12.1 Hct-35.1*
MCV-85 MCH-29.1 MCHC-34.5 RDW-15.7* Plt Ct-303
[**2163-9-15**] 10:00AM BLOOD Neuts-80.0* Lymphs-15.5* Monos-3.2
Eos-0.9 Baso-0.3
[**2163-9-15**] 10:00AM BLOOD PT-43.3* PTT-33.2 INR(PT)-4.8*
[**2163-9-15**] 10:00AM BLOOD Glucose-105 UreaN-13 Creat-0.7 Na-142
K-3.0* Cl-100 HCO3-35* AnGap-10
[**2163-9-16**] 04:20AM BLOOD Calcium-9.0 Phos-3.5 Mg-2.1
[**2163-9-15**] 08:04PM BLOOD LH-4.1 Prolact-13 TSH-2.2
[**2163-9-15**] 08:04PM BLOOD T4-7.9 Free T4-1.1
[**2163-9-15**] 08:04PM BLOOD Cortsol-30.2*
[**2163-9-15**] 10:00AM BLOOD Digoxin-0.4*

Labs on Discharge:
[**2163-9-29**] 10:55AM BLOOD WBC-18.3* RBC-4.17* Hgb-12.4 Hct-35.9*
MCV-86 MCH-29.7 MCHC-34.5 RDW-16.1* Plt Ct-458*
[**2163-9-30**] 09:10AM BLOOD PT-23.3* PTT-45.7* INR(PT)-2.3*
[**2163-9-29**] 10:55AM BLOOD Glucose-141* UreaN-14 Creat-0.8 Na-144
K-3.3 Cl-102 HCO3-32 AnGap-13
[**2163-9-29**] 10:55AM BLOOD Calcium-9.9 Phos-3.5 Mg-2.3

Imaging:
Head CT ([**9-15**]):
IMPRESSION: Hyperdense sellar mass extending to suprasellar
region, most
likely a pituitary macroadenoma. MRI of sella would be helpful
for further
evaluation.

Head CTA([**9-15**])
IMPRESSION:
1. Sellar mass with suprasellar extension and potential mass
effect upon the optic chiasm. MRI is recommended if possible to
further evaluate these
structures. Diagnostic possibilities include macroadenoma, with
or without
hemorrhage, and less likely a Rathke's cleft cyst.
2. No evidence of intracranial hemorrhage. However, the density
of hte lesion itself may reflect prior bleeding. Pituitary
apoplexy cannot be excluded on CT imaging. Normal CTA circle of
[**Location (un) 431**].

Cards ECHO([**9-16**])
IMPRESSION: Normal global and regional left ventricular systolic
function. Mild global right ventricular systolic dysfunction.
Mechanical mitral valve prosthesis with borderline-high
gradients. Normally-functioning tricuspid annuloplasty ring.
Mild pulmonary hypetension.

CXR [**9-20**]:
IMPRESSION:
1. No acute cardiopulmonary abnormality.
2. Unchanged cardiomegaly.
3. Subsegmental atelectasis left lung base.

Head CT [**9-21**]:
NOTE ADDED IN ATTENDING REVIEW:
1) No short-interval change in hyperattenuating, round primarily
intrasellar mass with suprasellar extension, remodeling the
dorsum sellae; dDx includes macroadenoma, perhaps with
hemorrhage, as well as intrasellar
craniopharyngioma or Rathke cyst.
2) Possibly low-lying cerebellar tonsils (unrelated), which
should be
clarified at time of MRI.

Head CT [**9-28**]:
IMPRESSION:
1. No acute intracranial abnormality.
2. Posteroperative chcanges of trans-sphenoidal resection of
pituitary mass, with decreased volume of mass within the sella
turcica.



Brief Hospital Course:
Patient was admitted on [**9-15**] via ED with complaint of Nausea and
vomiting for three days. Head ct was performed and a pituitary
mass identified.
Dx:Non-hem. pituitary lesion. After adequate work up and
consults with opthomology for visual field testing and
endocrinology, transpenoidal pituitary resection was conducted
on [**9-21**]. Post operatively her neuro exam was completely intact,
but there was question as to her pacemaker working appropriated.
It was interrogated, and deemed appropriate. Diuretic therapy
was withheld for several days post operatively to ensure the
absence of DI symptoms. She was restarted on Lasix on [**9-28**] at
60mg twice daily, as she appeared to be adequately diuresed
after surgery.  Serum sodium and osm, as well as urine sodium,
osm, and specific gravity remained stable during
hospitalization, only requiring one dose of vasopressin on
POD#3. On POD#5, systemic heparin drip was started for her
mechanical valve.  Coumadin was restarted on [**2163-9-27**].  She
received the following doses, 10mg, 10mg, 15mg, and 5mg during
her hospitalization.  On [**10-2**] she was discharge to home without
the need of services with a INR of 2.5 and direction to follow
up with PCP on [**Name9 (PRE) 766**] AM for blood drawing to ensure adequate
INR level.

Medications on Admission:
Levothyroxine 75mcg', Digoxin 125mcg', Lopressor 50mg", Cartia
XT 120mg', Lisinopril 20mg', Lasix 120mg',Coumadin 5mg', Lipitor
10mg'.


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
9. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for Pain.
Disp:*30 Tablet(s)* Refills:*0*
11. Furosemide 20 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day).
Disp:*90 Tablet(s)* Refills:*0*
12. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.
13. Dexamethasone Sodium Phosphate 4 mg/mL Solution Sig: One (1)
 Injection once a day: Inject into the muscle daily on days that
you feel ill and/or unable to take your oral steroid medication.
Disp:*QS 4 doses* Refills:*0*
14. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
15. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*3 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Pituitary Mass


Discharge Condition:
Neurologically Stable


Discharge Instructions:
General Instructions

??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
  *Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	You may continue to take your oral anticoagulation as
prescribed before hospitalization.  Please be sure to follow up
with your PCP in the next couple days for blood drawing to
ensure an appropriate blood level
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.

If on any day you do not feel well enought to take your oral
steriods; be sure to take the injection version as prescribed.

Followup Instructions:
Follow-Up Appointment Instructions
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in 6 weeks.
??????You will need a CT scan of the brain without contrast.

You also have the following appointments scheduled:
Endocrine:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 37077**], MD Phone:[**Telephone/Fax (1) 1803**]
Date/Time:[**2163-10-14**] 4:00
{'Benign neoplasm of pituitary gland and craniopharyngeal duct,Other optic neuritis,Other primary cardiomyopathies,Other disorders of the pituitary and other syndromes of diencephalohypophyseal origin,Headache,Nausea with vomiting,Heart valve replaced by other means,Cardiac pacemaker in situ,Other chronic pulmonary heart diseases,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Personal history of tobacco use,Rheumatic heart disease, 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: H/A, N/V x3days

PRESENT ILLNESS: 54F c/o H/A in frontal region of head since Tuesday morning
unrelieved with NSAIDS. She began vomiting Tuesday afternoon and
reports nausea and vomiting since. She denies falls or head
trauma. Denies difficulty walking, dizziness.

MEDICAL HISTORY: 1. Rheumatic heart disease; status post mitral valve replacement
and tricuspid valve replacement in [**2156**] complicated by
postoperative heart block and now status post pacemaker.
2. Dilated cardiomyopathy with an ejection fraction of 40% to
45%.
3. Paroxysmal atrial fibrillation; status post cardioversion.
4. Status post atrial septal defect in [**2133**].
5. Hypertension.
6. Hypothyroidism.
7. Anemia.

MEDICATION ON ADMISSION: Levothyroxine 75mcg', Digoxin 125mcg', Lopressor 50mg", Cartia
XT 120mg', Lisinopril 20mg', Lasix 120mg',Coumadin 5mg', Lipitor
10mg'.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admisson:
Gen: Comfortable, NAD.
HEENT:Atraumatic, Normocephalic Pupils: PERRL     EOMs full
Neck: Supple.
Neuro:
Mental status: Awake and alert x3, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Heart disease

SOCIAL HISTORY: She is a homemaker and lives with husband and children in
[**Name (NI) 1468**].  Quit smoking 3 years ago, 4pack per year history.  No
IVDU, No EtOH 

### Response:
{'Benign neoplasm of pituitary gland and craniopharyngeal duct,Other optic neuritis,Other primary cardiomyopathies,Other disorders of the pituitary and other syndromes of diencephalohypophyseal origin,Headache,Nausea with vomiting,Heart valve replaced by other means,Cardiac pacemaker in situ,Other chronic pulmonary heart diseases,Atrial fibrillation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Personal history of tobacco use,Rheumatic heart disease, unspecified'}
