CHIEF COMPLAINT: Right frontal brain tumor

PRESENT ILLNESS: 60yo Rt-handed female presented on [**11-8**] for scheduled craniotomy
and right frontal brain tumor resection.  She has h/o breast
cancer, is on Xeloda and Zometa systemic treatment, s/p
Adriamycin and Cytoxan and radiation, now with diffuse
metastatic disease to spine, and brain mass found on staging
head MRI on [**2147-6-4**].  She had a brain biopsy on [**2148-8-7**] that was
non-diagnostic.  Over last few weeks, she developed left upper
extremity lymphedema, and arm is wrapped.  +Fatigue, Denies any
headache, nausea/vomiting, or visual changes.

MEDICAL HISTORY: 1. Breast Cancer(patient of Dr. [**Last Name (STitle) 2036**]: metastatic to
bone(multiple vertebral bodies, lytic lesions seen throughout
the pelvis and lower lumbar spine). Brain lesion seen on MRI,
biopsy non-diagnostic.  Currrently on Xeloda and Zometa. Also
uses large amount of pain medication: MS Contin 100 QAM and 60
QHS, oxycodone 5mg prn.
2. s/p spine irradiation from T10-T12
3. s/p brain biopsy [**2148-8-7**]
4. pulmonary embolism on coumadin since [**9-16**].
5. recently treated with valtrex for HSV on positive anal
swab([**7-17**]) found due to diarrhea after radiation treatment
6. left femur rod for pathologic fracture

MEDICATION ON ADMISSION: Oxycontin 30 [**Hospital1 **], Oxycodone [**6-20**] prn breakthrough pain, Xeloda
1000 [**Hospital1 **] (14 days on, 7 days off), Zometa infusion Q3months,
Coumadin 3-4 mg QHS, Lorazepam 0.5 QHS prn insomnia

ALLERGIES: Morphine

PHYSICAL EXAM: On admission:
Gen: NAD
CV: RRR
Lungs: CTAB
Abd: soft, NTND

FAMILY HISTORY: Father died from MI at age 79
Mother died from Breast cancer in age 70's.

SOCIAL HISTORY: She is a real estate [**Doctor Last Name 360**]. Has an adopted daughter from [**Name (NI) **].
No tobacco, no etoh. Independent.
Malignant neoplasm of brain, unspecified,Secondary malignant neoplasm of bone and bone marrow,Personal history of malignant neoplasm of breast,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism
Malig neo brain NOS,Secondary malig neo bone,Hx of breast malignancy,Long-term use anticoagul,Hx-ven thrombosis/embols
Name:  [**Known lastname **],[**Known firstname **] J                    Unit No:   [**Numeric Identifier 17224**]

Admission Date:  [**2148-11-8**]              Discharge Date:   [**2148-11-11**]

Date of Birth:  [**2088-3-3**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Morphine

Attending:[**First Name3 (LF) 599**]
Addendum:
The patient has an appointment scheduled with Dr. [**First Name8 (NamePattern2) 17225**]
[**Last Name (NamePattern1) 17226**] (primary care provider covering for Dr. [**Last Name (STitle) 17227**] on
[**2148-11-20**] at 12:40pm to discuss whether Coumadin can be
discontinued.  Pt has a h/o hospitalization for PE on [**9-16**], and
has been holding her Coumadin secondary to craniotomy.

Discharge Disposition:
Home

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 603**] MD [**MD Number(2) 604**]

Completed by:[**2148-11-11**]

Admission Date:  [**2148-11-8**]              Discharge Date:   [**2148-11-11**]

Date of Birth:  [**2088-3-3**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Morphine

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Right frontal brain tumor

Major Surgical or Invasive Procedure:
Right sided craniotomy for removal of brain tumor


History of Present Illness:
60yo Rt-handed female presented on [**11-8**] for scheduled craniotomy
and right frontal brain tumor resection.  She has h/o breast
cancer, is on Xeloda and Zometa systemic treatment, s/p
Adriamycin and Cytoxan and radiation, now with diffuse
metastatic disease to spine, and brain mass found on staging
head MRI on [**2147-6-4**].  She had a brain biopsy on [**2148-8-7**] that was
non-diagnostic.  Over last few weeks, she developed left upper
extremity lymphedema, and arm is wrapped.  +Fatigue, Denies any
headache, nausea/vomiting, or visual changes.

Past Medical History:
1. Breast Cancer(patient of Dr. [**Last Name (STitle) 2036**]: metastatic to
bone(multiple vertebral bodies, lytic lesions seen throughout
the pelvis and lower lumbar spine). Brain lesion seen on MRI,
biopsy non-diagnostic.  Currrently on Xeloda and Zometa. Also
uses large amount of pain medication: MS Contin 100 QAM and 60
QHS, oxycodone 5mg prn.
2. s/p spine irradiation from T10-T12
3. s/p brain biopsy [**2148-8-7**]
4. pulmonary embolism on coumadin since [**9-16**].
5. recently treated with valtrex for HSV on positive anal
swab([**7-17**]) found due to diarrhea after radiation treatment
6. left femur rod for pathologic fracture


Social History:
She is a real estate [**Doctor Last Name 360**]. Has an adopted daughter from [**Name (NI) **].
No tobacco, no etoh. Independent.


Family History:
Father died from MI at age 79
Mother died from Breast cancer in age 70's.

Physical Exam:
On admission:
Gen: NAD
CV: RRR
Lungs: CTAB
Abd: soft, NTND

Neuro: A&Ox3, language clear and fluent with good comprehension.
Pupils 3 to 2 bilaterally, equally reactive to light.  Visual
fields and EOM's intact bilaterally without nystagmus.
CN2-12 intact. No pronator drift. Sensation intact bilaterally
throughout.  Strength 5/5 bilaterally throughout.  Normal gait.

Pertinent Results:
On admission:
[**2148-11-8**] WBC-4.1# RBC-3.01* HGB-11.5* HCT-32.4* MCV-108*
MCH-38.1* MCHC-35.4* RDW-15.6*  PLT COUNT-102*
[**2148-11-8**] GLUCOSE-142* UREA N-12 CREAT-0.6 SODIUM-147*
POTASSIUM-3.3 CHLORIDE-111* TOTAL CO2-29 ANION GAP-10
[**2148-11-8**] PT-11.6 PTT-25.9 INR(PT)-1.0
[**2148-11-8**] CALCIUM-8.7 PHOSPHATE-1.5*

On discharge:
[**2148-11-11**] WBC-5.2 RBC-3.44* Hgb-12.7 Hct-36.6 MCV-107* MCH-36.8*
MCHC-34.6 RDW-16.0* Plt Ct-85*
[**2148-11-11**] Glucose-101 UreaN-11 Creat-0.5 Na-143 K-3.5 Cl-107
HCO3-29

Brief Hospital Course:
Pt underwent right-sided craniotomy and Rt frontal tumor
resection on [**2148-11-8**].  She was admitted to ICU post-operatively
for close monitoring.  Post-op course was uncomplicated, and she
was transferred to the floor on POD#1.  Pt's neurologic
condition remained stable throughout.  Preoperatively, the pt
was being seen by physical therapy as outpt for wrapping her arm
(lymphedema).  PT/OT were consulted while pt was inpatient, and
they recommended that she continue her outpt treatments upon
d/c.  On the day of discharge, she is doing well, afebrile,
AVSS, tolerating PO, ambulating.

Medications on Admission:
Oxycontin 30 [**Hospital1 **], Oxycodone [**6-20**] prn breakthrough pain, Xeloda
1000 [**Hospital1 **] (14 days on, 7 days off), Zometa infusion Q3months,
Coumadin 3-4 mg QHS, Lorazepam 0.5 QHS prn insomnia

Discharge Medications:
** Note: Hold Coumadin until seen in [**Hospital 4695**] clinic for
follow-up.

1. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
Disp:*90 Capsule(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. OxyContin 20 mg Tablet Sustained Release 12 hr Sig: 1.5
Tablet Sustained Release 12 hrs PO twice a day as needed for
pain for 2 weeks.
Disp:*60 Tablet Sustained Release 12 hr(s)* Refills:*0*
4. Dexamethasone 1 mg Tablet Sig: Four (4) Tablet PO tid () for
6 doses: Take 4 tablets three times a day x6 doses, then 3
tablets TID x6 doses, then 2 tablets TID x6 doses, then 2
tablets [**Hospital1 **] continuous until otherwise directed.
Disp:*100 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Brain Mass, Breast Cancer


Discharge Condition:
Neurologically stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY/HEAD INJURY

??????	Have a family member check your incision daily for signs of
infection
??????	Take your pain medicine as prescribed
??????	Exercise should be limited to walking; no lifting, straining,
excessive bending
??????	You may wash your hair only after sutures and/or staples have
been removed
??????	You may shower before this time with assistance and use of a
shower cap
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????	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, drainage
??????	Fever greater than or equal to 101?????? F


Followup Instructions:
[**2148-11-18**]:  Dr.[**Name (NI) 9034**] clinic ([**Telephone/Fax (1) 673**]) for follow-up and
to have your staples out.
Note: Do not take your Coumadin until you are seen in followup
at Dr.[**Name (NI) 9034**] office.
{'Malignant neoplasm of brain, unspecified,Secondary malignant neoplasm of bone and bone marrow,Personal history of malignant neoplasm of breast,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism'}


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: Right frontal brain tumor

PRESENT ILLNESS: 60yo Rt-handed female presented on [**11-8**] for scheduled craniotomy
and right frontal brain tumor resection.  She has h/o breast
cancer, is on Xeloda and Zometa systemic treatment, s/p
Adriamycin and Cytoxan and radiation, now with diffuse
metastatic disease to spine, and brain mass found on staging
head MRI on [**2147-6-4**].  She had a brain biopsy on [**2148-8-7**] that was
non-diagnostic.  Over last few weeks, she developed left upper
extremity lymphedema, and arm is wrapped.  +Fatigue, Denies any
headache, nausea/vomiting, or visual changes.

MEDICAL HISTORY: 1. Breast Cancer(patient of Dr. [**Last Name (STitle) 2036**]: metastatic to
bone(multiple vertebral bodies, lytic lesions seen throughout
the pelvis and lower lumbar spine). Brain lesion seen on MRI,
biopsy non-diagnostic.  Currrently on Xeloda and Zometa. Also
uses large amount of pain medication: MS Contin 100 QAM and 60
QHS, oxycodone 5mg prn.
2. s/p spine irradiation from T10-T12
3. s/p brain biopsy [**2148-8-7**]
4. pulmonary embolism on coumadin since [**9-16**].
5. recently treated with valtrex for HSV on positive anal
swab([**7-17**]) found due to diarrhea after radiation treatment
6. left femur rod for pathologic fracture

MEDICATION ON ADMISSION: Oxycontin 30 [**Hospital1 **], Oxycodone [**6-20**] prn breakthrough pain, Xeloda
1000 [**Hospital1 **] (14 days on, 7 days off), Zometa infusion Q3months,
Coumadin 3-4 mg QHS, Lorazepam 0.5 QHS prn insomnia

ALLERGIES: Morphine

PHYSICAL EXAM: On admission:
Gen: NAD
CV: RRR
Lungs: CTAB
Abd: soft, NTND

FAMILY HISTORY: Father died from MI at age 79
Mother died from Breast cancer in age 70's.

SOCIAL HISTORY: She is a real estate [**Doctor Last Name 360**]. Has an adopted daughter from [**Name (NI) **].
No tobacco, no etoh. Independent. 

### Response:
{'Malignant neoplasm of brain, unspecified,Secondary malignant neoplasm of bone and bone marrow,Personal history of malignant neoplasm of breast,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism'}
