CHIEF COMPLAINT: 

PRESENT ILLNESS: Ms [**Known lastname 12746**] is a 41 year old
woman who first presented to the [**Hospital **] Clinic with a known
high risk for developing breast cancer due to having a BRCA-2
mutation.  Prior to her presentation she felt a lump within
undergone a fine needle aspiration at the time which was
nondiagnostic.  She had also undergone a diagnostic left
mammogram and ultrasound which were suspicious for cancer.
The patient then underwent excision of the mass at the [**Hospital 36653**]
Clinic in [**2173-2-10**] which revealed infiltrating ductal
carcinoma.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 1.  Lexapro 10 mg p.o. q. day; 2.
Clonazepam 1.5 mg t.i.d.; 3.  Synthroid 1 mg q. day; 4.
Verapamil 120 mg q. AM; 5.  Hydrochlorothiazide 37.5 mg q.
day; 6.  Chlorcon q. AM; 7.  B12 vitamin; 8.  Iron; 9.
Elavil 40 mg p.o. q.h.s.; 9.  Flovent inhaler; 10.  Atrovent
inhaler; 11. Albuterol inhaler

ALLERGIES: Codeine as well as narcotics, Prozac, Neurontin,
Penicillin, Bactrim, Iodine, Betadine, Versed, Stadol, Biaxin
and adhesive tape.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for her sister developing breast
cancer at age 41 and testing positive for mutation of the BRCA
gene. She also has a mother who had breast cancer at the age of
62 and both maternal aunts and maternal grandmother with breast
cancer their the early 60s.  No history of ovarian cancers in
the family.

SOCIAL HISTORY: The patient does not smoke and does not
drink.  She has one daughter.
Malignant neoplasm of other specified sites of female breast,Mitral valve disorders,Asthma, unspecified type, unspecified,Sicca syndrome,Iron deficiency anemia, unspecified,Family history of malignant neoplasm of breast,Obsessive-compulsive disorders
Malign neopl breast NEC,Mitral valve disorder,Asthma NOS,Sicca syndrome,Iron defic anemia NOS,Family hx-breast malig,Obsessive-compulsive dis
Admission Date:  [**2173-3-24**]       Discharge Date:  [**2173-3-27**]

Date of Birth:   [**2131-6-22**]       Sex:  F


HISTORY OF PRESENT ILLNESS:  Ms [**Known lastname 12746**] is a 41 year old
woman who first presented to the [**Hospital **] Clinic with a known
high risk for developing breast cancer due to having a BRCA-2
mutation.  Prior to her presentation she felt a lump within
undergone a fine needle aspiration at the time which was
nondiagnostic.  She had also undergone a diagnostic left
mammogram and ultrasound which were suspicious for cancer.
The patient then underwent excision of the mass at the [**Hospital 36653**]
Clinic in [**2173-2-10**] which revealed infiltrating ductal
carcinoma.

anemia.  3.  Iron deficiency.  4.  Chronic fatigue syndrome.
5.  Fibromyalgia.  6.  Obsessive compulsive disorder.  7.
Mitral valve prolapse with murmur.  8.  Endometriosis.  9.
Cervical arthritis.  10.  Asthma.  11.  History of
sarcoidosis.  12.  Neurogenic bladder.  13.  Probable
atypical migraine.  14.  Probable Raynaud's phenomenon.  15.
Possible Sjogren's disease.

FAMILY HISTORY:  Significant for her sister developing breast
cancer at age 41 and testing positive for mutation of the BRCA
gene. She also has a mother who had breast cancer at the age of
62 and both maternal aunts and maternal grandmother with breast
cancer their the early 60s.  No history of ovarian cancers in
the family.

ALLERGIES:  Codeine as well as narcotics, Prozac, Neurontin,
Penicillin, Bactrim, Iodine, Betadine, Versed, Stadol, Biaxin
and adhesive tape.

MEDICATIONS ON ADMISSION:  1.  Lexapro 10 mg p.o. q. day; 2.
Clonazepam 1.5 mg t.i.d.; 3.  Synthroid 1 mg q. day; 4.
Verapamil 120 mg q. AM; 5.  Hydrochlorothiazide 37.5 mg q.
day; 6.  Chlorcon q. AM; 7.  B12 vitamin; 8.  Iron; 9.
Elavil 40 mg p.o. q.h.s.; 9.  Flovent inhaler; 10.  Atrovent
inhaler; 11. Albuterol inhaler

PAST SURGICAL HISTORY:  1.  Laparoscopy followed by two
further surgeries for endometriosis; 2.  Total thyroidectomy;
3.  Partial parathyroidectomy; 4.  Sinus surgery; 5.
[**Last Name (un) 14896**] procedure; 6.  Stimulator placement for neurogenic
bladder.

SOCIAL HISTORY:  The patient does not smoke and does not
drink.  She has one daughter.

PHYSICAL EXAMINATION:  Well-appearing female in no acute
distress.  Blood pressure 106/76, pulse 80, respiratory rate
12.  Head, eyes, ears, nose and throat examination, within
normal limits.  Lung examination, clear to auscultation
bilaterally.  Cardiac examination, regular rate and rhythm
without murmurs, gallops or rubs.  Breast examination shows
prior [**Last Name (un) 14896**] procedure scar in the upper inner quadrant
of the left breast as well as transverse healing scar along
the lower inner quadrant of the left breast.  There were no
suspicious skin changes in four positions.  To palpation she
has normal postoperative changes with no dominant masses.
She has a normal feeling axillary node within the left with
no suspicious axillary, supraclavicular or infraclavicular
lymphadenopathy.

LABORATORY DATA:  Radiologic data - A left mammogram from the
outside hospital was reviewed which showed dense parenchymal
tissue as well as the denser nodule within the lower inner
quadrant of her left breast.  Ultrasound showed a very
irregular hypoechoic mass which was suspicious for carcinoma.

HOSPITAL COURSE:  The patient was explained the different
possibilities given her diagnosis of infiltrating ductal
carcinoma as well as her testing positive for the BRCA gene.
The decision was made to proceed with bilateral mastectomy.
Informed consent was signed and the patient understood the
risks and benefits of the procedure.  On [**2173-3-24**],
the patient was taken to the Operating Room and underwent
bilateral mastectomies and left axillary dissection.  There were
no complications. [**Location (un) 1661**]-[**Location (un) 1662**] drains were placed, two on each
side.  The patient was successfully extubated and transferred to
the Post Anesthesia Care Unit in stable condition.  In the Post
Anesthesia Care Unit she was noted to be very sedated.
Consequently, due to the late hour, the patient was transferred
to the Intensive Care Unit over night.  She continued to do well.
She received adequate intravenous fluids.  She remained NPO over
night.  Her sedation gradually resolved and she was more
alert and oriented on postoperative day #1.  Her pain was
treated with extra strength Tylenol and intravenous Toradol as
she wished to avoid all narcotics.  The patient was advanced to
clears and then regular diet as tolerated.  She was noted to be
hypotensive on post op day #2 slowing ambulation and received
extra intravenous fluids. Her usual Verapamil as well as the
Hydrochlorothiazide were held and her blood pressure stabilized.
She continued to ambulate first with some difficulty but she then
continued to do well without assistance.  Physical therapy was
consulted as well and she ambulated without difficulty.  The
patient was continued on the rest of her outpatient medications
as mentioned above.  The [**Location (un) 1661**]-[**Location (un) 1662**] drains continued to put
out serosanguinous fluid which somewhat decreased in amount.
Her incision continued to look clean, dry and intact
bilaterally.  There was no significant erythema.  There was
minimal swelling.  There were no signs of infection.  The
patient was tolerating regular diet.  The patient received
drain teaching.  She was discharged to home in stable
condition on [**2173-3-27**].

CONDITION ON DISCHARGE:  Good.

DISCHARGE DESTINATION:  Home with [**Hospital6 407**]
Services.

DISCHARGE DIAGNOSIS:
1.  Left breast cancer, status post bilateral mastectomies.
2.  Thyroid cancer.
3.  Pernicious anemia.
4.  Iron deficiency anemia.
5.  Chronic fatigue syndrome.
6.  Fibromyalgia.
7.  Obsessive compulsive disorder.
8.  Endometriosis.
9.  Asthma.
10. Cervical arthritis.
11. History of sarcoidosis.
12. Neurogenic bladder.

DISCHARGE INSTRUCTIONS:  The patient is to follow up with Dr.
[**First Name8 (NamePattern2) 553**] [**Last Name (NamePattern1) **] next week as arranged.  The patient is to empty
her [**Location (un) 1661**]-[**Location (un) 1662**] drains with the help of the visiting nurse
[**First Name (Titles) 3**] [**Last Name (Titles) 8757**] and they are to be removed in the next visit
with Dr. [**Last Name (STitle) **].

DISCHARGE MEDICATIONS:
1.  Extra strength Tylenol and Ibuprofen as needed
2.  Lexapro
3.  Clonazepam
4.  Synthroid
5.  Verapamil
6.  Hydrochlorothiazide
7.  Chlorcon
8.  Vitamin B12
9.  Elavil
10. Iron supplements
11. Flovent
12. Atrovent
13. Albuterol



                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 45904**], M.D.  [**MD Number(1) 45905**]

Dictated By:[**Last Name (NamePattern1) 1741**]
MEDQUIST36

D:  [**2173-3-28**]  18:00
T:  [**2173-3-28**]  18:06
JOB#:  [**Job Number 45906**]
{'Malignant neoplasm of other specified sites of female breast,Mitral valve disorders,Asthma, unspecified type, unspecified,Sicca syndrome,Iron deficiency anemia, unspecified,Family history of malignant neoplasm of breast,Obsessive-compulsive disorders'}


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: Ms [**Known lastname 12746**] is a 41 year old
woman who first presented to the [**Hospital **] Clinic with a known
high risk for developing breast cancer due to having a BRCA-2
mutation.  Prior to her presentation she felt a lump within
undergone a fine needle aspiration at the time which was
nondiagnostic.  She had also undergone a diagnostic left
mammogram and ultrasound which were suspicious for cancer.
The patient then underwent excision of the mass at the [**Hospital 36653**]
Clinic in [**2173-2-10**] which revealed infiltrating ductal
carcinoma.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 1.  Lexapro 10 mg p.o. q. day; 2.
Clonazepam 1.5 mg t.i.d.; 3.  Synthroid 1 mg q. day; 4.
Verapamil 120 mg q. AM; 5.  Hydrochlorothiazide 37.5 mg q.
day; 6.  Chlorcon q. AM; 7.  B12 vitamin; 8.  Iron; 9.
Elavil 40 mg p.o. q.h.s.; 9.  Flovent inhaler; 10.  Atrovent
inhaler; 11. Albuterol inhaler

ALLERGIES: Codeine as well as narcotics, Prozac, Neurontin,
Penicillin, Bactrim, Iodine, Betadine, Versed, Stadol, Biaxin
and adhesive tape.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for her sister developing breast
cancer at age 41 and testing positive for mutation of the BRCA
gene. She also has a mother who had breast cancer at the age of
62 and both maternal aunts and maternal grandmother with breast
cancer their the early 60s.  No history of ovarian cancers in
the family.

SOCIAL HISTORY: The patient does not smoke and does not
drink.  She has one daughter. 

### Response:
{'Malignant neoplasm of other specified sites of female breast,Mitral valve disorders,Asthma, unspecified type, unspecified,Sicca syndrome,Iron deficiency anemia, unspecified,Family history of malignant neoplasm of breast,Obsessive-compulsive disorders'}
