CHIEF COMPLAINT: ICH

PRESENT ILLNESS: The patient is a 74yo R-handed man with a history of MI,
hyperlipidemia and melanoma, who is transferred from OSH for an
ICH.

MEDICAL HISTORY: -NSTEMI [**2129**] with OM1 PTCA
-Dyslipidemia
-Previous epistaxis r/t ASA
-Asthma
-denies HTN
-melanoma x2 (chest, first superficial then recurred deeper with
negative axillary lymphnodes

MEDICATION ON ADMISSION: Lipitor 40mg daily
Gemfibrozil 600mg [**Hospital1 **]
Zetia 10mg daily
ASA 325mg daily
Pepcid 10mg daily
Prevacid 30mg p.r.n.
Advair 1 puff [**Hospital1 **]
Albuterol inhaler p.r.n.
Viagra p.r.n.
Ambien p.r.n.

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: VITALS: Tafebrile HR87 BP102/58 (162/83) RR11  sO2 100
GEN: intubated
HEENT: mmm, no scleral icterus
NECK: no LAD; no carotid bruits; neck supple
LUNGS: Clear to auscultation bilaterally
HEART: Regular rate and rhythm, normal S1 and S2
ABDOMEN: normal bowel sounds, soft, nontender, nondistended
EXTREMITIES: no clubbing, cyanosis, ecchymosis, or edema; no
suspicious moles on the chest

FAMILY HISTORY: CAD: Brother had CABG in his 60's.

SOCIAL HISTORY: Occupation: toy salesman.
married for 35 years
Son who lives in the area and another lives in [**Doctor First Name 5256**]
and is a Neurosurgery PA.
Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Secondary malignant neoplasm of lung,Other convulsions,Acute respiratory failure,Iatrogenic pneumothorax,Personal history of malignant melanoma of skin,Late effects of cerebrovascular disease, aphasia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Old myocardial infarction,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Percutaneous transluminal coronary angioplasty status
Sec mal neo brain/spine,Intracerebral hemorrhage,Secondary malig neo lung,Convulsions NEC,Acute respiratry failure,Iatrogenic pneumothorax,Hx-malig skin melanoma,Late eff CV dis-aphasia,BPH w/o urinary obs/LUTS,Old myocardial infarct,Hyperlipidemia NEC/NOS,Asthma NOS,Fam hx-ischem heart dis,Status-post ptca
Name:  [**Known lastname **],[**Known firstname 1500**]                    Unit No:   [**Numeric Identifier 14972**]

Admission Date:  [**2144-11-6**]              Discharge Date:   [**2144-11-15**]

Date of Birth:  [**2070-9-6**]             Sex:   M

Service: NEUROLOGY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 542**]
Addendum:
Was noticed by floating case manager that there are no VNA
services available in the area which Mr. [**Known lastname **] lives. VNA was
arranged for home safety evaluation and to get his dilantin
level checked. I will contact his primary care phyisican [**Name (NI) 14974**]
[**Doctor Last Name 14975**] regarding checking his dilantin level as her transitions
to Keppra and possibly helping set up a home safety evaluation
through her offices.

Discharge Disposition:
Home With Service

Facility:
[**Company 720**]

                             [**First Name11 (Name Pattern1) 194**] [**Last Name (NamePattern4) 544**] MD [**MD Number(1) 545**]

Completed by:[**2144-11-18**]

Name:  [**Known lastname **],[**Known firstname 1500**]                    Unit No:   [**Numeric Identifier 14972**]

Admission Date:  [**2144-11-6**]              Discharge Date:   [**2144-11-15**]

Date of Birth:  [**2070-9-6**]             Sex:   M

Service: NEUROLOGY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 542**]
Addendum:
Called Mr. [**Known lastname 14973**] family regarding follow-up in [**Hospital 9348**]
clinic at [**Last Name (NamePattern1) 3895**] [**Hospital Unit Name **] [**Location (un) **] on [**2144-11-20**] between
10am to 12pm to get your stitches removed.

Discharge Disposition:
Home With Service

Facility:
[**Company 720**]

                             [**First Name11 (Name Pattern1) 194**] [**Last Name (NamePattern4) 544**] MD [**MD Number(1) 545**]

Completed by:[**2144-11-18**]

Admission Date:  [**2144-11-6**]              Discharge Date:   [**2144-11-15**]

Date of Birth:  [**2070-9-6**]             Sex:   M

Service: NEUROLOGY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 4583**]
Chief Complaint:
ICH

Major Surgical or Invasive Procedure:
Intubation x2
Stereotactic brain biopsy


History of Present Illness:
The patient is a 74yo R-handed man with a history of MI,
hyperlipidemia and melanoma, who is transferred from OSH for an
ICH.

The patient was at home watching TV, when he suddenly became
unable to speak. He walked to his wife who was in another room
(normal giat, no facial droop noticed), and was only able to get
a few words out ([**Last Name (un) 46536**], [**Last Name (un) 46536**]). He could not give his wife the
name of his children or the date, and at that point she decided
to call 911.

At the OSH, he continued to be unable to speak, but otherwise he
seemed intact. A CT head revealed an ICH in the L-frontotemporal
region, with some edema, possibly underlying mass. He received
decadron 10mg iv before he was transferred to [**Hospital1 18**].

When he arrived in the ED, he was still unable to speak. He was
unable to follow commands per nursing staff. Otherwise he still
appeared intact. Around 20.00 he had a seizure. He turned his
head and eyes to the R and then the seizure generalized. It
lasted a few minutes and he received ativan 1mg iv. He was
postictal for some 5 minutes, hardly responsive, but then seemed
to recover some. He was still not speaking. Then he became very
combatative and was intubated.

ROS: per wife he did not complain of any fever, chills,
headache, neck pain, nausea, vomiting, weakness, chest pain.

Past Medical History:
-NSTEMI [**2129**] with OM1 PTCA
-Dyslipidemia
-Previous epistaxis r/t ASA
-Asthma
-denies HTN
-melanoma x2 (chest, first superficial then recurred deeper with
negative axillary lymphnodes


Social History:
Occupation: toy salesman.
married for 35 years
Son who lives in the area and another lives in [**Doctor First Name 5256**]
and is a Neurosurgery PA.


Family History:
CAD: Brother had CABG in his 60's.

Physical Exam:
VITALS: Tafebrile HR87 BP102/58 (162/83) RR11  sO2 100
GEN: intubated
HEENT: mmm, no scleral icterus
NECK: no LAD; no carotid bruits; neck supple
LUNGS: Clear to auscultation bilaterally
HEART: Regular rate and rhythm, normal S1 and S2
ABDOMEN: normal bowel sounds, soft, nontender, nondistended
EXTREMITIES: no clubbing, cyanosis, ecchymosis, or edema; no
suspicious moles on the chest

MENTAL STATUS:
intubated; not responding to voice; not following commands

CRANIAL NERVES:
II: pupils 0.5mm non-reactive
III, IV, VI: oculocephalics intact
V: corneal and nose tickle intact
VII: Facial movement symmetrical when grimacing
VIII: -
IX: gag intact
XII: -
[**Doctor First Name 81**]: -

MOTOR SYSTEM: Normal bulk and tone bilaterally. Moves all
extremities to noxious: withdrawal on the RUE, RLE; extension on
the LUE and triple flexion in the LLE.

SENSORY SYSTEM: responds to noxious in all 4 extremities (see
above)

REFLEXES:
B T Br Pa Pl
Right 2 2 2 2 1
Left  2 2 2 2 1, reflexes are symmetrically brisk in UE
Toes: downgoing on the R, upgoing on the L

COORDINATION: unable to assess

GAIT: unable to assess

Pertinent Results:
Urine Cocaine Pos
Urine Benzos, Barbs, Opiates, Amphet, Mthdne Negative

Trop-*T*: <0.01

145  104  13      AGap=30
--------------< 133
4.1  15  1.0

CK: 182  MB: Pnd
Ca: 10.4 Mg: 2.4 P: 4.2
Serum ASA, EtOH, [**Last Name (LF) 2238**], [**First Name3 (LF) **], Tricyc Negative
Serum Acetmnphn Pending


WBC16.2  PLT442 Hct41.7
 N:72.9 L:23.4 M:1.4 E:2.0 Bas:0.2
Anisocy: 1+ Microcy: 1+

PT: 12.7  PTT: 21.5  INR: 1.1

CT head: round hyperdense lesion L-frontotemporal region with
some edema

CXR: 2.5cm pulmonary nodule (L middle lobe)

Brief Hospital Course:
The patient is a 74yo R-handed man with a history of MI,
hyperlipidemia and melanoma, who is transferred from OSH for an
ICH with possible underlying mass (L-frontotemporal region). He
presented with inability to speak and follow commands. He had no
symptoms otherwise. After transfer, he had a secondary
generalized seizure, after which he was intubated. On exam after
intubation, his CN were intact, and motor/sensory exam shows
some assymmetries (extension LUE). Tox screen was positive for
cocaine. At the OSH, he received decadron IV and he was loaded
on dilantin
in the ED.

NEURO:
Patient was admitted to Neuro ICU. Continued decadron and
dilantin. MRI showed an intra-parenchymal hemorrhage within the
left temporal lobe which demonstrated surrounding edema
suspicious for an underlying mass. He had a normal portable EEG
in the waking state. There were no areas of persistent focal
slowing, and there were no clearly epileptiform features. Blood
pressure was controlled with IV labetolol as needed and he was
extubated without complications. He was transferred to the floor
on [**11-9**]. On [**11-10**], patient had a seizure with loss of
consciousness, transient hypotension and was intubated for
airway protection. Patient was again transferred to the Neuro
ICU. He received a bolus of dilantin and extubated the following
day. He went for stereotactic brain biopsy on [**2144-11-12**] without
complication. He was transferred to the floor post-operatively.
Prior to discharge, patient was started on Keppra with the plan
continue transitioning from Dilantin to Keppra with appropriate
overlap. He will follow-up with Dr. [**Last Name (STitle) **] in Brain [**Hospital 341**] Clinic
as an outpatient.

CV:
Cycled enzymes which were negative and monitored on caridac
telemetry without events. EKG unchanged. Continued lipitor and
zetia. Held aspirin prior to biopsies. Unclear per notes,
whether patient was taking Plavix as well. He will follow-up
with his primary care physician as an outpatient and may resume
taking aspirin.

PULM/ONC: Lung mass was found on torso CT. There was a left
lower lobe 1.6 x 1.7 cm mass with ground-glass opacity in the
right upper lobe. A nodular peripheral opacity measuring 7 mm in
the left upper lobe, near the lung apex was also seen.
Cardiothoracic surgery was consulted. Patient had CT guided
biopsy on [**11-10**] and developed an asymptomatic small left
pneumothorax that was followed with serial chest x-rays and
treated with O2 nasal cannula. Pathology was pending at time of
discharge. Patient will follow-up with in [**Hospital 94667**] clinic
and get a PET scan per their recs. Of note, pelvic CT on [**11-6**]
noted an enlarged prostate with lobulated appearance, more
prominent on the right, it measures 7.1 x 5.6 cm in axial
dimension. Which will likely need to be monitored and further
evaluated as an outpatient.

FEN: Patient was on decadron and covered with insulin sliding
scale four times daily. He passed a speech and swallow
evaluation and was put on a regular diet.

PPX: Pneumoboots, Tylenol PRN

COMMUNICATION: [**First Name8 (NamePattern2) **] [**Known lastname **] [**Telephone/Fax (1) 94668**] (wants to know lung
pathology or brain pathology results IMEDIATELY when it returns)

Medications on Admission:
Lipitor 40mg daily
Gemfibrozil 600mg [**Hospital1 **]
Zetia 10mg daily
ASA 325mg daily
Pepcid 10mg daily
Prevacid 30mg p.r.n.
Advair 1 puff [**Hospital1 **]
Albuterol inhaler p.r.n.
Viagra p.r.n.
Ambien p.r.n.

Discharge Medications:
1. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
3. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
5. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for fever or pain.
6. Decadron 4 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours.
Disp:*1 month* Refills:*2*
7. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Keppra 500 mg Tablet Sig: Two (2) Tablet PO twice a day:
[**Date range (1) 94669**] take 2 tab twice daily. [**Date range (1) **] take 3 tabs in
am and 2 tabs in pm. On [**11-21**] & thereafter, take 3 tabs twice
daily.
Disp:*120 Tablet(s)* Refills:*2*
9. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO twice a day: Take until [**11-21**] then may discontinue
medication.
Disp:*30 Capsule(s)* Refills:*0*
10. Diastat 5 mg Kit Sig: One (1) kit Rectal QD as needed for
seizure lasting >3minutes or >3 seizures per hour: To be used
ONLY in EMERGENCY for prolonged seizure >3 minutes or >3
seizures per hour. Please call PCP if you have to use this kit.
Disp:*3 kits* Refills:*0*
11. Outpatient Physical Therapy
Please perform outpatient physical therapy

12. Outpatient Occupational Therapy
Please perform outpatient occupational therapy


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Primary diagnosis:
Left frontotemporal mass
Lung nodules

Secondary diagnosis:
Asthma
Hyperlipidemia
H/o NSTEMI
H/o melanoma


Discharge Condition:
Neurologically stable. Mild fluent aphasia with decreased
comprehension. Motor and sensation exam intact.


Discharge Instructions:
Please take medications as prescribed.

Please keep follow-up appointments.

If you have any fevers/chills, persistent headaches or neck
pain, increasing confusion, numbness or weakness or any other
worrying symptoms, please call your primary care physician [**Last Name (NamePattern4) **].
[**First Name (STitle) 9959**] [**Name (STitle) 9960**] or return to the emergency room.

Followup Instructions:
Please follow-up with in Brain [**Hospital 341**] Clinic. Call [**Telephone/Fax (1) 1844**]
on Monday and schedule an appointment to be seen within [**2-10**]
weeks of discharge.

Please follow-up with your primary care physician [**Last Name (NamePattern4) **]. [**First Name (STitle) 9959**]
[**Name (STitle) 9960**]. Call [**0-0-**] on Monday to schedule an appointment
to be seen within 1-2 weeks of discharge.

Please follow-up in thoracic surgery [**Hospital 94670**] clinic in
[**2-10**] weeks, [**Telephone/Fax (1) **], with Dr. [**Last Name (STitle) **].  Please call the
office prior to your appointment to schedule a PET CT scan.
Please get this scan before your appointment.



Completed by:[**2144-11-17**]
{'Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Secondary malignant neoplasm of lung,Other convulsions,Acute respiratory failure,Iatrogenic pneumothorax,Personal history of malignant melanoma of skin,Late effects of cerebrovascular disease, aphasia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Old myocardial infarction,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Percutaneous transluminal coronary angioplasty status'}


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: ICH

PRESENT ILLNESS: The patient is a 74yo R-handed man with a history of MI,
hyperlipidemia and melanoma, who is transferred from OSH for an
ICH.

MEDICAL HISTORY: -NSTEMI [**2129**] with OM1 PTCA
-Dyslipidemia
-Previous epistaxis r/t ASA
-Asthma
-denies HTN
-melanoma x2 (chest, first superficial then recurred deeper with
negative axillary lymphnodes

MEDICATION ON ADMISSION: Lipitor 40mg daily
Gemfibrozil 600mg [**Hospital1 **]
Zetia 10mg daily
ASA 325mg daily
Pepcid 10mg daily
Prevacid 30mg p.r.n.
Advair 1 puff [**Hospital1 **]
Albuterol inhaler p.r.n.
Viagra p.r.n.
Ambien p.r.n.

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: VITALS: Tafebrile HR87 BP102/58 (162/83) RR11  sO2 100
GEN: intubated
HEENT: mmm, no scleral icterus
NECK: no LAD; no carotid bruits; neck supple
LUNGS: Clear to auscultation bilaterally
HEART: Regular rate and rhythm, normal S1 and S2
ABDOMEN: normal bowel sounds, soft, nontender, nondistended
EXTREMITIES: no clubbing, cyanosis, ecchymosis, or edema; no
suspicious moles on the chest

FAMILY HISTORY: CAD: Brother had CABG in his 60's.

SOCIAL HISTORY: Occupation: toy salesman.
married for 35 years
Son who lives in the area and another lives in [**Doctor First Name 5256**]
and is a Neurosurgery PA. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Secondary malignant neoplasm of lung,Other convulsions,Acute respiratory failure,Iatrogenic pneumothorax,Personal history of malignant melanoma of skin,Late effects of cerebrovascular disease, aphasia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Old myocardial infarction,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Percutaneous transluminal coronary angioplasty status'}
