CHIEF COMPLAINT: 3 weeks of intermittent headache.

PRESENT ILLNESS: This is a 45 year old female with a history of breast cancer
dx'd in [**2131**] s/p chemo, mastectomy and XRT who presents with 3
weeks of intermittent headache and one episode of vomiting.  She
denies seizure, visual changes, MS changes. went to OSH and head
CT revealed left frontal mass with edema. She was given
decadrom 8mg Transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: Depression
Left breast cancer

MEDICATION ON ADMISSION: tamoxifen, effexor

ALLERGIES: Amoxicillin / Bactrim

PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:  4->2       EOMs full
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.

FAMILY HISTORY: no cancer, mother h/o 2 brain aneurysms A&W, brother
[**Name (NI) 4522**]

SOCIAL HISTORY: Ms. [**Known lastname 83070**] lives with her mother, brother, and sister.  She is a
substitute teacher in the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] system.
never smoked, no EtOh
Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Obesity, unspecified
Sec mal neo brain/spine,Cerebral edema,Hx of breast malignancy,Hx of irradiation,Hx antineoplastic chemo,Obesity NOS
Admission Date:  [**2133-10-25**]              Discharge Date:   [**2133-10-28**]

Date of Birth:  [**2088-9-11**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Amoxicillin / Bactrim

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
3 weeks of intermittent headache.

Major Surgical or Invasive Procedure:
L craniotomy for mass resection [**2133-10-26**] Dr. [**First Name (STitle) **]


History of Present Illness:
This is a 45 year old female with a history of breast cancer
dx'd in [**2131**] s/p chemo, mastectomy and XRT who presents with 3
weeks of intermittent headache and one episode of vomiting.  She
denies seizure, visual changes, MS changes. went to OSH and head
CT revealed left frontal mass with edema. She was given
decadrom 8mg Transferred to [**Hospital1 18**] for further management.


Past Medical History:
Depression
Left breast cancer

Social History:
Ms. [**Known lastname 83070**] lives with her mother, brother, and sister.  She is a
substitute teacher in the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] system.
never smoked, no EtOh


Family History:
no cancer, mother h/o 2 brain aneurysms A&W, brother
[**Name (NI) 4522**]


Physical Exam:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:  4->2       EOMs full
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, 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, 4to2
mm 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 [**6-4**] throughout. No pronator drift

Sensation: Intact to light touch bilaterally.

Toes downgoing bilaterally

Exam on Dischare:
Intact


Pertinent Results:
[**2133-10-25**] 06:30PM   PT-12.2 PTT-21.2* INR(PT)-1.0
[**2133-10-25**] 06:30PM   PLT COUNT-326

CT HEAD [**2133-10-25**]:
L frontal lesion with significant mass effect and midline shift.
No acute hemorrhage.

[**10-27**] MRI:
1. Interval resection of the left frontal mass with
post-surgical changes
noted in the form of left frontal craniotomy defects and
hemorrhage in the
anterior interhemispheric fissure and along the left frontal
convexity.
2. Thick meningeal enhancement along bilateral frontal
convexities and in the
anterior interhemispheric fissure. Small focus of enhancement is
noted to the
left of the falx which may represent residual enhancement.
3. There is no significant change in the mass effect with shift
of midline
structures to the right. Unchanged dilatation of the right
lateral ventricle
with transependymal flow.
4. The FLAIR and T2 hyperintensity surrounding the resection
cavity is
unchanged.


Brief Hospital Course:
This is a 45 year old woman with history of breast CA  who
presents with 3 weeks of intermittent headaches. A head CT
revealed a left frontal lesion with significant midline shift
and mass effect. She was admitted to neurosurgery for further
management. She was placed on decadron and an MRI head was done.
On [**10-26**], patient was taken to the OR for left craniotomy for
resection of L frontal lesion. She received Mannitol and
Decadron in the OR. Frozen section was metastatic tumor.Post
operatively, patient was transferred to the ICU extubated. She
had a CT ehad that showed improvement in mass effect on the left
lateral ventricle. She was neurologically stable.

Medications on Admission:
tamoxifen, effexor


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. venlafaxine 75 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO DAILY (Daily).
3. tamoxifen 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
5. levetiracetam 250 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*2*
6. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO tid (): 2 mg
po tid for 48hrs. then decrease to 2mg po bid and maintain this
dose.
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
L frontal brain lesion


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
??????	Have a friend/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,
or excessive bending.
??????	You may wash your hair at any time. You may get your incision
wet with water four days after your operation, do not scrub the
area. have been removed.
??????	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.
??????	. If you have been discharged on Keppra (Levetiracetam), you
will not require blood work monitoring. You have been placed on
a taper of your steroids ( dexamethasone) please have your
oncologist advise you on how to taper off of the medication when
you see him in follow up.

??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.

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.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in 10 days(from your date of
surgery) for removal of your sutures and wound check. This
appointment can be made with the Nurse Practitioner/ Physician
[**Name Initial (PRE) 19158**].  Please make this appointment by calling
[**Telephone/Fax (1) 1669**].

You have the following Appointment in the system:

Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) 17688**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2134-1-18**] 1:00
Provider: [**Known firstname **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 14688**], RN Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2134-1-18**] 1:30
Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2134-7-1**] 9:00



Completed by:[**2133-11-11**]
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Obesity, 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: 3 weeks of intermittent headache.

PRESENT ILLNESS: This is a 45 year old female with a history of breast cancer
dx'd in [**2131**] s/p chemo, mastectomy and XRT who presents with 3
weeks of intermittent headache and one episode of vomiting.  She
denies seizure, visual changes, MS changes. went to OSH and head
CT revealed left frontal mass with edema. She was given
decadrom 8mg Transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: Depression
Left breast cancer

MEDICATION ON ADMISSION: tamoxifen, effexor

ALLERGIES: Amoxicillin / Bactrim

PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:  4->2       EOMs full
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.

FAMILY HISTORY: no cancer, mother h/o 2 brain aneurysms A&W, brother
[**Name (NI) 4522**]

SOCIAL HISTORY: Ms. [**Known lastname 83070**] lives with her mother, brother, and sister.  She is a
substitute teacher in the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] system.
never smoked, no EtOh 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy,Obesity, unspecified'}
