CHIEF COMPLAINT: Metastatic colon CA to brain

PRESENT ILLNESS: 55M with metastatic colorectal CA on routine surveillance chest
CT found to have asymptomatic LLL PE. Of note, one month prior,
he had complained of left sided neck pain, shortness of breath,
and was referred to a local ED and found was negative for PE at
that time by CTA.  He now complains of a 3 week duration of L
retroorbital HA initially controlled with percocet. Otherwise
states has been having diarrhea/constipation with chemotherapy.

MEDICAL HISTORY: rectosigmoid CA s/p resection [**2116**] and chemo/XRT
HTN
hyperlipidemia
VATS- RUL/LLL nodule - cervical meiastinoscopy with LN biopsy
revealed no evidence of malignancy, then s/p VATS RUL

MEDICATION ON ADMISSION: aspirin 325 mg a day,
Ativan 0.5 mg for sleep,
Compazine 10 mg as needed for nausea,
fluoxetine 40 mg a day
hydrochlorothiazide 12.5 mg qd
lisinopril 40 mg a day
MiraLax 70 g a day
Percocet 1-2 tablets q6hrs prn
trazodone 50 mg at bedtime.
Claritin 10mg qd
zofran prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS  96  160/98  50 18  98RA
Gen: appears older than stated age, NAD,
HEENT: PERRL, EOMI, No LAD, no JVD, anicteric, OP with post
palate erythema, dry MM
CV: RRR no mrg
Chest: Slight rhonchi RLB
Abd: +BS nt/nd no organomegaly
Ext: No c/c/e 2+DP
Neuro: AAOx3 CNII-CNXII intact, no focal deficits, motor [**5-15**]
b/l, sensation intact

FAMILY HISTORY: Father died of cirrhosis at the age of 49. One
sibling with paranoid schizophrenia. One grandparent died of TB.

SOCIAL HISTORY: Seven to ten pack year history, discontinued in
the [**2086**]. He has had exposure to asbestos working in a shipyard
Secondary malignant neoplasm of brain and spinal cord,Other pulmonary embolism and infarction,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Secondary malignant neoplasm of lung,Personal history of malignant neoplasm of large intestine,Pure hypercholesterolemia,Dysthymic disorder,Esophageal reflux,Unspecified essential hypertension,Mononeuritis of lower limb, unspecified
Sec mal neo brain/spine,Pulm embol/infarct NEC,Ac DVT/emb distl low ext,Secondary malig neo lung,Hx of colonic malignancy,Pure hypercholesterolem,Dysthymic disorder,Esophageal reflux,Hypertension NOS,Mononeuritis leg NOS
Admission Date:  [**2122-6-16**]              Discharge Date:   [**2122-6-24**]

Date of Birth:  [**2067-3-30**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 25083**]
Chief Complaint:
 Metastatic colon CA to brain

Major Surgical or Invasive Procedure:
IVC Filter Placement

History of Present Illness:
55M with metastatic colorectal CA on routine surveillance chest
CT found to have asymptomatic LLL PE. Of note, one month prior,
he had complained of left sided neck pain, shortness of breath,
and was referred to a local ED and found was negative for PE at
that time by CTA.  He now complains of a 3 week duration of L
retroorbital HA initially controlled with percocet. Otherwise
states has been having diarrhea/constipation with chemotherapy.

ROS:  Nausea/emesis chemorelated, controlled with zofran, no
f/c. no cp/ chronic sob/ no pnd/orthopnea.

Onc Hx: Dx'd [**2116**] with lower colonic upper rectal CA s/p
neoadjuvant 5-FU and xrt with good response.  Then had lower
ant. resection with no colostomy with f/u adjuvant 5-FU
leucovorin.  Did well until [**9-/2121**] with rising CEA, and found to
have mass in RUL, s/p resection found to be colon CA. Now s/p 3
course of FOLFOX + avastatin most recently finished on [**2122-6-11**]


Past Medical History:
rectosigmoid CA s/p resection [**2116**] and chemo/XRT
HTN
hyperlipidemia
VATS- RUL/LLL nodule - cervical meiastinoscopy with LN biopsy
revealed no evidence of malignancy, then s/p VATS RUL

Social History:
Seven to ten pack year history, discontinued in
the [**2086**]. He has had exposure to asbestos working in a shipyard

from [**2090**] to [**2095**]. He uses alcohol occasionally and socially.
He denies any exposure to uranium, nickel, cadmium, or radon.
Lives with wife and 2 [**Name2 (NI) 25084**] 17/19.

Family History:
Father died of cirrhosis at the age of 49. One
sibling with paranoid schizophrenia. One grandparent died of TB.


One grandparent had a stroke. One grandparent had an MI.

Physical Exam:
VS  96  160/98  50 18  98RA
Gen: appears older than stated age, NAD,
HEENT: PERRL, EOMI, No LAD, no JVD, anicteric, OP with post
palate erythema, dry MM
CV: RRR no mrg
Chest: Slight rhonchi RLB
Abd: +BS nt/nd no organomegaly
Ext: No c/c/e 2+DP
Neuro: AAOx3 CNII-CNXII intact, no focal deficits, motor [**5-15**]
b/l, sensation intact

Brief Hospital Course:
A/P
55 YO M with metastatic colon CA p/w PE and brain mass

# Brain Mass- He was found to have a new brain lesion on MRI
after presenting to the ED with a left retroorbital headache.
He was started on decadron and was neurooncology, radiation
oncology, and neurosurgery were consulted. There was concern for
leptomeningeal disease, and a lumbar puncture was performed to
evaluate for leptomeningeal disease, which was noted to have a
high opening pressure of 27, but without positive cytology or
suggestive chemistries.  Therefore, he was subsequently
evaluated by neurosurgery and brain tumor resection was
performed.
Pt was taken to the OR [**6-19**] electiveley where under general
anesthesia he underwent right occipital craniotomy with excision
of metastatic lesion. He tolerated this well and was transferred
to the PACU overnight for close neurologic monitoring.  He
remained stable and was transferred to the floor. Diet and
activity were advanced without difficulty.  Wound was clean ,
dry and intact. He was transferred back to Omed [**6-21**].  He was
also started on Dilantin for seizure prophylaxis after his
surgery was performed.  He was never noted to have seizures
during his hospital course, continuation of Dilantin and/or
level monitoring was to be performed at a follow up appointment
with neurooncology. The pathology indicated likely colonic
adenocarcinoma.  His headached were well controlled on
decadrone, and he was continued on his dilantin, to follow up in
[**Hospital 20891**] clinic for monitoring.  His treatment plan was to
include radiation therapy, he was discharged with follow up with
[**Hospital1 18**] radiation treatment.

# PE- He was noted to have a  small 1 vessel, segmental thrombus
noted on CT thorax.  This was confirmed on a dedicated CTA of
chest, he had negative LENIs and was clinically asymptomatic
without no ekg changes. A IVC filter was placed for prophylaxis.
 As his left porta cath had no drawback, and on history was
noted to have neck pain a few weeks prior, his left upper
extremity was dopplered and demonstrated an upper extremity
clot.  He was not systemically anticoagulated, and this was to
be discussed at a future oncological appointment, as the risk of
bleed was thought greater than that of a PE.

# Colon CA-s/p resection, adjuvant chemo FOLFOX+avastin . He was
found to have a brain metastasis on this admission.  His
headache was well controlled with steroids and narcotics, and
nausea controlled with antiemetics. Further chemotherapy was to
be discussed as an outpatient.

# CV- HTN - Stable continued on lisinopril, HCTZ, and aspirin
was held.

# Depression- He became more depressed during his hospital
course, and his fluoxetine was increased during his hospital
course.

# Seasonal allergies: Held  claritin

# Contact: Wife [**Name (NI) 501**] [**Name (NI) 11923**] [**Telephone/Fax (1) 25085**] - called today, no
answer


Medications on Admission:
aspirin 325 mg a day,
Ativan 0.5 mg for sleep,
Compazine 10 mg as needed for nausea,
fluoxetine 40 mg a day
hydrochlorothiazide 12.5 mg qd
lisinopril 40 mg a day
MiraLax 70 g a day
Percocet 1-2 tablets q6hrs prn
trazodone 50 mg at bedtime.
Claritin 10mg qd
zofran prn

Discharge Medications:
1. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for Insomnia.
Disp:*30 Tablet(s)* Refills:*0*
2. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.
Disp:*30 Tablet(s)* Refills:*0*
5. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
Disp:*90 Tablet(s)* Refills:*2*
6. 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:*2*
7. Oxycodone 20 mg Tablet Sustained Release 12HR Sig: One (1)
Tablet Sustained Release 12HR PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release 12HR(s)* Refills:*2*
8. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q2-4H (every 2
to 4 hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
9. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
10. Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO BID
(2 times a day).
Disp:*120 Capsule(s)* Refills:*2*
11. Fluoxetine 20 mg Capsule Sig: Three (3) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*2*
12. Prochlorperazine 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
13. Dilantin 100 mg Capsule Sig: Three (3) Capsule PO at
bedtime.
Disp:*30 Capsule(s)* Refills:*2*
14. Claritin 10 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
metastatic colorectal cancer


Discharge Condition:
Stable


Discharge Instructions:
Please take your medications as instructed

If you experience increased headaches, fevers, chills or other
concerning symptoms please call your physician [**Name Initial (PRE) 2227**]

Please pick up copies of your head MRIs and CTs of your head on
CD format at the Radiology Department prior to your departure

Please follow up with the physicians listed below

You will receive an update in regards to your radiation
treatment from Dr. [**Last Name (STitle) **]

Followup Instructions:
You have an appointment with Radiation Oncology on [**6-29**] at
11:00am in the [**Hospital Ward Name 23**] Building [**Location (un) **]

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 25086**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2122-7-2**] 2:00

Provider: [**First Name11 (Name Pattern1) 569**] [**Last Name (NamePattern4) 12637**], M.D. Date/Time:[**2122-7-17**] 11:00

Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2122-11-5**] 9:30

Provider: [**Name10 (NameIs) 1532**] [**Name11 (NameIs) 1533**], MD Phone:[**0-0-**]
Date/Time:[**2122-11-5**] 10:00
{'Secondary malignant neoplasm of brain and spinal cord,Other pulmonary embolism and infarction,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Secondary malignant neoplasm of lung,Personal history of malignant neoplasm of large intestine,Pure hypercholesterolemia,Dysthymic disorder,Esophageal reflux,Unspecified essential hypertension,Mononeuritis of lower limb, 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: Metastatic colon CA to brain

PRESENT ILLNESS: 55M with metastatic colorectal CA on routine surveillance chest
CT found to have asymptomatic LLL PE. Of note, one month prior,
he had complained of left sided neck pain, shortness of breath,
and was referred to a local ED and found was negative for PE at
that time by CTA.  He now complains of a 3 week duration of L
retroorbital HA initially controlled with percocet. Otherwise
states has been having diarrhea/constipation with chemotherapy.

MEDICAL HISTORY: rectosigmoid CA s/p resection [**2116**] and chemo/XRT
HTN
hyperlipidemia
VATS- RUL/LLL nodule - cervical meiastinoscopy with LN biopsy
revealed no evidence of malignancy, then s/p VATS RUL

MEDICATION ON ADMISSION: aspirin 325 mg a day,
Ativan 0.5 mg for sleep,
Compazine 10 mg as needed for nausea,
fluoxetine 40 mg a day
hydrochlorothiazide 12.5 mg qd
lisinopril 40 mg a day
MiraLax 70 g a day
Percocet 1-2 tablets q6hrs prn
trazodone 50 mg at bedtime.
Claritin 10mg qd
zofran prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS  96  160/98  50 18  98RA
Gen: appears older than stated age, NAD,
HEENT: PERRL, EOMI, No LAD, no JVD, anicteric, OP with post
palate erythema, dry MM
CV: RRR no mrg
Chest: Slight rhonchi RLB
Abd: +BS nt/nd no organomegaly
Ext: No c/c/e 2+DP
Neuro: AAOx3 CNII-CNXII intact, no focal deficits, motor [**5-15**]
b/l, sensation intact

FAMILY HISTORY: Father died of cirrhosis at the age of 49. One
sibling with paranoid schizophrenia. One grandparent died of TB.

SOCIAL HISTORY: Seven to ten pack year history, discontinued in
the [**2086**]. He has had exposure to asbestos working in a shipyard 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Other pulmonary embolism and infarction,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Secondary malignant neoplasm of lung,Personal history of malignant neoplasm of large intestine,Pure hypercholesterolemia,Dysthymic disorder,Esophageal reflux,Unspecified essential hypertension,Mononeuritis of lower limb, unspecified'}
