CHIEF COMPLAINT: Low back pain.

PRESENT ILLNESS: 54-year-old portugese-speaking Brazilian woman (limited english,
translation via daughter) with metastatic bronchogenic
carcinoma, bilateral pulmonary emboli, history of back surgery,
disk herniation, who is transferred from [**Hospital 8**] hospital
[**2155-9-4**] for evaluation for cord compression. She presented to
[**Hospital **] hospital on [**2155-9-3**] with worsening mid to upper back
pain and inability to walk. She awoke at 3:30 AM prior to
admission with upper back pain that prevented her from standing.
She had no numbness, bowl or bladder sx, tingling, weakness, or
shooting pain.  She presented to [**Hospital1 3494**] ED, with an intial
sat of 84% on RA. She had CT torso showing bilateral pulmonary
emboli and right-hilar and lower-lobe infiltrate mass,
consistent with bronchogenic carcinoma with mets to back and
liver. She was admitted to the ICU.

MEDICAL HISTORY: Herniated Disk
Back surgery in [**Country 4194**]
Left clavicular fracture repair
Left eye glaucoma, remote history
Herpes opthhalmicus on acyclovir

MEDICATION ON ADMISSION: Acyclovir 800 mg PO daily
Percocet
Ultram 37.5mg/paracetamol 325 mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 99.2 HR 90 BP 108/77 RR 18 Sat 96% 2L NC
Gen: Thin, well appearing woman in NAD
Eye: extra-ocular movements intact, pupil 3mm->2mm OD, 8mm
irregular, non-reactive OS, sclera anicteric, not injected, no
exudates
ENT: mucus membranes moist, no ulcerations or exudates
Neck: no thyromegally, JVD:
Cardiovascular: regular rate and rhythm, normal s1, s2, no
murmurs, rubs or gallops
Respiratory: Clear to auscultation bilaterally,
superiorly/anteriorly
Abd: Soft, non tender, non distended, bowel sounds present,
guaiac negative
Extremities: No cyanosis, clubbing, edema, joint swelling
Neurological: Alert and oriented x3, CN III-XII intact, normal
attention, sensation normal, asterixis absent, speech fluent,
DTR's 1+ patellar, achilles, biceps, triceps, brachioradialis
bilaterally, babinski down-going bilaterally, strength 5/5 upper
extremities and lower extremities throughout
Integument: Warm, moist, no rash or ulceration
Psychiatric: appropriate

FAMILY HISTORY: Mother died from brain cancer.

SOCIAL HISTORY: Lives in [**Location 4194**] with husband, comes to visit daughter in
[**Name (NI) 3494**]. Works in the cleaning industry with significant
detergent and fume exposure. Non-smoker. Denies Alcohol or drug
use.
Secondary malignant neoplasm of brain and spinal cord,Other pulmonary embolism and infarction,Malignant neoplasm of lower lobe, bronchus or lung,Malignant neoplasm of liver, secondary,Pathologic fracture of vertebrae,Herpes simplex with unspecified ophthalmic complication
Sec mal neo brain/spine,Pulm embol/infarct NEC,Mal neo lower lobe lung,Second malig neo liver,Path fx vertebrae,Herpes simplex eye NOS
Admission Date:  [**2155-9-4**]              Discharge Date:   [**2155-9-10**]

Date of Birth:  [**2101-2-26**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1943**]
Chief Complaint:
Low back pain.

Major Surgical or Invasive Procedure:
Bronchoscopy with tissue biopsy on [**2155-9-5**].

History of Present Illness:
54-year-old portugese-speaking Brazilian woman (limited english,
translation via daughter) with metastatic bronchogenic
carcinoma, bilateral pulmonary emboli, history of back surgery,
disk herniation, who is transferred from [**Hospital 8**] hospital
[**2155-9-4**] for evaluation for cord compression. She presented to
[**Hospital **] hospital on [**2155-9-3**] with worsening mid to upper back
pain and inability to walk. She awoke at 3:30 AM prior to
admission with upper back pain that prevented her from standing.
She had no numbness, bowl or bladder sx, tingling, weakness, or
shooting pain.  She presented to [**Hospital1 3494**] ED, with an intial
sat of 84% on RA. She had CT torso showing bilateral pulmonary
emboli and right-hilar and lower-lobe infiltrate mass,
consistent with bronchogenic carcinoma with mets to back and
liver. She was admitted to the ICU.

She had back pain that was concerning and weakness that was
concerning for cord compression vs. limitation from pain. She
was started on dexamethasone 10 mg once followed by 4 mg q6H.
She had spine MRI that showed multiple small foci of enhancement
in the brain and spine mets with cord edema. She had Q1H neuro
exams with no focal deficits. She remained hemodynamically
stable w/r/t her PE with a sat of 100% on RA and no right heart
strain on EKG.

On transfer she had an IVC filter placed (not anticoagulated due
to brain mets, concern for bleeding). She has been stable and
had pathology sent from endobronchial biopsy, awaiting final
result.

Currently she notes minimal ([**2156-1-31**]) back pain located on the
left in the mid-thoracic region without radiation or pleuritic
component. She is tolerating the TLSO brace well, without
dyspnea. She acknowledges non-productive cough.

ROS: 6 lbs wt loss in 10 days prior to presentation, no fevers,
chills, night sweats. She has not had a BM in 3 days which is
unusual for her and feels constipated. She notes nausea with
pain medications. 10 point review of systems negative except as
noted above.

Past Medical History:
Herniated Disk
Back surgery in [**Country 4194**]
Left clavicular fracture repair
Left eye glaucoma, remote history
Herpes opthhalmicus on acyclovir

Oncology History: Found to have a pulmonary nodule in [**3-9**] in
[**Country 4194**], with no follow up. She was then seen at [**Hospital1 3793**] in [**2155-7-22**] for left clavicular pain after hitting a
table and breaking her clavicle. She had studies showing a lung
nodule and was referred to heme-onc for work-up. She decided to
go to [**Country 4194**] instead because she didn't have health insurance,
but was told there that everything was normal and given pain
medications. She then presented to [**Hospital 8**] hospital on [**2155-9-3**],
described above.

Social History:
Lives in [**Location 4194**] with husband, comes to visit daughter in
[**Name (NI) 3494**]. Works in the cleaning industry with significant
detergent and fume exposure. Non-smoker. Denies Alcohol or drug
use.

Family History:
Mother died from brain cancer.

Physical Exam:
VS: T 99.2 HR 90 BP 108/77 RR 18 Sat 96% 2L NC
Gen: Thin, well appearing woman in NAD
Eye: extra-ocular movements intact, pupil 3mm->2mm OD, 8mm
irregular, non-reactive OS, sclera anicteric, not injected, no
exudates
ENT: mucus membranes moist, no ulcerations or exudates
Neck: no thyromegally, JVD:
Cardiovascular: regular rate and rhythm, normal s1, s2, no
murmurs, rubs or gallops
Respiratory: Clear to auscultation bilaterally,
superiorly/anteriorly
Abd: Soft, non tender, non distended, bowel sounds present,
guaiac negative
Extremities: No cyanosis, clubbing, edema, joint swelling
Neurological: Alert and oriented x3, CN III-XII intact, normal
attention, sensation normal, asterixis absent, speech fluent,
DTR's 1+ patellar, achilles, biceps, triceps, brachioradialis
bilaterally, babinski down-going bilaterally, strength 5/5 upper
extremities and lower extremities throughout
Integument: Warm, moist, no rash or ulceration
Psychiatric: appropriate

Pertinent Results:
CXR [**2155-9-4**]: Right-sided hilar mass in patient with history of
carcinoma. No pneumothorax or pleural effusion. Referral is made
to newly entered chest CT performed at other hospital.

CT T- and L-Spine [**2155-9-4**]:
1. Complete collapse of vertebral body of T6, likely pathologic
fracture, with metastatic involvement of the right pedicle at
this level. Metastatic involvement of vertebral body of L1,
lower left portion, with involvement of the left pedicle.
2. Lucent lesion in the right iliac bone, with cortical
destruction and
extension in the soft tissue.
3. Right hilar mass, with associated atelectasis, in keeping
with diagnosis of known lung cancer. Atelectasis at the left
lung. Prominent lymph nodes in the mediastinum and hilum.
4. Prominence of the adrenal glands bilaterally, likely
metastatic
involvement.
5. Lesion in the liver, likely metastatic deposit.

Final Attending Comment: In addition to above there is likely
epidural tumor at T6 indenting the cord which would be better
assessed by MRI.There is epidural soft tissue at L1 also which
could represent prominent vein versus epidural tumor.

Pathology Examination [**2155-9-5**]:
SPECIMEN SUBMITTED: ENDOBRONCHIAL BX (1 JAR)
DIAGNOSIS: Lung, right lower lobe, endobronchial biopsy:
Poorly-differentiated squamous cell carcinoma.

CT Torso [**2155-9-8**]:
IMPRESSION:
1. Extensive mediastinal and right hilar lymphadenopathy with
right lower
lobe lung mass as described above. There is encasement of the
right lower
lobe superior segment, causing worsening atelectasis of the
right lower lobe.
2. Metastatic deposit within the liver, left adrenal gland and
osseous
structures as described above.
3. Small pulmonary embolus in right middle lobe pulmonary artery
and thrombus
in situ in IVC filter.
4. Pathologic compression fracture of T6.
5. Metastatic disease to bones: left clavicle pathological
fracture associated with a lytic lesion (3:7), several ribs,
iliac [**Doctor First Name 362**], left femoral head, right humeral head

Brief Hospital Course:
1. Squamous cell carcinoma of lung metastatic to
brain/spine/bones/liver/adrenals: Diagnosis made from tissue
obtained by bronchoscopy on [**9-5**].  Pathology results showed
poorly differentiated squamous cell carcinoma. Hematology
Oncology was consulted and recommended the patient get started
with palliative radiation first and patient can follow up with
thoracic oncology as an outpatient. Orthopedic oncology was
consulted for left femoral head tumor and they did not recommend
any surgical intervention at this time given that patient was
ambulatory and pain free in her leg. Rather they will follow up
with the patient as an outpatient.

2. Vertebral compression fracture, metastatic: Neurosurgery
consult stated that no intervention recommended at this time.
She was placed in a TLSO brace when upright or out of bed per
neurosurgery recommendations.  XRT was started on [**2155-9-9**] with
no improvement of her symptoms.  Pt given fentanyl patch for
pain control and prn narcotics along with a robust bowel
regimen.

3. Pulmonary emboli: The patient was found to have bilateral
pulmonary emboli on CT performed at the outside hospital.  She
was hemodynamically stable. Given brain met/spine mets, she was
not started on on anticoagulation.  A removable IVC filter was
placed.

4. Herpes ophthamicus: The patient is followed by [**Hospital 39111**] for this condition.  She is currently in the midst of a 2
year course of acyclovir; this was continued. She will follow up
as an outpatient.

5. Long-term plan: The patient is very interested to return to
[**Country 4194**] where most of her family lives as soon as possible and
before she is unable to travel.  She and her family understand
the poor prognosis of her disease.

Medications on Admission:
Acyclovir 800 mg PO daily
Percocet
Ultram 37.5mg/paracetamol 325 mg PO daily

of note has been receiving dilaudid 0.5mg iv q3-4 hours with
relief

Discharge Medications:
1. Acyclovir 800 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*0*
3. Polyethylene Glycol 3350 100 % Powder Sig: One (1)  PO DAILY
(Daily).
Disp:*30 * Refills:*0*
4. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily).
Disp:*30 Adhesive Patch, Medicated(s)* Refills:*0*
5. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO every twelve (12)
hours as needed for constipation.
Disp:*100 Tablet(s)* Refills:*0*
6. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO every six
(6) hours as needed for pain.
Disp:*100 Tablet(s)* Refills:*0*
7. Dilaudid 2 mg Tablet Sig: 1-2 Tablets PO every four (4) hours
as needed for pain: Use for moderate or severe pain as needed.
Disp:*50 Tablet(s)* Refills:*0*
8. Fentanyl 25 mcg/hr Patch 72 hr Sig: One (1) patch Transdermal
every seventy-two (72) hours.
Disp:*10 patches* Refills:*0*
9. Fentanyl 12 mcg/hr Patch 72 hr Sig: One (1) patch Transdermal
every seventy-two (72) hours.
Disp:*10 patches* Refills:*0*
10. Ambien 5 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.
Disp:*28 Tablet(s)* Refills:*0*
11. Zofran 4 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for nausea.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Metastatic squamous cell cancer of the lung
2. Compression fracture of the 6th thoracic vertebra
3. Pulmonary embolus
4. Herpes ophthalmicus


Discharge Condition:
Fair condition.


Discharge Instructions:
You have a fracture in your spine that was evaluated by
neurosurgery and they determined it to be stable currently.  You
should wear a special brace. Please wear this brace whenever you
are sitting or standing.

If you go on a long trip (car or airplane), please get up and
walk around every one or two hours to reduce the risk of
developing blood clots.

Seek medical attention if you develop worsening of symptoms
including pain, shortness of breath, weakness, or other concern.

Followup Instructions:
1. Continue your treatments with Radiation Oncology
2. You will be called for an appointment with Thoracic Oncology
3. You will be called for an appointment with Orthopedic
Oncology
{'Secondary malignant neoplasm of brain and spinal cord,Other pulmonary embolism and infarction,Malignant neoplasm of lower lobe, bronchus or lung,Malignant neoplasm of liver, secondary,Pathologic fracture of vertebrae,Herpes simplex with unspecified ophthalmic complication'}


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: Low back pain.

PRESENT ILLNESS: 54-year-old portugese-speaking Brazilian woman (limited english,
translation via daughter) with metastatic bronchogenic
carcinoma, bilateral pulmonary emboli, history of back surgery,
disk herniation, who is transferred from [**Hospital 8**] hospital
[**2155-9-4**] for evaluation for cord compression. She presented to
[**Hospital **] hospital on [**2155-9-3**] with worsening mid to upper back
pain and inability to walk. She awoke at 3:30 AM prior to
admission with upper back pain that prevented her from standing.
She had no numbness, bowl or bladder sx, tingling, weakness, or
shooting pain.  She presented to [**Hospital1 3494**] ED, with an intial
sat of 84% on RA. She had CT torso showing bilateral pulmonary
emboli and right-hilar and lower-lobe infiltrate mass,
consistent with bronchogenic carcinoma with mets to back and
liver. She was admitted to the ICU.

MEDICAL HISTORY: Herniated Disk
Back surgery in [**Country 4194**]
Left clavicular fracture repair
Left eye glaucoma, remote history
Herpes opthhalmicus on acyclovir

MEDICATION ON ADMISSION: Acyclovir 800 mg PO daily
Percocet
Ultram 37.5mg/paracetamol 325 mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 99.2 HR 90 BP 108/77 RR 18 Sat 96% 2L NC
Gen: Thin, well appearing woman in NAD
Eye: extra-ocular movements intact, pupil 3mm->2mm OD, 8mm
irregular, non-reactive OS, sclera anicteric, not injected, no
exudates
ENT: mucus membranes moist, no ulcerations or exudates
Neck: no thyromegally, JVD:
Cardiovascular: regular rate and rhythm, normal s1, s2, no
murmurs, rubs or gallops
Respiratory: Clear to auscultation bilaterally,
superiorly/anteriorly
Abd: Soft, non tender, non distended, bowel sounds present,
guaiac negative
Extremities: No cyanosis, clubbing, edema, joint swelling
Neurological: Alert and oriented x3, CN III-XII intact, normal
attention, sensation normal, asterixis absent, speech fluent,
DTR's 1+ patellar, achilles, biceps, triceps, brachioradialis
bilaterally, babinski down-going bilaterally, strength 5/5 upper
extremities and lower extremities throughout
Integument: Warm, moist, no rash or ulceration
Psychiatric: appropriate

FAMILY HISTORY: Mother died from brain cancer.

SOCIAL HISTORY: Lives in [**Location 4194**] with husband, comes to visit daughter in
[**Name (NI) 3494**]. Works in the cleaning industry with significant
detergent and fume exposure. Non-smoker. Denies Alcohol or drug
use. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Other pulmonary embolism and infarction,Malignant neoplasm of lower lobe, bronchus or lung,Malignant neoplasm of liver, secondary,Pathologic fracture of vertebrae,Herpes simplex with unspecified ophthalmic complication'}
