CHIEF COMPLAINT: Nausea and vomiting.

PRESENT ILLNESS: The patient is a 51-year-old
male with a history of multiple myeloma and chest
plasmacytoma (status post radiation therapy approximately two
weeks ago) who now presents with nausea, vomiting, decided
oral intake, and chest pressure.

MEDICAL HISTORY: (His past medical history is
significant for)
1.  Multiple myeloma and chest wall plasmacytoma diagnosed in
[**Country 5881**] in [**2117-11-5**] where it was initially treated in
[**2119-8-6**] with .................... and prednisone.
The patient has received CVAD through [**2119-11-5**], and
he received radiation therapy treatment to the anterior chest
wall (which was completed approximately two weeks ago).  The
patient did have a large 18-cm X 17-cm plasmacytoma extending
from the inferior portion of the sternum to the inferior
peritoneum.  This mass was concerning for advancement to the
pericardium, left hepatic lobe, and anterior stomach wall.
2.  The patient has a history of chronic obstructive
pulmonary disease/asthma (which has never required
intubations in the past).
3.  He has a question of diabetes; given that he had elevated
blood sugars while on dexamethasone.

MEDICATION ON ADMISSION: (His medications included)
1.  OxyContin 20 mg p.o. b.i.d.
2.  Oxycodone 5 mg to 10 mg p.o. q.4-6h. p.o. as needed.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient smokes at home.  He lives with
his wife.  [**Name (NI) **] is from [**Country 5881**].  He does not drink alcohol.
Other immunoproliferative neoplasms, without mention of having achieved remission,Pathologic fracture of humerus,Injury to brachial plexus,Chronic airway obstruction, not elsewhere classified,Acute pericarditis, unspecified,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Tobacco use disorder,Esophageal reflux
Oth imno npl wo ach rmsn,Path fx humerus,Brachial plexus injury,Chr airway obstruct NEC,Acute pericarditis NOS,Chr stomach ulc w hem,Tobacco use disorder,Esophageal reflux
Admission Date:  [**2120-1-28**]       Discharge Date:  [**2120-2-9**]

Date of Birth:   [**2068-6-11**]       Sex:  M

Service:

CHIEF COMPLAINT:  Nausea and vomiting.

HISTORY OF PRESENT ILLNESS:  The patient is a 51-year-old
male with a history of multiple myeloma and chest
plasmacytoma (status post radiation therapy approximately two
weeks ago) who now presents with nausea, vomiting, decided
oral intake, and chest pressure.

The chest pressure is not exertional, it is not new, and is
presumably secondary to the large retrosternal plasmacytoma.
The patient has had nausea and vomiting for the two weeks
prior to admission, and he describes his vomitus as black
with chunks, and his stool as dark.  The patient vomited once
after presenting to the Emergency Room and had clear yellow
emesis.  He also complained of early satiety, orthopnea, and
a persistent cough.  The patient described some shortness of
breath related to this full feeling in his chest.

Of note, he had a repeat chest computed tomography prior to
admission which revealed a decreased size of the retrosternal
mass, a thickened pericardium, and thickened wall of the
stomach to 6.1 cm.

In the Emergency Department, his systolic blood pressure was
in the high 80s/low 90s.  He had no pulsus paradoxus, and he
was mentating well.  He received intravenous fluids while in
the Emergency Department and was sent to the Medical
Intensive Care Unit.

PAST MEDICAL HISTORY:  (His past medical history is
significant for)
1.  Multiple myeloma and chest wall plasmacytoma diagnosed in
[**Country 5881**] in [**2117-11-5**] where it was initially treated in
[**2119-8-6**] with .................... and prednisone.
The patient has received CVAD through [**2119-11-5**], and
he received radiation therapy treatment to the anterior chest
wall (which was completed approximately two weeks ago).  The
patient did have a large 18-cm X 17-cm plasmacytoma extending
from the inferior portion of the sternum to the inferior
peritoneum.  This mass was concerning for advancement to the
pericardium, left hepatic lobe, and anterior stomach wall.
2.  The patient has a history of chronic obstructive
pulmonary disease/asthma (which has never required
intubations in the past).
3.  He has a question of diabetes; given that he had elevated
blood sugars while on dexamethasone.

MEDICATIONS ON ADMISSION:  (His medications included)
1.  OxyContin 20 mg p.o. b.i.d.
2.  Oxycodone 5 mg to 10 mg p.o. q.4-6h. p.o. as needed.

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:   Family history was noncontributory.

SOCIAL HISTORY:  The patient smokes at home.  He lives with
his wife.  [**Name (NI) **] is from [**Country 5881**].  He does not drink alcohol.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on admission revealed vital signs with a temperature of
100.3; other vital signs were stable.  General appearance
revealed a well-appearing and well-nourished male in no
apparent distress.  Head, eyes, ears, nose, and throat
examination revealed pupils were equally round and reactive
to light and accommodation.  Sclerae were anicteric.
Extraocular movements were intact.  The neck was supple.
Jugular venous distention of 9 cm.  Heart was regular in rate
and rhythm, distant.  No murmurs, rubs, or gallops.
Pulmonary examination revealed no crackles.  Clear to
auscultation bilaterally.  The abdomen revealed positive
bowel sounds, soft, nontender, and nondistended.  Rectal
examination was guaiac-negative.  Extremity examination
revealed no edema.

PERTINENT LABORATORY VALUES ON PRESENTATION:  His complete
blood count on admission showed white blood cell count was 4,
hematocrit was 30.6, and an elevated neutrophil and band
count.  His urinalysis was sent and remained essentially
normal.  His electrolytes were within normal.

HOSPITAL COURSE:   Given the above, the patient was sent to
the Medical Intensive Care Unit for further without.

1.  PLASMACYTOMA ISSUES:  The patient initially was monitored
in the Intensive Care Unit to prevent any further drop in his
hematocrit or any further episodes of hematemesis or bright
red blood per rectum.  However, after remaining stable he was
transferred to the Bone Marrow Transplant Service for the
possible recurrence of plasmacytoma.

He had an endoscopy with biopsies performed by the
Gastroenterology Service.  These initially showed a cardiac
ulcer with granulation tissue, but no tumor.  Therefore, the
patient had a repeat esophagogastroduodenoscopy performed.
The second esophagogastroduodenoscopy showed hyperplasia and
mild regeneration of the gastric pit.  No neoplasm was seen
in this sample.  Considering the gross appearance, the lesion
was thought to represent either an inflammatory or
hypoplastic polyp.  There was also possibly an underlying
lesion of the gastric wall.

The third biopsy was performed with ultrasound guidance which
was not available at the time of discharge; however, it
suggested fungal elements with possible lymphocytes
consistent with plasmacytoma.  The patient was instructed to
follow up as an outpatient for this recurrence of his
plasmacytoma.

2.  GASTROINTESTINAL ISSUES:  Otherwise, in terms of
gastrointestinal issues, the patient continued to have
guaiac-positive stools for the first few days of his
hospitalization; however, these normalized.  He experienced
constipation and was treated with an aggressive bowel
regimen.

3.  MUSCULOSKELETAL ISSUES:  His left arm had severe pain on
admission; requiring an increase in his OxyContin dose to
approximately 60 mg p.o. b.i.d. over the next few days.  The
patient was seen by the Orthopaedic Surgery Service, and
plain films were obtained which suggested a left humeral
fracture and a thrombolytic lesion.

This thrombolytic lesion appeared to impinge on the ulnar
nerve (according to a computed tomography scan which was
performed).  Therefore, Radiology/Oncology was also
consulted.  Orthopaedic Surgery felt that the fracture was
not significant enough to be repaired surgically.  Therefore,
they signed off.  Radiology/Oncology treated the thrombolytic
lesion in the humerus for a few days prior to discharge.
They set up outpatient appointments as well for the patient.

Otherwise, the patient also experienced some left hip pain;
for which plain films were obtained, suggesting a
thrombolytic lesion in the proximal femur.  This will also be
followed up as an outpatient.

As well, the patient had some radial and medial nerve damage;
according to an electromyogram which was performed while he
was in house.  This possibly suggested a brachial plexus
nerve route injury, and a magnetic resonance imaging was
attempted.  However, the patient had significant anxiety
despite Haldol, Xanax, morphine, and Ativan.  Anesthesia was
consulted, and the patient was to return on [**2120-2-15**]
for a magnetic resonance imaging of the neck and left arm
under anesthesia.

DISCHARGE STATUS:  The patient was discharged to home on
[**2120-2-9**].

MEDICATIONS ON DISCHARGE:
1.  OxyContin 20 mg p.o. b.i.d.
2.  Oxycodone 5 mg to 10 mg p.o. q.4-6h. as needed.
3.  Zofran 8 mg p.o. q.4-6h. as needed.
4.  Colace 100 mg p.o. b.i.d.
5.  Dulcolax 10 mg p.o. q.d.
6.  Lactulose 5 cc to 10 cc p.o. q.i.d. as needed.
7.  Protonix 40 mg p.o. b.i.d.

The patient was not continued on his Glucophage.  He was not
continued on his allopurinol.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with Dr.
[**Last Name (STitle) **].
2.  The patient was to follow in the Radiology/[**Hospital **]
Clinic.
3.  The patient was also to follow up for his magnetic
resonance imaging on [**2120-2-15**].





                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5387**], M.D.  [**MD Number(1) 7782**]

Dictated By:[**Name8 (MD) 10249**]
MEDQUIST36

D:  [**2120-2-11**]  16:11
T:  [**2120-2-11**]  16:17
JOB#:  [**Job Number 35422**]
{'Other immunoproliferative neoplasms, without mention of having achieved remission,Pathologic fracture of humerus,Injury to brachial plexus,Chronic airway obstruction, not elsewhere classified,Acute pericarditis, unspecified,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Tobacco use disorder,Esophageal reflux'}


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: Nausea and vomiting.

PRESENT ILLNESS: The patient is a 51-year-old
male with a history of multiple myeloma and chest
plasmacytoma (status post radiation therapy approximately two
weeks ago) who now presents with nausea, vomiting, decided
oral intake, and chest pressure.

MEDICAL HISTORY: (His past medical history is
significant for)
1.  Multiple myeloma and chest wall plasmacytoma diagnosed in
[**Country 5881**] in [**2117-11-5**] where it was initially treated in
[**2119-8-6**] with .................... and prednisone.
The patient has received CVAD through [**2119-11-5**], and
he received radiation therapy treatment to the anterior chest
wall (which was completed approximately two weeks ago).  The
patient did have a large 18-cm X 17-cm plasmacytoma extending
from the inferior portion of the sternum to the inferior
peritoneum.  This mass was concerning for advancement to the
pericardium, left hepatic lobe, and anterior stomach wall.
2.  The patient has a history of chronic obstructive
pulmonary disease/asthma (which has never required
intubations in the past).
3.  He has a question of diabetes; given that he had elevated
blood sugars while on dexamethasone.

MEDICATION ON ADMISSION: (His medications included)
1.  OxyContin 20 mg p.o. b.i.d.
2.  Oxycodone 5 mg to 10 mg p.o. q.4-6h. p.o. as needed.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was noncontributory.

SOCIAL HISTORY: The patient smokes at home.  He lives with
his wife.  [**Name (NI) **] is from [**Country 5881**].  He does not drink alcohol. 

### Response:
{'Other immunoproliferative neoplasms, without mention of having achieved remission,Pathologic fracture of humerus,Injury to brachial plexus,Chronic airway obstruction, not elsewhere classified,Acute pericarditis, unspecified,Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction,Tobacco use disorder,Esophageal reflux'}
