CHIEF COMPLAINT: Lethargy

PRESENT ILLNESS: 83yoF w h/o cerebellar and parafalcine mass, gastric bleed
on steroids, now off steroids with progressive lethargy at rehab
x 4 days. She had a recent admission approx 1 wk ago for similar
symptoms found to have UTI with some improvement on treatment.
Patient improved but not to baseline at rehab until few days
ago,
general lack of energy now arousable but non-verbal. J-tube
feeding at rehab. Also intractable nausea unclear relief with
zofran. Denies pain.  Noted on CXR at rehab to have signs of CHF
and consolidation thought to be PNA and started on cefpodoxime.
No cough, fevers.  Today sent to NWH, CT with obstructive
hydrocephalus, xfr to [**Hospital1 18**].

MEDICAL HISTORY: - extra-axial masses in the right cerebellopontine angle and
also in the anterior parafalcine regions, likely meningioma,
base on MRI [**2146-12-21**]
- recent gastric ulcer and perforation, hemorrhagic shock, ARF
[**3-9**] steroid use, requiring ex-lap Bilroth II gastric resection
and esophago-gastroduodenoscopy
- UGIB s/p EGD [**2147-1-23**] found gastritis and ulcer around the
anastomosis
- h/o uterine CA treated with chemo in [**2137**]
- HTN
- vertigo
- lumbar stenosis
- UTI

MEDICATION ON ADMISSION: Tylenol 650mg Q6
amlodipine 2.5mg qd
cefpodoxime 400mg qd
lactobacilus TID
Ritalin 2.5mg [**Hospital1 **]
lopressor 25mg TID
omeprazole 40mg [**Hospital1 **]
ondansetron 8mg q8h
simethicone 80mg TID
sucralfate 1gm [**Hospital1 **]
Dulcolax 10 qd
milk of magnesia
senna
Atarax 25 q4

ALLERGIES: Codeine / Optiray 300

PHYSICAL EXAM: ON ADMISSION PHYSICAL EXAM:
O: Temp: 96.8 HR: 80 BP: 158/87 Resp: 18 O(2)Sat: 100 2L Nasal
Cannula
Gen: comfortable, NAD.
HEENT: Pupils: equal round reactive 4 to 3 mm b/l, pt
non-compliant with EOM exam
Neck: Supple.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Drowsy but arousable, minimally cooperative with
exam, not verbally responsive
Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Grossly moving all 4 extremities in bed for purposeful
motions.
Sensation: responds to noxious stimuli

FAMILY HISTORY: N/C

SOCIAL HISTORY: Prior to prolonged and complicated recent hospital course,
patient was living at home with daughter
- denies ETOH, tobacco or IVDA
Benign neoplasm of cerebral meninges,Cerebral edema,Obstructive hydrocephalus,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of other parts of uterus,Hip joint replacement,Status of other artificial opening of gastrointestinal tract
Ben neo cerebr meninges,Cerebral edema,Obstructiv hydrocephalus,Delirium d/t other cond,Hypertension NOS,Crnry athrscl natve vssl,Hx-uterus malignancy NEC,Joint replaced hip,Enterostomy status NEC
Admission Date:  [**2147-2-9**]              Discharge Date:   [**2147-2-13**]

Date of Birth:  [**2063-12-9**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Codeine / Optiray 300

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Lethargy

Major Surgical or Invasive Procedure:
none


History of Present Illness:
83yoF w h/o cerebellar and parafalcine mass, gastric bleed
on steroids, now off steroids with progressive lethargy at rehab
x 4 days. She had a recent admission approx 1 wk ago for similar
symptoms found to have UTI with some improvement on treatment.
Patient improved but not to baseline at rehab until few days
ago,
general lack of energy now arousable but non-verbal. J-tube
feeding at rehab. Also intractable nausea unclear relief with
zofran. Denies pain.  Noted on CXR at rehab to have signs of CHF
and consolidation thought to be PNA and started on cefpodoxime.
No cough, fevers.  Today sent to NWH, CT with obstructive
hydrocephalus, xfr to [**Hospital1 18**].

Past Medical History:
- extra-axial masses in the right cerebellopontine angle and
also in the anterior parafalcine regions, likely meningioma,
base on MRI [**2146-12-21**]
- recent gastric ulcer and perforation, hemorrhagic shock, ARF
[**3-9**] steroid use, requiring ex-lap Bilroth II gastric resection
and esophago-gastroduodenoscopy
- UGIB s/p EGD [**2147-1-23**] found gastritis and ulcer around the
anastomosis
- h/o uterine CA treated with chemo in [**2137**]
- HTN
- vertigo
- lumbar stenosis
- UTI


Social History:
Prior to prolonged and complicated recent hospital course,
patient was living at home with daughter
- denies ETOH, tobacco or IVDA


Family History:
N/C

Physical Exam:
ON ADMISSION PHYSICAL EXAM:
O: Temp: 96.8 HR: 80 BP: 158/87 Resp: 18 O(2)Sat: 100 2L Nasal
Cannula
Gen: comfortable, NAD.
HEENT: Pupils: equal round reactive 4 to 3 mm b/l, pt
non-compliant with EOM exam
Neck: Supple.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Drowsy but arousable, minimally cooperative with
exam, not verbally responsive
Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Grossly moving all 4 extremities in bed for purposeful
motions.
Sensation: responds to noxious stimuli

ON DISCHARGE:
Alert
No commands
Nods head appropriately
MAE spontaneously

Pertinent Results:
[**2147-2-9**] CT Head - stable right cerebellopontine large meningioma
with effacement 4th ventricle and hydrocephalus, stable small
left frontal meningioma

[**2147-2-9**] 01:12PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-LG
[**2147-2-9**] 01:12PM URINE  RBC-2 WBC-123* BACTERIA-NONE YEAST-NONE
EPI-1


Brief Hospital Course:
Ms. [**Known lastname **] presented to the [**Hospital1 18**] ED from rehab with increasing
lethargy.  She was evaluated by the Neurosurgery team who noted
increased hydrocephalus on CT Head.  General Surgery was
consulted for evaluation of potential VPS in setting of recent
abdominal surgery.  The patient was admitted to the ICU with
Neuro-oncology, Palliative Care, and Medicine consults.  The
patient remained stable overnight with anti-emesis and serial
neuro exams.  After extensive discussions by the patient's
family, social work, and palliative care teams, it was decided
to defer any intervention.  The patient was transferred to the
floor on [**2147-2-10**]. On [**2-12**], after much family discussion, patient
was made comfort measures only and was transferred to hospice.

Medications on Admission:
Tylenol 650mg Q6
amlodipine 2.5mg qd
cefpodoxime 400mg qd
lactobacilus TID
Ritalin 2.5mg [**Hospital1 **]
lopressor 25mg TID
omeprazole 40mg [**Hospital1 **]
ondansetron 8mg q8h
simethicone 80mg TID
sucralfate 1gm [**Hospital1 **]
Dulcolax 10 qd
milk of magnesia
senna
Atarax 25 q4

Discharge Medications:
1. morphine 10 mg/5 mL Solution Sig: 2.5-5 ml PO Q2H as needed
for pain.
Disp:*100 ml* Refills:*0*
2. Ativan 0.5 mg Tablet Sig: 1-2 Tablets PO Q2H.
Disp:*60 Tablet(s)* Refills:*2*
3. Levsin 0.125 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital 13054**] Hospice

Discharge Diagnosis:
Cerebellar and parafalcine brain mass
Obstructive Hydrocephalus


Discharge Condition:
Neurologically stable


Discharge Instructions:
You are being discharged to hospice where your comfort focused
care will be continued.

Followup Instructions:
Follow up as requested by Patient and Family.  You may call
([**Telephone/Fax (1) 88**] to schedule an appointment with Dr. [**First Name (STitle) **] as
needed.



Completed by:[**2147-2-13**]
{'Benign neoplasm of cerebral meninges,Cerebral edema,Obstructive hydrocephalus,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of other parts of uterus,Hip joint replacement,Status of other artificial opening of gastrointestinal tract'}


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: Lethargy

PRESENT ILLNESS: 83yoF w h/o cerebellar and parafalcine mass, gastric bleed
on steroids, now off steroids with progressive lethargy at rehab
x 4 days. She had a recent admission approx 1 wk ago for similar
symptoms found to have UTI with some improvement on treatment.
Patient improved but not to baseline at rehab until few days
ago,
general lack of energy now arousable but non-verbal. J-tube
feeding at rehab. Also intractable nausea unclear relief with
zofran. Denies pain.  Noted on CXR at rehab to have signs of CHF
and consolidation thought to be PNA and started on cefpodoxime.
No cough, fevers.  Today sent to NWH, CT with obstructive
hydrocephalus, xfr to [**Hospital1 18**].

MEDICAL HISTORY: - extra-axial masses in the right cerebellopontine angle and
also in the anterior parafalcine regions, likely meningioma,
base on MRI [**2146-12-21**]
- recent gastric ulcer and perforation, hemorrhagic shock, ARF
[**3-9**] steroid use, requiring ex-lap Bilroth II gastric resection
and esophago-gastroduodenoscopy
- UGIB s/p EGD [**2147-1-23**] found gastritis and ulcer around the
anastomosis
- h/o uterine CA treated with chemo in [**2137**]
- HTN
- vertigo
- lumbar stenosis
- UTI

MEDICATION ON ADMISSION: Tylenol 650mg Q6
amlodipine 2.5mg qd
cefpodoxime 400mg qd
lactobacilus TID
Ritalin 2.5mg [**Hospital1 **]
lopressor 25mg TID
omeprazole 40mg [**Hospital1 **]
ondansetron 8mg q8h
simethicone 80mg TID
sucralfate 1gm [**Hospital1 **]
Dulcolax 10 qd
milk of magnesia
senna
Atarax 25 q4

ALLERGIES: Codeine / Optiray 300

PHYSICAL EXAM: ON ADMISSION PHYSICAL EXAM:
O: Temp: 96.8 HR: 80 BP: 158/87 Resp: 18 O(2)Sat: 100 2L Nasal
Cannula
Gen: comfortable, NAD.
HEENT: Pupils: equal round reactive 4 to 3 mm b/l, pt
non-compliant with EOM exam
Neck: Supple.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Drowsy but arousable, minimally cooperative with
exam, not verbally responsive
Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Grossly moving all 4 extremities in bed for purposeful
motions.
Sensation: responds to noxious stimuli

FAMILY HISTORY: N/C

SOCIAL HISTORY: Prior to prolonged and complicated recent hospital course,
patient was living at home with daughter
- denies ETOH, tobacco or IVDA 

### Response:
{'Benign neoplasm of cerebral meninges,Cerebral edema,Obstructive hydrocephalus,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of other parts of uterus,Hip joint replacement,Status of other artificial opening of gastrointestinal tract'}
