CHIEF COMPLAINT: metastatic melanoma

PRESENT ILLNESS: HPI:57 y/o M with metastatic melanoma presents today in clinic
s/p MRI head revealing increase in size of R cerebellar lesion.
Patient has received Gamma Knife and cyberknife treatment for
lesions in cerebellar region prior to this. He did present to
BTC
with headaches, but currently has none. He also denies any n/v,
dizziness, gait instability, or blurred vision.

MEDICAL HISTORY: 1.  Hypothyroid.
2.  Gastroesophageal reflux.
3.  Malignant melanoma.

MEDICATION ON ADMISSION: levothyroxine, prednisone, androgel

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
Gen: WD/WN, comfortable, NAD.
HEENT: atraumatic
Pupils: 3-2mm bilaterally        EOMs: intact
Neck: Supple.
Lungs: no audible wheezing.
Cardiac: RRR
Abd: Soft, NT
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: No malignancy in family.

SOCIAL HISTORY: Married, four children, owns business in sheet metal parts,
non-smoker, drinks 2-4 beers daily, denies illicit drug use.
Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Secondary malignant neoplasm of lung,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of malignant melanoma of skin,Long-term (current) use of steroids
Sec mal neo brain/spine,Cerebral edema,Secondary malig neo lung,Hypothyroidism NOS,Esophageal reflux,Hx-malig skin melanoma,Long-term use steroids
Admission Date:  [**2196-8-19**]              Discharge Date:   [**2196-8-21**]

Date of Birth:  [**2138-10-15**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
metastatic melanoma


Major Surgical or Invasive Procedure:
Right occipital craniectomy resection of cerebellar mass

History of Present Illness:
HPI:57 y/o M with metastatic melanoma presents today in clinic
s/p MRI head revealing increase in size of R cerebellar lesion.
Patient has received Gamma Knife and cyberknife treatment for
lesions in cerebellar region prior to this. He did present to
BTC
with headaches, but currently has none. He also denies any n/v,
dizziness, gait instability, or blurred vision.

PMHx:metastatic melanoma R parietal scalp lesion s/p resection,
R
cerebellar lesion, R parotid lesion, s/p resection.

All:NKDA

Medications prior to admission:--------------- ---------------
--------------- ---------------
Active Medication list as of [**2196-8-16**]:

Medications - Prescription
LEVOTHYROXINE - 50 mcg Tablet - 1 Tablet(s) by mouth daily
PREDNISONE -  (Prescribed by Other Provider; Dose adjustment -
no
new Rx) - 5 mg Tablet - 1 and [**2-1**] Tablet(s) by mouth once a day
total dose 6.5 mg daily.
TESTOSTERONE [ANDROGEL] -  (Not Taking as Prescribed) - 1.25
gram
per Actuation (1 %) Gel in Metered-dose Pump - 4 pumps daily

Medications - OTC
ACETAMINOPHEN -  (Prescribed by Other Provider; OTC; Dose
adjustment - no new Rx) - 500 mg Tablet - 2 Tablet(s) by mouth
every 4 hours as needed for headaches
--------------- --------------- --------------- ---------------
Social Hx:pilot, 6 beers/week, +tobacco ages 15-20

Family Hx:NC
ROS:as above


Past Medical History:
1.  Hypothyroid.
2.  Gastroesophageal reflux.
3.  Malignant melanoma.


Social History:
Married, four children, owns business in sheet metal parts,
non-smoker, drinks 2-4 beers daily, denies illicit drug use.


Family History:
No malignancy in family.

Physical Exam:
PHYSICAL EXAM:
Gen: WD/WN, comfortable, NAD.
HEENT: atraumatic
Pupils: 3-2mm bilaterally        EOMs: intact
Neck: Supple.
Lungs: no audible wheezing.
Cardiac: RRR
Abd: Soft, NT
Extrem: Warm and well-perfused. No C/C/E.

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**3-31**] objects at 5 minutes.
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,3 to 2
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 finger rub bilaterally.
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 [**6-2**] throughout. No pronator drift

Sensation: Intact to light touch

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger

PHYSICAL EXAM UPON DISCHARGE:
non-focal


Pertinent Results:
[**8-19**] CT-Head: IMPRESSION:
1. Status post suboccipital craniotomy for mass resection with
expected
post-surgical appearance.
2. Right cerebellar edema with possible small amount of blood in
the
resection site, though this could be artifactual given typical
artifacts in the posterior fossa.
3. Hypodensity in the right subinsular region corresponding to
known
metastatic lesion.

[**8-20**] MRI Brain:
CONCLUSION: Status post right suboccipital craniectomy with
expected
postoperative changes and continuing posterior fossa mass
effect. Multiple
other brain metastases appear unchanged.


Brief Hospital Course:
Patient was admitted to Neurosurgery on [**8-19**] and underwent the
above stated procedure.  He was extubated without incident and
transferred to the ICU for further mangement post op Head Ct
showed no hemorrhage, post operative changes. He remained stable
overnight, complaining only of nausea.

On 7.23 an Brain MRI was obtained which revealed good resection.
He was cleared for transfer to the floor. PT/OT were consulted
for assistance with discharge planning.
On [**8-21**] he was again neurologically stable. Nausea has resolved
and he was tolerating PO. Foley was discontinued and decadron
was tapered oever 5 days to 2mg [**Hospital1 **]. PT cleared the patient for
discharge.

Medications on Admission:
levothyroxine, prednisone, androgel


Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever/pain.
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours)
as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
4. levothyroxine 25 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. 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*
6. dexamethasone 2 mg Tablet Sig: taper Tablet PO taper: 4mg PO
Q8hrs on [**8-21**], 3mg PO Q8hrs on [**8-22**],2mg PO Q8hrs on [**8-23**],2mg PO
Q12hrs [**8-24**] & til f/u.
Disp:*80 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Right suboccipital brain lesion


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


Discharge Instructions:
General Instructions/Information

??????	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 only after sutures and/or staples have
been removed. If your wound closure uses dissolvable sutures,
you must keep that area dry for 10 days.
??????	You may shower before this time using a shower cap to cover
your head.
??????	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.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	If you are being sent home on steroid medication, make sure
you are taking a medication to protect your stomach (Prilosec,
Protonix, or Pepcid), as these medications can cause stomach
irritation.  Make sure to take your steroid medication with
meals, or a glass of milk.
??????	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.


Followup Instructions:
Follow-Up Appointment Instructions

??????You need an appointment in the Brain [**Hospital 341**] Clinic on in [**1-31**]
weeks.  The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 516**] of
[**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their phone number is
[**Telephone/Fax (1) 1844**]. They will contact you regarding date and time of
your appt. Please call if you need to change your appointment,
or require additional directions.



Completed by:[**2196-8-21**]
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Secondary malignant neoplasm of lung,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of malignant melanoma of skin,Long-term (current) use of steroids'}


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 melanoma

PRESENT ILLNESS: HPI:57 y/o M with metastatic melanoma presents today in clinic
s/p MRI head revealing increase in size of R cerebellar lesion.
Patient has received Gamma Knife and cyberknife treatment for
lesions in cerebellar region prior to this. He did present to
BTC
with headaches, but currently has none. He also denies any n/v,
dizziness, gait instability, or blurred vision.

MEDICAL HISTORY: 1.  Hypothyroid.
2.  Gastroesophageal reflux.
3.  Malignant melanoma.

MEDICATION ON ADMISSION: levothyroxine, prednisone, androgel

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
Gen: WD/WN, comfortable, NAD.
HEENT: atraumatic
Pupils: 3-2mm bilaterally        EOMs: intact
Neck: Supple.
Lungs: no audible wheezing.
Cardiac: RRR
Abd: Soft, NT
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: No malignancy in family.

SOCIAL HISTORY: Married, four children, owns business in sheet metal parts,
non-smoker, drinks 2-4 beers daily, denies illicit drug use. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,Secondary malignant neoplasm of lung,Unspecified acquired hypothyroidism,Esophageal reflux,Personal history of malignant melanoma of skin,Long-term (current) use of steroids'}
