CHIEF COMPLAINT: headache

PRESENT ILLNESS: 65F with hx. of breast Ca. with bone mets, presented with 4
weeks of occipital headache. Associated symptoms are nausea and
vomiting, no change in vision, balance, smell. Had imaging (CT
+MRI) at OSH that showed cerebellar metastases with 8mm downward
herniation. 4th ventricle was near-totally obstructed, and
lateral ventricles were enlarged. She was given decadron 4mg IV
at [**Hospital3 4107**], and she received devadron 6mg IV in [**Hospital1 18**]
emergency [**Hospital1 **].

MEDICAL HISTORY: Breast cancer, s/p chemotherapy with Taxol.
Known mets to right femur/hip, s/p ORIF for fixation.
Hypertension

MEDICATION ON ADMISSION: HCTZ 25mg',Herceptin,Zometa

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
98.2 62 137/68 20 100%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: bilaterally reactive to light
EOMs: intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**4-1**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: Smokes
widowed, children.
Secondary malignant neoplasm of brain and spinal cord,Obstructive hydrocephalus,Compression of brain,Malignant neoplasm of other specified sites of female breast,Estrogen receptor positive status [ER+],Headache,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Personal history of antineoplastic chemotherapy
Sec mal neo brain/spine,Obstructiv hydrocephalus,Compression of brain,Malign neopl breast NEC,Estrogen recep pstv stat,Headache,Hypertension NOS,Anxiety state NOS,Tobacco use disorder,Hx antineoplastic chemo
Admission Date:  [**2106-3-9**]              Discharge Date:   [**2106-3-15**]

Date of Birth:  [**2040-12-6**]             Sex:   F

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
Suboccipital Craniotomy for mass resection


History of Present Illness:
65F with hx. of breast Ca. with bone mets, presented with 4
weeks of occipital headache. Associated symptoms are nausea and
vomiting, no change in vision, balance, smell. Had imaging (CT
+MRI) at OSH that showed cerebellar metastases with 8mm downward
herniation. 4th ventricle was near-totally obstructed, and
lateral ventricles were enlarged. She was given decadron 4mg IV
at [**Hospital3 4107**], and she received devadron 6mg IV in [**Hospital1 18**]
emergency [**Hospital1 **].

Past Medical History:
Breast cancer, s/p chemotherapy with Taxol.
Known mets to right femur/hip, s/p ORIF for fixation.
Hypertension

Social History:
Smokes
widowed, children.

Family History:
NC

Physical Exam:
PHYSICAL EXAM:
98.2 62 137/68 20 100%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: bilaterally reactive to light
EOMs: intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**4-1**] 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, to
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 voice.
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 [**6-3**] throughout. No pronator drift

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Reflexes: B T Br Pa Ac
Right     2 2 2   2  2
Left      2 2 2   2  2

Toes downgoing bilaterally

Cerebellar testing:
No dysmetria with finger to nose bilaterally.
Unable to do hand flapping on left side. No problems with right
side.
Normal heel to shin bilaterally.

Exam upon discharge:
Slight left dysmetria, otherwise intact

Pertinent Results:
MRI:
OSH MRI: 3 cerebellar metasteses with 8mm downward herniation.

CT Head [**3-12**] Post op

No acute bleed.


Brief Hospital Course:
Pt was admitted to ICU and monitored closely and remained
stable.  She was started on steroids.  She transferred to floor
[**2105-3-10**].  She underwent CT torso for staging which appears to be
grossly stable when compared with history obtained from
oncologist.  She was readied for the OR and underwent an
uncomplicated suboccipital craniotomy for tumor resection on
[**3-12**]. Post operatively she remained intubated and was
transferred to the ICU for further care including q1 neuro
checks and strict blood pressure control. On post op exam she
was awake and alert, following commands and moving all
extremities with full strength. She was extubated in the early
morning of [**3-13**]. Her diet was advanced and she was tolerating a
diet well. She was transferred to the floor in stable condition.
She was ambulatory in the halls without assistance and deemed
fit for discharge on [**3-15**].  She was given instructions for
follow-up  and discharged

Medications on Admission:
HCTZ 25mg',Herceptin,Zometa


Discharge Medications:
1. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
2. acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever,pain.
3. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
Disp:*90 Tablet(s)* Refills:*2*
5. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO q3hours as needed
for pain.
Disp:*45 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Cerebellar Metastasis


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.
CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	Any signs of infection at the wound site: increasing redness,
increased swelling, increased tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.

.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in [**8-8**] days (from your date of
surgery) for removal of your staples/sutures and/or a wound
check. This appointment can be made with the Nurse Practitioner.
 Please make this appointment by calling [**Telephone/Fax (1) 1669**]. If you
live quite a distance from our office, please make arrangements
for the same, with your PCP.
??????You will be contact[**Name (NI) **] by The Brain [**Hospital 341**] Clinic for meeting
regarding radiation with Dr [**First Name (STitle) 13014**].  He is located on the [**Hospital Ward Name 5074**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) 442**]. Your
appointment will msot likely be friday [**3-19**]. Their phone
number is [**Telephone/Fax (1) 1844**]. Please call if you have any questions
??????You will / will not need an MRI of the brain with/ or without
gadolinium contrast.  If you are required to have a MRI, you may
also require a blood test to measure your BUN and Cr within 30
days of your MRI.  This can be measured by your PCP, [**Name10 (NameIs) **]
please make sure to have these results with you, when you come
in for your appointment



Completed by:[**2106-3-15**]
{'Secondary malignant neoplasm of brain and spinal cord,Obstructive hydrocephalus,Compression of brain,Malignant neoplasm of other specified sites of female breast,Estrogen receptor positive status [ER+],Headache,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Personal history of antineoplastic chemotherapy'}


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: headache

PRESENT ILLNESS: 65F with hx. of breast Ca. with bone mets, presented with 4
weeks of occipital headache. Associated symptoms are nausea and
vomiting, no change in vision, balance, smell. Had imaging (CT
+MRI) at OSH that showed cerebellar metastases with 8mm downward
herniation. 4th ventricle was near-totally obstructed, and
lateral ventricles were enlarged. She was given decadron 4mg IV
at [**Hospital3 4107**], and she received devadron 6mg IV in [**Hospital1 18**]
emergency [**Hospital1 **].

MEDICAL HISTORY: Breast cancer, s/p chemotherapy with Taxol.
Known mets to right femur/hip, s/p ORIF for fixation.
Hypertension

MEDICATION ON ADMISSION: HCTZ 25mg',Herceptin,Zometa

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
98.2 62 137/68 20 100%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: bilaterally reactive to light
EOMs: intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**4-1**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: Smokes
widowed, children. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Obstructive hydrocephalus,Compression of brain,Malignant neoplasm of other specified sites of female breast,Estrogen receptor positive status [ER+],Headache,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Personal history of antineoplastic chemotherapy'}
