CHIEF COMPLAINT: Headache, Decreased Smell

PRESENT ILLNESS: 55yo RHM with right temporal mass on CT.Pt has been well until
4-5 months ago noted intermittent strange,very potent, smells
that he was unable to characterize. Friends and family nearby
did not notice any smell. He then noted
intermittent headaches, mostly R frontal, at times
retro-orbital, dull, nonthrobbing. He does not normally have
headaches. His headaches increased in severity and frequency
over the last few weeks. The last two days he noted a severe
headache. Much worse when laying supine. He went to his PCP who
obtained [**Name Initial (PRE) **] head CT revealing a large R temporal-parietal area of
hypodensity on CT.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T: 97  BP: 139/87  HR: 66 R: 18  O2Sats: 97% RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCAT, MMM, OP clear
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**3-15**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Father had MI at 60. No h/o neurological problems or CNS
neoplasm

SOCIAL HISTORY: Married, works as an accountant, non-smoker, drinks 3-6 drinks
per evening on weekends, no illicit or IV drugs.
Malignant neoplasm of temporal lobe,Cerebral edema,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Headache
Mal neo temporal lobe,Cerebral edema,Psymotr epil w/o int epi,Headache
Admission Date:  [**2101-12-28**]              Discharge Date:   [**2102-1-4**]

Date of Birth:  [**2046-10-9**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
Headache, Decreased Smell

Major Surgical or Invasive Procedure:
R temporal lobectomy/tumor resection

History of Present Illness:
55yo RHM with right temporal mass on CT.Pt has been well until
4-5 months ago noted intermittent strange,very potent, smells
that he was unable to characterize. Friends and family nearby
did not notice any smell. He then noted
intermittent headaches, mostly R frontal, at times
retro-orbital, dull, nonthrobbing. He does not normally have
headaches. His headaches increased in severity and frequency
over the last few weeks. The last two days he noted a severe
headache. Much worse when laying supine. He went to his PCP who
obtained [**Name Initial (PRE) **] head CT revealing a large R temporal-parietal area of
hypodensity on CT.


Past Medical History:
None

Social History:
Married, works as an accountant, non-smoker, drinks 3-6 drinks
per evening on weekends, no illicit or IV drugs.


Family History:
Father had MI at 60. No h/o neurological problems or CNS
neoplasm

Physical Exam:
O: T: 97  BP: 139/87  HR: 66 R: 18  O2Sats: 97% RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCAT, MMM, OP clear
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**3-15**] 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, R 4 to 3mm, L
5-->4mm. 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 [**5-17**] throughout. slight left
pronator
drift

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

Discharge exam:
Awake, alert and orientated X3, subtle flattening of left nasal
labial fold and a right pronator drift. He had full motor
strenght.


Pertinent Results:
[**2102-1-2**] 06:55AM BLOOD WBC-13.2* RBC-3.77* Hgb-11.7* Hct-33.1*
MCV-88 MCH-31.0 MCHC-35.3* RDW-13.0 Plt Ct-198
[**2101-12-27**] 07:44PM BLOOD Neuts-80.6* Lymphs-16.3* Monos-2.2
Eos-0.7 Baso-0.3
[**2102-1-2**] 06:55AM BLOOD Plt Ct-198
[**2102-1-2**] 06:55AM BLOOD Glucose-125* UreaN-26* Creat-0.7 Na-138
K-4.0 Cl-103 HCO3-26 AnGap-13
[**2102-1-2**] 06:55AM BLOOD Calcium-8.6 Phos-3.4 Mg-2.3

Brief Hospital Course:
Mr. [**Known lastname 13013**] was admitted to the neurosurgery service, and
following a repeat CT in the Emergency department, he underwent
an MRI, which demonstrated a large cystic and solid right
temporal lobe mass with moderate mass effect. He was placed on
IV decadron and keppra, and was taken to the operating room on
[**12-30**] for a R temporal lobectomy and resection of this mass.  He
tolerated the procedure well, and was transferred to the ICU his
BP was kept less than <140 he was continued on steroids. On post
op day 1 he was transferred to the surgical floor. He had
difficulty with post operative headaches, post op CTs showed no
hemorrhage, post op MRI showed
Mild residual enhancement is seen at the medial superior aspect
of the surgical cavity. There remained mild mass effect on the
right lateral ventricle when his headache did not improve with
Dilaudid or Fiorcet his Decadron was increased to 4mg qid. On
[**1-3**] his headache had not improved so Oxycontin 20mg [**Hospital1 **] was
added. On discharge his headache was much more improved. He was
ambulating, tolerating a regular diet and voiding without
difficulty.


Medications on Admission:
None

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-3 Tablets PO Q6H (every 6
hours) as needed for pain/fever.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): Use while on Percocet.
Disp:*40 Capsule(s)* Refills:*0*
3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours): Use while on Steroids.
Disp:*60 Tablet(s)* Refills:*1*
4. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
5. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed for insomnia.
Disp:*15 Tablet(s)* Refills:*0*
6. Hydromorphone 2 mg Tablet Sig: 1-3 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
7. Dexamethasone 2 mg Tablet Sig: 2 tabs tid X3 days; 2 tabs [**Hospital1 **]
X 3 days; 1 tab tid X 3 days then 1 tab [**Hospital1 **] until follow up
Tablets PO see above.
Disp:*90 Tablet(s)* Refills:*2*
8. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours).
Disp:*10 Tablet Sustained Release 12 hr(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
R temporal Mass: Prelim Path GBM


Discharge Condition:
Stable


Discharge Instructions:
General Instructions

??????	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.
??????	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, unless you have been instructed not to.

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: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

??????You will have your staples removed at your brain tumor clinic
appointment which is on [**1-9**] at 2pm [**Hospital Ward Name 516**] [**Hospital Ward Name 23**]
Building [**Location (un) **]. You will meet with your  neuro-oncologist
and radiation oncologist they will develop a formal plan for
your care.


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2102-1-4**]
{'Malignant neoplasm of temporal lobe,Cerebral edema,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Headache'}


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, Decreased Smell

PRESENT ILLNESS: 55yo RHM with right temporal mass on CT.Pt has been well until
4-5 months ago noted intermittent strange,very potent, smells
that he was unable to characterize. Friends and family nearby
did not notice any smell. He then noted
intermittent headaches, mostly R frontal, at times
retro-orbital, dull, nonthrobbing. He does not normally have
headaches. His headaches increased in severity and frequency
over the last few weeks. The last two days he noted a severe
headache. Much worse when laying supine. He went to his PCP who
obtained [**Name Initial (PRE) **] head CT revealing a large R temporal-parietal area of
hypodensity on CT.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T: 97  BP: 139/87  HR: 66 R: 18  O2Sats: 97% RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCAT, MMM, OP clear
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**3-15**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Father had MI at 60. No h/o neurological problems or CNS
neoplasm

SOCIAL HISTORY: Married, works as an accountant, non-smoker, drinks 3-6 drinks
per evening on weekends, no illicit or IV drugs. 

### Response:
{'Malignant neoplasm of temporal lobe,Cerebral edema,Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy,Headache'}
