CHIEF COMPLAINT: Skull lesion

PRESENT ILLNESS: Ms. [**Known lastname 3708**] is otherwise healthy,64-year-old lady who was
originally diagnosed with renal cell cancer in [**2144**].  She had
metastatic disease in the adrenal gland. She has had resection
following whichshe was on steroid replacements.  She also has
other pulmonary disease.  CT scan in [**2150-5-31**] showed some lung
infiltrates.  She was being on followup and further staging CT
scans were done.  More recently, she had a history of what she
thought was a hit to her head and she noticed some bump and
initially thought to have trauma and skull film was done on [**8-20**], [**2149**], which was followed up by an MRI.  MRI
showed an expansile 4 x 2.2 x 3.0 cm enhancing mass centered in
the diploic space at the left frontal bone marginated by frontal
suture posteriorly with thinning and depression inner table.
The patient was then seen by me for consideration of radiation
after consideration of histologic diagnosis.

MEDICAL HISTORY: Metastatic renal cell cancer status post
radical nephrectomy in [**2144**], adrenal insufficiency and
disposition of the chronic renal disease, however, prior
obesity,
hypertension, chronic obstructive pulmonary disease,
hypercholesterolemia, and depression.

MEDICATION ON ADMISSION: hydrocortisone, chlorthalidone, fludrocortisone, mirtazapine,
sertraline, simvastatin, atenolol, albuterol, combivent

ALLERGIES: adhesive tape

PHYSICAL EXAM: Pre-op
She appears comfortable at rest, alert,
and oriented.  Eyes, ears, nostrils, and oropharynx are
unremarkable.  Neck is soft.  No nodes, elevated JVP, or thyroid
swelling.  Chest, bilateral good air entry.  Normal heart
sounds.
 No decreased heart sounds.  Abdomen is soft.  No mass,
tenderness, or hepatosplenomegaly.  Neurological and
musculoskeletal examination is grossly intact.  Examination of
the skull itself reveals circumscribed bump on the scalp from
the
underlying calvaria in the left frontal area

FAMILY HISTORY: No history of cancer in family

SOCIAL HISTORY: She does not abuse tobacco or alcohol
Secondary malignant neoplasm of bone and bone marrow,Glucocorticoid deficiency,Delirium due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Hemorrhage complicating a procedure,Chronic kidney disease, Stage III (moderate),Personal history of malignant neoplasm of kidney,Chronic airway obstruction, not elsewhere classified,Hypopotassemia,Disorders of phosphorus metabolism,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Physical restraints status,Other specified visual disturbances,Colostomy status
Secondary malig neo bone,Glucocorticoid deficient,Delirium d/t other cond,Hy kid NOS w cr kid I-IV,Hemorrhage complic proc,Chr kidney dis stage III,Hx of kidney malignancy,Chr airway obstruct NEC,Hypopotassemia,Dis phosphorus metabol,Hyperlipidemia NEC/NOS,Depressive disorder NEC,Physical restrain status,Visual disturbances NEC,Colostomy status
Admission Date:  [**2151-9-1**]              Discharge Date:   [**2151-9-6**]

Date of Birth:  [**2086-5-15**]             Sex:   F

Service: NEUROSURGERY

Allergies:
adhesive tape

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

Major Surgical or Invasive Procedure:
Resection Left skull lesion and cranioplasty Dr. [**Last Name (STitle) **] [**2151-9-1**]


History of Present Illness:
Ms. [**Known lastname 3708**] is otherwise healthy,64-year-old lady who was
originally diagnosed with renal cell cancer in [**2144**].  She had
metastatic disease in the adrenal gland. She has had resection
following whichshe was on steroid replacements.  She also has
other pulmonary disease.  CT scan in [**2150-5-31**] showed some lung
infiltrates.  She was being on followup and further staging CT
scans were done.  More recently, she had a history of what she
thought was a hit to her head and she noticed some bump and
initially thought to have trauma and skull film was done on [**8-20**], [**2149**], which was followed up by an MRI.  MRI
showed an expansile 4 x 2.2 x 3.0 cm enhancing mass centered in
the diploic space at the left frontal bone marginated by frontal
suture posteriorly with thinning and depression inner table.
The patient was then seen by me for consideration of radiation
after consideration of histologic diagnosis.

The patient herself noticed a bump, some achiness in this area,
but otherwise no other higher function, cranial nerves, sensory,
motor, or neurological dysfunction.


Past Medical History:
Metastatic renal cell cancer status post
radical nephrectomy in [**2144**], adrenal insufficiency and
disposition of the chronic renal disease, however, prior
obesity,
hypertension, chronic obstructive pulmonary disease,
hypercholesterolemia, and depression.


Social History:
She does not abuse tobacco or alcohol

Family History:
No history of cancer in family

Physical Exam:
Pre-op
She appears comfortable at rest, alert,
and oriented.  Eyes, ears, nostrils, and oropharynx are
unremarkable.  Neck is soft.  No nodes, elevated JVP, or thyroid
swelling.  Chest, bilateral good air entry.  Normal heart
sounds.
 No decreased heart sounds.  Abdomen is soft.  No mass,
tenderness, or hepatosplenomegaly.  Neurological and
musculoskeletal examination is grossly intact.  Examination of
the skull itself reveals circumscribed bump on the scalp from
the
underlying calvaria in the left frontal area

On discharge:
AVSS
AxOx3
NAD
pleasant
symmetric chest rise, breathimg comfortably
sitting up in bed
incision c/d/i w/o induration or erythema
CNII-XII intact
No focal or diffuse neurologic deficits appreciated.

Pertinent Results:
[**9-1**] MRI brain with and without contrast: Enhancing left frontal
skull mass as described corresponding to a lytic lesion in the
skull radiograph in keeping with metastatic disease.  No
intraparenchymal extension of this mass.  No enhancing lesions
within the brain.

[**9-1**] CT head: The patient is post left frontal craniectomy and
resection of a large calvarial-based mass, seen on the
preoperative [**2151-9-1**] MR examination.  There is mild
pneumocephalus (2:12).  A cranial plate overlies the resection
site.  There is a small amount of subcutaneous emphysema.  No
large hemorrhage, edema, or mass effect is seen.  The middle ear
cavities, mastoid air cells, and included views of the paranasal
sinuses are clear.

[**9-2**] MRI Brain with and without: 1.  Expected post-surgical
appearance of left frontal craniectomy and resection of the left
calvarial mass.
2.  No mass-like enhancement around the surgical cavity.
Persistent left
frontal dural enhancement, also seen in the pre-operative study.

3.  No acute infarcts.


Brief Hospital Course:
Ms. [**Known lastname 3708**] was admitted to [**Hospital1 18**] under the care of Dr. [**Last Name (STitle) **] for
resection of left calvarial mass and cranioplasty. She was given
stress dose steroids prior to case for adrenal insufficiency.
During the operative case she lost 2L of blood and received 2
units PRBS. Post-op hct was 37. She had hypokalemia intra-op due
to her adrenal insufficiency but this corrected to 3.1. She was
extubated post-op and was taken to the ICU.  Postoperatively she
remained neurologically intact.  Postop Head CT demonstrated no
hemorrhage.

On [**9-2**], POD1 she was doing well, advanced her diet and was up
and out of bed.  Postoperative MRI was performed and she was
transfered to the regular floor.

On [**9-3**] the patient was noted to be delerious, not oriented to
the month or specific hospital. She was afebrile, urinalysis was
negative for infection and possibly delerium inducing
medications were stopped. BMP did reveal significant
abnormalities including hypokelemia, hypophosphotemia and low
magnesium. A geriatric consult was called and they felt that the
electrolyte abnormalities were most likely responsible for the
delerium. These were repleted and her chlorthalidone was d/c'd .
Overnight the patient was refusing care and IV placement. She
was temporarilly restrained in order to get an IV placed.
On [**9-4**] her exam was much improved. She was alert and oriented
but still slow compared to her baseline. Repeat electrolytes
showed improvement but were still low so they were again
repleted per Geriatrics recommendation. Creatinine was back to
baseline. Also she was started on standing tylenol for pain
control.

On [**9-4**], the patient returned to baseline level of functioning
and electrolytes normalized. Discharge planning to
rehabilitation facility was undertaken.

On [**9-5**], the patient awaited transfer to rehabilitation facility.

On [**9-6**], the patient was discharged in stable condition. The
patient expressed readiness for discharge and was alert and
oriented to person, place, and date. All questions were
answered.

ESTIMATED LENGTH OF STAY AT ACUTE REHAB FACILITY <30DAYS

Medications on Admission:
hydrocortisone, chlorthalidone, fludrocortisone, mirtazapine,
sertraline, simvastatin, atenolol, albuterol, combivent

Discharge Medications:
1. Acetaminophen 1000 mg PO Q6H
2. Albuterol-Ipratropium [**2-1**] PUFF IH Q6H:PRN wheeze
3. Atenolol 100 mg PO DAILY
4. Docusate Sodium 100 mg PO BID
5. Fludrocortisone Acetate 0.1 mg PO DAILY
6. Heparin 5000 UNIT SC TID
7. Hydrocortisone 15 mg PO QAM
8. Hydrocortisone 10 mg PO QPM
9. OxycoDONE (Immediate Release)  5-10 mg PO Q4H:PRN pain
10. Senna 1 TAB PO HS
11. Sertraline 200 mg PO DAILY
12. Simvastatin 20 mg PO HS
13. Phosphorus 500 mg PO BID


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Nursing & Therapy Center - [**Location 1268**] ([**Location (un) 86**] Center
for Rehabilitation and Sub-Acute Care)

Discharge Diagnosis:
Left skull lesion


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge 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.
??????	Dressing may be removed on Day 2 after surgery.
??????	**You have dissolvable sutures you may wash your hair and get
your incision wet day 3 after surgery.  You may shower before
this time using a shower cap to cover your head.
??????	**Your wound was closed with staples or non-dissolvable
sutures then you must wait until after they are removed to wash
your hair. 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:
ESTIMATED LENGTH OF STAY AT ACUTE REHAB FACILITY <30DAYS

??????Please return to the office in [**8-10**] days(from your date of
surgery) for removal of your sutures and/or a wound check. This
appointment can be made with the Physician Assistant or [**Name9 (PRE) **]
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 also may have them removed at your rehab facility.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain



Completed by:[**2151-9-6**]
{'Secondary malignant neoplasm of bone and bone marrow,Glucocorticoid deficiency,Delirium due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Hemorrhage complicating a procedure,Chronic kidney disease, Stage III (moderate),Personal history of malignant neoplasm of kidney,Chronic airway obstruction, not elsewhere classified,Hypopotassemia,Disorders of phosphorus metabolism,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Physical restraints status,Other specified visual disturbances,Colostomy status'}


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: Skull lesion

PRESENT ILLNESS: Ms. [**Known lastname 3708**] is otherwise healthy,64-year-old lady who was
originally diagnosed with renal cell cancer in [**2144**].  She had
metastatic disease in the adrenal gland. She has had resection
following whichshe was on steroid replacements.  She also has
other pulmonary disease.  CT scan in [**2150-5-31**] showed some lung
infiltrates.  She was being on followup and further staging CT
scans were done.  More recently, she had a history of what she
thought was a hit to her head and she noticed some bump and
initially thought to have trauma and skull film was done on [**8-20**], [**2149**], which was followed up by an MRI.  MRI
showed an expansile 4 x 2.2 x 3.0 cm enhancing mass centered in
the diploic space at the left frontal bone marginated by frontal
suture posteriorly with thinning and depression inner table.
The patient was then seen by me for consideration of radiation
after consideration of histologic diagnosis.

MEDICAL HISTORY: Metastatic renal cell cancer status post
radical nephrectomy in [**2144**], adrenal insufficiency and
disposition of the chronic renal disease, however, prior
obesity,
hypertension, chronic obstructive pulmonary disease,
hypercholesterolemia, and depression.

MEDICATION ON ADMISSION: hydrocortisone, chlorthalidone, fludrocortisone, mirtazapine,
sertraline, simvastatin, atenolol, albuterol, combivent

ALLERGIES: adhesive tape

PHYSICAL EXAM: Pre-op
She appears comfortable at rest, alert,
and oriented.  Eyes, ears, nostrils, and oropharynx are
unremarkable.  Neck is soft.  No nodes, elevated JVP, or thyroid
swelling.  Chest, bilateral good air entry.  Normal heart
sounds.
 No decreased heart sounds.  Abdomen is soft.  No mass,
tenderness, or hepatosplenomegaly.  Neurological and
musculoskeletal examination is grossly intact.  Examination of
the skull itself reveals circumscribed bump on the scalp from
the
underlying calvaria in the left frontal area

FAMILY HISTORY: No history of cancer in family

SOCIAL HISTORY: She does not abuse tobacco or alcohol 

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Glucocorticoid deficiency,Delirium due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Hemorrhage complicating a procedure,Chronic kidney disease, Stage III (moderate),Personal history of malignant neoplasm of kidney,Chronic airway obstruction, not elsewhere classified,Hypopotassemia,Disorders of phosphorus metabolism,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Physical restraints status,Other specified visual disturbances,Colostomy status'}
