CHIEF COMPLAINT: Transfer for high-dose methotrexate.

PRESENT ILLNESS: Ms. [**Known firstname 77781**] [**Known lastname 77782**] is a 55-year-old right-handed woman from
[**Country 4194**] with a past medical history of depression, who presented
to the [**Hospital1 18**] on [**2148-4-21**] with one week of headaches, dizziness,
and a two day history of diplopia. A head MRI of the brain
showed a tectal mass and three areas of nodular enhancement on
the ventricular surfaces, concerning for brain metastases with
ventricular seeding. She underwent a stereotactic biopsy on
[**2148-4-22**] which was consistent with high-grade B-cell lymphoma.
CT of the torso on [**2148-4-24**] did not show a distinct primary
site, only some subcentimeter left axillary lymph nodes. Dr.
[**Last Name (STitle) 724**] was consulted for help in management, and recommended
high-dose methotrexate.

MEDICAL HISTORY: Depression.

MEDICATION ON ADMISSION: Acetaminophen 325-650 mg PO Q6H:PRN
Famotidine 20 mg PO BID
Dexamethasone 4 mg IV Q6H
Morphine Sulfate 2-4 mg IV Q4H:PRN
Insulin sliding scale

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION: Temperature is 98.8 F. Her blood pressure
is 160/86. Heart rate is 73. Respiratory rate is 16. Oxygen
saturation is 98% in room air. Her measured weight is 162.3 lbs
and her measured height is 62 inches.
GENERAL: Pleasant, well appearing female in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND.  No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.

FAMILY HISTORY: Everyone is healthy.

SOCIAL HISTORY: She came to the United States form [**Country 4194**] in [**2147-12-23**]. She
does not smoke cigarettes or drink alcohol.
Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hyperosmolality and/or hypernatremia,Diplopia,Unspecified essential hypertension,Depressive disorder, not elsewhere classified
Oth lymp unsp xtrndl org,Hyperosmolality,Diplopia,Hypertension NOS,Depressive disorder NEC
Admission Date:  [**2148-4-21**]              Discharge Date:   [**2148-4-28**]

Date of Birth:  [**2092-5-25**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8850**]
Chief Complaint:
Transfer for high-dose methotrexate.

Major Surgical or Invasive Procedure:
Stereotactic brain biopsy.

History of Present Illness:
Ms. [**Known firstname 77781**] [**Known lastname 77782**] is a 55-year-old right-handed woman from
[**Country 4194**] with a past medical history of depression, who presented
to the [**Hospital1 18**] on [**2148-4-21**] with one week of headaches, dizziness,
and a two day history of diplopia. A head MRI of the brain
showed a tectal mass and three areas of nodular enhancement on
the ventricular surfaces, concerning for brain metastases with
ventricular seeding. She underwent a stereotactic biopsy on
[**2148-4-22**] which was consistent with high-grade B-cell lymphoma.
CT of the torso on [**2148-4-24**] did not show a distinct primary
site, only some subcentimeter left axillary lymph nodes. Dr.
[**Last Name (STitle) 724**] was consulted for help in management, and recommended
high-dose methotrexate.

Past Medical History:
Depression.

Social History:
She came to the United States form [**Country 4194**] in [**2147-12-23**]. She
does not smoke cigarettes or drink alcohol.

Family History:
Everyone is healthy.

Physical Exam:
PHYSICAL EXAMINATION: Temperature is 98.8 F. Her blood pressure
is 160/86. Heart rate is 73. Respiratory rate is 16. Oxygen
saturation is 98% in room air. Her measured weight is 162.3 lbs
and her measured height is 62 inches.
GENERAL: Pleasant, well appearing female in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND.  No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.

NEUROLOGICAL EXAMINATION: Her Karnofsky Performance Score is 70.
She is awake, alert, and able to follow simple commands. Her
language is fluent with good comprehension, naming, and
repetition (her son [**Name (NI) **] translates for her). Cranial Nerve
Examination: Her pupils are equal and reactive to light, 4 mm to
3 mm bilaterally. Extraocular movements are full; there is no
saccadic intrusion or nystagmus. Visual fields are full to
confrontation. Funduscopic examination reveals sharp disks
margins bilaterally, and there is spontaneous venous pulsations.
Her face is symmetric. Facial sensation is intact bilaterally.
Her hearing is intact bilaterally. Her tongue is midline. Palate
goes up in the midline. Sternocleidomastoids and upper trapezius
are strong. Motor Examination: She does not have a drift. Her
muscle strengths are [**5-27**] at all muscle groups. Her reflexes are
2-. Her ankle jerks are absent. Her toes are down going.
Coordination examination does not reveal dysmetria. Her gait is
steady. She does not have a Romberg.

Pertinent Results:
MRI Brain, Pre Methotrexate:
Three areas of abnormal nodular enhancement on ventricular
surfaces, including 9.4 mm nodule on the dorsal mid brain, and
small foci of
abnormal enhancement in the anterior aspect of the frontal [**Doctor Last Name 534**]
of each lateral ventricle. Most probably, these abnormalities
represent metastatic disease with ventricular seeding. Although
the lesion in the tegmentum appears somewhat infiltrative, a
glioma would be less likely to seed the ventricle, much less
likely would be a process such as lymphoma, or granulomatous
disease such as sarcoidosis or tuberculosis.

MRI Brain, Post Methotrexate (Preliminary Read):
Marked improvment in dominant midbrain lesion, now diminished to
3-4mm
slightly heterogenously enhancing nodule with no hydrocephalus
or aqueduct
stenosis. edema surounding midbrain lesion markedly improved
with less
improvement to regions of edema surrounding bifrontal
periventricular nodules. The left nodule displays diminished,
now faint, enhancement. New right precentral parenchymal edema
appears post procedural as due small foci of microhemmorhage
along biopsy tract.

CT Torso:
1. No definite evidence for a primary tumor.
2. Subcentimeter lymph nodes seen within the left axilla.

Brief Hospital Course:
Ms. [**Known lastname 77782**] is a 55F with metastatic lymphoma to the brain
being transferred to the OMED service for methotrexate. She
underwent her first round of methotrexate treatment without
complications. A follow up MRI showed diminished size of her
midbrain lesion and overal edema. She will return on [**2148-5-8**]
for her next round.

Medications on Admission:
Acetaminophen 325-650 mg PO Q6H:PRN
Famotidine 20 mg PO BID
Dexamethasone 4 mg IV Q6H
Morphine Sulfate 2-4 mg IV Q4H:PRN
Insulin sliding scale

Discharge Medications:
1. Dexamethasone 4 mg Tablet Sig: 1.5 Tablets PO Q8H (every 8
hours).
Disp:*135 Tablet(s)* Refills:*2*
2. Ranitidine HCl 150 mg Capsule Sig: One (1) Capsule PO twice a
day: This is over the counter at the drug store, you do not need
a prescription. Capsule(s)

Discharge Disposition:
Home

Discharge Diagnosis:
CNS Lymphoma.

Discharge Condition:
Stable.

Discharge Instructions:
You were admitted for treatment of your brain tumor. You
tolerated your chemotherapy very well. We would like you to
return for your next treatment on [**2148-5-8**]. Please take your
medications as directed.

If you develop any concerning symptoms such as headaches,
worsening of your vision, intractable vomiting, or sudden
weakness, please return to the emergency department to be
evaluated.

Followup Instructions:
Please return to [**Hospital1 69**] on
[**2148-5-8**] for your next round of chemotherapy. You will need to
come to the seventh floor on the [**Hospital Ward Name 1950**] side.
{'Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hyperosmolality and/or hypernatremia,Diplopia,Unspecified essential hypertension,Depressive disorder, not elsewhere classified'}


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: Transfer for high-dose methotrexate.

PRESENT ILLNESS: Ms. [**Known firstname 77781**] [**Known lastname 77782**] is a 55-year-old right-handed woman from
[**Country 4194**] with a past medical history of depression, who presented
to the [**Hospital1 18**] on [**2148-4-21**] with one week of headaches, dizziness,
and a two day history of diplopia. A head MRI of the brain
showed a tectal mass and three areas of nodular enhancement on
the ventricular surfaces, concerning for brain metastases with
ventricular seeding. She underwent a stereotactic biopsy on
[**2148-4-22**] which was consistent with high-grade B-cell lymphoma.
CT of the torso on [**2148-4-24**] did not show a distinct primary
site, only some subcentimeter left axillary lymph nodes. Dr.
[**Last Name (STitle) 724**] was consulted for help in management, and recommended
high-dose methotrexate.

MEDICAL HISTORY: Depression.

MEDICATION ON ADMISSION: Acetaminophen 325-650 mg PO Q6H:PRN
Famotidine 20 mg PO BID
Dexamethasone 4 mg IV Q6H
Morphine Sulfate 2-4 mg IV Q4H:PRN
Insulin sliding scale

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION: Temperature is 98.8 F. Her blood pressure
is 160/86. Heart rate is 73. Respiratory rate is 16. Oxygen
saturation is 98% in room air. Her measured weight is 162.3 lbs
and her measured height is 62 inches.
GENERAL: Pleasant, well appearing female in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND.  No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses.

FAMILY HISTORY: Everyone is healthy.

SOCIAL HISTORY: She came to the United States form [**Country 4194**] in [**2147-12-23**]. She
does not smoke cigarettes or drink alcohol. 

### Response:
{'Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hyperosmolality and/or hypernatremia,Diplopia,Unspecified essential hypertension,Depressive disorder, not elsewhere classified'}
