CHIEF COMPLAINT: s/p fall, found to have a brain mass

PRESENT ILLNESS: This is a 60-year-old female who fell following dialysis. She
had 5 1/2 L taken off of dialysis but otherwise just did not
feel "like herself". She states that she has been having
intermittent blurry vision for weeks. Prior to the fall she was
moving a chair around, near a landing, and she placed it in such
a way that the chair has fallen, and she fell after it.
She fell forward hitting her head and back. She went into her
apartment, but was still feeling unwell so she called EMS, who
took her to [**Hospital6 **]. She never lost consciousness.
She walked fine with minimal hip pain after her fall and made it
to dialysis. She decided to go to the hospital after this and
went to [**Hospital3 **].

MEDICAL HISTORY: PAST ONCOLOGIC HISTORY:
LLL mass discovered in [**2176**] at time of GI bleed. Bx at [**Hospital1 34**]
[**6-/2176**] +NSCLC. No apparent mets then, although workup suboptimal
due to "other issues" per Onc note. The lesion 7+cm, attached to
post peripheral chest wall, and moved <6mm on 4D scan, volume
was felt too large to treat quickly. IMRT plan was superior to
3D conformal plan on normal lung sparing parameters.  Per Dr.
[**Last Name (STitle) 89344**].
= Biopsy demonstrates TTF-1-positive adenocarcinoma back in
[**2176**]. This is felt to be at least Stage IIIA, given presence of
bulky mediastinal lymphadenopathy, and large 7cm LLL mass.
= At that time felt not to be a surgical candidate
= Recommended Rad Onc with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] - recommended
further eval with mediastinoscopy prior to commiting to either
CyberKnife or external beam palliative radition. She failed to
have this done because she fell and broke her hip and was
hospitalized, then discharged to rehab on [**2177-1-11**]. Now s/p
radiation for 6 weeks.

MEDICATION ON ADMISSION: - ativan 0.5-1mg Q6H PRN
- gabapenting 100mg QD
- warfarin 5-10mg QD
- pantoprazole 40mg [**Hospital1 **]
- clonidine 0.4mg QD
- torsemide 40mg QD
- renal caps 1 tab QD
- calcitriol 0.25mcg QD
- fluoxetine 20mg QD
- lisinopril 10mg QD
- atorvastatin 80mg QD
- cireg 25mg [**Hospital1 **]
- amlodipine 10mg QD
- trazodone

ALLERGIES: Celexa / optiflux dialyzer

PHYSICAL EXAM: On Admission:
Vitals 98.9-66-155/69-98%RA
Gen: WD/WN, comfortable, NAD.
HEENT: OP clear, supple neck, no JVD.
Lungs: CTA bilaterally.
Chest: Well healed scar
CV: RRR. S1/S2.
Abd: Soft, NT, BS+, multiple scars in abdomen, well healed.
Extrem: Warm and well-perfused.
Neuro: CN II-XII intact grossly, other than loss of vision in
Upper Outer quadrant in Left Eye.
Skin: Multiple hypopigmented macules diffusely throughout the
body. Small abrasion on left hand (she tells me from her fall)

FAMILY HISTORY: Sister with [**Name (NI) 2091**] on HD. Father and mother with DM. Father with
CAD

SOCIAL HISTORY: She quit smoking 3 weeks ago (1ppd x 20 years). No etoh or IVDA.
She is disabled but formerly worked for red cross. She lives
with her husband in [**Name (NI) **].
Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,End stage renal disease,Malignant neoplasm of lower lobe, bronchus or lung,Chronic systolic heart failure,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease,Fall from other slipping, tripping, or stumbling,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Anemia in chronic kidney disease,Fitting and adjustment of automatic implantable cardiac defibrillator
Sec mal neo brain/spine,Cerebral edema,End stage renal disease,Mal neo lower lobe lung,Chr systolic hrt failure,Ben hyp kid w cr kid V,Fall from slipping NEC,Aortocoronary bypass,DMII wo cmp nt st uncntr,Chr airway obstruct NEC,Long-term use anticoagul,Hx-ven thrombosis/embols,Anemia in chr kidney dis,Ftng autmtc dfibrillator
Admission Date:  [**2177-7-12**]              Discharge Date:   [**2177-7-22**]

Date of Birth:  [**2117-2-4**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Celexa / optiflux dialyzer

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
s/p fall, found to have a brain mass


Major Surgical or Invasive Procedure:
[**2177-7-15**]: IVC Filter
[**2177-7-15**]: removal of left IJ HD catheter
[**2177-7-19**]: Right Craniotomy and resection of mass


History of Present Illness:
This is a 60-year-old female who fell following dialysis. She
had 5 1/2 L taken off of dialysis but otherwise just did not
feel "like herself". She states that she has been having
intermittent blurry vision for weeks. Prior to the fall she was
moving a chair around, near a landing, and she placed it in such
a way that the chair has fallen, and she fell after it.
She fell forward hitting her head and back. She went into her
apartment, but was still feeling unwell so she called EMS, who
took her to [**Hospital6 **]. She never lost consciousness.
She walked fine with minimal hip pain after her fall and made it
to dialysis. She decided to go to the hospital after this and
went to [**Hospital3 **].

She had CT scans of her head and torso, and she was found to
have a 2.5 by 2.9  parietal/occiptial mass with vasogenic edema.
 She does have a history of Non-small cell lung cancer and the
fact that she prefers to get her care here.


Past Medical History:
PAST ONCOLOGIC HISTORY:
LLL mass discovered in [**2176**] at time of GI bleed. Bx at [**Hospital1 34**]
[**6-/2176**] +NSCLC. No apparent mets then, although workup suboptimal
due to "other issues" per Onc note. The lesion 7+cm, attached to
post peripheral chest wall, and moved <6mm on 4D scan, volume
was felt too large to treat quickly. IMRT plan was superior to
3D conformal plan on normal lung sparing parameters.  Per Dr.
[**Last Name (STitle) 89344**].
= Biopsy demonstrates TTF-1-positive adenocarcinoma back in
[**2176**]. This is felt to be at least Stage IIIA, given presence of
bulky mediastinal lymphadenopathy, and large 7cm LLL mass.
= At that time felt not to be a surgical candidate
= Recommended Rad Onc with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] - recommended
further eval with mediastinoscopy prior to commiting to either
CyberKnife or external beam palliative radition. She failed to
have this done because she fell and broke her hip and was
hospitalized, then discharged to rehab on [**2177-1-11**]. Now s/p
radiation for 6 weeks.

PAST MEDICAL HISTORY:
# CHF (ef 40% on TTE [**8-26**], class III)
# [**Month/Year (2) 2091**] - on dialysis
# CAD s/p CABG [**75**] years ago c/b sternal wound infection
# Extensive PVD
# DVT - now on Coumadin indefinitely
# Obesity
# Hyperparathyroidism
# Hypothyroidism
# Anxiety
# Type 2 DM
# COPD
# Benign Hypertension
# Anemia (Hct baseline high 20s), also had a GI bleed back in
[**2177**] requiring 12 units.

Social History:
She quit smoking 3 weeks ago (1ppd x 20 years). No etoh or IVDA.
She is disabled but formerly worked for red cross. She lives
with her husband in [**Name (NI) **].


Family History:
Sister with [**Name (NI) 2091**] on HD. Father and mother with DM. Father with
CAD

Physical Exam:
On Admission:
Vitals 98.9-66-155/69-98%RA
Gen: WD/WN, comfortable, NAD.
HEENT: OP clear, supple neck, no JVD.
Lungs: CTA bilaterally.
Chest: Well healed scar
CV: RRR. S1/S2.
Abd: Soft, NT, BS+, multiple scars in abdomen, well healed.
Extrem: Warm and well-perfused.
Neuro: CN II-XII intact grossly, other than loss of vision in
Upper Outer quadrant in Left Eye.
Skin: Multiple hypopigmented macules diffusely throughout the
body. Small abrasion on left hand (she tells me from her fall)

At Discharge:
Her wound was clean and dry. She is AAOr x 3 with a left field
cut (hemianopia].

Pertinent Results:
On admission:

[**2177-7-12**] 03:55AM BLOOD WBC-5.4 RBC-3.66*# Hgb-10.3* Hct-33.3*#
MCV-91 MCH-28.3 MCHC-31.0 RDW-16.5* Plt Ct-211
[**2177-7-12**] 03:55AM BLOOD Neuts-83.4* Lymphs-14.3* Monos-1.8*
Eos-0.3 Baso-0.3
[**2177-7-12**] 03:55AM BLOOD PT-34.4* PTT-43.8* INR(PT)-3.3*
[**2177-7-12**] 03:55AM BLOOD Glucose-211* UreaN-20 Creat-2.2* Na-139
K-4.2 Cl-100 HCO3-27 AnGap-16

Imaging:

From [**Hospital6 33**]:
- CT head: 2.5 x 2.9 mass centered within subcortical white
matter at the junction of the right posterior parietal and
occiipital lobes. surrounding vasogenic edema extending into the
posterior superior right temporal lobe. mass effect compressing
the right occipital [**Doctor Last Name 534**] and < 5 mm midline shift from the right
to the left at the level of the septum pellucidum. no fx
- CT abd w/ contrast: no acute abdominal process.
- CT chest w/ contrast: 3.1 cm diameter partially calcified
pleural based mass at the low posterior left lower lobe, at the
site of previously dx lung cancer.
- renal is aware of patient, no need for urgent dialysis

XRAY [**2177-7-11**]: Four Views of lumbar spine: revela diffuse bone
demineralization. No evidence of Acute compression fracture,
disc space narrowing or spondylolisthesiis. There is mild low
lumbar facet osteoparthropathy. Vascular calcifications are
noted.

[**Hospital1 18**] IMAGING:

[**2177-7-12**] CT C-spine without contrast
1.  No acute fracture of the cervical spine. Markedly rotated
position and mild motion limit assessment of symmetry of
structures. No canal or foraminal stenosis.
2.  Enlargement of the main pulmonary artery segment consistent
with pulmonary hypertension with associated mild cardiac
decompensation.
3. T3 (thoracic 3) vertebral body- mild anterior wedging and
superior
end-plate depression.  Correlate clinically for dedicated
imaging.

CXR PA and Lateral [**2177-7-12**]

1.  Airspace opacity in the left lower lobe, consistent with
pneumonia in the appropriate clinical setting.
2.  Enlargement of the main pulmonary artery, consistent with
diagnosis of pulmonary hypertension.
3.  Cardiomegaly and interstitial edema consistent with mild
congestive heart failure.

CT Head w/o contrast [**2177-7-12**]
3.1 x 2.7 cm right parieto-occipital mass with extensive
neighboring edema and moderate neighboring mass effect but no
evidence for herniation.

CT Head with contrast [**2177-7-13**]
A 3.1 x 2.8 cm mass centered in the right parieto-occipital
region with avid peripheral enhancement and extensive
surrounding vasogenic edema compatible with metastatic disease
given the history.

[**7-15**] ECHO: The left atrium is dilated. There is moderate
symmetric left ventricular hypertrophy. The left ventricular
cavity is mildly dilated. There is mild to moderate regional
left ventricular systolic dysfunction with apical septal
akinesis, apical anterior akinesis/hypokinesis, distal apical
akinesis/dyskinesis and inferoseptal hypokinesis. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened. There is no
aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. Moderate (2+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. Moderate [2+] tricuspid regurgitation is seen. There
is moderate pulmonary artery systolic hypertension. There is no
pericardial effusion.

[**7-18**] CT Head: IMPRESSION:  Stable 3.3 cm right parieto-occipital
mass compatible with a history of metastatic lung cancer.

[**7-19**] CXR: FINDINGS:  The right-sided hemodialysis catheter has
been removed.  The left chest AICD is in place.  There continues
to be some retrocardiac opacity that could be due to volume loss
or infiltrate.  Otherwise, the lungs are clear.  Overall, the
appearance is similar compared to the study from five days ago.

[**7-19**] CT Head: IMPRESSION:  Expected postoperative parietal
craniotomy changes.


Brief Hospital Course:
ASSESSMENT/PLAN:  60 yo woman with PMHx of [**Month/Day (2) 2091**] (on HD), CABG,
HTN, HL, DM2 and NSCLC who presented from an OSH after a CT head
showed a new 2.5x2.9cm mass at the parietal-occipital lobe
junction.

# intracranial brain mass:  Ms. [**Location (un) 89345**] presented with
new visual symptoms and a new isolated mass at the
parietal-occipital junction, with surrounding vasogenic edema.
This likely represents a metastasis from her primary NSCLC.  She
was treated with dexamethasone to suppress inflammation.  She
was seen by neurosurgery, neuro-oncology, and radiation
oncology.  It was recommended that the patient should be on
seizure prophylaxis with dilantin.  Given the solitary nature of
the lesion, the decision was made for surgically removal.
Although the patient has multiple comorbidities, neurosurgical
intervention was thought to be potentially life-saving.  The
patient was seen by cardiology and cleared for the operation.
She had an ECHO done which showed focal wall motion
abnormalities c/w prior cardiac event. She was extubated post-op
and taken to the ICU. She was given three doses of post-op
Ancef. A corrected serum dilantin level was 4.8 on [**7-21**]. The
patient was given a 500mg IV bolus of dilantin. She remained
neurologically intact with a persistent field cut. On [**7-19**] the
patient was transferred to the neurosurgical service and went to
the OR for a craniotomy and resection of tumor. Her pacemaker
was interrogated by EP pre-op. Surgery was without complication.
She was extubated and transferred to the ICU in stable
condition. She remained neurologically stable post op and head
CT revealed expected post op changes. On [**7-20**] she was again
stable and cleared for transfer to the floor. Her Foley was
d/c'd and a CT with contrast was ordered to evaluate for
residual tumor. She was discharged on a Decadron taper.

#  [**Month/Day (4) 2091**]:  The patient was continued on HD M,W,F.  She was also
started on Nephrocaps.  The patient got dialyzed the day prior
to her operation.  On [**2177-7-21**], the patient had Hemodialysis and
7 liters were taken off.  Physical Therapy saw the patient and
when the patient was out of bed she became orthostatic with SBP
to 70/38. The patient was placed back in bed and the blood
pressure resolved a systolic of 100.

#  Lung CA:  The patient had a CT torso obtained at OSH that
showed stable disease in chest, with no disease in the abdomen.
As above, head CT showed new solitary brain lesion, likely
metastatic.

# CAD s/p CABG [**75**] years ago c/b sternal wound infection:  EKG
unchanged.  We obtained a pre-operative Echo which showed focal
wall motion abnormalities c/w prior cardiac event.  The
patient's home medications were continued.  She was also seen by
Atrius cardiology who cleared her for surgery.

# S/P DVT: Ms. [**Location (un) 89345**] is on lifetime Coumadin. Given the
fact that her intracranial mass was going to be surgically
resected, it was decided that IR placement of IVC filter was
indicated, as anticoagulation would have to be avoided for a few
weeks postoperatively.  This was done on [**2177-7-15**].

# Type 2 DM: As per the patient, has not been taking any
medications since starting HD.  During the hospitalization, the
patient was given Dexamethasone, with associated elevations in
blood glucose.  The patient was maintained on insulin sliding
scale during the hospitalization.  However, after her
dexamethasone was increased, her sugars remained very elevated,
and ultimately she was started on long acting Lantus 30 units
daily, in addition to sliding scale while she was an inpatient.



Medications on Admission:
- ativan 0.5-1mg Q6H PRN
- gabapenting 100mg QD
- warfarin 5-10mg QD
- pantoprazole 40mg [**Hospital1 **]
- clonidine 0.4mg QD
- torsemide 40mg QD
- renal caps 1 tab QD
- calcitriol 0.25mcg QD
- fluoxetine 20mg QD
- lisinopril 10mg QD
- atorvastatin 80mg QD
- cireg 25mg [**Hospital1 **]
- amlodipine 10mg QD
- trazodone

Discharge Medications:
1. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety.
2. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. polyethylene glycol 3350 17 gram Powder in Packet Sig: One
(1) Powder in Packet PO DAILY (Daily).
6. 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*
7. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain, fever: max 4g/24 hrs.
9. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
10. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3
times a day) as needed for constipation.
11. gabapentin 100 mg Capsule Sig: One (1) Capsule PO Q24H
(every 24 hours).
12. torsemide 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

13. carvedilol 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
14. clonidine 0.2 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
15. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

16. calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
17. fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
18. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
19. phenytoin sodium extended 100 mg Capsule Sig: One (1)
Capsule PO TID (3 times a day).
Disp:*30 Capsule(s)* Refills:*2*
20. trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as
needed for sleep.
21. dexamethasone 1 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours: Starting [**7-23**], Take 1 tab po Q12 hrs ongoing.
Disp:*30 Tablet(s)* Refills:*0*
22. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Primary: Brain metastasis, lung cancer
Secondary: DVT


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:
Craniotomy for Subdural/Epidural Hematoma
Dr. [**Last Name (STitle) 14354**] [**Name (STitle) **]

??????	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 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.
??????	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.
??????	You were on a medication Coumadin (Warfarin),  prior to your
surgery, you may safely resume taking this on Day #7 after
surgery ([**7-27**]).
??????	**You have been prescribed Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed and follow up with
laboratory blood drawing in one week.  This can be drawn at your
PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**].

??????	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.


Followup Instructions:
Follow-Up Appointment Instructions

You are schedule to follow up with [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 4861**], MD
Phone:[**Telephone/Fax (1) 1844**] on [**2177-8-4**] at 1:00pm. Brain tumor clinic is
located on the [**Hospital Ward Name 516**] in the [**Hospital Ward Name 23**] building.

You need to make a follow up appointment with your PCP. [**Name10 (NameIs) **] were
started on long acting insulin (Lantus) for while you are on
steroids. Once the steroids are off, you need to be evaluated
and may be able to stop the lantus. You were also given an IVC
filter which may be removed in the future.

Hematology/Oncology Appointment:
When:Wednesday, [**8-6**] at 1:30pm
With: Dr.[**Last Name (STitle) **] [**Name (STitle) 2405**]
Location: [**Location (un) 2274**]-[**Location (un) 2129**], [**Location (un) 86**], MA
Phone:[**Telephone/Fax (1) 3468**]



Completed by:[**2177-7-22**]
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,End stage renal disease,Malignant neoplasm of lower lobe, bronchus or lung,Chronic systolic heart failure,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease,Fall from other slipping, tripping, or stumbling,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Anemia in chronic kidney disease,Fitting and adjustment of automatic implantable cardiac defibrillator'}


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: s/p fall, found to have a brain mass

PRESENT ILLNESS: This is a 60-year-old female who fell following dialysis. She
had 5 1/2 L taken off of dialysis but otherwise just did not
feel "like herself". She states that she has been having
intermittent blurry vision for weeks. Prior to the fall she was
moving a chair around, near a landing, and she placed it in such
a way that the chair has fallen, and she fell after it.
She fell forward hitting her head and back. She went into her
apartment, but was still feeling unwell so she called EMS, who
took her to [**Hospital6 **]. She never lost consciousness.
She walked fine with minimal hip pain after her fall and made it
to dialysis. She decided to go to the hospital after this and
went to [**Hospital3 **].

MEDICAL HISTORY: PAST ONCOLOGIC HISTORY:
LLL mass discovered in [**2176**] at time of GI bleed. Bx at [**Hospital1 34**]
[**6-/2176**] +NSCLC. No apparent mets then, although workup suboptimal
due to "other issues" per Onc note. The lesion 7+cm, attached to
post peripheral chest wall, and moved <6mm on 4D scan, volume
was felt too large to treat quickly. IMRT plan was superior to
3D conformal plan on normal lung sparing parameters.  Per Dr.
[**Last Name (STitle) 89344**].
= Biopsy demonstrates TTF-1-positive adenocarcinoma back in
[**2176**]. This is felt to be at least Stage IIIA, given presence of
bulky mediastinal lymphadenopathy, and large 7cm LLL mass.
= At that time felt not to be a surgical candidate
= Recommended Rad Onc with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] - recommended
further eval with mediastinoscopy prior to commiting to either
CyberKnife or external beam palliative radition. She failed to
have this done because she fell and broke her hip and was
hospitalized, then discharged to rehab on [**2177-1-11**]. Now s/p
radiation for 6 weeks.

MEDICATION ON ADMISSION: - ativan 0.5-1mg Q6H PRN
- gabapenting 100mg QD
- warfarin 5-10mg QD
- pantoprazole 40mg [**Hospital1 **]
- clonidine 0.4mg QD
- torsemide 40mg QD
- renal caps 1 tab QD
- calcitriol 0.25mcg QD
- fluoxetine 20mg QD
- lisinopril 10mg QD
- atorvastatin 80mg QD
- cireg 25mg [**Hospital1 **]
- amlodipine 10mg QD
- trazodone

ALLERGIES: Celexa / optiflux dialyzer

PHYSICAL EXAM: On Admission:
Vitals 98.9-66-155/69-98%RA
Gen: WD/WN, comfortable, NAD.
HEENT: OP clear, supple neck, no JVD.
Lungs: CTA bilaterally.
Chest: Well healed scar
CV: RRR. S1/S2.
Abd: Soft, NT, BS+, multiple scars in abdomen, well healed.
Extrem: Warm and well-perfused.
Neuro: CN II-XII intact grossly, other than loss of vision in
Upper Outer quadrant in Left Eye.
Skin: Multiple hypopigmented macules diffusely throughout the
body. Small abrasion on left hand (she tells me from her fall)

FAMILY HISTORY: Sister with [**Name (NI) 2091**] on HD. Father and mother with DM. Father with
CAD

SOCIAL HISTORY: She quit smoking 3 weeks ago (1ppd x 20 years). No etoh or IVDA.
She is disabled but formerly worked for red cross. She lives
with her husband in [**Name (NI) **]. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Cerebral edema,End stage renal disease,Malignant neoplasm of lower lobe, bronchus or lung,Chronic systolic heart failure,Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease,Fall from other slipping, tripping, or stumbling,Aortocoronary bypass status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Anemia in chronic kidney disease,Fitting and adjustment of automatic implantable cardiac defibrillator'}
