CHIEF COMPLAINT: Right sided weakness.

PRESENT ILLNESS: Mr. [**Known lastname 54910**] is a 62-year-old
male who had known metastatic melanoma. His initial illness
began in [**2130**], where he had a dark line across his right
great toenail which widened. He had seen a podiatrist. The
lesion was getting bigger and ulcerative. The toenail was
removed. He was referred to [**Hospital3 **] in [**2133-3-19**] and had
an amputation of his right toe. In [**2134-1-19**], he had an
extensive work-up. A full body CT showed bilateral small
pulmonary nodules, and the spleen limber for which MRI of the
body was recommended, and prominent left pelvic and
periaortic lymph nodes were not determined to be pathologic
at that time. MRI of the whole spine showed diffuse
metastatic disease without spinal cord involvement. A bone
marrow biopsy on [**2-8**] was positive for extensive
melanoma involvement. A head CT showed a left frontal
metastasis. He was seen by Dr. [**First Name8 (NamePattern2) 52041**] [**Last Name (NamePattern1) 22152**] from neuro-oncology
at that time. It was recommended that he have surgical
removal and be treated with SRS in the resection cavity.
However, he on [**2134-3-2**] developed sudden right-sided
weakness and underwent an emergent craniotomy.

MEDICAL HISTORY: -[**Doctor Last Name **] stage IV metastatic melanoma
Oncologic Hx:  In mid [**2131**],  the pt. developed a dark line
running horizontally across his right great toenail. Over that
time, the area widened apparently, and an opening appeared close
to the cutical, which moved with the outward growth of the nail.
He noted that bloody fluid eventually leaked from this opening,
A medial and lateral biopsy of the nail bed was performed and
initial biopsy was read as potentially a lymphoma. However,
follow-up pathology report was read as an ungal melanoma. His R
great toe was amputated on [**2133-4-11**].  His melanoma returned on R
great toe stump and biopsy on [**2134-2-4**] showed dermal metastatic
melanoma.  A full body CT/PET was performed and showed
metastatic lesions to the vertebral bodies, spleen, liver, and
brain (L frontal lobe).

MEDICATION ON ADMISSION: Medications on transfer:
-acetaminophen 500mg po/pr q4h
-bisacodyl 10mg po/pr daily;prn
-dexamethasone 2mg po q12h
-docusate 100mg po bid
-ferrous sulfate 325mg po daily
-gabapentin 600mg po tid
-heparin 5000units sc tid
-regular insulin sliding scale
-keppra 500mg po bid
-lorazepam 0.5mg po bid;prn
-metoprolol 75mg po tid
-milk of magnesia 30ml po tid;prn
-morphine SR 30mg po tid
-morphine IR 15-30mg po q3-4h;prn
-pantoprazole 40mg po daily
-senna 2tab po qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.7F P: 100 R: 26 BP: 160/82 SaO2: 98% RA
General: Awake, alert, appears comfortable and in NAD.
HEENT: Craniotomy scar noted over L frontal bone, PERRL, EOMI
without nystagmus, no scleral icterus noted, MMM, no lesions
noted in OP
Neck: supple, no JVD or carotid bruits appreciated
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: tachycardic, RR, nl. S1S2, no M/R/G noted
Abdomen: soft, nontender to palpation, mildly distended,
normoactive bowel sounds, no masses or organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP and PT pulses
b/l.
Lymphatics: No cervical, supraclavicular, axillary or inguinal
lymphadenopathy noted.
Neurologic:
-mental status: Alert, oriented x 2 (not date/time).  Attends to
examiner and follows commands.  Expressive aphasia with intact
repitition and comprehension.  Perseverative thought process at
times.
-cranial nerves: II-VI intact, R flattenend nasolabial fold,
VIII-XII intact.
-motor: Tone spastic on right. Normal bulk throughout.
  delt. bic. tric. wr.fl. wr. ext. ffl. IP Quad Ham TibA. [**Last Name (un) **].
[**Last Name (un) 938**]
R   0    0     0     0       0      0    1   1    1   1     1
N/A
L   4+   5     5     5       5      5    4+  5    4+  5     5
5

FAMILY HISTORY: Remarkable for mother and a sister with stroke.

SOCIAL HISTORY: The pt. is a retired mechanical designer.  He lives with his
wife.  [**Name (NI) **] is a former cigarette smoker (30 pack year history).
Former 10drink/wk alcohol use.
Secondary malignant neoplasm of brain and spinal cord,Pneumonia, organism unspecified,Malignant neoplasm of liver, secondary,Anemia in neoplastic disease,Unspecified essential hypertension,Personal history of malignant melanoma of skin,Internal hemorrhoids with other complication
Sec mal neo brain/spine,Pneumonia, organism NOS,Second malig neo liver,Anemia in neoplastic dis,Hypertension NOS,Hx-malig skin melanoma,Int hemrrhoid w comp NEC
Admission Date: [**2134-3-3**]        Discharge Date: [**2134-3-15**]

Date of Birth:  [**2070-11-9**]        Sex:  M

Service:  NSU


INTERIM CARE SUMMARY

DATE OF TRANSFER TO HEMATOLOGY/ONCOLOGY SERVICE:  [**2134-3-15**]

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 54910**] is a 62-year-old
male who had known metastatic melanoma. His initial illness
began in [**2130**], where he had a dark line across his right
great toenail which widened. He had seen a podiatrist. The
lesion was getting bigger and ulcerative. The toenail was
removed. He was referred to [**Hospital3 **] in [**2133-3-19**] and had
an amputation of his right toe. In [**2134-1-19**], he had an
extensive work-up. A full body CT showed bilateral small
pulmonary nodules, and the spleen limber for which MRI of the
body was recommended, and prominent left pelvic and
periaortic lymph nodes were not determined to be pathologic
at that time. MRI of the whole spine showed diffuse
metastatic disease without spinal cord involvement. A bone
marrow biopsy on [**2-8**] was positive for extensive
melanoma involvement. A head CT showed a left frontal
metastasis. He was seen by Dr. [**First Name8 (NamePattern2) 52041**] [**Last Name (NamePattern1) 22152**] from neuro-oncology
at that time. It was recommended that he have surgical
removal and be treated with SRS in the resection cavity.
However, he on [**2134-3-2**] developed sudden right-sided
weakness and underwent an emergent craniotomy.

PHYSICAL EXAMINATION:  On admission, his vital signs were
98.9, blood pressure 188/102, respirations 20. He was in no
acute distress, but uncomfortable. LUNGS: Clear. ABDOMEN:
Benign. He had no movement in his right side.

HOSPITAL COURSE:  He was taken emergently to the operating
room and underwent a left-sided frontal craniotomy.
Postoperatively, he responded to voice, but was not able to
move his right side postoperatively. He had full movement of
his left side. He remained in the postanesthesia recovery
unit overnight on the evening of [**2134-3-3**] for pain
control and to check his neurologic signs. A postoperative
MRI showed postoperative changes in the posterior left
frontal lobe with no increased mass effect as compared to his
preop study. There was linear enhancement along the anterior
aspect of the operative site, and a small amount of residual
tumor could not be excluded. There was an area of T1
hyperintensity and susceptibility effect in the operative
site which might be related to a small amount of blood
products following the surgery.

He remained in the ICU until [**2134-3-5**] for blood
pressure control monitoring and due to his dense right
hemiparesis and fever to the 102 range. He was more sleepy. He
had a
chest x-ray and a urine. Initially, the urine looked like it
was positive for a UTI, but the cultures were negative. He
did have a chest x-ray that was questionable for pneumonia
and was started on Levaquin for that. He continued to have
high fevers through the [**2134-3-12**]. He continued to
have full work-up surveillance cultures which showed no
source of infection. At that time, we had recommended a
meningitis work-up, and Mr. [**Known lastname 54910**] refused to have
an LP done. Four different medical providers, including his
oncologist, Dr. [**Last Name (STitle) **], spoke with him of the importance of
having a work-up for meningitis.

On [**3-10**], he had complained of excruciating back pain
which was not relieved with Dilaudid, percent and his MS
Contin. A pain service consultation was obtained, which they
recommended placing him on a PCA overnight to get his pain
under control, and then he was started on morphine sulfate IR
15-30 mg q.3-4h. p.o. p.r.n., and morphine sulfate SR 30 mg
q. 8h., Tylenol 500 mg q.4h., and within 2 days his pain was
much better under control.

His Dilantin was stopped, thinking that may have related his
fevers, and he was started on Keppra. He continued to have
fevers, though they lessened to 101 for the 25 through the
28. He remained neurologically stable, awake, alert, oriented
x3, moving his left side spontaneously with minimal to no
movement in his right side, tolerating a regular diet, and
his pain was much more controlled on his morphine sulfate SR,
and his morphine sulfate IR, and it was felt that he could
benefit from spinal radiation therapy. For that reason, he is
being transferred to the hematology/oncology service of Dr.[**Name (NI) 54911**] service to have radiation to his back. On the morning
of transfer, his hematocrit was 26, and they recommended 2
units of blood. However, before he left he was unable to be
typed and screened due to his appointment for radiation
oncology. His neurosurgery follow-up should be in the brain
tumor clinic in the next 3 weeks. He should be kept on
Decadron 2 mg p.o. q.12h. and Keppra 500 mg p.o. b.i.d. His
staples have been removed, and his incision is dry and intact
without signs of infection. The patient is being transferred
to the hematology/oncology service.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 8632**]

Dictated By:[**Last Name (NamePattern1) 12790**]
MEDQUIST36
D:  [**2134-3-15**] 08:49:23
T:  [**2134-3-15**] 10:02:24
Job#:  [**Job Number 54912**]













Admission Date:  [**2134-3-2**]              Discharge Date:   [**2134-3-22**]

Date of Birth:  [**2070-11-9**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 45556**]
Chief Complaint:
Right sided weakness.

Major Surgical or Invasive Procedure:
Craniotomy on [**2134-3-3**].

History of Present Illness:
The pt. is a 63 year-old gentleman with a history of [**Doctor Last Name **] stage
IV metastatic melanoma who initially presented to [**Hospital1 18**] on
[**2134-3-2**] with acute-onset right-sided weakness and expressive
dysphasia.

He was originally scheduled to undergo craniotomy and
stereotactic surgery on [**2134-3-8**] for known metastatic lesions to
the brain.  He was started on dacarbazine on [**2134-3-1**] and
presented on the following day with the acute onset of
right-sided weakness and dysphasia.  He was found to have
increased size of a left frontal lobe mass (1cm on [**2134-1-29**] to
3cm on [**2134-3-2**]) with vasogenic edema exerting a mass effect.  He
was taken to the OR for a craniotomy on [**2134-3-3**] and a
stereotactically-guided procedure was performed and the left
frontal mass was removed. The mass was noted to have associated
hemorrhage. Since surgery, he has been treated in the NSICU for
blood pressure management (nipride, then labetolol drip, now on
p.o. lopressor), blood transfusions, seizure ppx. and pain
control.  His course has been complicated by post-operative
fever and FTT in addition to significant pain.  He was
transferred to OMED to initiate palliative XRT and continued
pain control.

On transfer to medicine on [**2134-3-15**], the pt. offered no specific
complaints.  He stated that his back pain was currently
well-controlled.  He denied recent fever, chills, shortness of
breath, chest pain, nausea, vomiting, abdominal pain.

Past Medical History:
-[**Doctor Last Name **] stage IV metastatic melanoma
Oncologic Hx:  In mid [**2131**],  the pt. developed a dark line
running horizontally across his right great toenail. Over that
time, the area widened apparently, and an opening appeared close
to the cutical, which moved with the outward growth of the nail.
He noted that bloody fluid eventually leaked from this opening,
A medial and lateral biopsy of the nail bed was performed and
initial biopsy was read as potentially a lymphoma. However,
follow-up pathology report was read as an ungal melanoma. His R
great toe was amputated on [**2133-4-11**].  His melanoma returned on R
great toe stump and biopsy on [**2134-2-4**] showed dermal metastatic
melanoma.  A full body CT/PET was performed and showed
metastatic lesions to the vertebral bodies, spleen, liver, and
brain (L frontal lobe).

-s/p R great toe amputation on [**2133-4-11**]
-s/p appendectomy
-s/p umbilical hernia repair
-s/p T and A


Social History:
The pt. is a retired mechanical designer.  He lives with his
wife.  [**Name (NI) **] is a former cigarette smoker (30 pack year history).
Former 10drink/wk alcohol use.


Family History:
Remarkable for mother and a sister with stroke.

Physical Exam:
Vitals: T: 98.7F P: 100 R: 26 BP: 160/82 SaO2: 98% RA
General: Awake, alert, appears comfortable and in NAD.
HEENT: Craniotomy scar noted over L frontal bone, PERRL, EOMI
without nystagmus, no scleral icterus noted, MMM, no lesions
noted in OP
Neck: supple, no JVD or carotid bruits appreciated
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: tachycardic, RR, nl. S1S2, no M/R/G noted
Abdomen: soft, nontender to palpation, mildly distended,
normoactive bowel sounds, no masses or organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP and PT pulses
b/l.
Lymphatics: No cervical, supraclavicular, axillary or inguinal
lymphadenopathy noted.
Neurologic:
-mental status: Alert, oriented x 2 (not date/time).  Attends to
examiner and follows commands.  Expressive aphasia with intact
repitition and comprehension.  Perseverative thought process at
times.
-cranial nerves: II-VI intact, R flattenend nasolabial fold,
VIII-XII intact.
-motor: Tone spastic on right. Normal bulk throughout.
  delt. bic. tric. wr.fl. wr. ext. ffl. IP Quad Ham TibA. [**Last Name (un) **].
[**Last Name (un) 938**]
R   0    0     0     0       0      0    1   1    1   1     1
N/A
L   4+   5     5     5       5      5    4+  5    4+  5     5
5

No abnormal movements noted.
-sensory: No deficits to light touch appreciated, although exam
limited.
-cerebellar: No nystagmus, dysarthria.
-DTRs:
  bic.  tri.  [**Last Name (un) **].  ffl.  patellar Achilles    Plantar
response
R  3     3      3      3       3        2          N/A
L  2     2      2      2       2        1          withdrawal

+[**Doctor Last Name 937**] sign bilaterally R>L

Pertinent Results:
Radiologic Data:
-MRI of head, [**2134-3-3**]:
Study performed demonstrating left frontal metastatic lesion,
which has increased in size compared to [**2134-2-20**]. Vasogenic
edema has also increased. No new lesions are identified

-MRI of head, [**2134-3-4**]:
There are postoperative changes in the posterior left frontal
lobe with no increase in mass effect compared to the
preoperative study. There is linear enhancement along the
anterior aspect of the operative site and a small amount of
residual tumor cannot be excluded. There are areas of T1
hyperintensity and susceptibility effect in the operative site
which might be related to small amounts of blood breakdown
products following the surgery, although they are also identical
in signal intensity to the original melanoma

Labs on transfer:

[**2134-3-15**] 05:50AM BLOOD WBC-7.2 RBC-3.02* Hgb-8.7* Hct-26.9*
MCV-89 MCH-28.7 MCHC-32.2 RDW-14.6 Plt Ct-184
[**2134-3-15**] 05:50AM BLOOD Glucose-108* UreaN-9 Creat-0.4* Na-138
K-3.3 Cl-101 HCO3-28 AnGap-12

Brief Hospital Course:
For details of the hospitalization prior to [**2134-3-14**], please
refer to the HPI.

1. Metastatic melanoma:  Upon transfer to medicine, the goal of
care was palliation with XRT to bony metastases.  He underwent
five sessions of XRT.  His pain was controlled with morphine and
acetaminophen.  The phsyical therapy and speech therapy services
were consulted to work with the pt regarding his neurologic
residua.  He was maintained on keppra for seizure prophylaxis.
He was also maintained on dexamethasone for cerebral edema.

2. HTN: The pt. had elevated blood pressure after surgery as
discussed in the HPI.  On transfer to medicine, he was placed on
metoprolol with adequate blood pressure control.

3. Anemia: Secondary to bone marrow involvement with melanoma as
diagnosed on bone marrow biopsy.  He was transfused a total of 2
units of PRBCs after transfer to medicine for Hct < 25.  His Hct
was stable and over 30 for the last 5 days of admission.

4. RLL pneumonia: The pt. developed low-grade fever seven days
prior to discharge.  A chest x-ray was performed that showed a
questionable right lower lobe pneumonia.  He was started on
empiric levofloxacin and metronidazole and subsequently
defervesced.  He was discharged with a prescription for a seven
day course of these antibiotics to complete a 14 day course.

5. BRBPR: The pt. was noted to have scant BRBPR on [**2134-3-17**].  His
hematocrit remained stable.  Rectal exam disclosed internal
hemorrhoids.  He was also maintained on a PPI and carafate for
GI prophylaxis while on dexamethasone.

Medications on Admission:
Medications on transfer:
-acetaminophen 500mg po/pr q4h
-bisacodyl 10mg po/pr daily;prn
-dexamethasone 2mg po q12h
-docusate 100mg po bid
-ferrous sulfate 325mg po daily
-gabapentin 600mg po tid
-heparin 5000units sc tid
-regular insulin sliding scale
-keppra 500mg po bid
-lorazepam 0.5mg po bid;prn
-metoprolol 75mg po tid
-milk of magnesia 30ml po tid;prn
-morphine SR 30mg po tid
-morphine IR 15-30mg po q3-4h;prn
-pantoprazole 40mg po daily
-senna 2tab po qhs


Discharge Medications:
1. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
[**Hospital1 **] (2 times a day) as needed.
Disp:*30 Suppository(s)* Refills:*2*
2. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
Disp:*500 ML(s)* Refills:*2*
3. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO BID (2
times a day).
Disp:*qs qs* Refills:*2*
4. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).
Disp:*60 Tablet(s)* Refills:*2*
5. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
Disp:*60 Tablet(s)* Refills:*0*
6. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours).
Disp:*60 Tablet(s)* Refills:*2*
8. Acetaminophen 500 mg Tablet Sig: One (1) Tablet PO Q4H (every
4 hours).
Disp:*180 Tablet(s)* Refills:*2*
9. Morphine Sulfate 30 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO Q8H (every 8 hours).
Disp:*90 Tablet Sustained Release(s)* Refills:*0*
10. Morphine Sulfate 15 mg Tablet Sig: 1-2 Tablets PO Q3-4H ()
as needed.
Disp:*120 Tablet(s)* Refills:*0*
11. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*2*
12. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
13. Sucralfate 1 g Tablet Sig: One (1) Tablet PO QID (4 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
14. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
15. Gabapentin 600 mg Tablet Sig: One (1) Tablet PO three times
a day.
Disp:*90 Tablet(s)* Refills:*2*
16. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO three
times a day for 7 days.
Disp:*21 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Hospice and VNA

Discharge Diagnosis:
-metastatic melanoma
-s/p R craniotomy and stereotactic removal of brain metasases
-hypertension
-right lower lobe pneumonia, resolved


Discharge Condition:
Stable.

Discharge Instructions:
Please continue all medications as prescribed.  If you
experience any concerning symptoms, please call your oncologist
or come to the emergency department for evaluation.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 9402**], MD Where: [**Hospital6 29**]
HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2134-3-24**] 2:30
Provider: [**Name10 (NameIs) **],HEM/ONC HEMATOLOGY/ONCOLOGY-CC9 Where: [**Hospital 273**] HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**] Date/Time:[**2134-3-24**]
2:30
{'Secondary malignant neoplasm of brain and spinal cord,Pneumonia, organism unspecified,Malignant neoplasm of liver, secondary,Anemia in neoplastic disease,Unspecified essential hypertension,Personal history of malignant melanoma of skin,Internal hemorrhoids with other complication'}


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: Right sided weakness.

PRESENT ILLNESS: Mr. [**Known lastname 54910**] is a 62-year-old
male who had known metastatic melanoma. His initial illness
began in [**2130**], where he had a dark line across his right
great toenail which widened. He had seen a podiatrist. The
lesion was getting bigger and ulcerative. The toenail was
removed. He was referred to [**Hospital3 **] in [**2133-3-19**] and had
an amputation of his right toe. In [**2134-1-19**], he had an
extensive work-up. A full body CT showed bilateral small
pulmonary nodules, and the spleen limber for which MRI of the
body was recommended, and prominent left pelvic and
periaortic lymph nodes were not determined to be pathologic
at that time. MRI of the whole spine showed diffuse
metastatic disease without spinal cord involvement. A bone
marrow biopsy on [**2-8**] was positive for extensive
melanoma involvement. A head CT showed a left frontal
metastasis. He was seen by Dr. [**First Name8 (NamePattern2) 52041**] [**Last Name (NamePattern1) 22152**] from neuro-oncology
at that time. It was recommended that he have surgical
removal and be treated with SRS in the resection cavity.
However, he on [**2134-3-2**] developed sudden right-sided
weakness and underwent an emergent craniotomy.

MEDICAL HISTORY: -[**Doctor Last Name **] stage IV metastatic melanoma
Oncologic Hx:  In mid [**2131**],  the pt. developed a dark line
running horizontally across his right great toenail. Over that
time, the area widened apparently, and an opening appeared close
to the cutical, which moved with the outward growth of the nail.
He noted that bloody fluid eventually leaked from this opening,
A medial and lateral biopsy of the nail bed was performed and
initial biopsy was read as potentially a lymphoma. However,
follow-up pathology report was read as an ungal melanoma. His R
great toe was amputated on [**2133-4-11**].  His melanoma returned on R
great toe stump and biopsy on [**2134-2-4**] showed dermal metastatic
melanoma.  A full body CT/PET was performed and showed
metastatic lesions to the vertebral bodies, spleen, liver, and
brain (L frontal lobe).

MEDICATION ON ADMISSION: Medications on transfer:
-acetaminophen 500mg po/pr q4h
-bisacodyl 10mg po/pr daily;prn
-dexamethasone 2mg po q12h
-docusate 100mg po bid
-ferrous sulfate 325mg po daily
-gabapentin 600mg po tid
-heparin 5000units sc tid
-regular insulin sliding scale
-keppra 500mg po bid
-lorazepam 0.5mg po bid;prn
-metoprolol 75mg po tid
-milk of magnesia 30ml po tid;prn
-morphine SR 30mg po tid
-morphine IR 15-30mg po q3-4h;prn
-pantoprazole 40mg po daily
-senna 2tab po qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.7F P: 100 R: 26 BP: 160/82 SaO2: 98% RA
General: Awake, alert, appears comfortable and in NAD.
HEENT: Craniotomy scar noted over L frontal bone, PERRL, EOMI
without nystagmus, no scleral icterus noted, MMM, no lesions
noted in OP
Neck: supple, no JVD or carotid bruits appreciated
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: tachycardic, RR, nl. S1S2, no M/R/G noted
Abdomen: soft, nontender to palpation, mildly distended,
normoactive bowel sounds, no masses or organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP and PT pulses
b/l.
Lymphatics: No cervical, supraclavicular, axillary or inguinal
lymphadenopathy noted.
Neurologic:
-mental status: Alert, oriented x 2 (not date/time).  Attends to
examiner and follows commands.  Expressive aphasia with intact
repitition and comprehension.  Perseverative thought process at
times.
-cranial nerves: II-VI intact, R flattenend nasolabial fold,
VIII-XII intact.
-motor: Tone spastic on right. Normal bulk throughout.
  delt. bic. tric. wr.fl. wr. ext. ffl. IP Quad Ham TibA. [**Last Name (un) **].
[**Last Name (un) 938**]
R   0    0     0     0       0      0    1   1    1   1     1
N/A
L   4+   5     5     5       5      5    4+  5    4+  5     5
5

FAMILY HISTORY: Remarkable for mother and a sister with stroke.

SOCIAL HISTORY: The pt. is a retired mechanical designer.  He lives with his
wife.  [**Name (NI) **] is a former cigarette smoker (30 pack year history).
Former 10drink/wk alcohol use. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Pneumonia, organism unspecified,Malignant neoplasm of liver, secondary,Anemia in neoplastic disease,Unspecified essential hypertension,Personal history of malignant melanoma of skin,Internal hemorrhoids with other complication'}
