CHIEF COMPLAINT: "I have not felt well for over a year"

PRESENT ILLNESS: This is a very pleasant 58 year old female who present to
the office for second opinion regarding her bifrontal brain
lesion.  She reports that for over a 1 year she was complaining
of dizziness, nausea and general fatigue.  She was initially
treated for HTN.  Then she reported a fall due to her dizziness.

MEDICAL HISTORY: HTN, Hashimotis thyroiditis, anxiety

MEDICATION ON ADMISSION: levoxyl 50mcg daily, xanax 0.5mg prn

ALLERGIES: Latex / Penicillins / lisinopril / hydrochlorothiazide / sulfa /
Losartan / amlodipine

PHYSICAL EXAM: O: 5'7", 147 lbs.
Gen: WD/WN, comfortable, NAD.
HEENT: normal, eyes clear, ears hearing intact, nasal passages
patent, oropharynx pink without exudate,Pupils: PERRL EOMs full
Neck: Supple.
Lungs: CTA bilaterally, no w/c/r
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-25**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: married, cosmetic sales, 1 child
Benign neoplasm of cerebral meninges,Compression of brain,Headache,Unspecified essential hypertension,Chronic lymphocytic thyroiditis,Esophageal reflux,Anxiety state, unspecified,Nausea with vomiting
Ben neo cerebr meninges,Compression of brain,Headache,Hypertension NOS,Chr lymphocyt thyroidit,Esophageal reflux,Anxiety state NOS,Nausea with vomiting
Admission Date:  [**2181-10-24**]              Discharge Date:   [**2181-10-27**]

Date of Birth:  [**2122-11-11**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Latex / Penicillins / lisinopril / hydrochlorothiazide / sulfa /
Losartan / amlodipine

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
"I have not felt well for over a year"


Major Surgical or Invasive Procedure:
[**2181-10-24**] Bifrontal craniotomy resection of mass


History of Present Illness:
This is a very pleasant 58 year old female who present to
the office for second opinion regarding her bifrontal brain
lesion.  She reports that for over a 1 year she was complaining
of dizziness, nausea and general fatigue.  She was initially
treated for HTN.  Then she reported a fall due to her dizziness.

As a result, a brain MRI was obtained which demonstrated a
bifrontal enhancing lesion origination from olfactory groove
meningioma.  She was referred to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Hospital1 **]
who recommended surgical intervention.  She presents for second
opinion.


Past Medical History:
HTN, Hashimotis thyroiditis, anxiety


Social History:
married, cosmetic sales, 1 child


Family History:
NC

Physical Exam:
O: 5'7", 147 lbs.
Gen: WD/WN, comfortable, NAD.
HEENT: normal, eyes clear, ears hearing intact, nasal passages
patent, oropharynx pink without exudate,Pupils: PERRL EOMs full
Neck: Supple.
Lungs: CTA bilaterally, no w/c/r
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-25**] 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, 3 to 2
mm bilaterally. 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 [**3-29**] throughout. No pronator drift

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

Reflexes: B T Br Pa Ac
Right    2+ ----------
Left     2+ -----------

Toes downgoing bilaterally

Handedness Right

Discharge: Stable and intact.  Bilateral facial edema and
periorbital ecchymosis

Pertinent Results:
Brain MRI with and without contrast [**2181-8-10**]:  large bifrontal
enhancing lesion originating from olfactory groove without
signficant edema.  60% of lesion lay on the left side.  No
compression on pituitary stalk.  Question compression of
opthalmic artery.

[**2181-10-24**] CT head shows expected postop changes and a substantial
amount of bifrontal pneumocephalus.

[**2181-10-25**] MRI Brain: expected postop changes, improved
pneumocephalus, no evidence of stroke

Brief Hospital Course:
Patient was admitted to Neurosurgery on [**2181-10-24**] and underwent
the above stated procedure.  Please review dictated operative
report for details.  Patient was extubated without incident and
transferred to the ICU for Q1 hour neurochecks and systolic
blood pressure control less than 140.  Postop head CT was
negative for hemorrhage but demostrated significant bifrontal
pneumocephalus and thus the patient was placed on 100% oxygen
via facemask for 24 hours.  On POD 1 she was placed on double
antiemetic therapy for pesistent nausea and vomiting.  MRI on
[**10-25**] demosntrated no evidence of stroke with good tumor
resection and resolving pneumocephalus.  She transferred to the
regular floor in stable condition.

She continued to have persistent nausea and vomiting and so she
was maintained on IV Fluids fo hydration and electrolyte
replacement.

By [**10-27**] she was mobilizing well and tolerating adequate PO
intake and stable for discharge.  At the time of discharge she
was ambulating without difficulty, tolerating a regular diet,
afebrile with stable vital signs.  Patient's pain is
well-controlled.  Pt's incision is clean, dry and inctact
without evidence of infection.  She is set for discharge home in
stable condition and will follow-up accordingly.

Medications on Admission:
levoxyl 50mcg daily, xanax 0.5mg prn


Discharge Medications:
1. levothyroxine 25 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
5. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain, HA, fever.
6. dexamethasone 1 mg Tablet Sig: Taper PO Taper: [**10-27**]: 3mg
Q6hrs 12/4-5: 3mg Q8hrs
12/6-7: 2mg Q8hrs
12/8-9: 2mg [**Hospital1 **]
[**2181-11-3**]: 2mg Daily
[**11-5**]: stop.
Disp:*48 Tablet(s)* Refills:*0*
7. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for constipation.
8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
9. phenytoin sodium extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
Disp:*90 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
bifrontal cerebral mass


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


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.
??????	Your wound was closed with staples and ypou 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.
??????	If 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.

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

??????Please return to the office in [**6-3**] days(from your date of
surgery) for removal of your staples and a wound check. This
appointment can be made with the Nurse Practitioner.  Please
make this appointment by calling [**Telephone/Fax (1) 1669**].
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in [**2-28**] weeks.
??????       You have an appointment in the Brain tumor Clinic on
[**2181-12-3**] at 930am with Dr [**Last Name (STitle) 724**]. His office is located on
the [**Location (un) **] of the [**Hospital Ward Name 23**] building on the [**Hospital Ward Name 516**]. His
office can be reached at [**Telephone/Fax (1) 1844**].



Completed by:[**2181-10-29**]
{'Benign neoplasm of cerebral meninges,Compression of brain,Headache,Unspecified essential hypertension,Chronic lymphocytic thyroiditis,Esophageal reflux,Anxiety state, unspecified,Nausea with vomiting'}


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: "I have not felt well for over a year"

PRESENT ILLNESS: This is a very pleasant 58 year old female who present to
the office for second opinion regarding her bifrontal brain
lesion.  She reports that for over a 1 year she was complaining
of dizziness, nausea and general fatigue.  She was initially
treated for HTN.  Then she reported a fall due to her dizziness.

MEDICAL HISTORY: HTN, Hashimotis thyroiditis, anxiety

MEDICATION ON ADMISSION: levoxyl 50mcg daily, xanax 0.5mg prn

ALLERGIES: Latex / Penicillins / lisinopril / hydrochlorothiazide / sulfa /
Losartan / amlodipine

PHYSICAL EXAM: O: 5'7", 147 lbs.
Gen: WD/WN, comfortable, NAD.
HEENT: normal, eyes clear, ears hearing intact, nasal passages
patent, oropharynx pink without exudate,Pupils: PERRL EOMs full
Neck: Supple.
Lungs: CTA bilaterally, no w/c/r
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-25**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: married, cosmetic sales, 1 child 

### Response:
{'Benign neoplasm of cerebral meninges,Compression of brain,Headache,Unspecified essential hypertension,Chronic lymphocytic thyroiditis,Esophageal reflux,Anxiety state, unspecified,Nausea with vomiting'}
