CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 74-year-old
woman, with a complicated medical history which includes a
meningioma resection in [**2143**], [**2152**], breast cancer with
lumpectomy in [**2154**] and [**2136**] with metastasis to the liver, and
an AV fistula that was embolized in [**2156-3-1**] and then again
in [**2156**].  The patient is again admitted for repair of AV
fistula.  The patient has been complaining of increased
occipital pain due to this AV fistula.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: She appears her stated age.  She is awake,
alert and oriented x 3.  Cardiac is regular rate and rhythm.
No murmur, rub or gallop.  Her lungs are clear to
auscultation.  Abdomen soft, nontender, nondistended, with a
midline scar.  Extremities - no clubbing, cyanosis or edema.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Cerebral aneurysm, nonruptured,Congestive heart failure, unspecified,Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Personal history of malignant neoplasm of breast
Nonrupt cerebral aneurym,CHF NOS,Second malig neo liver,Pneumonia, organism NOS,Hx of breast malignancy
Admission Date: [**2158-5-2**]        Discharge Date: [**2158-5-17**]

Date of Birth:  [**2083-8-18**]        Sex:  F

Service:  NSU


HISTORY OF PRESENT ILLNESS:  The patient is a 74-year-old
woman, with a complicated medical history which includes a
meningioma resection in [**2143**], [**2152**], breast cancer with
lumpectomy in [**2154**] and [**2136**] with metastasis to the liver, and
an AV fistula that was embolized in [**2156-3-1**] and then again
in [**2156**].  The patient is again admitted for repair of AV
fistula.  The patient has been complaining of increased
occipital pain due to this AV fistula.

PHYSICAL EXAM:  She appears her stated age.  She is awake,
alert and oriented x 3.  Cardiac is regular rate and rhythm.
No murmur, rub or gallop.  Her lungs are clear to
auscultation.  Abdomen soft, nontender, nondistended, with a
midline scar.  Extremities - no clubbing, cyanosis or edema.

HOSPITAL COURSE:  She is admitted status post craniotomy and
resection of an AV fistula on [**2158-5-2**] by Dr. [**Last Name (STitle) 1132**].  She
underwent suboccipital crani for repair of this AV fistula
without intraop complication.  Postop, her vital signs are
stable.
She is afebrile.  She is awake, alert.  EOMS are full.  Face
is symmetric.  Her strength is [**4-5**] in all muscle groups.  Her
tongue is midline.  Her dressing is clean, dry and intact.
She was in the recovery room overnight.  She remained
neurologically stable and was transferred to the regular
floor on postop day 1.  She was awake, alert and oriented x
3.  EOMS full.  No drift.  Her strength was full in all
muscle groups.  Her dressing was clean, dry and intact.

On [**2158-5-5**], the patient's O2 requirements started to
increase.  She was 94 percent with a 50 percent face mask.
Chest x-ray on [**2158-5-5**] showed worsening left lower lobe
opacity which may relate to atelectasis or pneumonia.  The
patient also had increase in the left pleural effusion at the
time.

On [**5-6**], the patient continued to have increasing O2
requirements with shortness of breath.  Her SAT's were 88
percent on room air.  She was following commands and
answering all questions.  She did have bibasilar rales.  She
was given 10 mg of IV Lasix and had a repeat chest x-ray on
[**5-6**] which showed increase in mild CHF with no pleural
effusion.  She was treated with Lasix with good diuresis.
The patient's respiratory status continued to decline and;
therefore, a pulmonary consult was obtained no [**2158-5-9**].
Pulmonary recommended antibiotic coverage for her pneumonia,
and due to the patient's complicated allergy history to IV
antibiotics, the patient was covered with aztreonam, and then
linezolid was added due to risk of MRSA.  The patient's O2
requirements continued to be high.  She was still on the 50
percent face mask with SAT's 92 percent, and then 94 percent
on 3 liters, 88 percent on room air.  Chest x-ray continued
to show worsening pneumonia, multilobar pneumonia, and
pulmonary continued to follow the patient carefully.

ID was also involved when on [**2158-5-13**], the patient
developed a rash.  ID recommended continuing aztreonam and
linezolid for a 14-day course for this complicated pneumonia,
and the patient was screened for MRSA.  So far, the MRSA
screen has come back negative.  The patient also had a CTA to
rule out pulmonary embolism which was negative.  The
patient's rash was kind of a papular that comes and goes,
usually after her dose of antibiotics.  The ID staff was
aware of this, but recommended continuing the IV antibiotics
at this time.  The patient was treated with Benadryl for the
rash, and ID recommended trying to finish the course of
antibiotics for her pneumonia.  Currently, she was weaned to
3 liters of nasal cannula oxygen with her SAT's 96-97
percent.

DISCHARGE MEDICATIONS:  She continued on aztreonam 2,000 mg
IV q 8 h, linezolid 600 mg IV q 12 h, both day 10 of 14 days,
so the patient has 4 more days of antibiotics for this
pneumonia.
1. Metoprolol 12.5 mg po bid--hold for heart rate less than
   60, SBP less than 120.
2. Oxycodone 5 mg po q 4 h prn.
3. Miconazole powder 2 percent 1 application tid prn.
4. Femara 2.5 mg po qd.
5. Keppra 500 mg po bid.
6. Colace 100 mg po bid.
7. Benadryl 25 po prn rash.
8. Hydralazine 20 mg po q 6 h prn SBP greater than 150.


CONDITION ON DISCHARGE:  Stable.

FOLLOW UP:  She will follow-up with Dr. [**Last Name (STitle) 1132**] in 2 week's
time.



                        [**Name6 (MD) **] [**Last Name (NamePattern4) 1359**], [**MD Number(1) 1360**]

Dictated By:[**Last Name (NamePattern1) 6583**]
MEDQUIST36
D:  [**2158-5-17**] 10:40:54
T:  [**2158-5-17**] 11:14:54
Job#:  [**Job Number 19322**]
{'Cerebral aneurysm, nonruptured,Congestive heart failure, unspecified,Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Personal history of malignant neoplasm of breast'}


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: 

PRESENT ILLNESS: The patient is a 74-year-old
woman, with a complicated medical history which includes a
meningioma resection in [**2143**], [**2152**], breast cancer with
lumpectomy in [**2154**] and [**2136**] with metastasis to the liver, and
an AV fistula that was embolized in [**2156-3-1**] and then again
in [**2156**].  The patient is again admitted for repair of AV
fistula.  The patient has been complaining of increased
occipital pain due to this AV fistula.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: She appears her stated age.  She is awake,
alert and oriented x 3.  Cardiac is regular rate and rhythm.
No murmur, rub or gallop.  Her lungs are clear to
auscultation.  Abdomen soft, nontender, nondistended, with a
midline scar.  Extremities - no clubbing, cyanosis or edema.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Cerebral aneurysm, nonruptured,Congestive heart failure, unspecified,Malignant neoplasm of liver, secondary,Pneumonia, organism unspecified,Personal history of malignant neoplasm of breast'}
