CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 60-year-old
woman with a diagnosis of metastatic breast cancer diagnosed
in [**2191**] with a lesion that was too small to be excised,
though it was biopsied and metastasis to bone and brain were
apparently found at the time of diagnosis.  In [**2197-4-25**]
she was found to have a tonic-clonic seizure and was started
on Dilantin to which she developed a rash to, and she was
switched to Depakote.  Also sometime in the past she was
given radiation to the right parietal lobe and excision of
the left cerebellum, and she has undergone chemotherapy.

MEDICAL HISTORY: (Past medical history includes)
1.  Metastatic breast cancer.
2.  L5 vertebral metastases.
3.  Brain metastasis.
4.  Dehydration.
5.  Hypokalemia.
6.  Hypertension.
7.  Helicobacter pylori ulcer disease.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Pathologic fracture of vertebrae,Secondary malignant neoplasm of bone and bone marrow,Other convulsions,Hemorrhage of gastrointestinal tract, unspecified,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Acute respiratory failure,Personal history of malignant neoplasm of breast
Path fx vertebrae,Secondary malig neo bone,Convulsions NEC,Gastrointest hemorr NOS,Pneumonia, organism NOS,CHF NOS,Acute respiratry failure,Hx of breast malignancy
Admission Date:  [**2197-10-27**]     Discharge Date:  [**2197-11-8**]

Date of Birth:   [**2137-1-4**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 60-year-old
woman with a diagnosis of metastatic breast cancer diagnosed
in [**2191**] with a lesion that was too small to be excised,
though it was biopsied and metastasis to bone and brain were
apparently found at the time of diagnosis.  In [**2197-4-25**]
she was found to have a tonic-clonic seizure and was started
on Dilantin to which she developed a rash to, and she was
switched to Depakote.  Also sometime in the past she was
given radiation to the right parietal lobe and excision of
the left cerebellum, and she has undergone chemotherapy.

She was admitted to [**Hospital1 69**] with
lower back pain.  MRI showed pathologic fracture at the L5
level and compression of L3 and narrowing of L5-S1, but no
real cord compression.

PAST MEDICAL HISTORY:  (Past medical history includes)
1.  Metastatic breast cancer.
2.  L5 vertebral metastases.
3.  Brain metastasis.
4.  Dehydration.
5.  Hypokalemia.
6.  Hypertension.
7.  Helicobacter pylori ulcer disease.

PHYSICAL EXAMINATION ON PRESENTATION:  On physical
examination, she was alert, cooperative, and in no acute
distress.  Her eyes revealed extraocular movements were full.
Pupils were equal, round, and reactive to light.  Throat
showed no lesions.  There was no nystagmus.   Carotids were
palpable.  Chest was clear to percussion.  No breast masses
were palpable.  Heart showed no murmurs, rubs or gallops.  A
regular rate and rhythm.  Abdomen was mildly distended.  No
organomegaly, masses, or tenderness, with active bowel
sounds. Extremities showed 2 to 3+ pitting edema in both
legs.  The feet were warm.  Neurologically, she had terminal
dysmetria, prominent on the right and mild on the left.
There were rapid alternating movements and had poor
heel-to-shin with the left leg and better with the right leg.


HOSPITAL COURSE:   On [**2197-10-27**], the patient underwent
L4 to S2 laminectomies with L4 to S1 pedicle screw fixation
and allograft without intraoperative complications.

Postoperative vital signs revealed the patient spiked a
temperature to 101 and was fully cultured.  Her hematocrit
was 26.  She was transfused with 2 units of packed red blood
cells.

On [**2197-10-29**], the patient vomited coffee-grounds
material.  Her hematocrit was stable at 38.2.  On [**2197-10-30**], the patient had elevated coagulations with an INR
of 3.2, PT of 21.5, and PTT of 38.7.  Her hematocrit was
stable post transfusion at 39.8.  She was also seen by the
Gastrointestinal Service for the coffee-grounds emesis.
Gastrointestinal recommendation was to monitor vital signs
q.1h. and monitor hematocrit q.8h.  The patient did not have
a drop in hematocrit and was no longer actively bleeding.
They opted for conservative management given her spinal
surgery and her elevated coagulations.

On [**2197-10-30**], the patient dropped her saturations into
the 80s.  Chest x-ray was consistent with congestive heart
failure.  The patient was transferred back to Intensive Care
Unit.  She was diuresed.  She was intubated, and her
coagulopathy was corrected with 2 units of fresh frozen
plasma and vitamin K with no further problems with her
coagulations.

The patient was also ruled out for a myocardial infarction
and seen by the Cardiology Service for the congestive heart
failure.  Her troponin level came back at 6.2, down to 3.9,
and then 3.2.  Creatine kinases were 73, 51, and 50.
Cardiology attributed her ischemia as to being multifactorial
due to low hematocrit, coagulopathy, and stress of being
hospitalized.  Her transthoracic echocardiogram showed
overall left ventricular systolic function to be moderately
depressed, normal right ventricular size, and left
ventricular size was within normal limits.  It was a
suboptimal study but was consistent with anterior septal and
apical hypokinesis.  Cardiology attending agreed that it was
most likely ischemic anterior changes with a slight troponin
leak.  Her estimated ejection fraction was at 40%.  She was
gradually started on captopril with Lasix and was to start
aspirin when okay from a surgical point of view.

On [**2197-11-1**], the patient was also seen by the
Pulmonary Service for her respiratory failure and need for
intubation.  It was unclear from their point of view why she
developed congestive heart failure; although, they felt it
was multifactorial, and the goal of treatment was to wean her
from the mechanical ventilation as soon as it was tolerated
and diurese her.

The patient was extubated on [**2197-11-3**].  She was awake
and alert and followed commands.  Her motor strength in her
lower extremities revealed she was 4+ in the bilateral
iliopsoas, 5 in the quadriceps, a 1 in the left AT, and a 4-
in the right AT and numbness in bilateral feet.  Vital signs
remained stable, and she was afebrile.

The patient was also seen by the Hematology Service and
worked up for a possible transfusion reaction to the fresh
frozen plasma which may have been the reason for the rapid
onset of congestive heart failure post fresh frozen plasma
transfusion.  The patient was started on levofloxacin for a
7-day course for pneumonia.

From a cardiac standpoint, the patient was started on
captopril with the dose increased and then switched to
lisinopril 20 mg p.o. q.d. for afterload reduction.

Pulmonary wise, the patient was on 2 liters with saturations
in the high 90s.  Vital signs were stable.  She continued on
levofloxacin to complete a 7-day course.

Hematologically, her coagulations were within normal limits
since being transfused with fresh frozen plasma and given
vitamin K.

From a neurosurgical standpoint, the patient was seen by
Physical Therapy and Occupational Therapy and found to
require rehabilitation prior to discharge to home.

MEDICATIONS ON DISCHARGE:
1.  Lisinopril 20 mg p.o. q.d.
2.  Prevacid 30 mg p.o. q.d.
3.  Depakote 250 mg p.o. q.i.d.
4.  Levaquin 500 mg p.o. q.d. (started on [**2197-11-4**]).
5.  Albuterol nebulizers q.4h. p.r.n.
6.  Percocet 1 p.o. q.6h. p.r.n.
7.  Heparin 5000 units subcutaneous b.i.d.
8.  Lasix 40 mg p.o. q.d.
9.  [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mEq p.o. q.d.

DISCHARGE DISPOSITION:  Vital signs remained stable.  The
patient was afebrile, and the patient was stable and ready
for transfer to rehabilitation with follow up with Dr. [**Last Name (STitle) 1327**]
in 10 days for staple removal.




                          [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D.  [**MD Number(1) 1341**]

Dictated By:[**Last Name (NamePattern1) 344**]

MEDQUIST36

D:  [**2197-11-7**]  14:32
T:  [**2197-11-7**]  13:40
JOB#:  [**Job Number 16923**]

 (cclist)


Name:  [**Known lastname 5990**], [**Known firstname 194**] H                 Unit No:  [**Numeric Identifier 17202**]

Admission Date:  [**2197-10-27**]     Discharge Date:  [**2197-11-13**]

Date of Birth:   [**2137-1-4**]     Sex:  F

Service:

DISCHARGE SUMMARY ADDENDUM:  The patient's discharge was
delayed secondary to lack of rehabilitation bed.  The
patient's condition remained stable throughout her hospital
stay from [**2197-11-7**] to [**2197-11-13**]. She was stable at the
time of discharge with follow up with Dr. [**Last Name (STitle) **] in one
week's time for staple removal.


                         DR.[**Last Name (STitle) 562**],[**First Name3 (LF) 863**] 14-127

Dictated By:[**Last Name (NamePattern1) 366**]

MEDQUIST36

D:  [**2197-12-14**]  13:51
T:  [**2197-12-14**]  12:12
JOB#:  [**Job Number 17206**]
{'Pathologic fracture of vertebrae,Secondary malignant neoplasm of bone and bone marrow,Other convulsions,Hemorrhage of gastrointestinal tract, unspecified,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Acute respiratory failure,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 60-year-old
woman with a diagnosis of metastatic breast cancer diagnosed
in [**2191**] with a lesion that was too small to be excised,
though it was biopsied and metastasis to bone and brain were
apparently found at the time of diagnosis.  In [**2197-4-25**]
she was found to have a tonic-clonic seizure and was started
on Dilantin to which she developed a rash to, and she was
switched to Depakote.  Also sometime in the past she was
given radiation to the right parietal lobe and excision of
the left cerebellum, and she has undergone chemotherapy.

MEDICAL HISTORY: (Past medical history includes)
1.  Metastatic breast cancer.
2.  L5 vertebral metastases.
3.  Brain metastasis.
4.  Dehydration.
5.  Hypokalemia.
6.  Hypertension.
7.  Helicobacter pylori ulcer disease.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Pathologic fracture of vertebrae,Secondary malignant neoplasm of bone and bone marrow,Other convulsions,Hemorrhage of gastrointestinal tract, unspecified,Pneumonia, organism unspecified,Congestive heart failure, unspecified,Acute respiratory failure,Personal history of malignant neoplasm of breast'}
