CHIEF COMPLAINT: Headache, Nausea, Vomiting, recent falls

PRESENT ILLNESS: 51F w/ 1 month h/o worsening posterior H/A; initially treated
for sinusitis, otitis; past 2 weeks, has been feeling nauseous,
vomitting -> 6x/day; also felt dizzy, multiple falls with
tendency towards her left side; left UE and LE have felt
somewhat weak/stiff; presented to OSH on [**10-19**] where head CT
showed left posterior fossa mass; Patient reports 20 lbs weight
loss due to inability to keep food down;

MEDICAL HISTORY: HTN, s/p AVR (bovine) 1yr ago, s/p resection melanoma  (wrist) 6
yrs ago, depression

MEDICATION ON ADMISSION: Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily).
Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig:
One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).

ALLERGIES: Penicillins / Depakote / Haldol

PHYSICAL EXAM: On Admission:
BP: 130/72    HR: 95    R: 16     O2Sats: 98%
Patient is awake, alert, oriented x3, in NAD;
Feels drowsy since she received ativan at OSH, otherwise denies
it at baseline;
Language: Speech slow but with good comprehension and
repetition.
Naming intact.
II: Pupils equally round and reactive to light, bilaterally.
Papilledema appreciated on the right;
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 grossly intact to finger rub.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.
Motor: increased tone in left UE+LE. No abnormal movements,
tremors. Strength full [**4-6**] on right, discreetely weak 5-/5 on
left. No pronator drift.
Sensation: Intact to light touch, propioception bilaterally.
Reflexes: B T  Pa Ac
Right     1 1  2  1
Left      1 1  2  1
Toes downgoing bilaterally
Coordination: left sided dysmetria on finger-to-nose, left
disdiadokinesias

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Resides at home with husband.
Secondary malignant neoplasm of brain and spinal cord,Obstructive hydrocephalus,Unspecified pleural effusion,Compression of brain,Palsy of conjugate gaze,Neoplasm of uncertain behavior of ovary,Personal history of malignant melanoma of skin,Depressive disorder, not elsewhere classified,Heart valve replaced by transplant
Sec mal neo brain/spine,Obstructiv hydrocephalus,Pleural effusion NOS,Compression of brain,Palsy of conjugate gaze,Unc behav neo ovary,Hx-malig skin melanoma,Depressive disorder NEC,Heart valve transplant
Admission Date:  [**2133-10-20**]              Discharge Date:   [**2133-10-27**]

Date of Birth:  [**2082-7-2**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins / Depakote / Haldol

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Headache, Nausea, Vomiting, recent falls

Major Surgical or Invasive Procedure:
[**10-21**] Stereotactic 3rd ventriculostomy
[**10-23**] Suboccipital Crani for Mass

History of Present Illness:
51F w/ 1 month h/o worsening posterior H/A; initially treated
for sinusitis, otitis; past 2 weeks, has been feeling nauseous,
vomitting -> 6x/day; also felt dizzy, multiple falls with
tendency towards her left side; left UE and LE have felt
somewhat weak/stiff; presented to OSH on [**10-19**] where head CT
showed left posterior fossa mass; Patient reports 20 lbs weight
loss due to inability to keep food down;


Past Medical History:
HTN, s/p AVR (bovine) 1yr ago, s/p resection melanoma  (wrist) 6
yrs ago, depression


Social History:
Resides at home with husband.

Family History:
Non-contributory

Physical Exam:
On Admission:
BP: 130/72    HR: 95    R: 16     O2Sats: 98%
Patient is awake, alert, oriented x3, in NAD;
Feels drowsy since she received ativan at OSH, otherwise denies
it at baseline;
Language: Speech slow but with good comprehension and
repetition.
Naming intact.
II: Pupils equally round and reactive to light, bilaterally.
Papilledema appreciated on the right;
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 grossly intact to finger rub.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.
Motor: increased tone in left UE+LE. No abnormal movements,
tremors. Strength full [**4-6**] on right, discreetely weak 5-/5 on
left. No pronator drift.
Sensation: Intact to light touch, propioception bilaterally.
Reflexes: B T  Pa Ac
Right     1 1  2  1
Left      1 1  2  1
Toes downgoing bilaterally
Coordination: left sided dysmetria on finger-to-nose, left
disdiadokinesias

On Discharge:
AOx3, cooperative with examination. PERRL, EOMI without
nystagmus. Slight right pronator drift and left sided dysmetria.
Full strength and power throughout upper and lower extremities.

Pertinent Results:
Labs on Admission:
[**2133-10-20**] 02:30AM BLOOD WBC-6.5 RBC-4.52 Hgb-12.5 Hct-37.3 MCV-83
MCH-27.6 MCHC-33.4 RDW-13.1 Plt Ct-337
[**2133-10-20**] 02:30AM BLOOD Neuts-52.6 Lymphs-37.2 Monos-6.6 Eos-2.8
Baso-0.8
[**2133-10-20**] 02:30AM BLOOD PT-14.8* PTT-31.4 INR(PT)-1.3*
[**2133-10-20**] 02:30AM BLOOD Glucose-95 UreaN-18 Creat-0.9 Na-141
K-3.4 Cl-104 HCO3-26 AnGap-14
[**2133-10-21**] 02:28AM BLOOD Calcium-8.3* Phos-3.8 Mg-2.0

Imaging:
MRI Head +/- contrast [**10-20**]:
IMPRESSION:
1. Large posterior fossa mass located adjacent to the left
cerebellar
hemisphere causing mass effect upon the fourth ventricle with
some slight
prominence of the ventricular system and no associated tonsillar
herniation. This mass has properties that are most likely
consistent with a meningioma, however, metastasis is also
considered in the differential diagnosis.
2. Focal area of enhancement in the ventral aspect of the right
basal ganglia possibly consistent with telangiectasia, however,
a tiny focus of metastasis cannot be excluded from the
differential.

Pre-op CXR [**10-21**]:
No prior study for comparison.
Prior sternotomy was performed with all wires intact.
Left lower lobe consolidation is likely associated with a small
pleural
effusion, could be pneumonia. Further characterization with
standard PA and  lateral views is recommended as well as
followup after treatment until
complete resolution. The cardiomediastinal silhouette is normal.
The right
lung is clear.

CTA Head [**10-22**]:
IMPRESSION:
1. Stable large posterior fossa mass with multiple prominent
vessels
indicating hypervascularity. While this most likely represents a
meningioma, differential includes hemangioblastoma, lymphoma,
metastatic disease, and sarcoid.
2. Pneumocranium associated with recent third ventriculostomy.

Head CT [**10-23**](post-crani):
FINDINGS: The patient has undergone left occipital craniotomy
and resection of the large posterior fossa mass, with a small
amount of hyperdense material in the resection cavity which may
represent a tiny amount of hemorrhage. There is expected degree
of pneumocephalus, compatible with recent postoperative state.
There is evidence of prior ventriculostomy via right frontal
approach.
The mass effect in the posterior fossa continues to be present.
There is no hydrocephalus.
The bone windows demonstrate evidence of left occipital
craniotomy and the
right frontal burr hole. Gas is noted in the soft tissues of the
left
parieto-occipital region, consistent with recent operation.

CT of Chest/Abdomen/Pelvis + contrast:
[**10-23**]
TECHNIQUE: MDCT axial images were obtained from the thoracic
inlet to the
symphysis pubis with administration of IV and oral contrast.
Coronal and
sagittal reformations were obtained.
CT OF THE CHEST WITH IV CONTRAST: Aortic valvular calcifications
are seen.
Otherwise, heart and pericardium are unremarkable. There are
scattered
mediastinal nodes, not meeting size criteria for pathologic
enlargement.
There is a large left pleural effusion with associated
atelectasis of the
adjacent lung. In addition, there is a smaller right pleural
effusion, with associated atelectasis of the adjacent lung.
Within the visualized right lung, there are numerous scattered
pulmonary nodules, largest in the right lung base measuring
approximately 6 mm (3:31). Additional scattered nodules measure
up to 4-5 mm. An endotracheal tube is visualized, with tip
approximately 3 cm from the carina, in standard position.
CT OF THE ABDOMEN WITH IV CONTRAST: The liver, spleen, pancreas,
adrenal
glands, and kidneys are unremarkable.
There are several enhancing lesions seen within the gallbladder,
the largest measuring up to approximately 2 cm, not definitively
seen on the pre-contrast images.
The stomach and small bowel are within normal limits. There is
extensive
omental caking with peritoneal nodular deposits throughout, some
of which are located subserosal and directly abutting the colon.
However, the colon
appears grossly unremarkable otherwise. There is no free
intraperitoneal air. Scattered mesenteric and retroperitoneal
nodes are seen, measuring up to 8-10 mm in short axis.
Additionally, there is a small amount of free fluid.
CT OF THE PELVIS WITH IV CONTRAST: There is a large
heterogeneous lobulated left adnexal mass, difficult to measure,
but measures grossly 8 cm in craniocaudad dimensions, with areas
of nodularity, and areas of low
attenuation centrally. This is concerning for a primary ovarian
neoplasm.
Additionally, enhancing nodules are seen immediately superior to
the bladder, may reflect additional metastatic deposits. There
is free fluid within the pelvis. Rectum is unremarkable.
OSSEOUS STRUCTURES: No suspicious lytic or sclerotic lesion is
identified.




Brief Hospital Course:
Patient was admitted to neurosurgery service from the emergency
department after experiencing  approximately 2 weeks of
headache, nausea, dizziness and falls.  Upon arrival to the
[**Hospital1 18**] ED she was found to have a posterior fossa mass and
associated hydrocephalus.  Due to the location of the mass, and
hydrocephalus, she was admitted to the ICU for close observation
given her risk of herniation.  On [**10-21**] she underwent
stereotactic 3rd ventriculostomy for facilitate CSF drainage and
alleviate hydrocephalus.  On [**10-23**] she then underwent
suboccipital craniotomy for mass resection, which was tolerated
well.  She was further observed in the ICU for 48hrs for
continued recovery.  [**10-24**] she was found to have LLL pleural
effusion, which was aspirated at the bedside, without ill
effect. She also had a CT of the chest abdomen and pelvis which
revealed multiple foci of disease within the abdomen.  Consults
were obtained from [**Hospital 11212**] medical oncology, radiation
oncology, neuroncology, gyn surgery, and social work.  Patient
resides on the northshore and has difficulty commuting into
[**Location (un) 86**] for follow up cancer treatment, so she elected to have
all follow up care arranged through the [**Hospital 45790**] Cancer center under
Drs. [**Last Name (STitle) 31966**] and [**Name5 (PTitle) 81491**].  She was also evaluated by physical and
occupational therapy and found to be an appropriate rehab
candidate. She was discharged to said facility on [**10-27**], with
appropriate follow up arranged with the above doctors as [**Name5 (PTitle) **] as
Dr. [**Last Name (STitle) **] for neurosurgical follow-up.


Medications on Admission:
Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily).
Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig:
One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).

Discharge Medications:
1. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
2. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
4. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
9. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
10. Dexamethasone 2 mg Tablet Sig: 1.5 Tablets PO TID (3 times a
day) for 1 days.
11. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 1 days.
12. Dexamethasone 2 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day) for 1 days.
13. Dexamethasone 2 mg Tablet Sig: 0.5 Tablet PO BID (2 times a
day) for 1 days.
14. Dexamethasone 2 mg Tablet Sig: 0.5 Tablet PO QD () for 1
days.
15. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): Insulin sliding scale per Nursing
flow sheet.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **]

Discharge Diagnosis:
Metastatic Melanoma
Hydrocephalus

Discharge Condition:
Neurologically Stable

Discharge Instructions:
General Instructions/Information

??????	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 may wash your hair only after sutures have been removed.
??????	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 are being sent home on steroid medication, make sure you
are taking a medication to protect your stomach (Prilosec,
Protonix, or Pepcid), as these medications can cause stomach
irritation.  Make sure to take your steroid medication with
meals, or a glass of milk.
??????	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.
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: increasing redness,
increased swelling, increased tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

??????	Please return to the office in [**6-11**] days for removal of your
staples/sutures and a wound check. This may also be done while
at the rehab facility. otherwise, this appointment can be made
with the Nurse Practitioner.  Please make this appointment by
calling [**Telephone/Fax (1) 1669**]. If you live quite a distance from our
office, please make arrangements for the same, with your PCP.
??????	You have an appointment in the Brain [**Hospital 341**] Clinic on [**11-16**] at 3pm with Dr. [**Last Name (STitle) **].  The Brain [**Hospital 341**] Clinic is located
on the [**Hospital Ward Name 516**] of [**Hospital1 18**] in the [**Hospital Ward Name 23**] Building. Their phone
number is [**Telephone/Fax (1) 1844**]. Please call if you need to change your
appointment, or require additional directions.
??????	You will not need an MRI of the brain.
*********
You have appointments scheduled at [**Hospital 45790**] Cancer Center with Dr.
[**Last Name (STitle) 81491**](oncology medicine) on Novemeber 26th at 1pm and Dr.
[**Last Name (STitle) 31966**] (radiation oncologist) on [**11-3**] at 1pm. If you
have any questions please call them directly at: [**Telephone/Fax (1) 81492**]


Completed by:[**2133-10-27**]
{'Secondary malignant neoplasm of brain and spinal cord,Obstructive hydrocephalus,Unspecified pleural effusion,Compression of brain,Palsy of conjugate gaze,Neoplasm of uncertain behavior of ovary,Personal history of malignant melanoma of skin,Depressive disorder, not elsewhere classified,Heart valve replaced by transplant'}


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: Headache, Nausea, Vomiting, recent falls

PRESENT ILLNESS: 51F w/ 1 month h/o worsening posterior H/A; initially treated
for sinusitis, otitis; past 2 weeks, has been feeling nauseous,
vomitting -> 6x/day; also felt dizzy, multiple falls with
tendency towards her left side; left UE and LE have felt
somewhat weak/stiff; presented to OSH on [**10-19**] where head CT
showed left posterior fossa mass; Patient reports 20 lbs weight
loss due to inability to keep food down;

MEDICAL HISTORY: HTN, s/p AVR (bovine) 1yr ago, s/p resection melanoma  (wrist) 6
yrs ago, depression

MEDICATION ON ADMISSION: Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily).
Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr Sig:
One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).

ALLERGIES: Penicillins / Depakote / Haldol

PHYSICAL EXAM: On Admission:
BP: 130/72    HR: 95    R: 16     O2Sats: 98%
Patient is awake, alert, oriented x3, in NAD;
Feels drowsy since she received ativan at OSH, otherwise denies
it at baseline;
Language: Speech slow but with good comprehension and
repetition.
Naming intact.
II: Pupils equally round and reactive to light, bilaterally.
Papilledema appreciated on the right;
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 grossly intact to finger rub.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.
Motor: increased tone in left UE+LE. No abnormal movements,
tremors. Strength full [**4-6**] on right, discreetely weak 5-/5 on
left. No pronator drift.
Sensation: Intact to light touch, propioception bilaterally.
Reflexes: B T  Pa Ac
Right     1 1  2  1
Left      1 1  2  1
Toes downgoing bilaterally
Coordination: left sided dysmetria on finger-to-nose, left
disdiadokinesias

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Resides at home with husband. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Obstructive hydrocephalus,Unspecified pleural effusion,Compression of brain,Palsy of conjugate gaze,Neoplasm of uncertain behavior of ovary,Personal history of malignant melanoma of skin,Depressive disorder, not elsewhere classified,Heart valve replaced by transplant'}
