CHIEF COMPLAINT: Neck pain

PRESENT ILLNESS: 85 year old female who presents with a week and a half of
worsening neck pain that has affected her ability to ambulate
and chew food comfortably. She was ambulating with a walker but
because of the pain she has been unable. She also reports some
numbness/tingling to her R fingertips but reports a history of
carpal tunnel. A C-spine CT was done four days prior which
showed a cervical mass but pain had intensified over the last
few days and was brought to ER for pain management.

MEDICAL HISTORY: 1. CAD RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
- Mitral valve regurgitation S/P post mitral valve repair
with annuloplasty ring on [**2192-5-23**].
- Atrial fibrillation, off Coumadin
- Mild hypertension.
-CABG: Never
-PERCUTANEOUS CORONARY INTERVENTIONS: Cath in [**2191**], no
interventions.
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
- Osteoarthritis
- Osteopenia
- Gastroesophageal Reflux Disease
- Rectal polyp s/p partial resection [**3-16**]
- Diverticulosis
- CHF with preserved EF on ECHO [**4-5**]
- cervical and lumbar spondylosis
SURGICAL HISTORY:
- s/p right total knee replacement [**2188**]. [**Doctor Last Name 15568**]-NWH
- s/p cholecystectomy in [**2145**]
- s/p appendectomy in [**2145**]
- s/p cataract removal
- s/p bilateral carpal tunnel release

MEDICATION ON ADMISSION: 1.  Atenolol 50 mg once a day.
2.  Atorvastatin 80 mg once a day.
3.  Aspirin 81 mg once a day.
4.  Famotidine 20 mg once a day.
5.  Levothyroxine 75 mcg once a day everyday with a skip at one
day a week.

ALLERGIES: Codeine / Percocet / Lisinopril / Lidocaine/Transparent Dressing

PHYSICAL EXAM: PHYSICAL EXAM on Admission:
O: T: 97.6  BP: 138/66   HR: 72    R 16    O2Sats 96% RA

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: She has 3 daughters. Widowed. Retired executive secretary who
was also a sales representative for Nestle.
-Tobacco history: Denies
-ETOH: Occasional
Vascular myelopathies,Chronic combined systolic and diastolic heart failure,Cervical spondylosis without myelopathy,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Knee joint replacement,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Disorder of bone and cartilage, unspecified
Vascular myelopathies,Chr syst/diastl hrt fail,Cervical spondylosis,Old myocardial infarct,Crnry athrscl natve vssl,Joint replaced knee,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Bone & cartilage dis NOS
Admission Date:  [**2194-2-15**]              Discharge Date:   [**2194-2-21**]


Service: NEUROSURGERY

Allergies:
Codeine / Percocet / Lisinopril / Lidocaine/Transparent Dressing

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Neck pain


Major Surgical or Invasive Procedure:
[**2-19**]: C1,C2 Laminectomy and lesion biopsy


History of Present Illness:
85 year old female who presents with a week and a half of
worsening neck pain that has affected her ability to ambulate
and chew food comfortably. She was ambulating with a walker but
because of the pain she has been unable. She also reports some
numbness/tingling to her R fingertips but reports a history of
carpal tunnel. A C-spine CT was done four days prior which
showed a cervical mass but pain had intensified over the last
few days and was brought to ER for pain management.

Past Medical History:
1. CAD RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
- Mitral valve regurgitation S/P post mitral valve repair
with annuloplasty ring on [**2192-5-23**].
- Atrial fibrillation, off Coumadin
- Mild hypertension.
-CABG: Never
-PERCUTANEOUS CORONARY INTERVENTIONS: Cath in [**2191**], no
interventions.
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
- Osteoarthritis
- Osteopenia
- Gastroesophageal Reflux Disease
- Rectal polyp s/p partial resection [**3-16**]
- Diverticulosis
- CHF with preserved EF on ECHO [**4-5**]
- cervical and lumbar spondylosis
SURGICAL HISTORY:
- s/p right total knee replacement [**2188**]. [**Doctor Last Name 15568**]-NWH
- s/p cholecystectomy in [**2145**]
- s/p appendectomy in [**2145**]
- s/p cataract removal
- s/p bilateral carpal tunnel release

Social History:
She has 3 daughters. Widowed. Retired executive secretary who
was also a sales representative for Nestle.
-Tobacco history: Denies
-ETOH: Occasional


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
PHYSICAL EXAM on Admission:
O: T: 97.6  BP: 138/66   HR: 72    R 16    O2Sats 96% RA

Gen: WD/WN, comfortable, NAD.
HEENT: Normocephalic
Neck: Supple.
Extrem: Warm and well-perfused. Arthritic.

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor:
      D    B     T    WE   WF    IP    Q  H     AT    [**Last Name (un) 938**]    G
R     5    5     5    5    5     5     5  5     5     5      5
L     5    5     5    5    5     5     5  5     5     5      5

Sensation: Intact to light touch, proprioception intact
bilaterally

Reflexes: B T Br Pa Ac
Right     2 2 1  2  0
Left      2 2 0  2  0

Proprioception intact
Toes up-going bilaterally

[**2194-2-21**]: Awake alert and oriented x3. Neuro: exam bilat upper
and lower extremities full strength without decreased sensation.
Left shoulder strength mildly decreased at baseline secondary to
old rotator cuff injury. Tolerating Aspen collar. Dressing at
posterior cervical site removed. Sutures intact, wound open to
air, no drainage.

Pertinent Results:
ADMISSION LABS:
[**2194-2-14**] 11:30PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.007
[**2194-2-15**] 01:00AM   WBC-7.8 RBC-4.68 HGB-13.4 HCT-39.3 MCV-84
MCH-28.7 MCHC-34.2 RDW-13.9
[**2194-2-15**] 01:00AM   GLUCOSE-108* UREA N-21* CREAT-0.7 SODIUM-141
POTASSIUM-3.6 CHLORIDE-98 TOTAL CO2-32 ANION GAP-15
[**2194-2-15**] 05:30PM   WBC-9.7 RBC-4.67 HGB-13.6 HCT-39.3 MCV-84
MCH-29.0 MCHC-34.5 RDW-13.8

Discharge Labs:
[**2194-2-21**] 06:00AM BLOOD WBC-10.7 RBC-4.24 Hgb-12.9 Hct-35.9*
MCV-85 MCH-30.3 MCHC-35.9* RDW-13.7 Plt Ct-261
[**2194-2-21**] 06:00AM BLOOD Plt Ct-261
[**2194-2-21**] 06:00AM BLOOD Glucose-99 UreaN-16 Creat-0.6 Na-133
K-3.1* Cl-94* HCO3-31 AnGap-11
[**2194-2-21**] 06:00AM BLOOD Calcium-9.0 Phos-3.2 Mg-1.8
IMAGING:
C-spine MRI [**2-15**]:
Thickening of the ligaments at the atlanto-odontoid joint with
isointense and slightly enhancing mass on the right side of the
spinal canal at C1 level and extending posteriorly and merging
with the thickened ligaments. The combination of changes most
likely suggests extensive degenerative change with degenerative
pseudotumor with moderate compression of the spinal cord and
moderate-to-severe spinal stenosis at C1 level. Multilevel
degenerative changes are also noted at other levels as described
above.

CTA Neck [**2-15**]:
No evidence of vascular occlusion or stenosis identified. In
particular, no vertebral artery occlusion or displacement
identified.
Degenerative changes at the craniocervical junction with
thickening ligaments as noted on the previous MRI.

MR [**Name13 (STitle) 2853**] [**2-20**]:
Status post posterior decompression and resection of the soft
tissue present at the C2 level. The spinal canal has been
decompressed, and the spinal cord appears normal. No definite
residual tissue is detected although small amounts may be
obscured by the expected postoperative changes.


Brief Hospital Course:
The patient was admitted to the NSurg service for pain control
and for further evaluation of this cervical lesion. She was
placed on Decadron 4mg Q8, and was given a soft collar for
comfort.  It was decided that she have an open biopsy of this
cervical lesion to yeild diagnosis.  Prior to the OR, she was
seen by her cardiologist Dr.[**Name (NI) 53712**], who, from a cardiac
standpoint, cleared her for surgery.  He ordered an ECHO, which
was acceptable, and requested the patient be on telemetry.

The patient went to the operating room on [**2194-2-19**] for a C1,2
Laminectomy and lesion biopsy with Dr. [**Last Name (STitle) **]. Pathology
revealed hematoma and not malignancy therefore steroid was
discontinued. She was in an Aspen collar while awake. Speech and
Swallow service saw her on [**2-20**]. They recommended an altered
diet and this was initiated.

MR W/WO Contrasat [**2194-2-20**]: Status post posterior decompression
and resection of the soft tissue present at the C2 level. The
spinal canal has been decompressed, and
the spinal cord appears normal. No definite residual tissue is
detected
although small amounts may be obscured by the expected
postoperative changes.

On POD#2, her surgical dressing was removed showing a small
amount of erythema, however no obvious drainage or foul odor.
She was seen by PT and OT, who recommended rehabilitation. She
was discharged to an appropriate facility on [**2-21**].


Medications on Admission:
1.  Atenolol 50 mg once a day.
2.  Atorvastatin 80 mg once a day.
3.  Aspirin 81 mg once a day.
4.  Famotidine 20 mg once a day.
5.  Levothyroxine 75 mcg once a day everyday with a skip at one
day a week.


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for Pain.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Methocarbamol 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
9. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
10. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).


Discharge Disposition:
Extended Care

Facility:
[**Known firstname 3548**] [**Doctor Last Name 3549**] Nursing & Rehabilitation Center - [**Location (un) 1110**]

Discharge Diagnosis:
C1- C2 Cervical Lesion **found to be hematoma(path not
finalized)


Discharge Condition:
Neurologically stable


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight goes up more
than 3 lbs.
??????	Do not smoke.
??????	Keep your wound(s) clean and dry / No tub baths or pool
swimming for two weeks from your date of surgery
??????	No pulling up, lifting more than 10 lbs., or excessive bending
or twisting.
??????	Limit your use of stairs to 2-3 times per day.
??????	Have a friend or family member check your incision daily for
signs of infection.
??????	Take your pain medication as instructed; you may find it best
if taken in the morning when you wake-up for morning stiffness,
and before bed for sleeping discomfort.
-Please wear your Cervical collar while awake, you may take it
off while sleeping, or briefly when you shower.
??????	Do not take any anti-inflammatory medications such as Motrin,
Advil, Aspirin, and Ibuprofen etc. unless directed by your
doctor.
??????	Increase your intake of fluids and fiber, as pain medicine
(narcotics) can cause constipation. We recommend taking an over
the counter stool softener, such as Docusate (Colace) while
taking narcotic pain medication.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????	Pain that is continually increasing or not relieved by pain
medicine.
??????	Any weakness, numbness, tingling in your extremities.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, and drainage.
??????	Fever greater than or equal to 101?????? F.
??????	Any change in your bowel or bladder habits (such as loss of
bowl or urine control).


Followup Instructions:
Follow Up Instructions/Appointments

??????Please return to the office in [**6-7**] days for removal of your
sutures. Please call the office at ([**Telephone/Fax (1) 88**] for an
appointment for suture removal.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with
Dr.[**Last Name (STitle) **] to be seen in 6 weeks.



Completed by:[**2194-2-21**]
{'Vascular myelopathies,Chronic combined systolic and diastolic heart failure,Cervical spondylosis without myelopathy,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Knee joint replacement,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Disorder of bone and cartilage, unspecified'}


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: Neck pain

PRESENT ILLNESS: 85 year old female who presents with a week and a half of
worsening neck pain that has affected her ability to ambulate
and chew food comfortably. She was ambulating with a walker but
because of the pain she has been unable. She also reports some
numbness/tingling to her R fingertips but reports a history of
carpal tunnel. A C-spine CT was done four days prior which
showed a cervical mass but pain had intensified over the last
few days and was brought to ER for pain management.

MEDICAL HISTORY: 1. CAD RISK FACTORS: Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
- Mitral valve regurgitation S/P post mitral valve repair
with annuloplasty ring on [**2192-5-23**].
- Atrial fibrillation, off Coumadin
- Mild hypertension.
-CABG: Never
-PERCUTANEOUS CORONARY INTERVENTIONS: Cath in [**2191**], no
interventions.
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
- Osteoarthritis
- Osteopenia
- Gastroesophageal Reflux Disease
- Rectal polyp s/p partial resection [**3-16**]
- Diverticulosis
- CHF with preserved EF on ECHO [**4-5**]
- cervical and lumbar spondylosis
SURGICAL HISTORY:
- s/p right total knee replacement [**2188**]. [**Doctor Last Name 15568**]-NWH
- s/p cholecystectomy in [**2145**]
- s/p appendectomy in [**2145**]
- s/p cataract removal
- s/p bilateral carpal tunnel release

MEDICATION ON ADMISSION: 1.  Atenolol 50 mg once a day.
2.  Atorvastatin 80 mg once a day.
3.  Aspirin 81 mg once a day.
4.  Famotidine 20 mg once a day.
5.  Levothyroxine 75 mcg once a day everyday with a skip at one
day a week.

ALLERGIES: Codeine / Percocet / Lisinopril / Lidocaine/Transparent Dressing

PHYSICAL EXAM: PHYSICAL EXAM on Admission:
O: T: 97.6  BP: 138/66   HR: 72    R 16    O2Sats 96% RA

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: She has 3 daughters. Widowed. Retired executive secretary who
was also a sales representative for Nestle.
-Tobacco history: Denies
-ETOH: Occasional 

### Response:
{'Vascular myelopathies,Chronic combined systolic and diastolic heart failure,Cervical spondylosis without myelopathy,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Knee joint replacement,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Disorder of bone and cartilage, unspecified'}
