CHIEF COMPLAINT: CC:Spine Hardware protruding through skin. Left shoulder pain

PRESENT ILLNESS: HPI:67 yo male with metastatic thyroid CA to spine, who is well
known to this service presents from home with previously placed
spine hardware externalizing from his skin. There is associated
foul smelling drainage and erythema. He also has left shoulder
pain which began [**2161-1-26**] after feeling a "[**Doctor Last Name **]" in the shoulder
with no associated trauma.

MEDICAL HISTORY: Metastatic Thyroid Ca
HTN
Atrial Fibrillation
Pulmonary Embolus [**1-28**] - Anticoagulated with coumadin; has
two small lesions on MRI head c/w mets but not contraindications

MEDICATION ON ADMISSION: D
i
g
o
x
i
n
,
A
m
i
o
d
a
r
o
n
e
,
G
a
b
a
p
e
n
t
in,Dexamethasone,Omeprazole,Senna,Oxycodone,OxyconTin,Metoprolol
XL, Levothyroxine,

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: 98% O2Sats 4L N/C
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRLA   EOMs full
Neck: Supple. No carotid upstrokes
Lungs: CTA bilaterally. Diminished Lt base
Cardiac: RRR. S1/S2. No gallop, M/R
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.
Motor:
      D    B     T    IP    Q  H     AT    [**Last Name (un) 938**]    G
R     4    4     4    4     4  4      5     5     4
L     4    4     4-    4     4  4      5     5     4

FAMILY HISTORY: Mother with h/o emphysema.

SOCIAL HISTORY: Lives with wife.   Retired from full time work in [**2157-9-22**].
Smoked approximately 30 years ago (quit in [**2126**])
Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Pressure ulcer, stage III,Disruption of external operation (surgical) wound,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Disorders of bursae and tendons in shoulder region, unspecified,Personal history of malignant neoplasm of thyroid,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Hip joint replacement
React-oth int ortho dev,Pressure ulcer,stage III,Disrup-external op wound,Secondary malig neo bone,Secondary malig neo lung,MRSA elsewhere/NOS,Hypertension NOS,Atrial fibrillation,Obstructive sleep apnea,Hypothyroidism NOS,Rotator cuff synd NOS,Hx of thyroid malignancy,Hx-ven thrombosis/embols,Long-term use anticoagul,Joint replaced hip
Admission Date:  [**2161-1-27**]              Discharge Date:   [**2161-2-12**]

Date of Birth:  [**2093-10-4**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Iodine; Iodine Containing

Attending:[**First Name3 (LF) 2724**]
Chief Complaint:
CC:Spine Hardware protruding through skin. Left shoulder pain

Major Surgical or Invasive Procedure:
Thoracic wound debridement/hardware removal
Placement of VAC dressing
Flap rotation with thoracic wound closure
dobhoff placement


History of Present Illness:
HPI:67 yo male with metastatic thyroid CA to spine, who is well
known to this service presents from home with previously placed
spine hardware externalizing from his skin. There is associated
foul smelling drainage and erythema. He also has left shoulder
pain which began [**2161-1-26**] after feeling a "[**Doctor Last Name **]" in the shoulder
with no associated trauma.

Past Medical History:
Metastatic Thyroid Ca
HTN
Atrial Fibrillation
Pulmonary Embolus [**1-28**] - Anticoagulated with coumadin; has
two small lesions on MRI head c/w mets but not contraindications

to anticoag.
Hypothyroidism

Social History:
Lives with wife.   Retired from full time work in [**2157-9-22**].
Smoked approximately 30 years ago (quit in [**2126**])


Family History:
Mother with h/o emphysema.

Physical Exam:
      98% O2Sats 4L N/C
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRLA   EOMs full
Neck: Supple. No carotid upstrokes
Lungs: CTA bilaterally. Diminished Lt base
Cardiac: RRR. S1/S2. No gallop, M/R
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.
Motor:
      D    B     T    IP    Q  H     AT    [**Last Name (un) 938**]    G
R     4    4     4    4     4  4      5     5     4
L     4    4     4-    4     4  4      5     5     4

Sensation: Intact to light touch, propioception
Reflexes: B T Br Pa Ac
Right     2 2 2  2   1
Left      2 2 2  2   1

Propioception intact
Toes downgoing bilaterally

Pertinent Results:
CT/MRI: Thoracic Spine with no obvious thoracic fluid
collection.
Air in the prior drain site.

[**2161-1-27**] 08:27PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.007
[**2161-1-27**] 08:27PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG

[**2161-1-27**] 12:00PM   GLUCOSE-193* UREA N-18 CREAT-0.6 SODIUM-135
POTASSIUM-4.9 CHLORIDE-96 TOTAL CO2-31 ANION GAP-13
[**2161-1-27**] 12:00PM   CRP-79.1*
[**2161-1-27**] 12:00PM   WBC-12.8*# RBC-4.47* HGB-12.8* HCT-38.0*
MCV-85 MCH-28.7 MCHC-33.8 RDW-16.7*
[**2161-1-27**] 12:00PM   NEUTS-96.0* LYMPHS-1.9* MONOS-1.7* EOS-0.3
BASOS-0.1
[**2161-1-27**] 12:00PM   PLT COUNT-81*
[**2161-1-27**] 12:00PM   SED RATE-40*

Brief Hospital Course:
Mr [**Known lastname 20598**] was admitted to the neurosurgery service after it
was noted that his spinal hardware was eroding through the skin.
He went to the OR and the wound was completely irrigated,
fibrous exudate was noted and a cross link was removed. In
conjunction with plastic surgery a VAC dressing was placed over
the wound. Post operatively he was back to his baseline
neurologic status, which was full motor strength with the
exception of his deltoids and slightly weaker left arm due to a
rotator cuff injury. Subsequent cultures showed STAPH AUREUS
COAG + he was placed on Vancomycin on admission that was
continued, a PICC line was also placed. The patient was started
on a calorie count due to his recent weight loss prior to
admission. On [**2-3**] he went to the OR in conjuction with plastic
to have a muscle flap placed for formal closure of the wound.
There were no perioperative complications to report.A dobhoff
feeding tube was also placed for good nutrition status while
wound healing. He has begun to work with PT again on [**2-4**]. He is
tolerating all p.o. food and fluids well with no nausea or
vomiting. Calorie counts have been maintained and nutrition made
recommendations on tube feeds for optimal support.  He had JP
drains placed intra-op that are monitored for output and he will
go home with these.  His dressings were dry with minimal
staining and monitored by plastic surgery.  He was also followed
by hematology for a low platelet count and received platelet
transfusions peri-op.
Plans were made to discharge pt home with hospice but on [**2-6**] he
developed increasing oxygen needs.  He recieved multiple doses
of lasix with good diuresis followed by chest xrays but
respiratory distress increased.  He was transferred to ICU on
[**2-8**]. Conversations occurred between Dr. [**Last Name (STitle) 548**], the patient and
his wife with information provided by pts oncologist at [**Hospital1 2025**].
After discussions he was made DNR and DNI on [**2-10**].  Morphine IV
q1hr was begun, pt was transferred to the floor.  Palliative
care service was consulted. After discussion, family wished
comfort measures.  Feeding tube was removed at their request,
morphine drip with bolus doses and scopalamine patch were
initiated. On [**2161-2-12**] he expired.

Medications on Admission:
D
i
g
o
x
i
n
,
A
m
i
o
d
a
r
o
n
e
,
G
a
b
a
p
e
n
t
in,Dexamethasone,Omeprazole,Senna,Oxycodone,OxyconTin,Metoprolol
XL, Levothyroxine,


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
metastatic thyroid cancer
MRSA wound infection
pressure ulcer- stage 3, thoracic spine
respiratory distress


Discharge Condition:
Expired


Discharge Instructions:
Expired

Followup Instructions:
Expired



Completed by:[**2161-2-12**]
{'Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Pressure ulcer, stage III,Disruption of external operation (surgical) wound,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Disorders of bursae and tendons in shoulder region, unspecified,Personal history of malignant neoplasm of thyroid,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Hip joint replacement'}


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: CC:Spine Hardware protruding through skin. Left shoulder pain

PRESENT ILLNESS: HPI:67 yo male with metastatic thyroid CA to spine, who is well
known to this service presents from home with previously placed
spine hardware externalizing from his skin. There is associated
foul smelling drainage and erythema. He also has left shoulder
pain which began [**2161-1-26**] after feeling a "[**Doctor Last Name **]" in the shoulder
with no associated trauma.

MEDICAL HISTORY: Metastatic Thyroid Ca
HTN
Atrial Fibrillation
Pulmonary Embolus [**1-28**] - Anticoagulated with coumadin; has
two small lesions on MRI head c/w mets but not contraindications

MEDICATION ON ADMISSION: D
i
g
o
x
i
n
,
A
m
i
o
d
a
r
o
n
e
,
G
a
b
a
p
e
n
t
in,Dexamethasone,Omeprazole,Senna,Oxycodone,OxyconTin,Metoprolol
XL, Levothyroxine,

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: 98% O2Sats 4L N/C
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRLA   EOMs full
Neck: Supple. No carotid upstrokes
Lungs: CTA bilaterally. Diminished Lt base
Cardiac: RRR. S1/S2. No gallop, M/R
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.
Motor:
      D    B     T    IP    Q  H     AT    [**Last Name (un) 938**]    G
R     4    4     4    4     4  4      5     5     4
L     4    4     4-    4     4  4      5     5     4

FAMILY HISTORY: Mother with h/o emphysema.

SOCIAL HISTORY: Lives with wife.   Retired from full time work in [**2157-9-22**].
Smoked approximately 30 years ago (quit in [**2126**]) 

### Response:
{'Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft,Pressure ulcer, stage III,Disruption of external operation (surgical) wound,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Methicillin resistant Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Unspecified essential hypertension,Atrial fibrillation,Obstructive sleep apnea (adult)(pediatric),Unspecified acquired hypothyroidism,Disorders of bursae and tendons in shoulder region, unspecified,Personal history of malignant neoplasm of thyroid,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Hip joint replacement'}
