CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 69-year-old
woman originally admitted to the Medical Service with a
remote history of breast cancer and six weeks of midthoracic
back pain radiating to bilateral flanks, worse with movement.

MEDICAL HISTORY: Hypertension.  Hypercholesterolemia.
Anxiety and depression.  History of breast cancer in [**2112**],
status post lumpectomy and radiation therapy.

MEDICATION ON ADMISSION: Lescol 40 mg, Xanax, Prozac 20 mg
q.d., Aspirin 81 q.d., Percocet p.r.n., Evista 60 mg q.d.

ALLERGIES: PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Secondary malignant neoplasm of bone and bone marrow,Pathologic fracture of vertebrae,Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Cardiac arrest,Malignant neoplasm of liver, secondary,Other pulmonary embolism and infarction
Secondary malig neo bone,Path fx vertebrae,Gastrointest hemorr NOS,Mal neo lower lobe lung,Cardiac arrest,Second malig neo liver,Pulm embol/infarct NEC
Admission Date:  [**2129-11-14**]       Discharge Date:  [**2129-12-1**]

Date of Birth:                    Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 69-year-old
woman originally admitted to the Medical Service with a
remote history of breast cancer and six weeks of midthoracic
back pain radiating to bilateral flanks, worse with movement.

She was treated with Percocet but continued with significant
back pain, abdominal pain and constipation.  She denied
numbness, tingling, or weakness.

PAST MEDICAL HISTORY:  Hypertension.  Hypercholesterolemia.
Anxiety and depression.  History of breast cancer in [**2112**],
status post lumpectomy and radiation therapy.

MEDICATIONS ON ADMISSION:  Lescol 40 mg, Xanax, Prozac 20 mg
q.d., Aspirin 81 q.d., Percocet p.r.n., Evista 60 mg q.d.

ALLERGIES:  PENICILLIN.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 98.7??????, blood
pressure 149/100, heart rate 91, respirations 20, oxygen
saturation 93% on room air.  General:  The patient was an
elderly woman in moderate pain.  HEENT:  Pupils equal, round
and reactive to light.  Extraocular movements intact.
Oropharynx clear.  Neck:  Supple.  No jugular venous
distention.  Pulmonary:  Chest clear to auscultation.
Cardiovascular:  Regular, rate and rhythm.  No murmurs, rubs,
or gallops.  Abdomen:  Soft, nontender, nondistended.
Rectum:  Normal rectal tone.  Guaiac negative stool.  Back:
There was positive midthoracic tenderness.  Extremities:  No
clubbing, cyanosis, or edema.  Neurological:  The patient was
awake, alert and oriented times three.  Cranial nerves II-XII
intact.  Strength was 5 out of 5 in all muscle groups.
Sensation intact to light touch and pinprick.  Reflexes were
1+ at the biceps patella, and Achilles.

The patient was seen by the Neurosurgery Service who noted a
compression fracture at T9 on plain films.  MRI of thoracic
spine revealed a large right paraspinal mass at 3 x 5 x 3 cm
and T9 anterior wedge compression fracture with retropulsed
segment compressing the cord.  There was evidence of
metastases at C7, T1, T4, T8, T11, and T12.

They recommended bone scan and repeat MRI scan.

CT Surgery was consulted to rule out paraspinal mass in the
thoracic region.  Dr. [**Last Name (STitle) 1327**] recommended T9 vertebrectomy
with T8-T10 arthrodesis for stabilization, for palliation and
relief of pain.

This most likely represented a primary lung cancer with
direct extension to the T9 vertebrae with paraspinal soft
tissue mass.

Bone scan results showed multifocal osseous metastatic
disease.  Head CT showed no lesions.

Chest, abdomen and pelvis CT showed right lower lobe mass
with a lung mediastinal hilar lymphadenopathy and compression
fracture of T9.

She underwent embolization of the tumor on [**2129-11-17**],
without complications.  She tolerated the procedure well.

She was followed by the Oncology Service, as well as
Radiation Oncology and Surgical Service.

On [**2129-11-21**], the patient underwent T9 vertebrectomy
with thoracic stabilization for palliation.  The patient
tolerated the procedure well.  There were no intraoperative
complications.

Postoperatively the patient was monitored in the Surgical
Intensive Care Unit.  She remained intubated and sedated.
She was then awake off Propofol.  She did not follow
commands.  She was moving all extremities spontaneously.  She
flexed bilateral legs at the hips and knees.

Chest tube put out a total of 500 cc postoperatively.  The
patient remained intubated.

On [**11-23**], the patient was localizing to pain on the
right, and withdrew the right lower extremity.  She did not
follow commands.  Dressing was clean, dry, and intact.  No
drainage.  Chest tube continued to be in place.

The plan was to wean the ventilator and extubated the patient
if possible.  On [**2129-11-28**], the patient opened her
eyes.  Gaze was conjugate.  Pupils were 3 down to 2 mm.  She
was not following commands.  She withdrew with antigravity
strength in lower extremities.  Incision was clean, dry, and
intact.

Her LFTs began to rise.  She had a liver and gallbladder
ultrasound which showed multiple metastatic lesions with no
ductal dilatation and no cholelithiasis.

She continued to not follow commands.  Toes were downgoing.
She had sluggish movement of the upper extremities and
withdrew the lower extremities.  LFTs continued to rise.

Gastrointestinal was consulted.  The abdomen showed an
increase in size of all lesions, right lung base,
gallbladder, and biliary system.

A family meeting on [**2129-12-1**], made the patient DNR.
The patient's condition continued to deteriorate, and the
family decided on [**2129-12-1**], to make the patient
comfort measures.  The patient was extubated on [**2129-12-1**], and expired.




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

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2130-1-31**]  13:24
T:  [**2130-1-31**]  13:25
JOB#:  [**Job Number 104194**]
{'Secondary malignant neoplasm of bone and bone marrow,Pathologic fracture of vertebrae,Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Cardiac arrest,Malignant neoplasm of liver, secondary,Other pulmonary embolism and infarction'}


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 69-year-old
woman originally admitted to the Medical Service with a
remote history of breast cancer and six weeks of midthoracic
back pain radiating to bilateral flanks, worse with movement.

MEDICAL HISTORY: Hypertension.  Hypercholesterolemia.
Anxiety and depression.  History of breast cancer in [**2112**],
status post lumpectomy and radiation therapy.

MEDICATION ON ADMISSION: Lescol 40 mg, Xanax, Prozac 20 mg
q.d., Aspirin 81 q.d., Percocet p.r.n., Evista 60 mg q.d.

ALLERGIES: PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Pathologic fracture of vertebrae,Hemorrhage of gastrointestinal tract, unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Cardiac arrest,Malignant neoplasm of liver, secondary,Other pulmonary embolism and infarction'}
