CHIEF COMPLAINT: Headache

PRESENT ILLNESS: Ms. [**Known lastname **] is a 58yo woman w/ non-functioning pituitary adenoma
s/p transsphenoidal surgery in [**2168**], recent Cyber Knife
treatment last week, fibromyalgia, anxiety who p/w severe
headache. She had been doing well after her Cyber Knife
treatment, which was completed one week ago. Since then, she has
had mild fatigue and nausea, but was otherwise doing well. She
spent most of the week at home. Yesterday, she drove herself to
her relative's home for [**Holiday 1451**]. While there, she developed
a severe sharp frontal headache between her eyes as well as eye
pain/soreness. She has a history of migraines in the past, which
she believes were less severe and different in quality than this
headache. She reports that the pain made her nausea, and she
began profusely vomiting non-bloody, non-bilious emesis. She
tried drinking chamomile tea, which did not help. She endorses
recent sinus congestion and watery nasal drainage over the past
2 weeks. Denies fevers, blurred vision, diplopia, or sick
contacts. [**Name (NI) **] some posterior neck pain/stiffness. Denies weight
loss, night sweats. Her family noticed that she was ill, so they
brought her to the ED.
.
Vitals in ED: 97.8 59 141/81 18 100% RA. Given Zofran x2, IV
Morphine 4mg x1, IV Bendaryl 50mg x1, IV Dilaudid 1mg x1, Reglan
10mg x1, Ativan 2mg x1.
.
REVIEW OF SYSTEMS:
CONSTITUTIONAL:    [ ] All Normal
[ ] Fever  [x] Chills   [ ] Sweats  [x] Fatigue   [ ] Malaise
[ ] Anorexia  [ ]Night sweats  [ ] Weight loss/gain
HEENT:          [ ] All Normal
[ ] Blurred vision   [ ] Blindness  [ ] Photophobia
[ ] Decreased acuity [ ] Dry mouth  [ ] Bleeding gums
[ ] Oral ulcers  [ ] Sore throat    [ ] Epistaxis  [ ] Tinnitus
[ ] Decreased hearing    [ ]Tinnitus [ ] Other: [x] eye pain
RESPIRATORY:    [x] All Normal
[ ] SOB     [ ] DOE    [ ] Can't walk 2 flights     [ ] Cough
[ ] Wheeze  [ ] Purulent sputum    [ ] Hemoptysis   [ ]Pleuritic
pain
[ ] Other:
CARDIAC:        [x]  All Normal
[ ] Angina    [ ] Palpitations   [ ] Edema   [ ] PND
[ ] Orthopnea    [ ] Chest Pain [ ] Other:
GI:             [] All Normal
[ ] Blood in stool     [ ] Hematemesis     [ ] Odynophagia
[ ] Dysphagia:   [ ] Solids    [ ] Liquids
[ ] Anorexia    [x] Nausea  [x] Vomiting   [ ] Reflux
[ ] Diarrhea    [ ] Constipation  []  Abd pain  [ ] Other:
GU:             [x] All Normal
[ ] Dysuria      [ ] Frequency    [ ] Hematuria  []Discharge
[]Menorrhagia
SKIN:           [x] All Normal
[ ] Rash        [ ] Pruritus
MS:             [x] All Normal
[ ] Joint pain    [ ] Jt swelling   [ ] Back pain  [ ] Bony pain
NEURO:          [] All Normal
[x] Headache    [ ] Visual changes   [ ] Sensory change [ ]
Confusion [ ]Numbness of extremities [ ] Seizures   [ ] Weakness
[ ] Dizziness/Lightheaded [ ]Vertigo
ENDOCRINE:     [x] All Normal
[ ] Skin changes  [ ] Hair changes   [ ] Temp subjectivity
HEME/LYMPH:    [] All Normal
[x] Easy bruising   [x] Easy bleeding    [ ] Adenopathy
PSYCH:         [x] All Normal
[ ] Mood change        []Suicidal Ideation  [ ] Other:

MEDICAL HISTORY: - Non-secretory 1.3 cm pituitary adenoma s/p transsphenoidal
surgery in [**2168**] with minimal but slowly growing residual tumor
- Central adrenal insufficiency
- Hashimoto's disease/hypothyroidism/thyroid nodules.
- Osteopenia s/p traumatic compression fractures in [**2178**].
- anxiety/panic attacks
- atypical depression
- migraine headaches
- [**Female First Name (un) **] esophagitis
- hiatatal hernia/GERD
- IBS
- Chronic abdominal pain
- rectal prolapse s/p rectopexy in [**2172**]
- Transaminitis in the past s/p biopsy in [**2176**] complicated by
hematobilia and then by post ERCP pancreatitis
- kidney stones
- osteoporosis
- chronic interstitial cystitis s/p several bladder surgeries
- Fibromyalgia/chronic pain
- fibroids
- D&C for menorrhagia in [**2174**]
- cholecystectomy in [**2144**]
- appendectomy in [**2139**]
- major MVA in [**2177**]
- left distal radius and ulnar fractures s/p ORIF in [**7-24**]
- left 4th-7th/right 6th rib fractures.

MEDICATION ON ADMISSION: Clonazepam 1mg [**Hospital1 **]
Flonase 50mcg [**1-17**] sprays daily
Levothyroxine 50mcg M/Tu/Wed/Th, 100mcg F/Sa/[**Doctor First Name **]
Oxybutynin 10mg daily (listed as [**Hospital1 **] in OMR, but pt taking qday)
Protonix 40mg daily
Pentosan 100mg [**Hospital1 **]
Prednisone 5mg QAM + 8mg QPM
Lyrica 200mg TID
Promethazine 25mg QID PRN
Tramadol 50-100 QID PRN
Trazodone 200mg QHS

ALLERGIES: Codeine / Zolmitriptan / Celebrex / Zanaflex / Morphine /
amoxicillin-pot clavulanate

PHYSICAL EXAM: Vitals: 97.3 127/64 76 16 97% RA
Gen: A&Ox3, in acute pain distress from headache
HEENT: PERRL, EOMI, CN 2-12 intact, OP clear, MMM, no cranial
tenderness
Neck: supple, full active ROM (although limited by neck pain),
posterior cervical point tenderness to palpation
CV: RRR, S1/S2 nl, no MRG
Lungs: CTAB, no w/r/r
Abd: soft, NT, ND, NABS, no HSM
Ext: no c/c/e, +2 pulses, WWP
Neuro: non-focal
Skin: intact
Psych: appropriate, cooperative

FAMILY HISTORY: Parents are healthy. No family history of early MI,
cardiomyopathies, or sudden cardiac death.
.
Paternal grandmother: stomach CA
Paternal aunt: breast CA
Maternal aunt: breast CA
Maternal uncle: stomach CA
Son: hypothyroidism

SOCIAL HISTORY: Separated from husband, lives alone, has 2 sons, owned [**Name2 (NI) 12566**] in
past, now on disability, denies tobacco/EtOH/illicits
Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Acute kidney failure, unspecified,Other adrenal hypofunction,Benign neoplasm of pituitary gland and craniopharyngeal duct,Volume depletion, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Anxiety state, unspecified,Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Chronic interstitial cystitis,Esophageal reflux,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypoxemia,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use
Migrne unsp wo ntrc mgrn,Acute kidney failure NOS,Adrenal hypofunction NEC,Benign neo pituitary,Volume depletion NOS,Elev transaminase/ldh,Anxiety state NOS,Myalgia and myositis NOS,Hypothyroidism NOS,Chr interstit cystitis,Esophageal reflux,Abn react-radiotherapy,Hypoxemia,Adv eff sedat/hypnot NOS
Admission Date:  [**2179-12-10**]              Discharge Date:   [**2179-12-12**]

Date of Birth:  [**2121-1-6**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine / Zolmitriptan / Celebrex / Zanaflex / Morphine /
amoxicillin-pot clavulanate

Attending:[**First Name3 (LF) 9160**]
Chief Complaint:
Headache

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Ms. [**Known lastname **] is a 58yo woman w/ non-functioning pituitary adenoma
s/p transsphenoidal surgery in [**2168**], recent Cyber Knife
treatment last week, fibromyalgia, anxiety who p/w severe
headache. She had been doing well after her Cyber Knife
treatment, which was completed one week ago. Since then, she has
had mild fatigue and nausea, but was otherwise doing well. She
spent most of the week at home. Yesterday, she drove herself to
her relative's home for [**Holiday 1451**]. While there, she developed
a severe sharp frontal headache between her eyes as well as eye
pain/soreness. She has a history of migraines in the past, which
she believes were less severe and different in quality than this
headache. She reports that the pain made her nausea, and she
began profusely vomiting non-bloody, non-bilious emesis. She
tried drinking chamomile tea, which did not help. She endorses
recent sinus congestion and watery nasal drainage over the past
2 weeks. Denies fevers, blurred vision, diplopia, or sick
contacts. [**Name (NI) **] some posterior neck pain/stiffness. Denies weight
loss, night sweats. Her family noticed that she was ill, so they
brought her to the ED.
.
Vitals in ED: 97.8 59 141/81 18 100% RA. Given Zofran x2, IV
Morphine 4mg x1, IV Bendaryl 50mg x1, IV Dilaudid 1mg x1, Reglan
10mg x1, Ativan 2mg x1.
.
REVIEW OF SYSTEMS:
CONSTITUTIONAL:    [ ] All Normal
[ ] Fever  [x] Chills   [ ] Sweats  [x] Fatigue   [ ] Malaise
[ ] Anorexia  [ ]Night sweats  [ ] Weight loss/gain
HEENT:          [ ] All Normal
[ ] Blurred vision   [ ] Blindness  [ ] Photophobia
[ ] Decreased acuity [ ] Dry mouth  [ ] Bleeding gums
[ ] Oral ulcers  [ ] Sore throat    [ ] Epistaxis  [ ] Tinnitus
[ ] Decreased hearing    [ ]Tinnitus [ ] Other: [x] eye pain
RESPIRATORY:    [x] All Normal
[ ] SOB     [ ] DOE    [ ] Can't walk 2 flights     [ ] Cough
[ ] Wheeze  [ ] Purulent sputum    [ ] Hemoptysis   [ ]Pleuritic
pain
[ ] Other:
CARDIAC:        [x]  All Normal
[ ] Angina    [ ] Palpitations   [ ] Edema   [ ] PND
[ ] Orthopnea    [ ] Chest Pain [ ] Other:
GI:             [] All Normal
[ ] Blood in stool     [ ] Hematemesis     [ ] Odynophagia
[ ] Dysphagia:   [ ] Solids    [ ] Liquids
[ ] Anorexia    [x] Nausea  [x] Vomiting   [ ] Reflux
[ ] Diarrhea    [ ] Constipation  []  Abd pain  [ ] Other:
GU:             [x] All Normal
[ ] Dysuria      [ ] Frequency    [ ] Hematuria  []Discharge
[]Menorrhagia
SKIN:           [x] All Normal
[ ] Rash        [ ] Pruritus
MS:             [x] All Normal
[ ] Joint pain    [ ] Jt swelling   [ ] Back pain  [ ] Bony pain
NEURO:          [] All Normal
[x] Headache    [ ] Visual changes   [ ] Sensory change [ ]
Confusion [ ]Numbness of extremities [ ] Seizures   [ ] Weakness
[ ] Dizziness/Lightheaded [ ]Vertigo
ENDOCRINE:     [x] All Normal
[ ] Skin changes  [ ] Hair changes   [ ] Temp subjectivity
HEME/LYMPH:    [] All Normal
[x] Easy bruising   [x] Easy bleeding    [ ] Adenopathy
PSYCH:         [x] All Normal
[ ] Mood change        []Suicidal Ideation  [ ] Other:

[x]all other systems negative except as noted above

Past Medical History:
- Non-secretory 1.3 cm pituitary adenoma s/p transsphenoidal
surgery in [**2168**] with minimal but slowly growing residual tumor
- Central adrenal insufficiency
- Hashimoto's disease/hypothyroidism/thyroid nodules.
- Osteopenia s/p traumatic compression fractures in [**2178**].
- anxiety/panic attacks
- atypical depression
- migraine headaches
- [**Female First Name (un) **] esophagitis
- hiatatal hernia/GERD
- IBS
- Chronic abdominal pain
- rectal prolapse s/p rectopexy in [**2172**]
- Transaminitis in the past s/p biopsy in [**2176**] complicated by
hematobilia and then by post ERCP pancreatitis
- kidney stones
- osteoporosis
- chronic interstitial cystitis s/p several bladder surgeries
- Fibromyalgia/chronic pain
- fibroids
- D&C for menorrhagia in [**2174**]
- cholecystectomy in [**2144**]
- appendectomy in [**2139**]
- major MVA in [**2177**]
- left distal radius and ulnar fractures s/p ORIF in [**7-24**]
- left 4th-7th/right 6th rib fractures.

Social History:
Separated from husband, lives alone, has 2 sons, owned [**Name2 (NI) 12566**] in
past, now on disability, denies tobacco/EtOH/illicits

Family History:
Parents are healthy. No family history of early MI,
cardiomyopathies, or sudden cardiac death.
.
Paternal grandmother: stomach CA
Paternal aunt: breast CA
Maternal aunt: breast CA
Maternal uncle: stomach CA
Son: hypothyroidism

Physical Exam:
Vitals: 97.3 127/64 76 16 97% RA
Gen: A&Ox3, in acute pain distress from headache
HEENT: PERRL, EOMI, CN 2-12 intact, OP clear, MMM, no cranial
tenderness
Neck: supple, full active ROM (although limited by neck pain),
posterior cervical point tenderness to palpation
CV: RRR, S1/S2 nl, no MRG
Lungs: CTAB, no w/r/r
Abd: soft, NT, ND, NABS, no HSM
Ext: no c/c/e, +2 pulses, WWP
Neuro: non-focal
Skin: intact
Psych: appropriate, cooperative

Pertinent Results:
[**2179-12-10**] 12:35AM   GLUCOSE-98 UREA N-17 CREAT-1.2* SODIUM-142
POTASSIUM-4.5 CHLORIDE-101 TOTAL CO2-31 ANION GAP-15
[**2179-12-10**] 12:35AM   WBC-7.8 RBC-4.55 HGB-12.6 HCT-38.6 MCV-85
MCH-27.6 MCHC-32.5 RDW-14.7
[**2179-12-10**] 12:35AM   NEUTS-43.5* LYMPHS-48.2* MONOS-6.4 EOS-1.3
BASOS-0.6
[**2179-12-10**] 12:35AM   PLT COUNT-248#
[**2179-12-10**] 12:35AM   PT-12.5 PTT-25.5 INR(PT)-1.1
[**2179-12-10**] 12:35AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.008
[**2179-12-10**] 12:35AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0
LEUK-NEG
.
CT head non-contrast ([**2179-12-10**]): There is no evidence of
infarction, edema, hemorrhage, mass effect or shift of normally
midline structures. The ventricles and sulci are normal in size
and configuration. [**Doctor Last Name **]-white matter differentiation is
preserved. Again noted is a known pituitary lesion within the
left lateral aspect of the sella which appears isodense to the
brain. There appears to be extension of this lesion into the
left cavernous sinus.
.
MRI brain w/w/o contrast ([**2179-11-20**]): Again demonstrated is the
rounded lesion within the left lateral aspect of the sella,
isointense to [**Doctor Last Name 352**] matter on T1- and T2-weighted imaging. It
measures 1.3 (CC) x 1.7 (AP) x 1.7 cm (TRV) which, allowing for
technical differences, is overall unchanged. Again noted is
expansion of the sella floor with inferior extension into the
sphenoid sinus. There is slight effacement of the ipsilateral
aspect of the suprasellar cistern. As previously described, the
lesion demonstrates significant encasement of the cavernous
carotid artery without obstruction of flow. There has been
rightward displacement of the infundibular stalk, with no
involvement upon the optic pathway. There are no findings to
suggest acute hemorrhage. There is no evidence for intra- or
extra-axial hemorrhage, edema, additional mass or shift of the
normally midline structures. No other abnormal foci of
enhancement or FLAIR-signal are seen. Again incidentally noted
is a small developmental venous anomaly within the left basal
ganglia. IMPRESSION: No overall change in the known macroadenoma
occupying the left lateral aspect of the sella.

Brief Hospital Course:
## Headache: Ms. [**Known lastname **] was admitted for pain control for her
severe frontal headache. This was thought to be a side effect of
her recent Cyber Knife treatment for her pituitary adenoma. She
had a non-contrast head CT and MRI w/w/o contrast during this
admission that failed to show growth of the meningioma,
hemorrhage, infarction, cerebral edema, or sinusitis. She had
mild neck stiffness but no fever, so lumbar puncture was not
done. She was not on antibiotics at any point of this admission.
Her pain was initially treated with Dilaudid and Toradol. She
seemed to have a more pronounced response to Toradol, however
this was initially insufficient. In the setting of receiving 5mg
of IV Dilaudid on the floor over the course of 10 hours, she was
found to be hypoventilating, although still alert and responsive
to commands. She was transferred to the ICU for monitoring
overnight. By the next day, she was doing well on Toradol
monotherapy for her pain and was off narcotics. The day of
discharge she complained of "no pain" and was sent home with PRN
Ibuprofen.
.
## Acute kidney injury: Cr elevated to 1.2 on admission, which
was above her baseline and likely due to volume depletion from
vomiting in setting of her headaches. Cr improved with 3L IV
fluids that she received in the ED.
.
## Transaminitis: She was incidentally found to have
transaminitis during this admission. The etiology was not
identified, but the liver enzymes trended down on their own
prior to discharge. No imaging of the liver was performed.
Hepatitis serologies are pending at the time of discharge.
.
Chronic stable issues:
## Anxiety: Continued home Clonazepam.
## Fibromyalgia: Continued home Lyrica.
## Hypothyroidism: Continued home Levothyroxine.
## Chronic interstitial cystitis: Continued home Pentosan 100mg
[**Hospital1 **].
## Adrenal insufficiency: Continued home Prednisone 5mg QAM +
8mg QPM.
## GERD: Continued home Protonix.
## Code status: FULL CODE, which was confirmed during this
admission.
.
Transitional issues:
- Need to clarify with Radiation Oncology regarding when to
repeat MRI since she ended up having one in-house and had
follow-up MRI scheduled for [**2180-1-3**].
- Hepatitis serologies need to be followed up.

Medications on Admission:
Clonazepam 1mg [**Hospital1 **]
Flonase 50mcg [**1-17**] sprays daily
Levothyroxine 50mcg M/Tu/Wed/Th, 100mcg F/Sa/[**Doctor First Name **]
Oxybutynin 10mg daily (listed as [**Hospital1 **] in OMR, but pt taking qday)
Protonix 40mg daily
Pentosan 100mg [**Hospital1 **]
Prednisone 5mg QAM + 8mg QPM
Lyrica 200mg TID
Promethazine 25mg QID PRN
Tramadol 50-100 QID PRN
Trazodone 200mg QHS

Discharge Medications:
1. clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. pentosan polysulfate sodium 100 mg Capsule Sig: One (1)
Capsule PO BID (2 times a day).
3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
4. oxybutynin chloride 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Flonase 50 mcg/Actuation Spray, Suspension Sig: [**1-17**] sprays
Nasal once a day.
6. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO
QFRI-SAT-SUN ().
7. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO
QMON-TUES-WED-THURS ().
8. pregabalin 25 mg Capsule Sig: Eight (8) Capsule PO TID (3
times a day).
9. trazodone 100 mg Tablet Sig: Two (2) Tablet PO at bedtime as
needed for insomnia.
10. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO three times a
day as needed for headache.
Disp:*30 Tablet(s)* Refills:*0*
11. prednisone 5 mg Tablet Sig: One (1) Tablet PO once a day.
12. prednisone 1 mg Tablet Sig: Eight (8) Tablet PO at bedtime.



Discharge Disposition:
Home

Discharge Diagnosis:
Headache
Acute renal failure
Transaminitis
Pituitary adenoma


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted for treatment of severe headache, which was
thought to be a side effect of your CyberKnife treatment. CAT
scan and MRI did not show any change in the size of your adenoma
or any swelling or inflammation of your brain tissues. You can
take Ibuprofen as needed for pain. No changes were made to your
home medications.

Followup Instructions:
Please call your primary doctor to make a follow-up appointment
within 1 week. Also call Dr. [**Last Name (STitle) 3929**] tomorrow to ask when you
should have your next MRI.

Department: NEUROLOGY
When: MONDAY [**2180-1-3**] at 2:00 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 12567**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 1844**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 9162**]

Completed by:[**2179-12-13**]
{'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Acute kidney failure, unspecified,Other adrenal hypofunction,Benign neoplasm of pituitary gland and craniopharyngeal duct,Volume depletion, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Anxiety state, unspecified,Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Chronic interstitial cystitis,Esophageal reflux,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypoxemia,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use'}


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

PRESENT ILLNESS: Ms. [**Known lastname **] is a 58yo woman w/ non-functioning pituitary adenoma
s/p transsphenoidal surgery in [**2168**], recent Cyber Knife
treatment last week, fibromyalgia, anxiety who p/w severe
headache. She had been doing well after her Cyber Knife
treatment, which was completed one week ago. Since then, she has
had mild fatigue and nausea, but was otherwise doing well. She
spent most of the week at home. Yesterday, she drove herself to
her relative's home for [**Holiday 1451**]. While there, she developed
a severe sharp frontal headache between her eyes as well as eye
pain/soreness. She has a history of migraines in the past, which
she believes were less severe and different in quality than this
headache. She reports that the pain made her nausea, and she
began profusely vomiting non-bloody, non-bilious emesis. She
tried drinking chamomile tea, which did not help. She endorses
recent sinus congestion and watery nasal drainage over the past
2 weeks. Denies fevers, blurred vision, diplopia, or sick
contacts. [**Name (NI) **] some posterior neck pain/stiffness. Denies weight
loss, night sweats. Her family noticed that she was ill, so they
brought her to the ED.
.
Vitals in ED: 97.8 59 141/81 18 100% RA. Given Zofran x2, IV
Morphine 4mg x1, IV Bendaryl 50mg x1, IV Dilaudid 1mg x1, Reglan
10mg x1, Ativan 2mg x1.
.
REVIEW OF SYSTEMS:
CONSTITUTIONAL:    [ ] All Normal
[ ] Fever  [x] Chills   [ ] Sweats  [x] Fatigue   [ ] Malaise
[ ] Anorexia  [ ]Night sweats  [ ] Weight loss/gain
HEENT:          [ ] All Normal
[ ] Blurred vision   [ ] Blindness  [ ] Photophobia
[ ] Decreased acuity [ ] Dry mouth  [ ] Bleeding gums
[ ] Oral ulcers  [ ] Sore throat    [ ] Epistaxis  [ ] Tinnitus
[ ] Decreased hearing    [ ]Tinnitus [ ] Other: [x] eye pain
RESPIRATORY:    [x] All Normal
[ ] SOB     [ ] DOE    [ ] Can't walk 2 flights     [ ] Cough
[ ] Wheeze  [ ] Purulent sputum    [ ] Hemoptysis   [ ]Pleuritic
pain
[ ] Other:
CARDIAC:        [x]  All Normal
[ ] Angina    [ ] Palpitations   [ ] Edema   [ ] PND
[ ] Orthopnea    [ ] Chest Pain [ ] Other:
GI:             [] All Normal
[ ] Blood in stool     [ ] Hematemesis     [ ] Odynophagia
[ ] Dysphagia:   [ ] Solids    [ ] Liquids
[ ] Anorexia    [x] Nausea  [x] Vomiting   [ ] Reflux
[ ] Diarrhea    [ ] Constipation  []  Abd pain  [ ] Other:
GU:             [x] All Normal
[ ] Dysuria      [ ] Frequency    [ ] Hematuria  []Discharge
[]Menorrhagia
SKIN:           [x] All Normal
[ ] Rash        [ ] Pruritus
MS:             [x] All Normal
[ ] Joint pain    [ ] Jt swelling   [ ] Back pain  [ ] Bony pain
NEURO:          [] All Normal
[x] Headache    [ ] Visual changes   [ ] Sensory change [ ]
Confusion [ ]Numbness of extremities [ ] Seizures   [ ] Weakness
[ ] Dizziness/Lightheaded [ ]Vertigo
ENDOCRINE:     [x] All Normal
[ ] Skin changes  [ ] Hair changes   [ ] Temp subjectivity
HEME/LYMPH:    [] All Normal
[x] Easy bruising   [x] Easy bleeding    [ ] Adenopathy
PSYCH:         [x] All Normal
[ ] Mood change        []Suicidal Ideation  [ ] Other:

MEDICAL HISTORY: - Non-secretory 1.3 cm pituitary adenoma s/p transsphenoidal
surgery in [**2168**] with minimal but slowly growing residual tumor
- Central adrenal insufficiency
- Hashimoto's disease/hypothyroidism/thyroid nodules.
- Osteopenia s/p traumatic compression fractures in [**2178**].
- anxiety/panic attacks
- atypical depression
- migraine headaches
- [**Female First Name (un) **] esophagitis
- hiatatal hernia/GERD
- IBS
- Chronic abdominal pain
- rectal prolapse s/p rectopexy in [**2172**]
- Transaminitis in the past s/p biopsy in [**2176**] complicated by
hematobilia and then by post ERCP pancreatitis
- kidney stones
- osteoporosis
- chronic interstitial cystitis s/p several bladder surgeries
- Fibromyalgia/chronic pain
- fibroids
- D&C for menorrhagia in [**2174**]
- cholecystectomy in [**2144**]
- appendectomy in [**2139**]
- major MVA in [**2177**]
- left distal radius and ulnar fractures s/p ORIF in [**7-24**]
- left 4th-7th/right 6th rib fractures.

MEDICATION ON ADMISSION: Clonazepam 1mg [**Hospital1 **]
Flonase 50mcg [**1-17**] sprays daily
Levothyroxine 50mcg M/Tu/Wed/Th, 100mcg F/Sa/[**Doctor First Name **]
Oxybutynin 10mg daily (listed as [**Hospital1 **] in OMR, but pt taking qday)
Protonix 40mg daily
Pentosan 100mg [**Hospital1 **]
Prednisone 5mg QAM + 8mg QPM
Lyrica 200mg TID
Promethazine 25mg QID PRN
Tramadol 50-100 QID PRN
Trazodone 200mg QHS

ALLERGIES: Codeine / Zolmitriptan / Celebrex / Zanaflex / Morphine /
amoxicillin-pot clavulanate

PHYSICAL EXAM: Vitals: 97.3 127/64 76 16 97% RA
Gen: A&Ox3, in acute pain distress from headache
HEENT: PERRL, EOMI, CN 2-12 intact, OP clear, MMM, no cranial
tenderness
Neck: supple, full active ROM (although limited by neck pain),
posterior cervical point tenderness to palpation
CV: RRR, S1/S2 nl, no MRG
Lungs: CTAB, no w/r/r
Abd: soft, NT, ND, NABS, no HSM
Ext: no c/c/e, +2 pulses, WWP
Neuro: non-focal
Skin: intact
Psych: appropriate, cooperative

FAMILY HISTORY: Parents are healthy. No family history of early MI,
cardiomyopathies, or sudden cardiac death.
.
Paternal grandmother: stomach CA
Paternal aunt: breast CA
Maternal aunt: breast CA
Maternal uncle: stomach CA
Son: hypothyroidism

SOCIAL HISTORY: Separated from husband, lives alone, has 2 sons, owned [**Name2 (NI) 12566**] in
past, now on disability, denies tobacco/EtOH/illicits 

### Response:
{'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Acute kidney failure, unspecified,Other adrenal hypofunction,Benign neoplasm of pituitary gland and craniopharyngeal duct,Volume depletion, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Anxiety state, unspecified,Myalgia and myositis, unspecified,Unspecified acquired hypothyroidism,Chronic interstitial cystitis,Esophageal reflux,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypoxemia,Unspecified sedatives and hypnotics causing adverse effects in therapeutic use'}
