CHIEF COMPLAINT: Confusion

PRESENT ILLNESS: 55 yo female s/p right mastectomy/xrt/chemo with diffusely
metastatic CA presented w/ MS changes and dehydration. Patient
became obtunded/agitated in ED, was noted to have a large JVD
and right arm edema.  She was given Ativan for agitation.
CT scan of chest showed a large mediastinal mass that was
impinging on her SVC.
History limited to ED notes as patient did not have a family
member with her upon arrival to ICU.

MEDICAL HISTORY: 1. Metastatic breast cancer:
- noted RUE swelling in [**9-28**]
- breast biopsy and the pathology showed infiltrating poorly
differentiated carcinoma with invasion into skeletal muscles.
- She was treated with 4 cycles of dose dense Adriamycin and
cyclophosphamide, followed by Taxol and Taxotere.
-She underwent a right mastectomy with left breast reduction by
Dr. [**Last Name (STitle) 56753**] at [**Hospital6 1708**]. She was ER and PR
negative and her Her2neu was negative as well.
-history of carcinomatous meningitis
-has undergone whole brain irradiation
-[**2190-7-14**] Omaya resevoir placed

MEDICATION ON ADMISSION: neurontin 300 TID
oxycodone 5mg prn (usually needs two a day)
Decadron 4 mg po bid (last dose 7/29)
Pepcid 4 mg po bid
Epo
Iron
Famotidine
Levofloxacin

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: Vit:  97.7  111/57   104   26   98% RA
Gen: middle aged woman, resting in bed, crying intermittently
HEENT: PERRLA, EOMI
CV: RRR, no MGR
Pulm: rhonchi bilaterally anteriorly
Abd: +BS, soft, NT, ND
Ext: R UE erythematous and warm with pitting edema, no edema of
other extremities.
Skin: scar on right breast, multiple metastatic nodules on right
breast
Neuro: does not follow commands

FAMILY HISTORY: Mother was deceased at age 74 and she had diabetes and breast
cancer (she had a mastectomy). Her father is alive at age 89 and
he has peripheral vascular disease. She has one sister at age 57
and she has diabetes.

SOCIAL HISTORY: She is married. She admits to use of tobacco and quit at the age
of 33. She drinks one alcoholic drink per month. She does not
use any illicit drugs.
Secondary malignant neoplasm of other parts of nervous system,Secondary malignant neoplasm of mediastinum,Unspecified pleural effusion,Compression of vein,Personal history of malignant neoplasm of breast
Sec malig neo nerve NEC,Sec mal neo mediastinum,Pleural effusion NOS,Compression of vein,Hx of breast malignancy
Admission Date:  [**2190-7-31**]              Discharge Date:   [**2190-8-5**]

Date of Birth:  [**2135-7-24**]             Sex:   F

Service: MEDICINE

Allergies:
Iodine; Iodine Containing

Attending:[**First Name3 (LF) 2024**]
Chief Complaint:
Confusion

Major Surgical or Invasive Procedure:
none

History of Present Illness:
55 yo female s/p right mastectomy/xrt/chemo with diffusely
metastatic CA presented w/ MS changes and dehydration. Patient
became obtunded/agitated in ED, was noted to have a large JVD
and right arm edema.  She was given Ativan for agitation.
CT scan of chest showed a large mediastinal mass that was
impinging on her SVC.
History limited to ED notes as patient did not have a family
member with her upon arrival to ICU.


Past Medical History:
1. Metastatic breast cancer:
- noted RUE swelling in [**9-28**]
- breast biopsy and the pathology showed infiltrating poorly
differentiated carcinoma with invasion into skeletal muscles.
- She was treated with 4 cycles of dose dense Adriamycin and
cyclophosphamide, followed by Taxol and Taxotere.
-She underwent a right mastectomy with left breast reduction by
Dr. [**Last Name (STitle) 56753**] at [**Hospital6 1708**]. She was ER and PR
negative and her Her2neu was negative as well.
-history of carcinomatous meningitis
-has undergone whole brain irradiation
-[**2190-7-14**] Omaya resevoir placed


Social History:
She is married. She admits to use of tobacco and quit at the age
of 33. She drinks one alcoholic drink per month. She does not
use any illicit drugs.


Family History:
Mother was deceased at age 74 and she had diabetes and breast
cancer (she had a mastectomy). Her father is alive at age 89 and
he has peripheral vascular disease. She has one sister at age 57
and she has diabetes.


Physical Exam:
Vit:  97.7  111/57   104   26   98% RA
Gen: middle aged woman, resting in bed, crying intermittently
HEENT: PERRLA, EOMI
CV: RRR, no MGR
Pulm: rhonchi bilaterally anteriorly
Abd: +BS, soft, NT, ND
Ext: R UE erythematous and warm with pitting edema, no edema of
other extremities.
Skin: scar on right breast, multiple metastatic nodules on right
breast
Neuro: does not follow commands


Pertinent Results:
2.4 > 10.0/30.5 < 67   MCV-88
 N:94.3 Band:0 L:3.9 M:1.1 E:0.7 Bas:0.1
Anisocy: 1+ Macrocy: 1+
.
136 / 102 / 26
------------< 112
4.6 / 21 / 0.5
.
Ca: 9.5 Mg: 2.1 P: 3.0
.
7.39/34/74 HCO3 21
Lactate:2.5
PT: 13.2  PTT: 25.4  INR: 1.2
.
CT HEAD:
IMPRESSION: Markedly limited examination. No definite evidence
of acute intracranial hemorrhage or mass effect. A questionable
density within the left frontal lobe on one image is
incompletely evaluated and may relate to artifact.
.
CHEST CT:
Compression of SVC. 30% patent
.
CXR:
IMPRESSION:
1. Moderate to large size right pleural effusion layering
posteriorly. An underlying consolidation within the right lung
cannot be excluded.
2. Right anterior mediastinal density, which may represent a
mediastinal mass, is unchanged from [**2190-6-25**]. Right anterior
mediastinal density is unchanged from the prior study and may
represent a mediastinal mass.

Brief Hospital Course:
55 yo female s/p right mastectomy/xrt/chemo with diffusely
metastatic CA (including carcinomatous meningitis by MRI)
presents w/ MS changes and dehydration. Pt's mental status and
agitation initially improved with ativan.  She was initially
started on antibiotics in view of recent chemothearapy and
declining cell counts, cultures were drawn.  In addition, pt was
found to have compression of her SVC, which she was started on
IVF for.  Initially there was discussion regarding possibly
tapping her pleural effusion as well as doing a spinal tap.
However, after discussion with family in view of her metastatic
breast cancer resistant to treatment, it was decided that
patient's care should focus on comfort and any further
diagnostic test were discontinued.  Pt was made comfortable with
use a morphine drip.  She continued to be able to interact
slightly by opening her eyes and look around.  Pt expired on
[**8-5**] at 10:50.

Medications on Admission:
neurontin 300 TID
oxycodone 5mg prn (usually needs two a day)
Decadron 4 mg po bid (last dose 7/29)
Pepcid 4 mg po bid
Epo
Iron
Famotidine
Levofloxacin

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
deceased

Discharge Condition:
deceased


Completed by:[**2190-8-5**]
{'Secondary malignant neoplasm of other parts of nervous system,Secondary malignant neoplasm of mediastinum,Unspecified pleural effusion,Compression of vein,Personal history of malignant neoplasm of breast'}


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: Confusion

PRESENT ILLNESS: 55 yo female s/p right mastectomy/xrt/chemo with diffusely
metastatic CA presented w/ MS changes and dehydration. Patient
became obtunded/agitated in ED, was noted to have a large JVD
and right arm edema.  She was given Ativan for agitation.
CT scan of chest showed a large mediastinal mass that was
impinging on her SVC.
History limited to ED notes as patient did not have a family
member with her upon arrival to ICU.

MEDICAL HISTORY: 1. Metastatic breast cancer:
- noted RUE swelling in [**9-28**]
- breast biopsy and the pathology showed infiltrating poorly
differentiated carcinoma with invasion into skeletal muscles.
- She was treated with 4 cycles of dose dense Adriamycin and
cyclophosphamide, followed by Taxol and Taxotere.
-She underwent a right mastectomy with left breast reduction by
Dr. [**Last Name (STitle) 56753**] at [**Hospital6 1708**]. She was ER and PR
negative and her Her2neu was negative as well.
-history of carcinomatous meningitis
-has undergone whole brain irradiation
-[**2190-7-14**] Omaya resevoir placed

MEDICATION ON ADMISSION: neurontin 300 TID
oxycodone 5mg prn (usually needs two a day)
Decadron 4 mg po bid (last dose 7/29)
Pepcid 4 mg po bid
Epo
Iron
Famotidine
Levofloxacin

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: Vit:  97.7  111/57   104   26   98% RA
Gen: middle aged woman, resting in bed, crying intermittently
HEENT: PERRLA, EOMI
CV: RRR, no MGR
Pulm: rhonchi bilaterally anteriorly
Abd: +BS, soft, NT, ND
Ext: R UE erythematous and warm with pitting edema, no edema of
other extremities.
Skin: scar on right breast, multiple metastatic nodules on right
breast
Neuro: does not follow commands

FAMILY HISTORY: Mother was deceased at age 74 and she had diabetes and breast
cancer (she had a mastectomy). Her father is alive at age 89 and
he has peripheral vascular disease. She has one sister at age 57
and she has diabetes.

SOCIAL HISTORY: She is married. She admits to use of tobacco and quit at the age
of 33. She drinks one alcoholic drink per month. She does not
use any illicit drugs. 

### Response:
{'Secondary malignant neoplasm of other parts of nervous system,Secondary malignant neoplasm of mediastinum,Unspecified pleural effusion,Compression of vein,Personal history of malignant neoplasm of breast'}
