history of present illness: the patient is a 73 year-old woman with a history of ataxia and dizziness associated with nausea and vomiting since . she was evaluated by the a gi physician and the examination was unremarkable. she had a head ct, which showed a cerebellar mass. the patient essentially is wheel chair bound due to the ataxia and also complained of back pain. she has had weight loss from frequent vomiting, 20 pounds. past medical history: 1. asthma. 2. hypertension. 3. gastritis. 4. hiatal hernia. 5. mitral regurgitation ef of 60%. 6. normal mammogram in and normal pap smear in . past surgical history: 1. appendectomy. 2. tubal ligation. allergies: sulfa. medications: 1. decadron 4 mg q 6 hours. 2. verapamil 240 mg q day. 3. prevacid 30 mg q.d. 4. tylenol #3 for pain. 5. phenergan prn for severe nausea. physical examination: the patient's temperature is 98.7. blood pressure 162/80. heart rate 73. respiratory rate 20. sats 95% on room air. the patient is awake, alert and oriented times three and in no acute distress. mucous membranes are moist. no lesions. tongue midline. neck supple. lungs cleared bilaterally. cardiac regular rate and rhythm. 2/6 systolic murmur. gastrointestinal abdomen soft, nontender, positive bowel sounds. no hepatosplenomegaly. back nontender. no costovertebral angle tenderness. extremities no edema. 2+ pedal pulses. neurologically awake, alert and oriented times three. pupils are equal, round and reactive to light. extraocular movements intact. negative drift. smile symmetric. cranial nerves ii through xii intact. finger to nose intact. no dysmetria. motor strength is 5 out of 5 in all muscle groups. normal sensation to light touch. mri shows 3 by 3 cm cerebellar mass with some mass effect. the patient is admitted to the neurosurgery service and started on decadron 4 mg intravenous q 6 hours. the patient had a chest, abdomen and pelvis ct, which showed a lung mass. the patient was taken to the operating room on for debulking of this tumor. postoperatively, she was monitored in the intensive care unit. her vital signs were stable. she was afebrile. she was awake, alert and oriented. pupils are equal, round and reactive to light. extraocular movements intact. her incision was clean, dry and intact. her lungs were clear. chest ct did show a 3 by 3.7 cm right lower lobe mass. the patient was seen by the cardiothoracic service for possible treatment and biopsy of that lung mass. she remained in the intensive care unit with some episodes of confusion, transferred to the regular floor on with a sitter due to confusion. she was awake, alert and oriented times three, although had episodes of confusion. her vital signs remained stable. she was afebrile. she was seen by dr. from the neuro/oncology service. postoperatively, she did have bilateral ophthalmoplegia secondary to third nerve problems due to tumor resection. dr. recommended an lp to rule out leptomeningeal metastasis due to her mental status confusion and agitation. she also had an ldh and a cea level sent. her pathology came back small cell ca of the lung with mets to the brain. she was seen by physical therapy and occupational therapy and found to require rehab. her vital signs remained stable. she was afebrile. medications on discharge: 1. labetalol 300 mg po b.i.d. hold for systolic less then 110. 2. decadron current getting 4 mg po q 12 hours. 3. captopril 12.5 mg po t.i.d. 4. insulin sliding scale. 5. famotidine 20 mg po b.i.d. 6. verapamil 240 mg po q 24 hours. 7. dilantin 100 mg po t.i.d. 8. colace 100 mg po b.i.d. 9. percocet one to two tabs po q 4 hours prn for pain. 10. dulcolax suppository one pr q.h.s. prn. condition on discharge: stable. she will follow up in the brain clinic in two weeks and follow up in the thoracic oncology clinic in two weeks after discharge. , m.d. dictated by: medquist36 Procedure: Spinal tap Incision of lung Other operations on extraocular muscles and tendons Other excision or destruction of lesion or tissue of brain Diagnoses: Mitral valve disorders Unspecified essential hypertension Asthma, unspecified type, unspecified Secondary malignant neoplasm of brain and spinal cord Malignant neoplasm of lower lobe, bronchus or lung