CHIEF COMPLAINT: weakness

PRESENT ILLNESS: 77yo woman with history of CAD without MI, not on medications,
no stent who presents with a chief complaint of generalized
weakness. Patient reports an ongoing URI for the past two weeks
with specific complaints of cough intermittently productive of
yellow sputum, congestion and laryngitis. She identifies both
her daughter and grandson and [**Name2 (NI) **] contacts as they have been
experiencing the same symptoms and the daughter notes being
diagnosed with "pneumonia". These symptoms were gradually
resolving, but on Friday, [**3-11**], patient noted fevers to 101
without chills or sweats as well as persistent left shoulder
pain. She denies any injury to her shoulder, though she does
admit to heavy lifting as she was cleaning her attick. Her
shoulder pain continued until Saturday and led her to take
Tylenol every 6 hours with moderate relief. On [**Month/Year (2) 1017**], the day
of admission, patient reports waking up and feeling profoundly
lethargic, unable to walk down the stairs of her home to prepare
coffee. She also reports feeling presyncopal without actual
syncope. Patient denies chest pain, SOB, palpitations, abdominal
pain, diarrhea, melena, hematochezia, hematemesis, rashes, but
does recall noticing that her skin and eyes looked "beige" since
Friday. She also recalls hematuria and urinary frequency without
dysuria.

MEDICAL HISTORY: CAD (cath done at OSH because of EKG changes revealed "mild CAD"
which was not intervened upon)

MEDICATION ON ADMISSION: none

ALLERGIES: Aspirin / Atorvastatin

PHYSICAL EXAM: Vitals: T - 97.1, BP - 143/63, HR - 81, RR - 18, O2 - 99% 2 L NC

FAMILY HISTORY: NC

SOCIAL HISTORY: Patient has a former history of tobacco use, up to 1 ppd, but
stopped in [**2173-6-23**]. She very infrequently consumes
alcohol and denies illicit drug use. She used to do office work
for her father's business in her 30s, but has since worked as a
homemaker. She has one daugher and one grandson. She lives alone
and performs all of her ADLs.
Autoimmune hemolytic anemias,Pneumonia, organism unspecified,Dissection of aorta, abdominal,Coronary atherosclerosis of native coronary artery,Other diseases of lung, not elsewhere classified
Autoimmun hemolytic anem,Pneumonia, organism NOS,Dsct of abdominal aorta,Crnry athrscl natve vssl,Other lung disease NEC
Admission Date:  [**2174-3-14**]              Discharge Date:   [**2174-3-18**]

Date of Birth:  [**2096-8-9**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin / Atorvastatin

Attending:[**First Name3 (LF) 545**]
Chief Complaint:
weakness

Major Surgical or Invasive Procedure:
none


History of Present Illness:
77yo woman with history of CAD without MI, not on medications,
no stent who presents with a chief complaint of generalized
weakness. Patient reports an ongoing URI for the past two weeks
with specific complaints of cough intermittently productive of
yellow sputum, congestion and laryngitis. She identifies both
her daughter and grandson and [**Name2 (NI) **] contacts as they have been
experiencing the same symptoms and the daughter notes being
diagnosed with "pneumonia". These symptoms were gradually
resolving, but on Friday, [**3-11**], patient noted fevers to 101
without chills or sweats as well as persistent left shoulder
pain. She denies any injury to her shoulder, though she does
admit to heavy lifting as she was cleaning her attick. Her
shoulder pain continued until Saturday and led her to take
Tylenol every 6 hours with moderate relief. On [**Month/Year (2) 1017**], the day
of admission, patient reports waking up and feeling profoundly
lethargic, unable to walk down the stairs of her home to prepare
coffee. She also reports feeling presyncopal without actual
syncope. Patient denies chest pain, SOB, palpitations, abdominal
pain, diarrhea, melena, hematochezia, hematemesis, rashes, but
does recall noticing that her skin and eyes looked "beige" since
Friday. She also recalls hematuria and urinary frequency without
dysuria.

Given the ongoing symptoms, namely fatigue, patient presented to
[**Hospital **] Hospital where labs revealed a Hct of 14 and a smear
showed shistocytes. There was concern for hemolysis and need for
further work-up so she was transferred to [**Hospital1 18**] for further
evaluation. In the [**Hospital1 18**] ED, repeat Hct was 16 with high LDH and
T bili. Haptoglobin was still pending at the time of admission.
Though patient was hemodynamically stable, she was admitted to
the ICU for close monitoring while the work-up for presumed
hemolytic anemia continued.

Past Medical History:
CAD (cath done at OSH because of EKG changes revealed "mild CAD"
which was not intervened upon)

Allergies/Adverse Reactions:
Aspirin (epistaxis)
Lipitor (muscle aches)

Social History:
Patient has a former history of tobacco use, up to 1 ppd, but
stopped in [**2173-6-23**]. She very infrequently consumes
alcohol and denies illicit drug use. She used to do office work
for her father's business in her 30s, but has since worked as a
homemaker. She has one daugher and one grandson. She lives alone
and performs all of her ADLs.

Family History:
NC

Physical Exam:
Vitals: T - 97.1, BP - 143/63, HR - 81, RR - 18, O2 - 99% 2 L NC

General: Awake, alert, NAD
HEENT: NC/AT; PERRLA, EOMI, + scleral icterus; OP clear,
nonerythematous, icteric mucous membranes
Neck: Supple, no LAD
Chest/CV: S1, S2 nl, no m/r/g appreciated
Lungs: CTAB
Abd: Soft, NT, ND, + BS
Rectal: Brown, guaiac negative stool
Ext: No c/c/e
Neuro: Grossly intact
Skin: No lesions

Pertinent Results:
[**2174-3-13**] 11:43PM BLOOD WBC-28.6* RBC-1.95* Hgb-6.0* Hct-16.7*
MCV-86 MCH-30.6 MCHC-35.8* RDW-17.2* Plt Ct-683*
[**2174-3-13**] 11:43PM BLOOD Neuts-86* Bands-2 Lymphs-3* Monos-5 Eos-0
Baso-0 Atyps-4* Metas-0 Myelos-0
[**2174-3-13**] 11:43PM BLOOD Hypochr-3+ Anisocy-2+ Poiklo-2+
Macrocy-2+ Microcy-1+ Polychr-2+ Ovalocy-OCCASIONAL Target-2+
Stipple-1+
[**2174-3-13**] 11:43PM BLOOD Plt Ct-683*
[**2174-3-14**] 01:00AM BLOOD Fibrino-788* D-Dimer-[**2085**]*
[**2174-3-13**] 11:43PM BLOOD Ret Aut-7.0*
[**2174-3-13**] 11:43PM BLOOD Glucose-178* UreaN-32* Creat-0.9 Na-134
K-4.9 Cl-102 HCO3-22 AnGap-15
[**2174-3-13**] 11:43PM BLOOD ALT-31 AST-65* LD(LDH)-2069* AlkPhos-123*
TotBili-5.4*
[**2174-3-13**] 11:43PM BLOOD Lipase-52
[**2174-3-13**] 11:43PM BLOOD Hapto-LESS THAN
[**2174-3-13**] 11:43PM URINE Color-[**Location (un) **] Appear-Cloudy Sp [**Last Name (un) **]-1.014
[**2174-3-13**] 11:43PM URINE Blood-LG Nitrite-NEG Protein-30
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-TR
[**2174-3-13**] 11:43PM URINE RBC-[**5-3**]* WBC-[**5-3**]* Bacteri-MOD
Yeast-NONE Epi-[**1-26**] RenalEp-0-2
[**2174-3-13**] 11:43PM URINE CastGr-[**1-26**]* CastHy-0-2
[**2174-3-13**] 11:43PM URINE Mucous-MOD

CHEST (PORTABLE AP)  [**2174-3-13**] 11:24 PM
FINDINGS: Single portable upright chest radiograph is reviewed
without comparison. Cardiomediastinal silhouette is unremarkable
allowing for the limitations of portable technique. Pulmonary
vascularity appears normal. Ill- defined opacity projecting over
the left lung base most likely represents superimposed breast
shadow. A dedicated PA and lateral examination would be helpful
in resolving, if this is an area of clinical concern. Otherwise,
the lungs are clear. There is no pleural effusion or
pneumothorax.

CT ABD W&W/O C  [**2174-3-14**] 7:41 PM
CTA CHEST W&W/O C&RECONS, NON-; CT ABD W&W/O C
IMPRESSION:
1. No pulmonary embolism is detected.
2. Lingular atelectasis and mild inflammatory changes in the
left upper lobe.
3. 1.3cm right upper lobe nodule is concerning for lung cancer.
Further evaluation with PET scan is recommended.
4. Small focal dissection in the infrarenal aorta likely
chronic.

Brief Hospital Course:
77yo woman with recent URI admitted with hemolytic anemia (Hct
14) due to cold agglutinins.

# HEMOLYTIC ANEMIA:
The patient was found to have autoimmune hemolytic anemia due to
cold agglutinins. Possible causes include infections such as
mycoplasma pneumonia, EBV, CMV, or varicella or
lymphoproliferative disorders.  Mycoplasma, EBV and CMV
serologies were negative for recent infection; preliminary
results from flow cytometry were not suggestive of lymphoma, but
the final results were still pending at time of discharge.

She received transfusions of packed red blood cells and her
hematocrit improved to 30, which was stable for 2 days prior to
her discharge.  Her hemolysis labs were improving at the time of
discharge.  She was given follow-up with hematology within one
week of discharge.

# RUL LUNG MASS:
Patient underwent CT of her chest for work-up of possible
pneumonia, and right upper lobe nodule was incidentally found.
Per hematology, even if this nodule represented lung cancer, a
solid lung tumor is not likley to be associated with her cold
agglutinin hemolytic anemia.

The patient should undergo PET scan and biopsy (likely by CT
guided approach given peripheral nature of lesion) in the next
several weeks.  This was discussed with Dr. [**Last Name (STitle) 29188**], the covering
physician for the patient's PCP.  [**Name10 (NameIs) **] patient has follow-up with
her PCP in less than one week, and the patient understands that
the lung lesion needs to be biopsied.

# PNEUMONIA:
Left lower lung opacity on CXR suggestive of pneumonia.  Given
recent clinical symptoms of cough, the patient was treated with
cefpodoxime and azithromycin for possible pneumonia.

# INFRARENAL AORTIC DISSECTION:
A small focal dissection was incidentally noted on CT.  She will
need outpatient medical management and follow-up imaging, to be
coordinated by her PCP.

# CAD:
The patient has h/o CAD with wall motion abnormalities on stress
echo in [**2169**], but only mild CAD on cath in [**2169**] with no
significant stenoses. The patient was initially maintained on
telemetry but this was discontinued as she was hemodynamically
stable, the T wave inversions noted on admission ECG were
present on last ECG in [**6-/2170**], and 4 sets of cardiac enzymes
were sent during hospitalization and were all negative.  She was
not started on a daily aspirin given her h/o significant
epistaxis while on aspirin and only mild CAD.

# HYPERLIPIDEMIA:
Patient has not been able to adhere to lifestyle modifications
to reduce cholesterol since CAD diagnosis in [**2169**].  She had
muscle aches with Lipitor in past, but unclear if had elevated
LFTs or CK.  No changes in medication were made while in
hospital, but the patient was advised to ask her PCP for
referral to a dietitian.

# LLE PAIN:
The patient noted pain in her left lower extremity mid-way
through hospitalization. The pain was reproducible with
straightening of her leg but not tender to palpation, and she
had no swelling or erythema. The pain improved with ambulation
during the course of the day, and muscular cramping was
considered the most likely etiology. Physical therapy was
consulted, particularly given the patient's dizziness prior to
admission and noted no deficits in the patient's mobility.


Medications on Admission:
none

Discharge Medications:
1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Azithromycin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 2 days: please take on Saturday and on [**Year (4 digits) 1017**] and then stop.
Disp:*2 Tablet(s)* Refills:*0*
3. Cefpodoxime 200 mg Tablet Sig: One (1) Tablet PO twice a day
for 2 days: Last day to take is [**Year (4 digits) 1017**] [**3-20**].
Disp:*5 Tablet(s)* Refills:*0*
4. Outpatient Lab Work
Please draw patient's hematocrit and have the result called to
Dr. [**Last Name (STitle) 29188**] at [**Telephone/Fax (1) 9146**].  The result should also be faxed to
Dr. [**Last Name (STitle) 78856**] at [**Telephone/Fax (1) 78857**].  Please note that the patient's
hematocrit on [**3-18**] is 30.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:  Hemolytic Anemia due to cold agglutinins
Secondary Diagnoses:  Pneumonia, Mild coronary artery disease,
Infrarenal aortic dissection, Right upper lobe lung nodule


Discharge Condition:
Afebrile with stable vital signs, feeling well.  Cough improved.
 Hematocrit stable at 30 for 2 days.


Discharge Instructions:
You were admitted with anemia that was found to be due to cold
agglutinins, which are antibodies that can cause your blood
cells to be chewed up.  You received blood transfusions and your
blood counts have been stable.  You were also treated for a
pneumonia.

1. Please take all medications as prescribed.
The following medications were started during your stay here:
- antibiotics (cefpodoxime and azithromycin) for the pneumonia
- folate to help you with your anemia

2. Please attend all follow-up appointments listed below.

3. Please call your doctor or return to the hospital if you
develop fevers, yellowing of your skin, fatigue, worsening
cough, change in color of your fingers, or any other concerning
symptom.

4. We recommend that you wear hats, scarfs, and mittens on cool
days and that you avoid going out in the cold weather.  Please
discuss these recommendations with hematology when you see them.

5. Please have your blood drawn on [**Last Name (LF) 1017**], [**3-20**].  The
results will be sent to Dr. [**Last Name (STitle) **] and to his covering
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 29188**].  Note that your hematocrit before you
left the hospital was 30.

Followup Instructions:
1. You have an appointment with your primary care doctor, D.
[**Last Name (STitle) **], on Thursday [**3-24**] at 3:15pm.  It is important that
you discuss with your primary doctor getting a biopsy of the
spot on your lung.

2. You have an appointment with Hematology:
Provider: [**First Name11 (Name Pattern1) 2295**] [**Last Name (NamePattern4) 11222**], MD Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2174-3-23**] 4:00pm on the [**Location (un) **] of the [**Hospital Ward Name 23**]
building at the corner of [**Location (un) **] and [**Hospital1 1426**] Avenues.



Completed by:[**2174-3-23**]
{'Autoimmune hemolytic anemias,Pneumonia, organism unspecified,Dissection of aorta, abdominal,Coronary atherosclerosis of native coronary artery,Other diseases of lung, not elsewhere classified'}


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: weakness

PRESENT ILLNESS: 77yo woman with history of CAD without MI, not on medications,
no stent who presents with a chief complaint of generalized
weakness. Patient reports an ongoing URI for the past two weeks
with specific complaints of cough intermittently productive of
yellow sputum, congestion and laryngitis. She identifies both
her daughter and grandson and [**Name2 (NI) **] contacts as they have been
experiencing the same symptoms and the daughter notes being
diagnosed with "pneumonia". These symptoms were gradually
resolving, but on Friday, [**3-11**], patient noted fevers to 101
without chills or sweats as well as persistent left shoulder
pain. She denies any injury to her shoulder, though she does
admit to heavy lifting as she was cleaning her attick. Her
shoulder pain continued until Saturday and led her to take
Tylenol every 6 hours with moderate relief. On [**Month/Year (2) 1017**], the day
of admission, patient reports waking up and feeling profoundly
lethargic, unable to walk down the stairs of her home to prepare
coffee. She also reports feeling presyncopal without actual
syncope. Patient denies chest pain, SOB, palpitations, abdominal
pain, diarrhea, melena, hematochezia, hematemesis, rashes, but
does recall noticing that her skin and eyes looked "beige" since
Friday. She also recalls hematuria and urinary frequency without
dysuria.

MEDICAL HISTORY: CAD (cath done at OSH because of EKG changes revealed "mild CAD"
which was not intervened upon)

MEDICATION ON ADMISSION: none

ALLERGIES: Aspirin / Atorvastatin

PHYSICAL EXAM: Vitals: T - 97.1, BP - 143/63, HR - 81, RR - 18, O2 - 99% 2 L NC

FAMILY HISTORY: NC

SOCIAL HISTORY: Patient has a former history of tobacco use, up to 1 ppd, but
stopped in [**2173-6-23**]. She very infrequently consumes
alcohol and denies illicit drug use. She used to do office work
for her father's business in her 30s, but has since worked as a
homemaker. She has one daugher and one grandson. She lives alone
and performs all of her ADLs. 

### Response:
{'Autoimmune hemolytic anemias,Pneumonia, organism unspecified,Dissection of aorta, abdominal,Coronary atherosclerosis of native coronary artery,Other diseases of lung, not elsewhere classified'}
