CHIEF COMPLAINT: Aplastic anemia

PRESENT ILLNESS: Pt is a 73 yo woman who is transferred from [**Hospital **] Hospital for
further evaluation and treatment of her newly diagnosed aplastic
anemia.  Pt reported that she presented to OSH two weeks ago
Tuesday with 7 episodes of loose stool mixed with sig. amounts
of bright red blood.  At the time her plt ct was reportedly
5,000 and HBG was 10; she received 1 unit of plts with increase
to 60,000 and 2 units of PRBCs.  Heme/onc was consulted, and she
had a bone marrow aspirate with flow cytometry that showed
aplastic anemia with 5-10% celularity, no sig. blast population,
cytogenics pending.  Viral serologies were obtained for
hepatitis A, B, C, EBV, CMV, and parovirus and was only sig. for
parvovirus IgG antigen of 19 c/w prior infection.  No colonscopy
was performed as she had one 2 years ago without sig. findings.
Pt was discharged on the following Friday.
.
On Monday, she went for routine lab work that was sig. for plt
ct of 11; she was transfused, which increased the plt ct to 51.
The following Thursday, she went for another routine lab work,
and ANC was noted to be 324.  She was told to monitor her
temperature at home.  She noted a temperature of 101.5 on
Friday.  At home, pt did not note any URI sxs inc. cough and
SOB, diarrhea, abdominal pain, and dysuria.  Pt was told to go
to the Emergency Department.  In the [**Name (NI) **], pt reported that she
was noted to be neutropenic for the first time.  She was started
on Ceftazidime.  CXR was reportedly unremarkable and U/A and UCx
grew 10^5 gram positive growth, which was presumed to be
contamination.  ID was consulted.  She defervesced and was d/c'd
off abx on [**7-17**], her fever returned the next day at 102, and she
was placed back on abx.  Repeat CXR was also unremarkable.  CT
scan of the chest from [**7-5**] did show a pulmonary noudle in the
subpleural R lung.  During the hospital course she also reported
received plt transfusions (plt ct 5,000), empiric trial of G-CSF
300 SQ daily since admission, and T and spectra cell
transfusion.  Course has been c/b nausea, relieved by Zofran.
.
Prior to the admission 2 weeks ago, pt did not believe she was
more fatigued.  Pt's daughter noticed that she fell asleep more
quickly during the day starting about 1 month ago while on
vacation in [**State 108**].  No fever/chills then.  No sig. weight
changes.  She noticed easy brusing 1 week prior to first
admission but no bleeding.  ROS otherwise only sig. for mild
frontal HA, [**2-11**].

MEDICAL HISTORY: 1.  PMR:  Pt reported arthralgia for the pat year, particularly
in shoulders, low back, and hips.  She was finally diagnosed in
[**Month (only) 547**] with PMR and started on prednisone [**9-13**].  This was
recently tapered to [**5-9**].
2.  HTN
3.  Hypercholesterolemia
4.  Osteoporosis
5.  ?TIA 6 years ago with L sided tingling and numbness
6.  h/o RA as a child, treated with steroids.

MEDICATION ON ADMISSION: Medications on transfer:
ceftazidime 2 gm Iv q8 hrs
Colace 200 mg po qhs
Zofran 8 mg IV po q6 hours
Clonidine 0.1 mg po bid
Prilosec 20 mg po daily
Tylenol prn
G-CSF 300 SQ daily
.
Medications at home:
Prednisone [**5-9**]
Prilosec OTC
Lipitor 20 mg
Lisinopril 30 mg
Fosamax 10 mg
ASA 81 mg
MTV

ALLERGIES: Novocain

PHYSICAL EXAM: VS:  T100.3/102.4, P94, R18, BP160/82
Gen:  NAD, pleasant woman
HEENT:  conjunctiva clear, sclera nonicteric, MMM, white patch
on R side of tongue and on R buccal mucosa.
Neck:  supple without LAD
CV:  RRR, no murmurs
Pulm:  CTAB, no crackles or wheezes
Abd:  +BS, soft, NT, ND, no HSM noted
Ext:  warm, no edema, 2+ DP pulses
Neuro:  CN II-XII grossly intact, Muscle strength 5/5 and equal
Skin:  slight petechial rash on LEs.

FAMILY HISTORY: Father with [**Name2 (NI) 499**] cancer diagnosed at age 60, died of "blocked
arteries in neck" at 69.  Mother with "sickness everywhere."
The healthy daughters.

SOCIAL HISTORY: Pt lives with her daughter and grandchildren in [**Name (NI) **], [**Name (NI) 1727**].
She is very active and leads an senior exercise program 3x/wk.
She was in [**State 108**] about 1 month ago.  Tob:  40 yrs x 1.5 ppd,
quit 16 years ago.  ETOH:  glass of wine/wk.  Recreational
drugs:  none.  Herbal supplements/OTC:  none.
Intestinal infection due to Clostridium difficile,Diastolic heart failure, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Paralytic ileus,Hypoxemia,Hemophagocytic syndromes,Polymyalgia rheumatica,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Accidents occurring in residential institution
Int inf clstrdium dfcile,Diastolc hrt failure NOS,Acute respiratry failure,Acute kidney failure NOS,Paralytic ileus,Hypoxemia,Hemophagocytic syndromes,Polymyalgia rheumatica,Hypertension NOS,Pure hypercholesterolem,Osteoporosis NOS,Pancreatic disorder NEC,Adv eff corticosteroids,Accid in resident instit
Admission Date:  [**2147-7-19**]              Discharge Date:   [**2147-8-2**]

Date of Birth:  [**2073-8-15**]             Sex:   F

Service: MEDICINE

Allergies:
Novocain

Attending:[**First Name3 (LF) 3233**]
Chief Complaint:
Aplastic anemia

Major Surgical or Invasive Procedure:
Bone marrow biopsy
endotracheal intubation
Central line placement
Arterial line placement

History of Present Illness:
Pt is a 73 yo woman who is transferred from [**Hospital **] Hospital for
further evaluation and treatment of her newly diagnosed aplastic
anemia.  Pt reported that she presented to OSH two weeks ago
Tuesday with 7 episodes of loose stool mixed with sig. amounts
of bright red blood.  At the time her plt ct was reportedly
5,000 and HBG was 10; she received 1 unit of plts with increase
to 60,000 and 2 units of PRBCs.  Heme/onc was consulted, and she
had a bone marrow aspirate with flow cytometry that showed
aplastic anemia with 5-10% celularity, no sig. blast population,
cytogenics pending.  Viral serologies were obtained for
hepatitis A, B, C, EBV, CMV, and parovirus and was only sig. for
parvovirus IgG antigen of 19 c/w prior infection.  No colonscopy
was performed as she had one 2 years ago without sig. findings.
Pt was discharged on the following Friday.
.
On Monday, she went for routine lab work that was sig. for plt
ct of 11; she was transfused, which increased the plt ct to 51.
The following Thursday, she went for another routine lab work,
and ANC was noted to be 324.  She was told to monitor her
temperature at home.  She noted a temperature of 101.5 on
Friday.  At home, pt did not note any URI sxs inc. cough and
SOB, diarrhea, abdominal pain, and dysuria.  Pt was told to go
to the Emergency Department.  In the [**Name (NI) **], pt reported that she
was noted to be neutropenic for the first time.  She was started
on Ceftazidime.  CXR was reportedly unremarkable and U/A and UCx
grew 10^5 gram positive growth, which was presumed to be
contamination.  ID was consulted.  She defervesced and was d/c'd
off abx on [**7-17**], her fever returned the next day at 102, and she
was placed back on abx.  Repeat CXR was also unremarkable.  CT
scan of the chest from [**7-5**] did show a pulmonary noudle in the
subpleural R lung.  During the hospital course she also reported
received plt transfusions (plt ct 5,000), empiric trial of G-CSF
300 SQ daily since admission, and T and spectra cell
transfusion.  Course has been c/b nausea, relieved by Zofran.
.
Prior to the admission 2 weeks ago, pt did not believe she was
more fatigued.  Pt's daughter noticed that she fell asleep more
quickly during the day starting about 1 month ago while on
vacation in [**State 108**].  No fever/chills then.  No sig. weight
changes.  She noticed easy brusing 1 week prior to first
admission but no bleeding.  ROS otherwise only sig. for mild
frontal HA, [**2-11**].

Past Medical History:
1.  PMR:  Pt reported arthralgia for the pat year, particularly
in shoulders, low back, and hips.  She was finally diagnosed in
[**Month (only) 547**] with PMR and started on prednisone [**9-13**].  This was
recently tapered to [**5-9**].
2.  HTN
3.  Hypercholesterolemia
4.  Osteoporosis
5.  ?TIA 6 years ago with L sided tingling and numbness
6.  h/o RA as a child, treated with steroids.

Social History:
Pt lives with her daughter and grandchildren in [**Name (NI) **], [**Name (NI) 1727**].
She is very active and leads an senior exercise program 3x/wk.
She was in [**State 108**] about 1 month ago.  Tob:  40 yrs x 1.5 ppd,
quit 16 years ago.  ETOH:  glass of wine/wk.  Recreational
drugs:  none.  Herbal supplements/OTC:  none.

Family History:
Father with [**Name2 (NI) 499**] cancer diagnosed at age 60, died of "blocked
arteries in neck" at 69.  Mother with "sickness everywhere."
The healthy daughters.

Physical Exam:
VS:  T100.3/102.4, P94, R18, BP160/82
Gen:  NAD, pleasant woman
HEENT:  conjunctiva clear, sclera nonicteric, MMM, white patch
on R side of tongue and on R buccal mucosa.
Neck:  supple without LAD
CV:  RRR, no murmurs
Pulm:  CTAB, no crackles or wheezes
Abd:  +BS, soft, NT, ND, no HSM noted
Ext:  warm, no edema, 2+ DP pulses
Neuro:  CN II-XII grossly intact, Muscle strength 5/5 and equal
Skin:  slight petechial rash on LEs.

Pertinent Results:
Admission labs:
[**2147-7-19**] 05:42PM   GLUCOSE-128* UREA N-15 CREAT-1.0 SODIUM-135
POTASSIUM-3.7 CHLORIDE-101 TOTAL CO2-24 ANION GAP-14
[**2147-7-19**] 05:42PM   estGFR-Using this
[**2147-7-19**] 05:42PM   ALT(SGPT)-17 AST(SGOT)-17 LD(LDH)-258* ALK
PHOS-56 TOT BILI-1.0
[**2147-7-19**] 05:42PM   ALBUMIN-3.5 CALCIUM-8.7 PHOSPHATE-2.3*
MAGNESIUM-1.9 URIC ACID-3.8
[**2147-7-19**] 05:42PM   RBC-2.95* HGB-9.3* HCT-24.6* MCV-83 MCH-31.6
MCHC-37.9* RDW-14.8
[**2147-7-19**] 05:42PM   PT-12.4 PTT-28.8 INR(PT)-1.1

[**7-26**].  Chest CT.
IMPRESSION: Extensive pulmonary consolidation is most likely a
combination of pulmonary hemorrhage and pneumonia, rather than
cardiogenic edema.


Brief Hospital Course:
Pt is a 73 yo woman with PMHx sig. for PMR who is transferred
from [**Hospital **] Hospital for further evaluation and treatment of her
newly diagnosed aplastic anemia.  This was thought to be due to
hemophagocytic syndrome based on bone marrow biopsy results. She
did not respond to cyclosporin and decadron.  The family decided
on [**8-2**] to extubate patient.  She was made comfortable and soon
expired on [**8-2**].
.
1.  Pancytopenia:  Patient had pancytopenia, likely secondary to
hemophagocytic syndrome.  Was treated with decadron and
cyclosporin.  On [**8-1**], she was given one dose of IV
methlyprenisolone and etopiside.  She remained persistently
pancytopenic.  Patient was transfused several units of PRBCs and
platelets.
.
2.  Pulmonary hemorrhage.  Patient was intubated for respiratory
failure secondary to pulmonary hemorrhage in setting of low
platelets.  She was extuabated for one day, but was tachypneic
and alkalotic and so was reintubated.

3.  Febrile Neutropenia.  Patient was treated with caspofungin
and meropenem for febrile neutropenia.  There were no positive
cultures. A source of fever was never found.
.
4.  HTN.  Patient was hypertensive during hospital stay.  She
was treated with amlodipine and metoprolol.
.
5. C diff colitis.  Patient was treated with continue Vanco and
Flagyl for C. diff colitis

Contact: [**Name (NI) **] [**Name (NI) 73975**], daughter, [**Telephone/Fax (1) 73976**] cell

Medications on Admission:
Medications on transfer:
ceftazidime 2 gm Iv q8 hrs
Colace 200 mg po qhs
Zofran 8 mg IV po q6 hours
Clonidine 0.1 mg po bid
Prilosec 20 mg po daily
Tylenol prn
G-CSF 300 SQ daily
.
Medications at home:
Prednisone [**5-9**]
Prilosec OTC
Lipitor 20 mg
Lisinopril 30 mg
Fosamax 10 mg
ASA 81 mg
MTV

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
hemophagocytic syndrome
pulmonary hemorrhage

Discharge Condition:
patient expired

Discharge Instructions:
N/A.

Followup Instructions:
N/A.
{'Intestinal infection due to Clostridium difficile,Diastolic heart failure, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Paralytic ileus,Hypoxemia,Hemophagocytic syndromes,Polymyalgia rheumatica,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Accidents occurring in residential institution'}


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: Aplastic anemia

PRESENT ILLNESS: Pt is a 73 yo woman who is transferred from [**Hospital **] Hospital for
further evaluation and treatment of her newly diagnosed aplastic
anemia.  Pt reported that she presented to OSH two weeks ago
Tuesday with 7 episodes of loose stool mixed with sig. amounts
of bright red blood.  At the time her plt ct was reportedly
5,000 and HBG was 10; she received 1 unit of plts with increase
to 60,000 and 2 units of PRBCs.  Heme/onc was consulted, and she
had a bone marrow aspirate with flow cytometry that showed
aplastic anemia with 5-10% celularity, no sig. blast population,
cytogenics pending.  Viral serologies were obtained for
hepatitis A, B, C, EBV, CMV, and parovirus and was only sig. for
parvovirus IgG antigen of 19 c/w prior infection.  No colonscopy
was performed as she had one 2 years ago without sig. findings.
Pt was discharged on the following Friday.
.
On Monday, she went for routine lab work that was sig. for plt
ct of 11; she was transfused, which increased the plt ct to 51.
The following Thursday, she went for another routine lab work,
and ANC was noted to be 324.  She was told to monitor her
temperature at home.  She noted a temperature of 101.5 on
Friday.  At home, pt did not note any URI sxs inc. cough and
SOB, diarrhea, abdominal pain, and dysuria.  Pt was told to go
to the Emergency Department.  In the [**Name (NI) **], pt reported that she
was noted to be neutropenic for the first time.  She was started
on Ceftazidime.  CXR was reportedly unremarkable and U/A and UCx
grew 10^5 gram positive growth, which was presumed to be
contamination.  ID was consulted.  She defervesced and was d/c'd
off abx on [**7-17**], her fever returned the next day at 102, and she
was placed back on abx.  Repeat CXR was also unremarkable.  CT
scan of the chest from [**7-5**] did show a pulmonary noudle in the
subpleural R lung.  During the hospital course she also reported
received plt transfusions (plt ct 5,000), empiric trial of G-CSF
300 SQ daily since admission, and T and spectra cell
transfusion.  Course has been c/b nausea, relieved by Zofran.
.
Prior to the admission 2 weeks ago, pt did not believe she was
more fatigued.  Pt's daughter noticed that she fell asleep more
quickly during the day starting about 1 month ago while on
vacation in [**State 108**].  No fever/chills then.  No sig. weight
changes.  She noticed easy brusing 1 week prior to first
admission but no bleeding.  ROS otherwise only sig. for mild
frontal HA, [**2-11**].

MEDICAL HISTORY: 1.  PMR:  Pt reported arthralgia for the pat year, particularly
in shoulders, low back, and hips.  She was finally diagnosed in
[**Month (only) 547**] with PMR and started on prednisone [**9-13**].  This was
recently tapered to [**5-9**].
2.  HTN
3.  Hypercholesterolemia
4.  Osteoporosis
5.  ?TIA 6 years ago with L sided tingling and numbness
6.  h/o RA as a child, treated with steroids.

MEDICATION ON ADMISSION: Medications on transfer:
ceftazidime 2 gm Iv q8 hrs
Colace 200 mg po qhs
Zofran 8 mg IV po q6 hours
Clonidine 0.1 mg po bid
Prilosec 20 mg po daily
Tylenol prn
G-CSF 300 SQ daily
.
Medications at home:
Prednisone [**5-9**]
Prilosec OTC
Lipitor 20 mg
Lisinopril 30 mg
Fosamax 10 mg
ASA 81 mg
MTV

ALLERGIES: Novocain

PHYSICAL EXAM: VS:  T100.3/102.4, P94, R18, BP160/82
Gen:  NAD, pleasant woman
HEENT:  conjunctiva clear, sclera nonicteric, MMM, white patch
on R side of tongue and on R buccal mucosa.
Neck:  supple without LAD
CV:  RRR, no murmurs
Pulm:  CTAB, no crackles or wheezes
Abd:  +BS, soft, NT, ND, no HSM noted
Ext:  warm, no edema, 2+ DP pulses
Neuro:  CN II-XII grossly intact, Muscle strength 5/5 and equal
Skin:  slight petechial rash on LEs.

FAMILY HISTORY: Father with [**Name2 (NI) 499**] cancer diagnosed at age 60, died of "blocked
arteries in neck" at 69.  Mother with "sickness everywhere."
The healthy daughters.

SOCIAL HISTORY: Pt lives with her daughter and grandchildren in [**Name (NI) **], [**Name (NI) 1727**].
She is very active and leads an senior exercise program 3x/wk.
She was in [**State 108**] about 1 month ago.  Tob:  40 yrs x 1.5 ppd,
quit 16 years ago.  ETOH:  glass of wine/wk.  Recreational
drugs:  none.  Herbal supplements/OTC:  none. 

### Response:
{'Intestinal infection due to Clostridium difficile,Diastolic heart failure, unspecified,Acute respiratory failure,Acute kidney failure, unspecified,Paralytic ileus,Hypoxemia,Hemophagocytic syndromes,Polymyalgia rheumatica,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Other specified disorders of pancreatic internal secretion,Adrenal cortical steroids causing adverse effects in therapeutic use,Accidents occurring in residential institution'}
