CHIEF COMPLAINT: Flushing and tachycardia

PRESENT ILLNESS: Ms [**Known lastname 2696**] is a 28 year old woman with a 9 yr history of
systemic mastocytosis, with 2 recent admissions for flares,
presenting with an acute flare which began last night.
.
She woke from sleep with symptoms of skin flushing and
palpitations and wanted to seek medical care before things got
worse. She denies n/v, abdominal pain and diarrhea which normall
accompany her flares.  She cannot identify a particular trigger.
Since her last admission 2 weeks ago, she has been having some
flushing nightly, and several episodes of "[**Known lastname 500**] pain" in her
wrists, elbows, shoulders and back which is new for her.  She is
still on a prednisone taper from her last flare earlier this
month at which time she was admitted from [**Date range (1) 59412**].  That flare
occured while still on a prednisone taper from a flare in late
[**Month (only) 404**] attibuted to a viral illness.  The patient is used to
having flares only 2-3 times per year, and never while still on
a prednisone dose.
.
Her first episode began at age 19 with flushing associated with
hypotension and heart racing. She was diagnosed 3yrs later in
[**2136**] when tryptase levels were noted to be elevated. She has not
had a successful [**Year (4 digits) 500**] marrow biopsy in the past despite 2
attempts at UCSF. Triggers include stress, NSAIDS, ASA, opiates,
and iodine including contrast dyes.
.
In the ED Vitals: T 97.6 HR 97 150/87 RR 20 O2 Sat 100% RA.
Patient given 125mg solumedrol, 50mg IV Benadryl x 2, Famotidine
and Tylenol 650 mg PO x1 and NS IV fluids.  The patient's
symptoms improved and she was admitted to the floor.
.
This morning, the patient feels well and symptoms are mostly
resolved. She remains very anxious about her conditions and
making sure the flare does not return, and is concerned with the
apparent recent progression of her illness.  She also admits to
increase stress secondary to her condition, and is becoming more
convinced that some therapy may be useful to her.  She was
recently started on as standing lorazepam dose of 0.5mg [**Hospital1 **] by
her allergist to help her stay more calm.

MEDICAL HISTORY: -Systemic mastocytosis, followed by Dr.[**Last Name (STitle) 2603**], Allergy
specialist and Dr. [**Last Name (STitle) **] of [**Hospital1 112**]
-History of coffee ground emesis in the setting of Mastocytosis
flare and nausea/vomitting in [**7-/2142**]
-Anemia, low normal MCV, iron panel in [**3-/2141**] iron 79, TIBC 364,
Ferritin 55, Transferin 280, in [**10/2142**] normal B12 and folate
-Thumb surgery
-Tonsillectomy
-Hemorrhoids

MEDICATION ON ADMISSION: 1. Cetirizine 10 mg Tablet Sig: One (1) Tablet PO twice a day.
2. Cromolyn 100 mg/5 mL Solution Sig: Two Hundred (200) mg PO
four times a day.
3. Doxepin 50 mg Capsule Sig: One (1) Capsule PO twice a day.
4. EpiPen 0.3 mg/0.3 mL Pen Injector Sig: One (1) injection
Intramuscular once as needed for as directed.- confirmed not
expired
5. Hydroxyzine HCl 50 mg Tablet Sig: One (1) Tablet PO twice a
day.
6. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for anxiety.
7. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID
9. Prednisone taper (currently on 30 mg daily but took a total
of 60 mg today at home due to flare)
10. NuvaRing
11. Cromolyn Cream (not currently using)
12. Ketotifen 2mg [**Hospital1 **] (canadian medication)

ALLERGIES: Aspirin / Iodine / Nsaids / Opioid Analgesics

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS: 98.3  129/91   108  18  100% RA
GEN: NAD, awake, alert
HEENT: EOMI, PERRL 9->5, sclera anicteric, conjunctivae clear,
pale, OP moist and without lesion
NECK: Supple, no JVD, no LAD
CV: Slightly tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Protuberent, Soft, NT, ND, no HSM
EXT: No c/c/e, 2+ radian and PT pulses
SKIN: erythematous macular region on left face. No decoloration
on legs or arms.
Neuro: no focal findings, A Ox3
Psych: appears somewhat anxious, near tearful when discussing
her disease.  Overall appropriate.

FAMILY HISTORY: Father alive and in good health, mother has MS. [**Name13 (STitle) **] family h/o
allergic, rheumatologic, or autoimmune diseases. Grandfather
with CAD, colon CA and grandmother with skin CA.

SOCIAL HISTORY: Patient employed as a librarian. Honorably discharged from air
force in [**2139**] due to her recurrent mastocytosis flares and
hospitalizations.
Married, no children. Does not smoke or use drugs, social
drinker.
Malignant mast cell tumors, unspecified site, extranodal and solid organ sites,Hypovolemia,Esophagitis, unspecified,Disorder of bone and cartilage, unspecified,Anemia, unspecified,Anxiety state, unspecified,Long-term (current) use of steroids,Need for desensitization to allergens,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Nonspecific abnormal findings in stool contents
Mlg mast unsp xtrndl org,Hypovolemia,Esophagitis, unspecified,Bone & cartilage dis NOS,Anemia NOS,Anxiety state NOS,Long-term use steroids,Desensitiza to allergens,Gstr/ddnts NOS w/o hmrhg,Abn find-stool contents
Admission Date:  [**2143-3-28**]              Discharge Date:   [**2143-4-2**]

Date of Birth:  [**2114-5-11**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin / Iodine / Nsaids / Opioid Analgesics

Attending:[**First Name3 (LF) 5806**]
Chief Complaint:
Flushing and tachycardia

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Ms [**Known lastname 2696**] is a 28 year old woman with a 9 yr history of
systemic mastocytosis, with 2 recent admissions for flares,
presenting with an acute flare which began last night.
.
She woke from sleep with symptoms of skin flushing and
palpitations and wanted to seek medical care before things got
worse. She denies n/v, abdominal pain and diarrhea which normall
accompany her flares.  She cannot identify a particular trigger.
Since her last admission 2 weeks ago, she has been having some
flushing nightly, and several episodes of "[**Known lastname 500**] pain" in her
wrists, elbows, shoulders and back which is new for her.  She is
still on a prednisone taper from her last flare earlier this
month at which time she was admitted from [**Date range (1) 59412**].  That flare
occured while still on a prednisone taper from a flare in late
[**Month (only) 404**] attibuted to a viral illness.  The patient is used to
having flares only 2-3 times per year, and never while still on
a prednisone dose.
.
Her first episode began at age 19 with flushing associated with
hypotension and heart racing. She was diagnosed 3yrs later in
[**2136**] when tryptase levels were noted to be elevated. She has not
had a successful [**Year (4 digits) 500**] marrow biopsy in the past despite 2
attempts at UCSF. Triggers include stress, NSAIDS, ASA, opiates,
and iodine including contrast dyes.
.
In the ED Vitals: T 97.6 HR 97 150/87 RR 20 O2 Sat 100% RA.
Patient given 125mg solumedrol, 50mg IV Benadryl x 2, Famotidine
and Tylenol 650 mg PO x1 and NS IV fluids.  The patient's
symptoms improved and she was admitted to the floor.
.
This morning, the patient feels well and symptoms are mostly
resolved. She remains very anxious about her conditions and
making sure the flare does not return, and is concerned with the
apparent recent progression of her illness.  She also admits to
increase stress secondary to her condition, and is becoming more
convinced that some therapy may be useful to her.  She was
recently started on as standing lorazepam dose of 0.5mg [**Hospital1 **] by
her allergist to help her stay more calm.


Past Medical History:
-Systemic mastocytosis, followed by Dr.[**Last Name (STitle) 2603**], Allergy
specialist and Dr. [**Last Name (STitle) **] of [**Hospital1 112**]
-History of coffee ground emesis in the setting of Mastocytosis
flare and nausea/vomitting in [**7-/2142**]
-Anemia, low normal MCV, iron panel in [**3-/2141**] iron 79, TIBC 364,
Ferritin 55, Transferin 280, in [**10/2142**] normal B12 and folate
-Thumb surgery
-Tonsillectomy
-Hemorrhoids


Social History:
Patient employed as a librarian. Honorably discharged from air
force in [**2139**] due to her recurrent mastocytosis flares and
hospitalizations.
Married, no children. Does not smoke or use drugs, social
drinker.


Family History:
Father alive and in good health, mother has MS. [**Name13 (STitle) **] family h/o
allergic, rheumatologic, or autoimmune diseases. Grandfather
with CAD, colon CA and grandmother with skin CA.

Physical Exam:
PHYSICAL EXAMINATION:
VS: 98.3  129/91   108  18  100% RA
GEN: NAD, awake, alert
HEENT: EOMI, PERRL 9->5, sclera anicteric, conjunctivae clear,
pale, OP moist and without lesion
NECK: Supple, no JVD, no LAD
CV: Slightly tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Protuberent, Soft, NT, ND, no HSM
EXT: No c/c/e, 2+ radian and PT pulses
SKIN: erythematous macular region on left face. No decoloration
on legs or arms.
Neuro: no focal findings, A Ox3
Psych: appears somewhat anxious, near tearful when discussing
her disease.  Overall appropriate.


Pertinent Results:
CHEST (PA & LAT)	 [**2143-3-28**]:
IMPRESSION: No acute cardiopulmonary process.

HEMATOLOGY:
[**2143-3-27**] 11:55PM BLOOD WBC-12.6* RBC-3.84* Hgb-11.4* Hct-32.2*
MCV-84 MCH-29.6 MCHC-35.3* RDW-15.0 Plt Ct-292
[**2143-3-30**] 09:00AM BLOOD WBC-14.7* RBC-3.31* Hgb-9.9* Hct-29.7*
MCV-90 MCH-30.0 MCHC-33.5 RDW-15.0 Plt Ct-207
[**2143-4-2**] 06:00AM BLOOD WBC-17.9* RBC-4.54 Hgb-13.3 Hct-38.4
MCV-85 MCH-29.2 MCHC-34.6 RDW-14.9 Plt Ct-335

COAGS:
[**2143-3-28**] 06:00AM BLOOD PT-13.0 PTT-26.0 INR(PT)-1.1
[**2143-3-31**] 08:45AM BLOOD PT-16.1* PTT-24.3 INR(PT)-1.4*
[**2143-4-1**] 06:15AM BLOOD PT-14.8* PTT-25.2 INR(PT)-1.3*

CHEMISTRY:
[**2143-3-28**] 06:00AM BLOOD Glucose-126* UreaN-8 Creat-0.9 Na-141
K-4.1 Cl-106 HCO3-23 AnGap-16
[**2143-3-28**] 06:00AM BLOOD Calcium-9.4 Phos-3.2 Mg-2.2
[**2143-3-28**] 06:00AM BLOOD LD(LDH)-235 AlkPhos-54
[**2143-3-31**] 08:45AM BLOOD Glucose-125* UreaN-16 Creat-0.7 Na-141
K-4.1 Cl-109* HCO3-21* AnGap-15
[**2143-3-31**] 08:45AM BLOOD Calcium-9.0 Phos-3.1 Mg-2.2
[**2143-4-1**] 06:15AM BLOOD Glucose-114* UreaN-17 Creat-0.8 Na-143
K-4.0 Cl-106 HCO3-26 AnGap-15
[**2143-4-1**] 06:15AM BLOOD Calcium-9.1 Phos-4.1 Mg-2.4

URINE:
[**2143-3-28**] 12:00AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG

MISCELLANEOUS:
Test                          Result              Reference
Range/Units
TRYPTASE                      98  H               [**3-12**] NG/ML


Brief Hospital Course:
## Mastocytosis:
Pt has a 9 yr history of the systemic mastocytosis, with flares
normally 3/year.  This is patient's 3rd flare in 2 months, while
still on steroid taper and [**Month/Year (2) 500**] pain which is new for her.  She
responded well to 125 mg IV steroids q 8 hrs and IV
diphenydramine in addition to her continuing home regimen.  CBC
was at her baseline, w/normal differential. [**Month/Year (2) **] pain was
investigated with LDH and AlkPhos which were both WNL. Her new
[**Hospital1 112**] allergist, Dr. [**Last Name (STitle) **] was contact[**Name (NI) **].  She recommended
repeating her serum tryptase, ordering a 24 hr urine histamine,
and if possible performing an aspirin challenge in house.  Serum
tryptase revealed a high value at 84. The patient has a
particularly high level of urine prostaglandins, making aspirin
therapy an ideal treatment.  Unfortunately, she had a possible
flare [**3-4**] aspirin in [**2136**].  The challenge was performed the day
of admission and an adverse reaction at the maximum aspirin dose
resulted in an ICU course. She was stabilized on IV steroids and
IV benadryl and transferred back to the medical floor. She
continued on her home histamine receptor blockers and was
transitioned from IV to PO steroids and benadryl and observed
overnight prior to discharge on a steroid taper as recommended
by  Dr. [**Last Name (STitle) 2603**], [**Hospital1 18**] allergist. She had no further symptoms of
flushing or tachycardia following transfer from the ICU to the
medical floor and was discharged on her home meds, prednisone
taper, GI prophylaxis with PPI, Calcium and vitamin D, and SS
bactrim for PCP [**Name Initial (PRE) 1102**].

## Anxiety/depression:
Pt admitted to a problem with worsening anxiety, and that she
appreciates the sedative affect of her IV diphenhydramine.  She
had been feeling down since her severe flare in [**2142-10-1**], and
that she does not go out with her husband because she fears a
flare.  She denied hopelessness or intent to harm self or
others.  She has agreed to outpatient therapy and has been
referred.  Per PCP [**Name Initial (PRE) **]'s she is discharged on 0.5 ativan TID PRN
up from [**Hospital1 **].

Medications on Admission:
1. Cetirizine 10 mg Tablet Sig: One (1) Tablet PO twice a day.
2. Cromolyn 100 mg/5 mL Solution Sig: Two Hundred (200) mg PO
four times a day.
3. Doxepin 50 mg Capsule Sig: One (1) Capsule PO twice a day.
4. EpiPen 0.3 mg/0.3 mL Pen Injector Sig: One (1) injection
Intramuscular once as needed for as directed.- confirmed not
expired
5. Hydroxyzine HCl 50 mg Tablet Sig: One (1) Tablet PO twice a
day.
6. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for anxiety.
7. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID
9. Prednisone taper (currently on 30 mg daily but took a total
of 60 mg today at home due to flare)
10. NuvaRing
11. Cromolyn Cream (not currently using)
12. Ketotifen 2mg [**Hospital1 **] (canadian medication)


Discharge Medications:
1. Cetirizine 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. ketotifen  Sig: Two (2) mg PO twice a day.
5. NuvaRing 0.12-0.015 mg/24 hr Ring Sig: One (1)  Vaginal once
a month.
6. Bactrim 80-400 mg Tablet Sig: One (1) Tablet PO once a day:
Please take once daily as long as you are taking prednisone.
Disp:*30 Tablet(s)* Refills:*2*
7. Caltrate-600 Plus Vitamin D3 600-400 mg-unit Tablet Sig: One
(1) Tablet PO twice a day: Please take once daily as long as you
are taking prednisone.
Disp:*60 Tablet(s)* Refills:*2*
8. Cromolyn 100 mg/5 mL Solution Sig: Ten (10) mL PO QID (4
times a day) as needed for mastocytosis.
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day): Please
take twice daily as long as you are taking prednisone.
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
10. Hydroxyzine HCl 25 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
Disp:*180 Tablet(s)* Refills:*2*
11. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety.
Disp:*30 Tablet(s)* Refills:*0*
12. Doxepin 25 mg Capsule Sig: Two (2) Capsule PO BID (2 times a
day).
13. Prednisone 10 mg Tablet Sig: Five (5) Tablet PO twice a day
for 5 days: At end of 5 days, on [**2143-4-7**], start once daily
prednisone taper as instructed.
14. Prednisone 10 mg Tablet Sig: As per taper. Tablet PO once a
day for 9 weeks: After 5 days of 50 mg twice daily, starting on
[**2143-4-7**] take 6 pills for 5 days, 5 pills for 7 days, 4 pills
for 7 days, 3 pills for 7 days, 2 pills for 7 days, 1.5 pills
for 7 days, 1 pill for 7 days, 0.5 pill for 7 days.
Disp:*210 Tablet(s)* Refills:*0*
15. Diphenhydramine HCl 25 mg Capsule Sig: [**2-1**] Capsules PO Q6H
(every 6 hours) as needed.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Mastocytosis
Secondary Diagnosis:
Anxiety


Discharge Condition:
Hemodynamically Stable


Discharge Instructions:
You were admitted to the hospital with flushing and a fast heart
rate, consistent with a flare of your mastocystosis.  You were
treated with IV steroids, IV benadryl, and your home
medications. You have been discharged on a gradual steroid
taper, since you have been on steroids for over 6 weeks now.

Please continue to take you medicines as directed, the changes
you should make are as follows:
Prednisone Taper:
50 mg twice daily for 5 days,
60 mg once daily for 5 days,
50 mg once daily for 7 days,
40 mg once daily for 7 days,
30 mg once daily for 7 days,
20 mg once daily for 7 days,
15 mg once daily for 7 days,
10 mg once daily for 7 days,
5 mg once daily for 7 days.
Caltrate 600 + D: One tablet twice daily while on prednisone to
prevent [**Month/Day (2) 500**] loss.
Omeprazole: One tablet twice daily while on prednisone to
prevent ulcer.
Bactrim: One tablet every day while on prednisone to prevent
infections.

Please attend the follow up appointments listed below.

Please seek medical help if you experience more signs of a
worsening flare, chest pain or pressure, severe fever, or any
other concerning symptoms.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Apartment Address(1) **] (ST-3) GI ROOMS Date/Time:[**2143-4-9**] 8:30

Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2143-4-9**]
8:30

Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 5808**] Date/Time:[**2143-4-11**]
4:00



Completed by:[**2143-4-7**]
{'Malignant mast cell tumors, unspecified site, extranodal and solid organ sites,Hypovolemia,Esophagitis, unspecified,Disorder of bone and cartilage, unspecified,Anemia, unspecified,Anxiety state, unspecified,Long-term (current) use of steroids,Need for desensitization to allergens,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Nonspecific abnormal findings in stool contents'}


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: Flushing and tachycardia

PRESENT ILLNESS: Ms [**Known lastname 2696**] is a 28 year old woman with a 9 yr history of
systemic mastocytosis, with 2 recent admissions for flares,
presenting with an acute flare which began last night.
.
She woke from sleep with symptoms of skin flushing and
palpitations and wanted to seek medical care before things got
worse. She denies n/v, abdominal pain and diarrhea which normall
accompany her flares.  She cannot identify a particular trigger.
Since her last admission 2 weeks ago, she has been having some
flushing nightly, and several episodes of "[**Known lastname 500**] pain" in her
wrists, elbows, shoulders and back which is new for her.  She is
still on a prednisone taper from her last flare earlier this
month at which time she was admitted from [**Date range (1) 59412**].  That flare
occured while still on a prednisone taper from a flare in late
[**Month (only) 404**] attibuted to a viral illness.  The patient is used to
having flares only 2-3 times per year, and never while still on
a prednisone dose.
.
Her first episode began at age 19 with flushing associated with
hypotension and heart racing. She was diagnosed 3yrs later in
[**2136**] when tryptase levels were noted to be elevated. She has not
had a successful [**Year (4 digits) 500**] marrow biopsy in the past despite 2
attempts at UCSF. Triggers include stress, NSAIDS, ASA, opiates,
and iodine including contrast dyes.
.
In the ED Vitals: T 97.6 HR 97 150/87 RR 20 O2 Sat 100% RA.
Patient given 125mg solumedrol, 50mg IV Benadryl x 2, Famotidine
and Tylenol 650 mg PO x1 and NS IV fluids.  The patient's
symptoms improved and she was admitted to the floor.
.
This morning, the patient feels well and symptoms are mostly
resolved. She remains very anxious about her conditions and
making sure the flare does not return, and is concerned with the
apparent recent progression of her illness.  She also admits to
increase stress secondary to her condition, and is becoming more
convinced that some therapy may be useful to her.  She was
recently started on as standing lorazepam dose of 0.5mg [**Hospital1 **] by
her allergist to help her stay more calm.

MEDICAL HISTORY: -Systemic mastocytosis, followed by Dr.[**Last Name (STitle) 2603**], Allergy
specialist and Dr. [**Last Name (STitle) **] of [**Hospital1 112**]
-History of coffee ground emesis in the setting of Mastocytosis
flare and nausea/vomitting in [**7-/2142**]
-Anemia, low normal MCV, iron panel in [**3-/2141**] iron 79, TIBC 364,
Ferritin 55, Transferin 280, in [**10/2142**] normal B12 and folate
-Thumb surgery
-Tonsillectomy
-Hemorrhoids

MEDICATION ON ADMISSION: 1. Cetirizine 10 mg Tablet Sig: One (1) Tablet PO twice a day.
2. Cromolyn 100 mg/5 mL Solution Sig: Two Hundred (200) mg PO
four times a day.
3. Doxepin 50 mg Capsule Sig: One (1) Capsule PO twice a day.
4. EpiPen 0.3 mg/0.3 mL Pen Injector Sig: One (1) injection
Intramuscular once as needed for as directed.- confirmed not
expired
5. Hydroxyzine HCl 50 mg Tablet Sig: One (1) Tablet PO twice a
day.
6. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for anxiety.
7. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID
9. Prednisone taper (currently on 30 mg daily but took a total
of 60 mg today at home due to flare)
10. NuvaRing
11. Cromolyn Cream (not currently using)
12. Ketotifen 2mg [**Hospital1 **] (canadian medication)

ALLERGIES: Aspirin / Iodine / Nsaids / Opioid Analgesics

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS: 98.3  129/91   108  18  100% RA
GEN: NAD, awake, alert
HEENT: EOMI, PERRL 9->5, sclera anicteric, conjunctivae clear,
pale, OP moist and without lesion
NECK: Supple, no JVD, no LAD
CV: Slightly tachycardic, normal S1, S2. No m/r/g.
CHEST: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABD: Protuberent, Soft, NT, ND, no HSM
EXT: No c/c/e, 2+ radian and PT pulses
SKIN: erythematous macular region on left face. No decoloration
on legs or arms.
Neuro: no focal findings, A Ox3
Psych: appears somewhat anxious, near tearful when discussing
her disease.  Overall appropriate.

FAMILY HISTORY: Father alive and in good health, mother has MS. [**Name13 (STitle) **] family h/o
allergic, rheumatologic, or autoimmune diseases. Grandfather
with CAD, colon CA and grandmother with skin CA.

SOCIAL HISTORY: Patient employed as a librarian. Honorably discharged from air
force in [**2139**] due to her recurrent mastocytosis flares and
hospitalizations.
Married, no children. Does not smoke or use drugs, social
drinker. 

### Response:
{'Malignant mast cell tumors, unspecified site, extranodal and solid organ sites,Hypovolemia,Esophagitis, unspecified,Disorder of bone and cartilage, unspecified,Anemia, unspecified,Anxiety state, unspecified,Long-term (current) use of steroids,Need for desensitization to allergens,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Nonspecific abnormal findings in stool contents'}
