CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 60 year old
female with a history of low grade Stage IV follicular
lymphoma, status post multiple recurrences auto bone marrow
transplant and questionable history of congestive heart
failure, who presented from clinic with fever and
neutropenia.  She was recently admitted one week prior with
increasing neck lymphadenopathy and was treated with CEPP and
sent home with p.o. Etoposide and Prednisone.  She had been
feeling well and has no complaints.  She denies fevers,
chills, nausea, vomiting, diarrhea, dysuria, neck pain,
worsening cough or other symptoms.  Her review of systems was
unremarkable.  She did complain of chronic sore throat and a
herpetic lesion on her right lip.  The patient came to clinic
today for regular follow-up care and it was not an episodic
visit.  She was surprised to learn that she was febrile.

MEDICAL HISTORY: 1. Low grade lymphoma initially Stage IV follicular lymphoma
   diagnosed in [**2180**].  At the same time, Stage 0 lung
   carcinoma was diagnosed.  She is status post thoracostomy
   [**2180-6-5**], for resection.  She had multiple chemotherapy
   cycles. auto bone marrow transplant in [**2183**], had eighteen
   months of remission with recurrence and was treated with
   Rituxan in [**2185**], [**2186**], and [**2187**].  In [**2188-9-5**], she was
   found to have new anemia and progressive lymphadenopathy
   in the axillary, hilar, subcarinal, inguinal regions.  She
   was admitted for Antastan and Cytoxan with the course
   complicated by neutropenia.  She was admitted again [**10-9**],
   with another cycle with the course complicated by
   congestive heart failure that responded to diuretics.  She
   was admitted again in [**11-8**], for a third cycle with a
   complicated course in which she was intubated and required
   monitoring in the Intensive Care Unit.  She subsequently
   went to [**State 108**] for the winter and was recently admitted
   [**5-10**], for a cycle of CEPP with Cytoxan, Etoposide,
   Prednisone for presumably large B cell lymphoma
   transformation.
2. Paget's disease.
3. History of shingles T10 to T12 with postherpetic
   neuralgia.
4. History of pneumonia.
5. History of gastroesophageal reflux disease.
6. Status post cholecystectomy.
7. Seasonal allergies.
8. Possible history of congestive heart failure with an
   ejection fraction of 45 to 50 percent on previous
   echocardiograms.
9. Total abdominal hysterectomy, bilateral salpingo-
   oophorectomy.

MEDICATION ON ADMISSION: 1. Ciprofloxacin 500 mg twice a day.
2. Colace 100 mg twice a day.
3. Detrol 2 mg twice a day.
4. Trazodone 150 mg q.h.s.
5. Allopurinol 300 mg once daily.
6. OxyContin 80 mg twice a day.
7. Compazine 10 mg p.r.n.
8. Nexium 40 mg once daily.
9. Lorazepam 0.5 mg q6-8hours p.r.n.
10.      Paxil 30 mg once daily.
11.      Multivitamin.
12.      Bisacodyl 10 mg q.h.s.
13.      [**Doctor First Name **] 60 mg twice a day.
14.      Oxycodone 10 mg three times a day.
15.      Prednisone taper 100 mg number six of eight today.
16.      Etoposide 240 mg times two days which were given
   [**2189-5-30**], and [**2189-5-31**].
17.      Aranesp given two weeks in clinic.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She is a retired kindergarten teacher,
married, lives with her sister who is now her caretaker.  [**Name (NI) **]
husband is currently in the [**Hospital **] Hospital.
Pneumonia due to Klebsiella pneumoniae,Reticulosarcoma, unspecified site, extranodal and solid organ sites,Secondary malignant neoplasm of pleura,Herpes zoster with other nervous system complications,Other disorders of neurohypophysis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified
K. pneumoniae pneumonia,Retclsrc unsp xtrndl org,Second malig neo pleura,H zoster nerv syst NEC,Neurohypophysis dis NEC,Chr airway obstruct NEC,CHF NOS
Admission Date: [**2189-6-4**]        Discharge Date: [**2189-6-28**]

Date of Birth:  [**2129-2-24**]        Sex:  F

Service:


This is a discharge summary up until [**2189-6-20**].  A subsequent
dictation summary addendum will follow.

HISTORY OF PRESENT ILLNESS:  The patient is a 60 year old
female with a history of low grade Stage IV follicular
lymphoma, status post multiple recurrences auto bone marrow
transplant and questionable history of congestive heart
failure, who presented from clinic with fever and
neutropenia.  She was recently admitted one week prior with
increasing neck lymphadenopathy and was treated with CEPP and
sent home with p.o. Etoposide and Prednisone.  She had been
feeling well and has no complaints.  She denies fevers,
chills, nausea, vomiting, diarrhea, dysuria, neck pain,
worsening cough or other symptoms.  Her review of systems was
unremarkable.  She did complain of chronic sore throat and a
herpetic lesion on her right lip.  The patient came to clinic
today for regular follow-up care and it was not an episodic
visit.  She was surprised to learn that she was febrile.

PAST MEDICAL HISTORY:
1. Low grade lymphoma initially Stage IV follicular lymphoma
   diagnosed in [**2180**].  At the same time, Stage 0 lung
   carcinoma was diagnosed.  She is status post thoracostomy
   [**2180-6-5**], for resection.  She had multiple chemotherapy
   cycles. auto bone marrow transplant in [**2183**], had eighteen
   months of remission with recurrence and was treated with
   Rituxan in [**2185**], [**2186**], and [**2187**].  In [**2188-9-5**], she was
   found to have new anemia and progressive lymphadenopathy
   in the axillary, hilar, subcarinal, inguinal regions.  She
   was admitted for Antastan and Cytoxan with the course
   complicated by neutropenia.  She was admitted again [**10-9**],
   with another cycle with the course complicated by
   congestive heart failure that responded to diuretics.  She
   was admitted again in [**11-8**], for a third cycle with a
   complicated course in which she was intubated and required
   monitoring in the Intensive Care Unit.  She subsequently
   went to [**State 108**] for the winter and was recently admitted
   [**5-10**], for a cycle of CEPP with Cytoxan, Etoposide,
   Prednisone for presumably large B cell lymphoma
   transformation.
2. Paget's disease.
3. History of shingles T10 to T12 with postherpetic
   neuralgia.
4. History of pneumonia.
5. History of gastroesophageal reflux disease.
6. Status post cholecystectomy.
7. Seasonal allergies.
8. Possible history of congestive heart failure with an
   ejection fraction of 45 to 50 percent on previous
   echocardiograms.
9. Total abdominal hysterectomy, bilateral salpingo-
   oophorectomy.


ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS ON ADMISSION:
1. Ciprofloxacin 500 mg twice a day.
2. Colace 100 mg twice a day.
3. Detrol 2 mg twice a day.
4. Trazodone 150 mg q.h.s.
5. Allopurinol 300 mg once daily.
6. OxyContin 80 mg twice a day.
7. Compazine 10 mg p.r.n.
8. Nexium 40 mg once daily.
9. Lorazepam 0.5 mg q6-8hours p.r.n.
10.      Paxil 30 mg once daily.
11.      Multivitamin.
12.      Bisacodyl 10 mg q.h.s.
13.      [**Doctor First Name **] 60 mg twice a day.
14.      Oxycodone 10 mg three times a day.
15.      Prednisone taper 100 mg number six of eight today.
16.      Etoposide 240 mg times two days which were given
   [**2189-5-30**], and [**2189-5-31**].
17.      Aranesp given two weeks in clinic.


SOCIAL HISTORY:  She is a retired kindergarten teacher,
married, lives with her sister who is now her caretaker.  [**Name (NI) **]
husband is currently in the [**Hospital **] Hospital.

PHYSICAL EXAMINATION:  Initial vital signs showed a
temperature 98.4, blood pressure 112/74, pulse 60,
respiratory rate 16 breaths per minute, stable oxygen
saturation.  General appearance, the patient is comfortable
in no apparent distress.  Head and neck examination revealed
mild alopecia.  The mucous membranes are moist.  The
oropharynx showed some diffuse erythema.  Neck - mild shotty
cervical lymphadenopathy, no swelling.  Lungs revealed slight
decreased breath sounds at the bases bilaterally, right
greater than left.  Cardiovascular examination revealed
regular rate and rhythm, no murmurs, rubs or gallops.  The
abdomen is soft, nontender, nondistended.  Extremities - no
cyanosis, clubbing or edema.  Neurologic examination was
nonfocal.

LABORATORY DATA:  Initial laboratories were notable for a
white blood cell count of 0.8 with 80 percent neutrophils, 7
percent bands, 10 percent lymphocytes, 2 percent monocytes,
hematocrit 31.5, platelet count 108,000, and ANC 180.  Normal
Chem7.  Normal liver function tests.  Calcium, magnesium and
phosphorus within normal limits.

HOSPITAL COURSE:
1. Cardiovascular - The patient had stable blood pressure on
   admission but with her fever and neutropenia, she did have
   an episode of lower systolic blood pressure into the 80s.
   She was briefly admitted into the Intensive Care Unit and
   was given intravenous fluid hydration with improvement.
   She had an echocardiogram at that time showing a normal
   ejection fraction.  Also of note, there was a sessile mass
   in the right atrium unclear significance.  Her blood
   pressure was subsequently stable with no further episodes
   of hypotension.

1. Oncology/neutropenia - The patient is followed by Dr.
   [**First Name (STitle) 1557**].  She was persistently neutropenic during the first
   several weeks of her hospital course.  Her counts were
   slowly beginning to recover.  Her G-CSF was discontinued
   [**2189-6-20**], for an ANC over 500.  She had a small pleural
   effusion tapped looking for source of infection which did
   show atypical lymphocytes consistent with persistent
   malignancy.

1. Pulmonary/infectious disease - The patient had febrile
   neutropenia initially treated with Vancomycin, [**Month/Day/Year 18517**] and
   AmBisome, as well as Flagyl.  She developed some diffuse
   erythema of unclear etiology and her [**Name (NI) 18517**] was changed to
   Levofloxacin and AmBisome was changed to Voriconazole
   although a clear allergy had not been documented.  She
   slowly developed increasing oxygen requirement.  Although
   her initial chest x-ray findings were negative, she seemed
   to develop increasing infiltrates and effusions.
   Pulmonary and infectious disease teams were involved.  The
   patient had sputum which was sent and consistent with a
   pan-resistant Klebsiella which is only sensitive to
   Meropenem.  At that time, the patient was switched to
   Vancomycin, Meropenem and Voriconazole as there did not
   seem to be added benefit of Levofloxacin or Flagyl with
   this regimen.  She continued to have an increasing oxygen
   requirement and at times required a nonrebreather.  She
   had been getting nebulizers and steroid treatments because
   of a possible history of chronic obstructive pulmonary
   disease and chronic outpatient steroid use.  She was
   aggressively diuresed for possible pulmonary edema
   component of her hypoxia.  She had a bronchoscopy done by
   pulmonary.  This showed significant mucous plugging and
   also grew out some other pan-resistant Klebsiella.  The
   patient was persistently hypoxic at the time of this
   dictation.

1. Code Status - It was explained to the patient that as her
   white blood cell counts increased and that we now
   beginning to treat this pan-resistant Klebsiella that her
   pulmonary status may decline in the short term until this
   pneumonia resolves.  She stated clearly in the presence of
   her family that she did not desire resuscitative measures
   and did not want to be intubated if she were to decline.
   The patient was made DNR/DNI and the [**Hospital Unit Name 153**] team was not
   involved as the patient would not want more aggressive
   measures.

1. Pain control - The patient had been on outpatient
   OxyContin and her dose was lowered because of her tenuous
   respiratory status.

1. Anxiety - The patient appears to have a component of
   anxiety with her hypoxia.  She was continued on Paxil.
   She was initially placed on Ativan and was given Ativan
   prior to procedures.  Standing benzodiazepines were
   discontinued because of her tenuous respiratory status.

1. Orthopedics - The patient was wearing a brace on her right
   hand for a healing fracture.  The patient self
   discontinued her brace and was using her hand without any
   significant discomfort.

1. Bladder spasms - The patient was continued on Detrol as
   she was taking as an outpatient.

A follow-up dictation summary addendum will relay the
[**Hospital 228**] hospital course after [**2189-6-20**].





              DR.[**Last Name (STitle) **],[**First Name3 (LF) **]

Dictated By:[**Last Name (NamePattern1) 2366**]
MEDQUIST36
D:  [**2189-6-21**] 11:26:46
T:  [**2189-6-21**] 12:58:47
Job#:  [**Job Number **]




Name:  [**Known lastname 2738**], [**Known firstname 2739**]           Unit No:  [**Numeric Identifier 2740**]

Admission Date: [**2189-6-4**]        Discharge Date: [**2189-6-28**]

Date of Birth:  [**2129-2-24**]        Sex:  F

Service:  OME


ADDENDUM:  This is a Discharge Summary Addendum for the dated
[**2189-6-21**] to [**2189-6-28**].  Please see previous dictation
for admission and hospital course summary.

Shortly after [**2189-6-22**] the patient was made comfort
measures only after continuing to have increasing oxygen
requirements and indicating that she did not wish to pursue
further treatment.  The patient's family concurred with this
plan of action.  Therefore, on [**2189-6-26**] the patient was
started on a morphine drip for comfort given her oxygen
requirement on a nonrebreather plus nasal cannula.  She
passed away peacefully in the presence of her loved ones on
[**2189-6-28**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 2744**]

Dictated By:[**Last Name (NamePattern1) 2745**]
MEDQUIST36
D:  [**2189-7-25**] 16:49:13
T:  [**2189-7-25**] 18:30:32
Job#:  [**Job Number 2746**]
{'Pneumonia due to Klebsiella pneumoniae,Reticulosarcoma, unspecified site, extranodal and solid organ sites,Secondary malignant neoplasm of pleura,Herpes zoster with other nervous system complications,Other disorders of neurohypophysis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified'}


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: 

PRESENT ILLNESS: The patient is a 60 year old
female with a history of low grade Stage IV follicular
lymphoma, status post multiple recurrences auto bone marrow
transplant and questionable history of congestive heart
failure, who presented from clinic with fever and
neutropenia.  She was recently admitted one week prior with
increasing neck lymphadenopathy and was treated with CEPP and
sent home with p.o. Etoposide and Prednisone.  She had been
feeling well and has no complaints.  She denies fevers,
chills, nausea, vomiting, diarrhea, dysuria, neck pain,
worsening cough or other symptoms.  Her review of systems was
unremarkable.  She did complain of chronic sore throat and a
herpetic lesion on her right lip.  The patient came to clinic
today for regular follow-up care and it was not an episodic
visit.  She was surprised to learn that she was febrile.

MEDICAL HISTORY: 1. Low grade lymphoma initially Stage IV follicular lymphoma
   diagnosed in [**2180**].  At the same time, Stage 0 lung
   carcinoma was diagnosed.  She is status post thoracostomy
   [**2180-6-5**], for resection.  She had multiple chemotherapy
   cycles. auto bone marrow transplant in [**2183**], had eighteen
   months of remission with recurrence and was treated with
   Rituxan in [**2185**], [**2186**], and [**2187**].  In [**2188-9-5**], she was
   found to have new anemia and progressive lymphadenopathy
   in the axillary, hilar, subcarinal, inguinal regions.  She
   was admitted for Antastan and Cytoxan with the course
   complicated by neutropenia.  She was admitted again [**10-9**],
   with another cycle with the course complicated by
   congestive heart failure that responded to diuretics.  She
   was admitted again in [**11-8**], for a third cycle with a
   complicated course in which she was intubated and required
   monitoring in the Intensive Care Unit.  She subsequently
   went to [**State 108**] for the winter and was recently admitted
   [**5-10**], for a cycle of CEPP with Cytoxan, Etoposide,
   Prednisone for presumably large B cell lymphoma
   transformation.
2. Paget's disease.
3. History of shingles T10 to T12 with postherpetic
   neuralgia.
4. History of pneumonia.
5. History of gastroesophageal reflux disease.
6. Status post cholecystectomy.
7. Seasonal allergies.
8. Possible history of congestive heart failure with an
   ejection fraction of 45 to 50 percent on previous
   echocardiograms.
9. Total abdominal hysterectomy, bilateral salpingo-
   oophorectomy.

MEDICATION ON ADMISSION: 1. Ciprofloxacin 500 mg twice a day.
2. Colace 100 mg twice a day.
3. Detrol 2 mg twice a day.
4. Trazodone 150 mg q.h.s.
5. Allopurinol 300 mg once daily.
6. OxyContin 80 mg twice a day.
7. Compazine 10 mg p.r.n.
8. Nexium 40 mg once daily.
9. Lorazepam 0.5 mg q6-8hours p.r.n.
10.      Paxil 30 mg once daily.
11.      Multivitamin.
12.      Bisacodyl 10 mg q.h.s.
13.      [**Doctor First Name **] 60 mg twice a day.
14.      Oxycodone 10 mg three times a day.
15.      Prednisone taper 100 mg number six of eight today.
16.      Etoposide 240 mg times two days which were given
   [**2189-5-30**], and [**2189-5-31**].
17.      Aranesp given two weeks in clinic.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She is a retired kindergarten teacher,
married, lives with her sister who is now her caretaker.  [**Name (NI) **]
husband is currently in the [**Hospital **] Hospital. 

### Response:
{'Pneumonia due to Klebsiella pneumoniae,Reticulosarcoma, unspecified site, extranodal and solid organ sites,Secondary malignant neoplasm of pleura,Herpes zoster with other nervous system complications,Other disorders of neurohypophysis,Chronic airway obstruction, not elsewhere classified,Congestive heart failure, unspecified'}
