CHIEF COMPLAINT: Transfer from OSH after bleed into mesenteric B cell lymphoma
s/p recent CHOP

PRESENT ILLNESS: Pt is a 60F with large B cell lymphoma, HTN recently discharged
on [**2156-9-19**] from [**Hospital1 18**] after starting CHOP for newly diagnosed
lymphoma.  On her last hospitalization she was tolerating CHOP
well, had thrombocytopenia thought to be secondary to autoimmune
destruction and she was tranfused 1 unit of plts before
discharge and went up to 47 with follow up in 2 days in clinic.
Also, had some hallucinations related to percocet but she wanted
to stay on this because she felt it controlled her pain well and
was aware of the hallucinations.  She was discharged home on 1
lst day of steroids, compazine, percocet, potassium,
allopurinol, colace, senna and lactulose.  Her dyazide was held
because she was hypotensive and her K was low.
     On the day after discharge her husband called me as she had
an episode of syncope after bought of diarrhea. Denied head
trauma. Told her to go to the ED. She had another episode when
the EMTs arrived and 3 subsequent episodes related to position
in the ED at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 55412**] Hospital. Found to be hypotensive with
10 pt drop in hct to 18 and SBP remained in 80's depsite 2 lites
of fluid. Ct abdomen reportedly showed hemoperitoneum. She was
transfused 3 units pRBCs, 3 bags of plts. Hct stable in 25-27
range post transfusion originally transfused to SICU. Now
transferred to OMED service for further management.
 Currently feels OK. Denies fevers, chills, CP, SOB,
palpitations, diarrhea, melena, BRBPR, N/V, dysuria. Denies any
dizziness. Does say that she had some "floaters" in her vision
was she was hypotensive but since resolved. Noticed a few more
bruises, no bleeding gums, small amount of crusted blood in
nose.

MEDICAL HISTORY: 1. Hypertension
2. s/p ovarian cystectomy of 7cm benign L ovarian cyst [**2147**] at
[**Hospital 189**] Hosp
2. s/p D&C for menometrorrhagia [**2147**]
3. s/p post-partum tubal ligation
4. Gyn history: menarche 15-16, regular monthly menses, OCP from
'[**18**]-'[**30**] for contraception, LMP: 5 years ago
5. Abdominal mass s/p bx with Large B cell lymphoma s/p CHOP
last week (as above)

MEDICATION ON ADMISSION: MVI, Percocet prn, Docusate, Acetaminophen prn, Allopurinol,
Lactulose, Bisacodyl prn, Prochlorperazine prn, Senna, KCl 40
meq qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS Tm 99.4 Tc 99.3 BP 117-140/60-90 HR 68 (68-98) RR 18 97% RA
I/O 2720/950
GEN: thin female in NAD
HEENT: PERRL, EOMI, anicteric, neck supple and symmetric
CV: Reg S1 S2 no m/r/g
LUNG: crackles at L bases, clear with cough, otherwise CTA b/l
ABD: mild distention, no HSM, bandaid in hypogastric area from
bx, non-tender, NABS
EXT: no edema
Neuro: A&O x 3, CN 2-12 intact, 5/5 strength in all ext,
sensation grossly intact
Back: no spinal tenderness, no flank pain

FAMILY HISTORY: + CAD/CHF
no ovarian/colon/uterine/cervix CA, maternal great aunt with
breast CA
Mother died last year of dementia
Has a son with schizophrenia

SOCIAL HISTORY: [**Name6 (MD) 1403**] as RN. Used to work on 7F. Nonsmoker. Very rare EtoH.
Married with 2 children, 1 son who is schizophrenic.  Very
active walking up to 4 miles per day.
Reticulosarcoma, intra-abdominal lymph nodes,Hemoperitoneum (nontraumatic),Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Other specified disease of white blood cells
Reticulosarcoma abdom,Hemoperitoneum,Urin tract infection NOS,Ac posthemorrhag anemia,Wbc disease NEC
Admission Date:  [**2156-9-20**]              Discharge Date:   [**2156-9-30**]

Date of Birth:  [**2096-8-13**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 16983**]
Chief Complaint:
Transfer from OSH after bleed into mesenteric B cell lymphoma
s/p recent CHOP

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Pt is a 60F with large B cell lymphoma, HTN recently discharged
on [**2156-9-19**] from [**Hospital1 18**] after starting CHOP for newly diagnosed
lymphoma.  On her last hospitalization she was tolerating CHOP
well, had thrombocytopenia thought to be secondary to autoimmune
destruction and she was tranfused 1 unit of plts before
discharge and went up to 47 with follow up in 2 days in clinic.
Also, had some hallucinations related to percocet but she wanted
to stay on this because she felt it controlled her pain well and
was aware of the hallucinations.  She was discharged home on 1
lst day of steroids, compazine, percocet, potassium,
allopurinol, colace, senna and lactulose.  Her dyazide was held
because she was hypotensive and her K was low.
     On the day after discharge her husband called me as she had
an episode of syncope after bought of diarrhea. Denied head
trauma. Told her to go to the ED. She had another episode when
the EMTs arrived and 3 subsequent episodes related to position
in the ED at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 55412**] Hospital. Found to be hypotensive with
10 pt drop in hct to 18 and SBP remained in 80's depsite 2 lites
of fluid. Ct abdomen reportedly showed hemoperitoneum. She was
transfused 3 units pRBCs, 3 bags of plts. Hct stable in 25-27
range post transfusion originally transfused to SICU. Now
transferred to OMED service for further management.
 Currently feels OK. Denies fevers, chills, CP, SOB,
palpitations, diarrhea, melena, BRBPR, N/V, dysuria. Denies any
dizziness. Does say that she had some "floaters" in her vision
was she was hypotensive but since resolved. Noticed a few more
bruises, no bleeding gums, small amount of crusted blood in
nose.


Past Medical History:
1. Hypertension
2. s/p ovarian cystectomy of 7cm benign L ovarian cyst [**2147**] at
[**Hospital 189**] Hosp
2. s/p D&C for menometrorrhagia [**2147**]
3. s/p post-partum tubal ligation
4. Gyn history: menarche 15-16, regular monthly menses, OCP from
'[**18**]-'[**30**] for contraception, LMP: 5 years ago
5. Abdominal mass s/p bx with Large B cell lymphoma s/p CHOP
last week (as above)

Social History:
[**Name6 (MD) 1403**] as RN. Used to work on 7F. Nonsmoker. Very rare EtoH.
Married with 2 children, 1 son who is schizophrenic.  Very
active walking up to 4 miles per day.


Family History:
+ CAD/CHF
no ovarian/colon/uterine/cervix CA, maternal great aunt with
breast CA
Mother died last year of dementia
Has a son with schizophrenia

Physical Exam:
VS Tm 99.4 Tc 99.3 BP 117-140/60-90 HR 68 (68-98) RR 18 97% RA
I/O 2720/950
GEN: thin female in NAD
HEENT: PERRL, EOMI, anicteric, neck supple and symmetric
CV: Reg S1 S2 no m/r/g
LUNG: crackles at L bases, clear with cough, otherwise CTA b/l
ABD: mild distention, no HSM, bandaid in hypogastric area from
bx, non-tender, NABS
EXT: no edema
Neuro: A&O x 3, CN 2-12 intact, 5/5 strength in all ext,
sensation grossly intact
Back: no spinal tenderness, no flank pain


Pertinent Results:
[**2156-9-24**] CXR: Limited exam, with bibasilar atelectasis. Early
infiltrate cannot be excluded
.
Blood cultures x2: No growth

URINE CULTURE (Final [**2156-9-27**]):
      ESCHERICHIA COLI.
         >100,000 ORGANISMS/ML. PRESUMPTIVE IDENTIFICATION.
         Trimethoprim/sulfa sensitivity confirmed by
[**Doctor Last Name 3077**]-[**Doctor Last Name 3060**].
      ENTEROBACTER AEROGENES.    >100,000 ORGANISMS/ML..
         Trimethoprim/sulfa sensitivity confirmed by
[**Doctor Last Name 3077**]-[**Doctor Last Name 3060**].
         This organism may develop resistance to third
generation
         cephalosporins during prolonged therapy. Therefore,
isolates that
         are initially susceptible may become resistant within
three to
         four days after initiation of therapy.  For serious
infections,
         repeat culture and sensitivity testing may therefore be
warranted
         if third generation cephalosporins were used.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |          ENTEROBACTER AEROGENES
                             |          |
AMPICILLIN------------   <=2 S
AMPICILLIN/SULBACTAM--   <=2 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S      <=1 S
CEFTAZIDIME-----------   <=1 S      <=1 S
CEFTRIAXONE-----------   <=1 S      <=1 S
CEFUROXIME------------     4 S
GENTAMICIN------------   <=1 S      <=1 S
IMIPENEM--------------   <=1 S        2 S
LEVOFLOXACIN----------<=0.25 S   <=0.25 S
MEROPENEM-------------<=0.25 S   <=0.25 S
NITROFURANTOIN--------  <=16 S       32 S
PIPERACILLIN----------   <=4 S       16 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S      <=1 S
TRIMETHOPRIM/SULFA----   <=1 S      <=1 S
.
Repeat urine culture on [**2156-9-27**]: No growth

[**2156-9-19**] 06:00AM BLOOD WBC-5.0 RBC-3.39* Hgb-10.0* Hct-28.2*
MCV-83 MCH-29.4 MCHC-35.4* RDW-11.9 Plt Ct-21*
[**2156-9-22**] 09:01PM BLOOD WBC-2.5* RBC-3.18* Hgb-9.7* Hct-27.1*
MCV-85 MCH-30.4 MCHC-35.6* RDW-12.6 Plt Ct-47*
[**2156-9-24**] 07:50AM BLOOD WBC-0.6*# RBC-3.68* Hgb-10.9* Hct-31.0*
MCV-84 MCH-29.5 MCHC-35.1* RDW-12.2 Plt Ct-18*
[**2156-9-25**] 09:10PM BLOOD WBC-0.1*# RBC-3.52* Hgb-10.5* Hct-30.0*
MCV-85 MCH-29.8 MCHC-35.0 RDW-12.5 Plt Ct-7*#
[**2156-9-30**] 08:10AM BLOOD WBC-3.3*# RBC-3.87* Hgb-11.5* Hct-33.3*
MCV-86 MCH-29.7 MCHC-34.5 RDW-15.6* Plt Ct-64*
[**2156-9-19**] 06:00AM BLOOD Neuts-93* Bands-0 Lymphs-7* Monos-0 Eos-0
Baso-0 Atyps-0 Metas-0 Myelos-0
[**2156-9-30**] 08:10AM BLOOD Neuts-19* Bands-8* Lymphs-39 Monos-18*
Eos-0 Baso-4* Atyps-0 Metas-6* Myelos-0 Promyel-4* Other-2*
[**2156-9-21**] 01:11AM BLOOD Fibrino-273
[**2156-9-22**] 08:10AM BLOOD Fibrino-237
[**2156-9-23**] 05:15PM BLOOD Gran Ct-1140*
[**2156-9-25**] 07:50AM BLOOD Gran Ct-30*
[**2156-9-27**] 08:00AM BLOOD Gran Ct-30*
[**2156-9-29**] 08:10AM BLOOD Gran Ct-30*
[**2156-9-30**] 08:10AM BLOOD Gran Ct-1221*
[**2156-9-19**] 06:00AM BLOOD Glucose-124* UreaN-8 Creat-0.5 Na-140
K-3.3 Cl-105 HCO3-26 AnGap-12
[**2156-9-21**] 11:00PM BLOOD Glucose-129* UreaN-15 Creat-0.5 Na-138
K-3.7 Cl-106 HCO3-26 AnGap-10
[**2156-9-28**] 08:00AM BLOOD Glucose-76 UreaN-13 Creat-0.6 Na-140
K-3.3 Cl-105 HCO3-24 AnGap-14
[**2156-9-30**] 08:10AM BLOOD Glucose-98 UreaN-17 Creat-0.6 Na-137
K-3.2* Cl-101 HCO3-27 AnGap-12
[**2156-9-21**] 11:00PM BLOOD Calcium-8.6 Phos-2.6* Mg-2.2 UricAcd-1.5*
[**2156-9-26**] 08:20AM BLOOD Calcium-9.0 Phos-2.5* Mg-2.0
[**2156-9-30**] 08:10AM BLOOD Calcium-9.2 Phos-2.5* Mg-1.9

Brief Hospital Course:
60F with history of abdominal B cell lymphoma s/p CHOP
complicated by bleeding into tumor now with stable hct and
transferred to OMED further management of thrombocytopenia and
lymphoma. During admission devloped febrile neutropenia
secondary to UTI.
.
1. Large b-cell lymphoma: Received CHOP few days prior to
admission without complications. Soon after discharge she
presented to OSH after syncopal episode and was found to have
bleed into her tumor on CT scan and was transferred back to
[**Hospital1 18**] for further management after transfusion with 3 units
pRBCs and platelets. She received 2 bags of platelets while in
the SICU. Upon admission to he OMED service her hematocrit and
blood pressure remained stable, and she had no further abdominal
pain. She received 1 does of Rituxan and was continued on
allopurinol. She will follow up with Dr. [**First Name (STitle) 1557**].

2. Thrombocytopenia: This was felt to be ITP secondary to her
lymphoma. She was treated initially with IVIG with little
response as well as prednisone.  She was then treated with
Rituxan and continued on steroids and her platelets began to
trend up. She was only given one dose of Rituxan as it was
believed that it was contributing to her persistent neutropenia.
 She received a total of 5 bags of platelets during admission.
At discharge her platelets were trending up and she was
discharged on a prednisone taper with follow up with Dr. [**First Name (STitle) 1557**].
.
3. Febrile neutropenia: Patient developed fever but was totally
asymptomatic. Blood cultures were negative and CXR revealed
bibasilar atelectasis and possible early pneumonia. Urine
culture grew enterococcus and e. coli sensitive to levofloxacin.
She was started on cefepime empirically and then switched to
ciprofloxacin when she was no longer neutropenic for 7 days
after discharge. She was afebrile and had no respiratory
symptoms or urinary symptoms at discharge. She received 1 dose
of Neupogen and her ANC a discharge was 1221.
.
4. Anemia: Initial drop in HCT due to bleed into her tumor. She
received  1 unit pRBCs at the beginning of admission and her
hematocrit remained stable in the low 30's. She received 20,000
units of Procrit, and her HCT at discharge was 33. She was
originally discharged with Procrit  Monday, Wednesday, Friday,
but as her HCT was sufficient she will follow up as an
outpatient for further dosing.
.
5) Visual changes: Patient had some visual changes prior to
admission including floaters that her most likely secondary to
hypotension.  However, considering her low platelets and risk
for bleed; a ophthalmology consult was obtained. Her exam was
normal; and she was educated regarding the signs of retinal
detachment. She had no further visual symptoms during admission.
.
6) Vaginal lesion: She developed a <0.5 cm ulceration between
her labia majora  and minora that was minimally painful with no
drainage and no other spread.  It did not appear to be
infectious and was most likely from recent trauma from her
Foley. Antibiotic ointment was applied and the lesion resolved
and no further lesion devloped.

Medications on Admission:
MVI, Percocet prn, Docusate, Acetaminophen prn, Allopurinol,
Lactulose, Bisacodyl prn, Prochlorperazine prn, Senna, KCl 40
meq qd

Discharge Medications:
1. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Epoetin Alfa 20,000 unit/mL Solution Sig: One (1) shot
Injection QMOWEFR (Monday -Wednesday-Friday).
Disp:*qs shot* Refills:*2*
4. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*
5. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
6. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO once a day: Continue
until your have you labs checked by your oncologist.
Disp:*60 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
7. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day:
[**10-1**] Take 4 tabs for a total of 40 mg
[**10-2**] Take 3 tabs for a total of 30 mg
[**10-3**] Take 2 tabs
for a total of 20 mg
[**10-4**] and [**10-5**] take 10 mg each day
Then switch to 5 mg tabs for 2 days as directed.
Disp:*11 Tablet(s)* Refills:*0*
8. Prednisone 5 mg Tablet Sig: One (1) Tablet PO once a day for
2 days: On [**10-6**] and [**10-7**] take 5mg q day to finish your taper.
Disp:*2 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
1. Thrombocytopenia
2. Lymphoma
3. UTI


Discharge Condition:
Afebrile, pain controlled.


Discharge Instructions:
If you have fevers, chills, shortness of breath, chest pain,
diarrhea/nausea, please call your PCP or Dr [**First Name (STitle) 1557**].

1. Take medications as directed
2. You will be on cipro for a 7 day course for your UTI.
3. Do not take your Dyazide as your blood pressure has been
stable and this could further lower your potassium. You can
discuss restarting this as an outpatient.
3. Attend all follow up appointments.

Followup Instructions:
You have the following appointments:
Provider: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], RN Where: [**Hospital6 29**]
HEMATOLOGY/[**Hospital6 3242**] Phone:[**Telephone/Fax (1) 3241**] Date/Time:[**2156-10-7**] 9:00
.
Provider: [**Name10 (NameIs) 3242**] CHAIR 5  Date/Time:[**2156-10-7**] 9:00
.
Provider: [**Name10 (NameIs) **],HEM/ONC HEMATOLOGY/ONCOLOGY-CC9 Where: [**Hospital 4054**] HEMATOLOGY/ONCOLOGY Phone:[**Telephone/Fax (1) 22**]
Date/Time:[**2156-10-7**] 9:30


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 16984**] MD, [**MD Number(3) 16985**]
{'Reticulosarcoma, intra-abdominal lymph nodes,Hemoperitoneum (nontraumatic),Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Other specified disease of white blood cells'}


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: Transfer from OSH after bleed into mesenteric B cell lymphoma
s/p recent CHOP

PRESENT ILLNESS: Pt is a 60F with large B cell lymphoma, HTN recently discharged
on [**2156-9-19**] from [**Hospital1 18**] after starting CHOP for newly diagnosed
lymphoma.  On her last hospitalization she was tolerating CHOP
well, had thrombocytopenia thought to be secondary to autoimmune
destruction and she was tranfused 1 unit of plts before
discharge and went up to 47 with follow up in 2 days in clinic.
Also, had some hallucinations related to percocet but she wanted
to stay on this because she felt it controlled her pain well and
was aware of the hallucinations.  She was discharged home on 1
lst day of steroids, compazine, percocet, potassium,
allopurinol, colace, senna and lactulose.  Her dyazide was held
because she was hypotensive and her K was low.
     On the day after discharge her husband called me as she had
an episode of syncope after bought of diarrhea. Denied head
trauma. Told her to go to the ED. She had another episode when
the EMTs arrived and 3 subsequent episodes related to position
in the ED at [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 55412**] Hospital. Found to be hypotensive with
10 pt drop in hct to 18 and SBP remained in 80's depsite 2 lites
of fluid. Ct abdomen reportedly showed hemoperitoneum. She was
transfused 3 units pRBCs, 3 bags of plts. Hct stable in 25-27
range post transfusion originally transfused to SICU. Now
transferred to OMED service for further management.
 Currently feels OK. Denies fevers, chills, CP, SOB,
palpitations, diarrhea, melena, BRBPR, N/V, dysuria. Denies any
dizziness. Does say that she had some "floaters" in her vision
was she was hypotensive but since resolved. Noticed a few more
bruises, no bleeding gums, small amount of crusted blood in
nose.

MEDICAL HISTORY: 1. Hypertension
2. s/p ovarian cystectomy of 7cm benign L ovarian cyst [**2147**] at
[**Hospital 189**] Hosp
2. s/p D&C for menometrorrhagia [**2147**]
3. s/p post-partum tubal ligation
4. Gyn history: menarche 15-16, regular monthly menses, OCP from
'[**18**]-'[**30**] for contraception, LMP: 5 years ago
5. Abdominal mass s/p bx with Large B cell lymphoma s/p CHOP
last week (as above)

MEDICATION ON ADMISSION: MVI, Percocet prn, Docusate, Acetaminophen prn, Allopurinol,
Lactulose, Bisacodyl prn, Prochlorperazine prn, Senna, KCl 40
meq qd

ALLERGIES: Penicillins

PHYSICAL EXAM: VS Tm 99.4 Tc 99.3 BP 117-140/60-90 HR 68 (68-98) RR 18 97% RA
I/O 2720/950
GEN: thin female in NAD
HEENT: PERRL, EOMI, anicteric, neck supple and symmetric
CV: Reg S1 S2 no m/r/g
LUNG: crackles at L bases, clear with cough, otherwise CTA b/l
ABD: mild distention, no HSM, bandaid in hypogastric area from
bx, non-tender, NABS
EXT: no edema
Neuro: A&O x 3, CN 2-12 intact, 5/5 strength in all ext,
sensation grossly intact
Back: no spinal tenderness, no flank pain

FAMILY HISTORY: + CAD/CHF
no ovarian/colon/uterine/cervix CA, maternal great aunt with
breast CA
Mother died last year of dementia
Has a son with schizophrenia

SOCIAL HISTORY: [**Name6 (MD) 1403**] as RN. Used to work on 7F. Nonsmoker. Very rare EtoH.
Married with 2 children, 1 son who is schizophrenic.  Very
active walking up to 4 miles per day. 

### Response:
{'Reticulosarcoma, intra-abdominal lymph nodes,Hemoperitoneum (nontraumatic),Urinary tract infection, site not specified,Acute posthemorrhagic anemia,Other specified disease of white blood cells'}
