CHIEF COMPLAINT: Tracheobronchomalacia

PRESENT ILLNESS: Mrs [**Known lastname **] is a well known patient to us, being followed for
malacia of the Left main stem bronchus. She is a 39-year-old
woman with IgG deficiency who has had recurrent pneumonias since
childhood. She [**Known lastname 1834**] the placement of a Y stent on
[**2142-11-19**] which she tolerated very well and reported significant
improvement after. The Y stent was removed about 2 weeks later,
and since she reports some dypnea upon exertion, cough with
yellowish secretions, no fever but some low grade temperature.
Her voice is better, appetite is good. she still takes her
inhalers as before (advair, albuterol + mucomyst)
She thinks that she was better when she had the stent. She is [**Name8 (MD) **]
RN who has not come back to work yet.

MEDICAL HISTORY: Past Medical History:
1.  Asthma.
2.  IgG deficiency. Recurrent pneumonias, bronchitis, sinusitis,
otitis media, UTI, pyelonephritis.
3.  Patent foramen ovale: discovered during w/u for SOB during
her first pregnancy. Per patient, this is a small defect that
has not needed surgical repair.
4.  Sjogren's syndrome:  Per the patient this is manifested by
dry eyes and mouth and has not required treatment.
5.  Papillary thyroid cancer:  The patient was treated with
thyroidectomy [**4-28**] and radioactive iodine [**6-28**]. At recent
outpatient endocrine visit: No evidence of persistent, recurrent
or metastatic disease.
6.  Pulmonary nodules:  Found incidentally on chest CT and
stable
from this period of [**2141-9-20**] to [**2142-3-21**].
7. Fibromyalgia
8. Depression
9. Mood disorder--?Cyclothymia
10. Post-nasal drip
11. ?SLE. Per patient, had positive [**Doctor First Name **] and malar rash, unclear
if Dx was ever made

MEDICATION ON ADMISSION: Albuterol, Albuterl neb, Astelin 2 sprays, Wellbutrin SR 300,
Celexa 10, Codeine-Guaifenesin prn, Advair Diskus 250/50, IgG,
Levothyroxine 188, Provigil 400, Nasonex 2 sprays, Singulair 10,
Oxcarbazepine 150, Benadryl prn

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: VS: T 98.6, HR 103, BP 124/79, RR 20, O2 sats 97% RA
Physical Exam:
Gen: pleasant, highly energized
Lungs: trace rales t/o
CV: RRR S1, S2, no MRG
Abd: soft, NT, ND
Ext: warm, no edema
right thoracotomy site without redness, purulence or drg

FAMILY HISTORY: Father with HTN and MI. Mother with EtOH abuse/dependence.

SOCIAL HISTORY: Works as a nurse at a methadone clinic and at a prison substance
abuse facility. Lives in [**Location 1475**] on the [**Hospital3 **] with her
husband and two daughters ages 5 and 10. No tobacco, 1 EtOH
drink per month, no other drug use. Exercises regularly-yoga,
running.
Other diseases of trachea and bronchus,Other selective immunoglobulin deficiencies,Pulmonary collapse,Ostium secundum type atrial septal defect,Asthma, unspecified type, unspecified,Sicca syndrome,Depressive disorder, not elsewhere classified,Cyclothymic disorder,Personal history of malignant neoplasm of thyroid,Other acute postoperative pain,Fever, unspecified
Trachea & bronch dis NEC,Selective ig defic NEC,Pulmonary collapse,Secundum atrial sept def,Asthma NOS,Sicca syndrome,Depressive disorder NEC,Cyclothymic disorder,Hx of thyroid malignancy,Acute postop pain NEC,Fever NOS
Admission Date:  [**2143-1-25**]              Discharge Date:   [**2143-1-31**]

Date of Birth:  [**2103-6-17**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Tracheobronchomalacia

Major Surgical or Invasive Procedure:
[**2143-1-25**]
Right thoracotomy, thoracic tracheoplasty with
mesh, right mainstem bronchus/bronchus intermedius
bronchoplasty with mesh, left mainstem bronchoplasty with
mesh, right lower lobe wedge resection, bronchoscopy with
bronchoalveolar lavage.


History of Present Illness:
Mrs [**Known lastname **] is a well known patient to us, being followed for
malacia of the Left main stem bronchus. She is a 39-year-old
woman with IgG deficiency who has had recurrent pneumonias since
childhood. She [**Known lastname 1834**] the placement of a Y stent on
[**2142-11-19**] which she tolerated very well and reported significant
improvement after. The Y stent was removed about 2 weeks later,
and since she reports some dypnea upon exertion, cough with
yellowish secretions, no fever but some low grade temperature.
Her voice is better, appetite is good. she still takes her
inhalers as before (advair, albuterol + mucomyst)
She thinks that she was better when she had the stent. She is [**Name8 (MD) **]
RN who has not come back to work yet.


Past Medical History:
Past Medical History:
1.  Asthma.
2.  IgG deficiency. Recurrent pneumonias, bronchitis, sinusitis,
otitis media, UTI, pyelonephritis.
3.  Patent foramen ovale: discovered during w/u for SOB during
her first pregnancy. Per patient, this is a small defect that
has not needed surgical repair.
4.  Sjogren's syndrome:  Per the patient this is manifested by
dry eyes and mouth and has not required treatment.
5.  Papillary thyroid cancer:  The patient was treated with
thyroidectomy [**4-28**] and radioactive iodine [**6-28**]. At recent
outpatient endocrine visit: No evidence of persistent, recurrent
or metastatic disease.
6.  Pulmonary nodules:  Found incidentally on chest CT and
stable
from this period of [**2141-9-20**] to [**2142-3-21**].
7. Fibromyalgia
8. Depression
9. Mood disorder--?Cyclothymia
10. Post-nasal drip
11. ?SLE. Per patient, had positive [**Doctor First Name **] and malar rash, unclear
if Dx was ever made

Social History:
Works as a nurse at a methadone clinic and at a prison substance
abuse facility. Lives in [**Location 1475**] on the [**Hospital3 **] with her
husband and two daughters ages 5 and 10. No tobacco, 1 EtOH
drink per month, no other drug use. Exercises regularly-yoga,
running.


Family History:
Father with HTN and MI. Mother with EtOH abuse/dependence.


Physical Exam:
VS: T 98.6, HR 103, BP 124/79, RR 20, O2 sats 97% RA
Physical Exam:
Gen: pleasant, highly energized
Lungs: trace rales t/o
CV: RRR S1, S2, no MRG
Abd: soft, NT, ND
Ext: warm, no edema
right thoracotomy site without redness, purulence or drg

Pertinent Results:
[**2143-1-31**] 07:00AM BLOOD WBC-8.1 RBC-3.31* Hgb-9.9* Hct-30.1*
MCV-91 MCH-29.9 MCHC-32.9 RDW-14.5 Plt Ct-337
[**2143-1-30**] 06:25AM BLOOD K-4.2
[**2143-1-28**] 10:50AM BLOOD Glucose-104* UreaN-9 Creat-0.7 Na-138
K-4.2 Cl-102 HCO3-27 AnGap-13

[**2143-1-30**]
PA AND LATERAL VIEWS OF THE CHEST

REASON FOR EXAM: S/P tracheoplasty with new fevers.

Comparison is made with prior study performed a day earlier.
A small left pleural effusion is unchanged. Small-to-moderate
right pleural effusion loculated in the major fissure is
unchanged. New opacity projecting over the lingula could
represent a new atelectasis. Linear atelectases in the right
lower lobe are unchanged. No evidence of pneumonia.

cultures negative to date.


Brief Hospital Course:
Ms. [**Known lastname **] [**Last Name (Titles) 1834**] a tracheoplasty on [**2143-1-25**] and was
admitted to the SICU post-operatively. She was extubated the
night of surgery in the SICU. Intially her chest tube was to
suction. She had no air leak and the chest tube was changed to
water seal on POD #1 and continued to have have no air leak.
Creatinine kinase levels were cycled to evaluated for
rhabdomyolysis and peaked at 2653 approximately 24 hours after
surgery, after which they trended downward. Her chest tube was
dc'd [**2143-1-28**] without PTX on CXR. The patient was aggressive with
her pulmonary toilet, ambulated and used her IS. She spiked a
101.7 fever POD 5, was pancultured which cultures all negative
to date, and placed on levaquin. Her fevers came down, and CXR
did not reveal any concerns. The antibiotics were stopped but
due to the patients low grade fever, and rales, and history of
pneumonia, she was placed on levaquin for 7 days on date of
discharge. She tolerated orals, had a bowel movement and
adequate pain control. An epidural was placed preoperatively and
was replaced on POD2 after it was found to be out. Additionally,
she received Neurotin 300 Q8hr for pain control. The epidural
was removed [**2143-1-28**] and the patient's pain was overall controlled
with dilaudid and neurontin 600mg po tid. Dr. [**Last Name (STitle) **] deemed
the patient safe to discharge home today.

Medications on Admission:
Albuterol, Albuterl neb, Astelin 2 sprays, Wellbutrin SR 300,
Celexa 10, Codeine-Guaifenesin prn, Advair Diskus 250/50, IgG,
Levothyroxine 188, Provigil 400, Nasonex 2 sprays, Singulair 10,
Oxcarbazepine 150, Benadryl prn

Discharge Medications:
1. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q4H (every 4 hours) as needed for wheezing.

2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Bupropion HCl 150 mg Tablet Sustained Release Sig: Two (2)
Tablet Sustained Release PO QAM (once a day (in the morning)).
4. Citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
5. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) inh Inhalation [**Hospital1 **] (2 times a day).
6. Oxcarbazepine 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
8. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO once a
day.
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed for constipation.
11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
12. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H
(every 8 hours).
13. Hydromorphone 2 mg Tablet Sig: 1-3 Tablets PO Q4H (every 4
hours) as needed for pain.
[**Hospital1 **]:*75 Tablet(s)* Refills:*0*
14. Azelastine  Nasal
15. Gabapentin 600 mg Tablet Sig: One (1) Tablet PO three times
a day: continue this and will defer discontinuation to your
primary care MD.
[**Last Name (Titles) **]:*90 Tablet(s)* Refills:*2*
16. Levaquin 750 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
[**Last Name (Titles) **]:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Tracheobronchomalacia.


Discharge Condition:
Mental Status:Clear and coherent
Level of Consciousness:Alert and interactive
Activity Status:Ambulatory - Independent


Discharge Instructions:
-Do not drive while taking narcotics.
-Pain will persist over two weeks. Take your pain medications
and stool softeners to prevent constipation.
-You may shower.
-Walk around.
-Use your incentive spirometer.
-Call Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 2348**] if you experience fevers
>101.5, chills, shakes, chestpains, worsening cough, worsening
shortness of breath, or any other problems.
-Remember you just had major surgery and it will take a few
weeks to feel better. Don't be too hard on yourself. Do not work
until cleared by a physician.
[**Name10 (NameIs) **] if your thoractomy site becomes angry red, drains, or
opens.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in 2 weeks with chest xray.
Call Dr.[**Name (NI) 2347**] office for the appointment.



Completed by:[**2143-1-31**]
{'Other diseases of trachea and bronchus,Other selective immunoglobulin deficiencies,Pulmonary collapse,Ostium secundum type atrial septal defect,Asthma, unspecified type, unspecified,Sicca syndrome,Depressive disorder, not elsewhere classified,Cyclothymic disorder,Personal history of malignant neoplasm of thyroid,Other acute postoperative pain,Fever, 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: Tracheobronchomalacia

PRESENT ILLNESS: Mrs [**Known lastname **] is a well known patient to us, being followed for
malacia of the Left main stem bronchus. She is a 39-year-old
woman with IgG deficiency who has had recurrent pneumonias since
childhood. She [**Known lastname 1834**] the placement of a Y stent on
[**2142-11-19**] which she tolerated very well and reported significant
improvement after. The Y stent was removed about 2 weeks later,
and since she reports some dypnea upon exertion, cough with
yellowish secretions, no fever but some low grade temperature.
Her voice is better, appetite is good. she still takes her
inhalers as before (advair, albuterol + mucomyst)
She thinks that she was better when she had the stent. She is [**Name8 (MD) **]
RN who has not come back to work yet.

MEDICAL HISTORY: Past Medical History:
1.  Asthma.
2.  IgG deficiency. Recurrent pneumonias, bronchitis, sinusitis,
otitis media, UTI, pyelonephritis.
3.  Patent foramen ovale: discovered during w/u for SOB during
her first pregnancy. Per patient, this is a small defect that
has not needed surgical repair.
4.  Sjogren's syndrome:  Per the patient this is manifested by
dry eyes and mouth and has not required treatment.
5.  Papillary thyroid cancer:  The patient was treated with
thyroidectomy [**4-28**] and radioactive iodine [**6-28**]. At recent
outpatient endocrine visit: No evidence of persistent, recurrent
or metastatic disease.
6.  Pulmonary nodules:  Found incidentally on chest CT and
stable
from this period of [**2141-9-20**] to [**2142-3-21**].
7. Fibromyalgia
8. Depression
9. Mood disorder--?Cyclothymia
10. Post-nasal drip
11. ?SLE. Per patient, had positive [**Doctor First Name **] and malar rash, unclear
if Dx was ever made

MEDICATION ON ADMISSION: Albuterol, Albuterl neb, Astelin 2 sprays, Wellbutrin SR 300,
Celexa 10, Codeine-Guaifenesin prn, Advair Diskus 250/50, IgG,
Levothyroxine 188, Provigil 400, Nasonex 2 sprays, Singulair 10,
Oxcarbazepine 150, Benadryl prn

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: VS: T 98.6, HR 103, BP 124/79, RR 20, O2 sats 97% RA
Physical Exam:
Gen: pleasant, highly energized
Lungs: trace rales t/o
CV: RRR S1, S2, no MRG
Abd: soft, NT, ND
Ext: warm, no edema
right thoracotomy site without redness, purulence or drg

FAMILY HISTORY: Father with HTN and MI. Mother with EtOH abuse/dependence.

SOCIAL HISTORY: Works as a nurse at a methadone clinic and at a prison substance
abuse facility. Lives in [**Location 1475**] on the [**Hospital3 **] with her
husband and two daughters ages 5 and 10. No tobacco, 1 EtOH
drink per month, no other drug use. Exercises regularly-yoga,
running. 

### Response:
{'Other diseases of trachea and bronchus,Other selective immunoglobulin deficiencies,Pulmonary collapse,Ostium secundum type atrial septal defect,Asthma, unspecified type, unspecified,Sicca syndrome,Depressive disorder, not elsewhere classified,Cyclothymic disorder,Personal history of malignant neoplasm of thyroid,Other acute postoperative pain,Fever, unspecified'}
