CHIEF COMPLAINT: Tracheobronchomalacia

PRESENT ILLNESS: The patient is a 74-year-old man who has had a chronic and
severe cough since
[**2162-12-23**]. It is severely limiting to his activities of
daily life, and he has severe dyspnea on exertion. He has had
several bouts of upper respiratory infections treated with
antibiotics. He is unable to clear his secretions readily. Mr.
[**Name13 (STitle) **] had undergone a stent trial with a Y-stent placed on
[**2164-3-6**] and noted that his breathing and cough
improved, however the stent was removed on [**2164-3-14**]. He
was recently admitted to the hospital for treatment of a left
lower lobe pneumonia., treated with antibiotics at home.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
CAD status post MI s/p CABG in [**2157**]
GERD
OSA
Tracheobronchomalacia s/p Y stent placement and removal [**3-14**]
Basal cell carcinoma of the skin
Status post resection
Squamous cell carcinoma of the skin status
post resection
Melanoma status post resection
Prostate cancer diagnosed in [**2147**] status post radical
prostatectomy Diverticular disease s/p colon resection
Cholecystectomy
Inguinal hernia repair multiple times, last time in [**2156**].

MEDICATION ON ADMISSION: Lopressor 50A/25P, Norvasc 5A/2.5P, Isordil 60", Xanax 5/prn,
Citalopram 40', Detrol LA5', Omeprazole 20', Folate 1', Vit E
400', Vit C 500', ASA 81', Albuterol, Pulmoicort, Zetia 10'

ALLERGIES: Penicillins / Lipitor

PHYSICAL EXAM: VS: T 96.6 BP 125/62 HR 72 RR 16 95% RA
General: well-nourished, well-appearing, speaking in full
sentences with occasional coughing
HEENT: NC/AT, EOMI, OP clear, MMM, anicteric
Neck: supple, no LAD, no carotid bruits
CV: RRR, normal S1/S2, no m/r/g noted
Lungs: scattered rhonchi thorughout with scattered inspiratory
wheezes
Abdomen: soft, NT/ND, normoactive BS, no masses, no rebound or
tenderness.
Ext: warm, no edema
Skin: no rashes, no lesions
Neuro: AAO x3, muscle strength 5/5 in all 4 extremities

FAMILY HISTORY: His father died secondary to prostate cancer, mother had
[**Name (NI) 2481**], and brother had lung cancer.

SOCIAL HISTORY: He is married, retired, used to work in construction, drinks
alcohol socially, used to smoke 20-pack-year quit 15 years ago,
and has been exposed to asbestos.
Other diseases of trachea and bronchus,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate,Obstructive sleep apnea (adult)(pediatric)
Trachea & bronch dis NEC,Atrial fibrillation,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hypertension NOS,Hx-prostatic malignancy,Obstructive sleep apnea
Admission Date:  [**2164-4-2**]              Discharge Date:   [**2164-4-8**]

Date of Birth:  [**2089-11-22**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Lipitor

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

Major Surgical or Invasive Procedure:
Tracheobronchoplasty via right thoracotomy


History of Present Illness:
The patient is a 74-year-old man who has had a chronic and
severe cough since
[**2162-12-23**]. It is severely limiting to his activities of
daily life, and he has severe dyspnea on exertion. He has had
several bouts of upper respiratory infections treated with
antibiotics. He is unable to clear his secretions readily. Mr.
[**Name13 (STitle) **] had undergone a stent trial with a Y-stent placed on
[**2164-3-6**] and noted that his breathing and cough
improved, however the stent was removed on [**2164-3-14**]. He
was recently admitted to the hospital for treatment of a left
lower lobe pneumonia., treated with antibiotics at home.

Past Medical History:
Hypertension
Hypercholesterolemia
CAD status post MI s/p CABG in [**2157**]
GERD
OSA
Tracheobronchomalacia s/p Y stent placement and removal [**3-14**]
Basal cell carcinoma of the skin
Status post resection
Squamous cell carcinoma of the skin status
post resection
Melanoma status post resection
Prostate cancer diagnosed in [**2147**] status post radical
prostatectomy Diverticular disease s/p colon resection
Cholecystectomy
Inguinal hernia repair multiple times, last time in [**2156**].


Social History:
He is married, retired, used to work in construction, drinks
alcohol socially, used to smoke 20-pack-year quit 15 years ago,
and has been exposed to asbestos.


Family History:
His father died secondary to prostate cancer, mother had
[**Name (NI) 2481**], and brother had lung cancer.

Physical Exam:
VS: T 96.6 BP 125/62 HR 72 RR 16 95% RA
General: well-nourished, well-appearing, speaking in full
sentences with occasional coughing
HEENT: NC/AT, EOMI, OP clear, MMM, anicteric
Neck: supple, no LAD, no carotid bruits
CV: RRR, normal S1/S2, no m/r/g noted
Lungs: scattered rhonchi thorughout with scattered inspiratory
wheezes
Abdomen: soft, NT/ND, normoactive BS, no masses, no rebound or
tenderness.
Ext: warm, no edema
Skin: no rashes, no lesions
Neuro: AAO x3, muscle strength 5/5 in all 4 extremities

Pertinent Results:
[**2164-4-2**] 03:32PM BLOOD WBC-9.7 RBC-3.42* Hgb-11.5* Hct-32.8*
MCV-96 MCH-33.7* MCHC-35.1* RDW-13.4 Plt Ct-250
[**2164-4-2**] 03:32PM BLOOD PT-13.8* PTT-26.3 INR(PT)-1.2*
[**2164-4-2**] 03:32PM BLOOD Glucose-200* UreaN-16 Creat-0.4* Na-138
K-4.5 Cl-105 HCO3-26 AnGap-12
[**2164-4-2**] 03:32PM BLOOD Calcium-8.8 Mg-1.7

[**4-2**] CXR: Left basilar opacity is likely effusion and
atelectasis, though an infectious consolidation cannot be
excluded.  Two right-sided chest tubes with no evidence of
pneumothorax.  NG tube tip lies within the stomach, though the
tube could be advanced to ensure that the side hole is within
the stomach.  Mediastinal and subcutaneous emphysema are
consistent with recent tracheobronchoplasty and chest tube
insertion.

[**4-3**] CXR: Status post removal of right apical chest tube, with
no residual right pneumothorax. Right basilar chest tube is
still in place. Also, status post removal of the nasogastric
tube. Otherwise, unchanged appearance since yesterday

[**4-4**] CXR: There is no pneumothorax after removal of the right
chest tube, given the limitation of patient motion. There are
small bilateral pleural effusions, possibly loculated. The aorta
remains dilated and tortuous. No new consolidations.

[**4-5**] CXR: Moderate right and small left pleural effusions are
unchanged, with apparent loculation of the right effusion
laterally. No pneumothorax is identified. Cardiac and
mediastinal contours are stable

Brief Hospital Course:
Mr. [**Known lastname 24400**] was admitted to the Thoracic Surgery service under
the care of Dr. [**Last Name (STitle) **] on [**2164-4-2**] after undergoing a
tracheobronchoplast for his tracheobronchomalacia.  Please refer
to the operative note for details of this procedure.
Postoperatively, he was cared for in the CSRU.

On postoperative day one, his pain was controlled with an
epidural.  His chest tube was removed.  His [**Doctor Last Name **] drain remained
until POD2.  He was noted to be in atrial fibrillation, and was
begun on an amiodarone and a diltiazem drip.  The Diltiazem was
stopped.  His rhythm had converted to sinus.

On POD3, he was transferred to the [**Wardname 836**] floor unit.  His
amiodarone was converted to an oral dose of 400 mg twice a day,
to continue for a total of 7 days, and then taper to a dose of
200 mg daily.  On POD4, he was seen by Physical Therapy, who
felt he may be able to go home with services, however, his wife
is currently disabled, and his family felt strongly about his
being placed in a rehabilitation facilty for a short time.

He continued to do well, and was discharged to a rehabilitation
facility on POD6.

Medications on Admission:
Lopressor 50A/25P, Norvasc 5A/2.5P, Isordil 60", Xanax 5/prn,
Citalopram 40', Detrol LA5', Omeprazole 20', Folate 1', Vit E
400', Vit C 500', ASA 81', Albuterol, Pulmoicort, Zetia 10'

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO QAM (once a day
(in the morning)).
3. Amlodipine 5 mg Tablet Sig: 0.5 Tablet PO QPM (once a day (in
the evening)).
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO QAM
(once a day (in the morning)).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO QPM
(once a day (in the evening)).
6. Isosorbide Dinitrate 20 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
7. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

8. Tolterodine 1 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
Beginning after 400 [**Hospital1 **] dosing has completed.
10. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO twice a day
for 4 days.
11. Xanax 0.5 mg Tablet Sig: One (1) Tablet PO Q8H PRN as
needed.
12. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
13. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

15. Vitamin E 400 unit Tablet Sig: One (1) Tablet PO once a day.

16. Vitamin C 500 mg Tablet, Chewable Sig: One (1) Tablet,
Chewable PO once a day.
17. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation every four (4) hours as needed for shortness of
breath or wheezing.
18. Pulmicort Turbuhaler 200 mcg/Inhalation Aerosol Powdr Breath
Activated Sig: Two (2) puffs Inhalation twice a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 2670**] [**Location (un) 5871**]

Discharge Diagnosis:
Tracheobronchomalacia


Discharge Condition:
Good


Discharge Instructions:
Call Dr.[**Name (NI) 2347**] office at [**Telephone/Fax (1) 170**] if you develop:
--Chest pain
--Shortness of breath
--Difficulty swallowing
--Fever greater than 101.5 F
--Redness or drainage from your incision sites.

No lifting anything greater than 10 pounds for 6 weeks.
Do not drive while taking pain medication.

Followup Instructions:
Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 170**] for a follow up
appointment in 2 weeks
{'Other diseases of trachea and bronchus,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate,Obstructive sleep apnea (adult)(pediatric)'}


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: The patient is a 74-year-old man who has had a chronic and
severe cough since
[**2162-12-23**]. It is severely limiting to his activities of
daily life, and he has severe dyspnea on exertion. He has had
several bouts of upper respiratory infections treated with
antibiotics. He is unable to clear his secretions readily. Mr.
[**Name13 (STitle) **] had undergone a stent trial with a Y-stent placed on
[**2164-3-6**] and noted that his breathing and cough
improved, however the stent was removed on [**2164-3-14**]. He
was recently admitted to the hospital for treatment of a left
lower lobe pneumonia., treated with antibiotics at home.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
CAD status post MI s/p CABG in [**2157**]
GERD
OSA
Tracheobronchomalacia s/p Y stent placement and removal [**3-14**]
Basal cell carcinoma of the skin
Status post resection
Squamous cell carcinoma of the skin status
post resection
Melanoma status post resection
Prostate cancer diagnosed in [**2147**] status post radical
prostatectomy Diverticular disease s/p colon resection
Cholecystectomy
Inguinal hernia repair multiple times, last time in [**2156**].

MEDICATION ON ADMISSION: Lopressor 50A/25P, Norvasc 5A/2.5P, Isordil 60", Xanax 5/prn,
Citalopram 40', Detrol LA5', Omeprazole 20', Folate 1', Vit E
400', Vit C 500', ASA 81', Albuterol, Pulmoicort, Zetia 10'

ALLERGIES: Penicillins / Lipitor

PHYSICAL EXAM: VS: T 96.6 BP 125/62 HR 72 RR 16 95% RA
General: well-nourished, well-appearing, speaking in full
sentences with occasional coughing
HEENT: NC/AT, EOMI, OP clear, MMM, anicteric
Neck: supple, no LAD, no carotid bruits
CV: RRR, normal S1/S2, no m/r/g noted
Lungs: scattered rhonchi thorughout with scattered inspiratory
wheezes
Abdomen: soft, NT/ND, normoactive BS, no masses, no rebound or
tenderness.
Ext: warm, no edema
Skin: no rashes, no lesions
Neuro: AAO x3, muscle strength 5/5 in all 4 extremities

FAMILY HISTORY: His father died secondary to prostate cancer, mother had
[**Name (NI) 2481**], and brother had lung cancer.

SOCIAL HISTORY: He is married, retired, used to work in construction, drinks
alcohol socially, used to smoke 20-pack-year quit 15 years ago,
and has been exposed to asbestos. 

### Response:
{'Other diseases of trachea and bronchus,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate,Obstructive sleep apnea (adult)(pediatric)'}
