CHIEF COMPLAINT: dyspnea

PRESENT ILLNESS: This is a 64F with sarcoidosis, h/o left lower lobe wedge
resection for pulmonary nodules, and tracheobronchomalacia who
was recently admitted ([**Date range (1) 40041**]) for removal of Y stent and
debridement of granulation tissue in the L mainstem bronchus who
now presents with increased shortness of breath--could not walk
to bathroom without severe dyspnea--went to OSH, found to be in
rapid afib; started dilt gtt at OSH, and transferred here, where
she was in sinus rhythm on dilt gtt. However, still dyspneic.

MEDICAL HISTORY: 1. Obesity.
2. History of pericarditis/tamponade secondary to polyserositis.
She has been on steroids for this for the past 17 years.
3. History of pleural effusion.
4. Sarcoidosis.
5. GERD.
6. History of lung nodule status post thoracotomy with left
lower lobe wedge resection ([**Hospital1 2025**] [**2160**]).
7. Asthma.
8. Hiatal hernia.
9. OSA on nocturnal CPAP (plus 12)
10. Hypertension.
11. Lactose intolerance.
12. Tracheobronchomalacia; had Y stent placed [**2169-11-6**], with no
improvement in dyspnea but worse [**Last Name (LF) **], [**First Name3 (LF) **] it was removed
[**2169-12-4**].

MEDICATION ON ADMISSION: 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
4. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Aspirin / Ciprofloxacin / Procardia / Niacin / Biaxin / Niaspan
/ Ibuprofen / Crestor / Quinolones / Neosporin / Adhesive Tape

PHYSICAL EXAM: Vitals: T:98.5 BP:154/39 HR:75 RR:12 O2Sat:97% 3L
GEN: Well-appearing, well-nourished, no acute distress
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses

FAMILY HISTORY: There is no family history of lung disease or sarcoid. Her
mother died secondary to rectal cancer 82 years old. Notably she
did have lupus. Her father died secondary to an MI at 72 years
old. Her son is healthy.

SOCIAL HISTORY: The patient is divorced. She lives alone in [**Location (un) **],
[**State 350**]. She has one son who lives close by. She has been
on disability since [**2149**]. Prior to that, she worked as a
financial analyst. She has a rare glass of wine. She quit
smoking in [**2160**]. Prior to that she smoked a pack a day for 40
years. She has never used any illicit drugs. She denies asbestos
exposure and reports no known TB exposures. She had a negative
PPD test last year prior to starting Enbrel therapy.
Pulmonary collapse,Pneumonia, organism unspecified,Constrictive pericarditis,Other diseases of trachea and bronchus,Atrial fibrillation,Unspecified essential hypertension,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Obstructive sleep apnea (adult)(pediatric),Extrinsic asthma, unspecified,Intestinal disaccharidase deficiencies and disaccharide malabsorption,Other chronic pain,Obesity, unspecified,Long-term (current) use of steroids
Pulmonary collapse,Pneumonia, organism NOS,Constrictiv pericarditis,Trachea & bronch dis NEC,Atrial fibrillation,Hypertension NOS,Sarcoidosis,Lung involv in oth dis,Esophageal reflux,Diaphragmatic hernia,Obstructive sleep apnea,Extrinsic asthma NOS,Disaccharidase def/malab,Chronic pain NEC,Obesity NOS,Long-term use steroids
Admission Date:  [**2169-11-29**]              Discharge Date:   [**2169-12-2**]

Date of Birth:  [**2105-9-19**]             Sex:   F

Service: MEDICINE

Allergies:
Aspirin / Ciprofloxacin / Procardia / Niacin / Biaxin / Niaspan
/ Ibuprofen / Crestor / Quinolones / Neosporin / Adhesive Tape

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
dyspnea

Major Surgical or Invasive Procedure:
bronchoscopy
PICC placement


History of Present Illness:
This is a 64F with sarcoidosis, h/o left lower lobe wedge
resection for pulmonary nodules, and tracheobronchomalacia who
was recently admitted ([**Date range (1) 40041**]) for removal of Y stent and
debridement of granulation tissue in the L mainstem bronchus who
now presents with increased shortness of breath--could not walk
to bathroom without severe dyspnea--went to OSH, found to be in
rapid afib; started dilt gtt at OSH, and transferred here, where
she was in sinus rhythm on dilt gtt. However, still dyspneic.

In the ED, still on dilt gtt. CTA looks like collapse of LLL (no
PE); IP aware, and plan bronch tomorrow (NPO p MN, coags
buffed). 85, 102/65, 25, 93-6% 3L.

ROS: Had been constipated during recent hospital stay, then had
large BM at home. The patient denies any fevers, chills, weight
change, nausea, vomiting, abdominal pain, melena, hematochezia,
chest pain, orthopnea, PND, lower extremity oedema, urinary
frequency, urgency, dysuria, lightheadedness, gait unsteadiness,
focal weakness, vision changes, headache, rash or skin changes.


Past Medical History:
1. Obesity.
2. History of pericarditis/tamponade secondary to polyserositis.
She has been on steroids for this for the past 17 years.
3. History of pleural effusion.
4. Sarcoidosis.
5. GERD.
6. History of lung nodule status post thoracotomy with left
lower lobe wedge resection ([**Hospital1 2025**] [**2160**]).
7. Asthma.
8. Hiatal hernia.
9. OSA on nocturnal CPAP (plus 12)
10. Hypertension.
11. Lactose intolerance.
12. Tracheobronchomalacia; had Y stent placed [**2169-11-6**], with no
improvement in dyspnea but worse [**Last Name (LF) **], [**First Name3 (LF) **] it was removed
[**2169-12-4**].

Social History:
The patient is divorced. She lives alone in [**Location (un) **],
[**State 350**]. She has one son who lives close by. She has been
on disability since [**2149**]. Prior to that, she worked as a
financial analyst. She has a rare glass of wine. She quit
smoking in [**2160**]. Prior to that she smoked a pack a day for 40
years. She has never used any illicit drugs. She denies asbestos
exposure and reports no known TB exposures. She had a negative
PPD test last year prior to starting Enbrel therapy.


Family History:
There is no family history of lung disease or sarcoid. Her
mother died secondary to rectal cancer 82 years old. Notably she
did have lupus. Her father died secondary to an MI at 72 years
old. Her son is healthy.

Physical Exam:
Vitals: T:98.5 BP:154/39 HR:75 RR:12 O2Sat:97% 3L
GEN: Well-appearing, well-nourished, no acute distress
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses

Pertinent Results:
[**2169-11-29**] 03:53PM   GLUCOSE-135* NA+-139 K+-4.5 CL--94* TCO2-31*
[**2169-11-29**] 03:45PM   UREA N-13 CREAT-0.5
[**2169-11-29**] 03:45PM   CK(CPK)-24*
[**2169-11-29**] 03:45PM   cTropnT-<0.01
[**2169-11-29**] 03:45PM   CK-MB-NotDone
[**2169-11-29**] 03:45PM   WBC-18.8* RBC-4.52 HGB-12.0 HCT-35.5* MCV-79*
MCH-26.5* MCHC-33.7 RDW-14.9
[**2169-11-29**] 03:45PM   NEUTS-91.0* LYMPHS-5.6* MONOS-1.9* EOS-1.1
BASOS-0.3
[**2169-11-29**] 03:45PM   PLT COUNT-778*
[**2169-11-29**] 03:45PM   PT-14.1* PTT-28.5 INR(PT)-1.2*
[**2169-11-29**] 04:15PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG

Laboratories:
OSH labs this morning notable for TnI 0.04, BNP 17, CBC and
lytes similar to ED labs here.

ECG: Sinus rhythm at 91 bpm, nml axis, incomplete RBBB, ant T
waves are flat, similar to [**2169-11-26**].

Imaging:
CXR: There is atelectasis at the left lung base. There is stable
cardiomegaly. The right lung is clear.
CONCLUSION: Minimal stable atelectasis in the left lower lobe
with no acute cardiopulmonary process.

CTA Chest [**2169-11-29**]:
IMPRESSION:
1. No pulmonary embolism.
2. Worsening left basilar collapse, presumably secondary to
collapse of the left mainstem bronchus, likely due to the
patient's known diagnosis of
tracheobronchomalacia. Extrinsic compression is less likely,
though there is some increased soft tissue surrounding the area
of the collapsed left mainstem bronchus, and scattered
borderline mediastinal lymph nodes as previously described.

TTE [**2169-12-1**]: The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF 70%). There is no ventricular septal
defect. Right ventricular chamber size and free wall motion are
normal. The aortic arch is mildly dilated. There are focal
calcifications in the aortic arch. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. There is mild
pulmonary artery systolic hypertension. There is no pericardial
effusion.


Brief Hospital Course:
64yoF with tracheobronchomalacia, recently admitted for removal
of Y stent in the L mainstem, now with LLL collapse, likely from
mucus plugging, pt was admitted to the [**Hospital Unit Name 153**] for new onset afib
requiring a Diltiazem drip.
.
# Dyspnea/LLL collapse: [**11-30**] bronchoscopy revealed
reaccumulation of granulation tissue and mucous which appeared
purulent. BAL could not be sent due to limited size of her
airways. She was started on Vanc/Cefepime day 1=[**12-1**], 7 day
course complete on [**2169-12-7**] for healthcare associated pneumonia.
PICC line was placed [**2169-12-1**]. Pt was continued on [**Month/Day/Year **]
suppressants, supplemental oxygen as needed, and nebulizer
treatments. Sats remained stable throughout this hospitalization
on 2-3L oxygen via nasal cannula.
.
# afib: Pt has had new afib observed over a few days prior to
her unit admission, with poor rate control on arrival from OSH.
Pt was initially transferred from the ED to the ICU on a
diltizaem however several hours into admission was able to be
weaned to PO Diltiazem and Metorpolol. Given her CHADS2 score of
1, pt was not started on anticoagulation. Noted to be in sinus
rhythm on day of transfer so no DCCV was initiated. A TSH was
checked for the a. fib work up and was 0.081 with a free T4 of
1.9. She had no further episodes of atrila fibrillation HD [**12-19**].
TTE on [**2169-12-1**] revealed mildly dilated left atrium. LVEF 70%.

# HTN: on micardis 40/12.5 at home, as well as lasix and toprol
XL 25mg daily. Her Toprol was continued at her home dose, but
her outpatient micardis was held. She was started on diltiazem
30mg QID for control of her atrial fibrillation as well as
control of her blood pressure. Her blood pressure was stable on
this regimen.

# asthma: Pt was continued on montelukast, advair 250-50 [**Hospital1 **]
.
# allergic rhinitis: Pt was continued on fluticasone nasal,
zyrtec
.
# sarcoidosis, h/o serositis: not active. Continued prednisone
taper and bactrim for PJP prophylaxis.
.
# chronic pain: continued cyclobenzaprine, oxycodone
.
# OSA: continued home CPAP of 12 cm H20

In the out patient: Diltiazem can be changed to long acting
formulation, or alternatively, discontinued, and her BBloker
dose can be increased to 50 Mg daily to minimize her
medications.


Medications on Admission:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
4. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO BID (2 times a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
8. Cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) as needed.
9. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal DAILY (Daily).
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed.
11. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
12. Prednisone 10 mg Tablet Sig: Four (4) Tablet PO once a day
for 2 days.
Disp:*25 Tablet(s)* Refills:*0*
13. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 3 days.
14. Prednisone 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily)
for 3 days: then 1 x days, then [**11-17**] tablet (5mg) x 3 days.
15. Saline     Solution Sig: Three (3) ML Miscellaneous three
times a day: Nebulizers.Disp:*300 * Refills:*2*
16. Micardis HCT 40-12.5 mg Tablet Sig: One (1) Tablet PO once a
day.
17. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO three times a day.
18. Zyrtec 10 mg Tablet Sig: One (1) Tablet PO once a day.
19. Cyproheptadine 4 mg Tablet Sig: One (1) Tablet PO twice a
day.
20. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day as
needed.
21. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: 0.5
Tablet Sustained Release 24 hr PO once a day.Disp:*15 Tablet
Sustained Release 24 hr(s)* Refills:*2*


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed.
2. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
3. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
4. Diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO QID (4
times a day).
5. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
7. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO daily () for
1 days: [**12-3**].
8. Prednisone 20 mg Tablet Sig: One (1) Tablet PO daily () for 3
days: [**Date range (1) 40042**].
9. Prednisone 10 mg Tablet Sig: One (1) Tablet PO daily () for 3
days: [**Date range (1) 23500**].
10. Prednisone 5 mg Tablet Sig: One (1) Tablet PO daily () for 3
days: [**Date range (1) 23501**].
11. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
12. Cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed.
13. Calcium Carbonate 500 mg (1,250 mg) Tablet Sig: One (1)
Tablet PO every twelve (12) hours.
14. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
15. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
16. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
17. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
18. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
19. Cyproheptadine 4 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
20. Oxycodone 5 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4
hours) as needed.
21. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day).
22. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
23. Chlorpheniramine-Hydrocodone 8-10 mg/5 mL Suspension,
Sust.Release 12 hr Sig: Five (5) ML PO Q12H (every 12 hours) as
needed.
24. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
25. Menthol-Cetylpyridinium 3 mg Lozenge Sig: One (1) Lozenge
Mucous membrane PRN (as needed).
26. Codeine-Guaifenesin 10-100 mg/5 mL Syrup Sig: 5-10 MLs PO
Q6H (every 6 hours).
27. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): see attached insulin sliding
scale.
28. Ondansetron 4 mg IV Q8H:PRN
29. CefePIME 2 g IV Q12H
30. Vancomycin 1000 mg IV Q 12H
31. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day as
needed for fluid overload.
32. Saline Mist 0.65 % Aerosol, Spray Sig: One (1)  Nasal four
times a day as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
primary:
left lower lobe collapse
tracheobronchomalacia
atrial fibrillation

secondary:
sarcoidosis
obstructive sleep apnea
hypertension
obesity


Discharge Condition:
stable


Discharge Instructions:
You were admitted for collapse of your left lower lobe due to
your tracheobronchomalacia. While you were here, you had
bronchoscopy which revealed granulation tissue and mucous
plugging. You were started on antibiotics to treat a hospital
acquired pneumonia, you should continue these until a 7 day
course is complete on [**2169-12-7**].
While you were here, you had atrial fibrillation. You were
started on a new medication called diltiazem to control your
heart rate. This also helps to control your blood pressure. You
should continue to take this medication outpatient. Also,
because it helps to control your blood pressure, your other
blood pressure medication, Micardis, was held. If necessary,
this can be restarted outpatient.
If you should have worsening shortness of breath, fever/chills,
headache/dizzyness, you should call your regular doctor or
present to the emergency department.
It is very important that you take all of your medications as
directed and follow up with your appointments.

Followup Instructions:
You have the following appointments:
Antibiotic regimen complete [**2169-12-7**](day 1 of CTX/Vanc= [**2169-12-1**])
Provider: [**Name10 (NameIs) 12554**] CLINIC INTERVENTIONAL PULMONARY (SB)
Phone:[**Telephone/Fax (1) 3020**] Date/Time:[**2169-12-12**] 10:30
Provider: [**Name10 (NameIs) 1532**] [**Last Name (NamePattern4) 8786**], MD Phone:[**Telephone/Fax (1) 3020**]
Date/Time:[**2169-12-12**] 10:00
{'Pulmonary collapse,Pneumonia, organism unspecified,Constrictive pericarditis,Other diseases of trachea and bronchus,Atrial fibrillation,Unspecified essential hypertension,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Obstructive sleep apnea (adult)(pediatric),Extrinsic asthma, unspecified,Intestinal disaccharidase deficiencies and disaccharide malabsorption,Other chronic pain,Obesity, unspecified,Long-term (current) use of steroids'}


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: dyspnea

PRESENT ILLNESS: This is a 64F with sarcoidosis, h/o left lower lobe wedge
resection for pulmonary nodules, and tracheobronchomalacia who
was recently admitted ([**Date range (1) 40041**]) for removal of Y stent and
debridement of granulation tissue in the L mainstem bronchus who
now presents with increased shortness of breath--could not walk
to bathroom without severe dyspnea--went to OSH, found to be in
rapid afib; started dilt gtt at OSH, and transferred here, where
she was in sinus rhythm on dilt gtt. However, still dyspneic.

MEDICAL HISTORY: 1. Obesity.
2. History of pericarditis/tamponade secondary to polyserositis.
She has been on steroids for this for the past 17 years.
3. History of pleural effusion.
4. Sarcoidosis.
5. GERD.
6. History of lung nodule status post thoracotomy with left
lower lobe wedge resection ([**Hospital1 2025**] [**2160**]).
7. Asthma.
8. Hiatal hernia.
9. OSA on nocturnal CPAP (plus 12)
10. Hypertension.
11. Lactose intolerance.
12. Tracheobronchomalacia; had Y stent placed [**2169-11-6**], with no
improvement in dyspnea but worse [**Last Name (LF) **], [**First Name3 (LF) **] it was removed
[**2169-12-4**].

MEDICATION ON ADMISSION: 1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
4. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Aspirin / Ciprofloxacin / Procardia / Niacin / Biaxin / Niaspan
/ Ibuprofen / Crestor / Quinolones / Neosporin / Adhesive Tape

PHYSICAL EXAM: Vitals: T:98.5 BP:154/39 HR:75 RR:12 O2Sat:97% 3L
GEN: Well-appearing, well-nourished, no acute distress
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: alert, oriented to person, place, and time. CN II ?????? XII
grossly intact. Moves all 4 extremities. Strength 5/5 in upper
and lower extremities. Patellar DTR +1. Plantar reflex
downgoing. No gait disturbance. No cerebellar dysfunction.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses

FAMILY HISTORY: There is no family history of lung disease or sarcoid. Her
mother died secondary to rectal cancer 82 years old. Notably she
did have lupus. Her father died secondary to an MI at 72 years
old. Her son is healthy.

SOCIAL HISTORY: The patient is divorced. She lives alone in [**Location (un) **],
[**State 350**]. She has one son who lives close by. She has been
on disability since [**2149**]. Prior to that, she worked as a
financial analyst. She has a rare glass of wine. She quit
smoking in [**2160**]. Prior to that she smoked a pack a day for 40
years. She has never used any illicit drugs. She denies asbestos
exposure and reports no known TB exposures. She had a negative
PPD test last year prior to starting Enbrel therapy. 

### Response:
{'Pulmonary collapse,Pneumonia, organism unspecified,Constrictive pericarditis,Other diseases of trachea and bronchus,Atrial fibrillation,Unspecified essential hypertension,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Obstructive sleep apnea (adult)(pediatric),Extrinsic asthma, unspecified,Intestinal disaccharidase deficiencies and disaccharide malabsorption,Other chronic pain,Obesity, unspecified,Long-term (current) use of steroids'}
