CHIEF COMPLAINT: Difficulty swallowing

PRESENT ILLNESS: Mr. [**Known lastname 7739**] is a 62 year old man with no past medical history
who presented to an OSH with sore throat and neck swelling. He
had noted a "tickle" in his throat on Monday (three days prior
to admission), and over the subsequent days, he noted more
discomfort swallowing. He had a subjective fever, but denies
chills, nausea, vomiting, chest pain, shortness of breath,
abdominal pain, diarrhea, dysuria, decreased urine output. Has
been able to drink fluids. CT scan at OSH demonstrated
parapharyngeal soft tissue swelling, he received one dose of
ceftriaxone, and he was transferred to [**Hospital1 18**] for ENT workup.
.
In the ED, he received Decadron and clindamycin. Stat ENT
consult was obtained, and fiberoptic laryngoscopy was performed,
demonstrating edema of the left larynx. Anesthesia was also
consulted for fiberoptic examination in case of need for
emergent fiberoptic intubation.
.
In the MICU the patient continued to be on Dexamethasone which
was stopped today. Clindamycin was continued. ENT did not plan
any further intervention. A CT suggestive of parapharyngeal soft
tissue with inflammatory stranding, no abscess was identified.
The patient was also diagnosed with diabetes, which is probably
in part due to steroids. Patient states at physical exams
throughout the years he has had "high pressure" in the 200s
systolic secondary to what he calls "my white coat syndrome".
Denies any history of polyuria and polyphagia.

MEDICAL HISTORY: None  - Patient has not seen a PCP [**Name Initial (PRE) 15925**]

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VITALS: T99.0, BP 148/42, HR 86;79-92, RR 20, Sat 96%RA  I/O
+2135 during ICU stay
GENERAL: NAD, alert and oriented times 3, pleasant and
cooperative, resting comfortably in bed, no respiratory
distress, not on O2
HEENT: EOMI, PERRL, no tenderness to palpation along left neck,
left side neck appears more swollen compared to right
NECK: No JVD appreciated, LAD hard to assess given soft tissue
swelling
CARD: RRR, normal S1/S2, no m/r/g, no S3 or S4, no heaves or
thrills
RESP: Diffuse expiratory wheezes, decreased breath sounds
throughout, no rhonchi, fine dry crackles at bases bilaterally
ABD: Soft, non-tender, non-distended + bowel sounds, no
organomegaly
EXT: No edema, 2+ pulses bilaterally

FAMILY HISTORY: No known cancer. Mother with diabetes, died of CHF. Father died
in accident. Brother and sister in good health. Daughter with
type 1 diabetes, son in good health.

SOCIAL HISTORY: Lives in [**Location 15749**]. 48 year smoking history (1 pack-1.5 pack
per day). No EtOH, no illicits. Has daughter in area, son in
[**Name (NI) 108**]. Girlfriend [**Name (NI) **] is health care proxy.
Parapharyngeal abscess,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Tobacco use disorder
Parapharyngeal abscess,DMII wo cmp nt st uncntr,Hypertension NOS,Tobacco use disorder
Admission Date:  [**2163-11-17**]              Discharge Date:   [**2163-11-22**]

Date of Birth:  [**2101-10-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2145**]
Chief Complaint:
Difficulty swallowing

Major Surgical or Invasive Procedure:
Fiberoptic laryngoscopy

History of Present Illness:
Mr. [**Known lastname 7739**] is a 62 year old man with no past medical history
who presented to an OSH with sore throat and neck swelling. He
had noted a "tickle" in his throat on Monday (three days prior
to admission), and over the subsequent days, he noted more
discomfort swallowing. He had a subjective fever, but denies
chills, nausea, vomiting, chest pain, shortness of breath,
abdominal pain, diarrhea, dysuria, decreased urine output. Has
been able to drink fluids. CT scan at OSH demonstrated
parapharyngeal soft tissue swelling, he received one dose of
ceftriaxone, and he was transferred to [**Hospital1 18**] for ENT workup.
.
In the ED, he received Decadron and clindamycin. Stat ENT
consult was obtained, and fiberoptic laryngoscopy was performed,
demonstrating edema of the left larynx. Anesthesia was also
consulted for fiberoptic examination in case of need for
emergent fiberoptic intubation.
.
In the MICU the patient continued to be on Dexamethasone which
was stopped today. Clindamycin was continued. ENT did not plan
any further intervention. A CT suggestive of parapharyngeal soft
tissue with inflammatory stranding, no abscess was identified.
The patient was also diagnosed with diabetes, which is probably
in part due to steroids. Patient states at physical exams
throughout the years he has had "high pressure" in the 200s
systolic secondary to what he calls "my white coat syndrome".
Denies any history of polyuria and polyphagia.

Past Medical History:
None  - Patient has not seen a PCP [**Name Initial (PRE) 15925**]

Social History:
Lives in [**Location 15749**]. 48 year smoking history (1 pack-1.5 pack
per day). No EtOH, no illicits. Has daughter in area, son in
[**Name (NI) 108**]. Girlfriend [**Name (NI) **] is health care proxy.


Family History:
No known cancer. Mother with diabetes, died of CHF. Father died
in accident. Brother and sister in good health. Daughter with
type 1 diabetes, son in good health.

Physical Exam:
PHYSICAL EXAMINATION:
VITALS: T99.0, BP 148/42, HR 86;79-92, RR 20, Sat 96%RA  I/O
+2135 during ICU stay
GENERAL: NAD, alert and oriented times 3, pleasant and
cooperative, resting comfortably in bed, no respiratory
distress, not on O2
HEENT: EOMI, PERRL, no tenderness to palpation along left neck,
left side neck appears more swollen compared to right
NECK: No JVD appreciated, LAD hard to assess given soft tissue
swelling
CARD: RRR, normal S1/S2, no m/r/g, no S3 or S4, no heaves or
thrills
RESP: Diffuse expiratory wheezes, decreased breath sounds
throughout, no rhonchi, fine dry crackles at bases bilaterally
ABD: Soft, non-tender, non-distended + bowel sounds, no
organomegaly
EXT: No edema, 2+ pulses bilaterally

Pertinent Results:
CHEST (PORTABLE AP)  [**2163-11-17**] 3:51 PM

CHEST (PORTABLE AP)

Reason: Please evaluate lung fields

[**Hospital 93**] MEDICAL CONDITION:
62 year old man with no pmhx
REASON FOR THIS EXAMINATION:
Please evaluate lung fields
PORTABLE CHEST OF [**2163-11-17**]

INDICATION: Evaluate lungs.

Heart size, mediastinal and hilar contours are within normal
limits for technique, and lungs and pleural surfaces are clear.
If clinical suspicion for acute pulmonary abnormality persists,
dedicated PA and lateral chest radiographs may be considered for
more complete assessment.
CT NECK W/CONTRAST (EG:PAROTIDS)  [**2163-11-17**] 6:36 AM

CT NECK W/CONTRAST (EG:PAROTID

Reason: please eval L lateral soft tissue mass

[**Hospital 93**] MEDICAL CONDITION:
62M w/no pmh tx from [**Hospital3 **] for ENT eval of new L
parapharyngeal soft tissue mass. Presented with increasing
dysphagia. WBC 24. Got ceftriaxone.
REASON FOR THIS EXAMINATION:
please eval L lateral soft tissue mass
CONTRAINDICATIONS for IV CONTRAST: None.

HISTORY: 62-year-old man with no past medical history,
transferred from [**Hospital3 **] with new left parapharyngeal
soft tissue mass and increasing dysphasia. White blood cell
count 24,000.

TECHNIQUE: Multidetector axial images of the neck were obtained
with 90 cc Optiray intravenous contrast. Coronal reformatted
images were performed.

There is significant enlargement of the left parapharyngeal soft
tissues with prominent surrounding inflammatory stranding. There
is soft tissue enhancement around the left styloid process. The
masticator space is also involved with loss of fat planes and
enlargement of the medial and lateral pterygoid muscles. No
fluid collections are identified. Prominent left level II lymph
nodes are identified. Vascular structures are patent. The left
external carotid artery courses through the areas of stranding.
The inflammatory stranding extends inferiorly to the level of
the false cords. The airway is patent but narrowed to 4 mm in
the lower pharynx. There is mild maxillary sinus mucosal
thickening. No air-fluid levels are identified. Visualized
portions of the brain are within normal limits. Osseous
structures are unremarkable.

IMPRESSION: Marked thickening and enhancement of the left
parapharyngeal soft tissues with extension of inflammatory
stranding into the masticator space and inferiorly to the level
of the false cords. No focal collections to suggest an abscess.
The appearance and clinical history are more suggestive of
infection/inflammation. However, correlation with direct
inspection and response to therapy is recommended to exclude an
underlying neoplasm. The airway is patent but at least
moderately narrowed.

[**2163-11-21**] 06:15AM BLOOD WBC-12.6* RBC-5.34 Hgb-16.4 Hct-49.1
MCV-92 MCH-30.7 MCHC-33.5 RDW-13.3 Plt Ct-255
[**2163-11-21**] 06:15AM BLOOD Neuts-70.6* Lymphs-22.7 Monos-5.3 Eos-0.4
Baso-0.9
[**2163-11-18**] 02:39AM BLOOD Glucose-318* UreaN-17 Creat-0.7 Na-137
K-4.5 Cl-100 HCO3-24 AnGap-18
[**2163-11-21**] 06:15AM BLOOD Glucose-190*
[**2163-11-17**] 05:06PM BLOOD ALT-21 AST-11 LD(LDH)-182 AlkPhos-83
TotBili-0.5
[**2163-11-17**] 05:06PM BLOOD Triglyc-89 HDL-47 CHOL/HD-3.6 LDLcalc-104

Brief Hospital Course:
62 year old man with no known past medical history presenting
with left sided neck swelling, with CT suggestive of
parapharyngeal soft tissue inflammatory stranding, new diagnosis
of hypertension and type 2 diabetes.
.
#) Left sided parapharyngeal inflammation

Patient initially presented with odynophagia, CT showed marked
thickening and enhancement of the left parapharyngeal soft
tissues with extension of inflammatory stranding into the
masticator space and inferiorly to the level of the false cords.
He was evaluated by ENT and found on fiberoptic exam to have
significant edema of the lateral pharyngeal wall, as well as
edema/erythema to uvula and epiglottis. He received brief course
of decadron and started on IV clindamycin. His swelling
decreased significantly though he does have some discomfort
swallowing hard solids at time of discharge. He is to complete a
14 day course of clindamycin and f/u as below with Dr. [**First Name (STitle) **] of
ENT. They did not feel repeat f/u imaging was necessary at this
time but they will reassess him in clinic in order to exclude a
malignant process as underlying etiology.
.
#) Hypertension

No history of hypertension, no home medications. Patient was
started on low dose lisinopril with improvement in blood
pressure. He was scheduled an outpatient PCP appointment for
follow up of electrolytes and titration of blood pressure
medication.
.
#) Diabetes II

Initially in setting of steroid administration, but family
history, glucosuria, and body habitus are suggestive of
underlying glucose intolerance. His blood glucose remained
elevated off steroids, HbA1C was 11.2%, patient's work schedule
made it difficult for him to be placed on insulin as [**First Name8 (NamePattern2) **] [**Last Name (un) **]
recommendation. He travels at times for work (3 months at a
time) and stated he was very reluctant to start insulin because
he has no reliable means of refrigeration. Trial of oral
medication with metformin 1g [**Hospital1 **] and glipizide 10mg [**Hospital1 **] was
begun. Patient is to schedule [**Last Name (un) **] follow up as outpatient
once insurance situation is settled.
.
#) Social

He does not currently have insurance and is working with social
worker on this issue.  He also stated he might consider finding
a PCP closer to his home but for now we have set him up for PCP,
[**Name10 (NameIs) **], and ENT appt as below. At discharge he was given 4 weeks
worth of medication until his insurance company begins and his
copayments are lowered.


Medications on Admission:
none

Discharge Medications:
1. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*14 Tablet(s)* Refills:*0*
2. Clindamycin HCl 300 mg Capsule Sig: One (1) Capsule PO four
times a day for 8 days.
Disp:*32 Capsule(s)* Refills:*0*
3. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*28 Tablet(s)* Refills:*0*
4. Glipizide 10 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*28 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Parapharyngeal soft tissue infection

Secondary:
Diabetes mellitus type II
Hypertension


Discharge Condition:
Stable, ambulating well, swallowing improving daily


Discharge Instructions:
You were admitted with an infection in the back of your throat.
You were seen by the ENT specialists who you will follow up
with. You also are to complete a course of antibiotics for 14
days. You were also diagnosed with diabetes and high blood
pressure. Appointments have been scheduled with a primary care
doctor, ENT, and [**Last Name (un) **] for diabetes follow up.

Return to the ER if you have worsening trouble swallowing or
breathing, fever, chills or any worrisome symptoms.

A list of your medications and follow up appointments will be
given to you.

Followup Instructions:
Provider: [**Name10 (NameIs) 31494**] [**First Name8 (NamePattern2) **] [**Name (NI) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2163-11-24**] 2:30
.
Dr. [**First Name4 (NamePattern1) 10827**] [**Last Name (NamePattern1) **] of Ear Nose Throat on [**2163-12-1**] 11:30 AM
[**Location (un) **], [**Location (un) 55**], [**Numeric Identifier **]
([**Telephone/Fax (1) 7767**]
.
[**Last Name (un) **] Center
([**Telephone/Fax (1) 4847**]
Please call to make an appointment as soon as possible.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2158**]
{'Parapharyngeal abscess,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Tobacco use disorder'}


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: Difficulty swallowing

PRESENT ILLNESS: Mr. [**Known lastname 7739**] is a 62 year old man with no past medical history
who presented to an OSH with sore throat and neck swelling. He
had noted a "tickle" in his throat on Monday (three days prior
to admission), and over the subsequent days, he noted more
discomfort swallowing. He had a subjective fever, but denies
chills, nausea, vomiting, chest pain, shortness of breath,
abdominal pain, diarrhea, dysuria, decreased urine output. Has
been able to drink fluids. CT scan at OSH demonstrated
parapharyngeal soft tissue swelling, he received one dose of
ceftriaxone, and he was transferred to [**Hospital1 18**] for ENT workup.
.
In the ED, he received Decadron and clindamycin. Stat ENT
consult was obtained, and fiberoptic laryngoscopy was performed,
demonstrating edema of the left larynx. Anesthesia was also
consulted for fiberoptic examination in case of need for
emergent fiberoptic intubation.
.
In the MICU the patient continued to be on Dexamethasone which
was stopped today. Clindamycin was continued. ENT did not plan
any further intervention. A CT suggestive of parapharyngeal soft
tissue with inflammatory stranding, no abscess was identified.
The patient was also diagnosed with diabetes, which is probably
in part due to steroids. Patient states at physical exams
throughout the years he has had "high pressure" in the 200s
systolic secondary to what he calls "my white coat syndrome".
Denies any history of polyuria and polyphagia.

MEDICAL HISTORY: None  - Patient has not seen a PCP [**Name Initial (PRE) 15925**]

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VITALS: T99.0, BP 148/42, HR 86;79-92, RR 20, Sat 96%RA  I/O
+2135 during ICU stay
GENERAL: NAD, alert and oriented times 3, pleasant and
cooperative, resting comfortably in bed, no respiratory
distress, not on O2
HEENT: EOMI, PERRL, no tenderness to palpation along left neck,
left side neck appears more swollen compared to right
NECK: No JVD appreciated, LAD hard to assess given soft tissue
swelling
CARD: RRR, normal S1/S2, no m/r/g, no S3 or S4, no heaves or
thrills
RESP: Diffuse expiratory wheezes, decreased breath sounds
throughout, no rhonchi, fine dry crackles at bases bilaterally
ABD: Soft, non-tender, non-distended + bowel sounds, no
organomegaly
EXT: No edema, 2+ pulses bilaterally

FAMILY HISTORY: No known cancer. Mother with diabetes, died of CHF. Father died
in accident. Brother and sister in good health. Daughter with
type 1 diabetes, son in good health.

SOCIAL HISTORY: Lives in [**Location 15749**]. 48 year smoking history (1 pack-1.5 pack
per day). No EtOH, no illicits. Has daughter in area, son in
[**Name (NI) 108**]. Girlfriend [**Name (NI) **] is health care proxy. 

### Response:
{'Parapharyngeal abscess,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Tobacco use disorder'}
