CHIEF COMPLAINT: Sore Throat

PRESENT ILLNESS: 58 year old Cantonese-speaking female with no significant past
medical history presenting with progressive sore throat,
odynophagia, and voice change over the past 24 hours.  While in
ED, CT neck was obtained that was concerning for an infectious
process at base of tongue/epiglottis tracking to glottis.
Otolaryngology was consulted to evaluate airway.

MEDICAL HISTORY: -Tubal ligation

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: General Appearance: Well nourished, in pain

FAMILY HISTORY: NC

SOCIAL HISTORY: NC
Other diseases of pharynx, not elsewhere classified,Thrombocytopenia, unspecified,Unspecified deficiency anemia
Disease of pharynx NEC,Thrombocytopenia NOS,Deficiency anemia NOS
Admission Date:  [**2120-7-27**]              Discharge Date:   [**2120-7-30**]

Date of Birth:  [**2062-7-20**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 16851**]
Chief Complaint:
Sore Throat


Major Surgical or Invasive Procedure:
laryngoscopy

History of Present Illness:
58 year old Cantonese-speaking female with no significant past
medical history presenting with progressive sore throat,
odynophagia, and voice change over the past 24 hours.  While in
ED, CT neck was obtained that was concerning for an infectious
process at base of tongue/epiglottis tracking to glottis.
Otolaryngology was consulted to evaluate airway.

The patient reports she awoke yesterday with a sore throat.  It
worsened throughout the day.  She presented to PCP office in the
afternoon and was started on antibiotics augmentin and told to
come to ED if her symptoms worsening.  She then developed voice
changes and difficulty managing her secretions so she came to
[**Hospital1 18**] for further evaluation.

She has had no trouble breathing.  No fevers, chills.  No
otolgia.  No cough.  No rhinorrhea.  She does not recall changes
in diet or swallowing something that might have gotten stuck in
her throat.

In the ED, initial VS were: 99.9, 75, 101/67, 18, 96%RA.  A CT
neck was obtained which demonstrated rim enhancing edema
extending from the left palatine tonsil to the true vocal cord.
And moderate to severe narrowing of the airway at the orophyranx
to the hyoid.  She was scopped by ENT who exam confirmed the CT
findings, but had no evidence of stridor or impending airway
compromise.


Past Medical History:
-Tubal ligation


Social History:
NC

Family History:
NC

Physical Exam:
General Appearance: Well nourished, in pain

ADMISSION:
Eyes / Conjunctiva: PERRL, Pupils dilated, Conjunctiva pale,
No(t) Sclera edema
Head, Ears, Nose, Throat: Normocephalic, no tonsilar errythema
or masses, non-deviated uvula
Lymphatic: neck not tender to palpation, no masses
Cardiovascular: (PMI Normal), (S1: Normal), (S2: Normal)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Clear : )
Abdominal: Soft, Non-tender, Bowel sounds present
Skin:  Not assessed
Neurologic: Attentive, Follows simple commands, Responds to: Not
assessed, Movement: Not assessed, Tone: Not assessed

DISCHARGE:
VS: 97.8  117/90  66  18  99%ra
PAIN: 0GEN: nad
ENT: op clear, no edema, erythema or exudates
CHEST: ctab
CV: rrr no m/r/g
ABD: soft, nt/nd
EXT: no e/c/c
NEURO: normal gait


Pertinent Results:
[**7-27**] CT Neck
FINDINGS:
CT OF THE NECK:
There is an extensive partially solid, partially rim-enhancing,
likely an
infectious, phlegmonous process extending from the left inferior
palatine
tonsil (series 7, image 29) caudally to the level of the true
vocal cord
(series 7, image 51), and centered in the left lingual tonsil
(series 7, image 37).  Sagittal images nicely show the
craniocaudal extent of this process (series 801B, image 45).
There is narrowing of the airway at the level of the lingual
tonsil (series 7, image 37) and at the level of the hyoid bone
(series 7, image 43). There is extensive retropharyngeal edema
with effacement of the (left greater than right) pyriform sinus
and edema of the false vocal cord on the left side.  The same
swelling and hypodensity extends to involve the epiglottis and
left aryepiglottic fold. There are no pathologically enlarged
lymph nodes; however, enhancing level 2A lymph nodes are seen on
the left which measure about 7 mm (series 7, image 39 and series
7, image 32) with possible central necrosis. Overall, etiology
of this process is most likely infectious given acute onset and
widespread craniocaudal dimension, malignancy
is unlikely, but cannot be completely excluded especially since
the process is centered in the lingual tonsil.  The jugular
veins, vertebral and carotid arteries are normal. The thyroid
gland are normal.  The lung apices are clear. The paranasal
sinuses and mastoid air cells are clear.
BONES:  There are no suspicious lytic or sclerotic bony lesions.

IMPRESSION:
1. Rim-enhancing likely infectious phlegmonous process extending
from the
lower part of the left palatine tonsil to the true vocal cord,
and centered in left lingual tonsil.
2. Moderate to severe narrowing of the airway at lingual tonsil
level and at the level of the hyoid bone. No foreign bodies.
3. Extensive retropharyngeal edema effacing the left pyriform
sinus and
extending to the level of the true vocal cords.
4. Two 7 mm enhancing left level Ia cervical lymph nodes.
5. Mediastinum is currently not involved, but concern for
further caudal
progression remains.

[**7-27**] CHEST XR
FINDINGS:
Nipple shadows should not be mistaken for pulmonary masses.  The
lungs are clear. The cardiomediastinal silhouette and hila are
normal.  There is no pleural effusion and no pneumothorax.
IMPRESSION:  No acute cardiothoracic process.

[**2120-7-27**] 12:55AM   GLUCOSE-113* UREA N-10 CREAT-0.7 SODIUM-143
POTASSIUM-3.2* CHLORIDE-104 TOTAL CO2-30 ANION GAP-12
[**2120-7-27**] 12:55AM   WBC-8.5# RBC-3.67* HGB-12.4 HCT-37.2 MCV-101*
MCH-33.8* MCHC-33.4 RDW-12.4
[**2120-7-27**] 12:55AM   NEUTS-81.9* LYMPHS-12.2* MONOS-5.5 EOS-0.2
BASOS-0.2
[**2120-7-27**] 12:55AM   PLT SMR-LOW PLT COUNT-90*
[**2120-7-27**] 12:55AM   PT-11.9 PTT-27.0 INR(PT)-1.1
[**2120-7-29**] 06:12AM BLOOD VitB12-778
[**2120-7-29**] 06:12AM BLOOD TSH-0.31

Brief Hospital Course:
58 year old Cantonese-speaking female with [**Last Name (un) 15883**]/difficulty
with phonation due to severe upper airway edema and
inflammation.

# Pharyngeal/laryngeal phlegmon:  Patient's symptoms of pain and
edema demonstrated on both CT and laryngoscopy were suggestive
of a deep space infection (ludwig's angina variant).  ENT did
not see any evidence of pending airway compromise nessecitating
emergent intubation.  Covered for any deep space infection with
unasyn and monitor in the MICU for 24 hours prior to a repeat
scope by ENT. ENT scoped and noted a likely valecular cyst,
probably infected.  Dexamethasone was started overnight, and
patient was monitored.  Patient remained without respiratory
distress and was transferred to the floor.  ENT recommended
continuing steroids through the day on [**2120-7-29**], based on
dramatic symptom improvement, deemed repeat scope was not
needed. Pt transitioned to PO clinda, to complete 10 day course.
Was also seen by speech/swallow and clear for general diet with
thin liquids.

# Thrombocytopenia- noted on baseline labs from 3/[**2119**].  Plt
count dipped to 60,000 on Unasyn, and clindamycin was started in
place. No evidence of bleeding during course, coags normal.

# Macrocytic anemia- B12, TSH both normal.

Medications on Admission:
None

Discharge Medications:
1. Clindamycin 300 mg PO Q6H Duration: 9 Days
RX *clindamycin HCl 300 mg 1 capsule(s) by mouth four times a
day Disp #*34 Capsule Refills:*0


Discharge Disposition:
Home

Discharge Diagnosis:
Pharyngeal/laryngeal phlegmon
Thrombocytopenia
Macrocytic Anemia

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

Discharge Instructions:
You were admitted to the hospital with severe narrowing in your
throat.  You were initially monitored in the ICU, and seen by
the ear/nose/throat surgeons.  Your symptoms improved with
steroids and antibiotics.  You were then able to leave the ICU
and were monitored on the medical floor. Where your symptoms
continued to improve. You were evaluated by the swallowing
specialist and found to have normal swallowing function without
the need for a special diet. You will continue antibiotics until
[**8-7**].
You were also found to have low platelet counts. This will need
to be evaluated further by your primary care doctor.

Followup Instructions:
Name: [**Last Name (LF) 59927**],[**First Name3 (LF) 1730**] C.
Location: [**Hospital3 8233**]
Address: [**State 8234**], [**Location (un) **],[**Numeric Identifier 8235**]
Phone: [**Telephone/Fax (1) 8236**]
Appt:  [**Last Name (LF) 766**], [**8-5**] at 4:15pm

Department: OTOLARYNGOLOGY-AUDIOLOGY
When: TUESDAY [**2120-8-13**] at 11:30 AM
With: [**Female First Name (un) **] [**Last Name (un) 27666**], MD [**Telephone/Fax (1) 41**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) 895**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{'Other diseases of pharynx, not elsewhere classified,Thrombocytopenia, unspecified,Unspecified deficiency anemia'}


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: Sore Throat

PRESENT ILLNESS: 58 year old Cantonese-speaking female with no significant past
medical history presenting with progressive sore throat,
odynophagia, and voice change over the past 24 hours.  While in
ED, CT neck was obtained that was concerning for an infectious
process at base of tongue/epiglottis tracking to glottis.
Otolaryngology was consulted to evaluate airway.

MEDICAL HISTORY: -Tubal ligation

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: General Appearance: Well nourished, in pain

FAMILY HISTORY: NC

SOCIAL HISTORY: NC 

### Response:
{'Other diseases of pharynx, not elsewhere classified,Thrombocytopenia, unspecified,Unspecified deficiency anemia'}
