CHIEF COMPLAINT: Sore throat

PRESENT ILLNESS: 38yo F p/w progressive sore throat for 4 days and fever. She
noted sore throat became worse on the left, and developed AS
otalgia. She's had progressive odynophagia, now w/ significantly
limited POs. Report fever to 104 at home. She usually gets 1
sore throat per year, but has never had a PTA. No difficulty
breathing. She was given dilaudid and Clindamyin in the ED.
Of note, she finished chemotherapy for breast cancer 2 months
ago.

MEDICAL HISTORY: Past Medical History:
Metastatic breast cancer with verterbral metastasis s/p XRT to
thoracic spine
HTN
Morbid Obesity
Depression
Anemia
Post partum cardiomyopathy- EF now improved to 45-50%

MEDICATION ON ADMISSION: Medications:
1. Lisinopril 40 mg daily
2. Metoprolol Succinate 50 mg daily
3. Hydrochlorothiazide 50 mg daily
4. Aspirin 325 mg daily
5. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO Q4H prn pain
6. Zofran 4 mg q8hr prn nausea
7. Ferrous Sulfate 325 mg daily
8. Docusate Sodium 100 mg [**Hospital1 **] prn
9. Senna 8.6 mg [**Hospital1 **] prn
10. Morphine 15 mg [**Hospital1 **] prn

ALLERGIES: Iodine; Iodine Containing / Morphine

PHYSICAL EXAM: 101.1 98.9 90 120/74 16 97%RA
NAD, no stridor, no work of breathing, appears uncomfortable
[**Name Prefix (Prefixes) **] - [**Last Name (Prefixes) **] without edema/erythema, TM intact without erythema
Nose - normal mucosa anteriorly bil, no drainage middle meatus
bil
OC - no trismus, tongue- no edema, soft FOM
OP - + erythema, 2+ tonsils thin exudate, uvula midline,
asymmetry of left anterior tonsillar fossa- which is displaced
toward midline inferiorly
Neck - + tender LAD on left, no stiffness
Fiberoptic exam: NP - no mass or drainage, patent ET bil, left
pharyngeal wall w/ significant edema narrowing OP by about 30%,
starting at inferior aspect of OP, partially obliterating left
vallecue, and extending into hypopharynx, left piriform sinus
partially obliterated by lateral pharyngeal wall edema, AE
folds- no edema, arytenoids- no edema, bil normal VC motion, VC
without edema, small amt pooled secretions in postcricoid space,
crisp epiglottis, normal R valleculae and piriform sinus

FAMILY HISTORY: Aunt with [**Name2 (NI) 499**] cancer at 46. Grandmother had
leukemia. Mother: diabetes. [**Hospital 5772**] medical history unknown to
patient.

SOCIAL HISTORY: Lives at home with husband and children. smoking [**1-16**] cigarettes
per day
Peritonsillar abscess,Secondary malignant neoplasm of bone and bone marrow,Unspecified essential hypertension,Personal history of malignant neoplasm of breast
Peritonsillar abscess,Secondary malig neo bone,Hypertension NOS,Hx of breast malignancy
Admission Date:  [**2102-7-27**]              Discharge Date:   [**2102-7-29**]

Date of Birth:  [**2063-8-23**]             Sex:   F

Service: MEDICINE

Allergies:
Iodine; Iodine Containing / Morphine

Attending:[**First Name3 (LF) 3561**]
Chief Complaint:
Sore throat

Major Surgical or Invasive Procedure:
Needle aspiration of abscess


History of Present Illness:
38yo F p/w progressive sore throat for 4 days and fever. She
noted sore throat became worse on the left, and developed AS
otalgia. She's had progressive odynophagia, now w/ significantly
limited POs. Report fever to 104 at home. She usually gets 1
sore throat per year, but has never had a PTA. No difficulty
breathing. She was given dilaudid and Clindamyin in the ED.
Of note, she finished chemotherapy for breast cancer 2 months
ago.

Past Medical History:
Past Medical History:
Metastatic breast cancer with verterbral metastasis s/p XRT to
thoracic spine
HTN
Morbid Obesity
Depression
Anemia
Post partum cardiomyopathy- EF now improved to 45-50%


Social History:
Lives at home with husband and children. smoking [**1-16**] cigarettes
per day


Family History:
Aunt with [**Name2 (NI) 499**] cancer at 46. Grandmother had
leukemia. Mother: diabetes. [**Hospital 5772**] medical history unknown to
patient.


Physical Exam:
101.1 98.9 90 120/74 16 97%RA
NAD, no stridor, no work of breathing, appears uncomfortable
[**Name Prefix (Prefixes) **] - [**Last Name (Prefixes) **] without edema/erythema, TM intact without erythema
Nose - normal mucosa anteriorly bil, no drainage middle meatus
bil
OC - no trismus, tongue- no edema, soft FOM
OP - + erythema, 2+ tonsils thin exudate, uvula midline,
asymmetry of left anterior tonsillar fossa- which is displaced
toward midline inferiorly
Neck - + tender LAD on left, no stiffness
Fiberoptic exam: NP - no mass or drainage, patent ET bil, left
pharyngeal wall w/ significant edema narrowing OP by about 30%,
starting at inferior aspect of OP, partially obliterating left
vallecue, and extending into hypopharynx, left piriform sinus
partially obliterated by lateral pharyngeal wall edema, AE
folds- no edema, arytenoids- no edema, bil normal VC motion, VC
without edema, small amt pooled secretions in postcricoid space,
crisp epiglottis, normal R valleculae and piriform sinus


Pertinent Results:
[**2102-7-27**] 05:47AM BLOOD WBC-6.8 RBC-4.03* Hgb-11.6* Hct-34.9*
MCV-87 MCH-28.9 MCHC-33.3 RDW-14.2 Plt Ct-336
[**2102-7-27**] 05:47AM BLOOD Neuts-73.5* Lymphs-17.1* Monos-7.1
Eos-1.9 Baso-0.5
[**2102-7-27**] 05:47AM BLOOD Glucose-116* UreaN-17 Creat-0.8 Na-141
K-3.8 Cl-103 HCO3-27 AnGap-15
[**2102-7-28**] 06:30AM BLOOD Calcium-10.0 Phos-3.9 Mg-2.5

CT NECK W/CONTRAST
IMPRESSION:
1.  A 1.7 cm rim enhancing collection in the left palatine
tonsil that
represents phlegmon or developing abscess.
2.  New lytic lesions in the cervical spine are concerning for
progression of
known breast malignancy.


Brief Hospital Course:
Ms. [**Known lastname 3444**] was admitted to the MICU from the ER for continuous O2
sat monitoring, IV abx and steroids given the concern for
possible airway compromise.  She was started on all of her home
medications.  A repeat fiberoptic exam was done on the afternoon
of admission which showed a persistent mass/edema in the L
pharyngeal wall to within 1/2 cm from the epiglottis.  An
attempt was made at aspiration of the peritonsillar area which
failed to return any purulent drainage.  She was transferred out
of the MICU on HD 2 as she was clinically improving.  She
received a total of 3 doses of steroids.  On the floor she
continued to improve clinically.  We suggested 24 hours
additional of IV antibiotics but the patient refused.  Given her
refusal to stay and her clinical improvement we have decided on
a discharge plan including 10 days of high dose oral antibiotics
and close follow up.  She will be seen on Wednesday in clinic
and was instructed to immediately return to the ER should she
experience any worsening symptoms.
Patient is being discharged: afebrile, tolerating regular diet
without nausea/vomiting,  voiding, and ambulating well.

Medications on Admission:
Medications:
1. Lisinopril 40 mg daily
2. Metoprolol Succinate 50 mg daily
3. Hydrochlorothiazide 50 mg daily
4. Aspirin 325 mg daily
5. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO Q4H prn pain
6. Zofran 4 mg q8hr prn nausea
7. Ferrous Sulfate 325 mg daily
8. Docusate Sodium 100 mg [**Hospital1 **] prn
9. Senna 8.6 mg [**Hospital1 **] prn
10. Morphine 15 mg [**Hospital1 **] prn


Discharge Medications:
1. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

2. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
3. Hydrochlorothiazide 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed.
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Augmentin 875-125 mg Tablet Sig: One (1) Tablet PO twice a
day for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
8. Amoxicillin 250 mg Capsule Sig: One (1) Capsule PO twice a
day for 10 days: take in addition to Augmentin.
Disp:*20 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
peritonsillar phlegmon


Discharge Condition:
Stable


Discharge Instructions:
Seek immediate medical attention for fever >101.5, chills,
shortness of breath, change in your voice, chest pain or
anything else that is troubling you. Resume all home
medications. Call your surgeon to make follow up appointment.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) 5773**]/Dr. [**Last Name (STitle) **] in ENT on Wednesday.
Call [**Telephone/Fax (1) **] on Monday to schedule an appointment
{'Peritonsillar abscess,Secondary malignant neoplasm of bone and bone marrow,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}


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: 38yo F p/w progressive sore throat for 4 days and fever. She
noted sore throat became worse on the left, and developed AS
otalgia. She's had progressive odynophagia, now w/ significantly
limited POs. Report fever to 104 at home. She usually gets 1
sore throat per year, but has never had a PTA. No difficulty
breathing. She was given dilaudid and Clindamyin in the ED.
Of note, she finished chemotherapy for breast cancer 2 months
ago.

MEDICAL HISTORY: Past Medical History:
Metastatic breast cancer with verterbral metastasis s/p XRT to
thoracic spine
HTN
Morbid Obesity
Depression
Anemia
Post partum cardiomyopathy- EF now improved to 45-50%

MEDICATION ON ADMISSION: Medications:
1. Lisinopril 40 mg daily
2. Metoprolol Succinate 50 mg daily
3. Hydrochlorothiazide 50 mg daily
4. Aspirin 325 mg daily
5. Hydromorphone 4 mg Tablet Sig: 1-2 Tablets PO Q4H prn pain
6. Zofran 4 mg q8hr prn nausea
7. Ferrous Sulfate 325 mg daily
8. Docusate Sodium 100 mg [**Hospital1 **] prn
9. Senna 8.6 mg [**Hospital1 **] prn
10. Morphine 15 mg [**Hospital1 **] prn

ALLERGIES: Iodine; Iodine Containing / Morphine

PHYSICAL EXAM: 101.1 98.9 90 120/74 16 97%RA
NAD, no stridor, no work of breathing, appears uncomfortable
[**Name Prefix (Prefixes) **] - [**Last Name (Prefixes) **] without edema/erythema, TM intact without erythema
Nose - normal mucosa anteriorly bil, no drainage middle meatus
bil
OC - no trismus, tongue- no edema, soft FOM
OP - + erythema, 2+ tonsils thin exudate, uvula midline,
asymmetry of left anterior tonsillar fossa- which is displaced
toward midline inferiorly
Neck - + tender LAD on left, no stiffness
Fiberoptic exam: NP - no mass or drainage, patent ET bil, left
pharyngeal wall w/ significant edema narrowing OP by about 30%,
starting at inferior aspect of OP, partially obliterating left
vallecue, and extending into hypopharynx, left piriform sinus
partially obliterated by lateral pharyngeal wall edema, AE
folds- no edema, arytenoids- no edema, bil normal VC motion, VC
without edema, small amt pooled secretions in postcricoid space,
crisp epiglottis, normal R valleculae and piriform sinus

FAMILY HISTORY: Aunt with [**Name2 (NI) 499**] cancer at 46. Grandmother had
leukemia. Mother: diabetes. [**Hospital 5772**] medical history unknown to
patient.

SOCIAL HISTORY: Lives at home with husband and children. smoking [**1-16**] cigarettes
per day 

### Response:
{'Peritonsillar abscess,Secondary malignant neoplasm of bone and bone marrow,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}
