CHIEF COMPLAINT: irritated throat, itchy lips

PRESENT ILLNESS: Ms. [**Known lastname 14323**] is a 26yo woman with h/o recent intubation at [**Hospital1 2177**]
presenting with itchy throat x 1 day.
.
The evening before admission, she noticed a "fleshy" feeling
when she was clearing her throat. She started developing a sore
throat and noted that it hurt when she swallowed her spit. A
little later, she developed an itch around her lips, nose, and
ears. She denies rash or lip swelling. She did not have the
sensation of her throat closing up or having difficulty
breathing. She went to her PCP, [**Name10 (NameIs) 1023**] gave her an Epi injection
and sent her to the ED.
.
Of note, she presented to [**Hospital1 2177**] 2-3 weeks ago with similar
symptoms, which she describes as a "throat ache." She did not
have any sensation of itch at the time. She reports that they
passed a scope through her nose and told her that her airway was
somewhat [**Last Name (LF) 15015**], [**First Name3 (LF) **] the doctors [**Name5 (PTitle) 15016**] [**Name5 (PTitle) **] [**Name5 (PTitle) **] 3 days. She
recalls that SaO2 was 98% prior to intubation. She did well
after extubation and was sent home with an EpiPen.
Unfortunately, she did not make her f/u appointment with
Allergy.
.
On review of systems, she c/o a dry cough and an episode of
yellow emesis x 1 on the morning of admission. She has had brief
headaches that last 1-2 minutes for the last couple of months.
In addition, she has been quite [**Doctor Last Name 11506**] lately and admits to
crying for no reason. Finally, she is concerned about a bump
that developed on her right thigh 2 days ago. She denies fevers,
chills, abdominal pain, diarrhea, or dysuria. Her LMP was one
month ago.
.
Other than eating a fish [**Doctor Last Name **] 2 nights ago, she has not had any
unusual foods recently. She has not changed detergents or soaps.
She has not picked up any new hobbies such as gardening.
.
In the ED, initial VS were: 97.3 117/73 66 16 100%. She had no
signs of respiratory distress. A scope of her upper airway
showed that her nasal turbinates and epiglottis were somewhat
edematous. Her airway proximal to the vocal cords was described
as "full." She was given benadryl 50mg IV, pepcid 20mg IV,
solumedrol 125mg IV.
.
Upon arrival to the ICU, she reported that the itching had
resolved. She felt almost back to baseline.

MEDICAL HISTORY: Obesity
Giant cell fibroblastoma of left thigh s/p excision [**3-26**]
Depression
Fibrocystic breasts
s/p abortion
s/p appendectomy and unilateral oophorectomy

MEDICATION ON ADMISSION: Took motrin 800mg x 1 after her throat irritation began without
any change in symptoms.
Mirena IUD

ALLERGIES: Latex

PHYSICAL EXAM: No temp 75 112/63 19 100% RA
Very pleasant, overweight woman in no distress.
PERRL, EOMI, no conjunctival injection or scleral icterus.
No swelling of lips or tongue. Mucous membranes moist. Tonsils
are generous in size but not erythematous and no sign of
exudate.
No tenderness on palpation of pharynx externally. No adenopathy
or enlargement of thyroid gland. Neck is supple.
S1, S2, RRR, no murmur.
Lungs clear b/l without crackles or wheeze. No sign of
respiratory distress; speaking in full sentences.
Abd: +BS, soft, NT, ND. No hepatomegaly.
Neuro: Alert and oriented, speech intact. Strength 5/5 in UE and
LE b/l.
Psych: Appropriate but has moments when she is almost tearful.
Ext: No LE edema. DP +2 b/l. Warm, well perfused.
Skin: +acanthosis nigricans. +firm papule on medial right thigh
without evidence of fluid collection. No urticaria

FAMILY HISTORY: No h/o problems with throat swelling or angioedema. No cancers
in the family. Daughter has eczema and asthma.

SOCIAL HISTORY: [**11-21**] PPD smoker and is interested in quitting (only quit in past
when pregnant). Also smokes marijuana daily. Drinks socially
once or twice a month. Lives with her aunt and her 5 year old
daughter. She recently lost her job at the [**Location (un) 86**] Globe and is
volunteering at a school library. Will be leaving the house with
her aunt and moving to a shelter in mid [**Month (only) 205**]. She is sexually
active and uses the Mirena for contraception. Her boyfriend is
very supportive.
Swelling, mass, or lump in head and neck,Unspecified pruritic disorder,Obesity, unspecified,Depressive disorder, not elsewhere classified,Tobacco use disorder,Leukocytosis, unspecified
Swelling in head & neck,Pruritic disorder NOS,Obesity NOS,Depressive disorder NEC,Tobacco use disorder,Leukocytosis NOS
Admission Date:  [**2139-5-13**]              Discharge Date:   [**2139-5-14**]

Date of Birth:  [**2113-4-24**]             Sex:   F

Service: MEDICINE

Allergies:
Latex

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
irritated throat, itchy lips

Major Surgical or Invasive Procedure:
Laryngoscopy


History of Present Illness:
Ms. [**Known lastname 14323**] is a 26yo woman with h/o recent intubation at [**Hospital1 2177**]
presenting with itchy throat x 1 day.
.
The evening before admission, she noticed a "fleshy" feeling
when she was clearing her throat. She started developing a sore
throat and noted that it hurt when she swallowed her spit. A
little later, she developed an itch around her lips, nose, and
ears. She denies rash or lip swelling. She did not have the
sensation of her throat closing up or having difficulty
breathing. She went to her PCP, [**Name10 (NameIs) 1023**] gave her an Epi injection
and sent her to the ED.
.
Of note, she presented to [**Hospital1 2177**] 2-3 weeks ago with similar
symptoms, which she describes as a "throat ache." She did not
have any sensation of itch at the time. She reports that they
passed a scope through her nose and told her that her airway was
somewhat [**Last Name (LF) 15015**], [**First Name3 (LF) **] the doctors [**Name5 (PTitle) 15016**] [**Name5 (PTitle) **] [**Name5 (PTitle) **] 3 days. She
recalls that SaO2 was 98% prior to intubation. She did well
after extubation and was sent home with an EpiPen.
Unfortunately, she did not make her f/u appointment with
Allergy.
.
On review of systems, she c/o a dry cough and an episode of
yellow emesis x 1 on the morning of admission. She has had brief
headaches that last 1-2 minutes for the last couple of months.
In addition, she has been quite [**Doctor Last Name 11506**] lately and admits to
crying for no reason. Finally, she is concerned about a bump
that developed on her right thigh 2 days ago. She denies fevers,
chills, abdominal pain, diarrhea, or dysuria. Her LMP was one
month ago.
.
Other than eating a fish [**Doctor Last Name **] 2 nights ago, she has not had any
unusual foods recently. She has not changed detergents or soaps.
She has not picked up any new hobbies such as gardening.
.
In the ED, initial VS were: 97.3 117/73 66 16 100%. She had no
signs of respiratory distress. A scope of her upper airway
showed that her nasal turbinates and epiglottis were somewhat
edematous. Her airway proximal to the vocal cords was described
as "full." She was given benadryl 50mg IV, pepcid 20mg IV,
solumedrol 125mg IV.
.
Upon arrival to the ICU, she reported that the itching had
resolved. She felt almost back to baseline.


Past Medical History:
Obesity
Giant cell fibroblastoma of left thigh s/p excision [**3-26**]
Depression
Fibrocystic breasts
s/p abortion
s/p appendectomy and unilateral oophorectomy


Social History:
[**11-21**] PPD smoker and is interested in quitting (only quit in past
when pregnant). Also smokes marijuana daily. Drinks socially
once or twice a month. Lives with her aunt and her 5 year old
daughter. She recently lost her job at the [**Location (un) 86**] Globe and is
volunteering at a school library. Will be leaving the house with
her aunt and moving to a shelter in mid [**Month (only) 205**]. She is sexually
active and uses the Mirena for contraception. Her boyfriend is
very supportive.

Family History:
No h/o problems with throat swelling or angioedema. No cancers
in the family. Daughter has eczema and asthma.

Physical Exam:
No temp 75 112/63 19 100% RA
Very pleasant, overweight woman in no distress.
PERRL, EOMI, no conjunctival injection or scleral icterus.
No swelling of lips or tongue. Mucous membranes moist. Tonsils
are generous in size but not erythematous and no sign of
exudate.
No tenderness on palpation of pharynx externally. No adenopathy
or enlargement of thyroid gland. Neck is supple.
S1, S2, RRR, no murmur.
Lungs clear b/l without crackles or wheeze. No sign of
respiratory distress; speaking in full sentences.
Abd: +BS, soft, NT, ND. No hepatomegaly.
Neuro: Alert and oriented, speech intact. Strength 5/5 in UE and
LE b/l.
Psych: Appropriate but has moments when she is almost tearful.
Ext: No LE edema. DP +2 b/l. Warm, well perfused.
Skin: +acanthosis nigricans. +firm papule on medial right thigh
without evidence of fluid collection. No urticaria


Pertinent Results:
Admission labs:
[**2139-5-13**] 04:45PM   WBC-13.8* RBC-4.68 HGB-13.8 HCT-40.3 MCV-86
MCH-29.4 MCHC-34.1 RDW-13.8
[**2139-5-13**] 04:45PM   NEUTS-58.3 LYMPHS-34.1 MONOS-5.1 EOS-1.3
BASOS-1.2
[**2139-5-13**] 04:45PM   PLT COUNT-371
[**2139-5-13**] 04:45PM   GLUCOSE-80 UREA N-10 CREAT-0.7 SODIUM-137
POTASSIUM-3.8 CHLORIDE-104 TOTAL CO2-24 ANION GAP-13

Brief Hospital Course:
A/P: 26yo woman recently [**Month/Day/Year 15016**] at [**Hospital1 2177**] for possible laryngeal
edema admitted to the ICU in the setting of perioral itching and
minor epiglottis edema.
.
# Irritated throat / Facial itching:  DDx includes allergic
reaction/anaphylaxis vs hereditary angioedema vs C1 inhibitor
disorder vs. anxiety given social stressors. Patient is unable
to identify possible environmental triggers and she has not been
started on any new medications. Lack of urticaria would be
consistent with C1 inhibitor disorders. Given her age and lack
of family history, hereditary angioedema seems unlikely.
Acquired C1 inhibitor disorders are usually associated with an
underlying condition, such as autoimmune disease or
lymphoproliferative disorders. NSAIDs can cause angioedema, but
she is clear that she did not have motrin until after her
symptoms began. Finally, the mild epiglottis swelling on her
scope in the ED may in fact be a normal finding in the setting
of her recent intubation.  Pt received solmedrol in the ED and
was continued on a prednisone taper to be completed at home.
She was also treated with famotidine and benadryl while
hospitalized.  Her symptoms completely resolved within 12 hours.
 She was also evaluated by ENT who noted widely patent airway
and no evidence of compromise.  She was strongly advised to
follow up with Allergy for further evaluation (C4, C1 inhibitor,
and C1q).  Pt is advised to schedule f/u with ORL 7-10 days
after discharge ([**Telephone/Fax (1) 2349**] or [**Telephone/Fax (1) 41**]).
.
# Leukocytosis:  Infectious review of systems is negative and
differential is completely normal, so there was no indication
for antibiotics.
.
# Tobacco abuse:  Pt was provided smoking cessation counseling.
.
# Possible depression, social stress:  Social worked evaluated
the patient and recommended follow-up with SW at [**Hospital **] Clinic.


Medications on Admission:
Took motrin 800mg x 1 after her throat irritation began without
any change in symptoms.
Mirena IUD


Discharge Medications:
1. Prednisone 10 mg Tablet Sig: per below instructions Tablet PO
once a day for 4 days: For prednisone taper. You already got 50
mg X 1 today. Start with  40 mg X 1 on day 2, then 30 mg X 1 on
day 3, then 20 mg X 1 on day 4, then 10 mg X 1 on day 5. .
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Throat Swelling


Discharge Condition:
Good. Vital signs stable, no signs of respiratory distress.


Discharge Instructions:
You were admitted to the hospital with a question of throat
swelling and were observed in the ICU overnight with improvement
in your symptoms.

You will need to take a taper of steroids over the next 5 days.
You already took prednisone 50 mg today, then you will take 40
mg tomorrow, then 30 mg the day after, 20 mg the day after that,
and 10 mg on the 5th and final day of your taper.

Please call your doctor or return to the emergency room if you
develop any of the following symptoms: worsening shortness of
breath, throat swelling or sensation of it closing, wheezing,
inability to control your mouth secretions.

Followup Instructions:
You will need to follow-up with an allergy specialist. Please
call [**Telephone/Fax (1) 9316**] to make an appointment.

Please follow-up with your PCP [**Name Initial (PRE) 176**] 1 week.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]
{'Swelling, mass, or lump in head and neck,Unspecified pruritic disorder,Obesity, unspecified,Depressive disorder, not elsewhere classified,Tobacco use disorder,Leukocytosis, unspecified'}


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: irritated throat, itchy lips

PRESENT ILLNESS: Ms. [**Known lastname 14323**] is a 26yo woman with h/o recent intubation at [**Hospital1 2177**]
presenting with itchy throat x 1 day.
.
The evening before admission, she noticed a "fleshy" feeling
when she was clearing her throat. She started developing a sore
throat and noted that it hurt when she swallowed her spit. A
little later, she developed an itch around her lips, nose, and
ears. She denies rash or lip swelling. She did not have the
sensation of her throat closing up or having difficulty
breathing. She went to her PCP, [**Name10 (NameIs) 1023**] gave her an Epi injection
and sent her to the ED.
.
Of note, she presented to [**Hospital1 2177**] 2-3 weeks ago with similar
symptoms, which she describes as a "throat ache." She did not
have any sensation of itch at the time. She reports that they
passed a scope through her nose and told her that her airway was
somewhat [**Last Name (LF) 15015**], [**First Name3 (LF) **] the doctors [**Name5 (PTitle) 15016**] [**Name5 (PTitle) **] [**Name5 (PTitle) **] 3 days. She
recalls that SaO2 was 98% prior to intubation. She did well
after extubation and was sent home with an EpiPen.
Unfortunately, she did not make her f/u appointment with
Allergy.
.
On review of systems, she c/o a dry cough and an episode of
yellow emesis x 1 on the morning of admission. She has had brief
headaches that last 1-2 minutes for the last couple of months.
In addition, she has been quite [**Doctor Last Name 11506**] lately and admits to
crying for no reason. Finally, she is concerned about a bump
that developed on her right thigh 2 days ago. She denies fevers,
chills, abdominal pain, diarrhea, or dysuria. Her LMP was one
month ago.
.
Other than eating a fish [**Doctor Last Name **] 2 nights ago, she has not had any
unusual foods recently. She has not changed detergents or soaps.
She has not picked up any new hobbies such as gardening.
.
In the ED, initial VS were: 97.3 117/73 66 16 100%. She had no
signs of respiratory distress. A scope of her upper airway
showed that her nasal turbinates and epiglottis were somewhat
edematous. Her airway proximal to the vocal cords was described
as "full." She was given benadryl 50mg IV, pepcid 20mg IV,
solumedrol 125mg IV.
.
Upon arrival to the ICU, she reported that the itching had
resolved. She felt almost back to baseline.

MEDICAL HISTORY: Obesity
Giant cell fibroblastoma of left thigh s/p excision [**3-26**]
Depression
Fibrocystic breasts
s/p abortion
s/p appendectomy and unilateral oophorectomy

MEDICATION ON ADMISSION: Took motrin 800mg x 1 after her throat irritation began without
any change in symptoms.
Mirena IUD

ALLERGIES: Latex

PHYSICAL EXAM: No temp 75 112/63 19 100% RA
Very pleasant, overweight woman in no distress.
PERRL, EOMI, no conjunctival injection or scleral icterus.
No swelling of lips or tongue. Mucous membranes moist. Tonsils
are generous in size but not erythematous and no sign of
exudate.
No tenderness on palpation of pharynx externally. No adenopathy
or enlargement of thyroid gland. Neck is supple.
S1, S2, RRR, no murmur.
Lungs clear b/l without crackles or wheeze. No sign of
respiratory distress; speaking in full sentences.
Abd: +BS, soft, NT, ND. No hepatomegaly.
Neuro: Alert and oriented, speech intact. Strength 5/5 in UE and
LE b/l.
Psych: Appropriate but has moments when she is almost tearful.
Ext: No LE edema. DP +2 b/l. Warm, well perfused.
Skin: +acanthosis nigricans. +firm papule on medial right thigh
without evidence of fluid collection. No urticaria

FAMILY HISTORY: No h/o problems with throat swelling or angioedema. No cancers
in the family. Daughter has eczema and asthma.

SOCIAL HISTORY: [**11-21**] PPD smoker and is interested in quitting (only quit in past
when pregnant). Also smokes marijuana daily. Drinks socially
once or twice a month. Lives with her aunt and her 5 year old
daughter. She recently lost her job at the [**Location (un) 86**] Globe and is
volunteering at a school library. Will be leaving the house with
her aunt and moving to a shelter in mid [**Month (only) 205**]. She is sexually
active and uses the Mirena for contraception. Her boyfriend is
very supportive. 

### Response:
{'Swelling, mass, or lump in head and neck,Unspecified pruritic disorder,Obesity, unspecified,Depressive disorder, not elsewhere classified,Tobacco use disorder,Leukocytosis, unspecified'}
