CHIEF COMPLAINT: food stuck in throat, fever

PRESENT ILLNESS: This is a 44 yo M with h/o developmental delay, hiatal hernia,
GE junction stricture, esophagitis and Crohn's disease who
presented with fevers, cough, and a sensation of food stuck in
his throat. He was eating meat yesterday when he felt it get
caught in his throat, which resulted in nausea and multiple
episodes of non-bloody, non-bilious emesis not associated with
abdominal pain or diarrhea. Per group home staff, pt was noted
to swallow his vomit. Due to concern for aspiration and new
onset of productive cough, he was seen in urgent care clinic
where he was reportedly diagnosed with a LLL vs. RLL PNA (ED
documentation unclear) on a CXR and was sent to the ED for
evaluation. The patient denies fevers, chills. He has had
several sick contacts at his group home but group home staff
deny any H1N1 or influenza cases at group home recently.
.
In the [**Name (NI) **], pt with low grade fever to 100.1, RR 28, O2 sat 97%
4L NC. Labs notable for WBC 15.1 with 83% neutrophils, BUN 21,
Cr 1.2, and lactate 1.1. CXR revealed low lung volumes without a
clear infiltrate but possible retrocardiac opacity and neck
x-ray did not definitely show the presence of any foreign
bodies. Given levofloxacin 750 mg IV X 1, flagyl 500 mg IV X 1,
zofran 4 mg IV X 1, and 1 L IVFs. GI consulted who recommended
admission to ICU for likely EGD to rule out food impaction.
.
Pt was sent to the [**Hospital Unit Name 153**] for EGD which showed food proximal to a
14 mm esophageal stricture. The food was advanced to the
stomach, remaining EGD unremarkable.  Pt remained in the [**Hospital Unit Name 153**]
for difficulty with oxygenation.

MEDICAL HISTORY: Developmental delay
Bipolar disorder
Hypothyroidism
Hiatal hernia
GE junction stricture
Esophagitis
Crohn's disease
Anxiety

MEDICATION ON ADMISSION: Advair 100/50 1 puff [**Hospital1 **] --> recently d/c'd per NH staff
Asacol 800 mg tid
Desonide 0.05% to face at bedtime
Divalproex 1000 mg tid
Fluoxetine 40 mg daily
Dulcolax 10 mg qhs prn
Albuterol 2 puffs q2h prn
Tylenol 625 mg q4h prn
Cetaphil lotion
Diazepam 10 mg 1 hr prior to dental procedures
Benadryl 25 mg prn for itching/rash
Guaifenesin 15 cc q6h prn for cough
Kaopectate 15 cc q6h prn for diarrhea or loose stools
Ketoconazole
Levothyroxine 50 mcg daily
Milk of magnesia prn
Neutrogena T Gel
Omeprazole 40 mg daily
Zyprexa 30 mg qhs

ALLERGIES: Klonopin / Penicillins / Clozaril / Latex / Food Extracts

PHYSICAL EXAM: PE on admission: T 99.4  BP 125/68  HR 109   RR 29  O2 91% on
neb
Gen - mild respiratory distress with mild accecessory muscle
use, tachypneic, obese male, non-toxic appearing, sleepy but
easily arousable
HEENT - no JVD appreciated, supple
CV - tachycardic, no m/r/g appreciated
Lungs - bilataral coase upper airway breath sounds with diffuse
scattered wheezes and rhonchi throughout, no crackles
Abd - Soft, obese, NT, ND, normoactive BS
Ext - no LE edema, WWP
Skin - no rashes or lesions

FAMILY HISTORY: unknown

SOCIAL HISTORY: Denies h/o tobacco, illicits, EtOH. Lives in living facility in
[**Hospital1 **].
Foreign body in esophagus,Pneumonitis due to inhalation of food or vomitus,Regional enteritis of unspecified site,Foreign body accidentally entering other orifice,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified delay in development,Stricture and stenosis of esophagus,Bipolar disorder, unspecified,Unspecified acquired hypothyroidism,Anxiety state, unspecified
Foreign body esophagus,Food/vomit pneumonitis,Regional enteritis NOS,FB entering oth orifice,Diaphragmatic hernia,Development delay NOS,Esophageal stricture,Bipolar disorder NOS,Hypothyroidism NOS,Anxiety state NOS
Admission Date:  [**2133-5-22**]              Discharge Date:   [**2133-5-26**]

Date of Birth:  [**2089-2-6**]             Sex:   M

Service: MEDICINE

Allergies:
Klonopin / Penicillins / Clozaril / Latex / Food Extracts

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
food stuck in throat, fever

Major Surgical or Invasive Procedure:
Endoscopy

History of Present Illness:
This is a 44 yo M with h/o developmental delay, hiatal hernia,
GE junction stricture, esophagitis and Crohn's disease who
presented with fevers, cough, and a sensation of food stuck in
his throat. He was eating meat yesterday when he felt it get
caught in his throat, which resulted in nausea and multiple
episodes of non-bloody, non-bilious emesis not associated with
abdominal pain or diarrhea. Per group home staff, pt was noted
to swallow his vomit. Due to concern for aspiration and new
onset of productive cough, he was seen in urgent care clinic
where he was reportedly diagnosed with a LLL vs. RLL PNA (ED
documentation unclear) on a CXR and was sent to the ED for
evaluation. The patient denies fevers, chills. He has had
several sick contacts at his group home but group home staff
deny any H1N1 or influenza cases at group home recently.
.
In the [**Name (NI) **], pt with low grade fever to 100.1, RR 28, O2 sat 97%
4L NC. Labs notable for WBC 15.1 with 83% neutrophils, BUN 21,
Cr 1.2, and lactate 1.1. CXR revealed low lung volumes without a
clear infiltrate but possible retrocardiac opacity and neck
x-ray did not definitely show the presence of any foreign
bodies. Given levofloxacin 750 mg IV X 1, flagyl 500 mg IV X 1,
zofran 4 mg IV X 1, and 1 L IVFs. GI consulted who recommended
admission to ICU for likely EGD to rule out food impaction.
.
Pt was sent to the [**Hospital Unit Name 153**] for EGD which showed food proximal to a
14 mm esophageal stricture. The food was advanced to the
stomach, remaining EGD unremarkable.  Pt remained in the [**Hospital Unit Name 153**]
for difficulty with oxygenation.


Past Medical History:
Developmental delay
Bipolar disorder
Hypothyroidism
Hiatal hernia
GE junction stricture
Esophagitis
Crohn's disease
Anxiety

Social History:
Denies h/o tobacco, illicits, EtOH. Lives in living facility in
[**Hospital1 **].

Family History:
unknown

Physical Exam:
PE on admission: T 99.4  BP 125/68  HR 109   RR 29  O2 91% on
neb
Gen - mild respiratory distress with mild accecessory muscle
use, tachypneic, obese male, non-toxic appearing, sleepy but
easily arousable
HEENT - no JVD appreciated, supple
CV - tachycardic, no m/r/g appreciated
Lungs - bilataral coase upper airway breath sounds with diffuse
scattered wheezes and rhonchi throughout, no crackles
Abd - Soft, obese, NT, ND, normoactive BS
Ext - no LE edema, WWP
Skin - no rashes or lesions


Pertinent Results:
[**2133-5-25**] 05:20AM BLOOD WBC-10.4 RBC-4.10* Hgb-12.9* Hct-38.8*
MCV-95 MCH-31.5 MCHC-33.2 RDW-13.9 Plt Ct-205

[**2133-5-25**] 03:48AM BLOOD Glucose-124* UreaN-14 Creat-0.9 Na-141
K-3.8 Cl-105 HCO3-26 AnGap-14

[**2133-5-24**] 04:25AM BLOOD ALT-29 AST-28 LD(LDH)-187 AlkPhos-92
TotBili-0.7

[**2133-5-25**] 03:48AM BLOOD Calcium-9.6 Phos-3.6 Mg-2.0

[**2133-5-22**] 02:45PM BLOOD TSH-7.7*

[**2133-5-22**] 02:45PM BLOOD Free T4-1.1

[**2133-5-23**] 03:57PM BLOOD Type-ART Temp-38.9 pO2-65* pCO2-41
pH-7.42 calTCO2-28 Base XS-1 Intubat-NOT INTUBA

[**2133-5-22**] 03:01PM BLOOD Lactate-1.8

STUDY: CXR [**2133-5-24**]
There is again seen bibasilar infiltrates some of which may
represent
atelectasis particularly on the left side. There are low lung
volumes.
Overall, there is no appreciable change.

[**2133-5-23**] 7:38 pm SPUTUM      Source: Expectorated.
   GRAM STAIN (Final [**2133-5-24**]):
      >25 PMNs and <10 epithelial cells/100X field.
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS AND CLUSTERS.
   RESPIRATORY CULTURE (Final [**2133-5-26**]):
      MODERATE GROWTH OROPHARYNGEAL FLORA.

Brief Hospital Course:
44 year-old man with developmental delay who presented with
fevers, cough, and food impaction. He had a history of
esophageal stricture in the distal esophagus. He underwent
endoscopy and was found to have a piece of steak impacted in the
distal esophagus 14 mm proximal to his esophageal stricture. The
food was advanced and the impaction resolved with passage of the
food material. He was advised to chew his food more carefully
and to cut foods into smaller pieces before chewing. His
presentation was concerning for aspiration pneumonia or
pneumonitis; he had an elevated WBC at 15.1, mild hypoxia
requiring 2L nasal cannula, and a CXR showing  LLL basilar
infiltrates. He completed a five day course of levofloxacin. His
oxygen saturation was 95% on room air at rest and 91% with
ambulation on the day of discharge with no subjective symptoms
of dyspnea.  Sputum cultures were negative. In regards to his
hypothyroidism, the TSH was found to be mildly elevated with a
normal FT4.  He should undergo repeat TSH testing in four weeks.
 No changes were made to his levothyroxine.

Communication; [**First Name8 (NamePattern2) **] [**Known lastname 1169**]/mother [**Telephone/Fax (1) 67315**]. [**First Name8 (NamePattern2) 4457**]
[**Last Name (NamePattern1) 7962**]/sister [**Telephone/Fax (1) 67316**]. Group home [**Telephone/Fax (1) 67317**], [**Doctor Last Name **].


Medications on Admission:
Advair 100/50 1 puff [**Hospital1 **] --> recently d/c'd per NH staff
Asacol 800 mg tid
Desonide 0.05% to face at bedtime
Divalproex 1000 mg tid
Fluoxetine 40 mg daily
Dulcolax 10 mg qhs prn
Albuterol 2 puffs q2h prn
Tylenol 625 mg q4h prn
Cetaphil lotion
Diazepam 10 mg 1 hr prior to dental procedures
Benadryl 25 mg prn for itching/rash
Guaifenesin 15 cc q6h prn for cough
Kaopectate 15 cc q6h prn for diarrhea or loose stools
Ketoconazole
Levothyroxine 50 mcg daily
Milk of magnesia prn
Neutrogena T Gel
Omeprazole 40 mg daily
Zyprexa 30 mg qhs

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever, pain.
2. Mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO TID (3 times a day).
3. Divalproex 500 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO TID (3 times a day).
4. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
6. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed for coughing.
7. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
9. Olanzapine 10 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
10. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for nausea, GI upset,
constpation.
11. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
12. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation q2h as needed for shortness of breath or
wheezing.
13. Diazepam 10 mg Tablet Sig: One (1) Tablet PO once a day as
needed for prior to dental appointments.
14. Benadryl 25 mg Capsule Sig: One (1) Capsule PO every six (6)
hours as needed for itching.
15. Kaopectate (bismuth subsalicy) 262 mg/15 mL Suspension Sig:
Fifteen (15) cc PO every six (6) hours as needed for diarrhea.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Aspiration pneumonia
Esophogeal food impaction
Esophogeal stricture


Discharge Condition:
Good

Discharge Instructions:
You were admitted because food was stuck in your esophagus.  We
performed an endoscopy and dislodged the food.  You also had
aspiration pneumonia because of the food impaction and
subsequent vomiting, and we treated you with antibiotics.

Please take all of your medications as prescribed. Please keep
all of your follow-up appointments.

Please call your doctor or return to the hospital if you
experience fevers, chills, sweats, chest pain, shortness of
breath or anything else of concern.


Followup Instructions:
Scheduled Appointments :
Provider [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 463**]
Date/Time:[**2133-6-10**] 10:15

Provider GI [**Apartment Address(1) 871**] (ST-3) GI ROOMS Date/Time:[**2133-6-10**] 10:15



Completed by:[**2133-5-27**]
{'Foreign body in esophagus,Pneumonitis due to inhalation of food or vomitus,Regional enteritis of unspecified site,Foreign body accidentally entering other orifice,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified delay in development,Stricture and stenosis of esophagus,Bipolar disorder, unspecified,Unspecified acquired hypothyroidism,Anxiety state, 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: food stuck in throat, fever

PRESENT ILLNESS: This is a 44 yo M with h/o developmental delay, hiatal hernia,
GE junction stricture, esophagitis and Crohn's disease who
presented with fevers, cough, and a sensation of food stuck in
his throat. He was eating meat yesterday when he felt it get
caught in his throat, which resulted in nausea and multiple
episodes of non-bloody, non-bilious emesis not associated with
abdominal pain or diarrhea. Per group home staff, pt was noted
to swallow his vomit. Due to concern for aspiration and new
onset of productive cough, he was seen in urgent care clinic
where he was reportedly diagnosed with a LLL vs. RLL PNA (ED
documentation unclear) on a CXR and was sent to the ED for
evaluation. The patient denies fevers, chills. He has had
several sick contacts at his group home but group home staff
deny any H1N1 or influenza cases at group home recently.
.
In the [**Name (NI) **], pt with low grade fever to 100.1, RR 28, O2 sat 97%
4L NC. Labs notable for WBC 15.1 with 83% neutrophils, BUN 21,
Cr 1.2, and lactate 1.1. CXR revealed low lung volumes without a
clear infiltrate but possible retrocardiac opacity and neck
x-ray did not definitely show the presence of any foreign
bodies. Given levofloxacin 750 mg IV X 1, flagyl 500 mg IV X 1,
zofran 4 mg IV X 1, and 1 L IVFs. GI consulted who recommended
admission to ICU for likely EGD to rule out food impaction.
.
Pt was sent to the [**Hospital Unit Name 153**] for EGD which showed food proximal to a
14 mm esophageal stricture. The food was advanced to the
stomach, remaining EGD unremarkable.  Pt remained in the [**Hospital Unit Name 153**]
for difficulty with oxygenation.

MEDICAL HISTORY: Developmental delay
Bipolar disorder
Hypothyroidism
Hiatal hernia
GE junction stricture
Esophagitis
Crohn's disease
Anxiety

MEDICATION ON ADMISSION: Advair 100/50 1 puff [**Hospital1 **] --> recently d/c'd per NH staff
Asacol 800 mg tid
Desonide 0.05% to face at bedtime
Divalproex 1000 mg tid
Fluoxetine 40 mg daily
Dulcolax 10 mg qhs prn
Albuterol 2 puffs q2h prn
Tylenol 625 mg q4h prn
Cetaphil lotion
Diazepam 10 mg 1 hr prior to dental procedures
Benadryl 25 mg prn for itching/rash
Guaifenesin 15 cc q6h prn for cough
Kaopectate 15 cc q6h prn for diarrhea or loose stools
Ketoconazole
Levothyroxine 50 mcg daily
Milk of magnesia prn
Neutrogena T Gel
Omeprazole 40 mg daily
Zyprexa 30 mg qhs

ALLERGIES: Klonopin / Penicillins / Clozaril / Latex / Food Extracts

PHYSICAL EXAM: PE on admission: T 99.4  BP 125/68  HR 109   RR 29  O2 91% on
neb
Gen - mild respiratory distress with mild accecessory muscle
use, tachypneic, obese male, non-toxic appearing, sleepy but
easily arousable
HEENT - no JVD appreciated, supple
CV - tachycardic, no m/r/g appreciated
Lungs - bilataral coase upper airway breath sounds with diffuse
scattered wheezes and rhonchi throughout, no crackles
Abd - Soft, obese, NT, ND, normoactive BS
Ext - no LE edema, WWP
Skin - no rashes or lesions

FAMILY HISTORY: unknown

SOCIAL HISTORY: Denies h/o tobacco, illicits, EtOH. Lives in living facility in
[**Hospital1 **]. 

### Response:
{'Foreign body in esophagus,Pneumonitis due to inhalation of food or vomitus,Regional enteritis of unspecified site,Foreign body accidentally entering other orifice,Diaphragmatic hernia without mention of obstruction or gangrene,Unspecified delay in development,Stricture and stenosis of esophagus,Bipolar disorder, unspecified,Unspecified acquired hypothyroidism,Anxiety state, unspecified'}
