CHIEF COMPLAINT: Airway monitoring

PRESENT ILLNESS: 61 year old female with PMHX of HTH presented with severe sore
throat for 2 days rapidly getting worse associated with
difficulty swallowing liquids and neck pain. Also found to have
fever and tachycardia. Unable to take meds, only took BP meds
this am. Voice is hoarse and descrbed as "hot potato" by PCP.
[**Name10 (NameIs) 1403**] as a flight attendant, travelled all over Europe recently.
Sister with sore throat as well. In PCPs office, unable to open
her mouth, tender thick neck unable to evaluate pharynx. Per
report pts sore throat has progressed rapidly over past 2 days.
Unable to swallow her secretions, no tipoding or drooling
present.
.
In the ED, 100.8 81 125/77 16 99%RA.  She was given Clindamycin,
Dexamethasone, Morphine Sulfate 4mg Syringe, HYDROmorphone
(Dilaudid) 1mg/1mL Syringe, Gentamicin 80mg. Labs unremarkable.
CT neck showed retropharyngeal phlegmon. ENT scoped her, has
epiglottis and supraglottic swelling. Symptoms improved. Fever
102 in ED. Prior to transfer 117/78 18 100% RA.
.
Upon arrival to the floor, patient able to phonate but voice
still hoarse. No stridor or tripoding noted. Reports inability
to get secretions up.
.
Review of systems:
(+) Per HPI
(-) Denies night sweats, recent weight loss or gain. Denies
headache, sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: Hypertension
Allergic rhinitis

MEDICATION ON ADMISSION: -Lipitor 20 mg Tab 1 Tablet(s) by mouth once a day
-atenolol 100 mg Tab 1 Tablet(s) by mouth once a day
-ProAir HFA 90 mcg/Actuation Aerosol Inhaler
two puffs(s) inhaled every 4-6 hours as needed for SOB/wheezes
-Flovent HFA 110 mcg/Actuation Aerosol Inhaler 2 puffs(s) twice
a day
-fluticasone 50 mcg/Actuation Nasal Spray, Susp 2 sprays each
nostril daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission Exam:
VS: 98.7 82 136/65 13 98% on RA
GA: AOx3, hoarse voice
HEENT:  PERRLA. MMM. no LAD. no JVD. neck tender to palpation
anterior and posterioly, unable to visualize pharynx
Cards: PMI palpable at 5/6th IC space. No RVH. RRR S1/S2 heard.
no murmurs/gallops/rubs.
Pulm: rhonchi heard and left base
Abd: soft, NT, +BS. no g/rt. neg HSM. neg [**Doctor Last Name 515**] sign.
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: wnl
Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities.
DTRs 2+ BL (biceps, achilles, patellar). sensation intact to LT,
pain, temperature, vibration, proprioception. cerebellar fxn
intact (FTN, HTS). gait WNL.
.

FAMILY HISTORY: Sister with [**Name2 (NI) 499**] cancer and thyroid cancer in 50s

SOCIAL HISTORY: Lives with sister, smokes 1/2-1ppd for the past 40 years, drinks
on occasion, denies drugs. She was flight attendent for US Air.
Supraglottitis unspecified, without obstruction,Pneumonia, organism unspecified,Other specified forms of effusion, except tuberculous,Retropharyngeal abscess,Toxic erythema,Hemophilus influenzae [H. influenzae] infection in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Bacteremia,Pulmonary collapse,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Other specified cardiac dysrhythmias
Supraglottis w/o obs NOS,Pneumonia, organism NOS,Effusion NEC exc tb,Retropharyngeal abscess,Toxic erythema,H. influenzae infect NOS,Chr airway obstruct NEC,Bacteremia,Pulmonary collapse,Hypertension NOS,Tobacco use disorder,Hyperlipidemia NEC/NOS,Cardiac dysrhythmias NEC
Admission Date:  [**2105-4-16**]              Discharge Date:   [**2105-4-27**]

Date of Birth:  [**2044-3-8**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2344**]
Chief Complaint:
Airway monitoring

Major Surgical or Invasive Procedure:
[**2105-4-24**]: Right video-assisted thoraoscopy with decortication


History of Present Illness:
61 year old female with PMHX of HTH presented with severe sore
throat for 2 days rapidly getting worse associated with
difficulty swallowing liquids and neck pain. Also found to have
fever and tachycardia. Unable to take meds, only took BP meds
this am. Voice is hoarse and descrbed as "hot potato" by PCP.
[**Name10 (NameIs) 1403**] as a flight attendant, travelled all over Europe recently.
Sister with sore throat as well. In PCPs office, unable to open
her mouth, tender thick neck unable to evaluate pharynx. Per
report pts sore throat has progressed rapidly over past 2 days.
Unable to swallow her secretions, no tipoding or drooling
present.
.
In the ED, 100.8 81 125/77 16 99%RA.  She was given Clindamycin,
Dexamethasone, Morphine Sulfate 4mg Syringe, HYDROmorphone
(Dilaudid) 1mg/1mL Syringe, Gentamicin 80mg. Labs unremarkable.
CT neck showed retropharyngeal phlegmon. ENT scoped her, has
epiglottis and supraglottic swelling. Symptoms improved. Fever
102 in ED. Prior to transfer 117/78 18 100% RA.
.
Upon arrival to the floor, patient able to phonate but voice
still hoarse. No stridor or tripoding noted. Reports inability
to get secretions up.
.
Review of systems:
(+) Per HPI
(-) Denies night sweats, recent weight loss or gain. Denies
headache, sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.


Past Medical History:
Hypertension
Allergic rhinitis

Social History:
Lives with sister, smokes 1/2-1ppd for the past 40 years, drinks
on occasion, denies drugs. She was flight attendent for US Air.


Family History:
Sister with [**Name2 (NI) 499**] cancer and thyroid cancer in 50s

Physical Exam:
Admission Exam:
VS: 98.7 82 136/65 13 98% on RA
GA: AOx3, hoarse voice
HEENT:  PERRLA. MMM. no LAD. no JVD. neck tender to palpation
anterior and posterioly, unable to visualize pharynx
Cards: PMI palpable at 5/6th IC space. No RVH. RRR S1/S2 heard.
no murmurs/gallops/rubs.
Pulm: rhonchi heard and left base
Abd: soft, NT, +BS. no g/rt. neg HSM. neg [**Doctor Last Name 515**] sign.
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: wnl
Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities.
DTRs 2+ BL (biceps, achilles, patellar). sensation intact to LT,
pain, temperature, vibration, proprioception. cerebellar fxn
intact (FTN, HTS). gait WNL.
.


Pertinent Results:
[**2105-4-16**] 05:02PM   LACTATE-1.4
[**2105-4-16**] 04:23PM   GLUCOSE-116* UREA N-9 CREAT-0.7 SODIUM-139
POTASSIUM-4.2 CHLORIDE-106 TOTAL CO2-23 ANION GAP-14
[**2105-4-16**] 04:23PM   WBC-10.1# RBC-4.27 HGB-13.6 HCT-37.9 MCV-89
MCH-31.9 MCHC-36.0* RDW-13.1
[**2105-4-16**] 04:23PM   NEUTS-92.8* LYMPHS-4.1* MONOS-2.8 EOS-0
BASOS-0.2
[**2105-4-16**] 04:23PM   PLT COUNT-225
.
Scope ENT (on admission): Her glottic opening is about 4mm on
scope exam without symptoms including stridor or retraction.
.
CT neck with contrast ([**2105-4-16**]): Retropharyngeal fluid
collection spanning from C2/3 to C5/6 with extensive surrounding
edema and inflammation of the hypopharynx. The airway is
narrowed to 4mm at the level of the hyoid. Patent cervical
vasculature.
.
CXR ([**2105-4-17**]): As compared to the previous radiograph, there
is no relevant change. No pathologic mediastinal widening.
Borderline size of the cardiac silhouette. Presence of minimal
pleural effusions cannot be excluded. No focal parenchymal
opacity suggesting pneumonia. No pulmonary edema.
.
CT neck and chest w/ contrast ([**2105-4-18**]):
1. Interval slight decrease of the retropharyngeal fluid
collection and
improved airway patency.
2. No evidence of Lemierre's disease or new abscess formation.

3. No evidence of extension of the fluid collection into the
mediastinum. No evidence of mediastinitis.
.
Chest CT ([**4-22**]): IMPRESSION:
1. Rapidly enlarging multiloculated right pleural effusion. This
could be due to empyema considering clinical suspicion for this
entity, but definitive diagnosis would require correlation with
thoracentesis results.
2. Small dependent left pleural effusion has also increased in
size since the prior study but does not have loculated
components.
3. Slight increase in size of pre- and sub-carinal lymph nodes
as well as right hilar nodes. These are likely reactive.
4. Ground-glass opacities in left upper lobe which are likely
infectious or inflammatory in etiology.
.
TTE ([**4-22**]): The left atrium is mildly dilated. No atrial septal
defect is seen by 2D or color Doppler. Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF >55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
diameters of aorta at the sinus, ascending and arch levels are
normal. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No masses or vegetations are
seen on the aortic valve. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. No mass or vegetation is seen on the mitral
valve. Trivial mitral regurgitation is seen. There is borderline
pulmonary artery systolic hypertension. There is a
trivial/physiologic pericardial effusion. There are no
echocardiographic signs of tamponade.
.
[**4-23**] CXR
REASON FOR EXAMINATION: Evaluation of the patient with
complicated pleural
effusion.

Portable AP radiograph of the chest was reviewed in comparison
to [**2105-4-21**].

There is interval increase in right pleural effusion, loculated,
better
appreciated on the prior radiograph but the change in size is
significant. No pneumothorax is seen. Left pleural effusion is
unchanged. Bibasal areas of atelectasis are noted.
.
5/28CXR

Discharge Labs
.
Micro.

Blood Culture, Routine (Preliminary):
      HAEMOPHILUS INFLUENZAE, BETA-LACTAMASE NEGATIVE.
         BETA- LACTAMASE NEGATIVE: PRESUMPTIVELY SENSITIVE TO
AMPICILLIN. .
         BETA-LACTAMASE CONFIRMATION REQUESTED BY DR. [**Last Name (STitle) 2345**].

   Aerobic Bottle Gram Stain (Final [**2105-4-18**]):
      Reported to and read back by DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) 2346**] ON [**2105-4-18**] AT
0720.
      GRAM NEGATIVE ROD(S).


Brief Hospital Course:
61 yo F with PMHX of HTN presenting with sore throat, neck pain,
and odynophagia found to have epiglottis and retrophargyneal
phlegmon.
.
#Epiglottis/retropharyngenal phlegmon: Diagnosed on CT neck and
by ENT scope. Symptoms consistent with this. The patient did
improve clinically with steroids, Ceftriaxone and clindamycin.
The patient's airway was closely monitored in the ICU and
underwent repeat ENT scoping on [**2105-4-18**] that showed ongoing
arytenoid edema but completely patent airway. Repeat CT neck and
chest with contrast, in the setting of ongoing posterior neck
pain and inspiration pain as well as worsening erythematous
lesion (see below), did not show Lemierre's or mediastinitis.
There was minimal interval improvement in the phlegmon
collection, however. Blood cultures from admission were positive
for GNRs, later grew out HAEMOPHILUS INFLUENZAE. Planned for 14
day course from day of first negative culture. The patient
remained hemodynamically stable and re-evaluation by ENT in the
ICU showed improved of supraglottic swelling so she was
transfered to the floor. Repeat cultures were negative ???? HIV
was sent and was negative. Patient continued to be symptom free
on the floor and did not have any further airway complaints or
problems. She was treated symptomatically with cepacol lozenges
and was kept on a nicotine patch and received nebulizers PRN.
.
#Erythematous lesion: Patient developed a 3X3 inch erythematous
lesion on her anterior chest, 2 inches below cricoid and poorly
demarcated. The patient endorsed feeling warm and mildly tender
to palpation in this area with no pruritis. No
plaques/papules/bullae. The lesion was very blanching.
Dermatology was consulted on [**2105-4-18**] given spread of this
lesion to ~4X4 inches despite broadening to Vancomycin. Given
the timing of her antibiotics, this lesion was not felt due to
drug eruption, although a very early drug eruption can not be
ruled out. The erythema was felt most consistent with a toxic
exanthem, which is a vasodilation that occurs in patients with
bactermia (more often staph, strep). Supportive care was
provided. Derm followed patient while in house. by hospital day
4 the rash had significantly receeded. Derm did not feel
compelled to biopsy - they thought it was likely due to her
infectious process but did not represent a cellulitis. Her rash
improved later in her hospital course.
.
#Pneumonia and pleural effusion: She was noted to have
intermittent hypoxemia and R sided pleuritic chest pain on [**4-20**].
Medicine was consulted on [**4-22**], and in setting of new moderate
pleural effusions R>L on CXR, recommended chest CT, which showed
rapidly expanding and loculated effusion on R. She was then
transferred to medicine, and ID was consulted. Her antibiotics
were changed to ceftriaxone. Her pleural effusion was attempted
to be drained by IR, but they only withdrew 30 cc of fluid,
given loculation. Thoracic surgery was then involved and carried
out a VATS procedure which was uncomplicated and the patient was
transferred back to medicine.
.
#Hypertension: Blood pressures normal and intermittently high
(SBPs 150s) in-house. The patient's atenolol, lipitor were held
in the setting of epiglottis/retropharyngeal phlegmon but
restarted once she was able to tolerate POs. Atenolol was
initially started at half home dose 50mg, then back to her full
dose.However due to asymp. bradycardia into the 40's atenolol
was discontinued ad replaced with Chlorthalidone on [**4-25**].
.
# Intermittent bradycardia to 40s, asymptomatic: She was
monitored on telemetry with occasional intermittent bradycardia
to the 40s. her EKG was otherwise normal, without AVB. TTE was
done which showed no HD significant pericardial effusion,
abscess, or vegetations. Her bradycardia may have been due to
vagal tone in setting of pleural effusions and pleuritic pain.
.
# Lower extremity edema: She noted increased edema during this
admission. She had some baseline edema as a flight attendant but
only while standing for long durations. She had no JVD or HJR,
and TTE was normal.
.
#PPX: Heparin sq
#Full Code, confirmed.


Medications on Admission:
-Lipitor 20 mg Tab 1 Tablet(s) by mouth once a day
-atenolol 100 mg Tab 1 Tablet(s) by mouth once a day
-ProAir HFA 90 mcg/Actuation Aerosol Inhaler
two puffs(s) inhaled every 4-6 hours as needed for SOB/wheezes
-Flovent HFA 110 mcg/Actuation Aerosol Inhaler 2 puffs(s) twice
a day
-fluticasone 50 mcg/Actuation Nasal Spray, Susp 2 sprays each
nostril daily


Discharge Medications:
1. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
Disp:*30 Patch 24 hr(s)* Refills:*2*
2. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. oxycodone-acetaminophen 5-325 mg/5 mL Solution Sig: Five (5)
ML PO Q4H (every 4 hours) as needed for pain.
Disp:*250 ML(s)* Refills:*0*
6. ProAir HFA 90 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2)
puffs Inhalation every 4-6 hours as needed for shortness of
breath or wheezing.
7. Flovent HFA 110 mcg/Actuation Aerosol Sig: Two (2) puffs
puffs Inhalation twice a day.
8. fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
puffs Nasal once a day: 2 sprays to nose daily.
9. Outpatient Lab Work
1. CBC with differential
2. ESR
3. CRP

Please obtain this blood work on [**2105-5-4**] and fax results
to infectious disease at ([**Telephone/Fax (1) 1354**]

10. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
11. chlorthalidone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 14 days.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Bacterial supraglottitis
Bacteremia
Loculated pleural effusions
Pneumonia


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


Discharge Instructions:
Please call your doctor or nurse practitioner if you experience
the following:
*You experience new chest pain, pressure, squeezing or
tightness.
*New or worsening cough, shortness of breath, or wheeze.
*If you are vomiting and cannot keep down fluids or your
medications.
*You are getting dehydrated due to continued vomiting, diarrhea,
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat, or feeling dizzy or faint when standing.
*You see blood or dark/black material when you vomit or have a
bowel movement.
*You experience burning when you urinate, have blood in your
urine, or experience a discharge.
*Your pain is not improving within 8-12 hours or is not gone
within 24 hours. Call or return immediately if your pain is
getting worse or changes location or moving to your chest or
back.
*You have shaking chills, or fever greater than 101.5 degrees
Fahrenheit or 38 degrees Celsius.
*Any change in your symptoms, or any new symptoms that concern
you.
.
General Discharge Instructions:
Please resume all regular home medications , unless specifically
advised not to take a particular medication.  Also, please take
any new medications as prescribed.
Please get plenty of rest, continue to ambulate several times
per day, and drink adequate amounts of fluids.  Avoid lifting
weights greater than [**4-7**] lbs until you follow-up with your
surgeon, who will instruct you further regarding activity
restrictions.
Avoid driving or operating heavy machinery while taking pain
medications.
Please follow-up with your surgeon and Primary Care Provider
(PCP) as advised.

You were admitted with a severe throat infection and bacteremia
with H influenza. You also developed a rash on your chest
thought to be due to this bacteria. Your rash and throat
improved, but you then developed shortness of breath due to
increasing pleural effusions. You were thought to have
pneumonia, and your pleural effusion was treated by thoracic
surgery with VATS procedure. Your antibiotic course will be
levofloxacin until told to stop by the infectious disease
doctors. You will be seen by them as an outpatient.
.
Medication changes:
START Levaquin (aka Levofloxacin) for your infection
STOP  Atenolol (this was stopped because your heart rate was
low)
START Chlorthalidone (for blood pressure control)
.
You should take all your other medication as prescribed by your
doctors.
.
Thoracic surgery
Call Dr.[**Name (NI) 2347**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, cough (it is normal to cough-up
blood tinge sputum for a few days) or chest pain
-Incision develops drainage or increased redness
-Chest tube site remove dressing and cover site with a bandaid
until healed
-Should site drain cover with a clean dressing and change as
needed

Activity
-Shower daily. Wash incision with mild soap and water, rinse,
pat dry
-No tub bathing, swimming or hot tubs until incision healed
-No lifting greater than 10 pounds
-No driving while taking narcotics


Followup Instructions:
ENT (ears nose and throat):
Please follow up with Dr. [**First Name (STitle) **] in 2 weeks. Her office can be
reached at [**Telephone/Fax (1) 2349**] to make a follow-up appointment.
.
Infectious disease :
You have an appointment on [**2105-5-7**] with Dr. [**Last Name (STitle) 2350**] @
2:50pm. Please note that you also have a CT of your neck ordered
for [**2105-5-4**] (You need to call [**Telephone/Fax (1) 327**] to confirm the
time/location of this exam). Before your appointment with Dr.
[**Last Name (STitle) 2350**], you will need to have your blood drawn and have the
results faxed to ([**Telephone/Fax (1) 1353**].

Thoracic surgery:
Follow-up with Dr. [**Last Name (STitle) **] [**0-0-**] Date/Time:[**2105-5-12**]
3:00
on the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center, [**Location (un) **]
Chest X-Ray [**Location (un) 861**] Radiology 30 minutes before your
appointment

Please also follow up with your PCP. [**Name10 (NameIs) 2351**] your appointment you
should have your blood drawn with the following results sent to
the infectious disease team (CBC with differential; ESR;CRP).
The number to fax them to is ([**Telephone/Fax (1) 1353**].

Note that you have the following appointment scheduled:
Department: [**Hospital1 18**] [**Location (un) 2352**]- ADULT MED
When: MONDAY [**2105-5-4**] at 10:15 AM
With: [**First Name4 (NamePattern1) 2353**] [**Last Name (NamePattern1) 2354**], MD [**Telephone/Fax (1) 1144**]
Building: [**Location (un) 2355**] ([**Location (un) **], MA) [**Location (un) 551**]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site
{'Supraglottitis unspecified, without obstruction,Pneumonia, organism unspecified,Other specified forms of effusion, except tuberculous,Retropharyngeal abscess,Toxic erythema,Hemophilus influenzae [H. influenzae] infection in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Bacteremia,Pulmonary collapse,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Other specified cardiac dysrhythmias'}


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: Airway monitoring

PRESENT ILLNESS: 61 year old female with PMHX of HTH presented with severe sore
throat for 2 days rapidly getting worse associated with
difficulty swallowing liquids and neck pain. Also found to have
fever and tachycardia. Unable to take meds, only took BP meds
this am. Voice is hoarse and descrbed as "hot potato" by PCP.
[**Name10 (NameIs) 1403**] as a flight attendant, travelled all over Europe recently.
Sister with sore throat as well. In PCPs office, unable to open
her mouth, tender thick neck unable to evaluate pharynx. Per
report pts sore throat has progressed rapidly over past 2 days.
Unable to swallow her secretions, no tipoding or drooling
present.
.
In the ED, 100.8 81 125/77 16 99%RA.  She was given Clindamycin,
Dexamethasone, Morphine Sulfate 4mg Syringe, HYDROmorphone
(Dilaudid) 1mg/1mL Syringe, Gentamicin 80mg. Labs unremarkable.
CT neck showed retropharyngeal phlegmon. ENT scoped her, has
epiglottis and supraglottic swelling. Symptoms improved. Fever
102 in ED. Prior to transfer 117/78 18 100% RA.
.
Upon arrival to the floor, patient able to phonate but voice
still hoarse. No stridor or tripoding noted. Reports inability
to get secretions up.
.
Review of systems:
(+) Per HPI
(-) Denies night sweats, recent weight loss or gain. Denies
headache, sinus tenderness, rhinorrhea or congestion. Denied
cough, shortness of breath. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias.

MEDICAL HISTORY: Hypertension
Allergic rhinitis

MEDICATION ON ADMISSION: -Lipitor 20 mg Tab 1 Tablet(s) by mouth once a day
-atenolol 100 mg Tab 1 Tablet(s) by mouth once a day
-ProAir HFA 90 mcg/Actuation Aerosol Inhaler
two puffs(s) inhaled every 4-6 hours as needed for SOB/wheezes
-Flovent HFA 110 mcg/Actuation Aerosol Inhaler 2 puffs(s) twice
a day
-fluticasone 50 mcg/Actuation Nasal Spray, Susp 2 sprays each
nostril daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission Exam:
VS: 98.7 82 136/65 13 98% on RA
GA: AOx3, hoarse voice
HEENT:  PERRLA. MMM. no LAD. no JVD. neck tender to palpation
anterior and posterioly, unable to visualize pharynx
Cards: PMI palpable at 5/6th IC space. No RVH. RRR S1/S2 heard.
no murmurs/gallops/rubs.
Pulm: rhonchi heard and left base
Abd: soft, NT, +BS. no g/rt. neg HSM. neg [**Doctor Last Name 515**] sign.
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: wnl
Neuro/Psych: CNs II-XII intact. 5/5 strength in U/L extremities.
DTRs 2+ BL (biceps, achilles, patellar). sensation intact to LT,
pain, temperature, vibration, proprioception. cerebellar fxn
intact (FTN, HTS). gait WNL.
.

FAMILY HISTORY: Sister with [**Name2 (NI) 499**] cancer and thyroid cancer in 50s

SOCIAL HISTORY: Lives with sister, smokes 1/2-1ppd for the past 40 years, drinks
on occasion, denies drugs. She was flight attendent for US Air. 

### Response:
{'Supraglottitis unspecified, without obstruction,Pneumonia, organism unspecified,Other specified forms of effusion, except tuberculous,Retropharyngeal abscess,Toxic erythema,Hemophilus influenzae [H. influenzae] infection in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Bacteremia,Pulmonary collapse,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Other specified cardiac dysrhythmias'}
