CHIEF COMPLAINT: Increased cough and wheezes

PRESENT ILLNESS: Ms. [**Known lastname 56072**] is a 54-year-old woman who had previously undergone
tracheoplasty and bilateral bronchoplasty with mesh on [**2113-6-23**] by Dr. [**First Name4 (NamePattern1) 951**] [**Last Name (NamePattern1) 952**].
She represented recently with shortness of breath symptoms and
was found to have severe recurrent bronchomalacia in the
bronchus intermedius on the right. Placement of a bronchus
intermedius silicone stent alleviated her symptoms markedly and
because of this, she was considered for reoperation.

MEDICAL HISTORY: Tracheobronchomalacia s/p tracheobronoplasty with mesh [**6-/2113**]
Recurrent Bronchomalacia
Hypercholesterolemia
Multiple sclerosis
Urinary incontinence
Tremors
Postmenopausal
Tonsillectomy
Appendectomy
Hysterectomy

MEDICATION ON ADMISSION: -Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO QID (4 times
a day).
-Conjugated Estrogens 0.625 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
-Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
-Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
-Cymbalta 1tab QHS
-Betaseron 1cc QOD
-Ambien CR PRN QHS
-Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
-B-Complex with Vitamin C Tablet Sig: One (1) Tablet PO DAILY
(Daily).
-Vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY
(Daily).
-Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
-Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation [**Hospital1 **] (2 times a day).
-Salmeterol 50 mcg/Dose Disk with Device Sig: One (1) Disk with
Device Inhalation Q12H (every 12 hours).
-Ditropan XL 10 mg Tab,Sust Rel Osmotic Push 24hr Sig: One (1)
Tab,Sust Rel Osmotic Push 24hr PO once a day.
-Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO BID -30 MIN BEFORE B-FAST AND
DINNER ().
-Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for asthma.
- Potassium 90mg. Two QAM
- ASA 81 QDay

ALLERGIES: Penicillins / Sulfur / Iodine

PHYSICAL EXAM: General: 54 year-old well-appearing female in no acute distress
HEENT: normocephalic, mucus membranes mosit
Neck:  supple no lymphadenopathy
Card:  regular, rate & rhythm, normal S1,S2 no murmur/gallop or
rub
Resp:  decreased breath sounds  ---
GI: bowel  sounds positive, abdomen soft
non-tender/non-distended
Extre: warm no edema
Wound:  clean, dry intact
Neuro: non-focal

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: She works as a  respiratory therapist in the past, currently on
disability
Lives with her husband
Other diseases of trachea and bronchus,Multiple sclerosis,Unspecified essential hypertension,Urinary incontinence, unspecified,Postinflammatory pulmonary fibrosis,Esophageal reflux,Essential and other specified forms of tremor,Pure hypercholesterolemia,Asthma, unspecified type, unspecified
Trachea & bronch dis NEC,Multiple sclerosis,Hypertension NOS,Urinary incontinence NOS,Postinflam pulm fibrosis,Esophageal reflux,Tremor NEC,Pure hypercholesterolem,Asthma NOS
Admission Date:  [**2114-11-14**]              Discharge Date:   [**2114-12-1**]

Date of Birth:  [**2060-2-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Sulfur / Iodine

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
Increased cough and wheezes

Major Surgical or Invasive Procedure:
[**2114-11-23**] Bronchoscopy, Right thoracotomy, Right lower lobe
nodule Biopsy, Right Bronchoplasty
[**2114-11-21**] Rigid Bronchoscopy with Stent Removal
[**2114-11-19**] Flexible Bronchoscopy, Rigid bronchoscopy, Stent
Placement


History of Present Illness:
Ms. [**Known lastname 56072**] is a 54-year-old woman who had previously undergone
tracheoplasty and bilateral bronchoplasty with mesh on [**2113-6-23**] by Dr. [**First Name4 (NamePattern1) 951**] [**Last Name (NamePattern1) 952**].
She represented recently with shortness of breath symptoms and
was found to have severe recurrent bronchomalacia in the
bronchus intermedius on the right. Placement of a bronchus
intermedius silicone stent alleviated her symptoms markedly and
because of this, she was considered for reoperation.


Past Medical History:
Tracheobronchomalacia s/p tracheobronoplasty with mesh [**6-/2113**]
Recurrent Bronchomalacia
Hypercholesterolemia
Multiple sclerosis
Urinary incontinence
Tremors
Postmenopausal
Tonsillectomy
Appendectomy
Hysterectomy


Social History:
She works as a  respiratory therapist in the past, currently on
disability
Lives with her husband

Family History:
non-contributory

Physical Exam:
General: 54 year-old well-appearing female in no acute distress
HEENT: normocephalic, mucus membranes mosit
Neck:  supple no lymphadenopathy
Card:  regular, rate & rhythm, normal S1,S2 no murmur/gallop or
rub
Resp:  decreased breath sounds  ---
GI: bowel  sounds positive, abdomen soft
non-tender/non-distended
Extre: warm no edema
Wound:  clean, dry intact
Neuro: non-focal


Pertinent Results:
[**2114-11-25**] WBC-16.3* RBC-3.68* Hgb-11.3* Hct-32.3* Plt Ct-233
[**2114-11-25**] Glucose-86 UreaN-13 Creat-0.8 Na-135 K-4.1 Cl-98
HCO3-26

Pathology Examination: SPECIMEN SUBMITTED:  FS Right Lower Lobe
Nodule.
DIAGNOSIS:
Lung, right lower lobe: Lung parenchyma with subpleural
fibrosis, focal alveolar lining reactive changes, and scar.
Clinical:  Tracheal bronchomalacia.


Brief Hospital Course:
Mrs. [**Known lastname 56072**] was admitted on [**2114-11-14**] with increased shortness of
breath and cough and underwent a flex bronchoscopy which
revealed recurrent severe distal tracheobronchomalacia.
Pulmonary was consulted and recommenced increasing her Nexium to
40 mg [**Hospital1 **] and Flovent and Serevent.  GI was consulted and
recommended aggressive reflux management.  On HD #2 her cough
and wheezes persisted and she was started on pulse steroids.
ENT was consulted to assess her vocal cords which was normal.
Her symptoms improved slightly and underwent a rigid
bronchoscopy and silicone stent placement on HD #6.  Her
respiratory status continued to improved and the stent was
removed on HD#8.  On HD #9 ([**2114-11-23**]) she underwent successful
Redo right thoracotomy, Removal of previous bronchoplasty Marlex
mesh, Suture bronchoplasty of the right bronchus intermedius,
coverage with a pleural flap buttress, flexible bronchoscopy and
right lower lobe wedge resection. Post-operative pain was
controlled with an epidural catheter which was later switched to
a PCA. Two chest tubes were placed intraoperatively. Pt was
extubated [**11-23**] and remained in the ICU post-operatively and was
oxygenating well with a face mask. Pt was advanced to a regular
diet on [**11-25**], was transferred out of the ICU to a regular floor
bed, the chest tube was removed and the chest [**Doctor Last Name 406**] drain was
placed to bulb suction. During the night of [**11-22**] pt had a
decreased respiratory rate and oxygenation due to over
narcotization and was given Narcan, supplemental O2, and a
nebulizer with good effect. On [**11-26**] the pt underwent a flexible
bronchoscopy which showed normal clearing airways. Pt was
switched to oral pain medication on [**11-27**], supplemental oxygen
was weaned, [**Doctor Last Name 406**] drain was removed, and central venous line was
removed. peri-operative Levofloxacin and Vancomycin were
completed on [**11-30**]. Pt was discharged on [**12-1**] tolerating a
regular diet, pain well controlled with oral medication, and
ambulating without assistance.

Medications on Admission:
-Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO QID (4 times
a day).
-Conjugated Estrogens 0.625 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
-Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
-Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
-Cymbalta 1tab QHS
-Betaseron 1cc QOD
-Ambien CR PRN QHS
-Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
-B-Complex with Vitamin C Tablet Sig: One (1) Tablet PO DAILY
(Daily).
-Vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY
(Daily).
-Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
-Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation [**Hospital1 **] (2 times a day).
-Salmeterol 50 mcg/Dose Disk with Device Sig: One (1) Disk with
Device Inhalation Q12H (every 12 hours).
-Ditropan XL 10 mg Tab,Sust Rel Osmotic Push 24hr Sig: One (1)
Tab,Sust Rel Osmotic Push 24hr PO once a day.
-Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO BID -30 MIN BEFORE B-FAST AND
DINNER ().
-Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for asthma.
- Potassium 90mg. Two QAM
- ASA 81 QDay

Discharge Medications:
1. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO QID (4
times a day).
2. Conjugated Estrogens 0.625 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
3. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
6. B-Complex with Vitamin C     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
7. Vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY
(Daily).
8. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
9. Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation [**Hospital1 **] (2 times a day).
10. Salmeterol 50 mcg/Dose Disk with Device Sig: One (1) Disk
with Device Inhalation Q12H (every 12 hours).
11. Ditropan XL 10 mg Tab,Sust Rel Osmotic Push 24hr Sig: One
(1) Tab,Sust Rel Osmotic Push 24hr PO once a day.
12. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO BID -30 MIN BEFORE  B-FAST
AND DINNER ().
13. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) as needed for asthma.
14. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
15. Zantac 150 mg Capsule Sig: One (1) Capsule PO once a day.
16. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
17. Prednisone 5 mg Tablet Sig: One (1) Tablet PO once a day as
needed for asthma: [**12-1**]: 2 tabs (10mg)
[**12-2**]: 1 tab (5mg)
[**12-3**]: 1 tab (5mg).
Disp:*4 Tablet(s)* Refills:*0*
18. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
19. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed.
Disp:*60 Tablet(s)* Refills:*0*
20. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Tracheobronchomalacia s/p tracheobronoplasty with mesh
Hypercholesterolemia
Multiple sclerosis
Urinary incontinence
Tremors
Postmenopausal
Tonsillectomy
Appendectomy
Hysterectomy


Discharge Condition:
Good


Discharge Instructions:
Call Dr.[**Name (NI) 2347**] office if experience while here in [**Location (un) 86**]
-Fever >101 or chills
-Increased shortness of breath, cough or sputum production
-Chest pain
-Incision develops drainage
Chest-tube site cover with a bandaid.  Should site begin to
drain cover with a clean dressing and change as needed to keep
site clean and dry.
No driving while taking narcotics
No bathing or swimming for 6 weeks

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **]. Please call [**Telephone/Fax (1) 170**] to
schedule a follow-up appointment
Follow-up with your pulmonologist in [**State **]
{'Other diseases of trachea and bronchus,Multiple sclerosis,Unspecified essential hypertension,Urinary incontinence, unspecified,Postinflammatory pulmonary fibrosis,Esophageal reflux,Essential and other specified forms of tremor,Pure hypercholesterolemia,Asthma, unspecified type, 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: Increased cough and wheezes

PRESENT ILLNESS: Ms. [**Known lastname 56072**] is a 54-year-old woman who had previously undergone
tracheoplasty and bilateral bronchoplasty with mesh on [**2113-6-23**] by Dr. [**First Name4 (NamePattern1) 951**] [**Last Name (NamePattern1) 952**].
She represented recently with shortness of breath symptoms and
was found to have severe recurrent bronchomalacia in the
bronchus intermedius on the right. Placement of a bronchus
intermedius silicone stent alleviated her symptoms markedly and
because of this, she was considered for reoperation.

MEDICAL HISTORY: Tracheobronchomalacia s/p tracheobronoplasty with mesh [**6-/2113**]
Recurrent Bronchomalacia
Hypercholesterolemia
Multiple sclerosis
Urinary incontinence
Tremors
Postmenopausal
Tonsillectomy
Appendectomy
Hysterectomy

MEDICATION ON ADMISSION: -Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO QID (4 times
a day).
-Conjugated Estrogens 0.625 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
-Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
-Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
-Cymbalta 1tab QHS
-Betaseron 1cc QOD
-Ambien CR PRN QHS
-Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
-B-Complex with Vitamin C Tablet Sig: One (1) Tablet PO DAILY
(Daily).
-Vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY
(Daily).
-Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
-Fluticasone 110 mcg/Actuation Aerosol Sig: Four (4) Puff
Inhalation [**Hospital1 **] (2 times a day).
-Salmeterol 50 mcg/Dose Disk with Device Sig: One (1) Disk with
Device Inhalation Q12H (every 12 hours).
-Ditropan XL 10 mg Tab,Sust Rel Osmotic Push 24hr Sig: One (1)
Tab,Sust Rel Osmotic Push 24hr PO once a day.
-Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO BID -30 MIN BEFORE B-FAST AND
DINNER ().
-Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for asthma.
- Potassium 90mg. Two QAM
- ASA 81 QDay

ALLERGIES: Penicillins / Sulfur / Iodine

PHYSICAL EXAM: General: 54 year-old well-appearing female in no acute distress
HEENT: normocephalic, mucus membranes mosit
Neck:  supple no lymphadenopathy
Card:  regular, rate & rhythm, normal S1,S2 no murmur/gallop or
rub
Resp:  decreased breath sounds  ---
GI: bowel  sounds positive, abdomen soft
non-tender/non-distended
Extre: warm no edema
Wound:  clean, dry intact
Neuro: non-focal

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: She works as a  respiratory therapist in the past, currently on
disability
Lives with her husband 

### Response:
{'Other diseases of trachea and bronchus,Multiple sclerosis,Unspecified essential hypertension,Urinary incontinence, unspecified,Postinflammatory pulmonary fibrosis,Esophageal reflux,Essential and other specified forms of tremor,Pure hypercholesterolemia,Asthma, unspecified type, unspecified'}
