CHIEF COMPLAINT: Worsening shortness of breath

PRESENT ILLNESS: 67yo female with a history of schizoaffective disorder, DM, HTN
with a history of respiratory failure requiring intubation, then
failure to wean off ventilator (required trach and PEG), now
with post-intubation tracheal stenosis requiring multiple
bronchoscopic procedures with trials of T tubes, tracheostomy
tubes.

MEDICAL HISTORY: 1. Respiratory failure requiring intubation, followed by failure
to wean, requiring tracheostomy.
2. Post-intubation tracheal stenosis, requiring chronic
tracheostomy.
3. Subglottic stenosis causing nearly 90% occlusion of the
airway status post rigid bronchoscopy, tracheal dilatation and
redo percutaneous tracheostomy on [**2106-10-12**].
4. Type 2 diabetes mellitus, insulin dependent.
5. Chronic pain disorder.
6. Schizoaffective disorder.
7. Depression.
8. Hypertension.
9. Glaucoma.
10. Cataracts bilaterally.
.
PAST SURGICAL HISTORY:
1. Trach and PEG placement initially in [**2105-5-5**].
2. Rigid bronchoscopy, tracheal dilatation and redo percutaneous
tracheostomy on [**2106-10-12**].

MEDICATION ON ADMISSION: Duonebs IH QID
Lasix 20mg PO daily
Flonase 1 spray NU daily
Clonazepam 0.5mg PO BID
Clonazepam 0.5mg PO Q4H:PRN insomnia
Bisacodyl 10mg daily:PRN consiptation
Milk of Mag 30mL daily:PRN constipation
Lisinopril 30mg PO daily
Tylenol 650mg PO/PR Q4H:PRN pain/fever
Lipitor 10mg PO QHS
Acidophillus 1 tab PO BID
Amlodipine 10mg PO daily
Senna 1 tab PO QHS
Citalopram 20mg PO daily
Risperidone 4mg PO BID
Benztropine 0.5mg [**Hospital1 **]
Labetalol 200mg PO BID
Colace 100mg PO BID
guaifenesin 600 mg ER PO BID
latanoprost 0.05% 1 drop OU QHS
Ranitidine 300mg PO QHS
Lantus 58 units SC QHS
Novolog 12 units before breakfast/lunch, 8 units before dinner
MVI 1 tab PO daily
ASA 81mg PO daily
Omeprazole 40mg PO daily

ALLERGIES: Penicillins / Keflex

PHYSICAL EXAM: Physical Exam on Admission:
Vitals: T: 98.4 BP: 141/63 P: 81 R: 28 O2: 100%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, prominent adenoids, no LAD
CV: Regular rate and rhythm, normal S1 + S2, II/VI systolic
murmur
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi. Has inspiratory stridor
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred, finger-to-nose intact

FAMILY HISTORY: Father: died brain tumor
Mother: died from CHF

SOCIAL HISTORY: Prior to hospitalization for PNA in Summer [**2104**], the patient
lived alone in [**Location (un) 1294**]; she now lives at [**Hospital 44563**]
nursing home ([**Hospital1 **] system). She retired as a school teacher
(French and [**Doctor First Name 533**]). She smoked 2 ppd for 40 years.
Mechanical complication of tracheostomy,Obesity hypoventilation syndrome,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Personal history of tobacco use,Solitary pulmonary nodule,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Retention of urine, unspecified,Schizoaffective disorder, unspecified,Unspecified essential hypertension,Dysthymic disorder,Anemia of other chronic disease,Do not resuscitate status,Body Mass Index 36.0-36.9, adult,Chronic airway obstruction, not elsewhere classified,Other and unspecified general anesthetics causing adverse effects in therapeutic use,Obstructive sleep apnea (adult)(pediatric),Stridor
Tracheostomy - mech comp,Obesity hypovent synd,Abn react-surg proc NEC,Hyperpotassemia,History of tobacco use,Solitary pulmonry nodule,DMII wo cmp nt st uncntr,Long-term use of insulin,Crnry athrscl natve vssl,Esophageal reflux,Hx TIA/stroke w/o resid,Retention urine NOS,Schizoaffective dis NOS,Hypertension NOS,Dysthymic disorder,Anemia-other chronic dis,Do not resusctate status,BMI 36.0-36.9,adult,Chr airway obstruct NEC,Adv eff gen anes NEC/NOS,Obstructive sleep apnea,Stridor
Admission Date:  [**2107-4-26**]              Discharge Date:   [**2107-5-1**]

Date of Birth:  [**2039-8-31**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Keflex

Attending:[**First Name3 (LF) 7744**]
Chief Complaint:
Worsening shortness of breath


Major Surgical or Invasive Procedure:
rigid bronchoscopy and tracheostomy [**2107-4-29**]


History of Present Illness:
67yo female with a history of schizoaffective disorder, DM, HTN
with a history of respiratory failure requiring intubation, then
failure to wean off ventilator (required trach and PEG), now
with post-intubation tracheal stenosis requiring multiple
bronchoscopic procedures with trials of T tubes, tracheostomy
tubes.

This morning she woke up feeling like her normal self. She
usually has a feeling of phlegm in her throat, and for the last
4 days or so her chronic cough has become productive of yellow
sputum. She has had temps up to 99F, but no frank fevers. No
chest pain, palpitations, orthopnea, or worsening LE edema.
After breakfast, around 9am, she acutely felt 'tight', like she
was 'breathing through a straw'. She became very anxious, and
reportedly desaturated to the mid 80's on room air. EMS was
called to her nursing home, but she said she was more relaxed
and her symptoms had improved by the time she was being taken
away by ambulance an hour later. She had one briefer episode of
difficulty breathing in the ambulance, but only lasted about 10
minutes.

Of note, Dr. [**Last Name (STitle) **] has been recommending tracheal resection and
reconstruction. However, the patient has been reluctant.

In the ED, initial VS were: 96.6,146/66,76,19,100 @2L
CXR was clear, and a 20G was placed in the R hand. She was given
albuterol nebs.
Vitals prior to transfer were  96.6,146/66,76,19,100 @2L.

On arrival to the MICU, the patient reported feeling her
baseline. On ROS she notes 3 loose bowel movements per day. She
denies nausea/vomiting, abdominal pain, dysuria. At baseline she
walks with a walker and has not had worsening dyspnea on
exertion or chest pain. She has some chronic joint pains in her
hands. No rash. All other ROS negative.


Past Medical History:
1. Respiratory failure requiring intubation, followed by failure
to wean, requiring tracheostomy.
2. Post-intubation tracheal stenosis, requiring chronic
tracheostomy.
3. Subglottic stenosis causing nearly 90% occlusion of the
airway status post rigid bronchoscopy, tracheal dilatation and
redo percutaneous tracheostomy on [**2106-10-12**].
4. Type 2 diabetes mellitus, insulin dependent.
5. Chronic pain disorder.
6. Schizoaffective disorder.
7. Depression.
8. Hypertension.
9. Glaucoma.
10. Cataracts bilaterally.
.
PAST SURGICAL HISTORY:
1. Trach and PEG placement initially in [**2105-5-5**].
2. Rigid bronchoscopy, tracheal dilatation and redo percutaneous
tracheostomy on [**2106-10-12**].


Social History:
Prior to hospitalization for PNA in Summer [**2104**], the patient
lived alone in [**Location (un) 1294**]; she now lives at [**Hospital 44563**]
nursing home ([**Hospital1 **] system). She retired as a school teacher
(French and [**Doctor First Name 533**]). She smoked 2 ppd for 40 years.

HCP: (brother) [**Name (NI) 2174**] [**Name (NI) **] [**Telephone/Fax (1) 86961**]


Family History:
Father: died brain tumor
Mother: died from CHF

Physical Exam:
Physical Exam on Admission:
Vitals: T: 98.4 BP: 141/63 P: 81 R: 28 O2: 100%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, prominent adenoids, no LAD
CV: Regular rate and rhythm, normal S1 + S2, II/VI systolic
murmur
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi. Has inspiratory stridor
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred, finger-to-nose intact

DISCHARGE
Vitals: 99.5 122/75 89 20 100RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, PERRL
CV: Regular rate and rhythm, normal S1 + S2, II/VI systolic
murmur
Lungs: mild ronchi, otherwise clear to auscultation bilaterally

Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: foley w/ yellow, clear urine



Pertinent Results:
Lab Results on Admission:

[**2107-4-26**] 03:40PM BLOOD WBC-9.2# RBC-3.62* Hgb-10.7* Hct-34.0*
MCV-94 MCH-29.6 MCHC-31.5 RDW-14.7 Plt Ct-305
[**2107-4-26**] 03:40PM BLOOD Neuts-65.1 Lymphs-25.4 Monos-5.5 Eos-3.5
Baso-0.4
[**2107-4-26**] 03:40PM BLOOD Glucose-142* UreaN-16 Creat-0.8 Na-138
K-4.4 Cl-99 HCO3-25 AnGap-18
[**2107-4-26**] 03:40PM BLOOD proBNP-83
[**2107-4-27**] 06:54AM BLOOD Calcium-8.7 Phos-4.6*# Mg-2.3

Imaging:

Radiology Report CHEST (PA & LAT) Study Date of [**2107-4-26**] 3:52 PM

IMPRESSION:  No acute cardiopulmonary process.

Discharge labs:
[**2107-5-1**] 07:24AM BLOOD WBC-10.7 RBC-3.42* Hgb-9.8* Hct-31.3*
MCV-92 MCH-28.8 MCHC-31.4 RDW-14.3 Plt Ct-249
[**2107-4-30**] 10:58AM BLOOD Glucose-83 UreaN-14 Creat-0.8 Na-139
K-4.2 Cl-99 HCO3-31 AnGap-13
[**2107-5-1**] 07:24AM BLOOD Glucose-234* UreaN-21* Creat-0.9 Na-135
K-4.3 Cl-96 HCO3-28 AnGap-15
[**2107-4-30**] 10:58AM BLOOD Calcium-8.7 Phos-4.5 Mg-2.2
[**2107-5-1**] 07:24AM BLOOD Calcium-8.5 Phos-4.1 Mg-2.2

Brief Hospital Course:
PRIMARY REASON FOR HOSPITALIZATION: Patient is a 67yo female s/p
post intubation for hypoxic respiratory failure with subsequent
tracheal stenosis, s/p multiple IP procedures, who presents with
an episode of stridor and difficulty breathing. The episode
self-resolved but given patient's tenuous airway with stenosis
and increased sputum, she was admitted for observation and
potential IP management.

ACUTE CARE:
# Tracheal stenosis:
Unclear whether this was a discrete episode, or a worsening that
requires urgent intervention, but patient did experience desats
to 80's at rehab. While she's had an increase in yellowish
sputum, but no fevers and no leukocytosis to suggest infection.
Given that she was not having difficulty breathing following
admission she was not given a repeat dose of steroids and there
was no evidence to start antibiotics. The patient was seen by IP
who recommended tracheal resection and reconstruction with
thoracic surgery, however, the patient deferred in favor of
repeat trach. She underwent successful trach on [**2107-4-29**] w/
placement of #6 cuffed Portex, and resumed a normal diet on
[**2107-4-30**] with no issues. Pt had minimal pain and bleeding after
the procedure. Pt was discharged to [**Hospital1 1501**] w/ instruction for the
facility to provide a portex thermovent tracheostomy valve to be
used during the day and then removed at night and leave to the
trach collar humidifier. The portex thermovent tracheostomy
valve will need to be changed daily. The [**Hospital1 1501**] will also provide
Passy Muir valve to be used during the day as needed to aid with
speech. Pt will use only the Trach collar at night.
The rehab facility should remove the 2 sutures holding the trach
in 2 weeks and keep the trach collar belt on thereafter. IP has
also recommended red cap trials as tolerated for one hour at a
time starting on Tuesday [**2107-5-3**].

# Anemia
Patient with chronic anemia likely due to anemia of chronic
disease.  Did note a HCT drop from baseline 33-35 to 31
following tracheostomy. No signs of active bleeding and patient
remained hemodynamically stable. Would recommend repeat HCT upon
discharge to ensure remains stable.

# Urinary Retention
Patient developed urinary retention following IP procedure.
Possibly related to anesthesia. Patient does report h/o urinary
retention with previous hospitalizations. Bladder scan revealed
up to 800cc urine. Patient straight cathed several times, then
foley placed on [**2107-5-1**]. She will need a voiding trial in about
two days. If she continues to have difficulty voiding, could
consider holding Benztropine as this can cause urinary retention
with further investigation of underlying cause.

CHRONIC CARE
# Diabetes:
Continued home insulin regimen.

# CAD/Hypertension:
Continued home lisinopril, labetalol, amlodipine, aspirin and
atorvastatin.

# Depression/Anxiety:
Continued home citalopram, clonazepam and lorazepam.

# Schizoaffective:
Continued resperidone and benztropine.

# GERD:
Continued home omeprazole and ranitidine.

TRANSITION OF CARE:
-followup with interventional pulmonary clinic
-voiding trial and evaluation of urinary retention
-repeat CBC

Medications on Admission:
Duonebs IH QID
Lasix 20mg PO daily
Flonase 1 spray NU daily
Clonazepam 0.5mg PO BID
Clonazepam 0.5mg PO Q4H:PRN insomnia
Bisacodyl 10mg daily:PRN consiptation
Milk of Mag 30mL daily:PRN constipation
Lisinopril 30mg PO daily
Tylenol 650mg PO/PR Q4H:PRN pain/fever
Lipitor 10mg PO QHS
Acidophillus 1 tab PO BID
Amlodipine 10mg PO daily
Senna 1 tab PO QHS
Citalopram 20mg PO daily
Risperidone 4mg PO BID
Benztropine 0.5mg [**Hospital1 **]
Labetalol 200mg PO BID
Colace 100mg PO BID
guaifenesin 600 mg ER PO BID
latanoprost 0.05% 1 drop OU QHS
Ranitidine 300mg PO QHS
Lantus 58 units SC QHS
Novolog 12 units before breakfast/lunch, 8 units before dinner
MVI 1 tab PO daily
ASA 81mg PO daily
Omeprazole 40mg PO daily


Discharge Medications:
1. DuoNeb 0.5 mg-3 mg(2.5 mg base)/3 mL Solution for
Nebulization Sig: One (1) nebulizer Inhalation four times a day.

2. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. fluticasone 50 mcg/actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
4. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
5. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.
6. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
7. Milk of Magnesia 400 mg/5 mL Suspension Sig: Thirty (30) mL
PO once a day as needed for constipation.
8. lisinopril 30 mg Tablet Sig: One (1) Tablet PO once a day.
9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
10. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
11. Acidophilus     Capsule Sig: One (1) Capsule PO twice a day.

12. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
13. senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

14. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. risperidone 4 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
16. benztropine 0.5 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
17. labetalol 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
18. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
19. guaifenesin 600 mg Tablet Extended Release Sig: One (1)
Tablet Extended Release PO twice a day.
20. latanoprost 0.005 % Drops Sig: One (1) drop Ophthalmic OU
QHS.
21. ranitidine HCl 300 mg Tablet Sig: One (1) Tablet PO at
bedtime.
22. insulin glargine 100 unit/mL Solution Sig: Fifty Eight (58)
UNITS Subcutaneous at bedtime.
23. Novolog 100 unit/mL Solution Sig: AS DIRECTED  Subcutaneous
AS DIRECTED: 12 units before breakfast/lunch, 8 units before
dinner  .
24. multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
25. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
26. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
27. Medical Equipment
Please provide a portex thermovent tracheostomy valve. Change
daily. Only use during the day. (Trach collar at night).
28. Medical equipment
Please provide Passy Muir valve to aid with speech when needed.
Remove this at night. (Use trach mask at night)


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 44563**] Nursing and Rehabilitation Center - [**Hospital1 10478**]

Discharge Diagnosis:
Subglottic Tracheal stenosis

Secondary:
type 2 diabetes
chronic pain
schizoaffective disorder
depression
hypertension
glaucoma
cataracts


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Dear Ms. [**Known lastname 174**],

You were admitted to [**Hospital1 18**] because you were having trouble
breathing.  We were concerned that this was related to your
tracheal stenosis. You underwent successful tracheostomy.  It is
very important that you protect against self-deccanulation.
Please follow up with the interventional pulmonologist after
discharge.

No changes were made to your medications. Please continue taking
all of your medications as previously prescribed. It was a
pleasure taking care of you.

You will be provided with a passy muir valve and a portex
thermovent at your rehabilitation facility.

Followup Instructions:
Department: WEST [**Hospital 2002**] CLINIC
When: TUESDAY [**2107-5-10**] at 9:30 AM
With: [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 3020**]
Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage

Department: WEST [**Hospital 2002**] CLINIC
When: TUESDAY [**2107-5-10**] at 10:00 AM
With: [**Name6 (MD) 1532**] [**Last Name (NamePattern4) 8786**], MD [**Telephone/Fax (1) 3020**]
Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage
{'Mechanical complication of tracheostomy,Obesity hypoventilation syndrome,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Personal history of tobacco use,Solitary pulmonary nodule,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Retention of urine, unspecified,Schizoaffective disorder, unspecified,Unspecified essential hypertension,Dysthymic disorder,Anemia of other chronic disease,Do not resuscitate status,Body Mass Index 36.0-36.9, adult,Chronic airway obstruction, not elsewhere classified,Other and unspecified general anesthetics causing adverse effects in therapeutic use,Obstructive sleep apnea (adult)(pediatric),Stridor'}


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: Worsening shortness of breath

PRESENT ILLNESS: 67yo female with a history of schizoaffective disorder, DM, HTN
with a history of respiratory failure requiring intubation, then
failure to wean off ventilator (required trach and PEG), now
with post-intubation tracheal stenosis requiring multiple
bronchoscopic procedures with trials of T tubes, tracheostomy
tubes.

MEDICAL HISTORY: 1. Respiratory failure requiring intubation, followed by failure
to wean, requiring tracheostomy.
2. Post-intubation tracheal stenosis, requiring chronic
tracheostomy.
3. Subglottic stenosis causing nearly 90% occlusion of the
airway status post rigid bronchoscopy, tracheal dilatation and
redo percutaneous tracheostomy on [**2106-10-12**].
4. Type 2 diabetes mellitus, insulin dependent.
5. Chronic pain disorder.
6. Schizoaffective disorder.
7. Depression.
8. Hypertension.
9. Glaucoma.
10. Cataracts bilaterally.
.
PAST SURGICAL HISTORY:
1. Trach and PEG placement initially in [**2105-5-5**].
2. Rigid bronchoscopy, tracheal dilatation and redo percutaneous
tracheostomy on [**2106-10-12**].

MEDICATION ON ADMISSION: Duonebs IH QID
Lasix 20mg PO daily
Flonase 1 spray NU daily
Clonazepam 0.5mg PO BID
Clonazepam 0.5mg PO Q4H:PRN insomnia
Bisacodyl 10mg daily:PRN consiptation
Milk of Mag 30mL daily:PRN constipation
Lisinopril 30mg PO daily
Tylenol 650mg PO/PR Q4H:PRN pain/fever
Lipitor 10mg PO QHS
Acidophillus 1 tab PO BID
Amlodipine 10mg PO daily
Senna 1 tab PO QHS
Citalopram 20mg PO daily
Risperidone 4mg PO BID
Benztropine 0.5mg [**Hospital1 **]
Labetalol 200mg PO BID
Colace 100mg PO BID
guaifenesin 600 mg ER PO BID
latanoprost 0.05% 1 drop OU QHS
Ranitidine 300mg PO QHS
Lantus 58 units SC QHS
Novolog 12 units before breakfast/lunch, 8 units before dinner
MVI 1 tab PO daily
ASA 81mg PO daily
Omeprazole 40mg PO daily

ALLERGIES: Penicillins / Keflex

PHYSICAL EXAM: Physical Exam on Admission:
Vitals: T: 98.4 BP: 141/63 P: 81 R: 28 O2: 100%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, prominent adenoids, no LAD
CV: Regular rate and rhythm, normal S1 + S2, II/VI systolic
murmur
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi. Has inspiratory stridor
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait deferred, finger-to-nose intact

FAMILY HISTORY: Father: died brain tumor
Mother: died from CHF

SOCIAL HISTORY: Prior to hospitalization for PNA in Summer [**2104**], the patient
lived alone in [**Location (un) 1294**]; she now lives at [**Hospital 44563**]
nursing home ([**Hospital1 **] system). She retired as a school teacher
(French and [**Doctor First Name 533**]). She smoked 2 ppd for 40 years. 

### Response:
{'Mechanical complication of tracheostomy,Obesity hypoventilation syndrome,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Hyperpotassemia,Personal history of tobacco use,Solitary pulmonary nodule,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Retention of urine, unspecified,Schizoaffective disorder, unspecified,Unspecified essential hypertension,Dysthymic disorder,Anemia of other chronic disease,Do not resuscitate status,Body Mass Index 36.0-36.9, adult,Chronic airway obstruction, not elsewhere classified,Other and unspecified general anesthetics causing adverse effects in therapeutic use,Obstructive sleep apnea (adult)(pediatric),Stridor'}
