CHIEF COMPLAINT: Cough s/p bronchoscopy

PRESENT ILLNESS: 64F with PMH of morbid obesity, OSA, severe COPD, and TBM s/p
placement of Y-stent on [**2169-11-6**], who presented today for
scheduled removal of her Y-stent. She states that since having
the stent in place she has suffered from increased shortness of
breath and coughing, with increased sputum and mucus production.
The procedure itself was uncomplicated, but in the PACU she had
nearly 2 hours of prolonged coughing which developed into
pleuritic CP. She received albuterol nebs, lidocaine nebs, IV
codeine, and 125mg IV solumedrol. A CXR revealed diffuse left
lung collapse from mucus plugging and probable aspiration. She
was placed on CPAP in the PACU with some improvement in
respiratory stauts. ABG was 7.41/47/65/31. EKG was not
concerning for ischemia. Cardiac enzymes were negative. The
decision was made to to perform bronchoscopy at that time, but
to admit to MICU for repsiraotry monitoring and possible bronch
in AM if plug had not cleared by then.
.
Currently she endorses shortness of breath above her baseline.
She has diffuse pleuritic chest pain that is non-radiating. She
occasionally has spasms of uncontrollable coughing.

MEDICAL HISTORY: 1. Obesity.
2. History of pericarditis/tamponade secondary to polyserositis.

MEDICATION ON ADMISSION: # Micardis/HCTZ 40/12.5 one tablet daily
# Nexium 40 mg t.i.d.
# Flexeril 10 mg b.i.d.
# Medrol 4 mg daily,
# Zyrtec 10 mg daily
# Singulair 10 mg daily
# cyproheptadine 4 mg b.i.d.
# Lasix 20 mg daily p.r.n. edema
# Enbrel injections 50 mg every week (has not taken in the past
two weeks)
# Advair 250/50 one puff twice daily
# Rhinocort 32 mcg two sprays per nostril daily
# vitamin E
# calcium
# vitamin C
# vitamin B12
# multivitamin
# vitamin D
# Imodium p.r.n.
# Benadryl p.r.n
# Tylenol p.r.n.

ALLERGIES: Aspirin / Ciprofloxacin / Procardia / Niacin / Biaxin / Niaspan
/ Ibuprofen / Crestor / Quinolones / Neosporin / Adhesive Tape

PHYSICAL EXAM: VS: 99.6 94 113/51 24 90% 2L NC
Gen: obese middle aged female, frequently coughing, but not in
acute resp distress, speaking in full sentences
HEENT: NC/AT, MMM
Neck: obese
Cor: RRR, 2/6 systolic murmur at LSB
Resp: Scattered wheezes bilateral
Abd: obese, s/nt/nd +BS
Ext: WWP. 2+ b/l pitting edema to knee. + digital clubbing

FAMILY HISTORY: There is no family history of lung disease or sarcoid. Her
mother died secondary to rectal cancer 82 years old. Notably she
did have lupus. Her father died secondary to an MI at 72 years
old. Her son is healthy.

SOCIAL HISTORY: The patient is divorced. She lives alone in [**Location (un) **],
[**State 350**]. She has one son who lives close by. She has been
on disability since [**2149**]. Prior to that, she worked as a
financial analyst. She has a rare glass of wine. She quit
smoking in [**2160**]. Prior to that she smoked a pack a day for 40
years. She has never used any illicit drugs. She denies asbestos
exposure and reports no known TB exposures. She had a negative
PPD test last year prior to starting Enbrel therapy.
Chronic obstructive asthma with (acute) exacerbation,Pneumonitis due to inhalation of food or vomitus,Other specified forms of effusion, except tuberculous,Other diseases of trachea and bronchus,Other chest pain,Atrial fibrillation,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Obstructive sleep apnea (adult)(pediatric),Other chronic pain,Morbid obesity,Unspecified essential hypertension,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Long-term (current) use of steroids,Personal history of tobacco use,Other artificial opening status
Ch obst asth w (ac) exac,Food/vomit pneumonitis,Effusion NEC exc tb,Trachea & bronch dis NEC,Chest pain NEC,Atrial fibrillation,Sarcoidosis,Lung involv in oth dis,Obstructive sleep apnea,Chronic pain NEC,Morbid obesity,Hypertension NOS,Esophageal reflux,Diaphragmatic hernia,Long-term use steroids,History of tobacco use,Artif open status NEC
Admission Date:  [**2169-11-23**]              Discharge Date:   [**2169-11-28**]

Date of Birth:  [**2105-9-19**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Aspirin / Ciprofloxacin / Procardia / Niacin / Biaxin / Niaspan
/ Ibuprofen / Crestor / Quinolones / Neosporin / Adhesive Tape

Attending:[**First Name3 (LF) 3948**]
Chief Complaint:
Cough s/p bronchoscopy

Major Surgical or Invasive Procedure:
[**2169-11-24**] : Rigid bronchoscopy with black Dumon bronchoscope.
Cryotherapy for debridement of granulation tissue, distal left
main-stem. Balloon dilatation to 10 mm, distal left main-stem.
Mechanical debridement of granulation tissue, left main-stem.
[**2169-11-24**]: Flexible bronchoscopy
[**2169-11-23**]: Rigid bronchoscopy. Foreign body removal (Y-stent).


History of Present Illness:
64F with PMH of morbid obesity, OSA, severe COPD, and TBM s/p
placement of Y-stent on [**2169-11-6**], who presented today for
scheduled removal of her Y-stent. She states that since having
the stent in place she has suffered from increased shortness of
breath and coughing, with increased sputum and mucus production.
The procedure itself was uncomplicated, but in the PACU she had
nearly 2 hours of prolonged coughing which developed into
pleuritic CP. She received albuterol nebs, lidocaine nebs, IV
codeine, and 125mg IV solumedrol. A CXR revealed diffuse left
lung collapse from mucus plugging and probable aspiration. She
was placed on CPAP in the PACU with some improvement in
respiratory stauts. ABG was 7.41/47/65/31. EKG was not
concerning for ischemia. Cardiac enzymes were negative. The
decision was made to to perform bronchoscopy at that time, but
to admit to MICU for repsiraotry monitoring and possible bronch
in AM if plug had not cleared by then.
.
Currently she endorses shortness of breath above her baseline.
She has diffuse pleuritic chest pain that is non-radiating. She
occasionally has spasms of uncontrollable coughing.


Past Medical History:
1. Obesity.
2. History of pericarditis/tamponade secondary to polyserositis.

She has been on steroids for this for the past 17 years.
3. History of pleural effusion.
4. Sarcoidosis.
5. GERD.
6. History of lung nodule status post thoracotomy with left
lower lobe wedge resection and ([**Hospital1 2025**] [**2160**]).
7. Asthma.
8. Hiatal hernia.
9. OSA on nocturnal CPAP (plus 12)
10. Hypertension.
11. Lactose intolerance.
12. Tracheobronchomalacia


Social History:
The patient is divorced. She lives alone in [**Location (un) **],
[**State 350**]. She has one son who lives close by. She has been
on disability since [**2149**]. Prior to that, she worked as a
financial analyst. She has a rare glass of wine. She quit
smoking in [**2160**]. Prior to that she smoked a pack a day for 40
years. She has never used any illicit drugs. She denies asbestos
exposure and reports no known TB exposures. She had a negative
PPD test last year prior to starting Enbrel therapy.

Family History:
There is no family history of lung disease or sarcoid. Her
mother died secondary to rectal cancer 82 years old. Notably she
did have lupus. Her father died secondary to an MI at 72 years
old. Her son is healthy.

Physical Exam:
VS: 99.6 94 113/51 24 90% 2L NC
Gen: obese middle aged female, frequently coughing, but not in
acute resp distress, speaking in full sentences
HEENT: NC/AT, MMM
Neck: obese
Cor: RRR, 2/6 systolic murmur at LSB
Resp: Scattered wheezes bilateral
Abd: obese, s/nt/nd +BS
Ext: WWP. 2+ b/l pitting edema to knee. + digital clubbing


Pertinent Results:
[**2169-11-26**] WBC-17.5* RBC-4.55 Hgb-12.1 Hct-35.6* Plt Ct-755*
[**2169-11-25**] WBC-20.0* RBC-4.08* Hgb-10.7* Hct-31.9* Plt Ct-684*
[**2169-11-24**] WBC-15.7* RBC-3.93* Hgb-10.6* Hct-30.3* Plt Ct-603*
[**2169-11-23**] WBC-19.6*# RBC-4.12* Hgb-10.9* Hct-32.0* Plt Ct-624*
[**2169-11-23**] Neuts-91.9* Lymphs-6.2* Monos-1.4* Eos-0.5 Baso-0.1
[**2169-11-27**] Glucose-80 UreaN-25* Creat-0.8 Na-137 K-4.1 Cl-97
HCO3-33*
[**2169-11-27**] 02:35AM BLOOD K-4.0
[**2169-11-25**] Glucose-129* UreaN-21* Creat-0.6 Na-139 K-3.8 Cl-96
HCO3-32
[**2169-11-23**] Glucose-126* UreaN-8 Na-136 K-4.1 Cl-94* HCO3-31
[**2169-11-26**] CK(CPK)-36 [**2169-11-24**] CK(CPK)-29 [**2169-11-23**] CK(CPK)-40
[**2169-11-27**] BLOOD cTropnT-<0.01 [**2169-11-26**] CK-MB-NotDone
cTropnT-<0.01
[**2169-11-27**] BLOOD Calcium-9.2 Phos-3.9 Mg-2.0

CXR:
[**2169-11-24**]  In comparison with study of [**11-23**], there has been
substantial
re-expansion of the left lung, presumably from expectoration of
a mucus plug.  Atelectatic changes persist at the left base and
there is continued elevation of the left hemidiaphragmatic
contour.

[**2169-11-23**] In comparison with the study of [**11-17**], there has been
substantial volume loss in the left lung with opacification of
most of the left hemithorax following stent removal. Some patchy
quality of the opacification raises the possibility of
supervening aspiration or hemorrhage from recent bronchoscopy.

Chest CT: [**2169-11-27**]
1. Negative examination for pulmonary embolism.
2. Long-term stability of noncalcified pulmonary nodules,
consistent with a benign etiology.
3. Stable appearance of the left lower lobe post-surgical
changes with
scarring.
4. Coronary calcifications.
5. Mucoid impactation in bronchi of left lower lobe.



Brief Hospital Course:
64F with OSA, severe COPD, and TBP s/p removal of Y-stent [**11-23**]
who is admitted to the MICU post-procedurally with left lung
collapse and evidence of mucus plugging and aspiration and
respiratory failure. She was placed on CPAP with aggressive
pulmonary toileting, chest PT and mucolytics. Intravenous
steroids were started for COPD excerbation.  Cardiac enzymes
were negative.  On [**2168-11-23**] she had Flexible bronchoscopy which
showed granulation tissue distal to LMS occluding 75% of lunar.
Distal airway was patent.  She then procedued to the operating
room for Rigid bronchoscopy, Cryotherapy for debridement of
granulation tissue, distal left main-stem. Balloon dilatation to
10 mm, distal left main-stem. Mechanical debridement of
granulation tissue, left main-stem.  She tolerated the procedure
her saturations were monitored in the ICU prior to transfer to
the floor. The post procedure chest film showed some residual
atelectasis and possibly effusion at the left base with
elevation of the left hemidiaphragmatic contour, no recurrence
of the substantial volume loss seen previously and no evidence
of pneumothorax. Her oxygenation improved Sats were 91% on 2L
nasal cannula.  She transferred to the floor on a steroid taper,
home CPAP settings, aggressive pulmonary toileting and chest PT.
 On [**2169-11-25**] her pain was managed with PO pain medicaiton, the
foley was removed and she voided. Her diet was advanced and she
ambulated in the halls.  On [**2169-11-26**] she had an episode of atrial
fibrillation in the 150's.  She was given IV lopressor with
spontaneous conversion to sinus rhythm.  She was started on a
standing dose of low dose beta-blocker, her lytes were repleted.
 On [**2169-11-27**] Chest CT was negative for pulmonary embolism. On
[**2169-11-28**] her respiratory status was at baseline, she continued on
a steroid taper, and was discharged to home with VNA.  She will
follow-up as an outpatient.


Medications on Admission:
# Micardis/HCTZ 40/12.5 one tablet daily
# Nexium 40 mg t.i.d.
# Flexeril 10 mg b.i.d.
# Medrol 4 mg daily,
# Zyrtec 10 mg daily
# Singulair 10 mg daily
# cyproheptadine 4 mg b.i.d.
# Lasix 20 mg daily p.r.n. edema
# Enbrel injections 50 mg every week (has not taken in the past
two weeks)
# Advair 250/50 one puff twice daily
# Rhinocort 32 mcg two sprays per nostril daily
# vitamin E
# calcium
# vitamin C
# vitamin B12
# multivitamin
# vitamin D
# Imodium p.r.n.
# Benadryl p.r.n
# Tylenol p.r.n.


Discharge Medications:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
2. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
4. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO BID (2 times a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
8. Cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) as needed.
9. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal DAILY (Daily).
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed.
11. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
12. Prednisone 10 mg Tablet Sig: Four (4) Tablet PO once a day
for 2 days.
Disp:*25 Tablet(s)* Refills:*0*
13. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 3 days.
14. Prednisone 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily)
for 3 days: then 1 x days, then [**11-17**] tablet (5mg) x 3 days.
15. Saline     Solution Sig: Three (3) ML Miscellaneous three
times a day: Nebulizers .
Disp:*300 * Refills:*2*
16. Micardis HCT 40-12.5 mg Tablet Sig: One (1) Tablet PO once a
day.
17. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO three times a day.
18. Zyrtec 10 mg Tablet Sig: One (1) Tablet PO once a day.
19. Cyproheptadine 4 mg Tablet Sig: One (1) Tablet PO twice a
day.
20. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day as
needed.
21. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: 0.5
Tablet Sustained Release 24 hr PO once a day.
Disp:*15 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 486**]

Discharge Diagnosis:
Obesity.
History of pericarditis/tamponade secondary to polyserositis,
steroids x 17 yrs
History of pleural effusion.
Sarcoidosis.
GERD.
History of lung nodule status post thoracotomy with left lower
lobe wedge resection and ([**Hospital1 2025**] [**2160**]).
Asthma.
Hiatal hernia.
OSA on nocturnal CPAP (plus 12)
Hypertension.
Lactose intolerance.


Discharge Condition:
stable


Discharge Instructions:
Call Dr.[**Name (NI) 14679**] office [**Telephone/Fax (1) 7769**] if develops:
-Fever > 101 or chills
-Increased shortness of breath, cough or sputum production
Prednisone taper 40 x 2 days, 30 x 3 days, 20 x 3 days, 10 x 3
days then 5 mg day.  Please contact your rheumatologist
regarding your medrol 4 mg daily. (when to start)

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] [**12-12**] @10:00am in the [**Hospital Ward Name 121**]
Building [**Hospital1 **] I Chest Disease Center, [**Location (un) **]
Follow-up with Dr. [**Last Name (STitle) **] [**12-12**] at 10:30 am Chest Disease Center
Please follow-up with your rheumatologist regarding steroids



Completed by:[**2169-11-29**]
{'Chronic obstructive asthma with (acute) exacerbation,Pneumonitis due to inhalation of food or vomitus,Other specified forms of effusion, except tuberculous,Other diseases of trachea and bronchus,Other chest pain,Atrial fibrillation,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Obstructive sleep apnea (adult)(pediatric),Other chronic pain,Morbid obesity,Unspecified essential hypertension,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Long-term (current) use of steroids,Personal history of tobacco use,Other artificial opening status'}


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: Cough s/p bronchoscopy

PRESENT ILLNESS: 64F with PMH of morbid obesity, OSA, severe COPD, and TBM s/p
placement of Y-stent on [**2169-11-6**], who presented today for
scheduled removal of her Y-stent. She states that since having
the stent in place she has suffered from increased shortness of
breath and coughing, with increased sputum and mucus production.
The procedure itself was uncomplicated, but in the PACU she had
nearly 2 hours of prolonged coughing which developed into
pleuritic CP. She received albuterol nebs, lidocaine nebs, IV
codeine, and 125mg IV solumedrol. A CXR revealed diffuse left
lung collapse from mucus plugging and probable aspiration. She
was placed on CPAP in the PACU with some improvement in
respiratory stauts. ABG was 7.41/47/65/31. EKG was not
concerning for ischemia. Cardiac enzymes were negative. The
decision was made to to perform bronchoscopy at that time, but
to admit to MICU for repsiraotry monitoring and possible bronch
in AM if plug had not cleared by then.
.
Currently she endorses shortness of breath above her baseline.
She has diffuse pleuritic chest pain that is non-radiating. She
occasionally has spasms of uncontrollable coughing.

MEDICAL HISTORY: 1. Obesity.
2. History of pericarditis/tamponade secondary to polyserositis.

MEDICATION ON ADMISSION: # Micardis/HCTZ 40/12.5 one tablet daily
# Nexium 40 mg t.i.d.
# Flexeril 10 mg b.i.d.
# Medrol 4 mg daily,
# Zyrtec 10 mg daily
# Singulair 10 mg daily
# cyproheptadine 4 mg b.i.d.
# Lasix 20 mg daily p.r.n. edema
# Enbrel injections 50 mg every week (has not taken in the past
two weeks)
# Advair 250/50 one puff twice daily
# Rhinocort 32 mcg two sprays per nostril daily
# vitamin E
# calcium
# vitamin C
# vitamin B12
# multivitamin
# vitamin D
# Imodium p.r.n.
# Benadryl p.r.n
# Tylenol p.r.n.

ALLERGIES: Aspirin / Ciprofloxacin / Procardia / Niacin / Biaxin / Niaspan
/ Ibuprofen / Crestor / Quinolones / Neosporin / Adhesive Tape

PHYSICAL EXAM: VS: 99.6 94 113/51 24 90% 2L NC
Gen: obese middle aged female, frequently coughing, but not in
acute resp distress, speaking in full sentences
HEENT: NC/AT, MMM
Neck: obese
Cor: RRR, 2/6 systolic murmur at LSB
Resp: Scattered wheezes bilateral
Abd: obese, s/nt/nd +BS
Ext: WWP. 2+ b/l pitting edema to knee. + digital clubbing

FAMILY HISTORY: There is no family history of lung disease or sarcoid. Her
mother died secondary to rectal cancer 82 years old. Notably she
did have lupus. Her father died secondary to an MI at 72 years
old. Her son is healthy.

SOCIAL HISTORY: The patient is divorced. She lives alone in [**Location (un) **],
[**State 350**]. She has one son who lives close by. She has been
on disability since [**2149**]. Prior to that, she worked as a
financial analyst. She has a rare glass of wine. She quit
smoking in [**2160**]. Prior to that she smoked a pack a day for 40
years. She has never used any illicit drugs. She denies asbestos
exposure and reports no known TB exposures. She had a negative
PPD test last year prior to starting Enbrel therapy. 

### Response:
{'Chronic obstructive asthma with (acute) exacerbation,Pneumonitis due to inhalation of food or vomitus,Other specified forms of effusion, except tuberculous,Other diseases of trachea and bronchus,Other chest pain,Atrial fibrillation,Sarcoidosis,Lung involvement in other diseases classified elsewhere,Obstructive sleep apnea (adult)(pediatric),Other chronic pain,Morbid obesity,Unspecified essential hypertension,Esophageal reflux,Diaphragmatic hernia without mention of obstruction or gangrene,Long-term (current) use of steroids,Personal history of tobacco use,Other artificial opening status'}
