diff --git a/Diagnosis_flowchart/Acute Coronary Syndrome.json b/Diagnosis_flowchart/Acute Coronary Syndrome.json new file mode 100644 index 0000000000000000000000000000000000000000..a7d6ea3afe58ce9b760390d2205077cc757a8f60 --- /dev/null +++ b/Diagnosis_flowchart/Acute Coronary Syndrome.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected ACS": {"Strongly Suspected ACS": {"NSTE-ACS": {"UA": [], "NSTEMI": []}, "STEMI-ACS": []}}}, "knowledge": {"Suspected ACS": {"Risk Factors": "Hyperlipidemia, hypertension, smoking, diabetes, infection, hyperthyroidism, severe arrhythmia, anemia, hypoxemia; etc.", "Symptoms": "Chest pain, sweating, nausea, vomiting, palpitations, dyspnea, arrhythmia with weakness, dizziness or syncope, hypotensive shock, acute left heart failure; etc."}, "Strongly Suspected ACS": "More severe clinical presentations; slight cardiac structural abnormalities;Coronary stenosis", "NSTE-ACS": "non-ST-elevation", "UA": "hs-cTn levels are normal\uff0cNormal ECG", "NSTEMI": "The peak hs-cTn exceeded the 99th percentile of the normal control value; Elevated levels of cardiac biomarkers, especially troponin T or I ", "STEMI-ACS": "ST-elevation; ECG Wide and deep Q waves;T-wave inversion hs-cTn increases at 3-4 hours and peaks at 11-12 hours;Elevated levels of cardiac biomarkers, especially troponin T or I"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Adrenal Insufficiency.json b/Diagnosis_flowchart/Adrenal Insufficiency.json new file mode 100644 index 0000000000000000000000000000000000000000..859573c5b4bb71df37771a15fd6f08af09c6cec7 --- /dev/null +++ b/Diagnosis_flowchart/Adrenal Insufficiency.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Adrenal Insufficiency": {"Primary Adrenal Insufficiency": [], "Secondary Adrenal Insufficiency": [], "Congenital Adrenal Hyperplasia": []}}, "knowledge": {"Suspected Adrenal Insufficiency": {"Risk Factors": "Autoimmune diseases; Genetic predisposition; Infections (e.g., tuberculosis, HIV); Adrenal hemorrhage; Anticoagulant therapy; Chronic use of glucocorticoids or other immunosuppressive drugs; Certain medications that affect adrenal function; etc.", "Symptoms": "Fatigue; Muscle weakness; Weight loss; Gastrointestinal symptoms (nausea, vomiting, diarrhea); Low blood sugar; Hyperpigmentation (in primary adrenal insufficiency); Various abnormal manifestations of skin;Changes in serum potassium levels; Salt craving; Dizziness or fainting upon standing; Low blood sugar levels; etc.", "Signs": "Hyperpigmentation (especially in creases of skin, on scars, or gums, in primary adrenal insufficiency); Low blood pressure; especially when standing (orthostatic hypotension); Dehydration; Abdominal tenderness; Electrolyte imbalances (hyponatremia, hyperkalemia); Rapid heart rate; etc."}, "Primary Adrenal Insufficiency": "1. Often there are high ACTH levels because the adrenal glands do not respond to ACTH \n 2. Both PAI and SAI may present with hyporesponsiveness, but in PAI cortisol does not increase even when ACTH is given because the adrenal glands are damaged \n 3. In PAI, imaging studies may show structural abnormalities in the adrenal glands.\n 4. May be associated with significant electrolyte imbalances such as hyponatremia and hyperkalemia \n 5. Aldosterone is usually not involved, so hyperkalemia is unlikely \n 6 have Addison's disease. \n", "Secondary Adrenal Insufficiency": "1. ACTH levels are low or normal because the problem originates from the pituitary gland or hypothalamus, which does not secrete ACTH adequately.\n 2. Cortisol increases when ACTH is given \n 3 For SAI, an MRI or CT scan may be needed to evaluate the structure of the pituitary gland and hypothalamus .\n", "Congenital Adrenal Hyperplasia": "1.Hormone measurements in blood and urine, specifically 17 hydroxyprogesterone (17-OHP), cortisol, androgens, and aldosterone. 2.Patients with CAH often present with abnormally elevated 17-OHP levels. 3.ACTH stimulation test: Measures changes in 17-OHP levels before and after ACTH (adrenocorticotropic hormone) injection to evaluate adrenocortical function.4. Genetic testing can confirm the diagnosis of CAH and identify the specific type of enzyme defect, the most common being 21-hydroxylase deficiency.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Alzheimer.json b/Diagnosis_flowchart/Alzheimer.json new file mode 100644 index 0000000000000000000000000000000000000000..585d37b321c6c52d80b6d784e84b86cbf5fbdc0f --- /dev/null +++ b/Diagnosis_flowchart/Alzheimer.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Alzheimer": {"Alzheimer": []}}, "knowledge": {"Suspected Alzheimer": {"Risk Factors": "Age; genetic factors; gender; cardiovascular health; head trauma; intellectual activity; lifestyle and diet; other diseases such as diabetes, depression, and sleep disorders.; etc.", "Symptoms": "Cognitive decline, including memory loss and deterioration of other functions; impairment in at least two cognitive areas; progressive decline in memory and cognition without loss of consciousness; typically occurs between ages 40 and 90, with higher frequency after 65; absence of other systemic or brain diseases to explain the decline; specific cognitive functions may deteriorate, such as language, motor skills, and perception; difficulty in daily activities and changes in behavior; family history of similar disorders, especially if confirmed by neuropathology; additional symptoms may include depression, insomnia, incontinence, delusions, hallucinations, outbursts, sexual disorders, and weight loss; some patients may exhibit neurological abnormalities like increased muscle tone, myoclonus, or gait disturbances; seizures may occur in advanced stages. ; etc."}, "Alzheimer": "1. Clinical Assessment\n Detailed medical history and neuropsychological tests: Evaluate the patient's cognitive functions, including memory, attention, language abilities, executive functions, and visuospatial skills.\n Neuropsychological assessment tools: Such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).\n2. Imaging Studies\n Magnetic Resonance Imaging (MRI): Used to check for structural changes in the brain, particularly atrophy in the hippocampus and other memory-related areas.\n Positron Emission Tomography (PET):\n FDG-PET: Assesses brain metabolic activity; patients with Alzheimer's disease typically show reduced glucose metabolism in the temporal-parietal lobes.\n Amyloid PET: Detects amyloid-beta deposits in the brain, a significant biomarker of Alzheimer's disease.\n3. Cerebrospinal Fluid (CSF) Biomarkers\n Amyloid-beta 42 (A\u03b242): In patients with Alzheimer's, the level of A\u03b242 in the CSF is typically reduced.\n Total tau and phosphorylated tau proteins: Levels of these markers are usually elevated in the CSF of patients with Alzheimer's.\n4. Genetic Testing\n APOE \u03b54 allele: This is one of the most significant genetic markers known to be associated with an increased risk of Alzheimer's disease.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Aortic Dissection.json b/Diagnosis_flowchart/Aortic Dissection.json new file mode 100644 index 0000000000000000000000000000000000000000..616e449c2df5dbd11bc91335526e225808407973 --- /dev/null +++ b/Diagnosis_flowchart/Aortic Dissection.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Aortic Dissection": {"Type A Aortic Dissection": [], "Type B Aortic Dissection": []}}, "knowledge": {"Suspected Aortic Dissection": {"Risk Factors": "Hypertension, Atherosclerosis, Family history, High cholesterol, Smoking, Inherited connective tissue disorders, Previous cardiac surgery, Pregnancy; etc.", "Symptoms": "Intense chest or upper back pain, Sudden severe abdominal pain, Loss of consciousness, Shortness of breath, Weakness or paralysis, Weak pulse in one arm or thigh, Leg pain, Difficulty speaking or loss of vision; etc."}, "Type A Aortic Dissection": "CT, MRI, TEE checking\nType A: Dissection affecting the ascending aorta and possibly extending into the descending aorta\n", "Type B Aortic Dissection": "CT, MRI, TEE checking\nType B: Dissection limited to descending aorta\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Asthma.json b/Diagnosis_flowchart/Asthma.json new file mode 100644 index 0000000000000000000000000000000000000000..10532fc3f6a4d60f08ea79d4714456f326154f9c --- /dev/null +++ b/Diagnosis_flowchart/Asthma.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Asthma": {"Asthma": {"Severe Asthma": [], "Allergic Asthma": [], "Non-Allergic Asthma": [], "Cough-Variant Asthma": [], "Asthma-COPD": []}}}, "knowledge": {"Suspected Asthma": {"Risk Factors": "Allergies; family history of asthma or allergies; occupational exposures; smoking or exposure to secondhand smoke; air pollution; frequent respiratory infections; etc.", "Symptoms": "Recurrent episodes of wheezing; breathlessness; chest tightness; blood-tinged sputum and coughing; particularly at night or early morning; Sometimes accompanied by hypertension.;etc.", "Signs": "Observable signs during a physical examination might include wheezing on auscultation, especially after exercise or during an acute episode;after giving medicine, patient still has different breathe sound; etc."}, "Asthma": "Spirometry: A significant improvement in FEV1 (Forced Expiratory Volume in 1 second) of more than 12% and 200 ml from baseline after administration of a bronchodilator confirms the reversibility of airflow obstruction.\nFractional Exhaled Nitric Oxide (FeNO): Elevated levels indicate eosinophilic inflammation, supporting the diagnosis of asthma.\nPeak Expiratory Flow Variability: Monitoring over time can show variability in lung function, supporting an asthma diagnosis.\nHyperreactivity tests :An abnormal result in non-specific bronchial hyperreactivity tests (e.g., methacholine challenge test) may also lead to a strong suspicion of asthma.\n", "Severe Asthma": "doesn't respond well to conventional treatments needs stronger treatments;family history can also increase the probability; acute attack regularly and severe; persistent flow limitation, even after giving enough bronchodilators; often accompanied with obesity or anxiety and depression", "Allergic Asthma": "Triggered by allergens such as pollen, dust mites, or pet dander, etc.", "Non-Allergic Asthma": "Triggered by factors not related to allergies, like stress, exercise, illnesses, or cold air, etc.", "Cough-Variant Asthma": "long-lasting dry cough that is not accompanied by other typical asthma symptoms such as wheezing or difficulty breathing; diurnal variation of peak expiratory flow>20%; often accompanied by a marked irritating cough at night; bronchodilators are effective", "Asthma-COPD": "Features of both asthma and chronic obstructive pulmonary disease (COPD), with symptoms and airflow limitation that aren't fully reversible;lasting airflow limitation; the elder has obvious symptoms"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Atrial Fibrillation.json b/Diagnosis_flowchart/Atrial Fibrillation.json new file mode 100644 index 0000000000000000000000000000000000000000..966f36d4b4a37770b7ac3bac49d1344e8f3bafc3 --- /dev/null +++ b/Diagnosis_flowchart/Atrial Fibrillation.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Atrial Fibrillation": {"Paroxysmal Atrial Fibrillation": [], "Persistent Atrial Fibrillation": []}}, "knowledge": {"Suspected Atrial Fibrillation": {"Risk Factors": "High blood pressure, Hyperthyroidism, Obesity, Diabetes, Smoking and alcohol consumption, Sleep apnea, Family history, Age, Gender; etc.", "Symptoms": "Palpitations or a feeling that the heart is beating too fast, Fatigue, Shortness of breath, especially during activity, Dizziness or a feeling of fainting, Chest pain, Decreased ability to exercise, Irritability or anxiety, Insomnia; etc."}, "Paroxysmal Atrial Fibrillation": "ECG: Episodes of AF that terminate spontaneously, usually within 7 days, most often within 24 hours. During an episode, the ECG shows absence of P waves, replaced by irregular atrial activity, and irregular R-R intervals\n", "Persistent Atrial Fibrillation": "ECG: AF episodes that last more than 7 days. The ECG features are similar, showing no P waves, irregular atrial activity, and irregular R-R intervals.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/COPD.json b/Diagnosis_flowchart/COPD.json new file mode 100644 index 0000000000000000000000000000000000000000..0b81bc91a6cea2c9ff952cf3b14aad6c17d07590 --- /dev/null +++ b/Diagnosis_flowchart/COPD.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected COPD": {"COPD": {"Mild COPD": [], "Moderate COPD": [], "Severe COPD": [], "Very Severe COPD": []}}}, "knowledge": {"Suspected COPD": {"Risk Factors": "Long-term exposure to harmful particles or gases (tobacco smoke, occupational dust and chemicals, air pollution) / Genetic predisposition (e.g., alpha-1 antitrypsin deficiency); etc.", "Symptoms": ": Chronic cough, Sputum production, Dyspnea, especially during physical activities, Frequent respiratory infections; etc.", "Signs": "Wheezing\u3001Chest tightness\u3001Prolonged expiratory phase\u3001Decreased breath sounds\u3001Cyanosis (in advanced stages)\u3001Use of accessory muscles for breathing.; etc."}, "COPD": "Post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation.", "Mild COPD": "FEV1 \u2265 80% predicted", "Moderate COPD": "50% \u2264 FEV1 < 80% predicted", "Severe COPD": "30% \u2264 FEV1 < 50% predicted", "Very Severe COPD": "FEV1 < 30% predicted or FEV1 < 50% predicted plus chronic respiratory failure"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Cardiomyopathy.json b/Diagnosis_flowchart/Cardiomyopathy.json new file mode 100644 index 0000000000000000000000000000000000000000..89c027a7d4a920e468fbac0ddfcf287c7e65f762 --- /dev/null +++ b/Diagnosis_flowchart/Cardiomyopathy.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Cardiomyopathy": {"Dilated Cardiomyopathy": [], "Hypertrophic Cardiomyopathy": [], "Restrictive Cardiomyopathy": [], "Arrhythmogenic Right Ventricular Cardiomyopathy": []}}, "knowledge": {"Suspected Cardiomyopathy": {"Risk Factors": "Genetic predisposition, Long-standing high blood pressure, Viral infections, Alcohol and toxins, Metabolic disorders and nutritional deficiencie; etc.", "Symptoms": "Fatigue and weakness, Shortness of breath, Swelling of the legs and ankles, Arrhythmias, Chest pain; etc."}, "Dilated Cardiomyopathy": "Echocardiogram: Demonstrates enlargement of the left ventricle or both ventricles and reduced contractile function. Specific values include increased Left Ventricular End-Diastolic Diameter (LVEDD) and a Left Ventricular Ejection Fraction (LVEF) below the normal range (<50%).\nECG: May reveal signs of abnormal rhythms or ventricular enlargement.\nMRI: Can further assess cardiac structure and function, confirming ventricular volume enlargement and myocardial mass increase.\nCardiac catheterization and endomyocardial biopsy: In certain cases, these may be necessary to determine the heart's pressures and pumping efficiency and to directly examine the heart muscle tissue.\n", "Hypertrophic Cardiomyopathy": "Echocardiogram: Increased thickness of the myocardial wall (typically >15mm) without any other cardiac disease that could explain the thickening.\nMRI: Used for a detailed assessment of myocardial thickness and to detect areas of hypertrophy that might not be visible on an echocardiogram\n", "Restrictive Cardiomyopathy": "Echocardiogram: Shows normal or nearly normal ventricular sizes and wall thickness but abnormal ventricular filling and mitral inflow patterns indicative of restrictive filling.\nMRI: Helps assess cardiac structure, particularly for any fibrosis or calcification of the myocardium and pericardium.\nCardiac catheterization: Measures intracardiac pressures, showing elevated pressures during mitral inflow, consistent with a typical restrictive filling pattern.\n", "Arrhythmogenic Right Ventricular Cardiomyopathy": "Echocardiogram: May reveal specific arrhythmias, T-wave inversions in right ventricular leads, and epsilon waves on the ECG\nECG: Shows enlargement and dysfunction of the right ventricle.\nMRI: Visualizes fatty infiltration and/or scarring of the right ventricle.\nCardiac Biopsy: In some cases, can diagnose by detecting fat and fibrous tissue changes in the myocardium.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Diabetes.json b/Diagnosis_flowchart/Diabetes.json new file mode 100644 index 0000000000000000000000000000000000000000..a37584d2e83d12b06c5e419ffb9b7d9977b89bc2 --- /dev/null +++ b/Diagnosis_flowchart/Diabetes.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Diabetes": {"Diabetes": {"Type I Diabetes": [], "Type II Diabetes": [], "Specific Types of Diabetes": [], "Gestational Diabetes Mellitus": []}}}, "knowledge": {"Suspected Diabetes": {"Risk Factors": "family history of diabetes; obesity or overweight; physical inactivity; high blood pressure; abnormal cholesterol levels; history of gestational diabetes; polycystic ovary syndrome; age greater than 45 years; certain racial or ethnic backgrounds; etc.", "Symptoms": "increased thirst; frequent urination; unexplained weight loss; increased hunger; blurry vision; numbness or tingling in the feet or hands; sores that do not heal; extreme fatigue; etc.", "Signs": "high fasting plasma glucose levels; elevated 2-hour plasma glucose levels during an oral glucose tolerance test; high A1C levels; presence of ketones in urine; rapid weight loss; acanthosis nigricans; etc."}, "Diabetes": "The definitive diagnosis of diabetes hinges on meeting one of the following criteria: a fasting plasma glucose (FPG) level of \u2265126 mg/dL; a 2-hour glucose value of \u2265200 mg/dL during an OGTT, or a random plasma glucose of \u2265200 mg/dL in the presence of classic symptoms of hyperglycemia or hyperglycemic crisis.", "Type I Diabetes": "Type 1 diabetes often involves an autoimmune process, so the following autoimmune markers can be used to aid diagnosis: anti-islet cell antibodies (ICA) ;anti-glutamate decarboxylase antibodies (GADA); anti-insulin antibodies (IAA) ;anti-tyrosine phosphatase-related Antibodies (IA-2A);These antibodies are positive in most patients with type 1 diabetes but are usually absent in patients with type 2 diabetes. ", "Type II Diabetes": "Type 2 diabetes is often associated with insulin resistance and may involve testing for Insulin levels and C-peptide levels: The diagnosis of type II diabetes should be determined according to the curve shape of the values of C-peptide release test and insulin release test in different states,for example,fasting,30min,60min,120min,180min. Able-bodied person:fasting basic plasma insulin is 5-20mlU/L,OGTT reached the peak value after 10min,and insulin returns to the basic level after 180 min;fasting C-peptide level was 1.1-4.4ng/ml,the secretion reached the peak which reaches 5-6 times of the basic value. Pre-diabetic patients:often in early stage type II diabetes, insulin levels may be normal or high. Classic type II diabetes:fasting insulin levels are normal or above the normal range.the peak is delayed after oral glucose,may reach the peak at 120min,but did not fall to the normal levels at 180min;fasting C-peptide level can be normal,high or low,the release curve rises slowly after taking sugar,the peak is delayed,and the release curve still does not fall back to the fasting level after 180 min. C-peptide testing can help evaluate the function of pancreatic beta cells and their ability to produce insulin.", "Specific Types of Diabetes": "Due to other conditions", "Gestational Diabetes Mellitus": "Diagnosed during pregnancy through glucose testing strategies that may include the OGTT"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Epilepsy.json b/Diagnosis_flowchart/Epilepsy.json new file mode 100644 index 0000000000000000000000000000000000000000..c3c40cc30805231f7dc6db97b6e04e2194184208 --- /dev/null +++ b/Diagnosis_flowchart/Epilepsy.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Epilepsy": {"Non-epileptic Seizure": [], "Epilepsy": []}}, "knowledge": {"Suspected Epilepsy": {"Risk Factors": "fever, mental or physical stress, certain medications, excessive alcohol or caffeine intake. Brain Malformations, Genetic Abnormalities: Such as intracranial structural abnormalities, genetic neurodevelopmental disorders. Metabolic Abnormalities: Such as electrolyte imbalances, hypoglycemia. Central Nervous System Infections: Meningitis, encephalitis; etc.", "Symptoms": "Patients with epilepsy may experience seizures that vary in frequency from several weeks to several months apart. Some may have seizures more likely to occur under specific conditions, such as lack of sleep, high stress, or exposure to intense light.; etc.", "Signs": "Before, mood changes, unusual sensations (such as strange tastes or sounds), fear, or gastrointestinal discomfort. During a Seizure: Symptoms can include loss of consciousness, muscle twitching, involuntary movements, cessation of activity, staring, chewing, or fumbling movements. After a Seizure (Postictal Symptoms): Post-seizure confusion, fatigue, headache, muscle pain, or memory loss are common., etc."}, "Non-epileptic Seizure": "Maybe related to specific situations, such as emotional stress or psychological trauma, without prodromal symptoms\nEEG shows normal or no typical epileptic discharges\n", "Epilepsy": "EEG typical epileptiform discharges, such as spikes and slow waves, may be recorded;\nVideo EEG-recorded epileptiform discharges, matching clinical seizure symptoms;\nImaging Studies:\n MRI: Preferred imaging modality for its ability to reveal subtle structural abnormalities such as cavernomas, cerebellar hypoplasia, or heterotopia, which could underlie epilepsy.\t\n CT Scan: Often used in emergency settings for rapid identification of large-scale abnormalities like tumors, hemorrhage, or significant brain atrophy, particularly when an MRI is not immediately available.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Gastro-oesophageal Reflux Disease.json b/Diagnosis_flowchart/Gastro-oesophageal Reflux Disease.json new file mode 100644 index 0000000000000000000000000000000000000000..d8e0fe3f0c89f88461141ac43e5b72c7c650d277 --- /dev/null +++ b/Diagnosis_flowchart/Gastro-oesophageal Reflux Disease.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Gastro-oesophageal Reflux Disease": {"Gastro-oesophageal Reflux Disease": []}}, "knowledge": {"Suspected Gastro-oesophageal Reflux Disease": {"Risk Factors": "obesity; dietary habits such as eating fatty or spicy foods, chocolate, and coffee; smoking; excessive alcohol consumption; pregnancy; certain medications such as calcium channel blockers, sedatives, and antidepressants; aging; delayed gastric emptying; body posture, like bending over or lying down right after eating; esophageal disorders such as esophageal stricture or motility disorders.; etc.", "Symptoms": "Typical: heartburn, oesophageal chest pain and regurgitation.atypical symptoms: belching, chronic cough, wheezing hoarseness, globus, nausea, abdominal pain and other dyspeptic symptoms; etc."}, "Gastro-oesophageal Reflux Disease": "conclusive evidence for gastro- esophageal reflux disease(off therapy): \nEndoscopy (endoscopy should be performed 2\u20134 weeks after discontinuation of antisecretory therapy ): LA grades B, C and D oesophagitis, biopsy proven Barrett\u2019s oesophagus and peptic stricture are conclusive for a diagnosis of GERD.\nAmbulatory reflux monitor (pH or pH-impendance):AET>6% on at least 2 days of wireless pH monitoring or total AET>6% on pH-impedance monitoring (Total reflux episodes >80/day and baseline impedance of <1500 ohms are adjunctive evidence).\nEsophageal Manometry\n Lower Esophageal Sphincter (LES) Resting Pressure: Normal values: 10-45 mmHg\n Lower Esophageal Sphincter Relaxation Pressure: During swallowing, the LES should relax completely, approaching the intrathoracic pressure.\n Esophageal Body Peristaltic Wave Amplitude: Normal values: 30-180 mmHg\n Esophageal Peristaltic Wave Propagation Speed: Normal values: 2-4 cm/s\n Complete Peristaltic Waves: Normally, more than 70% of swallowing actions should induce effective peristaltic waves.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Heart Failure.json b/Diagnosis_flowchart/Heart Failure.json new file mode 100644 index 0000000000000000000000000000000000000000..8976945a680407a413538725ac0b46295c91b211 --- /dev/null +++ b/Diagnosis_flowchart/Heart Failure.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Heart Failure": {"Strongly Suspected Heart Failure": {"Heart Failure": {"HFrEF": [], "HFmrEF": [], "HFpEF": []}}}}, "knowledge": {"Suspected Heart Failure": {"Risk Factors": "CAD, Hypertension, Valve disease, Arrhythmias, CMPs, Congenital heart disease, Infective, Drug-induced, Infiltrative, Storage disorders, Endomyocardial disease, Pericardial disease, Metabolic, Neuromuscular disease; etc.", "Symptoms": "Typical: Breathlessness, Orthopnoea, Paroxysmal nocturnal dyspnoea, Reduced exercise tolerance, Fatigue, tiredness, increased time to recover after exercise, Ankle swelling. Less typical: Nocturnal cough, Wheezing, Bloated feeling, Loss of appetite, Confusion (especially in the elderly), Depression, Palpitation, Dizziness, Syncope.; etc.", "Signs": "More specific: Elevated jugular venous pressure, Hepatojugular reflux, Third heart sound (gallop rhythm), Laterally displaced apical impulse. Less specific: Weight gain (>2 kg/week), Weight loss (in advanced HF), Tissue wasting (cachexia), Cardiac murmur, Peripheral edema (ankle, sacral, scrotal), Pulmonary crepitations, Pleural effusion, Tachycardia, Irregular pulse, Tachypnoea, Cheyne-Stokes respiration, Hepatomegaly, Ascites, Cold extremities, Oliguria, Narrow pulse pressure."}, "Strongly Suspected Heart Failure": "NT-proBNP \u2265 125 pg/mLor BNP \u2265 35 pg/mL\n", "Heart Failure": "Abnormal findings from echocardiography\uff1aLV mass index\u226595 g/m2 (Female), \u2265 115 g/m2 (Male), Relative wall thickness >0.42, LA volume index>34 mL/m2, E/e\u2019 ratio at rest >9, PA systolic pressure >35 mmHg, TR velocity at rest >2.8 m/s, etc.", "HFrEF": "LVEF\u226440%", "HFmrEF": "LVEF41\u201349%", "HFpEF": "LVEF\u226550%"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Hyperlipidemia.json b/Diagnosis_flowchart/Hyperlipidemia.json new file mode 100644 index 0000000000000000000000000000000000000000..9a1115cfa6376985d7c251a57f05b860d99a540e --- /dev/null +++ b/Diagnosis_flowchart/Hyperlipidemia.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Hyperlipidemia": {"Hyperlipidemia": []}}, "knowledge": {"Suspected Hyperlipidemia": {"Risk Factors": "Genetics, Diet, Physical inactivity, Weight, Smoking, Age and gender, Alcohol, medical conditions: Including diabetes, hypertension, kidney diseases, and some liver diseases, can be linked to hyperlipidemia, Certain medications: Including some contraceptives, diuretics, \u03b2-blockers, and steroids, can affect blood lipid levels; etc.", "Symptoms": "Xanthomas, Xanthelasmas, Corneal arcus; etc."}, "Hyperlipidemia": "Total Cholesterol\n Borderline high: 200-239 mg/dL\n High: 240 mg/dL and above\nLDL Cholesterol (Low-Density Lipoprotein Cholesterol)\n Borderline high: 130-159 mg/dL\n High: 160-189 mg/dL\n Very high: 190 mg/dL and above\nHDL Cholesterol (High-Density Lipoprotein Cholesterol)\n Low: Less than 40 mg/dL for men and less than 50 mg/dL for women \n High: 60 mg/dL and above\nTriglycerides\n Borderline high: 150-199 mg/dL\n High: 200-499 mg/dL\n Very high: 500 mg/dL and above\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Hypertension.json b/Diagnosis_flowchart/Hypertension.json new file mode 100644 index 0000000000000000000000000000000000000000..35a76b5a49f9aed36c2aef04ad02bb4b8d0f42ed --- /dev/null +++ b/Diagnosis_flowchart/Hypertension.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Hypertension": {"Hypertension": []}}, "knowledge": {"Suspected Hypertension": {"Risk Factors": "Age, Family history, Race, Being overweight or obese, Unhealthy diet, Lack of physical activity, Smoking and drinking alcohol, Stress, Chronic conditions, Sleep disorders; etc.", "Symptoms": "Headaches, Dizziness or light-headedness, Blurred vision or other visual disturbances, Chest pain, Shortness of breath, Rapid or irregular heartbeat, Tinnitus, Nosebleeds; etc."}, "Hypertension": "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed by at least two to three visits is the diagnostic criteria of hypertension\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Migraine.json b/Diagnosis_flowchart/Migraine.json new file mode 100644 index 0000000000000000000000000000000000000000..2968131a32c0ef91a83111260d8feddf7d091594 --- /dev/null +++ b/Diagnosis_flowchart/Migraine.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Migraine": {"Migraine Without Aura": [], "Migraine With Aura": []}}, "knowledge": {"Suspected Epilepsy": {"Risk Factors": "Genetic predispositions, environmental triggers (such as stress, certain foods or drinks, hormonal changes, changes in sleep patterns; etc.", "Symptoms": "headache on one side, pulsating pain, Moderate to severe pain intensity, nausea or vomiting, Sensitivity to light, sound or smell; etc."}, "Migraine Without Aura": "Headache attacks often begin suddenly, with no apparent warning period. \nA: At least 5 attacks.\nB: Each attack lasts from 2 to 72 hours.\nC: The attack has two or more of the following characteristics:\n Unilateral pain\n pain of pulsating nature\n Moderate or severe pain intensity\n Physical activity (such as walking up and down stairs) can worsen pain\nD: accompanied by at least one of the following symptoms during the attack:\n Nausea and/or vomiting\n Sensitivity to light, sound, or smells (photophobia, soundphobia, or odorphobia\n", "Migraine With Aura": "Headache attacks are preceded by a specific set of symptoms of neurological dysfunction. The aura usually lasts from 5 to 60 minutes and is immediately followed or overlapped by a headache attack. These include visual abnormalities (such as flashes of light, loss of visual field), sensory abnormalities (such as tingling or numbness in the hands and feet), and speech or language impairment. In rare cases, aura may include movement disorders.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Multiple Sclerosis.json b/Diagnosis_flowchart/Multiple Sclerosis.json new file mode 100644 index 0000000000000000000000000000000000000000..e986069cc702e7e2a30c350741f0f5299c1b3995 --- /dev/null +++ b/Diagnosis_flowchart/Multiple Sclerosis.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Multiple Sclerosis": {"Multiple Sclerosis": {"Relapsing-Remitting Multiple Sclerosis": [], "Primary Progressive Multiple Sclerosis": [], "Secondary Progressive Multiple Sclerosis": [], "Benign Multiple Sclerosis": []}}}, "knowledge": {"Suspected Multiple Sclerosis": {"Risk Factors": "Gender and age: MS is more common in women than men, with the onset usually occurring between the ages of 15 and 50. Location of the lesion: The signs and symptoms of MS depend on the location of the lesion in the central nervous system. Genetic and environmental factors: Although not specifically mentioned in the literature, it is generally believed that genetic and environmental factors (such as viral infections, smoking, vitamin D deficiency) may play a role in the pathogenesis of MS.; etc.", "Symptoms": "Inflammation, demyelination, and axonal damage. Vision loss: usually in one eye and may be painful. Double vision or blurred vision. Lhermitte phenomenon: An electric shock-like sensation when the neck is tilted forward. Motor or sensory impairment: In the central nervous system distribution area.\n; etc."}, "Multiple Sclerosis": "MRI: MRI is one of the most important tools for diagnosing MS, showing areas of damage (called lesions or plaques) in the brain and spinal cord. MRI can detect damage to myelin, a key feature of MS.\nCSF Analysis: A sample of cerebrospinal fluid is obtained through a lumbar puncture (spinal tap) and analyzed for the presence of immune system activity, which is common in people with MS. CSF analysis may show abnormal immunoglobulin G (IgG) levels and oligoclonal bands, which are hallmarks of MS. \nVisual Evoked Potentials, VEPs: In people with MS, visual pathways may have conduction delays due to damage to myelin sheaths\n ", "Relapsing-Remitting Multiple Sclerosis": "Clinical Presentation: At least two clinical attacks, each with symptoms indicating involvement of different central nervous system (CNS) areas. The condition has distinct attacks (relapses) and remission periods. During an attack, symptoms suddenly worsen, followed by a remission phase in which symptoms partially or completely subside and the condition remains stable without significant progression.\nMRI:Presence of at least two distinct lesions in different CNS locations consistent with demyelination. Utilization of weighted imaging and contrast enhancement to demonstrate the presence and evolution of new and old lesions.\nCerebrospinal Fluid (CSF):Detection of oligoclonal bands (OCB) or elevated IgG index (value above 0.7).", "Primary Progressive Multiple Sclerosis": "Clinical Presentation: Disease progression from onset without distinct relapses.\nDisease Duration: Progression for at least 1 year.\nMRI:Presence of at least two T2-weighted lesions in the brain and/or spinal cord.\nCerebrospinal Fluid (CSF):Detection of oligoclonal bands or elevated IgG index (value above 0.7).", "Secondary Progressive Multiple Sclerosis": "Clinical Presentation: Initially presents as RRMS, later transitioning to sustained worsening of disease with or without new relapses.\nDisease Duration: Progression to SPMS at least 3 years after RRMS diagnosis.\nMRI:Continued increase in the number of CNS lesions.\nCerebrospinal Fluid (CSF):Confirmation of persistent oligoclonal bands or elevated IgG index.", "Benign Multiple Sclerosis": " Clinical Presentation: After 10 years, maintains good function with minimal disability (EDSS score \u2264 3).\nLong-Term Observation: Approximately 55% of patients maintain low disability status over the next 10 years.\nMRI:May show fewer CNS lesions, with slow lesion progression.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Peptic Ulcer Disease.json b/Diagnosis_flowchart/Peptic Ulcer Disease.json new file mode 100644 index 0000000000000000000000000000000000000000..7ed768b8e225dc1a005d559cfd0002331acec729 --- /dev/null +++ b/Diagnosis_flowchart/Peptic Ulcer Disease.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Peptic Ulcer Disease": {"Gastric Ulcers": [], "Duodenal Ulcers": []}}, "knowledge": {"Suspected Peptic Ulcer Disease": {"Risk Factors": "H. pylori Infection; (Nonsteroidal antiinflammatory drugs) NSAIDs Usage; Other Co-administration of corticosteroids and bisphosphonates with NSAIDs; Neoplasms :gastrinoma, gastric adenocarcinoma, carcinoid syndrome; Other Factors: smoking, age, chronic medical conditions, genetic factors, stress and psychological factors and diet.; etc.", "Symptoms": "exhibit signs is epigastric pain; potentially accompanied by dyspepsia; Pain after meals, weight loss; bloating; abdominal fullness or discomfort; nausea; acid reflux; heratburn;belching,anorexia and early satiety.; etc."}, "Gastric Ulcers": "Upper Endoscopy: Typically located on the lesser curvature of the stomach, especially in the antrum and body of the stomach; May be accompanied by thickening of the stomach wall, and redness or swelling of the mucosa.\n;H. pylori Testing: Urea breath testing, stool antigen testing, rapid urease testing, or histology.\n", "Duodenal Ulcers": "Upper Endoscopy: Most commonly found in the duodenal bulb, the initial part of the duodenum. Duodenal ulcers usually appear round or oval with clearer edges, and the center sometimes shows white scar tissue; Common accompanying features include congestion and swelling of the nearby duodenal mucosa. Less commonly, perforation or bleeding may occur.\nH. ;pylori Testing: Urea breath testing, stool antigen testing, rapid urease testing, or histology.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Pituitary Disease.json b/Diagnosis_flowchart/Pituitary Disease.json new file mode 100644 index 0000000000000000000000000000000000000000..1f65f4ffff02c44a0de13d6d5ae139400a1cd1fe --- /dev/null +++ b/Diagnosis_flowchart/Pituitary Disease.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Pituitary Disease": {"Pituitary Microadenomas": [], "Pituitary Macroadenomas": [], "Pituitary Silent Adenomas ": []}}, "knowledge": {"Suspected Pituitary Disease": {"Risk Factors": "family history; Genetic syndromes (MEN1, MEN4, McCune-Albright syndrome; Carney complex; Familial Isolated Pituitary Adenoma); Age (30s-40s); Ethnic background (Ashkenazi Jewish descent); Sex (women more likely for certain adenomas); etc.", "Symptoms": "Typical: Headaches, Vision problems (blurred vision, double vision, loss of peripheral vision); Unexplained weight changes; Fatigue; Changes in menstrual cycle or sexual function; Increased growth in hands and feet (acromegaly); \n High blood pressure; High or low blood sugar levels; Mood changes. Less typical: Facial numbness or pain; Dizziness; Loss of consciousness; Unexplained lactation; Feeling cold; Erectile dysfunction in men; Growth of breast tissue in men; Decreased interest in sex; etc.", "Signs": "Visual field defects; Features of hormonal excess (e.g., acromegaly signs, Cushingoid appearance); Pituitary apoplexy symptoms (sudden headache, vomiting, visual changes, possibly coma); etc."}, "Pituitary Microadenomas": "Pituitary adenomas that are less than 1 centimeter (10 millimeters) in size are called microadenomas. ; The gold standard diagnosis is through magnetic resonance imaging (MRI), which can accurately show the size and location of adenomas. ", "Pituitary Macroadenomas": "Pituitary adenomas that are 1 cm or larger in size are called macroadenomas. In addition to MRI, giant adenomas may also cause symptoms through their compression of surrounding structures, such as vision problems, in which case visual field testing is also required.", "Pituitary Silent Adenomas ": "Nonfunctioning adenomas are pituitary adenomas that do not produce physiologically active levels of hormone, and they do not cause the clinical symptoms associated with hormone excess. Often discovered incidentally during MRI examinations, they are so-called incidentalomas"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Pneumonia.json b/Diagnosis_flowchart/Pneumonia.json new file mode 100644 index 0000000000000000000000000000000000000000..68a47305a0d248a3ed27bee3049cf3dbc8218188 --- /dev/null +++ b/Diagnosis_flowchart/Pneumonia.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Pneumonia": {"Pneumonia": {"Bacterial Pneumonia": [], "Viral Pneumonia": []}}}, "knowledge": {"Suspected Pneumonia": {"Risk Factors": "Exposure to pathogens (e.g., in community, hospitals, or through travel); Smoking and chronic lung diseases (COPD, asthma);OSA; Immunosuppressive conditions (HIV/AIDS, use of immunosuppressive drugs); Elderly age; Comorbidities (diabetes, heart disease); etc.", "Symptoms": "Typical: Cough (dry or productive of sputum), fever, chills, dyspnea (shortness of breath), Less typical: Chest pain, headache, fatigue, myalgia (muscle pain).; etc.", "Signs": "More specific: Crackles and/or wheezing on lung auscultation, tachypnea (increased respiratory rate), fever, cyanosis (bluish skin color due to lack of oxygen). Less specific: Hypotension, tachycardia (increased heart rate), altered mental status in severe cases.; etc."}, "Pneumonia": "Radiological examination: Chest X-rays or CT scans are the most commonly used methods and can show areas of inflammation in the lungs. On X-ray or CT images, inflammation appears as localized shadows or infiltrative lesions.\nMicrobiological tests: Identification of the causative pathogen can be confirmed through microbial cultures and PCR tests of body fluids such as sputum, blood, or bronchoalveolar lavage fluid.\nComplete blood count (CBC): An increased white blood cell count in the CBC is commonly associated with infection but is not a specific indicator.\nBlood gas analysis: For patients with severe pneumonia, blood gas analysis can help assess oxygenation and acid-base balance.\nC-reactive protein and other inflammatory markers: Levels of these markers typically rise during infections, but they also lack specificity.\n", "Bacterial Pneumonia": "Detection of specific bacteria by PCR or other molecular biology methods. Or suppuration caused by bacteria", "Viral Pneumonia": "PCR technology detects the genetic material of a specific virus"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Pulmonary Embolism.json b/Diagnosis_flowchart/Pulmonary Embolism.json new file mode 100644 index 0000000000000000000000000000000000000000..54345fd35a624918975287bd781a09132bad5f8e --- /dev/null +++ b/Diagnosis_flowchart/Pulmonary Embolism.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Pulmonary Embolism": {"Pulmonary Embolism": {"Massive PE": [], "Submassive PE": [], "Low-risk PE": []}}}, "knowledge": {"Suspected Pulmonary Embolism": {"Risk Factors": "HTN; Previous VTE; Immobility or recent surgery; Cancer; Thrombophilia; Hormonal therapy (e.g., oral contraceptives or hormone replacement therapy); Pregnancy and the postpartum period; Obesity; Smoking; Long travel history.; etc.", "Symptoms": "Sudden onset of dyspnea; Chest pain (sharp and worsened with deep breaths); Hemoptysis; Syncope or dizziness; Tachypnea; Tachycardia; etc.", "Signs": "Tachypnea (rapid breathing); Tachycardia (rapid heart rate); Hypoxia (low oxygen levels in the blood); Cyanosis (blueish coloration of the skin and lips); Fever; Signs of deep vein thrombosis (DVT), such as swelling, redness, or pain in the leg.; etc."}, "Pulmonary Embolism": "Multi-slice spiral CT (CTPA): directly displays thrombus in the pulmonary artery.\nD-dimer test: This is a blood test in which high levels of D-dimer may indicate blood clots, but low levels can be used to rule out pulmonary embolism. Normal values for D-dimer should be lower, using age \u00d7 10 \u03bcg/L as the threshold\nEchocardiography: Assess right ventricular function and hemodynamics, especially important in high-risk patients. \n Right ventricular dimensions: An enlarged right ventricle (RV) appears as increased width in cross-sectional long-axis view. Tricuspid annular plane \n systolic excursion (TAPSE): If TAPSE is less than 16 mm, it indicates reduced RV function. \n Tricuspid annular peak systolic velocity (S'): If the peak systolic velocity of the tricuspid annulus is less than 9.5 cm/sec, it may indicate RV insufficiency. \n RV/LV diameter ratio: In the emergency setting, an RV to left ventricular (LV) diameter ratio greater than 1.0 can be used as an indicator of RV dysfunction. \n RV wall thickness: During acute right ventricular pressure overload, echocardiography may detect increased RV wall thickness or tricuspid regurgitation ejection flow velocity exceeding 3.8 m/s or tricuspid peak systolic pressure gradient exceeding 60 mmHg.\nLower extremity venous ultrasound: Checks for the presence of deep vein thrombosis in the lower extremities, which may dislodge and become a pulmonary embolism.\nV/Q lung scan: compares the ventilation (V) and perfusion (Q) of the lungs to detect abnormal areas, which may indicate the presence of blood clots.\n", "Massive PE": "The patient develops hemodynamic instability, such as sustained hypotension, shock, or cardiac arrest. These patients are high-risk PE and require immediate thrombolytic treatment or surgical intervention.", "Submassive PE": "The patient is hemodynamically stable, but there is evidence of RV functional impairment, such as RV enlargement or ventricular septal deviation on echocardiography, and elevated blood biomarkers (such as cardiac troponin). These patients are intermediate-risk PE and require hospitalization and close monitoring to detect potential hemodynamic instability promptly.", "Low-risk PE": "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels. A low Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI) score indicates a low risk of death."}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Stroke.json b/Diagnosis_flowchart/Stroke.json new file mode 100644 index 0000000000000000000000000000000000000000..3288c690d8cf1378f08c2433d534960e0a4b2c5b --- /dev/null +++ b/Diagnosis_flowchart/Stroke.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Stroke": {"Ischemic Stroke": [], "Hemorrhagic Stroke": []}}, "knowledge": {"Suspected Stroke": {"Risk Factors": "hypertension, diabetes, cardiac history, smoking, hyperlipidemia, family history, atrial fibrillation, sedentary lifestyle, obesity, alcohol abuse, previous stroke or transient ischemic attack (TIA), high cholesterol, poor diet, age, gender, race, and certain medical conditions like sickle cell disease; etc.", "Symptoms": "sudden numbness or weakness in the face, arm, or leg, especially on one side of the body, confusion, trouble speaking or understanding speech, visual disturbances in one or both eyes, difficulty walking, dizziness, loss of balance or coordination, severe headache with no known cause; etc.", "Signs": "facial drooping, arm weakness, speech difficulties, vision problems, severe headache, dizziness or loss of balance, confusion, difficulty walking, numbness or paralysis on one side of the body, sudden behavioral change, and loss of consciousness"}, "Ischemic Stroke": "MRI Scan (especially the DWI sequence):\n Positive DWI: Indicates ischemic damage to brain tissue at the time of scanning. On DWI, ischemic areas appear as high signal (bright white).\n ADC Images: Accompanying DWI, this sequence shows low signal (dark areas) representing restricted movement of water molecules, characteristic of early ischemia.\nCT Scan:\n Early ischemic changes: Within hours of an ischemic stroke, subtle loss of cerebral cortex and narrowing of brain sulci, referred to as \"sulcal effacement\", may be observed.\n Low-density areas: Low-density areas in the brain parenchyma indicating ischemic tissue.\nCarotid and Intracranial Vessel Imaging:\n Ultrasound: Carotid intima-media thickness \u22651.0 mm or visible plaque.\n CTA/MRA: Demonstrating arterial stenosis of \u226550%.\n", "Hemorrhagic Stroke": "Non-contrast CT Scan:\n High-density areas: Typical manifestation of hemorrhagic stroke on CT is a high-density area representing fresh bleeding. The density usually ranges from 50-80 Hounsfield Units (HU).\n Hemorrhage volume: The volume and location of the bleed correlate closely with clinical manifestations; larger volumes generally have a poorer prognosis.\nMRI Scan:\n T1 and T2 Weighted Imaging: Hemorrhage shows different signals on T1 and T2 sequences depending on the age of the bleed. Fresh bleeding may appear isointense or hypointense on T1 and hyperintense on T2.\n Gradient Echo Sequence (GRE): Especially sensitive to blood breakdown products, such as deoxyhemoglobin and iron, used for detecting microbleeds.\nCerebral Angiography:\n Detection of vascular abnormalities: Aneurysms, vascular malformations, or stenoses. Diagnosis of an aneurysm typically requires visualization of a typical \"saccular\" dilation.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Thyroid Disease.json b/Diagnosis_flowchart/Thyroid Disease.json new file mode 100644 index 0000000000000000000000000000000000000000..b4c668d49a13367dd570c62e8ce5a5212fd7e20e --- /dev/null +++ b/Diagnosis_flowchart/Thyroid Disease.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Thyroid Disease": {"Hypothyroidism": [], "Hyperthyroidism": [], "Thyroiditis": [], "Thyroid Nodules": {"Thyroid Cancer": []}}}, "knowledge": {"Suspected Thyroid Disease": {"Risk Factors": "Gender and Age; Both iodine deficiency and excess; Presence of thyroid autoantibodies ; Exposure to radiation; Family history of thyroid disease; Pregnancy itself alters thyroid function; Smoking; Certain Medications, e.g., Lithium, Amiodarone, Interferons, Rifampin, PTU, MMI, SSRIs", "Symptoms": "Hypothyroidism: Fatigue and sluggishness; Increased sensitivity to cold; Constipation; Dry skin and hair; Weight gain; Puffy face; Hoarseness; Muscle weakness; Elevated blood cholesterol level; Muscle aches, tenderness, and stiffness; Pain, stiffness, or swelling in your joints; Heavier than normal or irregular menstrual periods; Thinning hair; Slowed heart rate; Depression; Impaired memory; bradycardia; decrease in basal body temperature\n Hyperthyroidism: Sudden weight loss; Rapid heartbeat; Irregular heartbeat; Pounding of your heart; Increased appetite; Nervousness, anxiety, and irritability; Tremor \u2014 usually a fine trembling in your hands and fingers; Sweating; Changes in menstrual patterns; Increased sensitivity to heat; Changes in bowel patterns, especially more frequent bowel movements; An enlarged thyroid gland ; Fatigue, muscle weakness; Difficulty sleeping; Shortness of breath; Eye swelling and increased tearing\n Thyroiditis: Enlargement of the thyroid gland"}, "Hypothyroidism": {"Criteria": "TSH > 4.0-4.5 mIU/L ; Free T4 (FT4) below the normal range (0.9-1.7 ng/dL); FT3<2.0 pg/ml; T3<80 ng/dL; T4<5.0 ng/dL"}, "Hyperthyroidism": {"Criteria": "Low TSH (<0.1 mIU/L) ; high levels of T4 (> 12.0 ng/dL) ;Triiodothyronine (T3) (> 180 ng/dL); FT4> 1.7 pg/ml; FT3 > 4.4 pg/ml"}, "Thyroiditis": {"Criteria": "Thyroid function tests and thyroid antibody tests (such as anti-thyroid peroxidase antibodies, TPOAb); ultrasound shows thyroid size and shape may appear enlarged or morphologically altered; Changes in Echogenicity showing areas of hypoechoicity, indicating tissue heterogeneity; ultrasound imaging may show increased or abnormal blood flow; ultrasound find thyroid tissue may display structural heterogeneity"}, "Thyroid Nodules": {"Criteria": "Thyroid ultrasound is the preferred method for evaluating thyroid nodules, which can help determine the nature of the nodules (likelihood of benign vs. malignant);\n\nEchogenicity\uff1a\n Hypoechoic: The nodule appears darkerthan the surrounding thyroid tissue, which may suggest malignancy.\n Isoechoic or Hyperechoic: The nodule appears similar to or brighter than surrounding tissue, usually indicating benignity.\n\nMargins:\n Irregular margins: May indicate malignancy. \n Smooth and well-defined margins: Typically indicate a benign nodule.\n\nShape:\n Taller-than-wide: Nodules that are taller than they are wide (vertical to the skin) may be malignant.\n Wider-than-tall: Nodules that are wider than they are tall (horizontal to the skin) are usually benign.\n\nMicrocalcifications:\n Small calcium deposits within a nodule may suggest malignancy.\n\nBlood flow pattern:\n Using Doppler ultrasound, increased abnormal blood flow may be associated with malignant nodules. \n\nFor suspicious nodules, fine-needle aspiration biopsy (FNA) is crucial for definitive diagnosis."}, "Thyroid Cancer": {"Criteria": " If FNA results suggest cancer or are suspicious for cancer, surgery, and further histopathological evaluation are usually necessary. Sufficient sample size is needed to make a diagnosis."}}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Tuberculosis.json b/Diagnosis_flowchart/Tuberculosis.json new file mode 100644 index 0000000000000000000000000000000000000000..0fa3c237ac9777a37dde698321ec1c99bf67c82b --- /dev/null +++ b/Diagnosis_flowchart/Tuberculosis.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Tuberculosis": {"LTBI": [], "Tuberculosis": []}}, "knowledge": {"Suspected Tuberculosis": {"Risk Factors": ": Close contact with someone with infectious TB\u3001HIV infection; Areas with high TB prevalence (geographical risk factors);Immunosuppression (e.g., corticosteroid use, organ transplant); Previous history of TB or inadequately treated TB; Socioeconomic factors: homelessness, incarceration\u3001Substance abuse: tobacco smoking, drug use\u3001Health care workers with exposure to TB.; etc.", "Symptoms": "Typical: Persistent cough for more than three weeks; coughing up blood; chest pain; fever; night sweats; weight loss; fatigue. Less typical: Shortness of breath; lymphadenopathy; anorexia; etc.", "Signs": "More specific: Evidence of weight loss; fever; signs of pleural effusion on physical examination Less specific: Lymphadenopathy; signs of comorbid conditions (e.g., HIV infection signs).; etc."}, "LTBI": "Interferon-gamma release test (IGRA): This is a blood test that can detect whether there is an immune response to Mycobacterium tuberculosis in the body. It is not affected by BCG vaccination, so it is especially suitable in areas where BCG has been vaccinated. \nTuberculin test (TST): Inject a certain amount of purified protein derivative (PPD) into the skin and observe the reaction of the skin 48 to 72 hours later to determine whether the patient is infected with Mycobacterium tuberculosis. Results need to be judged based on the size of the induration, usually 5 mm or larger is considered a positive reaction, but this also depends on the individual's specific circumstances such as HIV infection or recent exposure to a case of tuberculosis.\n", "Tuberculosis": "Sputum smear microscopy: This is a rapid test that uses a microscope to examine sputum samples for tuberculosis bacteria. Although simple and low-cost, it is less sensitive. \nSputum culture: This is the gold standard for diagnosing tuberculosis. The sputum sample is cultured in a specific medium to see if Mycobacterium tuberculosis is growing. Culture can provide information about resistance but takes a long time (usually weeks to months). \nMolecular biology detection methods: such as PCR technology, which can quickly detect the genetic material of Mycobacterium tuberculosis with high sensitivity and specificity, and is especially suitable for patients with negative sputum smear. \nChest X-ray: Chest X-ray is a commonly used screening tool for patients suspected of having active pulmonary tuberculosis, which can reveal abnormalities in the lungs, such as patchy shadows, cavities, etc.\n"}} \ No newline at end of file diff --git a/Diagnosis_flowchart/Upper Gastrointestinal Bleeding.json b/Diagnosis_flowchart/Upper Gastrointestinal Bleeding.json new file mode 100644 index 0000000000000000000000000000000000000000..269ad1879d9b945f05f0174f7876036672a0771b --- /dev/null +++ b/Diagnosis_flowchart/Upper Gastrointestinal Bleeding.json @@ -0,0 +1 @@ +{"diagnostic": {"Suspected Upper Gastrointestinal Bleeding": {"Upper Gastrointestinal Bleeding": []}}, "knowledge": {"Suspected Upper Gastrointestinal Bleeding": {"Risk Factors": "peptic ulcers; prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs); Helicobacter pylori infection; esophageal varices; alcohol abuse; tumors; anticoagulant medications; stress ulcers; esophagitis or gastritis.; etc.", "Symptoms": "hematemesis (vomiting of red blood or coffee-grounds material); melena (black, tarry stool), or hematochezia (passage of red or maroon material per rec-tum); anemia; Hemorrhagic peripheral circulatory collapse(dizziness, palpitations, fatigue, fainting when standing up suddenly from a flat position, cold sensation of the limbs, increased heart rate, and low blood pressure);fever;zaotemia.; etc."}, "Upper Gastrointestinal Bleeding": "Bleeding outside the digestive tract was excluded: Melena caused by eating and bleeding from the respiratory tract mouth, nose, and throat were excluded.\nGastroscopy: Bleeding is observed or has stopped\n"}} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/11535902-DS-14.json b/Finished/Acute Coronary Syndrome/NSTEMI/11535902-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..8ff161b7408be5c345875ed281a1b252e6133664 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/11535902-DS-14.json @@ -0,0 +1,69 @@ +{ + "NSTEMI$Intermedia_5": { + "hs-cTn is a strong value for ACS$Cause_1": { + "Trop-T:0.55$Input2": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "cTropnT-0.55*\ncTropnT-0.66*\ncTropnT-0.38*\ncTropnT-0.38*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "HTN, hypothyroidism are risk factors of ACS$Cause_1": { + "F presents with history of HTN, hypothyroidism,$Input2": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "symptom of ACS.$Cause_1": { + "Patient endorses right sided chest pain for the last 2 days which worsened today, at which point she started having nausea and vomiting.$Input2": {} + }, + "risk factors of ACS$Cause_1": { + "+ \"Irregular heart rhythm, for a long time\" per pt for which she takes Toprol XL\n+ Hyperlipidemia$Input3": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "HTN, hypothyroidism are risk factors of ACS$Cause_1": { + "F presents with history of HTN, hypothyroidism,$Input2": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "ST depressions in V2-V4$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "HTN, hypothyroidism are risk factors of ACS$Cause_1": { + "F presents with history of HTN, hypothyroidism,$Input2": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "symptom of ACS.$Cause_1": { + "Patient endorses right sided chest pain for the last 2 days which worsened today, at which point she started having nausea and vomiting.$Input2": {} + }, + "risk factors of ACS$Cause_1": { + "+ \"Irregular heart rhythm, for a long time\" per pt for which she takes Toprol XL\n+ Hyperlipidemia$Input3": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "HTN, hypothyroidism are risk factors of ACS$Cause_1": { + "F presents with history of HTN, hypothyroidism,$Input2": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "F presents with history of HTN, hypothyroidism, no priorcardiac hx who presented to ED with chest pain.\n\nPatient endorses right sided chest pain for the last 2 days which worsened today, at which point she started having nausea and vomiting. Chest pain both at rest and on exertion. At baseline she walks with a walker throughout her house. No shortness of breath or leg swelling. Denies any anginal symptoms, pre-syncope, or syncope. \n\nShe had 2 falls and was treated at outside hospitals. Per patient, injured her pelvis and R leg but unsure of specifics. Hospital course c/b aspiration PNA. Otherwise no recent falls or hospitalizations. \n\nNo family history of cardiac disease known to patient. Her granddaughter passed away yesterday from breast cancer.\n\nIn the ED initial vitals were: 96.7 70 163/78 18 97% RA weight: 88lb height: 5ft \nEKG: ST depressions in V2-V4 \nLabs/studies notable for: Trop-T: 0.55, lactate 2.9, K 6.0, WC 11.5 \nPatient was given: ASA 300, metop tartrate 12.5, nitro SL, atorva 80, Lasix 20, insulin 10u+ 25 gm dextrose 50%, hep gtt \nVitals on transfer: 65 120/61 21 99% RA \n \nOn the floor, denies any current CP, dyspnea, N/V. Feels at her baseline overall.\n\nREVIEW OF SYSTEMS: \n10 point ROS otherwise negative.\n", + "input3": "+ \"Irregular heart rhythm, for a long time\" per pt for which she takes Toprol XL\n+ Hyperlipidemia\n+ H/o Cdiff per recent OMR notes\n+ Esophageal strictures s/p several dilations in the past\n+ Temporal arteritis --> she states she's been taking Prednisone \n+ Hypothyroidism\n+ History of lower GI bleed\n+ DJD\n+ Lumbar stenosis, lumbar radiculopathy, hip pain\n+ Osteoporosis\n\n+ Admitted with n/v/d/rectal bleeding, found to have a portal vein thrombosis, which was felt to be likely due to ascending thrombophlebitis from a UTI. Abdominal pelvic CT scan with contrast which shows a persistent thrombosis in her superior right portal vein with evidence of partial degradation of clot; there is no longer filling defect with the right main portal vein as was seen on prior study. \n+ Large hiatal hernia\n+ She denies any AMI's/CABG/caths, CVA's, DM, HTN, or other heart/lung/kidney/liver/GI major diseases\n+admission for pan sensitive Ecoli urosepsis treated with IV Ceftriaxone, d/c'd home with 2wk course of PO Cipro. Bladder defects again seen on CT scan, but repeat bladder u/s normal.\n", + "input4": "None\n", + "input5": "Admission Physical Exam:\n\nVS: 97.5PO 127 / 70 56 18 99 ra \nGENERAL: NAD Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor\nor cyanosis of the oral mucosa. No xanthelasma. \nNECK: Supple with JVP 12\nCARDIAC: PMI located in intercostal space, midclavicularline. RRR, normal S1, S2. soft systolic cresc/decresc murmur. No thrills, lifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: Distal pulses palpable and symmetric\n", + "input6": "Admission Labs:\n\n___ 03:30PM BLOOD WBC-11.5* RBC-3.91 Hgb-11.6 Hct-36.2 MCV-93 MCH-29.7 MCHC-32.0 RDW-15.2 RDWSD-51.2* Plt ___\n___ 03:30PM BLOOD Neuts-66.3 ___ Monos-10.1 Eos-1.4 Baso-0.7 Im ___ AbsNeut-7.62* AbsLymp-2.41 AbsMono-1.16* AbsEos-0.16 AbsBaso-0.08\n___ 03:30PM BLOOD ___ PTT-22.3* ___\n___ 03:30PM BLOOD Glucose-124* UreaN-14 Creat-0.5 Na-137 K-6.0* Cl-99 HCO3-17* AnGap-21*\n___ 03:30PM BLOOD ALT-15 AST-40 AlkPhos-39 TotBili-0.8\n___ 03:30PM BLOOD cTropnT-0.09*\n___ 09:55PM BLOOD CK-MB-25* cTropnT-0.55*\n___ 07:25AM BLOOD CK-MB-19* cTropnT-0.66*\n___ 02:20AM BLOOD CK-MB-8 cTropnT-0.38*\n___ 06:20AM BLOOD cTropnT-0.38*\n___ 03:38PM BLOOD Lactate-2.9*\n\nImaging:\nChest Xray ___\nIMPRESSION: \nModerate to large hiatal hernia with mild bibasilar atelectasis. No subdiaphragmatic free air or cardiomegaly. \n\nECHO ___\nIMPRESSION: Normal left ventricular cavity size with mild regional systolic dysfunction. Mild-moderate mitral regurgitation. Moderate tricuspoid regurgitation. Increased PCWP. Compared with the prior study (images reviewed), very mild regional LV dysfunction is now seen and the severity of mitral regurgitation is increased.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/11859083-DS-17.json b/Finished/Acute Coronary Syndrome/NSTEMI/11859083-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..9cfcf02ae75ec5b67942cf8510b553dab8a51b27 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/11859083-DS-17.json @@ -0,0 +1,108 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "BLOOD cTropnT-0.60*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "Chest Pain is a symptom of ACS..$Cause_1": { + "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back.$Input2": {} + }, + "Coronary artery disease \nHypercholesterolemia are big risk factors$Cause_1": { + "Coronary artery disease \nHypercholesterolemia \n+DM + TYPE 2 UNCNTRLD$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Fatty liver \nHypertension goal BP (blood pressure) < 130/80 \n+Chronic pain$Input3": {} + }, + "Morbid obesity is a risk factor$Cause_1": { + "Morbid obesity with BMI of 40.0-44.9, adult \n+Type 2 diabetes, uncontrolled, with renal manifestation$Input3": {} + }, + "Family history is a big risk factor$Cause_1": { + "Father with MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "Chest Pain is a symptom of ACS..$Cause_1": { + "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back.$Input2": {} + }, + "Coronary artery disease \nHypercholesterolemia are big risk factors$Cause_1": { + "Coronary artery disease \nHypercholesterolemia \n+DM + TYPE 2 UNCNTRLD$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Fatty liver \nHypertension goal BP (blood pressure) < 130/80 \n+Chronic pain$Input3": {} + }, + "Morbid obesity is a risk factor$Cause_1": { + "Morbid obesity with BMI of 40.0-44.9, adult \n+Type 2 diabetes, uncontrolled, with renal manifestation$Input3": {} + }, + "Family history is a big risk factor$Cause_1": { + "Father with MI$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation$Cause_1": { + "EKG: Sinus, rate 62, QTC 456, no new ischemic changes \nExam notable for: Distant heart sounds, RRR no R/M/G, CTAB, soft, obese, non distended, no abdominal pain non-ST-elevation$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "Chest Pain is a symptom of ACS..$Cause_1": { + "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back.$Input2": {} + }, + "Coronary artery disease \nHypercholesterolemia are big risk factors$Cause_1": { + "Coronary artery disease \nHypercholesterolemia \n+DM + TYPE 2 UNCNTRLD$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Fatty liver \nHypertension goal BP (blood pressure) < 130/80 \n+Chronic pain$Input3": {} + }, + "Morbid obesity is a risk factor$Cause_1": { + "Morbid obesity with BMI of 40.0-44.9, adult \n+Type 2 diabetes, uncontrolled, with renal manifestation$Input3": {} + }, + "Family history is a big risk factor$Cause_1": { + "Father with MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "Chest Pain is a symptom of ACS..$Cause_1": { + "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back.$Input2": {} + }, + "Coronary artery disease \nHypercholesterolemia are big risk factors$Cause_1": { + "Coronary artery disease \nHypercholesterolemia \n+DM + TYPE 2 UNCNTRLD$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Fatty liver \nHypertension goal BP (blood pressure) < 130/80 \n+Chronic pain$Input3": {} + }, + "Morbid obesity is a risk factor$Cause_1": { + "Morbid obesity with BMI of 40.0-44.9, adult \n+Type 2 diabetes, uncontrolled, with renal manifestation$Input3": {} + }, + "Family history is a big risk factor$Cause_1": { + "Father with MI$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "Patient reports that she began having chest pain yesterday at rest. Previous chest pain is a sharp pain but this was a dull ache that started in her back and chest. Never had this type of pain before or pain that has lasted this long before. No radiation aside from into her back. Some associated SOB that has been ongoing for several weeks. Chest pain not relieved with multiple SL nitro at home (but patient thinks these may have been expired). No fever, chills, nausea or vomiting. Her friend encouraged her to come to ED. \n \nIn the ED initial vitals were: 98, 88, 186/71, 18, 98% RA \nEKG: Sinus, rate 62, QTC 456, no new ischemic changes \nExam notable for: Distant heart sounds, RRR no R/M/G, CTAB, soft, obese, non distended, no abdominal pain non-ST-elevation\r\nLabs/studies notable for: \n - CBC: 9.3/13.7/41.6/228 \n - CHem&: ___ \n - Trp 0.04 \n - Ddimer 251 \n CXR: No acute cardiopulmonary process \n \nPatient was given: \n ___ 00:48 IV Morphine Sulfate 2 mg \n ___ 01:26 IV Morphine Sulfate 2 mg \n ___ 01:29 IV Ondansetron 4 mg \n ___ 02:20 IV Morphine Sulfate 4 mg \n ___ 02:20 IV Heparin Started 800 \n \nVitals on transfer: 98.3, 63, 138/63, 16, 96% RA \n \nOn the floor: patient reports feeling the best she has felt in 24 hours. Chest pain is resolved. feels small dull ache but nothing compared with past 24 hours per her report. she recently went to her cardiologist and was suppose to start Lasix 20mg for increased lower extremity edema but she has not filled this medication yet.\n", + "input3": "+Nephrolithiasis \n+Hypothyroidism \n+Asthma \n+Low back pain \n+Rhinitis, allergic \n+Coronary artery disease \n+Hypercholesterolemia \n+DM + TYPE 2 UNCNTRLD \n+Hemorrhoids \n+Lichen sclerosus et atrophicus \n+OSTEOARTHRITIS, LOCALIZED PRIMARY + KNEE \n+History of total knee replacement \n+Sleep apnea \n+Fatty liver \n+Hypertension goal BP (blood pressure) < 130/80 \n+Chronic pain \n+Colonic adenoma \n+Cervical high risk human papillomavirus (HPV) DNA test positive \n+S/P total knee arthroplasty \n+Pain due to total right knee replacement \n+Morbid obesity with BMI of 40.0-44.9, adult \n+Type 2 diabetes, uncontrolled, with renal manifestation\n", + "input4": "Father with MI\n", + "input5": "Admission Physical\n\nVS:97.6, 124/62, 57, 18, 98% RA \nFinger stick: 227 \nWeight: 107.3kg \nGENERAL: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. \nNECK: Supple with no elevated JVD \nCARDIAC: RRR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. \nLUNGS: CTAB. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: 1+ pitting edema bilaterally, warm \nNEURO: grossly non focal, moving all extremities.\n", + "input6": "Admission Labs\n===============\n___ 12:45AM BLOOD WBC-9.3 RBC-4.96 Hgb-13.7 Hct-41.6 MCV-84 MCH-27.6 MCHC-32.9 RDW-13.4 RDWSD-40.8 Plt ___\n___ 12:45AM BLOOD Neuts-56.6 ___ Monos-5.6 Eos-2.7 Baso-0.5 AbsNeut-5.25 AbsLymp-3.18 AbsMono-0.52 AbsEos-0.25 AbsBaso-0.05\n___ 12:45AM BLOOD PTT-33.0\n___ 12:45AM BLOOD Glucose-339* UreaN-15 Creat-0.7 Na-135 K-4.0 Cl-100 HCO3-24 AnGap-15\n___ 12:45AM BLOOD cTropnT-0.60*\n___ 06:55AM BLOOD Calcium-9.2 Phos-3.8 Mg-1.8\n\nImaging & Studies\n\nTTE ___\nThe left atrium and right atrium are normal in cavity size. There is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (LVEF>55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.\n\nIMPRESSION: Suboptimal image quality. Mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. No valvular pathology or pathologic flow identified. \n\nCXR ___\nFINDINGS: \n \nThe lungs are well-expanded and clear. The cardiomediastinal and hilar contours are unremarkable. There is no pneumothorax, pleural \neffusion, or consolidation.\n \nIMPRESSION: \nNo acute cardiopulmonary process.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/11990712-DS-12.json b/Finished/Acute Coronary Syndrome/NSTEMI/11990712-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..81ae01aa90e2fd7ca6286fd5ca00dcbe161b2a4c --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/11990712-DS-12.json @@ -0,0 +1,90 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "He was noted to have ECG with known LBBB with troponin 0.59 --> 1.45.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "A history of heart disease is an important risk factor$Cause_1": { + "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.$Input2": {} + }, + "Hypertension and else are risk factors$Cause_1": { + "+ Hypertension \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency$Input3": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "Patient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.$Input2": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "CONCLUSION:\nThe left atrium is elongated. The right atrium is mildly enlarged. There \nis mild symmetric left ventricular hypertrophy with a normal cavity size. There is egional left ventricular systolic dysfunction with very mild hypokinesis of the mid anteroseptum (see schematic) and preserved/normal contractility of the remaining segments. The visually estimated left ventricular ejection fraction is 55-60%. There is no resting left ventricular outflow tract gradient. Normal right ventricular cavity size with normal free wall motion. The aortic sinus diameter is normal for gender with normal ascending aorta diameter for gender. The aortic valve leaflets (?#) are mildly thickened. There is no aortic valve stenosis. There is trace aortic regurgitation. The mitral valve leaflets are mildly thickened with no mitral valve prolapse. There is trivial mitral regurgitation. The tricuspidvalve leaflets appear structurally normal. There is physiologic tricuspid regurgitation. The pulmonary artery systolic pressure could not be estimated. There is no pericardial effusion.\nIMPRESSION: Mild symmetric left ventricular hypertrophy with mild regional systolic dysfunction.$Input6": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "CARDIAC: RRR, normal S1, S2. II/VI systolic ejection murmur appreciated best at RUSB without radiation to carotids.$Input5": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "A history of heart disease is an important risk factor$Cause_1": { + "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.$Input2": {} + }, + "Hypertension and else are risk factors$Cause_1": { + "+ Hypertension \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency$Input3": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "Patient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.$Input2": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation\r is a sign of NSTE-ACS$Cause_1": { + ".non-ST-elevation$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "A history of heart disease is an important risk factor$Cause_1": { + "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.$Input2": {} + }, + "Hypertension and else are risk factors$Cause_1": { + "+ Hypertension \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency$Input3": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "Patient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.$Input2": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "CONCLUSION:\nThe left atrium is elongated. The right atrium is mildly enlarged. There \nis mild symmetric left ventricular hypertrophy with a normal cavity size. There is egional left ventricular systolic dysfunction with very mild hypokinesis of the mid anteroseptum (see schematic) and preserved/normal contractility of the remaining segments. The visually estimated left ventricular ejection fraction is 55-60%. There is no resting left ventricular outflow tract gradient. Normal right ventricular cavity size with normal free wall motion. The aortic sinus diameter is normal for gender with normal ascending aorta diameter for gender. The aortic valve leaflets (?#) are mildly thickened. There is no aortic valve stenosis. There is trace aortic regurgitation. The mitral valve leaflets are mildly thickened with no mitral valve prolapse. There is trivial mitral regurgitation. The tricuspidvalve leaflets appear structurally normal. There is physiologic tricuspid regurgitation. The pulmonary artery systolic pressure could not be estimated. There is no pericardial effusion.\nIMPRESSION: Mild symmetric left ventricular hypertrophy with mild regional systolic dysfunction.$Input6": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "CARDIAC: RRR, normal S1, S2. II/VI systolic ejection murmur appreciated best at RUSB without radiation to carotids.$Input5": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "A history of heart disease is an important risk factor$Cause_1": { + "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.$Input2": {} + }, + "Hypertension and else are risk factors$Cause_1": { + "+ Hypertension \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency$Input3": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "Patient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.$Input2": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "77 year old male with very significant past coronary history with multiple PCIs, CABG with LIMA-LAD, SVG-OM, SVG-DM with patient report of \"two of those grafts being down,\" HTN, and LBBB who presented to OSH.\n\nPatient reports that around 830PM he began experiencing substernal chest pain that radiated to his right shoulder and neck. Of note, he had just completed a large meal and was doing some housework with his upper body and exerting himself. He has known stable angina and took his SLN x3 without significant relief of his symptoms.\n\nHe was noted to have ECG with known LBBB with troponin 0.59 --> 1.45. He was given aspirin, Plavix, and lovenoxand transferred for further management and likely cath. Of note, his chest pain resolved sometime though patient could not specify exactly when.\n\nHis initial vitals were notable for BPs 170s/80-90s. An ECG confirmed known LBBB but was negative for Sgarbossa criteria. Labs notable for trop 0.06 --> 0.1 with MB 15. He received metoprolol succinate 50mg and Lisinopril 5mg. Heparin gtt was deferred as he had received Lovenox at around 2300 the night prior.non-ST-elevation\r\n\nOn the floor, the patient confirms the above. He is chest pain free and denies shortness of breath, nausea, vomiting, lightheadedness, and dizziness.\n", + "input3": "+ Hypertension \n+ CABG\n-LAD, SVG-OM, SVG-Diag\n+ PERCUTANEOUS CORONARY INTERVENTIONS: Multiple\n+ Vitamin D deficiency\n", + "input4": "Father died of LM disease. Mother had breast cancer. Siblings and children do not have any known history of CAD, sudden death, or MIs.\n", + "input5": "ADMISSION PHYSICAL EXAMINATION: \n================================ \nVITALS: 97.4 169/97 74 16 95%RA\nGENERAL: Well-developed, well-nourished. NAD. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \nNECK: Supple with no JVD\nCARDIAC: RRR, normal S1, S2. II/VI systolic ejection murmur appreciated best at RUSB without radiation to carotids. \nLUNGS: Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. \nPULSES: Distal pulses palpable and symmetric\n", + "input6": "ADMISSION LABS\n==============\n___ 05:30AM BLOOD WBC-5.4 RBC-5.28 Hgb-15.5 Hct-47.1 MCV-89 MCH-29.4 MCHC-32.9 RDW-12.5 RDWSD-41.0 Plt ___\n___ 05:30AM BLOOD Neuts-56.1 ___ Monos-8.9 Eos-5.2 Baso-0.9 Im ___ AbsNeut-3.01 AbsLymp-1.53 AbsMono-0.48 AbsEos-0.28 AbsBaso-0.05\n___ 05:30AM BLOOD ___ PTT-41.6* ___\n___ 05:30AM BLOOD Glucose-129* UreaN-11 Creat-0.8 Na-138 K-4.2 Cl-101 HCO3-23 AnGap-14\n___ 05:30AM BLOOD CK(CPK)-174\n___ 05:30AM BLOOD CK-MB-15* MB Indx-8.6*\n___ 05:30AM BLOOD cTropnT-0.06*\n___ 05:30AM BLOOD Calcium-9.2 Phos-3.4 Mg-2.1\n\nSTUDIES\n=======\nTTE ___\nCONCLUSION:\nThe left atrium is elongated. The right atrium is mildly enlarged. There \nis mild symmetric left ventricular hypertrophy with a normal cavity size. There is egional left ventricular systolic dysfunction with very mild hypokinesis of the mid anteroseptum (see schematic) and preserved/normal contractility of the remaining segments. The visually estimated left ventricular ejection fraction is 55-60%. There is no resting left ventricular outflow tract gradient. Normal right ventricular cavity size with normal free wall motion. The aortic sinus diameter is normal for gender with normal ascending aorta diameter for gender. The aortic valve leaflets (?#) are mildly thickened. There is no aortic valve stenosis. There is trace aortic regurgitation. The mitral valve leaflets are mildly thickened with no mitral valve prolapse. There is trivial mitral regurgitation. The tricuspidvalve leaflets appear structurally normal. There is physiologic tricuspid regurgitation. The pulmonary artery systolic pressure could not be estimated. There is no pericardial effusion.\nIMPRESSION: Mild symmetric left ventricular hypertrophy with mild regional systolic dysfunction.\n\nCardiac Cath ___\nFindings\nThe left main is normal\nThe LAD has severe proximal and mid disease with mid occlusion. The distal vessel fills via the LIMA graft with diffuse iorregularities. The LCX has proximal occlusion; The distal OM fills via a patent SVG and has severe diffuse disease\nThe RCA has widely patent proximal and mid stents. The distal RCA, PDA and PL branches have severe diffuse disease\nThe LIMA-LAD is normal\nThe SVG-OM has diffuse mild disease with severe disease in distal native OM unchanged\nThe SVG-diagonal has diffuse severe disease with slow flow into very small diseased distal vessels\nLVEDEP is normal\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/11992836-DS-23.json b/Finished/Acute Coronary Syndrome/NSTEMI/11992836-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..7bc6b94f453295748d8b00f637710ad83c5ccbc5 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/11992836-DS-23.json @@ -0,0 +1,72 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "cTropnT-0.14*\ncTropnT-0.21*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm.$Input2": {} + }, + "Dyslipidemia \n Rheumatoid Arthritis are Risk factors$Cause_1": { + "Dyslipidemia \n Rheumatoid Arthritis$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "Mild symmetric left ventricular hypertrophy with subtle hypokinesis of the midinferoseptum. No clinically significant valvular regurgitation or stenosis. Indeterminate pulmonary pressure\n\nCATH ___:\nSuccessful PCI of the mid RCA with 3.0 DES(Mild disease in the other coronaries) Re load with clopidgrel 600 mg tonite and continue DAPT with ASA.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm.$Input2": {} + }, + "Dyslipidemia \n Rheumatoid Arthritis are Risk factors$Cause_1": { + "Dyslipidemia \n Rheumatoid Arthritis$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation\r is a sign of NSTE-ACS$Cause_1": { + "ECG\uff1a\nnon-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm.$Input2": {} + }, + "Dyslipidemia \n Rheumatoid Arthritis are Risk factors$Cause_1": { + "Dyslipidemia \n Rheumatoid Arthritis$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "Mild symmetric left ventricular hypertrophy with subtle hypokinesis of the midinferoseptum. No clinically significant valvular regurgitation or stenosis. Indeterminate pulmonary pressure\n\nCATH ___:\nSuccessful PCI of the mid RCA with 3.0 DES(Mild disease in the other coronaries) Re load with clopidgrel 600 mg tonite and continue DAPT with ASA.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm.$Input2": {} + }, + "Dyslipidemia \n Rheumatoid Arthritis are Risk factors$Cause_1": { + "Dyslipidemia \n Rheumatoid Arthritis$Input3": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "Female with PMH of rheumatoid arthritis on prednisone, current smoker, who presents 1 day history of chest pain. She was in her USOH until yesterday, noted sudden onset left sided chest pressure w/ nausea, diaphoresis, vomiting, radiation of pain down L arm. Went to OSH and received ASA 325. Currently CP free, BPs 110s/74 HR 58, on RA. EKG notable initial submilimeter elevation AVL, no other elevations; resolved on repeat EKGs; noted TWI in AVF and VIII. Her troponins were elevated at 0.14, 0.21, and she was sent for PCI for NSTEMI. She was found to have a 99% occlusion of the RCA s/p DES and minimial residual disease in other vessels. Given full dose ASA and loaded with Plavix.\n\nCurrently she is chest pain free. She states that she has had small episodes of chest pressure and DOE recently that have always resolved quickly when she sits down. She denies headache, chest pain, fevers, chills, SOB, nausea, vomiting, or diarrhea.\n\nREVIEW OF SYSTEMS: \nPositive per HPI. \nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope, or presyncope. On further review of systems, denies fevers or chills. Denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. Denies exertional buttock or calf pain. All of the other review of systems were negative.\n", + "input3": "+ Dyslipidemia \n+ Rheumatoid Arthritis\n+ Osteopenia\n+ Vitamin D Deficiency\n+ Coronaries: Unknown\n+ Pump: Unknown\n+ Rhythm: NSR\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death. Sister had a hear murmur as a child.\n", + "input5": "ADMISSION PHYSICAL EXAM\n=======================\nBP: 104/75 HR: 53 O2 sat: 98%\nGENERAL: Well developed, well nourished female in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI. Conjunctiva were pink. No pallor or cyanosis of the oral mucosa. No xanthelasma. \nCARDIAC: PMI located in intercostal space, midclavicular line. bradycardic, regular. Normal S1, S2. No murmurs, rubs, or gallops. No thrills or lifts. \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, non-tender, non-distended. No hepatomegaly. No splenomegaly. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema. R wrist non-tender with pulses intact, TR band in place with no evidence of hematoma. Sensation intact. \nSKIN: No significant skin lesions or rashes. \nPULSES: Distal pulses palpable and symmetric.\n", + "input6": "ADMISSION LABS\n==============\n___ 06:00AM BLOOD WBC-9.0 RBC-3.98 Hgb-12.1 Hct-36.5 MCV-92 MCH-30.4 MCHC-33.2 RDW-15.1 RDWSD-50.6* Plt ___\n___ 06:00AM BLOOD Neuts-51.1 ___ Monos-7.3 Eos-1.4 Baso-0.6 Im ___ AbsNeut-4.59 AbsLymp-3.50 AbsMono-0.66 AbsEos-0.13 AbsBaso-0.05\n___ 09:33AM BLOOD ___ PTT-69.2* ___\n___ 06:00AM BLOOD Glucose-106* UreaN-14 Creat-0.9 Na-148* K-4.3 Cl-111* HCO3-23 AnGap-14\n___ 06:00AM BLOOD cTropnT-0.14*\n___ 09:33AM BLOOD cTropnT-0.21*\n___ 08:10AM BLOOD Calcium-9.3 Phos-4.0 Mg-2.0\n\nIMAGING\n=======\nTTE ___: Mild symmetric left ventricular hypertrophy with subtle hypokinesis of the midinferoseptum. No clinically significant valvular regurgitation or stenosis. Indeterminate pulmonary pressure\n\nCATH ___:\nSuccessful PCI of the mid RCA with 3.0 DES(Mild disease in the other coronaries) Re load with clopidgrel 600 mg tonite and continue DAPT with ASA.\n\nECG\uff1a\nnon-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/12054012-DS-14.json b/Finished/Acute Coronary Syndrome/NSTEMI/12054012-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..a762e4ab010e321ab396cc50161baeccfb947768 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/12054012-DS-14.json @@ -0,0 +1,84 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "cTropnT-0.11*\n cTropnT-0.24*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Weakness, diaphoresis are symptoms of ACS$Cause_1": { + "Weakness, diaphoresis$Input1": {} + }, + "weakness, hypotension and diaphoresis.\n are symptom of ACS.$Cause_1": { + "presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis.$Input2": {} + }, + "chronic back pain is a risk factor$Cause_1": { + "+PMHx: No medical care for the past decade\n+chronic back pain$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "ECHOCARDIOGRAM\nThe left atrium is elongated. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. There is severe regional left ventricular systolic dysfunction with akinesis of the mid anterior, lateral, and inferior walls and entire distal apex. hypokinesis of . There is severe hypokinesis of the remaining segments, with worse hypokinesis in the mid-level compared with the basal walls (LVEF = 15 %). The estimated cardiac index is normal (>=2.5L/min/m2). No masses or thrombi are seen in the left ventricle. Diastolic function could not be assessed. Right ventricular chamber size is normal with borderline normal free wall function. The aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.IMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.\n\n___ CARDIAC CATHETERIZATION\nMultiple attempts were required for right radial arterial access. The Magic Torque wire could not be delivered into the proximalright subclavian artery past the right vertebral artery due toextreme tortuousity (most likely a 360 degree turn). Rightfemoral artery access was then obtained using ultrasound imagingguidance and a MicroPuncture kit on the attempt. The RIMA waspatent.\n\nThe heart appeared dilated with splayed coronary arteries widely separated. There was dense posterior mitral annular calcification.\n\nCoronary angiography: CO-dominant\n LMCA: The LMCA was short with distal funneling to 25%.\n LAD: The proximal LAD was heavily calcified. The mid LAD was occluded after small D1, D2 and D3 branches. There was faint reconstitution of the mid-distal LAD via left-to-left collaterals.\n LCX: The AV groove CX was large in caliber with mild plaquing throughout. There were 2 short OM1 and OM2 branches with no obvious perfusion of the high lateral wall (raising the possibility of an occluded ramus intermedius branch). The major OM3/LPL1 had an origin tubular 70% stenosis. LPL2 was subtotally occluded proximally and reconstituted via left-to-left collaterals with distal moderate disease at a bifurcation and TIM1 flow. The distal CX supplied collaterals to the diseased RPDA and RCA with retrograde filling up to the mid RCA. The LPDA was somewhat tortuous.\n RCA: The RCA was occluded proximally past the conus and SA nodal branches. There was no reconstitution of the native RCA beyond.\n\n___ CXR \nThere is mild-to-moderate cardiomegaly with left ventricular configuration. The aorta is unfolded. There is possible minimal upper zone re-distribution, but no other evidence of CHF. No focal infiltrate or effusion. No pneumothorax detected. Increased opacity adjacent to the left cardiac apex/left costophrenic angle most likely is related to a cardiac fat pad and/or overlying soft tissues. \n \nIMPRESSION: Cardiomegaly. No acute pulmonary process identified.$Input6": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "An EKG then was significant for T wave inversions in the inferolateral leads.$Input2": {} + }, + "Abnormal electrocardiogram can be a strongly sign of acs$Cause_1": { + "A repeat ECG had <1mm ST elevations in I and aVL with Qs anteriorly and inferiorly. TTE showed LVEF of 15% globally with akinetic apex.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Weakness, diaphoresis are symptoms of ACS$Cause_1": { + "Weakness, diaphoresis$Input1": {} + }, + "weakness, hypotension and diaphoresis.\n are symptom of ACS.$Cause_1": { + "presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis.$Input2": {} + }, + "chronic back pain is a risk factor$Cause_1": { + "+PMHx: No medical care for the past decade\n+chronic back pain$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation\r is a sign of NSTE-ACS$Cause_1": { + "non-ST-elevation$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Weakness, diaphoresis are symptoms of ACS$Cause_1": { + "Weakness, diaphoresis$Input1": {} + }, + "weakness, hypotension and diaphoresis.\n are symptom of ACS.$Cause_1": { + "presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis.$Input2": {} + }, + "chronic back pain is a risk factor$Cause_1": { + "+PMHx: No medical care for the past decade\n+chronic back pain$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "ECHOCARDIOGRAM\nThe left atrium is elongated. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. There is severe regional left ventricular systolic dysfunction with akinesis of the mid anterior, lateral, and inferior walls and entire distal apex. hypokinesis of . There is severe hypokinesis of the remaining segments, with worse hypokinesis in the mid-level compared with the basal walls (LVEF = 15 %). The estimated cardiac index is normal (>=2.5L/min/m2). No masses or thrombi are seen in the left ventricle. Diastolic function could not be assessed. Right ventricular chamber size is normal with borderline normal free wall function. The aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.IMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.\n\n___ CARDIAC CATHETERIZATION\nMultiple attempts were required for right radial arterial access. The Magic Torque wire could not be delivered into the proximalright subclavian artery past the right vertebral artery due toextreme tortuousity (most likely a 360 degree turn). Rightfemoral artery access was then obtained using ultrasound imagingguidance and a MicroPuncture kit on the attempt. The RIMA waspatent.\n\nThe heart appeared dilated with splayed coronary arteries widely separated. There was dense posterior mitral annular calcification.\n\nCoronary angiography: CO-dominant\n LMCA: The LMCA was short with distal funneling to 25%.\n LAD: The proximal LAD was heavily calcified. The mid LAD was occluded after small D1, D2 and D3 branches. There was faint reconstitution of the mid-distal LAD via left-to-left collaterals.\n LCX: The AV groove CX was large in caliber with mild plaquing throughout. There were 2 short OM1 and OM2 branches with no obvious perfusion of the high lateral wall (raising the possibility of an occluded ramus intermedius branch). The major OM3/LPL1 had an origin tubular 70% stenosis. LPL2 was subtotally occluded proximally and reconstituted via left-to-left collaterals with distal moderate disease at a bifurcation and TIM1 flow. The distal CX supplied collaterals to the diseased RPDA and RCA with retrograde filling up to the mid RCA. The LPDA was somewhat tortuous.\n RCA: The RCA was occluded proximally past the conus and SA nodal branches. There was no reconstitution of the native RCA beyond.\n\n___ CXR \nThere is mild-to-moderate cardiomegaly with left ventricular configuration. The aorta is unfolded. There is possible minimal upper zone re-distribution, but no other evidence of CHF. No focal infiltrate or effusion. No pneumothorax detected. Increased opacity adjacent to the left cardiac apex/left costophrenic angle most likely is related to a cardiac fat pad and/or overlying soft tissues. \n \nIMPRESSION: Cardiomegaly. No acute pulmonary process identified.$Input6": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "An EKG then was significant for T wave inversions in the inferolateral leads.$Input2": {} + }, + "Abnormal electrocardiogram can be a strongly sign of acs$Cause_1": { + "A repeat ECG had <1mm ST elevations in I and aVL with Qs anteriorly and inferiorly. TTE showed LVEF of 15% globally with akinetic apex.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Weakness, diaphoresis are symptoms of ACS$Cause_1": { + "Weakness, diaphoresis$Input1": {} + }, + "weakness, hypotension and diaphoresis.\n are symptom of ACS.$Cause_1": { + "presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis.$Input2": {} + }, + "chronic back pain is a risk factor$Cause_1": { + "+PMHx: No medical care for the past decade\n+chronic back pain$Input3": {} + } + } + } + } + }, + "input1": "symptom of ACS\n", + "input2": "He is a 66 year old male who presented with the chief complaint of urinary retention. He had a Foley placed and then developed profound weakness, hypotension and diaphoresis. An EKG then was significant for T wave inversions in the inferolateral leads. His troponin was elevated to .34. He received ASA 325 and heparin gtt at 10 AM. Of note, he endorsed having intermittent episodes of weakness over the past month as well as syncopal episodes. Per wife, husband has had decreased ability to perform daily tasks and becomes short of breath + experiences CP with even brief bursts of acitivity; no longer mows the lawn. With this episode at the ED, he denies experiencing chest pain, arm pain, scapular pain, or nausea. \n\nAt the ED, his vitals were Temp: 98.4 HR: 98 BP: 157/85 Resp: 16 O(2)Sat: 98 Normal\n\nHis cardiac catheterization is significant for 3 VD with fully occluded RCA and LAD / Cx with diffuse disease. \n\nA repeat ECG had <1mm ST elevations in I and aVL with Qs anteriorly and inferiorly. TTE showed LVEF of 15% globally with akinetic apex and non-ST-elevation\n", + "input3": "+PMHx: No medical care for the past decade\n+chronic back pain\n", + "input4": "Noncontributory\n", + "input5": "Admit PE: \nTemp: 98.4 HR: 98 BP: 157/85 Resp: 16 O(2)Sat: 98 Normal\nConstitutional: Comfortable\nChest: Clear to auscultation\nCardiovascular: Regular Rate and Rhythm\nAbdominal: Soft\nGU/Flank: No costovertebral angle tenderness\nExtr/Back: No cyanosis, clubbing or edema\nSkin: Warm and dry, No rash\nNeuro: Speech fluent\nPsych: Normal mood, Normal mentation\n", + "input6": "ADMISSION LABS\n___ 12:42PM BLOOD WBC-10.8 RBC-5.43 Hgb-15.4 Hct-47.1 MCV-87 MCH-28.5 MCHC-32.8 RDW-14.7 Plt ___\n___ 12:42PM BLOOD Neuts-91.9* Lymphs-5.0* Monos-2.4 Eos-0.6 Baso-0.2\n___ 12:42PM BLOOD ___ PTT-83.6* ___\n___ 12:42PM BLOOD Glucose-127* UreaN-20 Creat-1.1 Na-141 K-3.9 Cl-105 HCO3-24 AnGap-16\n___ 12:42PM BLOOD ALT-21 AST-28 CK(CPK)-96 AlkPhos-61 TotBili-0.4\n___ 12:42PM BLOOD cTropnT-0.11*\n___ 06:20AM BLOOD cTropnT-0.24*\n___ 12:42PM BLOOD Albumin-4.2 Calcium-8.6 Phos-2.7 Mg-1.9\n___ 07:30PM BLOOD %HbA1c-5.5 eAG-111\n___ 12:52PM BLOOD Lactate-1.6\n\nOTHER STUDIES\n___ ECHOCARDIOGRAM\nThe left atrium is elongated. Left ventricular wall thicknesses are normal. The left ventricular cavity is mildly dilated. There is severe regional left ventricular systolic dysfunction with akinesis of the mid anterior, lateral, and inferior walls and entire distal apex. hypokinesis of . There is severe hypokinesis of the remaining segments, with worse hypokinesis in the mid-level compared with the basal walls (LVEF = 15 %). The estimated cardiac index is normal (>=2.5L/min/m2). No masses or thrombi are seen in the left ventricle. Diastolic function could not be assessed. Right ventricular chamber size is normal with borderline normal free wall function. The aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: Dilated left ventricle with severe regional and global dysfunction c/w CAD (3VD). Borderline right ventricular systolic function.\n\n___ CARDIAC CATHETERIZATION\nMultiple attempts were required for right radial arterial access. The Magic Torque wire could not be delivered into the proximalright subclavian artery past the right vertebral artery due toextreme tortuousity (most likely a 360 degree turn). Rightfemoral artery access was then obtained using ultrasound imagingguidance and a MicroPuncture kit on the attempt. The RIMA waspatent.\n\nThe heart appeared dilated with splayed coronary arteries widely separated. There was dense posterior mitral annular calcification.\n\nCoronary angiography: CO-dominant\n LMCA: The LMCA was short with distal funneling to 25%.\n LAD: The proximal LAD was heavily calcified. The mid LAD was occluded after small D1, D2 and D3 branches. There was faint reconstitution of the mid-distal LAD via left-to-left collaterals.\n LCX: The AV groove CX was large in caliber with mild plaquing throughout. There were 2 short OM1 and OM2 branches with no obvious perfusion of the high lateral wall (raising the possibility of an occluded ramus intermedius branch). The major OM3/LPL1 had an origin tubular 70% stenosis. LPL2 was subtotally occluded proximally and reconstituted via left-to-left collaterals with distal moderate disease at a bifurcation and TIM1 flow. The distal CX supplied collaterals to the diseased RPDA and RCA with retrograde filling up to the mid RCA. The LPDA was somewhat tortuous.\n RCA: The RCA was occluded proximally past the conus and SA nodal branches. There was no reconstitution of the native RCA beyond.\n\n___ CXR \nThere is mild-to-moderate cardiomegaly with left ventricular configuration. The aorta is unfolded. There is possible minimal upper zone re-distribution, but no other evidence of CHF. No focal infiltrate or effusion. No pneumothorax detected. Increased opacity adjacent to the left cardiac apex/left costophrenic angle most likely is related to a cardiac fat pad and/or overlying soft tissues. \n \nIMPRESSION: Cardiomegaly. No acute pulmonary process identified.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/12137011-DS-27.json b/Finished/Acute Coronary Syndrome/NSTEMI/12137011-DS-27.json new file mode 100644 index 0000000000000000000000000000000000000000..ff5a98c21690a4cf0b9f1f8803e6ee8822660173 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/12137011-DS-27.json @@ -0,0 +1,96 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "TnT 0.12$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "chest Pain after exercisec is a symptom of ACS.$Cause_1": { + "He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V.$Input2": {} + }, + "Status post aortic valve replacement and mitral valve is Risk factors$Cause_1": { + "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.$Input3": {} + }, + "Family history is a big risk factor$Cause_1": { + "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "Normal functioning bileaflet AVR and MVR. Symmetric left ventricular hypertrophy with regional systolic dysfunction most c/w CAD. Mildly dilated ascending aorta.$Input6": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "EKG: Regular sinus rhythm, RBBB, diffuse ST elevation in II, III, aVF, V2 through V6, Q wave in I, II, and aVL, unchanged from prior$Input2": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS.$Cause_1": { + "Right bundle-branch block. Left anterior fascicular block. Anterior wall myocardial infarction of indeterminate age. Prolonged Q-T interval. Compared to the previous tracing P-R interval is now prolonged.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "chest Pain after exercisec is a symptom of ACS.$Cause_1": { + "He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V.$Input2": {} + }, + "Status post aortic valve replacement and mitral valve is Risk factors$Cause_1": { + "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.$Input3": {} + }, + "Family history is a big risk factor$Cause_1": { + "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation\r is a sign of NSTE-ACS$Cause_1": { + "non-ST-elevation$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "chest Pain after exercisec is a symptom of ACS.$Cause_1": { + "He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V.$Input2": {} + }, + "Status post aortic valve replacement and mitral valve is Risk factors$Cause_1": { + "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.$Input3": {} + }, + "Family history is a big risk factor$Cause_1": { + "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "Normal functioning bileaflet AVR and MVR. Symmetric left ventricular hypertrophy with regional systolic dysfunction most c/w CAD. Mildly dilated ascending aorta.$Input6": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "EKG: Regular sinus rhythm, RBBB, diffuse ST elevation in II, III, aVF, V2 through V6, Q wave in I, II, and aVL, unchanged from prior$Input2": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS.$Cause_1": { + "Right bundle-branch block. Left anterior fascicular block. Anterior wall myocardial infarction of indeterminate age. Prolonged Q-T interval. Compared to the previous tracing P-R interval is now prolonged.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "chest Pain after exercisec is a symptom of ACS.$Cause_1": { + "He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V.$Input2": {} + }, + "Status post aortic valve replacement and mitral valve is Risk factors$Cause_1": { + "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.$Input3": {} + }, + "Family history is a big risk factor$Cause_1": { + "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "He is with history of bicuspid aortic valve status post prosthetic aortic valve, staphylococcus epidermidis endocarditis requiring a repeat aortic valve surgery, thromboembolic myocardial infarction s/p balloon angioplasty of the left circumflex artery, HLD, CKD (baseline creatinine 1.4), gout, Crohn's disease, who presented with chest pain. \n\nPatient reported that he was in his usual state of health until the day of presentation. He went up and down stairs twice outside in the heat, and developed acute chest pressure/pain after exertion. the chest pain was midsternal, non-radiating, and associated with extreme flushing/diaphoresis, no N/V. Feeling much improved. Also w/+SOB and DOE, no orthopnea. He has a history of MI but doesn't know if this is a similar pain. He also reported bad taste in his mouth with this episode. Wife noted that his ankles appear more swollen b/l. \n\nHe denies fever, chills, headache, dizziness, dysuria, calf tenderness. He has cough at baseline. \n\nIn the ED, initial vitals were: 98.3 63 121/71 17 96% RA \nExam notable for: rrr, s1/s2, ___ murmurs ctabl no w/c/r soft, +bs, nd/nt no edema, no tenderness b/l, wwp \n\nLabs notable for: \nWBC 8.0 N:75.4 H/H 13.3/41.6 Platelets: 163 \nNa 137 K 3.9 creatinine 1.5 \nPTT: 54.1 INR: 3.8 \nALT: 47 AP: 94 Tbili: 0.8 Alb: 4.0 AST: 61 \n2100 Trop-T: 0.12 CK: 135 MB: 4 \n0300 Trop-T: 0.12 CK: 112 MB: 4 \nUA within normal limits \nImaging notable for: CXR with no acute cardiopulmonary process. \n\nEKG: Regular sinus rhythm, RBBB, diffuse ST elevation in II, III, aVF, V2 through V6, Q wave in I, II, and aVL, unchanged from prior \n non-ST-elevation \n \nPatient was given: \nNitroglycerin SL .4 mg PO/NG Atorvastatin 80 mg Metoprolol Tartrate 25 mg \n\nCardiology consulted and recommended: Hx of nonobstructive CAD. P/w several ours of chest pain at rest. resolved after arriving to ED (NTG). TnT 0.12, second set pending. ECG essentially unchanged from baseline. RBBB j point elevations V4-6. New isolated concordant STD in V1. on VKA, INR supratheraputic, hold UFH, give ASA and high potency statin.\n", + "input3": "+Status post aortic valve replacement and mitral valve\n+Prosthetic valve endocarditis (Staphylococcus epidermidis)\n+Myocardial infarction secondary to endocarditis, septic embolus\n+History of atrial fibrillation.\n+History of Crohn's disease\n-Hypertension.\n+Hypercholesterolemia.\n", + "input4": "Father -diabetes, chronic obstructive pulmonary disease, and a history of cerebrovascular accidents;Brother with lupus.\n", + "input5": "ADMISSION PHYSICAL EXAM: \n=========================\nVital Signs: 97.8 | 155/91 | 54 | 18 | 96%RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL, neck supple, JVP not elevated, no LAD \nCV: Regular mechanical heart sounds, no murmurs, rubs, gallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nAbdomen: Soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding \nGU: No foley \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nNeuro: Grossly non-focal\n", + "input6": "IMAGING & STUDIES: \n\n___ Imaging CHEST (PA & LAT) \nMidline sternotomy wires again noted. Cardiomediastinal silhouette is unchanged with mild cardiac enlargement. Aortic and mitral valve replacements are noted. Lungs are clear without overt signs of edema or pneumonia. Mild hilar congestion is suspected. No large effusion or pneumothorax. Bony structures are intact. Degenerative changes of the left shoulder partially imaged \n\n___ Cardiovascular ECG \nSinus rhythm with A-V conduction delay. Right bundle-branch block. Left anterior fascicular block. Anterior wall myocardial infarction of indeterminate age. Prolonged Q-T interval. Compared to the previous tracing P-R interval is now prolonged. \nTRACING #1 \n\n___ Cardiovascular ECG \nSinus rhythm. Right bundle-branch block. Left anterior fascicular block. A-V conduction delay. Anterior wall myocardial infarction of indeterminate age. Compared to tracing #1 findings are similar. \nTRACING #2 \n\n___ Cardiovascular ECG \nSinus bradycardia. A-V conduction delay. Right bundle-branch block. Left anterior fascicular block. Anterior wall myocardial infarction of indeterminate age. Compared to tracing #2 the heart rate has slowed. \nTRACING #3 \n\n___: ECHO: (LVEF = 41%)\nThe left atrial volume index is moderately increased. There is moderate symmetric left ventricular hypertrophy with normal cavity size. There is mild regional left ventricular systolic dysfunction with thinning/akinesis of the distal half of the inferolateral and distal inferior wall. The remaining segments contract normally (LVEF = 41%). No masses or thrombi are seen in the left ventricle. The ascending aorta is mildly dilated. A bileaflet aortic valve prosthesis is present. The aortic valve prosthesis appears well seated, with normal disc motion and transvalvular gradients. No aortic regurgitation is seen. A bileaflet mitral valve prosthesis is present. The mitral prosthesis appears well seated, with normal disc motion and transvalvular gradients. No mitral regurgitation is seen. Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: Suboptimal image quality. Normal functioning bileaflet AVR and MVR. Symmetric left ventricular hypertrophy with regional systolic dysfunction most c/w CAD. Mildly dilated ascending aorta.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/12275216-DS-11.json b/Finished/Acute Coronary Syndrome/NSTEMI/12275216-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..5440c9f0b0ccad3672e1ae4cfcb0cb2a130a5ba6 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/12275216-DS-11.json @@ -0,0 +1,90 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "Troponins initially .06, repeat troponin at 8:20AM day of transfer, 0.25.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "+Hypertension \n+Hyperlipidemia\nis a risk factor of ACS$Cause_1": { + "+Hypertension \n+Hyperlipidemia$Input3": {} + }, + "Chest Pain is a symptom of ACS$Cause_1": { + "At the time of presentation, patient's pain was in severity.$Input2": {} + }, + "Family history is a big risk factor$Cause_1": { + "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Cardiac structural abnormalities is a diagnostic criteria of ACS$Cause_1": { + "He is a gentleman with CAD (known occluded RCA with collaterals s/p PCI's (PTCA and stenting of ostial LCx and PTCA ostial RI c/b instent restenosis at ostium of LCx and restenosis of ramus branch s/p PTCA of LCx ostium and ramus ostium, HTN, HL, chronic low back pain and anxiety who presented to OSH with chest pain.$Input2": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "CV: RR, normal S1, S2. No m/r/g. No S3 or S4. Distant heart \nsounds.$Input5": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "+Hypertension \n+Hyperlipidemia\nis a risk factor of ACS$Cause_1": { + "+Hypertension \n+Hyperlipidemia$Input3": {} + }, + "Chest Pain is a symptom of ACS$Cause_1": { + "At the time of presentation, patient's pain was in severity.$Input2": {} + }, + "Family history is a big risk factor$Cause_1": { + "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation\r is a sign of NSTE-ACS$Cause_1": { + "ECG\uff1a\nnon-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "+Hypertension \n+Hyperlipidemia\nis a risk factor of ACS$Cause_1": { + "+Hypertension \n+Hyperlipidemia$Input3": {} + }, + "Chest Pain is a symptom of ACS$Cause_1": { + "At the time of presentation, patient's pain was in severity.$Input2": {} + }, + "Family history is a big risk factor$Cause_1": { + "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "Cardiac structural abnormalities is a diagnostic criteria of ACS$Cause_1": { + "He is a gentleman with CAD (known occluded RCA with collaterals s/p PCI's (PTCA and stenting of ostial LCx and PTCA ostial RI c/b instent restenosis at ostium of LCx and restenosis of ramus branch s/p PTCA of LCx ostium and ramus ostium, HTN, HL, chronic low back pain and anxiety who presented to OSH with chest pain.$Input2": {} + }, + "Abnormal electrocardiogram is a diagnostic criteria of ACS$Cause_1": { + "CV: RR, normal S1, S2. No m/r/g. No S3 or S4. Distant heart \nsounds.$Input5": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "+Hypertension \n+Hyperlipidemia\nis a risk factor of ACS$Cause_1": { + "+Hypertension \n+Hyperlipidemia$Input3": {} + }, + "Chest Pain is a symptom of ACS$Cause_1": { + "At the time of presentation, patient's pain was in severity.$Input2": {} + }, + "Family history is a big risk factor$Cause_1": { + "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.$Input4": {} + } + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "He is a gentleman with CAD (known occluded RCA with collaterals s/p PCI's (PTCA and stenting of ostial LCx and PTCA ostial RI c/b instent restenosis at ostium of LCx and restenosis of ramus branch s/p PTCA of LCx ostium and ramus ostium, HTN, HL, chronic low back pain and anxiety who presented to OSH with chest pain. He was found to have an NSTEMI and was transferred to for catheterization.\n \nAt the time of presentation, patient's pain was in severity. Troponins initially .06, repeat troponin at 8:20AM day of transfer, 0.25. VS on transfer: 136/59, HR 69 SR, 16, 97% 2 liters, afebrile. Patient arrived and underwent uncomplicated cardiac cath with right femoral access. During procedure DES was placed in the ostial LCx with residual 40-50% distal left main to LAD. Plan per interventional is ASA, plavix, IVF overnight with plan for TTE, consult in the AM. Of note patient received ample versed and Fentanyl \n\nOn arrival to the floor, patient without complaint. Denies chest pain, shortness of breath, palpitations. Tolerating PO without nausea, vomiting. Chronic back pain is at its baseline. Last BM yesterday.\n", + "input3": "+CAD s/p MI and multiple PCI's \n+Hypertension \n+Hyperlipidemia \n+Chronic low back pain\n+s/p cholecystectomy \n+h/o osteomyelitis \n+Depression \n+Anxiety \n+Umbilical hernia\n", + "input4": "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.\n", + "input5": "ADMISSION EXAM\nVS T 97.8 102/60 72 14 96%RA \nGen: Obese M in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNeck: Supple with no JVD noted (difficult to assess). \nCV: RR, normal S1, S2. No m/r/g. No S3 or S4. Distant heart \nsounds. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nAbd: NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Morphine pump can be felt on the RLQ under the skin. \nExt: no c/c/e. Right femoral cath site c/d/i under tegaderm. \nSkin: No stasis dermatitis, ulcers, scars, xanthomas. + tattoos noted \nRight: 2+ DPs \nLeft: 2+ DP and radial\n", + "input6": "ADMISSION LABS\n--------------------\n___ 02:34AM BLOOD Plt ___\n___ 02:34AM BLOOD UreaN-15 Creat-1.1 Na-140 K-4.8 Cl-104\n___ 02:34AM BLOOD CK(CPK)-78\n___ 02:34AM BLOOD CK-MB-3 cTropnT-0.10*\n\nECG\uff1a\nnon-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/12364675-DS-12.json b/Finished/Acute Coronary Syndrome/NSTEMI/12364675-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..450254ee6ef8929f6e8a8235e0e0ee95ae359e8a --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/12364675-DS-12.json @@ -0,0 +1,96 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "Peak troponin greater than 8.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Dyspnea is a symptom of ACS$Cause_1": { + "Dyspnea$Input1": {} + }, + "DM is a risk factor of ACS$Cause_1": { + "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.$Input2": {} + }, + "HTN is is a risk factor of ACS$Cause_1": { + "+HTN$Input3": {} + }, + "DM is is a risk factor of ACS.$Cause_1": { + "+DM managed with metformin$Input3": {} + }, + "CAD is a risk factor of ACS.$Cause_1": { + "+CAD s/p stenting$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "s1, s2 present, systolic murmur on LSB w/radiation to carotid is a sign of ACS$Cause_1": { + "CARDIAC: RRR, s1, s2 present, systolic murmur on LSB w/radiation to carotid$Input5": {} + }, + "Suspected ACS$Intermedia_2": { + "Dyspnea is a symptom of ACS$Cause_1": { + "Dyspnea$Input1": {} + }, + "DM is a risk factor of ACS$Cause_1": { + "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.$Input2": {} + }, + "HTN is is a risk factor of ACS$Cause_1": { + "+HTN$Input3": {} + }, + "DM is is a risk factor of ACS.$Cause_1": { + "+DM managed with metformin$Input3": {} + }, + "CAD is a risk factor of ACS.$Cause_1": { + "+CAD s/p stenting$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation\r is a sign of NSTE-ACS$Cause_1": { + "ECG\uff1a\nnon-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Dyspnea is a symptom of ACS$Cause_1": { + "Dyspnea$Input1": {} + }, + "DM is a risk factor of ACS$Cause_1": { + "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.$Input2": {} + }, + "HTN is is a risk factor of ACS$Cause_1": { + "+HTN$Input3": {} + }, + "DM is is a risk factor of ACS.$Cause_1": { + "+DM managed with metformin$Input3": {} + }, + "CAD is a risk factor of ACS.$Cause_1": { + "+CAD s/p stenting$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "s1, s2 present, systolic murmur on LSB w/radiation to carotid is a sign of ACS$Cause_1": { + "CARDIAC: RRR, s1, s2 present, systolic murmur on LSB w/radiation to carotid$Input5": {} + }, + "Suspected ACS$Intermedia_2": { + "Dyspnea is a symptom of ACS$Cause_1": { + "Dyspnea$Input1": {} + }, + "DM is a risk factor of ACS$Cause_1": { + "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.$Input2": {} + }, + "HTN is is a risk factor of ACS$Cause_1": { + "+HTN$Input3": {} + }, + "DM is is a risk factor of ACS.$Cause_1": { + "+DM managed with metformin$Input3": {} + }, + "CAD is a risk factor of ACS.$Cause_1": { + "+CAD s/p stenting$Input3": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "w/ DM2, h/o prostate ca, h/o thyroid ca, stage IV SCC tongue, s/p dissection and chemorad , G-tube, presents as a transfer for I/s/o CAD.\n\nHad acute onset of SOB after receiving daily hydration at theinfusion clinic. And 5 days ago, went into acute pulmonary edema while at the infusion clinic. BNP was greater. Peak troponin greater than 8. Treated ICU with BiPAP and diuresis and is now compensated. Echo revealed an EF with aortic stenosis with a mean gradient of 12 mmHg and a valve area of 0.9cm2. Right heart cath today: Mean Wedge 20mmHG, pulmonary artery pressure 46/21. Mean aortic gradient 9 mmHg. Valve area calculated at 2.93. Left ventriculogram: EF 25%. Coronary angiography revealed a patent LAD stent with an 80% stenosis immediately after. Ostial circumflex with a 90% stenosis. RCA 70% proximal with a chronically occluded right PDA. A large ramus had a 60% proximal stenosis. Patient was stable in the ICU and no longer required ICU care. \n\nOf note, there is a report of him having some intermittent confusion and combativeness at home. PCP had started him on Keppra for ? concern for seizures. His G tube got clogged and was pulled out this admission. Is able to eat applesauce, protein shakes. Has lost significant weight. They have not been able to put the tube back in due to his current cardiac status. Takes all pills whole in applesauce. Of note, right radial access today: TR band is still in place but depressurized. No bleeding or hematoma. \n\nVitals prior to transfer: 127/48, 89, 16, afebrile, 96% on 4 liters\n\nOn the floor VSS, on 4L O2, pt is stable. Reporting improvement of SOB, and denies CP now and in the past. Only had CP when he had PCI. had his last chemo for tongue SCC lastweek.\n", + "input3": "+CAD s/p stenting\n+Osteoarthritis with severe arthritis of the left hip (? cane at baseline)\n+HTN\n+HLD\n+DM managed with metformin\n+Hypothyroidism\n+Sporadic Medullary Thyroid Carcinoma s/p thyroidectomy and \ncentral compartment lymph node dissection\n+Migraine headache\n+Esophageal diverticulum and perforation s/p esophageal stent/repair via right thoracotomy with subsequent removal complicated by intrathoracic abscess weeks post op from esophageal repair as mentioned above)\n+Glaucoma\n+Oral leukoplakia\n+Pulmonary nodule right lower lobe (unchanged over years)\n", + "input4": "Per record, brother with hx of colon problems. Mother hx. of DM.\n", + "input5": "ADMISSION PHYSICAL EXAM\n=======================\nGENERAL: NAD Oriented x3. Mood, affect appropriate. \nNECK: Supple. JVP of 15 cm. \nCARDIAC: RRR, s1, s2 present, systolic murmur on LSB w/radiation to carotid\nLUNGS: Bilateral crackles from mid to base\nABDOMEN: Soft, non-tender, non-distended. No hepatomegaly. No\nsplenomegaly. \nEXTREMITIES: traces of edema\n\nGeneral: NAD\nLungs: Quiet bilaterally, poor air movement \nCV: RRR, S1, S2 present with ___ systolic murmur radiating to\ncarotid, heard at ___\nAbdomen: BS+, ND, NT, soft\nExt: no edema\n", + "input6": "ADMISSION LABS\n===========================\n___ 08:04PM BLOOD WBC-4.8 RBC-2.84* Hgb-8.6* Hct-27.5* MCV-97 MCH-30.3 MCHC-31.3* RDW-20.2* RDWSD-69.8* Plt ___\n___ 08:04PM BLOOD ___ PTT-25.9 ___\n___ 08:04PM BLOOD Glucose-166* UreaN-15 Creat-0.7 Na-134* K-4.4 Cl-95* HCO3-28 AnGap-11\n___ 08:04PM BLOOD ___\n___ 08:04PM BLOOD Calcium-6.8* Phos-3.6 Mg-1.8\n___ 08:04PM BLOOD TSH-1.9\n\nDISCHARGE LABS\n===========================\n___ 04:49AM BLOOD WBC-4.8 RBC-2.74* Hgb-8.2* Hct-26.4* MCV-96 MCH-29.9 MCHC-31.1* RDW-19.9* RDWSD-68.8* Plt ___\n___ 04:49AM BLOOD ___ PTT-38.4* ___\n___ 04:49AM BLOOD Glucose-117* UreaN-13 Creat-0.7 Na-138 K-3.7 Cl-95* HCO3-29 AnGap-14\n\nIMAGING\n============================\nCXR ___ IMPRESSION: \nThere is a left chest wall Port-A-Cath with the tip terminating in the \nsuperior vena cava. There are small bilateral pleural effusions (right greater than left) with bibasilar atelectasis. Underlying consolidation cannot be excluded. There is no pneumothorax. The cardiomediastinal silhouette is within normal limits. There is no pulmonary edema. No acute osseous abnormalities are identified. \n\n\nFindings\nSuccessful PCI with drug-eluting stent of the circumflex coronary artery.\n\nECG\uff1a\nnon-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/12806822-DS-18.json b/Finished/Acute Coronary Syndrome/NSTEMI/12806822-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..eec644165485439d0016141b710bdbbb2e9d404c --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/12806822-DS-18.json @@ -0,0 +1,72 @@ +{ + "NSTEMI$Intermedia_5": { + "Changes in heart structure is a diagnostic criteria of ACS.$Cause_1": { + "cTropnT-0.55$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "diaphoresis, and clammy feeling is a symptom of ACS.$Cause_1": { + "he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.$Input2": {} + }, + "hemmoroids is a risk fact$Cause_1": { + "hemmoroids$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n are strongly signs of acs$Cause_1": { + "Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "diaphoresis, and clammy feeling is a symptom of ACS.$Cause_1": { + "he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.$Input2": {} + }, + "hemmoroids is a risk fact$Cause_1": { + "hemmoroids$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation\r is a sign of NSTE-ACS$Cause_1": { + "ECG\uff1a\nnon-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "diaphoresis, and clammy feeling is a symptom of ACS.$Cause_1": { + "he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.$Input2": {} + }, + "hemmoroids is a risk fact$Cause_1": { + "hemmoroids$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n are strongly signs of acs$Cause_1": { + "Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "diaphoresis, and clammy feeling is a symptom of ACS.$Cause_1": { + "he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm.$Input2": {} + }, + "hemmoroids is a risk fact$Cause_1": { + "hemmoroids$Input3": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "69 yo M w/o any signicant PMH presents with CP. Each morning he walks 1.5mi and this morning when he was walking pt abruptly started having a dull CP at this chest in severity. He also had some diaphoresis, and clammy feeling but denies any jaw or neck pain, radiating pain to the arm. Once the pain occured he sat down, and the pain lasted a total of 10 minutes and completely went away. Pt did admit that he had some R hand numbness. Pt did not take an asprin or any other med, and when he got back home did take one prilosec. The pain was different from indigestion he has been having over the last couple months which is lower on his chest and a feeling offullness and some acid reflux feeling. Pt said he also had similar CP on (4d ago) when doing yard work and shoveling, and also later that night with the same pattern of pain/length and resolution when resting.\n \nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. Only (+) for blurry vision - for a couple minutes at a time over the last couple weeks pt would have a small area of his visual field that would be blurry and go away. \n\nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "+hemmoroids\n-no other medical hx\n", + "input4": "There is no family history of premature coronary artery disease or sudden death.\n", + "input5": "VS - 97.3, 143/89, 61, 18, 100%RA\nGen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNeck: Supple with JVP of *** cm. \nCV: PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nAbd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nExt: No c/c/e. No femoral bruits. \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas. \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+\n", + "input6": "___ 09:08PM CK(CPK)-107\n___ 09:08PM CK-MB-4\n___ 09:08PM PLT COUNT-179\n___ 09:28AM GLUCOSE-116* UREA N-26* CREAT-1.0 SODIUM-144 POTASSIUM-4.6 CHLORIDE-108 TOTAL CO2-29 ANION GAP-12\n___ 09:28AM estGFR-Using this\n___ 09:28AM CK(CPK)-148\n___ 09:28AM cTropnT-0.55\n___ 09:28AM CK-MB-5\n___ 09:28AM WBC-5.1 RBC-4.68 HGB-14.4 HCT-42.1 MCV-90 MCH-30.7 MCHC-34.1 RDW-13.6\n___ 09:28AM NEUTS-73.6* ___ MONOS-3.9 EOS-1.7 BASOS-0.5\n___ 09:28AM PLT COUNT-191\n___ 09:28AM ___ PTT-23.5 ___\n\nECG\uff1a\nnon-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/12808249-DS-8.json b/Finished/Acute Coronary Syndrome/NSTEMI/12808249-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..3df2a9c7c194af1ae6ac3b31b284d42629c53cdc --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/12808249-DS-8.json @@ -0,0 +1,114 @@ +{ + "NSTEMI$Intermedia_5": { + "The peak hs-cTn exceeded the 99th percentile of the normal control value$Cause_1": { + "cTropnT-1.77*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Possible mitral regurgitation$Cause_1": { + "Trivial mitral regurgitation is seen.$Input6": {} + }, + "Chest pain is the mainly clinical presentation$Cause_1": { + "patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell$Input2": {} + }, + "Chest pain is a clinical presentation$Cause_1": { + "Chest Pain$Input1": {} + }, + "DM, AFib and HTN etc are the risk factors of ACS$Cause_1": { + "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak$Input2": {} + }, + "DM, AFib and HTN etc are the risk factors.$Cause_1": { + "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension$Input3": {} + }, + "may be a family history$Cause_1": { + "Father MI in late, Mother DM$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "transient ST-segment elevation, persistent or transient ST-segment depression, and T wave abnormalities, including hyperacute T waves, T wave inversion, biphasic T waves, flat T waves.$Cause_1": { + "Sinus rhythm. ST segment elevation in leads III and possibly lead aVF. T wave inversions in leads V4-V6. ST segment depressions in leads I and V6 consistent with acute ischemia or an infarction. No previous tracing available for comparison.$Input6": {} + }, + "transient ST-segment elevation, persistent or transient ST-segment depression, and T wave abnormalities, including hyperacute T waves, T wave inversion, biphasic T waves, flat T waves, and pseudonormalization of T waves.$Cause_1": { + "Sinus Rhythm at 75 ant/septal and lateral ST-T changes, ST elevation in III, and + TWI.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Possible mitral regurgitation$Cause_1": { + "Trivial mitral regurgitation is seen.$Input6": {} + }, + "Chest pain is the mainly clinical presentation$Cause_1": { + "patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell$Input2": {} + }, + "Chest pain is a clinical presentation$Cause_1": { + "Chest Pain$Input1": {} + }, + "DM, AFib and HTN etc are the risk factors of ACS$Cause_1": { + "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak$Input2": {} + }, + "DM, AFib and HTN etc are the risk factors.$Cause_1": { + "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension$Input3": {} + }, + "may be a family history$Cause_1": { + "Father MI in late, Mother DM$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation\r is a sign of NSTE-ACS$Cause_1": { + "ECG\uff1anon-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Possible mitral regurgitation$Cause_1": { + "Trivial mitral regurgitation is seen.$Input6": {} + }, + "Chest pain is the mainly clinical presentation$Cause_1": { + "patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell$Input2": {} + }, + "Chest pain is a clinical presentation$Cause_1": { + "Chest Pain$Input1": {} + }, + "DM, AFib and HTN etc are the risk factors of ACS$Cause_1": { + "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak$Input2": {} + }, + "DM, AFib and HTN etc are the risk factors.$Cause_1": { + "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension$Input3": {} + }, + "may be a family history$Cause_1": { + "Father MI in late, Mother DM$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "transient ST-segment elevation, persistent or transient ST-segment depression, and T wave abnormalities, including hyperacute T waves, T wave inversion, biphasic T waves, flat T waves.$Cause_1": { + "Sinus rhythm. ST segment elevation in leads III and possibly lead aVF. T wave inversions in leads V4-V6. ST segment depressions in leads I and V6 consistent with acute ischemia or an infarction. No previous tracing available for comparison.$Input6": {} + }, + "transient ST-segment elevation, persistent or transient ST-segment depression, and T wave abnormalities, including hyperacute T waves, T wave inversion, biphasic T waves, flat T waves, and pseudonormalization of T waves.$Cause_1": { + "Sinus Rhythm at 75 ant/septal and lateral ST-T changes, ST elevation in III, and + TWI.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Possible mitral regurgitation$Cause_1": { + "Trivial mitral regurgitation is seen.$Input6": {} + }, + "Chest pain is the mainly clinical presentation$Cause_1": { + "patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell$Input2": {} + }, + "Chest pain is a clinical presentation$Cause_1": { + "Chest Pain$Input1": {} + }, + "DM, AFib and HTN etc are the risk factors of ACS$Cause_1": { + "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak$Input2": {} + }, + "DM, AFib and HTN etc are the risk factors.$Cause_1": { + "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension$Input3": {} + }, + "may be a family history$Cause_1": { + "Father MI in late, Mother DM$Input4": {} + } + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "He is a Male w/ DM, AFib and HTN who presented to ED w/ one day of epigastric pain, EKG changes, and a troponin leak most consistent with Acute coronary syndrome.\n\nIn ED, patient reported epigastric pressure while at rest which was non-radiating. Pain started while sitting, then lasted until he fell). Patient noted similar pain the morning of admission after taking daily medications. He took ASA 325 mg at home with complete relief of symptoms. Denied pain on exertion, SOB, N/V, or diaphoresis. \n\nED Course: \nInitial Vitals: pain HR 74 140/82 15 94%. \nTrop: 0.27, INR of 1.0 and hemeoccult neg, will start heparin. \nEKG: Sinus Rhythm at 75 ant/septal and lateral ST-T changes, ST elevation in III, and + TWI. Cards consult: dx NSTEMI vs missed STEMI, admit, cath in AM. Heparin gtt initiated; guaiac neg At time of transfer to floor vitals were: 98.4 HR 57 122/67 21 95% RA \n\nOn arrival to floor, patient denies any chest pain, abdominal pain, or dyspnea. Overall, feels well.\n\nROS: + diarrhea x1 month with some normal BM's usually after takes meds; Otherwise full 10 pt review of systems negative except for above. Of note, no denies any abdominal pain, dyspnea, fever, nausea or vomiting.\n", + "input3": "+ Diabetes mellitus type II: oral agents & insulin\n+ Atrial Fibrillation\n+ Hypertension\n", + "input4": "Father MI in late, Mother DM\n", + "input5": "Admission Physical Exam:\nVS: 98.0 122/80 HR 70 sat 98% on RA; weight 92 kg\nGen: NAD\nHEENT: clear OP\nCV: NR, RR, no murmur\nPulm: CTAB, nonlabored\nAbd: soft, NT, ND\nGU: no Foley\nExt: no edema\nSkin: no lesions noted\nNeuro: no gross deficits, A&Ox3\nPsych: appropriate\n", + "input6": "Admission Labs:\n___ 03:23PM ___ PTT-30.3 ___\n___ 03:23PM PLT COUNT-260\n___ 03:23PM NEUTS-77.3* LYMPHS-16.7* MONOS-4.7 EOS-0.3 BASOS-1.0\n___ 03:23PM WBC-9.5 RBC-4.66 HGB-15.0 HCT-43.6 MCV-94 MCH-32.2* MCHC-34.4 RDW-12.9\n___ 03:23PM cTropnT-0.27*\n___ 03:23PM estGFR-Using this\n___ 03:23PM GLUCOSE-286* UREA N-16 CREAT-0.8 SODIUM-138 POTASSIUM-4.4 CHLORIDE-102 TOTAL CO2-26 ANION GAP-14\n___ 09:45PM cTropnT-1.77*\n___:37PM PTT-52.7*\n\nImaging/Studies:\n# CXR: IMPRESSION: No evidence of an acute cardiopulmonary process.\n# ECG: Sinus rhythm. ST segment elevation in leads III and possibly lead aVF. T wave inversions in leads V4-V6. ST segment depressions in leads I and V6 consistent with acute ischemia or an infarction. No previous tracing available for comparison. \n# ECG: Sinus rhythm. Similar to tracing #1.\n# ECG: Sinus rhythm with partial resolution of the ST-T wave abnormalities in the anterolateral wall. \n# ECG: Sinus rhythm. Similar to tracing #3.\nECG\uff1anon-ST-elevation\n\nFindings\nESTIMATED blood loss: < 50 cc\nHemodynamics (see above): Coronary angiography: right dominant\nLMCA: Mild diffuse\nLAD: Proximal diffuse 30%; Mid 40%; Calcified;\nLCX: Diffuse disease with mid 40%;\nRCA: Heavily calcified; Severe diffuse ectasia and tortuosity;Lesion severity difficult to assess due to tortuosity; Visual estimate is 60-70% proximal, 70% mid and 60-70% distal.\n\n# Trans-thoracic Echocardiogram:\nThe left atrium is mildly dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is low normal (LVEF 50%) secondary to apical hypokinesis with focal apical dyskinesis. The inferior and posterior walls (suboptimally visualized) may also be hypokinetic. Right ventricular chamber size and free wall motion are normal. There are focal calcifications in the aortic arch. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17105161-DS-12.json b/Finished/Acute Coronary Syndrome/NSTEMI/17105161-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..0f70e35fd63c1295ec80e64aee07bd0f2794b281 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17105161-DS-12.json @@ -0,0 +1,87 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "CK-MB-41* MB Indx-7.2* cTropnT-1.63*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "CK-MB-57* MB Indx-8.6* cTropnT-2.08*$Input6": {} + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "There is likely underlying complete heart block with demand ventricular pacing. Findings are similar to tracing #1.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy.\n isa sign of acs$Cause_1": { + "Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy.$Input2": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Atrial fibrillation s/p ablation is a risk factor$Cause_1": { + "Atrial fibrillation s/p ablation$Input3": {} + }, + "Bradycardia s/p dual-chamber permanent pacemaker is a risk factor$Cause_1": { + "Bradycardia s/p dual-chamber permanent pacemaker$Input3": {} + }, + "CHF (unknown EF is a risk factor$Cause_1": { + "CHF (unknown EF$Input3": {} + }, + "Asthma (never intubated) is a risk factor$Cause_1": { + "Asthma (never intubated)$Input3": {} + }, + "Hypothyroidism is a risk factor$Cause_1": { + "Hypothyroidism$Input3": {} + }, + "Anxietyis a risk factor$Cause_1": { + "Anxiety$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "with atrial fibrillation status post ablation, heart block s/p pacemaker (with EF at most 40%, per pt report) presents with gradual onset of substernal chest pressure that radiates to her back.$Input2": {} + }, + "The atrial flutter waves are more defined. is a strongly sign of acs$Cause_1": { + "EKG: The atrial flutter waves are more defined.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy.\n isa sign of acs$Cause_1": { + "Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy.$Input2": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Atrial fibrillation s/p ablation is a risk factor$Cause_1": { + "Atrial fibrillation s/p ablation$Input3": {} + }, + "Bradycardia s/p dual-chamber permanent pacemaker is a risk factor$Cause_1": { + "Bradycardia s/p dual-chamber permanent pacemaker$Input3": {} + }, + "CHF (unknown EF is a risk factor$Cause_1": { + "CHF (unknown EF$Input3": {} + }, + "Asthma (never intubated) is a risk factor$Cause_1": { + "Asthma (never intubated)$Input3": {} + }, + "Hypothyroidism is a risk factor$Cause_1": { + "Hypothyroidism$Input3": {} + }, + "Anxietyis a risk factor$Cause_1": { + "Anxiety$Input3": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "with atrial fibrillation status post ablation, heart block s/p pacemaker (with EF at most 40%, per pt report) presents with gradual onset of substernal chest pressure that radiates to her back. Patient trying to fall asleep when she developed chest pressure with radiation to back and both shoulders, associated with nausea, and later felt clammy. Pressure was ongoing from 9:30PM, unrelieved by SLNTG x 3 in ambulance, and finally subsided after morphine 5mg given ~1AM in ED. The only other time she has had this kind of chest pressure, when a catheterization showed \"no obstructions or clots.\" Patient denies any shortness of breath, vomiting, abdominal pain, fevers, chills, cough. Patient did have a recent car trip.\n", + "input3": "+ Hypertension\n+ Dyslipidemia\n+ Atrial fibrillation s/p ablation\n+ Bradycardia s/p dual-chamber permanent pacemaker\n+ Bilateral subdural hematoma while on warfarin for Afib, s/p \ncraniotomy\n+ CHF (unknown EF)\n+ Asthma (never intubated)\n+ Carcinoid s/p proximal colon and appendix resection\n+ Temporal arteritis\n+ Diverticulitis c/b abscess, s/p resection\n+ Hypothyroidism\n+ Anxiety\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "ADMISSION\nVS: 97.6 159/86-170/93 72 14 94%RA\nGeneral: WDWN woman appearing stated age in no distress\nHEENT: MMM, OP clear \nNeck: no JVD appreciated \nCV: RRR, nl S1, loud S2, no murmur appreciated\nLungs: trace inspiratory crackles and faint expiratory wheeze on left\nAbdomen: soft, NT, normoactive BS, vertical scar below umbilicus\nGU: no foley\nExt: warm, no edema \nNeuro: Pt with slight droop of left face, however appears normal to her husband. nerve strength equal bilaterally. \nstrength in upper and lower compartments bilaterally. \nSkin: no rashes noted\nPULSES: 2+ DP pulses\n", + "input6": "ADMISSION LABS\n01:25AM BLOOD WBC-10.2 RBC-4.33 Hgb-13.0 Hct-39.9 \nMCV-92 MCH-30.0 MCHC-32.6 RDW-13.2\n01:25AM BLOOD Neuts-79.6* Lymphs-12.4* Monos-3.4 \nEos-3.7 Baso-0.9\n01:25AM BLOOD Glucose-167* UreaN-25* Creat-1.0 Na-136 \nK-3.8 Cl-100 HCO3-25 AnGap-15\n07:10AM BLOOD Calcium-9.3 Phos-4.1 Mg-2.0\n01:25AM BLOOD cTropnT-<0.01\n07:10AM BLOOD cTropnT-0.14*\n02:44PM BLOOD CK-MB-57* MB Indx-8.6* cTropnT-2.08*\n09:56PM BLOOD CK-MB-41* MB Indx-7.2* cTropnT-1.63*\n07:40AM BLOOD CK-MB-24* MB Indx-6.0 cTropnT-1.11*\n07:40AM BLOOD Cholest-111\n07:40AM BLOOD HDL-41 CHOL/HD-2.7\n03:10PM BLOOD %HbA1c-6.1* eAG-128*\n07:40AM BLOOD TSH-4.1\n\ufeff\nEKG: Extensive baseline artifact precludes accurate rhythm identification. It is a ventricularly paced rhythm and the atrial mechanism appears to be an atrial flutter versus tachycardia with variable block. No previous tracing available for comparison.\n\ufeff\nEKG: The atrial flutter waves are more defined. The ventricular rhythm remains paced given the regular ventricular rate of 65 beats per minute. There is likely underlying complete heart block with demand ventricular pacing. Findings are similar to tracing #1.\n\ufeff\nCXR: FINDINGS: Portable upright frontal view of the \nchest. A dual-chamber cardiac pacer is present. There is moderate \ncardiomegaly, and an unfolded, slightly tortuous aorta. There are coarse increased interstitial markings throughout both lung bases, consistent with mild interstitial edema. There is no overt pulmonary edema. lines are noted and could reflect chronic CHF. Increased retrocardiac density may represent a combination of atelectasis and CHF findings. No definite focal consolidation. No pleural effusion or pneumothorax is detected. Incidental note made of soft tissue anchor over left humeral head.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17132866-DS-21.json b/Finished/Acute Coronary Syndrome/NSTEMI/17132866-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..43ba735a68a6c518e04ce6bef5520053cbb5c784 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17132866-DS-21.json @@ -0,0 +1,144 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L$Cause_1": { + "BLOOD CK-MB-9 cTropnT-0.23*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain, shortness of breath\n is a symptom of ACS.$Cause_1": { + "Chest pain, shortness of breath$Input1": {} + }, + "he awoke w left sided arm and chest pain, mild, not a/w SOB.\n is sign of acs$Cause_1": { + "2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB.$Input2": {} + }, + "Diabetes is a risk factor$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is a risk factorv$Cause_1": { + "Hypertension$Input3": {} + }, + "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE is a risk factor$Cause_1": { + "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE$Input3": {} + }, + "NEPHROPATHY - DIABETIC stage 3 CKD is a risk factor$Cause_1": { + "NEPHROPATHY - DIABETIC stage 3 CKD$Input3": {} + }, + "HYPERLIPIDEMIA is a risk factor$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "DM - TYPE 1 DIABETES MELLITUS is a risk factor$Cause_1": { + "DM - TYPE 1 DIABETES MELLITUS$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "hx single vessel CAD s/p BMS$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain, shortness of breath\n is a symptom of ACS.$Cause_1": { + "Chest pain, shortness of breath$Input1": {} + }, + "he awoke w left sided arm and chest pain, mild, not a/w SOB.\n is sign of acs$Cause_1": { + "2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB.$Input2": {} + }, + "Diabetes is a risk factor$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is a risk factorv$Cause_1": { + "Hypertension$Input3": {} + }, + "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE is a risk factor$Cause_1": { + "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE$Input3": {} + }, + "NEPHROPATHY - DIABETIC stage 3 CKD is a risk factor$Cause_1": { + "NEPHROPATHY - DIABETIC stage 3 CKD$Input3": {} + }, + "HYPERLIPIDEMIA is a risk factor$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "DM - TYPE 1 DIABETES MELLITUS is a risk factor$Cause_1": { + "DM - TYPE 1 DIABETES MELLITUS$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG w new TWI inferiorly, obs'd for 2 sets.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain, shortness of breath\n is a symptom of ACS.$Cause_1": { + "Chest pain, shortness of breath$Input1": {} + }, + "he awoke w left sided arm and chest pain, mild, not a/w SOB.\n is sign of acs$Cause_1": { + "2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB.$Input2": {} + }, + "Diabetes is a risk factor$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is a risk factorv$Cause_1": { + "Hypertension$Input3": {} + }, + "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE is a risk factor$Cause_1": { + "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE$Input3": {} + }, + "NEPHROPATHY - DIABETIC stage 3 CKD is a risk factor$Cause_1": { + "NEPHROPATHY - DIABETIC stage 3 CKD$Input3": {} + }, + "HYPERLIPIDEMIA is a risk factor$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "DM - TYPE 1 DIABETES MELLITUS is a risk factor$Cause_1": { + "DM - TYPE 1 DIABETES MELLITUS$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "hx single vessel CAD s/p BMS$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain, shortness of breath\n is a symptom of ACS.$Cause_1": { + "Chest pain, shortness of breath$Input1": {} + }, + "he awoke w left sided arm and chest pain, mild, not a/w SOB.\n is sign of acs$Cause_1": { + "2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB.$Input2": {} + }, + "Diabetes is a risk factor$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is a risk factorv$Cause_1": { + "Hypertension$Input3": {} + }, + "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE is a risk factor$Cause_1": { + "CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE$Input3": {} + }, + "NEPHROPATHY - DIABETIC stage 3 CKD is a risk factor$Cause_1": { + "NEPHROPATHY - DIABETIC stage 3 CKD$Input3": {} + }, + "HYPERLIPIDEMIA is a risk factor$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "DM - TYPE 1 DIABETES MELLITUS is a risk factor$Cause_1": { + "DM - TYPE 1 DIABETES MELLITUS$Input3": {} + } + } + } + } + }, + "input1": "Chest pain, shortness of breath\n", + "input2": "hx single vessel CAD s/p BMS, DM1 on insulin pump, HTN, HLP, CKD, legally blind who is s/p cataract surgery with trabeculectomy. 2d later while at home he awoke w left sided arm and chest pain, mild, not a/w SOB. Noted his BS to be in the 400-500s that morning, and went to hosptial for eval. There, initial trop 0.02, EKG w new TWI inferiorly, obs'd for 2 sets. Per pt he stopped all of his cardiac meds (except insulin) for unclear reasons. Was given ASA 325, plavix 75 (not loaded), metop, atorva and heparin gtt and transferred here. On the floor he has no acute complaints.\n", + "input3": "+ Diabetes\n+ Dyslipidemia\n+ Hypertension \n+ CORONARY ARTERY DISEASE, UNSPEC VESSEL TYPE \n+ SEIZURE DISORDER, UNSPEC \n+ OSTEOARTHRITIS, UNSPEC \n+ CATARACT, UNSPEC \n+ NEPHROPATHY - DIABETIC stage 3 CKD \n+ HYPERLIPIDEMIA \n+ VITREOUS HEMORRHAGE \n+ DM - TYPE 1 DIABETES MELLITUS \n+ NEUROPATHY - DIABETIC\n", + "input4": "No DM in family. Reports no medical illnesses in his family\n", + "input5": "Vitals - 98.5 132/77 59 95%RA \nGENERAL: NAD \nHEENT: AT/NC, EOMI \nNECK: no JVD \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi \nABDOMEN: nondistended, +BS, nontender in all quadrants \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing \nor edema \nPULSES: 2+ DP pulses bilaterally \nNEURO: grossly intact \nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes\n", + "input6": "07:00AM BLOOD WBC-4.4 RBC-3.70* Hgb-12.4* Hct-39.8* \nMCV-108* MCH-33.5* MCHC-31.2 RDW-12.2\n07:00AM BLOOD UreaN-22* Creat-1.2 Na-137 K-5.0 Cl-104 \nHCO3-25 AnGap-13\n12:00AM BLOOD CK-MB-9 cTropnT-0.23*\n\ufeff\n07:10AM BLOOD UreaN-24* Creat-1.4* Na-136 K-3.8 Cl-98 \nHCO3-26 AnGap-16\n11:31PM BLOOD CK-MB-12* cTropnT-0.35*\n06:55AM BLOOD CK-MB-120* cTropnT-1.61*\n07:00AM BLOOD CK-MB-82* cTropnT-3.86*\n07:10AM BLOOD CK-MB-25* cTropnT-2.65*\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17183564-DS-13.json b/Finished/Acute Coronary Syndrome/NSTEMI/17183564-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..e0d5f14dda5e9ddc02bc8e4a9a599a0758cbfc73 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17183564-DS-13.json @@ -0,0 +1,108 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "cTropnT-0.60*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "PMHx of HTN and chronic hepatitis are risk facts and Chest Pain is a symptom of ACS$Cause_1": { + "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain.$Input2": {} + }, + "experience chest pain is a symptom of ACS.$Cause_1": { + "The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes.$Input2": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + }, + "Chronic hepatitis C\n is a risk factor$Cause_1": { + "Chronic hepatitis C$Input3": {} + }, + "father deceased before, h/o alcoholism and pancreatitis is a risk fact$Cause_1": { + "father deceased before, h/o alcoholism and pancreatitis$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "acute thrombotic 1 vessel coronary artery disease is a strongly sign of acs$Cause_1": { + "Selective coronary angiography in this right dominant system demonstrated acute thrombotic 1 vessel coronary artery disease.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "PMHx of HTN and chronic hepatitis are risk facts and Chest Pain is a symptom of ACS$Cause_1": { + "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain.$Input2": {} + }, + "experience chest pain is a symptom of ACS.$Cause_1": { + "The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes.$Input2": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + }, + "Chronic hepatitis C\n is a risk factor$Cause_1": { + "Chronic hepatitis C$Input3": {} + }, + "father deceased before, h/o alcoholism and pancreatitis is a risk fact$Cause_1": { + "father deceased before, h/o alcoholism and pancreatitis$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "PMHx of HTN and chronic hepatitis are risk facts and Chest Pain is a symptom of ACS$Cause_1": { + "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain.$Input2": {} + }, + "experience chest pain is a symptom of ACS.$Cause_1": { + "The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes.$Input2": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + }, + "Chronic hepatitis C\n is a risk factor$Cause_1": { + "Chronic hepatitis C$Input3": {} + }, + "father deceased before, h/o alcoholism and pancreatitis is a risk fact$Cause_1": { + "father deceased before, h/o alcoholism and pancreatitis$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "acute thrombotic 1 vessel coronary artery disease is a strongly sign of acs$Cause_1": { + "Selective coronary angiography in this right dominant system demonstrated acute thrombotic 1 vessel coronary artery disease.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "PMHx of HTN and chronic hepatitis are risk facts and Chest Pain is a symptom of ACS$Cause_1": { + "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain.$Input2": {} + }, + "experience chest pain is a symptom of ACS.$Cause_1": { + "The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes.$Input2": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + }, + "Chronic hepatitis C\n is a risk factor$Cause_1": { + "Chronic hepatitis C$Input3": {} + }, + "father deceased before, h/o alcoholism and pancreatitis is a risk fact$Cause_1": { + "father deceased before, h/o alcoholism and pancreatitis$Input4": {} + } + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "a man with PMHx of HTN and chronic hepatitis C who presents with substernal chest pain. The patient reports that he was sitting in a recliner this AM drinking coffee, when he began to experience chest pain. The pain dissipated sponatneously after a few minutes, and then returned for approximately 30 minutes. The pain resolved immediately with nitro and aspirin administered by the EMTs. Reports tingling down both extremities and associated diaphoresis and shortness of breath. Denies nausea, vomiting, palpitations, and loss of conscioussness. The patient reports no cardiac history, and has never experienced chest pain like this before.\n", + "input3": "+ HTN\n+ Chronic hepatitis C\n+ h/o H. pylori\n+ h/o bacterial PNA\n+ h/o acute pancreatitis\n+ s/p lap cholecystectomy\n", + "input4": "father deceased before, h/o alcoholism and pancreatitis\n", + "input5": "VS - 98.9 134/82 59 97% RA\nGen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: PERRL, EOMI. \nNeck: Supple.\nCV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \n \nChest: Resp were unlabored, no accessory muscle use. CTAB anteriorly.\nAbd: Soft, NTND. No HSM or tenderness. \nExt: No c/c/e. No femoral bruits. No hematoma.\n", + "input6": "Labs:\n06:20AM BLOOD WBC-5.6 RBC-4.43* Hgb-13.9* Hct-40.7 MCV-92 MCH-31.3 MCHC-34.0 RDW-13.1\n06:20AM BLOOD Neuts-53.1 Monos-4.1 Eos-1.4 Baso-1.1\n06:20AM BLOOD Glucose-120* UreaN-21* Creat-1.0 Na-140 \nK-3.9 Cl-107 HCO3-27 AnGap-10\n06:20AM BLOOD cTropnT-0.60*\n06:20AM BLOOD CK-MB-3 cTropnT-0.09*\n06:20AM BLOOD Triglyc-128 HDL-38 CHOL/HD-3.8 LDLcalc-81\n\ufeff\nCath Report:\n1. Selective coronary angiography in this right dominant system demonstrated acute thrombotic 1 vessel coronary artery disease. The LMCA, LAD, and LCx had no angiographically apparent flow-limiting disease. The RCA had a 90% proximal stenosis with extensive thrombus,as well as a 70% mid to distal segment stenosis.\n2. Limited resting hemodynamics revealed mild systemic systolic arterial hypertension with an SBP of 145 mmHg.\n3. Successful angiojet/PTCA/stenting of the mid and distal RCA: the mid-distal RCA was stented with a VISIOn 3.5x12mm bare-metal stent (BMS) and post-dilated with an NC Quantum Apex MR 3.75x20mm balloon and the mid RCA was stented with a VISION 3.5x28mm BMS and then postdilated with an NC Quantum Apex OTW 4.0x20mm balloon. Final angiography revealed 0%residual stenosis, no angiographically apparent dissection and normal flow.\n4. femoral artery angioseal closure device deployed without complications.\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17357689-DS-2.json b/Finished/Acute Coronary Syndrome/NSTEMI/17357689-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..c38b04afcd1600354d4e09f93aa28b53a5d24865 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17357689-DS-2.json @@ -0,0 +1,147 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "BLOOD CK-MB-20* MB Indx-9.4* cTropnT-0.18*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "BLOOD CK-MB-16* MB Indx-9.7* cTropnT-0.17*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "T2DM, HTN are risk facts$Cause_1": { + "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days.$Input2": {} + }, + "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.\n is signs of acs$Cause_1": { + "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.$Input2": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + }, + "T2DM is a risk factor$Cause_1": { + "T2DM$Input3": {} + }, + "Hypercholesterolemia is a risk factor$Cause_1": { + "Hypercholesterolemia$Input3": {} + }, + "Family history:Brothers x2 w/ CABG is a big risk factor$Cause_1": { + "Brothers x2 w/ CABG$Input4": {} + }, + "Family history:Sister with MI is a big risk factor$Cause_1": { + "Sister with MI$Input4": {} + }, + "Family history:Father died of MI is a big risk factor$Cause_1": { + "Father died of MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Compared to tracing xx wave abnormalities. The small Q waves are unchanged. Clinical correlation is suggested.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "T2DM, HTN are risk facts$Cause_1": { + "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days.$Input2": {} + }, + "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.\n is signs of acs$Cause_1": { + "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.$Input2": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + }, + "T2DM is a risk factor$Cause_1": { + "T2DM$Input3": {} + }, + "Hypercholesterolemia is a risk factor$Cause_1": { + "Hypercholesterolemia$Input3": {} + }, + "Family history:Brothers x2 w/ CABG is a big risk factor$Cause_1": { + "Brothers x2 w/ CABG$Input4": {} + }, + "Family history:Sister with MI is a big risk factor$Cause_1": { + "Sister with MI$Input4": {} + }, + "Family history:Father died of MI is a big risk factor$Cause_1": { + "Father died of MI$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG: Sinus rhythm. Modest inferolateral ST-T wave abnormalities. Cannot rule out myocardial ischemia. Prominent early R wave progression. No previous tracing available for comparison. Clinical correlation is suggested.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "T2DM, HTN are risk facts$Cause_1": { + "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days.$Input2": {} + }, + "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.\n is signs of acs$Cause_1": { + "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.$Input2": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + }, + "T2DM is a risk factor$Cause_1": { + "T2DM$Input3": {} + }, + "Hypercholesterolemia is a risk factor$Cause_1": { + "Hypercholesterolemia$Input3": {} + }, + "Family history:Brothers x2 w/ CABG is a big risk factor$Cause_1": { + "Brothers x2 w/ CABG$Input4": {} + }, + "Family history:Sister with MI is a big risk factor$Cause_1": { + "Sister with MI$Input4": {} + }, + "Family history:Father died of MI is a big risk factor$Cause_1": { + "Father died of MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Compared to tracing xx wave abnormalities. The small Q waves are unchanged. Clinical correlation is suggested.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "T2DM, HTN are risk facts$Cause_1": { + "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days.$Input2": {} + }, + "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.\n is signs of acs$Cause_1": { + "Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm.$Input2": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + }, + "T2DM is a risk factor$Cause_1": { + "T2DM$Input3": {} + }, + "Hypercholesterolemia is a risk factor$Cause_1": { + "Hypercholesterolemia$Input3": {} + }, + "Family history:Brothers x2 w/ CABG is a big risk factor$Cause_1": { + "Brothers x2 w/ CABG$Input4": {} + }, + "Family history:Sister with MI is a big risk factor$Cause_1": { + "Sister with MI$Input4": {} + }, + "Family history:Father died of MI is a big risk factor$Cause_1": { + "Father died of MI$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "with T2DM, HTN who presents with exertional chest tightness and dyspnea x3 days. Episodic, duration of episodes becoming longer, associated with activity. Radiation to left side of neck and left arm. Associated with nausea and dyspepsia. Denies vomiting, abdominal pain. Reports having had a prior stress test that showed a \"minor blockage.\" but has never had a cardiac cath. Strong FH of CAD in 1st degree relatives. pain free in the ED.\n", + "input3": "+ HTN\n+ T2DM\n+ Hypercholesterolemia\n+ Carpal tunnel syndrome\n+ Claudication (ABI's negative)\n", + "input4": "Brothers x2 w/ CABG\nSister with MI\nFather died of MI\nNo family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "ADMISSION PHYSICAL EXAMINATION: \nVS: T 98.2, 146/71, 78, 18, 100%RA\nGeneral: Middle-aged woman in NAD\nHEENT: Anicteric sclera, MMM\nNeck: No JVD\nCV: RRR w/o m/r/g\nLungs: CTAB\nAbdomen: Soft, NTND\nGU: No foley\nExt: No clubbing, cyanosis or edema \nNeuro: A&Ox3, moving all extremities\nPULSES: 2+ radial and DP pulses bilaterally\n", + "input6": "==== ADMISSION LABS ====\n\ufeff\n07:00AM BLOOD WBC-9.8 RBC-4.22 Hgb-12.4 Hct-37.2 MCV-88 MCH-29.4 MCHC-33.4 RDW-13.4\n07:00AM BLOOD Neuts-75.6* Lymphs-15.7* Monos-4.8 \nEos-3.6 Baso-0.4\n07:00AM BLOOD Glucose-327* UreaN-23* Creat-0.7 Na-139 K-4.2 Cl-102 HCO3-29 AnGap-12\n05:50AM BLOOD Calcium-8.8 Phos-3.5 Mg-2.0\n\ufeff\n==== PERTINENT LABS ====\n\ufeff\n07:00AM BLOOD proBNP-429*\n07:00AM BLOOD cTropnT-0.05*\n02:00PM BLOOD cTropnT-0.12*\n07:37PM BLOOD CK-MB-20* MB Indx-9.4* cTropnT-0.18*\n___ 05:50AM BLOOD CK-MB-16* MB Indx-9.7* cTropnT-0.17*\n\ufeff\n==== IMAGING ====\n\ufeff\nCXR:\nNo acute cardiopulmonary process.\n\ufeff\nEKG: Sinus rhythm. Compared to tracing xx wave abnormalities. The small Q waves are unchanged. Clinical correlation is suggested. \n\ufeff\nEKG: Sinus rhythm. Prominent early R wave progression. Inferior ST-T wave abnormality. Cannot rule out myocardial ischemia. Compared to the previous tracing there is no significant diagnostic change. \n\ufeff\nEKG: Sinus rhythm. Modest inferolateral ST-T wave abnormalities. Cannot rule out myocardial ischemia. Prominent early R wave progression. No previous tracing available for comparison. Clinical correlation is suggested.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17399182-DS-7.json b/Finished/Acute Coronary Syndrome/NSTEMI/17399182-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..7dc9fa6af0799dbb4224d292ba7b6e137f211efe --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17399182-DS-7.json @@ -0,0 +1,111 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "Seen at and was reportedly found to have a troponin of 4.55 (could have been trop I?).$Input2": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L$Cause_1": { + "BLOOD cTropnT-0.33*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "1 week of exertional angina and dyspnea. is a sign of acs$Cause_1": { + "man presents emergency room today with 1 week of exertional angina and dyspnea.$Input2": {} + }, + "fistula (rectal) repair is a risk factor$Cause_1": { + "fistula (rectal) repair$Input3": {} + }, + "hemorrhoids is a risk factor$Cause_1": { + "hemorrhoids$Input3": {} + }, + "Family history:Mother with stroke and MI is a big risk factor$Cause_1": { + "Mother with stroke and MI$Input4": {} + }, + "Family history:Sister with MI is a big risk factor$Cause_1": { + "Sister with DM$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Mild to moderate aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Moderate (2+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "1 week of exertional angina and dyspnea. is a sign of acs$Cause_1": { + "man presents emergency room today with 1 week of exertional angina and dyspnea.$Input2": {} + }, + "fistula (rectal) repair is a risk factor$Cause_1": { + "fistula (rectal) repair$Input3": {} + }, + "hemorrhoids is a risk factor$Cause_1": { + "hemorrhoids$Input3": {} + }, + "Family history:Mother with stroke and MI is a big risk factor$Cause_1": { + "Mother with stroke and MI$Input4": {} + }, + "Family history:Sister with MI is a big risk factor$Cause_1": { + "Sister with DM$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "1 week of exertional angina and dyspnea. is a sign of acs$Cause_1": { + "man presents emergency room today with 1 week of exertional angina and dyspnea.$Input2": {} + }, + "fistula (rectal) repair is a risk factor$Cause_1": { + "fistula (rectal) repair$Input3": {} + }, + "hemorrhoids is a risk factor$Cause_1": { + "hemorrhoids$Input3": {} + }, + "Family history:Mother with stroke and MI is a big risk factor$Cause_1": { + "Mother with stroke and MI$Input4": {} + }, + "Family history:Sister with MI is a big risk factor$Cause_1": { + "Sister with DM$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Mild to moderate aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Moderate (2+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "1 week of exertional angina and dyspnea. is a sign of acs$Cause_1": { + "man presents emergency room today with 1 week of exertional angina and dyspnea.$Input2": {} + }, + "fistula (rectal) repair is a risk factor$Cause_1": { + "fistula (rectal) repair$Input3": {} + }, + "hemorrhoids is a risk factor$Cause_1": { + "hemorrhoids$Input3": {} + }, + "Family history:Mother with stroke and MI is a big risk factor$Cause_1": { + "Mother with stroke and MI$Input4": {} + }, + "Family history:Sister with MI is a big risk factor$Cause_1": { + "Sister with DM$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "This is an otherwise healthy man presents emergency room today with 1 week of exertional angina and dyspnea. Seen at and was reportedly found to have a troponin of 4.55 (could have been trop I?). Started on heparin and given aspirin at OS, then transferred for higher level of care. \n\ufeff\nThe pt is accompanied by his son and daughter, whom are both college students. He is currently in the visiting his children and is in for 17 more days. The son provided translation. The pt started having substernal chest pain 1 week ago, only with walking. He has never had the pain at rest. He denies accompanying symptoms, including diaphoresis, nausea, arm/jaw pain.\n", + "input3": "+ fistula (rectal) repair\n+ hemorrhoids\n", + "input4": "Mother with stroke and MI\nSister with DM\n", + "input5": "ADMISSION PHYSICAL EXAM:\n\ufeff\nVS: 1547 98.2 135/85 60 18 95 Ra \nGENERAL: WDWN. Pleasant. Accompanied by daughter and son. In NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\ufeff\nNECK: Supple with no JVD. \nCARDIAC: PMI located in intercostal space, midclavicular \nline. RRR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: 2+ peripheral pulses\n", + "input6": "ADMISSION LABS:\n=====================\n01:45PM BLOOD WBC-7.2 RBC-5.59 Hgb-15.8 Hct-47.5 MCV-85 MCH-28.3 MCHC-33.3 RDW-12.6 RDWSD-39.2\n01:45PM BLOOD Neuts-73.5* Monos-5.7 \nEos-0.4* Baso-0.1 AbsNeut-5.29 AbsLymp-1.44 AbsMono-0.41 AbsEos-0.03* AbsBaso-0.01\n01:45PM BLOOD Glucose-102* UreaN-12 Creat-1.0 Na-139 K-4.2 Cl-101 HCO3-26 AnGap-16\n01:45PM BLOOD cTropnT-0.33*\n\ufeff\nCardiovascular ECHO:\nThe left atrial volume index is normal. No atrial septal defect is seen by 2D or color Doppler. Normal left ventricular wall thickness, cavity size, and global systolic function (3D LVEF = 55 %). 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) appear structurally normal with good leaflet excursion and no aortic stenosis. Mild to moderate aortic regurgitation is seen. The mitral valve leaflets are structurally normal. Moderate (2+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. \n\ufeff\nIMPRESSION: Normal biventricular cavity sizes with preserved regional and global biventricular systolic function. Mild-moderate aortic regurgitation. Moderate mitral regurgitation. Mild pulmonary artery systolic hypertension.\n\nECG:non-ST-elevation \n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17409962-DS-5.json b/Finished/Acute Coronary Syndrome/NSTEMI/17409962-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..ac9b1e88f982ce8e2e2861a5e333ddc18fb19aad --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17409962-DS-5.json @@ -0,0 +1,123 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L.$Cause_1": { + "CK-MB-12* MB Indx-3.8 cTropnT-0.33*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L$Cause_1": { + "CK-MB-5 cTropnT-0.45*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "HTN and yperlipidemia who presents with weeks of exterional chest pain.\n is a risk fact$Cause_1": { + "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain.$Input2": {} + }, + "he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.\n is a sign of acs$Cause_1": { + "atient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.$Input2": {} + }, + "Dyslipidemia, Hypertension is a risk factor$Cause_1": { + "CARDIAC RISK FACTORS: Dyslipidemia, Hypertension$Input3": {} + }, + "BPH, depression is a risk factor$Cause_1": { + "OTHER PAST MEDICAL HISTORY: BPH, depression$Input3": {} + }, + "Family history:Brother with MI is a big risk factor$Cause_1": { + "Brother with MI$Input4": {} + }, + "Family history:Father with MI is a big risk factor$Cause_1": { + "Father with MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. No pulmonary vascular congestion is present.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "HTN and yperlipidemia who presents with weeks of exterional chest pain.\n is a risk fact$Cause_1": { + "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain.$Input2": {} + }, + "he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.\n is a sign of acs$Cause_1": { + "atient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.$Input2": {} + }, + "Dyslipidemia, Hypertension is a risk factor$Cause_1": { + "CARDIAC RISK FACTORS: Dyslipidemia, Hypertension$Input3": {} + }, + "BPH, depression is a risk factor$Cause_1": { + "OTHER PAST MEDICAL HISTORY: BPH, depression$Input3": {} + }, + "Family history:Brother with MI is a big risk factor$Cause_1": { + "Brother with MI$Input4": {} + }, + "Family history:Father with MI is a big risk factor$Cause_1": { + "Father with MI$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG (resident read): \nNSR 80, NA/NI, ST depressions in III, aVF, V2-3$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "HTN and yperlipidemia who presents with weeks of exterional chest pain.\n is a risk fact$Cause_1": { + "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain.$Input2": {} + }, + "he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.\n is a sign of acs$Cause_1": { + "atient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.$Input2": {} + }, + "Dyslipidemia, Hypertension is a risk factor$Cause_1": { + "CARDIAC RISK FACTORS: Dyslipidemia, Hypertension$Input3": {} + }, + "BPH, depression is a risk factor$Cause_1": { + "OTHER PAST MEDICAL HISTORY: BPH, depression$Input3": {} + }, + "Family history:Brother with MI is a big risk factor$Cause_1": { + "Brother with MI$Input4": {} + }, + "Family history:Father with MI is a big risk factor$Cause_1": { + "Father with MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Cardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. No pulmonary vascular congestion is present.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "HTN and yperlipidemia who presents with weeks of exterional chest pain.\n is a risk fact$Cause_1": { + "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain.$Input2": {} + }, + "he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.\n is a sign of acs$Cause_1": { + "atient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home.$Input2": {} + }, + "Dyslipidemia, Hypertension is a risk factor$Cause_1": { + "CARDIAC RISK FACTORS: Dyslipidemia, Hypertension$Input3": {} + }, + "BPH, depression is a risk factor$Cause_1": { + "OTHER PAST MEDICAL HISTORY: BPH, depression$Input3": {} + }, + "Family history:Brother with MI is a big risk factor$Cause_1": { + "Brother with MI$Input4": {} + }, + "Family history:Father with MI is a big risk factor$Cause_1": { + "Father with MI$Input4": {} + } + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "He is a gentleman with with HTN and yperlipidemia who presents with weeks of exterional chest pain. \n\ufeff\nPatient reports that for the last two weeks he has noticed chest tightness in his sternum when walking blocks or climbing the stairs in his home. He tried to continue activities despite the discomfort, which would resolve spontaneously. He has not had previous episodes of chest pain and has never needed cardiac evaluation, though he does have a strong family history of CAD. He was driving from house to company and awoke yesterday with the same chest pain; however, unlike previous episodes it did not resolve completely. This morning, he awoke with the same pain, now radiating to his back and right shoulder. He denies lightheadedness, nausea, lightheadedness, diaphoresis, SOB with these episodes of chest pain. He has had left calf pain for several years when standing for prolonged periods of time; this has not changed.\n", + "input3": "1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension \n2. CARDIAC HISTORY: None \n3. OTHER PAST MEDICAL HISTORY: BPH, depression\n", + "input4": "Brother with MI\nFather with MI\n", + "input5": "ADMISSION EXAM\nVS: 98.6 129/94 72 18 96%RA \nGENERAL: WDWN male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\ufeff\nNECK: Supple, no JVD \nCARDIAC: PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nNEURO: A & O x 3, no focal neuro deficits\n", + "input6": "ADMISSION LABS\n08:40PM BLOOD WBC-10.7 RBC-4.54* Hgb-14.1 Hct-40.7 MCV-90 MCH-31.0 MCHC-34.6 RDW-12.8\n08:40PM BLOOD Glucose-110* UreaN-12 Creat-0.9 Na-137 \nK-4.3 Cl-98 HCO3-25 AnGap-18\n08:40PM BLOOD CK(CPK)-344*\n05:40AM BLOOD Calcium-9.6 Phos-3.5 Mg-2.2 Cholest-358*\n08:40PM BLOOD D-Dimer-655*\n05:40AM BLOOD Triglyc-296* HDL-44 CHOL/HD-8.1 \nLDLcalc-255*\n\ufeff\nENZYMES\n08:40PM BLOOD CK-MB-15* MB Indx-4.4\n08:40PM BLOOD cTropnT-0.17*\n05:40AM BLOOD CK-MB-12* MB Indx-3.8 cTropnT-0.33*\n04:50PM BLOOD CK-MB-7 cTropnT-0.45*\n06:45AM BLOOD CK-MB-5 cTropnT-0.45*\n08:40PM BLOOD CK(CPK)-344*\n05:40AM BLOOD ALT-37 AST-53* CK(CPK)-317\n04:50PM BLOOD CK(CPK)-255\n\ufeff\nSTUDIES\nCTA\n1. No pulmonary embolus. \n2. Esophageal thickening which may represent reflux \n\ufeff\nCXR\nCardiac silhouette size is normal. Mediastinal and hilar contours are unremarkable. No pulmonary vascular congestion is present. Aside from mild bibasilar atelectasis, the lungs are clear. No focal consolidation, pleural effusion or pneumothorax is seen. There are multilevel degenerative changes in the thoracic spine. IMPRESSION: No acute cardiopulmonary abnormality. \n\ufeff\nEKG (resident read): \nNSR 80, NA/NI, ST depressions in III, aVF, V2-3\n\ufeff\nCardiac Catheterization:\nFINAL REPORT PENDING\nPLEASE SEE DISC AND PRELIM REPORT (disc and hardcopies provided to patient)\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17505744-DS-20.json b/Finished/Acute Coronary Syndrome/NSTEMI/17505744-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..2cd3b0976350e93465759ea28bf6dc5b462b7b21 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17505744-DS-20.json @@ -0,0 +1,108 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "but tropoin I peaked at 1.09.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "\"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. is sign ofa acs$Cause_1": { + "she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank$Input2": {} + }, + "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery\n is a risk factor$Cause_1": { + "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery$Input3": {} + }, + "AAA- 4.9cm on OSH CT extending superiorly ofof the is a risk factor$Cause_1": { + "AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies$Input3": {} + }, + "COPD is a risk factor$Cause_1": { + "COPD$Input3": {} + }, + "family histoy:brother and sister with MIs. is a risk fact.$Cause_1": { + "brother and sister with MIs.$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "OSH Echo: EF 55%, no signifiacnt valvular dz, and mild distal septal hypokinesis. Aortic root was normal in size.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "\"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. is sign ofa acs$Cause_1": { + "she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank$Input2": {} + }, + "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery\n is a risk factor$Cause_1": { + "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery$Input3": {} + }, + "AAA- 4.9cm on OSH CT extending superiorly ofof the is a risk factor$Cause_1": { + "AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies$Input3": {} + }, + "COPD is a risk factor$Cause_1": { + "COPD$Input3": {} + }, + "family histoy:brother and sister with MIs. is a risk fact.$Cause_1": { + "brother and sister with MIs.$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG: NSR, no ST changes, no q waves, TWI in V1,2,3, TW flattening V5,V6$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "\"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. is sign ofa acs$Cause_1": { + "she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank$Input2": {} + }, + "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery\n is a risk factor$Cause_1": { + "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery$Input3": {} + }, + "AAA- 4.9cm on OSH CT extending superiorly ofof the is a risk factor$Cause_1": { + "AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies$Input3": {} + }, + "COPD is a risk factor$Cause_1": { + "COPD$Input3": {} + }, + "family histoy:brother and sister with MIs. is a risk fact.$Cause_1": { + "brother and sister with MIs.$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "OSH Echo: EF 55%, no signifiacnt valvular dz, and mild distal septal hypokinesis. Aortic root was normal in size.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "\"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. is sign ofa acs$Cause_1": { + "she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank$Input2": {} + }, + "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery\n is a risk factor$Cause_1": { + "thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery$Input3": {} + }, + "AAA- 4.9cm on OSH CT extending superiorly ofof the is a risk factor$Cause_1": { + "AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies$Input3": {} + }, + "COPD is a risk factor$Cause_1": { + "COPD$Input3": {} + }, + "family histoy:brother and sister with MIs. is a risk fact.$Cause_1": { + "brother and sister with MIs.$Input4": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "F with h/o thoracic and abdominal aortic aneurysm with recent NSTEMI medically managed w/o intervention, now presenting with new CP begining today, transferred from OSH ED for possible cardiac cath. With pt's NSTEMI, she described her CP as \"heaviness\" at the center and L side of her chest, with SOB, and severe diaphoresis, along with radiation to the L shoulder and L flank. No EKG changes, but tropoin I peaked at 1.09. Echo on d/c showed EF 55%. Pt was transferred for \ntertiary care/cardiac and vascular eval, but she left AMA after being scared off by the vascular surgeon. Then today she had another episode of CP at 5am. Pt described it as similar in quality, and was brought to the ED. The CP resolved there with NTG sl. The EKG was changed from previous in now having TWI V2/3, flattening V4-6, .5 mm depression v4. She was then transferred from the ED for possible cath. \n. \nIn the ED, initial vitals were 97.3, 122/82, 60, 18, 99%2L pt was CP free. Currently she denies any CP, says she is a little SOB but this is chronic. \n. \nOn review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. \n. \nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope\n", + "input3": "+ thoracic aortic aneurysm 4.4cm on OSH CT originating just distal to the origin of the L subclavian artery \n+ AAA- 4.9cm on OSH CT extending superiorly ofof the \nrenal arteies \n+ COPD \n+ diffuse panlobar \n+ h/o diverticulitis \n+ fibromyalgia \n+ migraine headaches \n+ recent UTI -GNR >100,000, tx w/ levaquin\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death. Father was a police and was killed in duty. brother and sister with MIs.\n", + "input5": "VS: 97.8, 112/73, 66, 20, 98%3L \nGENERAL: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\n\nNECK: Supple with flat \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. bibasilar rales\n", + "input6": "Trop-T: <0.01 CK: 98 MB: Notdone \n140 101 10 \n---------------< 90 \n3.7 29 0.5 \nMCV: 88 \n11.2 \n6.1 >------< 345 \n33.5 \nN:72 Band:0 M:6 E:1 Bas:0 \nEKG: NSR, no ST changes, no q waves, TWI in V1,2,3, TW flattening V5,V6 \n. \nOSH Echo: EF 55%, no signifiacnt valvular dz, and mild distal septal hypokinesis. Aortic root was normal in size.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17509032-DS-16.json b/Finished/Acute Coronary Syndrome/NSTEMI/17509032-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..987cb8d79608f7624189971c6ad650d35fe389bf --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17509032-DS-16.json @@ -0,0 +1,72 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "CK-MB-31* cTropnT-0.25*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "old with DM,CAD, CABG, HTN, DM, PVD, are risk facts$Cause_1": { + "PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM,$Input3": {} + }, + "GERD,hypothyroidism are risk facts$Cause_1": { + "GERD,hypothyroidism$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "CP/NSTEMI. He underwent diagnostic cath which showed occluded OM and diagonal vessels filling via collaterals and patent LIMA to LAD and SVG to PDA.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "old with DM,CAD, CABG, HTN, DM, PVD, are risk facts$Cause_1": { + "PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM,$Input3": {} + }, + "GERD,hypothyroidism are risk facts$Cause_1": { + "GERD,hypothyroidism$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "old with DM,CAD, CABG, HTN, DM, PVD, are risk facts$Cause_1": { + "PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM,$Input3": {} + }, + "GERD,hypothyroidism are risk facts$Cause_1": { + "GERD,hypothyroidism$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "CP/NSTEMI. He underwent diagnostic cath which showed occluded OM and diagonal vessels filling via collaterals and patent LIMA to LAD and SVG to PDA.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "old with DM,CAD, CABG, HTN, DM, PVD, are risk facts$Cause_1": { + "PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM,$Input3": {} + }, + "GERD,hypothyroidism are risk facts$Cause_1": { + "GERD,hypothyroidism$Input3": {} + } + } + } + } + }, + "input1": "Chest pain \n", + "input2": "old with DM,CAD, CABG, HTN, DM, PVD, cardiomyopathy with EF 30% and BiV ICD who was tx for a cath after NSTEMI/CP. He is s/p diagnostic cath. Left radial, which showed occluded OM and diagonal vessels filling via collaterals and patent LIMA to LAD and SVG to PDA (see cath report for details).\n", + "input3": "+ PMH: PVD, CAD s/p MI, HTN, hyperlipidemia, DM, \n+ GERD,hypothyroidism\n", + "input4": "Non-contributory\n", + "input5": "VS: temp 98.3 HR 59 RR 18 BP 120-61 O2 sat 96% on room air\nGen: alert, in no acute distress\nCV: RRR, S1S2, no murmurs\nLungs: CTAB\nAbd: NT, ND, soft\nExt: no edema\nNeuro: alert, oriented X3, no focal deficits\nTele: AS-VP\n", + "input6": "03:55PM WBC-9.2 RBC-4.30* HGB-13.0* HCT-39.1* MCV-91 \nMCH-30.2 MCHC-33.2 RDW-13.6 RDWSD-45.4\n03:55PM PLT COUNT-155\n03:47PM UREA N-12 CREAT-0.7 SODIUM-137 POTASSIUM-4.1 \nCHLORIDE-104 TOTAL CO2-24 ANION GAP-13\n03:47PM estGFR-Using this\n03:47PM CK-MB-31* cTropnT-0.25*\n03:47PM CALCIUM-8.8 PHOSPHATE-4.5 MAGNESIUM-1.male with DM, CAD, CM was admitted with \nCP/NSTEMI. He underwent diagnostic cath which showed occluded OM and diagonal vessels filling via collaterals and patent LIMA to LAD and SVG to PDA. He had no complications post procedure and was admitted to the telemetry floor for overnight monitoring. He had no further symptoms and is being continued on all his home cardiac medications and started on isosorbide 30mg PO daily. His labs remained stable. He is being discharge to home today.\nECG:non-ST-elevation \n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17511292-DS-12.json b/Finished/Acute Coronary Syndrome/NSTEMI/17511292-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..a81276300f74b2685f43a1e309247fa33078577d --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17511292-DS-12.json @@ -0,0 +1,114 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "BLOOD CK-MB-3 cTropnT-0.38*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain on exertion is a symptom of ACS.$Cause_1": { + "Chest pain on exertion$Input1": {} + }, + "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.\n is sign of acs$Cause_1": { + "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.$Input2": {} + }, + "Diabetes is a risk factor$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "family fistory: brother has hypertension is a risk fact$Cause_1": { + "brother has hypertension$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "PERCUTANEOUS CORONARY INTERVENTIONS: 2 x DES to RCA per report. Most recent cath - LAD w/ 40% mid-occlusion, normal LCx, RCA w/ 99% occlusion at the origin of the PDA, and 40% occluded ramus. \n+ PACING/ICD: pacemaker for complete heart block s/p multiple lead revisions$Input3": {} + }, + "The heart structure is abnormalwhich is a strongly sign of acs\n\n\n.$Cause_1": { + "The large high OM1 (functionally a ramus intermedius) had a mild ostial plaque and patent stents. Flow was slightly slow and pulsatile, consistent with microvascular dysfunction.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain on exertion is a symptom of ACS.$Cause_1": { + "Chest pain on exertion$Input1": {} + }, + "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.\n is sign of acs$Cause_1": { + "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.$Input2": {} + }, + "Diabetes is a risk factor$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "family fistory: brother has hypertension is a risk fact$Cause_1": { + "brother has hypertension$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "She went outside hospital had a negative EKG$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain on exertion is a symptom of ACS.$Cause_1": { + "Chest pain on exertion$Input1": {} + }, + "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.\n is sign of acs$Cause_1": { + "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.$Input2": {} + }, + "Diabetes is a risk factor$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "family fistory: brother has hypertension is a risk fact$Cause_1": { + "brother has hypertension$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "PERCUTANEOUS CORONARY INTERVENTIONS: 2 x DES to RCA per report. Most recent cath - LAD w/ 40% mid-occlusion, normal LCx, RCA w/ 99% occlusion at the origin of the PDA, and 40% occluded ramus. \n+ PACING/ICD: pacemaker for complete heart block s/p multiple lead revisions$Input3": {} + }, + "The heart structure is abnormalwhich is a strongly sign of acs\n\n\n.$Cause_1": { + "The large high OM1 (functionally a ramus intermedius) had a mild ostial plaque and patent stents. Flow was slightly slow and pulsatile, consistent with microvascular dysfunction.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain on exertion is a symptom of ACS.$Cause_1": { + "Chest pain on exertion$Input1": {} + }, + "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.\n is sign of acs$Cause_1": { + "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.$Input2": {} + }, + "Diabetes is a risk factor$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "family fistory: brother has hypertension is a risk fact$Cause_1": { + "brother has hypertension$Input4": {} + } + } + } + } + }, + "input1": "Chest pain on exertion\n", + "input2": "This patient is a male who complains of Chest pain, Transfer. Patient presents with intermittent chest pain for 3 days. Patient states is worse with exercise.Patient denies any shortness of breath. But does note fatigue when he gets chest pain. Patient states when he stops ambulating and improves. He denies any fevers or chills. She went outside hospital had a negative EKG \n", + "input3": "+ Diabetes\n+ Dyslipidemia\n+ Hypertension\n+ CABG: none\n+ PERCUTANEOUS CORONARY INTERVENTIONS: 2 x DES to RCA per report. Most recent cath - LAD w/ 40% mid-occlusion, normal LCx, RCA w/ 99% occlusion at the origin of the PDA, and 40% occluded ramus. \n+ PACING/ICD: pacemaker for complete heart block s/p multiple lead revisions \n+ RBBB\n+ GERD \n+ B12 deficiency \n+ allergic rhinitis \n+ chronic sinusitis \n+ AAA \n+ peripheral neuropathy \n+ lumbar degenerative disc disease \n+ h/o strokes \n+ BPH\n", + "input4": "-father died from liver disease \n-mother died from complications after cholecystectomy \n-brother has hypertension\n", + "input5": "Admission PE: \nVitals - T: 98.3 BP: 174-190/81-93 HR: 62 RR: 18 02 sat: 98% RA \n\ufeff\nGENERAL: NAD \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, patent nares, MMM, good dentition \nNECK: nontender supple neck, no LAD, no JVD (8cm) \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding. \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing or edema \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "Admission Labs: \n\ufeff\n07:00AM BLOOD WBC-5.6 RBC-4.61 Hgb-13.0* Hct-40.4 \nMCV-88 MCH-28.3 MCHC-32.3 RDW-15.0\n07:00AM BLOOD Glucose-111* UreaN-13 Creat-1.3* Na-141 \nK-3.6 Cl-106 HCO3-28 AnGap-11\n01:00AM BLOOD CK(CPK)-125\n01:00AM BLOOD CK-MB-3 cTropnT-0.08*\n07:00AM BLOOD CK-MB-3 cTropnT-0.38*\n07:00AM BLOOD Calcium-8.9 Phos-2.7 Mg-2.1\n\ufeff\nIMAGING:\n\ufeff\nCath: \nCoronary angiography: right dominant\nLMCA: The moderate long LMCA tapered to 35% distally.\nLAD: The LAD had an ostial 30% stenosis. There was a proximal-mid diffuse LAD lesion to 60% beginning just before S1. A mildly diseased segment of the mid LAD may have been intramyocardial. There was a very distal apical 75% stenosis (unchanged from previous) before the LAD wrapped around the apex in a terminal bifurcation. The distal diagonals were fairly large and long vessels. Flow in the LAD was slow, consistent with microvascular dysfunction. There were septal collaterals to the\nRPDA.\nLCX: The large high OM1 (functionally a ramus intermedius) had a mild ostial plaque and patent stents. Flow was slightly slow and pulsatile, consistent with microvascular dysfunction. The true AV groove CX was small, diffusely diseased and supplied several small OM and LPL branches, as well as several small atrial branches.\nRCA: The RCA had diffuse disease throughout the mid-distal vessel to 35% mid vessel and 45% in the mid-distal RCA. The prior stent(s) in the distal RCA before the RPDA were patent. The RPDA was subtotally occluded with 99% stenosis at its origin and minimal antegrade filling (TIMI 1), likely the culprit lesion for the current (? recent vs. subacute) NSTEMI. The AV groove RCA just after the RPDA had an 85% stenosis (distal stent edge restenosis) with TIMI 2 pulsatile flow. The RPL1 just beyond this 85% stenosis had an origin 50% stenosis. RPL2 was of modest caliber and diffusely diseased. RPL3 had a laterally oriented sidebranch. The RCA ran well up the lateral aspect of the AV\ngroove.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17539265-DS-9.json b/Finished/Acute Coronary Syndrome/NSTEMI/17539265-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..59ec830dc31bc000ffc6acc4031835971d83e3b1 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17539265-DS-9.json @@ -0,0 +1,102 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "Initial troponin was elevated to .53, which trended down to .38.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Shortness of breath is a symptom of ACS.$Cause_1": { + "Shortness of breath$Input1": {} + }, + "CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism\n are risk facts$Cause_1": { + "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism$Input2": {} + }, + "CAD s/p MI, heparin stent to the RCA isrisk fact$Cause_1": { + "CAD s/p MI, heparin stent to the RCA$Input3": {} + }, + "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \nare risk facts$Cause_1": { + "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "the patient had an inferior wall STEMI where she was found during cardiac cathaterization to have 3 vessel disease including a 70% lesion of the proximal RCA, which received a hepacoat stent.$Input2": {} + }, + "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": { + "Echo following this incident showed an EF, hypo to akinesis of the distal anterior septum, apex and basal/mid inferior and inferolateral segments and moderate mitral regurgitation.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Shortness of breath is a symptom of ACS.$Cause_1": { + "Shortness of breath$Input1": {} + }, + "CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism\n are risk facts$Cause_1": { + "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism$Input2": {} + }, + "CAD s/p MI, heparin stent to the RCA isrisk fact$Cause_1": { + "CAD s/p MI, heparin stent to the RCA$Input3": {} + }, + "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \nare risk facts$Cause_1": { + "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG was significant for old inferior wall infarct.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Shortness of breath is a symptom of ACS.$Cause_1": { + "Shortness of breath$Input1": {} + }, + "CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism\n are risk facts$Cause_1": { + "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism$Input2": {} + }, + "CAD s/p MI, heparin stent to the RCA isrisk fact$Cause_1": { + "CAD s/p MI, heparin stent to the RCA$Input3": {} + }, + "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \nare risk facts$Cause_1": { + "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "the patient had an inferior wall STEMI where she was found during cardiac cathaterization to have 3 vessel disease including a 70% lesion of the proximal RCA, which received a hepacoat stent.$Input2": {} + }, + "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": { + "Echo following this incident showed an EF, hypo to akinesis of the distal anterior septum, apex and basal/mid inferior and inferolateral segments and moderate mitral regurgitation.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Shortness of breath is a symptom of ACS.$Cause_1": { + "Shortness of breath$Input1": {} + }, + "CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism\n are risk facts$Cause_1": { + "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism$Input2": {} + }, + "CAD s/p MI, heparin stent to the RCA isrisk fact$Cause_1": { + "CAD s/p MI, heparin stent to the RCA$Input3": {} + }, + "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \nare risk facts$Cause_1": { + "PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + } + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "This is a F w/ a h/o CAD s/p inferior wall STEMI in w/ PCI, PEA arrest secondary to respiratory failure in the setting of pneumonia, CHF, HTN, HL, type B chronic aortic dissection and hyperthyroidism who presents as a transfer from OSH where she initially presented with acute pulmonary edema and an elevated Troponin, now stable without dyspnea. \n\ufeff\nThe patient was in her usual state of health when she suddenly became short of breath while eating breakfast. According to her son she was not short of breath prior to this event and has been walking distances of several miles, including stairs. No orthopnea or edema in her lower extremities. She did not have any chest pain prior to or during this event and denies any angina in the past six months. She denies recent illness. \n\ufeff\nthe patient was short of breath but without chest pain. Initial CXR indicated pulmonary edema and a BNP was elevated to 341. EKG was significant for old inferior wall infarct. Initial troponin was elevated to .53, which trended down to .38. She was given 40 of IV Lasix at which time her symptoms improved significantly. She was transferred for possible cardiac cath. Upon transfer she was no longer short of breath and had no signs of fluid overload on exam. \n\ufeff\nthe patient is not short of breath and denies chest pain. Initial vitals were 84 135/93 19 96% on Room O2.\n\ufeff\nOf note the patient had an inferior wall STEMI where she was found during cardiac cathaterization to have 3 vessel disease including a 70% lesion of the proximal RCA, which received a hepacoat stent. Successful PTCA of the small rPDA was performed. she was again hospitalized following a PEA arrest which was thought to be secondary to respiratory arrest in the setting of severe CAP. She was successfully \nresuscitated using a cooling protocol, treated with antibiotics and subsequently extubated with recovery of function. At that time she was found to have a chronic type B dissection distal to the L subclavian. Echo following this incident showed an EF, hypo to akinesis of the distal anterior septum, apex and basal/mid inferior and inferolateral segments and moderate mitral regurgitation. She has been healthy since being discharged to rehab after this admission.\n", + "input3": "+ CAD s/p MI, heparin stent to the RCA \n+ PEA arrest, thought to be secondary to respiratory arrest in the setting of either severe CAP or episode of pulmonary edema \n+ HTN\n+ HL\n+ Grave's s/p radioactive iodine ablation now on thyroid replacement\n+ Vitiligo\n", + "input4": "None\n", + "input5": "Admission Exam:\nVS- T= 98.3...BP= 135/93...HR= 84...RR= 19...O2 sat= 96% Room \nO2 \nGENERAL- WA, Asian-female, NAD, alert and oriented x 3, does not \ngive a clear history \nHEENT- NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\ufeff\nNECK- Supple with estimated JVD of 5cm from the right atrium \nCARDIAC- PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS- No chest wall deformities. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN- Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nEXTREMITIES- No c/c/e. No femoral bruits. \nSKIN- No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES- \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP\nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP\n", + "input6": "Admission Labs:\n04:57PM BLOOD WBC-6.5 RBC-4.71# Hgb-15.4# Hct-45.8# \nMCV-97 MCH-32.7* MCHC-33.7 RDW-13.7\n\ufeff\n04:57PM BLOOD Glucose-86 UreaN-38* Creat-0.9 Na-140 \nK-4.7 Cl-104 HCO3-25 AnGap-16\n04:57PM BLOOD Calcium-10.2 Phos-4.3# Mg-2.2\n.\nCardiac Labs:\n04:57PM BLOOD CK-MB-5 cTropnT-0.06*\n06:36AM BLOOD cTropnT-0.05*\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17577620-DS-14.json b/Finished/Acute Coronary Syndrome/NSTEMI/17577620-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..4a665eed54c46dde8c5d04d81c33e6eb25fc42b9 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17577620-DS-14.json @@ -0,0 +1,108 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "cTropnT-0.33*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "family history :male with history of CAD s/p CABG grafts patent is risk fact$Cause_1": { + "male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain.$Input2": {} + }, + "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.\nis sign of acs$Cause_1": { + "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.$Input2": {} + }, + "CAD s/p CABG is a risk factor$Cause_1": { + "CAD s/p CABG$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Per EMS report, en route patient began having frequent PVCs. Per initial report there was concern about wide-complex tachycardia for which patient received 150mg amiodarone.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "family history :male with history of CAD s/p CABG grafts patent is risk fact$Cause_1": { + "male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain.$Input2": {} + }, + "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.\nis sign of acs$Cause_1": { + "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.$Input2": {} + }, + "CAD s/p CABG is a risk factor$Cause_1": { + "CAD s/p CABG$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG was performed which showed atrial fibrillation, regular and paced beats. No change from EKG.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "family history :male with history of CAD s/p CABG grafts patent is risk fact$Cause_1": { + "male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain.$Input2": {} + }, + "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.\nis sign of acs$Cause_1": { + "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.$Input2": {} + }, + "CAD s/p CABG is a risk factor$Cause_1": { + "CAD s/p CABG$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Per EMS report, en route patient began having frequent PVCs. Per initial report there was concern about wide-complex tachycardia for which patient received 150mg amiodarone.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "family history :male with history of CAD s/p CABG grafts patent is risk fact$Cause_1": { + "male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain.$Input2": {} + }, + "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.\nis sign of acs$Cause_1": { + "Patient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure.$Input2": {} + }, + "CAD s/p CABG is a risk factor$Cause_1": { + "CAD s/p CABG$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "HTN is a risk factor$Cause_1": { + "HTN$Input3": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "This is a pleasant male with history of CAD s/p CABG grafts patent, tachybrady syndrome s/p PPM, atrial fibrillation on Coumadin, who presents with chest pain. \n\ufeff\nPatient states he was awakened from sleep by pain posteriorly across both shoulders at around 2 AM the morning of admission. Over the course of the next two hours the pain became more of a bilateral anterior chest pressure. The pain was not positional, not exertional, had mild associated SOB but no n/v/diaphoresis. After that time, the chest pain began improving spontaneously and by the time he went to his scheduled PCP appointment this morning, he had some remnant left sided chest pressure but his other symptoms had resolved. \n\ufeff\nAt his PCP's office, he reported these symptoms and was given SL nitro x1, aspirin 324mg, and an EKG was performed which showed atrial fibrillation, regular and paced beats. No change from EKG.\n\ufeff\nPer EMS report, en route patient began having frequent PVCs. Per initial report there was concern about wide-complex tachycardia for which patient received 150mg amiodarone. His BP was stable,no chest pain, mentating well. On review of the rhythm strips this rhythm was likely more consistent with V-pacing, heart rate of about 100 bpm rather than a wide-complex tachycardia or VT.\n\ufeff\nIn the ED, patient reported feeling well without any ongoing chest pain. \n- Initial vitals were: T 96.9 HR 97 BP 124/91 RR 18 O2 sat 97% RA\n- EKG afib/aflutter, V pacing. Normal rate. \n- Labs/studies notable for: trop 0.13, Mg 1.3, WBC 14.3. Cr at baseline 0.9. LFTs wnl. \n- Patient was given: 2g Mg\n\ufeff\nOn ROS, patient denies shortness of breath, palpitations, lightheadedness, nausea, diaphoresis, recent exertional chest pain, lower extremity edema, cough, fevers. He does state that for the past 4 or 5 days he has had several episodes of diarrhea daily, though he has a history of intermittent diarrhea for which he sees GI and this is not significantly different. Earlier in the week he had some abdominal pain that has since resolved.\n", + "input3": "+ PAF \n+ CAD s/p CABG\n+ Hyperlipidemia \n+ Colonic Adenoma \n+ Throat CA s/p XRT completed\n+ Vocal cord polyp \n+ Diverticulosis \n+ HTN \n+ Positive PPD as a child with negative CXR \n+ GERD \n+ Tonsillectomy \n+ Right Inguinal Hernia Repair\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "VS: T 97.9 BP 135 / 85 HR 71 RR 16 98 RA \nGENERAL: Well developed, well nourished, in NAD. Oriented x3.\nMood, affect appropriate. \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI.\nNECK: Supple. No JVD. \nCARDIAC: Regular rate and rhythm. Normal S1, S2. No murmurs, rubs, or gallops. no thrills or lifts. \nLUNGS: CTAB. Respiration is unlabored with no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, non-tender, non-distended. No HSM. \nEXTREMITIES: Warm, well perfused. Trace bilateral lower extremity\nedema. \nSKIN: No significant skin lesions or rashes. \nPULSES: Distal pulses palpable and symmetric.\n", + "input6": "ADMISSION LABS\n===========================\n11:10AM BLOOD WBC-14.7* RBC-4.80 Hgb-16.1 Hct-48.7 \nMCV-102* MCH-33.5* MCHC-33.1 RDW-15.3 RDWSD-57.5*\n11:10AM BLOOD Neuts-74.7* Lymphs-15.1* Monos-7.5 Eos-0.9* Baso-0.5 AbsNeut-11.02* AbsLymp-2.22 \nAbsMono-1.11* AbsEos-0.13 AbsBaso-0.07\n11:10AM BLOOD Glucose-103* UreaN-22* Creat-0.9 Na-140 \nK-4.4 Cl-103 HCO3-22 AnGap-15\n11:10AM BLOOD CK-MB-29* MB Indx-10.3*\n11:10AM BLOOD cTropnT-0.33*\n11:10AM BLOOD Albumin-3.8 Calcium-9.8 Phos-2.9 Mg-1.3*\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17581064-DS-6.json b/Finished/Acute Coronary Syndrome/NSTEMI/17581064-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..7394211deea5ae0e19b2feceba098ebeed79e389 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17581064-DS-6.json @@ -0,0 +1,156 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "initial troponin negative, repeat troponin elevated at 0.21,$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "with history of hypertension and dyslipidemia are risk facts$Cause_1": { + "with history of hypertension and dyslipidemia$Input2": {} + }, + "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.\n is sign of acs$Cause_1": { + "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.$Input2": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.\n is a risk factor$Cause_1": { + "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.$Input3": {} + }, + "family history\uff1a Hypertension is risk fact$Cause_1": { + "Hypertension$Input4": {} + }, + "family history\uff1aDyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input4": {} + }, + "family history\uff1aStress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis\nis risk fact$Cause_1": { + "Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis$Input4": {} + }, + "family history\uff1aMI in mother is risk fact$Cause_1": { + "MI in mother$Input5": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is a trivial/physiologic pericardial effusion.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "with history of hypertension and dyslipidemia are risk facts$Cause_1": { + "with history of hypertension and dyslipidemia$Input2": {} + }, + "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.\n is sign of acs$Cause_1": { + "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.$Input2": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.\n is a risk factor$Cause_1": { + "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.$Input3": {} + }, + "family history\uff1a Hypertension is risk fact$Cause_1": { + "Hypertension$Input4": {} + }, + "family history\uff1aDyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input4": {} + }, + "family history\uff1aStress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis\nis risk fact$Cause_1": { + "Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis$Input4": {} + }, + "family history\uff1aMI in mother is risk fact$Cause_1": { + "MI in mother$Input5": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "Patient was evaluated with a similar presentation. At that time, the EKG was unremarkable and trops x 3 were negative. A stress test was also negative.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "with history of hypertension and dyslipidemia are risk facts$Cause_1": { + "with history of hypertension and dyslipidemia$Input2": {} + }, + "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.\n is sign of acs$Cause_1": { + "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.$Input2": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.\n is a risk factor$Cause_1": { + "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.$Input3": {} + }, + "family history\uff1a Hypertension is risk fact$Cause_1": { + "Hypertension$Input4": {} + }, + "family history\uff1aDyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input4": {} + }, + "family history\uff1aStress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis\nis risk fact$Cause_1": { + "Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis$Input4": {} + }, + "family history\uff1aMI in mother is risk fact$Cause_1": { + "MI in mother$Input5": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is a trivial/physiologic pericardial effusion.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "with history of hypertension and dyslipidemia are risk facts$Cause_1": { + "with history of hypertension and dyslipidemia$Input2": {} + }, + "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.\n is sign of acs$Cause_1": { + "She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation.$Input2": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is a risk factor$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.\n is a risk factor$Cause_1": { + "Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise.$Input3": {} + }, + "family history\uff1a Hypertension is risk fact$Cause_1": { + "Hypertension$Input4": {} + }, + "family history\uff1aDyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input4": {} + }, + "family history\uff1aStress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis\nis risk fact$Cause_1": { + "Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis$Input4": {} + }, + "family history\uff1aMI in mother is risk fact$Cause_1": { + "MI in mother$Input5": {} + } + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "with history of hypertension and dyslipidemia, who presented with chest pain. Patient reported onset at 4:30 AM as patient was doing her normal am routine. She described a chest tightness with some crampy discomfort in left arm and sharper pain in the left shoulder/superior scapula. She reported that the tightness and shoulder/left scapular pain has begun to abate gradually at the time of evaluation. Of note, reported a similar episodes 1 month ago that resolved within about 2 hours.\n\ufeff\nPatient was evaluated with a similar presentation. At that time, the EKG was unremarkable and trops x 3 were negative. A stress test was also negative. She was discharged from the ED with cardiology outpatient follow-up (did not find any records in the Atrius Epicweb). \n\ufeff\nIn the ED initial vitals were: 97.9 72 144/83 18 100% RA EKG: sinus at 58, nl axis, nl intervals, no TWI, 0.5mm ST elevation in aVR, repeat EKG stable from prior Labs/studies notable for: unremarkable CBC/chem-7, CXR wnl, initial troponin negative, repeat troponin elevated at 0.21, ETT w/ ECHO ordered but subsequently canceled. Patient was given: aspirin with Zofran given history of GI tolerance with aspirin, started on heparin gtt. She was taken to the cath lab with catheterization results showing subtotal occluded OM s/p DES as well as 95% RCA that was not intervened upon given contrast load. Initially, they attempted radial access but that was unsuccessful given small radial artery. Also, patient developed radial hematoma. She had groin access. She was treated with bivalirusin drip during the case and 30 minutes afterwards. She was loaded with Plavix. She was also started on ICF for hydration. \n\ufeff\nOn the floor, patient was tired but chest pain free. She was surrounded by family and they confirmed the history detailed above.\n", + "input3": "1. CARDIAC RISK FACTORS\n- Hypertension\n- Dyslipidemia\n2. CARDIAC HISTORY\n- Stress test in ___ showing atypical symptoms with borderline \nischemic EKG changes at the achieved workload. Good functional \ncapacity and blunted blood pressure response to exercise. \n3. OTHER PAST MEDICAL HISTORY\n- Herpes progenitalis \n- Sciatica \n- Anemia \n- Monilal vulvovaginitis \n- Cervical radiculopathy\n", + "input4": "+ Hypertension\n+ Dyslipidemia\n+ Stress test showing atypical symptoms with borderline ischemic EKG changes at the achieved workload. Good functional capacity and blunted blood pressure response to exercise. \n+ Herpes progenitalis \n+ Sciatica \n+ Anemia \n+ Monilal vulvovaginitis \n+ Cervical radiculopathy\n", + "input5": "MI in mother\n", + "input6": "LABS:\n=====\n08:25AM BLOOD CK-MB-7 cTropnT-0.13*\n07:58AM GLUCOSE-96 UREA N-20 CREAT-0.7 SODIUM-139 \nPOTASSIUM-3.8 CHLORIDE-101 TOTAL CO2-26 ANION GAP-16\n06:40AM GLUCOSE-144* UREA N-22* CREAT-0.8 SODIUM-131* \nPOTASSIUM-7.1* CHLORIDE-96 TOTAL CO2-21* ANION GAP-21*\n06:40AM estGFR-Using this\n06:40AM cTropnT-<0.01\n06:40AM WBC-5.4 RBC-4.78 HGB-13.7 HCT-41.3 MCV-86 \nMCH-28.7 MCHC-33.2 RDW-14.7 RDWSD-46.9*\n06:40AM NEUTS-55.7 MONOS-7.3 EOS-2.4 BASOS-0.7 IM AbsNeut-2.98 AbsLymp-1.78 AbsMono-0.39 AbsEos-0.13 AbsBaso-0.04\n06:40AM PLT COUNT-228\n\ufeff\nIMAGING:\n========\nCXR:\nNo acute cardiopulmonary process. \n\ufeff\nTTE:\nThe left atrial volume index is normal. Normal left ventricular wall thickness, cavity size, and regional/global systolic function (biplane LVEF = 61 %). 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) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is a trivial/physiologic pericardial effusion. \n\ufeff\nIMPRESSION: Normal biventricular cavity sizes with preserved regional and global biventricular systolic function. Mild mitral regurgitation with normal valve morphology.\n\ufeff\nCLINICAL IMPLICATIONS: \nAHA endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is NOT recommended. Clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17685057-DS-12.json b/Finished/Acute Coronary Syndrome/NSTEMI/17685057-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..dcdf51840e62b4819048d0f5032ef3dea5ab6a59 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17685057-DS-12.json @@ -0,0 +1,132 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "02:30PM BLOOD cTropnT-0.91*\n06:30PM BLOOD cTropnT-1.09*\n01:26AM BLOOD cTropnT-1.24*\n05:55AM BLOOD CK-MB-4 cTropnT-1.16*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.\n is sign of acs$Cause_1": { + "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.$Input2": {} + }, + "DMII is a risk factor$Cause_1": { + "DMII$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Chronic Kidney Disease is a risk factor$Cause_1": { + "Chronic Kidney Disease$Input3": {} + }, + "family history\uff1a Both parents died of reasons unknown to him. is risk fact$Cause_1": { + "Both parents died of reasons unknown to him.$Input4": {} + }, + "family history\uff1a Two sisters and a brother died of reasons unknown as well. is risk fact$Cause_1": { + "Two sisters and a brother died of reasons unknown as well.$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "EKG taken today showed sinus rhythm, incomplete right bundle-branch block, which appeared new, possible septal infarct and T-wave inversions in the lateral precordial leads, possible anterolateral ischemia, which were changed from prior.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.\n is sign of acs$Cause_1": { + "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.$Input2": {} + }, + "DMII is a risk factor$Cause_1": { + "DMII$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Chronic Kidney Disease is a risk factor$Cause_1": { + "Chronic Kidney Disease$Input3": {} + }, + "family history\uff1a Both parents died of reasons unknown to him. is risk fact$Cause_1": { + "Both parents died of reasons unknown to him.$Input4": {} + }, + "family history\uff1a Two sisters and a brother died of reasons unknown as well. is risk fact$Cause_1": { + "Two sisters and a brother died of reasons unknown as well.$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG taken today showed sinus rhythm, incomplete right bundle-branch block, which appeared new, possible septal infarct and T-wave inversions in the lateral precordial leads, possible anterolateral ischemia, which were changed from prior. He was given aspirin 325mg.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.\n is sign of acs$Cause_1": { + "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.$Input2": {} + }, + "DMII is a risk factor$Cause_1": { + "DMII$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Chronic Kidney Disease is a risk factor$Cause_1": { + "Chronic Kidney Disease$Input3": {} + }, + "family history\uff1a Both parents died of reasons unknown to him. is risk fact$Cause_1": { + "Both parents died of reasons unknown to him.$Input4": {} + }, + "family history\uff1a Two sisters and a brother died of reasons unknown as well. is risk fact$Cause_1": { + "Two sisters and a brother died of reasons unknown as well.$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "EKG taken today showed sinus rhythm, incomplete right bundle-branch block, which appeared new, possible septal infarct and T-wave inversions in the lateral precordial leads, possible anterolateral ischemia, which were changed from prior.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest Pain$Input1": {} + }, + "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.\n is sign of acs$Cause_1": { + "The patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks.$Input2": {} + }, + "DMII is a risk factor$Cause_1": { + "DMII$Input3": {} + }, + "Hypertension is a risk factor$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Chronic Kidney Disease is a risk factor$Cause_1": { + "Chronic Kidney Disease$Input3": {} + }, + "family history\uff1a Both parents died of reasons unknown to him. is risk fact$Cause_1": { + "Both parents died of reasons unknown to him.$Input4": {} + }, + "family history\uff1a Two sisters and a brother died of reasons unknown as well. is risk fact$Cause_1": { + "Two sisters and a brother died of reasons unknown as well.$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "Mr. Mike is a man with PMH significant for COPD, HTN, HLD who presents with progressive shortness of breath and chest pain.\n\ufeff\nThe patient reports for the last one to two weeks feeling very fatigued, moving slower and not normal. Also notes feeling more short of breath and after climbing a flight of stairs he had to stop and rest due to difficulty breathing. He also notes intermittent \"sharp\" sub-sternal chest pain for the past one to two weeks. THe pain lasts for about 1 hour and took a pain medication called \"coltaradin\" with relief. The pain occurred both at rest and on exertion and he did not report any clear exaccerbating factors. He noted associated radiation to his bilateral shoulders. He denies associated shortness of breath, nausea, and diaphoresis. He notes it does not feel like his acid reflux pain. The pain does not wake him from sleep. He also usually plants a garden, but his sister found him very short of breath and lacking energy, so she did not let him plant the garden this year.\n\ufeff\nHe presented today to see his Atrius Pulmonologist Dr.Wang for these symptoms. Vitals in clinic were Temp afebirle, BP 132/84, HR 108, RR 18, O2 sat 95% RA. EKG taken today showed sinus rhythm, incomplete right bundle-branch block, which appeared new, possible septal infarct and T-wave inversions in the lateral precordial leads, possible anterolateral ischemia, which were changed from prior. He was given aspirin 325mg. \n\ufeff\ninitial vitals were Temp 99.4, BP 167/95, HR 113, RR 22, O2 sat 100% RA. Labs were significatn for TropI 4.8, WBC 4.1, H/H 11.3/36.0, Plt 140, Na 138, K 4.0, LFTs wnl. He was started on heparin ggt for suspected NSTEMI. CXR with increased interstitial markings and concern for adenopathy with recommendation for CT scan to evaluate for mass. He was transferred to someplace for cardiac cath.\n \n- In the ED, initial vitals were: 99.1 104 148/97 18 99% RA.\n- Labs were significant for WBC 4.0, H/H 10.8, Plt 115, INR 1.1, PTT 123.5 -> repeat 81.7, Cr 0.9, K 3.1, TropT 0.91 -> 1.09.\n- Patient was continued on heparin gtt at 700 units/hr.\n- Atrius Cards consulted and on schedule for cath lab tomorrow first case.\n- Vitals prior on transfer were: 97.8 98 146/88 20 99% RA. \n \nOn arrival to the floor, he denies chest pain. He denies fevers/chills, nausea/vomiting, abdominal pain, diarrhea, dysuria, and lower extremity swelling.\n", + "input3": "+ DMII\n+ Hypertension\n+ Hyperlipidemia\n+ Chronic Kidney Disease\n+ GERD\n+ BPH\n+ Rhinitis\n+ Asthma/COPD\n+ Bronchiectasis\n+ Alpha Thalassemia Trait\n+ Hematuria\n+ Gastric Adenoma\n+ Pneumonia\n+ s/p cataract surgery\n", + "input4": "Both parents died of reasons unknown to him. Two sisters and a brother died of reasons unknown as well.\n", + "input5": "ADMISSION PHYSICAL EXAMINATION: \nVS: Temp 97.7, BP 168/90, HR 108, RR 20, O2 sat 99% 2L, Weight 55.6 kg\nGeneral: Well-appearing man in no acute distress. \nHEENT: EOMI, PERRLA, clear oropharynx, moist mucous membranes. \nNeck: Supple, no JVP, no lympadenopathy.\nCV: RRR, normal s1/s2, no m/r/g. \nLungs: Transmitted upper airway sounds, no crackles, poor air movement bilaterally.\nAbdomen: Soft, mildly distended, non-tender, normal bowel sounds, no organomegaly. \nExt: Warm, well-perfused, no edema.\nNeuro: A&Ox3, CNII-XII intact, gross motor and sensory intact bilaterally.\nSkin: No rashes.\n", + "input6": "ADMISSION LABS\n==============\n02:30PM BLOOD WBC-4.0 RBC-4.67 Hgb-10.8* Hct-32.6* \nMCV-70* MCH-23.2* MCHC-33.3 RDW-18.7*\n02:30PM BLOOD Neuts-57.8 Monos-7.8 Eos-6.2* Baso-0.2\n02:30PM BLOOD Glucose-101* UreaN-13 Creat-0.9 Na-135 \nK-3.1* Cl-108 HCO3-21* AnGap-9\n02:30PM BLOOD Calcium-8.5 Phos-2.7 Mg-1.9\n\ufeff\nPERTINENT LABS\n==============\n02:30PM BLOOD cTropnT-0.91*\n06:30PM BLOOD cTropnT-1.09*\n01:26AM BLOOD cTropnT-1.24*\n05:55AM BLOOD CK-MB-4 cTropnT-1.16*\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17753691-DS-7.json b/Finished/Acute Coronary Syndrome/NSTEMI/17753691-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..49c109a6bb8b44c5191b0fe0c5efe602b364a165 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17753691-DS-7.json @@ -0,0 +1,126 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "labs showed a 0.87 trop-i, w/ 0.9 Cr,$Input2": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L$Cause_1": { + "BLOOD CK-MB-7 cTropnT-0.23*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Epigastric pain is a symptom of ACS.$Cause_1": { + "Epigastric pain$Input1": {} + }, + "DM is a risk fact of acs$Cause_1": { + "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday.$Input2": {} + }, + "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,\n are sign of acs$Cause_1": { + "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,$Input2": {} + }, + "DMII is risk fact$Cause_1": { + "DMII$Input3": {} + }, + "VITAMIN D DEFICIENC is risk fact$Cause_1": { + "VITAMIN D DEFICIENCY$Input3": {} + }, + "HYPERLIPIDEMIA is risk fact$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "family history\uff1aFather passed away from an MI is risk fact$Cause_1": { + "Father passed away from an MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": { + "2.Successful PTCA and stenting of totally occluded LAD with Resolute Integrtity drug-eluting stent (3.0x18 mm)$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Epigastric pain is a symptom of ACS.$Cause_1": { + "Epigastric pain$Input1": {} + }, + "DM is a risk fact of acs$Cause_1": { + "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday.$Input2": {} + }, + "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,\n are sign of acs$Cause_1": { + "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,$Input2": {} + }, + "DMII is risk fact$Cause_1": { + "DMII$Input3": {} + }, + "VITAMIN D DEFICIENC is risk fact$Cause_1": { + "VITAMIN D DEFICIENCY$Input3": {} + }, + "HYPERLIPIDEMIA is risk fact$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "family history\uff1aFather passed away from an MI is risk fact$Cause_1": { + "Father passed away from an MI$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ekg showed inf t wave changes,$Input2": {} + }, + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "EKG demonstrated sinus at 87 Q in III, avf and lateral t-wave flattening similar to prior. The patient was continued on a heparin gtt.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Epigastric pain is a symptom of ACS.$Cause_1": { + "Epigastric pain$Input1": {} + }, + "DM is a risk fact of acs$Cause_1": { + "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday.$Input2": {} + }, + "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,\n are sign of acs$Cause_1": { + "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,$Input2": {} + }, + "DMII is risk fact$Cause_1": { + "DMII$Input3": {} + }, + "VITAMIN D DEFICIENC is risk fact$Cause_1": { + "VITAMIN D DEFICIENCY$Input3": {} + }, + "HYPERLIPIDEMIA is risk fact$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "family history\uff1aFather passed away from an MI is risk fact$Cause_1": { + "Father passed away from an MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": { + "2.Successful PTCA and stenting of totally occluded LAD with Resolute Integrtity drug-eluting stent (3.0x18 mm)$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Epigastric pain is a symptom of ACS.$Cause_1": { + "Epigastric pain$Input1": {} + }, + "DM is a risk fact of acs$Cause_1": { + "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday.$Input2": {} + }, + "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,\n are sign of acs$Cause_1": { + "presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit,$Input2": {} + }, + "DMII is risk fact$Cause_1": { + "DMII$Input3": {} + }, + "VITAMIN D DEFICIENC is risk fact$Cause_1": { + "VITAMIN D DEFICIENCY$Input3": {} + }, + "HYPERLIPIDEMIA is risk fact$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "family history\uff1aFather passed away from an MI is risk fact$Cause_1": { + "Father passed away from an MI$Input4": {} + } + } + } + } + }, + "input1": "Epigastric pain\n", + "input2": "a Man w/ hx of DM on insulin w/ neuropathy- on lantus, HTN hx of non-compliance who presents w/ several weeks of epigastric pain that is sharp much worse since the yesterday. Patient reports pain has been present for the past several weeks worse with activit, improved with rest and increasing in frequency. Pain has been constant over the past week. He has also subsequently developed associated diaphoresis, dizziness and nausea without vomiting over the past weeks. He had new back pain also several weeks ago that starts in the back and goes down toward his groin- it feel like muscle spasms to him but is now resolved. No chest pain during any of these episodes. He denies being sob. Denies leg pain or swelling. He went into hospital because he thought he was having ulcers and was expected some \"tums\" and being d/ced. However labs showed a 0.87 trop-i, w/ 0.9 Cr, and ekg showed inf t wave changes, abd labs were unremarkable, glu 279. he was given asa, heparin and nitro drips for hypertension. Transfer was attmpted to hospital where the pt has his pcp, but transfer was not possible.\n \nIn the ED, initial vitals were 94 122/83 13 99%. Labs were notable for a WBC of 14, trop of 0.1 with a normal CK-MB and INR of 1.2. EKG demonstrated sinus at 87 Q in III, avf and lateral t-wave flattening similar to prior. The patient was continued on a heparin gtt. Given metoprolol 25 mg and taken to the cath lab. \nThere he was given a plavix load, ASA, and bival. In the cath lab he was noted to have an extremely tight LAD (near complete occlusion) without evidence of collaterals. He underwent placement of a DES to the LAD with good restoration of flow. The procedure was complicated by a vagal event for which the patient recieved 1 mg of atropine and L fluid with improvement in blood pressure and heart rate.\n", + "input3": "+ DMII\n+ VITAMIN D DEFICIENCY \n+ HYPERLIPIDEMIA \n+ HYPERTENSION NOS\n", + "input4": "Father passed away from an MI\n", + "input5": "PHYSICAL EXAMINATION: \nVS: T= 97.5 BP= 134/81 HR= 91 RR= 18 O2 sat= 99% RA \nGENERAL: WDWN male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\ufeff\nNECK: Supple with JVP difficult to assess \nCARDIAC: midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS:CTA ant \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominal bruits. \nEXTREMITIES: No c/c/e. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: R TR band in place, 2+ DP \nLeft: DP 2+ Radial 2+\n", + "input6": "ADMISSION:\n04:15PM BLOOD WBC-14.3* RBC-5.61 Hgb-16.7 Hct-47.8 \nMCV-85 MCH-29.7 MCHC-34.9 RDW-13.7\n04:15PM BLOOD Glucose-246* UreaN-12 Creat-0.7 Na-138 \nK-3.6 Cl-101 HCO3-27 AnGap-14\n\ufeff\nCARDIAC:\n0.87 tropI at OSH\n04:15PM BLOOD cTropnT-0.10*\n08:18AM BLOOD CK-MB-7 cTropnT-0.23*\n08:45AM BLOOD CK-MB-7 cTropnT-0.18*\n\ufeff\nCARDIAC:\nAssessment & Recommendations\n1.One vessel CAD\n2.Successful PTCA and stenting of totally occluded LAD with Resolute Integrtity drug-eluting stent (3.0x18 mm) \n\ufeff\nwith excellent result\n3.Successful removal of R radail sheath and placement of Terumo band\n4.Prasugrel 60 mg po given post procedure x mg daily for 12 months (option to switch to Clopidogrel in 3 months)\n5.ASA 325 mg po daily x minimum 3 months then 162 mg daily indefinitely\n\ufeff\n7.Cardiac rehab after submaximal ETT (to be arranged by PCP/cardiologist).\n\ufeff\nECG ON ADMISSION: sinus at 87 Q in III, avf and lateral t-wave flattening similar to prior.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17822063-DS-15.json b/Finished/Acute Coronary Syndrome/NSTEMI/17822063-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..d26d2ad7c630231193ed9d476a4e6edb58ad43da --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17822063-DS-15.json @@ -0,0 +1,52 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "Labs were significant for an elevated troponin of 0.41$Input2": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "BLOOD cTropnT-0.41*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09..$Cause_1": { + "03:23PM BLOOD CK-MB-38*\n03:23PM BLOOD cTropnT-0.41*\n11:15PM BLOOD CK-MB-29* cTropnT-1.85*\n06:04AM BLOOD CK-MB-21* cTropnT-0.99*$Input6": {} + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "His ECG revealed new ST depressions and trop-I was elevated to 3.23. He was given Lovenox ,$Input2": {} + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs.$Cause_1": { + "He was treated with metoprolol, nitro gtt, dilaudid, and was sent to the cath lab where a DES was placed to his LCX. After the procedure he continued to have chest pain and ECG changes so was started on an Eptifibatide gtt and admitted to the CCU.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS.$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p stents, DM, HTN are risk facts$Cause_1": { + "h/o CAD s/p stents, DM, HTN, who presented with chest pain,$Input2": {} + }, + "He began having chest/epigastric discomfort over the weekend while doing chores. The pain would come and go, was pressure and stinging like in sensation, pain at its worst, was associated with SOB, diaphoresis, nausea, and arm tingling.\n are signs of acs$Cause_1": { + "He began having chest/epigastric discomfort over the weekend while doing chores. The pain would come and go, was pressure and stinging like in sensation, pain at its worst, was associated with SOB, diaphoresis, nausea, and arm tingling.$Input2": {} + }, + "Essential hypertension is risk fact$Cause_1": { + "Essential hypertension$Input3": {} + }, + "CAD (coronary artery disease) is risk fact$Cause_1": { + "CAD (coronary artery disease)$Input3": {} + }, + "Type II diabetes mellitus is risk fact$Cause_1": { + "Type II diabetes mellitus$Input3": {} + }, + "family history\uff1amother: CAD, asthma\n is risk fact$Cause_1": { + "mother: CAD, asthma$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "h/o CAD s/p stents, DM, HTN, who presented with chest pain, found to have NSTEMI and is now s/p DES to the LCX. \n\ufeff\nHe began having chest/epigastric discomfort over the weekend while doing chores. The pain would come and go, was pressure and stinging like in sensation, pain at its worst, was associated with SOB, diaphoresis, nausea, and arm tingling. Although this pain was similar to his cardiac chest pain during his last heart attack, he thought it was indigestion and treated it at home with Tums. He also had an associated sore throat for which he visited his PCP. He did not endorse chest pain at the time and did not have an ECG or cardiac workup. Today, he called his PCP again, endorsed chest pain, He tried SL nitro x 1 at home without relief. He initially presented to hospital where he was treated with ASA 324 and GI cocktail. His ECG revealed new ST depressions and trop-I was elevated to 3.23. He was given Lovenox , \n\ufeff\ninitial vitals were: 98.6 83 146/78 16 96%. ECG was significant for ST depressions in the lateral leads. Labs were significant for an elevated troponin of 0.41 and normal CBC/chem7. He was treated with metoprolol, nitro gtt, dilaudid, and was sent to the cath lab where a DES was placed to his LCX. After the procedure he continued to have chest pain and ECG changes so was started on an Eptifibatide gtt and admitted to the CCU. \n\ufeff\nUpon arrival to the floor, he continued to complain of chest pain. He was treated with SL nitro with relief to pain. A second SL NTG resulted in reduction to pain. A nitroglycerin drip was started.\n", + "input3": "+ Pure hypercholesterolemia \n+ Lumbosacral spondylosis without myelopathy \n+ Diarrhea \n+ Ankylosing spondylitis vs. Rheumatoid Arthritis\n+ Essential hypertension\n+ Malignant neoplasm of testis \n+ Impotence \n+ CAD (coronary artery disease) \n+ Raynaud's disease \n+ Type II diabetes mellitus \n+ Polyneuropathy in diabetes \n+ Microalbuminuria \n+ Rosacea \n+ Depression\n+ Headaches\n+ Remote h/o bleeding GI ulcer\n", + "input4": "mother: CAD, asthma\nsister: RA\nbrother: GERD\n", + "input5": "ADMISSION EXAM:\nVS: T=98.5 BP=126/70 HR=88 RR=19 O2 sat=96% RA \nGeneral: alert, nad\nHEENT: poor dentition, sclera anicteric\nNeck: no JVD\nCV: rrr, no murmurs\nLungs: ctab\nAbdomen: epigastric tenderness\nExt: trace BLE edema\nNeuro: EOMI, PERRL, alert, moving all extreities\nSkin: no rash\nPULSES: 2+ distal pulses (DP bilat, L radial (R radial in cuff))\n", + "input6": "ADMISSION LABS:\n\ufeff\n03:23PM BLOOD WBC-10.9 RBC-4.77 Hgb-14.5 Hct-44.7 \nMCV-94 MCH-30.4 MCHC-32.4 RDW-13.1\n03:23PM BLOOD Neuts-69.3 Monos-6.0 Eos-2.6 \nBaso-0.6\n03:23PM BLOOD Glucose-88 UreaN-14 Creat-1.1 Na-136 \nK-4.0 Cl-101 HCO3-23 AnGap-16\n03:23PM BLOOD CK-MB-38*\n03:23PM BLOOD cTropnT-0.41*\n\ufeff\nCARDIAC ENZYME TREND:\n\ufeff\n03:23PM BLOOD CK-MB-38*\n03:23PM BLOOD cTropnT-0.41*\n11:15PM BLOOD CK-MB-29* cTropnT-1.85*\n06:04AM BLOOD CK-MB-21* cTropnT-0.99*\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17842926-DS-8.json b/Finished/Acute Coronary Syndrome/NSTEMI/17842926-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..360f524c205da0ac61a0d36d4a7cfc1302ef93a4 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17842926-DS-8.json @@ -0,0 +1,108 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "BLOOD CK-MB-23* cTropnT-0.52**$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "headache, HTNis a symptom of ACS.$Cause_1": { + "headache, HTN$Input1": {} + }, + "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.\n is risk fact and sign of acs$Cause_1": { + "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.$Input2": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain.$Input2": {} + }, + "DM (diet controlled) is a risk factor$Cause_1": { + "DM (diet controlled)$Input3": {} + }, + "chronic cough is a risk factor$Cause_1": { + "chronic cough$Input3": {} + }, + "HTN (not on medical therapy) is a risk factor$Cause_1": { + "HTN (not on medical therapy)$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Suboptimal image quality. Moderate aortic stenosis. Mild symmetric left ventricular hypertrophy with preserved regional and global biventricular systolic function. Mild-moderate mitral regurgitation. Mild pulmonary artery systolic hypertension. Increased PCWP.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "headache, HTNis a symptom of ACS.$Cause_1": { + "headache, HTN$Input1": {} + }, + "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.\n is risk fact and sign of acs$Cause_1": { + "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.$Input2": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain.$Input2": {} + }, + "DM (diet controlled) is a risk factor$Cause_1": { + "DM (diet controlled)$Input3": {} + }, + "chronic cough is a risk factor$Cause_1": { + "chronic cough$Input3": {} + }, + "HTN (not on medical therapy) is a risk factor$Cause_1": { + "HTN (not on medical therapy)$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG: Sinus rhythm, 95, normal axis,, first degree heart block QTC 473 Imaging showed$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "headache, HTNis a symptom of ACS.$Cause_1": { + "headache, HTN$Input1": {} + }, + "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.\n is risk fact and sign of acs$Cause_1": { + "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.$Input2": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain.$Input2": {} + }, + "DM (diet controlled) is a risk factor$Cause_1": { + "DM (diet controlled)$Input3": {} + }, + "chronic cough is a risk factor$Cause_1": { + "chronic cough$Input3": {} + }, + "HTN (not on medical therapy) is a risk factor$Cause_1": { + "HTN (not on medical therapy)$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "Suboptimal image quality. Moderate aortic stenosis. Mild symmetric left ventricular hypertrophy with preserved regional and global biventricular systolic function. Mild-moderate mitral regurgitation. Mild pulmonary artery systolic hypertension. Increased PCWP.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "headache, HTNis a symptom of ACS.$Cause_1": { + "headache, HTN$Input1": {} + }, + "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.\n is risk fact and sign of acs$Cause_1": { + "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain.$Input2": {} + }, + "Chest Pain is a symptom of ACS.$Cause_1": { + "The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain.$Input2": {} + }, + "DM (diet controlled) is a risk factor$Cause_1": { + "DM (diet controlled)$Input3": {} + }, + "chronic cough is a risk factor$Cause_1": { + "chronic cough$Input3": {} + }, + "HTN (not on medical therapy) is a risk factor$Cause_1": { + "HTN (not on medical therapy)$Input3": {} + } + } + } + } + }, + "input1": "headache, HTN\n", + "input2": "a female with past medical history significant for hypertension, no longer on hypertensive medications comes in with elevated blood pressure, headache, chest pain. This afternoon, the patient 60 ibuprofen for left arm pain, after which time she began having a headache, and found her blood pressure to be elevated. The patient also reported some dull left-sided chest pressure that lasted several hours, however resolved prior to the time that she arrived. She no longer reports any headache. She only residual symptoms are left arm pain. The patient denies visual changes headache, chest pain, shortness of breath, abdominal pain. In the ED \n============= \nInitial vitals: 99.0 90 194/81 16 97% RA \nLabs were significant for \nTrop-T: 0.04 \n140 100 15 AGap=19 \n-------------< 117 \n4.2 25 0.7 \n11.5 MCV= 82 \n9.2 >-----<276 \n38.0 \n \nUA negative. \nEKG: Sinus rhythm, 95, normal axis,, first degree heart block QTC 473 Imaging showed \nCXR: Low lung volumes with probable mild pulmonary vascular congestion but no overt pulmonary edema. Re-demonstration rightward tracheal deviation due to known multinodular thyroid goiter \nThe patient received: \n21:59 PO Aspirin 243 mg \n22:10 IV Morphine Sulfate 4 mg \n22:10 IV Heparin 3800 UNIT \n22:10 IV Heparin \nThe patient was shifted to the floor. On the floor, the patient feels that her health is not normal and feels tired. however, denies chest pain, SOB or palpitations. complains of mild OA pain in the left wrist. \n \nROS: \nNo fevers, chills, night sweats, or weight changes. \nNo changes in vision or hearing, no changes in balance. \nNo nausea or vomiting. No diarrhea or constipation. \nNo dysuria or hematuria. \nNo hematochezia, no melena. \nNo numbness or weakness, no focal deficits. \n\ufeff\nPatient with sons at bedside this AM. Report that patient was sitting at home, doing normal activities and stated she had L arm pain, headache and chest pain. The patient states the arm pain started prior to the chest pain. she states she asked her son for tylenol/motrin but it did not help. \n\ufeff\nPer her son, her BP was higher than usual (normally 110-160). Patient states she has never had this chest pain before and she denies associated nausea, vomiting, recent illness, or history of MI/stroke (though son is unsure if she may have had \"small heart attack\" in the past.\n", + "input3": "+ DM (diet controlled)\n+ chronic cough\n+ HTN (not on medical therapy)\n+ osteoporosis\n+ osteoarthritis\n+ goiter\n+ hearing loss\n+ spinal stenosis/chronic back pain\n", + "input4": "She does not know majority of her family history. There is no cancer as far as she knows.\n", + "input5": "PHYSICAL EXAM ON ADMISSION: \n=============================================================== \n\ufeff\nVS: 98.0 188/76 90 22 96% wt 61.8kg \nGEN: Alert, lying in bed, no acute distress \nHEENT: Moist MM, anicteric sclerae, no conjunctival pallor. \nPERRLA, EOMI. \nNECK: Supple without LAD . no JVP elevation. \nPULM: full air entry bilaterally. crackles heard on the right base which cleared with cough. no wheeze. no rhonchi \nHEART: RRR (+)S1/S2 no m/r/g \nABD: Soft, non-distended, non-tender. No rebound/guarding. BS+ \n\ufeff\nEXTREM: Warm, well-perfused, no edema \nNEURO: CN II-XII intact, SLIT\n", + "input6": "LABS ON ADMISSION\n==================\n08:00PM BLOOD WBC-9.2 RBC-4.64 Hgb-11.5 Hct-38.0 MCV-82 \nMCH-24.8* MCHC-30.3* RDW-15.9* RDWSD-47.2*\n08:00PM BLOOD Glucose-117* UreaN-15 Creat-0.7 Na-140 \nK-4.2 Cl-100 HCO3-25 AnGap-19\n04:25AM BLOOD Calcium-8.8 Phos-4.0 Mg-1.7\n\ufeff\nTROPONINS\n=========\n08:00PM BLOOD cTropnT-0.04*\n04:25AM BLOOD CK-MB-44* cTropnT-0.14*\n12:40PM BLOOD CK-MB-57* cTropnT-0.35*\n06:46PM BLOOD CK-MB-46* MB Indx-11.0* cTropnT-0.60*\n02:25AM BLOOD CK-MB-24* cTropnT-0.51*\n04:25AM BLOOD CK-MB-23* cTropnT-0.52**\n\ufeff\nIMAGING\n========\nIMPRESSION: \n \nLow lung volumes with probable mild pulmonary vascular congestion but no overt pulmonary edema. Re-demonstration of rightward tracheal deviation due to known multinodular thyroid goiter. \n\ufeff\nECHO\nThe left atrium is elongated. The estimated right atrial pressure is xx mmHg. Mild symmetric left ventricular hypertrophy with normal cavity size, and regional/global systolic function (biplane LVEF = 64 %). The estimated cardiac index is normal (>=2.5L/min/m2). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The aortic valve leaflets are mildly thickened (?#). There is mild aortic valve stenosis (valve area 1.2-1.9cm2). Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild to moderate mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. \n\ufeff\nIMPRESSION: Suboptimal image quality. Moderate aortic stenosis. Mild symmetric left ventricular hypertrophy with preserved regional and global biventricular systolic function. Mild-moderate mitral regurgitation. Mild pulmonary artery systolic hypertension. Increased PCWP. \n\ufeff\nCompared with the prior study (images reviewed), the findings are similar.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17915457-DS-19.json b/Finished/Acute Coronary Syndrome/NSTEMI/17915457-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..c6d6ce61e66c34a05a87dc1a321806c53ab423cf --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17915457-DS-19.json @@ -0,0 +1,132 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "cTropnT-0.26*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n are risk facts$Cause_1": { + "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.$Input2": {} + }, + "chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm.\n is sign of acs$Cause_1": { + "he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm.$Input2": {} + }, + "Psoriatic Arthritis is a risk factor$Cause_1": { + "Psoriatic Arthritis$Input3": {} + }, + "Hypothyroidism is a risk factor$Cause_1": { + "Hypothyroidism$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Obstructive sleep apnea is a risk factor$Cause_1": { + "Obstructive sleep apnea$Input3": {} + }, + "Family history:PGF had MI is a big risk factor$Cause_1": { + "PGF had MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n are risk facts$Cause_1": { + "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.$Input2": {} + }, + "chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm.\n is sign of acs$Cause_1": { + "he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm.$Input2": {} + }, + "Psoriatic Arthritis is a risk factor$Cause_1": { + "Psoriatic Arthritis$Input3": {} + }, + "Hypothyroidism is a risk factor$Cause_1": { + "Hypothyroidism$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Obstructive sleep apnea is a risk factor$Cause_1": { + "Obstructive sleep apnea$Input3": {} + }, + "Family history:PGF had MI is a big risk factor$Cause_1": { + "PGF had MI$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG: sinus rhythm, 68 bpm, PVCs, early R-wave progressions, no significant ischemic changes$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n are risk facts$Cause_1": { + "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.$Input2": {} + }, + "chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm.\n is sign of acs$Cause_1": { + "he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm.$Input2": {} + }, + "Psoriatic Arthritis is a risk factor$Cause_1": { + "Psoriatic Arthritis$Input3": {} + }, + "Hypothyroidism is a risk factor$Cause_1": { + "Hypothyroidism$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Obstructive sleep apnea is a risk factor$Cause_1": { + "Obstructive sleep apnea$Input3": {} + }, + "Family history:PGF had MI is a big risk factor$Cause_1": { + "PGF had MI$Input4": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n are risk facts$Cause_1": { + "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.$Input2": {} + }, + "chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm.\n is sign of acs$Cause_1": { + "he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm.$Input2": {} + }, + "Psoriatic Arthritis is a risk factor$Cause_1": { + "Psoriatic Arthritis$Input3": {} + }, + "Hypothyroidism is a risk factor$Cause_1": { + "Hypothyroidism$Input3": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Obstructive sleep apnea is a risk factor$Cause_1": { + "Obstructive sleep apnea$Input3": {} + }, + "Family history:PGF had MI is a big risk factor$Cause_1": { + "PGF had MI$Input4": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "He is a yo man with history of hyperlipidemia, psoriatic arthritis on prednisone, hypothyroidism, OSA who presented to ED from OSH w/chest pain.\n\ufeff\nPatient reports he developed chest \"tightness\" while trying to go to sleep the night prior to presentation. He was lying on his side and felt discomfort/tightness in his chest, with occasional radiation to his back and L arm. He took Tums, omeprazole with no relief. Pain persisted throughout the following day. It is constant, no association with activity or positioning. No associated dyspnea, diaphoresis, nausea or vomiting. No cardiac history and reports normal stress test year ago. his pain was in severity. EKG showed no ischemic changes but trop I was elevated, so he was started on heparin gtt. CTA was performed and showed no aortic dissection. Pain improved with SL nitro and morphine. He was transferred for further evaluation and management. \n\ufeff\nIn the ED, initial VS were: 97.7, 68, 138/76, 19, 99% RA Exam was unremarkable, no murmurs, lungs CTAB, no edema. EKG: sinus rhythm, 68 bpm, PVCs, early R-wave progressions, no significant ischemic changes Labs notable for troponin 0.26, CK 407, MB 29, BNP 766, K 5.3 (non hemolyzed), Cr 1.2 (baseline 1.1-1.3 per OSH records), WBC 9.8, Hb 13.2, lactate 1.6. \nImaging showed: OSH imaging revealed no aortic dissection, no acute cardiopulmonary process. \nConsults: Cardiology, who recommended patient stat on heparin \nand nitro gtt, with admission for cardiac catheterization. \nPatient received: Morphine IV 4mg, SL nitro, ASA 324, continued\non heparin gtt and started on nitroglycerin gtt. \n \nTransfer VS were: 97.4, 66, 118/78, 20, 97% RA. \n\ufeff\nOn arrival to the floor, patient reports ongoing chest pain. No associated shortness of breath, nausea, diaphoresis. Feeling anxious about pain, possibility of procedure in the morning. No additional complaints.\n", + "input3": "+ Psoriatic Arthritis\n+ Hypothyroidism\n+ Hyperlipidemia\n+ Obstructive sleep apnea (not on CPAP)\n+ GERD\n+ Peptic Ulcer \n+ Multiple orthopedic procedures:\n+ L shoulder implant\n+ R hip implant\n+ Back surgery (Distectomy)\n+ R hand carpal tunnel relase\n", + "input4": "No family history of sudden cardiac death or early MI.\n", + "input5": "ADMISSION PHYSICAL EXAM\n======================= \nVS: 98.3 PO 126 / 66 72 19 94 Ra \nGENERAL: NAD \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, MMM \nNECK: supple, no LAD, no JVD \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles \nABDOMEN: nondistended, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no cyanosis, clubbing, or edema \nPULSES: 2+ DP pulses bilaterally \nNEURO: A&Ox3, moving all 4 extremities with purpose \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "ADMISSION LABS\n==============\n09:30PM BLOOD WBC-9.8 RBC-4.28* Hgb-13.2* Hct-40.4 MCV-94 MCH-30.8 MCHC-32.7 RDW-13.1 RDWSD-44.5\n09:30PM BLOOD Neuts-72.4* Lymphs-18.5* Monos-6.5 Eos-1.5 Baso-0.7 AbsNeut-7.10* AbsLymp-1.82 \nAbsMono-0.64 AbsEos-0.15 AbsBaso-0.07\n09:30PM BLOOD Glucose-111* UreaN-17 Creat-1.2 Na-139 K-5.3* Cl-99 HCO3-27 AnGap-13\n\ufeff\nPERTINENT LABS\n=============\n09:30PM BLOOD CK(CPK)-407*\n09:30PM BLOOD CK-MB-29* MB Indx-7.1* proBNP-766*\n09:30PM BLOOD cTropnT-0.26*\n\ufeff\nIMAGING\n==================\nTTE Conclusions\nLVEF 56%\nThe left atrial volume index is normal. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is xx mmHg. Normal left ventricular wall thickness, cavity size, and regional/global systolic function (3D LVEF = 56 %). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. \n\ufeff\n\ufeff\nIMPRESSION: Normal left ventricular wall thickness, cavity size, and regional/global systolic function. Mild aortic regurgitation. \n\ufeff\nCardiac Cath\nCoronary Anatomy\nDominance: Right\n* Left Main Coronary Artery\nThe LMCA is without significant disease.\n* Left Anterior Descending\nThe LAD is with mild irregularities, tapering to a small apical vessel.\nDiagonal is very small caliber with focal 95% stenosis.\nThe Diagonal is with mild disease.\n* Circumflex\nThe Circumflex is without significant disease.\nThe Marginal is without significant disease.\n* Right Coronary Artery\nThe RCA is with diffuse mid and 50% origin PL.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/NSTEMI/17923616-DS-20.json b/Finished/Acute Coronary Syndrome/NSTEMI/17923616-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..32fa94b98a3fc57490c078aa9103d96de8523d4b --- /dev/null +++ b/Finished/Acute Coronary Syndrome/NSTEMI/17923616-DS-20.json @@ -0,0 +1,93 @@ +{ + "NSTEMI$Intermedia_5": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "BLOOD CK-MB-14* MB Indx-7.0* cTropnT-0.65*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "BLOOD CK-MB-33* MB Indx-9.3* cTropnT-0.59*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "hyperlipidemia is arisk fact and Chest Pain is a symptom of ACS.$Cause_1": { + "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening.$Input2": {} + }, + "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. is a symptom of ACS.$Cause_1": { + "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times.$Input2": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "+ Hyperlipidemia$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "high hs-cTn is a strong value for ACS$Cause_1": { + "In the ED, the patient was found to have elevated troponin with TWI in V2-V6.$Input2": {} + }, + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "he was found to have a 90% LAD lesion and 90% ramus lesion, for which he received DES to each. He had a 60% distal RCA lesion that was not intervened on.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "hyperlipidemia is arisk fact and Chest Pain is a symptom of ACS.$Cause_1": { + "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening.$Input2": {} + }, + "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. is a symptom of ACS.$Cause_1": { + "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times.$Input2": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "+ Hyperlipidemia$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "hyperlipidemia is arisk fact and Chest Pain is a symptom of ACS.$Cause_1": { + "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening.$Input2": {} + }, + "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. is a symptom of ACS.$Cause_1": { + "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times.$Input2": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "+ Hyperlipidemia$Input3": {} + } + }, + "Strongly Suspected ACS$Intermedia_3": { + "high hs-cTn is a strong value for ACS$Cause_1": { + "In the ED, the patient was found to have elevated troponin with TWI in V2-V6.$Input2": {} + }, + "The heart structure is abnormalwhich is a strongly sign of acs$Cause_1": { + "he was found to have a 90% LAD lesion and 90% ramus lesion, for which he received DES to each. He had a 60% distal RCA lesion that was not intervened on.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a symptom of ACS.$Cause_1": { + "chest pain$Input1": {} + }, + "hyperlipidemia is arisk fact and Chest Pain is a symptom of ACS.$Cause_1": { + "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening.$Input2": {} + }, + "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. is a symptom of ACS.$Cause_1": { + "The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times.$Input2": {} + }, + "Hyperlipidemia is a risk factor$Cause_1": { + "+ Hyperlipidemia$Input3": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "He is a gentleman with hyperlipidemia who presented to the ED with chest pain while walking to work yesterday evening. The pain radiated down his left arm and was associated with diaphoresis. The pain improved with rest but came back at work a few more times. He reported no shortness of breath, nausea, or vomiting.\n\ufeff\nIn the ED, the patient was found to have elevated troponin with TWI in V2-V6. He was given aspirin and atorvastatin 80 mg and started on heparin drip. He was taken to the cath lab where he was found to have a 90% LAD lesion and 90% ramus lesion, for which he received DES to each. He had a 60% distal RCA lesion that was not intervened on. He received a ticagrelor load in the lab.\n\ufeff\nOn the floor, patient recounts story as above. States he's doing well without chest pain. \n\ufeff\nREVIEW OF SYSTEMS: On review of systems, denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. Denies recent fevers, chills or rigors. Denies exertional buttock or calf pain. All of the other review of systems were negative. \n\ufeff\nCardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "+ Hyperlipidemia\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "ADMISSION PHYSICAL\nVS: 97.8 18 97%RA\nGENERAL: WDWN M in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\ufeff\nNECK: Supple without JVD \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. R wrist dressed, without hematoma + pulses\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: Distal pulses palpable and symmetric\n", + "input6": "ADMISSION LABS\n03:05AM BLOOD WBC-5.4 RBC-4.54* Hgb-14.3 Hct-42.2 MCV-93 MCH-31.5 MCHC-33.9 RDW-12.8 RDWSD-43.8\n03:05AM BLOOD Neuts-72.0* Lymphs-14.8* Monos-10.0 Eos-2.4 Baso-0.6 AbsNeut-3.90 AbsLymp-0.80* \nAbsMono-0.54 AbsEos-0.13 AbsBaso-0.03\n03:05AM BLOOD Glucose-106* UreaN-37* Creat-1.3* Na-139 \nK-4.4 Cl-106 HCO3-17* AnGap-20\n03:05AM BLOOD CK(CPK)-179\n07:35AM BLOOD Calcium-9.4 Phos-3.0 Mg-2.1\n\ufeff\nCARDIAC ENZYME TREND \n03:05AM BLOOD CK-MB-6\n03:05AM BLOOD cTropnT-0.04*\n08:50AM BLOOD CK-MB-10 MB Indx-5.9 cTropnT-0.21*\n05:15PM BLOOD cTropnT-0.33*\n12:04AM BLOOD CK-MB-45* MB Indx-12.6* cTropnT-0.47*\n07:35AM BLOOD CK-MB-64* MB Indx-13.6* cTropnT-0.61*\n01:15PM BLOOD CK-MB-50* MB Indx-11.2* cTropnT-0.63*\n07:38PM BLOOD CK-MB-33* MB Indx-9.3* cTropnT-0.59*\n07:40AM BLOOD CK-MB-14* MB Indx-7.0* cTropnT-0.65*\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/11514847-DS-14.json b/Finished/Acute Coronary Syndrome/STEMI/11514847-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..cb6312022b28b34015d1ae5e06e4e5a857c74629 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/11514847-DS-14.json @@ -0,0 +1,52 @@ +{ + "NSTE-ACS$Intermedia_4": { + "ST-elevations is a symotom of acs-stemi$Cause_1": { + "Post-PCI EKG demonstrated improvement in ST-elevations$Input2": {} + }, + "Cardiac structural abnormalities is a sigh of ACS$Cause_1": { + "Mild inferolateral hypokinesis consistent with single vessel coronary artery disease. Mild tricuspid regurgitation. Moderate pulmonary hypertension.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Shortness of breath is a symptom of ACS$Cause_1": { + "Shortness of breath$Input1": {} + }, + "chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "family history of heart issues is a risk factor$Cause_1": { + "Father \"heart issues.\"$Input4": {} + }, + "family history oCAD is a risk factor.$Cause_1": { + "Mother with CAD.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "chest pain is a symptom of ACS.$Cause_1": { + "he began to experience non-radiating chest pressure. The chest pain was non-exertional and seemed to be triggered by alcohol use over the weekend.$Input2": {} + }, + "Cardiac surgery is one of the risk factors$Cause_1": { + "He was transferred for cardiac catheterization. He underwent cardiac cath and had 1 DES placed left CX-OM with good result via right radial approach.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Shortness of breath is a symptom of ACS$Cause_1": { + "Shortness of breath$Input1": {} + }, + "chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "family history of heart issues is a risk factor$Cause_1": { + "Father \"heart issues.\"$Input4": {} + }, + "family history oCAD is a risk factor.$Cause_1": { + "Mother with CAD.$Input4": {} + } + } + } + }, + "input1": "Shortness of breath, chest pain\n", + "input2": "A 46 yo male otherwise healthy gentlemen. Patient was in his normal state of health until approximately 4 days prior to admission when he began to experience non-radiating chest pressure. The chest pain was non-exertional and seemed to be triggered by alcohol use over the weekend. He initially experienced chest discomfort without any associated symptoms after taking Metronidazole and Maalox for recent H. pylori diagnosis. He thought the combination of Metronidazole and Flagyl triggered this chest discomfort, which resolved in a few hours. He had a similar experience, which again persisted for a few hours before resolving. He denies any prior history of chest pain, and maintains that he is active and runs without any limitations inflicted by chest pain or shortness of breath.\n\nEarlier on the day of presentation, patient was driving home and began to experience a similar chest discomfort, though this time was more severe. The chest pressure was unremitting without any associated symptoms and patient presented to OSH for further evaluation. \n\nAt OSH, he was loaded with ASA, heparin and trailed SL nitro. He was transferred for cardiac catheterization. He underwent cardiac cath and had 1 DES placed left CX-OM with good result via right radial approach. Post-PCI EKG demonstrated improvement in ST-elevations\n\nOn arrival to CCU, patient is chest pain free. He denies any shortness of breath, nausea/vomiting, palpitations, dizziness or lightheadedness.\n\nROS: Positive per HPI. Remaining 10 point ROS reviewed and negative.\n", + "input3": "Recently diagnosed H. pylori\n", + "input4": "Father \"heart issues.\" Mother with CAD. MGM with MI. HTN in maternal aunts/uncles. No history of diabetes. No history of sudden unexplained death in young individuals. No history of arrhythmias.\n", + "input5": "GENERAL: Well developed, well nourished in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI.\n\nNECK: Supple. JVP not elevated \nCARDIAC: Normal rate, regular rhythm. No murmurs, rubs, or gallops. \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No adventitious breath sounds. \nABDOMEN: Soft, non-tender, non-distended. No palpable hepatomegaly or splenomegaly. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema. \nSKIN: No significant lesions or rashes. \nPULSES: Right radial with bandage and good distal pulse \nNEURO: No focal deficits\n", + "input6": "Hematology \nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW RDWSD Plt \n\nCt \n___ 06:26AM 8.3 4.52* 13.5* 41.9 93 29.9 32.2 13.1 \n44.6 221 Import Result \n___ 02:20AM 10.6* 4.60 13.9 41.6 90 30.2 33.4 12.9 \n42.3 232 Import Result \n BASIC COAGULATION ___, PTT, PLT, INR) ___ PTT Plt Ct ___ \n___ 06:26AM 221 Import Result \n___ 02:20AM 232 Import Result \n___ 02:20AM 13.1* 36.7* 1.2* Import Result \n\n \n \nChemistry \n RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 06:26AM ___ 142 4.1 ___ Import Result \n___ 02:20AM 115* 10 0.7 142 4.1 ___ Import \nResult \nESTIMATED GFR (MDRD CALCULATION) estGFR \n___ 02:20AM Using this Import Result \nCHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron \n___ 06:26AM 8.8 3.5 2.4 Import Result \n___ 02:20AM 8.7 3.3 2.0 Import Result \n \n\nTTE: \nIMPRESSION: Mild inferolateral hypokinesis consistent with single vessel coronary artery disease. Mild tricuspid regurgitation. Moderate pulmonary hypertension.\n\nPCI: Percutaneous Coronary Intervention: Percutaneous coronary intervention (PCI) was performed on an ad hoc basis based on the coronary angiographic findings from the diagnostic portion of this procedure. A 6___ EBU3.5 guide provided adequate support. Crossed with a Prowater wire into the distal OM.\n\nPredilated with a 2.5 mm balloon and then deployed a 3.0 mm x 24 mm DES. Postdilated with a 3.5 x 15mm NC balloon in proximal segment at 18 ATM. Final angiography revealed normal flow, no dissection and 0% residual stenosis.\nComplications: There were no clinically significant complications.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/11528474-DS-10.json b/Finished/Acute Coronary Syndrome/STEMI/11528474-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..093f60c0b63cbd8376eb106075df4c6fd4a46ca3 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/11528474-DS-10.json @@ -0,0 +1,44 @@ +{ + "NSTE-ACS$Intermedia_4": { + "ST-elevations is a symotom of acs-stemi$Cause_1": { + "His EKG showed worsening ST elevations$Input2": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "BLOOD cTropnT-5.18*$Input6": {} + }, + "Cardiac structural abnormalities is a sigh of ACS.$Cause_1": { + "There is a 95% stenosis in the proximal segment.$Input6": {} + }, + "Cardiac structural abnormalities is a sigh of ACS$Cause_1": { + "There is a 70% stenosis in the mid and distal segments.$Input6": {} + }, + "Strongly suspected ACS$Intermedia_3": { + "More severe clinical presentations of acs$Cause_1": { + "he developed sudden onset dizziness, sweating, and chest pain that he described as \"knifelike\". He became so uncomfortable that he \"could not speak\"$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain to OSH$Input1": {} + }, + "Kidney stones can be a risk factor$Cause_1": { + "Kidney stones$Input3": {} + }, + "anxiety can be a risk factor$Cause_1": { + "Anxiety$Input3": {} + }, + "family history of CABG is a risk factor$Cause_1": { + "Mom with CABG.$Input4": {} + }, + "family history of CAD is a risk factor$Cause_1": { + "Brother with CAD with stents.$Input4": {} + } + } + } + }, + "input1": "Chest pain to OSH\n", + "input2": "Patient was in his usual state of health today, but did note some discomfort in his left shoulder while he was at the gym. He says his discomfort has been going on for a few weeks, and he has been attributing it to a musculoskeletal injury from working out. The pain subsided after working out at the gym, and he subsequently went to work. At some point later in the morning at work, he developed sudden onset dizziness, sweating, and chest pain that he described as \"knifelike\". He became so uncomfortable that he \"could not speak\". His wife, who works in the same office as him, called ___. He also had one episode of vomiting.\n\nHe was brought to cath lab where he had total occlusion of LAD. 3 DES (2.5mmx15mm, 3mmx15mm, 3.5mmx15mm) placed in LAD. There was no reflow which minimally responded to intracoronary agents. Given ongoing angina and poor flow in LAD, he was started on an IABP in addition to IV eptifibitide and IV heparin. Given 180 mcg of 325 mg, and 4000U heparin. Subsequently transferred here for further workup and management.\n\nVitals prior to transfer 138/77 w O2 sats 99% on 4L NC.\n\nOn arrival to the CCU, patient was having persistent chest pain and nausea. He was started on a nitro drip with little relief. His EKG showed worsening ST elevations, and the decision was made to bring him to the cath lab. In our Cath Lab his balloon pump was removed and replaced with an Impella via the right groin. His LVEDP went from ___ after balloon placement. Per verbal sign out from the Cath Lab, the stents placed earlier in the day appeared patent but there was residual disease distal to them. Ultimately 2 additional stents were placed in the LAD. Angiography of the LAD revealed TIMI III flow, 0% residual, occluded diagnoal branch likely due to pre-existing dissection, but no dissection in the LAD proper. \n\nHe also had another stent placed in his OM1 which was 95% occluded. Final angiography of the OM revealed TIMI III flow, 0% residual, and no dissection. He received about 1 L of IV fluid in the Cath Lab, as well as 210 cc of contrast.\n\nUpon return to the CCU, his Impella was noted to be properly placed on bedside ultrasound, and his chest pain had improved.\n\nLABS NOTABLE FOR: WBC 10.9 HGB 15.4 PLT GLC 126\n\nROS: Positive per HPI. Remaining 10 point ROS reviewed and negative.\n", + "input3": "+Kidney stones\n+Anxiety\n+Hypospadias surgery in childhood\n", + "input4": "Mom with CABG.\nBrother with CAD with stents.\n", + "input5": "ADMISSION EXAM\n\nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI. \nCARDIAC: Normal rate, regular rhythm. No murmurs, rubs, or gallops. \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No adventitious breath sounds. \nABDOMEN: Soft, non-tender, non-distended. No palpable hepatomegaly or splenomegaly. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema. Right wrist with TR band in place. Right groin with Impala in place, some blood under dressing but no surrounding erythema\nSKIN: No significant lesions or rashes. \nPULSES: Distal pulses palpable and symmetric. \nNEURO: AAO x3\n", + "input6": "ADMISSION LABS\n\n___ 02:45PM BLOOD WBC-15.4* RBC-4.68 Hgb-14.3 Hct-41.0 MCV-88 MCH-30.6 MCHC-34.9 RDW-11.7 RDWSD-37.5 Plt ___\n___ 02:45PM BLOOD WBC-15.4* RBC-4.68 Hgb-14.3 Hct-41.0 MCV-88 MCH-30.6 MCHC-34.9 RDW-11.7 RDWSD-37.5 Plt ___\n___ 02:45PM BLOOD Neuts-91.3* Lymphs-5.2* Monos-2.9* Eos-0.0* Baso-0.1 Im ___ AbsNeut-14.07* AbsLymp-0.80* AbsMono-0.44 AbsEos-0.00* AbsBaso-0.02\n___ 05:45PM BLOOD ___ PTT-31.3 ___\n___ 02:45PM BLOOD Glucose-108* UreaN-19 Creat-1.1 Na-138 K-4.7 Cl-103 HCO3-20* AnGap-15\n___ 02:45PM BLOOD ALT-33 AST-187* ___ AlkPhos-57 TotBili-0.7\n___ 02:45PM BLOOD CK-MB-124* MB Indx-6.5* cTropnT-3.32*\n___ 06:02AM BLOOD CK-MB-252* cTropnT-6.42*\n___ 01:49PM BLOOD cTropnT-5.18*\n___ 02:45PM BLOOD Calcium-9.1 Phos-3.0 Mg-2.1 Cholest-206*\n___ 02:45PM BLOOD Triglyc-141 HDL-46 CHOL/HD-4.5 LDLcalc-132*\n___ 02:45PM BLOOD %HbA1c-5.3 eAG-105\n\n\nIMAGING\n=======\nCXR ___No previous images. The tip of the IABP is approximately 3 cm above the carina. No evidence of vascular congestion, pleural effusion, or acute focal pneumonia. \n \nSTUDIES\n======\nCARDIAC CATH ___\nLM: The Left Main, arising from the left cusp, is a large caliber vessel. This vessel bifurcates into the Left Anterior Descending and Left Circumflex systems.\n \nLAD: The Left Anterior Descending artery, which arises from the LM, is a large caliber vessel. There is a stent in the proximal segment. There is a stent in the proximal segment. There is a 90% ulcerated plaque/dissction in the mid segment of the LAD after the bend of stents. The Septal Perforator, arising from the proximal segment, is a small caliber vessel. The Diagonal, arising from the proximal segment, is a medium caliber vessel. There is a 100% stenosis in the ostium.\n \nLeft Circumflex: The Circumflex artery, which arises from the LM, is a large caliber vessel. The Obtuse Marginal, arising from the proximal segment, is a large caliber vessel. There is a 95% stenosis in the proximal segment. The Superior lateral of the 1stOM, arising from the distal segment, is a medium caliber vessel. The Obtuse Marginal, arising from the proximal segment, is a medium caliber vessel. The Atrioventricular Circumflex, arising from the mid segment, is a medium caliber vessel. There is a 70% stenosis in the mid and distal segments. The Left Posterior Descending Artery, arising from the distal segment, is a medium caliber vessel. One injection show a small degree of air into the distal LCx but this resolved with 100% oxygen.\n\nRCA: The Right Coronary Artery, arising from the right cusp, is a small caliber \n\nTTE\nEF 35%. Moderate regional left ventricular systolic dysfunction, c/w CAD. Well-positioned Impella CP device.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/11801858-DS-13.json b/Finished/Acute Coronary Syndrome/STEMI/11801858-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..ddfe1838041eaa658754e1657a90c956dcb8881d --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/11801858-DS-13.json @@ -0,0 +1,55 @@ +{ + "NSTE-ACS$Intermedia_4": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "cTropnT-5.97*$Input6": {} + }, + "Cardiac structural abnormalities is a sigh of ACS.$Cause_1": { + "The LAD had a ___ mid vessel stenosis. The Cx had a 100% mid vessel thrombotic occlusion. The RCA had a mid vessel stenosis.$Input6": {} + }, + "Cardiac structural abnormalities is a sigh of ACS$Cause_1": { + "Overall left ventricular systolic function is severely depressed (LVEF= 15X %). with depressed free wall contractility. The number of aortic valve leaflets cannot be determined. The aortic valve leaflets are moderately thickened. The mitral valve leaflets are structurally normal. Moderate to severe (3+) mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "history of HTN, dCHF, severe AS, HLD ARE risk factors$Cause_1": { + "Female with history of HTN, dCHF, severe AS, HLD$Input2": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN$Input3": {} + }, + "Severe AS is the risk fact for ACS$Cause_1": { + "Severe AS$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "More severe clinical presentations of acs$Cause_1": { + "She felt exhausted and lightheaded and also had some diarrhea last night. Also noticed some numbness in her right leg whihc comes and goes$Input2": {} + }, + "EKG changes are sign of ACS$Cause_1": { + "Was found to have EKG changes.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "history of HTN, dCHF, severe AS, HLD ARE risk factors$Cause_1": { + "Female with history of HTN, dCHF, severe AS, HLD$Input2": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN$Input3": {} + }, + "Severe AS is the risk fact for ACS$Cause_1": { + "Severe AS$Input3": {} + } + } + } + }, + "input1": "chest pain\n", + "input2": "Female with history of HTN, dCHF, severe AS, HLD who presented initially with complaint of chest pressure anteriorly. She described it as substernal, constant since last night. She felt exhausted and lightheaded and also had some diarrhea last night. Also noticed some numbness in her right leg whihc comes and goes. Was found to have EKG changes. She had no prior cardiac history. Had been seen last week at ED and ruled out with -ve sets after \"strained muscle in her chest moving her arm\". A CTA of the chest showed mild emphysema, but no evidence of PE. \n\nInitial VS were 97.8, HR 109, BP 121/84, RR 22, 02 sat 78% and pain. In ED she was noted to have an o2 sat of 80% and was lightheaded. Found to be guaiac positive. She got ASA and was started on a heaprin gtt (w/o bolus). IN cath lab, they went in through the lt radial huge and found a thrombus in lcx, mild right disease. She got 600 plavix after cath, bival, bms in lcx, and had a hematoma in lt radial. Transferred to CCU after procedure.\n", + "input3": "+HTN\n+HL\n+dCHF\n+Severe AS\n+GERD\n+Osteoprosis: Pseudoclaudication, likely because of spinal stenosis, history of falls and shoulder injury, s/p ORIF right patellar fracture\n", + "input4": "non-contributory\n", + "input5": "On transfer to CCU\nVS: 98.4, 103, 131/87, 19, 90% on NRB\nGENERAL: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nNEURO: AAOx3, CNII-XII intact, strength biceps, triceps, wrist, knee/hip flexors/extensors, 2+ reflexes biceps, brachioradialis, patellar, ankle. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+\n", + "input6": "___ 05:22PM BLOOD CK(CPK)-___*\n___ 05:22PM BLOOD CK-MB-114* MB Indx-6.2* cTropnT-5.97*\n\nCardiac Cath\n1. Selective coronary angiography in this right dominant systemdemonstrated one vessel disease. The LMCA had noangiographically apparent disease. The LAD had a ___ mid vessel stenosis. The Cx had a 100% mid vessel thrombotic occlusion. The RCA had a mid vessel stenosis. \n\n2. Limited resting hemodynamics revealed a central aortic pressure of 132.86 mmHg. \n\n3. Successful PTCA and stenting of the mid Cx with a 2.25x8mm INTEGRITY stent which was postdilated to 2.75mm. Final angiography revealed no residual stenosis, no angiographically apparent dissection and TIMI II to III flow. \n \nBedside TTE\nOverall left ventricular systolic function is severely depressed (LVEF= 15X %). with depressed free wall contractility. The number of aortic valve leaflets cannot be determined. The aortic valve leaflets are moderately thickened. The mitral valve leaflets are structurally normal. Moderate to severe (3+) mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion. \n\nCXR (___)\nWide spread bilateral dense reticular opacities with relative left lower lung and right mid lung sparing, likely representing flash pulmonary edema due to acute cardiac decompensation in the setting of ischemia/infarct.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/12238650-DS-22.json b/Finished/Acute Coronary Syndrome/STEMI/12238650-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..b6e9a8e2b81d11fbe9624fa56c16325aa03460e8 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/12238650-DS-22.json @@ -0,0 +1,82 @@ +{ + "NSTE-ACS$Intermedia_4": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "cTropnT-6.61*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "cTropnT-12.62*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09 .$Cause_1": { + "cTropnT-11.69*$Input6": {} + }, + "Cardiac structural abnormalities is a sigh of ACS.$Cause_1": { + "Left\nThe LMCA was short with nearly separate ostia in the LAD and Cx. The LAD was widely patent with no thrombosis in the stent and only mild luminal irregularities. The Cx had mild plaquing. The RCA was nondominant with luminal irregularities as before.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "history of coronary artery disease is a risk factor$Cause_1": { + "Male with history of coronary artery disease$Input2": {} + }, + "Chest pain is a symptom of ACS.$Cause_1": { + "The patient has been complaining of progressive, exertional, left sided chest pain.$Input2": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN$Input3": {} + }, + "DM2 is the risk fact for ACS$Cause_1": { + "DM2$Input3": {} + }, + "HLD is the risk fact for ACS$Cause_1": { + "HLD$Input3": {} + }, + "family history of HTN is a risk factor$Cause_1": { + "HTN in both parents$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "Coronary stenosis isa sign of acs$Cause_1": { + "The patient underwent elective coronary angiography which demonstrated a 90% proximal LAD lesion for which a 3.0x12 Xience (DES).$Input2": {} + }, + "More severe clinical presentations of acs$Cause_1": { + "before the patient could pick up with prescription, he had the sudden onset of sharp, mid-abdominal pain. This was without radiation, nausea, vomiting or diarrhea.$Input2": {} + }, + "More severe clinical presentations of acs.$Cause_1": { + "the patient reported sudden onset of dyspnea, nausea/vomiting and diaphoresis.$Input2": {} + }, + "EKG changes are sign of ACS$Cause_1": { + "An ECG was obtained which demonstrated sinus rhythm at a rate of 89 with STE V2-V5 and aVL with reciprocal changed in II and III.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "history of coronary artery disease is a risk factor$Cause_1": { + "Male with history of coronary artery disease$Input2": {} + }, + "Chest pain is a symptom of ACS.$Cause_1": { + "The patient has been complaining of progressive, exertional, left sided chest pain.$Input2": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN$Input3": {} + }, + "DM2 is the risk fact for ACS$Cause_1": { + "DM2$Input3": {} + }, + "HLD is the risk fact for ACS$Cause_1": { + "HLD$Input3": {} + }, + "family history of HTN is a risk factor$Cause_1": { + "HTN in both parents$Input4": {} + } + } + } + }, + "input1": "Chest pain\n", + "input2": "Male with history of coronary artery disease s/p recent PCI presents with in-stent thrombosis.\n\nThe patient has been complaining of progressive, exertional, left sided chest pain. He underwent a nuclearstress test that demonstrated METs with chest pain symptoms. Normal myocardial perfusion study. LVEF 46&\". In addition, a TTE demonstrated \"LVEF 60-65%, normal RV, mild MR\".\n\nHe was seen that his chest pain was attributed to possible angina though this was deemed less likely given his negative stress testing. Given his risk factors and family history the patient, along with his cardiologist elected to pursue angiography. \n\nThe patient underwent elective coronary angiography which demonstrated a 90% proximal LAD lesion for which a 3.0x12 Xience (DES). He was loaded with ticagrelor and discharged the same day. \n\nThe patient was seen in the CDAC for abdominal discomfort that is exacerbated after eating food ever since he started taking his ticagrelor. He was instructed to start pantoprazole and to discontinue his ticagrelor. He was given a prescription for clopidogrel 75mg daily after a 300mg loading dose. \n\nHe had taken his morning dose of ticagrelor. He was instructed to hold his evening dose and load with clopidogrel 300mg the next morning. The patient went to his pharmacy that evening to pick up his prescription. The pharmacist said they did not have the 300mg loading dose available but that the patient should come back the next day to pick it up. The patient took clopidogrel 75mg the next morning with plans to pick up his loading dose later in the day. \n\nHowever, before the patient could pick up with prescription, he had the sudden onset of sharp, mid-abdominal pain. This was without radiation, nausea, vomiting or diarrhea. \n\nHis vitals on presentation were notable for T 98.2 HR 73 R 16 BP146/101 SpO2 99. His Chemistry panel was wnl. LFTs were notable for AST 20 ALT 38 AP 62 and Lipase 128. INR was 1.2 CBC was wnl.\n\nHe underwent a CT abd which showed evidence of mild pancreatitis. He was admitted for abdominal pain with concern for pancretitis.\n\nHis ECG on admission demonstrated normal sinus rhythm at a rate of 66 with normal axis and intervals. There was TWI in V4-6 and STD I-II. \n\nThe next day, the patient reported sudden onset of dyspnea, nausea/vomiting and diaphoresis. An ECG was obtained which demonstrated sinus rhythm at a rate of 89 with STE V2-V5 and aVL with reciprocal changed in II and III. He was transferred out of concern for in-stent thrombosis.\n\nUpon arrival, he was taken directly to the cath lab where he underwent coronary angiography via the R radial artery. This demonstrated complete occlusion of the LAD for which he received POBA. \n\nHe was then transferred to the floor where he was complaining of mild dyspnea but improved abdominal pain. He has no fevers or chills. No chest pain or papliations. His ECG showed improved anteroseptal STEs.\n\nOf note, the patient has had an episode of pancreatitis that was thought to be possible due to biliary obstruction but no stones were seen on EUS. Therefore the etiology was thought to be from resolved choledocholithiasis vs. idiopathic. The patient states that this abdominal pain is very similar to this episode.\n", + "input3": "+HTN\n+HLD\n+CVA c/b R arm and leg weakness\n+DM2\n+Pancreatitis\n", + "input4": "HTN in both parents, father with CHF, mother with CABG in her, multiple siblings with HTN. Had myopathy to rosuvastatin \nand cough to lisinopril.\n", + "input5": "ADMISSION PHYSICAL EXAMINATION: \n===============================\nVS: T 98.2 BP 159/98 HR 91 R 18 SpO2 98 ra \nGEN: NAD\nHEENT: Clear OP, no scleral icterus\nRESP: No increased WOB. Mild, end-expiratory crackles R base\nABD: NTND no HSM\nEXT: Warm, no edema. No mass by R radial artery. Bandage c/d/i\nNEURO: CN II-XII intact. Strength ___ LUE and LLE ___ RUE and RLE\n", + "input6": "ADMISSION LABS:\n===============\n___ 11:00AM BLOOD WBC-7.6 RBC-4.56* Hgb-13.5* Hct-39.9* MCV-88 MCH-29.6 MCHC-33.8 RDW-13.2 RDWSD-42.2 Plt ___\n___ 11:00AM BLOOD Neuts-86.3* Lymphs-9.6* Monos-3.3* Eos-0.1* Baso-0.3 Im ___ AbsNeut-6.58* AbsLymp-0.73* AbsMono-0.25 AbsEos-0.01* AbsBaso-0.02\n___ 11:00AM BLOOD Glucose-253* UreaN-10 Creat-1.1 Na-140 K-4.0 Cl-101 HCO3-25 AnGap-14\n___ 11:00AM BLOOD ALT-63* AST-304* LD(LDH)-690* AlkPhos-57 Amylase-29 TotBili-0.9\n___ 11:00AM BLOOD Lipase-77*\n___ 11:00AM BLOOD CK-MB-214* cTropnT-6.61*\n___ 08:00PM BLOOD cTropnT-12.62*\n___ 09:52PM BLOOD CK-MB-259* cTropnT-11.69*\n___ 11:00AM BLOOD Albumin-4.2 Calcium-9.1 Phos-4.0 Mg-1.9 Iron-50 Cholest-108\n___ 11:00AM BLOOD calTIBC-325 Ferritn-204 TRF-250\n___ 11:00AM BLOOD Triglyc-28 HDL-44 CHOL/HD-2.5 LDLcalc-58\n\n\nIMAGING/STUDIES:\n================\nCORONARY ANGIOGRAPHY ___:\nFINDINGS:\nHemodynamics: State: Baseline\nDominance: Left\nThe LMCA was short with nearly separate ostia in the LAD and Cx. The LAD was widely patent with no thrombosis in the stent and only mild luminal irregularities. The Cx had mild plaquing. The RCA was nondominant with luminal irregularities as before.\nImpressions:\n1. No change in coronary disease.\n\nCXR:\nThere is a right lower lobe patchy opacity. No pleural effusion or pneumothorax identified. The size of the cardiac silhouette is within normal limits. \nIMPRESSION: \nRight basilar atelectasis and/or consolidation. \n\nLIVER OR GALLBLADDER U/S:\n1. Echogenic liver most likely due to fatty deposition. Please note, on the basis of this appearance, more advanced forms liver disease not excluded. \n2. Status post cholecystectomy. No biliary ductal dilation.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/12392100-DS-22.json b/Finished/Acute Coronary Syndrome/STEMI/12392100-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..cf4c2552456663727438ee4f5134a67e24d3d1d7 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/12392100-DS-22.json @@ -0,0 +1,79 @@ +{ + "NSTE-ACS$Intermedia_4": { + "ST-elevations is a symotom of acs-stemi$Cause_1": { + "On arrival, there is observed to be anterior ST elevations.$Input2": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "repeat troponin at 8:20AM day of transfer, 0.25.$Input2": {} + }, + "Cardiac structural abnormalities is a sigh of ACS.$Cause_1": { + "Dilated right ventricular cavity with mild global free wall hypokinesis. The aortic sinus is mildly dilated with normal ascending aorta diameter for gender. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. There is no aortic regurgitation. The mitral valve leaflets appear structurally normal with no mitral valve prolapse. There is trivial mitral regurgitation.$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09 .$Cause_1": { + "CK-MB-3 cTropnT-0.10*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Cardiac ArrestChest Pain$Input1": {} + }, + "alcohol use and heavy smoking are risk factors$Cause_1": { + "He is a 58 year old gentleman with a history of significant alcohol use and heavy smoking$Input2": {} + }, + "Hypertension is the risk fact for ACS$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is the risk fact for ACS$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Chronic low back pain is the risk fact for ACS$Cause_1": { + "Chronic low back pain$Input3": {} + }, + "Anxiety is the risk fact for ACS$Cause_1": { + "Anxiety$Input3": {} + }, + "family history of coronary artery disease is a risk factor$Cause_1": { + "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "Changes in the nervous system can be a sigh$Cause_1": { + "He's also had erratic behavior including spending all his time naked, being incontinent of urine and sometimes stool, shouting sporadically and playing loud music, and other behavior that is very atypical for him.$Input2": {} + }, + "More severe clinical presentations of acs$Cause_1": { + "She found him to have jerking movements of his extremities and not responding to her.$Input2": {} + }, + "Coronary stenosis is a sigh of acs$Cause_1": { + "Angiography showed 95% LM ostial stenosis, 90% LAD extending to mid-LAD and 90% stenosis at large diagonal. the circumflex has 80% mid stenosis.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Cardiac ArrestChest Pain$Input1": {} + }, + "alcohol use and heavy smoking are risk factors$Cause_1": { + "He is a 58 year old gentleman with a history of significant alcohol use and heavy smoking$Input2": {} + }, + "Hypertension is the risk fact for ACS$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is the risk fact for ACS$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Chronic low back pain is the risk fact for ACS$Cause_1": { + "Chronic low back pain$Input3": {} + }, + "Anxiety is the risk fact for ACS$Cause_1": { + "Anxiety$Input3": {} + }, + "family history of coronary artery disease is a risk factor$Cause_1": { + "Strong family history of coronary artery disease in several first degree relatives on his mother's side of family.$Input4": {} + } + } + } + }, + "input1": "Cardiac ArrestChest Pain\n", + "input2": "He is a 58 year old gentleman with a history of significant alcohol use and heavy smoking with a recent neurologic decline who presents to the CCU after witnessed cardiac arrest. \n\nHe has had a steep neurologic decline over the past two months. He has been a lifelong heavy drinker and smoker, but he's been drinking far more than usual and at atypical times of day. He's also had erratic behavior including spending all his time naked, being incontinent of urine and sometimes stool, shouting sporadically and playing loud music, and other behavior that is very atypical for him. He was recently hospitalized for a rectal foreign body that was removed successfully. Due to concern for behavioral changes and rapidly progressive dementia, neurology was consulted. They suggested an extensive neurologic workup but the patient left AMA. He has since established with neurology but has also declined a workup there. \n\nHe was having a typical day, and drinking heavily during the day. His wife made him a sandwich and left the room briefly and returned when she heard gurgling sounds. She found him to have jerking movements of his extremities and not responding to her. She called EMS who arrived within minutes and found him to be pulseless VF and delivered a shock, regaining a pulse. He was intubated in the field. He received an amiodarone bolus. He was given 600mg aspirin PR. \n\nOn arrival, there is observed to be anterior ST elevations. Angiography showed 95% LM ostial stenosis, 90% LAD extending to mid-LAD and 90% stenosis at large diagonal. the circumflex has 80% mid stenosis. The RCA had minimal disease. An intra-aortic balloon pump was placed using R femoral access. \n\nOn arrival for to the ICU, he was found to not be following commands and post-arrest was consulted who recommended targeted-temperature management and EEG.He is a gentleman with CAD (known occluded RCA with collaterals s/p PCI's (PTCA and stenting of ostial LCx and PTCA ostial RI c/b instent restenosis at ostium of LCx and restenosis of ramus branch s/p PTCA of LCx ostium and ramus ostium, HTN, HL, chronic low back pain and anxiety who presented to OSH with chest pain. He was found to have an NSTEMI and was transferred to for catheterization.\n \nAt the time of presentation, patient's pain was in severity. Troponins initially .06, repeat troponin at 8:20AM day of transfer, 0.25. VS on transfer: 136/59, HR 69 SR, 16, 97% 2 liters, afebrile. Patient arrived and underwent uncomplicated cardiac cath with right femoral access. During procedure DES was placed in the ostial LCx with residual 40-50% distal left main to LAD. Plan per interventional is ASA, plavix, IVF overnight with plan for TTE, consult in the AM. Of note patient received ample versed and Fentanyl \n\nOn arrival to the floor, patient without complaint. Denies chest pain, shortness of breath, palpitations. Tolerating PO without nausea, vomiting. Chronic back pain is at its baseline. Last BM yesterday.\n", + "input3": "+Arthritis (several joints) \n+Erectile dysfunction \n+Rapid onset dementia currently being worked up+CAD s/p MI and multiple PCI's \n+Hypertension \n+Hyperlipidemia \n+Chronic low back pain\n+s/p cholecystectomy \n+h/o osteomyelitis \n+Depression \n+Anxiety \n+Umbilical hernia\n", + "input4": "Sister with lung CA \nFather died of liver disease with no history of alcohol useStrong family history of coronary artery disease in several first degree relatives on his mother's side of family. Thinks his family members have hypercholesterolemia, diabetes, hypertension. + early cardiac death.\n", + "input5": "ADMISSION PHYSICAL EXAMINATION:\n\nVS: T98.4, HR 90, BP 132/74, RR 21, O2 100% on 60% FiO2\nGENERAL: Intubated, no apparent distress\nHEENT: Pupils equal and briskly reactive, ETT tube, small abrasion on nasal bridge, no scleral icterus, moist mucous membranes\nNECK: JVP not elevated\nCARDIAC: S1/S2 regular, balloon pump auscultated, no other obvious murmurs\nLUNGS: Rhonchorous bilaterally\nABDOMEN: Soft, non-distended\nEXTREMITIES: No lower extremity edema, hair loss at the lower shins and distally. Balloon pump in R groin with no hematoma. Palpable R pedal pulses. \nNEURO: Moving both extremities and gagging on tube after arrival, then much less activity subsequently. Not following any commands. Some movement of eyes and eyelids spontaneouslyADMISSION EXAM\nVS T 97.8 102/60 72 14 96%RA \nGen: Obese M in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNeck: Supple with no JVD noted (difficult to assess). \nCV: RR, normal S1, S2. No m/r/g. No S3 or S4. Distant heart \nsounds. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nAbd: NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. Morphine pump can be felt on the RLQ under the skin. \nExt: no c/c/e. Right femoral cath site c/d/i under tegaderm. \nSkin: No stasis dermatitis, ulcers, scars, xanthomas. + tattoos noted \nRight: 2+ DPs \nLeft: 2+ DP and radial\n", + "input6": "ADMISSION LABS:\n\n___ 07:20PM BLOOD WBC-13.2* RBC-3.80* Hgb-13.1* Hct-39.9* MCV-105* MCH-34.5* MCHC-32.8 RDW-12.0 RDWSD-46.7* Plt ___\n___ 07:20PM BLOOD Neuts-60.9 ___ Monos-10.0 Eos-3.4 Baso-0.6 Im ___ AbsNeut-8.01* AbsLymp-3.00 AbsMono-1.32* AbsEos-0.45 AbsBaso-0.08\n___ 07:20PM BLOOD ___ PTT-27.7 ___\n___ 07:20PM BLOOD Glucose-143* UreaN-10 Creat-0.8 Na-132* K-4.1 Cl-98 HCO3-13* AnGap-21*\n___ 07:20PM BLOOD ALT-33 AST-60* AlkPhos-90 TotBili-0.3\n___ 07:20PM BLOOD Lipase-49\n___ 07:20PM BLOOD cTropnT-<0.01\n___ 07:20PM BLOOD Albumin-3.7 Calcium-8.2* Phos-4.9* Mg-2.3\n___ 07:20PM BLOOD ASA-NEG Ethanol-36* Acetmnp-NEG Tricycl-NEG\n___ 07:46PM BLOOD ___ pO2-42* pCO2-46* pH-7.21* calTCO2-19* Base XS--9 Comment-PERIPHERAL\n\nMICRO:\n___ BLOOD CULTURE x2 - no growth\n___ URINE CULTURE - no growth\n\n\nIMAGING/STUDIES:\n___ EEG\nThis was an abnormal continuous ICU EEG monitoring study due to severe diffuse encephalopathy as demonstrated by diffuse slowing and disorganization. There were no electrographic seizures or epileptiform discharges. \n\n___ CXR\nThe ET tube projects approximately 4 cm from the carina. The NG tube projects to the stomach and is coiled up within the stomach. The aortic balloon pump tip projects over the aortic arch. Lungs are low volume with bibasilar atelectasis. No evidence of pneumonia edema or pneumothorax. No effusions. Old healed fracture involving the right clavicle. \n\n___ CORONARY ANGIOGRAM\nThe left main coronary artery. There is a 95% stenosis calcified ostial stenosis. The left anterior descending coronary artery. There is a 90% stenosis proximal LAD extending to the mid LAD. There was a 90% stenosis of the diagonal branch which was a large vessel. The mid and distal LAD had minor lumen irregularities. The circumflex coronary artery. There was a 50% stenosis in the proximal LAD. There is a 80% stenosis in the mid LCx. The distal LCx supplied the left PDA and PL branches. There was a 90% stenosis of a large bifurcating OMB. The right coronary artery. There is a 20% stenosis. IABP placed for high risk anatomy.\n\n___ EEG\nThis was an abnormal continuous ICU EEG monitoring study due to severe diffuse encephalopathy as demonstrated by diffuse slowing and disorganization. There were no electrographic seizures or epileptiform discharges. \n\n___ CXR\nET and NG tube is unchanged. The intra aortic balloon pump is also unchanged. Lungs are low volume with worsening pulmonary vascular congestion. Cardiomediastinal silhouette is stable. There is no pleural effusion. No pneumothorax. \n\n___ TTE\nThe left atrium is normal in size. The inferior vena cava is dilated (>2.5 cm). There is mild symmetric left ventricular hypertrophy with a normal cavity size. There is moderate regional left ventricular systolic dysfunction with distal septal, anterior and septal hypokinesis as well as inferior wall and basal to mid inferolateral (see schematic) and preserved/normal contractility of the remaining segments. The visually estimated left ventricular ejection fraction is 35-45%. There is no resting left ventricular outflow tract gradient. Dilated right ventricular cavity with mild global free wall hypokinesis. The aortic sinus is mildly dilated with normal ascending aorta diameter for gender. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. There is no aortic regurgitation. The mitral valve leaflets appear structurally normal with no mitral valve prolapse. There is trivial mitral regurgitation. The pulmonic valve leaflets are normal. The tricuspid valve leaflets are mildly thickened. There is physiologic tricuspid regurgitation. The pulmonary artery systolic pressure could not be estimated. There is no pericardial effusion.\n\n___ CXR\nModerate pulmonary edema has increased and change distributions. Heart size normal. No appreciable pleural effusion or pneumothorax. Normal mediastinal and hilar contours.ADMISSION LABS\n--------------------\n___ 02:34AM BLOOD Plt ___\n___ 02:34AM BLOOD UreaN-15 Creat-1.1 Na-140 K-4.8 Cl-104\n___ 02:34AM BLOOD CK(CPK)-78\n___ 02:34AM BLOOD CK-MB-3 cTropnT-0.10*\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/13007301-DS-11.json b/Finished/Acute Coronary Syndrome/STEMI/13007301-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..47f6bce8999dd5a774653a8356e45843d805d483 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/13007301-DS-11.json @@ -0,0 +1,58 @@ +{ + "NSTE-ACS$Intermedia_4": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "BLOOD cTropnT-<0.01$Input6": {} + }, + "ECG change is a evidence of ACS-STEMI$Cause_1": { + "EKG: On arrival to ED, EKG demonstrated normal sinus rhythm with PVC's, ST elevations V1-V6$Input6": {} + }, + "Cardiac structural abnormalities is a diagnostic criteria of ACS-STEMI$Cause_1": { + "CARDIAC CATH: Right dominant. Total occlusion of mid-LAD. LCx with moderate disease; 90% lesion in a small ramus and subtotal lesion in a branch of the ramus. No obstructive RCA disease. DES placed in mid-LAD.$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "BLOOD CK-MB-48* MB Indx-5.3 cTropnT-1.59*$Input6": {} + }, + "Suspected ACS$Cause_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "Risk factors$Cause_1": { + "+ Mixed Hyperlipidemia + initally had low HDL levels and \nelevated triglycerides.$Input3": {} + }, + "Chest pain is a symptom of ACS.$Cause_1": { + "Two days prior to admission, he had similar pain, which he dismissed (given his previous episodes). It awoke him from sleep,$Input2": {} + }, + "Family history is a risk factor$Cause_1": { + "Father with MI$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "maybe evidence of ACS-STEMI$Cause_1": { + "He has a history of similar pain for which he was evaluated with stress test (atypical/non-anginal type symptoms in the absence of ischemic ST segment changes).$Input2": {} + }, + "Occlusion of the coronary artery is a symbol of ACS$Cause_1": { + "Coronary Angiography demonstrated a total occlusion of his mid LAD and a 90% occlusion of his ramus intermedius. He had a drug eluting stent placed to his mid LAD.$Input2": {} + }, + "Suspected ACS$Cause_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "Risk factors$Cause_1": { + "+ Mixed Hyperlipidemia + initally had low HDL levels and \nelevated triglycerides.$Input3": {} + }, + "Chest pain is a symptom of ACS.$Cause_1": { + "Two days prior to admission, he had similar pain, which he dismissed (given his previous episodes). It awoke him from sleep,$Input2": {} + }, + "Family history is a risk factor$Cause_1": { + "Father with MI$Input4": {} + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "68 y/o man with history of moderate mixed hyperlipidemia, recently diagnosed type II diabetes, presented to the emergency department today with severe chest pain. He has a history of similar pain for which he was evaluated with stress test (atypical/non-anginal type symptoms in the absence of ischemic ST segment changes). Two days prior to admission, he had similar pain, which he dismissed (given his previous episodes). It awoke him from sleep, but again went away on its own. On the day of presentation, it awoke him from sleep, and he was brought emergently to the ED. He denied shortness of breath and nausea but noted diaphoresis. The pain was located over his left chest. He was noted to have ST elevations anteriorly and was taken urgently to the cath lab. \n\nCoronary Angiography demonstrated a total occlusion of his mid LAD and a 90% occlusion of his ramus intermedius. He had a drug eluting stent placed to his mid LAD.\n", + "input3": "+ Mixed Hyperlipidemia + initally had low HDL levels and \nelevated triglycerides.\n+ GERD\n", + "input4": "Father with MI\n", + "input5": "Vitals: T98.5F, 150/99, 83, RR 23, 99%RA\nGeneral: Well-appearing, no acute distress\nHEENT: MMM, OP clear\nNeck: JVP not elevated\nHeart: RRR no m/r/g\nLung: Clear anteriorly\nAbd: Soft, non-tender, non-distended; + bowel sounds\nGroin: Mild fullness over right groin site, moderate tenderness; no obvious hematoma\nExt: no c/c/e; 2+ DP pulses bilaterally\n", + "input6": "___ 10:25AM BLOOD WBC-8.1# RBC-5.46 Hgb-15.4 Hct-46.2 MCV-85 MCH-28.2 MCHC-33.4 RDW-13.6 Plt ___\n___ 07:30AM BLOOD WBC-8.0 RBC-4.27* Hgb-12.3* Hct-35.1* MCV-82 MCH-28.9 MCHC-35.1* RDW-13.5 Plt ___\n___ 10:25AM BLOOD Glucose-212* UreaN-26* Creat-1.3* Na-138 K-3.8 Cl-101 HCO3-26 AnGap-15\n___ 07:30AM BLOOD Glucose-119* UreaN-22* Creat-1.4* Na-139 K-4.0 Cl-103 HCO3-27 AnGap-13\n___ 07:30AM BLOOD ALT-38 AST-29 AlkPhos-56 TotBili-0.6\n___ 10:25AM BLOOD CK(CPK)-173\n___ 04:51PM BLOOD CK(CPK)-1286*\n___ 01:42AM BLOOD CK(CPK)-903*\n___ 10:25AM BLOOD cTropnT-<0.01\n___ 04:51PM BLOOD CK-MB-83* MB Indx-6.5 cTropnT-2.05*\n___ 01:42AM BLOOD CK-MB-48* MB Indx-5.3 cTropnT-1.59*\n\nEKG: On arrival to ED, EKG demonstrated normal sinus rhythm with PVC's, ST elevations V1-V6\n\nTELEMETRY: Sinus tachycardia\n\n2D-ECHOCARDIOGRAM: none \n\nETT: none\n\nCARDIAC CATH: Right dominant. Total occlusion of mid-LAD. LCx with moderate disease; 90% lesion in a small ramus and subtotal lesion in a branch of the ramus. No obstructive RCA disease. DES placed in mid-LAD.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/13288722-DS-12.json b/Finished/Acute Coronary Syndrome/STEMI/13288722-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..6b26c7c209682683a65e1635f2c04c77a31ba683 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/13288722-DS-12.json @@ -0,0 +1,61 @@ +{ + "NSTE-ACS$Intermedia_4": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "BLOOD cTropnT-0.85*$Input6": {} + }, + "ECG change is a evidence of ACS-STEMI$Cause_1": { + "Sinus rhythm. Possible prior inferior wall myocardial infarction. Left atrial abnormality. Diffuse non-specific ST-T wave abnormalities. No previous tracing available for comparison.$Input6": {} + }, + "Occlusion of the coronary artery is symbol of acs$Cause_1": { + "ESTIMATED blood loss: <60 cc\nHemodynamics (see above):\nCoronary angiography: right dominant\nLMCA: No angiographically apparent CAD\nLAD: Ostial 40%, mild luminal irregularities. Long 60% diagonal stenosis.\nLCX: Proximal 30%, Origin OM1 had 60% stenosis and the Cx continuation had thrombotic subtotal occlusion with 95% stenosis\nRCA: Chronic mid vessel total occlusion with collaterals from the LCA$Input6": {} + }, + "Cardiac structural abnormalities is a diagnostic criteria of ACS-STEMI$Cause_1": { + "The left atrium is mildly dilated. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. There is mild regional left ventricular systolic dysfunction with hypokinesis of the basal inferior, inferolateral and lateral walls (LCx disease). The remaining segments contract normally (LVEF = 40-45%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09..$Cause_1": { + "CK-MB-88* cTropnT-1.33*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09...$Cause_1": { + "cTropnT-0.71*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "symptom of ACS$Cause_1": { + "72 year old man with GERD, HTN, no known CAD, presented this am with several hours of retrosternal chest pressure similar but more severe than prior episodes of GERD.$Input2": {} + }, + "risk factors$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "family history is a risk factor$Cause_1": { + "Father died by cardiac issue. Mother died of pancreatic ca. Family Hx colon ca. Older brother well.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "maybe evidence of ACS-STEMI$Cause_1": { + "Found to have inferior STe with reciprocal STd in I, aVL, QW in v4-6. Trop elevated at 0.09 (ref <0.03).$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "symptom of ACS$Cause_1": { + "72 year old man with GERD, HTN, no known CAD, presented this am with several hours of retrosternal chest pressure similar but more severe than prior episodes of GERD.$Input2": {} + }, + "risk factors$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "family history is a risk factor$Cause_1": { + "Father died by cardiac issue. Mother died of pancreatic ca. Family Hx colon ca. Older brother well.$Input4": {} + } + } + } + }, + "input1": "Chest pain\n", + "input2": "72 year old man with GERD, HTN, no known CAD, presented this am with several hours of retrosternal chest pressure similar but more severe than prior episodes of GERD. Found to have inferior STe with reciprocal STd in I, aVL, QW in v4-6. Trop elevated at 0.09 (ref <0.03). Received clopidogrel 600mg, ASA 325, Atorva 80. Started on nitro and heparin gtt and transferred cath. \n \nCath showed LCx <100% lesion and received DESx3. Jailed OM was wired and ballooned with good flow following. He was chest pain free following the procedure and EKG changes resolved. \n\nOn arrival to the floor, pt reports resolution of CP. Denies N/V/F/C/SOB. Reports feeling anxious about being in the hospital.\n", + "input3": "+Hyperlipidemia\n+chronic GERD\n+OSA\n", + "input4": "Father died by cardiac issue. Mother died of pancreatic ca. Family Hx colon ca. Older brother well.\n", + "input5": "ADMISSION\nVS: 98.5 147/81 91 16 97%RA\nGeneral: WDWN man laying comfortably in hospital bed\nHEENT: NCAT, PERRL, EOMI\nNeck: supple, no JVD\nCV: regular rhythm, no m/r/g\nLungs: CTAB, no w/r/r\nAbdomen: soft, NT/ND, BS+\nExt: WWP, no c/c/e, 2+ distal pulses bilaterally\nNeuro: AAOx3 moving all extremities grossly\n", + "input6": "___ 08:00AM BLOOD WBC-9.1 RBC-4.55* Hgb-15.3 Hct-43.1 MCV-95 MCH-33.6* MCHC-35.5* RDW-13.0 Plt ___\n___ 07:45AM BLOOD WBC-6.6 RBC-4.21* Hgb-14.5 Hct-39.2* MCV-93 MCH-34.5* MCHC-37.0* RDW-13.0 Plt ___\n___ 12:46AM BLOOD Plt ___\n___ 08:00AM BLOOD Plt ___\n___ 07:45AM BLOOD Plt ___\n___ 12:46AM BLOOD Na-140 K-3.8 Cl-105\n___ 08:00AM BLOOD Glucose-115* UreaN-14 Creat-1.0 Na-139 K-3.8 Cl-102 HCO3-25 AnGap-16\n___ 07:45AM BLOOD Glucose-112* UreaN-14 Creat-1.0 Na-140 K-4.2 Cl-103 HCO3-25 AnGap-16\n___ 12:46AM BLOOD cTropnT-0.85*\n___ 08:00AM BLOOD CK-MB-88* cTropnT-1.33*\n___ 07:45AM BLOOD cTropnT-0.71*\n___ 08:00AM BLOOD Calcium-9.1 Phos-3.3 Mg-2.1\n___ 07:45AM BLOOD Calcium-9.1 Phos-3.6 Mg-2.1\n\nSTUDIES\n___ ECG\nSinus rhythm. Possible prior inferior wall myocardial infarction. Left atrial abnormality. Diffuse non-specific ST-T wave abnormalities. No previous tracing available for comparison. \n\n___ Cardiac Cath\nESTIMATED blood loss: <60 cc\nHemodynamics (see above):\nCoronary angiography: right dominant\nLMCA: No angiographically apparent CAD\nLAD: Ostial 40%, mild luminal irregularities. Long 60% diagonal stenosis.\nLCX: Proximal 30%, Origin OM1 had 60% stenosis and the Cx continuation had thrombotic subtotal occlusion with 95% stenosis\nRCA: Chronic mid vessel total occlusion with collaterals from the LCA\n\n___ ECHO\nThe left atrium is mildly dilated. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. There is mild regional left ventricular systolic dysfunction with hypokinesis of the basal inferior, inferolateral and lateral walls (LCx disease). The remaining segments contract normally (LVEF = 40-45%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/13696506-DS-8.json b/Finished/Acute Coronary Syndrome/STEMI/13696506-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..7ba83086304910dcb86f4ca6931e337797133a5b --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/13696506-DS-8.json @@ -0,0 +1,58 @@ +{ + "NSTE-ACS$Intermedia_4": { + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "BLOOD cTropnT-0.02*$Input6": {} + }, + "ECG change is a evidence of NSTE-ACS$Cause_1": { + "Sinus arrhythmia with ventricular premature beats. Right bundle-branch block. Since the previous tracing of ST segment depression in lead V2 is more prominent.$Input6": {} + }, + "Occlusion of the coronary artery is symbol of acs$Cause_1": { + "1. Selective coronary angiography in this right dominant system revealed \n2 vessel coronary artery disease. The LM had minimal angiographically apparent disease. The LAD had no angiographically apparent changes from last angiogram. The LCx had 100% ostial occlusion and was a small vessel; remained unchanged from previous cath. The RCA had 100% acute thrombus in RPLV branch. \n2. Limited resting hemodynamics revealed normal systemic arterial pressure of 143/76mmHg.$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "BLOOD CK-MB-50* MB Indx-11.6* cTropnT-0.35$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09..$Cause_1": { + "BLOOD CK-MB-51* MB Indx-12.1* cTropnT-0.80*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "symptom of ACS$Cause_1": { + "he had been asymptomatic where he had skiied with out any chest pain. Earlier today he was walking with his wife when he noted substernal chest pain that was relieved by rest. He has angina, but he did not have chest pain to this magnitude in the past.$Input2": {} + }, + "risk factors of acs$Cause_1": { + "CAD \nAortic valve replacement- porcine$Input3": {} + }, + "family history is a risk factor$Cause_1": { + "Mother with MI,$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "evidence of acs$Cause_1": { + "his last Cath demonstrated 90% focal mid/distal LAD setnosis of a twin LAD. 90% LCX and serioal stenosis of the RCA. He has not had any stents placed. He had no intervention from his last Cath.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "symptom of ACS$Cause_1": { + "he had been asymptomatic where he had skiied with out any chest pain. Earlier today he was walking with his wife when he noted substernal chest pain that was relieved by rest. He has angina, but he did not have chest pain to this magnitude in the past.$Input2": {} + }, + "risk factors of acs$Cause_1": { + "CAD \nAortic valve replacement- porcine$Input3": {} + }, + "family history is a risk factor$Cause_1": { + "Mother with MI,$Input4": {} + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "58 y/o gentlemen with recent CATH showing no interveinable CAD, dyslipidemia, AVR, with h/o PE on coumadin who presents with persistent exertional chest pain. \n\nPer the patient, he had been asymptomatic where he had skiied with out any chest pain. Earlier today he was walking with his wife when he noted substernal chest pain that was relieved by rest. He has angina, but he did not have chest pain to this magnitude in the past. He was able to go home where Nitro SL provided some relief. He reported some nausea, but no jaw pain, shoulder pain, diaphoresis or emesis. The chest pain persisted and he presented to the ED. \n\nOf note his last Cath demonstrated 90% focal mid/distal LAD setnosis of a twin LAD. 90% LCX and serioal stenosis of the RCA. He has not had any stents placed. He had no intervention from his last Cath. \n\nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. \n\nIn the ED, his vital signs were 97.2 71 BP 194/95 14 100% RA. He was given the following medications: ASA 81 mg x 3, SL nitro x 3, strated on nitro gtt, and heparin drip. He was also given IV morphine. \n\nOn the floor, he had additional chest pain that was relieved when the nitro gtt was uptitrated. At the time of this interview his chest pain was minimal.\n", + "input3": "1. CARDIAC RISK FACTORS: (+) Dyslipidemia \n2. CARDIAC HISTORY:\n3. OTHER PAST MEDICAL HISTORY: \n+BPH \n+CAD \n+Aortic valve replacement- porcine\n+Pulmonary embolism \n+Hyperlipidemia \n+Arthritis \n+s/p Appendectomy \n-GERD\n", + "input4": "Mother with MI, Brother with early CABG\n", + "input5": "GENERAL: Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNECK: Supple with JVP not appreciated at 30 degrees. \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.\n", + "input6": "Admission:\n___ 01:44PM BLOOD WBC-8.2 RBC-4.93 Hgb-15.2 Hct-44.2 MCV-90 MCH-30.8 MCHC-34.4 RDW-13.3 Plt ___\n___ 01:44PM BLOOD ___ PTT-24.3 ___\n___ 01:44PM BLOOD Glucose-109* UreaN-20 Creat-1.1 Na-139 K-4.5 Cl-103 HCO3-28 AnGap-13\n___ 01:44PM BLOOD CK(CPK)-185\n___ 01:44PM BLOOD Calcium-9.5 Phos-2.9 Mg-2.2\n.\nCardiac Enzymes:\n___ 01:44PM BLOOD cTropnT-0.02*\n___ 12:50AM BLOOD CK-MB-50* MB Indx-11.6* cTropnT-0.35*\n___ 02:00AM BLOOD CK-MB-52* MB Indx-12.8* cTropnT-0.49*\n___ 07:00AM BLOOD CK-MB-51* MB Indx-12.1* cTropnT-0.80*\n___ 12:55AM BLOOD CK-MB-25* MB Indx-8.1*\n___ 07:25AM BLOOD CK-MB-35* MB Indx-9.5*\n\nECG:\nSinus arrhythmia with ventricular premature beats. Right bundle-branch block. Since the previous tracing of ST segment depression in lead V2 is more prominent. \n\nCATH:\nCOMMENTS: \n1. Selective coronary angiography in this right dominant system revealed \n2 vessel coronary artery disease. The LM had minimal angiographically apparent disease. The LAD had no angiographically apparent changes from last angiogram. The LCx had 100% ostial occlusion and was a small vessel; remained unchanged from previous cath. The RCA had 100% acute thrombus in RPLV branch. \n2. Limited resting hemodynamics revealed normal systemic arterial pressure of 143/76mmHg.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/15100941-DS-6.json b/Finished/Acute Coronary Syndrome/STEMI/15100941-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..c88730668c76dba7c947a49a74dc4d24eb19cbc0 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/15100941-DS-6.json @@ -0,0 +1,53 @@ +{ + "NSTE-ACS$Intermedia_5": { + "a sigh of STEMI$Cause_1": { + "Grade I/VI systolic ejection murmur at LUSB$Input5": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09$Cause_1": { + "cTropnT-0.38*$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "cTropnT-0.33*$Input6": {} + }, + "Strongly suspected ACS$Intermedia_4": { + "high hs-cTn is a strong value for ACS$Cause_1": { + "Labs were notable for a Trop-T of 0.33$Input2": {} + }, + "Cardiac structural abnormalities is a sigh of ACS$Cause_1": { + "Cardiac catheterization demonstrated 80-90% blockage of the proximal RCA, occluded L circumflex, severe LAD disease.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Weakness is a symptom of ACS$Cause_1": { + "Weakness$Input1": {} + }, + "severe weakness is a symptom of ACS$Cause_1": { + "The patient reports that she had a 45 minute to one hour episode of severe weakness earlier today with inability to rise from her chair and called.$Input2": {} + }, + "family history of CHF is a risk factor$Cause_1": { + "Father: deceased (CHF)$Input4": {} + }, + "carotid endarterectomy is the risk fact for ACS$Cause_1": { + "R carotid stenosis s/p carotid endarterectomy$Input3": {} + }, + "CKD is the risk fact for ACS$Cause_1": { + "CKD IV$Input3": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN$Input3": {} + }, + "CVA is the risk fact for ACS$Cause_1": { + "CVA$Input3": {} + }, + "family history of heart diseas is a risk factor$Cause_1": { + "Mother: deceased (unspecified heart diseas)$Input4": {} + } + } + } + }, + "input1": "Weakness\n", + "input2": "She was transfer from outside hospital with elevated troponin level for further evaluation. The patient reports that she had a 45 minute to one hour episode of severe weakness earlier today with inability to rise from her chair and called. She was brought to outside hospital where she had elevated troponins concerning for MI and was sent for cardiac catheterization. Patient was dyspneic in the ED, with coarse breath sounds. \n\nIn the ED, initial vitals were: T 97.1F P43 BP 187/85 RR18 O2 98%. Physical examination was unremarkable. Labs were notable for a Trop-T of 0.33, with CK 63 and MB 4. Chemistries were Na 142, K 5.3, Cl 109, HCO3 18, BUN 53, Cr 2.7, Gluc 97. WBC 8.6 (N 67.3%, L 17.8%), H/H of 11.4/38.2, PLT of 286. 11.2, PTT 136.1, INR 1.0. UA with large leuks, 104 WBC, moderate bacteria, no nitrite, no gluc, no ketones. She complained of L scapular pain, possibly anginal in origin, but denied chest pain and dyspnea. There were reports of dynamic changes on EKG during her symptoms of weakness. \n\nCardiac catheterization demonstrated 80-90% blockage of the proximal RCA, occluded L circumflex, severe LAD disease. Post-procedurally, she developed bleeding from her R femoral access site, pressure maintained for 45+ minutes in cath lab, and continued upon arrival to the floor. Initially surrounding tissue from access site firm, but with improvement after maintaining prolonged pressure.\n\nPatient was given:\n___ 09:10 IV Heparin 1000 units/hr \n___ 11:12 IVF 1000 mL NS Started 250 mL/hr \n___ 11:12 IV Ciprofloxacin 400 mg \n___ 11:17 PO Acetaminophen 1000 mg\n", + "input3": "+ R carotid stenosis s/p carotid endarterectomy\n+ CVA\n+ HLD\n+ HTN\n+ CKD IV\n+ vitamin D deficiency\n+ bleeding duodenal ulcer (H pylori normal)\n+ urinary incontinence\n+ psoriasis \n+ psoriatic arthritis\n+ tobacco use disorder\n+ essential tremor\n+ shingles\n", + "input4": "Father: deceased (CHF)\nMother: deceased (unspecified heart diseas)\n- 1 brother passed away from a fall\n- 1 living sister\n", + "input5": "ADMISSION EXAM:\n\nVitals: per metavision\nGen: Oriented to self, anxious, confused, asking repeatedly about her cigarettes and her housekeeper.\nHEENT: No conjunctival pallor. No scleral icterus. MMM. OP clear. \nNECK: R IJ CVL in place, dressing C/D/I, Neck supple without LAD. JVP low. Normal carotid upstroak without bruits. \nCV: Bradycardic, regular rhythm, Grade I/VI systolic ejection murmur at LUSB, normal S1 and S2, no rubs, clicks, or gallops\nLUNGS: Clear to anterior auscultation bilaterally, no wheezes, rhonchi, or rales. \nABD: Hypoactive bowel sounds. Abdomen distended, nontender, no organomegaly. No appreciable abdominal bruits. \nEXT: R Groin with Femostop in place, no appreciable superficial bleeding, mild tenderness to palpation over R groin and anterior thigh. Full distal pulses bilaterally. Wrist restraints in place bilaterally\nNEURO: Alert, oriented to self only, agitated and confused. Unable to cooperate with full neurologic examination, but does follow ___ setp commands. Gait assessment deferred\nLINES: Foley in place, R IJ CVL in place C/D/I\n", + "input6": "ADMISSION LABS:\n___ 08:08PM GLUCOSE-128* UREA N-50* CREAT-2.5* SODIUM-142 POTASSIUM-5.3* CHLORIDE-114* TOTAL CO2-18* ANION GAP-15\n___ 08:08PM CK(CPK)-43\n___ 08:08PM CK-MB-4 cTropnT-0.39*\n___ 08:08PM CALCIUM-8.4 PHOSPHATE-4.3 MAGNESIUM-1.9\n___ 08:08PM WBC-14.1*# RBC-3.20* HGB-9.4* HCT-32.1* MCV-100* MCH-29.4 MCHC-29.3* RDW-14.8 RDWSD-55.0*\n___ 08:08PM PLT COUNT-360\n___ 08:08PM ___ PTT-28.8 ___\n___ 05:00PM GLUCOSE-107* UREA N-50* CREAT-2.3* SODIUM-142 POTASSIUM-4.7 CHLORIDE-113* TOTAL CO2-18* ANION GAP-16\n___ 05:00PM ALT(SGPT)-11 AST(SGOT)-16 ALK PHOS-65 TOT BILI-0.2\n___ 05:00PM cTropnT-0.38*\n___ 05:00PM ALBUMIN-3.5\n___ 05:00PM WBC-8.2 RBC-3.50* HGB-10.1* HCT-33.9* MCV-97 MCH-28.9 MCHC-29.8* RDW-14.8 RDWSD-52.4*\n___ 05:00PM NEUTS-63.0 ___ MONOS-8.5 EOS-6.5 BASOS-1.7* IM ___ AbsNeut-5.16 AbsLymp-1.61 AbsMono-0.70 AbsEos-0.53 AbsBaso-0.14*\n___ 05:00PM PLT COUNT-270\n___ 05:00PM ___\n___ 09:00AM GLUCOSE-97 UREA N-53* CREAT-2.7*# SODIUM-142 POTASSIUM-5.3* CHLORIDE-109* TOTAL CO2-18* ANION GAP-20\n___ 09:00AM estGFR-Using this\n___ 09:00AM CK(CPK)-63\n___ 09:00AM cTropnT-0.33*\n___ 09:00AM CK-MB-4\n___ 09:00AM URINE HOURS-RANDOM\n___ 09:00AM URINE HOURS-RANDOM\n___ 09:00AM URINE UHOLD-HOLD\n___ 09:00AM URINE GR HOLD-HOLD\n___ 09:00AM WBC-8.6 RBC-3.90 HGB-11.4 HCT-38.2# MCV-98# MCH-29.2 MCHC-29.8*# RDW-15.1 RDWSD-53.9*\n___ 09:00AM NEUTS-67.3 LYMPHS-17.8* MONOS-7.6 EOS-5.6 BASOS-1.4* IM ___ AbsNeut-5.80 AbsLymp-1.54 AbsMono-0.66 AbsEos-0.48 AbsBaso-0.12*\n___ 09:00AM PLT COUNT-286\n___ 09:00AM ___ PTT-136.1* ___\n___ 09:00AM URINE COLOR-Straw APPEAR-Hazy SP ___\n___ 09:00AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-100 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-LG\n___ 09:00AM URINE RBC-0 WBC-104* BACTERIA-MOD YEAST-NONE EPI-1\n___ 09:00AM URINE MUCOUS-RARE\n\n\nIMAGING/STUDIES\nCHEST PORT. LINE PLACEM\nIMPRESSION: \nIn comparison to radiograph, a right internal jugular central venous catheter is been placed, terminating in the lower superior vena cava, with no visible pneumothorax. Slight widening of the mediastinum is likely due to accentation of a tortuous thoracic aorta by patient rotation and supine portable technique, but a repeat nonrotated radiograph would be helpful to confirm this impression when the patient's condition permits. Lungs are clear except for minor atelectasis at the left lung base. \n\nCHEST (PORTABLE AP) \nIMPRESSION: \nAs compared to previous study of 1 day earlier, there has not been a substantial change in the appearance of the chest except for slight \nimprovement in minor left basilar atelectasis. \n\nFEMORAL VASCULAR US RIG\nIMPRESSION: \n1. No evidence of pseudoaneurysm or AV fistula and the right groin. \n2. Organized hematoma in the right groin measuring up to 7 cm. \n3. No drainable fluid collection. \n \nCT ABD & PELVIS W/O CON\nIMPRESSION: \n1. Infrarenal fusiform abdominal aortic aneurysm measuring up to is 4.7 cm in maximum diameter without evidence of aneurysmal leak, impending or contained rupture. Recommend follow-up CT at 6 month interval. \n2. Status post LHC complicated by a right arterial groin bleed. 6.7 x 2.3 cm area of increased density in the anteromedial aspect of right thigh with extensive soft tissue stranding and edema, most consistent with a soft tissue hematoma. No evidence of retroperitoneal hematoma. \n3. Cholelithiasis without cholecystitis. \n4. Focal consolidation of the apex of the left upper lobe, likely related to scarring from chronic parenchymal disease. \n\nCHEST (PORTABLE AP) \nFINDINGS: \nCardiomegaly is a stable. The patient is rotated, this accentuates the widened mediastinum and tortuous aorta. Improving left lower lobe atelectasis, otherwise the lungs are clear. There is no pneumothorax or pleural effusion. Right IJ catheter tip is in the lower SVC\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/15314906-DS-14.json b/Finished/Acute Coronary Syndrome/STEMI/15314906-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..c93cab8bfe41913b52f58fec056780ce26f711e9 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/15314906-DS-14.json @@ -0,0 +1,55 @@ +{ + "NSTE-ACS$Intermedia_4": { + "ECG changes are sympyoms of ACS-STEMI$Cause_1": { + "Sinus rhythm. Delayed precordial R wave progression. Non-specific anterolateral ST-T wave changes. Compared to the previous tracing of wave changes are new. Cannot rule out myocardial ischemia.$Input6": {} + }, + "Strong evidence proves of acs-stemi$Cause_1": { + "Hemodynamics (see above):\nCoronary angiography: right dominant\nLMCA: No angiographically apparent CAD\nLAD: Proximal 40%, mild luminal irregularities\nLCX: Total occlusion of OM1. Mild disease.\nRCA: No angiographically apparent CAD.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "symptom of acs$Cause_1": { + "Patient had episode of 'heart burn' 2 nights ago that self resolved, then last night had repeat episode followed by episode of substernal chest pain, described as 'dull', located at his chest, nonradiating.$Input2": {} + }, + "Possible family history$Cause_1": { + "Mother died of cancer.$Input4": {} + }, + "Possible family history.$Cause_1": { + "Father had CABG and has type II DM.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "Cardiac structural abnormalities is a diagnostic criteria of ACS-STEMI$Cause_1": { + "The left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is low normal (LVEF = 50%) secondary to focal hypokinesis of the posterior and lateral walls. Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion.$Input6": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09\nSTD V2-V4 and less than 0.5mm STE inferiorly maybe is a sign$Cause_1": { + "he was found to have elevated troponint to 0.11 and ECG changes w/ STD V2-V4 and less than 0.5mm STE inferiorly which normalized after treatment with nitro.$Input2": {} + }, + "high hs-cTn is a strong value for ACS(> 0.2 \u03bcg/L\uff09.$Cause_1": { + "BLOOD cTropnT-0.17*$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "symptom of acs$Cause_1": { + "Patient had episode of 'heart burn' 2 nights ago that self resolved, then last night had repeat episode followed by episode of substernal chest pain, described as 'dull', located at his chest, nonradiating.$Input2": {} + }, + "Possible family history$Cause_1": { + "Mother died of cancer.$Input4": {} + }, + "Possible family history.$Cause_1": { + "Father had CABG and has type II DM.$Input4": {} + } + } + } + }, + "input1": "Chest pain\n", + "input2": "66 year old male with no significant PMH presenting with c/o dyspepsia and chest pain, found to have NSTEMI and transferred for cardiac catheterization. \n \nPatient had episode of 'heart burn' 2 nights ago that self resolved, then last night had repeat episode followed by episode of substernal chest pain, described as 'dull', located at his chest, nonradiating. No associated symptoms. Pain was not positional, not worsened with exertion or taking a deep breath, denies any specific aggravating factors. Initially improved with having a bowel movement. This pain then recurred 1h later and pateint decided to go to the ED. Denies prior hx. chest pain, denies new swelling in his legs, no orthopnea. Is fairly active, denies recent exertional chest pain. \n \nPatient originally presented with these complaints where where he was found to have elevated troponint to 0.11 and ECG changes w/ STD V2-V4 and less than 0.5mm STE inferiorly which normalized after treatment with nitro. There he was given GI cocktail, full dose aspirin, nitro, and started on a heparin drip after which patient was chest pain free. Patient was also given ASA prior to transfer and eval'ed to BI admission w/ plan for cath. On arrival to ED, patient stated that his discomfort was down from initially. \n \nIn the ED initial vitals were: 99.4 68 144/90 16 99% RA. \n - Labs were significant for trop t 0.17, PTT 105 (prior CBC and chem-7 @ unremarkable) \n - Patient was continued on heparin gtt and nitro gtt, as was given ativan x1. \nOn the floor patient overall feels well, says having chest pain, much improved from prior. No other complaints.\n", + "input3": "None\n", + "input4": "No family history of colon or prostate cancer. Mother died of cancer. Father had CABG and has type II DM.\n", + "input5": "ADMISSION PHYSICAL EXAM: \nVitals - 98 119/76 hr 51 18 100% RA \nGENERAL: alert, NAD sitting on side of bed \nHEENT: EOMI, PERRLA, OMM no lesions \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing or edema \nNEURO: CN II-XII intact, moves all fours \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "ADMISSION LABS:\n___ 09:35AM BLOOD WBC-7.8 RBC-4.06* Hgb-12.9* Hct-39.1* MCV-96 MCH-31.7 MCHC-32.9 RDW-13.0 Plt ___\n___ 02:00AM BLOOD ___ PTT-105.7* ___\n___ 09:35AM BLOOD Glucose-115* UreaN-10 Creat-0.8 Na-140 K-4.1 Cl-108 HCO3-26 AnGap-10\n___ 09:35AM BLOOD Mg-1.8\n___ 02:00AM BLOOD %HbA1c-5.4 eAG-108\n___ 02:00AM BLOOD cTropnT-0.17*\n___ 09:35AM BLOOD CK-MB-180* cTropnT-4.31*\n___ 03:30PM BLOOD CK-MB-185* cTropnT-4.99*\n___ 08:00AM BLOOD CK-MB-35* cTropnT-2.28*\n\nMICRO: None\n\nSTUDIES:\n\nEKG ___:\nSinus rhythm. Delayed precordial R wave progression. Non-specific anterolateral ST-T wave changes. Compared to the previous tracing of wave changes are new. Cannot rule out myocardial ischemia. \n\nTTE ___\nThe left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is low normal (LVEF = 50%) secondary to focal hypokinesis of the posterior and lateral walls. Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \n\nLeft heart catheterization:\nFindings\nESTIMATED blood loss: <50 cc\nHemodynamics (see above):\nCoronary angiography: right dominant\nLMCA: No angiographically apparent CAD\nLAD: Proximal 40%, mild luminal irregularities\nLCX: Total occlusion of OM1. Mild disease.\nRCA: No angiographically apparent CAD.\n\nInterventional details\nChange for 6 XB3.5 guide. Crossed with Prowater wire. Deployed a 2.5 x 12 mm Xience drug-eluting stent. Postdilatedwith a 2.5 mm balloon. Final angiography revealed normal flow, no dissection and 0% residual stenosis with 10% plaquing distal to the stent.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/15379632-DS-17.json b/Finished/Acute Coronary Syndrome/STEMI/15379632-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..7c56b7b75d5fa0d9d092ff30dbe7fb7ebf53a461 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/15379632-DS-17.json @@ -0,0 +1,38 @@ +{ + "STEMI-ACS$Intermedia_4": { + "Electrocardiogram showing ST segment depression and ST segment elevation is a key indicator for diagnosing STEMI. This change indicates possible myocardial ischemia or damage.$Cause_1": { + "Second EKG: rate 84, NSR, left axis deviation, worsened STD in V2-V3. Third EKG: rate 86, NSR, LAD STD in AVR, V1, V2 with mild ST elevation in V4-V6.$Input2": {} + }, + "Elevated cardiac troponin is a marker of myocardial injury and supports the diagnosis of STEMI$Cause_1": { + "Labs were notable for troponin 0.36$Input2": {} + }, + "Strongly Suspected ACS$Intermedia_3": { + "This description refers to the characteristic feeling of angina, which is a pressure or heaviness centered in the chest.$Cause_1": { + "pain as feeling like someone was pushing their forearm against his mid-chest$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is a common symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "Acute chest pain is one of the typical symptoms of ACS. Its short duration and sudden onset are key diagnostic clues.$Cause_1": { + "<1 day of acute chest pain$Input2": {} + }, + "Night sweats with chest pain are due to an exaggerated sympathetic response, often seen in severe cardiac events.$Cause_1": { + "pain was associated with diaphoresis and a mild headache$Input2": {} + }, + "Hyperlipidemia is a significant risk factor for coronary artery disease$Cause_1": { + "HLD$Input3": {} + }, + "Tachycardia may be caused by the heart trying to compensate for insufficient blood flow to the coronary arteries and is a common symptom of heart disease.$Cause_1": { + "HR102$Input5": {} + } + } + } + }, + "input1": "Chest pain\n", + "input2": "He is a man with HLD, who presents with <1 day of acute chest pain. \nThe chest pain woke him from sleep at 4 AM the day of presentation, and lasted one hour. He describes the pain as feeling like someone was pushing their forearm against his mid-chest. The pain was associated with diaphoresis and a mild headache. The pain is worse with lying flat, improved sitting up. There was no dyspnea, nausea, vomiting, abdominal pain, or radiation, and he has had no recent illnesses or URI symptoms. He took a Zantac and Advil, which improved his symptoms but they did not completely resolve. The chest pain continued throughout the day. He shares that the day before he had lifted weights and had a heavy dinner, and did not have chest pain during either. He has never had chest pain or pressure before. He occasionally has heart burn after eating certain foods, but never has had heart burn with exertion, and his symptoms this time were very distinct. \nIn the ED initial vitals were: T 97.1 HR 89 BP 138/79 Resp 19 98% RA. Cr 1, Hb 16.2, Platelet 176, INR 1.1, PTT 30.7. Initial EKG: Initial: rate 83, NSR left axis deviation, no ischemic changes. Second EKG: rate 84, NSR, left axis deviation, worsened STD in V2-V3. Third EKG: rate 86, NSR, LAD STD in AVR, V1, V2 with mild ST elevation in V4-V6. CXR showed no acute cardiopulmonary process. He was given a full dose aspirin, SL nitroglycerin, and IV heparin. \nCardiology was consulted and he was taken to the cath lab. A DES was placed in the proximal LCX. He was loaded with Plavix. \nUpon arrival to the floor, the patient gives the above history. He is currently chest pain free. He reiterates that he has never had symptoms like this before. He exercises a few times per week and always feels well. He has no history of presyncope/syncope,orthopnea, PND, or leg swelling. \nREVIEW OF SYSTEMS: \nOn further review of systems, denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. Denies exertional buttock or calf pain. Denies recent fevers, chills or rigors. All of the other review of systems were negative.\n", + "input3": "+ HLD \n+ CABG: None \n+ PERCUTANEOUS CORONARY INTERVENTIONS: None \n+ PACING/ICD: None \n+ Cataracts\n", + "input4": "Father: Cancer \nMother: HTN \nBrother: potentially had a cardiac condition a few years ago, unsure of details.\n", + "input5": "Admission physical exam:\n========================\nVS: T98.5 BP130/80 HR102 RR16 O2 SAT 98 RA \nGENERAL: Pleasant and well appearing gentleman, NAD. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\ufeff\nNECK: No JVD. No carotid bruits. \nCARDIAC: RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. Warm. TR band in place on RUE. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: Distal pulses palpable and symmetric \nNEURO: CN intact, BUE and BLE, AOX3.\n", + "input6": "Admission labs:\n===============\n10:02AM BLOOD WBC-7.7 RBC-5.19 Hgb-16.2 Hct-47.1 MCV-91 MCH-31.2 MCHC-34.4 RDW-12.3 RDWSD-40.7\n10:02AM BLOOD Neuts-80.9* Lymphs-12.5* Monos-5.5 Eos-0.4* Baso-0.4 AbsNeut-6.24* AbsLymp-0.96* \nAbsMono-0.42 AbsEos-0.03* AbsBaso-0.03\n10:02AM BLOOD Glucose-104* UreaN-19 Creat-1.0 Na-140 K-4.1 Cl-103 HCO3-22 AnGap-19\n07:05AM BLOOD Calcium-8.6 Phos-2.8 Mg-2.3 Cholest-175\n07:05AM BLOOD %HbA1c-5.3 eAG-105\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/15402809-DS-20.json b/Finished/Acute Coronary Syndrome/STEMI/15402809-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..9fc4fde29c0884a00b205eb79d14de319d9f39c6 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/15402809-DS-20.json @@ -0,0 +1,41 @@ +{ + "STEMI-ACS$Intermedia_4": { + "The electrocardiogram shows ST segment elevation in leads V2 to V6, I, and aVL, and ST segment depression in leads II, III, and aVF, which is the key basis for diagnosing STEMI.$Cause_1": { + "found to have STE in V2-V6, I and aVL, and STD II, III and aVF c/f STEMI$Input2": {} + }, + "From 0.12 to 14.15. Cardiac troponin T is an important marker for the diagnosis of acute myocardial infarction. Its significant increase usually indicates myocardial damage.$Cause_1": { + "cTropnT-14.15$Input6": {} + }, + "Strongly Suspected ACS$Intermedia_3": { + "This description refers to the characteristic feeling of angina, which is a pressure or heaviness centered in the chest.$Cause_1": { + "a central chest pressure radiating to both arms and jaw$Input2": {} + }, + "Coronary angiography showed 100% blockage of the left anterior descending artery (LAD), which was the direct cause of STEMI.$Cause_1": { + "coronary angiography revealed 100% occlusion LAD$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "The patient experienced a feeling of pressure behind the sternum, with symptoms radiating to the arms and jaw, and nausea, which are typical symptoms of myocardial infarction.$Cause_1": { + "initially with substernal chest pressure radiating to both arms and jaw with associated nausea$Input2": {} + }, + "The patient developed chest pain shortly after using \"poppers,\" an inhaled street drug that can cause blood vessels to dilate and a sudden drop in blood pressure. This suggests that drug use may have been a trigger for the heart attack.$Cause_1": { + "developed chest pressure shortly after taking \"poppers\"$Input2": {} + }, + "Diabetes is an important risk factor for cardiovascular disease$Cause_1": { + "Diabetes$Input3": {} + }, + "Hypertension is also a major risk factor for cardiovascular disease$Cause_1": { + "Hypertension$Input3": {} + }, + "Family history of myocardial infarction increases an individual's risk of ACS$Cause_1": { + "Uncle with MI\nFather with suspected missed MI at early age$Input4": {} + } + } + } + }, + "input1": "None\n", + "input2": "He is a man who initially with substernal chest pressure radiating to both arms and jaw with associated nausea found to have STE in V2-V6, I and aVL, and STD II, III and aVF c/f STEMI now transferred to hospital for emergent coronary angiography. \n\ufeff\nThe patient states that yesterday evening, he developed chest pressure shortly after taking \"poppers\" and engaging in sexual intercourse with his husband. The pain was sudden in onset and was described as a central chest pressure radiating to both arms and jaw. Had associated nausea. Initially thought it was due to indigestion and tried to drink seltzer water, however, his symptoms persisted and he began to vomit. He decided to go to hospital for further management.\n\ufeff\ncoronary angiography revealed 100% occlusion LAD. No significant right coronary or LCx disease. 2 something were placed without complication. During the procedure, he received tirofoban with plans to transition to ticagrelor. He tolerated the procedure well and was transferred to the CCU for further monitoring.\n \nOn arrival to the CCU: the patient is awake and alert. He complains of mild chest pressure that is much improved from prior. No SOB, palpitations, lightheadedness, fevers or chills. He denies any history of chest pain or SOB with exertion.\n", + "input3": "+ Diabetes (-) \n+ Hypertension (-) \n+ Dyslipidemia \n+ No known cardiac history \n+ Hiatal hernia\n+ OSA on BiPAP\n", + "input4": "Uncle with MI\nFather with suspected missed MI at early age\n", + "input5": "ADMISSION PHYSICAL EXAM:\n====================================\nVS: 99 134/81 102 16 97%RA \nGENERAL: Well developed, well nourished in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI. Conjunctiva were pink. No pallor \nNECK: Supple. JVP not elevated \nCARDIAC: RR, no m/r/g \nLUNGS: CTAB no r/r/w. \nABDOMEN: Soft, non-tender, non-distended. No hepatomegaly. No splenomegaly. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema. \nSKIN: No significant skin lesions or rashes. \nPULSES: Distal pulses palpable and symmetric. \nLABS AND MICROBIOLOGY: Reviewed in OMR.\n", + "input6": "ADMISSION/IMPORTANT LABS\n04:38AM BLOOD WBC-20.4* RBC-4.99 Hgb-15.3 Hct-42.0 MCV-84 MCH-30.7 MCHC-36.4 RDW-12.0 RDWSD-36.2\n04:38AM BLOOD Glucose-113* UreaN-19 Creat-1.0 Na-138 K-3.1* Cl-103 HCO3-16* AnGap-22*\n04:38AM BLOOD CK(CPK)-316\n05:50PM BLOOD CK(CPK)-3528*\n04:52AM BLOOD ALT-78* AST-245* LD(LDH)-1188* AlkPhos-55 TotBili-1.3\n04:38AM BLOOD CK-MB-19* MB Indx-6.0 cTropnT-0.12*\n11:30AM BLOOD cTropnT-14.15*\n04:38AM BLOOD Calcium-9.6 Phos-2.2* Mg-1.7 Cholest-211*\n04:38AM BLOOD %HbA1c-4.8 eAG-91\n04:38AM BLOOD Triglyc-198* HDL-31 CHOL/HD-6.8 LDLcalc-140*\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/15838052-DS-15.json b/Finished/Acute Coronary Syndrome/STEMI/15838052-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..4760be0ad8b50e44685e519efc1f804e5708ceb2 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/15838052-DS-15.json @@ -0,0 +1,32 @@ +{ + "STEMI-ACS$Intermedia_4": { + "Increased cardiac troponin T is an important marker of myocardial damage$Cause_1": { + "a troponin T of 0.915$Input2": {} + }, + "Elevated cTropnT is often a marker of cardiomyocyte damage, especially in myocardial infarction.$Cause_1": { + "cTropnT-1.02$Input6": {} + }, + "ST-elevation is the critical for STEMI$Cause_1": { + "ST-elevation$Input6": {} + }, + "Strongly Suspected ACS$Intermedia_3": { + "Echocardiography showed left atrial enlargement is consistent with coronary artery disease.$Cause_1": { + "The left atrial volume is increased.$Input6": {} + }, + "Coronary angiography revealed multivessel disease and severe coronary artery obstruction, which is a typical cause of ACS$Cause_1": { + "The LAD had a mid vessel 80% ulcerated plaque$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Myocardial infarction is a manifestation of coronary artery disease, which is one of the main causes of STEMI-ACS. Family history indicates that the patient may have a higher genetic risk.$Cause_1": { + "He maternal uncles both died of MIs.$Input4": {} + } + } + } + }, + "input1": "Elbow pain.\n", + "input2": "He is a man with no significant past medical history who presents with elbow pain and positive troponin. \n. \nWas in his usual state of health until three days prior to admission when he noted sharp pain in his left elbow. This would, at times, radiate to his hand or armpit. This would occur at rest and particularly at night, but would not worsen with exertion. This pain ocurred on two consecutive evenings. It was not associated with any SOB or diapheresis though he does reports feeling fatigued. \n. \nOn the day of admission, he presented to his PCP who then him to an OSH. At the OSH, he was found to have a troponin T of 0.915 with a CK of 293 and an MB of 18.5. He was given lopressor and heparin and transferred for further care. \n\ufeff\nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. \n. \nCardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "GERD\n", + "input4": "He maternal uncles both died of MIs. Otherwise, no early CAD.\n", + "input5": "Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\ufeff\nNeck: Supple with JVD flat. \nCV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \n \nCHEST: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABD: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by \npalpation. No abdominial bruits. \nEXT: No c/c/e. No femoral bruits. \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.\n", + "input6": "08:00PM BLOOD WBC-12.1* RBC-4.24* Hgb-13.2* Hct-38.3* MCV-90 MCH-31.1 MCHC-34.4 RDW-13.5\n06:25AM BLOOD WBC-10.1 RBC-3.84* Hgb-12.1* Hct-34.3* MCV-90 MCH-31.6 MCHC-35.3* RDW-12.9\n08:00PM BLOOD Glucose-120* UreaN-20 Creat-1.1 Na-143 K-4.1 Cl-108 HCO3-26 AnGap-13\n06:25AM BLOOD Glucose-101 UreaN-9 Creat-1.0 Na-140 K-4.0 Cl-107 HCO3-26 AnGap-11\n08:00PM BLOOD CK(CPK)-272*\n02:28AM BLOOD CK(CPK)-516*\n11:57PM BLOOD CK(CPK)-243*\n08:00PM BLOOD CK-MB-19* MB Indx-7.0*\n08:00PM BLOOD cTropnT-1.02*\n08:00PM BLOOD Calcium-8.7 Phos-2.8 Mg-2.2\n09:10AM BLOOD Calcium-8.9 Phos-2.8 Mg-1.9 Cholest-160\n09:10AM BLOOD Triglyc-119 HDL-39 CHOL/HD-4.1 LDLcalc-97\n\ufeff\nTTE:\n\ufeff\nThe left atrial volume is increased. There is mild regional left ventricular systolic dysfunction with dyskinesis of the basal to mid inferior and inferolateral segments and hypokinesis of the basal to mid lateral segments and inferior apex . [Intrinsic left ventricular systolic function is likely more depressed given the severity of valvular regurgitation.] Quantitative (biplane) LVEF = 47 %. There is no ventricular septal defect. The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. (4) ST-elevation\n\ufeff\nIMPRESSION: Regional left ventricular systolic dysfunction consistent with coronary artery disease. Mildly dilated and hypokinetic right ventricle. Moderate mitral regurgitation. \n\ufeff\nCath:\nCOMMENTS: 1. Selective coronary angiography of this right dominant system demonstrated three vessel coronary artery disease. The LMCA had a 20% ostial and distal stenosis. The LAD had a mid vessel 80% ulcerated plaque. The Ramus had a mid 70% stenosis. The RCA has total ostial occulsion with robust left to right collaterals. The LCx had mild luminal irregularities. \n2. Resting hemodynamic measurement demonstrated normal systemic arterial pressure at 112/72 mm Hg. Pullback of the pigtail catheter from the LV to the aorta did not demonstrate a gradient. The left sided filling pressure was elevated with an LVEDP of 25 mmHg. \n3. Successful ptca and stenting of the mid LAD with a 3.5x18 mm cypher stent. Successful ptca and stenting of the mid Ramus with a 2.5x8mm cypher stent. Successful ptca and stenting of the proximal rca with a 3.5x33mm cypher stent. Final angiography revealed 0% residual stenosis, no angiographically apparet dissection and timi 3 flow. The patient left the lab free of angina and in stable condition.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/16137568-DS-5.json b/Finished/Acute Coronary Syndrome/STEMI/16137568-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..a9c4d5b9fca745b93f6b68a7a3bf0e5695e7c712 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/16137568-DS-5.json @@ -0,0 +1,44 @@ +{ + "STEMI-ACS$Intermedia_4": { + "Electrocardiogram shows inferior ST segment elevation, which is direct evidence for the diagnosis of inferior STEMI$Cause_1": { + "Subsequent EKG showed ST elevations$Input2": {} + }, + "The blood report showed that cardiac troponin was 0.14, which is marked as abnormal. Cardiac troponin is a marker of myocardial damage. Its increase may indicate myocardial damage, which is common in myocardial infarction.$Cause_1": { + "cTropnT-0.14$Input6": {} + }, + "Strongly Suspected ACS$Intermedia_3": { + "The patient describes recurrent chest discomfort over the past 3 days, which feels like a heavy weight on the chest. This description is common in angina pectoris.$Cause_1": { + "For the last 3 days, patient states she was having waxing and waning chest discomfort. She says it \"felt like a car was on my chest\".$Input2": {} + }, + "The presence of moderate calcification and obtuse marginal branch stenosis, which are signs of coronary artery disease$Cause_1": { + "alcified with sluggish flow distally$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "chest discomfort is the symptom of ACS$Cause_1": { + "chest discomfort$Input1": {} + }, + "Pain radiating to the jaw and back bilaterally is a typical path of cardiac pain, which increases the possibility of cardiac problems.$Cause_1": { + "radiation to the jaw on both sides, as well as radiation to the back$Input2": {} + }, + "The persistence and non-exertional nature of chest pain suggest possible coronary artery disease$Cause_1": { + "This discomfort was waxing and waning and was not associated with exertion, but became persistent the night prior to presentation$Input2": {} + }, + "Mild shortness of breath, which may indicate that the heart is not pumping enough, a common symptom of heart disease$Cause_1": { + "endorse mild shortness of breath$Input2": {} + }, + "High blood pressure is one of the main risk factors for coronary artery disease$Cause_1": { + "Hypertension$Input3": {} + }, + "Family history of heart disease improve the risk$Cause_1": { + "Father with angina\nMother with CHF, lived to her\nBrother with CABG in his$Input4": {} + } + } + } + }, + "input1": "chest discomfort\n", + "input2": "\nFor the last 3 days, patient states she was having waxing and waning chest discomfort. She says it \"felt like a car was on my chest\". She also described radiation to the jaw on both sides, as well as radiation to the back. This discomfort was waxing and waning and was not associated with exertion, but became persistent the night prior to presentation. It was not associated with any nausea, vomiting, diaphoresis. She does endorse mild shortness of breath, and states that last week when she was on vacation she was also feeling short of \nbreath after ambulating long distances. All of the symptoms are totally new for her.\n\ufeff\nGiven the fact that her discomfort became persistent, she decided to present to the emergency room. Labs were notable for a troponin T of 0.14, normal CBC, initial EKG with nonspecific ST changes. She was given sublingual nitro with help with her chest discomfort, as well as full dose aspirin and ticagrelor 180. Subsequent EKG showed ST elevations \n\ufeff\nHer chest pain had improved. Per verbal sign out, in the Cath Lab, she initially underwent right radial approach and had findings consistent with RCA with a subtotal occlusion that appeared chronic and calcified with sluggish flow distally. Her left-sided circulation showed a 60% stenosis of her obtuse marginal, and an LAD with no significant disease but moderate calcifications. Her access had to be switched to right groin because of a short and tortuous aorta. The operator was unable to wire the RCA lesion successfully because of likely chronic nature and calcifications. Given that she was chest pain-free and her EKG had improved, no further intervention was pursued. She was brought to the CCU with a plan to potentially return to the Cath Lab later this morning for CTO procedure.\n\ufeff\nOn arrival to the CCU, She is comfortable, cheerful, and chest pain-free. Her husband is at bedside.\n\ufeff\nROS: Positive per HPI. Remaining 10 point ROS reviewed and negative.\n", + "input3": "+ Hypertension\n+ Osteoporosis on Reclast\n+ Meniscus surgery\n+ Hysterectomy\n+ Hypercalcemia status post workup negative for multiple myeloma including bone biopsy\n", + "input4": "Father with angina\nMother with CHF, lived to her\nBrother with CABG in his\n", + "input5": "ADMISSION PHYSICAL EXAMINATION: \n===============================\nVS: Reviewed in metavision\nGENERAL: Well developed, well nourished in NAD. Oriented x3.\nMood, affect appropriate. Appears younger than stated age. \nTanned skin.\nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI. \n\ufeff\n\ufeff\nCARDIAC: Normal rate, regular rhythm. No murmurs, rubs, or gallops. \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No adventitious breath sounds. \nABDOMEN: Soft, non-tender, non-distended. No palpable hepatomegaly or splenomegaly. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema. Right groin with pressure dressing in place, no bruit. Right wrist with TR band in place, warm hand\nSKIN: No significant lesions or rashes. \nPULSES: Distal pulses palpable and symmetric. \nNEURO: ANO x3, moving all extremities, grossly nonfocal\n", + "input6": "ADMISSION LABS: \n===============\n12:09AM BLOOD WBC-8.8 RBC-4.17 Hgb-11.0* Hct-35.0 \nMCV-84 MCH-26.4 MCHC-31.4* RDW-16.7* RDWSD-50.7*\n12:09AM BLOOD Neuts-57.0 Monos-9.1 Eos-2.0 \nBaso-0.6 AbsNeut-5.02 AbsLymp-2.70 AbsMono-0.80 \nAbsEos-0.18 AbsBaso-0.05\n12:09AM BLOOD Glucose-154* UreaN-20 Creat-0.7 Na-142 K-4.0 Cl-105 HCO3-23 AnGap-14\n12:09AM BLOOD cTropnT-0.14*\n12:09AM BLOOD Calcium-10.9* Phos-2.9 Mg-1.8 Cholest-167\n05:03AM BLOOD %HbA1c-5.3 eAG-105\n12:09AM BLOOD Triglyc-95 HDL-52 CHOL/HD-3.2 LDLcalc-96\n\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/STEMI/16250904-DS-15.json b/Finished/Acute Coronary Syndrome/STEMI/16250904-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..ba338041ab4f930958098b758b9cb56d5f6fc3c4 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/STEMI/16250904-DS-15.json @@ -0,0 +1,32 @@ +{ + "STEMI-ACS$Intermedia_4": { + "The electrocardiogram shows ST segment elevation in leads II, III, and aVF and ST segment depression in leads V1-2, which are key electrocardiogram manifestations for diagnosing STEMI.$Cause_1": { + "EKG showed ST elevations in leads II, III, aVF, ST depressions in leads V1-2.$Input2": {} + }, + "Cardiac troponin T is an important biomarker of myocardial injury. Although this value is within the normal range, any sign of myocardial injury needs attention, as myocardial infarction can cause this indicator to increase.$Cause_1": { + "cTropnT-0.10$Input6": {} + }, + "Strongly Suspected ACS$Intermedia_3": { + "Increased pain, sweating, and dyspnea are common symptoms in STEMI, indicating that the heart is overloaded and heart function may be declining sharply.$Cause_1": { + "worsening pain, diaphoresis, dyspnea$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest Pain is the symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "Sharp pain behind the sternum that radiates into the arms is a classic symptom of angina or myocardial infarction, reflecting ischemia in the heart area.$Cause_1": { + "developed stabbing retrosternal chest pain radiating to the arm$Input2": {} + }, + "High blood pressure is a major risk factor for heart disease, especially acute coronary syndrome$Cause_1": { + "Hypertension$Input3": {} + } + } + } + }, + "input1": "chest pain\n", + "input2": "He is a year old man w now s/p DES to the left circumflex. \nPatient is generally healthy and active with frequent exercise. Only medical comorbidity to this point is hypertension. He was exercising in the gym (weight lifting and running) around 7pm, and near the end of the work-out developed stabbing retrosternal chest pain radiating to the arm. He returned home, and with rest and a shower felt a little improvement in his chest pain. He went to sleep still having chest pain, but around 1130 woke with worsening pain, diaphoresis, dyspnea, and decided to come to the ED. \nIn the ED, initial vitals were: T 97.9, HR 89, BP 167/90, RR 18, SPO2 100% on RA. \nEKG showed ST elevations in leads II, III, aVF, ST depressions in leads V1-2. \n\n", + "input3": "+ Hypertension \n+ Appendectomy\n", + "input4": "father with hypertension\n", + "input5": "VS: T98, BP 121/73, HR 62, RR 18, O2 96% on RA \nTele: no alarms \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclerae anicteric\nNeck: Supple \nCV: RRR, nl S1 S2, no m/r/g \nLungs: CTA b/l, no wheezes, rales, rhonchi \nAbdomen: Soft, non-tender, non-distended\nGU: No foley \nExt: WWP, DP 2+ bilaterally \nNeuro: CNII-XII intact\n", + "input6": "admissions labs:\n05:46AM GLUCOSE-93 UREA N-14 CREAT-0.9 SODIUM-138 POTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-20* ANION GAP-18\n05:46AM CALCIUM-9.1 PHOSPHATE-3.6 MAGNESIUM-2.7* CHOLEST-173\n05:46AM %HbA1c-5.6 eAG-114\n05:46AM TRIGLYCER-126 HDL CHOL-36 CHOL/HDL-4.8 LDL(CALC)-112\n05:46AM WBC-5.8 RBC-5.28 HGB-15.9 HCT-46.9 MCV-89 MCH-30.1 MCHC-33.9 RDW-12.4 RDWSD-40.7\n05:46AM PLT COUNT-285\n01:39AM TYPE-ART PH-7.35 INTUBATED-NOT INTUBA\n01:39AM GLUCOSE-104 NA+-131* K+-3.5 CL--97 TCO2-24\n01:39AM freeCa-1.13\n12:45AM GLUCOSE-117* UREA N-15 CREAT-1.0 SODIUM-138 POTASSIUM-3.9 CHLORIDE-98 TOTAL CO2-26 ANION GAP-18\n12:45AM estGFR-Using this\n12:45AM cTropnT-0.10*\n12:45AM WBC-7.7# RBC-5.50 HGB-16.5 HCT-49.0 MCV-89 MCH-30.0 MCHC-33.7 RDW-12.4 RDWSD-40.6\n12:45AM NEUTS-23.2* LYMPHS-60.9* MONOS-10.5 EOS-3.5 \nBASOS-1.8* IM AbsNeut-1.80 AbsLymp-4.71* AbsMono-0.81* \nAbsEos-0.27 AbsBaso-0.14*\n___ 12:45AM HYPOCHROM-NORMAL ANISOCYT-NORMAL \nPOIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL \nPOLYCHROM-NORMAL\n___ 12:45AM PLT COUNT-296\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/11657791-DS-21.json b/Finished/Acute Coronary Syndrome/UA/11657791-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..d90f9e1765d1fb6cc5cfd51be0455a17b56a8ca4 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/11657791-DS-21.json @@ -0,0 +1,105 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "He reports that the pain seemed to radiate to the back b/w the scapulae and worsened with breathing but denies other assoc symptoms other than slight dyspnea. Pain lasted for approx 30 min- pt reports \"nearly passing out\" when taking sublingual nitroglycerin.$Input2": {} + }, + "nomal(<0.2 \u03bcg/L)$Cause_1": { + "BLOOD cTropnT-<0.01$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN,$Input3": {} + }, + "HLD is the risk fact for ACS$Cause_1": { + "HLD$Input3": {} + }, + "former smoker is the risk fact for ACS$Cause_1": { + "former smoker$Input3": {} + }, + "Obesity is the risk fact for ACS$Cause_1": { + "Obesity$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "PCIs (following MI, RCA stent are the risk facts for ACS$Cause_1": { + "He is a 66 yr old male with known CAD s/p multiple PCIs (following MI, RCA stent, 2 RCA stents on.$Input2": {} + }, + "Chest pain is a symptom of ACS.$Cause_1": { + "He reports an episode of dull substernal chest pain 2 days ago when he was out shopping with his wife.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN,$Input3": {} + }, + "HLD is the risk fact for ACS$Cause_1": { + "HLD$Input3": {} + }, + "former smoker is the risk fact for ACS$Cause_1": { + "former smoker$Input3": {} + }, + "Obesity is the risk fact for ACS$Cause_1": { + "Obesity$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG\uff1anon-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN,$Input3": {} + }, + "HLD is the risk fact for ACS$Cause_1": { + "HLD$Input3": {} + }, + "former smoker is the risk fact for ACS$Cause_1": { + "former smoker$Input3": {} + }, + "Obesity is the risk fact for ACS$Cause_1": { + "Obesity$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "PCIs (following MI, RCA stent are the risk facts for ACS$Cause_1": { + "He is a 66 yr old male with known CAD s/p multiple PCIs (following MI, RCA stent, 2 RCA stents on.$Input2": {} + }, + "Chest pain is a symptom of ACS.$Cause_1": { + "He reports an episode of dull substernal chest pain 2 days ago when he was out shopping with his wife.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "HTN is the risk fact for ACS$Cause_1": { + "HTN,$Input3": {} + }, + "HLD is the risk fact for ACS$Cause_1": { + "HLD$Input3": {} + }, + "former smoker is the risk fact for ACS$Cause_1": { + "former smoker$Input3": {} + }, + "Obesity is the risk fact for ACS$Cause_1": { + "Obesity$Input3": {} + } + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "He is a 66 yr old male with known CAD s/p multiple PCIs (following MI, RCA stent, 2 RCA stents on. Of note, pt is s/p negative nuclear stress testing and coronary angiography. He reports an episode of dull substernal chest pain 2 days ago when he was out shopping with his wife. He reports that the pain seemed to radiate to the back b/w the scapulae and worsened with breathing but denies other assoc symptoms other than slight dyspnea. Pain lasted for approx 30 min- pt reports \"nearly passing out\" when taking sublingual nitroglycerin. Of note, at baseline pt reports substernal chest pain at its worst lasting min- he notes that this baseline pain occasionally occurs at rest and has been present since discharge from last month; he feels that he has had approximately 6 episodes in the last day. \n\nPt saw his PCP yesterday and reported his chest pain from the day before along w/hx of baseline symptoms, and was subsequently referred. Pt was afebrile, BP 158/80, HR 56, RR 18, SaO2 98% RA. Work-up yielded Troponin I x3 <0.015 (<0.046 ng/mL), CPK-MB 2.6 (0.5-3.6 ng/mL), EKG showed normal sinus rhythm, CXR showed no acute cardiopulmonary process.\n", + "input3": "+Cardiac Risk Factors: \n+HTN, \n+HLD, \n+former smoker \n+CAD s/p multiple PCIs: following MI, RCA stent, 2 RCA stents.\n+Pulmonary hypertension\n+Mitral valve regurgitation\n+psoriatic arthritis (denies any medical management)\n+Obesity\n+Scarlet fever as a child\n+Bilateral cataracts s/p cataract surgery\n+Bladder cancer , s/p surgery + chemotherapy\n+S/P hernia repair\n+s/p fracture left shoulder, s/p ORIF\n+Persistent hip pain, left\n", + "input4": "-Father died, hx of ETOH overconsumption\n-Mother died when pt was young, reportedly from complications assoc w/gestational diabetes\n-No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death\n", + "input5": "ADMISSION\nT 97.8F, BP 124/68, HR 50, RR 18, SaO2 99% RA. \nPleasant elderly man resting comfortably in bed, no acute distress\nHEENT: NCAT. Pupils slightly asymmetric, pupillary light reflex not appreciable prior cataract surgery); pt wearing blue-colored contact lenses. Conjunctiva pink, sclera anicteric, moist mucous membranes. Patient wearing partial upper and lower dentures.\nNeck: supple, no JVD\nCV: RRR, HS 1 and 2 audible on auscultation, no m/r/g\nLungs: CTAB \nAbdomen: soft, nontender, non-distended, BS+\nExt: 2+ distal pulses in upper and lower extremities \nbilaterally. Scars on ulnar aspect L forearm (reported to be psoriasis)\nNeuro: A&O x3, cranial nerves II to XII grossly intact. strength in upper and lower extremities bilaterally\n", + "input6": "___ 07:45AM BLOOD ___\n___ 04:30PM BLOOD Plt ___\n___ 07:45AM BLOOD Glucose-100 UreaN-17 Creat-1.0 Na-139 K-4.1 Cl-104 HCO3-28 AnGap-11\n___ 04:30PM BLOOD Na-140 K-4.1 Cl-105\n___ 04:30PM BLOOD cTropnT-<0.01\n\nECG\uff1anon-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/11677801-DS-33.json b/Finished/Acute Coronary Syndrome/UA/11677801-DS-33.json new file mode 100644 index 0000000000000000000000000000000000000000..5606bf2b25392bffb022af1b46507c2dc27c8e02 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/11677801-DS-33.json @@ -0,0 +1,105 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "Reports pain during the last month which starts in left parasternal region, radiates to the left elbow. For the past week the patient has had worsening left-sided chest pressure with any exertional activities. This is associated with dyspnea and recovers after a couple of minutes of rest$Input2": {} + }, + "Severe chest pain is symbol of ACS-UA.$Cause_1": { + "He states this felt unlike his prior episodes of angina. It lasted for about 25 min and resolved en route.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "CAD c/b MI s/p 3v CABG and BMS can be risk factors$Cause_1": { + "CAD c/b MI s/p 3v CABG and BMS$Input3": {} + }, + "family history can be risk fact$Cause_1": { + "Mother CAD, CHF, Tremor$Input4": {} + }, + "family history can be risk fact.$Cause_1": { + "Father CAD$Input4": {} + }, + "family history can be risk fact..$Cause_1": { + "Brother CAD$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "ECG changes can be sign of acs-ua$Cause_1": { + "EKG showed SR @ 58, old TWI in lead III, LAD. Currently reports continued left arm discomfort$Input2": {} + }, + "Coronary stenosis can strongly be a sign of acs$Cause_1": { + "LMCA: distal 60%\nLAD: proximally occluded, distal vessel fills via LIMA\nLCX: proximal 80% lesion with small distal vessel\nRCA: diffuse proximal/mid disease with mid occlusion;$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "CAD c/b MI s/p 3v CABG and BMS can be risk factors$Cause_1": { + "CAD c/b MI s/p 3v CABG and BMS$Input3": {} + }, + "family history can be risk fact$Cause_1": { + "Mother CAD, CHF, Tremor$Input4": {} + }, + "family history can be risk fact.$Cause_1": { + "Father CAD$Input4": {} + }, + "family history can be risk fact..$Cause_1": { + "Brother CAD$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "CAD c/b MI s/p 3v CABG and BMS can be risk factors$Cause_1": { + "CAD c/b MI s/p 3v CABG and BMS$Input3": {} + }, + "family history can be risk fact$Cause_1": { + "Mother CAD, CHF, Tremor$Input4": {} + }, + "family history can be risk fact.$Cause_1": { + "Father CAD$Input4": {} + }, + "family history can be risk fact..$Cause_1": { + "Brother CAD$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "ECG changes can be sign of acs-ua$Cause_1": { + "EKG showed SR @ 58, old TWI in lead III, LAD. Currently reports continued left arm discomfort$Input2": {} + }, + "Coronary stenosis can strongly be a sign of acs$Cause_1": { + "LMCA: distal 60%\nLAD: proximally occluded, distal vessel fills via LIMA\nLCX: proximal 80% lesion with small distal vessel\nRCA: diffuse proximal/mid disease with mid occlusion;$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "CAD c/b MI s/p 3v CABG and BMS can be risk factors$Cause_1": { + "CAD c/b MI s/p 3v CABG and BMS$Input3": {} + }, + "family history can be risk fact$Cause_1": { + "Mother CAD, CHF, Tremor$Input4": {} + }, + "family history can be risk fact.$Cause_1": { + "Father CAD$Input4": {} + }, + "family history can be risk fact..$Cause_1": { + "Brother CAD$Input4": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "He with h/o CAD s/p CABG and BM stent location, muscle invasive urothelial bladder ca s/p cystectomy and creating of neobladder, intraductal papillary mucinous neoplasm s/p Whipple procedure, who presents with chest pain. Reports pain during the last month which starts in left parasternal region, radiates to the left elbow. For the past week the patient has had worsening left-sided chest pressure with any exertional activities. This is associated with dyspnea and recovers after a couple of minutes of rest. \n\nThis morning at 4am he awoke with throbbing chest pain in the middle of his chest that radiated to his shoulders and his left arm. This was associated with nausea and palpitations, but not shortness of breath or diaphoresis. He states this felt unlike his prior episodes of angina. It lasted for about 25 min and resolved en route.\n\nWas seen where vitals were 97.8 63 126/58 15 96%. Initial ECG did not show evidence of STEMI/NSTEMI and troponin was negative. Received morphine and NTG with improvement in discomfort. He was transferred for possible cath.\n\nIn the ED, initial vitals were 97.4 60 146/54 16 100%. EKG showed SR @ 58, old TWI in lead III, LAD. Currently reports continued left arm discomfort, though no chest pain or shortness of breath. He denies cough, fever, pleuritic chest pain, orthopnea, syncope, leg swelling.ECG:non-ST-elevation\n", + "input3": "+muscle invasive urothelial bladder ca s/p cystectomy and creating of neobladder\n-intraductal papillary mucinous neoplasm s/p Whipple procedure \n+ventral hernia s/p repair\n+Ulcer s/p cautery\n+pulmonary embolus (was on coumadin for 6 mo)\n+CAD c/b MI s/p 3v CABG and BMS\n", + "input4": "Mother CAD, CHF, Tremor\nFather CAD\nBrother CAD, EtOH abuse\nBrother Living TREMOR, CAD \nAunt LUNG CANCER\n", + "input5": "ADMISSION EXAM\n\n\nVS: Wt=215lbs T=97.8 BP=132/82 HR=67 RR=16 O2 sat=96% on RA \nGeneral: well-appearing man in NAD \nHEENT: EOMI, anicteric sclera, mucus membranes moist\nNeck: supple JVD 6cm \nCV: regular rate and rhythm, no murmurs, rubs, or gallops\nLungs: breathing comfortably on room air, CTAB\nAbdomen: +BS, S NT ND\nGU: no foley\nExt: warm and well perfused, no edema\nNeuro: A&Ox3, CN2-12 intact, moving all extremities\nSkin: no rashes\nPULSES: 2+\n", + "input6": "ADMISSION LABS\n\n___ 08:56AM BLOOD WBC-8.0# RBC-4.74 Hgb-15.3 Hct-47.2 MCV-99* MCH-32.3* MCHC-32.5 RDW-13.6 Plt ___\n___ 08:56AM BLOOD Neuts-69.9 ___ Monos-5.7 Eos-2.4 Baso-1.1\n___ 02:56PM BLOOD ___\n___ 08:56AM BLOOD Glucose-109* UreaN-21* Creat-1.3* Na-139 K-4.9 Cl-107 HCO3-21* AnGap-16\n___ 08:56AM BLOOD CK-MB-3\n\nSTUDIES\n\n___: Findings\nESTIMATED blood loss: 20 cc\nHemodynamics (see above):Coronary angiography: right dominant\nLMCA: distal 60%\nLAD: proximally occluded, distal vessel fills via LIMA\nLCX: proximal 80% lesion with small distal vessel\nRCA: diffuse proximal/mid disease with mid occlusion; distal PLand PDA branches fill via SVG with no significant diseaseSVG sequentially to PL and PDA branches: prior stent patent; 90%lesion proximal to proximal PL anastomosis LIMA- diagonal: normal; retrograde filling of distal LAD which is a small vessel\n\nInterventional details\nChange for Fr AL 0.75 guide. Using Spider distal protection,mid graft lersion crossed with Prowater wire , dilated with 2.5 balloon and stented with 3.5x12 Premier to 3.75 mm at 18 atm. No residual, normal flow. Angioseal femoral closure.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/11677801-DS-34.json b/Finished/Acute Coronary Syndrome/UA/11677801-DS-34.json new file mode 100644 index 0000000000000000000000000000000000000000..e6468543a2e22363a61eb5b5bf2b814893b5815c --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/11677801-DS-34.json @@ -0,0 +1,58 @@ +{ + "UA$Intermedia_4": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "Patient reports exertional chest pain and shortness of breath over the last few days.$Input2": {} + }, + "Severe chest pain is symbol of ACS-UA.$Cause_1": { + "Chest pain described as midsternal chest pain with radiation to the left arm that feels similar to his previous cardiac chest pain. He experienced left jaw pain for the first time.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD is risk fact of acs$Cause_1": { + "He is with h/o CAD s/p CABG and BM$Input2": {} + }, + "CAD of family history can be risk fact$Cause_1": { + "Mother CAD, CHF, Tremor$Input4": {} + }, + "CAD of family history can be risk fact.$Cause_1": { + "Father CAD$Input4": {} + }, + "CAD of family history can be risk fact..$Cause_1": { + "Brother CAD,$Input4": {} + } + }, + "NSTE-ACS$Intermedia_3": { + "Severe chest pain is symbol of ACS-UA..$Cause_1": { + "Patient notes chest pain has been worse with walking for a distance more than yards. Had difficulty walking from parking lot to hospital the other day when visiting a friend.$Input2": {} + }, + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG - sinus, NANI, no STEMI non-ST-elevation$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD is risk fact of acs$Cause_1": { + "He is with h/o CAD s/p CABG and BM$Input2": {} + }, + "CAD of family history can be risk fact$Cause_1": { + "Mother CAD, CHF, Tremor$Input4": {} + }, + "CAD of family history can be risk fact.$Cause_1": { + "Father CAD$Input4": {} + }, + "CAD of family history can be risk fact..$Cause_1": { + "Brother CAD,$Input4": {} + } + } + } + }, + "input1": "Chest pain\n", + "input2": "He is with h/o CAD s/p CABG and BM, DES in SVG-PDA with restenosis, muscle invasive urothelial bladder ca s/p cystectomy and neobladder, intraductal papillary mucinous neoplasm s/p Whipple procedure, who presents with chest pain. Patient reports exertional chest pain and shortness of breath over the last few days. Chest pain described as midsternal chest pain with radiation to the left arm that feels similar to his previous cardiac chest pain. He experienced left jaw pain for the first time. Patient notes chest pain has been worse with walking for a distance more than yards. Had difficulty walking from parking lot to hospital the other day when visiting a friend. Reports increased chest discomfort and SOB when walking up slight inclines. Pain and dyspnea only associated with exertion. Improved with couple mintues of rest and deep breathing. Denies any symptoms at rest. Notes associated lightheadedness. \n\nPatient was concerned and presented to the ED. In the ED, initial vitals were 98.2 63 141/88 18 94% 2L. Denies any active chest pain or SOB. Exam notable for : mild crackle to right lung\n\nChest Xray- No acute cardiopulmonary process.\nEKG - sinus, NANI, no STEMI non-ST-elevation\n\nOn arrival to the floor patient is stable. Denies any active chest pain or SOB. Currently asymptomatic. \n\nREVIEW OF SYSTEMS: + as per HPI. Denies nausea, vomiting. \nDiarrhea for past 7 days but reports this is common due to his Whipple. No associated fevers or chills. \n\nCardiac review of systems is notable for chest pain, dyspnea on exertion, negative for paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "+muscle invasive urothelial bladder ca s/p cystectomy and creating of neobladder \n+intraductal papillary mucinous neoplasm s/p Whipple procedure \n+ventral hernia s/p repair\n+Ulcer s/p cautery \n+pulmonary embolus (was on coumadin for 6 mo)\n", + "input4": "Mother CAD, CHF, Tremor\nFather CAD\nBrother CAD, EtOH abuse\nBrother Living 72 TREMOR, CAD \nAunt LUNG CANCER\n", + "input5": "ADMISSION PHYSICAL EXAMINATION:\nVitals: 98.0 123/80 70 18 98%RA\nGeneral: well-appearing man in NAD \nHEENT: EOMI, anicteric sclera, mucus membranes moist\nNeck: supple, level of clavicle sitting upright\nCV: regular rate and rhythm, no murmurs, rubs, or gallops\nLungs: breathing comfortably on room air, CTAB\nAbdomen: +BS, soft, nontender, nondistended, multiple well healed scars.\nGU: No foley\nExt: warm and well perfused, no edema. Peripheral pulses \nintact.\nNeuro: A&Ox3, CN2-12 intact, moving all extremities\nSkin: no rashes\n", + "input6": "ADMISSION LABS\n==================\n___ 07:10AM BLOOD WBC-6.1 RBC-4.52* Hgb-13.9 Hct-43.5 MCV-96 MCH-30.8 MCHC-32.0 RDW-13.6 RDWSD-48.6* Plt\n___ 07:10AM BLOOD Neuts-64.4 Monos-10.2 Eos-2.5 Baso-0.7 AbsNeut-3.94 AbsLymp-1.34 AbsMono-0.62 AbsEos-0.15 AbsBaso-0.04\n___ 07:10AM BLOOD\n___ 07:10AM BLOOD Glucose-117* UreaN-17 Creat-1.4* Na-142 K-4.6 Cl-109* HCO3-21* AnGap-17\n___ 07:10AM BLOOD CK-MB-1 cTropnT-<0.01\n___ 01:12PM BLOOD CK-MB-1 cTropnT-<0.01\n___ 07:10AM BLOOD Calcium-9.2 Phos-3.1 Mg-2.0\n\nIMAGING\n==================\nCHEST (PA & LAT)\nThere are slightly low lung volumes, which results in bronchovascular crowding. The cardiomediastinal and hilar contours are unchanged. The aorta is tortuous. The patient is status post CABG. There is no pneumothorax, pleural effusion, or consolidation. \n \nIMPRESSION: No acute cardiopulmonary process.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/11706286-DS-17.json b/Finished/Acute Coronary Syndrome/UA/11706286-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..9822e147df78f593548ba6b82158a1590b384ffa --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/11706286-DS-17.json @@ -0,0 +1,60 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "He was walking up the stairs today when he experienced chest pain for two minutes associated with palpitations. The pain lasted for 10 minutes. He has had a few other episodes with exertion this week.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Hyperkalemia is a symptom of ACS$Cause_1": { + "Hyperkalemia$Input1": {} + }, + "+Dyslipidemia can be risk fact$Cause_1": { + "+Dyslipidemia$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "ECG changes can be sign of acs$Cause_1": { + "EKG: sinus rhythm with subtle ST depression in lateral leads withpoor R wave progression$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Hyperkalemia is a symptom of ACS$Cause_1": { + "Hyperkalemia$Input1": {} + }, + "+Dyslipidemia can be risk fact$Cause_1": { + "+Dyslipidemia$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "and non-ST-elevation$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Hyperkalemia is a symptom of ACS$Cause_1": { + "Hyperkalemia$Input1": {} + }, + "+Dyslipidemia can be risk fact$Cause_1": { + "+Dyslipidemia$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "ECG changes can be sign of acs$Cause_1": { + "EKG: sinus rhythm with subtle ST depression in lateral leads withpoor R wave progression$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Hyperkalemia is a symptom of ACS$Cause_1": { + "Hyperkalemia$Input1": {} + }, + "+Dyslipidemia can be risk fact$Cause_1": { + "+Dyslipidemia$Input3": {} + } + } + } + } + }, + "input1": "Hyperkalemia\n", + "input2": "He is a 69 year old male with history of hypothyroidism who presents to the ED after an episode of exertional chest pain.\n\nHe was walking up the stairs today when he experienced chest pain for two minutes associated with palpitations. The pain lasted for 10 minutes. He has had a few other episodes with exertion this week. He denies n/v, diaphoresis, radiation of the pain to either arm or to his jaw. He denies any prior issues with bleeding, has no upcoming planned surgeries. \n\nIn the ED initial vitals were: T: 97.4 HR: 95 BP: 136/54 RR: 18 SPO2: 100% RA \n\nEKG: sinus rhythm with subtle ST depression in lateral leads withpoor R wave progression and non-ST-elevation\n \nPatient was given: PO Aspirin 324 mg \n\nOn the floor, patient denies any recurrent chest pain but does note some mild indigestion which he is quick to point out is quite different from his prior chest pain.\n", + "input3": "+Dyslipidemia \n+Rhythm: NSR\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death.\n", + "input5": "Vitals: 97.6 139 / 90 71 18 97 RA \nTelemetry: no events\nGeneral: laying comfortably in bed\nLungs: breathing comfortably, CTA b/l\nCV: rrr, no mrg, JVP not elevated\nAbdomen: soft, ntnd\nExt: no peripheral edema\n", + "input6": "___ 07:30AM BLOOD WBC-8.0 RBC-4.95 Hgb-14.9 Hct-44.7 MCV-90 MCH-30.1 MCHC-33.3 RDW-13.5 RDWSD-44.5 Plt ___\n___ 07:30AM BLOOD Plt ___\n___ 07:30AM BLOOD Glucose-99 UreaN-13 Creat-0.9 Na-141 K-4.5 Cl-102 HCO3-29 AnGap-10\n___ 08:45AM BLOOD CK(CPK)-45*\n___ 09:03AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 03:02AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 08:45AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:30AM BLOOD Calcium-9.0 Phos-3.1 Mg-2.2\n___ 03:20AM BLOOD RedHold-HOLD\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/11959580-DS-12.json b/Finished/Acute Coronary Syndrome/UA/11959580-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..26a12bb2269376ab7ca255f81727aeef1b886a7b --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/11959580-DS-12.json @@ -0,0 +1,87 @@ +{ + "UA$Intermedia_5": { + "Chest pain is a symptom of ACS.$Cause_1": { + "who presents chest pain this am at 0850 while walking across a parking a lot, that lasted about about 8 mins pain radiated left arm, no nausea, no diaphoresis during event.$Input2": {} + }, + "Severe chest pain is symbol of ACS-UA.$Cause_1": { + "She complained of mild mid-sternal to left shoulder pressure at peak exercise, which resolved almost completely by 5 minutes of recovery with the remaining discomfort only occuring with palpation.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "+STEMI is a risk fact$Cause_1": { + "+STEMI$Input3": {} + }, + "HLD is a risk fact$Cause_1": { + "+HLD$Input3": {} + }, + "family history can be risk fact$Cause_1": { + "Mother father with CAD and CHF.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities can be sign of acs$Cause_1": { + "The right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. There is abnormal septal motion/position. The aortic root is mildly dilated at the sinus level.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "+STEMI is a risk fact$Cause_1": { + "+STEMI$Input3": {} + }, + "HLD is a risk fact$Cause_1": { + "+HLD$Input3": {} + }, + "family history can be risk fact$Cause_1": { + "Mother father with CAD and CHF.$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:\nnon-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "+STEMI is a risk fact$Cause_1": { + "+STEMI$Input3": {} + }, + "HLD is a risk fact$Cause_1": { + "+HLD$Input3": {} + }, + "family history can be risk fact$Cause_1": { + "Mother father with CAD and CHF.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities can be sign of acs$Cause_1": { + "The right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. There is abnormal septal motion/position. The aortic root is mildly dilated at the sinus level.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "+STEMI is a risk fact$Cause_1": { + "+STEMI$Input3": {} + }, + "HLD is a risk fact$Cause_1": { + "+HLD$Input3": {} + }, + "family history can be risk fact$Cause_1": { + "Mother father with CAD and CHF.$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "Male-to-female transgender pt (on estrogen and spironolactone), h/o CAD (STEMI and cabg who presents chest pain this am at 0850 while walking across a parking a lot, that lasted about about 8 mins pain radiated left arm, no nausea, no diaphoresis during event. She originally was seen, EKG unchanged compared to prior, trop neg, pt continued to have CP and was given nitro SL and paste x 2, morphine, and ASA lovenox cs, metop tartrate 5,g IV, before transfer. In the ED intial vitals were:97.9 88 110/64 16 96% 2L pt became hypotensive to 77/44 while on nitro patch this resolved when removing the nitro patch adn BPs went up to the 100s \n\nLabs were significant for Ddimer <150, trop neg x1 wbc 11 cardiology was consulted and felt there were no frank abnormalities on echo though difficult views, systolic function appeared low normal, ecg unchanged from prior.\n", + "input3": "+STEMI\n+CABG\n+HLD \n+transgender M-->F\n", + "input4": "Mother father with CAD and CHF.\n", + "input5": "ADMISSION:\nVitals - 98.3 126/73 73 18 98%ra \nGENERAL: NAD \nHEENT: no elev JVP \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no edema\n", + "input6": "ADMISSION LABS:\n___ 04:00PM BLOOD WBC-11.1* RBC-4.10* Hgb-13.8 Hct-39.1 MCV-96 MCH-33.6* MCHC-35.2* RDW-12.0 Plt ___\n___ 04:00PM BLOOD Neuts-67.7 ___ Monos-5.3 Eos-1.5 Baso-0.9\n___ 04:00PM BLOOD ___ PTT-40.8* ___\n___ 04:00PM BLOOD Glucose-89 UreaN-15 Creat-1.0 Na-136 K-4.5 Cl-102 HCO3-25 AnGap-14\n___ 04:00PM BLOOD Calcium-9.9 Phos-4.1 Mg-2.1\n___ 04:00PM BLOOD cTropnT-<0.01\n___ 04:14PM BLOOD Lactate-1.8\n\nIMAGING AND STUDIES:\n\nExercise Stress MIBI:\nINTERPRETATION: THis was an active 61 year old transgender (M to \nF) woman with CAD (MI/cabg, HLD and CHF, who was referred to the lab from the inpatient floor for an evaluation of chest discomfort. She exercised for 6.5 minutes of protocol METs) and stopped due to fatigue. This represents a fair functional capacity for her age. She complained of mild mid-sternal to left shoulder pressure at peak exercise, which resolved almost completely by 5 minutes of recovery with the remaining discomfort only occuring with palpation. In the presence of RBBB on baseline ECG, there were no changes in ST segment or T wave morphology noted during exercise or in recovery. The rhythm was sinus with one isolated PVC seen during exercise and one ventricular couplet seen in immediate recovery. The heart rate and blood pressure responses were mildly blunted (beta blockade). \n \n___ CXR:\nNo acute cardiopulmonary abnormality. \n \n___ ECHO bedside:\nThe left atrium is normal in size. Left ventricular wall thicknesses and cavity size are normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded - it appears that the inferior wall may be hypokinetic. Overall left ventricular systolic function is low normal (LVEF 50-55%). The right ventricular cavity is mildly dilated with focal hypokinesis of the apical free wall. There is abnormal septal motion/position. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. If clinically indicated, a complete transthoracic examination with Doppler is recommended. \n\nCompared with the prior study (images reviewed), right ventricle is slightly larger. Regional left ventricular function cannot be reliably assessed on this emergency study.\n\nECG:\nnon-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/11985139-DS-4.json b/Finished/Acute Coronary Syndrome/UA/11985139-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..381f50f80da60212847e16bb0b30950c68ddbd1b --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/11985139-DS-4.json @@ -0,0 +1,96 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "tient noted chest pain more frequent and extended episodes. The pain occurs every night for the past week, lasts up to 2 hours. She uses two tablets of NTG without good resolution of pain.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "DOE is a symptom of ACS$Cause_1": { + "DOE$Input1": {} + }, + "Diaphoresis is a symptom of ACS$Cause_1": { + "Diaphoresis$Input1": {} + }, + "CAD HTN, DM2, HLD,are risk facts$Cause_1": { + "She is an female with history of CAD (3 vessel disease, previous cath stent to LCX), HTN, DM2, HLD,$Input2": {} + }, + "family history is a risk fact$Cause_1": { + "1 brother alive without CAD. 1 sister with CAD$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "Normal global and regional biventricular systolic function. Mild mitral regurgitation.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "DOE is a symptom of ACS$Cause_1": { + "DOE$Input1": {} + }, + "Diaphoresis is a symptom of ACS$Cause_1": { + "Diaphoresis$Input1": {} + }, + "CAD HTN, DM2, HLD,are risk facts$Cause_1": { + "She is an female with history of CAD (3 vessel disease, previous cath stent to LCX), HTN, DM2, HLD,$Input2": {} + }, + "family history is a risk fact$Cause_1": { + "1 brother alive without CAD. 1 sister with CAD$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "DOE is a symptom of ACS$Cause_1": { + "DOE$Input1": {} + }, + "Diaphoresis is a symptom of ACS$Cause_1": { + "Diaphoresis$Input1": {} + }, + "CAD HTN, DM2, HLD,are risk facts$Cause_1": { + "She is an female with history of CAD (3 vessel disease, previous cath stent to LCX), HTN, DM2, HLD,$Input2": {} + }, + "family history is a risk fact$Cause_1": { + "1 brother alive without CAD. 1 sister with CAD$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "Normal global and regional biventricular systolic function. Mild mitral regurgitation.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "DOE is a symptom of ACS$Cause_1": { + "DOE$Input1": {} + }, + "Diaphoresis is a symptom of ACS$Cause_1": { + "Diaphoresis$Input1": {} + }, + "CAD HTN, DM2, HLD,are risk facts$Cause_1": { + "She is an female with history of CAD (3 vessel disease, previous cath stent to LCX), HTN, DM2, HLD,$Input2": {} + }, + "family history is a risk fact$Cause_1": { + "1 brother alive without CAD. 1 sister with CAD$Input4": {} + } + } + } + } + }, + "input1": "Chest pain, DOE, Diaphoresis\n", + "input2": "She is an female with history of CAD (3 vessel disease, previous cath stent to LCX), HTN, DM2, HLD, presents with unstable angina, dyspnea on exertion, and diaphoresis x 3 weeks. She cannot have a CABG as she refuses transfusions. Since her stent to Lcx, she had been pain free for a while on maximum anginal therapy up until one month ago, but now her symptoms are returning. Patient saw her PCP. And per PCP's note during that visit patient noted chest pain more frequent and extended episodes. The pain occurs every night for the past week, lasts up to 2 hours. She uses two tablets of NTG without good resolution of pain. Pt was advised to come to the ED for further evaluation, given CT surgery here.\n", + "input3": "+Diabetes \n+Dyslipidemia\n+Hypertension \n+Iron deficiency anemia\n+Vitamin B deficiency\n+Osteoarthritis\n+Asthma\n+Right carotid artery stenosis\n+Chronic open angle glaucoma\n+Cataract left eye\n", + "input4": "Father and mother deceased - unknown cause. 1 brother alive without CAD. 1 sister with CAD. Multiple siblings deceased.\n", + "input5": "ADMISSION:\nVS: T=97.4 BP=131/47 HR=57 RR=16 O2 sat=98%RA \nGeneral: A&O x 3, NAD\nHEENT: NCAT, EOMi \nNeck: No JVD \nCV: RRR, normal S1, S2, no murmurs\nLungs: CTAB\nAbdomen: Soft, NTND\nExt: No lower extremity edema \nNeuro: CN grossly intact, moves all extremities \nPULSES: 2+ DP pulses\n", + "input6": "ADMISSION LABS:\n___ 01:05PM BLOOD WBC-4.9 RBC-3.62* Hgb-11.9* Hct-37.5 MCV-104* MCH-33.0* MCHC-31.9 RDW-12.4 Plt ___\n___ 01:05PM BLOOD Neuts-62.1 ___ Monos-8.4 Eos-2.1 Baso-0.7\n___ 01:05PM BLOOD ___ PTT-32.0 ___\n___ 01:05PM BLOOD Glucose-173* UreaN-16 Creat-0.8 Na-137 K-5.3* Cl-101 HCO3-29 AnGap-12\n___ 01:05PM BLOOD Calcium-9.5 Phos-3.7 Mg-2.2\n___ 01:05PM BLOOD cTropnT-<0.01\n\nIMAGING:\n\nECHO ___:\nThe left atrium is mildly dilated. 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 aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion. \n\nIMPRESSION: Normal global and regional biventricular systolic function. Mild mitral regurgitation.\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/12261639-DS-4.json b/Finished/Acute Coronary Syndrome/UA/12261639-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..4da075c49d3c26527010151f9739c4f447864619 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/12261639-DS-4.json @@ -0,0 +1,40 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA.$Cause_1": { + "Patient reports 2 weeks of chest pressure, non-radiating, worsened by exertion and relieved by rest. It has progressed to the point where she has the chest discomfort with minimal exertion such as folding laundry. She reports some chest pressure at rest.$Input2": {} + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Strongly Suspected ACS$Intermedia_3": { + "ECG changes can be a sign of acs$Cause_1": { + "An office EKG was done and showed new T wave inversion in V2(new from prior EKG.$Input2": {} + }, + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "There is mild regional left ventricular systolic dysfunction with focal apical hypokinesis (clip 2). The remaining segments contract normally (LVEF >= 60 %).$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Severe chest pain is symbol of ACS$Cause_1": { + "She reports substernal pressure brought on by exertion and relieved by rest that is occurring even with minimal exertion. It is associated with SOB.$Input2": {} + }, + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "CAD,DM AD are risk facts$Cause_1": { + "Female w/ h/o CAD (IMI s/p x 2 BMS and s/p DES the proximal RCA), type I DM, and Addison's disease$Input2": {} + }, + "family history is a risk fact$Cause_1": { + "Father- MI$Input4": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "Female w/ h/o CAD (IMI s/p x 2 BMS and s/p DES the proximal RCA), type I DM, and Addison's disease presented to the ED 2 weeks of worsening chest pressure similar in quality to her prior angina pain. She reports substernal pressure brought on by exertion and relieved by rest that is occurring even with minimal exertion. It is associated with SOB. No radiation, no pleuritic or positional features. She presented to her endocrinologist Dr. on the AM. She told Dr. her exertional chest pain and she felt like she was experiencing chest pressure in the waiting room. An office EKG was done and showed new T wave inversion in V2(new from prior EKG. She took a SL nitro which relieved the pain. She was referred to the ED for further management. \n\nIn the ED initial vitals were: T97.8 64 135/62 16 100% RA \nEKG: Sinus brady, new TWI in V1 and V2 \nLabs/studies notable for: Cr .9, BG 258, negative troponins x 1\nPatient was given: hep ggt, nitro ggt, ASA 325 mg and chest pain improved.\nVitals on transfer: HR 53 BP 119/57 15 98% \n \nOn the floor patient is comfortable and chest pain free on nitro drip. Patient reports 2 weeks of chest pressure, non-radiating, worsened by exertion and relieved by rest. It has progressed to the point where she has the chest discomfort with minimal exertion such as folding laundry. She reports some chest pressure at rest. The pressure is associated with SOB, lightheadedness. She denies diaphoresis, N/V. Patient reports recent weight gain of 15 lbs. She reports calf pain that occurs with walking more than 10 min which is relived by rest. She denies orthopnea, PND, ankle edema.\n\nREVIEW OF SYSTEMS: \nCardiac review of systems is notable for absence paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope, or presyncope. \n\nOn further review of systems, denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. Denies recent fevers, chills or rigors. All of the other review of systems were negative.\n", + "input3": "+Adrenal insufficiency\n+Gastroparesis \n+Appendectomy\n+Hernia surgery\n+Hypothyroidism\n", + "input4": "Father- MI\nBrother- \"does not go to the doctor\"\n", + "input5": "ADMISSION PHYSICAL EXAM: \n=======================\nVS: T98 BP 143/66 HR 60 RR 14 100% RA \nGENERAL: WDWN female in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\nNECK: Supple with no JVD \nCARDIAC: PMI located intercostal space, midclavicular line. RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. No chest wall ttp.\nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: well healing scab on left knee. \nPULSES: 1+ DP pulses.\n", + "input6": "ADMISSION LABS: \n==============\n___ 05:00PM GLUCOSE-258* UREA N-13 CREAT-0.9 SODIUM-136 POTASSIUM-4.3 CHLORIDE-100 TOTAL CO2-23 ANION GAP-17\n___ 05:00PM estGFR-Using this\n___ 05:00PM cTropnT-<0.01\n___ 05:00PM CALCIUM-9.2 PHOSPHATE-3.8 MAGNESIUM-2.0\n___ 05:00PM WBC-7.2 RBC-4.03 HGB-12.4 HCT-38.3 MCV-95 MCH-30.8 MCHC-32.4 RDW-13.1 RDWSD-45.8\n___ 05:00PM NEUTS-66.0 MONOS-9.1 EOS-1.4 BASOS-1.0 AbsNeut-4.78 AbsLymp-1.61 AbsMono-0.66 AbsEos-0.10 AbsBaso-0.07\n___ 05:00PM PLT COUNT-298\n___ 05:00PM PTT-36.2\n\nIMAGING/STUDIES: \n================\n# CXR ___\nLungs are clear without focal consolidation. No pleural effusion or pneumothorax is seen. Cardiac and mediastinal silhouettes are stable. The mediastinum is not widened.\n\n# CORONARY ANGIOGRAM ___:\nCoronary Anatomy\nDominance: Right\nThe LMCA had no angiographically apparent CAD. The LAD had mild luminal irregularities unchanged from prior. The Cx had no significant disease. The RCA had no significant stenosis with widely patent stents.\n\n# TTE ___:\nThe left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is ___ mmHg. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with focal apical hypokinesis (clip 2). The remaining segments contract normally (LVEF >= 60 %). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/12445879-DS-18.json b/Finished/Acute Coronary Syndrome/UA/12445879-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..c4bba68c88b697c913690ccea96ce43ce163aa55 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/12445879-DS-18.json @@ -0,0 +1,120 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "Prior to this, his chest pain would only be provoked by significant exertion (i.e. climbing 5 flights of walks), but recently he has began to experience chest pain at shorter distances. T$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "hypertension, hyperlipidemia and recent LHC are risk facts$Cause_1": { + "He is a 70 y.o. male with ESRD on dialysis (3x/week, hypertension, hyperlipidemia and recent LHC$Input2": {} + }, + "Obesity is a risk fact$Cause_1": { + "Obesity$Input3": {} + }, + "Dylipidemia is a risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "CKD is a risk fact$Cause_1": { + "CKD$Input3": {} + }, + "Family history is a risk fact$Cause_1": { + "Father and uncles who had MIs at older age$Input4": {} + }, + "Family history is a risk fact.$Cause_1": { + "mother \nwith DM$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "# Coronaries: known 90% stenosis of OM1 of the LCx by ___ prior \nto admission, now with increasing angina\n- DES to OM1 of the LCx\n- Plavix loaded, followed with 75 mg daily\n- continued Metoprolol Succinate 50 mg daily, increased ASA to \n325 mg daily, increased stating to 80 mg daily\n- follow up with Dr. ___ discharge\n.\n# ESRD: dialysis normally scheduled for ___, \n___\n- dialysis held on ___ of admission for following day \npost-catheterization\n- continue follow up with Nephrologist\n.\n# Hypertension: hypertensive on admission (SBPs>200)\n- continued home anti-hypertensives (Metoprolol Succinate 50 mg \ndaily, Nifedipine CR 30 mg daily, Prazosin 5 mg daily)\n- given Nitropaste on admission, followed by Hydralazine 25 mg \nPO q6 hours PRN for blood pressure controll\n \nMedications on Admission:\nAllopurinol ___ mg daily\nSynthroid ___ mcg daily\nLovastatin 20 mg daily\nToprol XL 50 mg daily\nNifedipine ER 30 mg daily\nPrazosin 5 mg daily\nASA 81 mg daily\nSensipar 60 mg daily\nRenal Caps 800 mg TID with meals \n \nDischarge Medications:\nAllopurinol ___ mg daily\nSynthroid ___ mcg daily\nAtorvastatin 80 mg daily\nToprol XL 50 mg daily\nNifedipine ER 30 mg daily\nPrazosin 5 mg daily\nASA 325 mg daily\nSensipar 60 mg daily\nRenal Caps 800 mg TID with meals \nPlavix 75 mg daily\n \nDischarge Disposition:\nHome\n \nDischarge Diagnosis:\nunstable angina\n\n \nDischarge Condition:\nMental Status: Clear and coherent.\nLevel of Consciousness: Alert and interactive.\nActivity Status: Ambulatory - Independent.\n\n \nDischarge Instructions:\nMr. ___,\nIt was a pleasure to take part in your care during your \nhospitalization at the ___. You were admitted for chest pain \nand for a cardiac catheterization to place a stent in your \ncoronary arteries. It is important that after leaving the \nhospital you remember the following:\n1) Please take your cardiac medications as prescribed by your \ncardiologist and during this hospitalization. These include: \nAtorvastatin 80 mg daily, Aspirin 325 mg daily, Plavix 75 mg \ndaily, Metoprolol (Succinate) 50 mg daily, Nifedipine CR 30 mg \ndaily and Prazosin 5 mg daily. We have increased your \nAtorvastatin dose to 80 mg and increased your Aspirin to 325 mg \ndaily. You have also started Plavix.\n2) Please continue to take your renal medications and restart \nyour normal dialysis schedule per your Nephrologist.\n3) Please follow up with your cardiologist as listed below. \n \nFollowup Instructions:\n___$Cause_1": { + "known 90% stenosis of OM1 of the LCx by ___ prior \nto admission, now with increasing angina\n- DES to OM1 of the LCx\n- Plavix loaded, followed with 75 mg daily\n- continued Metoprolol Succinate 50 mg daily, increased ASA to \n325 mg daily, increased stating to 80 mg daily\n- follow up with Dr. ___ discharge$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "hypertension, hyperlipidemia and recent LHC are risk facts$Cause_1": { + "He is a 70 y.o. male with ESRD on dialysis (3x/week, hypertension, hyperlipidemia and recent LHC$Input2": {} + }, + "Obesity is a risk fact$Cause_1": { + "Obesity$Input3": {} + }, + "Dylipidemia is a risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "CKD is a risk fact$Cause_1": { + "CKD$Input3": {} + }, + "Family history is a risk fact$Cause_1": { + "Father and uncles who had MIs at older age$Input4": {} + }, + "Family history is a risk fact.$Cause_1": { + "mother \nwith DM$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "hypertension, hyperlipidemia and recent LHC are risk facts$Cause_1": { + "He is a 70 y.o. male with ESRD on dialysis (3x/week, hypertension, hyperlipidemia and recent LHC$Input2": {} + }, + "Obesity is a risk fact$Cause_1": { + "Obesity$Input3": {} + }, + "Dylipidemia is a risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "CKD is a risk fact$Cause_1": { + "CKD$Input3": {} + }, + "Family history is a risk fact$Cause_1": { + "Father and uncles who had MIs at older age$Input4": {} + }, + "Family history is a risk fact.$Cause_1": { + "mother \nwith DM$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "# Coronaries: known 90% stenosis of OM1 of the LCx by ___ prior \nto admission, now with increasing angina\n- DES to OM1 of the LCx\n- Plavix loaded, followed with 75 mg daily\n- continued Metoprolol Succinate 50 mg daily, increased ASA to \n325 mg daily, increased stating to 80 mg daily\n- follow up with Dr. ___ discharge\n.\n# ESRD: dialysis normally scheduled for ___, \n___\n- dialysis held on ___ of admission for following day \npost-catheterization\n- continue follow up with Nephrologist\n.\n# Hypertension: hypertensive on admission (SBPs>200)\n- continued home anti-hypertensives (Metoprolol Succinate 50 mg \ndaily, Nifedipine CR 30 mg daily, Prazosin 5 mg daily)\n- given Nitropaste on admission, followed by Hydralazine 25 mg \nPO q6 hours PRN for blood pressure controll\n \nMedications on Admission:\nAllopurinol ___ mg daily\nSynthroid ___ mcg daily\nLovastatin 20 mg daily\nToprol XL 50 mg daily\nNifedipine ER 30 mg daily\nPrazosin 5 mg daily\nASA 81 mg daily\nSensipar 60 mg daily\nRenal Caps 800 mg TID with meals \n \nDischarge Medications:\nAllopurinol ___ mg daily\nSynthroid ___ mcg daily\nAtorvastatin 80 mg daily\nToprol XL 50 mg daily\nNifedipine ER 30 mg daily\nPrazosin 5 mg daily\nASA 325 mg daily\nSensipar 60 mg daily\nRenal Caps 800 mg TID with meals \nPlavix 75 mg daily\n \nDischarge Disposition:\nHome\n \nDischarge Diagnosis:\nunstable angina\n\n \nDischarge Condition:\nMental Status: Clear and coherent.\nLevel of Consciousness: Alert and interactive.\nActivity Status: Ambulatory - Independent.\n\n \nDischarge Instructions:\nMr. ___,\nIt was a pleasure to take part in your care during your \nhospitalization at the ___. You were admitted for chest pain \nand for a cardiac catheterization to place a stent in your \ncoronary arteries. It is important that after leaving the \nhospital you remember the following:\n1) Please take your cardiac medications as prescribed by your \ncardiologist and during this hospitalization. These include: \nAtorvastatin 80 mg daily, Aspirin 325 mg daily, Plavix 75 mg \ndaily, Metoprolol (Succinate) 50 mg daily, Nifedipine CR 30 mg \ndaily and Prazosin 5 mg daily. We have increased your \nAtorvastatin dose to 80 mg and increased your Aspirin to 325 mg \ndaily. You have also started Plavix.\n2) Please continue to take your renal medications and restart \nyour normal dialysis schedule per your Nephrologist.\n3) Please follow up with your cardiologist as listed below. \n \nFollowup Instructions:\n___$Cause_1": { + "known 90% stenosis of OM1 of the LCx by ___ prior \nto admission, now with increasing angina\n- DES to OM1 of the LCx\n- Plavix loaded, followed with 75 mg daily\n- continued Metoprolol Succinate 50 mg daily, increased ASA to \n325 mg daily, increased stating to 80 mg daily\n- follow up with Dr. ___ discharge$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "hypertension, hyperlipidemia and recent LHC are risk facts$Cause_1": { + "He is a 70 y.o. male with ESRD on dialysis (3x/week, hypertension, hyperlipidemia and recent LHC$Input2": {} + }, + "Obesity is a risk fact$Cause_1": { + "Obesity$Input3": {} + }, + "Dylipidemia is a risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "CKD is a risk fact$Cause_1": { + "CKD$Input3": {} + }, + "Family history is a risk fact$Cause_1": { + "Father and uncles who had MIs at older age$Input4": {} + }, + "Family history is a risk fact.$Cause_1": { + "mother \nwith DM$Input4": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "He is a 70 y.o. male with ESRD on dialysis (3x/week, hypertension, hyperlipidemia and recent LHC showing 90% stenosis of OM1 of the LCx who presents from home for elective PCI with a history of exertional angina and one episode of angina at rest. He is preparing for kidney transplant and is being evaluated for cardiac clearance. He first presented to Dr. with a history of exertional angina. He had a prior ETT that showed a mild, reversible inferior wall defect. Dr. a diagnostic LHC that was performed . At catheterization, he was found to have a 90% stenosis of OM1 of the LCx, with no significant lesions found in the LAD or RCA. The procedure was complicated by hematoma in the right groin, precluding PCI at the time of catheterization. He was scheduled for elective PCI in a few weeks, but the morning of admission contacted Dr. office with complaints of chest pain at rest and was asked to come for PCI.\n.\nIn interviewing, he describes his chest pain as a substernal pain that is not sharp, but also not described as a pressure. Prior to this, his chest pain would only be provoked by significant exertion (i.e. climbing 5 flights of walks), but recently he has began to experience chest pain at shorter distances. The night prior to admission he experienced an episode of substernal chest pain while lying in bed at rest. His chest pain is not associated with any radition, numbness or tingling. He does not complain of shortness of breath, light headedness or palpitations at the time of the chest pain. Additionaly, he has no nausea or abdominal discomfort associated with his chest pain.\n", + "input3": "+Dyslipidemia\n+Hypertension\n+CKD\n+Gout \n+Secondary \n+hyperparathyroidism\n+Obesity\n", + "input4": "Father and uncles who had MIs at older age (___), mother \nwith DM\n", + "input5": "\n", + "input6": "Coronaries: known 90% stenosis of OM1 of the LCx by ___ prior \nto admission, now with increasing angina\n- DES to OM1 of the LCx\n- Plavix loaded, followed with 75 mg daily\n- continued Metoprolol Succinate 50 mg daily, increased ASA to \n325 mg daily, increased stating to 80 mg daily\n- follow up with Dr. ___ discharge\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/12789116-DS-11.json b/Finished/Acute Coronary Syndrome/UA/12789116-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..05e5984ce1190d1c1eab1ed0db1191e6d7af35f1 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/12789116-DS-11.json @@ -0,0 +1,60 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "At that tim walking 10 minutes on a treadmill (normally can walk >1 mile) and developed substernal, nonradiating chest pressure and shortness of breath$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pressure is a symptom of ACS$Cause_1": { + "chest pressure$Input1": {} + }, + "HTN, DM, HLD, hypothyroidism are risk fact$Cause_1": { + "Male with HTN, DM, HLD, hypothyroidism$Input2": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "Imaging changes of lungs can be a sign of acs$Cause_1": { + "FINDINGS: The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion or pneumothorax. There are mild degenerative changes at the lower thoracic spine. \nIMPRESSION: No acute process.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pressure is a symptom of ACS$Cause_1": { + "chest pressure$Input1": {} + }, + "HTN, DM, HLD, hypothyroidism are risk fact$Cause_1": { + "Male with HTN, DM, HLD, hypothyroidism$Input2": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pressure is a symptom of ACS$Cause_1": { + "chest pressure$Input1": {} + }, + "HTN, DM, HLD, hypothyroidism are risk fact$Cause_1": { + "Male with HTN, DM, HLD, hypothyroidism$Input2": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "Imaging changes of lungs can be a sign of acs$Cause_1": { + "FINDINGS: The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion or pneumothorax. There are mild degenerative changes at the lower thoracic spine. \nIMPRESSION: No acute process.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "chest pressure is a symptom of ACS$Cause_1": { + "chest pressure$Input1": {} + }, + "HTN, DM, HLD, hypothyroidism are risk fact$Cause_1": { + "Male with HTN, DM, HLD, hypothyroidism$Input2": {} + } + } + } + } + }, + "input1": "chest pressure\n", + "input2": "Male with HTN, DM, HLD, hypothyroidism who presents with intermittent chest pressure x4 days duration. \n\nThe patient was in his usual state of health until 4 days prior to presentation. At that time he was walking 10 minutes on a treadmill (normally can walk >1 mile) and developed substernal, nonradiating chest pressure and shortness of breath. He denies nausea, vomiting or diaphoresis. The chest pressure went away after minutes of rest. The patient now feels chest pressure anytime he walks any distance or lifts any object. It always resolves with rest. \n. \nHe presented to EW with initial vitals of: Pain 5, T 97.8, HR 79, BP 155/75, RR 16, SaO2 98% RA. He was given ASA and SL NTG with relief of pain. His creatinine is elevated from baseline to 1.5 and his troponin was elevated as well. The EW started heparin gtt for ACS. EKG without any ischemic changes. The patient was admitted to cardiology service for further evaluation. \n\nCurrently, he denies any symptoms and feels well. \n\nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. \n\nCardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "+Hypertension \n+Diabetes mellitus \n+Hyperlipidemia \n+Hypothyroidism \n+Asthma\n", + "input4": "Noncontributory.\n", + "input5": "VS: 97.7 123/66 72 98% 2L \nGENERAL: Alert, appropriate, no acute distress. \nHEENT: Sclera anicteric. PERRL, EOMI. MMM. \nNECK: Supple. Low JVD \nCARDIAC: RR, nl rate, no m/r/g. \nLUNGS: CTAB, no crackles, wheezes, rhonchi. \nABDOMEN: Soft, NTND. \nEXTREMITIES: Warm. No c/c/e. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.\n", + "input6": "Admission Labs:\n___ 08:55PM BLOOD WBC-6.9 RBC-4.08* Hgb-13.1* Hct-37.5* MCV-92 MCH-32.2* MCHC-35.0 RDW-12.4 Plt ___\n___ 08:55PM BLOOD Neuts-49.4* ___ Monos-10.6 Eos-4.0 Baso-1.1\n___ 08:55PM BLOOD ___ PTT-23.0 ___\n___ 08:55PM BLOOD Glucose-217* UreaN-39* Creat-1.5* Na-138 K-4.2 Cl-101 HCO3-27 AnGap-14\n___ 08:55PM BLOOD cTropnT-0.09*\n___ 08:55PM BLOOD CK-MB-5\n\nDischarge Labs:\n___ 03:15AM BLOOD WBC-7.9 RBC-3.82* Hgb-12.3* Hct-34.8* MCV-91 MCH-32.3* MCHC-35.5* RDW-12.8 Plt ___\n___ 03:15AM BLOOD Glucose-141* UreaN-37* Creat-1.2 Na-140 K-4.1 Cl-104 HCO3-26 AnGap-14\n___ 03:15AM BLOOD CK-MB-4 cTropnT-0.11*\n___ 03:15AM BLOOD Calcium-8.3* Phos-3.8 Mg-2.3\n\nCXR ___\nCOMPARISON: Chest radiograph\nFINDINGS: The lungs are clear, the cardiomediastinal silhouette and hila are normal. There is no pleural effusion or pneumothorax. There are mild degenerative changes at the lower thoracic spine. \nIMPRESSION: No acute process.\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/12924595-DS-15.json b/Finished/Acute Coronary Syndrome/UA/12924595-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..8db6175ed71ee09a53ad6d963b94d925de325cf7 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/12924595-DS-15.json @@ -0,0 +1,60 @@ +{ + "UA$Intermedia_5": { + "in-stent stenosis of RCA is a sign of acs$Cause_1": { + "Significant in-stent stenosis of RCA but good collaterals Left circumflex with 80% lesions;$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain and pressure is a sign of acs$Cause_1": { + "Chest pain and pressure$Input1": {} + }, + "vessel disease and DM are risk facts$Cause_1": { + "Female with h/o known 1 vessel disease; s/p DES to RCA x 2, -TnI <0.01 x 3), poorly controlled diabetes$Input2": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "she reports she woke up with. Describes pain as \"pulling sensation\" on L side of chest, lasts a few seconds, does not radiate and in intensity. Reports feels similar to initial presenting cardiac sxs but not as intense. She reports nausea, palpitations, dizziness, chills, dyspnea on exertion, and presyncope.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain and pressure is a sign of acs$Cause_1": { + "Chest pain and pressure$Input1": {} + }, + "vessel disease and DM are risk facts$Cause_1": { + "Female with h/o known 1 vessel disease; s/p DES to RCA x 2, -TnI <0.01 x 3), poorly controlled diabetes$Input2": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain and pressure is a sign of acs$Cause_1": { + "Chest pain and pressure$Input1": {} + }, + "vessel disease and DM are risk facts$Cause_1": { + "Female with h/o known 1 vessel disease; s/p DES to RCA x 2, -TnI <0.01 x 3), poorly controlled diabetes$Input2": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "she reports she woke up with. Describes pain as \"pulling sensation\" on L side of chest, lasts a few seconds, does not radiate and in intensity. Reports feels similar to initial presenting cardiac sxs but not as intense. She reports nausea, palpitations, dizziness, chills, dyspnea on exertion, and presyncope.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain and pressure is a sign of acs$Cause_1": { + "Chest pain and pressure$Input1": {} + }, + "vessel disease and DM are risk facts$Cause_1": { + "Female with h/o known 1 vessel disease; s/p DES to RCA x 2, -TnI <0.01 x 3), poorly controlled diabetes$Input2": {} + } + } + } + } + }, + "input1": "Chest pain and pressure\n", + "input2": "Female with h/o known 1 vessel disease; s/p DES to RCA x 2, -TnI <0.01 x 3), poorly controlled diabetes p/w intermittent chest pain since 6 am, which she reports she woke up with. Describes pain as \"pulling sensation\" on L side of chest, lasts a few seconds, does not radiate and in intensity. Reports feels similar to initial presenting cardiac sxs but not as intense. She reports nausea, palpitations, dizziness, chills, dyspnea on exertion, and presyncope. Denies vomiting, SOB, F, sick contact, cough symptoms, acid reflux, trauma. However, she has been nauseaus and feeling fatigued for the past few days and a bit short of breath yesterday. \n\nShe was admitted to where she has had her cardiac care. She was admitted for atypical chest pain at that time - ruled out for MI with serial enzymes. ETT was also negative for ischemia.\n", + "input3": "+Type 1 Diabetes\n+1 vessel disease; s/p DES to RCA x 2 ___ -TnI <0.01 x 3)\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "Admission Exam:\n\nVS: Wt= 62.3 T= 98.4 BP=115/71 HR= 81 RR= 18 O2 sat= 99%\nGeneral: NAD\nHEENT: PERRL, EOMI\nNeck: No JVD, no LAD\nCV: RRR, no m/r/g appreciated\nLungs: CTAB\nAbdomen: Diffuse tenderness, no guarding; no hepatosplenomegaly \nappreciated; NABS\nExt: No edema/cyanosis/clubbing\nNeuro: Grossly intact\nSkin: No rashes, lesions appreciated\nPULSES: 2+ DP\n", + "input6": "___ 09:33PM cTropnT-<0.01\n___ 04:30PM URINE HOURS-RANDOM\n___ 04:30PM URINE UHOLD-HOLD\n___ 04:30PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 04:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-1000 KETONE-40 BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 LEUK-NEG\n___ 03:16PM GLUCOSE-76 UREA N-7 CREAT-0.7 SODIUM-139 POTASSIUM-4.7 CHLORIDE-101 TOTAL CO2-27 ANION GAP-16\n___ 03:16PM estGFR-Using this\n___ 03:16PM cTropnT-<0.01\n___ 03:16PM WBC-10.4 RBC-5.02 HGB-15.0 HCT-44.5 MCV-89 MCH-30.0 MCHC-33.8 RDW-12.8\n___ 03:16PM NEUTS-52 BANDS-0 ___ MONOS-5 EOS-1 BASOS-1 ___ MYELOS-0\n___ 03:16PM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL\n___ 03:16PM PLT SMR-NORMAL PLT COUNT-312\n___ 09:10AM BLOOD WBC-6.2 RBC-4.37 Hgb-13.0 Hct-37.9 MCV-87 MCH-29.9 MCHC-34.4 RDW-12.8 Plt ___\n___ 09:10AM BLOOD Plt ___\n___ 09:10AM BLOOD Glucose-214* UreaN-8 Creat-0.6 Na-137 K-4.2 Cl-101 HCO3-28 AnGap-12\n___ 12:45PM BLOOD cTropnT-<0.01\n___ 05:55AM BLOOD cTropnT-<0.01\n___ 12:30AM BLOOD cTropnT-<0.01\n___ 06:35PM BLOOD cTropnT-<0.01\n___ 03:55AM BLOOD cTropnT-<0.01\n___ 09:15AM BLOOD cTropnT-<0.01\n___ 09:33PM BLOOD cTropnT-<0.01\n___ 09:10AM BLOOD Calcium-8.8 Phos-2.8 Mg-1.5*\n___ 09:20AM BLOOD %HbA1c-9.0* eAG-212*\n___ 04:50AM BLOOD Triglyc-103 HDL-56 CHOL/HD-2.8 LDLcalc-78 LDLmeas-83\n\nStudies:\n\nSignificant in-stent stenosis of RCA but good collaterals Left circumflex with 80% lesions; s/p 1 DES to mid-circumflexGiven 600mg plavix TR band at radial and angioseal at right groin Will need chronic aspirin and plavix for year. \n\n\n___ CXR: \nThe heart is normal in size. The mediastinal and hilar contours appear within normal limits. There is no pleural effusion or pneumothorax. The lungs appear clear. Bony structures appear within normal limits. \n \n___ ECHO:\n\nFindings \nLEFT ATRIUM: Normal LA and RA cavity sizes. \n\nLEFT VENTRICLE: Normal LV wall thickness, cavity size, and regional/global systolic function (biplane LVEF>55%). Estimated cardiac index is normal (>=2.5L/min/m2). Transmitral Doppler E>A and TDI E/e' <8 suggesting normal diastolic function, and normal LV filling pressure (PCWP<12mmHg). \n\nRIGHT VENTRICLE: Normal RV chamber size and free wall motion. \n\nAORTA: Normal diameter of aorta at the sinus, ascending and arch levels. \n\nAORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR. \n\nMITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP. Normal mitral valve supporting structures.\n\n___ VALVE: Normal tricuspid valve leaflets with trivial \nTR. Normal PA systolic pressure. \n\nPERICARDIUM: No pericardial effusion. \nConclusions \n The left atrium and right atrium are normal in cavity size. Normal left ventricular wall thickness, cavity size, and regional/global systolic function (biplane LVEF = 60 %). The estimated cardiac index is normal (>=2.5L/min/m2). Transmitral and tissue Doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (PCWP<12mmHg). 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) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \n\nIMPRESSION: Normal biventricular regional/global systolic \nfunction. Normal left ventricular diastolic function with normal \nleft ventricular enddiastolic pressure.\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/13000968-DS-9.json b/Finished/Acute Coronary Syndrome/UA/13000968-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..5f2c35fbdec043220acae47a787ce7a4d641543e --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/13000968-DS-9.json @@ -0,0 +1,96 @@ +{ + "UA$Intermedia_5": { + "symptom of acs-ua$Cause_1": { + "He experienced two episodes of SSCP radiating to the left arm that were responsive to NTG.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "CAD history is a risk fact$Cause_1": { + "She is a 68 y/o male with a complex CAD history$Input2": {} + }, + "HTN is a risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HL is a risk fact$Cause_1": { + "HL$Input3": {} + }, + "family history is a risk fact$Cause_1": { + "Many family members with CAD in his father side.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "ECG changes are symbol of acs$Cause_1": { + "ECG - Sinus rhythm. Prior inferior myocardial infarction. Compared to the previous tracing of the rate has slowed. The inferior lead Q waves are more prominent. The anterolateral ST-T wave abnormalities have improved. There is now ST segment flattening and depression in leads I, aVL and V5-V6 and the rate has slowed.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "CAD history is a risk fact$Cause_1": { + "She is a 68 y/o male with a complex CAD history$Input2": {} + }, + "HTN is a risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HL is a risk fact$Cause_1": { + "HL$Input3": {} + }, + "family history is a risk fact$Cause_1": { + "Many family members with CAD in his father side.$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "CAD history is a risk fact$Cause_1": { + "She is a 68 y/o male with a complex CAD history$Input2": {} + }, + "HTN is a risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HL is a risk fact$Cause_1": { + "HL$Input3": {} + }, + "family history is a risk fact$Cause_1": { + "Many family members with CAD in his father side.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "ECG changes are symbol of acs$Cause_1": { + "ECG - Sinus rhythm. Prior inferior myocardial infarction. Compared to the previous tracing of the rate has slowed. The inferior lead Q waves are more prominent. The anterolateral ST-T wave abnormalities have improved. There is now ST segment flattening and depression in leads I, aVL and V5-V6 and the rate has slowed.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "CAD history is a risk fact$Cause_1": { + "She is a 68 y/o male with a complex CAD history$Input2": {} + }, + "HTN is a risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HL is a risk fact$Cause_1": { + "HL$Input3": {} + }, + "family history is a risk fact$Cause_1": { + "Many family members with CAD in his father side.$Input4": {} + } + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "She is a 68 y/o male with a complex CAD history including CABG (LIMA to Diag, SVG to OM1, SVG to PDA) and re-do CABG (radial to LAD and diagonal and repeat SVG to LCx and rPDA) with stress testing last showing a severe fixed inferoapical defect with an EF of 60% who is admitted from home due to a 10-day h/o exertional chest pain now ocurring at rest.\n.\nThe patient was scheduled to undergo outpatient cardiac cath. He experienced two episodes of SSCP radiating to the left arm that were responsive to NTG. The patient called Dr. suggested direct admit for observation pending cardiac cath in AM.\n\nThe patient describes his CP as mostly exertional over the past 10 days. Says that prior to two weeks ago he was able to walk blocks but now cannot walk more than 100 feet without the onset of CP. Has been progressively worsening with the worse symptoms over this past weekend. Denies SOB or leg swelling. Rare palpitations that self terminate.\n\nOn admission the patient's VS were 94.9 114/87 67 18 97%RA. He denied any active CP, palp or SOB. Felt generally well.\n", + "input3": "+ HTN\n+ HL\n+ Vertigo\n+ GERD\n+ Basal Cell CA \n+ Depression \n+ Right Hip Bursitis\n", + "input4": "Many family members with CAD in his father side. He is an only child. Mother had ALS.\n", + "input5": "Vital Signs - 94.9 114/87 67 18 97%RA\nGeneral - Patient appears well and is in NAD\nHEENT - PERRLA, EOMI, anicteric, MMM, OP clear\nCV - RRR, S1 and S2, no m/r/g\nLung - Mild bibasilar crackles, otherwise good air entry\nAbdomen - Soft, NT/ND, BSx4\nExtremities - No edema\nNeuro - Awake, alert and oriented. Moving all extremities. CN II-XII grossly intact.\n", + "input6": "Labs:\n___ 11:55AM BLOOD WBC-8.3 RBC-4.77 Hgb-13.3* Hct-42.1 MCV-88 MCH-27.9 MCHC-31.6 RDW-13.1 Plt ___\n___ 11:55AM BLOOD ___\n___ 11:55AM BLOOD UreaN-13 Creat-1.1 Na-137 K-4.2 Cl-101 HCO3-24 AnGap-16\n___ 12:45PM BLOOD Calcium-9.7 Phos-3.7 Mg-1.8\n___ 12:45PM BLOOD CK(CPK)-139\n___ 12:45PM BLOOD CK-MB-3 cTropnT-<0.01\n\nStudies:\n\nECG - Sinus rhythm. Prior inferior myocardial infarction. Compared to the previous tracing of the rate has slowed. The inferior lead Q waves are more prominent. The anterolateral ST-T wave abnormalities have improved. There is now ST segment flattening and depression in leads I, aVL and V5-V6 and the rate has slowed.non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/13136218-DS-5.json b/Finished/Acute Coronary Syndrome/UA/13136218-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..17e92d96d3e0b3f42d80c06a3703b9d0275d0f68 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/13136218-DS-5.json @@ -0,0 +1,108 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "she started to feel badly as if she was in a 'fog' and was lightheaded.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "lightheadedness is a symptom of ACS$Cause_1": { + "lightheadedness$Input1": {} + }, + "PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, are risk factors of acs$Cause_1": { + "69 yo F with PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, macular degeneration admitted for lightheadedness.$Input2": {} + }, + "HTN is a risk fact$Cause_1": { + "HTN$Input3": {} + }, + "MI s/p PCI with stent placement, repeat PCI with stenting is a risk factor$Cause_1": { + "MI s/p PCI with stent placement, repeat PCI with stenting$Input3": {} + }, + "Hyperlipidemia is a risk fact$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Glaucoma is a risk fact$Cause_1": { + "Glaucoma$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "can strongly suspected ACS$Cause_1": { + "IMPRESSION: \n1. Bilateral, left greater than right, bibasilar linear atelectases. No focal consolidation or pleural effusion. \n2. Diffuse osteopenia. Apparent multi-level vertebral body wedge$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "lightheadedness is a symptom of ACS$Cause_1": { + "lightheadedness$Input1": {} + }, + "PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, are risk factors of acs$Cause_1": { + "69 yo F with PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, macular degeneration admitted for lightheadedness.$Input2": {} + }, + "HTN is a risk fact$Cause_1": { + "HTN$Input3": {} + }, + "MI s/p PCI with stent placement, repeat PCI with stenting is a risk factor$Cause_1": { + "MI s/p PCI with stent placement, repeat PCI with stenting$Input3": {} + }, + "Hyperlipidemia is a risk fact$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Glaucoma is a risk fact$Cause_1": { + "Glaucoma$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of c$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "lightheadedness is a symptom of ACS$Cause_1": { + "lightheadedness$Input1": {} + }, + "PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, are risk factors of acs$Cause_1": { + "69 yo F with PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, macular degeneration admitted for lightheadedness.$Input2": {} + }, + "HTN is a risk fact$Cause_1": { + "HTN$Input3": {} + }, + "MI s/p PCI with stent placement, repeat PCI with stenting is a risk factor$Cause_1": { + "MI s/p PCI with stent placement, repeat PCI with stenting$Input3": {} + }, + "Hyperlipidemia is a risk fact$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Glaucoma is a risk fact$Cause_1": { + "Glaucoma$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "can strongly suspected ACS$Cause_1": { + "IMPRESSION: \n1. Bilateral, left greater than right, bibasilar linear atelectases. No focal consolidation or pleural effusion. \n2. Diffuse osteopenia. Apparent multi-level vertebral body wedge$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "lightheadedness is a symptom of ACS$Cause_1": { + "lightheadedness$Input1": {} + }, + "PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, are risk factors of acs$Cause_1": { + "69 yo F with PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, macular degeneration admitted for lightheadedness.$Input2": {} + }, + "HTN is a risk fact$Cause_1": { + "HTN$Input3": {} + }, + "MI s/p PCI with stent placement, repeat PCI with stenting is a risk factor$Cause_1": { + "MI s/p PCI with stent placement, repeat PCI with stenting$Input3": {} + }, + "Hyperlipidemia is a risk fact$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Glaucoma is a risk fact$Cause_1": { + "Glaucoma$Input3": {} + } + } + } + } + }, + "input1": "lightheadedness\n", + "input2": "69 yo F with PMH CAD s/p MI and stenting, HTN, hyperlipidemia, glaucoma, macular degeneration admitted for lightheadedness. \n\nPatient reports that earlier this afternoon while playing scrabble she started to feel badly as if she was in a 'fog' and was lightheaded. At that time, she did not have CP, SOB, HA, blurred vision or N/V. 911 was called and she was brought to where she received ASA, SL NG x1 with resolution of her symptoms. EKG was unchanged. Patient was placed on heparin gtt and transferred here for further management. Per records, patient had a positive PMIBI in anterior wall distrubution this week.\n\nIn the ED here VS: 97.9 60 146/70 17 97%2L. Repeat CE were negative. EKG unchanged from prior. CXR without acute process per my read. \n\nROS: Currently denies fevers, weight loss, weight gain, chest pain, shortness of breath, DOE, PND, orthopnea, abdominal pain, nausea, vomiting, hematemesis, constipation, BRBPR, change in bowel or bladder habits, dysuria, hematuria, lower extremity edema.\n", + "input3": "+MI s/p PCI with stent placement, repeat PCI with stenting \n+HTN \n+Hyperlipidemia \n+Glaucoma \n+Macular Degeneration\n", + "input4": "NC\n", + "input5": "Vitals T:97.1 BP:153/89 HR:65 RR:18 98% on RA \nGnl: NAD, Alert and oriented x 3 \nHEENT: PERRLA, Anicteric, MMM, no JVD \nCV: regular rate, loud s2, SEM at RUSB \nResp: Clear to auscultation bilaterally, No wheezes or crackles \nAbd: obese, +bs, soft, nontender, mo hepatosplenomegaly \nExtremities: No cyanosis, clubbing or edema \nskin/nails: no rashes/no jaundice/no splinters \nNeuro: AAOx3. Cn II-XII intact. ___ strength throughout. No sensory deficits to light touch appreciated. 2+DTR's-patellar and biceps. gait not assessed \nRectal: not done\n", + "input6": "Labs on admission:\n\n___ 08:10PM GLUCOSE-102 UREA N-14 CREAT-0.8 SODIUM-144 POTASSIUM-3.7 CHLORIDE-110* TOTAL CO2-22 ANION GAP-16\n___ 08:10PM WBC-6.0 RBC-4.40 HGB-13.3 HCT-40.1 MCV-91 MCH-30.3 MCHC-33.3 RDW-13.5\n___ 08:10PM NEUTS-47.7* LYMPHS-42.1* MONOS-5.1 EOS-4.5* BASOS-0.6\n___ 08:10PM PLT COUNT-197\n\nCardiac enzymes:\n___ set negative at OSH)\n___ 06:15AM BLOOD CK(CPK)-88\n___ 06:15AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 08:10PM BLOOD CK(CPK)-96\n___ 08:10PM BLOOD cTropnT-<0.01\n\nCXR: \nIMPRESSION: \n1. Bilateral, left greater than right, bibasilar linear atelectases. No focal consolidation or pleural effusion. \n2. Diffuse osteopenia. Apparent multi-level vertebral body wedge\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14167883-DS-17.json b/Finished/Acute Coronary Syndrome/UA/14167883-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..3a05e60ffbf717f893bdc2fe68fa7eb7d8bdc1fa --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14167883-DS-17.json @@ -0,0 +1,99 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "Pt reports that initially had pain previously with associated palpitations and SOB. Then two weeks prior to this presentation developed left sided chest pain with walking and SOB that improved with rest. As these symptoms recurred.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "obesity, HTN and HLP are risk facts$Cause_1": { + "hx of obesity, HTN and HLP presented on day prior to admission with chest pain and EKG changes to her PCP's office.$Input2": {} + }, + "+ HLP is risk fact$Cause_1": { + "+ HLP$Input3": {} + }, + "subclinical hypothyroidism is risk fact$Cause_1": { + "subclinical hypothyroidism$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "The stress echo showed new regional wall motion abnormalities with severe hypokinesis of the mid- and distal segments of the anterior wall, septum concerning for mid LAD territory.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "obesity, HTN and HLP are risk facts$Cause_1": { + "hx of obesity, HTN and HLP presented on day prior to admission with chest pain and EKG changes to her PCP's office.$Input2": {} + }, + "+ HLP is risk fact$Cause_1": { + "+ HLP$Input3": {} + }, + "subclinical hypothyroidism is risk fact$Cause_1": { + "subclinical hypothyroidism$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG in the ED showed Sinus rhythm, left axis deviation, normal intervals, TWI in R, V1-13 with poor R wave progression in the precordial leads.$Input2": {} + }, + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "Poor functional capacity. No anginal type symptoms \nor ischemic EKG changes.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "obesity, HTN and HLP are risk facts$Cause_1": { + "hx of obesity, HTN and HLP presented on day prior to admission with chest pain and EKG changes to her PCP's office.$Input2": {} + }, + "+ HLP is risk fact$Cause_1": { + "+ HLP$Input3": {} + }, + "subclinical hypothyroidism is risk fact$Cause_1": { + "subclinical hypothyroidism$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "The stress echo showed new regional wall motion abnormalities with severe hypokinesis of the mid- and distal segments of the anterior wall, septum concerning for mid LAD territory.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "obesity, HTN and HLP are risk facts$Cause_1": { + "hx of obesity, HTN and HLP presented on day prior to admission with chest pain and EKG changes to her PCP's office.$Input2": {} + }, + "+ HLP is risk fact$Cause_1": { + "+ HLP$Input3": {} + }, + "subclinical hypothyroidism is risk fact$Cause_1": { + "subclinical hypothyroidism$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "w/ hx of obesity, HTN and HLP presented on day prior to admission with chest pain and EKG changes to her PCP's office. Pt reports that initially had pain previously with associated palpitations and SOB. Then two weeks prior to this presentation developed left sided chest pain with walking and SOB that improved with rest. As these symptoms recurred. she presented to her PCP's office where she was complaining of CP. EKG performed in the office showed new anterior lateral T-wave inversions. She received an aspirin and was transferred \nto the ED for further evaluation. In the ED, initial VS were 98.2 74 140/61 16 97% RA. EKG in the ED showed Sinus rhythm, left axis deviation, normal intervals, TWI in R, V1-13 with poor R wave progression in the precordial leads. No Q waves for ST changes. She was admitted to the observation unit and received 2 sets of cardiac enzymes that were negative and a stress echo on the morning of admission. The stress echo showed new regional wall motion abnormalities with severe hypokinesis of the mid- and distal segments of the anterior wall, septum concerning for mid LAD territory. Her last VS in the observatin unit were: 76 142/64 18 98% RA. On arrival tot he floor patient denies any chest pain or pressure. No palpitations, No headache. She denies any orthopnea, shortness of breath, orthopnea, peripheral edema, syncope. She denies any claudication\n", + "input3": "+ HLP \n+ subclinical hypothyroidism \n+ HTN \n+ s/p right total knee replacement \n+ asthma\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "Admission exam\nGeneral: Well appearing white female in NAD, sitting up in bed comfortably \nNeck: no elevated JVP \nCV: RRR, no MRG appreicated \nLungs: CTAB no wheezes or rales \nAbdomen: Obese, soft, nontender, nondistende \nGU: no foley \nExt: no peripheral edema \nSkin: no visible lesions\n", + "input6": "Labs\n06:35PM BLOOD WBC-8.4 RBC-4.58 Hgb-14.4 Hct-42.5 MCV-93 MCH-31.4 MCHC-33.8 RDW-12.0\n06:35PM BLOOD Neuts-66.0 Monos-6.2 Eos-2.0 Baso-0.9\n12:30PM BLOOD Glucose-91 UreaN-19 Creat-0.8 Na-138 K-4.3 Cl-102 HCO3-23 AnGap-17\n12:30PM BLOOD cTropnT-<0.01\n06:35PM BLOOD cTropnT-<0.01\n12:40PM URINE Color-Straw Appear-Clear\n12:40PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n\ufeff\nMicro:\n12:40 pm URINE\n\ufeff\n**FINAL REPORT\n\ufeff\nURINE CULTURE (<10,000 organisms/ml. \nCXR: IMPRESSION: No acute cardiopulmonary abnormality. \nStress test: INTERPRETATION: This woman with h/o HLD, obesity, and asthma was referred to the lab from the ED following negative serial cardiac enzymes for evaluation of chest discomfort and abnormal EKG. The patient exercised for 5 minutes of a Modified protocol and was stopped for fatigue. The estimated peak MET capacity was 3.8, which represents a poor exercise tolerance for her age. There were no reports of chest, back, neck, or arm discomforts during the study. Dyspnea was noted throughout exercise which improved during recovery. There were no significant ST segment changes noted during exercise or early recovery. After 3 minutes of recovery, the facility lost power and EKGs were not acquired for the remainder of the study. Rhythm was sinus with occasional isolated VPBs and rare isolated APBs. The heart rate response was appropriate during exercise and recovery. Mild resting hypertension with an appropriate blood pressure response to exercise. \nIMPRESSION: Poor functional capacity. No anginal type symptoms \nor ischemic EKG changes. Mild resting hypertension. Echo report sent separately. \nThe patient exercised for 5 minutes and 0 seconds according to a \nModified treadmill protocol METS) reaching a peak heart rate of 139 bpm and a peak blood pressure of 206/82 mmHg. \nThe test was stopped because of fatigue. This level of exercise represents a poor exercise tolerance for age. In response to stress, the ECG showed no diagnostic ST-T wave changes (see exercise report for details). There is resting hypertension. There were normal blood pressure and heart rate responses to stress. \nResting images were acquired at a heart rate of 74 bpm and a blood pressure of 150/90 mmHg. These demonstrated normal regional and global left ventricular systolic function. Right ventricular free wall motion is normal. There is no pericardial effusion. Doppler demonstrated no aortic stenosis, aortic regurgitation or significant mitral regurgitation or resting LVOT gradient. \nEcho images were acquired within 45 seconds after peak stress at heart rates of 136 - 116 bpm. These demonstrated new regional dysfunction with severe hypokinesis of the mid- and distal segments of the anterior wall, septum as the apex (mid-LAD territory). The remaining segments augment appropriately. There was augmentation of right ventricular free wall motion. \n\ufeff\nIMPRESSION: Poor functional exercise capacity. Non-diagnostic ECG changes. 2D echocardiographic evidence of inducible ishemia in the LAD territory at achieved workload. Resting hypertension.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14207519-DS-22.json b/Finished/Acute Coronary Syndrome/UA/14207519-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..0af6bc77aaaeda773b62e5dd7dae472a20fb0475 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14207519-DS-22.json @@ -0,0 +1,96 @@ +{ + "UA$Intermedia_5": { + "her cardiologist Dr. This morning at 03:30 she awoke suddenly from sleep with pain in her left arm, shoulder, neck, and jaw and significant diaphoresis. \nShe felt very nauseated and vomited. She then sat down, took 2 full-strength Aspirin,\n are sign of acs-ua$Cause_1": { + "her cardiologist Dr. This morning at 03:30 she awoke suddenly from sleep with pain in her left arm, shoulder, neck, and jaw and significant diaphoresis. \nShe felt very nauseated and vomited. She then sat down, took 2 full-strength Aspirin,$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "history of NSTEMI is risk fact of acs$Cause_1": { + "with history of NSTEMI (cath'ed at hospital which showed RCA lesion that was medically managed)$Input2": {} + }, + "dyslipidemia Is risk fact of acs$Cause_1": { + "dyslipidemia$Input3": {} + }, + "family history:Dad had MI requiring CABG is a risk fact$Cause_1": { + "Dad had MI requiring CABG$Input4": {} + }, + "family history:Aunt dropped dead from MI is a risk fact$Cause_1": { + "Aunt dropped dead from MI$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "PERCUTANEOUS CORONARY INTERVENTIONS: catheterization done in the past with suspected blockage in small branch off RCA$Input3": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "history of NSTEMI is risk fact of acs$Cause_1": { + "with history of NSTEMI (cath'ed at hospital which showed RCA lesion that was medically managed)$Input2": {} + }, + "dyslipidemia Is risk fact of acs$Cause_1": { + "dyslipidemia$Input3": {} + }, + "family history:Dad had MI requiring CABG is a risk fact$Cause_1": { + "Dad had MI requiring CABG$Input4": {} + }, + "family history:Aunt dropped dead from MI is a risk fact$Cause_1": { + "Aunt dropped dead from MI$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "EKG: SR, normal rate, no ST elevations$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "history of NSTEMI is risk fact of acs$Cause_1": { + "with history of NSTEMI (cath'ed at hospital which showed RCA lesion that was medically managed)$Input2": {} + }, + "dyslipidemia Is risk fact of acs$Cause_1": { + "dyslipidemia$Input3": {} + }, + "family history:Dad had MI requiring CABG is a risk fact$Cause_1": { + "Dad had MI requiring CABG$Input4": {} + }, + "family history:Aunt dropped dead from MI is a risk fact$Cause_1": { + "Aunt dropped dead from MI$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "PERCUTANEOUS CORONARY INTERVENTIONS: catheterization done in the past with suspected blockage in small branch off RCA$Input3": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "chest pain$Input1": {} + }, + "history of NSTEMI is risk fact of acs$Cause_1": { + "with history of NSTEMI (cath'ed at hospital which showed RCA lesion that was medically managed)$Input2": {} + }, + "dyslipidemia Is risk fact of acs$Cause_1": { + "dyslipidemia$Input3": {} + }, + "family history:Dad had MI requiring CABG is a risk fact$Cause_1": { + "Dad had MI requiring CABG$Input4": {} + }, + "family history:Aunt dropped dead from MI is a risk fact$Cause_1": { + "Aunt dropped dead from MI$Input4": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "Mrs. White with history of NSTEMI (cath'ed at hospital which showed RCA lesion that was medically managed) who presents from home today after calling her cardiologist Dr. This morning at 03:30 she awoke suddenly from sleep with pain in her left arm, shoulder, neck, and jaw and significant diaphoresis. \nShe felt very nauseated and vomited. She then sat down, took 2 full-strength Aspirin, and the episode resolved after about 15 minutes. She then went back to sleep. She called her cardiologist who advised her to come to the hospital. This is very similar to the episode that happened back.\n\ufeff\nIn the ED initial vitals were: 98.8 72 131/71 18 98% RA And she was given SL nitro x 1\nEKG: SR, normal rate, no ST elevations\nLabs/studies notable for: negative troponin\nVitals on transfer: 72 116/60 18 99% RA \nOn the floor she is overall comfortable but still endorses a very mild vague discomfort in her upper chest. Denies diaphoresis, nausea, vomiting, dysuria, myalgias, arthralgias.\n\ufeff\nROS: A complete and thorough review of systems was obtained and is otherwise negative.\n", + "input3": "+ dyslipidemia\n+ CABG: None\n+ PERCUTANEOUS CORONARY INTERVENTIONS: catheterization done in the past with suspected blockage in small branch off RCA\n+ PACING/ICD: None\n", + "input4": "Dad had MI requiring CABG\nAunt dropped dead from MI\n", + "input5": "Admission Physical Exam:\nVS: 98.1 117/75 87 16 97RA Wt 80.6kg\nGENERAL: well-appearing woman in NAD\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.\nNECK: Supple with JVP of 5 cm.\nCARDIAC: PMI located intercostal space, midclavicular line. RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts.\nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi.\nABDOMEN: Soft, NTND. No HSM or tenderness.\nEXTREMITIES: No c/c/e. No femoral bruits.\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.\nPULSES: Distal pulses palpable and symmetric\n", + "input6": "Admission Labs:\n01:05PM BLOOD WBC-7.6 RBC-4.54 Hgb-14.3 Hct-43.5 MCV-96 MCH-31.5 MCHC-32.9 RDW-12.9 RDWSD-45.4\n01:05PM BLOOD Neuts-66.0 Monos-9.5 Eos-2.8 \nBaso-0.5 AbsNeut-5.02 AbsLymp-1.56 AbsMono-0.72 \nAbsEos-0.21 AbsBaso-0.04\n01:05PM BLOOD Glucose-84 UreaN-22* Creat-0.9 Na-139 K-4.8 Cl-102 HCO3-30 AnGap-12\n01:05PM BLOOD Calcium-9.8 Phos-3.7 Mg-2.1\n\ufeff\nPertinent Labs:\n01:05PM BLOOD cTropnT-<0.01\n09:40PM BLOOD CK-MB-3 cTropnT-<0.01\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14301754-DS-15.json b/Finished/Acute Coronary Syndrome/UA/14301754-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..1f74127454ea6f5ce584b632d40cbed9f258887e --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14301754-DS-15.json @@ -0,0 +1,156 @@ +{ + "UA$Intermedia_5": { + "Patient states that he has had pain in his chest, bilateral lower biceps, and between his shoulder blades which he says is worsened with exertion and relieved by rest for past 2 weeks. are sign ofa acs-ua$Cause_1": { + "Patient states that he has had pain in his chest, bilateral lower biceps, and between his shoulder blades which he says is worsened with exertion and relieved by rest for past 2 weeks.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "history of HTN, HLD, PVD, tobacco are risk facts of acs$Cause_1": { + "He is a gentleman with history of HTN, HLD, PVD, tobacco use presenting with two weeks of intermittent chest pain worsened with exertion.$Input2": {} + }, + "hypertension is risk fact$Cause_1": { + "hypertension$Input3": {} + }, + "dyslipidemia is risk fact$Cause_1": { + "dyslipidemia$Input3": {} + }, + "ALCOHOL ABUSE is risk fact$Cause_1": { + "ALCOHOL ABUSE$Input3": {} + }, + "HYPERLIPIDEMIA is risk fact$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "HYPERTENSION is risk fact$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "family history:Father with MI at died of MI.\n is a risk fact$Cause_1": { + "Father with MI at died of MI.$Input4": {} + }, + "family history:Paternal aunts with cardiovascular disease. is a risk fact$Cause_1": { + "Paternal aunts with cardiovascular disease.$Input4": {} + }, + "family history:Paternal grandmother with cardiovascular is a risk fact$Cause_1": { + "Paternal grandmother with cardiovascular$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts.$Input5": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "history of HTN, HLD, PVD, tobacco are risk facts of acs$Cause_1": { + "He is a gentleman with history of HTN, HLD, PVD, tobacco use presenting with two weeks of intermittent chest pain worsened with exertion.$Input2": {} + }, + "hypertension is risk fact$Cause_1": { + "hypertension$Input3": {} + }, + "dyslipidemia is risk fact$Cause_1": { + "dyslipidemia$Input3": {} + }, + "ALCOHOL ABUSE is risk fact$Cause_1": { + "ALCOHOL ABUSE$Input3": {} + }, + "HYPERLIPIDEMIA is risk fact$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "HYPERTENSION is risk fact$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "family history:Father with MI at died of MI.\n is a risk fact$Cause_1": { + "Father with MI at died of MI.$Input4": {} + }, + "family history:Paternal aunts with cardiovascular disease. is a risk fact$Cause_1": { + "Paternal aunts with cardiovascular disease.$Input4": {} + }, + "family history:Paternal grandmother with cardiovascular is a risk fact$Cause_1": { + "Paternal grandmother with cardiovascular$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "ECG:non-ST-elevation.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "history of HTN, HLD, PVD, tobacco are risk facts of acs$Cause_1": { + "He is a gentleman with history of HTN, HLD, PVD, tobacco use presenting with two weeks of intermittent chest pain worsened with exertion.$Input2": {} + }, + "hypertension is risk fact$Cause_1": { + "hypertension$Input3": {} + }, + "dyslipidemia is risk fact$Cause_1": { + "dyslipidemia$Input3": {} + }, + "ALCOHOL ABUSE is risk fact$Cause_1": { + "ALCOHOL ABUSE$Input3": {} + }, + "HYPERLIPIDEMIA is risk fact$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "HYPERTENSION is risk fact$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "family history:Father with MI at died of MI.\n is a risk fact$Cause_1": { + "Father with MI at died of MI.$Input4": {} + }, + "family history:Paternal aunts with cardiovascular disease. is a risk fact$Cause_1": { + "Paternal aunts with cardiovascular disease.$Input4": {} + }, + "family history:Paternal grandmother with cardiovascular is a risk fact$Cause_1": { + "Paternal grandmother with cardiovascular$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts.$Input5": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest Pain$Input1": {} + }, + "history of HTN, HLD, PVD, tobacco are risk facts of acs$Cause_1": { + "He is a gentleman with history of HTN, HLD, PVD, tobacco use presenting with two weeks of intermittent chest pain worsened with exertion.$Input2": {} + }, + "hypertension is risk fact$Cause_1": { + "hypertension$Input3": {} + }, + "dyslipidemia is risk fact$Cause_1": { + "dyslipidemia$Input3": {} + }, + "ALCOHOL ABUSE is risk fact$Cause_1": { + "ALCOHOL ABUSE$Input3": {} + }, + "HYPERLIPIDEMIA is risk fact$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "HYPERTENSION is risk fact$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "family history:Father with MI at died of MI.\n is a risk fact$Cause_1": { + "Father with MI at died of MI.$Input4": {} + }, + "family history:Paternal aunts with cardiovascular disease. is a risk fact$Cause_1": { + "Paternal aunts with cardiovascular disease.$Input4": {} + }, + "family history:Paternal grandmother with cardiovascular is a risk fact$Cause_1": { + "Paternal grandmother with cardiovascular$Input4": {} + } + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "He is a gentleman with history of HTN, HLD, PVD, tobacco use presenting with two weeks of intermittent chest pain worsened with exertion. \n\ufeff\nPatient states that he has had pain in his chest, bilateral lower biceps, and between his shoulder blades which he says is worsened with exertion and relieved by rest for past 2 weeks. He is concerned that this represents angina given his risk factors and family history of cardiovascular disease. He describes the chest pain as a pressure. He denies any DOE or SOB at rest, he has occasional sweating but denies that it correlates with his chest pain. \n\ufeff\nHe states that he is very active at work. He also reports a chronic cough but otherwise has no acute complaints. \n\ufeff\nIn the ED initial vitals were: \n98.5 82 129/84 18 99% RA \nExam notable for: Comfortable, Heart: RRR no m/r/g, Chest: Unable to reproduce chest pain with palpation, Back: Tenderness to paraspinal musculature in the upper back, Lungs: CTAB, no w/r/c, Ext: No c/c/e EKG: sinus 75, NA, NI, no STE, STD \nLabs/studies notable for: CBC normal, trop <0.01 x 2, Cr 1.1, K 7.4 grossly hemolyzed, green top K 4.1 \nCXR: No acute cardiopulmonary abnormality. No displaced rib fractures are seen. \n\ufeff\nPatient was given: \nASA 243 mg \nPlan was 2 sets of trops and stress however unable to obtain to interpreter so admitted for further workup of chest pain, pMIBI.\n\ufeff\nVitals on transfer: \n98.7 73 105/67 16 94% RA \n\ufeff\nOn the floor patient is feeling well and very grateful for the care he has been receiving. He denies any current chest pain, shortness of breath. He reports chronic low back pain and has received injections for this in the past. No lower extremity weakness or paresthesias, no incontinence of urine or stool.\n", + "input3": "+ hypertension\n+ dyslipidemia \n+ PVD \n+ ALCOHOL ABUSE \n+ H PYLORI \n+ HERPES ZOSTER \n+ HYPERLIPIDEMIA \n+ HYPERTENSION \n+ PEPTIC ULCER DISEASE \n+ PERIPHERAL VASCULAR DISEASE \n+ TOBACCO ABUSE \n+ BACK PAIN \n+ COLONIC POLYPS \n+ LUNG NODULE\n", + "input4": "Father with MI at died of MI. Paternal aunts with cardiovascular disease. Paternal grandmother with cardiovascular\n", + "input5": "ADMISSION PHYSICAL EXAM:\n=========================\nVS: 98.2 137/30 90 18 985 on RA \nweight 92.4kg \nGENERAL: WDWN very pleasant middle aged gentleman in NAD. \nOriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\ufeff\nNECK: Supple with no JVD. \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nBACK: lower back with paraspinal muscle tenderness, no midline tenderness \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: Distal pulses palpable and symmetric\n", + "input6": "12:45PM BLOOD WBC-5.0 RBC-4.73 Hgb-14.7 Hct-43.7 MCV-92 \nMCH-31.1 MCHC-33.6 RDW-12.9 RDWSD-43.0\n12:45PM BLOOD Neuts-55.5 Monos-7.0 Eos-3.2 \nBaso-0.2 AbsNeut-2.77 AbsLymp-1.69 AbsMono-0.35 \nAbsEos-0.16 AbsBaso-0.01\n12:45PM BLOOD Glucose-98 UreaN-14 Creat-1.1 Na-135 \nK-7.1* Cl-101 HCO3-23 AnGap-18\n06:50PM BLOOD cTropnT-<0.01\n12:45PM BLOOD cTropnT-<0.01\n07:45AM BLOOD Calcium-9.1 Phos-4.2 Mg-2.1\n03:16PM BLOOD K-4.1\n\nECG:non-ST-elevation.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14511469-DS-8.json b/Finished/Acute Coronary Syndrome/UA/14511469-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..9b4d4407ee2f8df2a181f93f9addf7507c752e89 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14511469-DS-8.json @@ -0,0 +1,96 @@ +{ + "UA$Intermedia_5": { + "diffuse, pressure, across his chest, radiating to both arms and neck, and associated with diaphoresis are sign of acs-ua$Cause_1": { + "His pain began around 10pm yesterday after eating fish for dinner and was diffuse, pressure, across his chest, radiating to both arms and neck, and associated with diaphoresis.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain. can be a sign of acs$Cause_1": { + "a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain.$Input2": {} + }, + "Hypertension is risk fact$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Diabetes mellitus, type 2 is risk fact$Cause_1": { + "Diabetes mellitus, type 2$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities: The LAD was occluded at the ostium with distal vessels filled on significant disease. The LCx was subtotally occluded at its ostiim. The\nRCA had 80% mid-vessel disease.\n is a sign of acs$Cause_1": { + "The LAD was occluded at the ostium with distal vessels filled on significant disease. The LCx was subtotally occluded at its ostiim. The\nRCA had 80% mid-vessel disease.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain. can be a sign of acs$Cause_1": { + "a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain.$Input2": {} + }, + "Hypertension is risk fact$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Diabetes mellitus, type 2 is risk fact$Cause_1": { + "Diabetes mellitus, type 2$Input3": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "ECG showed sinus rhythm without STTW changes. CXR showed no acute process.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain. can be a sign of acs$Cause_1": { + "a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain.$Input2": {} + }, + "Hypertension is risk fact$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Diabetes mellitus, type 2 is risk fact$Cause_1": { + "Diabetes mellitus, type 2$Input3": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities: The LAD was occluded at the ostium with distal vessels filled on significant disease. The LCx was subtotally occluded at its ostiim. The\nRCA had 80% mid-vessel disease.\n is a sign of acs$Cause_1": { + "The LAD was occluded at the ostium with distal vessels filled on significant disease. The LCx was subtotally occluded at its ostiim. The\nRCA had 80% mid-vessel disease.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain. can be a sign of acs$Cause_1": { + "a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain.$Input2": {} + }, + "Hypertension is risk fact$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Diabetes mellitus, type 2 is risk fact$Cause_1": { + "Diabetes mellitus, type 2$Input3": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "with a history of diabetes, hypertension, CAD with CABG, and known occlusion of SVGs as part of CTA research study presents with chest pain. Of note, he was scheduled for elective catheterization today.\n\ufeff\nHis pain began around 10pm yesterday after eating fish for dinner and was diffuse, pressure, across his chest, radiating to both arms and neck, and associated with diaphoresis. There was no SOB, N/V. He took 1 NTG and called EMS. After his second NTG his pain improved significantly. He was also given an aspirin. He is currently pain free. \n\ufeff\nHe does not generally experience exertional chest pain but beginning about two weeks ago he began to experience chest pain while on his treadmill and improving with rest. He had not required any NTGs.\n\ufeff\nPer documentation, he had onset of pressure across his anterior chest occurring at rest and was taken by EMS. Apparently, his chest symptoms resolved after having been given additional aspirin in about one hour. He has no recall having been given nitroglycerin. In the ED, ECG was reported as normal and troponin slightly elevated to 0.133 (top normal at 0.045). \nD-dimer was negative. Renal function was normal. Because of the elevated troponin, he was advised to have immediate cardiac catheterization, but signed out against advice and came to see \nDr. at his regularly scheduled appointment.\n \nIn the ED, initial vitals were 76 128/65 16 100% RA. Labs notable for chem 7 wnl, Hgb 13.1, plt 149, trop <0.01. ECG showed sinus rhythm without STTW changes. CXR showed no acute process. \n\ufeff\nSeen by cardiology who recommended admission and cardiac cath in the AM.\n\ufeff\nCurrently, he reports feeling well and denies chest pain. He has no complaints.\n\ufeff\nROS positive for 3 pillow orthopnea which has been stable \"for years\"\n\ufeff\nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional extremity pain. All of the other review of systems were negative. \n \nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "+ Hypertension\n+ Dyslipidemia\n+ Diabetes mellitus, type 2\n+ Diabetic neuropathy\n+ BPH\n+ Hemorrhoids\n+ Colon cancer s/p resection and chemotherapy\n+ Cataracts s/p excision\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "VS: T 97.8 BP 115/67 HR 62 RR 12 SaO2 99% on RA\nGENERAL: Well appearing man speaking on the phone but also fluent.\nHEENT: EOMI, MMM\nNECK: JVP ~7cm H2O\nCARDIAC: RRR, no m/r/g\nLUNGS: CTAB\nABDOMEN: Soft, nontender, healed surgical scar.\nEXTREMITIES: Nonedematous, warm, well perfused\nSKIN: No rashes\nPULSES: \nRight: 2+ DP \nLeft: 2+ DP\n", + "input6": "01:15AM BLOOD WBC-5.3 RBC-4.29* Hgb-13.1* Hct-37.3* MCV-87 MCH-30.5 MCHC-35.1* RDW-13.5\n06:20AM BLOOD WBC-8.4# RBC-4.35* Hgb-12.7* Hct-37.8* MCV-87 MCH-29.2 MCHC-33.6 RDW-13.5\n06:20AM BLOOD Glucose-83 UreaN-15 Creat-0.8 Na-141 K-4.3 Cl-103 HCO3-29 AnGap-13\n01:15AM BLOOD cTropnT-<0.01\n11:00AM BLOOD cTropnT-<0.01\n07:55PM BLOOD cTropnT-<0.01\n06:20AM BLOOD cTropnT-0.03*\n\ufeff\nCARDIAC CATH\n1. Selective coronary angiography of this right dominant system demonstrated a LMCA with a common ostium for the LAD and LCx. \nThe LAD was occluded at the ostium with distal vessels filled on significant disease. The LCx was subtotally occluded at its ostiim. The\nRCA had 80% mid-vessel disease.\n2. Arterial conduit angiography demonstrated patent LIMA to LAD.\n3. Venous conduit angiogrpahy was not performed due to known occluded saphenous venous grafts.\n4. Limited resting hemodynamics revealed normal central aortic blood pressures.\n5. Successful PCI of mid RCA with Resolute 2.25 X 22mm DES with reduction in stenosis from 80% to 0%.\n6. Successful PCI of LM/proximal LCX with 3 overlapping DESs with reduction in stenosis from 99% to 0%.\n7. Adequate hemostasis was obtained at the right femoral arteriotomy\nsite.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14512858-DS-5.json b/Finished/Acute Coronary Syndrome/UA/14512858-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..93a1a39d0729863b1768cc5d8e4c572a1bc248c7 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14512858-DS-5.json @@ -0,0 +1,132 @@ +{ + "UA$Intermedia_5": { + "At baseline she is able to climb flights of stair before getting short of breath however for the past 2 days she has been having chest discomfort at rest which is new and minimal shortness of breath at rest or with minimal exertion.\n can be a sign of acs-ua$Cause_1": { + "At baseline she is able to climb flights of stair before getting short of breath however for the past 2 days she has been having chest discomfort at rest which is new and minimal shortness of breath at rest or with minimal exertion.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain\uff0c shortness of breath is a symptom of ACS$Cause_1": { + "chest pain, shortness of breath$Input1": {} + }, + "Family fistory:Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms.\n can be a risk fact of acs$Cause_1": { + "Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms.$Input2": {} + }, + "istory of stable angina and had stress test which showed likely inferior ischemia on stress TTE.\n is a risk fact of acs$Cause_1": { + "Patient has history of stable angina and had stress test which showed likely inferior ischemia on stress TTE.$Input2": {} + }, + "Diabetes is risk fact$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is risk fact$Cause_1": { + "Hypertension$Input3": {} + }, + "CORONARY ARTERY DISEASE is risk fact$Cause_1": { + "CORONARY ARTERY DISEASE$Input3": {} + }, + "Family fistory:CAD in both parents can be a risk fact of acs$Cause_1": { + "CAD in both parents$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities:is a sign of acs$Cause_1": { + "Change for 6 XB LAD 3.0; The lesion was crossed with Prowater wire and predilated with 2.5 x 15 balloon at ATM. A 2.5 x 28 mm Promus Element drug-eluting was deployed to cover the mid lesion at 12 ATM and was post-dilated with 3.0 x 15 NC ballon at ATM and then 3.25 x 9 NC balloon at ATM.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain\uff0c shortness of breath is a symptom of ACS$Cause_1": { + "chest pain, shortness of breath$Input1": {} + }, + "Family fistory:Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms.\n can be a risk fact of acs$Cause_1": { + "Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms.$Input2": {} + }, + "istory of stable angina and had stress test which showed likely inferior ischemia on stress TTE.\n is a risk fact of acs$Cause_1": { + "Patient has history of stable angina and had stress test which showed likely inferior ischemia on stress TTE.$Input2": {} + }, + "Diabetes is risk fact$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is risk fact$Cause_1": { + "Hypertension$Input3": {} + }, + "CORONARY ARTERY DISEASE is risk fact$Cause_1": { + "CORONARY ARTERY DISEASE$Input3": {} + }, + "Family fistory:CAD in both parents can be a risk fact of acs$Cause_1": { + "CAD in both parents$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain\uff0c shortness of breath is a symptom of ACS$Cause_1": { + "chest pain, shortness of breath$Input1": {} + }, + "Family fistory:Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms.\n can be a risk fact of acs$Cause_1": { + "Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms.$Input2": {} + }, + "istory of stable angina and had stress test which showed likely inferior ischemia on stress TTE.\n is a risk fact of acs$Cause_1": { + "Patient has history of stable angina and had stress test which showed likely inferior ischemia on stress TTE.$Input2": {} + }, + "Diabetes is risk fact$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is risk fact$Cause_1": { + "Hypertension$Input3": {} + }, + "CORONARY ARTERY DISEASE is risk fact$Cause_1": { + "CORONARY ARTERY DISEASE$Input3": {} + }, + "Family fistory:CAD in both parents can be a risk fact of acs$Cause_1": { + "CAD in both parents$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities:is a sign of acs$Cause_1": { + "Change for 6 XB LAD 3.0; The lesion was crossed with Prowater wire and predilated with 2.5 x 15 balloon at ATM. A 2.5 x 28 mm Promus Element drug-eluting was deployed to cover the mid lesion at 12 ATM and was post-dilated with 3.0 x 15 NC ballon at ATM and then 3.25 x 9 NC balloon at ATM.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain\uff0c shortness of breath is a symptom of ACS$Cause_1": { + "chest pain, shortness of breath$Input1": {} + }, + "Family fistory:Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms.\n can be a risk fact of acs$Cause_1": { + "Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms.$Input2": {} + }, + "istory of stable angina and had stress test which showed likely inferior ischemia on stress TTE.\n is a risk fact of acs$Cause_1": { + "Patient has history of stable angina and had stress test which showed likely inferior ischemia on stress TTE.$Input2": {} + }, + "Diabetes is risk fact$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is risk fact$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is risk fact$Cause_1": { + "Hypertension$Input3": {} + }, + "CORONARY ARTERY DISEASE is risk fact$Cause_1": { + "CORONARY ARTERY DISEASE$Input3": {} + }, + "Family fistory:CAD in both parents can be a risk fact of acs$Cause_1": { + "CAD in both parents$Input4": {} + } + } + } + } + }, + "input1": "chest pain, shortness of breath\n", + "input2": "Sister is a woman with history of hypertension, CAD who was sent from Dr. for cardiac cath for worsening anginal symptoms. Patient has history of stable angina and had stress test which showed likely inferior ischemia on stress TTE. Patient opted out for minimal medical management. At baseline she is able to climb flights of stair before getting short of breath however for the past 2 days she has been having chest discomfort at rest which is new and minimal shortness of breath at rest or with minimal exertion. She declines any nausea, vomiting, diaphoresis, lightheadedness, palpitations. She also denies any orthopnea, PND or peripheral edema. \n\ufeff\nShe was urgently seen by Dr. transfered patient to center department for cath to evalaute her right RCA lesion.\n", + "input3": "+ Diabetes\n+ Dyslipidemia\n+ Hypertension \n+ CORONARY ARTERY DISEASE \n+ Osteoarthritis \n+ Hx of Cararacts\n", + "input4": "CAD in both parents\n", + "input5": "VS: 97.7 160/77 61 99%RA \nGENERAL: Well appearing Oriented x3 \nHEENT: Sclera anicteric. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. \nNECK: Supple with flat JVD\nCARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness\nEXTREMITIES: No c/c/e. Warm and well pefused.\n", + "input6": "Pertinent Labs:\n02:45PM BLOOD WBC-5.1 RBC-4.42 Hgb-14.1 Hct-43.0 MCV-97 MCH-31.8 MCHC-32.7 RDW-13.1\n02:45PM BLOOD UreaN-16 Creat-0.9 Na-141 K-3.5 Cl-102\n02:45PM BLOOD CK-MB-4 cTropnT-<0.01\n08:00PM BLOOD cTropnT-<0.01\n05:50AM BLOOD cTropnT-<0.01\n\ufeff\nCardiac Catheterization & Endovascular Procedure Report Interventional details\nChange for 6 XB LAD 3.0; The lesion was crossed with Prowater wire and predilated with 2.5 x 15 balloon at ATM. A 2.5 x 28 mm Promus Element drug-eluting was deployed to cover the mid lesion at 12 ATM and was post-dilated with 3.0 x 15 NC ballon at ATM and then 3.25 x 9 NC balloon at ATM.\nThe proximal lesion was directly stented with 3.0 x 12 Promus Element drug-eluting, leaving a 6-8 mm gap of unstented normal appearing vessel. This was post-dilated with the 3.25 x 9 NC balloon at 14 ATM. Final angiography showed 10% residual in proximal segment of mid, no dissection and TIMI 3 flow.\n\ufeff\nPotential for Radiation Injury\nThis patient underwent a procedure performed under fluoroscopic (X-ray) guidance. Procedures involving lengthy exposures to X-rays may cause damage to the skin and/or hair. These adverse effects may be increased if one has had previous (especially recent) radiation exposure to the same skin area. Radiation injury to the skin can take many forms, including an area of redness, blistering, hair loss, or ulceration. These effects may appear after a few weeks or even after several months. If an of these occur on the side and back of the torso (or elsewhere), please contact the Interventional Cardiology Section to arrange further evaluation.\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14876183-DS-3.json b/Finished/Acute Coronary Syndrome/UA/14876183-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..52e6e4925120c9f004b52e91cb1b4a690ec1f0aa --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14876183-DS-3.json @@ -0,0 +1,87 @@ +{ + "UA$Intermedia_5": { + "Severe chest pain is symbol of ACS-UA$Cause_1": { + "He is a pleasant male who was previously healthy who is admitted after a positive stress test.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "Coronary calcification seen on chest CT is risk fact$Cause_1": { + "Coronary calcification seen on chest CT$Input3": {} + }, + "family history:Father: Died of MI is a risk fact$Cause_1": { + "Father: Died of MI$Input4": {} + }, + "family history:Mother: Died of pancreatic cancer\n is a risk fact$Cause_1": { + "Mother: Died of pancreatic cancer$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "He thus underwent a nuclear stress on hospital which revealed a reversible defect in the mid-LAD region.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "Coronary calcification seen on chest CT is risk fact$Cause_1": { + "Coronary calcification seen on chest CT$Input3": {} + }, + "family history:Father: Died of MI is a risk fact$Cause_1": { + "Father: Died of MI$Input4": {} + }, + "family history:Mother: Died of pancreatic cancer\n is a risk fact$Cause_1": { + "Mother: Died of pancreatic cancer$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "- ECG showed sinus bradycaria, STE in V4 (1 mm), sub-mm in V5,$Input2": {} + }, + "without ischemic ECG chages is a sign of NSTE-ACS$Cause_1": { + "and ruled out for MI. He subsequently underwent an exercise ECG stress on hospital where he reached stage and experienced chest discomfort but was without ischemic ECG chages.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "Coronary calcification seen on chest CT is risk fact$Cause_1": { + "Coronary calcification seen on chest CT$Input3": {} + }, + "family history:Father: Died of MI is a risk fact$Cause_1": { + "Father: Died of MI$Input4": {} + }, + "family history:Mother: Died of pancreatic cancer\n is a risk fact$Cause_1": { + "Mother: Died of pancreatic cancer$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "He thus underwent a nuclear stress on hospital which revealed a reversible defect in the mid-LAD region.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "Coronary calcification seen on chest CT is risk fact$Cause_1": { + "Coronary calcification seen on chest CT$Input3": {} + }, + "family history:Father: Died of MI is a risk fact$Cause_1": { + "Father: Died of MI$Input4": {} + }, + "family history:Mother: Died of pancreatic cancer\n is a risk fact$Cause_1": { + "Mother: Died of pancreatic cancer$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "He is a man seen at hospital where he ruled out for an MI. He had a nuclear stress test that showed mid-LAD ischemia and since has been having chest pain. He has been started on heparin and will go for cath tomorrow.\nHe is a pleasant male who was previously healthy who is admitted after a positive stress test. He was in his usual state of excellent health (avid daily long-distance biker), until someday when he began to experience exertional chest pain. Per report, he thus presented certain symptoms and ruled out for MI. He subsequently underwent an exercise ECG stress on hospital where he reached stage and experienced chest discomfort but was without ischemic ECG chages. He thus underwent a nuclear stress on hospital which revealed a reversible defect in the mid-LAD region. He continued to experience low grade chest discomfort for several hours after his MIBI and his cardiologist asked him to go to check. His cardiologist recommended \"1. Admit to Cardiology Service -- Dr., attending of record.\n2. Start on heparin.\n3. Heart rates slow, would defer beta-blocker therapy. Aspirin 325 mg already given.\n4. NPO. after midnight for planned cardiac catheterization.\n5. Rule out protocol -- emergent cath if elevated troponin's today. He has already eaten and suspect stable for cath\"Of note, approximately two weeks ago, the patient reports some blood on his toilet paper. He thinks it was hemorrhoids. In the ED, initial vitals were 1 98.0 51 140/82 16 98% RA\n- Labs were notable for WBC 4.5, Hgb 16, Plt 145, Na 143, K 4.2, Cl 103, HCO3 31, BUN 22, Cr 0.8, trop <0.01 (15:50)\n- ECG showed sinus bradycaria, STE in V4 (1 mm), sub-mm in V5, \nappear similar to ECG from today thought to be early repolarization changes\n- He started on a heparin gtt Prior to transfer vitals were 0 98.0 56 114/69 14 97% On arrival to the floor, He reports feeling generally well but has some ongoing chest pressure.\n", + "input3": "+ Seasonal allergies\n+ Asthma\n+ Pulmonary nodule\n+ Coronary calcification seen on chest CT\n", + "input4": "- Father: Died of MI\n- Mother: Died of pancreatic cancer\n- Siblings: Sister is smoker but healthy\n", + "input5": "ADMISSION:\nVS: T 98 BP 128/92 HR 58 RR 16 SaO2 98% on RA\nGeneral: Well appearing fit man in no apparent distress\nHEENT: EOMI, MMM\nNeck: No JVD\nCV: Bradycardic, no m/r/g\nLungs: CTAB\nAbdomen: Soft, nontender, nondistended\nRectal: Normal rectal tone. Brown stool in vault. FOBT negative.\nExt: 3+ radial pulses, 3+ femoral pulses\n", + "input6": "03:50PM PLT COUNT-145*\n03:50PM NEUTS-66.3 MONOS-4.9 EOS-3.0 BASOS-1.2\n03:50PM WBC-4.5 RBC-5.41 HGB-16.2 HCT-47.7 MCV-88 MCH-30.0 MCHC-34.1 RDW-13.2\n03:50PM cTropnT-<0.01\n03:50PM GLUCOSE-96 UREA N-22* CREAT-0.8 SODIUM-143 POTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-31 ANION GAP-13\n06:55PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-NEG\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14879291-DS-16.json b/Finished/Acute Coronary Syndrome/UA/14879291-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..31f4cf57e1f7d4d60bd85b9bb894f4b52179cecb --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14879291-DS-16.json @@ -0,0 +1,96 @@ +{ + "UA$Intermedia_5": { + "chest pressure at rest, SOB with minimal exertion are signs of acs-ua$Cause_1": { + "chest pressure at rest, SOB with minimal exertion$Input1": {} + }, + "Suspected ACS$Intermedia_2": { + "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.\nare risk facts of acs$Cause_1": { + "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.$Input2": {} + }, + "CKD- stage IV (eGFR 31 last admit, now lower) is risk fact$Cause_1": { + "CKD- stage IV (eGFR 31 last admit, now lower)$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HLD is risk fact$Cause_1": { + "HLD$Input3": {} + }, + "family history:Mother: CAD, CABG is a risk fact$Cause_1": { + "Mother: CAD, CABG$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "There is moderate hypokinesis of the inferior wall and anterior septum with the apex severely hypokinetic.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.\nare risk facts of acs$Cause_1": { + "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.$Input2": {} + }, + "CKD- stage IV (eGFR 31 last admit, now lower) is risk fact$Cause_1": { + "CKD- stage IV (eGFR 31 last admit, now lower)$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HLD is risk fact$Cause_1": { + "HLD$Input3": {} + }, + "family history:Mother: CAD, CABG is a risk fact$Cause_1": { + "Mother: CAD, CABG$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.\nare risk facts of acs$Cause_1": { + "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.$Input2": {} + }, + "CKD- stage IV (eGFR 31 last admit, now lower) is risk fact$Cause_1": { + "CKD- stage IV (eGFR 31 last admit, now lower)$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HLD is risk fact$Cause_1": { + "HLD$Input3": {} + }, + "family history:Mother: CAD, CABG is a risk fact$Cause_1": { + "Mother: CAD, CABG$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities is a sign of acs$Cause_1": { + "There is moderate hypokinesis of the inferior wall and anterior septum with the apex severely hypokinetic.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.\nare risk facts of acs$Cause_1": { + "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.$Input2": {} + }, + "CKD- stage IV (eGFR 31 last admit, now lower) is risk fact$Cause_1": { + "CKD- stage IV (eGFR 31 last admit, now lower)$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HLD is risk fact$Cause_1": { + "HLD$Input3": {} + }, + "family history:Mother: CAD, CABG is a risk fact$Cause_1": { + "Mother: CAD, CABG$Input4": {} + } + } + } + } + }, + "input1": "chest pressure at rest, SOB with minimal exertion\n", + "input2": "This is a male with a PMH significant for IDDM, HTN, CKD Stage III-IV (last admit eGFR 31), HLD, unstable angina, CAD s/p MI, and PCIs as outlined below.\n Declined by surgery in past (x 2) presented to hospital with angina at very low workload (getting dressed). Pro BNP 5652, and at discharge his lungs clear with 1+ edema. Echo performed at shows reduced EF with diastolic dysfunctin. There is moderate hypokinesis of the inferior wall and anterior septum with the apex severely hypokinetic. There is no evidence of LV thrombus and is noted to have moderate MR and mil had a Renal consult yesterday and was started on mucomyst yesterday. No further diuresis since yesterday and his Lisinopril has been held. Dr. is aware of his creatinine, no prehydration was ordered.\n", + "input3": "+ CX 2.5 x 12 Promus; POBA distal LAD \n+ CKD- stage IV (eGFR 31 last admit, now lower)\n+ IDDM\n+ HTN\n+ HLD\n+ GERD\n+ s/p surgical repair undescended testicle as a child \n+ Iron Deficiency anemia Anemia \n+ Surgical rpr. for undescended testicle as a child\n", + "input4": "Mother: CAD, CABG\n", + "input5": "Gen: old man in NAD. Denies SOB, dizziness, no further CP, has been ambulating \nNeuro: Alert and oriented, no focal deficits or asymmetries noted\nNeck/JVP: JVP approx. 6 cm above clavicle\nCV: S1S2 regular, no MRG\nChest: Decreased in bases but no crackles or wheezes b/l \nABD: soft, non-tender, BS+\nExtr: Right femoral site is soft with no bleeding, hematoma or \nbruit. dopplerable b/l. No edema. Extremities are warm and well perfused. \nSkin: No rashes or lesions\n", + "input6": "ADMISSION LABS:\n\ufeff\n06:55AM BLOOD PTT-36.9*\n06:55AM BLOOD Glucose-107* UreaN-45* Creat-2.8* Na-144 \nK-6.0* Cl-111* HCO3-16* AnGap-18\n06:55AM BLOOD CK(CPK)-110\n06:55AM BLOOD CK-MB-3 cTropnT-0.09*\n06:55AM BLOOD Mg-1.6\n\nECG:non-ST-elevation\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14895513-DS-2.json b/Finished/Acute Coronary Syndrome/UA/14895513-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..d58e15118582a80bd4de666e2f1b7aacc5754606 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14895513-DS-2.json @@ -0,0 +1,96 @@ +{ + "UA$Intermedia_5": { + "a worsening pressure like sensation on the left side of his chest with assocated left jaw numbess and left arm pressure.\n is sign of acs-ua$Cause_1": { + "Pt states that he's developed a worsening pressure like sensation on the left side of his chest with assocated left jaw numbess and left arm pressure.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "PMH of HTN/HLD presented to ED w/ chest pain are risk fact of acs$Cause_1": { + "w/ PMH of HTN/HLD presented to ED w/ chest pain,$Input2": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HLD is risk fact$Cause_1": { + "HLD$Input3": {} + }, + "family history:CAD multiple members on maternal side can be a risk fact$Cause_1": { + "CAD multiple members on maternal side$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities:The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. is a sign of acs$Cause_1": { + "The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "PMH of HTN/HLD presented to ED w/ chest pain are risk fact of acs$Cause_1": { + "w/ PMH of HTN/HLD presented to ED w/ chest pain,$Input2": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HLD is risk fact$Cause_1": { + "HLD$Input3": {} + }, + "family history:CAD multiple members on maternal side can be a risk fact$Cause_1": { + "CAD multiple members on maternal side$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "EKG was without ischemic changes.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "PMH of HTN/HLD presented to ED w/ chest pain are risk fact of acs$Cause_1": { + "w/ PMH of HTN/HLD presented to ED w/ chest pain,$Input2": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HLD is risk fact$Cause_1": { + "HLD$Input3": {} + }, + "family history:CAD multiple members on maternal side can be a risk fact$Cause_1": { + "CAD multiple members on maternal side$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities:The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. is a sign of acs$Cause_1": { + "The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "PMH of HTN/HLD presented to ED w/ chest pain are risk fact of acs$Cause_1": { + "w/ PMH of HTN/HLD presented to ED w/ chest pain,$Input2": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "HLD is risk fact$Cause_1": { + "HLD$Input3": {} + }, + "family history:CAD multiple members on maternal side can be a risk fact$Cause_1": { + "CAD multiple members on maternal side$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "w/ PMH of HTN/HLD presented to ED w/ chest pain, ruled out for ACS, but had positive stress test so was admitted to for cardiac catheterization. \n\ufeff\nPt states that he's developed a worsening pressure like sensation on the left side of his chest with assocated left jaw numbess and left arm pressure. No palpitations, N&V, ABD pain, diaphoresis, recent illness, fevers/chills. Pt states he's had similar chest pains for the last two years but its frequency/intensity has increased in the past few weeks and was especially bothersome night of admission.\n\ufeff\nPt states he gets winded when walking up incline but had difficulty quantifying ET. He did noted that he only ever has the pain at rest, never while exercising (he does calisthenics). There is a mild positional component wherein it is worse lying down and he sits up for some relief. Though not any association w/ prodromal URI, SOB, dyspnea. Never smoker. Alcohol socially. Of note, patient had a negative stress test , completing 7:00 of protocol. \n\ufeff\nIn the ED, initial VS were: 97.4 72 132/88 18 97% RA. EKG was without ischemic changes. Labs were significant for CBC (within normal limits), CHEM wnl, troponin negative x2. UA negative for infection. CXR showed mild pulmonary vascular congestion and bibasilar atelectasis in the setting of low lung volumes. \n\ufeff\nAspirin 324 given. Patient stayed for ETT which was terminated for chest discomfort at min 4.5 with 0.5 mm horizontal STD V4-V6 and drop in BP with total METs. CP resolved with rest. Given high risk stress test findings of chest discomfort and drop in BP at a low workload, admitted to hospital for urgent cath tomorrow. On arrival to the floor, patient was stable. He conversed easilly and confirmed the above history. He denies currently having any chest pain.\n", + "input3": "+ HTN\n+ HLD\n+ GERD\n+ COPD\n", + "input4": "CAD multiple members on maternal side\n", + "input5": "Admission Exam:\nVitals:98.0 68 122/72 18 95%RA\nGeneral: Elderly male in no acute distress, sitting in bed comfortably, pleasant\nNEURO: PERRL, AAOx3, moving all extremities\nHEENT: NCAT, MMM, no lymphadenopathy, no JVD\nCV: RRR without MRG, S1 and S2 normal\nLUNGS: CTAB without increased WOB, no tachypnea\nABD: NTND, BS+, soft\nEXT: WWP, trace edema below knees bilaterally\n", + "input6": "Admission Labs:\n05:53PM BLOOD WBC-7.3 RBC-4.71 Hgb-14.2 Hct-41.2 MCV-88 MCH-30.1 MCHC-34.5 RDW-13.0 RDWSD-41.4\n05:53PM BLOOD Neuts-60.8 Monos-9.5 Eos-1.5 \nBaso-0.5 Im AbsNeut-4.43 AbsLymp-2.00 AbsMono-0.69 AbsEos-0.11 AbsBaso-0.04\n05:53PM BLOOD Glucose-105* UreaN-21* Creat-1.0 Na-143 K-4.2 Cl-105 HCO3-25 AnGap-17\n05:53PM BLOOD cTropnT-<0.01\n07:40AM BLOOD Calcium-9.3 Phos-3.0 Mg-2.0\n\ufeff\nImaging:\nTTE\nThe left atrium is elongated. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). 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) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. IMPRESSION: Normal global and regional biventricular systolic \nfunction. \n\ufeff\nCXR showed mild pulmonary vascular congestion and bibasilar atelectasis in the setting of low lung volumes. \n\ufeff\nETT stress\nTerminated for chest discomfort at min 4.5 with 0.5 mm horizontal STD V4-V6 and drop in BP with total METs. CP resolved with rest\n\ufeff\nCardiac Catheterization\nLMCA was patent, LAD had mild plaquing proximally to 20% after S1. diagnoal branch had slow flow. Mid LAD had 40% stenosis just after D1, followed by a tapering (likely recanalized) total occlusion with TIMI 1 flow into the lesion and essentially TIMI 0 flow w/ faint contrast retention beyone from competitive flow from right to left collaterals. Ramus intermedius had mild plaquing and slightly delayed pulsatile flow. LCx was patent, RCA not imaged. LAD had drug eluting stent placed.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/14946203-DS-21.json b/Finished/Acute Coronary Syndrome/UA/14946203-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..1f66b756d9ea901ae687a3af7550053605afd08a --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/14946203-DS-21.json @@ -0,0 +1,141 @@ +{ + "UA$Intermedia_5": { + "Was treating at home with sodium bicarb with no effect. He states that he has had occ SOB and chest pain with walking dog and endorses decreased exercise tolerance since last time. can be signs of acs-ua$Cause_1": { + "Was treating at home with sodium bicarb with no effect. He states that he has had occ SOB and chest pain with walking dog and endorses decreased exercise tolerance since last time.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer are risk facts of acs$Cause_1": { + "He is a pleasant man with CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer, who was admitted to hospital with complaints of discomfort/heartburn x 3 days.$Input2": {} + }, + "afib, s/p cardioversion two months ago, on coumadin is risk fact$Cause_1": { + "afib, s/p cardioversion two months ago, on coumadin$Input3": {} + }, + "Hx MI, s/p cabg and revision is risk fact$Cause_1": { + "Hx MI, s/p cabg and revision$Input3": {} + }, + "family historyFather with diabetes, MI. can be a risk fact of acs$Cause_1": { + "Father with diabetes, MI.$Input4": {} + }, + "family history:3 sisters with DM, stroke,can be a risk fact of acs$Cause_1": { + "3 sisters with DM, stroke,$Input4": {} + }, + "family history:brother with bladder cancer, \ncan be a risk fact of acs$Cause_1": { + "brother with bladder cancer,$Input4": {} + }, + "family history:other brother with heart pbs. can be a risk fact of acs$Cause_1": { + "other brother with heart pbs.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities: Cardiac cath showed occluded vein graft, two DES placed. Procedure was complicated by a small hematoma.\n\n is a sign of acs$Cause_1": { + "Cardiac cath showed occluded vein graft, two DES placed. Procedure was complicated by a small hematoma.$Input2": {} + }, + "slight cardiac structural abnormalities: Mitral valve replacement with mosaic tissue valve is a sign of acs$Cause_1": { + "Mitral valve replacement with mosaic tissue valve$Input3": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer are risk facts of acs$Cause_1": { + "He is a pleasant man with CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer, who was admitted to hospital with complaints of discomfort/heartburn x 3 days.$Input2": {} + }, + "afib, s/p cardioversion two months ago, on coumadin is risk fact$Cause_1": { + "afib, s/p cardioversion two months ago, on coumadin$Input3": {} + }, + "Hx MI, s/p cabg and revision is risk fact$Cause_1": { + "Hx MI, s/p cabg and revision$Input3": {} + }, + "family historyFather with diabetes, MI. can be a risk fact of acs$Cause_1": { + "Father with diabetes, MI.$Input4": {} + }, + "family history:3 sisters with DM, stroke,can be a risk fact of acs$Cause_1": { + "3 sisters with DM, stroke,$Input4": {} + }, + "family history:brother with bladder cancer, \ncan be a risk fact of acs$Cause_1": { + "brother with bladder cancer,$Input4": {} + }, + "family history:other brother with heart pbs. can be a risk fact of acs$Cause_1": { + "other brother with heart pbs.$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS.$Cause_1": { + "EKG: Ventricular paced rhythm. Compared to the previous tracing of atrial pacing spikes are probably not present.$Input6": {} + }, + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "EKG: A-V sequential paced rhythm. Compared to tracing #2 on the atrial pacing spikes are now apparent.$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer are risk facts of acs$Cause_1": { + "He is a pleasant man with CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer, who was admitted to hospital with complaints of discomfort/heartburn x 3 days.$Input2": {} + }, + "afib, s/p cardioversion two months ago, on coumadin is risk fact$Cause_1": { + "afib, s/p cardioversion two months ago, on coumadin$Input3": {} + }, + "Hx MI, s/p cabg and revision is risk fact$Cause_1": { + "Hx MI, s/p cabg and revision$Input3": {} + }, + "family historyFather with diabetes, MI. can be a risk fact of acs$Cause_1": { + "Father with diabetes, MI.$Input4": {} + }, + "family history:3 sisters with DM, stroke,can be a risk fact of acs$Cause_1": { + "3 sisters with DM, stroke,$Input4": {} + }, + "family history:brother with bladder cancer, \ncan be a risk fact of acs$Cause_1": { + "brother with bladder cancer,$Input4": {} + }, + "family history:other brother with heart pbs. can be a risk fact of acs$Cause_1": { + "other brother with heart pbs.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities: Cardiac cath showed occluded vein graft, two DES placed. Procedure was complicated by a small hematoma.\n\n is a sign of acs$Cause_1": { + "Cardiac cath showed occluded vein graft, two DES placed. Procedure was complicated by a small hematoma.$Input2": {} + }, + "slight cardiac structural abnormalities: Mitral valve replacement with mosaic tissue valve is a sign of acs$Cause_1": { + "Mitral valve replacement with mosaic tissue valve$Input3": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer are risk facts of acs$Cause_1": { + "He is a pleasant man with CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer, who was admitted to hospital with complaints of discomfort/heartburn x 3 days.$Input2": {} + }, + "afib, s/p cardioversion two months ago, on coumadin is risk fact$Cause_1": { + "afib, s/p cardioversion two months ago, on coumadin$Input3": {} + }, + "Hx MI, s/p cabg and revision is risk fact$Cause_1": { + "Hx MI, s/p cabg and revision$Input3": {} + }, + "family historyFather with diabetes, MI. can be a risk fact of acs$Cause_1": { + "Father with diabetes, MI.$Input4": {} + }, + "family history:3 sisters with DM, stroke,can be a risk fact of acs$Cause_1": { + "3 sisters with DM, stroke,$Input4": {} + }, + "family history:brother with bladder cancer, \ncan be a risk fact of acs$Cause_1": { + "brother with bladder cancer,$Input4": {} + }, + "family history:other brother with heart pbs. can be a risk fact of acs$Cause_1": { + "other brother with heart pbs.$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n\n", + "input2": "He is a pleasant man with CAD s/p CABGx 2, cath, hx of cardiomyopathy, s/p tissue mitral valve replacement, afib on coumadin, pacer, who was admitted to hospital with complaints of discomfort/heartburn x 3 days. The pain woke him up from sleep, not accompanied by diaphoresis, SOB, non-radiating, similar to prior MIs. No aggravating or alleviating factors. Was treating at home with sodium bicarb with no effect. He states that he has had occ SOB and chest pain with walking dog and endorses decreased exercise tolerance since last time. When he presented to OSH, troponins were elevated to 1.39, peaked at 1.8. Pain resolved with IV nitro at 10mcg/min. He was transferred to hospital for cath. Cardiac cath showed occluded vein graft, two DES placed. Procedure was complicated by a small hematoma. He was started on integrellin x12 hrs for thrombus burden. On the floor, he denies SOB, CP. He has mild back pain similar to his chronic back pain, no groin pain.\n\ufeff\nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, bleeding at the time of surgery, myalgias, joint pains. He does have a mild chronic cough and rhinorrhea. No hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative.\n\ufeff\nCardiac review of systems is notable for absence paroxysmal nocturnal dyspnea, orthopnea, ankle edema, syncope or presyncope. Does c/o occ palpitations.\n", + "input3": "+ BiV ICD\n+ BPH s/p TURP\n+ Chronic lower back pain\n+ s/p epidural injections\n+ T&A\n+ GERD\n+ Rosacea\n+ DJD and facet disease\n+ hx of PE, AAA (not repaired)\n+ some w/u for concerns for PVD/claudication.\n+ Mitral valve replacement with mosaic tissue valve\n+ afib, s/p cardioversion two months ago, on coumadin\n+ Hx MI, s/p cabg and revision\n+ CHF EF\n+ Benign thyroid nodule\n+ Rosacea\n", + "input4": "Father with diabetes, MI. 3 sisters with DM, stroke, brother with bladder cancer, other brother with heart pbs.\n", + "input5": "VS - 123/60 62 16 97 2L 97.4\nGen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.\nNeck: Supple with JVP of 7 cm.\nCV: PMI located in intercostal space, midclavicular line. \nRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.\nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB anteriorly, no crackles, wheezes or rhonchi.\nAbd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits.\nExt: No c/c/e. No femoral bruits. R-sided cath site with mild edema, small amt of fresh blood, no TTP, no burits.\nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.\nNeuro: aaox3, CNs intact.\n", + "input6": "10:44AM BLOOD WBC-10.8 RBC-4.23* Hgb-14.0 Hct-39.6* \nMCV-94 MCH-33.1* MCHC-35.4* RDW-14.5 Plt Ct-76*\n03:50AM BLOOD Glucose-82 UreaN-18 Creat-1.3* Na-138 \nK-3.9 Cl-99 HCO3-32 AnGap-11\n03:50AM BLOOD calTIBC-261 Ferritn-134 TRF-201\n03:50AM BLOOD Digoxin-1.1\n\ufeff\nEKG: Ventricular paced rhythm. Compared to the previous tracing of atrial pacing spikes are probably not present.\n\ufeff\nEKG: A-V sequential paced rhythm. Compared to tracing #2 on the atrial pacing spikes are now apparent. \n\ufeff\n03:50AM BLOOD WBC-7.3 RBC-4.04* Hgb-13.5* Hct-37.5* MCV-93 MCH-33.5* MCHC-36.0* RDW-14.3 Plt Ct-65*\n12:20AM BLOOD WBC-7.4 RBC-4.03* Hgb-13.4* Hct-37.5* MCV-93# MCH-33.3* MCHC-35.7*# RDW-14.4 Plt Ct-97*#\n10:44AM BLOOD WBC-10.8 RBC-4.23* Hgb-14.0 Hct-39.6* MCV-94 MCH-33.1* MCHC-35.4* RDW-14.5 Plt Ct-76*\n\ufeff\nCardiac Cath (prelim report): \n1. Selective coronary angiography of this right dominant system revealed three vessel coronary artery disease. The heart had no angiographically apparent flow limiting stenosis. The LAD had 100% occlusion in the mid portion. The distal vessel and the diagonal filled via the LIMA. The ramus branch was patent. The Cx had 100% proximal occlusion. The distal vessel filled via the SVG-OM1. The RCA had 100%mid vessel occlusion. \n2. Arterial conduit arteriography revealed a patent LIMA to the LAD. \n3. Selective vein graft angiography revealed a patent SVG-OM1. The SVG to the RCA and PDA was patent to the RCA and then severe 90% stenosis to the PDA. \n4. Resting hemodynamics revealed very mildly elevated central \nsystemic pressures (134/73 with a mean of 88 mm Hg).\n5. Successful stenting of the Distal SVG-PDA with 2.5 mm X 12 mm and 3.0 mm X 28 mm Vision BMS at the anastamotic site and 3.5 X 28 mm Vision stent in distal SVG, with post dialtion to 3.5 mm. TIMI 3 flow and no dissection.\n" +} \ No newline at end of file diff --git a/Finished/Acute Coronary Syndrome/UA/15171397-DS-22.json b/Finished/Acute Coronary Syndrome/UA/15171397-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..0a05562c1162bb78ffb030c8b0328848aab5e872 --- /dev/null +++ b/Finished/Acute Coronary Syndrome/UA/15171397-DS-22.json @@ -0,0 +1,111 @@ +{ + "UA$Intermedia_5": { + "a history of Aortic stenosis (s/p bioprosthetic AVR and CAD (s/p CABG nd DESx2) who presents with chest pain. are risk facts of asc-ua$Cause_1": { + "He is a male with a history of Aortic stenosis (s/p bioprosthetic AVR and CAD (s/p CABG nd DESx2) who presents with chest pain.$Input2": {} + }, + "This morning he woke up with some mild chest discomfort. This later progressed to chest pain with radiation to the L neck and arm. He took two nitro without any relief as well as ASA.\n can be a sign of acs-ua$Cause_1": { + "This morning he woke up with some mild chest discomfort. This later progressed to chest pain with radiation to the L neck and arm. He took two nitro without any relief as well as ASA.$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p CABG with redo c/b CVA) is risk fact$Cause_1": { + "CAD s/p CABG with redo c/b CVA)$Input3": {} + }, + "Aortic stenosis s/p bioprosthetic AVR is risk fact$Cause_1": { + "Aortic stenosis s/p bioprosthetic AVR$Input3": {} + }, + "Carotid stenosis s/p left CEA is risk fact$Cause_1": { + "Carotid stenosis s/p left CEA$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "family history:Father had first MI, had MIs total, died at heart failure.\n be a risk fact of acs$Cause_1": { + "Father had first MI, had MIs total, died at heart failure.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities: Aortic stenosis (s/p bioprosthetic AVR and CAD (s/p CABG nd DESx2 is a sign of acs$Cause_1": { + "Aortic stenosis (s/p bioprosthetic AVR and CAD (s/p CABG nd DESx2$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p CABG with redo c/b CVA) is risk fact$Cause_1": { + "CAD s/p CABG with redo c/b CVA)$Input3": {} + }, + "Aortic stenosis s/p bioprosthetic AVR is risk fact$Cause_1": { + "Aortic stenosis s/p bioprosthetic AVR$Input3": {} + }, + "Carotid stenosis s/p left CEA is risk fact$Cause_1": { + "Carotid stenosis s/p left CEA$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "family history:Father had first MI, had MIs total, died at heart failure.\n be a risk fact of acs$Cause_1": { + "Father had first MI, had MIs total, died at heart failure.$Input4": {} + } + } + }, + "NSTE-ACS$Intermedia_4": { + "non-ST-elevation is a sign of NSTE-ACS$Cause_1": { + "ECG:non-ST-elevation$Input6": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p CABG with redo c/b CVA) is risk fact$Cause_1": { + "CAD s/p CABG with redo c/b CVA)$Input3": {} + }, + "Aortic stenosis s/p bioprosthetic AVR is risk fact$Cause_1": { + "Aortic stenosis s/p bioprosthetic AVR$Input3": {} + }, + "Carotid stenosis s/p left CEA is risk fact$Cause_1": { + "Carotid stenosis s/p left CEA$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "family history:Father had first MI, had MIs total, died at heart failure.\n be a risk fact of acs$Cause_1": { + "Father had first MI, had MIs total, died at heart failure.$Input4": {} + } + }, + "Strongly suspected ACS$Intermedia_3": { + "slight cardiac structural abnormalities: Aortic stenosis (s/p bioprosthetic AVR and CAD (s/p CABG nd DESx2 is a sign of acs$Cause_1": { + "Aortic stenosis (s/p bioprosthetic AVR and CAD (s/p CABG nd DESx2$Input2": {} + }, + "Suspected ACS$Intermedia_2": { + "Chest pain is a symptom of ACS$Cause_1": { + "Chest pain$Input1": {} + }, + "CAD s/p CABG with redo c/b CVA) is risk fact$Cause_1": { + "CAD s/p CABG with redo c/b CVA)$Input3": {} + }, + "Aortic stenosis s/p bioprosthetic AVR is risk fact$Cause_1": { + "Aortic stenosis s/p bioprosthetic AVR$Input3": {} + }, + "Carotid stenosis s/p left CEA is risk fact$Cause_1": { + "Carotid stenosis s/p left CEA$Input3": {} + }, + "HTN is risk fact$Cause_1": { + "HTN$Input3": {} + }, + "family history:Father had first MI, had MIs total, died at heart failure.\n be a risk fact of acs$Cause_1": { + "Father had first MI, had MIs total, died at heart failure.$Input4": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "He is a male with a history of Aortic stenosis (s/p bioprosthetic AVR and CAD (s/p CABG nd DESx2) who presents with chest pain. The \npatient was just discharged from the cardiology service yesterday after having an NSTEMI with new RBBB. He had 2 Drug eluting stents placed to the and LCx. He was chest pain free for >24 hours prior to discharge. This morning he woke up with some mild chest discomfort. This later progressed to chest pain with radiation to the L neck and arm. He took two nitro without any relief as well as ASA. He denies any fever, cough, shortness of breath, nausea/vomiting, or dizziness.\n", + "input3": "+ DES to the LCx\n+ CAD s/p CABG with redo c/b CVA)\n+ Aortic stenosis s/p bioprosthetic AVR\n+ Carotid stenosis s/p left CEA\n+ HTN\n+ HL\n+ Lumbosacral stenosis w/chronic back pain s/p \n+ decompression/fusion\n", + "input4": "Father had first MI, had MIs total, died at heart failure.\n", + "input5": "Admission exam:\n\ufeff\nVS: 98.4 121/50 67 18 96/2L NC \nGeneral: NAD, comfortable, pleasant\nHEENT: NCAT, PERRL, EOMI\nNeck: supple, no JVD\nCV: RRR. III/VI systolic ejection murmur best heard. No lower extremity edema\nLungs: CTAB\nAbdomen: soft, NT/ND, BS+\nExt: WWP, no c/c/e, 2+ distal pulses bilaterally\nNeuro: Left sided facial droop. No pronator drift. Interosseus muscles and rest of upper body. Normal nose finger nose.\n", + "input6": "Admission labs:\n\ufeff\n01:30PM BLOOD WBC-4.6 RBC-2.88* Hgb-9.0* Hct-26.3* \nMCV-91 MCH-31.4 MCHC-34.3 RDW-13.6\n01:30PM BLOOD Glucose-227* UreaN-20 Creat-1.2 Na-132* \nK-4.2 Cl-98 HCO3-25 AnGap-13\n01:30PM BLOOD cTropnT-0.12*\n10:30AM BLOOD Calcium-8.5 Phos-3.4 Mg-2.4\n\nECG:non-ST-elevation \n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/13281479-DS-19.json b/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/13281479-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..5442fb4f8912eea95680f852043a5b093390db74 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/13281479-DS-19.json @@ -0,0 +1,30 @@ +{ + "Congenital Adrenal Hyperplasia$Intermedia_3": { + "Genetic defects directly diagnose CAH$Cause_1": { + "Genetic test reveals 21-hydroxylase deficiency$Input6": {} + }, + "Suspected adrenal insufficiency$Intermedia_2": { + "Adrenal medullary hyperplasia may indicate adrenal dysfunction$Cause_1": { + "adrenal medullary hyperplasia$Input2": {} + }, + "MEN2A is a genetic disorder that often involves problems with the thyroid and adrenal glands$Cause_1": { + "MEN2A$Input2": {} + }, + "This may be due to adrenal overactivity or an adrenal tumor, both of which may overlap with CAH.$Cause_1": { + "bilateral adrenalectomy$Input2": {} + }, + "Patients with CAH may be accompanied by metabolic abnormalities, such as impaired glucose tolerance$Cause_1": { + "Glucose-133$Input6": {} + }, + "Changes in serum potassium levels may be related to adrenocortical dysfunction, which is common in CAH$Cause_1": { + "K-3.5$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "She is a 22 yo female with MEN2A, h/othyroidectomy, and adrenal medullary hyperplasia who presents for bilateral adrenalectomy. The patient was diagnosed with MEN2A by a blood test (likely RET mutation analysis) due to the significant family history (see below). She had a prophylactic thyroidectomy shortly thereafter. \n", + "input3": "+MEN II (thyroid mass, s/p thyroidectomy)\n+Depression\n+Anxiety\n", + "input4": "majoring in biobiopsychology with minor statistics with plans for career in ___. Lives with 1 roommate in dorm. Denies tobacco or illicit drug use; occasional EtOH. Sexually active with 1 partner, always uses condoms, no h/o STDs. \n", + "input5": "N/A\n", + "input6": "___ 06:00AM BLOOD WBC-9.9 RBC-3.61* Hgb-11.3* Hct-31.7* MCV-88 MCH-31.2 MCHC-35.6* RDW-12.9 Plt ___\n___ 06:50PM BLOOD WBC-8.4 RBC-3.41* Hgb-10.5* Hct-29.8* MCV-87 MCH-30.8 MCHC-35.2* RDW-12.3 Plt ___\n___ 06:00AM BLOOD Glucose-133* UreaN-4* Creat-0.6 Na-141 K-3.5 Cl-104 HCO3-28 AnGap-13\n\nGenetic test reveals 21-hydroxylase deficiency\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/13281479-DS-1912.json b/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/13281479-DS-1912.json new file mode 100644 index 0000000000000000000000000000000000000000..b4b875b655f664ecfb314dc6621e1cf38e8eaec5 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/13281479-DS-1912.json @@ -0,0 +1,30 @@ +{ + "Congenital Adrenal Hyperplasia$Intermedia_3": { + "Genetic defects directly diagnose CAH$Cause_1": { + "Genetic test reveals 21-hydroxylase deficiency$Input6": {} + }, + "Suspected adrenal insufficiency$Intermedia_2": { + "Adrenal medullary hyperplasia may indicate adrenal dysfunction$Cause_1": { + "adrenal medullary hyperplasia$Input2": {} + }, + "MEN2A is a genetic disorder that often involves problems with the thyroid and adrenal glands$Cause_1": { + "MEN2A$Input2": {} + }, + "This may be due to adrenal overactivity or an adrenal tumor, both of which may overlap with CAH.$Cause_1": { + "bilateral adrenalectomy$Input2": {} + }, + "Patients with CAH may be accompanied by metabolic abnormalities, such as impaired glucose tolerance$Cause_1": { + "Glucose-133$Input6": {} + }, + "Changes in serum potassium levels may be related to adrenocortical dysfunction, which is common in CAH$Cause_1": { + "K-3.5$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "She is a 22-year-old female with Multiple Endocrine Neoplasia type 2A (MEN2A), a history of thyroidectomy, and adrenal medullary hyperplasia, presenting for bilateral adrenalectomy. The diagnosis of MEN2A was confirmed through a blood test, likely RET mutation analysis, due to a significant family history (details provided below). Following the diagnosis, she underwent a prophylactic thyroidectomy.\n", + "input3": "+MEN II (thyroid mass, s/p thyroidectomy)\n+Depression\n+Anxiety\n", + "input4": "majoring in biobiopsychology with minor statistics with plans for career in ___. Lives with 1 roommate in dorm. Denies tobacco or illicit drug use; occasional EtOH. Sexually active with 1 partner, always uses condoms, no h/o STDs.\n", + "input5": "N/A\n", + "input6": "___ 06:00AM BLOOD WBC-9.9 RBC-3.61* Hgb-11.3* Hct-31.7* MCV-88 MCH-31.2 MCHC-35.6* RDW-12.9 Plt ___\n___ 06:50PM BLOOD WBC-8.4 RBC-3.41* Hgb-10.5* Hct-29.8* MCV-87 MCH-30.8 MCHC-35.2* RDW-12.3 Plt ___\n___ 06:00AM BLOOD Glucose-133* UreaN-4* Creat-0.6 Na-141 K-3.5 Cl-104 HCO3-28 AnGap-13\n\nGenetic test reveals 21-hydroxylase deficiency\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/16003330-DS-18.json b/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/16003330-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..06c04f6c955459abdce10bb69c98872f8ca42168 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Congenital Adrenal Hyperplasia/16003330-DS-18.json @@ -0,0 +1,33 @@ +{ + "Congenital Adrenal Hyperplasia$Intermedia_3": { + "Low cortisol levels and unresponsiveness to ACTH stimulation are typical biochemical features of CAH and indicate adrenocortical insufficiency.$Cause_1": { + "found to have significantly low cortisol with no response to ACTH stimulation testing.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Abnormalities in adrenal hormones may affect the water and electrolyte balance in the body, causing dizziness$Cause_1": { + "Lightheadedness$Input1": {} + }, + "This describes a symptom of positional hypotension, which is dizziness caused by a drop in blood pressure when standing. Lower overall blood pressure, possibly due to adrenal insufficiency$Cause_1": { + "over the past 3 months he has had intermittent lightheadedness occurring a few seconds after hestands up and starts walking.$Input2": {} + }, + "This can be caused by a temporary lack of blood flow to the brain and is often associated with low blood pressure. Sustained hypotension may occur due to insufficient cortisol, which may indirectly cause similar symptoms.$Cause_1": { + "It lasts for a second and he has associated vision changes, described as vision \"going black\"$Input2": {} + }, + "A lack of cortisol may lead to changes in metabolic rate, causing weight loss$Cause_1": { + "he reports a 20 pound weight loss over the past 12 months that was unintentional.$Input2": {} + }, + "Hypotension can be a direct manifestation of adrenocortical hormone deficiency$Cause_1": { + "was found to be hypotensive$Input2": {} + }, + "Low sodium value is a direct manifestation of insufficient adrenocortical hormones$Cause_1": { + "Na-130*$Input6": {} + } + } + }, + "input1": "Lightheadedness\n", + "input2": "He is a 45 male with PMH notable for being ahemochromatosis carrier, who presents with lightheadedness.Patient states that over the past 3 months he has had intermittent lightheadedness occurring a few seconds after hestands up and starts walking. It lasts for a second and he has associated vision changes, described as vision \"going black\". The vision changes then resolves completely. He has not syncopized during this time he has no chest pain, shortness of breath, or abdominal pain. He endorses associated nausea but deniesvomiting. Denies family history of sudden cardiac death. \n\nAdditionally, he reports a 20 pound weight loss over the past 12 months that was unintentional. He denies cough, night sweats, history of incarceration, hemoptysis, recent travel, or lower extremity swelling. \n\nHe was seen by his primary care doctor multiple times and has follow-up with a cardiologist. He went back to his primary care doctor today prior to presentation and was found to be hypotensive, which prompted his referral to the emergency department. \n", + "input3": "Hemochromatosis carrier\n", + "input4": "great-grandfather - colon cancer\ngrandfather - CAD s/p CABG\nPaternal uncle - heart transplant (unsure why)\nMaternal aunt/grandmother - breast cancer\nMaternal aunt - pancreatic cancer\n", + "input5": "VITALS: T 98.2 BP 113/62 HR 73 RR 14 O2 100% RA \nGENERAL: Well-appearing, well-groomed young man, restingcomfortably in bed, in NAD\nHEENT: NC/AT, EOMI, PERRL, anicteric sclera, MMM\nNECK: Supple, no JVD\nHEART: RRR, normal S1/S2, no m/r/g\nLUNGS: CTAB, breathing comfortably on RA without use of accessory mm, no wheezes/rhonci/rales\nABDOMEN: Soft, non-tender, non-distended, active bowel sounds, noorganomegaly\nGU: Testicles without edema or palpable masses, no inguinallympahdenopahy, no penile discharge\nEXTREMITIES: No c/c/e\nSKIN: Warm, well-perfused, no ___\nNEURO: Alert, oriented x3, CN II-XII intact, ___ strength in b/l upper and lower extremities, normal sensation \n\n", + "input6": "___ 12:12AM BLOOD WBC-7.2 RBC-4.46* Hgb-13.1* Hct-38.0* MCV-85 MCH-29.4 MCHC-34.5 RDW-12.5 RDWSD-38.4 Plt ___\n___ 12:12AM BLOOD Neuts-41.3 ___ Monos-7.3 Eos-2.5 Baso-0.7 Im ___ AbsNeut-2.98 AbsLymp-3.47 AbsMono-0.53 AbsEos-0.18 AbsBaso-0.05\n___ 06:05AM BLOOD Hypochr-NORMAL Anisocy-NORMAL Poiklo-1+* Macrocy-NORMAL Microcy-NORMAL Polychr-OCCASIONAL Ovalocy-OCCASIONAL\n___ 12:12AM BLOOD Plt ___\n___ 12:12AM BLOOD Glucose-99 UreaN-26* Creat-0.9 Na-130* K-4.9 Cl-97 HCO3-27 AnGap-6*\n___ 12:12AM BLOOD ALT-66* AST-58* AlkPhos-66 TotBili-0.5\n___ 12:12AM BLOOD Albumin-4.2 Calcium-9.6 Phos-5.2* Mg-1.6\n\nIMAGING\n==========================\nCXR ___\nIMPRESSION: \nNo acute cardiopulmonary process. \n\nRUQUS ___\nIMPRESSION: \n1. No cholelithiasis or sonographic evidence of acute cholecystitis. \n2. No evidence of hepatic lesion. \n3. Mild splenomegaly measuring 13.7 cm. \n\nfound to have significantly low cortisol with no response to ACTH stimulation testing.\n\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/16379709-DS-6.json b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/16379709-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..86d83222dca0159af132582ffd1077d75fc12ab1 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/16379709-DS-6.json @@ -0,0 +1,33 @@ +{ + "Primary Adrenal Insufficiency$Intermedia_3": { + "This is the standard for diagnosing Primary Adrenal Insufficiency$Cause_1": { + "cortisol does not increase even when ACTH is given because the adrenal glands are damaged$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Persistent fatigue, which may be caused by insufficient secretion of adrenocortical hormones$Cause_1": { + "he feels like he never recovered his energy$Input2": {} + }, + "Decreased physical strength, which may be caused by insufficient secretion of adrenocortical hormones$Cause_1": { + "particularly when walking to work, which he was able to do with difficulty prior$Input2": {} + }, + "These symptoms may be related to low blood pressure, and adrenal insufficiency affects electrolyte balance and blood pressure regulation in the body.$Cause_1": { + "intermittent dizziness and lightheadedness with standing$Input2": {} + }, + "Adrenal insufficiency can cause gastrointestinal symptoms such as abdominal pain, as well as weight loss due to decreased appetite and changes in metabolism$Cause_1": { + "intermittent cramping abdominal pain and a 20lbs unintentional weight loss over the past 2 months$Input2": {} + }, + "Electrolyte abnormalities are a typical biochemical feature of primary adrenal insufficiency$Cause_1": { + "hyponatermia to 121, hyperkalemia to 5.8$Input2": {} + }, + "Adrenocortisol is the main hormone secreted by the adrenal cortex, and abnormally low levels usually indicate adrenal insufficiency.$Cause_1": { + "low pm cortisol of 0.7$Input2": {} + } + } + }, + "input1": "abnormal labs\n", + "input2": "This is a 33 year male referred to ED by his endocrinology for abnormal labs. \n\nThe patient reports that 1 month ago he had a viral URI that resolved, however he feels like he never recovered his energy. He noticed DOE, particularly when walking to work, which he was able to do with difficulty prior. He is at baseline very athletic. He also noticed intermittent dizziness and lightheadedness with standing, intermittent cramping abdominal pain and a 20lbs unintentional weight loss over the past 2 months. He reports his appetite is still at baseline but has been limited by his abdominal pain. He endorses nausea at the time of his URI. Given these symptoms he saw his PCP. His PCP ran series of lab notable for TSH 0.21, AlP 76, AST 48, K 5.3. He had a RAIU+S, which showed a homogenous gland with uptake at the upper limit of normal. He was then referred to endocrine for further evaluation.\n \nHe was seen in clinic the day of admission and was initally thought to have resolving thyroditis, and was sent to have several labs checked. Labs from clinic were notable for elevated TSH of 22, low T4 at 3.6 with normal T 3,hyponatermia to 121, hyperkalemia to 5.8, hyperphosphatemia to 5.6, low pm cortisol of 0.7. Given these finding he was recommended to come to the ED for eval for concern for adrenal insufficiency. \n\n\n", + "input3": "none\n", + "input4": "Father and sister with Celiac \n", + "input5": "ADMISSION EXAM:\nVitals - T 97.5 BP 97/50 P 70 RR 18 10% RA \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera. No proptosis or exopthalmos \nNeck: neck supple, non tender, no thyromegally or nodules appreciated. No lymphadenopathy. \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing or edema \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no rashes \n", + "input6": "ADMISSION LABS:\n\nBLOOD:\n___ 12:47PM BLOOD WBC-7.2 RBC-5.47 Hgb-14.9 Hct-45.0MCV-82 MCH-27.1 MCHC-33.0 RDW-12.1 Plt ___\n___ 11:05PM BLOOD Neuts-38.2* Lymphs-51.9* Monos-6.0 Eos-3.1 Baso-0.7\n___ 12:47PM BLOOD UreaN-25* Creat-1.1 Na-121* K-5.8* Cl-87* HCO3-23 AnGap-17\n___ 12:47PM BLOOD ALT-62* AST-48* AlkPhos-78 TotBili-0.7\n___ 12:47PM BLOOD GGT-9\n___ 12:47PM BLOOD CK-MB-11* MB Indx-3.2\n___ 12:47PM BLOOD Albumin-4.4 Calcium-10.4* Phos-5.6* Mg-1.9\n___ 11:05PM BLOOD Osmolal-260*\n___ 12:47PM BLOOD Prolact-19* TSH-22*\n___ 12:47PM BLOOD T4-3.6* T3-101 Free T4-0.64*\n___ 11:05PM BLOOD Cortsol-0.7*\n___ 12:47PM BLOOD 25VitD-14*\n\n\ncortisol does not increase even when ACTH is given because the adrenal glands are damaged\n\nIMAGING: ___ Thyroid scan with uptake \n\"IMPRESSION: 24 hour uptake of radioiodine at the upper limits of normal. If TSH is suppressed, this finding suggest sautonomy, such as with Graves disease.\"\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/17076162-DS-12.json b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/17076162-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..bae5329c5b94792bd1ccb9eb6dccfbd8ad146dec --- /dev/null +++ b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/17076162-DS-12.json @@ -0,0 +1,27 @@ +{ + "Primary Adrenal Insufficiency$Intermedia_3": { + "This is the standard for diagnosing Primary Adrenal Insufficiency$Cause_1": { + "cortisol does not increase even when ACTH is given because the adrenal glands are damaged$Input6": {} + }, + "Cosyntropin is a medication used to diagnose adrenal insufficiency. Test results show that cortisol levels fail to reach the expected response range after stimulation, supporting the diagnosis of adrenal insufficiency.$Cause_1": { + "BLOOD Cortsol-1.4* DHEA-SO-61* (30 min into \nstim)$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Fatigue and muscle cramps are classic symptoms of adrenal insufficiency.$Cause_1": { + "fatigue, muscle cramping$Input2": {} + }, + "The persistence and pervasiveness of fatigue and muscle cramping highlight the severity of symptoms and the impact on patients' daily activities.$Cause_1": { + "generalized weakness and fatigue, along with muscle cramping, over the past several days$Input2": {} + }, + "Hypothyroidism can affect the body's response to other hormones, including adrenocortical hormones.$Cause_1": { + "HYPOTHYROIDISM$Input3": {} + } + } + }, + "input1": "N/A\n", + "input2": "A female patient with symptoms of fatigue, muscle cramping, and abnormal lab results. She has been experiencing generalized weakness and fatigue, along with muscle cramping, over the past several days. She recently had a urinary tract infection (UTI) and was treated in the emergency department, where she was prescribed a one-week course of cefpodoxime, which she completed yesterday. The urine culture indicated pan-sensitive E. coli.\n", + "input3": "HYPOTHYROIDISM \nIRON DEFICIENCY ANEMIA \nOSTEOPENIA \nSPINAL STENOSIS \nLACTOSE INTOLERANCE \nRHEUMATOID ARTHRITIS \nH/o COLLAGENOUS COLITIS\n", + "input4": "N/A\n", + "input5": "ADMISSION PHYSICAL EXAM\nVitals: 97.9 130/83 88 20 96% RA\nGeneral: well appearing, nontoxic, NAD\nHEENT: MM dry, EOMI, PERRL, no nystagmus\nNeck: supple\nLungs: CTAB, no w/r/r\nCV: normal rate, reg rhythm, no m/r/g\nAbdomen: Soft, NABS, very mild tenderness over all of abdomen (pt states \"it feels like I need to have a bowel movement\")\nExt: wwp, no c/c/e\nNeuro: no nystagmus. CN II-XII intact grossly. ___ strength UE \nand ___ b/l.\n", + "input6": "___ 05:53AM BLOOD WBC-8.6 RBC-4.70 Hgb-14.5 Hct-40.3 MCV-86 \nMCH-30.9 MCHC-36.0 RDW-12.2 RDWSD-38.3 Plt ___\n___ 06:30PM BLOOD Glucose-336* UreaN-12 Creat-0.8 Na-134* \nK-5.0 Cl-94* HCO3-24 AnGap-16\n___ 06:30PM BLOOD ALT-12 AST-23 AlkPhos-53 TotBili-0.8\n___ 06:30PM BLOOD Lipase-48\n___ 05:53AM BLOOD %HbA1c-8.3* eAG-192*\n___ 05:53AM BLOOD TSH-2.4\n___ 06:53AM BLOOD Free T4-1.8*\n___ 05:10PM BLOOD Cortsol-1.4* DHEA-SO-61* (30 min into \nstim)\n\ncortisol does not increase even when ACTH is given because the adrenal glands are damaged\n\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/17076162-DS-1222.json b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/17076162-DS-1222.json new file mode 100644 index 0000000000000000000000000000000000000000..bff76c80cf0d4d0e1b24771c67c4338d226aa9b2 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/17076162-DS-1222.json @@ -0,0 +1,27 @@ +{ + "Primary Adrenal Insufficiency$Intermedia_3": { + "This is the standard for diagnosing Primary Adrenal Insufficiency$Cause_1": { + "cortisol does not increase even when ACTH is given because the adrenal glands are damaged$Input6": {} + }, + "Cosyntropin is a medication used to diagnose adrenal insufficiency. Test results show that cortisol levels fail to reach the expected response range after stimulation, supporting the diagnosis of adrenal insufficiency.$Cause_1": { + "BLOOD Cortsol-1.4* DHEA-SO-61* (30 min into \nstim)$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Fatigue and muscle cramps are classic symptoms of adrenal insufficiency.$Cause_1": { + "fatigue, muscle cramping$Input2": {} + }, + "The persistence and pervasiveness of fatigue and muscle cramping highlight the severity of symptoms and the impact on patients' daily activities.$Cause_1": { + "generalized weakness and fatigue, along with muscle cramping, over the past several days$Input2": {} + }, + "Hypothyroidism can affect the body's response to other hormones, including adrenocortical hormones.$Cause_1": { + "HYPOTHYROIDISM$Input3": {} + } + } + }, + "input1": "N/A\n", + "input2": "A female patient presents with fatigue, muscle cramping, and abnormal lab results. She has experienced generalized weakness and muscle cramping for several days. Recently, she had a urinary tract infection (UTI) and was treated in the emergency department with a one-week course of cefpodoxime, completed yesterday. The urine culture indicated pan-sensitive E. coli.\n", + "input3": "HYPOTHYROIDISM \nIRON DEFICIENCY ANEMIA \nOSTEOPENIA \nSPINAL STENOSIS \nLACTOSE INTOLERANCE \nRHEUMATOID ARTHRITIS \nH/o COLLAGENOUS COLITIS\n", + "input4": "N/A\n", + "input5": "ADMISSION PHYSICAL EXAM\nVitals: 97.9 130/83 88 20 96% RA\nGeneral: well appearing, nontoxic, NAD\nHEENT: MM dry, EOMI, PERRL, no nystagmus\nNeck: supple\nLungs: CTAB, no w/r/r\nCV: normal rate, reg rhythm, no m/r/g\nAbdomen: Soft, NABS, very mild tenderness over all of abdomen (pt states \"it feels like I need to have a bowel movement\")\nExt: wwp, no c/c/e\nNeuro: no nystagmus. CN II-XII intact grossly. ___ strength UE \nand ___ b/l.\n", + "input6": "___ 05:53AM BLOOD WBC-8.6 RBC-4.70 Hgb-14.5 Hct-40.3 MCV-86 \nMCH-30.9 MCHC-36.0 RDW-12.2 RDWSD-38.3 Plt ___\n___ 06:30PM BLOOD Glucose-336* UreaN-12 Creat-0.8 Na-134* \nK-5.0 Cl-94* HCO3-24 AnGap-16\n___ 06:30PM BLOOD ALT-12 AST-23 AlkPhos-53 TotBili-0.8\n___ 06:30PM BLOOD Lipase-48\n___ 05:53AM BLOOD %HbA1c-8.3* eAG-192*\n___ 05:53AM BLOOD TSH-2.4\n___ 06:53AM BLOOD Free T4-1.8*\n___ 05:10PM BLOOD Cortsol-1.4* DHEA-SO-61* (30 min into \nstim)\n\ncortisol does not increase even when ACTH is given because the adrenal glands are damaged\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/18136887-DS-67.json b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/18136887-DS-67.json new file mode 100644 index 0000000000000000000000000000000000000000..b8cdeda11339e6dda63121d38b485f00b1bb56b9 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/18136887-DS-67.json @@ -0,0 +1,24 @@ +{ + "Primary Adrenal Insufficiency$Intermedia_3": { + "The patient has a history of Addison's disease, which is a direct diagnostic basis for primary adrenal insufficiency.$Cause_1": { + "Addison's disease$Input2": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "These symptoms are typical of adrenal insufficiency$Cause_1": { + "1 week of lethargy, weakness, malaise$Input2": {} + }, + "Digestive symptoms, such as abdominal pain and diarrhea, which may be related to electrolyte imbalances or abnormal hormone levels$Cause_1": { + "Her weakness and vague abdominal pain with loose stools$Input2": {} + }, + "The patient's rapid and obvious response to treatment may indicate that the original symptoms were related to a hormone or electrolyte deficiency, consistent with a diagnosis of Addison's disease$Cause_1": { + "On arrival to the floor she reports significant improvement from her initial presentation$Input2": {} + } + } + }, + "input1": "Weakness, abdominal pain\n", + "input2": "Ms. is 26 year old lady with a history of Addison's disease presenting with 1 week of lethargy, weakness, malaise, and anorexia after her dog of 7 years passed away. She commented that managing her medicines seems to occupy a great deal of concentration, and since grieving for the dog, she has felt like she has \"gotten behind\" with dose adjustments of her fludricortisone, predisone, and anti-hypertensives. Her weakness and vague abdominal pain with loose stools persisted to the point that she came into the ED to for further evaluation. \n\nOn arrival to the floor she reports significant improvement from her initial presentation. She feels thirsty, but otherwise her headache and abdominal pain have resolved since treatment. She denies any underlying illness: coughing, sneezing, sick contacts, fevers, chills, dysuria.\n\nROS: Denies fever, chills, night sweats, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, constipation, BRBPR, melena, hematochezia,dysuria, hematuria.\n", + "input3": "1. Addison's disease\n2. ___'s Thyroiditis now w/ Hypothyroidism - ___\n3. ___ syndrome while on steroids \n4. Benign Hypertension (inactive) \n5. Migraine headache \n6. Microscopic colitis\n7. Depression/anxiety \n8. Osteoarthritis \n9. Spondylolisthesis status-post lumbar fusion - ___ \n10. Status-post ligation - ___\n11. H/o Transaminitis in setting of unintentional tylenol overdose\n", + "input4": "Mother - rheumatoid arthritis \nFather - CAD with first MI\n", + "input5": "Admission Exam:\nVS: 96.1 122/80 87 20 97% RA\nGENERAL: Well-appearing woman in NAD, comfortable, appropriate. \n\nHEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear. \nNECK: Supple, no thyromegaly, no JVD, no carotid bruits. \nHEART: RRR, no MRG, nl S1-S2. \nLUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. \n \nABDOMEN: Soft/ND, mildly tender to palpation diffusely no masses or HSM, no rebound/guarding. \nEXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses. \nSKIN: No rashes or lesions. Dark skin tone without involvement \nof palmar creases \nLYMPH: No cervical LAD. \nNEURO: Awake, A&Ox3, CNs II-XII grossly intact, muscle strength throughout, steady gait.\n", + "input6": "Admission Labs:\n133 101 17 \n-------------<90 \n4.9 18 1.1 \nestGFR: 52/63 (click for details) \n.\nUCG: Negative \n.\n13.9 \n7.7>---<415\n40.3 \nN:49.9 L:39.5 M:5.1 E:4.2 Bas:1.3 \n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/18136887-DS-78.json b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/18136887-DS-78.json new file mode 100644 index 0000000000000000000000000000000000000000..c676117eb3094cb9de9556a7d7291e88edda1d56 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/18136887-DS-78.json @@ -0,0 +1,30 @@ +{ + "Primary Adrenal Insufficiency$Intermedia_3": { + "Direct diagnosis of Primary Adrenal Insufficiency$Cause_1": { + "Addison's disease$Input2": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "presents for fatigue, cramping is a common symptom of adrenaline deficiency$Cause_1": { + "presents for fatigue, cramping$Input2": {} + }, + "Reflects electrolyte imbalance caused by adrenal insufficiency$Cause_1": { + "Na 127, K 6.8$Input2": {} + }, + "Adrenal insufficiency may lead to reduced physical endurance and impaired cardiopulmonary function, resulting in shortness of breath during light exertion.$Cause_1": { + "report some shortness of breath$Input2": {} + }, + "Hyperkalemia may indicate an inadequately controlled adrenocortical hormone deficiency, further supporting the diagnosis of adrenal insufficiency$Cause_1": { + "K to be 5.8$Input2": {} + }, + "Generalized weakness and fatigue are common symptoms of adrenal insufficiency, leading to reduced energy metabolism and muscle function.$Cause_1": { + "been feeling \"wonky\" with generalized weakness and fatigue with muscle cramping$Input2": {} + } + } + }, + "input1": "none\n", + "input2": "Female of Addison's disease who presents for fatigue, cramping, abnormal labs. She has been feeling \"wonky\" with generalized weakness and fatigue with muscle cramping over the last several days. She had a UTI and was seen in the ED for this; she was given a 1 week course of cefpodoxime which she just finished yesterday. (Urine cx came back with pan-sensitive \nE.coli). At that time, her labs were sig for Na 127, K 6.8 (although hemolyzed). She received fluids and was sent home. She didn't take a higher dose of steroids at the time. However, since that time she feels she never quite recovered in terms of fatigue and weakness, although the urinary symptoms are gone. She does report some shortness of breath with exertion like going up stairs. There was no e/o upper tract disease at the time. She was seen by her PCP yesterday who drew labs and found her K to be 5.8, so in combination with her symptoms, sent her to the ED. She took twice her usual dose of prednisone today (doubled to 10mg from 5mg). She denies chest pain, cough, fevers, chills, nausea vomiting and diarrhea. \n", + "input3": "GASTROESOPHAGEAL REFLUX \nHYPERCHOLESTEROLEMIA \nHYPOTHYROIDISM \nIRON DEFICIENCY ANEMIA \nOSTEOPENIA \nSPINAL STENOSIS \nLACTOSE INTOLERANCE \nRHEUMATOID ARTHRITIS \nH/o COLLAGENOUS COLITIS\n", + "input4": "Per OMR and confirmed w/pt: 2 sisters w/breast cancer, 1 sister w/CAD, mother w/dementia and arthritis, father deceased w/heart disease\n", + "input5": "ADMISSION PHYSICAL EXAM\nVitals: 97.9 130/83 88 20 96% RA\nGeneral: well appearing, nontoxic, NAD\nHEENT: MM dry, EOMI, PERRL, no nystagmus\nNeck: supple\nLungs: CTAB, no w/r/r\nCV: normal rate, reg rhythm, no m/r/g\nAbdomen: Soft, NABS, very mild tenderness over all of abdomen (pt states \"it feels like I need to have a bowel movement\")\nExt: wwp, no c/c/e\nNeuro: no nystagmus. CN II-XII intact grossly. ___ strength UE \nand ___ b/l.\n", + "input6": "ADMISSION LABS\n\n\n\n\nIMAGING\n\nCXR ___\nIMPRESSION: \nNo acute cardiopulmonary process. \n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/19102476-DS-17.json b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/19102476-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..948e04bdb3c495abf1f995acd318aa5cdb343d7f --- /dev/null +++ b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/19102476-DS-17.json @@ -0,0 +1,39 @@ +{ + "Primary Adrenal Insufficiency$Intermedia_3": { + "Failure to increase ACTcortisol after administration is direct evidence of primary adrenal insufficiency$Cause_1": { + "cortisol does not increase even when ACTH is given$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Two drugs commonly used to treat adrenal insufficiency suggest he may have the condition$Cause_1": { + "he did take his normal AM dose of fludrocortisone and hydrocortisone$Input2": {} + }, + "Insomnia may also occur in adrenal insufficiency$Cause_1": { + "difficulty sleeping for three nights prior to admission$Input2": {} + }, + "Loss of appetite is a common symptom of adrenal insufficiency$Cause_1": { + "decreased appetite$Input2": {} + }, + "Abnormal weight loss is the symptom of adrenal insufficiency$Cause_1": { + "Abnormal weight loss$Input3": {} + }, + "Low sodium is a classic biochemical manifestation of adrenal insufficiency$Cause_1": { + "Na-124$Input6": {} + }, + "High potassium is a classic biochemical manifestation of adrenal insufficiency$Cause_1": { + "K-5.6$Input6": {} + }, + "Hypochloride is classic biochemical manifestations of adrenal insufficiency$Cause_1": { + "Cl-93$Input6": {} + }, + "hypocarbonate is classic biochemical manifestations of adrenal insufficiency$Cause_1": { + "HCO3-19$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "He is a 34 yo M with chest pain. \n\nPer history obtained in the ED, pt abruptly developed L-sided chest pressure around noon on the day of presentation. The pain radiated to his L shoulder blade, and was worse on inspiration. The chest pain mostly resolved within 3 hours, but pt continued to endorse mild discomfort with deep inspiration. Pt denied trauma, recent travel, lower extremity swelling or pain, infectious symptoms. He never experienced chest pain like this before. \n\nOn arrival to the floor, patient endorsed the above history. Additionally, he noted having a decreased appetite the morning of admission. He did not eat anything the morning prior to arrival to the ED, but had been drinking water. Pt says that he did take his normal AM dose of fludrocortisone and hydrocortisone. He also notes that he had difficulty sleeping for three nights prior to admission. He denies recent stressors. He also denies diarrhea, vomiting, fever, chills, cough. Pt says he started feeling better once he was in the ED, and was able to eat a grilled cheese sandwich . \n\nREVIEW OF SYSTEMS:\n==================\nPer HPI, otherwise, 10-point review of systems was within normal limits.\n", + "input3": "Back pain\nAbnormal weight loss\n", + "input4": "Mother and maternal aunt with breast cancer. Father with DM and liver cancer. Denies family history of autoimmune disorders or anemia. \n", + "input5": "Temp: 96.2 HR: 90 BP: 100/62 Resp: 14 O2 Sat: 99\nGENERAL: Alert and interactive. In no acute distress.\nHEENT: PERRL, EOMI. Sclera anicteric and without injection. MMM.\nNECK: No cervical lymphadenopathy. \nCARDIAC: Regular rhythm, normal rate. Audible S1 and S2. No\nmurmurs/rubs/gallops.\nLUNGS: Clear to auscultation bilaterally. No wheezes, rhonchi or rales. No increased work of breathing.\nABDOMEN: Normal bowels sounds, non distended, non-tender. No\norganomegaly.\nEXTREMITIES: No clubbing, cyanosis, or edema. \nSKIN: Warm. Cap refill <2s. Good skin turgor, no tenting. \nNEUROLOGIC: AOx3. Grossly intact.\n", + "input6": "INITIAL LABS: \n=================\n___ 04:19PM BLOOD WBC-9.7 RBC-5.70 Hgb-16.9 Hct-48.2 MCV-85 \nMCH-29.6 MCHC-35.1 RDW-11.9 RDWSD-35.8 Plt ___\n___ 04:19PM BLOOD Neuts-63.4 ___ Monos-11.2 Eos-0.5* Baso-0.3 Im ___ AbsNeut-6.15* AbsLymp-2.34 AbsMono-1.09* AbsEos-0.05 AbsBaso-0.03\n___ 04:19PM BLOOD Plt ___\n___ 04:19PM BLOOD Glucose-81 UreaN-23* Creat-0.8 Na-124* K-5.6* Cl-93* HCO3-19* AnGap-12\n___ 04:19PM BLOOD cTropnT-<0.01\n\n\ncortisol does not increase even when ACTH is given \n\n\nMICRO: \n=================\nUrine Dipstick: unremarkable, nitrites negative\n\nIMAGING\n=================\n\nEKG: sinus rhythm\n \nTECHNIQUE: Chest PA and lateral \nFINDINGS: \nHeart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities. \n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/19102476-DS-1777.json b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/19102476-DS-1777.json new file mode 100644 index 0000000000000000000000000000000000000000..bf352da744b3844b837f811ab83ef71743c260fc --- /dev/null +++ b/Finished/Adrenal Insufficiency/Primary Adrenal Insufficiency/19102476-DS-1777.json @@ -0,0 +1,42 @@ +{ + "Primary Adrenal Insufficiency$Intermedia_3": { + "Failure to increase ACTcortisol after administration is direct evidence of primary adrenal insufficiency$Cause_1": { + "cortisol does not increase even when ACTH is given$Input6": {} + }, + "These drugs are commonly used to treat adrenal insufficiency and indicate that the patient may have known adrenal insufficiency.$Cause_1": { + "fludrocortisone and hydrocortisone$Input2": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Abnormal weight loss is the symptom of adrenal insufficiency$Cause_1": { + "Abnormal weight loss$Input3": {} + }, + "Low sodium is a classic biochemical manifestation of adrenal insufficiency$Cause_1": { + "Na-124$Input6": {} + }, + "High potassium is a classic biochemical manifestation of adrenal insufficiency$Cause_1": { + "K-5.6$Input6": {} + }, + "Hypochloride is classic biochemical manifestations of adrenal insufficiency$Cause_1": { + "Cl-93$Input6": {} + }, + "hypocarbonate is classic biochemical manifestations of adrenal insufficiency$Cause_1": { + "HCO3-19$Input6": {} + }, + "Adrenal insufficiency can cause electrolyte imbalances and fluid distribution abnormalities, which can sometimes cause chest discomfort or pain.$Cause_1": { + "abruptly developed left-sided chest pressure$Input2": {} + }, + "Anorexia is a common symptom of primary adrenal insufficiency and may be related to chronic cortisol deficiency.$Cause_1": { + "decreased appetite$Input2": {} + }, + "Adrenal insufficiency can affect the body's stress response mechanisms, leading to problems such as insomnia.$Cause_1": { + "difficulty sleeping$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "The patient abruptly developed left-sided chest pressure around noon on the day of presentation. The pain radiated to his left shoulder blade and worsened with inspiration. The chest pain mostly resolved within three hours, but the patient continued to experience mild discomfort with deep inspiration. The patient denied any trauma, recent travel, lower extremity swelling or pain, or infectious symptoms. He had never experienced chest pain like this before.\n\nUpon arrival to the floor, the patient confirmed the above history. Additionally, he noted a decreased appetite on the morning of admission. He did not eat anything the morning before arriving at the ED, but had been drinking water. The patient took his usual morning doses of fludrocortisone and hydrocortisone. He also reported having difficulty sleeping for three nights prior to admission but denied recent stressors. The patient denied diarrhea, vomiting, fever, chills, or cough. He mentioned that he started feeling better once he was in the ED and was able to eat a grilled cheese sandwich.\n", + "input3": "Back pain\nAbnormal weight loss\n", + "input4": "Mother and maternal aunt with breast cancer. Father with DM and liver cancer. Denies family history of autoimmune disorders or anemia.\n", + "input5": "Temp: 96.2 HR: 90 BP: 100/62 Resp: 14 O2 Sat: 99\nGENERAL: Alert and interactive. In no acute distress.\nHEENT: PERRL, EOMI. Sclera anicteric and without injection. MMM.\nNECK: No cervical lymphadenopathy. \nCARDIAC: Regular rhythm, normal rate. Audible S1 and S2. No\nmurmurs/rubs/gallops.\nLUNGS: Clear to auscultation bilaterally. No wheezes, rhonchi or rales. No increased work of breathing.\nABDOMEN: Normal bowels sounds, non distended, non-tender. No\norganomegaly.\nEXTREMITIES: No clubbing, cyanosis, or edema. \nSKIN: Warm. Cap refill <2s. Good skin turgor, no tenting. \nNEUROLOGIC: AOx3. Grossly intact.\n", + "input6": "INITIAL LABS: \n=================\n___ 04:19PM BLOOD WBC-9.7 RBC-5.70 Hgb-16.9 Hct-48.2 MCV-85 \nMCH-29.6 MCHC-35.1 RDW-11.9 RDWSD-35.8 Plt ___\n___ 04:19PM BLOOD Neuts-63.4 ___ Monos-11.2 Eos-0.5* Baso-0.3 Im ___ AbsNeut-6.15* AbsLymp-2.34 AbsMono-1.09* AbsEos-0.05 AbsBaso-0.03\n___ 04:19PM BLOOD Plt ___\n___ 04:19PM BLOOD Glucose-81 UreaN-23* Creat-0.8 Na-124* K-5.6* Cl-93* HCO3-19* AnGap-12\n___ 04:19PM BLOOD cTropnT-<0.01\n\n\ncortisol does not increase even when ACTH is given \n\n\nMICRO: \n=================\nUrine Dipstick: unremarkable, nitrites negative\n\nIMAGING\n=================\n\nEKG: sinus rhythm\n \nTECHNIQUE: Chest PA and lateral \nFINDINGS: \nHeart size is normal. The mediastinal and hilar contours are normal. The pulmonary vasculature is normal. Lungs are clear. No pleural effusion or pneumothorax is seen. There are no acute osseous abnormalities.\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/11698212-DS-3.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/11698212-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..1e7a905d40e6ee41b526a40878e3a37a3918d8e4 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/11698212-DS-3.json @@ -0,0 +1,33 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "This indicates that cortisol levels are abnormally low (0.5) in the morning, which is typically below the normal range. ACTH stimulation testing shows an increase in cortisol levels after administration of ACTH, which may indicate a possible problem at the level of the hypothalamic-pituitary-adrenal axis in the adrenal gland's response to ACTH.$Cause_1": { + "An AM cortisol returned at 0.5. A stim test find that cortisol increases when ACTH is given.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Abdominal pain is a common symptom in many endocrine disorders, especially when associated with adrenal dysfunction. The pain may be dull or acute.$Cause_1": { + "Abdmonial pain$Input1": {} + }, + "Tachycardia may be caused by a stress response in the body, where the heart beats faster in response to pain or other discomfort. When the adrenal glands are underactive, the body does not produce enough corticosteroids to respond to stress, which may lead to tachycardia.$Cause_1": { + "HR 107$Input2": {} + }, + "Electrolyte imbalances, especially hyponatremia and hypokalemia, are typical symptoms of adrenal insufficiency because adrenal cortex hormones regulate the balance of sodium and potassium in the body.$Cause_1": { + "NA 129, K 3.2$Input2": {} + }, + "The patient was taking prednisone, a synthetic corticosteroid used to treat adrenal insufficiency.$Cause_1": { + "taking her prednisone$Input2": {} + }, + "Hypothyroidism may co-occur with adrenal insufficiency because the functions of different glands of the endocrine system often influence each other.$Cause_1": { + "hypothyroidism$Input3": {} + }, + "Tachycardia may be related to abnormal hormone levels in the body$Cause_1": { + "tachycardic$Input5": {} + } + } + }, + "input1": "Abdmonial pain\n", + "input2": " Patient was seen in clinic and was found to be tachycardic with HR 107, but with significant epigastric tenderness and mild rebound. She describes the pain as a tightness that is constant and does not go away . It is rated a ___. She denies any worsening with food/drink. She denies vomiting/diarrhea, her last bm was 2pm. Denies any blood or melena. Of note, patient has been taking her prednisone as scheduled (7.5mg daily) but has not increased the dose. Patient has chronic leukocytosis upon review of OMR. In the ED, initial vitals were: 98 94 142/90 18 98% RA \n - Labs were significant for WBC 20.4, H/H ___, Plt 461, NA 129, K 3.2, Cr 1.1, normal LFTs and lipase. Normal coags. Lactate 2.5 \n - Imaging revealed: RUQ notable for steatosis but no etiology for abdominal pain. \n - The patient was given: 2L NS, Morphine Sulfate 2mg x1, Zofran 4mg x1, Hydrocot 100mg x1, KCl 40mEq, Pantoprazole 40mg IV x1 \n - Upon arrival to the floor, patient reports feeling improved from when she arrived in the ED. She reports chronic abdominal pain, denies current nausea, fevers, chills, sweats. Reports mild dysuria.\n", + "input3": "- Chronic abdominal pain\n- hypothyroidism\n- type 2 diabetes\n- osteopenia\n- hyperlipidemia\n- hypertension\n- degenerative joint disease\n- GERD\n- constipation\n- fibromyalgia\n- obesity \n- asthma\n", + "input4": "Father and sister both with coronary artery disease \n", + "input5": "Vitals: 97.4 148/70 88 18 99% on RA \nGen: ___ speaking, WD/WN, AOx3, NAD but appears \nuncomfortable, Cushingoid with facial plethora and increased \nposterior neck adiposity \nHEENT: MMM, oropharynx clear, EOMI, PERRLA, neck supple with no \n\nLAD/JVD \nCardio: tachycardic, normal S1/S2, no m/r/g \nPulm: CTAB, normal work of breathing \nAbd: soft, tender epigastrium, nondistractable, NABS, no \norganomegaly \nExt: WWP, no c/c/e, pulses 2+ and symmetric \n", + "input6": "___ 05:10PM BLOOD WBC-20.4* RBC-4.95 Hgb-15.1 Hct-45.9* \nMCV-93 MCH-30.5 MCHC-32.9 RDW-12.6 RDWSD-42.7 Plt ___\n___ 05:10PM BLOOD Neuts-56.7 ___ Monos-7.2 Eos-0.8* \nBaso-0.8 Im ___ AbsNeut-11.54* AbsLymp-6.91* AbsMono-1.46* \nAbsEos-0.17 AbsBaso-0.17*\n___ 05:10PM BLOOD Hypochr-NORMAL Anisocy-NORMAL \nPoiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL\n___ 05:10PM BLOOD ___ PTT-30.8 ___\n___ 05:10PM BLOOD Glucose-100 UreaN-15 Creat-1.1 Cl-89* HCO3-25 AnGap-18\n\n1. Echogenic liver consistent with steatosis. Other forms of liver disease and more advanced liver disease including steatohepatitis or significant hepatic fibrosis/cirrhosis cannot be excluded on this study.\n2. No evidence of cholelithiasis or acute cholecystitis.\n3. An AM cortisol returned at 0.5. A stim test find that cortisol increases when ACTH is given.\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12468016-DS-60.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12468016-DS-60.json new file mode 100644 index 0000000000000000000000000000000000000000..25ec00bdfda88555b12a603cc8bd1e85a30f06b7 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12468016-DS-60.json @@ -0,0 +1,60 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "If cortisol levels respond normally to increases in ACTH, this usually indicates that the adrenal glands themselves are functioning normally and there may be a problem with the pituitary gland, resulting in secondary adrenal hormone insufficiency.$Cause_1": { + "Cortisol levels rise in response to ACTH administration.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Adrenal insufficiency may be related to impaired renal function, because renal failure may lead to the accumulation of metabolites in the body, which in turn affects the synthesis and secretion of adrenal hormones. Acute exacerbation of chronic renal failure indicates long-term and ongoing worsening of the patient's kidney function problems$Cause_1": { + "Acute on chronic renal failure$Input1": {} + }, + "Hypotension is one of the common symptoms of adrenal insufficiency because adrenocortical hormones are critical to maintaining stable blood pressure. When adrenocortical hormone secretion is insufficient, vasodilation may occur, resulting in hypotension.$Cause_1": { + "hypotension$Input1": {} + }, + "Hypotension requiring treatment with norepinephrine may be due to adrenocortical insufficiency resulting in insufficient cortisol levels to maintain normal blood pressure$Cause_1": { + "hypotension requiring norepinephrine$Input2": {} + }, + "Low blood pressure and a moderate heart rate may indicate abnormal cortisol levels in the body.$Cause_1": { + "Documented vitals 97.8 91/51 75 18 100%RA$Input2": {} + }, + "Insufficient secretion of adrenal cortical hormones affects the water and electrolyte balance in the body$Cause_1": { + "Repeat electrolytes 10 hours later$Input2": {} + }, + "Decreased urine output may be related to adrenal insufficiency because adrenal hormones regulate fluid balance$Cause_1": { + "he is able to recount making less urine than normal for the past 2 days$Input2": {} + }, + "Insufficient adrenocortical hormones may lead to fluid retention, which can lead to edema$Cause_1": { + "He notes that his legs are much more swollen than normal$Input2": {} + }, + "Having adrenal insufficiency in the past is a potential risk factor$Cause_1": { + "adrenal insufficiency$Input3": {} + }, + "Hyperkalemia is a classic symptom of adrenal insufficiency because cortisol helps regulate electrolyte balance in the body$Cause_1": { + "hyperlipidemia$Input2": {} + }, + "Severe COPD may lead to long-term use of corticosteroids, which may suppress adrenal function in the body.$Cause_1": { + "COPD stage IV$Input3": {} + }, + "Adrenal insufficiency may lead to changes in fluid regulation and vascular responses, which may affect blood pressure stability$Cause_1": { + "158/114 (rechecked 96/41)$Input5": {} + }, + "Chronic fatigue and low energy are common symptoms of adrenal insufficiency.$Cause_1": { + "Rouses appropriately to voice but intermittently falling asleep during interview, oriented, no acute distress$Input5": {} + }, + "Altered mental status (e.g., reduced level of consciousness or impaired cognitive function) may be associated with chronic glucocorticoid deficiency.$Cause_1": { + "unable to participate in complete exam due to mental status$Input5": {} + }, + "These electrolyte abnormalities may be related to adrenal insufficiency, especially insufficient secretion of adrenocortical hormones, which may lead to imbalance of electrolytes in the body.$Cause_1": { + "Na-126* K-7.0* Cl-87* HCO3-19* AnGap-20*$Input6": {} + }, + "Elevated blood urea nitrogen (UreaN-90) and creatinine (Creat-4.0) indicate impaired renal function. Adrenal insufficiency may indirectly affect renal function because adrenocortical hormones play an important role in maintaining blood pressure and renal blood flow.$Cause_1": { + "Glucose-85 UreaN-90*$Input6": {} + } + } + }, + "input1": "Acute on chronic renal failure, hypotension\n", + "input2": "He is with history of HFpEF (60% on TTE), hypertension, hyperlipidemia, DVT/PE on warfarin, CKD, disease s/p total colectomy, and abdominal surgical wound c/b enterocutaneous fistula, recent hospital admission including MICU stay for cellulitis/staph bacteremia and hemorrhagic shock in setting of gluteal hematoma now who now presents with acute on chronic kidney injury, hyperkalemia, hypotension requiring norepinephrine. He had no acute EKG changes felt to be related to hyperkalemia. Given his hypotension, he had a RIJ CVL placed in the ED to continue norepinephrine and was transferred to MICU for further management. In the ED, there was suspicion for cellulitlis given groin rash, and he was started on empiric vanc/zosyn. He received no potassium-lowering therapy.\n \nIn ED initial VS: per ED resident, SBP in 150s and on home O2. Documented vitals 97.8 91/51 75 18 100%RA\nExam: none documented\nLabs significant for: \n\n___\n---------<85\n7.0/___/4.0\n\nCa 9.9 Mg 2.0 Phos 5.2\n14.4>10.1/32.1<706 MCV 99 with 66%N\nRepeat electrolytes 10 hours later, whole blood showed:\nNa 123, K 5.7, Cl 90 TCO2 20, Hgb 11.0\n\nEKG with sinus rhythm, normal axis/intervals, no acute ST elevations/depressions. T waves more pronounced that last ECG, however no severe peaking\n\nPatient was given: Calcium gluconate, vancomycin, zosyn\n\nImaging notable for: \nPortable CXR with mild cardiomegaly, trace bilateral effusions, no major change from CXR\n\nConsults: none\nVS prior to transfer: 94/57 65 18 100%RA\n \nOn arrival to the MICU, he is able to recount making less urine than normal for the past 2 days. He is otherwise feeling fairly well, denying any recent lightheadedness/dizziness, fevers, chills, chest pain, dyspnea, abdominal pain, nausea, vomiting. He notes that his legs are much more swollen than normal.\n", + "input3": " - HTN \n - HLD \n - c/b fistulae w/ abscess, s/p total colectomy and splenectomy with ileo-rectal anastomosis. Previously on Remicade and Humira, stopped due to anaphylaxis and recurrent pneumonias\n - Recurrent C. Diff\n - COPD stage IV \n - Diastolic congestive heart failure \n - DVT: in right popliteal vein & started on 6 months of coumadin; provoked DVT in RUE in secondary to a line. Coumadin stopped s/p GI bleeding incident, with PE prompting reinitiation of coumadin. \n - Reactive arthritis \n - OSA: on CPAP \n - Obesity \n - Depression \n - Osteoarthritis \n - adrenal insufficiency\n", + "input4": "- Mother: CHF; DM; COPD; Angina; HTN\n- Father: ___ DM; stroke\n- GM: CAD; MI\n- Sister #1: DM, Depression\n- Sister #2: Depression; Psoriasis\n- Sister #3: COPD, Asthma\n- 3 sons and 1 daughter: healthy except one son has anal fissure \n- No family hx of IBD or colon cancer \n \n", + "input5": "VITALS: 158/114 (rechecked 96/41), 82 12 96%4L\nGENERAL: Rouses appropriately to voice but intermittently falling asleep during interview, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple, JVP difficult to assess given habitus, no LAD \nLUNGS: Distant breath sounds, minimal wheezing\nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, gallops (distant heart sounds) \nABD: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. 4cm enterocutaneous fistula with small brown residue, no purulent output. Ostomy with loose brown stool. \nEXT: 2+ pitting edema to bilateral thighs\nSKIN: many areas of weeping and bullous edematous changes, see abd exam for fistula\nNEURO: unable to participate in complete exam due to mental status\n", + "input6": "___ 08:34PM BLOOD WBC-14.4* RBC-3.24* Hgb-10.1* Hct-32.1* MCV-99* MCH-31.2 MCHC-31.5* RDW-15.7* RDWSD-56.3* Plt ___\n___ 08:34PM BLOOD Neuts-66.3 ___ Monos-6.0 Eos-2.9 Baso-0.9 NRBC-0.1* Im ___ AbsNeut-9.53* AbsLymp-3.14 AbsMono-0.86* AbsEos-0.42 AbsBaso-0.13*\n___ 03:15AM BLOOD ___ PTT-32.0 ___\n___ 10:00AM BLOOD Glucose-85 UreaN-90* Creat-4.0*# Na-126* K-7.0* Cl-87* HCO3-19* AnGap-20*\n___ 10:00AM BLOOD Calcium-9.9 Phos-5.2* Mg-2.0\n___ 08:39PM BLOOD Glucose-111* Na-123* K-5.7* Cl-90* calHCO3-20*\n___ 08:39PM BLOOD Hgb-11.0* calcHCT-33\n\nMICROBIOLOGY\n============\nBLOOD CULTURE (___): NGTD\nURINE CULTURE (Final: NO GROWTH. SPUTUM GRAM STAIN (Final: >25 PMNs and >10 epithelial cells/100X field. Gram stain indicates extensive contamination with upper respiratory\n\nIMAGING:\n========\nCXR (___)\nIMPRESSION:\n1. Right internal jugular central venous catheter tip projects over the cavoatrial junction. \n2. Worsening right lower lung atelectasis or consolidation. \n\nTTE (___)\nThe estimated right atrial pressure is ___ mmHg. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. No masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. No masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: No vegetations or clinically-significant regurgitant valvular disease seen (suboptimal-quality study). Normal global and regional biventricular systolic function. In presence of high clinical suspicion, absence of vegetations on transthoracic echocardiogram does not exclude endocarditis. \n\nRENAL US (___)\nIMPRESSION:\nNo hydronephrosis. \nCortisol levels rise in response to ACTH administration.\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12468016-DS-6000.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12468016-DS-6000.json new file mode 100644 index 0000000000000000000000000000000000000000..40a4a212da39e42d7370e8d0349ef74bea0d65f5 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12468016-DS-6000.json @@ -0,0 +1,57 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "If cortisol levels respond normally to increases in ACTH, this usually indicates that the adrenal glands themselves are functioning normally and there may be a problem with the pituitary gland, resulting in secondary adrenal hormone insufficiency.$Cause_1": { + "Cortisol levels rise in response to ACTH administration.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Adrenal insufficiency may be related to impaired renal function, because renal failure may lead to the accumulation of metabolites in the body, which in turn affects the synthesis and secretion of adrenal hormones. Acute exacerbation of chronic renal failure indicates long-term and ongoing worsening of the patient's kidney function problems$Cause_1": { + "Acute on chronic renal failure$Input1": {} + }, + "Hypotension is one of the common symptoms of adrenal insufficiency because adrenocortical hormones are critical to maintaining stable blood pressure. When adrenocortical hormone secretion is insufficient, vasodilation may occur, resulting in hypotension.$Cause_1": { + "hypotension$Input1": {} + }, + "Hypotension requiring treatment with norepinephrine may be due to adrenocortical insufficiency resulting in insufficient cortisol levels to maintain normal blood pressure$Cause_1": { + "hypotension requiring norepinephrine$Input2": {} + }, + "Low blood pressure and a moderate heart rate may indicate abnormal cortisol levels in the body.$Cause_1": { + "Documented vitals 97.8 91/51 75 18 100%RA$Input2": {} + }, + "Insufficient secretion of adrenal cortical hormones affects the water and electrolyte balance in the body$Cause_1": { + "Repeat electrolytes 10 hours later$Input2": {} + }, + "Decreased urine output may be related to adrenal insufficiency because adrenal hormones regulate fluid balance$Cause_1": { + "he is able to recount making less urine than normal for the past 2 days$Input2": {} + }, + "Insufficient adrenocortical hormones may lead to fluid retention, which can lead to edema$Cause_1": { + "He notes that his legs are much more swollen than normal$Input2": {} + }, + "Having adrenal insufficiency in the past is a potential risk factor$Cause_1": { + "adrenal insufficiency$Input3": {} + }, + "Severe COPD may lead to long-term use of corticosteroids, which may suppress adrenal function in the body.$Cause_1": { + "COPD stage IV$Input3": {} + }, + "Adrenal insufficiency may lead to changes in fluid regulation and vascular responses, which may affect blood pressure stability$Cause_1": { + "158/114 (rechecked 96/41)$Input5": {} + }, + "Chronic fatigue and low energy are common symptoms of adrenal insufficiency.$Cause_1": { + "Rouses appropriately to voice but intermittently falling asleep during interview, oriented, no acute distress$Input5": {} + }, + "Altered mental status (e.g., reduced level of consciousness or impaired cognitive function) may be associated with chronic glucocorticoid deficiency.$Cause_1": { + "unable to participate in complete exam due to mental status$Input5": {} + }, + "These electrolyte abnormalities may be related to adrenal insufficiency, especially insufficient secretion of adrenocortical hormones, which may lead to imbalance of electrolytes in the body.$Cause_1": { + "Na-126* K-7.0* Cl-87* HCO3-19* AnGap-20*$Input6": {} + }, + "Elevated blood urea nitrogen (UreaN-90) and creatinine (Creat-4.0) indicate impaired renal function. Adrenal insufficiency may indirectly affect renal function because adrenocortical hormones play an important role in maintaining blood pressure and renal blood flow.$Cause_1": { + "Glucose-85 UreaN-90*$Input6": {} + } + } + }, + "input1": "Acute on chronic renal failure, hypotension\n", + "input2": "He is with history of HFpEF (60% on TTE), hypertension, DVT/PE on warfarin, CKD, disease s/p total colectomy, and abdominal surgical wound c/b enterocutaneous fistula, recent hospital admission including MICU stay for cellulitis/staph bacteremia and hemorrhagic shock in setting of gluteal hematoma now who now presents with acute on chronic kidney injury, hyperkalemia, hypotension requiring norepinephrine. He had no acute EKG changes felt to be related to hyperkalemia. Given his hypotension, he had a RIJ CVL placed in the ED to continue norepinephrine and was transferred to MICU for further management. In the ED, there was suspicion for cellulitlis given groin rash, and he was started on empiric vanc/zosyn. He received no potassium-lowering therapy.\n \nIn ED initial VS: per ED resident, SBP in 150s and on home O2. Documented vitals 97.8 91/51 75 18 100%RA\nExam: none documented\nLabs significant for: \n\n___\n---------<85\n7.0/___/4.0\n\nCa 9.9 Mg 2.0 Phos 5.2\n14.4>10.1/32.1<706 MCV 99 with 66%N\nRepeat electrolytes 10 hours later, whole blood showed:\nNa 123, K 5.7, Cl 90 TCO2 20, Hgb 11.0\n\nEKG with sinus rhythm, normal axis/intervals, no acute ST elevations/depressions. T waves more pronounced that last ECG, however no severe peaking\n\nPatient was given: Calcium gluconate, vancomycin, zosyn\n\nImaging notable for: \nPortable CXR with mild cardiomegaly, trace bilateral effusions, no major change from CXR\n\nConsults: none\nVS prior to transfer: 94/57 65 18 100%RA\n\n", + "input3": "- HTN \n - HLD \n - c/b fistulae w/ abscess, s/p total colectomy and splenectomy with ileo-rectal anastomosis. Previously on Remicade and Humira, stopped due to anaphylaxis and recurrent pneumonias\n - Recurrent C. Diff\n - COPD stage IV \n - Diastolic congestive heart failure \n - DVT: in right popliteal vein & started on 6 months of coumadin; provoked DVT in RUE in secondary to a line. Coumadin stopped s/p GI bleeding incident, with PE prompting reinitiation of coumadin. \n - Reactive arthritis \n - OSA: on CPAP \n - Obesity \n - Depression \n - Osteoarthritis \n - adrenal insufficiency\n", + "input4": "- Mother: CHF; DM; COPD; Angina; HTN\n- Father: ___ DM; stroke\n- GM: CAD; MI\n- Sister #1: DM, Depression\n- Sister #2: Depression; Psoriasis\n- Sister #3: COPD, Asthma\n- 3 sons and 1 daughter: healthy except one son has anal fissure \n- No family hx of IBD or colon cancer\n", + "input5": "VITALS: 158/114 (rechecked 96/41), 82 12 96%4L\nGENERAL: Rouses appropriately to voice but intermittently falling asleep during interview, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple, JVP difficult to assess given habitus, no LAD \nLUNGS: Distant breath sounds, minimal wheezing\nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, gallops (distant heart sounds) \nABD: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. 4cm enterocutaneous fistula with small brown residue, no purulent output. Ostomy with loose brown stool. \nEXT: 2+ pitting edema to bilateral thighs\nSKIN: many areas of weeping and bullous edematous changes, see abd exam for fistula\nNEURO: unable to participate in complete exam due to mental status\n", + "input6": "___ 08:34PM BLOOD WBC-14.4* RBC-3.24* Hgb-10.1* Hct-32.1* MCV-99* MCH-31.2 MCHC-31.5* RDW-15.7* RDWSD-56.3* Plt ___\n___ 08:34PM BLOOD Neuts-66.3 ___ Monos-6.0 Eos-2.9 Baso-0.9 NRBC-0.1* Im ___ AbsNeut-9.53* AbsLymp-3.14 AbsMono-0.86* AbsEos-0.42 AbsBaso-0.13*\n___ 03:15AM BLOOD ___ PTT-32.0 ___\n___ 10:00AM BLOOD Glucose-85 UreaN-90* Creat-4.0*# Na-126* K-7.0* Cl-87* HCO3-19* AnGap-20*\n___ 10:00AM BLOOD Calcium-9.9 Phos-5.2* Mg-2.0\n___ 08:39PM BLOOD Glucose-111* Na-123* K-5.7* Cl-90* calHCO3-20*\n___ 08:39PM BLOOD Hgb-11.0* calcHCT-33\n\nMICROBIOLOGY\n============\nBLOOD CULTURE (___): NGTD\nURINE CULTURE (Final: NO GROWTH. SPUTUM GRAM STAIN (Final: >25 PMNs and >10 epithelial cells/100X field. Gram stain indicates extensive contamination with upper respiratory\n\nIMAGING:\n========\nCXR (___)\nIMPRESSION:\n1. Right internal jugular central venous catheter tip projects over the cavoatrial junction. \n2. Worsening right lower lung atelectasis or consolidation. \n\nTTE (___)\nThe estimated right atrial pressure is ___ mmHg. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. No masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. No masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nIMPRESSION: No vegetations or clinically-significant regurgitant valvular disease seen (suboptimal-quality study). Normal global and regional biventricular systolic function. In presence of high clinical suspicion, absence of vegetations on transthoracic echocardiogram does not exclude endocarditis. \n\nRENAL US (___)\nIMPRESSION:\nNo hydronephrosis. \nCortisol levels rise in response to ACTH administration.\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12544251-DS-14.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12544251-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..a21531d4385631537c2d138989eceadfa3c59eb5 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12544251-DS-14.json @@ -0,0 +1,30 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "This indicates that cortisol levels are abnormally low (0.5) in the morning, which is typically below the normal range. ACTH stimulation testing shows an increase in cortisol levels after administration of ACTH, which may indicate a possible problem at the level of the hypothalamic-pituitary-adrenal axis in the adrenal gland's response to ACTH.$Cause_1": { + "An AM cortisol returned at 0.5. A stim test find that cortisol increases when ACTH is given.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "This is one of the common clinical manifestations of adrenaline deficiency. Adrenaline hormones regulate blood pressure, and a lack of these hormones can lead to a drop in blood pressure$Cause_1": { + "Hypotension$Input1": {} + }, + "Orthostatic hypotension is a common finding in adrenal insufficiency because insufficient adrenocortical hormones may cause an imbalance in the body's water and electrolyte balance.$Cause_1": { + "have orthostatic hypotension with supine BP of 110/50 and standing of 60/20.$Input2": {} + }, + "Darkening of vision can be the result of low blood pressure and reduced blood flow to the brain, which can occur in adrenal insufficiency.$Cause_1": { + "had some blackening of his vision during these events$Input2": {} + }, + "Nausea, abdominal bloating, shortness of breath, and anxiety are nonspecific symptoms that may occur in adrenal insufficiency. These symptoms can occur due to an insufficient overall physiological stress response caused by low cortisol levels.$Cause_1": { + "he reports feeling some nausea, abdominal bloating, shortness of breath and anxiety$Input2": {} + }, + "Facial erythema and desquamation between eyebrows may be related to abnormal hormone levels. Especially in the case of cortisol deficiency, various abnormal skin manifestations may occur.$Cause_1": { + "Facial erythema with some scaling across eyebrows$Input5": {} + } + } + }, + "input1": "Hypotension\n", + "input2": "He is a 31 M with complicated history of undiagnosed myopathy who has been recently evaluated for numerous falls. He was seen by his PCP today for routine and noted to have orthostatic hypotension with supine BP of 110/50 and standing of 60/20. Patient was sent to the ER. \n\nOf note, he had 3 \"falls\" in which he says his legs dropped out from under him and he fell. He had some blackening of his vision during these events but no associated chest pain, palpitations or shortness of breath. After one of the episodes, he says his girlfriend found him down on the ground and was \"out\" for a minute. He was seen in the ER for this and evaluated by neurology at that time. He had a thorough examination, including CT head, abdomen, and pelvis, and CXR which were all fine. Patient was initially hypotensive at arrival which later resolved. He was sent home. \n\nIn the ED today, initial vitals were 97.3, 146/81, 64, 16, 100%2L NC. His orthostatics were lying: 55, 148/83; sitting: 61, 162/81 with mild dizziness; standing: 70, 144/83 w/ increased dizziness/no cp/sob. EKG was unremarkable. Patient was admitted to medicine for syncope workup. \n\nOn the medical floor, he reports feeling some nausea, abdominal bloating, shortness of breath and anxiety. He currently denies feeling dizzy, lightheaded or palpitations. \n", + "input3": "+ETOH pancreatitis\n+hypomagnesemia\n+Hyperhomocysteinemia--has IVC filter, on coumadin\n+anemia\n+DVT, Pulmonary Embolism\n+HTN\n+hypercholesterolemia\n", + "input4": "None\n", + "input5": "Vital signs: T 98.7, HR 62, BP 160/77, RR 18, O2 Sat 99% RA \nGen: Well developed, nervous appearing male in NAD \nHEENT: NC/AT. Anicteric sclerae. Moist mucous membranes. OP clear. \nNeck: Supple, no carotid bruits. \nResp: Normal respiratory effort. CTAB. \nCV: RRR. Normal s1 and s2. No M/G/R. \nAbd: +BS. Soft. RUQ and LUQ tenderness without rebound or guarding. No hepatosplenomegaly. \nExt: Warm and ___. DP pulses 2+ bilaterally. \nSkin: Facial erythema with some scaling across eyebrows \nNeuro: A+Ox3.\n", + "input6": "ECHO:\nThe left atrium and right atrium are normal in cavity size. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). The estimated cardiac index is normal (>=2.5L/min/m2). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). There is no left ventricular outflow obstruction at rest or with Valsalva. 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 aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nHEAD CT\nThere is no acute intracranial hemorrhage, major vascular territory infarction, mass effect, or edema. The matter differentiation is well preserved. The ventricles and sulci are normal in size and appearance. The globes and lenses are intact. The visualized paranasal sinuses and mastoid air cells are well aerated. There is no fracture identified. \n \nIMPRESSION: \n1. No acute intracranial abnormality. \n\n\nAn AM cortisol returned at 0.5. A stim test find that cortisol increases when ACTH is given.\n\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12964119-DS-35.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12964119-DS-35.json new file mode 100644 index 0000000000000000000000000000000000000000..d0c093b664562186b4b204ba866dbfb6ea5171cc --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12964119-DS-35.json @@ -0,0 +1,30 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "This indicates that the adrenal response to ACTH is present but inadequate, suggesting that adrenal insufficiency may be central (i.e., brain-related, such as pituitary or hypothalamic)$Cause_1": { + "A stim test find that cortisol increases when ACTH is given.$Input6": {} + }, + "Normal morning cortisol levels in adults should be above 10-20 \u03bcg/dL. Low levels may indicate adrenocortical insufficiency.$Cause_1": { + "An AM cortisol returned at 0.5$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Indicates that the patient has experienced similar situations before$Cause_1": { + "similar to prior \"adrenal crises\"$Input2": {} + }, + "Hydrocortisone is a commonly used corticosteroid used to treat adrenal insufficiency$Cause_1": { + "twice daily hydrocortisone$Input2": {} + }, + "Nausea and palpitations may be manifestations of unmet increased demand for corticosteroids during stress.$Cause_1": { + "Endorses nausea$Input2": {} + }, + "Tachycardia may be a sign of a diminished stress response, which is common in adrenocortical insufficiency.$Cause_1": { + "tachycardic$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "She states that her current symptoms are similar to prior \"adrenal crises\" that she's had in the past (reports these episodes occur approx. q month until her last episode in ___.\n\nShe was in her usual state of health and taking her twice daily hydrocortisone as prescribed (took 40mg PO this morning but has not yet taken 20mg ___ dose). This morning she woke up feeling \"unwell\" with mild abdominal and back pain. Endorses nausea but no vomiting. Has occasional palpitations but no CP or SOB. Denies contractions, VB, LOF, dysuria, hematuria, RUQ/epigastric pain, vision changes. \n", + "input3": "- Labs O+/Abs-/HBsAg-/HIV-/RPRNR/GBS unk\n- LR NIPT\n- FFS wnl\n- US ___ 93%ile\n", + "input4": "None\n", + "input5": "___ 18:59BP: 133/81 (92)\n___ ___: 117\n___ 19:00Temp.: 99.0\u00b0F\n___ 19:00Resp.: 20 / min\n___ 19:00MSpO2: 99%\n\n___ 21:40Glucose POC: 110 mg/dl\n___ 07:08Glucose POC: 97 mg/dl\n\nGen uncomfortable appearing\nCV regular rhythm, tachycardic\nPulm nl respiratory effort\nAbd soft, diffusely minimally TTP\nExt no calf tenderness/edema\n\nFHT 130/mod var/+accels/-decels\nToco flat\n\nDischarge:\n___ ___: 103\n___ 06:37BP: 135/76 (91)\n___ ___: 109\n___ 06:41Temp.: 98.6\u00b0F\n\nGen: [x] NAD\nResp: [x] No evidence of respiratory distress\nAbd: [x] soft [x] non-tender \nExt: [x] no edema [x] non-tender\n", + "input6": "___ 09:00PM BLOOD WBC-11.5* RBC-3.05* Hgb-8.4* Hct-26.3* \nMCV-86 MCH-27.5 MCHC-31.9* RDW-17.0* RDWSD-53.0* Plt ___\n___ 09:00PM BLOOD Neuts-85.6* Lymphs-9.7* Monos-3.5* \nEos-0.3* Baso-0.1 Im ___ AbsNeut-9.87* AbsLymp-1.12* \nAbsMono-0.40 AbsEos-0.04 AbsBaso-0.01\n___ 09:00PM BLOOD Glucose-95 UreaN-6 Creat-0.5 Na-138 K-4.1 \nCl-102 HCO3-21* AnGap-15\n___ 09:00PM BLOOD Calcium-8.2* Phos-4.0 Mg-1.7\n___ 08:40PM URINE Color-Yellow Appear-Hazy* Sp ___\n___ 08:40PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-40* Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG*\n___ 08:40PM URINE RBC-5* WBC-9* Bacteri-FEW* Yeast-NONE \nEpi-5\n\nAn AM cortisol returned at 0.5. A stim test find that cortisol increases when ACTH is given.\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12964119-DS-3555.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12964119-DS-3555.json new file mode 100644 index 0000000000000000000000000000000000000000..ce4b4f341dad98e35a0b56184a8398122e68896c --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/12964119-DS-3555.json @@ -0,0 +1,30 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "This indicates that the adrenal response to ACTH is present but inadequate, suggesting that adrenal insufficiency may be central (i.e., brain-related, such as pituitary or hypothalamic)$Cause_1": { + "A stim test find that cortisol increases when ACTH is given.$Input6": {} + }, + "Normal morning cortisol levels in adults should be above 10-20 \u03bcg/dL. Low levels may indicate adrenocortical insufficiency.$Cause_1": { + "An AM cortisol returned at 0.5$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Indicates that the patient has experienced similar situations before$Cause_1": { + "similar to previous \"adrenal crises\"$Input2": {} + }, + "Hydrocortisone is a commonly used corticosteroid used to treat adrenal insufficiency$Cause_1": { + "twice-daily hydrocortisone$Input2": {} + }, + "Nausea and palpitations may be manifestations of unmet increased demand for corticosteroids during stress.$Cause_1": { + "endorses nausea$Input2": {} + }, + "Tachycardia may be a sign of a diminished stress response, which is common in adrenocortical insufficiency.$Cause_1": { + "tachycardic$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "She states that her current symptoms are similar to previous \"adrenal crises\" she has experienced in the past, which typically occur approximately once a month, with the last episode occurring in ___.\n\nShe was in her usual state of health and taking her prescribed twice-daily hydrocortisone (took 40mg PO this morning but has not yet taken the 20mg ___ dose). This morning, she woke up feeling \"unwell\" with mild abdominal and back pain. She endorses nausea but has not vomited. She experiences occasional palpitations but no chest pain or shortness of breath. She denies experiencing contractions, vaginal bleeding, loss of fluid, dysuria, hematuria, right upper quadrant or epigastric pain, or vision changes.\n\n\n\n\n\n\n\n", + "input3": "- Labs O+/Abs-/HBsAg-/HIV-/RPRNR/GBS unk\n- LR NIPT\n- FFS wnl\n- US ___ 93%ile\n", + "input4": "None\n", + "input5": "___ 18:59BP: 133/81 (92)\n___ ___: 117\n___ 19:00Temp.: 99.0\u00b0F\n___ 19:00Resp.: 20 / min\n___ 19:00MSpO2: 99%\n\n___ 21:40Glucose POC: 110 mg/dl\n___ 07:08Glucose POC: 97 mg/dl\n\nGen uncomfortable appearing\nCV regular rhythm, tachycardic\nPulm nl respiratory effort\nAbd soft, diffusely minimally TTP\nExt no calf tenderness/edema\n\nFHT 130/mod var/+accels/-decels\nToco flat\n\nDischarge:\n___ ___: 103\n___ 06:37BP: 135/76 (91)\n___ ___: 109\n___ 06:41Temp.: 98.6\u00b0F\n\nGen: [x] NAD\nResp: [x] No evidence of respiratory distress\nAbd: [x] soft [x] non-tender \nExt: [x] no edema [x] non-tender\n", + "input6": "___ 09:00PM BLOOD WBC-11.5* RBC-3.05* Hgb-8.4* Hct-26.3* \nMCV-86 MCH-27.5 MCHC-31.9* RDW-17.0* RDWSD-53.0* Plt ___\n___ 09:00PM BLOOD Neuts-85.6* Lymphs-9.7* Monos-3.5* \nEos-0.3* Baso-0.1 Im ___ AbsNeut-9.87* AbsLymp-1.12* \nAbsMono-0.40 AbsEos-0.04 AbsBaso-0.01\n___ 09:00PM BLOOD Glucose-95 UreaN-6 Creat-0.5 Na-138 K-4.1 \nCl-102 HCO3-21* AnGap-15\n___ 09:00PM BLOOD Calcium-8.2* Phos-4.0 Mg-1.7\n___ 08:40PM URINE Color-Yellow Appear-Hazy* Sp ___\n___ 08:40PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-40* Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG*\n___ 08:40PM URINE RBC-5* WBC-9* Bacteri-FEW* Yeast-NONE \nEpi-5\n\nAn AM cortisol returned at 0.5. A stim test find that cortisol increases when ACTH is given.\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/16003330-DS-18.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/16003330-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..936c412fe343e868601ced7182947621ca8208a8 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/16003330-DS-18.json @@ -0,0 +1,27 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "ACTH stimulation testing shows an increase in cortisol levels after administration of ACTH, which may indicate a possible problem at the level of the hypothalamic-pituitary-adrenal axis in the adrenal gland's response to ACTH.$Cause_1": { + "A stim test find that cortisol increases when ACTH is given.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Adrenal insufficiency causes the body to have abnormally low levels of cortisol. Cortisol is a hormone that helps regulate blood pressure and cardiovascular function, and low cortisol levels can cause a drop in blood pressure, which can cause dizziness or lightheadedness.$Cause_1": { + "Lightheadedness$Input1": {} + }, + "Dizziness may be due to orthostatic hypotension, a sudden drop in blood pressure when standing up, which may be related to insufficient secretion of adrenal cortex hormones, as these hormones help regulate blood pressure and blood volume.$Cause_1": { + "intermittent lightheadedness$Input2": {} + }, + "Sudden blacking out of vision may be due to a temporary lack of blood flow to the brain, which can also be associated with low blood pressure, further supporting the possibility of adrenal insufficiency.$Cause_1": { + "vision changes, described as vision \"going black\"$Input2": {} + }, + "Significant weight loss without an obvious cause may be related to chronic conditions such as adrenal insufficiency, which can affect metabolism and appetite.$Cause_1": { + "20 pound weight loss$Input2": {} + } + } + }, + "input1": "Lightheadedness\n", + "input2": "Patient states that over the past 3 months he has had intermittent lightheadedness occurring a few seconds after he stands up and starts walking. It lasts for a second and he has associated vision changes, described as vision \"going black\". \nThe vision changes then resolves completely. He has not syncopized during this time he has no chest pain, shortness of breath, or abdominal pain. He endorses associated nausea but denies vomiting. Denies family history of sudden cardiac death. Additionally, he reports a 20 pound weight loss over the past 12 months that was unintentional. He denies cough, night sweats, history of incarceration, hemoptysis, recent travel, or lower extremity swelling. \n\nHe was seen by his primary care doctor multiple times and has follow-up with a cardiologist. He went back to his primary care doctor today prior to presentation and was found to be hypotensive, which prompted his referral to the emergency department. \n", + "input3": "Hemochromatosis carrier\n", + "input4": "Father - hemochromatosis \n___ great-grandfather - colon cancer\n___ grandfather - CAD s/p CABG\nPaternal uncle - heart transplant (unsure why)\nMaternal aunt/grandmother - breast cancer\nMaternal aunt - pancreatic cancer\n", + "input5": "VITALS: T 98.2 BP 113/62 HR 73 RR 14 O2 100% RA \nGENERAL: Well-appearing, well-groomed young man, resting\ncomfortably in bed, in NAD\nHEENT: NC/AT, EOMI, PERRL, anicteric sclera, MMM\nNECK: Supple, no JVD\nHEART: RRR, normal S1/S2, no m/r/g\nLUNGS: CTAB, breathing comfortably on RA without use of \naccessory\nmm, no wheezes/rhonci/rales\nABDOMEN: Soft, non-tender, non-distended, active bowel sounds, \nno\norganomegaly\nGU: Testicles without edema or palpable masses, no inguinal\nlympahdenopahy, no penile discharge\nEXTREMITIES: No c/c/e\nSKIN: Warm, well-perfused, no ___\nNEURO: Alert, oriented x3, CN II-XII intact, ___ strength in b/l upper and lower extremities, normal sensation \n", + "input6": "___ 12:12AM BLOOD WBC-7.2 RBC-4.46* Hgb-13.1* Hct-38.0* \nMCV-85 MCH-29.4 MCHC-34.5 RDW-12.5 RDWSD-38.4 Plt ___\n___ 12:12AM BLOOD Neuts-41.3 ___ Monos-7.3 Eos-2.5 \nBaso-0.7 Im ___ AbsNeut-2.98 AbsLymp-3.47 AbsMono-0.53 \nAbsEos-0.18 AbsBaso-0.05\n___ 06:05AM BLOOD Hypochr-NORMAL Anisocy-NORMAL Poiklo-1+* \nMacrocy-NORMAL Microcy-NORMAL Polychr-OCCASIONAL \nOvalocy-OCCASIONAL\n___ 12:12AM BLOOD Plt ___\n___ 12:12AM BLOOD Glucose-99 UreaN-26* Creat-0.9 Na-130* \nK-4.9 Cl-97 HCO3-27 AnGap-6*\n___ 12:12AM BLOOD ALT-66* AST-58* AlkPhos-66 TotBili-0.5\n___ 12:12AM BLOOD Albumin-4.2 Calcium-9.6 Phos-5.2* Mg-1.6\n\nIMAGING\n==========================\nCXR ___\nIMPRESSION: \nNo acute cardiopulmonary process. \n\nRUQUS ___\nIMPRESSION: \n1. No cholelithiasis or sonographic evidence of acute cholecystitis. \n2. No evidence of hepatic lesion. \n3. Mild splenomegaly measuring 13.7 cm. \n\nA stim test find that cortisol increases when ACTH is given.\n\n\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/16379709-DS-6.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/16379709-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..558590b991247287f9e8a52d77af8cef2068d058 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/16379709-DS-6.json @@ -0,0 +1,33 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "ACTH stimulation testing shows an increase in cortisol levels after administration of ACTH, which may indicate a possible problem at the level of the hypothalamic-pituitary-adrenal axis in the adrenal gland's response to ACTH.$Cause_1": { + "A stim test find that cortisol increases when ACTH is given.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "One of the common symptoms of adrenal insufficiency is persistent fatigue or loss of energy.$Cause_1": { + "feels like he never recovered his energy$Input2": {} + }, + "Adrenal insufficiency may lead to energy depletion, making it difficult for the patient to breathe while performing daily activities.$Cause_1": { + "noticed DOE, particularly when walking to work,$Input2": {} + }, + "These symptoms may be related to hypotension, a common finding in adrenal insufficiency.$Cause_1": { + "intermittent dizziness and lightheadedness with standing$Input2": {} + }, + "Significant involuntary weight loss may be a manifestation of adrenal insufficiency because hormonal imbalances affect appetite and metabolism.$Cause_1": { + "20lbs unintentional weight loss$Input2": {} + }, + "Hyponatremia and hyperkalemia, which is because adrenocortical hormone regulates electrolyte balance in the body.$Cause_1": { + "hyponatermia to 121, hyperkalemia to 5.8,$Input2": {} + }, + "Cortisol is an important hormone that is normally secreted by the adrenal glands in response to stress. It affects or regulates many body functions, such as metabolism and immune system response.$Cause_1": { + "low pm cortisol of 0.7$Input2": {} + } + } + }, + "input1": "abnormal labs\n", + "input2": "The patient reports that 1 month ago he had a viral URI that resolved, however he feels like he never recovered his energy. He noticed DOE, particularly when walking to work, which he was able to do with difficulty prior. He is at baseline very athletic. He also noticed intermittent dizziness and lightheadedness with standing, intermittent cramping abdominal pain and a 20lbs unintentional weight loss over the past 2 \nmonths. He reports his appetite is still at baseline but has been limited by his abdominal pain. He endorses nausea at the time of his URI. Given these symptoms he saw his PCP. His PCP ran ___ series of lab notable for TSH 0.21, AlP 76, AST 48, K 5.3. He had a RAIU+S, which showed a homogenous gland with uptake at the upper limit of normal. He was then referred to endocrine for further evaluation.\n \nHe was seen in ___ clinic the day of admission and was initally thought to have resolving thyroditis, and was sent to have several labs checked. Labs from clinic were notable for elevated TSH of 22, low T4 at 3.6 with normal T 3, hyponatermia to 121, hyperkalemia to 5.8, hyperphosphatemia to 5.6, low pm cortisol of 0.7. \n", + "input3": "none\n", + "input4": "Father and sister with Celiac \nMother with ___ \n", + "input5": "Vitals - T 97.5 BP 97/50 P 70 RR 18 10% RA \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera. No proptosis or \nexopthalmos \nNeck: neck supple, non tender, no thyromegally or nodules \nappreciated. No lymphadenopathy. \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding, no hepatosplenomegaly \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing \nor edema \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes \n", + "input6": "\"IMPRESSION: 24 hour uptake of radioiodine at the upper limits of normal. If TSH is suppressed, this finding suggests autonomy, such as with Graves disease.\"\n\nA stim test find that cortisol increases when ACTH is given.\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/18136887-DS-67.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/18136887-DS-67.json new file mode 100644 index 0000000000000000000000000000000000000000..f254c7450e55ca9e439c8d60bbac4b012a678970 --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/18136887-DS-67.json @@ -0,0 +1,30 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "The use of steroids to treat certain syndromes may result in adrenal suppression because exogenous steroids inhibit the body's natural production of adrenocortical hormones, a direct factor in secondary adrenal insufficiency.$Cause_1": { + "syndrome while on steroids$Input3": {} + }, + "An ACTH stimulation test was performed, and adrenocortical hormone (cortisol) increased after the administration of ACTH. In secondary adrenal insufficiency, ACTH secretion is decreased due to problems with the pituitary gland or hypothalamus, resulting in insufficient adrenal cortical hormone secretion.$Cause_1": { + "A stim test find that cortisol increases when ACTH is given.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Common symptoms of adrenal insufficiency include fatigue and nonspecific abdominal discomfort.$Cause_1": { + "weakness and vague abdominal pain with loose stools persisted$Input2": {} + }, + "The use of hydrocortisone is standard of care for acute adrenal crisis and indicates that physicians consider the possibility of adrenal insufficiency.$Cause_1": { + "pt received: Hydrocortisone 50mg x1 and Dilaudid IV, Zofran and NS$Input2": {} + }, + "Rapid improvement after hydrocortisone treatment further supports the diagnosis of adrenal insufficiency$Cause_1": { + "arrival to the floor she reports significant improvement from her initial presentation$Input2": {} + }, + "Hypothyroidism after thyroiditis may lead to an imbalance in the body's overall hormone balance, affecting the normal production and secretion of adrenal cortical hormones, which may in turn affect adrenal function.$Cause_1": { + "Thyroiditis now w/ Hypothyroidism$Input3": {} + } + } + }, + "input1": "N/A\n", + "input2": "She commented that managing her medicines seems to occupy a great deal of concentration, and since grieving for the dog, she has felt like she has \"gotten behind\" with dose adjustments of her fludricortisone, predisone, and anti-hypertensives. Her weakness and vague abdominal pain with loose stools persisted to the point that she came into the ED to for further evaluation. \n\n. \n-In the ED, initial VS: 97.3 87 119/85 16 100% RA \n-The pt underwent: no studies\n-The pt received: Hydrocortisone 50mg x1 and Dilaudid IV, Zofran and NS\n-The pt's case was discussed with ___ per report of the ED \nresident \n-Vitals prior to transfer: 98.9po 81 111/52 18 98%ra \n. \nOn arrival to the floor she reports significant improvement from her initial presentation. She feels thirsty, but otherwise her headache and abdominal pain have resolved since treatment. She denies any underlying illness: coughing, sneezing, sick contacts, fevers, chills, dysuria.\n.\nROS: Denies fever, chills, night sweats, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, constipation, BRBPR, melena, hematochezia, dysuria, hematuria.\n", + "input3": "1. Addison's disease \n2. ___'s Thyroiditis now w/ Hypothyroidism - ___\n3. ___ syndrome while on steroids \n4. Benign Hypertension (inactive) \n5. Migraine headache - started in ___ grade, improvement after menopause, last flair a few months ago\n6. Microscopic colitis (lymphocytic and collagenous colitis)- neg IBD serology. - dx in ___\n7. Depression/anxiety \n8. Osteoarthritis \n9. Spondylolisthesis status-post lumbar fusion - ___ \n", + "input4": "Mother - rheumatoid arthritis \nFather - CAD with first MI at age ___ s/p 2x CABG, ___ MIs in total; died of mesothelioma \n2 sisters with breast cancer in ___. She has never been tested for BRCA. \n", + "input5": "VS: 96.1 122/80 87 20 97% RA\nGENERAL: Well-appearing woman in NAD, comfortable, appropriate. \n\nHEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear. \nNECK: Supple, no thyromegaly, no JVD, no carotid bruits. \nHEART: RRR, no MRG, nl S1-S2. \nLUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored. \n \nABDOMEN: Soft/ND, mildly tender to palpation diffusely no masses or HSM, no rebound/guarding. \nEXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses. \nSKIN: No rashes or lesions. Dark skin tone without involvement of palmar creases \nLYMPH: No cervical LAD. \nNEURO: Awake, A&Ox3, CNs II-XII grossly intact, muscle strength ___ throughout, steady gait.\n", + "input6": "133 101 17 \n-------------<90 \n4.9 18 1.1 \nestGFR: 52/63 (click for details) \n.\nUCG: Negative \n.\n13.9 \n7.7>---<415\n40.3 \nN:49.9 L:39.5 M:5.1 E:4.2 Bas:1.3 \n. \nU/A: Within normal limits\nMICROBIOLOGY: None\n. \nSTUDIES: None\n\nA stim test find that cortisol increases when ACTH is given.\n" +} \ No newline at end of file diff --git a/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/18136887-DS-78.json b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/18136887-DS-78.json new file mode 100644 index 0000000000000000000000000000000000000000..94c2035d6e1596d5a587b9cf907495f5035a366d --- /dev/null +++ b/Finished/Adrenal Insufficiency/Secondary Adrenal Insufficiency/18136887-DS-78.json @@ -0,0 +1,36 @@ +{ + "Secondary Adrenal Insufficiency$Intermedia_3": { + "ACTH stimulation testing shows an increase in cortisol levels after administration of ACTH, which may indicate a possible problem at the level of the hypothalamic-pituitary-adrenal axis in the adrenal gland's response to ACTH.$Cause_1": { + "A stim test find that cortisol increases when ACTH is given.$Input6": {} + }, + "Suspected Adrenal Insufficiency$Intermedia_2": { + "Addison's disease is a primary adrenal insufficiency, which is itself a manifestation of insufficient adrenal cortex hormones.$Cause_1": { + "Addison's disease$Input2": {} + }, + "Generalized weakness is one of the common symptoms of adrenal insufficiency. Due to the reduced secretion of adrenal cortex hormones, patients may feel persistent fatigue and decreased physical strength, which affects daily life activities.$Cause_1": { + "generalized weakness$Input1": {} + }, + "These symptoms may be related to a further decline in adrenocortical hormones, especially in the setting of chronic Addison's disease.$Cause_1": { + "feeling \"wonky\" with generalized weakness and fatigue with muscle cramping$Input2": {} + }, + "These electrolyte abnormalities are typical of adrenal insufficiency and may indicate adrenocortical hormone insufficiency.$Cause_1": { + "Na 127, K 6.8$Input2": {} + }, + "This may be a manifestation of general fatigue and decreased strength caused by insufficient adrenal cortex hormones.$Cause_1": { + "shortness of breath with exertion$Input2": {} + }, + "Dryness of the oral mucosa. Hypofunction of the adrenal glands may cause problems with the body's water regulation, leading to dryness symptoms.$Cause_1": { + "MM dry$Input5": {} + }, + "Hypothyroidism may co-occur with adrenal insufficiency as they both involve dysfunction of the endocrine system.$Cause_1": { + "HYPOTHYROIDISM$Input3": {} + } + } + }, + "input1": "generalized weakness\n", + "input2": "___ w/hx of Addison's disease who presents for fatigue, cramping, abnormal labs. She has been feeling \"wonky\" with generalized weakness and fatigue with muscle cramping over the last several days. She had a UTI and was seen in the ED on ___ for this; she was given a 1 week course of cefpodoxime which she just finished yesterday. (Urine cx came back with pan-sensitive E.coli). At that time, her labs were sig for Na 127, K 6.8 (although hemolyzed). She received fluids and was sent home. She didn't take a higher dose of steroids at the time. However, since that time she feels she never quite recovered in terms of fatigue and weakness, although the urinary symptoms are gone. \n\nShe does report some shortness of breath with exertion like going up stairs. There was no e/o upper tract disease at the time. She was seen by her PCP yesterday who drew labs and found her K to be 5.8, so in combination with her symptoms, sent her to the ED. She took twice her usual dose of prednisone today (doubled to 10mg from 5mg). She denies chest pain, cough, fevers, chills, nausea vomiting and diarrhea. \n", + "input3": "GASTROESOPHAGEAL REFLUX \nHYPERCHOLESTEROLEMIA \nHYPOTHYROIDISM \nIRON DEFICIENCY ANEMIA \nOSTEOPENIA \nSPINAL STENOSIS \nLACTOSE INTOLERANCE \nRHEUMATOID ARTHRITIS \nH/o COLLAGENOUS COLITIS\n", + "input4": "Per OMR and confirmed w/pt: 2 sisters w/breast cancer, 1 sister w/CAD, mother w/dementia and arthritis, father deceased w/heart disease\n", + "input5": "Vitals: 97.9 130/83 88 20 96% RA\nGeneral: well appearing, nontoxic, NAD\nHEENT: MM dry, EOMI, PERRL, no nystagmus\nNeck: supple\nLungs: CTAB, no w/r/r\nCV: normal rate, reg rhythm, no m/r/g\nAbdomen: Soft, NABS, very mild tenderness over all of abdomen (pt states \"it feels like I need to have a bowel movement\")\nExt: wwp, no c/c/e\nNeuro: no nystagmus. CN II-XII intact grossly. ___ strength UE and ___ b/l.\n", + "input6": "___ 11:30AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-NEG\n___ 11:30AM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 12:00PM WBC-12.1* RBC-3.92* HGB-12.7 HCT-35.7* MCV-91 \nMCH-32.4* MCHC-35.6* RDW-14.1\n___ 12:00PM NEUTS-85.8* LYMPHS-10.3* MONOS-2.3 EOS-1.3 \nBASOS-0.4\n___ 12:00PM CALCIUM-10.1 PHOSPHATE-4.0 MAGNESIUM-1.9\n___ 12:00PM ALT(SGPT)-43* AST(SGOT)-36 ALK PHOS-47 TOT \nBILI-0.2\n___ 12:00PM GLUCOSE-99 UREA N-33* CREAT-1.3* SODIUM-135 \nPOTASSIUM-5.0 CHLORIDE-99 TOTAL CO2-24 ANION GAP-17\n___ 06:57PM URINE HOURS-RANDOM CREAT-19 SODIUM-61 \nPOTASSIUM-26 CHLORIDE-73\n\n A stim test find that cortisol increases when ACTH is given.\n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/11999108-DS-14.json b/Finished/Alzheimer/11999108-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..1e61fb4a7ada0671bcb6cd0b118d19a81bb7cc67 --- /dev/null +++ b/Finished/Alzheimer/11999108-DS-14.json @@ -0,0 +1,54 @@ +{ + "Alzheimer$Intermedia_3": { + "Amyloid deposition detected in frontal and temporal regions, one of the key pathological features of Alzheimer's disease and associated with cognitive deterioration$Cause_1": { + "Amyloid deposition was detected in areas of the frontal and temporal lobes of the brain.$Input6": {} + }, + "The hippocampus and frontal lobes were significantly atrophied. Atrophy in these areas is typical of Alzheimer's disease and is closely associated with loss of memory and cognitive function.$Cause_1": { + "Significant atrophy of hippocampus and frontal lobes$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "In Alzheimer's disease, this is due to changes in neurotransmitters due to damage and death of nerve cells in the brain.$Cause_1": { + "altered mental status$Input1": {} + }, + "This can manifest as verbal or physical aggression, mood swings, or threats to others. In people with Alzheimer's disease, aggressive behavior may be linked to damage to areas of the brain that regulate emotion.$Cause_1": { + "aggressive behavior$Input1": {} + }, + "These symptoms may indicate impaired cognitive and emotional control, a common finding in Alzheimer's disease.$Cause_1": { + "He now returns for reports of aggressive behavior, screaming and worsening mental status.$Input2": {} + }, + "Behavioral problems and resistant behaviors may be related to the cognitive decline and impaired understanding that are typical symptoms of Alzheimer's disease.$Cause_1": { + "becoming increasingly difficult to care for over the past week, refusing meds and requiring increased sedatives.$Input2": {} + }, + "These findings help rule out other possible causes of cognitive and behavioral symptoms, such as structural brain abnormalities or infections, making symptoms more likely to be related to Alzheimer's disease or other cognitive disorders.$Cause_1": { + "head CT neg, CXR showed no signs of infection, and EKG unchanged.$Input2": {} + }, + "This is one of the known risk factors for Alzheimer's disease because long-term high blood pressure can damage blood vessels in the brain.$Cause_1": { + "Hypertension$Input3": {} + }, + "This may indicate a widespread cognitive decline that may be a precursor to Alzheimer's disease.$Cause_1": { + "Cognitive disorder not otherwise specified$Input3": {} + }, + "Falls and subsequent head injuries may be associated with cognitive decline, which may be a marker of the development of Alzheimer's disease.$Cause_1": { + "Recent SDH after fall$Input3": {} + }, + "Changes in sleep patterns. People with Alzheimer's disease may experience changes in their sleep cycles, such as circadian reversal or sleep disturbances.$Cause_1": { + "sleeping comfortably, arouses$Input5": {} + }, + "Degree of cognitive orientation. This information suggests that the patient is cognitively oriented at least part of the time, which is important in assessing his or her cognitive status because a major symptom of Alzheimer's disease is cognitive decline.$Cause_1": { + "oriented to person$Input5": {} + }, + "Anemia is associated with an increased risk of Alzheimer's disease because it can affect the blood supply and oxygen supply to the brain.$Cause_1": { + "RBC-3.26* Hgb-9.7* Hct-30.7*$Input6": {} + }, + "Anemia associated with an increased risk of Alzheimer's disease because it can affect the blood supply and oxygen supply to the brain.$Cause_1": { + "RBC-3.80* Hgb-11.8* Hct-35.9*$Input6": {} + } + } + }, + "input1": "altered mental status/aggressive behavior \n", + "input2": "This is an 65 yo with aortic valve replacement, HTN, afib not on anticoagulation, and 3 recent admissions over the past month, most recently for pneumonia, c. diff, and delirium. He now returns for reports of aggressive behavior, screaming and worsening mental status. he was becoming increasingly difficult to care for over the past week, refusing meds and requiring increased sedatives. \n\nIn ED, 97.6, 73 142/86, 18 100%RA. head CT neg, CXR showed no signs of infection, and EKG unchanged. he received haldol 0.5 mg IV X1. Psychiatry was consulted in ED. \n \nOn arrival to the floor, patient not able to provide history. He denies pain. \n", + "input3": "1. Recent SDH after fall ___ \n2. Aortic valve replacement - porcine \n3. Atrial flutter \n4. Hypertension \n5. Hypercholesterolemia \n6. Right focal carcinoma in situ status post hemicolectomy in \n7. Inguinal hernia repair \n8. BPH \n9. Right upper extremity amputation due to trauma \n10. Cognitive disorder not otherwise specified \n11. Oppositional defiant disorder \n12. Multilevel DJD in the lower thoracic and lumbar spine \n13. L5-S1 disc herniation with left lumbosacral radiculopathy \n", + "input4": "Non-contributory.\n", + "input5": "PE: 98.4 121/86 103 18 96%RA O2 Sats \nGen: sleeping comfortably, arouses \nHEENT: Clear OP, MM dry \nNECK: Supple, No LAD, No JVD \nCV: RR, NL rate. NL S1, S2. ___ systolic murmur \nLUNGS: CTA ant and laterally \nABD: Soft, NT, ND. NL BS. No HSM \nEXT: No edema \nSKIN: tatoos, R arm amputation \nNEURO: moves 3 extremities. s/p right arm amputation. oriented to person. \n", + "input6": "___ 07:20AM BLOOD WBC-6.1 RBC-3.26* Hgb-9.7* Hct-30.7* MCV-94 MCH-29.8 MCHC-31.6 RDW-13.4 Plt ___\n___ 05:00PM BLOOD WBC-7.9 RBC-3.80* Hgb-11.8* Hct-35.9* MCV-94 MCH-31.0 MCHC-32.9 RDW-14.0 Plt ___\n___ 05:00PM BLOOD ___ PTT-25.4 ___\n___ 07:20AM BLOOD Glucose-94 UreaN-26* Creat-1.0 Na-143 K-3.9 Cl-107 HCO3-29 AnGap-11\n___ 07:35AM BLOOD Calcium-8.8 Phos-3.1 Mg-2.2\n___ 05:00PM BLOOD Digoxin-1.3\n___ 05:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 06:12PM URINE Color-Yellow Appear-Clear Sp ___\n___ 06:12PM URINE Blood-NEG Nitrite-NEG Protein-TR Glucose-TR Ketone-TR Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG\n___ 06:12PM URINE ___ WBC->50 Bacteri-FEW Yeast-FEW \n\nMICROBIOLOGY:\n___ 5:00 pm BLOOD CULTURE #2. \n Blood Culture, Routine (Final ___: NO GROWTH.\n\n___ 5:49 pm URINE Source: ___. \n URINE CULTURE (Final ___: \n YEAST. 10,000-100,000 ORGANISMS/ML..\n\n___ 2:15 pm URINE Source: ___. \n\n \nIMAGING:\n___ CT HEAD:\nIMPRESSION:\nNo evidence of intracranial hemorrhage. No change compared to \n___.\n\n___ CXR:\nIMPRESSION:\nNo pneumonia or CHF.\n\n___ ECG:\nAtrial fibrillation with moderate ventricular response. Left axis deviation consistent with left anterior hemiblock. Non-specific ST-T wave abnormalities. Compared to the previous tracing of ___ atrial fibrillation has replaced atrial \nflutter. \n\n___ CXR:\nIMPRESSION: No evidence of acute cardiopulmonary process.\n\n___ MRI:\nSignificant atrophy of hippocampus and frontal lobes\n\n___ PET:\nAmyloid deposition was detected in areas of the frontal and temporal lobes of the brain.\n\n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/12109697-DS-15.json b/Finished/Alzheimer/12109697-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..b7fc0ee819fb19579404d6ed8cfe815bcd2c05ee --- /dev/null +++ b/Finished/Alzheimer/12109697-DS-15.json @@ -0,0 +1,54 @@ +{ + "Alzheimer$Intermedia_3": { + "Failure to return to baseline after an altered mental status may indicate ongoing deterioration in cognitive function, a key feature of Alzheimer's disease.$Cause_1": { + "recent admission for AMS she has never returned to her baseline$Input2": {} + }, + "Chronic microvascular lesions are common in various cardiovascular and cerebrovascular diseases, which are strongly associated with cognitive decline and Alzheimer's disease.$Cause_1": { + "Persistent changes secondary to chronic microvascular \ndisease.$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "Fatigue may be an early symptom of Alzheimer's$Cause_1": { + "Fatigue$Input1": {} + }, + "Weakness refers to decreased muscle strength, which is common in people with Alzheimer's disease$Cause_1": { + "weakness$Input1": {} + }, + "Neurological instability, a common symptom of Alzheimer's disease$Cause_1": { + "altered mental status$Input2": {} + }, + "Increasing weakness may be linked to decreased muscle strength in Alzheimer's disease$Cause_1": { + "gradually worsening weakness$Input2": {} + }, + "Decreased strength and difficulty moving may be associated with impaired motor function in Alzheimer's disease$Cause_1": { + "unable to move the walker forward$Input2": {} + }, + "Blurred vision or perception problems may be a sign of cognitive impairment in Alzheimer's disease$Cause_1": { + "everything seemed kind of cloudy$Input2": {} + }, + "Symptoms of vertigo may indicate a decline in the brain's ability to process information, which could be linked to early symptoms of Alzheimer's disease$Cause_1": { + "vertiginous symptoms$Input2": {} + }, + "The decline in the ability to function independently may be due to the continued decline in cognition and function that is common in patients with Alzheimer's disease.$Cause_1": { + "no longer appropriate for an independent living facility$Input2": {} + }, + "Diabetes has a known link to Alzheimer's disease$Cause_1": { + "DM type 2$Input3": {} + }, + "Hypertension is a risk factor associated with cognitive decline$Cause_1": { + "HTN$Input3": {} + }, + "Hypertension is a risk factor associated with cognitive decline.$Cause_1": { + "BP:144/84$Input5": {} + }, + "High blood sugar levels may point to prediabetes or diabetes, a known risk factor for Alzheimer's disease$Cause_1": { + "Glucose-125*$Input6": {} + } + } + }, + "input1": "Fatigue, weakness\n", + "input2": "Patient is an ___ year old female with a history of HTN, DM type II and a recent admission for altered mental status that resolved on its own, who presents with subjective, gradually worsening weakness for the past day. Prior to presentation to the ER, this morning she was walking down the hall in her independent living facility and became weak, she was found by the staff hunched over her walker unable to move the walker forward. At that time she says that everything seemed kind of cloudy. She says that overall she just feels tired. She has had some vertiginous symptoms, but not particularly associated with her generalized weakness/fatigue. Her neice feels that since her recent admission for AMS she has never returned to her baseline. The niece does say that the staff where her aunt lives feels that she is no longer appropriate for an independent living facility. Patient says she has been eating and drinking well, no cp, shortness of breath, fevers, chills, n/v/d.\n\n", + "input3": "Hx of falls with fractures of her wrists, hip and pelvis \nDM type 2 \nHTN \nhx of breast ca \nosteoperosis \nanxiety \n", + "input4": "N/C\n", + "input5": "Vitals: T:96.3 BP:144/84 P:74 R:18 SaO2:96% on RA \nGENERAL: Pleasant, well appearing elderly caucasian female in NAD \nHEENT: No conjunctival pallor. No scleral icterus. EOMI. MMM. OP clear. Neck Supple, No LAD, No thyromegaly. \nCARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, \nrubs or ___. \nLUNGS: CTAB, good air movement biaterally, khyphotic spine \nABDOMEN: NABS. Soft, NT, ND. No HSM \nEXTREMITIES: trace bilateral edema\nSKIN: scattered SK's on back and abdomen \nNEURO: A&Ox3. Appropriate. CN ___ grossly intact. Preserved sensation throughout. ___ strength throughout. \nPSYCH: Listens and responds to questions appropriately, pleasant\n", + "input6": "___ 01:00PM BLOOD WBC-9.2 RBC-4.17* Hgb-11.6* Hct-37.0 MCV-89 MCH-27.8 MCHC-31.3 RDW-13.1 Plt ___\n___ 01:00PM BLOOD Glucose-125* UreaN-24* Creat-1.0 Na-139 K-4.3 Cl-101 HCO3-25 AnGap-17\n___ 01:00PM BLOOD cTropnT-<0.01\n___ 01:00AM BLOOD CK-MB-NotDone cTropnT-0.01\n___ 07:30AM BLOOD Calcium-9.1 Phos-3.7 Mg-1.8\n\nCT Head: \nIMPRESSION: \n1. No intracranial hemorrhage. No midline shift. \n2. Persistent changes secondary to chronic microvascular \ndisease. \n\nChest X-ray: IMPRESSION: \n1. Elevated left hemidiaphragm. No focal consolidation or pleural effusion seen. \n2. Diffuse osteopenia. Suggestion of vertebral body height loss \nin the mid thoracic region. \n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/12134520-DS-16.json b/Finished/Alzheimer/12134520-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..662574aff078a59988f6d9a4d58e8988156117d0 --- /dev/null +++ b/Finished/Alzheimer/12134520-DS-16.json @@ -0,0 +1,33 @@ +{ + "Alzheimer$Intermedia_3": { + "The hippocampus is a key area of \u200b\u200bthe brain responsible for learning and memory, and its shrinkage is often direct evidence of Alzheimer's disease$Cause_1": { + "Atrophy of the hippocampus region.$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "Anxiety is a common symptom in people with Alzheimer's disease$Cause_1": { + "Agitation$Input1": {} + }, + "Hypertension is a risk factor for dementia, including Alzheimer's disease$Cause_1": { + "hypertension$Input2": {} + }, + "Dementia is one of the main symptoms of Alzheimer's disease$Cause_1": { + "unable to provide a history due to dementia$Input2": {} + }, + "Hitting behavior is not a typical symptom of Alzheimer's disease, but it may occur at some point in the disease course.$Cause_1": { + "attacked another patient at the facility$Input2": {} + }, + "Urinary tract infections are common among older adults and can cause a temporary decline in cognitive function, particularly in patients with cognitive impairment.$Cause_1": { + "being treated for a UTI$Input2": {} + }, + "Patients experience memory impairment and disorientation, typical symptoms of Alzheimer's disease$Cause_1": { + "Alert, confused - at time forgetting the name of her daughter who is at bedside, oriented to self only$Input5": {} + } + } + }, + "input1": "Agitation\n", + "input2": "Ms. ___ is a ___ year old with hypertension, who presents from ___ long term living facility with aggressive behavior. \n\nPatient is unable to provide a history due to dementia. Some history is obtained from her daughter ___, who is at bedside, but she also has limited knowledge of the event. Per ___ and review of records from ___, the patient attacked another patient at the facility \"throwing them against a wall.\" She also tried to choke an aid. This is very much out of character for her, as she is normally quite pleasant. She is currently being treated for a UTI with nitrofurantoin, and according to ___ was near the end of her course. Otherwise, ___ does not know of any other recent medication changes or complaints from the patient. Given this behavior, patient was brought to the ED, though of note received all of her care normally at ___. \n\n", + "input3": "None\n", + "input4": "Reviewed and found to be not relevant to this illness/reason for hospitalization.\n", + "input5": "VITALS: T 98.0, HR 84, BP 138/89, RR 18, 96% RA \nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. Oropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur, no S3, no S4. No JVD.\nRESP: Lungs clear to auscultation with good air movement bilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel\nsounds present. No HSM\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full and symmetric bilaterally in all limbs\nSKIN: Some small scabbed over scars on right arm. Thickened toenails on first toes \nNEURO: Alert, confused - at time forgetting the name of her daughter who is at bedside, oriented to self only, face symmetric, gaze conjugate with EOMI, speech fluent, moves all limbs, sensation to light touch grossly intact throughout\nPSYCH: pleasant, appropriate affect\n", + "input6": "___ 03:45PM BLOOD WBC-8.6 RBC-4.37 Hgb-14.1 Hct-43.1 \nMCV-99* MCH-32.3* MCHC-32.7 RDW-11.7 RDWSD-42.4 Plt ___\n___ 03:45PM BLOOD Glucose-95 UreaN-12 Creat-0.7 Na-141 \nK-4.3 Cl-106 HCO3-22 AnGap-13\n___ 03:45PM BLOOD ALT-12 AST-18 AlkPhos-82 TotBili-0.6\n___ 03:45PM BLOOD Lipase-62*\n___ 03:45PM BLOOD cTropnT-<0.01\n___ 05:30AM BLOOD Calcium-8.8 Phos-4.9* Mg-2.4\n___ 05:30AM BLOOD VitB12-742\n___ 05:30AM BLOOD TSH-3.8\n\nMRI: \nAtrophy of the hippocampus region.\n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/12312333-DS-17.json b/Finished/Alzheimer/12312333-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..96f75a746ace2ceab753691fdee308bc3e057a4e --- /dev/null +++ b/Finished/Alzheimer/12312333-DS-17.json @@ -0,0 +1,39 @@ +{ + "Alzheimer$Intermedia_3": { + "The hippocampus and frontal lobes are brain regions closely related to memory and cognitive functions. Atrophy in these areas is typical of Alzheimer's disease.$Cause_1": { + "Significant atrophy of hippocampus and frontal lobes$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "Altered mental status may indicate an impact on the brain's cognitive functions, which is typical of Alzheimer's disease.$Cause_1": { + "Altered mental status$Input1": {} + }, + "Dementia is one of the main symptoms of Alzheimer's disease and typically manifests as memory loss, impaired thinking and daily functioning.$Cause_1": { + "PMHx dementia$Input2": {} + }, + "Malaise and acute disturbances of consciousness can be symptoms caused by neurodegenerative changes in the course of Alzheimer's disease, and these symptoms reflect an overall decline in brain function.$Cause_1": { + "presents with lethargy and AMS x several days$Input2": {} + }, + "Decreased activity may be due to cognitive decline and reduced physical fitness, which are common in people with Alzheimer's disease$Cause_1": { + "noted to not be as active as usual$Input2": {} + }, + "Decreased speech can be a sign of cognitive decline and impaired language abilities, which are classic symptoms of Alzheimer's disease.$Cause_1": { + "less verbal$Input2": {} + }, + "Reluctance to engage in activities may be due to reduced motivation or reduced physical ability, which is more common in people with Alzheimer's disease.$Cause_1": { + "less willing to participate in activities including walking.$Input2": {} + }, + "Long-term high blood pressure has the potential to increase the risk of Alzheimer's disease because it can lead to changes in brain structure and function.$Cause_1": { + "hypertension$Input3": {} + }, + "Alzheimer's disease may result in impaired speech, ranging from reduced speech to complete inability to speak.$Cause_1": { + "Non verbal, awake$Input5": {} + } + } + }, + "input1": "Altered mental status\n", + "input2": "The patient is an 77 year old man with PMHx dementia, HTN, HLD who presents with lethargy and AMS x several days. The patient resides in an assisted living facility where he was noted to not be as active as usual. He has been less verbal and less willing to participate in activities including walking.\n", + "input3": "chronic low back pain\nhypertension \nhyperlipidemia \nreflux \nanemia \nlower spinal DJD \ndiverticulitis \nsinusitis \n\n", + "input4": "Unable to be obtained\n", + "input5": "EXAM ON ADMISSION: \nVS: 96.6 187/96 68 20 99%3L NC BS: 106 \nGA: Non verbal, awake \nHEENT: PERRL. MMM. no LAD. no JVD. neck supple. \nCards: RRR, +S1, S2, no m/r/g \nPulm: CTAB on anterior exam \nAbd: soft, NT, +BS. no g/rt. neg HSM. neg ___ sign. \nExtremities: wwp, no edema. 2+ pulses. \nNeuro: Facial movements symmetric, is able to move pupils symmetrically. moves all 4 extremities spontaneusly, winces to painful stimuli all 4 extremities, increased tone all 4 extremities but able to passively move. \n", + "input6": "___ 06:25AM BLOOD WBC-7.5 RBC-3.40* Hgb-11.4* Hct-31.4* MCV-93 MCH-33.5* MCHC-36.2* RDW-13.8 Plt ___\n___ 01:30PM BLOOD Neuts-81.0* Lymphs-13.5* Monos-4.6 Eos-0.5 Baso-0.3\n___ 01:30PM BLOOD ___ PTT-27.1 ___\n___ 06:25AM BLOOD Glucose-80 UreaN-15 Creat-0.8 Na-140 K-4.2 Cl-106 HCO3-25 AnGap-13\n___ 06:35AM BLOOD CK-MB-6 cTropnT-<0.01\n___ 01:30PM BLOOD Albumin-3.9 Calcium-9.5 Phos-3.5 Mg-1.5*\n___ 04:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0Leuks-NEG\n___ 11:04AM URINE RBC-82* WBC-7* Bacteri-FEW Yeast-NONE Epi-0\n\nEKG ___: Sinus rhythm. Non-specific ST-T wave changes. No previous tracing available for comparison. \n\nCHEST X-RAY \nFINDINGS: Single AP upright portable view of the chest was obtained. The left costophrenic angle is not fully included on the image. The right costophrenic angle is slightly blunted which may be due to trace pleural effusion. No focal consolidation or pneumothorax is seen. The aorta is unfolded. The ascending aorta appears slightly prominent which could be further assessed on non-urgent chest CTA unless the patient has acute aortic symptoms. The cardiac silhouette is not enlarged. There is no pulmonary edema. \n\nCT HEAD W/O CONTRAST\nIMPRESSION: No acute intracranial process. If concern for stroke persists, further evaluation with MRI is recommended if patient is able. \n\nMRI\nSignificant atrophy of hippocampus and frontal lobes\n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/14238472-DS-8.json b/Finished/Alzheimer/14238472-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..d2d91ab157dafcd87cb18931294fd3d8545ce000 --- /dev/null +++ b/Finished/Alzheimer/14238472-DS-8.json @@ -0,0 +1,45 @@ +{ + "Alzheimer$Intermedia_3": { + "Amyloid deposition is one of the key biomarkers of Alzheimer's disease, and its accumulation in the prefrontal and temporal regions of the brain is associated with cognitive decline.$Cause_1": { + "Amyloid deposition was detected in areas of the frontal and temporal lobes of the brain$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "This suggests that patients may have cognitive impairment or reduced spatial orientation, which are common early symptoms of Alzheimer's disease.$Cause_1": { + "Found wondering$Input1": {} + }, + "Altered mental state, such as confusion or uncertainty, is a common early symptom of Alzheimer's disease$Cause_1": { + "presenting with altered mental status$Input2": {} + }, + "Frequent wandering off, especially from home without destination, is a common behavioral problem among people with Alzheimer's disease$Cause_1": { + "second episode in 2 weeks (OSH reports 4/week) in which he has wandered out of the house without telling her$Input2": {} + }, + "Short-term memory loss is one of the most characteristic symptoms of Alzheimer's disease$Cause_1": { + "he has developed short term memory loss$Input2": {} + }, + "Repetitive speech is common in people with Alzheimer's disease and reflects impairments in their memory and cognitive function.$Cause_1": { + "patient tells same stories again and again$Input2": {} + }, + "Forgetting basic daily activities, such as eating, is also a sign of memory impairment.$Cause_1": { + "forgets if he eats$Input2": {} + }, + "The need for frequent reminders to perform basic personal hygiene activities may indicate a decline in self-management skills, which is a sign of cognitive decline.$Cause_1": { + "has to be reminded to bathe etc$Input2": {} + }, + "Confusion about why you are in a certain environment (such as a hospital) may be due to severe impairment of cognitive function.$Cause_1": { + "not sure why he is in the hospital$Input2": {} + }, + "If there are discrepancies between the procedure report and the family member's memory, this may indicate memory problems in the patient or family member, and memory problems are one of the classic symptoms of Alzheimer's.$Cause_1": { + "s/p pylostomy per OSH notes, oper report daughter denies \nsurgeries$Input3": {} + }, + "High blood pressure is a known risk factor for cognitive decline and Alzheimer's disease.$Cause_1": { + "HTN$Input3": {} + } + } + }, + "input1": "Found wondering\n", + "input2": "He is with tobacco abuse, s/p pacer, presenting with altered mental status. He lives with his daughter and was found today by police away from home. Per daughter, this is the second episode in 2 weeks (OSH reports 4/week) in which he has wandered out of the house without telling her. She thinks he is going to the store. Other than these wanderings, there have been no changes in behavior, speech, etc - overall she thinks he has developed short term memory loss. She has tried to help him by writing down address on a card, but he did not bring this with him today. Other than that, dtr remarks that patient tells same stories again and again, forgets if he eats, has to be reminded to bathe etc. Has otherwise been okay, has chronic cough that may be slightly worse lately, no fevers or other symptoms. Patient reports cough productive of clear sputum. \n\nToday he presented to OSH where head CT was suggestive of SDH. He also reported falling off a truck while truck was it was moving 4 weeks ago. Transferred for evaluation by neurosurgery. \n\nIn the ED, initial VS were: 98.5 73 151/84 18 99% on 3L NC. Neuro exam unremarkable; not oriented and reporting gradiose delusions. Again told the truck story. Labs notable for WBC 13.5, plts 115, chems unremarkable, CEs negative, negative tox screen, UA neg for infection. Received levofloxacin. \n\nOn the floor, patient without complaint, not sure why he is in the hospital. . \n", + "input3": " s/p PPM - patient \n# s/p pylostomy per OSH notes, oper report daughter denies \nsurgeries \n# hx of GI bleed requring pRBCs, none recently \n# umbilical hernia \n# HTN \n", + "input4": "non-contributory \n", + "input5": "Vitals: T:97.5, 134/69, 65, 18, 100% 2L \nGeneral: Alert, very pleasant, no distress \nHEENT: Face symmetric, sclera anicteric, PERRL, EOMI, MMM, oropharynx clear \nNeck: supple, JVD 1-2 cm ASA, no LAD \nLungs: Clear to auscultation bilaterally, occ rhonchi at L base. \nCV: Regular rate and rhythm, normal S1 + S2, faint SM at LUSB \nAbdomen: soft, non-distended, bowel sounds present. Mild TTP in LUQ and overlying ribs. no rebound tenderness or guarding. No appreciable hepatomegaly or splenomegaly by percussion or palpation. \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis. 1+ \nbilateral pitting edema, equal. \nNeuro: CN II-XII intact. Sensory grossly intact. Gait not tested. \n\n", + "input6": "___ 12:23AM BLOOD WBC-13.5* RBC-4.46* Hgb-12.2* Hct-37.7* MCV-84 MCH-27.3 MCHC-32.3 RDW-13.6 Plt ___\n___ 12:23AM BLOOD ___ PTT-26.4 ___\n___ 12:23AM BLOOD Glucose-116* UreaN-16 Creat-0.8 Na-139 K-4.4 Cl-103 HCO3-28 AnGap-12\n___ 12:23AM BLOOD Albumin-4.1 Calcium-9.3 Phos-3.3 Mg-1.9\n___ 12:23AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\nCHEST X-RAY\nSINGLE PORTABLE UPRIGHT VIEW OF THE CHEST: A left chest pacing device demonstrates two intact leads. Patient rotation limits evaluation of the cardiomediastinal contour, but there is cardiomegaly and mild pulmonary edema. No site of focal consolidation is seen to suggest pneumonia and there is no pleural effusion. \n\nHEAD CT WITHOUT IV CONTRAST: There is no hemorrhage, edema, mass effect, shift of midline structures, or evidence of major vascular territory infarction. The ventricles and sulci are prominent and are enlarged in size, consistent with age-related parenchymal involutional change. In addition, there is asymmetric enlargement of the extra-axial CSF space on the left. This may represent a combination of asymmetric parenchymal atrophy and possible chronic subdural hematoma or hygroma, although this differentiation is difficult with lack of remote prior studies. The paranasal sinuses demonstrate circumferential mucosal thickening of the maxillary sinuses (2:3), as well as ethmoid opacification and sphenoid sinus opacification (2:9), The orbits appear unremarkable. The mastoid air cells appear normal. \nIMPRESSION: \n1. No hemorrhage or edema or evident acute process. \n2. Involutional change with enlargement of ventricles and sulci, and asymmetric enlargement of extra-axial CSF space on the left. \n\n\nECHOCARDIOGRAM:\nThe left atrium is moderately dilated. The right atrium is moderately dilated. There is asymmetric left ventricular hypertrophy. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with apical hypokinesis. The remaining segments contract normally (LVEF = 50%). There is no left ventricular outflow obstruction at rest or with Valsalva. These findings are consistent with hypertrophic non-obstructive cardiomyopathy (HCM). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The ascending aorta is moderately dilated. The aortic valve leaflets are moderately thickened. There is no aortic valve stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no systolic anterior motion of the mitral valve leaflets. Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \n\nPET:\nAmyloid deposition was detected in areas of the frontal and temporal lobes of the brain\n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/14795613-DS-21.json b/Finished/Alzheimer/14795613-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..943441fc48b3d84adc0ab0a22c9907ef1eb8cddb --- /dev/null +++ b/Finished/Alzheimer/14795613-DS-21.json @@ -0,0 +1,42 @@ +{ + "Alzheimer$Intermedia_3": { + "It shows decreased glucose metabolism in the temporal and parietal regions, which is a typical imaging feature of Alzheimer's disease and is associated with brain atrophy and functional decline. It is an important basis for directly supporting the diagnosis of Alzheimer's disease.$Cause_1": { + "FDG-PET: show reduced glucose metabolism in the temporal-parietal lobes.$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "Agitation manifests as emotional instability, which is a manifestation of Alzheimer's disease$Cause_1": { + "Agitation$Input1": {} + }, + "Loss of activity may be an early sign of cognitive decline in Alzheimer's disease$Cause_1": { + "less active in his iadls$Input2": {} + }, + "Loss of personal hygiene management ability is a common symptom of Alzheimer's disease$Cause_1": { + "stopped being able to take care of his personal hygiene$Input2": {} + }, + "Forgetfulness is one of the most common symptoms of Alzheimer's disease$Cause_1": { + "been forgetful$Input2": {} + }, + "Mood swings and irritability are common emotional symptoms in people with Alzheimer's$Cause_1": { + "occasionally becomes agitated$Input2": {} + }, + "Physical decline is one of the common signs of Alzheimer's disease$Cause_1": { + "doesn't walk as much as he used to$Input2": {} + }, + "Delusions or false beliefs are possible psychiatric symptoms in Alzheimer's disease$Cause_1": { + "delusions of where he has been but has not described visual hallucinations$Input2": {} + }, + "Diabetes has a known link to Alzheimer's disease$Cause_1": { + "Diabetes.$Input3": {} + }, + "This is a direct reference to cognitive decline, one of the main symptoms of Alzheimer's disease.$Cause_1": { + "Likely dementia$Input3": {} + } + } + }, + "input1": "Agitation\n", + "input2": "This morning, the patient does not have complaints. Collateral history obtained from daughter/HCP. She states ___ year ago, he started becoming less active in his iadls, and while he used to take care of his wife who has had a gradual medical decline, she began being more dominant taking care of him. Then, in ___ he stopped being able to take care of his personal hygiene. Since then, he has been forgetful, and occasionally becomes agitated. In the past, the daughter states this was in the setting of UTI. She noticed he doesn't walk as much as he used to, but has not particularly noticed a slow or shuffling gait. She describes he has had delusions of where he has been but has not described visual hallucinations.\n\nShe expresses frustration over his medical course over the last month. He was discharged to ___ facility, in which his medications were uptitrated. They started to treat him for a UTI and gave him a few days of abvx then stopped because the cultures were negative. He then was transferred to a rehab where the incident described in admission note occurred in the setting of her leaving him the first night. \n", + "input3": "Likely dementia\nBPH\nDiabetes. \nGlaucoma\nHx TIAS\n", + "input4": "None\n", + "input5": "Vital Signs: T 97.9 BP 152/71 HR 59 R 18 SpO2 97 RA \n GEN: NAD, sleeping comfortably \n HEENT: sclerae anicteric. b/l arcus senilis \n ___: RRR no MRG \n RESP: No increased WOB, CTAB no rhonchi, wheezing or crackles \n ABD: NTND \n EXT: warm, no edema \n NEURO: no facial droop. PERRL. Moving all 4 extremities. Able to follow commands. AAOx1-2 (person and knows its a hospital) \n\n", + "input6": "___ 08:26PM BLOOD WBC-5.4 RBC-4.01* Hgb-11.4* Hct-35.8* \nMCV-89 MCH-28.4 MCHC-31.8* RDW-13.5 RDWSD-44.6 Plt ___\n___ 08:26PM BLOOD Neuts-51.3 ___ Monos-10.2 Eos-2.4 \nBaso-0.6 Im ___ AbsNeut-2.78 AbsLymp-1.90 AbsMono-0.55 \nAbsEos-0.13 AbsBaso-0.03\n___ 08:26PM BLOOD Glucose-129* UreaN-32* Creat-1.5* Na-142 \nK-4.0 Cl-104 HCO3-29 AnGap-13\n___ 10:40AM BLOOD Calcium-9.5 Phos-3.2 Mg-2.2\n___ 09:45PM URINE Blood-NEG Nitrite-POS Protein-TR \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-SM \n___ 09:45PM URINE RBC-1 WBC-6* Bacteri-FEW Yeast-NONE Epi-0\n\n\nFDG-PET: show reduced glucose metabolism in the temporal-parietal lobes.\n\n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/14940781-DS-5.json b/Finished/Alzheimer/14940781-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..5c88358119e2011f897262cb64ddbcc0a7c130b8 --- /dev/null +++ b/Finished/Alzheimer/14940781-DS-5.json @@ -0,0 +1,45 @@ +{ + "Alzheimer$Intermedia_3": { + "The patient's Alzheimer's disease was moderate$Cause_1": { + "moderate Alzheimer's dementia$Input2": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "Decline in cognitive function, a key feature of Alzheimer's disease$Cause_1": { + "acute on chronic mental status change$Input1": {} + }, + "Delirium is an acute cognitive disorder that is sometimes observed in patients with Alzheimer's disease.$Cause_1": { + "delirium$Input1": {} + }, + "Increased agitation and confusion, common acute symptoms of Alzheimer's disease$Cause_1": { + "agitation episodes, worsening confusion$Input2": {} + }, + "These behavioral problems may be caused by cognitive decline and difficulty regulating emotions caused by the condition.$Cause_1": { + "\"physically threatening to wife\" (picked up a piece of cement and threatened to hurt her). In addition, he doesn't recognize sons, is threatening others$Input2": {} + }, + "Reflects the fluctuating nature of Alzheimer's symptoms$Cause_1": { + "good days and bad days$Input2": {} + }, + "Antipsychotics to control agitation. This suggests that doctors are trying to manage his behavioral problems$Cause_1": { + "seroquel 25 mg$Input2": {} + }, + "Hypertension is a common comorbidity in patients with Alzheimer's disease$Cause_1": { + "HTN$Input3": {} + }, + "The person has unusual behavior or changes in mental status, which are common symptoms of Alzheimer's disease$Cause_1": { + "acutely agitated man$Input5": {} + }, + "This indicates significant cognitive impairment, a classic symptom of Alzheimer's disease.$Cause_1": { + "Awake, A&Ox1, unsure of location or year$Input5": {} + }, + "Delirium may be related to multiple factors, including the neurodegenerative process of Alzheimer's disease$Cause_1": { + "not allowing me to examine due to severe agitation and delerium$Input5": {} + } + } + }, + "input1": "acute on chronic mental status change, delirium \n", + "input2": "___ y/o male with moderate Alzheimer's dementia, brought in for further evaluation for agitation episodes, worsening confusion. \n\nThese episodes have been ongoing x 1 month, and patient has now been \"physically threatening to wife\" (picked up a piece of cement and threatened to hurt her). In addition, he doesn't recognize sons, is threatening others. He apparently has \"good days and bad days.\" Brought in by son for further evaluation, and family is scared. \n\nOf note, he was recently started on seroquel 25 mg bid for these episodes of agitation. \n", + "input3": "- HTN\n- h/o stroke/TIA \n- hx of hearing loss \n- hx of benign positioanl vertigo \n- hx of cataract s/p surgery \n- internal hemorrhoids \n- carpal tunnel \n- spinal stenosis \n- hx of postherpetic neuralgia \n- hx of aspiration pneumonia \n- hx of weight loss \n", + "input4": "NC\n", + "input5": "VS: 97.7, 58, 138/78, 17, 100 RA \nGENERAL: acutely agitated man, with security at bedside \nHEENT: NC/AT, sclerae anicteric, MMM \nNECK: Supple, no thyromegaly \nHEART/LUGNS/ABDOMEN: not allowing me to examine. \nLUNGS: not allowing me to examine. \nABDOMEN: not allowing me to examine. \nEXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses. \nSKIN: No rashes or lesions, tattoos present. \nNEURO: Awake, A&Ox1, unsure of location or year, not allowing me to examine due to severe agitation and delerium, no dysarthria, normal gait.\n", + "input6": "___ 07:00PM BLOOD WBC-7.0 RBC-4.01* Hgb-12.6* Hct-38.4* \nMCV-96 MCH-31.4 MCHC-32.7 RDW-13.8 Plt ___\n___ 07:00PM BLOOD Neuts-69.8 Lymphs-17.9* Monos-5.0 \nEos-6.3* Baso-1.0\n___ 07:00PM BLOOD Glucose-98 UreaN-21* Creat-1.3* Na-145 \nK-4.2 Cl-107 HCO3-29 AnGap-13\n___ 07:00PM BLOOD Calcium-9.2 Phos-3.7 Mg-2.0\n___ 07:00PM BLOOD VitB12-465 Folate-12.2\n___ 07:00PM BLOOD TSH-1.0\n___ 07:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 07:17PM BLOOD Lactate-1.4\n.\nImaging:\n.\nPresenting CXR:\nStable blunting of the left costophrenic angle with left base opacity may be due to a trace left effusion with overlying atelectasis. Otherwise, no significant interval change. \n.\n___ Nightfloat CXR:\nA new large area of consolidation in the right upper and smaller in the right lower lung is due to pneumonia. Left lung is grossly clear. Heart size normal. Dr. ___ was paged. No pneumothorax. Small pleural effusion is not excluded. \n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/15898350-DS-19.json b/Finished/Alzheimer/15898350-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..2a477c1758708f5c26f5320ec71993ffe824c22e --- /dev/null +++ b/Finished/Alzheimer/15898350-DS-19.json @@ -0,0 +1,45 @@ +{ + "Alzheimer$Intermedia_3": { + "Global brain volume loss, a common feature of Alzheimer's disease, was detected on head CT scans.$Cause_1": { + "Global volume loss.$Input6": {} + }, + "Such deposits are one of the biomarkers for the diagnosis of Alzheimer's disease$Cause_1": { + "Amyloid PET: Detects amyloid-beta deposits in the brain.$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "Cognitive dysfunction is a common symptom of Alzheimer's disease$Cause_1": { + "Altered mental status$Input1": {} + }, + "This is a sign of cognitive impairment in Alzheimer's disease, which manifests as a decrease in social interaction and responsiveness.$Cause_1": { + "sitting on the couch but not he was responding$Input2": {} + }, + "Cognitive decline may be associated with other neurodegenerative symptoms as a symptom of Alzheimer's disease$Cause_1": { + "unable to move his extremities and would intermittently close his eyes$Input2": {} + }, + "Indicates a decreased level of consciousness, which may be a feature of Alzheimer's disease$Cause_1": { + "non-verbal but arousable$Input2": {} + }, + "Typical signs of cognitive decline, often seen in the early stages of Alzheimer's disease$Cause_1": { + "sometimes has trouble with word retrieval and occasionally looses train of thought$Input2": {} + }, + "It feels like a dream. This altered perception of reality may be a manifestation of cognitive impairment in Alzheimer's disease$Cause_1": { + "remembered being unresponsive to his family members, like it was a dream$Input2": {} + }, + "Hypertension is a known risk factor for cognitive decline and Alzheimer's disease$Cause_1": { + "Hypertension$Input3": {} + }, + "Feeling disoriented about place and time. This disorientation in time or space is a common symptom of Alzheimer's disease and may indicate cognitive decline.$Cause_1": { + "Oriented to person, not place, not time$Input5": {} + }, + "Muscle weakness in the lower right side of the face. This may be caused by a neurological disorder, as is common in Alzheimer's disease.$Cause_1": { + "7: R lower face weakness$Input5": {} + } + } + }, + "input1": "Altered mental status\n", + "input2": "___ w/ prior sigmoidectomy (sigmoid volvulus) ___, bipolar d/o. History per son in law, pt was OK last night (lives independently), this morning he went to check on the patient after he and his wife recieved a phone call from the visiting nurse who said the patient was not answering his door this morning. He found the patient sitting on the couch but not he was responding. There were no signs of trauma. The patient was unable to move his extremities and would intermittently close his eyes. He was non-verbal but arousable. His son called EMS who brought him to the ED. Per the son, he did not notice the patient loose continence. Per the family, the patient hadn't been feeling well for the past few weeks. At baseline, patient patient recognizes and remembers family and important dates, sometimes has trouble with word retrieval and occasionally looses train of thought. Patient lives on his own and has a visiting nurse, and exercises on a daily basis. Patient has experienced diarrhea over the past months, per his family at the bedside. The patient reports that he remembered being unresponsive to his family members, like it was a dream, and he remembers being transported to the emergency room by the EMTs.\n", + "input3": "1. Bipolar disease \n2. Hypertension. \n3. Chronic obstructive pulmonary disease. \n4. History of alcoholism. \n5. h/o PNA complicated by empyema requiring decortication. \n6. Status post right humerus fracture. \n7. Autonomic Dysfunction, followed by Dr. ___. \n", + "input4": "Mother - deceased age ___, unknown cause\nFather - deceased age ___, history of MI and stroke\n", + "input5": "Vitals: 97.9 160/66 66 20 100%3L\n General: Oriented to person, not place, not time, no acute distress \n HEENT: Sclerae anicteric, MMM, oropharynx clear \n Neck: supple, JVP not elevated, no LAD \n Lungs: CTAB anteriorly no wheezes, rales, rhonchi \n CV: RRR, Nl S1, S2, No MRG \n Abdomen: soft, NT/ND bowel sounds present, no rebound tenderness or guarding, no organomegaly \n GU: Foley\n Ext: warm, well perfused, 2+ pulses \n Neuro: CN3,4,6,9,10,11,12 intact. 1,2,8 not assessed. 7: R lower face weakness (but unchanged from prior photo on ___ left facial twitching with smile, UE strength equal bilateral, ___ strength equal\n", + "input6": "___ 09:45AM BLOOD Plt ___\n___ 09:45AM BLOOD ___ PTT-33.8 ___\n___ 09:45AM BLOOD ___ 09:45AM BLOOD UreaN-29* Creat-1.2\n___ 09:45AM BLOOD ALT-15 AST-28 AlkPhos-82 TotBili-0.4\n___ 09:45AM BLOOD Lipase-42\n___ 09:45AM BLOOD Albumin-4.0\n___ 09:45AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 10:07AM BLOOD Glucose-94 Lactate-1.0 Na-135 K-4.3 Cl-99 calHCO3-23\n\nImaging at admission:\nHead CT scan ___:\nNo acute intracranial process. Global volume loss.\nCXR ___:\nNo acute cardiopulmonary process.\n\nMicro at Admission:\nUrine Cx: no growth\n\nAmyloid PET: Detects amyloid-beta deposits in the brain.\n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/17277521-DS-10.json b/Finished/Alzheimer/17277521-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..f64a0561772af9e06f59c7d6e80760f8f64cf441 --- /dev/null +++ b/Finished/Alzheimer/17277521-DS-10.json @@ -0,0 +1,42 @@ +{ + "Alzheimer$Intermedia_3": { + "Amyloid deposition is one of the typical biomarkers of Alzheimer's disease, especially in the frontal and temporal lobes of the brain, which is an important basis for the diagnosis of Alzheimer's disease.$Cause_1": { + "Amyloid deposition was detected in areas of the frontal and temporal lobes of the brain$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "Alzheimer's disease is the most common cause of dementia$Cause_1": { + "Dementia$Input1": {} + }, + "Aggressive behavior can be observed in many patients with dementia, especially those with Alzheimer's disease.$Cause_1": { + "aggresive behavior$Input1": {} + }, + "Aggressive behavior may be associated with behavioral and psychological symptoms in people with Alzheimer's disease, often as a result of the patient's frustration or inability to appropriately express their needs.$Cause_1": { + "two recent ER visits for aggressive behavior$Input2": {} + }, + "Hoarding behavior and difficulty directing may be behavioral problems in the late stages of Alzheimer's disease, suggesting that patients may have signs of further cognitive decline.$Cause_1": { + "Noted hoarding behaviors, and difficulty with redirection in recent months.$Input2": {} + }, + "The use of antipsychotics such as risperidone is common to manage psychiatric symptoms in people with Alzheimer's disease$Cause_1": { + "Outpatient psychiatrist risperidone$Input2": {} + }, + "The patient appeared calm between outbursts and had no motor system (MS) changes that would support delirium, suggesting that these behaviors may be chronic and Alzheimer's disease-related psychobehavioral symptoms.$Cause_1": { + "Calm between outbursts, and no MS changes to support delirium.$Input2": {} + }, + "Sudden outbursts of aggressive behavior without apparent provocation may be due to disordered emotional control caused by the disorder.$Cause_1": { + "thrown silverware at people in the recent past, and has pointed knives at staff before$Input2": {} + }, + "Long-term hypertension may lead to changes in brain structure and function, which are indirectly related to cognitive decline.$Cause_1": { + "HTN$Input3": {} + }, + "One of the common symptoms of Alzheimer's disease patients is the deterioration of memory and cognitive function, especially the impairment of the sense of time and spatial orientation.$Cause_1": { + "Alert and interactive, oriented to person, birthday, not date, not place. Does not know why he is here.$Input5": {} + } + } + }, + "input1": "Dementia with aggresive behavior\n", + "input2": "Man with CAD, prostate cancer, meningioma, and gastritis, and two recent ER visits for aggressive behavior, sent from his nursing facility for safety evaluation after striking another resident in the face at the facility. \n\nThis patient has been living in the Memory Unit about the past year. Seen in our ED on for similar presentation. On his last visit, after one day in ED observation was willing to take the patient back if under good behavioral control, which he was felt to be. \n\nHe now represents for similar aggressive behavior where he reportedly repeatedly punched another (different) rehab resident and threw juice on him, per rehab nursing report. Has thrown silverware at people in the recent past, and has pointed knives at staff before. There has been no known provocation for these outbursts. Unclear if there were any racial slurs exchanged, both were speaking residents. Noted hoarding behaviors, and difficulty with redirection in recent months. \n\nOutpatient psychiatrist risperidone since last ED visit, and in setting of uptitration patient has had some difficulty walking. Per Dr. aggression has been worsening in last few weeks, and he is not safe to be around other frail elders. Calm between outbursts, and no MS changes to support delirium.\n\n\n\n", + "input3": "CAD\nHTN\nProstate Cancer\nMeningioma\nGastritis\nhiatal hernia\ns/p cholecystectomy\ns/p Mohs surgery for basal cell carcinoma\nNo history of seizures or head injuries.\n", + "input4": "None\n", + "input5": "Vitals: 97.3, 69, 137/79, 18, 98%RA\nGeneral: NAD, sitting in bed, eating a cookie, with his stuffed cow by his side\nHEENT: PERRL, NC/AT, MMM, clear OP\nLymph: No LAD appreciated\nCV: RRR, normal S1, S2, no m/r/g\nLungs: CTAB on the R, crackles in the L base\nAbdomen: soft, nontender, nondistended, +BS\nExt: wwp, 2+ peripheral pulses, no edema\nNeuro: Alert and interactive, oriented to person, birthday, not date, not place. Does not know why he is here. Answers appropriately. Sounds fluent but cannot discern if any aphasias. Moving all extremities.\n", + "input6": "___ 11:35AM GLUCOSE-127* UREA N-15 CREAT-0.8SODIUM-142 \nPOTASSIUM-4.0 CHLORIDE-105 TOTAL CO2-27 ANION GAP-14\n___ 11:35AM ALT(SGPT)-21 AST(SGOT)-20 ALK PHOS-51 TOT BILI-0.4\n___ 11:35AM ALBUMIN-4.3 CALCIUM-9.7 PHOSPHATE-3.0 MAGNESIUM-2.1\n___ 11:35AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 11:35AM WBC-4.5 RBC-4.30* HGB-13.4* HCT-38.2*MCV-89 MCH-31.3 MCHC-35.2* RDW-14.7\n___ 11:35AM NEUTS-58.4 ___ MONOS-6.6 EOS-1.9 BASOS-0.6\n___ 11:35AM PLT COUNT-151\n\nIMAGING:\n=================\nCXR ___\nIMPRESSION: \nMild bibasilar atelectasis in the setting of low lung volumes. Small consolidations at the bases cannot be entirely excluded. No effusion or pneumothorax.\n\n\nPET ___\nAmyloid deposition was detected in areas of the frontal and temporal lobes of the brain\n" +} \ No newline at end of file diff --git a/Finished/Alzheimer/17739375-DS-13.json b/Finished/Alzheimer/17739375-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..cb215eb438be70ad15b212f3fbe39d4adad203cb --- /dev/null +++ b/Finished/Alzheimer/17739375-DS-13.json @@ -0,0 +1,36 @@ +{ + "Alzheimer$Intermedia_3": { + "The hippocampus and frontal lobes are brain regions closely related to memory and cognitive functions. Atrophy in these areas is a typical imaging feature of Alzheimer's disease and is often associated with cognitive decline.$Cause_1": { + "Significant atrophy of hippocampus and frontal lobes$Input6": {} + }, + "Suspected Alzheimer$Intermedia_2": { + "Falls may be associated with loss of balance and movement, a common symptom in people with Alzheimer's disease, which affects areas of the brain that control movement.$Cause_1": { + "S/p Fall$Input1": {} + }, + "Alzheimer's disease is one of the most common causes of dementia and is characterized by the gradual degeneration and death of nerve cells in the brain.$Cause_1": { + "dementia$Input1": {} + }, + "This indicates that the patient has persistent disorientation, which is one of the common symptoms of Alzheimer's disease.$Cause_1": { + "She was found on the ground of her studio wearing high heels, conscious though disoriented$Input2": {} + }, + "The patient's spouse confirmed a continued decline in his mental status, which may be a sign of chronic progression of Alzheimer's disease.$Cause_1": { + "The husband spoke with the ED team and stated that this is her baseline mental status.$Input2": {} + }, + "This shows that the patient's cognition and daily living abilities have significantly declined and require professional care, which is a characteristic of mid- to late-stage Alzheimer's disease.$Cause_1": { + "husband has been trying to have her admitted to a locked dementia unit because of her declining status and inability to take care of her.$Input2": {} + }, + "The patient developed somnolence and disorientation, and even though he was awake and ambulatory the next morning, he remained disoriented. These symptoms may indicate cognitive dysfunction that is typical of Alzheimer's disease.$Cause_1": { + "somnolent, disoriented, no acute distress. the following morning she is alert and walking around but still quite disoriented$Input5": {} + }, + "Changes in white blood cell counts may indicate the presence of infection or inflammation, and long-term inflammation is considered a risk factor for Alzheimer's disease.$Cause_1": { + "NEUTS-88.0* LYMPHS-7.6*$Input6": {} + } + } + }, + "input1": "S/p Fall, dementia\n", + "input2": "___ presents after unwitnessed fall. She was found on the ground of her studio wearing high heels, conscious though disoriented (baseline) with bruise over R eye and wrist pain. In the ED initial vitals were: 98.8 100 143/72 16 100%. CT head, cspine, t spine did not show any acute changes. Plain films of l/s spine, hip, elbow, wrist films also were not notable. SHe did have a temp to ever to 100.9. UA was negative, CXR without infiltrates. Blood cultures were drawn. No abx were given. She was give olanzapine 5 mg for agitation.\n\nThe husband spoke with the ED team and stated that this is her baseline mental status. The husband has been trying to have her admitted to a locked dementia unit because of her declining status and inability to take care of her. \n\nOn the floor she is quite sleepy. She is disoriented but does not have any acute compliants. The husband is no longer here for further questions.\n\n", + "input3": "Glaucoma\n", + "input4": "NC\n", + "input5": "VS 98.7 110/62 87 18 97%RA\nGEN somnolent, disoriented, no acute distress. the following morning she is alert and walking around but still quite disoriented \nHEENT: ecchymoses over right eye/cheek, MMM EOMI sclera anicteric, OP clear \nNECK supple, no JVD, no LAD \nPULM Good aeration, CTAB no wheezes, rales, ronchi \nCV RRR normal S1/S2, no mrg\nABD soft NT ND normoactive bowel sounds, no r/g \nEXT WWP 2+ pulses palpable bilaterally, no c/c/e\nNEURO CNs2-12 intact, motor function grossly normal \nSKIN no ulcers or lesions\n", + "input6": "___ 08:15AM WBC-5.3 RBC-4.00* HGB-12.4 HCT-40.0 MCV-100* MCH-31.1 MCHC-31.0 RDW-12.9\n___ 08:15AM NEUTS-88.0* LYMPHS-7.6* MONOS-3.0 EOS-0.8 \nBASOS-0.7\n___ 08:15AM PLT COUNT-272\n___ 08:15AM ___ PTT-25.4 ___\n___ 08:15AM GLUCOSE-112* UREA N-14 CREAT-0.9 SODIUM-139 POTASSIUM-3.8 CHLORIDE-103 TOTAL CO2-24 ANION GAP-16\n___ 10:50AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-10 BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 LEUK-NEG\n___ 10:50AM URINE COLOR-Yellow APPEAR-Clear SP ___\n\nCT HEAD\nIMPRESSION: \n1. No acute intracranial hemorrhage or mass effect. \n2. Small new right mastoid effusion- correlate clinically. \n\nCT C-Spine\nIMPRESSION: \n1. No acutefracture of the cervical spine, multilevel degenerative changes are unchanged in appearance. Correlate clinically to decide on the need for further workup. \n\nTHREE VIEWS OF THE RIGHT SHOULDER: There is no acute fracture or dislocation. The bone mineralization is slightly decreased. No pneumothorax is seen within the right upper chest. No rib fractures are identified. There are no soft tissue calcifications or embedded radiopaque foreign bodies. \n \nTHREE VIEWS OF THE RIGHT ELBOW: No effusion is detected. There is no acute fracture or dislocation. No sclerotic or lytic lesions are identified. \n \nTHREE VIEWS OF THE RIGHT WRIST: There is moderate osteopenia. No acute fracture or dislocation is seen. There are no sclerotic or lytic lesions identified. Moderate triscaphe and first CMC joint space narrowing and subchondral sclerosis is most compatible with osteoarthritis. \n \nIMPRESSION: No fracture or dislocation. \n\nCXR\nFRONTAL CHEST RADIOGRAPHS: The heart size is top normal. The hilar and mediastinal contours are within normal limits. There is no pneumothorax, focal consolidation, or pleural effusion. \n\nMRI\nSignificant atrophy of hippocampus and frontal lobes\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type A Aortic Dissection/13040569-DS-4.json b/Finished/Aortic Dissection/Type A Aortic Dissection/13040569-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..c9a2c739ee51c88a8a93bb3c7fbcb7af91d4fc0e --- /dev/null +++ b/Finished/Aortic Dissection/Type A Aortic Dissection/13040569-DS-4.json @@ -0,0 +1,27 @@ +{ + "Type A Aortic Dissection$Intermedia_3": { + "Dissection affects the ascending aorta and may extend to the descending aorta Direct evidence of Type A Aortic Dissection$Cause_1": { + "CTA of the chest which demonstrated an ascending aortic dissection and descending thoracic dissection to the mid thorax$Input2": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "Chest pain is one of the common symptoms of aortic dissection$Cause_1": { + "chest pain$Input1": {} + }, + "Chest pain is one of the common symptoms of aortic dissection.$Cause_1": { + "experience chest pain while exertion approximately two weeks ago$Input2": {} + }, + "This indicates hemodynamic instability, possibly due to dissection$Cause_1": { + "dyspnea and increased pain with exertion$Input2": {} + }, + "Typical symptoms of aortic dissection include sudden, severe chest pain that often radiates to the back$Cause_1": { + "persistent with radiation to his back$Input2": {} + } + } + }, + "input1": "chest pain\n", + "input2": "He is a 67 year old man with no significant past medical history. He began to experience chest pain while exertion approximately two weeks ago. The pain became persistent with radiation to his back. He was evaluated at an outside hospital and discharged after observation. Since that time, he noted dyspnea and increased pain with exertion. He decreased his activity and followed up with his PCP who scheduled an \noutpatient echocardiogram. The results were suspicious for dissection and he underwent a CTA of the chest which demonstrated an ascending aortic dissection and descending thoracic dissection to the mid thorax. He was transferredfor further care.\n", + "input3": "None\n", + "input4": "Non contributory\n", + "input5": "HR: 78-101. BP: 111/88. RR: 17. O2 sat: 98%.\n\nGeneral:\nSkin: Dry [x] intact [x]\nHEENT: PERRLA [] EOMI [x]\nNeck: Supple [x] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: Irregularly irregular, distant heart sounds, no murmur \nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + []\nExtremities: Warm [x], well-perfused [x] Edema - none\nVaricosities: None [x]\nNeuro: Grossly intact [x]\nPulses:\nFemoral Right: 2+ palpable Left:2+ palpable \nDP Right: 2+ palpable Left:2+ palpable \nRadial Right: 2+ palpable Left:2+ palpable \n\nCarotid Bruit: None\nDischarge Vital exam:\nTemp 98 HR 85 SBP 117/79 resp 16 sats 98% RA\nwgt: 167.7kg\n", + "input6": "None\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type A Aortic Dissection/17304892-DS-10.json b/Finished/Aortic Dissection/Type A Aortic Dissection/17304892-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..c7aeea8ead40d9d9ede1091d3bcc3f7273dd5aab --- /dev/null +++ b/Finished/Aortic Dissection/Type A Aortic Dissection/17304892-DS-10.json @@ -0,0 +1,30 @@ +{ + "Type A Aortic Dissection$Intermedia_3": { + "The diameter of the ascending aorta was 6.6 cm, exceeding the upper limit of the normal value of 3.4 cm. Significant dilation of the aorta is an important indicator of aortic dissection.$Cause_1": { + "Aorta - Ascending: *6.6 cm <= 3.4 cm$Input6": {} + }, + "Severe dilatation of the aortic sinuses and ascending aorta. This dilatation of the aorta may indicate compromised structural integrity of the aortic wall and is a risk factor for aortic dissection.$Cause_1": { + "AORTA: Severe dilation of aorta at sinus level. Severely dilated ascending aorta.$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "Chest pain is one of the common symptoms of aortic dissection$Cause_1": { + "Chest pain$Input1": {} + }, + "Sudden chest pain is a common symptom of Type A aortic dissection$Cause_1": { + "sudden onset of chest pain$Input2": {} + }, + "Persistent chest pain and discomfort raise suspicion of aortic dissection$Cause_1": { + "Woke this AM with the same sensations$Input2": {} + }, + "The difference in the femoral pulse between the right and left sides, labeled equal to 2 on the right side and plus 2 on the left side, may indicate a stronger pulse on the left side. This asymmetry in the pulse may also be a sign of aortic dissection, where the dissection may be blocking blood flow on one side, causing the pulse to be different in strength.$Cause_1": { + "Right: =2 Left:+2$Input5": {} + } + } + }, + "input1": "Chest pain\n", + "input2": "32 year old man with sudden onset of chest pain after working yesterday. He went to bed with chest pain and indigestive symptoms. Did not sleep well. Woke this AM with the same sensations. His girlfriend brought patient to the OSH, where he underwent CTA. He was transferred urgerntly for cardiac surgery evaluation. Patient was brought emergently to the OR.\n", + "input3": "none\n", + "input4": "Family history of cervical and oral cancer\n", + "input5": "Admit PE:\nPulse:88 Resp: 16 O2 sat: RA 98%\nB/P Right:110/68 Left: \nHeight: 5ft 10\" Weight: 150lbs\n\nGeneral:\nSkin: Dry [x] intact [x]\nHEENT: PERRLA [x] EOMI [x]\nNeck: Supple [x] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [] Murmur [] grade ______ \nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds +[]\nExtremities: Warm [x], well-perfused [x] Edema []\nVaricosities: None [x]\nNeuro: Grossly intact [x]\nPulses:\nFemoral Right: =2 Left:+2\nDP Right: +2 Left:+2\nRadial Right:+2 Left:+2\n\nCarotid Bruit: Right: - Left:-\n", + "input6": "STUDIES:\nPA/LAT CXR ___:\nLungs are low volume with stable small bilateral effusions slightly increased in volume. Cardiomediastinal silhouette is stable. There is a lucency in the left apex which could represent a small left apical pneumothorax. \n.\nIntraop TEE ___, \nEchocardiographic Measurements \nResults \nMeasurements \nNormal Range \nLeft Ventricle - Ejection Fraction: 55% >= 55% \nAorta - Ascending: *6.6 cm <= 3.4 cm \n \nFindings \nLEFT ATRIUM: No thrombus/mass in the body of the LA. \nRIGHT ATRIUM/INTERATRIAL SEPTUM: Small PFO present. \nLEFT VENTRICLE: Normal LV wall thickness. Normal regional LV systolic function. \nRIGHT VENTRICLE: Normal RV chamber size and free wall motion. \n\nAORTA: Severe dilation of aorta at sinus level. Severely dilated ascending aorta. \n\nAORTIC VALVE: Three aortic valve leaflets. Moderate to severe (3+) AR. \nMITRAL VALVE: Normal mitral valve leaflets. Trivial MR.\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type A Aortic Dissection/18066087-DS-7.json b/Finished/Aortic Dissection/Type A Aortic Dissection/18066087-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..f5fa77b6a2510be3945026debb9f42cfc4c53ed1 --- /dev/null +++ b/Finished/Aortic Dissection/Type A Aortic Dissection/18066087-DS-7.json @@ -0,0 +1,33 @@ +{ + "Type A Aortic Dissection$Intermedia_3": { + "Confirmed aortic dissection, particularly involving the ascending aorta, which is the typical location of Type A aortic dissection$Cause_1": { + "received CT scan which showed dissection affecting the ascending aorta.$Input2": {} + }, + "The dissected valve extends into the aortic arch and descending aorta. This is direct evidence of aortic dissection, indicating that the dissection has affected multiple parts of the aorta.$Cause_1": { + "The dissection flap extends into the arch and descending aorta.$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "Back pain and chest pain are typical symptoms of aortic dissection, which are common in the early stages of a tear in the aortic wall.$Cause_1": { + "presented to osh this am with back and chest pain$Input2": {} + }, + "The patient's blood pressure was slightly high. Hypertension is an important risk factor for aortic dissection.$Cause_1": { + "BP 140/70$Input5": {} + }, + "This condition is usually associated with abnormalities of the aortic valve and nearby structures, possibly due to aortic dissection that impairs aortic valve function.$Cause_1": { + "Moderate to severe (3+) aortic regurgitation is seen$Input6": {} + }, + "A bicuspid aortic valve is a risk factor for aortic dissection because it may alter the hemodynamics of the aortic root.$Cause_1": { + "The aortic valve is bicuspid$Input6": {} + }, + "This is a common presentation of aortic dissection, as structural abnormalities in the aortic wall predispose to aortic dilation, which may lead to dissection.$Cause_1": { + "The ascending aorta is severely dilated$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "___ no previous medical history presented to osh this am with back and chest pain and taken for emergent repair with cardiac surgery. Upon brief interview in ED prior to OR patient reports pain started around 7am this am in back. He went to work but when chest pain started he went to ED and received CT scan which showed dissection affecting the ascending aorta.\n", + "input3": "s/p appendectomy\ns/p biceps tendon surgery\n", + "input4": "Reports no hx of aneurysm, vasculitis, connective tissue \ndisorder\n", + "input5": "P/E: Alert oriented x3 \nBP 140/70,75 NSR, sats 98%\nlungs clear\n___: S1 S2 NSR\nabdomen soft\nextremities: palpable femoral pulses bilaterally\nneurology: intact\n", + "input6": "___ Echo: Prebypass: Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The ascending aorta is severely dilated. The aortic valve is bicuspid. Moderate to severe (3+) aortic regurgitation is seen. Mild (1+) mitral regurgitation is seen. There is no pericardial effusion. The dissection flap extends into the arch and descending aorta.The ascending aorta is severely dilated .The arch and desceding thoracic aorta I normal in diameter.The sinotubular junction is effaced. Post bypass- This study was performed by Dr. ___. Patient is A paced on Epinephrine and Phenylephrine. Biventriculat systolic function is unchanged. Mechanical valve seen in the aortic position. Peak gradient is 13 mm Hg. Rest of examination is unchanged.\n\n___ 06:55AM BLOOD WBC-12.8* RBC-3.24* Hgb-10.5* Hct-32.5* \nMCV-100* MCH-32.4* MCHC-32.3 RDW-14.0 RDWSD-50.9* Plt ___\n___ 12:12PM BLOOD WBC-8.3 RBC-4.58* Hgb-15.3 Hct-44.8 \nMCV-98 MCH-33.4* MCHC-34.2 RDW-12.5 RDWSD-44.6 Plt ___\n___ 06:55AM BLOOD ___\n___ 06:19PM BLOOD ___ PTT-37.0* ___\n___ 06:55AM BLOOD UreaN-23* Creat-1.1 Na-138 K-4.2 Cl-100\n___ 12:12PM BLOOD Glucose-137* UreaN-15 Creat-1.2 Na-140 \nK-4.6 Cl-107 HCO3-20* AnGap-18\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type A Aortic Dissection/18252585-DS-3.json b/Finished/Aortic Dissection/Type A Aortic Dissection/18252585-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..2c7934d95ade28bc6553bd257508fb4d76a05290 --- /dev/null +++ b/Finished/Aortic Dissection/Type A Aortic Dissection/18252585-DS-3.json @@ -0,0 +1,33 @@ +{ + "Type A Aortic Dissection$Intermedia_3": { + "Abdominal CT scan shows abdominal aortic dissection. This is the key evidence for diagnosing aortic dissection.$Cause_1": { + "CT scan of the abdomen which showed a dissection of abdominal aorta$Input2": {} + }, + "Aortic dissection is a condition in which blood enters the aortic wall after a tear in the inner wall of the aorta. This can cause blood to accumulate under the pericardium, which can affect heart function. The condition is very serious and is diagnosed as type A aortic dissection.$Cause_1": { + "Long dissection with a small hemopericardium$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "Chest pain is one of the common symptoms of aortic dissection$Cause_1": { + "chest pain$Input1": {} + }, + "Typical symptoms of aortic dissection include abdominal pain, which may come on suddenly and be very severe.$Cause_1": { + "abdominal pain concern$Input2": {} + }, + "Systolic blood pressure was above 200 mmHg at admission. Hypertension is an important risk factor for aortic dissection.$Cause_1": { + "blood pressure on admission was in 200s systolic$Input2": {} + }, + "HTN is the risk of aortic dissection$Cause_1": { + "HTN$Input3": {} + }, + "Mild distension and tenderness in the abdomen may indicate internal bleeding or other complications, which are also possible symptoms of aortic dissection.$Cause_1": { + "mildly softly distended, minimally diffusely tender, + BS$Input5": {} + } + } + }, + "input1": "chest pain\n", + "input2": "Patient is a 38 year old male who is transferred with abdominal pain concern. The pain began at 9 am this morning. Patient underwent the CT scan of the abdomen which showed a dissection of abdominal aorta. Patient was subsequently transferred here. The blood pressure on admission was in 200s systolic. Patient was hemodynamically stable. At the time of presentation to the patient continued to be hemodynamically stable with sbp in 110 - 150s and hr in the ___ -100s, saturating well on room air. Patient denies any pain. He underwent an emergent CTA of the aorta with run offs.\n", + "input3": "HTN (untreated)\n", + "input4": "non-contributory\n", + "input5": "PE: on admission \nVS: 98 87 135/76 18 99% RA \ngen: alert and oriented, appropriate, seemed comfortable \nCV: RRR \npulm: CTA b/l \nabd: mildly softly distended, minimally diffusely tender, + BS \nextemities: pulses all palpable \n\n", + "input6": "imaging:\n___ CTA aorta with run-offs\n1. Long dissection with a small hemopericardium. RCA, LAD, and LCx remain opacified. Dissection extends through the common iliac arteries and into the proximal left and right internal iliac arteries and mid right external iliac artery. \n \n2. Complete infarction of the right kidney and spleen. Small amount of clot in the proximal left renal artery although the left kidney remains normally perfused. \n \n3. Liver remains perfused but the blood supply in the celiac trunk appears tenuous. Blood supply in the proximal superior mesenteric artery is also tenuous although good flow is seen distally. Inferior mesenteric artery remains normally opacified. \n\n___ 03:25PM BLOOD WBC-10.7 RBC-4.43* Hgb-13.4* Hct-40.2 MCV-91 MCH-30.3 MCHC-33.4 RDW-12.3 Plt ___\n___ 10:42PM BLOOD WBC-10.7 RBC-2.26* Hgb-6.8* Hct-20.8* MCV-92 MCH-29.9 MCHC-32.5 RDW-12.3 Plt ___\n___ 01:27AM BLOOD WBC-8.2 RBC-2.63* Hgb-8.1* Hct-25.2* MCV-96 MCH-30.6 MCHC-32.0 RDW-13.1 Plt Ct-23*#\n___ 03:25PM BLOOD ___ PTT-38.2* ___\n___ 09:03PM BLOOD ___ PTT-102.8* ___\n___ 01:27AM BLOOD ___ PTT-150* ___\n___ 01:27AM BLOOD Plt Smr-VERY LOW Plt Ct-23*#\n___ 03:25PM BLOOD Glucose-105* UreaN-14 Creat-1.4* Na-133 K-7.3* Cl-100 HCO3-23 AnGap-17\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type A Aortic Dissection/18297404-DS-6.json b/Finished/Aortic Dissection/Type A Aortic Dissection/18297404-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..8f84588ab0a6b8189cdbfa7e162a28014b3a8245 --- /dev/null +++ b/Finished/Aortic Dissection/Type A Aortic Dissection/18297404-DS-6.json @@ -0,0 +1,36 @@ +{ + "Type A Aortic Dissection$Intermedia_3": { + "Intimal flaps or dissections at different locations in the aorta indicate a loss of structural integrity of the aorta and are direct evidence of Type A aortic dissection.$Cause_1": { + "scending aortic intimal flap/dissection.. Aortic arch intimal flap/dissection. Descending aorta intimal flap/aortic dissection.$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "Back pain is a common symptom of Aortic Dissection$Cause_1": { + "back pain$Input1": {} + }, + "Sudden back and chest pain that may radiate down the aorta to the jaw is typical of a tear in the aortic lining$Cause_1": { + "acute onset of back, chest, and jaw pain$Input2": {} + }, + "Hypertension is one of the most common risk factors for aortic dissection$Cause_1": { + "hypertension$Input2": {} + }, + "Coronary artery disease may be accompanied by atherosclerosis of the entire cardiovascular system, which may also increase the risk of aortic dissection.$Cause_1": { + "coronary artery disease$Input2": {} + }, + "It revealed mild to moderate aortic regurgitation (AI) and a low left ventricular ejection fraction (EF) of about 35%, which may be due to the effect of aortic dissection on cardiac function. It clearly indicated the presence of aortic dissection.$Cause_1": { + "TEE - trace to mild AI, EF around 35%, Type A\nDissection$Input5": {} + }, + "Enlargement of the left atrium may be caused by the increased volume of blood that the heart has to handle, which is common in aortic dissection.$Cause_1": { + "The left atrium is moderately dilated$Input6": {} + }, + "Enlargement and weakening of the left ventricle may indicate that the heart is having trouble pumping blood, which can occur in aortic dissection because the structure of the heart is affected.$Cause_1": { + "The left ventricular cavity is severely dilated$Input6": {} + } + } + }, + "input1": "back pain\n", + "input2": "Mr. ___ is a ___ year old male with end stage kidney disease on peritoneal dialysis, hypertension, complete heart block and coronary artery disease who presented to ___ ___ with acute onset of back, chest, and jaw pain. A chest CT scan showed a Type A dissection of the aorta. He was intubated and sedated. He transferred to ___ for emergency surgery.\n", + "input3": "None\n", + "input4": "unobtainable\n", + "input5": "PE: BP 110/67 by ___ HR 80 (SR)\nGeneral - intubated and sedated, aline left radial\nHEENT - intubated, central line RIJ\nLungs - BS bilaterally\nCardio - NSR, TEE - trace to mild AI, EF around 35%, Abdomen - PD catheter LLQ, soft\nExt - +1 edema\nNeuro - intubated and sedated\n", + "input6": "BP (mm Hg): 110/70 Wgt (lb): 220 \nHR (bpm): 65 BSA (m2): \nIndication: Evaluate Valves, \nVentricular Function, Wall motion \nICD-9 Codes: 441.00 \nTest Information \nDate/Time: ___ at 22:52 ___ MD: ___, MD \n\nTest Type: TEE (Complete) Sonographer: ___, MD \nDoppler: Full Doppler and color Doppler Test Location: \nAnesthesia West OR cardiac \nContrast: None Tech Quality: Adequate \nTape #: ___-: Machine: u/s 6 \nEchocardiographic Measurements \nResults Measurements Normal Range \nLeft Atrium - Long Axis Dimension: *5.5 cm <= 4.0 cm \nLeft Ventricle - Inferolateral Thickness: *1.4 cm 0.6 - 1.1 cm \n \nLeft Ventricle - Diastolic Dimension: *7.2 cm <= 5.6 cm \nLeft Ventricle - Ejection Fraction: 40% to 50% >= 55% \nLeft Ventricle - Stroke Volume: 44 ml/beat \nLeft Ventricle - Cardiac Output: 2.87 L/min \nLeft Ventricle - Peak Resting LVOT gradient: 1 mm Hg <= 10 mm \nHg \nAorta - Annulus: 2.6 cm <= 3.0 cm \nAorta - Sinus Level: *3.7 cm <= 3.6 cm \nAorta - Sinotubular Ridge: *3.6 cm <= 3.0 cm \nAorta - Ascending: *3.6 cm <= 3.4 cm \nAorta - Arch: *3.6 cm <= 3.0 cm \nAorta - Descending Thoracic: *3.3 cm <= 2.5 cm \nAortic Valve - Peak Velocity: 0.8 m/sec <= 2.0 m/sec \nAortic Valve - Peak Gradient: 3 mm Hg < 20 mm Hg \nAortic Valve - Mean Gradient: 1 mm Hg \nAortic Valve - LVOT VTI: 9 \nAortic Valve - LVOT diam: 2.5 cm \nAortic Valve - Valve Area: *2.6 cm2 >= 3.0 cm2 \n \nFindings \nLEFT ATRIUM: Moderate ___. \n\nLEFT VENTRICLE: Mild symmetric LVH. Severely dilated LV cavity. Mild global LV hypokinesis. \n\nAORTA: Normal aortic diameter at the sinus level. Normal aortic arch diameter. Mildly dilated descending aorta. Ascending aortic intimal flap/dissection.. Aortic arch intimal flap/dissection. Descending aorta intimal flap/aortic dissection. \n\nAORTIC VALVE: Normal aortic valve leaflets (3). No AS. Mild (1+) \nAR. \n\nMITRAL VALVE: Mildly thickened mitral valve leaflets. Moderate \n(2+) MR. \n\n___ VALVE: Normal tricuspid valve leaflets with trivial \nTR. Mild [1+] TR. \n\nPULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets. \nNo PR. \n\nPERICARDIUM: Small pericardial effusion. \nConclusions \nPre Bypass: The left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is severely dilated. There is mild global left ventricular hypokinesis (LVEF = 40-50%) with some moderate inferior wall hypokinesis. The descending thoracic aorta is mildly dilated. A mobile density is seen in the ascending aorta consistent with an intimal flap/aortic dissection. A mobile density is seen in the aortic arch consistent with an intimal flap/aortic dissection. A mobile density is seen in the descending aorta consistent with an intimal flap/aortic dissection. The dissecton appears roughly 2 cm above the sinotubular junction and exents as far into the descending aorta as can be visualized. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion. There is no aortic valve stenosis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Moderate (2+) mitral regurgitation is seen. There is a small pericardial effusion. \n\n___ 05:00AM BLOOD WBC-8.2 RBC-2.93* Hgb-9.1* Hct-26.5* \nMCV-91 MCH-31.0 MCHC-34.3 RDW-15.6* Plt ___\n___ 05:27AM BLOOD ___ PTT-28.1 ___\n___ 05:00AM BLOOD Glucose-84 UreaN-60* Creat-10.5*# Na-134 \nK-4.3 Cl-93* HCO3-25 AnGap-20\n___ 05:00AM BLOOD ALT-41* AST-25 LD(LDH)-255* AlkPhos-79 \nAmylase-98 TotBili-0.3\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type B Aortic Dissection/13040569-DS-4.json b/Finished/Aortic Dissection/Type B Aortic Dissection/13040569-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..f37603293b8a56b14974d7be92ccbb2976ac93d4 --- /dev/null +++ b/Finished/Aortic Dissection/Type B Aortic Dissection/13040569-DS-4.json @@ -0,0 +1,27 @@ +{ + "Type B Aortic Dissection$Intermedia_3": { + "The CT scan results showed that the aortic dissection extended from the left subclavian artery to the iliac artery, indicating that the aortic dissection had a large extension, but did not extend to the ascending aorta. This is the key basis for diagnosing Type B Aortic Dissection.$Cause_1": { + "CT SCAN showing extending from L sblcv artery all the way down to both iliacs$Input2": {} + }, + "The CT scan results showed that the aortic dissection extended from the left subclavian artery to the iliac artery, indicating that the aortic dissection had a large extension, but did not extend to the ascending aorta. This is the key basis for diagnosing Type B Aortic Dissection$Cause_1": { + "originating just at the level of the origin of the left subclavian and extending through the entire descending thoracic aorta, the abdominal aorta, and both common iliac arteries.$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "Back pain is one of the common symptoms of aortic dissection.$Cause_1": { + "Back pain$Input1": {} + }, + "Back pain is also an important symptom of aortic dissection$Cause_1": { + "c/o CP and back pain$Input2": {} + }, + "Labetalol is a drug commonly used to control high blood pressure, a risk factor for aortic dissection.$Cause_1": { + "given labetalol$Input2": {} + } + } + }, + "input1": "Back pain\n", + "input2": "37 y/o chinese speaking only, on family visit. Reports falling yesterday afternoon in restroom. Pt is poor historian but he denied CP, SOB, seizure or LOC before or after fall. c/o CP and back pain today that prompted ER visit to OSH where CXR was done, then a CT SCAN showing extending from L sblcv artery all the way down to both iliacs. Was given labetalol during transport and in ER. Denies any prior medical problems, but no PCP visit for \"a while\". pt reports no extremity weakness in ER.\n", + "input3": "Denies\n", + "input4": "Denies\n", + "input5": "Pulse: 67 Resp: O2 sat: 98\nB/P Right: 115/78 Left: 112/80\nHeight: Weight:\n\nGeneral: relatively comfortable\nSkin: Dry [x] intact []\nHEENT: PERRLA [] EOMI [x]\nNeck: Supple [x] Full ROM []\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [] Murmur\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds + []\nExtremities: Warm [x], well-perfused [x] Edema Varicosities:\nNeuro: Grossly intact, moves 4 ext, R handed. follows commands\nPulses:\nFemoral Right: Left:\nDP Right: + Left: +\nRadial Right: + Left: +\nCarotid Bruit Right: - Left: -\n", + "input6": "___ CT Scan Chest\n1. Aortic dissection as described above originating just at the level of the origin of the left subclavian and extending through the entire descending thoracic aorta, the abdominal aorta, and both common iliac arteries. The SMA, celiac axis, and both renal arteries all originate from the true lumen with no flap visualized. Good opacification of both true and false lumens. Aneurysmal dilation of the descending abdominal aorta most prominent just at the bifurcation with associated thrombus formation up to 5.8 x 5.5 cm. \n \n2. Cirrhosis of the liver with sequelae of portal hypertension such as recanalization of the umbilical vein and gastroepiploic varices. \n\n\n___ 05:45AM BLOOD WBC-5.6 RBC-3.88* Hgb-13.4* Hct-37.5* MCV-97 MCH-34.5* MCHC-35.7* RDW-13.9 Plt ___\n___ 05:45AM BLOOD Glucose-89 UreaN-21* Creat-0.9 Na-139 K-4.1 Cl-103 HCO3-24 AnGap-16\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type B Aortic Dissection/13642689-DS-5.json b/Finished/Aortic Dissection/Type B Aortic Dissection/13642689-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..efe63f7304032fa58577c64522c975d8d855e0a7 --- /dev/null +++ b/Finished/Aortic Dissection/Type B Aortic Dissection/13642689-DS-5.json @@ -0,0 +1,27 @@ +{ + "Type B Aortic Dissection$Intermedia_3": { + "The CTA examination results confirmed the dissection of the descending aorta, but did not extend to the ascending aorta. This is the key basis for diagnosing Type B Aortic Dissection.$Cause_1": { + "dissection of descending thoracic aorta from just beyond origin of left subclavian artery extending to the aortic hiatus$Input2": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "Chest and back pain are typical symptoms of aortic dissection$Cause_1": { + "presented to w/ c/o chest and back pain$Input2": {} + }, + "Controlling blood pressure is an important part of managing aortic dissection$Cause_1": { + "BP control$Input2": {} + }, + "Hypertension is a major risk factor for aortic dissection$Cause_1": { + "w/ h/o HTN$Input2": {} + }, + "Obesity is a risk factor for aortic dissection$Cause_1": { + "obese$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "Male w/ h/o HTN, OSA, transferred for management of acute aortic dissection. He initially presented to w/ c/o chest and back pain. He was told he had gastritis and was discharged home. On follow-up with PCP, there was concern for PE, so CTA chest was obtained, which showed dissection of descending thoracic aorta from just beyond origin of left subclavian artery extending to the aortic hiatus. Patient was admitted to MICU. He was started on labetalol gtt for BP control. His chest pain resolved. Repeat chest CTA at 10:50PM showed extension of the dissection beyond the aortic bifurcation to include the right internal iliac artery and left common iliac artery. Troponins were negative x3. Creatinine was 0.6 and patient had good UOP.\n\nOn arrival to the MICU, patient denies any pain. Denies any numbness or weakness in extremities. Continues to have good UOP. SBPs in the 110s on labetalol drip.\n", + "input3": "+OSA\n+Depression / Anxiety\n", + "input4": "Father died of liver cancer\nMother died of breast cancer\nNo family history of HTN.\n", + "input5": "ADMISSION:\nVitals- 98.4 63 122/74 22 96%2L NC \nGeneral- NAD, well-appearing, obese\nHEENT- dry MM. EOMI. PERRL. OP clear\nNeck- supple. no JVP elevation appreciated\nCV- RRR. no m/r/g\nLungs- mild expiratory wheezes in R upper lung field, otherwise clear\nAbdomen- obese, benign\nGU- Foley in place\nExt- 2+ distal pulses. well-perfused, warm. sensation intact. strength throughout.\n", + "input6": "___ 05:30AM BLOOD WBC-8.4 RBC-4.07* Hgb-11.6* Hct-37.1* MCV-91 MCH-28.6 MCHC-31.4 RDW-12.8 Plt ___\n___ 05:30AM BLOOD Glucose-150* UreaN-10 Creat-0.5 Na-138 K-4.0 Cl-104 HCO3-25 AnGap-13\n___ 05:30AM BLOOD ALT-38 AST-22 CK(CPK)-57 AlkPhos-65 TotBili-0.3\n___ 05:30AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 05:30AM BLOOD Albumin-3.0* Calcium-8.2* Phos-2.9 Mg-1.7\n___ 05:39AM BLOOD Type-ART pO2-90 pCO2-47* pH-7.39 calTCO2-30 Base XS-2\n___ 05:39AM BLOOD Lactate-0.8\n\nCTA chest and abdomen ___:\n\n1. celiac trunk, superior mesenteric artery and right renal artery arise from the true lumen of the dissected abdominal aorta. the left renal artery and inferior mesenteric artery seem to arise from the false lumen of the dissected abdominal aorta with apparent slightly delayed nephrogram of the left kidney.\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type B Aortic Dissection/14210167-DS-14.json b/Finished/Aortic Dissection/Type B Aortic Dissection/14210167-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..34b6cde98c75d845760e1d4d3b56ff155018c6c6 --- /dev/null +++ b/Finished/Aortic Dissection/Type B Aortic Dissection/14210167-DS-14.json @@ -0,0 +1,48 @@ +{ + "Type B Aortic Dissection$Intermedia_3": { + "Confirmed aortic dissection, beginning distal to the left subclavian artery and extending to the area above the iliac bifurcation$Cause_1": { + "starting just past takeoff of L subclavian artery and extending down to above iliac bifurcation$Input6": {} + }, + "Not extend to the ascending aorta. This is the key basis for diagnosing Type B Aortic Dissection.$Cause_1": { + "No evidence of dissection extension into the proximal ascending thoracic aorta or the aortic arch branch vessels.$Input6": {} + }, + "Aortic dissection has steadily extended to the infrarenal portion of the abdominal aorta$Cause_1": { + "Stable extension of the dissection into the infrarenal portion of the abdominal aorta.$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "Back pain is the common symptom of Aortic Dissection$Cause_1": { + "acute onset back pain$Input1": {} + }, + "Chronic abdominal and back pain from previous surgery, which may indicate an ongoing anatomical problem or sequelae of surgery$Cause_1": { + "chronic abdominal and back pain for over 5 yrs$Input2": {} + }, + "Hypertension is a risk factor for aortic dissection, especially when systolic blood pressure is significantly elevated.$Cause_1": { + "SBP > 200$Input2": {} + }, + "Sudden onset of back pain, a classic symptom of aortic dissection$Cause_1": { + "acute onset of back pain while resting$Input2": {} + }, + "Pain radiating from the back to the abdomen is also a common symptom of aortic dissection, reflecting the possible location of the tear in the aorta that affects the abdomen.$Cause_1": { + "Pain radiating to abdomen$Input2": {} + }, + "Myocardial infarction is a cardiovascular disease that is associated with an increased risk of aortic dissection because cardiovascular problems can increase stress on the arterial wall.$Cause_1": { + "MI$Input3": {} + }, + "High blood pressure is one of the most important risk factors for aortic dissection. High blood pressure can increase the pressure within the arteries, increasing the risk of damage to the aortic wall.$Cause_1": { + "HTN$Input3": {} + }, + "Widespread tenderness over the entire abdomen, especially in the epigastrium. Aortic dissection may cause abdominal pain, especially if the dissection affects the abdominal aorta.$Cause_1": { + "tender diffusely but to epigastric\nregion$Input5": {} + }, + "There is some hypoperfusion of the right renal artery. Inhomogeneous blood flow to the renal artery can lead to impaired renal function, which is one of the hallmarks of aortic dissection that can lead to serious complications.$Cause_1": { + "R renal artery as discrepancy in perfusion of kidneys$Input6": {} + } + } + }, + "input1": "acute onset back pain\n", + "input2": "She is with chronic abdominal and back pain for over 5 yrs from previous surgeries p/w acute onset of back pain while resting. Pain radiating to abdomen. This was associated with profuse vomiting. \n\nOn arrival to ED, SBP > 200 and after nitroprusside and esmolol, her BP did respond. She was still complaining of abdominal and back pain but decreased in severity with narcotics.\n", + "input3": "+MI, \n+COPD\n+CVA\n+prolonged QT\n+rectocele\n+HTN\n+conversion disorder presenting with signs/sx of CVA\n", + "input4": "None\n", + "input5": "Gen: Mild distress, in bed, sleepy\nLungs: clear\nCardio: RRR\nAbd: soft, dist, obese, tender diffusely but to epigastric\nregion, no palpable masses\nExt: scabs t/o lower extremities, no edema or cyanosis\n\nPulses fem pop DP ___\nL p/d d p p/d\nR p/d d p p/d\n", + "input6": "139 103 8 \n-------------< 150 \n3.7 25 0.7 estGFR: >75 \nCa: 8.1 Mg: 1.8 P: 4.5\n15.3> 11.9/34.9< 413 N:86.9 L:9.5 M:2.6 E:0.4 Bas:0.6 \n___: 11.8 PTT: 20.0 INR: 1.0 \n\nCTA (OSH) - starting just past takeoff of L subclavian artery and extending down to above iliac bifurcation. There is some R renal artery as discrepancy in perfusion of kidneys (R96% 2L NC\nGen: Pleasant, calm. No acute distress. Sleeping comfortably flat in bed. Attentive to exam though intermittently disoriented.\nHEENT: No conjunctival pallor. No icterus. MMM. OP clear. \nNECK: Supple, No LAD. JVP difficult to assess. Normal carotid upstroke without bruits. \nCV: Distant heart sounds. PMI in intercostal space, mid clavicular line. RRR. normal 1,S2. No murmurs, rubs, clicks, or gallops \nLUNGS: CTAB anteriorly. No wheezes, rales, or rhonchi. \nABD: NABS. Soft, NT, ND. No abdominal bruits. \nEXT: WWP, NO CCE. Full distal pulses bilaterally. No femoral bruits. \nSKIN: No rashes/lesions, ecchymoses. \nNEURO: A&Ox3. CN grossly intact. Preserved sensation throughout and moves all four extremities. strength throughout. Normal coordination. Gait assessment deferred \nPSYCH: Mood was appropriate and affect was full.\n", + "input6": "CTA Torso: ___\n \nHEART AND VASCULATURE: An aortic dissection extends from just distal to the left subclavian artery, to the level of the SMA. The heart, \npericardium, and great vessels are within normal limits. No pericardial effusion is seen. \n \nAXILLA, HILA, AND MEDIASTINUM: No axillary, mediastinal, or hilar lymphadenopathy is present. No mediastinal mass or hematoma. \n \nPLEURAL SPACES: No pleural effusion or pneumothorax. \n \nLUNGS/AIRWAYS: Mild, bibasilar atelectasis. Otherwise, the lungs are clear without masses or areas of parenchymal opacification. The airways are patent to the level of the segmental bronchi bilaterally. \n \nBASE OF NECK: Visualized portions of the base of the neck show no abnormality. \n \nABDOMEN: \n \nHEPATOBILIARY: The liver demonstrates homogenous attenuation throughout. There is no evidence of focal lesion or laceration. There is no evidence of intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits. \n \nPANCREAS: The pancreas has normal attenuation throughout, without evidence of focal lesions or pancreatic ductal dilatation. There is no peripancreatic stranding. \n \nSPLEEN: The spleen shows normal size and attenuation throughout, without evidence of focal lesion or laceration. \n \nADRENALS: The right and left adrenal glands are normal in size and shape. \n \nURINARY: The kidneys are of normal and symmetric size with normal nephrogram. Right renal hypodensities measure up to 1.2 cm, compatible with cysts. There is no evidence of hydronephrosis. There is no perinephric abnormality. \n \nGASTROINTESTINAL: Small hiatal hernia. Small bowel loops demonstrate normal caliber, wall thickness, and enhancement throughout. Scattered colonic diverticulosis, without evidence of acute diverticulitis. The rectum appears normal. The appendix is not definitively identified. There is no evidence of mesenteric injury. \n \nThere is no free fluid or free air in the abdomen. \n \n \nLYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy. There is no pelvic or inguinal lymphadenopathy. \n \nVASCULAR: The aforementioned aortic dissection extends to approximately the level of the SMA. The celiac axis, SMA, and bilateral renal arteries are supplied by the true lumen. Moderate atherosclerotic disease is noted. \n \nBONES: There is no acute fracture. No focal suspicious osseous abnormality. Grade 1 anterolisthesis of L4 on L5 and L5 on S1, likely degenerative in etiology. \n \nSOFT TISSUES: Small, fat containing umbilical hernia. Otherwise, the abdominal and pelvic wall is within normal limits.\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type B Aortic Dissection/16310435-DS-20.json b/Finished/Aortic Dissection/Type B Aortic Dissection/16310435-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..a48cabfaab15034cb55648482a7138ef1da32c02 --- /dev/null +++ b/Finished/Aortic Dissection/Type B Aortic Dissection/16310435-DS-20.json @@ -0,0 +1,30 @@ +{ + "Type B Aortic Dissection$Intermedia_3": { + "The CTA examination results confirmed the dissection of the descending aorta, but did not extend to the ascending aorta. This is the key basis for diagnosing Type B Aortic Dissection.$Cause_1": { + "dissection of descending thoracic aorta from just beyond origin of left subclavian artery extending to the aortic hiatus.$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "chest and back pain are common symptom of Aortic Dissection$Cause_1": { + "chest and back pain$Input1": {} + }, + "A history of thoracic aortic aneurysm increases the risk of aortic dissection$Cause_1": { + "history of thoracic aortic aneurysm$Input2": {} + }, + "Tearing chest pain is a typical symptom of aortic dissection, especially if the pain radiates to the back.$Cause_1": { + "3 hour history of a tearing chest pain that radiated to his back$Input2": {} + }, + "The sudden onset of pain and its persistence are consistent with the pain characteristics of aortic dissection.$Cause_1": { + "the pain began during the day, however was a lower grade pain and around 11PM the pain became sharp, severe and constant$Input2": {} + }, + "Bradycardia, possibly due to circulatory problems, suggests underlying aortic problems$Cause_1": { + "HR 56$Input5": {} + } + } + }, + "input1": "chest and back pain\n", + "input2": "He is with a history of thoracic aortic aneurysm presents to the ER with a 3 hour history of a tearing chest pain that radiated to his back. He states the pain began during the day, however was a lower grade pain and around 11PM the pain became sharp, severe and constant. The pain intensity did not subside therefore he decided to be evaluated in the ER. He also reports he had a similar episode 2 weeks ago where he was evaluated and was told he had a thoracic aneurysm. He was evaluated by a surgeon who suggestive operative repair, however the patient was unable to go to his follow up appointments.\n", + "input3": "+Bentall with mechanical AVR\n+L THR x 3\n+removal of hardware\n", + "input4": "denies hx of aortic aneurysms, dissections or valvular disease\n", + "input5": "bp 106/62 HR 56 reg RR 12\n\nGen: lying in bed in NAD. Alert and oriented\nCV: RRR, audible click from mechanical aortic valve\nLungs: CTA bilat\nAbd: Soft no m/t/o\nExtremities: Warm, well perfused, palpable lower extremity pulses bilat\nWound: groin puncture c/d/i\n", + "input6": "___ 03:19AM BLOOD WBC-4.0 RBC-3.84* Hgb-12.2* Hct-35.9* MCV-93 MCH-31.7 MCHC-33.9 RDW-13.6 Plt ___\n\n___ 03:19AM BLOOD ___ PTT-27.2 ___\n___ 07:23AM BLOOD Glucose-98 UreaN-11 Creat-0.8 Na-139 K-4.0 Cl-108 HCO3-23 AnGap-12\n___ 07:23AM BLOOD ALT-22 AST-29 CK(CPK)-55 AlkPhos-73 TotBili-0.8\n___ 03:19AM BLOOD Lipase-17\n___ 07:23AM BLOOD CK-MB-1 cTropnT-<0.01\n___ 07:23AM BLOOD Albumin-3.7 Calcium-8.4 Phos-3.4 Mg-1.6\n\nCTA chest was obtained, which showed dissection of descending thoracic aorta from just beyond origin of left subclavian artery extending to the aortic hiatus.\n\n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type B Aortic Dissection/19210913-DS-17.json b/Finished/Aortic Dissection/Type B Aortic Dissection/19210913-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..0b2f9e3535d52313cf0c851ba71cb8f8ed337c14 --- /dev/null +++ b/Finished/Aortic Dissection/Type B Aortic Dissection/19210913-DS-17.json @@ -0,0 +1,36 @@ +{ + "Type B Aortic Dissection$Intermedia_3": { + "The anatomical features of Type B aortic dissection are described, which originates from the distal left subclavian artery and extends to the bilateral common iliac arteries and possibly the proximal internal and external iliac arteries.$Cause_1": { + "Originating immediately distal to the origin of the left subclavian artery and coursing distal to involve the bilateral common iliac arteries and likely very proximal internal and external iliac arteries$Input6": {} + }, + "It was confirmed that Type B aortic dissection started from the distal left subclavian artery and may extend to the left common iliac artery and the proximal left renal artery. The extent of the dissection did not change.$Cause_1": { + "Type B aortic dissection arising distal to left subclavian artery with probable extension into the left common iliac artery and proximal left renal artery, unchanged in extent$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "chest and back pain are common symptom of Aortic Dissection$Cause_1": { + "Chest/Back pain$Input1": {} + }, + "Bilateral lower abdominal pain may be an early symptom of Aortic Dissection$Cause_1": { + "Pt developed BLQ abdominal pain$Input2": {} + }, + "The pain spreads from the abdomen to the front of the chest, indicating that the condition is getting worse$Cause_1": { + "The pain then spread up to lower anterior chest$Input2": {} + }, + "The pain becomes sharp and spreads to the chest and back, which is a typical symptom of aortic dissection.$Cause_1": { + "became sharp, and continued to spread around chest bilaterally to his back$Input2": {} + }, + "Hypertension is a risk factor for aortic dissection$Cause_1": { + "SBPs in the 190s$Input2": {} + }, + "HTN is a significant risk factor for aortic dissection$Cause_1": { + "HTN$Input3": {} + } + } + }, + "input1": "Chest/Back pain\n", + "input2": "Pt developed BLQ abdominal pain that he thought was constipation on the evening prior to presentation to an OSH. The pain then spread up to lower anterior chest, became sharp, and continued to spread around chest bilaterally to his back and increased in severity prompting the pt to go to ___ at 19:00 last night. On arrival pt was diaphoretic, his HR was in the ___ and SBPs in the 190s. Pt had a non-con CT scan and was given pain medication,labetalol, and nitroglycerin. Pt was transferred to ___ this AM. On arrival, pt underwent a CTA. Pt's BP is being controlled with esmolol, nitroglycerin, and nicardipine drips. Pt reports ongoing back pain, though dull and less severe than before but denies abdominal or chest pain at this time. \n", + "input3": "PMH: HTN, hasn't see a doctor in ___ yrs\nPSH: back surgery x2, L wrist surgery\n", + "input4": "Father died of brain tumor at age ___.\n", + "input5": "HR 77, BP 135/73, RR 22, SaO2 97% on 2L NC\nNeuro/Psych: Oriented x3, Affect Normal, Anxious. \nNeck: No masses, Trachea midline, Thyroid normal size,\nnon-tender, no masses or nodules. \nNodes: No clavicular/cervical adenopathy, No inguinal \nadenopathy.\nSkin: No atypical lesions. \nHeart: Regular rate and rhythm. \nLungs: Clear, Normal respiratory effort, abnormal: Sternal\ntenderness. \nGastrointestinal: Abnormal: Firm w rigoring, epigastric\ntenderness (no rebound, unable to assess guarding d/t rigoring),\ndistented, umbilical hernia. \nRectal: Not Examined. \nExtremities: Wwp x4, no edema, no skin changes. \nPulse Exam (P=Palpation, D=Dopplerable, N=None)\n-RUE Radial: P. \n-LUE Radial: P. \n-RLE Femoral: P. Popiteal: P. DP: P. ___: P. \n-LLE Femoral: P. Popiteal: P. DP: P. ___: P. \n", + "input6": "___ 02:29AM BLOOD WBC-8.9 RBC-4.54* Hgb-13.6* Hct-38.8* \nMCV-86 MCH-29.9 MCHC-34.9 RDW-14.2 Plt ___\n___ 02:29AM BLOOD Glucose-153* UreaN-13 Creat-1.0 Na-138 \nK-3.9 Cl-103 HCO3-26 AnGap-13\n___ 02:02AM BLOOD ALT-20 AST-19 LD(LDH)-187 AlkPhos-61 \nTotBili-0.7\n___ 02:29AM BLOOD Calcium-8.4 Phos-3.9 Mg-2.2\n___ 02:59AM BLOOD %HbA1c-5.6 eAG-114\n\n___ CTA Torso:\nOriginating immediately distal to the origin of the left subclavian artery and coursing distal to involve the bilateral common iliac arteries and likely very proximal internal and external iliac arteries. The true lumen supplies the celiac axis, SMA, right renal artery, and ___. The false lumen supplies the left renal artery. Both kidneys are well perfused with normal symmetric nephrograms. \n\n\n___ CTA Torso: \n1. Type B aortic dissection arising distal to left subclavian artery with probable extension into the left common iliac artery and proximal left renal artery, unchanged in extent. Celiac axis, SMA, ___, and right renal artery arise from the true lumen. No CT evidence of vascular compromise of the solid organs. \n2. Dilated main pulmonary artery, suspicious for pulmonary artery \nhypertension. \n3. Bilateral nonhemorrhagic small pleural effusions with associated \natelectasis, increased from prior. \n4. 10 mm low-density right adrenal nodule, too small to characterize, but statistically most compatible with an adenoma. \n" +} \ No newline at end of file diff --git a/Finished/Aortic Dissection/Type B Aortic Dissection/19281526-DS-10.json b/Finished/Aortic Dissection/Type B Aortic Dissection/19281526-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..ec77756ded0028efc3a9b6477ada371bad92608d --- /dev/null +++ b/Finished/Aortic Dissection/Type B Aortic Dissection/19281526-DS-10.json @@ -0,0 +1,33 @@ +{ + "Type B Aortic Dissection$Intermedia_3": { + "Type B Aortic Dissection usually originates from the left subclavian artery and extends to the renal artery. This illustrates the starting location and extension of the arterial dissection, which is a typical feature of Type B Aortic Dissection.$Cause_1": { + "originating from left subclavian extending to renals$Input6": {} + }, + "Suspected Aortic Dissection$Intermedia_2": { + "back pain is the common symptom of Aortic Dissection$Cause_1": { + "Back pain$Input1": {} + }, + "Hypertension is one of the major risk factors for aortic dissection$Cause_1": { + "h/o HTN$Input2": {} + }, + "Acute mid-back and abdominal pain is one of the classic symptoms of aortic dissection$Cause_1": { + "acute onset of mid-back and abdominal pain$Input2": {} + }, + "Dyspnea may be due to pain or dissection, a complication$Cause_1": { + "difficulties breathing$Input2": {} + }, + "Hypertension is one of the common causes and symptoms of aortic dissection$Cause_1": { + "BP was elevated at 180's$Input2": {} + }, + "Myocardial infarction, especially STEMI, can cause impaired heart function, which in turn increases the risk of arterial disease, including aortic dissection.$Cause_1": { + "MI (inferior STEMI ___, SCC of lip$Input3": {} + } + } + }, + "input1": "Back pain\n", + "input2": "__ with h/o HTN, and stent in RCA here with acute onset of mid-back and abdominal pain that started a few hours prior to admission. C/O difficulties breathing ___ pain. Seen at ___ ED and CT scan showed Type B dissection. BP was elevated at 180's and pt given labetolol. Also given full dose ___.\n\nPatient currently stable on arrival to ___. Recieved morphine in ED and currently denies back or abdominal pain. No extremity pain. No headaches.\n", + "input3": "MI (inferior STEMI ___, SCC of lip\n", + "input4": "No family history of early MI, otherwise non-contributory. Her sister has CAD with stents in place. Her mother died at age ___ from ___, and her father at age ___ from ___. There is also a family history of CVA's. \n", + "input5": "Afebrile, vital signs stable\nMMM, no scleral icterus, tongue and trachea midline, no palpable \nlymphadenopathy\nRRR\nCTAB\nSoft, NT/ND, no masses felt\nR: P/P/P/P\nL: P/P/P/P\nLeft radial pulse palp and equal to right\n\n", + "input6": "CT: originating from left subclavian extending to renals. Celiac supplied by both true and false lumen whereas both SMA and renals supplied by true lumen.\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Allergic Asthma/11897861-DS-3.json b/Finished/Asthma/Allergic Asthma/11897861-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..802634ccadfb8e55a07735b15a5eb0adc54c7a61 --- /dev/null +++ b/Finished/Asthma/Allergic Asthma/11897861-DS-3.json @@ -0,0 +1,47 @@ +{ + "Allergic asthma$Intermedia_4": { + "If the patient could not identify any specific triggers, then the truggers might be the normal things in daily life, for example dust, pollen.$Cause_1": { + "The patient could not identify any specific triggers$Input2": {} + }, + "Asthma$Intermedia_3": { + "Monitoring over time can show variability in lung function,$Cause_1": { + "Cough occured at the end of third peak flow trial$Input5": {} + }, + "Elevated levels indicate eosinophilic inflammation$Cause_1": { + "Fractional Exhaled Nitric Oxide (FeNO): Elevated levels$Input6": {} + }, + "Suspected asthma$Intermedia_2": { + "Allergic rhinitis might cause asthma after sports or cause infection lead to asthma.$Cause_1": { + "allergic rhinitis$Input3": {} + }, + "Anxiety occurs easily during acute asthma attacks.$Cause_1": { + "anxiety$Input3": {} + }, + "Shortness of breath at night or early morning$Cause_1": { + "acute onset of shortness of breath at 9 am$Input2": {} + }, + "Hypertension might occurs during asthma attacts$Cause_1": { + "Hypertension$Input3": {} + }, + "Different breath sound from normal may lead to a lung or bronchus disease.$Cause_1": { + "Decreased breath sounds at the bases.$Input5": {} + }, + "Suspect medical change in lung or bronchus.$Cause_1": { + "cough$Input1": {} + }, + "Patient has a feeling of hardly breathe may lead to a lung or bronchus disease.$Cause_1": { + "\"heavy breathing\"$Input1": {} + }, + "A patient who has medical history of asthma or has been treated for asthma has a big probability of occuring asthma.$Cause_1": { + "Presumably treated for asthma$Input2": {} + } + } + } + }, + "input1": "\"heavy breathing\" and cough\n", + "input2": "This is a 45 male with who presented with acute onset of shortness of breath at 9 am. The patient could not identify any specific triggers although the interview was limited and through a phone interpreter. He does not have a history of asthma. However about 1 month ago he became acutely short of breath and was seen at an outside hospital and was givnen an albuteral inhailor and presumably treated for asthma. Unclear if he required steroids or even an admission at that time. He reports that with the inhailor he returned to his usual state of health until 9am on the day of admit. He does not note any fevers or recent uri symptoms. He does not note any sick contacts. He does not own pets. No chest pain. \n\nIn the ED he trigger for resp distress. His initial vitals were 106 125/77 28 100%. Labs were notable for WBC 15.9 (He was given steroids 2 hours prior to lab draw), hct of 36.2 (MCV 80). A CXR was without acute pulm process. He was given Duonebs x3, methylpred 125 IV x1 and magnesium 2g. On transfer vitals were 110, 101/58, 20, 100% nebs. Per ED report he was initially 98% on RA, then desatted to 94% on RA.\n", + "input3": "Allergic rhinitis\nAnxiety\nHypertension\n", + "input4": "Non-contributory.\n", + "input5": "Admission Physical Exam:\nVitals: 98.4, 105/66, 104, 98% ra\nPF: cough occured at the end of third peak flow trial\nGeneral: No acute distress, occasional coughing\nHEENT: MMM, Sclera anicteric, conjunctiva pink\nNeck: Supple, No LAD, JVP not elevated\nHeart: Tachycardic, No murmurs\nLungs: No wheezes heard, decreased breath sounds at the bases. \nAbdomen: Non tender, Non distended, soft, +BS\nExtremities: No edema\nNeurological: grossly intact\n", + "input6": "___ 11:45PM GLUCOSE-142* UREA N-11 CREAT-0.9 SODIUM-138 POTASSIUM-3.3 CHLORIDE-99 TOTAL CO2-26 ANION GAP-16\n___ 11:45PM estGFR-Using this\n___ 11:45PM WBC-15.9* RBC-4.51* HGB-12.9* HCT-36.2* MCV-80* MCH-28.7 MCHC-35.7* RDW-12.8\n___ 11:45PM NEUTS-81.5* LYMPHS-10.4* MONOS-1.8* EOS-6.0* BASOS-0.2\n___ 11:45PM PLT COUNT-259\n\nCXR ___: No acute cardiopulmonary process. \n\nElectrocardiogram ___: sinus rhythm, normal axis, rate: 95, normal intervals, no evidence of enlargment/hypertrophy, TW changes V3-6. No old for comparison.\n\nFractional Exhaled Nitric Oxide (FeNO): Elevated levels\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Asthma/13885966-DS-24.json b/Finished/Asthma/Asthma/13885966-DS-24.json new file mode 100644 index 0000000000000000000000000000000000000000..37344fb2fda2b80d11a04787edc491a617e9fd02 --- /dev/null +++ b/Finished/Asthma/Asthma/13885966-DS-24.json @@ -0,0 +1,45 @@ +{ + "Asthma$Intermedia_3": { + "Giving medicine of steroids is a way of asthma treatment.$Cause_1": { + "Each time steroids resolve his symptoms.$Input2": {} + }, + "Asthma may asociated with emphysema.$Cause_1": { + "CT chest showed mild emphysema.$Input2": {} + }, + "Suspected asthma$Intermedia_2": { + "It symbolizes patient may have chest or bronchus disease.$Cause_1": { + "short of breath$Input1": {} + }, + "Chest or bronchus diseases may associate hypertension.$Cause_1": { + "PMHx of HTN$Input2": {} + }, + "Chest pain indicates that patient may has respiratory system disease or heart disease.$Cause_1": { + "He also developed a constant, left-sided, substernal chest ache$Input2": {} + }, + "Patient may have respiratory system disease.$Cause_1": { + "Chest ache worse with inspiration and coughing$Input2": {} + }, + "Cough and short of breathe indicate that patient may have chest or bronchus disease.$Cause_1": { + "cough, SOB and CP x5 days$Input2": {} + }, + "When patient have chest or bronchus disease, sitting up may help them better.$Cause_1": { + "Sitting up in bed with bed raised at near 90 degrees.$Input5": {} + }, + "Patient has difficult in breathe, indicates patient may has repiratory system disease.$Cause_1": { + "Severe coughing intermittently with prolonged expiratory phase.$Input5": {} + }, + "Different sound of breath indicates patient may have chest or bronchus disease.$Cause_1": { + "Diffuse wheezing with good air movement.$Input5": {} + }, + "Different sound of breathe than normal indicates patient may have respiratory system disease.$Cause_1": { + "Crackles at the bases bilaterally.$Input5": {} + } + } + }, + "input1": "short of breath\n", + "input2": "Male with PMHx of HTN, dilated now resolved with EF %55% and renal insufficiency with baseline Cr 1.1-1.6 who presents with cough, SOB and CP x5 days. About 6 days ago he began experiencing SOB a/w a non-productive cough and new bilateral edema to the knees that reminds him. He endorses orthopnea, and denies PND. His abdomen seems distended to him and is uncomfortable. At that time he also developed a constant, left-sided, substernal chest ache that traveled down his left arm, worse with inspiration and coughing, not exacerbated on exertion. He denies N/V diaphoresis.\n\nOf note, the patient reports that he has experienced a similar cough and SOB every 3 months, though this cough seems worse and wetter than previous episodes. Each time steroids resolve his symptoms. In between episodes he does not have any symptoms. He was admitted for similar symptoms and was found to be hypoxic. At that time he had a TTE with bubble study which showed no PFO and no evidence of pulmonary HTN. CT at that time was negative for PE and PNA. Inpatient PFT's showed a mild gas exchange defect and a mild obstructive ventilatory defect, he was treated with steroids for presumed viral bronchiolitis and improved within 2 days. F/u PFT's one month later were WNL. CT chest showed mild emphysema.\n", + "input3": "+GERD\n+Renal Insufficiency: baseline Cr 1.1-1.6. \n+Rectal Prolapse\n+S/p cholycystectomy\n", + "input4": "Mother: deceased from Alzheimer's \nFather: deceased from CHF; had an MI\n2 Brothers: one deceased from melanoma \n1 Sister: in good health \n2 Paternal uncles: both died from MI\n", + "input5": "Vitals: 97.6 138/87 88 18 95%RA \nGeneral: Alert and interactive. Looks mildly uncomfortable but NAD. Mildly tachypneic but not using accessory muscles. Sitting up in bed with bed raised at near 90 degrees. Severe coughing intermittently with prolonged expiratory phase. \nHEENT: PERRL, EOMI, OP clear \nNeck: No JVD appreciated \nLungs: Diffuse wheezing with good air movement. Crackles at the bases bilaterally. \nCV: RRR, normal s1/s2, no m/r/g \nAbdomen: soft, +BS, bulging flanks. Diffusely tender to palpation without rebound or guarding. No appreciable organomegaly. \nExt: 1+ lower ankle edema b/l with trace edema to the knees bilaterally\n", + "input6": "___ 04:20PM BLOOD WBC-7.7 RBC-4.43* Hgb-14.1 Hct-39.6* MCV-90 MCH-31.9 MCHC-35.7* RDW-13.3 Plt ___\n___ 04:20PM BLOOD Neuts-65.5 ___ Monos-5.8 Eos-7.0* Baso-0.7\n___ 04:20PM BLOOD ___ PTT-30.7 ___\n___ 04:20PM BLOOD Glucose-105* UreaN-13 Creat-1.3* Na-136 K-3.3 Cl-96 HCO3-27 AnGap-16\n___ 06:10AM BLOOD ALT-13 AST-15 AlkPhos-58 TotBili-0.4\n___ 06:20AM BLOOD Calcium-9.6 Phos-3.0 Mg-2.0\n___ 04:28PM BLOOD D-Dimer-451\n\nStudies\n___ CXR: No acute cardiopulmonary process.\n\n___ TTE: The left atrium is normal in size. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. IMPRESSION: Normal global and regional biventricular systolic function.\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Asthma/18681184-DS-5.json b/Finished/Asthma/Asthma/18681184-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..0677ed46bc751919c661f05cc146408bcdd48081 --- /dev/null +++ b/Finished/Asthma/Asthma/18681184-DS-5.json @@ -0,0 +1,33 @@ +{ + "Asthma$Intermedia_3": { + "Albuterol nebs is a kind of SABA, the increase of dosage indicates that the asthma has not been under control.$Cause_1": { + "Received Albuterol nebs x3\uff0cbut still w/inspiratory & expiratory wheezes$Input2": {} + }, + "An increase of peak flow of more than 200ml after giving medicine comfirms the reversibility of airflow obstruction.$Cause_1": { + "After 2 nebs peak flow 300->650$Input2": {} + }, + "Suspected asthma$Intermedia_2": { + "It might relate to chest or bronchus diseases.$Cause_1": { + "Shortness of breath$Input1": {} + }, + "It indicates that the patient might have chest or bronchus disease.$Cause_1": { + "After prednisone & neb: Desats to 90% ambulatory room air, still has diffuse wheezes.$Input2": {} + }, + "After giving medicine, patient still has different sound of breath may indicates that patient has chest or bronchus disease.$Cause_1": { + "Received prednisone,but still w/inspiratory & expiratory wheezes$Input2": {} + }, + "Different breathe sound from normal may related to chest or bronchus disease.$Cause_1": { + "Chest: Difuse wheezes.$Input5": {} + }, + "Low persistence peak flow indicates that patient has chest or bronchus disease.$Cause_1": { + "Peak Flow: 510$Input5": {} + } + } + }, + "input1": "Shortness of breath\n", + "input2": "This is a 41 year old male who presents to the ED with shortness of breath times two weeks. He ran our of his MDI a few weeks ago. He tried an over the counter epinephrine INH without improvement. He presented to the ED because he was not improving. He does not report fevers or chills. No chest pain, no cough. \n \nIn the ED, initial vitals were 97.8 116 146/88 16 98. He recieved 60mg prednisone, IVF, and Albuterol nebs x3. After 2 nebs peak flow 300->650 but still tachy, at 94% on 2lpm, w/inspiratory & expiratory wheezes. After prednisone & neb: Desats to 90% ambulatory room air, still has diffuse wheezes. \n \nOn review of systems, notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. All of the other review of systems were negative.\n", + "input3": "None\n", + "input4": "Noncontributory\n", + "input5": "VS - 97.3, 114/86, 72, 20, 99%2L Peak Flow: 510 \nGen: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. \nCV: S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nChest: Difuse wheezes. No rhales or Rhonchi. Good air movement throughout chest. No dullness to percussion noted. \nAbd: Soft, NTND. No HSM or tenderness. \nExt: No c/c/e. \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas. \nNeuro: grossly intact.\n", + "input6": "CXR: ___: \nFINDINGS: PA and lateral views of the chest are obtained. The lungs are clear bilaterally demonstrating no evidence of pneumonia or CHF. Cardiomediastinal silhouette is normal. Osseous structures are intact. No free air is seen below the right hemidiaphragm.\n" +} \ No newline at end of file diff --git a/Finished/Asthma/COPD Asthma/11707288-DS-14.json b/Finished/Asthma/COPD Asthma/11707288-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..f711a0c2859f5f8efd2f224e1c4a628c82a71325 --- /dev/null +++ b/Finished/Asthma/COPD Asthma/11707288-DS-14.json @@ -0,0 +1,41 @@ +{ + "Asthma-COPD$Intermedia_4": { + "Lasting airflow limitation is a synptom of COPD or asthma.$Cause_1": { + "unable to adequately perform a peak flow$Input2": {} + }, + "Patient who have a history of COPD may have higher probability to develop COPD.$Cause_1": { + "feels like this is COPD$Input2": {} + }, + "Airflow limitation is not fully reversible, that is a symptom of asthma or asthma-COPD$Cause_1": { + "A significant improvement in FEV1 of more than 12% and 400 ml from baseline after administration of a bronchodilator confirms the reversibility of airflow obstruction.$Input6": {} + }, + "Asthma$Intermedia_3": { + "After giving bronchodilator, patient get improvment indicates that patient may have bronchus disease or asthma.$Cause_1": { + "3 x nebs, prednisone x1, patient reports significant improvement in her symptoms.$Input2": {} + }, + "suspected asthma$Intermedia_2": { + "It is a typical symptom of chest or bronchus disease.$Cause_1": { + "Shortness of Breath$Input1": {} + }, + "These indicates the patient may have chest or bronchus disease.$Cause_1": { + "cough, SOB, and wheezing$Input2": {} + }, + "Patient use bronchodilator in their daily life indicates that patient may have chest or bronchus disease.$Cause_1": { + "not amenable to her usual flovent and albuterol that she takes PRN$Input2": {} + }, + "Different sound of breath may indicates that patient have chest or bronchus disease.$Cause_1": { + "Lungs: Coarse breath sounds heard bilaterally in lower lung fields with end expiratory wheezes$Input5": {} + }, + "It can be accompanied with asthma.$Cause_1": { + "+HTN$Input3": {} + } + } + } + }, + "input1": "Shortness of Breath\n", + "input2": "38 y/o F with HTN, depression, and anxiety who presented to the ED after being seen in her PCPs office for a 3 day history of cough, SOB, and wheezing for concern for a COPD exacerbation vs infection. At her PCP office, she was noted to desat to 93% while walking on RA and unable to adequately perform a peak flow. She reports a few days prior of feeling tired and having a sore throat that has since improved but then noticed getting a cough with green phlegm, wheezing and SOB that were not amenable to her usual flovent and albuterol that she takes PRN. She denies any f/n/v but has had some chills. No known sick contacts. She has not been hospitalized for a COPD exacerbation for many years and feels like this is consistent with prior episodes including on a little more than a year ago. She denies any swelling, long travel, DOE, or known cardiac disease.\n\nOtherwise she has been in her usual state of health without any complaints.\n \nIn the ED, initial VS were 100.0 93 111/54 18 96/4L NC. Received azithromycin 500mg x1, 3 x nebs, prednisone x1, and ceftriaxone 1 gram. Transfer VS were 98.0 87 118/83 20 97/4L.\n\nOn arrival to the floor, patient reports significant improvement in her symptoms.\n", + "input3": "+Hysterectomy\n+hx abd wall surgery\n+OSA\n+Back pain\n+GERD\n+Osteoporosis\n+HTN\n+Depression\n+Restless leg syndrome\n+Oral sores\n", + "input4": "Father with heart issue.\nMother with stomach cancer.\n", + "input5": "ADMISSION PHYSICAL EXAM: \n98.0 87 118/83 20 97/4L.\nGeneral: Elderly lady lying in bed in NAD\nHEENT: NCAT\nNeck: No e/o JVD\nCV: RRR, no m/r/g, nml S1/S2\nLungs: Coarse breath sounds heard bilaterally in lower lung fields with end expiratory wheezes\nAbdomen: Soft, NT/ND, +BS, no hepatosplenomegaly\nGU: No foley\nExt: No c/c/e\nNeuro: Grossly normal, PEERL\nSkin: No rashes\n", + "input6": "___ 06:55AM BLOOD WBC-6.4 RBC-3.88* Hgb-11.9* Hct-36.7 MCV-95 MCH-30.6 MCHC-32.4 RDW-11.8 Plt ___\n___ 04:05PM BLOOD WBC-7.3 RBC-4.09* Hgb-12.8 Hct-38.4 MCV-94 MCH-31.3 MCHC-33.4 RDW-12.0 Plt ___\n___ 06:55AM BLOOD Glucose-187* UreaN-29* Creat-0.7 Na-140 K-3.7 Cl-103 HCO3-25 AnGap-16\n___ 04:05PM BLOOD Glucose-90 UreaN-21* Creat-0.9 Na-132* K-8.7* Cl-96 HCO3-26 AnGap-19\n___ 04:05PM BLOOD cTropnT-<0.01\n___ 04:05PM BLOOD proBNP-95\n___ 06:55AM BLOOD Calcium-9.3 Phos-2.9 Mg-2.0\n___ 04:15PM BLOOD Lactate-1.0 Na-139 K-4.4\n\nUA: Negative\n\nCXR (___):\nIMPRESSION: No acute cardiopulmonary process.\n\nA significant improvement in FEV1 of more than 12% and 400 ml from baseline after administration of a bronchodilator confirms the reversibility of airflow obstruction.\r\n" +} \ No newline at end of file diff --git a/Finished/Asthma/COPD Asthma/15798127-DS-19.json b/Finished/Asthma/COPD Asthma/15798127-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..3fb464463fe855e6fb97066abde40400914d698a --- /dev/null +++ b/Finished/Asthma/COPD Asthma/15798127-DS-19.json @@ -0,0 +1,47 @@ +{ + "Asthma-COPD$Intermedia_4": { + "History of COPD may increase the probability of patient develoop COPD.$Cause_1": { + "history of COPD$Input2": {} + }, + "A typical symptom of COPD or asthma-COPD.$Cause_1": { + "Lasting airflow limitation$Input2": {} + }, + "It indicates that airflow limitation that aren't fully reversible, patient may have COPD or asthma.$Cause_1": { + "A significant improvement in FEV1 of more than 12% and 200 ml from baseline after administration of a bronchodilator confirms the reversibility of airflow obstruction.$Input6": {} + }, + "Asthma$Intermedia_3": { + "Giving albuterol to treat indicates that patient may have bronchus disease.$Cause_1": { + "The patient was given 1 albuterol$Input2": {} + }, + "It shows that patient has an aggravate on her bronchus or chest disease.$Cause_1": { + "she is unable to walk 10 feet without feeling short of breath.$Input2": {} + }, + "Suspected asthma$Intermedia_2": { + "It indicates that patient may have chest or bronchus disease.$Cause_1": { + "Cough,$Input1": {} + }, + "A typical stmptom of chest or bronchus diseasse.$Cause_1": { + "SOB$Input1": {} + }, + "A patient who has history of asthma may have higher probability oto develop asthma.$Cause_1": { + "history of asthma$Input2": {} + }, + "History of asthma may increase the probability of patient develop asthma.$Cause_1": { + "+asthma$Input3": {} + }, + "It can be accompanied by asthma.$Cause_1": { + "+hypertension$Input3": {} + }, + "Different sound of breath from normal indicates that patient may have chest or bronchus disease.$Cause_1": { + "Lungs: Diffuse rhonchi with occasional expiratory wheezes$Input5": {} + } + } + } + }, + "input1": "Cough, SOB\n", + "input2": "She is with history of asthma, anemia, MGUS, COPD, and prior CVA, who presented with shortness of breath. Patient reports that she first developed what she thought was a cold 3 days ago. She had sore throat, rhinorrhea, headache and cough occasionally productive of clear sputum. She denies any fever or myalgias. She then began feeling progressively more short of breath. She does have some chronic dyspnea but is able to go about her ADLs, including shopping trips, without significant limitations. Over the past few days, however, she is unable to walk 10 feet without feeling short of breath. She sleeps with two pillows at home, which has not recently changed. She reports occasional PND chronically but denies orthopnea. She has had no recent travel, surgeries, or immobilzations. \n \nIn the ED, initial vitals were: 98.1 88 168/95 20 98% RA \n - Imaging revealed: CXR without evidence of pneumonia \n - The patient was given 1 albuterol and 1 ipratropium neb, 125mg IV solumedrol, 500mg azithromycin \n\nVitals prior to transfer were: 98.9 85 145/87 20 98% RA \nUpon arrival to the floor, initial vitals were 97.7 162/117 85 18 100% RA.\n\nLasting airflow limitation\n", + "input3": "+left occipital lobe stroke (cryptogenic) \n+remote right parietal, left cerebellar strokes by imaging \n+hypertension \n+hyperlipidemia \n+cataracts, s/p repair - at least on the right \n+glaucoma \n+asthma \n+MGUS \n+chronic anemia \n+CKD\n", + "input4": "Negative for stroke, migraine, seizure. Father with cancer and sister with colon cancer.\n", + "input5": "Vitals: 97.7 162/117 85 18 100% RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, EOMI \nNeck: Supple, JVP not elevated \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nLungs: Diffuse rhonchi with occasional expiratory wheezes \nAbdomen: Soft, non-tender, non-distended \nGU: No foley \nExt: Warm, well perfused, no clubbing, cyanosis or edema, b/l lower extremities with eccymoses over shins and venous stasis changes \nNeuro: CNII-XII grossly intact\n", + "input6": "Admission Labs:\n---------------\n___ 10:50PM BLOOD WBC-8.8 RBC-3.41* Hgb-10.5* Hct-31.4* MCV-92 MCH-30.8 MCHC-33.4 RDW-16.7* RDWSD-55.8*\n___ 10:50PM BLOOD Neuts-73.9* Lymphs-17.9* Monos-5.5 Eos-1.2 Baso-0.5 AbsNeut-6.53* AbsLymp-1.58 AbsMono-0.49 AbsEos-0.11 AbsBaso-0.04\n___ 10:50PM BLOOD PTT-35.3\n___ 10:50PM BLOOD Glucose-97 UreaN-22* Creat-1.2* Na-141 K-3.9 Cl-107 HCO3-18* AnGap-20\n___ 10:50PM BLOOD cTropnT-<0.01 proBNP-861*\n___ 06:16AM BLOOD Calcium-9.4 Phos-3.4 Mg-2.0\n___ 11:11PM BLOOD Lactate-1.6\n\n\nCXR: Hyperinflated lungs without superimposed acute process.\nECG: NSR at 83. Downsloping/scooped ST depressions in III and more mild in V6 (old)\n\n A significant improvement in FEV1 of more than 12% and 200 ml from baseline after administration of a bronchodilator confirms the reversibility of airflow obstruction.\r\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Cough-Variant Asthma/17892612-DS-5.json b/Finished/Asthma/Cough-Variant Asthma/17892612-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..be237da4e6ca42084452c20268fb2b04e1f14b12 --- /dev/null +++ b/Finished/Asthma/Cough-Variant Asthma/17892612-DS-5.json @@ -0,0 +1,41 @@ +{ + "Cough-Variant asthma$Intermedia_4": { + "A long time of non-productive cough is typical symptom of cough-variant asthma.$Cause_1": { + "She has been having progressively worsening shortness of breath, non-productive cough, and chest tightness since ending recent prednisone taper 6 days ago$Input2": {} + }, + "Asthma$Intermedia_3": { + "She has diagnosed asthma.$Cause_1": { + "She has asthma (recently diagnosed)$Input2": {} + }, + "Lower peak flow than bl indicates patient may have chest orr bronchus disease.$Cause_1": { + "Peak flow 300L/m (bl 450)$Input5": {} + }, + "Suspected asthma$Intermedia_2": { + "A symptom of chest or bronchus disease.$Cause_1": { + "shortness of breath$Input1": {} + }, + "Lower peak flow than baseline indicates patient may have chest or bronchus disease.$Cause_1": { + "Her peak flow was measured at 320 L/m (baseline is 420)$Input2": {} + }, + "Dyspneic is a symptom of chest or bronchus disease.$Cause_1": { + "Patient was dyspneic, but able to speak in full sentences.$Input2": {} + }, + "Patient who has a history of asthma still has a high probability develop asthma.$Cause_1": { + "+Asthma$Input3": {} + }, + "Family history of asthma indicates patient may have high probability of asthma.$Cause_1": { + "Mother:asthma$Input4": {} + }, + "It indicates that atient may have chest or bronchus disease.$Cause_1": { + "somewhat diminished air-movement$Input5": {} + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "She has asthma (recently diagnosed), G6PD def, and anemia presenting w/ worsening SOB, cough, and chest tightness. Symptoms have been steadily worsening since ending recent prednisone taper 6 days ago. She has been trying nebs at home without improvement. She denies any fevers/chills. Denies leg swelling or pain. States that her first asthma exacerbation was 3 weeks ago. 3 days prior to that she teaches at had farm animals visit. Since then, she has been to the ED several times for worsening chest tightness/SOB. She has been d/c'd from the ED twice with 5-day tapers of prednisone, starting at 20mg, only to have symptoms recur immediately upon cessation of steroids. More recently, after seeing new pulmonologist, she was started on Advair, Singulair, and a prednisone taper, starting at 60mg. This taper ended 6 days ago. Since then she has been having progressively worsening shortness of breath, non-productive cough, and chest tightness. Denies fevers/chills, abdominal pain, nausea, vomiting. States that her DuoNebs at home have been giving partial relief, but only lasting for hours. \n \nIn the ED, initial vitals 98.6 100 114/61 20 100% \nLabs notable for UA w/ moderate, Pos Nit., 1WBC, Few Bacteria. \nWBC 4.9, HCT 35.9. \nBicarb 18, AG 16 \nPhos 1.0 \n\nCXR showed no acute intrathoracic process. Patient was dyspneic, but able to speak in full sentences. Her peak flow was measured at 320 L/m (baseline is 420) The pt received duonebs, methylprednisolone, and 1 packet of NeutraPhos. \nVitals prior to transfer: 99.6 100 113/68 24 99%. \nCurrently, complains of chest tightness and only mild shortness of breath. \n \nROS: per HPI, denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, constipation, BRBPR, melena, hematochezia, dysuria, hematuria.\n", + "input3": "+Asthma \n+G6PD deficiency \n+Anemia\n", + "input4": "Mother: G6PD deficiency, asthma, allergic rhinitis \nSister: eczema\n", + "input5": "VS - 98.2 108/60 130 20 99%RA \nGENERAL - well-appearing young female in NAD, comfortable, appropriate \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, dry MM, OP clear \nNECK - supple, no thyromegaly, no JVD \nLUNGS - CTA bilat, no r/rh/wh, somewhat diminished air-movement, resp unlabored, no accessory muscle use. Peak flow 300L/m (bl 450) \nHEART - PMI non-displaced, tachycardic, regular rhythm no MRG, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \nSKIN - no rashes or lesions \nLYMPH - no cervical, axillary, or inguinal LAD \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength throughout, sensation grossly intact throughout\n", + "input6": "___ 02:40PM BLOOD WBC-4.9 RBC-4.42 Hgb-11.4* Hct-35.9* MCV-81* MCH-25.7* MCHC-31.6 RDW-14.6 Plt ___\n___ 07:55AM BLOOD WBC-8.2# RBC-4.27 Hgb-11.0* Hct-35.1* MCV-82 MCH-25.6* MCHC-31.2 RDW-14.8 Plt ___\n___ 02:40PM BLOOD Neuts-47.1* Lymphs-45.2* Monos-5.8 Eos-1.3 Baso-0.6\n___ 02:40PM BLOOD Glucose-91 UreaN-8 Creat-1.0 Na-137 K-4.9 Cl-103 HCO3-18* AnGap-21\n___ 07:55AM BLOOD Glucose-122* UreaN-9 Creat-0.8 Na-138 K-4.3 Cl-105 HCO3-22 AnGap-15\n___ 02:40PM BLOOD Calcium-9.3 Phos-1.0* Mg-1.9\n___ 07:55AM BLOOD Calcium-9.1 Phos-5.3*# Mg-1.8\n___ 08:00AM BLOOD Phos-3.6#\n___ 07:55AM BLOOD Hapto-123\n___ 08:00AM BLOOD ANCA-PND\n___ 08:00AM BLOOD ___\n___ 09:02PM BLOOD Type-ART pO2-121* pCO2-25* pH-7.44 calTCO2-18* Base XS--4\n\nIMAGING/OTHER STUDIES:\n\nEKG ___: Sinus tachycardia. Otherwise, normal ECG. No previous tracing available for comparison. \n\nCXR ___: FINDINGS: PA and lateral views of the chest provided demonstrate no focal consolidation, effusion, pneumothorax. The heart and mediastinal contours are normal. Bony structures are intact. No free air below the right hemidiaphragm.\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Non-Allergic Asthma/17832311-DS-23.json b/Finished/Asthma/Non-Allergic Asthma/17832311-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..4e3e45b36eafad2152e1e56c294e24d375e20aac --- /dev/null +++ b/Finished/Asthma/Non-Allergic Asthma/17832311-DS-23.json @@ -0,0 +1,47 @@ +{ + "Non-Allergic Asthma$Intermedia_4": { + "Mold is a known asthma trigger, especially in people with asthma, where it can cause or worsen respiratory symptoms.$Cause_1": { + "mold in the house$Input2": {} + }, + "Asthma$Intermedia_3": { + "Significant improvement in FEV1 is often used to assess asthma patients' response to treatment and to diagnose asthma.$Cause_1": { + "significant improvement in FEV1 of more than 16%$Input6": {} + }, + "Suspected Asthma$Intermedia_2": { + "Dyspnea is a common symptom of asthma$Cause_1": { + "Dyspnea$Input1": {} + }, + "Smoking is a known trigger for asthma$Cause_1": { + "tobacco use$Input2": {} + }, + "Atopic dermatitis and asthma share a common immunological background, and the two often coexist.$Cause_1": { + "atopic dermatitis who presents with acute onset dyspnea$Input2": {} + }, + "Acute onset of dyspnea is a typical symptom of asthma.$Cause_1": { + "acute onset dyspnea$Input2": {} + }, + "She received intravenous magnesium, solumetasone, and ipratropium bromide, which are commonly used to treat acute asthma attacks. Magnesium and hormones help relieve airway inflammation and dilate the airways.$Cause_1": { + "magnesium 2g IV, solumedrol 125mg IV, and combivent x2 en$Input2": {} + }, + "Previous history of asthma increase the risk$Cause_1": { + "asthma$Input3": {} + }, + "Family history inrease the risk$Cause_1": { + "Brother has asthma.$Input4": {} + }, + "An elevated white blood cell count may indicate infection or inflammation, which may be seen in people with asthma.$Cause_1": { + "WBC-12.9$Input6": {} + }, + "It is common in patients with dyspnea and hypoxemia, which may occur during an asthma attack.$Cause_1": { + "Sinus tachycardia$Input6": {} + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "She is current tobacco use, and atopic dermatitis who presents with acute onset dyspnea. \n\nPatient reports acute onset dyspnea this the morning of ___,\nwhich prompted her to call EMS. On arrival, EMS noted O2 sat 89% and placed patient on supplemental O2. She received magnesium 2g IV, solumedrol 125mg IV, and combivent x2 en route to ___. She was then placed on BiPAP. \n\nIn the ED, initial vitals were HR 95 BP 120/65 RR 15 POx 99% CPAP\n\nOn arrival to the floor, patient endorses the above history and adds that she is concerned her house may be the trigger for her recent exacerbations. She believes there may be mold in the house, as it is very old and has not been re-done. She denies recent infectious symptoms or sick contacts. She recently purchased a hypoallergenic mattress and pillows. She keeps her pets out of the bedroom. She is trying to cut back on how much she smokes, but did not smoke at all today or immediately before feeling short of breath.\n", + "input3": "-asthma (PFTs in ___: FEV1/FVC 78%, FEV1 1.8L) w/ prior intubation in ___ for asthma exacerbation in pregnancy\n-HTN\n-reported G6PD deficiency \n-prior splenectomy (reportedly for a splenic cyst ___\n-current tobacco use\n", + "input4": "Mother and 3 siblings with G6PD. Brother has asthma.\n", + "input5": "___ ___ Temp: 97.8 PO BP: 149/81 HR: 92 RR: 18 O2 sat: 96%\nO2 delivery: Ra \nGENERAL: Well-appearing, laying in bed comfortably, in NAD\nHEENT: NC/AT, EOMI, MMM\nNECK: No cervical lymphadenopathy. No JVD.\nCARDIAC: Regular rhythm, normal rate. Audible S1 and S2. Soft systolic murmur at RUSB\nLUNGS: Good air movement bilaterally, rare wheezes in bilateral bases, no rhonci\nABDOMEN: Normal bowels sounds, non distended, non-tender to deep palpation in all four quadrants. No organomegaly.\nEXTREMITIES: No clubbing, cyanosis, or edema.\nSKIN: Warm, well-perfused, no rashes\nNEUROLOGIC: A&Ox3, moving all extremities with purpose, no \nfacial asymmetry\n", + "input6": "___ 09:50AM BLOOD WBC-12.9* RBC-4.08 Hgb-12.7 Hct-39.1 \nMCV-96 MCH-31.1 MCHC-32.5 RDW-13.8 RDWSD-48.4* Plt ___\n___ 09:50AM BLOOD Glucose-169* UreaN-22* Creat-1.4* Na-140 \nK-3.9 Cl-101 HCO3-23 AnGap-16\n\n- ___ EKG: Sinus tachycardia, biatrial enlargement, LVH with\nsecondary repolarization abnormality and anterior ST elevation, unchanged from prior\n\nsignificant improvement in FEV1 of more than 16%\n\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Non-Allergic Asthma/18153872-DS-13.json b/Finished/Asthma/Non-Allergic Asthma/18153872-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..ccf5d25b26e6dec2ae922017d2d7cc80da9d6c7d --- /dev/null +++ b/Finished/Asthma/Non-Allergic Asthma/18153872-DS-13.json @@ -0,0 +1,32 @@ +{ + "Non-Allergic Asthma$Intermedia_4": { + "Poor asthma control and the need for daily albuterol use are direct evidence of worsening asthma symptoms.$Cause_1": { + "His asthma has been under a little worse control recently and he is needing to use albuterol pretty much every day.$Input2": {} + }, + "Asthma$Intermedia_3": { + "Significant improvement in FEV1 is often used to assess asthma patients' response to treatment and to diagnose asthma.$Cause_1": { + "significant improvement in FEV1 of more than 16%$Input6": {} + }, + "Suspected Asthma$Intermedia_2": { + "Chest pressure is a common symptom of asthma$Cause_1": { + "Chest pressure$Input1": {} + }, + "Patients feel a band-like pressure in the chest, which may be related to the dyspnea symptom of asthma.$Cause_1": { + "Feels like a band-like pressure sensation$Input2": {} + }, + "Recurring chest discomfort may indicate chronic or poorly controlled asthma.$Cause_1": { + "episodes of chest discomfort have recurred$Input2": {} + }, + "Hypertriglyceridemia may be associated with metabolic syndrome, which has been shown to be associated with the development and severity of asthma.$Cause_1": { + "Hypertriglyceridemia$Input3": {} + } + } + } + }, + "input1": "Chest pressure\n", + "input2": "He first noted the pain about 1 wk prior to admission. It came on in the morning while the patient was at rest. Feels like a band-like pressure sensation. He has no accompanying SOB, nausea, lightheadedness. He always feels sweaty. No pleuritic or positional component to the pain. The episodes of chest discomfort have recurred about ___ times per day over the past week.\n\nHe initially ignored it and tried to work through the discomfort. He was well enough to go to the fitness center. In fact he was able to run on a treadmill - going 3.75 miles in 30 minutes. He also was able to do squats and pushups. His CP was actually better after that workout. He came to the ER today because the chest discomfort was persistent, and he was just generally feeling tired and weak. \n. \nIn the ED, initial vitals were 98.6 ___ 16 100%. He remained quite hypertensive up to 215/110. EKG showed SR no ischemia. He was given ASA 324mg, nitroglycerin x1, nitropaste ___ inch. No CP free. Last vitals 77 172/79 16 99on2L. Bedside echo seemed unremarkable to ER resident. \n. \nOn evaluation on the floor, he is pain free. Reports his BPs have been \"borderline high\" 140's/90's at PCP; previously on a diuretic but more recently on diet/exercise approach for his BP. Has a history of \"migraines\" with increased headaches this week but no blurred vision or other neurologic symptoms. His asthma has been under a little worse control recently and he is needing to use albuterol pretty much every day. Also reports high cholesterols, but can't recall recent labs. Not a smoker, denies drug use. His grandparents both have a history of CAD. Review of systems otherwise negative for recent illness, fevers, chills, or sweats, leg pain, swelling, bleeding\n", + "input3": "Hyperlipidemia \nHypertriglyceridemia \nHypertension \nHypogonadism \nErectile Dysfunction \nDepression \nHeadaches\n", + "input4": "grandfathers with MIs age ___; grandmother with ___ in her\n", + "input5": "Vitals 97.9 73 141/79 20 97% on RA \nGeneral Overweight appears comfortable no distress \nHEENT Sclera white, conjunctiva pink, MMM \nNeck no JVD \nPulm lungs clear bilaterally, no rales or wheezing \nCV regular s1 s2 no m/r/g, chestwall nontender to palpation \nAbd abd soft nontender +bowel sounds no bruits \nExtrem warm no edema 2+ dp and pt \nNeuro alert and interactive, ambulatory, moving all extremities\n", + "input6": "___ 09:10AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 09:10AM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 09:10AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 \nLEUK-NEG\n___ 06:20AM GLUCOSE-101 UREA N-15 CREAT-1.0 SODIUM-140 \nPOTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-27 ANION GAP-13\n___ 06:20AM CK(CPK)-1066*\n___ 06:20AM CK-MB-8 cTropnT-<0.01\n___ 06:20AM MAGNESIUM-2.2 CHOLEST-296*\n___ 06:20AM TRIGLYCER-389* HDL CHOL-31 CHOL/HDL-9.5 \nLDL(CALC)-187*\n___ 06:20AM WBC-7.2 RBC-4.71 HGB-13.4* HCT-37.9* MCV-80* \nMCH-28.4 MCHC-35.4* RDW-13.6\n___ 12:30AM GLUCOSE-112* UREA N-17 CREAT-0.8 SODIUM-142 \nPOTASSIUM-4.6 CHLORIDE-105 TOTAL CO2-27 ANION GAP-15\n___ 12:30AM CK(CPK)-1394*\n___ 12:30AM cTropnT-<0.01\n\nsignificant improvement in FEV1 of more than 16%\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Non-Allergic Asthma/18699864-DS-8.json b/Finished/Asthma/Non-Allergic Asthma/18699864-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..2e1d6446642f0c56da18e10ac9225791507273fa --- /dev/null +++ b/Finished/Asthma/Non-Allergic Asthma/18699864-DS-8.json @@ -0,0 +1,32 @@ +{ + "Non-Allergic Asthma$Intermedia_4": { + "A typical scenario that triggers or exacerbates asthma symptoms, with shortness of breath worsening after inhaling smoke$Cause_1": { + "He breathed in the cigarette smoke and his symptoms got worse$Input2": {} + }, + "Asthma$Intermedia_3": { + "Low sustained peak flow rates usually indicate that there may be some kind of obstruction or narrowing of the airways, which is one of the classic symptoms of asthma.$Cause_1": { + "Peak expiratory flow show low persistence peak flow.$Input6": {} + }, + "Suspected Asthma$Intermedia_2": { + "Not taking asthma medication regularly can lead to poor symptom control and is a common problem in asthma management.$Cause_1": { + "not been taking all of his asthma medications regularly$Input2": {} + }, + "Regular smoking, including marijuana, can worsen asthma symptoms and has a direct irritating effect on the respiratory tract.$Cause_1": { + "continues to smoke 3 marijua blunts per day$Input2": {} + }, + "This indicates that the patient has had recurrent asthma attacks since childhood.$Cause_1": { + "Since childhood. Numerous asthma exacerbations$Input3": {} + }, + "Family history inrease the risk.$Cause_1": { + "+ history of asthma in maternal relatives.$Input4": {} + } + } + } + }, + "input1": "None\n", + "input2": "The pt reports that he was at a friend's house who was cooking dinner the day of admission, around 7pm. The smell of food was strong, so they turned on the ceiling fan. He felt short of breath so he went outside to get some air, and someone was smoking. He breathed in the cigarette smoke and his symptoms got worse. He then presented to the ED. Of note, the patient reports that he has not been taking all of his asthma medications regularly because he ran out. He also continues to smoke 3 marijua blunts per day. His seasonal allergies have been bad lately with watery eyes and stuffy nose. No cough recently, no URIs, no fevers. No sick contacts. No chest pain.\n\nIn the ED, initial VS were: 99.1 114 131/83 30 99% RA. HR improved to ___ and RR improved to 18. Labs were largely unremarkable. VBG 7.34/51/40/29. CXR showed no acute process. The patient received back to back duonebs, magnesium, and IV methylpred around 8:30pm, then duonebs again at 9pm and 11:30pm. \n\n \nUpon arrival to the floor, the patient reports that his breathing is much better. He does not know his baseline peak flow.\n", + "input3": "ALLERGIC RHINITIS\nASTHMA\n-- Since childhood. Numerous asthma exacerbations. Never intubated. Asthma exacerbations have required steroids frequently.\n", + "input4": "No history of CAD, MI, Early malignancy. + history of asthma in maternal relatives.\n", + "input5": "97.5, 123/66, 105, 18, 99% on RA\nGEN: well appearing young man in NAD\nHENT: NCAT, OP clear, MMM\nEyes: PERRL, EOMI, anicteric\nCV: RRR, no m/g/r\nResp: breathing comfortably without tachypnea or accessory muscle use. diffuse adventitious breath sounds b/l with no wheezing. Good air movement. \nGI: s, nd, nt, nabs\nGU: no foley\nExtr: wwp, no edema\nNeuro: CNs intact, ___ strength, full sensation\nSkin: no lesions or rashes\nPsych: normal affect and mood\n", + "input6": "___ 08:44PM ___ PO2-40* PCO2-51* PH-7.34* TOTAL \nCO2-29 BASE XS-0\n___ 08:15PM GLUCOSE-103* UREA N-6 CREAT-1.1 SODIUM-144 \nPOTASSIUM-3.6 CHLORIDE-105 TOTAL CO2-28 ANION GAP-15\n___ 08:15PM estGFR-Using this\n___ 08:15PM CALCIUM-9.5 PHOSPHATE-3.8 MAGNESIUM-1.9\n___ 08:15PM WBC-7.4 RBC-4.48* HGB-12.3* HCT-39.0* MCV-87 \nMCH-27.5 MCHC-31.5* RDW-14.4 RDWSD-45.4\n___ 08:15PM NEUTS-61.6 ___ MONOS-5.4 EOS-3.7 \nBASOS-0.4 IM ___ AbsNeut-4.52 AbsLymp-2.12 AbsMono-0.40 \nAbsEos-0.27 AbsBaso-0.03\n___ 08:15PM PLT COUNT-200\n\nImaging:\nCXR ___:\nFINDINGS: \nLungs are clear. The cardiomediastinal silhouette is within normal limits. No acute osseous abnormalities.\nIMPRESSION: \nNo acute cardiopulmonary process.\n\nPeak expiratory flow show low persistence peak flow. \n" +} \ No newline at end of file diff --git a/Finished/Asthma/Severe Asthma Exacerbation/16105600-DS-18.json b/Finished/Asthma/Severe Asthma Exacerbation/16105600-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..860bef94fef3b6b64f85fab9f51e44eb108215c1 --- /dev/null +++ b/Finished/Asthma/Severe Asthma Exacerbation/16105600-DS-18.json @@ -0,0 +1,47 @@ +{ + "Severe asthma$Intermedia_4": { + "It indicates that the symptom patient got has aggravated.$Cause_1": { + "cough with sputum production$Input2": {} + }, + "Patient has severe asthma or bronchus disease that she need to use different kinds of medicine to maintain the present status.$Cause_1": { + "she manages at home with albuterol, montelukast, etirizine and advair$Input2": {} + }, + "Asthma$Intermedia_3": { + "A typical symptom of asthma.$Cause_1": { + "dyspnea on exertion$Input2": {} + }, + "Different kind of breath from normal indicates that patient may have chest or bronchus disease.$Cause_1": { + "Lungs: scattered wheezes bilateraly$Input5": {} + }, + "Suspected asthma$Intermedia_2": { + "It indicates that patient may have chest or bronchus disease.$Cause_1": { + "Cough$Input1": {} + }, + "A common symptom of chest or bronchus disease.$Cause_1": { + "Shortness of Breath$Input1": {} + }, + "Patient with a history of asthma has higher probability to develop asthma than normal.$Cause_1": { + "a history of asthma$Input2": {} + }, + "A typical symptom of chest or bronchus disease.$Cause_1": { + "shortness of breath$Input2": {} + }, + "It indicates that patient may have chest or bronchus disease and has aggravated.$Cause_1": { + "blood in her sputum$Input2": {} + }, + "Patient who has history of asthma may have higher probability oto develop asthma than common people.$Cause_1": { + "Asthma$Input3": {} + }, + "It can be a trigger of asthma.$Cause_1": { + "Seasonal Allergies$Input3": {} + } + } + } + }, + "input1": "Cough and Shortness of Breath\n", + "input2": "She is a 47 year old woman with a history of asthma who presents with days of worsening shortness of breath on exertion and cough with sputum production. She reports that she has asthma that she manages at home with albuterol, montelukast, etirizine and advair. However, she noticed increasing dyspnea on exertion at home, also with worsening cough for days. Over the past two days, she has also noticed blood in her sputum. She denies fever, chills, chest pain, abdominal pain, nausea, vomiting or diarrhea. She has not traveled outside for years and has no known sick contacts at home. Of note, she presented to the ED at this institution with similar symptoms. She received azithromycin X 5 days, though it is unclear if she completed the course of this medication. \n\nInitial vital signs in the ED were as follows: 97.8 100 121/81 20 96%RA. She received three consecutive duonebs and one dose of Predisone 50mg. A CXR was unremarkable. She developed an increasing oxygen requirement while in the ED and vital signs at the time of transfer were 98.8 118/ 99/55 23 96% on 4L by NC.\n\nOn presentation to the FICU, she continues to complain of productive cough and shortness of breath. Her vitals initially were T 98.1 BP 103/76 HR 115 RR 29 and O2 SAT of 96% on 4L NC. She denies fever, chills, abdominal pain, nausea, vomiting or diarrhea.\n", + "input3": "Asthma\nSeasonal Allergies\n", + "input4": "None reported\n", + "input5": "Vitals: T 98.1 BP 103/76 HR 115 RR 29 and O2 SAT of 96% on 4L NC \nGeneral: coughing, sitting up in bed in no acute distress \nHEENT: sclera anicteric, EOMI \nNeck: supple, no lymphadenopathy\nLungs: scattered wheezes bilateraly, no crackles, moderate air movement\nCV: regular tachycardic, no murmurs, rubs, gallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding\nExt: warm, well perfused, 2+ pulses, no edema\n", + "input6": "___ 01:00PM NEUTS-49.4* ___ MONOS-5.4 EOS-6.1* BASOS-0.5\n___ 01:00PM PLT COUNT-345\n___ 01:00PM ___ PTT-32.1 ___\n___ 01:00PM estGFR-Using this\n___ 01:00PM WBC-6.8 RBC-5.18 HGB-15.7 HCT-48.8* MCV-94 MCH-30.3 MCHC-32.2 RDW-13.2\n___ 09:37PM D-DIMER-412\n___ 01:27PM LACTATE-2.1*\n___ 10:10PM OTHER BODY FLUID FluAPCR-NEGATIVE FluBPCR-NEGATIVE\n___ 10:00PM K+-4.4\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Severe Asthma Exacerbation/17567631-DS-16.json b/Finished/Asthma/Severe Asthma Exacerbation/17567631-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..d96dacfb8534b2f1201985d2e6fe64d7072bbc19 --- /dev/null +++ b/Finished/Asthma/Severe Asthma Exacerbation/17567631-DS-16.json @@ -0,0 +1,56 @@ +{ + "Severe asthma$Intermedia_4": { + "Giving albuterol to treat asthma regularly.$Cause_1": { + "During this period she had been using her albuterol inhaler for rescue up to three times daily.$Input2": {} + }, + "Lasting non-prodective cough is a symptom of asthma.$Cause_1": { + "she noted a nonproductive cough, which came in the form of cough attacks that resulted in feeling as though she was suffocating.$Input2": {} + }, + "It can be accompanied by asthma.$Cause_1": { + "+Obesity$Input3": {} + }, + "Asthma$Intermedia_3": { + "Poor air movement indicates that patient may have chest or bronchus disease.$Cause_1": { + "LUNG: poor air movement throughout$Input5": {} + }, + "Different sound of breath indicates that patient may have chest or bronchus disease.$Cause_1": { + "LUNG:diffuse expiratory wheezes, with prolonged expiratory phase$Input5": {} + }, + "Suspected asthma$Intermedia_2": { + "Patient feels like she has an asthma.$Cause_1": { + "asthma$Input1": {} + }, + "It can be accompanied by asthma or as a trigger of asthma.$Cause_1": { + "allergic rhinitis$Input2": {} + }, + "It is often accompanied by asthma.$Cause_1": { + "HTN$Input2": {} + }, + "Mental factors may asociataded with asthma.$Cause_1": { + "anxiety and depression$Input2": {} + }, + "Patient who has a history of asthma has high probability of develop asthma again.$Cause_1": { + "+Asthma$Input3": {} + }, + "It can be accompanied by asthma or be the trigger of asthma.$Cause_1": { + "+Allergic rhinitis$Input3": {} + }, + "Mental factors can be accompanied by severe asthma.$Cause_1": { + "+Depression$Input3": {} + }, + "Mental factors can be asociated with severe asthma.$Cause_1": { + "+Anxiety$Input3": {} + }, + "It can be accompanied by asthma$Cause_1": { + "+Hypertension$Input3": {} + } + } + } + }, + "input1": "asthma\n", + "input2": "Female with history of asthma on 3L O2 for ambulation, OSA on CPAP, allergic rhinitis, atopic dermatits, HTN, diabetes, anxiety and depression who presents with a severe asthma exacerbation. According to the patient, she was in her usual state of health until when she got wet in the rain. She states that on morning while on her way to work she felt SOB, and by that evening the shortness of breath worsened substantially. She noted fatigue associated with the SOB, she noted a nonproductive cough, which came in the form of cough attacks that resulted in feeling as though she was suffocating. She then developed runny nose and nasal congestion with subjective fevers and chills, and prior to presenting to the ED at the urging of a friend, she felt \"out of it.\" During this period she had been using her albuterol inhaler for rescue up to three times daily. She states that her last sever asthma attack was over years ago. She denies sick contacts. Of note, she states that she feels her current episode is the culmination of worsening asthma control over several months. She has missed several pulmonary appointments and OSA appointments in the last several months because she was upset that she had asthma.\n", + "input3": "+Asthma\n+Obstructive Sleep Apnea\n+Obesity Hypoventilation Syndrome\n+Anxiety\n+Depression\n+PTSD\n+Allergic rhinitis\n+Esophageal reflux\n+Tension headaches\n+Hypertension\n+Atopic dermatitis\n+Cholelithiasis\n+Fatty liver\n+Obesity\n", + "input4": "Noncontributory\n", + "input5": "VITAL SIGNS: Tmax 99, HR 52-107, BP 144-157/70-81, 94-954% on 3L \n\nGENERAL: NAD, no use of accessory muscles, minimal increased work of breathing \nHEENT: AT/NC, EOMI, PERRL, anicteric sclerae, pink conjunctivae, patent nares, MMM, good dentition, nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: poor air movement throughout, diffuse expiratory wheezes, with prolonged expiratory phase without use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: moving all extremities well, no cyanosis or clubbing 1+ pitting edema bilaterally, symmetrical \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "___ 09:05PM LACTATE-4.0*\n___ 04:01PM TYPE-ART TEMP-37.1 PO2-80* PCO2-48* PH-7.41 TOTAL CO2-31* BASE XS-4 INTUBATED-NOT INTUBA\n___ 04:01PM O2 SAT-95\n___ 10:41AM LACTATE-3.5*\n___ 10:34AM GLUCOSE-141* UREA N-12 CREAT-0.9 SODIUM-138 POTASSIUM-4.0 CHLORIDE-95* TOTAL CO2-28 ANION GAP-19\n___ 10:34AM WBC-12.3* RBC-4.49 HGB-14.0 HCT-41.3 MCV-92 MCH-31.1 MCHC-33.8 RDW-15.6*\n___ 10:34AM NEUTS-71.2* LYMPHS-14.9* MONOS-8.7 EOS-4.5* BASOS-0.7\n___ 10:34AM PLT COUNT-292\n___ 10:12AM URINE BLOOD-TR NITRITE-NEG PROTEIN-300 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.5 LEUK-NEG\n___ 10:12AM URINE BLOOD-TR NITRITE-NEG PROTEIN-300 GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.5 LEUK-NEG\n\nIMAGING:\nCXR ___:\nPatchy left basilar opacity may reflect atelectasis though infection is not excluded. Right basilar atelectasis.\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Severe Asthma Exacerbation/18192172-DS-11.json b/Finished/Asthma/Severe Asthma Exacerbation/18192172-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..69a06a911aa39548ec841717b1388193c31e9400 --- /dev/null +++ b/Finished/Asthma/Severe Asthma Exacerbation/18192172-DS-11.json @@ -0,0 +1,41 @@ +{ + "Severe Asthma$Intermedia_4": { + "Confirm the type of severe asthma$Cause_1": { + "He doesn't respond well to conventional treatments.$Input2": {} + }, + "Asthma$Intermedia_3": { + "Significant improvement in FEV1 is often used to assess asthma patients' response to treatment and to diagnose asthma.$Cause_1": { + "significant improvement in FEV1 of more than 16%$Input6": {} + }, + "Suspected Asthma$Intermedia_2": { + "Dyspnea is a common symptom of asthma$Cause_1": { + "Dyspnea$Input1": {} + }, + "Vomiting may be associated with exacerbated respiratory symptoms, especially during an asthma attack, and severe coughing may induce gastric discomfort.$Cause_1": { + "one episode of vomiting$Input2": {} + }, + "Stomach pain may be due to increased abdominal pressure when coughing, which is more common in people with asthma$Cause_1": { + "\"stomach hurts\" when she coughs.$Input2": {} + }, + "Sleeping with multiple pillows may be an attempt to relieve breathing difficulties and is a common coping mechanism among people with asthma.$Cause_1": { + "sleeping restlessly with 3 pillows$Input2": {} + }, + "An inconclusive history of PND may suggest nighttime breathlessness, a warning sign of an asthma exacerbation$Cause_1": { + "uncertain history of PND$Input2": {} + }, + "The patient has mild dyspnea, which indicates possible respiratory abnormalities, a common symptom of asthma$Cause_1": { + "mild respiratory distress$Input5": {} + }, + "Sporadic wheezing and prolonged exhalation are typical symptoms of asthma and indicate airway obstruction and inflammation.$Cause_1": { + "Diffuse wheezing and prolonged expiratory phase$Input5": {} + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "Had one episode of vomiting on the first night after her respiratory symptoms had already started. Denies associated chest pain, notes that her \"stomach hurts\" when she coughs. Has been sleeping restlessly with 3 pillows, uncertain history of PND, no peripheral edema. No calf tenderness or leg injury. No known sick contacts. No new medications. Initially attributed symptoms to \"pollen\", but has never had such severe symptoms with seasonal allergies in the past. Seen by her PCP at ___ ___ flow there measured 230. There, treated with solumedrol and nebulizer treatments with some relief. CXR without acute infiltrate. BNP not elevated. Currently feels much improved since earlier in the day, though still dyspneic at rest. He doesn't respond well to conventional treatments.\n", + "input3": "Essential hypertension\nGout\nHyperlipidemia\n(?)prior history of asthma (though patient denies), has been \nprescribed albuterol inhaler in past but she does not use. \nPrior echo with LVH, preserved systolic function, mild aortic \nstenosis.\n", + "input4": "No family history of heart disease or lung disease. Daughter passed away from pancreatic cancer.\n", + "input5": "VS: afebrile, BP 162/72, HR ___, O2 sat 98% on 3.5L by NC. RR ___.\nGEN: Pleasant, talkative in partial sentences, in mild respiratory distress. No accessory muscle use at rest.\nHEENT: Anicteric sclerae, OP clear with moist mucous membranes\nNECK: JVP approximately 7-8 cm, no palpable cervical adenopathy or thyromegaly\nCHEST: Diffuse wheezing and prolonged expiratory phase. No \nrales.\nCOR: S1 S2 with II/VI systolic murmur at base.\nABD: Soft, non-tender, non-distended, without palpable organomegaly.\nEXTREM: No clubbing, cyanosis, or edema. No calf tenderness.\nNEURO: Alert and oriented, fluent historian. Attentive, names ___ without difficulty. No asterixis. No pronator drift. CN \nII-XII intact. Strength ___ in upper and lower extremities \nbilaterally. Sensation to LT grossly intact. Gait not tested.\n", + "input6": "___ 02:30PM GLUCOSE-124* UREA N-22* CREAT-0.9 SODIUM-141 \nPOTASSIUM-3.7 CHLORIDE-101 TOTAL CO2-27 ANION GAP-17\n___ 02:30PM proBNP-98\n___ 02:30PM WBC-7.4 RBC-4.46 HGB-13.2 HCT-39.4 MCV-88 \nMCH-29.5 MCHC-33.5 RDW-16.0*\n___ 02:30PM PLT COUNT-230\n\nCXR: In comparison with study of earlier in this date, there is little change. Continued enlargement of the cardiac silhouette with mild fullness of pulmonary vessels consistent with elevated pulmonary venous pressure. No acute focal pneumonia. \n\nEKG: Sinus bradycardia 56, LAD, nl intervals. Non-significant Q-waves in I, avL. 0.5mm upsloping ST segment elevations in V2-V3.\n\nsignificant improvement in FEV1 of more than 16%\n\n" +} \ No newline at end of file diff --git a/Finished/Asthma/Severe Asthma Exacerbation/19219717-DS-16.json b/Finished/Asthma/Severe Asthma Exacerbation/19219717-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..c7acfc4b465cdbe35417666dcbf6b6f8f1178923 --- /dev/null +++ b/Finished/Asthma/Severe Asthma Exacerbation/19219717-DS-16.json @@ -0,0 +1,32 @@ +{ + "Severe Asthma$Intermedia_4": { + "The criteria to diagnose Severe Asthma$Cause_1": { + "Doesn't respond well to conventional treatments$Input2": {} + }, + "Asthma$Intermedia_3": { + "Significant improvement in FEV1 is often used to assess asthma patients' response to treatment and to diagnose asthma.$Cause_1": { + "significant improvement in FEV1 of more than 16%$Input6": {} + }, + "Suspected Asthma$Intermedia_2": { + "Seizures is a common symptom of asthma$Cause_1": { + "Seizures$Input1": {} + }, + "Chest tightness is one of the common symptoms of asthma, which manifests as shortness of breath and a feeling of pressure in the chest.$Cause_1": { + "chest tightness$Input2": {} + }, + "Obesity can increase the risk of asthma because it may affect respiratory function and chronic inflammatory state.$Cause_1": { + "morbid obesity$Input3": {} + }, + "Obesity may be linked to asthma because it puts more strain on the respiratory system, leading to breathing problems.$Cause_1": { + "cooperative obese female$Input5": {} + } + } + } + }, + "input1": "Seizures\n", + "input2": "She stated that she has been prescribed dilantin in past, but has not been complaint. Patient has had multiple visits to the emergency deparment with complaints of chest pain, but has not had any acute pathology. She presented for establishment of new PCP ___ and stated that she had acute LUE pain and was s/p seizure on ___. She complained of some chest tightness during her visit and was subsequently referred to the ER.\n.\nWhile in the ER, given her self reported history of PE, a CTA was obtained that was negative for PE, and had an EKG that showed non specific anterior precordial t wave inversions with no ST-T changes. Patient also had a LUE ultrasound that was negative for a DVT.\n.\nUpon chart review, it appears that the patient's self reported medical conditions have been mostly unverified. Records \nwererequested from ___ and ___. ___ records do not show that the patient had a PE at their hospital as the patient reports. Doesn't respond well to conventional treatments\n", + "input3": "seizure disorder, s/p head injury ___ years ago\nmorbid obesity\n", + "input4": "mother has diabetes\nfather has hypertension\nCousin at age ___ died of sudden cardiac death while playing football\n", + "input5": "Vitals: 98.0, 130/90, 77, 20, 98%RA\nGeneral: Awake, cooperative obese female in NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted inoropharynx. Horizontal nystagmus noted bilaterally.\nNeck: Supple, no JVD or carotid bruits appreciated. No nuchalrigidity \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: distant sounds RRR, nl. S1S2, II/VII Systolic flow \nmurmur at LUSB.\nAbdomen: obese soft, NT/ND, normoactive bowel sounds, no massesor organomegaly noted. \nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. \nSkin: no rashes noted. Left forearm with 3inch healed scar from lacteration. TTP LUE at anticubital fossa. No fluctuation or induration noted. \nNeuro: CN II/XII grossly intact, Horizontal nystagmus noted \nbilaterally. ___ strength noted in all extremities.\n", + "input6": "CTA ___: IMPRESSION:\n \n1. No central or segmental pulmonary embolus. Normal aorta.\n2. Lungs clear.\n.\nLUE U/S ___: INDICATION: ___ woman with swelling and pain over the left upper extremity forearm. \n.\nComparison: Internal jugular, subclavian, axillary, brachial, cephalic, and basilic veins were interrogated using grayscale, color, and Doppler ultrasounds. There is normal compressibility (where applicable), flow and augmentation. \n.\nIMPRESSION: No left upper extremity DVT. \n.\n___:\nNa 139, K 3.8, Cl 102, CO2 29, BUN/Cr ___, Glc 99\nSerum tox Negative\nPhenytoin level: 8.0\nCBC: WBC 5.3, H/H 11.2/33.2, Plt 327, MCV 87\nINR 1.1, PTT 34.1, ___ 13.2\nUrine tox Negative\nUCG negative\nUA: Lg Bld and Rare Bact, otherwise negative.\n\nsignificant improvement in FEV1 of more than 16%\n\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/12116250-DS-20.json b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/12116250-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..fbadcc788c9f4154b58fe6d9446c06d8fedf3341 --- /dev/null +++ b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/12116250-DS-20.json @@ -0,0 +1,51 @@ +{ + "Paroxysmal Atrial Fibrillation$Intermedia_3": { + "Arrhythmic events are an important symptom of AF, Not persistent attacks point to Paroxysmal Atrial Fibrillation$Cause_1": { + "Pt reports occasional epsiodes previously and now multiple episodes in the past few days$Input2": {} + }, + "Atrial fibrillation waves are found, which is a condition for diagnosis$Cause_1": { + "Irregular and rapid waveforms of atrial activity, irregular RR intervals$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "the upper chamber of the heart no longer contracts effectively, reducing the heart's pumping efficiency, which may lead to insufficient blood supply to the whole body, especially the brain, leading to syncope.$Cause_1": { + "Presyncope$Input1": {} + }, + "Symptoms such as dizziness may be due to atrial fibrillation causing a transient reduction in cardiac output$Cause_1": { + "On the day prior to presentation she was at a flu clinic line, sat down after standing for a while, then upon walking felt diaphoretic and lightheaded and thought she would fall down.$Input2": {} + }, + "Blurred or altered vision may be related to unstable cardiac output, which may be a transient reduction in cerebral blood flow due to AF.$Cause_1": { + "her vision was off$Input2": {} + }, + "Mild elevations in BNP may be due to cardiac stress or cardiac structural problems, which is consistent with increased cardiac workload in patients with AF.$Cause_1": { + "mildly elevated BNP at 4000$Input2": {} + }, + "Hypertension is an important risk factor for AF$Cause_1": { + "HTN$Input3": {} + }, + "Coronary artery disease (CAD) and myocardial infarction (MI) increase the risk of atrial fibrillation$Cause_1": { + "CAD with MI s/p PCI$Input3": {} + }, + "The tendency of the blood to clot, which is associated with the risk of atrial fibrillation and blood clots$Cause_1": { + "h/o DVT$Input3": {} + }, + "High blood pressure may be a risk factor for atrial fibrillation$Cause_1": { + "174/93$Input5": {} + }, + "A diastolic murmur may indicate a structural heart problem, which is also a risk factor for atrial fibrillation$Cause_1": { + "diastolic murmur at the RUSB nonradiating$Input5": {} + }, + "Blood circulation problems may indirectly increase the risk of heart disease$Cause_1": { + "mutliple varicocities bilaterally$Input5": {} + }, + "Elevated levels of proBNP are often a sign of cardiac dilation or impaired cardiac function and are associated with atrial fibrillation.$Cause_1": { + "proBNP-4620$Input6": {} + } + } + }, + "input1": "Presyncope\n", + "input2": "She is an 69 yo F w/ PMH of CAD, breast cancer s/p bilateral mastectomies who presents with lightheadedness. Pt reports occasional epsiodes previously and now multiple episodes in the past few days. On the day prior to presentation she was at a flu clinic line, sat down after standing for a while, then upon walking felt diaphoretic and lightheaded and thought she would fall down. Also felt as though her vision was off and others were asking her if she felt okay. +nausea associated. No chest pain no shortness of breath. No recent increase in peripheral edema, orthopnea or PND. She reports no changes in her medications. No recent changes in bowel movements, no hematochezia, no abdominal pain or vomiting. She has been eating normally and had eaten on the day of the symptoms. She went to her PCP's office who was concerned and sent her to the ED \n\nOn arrival to the ED her initial VS were 98.5, 130/72, 60, 16, 96%2L. EKG showed a LBBB that was unchanged compared to prior. Labs were notable for mildly elevated BNP at 4000, negative trop x1 and she was admitted for workup of presyncope given the increase in frequency and her cardiac history to rule out MI. On arrival to the floor she has no complaints and reports feeling well.\n", + "input3": "+HTN \n+CAD with MI s/p PCI \n+h/o DVT\n+Breast cancer s/p bilateral mastectomy \n+Carpal tunnel syndrome \n+Rotator cuff injury\n+Right shoulder dislocation/rotator cuff injury (no surgery adviced for severe arthritis?) \n+Left rotator cuff injury s/p surgery\n", + "input4": "Father with cancer, Mother with ALS. Denies FH of CAD, DM, HTN, stroke, MI, asthma, colon/skin/breast cancer.\n", + "input5": "Vitals- 97.7, 174/93, 69, 16, 96RA wt 80.2kg \nGeneral- Alert, oriented, no acute distress, lying in bed comfortably \nHEENT- Sclera anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, no LAD, no carotid bruits on exam \nLungs- Clear to auscultation bilaterally, no wheezes, rales, ronchi \nCV- Regular rate and rhythm, normal S1 + S2, diastolic murmur at the RUSB nonradiating \nAbdomen- soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nGU- no foley \nExt- mutliple varicocities bilaterally. Well healed scars bilaterally. No pitting edema. Brisk DP pulses bilaterally \nNeuro- CNs2-12 intact, motor function grossly normal\n", + "input6": "___ 05:40PM BLOOD D-Dimer-198\n___ 08:10AM BLOOD Calcium-9.0 Phos-3.8 Mg-1.7\n___ 05:40PM BLOOD proBNP-4620*\n___ 05:40PM BLOOD cTropnT-<0.01\n___ 05:40PM BLOOD Glucose-97 UreaN-26* Creat-1.1 Na-142 K-4.4 Cl-109* HCO3-24 AnGap-13\n___ 05:40PM BLOOD ___ PTT-45.6* ___\n___ 05:40PM BLOOD WBC-6.3 RBC-4.64 Hgb-12.4 Hct-35.4* MCV-76*# MCH-26.7* MCHC-35.0 RDW-14.4\n___ 05:40PM BLOOD Neuts-69.4 ___ Monos-4.0 Eos-4.5* Baso-0.7\n\nImaging:\nCXR ___: \nIMPRESSION: No evidence of pneumonia. \n \nEKG: Irregular and rapid waveforms of atrial activity, irregular RR intervals\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/13492756-DS-4.json b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/13492756-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..2f7721fad8688665846e989b2a031e3c58b97018 --- /dev/null +++ b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/13492756-DS-4.json @@ -0,0 +1,57 @@ +{ + "Paroxysmal Atrial Fibrillation$Intermedia_3": { + "This shows instability in the heart's electrical activity and is a confirmatory indicator of an episode of atrial fibrillation.$Cause_1": { + "The rhythm was sinus with two runs of PSVT (one 3 beat during infusion and the second ___ beat run in recovery), two PACs and single atrial couplet.$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "Palpitations are one of the common symptoms of AF$Cause_1": { + "Palpitations$Input1": {} + }, + "Atrial fibrillation causes the heart to beat irregularly and rapidly, causing palpitations$Cause_1": { + "presents with 2 days of palpitations$Input2": {} + }, + "Insufficient blood flow to the heart may cause a feeling of pressure in the chest$Cause_1": { + "chest pressure$Input2": {} + }, + "Atrial fibrillation may affect the heart's ability to pump blood, causing difficulty breathing$Cause_1": { + "dyspnea$Input2": {} + }, + "Insufficient blood flow to the heart may cause chest pain during physical activity$Cause_1": { + "noticed substernal chest pain on walking down the stairs$Input2": {} + }, + "Diabetes is a known risk factor for atrial fibrillation$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia increases the risk of cardiovascular disease and indirectly increases the probability of atrial fibrillation.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "High blood pressure is a common cause of atrial fibrillation$Cause_1": { + "Hypertension$Input3": {} + }, + "Diastolic dysfunction associated with atrial fibrillation$Cause_1": { + "Diastolic heart failure: intermittent lasix, spironolactoneuse.$Input3": {} + }, + "Low heart rates are common in patients with atrial fibrillation$Cause_1": { + "VS: 55$Input5": {} + }, + "A systolic ejection murmur may indicate heart valve problems or other structural abnormalities, which are potential risk factors for atrial fibrillation.$Cause_1": { + "systolic ejection murmur$Input5": {} + }, + "This may be an adaptive response of the heart to compensate for the hemodynamic changes caused by atrial fibrillation.$Cause_1": { + "Left ventricular systolic function is hyperdynamic (EF>75%)$Input6": {} + }, + "Mild dilation of the left atrium, which is one of the common physiological changes of atrial fibrillation$Cause_1": { + "The left atrium is mildly dilated$Input6": {} + }, + "Mild symmetrical left ventricular hypertrophy, which affects the electrophysiological properties of the heart and is related to the occurrence of atrial fibrillation$Cause_1": { + "mild symmetric left ventricular hypertrophy$Input6": {} + } + } + }, + "input1": "Palpitations\n", + "input2": "She is presents with 2 days of palpitations, chest pressure, and dyspnea. She was in her usual state of health until when she first noticed palpitations while lying in bed. She has had a history of occasional Afib, roughly once a year for a brief period, but she is familiar with the feeling. On this occasion her partner felt her pulse and noticed it was both rapid and irregular. Her symptoms rapidly improved, as they have in the past. She was not concerned until they recurred several times and accompanied by a feeling of weakness. She also noticed substernal chest pain on walking down the stairs that lasted for roughly an hour. This was not associated with dyspnea, N/V/D, or diaphoresis. The chest pain was similar to that she experienced prior to her CABG. Given the more frequent palpitations, the association of weakness with her palpitations, and this episode of chest pain, she presented to her PCP's office for evaluation.\n\nIn the PCP's office, she was noted to be in Afib. She was referred to the ED for evaluation. Per EMS, her rate varied from 70-140 during transport, but she was in the 60-80s in the ED. In the ED, initial vitals were 98.0 64 155/79 16 100%RA. EKG showed no changes, troponin negative x2. Cardiology was consulted who recommended a pMIBI. The initial result was not clearly normal, therefore a second day of testing was recommended. In the afternoon, the patient had a period of Afib with RVR, with her rate up to the 140s. She was provided metoprolol 5mg IV x1 and 25mg PO x1 with good control.\n \nOn review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. All of the other review of systems were negative. \n \nCardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, syncope or presyncope.\n", + "input3": "+Diabetes\n+Dyslipidemia \n+Hypertension \n+Diastolic heart failure: intermittent lasix, spironolactoneuse.\n+h/o paroxysmal atrial fibrillation, previously on amio/coumadin, now d/c\n", + "input4": "mother - deceased at young age of hodgkins\nfather - deceased of cad\nno breast, ovarian, uterine, colon cancer\nNo family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "ADMISSION PHYSICAL EXAMINATION: \nWeight: 116.1 kg \nVS: 97.9 133/65 55 20 99% RA\nGENERAL: NAD. Alert and oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. Right eye surgically non-reactive, left reactive to light, EOMI. \nNECK: Supple with no JVD. \nCARDIAC: RRR, normal S1, S2. ___ systolic ejection murmur. No S3 or S4. \nLUNGS: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, non-tender, non-distended. \nEXTREMITIES: No cyanosis, clubbing, edema. No femoral bruits. DP and ___ 2+ b/l\n", + "input6": "___ 06:40PM BLOOD WBC-6.8 RBC-4.37 Hgb-13.0 Hct-39.7 MCV-91 MCH-29.7 MCHC-32.7 RDW-13.4 Plt ___\n___ 06:40PM BLOOD Neuts-67.5 ___ Monos-4.7 Eos-0.5 Baso-0.7\n___ 06:40PM BLOOD ___ PTT-31.5 ___\n___ 06:40PM BLOOD Glucose-111* UreaN-26* Creat-1.3* Na-139 K-4.7 Cl-103 HCO3-23 AnGap-18\n___ 06:40PM BLOOD Calcium-9.1 Phos-4.4# Mg-2.1\n___ 07:10AM BLOOD WBC-6.2 RBC-4.00* Hgb-11.7* Hct-36.2 MCV-91 MCH-29.4 MCHC-32.4 RDW-13.5 Plt ___\n___ 07:10AM BLOOD Glucose-139* UreaN-27* Creat-1.3* Na-139 K-4.4 Cl-104 HCO3-28 AnGap-11\n___ 07:10AM BLOOD Calcium-8.8 Phos-4.0 Mg-2.1\n___ 06:40PM BLOOD cTropnT-<0.01\n___ 01:05AM BLOOD cTropnT-<0.01\n___ 07:10AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:10AM BLOOD CK(CPK)-79\n\nCXR ___:\nThe patient is status post median sternotomy and CABG. The cardiac and mediastinal silhouettes are stable. No focal consolidation, pleural effusion, or evidence of pneumothorax is seen. There is no overt pulmonary edema.\n\nStress ___:\nINTERPRETATION: DMII referred from the Emergency Department after two negative sets of cardiac biomarkers for evaluation of episodes of chest pain associated with shortness of breath and palpitations. The patient was infused 0.142 mg/kg/min of dipyridamole over 4 mins. No arm, chest, neck or back discomfort noted during the study. There were no ST segment changes during the infusion or during recovery. The rhythm was sinus with two runs of PSVT (one 3 beat during infusion and the second ___ beat run in recovery), two PACs and single atrial couplet. Appropriate hemodynamic response to infusion and recovery. The dipyridamole was reversed with 125 mg IV aminophylline.\n\nTTE ___:\nThe left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Left ventricular systolic function is hyperdynamic (EF>75%). Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are normal. A bioprosthetic aortic valve prosthesis is present. The aortic valve leaflets are not well visualized. The transaortic gradient is higher than expected for this type of prosthesis. No aortic regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. \n\nIMPRESSION: Mild symmetric left ventricular hypertrophy with hyperdynamic systolic function. Well seated aortic valve bioprosthesisleft with increased transaortic gradients, likely secondary to incrased flow from high output versus patient/prosthesis mismatch (similar mean gradient reported on post-op TEE. True prosthesis stenosis is less likely given the early peaking contour of the transaortic jet velocity (AT < 100 ms), although cannot completely exclude.\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/14647136-DS-8.json b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/14647136-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..2c44905f86d01243c7e71e5e9b86dac1e85a25b7 --- /dev/null +++ b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/14647136-DS-8.json @@ -0,0 +1,33 @@ +{ + "Paroxysmal Atrial Fibrillation$Intermedia_3": { + "Palpitations are a common symptom of atrial fibrillation, especially when they occur suddenly at rest, which can indicate paroxysmal atrial fibrillation.$Cause_1": { + "presented to the emergency room with palpations$Input2": {} + }, + "A significant increase in the rate and a decrease after drug control indicates the presence of atrial fibrillation and its response to treatment$Cause_1": { + "received diltiazem 20mg IV and 25mg IV and was rate controlled to 89/min from a high of 171/min$Input2": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "This is one of the most common symptoms of paroxysmal atrial fibrillation$Cause_1": { + "palpitations$Input1": {} + }, + "Chest discomfort, shortness of breath, and dizziness are also common symptoms of atrial fibrillation$Cause_1": { + "strange sensation in his chest associated with very minor shortness of breath and dizziness.$Input2": {} + }, + "Previous occurrence of similar symptoms, especially under certain circumstances (such as after a flight), may indicate Paroxysmal Atrial Fibrillation$Cause_1": { + "He reports that he has had this three times previously. The first time was after a flight and resolved within 30minutes. The second time was very brief and he cannot recall when it was. The most recent occassion was in last week and associated with lack of sleep.$Input2": {} + }, + "Lack of rest may increase risk of developing atrial fibrillation$Cause_1": { + "did not sleep the two night prior to admission due to work$Input2": {} + }, + "In atrial fibrillation, the upper chamber of the heart cannot contract normally, resulting in irregular heartbeats.$Cause_1": { + "Irregular rate$Input5": {} + } + } + }, + "input1": "palpitations\n", + "input2": "He is a generally healthy 65 year old man who presented to the emergency room with palpations that came on at rest around 5am today. He reports that he woke up to a strange sensation in his chest associated with very minor shortness of breath and dizziness. He denies sweats, chest pressure, chest pain, radiation, LOC, or nausea. He reports that he has had this three times previously. The first time was after a flight and resolved within 30minutes. The second time was very brief and he cannot recall when it was. The most recent occassion was in last week and associated with lack of sleep. The Pt reports that he did not sleep the two night prior to admission due to work. He denies stimulants, drugs, caffeine intake, home remidies or herbal medications. He denies exertional dyspnea, PND, orthopnea, presyncope, or syncope. He has no recent weight loss or fevers. He denies constipation, diarrhea, or neck or throat pain. He drinks 1 drink daily and almost never more than that. He smokes socially and only once in a while. \n\nIn the ED, initial vitals were T: 96.8 HR: 99 BP: 125/82 RR: 18 O2Sat: 100%RA. ECG showed Afib with RVR. Patient received diltiazem 20mg IV and 25mg IV and was rate controlled to 89/min from a high of 171/min and a repeat ECG showed ST-E in II, V3-6, and ST-D in aVR.\n", + "input3": "None\n", + "input4": "No family history of heart disease, dysrhythmias, sudden death, HTN, DM or cancer.\n", + "input5": "VS: 98.1 131/89 94 16 99%RA \nGEN: Young man in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNo palpable thyromegaly. No JVD. \nCV: PMI located in ___ intercostal space, midclavicular line. Irregular rate, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nPULM: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABD: BS+. Soft, NTND. No HSM or tenderness. \nLIMBS: No c/c/e. Reflexes 2+ at the biceps and patella. Toes down bilaterally. \nRight: Carotid 2+ Radial 2+ DP 2+ \nLeft: Carotid 2+ Radial 2+ DP 2+\n", + "input6": "___ 11:15AM BLOOD WBC-5.2 RBC-5.19 Hgb-16.3 Hct-46.4 MCV-90 MCH-31.4 MCHC-35.1* RDW-12.9 Plt ___\n___ 11:15AM BLOOD Glucose-89 UreaN-14 Creat-1.2 Na-140 K-4.1 Cl-102 HCO3-29 AnGap-13\n___ 11:15AM BLOOD ___ PTT-31.6 ___\n___ 11:15AM BLOOD Calcium-9.5 Phos-2.9 Mg-2.1\n___ 07:20PM BLOOD TSH-1.4\n\n\nTTE (Complete) Done ___ at 11:22:25 AM The left atrium and right atrium are normal in cavity size. No left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). Left ventricular wall thicknesses and cavity size are normal. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is low normal (LVEF 50-55%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \nIMPRESSION: Normal biventricular cavity sizes with preserved regional and low normal global left ventricular systolic function. Normal atrial size.\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/16089043-DS-12.json b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/16089043-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..9a26dc9e22259fa31f1c8a7c5fcb295e10970b82 --- /dev/null +++ b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/16089043-DS-12.json @@ -0,0 +1,33 @@ +{ + "Paroxysmal Atrial Fibrillation$Intermedia_3": { + "A criteria of Paroxysmal Atrial Fibrillation$Cause_1": { + "EKG: Irregular R-R intervals disappered after one day.$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "Chest pain is one of the common clinical manifestations of AF$Cause_1": { + "Chest Pain$Input1": {} + }, + "Symptoms of heart palpitations, accompanied by abnormal beating and rapid heartbeat. These are common symptoms of AF$Cause_1": { + "sensation of chest 'pressure,' which she clarifies as palpitations and not an actual pressure/tightness/pain associated with some skipped beats, and then later a fast heart beat.$Input2": {} + }, + "A history of atrial fibrillation, which is an important factor in determining whether the current symptoms may be AF$Cause_1": { + "similar to her past episode of afib.$Input2": {} + }, + "Echocardiography revealed mild pulmonary hypertension and diastolic dysfunction. These cardiac dysfunction may be related to the occurrence of AF.$Cause_1": { + "echo which suggested mild pulmonary hypertension, and diastolic dysfunction$Input2": {} + }, + "Lung disease can affect heart function and is associated with increased risk of AF attacks$Cause_1": { + "a CTA which showed moderate centrilobular emphysema and mild pulmonary edema$Input2": {} + }, + "Mitral valve prolapse may affect blood flow dynamics in the heart, and studies have shown a link between mitral valve prolapse and atrial fibrillation.$Cause_1": { + "Mitral valve prolapse$Input3": {} + } + } + }, + "input1": "Chest Pain\n", + "input2": "63 y/oF with a bladder sling procedure last month now comes in with af with rvr to 160s. At 2pm while washing her hair, she had the sensation of chest 'pressure,' which she clarifies as palpitations and not an actual pressure/tightness/pain associated with some skipped beats, and then later a fast heart beat. This felt similar to her past episode of afib. She denied chest pain, shortness of breath, nausea, or lightheadedness. At her assisted living facility, she called for attention. EMS administered 2.5mg of IV metoprolol in the ambulance. She was recently admitted to the hospital for elective sacrocolpopexy (bladder sling) which was complicated by post operative an episode of hypoxia. She had an echo which suggested mild pulmonary hypertension, and diastolic dysfunction. She had a CTA which showed moderate centrilobular emphysema and mild pulmonary edema, and no evidence of pulmomary embolism. \n\nIn the ED, vital signs were initially: 99.6 123 124/64 20 100. She was given 25mg of oral metoprolol and ECG prior to transfer was sinus with occasional atrial premature complexes. Now BP is 114/67 HR is 99 RR 16 sat 100% on 2L NC.\n", + "input3": "+Mitral valve prolapse, per pt report\n+Severe depression\n+Diabetes insipidus \n+Bladder retention- on an intermittent self-catheterization regimen \n+Hypothyroidism- as a result of prior radioactive iodine treatment for hyperthyroidism \n+\"fluid retention\"- for which her PCP gave her trial of HCTZ+Osteoporosis\n", + "input4": "NC\n", + "input5": "PHYSICAL EXAMINATION: \nVS: 98.6 138/70 67 16 96% RA \nGEN:The patient is in no distress and appears comfortable \nSKIN:No rashes or skin changes noted \nHEENT:No JVD, neck supple, No lymphadenopathy in cervical, \nposterior, or supraclavicular chains noted. \nCHEST:Lungs are clear without wheeze, rales, or rhonchi. \nCARDIAC: Regular rhythm; no murmurs, rubs, or gallops. \nABDOMEN: Soft, nt/nd. infraumbilical surgical incision c/d/i with steri strips. \nEXTREMITIES:no peripheral edema, warm without cyanosis. B/l \npalpable DP pulses. \nNEUROLOGIC: Alert and appropriate. CN II-XII grossly intact. Right sided foot drop.\n", + "input6": "___ 08:50PM BLOOD WBC-7.2 RBC-4.21# Hgb-13.0 Hct-39.5 MCV-94 MCH-30.8 MCHC-32.9 RDW-13.3 Plt ___\n___ 01:20PM BLOOD WBC-6.6 RBC-4.02* Hgb-12.2 Hct-38.1 MCV-95 MCH-30.3 MCHC-32.0 RDW-13.7 Plt ___\n___ 08:50PM BLOOD Neuts-50.2 ___ Monos-5.7 Eos-7.0* Baso-1.2\n___ 01:20PM BLOOD Neuts-55.3 ___ Monos-4.7 Eos-5.6* Baso-0.5\n___ 08:50PM BLOOD ___ PTT-29.4 ___\n___ 08:50PM BLOOD Plt ___\n___ 01:20PM BLOOD ___ PTT-27.7 ___\n___ 08:50PM BLOOD Glucose-94 UreaN-23* Creat-1.2* Na-144 K-4.4 Cl-110* HCO3-25 AnGap-13\n___ 01:20PM BLOOD Glucose-72 UreaN-23* Creat-1.3* Na-139 K-4.6 Cl-106 HCO3-25 AnGap-13\n___ 08:50PM BLOOD CK(CPK)-74\n___ 01:20PM BLOOD CK(CPK)-52\n___ 08:50PM BLOOD cTropnT-0.01\n___ 01:20PM BLOOD CK-MB-NotDone cTropnT-0.01\n___ 01:20PM BLOOD Calcium-9.5 Phos-3.0 Mg-2.___trial Fibrillation- \n \n# Chest Pressure- EKG did not show any ischemic changes and cardiac enzymes were negative x 2. Patient denied any chest pressure, jaw claudication, arm pain, loss of consciousness, dizziness or palpitations while in the hospital. Her history is more suggestive of only palpitations being her cause of chest discomfort, rather than angina. \n\n# Renal Insufficiency: Patient's creatinine of 1.2 on admission is in her recent normal range of 0.9-1.4. Patient tolerated PO's well. \n \n# Hypokalemia: Patient requires a fair amount of daily K repletion. On admission, potassium was 4.6. She did not require any additional potassium while in the hospital.\n\nEKG: Irregular R-R intervals disappered after one day.\n\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/16123634-DS-14.json b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/16123634-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..d33dd5fecb4b4bf62c00c94170bee5bc82ef6158 --- /dev/null +++ b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/16123634-DS-14.json @@ -0,0 +1,39 @@ +{ + "Paroxysmal Atrial Fibrillation$Intermedia_3": { + "direct indication of paroxysmal atrial fibrillation. No evidence for$Cause_1": { + "Atrial fibrillation with a mean ventricular rate of 104. Disappered within 24 hours.$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "Patients with atrial fibrillation may have a weakened heart pumping ability, resulting in reduced blood circulation efficiency, resulting in shortness of breath$Cause_1": { + "shortness of breath$Input1": {} + }, + "These symptoms may be a sign of reduced cardiac output due to atrial fibrillation.$Cause_1": { + "He had profound fatigue and dyspnea even on walking up a few stairs.$Input2": {} + }, + "This is a classic symptom of atrial fibrillation, and palpitations may indicate a possible irregular heartbeat.$Cause_1": { + "abrupt onset of dyspnea on exertion$Input2": {} + }, + "May indicate that the heart is under stress when it needs extra oxygen$Cause_1": { + "He denies dyspnea at rest, but does note some on chewing$Input2": {} + }, + "Chronic heart failure linked to atrial fibrillation$Cause_1": { + "sCHF, LVEF$Input3": {} + }, + "Diabetes linked to atrial fibrillation$Cause_1": { + "T2DM$Input3": {} + }, + "Irregular heartbeat. This is an important symptom of paroxysmal atrial fibrillation$Cause_1": { + "CARDIAC: irreg$Input5": {} + }, + "Slightly increased jugular venous pressure may be seen in patients with atrial fibrillation$Cause_1": { + "JVP of 9-10 cm.$Input5": {} + } + } + }, + "input1": "shortness of breath\n", + "input2": "He had profound fatigue and dyspnea even on walking up a few stairs. At that time he was cardioverted 3 times in a 2 week period. He has been maintained on a variety of medical regimens, most recently amiodarone. He has been very healthy and active, able to walk a mile a day. \n\nThree days ago he noticed the abrupt onset of dyspnea on exertion when he went out for his usual daily walk, such that he had to turn around and return home after a short distance. This dyspnea was also associated with palpitations, but not chest pain or diaphoresis. He denies dyspnea at rest, but does note some on chewing. He also notes that the shortness of breath is much less severe on this occasion than on prior episodes. He has noticed increased swelling. He has had increased frequency of urination, but denies dysuria or change in the quality of his urination. He continues to sleep with one pillow and denies PND. He states that he weighs himself each morning as part of his usual routine, and that his weight has not varied outside a range of 150-152 for months. He weighted 175 prior to moving a year ago, at which time he was able to lose 25 pounds that he has since maintained. He weighs himself without clothes. \n\nThe patient thinks that the recent dyspnea may be linked to a dietary indiscretion when he ate food two nights in a row. He typically is very careful about his salt intake, but this was a rare exception. He believes that his difficulty with dyspnea started two days after this intake.\n\n", + "input3": "+s/p inguinal hernia repair\n+sCHF, LVEF\n+s/p hip replacement\n+Sensorinueral hearing loss\n+Psoriasis\n+Osteoarthritis\n+h/o amaurosis fugax\n+BPH\n+Asthma\n+h/o actinic keratosis\n+T2DM\n+s/p colonoscopy showing polyp\n+h/o SCC of skin\n", + "input4": "non-contributory\n", + "input5": "VS: 97.5 106/71 108 16 98% RA \nGENERAL: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. \nNECK: Supple with JVP of 9-10 cm. \nCARDIAC: irreg, normal S1 S2, no MRG \nLUNGS: Resp were unlabored, no accessory muscle use. CTAB, no rales, wheezes or rhonchi. \nABDOMEN: Soft, non-tender, non-distended. No HSM. \nEXTREMITIES: No cyanosis, clubbing, or edema. Onychomycosis, dry skin of b/l feet. 2+ peripheral pulses\nNEURO: CN II-XII tested and intact, strength ___ throughout, sensation grossly normal. Gait not tested.\nSKIN: dry skin, no significant lesions or scars\n", + "input6": "___ 11:00AM BLOOD WBC-4.2 RBC-3.69* Hgb-10.9* Hct-35.7* MCV-97 MCH-29.5 MCHC-30.6* RDW-13.9 Plt ___\n___ 11:00AM BLOOD Neuts-67.0 ___ Monos-6.2 Eos-1.7 Baso-0.9\n___ 11:00AM BLOOD ___ PTT-41.2* ___\n___ 11:00AM BLOOD Glucose-113* UreaN-39* Creat-1.5* Na-142 K-4.3 Cl-105 HCO3-25 AnGap-16\n___ 11:00AM BLOOD Calcium-9.2 Phos-4.0 Mg-2.1\n\nEKG ___: Atrial fibrillation with a mean ventricular rate of 104. Disappered within 24 hours. Right bundle-branch block. Left axis deviation. Left anterior fascicular block. Non-diagnostic repolarization abnormalities. Possible anteroseptal myocardial infarction of indeterminate age. No previous tracing available for comparison.\n\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/17003536-DS-3.json b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/17003536-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..7202da4a6a1160fda219be4c0544b983f8b3f893 --- /dev/null +++ b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/17003536-DS-3.json @@ -0,0 +1,33 @@ +{ + "Paroxysmal Atrial Fibrillation$Intermedia_3": { + "This shows that atrial fibrillation is paroxysmal and can terminate itself, which is consistent with the characteristics of paroxysmal atrial fibrillation.$Cause_1": { + "planned for cardioversion but spontaneously converted back to NSR$Input2": {} + }, + "Sinus tachycardia and premature atrial contractions are common electrocardiographic manifestations of AF, indicating the presence of atrial fibrillation.$Cause_1": { + "Sinus rhythm with borderline sinus tachycardia and atrial premature beats. The findings are as outlined on previous tracing of the same date except that the rate is faster and atrial ectopy is now seen.$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "Palpitations are one of the common symptoms of atrial fibrillation$Cause_1": { + "Palpitations$Input1": {} + }, + "Palpitations are a common symptom of atrial fibrillation and indicate an abnormal heart rate.$Cause_1": { + "he began experiencing rapid heart palpitations$Input2": {} + }, + "Tachyarrhythmias may refer to atrial fibrillation, and carotid artery massage is a common emergency procedure used to try to terminate the abnormal heart rhythm.$Cause_1": { + "EMS who noted a tachyarrhythmia on monitor and recommended carotid massage$Input2": {} + }, + "Occasional premature ventricular contractions suggest underlying cardiac electrophysiological instability, which may be related to the onset of atrial fibrillation.$Cause_1": { + "In NSR on telemetry with occasional PVCs.$Input2": {} + }, + "High blood sugar may be a heart disease risk factor$Cause_1": { + "GLUCOSE-124*$Input6": {} + } + } + }, + "input1": "Palpitations \n", + "input2": "64 year old male. He was planned for cardioversion but spontaneously converted back to NSR earlier this morning. He was discharged home. Approximately 90 minutes after arriving home, he began experiencing rapid heart palpitations. He called EMS who noted a tachyarrhythmia on monitor and recommended carotid massage. This was effective in breaking the tachycardia. He was readmitted to the cardiology service. \n\nAt the time of arrival to the floor, he was feeling better with no palpitations or lightheadedness. In NSR on telemetry with occasional PVCs.\n", + "input3": "+grade 6 (3 + 3) adenocarcinoma of the prostate managed with watchful waiting \n+right cerebellar meningioma with growth to 4.4 cm x 3.1 cm.+nephrolithiasis \n+ocular migraine \n+hepatitis B \n+mononucleosis with subsequent hepatitis \n+genital herpes \n+leg fracture \n+ocular migraine \n+pyloric stenosis as an infant\n", + "input4": "CAD in both grandfathers. Cancer in father.\n", + "input5": "GENERAL: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNECK: Supple with JVP of 0 cm. \nCARDIAC: PMI located in intercostal space, midclavicular line. Regular rate and rhythm, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+\n", + "input6": "___ 06:00AM PTT-98.3*\n___ 06:00AM PLT COUNT-235\n___ 06:00AM WBC-5.4 RBC-4.89 HGB-14.7 HCT-43.3 MCV-89 MCH-30.0 MCHC-33.9 RDW-14.0\n___ 06:00AM CALCIUM-8.7 PHOSPHATE-3.5 MAGNESIUM-1.9\n___ 02:55PM ___ PTT-24.7 ___\n___ 02:55PM PLT COUNT-240\n___ 02:55PM NEUTS-70.9* ___ MONOS-7.2 EOS-0.7 BASOS-1.3\n___ 02:55PM WBC-5.9 RBC-5.17 HGB-15.8 HCT-45.8 MCV-89 MCH-30.6 MCHC-34.5 RDW-13.6\n___ 02:55PM GLUCOSE-124* UREA N-11 CREAT-0.9 SODIUM-140 \nPOTASSIUM-4.3 CHLORIDE-107 TOTAL CO2-23 ANION GAP-14\n\n========\nEKG ___: Sinus rhythm with borderline sinus tachycardia and atrial premature beats. The findings are as outlined on previous tracing of the same date except that the rate is faster and atrial ectopy is now seen.\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/17943628-DS-15.json b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/17943628-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..a49715c794db36bf24e9054ad2d639afaf34e4ee --- /dev/null +++ b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/17943628-DS-15.json @@ -0,0 +1,30 @@ +{ + "Paroxysmal Atrial Fibrillation$Intermedia_3": { + "The 4-hour ECG monitoring showed no acute events, but there were slight brief pauses (<3 seconds, about 6 times). This brief pause in the heartbeat may be a sign of atrial fibrillation, especially if the patient spontaneously returns to sinus rhythm after admission$Cause_1": { + "Telemetry: No acute events on 24 hour telemetry except for some mild <3 second pauses (approximately 6 episodes overnight). Patient spontaneously cardioverted to sinus rhythm the morning after admission.$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "Drinking alcohol, especially heavy drinking, may trigger atrial fibrillation$Cause_1": { + "night of drinking$Input2": {} + }, + "Rapid heartbeat and irregular rhythm are classic symptoms of atrial fibrillation$Cause_1": { + "felt his carotid pulse, and noticed that his heart was beating extremely fast, and with an irregular rhythm$Input2": {} + }, + "Drinking alcohol, especially heavy drinking, may trigger atrial fibrillation..$Cause_1": { + "had 4 vodkas last night with dinner$Input2": {} + }, + "Significantly increased heart rate is an acute manifestation of atrial fibrillation$Cause_1": { + "HR was elevated to 160s$Input2": {} + }, + "Antiarrhythmic drugs are commonly used to control heart rate in atrial fibrillation$Cause_1": { + "He was given a drug en route to the ED (unknown drug/dosage), after which his HR apparently decreased.$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "Patient is a 65 man with h/o anxiety with panic attacks who got up to the bathroom yesterday morning at 5:30 am after a night of drinking, and felt lightheaded and nauseous while he was urinating. As he walked back to his bedroom, he slowly syncopized onto the floor, which was witnessed by his wife. He was down for seconds. When he awoke, he felt his carotid pulse, and noticed that his heart was beating extremely fast, and with an irregular rhythm. His heart has beated fast during his past panic attacks (the rhythm is always regular during these attacks. He became extremely anxious at this point, and EMT was called. His wife states she did not notice any dysarthria or facial droop after he awoke. He had no associated diaphoresis, no CP, and no SOB during this episode. Of note, patient had 4 vodkas last night with dinner, and has been under increased stress/anxiety recently with the birth of preterm son, currently in the NICU. Pt visited his son last night at 6PM before he went out for dinner/drinks.\n \nOn EMT arrival, HR was elevated to 160s, bp was normal per pt report. He was given a drug en route to the ED (unknown drug/dosage), after which his HR apparently decreased. \n", + "input3": "+Anxiety with panic attacks\n+Various arthroscopy procedures.\n+Left inguinal hernia, asymptomatic and monitered by PCP.\n", + "input4": "Father had 4x-bypass, paternal uncle had heart attack, mother and 3 siblings in good health.\n", + "input5": "Vitals: 99.2, 112/70, HR 90, RR 16, 95% RA`\nGeneral: in NAD, sitting in bed with wife at side. Not \ncomplaining of palpitations or chest pain.\nHEENT: Nonicteric PERRL, OP clear. No palpable LAD.\nNeck: JVP not elevated. No carotid bruits. Thyroid elevation normal, with no physical exam findings suggestive of enlarged thyroid\nHeart: RRR, no m/r/g. PMI non-displaced.\nLungs: CTA bilaterally\nAbdomen: Soft, NTND. No hepatomegaly or splenomegaly. No \nascites.\nExtremities: Good ROM and full strength throughout. No \nperipheral edema.\nNeuro: CN II-XII tested and intact, however patient does have lateral gaze nystagmus in right eye.\n", + "input6": "___ 07:30AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 07:30AM BLOOD Calcium-9.3 Phos-2.2* Mg-2.1\n___ 07:29AM BLOOD Calcium-9.3 Phos-3.7 Mg-2.3\n___ 07:30AM BLOOD cTropnT-<0.01\n___ 02:50PM BLOOD cTropnT-<0.01\n___ 09:30PM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 07:30AM BLOOD CK(CPK)-78\n___ 02:50PM BLOOD CK(CPK)-70\n___ 09:30PM BLOOD CK(CPK)-72\n___ 07:30AM BLOOD Glucose-116* UreaN-18 Creat-0.6 Na-141 K-3.2* Cl-105 HCO3-22 AnGap-17\n___ 07:29AM BLOOD Glucose-96 UreaN-15 Creat-0.9 Na-142 K-4.6 Cl-107 HCO3-26 AnGap-14\n___ 07:30AM BLOOD WBC-7.2 RBC-5.29 Hgb-15.6 Hct-43.9 MCV-83 MCH-29.5 MCHC-35.5* RDW-13.6 Plt ___\n___ 07:30AM BLOOD Neuts-77.0* Bands-0 Lymphs-16.1* Monos-3.9 Eos-1.9 Baso-1.1\n___ 07:29AM BLOOD WBC-7.5 RBC-5.29 Hgb-15.8 Hct-44.8 MCV-85 MCH-29.9 MCHC-35.3* RDW-13.7\n___ 07:29AM BLOOD TSH-PND\n.\nTelemetry: No acute events on 24 hour telemetry except for some mild <3 second pauses (approximately 6 episodes overnight). Patient spontaneously cardioverted to sinus rhythm the morning after admission.\n\nImaging studies:\n___ CXR: Cardiac silhouette is within normal limits. Mediastinal contour and lung parenchyma show no abnormalities. Extrathoracic soft tissues and osseous structures are unremarkable.\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/19489502-DS-11.json b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/19489502-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..dca9d5b7ce6ec0f37013480ca20b3e103adba401 --- /dev/null +++ b/Finished/Atrial Fibrillation/Paroxysmal Atrial Fibrillation/19489502-DS-11.json @@ -0,0 +1,36 @@ +{ + "Paroxysmal Atrial Fibrillation$Intermedia_3": { + "Paroxysmal atrial fibrillation is characterized by symptoms that resolve spontaneously or are relieved by medical intervention$Cause_1": { + "entire episode lasted 15 minutes and his symptoms gradually started to go away$Input2": {} + }, + "Rapid heart rate is typical of atrial fibrillation$Cause_1": { + "EMS found him to be in rapid afib$Input2": {} + }, + "Absence of P waves is one of the typical features of atrial fibrillation$Cause_1": { + "ECG:No P wave$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "Palpitations, the feeling of an abnormal heartbeat, are one of the common symptoms of AF$Cause_1": { + "palpitations$Input1": {} + }, + "Palpitations are a common symptom of paroxysmal atrial fibrillation$Cause_1": { + "started to feel chest pressure/palpitations$Input2": {} + }, + "Dizziness may be caused by an irregular heartbeat that causes erratic blood flow to the brain$Cause_1": { + "slightly dizzy$Input2": {} + }, + "Hyperlipidemia is a factor in atrial fibrillation$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "This may be a symptom of atrial fibrillation$Cause_1": { + "Irregular Irregular$Input5": {} + } + } + }, + "input1": "palpitations\n", + "input2": "This 63 year old man with no cardiac history, BPH and GERD was transferred to our facility transferred with a.fib with RVR (initially on a dilt gtt) from OSH. This morning, the patient got up to go urinate, and suddently at 1 am started to feel chest pressure/palpitations, complained of difficulty swallowing, and tingling of left arm. He called out to his daughter (who lives upstairs). The patient reports the feeling of not being able to swallow, but denied overt chest pain. He felt slightly dizzy but denies LOC. He states that the entire episode lasted 15 minutes and his symptoms gradually started to go away, but resolved completely upon administration of medicines at OSH. EMS found him to be in rapid afib. He was taken at rapid a.fib to 140's got 20 IV dilt, 10 IV dilt, then dilt gtt. EKG showed some ST dep. CP resolved with rate control. Gave ASS 325 and neg trop.\n\n\n", + "input3": "+Dyslipidemia\n+BPH\n+GERD\n+Bilateral Eye surgery\n", + "input4": "Father died of MI. One brother - well, one brother died with alcoholism and prostate cancer. Two sisters one with a lung problem.\n", + "input5": "VS: ___\nGENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.\nHEENT: NCAT. Sclera anicteric. Pupils unreactive (bilateral surgery) Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. Missing all teeth. \nNECK: Supple with no JVD. \nCARDIAC: Irregular Irregular, S1, S2. no murmurs appreciated. \nLUNGS: Mild crackles at bases, no rales or ronchi.\nABDOMEN: Soft, NTND. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Popliteal 1+ DP 1+ \nLeft: Popliteal 1+ DP 1+\n", + "input6": "___ 05:35AM ___ PTT-30.1 ___\n___ 05:35AM PLT COUNT-253\n___ 05:35AM NEUTS-61.7 ___ MONOS-4.5 EOS-2.5 BASOS-0.5\n___ 05:35AM WBC-5.7 RBC-3.66* HGB-11.4* HCT-33.6* MCV-92 MCH-31.1 MCHC-33.9 RDW-14.3\n___ 05:35AM TSH-2.3\n___ 05:35AM CALCIUM-8.5 PHOSPHATE-4.0 MAGNESIUM-2.1\n___ 05:35AM proBNP-635\n___ 05:35AM cTropnT-0.04*\n___ 05:35AM estGFR-Using this\n___ 05:35AM GLUCOSE-114* UREA N-22* CREAT-1.1 SODIUM-140 POTASSIUM-4.1 CHLORIDE-106 TOTAL CO2-26 ANION GAP-12\n___ 12:45PM CK(CPK)-51\n___ 12:45PM CK(CPK)-51\n\nECG:No P wave\n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Persistent Atrial Fibrillation/15008480-DS-3.json b/Finished/Atrial Fibrillation/Persistent Atrial Fibrillation/15008480-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..fab53a576452d6e1fd939676a7e1e3a9f2a307f8 --- /dev/null +++ b/Finished/Atrial Fibrillation/Persistent Atrial Fibrillation/15008480-DS-3.json @@ -0,0 +1,48 @@ +{ + "Persistent Atrial Fibrillation$Intermedia_3": { + "An increase in the frequency of heart palpitations may indicate an increase in the frequency of atrial fibrillation$Cause_1": { + "recurrent atrial fibrillation$Input2": {} + }, + "Severe atrial fibrillation attacks may occur when existing drug treatments fail$Cause_1": { + "Propafenone was discontinued as it is no longer effective$Input2": {} + }, + "The patient had a history of two electrical cardioversion treatments, suggesting that atrial fibrillation may recur$Cause_1": { + "undergone two CV's$Input2": {} + }, + "Criteria for Persistent Atrial Fibrillation$Cause_1": { + "ECG: AF episodes that last more than 7 days.$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "Shortness of breath is a common symptom of atrial fibrillation$Cause_1": { + "short of breath$Input1": {} + }, + "Heart palpitations are a common symptom of atrial fibrillation$Cause_1": { + "recurrent palpitations$Input2": {} + }, + "Hypertension is an important risk factor for atrial fibrillation$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is an important risk factor for atrial fibrillation$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Diabetes linked to atrial fibrillation$Cause_1": { + "DM Type 2$Input3": {} + }, + "Mitral valve prolapse can lead to structural changes in the heart and abnormal heart function, thereby increasing the risk of atrial fibrillation.$Cause_1": { + "mitral valve prolapse$Input3": {} + }, + "Cardiovascular examination reveals tachycardia and irregular heartbeats, which are also characteristic of atrial fibrillation$Cause_1": { + "Tachycardia, irregular$Input5": {} + }, + "These are the classic symptoms of atrial fibrillation$Cause_1": { + "BP: 103/64 P: 90s-140s$Input5": {} + } + } + }, + "input1": "short of breath\n", + "input2": "This 56 year old woman. She was started on Propafenone and did well until when she developed recurrent palpitations. She was found to be in recurrent atrial fibrillation. She has undergone two CV's. She has since continued to have short episodes of palpitations, with episodes being more frequent. Propafenone was discontinued as it is no longer effective.\n", + "input3": "+Hypertension\n+Hyperlipidemia \n+MR, mitral valve prolapse\n+DM Type 2\n+Several TIA's\n+Hx of Cholelithiasis, cholecystitis s/p lap chole\n+Hx of acute pancreatitis\n+Cataracts s/p surgery\n+Breast biopsy\n+s/p right knee replacement\n", + "input4": "None\n", + "input5": "PE on hospital admission/post PVI:\nBP: 103/64 P: 90s-140s AF RR: 16 02 sat: 97% NC Pain: 2 (chest soreness) \nGeneral: Well appearing, in no apparent distress\nNeuro: Alert and oriented x4. Pleasant and cooperative. PERRLA 3->2. EOMI. No facial droop or arm drift. Speech clear, appropriate and comprehensible. Tongue midline, smile symmetric. Equal and strong strengths in bilat UEs and bilat LEs. \nCV: Tachycardia, irregular, no murmur appreciated \nLungs: Clear anteriorly, non-labored. No use of accessory muscles noted.\nAbdomen: soft, non-tender, + BS x4\nPV: WWP, + pedal pulses, No edema, Palpable Pedal pulses. \nAccess sites: Bilat femoral access sites soft without hematoma, ecchymosis, or ongoing drainage.\n", + "input6": "ECG: AF episodes that last more than 7 days. \n" +} \ No newline at end of file diff --git a/Finished/Atrial Fibrillation/Persistent Atrial Fibrillation/16368173-DS-2.json b/Finished/Atrial Fibrillation/Persistent Atrial Fibrillation/16368173-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..44aac643bbfe70821f41235cd830a548cc0cdf6f --- /dev/null +++ b/Finished/Atrial Fibrillation/Persistent Atrial Fibrillation/16368173-DS-2.json @@ -0,0 +1,30 @@ +{ + "Persistent Atrial Fibrillation$Intermedia_3": { + "This is a direct manifestation of Atrial Fibrillation$Cause_1": { + "increased AFIB burden with symptoms$Input2": {} + }, + "Criteria for Persistent Atrial Fibrillation$Cause_1": { + "ECG: AF episodes that last more than 7 days.$Input6": {} + }, + "Suspected Atrial Fibrillation$Intermedia_2": { + "This is a congenital disorder of the heart that may increase the risk of atrial fibrillation.$Cause_1": { + "had a patent ductus arteriosus detected on echo$Input2": {} + }, + "A history of syncope, which is also common in people with atrial fibrillation$Cause_1": { + "history of syncopal episode$Input2": {} + }, + "Appears irregularly, which may be due to atrial fibrillation$Cause_1": { + "100-120's at rest, 140-150's with movement$Input5": {} + }, + "Abnormal cardiac rhythm is a major characteristic of Atrial Fibrillation.$Cause_1": { + "irregular rate/rhythm$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "This is a 61 year old male who has had increased AFIB burden with symptoms and was admitted for Dofetilide loading. He had a patent ductus arteriosus detected on echo that has been followed by serial echo. He also has a history of syncopal episode while hiking which was consistent with a vagal mechanism.\n", + "input3": "+History of external condylomata\n+Exercise induced asthma\n+Sinusitis\n+Syncopal episode while hiking consistent with a vagal mechanism.\n", + "input4": "No smoking, social etoh, no illicits.\n", + "input5": "Tele: 100-120's at rest, 140-150's with movement\nVS: 97.7, BP 106/79, P 92, RR 18, 97%RA\nGen: sitting on side of bed with vistor eating take out. \nNeuro: alert and oriented, pleasant\nNeck/JVP: none appreciated\nCV: irregular rate/rhythm\nChest: clear bilaterally\nABD: +bs, soft nontender\nExtr: no edema\nSkin: no open areas\n", + "input6": "___ 07:42PM BLOOD WBC-7.8 RBC-4.98 Hgb-14.7 Hct-42.3 MCV-85 MCH-29.5 MCHC-34.8 RDW-13.4 RDWSD-41.5 Plt ___\n___ 07:42PM BLOOD Glucose-92 UreaN-21* Creat-0.9 Na-139 K-3.9 Cl-104 HCO3-25 AnGap-14\n___ 07:42PM BLOOD Mg-1.9\n\nECG: AF episodes that last more than 7 days.\n" +} \ No newline at end of file diff --git a/Finished/COPD/11482871-DS-15.json b/Finished/COPD/11482871-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..354b6a19fccd3ad444416e323d28b946c67fadbc --- /dev/null +++ b/Finished/COPD/11482871-DS-15.json @@ -0,0 +1,50 @@ +{ + "Mild COPD$Intermedia_4": { + "FEV1 \u2265 80% confirm Mild COPD$Cause_1": { + "FEV1 82%$Input6": {} + }, + "COPD$Intermedia_3": { + "confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC < 0.70$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "An elevated heart rate and a drop in oxygen saturation to 83% may indicate shortness of breath or lung dysfunction, common symptoms of COPD.$Cause_1": { + "tachypneic, with O2 sat of 83%$Input2": {} + }, + "A chest X-ray shows cord-like density in the right lower lung, which may be caused by lung infection or other structural abnormalities, which are more common in patients with COPD.$Cause_1": { + "CXR at clinic was notable for streaky densitites in the right lower base$Input2": {} + }, + "Atelectasis may worsen COPD symptoms.$Cause_1": { + "bibasilar opacities consistent with atelectasis$Input2": {} + }, + "The oxygen saturation dropped to 85% on standing, suggesting possible postural changes in oxygen saturation, which may be more pronounced in patients with COPD.$Cause_1": { + "desatted to 85% when standing$Input2": {} + }, + "The patient arrived at the ward with labored breathing, a classic symptom of COPD.$Cause_1": { + "labored breathing$Input2": {} + }, + "The patient sometimes felt short of breath and used CPAP to assist her breathing, suggesting that she may have long-term breathing problems, a common symptom of COPD.$Cause_1": { + "short of breath and had used her CPAP O2 at times$Input2": {} + }, + "A significant decrease in oxygen saturation may indicate an underlying respiratory dysfunction, a common symptom of COPD.$Cause_1": { + "94% RA, desats to 81% with ambulation$Input5": {} + }, + "Obesity is a risk factor for COPD because it can increase pressure in the chest cavity and affect breathing function.$Cause_1": { + "obese$Input5": {} + }, + "This is a common type of COPD in which the center of the lungs is destroyed, affecting breathing function.$Cause_1": { + "Moderate-to-severe centrilobular emphysema is seen in both lungs, predominant in the upper lobes$Input6": {} + }, + "This suggests that airway inflammation, or damage, is a key factor in the development of COPD.$Cause_1": { + "small airways wall thickening$Input6": {} + } + } + } + }, + "input1": "asymptomatic hypoxia\n", + "input2": "She with Stage III colon cancer s/p 11 cycles of FOLFOX who initially presented to clinic the day of presentation to have her post de-accessed presented to clinic today to have her port de-accessed when she was found to be tachypneic, with O2 sat of 83%. As per report, the patient was in mild distress but able to speak in full sensations. A CXR at clinic was notable for streaky densitites in the right lower base. In the ED, vitals 97.7 74 143/83 20 96% on RA, however, desatted to 85% when standing. CXR prelim read as bibasilar opacities consistent with atelectasis cannot exclude infection. Blood cultures sent and pt treated with vanc and ceftriaxone. UA significant for moderate leukocyte exterase and 8 WBCs. On arrival to the floor, pt does appear to have some labored breathing though she states that she feels well. She notes that several days ago she had been feeling short of breath and had used her CPAP O2 at times. She states that she had been feeling fine today, though without SOB. On ROS she does note that her legs felt a little weak today. She endorses headache. She states that her bowel movements and leg swelling are at baseline. The patient had been on lasix but the medication was discontinued when she began chemotherapy. Detailed ROS otherwise negative.\n", + "input3": "+ Diabetes Mellitus 2 \n+ Hypertension \n+ Chronic Kidney Disease \n+ OSA, uses CPAP at night \n+ Hypothyroidism\n", + "input4": "NC\n", + "input5": "VS: 97.8 131/57 86 18 94% RA, desats to 81% with ambulation\nGeneral: Pleasant, well appearing woman, NAD\nHEENT: EOMI, PERRL, MMM, no thrush\nNeck: Supple, obese\nCV: RRR S1 S2, no murmurs/rubs/gallops\nLungs: CTAB, no crackles\nAbdomen: soft, nontender, nondistended, +BS, obese \nExtremities: warm, well perfused, 2+ DP pulses, 1+ pitting edema bilaterally, symmetric, no calf tenderness appreciated \nSkin: No rashes\n", + "input6": "CXR: IMPRESSION: Bibasilar opacities likely due to atelectasis; however, infection is not completely excluded. Please correlate clinically. \n\ufeff\nCTA: \nFINDINGS: A right chest wall Port-A-Cath terminates in the cavo-atrial junction. The pulmonary arteries are well opacified to subsegmental levels, without evidence of pulmonary embolism. Mild atherosclerotic calcification is seen in the thoracic aorta, without aneurysmal dilation or dissection. Moderate mitral annular calcification is noted. The heart size is normal. There is no pericardial effusion. Mild coronary arterial calcification is present. Multiple small scattered reactive mediastinal lymph nodes are seen in the right paratracheal, prevascular, and subcarinal stations and hila, measuring up to 14 mm in the right hilum and 12 mm in the left hilum (3:37). \n \nThe major airways are patent to subsegmental levels bilaterally. \n \nModerate-to-severe centrilobular emphysema is seen in both lungs, predominant in the upper lobes. A 4-mm right perissural upper lobe pulmonary nodule (2:29) is seen. Mild small airways wall thickening is seen in both lower lobes, predominant in the right lower lobe. An area of consolidation in the medial segment of the right middle lobe (3:53) likely represents atelectasis. Linear subsegmental atelectasis is seen in both lower lobes. There are no pleural or pericardial effusions.\n\nPost-bronchodilator FEV1/FVC < 0.70. FEV1 82%\n" +} \ No newline at end of file diff --git a/Finished/COPD/11655904-DS-23.json b/Finished/COPD/11655904-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..4ea29443e6d2cced2915cc87a20c2192c95bf883 --- /dev/null +++ b/Finished/COPD/11655904-DS-23.json @@ -0,0 +1,41 @@ +{ + "Severe COPD$Intermedia_4": { + "30% \u2264 FEV1 < 50% is the criteria of Severe COPD$Cause_1": { + "FEV1 47% predicted.$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 is the criteria of COPD$Cause_1": { + "FEV1/FVC = 0.45$Input5": {} + }, + "Suspected COPD$Intermedia_2": { + "Drowsiness is a common symptom in COPD patients.$Cause_1": { + "Somnolence$Input1": {} + }, + "Confusion is a nonspecific symptom but may be associated with an acute exacerbation of respiratory disease, particularly in patients with COPD.$Cause_1": { + "increasing confusion$Input2": {} + }, + "Upper respiratory tract infection (URI)-like symptoms and cough with green sputum are common symptoms of COPD exacerbations.$Cause_1": { + "recent URI-like symptoms, with cough productive of green sputum$Input2": {} + }, + "The patient had recently completed a course of prednisone taper and antibiotics for a presumed acute exacerbation of COPD, which was direct evidence of a history of COPD.$Cause_1": { + "recently finished a prednisone taper and antibiotic course last week for presumed COPD exacerbation.$Input2": {} + }, + "Typical manifestations of COPD, indicating airway obstruction and airflow limitation$Cause_1": { + "very quiet breath sounds, with prolonged expiratory phase$Input5": {} + }, + "In patients with COPD, faint heart sounds may occur due to pneumothorax or hyperinflation$Cause_1": { + "although quiet heart sounds$Input5": {} + }, + "May indicate chronic hypercapnia, common in patients with COPD$Cause_1": { + "mild asterixis$Input5": {} + } + } + } + }, + "input1": "Somnolence\n", + "input2": "Ms. ___ is a ___ year old female who presents with one day of confusion. Patient notes increasing confusion starting earlier today. Daughter was concerned for increasing confusion, and also reported recent URI-like symptoms, with cough productive of green sputum. Daughter was concerned, and urged patient to seek evaluation. Patient denies f/c, no headache/neck stiffness. No pre-syncope/syncope. No recent falls. She also denies any chest pain/pressure, and denies any worsening DOE. Per report, patient recently finished a prednisone taper and antibiotic course last week for presumed COPD exacerbation. \n", + "input3": "None\n", + "input4": "Father: MI at age ___, died at age ___. Mother died of ___ of MI, Paternal Great Uncle died of MI at age ___. Brother has lung CA \n", + "input5": "VS: 105/42 HR 76 93% 3 liters n/c RR 16 \nGA: AOx3, NAD, no increased work of breathing \nHEENT: PERRLA. MMM. no LAD. no JVD. neck supple. \nCards: PMI palpable at ___ IC space. No RVH. RRR S1/S2 heard. no murmurs/gallops/rubs, although quiet heart sounds \nPulm: CTAB no crackles or wheezes. very quiet breath sounds, with prolonged expiratory phase \nAbd: soft, NT, +BS. no g/rt. neg HSM. neg ___ sign. \nExtremities: wwp, trace ___ edema. DPs, PTs 2+. \nSkin: \nNeuro/Psych: CNs II-XII intact. ___ strength in U/L extremities. DTRs 2+ ___ (biceps, achilles, patellar). sensation intact to LT, pain, temperature, vibration, proprioception. cerebellar fxn intact (FTN, HTS). gait deferred. mild asterixis \n\nFEV1/FVC = 0.45 \n", + "input6": "___ 09:51PM TYPE-ART PO2-137* PCO2-71* PH-7.37 TOTAL \nCO2-43* BASE XS-12\n___ 07:00PM TYPE-ART PO2-167* PCO2-73* PH-7.39 TOTAL \nCO2-46* BASE XS-15\n___ 05:20PM GLUCOSE-100 UREA N-12 CREAT-0.7 SODIUM-142 \nPOTASSIUM-4.2 CHLORIDE-96 TOTAL CO2-40* ANION GAP-10\n___ 05:20PM estGFR-Using this\n___ 05:20PM ALT(SGPT)-15 AST(SGOT)-18 CK(CPK)-79 ALK \nPHOS-99 TOT BILI-0.2\n___ 05:20PM cTropnT-<0.01\n___ 05:20PM CK-MB-5 proBNP-92\n___ 05:20PM URINE HOURS-RANDOM\n___ 05:20PM URINE GR HOLD-HOLD\n___ 05:20PM WBC-8.1 RBC-4.04* HGB-11.5* HCT-34.8* MCV-86 \nMCH-28.5 MCHC-33.1 RDW-14.5\n___ 05:20PM NEUTS-68.0 ___ MONOS-4.3 EOS-4.2* \nBASOS-0.5\n___ 05:20PM PLT COUNT-226\n___ 05:20PM ___ PTT-23.3 ___\n___ 05:20PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 05:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-MOD\n___ 05:20PM URINE RBC-0 ___ BACTERIA-MOD YEAST-NONE \n\nMicro: Legionella urine anigen-neg, MRSA-neg, Urine cx.-negative \n\nFEV1 47% predicted.\n\n" +} \ No newline at end of file diff --git a/Finished/COPD/12206678-DS-90.json b/Finished/COPD/12206678-DS-90.json new file mode 100644 index 0000000000000000000000000000000000000000..87a7da1e4dda7156f0be224658fc64f1ed8a0bcc --- /dev/null +++ b/Finished/COPD/12206678-DS-90.json @@ -0,0 +1,35 @@ +{ + "Mild COPD$Intermedia_4": { + "FEV1 \u2265 80% confirm Mild COPD$Cause_1": { + "FEV1 82%$Input6": {} + }, + "COPD$Intermedia_3": { + "confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC < 0.70.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Smoking is a risk factor for COPD$Cause_1": { + "current smoker$Input2": {} + }, + "Shortness of breath is one of the symptoms of COPD$Cause_1": { + "short of breath$Input2": {} + }, + "Long-term smoking history is one of the symptoms of COPD$Cause_1": { + "40+-pack-year smoking history$Input2": {} + }, + "Long-term smoking history is one of the risk fact of COPD$Cause_1": { + "tobacco use$Input3": {} + }, + "Cmild wheezes, one of the symptoms of COPD$Cause_1": { + "Cmild wheezes,$Input5": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "male current smoker presenting after feeling short of breath while visiting his wife earlier today. Patient states that he has a 40+-pack-year smoking history. He does not recall any inciting event. He went outside and smoked a cigarette and then felt worse. He presented to the emergency department from there.No cough productive of mucus, no fevers or chills. No chest pain. No prior cardiac history. \n", + "input3": "HTN\ntobacco use\n", + "input4": "Non contributory \n", + "input5": "General: Alert, oriented, no acute distress \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nLungs: Cmild wheezes, \nSkin: Warm, dry, no rashes or notable lesions. \nNeuro: CNII-XII intact, ___ strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally. \n", + "input6": "___ 02:45AM BLOOD WBC-11.9* RBC-4.99 Hgb-16.6 Hct-48.0 \nMCV-96 MCH-33.3* MCHC-34.6 RDW-15.0 RDWSD-52.8* Plt ___\n___ 02:45AM BLOOD Glucose-86 UreaN-12 Creat-0.7 Na-145 \nK-4.1 Cl-108 HCO3-19* AnGap-18\n\nPost-bronchodilator FEV1/FVC < 0.70.\nFEV1 82% \n\n" +} \ No newline at end of file diff --git a/Finished/COPD/12342173-DS-10.json b/Finished/COPD/12342173-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..0c7d86233b1b52c5b63d4ef262d9167c4ec90600 --- /dev/null +++ b/Finished/COPD/12342173-DS-10.json @@ -0,0 +1,44 @@ +{ + "Very Severe COPD$Intermedia_4": { + "FEV1 < 30% is the criteria of Very severe\nCOPD$Cause_1": { + "FEV1 25%$Input6": {} + }, + "COPD$Intermedia_3": { + "A chest x-ray shows overinflated lungs and severe emphysema, typical symptoms of COPD$Cause_1": { + "The lungs are hyperinflated and severe emphysema$Input6": {} + }, + "FEV1/FVC < 0.70 confirms COPD$Cause_1": { + "FEV1/FVC = 0.42$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Shortness of breath is a common symptom of COPD$Cause_1": { + "Shorntess of breath$Input1": {} + }, + "Cough is one of the common symptoms of COPD$Cause_1": { + "complaining of cough$Input2": {} + }, + "People with COPD often experience breathlessness during physical activity.$Cause_1": { + "subacute dyspnea$Input2": {} + }, + "Increasing dyspnea is a sign of worsening COPD symptoms$Cause_1": { + "3 weeks of worsening cough and SOB$Input2": {} + }, + "The need for continuous oxygen therapy indicates that her lung function is significantly impaired, a common feature in patients with COPD.$Cause_1": { + "has a home O2 requirement of 3 L at baseline and 4L$Input2": {} + }, + "This is a common symptom in people with COPD because the airway obstruction causes prolonged exhalation time.$Cause_1": { + "prolonged expiratory phase with deminished breath sounds$Input5": {} + }, + "The need for external oxygen support suggests that the patient has a chronic respiratory disease, such as COPD$Cause_1": { + "O2:97% 3L$Input5": {} + } + } + } + }, + "input1": "Shorntess of breath\n", + "input2": "Mrs. ___ is a ___ year-old woman who presents complaining of cough, subacute dyspnea on exertion and epigastric pain. Ms. ___ describes about 3 weeks of worsening cough and SOB. She describes that this SOB has gradual worsening over past few days. She attempted using a nebulized albuterol treatment and experianced a 5 minute episode of sudden epigastric pain that resolved without therapy after 5 minutes and was different from her GERD pain. She has a home O2 requirement of 3 L at baseline and 4L when particularly active; however, she is occasionally able to sit at rest without supplemental O2. She describes that she is not able to walk up a flight of stairs and is having a hard time functioning at home in the past few days. \n", + "input3": "HTN\ndCHF\nMitral regurgitation\nGERD\nHyperlipidemia\ns/p partial thyroidectomy for benign thyroid nodule\nOsteopenia\nprior R wrist fx\nAllergic Rhinitis\n", + "input4": "None\n", + "input5": "Vitals: T:96.1 BP:141/60 P:82 R:16 O2:97% 3L\nGeneral: Alert and oriented x 3, no acute distress\nHEENT: Sclera anicteric, MMM, oropharynx clear\nNeck: supple, JVP not elevated, no LAD\nLungs: prolonged expiratory phase with deminished breath sounds \nbilaterally\nCV: Regular rate and rhythm\nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly\nGU: no foley\nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\nNeuro: CNs2-12 intact, motor function grossly normal\n", + "input6": "___ 12:52PM BLOOD WBC-8.5 RBC-4.66 Hgb-14.4 Hct-41.7 MCV-90 \nMCH-30.9 MCHC-34.5 RDW-13.0 Plt ___\n___ 06:44AM BLOOD WBC-9.7 RBC-4.58 Hgb-14.7 Hct-40.9 MCV-89 \nMCH-32.0 MCHC-35.9* RDW-13.2 Plt ___\n___ 12:52PM BLOOD Glucose-84 UreaN-18 Creat-1.2* Na-135 \nK-4.0 Cl-99 HCO3-24 AnGap-16\n___ 06:44AM BLOOD Glucose-195* UreaN-22* Creat-1.2* Na-131* \nK-3.4 Cl-92* HCO3-26 AnGap-16\n___ 07:10AM BLOOD Glucose-101* UreaN-22* Creat-1.0 Na-132* \nK-4.3 Cl-95* HCO3-27 AnGap-14\n.\n___ 12:52PM BLOOD cTropnT-<0.01\n___ 06:44AM BLOOD cTropnT-<0.01\n.\nCXR ___\nFindings: PA and lateral views of the chest were obtained. The lungs are hyperinflated and severe emphysema is again noted, better seen on CT. There is no consolidation, pleural effusion or pneumothorax. The cardiomediastinal silhouette is stable with aortic arch calcifications.,Osseous structures are intact. No free air is seen below the right hemidiaphragm.\n\n\nFEV1/FVC = 0.42\nFEV1 25%\n" +} \ No newline at end of file diff --git a/Finished/COPD/13227028-DS-14.json b/Finished/COPD/13227028-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..9b8e29b55b8604b593547e1249e06fb5d7935b0f --- /dev/null +++ b/Finished/COPD/13227028-DS-14.json @@ -0,0 +1,38 @@ +{ + "Mild COPD$Intermedia_4": { + "FEV1 \u2265 80% confirm Mild COPD$Cause_1": { + "FEV1 84%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.7 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.60.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "SOB is the common symptom of COPD$Cause_1": { + "Shorntess of breath$Input1": {} + }, + "The patient had been experiencing shortness of breath and cough for five days. These symptoms may indicate that the patient's lung function is impaired and are common symptoms of COPD.$Cause_1": { + "breath and cough x 5 days$Input2": {} + }, + "The patient exhibited symptoms of an upper respiratory tract infection, including sneezing, coughing and white sputum, which are signs of COPD.$Cause_1": { + "URI symptoms sneezing and coughing productive of white sputu$Input2": {} + }, + "Tobacco use is a major risk factor for COPD$Cause_1": { + "used to smoke half a pack a day$Input2": {} + }, + "The patient's father has COPD. This is a symptom directly related to COPD, as COPD can run in families.$Cause_1": { + "Father CHRONIC OBSTRUCTIVE PULMONARY DISEASE$Input4": {} + }, + "The patient's respiratory system has scattered rales and wheezing. Rales are common in increased tracheal and bronchial secretions, while wheezing is a sign of airway narrowing, both of which are common symptoms of COPD.$Cause_1": { + "diffuse rhonchi and wheezes$Input5": {} + } + } + } + }, + "input1": "Shorntess of breath\n", + "input2": "CC: breath and cough x 5 days\nHPI: presenting with URI symptoms sneezing and coughing productive of white sputum 5 days -. \"It felt like a plug\". No prior diagnosis of COPD or asthma, does not use home O2 or home inhalers. Received an albuterol neb in ambulance for O2 saturation of 88% on RA with improvement. No fever/chills, used to smoke half a pack a day but quit in the, no sick contacts. Endorses whole body myalgias as well.\n\ufeff\n", + "input3": "+ HTN\n+ Hypercholestrolemia\n+ DDD lumbar spine\n+ Diverticulosis\n+ IBS\n+ Alopecia\n+ Osteoarthritis\n+ GI Bleed\n+ Diverticulitis\n+ Osteopenia\n+ RA\n+ Syncope\n+ H/o bronchitis x 5\n+ Multiple joint replacement surgeries b/l shoulder, B/L TKR, L \n+ hip arthroplasty\n+ S/p appendectomy\n+ s/p CCY\n+ C4/C5 cervical spine\n", + "input4": "Mother and uncle with COLON CANCER \nFather CHRONIC OBSTRUCTIVE PULMONARY DISEASE \nSister KNEE SURGERY \nHer son died in a MVA\n", + "input5": "Vitals: T 97.85 P 82 BP 152/79 RR 16 SaO2 97% on RA \nGEN: NAD, comfortable appearing \nHEENT: ncat anicteric MMM \nNECK: supple\nCV: s1s2 rr no m/r/g- distant heart sounds \nRESP: diffuse rhonchi and wheezes\nABD: +bs, soft, NT, ND, no guarding or rebound \nEXTR:no c/c/e 2+pulses \nDERM: no rash \nNEURO: face symmetric speech fluent, she is a very good \nhistorian. \nPSYCH: calm, cooperative\n", + "input6": "02:20PM URINE HOURS-RANDOM UREA N-357 CREAT-59 SODIUM-16 POTASSIUM-18 CHLORIDE-19\n02:20PM URINE HOURS-RANDOM\n02:20PM URINE OSMOLAL-231\n02:20PM URINE GR HOLD-HOLD\n02:20PM URINE COLOR-Yellow APPEAR-Hazy SP\n02:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-7.0 LEUK-TR\n02:20PM URINE RBC-1 WBC-3 BACTERIA-FEW YEAST-NONE \nEPI-0 TRANS EPI-<1\n02:20PM URINE MUCOUS-RARE\n08:05AM GLUCOSE-94 UREA N-8 CREAT-0.5 SODIUM-127* \nPOTASSIUM-3.8 CHLORIDE-91* TOTAL CO2-26 ANION GAP-14\n08:05AM CALCIUM-9.3 PHOSPHATE-3.5 MAGNESIUM-1.7\n08:05AM WBC-6.4 RBC-3.92 HGB-12.6 HCT-36.5 MCV-93 \nMCH-32.1* MCHC-34.5 RDW-12.5 RDWSD-42.3\n08:05AM PLT COUNT-216\n09:30PM OTHER BODY FLUID FluAPCR-NEGATIVE \nFluBPCR-NEGATIVE\n05:13PM LACTATE-1.0 K+-4.6\n05:09PM GLUCOSE-91 UREA N-8 CREAT-0.5 SODIUM-127* \nPOTASSIUM-5.3* CHLORIDE-88* TOTAL CO2-28 ANION GAP-16\n05:09PM estGFR-Using this\n05:09PM CALCIUM-9.1 PHOSPHATE-3.2 MAGNESIUM-2.0\n05:09PM WBC-6.2 RBC-4.12 HGB-13.1 HCT-38.3 MCV-93 \nMCH-31.8# MCHC-34.2 RDW-12.5 RDWSD-42.6\nBASOS-0.5 AbsNeut-3.06 AbsLymp-2.14 AbsMono-0.80 \nAbsEos-0.09 AbsBaso-0.03\n05:09PM PLT COUNT-232\n===========================\nECG: SR at 85 bpm.\n===============\nCXR: Images reviewed by author\nIMPRESSION: \n1. No focal consolidation concerning for pneumonia. \n======================= \n\ufeff\nPost-bronchodilator FEV1/FVC = 0.60.\nFEV1 84%\n" +} \ No newline at end of file diff --git a/Finished/COPD/13892051-DS-9.json b/Finished/COPD/13892051-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..b09b03bc8cebd5fdc1ff71c7fa8931ec5d5b0923 --- /dev/null +++ b/Finished/COPD/13892051-DS-9.json @@ -0,0 +1,38 @@ +{ + "Mild COPD$Intermedia_4": { + "FEV1 \u2265 80% confirm Mild COPD$Cause_1": { + "FEV1 82%$Input6": {} + }, + "COPD$Intermedia_3": { + "confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC < 0.70.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "SOB is the common symptom of COPD$Cause_1": { + "Shortness of breath$Input1": {} + }, + "The text states that the patient has a history of COPD and is a former smoker. Smoking is one of the major risk factors for COPD.$Cause_1": { + "hx of COPD (former smoker$Input2": {} + }, + "The patient had recurrent pleural effusions that required drainage three times per week. Pleural effusions may be caused by lung cancer or other complications and can increase dyspnea in patients with COPD.$Cause_1": { + "pleural effusions drained 3x/week$Input2": {} + }, + "COPD patients may experience low oxygen saturation due to insufficient oxygen exchange due to airway obstruction.$Cause_1": { + "Ambulatory oxygen sat = 91%$Input5": {} + }, + "This is one of the typical symptoms of COPD. Due to decreased lung function, even the slightest activity can cause shortness of breath.$Cause_1": { + "dyspneic with mild \nexertion$Input5": {} + }, + "A pericardial effusion may indicate stress or inflammation in the heart, which may occur with COPD-related heart problems such as cor pulmonale.$Cause_1": { + "a very small pericardial effusion$Input6": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "HPI: \nF pt with hx of COPD (former smoker) and squamous cell non small cell lung cancer, s/p chemo/radiation with no evidence of disease. She has a hx of PE and is on elloquis. No new leg swelling or CP. NO fever. SOB worse with exertion. She gets her pleural effusions drained 3x/week, last drained yesterday. No relief \nwith drainage yesterday (thought pt never has improvement of dyspnea with her drainage).\n.\nIn ER: (Triage Vitals:0 |97.5 |74 |103/56 |22 |96% RA ) \nMeds Given: None\nFluids given: None\nRadiology Studies: CXR\nconsults called: None\n\ufeff\nREVIEW OF SYSTEMS:\nCONSTITUTIONAL: As per HPI and no weight loss\nHEENT: [X] All normal\nRESPIRATORY: [+] per HPI, she is unable to walk more than 5 \nsteps without becoming short of breath, mild cough\nCARDIAC: [X] All normal- denies chest pain \nGI: As per HPI\nGU: [X] All normal\nSKIN: [X] All normal\nMUSCULOSKELETAL: [X] All normal\nNEURO: [X] All normal\nENDOCRINE: [X] All normal\nHEME/LYMPH: [X] All normal\nPSYCH: [X] All normal\nAll other systems negative except as noted above\n", + "input3": "Squamous Cell Lung Cancer as below\nAtrial fibrillation\nPulmonary Embolus\nCORONARY ARTERY DISEASE\nHYPOTHYROIDISM \nHYPERTENSION\nHYPERLIPIDEMIA \nCOLONIC POLYPS \nACTINIC KERATOSIS\nSEBORRHEIC KERATOSIS\n", + "input4": "3 brothers (all smokers) died of lung cancer. Ages at diagnosis uncertain. Mother deceased for heart attack. Father, pneumonia\n", + "input5": "Admission physical exam\nVitals: 98.3 18 97 RA '\nAmbulatory oxygen sat = 91%. She becomes dyspneic with mild \nexertion\n CONS: NAD, comfortable appearing \n HEENT: ncat anicteric MMM \nNo nasal discharge\nLaying flat her JVP does not appear to be elevated. \n CV: s1s2 rr no m/r/g \n RESP: b/l ae no w/c/r \nCatheter site c/d/i\n GI: +bs, soft, NT, ND, no guarding or rebound \n back: \n MSK:no c/c/e 2+pulses \n SKIN: no rash \n NEURO: face symmetric speech fluent \n PSYCH: calm, cooperative \nLAD: No cervical LAD\n", + "input6": "05:18AM BLOOD WBC-14.5*# RBC-4.25 Hgb-11.9 Hct-37.8 MCV-89 MCH-28.0 MCHC-31.5* RDW-17.1* RDWSD-55.6* \n05:18AM BLOOD Glucose-130* UreaN-14 Creat-0.7 Na-139 K-3.7 Cl-100 HCO3-28 AnGap-15\n\ufeff\nEcho\nEcho: The left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>65%).\nRegional left ventricular wall motion is normal. There is no ventricular septal defect. Right ventricular chamber size is normal with borderline normal free wall function. The diameters of aorta at the sinus, ascending and arch levels are normal. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. Moderate to severe [3+] eccentric tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is a very small pericardial effusion. There are no echocardiographic signs of tamponade. \n\ufeff\nIMPRESSION: Normal global left ventricular systolic function. Low normal global right ventricular systolic function. Moderate pulmonary hypertension. Moderate to severe tricuspid regurgitation. Very small pericardial effusion without 2D echo evidence of tamponade. \n\ufeff\nCompared with the prior study (images reviewed) a very small pericardial effusion is seen (trivial effusion was present on prior). Definitive right ventricular pressure/volume overload not seen on this study despite higher pulmonary pressures. \n\ufeff\nAnkle xray\nNo acute fracture or dislocation.\n\ufeff\nNo evidence of pulmonary embolism or aortic abnormality. \n2. Stable post treatment changes in the left lung with no evidence for \nprogression of malignancy. \n3. PleurX catheter in situ with decrease in size of the left pleural effusion. \n4. Stable small pericardial effusion.\n\n\nPost-bronchodilator FEV1/FVC < 0.70.\nFEV1 82%\n" +} \ No newline at end of file diff --git a/Finished/COPD/14725771-DS-12.json b/Finished/COPD/14725771-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..69b7d781d9c3b75c4b48b794aa3c37c570f9ce5e --- /dev/null +++ b/Finished/COPD/14725771-DS-12.json @@ -0,0 +1,38 @@ +{ + "Mild COPD$Intermedia_4": { + "FEV1 \u2265 80% confirm Mild COPD$Cause_1": { + "FEV1 82%$Input6": {} + }, + "COPD$Intermedia_3": { + "confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC < 0.70.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Dyspnea is one of the typical symptoms of COPD, indicating that the patient may have limited lung function.$Cause_1": { + "dyspnea$Input2": {} + }, + "Pulmonary edema may indicate that abnormal cardiac function leads to increased pulmonary pressure, which indirectly affects respiratory function, which is related to the clinical manifestations of COPD.$Cause_1": { + "CXR b/l insterstitial and lower lobe alveolar edema$Input2": {} + }, + "Pulmonary hypertension is common in patients with COPD and may be caused by lung disease and hypoxemia.$Cause_1": { + "Pulmonary hypertension$Input3": {} + }, + "Pulmonary embolism can occur in patients with COPD$Cause_1": { + "pulmonary embolism,$Input3": {} + }, + "COPD patients often suffer from hypoxemia and decreased oxygen saturation. Oxygen therapy can improve this condition, indicating that the patient may have respiratory insufficiency.$Cause_1": { + "85%RA --> 91% on 2L NC$Input5": {} + }, + "This is a typical clinical manifestation of COPD, reflecting the presence of airway obstruction and inflammation.$Cause_1": { + "diffuse crackles with some scattered wheezes.$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "Per general medicine admission note, he presented to the ED, brought in by his son, with one day of weakness, difficulty ambulating, loss of balance, left-sided constant chest pressure-like chest discomfort and dyspnea. On arrival to ED there VS 97.8 | 143/63 | 76 | 90% 2L NC, exam reportedly unremarkable. EKG w/ IV block but no ST-T changes. CXR b/l insterstitial and lower lobe alveolar edema. CT head w/o acute cranial process but chronic white matter microvascular changes. Labs significant for normal CBC, Cr 1.2 , TnT 0.01, BNP 94, AST 95, ALT 125, INR 1.8. Pt received IV Lasix and was admitted for further workup. Echo significant for LVEF, hypokinesis of inferior IVS, inf. wall, mid-distal inf.lat. wall. Seen by cardiology who recommended to keep INR therapeutic. Neurology was consulted but no consult note dictated at time of discharge. Considered MRI head but unable given ICD. Requested transfer to BID for neurology evaluation. Per discharge physical exam normal speech, normal mental status, normal strength in 4 extremities but unsteady gait.\n", + "input3": "+ Pulmonary hypertension \n+ CAD: Catheterization (per Atrius record): mild-moderate coronary artery disease, LMCA 20% stenosis, LAD 30% proximal stenosis, 60% mid RCA stenosis \n+ Glaucoma \n+ HFrEF\n+ VT s/p AICD \n+ Atrial fibrillation \n+ T2DM \n+ Vitamin D deficiency \n+ Scoliosis \n+ h/o abnl LFTs \n+ pulmonary embolism, full history unknown \n+ Non-ischemic cardiomyopathy\n", + "input4": "Non contributory\nFrom prior d/c summary:\nNo family history of CAD, DM, CHF or sudden death. Brother with cancer.\n", + "input5": "Vital Signs: 97.8 | 105/49 | 74 | 22 | 85%RA --> 91% on 2L NC \nGeneral: Alert, oriented, no acute distress. Having frequent \nnegative myoclonus in his four extremities. \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL, \nneck supple, JVP difficult to assess, no LAD \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nLungs: Kyphotic chest, diffuse crackles with some scattered wheezes. \nAbdomen: mildly globulous, no collateral circulation, normal bowel sounds, soft, mildly tender diffusely without guarding, no hepatomegaly \nGU: No foley \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nNeuro: Speech is normal. Negative myoclonus as above. Between beats of myoclonus grip and strength are preserved in four extremities. Nor\n", + "input6": "LAB RESULTS ON ADMISSION\n===========\n07:12AM BLOOD WBC-5.2 RBC-4.93 Hgb-15.6 Hct-49.2 MCV-100* MCH-31.6 MCHC-31.7* RDW-14.9 RDWSD-55.3*\n07:35AM BLOOD WBC-4.8 RBC-4.75 Hgb-15.2 Hct-48.7 \nMCV-103* MCH-32.0 MCHC-31.2* RDW-14.8 RDWSD-57.1*\n07:12AM BLOOD Glucose-101* UreaN-22* Creat-1.1 Na-138 \nK-3.9 Cl-94* HCO3-35* AnGap-13\n07:12AM BLOOD ALT-133* AST-127* LD(LDH)-306* AlkPhos-66 \nTotBili-0.7\n07:12AM BLOOD CK-MB-2 cTropnT-<0.01\n07:12AM BLOOD Albumin-3.1* Calcium-8.6 Phos-3.8 Mg-1.9\n07:12AM BLOOD %HbA1c-6.2* eAG-131*\n07:12AM BLOOD HCV Ab-Negative\n07:12AM BLOOD HBsAg-Negative HBsAb-Negative \nHBcAb-Negative HAV Ab-Negative\n07:55AM BLOOD pO2-75* pCO2-70* pH-7.35 \ncalTCO2-40* Base XS-9 Comment-GREEN TOP\n\ufeff\nPERTINENT LAB RESULTS\n======================\n08:21AM BLOOD WBC-4.5 RBC-4.83 Hgb-15.4 Hct-47.0 MCV-97 MCH-31.9 MCHC-32.8 RDW-14.7 RDWSD-53.0* \n08:04AM BLOOD WBC-4.4 RBC-4.62 Hgb-14.8 Hct-45.0 MCV-97 MCH-32.0 MCHC-32.9 RDW-14.7 RDWSD-52.6* \n\ufeff\nPost-bronchodilator FEV1/FVC < 0.70.\nFEV1 82%\n" +} \ No newline at end of file diff --git a/Finished/COPD/14818191-DS-13.json b/Finished/COPD/14818191-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..e19bc208d9e8e6be7c5609e746436697ca8686f4 --- /dev/null +++ b/Finished/COPD/14818191-DS-13.json @@ -0,0 +1,38 @@ +{ + "Mild COPD$Intermedia_4": { + "FEV1 \u2265 80% confirm Mild COPD$Cause_1": { + "FEV1 92%$Input6": {} + }, + "COPD$Intermedia_3": { + "confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC < 0.70.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "SOB is the common symptom of COPD$Cause_1": { + "Shortness of breath$Input1": {} + }, + "Long-term smoking is one of the main risk factors for COPD$Cause_1": { + "current smoker$Input2": {} + }, + "Feeling short of breath is one of the classic symptoms of COPD.$Cause_1": { + "short of breath$Input2": {} + }, + "More than 40 years of smoking history (pack-years are a measure of smoking) reflects a high risk of COPD$Cause_1": { + "40+-pack-year smoking history$Input2": {} + }, + "Smoking may make shortness of breath worse$Cause_1": { + "smoked a cigarette and then felt worse$Input2": {} + }, + "Distinguish breathing problems caused by COPD from possible heart disease, emphasizing that symptoms are more likely to be related to COPD.$Cause_1": { + "No prior cardiac history.$Input2": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "current smoker presenting after feeling short of breath while visiting his wife in the earlier today Patient states that he has a 40+-pack-year smoking history.\nHe does not recall any inciting event, but remembers being in his wife's room and feeling short of breath.He went outside and smoked a cigarette and then felt worse. He presented to the emergency department from there. No cough productive of mucus, no fevers or chills. No chest pain. No prior cardiac history.\n", + "input3": "+ HTN\n", + "input4": "Non contributory\n", + "input5": "General: Alert, oriented, no acute distress \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nLungs: Cmild wheezes, \nSkin: Warm, dry, no rashes or notable lesions. \nNeuro: CNII-XII intact, strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally.\n", + "input6": "02:45AM BLOOD WBC-11.9* RBC-4.99 Hgb-16.6 Hct-48.0 \nMCV-96 MCH-33.3* MCHC-34.6 RDW-15.0 RDWSD-52.8*\n02:45AM BLOOD Glucose-86 UreaN-12 Creat-0.7 Na-145 \nK-4.1 Cl-108 HCO3-19* AnGap-18\n\nPost-bronchodilator FEV1/FVC < 0.70.\nFEV1 92%\n" +} \ No newline at end of file diff --git a/Finished/COPD/14994182-DS-36.json b/Finished/COPD/14994182-DS-36.json new file mode 100644 index 0000000000000000000000000000000000000000..eaec110588b479d8e76df4b2d74959941c34c70e --- /dev/null +++ b/Finished/COPD/14994182-DS-36.json @@ -0,0 +1,32 @@ +{ + "Mild COPD$Intermedia_4": { + "FEV1 \u2265 80% confirm Mild COPD$Cause_1": { + "FEV1 82%$Input6": {} + }, + "COPD$Intermedia_3": { + "confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC < 0.70.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Dyspnea is a common symptom of COPD and is usually caused by limited lung function.$Cause_1": { + "admitted for dyspnea$Input2": {} + }, + "Responding to diuretics suggests that fluid retention may be present, which may be related to COPD-related heart problems.$Cause_1": { + "good response to Lasix$Input2": {} + }, + "Dyspnea at night may indicate a COPD exacerbation$Cause_1": { + "developed \nshortness of breath$Input2": {} + }, + "A dry cough is one of the classic symptoms of COPD, indicating irritation or inflammation of the airways.$Cause_1": { + "nonproductive cough but feel \nlike he can't get it out$Input2": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "During his last admission, he was admitted for dyspnea. He had a good response to Lasix given in the ED. He had a repeat ECHO that showed normal EF. He was started on Lasix 20 mg daily, diuresed 7.5 L. He was ambulating comfortably upondischarge. He also had abdominal pain/left hip pain with associated weakness. XRay and CT scanning did not reveal any acute processes. MRI of the L spine revealed stable post surgical changes. The cause of these symptoms were felt to be muscle strain/arthritic. The previous admission to this he was started on a 14 day prednisone taper and treated with levofloxacin.\nHe felt fine when he was discharged. Yesterday, he went out\nwith his friend, used his O2. Last night, he developed \nshortness of breath. He has a nonproductive cough but feel \nlike he can't get it out. He also reports orthopena, which is new, but no pedal edema. He also reports L-sided chest \npressure, no radiation, not associated with breathing or \nactivity, associated with palpitations. He also reports L sided abdominal/hip pain. No fever. He is currently is on the tail end of his prednisone. \n\n", + "input3": "N/A\n", + "input4": "N/A\n", + "input5": "N/A\n", + "input6": "___ 02:45AM BLOOD WBC-11.9* RBC-4.99 Hgb-16.6 Hct-48.0 \nMCV-96 MCH-33.3* MCHC-34.6 RDW-15.0 RDWSD-52.8* Plt ___\n___ 02:45AM BLOOD Glucose-86 UreaN-12 Creat-0.7 Na-145 \nK-4.1 Cl-108 HCO3-19* AnGap-18\n\nPost-bronchodilator FEV1/FVC < 0.70.\nFEV1 82%\n" +} \ No newline at end of file diff --git a/Finished/COPD/15166831-DS-16.json b/Finished/COPD/15166831-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..5e32e83b9e97a9cb49f3cdec2208ebfb8bf74e3a --- /dev/null +++ b/Finished/COPD/15166831-DS-16.json @@ -0,0 +1,47 @@ +{ + "Moderate COPD$Intermedia_4": { + "50% \u2264 FEV1 < 80% confirm Moderate COPD$Cause_1": { + "FEV1 62%$Input6": {} + }, + "COPD$Intermedia_3": { + "Sinus bradycardia and T wave flattening may indicate cardiac stress, which in patients with COPD may be caused by hypoxemia.$Cause_1": { + "Sinus bradycardia at 59 bpm, normal axis, TW flattening in III$Input6": {} + }, + "confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC < 0.70.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Bronchodilators are commonly used to treat COPD, which is a sign that the patient may have COPD.$Cause_1": { + "Symptoms during that time visit improved with bronchodilators$Input2": {} + }, + "Prednisone is an anti-inflammatory drug that is often used to treat acute exacerbations of COPD, which means that the patient may be in an acute exacerbation state at this time.$Cause_1": { + "discharged on prednisone burst (20mg daily X 4$Input2": {} + }, + "DOE is a classic symptom of COPD and refers to shortness of breath during physical activity.$Cause_1": { + "improvement in SOB but DOE with exertion$Input2": {} + }, + "Reduced exercise tolerance may be related to the decline in lung function caused by COPD.$Cause_1": { + "stress echo was notable for limited exercise tolerance$Input2": {} + }, + "Blood oxygen saturation is lower than normal, indicating that the patient may have respiratory insufficiency, which is common in COPD patients$Cause_1": { + "Ambulatory SaO2 at office was 87% on RA$Input2": {} + }, + "The patient has occasional end-expiratory wheezing, more on the right side than on the left. Common symptoms in patients with COPD include wheezing, especially during expiratory efforts, because air flow is restricted by partial airway obstruction.$Cause_1": { + "rare end \nexpiratory wheeze R>L$Input5": {} + }, + "There is mild indentation edema on both sides. In COPD patients, right heart failure may occur due to increased cardiac load, which can cause lower limb edema. This is a common complication in the late stage of COPD.$Cause_1": { + "1+ pitting edema bilaterally$Input5": {} + }, + "Poor exercise tolerance may be a manifestation of COPD because decreased lung function affects oxygen intake and exercise ability.$Cause_1": { + "Poor exercise tolerance without inducible ischemia at low workload.$Input6": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "with hx of cauda equina syndrome L 2 herniated disc. He notes onset of symptoms after stress echo he believes that he suffered an undiagnosed MI during his stress test. Reports that progress of his symptoms has been slow but steady.\n\ufeff\nSymptoms during that time visit improved with bronchodilators and patient was subsequently discharged on prednisone burst (20mg daily X 4 At PCP, pt reported improvement in SOB but DOE with exertion, most notable. Prior to stress test , he could walk around all day without difficulty. No change in baseline sputum production. Recent stress echo was notable for limited exercise tolerance, no inducible ischemia at low workload. Ambulatory SaO2 at office was 87% on RA. Pt was sent by PCP for further evaluation of persistent DOE and ambulatory hypoxia.\n", + "input3": "+ Cauda equina syndrome s/p decompression surgery\n+ C3-C6 anterior/posterior c-spine fusion\n+ Restless leg syndrome \n+ Hypothyroidism: Graves' disease status post ablation; followed by endocrinologist \n+ Mechanical fall with Type 2 Dens fx managed conservatively \n+ Left hip cyst s/p excision \n+ MRSA sputum positive \n+ Swab-positive influenza\n+ History of upper GI bleed due to duodenal stress ulcers.\n\ufeff\n", + "input4": "Sister died from lung and breast cancer. Denies hx of CAD, lung disease.\n", + "input5": "Admission Physical Exam:\nVS: 97.9, 130/76, 70, 96% RA\nGen: Very pleasant elderly male, sitting up in bed, NAD\nHEENT: PERRL, EOMI, clear oropharynx, anicteric sclera\nNeck: supple, no cervical or supraclavicular adenopathy\nCV: RRR, no m/r/g\nLungs: good air movement throughout, no crackles, rare end \nexpiratory wheeze R>L\nAbd: soft, nontender, nondistended, no rebound or guarding, +BS, no hepatomegaly\nGU: No foley\nExt: WWP, 1+ pitting edema bilaterally\nNeuro: L foot drop, alert and interactive, stands with cane,\ngrossly intact\n", + "input6": "07:07PM D-DIMER-345\n05:15PM GLUCOSE-124* UREA N-18 CREAT-0.7 SODIUM-137 \nPOTASSIUM-4.4 CHLORIDE-102 TOTAL CO2-26 ANION GAP-13\n05:15PM cTropnT-<0.01\n05:15PM proBNP-124\n05:15PM WBC-7.1 RBC-5.39 HGB-15.4 HCT-47.0 MCV-87 \nMCH-28.6 MCHC-32.8 RDW-15.4 RDWSD-48.2*\n05:15PM NEUTS-77.0* LYMPHS-17.8* MONOS-4.7* EOS-0.0* \nBASOS-0.1 AbsNeut-5.46# AbsLymp-1.26 AbsMono-0.33 \nAbsEos-0.00* AbsBaso-0.01\n05:15PM PLT COUNT-190\n\nEKG: Sinus bradycardia at 59 bpm, normal axis, TW flattening in III, no ST segment changes, no Q waves\n\nStress echo: Poor exercise tolerance without inducible ischemia at low workload. Abnormal hemodynamic response to physiologic stress. Normal PA systolic pressure.\n\nCXR: \"Again, there is chronic elevation of the left hemidiaphragm with basilar atelectasis. Bibasilar atelectasis is seen. No large pleural effusion is seen. There is no definite new focal consolidation. Cardiac and mediastinal silhouettes are grossly stable.\n\n\nPost-bronchodilator FEV1/FVC < 0.70.\nFEV1 62%\n" +} \ No newline at end of file diff --git a/Finished/COPD/17187522-DS-41.json b/Finished/COPD/17187522-DS-41.json new file mode 100644 index 0000000000000000000000000000000000000000..2524f6e46cec87c0a84b1b50b0179db6e130158a --- /dev/null +++ b/Finished/COPD/17187522-DS-41.json @@ -0,0 +1,41 @@ +{ + "Severe COPD$Intermedia_4": { + "30% \u2264 FEV1 < 50% confirm Severe COPD$Cause_1": { + "FEV1 42%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.40.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "SOB is the common symptom of COPD$Cause_1": { + "Shortness of Breath$Input1": {} + }, + "Smoking is one of the main risk factors for COPD and can lead to a gradual decline in lung function.$Cause_1": { + "tobacoo use$Input2": {} + }, + "This is a pathological condition that may aggravate breathing difficulties. Tracheal narrowing can affect air circulation and aggravate respiratory symptoms.$Cause_1": { + "tracheal stenosis$Input2": {} + }, + "Chest tightness and shortness of breath are common symptoms of COPD exacerbations$Cause_1": { + "chest tightness and SOB$Input2": {} + }, + "Cough and sputum are classic symptoms of COPD, and white sputum may indicate noninfectious inflammation.$Cause_1": { + "cough with white sputum$Input2": {} + }, + "A person has a history of multiple hospital admissions for COPD exacerbations, which suggests that their COPD may be unstable or poorly managed.$Cause_1": { + "admitted several times for COPD exacerbations$Input2": {} + }, + "Airflow limitation and end-expiratory wheezing are classic symptoms of COPD, indicating airway narrowing and obstruction.$Cause_1": { + "poor air movement with some end-expiratory wheezes, no rales$Input5": {} + } + } + } + }, + "input1": "Shortness of Breath\n", + "input2": "tobacoo use, tracheal stenosis who presents with chest tightness and SOB which started(3 days PTA) and worsened over the course of 3 days. Pt denies fevers or chills, has cough with white sputum. Pt has been admitted several times for COPD exacerbations after tapering prednisone dose. At home, was on liquid prednisolone approximately 30mg dose. He has been on chronic steroids for several years. He has also had a runny nose.\n", + "input3": "+ Anxiety\n+ LLL nodule\n+ S/p cholecystectomy\n+ Partial liver resection\n+ Gastritis\n+ Dysphagia\n", + "input4": "No family hx lung or heart disease.\n", + "input5": "Physical exam: \nVS: T96.4, 149/98, P89, R22, 94% RA\nGen: cushingoid-appearance, appears well, able to carry on \nconversation, NAD\nHEENT: PERRLA, OP clear, neck supple, no JVD, no LAD\nCV: distant heart sounds, RRR, nl s1/s2, no murmur\nPulm: poor air movement with some end-expiratory wheezes, no rales\nAbd: soft, non-tender, non-distended, no masses\nExt: no edema, no clubbing\nNeuro: grossly intact\n", + "input6": "03:50AM BLOOD WBC-10.1 RBC-5.66 Hgb-16.8# Hct-49.5 MCV-87 MCH-29.6 MCHC-33.9 RDW-13.6\n03:50AM BLOOD Glucose-95 UreaN-15 Creat-1.3* Na-140 K-4.4 Cl-103 HCO3-22 AnGap-19\n03:50AM BLOOD WBC-10.1 RBC-5.66 Hgb-16.8# Hct-49.5 MCV-87 MCH-29.6 MCHC-33.9 RDW-13.6\n_05:50AM BLOOD Glucose-125* UreaN-18 Creat-1.1 Na-141 K-3.9 Cl-105 HCO3-25 AnGap-15\n05:50AM BLOOD Neuts-87.1* Lymphs-6.2* Monos-5.3 Eos-0.2 \nBaso-0.0\nRadiology Report CHEST (PA & LAT) Study Date 11:29 AM\n\nPost-bronchodilator FEV1/FVC = 0.40.\nFEV1 42%\n" +} \ No newline at end of file diff --git a/Finished/COPD/17436407-DS-19.json b/Finished/COPD/17436407-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..a55538620b60ed51d23e3af8a0c4e38c1d563bd1 --- /dev/null +++ b/Finished/COPD/17436407-DS-19.json @@ -0,0 +1,38 @@ +{ + "Severe COPD$Intermedia_4": { + "30% \u2264 FEV1 < 50% confirm Severe COPD$Cause_1": { + "FEV1 32%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.38.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Shortness of breath is one of the classic symptoms of COPD and indicates that the patient may have impaired lung function.$Cause_1": { + "short of breath$Input2": {} + }, + "The need to use BiPAP indicates that the patient may have severe dyspnea, which is a common treatment for acute exacerbations of COPD.$Cause_1": { + "requiring non-invasive ventilation.$Input2": {} + }, + "The use of steroids and antibiotics indicates that the patient may have an infectious exacerbation or inflammatory response, which is common in the management of COPD.$Cause_1": { + "steroids, antibiotics$Input2": {} + }, + "Decreased breath sounds bilaterally and mild wheezing at the end of expiration. These are classic symptoms of COPD and indicate airflow limitation.$Cause_1": { + "Decreased breath sounds bilaterally slight end-expiratory wheezes$Input5": {} + }, + "Rales are often related to fluid accumulation or partial airway occlusion, which may occur in patients with COPD.$Cause_1": { + "slight bibasilar crackes also noted$Input5": {} + }, + "The patient required assisted ventilation and high concentrations of oxygen to maintain normal oxygenation levels. This indicates that the patient may have severe respiratory insufficiency, a serious stage in the progression of COPD.$Cause_1": { + "O2: 100% on 50% BiPAP$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "One week prior to admit she thought she had a sinusitis. She made an appointment to see her PCP but started feeling more short of breath and so went to the hospital. She denies fevers, chills, chest pain except for intermittent axillary sharp pain that goes beneath both axilla.\n.\nShe presented to , where initial ABG notable for ABG CTA negative for PE, troponin negative x1. She received steroids, antibiotics and BiPAP placement and sent to because there were no more ICU beds at their facility. \n.\ninitial vitals were: 96.3, 97, 132/67 30 97% on BiPAP. Patient appeared comfortable on BiPAP. Repeat ABG noted to be 7.3/234/47. CXR showed no focal consolidation, flattened diaphragm. She was admitted to the ICU as she was requiring non-invasive ventilation. \n.\nIn the ICU, transfer vitals were: 97, 101, 130/74, 21, 99% \nBiPAP. She was uncomfortable on the BiPAP mask. \n.\nReview of systems: \n(+) Per HPI\n(-) Denies fever, chills, night sweats, recent weight loss or gain. Denies chest pain, chest pressure, palpitations, or \nweakness. Denies nausea, vomiting, diarrhea, constipation, \nabdominal pain. Denies dysuria, frequency, or urgency. Denies arthralgias or myalgias. Denies rashes or skin changes. She does complain of some constipation.\n", + "input3": "+ h/o intubation in ICU\n", + "input4": "Non-contributory\n", + "input5": "Vitals: T: 95.6 BP: 119/65 P: 95 R: 17 O2: 100% on 50% BiPAP\nGeneral: Frail appearing\nHEENT: Sclera anicteric, MMM, oropharynx clear\nNeck: Supple, JVP not elevated, no LAD\nLungs: Decreased breath sounds bilaterally slight end-expiratory wheezes, slight bibasilar crackes also noted, no rhonchi\nCV: RRR no murmurs\nAbdomen: Soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly\nExt: No clubbing, cyanosis; 1+ radial pulses; moves all 4 \nextremities\n", + "input6": "Labs on Admission: \n139 | 90 | 9 \n------------------< 146 \n4.3 | 40 | 0.3 \n\nCa: 9.8 Mg: 1.7 P: 3.3\n\nCBC: 10.5 > 13.1/40.6 < 208\n\nPost-bronchodilator FEV1/FVC = 0.38.\nFEV1 32%\n" +} \ No newline at end of file diff --git a/Finished/COPD/17468815-DS-13.json b/Finished/COPD/17468815-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..54fab87980a63a15f5702f502297c0d481529b9a --- /dev/null +++ b/Finished/COPD/17468815-DS-13.json @@ -0,0 +1,44 @@ +{ + "Severe COPD$Intermedia_4": { + "30% \u2264 FEV1 < 50% confirm Severe COPD$Cause_1": { + "FEV1 45%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.43.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "These symptoms may indicate a limitation in the function of the respiratory system and are similar to the symptoms of COPD.$Cause_1": { + "awakening an hour later with SOB and then a panic attack per the patient (with increased heart rate, SOB but without chest pain)$Input2": {} + }, + "Aspiration pneumonia is caused by food, fluids, vomitus, or other foreign objects entering the lungs, which may worsen symptoms in people with COPD.$Cause_1": { + "discharged from with an aspiration PNA$Input2": {} + }, + "Prednisone is a corticosteroid commonly used for anti-inflammatory and management of acute exacerbations of COPD.$Cause_1": { + "prednisone taper$Input2": {} + }, + "The patient used home oxygen intermittently throughout the day, which indicated that she may have persistent dyspnea requiring additional oxygen support, a common symptom in COPD patients.$Cause_1": { + "intermittently uses home O2 (2L NC)$Input2": {} + }, + "This suggests that there may be a familial genetic factor$Cause_1": { + "sister with COPD$Input4": {} + }, + "These symptoms suggest that the patient may have airway inflammation and airway obstruction, which are typical manifestations of COPD.$Cause_1": { + "Diffuse mid-inspiratory crackles, mild end-expiratory\nwheeze, reduced air movement bilaterally$Input5": {} + }, + "Drumstick-shaped nail beds are often associated with a chronic hypoxic state, which may be due to persistent hypoxemia caused by COPD.$Cause_1": { + "Clubbing in both hands$Input5": {} + }, + "Kyphosis may be associated with long-term dyspnea and chest deformation, which is common in patients with chronic lung disease.$Cause_1": { + "significant\nkyphosis$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "After dinner last night she took her anxiety med (pt unsure of name) and then went to bed ~9pm, awakening an hour later with SOB and then a panic attack per the patient (with increased heart rate, SOB but without chest pain). She went outside to \"get some air\" and came back into her home and used her home O2 and asked her daughter to get EMS with persistent SOB. EMS noted and brought her to the ED. She has recently been discharged from with an aspiration PNA and completed a course of Abx approximately one week ago and is completing a prednisone taper that was extended by. She intermittently uses home O2 (2L NC), approximately usually for the whole day. She notes that since d/c from she has been using more O2. However, no CP, fever, vomiting, diarrhea, dysuria with mild nausea in the ambulance.\n", + "input3": "+ Anxiety\n+ hearing loss s/p multiple b/l ear surgeries\n+ GERD\n+ OA bilaterally s/p L knee repair w/ MRSA infection\n+ SVT\n+ s/p cholecystectomy\n+ easy bruising\n+ s/p tubal ligation\n+ hypothyroid\n+ sleep apnea (needs a repeat sleep study, wasn't able to \ncomplete first one)\n+ migraines\n+ dysphagia\n", + "input4": "Mother with uterine cancer, half-sister with DM, sister with COPD, 2 of her children have asthma.\n", + "input5": "Admission Physical Exam:\nVitals: T:97.8 BP:133/81 P:112 R:20 O2: 96 on 2L\nGeneral: Alert, oriented, no acute distress with significant\nkyphosis\nHEENT: Sclera anicteric, MMM, oropharynx clear\nNeck: supple, JVP not elevated, no LAD\nLungs: Diffuse mid-inspiratory crackles, mild end-expiratory\nwheeze, reduced air movement bilaterally.\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops\nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, loose skin over her belly wearing pants that demonstrate her recent weight loss (much larger than her current size, with a belt).\nGU: no foley\nExt: warm, well perfused, 2+ pulses. Clubbing in both hands, no cyanosis or edema.\n", + "input6": "05:15AM BLOOD WBC-8.9 RBC-4.26 Hgb-11.5* Hct-36.7 \nMCV-86 MCH-26.9* MCHC-31.2 RDW-15.5\n05:15AM BLOOD Neuts-81.1* Lymphs-12.7* Monos-4.6 \nEos-1.2 Baso-0.3\n05:15AM BLOOD Glucose-113* UreaN-14 Creat-1.0 Na-140 \nK-3.6 Cl-102 HCO3-30 AnGap-12\n05:15AM BLOOD cTropnT-<0.01\n05:15AM BLOOD CK-MB-2\n\nPost-bronchodilator FEV1/FVC = 0.43.\nFEV1 45%\n" +} \ No newline at end of file diff --git a/Finished/COPD/17808538-DS-23.json b/Finished/COPD/17808538-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..ba359966119e1843c3b79e1b0d8f79c37c276f32 --- /dev/null +++ b/Finished/COPD/17808538-DS-23.json @@ -0,0 +1,44 @@ +{ + "Severe COPD$Intermedia_4": { + "30% \u2264 FEV1 < 50% confirm Severe COPD$Cause_1": { + "FEV1 42%$Input6": {} + }, + "COPD$Intermedia_3": { + "Use of inhalers is the standard of care for COPD management, indicating that patients had previously been diagnosed and were managing COPD.$Cause_1": { + "taking her inhalers at home$Input2": {} + }, + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.40.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Hypoxemia is a common symptom of COPD. The co-occurrence of hypoxemia with multiple myeloma and polycythemia vera indicates that the patient may have an underlying blood disease, which may aggravate the condition of COPD.$Cause_1": { + "multiple myeloma and polycythemia presents with hypoxia$Input2": {} + }, + "Oxygen saturation below the normal range indicates impaired oxygen exchange in the lungs, which is a typical manifestation of COPD.$Cause_1": { + "low O2 saturations of 91-94%$Input2": {} + }, + "Increased carbon dioxide pressure in the blood usually indicates insufficient respiratory function and is an important sign of COPD progression.$Cause_1": { + "pCO2 of 86$Input2": {} + }, + "Dyspnea after exertion is a common symptom in COPD patients and reflects the limitations of their lung function.$Cause_1": { + "dyspnea on exertion$Input2": {} + }, + "Persistent cough is a common symptom of COPD$Cause_1": { + "Cough is at baseline$Input2": {} + }, + "An oxygen saturation of only 91% on 3 liters of oxygen indicates that the patient may be experiencing inadequate gas exchange, a common symptom of COPD.$Cause_1": { + "O2:91%3L$Input5": {} + }, + "Dispersed wheezing often indicates the presence of airway obstruction or inflammation, which is a typical clinical manifestation of COPD.$Cause_1": { + "scattered wheezing$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "multiple myeloma and polycythemia presents with hypoxia. She had a usual follow up with her oncologist today and was noted to have low O2 saturations of 91-94% in the office. A venous blood gas was sent which resulted after the patient went home, with a pCO2 of 86. Pt reports some dyspnea on exertion for a few weeks, Cough is at baseline, denied CP. She had been taking her inhalers at home with good effect. \n", + "input3": "+ CT-guided biopsy of this mass was consistent with a plasmacytoma. No morphologic evidence of any plasma cells within the bone marrow biopsy. Her only abnormality was an elevated serum free kappa. SPEP and UPEP were normal. \n+ treated with radiation therapy initially completing on \n+ completed second course radiation therapy as the \nsize of her sacral mass did not change considerably. \n+ total of six cycles of treatment with Velcade. \n+ unusual pulmonary infiltrates that were evaluated by Dr. \n+ repeat bone marrow aspirate and biopsy was aplastic related to the radiation therapy to the pelvis. \n+ stem cells were collected with Mozobil and Neupogen due to concerns for cytopenias with high-dose Cytoxan\n", + "input4": "Father deceased in house fire accident. Mother has arthritis, HTN, and fibrocystic breast disease. Two maternal aunts with history of breast cancer, paternal uncle with history of lymphoma.\n", + "input5": "Vitals: T:98.2 BP:130/80 P:97 R:16 O2:91%3L \nPAIN: 2\nGeneral: nad\nEYES: anicteric\nLungs: scattered wheezing\nCV: rrr no m/r/g\nAbdomen: bowel sounds present, soft, nt/nd\nExt: no e/c/c\nSkin: no rash\nNeuro: alert, follows commands\n", + "input6": "07:16PM TYPE-ART PO2-61* PCO2-46* PH-7.43 TOTAL \nCO2-32* BASE XS-4 INTUBATED-NOT INTUBA\n03:30PM UREA N-10 CREAT-0.7 SODIUM-137 POTASSIUM-4.6 \nCHLORIDE-96 TOTAL CO2-32 ANION GAP-14\n03:30PM GLUCOSE-99\n03:30PM ALT(SGPT)-12 AST(SGOT)-20 LD(LDH)-226 ALK \nPHOS-48 TOT BILI-0.2\n03:30PM TOT PROT-7.0 ALBUMIN-4.9 GLOBULIN-2.1 \nCALCIUM-9.6 PHOSPHATE-5.3* MAGNESIUM-2.2\n03:30PM IgG-730 IgA-137 IgM-34*\n03:30PM WBC-7.7 RBC-5.86* HGB-16.7* HCT-50.6* MCV-86 \nMCH-28.4 MCHC-32.9 RDW-12.4\n03:30PM NEUTS-65.0 MONOS-7.4 EOS-2.7 \nBASOS-1.1\n03:30PM PLT COUNT-293\n\nPost-bronchodilator FEV1/FVC = 0.40.\nFEV1 42%\n" +} \ No newline at end of file diff --git a/Finished/COPD/18096479-DS-10.json b/Finished/COPD/18096479-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..d89edc8351fe861ecb59c1e6eb79fec7a505663d --- /dev/null +++ b/Finished/COPD/18096479-DS-10.json @@ -0,0 +1,38 @@ +{ + "Mild COPD$Intermedia_4": { + "80% \u2264 FEV1 confirm Mild COPD$Cause_1": { + "FEV1 85%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.63.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "One of the classic symptoms of COPD is that the patient's breathlessness worsens during activity, to the point where he or she can only walk a few steps on flat ground and cannot walk up a slope or stairs.$Cause_1": { + "dyspnea on exertion has worsened to the point where she can only walk block on level ground and cannot walk more than a few steps up an incline or stairs$Input2": {} + }, + "The patient began noticing symptoms a week ago but acknowledged that they may have come on gradually. The development of COPD is usually slow, with gradual worsening.$Cause_1": { + "noting symptoms one week ago, but admits it may have been a more gradual onset$Input2": {} + }, + "The patient reports mild right-sided chest discomfort that may be exacerbated by coughing. This may be due to chest muscle fatigue caused by the persistent cough caused by COPD.$Cause_1": { + "mild right sided chest discomfort that may be worse with coughing$Input2": {} + }, + "A dry cough is a common symptom of COPD.$Cause_1": { + "increased cough$Input2": {} + }, + "People with COPD may experience progressive dyspnea, especially during physical activity, including speaking.$Cause_1": { + "slightly dyspneic while speaking$Input5": {} + }, + "Chronic scarring or pleural thickening in the left lower lobe may be the result of chronic inflammation or past infection, which is more common in patients with COPD.$Cause_1": { + "chronic scarring or pleural thickening at the left lower lobe$Input6": {} + } + } + } + }, + "input1": "None\n", + "input2": "Patient started noting symptoms one week ago, but admits it may have been a more gradual onset. Her dyspnea on exertion has worsened to the point where she can only walk block on level ground and cannot walk more than a few steps up an incline or stairs. She reports some mild right sided chest discomfort that may be worse with coughing. Denies diaphoresis, palpitations, lightheadedness. She reports some increased cough without any sputum production. denies any fevers or chills or sore throat. No orthopnea, peripheral edema or increased abdominal girth. She cannot assess for PND as she is on nocturnal CPAP, which she restarted a few weeks ago when they started monitoring compliance. denies any recent leg cramps or swelling. No N/V/ab pain.\n", + "input3": "+ Diabetes\n+ Dyslipidemia\n+ Hypertension \n+ anemia \n+ depression \n+ HTN \n+ HLD \n+ DM - diet controlled \n+ GERD \n+ OSA on nocturnal CPAP\n+ s/p CCK, appy, hysterectomy\n", + "input4": "Diabetes and CAD in mother and father, both of whom died in \ntheir. Sister also with diabetes.\n", + "input5": " VS: Wt=97.4kg (214lb) T=99.3 BP=103/69 HR=87 RR=17 O2 sat=96%/RA \nGeneral: well developed, overweight, reclining in bed comfortably. Appeared slightly dyspneic while speaking, but O2 sats remained at 96-97% and HR remained\nHEENT: PERRL, EOMI, scleral anicteric, OP clear, dentures in place\nNeck: supple, JVP 1cm above clavicle at 45 degrees \nCV: RRR, III/VI systolic murmur, radiating to carotids \nLungs: CTAB, no wheezes, rhonchi or crackles \nAbdomen: obese, soft, non-tender, BS present \nExt: 2+ pulses, warm and well perfused, no peripheral edema \nNeuro: AAOx3, CN II-XII intact, strength in BUE and BLE \nSkin: no lesions \nPULSES: 2+ dp and radial bilaterally\n", + "input6": "10:40AM WBC-6.2 RBC-4.05* HGB-11.4* HCT-34.5* MCV-85 \nMCH-28.2 MCHC-33.2 RDW-13.4\n10:40AM NEUTS-70.8* MONOS-5.3 EOS-2.9 \nBASOS-0.4\n10:40AM PLT COUNT-208\n10:40AM GLUCOSE-101* UREA N-22* CREAT-1.2* SODIUM-143 \nPOTASSIUM-4.1 CHLORIDE-105 TOTAL CO2-23 ANION GAP-19\n10:40AM proBNP-947*\n10:40AM cTropnT-<0.01\n12:16PM D-DIMER-369\n05:05AM BLOOD cTropnT-<0.01\n05:05AM BLOOD Glucose-104* UreaN-27* Creat-1.1 Na-141 K-4.2 Cl-102 HCO3-26 AnGap-17\n\nCXR: \nUpright PA and lateral radiographs of the chest. The lungs are normally expanded without focal airspace consolidation. There is chronic scarring or pleural thickening at the left lower lobe. The cardiomediastinal silhouette and hilar contours are normal. There is no pleural effusion or pneumothorax. The costophrenic sulci are sharp. The retrosternal clear space is opacified, but when referring to the next most recent CT of the chest, this represents mediastinal fat. \nIMPRESSION: No evidence of acute cardiopulmonary abnormality.\n\nPost-bronchodilator FEV1/FVC = 0.63.\nFEV1 85%\n" +} \ No newline at end of file diff --git a/Finished/COPD/18591903-DS-16.json b/Finished/COPD/18591903-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..a595155c8ed5fcf64815e6e0e23b957596b5fea7 --- /dev/null +++ b/Finished/COPD/18591903-DS-16.json @@ -0,0 +1,47 @@ +{ + "Severe COPD$Intermedia_4": { + "30% \u2264 FEV1 < 50% confirm Severe COPD$Cause_1": { + "FEV1 45%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.43.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Patients experience worsening dyspnea and chest pain during physical activity, which are typical symptoms of an acute exacerbation of COPD.$Cause_1": { + "worsening shortness of breath and chest pressure with exertion$Input2": {} + }, + "Patients feel that current symptoms are similar to past COPD exacerbations, suggesting that this may be a recurrence of COPD.$Cause_1": { + "feels similar to her previous COPD flare$Input2": {} + }, + "Salbutamol is a commonly used drug for treating acute symptoms of COPD. The patient's symptoms did not improve significantly after using it this time, which may indicate the severity of the disease.$Cause_1": { + "tried an albuterol inhaler for the first time, with little improvement in her symptoms$Input2": {} + }, + "Chronic and recently increased cough, especially worse at night when lying down and with production of thick sputum, is a typical manifestation of COPD symptoms.$Cause_1": { + "increase in her baseline cough over the past 1.5 months, and more acutely over the past 2 weeks$Input2": {} + }, + "Activity-induced dyspnea and reduced exercise capacity are often related to decreased lung function in patients with COPD.$Cause_1": { + "dyspnea on exertion and decreased exercise tolerance.$Input2": {} + }, + "This is a classic symptom of COPD and indicates narrowing of the airways.$Cause_1": { + "diffuse expiratory wheezes$Input5": {} + }, + "Common in COPD patients, due to airway obstruction, expiratory time is increased.$Cause_1": { + "prolonged expiratory phase$Input5": {} + }, + "COPD patients often present with increased respiratory work due to dyspnea.$Cause_1": { + "increased work of breathing$Input5": {} + }, + "Mucus plugging is a common symptom of COPD and reflects the accumulation of secretions within the airways, which can lead to airway obstruction and difficulty breathing.$Cause_1": { + "Mucous plugging in bilateral airways, most substantial in the left upper lobe$Input6": {} + } + } + } + }, + "input1": "None\n", + "input2": "The patient reports that over the past 1.5 months, she \nhas experienced worsening shortness of breath and chest pressure with exertion, which feels similar to her previous COPD flare. when she was hospitalized for an exacerbation while still living. She has never required intubation. She reports that she does not regularly take medications for her COPD, but the day prior to admission, tried an albuterol inhaler for the first time, with little improvement in her symptoms. She also reports that she has experienced an increase in her baseline cough over the past 1.5 months, and more acutely over the past 2 weeks. The cough is worse while supine at night and productive of a non-bloody thick mucus like sputum; she reports some improvement in her cough when sitting up. She also describes dyspnea on exertion and decreased exercise tolerance.\n\nOf note, the patient reports no history of heart disease, but describes that \"the blood supply through the heart is not good\" and has a family history of heart disease. She denies a history of swelling her her legs.\n", + "input3": "+ uterine polypectomy\n+ diabetes\n+ hypertension\n+ cerebral microvascular disease\n", + "input4": "Heart Disease: mother, sister, brother\nPulmonary Disease: mother\n", + "input5": "EXAM ON ADMISSION\nVitals- 97.0 96 128/74 16 94% RA \nGeneral- Alert, oriented, no acute distress \nHEENT- Sclerae anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, mild anterior cervical lymphadenopathy \nLungs- diffuse expiratory wheezes heard in all lung fields with prolonged expiratory phase, increased work of breathing, good air movement, no rhonchi or rales \nCV- RRR, Nl S1/S2, No MRG \nAbdomen- soft, NT/ND bowel sounds present, no rebound tenderness or guarding, no organomegaly \nGU- no foley \nExt- warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nNeuro- motor function grossly normal\n", + "input6": "ADMISSION LABS\n09:19PM CK-MB-1 cTropnT-<0.01\n04:05PM URINE COLOR-Yellow APPEAR-Hazy\n04:05PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0 \nLEUK-MOD\n04:05PM URINE RBC-3* WBC-2 BACTERIA-NONE YEAST-NONE \nEPI-2\n04:05PM URINE AMORPH-FEW\n04:05PM URINE MUCOUS-OCC\n12:31PM LACTATE-1.7\n12:15PM GLUCOSE-112* UREA N-20 CREAT-0.5 SODIUM-138 \nPOTASSIUM-3.2* CHLORIDE-103 TOTAL CO2-26 ANION GAP-12\n12:15PM estGFR-Using this\n12:15PM WBC-5.5 RBC-4.59 HGB-13.5 HCT-39.6 MCV-86 \nMCH-29.4 MCHC-34.1 RDW-12.4 RDWSD-38.1\n12:15PM NEUTS-59.3 MONOS-9.9 EOS-1.8 \nBASOS-0.5 AbsNeut-3.25 AbsLymp-1.55 AbsMono-0.54 \nAbsEos-0.10 AbsBaso-0.03\n12:15PM PLT COUNT-220\n\nIMAGING STUDIES:\nTTE Impression:\nThe left atrium is normal in size. 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 aortic regurgitation is seen. \nThe mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\nCTA Chest:\nIMPRESSION: \n \n1. No evidence of pulmonary embolism or acute aortic \nabnormality. No pleural effusions. \n2. Mucous plugging in bilateral airways, most substantial in the left upper lobe. No evidence of lobar collapse on the \ncurrent study. \n3. Left lower lobe opacities with mild adjacent \nbronchial wall thickening, a nonspecific finding that can be seen in the setting of micro-aspiration or atypical infection. \n4. 8 x 10 mm left lower lobe pulmonary nodule with somewhat\nspiculated margins, suspicious for malignancy. \n5. Mediastinal lymphadenopathy, most prominent in the hilar and subcarinal stations, suggesting underlying systemic process.\n\nPost-bronchodilator FEV1/FVC = 0.43.\nFEV1 45%\n" +} \ No newline at end of file diff --git a/Finished/COPD/18656167-DS-64.json b/Finished/COPD/18656167-DS-64.json new file mode 100644 index 0000000000000000000000000000000000000000..935eaa11deafdde9af373edf1856ee81e5185f36 --- /dev/null +++ b/Finished/COPD/18656167-DS-64.json @@ -0,0 +1,44 @@ +{ + "Severe COPD$Intermedia_4": { + "30% \u2264 FEV1 < 50% confirm Severe COPD$Cause_1": { + "FEV1 45%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.43.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "dyspnea is a common symptom of COPD$Cause_1": { + "dyspnea$Input1": {} + }, + "Nonproductive cough is one of the common symptoms of COPD.$Cause_1": { + "non-productive cough$Input2": {} + }, + "Pleuritic chest pain may be caused by inflammation or infection of the lungs and is common in people with COPD.$Cause_1": { + "pleuritic chest pain$Input2": {} + }, + "Fever may be a sign of a lung infection or an acute exacerbation of COPD.$Cause_1": { + "fevers$Input2": {} + }, + "Past COPD exacerbations can suggest that current symptoms may be related to COPD$Cause_1": { + "N/V are similar to previous COPD exacerbations$Input2": {} + }, + "Lung pain when taking a deep breath may be associated with COPD, especially during an acute exacerbation.$Cause_1": { + "pain in his lungs when he takes a deep breath.$Input2": {} + }, + "HIV is a virus that affects the immune system and may be involved in the pathogenesis of COPD, as HIV-infected individuals have a weakened immune system and are more susceptible to lung infections and chronic respiratory diseases.$Cause_1": { + "HIV$Input3": {} + }, + "PCP is an opportunistic infection that can seriously affect lung function and may lead to chronic respiratory problems such as COPD.$Cause_1": { + "PCP$Input3": {} + } + } + } + }, + "input1": "dyspnea\n", + "input2": "Pt reports sx began 3 days ago and have been getting progressively worse. Also with non-productive cough, pleuritic chest pain, fevers (Tm yesterday), and mild nausea with some vomiting. These sx, including N/V are similar to previous COPD exacerbations. Denies sick contacts, medication changes or abdominal pain.In ED CXR without evidence of PNA. Pt given duonebs x3. Steroids were not given due to history of steroid induced psychosis. Also given percocet, azithromycin and zofran.\n\nOn arrival to the floor pt reports pain in his lungs when he takes a deep breath.\n\nROS: +as above, otherwise reviewed and negative\n", + "input3": "+ HIV\n+ OIs:\n+ PCP\n+ Thrush\n+ MSSA abscess/cellulitis- multiple\n+ Otitis Externa\n+ Polysubstance abuse\n+ Chronic cervical polyradiculopathy\n+ Generalized axonal polyneuropathy\n+ Spinal Stenosis\n+ DJD\n+ Asthma\n+ BPH\n+ Epididymorchitis\n+ Varicoceles\n+ Cataract\n+ Depression\n+ Nephrolithiasis s/p cystoscopy\n+ Celiac artery stenosis \n+ s/p L carpal tunnel release\n", + "input4": "- Father: brain cancer \n- Mother: lung cancer \n- Brother: diabetes type 2 \n- Brother: died of drug overdose\n", + "input5": "None\n", + "input6": "04:07PM GLUCOSE-94 UREA N-12 CREAT-0.8 SODIUM-139 POTASSIUM-4.7 CHLORIDE-104 TOTAL CO2-27 ANION GAP-13\n04:11PM LACTATE-1.4\n04:07PM cTropnT-<0.01\n04:07PM WBC-5.9 RBC-3.97* HGB-14.7 HCT-46.0 MCV-116* \nMCH-37.0* MCHC-31.9 RDW-14.5\n04:07PM NEUTS-58.3 MONOS-8.7 EOS-1.1 BASOS-1.0\n04:07PM PLT COUNT-180\n\nCXR IMPRESSION: No acute cardiopulmonary abnormality. Near \ncomplete resolution of previously seen bibasilar pneumonia with only trace opacity seen, likely chronic sequela.\n\nPost-bronchodilator FEV1/FVC = 0.43.\nFEV1 45%\n" +} \ No newline at end of file diff --git a/Finished/COPD/18735835-DS-15.json b/Finished/COPD/18735835-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..63959baf1e7a1883421edbbaa0f09ca5148bc580 --- /dev/null +++ b/Finished/COPD/18735835-DS-15.json @@ -0,0 +1,29 @@ +{ + "Moderate COPD$Intermedia_4": { + "50% \u2264 FEV1 < 80% confirm Moderate COPD$Cause_1": { + "FEV1 75%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.63.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "SOB that worsens with activity is a common symptom of COPD$Cause_1": { + "SOB with walking$Input2": {} + }, + "Decreased oxygen saturation, especially during activity, is a key sign of COPD.$Cause_1": { + "desat on ambulation to 69% on RA$Input2": {} + }, + "Supplemental oxygen is a common treatment for acute exacerbations of COPD.$Cause_1": { + "put on 2L NC, and after rest with supplemental O2$Input2": {} + } + } + } + }, + "input1": "None\n", + "input2": "Patient reports he was feeling well at baseline when he presented to clinic appointment with Dr. Reports baseline SOB with walking, but reports that he is able to walk even a mile without stopping. Recently completed pulmonary rehab and did a 6-minute walk test, without any reported desaturation per patient. \n\nAt clinic, he was found to desat on ambulation to 69% on RA, with associated nausea. Chart reports concurrent SOB though patient denies this. He was put on 2L NC, and after rest with supplemental O2, HR 70 with O2 sat 96% so he was taken off NC. He reports having some LLE ankle pain for the past several days thought due to gout. No pain in calf or thigh.\n\nReview of Partners records show: goal weight is 174-176 lbs.\nPatient reports dry weight to be 175 lbs, which he is at \ncurrently.\n", + "input3": "+ Chronic atrial fibrillation,\n+ HFpEF \n+ Chronic back pain on norco\n+ Ruptured AAA s/p\n+ Non small cell lung cancer s/p lobectomy \n+ PVD s/p multiple stent placements, \n+ HTN \n+ HLD \n+ CKD \n+ Acute appendicitis S/P appendectomy \n+ Gout \n+ hemoptysis\n", + "input4": "Sister: Lung cancer sisters died of lung cancer)\nMother: stroke\n", + "input5": "ADMISSION PHYSCIAL EXAMINATION:\n===============================\n\nVITALS: 97.6PO 127 / 76 69 18 93 Ra \nGENERAL: AOx3, NAD \nHEENT: Normocephalic, atraumatic. Pupils equal, round, and reactive bilaterally, extraocular muscles intact. Sclera anicteric and without injection. Dry MM, wearing dentures. \nNECK: supple, JVP at clavicle at 45 deg\nCARDIAC: irregularly irregular, Audible S1 and S2. No murmurs appreciated. \nLUNGS: CTAB, no wheezing or rhonchi, no increased work of breathing.\nABDOMEN: Normal bowels sounds, non distended, soft, non-tender to deep palpation in all four quadrants. No organomegaly.EXTREMITIES: DP pulses bl. L ankle without obvious deformities, no erythema, no tenderness. \nSKIN: No rashes noted. \nNEUROLOGIC: A&Ox3, fluent speech, moving all extremities with purpose, no facial droop\n", + "input6": "ADMISSION LABS:\n===============\n\n06:10PM BLOOD WBC-8.8 RBC-4.77 Hgb-15.2 Hct-45.6 MCV-96 \nMCH-31.9 MCHC-33.3 RDW-14.3 RDWSD-49.9*\n06:10PM BLOOD Glucose-94 UreaN-27* Creat-1.3* Na-143 \nK-4.2 Cl-98 HCO3-30 AnGap-15\n06:10PM BLOOD proBNP-1549*\n06:10PM BLOOD cTropnT-<0.01\n\nPost-bronchodilator FEV1/FVC = 0.63.\nFEV1 75%\n" +} \ No newline at end of file diff --git a/Finished/COPD/18923313-DS-6.json b/Finished/COPD/18923313-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..70abb6841d0f281934b6dabd87390337953e878c --- /dev/null +++ b/Finished/COPD/18923313-DS-6.json @@ -0,0 +1,47 @@ +{ + "Severe COPD$Intermedia_4": { + "30% \u2264 FEV1 < 50% confirm Severe COPD$Cause_1": { + "FEV1 45%$Input6": {} + }, + "COPD$Intermedia_3": { + "FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation. It is a criteria of COPD$Cause_1": { + "Post-bronchodilator FEV1/FVC = 0.43.$Input6": {} + }, + "Suspected COPD$Intermedia_2": { + "Dyspnea is a common symptom of COPD$Cause_1": { + "Dyspnea$Input1": {} + }, + "Shortness of breath that worsens with activity is one of the classic symptoms of COPD.$Cause_1": { + "worsening dyspnea with exertion$Input2": {} + }, + "Chronic cough with white sputum is a common symptom of COPD$Cause_1": { + "chronic cough productive of white phlegm$Input2": {} + }, + "A short-acting bronchodilator (albuterol) was used but was ineffective, suggesting that persistent airway obstruction may exist.$Cause_1": { + "uses albuterol infrequently (once per week), which he does not feel improves his symptoms.$Input2": {} + }, + "Roflumilast is a drug used to treat COPD. Symptoms worsened after discontinuation of the drug, suggesting the possibility of a diagnosis of COPD.$Cause_1": { + "stopped six weeks later$Input2": {} + }, + "Prolonged expiratory phase and poor airflow are common symptoms of COPD. People with COPD often have difficulty breathing, especially when they exhale.$Cause_1": { + "prolonged expiratory phase, poor air movement$Input5": {} + }, + "Oxygen saturation was low (90% on 2 L nasal cannula oxygen; 81% on room air). This indicates that the patient's blood oxygen level was significantly lower than normal without oxygen assistance, probably due to poor oxygenation caused by COPD.$Cause_1": { + "90%2L NC (81%RA)$Input5": {} + }, + "Extremely severe centrilobular emphysema, a classic feature of COPD, indicates alveolar destruction and airflow limitation.$Cause_1": { + "extremely severe centrilobular emphysema$Input6": {} + }, + "There is secretion in the middle part of the trachea, which may be caused by increased airway secretions or poor discharge in COPD patients.$Cause_1": { + "Secretions within the mid trachea$Input6": {} + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "He reports that over the past several months he has had worsening dyspnea with exertion. He denies symptoms at rest. He is able to walk a little less than a grocery store aisle before having to stop. He has a chronic cough productive of white phlegm that has not increased or changed consistency. He uses albuterol infrequently (once per week), which he does not feel improves his symptoms. He denies fever, chills, night sweats although does endorse a 15 pound weight loss over that time. He attributes his symptoms to the roflumilast he was startd on but stopped six weeks later due to fatigue. \n\nHe also reports increased urinary frequency, dribbling for \nseveral months. Has been on Flomax in past but this stopped \naround same time symptoms started. On exam with PCP earlier in he was found to have abdominal distension. Had abdominal \nU/S had bladder distension extending to the level of the \numbilicus w/ 700cc post-void. He was referred to urology and was seen in clinic today where he reported dysuria, frequency, and incomplete emptying of bladder. He was bladder scanned and found to have 900cc urine. He was referred to ED given dyspnea. \n\n", + "input3": "+ CAD, MI\n+ BPH\n+ Urinary retention\n+ Hypertension\n+ Hyperlididemia\n+ GERD\n+ OA\n", + "input4": "Mother: Died AMI\nFather: Died , unsure of cause\nBrother: Died AMI\nBrother: schizophrenia\nSister: Died, unsure of cause\n", + "input5": "VS - 96.9 170/99 50 20 90%2L NC (81%RA) \nGENERAL - Caucasiane male, speaking in full sentences \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM\nNECK - supple, no JVD\nLUNGS - unlabored respiration, prolonged expiratory phase, poor air movement, no wheezes \nHEART - S1, S2 regular rhythm, normal rate S4\nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n \nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength throughout, sensation grossly intact throughout, steady gait\n", + "input6": "TTE: \nThe left atrium is normal in size. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. There is mild regional left ventricular systolic dysfunction with basal inferior/inferoseptal hypokinesis. Overall left ventricular systolic function is normal (LVEF>55%). \nThe right ventricular cavity is mildly dilated with borderline normal free wall function. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Physiologic mitral regurgitation is seen (within normal limits). The tricuspid valve leaflets are mildly thickened. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. Compared with the report of the prior study (images unavailable for review) of, findings are similar. \n.\nCTA CHEST: \n1. No pulmonary embolism or acute aortic syndrome.\n2. No pneumonia, though findings of acute bronchitis in the \nbilateral lowerlobes.\n3. Slightly increased mediastinal adenopathy, likely secondary tosuperimposed acute infection.\n4. Stable coronary atherosclerotic calcifications.\n5. Secretions within the mid trachea. Previously described \nasymmetric superior tracheal thickening is no longer apparent.\n6. Unchanged extremely severe centrilobular emphysema.\n\nPost-bronchodilator FEV1/FVC = 0.43.\nFEV1 45%\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Arrhythmogenic Right Ventricular Cardiomyopathy/16683512-DS-14.json b/Finished/Cardiomyopathy/Arrhythmogenic Right Ventricular Cardiomyopathy/16683512-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..97900bbc3e9e8acfc27d16d59433dd92a52caa48 --- /dev/null +++ b/Finished/Cardiomyopathy/Arrhythmogenic Right Ventricular Cardiomyopathy/16683512-DS-14.json @@ -0,0 +1,30 @@ +{ + "Arrhythmogenic Right Ventricular Cardiomyopathy$Intermedia_3": { + "sustained VT is a symptom of Arrhythmogenic Right Ventricular Cardiomyopathy$Cause_1": { + "She underwent VT ablation but subsequently VT recurred. She had two hospital visits for sustained VT$Input2": {} + }, + "CMR changes can be a sign of Arrhythmogenic Right Ventricular Cardiomyopathy \u3002$Cause_1": { + "mildly increased RV cavity size with moderate systolic dysfunction and severe HK of the mid, distal and apical free wall.$Input3": {} + }, + "ECG change like May reveal signs of abnormal rhythms or ventricular enlargement can be sigh of Arrhythmogenic Right Ventricular Cardiomyopathy \u3002$Intermedia_1": { + "ECG: \n left ventricular enlargement.$Input6": {} + }, + "Echocardiogram changes can be sign of Arrhythmogenic Right Ventricular Cardiomyopathy$Cause_1": { + "Echocardiogram: Demonstrates enlargement of the left ventricle or both ventricles and reduced contractile function.$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "palpitations is a symptom of Cardiomyopath$Cause_1": { + "palpitations$Input1": {} + }, + "palpitations is a symptom of Cardiomyopath.$Cause_1": { + "Today, she was sitting in a friend's room when she noted palpitations. This persisted for approximately 2 hrs, prompting her to present to the ED. She converted in the ED waiting room.$Input2": {} + } + } + }, + "input1": "palpitations\n", + "input2": "She is on sotalol, who presents with episdoes of palpitations: She underwent VT ablation but subsequently VT recurred. She had two hospital visits for sustained VT. She reports that the first episode was in early. She had an episode of VT lasting 2 hrs which was hemodynamically tolerated. She was given lidocaine IV and then converted. She was started on sotalol 120mg BID. The second episode was one week later, lasting about 1 hr, then self-terminated. Her sotalol was increased to 160mg po BID and she had no further episodes. Today, she was sitting in a friend's room when she noted palpitations. This persisted for approximately 2 hrs, prompting her to present to the ED. She converted in the ED waiting room. She denies chest pain, shortness of breath, and lightheadedness with the rhythm. \n \nIn the ED, initial vitals were: 98.0 140 141/87 16 100% RA \n-Labs were notable for: normal labs, K 3.9, Mg 1.8 \n-Pt was given: 1L IVF, potassium 40meq, mg 2g \n-She was evaluted by cardiology in the ED. Plan is for sotalol washout and then transition to amiodarone. Vitals prior to transfer: 98.1 125 139/82 15 99% RA She again went into VT at 21:37. Upon arrival to the floor, she is still in VT at a rate of 130s-140s. She endorses continued palpitations but no other symptoms.\n", + "input3": "+sustained VT \n+CMR: mildly increased RV cavity size with moderate systolic dysfunction and severe HK of the mid, distal and apical free wall. There was prominent trabeculation of these segments. The LV size and systolic function were normal Genetic testing: positive for PKP2 gene mutation (also present in father, aunt, uncle and cousin)\n", + "input4": "None\n", + "input5": "ADMISSION\nVitals: 98.8 119/58 136 16 97% on RA \nTelemetry: sustained VT \nGeneral: pleasant young woman, smiling, in no distress \nHEENT: MMM, EOMI, oropharynx normal \nNeck: hyperdynamic circulation with pulsations visible at clavicle. JVP is not elevated. \nChest: left chest with ICD in place, no surrounding tenderness or erythema \nCV: tachycardic, regular, no murmurs \nLungs: ctab \nAbdomen: soft, nontender, nondistended \nGU: no foley \nExtr: warm, well perfused, no peripheral edema or cyanosis \nNeuro: CN2-12 intact, normal gait, ___ strength throughout, no focal deficits, A&Ox3 \nSkin: no rash\n", + "input6": "ADMISSION\n___ 07:45PM BLOOD WBC-7.3 RBC-4.89 Hgb-14.1 Hct-41.9 MCV-86 MCH-28.8 MCHC-33.7 RDW-12.8 RDWSD-39.7 Plt ___\n___ 07:45PM BLOOD Neuts-54.8 ___ Monos-8.9 Eos-2.7 Baso-0.4 Im ___ AbsNeut-4.01 AbsLymp-2.42 AbsMono-0.65 AbsEos-0.20AbsBaso-0.03\n___ 07:45PM BLOOD ___ PTT-32.7 ___\n___ 07:45PM BLOOD Glucose-118* UreaN-12 Creat-0.9 Na-140 K-3.9 Cl-103 HCO3-25 AnGap-16\n___ 07:45PM BLOOD ALT-18 AST-27 AlkPhos-57 TotBili-0.8\n___ 07:45PM BLOOD Calcium-9.8 Phos-3.0 Mg-1.8\n___ 07:45PM BLOOD TSH-2.6\n___ 07:45PM BLOOD Lactate-1.2\n___ 09:00PM URINE Color-Straw Appear-Clear Sp ___\n___ 09:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG\n___ 09:00PM URINE UCG-NEG\n\nECG: \n left ventricular enlargement.\n\nEchocardiogram: Demonstrates enlargement of the left ventricle or both ventricles and reduced contractile function.\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Dilated Cardiomyopathy/13216060-DS-9.json b/Finished/Cardiomyopathy/Dilated Cardiomyopathy/13216060-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..b997a038fdb682cb55cdc8b51cf948cb8ea715d8 --- /dev/null +++ b/Finished/Cardiomyopathy/Dilated Cardiomyopathy/13216060-DS-9.json @@ -0,0 +1,39 @@ +{ + "Dilated Cardiomyopathy$Intermedia_3": { + "Specific values include increased Left Ventricular End-Diastolic Diameter (LVEDD) and a Left Ventricular Ejection Fraction (LVEF) below the normal range (<50%). is a sign of Dilated Cardiomyopathy$Cause_1": { + "Globally depression cardiac function with normal perfusion consistent with cardiomyopathy. LVEF 33%$Input6": {} + }, + "ECG changes May reveal signs of abnormal rhythms or ventricular enlargement.$Cause_1": { + ": NSR at 80bpm, normal axis, QTc minimally prolonged, TWI in III, aVR, <1cm ST depressions in III, III, aVF, <1cm ST elevations in I, aVL, V6$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "Chest pain is a symptom of Cardiomyopath$Cause_1": { + "Chest pain$Input1": {} + }, + "Fatigue and weakness, Shortness of breath, Swelling of the legs and ankles, Arrhythmias, Chest pain, etc are symptoms of Cardiomyopath$Cause_1": { + "Pt reports vague history of developing diffuse dull chest pain while walking, which then became sharp at times and lasted 4 hours. Symptoms were associated with shortness of breath, diaphoresis, mild nausea, radiation of pain to jaw and numbness of both hands.$Input2": {} + }, + "history of a prior MI is a risk fact of Cardiomyopath$Cause_1": { + "and also gives a vague history of a prior MI,$Input2": {} + }, + "occasional episodes is a sign of Cardiomyopath$Cause_1": { + "Patient also reports occasional episodes of feeling his heart racing, which occasionally causes him to become dizzy with diaphoresis, occasional chest pressure, and occasional loss of consciousness.$Input2": {} + }, + "Hypertension is the risk fact for Cardiomyopath$Cause_1": { + "Hypertension$Input3": {} + }, + "history of coronary artery disease is the risk fact for Cardiomyopath$Cause_1": { + "history of coronary artery disease$Input3": {} + }, + "history of traumatic head injury is the risk fact for Cardiomyopath$Cause_1": { + "history of traumatic head injury.$Input3": {} + } + } + }, + "input1": "Chest pain\n", + "input2": "She presented with chest pain of 1 days duration. Pt reports vague history of developing diffuse dull chest pain while walking, which then became sharp at times and lasted 4 hours. Symptoms were associated with shortness of breath, diaphoresis, mild nausea, radiation of pain to jaw and numbness of both hands. However, in the ED patient denied shortness of breath. Patient reports he typically takes SL nitro at home for this type of chest pain with resolution of pain, but did not have nitro with him during this episode. He sat down, but pain was not relieved by rest. Chest pain resolved when he was given Nitro in the ED. \n\nPt reports occasional episodes of similar chest pain, and also gives a vague history of a prior MI, does not remember where he was seen for this. He reports there was \"talk of a stent\" but this was ultimately not placed because \"there was no need.\" He reports having two stress tests in the past, and believes they were normal but cannot remember where he had the stress tests.\n\nPatient also reports occasional episodes of feeling his heart racing, which occasionally causes him to become dizzy with diaphoresis, occasional chest pressure, and occasional loss of consciousness. Denies incontinence with these episodes, denies confusion/disorientation upon waking, but does report he had \"seizures\" as a child. Patient reports months ago, he fell while walking (from tripping in a pot hole) and hit his chest, causing pain in his sternum, which he attributes to a \"healing fracture or chip\".\n\nOf note, patient was very distracted during interview with poor attention. He also fell asleep several times during the interview, and upon being awoken reported he has not slept for several days because he \"cannot fall asleep\" and attributes confusion to this.\n\nIn the ED, initial vs were: T98.4 HR 77 BP 112/80 R16 97% RA. Strange affect noted. CT head negative, CXR unremarkable. First set CEs negative, EKG showed TWIs as described below. Patient was given ASA but refused this, refused KCl repletion. Felt not to be a good obs candidate and was admitted to medicine.\n\nOn the floor, patient reported continued chest pain but continued to give a vague, somewhat inconsistent history.\n\nReview of sytems: \nDenies fever, chills, night sweats. Denied cough, recent palpitations. Denied vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias other than his \"typical\" pain.\n", + "input3": "+Hypertension\n+history of traumatic head injury.\n+history of coronary artery disease\n+prior MI\n", + "input4": "Reports family members had lung cancer, uterine cancer, gallbladder cancer.\n", + "input5": "Vitals: T: 96.1 BP: 140/82 P: 80 R: 22 PO2: 96%RA\nGeneral: Alert, oriented, unkept in appearance, no acute distress \nHEENT: PERRL at 1-1.5mm, sclera anicteric, MMM, oropharynx clear\nNeck: Supple, JVP not elevated, no LAD \nCV: Regular rate and rhythm, normal S1/S2, no murmurs, rubs, gallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi \nAbdomen: Soft, non-distended, bowel sounds present, minimally tender to palpation at LLQ without rebound or guarding, no organomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nNeuro: Strength in UE and sensation intact to light touch, CN II-XII intact though pt had difficulty following instructions.\nPsych: Rapid pressured speech, tangential thinking but redirectable, poor attention, paranoid speech and behavior (drew shade of window because he felt the workers were spying on him, also reports a doctor had \"punched a hole\" in his ear in the past and was trying to intentionally harm him), denies visual or auditory hallucinations. Reports not sleeping for the past several days, but vague when asked why - denies excessive spending, increased energy, periods of low energy and depressed mood.\n", + "input6": "___ 11:03a \nCK: 220 MB: 6 Trop-T: <0.01 \nCa: 9.0 Mg: 2.2 P: 3.4\nALT: 17 AP: 53 Tbili: 1.6 Alb: \nAST: 16 LDH: 175 Dbili: TProt: \nTSH:Pnd \n___ 04:05a \nTrop-T: <0.01 CK: 266 MB: 8 \n145 109 16 AGap=15 \n------------- 100 \n3.2 24 0.8 \nSerum ASA, EtOH, Acetmnphn, Benzo, Barb, Tricyc Negative \n 12.9\n6.4 ------ 210 \n 38.5 \nN:56.4 L:35.3 M:5.3 E:1.9 Bas:1.1 \n\n\nImages/Studies: \n\nStress ___ - No anginal symptoms or ischemic ST segment changes. Nuclear report sent separately. Globally depression cardiac function with normal perfusion consistent with cardiomyopathy. LVEF 33% \n\nCXR ___ - No acute cardiopulmonary process.\n\nCT head ___ - No acute intracranial process. Hypodensity in the centrum semiovale measuring 5 mm may represent a prior lacunar infarct or a perivascular space. There is focal mucosal thickening of the left maxillary sinus. \n\nEKG: NSR at 80bpm, normal axis, QTc minimally prolonged, TWI in III, aVR, <1cm ST depressions in III, III, aVF, <1cm ST elevations in I, aVL, V6.\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Dilated Cardiomyopathy/17369619-DS-15.json b/Finished/Cardiomyopathy/Dilated Cardiomyopathy/17369619-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..6107144dab1428070b8fe75cdd64c690772225e9 --- /dev/null +++ b/Finished/Cardiomyopathy/Dilated Cardiomyopathy/17369619-DS-15.json @@ -0,0 +1,30 @@ +{ + "Dilated Cardiomyopathy$Intermedia_3": { + "ECG: May reveal signs of abnormal rhythms or ventricular enlargement. This can be a sign of Dilated Cardiomyopathy$Cause_1": { + "In his PCP's office he was found to be tachy to 112 and EKG reportedly showed flipped T in I, aVL, V6, and possible Q wave in II and aVR.$Input2": {} + }, + "abnormal rhythms OF ECG can be a sign of Dilated Cardiomyopathy$Cause_1": { + "ECG: sinus tach @ 109, slightly low voltage, nml intervals, Suggestion of \"P-mitral\" p-wave in I and II, Q in III and aVF, J point elevation in V2 and V3, TWI in aVL. No comparison available.$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "DOE is a symptom of Cardiomyopath$Cause_1": { + "DOE$Input1": {} + }, + "Shortness of breath and DOE are symptoms of Cardiomyopath$Cause_1": { + "Pt was in his USOH until 2 weeks prior when he began to have difficulty sleeping due to waking up after sleeping for ~30 minute with shortness of breath and coughing. He attempted to sleep propped up with pillows, but he continued to wake up with dyspnea. During this time he also noted DOE$Input2": {} + }, + "borderline HTN is the risk fact for Cardiomyopath$Cause_1": { + "History of borderline HTN$Input3": {} + }, + "family history of diabetes and heart disease is a risk factor$Cause_1": { + "diabetes and heart disease in a maternal grandfather,$Input4": {} + } + } + }, + "input1": "DOE\n", + "input2": "He is with pmh of borderline htn presenting with complaint of new PND and DOE. Pt was in his USOH until 2 weeks prior when he began to have difficulty sleeping due to waking up after sleeping for ~30 minute with shortness of breath and coughing. He attempted to sleep propped up with pillows, but he continued to wake up with dyspnea. During this time he also noted DOE, finding himself dyspneic after walking up only 1 flight of stairs (was able to walk flights before). He denies palpitations, chest pain, lower extremity edema. He notes that he had influenza 6 weeks prior which he recovered from without comlpications. He denies fevers, night sweats, weight loss, joint pains, n/v/d, dysuria. He reports that he lives in a wooded area with ticks, and 1 month earlier found a tick on his right shoulder which he removed at that time. He has noted a perstant 1 cm erythematous rash that is blanching and non-pruritic, but no other rash. \n\nBecause of these symptoms of dyspnea pt went to his PCP. In his PCP's office he was found to be tachy to 112 and EKG reportedly showed flipped T in I, aVL, V6, and possible Q wave in II and aVR. Because of this he was sent to the ED.\n\nED Course: T:97.7, BP:133/87, HR:123, RR:22, O2:99% on RA. Labs were drawn, and D-Dimer was elevated. Chest Xray and CTA were performed (see below). CXR was clear, and CTA was without PE, but did show pulmonary edema. BNP was checked, and was found to be elevated. 1 set of CE were sent, and were negative.\n\nROS: negative, except as noted above\n", + "input3": "+History of borderline HTN\n+Status post tonsillectomy\n+Status post surgery for undescended right testicle\n+Status post arthroscopy\n+Status post Bankart repair of his right shoulder\n+Surgical debridement of foot infection\n", + "input4": "Family history significant for diabetes and heart disease in a maternal grandfather, breast cancer in an aunt, lung cancer in a paternal grandfather, and depression in an aunt. In addition, his paternal grandfather had a stroke.\n", + "input5": "VS: T:98.7, BP:110/80, HR:109, RR:18, O2:96RA \nGEN:mid aged man in NAD with wife at bedside, EOMI, MMM, OP clear\nNECK:supple, no lad, JVP not elevated\nCHEST: Crackles at bil bases, no wheeze\nCV: nml s1 s2, tachy regular, no m/r/g\nABD:soft, nt nd, no hsm\nEXT: no edema. No clubing or cyanosis\nNEURO: A+Ox3, grossly intact\nSkin: 1 cm erythematous blanching macule on the posterior right shoulder.\n", + "input6": "___ 07:40PM CK-MB-NotDone cTropnT-<0.01\n___ 07:40PM CK(CPK)-97\n___ 03:58PM URINE HOURS-RANDOM\n___ 03:58PM URINE GR HOLD-HOLD\n___ 03:58PM URINE COLOR-Yellow APPEAR-Clear SP ___- \n___ 03:58PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG\n___ 11:08AM CK(CPK)-112\n___ 11:08AM cTropnT-<0.01\n___ 11:08AM CK-MB-3 proBNP-1717*\n___ 11:08AM TSH-1.9\n___ 11:08AM WBC-11.8*# RBC-5.18 HGB-14.7 HCT-43.1 MCV-83 MCH-28.4 MCHC-34.1 RDW-13.9\n___ 11:08AM NEUTS-78.7* LYMPHS-16.4* MONOS-3.3 EOS-1.3 BASOS-0.4\n___ 11:08AM PLT COUNT-286\n___ 11:08AM ___ PTT-30.1 ___\n___ 11:08AM D-DIMER-675*\n\nECG: sinus tach @ 109, slightly low voltage, nml intervals, Suggestion of \"P-mitral\" p-wave in I and II, Q in III and aVF, J point elevation in V2 and V3, TWI in aVL. No comparison available.\n\nStudies: \nCHEST (PA & LAT) Study Date of 10:52 AM The lungs are clear. There is no pleural effusion or pneumothorax. Cardiomediastinal silhouette and pulmonary vasculature are within normal limits. The osseous structures are grossly unremarkable. \nIMPRESSION: No acute cardiopulmonary process. \n\nCTA Chest Prelim read:\nNo PE, Bilateral ground glass opacities and fluffly alveolar opacities.\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Dilated Cardiomyopathy/17519144-DS-15.json b/Finished/Cardiomyopathy/Dilated Cardiomyopathy/17519144-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..3dabcf60d73dbc65a0ad5ae2140a5963bb9f9cc1 --- /dev/null +++ b/Finished/Cardiomyopathy/Dilated Cardiomyopathy/17519144-DS-15.json @@ -0,0 +1,45 @@ +{ + "Dilated Cardiomyopathy$Intermedia_3": { + "Chronic systolic is the risk fact for Cardiomyopathy$Cause_1": { + "Chronic systolic$Input3": {} + }, + "abnormal rhythms of ECG can be a sign of Dilated Cardiomyopath$Cause_1": { + "CV: RRR, normal S1 and S2, +S3, ___ systolic murmur at apex, dressing over pacemaker site$Input5": {} + }, + "(LVEF<20 %) is a sign of Dilated Cardiomyopath$Cause_1": { + "The left ventricular cavity is dilated. Overall left ventricular systolic function is severely depressed (LVEF<20 %).$Input6": {} + }, + "reduced contractile function is a sign of Dilated Cardiomyopath$Cause_1": { + "The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion.$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "BiV pacemaker implantation is a risk fact of Cardiomyopathy$Cause_1": { + "BiV pacemaker implantation$Input1": {} + }, + "history of non-ischemic dilated cardiomyopathy is a risk fact.$Cause_1": { + "65 yo female with history of non-ischemic dilated cardiomyopathy with EF 20%, LBBB, and recent admission for heart failure exacerbation presented for BiV pacer implantation.$Input2": {} + }, + "dyspnea is a sign of Cardiomyopathy$Cause_1": { + "She reports having several months of progressive dyspnea and palpitations with minimal exertion (several feet). She was admitted for dyspnea.$Input2": {} + }, + "Nonischemic dilated CMP is the risk fact for Cardiomyopathy$Cause_1": { + "Nonischemic dilated CMP$Input3": {} + }, + "heart failure (EF 20%) is a sign for Dilated Cardiomyopath$Cause_1": { + "heart failure (EF 20%)$Input3": {} + }, + "Left bundle branch block is the risk fact for Cardiomyopathy$Cause_1": { + "Left bundle branch block$Input3": {} + }, + "family history of cardiomyopathy is a risk factor$Cause_1": { + "Brother had cardiomyopathy and died,$Input4": {} + } + } + }, + "input1": "BiV pacemaker implantation\n", + "input2": "65 yo female with history of non-ischemic dilated cardiomyopathy with EF 20%, LBBB, and recent admission for heart failure exacerbation presented for BiV pacer implantation. \n\nShe reports having several months of progressive dyspnea and palpitations with minimal exertion (several feet). She was admitted for dyspnea. Cardiac catheterization revealed clean coronaries. She was started on metoprolol, lisinopril, lasix, and symptoms improved. Course was further complicated by C. diff infection, for which she was started on PO flagyl (currently on PO vanc). Upon discharge she was readmitted at the ___ for a recurrent episode of congestive heart failure, which promptly resolved with diuresis, and was discharged back to rehab. She reports being quite ambulatory at ___, walking about 200 feet without symptoms. Endorses a productive cough of clear sputum. Denies PND, orthopnea. \n\nOn she underwent an implantation of a BiV pacer. The procedure was without complication, but after the procedure, she was hypotensive to and was started on phenylephrine 1mcg/kg/hr, and weaned down to 0.4mcg/kg/hr upon arrival to the ICU. \n\nUpon arrival to the CCU, T 98.0, HR 82, BP 99/58 (67), 99% RA, RR 18. Patient is alert, oriented, comfortable except for mild discomfort at the site of the BiV pacer. Denies shortness of breath, chest pain, palpitations, or leg edema. States she is thirsty.\n", + "input3": "+Nonischemic dilated CMP\n+Chronic systolic \n+heart failure (EF 20%)\n+Left bundle branch block \n+h/o C diff (s/p treatment with PO flagyl, currently on PO vanc)\n+H/o gastric ulcers\n+Hysterectomy\n+R wrist fracture\n+R hip fracture\n+Hemorrhoids\n", + "input4": "Brother had cardiomyopathy and died, unclear etiology. Otherwise no history of early cardiac death or MI\n", + "input5": "ADMISSION PHYSICAL EXAM\nVS: T 98.0, HR 82, BP 99/58 (67), 99% RA, RR 18 \nGeneral: A+Ox3, NAD \nHEENT: PERRL, EOMI, dry MM, normal oropharynx \nNeck: no JVP \nCV: RRR, normal S1 and S2, +S3, ___ systolic murmur at apex, dressing over pacemaker site \nLungs: clear anteriorly \nAbdomen: soft nontender, normal bowels ounds \nExt: trace to 1+ pitting edema bilateral lower extremities \nNeuro: CNII-XII grossly intact, moving extremities spontaneously \n\nSkin: warm to touch \nPULSES: 2+ ___ pulses\n", + "input6": "ADMISSION LABS\n\n___ 11:45AM BLOOD WBC-4.4 RBC-3.55* Hgb-11.7* Hct-32.3* MCV-91 MCH-33.1* MCHC-36.4* RDW-13.8 Plt ___\n___ 11:45AM BLOOD ___ PTT-29.6 ___\n___ 11:45AM BLOOD Glucose-117* UreaN-16 Creat-1.2* Na-141 K-3.1* Cl-101 HCO3-28 AnGap-15\n___ 08:45PM BLOOD Calcium-8.7 Phos-4.4# Mg-1.8\n\n==============\nIMAGING\n==============\nTTE ___\nFOCUSED STUDY/LIMITED VIEWS: The left ventricular cavity is dilated. Overall left ventricular systolic function is severely depressed (LVEF<20 %). with normal free wall contractility. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. There is a trivial/physiologic pericardial effusion. \n\nCompared with the prior study (images reviewed), the comparable findings are similar. \n\nCXR ___ \n \nINDICATION: Biventricular pacemaker placement. Rule out pneumothorax. \n \nCOMPARISON: Chest radiograph. \n \nAs compared to the previous radiograph, there is now status post placement of a biventricular pacemaker. The leads terminate in the right atrium, right ventricle and coronary sinus. There is no evidence of a pneumothorax. \n\nCXR ___\nCHEST RADIOGRAPH. \n \nINDICATION: Status post biventricular pacemaker, confirm lead position. \n \nCOMPARISON: Portable chest radiograph. \n \nFINDINGS: As compared to the previous radiograph, the leads are unchanged in position. No evidence of lead fracture or complications. Better seen on the lateral radiograph are bilateral pleural effusions that are not evident on the frontal film. Borderline size of the cardiac silhouette without pulmonary edema. No pneumothorax.\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Dilated Cardiomyopathy/18065146-DS-8.json b/Finished/Cardiomyopathy/Dilated Cardiomyopathy/18065146-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..801551f0e1f460fefe4b60ab344b3ae9daeb7e57 --- /dev/null +++ b/Finished/Cardiomyopathy/Dilated Cardiomyopathy/18065146-DS-8.json @@ -0,0 +1,39 @@ +{ + "Dilated Cardiomyopathy$Intermedia_3": { + "abnormal rhythms of ECG can be a sign of Dilated Cardiomyopath$Cause_1": { + "CV: tachy, reg rhythm, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.$Input5": {} + }, + "Mild-to-moderate cardiomegaly can be a sign of Dilated Cardiomyopath$Cause_1": { + "Mild-to-moderate cardiomegaly.$Input6": {} + }, + "Abnormal rhythms of ECG can be a sign of Dilated Cardiomyopath$Cause_1": { + "Left ventricular hypertrophy with secondary repolarization abnormalities.$Input6": {} + }, + "LVEF = 20 % ios a sign of Dilated Cardiomyopath$Cause_1": { + "There is severe global left ventricular hypokinesis (LVEF = 20 %).$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "Shortness of breath is a sign of Cardiomyopathy$Cause_1": { + "Shortness of breath$Input1": {} + }, + "PMH and HTN are risk facts of Cardiomyopathy$Cause_1": { + "70 yo male with PMH of recently diagnosed asthma, HTN presents with shortness of breath for the last 12 weeks.$Input2": {} + }, + "a sign of Cardiomyopathy$Cause_1": { + "He experiences SOB x/ day while at work. The SOB is occasionally associated with gasping and pressure at the xiphoid progress.$Input2": {} + }, + "CXR and ECG changes can be a sign of Cardiomyopathy$Cause_1": { + "CXR revealed cardiomegaly; ECG showed a strain pattern.$Input2": {} + }, + "family history of hypertension is a risk factor$Cause_1": { + "His mother has hypertension and his father died of prostate cancer.$Input4": {} + } + } + }, + "input1": "Shortness of breath\n", + "input2": "70 yo male with PMH of recently diagnosed asthma, HTN presents with shortness of breath for the last 12 weeks. He has episodes of SOB approximately every 30 minutes while in his apartment, which he relates to mold exposure. He experiences SOB x/ day while at work. The SOB is occasionally associated with gasping and pressure at the xiphoid progress. He experiences orthopnea but not DOE or PND. His PCP treated him with inhalers without relief. He was then given a 3 week course of corticosteroids which ended 2 days ago. \n\nTwo days ago, he reports increased frequency of SOB and new cough. His cough has been mostly non-productive but he did have a few episodes of pink-tinged sputum. He also experienced severe bilateral pedal edema 2 days ago which is now resolved. \n\nIn the ED, In the ED initial vitals were: 7 98.9 ___ 20 100. CXR revealed cardiomegaly; ECG showed a strain pattern. Patient was given albuterol/ipratroprium nebs, aspirin 81mg x4, and azithromycin 500mg. His shortness of breath slightly improved after the neb treatment. A CXR was down which shows cardiomegaly and right lower lobe hazy opacity.\n\nROS: Negative for recent fevers, chills or rigors, dyspnea on exertion, paroxysmal nocturnal dyspnea, palpitations, syncope or presyncope.\n", + "input3": "+Hypertension\n+Asthma \n+Pneumothorax\n+ADD\n", + "input4": "There is no family history of premature coronary artery disease, diabetes or sudden death. His mother has hypertension and his father died of prostate cancer.\n", + "input5": "VS: T: 98.1, BP: 139/100, P: 99, RR: 16, 92-100% on RA\nGen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. \nNeck: Supple, no JVD. \nCV: tachy, reg rhythm, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, sparse expiratory wheezes\nAbd: Soft, NTND. No HSM or tenderness. \nExt: trace edema over bilateral , radial and DP pulses 2+ bilaterally\n", + "input6": "___ 06:50PM BLOOD HIV Ab-NEGATIVE\n___ 07:05AM BLOOD CRP-9.8*\n___ 07:20AM BLOOD ANCA-NEGATIVE B\n___ 05:00AM BLOOD TSH-1.7\n___ 07:20AM BLOOD %HbA1c-6.7* eAG-146*\n___ 07:20AM BLOOD calTIBC-351 Ferritn-17* TRF-270\n___ 07:20AM BLOOD Albumin-3.5 Calcium-8.8 Phos-4.4 Mg-2.1 Iron-36*\n___ 05:00AM BLOOD proBNP-6310*\n___ 05:00AM BLOOD cTropnT-<0.01\n___ 06:50PM BLOOD CK-MB-4 cTropnT-<0.01\n___ 07:20AM BLOOD ALT-36 AST-22 LD(LDH)-203 AlkPhos-72 TotBili-0.7\n___ 05:00AM BLOOD Glucose-144* UreaN-17 Creat-1.5* Na-139 K-3.7 Cl-104 HCO3-26 AnGap-13\n___ 07:05AM BLOOD Glucose-105* UreaN-13 Creat-1.4* Na-141 K-4.1 Cl-104 HCO3-30 AnGap-11\n___ 05:00AM BLOOD ___ PTT-26.5 ___\n___ 05:00AM BLOOD Neuts-62.7 ___ Monos-6.1 Eos-6.9* Baso-0.5\n___ 07:20AM BLOOD Neuts-58.3 ___ Monos-6.3 Eos-8.2* Baso-0.3\n___ 07:05AM BLOOD Neuts-56.3 ___ Monos-8.0 Eos-7.6* Baso-0.3\n___ 05:00AM BLOOD WBC-6.9 RBC-4.73 Hgb-11.8* Hct-37.6* MCV-80* MCH-25.0* MCHC-31.4 RDW-16.2* \n___ 07:05AM BLOOD WBC-5.8 RBC-4.55* Hgb-11.7* Hct-35.8* MCV-79* MCH-25.7* MCHC-32.6 RDW-16.0*\n\nCXR ___: \n1. Right lower lobe hazy opacity, could represent early pneumonia. \n2. Mild-to-moderate cardiomegaly. \n\nECG: ___: \nLeft ventricular hypertrophy with secondary repolarization abnormalities. \n\nECHO ___:\nThe left atrium is moderately dilated. The right atrium is moderately dilated. The estimated right atrial pressure is ___ mmHg. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity is moderately dilated.There is severe global left ventricular hypokinesis (LVEF = 20 %). Systolic function of apical segments is relatively preserved and there is no apical aneurysm. No masses or thrombi are seen in the left ventricle. Right ventricular chamber size is mildly incresaed with severe global free wall hypokinesis. The aortic root is moderately dilated at the sinus level. The ascending aorta is moderately dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. There is at least mild pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. \n\nIMPRESSION: Biventricular cavity enlargement and global hypokinesis c/w diffuse process (toxin, metabolic, etc. - cannot fully exclude multivessel CAD but appears to be less likely). Pulmonary artery systolic hypertension. Moderate mitral regurgitation. Dilated ascending aorta.\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Hypertrophic Cardiomyopathy/11901665-DS-24.json b/Finished/Cardiomyopathy/Hypertrophic Cardiomyopathy/11901665-DS-24.json new file mode 100644 index 0000000000000000000000000000000000000000..dffbf2c4e65e07be5042b7a36bb6a6a95970d802 --- /dev/null +++ b/Finished/Cardiomyopathy/Hypertrophic Cardiomyopathy/11901665-DS-24.json @@ -0,0 +1,33 @@ +{ + "Hypertrophic Cardiomyopathy$Intermedia_3": { + "Abnormal rhythms of ECG can be a sign ofHypertrophic Cardiomyopathy$Cause_1": { + "EKG: Terminal T-wave inversion V2, 2mm STD V3 new from prior, persistent STD V4-V6, inferior leads; STE aVR consistent with prior$Input2": {} + }, + "Echocardiogram: Increased thickness of the myocardial wall (typically >15mm) can be diagnosised as Hypertrophic Cardiomyopathy$Cause_1": { + "Echocardiogram: \nIncreased thickness of the myocardial wall (18mm)$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "Chest Pain/L arm Pain is a sign of Cardiomyopathy$Cause_1": { + "Chest Pain/L arm Pain$Input1": {} + }, + "history of congestive heart failure and cheat pain are risk facts of Cardiomyopathy$Cause_1": { + "She is a 60 female with a history of congestive heart failure with preserved EF, atypical chest pain who presents for the evaluation of 1 day of waxing and waning, constant, sharp left-sided chest pain radiating to her neck and her left shoulder.$Input2": {} + }, + "HTN is a risk fact of Cardiomyopathy$Cause_1": { + "She thinks that her blood pressure was high over the days leading up to this admission$Input2": {} + }, + "Obesity with BMI of 46 is the risk fact for Cardiomyopathy$Cause_1": { + "Obesity with BMI of 46$Input3": {} + }, + "Hypothyroidismv is the risk fact for Cardiomyopathy$Cause_1": { + "Hypothyroidism$Input3": {} + } + } + }, + "input1": "Chest Pain/L arm Pain\n", + "input2": "She is a 60 female with a history of congestive heart failure with preserved EF, atypical chest pain who presents for the evaluation of 1 day of waxing and waning, constant, sharp left-sided chest pain radiating to her neck and her left shoulder. Pain began on the morning of presentation, waking her from sleep around 4am. She had episodes of this sharp left-sided pain throughout the day. Pain crescendos over several minutes and then subsides on its own. There is no exertional or pleuritic component. She denies any shortness of breath, cough, fevers, orthopnea, lower extremity edema. She thinks that her blood pressure was high over the days leading up to this admission; home readings were around 160s systolic. She notes 2 days of bifrontal headache without blurry vision or altered mental status or other neurological symptom. \n\nIn the ED initial vitals were: 98 BP 163/100, HR 62, RR 18 98RA \nEKG: Terminal T-wave inversion V2, 2mm STD V3 new from prior, persistent STD V4-V6, inferior leads; STE aVR consistent with prior \nLabs/studies notable for: normal CBC, chemistry panel, Troponin negative x1, UA negative, CXR with No acute cardiopulmonary process. \nPatient was given: PO 1g Acetaminophen, 10 mg IV metoclopramide, PO aspirin 243, carvedilol 3.25mg PO \nCardiology was consulted, recommended admission for BP medication titration. She has had many similar admissions, in past also with SOB with asthma exacerbation along with diastolic dysfunction. \n \nREVIEW OF SYSTEMS: \nPositive per HPI \n+mild frontal headache \nCardiac review of systems is notable for absence dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope, or presyncope.\n", + "input3": "+Hypertension \n+Obesity with BMI of 46 \n+Asthma triggered by URIs \n+Possible obstructive sleep apnea\n+Hypothyroidism\n+Carpal tunnel syndrome, requiring surgery\n+Nephrolithiasis\n+Hysterectomy \n+Upper extremity paresthesias and numbness. \n+Retropubic mid urethral sling procedure\n", + "input4": "Father: Died \"young\" from a brain aneurysm \nMother: Had \"fluid in her lungs\"\n", + "input5": "PHYSICAL EXAMINATION AT ADMISSION: \nVS: T 97.5, bp 158/89, HR 68, RR 18, SPO2 94% on RA. \nGENERAL: Well developed, well nourished woman in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI. Conjunctiva were pink. No pallor or cyanosis of the oral mucosa. No xanthelasma. \nNECK: Supple. JVP of 7 cm. \nCARDIAC: PMI located intercostal space, midclavicular line. Regular rate and rhythm. Normal S1, S2. No murmurs, rubs, or gallops. No thrills or lifts. \nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, non-tender, non-distended. No hepatomegaly. No splenomegaly. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema. \nSKIN: No significant skin lesions or rashes. \nPULSES: Distal pulses palpable and symmetric.\n", + "input6": "___ 04:45PM BLOOD WBC-7.6 RBC-5.03 Hgb-13.8 Hct-42.9 MCV-85 MCH-27.4 MCHC-32.2 RDW-13.1 RDWSD-40.3 Plt ___\n___ 04:45PM BLOOD Neuts-54.8 ___ Monos-5.0 Eos-2.1 Baso-0.7 Im ___ AbsNeut-4.14 AbsLymp-2.80 AbsMono-0.38 AbsEos-0.16 AbsBaso-0.05\n___ 04:45PM BLOOD Glucose-91 UreaN-12 Creat-0.8 Na-142 K-3.9 Cl-104 HCO3-25 AnGap-17\n___ 04:45PM BLOOD cTropnT-<0.01\n___ 10:50PM BLOOD cTropnT-<0.01\n\nEchocardiogram: \nIncreased thickness of the myocardial wall (18mm)\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Hypertrophic Cardiomyopathy/15466684-DS-15.json b/Finished/Cardiomyopathy/Hypertrophic Cardiomyopathy/15466684-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..56f3dd24a150de172b53f9682bfc10b1a70910cb --- /dev/null +++ b/Finished/Cardiomyopathy/Hypertrophic Cardiomyopathy/15466684-DS-15.json @@ -0,0 +1,33 @@ +{ + "Hypertrophic Cardiomyopathy$Intermedia_3": { + "Abnormal rhythms of ECG can be a sign ofHypertrophic Cardiomyopathy$Cause_1": { + "EKG showed: NSR, new LAD. CTA did not show PE. Echo showed sig LVOT obstruction, possibly HOCM. No arrhythmias were noted on telemetry.$Input2": {} + }, + "Echocardiogram: Increased thickness of the myocardial wall(typically >15mm) can be diagnosised as Hypertrophic Cardiomyopathy$Cause_1": { + "There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal.$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "Syncope is a sign of Cardiomyopathy$Cause_1": { + "Syncope$Input1": {} + }, + "hx of dCHF, HTN, CVA are risk facts of Cardiomyopathy$Cause_1": { + "Female with hx of dCHF, HTN, CVA, prior syncopal episode secondary PEs presented with a syncopal epsiode.$Input2": {} + }, + "lower GIB possibly in setting of lovenox treatment to reduce DVT risk perioperatively\n is a risk fact of Cardiomyopathy$Cause_1": { + "+lower GIB possibly in setting of lovenox treatment to reduce DVT risk perioperatively$Input3": {} + }, + "midsystolic murmur in the left sternal border that is louder with valsalva maneuver is sign of Cardiomyopathy$Cause_1": { + "CARDIAC: RRR, S1/S2, midsystolic murmur in the left sternal border that is louder with valsalva maneuver$Input5": {} + }, + "abnormal rhythms of ECG can be a sign ofHypertrophic Cardiomyopathy$Cause_1": { + "ECG :Sinus rhythm with change in the atrial morphology as compared with previous tracing. Prior anteroseptal myocardial infarction. Low precordial lead voltage as previously recorded.$Input6": {} + } + } + }, + "input1": "Syncope\n", + "input2": "Female with hx of dCHF, HTN, CVA, prior syncopal episode secondary PEs presented with a syncopal epsiode. The episode occurred day prior to admission while the patient was cooking breakfast. No prodrome: the patient denied lightheadedness, dizziness, chest pain, palpitations. Had otherwise been feeling well--was eating/drinking well, no dysuria, no fevers, no cp/sob. No recent medication changes, no narcotics/sleep aid usage. \n\nThe patient is on coumadin for previous provoked PEafter r TKR replacement. Last echo showed no significant valvular disease, with LVH and dCHF. \n \nIn the ED, initial vitals were 98.6 74 121/65 19 100% RA . \n\nLabs : WBC 8.8 Hbg 11.4 Hct 35.2 Plt 422\n___: 28.5 PTT: 40.5 INR: 2.7 \n\nEKG showed: NSR, new LAD. CTA did not show PE. Echo showed sig LVOT obstruction, possibly HOCM. No arrhythmias were noted on telemetry.\n", + "input3": "+Hypertension \n+Hyperlipidemia \n+Osteoarthritis \n+s/p ovarian Cancer BSO TAH \n+right knee replacement\n+lower GIB possibly in setting of lovenox treatment to reduce DVT risk perioperatively \n+Bell's palsy \n+Macrocytic anemia\n", + "input4": "NC\n", + "input5": "VS: 98.4 101/46 68 18 99% on RA\nGeneral: frail-looking AA female in NAD\nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, patent nares, MMM, good dentition\nNECK: nontender supple neck, no LAD, JVP 8-9cm\nCARDIAC: RRR, S1/S2, midsystolic murmur in the left sternal border that is louder with valsalva maneuver\nLUNG: mild crackles in the right base\nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly\nEXTREMITIES: 2+ edema up to knees b/l\nPULSES: 1+ DP pulses bilaterally\nNEURO: right sided facial droop, residual right sided weakness\nSKIN: dry\n", + "input6": "___ 05:05PM BLOOD WBC-8.8# RBC-3.38* Hgb-11.4* Hct-35.2* MCV-104* MCH-33.7* MCHC-32.5 RDW-13.6 Plt ___\n___ 06:55PM BLOOD ___ PTT-40.5* ___\n___ 05:05PM BLOOD Glucose-93 UreaN-22* Creat-0.9 Na-128* K-6.2* Cl-94* HCO3-29 AnGap-11\n___ 05:16PM URINE RBC-<1 WBC-1 BACTERIA-NONE YEAST-NONE EPI-<1\n___ 05:16PM URINE HYALINE-2*\n___ 05:16PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.5 LEUK-TR\n___ 05:16PM URINE HOURS-RANDOM UREA N-210 CREAT-20 SODIUM-40 POTASSIUM-25 CHLORIDE-40\n___ 06:20AM BLOOD ___ PTT-35.5 ___\n___ 06:00AM BLOOD ___ PTT-37.9* ___\n___ 06:00AM BLOOD WBC-8.0 RBC-3.07* Hgb-10.1* Hct-31.8* MCV-104* MCH-33.0* MCHC-31.9 RDW-13.6 Plt ___\n___ 06:00AM BLOOD Glucose-82 UreaN-20 Creat-0.8 Na-135 K-4.3 Cl-102 HCO3-27 AnGap-10\n\nECG (___): Sinus rhythm with change in the atrial morphology as compared with previous tracing. Prior anteroseptal myocardial infarction. Low precordial lead voltage as previously recorded. The ST-T wave flattening has improved. The rate has increased. The P-R interval is borderline prolonged. Otherwise, no diagnostic interim change.\n\nCXR (___): IMPRESSION: \n \nNo acute intrathoracic abnormality. Persistent severe degenerative changeswithin visualized right shoulder joint.\n\nCTA Chest with and without contrast (___):\nIMPRESSION: \n \n1. No acute pulmonary embolism.\n2. Enlarged heart with coronary artery calcifications.\n3. Multinodular goiter, seen previously unchanged. Nonemergent ultrasoundcan be performed if clinically indicated.\n\n___: There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. Left ventricular systolic function is hyperdynamic (EF>75%). There is a moderate resting left ventricular outflow tract obstruction \nsuggested. The gradient slightly increased with the Valsalva manuever. The findings are consistent with hypertrophic obstructive cardiomyopathy (HOCM). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. \n\nCompared with the prior study (images reviewed), resting LVOT obstruction is now detected (may haqve been underestimated on prior). Hyperdynamic LV systolic function and heart rate are similar.\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Restrictive Cardiomyopathy/17067683-DS-6.json b/Finished/Cardiomyopathy/Restrictive Cardiomyopathy/17067683-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..716513a5e5ef500114c399adf8524b2348b3fba8 --- /dev/null +++ b/Finished/Cardiomyopathy/Restrictive Cardiomyopathy/17067683-DS-6.json @@ -0,0 +1,33 @@ +{ + "Restrictive Cardiomyopathy$Intermedia_3": { + "abnormal echocardiogram can be a sign of Restrictive Cardiomyopathy$Cause_1": { + "The rhythm was sinus with frequent PVC's, sustained ventricular bigemeny and occasional ventricular couplets all occurring at low levels of exercise and resolved in immediate recovery.$Input6": {} + }, + "An eccentric, posteriorly directed jet (late systolic jet) of mild (1+) mitral regurgitation is seen can be a sign of Restrictive Cardiomyopathy$Cause_1": { + "An eccentric, posteriorly directed jet (late systolic jet) of mild (1+) mitral regurgitation is seen.$Input6": {} + }, + "Cardiac catheterization: Measures intracardiac pressures, showing elevated pressures during mitral inflow, consistent with a typical restrictive filling pattern.$Cause_1": { + "The vessels were ectatic. The LAD had a short intramyocardial segment in the \nmid-vessel which induced a 40% stenosis.$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "dyspnea on exertion is a sign of Cardiomyopathy$Cause_1": { + "dyspnea on exertion$Input1": {} + }, + "history of DOE (baseline can walk many blocks, climb 4 flights of stair), here after a cardiac stress test today showing very limited exercise capacity is a risk fact of Cardiomyopathy$Cause_1": { + "62 year old male with minimal pmh, wit history of DOE (baseline can walk many blocks, climb 4 flights of stair), here after a cardiac stress test today showing very limited exercise capacity and ventricular ectopy induced by exercise.$Input2": {} + }, + "abnormal rhythms of ECG can be a sign of Cardiomyopathy$Cause_1": { + "EKG was noted to be of I, II, V5, V6 has presistent Q-waves,$Input2": {} + }, + "family history is a risk fact of Cardiomyopathy$Cause_1": { + "Mother died from MI$Input4": {} + } + } + }, + "input1": "dyspnea on exertion\n", + "input2": "62 year old male with minimal pmh, wit history of DOE (baseline can walk many blocks, climb 4 flights of stair), here after a cardiac stress test today showing very limited exercise capacity and ventricular ectopy induced by exercise. The test was ordered as part of the evaluation of exertional dyspnea. He does not have prominent coronary disease risk factors but due to the worrisome stress test, he is referred for further evaluation. PCP would like cardiology evaluation in the ED but this was not done (per ED report, cards ). D-dimer was over 800 at PCP, repeat at ED was 500's. \n\nIn the ED, initial vs were: T97.5 53 155/83 18 100% room air. Patient was given aspirin, CTA of chest was negative. R/O'd PE. \n\nOn Floor, patient was stable without chest pain. EKG was noted to be of I, II, V5, V6 has presistent Q-waves, but CE were negative. \n\nReview of systems: \nDenies fever, chills, 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.\n", + "input3": "None\n", + "input4": "Mother died from MI, no early cardiac MI.\n", + "input5": "Vitals: T: 98 BP: 160/89 P: 46 R: 13 O2: 99RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\n", + "input6": "___ 09:51PM cTropnT-<0.01\n___ 03:15PM GLUCOSE-100 K+-4.2\n___ 03:05PM GLUCOSE-102* UREA N-13 CREAT-1.1 SODIUM-140 POTASSIUM-4.2 CHLORIDE-108 TOTAL CO2-25 ANION GAP-11\n___ 03:05PM cTropnT-<0.01\n___ 03:05PM D-DIMER-595*\n___ 03:05PM WBC-6.3 RBC-5.37 HGB-14.9 HCT-43.9 MCV-82 MCH-27.8 MCHC-34.0 RDW-16.0*\n___ 03:05PM NEUTS-53.4 ___ MONOS-5.0 EOS-4.1* BASOS-0.9\n___ 03:05PM PLT COUNT-218\n\nExercise stress test ___:\nThis was a 62 year old man who was referred to the lab for an evaluation of dyspnea with exertion. He exercised for only 2.5 minutes of protocol METs) and requested to stop due to difficulty breathing and an \"uncomfortable feeling\" in his chest. This represents a limited functional capacity for his age. He complained of chest discomfort with breathing at peak exercise, which resolved immediately with rest. There was no significant ST segment changes noted with exercise or recovery. The rhythm was sinus with frequent PVC's, sustained ventricular bigemeny and occasional ventricular couplets all occurring at low levels of exercise and resolved in immediate recovery. There was hypertension at rest with an exaggerated blood pressure response to low level exercise. The heart rate responded appropriately to the level of exercise performed. IMPRESSION: No significant ST segment changes noted. Sudden onset of ventricular ectopy at low workloads accompanied by difficult breathing. Limited functional capacity demonstrated. \n\nTTE ___:\nThe left atrium is mildly dilated. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF 60%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. There are focal calcifications in the aortic arch. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. An eccentric, posteriorly directed jet (late systolic jet) of mild (1+) mitral regurgitation is seen. There is borderline pulmonary artery systolic hypertension. There is no pericardial effusion.\n\nCardiac Catheterization ___:\n1. Selective coronary angiography of this co-dominant system demonstrated no obstructive coronary artery disease. The vessels were ectatic. The LAD had a short intramyocardial segment in the \nmid-vessel which induced a 40% stenosis. \n2. Resting hemodynamics revealed slightly normal left heart filling \npresssures and slightly elevated right heart filling pressures. The RVEDP and LVEDP were equal at 14mmHg. There was mild pulmonary hypertension with diastolic pressures equal to LVEDP and RVEDP. The pattern was consistent with restrictive/constrictive physiology. \n3. The patient was challeneged with 500cc of IVF bolused via the right \natrium. With this the LVEDP increased to 22mmHg and RVEDP to 18mmHg. Right atrial pressure increased to ___ (a/v/mean). \n4. After fluid bolus simultaneous LV and RV pressure tracings demonstrated concordance over the respiratory cycle and with valsalva. There was a dip and plateau morphology to LV filling. These findings are consistent with restrictive physiology.\n" +} \ No newline at end of file diff --git a/Finished/Cardiomyopathy/Restrictive Cardiomyopathy/18108905-DS-2.json b/Finished/Cardiomyopathy/Restrictive Cardiomyopathy/18108905-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..996fd1792b02f29c6e41437c0b23c9b442df89d3 --- /dev/null +++ b/Finished/Cardiomyopathy/Restrictive Cardiomyopathy/18108905-DS-2.json @@ -0,0 +1,48 @@ +{ + "Restrictive Cardiomyopathy$Intermedia_3": { + "Sinus rhythm with ventricular premature contractions. Inferior and lateral ST-T wave abnormalities. can be a sign of Restrictive Cardiomyopathy$Cause_1": { + "___ ECG\n\nSinus rhythm with ventricular premature contractions. Inferior and lateral ST-T wave abnormalities. No previous tracing available for comparison.$Input6": {} + }, + "abnormal echocardiogram can be a sign of Restrictive Cardiomyopathy$Cause_1": { + "Mild symmetric left ventricular hypertrophy with global hypokinesis suggestive of a non-coronary etiology. Mild-moderate mitral regurgitation. Pulmonary artery hypertension. Increased PCWP. Mildly dilated pulmonary artery.$Input6": {} + }, + "Suspected Cardiomyopathy$Intermedia_2": { + "Dyspnea on exertion with troponin elevation to 0.13 is a sign of Cardiomyopathy$Cause_1": { + "Dyspnea on exertion with troponin elevation to 0.13$Input1": {} + }, + "heart failure with echo demonstrating global hypokinesis with LVEF 35% is risk facts and signs of Cardiomyopathy$Cause_1": { + "0 y/o F w/ pmhx of newly diagnosed congestive heart failure with echo demonstrating global hypokinesis with LVEF 35%,$Input2": {} + }, + "dyspenea on exertion, substernal chest pain is a sign of Cardiomyopathy$Cause_1": { + "Per her daughters, she has had intermittent episodes of dyspenea on exertion, substernal chest pain,$Input2": {} + }, + "Hypertension is a risk fact of Cardiomyopathy$Cause_1": { + "Hypertension$Input3": {} + }, + "Systolic heart failure is a risk fact of Cardiomyopathy$Cause_1": { + "Systolic heart failure$Input3": {} + }, + "Dyslipidemia is a risk fact of Cardiomyopathy$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Colonic polyp is a risk fact of Cardiomyopathy$Cause_1": { + "Colonic polyp$Input3": {} + }, + "GERD/Gastritis is a risk fact of Cardiomyopathy$Cause_1": { + "GERD/Gastritis$Input3": {} + }, + "CKD is a risk fact of Cardiomyopathy$Cause_1": { + "CKD$Input3": {} + }, + "Abnormal heart sound can be a sign of Cardiomyopathy$Cause_1": { + "CARDIAC: Split S2, holosystolic murmur, frequent ectopy$Input5": {} + } + } + }, + "input1": "Dyspnea on exertion with troponin elevation to 0.13\n", + "input2": "70 y/o F w/ pmhx of newly diagnosed congestive heart failure with echo demonstrating global hypokinesis with LVEF 35%, gastritis/GERD, and hypertension for years who presents with acute onset dyspnea and intermittent substernal burning in her chest, found to have a troponin elevation to 0.13 and transferred here for diagnostic catheterization. Per her daughters, she has had intermittent episodes of dyspenea on exertion, substernal chest pain, and palpitations that have not responded to omeprazole. No weight gain since her diagnosis of heart failure, no peripheral edema, abdominal swelling, and no decrease in PO intake.\n", + "input3": "+Hypertension \n+Systolic heart failure \n+Dyslipidemia \n+Colonic polyp \n+GERD/Gastritis \n+CKD\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "Admission exam:\nVS: T= 97.7 BP= 140/80 HR= 73 RR= 12 O2 sat= 98% RA \nGENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \nNECK: Supple with JVP of 8 cm. \nCARDIAC: Split S2, holosystolic murmur, frequent ectopy \nLUNGS: Crackles at bases bilaterally . \nABDOMEN: Soft, NTND. + hepatic pulsation \nEXTREMITIES: Trace edema in feet \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: 2+ pulse\n", + "input6": "___ 11:40PM PTT-106.5*\n___ 11:40PM MAGNESIUM-1.9\n___ 11:40PM cTropnT-0.04*\n___ 11:40PM SODIUM-141 POTASSIUM-4.8 CHLORIDE-104\n___ 06:15AM PTT-87.5*\n___ 06:15AM PLT COUNT-188\n___ 06:15AM WBC-6.1 RBC-4.54 HGB-13.0 HCT-38.5 MCV-85 MCH-28.7 MCHC-33.8 RDW-15.6*\n___ 06:15AM TRIGLYCER-84 HDL CHOL-54 CHOL/HDL-3.0 LDL(CALC)-89\n___ 06:15AM CALCIUM-9.3 PHOSPHATE-3.3 MAGNESIUM-1.8 CHOLEST-160\n___ 06:15AM cTropnT-0.04*\n___ 06:15AM TOT BILI-2.1*\n___ 06:15AM estGFR-Using this\n___ 06:15AM GLUCOSE-71 UREA N-18 CREAT-1.3* SODIUM-142 POTASSIUM-3.0* CHLORIDE-105 TOTAL CO2-25 ANION GAP-15\n___ 10:00PM PTT-26.8\n___ 10:00PM GLUCOSE-98 UREA N-16 CREAT-1.2* SODIUM-139 POTASSIUM-3.8 CHLORIDE-105 TOTAL CO2-21* ANION GAP-17\n \n___ ECG\n\nSinus rhythm with ventricular premature contractions. Inferior and lateral ST-T wave abnormalities. No previous tracing available for comparison.\nTRACING #1\n\n___ Echo\n\nIMPRESSION: Mild symmetric left ventricular hypertrophy with global hypokinesis suggestive of a non-coronary etiology. Mild-moderate mitral regurgitation. Pulmonary artery hypertension. Increased PCWP. Mildly dilated pulmonary artery. This constellation of findings is suggestive of an infiltrative process - e.g., amyloid.\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type I Diabetes/12379918-DS-14.json b/Finished/Diabetes/Type I Diabetes/12379918-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..49a7ffdecf2d480325970117eeabb5e20bd8d01e --- /dev/null +++ b/Finished/Diabetes/Type I Diabetes/12379918-DS-14.json @@ -0,0 +1,32 @@ +{ + "Type I Diabetes$Intermedia_4": { + "CA antibodies are positive in most patients with type 1 diabetes$Cause_1": { + "ICA test result is positive$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "BLOOD Glucose-217$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "Hypertension is a symptom of diabetes.$Cause_1": { + "Hypertension$Input3": {} + }, + "Family history is a big risk factor.$Cause_1": { + "- mother - type I diabetes$Input4": {} + }, + "Thinness is a sign of diabetes.$Cause_1": { + "GENERAL: Thin woman$Input5": {} + }, + "Insulin degludec is a long-acting insulin used to treat diabetes. This may suggest that the patient may have diabetes or a condition that requires blood sugar control.$Cause_1": { + "subcutaneous Tresiba FlexTouch U-100 *NF*$Input2": {} + } + } + } + }, + "input1": "Hemoptysis\n", + "input2": "She has history of tracheal esophageal fistula, esophageal atresia, dysmotility, recurrent aspiration pneumonia, hypoplastic left lung, chronic cough, who presents with hemoptysis. \n\ufeff\nPatient reports that the day prior to admission she was in her usual state of health when she coughed up a dark red blood clot while playing mini-golf on vacation. The following day she again coughed up blood - this time around 1 teaspoon of bright red blood. She reports that prior to this she had no cough, shortness of breath, chest pain, fevers or chills. She also reports no nosebleeds, sore throat, nausea or vomiting. This has not happened to her before. She is not lightheaded or dizzy. \n\ufeff\nOn review of records, she was recently seen for a new chronic cough. st was felt that her ACEi and GERD were likely contributing factors. She was switched from Lisinopril to losartan and was started on a PPI twice daily for GERD. She was also noted to have a restrictive pattern of PFTs, thought possibly due to her hypoplastic lung. Patient states that since this visit her cough has improved and she has gone back to once daily omeprazole. \n\ufeff\nIn the ED:\n\ufeff\nInitial vital signs were notable for: T 97.9, HR 98, BP 148/81,RR 18, 100% RA \n\ufeff\nLabs were notable for:\n\ufeff\n- CBC: WBC 8.3, hgb 14.9, plt 167 \n\ufeff\n- Lytes:\n\ufeff\n140 / 102 / 14 AGap=13 \n-------------- 217 \n4.0 \\ 25 \\ 0.7 \n\ufeff\n- coags: ___: 10.9 PTT: 27.9 INR: 1.0 \n\ufeff\nConsults: IP was consulted, recommending CTA chest, evaluation of upper airway at bedside, broad spectrum antibiotics, and NPO at midnight for bronch \n\ufeff\nStudies performed include:\n- CTA chest with no evidence of active intrathoracic contrast extravasation/hemorrhage\n- Bedside evaluation of upper airways was normal \n\ufeff\nPatient was given: \n___ 21:57 subcutaneous Tresiba FlexTouch U-100 *NF* (insulin degludec) \n___ 21:59 IV CefTRIAXone (1 g ordered) \n___ 23:08 IV Azithromycin 500 mg \n\ufeff\nVitals on transfer: T 98.5, HR 66, BP 110/73, RR 18, 96% RA \n\ufeff\nUpon arrival to the floor, patient recounts history as above. Shestates she continues to feel well. \n\ufeff\nROS: Pertinent positives and negatives as noted in the HPI. All other systems were reviewed and are negative. \n\ufeff\n", + "input3": "+ She was born with esophageal atresia with a tracheal fistula that was repaired surgically as a child.\n+ atonic upper esophagus.\n+ Other congenital abnormalities include a hypoplastic left lung and breast, scoliosis and developmental delay among others.\n+ restrictive lung disease due to chest wall abnormalities. \n+ angioedema due to some foods.\n+ Aspiration w/ frequent aspiration pneumonia\n+ Hypothyroidism.\n+ Hypertension.\n", + "input4": "- mother - type I diabetes\n- father - mesothelioma\n- son - asthma, allergies\n- brother - crohns\n- sister - rheumatoid arthritis\n", + "input5": "================\nVITALS: T 98.5, HR 66, BP 110/73, RR 18, 96% RA \nGENERAL: Thin woman, alert and in no acute distress \nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. Oropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur, no S3, no S4. No JVD.\nRESP: Lungs clear to auscultation with good air movement bilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel sounds present. No HSM\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full and symmetric bilaterally in all limbs\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, oriented, face symmetric, gaze conjugate with EOMI, speech fluent, moves all limbs, sensation to light touch grossly intact throughout\nPSYCH: pleasant, appropriate affect\n", + "input6": "Admission Labs:\n================\n___ 04:13PM BLOOD WBC-8.3 RBC-4.98 Hgb-14.9 Hct-45.0 MCV-90 MCH-29.9 MCHC-33.1 RDW-12.8 RDWSD-42.2 \n___ 04:13PM BLOOD Neuts-70.5 Monos-6.3 Eos-0.5* Baso-0.7 AbsNeut-5.86 AbsLymp-1.79 AbsMono-0.52 AbsEos-0.04 AbsBaso-0.06\n___ 04:22PM BLOOD PTT-27.9\n___ 04:13PM BLOOD Glucose-217* UreaN-14 Creat-0.7 Na-140 K-4.0 Cl-102 HCO3-25 AnGap-13\n___ 04:13PM BLOOD Calcium-9.8 Phos-2.9 Mg-1.8\n\ufeff\nMicro:\n=========\nBAL from RUL of lung: Prelim gram stain with 3+ pmns, no microorganisms\n\ufeff\nBronch:\n===============\nNo evidence of old blood in proximal BI likely source RUL. No active bleeding. A bronchial lavage with 90mL of saline performed\n\nAntibody test:\n===============\nICA antibody test result is positive\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type I Diabetes/13839174-DS-21.json b/Finished/Diabetes/Type I Diabetes/13839174-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..904144f226d40cbfa62bc999701a20052accf0fd --- /dev/null +++ b/Finished/Diabetes/Type I Diabetes/13839174-DS-21.json @@ -0,0 +1,23 @@ +{ + "Type I diabetes$Intermedia_4": { + "GADA antibodies are positive in most patients with type I diabetes.$Cause_1": { + "GADA test result is positive$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "BLOOD Glucose-267$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "frequent urination is a symptom of diabetes.$Cause_1": { + "+frequent urination.$Input2": {} + } + } + } + }, + "input1": "fetal deceleration\n", + "input2": "Sent for prolonged monitoring due to 2 min fetal HR deceleration in office today. Pt has been having intermittent contractions, getting worse over last several days. Denies VB or LOF. +AFM.\n +frequent urination.\n", + "input3": "+Labs: A+/Ab-/HBsAg-/RPRNR/RI/HIV-/GBS+urine\n+Screening: LR ERA, Hg electro c/w alpha thal trait\n+FFS: WNL, posterior placenta, GIRL!\n+EFW: 63%ile, AC 90%ile\n+SVD female 6#9\n+G2 current\n+GynHx: ASCUS, HPV pos, colpo nl. chronic BV/yeast. Remote h/o chlamydia.\n", + "input4": "non-contributory\n", + "input5": "None\n", + "input6": "___ 06:11AM BLOOD Hct-22.9*#\n___ 06:29PM BLOOD WBC-13.2* RBC-4.52 Hgb-10.5* Hct-31.6* MCV-70* MCH-23.2* MCHC-33.2 RDW-15.3 RDWSD-37.8\n___ 06:29PM BLOOD Glucose-267* UreaN-10 Creat-0.6 Na-133 K-4.1 Cl-99 HCO3-21* AnGap-17\n___ 06:29PM GADA test result is positive\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type I Diabetes/15131866-DS-6.json b/Finished/Diabetes/Type I Diabetes/15131866-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..3f078c62a308704f6a58d880742cd158528a8c45 --- /dev/null +++ b/Finished/Diabetes/Type I Diabetes/15131866-DS-6.json @@ -0,0 +1,32 @@ +{ + "Type I Diabetes$Intermedia_4": { + "ICA antibodies are positive in most patients with type I diabetes.$Cause_1": { + "ICA test is positive$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal plasma glucose is a diagnostic criteria of diabetes.$Cause_1": { + "BLOOD Glucose-201*$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "Abnormal random plasma glucose is a big risk factor of diabetes.$Cause_1": { + "dashboard Labs significant for: glu 203,$Input2": {} + }, + "Insulin Lispro is a quick-acting insulin used to treat diabetes.This may suggest that the patient may have diabetes or a condition that requires plasma glucose to be controlled.$Cause_1": { + "She then rec'd a dose of SC Lispro 4U$Input2": {} + }, + "Family history is a big risk factor.$Cause_1": { + "sister with type one diabetes$Input4": {} + }, + "GTT is a glucose tolerance test which is uesd to diagnosed diabetes in cases where plasma glucose is higher than normal range but not high enough for a diagnosis of diabetes.$Cause_1": { + "started on insulin gtt$Input2": {} + } + } + } + }, + "input1": "nausea, vomiting, malaise\n", + "input2": "Last night the patient became nauseous, started vomiting, had palpitations and felt dyspneic. She had just eaten some tuna tartare. Noted that her BG was running in 200s, and it typically runs in the 150-180 range. Also endorsed lightheadedness. This brought her to the ED.\n \nIn ED initial VS: 98.2 110 118/69 20 99% RA Exam: not documented in dashboard Labs significant for: glu 203, AG 29, bicarb 12, pH 7.27 initially Patient was given:-2L NS then started on NS at 250 cc/hr (unsure how much fluid in total she rec'd) \n-started on insulin gtt\n-Zofran, Ativan, Toradol for nausea and headache\nImaging notable for: CXR unremarkable\n\ufeff\nShe was seen in the ED and kept in the CDU overnight. \nHer AG closed in the ED, after which her insulin gtt was dc'd. \nPer patient, the plan had been to stop the insulin gtt and have her insulin pump turned back on. However, she went about 4 hours without getting any insulin, and her gap opened back up. She then rec'd a dose of SC Lispro 4U, was restarted on an insulin gtt and admitted to the ICU.\n\ufeff\nVS prior to transfer: 98.4 96 95/56 18 98% RA \n \nOn arrival to the MICU, she is feeling better and reports the Ativan and Toradol have helped her nausea and headache. Still feeling SOB if she stands up. Doesn't feel comfortable eating yet but maybe in a few hours. Does not feel like she has been sick lately. No change in meds, diet or alcohol use. Also having vaginal itching that feels like prior yeast infections.\n\ufeff\nREVIEW OF SYSTEMS: per HPI. otherwise denies chest pain, fever, cough, dysuria\n\ufeff\n", + "input3": "+CARPAL TUNNEL SURGERY\n+RADIUS FACTURE \n+ankle fracture\n", + "input4": "per chart review: \nsister with type one diabetes and papillary thyroid carcinoma\n", + "input5": "Admission PHYSICAL EXAM: \nVITALS: please see Metavision. afebrile, HR 104, BP 99/62, SaO2 100% RA \nGENERAL: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, dry oral mucosa, oropharynx clear \nNECK: supple, JVP not elevated \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, gallops \nABD: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no edema \nSKIN: no significant rash \nNEURO: A&Ox3, no gross focal defects \n\ufeff\n", + "input6": "Admission Labs:\n___ 11:21AM BLOOD WBC-6.1 RBC-4.91 Hgb-14.2 Hct-43.6 MCV-89 MCH-28.9 MCHC-32.6 RDW-13.1 RDWSD-42.5\n___ 11:21AM BLOOD Neuts-81.1* Lymphs-16.1* Monos-2.0* Eos-0.0* Baso-0.5 AbsNeut-4.93 AbsLymp-0.98* AbsMono-0.12* AbsEos-0.00* AbsBaso-0.03\n___ 11:21AM BLOOD Glucose-203* UreaN-19 Creat-0.8 Na-138 K-4.9 Cl-96 HCO3-12* AnGap-30*\n___ 11:21AM BLOOD ALT-13 AST-19 AlkPhos-57 TotBili-0.4\n___ 11:21AM BLOOD Albumin-5.0\n___ 04:48AM BLOOD Calcium-8.2* Phos-2.2* Mg-2.0\n___ 11:32AM BLOOD pO2-68* pCO2-25* pH-7.27* calTCO2-12* Base XS--13 Comment-GREEN TOP \n___ 11:32AM BLOOD Glucose-201* Na-138 K-4.6 Cl-108\n___ 11:32AM BLOOD Hgb-14.9 calcHCT-45 O2 Sat-89\n___ 11:32AM ICA test is positive\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type I Diabetes/17517983-DS-49.json b/Finished/Diabetes/Type I Diabetes/17517983-DS-49.json new file mode 100644 index 0000000000000000000000000000000000000000..0b3494208e911b487fdc54b575182c6e931e7bff --- /dev/null +++ b/Finished/Diabetes/Type I Diabetes/17517983-DS-49.json @@ -0,0 +1,26 @@ +{ + "Type I Diabetes$Intermedia_4": { + "ICA antibodies are positive in most patients with type I diabetes.$Cause_1": { + "ICA-(+)$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal blood gluose is a diagnostic criteria of diabetes.$Cause_1": { + "GLUCOSE-237$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "DKA is a basic symptom.$Cause_1": { + "+/- DKA$Input2": {} + }, + "Family history is a big risk factor.$Cause_1": { + "Her grandmother had diabetes.$Input4": {} + } + } + } + }, + "input1": "Nausea/vomiting\n", + "input2": "Patient is a yo woman with DM1 and frequent admissions for nausea, vomting, and abdominal pain +/- DKA who presents recurrent nausea, vomiting, and abdominal pain. This morning, after she took her medications, within a couple of minutes she became nauseous and vomiting. She has not been able to eat anything all day due to nausea/vomiting. She has no abdominal pain, diarrhea, constipation. She has her chronic back pain. Zofran ODT did not help her. She received NS, dilaudid, zofran, and reglan.\n\ufeff\nIn the ED, initial VS were: 98 104 136/87 18 100%. Labs were notable for no AG. The patient received dilaudid, zofran. \n\ufeff\n", + "input3": "+Previous admissions for nausea/vomiting with h/o esophagitis and with concern for diabetic gastroparesis on metoclopramide \n+Esophagitis / H. Pylori \n+Stage I diabetic nephropathy \n+ Anxiety/panic attacks \n+ Depression \n+Hyperlipidemia \n+S/P MVA - lower back pain since then. Per patient, received oxycodone from her primary provider. \n+Goiter \n+G2P1Ab1, s/p miscarriage in trimester, s/p C-section \n\ufeff\nnot menstruating secondary to being on Depo-Provera \n+Genital Herpes\n", + "input4": "Her grandmother had diabetes.\n", + "input5": "Vitals: 97.8, 130/84, 82, 20, 100RA\nGen: vomiting during history, AOX3 \nHEENT: MMM, sclera anicteric, not injected \nNeck: no LAD, no JVD Cardiovascular: tachycardic, regular rhythm, no murmurs appreciated \nRespiratory: Clear to auscultation bilaterally, no wheezes, rales or rhonchi \nAbd: normoactive bowel sounds, soft, non-tender, non distended \nExtremities: No edema, 2+ DP pulses \nIntegument: Warm, moist, no rash or ulceration \nPsychiatric: appropriate, not anxious \n\ufeff\n", + "input6": "ADMISSION LABORATORY STUDIES:\n- ___ 10:40PM WBC-8.9# (NEUTS-62.9 LYMPHS-31.5 MONOS-1.9* EOS-1.9 BASOS-1.9) RBC-4.44 HGB-12.5 HCT-38.1 MCV-86 MCH-28.1 MCHC-32.7 RDW-14.4 PLT COUNT-316#\n- ___ 10:40PM GLUCOSE-237 UREA N-13 CREAT-0.8 SODIUM-137 POTASSIUM-3.6 CHLORIDE-99 TOTAL CO2-27 ANION GAP-15 ALT(SGPT)-15 AST(SGOT)-23 ALK PHOS-67 TOT BILI-0.3 LIPASE-28\n- ___ 10:40PM \t\tICA-(+)\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type I Diabetes/17517983-DS-78.json b/Finished/Diabetes/Type I Diabetes/17517983-DS-78.json new file mode 100644 index 0000000000000000000000000000000000000000..107a988778a37b0a89cf6019ffc89b4cc30c3921 --- /dev/null +++ b/Finished/Diabetes/Type I Diabetes/17517983-DS-78.json @@ -0,0 +1,32 @@ +{ + "Type I diabetes$Intermedia_4": { + "ICA antibodies are positive in most patients with type I diabetes.$Cause_1": { + "ICA-(+)*$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "BLOOD Glucose-263$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "The abnormal blood glucose in the presence of classic sympotoms of hyperglycemia is a diagnostic criteria of diabetes.$Cause_1": { + "hyperglycemia >500$Input2": {} + }, + "FSG is a symptom of diabetes.$Cause_1": { + "FSG of 50$Input2": {} + }, + "CKD is a symptom of diabetes.$Cause_1": { + "+CKD stage II-III (b/l creatinine 1.5-2.0)$Input3": {} + }, + "Family history is a big risk factor of diabetes.$Cause_1": { + "Diabetes in her grandmother$Input4": {} + } + } + } + }, + "input1": "Hypoglycemia\n", + "input2": "She with multiple admissions for gastroparesis over last year with ED eval 3 days prior for hyperglycemia >500 treated with IV fluids now presents after being found down at home with sugar of 50. At that point was given glucagon. \n\ufeff\nHas significant number of prior admissions for nausea/vomitting attributed to gastroparesis--per PCP usually episodes are set off by life stressors. Current stressors include her mother moving to an apartment farther away with inconvenient transportation. Her year old son is having difficulty in school due to ADHD diagnosis. Lives alone but is very close to her mother. Previously has had self-motivation to take charge of own care, but recently has required increasing degree of intervention from Social Worker. Seen a week ago and per PCP had more distant affect.\n\ufeff\nThis AM took her insulin 70/30 at 28 units as prescribed and proceeded to get ready fro appointment to have stitches removed that had been placed after last fall. Felt nauseated and did not eat--otherwise no symptoms of hypoglycemia. No increase in polyuria, no frank vomitting, no diarrhea. No prodrome before she blacked out. Found by sister who called for ambulance. EMS found her to have FSG of 50. At that point was given glucagon. Currently complains of R sided chest wall pain and R flank pain, unchanged from pain she was experiencing upon presentation to the ED 3 days prior, CXR and rib films at that time negative. \n\ufeff\nIn the ED, initial vital signs were 97.4 110 143/93 18 98% \nPatient was given. Pt having nausea and vomitting, so received 4mg iv zofran, 4mg po zofran, 10mg reglan and 1mg iv ativan. She received 0.5mg iv dilaudid for her chronic pain. Was tachy to 120's, on the monitor at times, but is coming down with ivf. her bp is high but pt has not been taking her meds, gave her am dose of amlodipine today. \n\ufeff\n", + "input3": "+Severe anxiety/panic attacks\n+Depression with psychotic features, currently seeing doctor for Psychiatric care\n+Esophagitis / H. Pylori s/p 2-weektriple therapy\n+Grade I esophageal varices seen on scope,negative liver ultrasound, normal LFTs, hep panel negative\n+Hyperlipidemia\n+S/P - lower back pain since then.\n+S/P ex-lap\n+G2P1Ab1, s/p miscarriage, s/p C-sectionin\n+Genital Herpes\n+Left tibial plateau fracture s/p ORIF\n+CKD stage II-III (b/l creatinine 1.5-2.0)\n", + "input4": "Diabetes in her grandmother and asthma.\n", + "input5": "Physical Exam:\nADMISSION\nVitals- 97.9 100RA BS 106\nGeneral- Alert, oriented, no acute distress \nHEENT- Sclera anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, no LAD \nLungs- Clear to auscultation bilaterally, no wheezes, rales, ronchi \nCV- Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen- soft, non-tender, non-distended, hypoactive bowel sounds present, no rebound tenderness or guarding, no organomegaly \nGU- no foley \nExt- warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\nNeuro- CNs2-12 intact, motor function grossly normal \n\nACTIVE ISSUES\n# S/P FALL: Likely secondary to hypoglycemia. Given significant and longstanding poor blood sugar control, possible patient has significant autonomic dysfunction. EKG with shortened PR, but no other signs of WPW. Had a fall on prior admission with sutures, which were removed on this admission.\n\ufeff\n# HTN: Patient with significant diastolic pressure >100 on admission. On amlodipine and lisinopril at home which patient has been complaint. Has missed her BP meds on day of admission.Prior symptomatic hypotension so would be careful about giving too much BP meds. Pressures possibly labile as above from autonomic dysfunction.\n\ufeff\nINACTIVE ISSUE\n# DEPRESSION WITH PSYCHOTIC FEATURES: Seeing doctor for Psychiatric care. Continued Risperdone.\n\ufeff\nTRANSITIONAL ISSUES\n# Go over insulin plan for poor PO intake with patient and ensure that she understands\n\ufeff\n", + "input6": "ADMISSION\n\ufeff\n___ 01:00PM BLOOD WBC-10.3 RBC-3.29* Hgb-9.4* Hct-29.1* MCV-88 MCH-28.5 MCHC-32.2 RDW-13.2\n___ 01:00PM BLOOD Glucose-263* UreaN-18 Creat-1.6* Na-135 K-3.8 Cl-100 HCO3-26 AnGap-13\n___ 01:00PM BLOOD Albumin-3.5 Calcium-9.1 Phos-2.1*# Mg-1.5*\n___ 01:07PM BLOOD Lactate-0.7\n___ 01:07PM ICA-(+)*\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type I Diabetes/17523255-DS-7.json b/Finished/Diabetes/Type I Diabetes/17523255-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..42c7a6445bad0d69fe8b5544f860351ee27d5072 --- /dev/null +++ b/Finished/Diabetes/Type I Diabetes/17523255-DS-7.json @@ -0,0 +1,23 @@ +{ + "Type I diabetes$Intermedia_4": { + "IA-2A antibodies are positive in most patients with type I diabetes.$Cause_1": { + "IA-2A (+)$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal random blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "GLUCOSE-1000$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "Poor glycemic control is a risk factor of diabetes.$Cause_1": { + "poor glycemic control$Input1": {} + } + } + } + }, + "input1": "poor glycemic control\n", + "input2": "Her G2P0 at 5w5d by ultrasound inconsistent with LMP presents for admission for glucose control. Presented 2days ago for dysuria, found to have a UTI for which she was admitted for IV antibiotics per her report. She left AMA and presented today where she was found to have a glucose of 44 mg/dl with reduced consciousness requiring glucagon and juice. BGS up to 102-> 224mg/dl. In the last 2 weeks limited testing bgs 73-501 on meter.\n\ufeff\nShe reports having an ultrasound done 2 days ago which showed a gestational sac with yolk sac, no fetal pole. She denies any cramping or bleeding.\n\ufeff\nShe currently reports feeling weak. Reports occasional nausea in the morning but none currently. She denies vomiting, HA, fevers, chills, abdominal pain, diarrhea, constipation, dysuria, abnormal vaginal discharge.\n\ufeff\n", + "input3": "OBHx:\nG1 SAB\nG2 current\n\ufeff\nGYN Hx: denies history of abnormal paps, fibroids, cysts, STDs\n\ufeff\nPMH: hypothyroidism (TSH recently normal off meds),bipolar/PTSD\nPSH: denies\n\ufeff\n", + "input4": "Adopted, little known of her family history\n", + "input5": "Discharge physical exam:\nGen: NAD\nCv: RRR\nP: No respiratory distress on RA\nAbd: soft, nontender, nondistended\nExt: WWP\n", + "input6": "___ 03:49PM URINE COLOR-Yellow APPEAR-Hazy\n___ 03:49PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 GLUCOSE-1000 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-LG\n___ 03:49PM URINE RBC-4* WBC-7* BACTERIA-FEW YEAST-RARE EPI-33 TRANS EPI-<1\n___ 03:49PM URINE MUCOUS-FEW\n___ 02:28PM ALT(SGPT)-17 AST(SGOT)-19\n___ 02:28PM CALCIUM-9.2 PHOSPHATE-4.4 MAGNESIUM-2.2\n___ 02:28PM %HbA1c-11.1* eAG-272*\n___ 02:28PM TSH-2.3\n___ 02:28PM WBC-7.2 RBC-4.24 HGB-12.9 HCT-38.8# MCV-92# MCH-30.4 MCHC-33.2 RDW-12.9 RDWSD-42.6\n___ 02:28PM NEUTS-66.5 MONOS-5.7 EOS-0.7* BASOS-0.4 AbsNeut-4.79 AbsLymp-1.90 AbsMono-0.41 AbsEos-0.05 AbsBaso-0.03\n___ 02:28PM PLT COUNT-293\n___ 02:28PM IA-2A (+)\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type I Diabetes/19142711-DS-8.json b/Finished/Diabetes/Type I Diabetes/19142711-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..2ea18ff82d5f0092a0916e699c4b4d6f62065fa5 --- /dev/null +++ b/Finished/Diabetes/Type I Diabetes/19142711-DS-8.json @@ -0,0 +1,35 @@ +{ + "Type I diabetes$Intermedia_4": { + "GADA antibodies are positive in most patients with type I diabetes.$Cause_1": { + "GADA-(+)$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "GLUCOSE-568$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "Polyuria is a classic symptom of diabetes.$Cause_1": { + "Polyuria$Input1": {} + }, + "Polydypsia is a classic symptom of diabetes.$Cause_1": { + "polydypsia$Input1": {} + }, + "Weight loss is a classic symptom of diabetes.$Cause_1": { + "weight loss$Input1": {} + }, + "Family history is a big risk factor of diabetes.$Cause_1": { + "Grandfather with DM$Input4": {} + }, + "Ketones in the urine is a sign of diabetes.$Cause_1": { + "KETONE-50$Input6": {} + } + } + } + }, + "input1": "Polyuria, polydypsia, weight loss\n", + "input2": "Male who has been experiencing dry mouth, polyuria (>20 times/day)and polydypsia with associated 15 lb weight loss over the past 3 weeks. Also with occasional sweats, nausea and loss of appetite. No fevers, recent infections or new medications. One day PTA he went to his center. He received 1L NS. \n. \nIn the ED, vitals were: 97.1 128/68 60 18 97% RA. His initial fingerstick was 568 with glucose and ketones in urine. He was called who recommended 10u of regular insulin. He given another 1L NS with 40meq KCL. Repeat chemistry showed glucose 365. AG = 14. He was admitted to medicine for further management. \n. \nROS: No fevers, H/A, CP or abdominal pain. No blurry vision. \n\ufeff\n", + "input3": "1. Concussion \n2. Muscle strain in neck \n3. Epistaxis - s/p cauterization x 2\n", + "input4": "Grandfather with DM. Otherwise NC\n", + "input5": "Vitals: 97.4 96.9 122/78 54 18 98% RA. ___ 345, 321 \nGEN: AAOx3, well appearing, sitting in bed, NAD \nHEENT: PERRL, EOMI. MMM. Oropharynx without lesions or exudate. \n\ufeff\nNECK: Supple, no cervical or supraclavicular LAD \nLUNGS: CTAB. Normal respiratory effort. \nHEART: RRR, no m/r/g \nABD: NABS, soft, non-tender, non-distended, no masses \nEXT: WWP, good DP pulses bilaterally, no c/c/e \nNEURO: CN ___ grossly intact bilaterally. ___ MS in bilateral \nupper and lower extremities. 2+ biceps, patellar DTRs.\n", + "input6": "___ 01:10AM WBC-7.7 RBC-4.91 HGB-15.0 HCT-40.2 MCV-82 MCH-30.6 MCHC-37.4* RDW-12.3\n___ 01:10AM GLUCOSE-568* UREA N-27* CREAT-1.1 SODIUM-130* POTASSIUM-4.0 CHLORIDE-92* TOTAL CO2-24 ANION GAP-18\n___ 02:00AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-1000 KETONE-50 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG\n___ 02:00AM GADA-(+)*\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type II Diabetes/13050690-DS-6.json b/Finished/Diabetes/Type II Diabetes/13050690-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..4707fce28a4867be63328c92d64675849ae5c7e2 --- /dev/null +++ b/Finished/Diabetes/Type II Diabetes/13050690-DS-6.json @@ -0,0 +1,32 @@ +{ + "Type II diabetes$Intermedia_4": { + "Related C-peptide peak is more common in patients with type II diabetes and is a sign of insulin resistance.$Cause_1": { + "C-peptide release test hints the peak relate,did not fall back to fasting values at 180min.$Input6": {} + }, + "Related insulin peak is more common in patients with type II diabetes.This indicator is often combined with C-peptide results for type diabetes.$Cause_1": { + "Insulin release test hints the high insulin levels and related peak,did not fall back to fasting values at 180min.$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal random blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "GLUCOSE-212$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "The right foot pain is a symptom of diabetes,a form of peripheral neuropathy.$Cause_1": { + "right foot tingling$Input1": {} + }, + "Dysuria is a symptom of diabetes,a form of autonomic neuropathy.$Cause_1": { + "Does report dysuria$Input2": {} + }, + "Hyperlipidemia is a risk factor of diabetes.$Cause_1": { + "HDL-62 CHOL/HD-4.0 LDLcalc-149$Input6": {} + } + } + } + }, + "input1": "right foot tingling\n", + "input2": "She is a right-handed woman with history notable for prior right occipital IPHs ascribed to suspected cerebral amyloid angiopathy, HTN, diet-controlled HLD, and anxiety transferred from after presenting with transient right foot paresthesiae. She reports going to bed yesterday evening in her usual state of health. On waking up this morning at 08:30, she noticed \"tingling\" paresthesiae over the sole of her right foot on rising from bed. She describes the sensation as 'pins and needles' similar to her foot falling asleep, but had not woken up in an unusual position or rested her leg on any hard surface overnight. Her paresthesiae did not resolve over the next few minutes, prompting her to activate EMS. There, she underwent a non-contrast head CT that was noted to have a few new linear areas of hyperdensity in the area of a prior parietal infarct; as a subdural hematoma could not beexcluded per report, she was transferred for Neurosurgical evaluation. Notably, her symptoms resolved while obtaining her imaging, lasting approximately two hours in total. She denies a similar recent history of paresthesiae, and denies headache, back pain, leg pain, focal weakness, vision change, speech disturbance, or gait disturbance associated with her most recent episode. She was recently seen in the ED for a small CT hyperdensity in the setting of headaches, which was felt to reflect mineralization vs. residual hemorrhage from prior infarct as well as hypertension, respectively. She was also recently admitted for a right parietooccipital IPH. \n\ufeff\nROS: As above; also denies recent fevers, chills, cough, congestion, chest discomfort, abdominal pain, or changes in bowel habits. Does report dysuria. \n\ufeff\n", + "input3": "Prior right occipital IPH (___) and right parietal IPH (___) ascribed to suspected cerebral amyloid angiopathy \nHTN \nHLD\n", + "input4": "Non-contributory.\n", + "input5": "ADMISSION PHYSICAL EXAMINATION \n==============================\nVitals: T: 98.4 HR: 67 BP: 139/97 RR: 16 SpO2: 97% RA General: NAD \nHEENT: NCAT, no oropharyngeal lesions, neck supple \nPulmonary: no tachypnea or increased WOB \nAbdomen: Soft, ND \nExtremities: Warm, no edema Neurologic Examination:\n+ Mental status: Awake, alert, oriented x 3. Able to relate history without difficulty. Attentive, able to nam backward without difficulty. Speech is slow but fluent without dysarthria. Able to follow both midline and appendicular commands. \n+ Cranial Nerves: PERRL (3.5 to 2.5 mm. Left inferior quadrantanopsia. EOMI, no nystagmus. V1-V3 without deficits to light touch bilaterally. No facial movement asymmetry. Hearing intact to finger rub bilaterally. Palate elevation symmetric. bilaterally. Tongue midline. \n+ Motor: No drift. \n[Delt][Bic][Tri][ECR][FEx][IP][Quad][Ham][TA]\nReflexes: \n[Bic] [Tri] [___] [Quad] [Gastroc] \nL 2+ 2+ 2+ 2+ 1+ \nR 2+ 2+ 2+ 2+ 1+ =\n+ Sensory: No deficits to light touch or pinprick throughout. No extinction to DSS. \n+ Coordination: No dysmetria with finger-to-nose testing bilaterally, though with slight action tremor. \n+ Gait: Narrow-based and steady. \n\nNeurologic Examination:\n+ Mental status: Awake, alert and oriented to the hospital anddate. Does not remember all interval events like discussionsyesterday and talking to her son. Her speech is fluent withoutdysarthria. No \n\ufeff\n+ Cranial Nerves: PERRL (Left inferior quadrantanopsia. EOMI, no nystagmus. No facial movement asymmetry. \n\ufeff\n+ Motor: No drift. Upper and lower ext full strength\n\ufeff\n+ Sensory: no deficits to light touch\n\ufeff\n+ Gait: narrow base and stride without sway\n", + "input6": "ADMISSION LABS: \n===============\n___ 06:00PM GLUCOSE-212* UREA N-23* CREAT-1.0 SODIUM-139 POTASSIUM-4.5 CHLORIDE-100 TOTAL CO2-25 ANION GAP-14\n___ 06:00PM CALCIUM-9.7 PHOSPHATE-4.1 MAGNESIUM-2.3 CHOLEST-262*\n___:00PM %HbA1c-6.7* eAG-146*\n___ 06:00PM TRIGLYCER-274* HDL CHOL-59 CHOL/HDL-4.4 LDL(CALC)-148*\n___ 06:00PM TSH-2.5\n___ 06:00PM WBC-7.5 RBC-4.52 HGB-13.8 HCT-41.4 MCV-92 MCH-30.5 MCHC-33.3 RDW-12.5 RDWSD-42.0\n___ 06:00PM PLT COUNT-263\n___ 11:54PM URINE HOURS-RANDOM\n___ 11:54PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG oxycodn-NEG mthdone-NEG\n___ 11:54PM URINE COLOR-Straw APPEAR-Clear\n___ 11:54PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG KETONE-TR* BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-SM*\n___ 11:54PM URINE RBC-1 WBC-1 BACTERIA-NONE YEAST-NONE EPI-0 TRANS EPI-<1\n___ 11:54PM URINE MUCOUS-RARE*\n___ 07:39PM estGFR-Using this\n___ 07:39PM estGFR-Using this\n___ 07:39PM WBC-7.0 RBC-4.55 HGB-14.4 HCT-43.0 MCV-95 MCH-31.6 MCHC-33.5 RDW-12.5 RDWSD-43.1\n___ 07:39PM NEUTS-42.6 MONOS-9.7 EOS-1.8 BASOS-0.6 AbsNeut-3.00 AbsLymp-3.18 AbsMono-0.68 AbsEos-0.13 AbsBaso-0.04\n___ 07:39PM PLT COUNT-256\n___ 07:39PM PTT-26.2\n___ 05:35AM BLOOD %HbA1c-6.6* eAG-143*\n___ 05:35AM BLOOD Triglyc-187* HDL-62 CHOL/HD-4.0 LDLcalc-149*\n\nC-PEPTIDE RELEASE TEST:\n=======================\nC-P0 1.93ng/ml\nC-P30 2.74ng/ml\nC-P60 6.56ng/ml\nC-P120 12.015ng/ml\nC-P180 5.29ng/ml\n\n+ C-peptide release test hints the peak relate,did not fall back to fasting values at 180min.\n\nINSULIN RELEASE TEST:\n=====================\nInsulin 22.06mlU/L\nInsulin30 93.500mlU/L\nInsulin60 156.72mlU/L\nInsulin120 211.350mlU/L\nInsulin180 82.60mlU/L\n\n+ Insulin release test hints the high insulin levels and related peak,did not fall back to fasting values at 180min. \n\n\ufeff\nIMAGING: \n========\n+ MRI brain w/ and w/o\n1. Unchanged, right parietal intraparenchymal subacute hemorrhage. No significant mass effect or midline shift. Peripheral enhancement is likely reactive to the blood products, but short-term interval follow-up is recommended to exclude an underlying lesion. No new focus of hemorrhage. \n2. Numerous, scattered foci of susceptibility suggestive of chronic microhemorrhages, possibly from underlying amyloid angiopathy. \n3. Additional periventricular and subcortical white matter FLAIR \n\ufeff\nhyperintensities are nonspecific, but likely represent sequela of chronic \nsmall vessel ischemic disease.\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type II Diabetes/13154769-DS-15.json b/Finished/Diabetes/Type II Diabetes/13154769-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..391c1a23745de9d430423956ebc2c64bfd46df77 --- /dev/null +++ b/Finished/Diabetes/Type II Diabetes/13154769-DS-15.json @@ -0,0 +1,47 @@ +{ + "Type II diabetes$Intermedia_4": { + "Related C-peptide peak is more common in patients with type II diabetes and is a sign of insulin resistance.$Cause_1": { + "C-peptide release test hints the peak relate,did not fall back to fasting values at 180min.$Input6": {} + }, + "Related insulin peak is more common in patients with type II diabetes.This indicator is often combined with C-peptide results for type diabetes.$Cause_1": { + "Insulin release test hints the peak relate,did not fall back to fasting values at 180min.$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "GLUCOSE-697$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "Obesity is a big risk factor of diabetes.$Cause_1": { + "history of obesity$Input2": {} + }, + "Polydipsia is a classic symptom of diabetes.$Cause_1": { + "polydipsia$Input2": {} + }, + "Polyuria is a classic symptom of diabetes.$Cause_1": { + "polyuria$Input2": {} + }, + "Blurry vision is a symptom of diabetes,which usually indicates diabetic retinopathy.$Cause_1": { + "blurry vision$Input2": {} + }, + "Vaginal erythema and itching is a symptom of diabetes commonly seen in female.$Cause_1": { + "vaginal erythema and itching$Input2": {} + }, + "Candidal vaginitis is a symptom of diabetes.$Cause_1": { + "candidal vaginitis$Input2": {} + }, + "Anxiety is a symptom of diabetes.$Cause_1": { + "anxiety/depression --PTSD$Input3": {} + }, + "Family history is a big risk factor of diabetes.$Cause_1": { + "sister with breast cancer/DM, son with DMI$Input4": {} + } + } + } + }, + "input1": "abdominal pain\n", + "input2": "She is a woman with a history of obesity, anxiety/depression, GERD who was sent from her PCP's office for new diagnosis nausea/vomiting. She notes 2 weeks of polydipsia, polyuria, blurry vision, nausea/vomiting andepigastric abdominal pain. She also complains of 2 days of chest pain last week which spontaneously resolved over the weekend. \nShe found these symptoms manageable but presented to her PCP's office for vaginal erythema and itching. She admits to douching BID. Her PCP performed ___ vaginal exam demonstrating erythema and scaling consistent with candidal vaginitis. She was sent to the ED for evaluation of possible DM. In the ED, initial VS were: 97.0 107 145/63 20 97%, urine demonstrated 1000 glucose, trace ketones. Glucose was initially679 and improved to 300 with insulin gtt. She was given 2L IVF. Initially was hyponatremic to 126 and improved to 132 with IVF and insulin. \n \nREVIEW OF SYSTEMS: \n(+) as above, also constipation \n\ufeff\n", + "input3": "anxiety/depression --PTSD \nSeasonal allergies \nGERD\n", + "input4": "sister with breast cancer/DM, son with DMI, Mother with CAD\n", + "input5": "ADMISSION PHYSICAL EXAM\nGENERAL - well-appearing woman in NAD, comfortable, appropriate, talkative \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, dry-MM, OP clear \n \nNECK - supple, no thyromegaly, no JVD, no carotid bruits \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use \nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, ttp in epigastrium, no masses or HSM, no rebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n \nSKIN - no rashes or lesions \nLYMPH - no cervical, axillary, or inguinal LAD \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, sensation grossly intact throughout, DTRs 2+ and symmetric, cerebellar exam intact, steady gait\n", + "input6": "___ 08:56PM GLUCOSE-332* NA+-132* K+-4.3 CL--94* TCO2-31*\n___ 06:49PM PO2-45* PCO2-48* PH-7.40 TOTAL CO2-31* BASE XS-3 COMMENTS-GREEN TOP\n___ 06:15PM GLUCOSE-499* UREA N-34* CREAT-1.4* SODIUM-127* POTASSIUM-4.9 CHLORIDE-86* TOTAL CO2-24 ANION GAP-22\n___ 06:15PM ALT(SGPT)-50* AST(SGOT)-45* LD(LDH)-439* ALK PHOS-138* TOT BILI-0.7\n___ 06:15PM LIPASE-55\n___ 06:15PM ALBUMIN-4.2\n___ 04:09PM GLUCOSE-GREATER TH LACTATE-2.5* NA+-126* K+-4.6 CL--86* TCO2-29\n___ 04:09PM HGB-15.3 calcHCT-46\n___ 03:50PM GLUCOSE-697* UREA N-40* CREAT-1.6* SODIUM-126* POTASSIUM-5.4* CHLORIDE-82* TOTAL CO2-27 ANION GAP-22\n___ 03:50PM OSMOLAL-308\n___ 03:50PM WBC-10.4 RBC-5.07 HGB-15.3 HCT-44.0 MCV-87 MCH-30.2 MCHC-34.7 RDW-12.1\n___ 03:50PM NEUTS-73.0* MONOS-4.7 EOS-0.7 BASOS-0.5\n___ 03:50PM PLT COUNT-316\n___ 03:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-1000 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD\n___ 03:50PM URINE RBC-1 WBC-4 BACTERIA-NONE YEAST-NONE EPI-1\n___ 03:50PM URINE MUCOUS-RARE\n___ 03:50PM URINE EOS-NEGATIVE \n___ 06:35AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:45AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:45AM BLOOD %HbA1c-13.8* eAG-349*\n___ 07:45AM C-peptide-135*\n\nIMAGING/STUDIES:\nECG: Sinus rhythm. Left atrial abnormality. Prior inferior wall myocardial infarction of indeterminate age with persistent ST segment elevation recorded also in the lateral precordium. Rule out myocardial infarction. Followup and clinical correlation are suggested. \n \nECG: Sinus rhythm. Inferior myocardial infarction, age undetermined. There are mild J point and ST segment elevations in the inferior leads and lead V6 of uncertain significance. Since the previous tracing the rate is now slower. Otherwise, unchanged. \n\ufeff\nCXR (AP Portable): Chest findings within normal limits as seen on single view AP chest examination. Thus, no evidence of pneumonia. \n \nTTE:\nThe left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion\n\nC-PEPTIDE RELEASE TEST:\nC-P0 2.03ng/ml\nC-P30 5.60ng/ml\nC-P60 9.830ng/ml\nC-P120 13.10ng/ml\nC-P180 4.68ng/ml\nC-peptide release test hints the peak relate,did not fall back to fasting values at 180min.\n\nINSULIN RELEASE TEST: \nInsulin 13.20mlU/L\nInsulin30 100.87mlU/L\nInsulin60 205.2mlU/L\nInsulin120 253.4mlU/L\nInsulin180 87.332mlU/L\nInsulin release test hints the peak relate,did not fall back to fasting values at 180min. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type II Diabetes/13180007-DS-17.json b/Finished/Diabetes/Type II Diabetes/13180007-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..ceb5a221bdbc249c7cf358a52fd9c1445fece20c --- /dev/null +++ b/Finished/Diabetes/Type II Diabetes/13180007-DS-17.json @@ -0,0 +1,38 @@ +{ + "Type II diabetes$Intermedia_4": { + "Related C-peptide peak is more common in patients with type II diabetes and is a sign of insulin resisitance.$Cause_1": { + "C-peptide release test hints the peak relate,did not fall back to the fasting values at 180min.$Input6": {} + }, + "Related insulin peak is more common in patients with type II diabetes.This indicator is often combined with C-peptide results for type diabetes.$Cause_1": { + "Insulin release test hints the peak relate,did not fall back to the fasting values at 180min.$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal random blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "BLOOD Glucose-298$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "CKD is a kind of microangiopathy,which is a symptom of diabetes.$Cause_1": { + "CKD$Input2": {} + }, + "Progressive short term memory loss is a symptom of diabetes.$Cause_1": { + "progressive short term memory loss$Input2": {} + }, + "Hypertension is a risk factor of diabetes.$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidiemia is a risk factor of diabetes.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Coronary artery diseas are risk factors of diabetes.$Cause_1": { + "Coronary artery diseas$Input3": {} + } + } + } + }, + "input1": "confusion\n", + "input2": "He speaking male with PMH of CVA, residualemotional lability, dysarthria), HFpEF, uncontrolled HTN,CAD, CKD.hypothyroidism, asthma who was brought in by familyfor altered mental status. They describe fluctuating cognitive and functional abilities since his CVA, which seem to have accelerated after hospitalization. Since that time, they have noted that he has had progressive short termmemory loss, often asking the same question repeatedly, thencalling the other daughter and asking the same question. Mostsignificantly, although he states that he takes his medicationsconsistently, in fact his daughters are both aware that he veryrarely takes them,including his insulin and antihypertensivesThey describe him as \"at his best\" when they are around, able toprovide food and ensure that he is taking his medications,although they also both believe that he is prescribed \"too manymedications,\" and that when he takes all of them, he is morefatigued and less interactive. His daughters are clear that,despite this impression, they never discourage him from takinghis prescribed medications, which he receives in bubble packs since his last discharge. \n\ufeff\nHe apparently told his daughters that hewas reaching for green bananas, lost his balance, and fell,rolling down the hill. He was able to get up \"little by little.\"When he came home, he apparently thought that he wasstill, confused his wife for his daughter. On morning, he fell again. He was confused about theconfiguration of the bathroom (no tub in bathroom in PR), so hetripped and fell, called his daughter in tears (he often getsemotional since his CVA). She booked an appointment for same day,at which his FSBG>500, HbA1c (point of care, not in OMR) was15.0%. He declined to be transferred to the ED. Daughter was on vacation from work, and so was able to check on himregularly. During these visits, she again established that he isnot taking prescribed medications. On the morning of presentation, pt's wife called daughter, concerned that ptwas increasingly confused. FSBG was >500, and administeredTresiba 50u at about 8 am. Pt called about 15 minuteslater, at which time she again noted confusion and slurredspeech, which has intermittently been present since his CVA.Decision was made to bring him to the ED. \n\ufeff\nOf note, during his last hospitalization , he had anepisode of dysarthria with confusion and mild expressive andreceptive aphasia for which code stroke was called. MRI/MRA brainand EEG were unrevealing, with chronic changes and EEG slowing only. He was continued on ASA and atorvastatin. \n\ufeff\n", + "input3": "1. CARDIAC RISK FACTORS \n+ Hypertension \n+ Dyslipidemia \n+ Coronary artery disease\n2. CARDIAC HISTORY \n+ Secondum ASD\n+ Mild AR\n3. OTHER PAST MEDICAL HISTORY \n+ Extensive intracranial atherosclerosis, worse in the rightMCA territory.\n+ Cerebrovascular disease, status post CVA in ___\n+ Asthma\n+ OSteoarthritis\n", + "input4": "Both parents have heart disease. Mother- w/ heart problems anddiabetes & father w/ diabetes. 16 brothers and sisters. Noknown hx of early coronary artery disease or sudden cardiac death.\n", + "input5": "Physical Exam:\nADMISSION EXAM:\n\ufeff\nVS: Temp: 97.3 PO BP: 168/78 HR: 85 RR: 18 O2 sat:97% O2 delivery: RA Dyspnea: 0 RASS: 0 Pain GEN: alert and interactive, comfortable, no acute distressHEENT: PERRL, anicteric, conjunctiva pink, oropharynx withoutlesion or exudate, moist mucus membranes, ears without lesions orapparent traumaLYMPH: no anterior/posterior cervical, supraclavicular adenopathyCARDIOVASCULAR: Regular rate and rhythm with late systolicmurmur at RUSB, no rubs or gallops\nLUNGS: clear to auscultation bilaterally without rhonchi,wheezes, or crackles\nGI: soft, nontender, without rebounding or guarding, nondistendedwith normal active bowel sounds, no hepatomegaly\nEXTREMITIES: no clubbing, cyanosis, or edema\nGU: no foley\nSKIN: no rashes, petechia, lesions, or echymoses; warm topalpation\nNEURO: Alert and interactive to person, cranial nerves II-XII intact, LLE, LUE elbow flexion/extension andhand grip. Gait is WNL, negative Romberg, negative pronator drift.\nPSYCH: normal mood and affect\n\ufeff\n", + "input6": "ADMISSION LABS:\n\ufeff\n___ 11:00AM BLOOD WBC-5.6 RBC-3.98* Hgb-10.6* Hct-32.6* MCV-82 MCH-26.6 MCHC-32.5 RDW-14.3 RDWSD-41.8\n___ 11:00AM BLOOD Neuts-78.9* Lymphs-11.1* Monos-7.5 Eos-1.6 Baso-0.5 AbsNeut-4.40 AbsLymp-0.62* AbsMono-0.42 AbsEos-0.09 AbsBaso-0.03\n___ 11:00AM BLOOD Glucose-298 UreaN-32* Creat-2.3* Na-139 K-4.1 Cl-100 HCO3-25 AnGap-14\n___ 11:00AM BLOOD ALT-8 AST-9 CK(CPK)-110 AlkPhos-144* TotBili-<0.2\n___ 11:00AM BLOOD Albumin-3.5 Calcium-9.2 Mg-2.3\n\nIMPORTANT RESULTS:\n\ufeff\n___ 11:00AM BLOOD %HbA1c-14.4* eAG-367*\n___ 09:00PM BLOOD TSH-1.3\n___ 11:11AM BLOOD Lactate-1.6\n___ 11:00AM BLOOD CK-MB-4 proBNP-754*\n\n\ufeff\nIMAGING:\n\ufeff\nChest X-ray: \nOn today's radiograph, a smallpleural left-sided calcification is seen. There also is a smallleft pleural effusion. Borderline size of the cardiac silhouettewithout pulmonary edema. No pneumonia, no pneumothorax. Thelateral radiograph shows mild flattening of the hemidiaphragms,potentially as a consequence of functional obstruction.\n\ufeff\nHead CT: 1. No evidence of acute intracranial abnormality.\n2. Unchanged appearance of chronic infarcts within the rightfrontal lobe and left occipital lobe.\n3. Chronic lacunar infarcts within the right basal ganglia.\n4. Redemonstration of few calcifications within the pons,findings which are unchanged in appearance and likely sequela ofprior ischemic or inflammatory process.\n___ 11:00AM BLOOD cTropnT-0.04*\n___ 09:00PM BLOOD cTropnT-0.02*\n___ 11:00AM BLOOD %HbA1c-14.4* eAG-367*\n___ 11:00AM BLOOD Lipase-73*\n___ 11:00AM BLOOD CK-MB-4 proBNP-754*\n\ufeff\nIMAGING:\n\ufeff\nCXR -\nOn today's radiograph, a small pleural\nleft-sided calcification is seen. There also is a small left pleural effusion. Borderline size of the cardiac silhouette without pulmonary edema. No pneumonia, no pneumothorax. The lateral radiograph shows mild flattening of the hemidiaphragms, potentially as a consequence of functional obstruction.\n\ufeff\nCT HEAD -\n1. No evidence of acute intracranial abnormality.\n2. Unchanged appearance of chronic infarcts within the right frontal lobe and left occipital lobe.\n3. Chronic lacunar infarcts within the right basal ganglia.\n4. Re-demonstration of few calcifications within the pons, findings which are unchanged in appearance and likely sequela of prior ischemic or inflammatory process.\n\nC-PEPTIDE RELEASE TEST:\nC-P0 2.370ng/ml\nC-P30 7.550ng/ml\nC-P60 10.40ng/ml\nC-P120 13.70ng/ml\nC-P180 5.230ng/ml \nC-peptide release test hints the peak relate,did not fall back to the fasting values at 180min.\n\nINSULIN RELEASE TEST:\nInsulin 32.200mlU/L\nInsulin30 87.130mlU/L\nInsulin60 173.90mlU/L\nInsulin120 198.80mlU/L\nInsulin180 124.60mlU/L\nInsulin release test hints the peak relate,did not fall back to the fasting values at 180min.\n\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type II Diabetes/13223220-DS-17.json b/Finished/Diabetes/Type II Diabetes/13223220-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..fa50182ba311ff82b5ceb461920595cce07a8f9d --- /dev/null +++ b/Finished/Diabetes/Type II Diabetes/13223220-DS-17.json @@ -0,0 +1,38 @@ +{ + "Type II diabetes$Intermedia_4": { + "Related C -peptide peak is more common in patients with type II diabetes and is a sign of insulin resistance$Cause_1": { + "C-peptide release test hints the peak relate,did not fall back to fasting values at 180min.$Input6": {} + }, + "Related insulin peak is more common in patients with type II diabetes.This indicator is often combined with C-peptide results for type II diabetes.$Cause_1": { + "Insulin release test hints the high insulin levels and related peak,did not fall back to fasting values at 180min.$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal random blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "GLUCOSE-383$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "Hyperglycemia is a classic symptom of diabetes.$Cause_1": { + "hyperglycemia$Input1": {} + }, + "Metformin is a biguanides drug used to control high blood glucose in patients with T2DM.$Cause_1": { + "recently been on metformin$Input2": {} + }, + "Frequent urination is a symptom of diabetes.$Cause_1": { + "urinary frequency$Input2": {} + }, + "Hypertension is a risk factor of diabetes.$Cause_1": { + "Hypertension$Input3": {} + }, + "Family history is a big risk factor of diabetes.$Cause_1": { + "Mother, Father both had DM2.Sister with DM2$Input4": {} + } + } + } + }, + "input1": "hyperglycemia\n", + "input2": "He is a man admitted from the ED with critically high blood sugars. He managed in the past with oral agents. He has most recently been on both metformin and oral prednisone. The oral prednisone was prescribed by ENT doctor nasal polyps. The course of prednisone is now complete and he is no longer on this medication (last took when taper completed). He was not able to be transitioned to insulin therapy safely in the outpatient setting. Please see OMR notes from NP Brain doctor.\n.\nPatient reports significant fatigue, urinary frequency. He says he has suffered considerably with his nasal polyps. He denies any recent chest discomfort but says that sometimes with extreme exertion, he'll get anterior chest discomfort. He denies any shortness of breath. He is otherwise feeling well. 10 point review of systems is negative except for noted above.\n", + "input3": "1) Hypertension\n2) h/o cocaine and alcohol abuse - none x per patient, active in AA\n3) h/o homelessness\n4) Allergic rhinitis with nasal polyps\n", + "input4": "Mother, Father both deceased, unclear reasons, both had DM2.Sister with DM2, on insulin therapy. Three children live with their mother, their health is fine as far as he is aware.\n\ufeff\n", + "input5": "GEN: Well-appearing middle-aged man, in no apparent distress\nVS: 98.5 122/86 95 20 97% RA - patient reports weight = 176 lbs\nHEENT: anicteric, PEERL, o/p without lesion, edentuous\nNECK: supple, no LAD, no JVD\nCV: reg rate, no m/r/g\nLUNGS: CTA bilaterally with good air entry\nABD: soft, NT/ND, no masses\nEXT: warm, no edema, no foot ulcers\nNEURO: alert, grossly intact, provides coherent HPI, gait normal\nPSYCH: appropriate\nSKIN: dry, no rash\n\nBrief Hospital Course:\nHe is a man with HTN, admitted with dehydration and marked hyperglycemia in need of insulin therapy. This was not able to be be achieved safely in the outpatient setting so he is thus admitted to ensure safe care. Metformin was continued at it's current dose. There was concern that Lantus would be too expensive for him given his current insurance, so he was given insulin 70/30 so he would only need 2 injections a day. His fasting glucose was 170 with this. He will record his fasting glucoses for the next week so his insulin can be adjusted.\ufeff\n", + "input6": "___ 02:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-1000 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG\n___ 12:45PM GLUCOSE-383* UREA N-10 CREAT-0.9 SODIUM-132* POTASSIUM-5.0 CHLORIDE-95* TOTAL CO2-29 ANION GAP-13\n___ 12:45PM WBC-8.4 RBC-4.31* HGB-11.0* HCT-34.9* MCV-81* MCH-25.6* MCHC-31.6 RDW-12.9\n___ 12:45PM NEUTS-58.1 MONOS-4.3 EOS-6.7* BASOS-0.3\n___ 12:45PM PLT COUNT-294\n___ 07:52AM UREA N-8 CREAT-0.9 SODIUM-135 POTASSIUM-5.0 CHLORIDE-93* TOTAL CO2-30 ANION GAP-17. EKG - normal sinus rhythm without ischemic changes\n\nC-PEPTIDE RELEASE TEST:\nC-P0 2.64ng/ml\nC-P30 3.89ng/ml\nC-P60 11.74ng/ml\nC-P120 16.48ng/ml\nC-P180 8.10ng/ml\n\nC-peptide release test hints the peak relate,did not fall back to fasting values at 180min.\n\nINSULIN RELEASE TEST:\nInsulin 6.300mlU/L\nInsulin30 58.85mlU/L\nInsulin60 197.4mlU/L\nInsulin120 258.3mlU/L\nInsulin180 96.20mlU/L\n\nInsulin release test hints the high insulin levels and related peak,did not fall back to fasting values at 180min.\n\n\n\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type II Diabetes/13301812-DS-3.json b/Finished/Diabetes/Type II Diabetes/13301812-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..5e3d761e44d5bb737e1e4d97176a6d4edd2a2c18 --- /dev/null +++ b/Finished/Diabetes/Type II Diabetes/13301812-DS-3.json @@ -0,0 +1,32 @@ +{ + "Type II diabetes$Intermedia_4": { + "Related C-peptide peak is more common in patients with type II diabetes and is a sign of insulin resistance.$Cause_1": { + "C-peptide release test hints the peak relate,did not fall back to fasting values at 180min$Input6": {} + }, + "Related insulin peak is more common in patients with type II diabetes.This indicator is often combined with C-peptide results for type diabetes.$Cause_1": { + "Insulin release test hints the peak relate,did not fall back to fasting values at 180min$Input6": {} + }, + "Diabetes$Intermedia_3": { + "Abnormal random blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "BLOOD Glucose-367$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "Metformin is a biguanides drug uesd to control high blood glucose in patients with T2DM.$Cause_1": { + "started on Metformin$Input2": {} + }, + "High blood pressure is a risk factor of diabetes.$Cause_1": { + "hypertension$Input3": {} + }, + "High GHBA1c level is a sign of diabetes.$Cause_1": { + "BLOOD %HbA1c-6.5$Input6": {} + } + } + } + }, + "input1": "hypoglycemia\n", + "input2": "This is a woman w/ a h/o for metformin, rheumatoid arthritis, and HTN, who p/w two days of episodic weakness, dizzyness, and diaphoresis. She found that sugary foods relieved her symptoms. On the morning or admission she went to work and after feeling diaphoretic, decided to go to the ED, vitals were 95.5, 88 127/68 16, 100%RA, and was found to have a FSBG of 72. She had a meal and FSBG increased to 100. Several hours later her sugar decreased to 29 and was given more Dextrose as well as Octreotide 75mcg SC for presumed Sulfonylurea-related hypoglycemia and was transferred to the MICU for further observation and management of her hypoglycemia. . \nWhile in the MICU the patient was kept for a period of time and all her oral anti-hypoglycemics were discontinued. Her hypoglycemia improved and she has had no further episodes of hypoglycemia during this admission. Given that her oral anti-hyperglycemic agents have been discontinued, her blood sugars have been somewhat labile, peaking at 434, however, her sugars have responded to coverage w/an insulin sliding scale. Now asymptommatic, eating a regular diet and re-started on Metformin, she is stable and ready to be transferred to the general medical floor. \n\ufeff\n", + "input3": "rheumatoid arthritis \nhypertension \ns/p abdominal surgery for GSW\n", + "input4": "NC\n", + "input5": "Physical Exam: \nV/S 98.1, 78, 20, 98% RA \nGEN: Well appearing, female in NAD \nHEENT: PERRL, EOMI, anicteric sclerae, MMM \nPULM: Good resp effort, CTAB without w/r/r \nCV: Regular, nl s1/s2, no m/g/r \nAbd: soft, flat, non-tender, linear well healed abdominal scar \nExt: warm, well perfused extremeties with no lower extremity edema \nNeuro: AAO x 3, CN II - XII intact, sensation grossly intact.\n", + "input6": "___ 05:20AM BLOOD WBC-6.3 RBC-3.52* Hgb-11.1* Hct-32.1* MCV-91 MCH-31.5 MCHC-34.6 RDW-14.0\n___ 06:00AM BLOOD WBC-7.1 RBC-3.32* Hgb-10.4* Hct-30.1* MCV-91 MCH-31.2 MCHC-34.3 RDW-14.2\n___ 05:19PM BLOOD Hct-28.4*\n___ 03:40AM BLOOD WBC-7.5 RBC-2.96* Hgb-9.6* Hct-26.7* MCV-90 MCH-32.6* MCHC-36.2* RDW-14.2\n___ 02:05PM BLOOD Hgb-10.0*\n___ 08:00AM BLOOD WBC-7.7 RBC-3.22* Hgb-10.1* Hct-30.2* MCV-94 MCH-31.4 MCHC-33.5 RDW-14.2\n___ 08:00AM BLOOD Neuts-83.1* Lymphs-10.8* Monos-3.8 Eos-2.3 Baso-0.1\n___ 05:20AM BLOOD Glucose-102 UreaN-17 Creat-1.0 Na-137 K-5.5* Cl-102 HCO3-26 AnGap-15\n___ 06:00AM BLOOD Glucose-107* UreaN-14 Creat-0.9 Na-132* K-4.3 Cl-101 HCO3-26 AnGap-9\n___ 03:40AM BLOOD Glucose-96 UreaN-14 Creat-0.9 Na-137 K-4.3 Cl-107 HCO3-21* AnGap-13\n___ 08:00AM BLOOD Glucose-367* UreaN-18 Creat-0.9 Na-140 K-4.0 Cl-108 HCO3-21* AnGap-15\n___ 03:40AM BLOOD ALT-12 AST-15 LD(LDH)-189 AlkPhos-74 Amylase-63 TotBili-0.2\n___ 03:40AM BLOOD Lipase-34\n___ 05:20AM BLOOD Calcium-9.7 Phos-4.0 Mg-1.8 Iron-57\n___ 05:20AM BLOOD calTIBC-291 Ferritn-192* TRF-224\n___ 02:05PM BLOOD %HbA1c-6.5*\n___ 08:00PM BLOOD Cortsol-44.2*\n___ 07:24PM BLOOD Cortsol-37.8*\n___ 05:20PM BLOOD Cortsol-5.8\n\nC-PEPTIDE RELEASE TEST:\n=======================\nC-P0 3.20ng/ml\nC-P30 4.59ng/ml\nC-P60 7.67ng/ml\nC-P120 12.48ng/ml\nC-P180 5.86ng/ml\n\n+ C-peptide release test hints the peak relate,did not fall back to fasting values at 180min.\n\nINSULIN RELEASE TEST:\n=====================\nInsulin 25.40mlU/L\nInsulin30 88.10mlU/L\nInsulin60 219.30mlU/L\nInsulin120 274.63mlU/L\nInsulin180 91.45mlU/L\n\n+ Insulin release test hints the peak relate,did not fall back to fasting values at 180min.\n" +} \ No newline at end of file diff --git a/Finished/Diabetes/Type II Diabetes/13918653-DS-4.json b/Finished/Diabetes/Type II Diabetes/13918653-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..dad905cc5e7a48390ae66e105103712d19e4e963 --- /dev/null +++ b/Finished/Diabetes/Type II Diabetes/13918653-DS-4.json @@ -0,0 +1,42 @@ +{ + "Type II diabetes$Intermedia_3": { + "Related C-peptide peak is more common in patients with type II diabetes and is a sign of insulin resistance.$Cause_1": { + "C-peptide release test hints the peak relate, did not fall back to fasting values at 180min$Input6": {} + }, + "Related insulin peak is more common in patients with type II diabetes.This indicator is often combined with C-peptide results for type II diabetes.$Cause_1": { + "Insulin release teat hints the peak relate,did not fall back to fasting values at 180min$Input6": {} + }, + "Suspected Diabetes$Intermedia_2": { + "Polyuria is a classic symptom of diabetes.$Cause_1": { + "Polyuria$Input1": {} + }, + "Polydipsia is a classic symptom of diabetes.$Cause_1": { + "Polydipsia$Input1": {} + }, + "Loss weight rapidly is a claasic symptom of diabetes.$Cause_1": { + "15lb weight loss in the last month$Input2": {} + }, + "Skin getting darker is a symptom of diabetes.$Cause_1": { + "his skin is getting darker$Input2": {} + }, + "Family history is a big risk factor of diabetes.$Cause_1": { + "Aunt with diabetes$Input4": {} + }, + "High GHbA1c level is a sign of diabetes.$Cause_1": { + "%HbA1c-10.8$Input6": {} + }, + "Abnormal cholesterol level is a risk factor of diabetes.$Cause_1": { + "Triglyc-403$Input6": {} + }, + "Abnormal random blood glucose is a diagnostic criteria of diabetes.$Cause_1": { + "Glucose-405$Input6": {} + } + } + }, + "input1": "Polyuria and Polydipsia\n", + "input2": "w/ h/o Hep C, unknown how he contracted it, not tolerant of interferon therapy presents with 2wk h/o of increase thirst, polyuria (up to 10x/day, clear urine), and diziness exacerbated by standing, and anorexia. Also endorses a 15lb weight loss in the last month. The symptoms became increasingly worse when his mouth became extremely dry which made it difficult for him to talk, increase diziness, new onset of non-radiating epigastric pain, and distended abdomen. Patient denies having any symptoms like this in the past. No family history of diabetes other than an aunt. Patient denies any recent fevers, chills, nausea, vomiting, diarrhea, or sick contacts. denies productive cough. Patient also notes that his skin is getting darker.\n\ufeff\nOn ROS, per above, with also dry cough which he says is chronic, and bright red blood spotting the toliet paper, not filling the bowl, which he attributes to his hemorrhoids. Patient also endorses some audio hallucinations of cop sirens and \"voices speaking around him\" however says they are non-threatening and he is able to distinguis them from reality. No visual hallucinations. No suicidal ideation. Otherwise, ROS neg.\n\ufeff\nIn the ED, the patient's admission vitals were 98.4 77 152/74 18 98% RA. The patient was given a bolus of 1L NS, and 10U of insulin. The patient was then transfered to the floor. Vitals on transfer was: 98.2 75 128/74 14 98% \n\ufeff\n", + "input3": "Hepatitis C, unclear transmission, denies transfusion, IVDU\nHTN\nDepression\nAnxiety\nGERD\nBPH\n", + "input4": "Aunt with diabetes, otherwise no contributory\n", + "input5": "ADMISSION PHYSICAL EXAM:\nVS:97.5, 130/69, 18, 98% RA\nSupine BP: 130/69\nSitting BP: 125/73\nStanding BP: 129/72\nGeneral: Pleasant gentleman, looks younger than stated age, NAD\nHEENT: PERRL, MMM, EOM-I, no oral lesions \nNeck: Supple, no lymphadenopathy \nCV: RRR, S1 S2, no R/G/M \nLungs: CTA-B, no wheezes, crackles\nAbdomen: abdomen distended, soft, tender to deep palpation epigastric and LLQ without radiation, no guarding, rebound tenderness\nGU: Uncircumcised, fully developed. Testicles are soft bilaterally.\nExt: No cyanosis, rashes, pitting edema. Peripheral pulses present and full bilaterally \nNeuro: strength in upper/lower extremities, grossly normal, no focal deficits\n", + "input6": "ADMISSION LABS\nWBC-8.2 RBC-4.96 Hgb-15.4 Hct-43.2 MCV-87 MCH-31.0 MCHC-35.6* \nRDW-12.1\nNeuts-53.0 Monos-4.8 Eos-0.9 Baso-1.3PTT-32.8 \nGlucose-405* UreaN-21* Creat-1.2 Na-131* K-3.7 Cl-94* HCO3-26 AnGap-15\nAlbumin-4.0 Calcium-9.4 Phos-3.5 Mg-1.9\n\ufeff\nMISC LABS\n___ Lipase-399*\n___ Lipase-57\n___ calTIBC-403 Ferritn-1597* TRF-310\n___ %HbA1c-10.8* eAG-263*\n___ Triglyc-403*\n\ufeff\nC-PEPTIDE TEST\nC-P0 2.2ng/ml\nC-P30 2.83ng/ml\nC-P60 6.40ng/ml\nC-P120 11.3ng/ml\nC-P180 4.2ng/ml\n+ C-peptide release test hints the peak relate, did not fall back to fasting values at 180min.\n\nINSULIN TEST\nInsulin 25mlU/L\nInsulin30 90mlU/L\nInsulin60 218mlU/L\nInsulin120 256mlU/L\nInsulin180 102mlU/L\n+ Insulin release teat hints the peak relate,did not fall back to fasting values at 180min.\n\nCX\nIMPRESSION: Low lung volumes, which accentuate the bronchovascular markings. Otherwise, no acute cardiopulmonary process. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Epilepsy/Epilepsy/14070294-DS-14.json b/Finished/Epilepsy/Epilepsy/14070294-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..02b3ff15355ea97f1c319466051c77aed0451996 --- /dev/null +++ b/Finished/Epilepsy/Epilepsy/14070294-DS-14.json @@ -0,0 +1,51 @@ +{ + "Epilepsy$Intermedia_3": { + "Epileptiform discharges have a unique spike waveform pattern. Spike waveform refers to the sharp, rapid peaks that appear in EEG recordings, which is one of the important bases for diagnosing epilepsy.$Cause_1": { + "EEG recordings often identify typical epileptiform discharEpileptiform discharges have a unique spike waveform pattern. Spike waveform refers to the sharp, rapid peaks that appear in EEG recordings, which is one of the important bases for diagnosing epilepsy.es which are characterized by their distinctive spike patterns.$Input6": {} + }, + "Suspected Epilepsy$Intermedia_2": { + "This symptom may occur during a seizure, especially one related to the area of \u200b\u200bthe brain that controls language function.$Cause_1": { + "Episodes of slurred speech$Input1": {} + }, + "These are typical symptoms of an epileptic seizure, involving a brief loss of consciousness and muscle twitches.$Cause_1": { + "consist of altered mental status, staring, upper lip twitching, occasional fluttering of eyelids$Input2": {} + }, + "Patients may experience cognitive dysfunction or subtle alterations in mental status while awake, which may be manifestations of chronic epileptic activity.$Cause_1": { + "able to engage in routine activities such as making coffee and doing chores but is perseverative and inattentive during conversations and has no recollection of events afterwards.$Input2": {} + }, + "Persistent confusion may indicate a non-habitual state of seizures$Cause_1": { + "Symptoms are typically prolonged with confusion lasting for hrs at a time with gradual improvement over the next 1 hrs.$Input2": {} + }, + "Has a history of seizures is a risk fact of epilepsy$Cause_1": { + "has had seizures since childhood$Input2": {} + }, + "Status nonatonicum is a form of epilepsy characterized by brief loss of consciousness, usually without overt motor manifestations.$Cause_1": { + "was found to be in nonconvulsiveabsence status.$Input2": {} + }, + "Adjustment of drug doses may affect epilepsy control$Cause_1": { + "She had been on keppra 1250 mg bid which was slowly tapered off over the past several weeks.$Input2": {} + }, + "Family history of stroke patients may be at increased risk of developing epilepsy in some cases$Cause_1": { + "mother with stroke$Input4": {} + }, + "Repetitive behaviors or topics, which may be post-epileptic status$Cause_1": { + "Very perseverative limiting further testing$Input5": {} + }, + "Impairments in memory and mental flexibility may be indirect manifestations of epileptic seizures$Cause_1": { + "Able to do DOY forwards but not any days backwards$Input5": {} + }, + "This reflects an impact on the area of \u200b\u200bthe brain that processes language, which is common in people with temporal lobe epilepsy.$Cause_1": { + "Perseverates when attempting to name objects or repeatsentences.$Input5": {} + }, + "Nystagmus, especially rapid rhythmic movements during distal gaze, may be a sign of neurologic dysfunction and is sometimes seen in neuropathy associated with epilepsy.$Cause_1": { + "beats of endgaze nystagmus b/l$Input5": {} + } + } + }, + "input1": "Episodes of slurred speech\n", + "input2": "67 yo F with history of afib on coumadin. Her symptom consist of altered mental status, staring, upper lip twitching, occasional fluttering of eyelids, and is able to engage in routine activities such as making coffee and doing chores but is perseverative and inattentive during conversations and has no recollection of events afterwards. Symptoms are typically prolonged with confusion lasting for hrs at a time with gradual improvement over the next 1 hrs. \nShe has had seizures since childhood and had been well-controlled on depakote monotherapy, with episodes 9 times per year. However due to a longstanding tremor, she was switched to keppra with frequency increasing to every two months. She had mild improvement with a switch from generic to brand keppra. She was admitted to the epilepsy service in early with her typical events and was found to be in nonconvulsiveabsence status. She was started on zonisamide but becamelethargic at 200 mg daily so was decreased to 100 mg daily andslowly titrated up back to current dose of 200 mg daily. (lethargy was also in context of ativan taper). She had been on keppra 1250 mg bid which was slowly tapered off over the past several weeks. She has also tried dilantin in the past. Per prior notes she has a remote history of GTCs and myoclonus but none recently.\n\nShe lives alone and typically calls her son every morning at 08 am. This AM when she did not call, her son was concerned and tried calling her but she did not pick up. Her arrived and noted her to be inattentive and perseverative. Her son arrived and thought her presentation was consistent with her typical seizures. Per his neurologist's instructions he gave her lorazepam 0.5 mg x2 and possibly with some transient improvement in her symptoms, but symptoms persisted, so he brought her to the ED for further evaluation.\n\nHe reports she has been compliant with his medications and does not believe she has had any recent fevers, chills, cough, SOB, chest pain, palpitations, nausea, vomiting, or diarrhea.\n", + "input3": "+spine fx\n+pelvic fx\n+afib on coumadin\n+osteoporosis\n+pneumonia\n", + "input4": "mother with stroke. Father with MI, sister with lupus.\n", + "input5": "VS: T 98 P 64 BP 139/64 RR 18 96% RA\nGen: lying in bed, NAD\nCV: RRR, no murmurs\nPulm: CTA anteriorly\nAbd: soft, nt, nd\nExtr: 1+ edema at anklesNeuro;\nMS: Awake, oriented to person and her age. Can tell me her son's name but not his birthday. Very perseverative limiting further testing. Able to do DOY forwards but not any days backwards. Follows appendicular commands and occasional two-step simple commands. Perseverates when attempting to name objects or repeatsentences. Registers, recalls at 1 and 3 minutes. \nCN: PERRL 4mm-->3mm, EOMI, beats of endgaze nystagmus b/l. Appears to blink to threat in all visual fields. Face symmetric, palate symmetric, tongue midline.\nMotor: normal bulk and tone. No pronator drift, tremor, or asterixis. Uncooperative with formal strength testing but maintains against gravity and symmetric at R and L delt, bicep, tricep, FE, FF, IP, TA, and gastrocs.\nSensory: intact to light touch throughout.\nReflexes: 1+ at biceps and brachioradialis, 0 at patellar and achilles b/l. Toes downgoing.\nCoordination: no dysmetria on FNF b/l.\nGait: deferred\n", + "input6": "Admission Labs: \nCBC Normal \nBMP/Ca/Mg/Phos: normal \nUA: Yellow, Hazy, 1.106, 4 RBC, 36 RBC, few bacteria\n\nEEG:\nEEG recordings often identify typical epileptiform discharges which are characterized by their distinctive spike patterns. \n" +} \ No newline at end of file diff --git a/Finished/Epilepsy/Epilepsy/14535113-DS-34.json b/Finished/Epilepsy/Epilepsy/14535113-DS-34.json new file mode 100644 index 0000000000000000000000000000000000000000..6ca600dee7d69fb2bbfb56cc729910df86749152 --- /dev/null +++ b/Finished/Epilepsy/Epilepsy/14535113-DS-34.json @@ -0,0 +1,39 @@ +{ + "Epilepsy$Intermedia_3": { + "Brain injury is one of the common causes of epilepsy, which may cause lesions or dysfunction of brain tissue.$Cause_1": { + "MRI scan, which revealed structural abnormalities in the brain. Specifically, the imaging showed brain injuries.$Input6": {} + }, + "Suspected Epilepsy$Intermedia_2": { + "Occurs during a seizure, possibly due to apnea or irregular breathing that causes a decrease in oxygen levels in the blood$Cause_1": { + "Event of cyanosis$Input1": {} + }, + "A generalized seizure lasts about 3 minutes and is accompanied by cyanosis. It refers to sudden muscle rigidity and convulsions throughout the body, often accompanied by loss of consciousness. It is a typical symptom of epilepsy.$Cause_1": { + "presented the following day for admission to psych when he was noticed to have generalized seizuers x 3 mins associated with cyanosis.$Input2": {} + }, + "Apnea is common in people with epilepsy$Cause_1": { + "represents to the ED for an episode of apnea$Input2": {} + }, + "Arteriovenous malformations are abnormal blood vessel structures in the brain that can cause seizures$Cause_1": { + "left frontal AVM s/p resection$Input2": {} + }, + "Possibly due to autonomic dysfunction in epileptic seizures$Cause_1": { + "presents secondary to apnea$Input2": {} + }, + "Past medical conditions directly related to epilepsy$Cause_1": { + "Seizure disorder$Input3": {} + }, + "Head injuries and concussions are known triggers of epilepsy$Cause_1": { + "History of head injury and concussion$Input3": {} + }, + "Arteriovenous malformations (AVMs) may increase risk of epilepsy$Cause_1": { + "s/p resection of left frontal AVM$Input3": {} + } + } + }, + "input1": "Event of cyanosis\n", + "input2": "56 y/o LHM with seizure d/o, left frontal AVM s/p resection, borderline personality d/o and depression who presents secondary to apnea. He was admitted for LTM, discharged on clonopin 0.25/0.25/0.5 and taken off other AEDs including dilantin and zonegran while on outpatient EEG monitoring. He then presented the following day for admission to psych when he was noticed to have generalized seizuers x 3 mins associated with cyanosis. This resolved with ativan 2mg. He was restarted on zonegran and his clonopin was increased. During this hospitalization, he left the hospital yesterday evening against medical advice. A recent evalaution deemed the patient not have the capacity to leave AMA. He then represents to the ED for an episode of apnea.\n\nPer the patient, after leaving the hospital he returned home and went to sleep. At ~10pm his roommate awake to use the bathroom and found him to not be breathing and \"blue\". He then shook the patient which resulted in him releasing a large \"gasp\". His partner was notified and he was taken for evaluation. They waited in the ED for ~8hrs and then determined that it would be better to go home, get a good night's sleep and come to the ED this morning.\n\nIn terms of yesterday's events, the patient states that the reason he left was that no EEGs were being obtained and \"none of the 3 doctors where telling the plan\". He also states he will \"never do it again\".\n\nROS:\nIn addition, there has been no other neurologic signs including seizure activity, change in mentation, vision difficulities, slurred speech, weakness or loss of bowel/bladder function. He does state that he did not take any of his medications today.\n", + "input3": "+Seizure disorder\n+Psychogenic non-epileptic seizures \n+s/p resection of left frontal AVM \n+PTSD related to history of sexual assault \n+Irritable bowel syndrome \n+Insomnia \n+Depression, h/o suicide attempts and psychiatric hospitalization \n+Hemorrhoids \n+Asthma \n+History of head injury and concussion \n+History of bulimia \n+Cognitive disorder, NOS \n+Borderline personality disorder \n+Hydrocele\n", + "input4": "Per record, maternal grandmother and cousin have h/o seizures. Notable also for schizophrenia, depression, alcoholism, and stroke.\n", + "input5": "- VS: Tc 97.0 HR 90 RR 12 BP 120/87 Sat 100% on RA\n- General: Awake, alert, interactive, cooperative with exam,NAD, sitting in bed in hall, obese\n- HEENT: NCAT, mucous membranes moist and pink, scleranon-icteric, OP clear\n- Neck: Supple, no thyromegaly, no lymphadenopathy\n- Lungs: Clear bilaterally, good aeration, no wheezing/crackles\n- Cardiac: Normal S1 and S2, no murmur\n- Abdomen: S/NT/obese, +BS\n- Extremities: no C/C/E, distal pulses full, warm and wellperfused, brisk capillary refill, left wrist in brace\n- Skin: diffuse erythematous rashes over areas of adhesive frommonitoring during admissions, EEG glue remains in hair\n \nNeurologic Examination:\n- MS: Of note, patient was ablet perform MS testing without prompting/questioning. Orientation - oriented to person, place and date, attentive. Language - speech is fluent, without paraphasic errors, intact registration, repetition, naming. \nMemory - recalls 3 items at 5 minutes. Correct DOWF and DOWB.\n", + "input6": "___ 07:05AM BLOOD WBC-6.0 RBC-4.92 Hgb-14.7 Hct-42.7 MCV-87 MCH-29.8 MCHC-34.3 RDW-14.2 Plt ___\n___ 08:45AM BLOOD Neuts-55.8 ___ Monos-4.5 Eos-1.0 Baso-1.0\n___ 07:05AM BLOOD Glucose-105* UreaN-18 Creat-0.9 Na-137 K-4.3 Cl-106 HCO3-24 AnGap-11\n___ 08:45AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 05:27AM BLOOD ZONISAMIDE(ZONEGRAN)-PND\n\nMRI:\nMRI scan, which revealed structural abnormalities in the brain. Specifically, the imaging showed brain injuries. Further diagnostic and therapeutic measures are recommended to ensure the patient's health is appropriately managed and monitored.\n" +} \ No newline at end of file diff --git a/Finished/Epilepsy/Epilepsy/14690121-DS-15.json b/Finished/Epilepsy/Epilepsy/14690121-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..f9c7ca0755396688e0c9e9549916f58a753b4045 --- /dev/null +++ b/Finished/Epilepsy/Epilepsy/14690121-DS-15.json @@ -0,0 +1,42 @@ +{ + "Epilepsy$Intermedia_3": { + "Typical epileptic discharges were observed during EEG examination, which is one of the criteria for diagnosis.$Cause_1": { + "EEG typical epileptiform discharges, showing as spikes$Input6": {} + }, + "Suspected Epilepsy$Intermedia_2": { + "Serious car accidents may cause brain damage, increase risk of epilepsy$Cause_1": { + "significant motor vehicle accident$Input2": {} + }, + "The patient had a series of epileptic seizures$Cause_1": { + "a flurry of seizures$Input2": {} + }, + "Bright or flashing lights can trigger seizures, called photosensitive epilepsy.$Cause_1": { + "been frustrated with the \"fluorescent lights\" at work$Input2": {} + }, + "A complex partial classic seizure lasting about five minutes$Cause_1": { + "a prolonged complex partial typical seizure.$Input2": {} + }, + "Memory loss is one of the symptoms of epilepsy$Cause_1": { + "She does not remember the conversation nor the remainder of the daily activities from yesterday.$Input2": {} + }, + "Lamotrigine and clonazepam are both drugs used to treat epilepsy. Unauthorized reduction of the dose may lead to a decrease in the blood concentration of the drug, weakening the control effect on epilepsy, thereby increasing the risk of seizures.$Cause_1": { + "she halved her LTG dose and the clonazepam dose (from 2 to 1mg QHS)$Input2": {} + }, + "Recurrent neurological dysfunction in the past is one of the risk factors$Cause_1": { + "Seizure disorder$Input3": {} + }, + "The patient is sweating, which may be a manifestation of an uncommon seizure.$Cause_1": { + "appeared diaphoretic but did not convulse$Input5": {} + }, + "Increased heart and breathing rates may be physiological responses during epileptic seizures$Cause_1": { + "HR increased to 105, and RR to about 26$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "This is a 60 woman with a history of PTSD anddepression and a significant motor vehicle accident in who presents to the ED following a flurry of seizures. The patient provides her own history. \n\nShe explains that her general physical health has largely been stable. She was treated with a course of amoxicillin last week for a \"head cold\". She has recently been able to secure employment over the past three months, and she has been frustrated with the \"fluorescent lights\" at work, which she feels may be exacerbating her seizure disorder. \n\nApparently last night, she had a prolonged complex partial typical seizure. This was only noted to her in retrospect - the seizure occurred while she was on the phone with her father and lasted for about five minutes. She does not remember the conversation nor the remainder of the daily activities from yesterday. She woke up this morning with an immense sense of anxiety and fear. She had a seizure at home, and upon speaking with Dr. G the seizure, she was directed to our ED.\n\nOn further questioning, she reports that she has been taking half of her dose of her lamotrigine. She could not tell me exactly when she started taking this dose. She reported to one of our on-call physicians over the phone 3 days prior) that she had taken Dr. G permission to do this, but Dr. G was not aware of this at all. She now explains that she was having difficulty functioning at work at the higher dose, and that she is \"extremely sensitive to medications\". She was also having some decreased appetite, and so she halved her LTG dose and the clonazepam dose (from 2 to 1mg QHS), but not the lacosamide (100mg BID). \n\nOn review of systems, she admits to having one episode of loose stool this morning, some mild headache and difficulties with concerntation and increased anxiety. She is due to get her period in a few days (menses is a typical trigger for her). \n\n", + "input3": "+Seizure disorder\n+S/p cholecystectomy\n+Depression/Anxiety/PTSD\n", + "input4": "Father: ETOH abuse and manic-depressive\n", + "input5": "vital signs were 98.7, HR 92, BP124/81, RR 18, 98%. \nIn general, patient is awake, cooperative, pleasant and appeared quite anxious. She had a flat affect with limited emotionality. During the interview, on one occasion, she was able to verbalize that she was having a seizure. She followed commands during this time. She appeared diaphoretic but did not convulse. Her HR increased to 105, and RR to about 26. Otherwise, the patient had a NCAT head without conjunctival icterus. Mucous membranes were moist and oropharynx is clear of lesions. Neck was supple without masses or thyromegaly. Chest examination revealed regular heart sounds without murmurs, and lungs were clear to auscultation bilaterally. Belly was thin and soft without focal tenderness, and extremities were warm and well perfused. Skin examination showed no rashes or lesions. \n\nNeurologically, the patient is awake, alert and oriented x 3. Able to relate history without difficulty. Attentive, able to name backward without difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Able to read without difficulty. Speech was not dysarthric. Able to follow both midline and appendicular commands. Pt. was able to register 3 objects and recall at 5 minutes.\n", + "input6": "___ 01:35PM GLUCOSE-103* UREA N-6 CREAT-0.6 SODIUM-136 POTASSIUM-3.7 CHLORIDE-102 TOTAL CO2-27 ANION GAP-11\n___ 01:35PM WBC-7.2 RBC-4.98 HGB-14.2 HCT-40.8 MCV-82 MCH-28.6 MCHC-34.9 RDW-12.9\n___ 01:35PM NEUTS-78.7* LYMPHS-14.6* MONOS-5.5 EOS-0.5 BASOS-0.8\n___ 01:35PM PLT COUNT-224\n___ 01:35PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 01:35PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG\n\nEEG:\nEEG typical epileptiform discharges, showing as spikes\n" +} \ No newline at end of file diff --git a/Finished/Epilepsy/Non-epileptic Seizure/12280090-DS-12.json b/Finished/Epilepsy/Non-epileptic Seizure/12280090-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..412f6c26a4e5e22ae75fb970fee6e08700d619f2 --- /dev/null +++ b/Finished/Epilepsy/Non-epileptic Seizure/12280090-DS-12.json @@ -0,0 +1,48 @@ +{ + "Non-epileptic Seizure$Intermedia_3": { + "EEG showed no signs of epilepsy$Cause_1": { + "There are no frank epileptiform discharges or electrographic seizures$Input6": {} + }, + "normal video-EEG rule out epilepsy$Cause_1": { + "a normal video-EEG monitoring session$Input6": {} + }, + "Suspected Epilepsy$Intermedia_2": { + "The patient's long-standing hearing problems and multiple ear surgeries may have led to abnormal body and nervous system responses to pressure, which could be associated with non-epileptic seizures.$Cause_1": { + "bilateral hearingloss and multiple ear surgeries,$Input2": {} + }, + "Vertigo and orthostatic hypotension may cause a temporary lack of blood flow to the brain, triggering a non-epileptic seizure$Cause_1": { + "Immediately after waking from that procedure she had severe vertigo, \"triple\" vision and orthostatic hypotension.$Input2": {} + }, + "Sudden loss of consciousness may be a seizure$Cause_1": { + "she suddenly lost consciousness$Input2": {} + }, + "Whole body shaking may be an epileptic seizure$Cause_1": { + "witnessed of whole body shaking$Input2": {} + }, + "Sensory abnormalities, such as strange tastes or flavors, may be related to abnormal activity in the nervous system.$Cause_1": { + "She recalls a metallic taste and a funny smell$Input2": {} + }, + "These symptoms are common in epileptic seizures$Cause_1": { + "She also bit her tongue and had urinary incontinence$Input2": {} + }, + "The use of sedatives such as diazepam may result in increased sensitivity of the nervous system, triggering or worsening symptoms of non-epileptic seizures.$Cause_1": { + "She has been trying to take less diazepam for the vertigo$Input2": {} + }, + "Neurological problems, such as long-standing headaches, weakness on the side of the body, and new numbness in the hands, may increase the risk of non-epileptic seizures.$Cause_1": { + "Has a chronic bandlike headache. She has chronic left sided weakness since cervical fusion.$Input2": {} + }, + "These are common triggers of non-epileptic seizures$Cause_1": { + "Bilateral hearing loss and surgeries$Input3": {} + }, + "Back surgery and chronic low back pain may lead to chronic pain, which is a known cause of non-epileptic seizures.$Cause_1": { + "Lumbar discectomy and fusion$Input3": {} + } + } + }, + "input1": "Seizure\n", + "input2": "This is a 31 year old woman with a history of bilateral hearingloss and multiple ear surgeries, and subsequent severe vertigo and orthostatic hypotension since the most recent surgery, who presents with 2 events concerning for seizures in the past 24 hours.\n\nThe patient reports bilateral hearing loss since her pregnancy. She thinks this was a result of her pregnancy and a virus. Since that time she has had multiple surgeries to try to improve her hearing including reconstruction of the eustasian tube. Most recently she had tympanoplasty of the right ear. Immediately after waking from that procedure she had severe vertigo, \"triple\" vision and orthostatic hypotension. The vertigo is constant and worse with activity and light. The triple vision is monocular and constant. The orthostatic hypotension is so severe that she passes out with little warning at least daily. She was in rehab for a month due to these symptoms and continues to get rehab. She walks with a walker for only a few minutes at a time.\n\nLast evening around 6pm she was sitting on her bed with her husband and child when she suddenly lost consciousness. She recalls a metallic taste and a funny smell immediately prior to this. He husband witnessed of whole body shaking. She also bit her tongue and had urinary incontinence. Upon regaining consciousness she felt extremely tired all evening and sore with a new headache, but no confusion. This morning around 8am as she was getting her child ready for daycare she had another event with the same prodrome while standing (had been standing for a few minutes). This lasted 5s. She also immediately regained consciousness.\n\nShe has been trying to take less diazepam for the vertigo and only took it once in the morning yesterday, though she has skipped a day in the past. No recent illnesses. Has a chronic bandlike headache. She has chronic left sided weakness since cervical fusion. Now new right hand numbness. + weight loss due to poor appetite.\n \nOn neuro ROS, the pt denies loss of vision, blurred vision, diplopia, dysarthria, dysphagia. Denies difficulties producing or comprehending speech.\n", + "input3": "+Bilateral hearing loss and surgeries\n+Lumbar discectomy and fusion\n", + "input4": "No seizure, stroke. Aunt with multiple strokes.\n", + "input5": "Vitals: 98.44 84 128/91 18 99% \nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx. Tube in left ear, artificial tympanic membrane on the right. \nNeck: Supple \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: RRR, nl. S1S2\nExtremities: No C/C/E bilaterally\n \nNeurologic: \n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Grossly attentive to exam. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency objects. Speech was not dysarthric. Able to follow both midline and appendicular commands. There was no evidence of neglect. \n \n-Cranial Nerves: \nII: PERRL 3 to 2mm and brisk. VFF to confrontation. Funduscopic exam revealed no papilledema, exudates, or hemorrhages. \nIII, IV, VI: EOMI without nystagmus. Slow and irregular saccades-appears volitional. \nV: Facial sensation intact to light touch. \nVII: No facial droop, facial musculature symmetric. \nVIII: Hearing intact to voice. \nIX, X: Palate elevates symmetrically. \nXI: strength in trapezii and SCM bilaterally. \nXII: Tongue protrudes in midline with normal strength\n", + "input6": "___\nEEG\nIMPRESSION: This is a minimally abnormal video-EEG monitoring session. A few isolated sleep-related sharp transients noted in the left temporal region are of questionable clinical significance. There are no frank epileptiform discharges or electrographic seizures. None of the patient's typical events are recorded. \n\n___\nEEG\nIMPRESSION: This is a normal video-EEG monitoring session. The patient had one of her typical episodes which involved whole-body jerking but with immediate ability to follow commands afterwards. No electrographic seizures or epileptiform discharges are recorded. \n\n___\nMR ___\nIMPRESSION: \nNo significant focal lesions. Slightly small left hippocampus on some images; no signal/architectural changes. Fluid in mastoids, right more than left. \n\n___ 05:48AM BLOOD WBC-5.4 RBC-4.51 Hgb-12.5 Hct-38.7 MCV-86 MCH-27.7 MCHC-32.3 RDW-12.7 Plt ___\n___ 05:48AM BLOOD Glucose-83 UreaN-15 Creat-0.7 Na-137 K-3.7 Cl-107 HCO3-24 AnGap-10\n___ 05:48AM BLOOD Calcium-8.3* Phos-3.8 Mg-1.8\n___ 03:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n" +} \ No newline at end of file diff --git a/Finished/Epilepsy/Non-epileptic Seizure/12381874-DS-9.json b/Finished/Epilepsy/Non-epileptic Seizure/12381874-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..6929d989b3c4ba67cb99f651fecb92fd91ce2c03 --- /dev/null +++ b/Finished/Epilepsy/Non-epileptic Seizure/12381874-DS-9.json @@ -0,0 +1,39 @@ +{ + "Epilepsy$Intermedia_3": { + "In video EEG monitoring, although multiple events were captured, there were no clear EEG changes, which is one of the important bases for the diagnosis of NES.$Cause_1": { + "Multiple events were captured with no clear EEG correlate but there was some temporal slowing after a few of the events$Input2": {} + }, + "Suspected Epilepsy$Intermedia_2": { + "The patient has an increase in the number of seizures$Cause_1": { + "Increased Seizure Frequency$Input1": {} + }, + "History of seizures is a important risk factor$Cause_1": { + "past history of seizures$Input2": {} + }, + "Patients present with nonrhythmic, asymmetric muscle twitches and postural fixations in partial seizures that are short-lived. This symptom may be associated with NES.$Cause_1": { + "most events occuring as staring into space, only some of which secondarily generalize to tonic asymmetric posture with either eyes rolled back or clenched tightly and non-rhythmic, asymmetric jerking or posturing lasting for <2 minutes per episode.$Input2": {} + }, + "After a seizure, there is often noticeable confusion or fatigue. However, patients show milder sequelae after the attack, such as a softer voice, which may point to NES$Cause_1": { + "very little post-ictal confusion or fatigue, rather only some quieter speech$Input2": {} + }, + "The patient's behaviors during the episodes, such as closing his eyes, leaning back, and asymmetrical muscle posturing, may be triggered by psychological or emotional factors and are consistent with NES.$Cause_1": { + "The semiology of these included the patient closing her eyes and becoming unresponsive, then her eyes became tightly closed with subsequent back arching and asymmetric tonic posturing of her upper and lower extremities.$Input2": {} + }, + "Head injuries can cause abnormal brain function, which can sometimes lead to epileptic seizures.$Cause_1": { + "Head injury$Input3": {} + }, + "Chronic headaches may be related to abnormalities in pain processing in the brain, which are also sometimes associated with epilepsy.$Cause_1": { + "Chronic headaches$Input3": {} + }, + "Family history is an important risk factor$Cause_1": { + "Paternal grandmother with epilepsy.$Input4": {} + } + } + }, + "input1": "Increased Seizure Frequency\n", + "input2": "She is a 44 year old right handed woman with past history of seizures since followed by Dr. G who presents with increasing seizure activity. Per the patient's husband, her seizure frequency was decreased from her prior presentation with most events occuring as staring into space, only some of which secondarily generalize to tonic asymmetric posture with either eyes rolled back or clenched tightly and non-rhythmic, asymmetric jerking or posturing lasting for <2 minutes per episode. This morning, the patient was in a continuing education seminar at which time, she was witnessed to have two of the asymmetric posturing and non-rhythmic tremor events for which EMS was activated. Per the run report of the patient to ED, she had two further events with very little post-ictal confusion or fatigue, rather only some quieter speech. She had another event while in transport, for which she received 1mg ativan with good effect. While in the ED she also had two events which were treated with 1mg ativan, and then 2mg ativan, roughly apart of each other.\n\nIn the ED with Neurology present, the patient had two further episodes of seizure which were not treated with any intervention. The semiology of these included the patient closing her eyes and becoming unresponsive, then her eyes became tightly closed with subsequent back arching and asymmetric tonic posturing of her upper and lower extremities. The patient subsequently began having nonrhythmic convulsive activity and was able to have alternating upper and lower extremity movement with a turn from her right to her left lateral decubitus. This event lasted for approximately 90 seconds with resolution. No postictal confusion or frank fatigue as noted, nor was any paralysis experienced. During his advanced the patient was able to pull off her EKG leads.\n\nRecently, she was admitted for characterization of these events on video EEG monitoring. Multiple events were captured with no clear EEG correlate but there was some temporal slowing after a few of the events which raised concern for deep seizures that weren't being captured by surface electrodes. SPECT was performed at which time she was placed back on VPA 500mg BID and ZNS 100mg BID, with a plan to increase the zonisamide slowely over the next 2 weeks. \n\nNo recent illness, trauma, or other exposures were noted. The patient and her husband were over the weekend; however, no tick bites or other rash was noted. The patient notes some increasing anxiety associated with returning to work her she is a high school.\n \nOn neuro ROS, the pt reports mild headache. Denies loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denies difficulties producing or comprehending speech. Denies focal weakness, numbness, parasthesiae. No bowel or bladder incontinence or retention. Denies difficulty with gait.\n", + "input3": "+Head injury \n+Chronic headaches \n+Ischemic colitis, no surgery\n+Low mood in context of illness\n+Nexium started by GI\n", + "input4": "Paternal grandmother with epilepsy. Father deceased from esophageal cancer. Mother is healthy. She has 2 brothers who are healthy.\n", + "input5": "Pain=0, T=97.4F, HR=71, BP=116/76, RR=18, SaO2=100% RA \nGeneral: Awake, cooperative, NAD, but looking somewhat tired\nHEENT: NC/AT\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity\nPulmonary: CTABL\nCardiac: RRR, no murmurs\nAbdomen: soft, nontender, nondistended\nExtremities: no edema, pulses palpated\nSkin: no rashes or lesions noted.\n \nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency objects. Able to read without difficulty. Speech was not dysarthric. Able to follow both midline and appendicular commands. Attentive, with good knowledge of current events. There was no evidence of apraxia or neglect. Calculations intact.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 5 to 3mm, both directly and consentually; brisk bilaterally. VFF to confrontation. Funduscopic exam revealed no papilledema, exudates, or hemorrhages.\nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch, pinprick in all distributions, and strength noted bilateral in masseter\nVII: No facial droop, facial musculature symmetric and strength in upper and lower distributions, bilaterally \nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline, and is equal strength bilaterally as evidenced by tongue-in-cheek testing.\n", + "input6": "___ 05:23PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 05:23PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG\n___ 03:00PM GLUCOSE-78 UREA N-17 CREAT-0.8 SODIUM-143 POTASSIUM-3.7 CHLORIDE-105 TOTAL CO2-28 ANION GAP-14\n___ 03:00PM estGFR-Using this\n___ 03:00PM WBC-8.9 RBC-4.20 HGB-13.5 HCT-38.5 MCV-92 MCH-32.1* MCHC-35.0 RDW-12.3\n___ 03:00PM NEUTS-65.7 ___ MONOS-5.7 EOS-3.5 BASOS-0.9\n___ 03:00PM PLT COUNT-214\n\nSinus rhythm. RSR' pattern in leads V1-V2 of unknown significance. Poor R wave progression across the precordium. Compared to the previous tracing the RSR' pattern is new and worrisome for right ventricular pathology.\n" +} \ No newline at end of file diff --git a/Finished/Epilepsy/Non-epileptic Seizure/12788473-DS-11.json b/Finished/Epilepsy/Non-epileptic Seizure/12788473-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..de1f77c53e8eab048b4a27bb7c2f0d92dc064491 --- /dev/null +++ b/Finished/Epilepsy/Non-epileptic Seizure/12788473-DS-11.json @@ -0,0 +1,30 @@ +{ + "Epilepsy$Intermedia_3": { + "No EEG activity was recorded, a finding that suggests that although the patient had significant paroxysmal motor symptoms, these were not due to epilepsy.$Cause_1": { + "NO ELECTROGRAPHIC SEIZURES RECORDED.$Input6": {} + }, + "Suspected Epilepsy$Intermedia_2": { + "Sudden, uncontrolled muscle contractions are a classic symptom of an epileptic seizure.$Cause_1": { + "convulsion spells concerning for seizure$Input1": {} + }, + "These symptoms are characterized by rapid shaking of body parts without cyanosis or vocalization, features consistent with nonepileptic seizures. Nonepileptic seizures are usually not accompanied by the physical symptoms of a typical epileptic seizure, such as cyanosis.$Cause_1": { + "rapid shaking of both arms or legs followed by shaking of the the other extremities, back and forth shaking of the head, progression from one limb to another happens within seconds, overall episode can last up to 2 minutes, eyes are forced closed, she does not turn blue and there are no vocalizations.$Input2": {} + }, + "Patients were still able to hear people around them during the seizures and did not completely lose consciousness, suggesting that these seizures were different from typical epilepsy.$Cause_1": { + "typically after an episode she almost immediately reorients to her surroundings and there is no significant post$Input2": {} + }, + "A long history of psychiatric illness and substance abuse may be important factors in nonepileptic seizures.$Cause_1": { + "on a background of significant and long standing psychiatric disease, substance abuse.$Input2": {} + }, + "Bipolar disorder is a mental health condition that involves extreme mood swings that may increase the risk of non-epileptic seizures.$Cause_1": { + "Bipolar disorder$Input3": {} + } + } + }, + "input1": "convulsion spells concerning for seizure\n", + "input2": "She is a 49 yo right handed female who presents with seizure-like events on a background of significant and long standing psychiatric disease, substance abuse. She was transfered to the ED after presenting to outpatient neurology clinic where she had several events concerning for non-epileptic seizure. \n\nShe reports episodes every 7 days that are described as follows: rapid shaking of both arms or legs followed by shaking of the the other extremities, back and forth shaking of the head, progression from one limb to another happens within seconds, overall episode can last up to 2 minutes, eyes are forced closed, she does not turn blue and there are no vocalizations. typically after an episode she almost immediately reorients to her surroundings and there is no significant post-ictal period - although she does feel generally tired. Typically she can hear people around her and denies complete loss of consciousness. No tongue biting and no episodes of incontinence during the seizure - although she does endorse chronic nocturia for which she intermittently wears diapers. She has no history of head trauma, concussion, motor vehicle accidents. \n\nIn the ED she experienced several episodes of whole body shaking for which she was not given rescue medication.\n\nShe has no family of seizure. Her brother suffered a stroke at age in post-op period and was found to have prothrombin gene mutation. The patient hreself was subsequently tested and found to have the mutation as well.\n", + "input3": "+Bipolar disorder\n+history of opiate/benzo dependence - narcotics contract\n+IV drug use - heroin , none in 4 months\n+hepatitis C\n+Prothrombin gene mutation; unclear significance, no history of clots, she was screened because her brother was found to have the mutation in a workup for stroke\n", + "input4": "Mother and grandmother with depression/anxiety, mother with prior substance addiction; \nfather with heroin abuse and depression. Brother with prothrombin mutation and episode of stroke\n", + "input5": "Vitals:\n97.6 70 124/72 18 98% RA \nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity\nPulmonary: CTABL\nCardiac: RRR, no murmurs\nAbdomen: soft, nontender, nondistended\nExtremities: no edema, pulses palpated\nSkin: no rashes or lesions noted.\n \nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency objects. Able to read without difficulty. Speech was not dysarthric. Able to follow both midline and appendicular commands. Attentive, able to name backward without difficulty. Pt. was able to register 3 objects and recall at 5 minutes. The pt. had good knowledge of current events. There was no evidence of apraxia or neglect.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm, both directly and consentually; brisk bilaterally. VFF to confrontation. \nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch, pinprick in all distributions, and strength noted bilateral in masseter\nVII: No facial droop, facial musculature symmetric and strength in upper and lower distributions, bilaterally \nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline, and is equal strength bilaterally as evidenced by tongue-in-cheek testing.\n", + "input6": "___ 03:00PM ___ PTT-28.6 ___\n___ 03:00PM PLT COUNT-205\n___ 03:00PM WBC-6.1 RBC-3.85* HGB-12.9 HCT-37.1 MCV-97 MCH-33.4* MCHC-34.6 RDW-13.6Lactate:1.4\n___ 03:00PM ALT(SGPT)-149* AST(SGOT)-96* ALK PHOS-60 TOT BILI-0.2\n___ 03:00PM ALBUMIN-3.8 CALCIUM-9.1 PHOSPHATE-3.8 MAGNESIUM-2.1\n___:00PM GLUCOSE-107* UREA N-12 CREAT-0.9 SODIUM-136 POTASSIUM-4.0 CHLORIDE-103 TOTAL CO2-26 ANION GAP-11\n___ 03:15PM URINE RBC-2 WBC-1 BACTERIA-NONE YEAST-NONE EPI-4\n___ 03:15PM URINE bnzodzpn-POS barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-POS\n___ 03:15PM URINE UCG-NEGATIVE\n\nEEG- multiple pushbutton events for her characteristic episodes of head shaking arm and leg convulsions with NO ELECTROGRAPHIC SEIZURES RECORDED.\n" +} \ No newline at end of file diff --git a/Finished/Epilepsy/Non-epileptic Seizure/12909121-DS-6.json b/Finished/Epilepsy/Non-epileptic Seizure/12909121-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..16581c8430a0e477124c560b8dd1c2b2324e5836 --- /dev/null +++ b/Finished/Epilepsy/Non-epileptic Seizure/12909121-DS-6.json @@ -0,0 +1,42 @@ +{ + "Epilepsy$Intermedia_3": { + "Non-epileptic seizures usually do not affect the ECG, ruling out epilepsy$Cause_1": { + "ECG is normal during the attack$Input6": {} + }, + "Suspected Epilepsy$Intermedia_2": { + "Seizure-like events, possibly epilepsy$Cause_1": { + "Seizure-like events$Input1": {} + }, + "The patient had a history of pseudoseizures, which directly suggested that the seizures were nonepileptic in nature. Depression/anxiety and polysubstance abuse are also common triggers of NES.$Cause_1": { + "w/ hx of pseudoseizures, depression/anxiety and polysubstance abuse$Input2": {} + }, + "Polysubstance abuse may trigger or exacerbate NES.$Cause_1": { + "treated at this facility for poly substance abuse including heroin, benzos and opiates on Methadone 100 mg day.$Input2": {} + }, + "Rapid discontinuation of benzodiazepines (such as Xanax) may trigger withdrawal symptoms, leading to pseudo-seizures$Cause_1": { + "benzos Xanax per day) were quickly weaned off$Input2": {} + }, + "Spasmodic movements and urinary incontinence are typical symptoms of epileptic seizures$Cause_1": { + "At OSH pt was noted to have an episodes of tonic clonic movement and convulsions with urinary incontinence$Input2": {} + }, + "Suddenly stops talking and begins shaking violently; these irregular, violent movements are more consistent with an epileptic seizure$Cause_1": { + "whole body began to shake violently$Input2": {} + }, + "Medical history is an important risk factor$Cause_1": { + "he first developed these type of events when he was 11 years old$Input2": {} + }, + "Medical history of seizure is an important risk factor$Cause_1": { + "Seizure disorder$Input3": {} + }, + "polysubstance abuse may cause epilepsy$Cause_1": { + "polysubstance abuse$Input3": {} + } + } + }, + "input1": "Seizure-like events\n", + "input2": "The patient is a 27 year old man w/ hx of pseudoseizures, depression/anxiety and polysubstance abuse who presents as OSH transfer for further management of seizure-like events. Hx obtained from pt and OSH records. \n\nPatient was recently admitted to section 35 from facility for evaluation of seizure like activity. He was being treated at this facility for poly substance abuse including heroin, benzos and opiates on Methadone 100 mg day. Per OSH documentation, benzos Xanax per day) were quickly weaned off at facility and may have prompted these events. At OSH pt was noted to have an episodes of tonic clonic movement and convulsions with urinary incontinence. He was managed in ICU out of concern for benzo withdrawal and was treated with high dose benzos. He was reportedly evaluated by neurology and thought that may be pseudo seizures (pt himself feels that these are pseudoseizures) started on Keppra 500 mg BID with no effect. He continued to have episodes per day. Routine EEG was performed but there was no neurologist to read due to neurologist there being on vacation until end. He was then transferred as a direct admission for further evaluation. \n\nOf note, en route he had an episode where he suddenly stopped talking to EMS and his whole body began to shake violently. EMS brought him to the ED where he continued to violently shake all his extremities non rhythmically. He was given 2mg Ativan x1 without improvement. ED resident put saline in his eyes which stopped the episode immediately. Entire episode lasted circa 15 minutes per report w/ postictal drowsiness.\n\nPer OSH documentation, pt has hx of \"partial complex seizure disorder\" for which he had previously been taking Lamictal and Lyrica, now on Tegretol. However, \n\nHet states that he first developed these type of events when he was 11 years old (at that time with aura of electrical activity moving up his body), at that time being started on Phenobarbital by his family doctor. He continued on this medication until he was 16 years old when his doctor left town and he could no longer obtain. He states that his seizures returned but evolved into more myoclonic activity (imitates in bed as a whole body jerk). Around this time he began to buy benzodiazepines on the street as preventative therapy, particularly when he felt that a seizure may be coming on. He thinks that he used this medication 1/month w/ control of his episodes. At the same time he also began to engage in heroin use. This behavior continued for some years until college when he began to have breakthrough events. Soon after that he was working in where he was able to obtain Phenobarbital with cessation of his episodes. However, they returned when he came back to US and was unable to receive medication. He had a similar experience while working in the following year. In the last years he quit heroin but began to take Valium daily. Because he continued to be dependent on this medication, he presented to detox when he had seizure like activity and was sent.\n", + "input3": "+Seizure disorder\n+Mood d/o\n+polysubstance abuse\n", + "input4": "NC\n", + "input5": "- General: Awake, cooperative, NAD.\n- HEENT: NC/AT\n- Neck: Supple\n- Pulmonary: no increased WOB\n- Cardiac: well perfused \n- Abdomen: soft, nontender, nondistended\n- Extremities: no edema, pulses palpated\n- Skin: no rashes or lesions noted.\n\nNeurologic:\n\n-Mental Status: Appears very drowsy, oriented to person place and year. Unable to relate history without difficulty. Inattentive, unable to name backward without difficulty. Language is hesitant but with intact repetition and comprehension. Able to name both high and low frequency objects. Speech was hypophonic and difficult to understand, but no obvious dysarthria. Able to follow both midline and appendicular commands.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk. VFF to confrontation. \nIII, IV, VI: EOMI without nystagmus. \nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n\n-Motor: Normal bulk, tone throughout. No adventitious movements, such as tremor, noted. No asterixis noted. Grossly full strength throughout, but somewhat limited by participation.\n", + "input6": "___ 05:20AM BLOOD WBC-8.2 RBC-3.89* Hgb-11.7* Hct-34.8* MCV-90 MCH-30.1 MCHC-33.6 RDW-13.1 RDWSD-41.6 Plt ___\n___ 12:58PM BLOOD WBC-12.6* RBC-4.49* Hgb-13.1* Hct-40.1 MCV-89 MCH-29.2 MCHC-32.7 RDW-12.8 RDWSD-41.1 Plt ___\n___ 05:20AM BLOOD ___ PTT-28.6 ___\n___ 05:20AM BLOOD Glucose-81 UreaN-22* Creat-1.4* Na-144 K-4.4 Cl-103 HCO3-20* AnGap-21*\n___ 12:58PM BLOOD Glucose-90 UreaN-19 Creat-1.5* Na-146 K-5.2 Cl-101 HCO3-25 AnGap-20*\n___ 05:20AM BLOOD ALT-151* AST-67*\n___ 05:20AM BLOOD Calcium-9.0 Phos-5.1* Mg-1.9\n___ 12:58PM BLOOD Calcium-9.9 Phos-6.4* Mg-1.8\n___ 01:06PM BLOOD Lactate-3.9*\n\nECG\nECG is normal during the attack\n" +} \ No newline at end of file diff --git a/Finished/Epilepsy/Non-epileptic Seizure/16314601-DS-5.json b/Finished/Epilepsy/Non-epileptic Seizure/16314601-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..d8ab80b0559745d700af94d070423621ae4b2760 --- /dev/null +++ b/Finished/Epilepsy/Non-epileptic Seizure/16314601-DS-5.json @@ -0,0 +1,27 @@ +{ + "Non-epileptic Seizure$Intermedia_3": { + "Normal neuroimaging and EEG findings may indicate that the seizures are not due to typical epileptic electrical activity, supporting the possibility of nonepileptic seizures.$Cause_1": { + "She says she has had a full workup with EEG and MRI. She was told these studies were normal.$Input2": {} + }, + "Suspected Epilepsy$Intermedia_2": { + "The patient has a history of seizures, which is a significant risk factor$Cause_1": { + "with a PMHx of anorexia and seizures$Input2": {} + }, + "Limb shaking and loss of consciousness may occur in epilepsy$Cause_1": { + "lost consciousness and had arm and leg shaking for 2 minutes$Input2": {} + }, + "Postepileptic state is usually accompanied by a period of disorientation or confusion$Cause_1": { + "When she woke up, she felt confused for about 20 minutes then went back to being like herself$Input2": {} + }, + "Substance use (such as alcohol and marijuana) may trigger seizures$Cause_1": { + "Chronologic Seizure History: Patient reports she first had a seizure 4months ago. The first seizure was in the setting of alcohol and marijuana use.$Input2": {} + } + } + }, + "input1": "Seizure\n", + "input2": "She is a 27 year old girl with a PMHx of anorexia and seizures who presents to the ED with 2 seizures. Per the patient, she was sitting on the floor around other people in where she is being treated for an eating disorder, when she started to feel 'tingling' which signals to her that she is going to have a seizure. She lost consciousness and had arm and leg shaking for 2 minutes according to the people who saw her. When she woke up, she felt confused for about 20 minutes then went back to being like herself. She was given Ativan by the nursing staff and went to have a snack of fig newtons. After eating, she had another seizure, again witnessed by others according to patient. \n\nShe was admitted to treatment of an eating disorder about a week ago. \n\nChronologic Seizure History: Patient reports she first had a seizure 4months ago. The first seizure was in the setting of alcohol and marijuana use. Patient reports that since then she has had \"seizures every day\" which are always the same (hand tingling followed by LOC and whole body shaking). She says she has had a full workup with EEG and MRI. She was told these studies were normal. \n \nOn neuro ROS, the pt endorses HA, lightheadedness, denies headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus, and hearing difficulty. Denies difficulties producing or comprehending speech. Denies focal weakness, numbness, and parasthesiae. No bowel or bladder incontinence or retention. Denies difficulty with gait.\n\nOn general review of systems, the pt denies recent fever or chills. No night sweats or recent weight loss or gain. Denies cough, shortness of breath. Denies chest pain or tightness, palpitations. Denies nausea, vomiting, diarrhea, constipation, or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denies arthralgias or myalgias. Denies rash.\n", + "input3": "+Anorexia\n+Depression\n", + "input4": "No Family History currently on file.\n", + "input5": "General: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted \nin oropharynx\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity\nPulmonary: Lungs CTA bilaterally \nCardiac: RRR, nl. S1S2, no M/R/G noted\nAbdomen: soft, NT/ND, \nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally.\nSkin: scars on b/l forearms.\n\nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history, generally knows what has been going on in her medical history but is unable to give extensive details. Mildly flat affect, Attentive, able to name backward without difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt was able to name both high and low frequency objects. Speech was not dysarthric. Able to follow both midline and appendicular commands. There was no evidence of apraxia or neglect.\n\n-Cranial Nerves:\n II, III, IV, VI: PERRL 3 to 2mm and brisk. EOMI without nystagmus. Normal saccades. VFF to confrontation.\n V: Facial sensation intact to light touch.\n VII: No facial droop, facial musculature symmetric.\n VIII: Hearing intact to finger-rub bilaterally.\n IX, X: Palate elevates symmetrically.\n XI: ___ strength in trapezii and SCM bilaterally.\n XII: Tongue protrudes in midline.\n\n-Motor: Normal bulk and tone. No pronation, no drift. No orbiting with arm roll. No tremor noted. No asterixis noted.\n", + "input6": "___ 12:27AM BLOOD WBC-7.3 RBC-3.70* Hgb-11.9 Hct-35.0 MCV-95 MCH-32.2* MCHC-34.0 RDW-12.0 RDWSD-41.9 Plt ___\n___ 12:27AM BLOOD Neuts-49.3 ___ Monos-5.2 Eos-1.9 Baso-0.4 Im ___ AbsNeut-3.59 AbsLymp-3.14 AbsMono-0.38 AbsEos-0.14 AbsBaso-0.03\n___ 12:27AM BLOOD Glucose-95 UreaN-12 Creat-0.6 Na-141 K-4.1 Cl-106 HCO3-21* AnGap-14\n___ 12:27AM BLOOD ALT-9 AST-10 AlkPhos-35 TotBili-0.3\n___ 12:27AM BLOOD Lipase-51\n___ 12:27AM BLOOD Albumin-4.1 Calcium-8.8 Phos-3.6 Mg-1.7\n___ 12:27AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 01:29AM URINE Color-Yellow Appear-Hazy* Sp ___\n___ 01:29AM URINE Blood-NEG Nitrite-NEG Protein-30* Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-SM*\n___ 01:29AM URINE RBC-0 WBC-4 Bacteri-FEW* Yeast-NONE Epi-7\n___ 01:29AM URINE UCG-NEGATIVE\n___ 01:29AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG oxycodn-NEG mthdone-NEG\n\n___ 1:29 am URINE\n URINE CULTURE (Final ___: < 10,000 CFU/mL. \n\n___ chest xray\nLeft basilar atelectasis. Otherwise, no acute cardiopulmonary abnormality.\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/11389640-DS-16.json b/Finished/Gastritis/Acute Gastritis/11389640-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..a0ab46c0b5f031c4874357a51dbb6796e4b9162e --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/11389640-DS-16.json @@ -0,0 +1,24 @@ +{ + "Acute gastritis$Intermedia_3": { + "Endoscopy is the gold standard for the examination of gastritis$Cause_1": { + "Stomach: Other Mild gastritis and erosion of the antrum \nDuodenum: Normal duodenum. \nOther findings: Mild duodenitis in the bulb\nOther findings: Mild duodenitis in the bulb$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Nausea and vomiting are symptoms that may occur in patients with gastritis.$Cause_1": { + "She states that she has had approximately 1 week of intermittent nausea and vomiting.$Input2": {} + }, + "NSAIDS are a common cause in patients with gastritis.$Cause_1": { + "Intermittently taking NSAIDS ___ tablets per day) and tylenol at home for headache$Input2": {} + }, + "Epigastric abdominal pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "She also developed epigastric abdominal pain following this prolonged emesis.$Input2": {} + } + } + }, + "input1": "nausea/vomiting\n", + "input2": "She is a ___ y/o female with depression/dysthymia, lumbar \nradiculopathy, morbid obesity, and endometriosis who presents with nausea and vomiting and a syncopal episode. She states that she has had approximately 1 week of intermittent nausea and vomiting. She underwent right S1 nerve root injection for radiculopathy and following this developed worsening of n/v as well as new headache. Intermittently taking NSAIDS ___ tablets per day) and tylenol at home for headache. She was seen in the ED by neurology for headache, started on medrol dose pack (currently taking 16mg). She presented to ED on for severe nausea and vomitting with inability to tolerate PO. She also developed epigastric abdominal pain following this prolonged emesis. She also noted blood tinged emesis. She denies loose stool, melana, hematochezia. \n\nIn the ED, initial VS were AF, 59, 100/59, 16, 99%. After arriving to the ___ ED, she went to the bathroom in triage. She called for her husband who found her sitting on the floor. She denies any preceding symptoms but believes she vomited just prior to the episode. She was unable to recall if she lost conciousness. For evaluation of her nausea and vomiting with hematemesis: An NG lavage revealed a small amount of clot but cleared after less than 60 cc of normal saline. Her CBC was remarkable for a leukocytosis of 12.5 with a normal diff. Electrolytes were within normal limits. AST, ALT, TB, AP, albumin and lipase were all noted to be within normal limits. UA was notable for hematuria but this was believed to be after a foley placement. A quantitative serum hCG was < 5 and urine hCG was negative. She was also noted to be guaiac negative on exam. A CT abdomen and pelvis revealed no acute process. For evaluation of her syncope: an EKG revealed SR @ 71 with normal axis and no ischemic changes or underlying arrhythmia. She received Zofran total 8 mg IV and Dilaudid 1 mg IV. Vital signs at transfer were Temp: 98.3 \u00b0F (36.8 \u00b0C), Pulse: 83, RR: 18, BP: 120/59, O2Sat: 100, O2Flow: ra.\n", + "input3": "- Dysthymic disorder \n- Arthralgias \n- Hypercholesterolemia \n- Endometriosis \n- Ovarian Cyst \n- Asthma \n- Anxiety \n- Lumbar radiculopathy\n", + "input4": "not obtained\n", + "input5": "VS: 99.4 99.4 126/76 HR:67 RR:18 O2: 92%RA\nGENERAL: female in NAD, asleep but arousable to voice\nHEENT: Sclera anicteric. MMM. \nCARDIAC: RRR with no excess sounds appreciated \nLUNGS: CTA b/l with no wheezing, rales, or rhonchi.\nABDOMEN: soft, epigastric tenderness to palpation, no guarding \nEXTREMITIES: Warm and well perfused, no clubbing or cyanosis. \nNEUROLOGY: face symmetric, tongue midline, EOMI, strength grossly intact bilaterally, asterixis\n", + "input6": "ADMISSION LABS\n___ 10:50PM BLOOD WBC-12.5* RBC-4.75 Hgb-14.4 Hct-41.7 MCV-88 MCH-30.2 MCHC-34.5 RDW-13.4 Plt ___\n___ 10:50PM BLOOD Neuts-68.7 ___ Monos-6.1 Eos-1.1 Baso-0.6\n___ 01:02AM BLOOD ___ PTT-29.2 ___\n___ 10:50PM BLOOD Glucose-108* UreaN-9 Creat-0.7 Na-135 K-3.4 Cl-95* HCO3-32 AnGap-11\n___ 10:50PM BLOOD ALT-16 AST-18 AlkPhos-39 TotBili-0.4\n___ 10:50PM BLOOD Lipase-21\n___ 10:50PM BLOOD cTropnT-<0.01\n___ 05:45AM BLOOD Calcium-8.5 Phos-3.1 Mg-1.8\n___ 10:56PM BLOOD Lactate-1.1\n\nMICRO\nBlood cx ___ no growth\nHELICOBACTER PYLORI ANTIBODY TEST (Final ___: NEGATIVE BY EIA.\n\nIMAGING\n-CT Abd/Pelvis No acute abdominal process\n-CT Head No acute intracranial process.\n-EGD Esophagus: Other Erosive esophagitis of the distal third and GE junction. Small hiatal hernia. \nStomach: Other Mild gastritis and erosion of the antrum \nDuodenum: Normal duodenum. \nOther findings: Mild duodenitis in the bulb\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/11520879-DS-3.json b/Finished/Gastritis/Acute Gastritis/11520879-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..87bfee0507f7083e55357133f5a2bbe7acdbb905 --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/11520879-DS-3.json @@ -0,0 +1,24 @@ +{ + "Acute gastritis$Intermedia_3": { + "Superficial erosion on gastroscopy is the gold standard for the diagnosis of acute gastritis$Cause_1": { + "Endoscopy:Superficial erosion of the antrum$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Surgery is a common cause in patients with acute gastritis$Cause_1": { + "with lap band placed, colonic adenoma removed 1 months ago with diverticulitis at that time who developed LLQ and central abdominal pain starting last week.$Input2": {} + }, + "Epigastric pain is a symptom that may occur in patients with gastritis\r.$Cause_1": { + "She fee epigastric pain is more of a twisting, knawing pain.$Input2": {} + }, + "!Epigastric pain is a symptom that may occur in patients with gastritis\r.$Cause_1": { + "She feelike the LLQ is more sharp and the epigastric pain is more of a twisting, knawing pain.$Input2": {} + } + } + }, + "input1": "Abdominal Pain\n", + "input2": "___ with lap band placed, colonic adenoma removed 1 months ago with diverticulitis at that time who developed LLQ and central abdominal pain starting last week. The ___ outpatient PCP prescribed ___. Pain persisted so ___ went to ___ where workup was negative. KUB and CT did not show any abnormalities. Lap band was in proper place. The ___ was prescribed PO oxycodone and sent home with ___ with bariatric. She presents here because the pain continued and she heard that we have a \"bariatric service\". No fevers, chills. Slight nausea with food, able to drink water. No fluid in lap band. No change in BMs, no blood.\n\nIn the ED, initial vitals: 98 78 150/96 16 99%. Exam with slight abdominal tenderness, no guarding or rebound. Labs were unremarkable. Bariatrics was consulted, recommended UGI series which was negative, showed no band prolapse. CT ABD/Pelvis showed \nShort-segmental jejunal intussception, nonobstructive. She recived multiple doses of morphine and dilaudid without relief. She is being admitted to medicine for pain control. Vitals prior to transfer: 98.2 74 125/67 16 100%.\n\nOf note, summary of ED visit:\nA CAT scan of the abdomen and pelvis with p.o. contrast shows no evidence of acute diverticulitis. There are no acute changes since CAT scan from last year. There is a lap-band in place. KUB upright and oblique shows an unremarkable bowel gas pattern. The ___ was prescribed OxyIR 5 mg p.o. q.4h. as needed along with Maalox as needed for constipation. \n\nCurrently, the ___ is in mild discomfort, but with improved pain. She states that since last ___, she is unable to keep any food down because she immediately vomits roughly 20 minutes after eating. This has never happened before. She feelike the LLQ is more sharp and the epigastric pain is more of a twisting, knawing pain. She is passing gas and haviong normal bowel movements.\n", + "input3": "HTN\ndepression\nMorbid obesity\ncolonic adenoma\ndiverticulosis and diverticulitis x2\nhistory of splenic injury at colonoscopy\n", + "input4": "No history of early cancer, heart disease\n", + "input5": "ADMISSION PE:\nVS - 98.2 117/72 71 18 99% RA \nGENERAL - NAD, comfortable \nHEENT - PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, no JVD \nHEART - PMI non-displaced, RRR, nl S1-S2, no MRG \nLUNGS - CTAB \nABDOMEN - Soft, obese, ND, mildly tender in LLQ and epigastrum\nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n \nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3\n", + "input6": "ADMISSION PE:\n\n___ 01:00PM BLOOD WBC-6.3 RBC-4.99 Hgb-15.0 Hct-42.7 MCV-86 \nMCH-30.0 MCHC-35.1* RDW-12.6 Plt ___\n___ 01:00PM BLOOD Plt ___\n___ 01:00PM BLOOD Glucose-92 UreaN-11 Creat-1.1 Na-140 \nK-4.0 Cl-102 HCO3-28 AnGap-14\n___ 01:00PM BLOOD ALT-50* AST-38 AlkPhos-75 TotBili-0.9\n___ 10:30AM BLOOD ALT-55* AST-38 AlkPhos-66 TotBili-0.9\n___ 01:00PM BLOOD Lipase-23\n___ 09:30PM BLOOD Calcium-9.1 Phos-3.7 Mg-2.2\n___ 10:30AM BLOOD 25VitD-14*\n___ 10:30AM BLOOD PTH-101*\n\nCT ABD/PELVIS:\nIMPRESSION: \n1. Short-segment jejunal intussuception, likely transient. \n2. Colonic diverticulosis. \n3. Hepatic cysts. \n\nUGI Study:\n1. Esophageal dysmotility. \n2. No gastric band prolapse, leak or obstruction. \n\nRUQ U/S:\nIMPRESSION: \n1. No evidence of cholelithiasis, cholecystitis, or biliary dilatation. \n2. Multiple hepatic cysts.\nEndoscopy:Superficial erosion of the antrum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/11541457-DS-17.json b/Finished/Gastritis/Acute Gastritis/11541457-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..7cb65b06b79970d815cb879454b66810673b839b --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/11541457-DS-17.json @@ -0,0 +1,33 @@ +{ + "Acute gastritis$Intermedia_3": { + "Superficial erosion on gastroscopy is the gold standard for the diagnosis of acute gastritis$Cause_1": { + "EGD:Esophagus: Normal esophagus. \nStomach: Superficial erosion of the antrum \nLumen: A small size hiatal hernia was seen. \nDuodenum: Normal duodenum.$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Alcohol is a common cause of acute gastritis.$Cause_1": { + "female with EToH abuse, epigastric pain,prior small interstinal bacterial overgrowth syndrome s/p treatment, who recently stopped drinking alcohol approximately 2 weeks ago, and presenting to care with two weeks of ongoing epigastric pain, heartburn, nausea, vomiting and inability to tolerate oral intake.$Input2": {} + }, + "Surgery is a common cause of acute gastritis.$Cause_1": { + "Meningioma status post resection s/p removal$Input3": {} + }, + "Nausea, vomiting andabdominal pain are possible symptom of gastritis.$Cause_1": { + "nausea, vomiting, abdominal pain$Input1": {} + }, + "Epigastric pain, heartburn, nausea and vomiting are possible symptom of gastritis.$Cause_1": { + "presenting to care with two weeks of ongoing epigastric pain, heartburn, nausea, vomiting and inability to tolerate oral intake.$Input2": {} + }, + "Nausea is a possible symptom of gastritis.$Cause_1": { + "She reports extreme nausea without vomiting.$Input2": {} + }, + "Epigastric pain is a possible symptom of gastritis.$Cause_1": { + "As discussed above, she reports that her epigastric pain had improved, but then had some burning pain in the epigastrium that would radiate to the RUQ or substernal area.$Input2": {} + } + } + }, + "input1": "nausea, vomiting, abdominal pain\n", + "input2": "___ female with EToH abuse, epigastric pain,prior small interstinal bacterial overgrowth syndrome s/p treatment, who recently stopped drinking alcohol approximately 2 weeks ago, and presenting to care with two weeks of ongoing epigastric pain, heartburn, nausea, vomiting and inability to tolerate oral intake.\n\nGiven worsening epigastric pain, intractable nausea, inability to tolerate oral intake, reported dysphagia to solids, heartburn,and reported weight loss, the patient was advised by her outpatient GI physician to present to care for endoscopy. Additionally, they recommended ordering copper, thiamine,\nmagnesium level, and TSH.\n\nIn the ED, initial VS were 98.0 64 120/76 18 98% RA.Neuro exam was nonfocal.BMP WNL. LFTS WNL. Serum toxicology negative. CBC WNL with H/H of 15.0/45.1. She received 1L NS and viscous lidocaine and Simethicone.\nShe was admitted to ___ for subsequent workup.\n\nIn review of her past medical history, it appears that she first presented to care at ___ for GI consultation in ___. She reported that her GI upset began about ___ years prior, which she described as a spasm in her upper abdomen occurring every day and lasting for hours. It was thought she might have functional abdominal pain at that time or possibly IBS. She underwent CT imaging in ___ which showed mild hypoattenuation of the pancreatic head, which could reflect pancreatitis. She was evaluated by Dr. Sam, and given her history of bacterial overgrowth syndrome without prior treatment, the patient was treated with Flagyl/rifaximin followed by erythromycin.\n \nUpon arrival to the floor, the patient tells the story as follows. She reports she had a \"series of decline\". She reports that she was recent admitted to hospital with abdominal pain. She reports she was found to have an elevated lipase and subsequently found to have pancreatitis. After that, she lost all interest in drinking. Since discharge, her abdominal pain improved. However, over the past two weeks since discharge, she reports the feeling of a \"lump in her throat,\" with dysphagia to solids, not liquids. She reports extreme nausea without vomiting. She reports that she was unable to eat much of anything. As discussed above, she reports that her epigastric pain had improved, but then had some burning pain in the epigastrium that would radiate to the RUQ or substernal area. She described this pain as intermittent, without clear exacerbating factors, but occasionally worsened by eating. She also endorses chronic constipation, for which she takes magnesium citrate at home, with her last bowel movement three day sago. She denies fevers, but endorses chills. She reports that since cessation of alcohol approximately two weeks ago, she had a headache for a few days after that. She denies tremors or hallucinations or other symptoms of withdrawal.\n\nROS: Pertinent positives and negatives as noted in the HPI. All other systems were reviewed and are negative.\n", + "input3": "- Meningioma status post resection s/p removal\n- Small bowel bacterial overgrowth: high methane level, positive methane\n- Hyperparathyroidism\n- Lichen sclerosus\n- Epigastric pain syndrome\n- Ileitis\n- Depression\n", + "input4": "+ Hodgkins lymphoma in her sister. \n+ Lichen sclerosis in mother. \n+ Thyroid disease in both sisters. FH of GI problems.\n", + "input5": "Admission Exam:\nVITALS: 97.5 PO 127 / 65 51 18 100 RA \nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. Oropharynx without visible lesion, erythema or exudate Mucous membranes moist \nCV: Heart regular, no murmur\nRESP: Lungs clear to auscultation with good air movement\nbilaterally\nGI: Abdomen soft, ___ to palpation\nMSK: Neck supple, moves all extremities, strength grossly full and symmetric bilaterally in all limbs\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, oriented, face symmetric, gaze conjugate with \nEOMI, speech fluent, moves all limbs\nPSYCH: pleasant, appropriate affect\n", + "input6": "___ 06:13AM BLOOD ___ \n___ Plt ___\n___ 05:36AM BLOOD ___ \n___ Plt ___\n___ 08:05AM BLOOD ___ \n___ Plt ___\n___ 04:07PM BLOOD ___ \n___ Plt ___\n___ 04:07PM BLOOD ___ \n___ Im ___ \n___ 06:13AM BLOOD Plt ___\n___ 05:36AM BLOOD Plt ___\n___ 08:05AM BLOOD Plt ___\n___ 04:07PM BLOOD Plt ___\n___ 06:13AM BLOOD ___ \n___ 05:36AM BLOOD ___ \n___ 08:05AM BLOOD ___ \n___ 04:07PM BLOOD ___ \n___ 04:07PM BLOOD ___\n___ 04:07PM BLOOD ___\n___ 08:05AM BLOOD cTropnT-<0.01\n___ 10:52PM BLOOD cTropnT-<0.01\n___ 04:07PM BLOOD cTropnT-<0.01\n___ 06:13AM BLOOD ___\n___ 05:36AM BLOOD ___\n___ 08:05AM BLOOD ___\n___ 04:07PM BLOOD ___\n___ 06:13AM BLOOD ___\n___ 04:07PM BLOOD ___\n___ 04:07PM BLOOD ___\n___ 04:07PM BLOOD ___ \n___\n\nRUQ U/S ___\n1. No cholelithiasis or biliary dilatation. \n2. 5 mm gallbladder polyp. \n3. Diffusely echogenic pancreas, which likely reflects fatty\nreplacement. \n\nHIDA ___\nIMPRESSION: Normal hepatobiliary study. Gallbladder ejection fraction normal. \n \nEUS ___\nImpression: \u0095EUS was performed using a linear echoendoscope at ___ MHz frequency: The head and uncinate pancreas were imaged from the duodenal bulb and the second / third duodenum. The body and tail [partially] were imaged from the gastric body and fundus.\n\u0095Pancreas parenchyma: The parenchyma in the uncinate, head, body and tail of the pancreas was homogenous, with a normal \"salt and pepper\" appearance.\n\u0095Pancreas duct: The pancreas duct was normal in echotexture and contour. No stones were noted. No dilated ___ were noted.\n\u0095Bile duct: The bile duct was imaged at the level of the ___, head of the pancreas and ampulla. The maximum diameter of the bile duct was 4 mm. The bile duct was normal in appearance. No intrinsic stones or sludge were noted. The bile duct and the pancreatic duct were imaged within the ampulla and appeared normal.\n\u0095Vessels [Arterial]: The celiac artery ___ from the Aorta and the superior mesenteric artery ___ from the Aorta were visualized and appeared normal. The ampulla was visualized endoscopically with both the echoendoscope as well as a duodenoscope. It appeared normal. There were no ampullary lesions and/or fishmouth appearances noted.\n\nEGD ___\nEsophagus: Normal esophagus. \nStomach: Superficial erosion of the antrum \nLumen: A small size hiatal hernia was seen. \nDuodenum: Normal duodenum. \n\nOther\nprocedures: Cold forceps biopsies were performed to assess for H. pylori at the stomach. Cold forceps biopsies were performed to assess for celiac disease at the second part of the duodenum and third part of the duodenum. \n\nImpression: Small hiatal hernia Normal EGD to third part of the duodenum with surveillance biopsies (biopsy, biopsy).\n\nEKG: interpretation is sinus rhythm, normal intervals, ___ inversions in V1 through V3.\n\nEsophagram:\n \nFINDINGS: \nThe esophagus was not dilated. There was no stricture within the esophagus. There was no esophageal mass. The primary peristaltic wave is normal aside from mild proximal escape. The lower esophageal sphincter opened and closed normally. There was no gastroesophageal reflux, spontaneously or with Valsalva maneuver. There was no hiatal hernia. No overt abnormality in the stomach on limited evaluation. \n \nIMPRESSION:\nNo esophageal stricture or gastroesophageal reflux identified.\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/11589948-DS-19.json b/Finished/Gastritis/Acute Gastritis/11589948-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..63fd36500ef317aba995b29b8f557fba1e1eabbe --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/11589948-DS-19.json @@ -0,0 +1,30 @@ +{ + "Acute gastritis$Intermedia_3": { + "Superficial erosion of the antrum is the gold standard for the diagnosis of acute gastritis.$Cause_1": { + "Endoscopy:Superficial erosion of the antrum$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Vomiting is a symptom that may occur in patients with gastritis$Cause_1": { + "presents with 1 day of ongoing vomiting.$Input2": {} + }, + "NSAIDS are a common cause in patients with gastritis.$Cause_1": { + "She received an aspirin.$Input2": {} + }, + "Nausea and vomiting are symptoms that may occur in patients with gastritis.$Cause_1": { + "nausea/vomiting$Input1": {} + }, + "!Vomiting is a symptom that may occur in patients with gastritis$Cause_1": { + "female with extensive PMHx including GERD, DM2, dCHF (EF 60-70%), CRI, iron deficiency anemia and hypothyroidism who presents with 1 day of ongoing vomiting.$Input2": {} + }, + "Abdominal pain is a symptom that may occur in patients with gastritis$Cause_1": { + "Endorses associated abdominal pain, weakness and chest soreness reproducible to palpation.$Input2": {} + } + } + }, + "input1": "nausea/vomiting\n", + "input2": "__ female with extensive PMHx including GERD, DM2, dCHF (EF 60-70%), CRI, iron deficiency anemia and hypothyroidism who presents with 1 day of ongoing vomiting. Patient states that the morning of admission she awoke and began vomiting. She has not been able to tolerate any PO (including her medications or fluids) since the day prior to admission. Endorses associated abdominal pain, weakness and chest soreness reproducible to palpation. Denies any fevers, chills or shortness of breath. Patient states that she has noticed epigastric abdominal pain since she was switched from omeprazole to ranitidine (she was having difficulty getting omeprazole from her pharmacy). States that she has had decreased appetite since then and \"not felt right\". \n \nIn ED intial VS were 97.2 85 194/69 18 100%RA. Rectal temp 99.6, EKG was AV-paced, and on rectal exam, patient had black, guaiac negative stool. She received an aspirin. Labs were notable for stable anemia and renal insufficiency as well as elevated LDH (374) and troponin 0.09 (MB 3). UA was positive for UTI. No focal infiltrate on preliminary read of chest xray. \n \nPatient was admitted to medicine for ongoing vomiting & inability to tolerate PO. Vital signs on transfer were 98.5, 70, 177/55, 11, 99% RA. \n\nThis morning she is not complaining of any abdominal pain or chest pain.\n", + "input3": "1. Type 2 diabetes \n2. Hypertension \n3. Hypercholesterolemia \n4. Diastolic congestive heart failure LVEF\uff0860-70%) \n5. S/p pacemaker placement for AV block after an SVT ablation \n6. Gastroesophageal reflux disease \n7. Osteopenia \n8. Falls \n9. Iron deficiency anemia \n10. Chronic kidney disease\n11. Hypothyroidism \n12. Status post dog bite with right distal ulnar fracture\n13. Decreased hearing \n14. Urinary urgency \n15. GI bleed - ___ Unclear etiology.\n", + "input4": "Mother died age ___ ? CAD\nGrandmother - CVA\n", + "input5": "Physical Exam on Admission:\nVS: 98.2, 186/50, 70, 18, 99%RA \nGEN: A+Ox3, NAD \nHEENT: NCAT. EOMI. PERRL. MMM. no LAD. no JVD. neck supple. Hard-of-hearing. \nCV: RRR, normal S1/S2, no murmurs/gallops/rubs. \nLUNG: CTAB, no wheezes, rales or rhonchi \nABD: soft, epigastrum tender to palpation, ND, hypoactive BS. no rebound or guarding. neg HSM. \nEXT: W/WP, trace ankle edema, no C/C. 2+ ___ pulses bilaterally. \nSKIN: W/D/I \nNEURO: CNs II-XII intact. ___ strength in U/L extremities. \nsensation intact to LT. \nPSYCH: flat affect\n", + "input6": "Labs on admission:\n\n___ WBC-10.1# RBC-3.16* Hgb-9.3* Hct-27.2* MCV-86 MCH-29.5 MCHC-34.4 RDW-13.9 Plt ___\n___ Glucose-184* UreaN-45* Creat-2.1* Na-144 K-4.3 Cl-106 HCO3-24 AnGap-18\n___ ALT-14 AST-23 LD(LDH)-374* AlkPhos-84 TotBili-0.5\n___ cTropnT-0.09*\n___ Albumin-4.2 Calcium-9.1 Phos-3.4 Mg-2.0\n___ TSH-6.3*\n___ Free T4-1.1\n\n___ SEROLOGY/BLOOD\n**FINAL REPORT ___\nHELICOBACTER PYLORI ANTIBODY TEST (Final ___: \nNEGATIVE BY EIA. \n(Reference Range-Negative). \n\n___ 7:45 pm URINE Site: CATHETER\n**FINAL REPORT ___\n\nURINE CULTURE (Final ___: \nESCHERICHIA COLI. >100,000 ORGANISMS/ML. OF TWO COLONIAL MORPHOLOGIES. \nPRESUMPTIVE IDENTIFICATION. Piperacillin/tazobactam sensitivity testing available on request. \n\nSENSITIVITIES: MIC expressed in MCG/ML\n\nESCHERICHIA COLI\n \nAMPICILLIN------------ =>32 R\nAMPICILLIN/SULBACTAM-- 8 S\nCEFAZOLIN------------- <=4 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN--------- =>4 R\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- <=16 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\nEndoscopy:Superficial erosion of the antrum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/11908878-DS-15.json b/Finished/Gastritis/Acute Gastritis/11908878-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..194fb664477521e759633503cbe94d8bac3de100 --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/11908878-DS-15.json @@ -0,0 +1,24 @@ +{ + "Acute gastritis$Intermedia_3": { + "Superficial erosion on endoscopy is the gold standard for the diagnosis of acute gastritis.$Cause_1": { + "Endoscopy:Superficial erosion of the antrum$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Epigastic pain is a symptom that may occur in patients with acute gastritis.$Cause_1": { + "year old woman with h/o endometriosis s/p surgery presents with epigastic pain x 1 month.$Input2": {} + }, + "Stress response to surgery is a common cause of acute gastritis$Cause_1": { + "Pelvic endometriosis and adhesions s/p surgery$Input3": {} + }, + "!Epigastric pain is a symptom that may occur in patients with acute gastritis.$Cause_1": { + "epigastric pain$Input1": {} + } + } + }, + "input1": "epigastric pain\n", + "input2": "___ year old woman with h/o endometriosis s/p surgery presents with epigastic pain x 1 month. She describes a dull pain most noticeable at night when she goes to bed that keeps her from falling asleep. It is less noticeable in the daytime. There is no improvement with positioning and no change with food. She does not have nausea or vomit. She had one episode of diarrhea four days ago but has not had a bowel movement since. No blood or dark stool. She reported this symptom to her previous PCP who prescribed her omeprazole 20 mg bid. She had been taking this without much improvement, although she does not always take every dose. Interestingly, her previous PCP also gave her lorazepam to sleep at night. Apparently, she has been feeling a lot of stress the past few months from work. \n \nShe also reports chest pressure that occurs at rest for the past two weeks. When she is at work and when she is stressed out, she feels chest pressure associated with shortness of breath. She would take deep breaths and this discomfort would pass. Occasionally she would feel palpitations. She does not have these symptoms on exertion. \n. \nIn the ED, initial vitals were 98.9, 159/74, 57, 18, 98%RA. She was given viscous lidocaine and maalox with improvement of her epigastric discomfort. Intial EKG showed sinus bradycardia with non-specific TWI in II, II, V1 and biphasic T in V3. First set of cardiac markers was negative. She was admitted to OBS for a rule out and stress. During observation, repeat EKG was done and there were new TWI's in V3-V5. Cardiology was contacted, and she was admitted to Medicine for further care. \n. \nROS: Denies fevers, chills, headaches, weight loss, dysuria.\n", + "input3": "Pelvic endometriosis and adhesions s/p surgery\n", + "input4": "Father has \"heart disese\". Mother and siblings without heart disease.\n", + "input5": "VITALS: 98.0, 120/82, 65, 20, 98%RA. \nGEN: NAD, appears unhappy, and tearful at times during interview when we mention stress and anixety \nHEENT: PERRLA, EOMI, OP clear, MMM \nNECK: No LAD \nCV: RRR, no M/G/R. Tender at sternum with palation but not \nsimilar to chest pressure or epigastric pain. \nPULM: CTAB, no W/R/R \nABD: Soft, ND, +BS. Mildly to minimally tender at epigastric area. Not tender anywhere else in her abdomen. No HSM. \nEXT: No peripheral edema\n", + "input6": "___ 12:20PM WBC-5.5 RBC-4.63 HGB-14.6 HCT-40.3 MCV-87 \nMCH-31.6 MCHC-36.3* RDW-12.9\n___ 12:20PM NEUTS-46.0* LYMPHS-47.9* MONOS-3.5 EOS-2.0 \nBASOS-0.6\n___ 12:20PM PLT COUNT-289\n___ 12:20PM ALT(SGPT)-28 AST(SGOT)-27 LD(LDH)-195 \nCK(CPK)-80 ALK PHOS-112 AMYLASE-64 TOT BILI-0.5\n___ 12:20PM LIPASE-38\n___ 12:20PM CK-MB-NotDone\n___ 12:20PM cTropnT-<0.01\n___ 06:46PM CK(CPK)-72\n___ 06:46PM cTropnT-<0.01\n___ 06:46PM CK-MB-NotDone\n\n___ EKG: Initial: Sinus brady at 50 BPM with NA, NI, and non-specific TWI in leads II, III, F, V1 and biphasic T in V3 \nand V4. Subsequent EKG at 18:45: Sinus brady at 58 BPM with NA, NI and TWI V3 to V5 that are more prominent than prior EKG. No ST changes. \n\nStudies:\n___ CXR: No pneumoperitoneum. Unremarkable chest radiograph.\n\n___ Exercise stress with myocardial perfusion:Possible ischemic EKG changes noted in the absence of anginal symptoms to the achieved workload(hemodynamic response as outlined). Nuclear report sent separately. 1) Normal myocardial perfusion at the level of exercise achieved. 2) LVEF is 71%.\nEndoscopy:Superficial erosion of the antrum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/12441564-DS-18.json b/Finished/Gastritis/Acute Gastritis/12441564-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..ae61df49f8ea75de1003314687845d025f01da8d --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/12441564-DS-18.json @@ -0,0 +1,21 @@ +{ + "Acute Gastritis$Intermedia_3": { + "Gastric erosions with heaped up mucosa around the erosions in the antrum and erythema and punctate red spots were noted in the cardia, which are the gold standard for the diagnosis of acute gastritis.$Cause_1": { + "EGD report:Esophagus: Normal esophagus. \nStomach: Other There were a few gastric erosions with heaped up mucosa around the erosions in the antrum. In addition, erythema and punctate red spots were noted in the cardia. Cold forceps biopsies were performed for histology at the antral erosions, cardia, stomach. \nDuodenum: \nMucosa: Normal mucosa was noted in the whole duodenum.$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Decreased appetite, abdominal pain, and nausea are symptoms that may occur in patients with acute gastritis.$Cause_1": { + "decreased appetite, abdominal pain, and nausea$Input2": {} + }, + "Nausea is a symptom that may occur in patients with gastritis.$Cause_1": { + "And family has noted that he has been unable to eat due to nausea.$Input2": {} + } + } + }, + "input1": "weight loss, fatigue, contipation\n", + "input2": "___ male presenting with history of atrial fibrillation on Coumadin, mild cognitive impairment, and failure to thrive for 1 month secondary to decreased p.o. intake due to decreased appetite, abdominal pain, and nausea with family suspecting a 15 lb weight loss in the past month. Patient was recently admitted here for paroxysmal hemicranias (discharged ___. Was treated with carbamazepine but had allergic reaction to that. Was switched to indomethacin and has had good control of his headaches. Since discharge earlier this month he has been increasingly weak. He has been complaining of a lower abdominal pain that he has difficulty characterizing. And family has noted that he has been unable to eat due to nausea. Was seen by PCP and arrange for a CT scan on ___. CT scan did show a sigmoid and rectal colitis. PCP called this morning and told patient to present to ED for further evaluation. One questionable episode of BRBPR (wife saw blood-streaked toilet; patient denies). No black or bloody stools. CT abdomen pelvis performed ___ (images not available for review but report shows): \n\nIMPRESSION: \nApparent wall thickening of the sigmoid rectal colon with surrounding inflammatory changes of the mesial rectal fascia. Similar findings were described on the prior CT exam, and if the prior CT exam images are made available for review, direct comparison will be made.Inflammatory and neoplastic etiologies should be considered. \n \nIn the ED, initial vitals: \n 98.6 |60 |159/106| 14| 100% RA \n - Labs notable for: \n - urine dipstick: trace ___, WBC 6, Bacteria few \n - Urine cx- pending \n - ___: 28.9 PTT: 34.5 INR: 2.6 \n - Pt given: \n - Acetaminophen 1000 mg \n - Vitals prior to transfer: 98.3 |89 |142/96 |17 |99% RA \nOn the floor, patient appears well with wife and daughter-in-law at bedside. He has been experiencing decreased appetite with a ~15 lb weight loss in the past month. He reports decreased energy over the past few days; he normally can walk around ___ with his wife in the evening and has been unable to in the past few days. He denies any SOB or chest pain. He currently has a right sided HA.\n", + "input3": "- Hearing loss, sensorineural \n- Impotence due to erectile dysfunction \n- Hypertension, essential \n- Colonic adenoma \n- Atrial fibrillation (Anticoagulant long-term use) \n- Carotid artery disease \n- Dry eyes \n- Dementia vs mild cognitive impairment (w/o behavioral \ndisturbance)\n- Squamous cell carcinoma in situ of skin of hand; face, ear, right temple\n- Hypercholesterolemia \n- Thrombocytopenia \n- CKD (chronic kidney disease) stage 3, GFR ___ ml/min \n- Pseudophakia \n- Retinal hole or tear \n- PVD (posterior vitreous detachment) \n- Dry senile macular degeneration \n- Aortic stenosis, moderate \n- Right inguinal hernia\n", + "input4": "Father - CAD/PVD; Hypertension\nMother - negative\n", + "input5": "ADMISSION PHYSICAL EXAM\nVital Signs: 97.6 PO| 183 / 118| 96 |18 |95% RA \nGeneral: Hard of hearing, pleasant, alert, oriented, no acute distress. \nHEENT: Right eye droop. Sclerae anicteric, mucous membranes moist , oropharynx without erythema or exudate, neck supple without LAD \nCV: Irregularly irregular, normal S1 + S2, II/VI systolic crescendo-decrescendo murmur in LUSB, no rubs or gallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nAbdomen: Normoactive bowel sounds. Soft, non-tender, non-distended, no organomegaly, no rebound or guarding \nGU: No foley \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nNeuro: Alert and oriented x3. No gross focal deficits.\n", + "input6": "ADMISSION LABS\n\n___ 03:56PM URINE HOURS-RANDOM\n___ 03:56PM URINE UHOLD-HOLD\n___ 03:56PM URINE COLOR-Yellow APPEAR-Hazy* SP ___\n___ 03:56PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-TR*\n___ 03:56PM URINE RBC-2 WBC-6* BACTERIA-FEW* YEAST-NONE \nEPI-2\n___ 02:57PM GLUCOSE-102* UREA N-16 CREAT-1.1 SODIUM-136 \nPOTASSIUM-4.5 CHLORIDE-99 TOTAL CO2-25 ANION GAP-17\n___ 02:57PM estGFR-Using this\n___ 02:57PM ALT(SGPT)-17 AST(SGOT)-26 ALK PHOS-79 TOT \nBILI-0.6\n___ 02:57PM LIPASE-52\n___ 02:57PM ALBUMIN-4.1 CALCIUM-9.7 PHOSPHATE-3.0 \nMAGNESIUM-1.9\n___ 02:57PM WBC-7.0 RBC-4.23* HGB-14.2 HCT-40.5 MCV-96 \nMCH-33.6* MCHC-35.1 RDW-13.7 RDWSD-47.8*\n___ 02:57PM NEUTS-75.0* LYMPHS-12.5* MONOS-9.5 EOS-2.0 \nBASOS-0.7 IM ___ AbsNeut-5.26 AbsLymp-0.88* AbsMono-0.67 \nAbsEos-0.14 AbsBaso-0.05\n___ 02:57PM PLT COUNT-164\n___ 02:57PM ___ PTT-34.5 ___\n\nFindings: \nMucosa: Normal mucosa was noted in the whole colon. \n\nProtruding Lesions A single sessile 2 mm non-bleeding polyp of benign appearance was found in the cecum. A single-piece polypectomy was performed using a cold snare in the cecum. The polyp was completely removed. A single sessile 2 mm non-bleeding polyp of benign appearance was found in the ascending colon. A single-piece polypectomy was performed using a hot snare in the ascending colon polyp. The polyp was completely removed. \n\nExcavated Lesions Multiple non-bleeding diverticula with medium openings were seen in the sigmoid colon. Diverticulosis appeared to be of mild severity. \n\n___ 6:00:00 AM - EGD report\nFindings: \nEsophagus: Normal esophagus. \nStomach: \n\nOther There were a few gastric erosions with heaped up mucosa around the erosions in the antrum. In addition, erythema and punctate red spots were noted in the cardia. Cold forceps biopsies were performed for histology at the antral erosions, cardia, stomach. \n\nDuodenum: \nMucosa: Normal mucosa was noted in the whole duodenum. Cold forceps biopsies were performed for histology at the duodenum. \n\nImpression: There were a few gastric erosions with heaped up mucosa around the erosions in the antrum. In addition, erythema and punctate red spots were noted in the cardia. (biopsy) Normal mucosa in the whole duodenum (biopsy) Otherwise normal EGD to third part of the duodenum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/17887687-DS-16.json b/Finished/Gastritis/Acute Gastritis/17887687-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..f095751e8e30199114d56a40704a0d3e6a169fb4 --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/17887687-DS-16.json @@ -0,0 +1,27 @@ +{ + "Acute Gastritis$Intermedia_3": { + "Acute gastritis may cause diarrhea, but it is usually not bloody.$Cause_1": { + "No blood in the stool$Input2": {} + }, + "Suspected Gastritis$Intermedia_2": { + "abdominal pain is the common symptom of gastritis$Cause_1": { + "abdominal pain$Input1": {} + }, + "Patients experience symptoms similar to those of previous C. difficile infections, which often cause diarrhea and abdominal discomfort that may overlap with symptoms of gastritis.$Cause_1": { + "feels like previouscdiff episode$Input2": {} + }, + "Abdominal discomfort and mild diarrhea. These symptoms may be common manifestations of gastritis, which often causes abdominal pain and indigestion.$Cause_1": { + "abdominal discomfort,some slightly loose stools$Input2": {} + }, + "These may indicate infection; acute gastritis may be accompanied by fever.$Cause_1": { + "102.7 felt chilled and sweats$Input2": {} + } + } + }, + "input1": "abdominal pain\n", + "input2": "Pt states feels like previouscdiff episode.\n\nShe traveled to ___ last week, felt great for several days. \nThen about 4 days ago she again had some abdominal discomfort,some slightly loose stools. She arrived home on ___. Then\nyesterday had a fever of 102.7 felt chilled and sweats. She alsohas some diarrhea. No blood in the stool. She had some period of times times where she did not have a stool than will have several times in an hour. \n\nWhile in ___, she stayed in a ___. The only time she left the resort was to go to the restaurant called ___. Did not eat or drink any food or water or ice from anywhere outside of the ___ or ___. Traveled with her husband, he is not experiencing any infectious or other symptoms.\n\nOn ROS, she denies headache, neck pain, rhinorrhea, sore throat, chest pain, palpitations, shortness of breath, cough, dysuria, lightheadedness, lower extremity edema.\n", + "input3": "-tobacco: denies \n -EtOH: social \n -occupation: ___\n -living situation: Lives w husband.\n", + "input4": "The patient reports that her father passed away in ___ from ___ body dementia.\n", + "input5": "VITALS: Reviewed in POE\nGENERAL: well developed, well nourished in NAD, appears tired\nHEENT: sclera anicteric, MMM\nCARDIAC: regular rate and rhythm, no murmurs, rubs, or gallops\nLUNGS: CTABL, no wheezes, rales, or rhonchi, normal WOB on room\nair\nABDOMEN: soft, diffusely TTP w guarding, +hyperactive bowel\nsounds, no rebound\nGU: No foley\nEXTREMITIES: warm, well perfused, no cyanosis or edema\nSKIN: warm, dry, no rashes or notable lesions\nNEURO: AOx3, face symmetric, moving all extremities\n", + "input6": "___ 03:20PM BLOOD WBC-14.3* RBC-4.22 Hgb-12.1 Hct-37.2 \nMCV-88 MCH-28.7 MCHC-32.5 RDW-13.0 RDWSD-41.3 Plt ___\n___ 03:20PM BLOOD Neuts-84.7* Lymphs-9.9* Monos-4.6* \nEos-0.1* Baso-0.2 Im ___ AbsNeut-12.09* AbsLymp-1.41 \nAbsMono-0.66 AbsEos-0.01* AbsBaso-0.03\n___ 09:26AM BLOOD ___ PTT-27.0 ___\n___ 03:20PM BLOOD Glucose-104* UreaN-13 Creat-0.9 Na-138 \nK-3.4* Cl-98 HCO3-26 AnGap-14\n___ 03:20PM BLOOD ALT-24 AST-22 AlkPhos-85 TotBili-0.6\n___ 03:20PM BLOOD Albumin-4.9 Calcium-9.7 Phos-4.0 Mg-2.0\n\n___ CT abdomen and pelvis w/ contrast\n \nIMPRESSION: \n \n1. Mild, circumferential wall thickening of the descending and sigmoid colons, with mild mucosal hyperemia and trace adjacent fat stranding, which could reflect colitis. \n2. Small volume pelvic free fluid.\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/18001923-DS-35.json b/Finished/Gastritis/Acute Gastritis/18001923-DS-35.json new file mode 100644 index 0000000000000000000000000000000000000000..d73dbfd211cecc70c64d078820798baf298b7299 --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/18001923-DS-35.json @@ -0,0 +1,30 @@ +{ + "Acute gastritis$Intermedia_3": { + "Lesions of gastric antrum erosion and hemorrhage on endoscopy are the gold standard for the diagnosis of acute gastritis$Cause_1": { + "Endoscopy:Lesions of gastric antrum erosion and hemorrhage$Input3": {} + }, + "suspected gastritis$Intermedia_2": { + "Abdominal pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "abdominal pain$Input1": {} + }, + "Alcohol is a common cause in patients with acute gastritis.$Cause_1": { + "Patient has a long history of frequent ed visits and admissions for various complaints in the setting of ETOH use.$Input2": {} + }, + "Multiple organ failure is a common cause in patients with acute gastritis.$Cause_1": { + "?Hx of MI (patient states he refused stent) \n- ?Hx of prostate cancer$Input3": {} + }, + "!Abdominal pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "Today in the ED he presented with chest/ abdomina pain and troponins remain negative x2 and EKG without impressive changes CXR revealed worsening consolidations in the RLL which could be c/w a pneumonia in the right clinical setting.$Input2": {} + }, + "Stomach pain and nausea are symptoms that may occur in patients with gastritis.$Cause_1": { + "He reports one of the medications they provided him in the ED really improved the stomach pain, and he thinks eatign will also help. He reports some dizziness and light headed ness, shortness of breath, headache, cough productive of yellow sputum, nausea, and occasional black/ bloody stools.$Input2": {} + } + } + }, + "input1": "Chest and abdominal pain\n", + "input2": "___ male with cirrhosis, grade one esophageal varices, hepatitis C, GERD, prostate cancer, bladder mass removal, ureteral stent presents for chest pain and abdominal pain. Patient states he developed substernal chest pain yesterday (___) without shortness of breath or radiation to his back. patient endorses a productive cough. patient also has pain when he urinates but denies any hematuria. Pt denies any fever, chills, vomiting, numbness or weakness. He did reprot a productive cough. Patient has a long history of frequent ed visits and admissions for various complaints in the setting of ETOH use. Per previous records at the time of sobriety he becomes combative and elects to leave against medical advice. Today in the ED he presented with chest/ abdomina pain and troponins remain negative x2 and EKG without impressive changes CXR revealed worsening consolidations in the RLL which could be c/w a pneumonia in the right clinical setting. The patient was given Po levofloxacin and admitted given his poor social support he remianed inebriated and his ETOH level was pending at the time of d/c. \n\nIn the ED, initial vitals were: \nT 98.4 88 130/80 18 98% RA \n\n- Labs were significant for \nCBC:\n4.0 8.1 134 \n 24.4 \n\nCHEM 7: \n139 106 20 \n-------------<96 \n4.0 20 1.2\n \nU tox positive for oxycodone\nS tox positive for EtOH\n\n- Imaging revealed \nRight middle/ lower lobe opacities are mildly increased over prior studies. The left lung remains clear. Cardiac size remains normal. No pneumothorax or pulmonary edema. No pleural effusion. \n \n \n- The patient was given \n1L IVF 4mg Zofran, donnatol and viscous lidocaine \n\nUpon arrival to the floor, vitals were 98.3 81 130/66 16 98% RA \n\nOn arrival to the floor he reprots hematuria with dysuria since seeing his urologist for bladder cancer f/u of ___ He continues to report active pain in his chast abdomen and back. He reports one of the medications they provided him in the ED really improved the stomach pain, and he thinks eatign will also help. He reports some dizziness and light headed ness, shortness of breath, headache, cough productive of yellow sputum, nausea, and occasional black/ bloody stools. \n\nHe reports taking all of his medications when I name them for him he agrees that he takes them but he also agreed that he took medications that were randomly named. He vehemently denied taking oxycodoone within the last 3 weeks (his urine was postive for oxycodone). He reports the iv zofran he received in the ED helped his stomach pain.\n", + "input3": "- Alcohol abuse \n- Cirrhosis, complicated by Grade 1 esophageal varices \n- Hepatitis C, Ab positive, VL 46million on ___ \n- GERD \n- Colonic angiectasias \n- Hypertension \n- Atypical chest pain \n- Chronic anemia \n- Exploratory laparotomy in ___ following MVC \n- ?Hx of MI (patient states he refused stent) \n- ?Hx of prostate cancer \n- Hemorrhoids\nEndoscopy:Lesions of gastric antrum erosion and hemorrhage\n", + "input4": "Father had a history of Diabetes Mellitus, Hypertension, 3x \nMyocardial Infarction died of MI. Mother had a history of Diabetes Mellitus, Hypertension, breast cancer, and died of colon cancer\n", + "input5": "ADMISSION PHYSICAL EXAM: \nVitals: 98 138/76 p 73 R 16 100% on RA \nGEN - Alert, NAD \nHEENT - NC/AT, OP clear \nNECK - Supple \nCV - RRR, ___ systolic murmur throughout, no r/g \nRESP - CTA B \nABD - S/ND, BS present, diffuse TTP in abdomen and back \ndistractable without rebound or guarding \nEXT - No ___ edema or calf tenderness \nSKIN - No apparent rashes \nNEURO - Nonfocal \nPSYCH - Calm, appropriate \nRECTAL: No obvious external lesions\n", + "input6": "___ 01:52AM BLOOD WBC-4.0 RBC-2.90* Hgb-8.1* Hct-24.4* MCV-84 MCH-27.8 MCHC-33.0 RDW-17.1* Plt ___\n___ 01:52AM BLOOD Neuts-58 Bands-0 ___ Monos-2 Eos-4 Baso-0 Atyps-4* ___ Myelos-0\n___ 01:52AM BLOOD Glucose-96 UreaN-20 Creat-1.2 Na-139 K-4.0 Cl-106 HCO3-20* AnGap-17\n___ 01:52AM BLOOD ALT-37 AST-70* AlkPhos-120 TotBili-0.3\n___ 01:52AM BLOOD Lipase-69*\n___ 01:52AM BLOOD cTropnT-<0.01\n___ 09:13AM BLOOD cTropnT-<0.01\n___ 04:15AM BLOOD ASA-NEG Ethanol-64* Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 06:05AM BLOOD Ret Aut-2.1\n___ 11:04AM BLOOD Hgb-8.0*\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/18151206-DS-22.json b/Finished/Gastritis/Acute Gastritis/18151206-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..4ac218ed562735435e53f201aaea4e4a2ad29477 --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/18151206-DS-22.json @@ -0,0 +1,27 @@ +{ + "Acute gastritis$Intermedia_3": { + "Lesions of gastric antrum erosion and hemorrhage on endoscopy are the gold standard for the diagnosis of acute gastritis.$Cause_1": { + "Endoscopy:Lesions of gastric antrum erosion and hemorrhage$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "abdominal pain, nausea and vomiting are symptoms that may occur in patients with gastritis$Cause_1": { + "He has diabetes, hypertension, gastroparesis, chronic abdominal pain with multiple admissions (erosive esophagitis and 2 possible tears) s/p EGD and abdominal pain/nausea/vomiting, and recent visit to ED. He presents now w/ abdominal pain for two days. Endorses midline epigastric pain, nonbloody vomiting. Pain does not migrate.$Input2": {} + }, + "Stress response to trauma is a common cause of acute gastritis$Cause_1": { + "Right knee trauma in ped v truck accident at work$Input3": {} + }, + "Pain in upper abdomen is a symptom that may occur in patients with gastritis.$Cause_1": { + "pain in upper abdomen$Input1": {} + }, + "Nausea and vomiting are symptoms that may occur in patients with gastritis$Cause_1": { + "He does have a moderate amount of nausea with meals, and one or two times of vomiting.$Input2": {} + } + } + }, + "input1": "pain in upper abdomen\n", + "input2": "He has diabetes, hypertension, gastroparesis, chronic abdominal pain with multiple admissions (erosive esophagitis and 2 possible tears) s/p EGD and abdominal pain/nausea/vomiting, and recent visit to ED. He presents now w/ abdominal pain for two days. Endorses midline epigastric pain, nonbloody vomiting. Pain does not migrate. Not worse w/ exertion. Not worse w/ eating. Denies fevers, chills, or diarrhea. Pt states he has been taking all of his meals as prescribed. He does have a moderate amount of nausea with meals, and one or two times of vomiting. He denies melena, BRBPR, hematemesis.\n\nIn the ED, mental status: vitals, pain 10 97.1 87 ___ RA. pt A&Ox3, moaning out in pain when first arrived, short answers to ?s. Pt has hx of ETOH/multiple admission. 22g in R thumb (pt is a difficult stick). 2L IVF. Received morphine 4mg iv, SQ ativan 0.5mg prior to iv access, and 4mg iv zofran. most recent BS=230. He is ambulatory at basline. BP 185/77 @ 1155. 4 mg IV morphine given at 1157\n\nHis vitals signs on 98.7 163/90 73 16 100%RA. Currently, patient reports abdominal pain and nausea. \n\nROS: Pt not cooperative with full ROS. Denies fevers, chills, chest pain, shortness of breath.\n", + "input3": "-HTN\n-Diabetes mellitus type II, insulin-dependent\n-Esophagitis\n-Chronic abdominal pain\n-Gastoperesis \n-Anxiety NOS \n-s/p bilateral cataract surgery ___ \n-Right knee trauma in ped v truck accident at work\n", + "input4": "mother alive with HTN, and DM father - died with unknown causes, sister with HTN Four kids, all well.\n", + "input5": "ADMISSION PHYSICAL EXAM\nVS - Temp 98.7 163/90 73 16 100%RA\nGENERAL - lying flat in bed clutching, NAD\nHEENT - NC/AT, PERRL, sclerae anicteric, MMM, OP clear\nNECK - supple, no thyromegaly, no JVD, no carotid bruits\nLUNGS - CTA bilat, no wheezes/rales/rhonchi\nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2\nABDOMEN - bowel sounds present, soft, slightly distended, diffusely tender to palpation\nEXTREMITIES - WWP, no c/c/e,\nNEURO - awake, oriented, CN II - XII grossly intact, moving all extremities\n", + "input6": "LABS: \n___ 10:00AM BLOOD WBC-6.3# RBC-4.12* Hgb-12.2* Hct-36.0* MCV-87 MCH-29.5 MCHC-33.7 RDW-13.4 Plt ___\n___ 07:00AM BLOOD WBC-5.2 RBC-4.21* Hgb-12.4* Hct-37.0* MCV-88 MCH-29.5 MCHC-33.6 RDW-13.3 Plt ___\n___ 10:00AM BLOOD Neuts-71.8* ___ Monos-6.6 Eos-0.7 Baso-0.3\n___ 07:00AM BLOOD Glucose-139* UreaN-10 Creat-0.8 Na-136 K-4.1 Cl-102 HCO3-25 AnGap-13\n___ 10:00AM BLOOD Glucose-216* UreaN-16 Creat-0.8 Na-135 K-4.1 Cl-103 HCO3-22 AnGap-14\n___ 10:00AM BLOOD ALT-15 AST-11 AlkPhos-66 TotBili-0.8\n___ 09:15PM BLOOD CK-MB-2 cTropnT-<0.01\n___ 10:00AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:00AM BLOOD Calcium-9.1 Phos-3.0 Mg-1.8\n___ 10:09AM BLOOD Lactate-1.___rief Hospital Course:\nHe is a 67 year-old male with history of h/o chronic abdominal pain, esophagitis, gastroparesis, IDDM, HTN who presents with recurrent nausea and abdominal pain.\n\n# Abdominal pain/Nausea/vomiting: Consistent with chronic abdominal pain. EGD from last admission showed severe esophagitis in the distal of esophagus likely secondary to GERD. Patient with many similar admissions for abdominal pain and nausea and was recently discharged on more than one occasion in the past month. e. LFTs including lipase normal without evidence of biliary pathology. No history of pancreatitis. Very unlikely to be ACS, as EKG unchanged from prior and cardiac enzymes neg x3. Pain likely esophagitis in the setting of medication non-compliance. In addition, gastroparesis likely causing nausea/vomiting when patient eats large meals. Continued omeprazole 40mg BID and other home regimen. Patient able to tolerate PO regular food prior to discharge. Counselled patient at length about foods to avoid to prevent GERD, need to adhere to medication regimen and to eat small meals as tolerated.Endoscopy:Lesions of gastric antrum erosion and hemorrhage\n\n# Hypertension: Patient with history of poorly controlled hypertension. However, BP in normal range once on meds in the hospital. Patient hypertensive on admission, possibly in setting not taking home BP medications ___ nausea, vomitng. Continued home antihypertensives - valsartan and amlodipine with SBP in 100-140s.\n\n# Nodular opacity seen on CXR: 0.8 cm nodular opacity projecting over the right mid-to-lower hemithorax, possible nipple shadow, seen on PRIOR ADMISSION. Consider repeat CXR with nipple markers in the future as an outpatient.\n\n# Diabetes mellitus: Most recent HgbA1c is 6.9% in ___. Continued home lantus and HISS.\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/18473921-DS-14.json b/Finished/Gastritis/Acute Gastritis/18473921-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..72e16b08f25f07b297c79593f199127a17351bc1 --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/18473921-DS-14.json @@ -0,0 +1,27 @@ +{ + "Acute gastritis$Intermedia_3": { + "Erythema, Lesions of erosion and hemorrhage in the antrum on endoscopy, which are the gold standard for the diagnosis of acute gastritis\r.$Cause_1": { + "Upper Endoscopy:final\nImpression: Normal mucosa in the esophagus, Erythema in the antrum.Lesions of erosion and hemorrhage.\nPolyps in the stomach body\nAbnormal mucosa in the duodenum (biopsy)\nOtherwise normal EGD to third part of the duodenum \nNo findings consistent with the reported duodenitis that was noted on CT scan.$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Surgery is a common cause in patients with gastritis.$Cause_1": { + "Female with asthma, htn, morbid obesity and POD s/p sacrospinous suspension, anterior repair, tension-free vaginal tape cystoscopy by Dr.$Input2": {} + }, + "Abdominal pain is a symptom that may occur in patients with gastritis$Cause_1": { + "Abdominal pain began two days ago, located in epigastric region.$Input2": {} + }, + "!Abdominal pain is a symptom that may occur in patients with gastritis$Cause_1": { + "is admitted from urgent care with two days of epigastric abdominal pain.$Input2": {} + }, + "Nausea is a symptom that may occur in patients with gastritis.$Cause_1": { + "Endorses nausea without any vomiting.$Input2": {} + } + } + }, + "input1": "abdominal pain\n", + "input2": "Female with asthma, htn, morbid obesity and POD s/p sacrospinous suspension, anterior repair, tension-free vaginal tape cystoscopy by Dr. A for urinary incontinence and recurrent UTIs who is admitted from urgent care with two days of epigastric abdominal pain. History obtained by neice who was at the bedside and able to interpret.\n\nAbdominal pain began two days ago, located in epigastric region. Pain is sharp, non-radiating, constant at max. Recent constipation, drank milk of magnesia two days ago, had a large BM then abdominal pain began. No brbpr or melena. Endorses nausea without any vomiting. Also with anorexia which she attributes to pain and nausea. Reports subjective fever yesterday. Occasional lightheadedness with standing over the past several days. No weight loss. Reports light vaginal bleeding (gyn aware stated it is expected) since surgery, no discharge, no incontinence.\n\nYesterday patient went to the ED. Evaluated by GYN, GU exam benign, thought no surgical need for re-exploration or admission. CT scan showed inflammatory stranding adjacent to pancreatic head and duodenum that could reflect duodenitis and/or pancreatitis. Continued to have pain overnight and went to Urgent Care. Given persistent abdominal pain, CT findings to suggest duodenitis vs pancreatitis decision made to admit patient. Per note she recently stopped her protonix however reports she takes nexium daily but has not taken x 2 days due to nausea.\n\nUrgent care: 98.3 72P 16 122/78 98%RA; morphine 5mg iv x 2, ranitidine 50mg x 1, zofran and IVFs\n\nROS: \n- General: + fevers, chills, sweats, no weight loss\n- HEENT: no changes in vision or hearing, no rhinorrhea, nasal congestion, headaches, sore throat\n- Lungs: no cough, shortness of breath, dyspnea on exertion\n- Cardiac: no chest pain, pressure, palpitations, orthopnea, PND\n- GI: + abdominal pain, + nausea, - vomiting, - diarrhea, + constipation, -BRBPR, - melena\n- GU: no dysuria, hematuria, urgency, frequncey\n- MSK: no arthralgias or myalgias\n- Neuro: no weakness, numbness, seizures, difficulty speaking, changes in memory.\n", + "input3": "1. Asthma.\n2. Hypertension.\n3. Morbid obesity.\n4. Hyperparathyroidism.\n5. Allergic rhinitis.\n", + "input4": "no known of malignancy\n", + "input5": "Exam on admission:\n\n100.6 148/73 76 18 96%RA\nGen: alert, NAD, pleasant, resting comfortably in bed\nHeent: anicteric, eomi, perrl, op clear s lesions, mmd\nNeck: supple, no LAD, no JVD\nCv: +s1, s2 -m/r/g\nPulm: clear bilaterally\nAbd: soft, ++ epigastric ttp, no distension, no rebound/guarding\nExtr: no edema, 2+ dp/pt\nNeuro: cn ___ grossly intact, no focal deficits\nSkin: no rashes\nRectal: no stool in vault, guaiac negative\n", + "input6": "Labs on admission:\n___ 11:46PM URINE BLOOD-TR NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG\n___ 08:29PM GLUCOSE-88 UREA N-6 CREAT-0.6 SODIUM-137 POTASSIUM-3.7 CHLORIDE-106 TOTAL CO2-24 ANION GAP-11\n___ 08:29PM ALT(SGPT)-20 AST(SGOT)-49* LD(LDH)-151 ALK PHOS-123* AMYLASE-53 TOT BILI-0.4\n___ 08:29PM LIPASE-23\n___ 08:29PM ALBUMIN-3.4* CALCIUM-8.5 PHOSPHATE-2.0* MAGNESIUM-1.7\n___ 08:29PM WBC-9.9 RBC-3.35* HGB-9.0* HCT-27.0* MCV-81* MCH-26.9* MCHC-33.4 RDW-16.0*\n___ 08:29PM NEUTS-75.4* LYMPHS-17.4* MONOS-5.4 EOS-1.6 BASOS-0.2\n___ 08:29PM ___ PTT-25.0 ___\n\nBlood Culture ___ and ___- NGTD\nHpylori antibody ___ - negative, final\nUrine culture ___- negative, final\n\n___ CT a/p:\n1. Inflammatory stranding adjacent to the pancreatic head/uncinate process as well as the C-sweep of the duodenum. Findings could reflect a duodenitis and/or pancreatitis. Correlate clinically. No fluid collections or free air. \n2. Post-surgical changes in deep posterior pelvis, with inflammatory stranding but no fluid collections or free air. \n3. Normal appendix. Status post cholecystectomy. \n4. Small fat-containing ventral hernia. \n\n___ PA and lateral CXR-final\nFINDINGS: Upright PA and lateral views of the chest were performed. Lungs are better inflated. Again seen is a left lower lobe opacity \nwhich is likely atelectasis, but could represent pneumonia and the source of the patient's pain. Right lower lobe atelectasis is slightly worsened. No pneumothorax. Stable small left pleural effusion. Mild cardiomegaly. \n \nIMPRESSION: Retrocardiac opacity could be atelectasis or pneumonia in the right clinical setting. \n\n___- AP chest x-ray-final.Comparison is made with prior study.There are lower lung volumes. New left lower lobe opacity could be atelectasis, but pneumonia cannot be excluded. Right lower lobe atelectasis has markedly worsened. There is no pneumothorax. Cardiomegaly is stable. If any, there is a small left pleural effusion \n\nCT abdomen and pelvis without contrast: \nIMPRESSION: \n1. Inflammatory stranding adjacent to the pancreatic head/uncinate process as well as the C-sweep of the duodenum. Findings could reflect a duodenitis and/or pancreatitis. Correlate clinically. No fluid collections or free air.\n2. Post-surgical changes in deep posterior pelvis, with inflammatory stranding but no fluid collections or free air. \n3. Normal appendix. Status post cholecystectomy. \n4. Small fat-containing ventral hernia. \n\n___- RUQ US-final\nIMPRESSION: \n1. Slightly coarse and echogenic liver consistent with hepatic steatosis. \nOther advanced forms of liver disease including fibrosis and cirrhosis cannot be excluded on this study. No focal liver lesion is identified on this technically limited study. \n2. Status post cholecystectomy with no intra- or extra-hepatic biliary ductal dilatation. No retained biliary stone identified. \n3. Pancreatic body is partially visualized and unremarkable. The head, uncinate process and tail of the pancreas are obscured by bowel gas and cannot be evaluated on this study. \n \n___- Upper Endoscopy:final\nImpression: Normal mucosa in the esophagus, Erythema in the antrum.Lesions of erosion and hemorrhage.\r\nPolyps in the stomach body\nAbnormal mucosa in the duodenum (biopsy)\nOtherwise normal EGD to third part of the duodenum \nNo findings consistent with the reported duodenitis that was noted on CT scan.\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/18519555-DS-2.json b/Finished/Gastritis/Acute Gastritis/18519555-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..4506a908713c980d39d0ff59870d316704dccc72 --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/18519555-DS-2.json @@ -0,0 +1,30 @@ +{ + "Acute gastritis$Intermedia_3": { + "Lesions of erosion and hemorrhage in theantrum on endoscopy are the gold standard for the diagnosis of acute gastritis\r.$Cause_1": { + "Endoscopy:\nesophageal:normal\nstomach:\n\nduodenum:normal$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Stress and alcohol are the common cause in patients with gastritis.$Cause_1": { + "he has been very stressed at work about a possible upcoming inspection so he has been having 8 beers daily.$Input2": {} + }, + "Abdominal pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "Yesterday morning he had onset of severe abdominal pain radiating through to his back.$Input2": {} + }, + "Surgery is a common cause in patients with gastritis.$Cause_1": { + "First episode of pancreatitis and spent 23 days in ICU in PR and gotplamapheresis Second episode of pancreatitis in third week for which he was hospitalized for 4 days and he felt well after.$Input3": {} + }, + "!Abdominal pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "Abdominal pain$Input1": {} + }, + "Nausea and vomiting are symptoms that may occur in patients with gastritis.$Cause_1": { + "Also experiencing nausea and vomiting with no blood or material and a \nas well as diarrhea with no black or bloody aspect.$Input2": {} + } + } + }, + "input1": "Abdominal pain\n", + "input2": "___ with hx hypertriglyceridemia, HLD and pancreatitis presenting with abdominal pain. He normally does not drink hard liquor because of his past pancreatitis but 2 days ago had a drink. Of note he has been very stressed at work about a possible upcoming inspection so he has been having 8 beers daily. He also had soup with hot sauce on it. Yesterday morning he had onset of severe abdominal pain radiating through to his back. He went to ED last night where he reports that his pancreas numbers were normal but his liver enzymes were elevated. They did an ultrasound which was reported to him as normal. He was prescribed Bentyl and discharged without ever speaking to an M.D. per patient. Since then his pain has persisted and he has not taken anything for it. Also experiencing nausea and vomiting with no blood or material and a \nas well as diarrhea with no black or bloody aspect. No fever or chills.\n\nPatient stopped crestor yesterday as PCP was worried it was contributing to LFT abnormalities\n\nIn ER: (Triage Vitals:10 |76 |151/97 |16 |97% RA ) \nMeds and IVF given:\n/___ 15:37 IV Morphine Sulfate 4 mg ___ \n___ 15:37 IV Ondansetron 4 mg ___ \n___ 15:37 IVF 1000 mL NS 1000 mL ___ \n___ 16:29 IV Morphine Sulfate 4 mg ___ \n___ 18:35 IVF 1000 mL NS 1000 mL ___ \n___ 18:35 IV HYDROmorphone (Dilaudid) .5 mg ___ \n \n___ 21:34 IV HYDROmorphone (Dilaudid) .5 mg ___ \n___ 23:47 IV HYDROmorphone (Dilaudid) .5 mg ___ \n___ 01:52 IV HYDROmorphone (Dilaudid) .5 mg ___ \n___ 01:52 IVF 1000 mL ___ ___ Started 100 mL/hr \n___ 03:06 PO/NG Enalapril Maleate 5 mg ___ \n___ 03:06 PO Pantoprazole 40 mg ___ \n\n[___] Labs - mild LFT elevation\n[x] US\n[x] IVF/pain/nausea control. He had significant abdominal pain and thus he had a CT scan performed which demonstrated:- \"Encapsulated fluid collections in peripancreatic region and bilateral retroperitoneum are consistent with walled off necrosis\"\n[ x] ACS consult --> no surgical management, abx deferred at this time\n- NPO\n- mIVF\n\nDispo:\n- admit to medicine for further management of walled off necrosis, pain control\n- consider starting gemfibrozil 600mg BID for hypertriglyceridemia\n\nPAIN SCALE: ___ diffuse generalized abdominal pain\nCONSTITUTIONAL: As per HPI\nHEENT: [X] All normal\nRESPIRATORY: [X] All normal\nCARDIAC: [X] All normal\nGI: [+] diarrhea with yellow stools -started two days ago, the same time as the pain\nGU: [X] All normal\nSKIN: [X] All normal\nMUSCULOSKELETAL: [X] All normal\nNEURO: [X] All normal\nENDOCRINE: [X] All normal\nHEME/LYMPH: [X] All normal\nPSYCH: [X] All normal\nAll other systems negative except as noted aboveREVIEW OF\n", + "input3": "-ACUTE PANCREATITIS\n-First episode of pancreatitis and spent 23 days in ICU in PR and gotplamapheresis Second episode of pancreatitis in third week for which he was hospitalized for 4 days and he felt well after.\n-TREMOR\n-ANXIETY\n-ABDOMINAL PAIN\n-EXERTIONAL DYSPNEA\n-SHORTNESS OF BREATH\n", + "input4": "MotherMYOCARDIAL INFARCTION \nHYPERCHOLESTEROLEMIA\nMGMMYOCARDIAL INFARCTION\nHYPERCHOLESTEROLEMIA\n\nAuntMYOCARDIAL INFARCTION\nHYPERCHOLESTEROLEMIA\n", + "input5": "ADMISSION EXAM\nVitals: 98.0 PO 150 / 93 66 18 100 RA \nCONS: non-toxic but appears uncomfortable \nHEENT: ncat anicteric MMM \nCV: s1s2 rr no m/r/g \nRESP: b/l ae no w/c/r \nGI: +bs, soft, + tenderness in all four quadrant without rebound or guarding \nMSK:no c/c/e 2+pulses \nSKIN: multiple tatoos\nNEURO: face symmetric speech fluent \nPSYCH: calm, cooperative\n", + "input6": "Admission Labs:\n___ 02:50PM BLOOD WBC-3.8*# RBC-4.31* Hgb-13.8 Hct-40.9 MCV-95# MCH-32.0 MCHC-33.7 RDW-13.4 RDWSD-47.6* Plt ___\n___ 02:50PM BLOOD Neuts-48.6 ___ Monos-7.4 Eos-3.7 Baso-1.3* Im ___ AbsNeut-1.85# AbsLymp-1.47 AbsMono-0.28 AbsEos-0.14 AbsBaso-0.05\n___ 02:50PM BLOOD Glucose-95 UreaN-10 Creat-0.8 Na-136 K-4.6 Cl-104 HCO3-23 AnGap-14\n___ 02:50PM BLOOD ALT-109* AST-119* AlkPhos-54 TotBili-0.5\n___ 02:50PM BLOOD Lipase-17\n___ 02:50PM BLOOD cTropnT-<0.01\n___ 02:50PM BLOOD Albumin-4.2\n___ 02:50PM BLOOD Triglyc-1513*\n\nRUQ U/S - IMPRESSION: \n1. Echogenic liver consistent with steatosis. Other forms of liver disease including steatohepatitis, hepatic fibrosis, or cirrhosis cannot be excluded on the basis of this examination. \n2. Normal gallbladder without cholelithiasis. \n\nCT A/P - IMPRESSION: \n1. Multiple encapsulated slightly complex fluid collections in the peripancreatic region and bilateral retroperitoneum likely reflect areas of walled off necrosis. \n2. Pancreas demonstrates mild atrophy but otherwise homogeneous attenuation without peripancreatic stranding to suggest acute pancreatitis. \n3. Hepatic steatosis.\nEndoscopy:\nesophageal:normal\nstomach:\nLesions of erosion and hemorrhage in the antrum\nduodenum:normal\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/19341663-DS-15.json b/Finished/Gastritis/Acute Gastritis/19341663-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..6c7f4a301dc9a0f625bd76e01b3f27bf621f659d --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/19341663-DS-15.json @@ -0,0 +1,21 @@ +{ + "Acute gastritis$Intermedia_3": { + "Lesions of gastric antrum erosion and hemorrhage on endoscopy are the gold standard for the diagnosis of acute gastritis$Cause_1": { + "Endoscopy:Lesions of gastric antrum erosion and hemorrhage$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "It is common in gastritis and is associated with the stomach pain mentioned above, indicating that the food may not be well digested.$Cause_1": { + "nausea and non-bloody emesis (vomited \"just food\")$Input2": {} + }, + "This could be caused by food, such as the prosciutto and tomatoes you eat for lunch.$Cause_1": { + "epigastric pain \nfollowing lunch (prosciutto, tomato)$Input2": {} + } + } + }, + "input1": "N/A\n", + "input2": "The patient reports yesterday she developed epigastric pain \nfollowing lunch (prosciutto, tomato). Associated with this was nausea and non-bloody emesis (vomited \"just food\"). She denies diarrhea, last BM was this AM that the patient reports to be normal. Denies CP, SOB, palpations, hematuria, dysuria, melena, BRBPR. Donepezil started 10 days ago, no other recent med changes.\n", + "input3": "-CHOLECYSTECTOMY \n-DIABETES TYPE II \n-GASTROESOPHAGEAL REFLUX \n-HYPERLIPIDEMIA \n-HYPERTENSION \n-OBESITY \n-OSTEOARTHRITIS \n-TOTAL ABDOMINAL HYSTERECTOMY\n", + "input4": "-mother and father passed away from \"old age\"\n", + "input5": "Vitals: T:98.1 B:159/65 HR:79 RR:18 O2: 96%RA\nGeneral: Alert, no acute distress \nHEENT: Sclera anicteric, moist membranes\nNeck: no LAD \nCV: Irregular rhythm, normal rate, S1 + S2, no murmurs\nLungs: Clear to auscultation bilaterally, no wheezes\nAbdomen: soft, non-tender, non-distended, bowel sounds present\nGU: no foley \nExt: Warm, trace edema \nNeuro: speech fluent, tongue midline\n", + "input6": "___ 05:40PM BLOOD Neuts-80.1* Lymphs-15.8* Monos-2.9 \nEos-0.6 Baso-0.6\n___ 05:40PM BLOOD WBC-12.9* RBC-4.46 Hgb-13.7 Hct-39.9 \nMCV-89# MCH-30.8 MCHC-34.4 RDW-13.7 Plt ___\n___ 05:40PM BLOOD Glucose-210* UreaN-23* Creat-0.9 Na-142 \nK-4.1 Cl-101 HCO3-27 AnGap-18\n___ 05:40PM BLOOD ALT-18 AST-20 AlkPhos-93 TotBili-0.6\n___ 05:40PM BLOOD Lipase-220*\n___ 05:40PM BLOOD Albumin-4.5\n___ 06:36PM BLOOD Lactate-1.4\n\nEndoscopy:Lesions of gastric antrum erosion and hemorrhage\n\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/19444258-DS-15.json b/Finished/Gastritis/Acute Gastritis/19444258-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..28945258b15297d72c666019efa4973c789c1bde --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/19444258-DS-15.json @@ -0,0 +1,21 @@ +{ + "Acute gastritis$Intermedia_3": { + "Multiple erosions in the antrum and the incisura of the stomach on EGD are the gold standard for the diagnosis of acute gastritis$Cause_1": { + "EGD: Normal mucosa in the esophagus, multiple erosions in the antrum and the incisura of the stomach, normal mucosa in the duodenum, small polyp in the first part of duodenum$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "Stress caused by mental strain is a common cause in patients with gastritis.$Cause_1": { + "A 72 female with a past medical historysignificant for depression, hyperlipidemia, depression/anxiety and IBS who presented to the ED$Input2": {} + }, + "Melena and dark red stools may be signs of severe acute gastritis.$Cause_1": { + "complaints of 3 days of melena and dark red stools.$Input2": {} + } + } + }, + "input1": "Melena/Hematochezia\n", + "input2": "A 72 female with a past medical historysignificant for depression, hyperlipidemia, depression/anxiety and IBS who presented to the ED with complaints of 3 days ofmelena and dark red stools. \n\nThe patient reports that 3 days prior to presentation she ate amultiple vegetables and garlic which typically triggers her IBS.Since then she has felt very bloated, and not eaten significantly. Her symptoms gradually improved, however she thendeveloped dark red stools later that night, and had multipleloose bowel movements at least 4 times daily. Her lastcolonoscopy was at least ___ years ago. She had not had any fevers/ chills/nausea/vomiting/weight gain or loss/abdominal pain/ bowel/ bladder incontinence during this time. She ultimately presented to the ED given her ongoing black bowel movements. Other than the color of her bowel movements, she has not had any other symptoms including fatigue, dizziness, palpitations, or shortness of breath. \n\nIn the ED the patient's vitals were hemodynamically stable. Her exam was notable for: Gen: NAD, A&Ox3 CV: ___ systolic murmur at\nRUSB Lung: CTAB Abd: NTND, no hsm Ext: Warm, well perfused, no\nedema Rectal: dark liquid stool in the perineum, guaiac positive\nNeuro: No gross/focal deficits. \n\nThe patient subsequently had a small bowel movement in the emergency room which was very dark and had small amounts of dark red blood. At that time her rectal exam was notable for guaiac positive and melena staining the perineum. She continued to be hemodynamically stable while in the ED. Here H&H was noted to have downtrended to 7.5 from her previous baseline. GI was consulted and recommended admitting the patient to medicine and EGD. She received 1 unit of PRBCs and was transferred to the medical floor. \n\nOn arrival to the floor, the patient was resting comfortably in no acute distress and had no specific complaints. She denied palpitations, syncope, fatigue, or lightheadedness. She did report some anxiety and insomnia and was asking for something for sleep. She was intermittently declining here.\n", + "input3": "-PMH: She has had multiple falls over the last several years\n-one resulted in a right hip fracture in which she required ahemiarthroplasty to the right hip. \n-anxiety, depression, osteopenia, elevated cholesterol.\n", + "input4": "Reviewed. none pertinent to this hospitalization.\n", + "input5": "Exam on Admission:\nVITALS: ___ 2325 Temp: 97.9 PO BP: 130/82 HR: 91 RR: 18 O2\nsat: 97% O2 delivery: Ra \n\nGENERAL: Alert and interactive. In no acute distress.\nHEENT: PERRL, EOMI. Sclera anicteric and without injection. MMM.\nNECK: No cervical lymphadenopathy. No JVD.\nCARDIAC: Regular rhythm, normal rate. Audible S1 and S2. No murmurs/rubs/gallops.\nLUNGS: Clear to auscultation bilaterally. No wheezes, rhonchi or\nrales. No increased work of breathing.\nBACK: No CVA tenderness.\nABDOMEN: Normal bowels sounds, non distended, non-tender to deep\npalpation in all four quadrants. No organomegaly.\nEXTREMITIES: No clubbing, cyanosis, or edema. Pulses DP/Radial 2+bilaterally.\nSKIN: Warm. Cap refill <2s. No rashes.\nNEUROLOGIC: AOx3. CN2-12 intact. Moving all 4 limbs spontaneously. ___ strength throughout. Normal sensation.\n", + "input6": "LABS\n================================================\nAdmission Labs\n___ 06:50PM GLUCOSE-105* UREA N-27* CREAT-0.9 SODIUM-144 POTASSIUM-4.0 CHLORIDE-107 TOTAL CO2-22 ANION GAP-15\n___ 06:50PM WBC-6.1 RBC-2.32* HGB-7.5* HCT-22.8* MCV-98 MCH-32.3* MCHC-32.9 RDW-14.6 RDWSD-51.0*\n___ 06:50PM NEUTS-64.4 ___ MONOS-9.0 EOS-1.1 BASOS-0.2 IM ___ AbsNeut-3.92 AbsLymp-1.52 AbsMono-0.55 AbsEos-0.07 AbsBaso-0.01\n\nMICROBIOLOGY\nNone\n\nIMAGING\n___ Colonscopy: multiple diverticula in the colon, normal mucosa throughout the colon\n\n___: EGD: Normal mucosa in the esophagus, multiple erosions in the antrum and the incisura of the stomach, normal mucosa in the duodenum, small polyp in the first part of duodenum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Acute Gastritis/19542790-DS-3.json b/Finished/Gastritis/Acute Gastritis/19542790-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..a048380ad42d7d0a23cca5277c92e4b6be307459 --- /dev/null +++ b/Finished/Gastritis/Acute Gastritis/19542790-DS-3.json @@ -0,0 +1,18 @@ +{ + "Acute gastritis$Intermedia_3": { + "Lesions of gastric antrum erosion and hemorrhage on endoscopy are the gold standard for the diagnosis of acute gastritis$Cause_1": { + "Endoscopy:Lesions of gastric antrum erosion and hemorrhage$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "GERD and gastritis share common symptoms and a possible causal relationship, as long-term acid reflux can lead to inflammation of the gastric mucosa.$Cause_1": { + "omeprazole for GERD$Input2": {} + } + } + }, + "input1": "N/A\n", + "input2": "She reports intermittent CP for months and presented to ___ on ___ with noted d-dimer of 640, negative CTA and patient was instructed to follow up for recommended repeat endoscopy and GI consultation which she ___ yet done. She presented to ___ ED on ___ with similar sx and had normal labs, neg Trop I, and partial ___ with no clot noted in left common femoral vein. Today around 6am the patient was hanging laundry at work and had sudden onset substernal chest pain ___ that was sharp in nature and radiated to the back. Pain is pleuritic, non-exertional, not positional and not related to eating. She reports associated SOB and lightheadedness. Denies nausea, vomiting, diaphoresis, cough, fever, syncope. No leg swelling, recent travel, smoking, hx DVT/PE in self or family. She is on depo-provera for birth control. No hx cardiac/sudden death in family. She takes omeprazole for GERD symptoms but ___ been symptomatic recently. No throat pain, cough or sour taste in the mouth. No chemical exposures at work.\n", + "input3": "Incomplete EGD (question of hiatal hernia)\nAsthma/reactive airways (no PFTs)\n", + "input4": "Mother has HTN. Does not know her father's medical history and ___ seen him in a long time. 1 brother and 1 sister are both in good health. Maternal grandmother has DM.\n", + "input5": "Vitals- 98.3, 115/73, 79, 100% RA (98% with ambulation) \nGeneral- Alert, oriented, no acute distress \nHEENT- Sclera anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, no LAD \nLungs- Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV- Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops. Sternal area is painful to palpation. \nAbdomen- soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nGU- no foley \nExt- warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema. calves are nontender and grossly symmetric. \nNeuro- CNs2-12 intact, motor function grossly normal\n", + "input6": "___ 01:40PM BLOOD WBC-8.60 RBC-5.05 Hgb-11.5* Hct-35.9* \nMCV-71* MCH-22.7* MCHC-31.9 RDW-15.1 Plt ___\n___ 07:40AM BLOOD WBC-6.7 RBC-5.25 Hgb-11.7* Hct-37.9 \nMCV-72* MCH-22.2* MCHC-30.8* RDW-15.1 Plt ___\n___ 01:40PM BLOOD Neuts-53 Bands-0 ___ Monos-5 Eos-1 \nBaso-0 ___ Myelos-0\n___ 01:40PM BLOOD Hypochr-1+ Anisocy-NORMAL Poiklo-NORMAL \nMacrocy-NORMAL Microcy-3+ Polychr-NORMAL\n___ 01:40PM BLOOD ___ PTT-29.8 ___\n___ 07:40AM BLOOD Plt ___\n___ 07:30AM BLOOD Glucose-87 UreaN-10 Creat-0.9 Na-140 \nK-4.3 Cl-107 HCO3-25 AnGap-12\n___ 07:30AM BLOOD ALT-13 AST-14 AlkPhos-67 TotBili-0.2\n___ 08:00AM BLOOD CK(CPK)-98\n___ 07:30AM BLOOD Lipase-26\n___ 08:00AM BLOOD CK-MB-1 cTropnT-<0.01\n___ 01:40PM BLOOD cTropnT-<0.01\n___ 07:30AM BLOOD Calcium-9.2 Phos-3.5 Mg-2.2\n___ 01:40PM BLOOD D-Dimer-879*\n\n\nThe specimen is received in two formalin containers, labeled with the patient's name, ___, the medical record number \nand additionally labeled \"mid esophagus biopsy\", \"antrum biopsy\". It consists of multiple pink-tan tissue fragments measuring up to 0.2 cm, and is entirely submitted in cassettes 1A-2A. Endoscopy:Lesions of gastric antrum erosion and hemorrhage\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Atrophic Gastritis/11389640-DS-16.json b/Finished/Gastritis/Chronic Atrophic Gastritis/11389640-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..8f911e6da9821b79dabd62aa7f7ab209c7a08853 --- /dev/null +++ b/Finished/Gastritis/Chronic Atrophic Gastritis/11389640-DS-16.json @@ -0,0 +1,29 @@ +{ + "Chronic atrophic gastritis$Intermedia_4": { + "Endoscopy is the gold standard for the examination of gastritis$Cause_1": { + "Stomach: chronic atrophic gastritis\r \nDuodenum: Normal duodenum. \nOther findings: Mild duodenitis in the bulb\nOther findings: Mild duodenitis in the bulb$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "Taking NSAIDS as a risk factor for chronic gastritis$Cause_1": { + "Intermittently taking NSAIDS ___ tablets per day) and tylenol at home for headache.$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Nausea and vomiting are symptoms that may occur in patients with gastritis.$Cause_1": { + "She states that she has had approximately 1 week of intermittent nausea and vomiting.$Input2": {} + }, + "Epigastric abdominal pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "She also developed epigastric abdominal pain following this prolonged emesis.$Input2": {} + }, + "!Nausea and vomiting are symptoms that may occur in patients with gastritis.$Cause_1": { + "She is a ___ y/o female with depression/dysthymia, lumbar \nradiculopathy, morbid obesity, and endometriosis who presents with nausea and vomiting and a syncopal episode.$Input2": {} + } + } + } + }, + "input1": "nausea/vomiting\n", + "input2": "She is a ___ y/o female with depression/dysthymia, lumbar \nradiculopathy, morbid obesity, and endometriosis who presents with nausea and vomiting and a syncopal episode. She states that she has had approximately 1 week of intermittent nausea and vomiting. She underwent right S1 nerve root injection for radiculopathy and following this developed worsening of n/v as well as new headache. Intermittently taking NSAIDS ___ tablets per day) and tylenol at home for headache. She was seen in the ED by neurology for headache, started on medrol dose pack (currently taking 16mg). She presented to ED on for severe nausea and vomitting with inability to tolerate PO. She also developed epigastric abdominal pain following this prolonged emesis. She also noted blood tinged emesis. She denies loose stool, melana, hematochezia. \n\nIn the ED, initial VS were AF, 59, 100/59, 16, 99%. After arriving to the ___ ED, she went to the bathroom in triage. She called for her husband who found her sitting on the floor. She denies any preceding symptoms but believes she vomited just prior to the episode. She was unable to recall if she lost conciousness. For evaluation of her nausea and vomiting with hematemesis: An NG lavage revealed a small amount of clot but cleared after less than 60 cc of normal saline. Her CBC was remarkable for a leukocytosis of 12.5 with a normal diff. Electrolytes were within normal limits. AST, ALT, TB, AP, albumin and lipase were all noted to be within normal limits. UA was notable for hematuria but this was believed to be after a foley placement. A quantitative serum hCG was < 5 and urine hCG was negative. She was also noted to be guaiac negative on exam. A CT abdomen and pelvis revealed no acute process. For evaluation of her syncope: an EKG revealed SR @ 71 with normal axis and no ischemic changes or underlying arrhythmia. She received Zofran total 8 mg IV and Dilaudid 1 mg IV. Vital signs at transfer were Temp: 98.3 \u00b0F (36.8 \u00b0C), Pulse: 83, RR: 18, BP: 120/59, O2Sat: 100, O2Flow: ra.\n", + "input3": "- Dysthymic disorder \n- Arthralgias \n- Hypercholesterolemia \n- Endometriosis \n- Ovarian Cyst \n- Asthma \n- Anxiety \n- Lumbar radiculopathy\n", + "input4": "not obtained\n", + "input5": "VS: 99.4 99.4 126/76 HR:67 RR:18 O2: 92%RA\nGENERAL: female in NAD, asleep but arousable to voice\nHEENT: Sclera anicteric. MMM. \nCARDIAC: RRR with no excess sounds appreciated \nLUNGS: CTA b/l with no wheezing, rales, or rhonchi.\nABDOMEN: soft, epigastric tenderness to palpation, no guarding \nEXTREMITIES: Warm and well perfused, no clubbing or cyanosis. \nNEUROLOGY: face symmetric, tongue midline, EOMI, strength grossly intact bilaterally, asterixis\n", + "input6": "ADMISSION LABS\n___ 10:50PM BLOOD WBC-12.5* RBC-4.75 Hgb-14.4 Hct-41.7 MCV-88 MCH-30.2 MCHC-34.5 RDW-13.4 Plt ___\n___ 10:50PM BLOOD Neuts-68.7 ___ Monos-6.1 Eos-1.1 Baso-0.6\n___ 01:02AM BLOOD ___ PTT-29.2 ___\n___ 10:50PM BLOOD Glucose-108* UreaN-9 Creat-0.7 Na-135 K-3.4 Cl-95* HCO3-32 AnGap-11\n___ 10:50PM BLOOD ALT-16 AST-18 AlkPhos-39 TotBili-0.4\n___ 10:50PM BLOOD Lipase-21\n___ 10:50PM BLOOD cTropnT-<0.01\n___ 05:45AM BLOOD Calcium-8.5 Phos-3.1 Mg-1.8\n___ 10:56PM BLOOD Lactate-1.1\n\nMICRO\nBlood cx ___ no growth\nHELICOBACTER PYLORI ANTIBODY TEST (Final ___: NEGATIVE BY EIA.\n\nIMAGING\n-CT Abd/Pelvis No acute abdominal process\n-CT Head No acute intracranial process.\n-EGD Esophagus: Other Erosive esophagitis of the distal third and GE junction. Small hiatal hernia. \nStomach: chronic atrophic gastritis\r \nDuodenum: Normal duodenum. \nOther findings: Mild duodenitis in the bulb\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Atrophic Gastritis/11546219-DS-21.json b/Finished/Gastritis/Chronic Atrophic Gastritis/11546219-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..7d20a13af9aea8ffd303284aaef28f4c63539d43 --- /dev/null +++ b/Finished/Gastritis/Chronic Atrophic Gastritis/11546219-DS-21.json @@ -0,0 +1,29 @@ +{ + "chronic atrophic gastritis$Intermedia_4": { + "The color of the mucosa became lighter and the folds become thin and flat are the gold standard for the diagnosis of chronic atrophic gastritis$Cause_1": { + "Endoscopy:stomach:The color of the mucosa became lighter.The folds become thin and flat.$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "GERD and H. pylori infection are common cause of chronic gastritis.$Cause_1": { + "He is a ___ with history of GERD, H. pylori (one year ago),$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Epigastric pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "Patient reports that the epigastric pain feels similar to his previous episodes in that the pain is worse when lying flat.$Input2": {} + }, + "!Epigastric pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "Epigastric pain$Input1": {} + }, + "Nausea is a symptom that may occur in patients with gastritis.$Cause_1": { + "He endorses subjective fevers and nausea associated with small amount of non-bloody, non-bilious emesis.$Input2": {} + } + } + } + }, + "input1": "Epigastric pain\n", + "input2": "He is a ___ with history of GERD, H. pylori (one year ago), chronic constipation ___ narcotic use, DMII who presents with ___ days of constant epigastric pain. Patient reports that the epigastric pain feels similar to his previous episodes in that the pain is worse when lying flat. The pain was insidious in onset, but unlike his previous episode of gastritis in ___, the pain is not abating. The pain does not radiate. He endorses subjective fevers and nausea associated with small amount of non-bloody, non-bilious emesis. He is tolerating yogurt and small amounts of liquids at home. Denies chest pain, shortness of breath, dysuria, hematuria, hematochezia, melena. No recent NSAID or alcohol use. \n \nIn the ED, initial VS: 98.2 78 128/77 16 100%RA. Labs were significant for lipase 62 and HCT 42.2. EKG showed NSR 77 NA/NI, no STEMI. CT A/P showed fat stranding and minimal mesenteric fluid adjacent to the gastric antrum and proximal/mid duodenum with likely duodenal wall thicking is suggestive of gastritis/duodenitis. No evidence of perforation or obstruction. He was given morphine 4 mg X 1, GI cocktail, and Zofran 4 mg X 1 without significant relief in symptoms. Labs at the time of transfer were: 109/73, hr 72, O2 99, temp 97.5, rr 17. \n \nCurrently, the patient reports worsening pain since his initial triage in the emergency room.\n", + "input3": "- Chronic bilateral leg pain and spasm, s/p over 30 surgeries in right knee and around 10 surgeries in left knee, total knee replacement in both knees. \n- DMII \n- Hypertension \n- Hyperlipidemia \n- Osteoarthritis \n- Asthma \n- Depression \n- GERD \n- Constipation \n- Erectile dysfunction \n- hearing deficit \n- Right carpal tunnel syndrome \n- h/o angioedema \n- Chronic follicular skin lesions, followed by dermatology \n- C3/C4 partial corpectomy with fusion on bilateral UE radiculitis secondary to large central disc herniation, chronic neck pain \n- Retropharyngeal abscess s/p I&D ___, MSSA and Corynebacterium on culture \n- Tracheostomy ___, now decanulated\n", + "input4": "Mom has significant cardiac hx. multiple MI's, first in her \n___. Deceased. Father passed from \"liver problems and emphysema\". 1 brother died from exsanguinating GIB/Ulcer, and other brother alive with DM,HTN,HLD.\n", + "input5": "VS - 98.2 120/76 75 20 100% on RA \nGENERAL - well nourished male in significant distress.\nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, no JVD, no carotid bruits \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use \nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN - Tender to palpation at epigastric region, rebound and \nguarding present. Bowel sounds present. \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n \nSKIN - no rashes or lesions \nLYMPH - no cervical, axillary, or inguinal LAD \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength ___ throughout, sensation grossly intact throughout, DTRs 2+ and symmetric, cerebellar exam intact, steady gait\n", + "input6": "___ 10:53PM BLOOD WBC-8.9 RBC-5.37 Hgb-13.2* Hct-42.2 MCV-79* MCH-24.7* MCHC-31.4 RDW-14.3 Plt ___\n___ 10:53PM BLOOD Glucose-142* UreaN-13 Creat-0.8 Na-134 K-4.6 Cl-101 HCO3-23 AnGap-15\n___ 10:53PM BLOOD ALT-21 AST-39 AlkPhos-63 TotBili-0.3\n___ 10:53PM BLOOD Lipase-62*\n___ 05:15AM BLOOD Lipase-19\n___ 10:53 pm BLOOD CULTURE\n\n\nINDICATION: Recent abdominal infection and abdominal pain. The patient is status post appendectomy. Evaluate for abscess or obstruction. \n \nTECHNIQUE: MDCT axial images were acquired from the lung bases through the lesser trochanters during infusion of 130 cc of intravenous Optiray contrast material. Multiplanar reformations were performed. \n \nCOMPARISON: CT abdomen and pelvis from ___. \n \nABDOMEN CT: The visualized portions of the lung bases are unremarkable. The liver is normal in appearance. There is no intrahepatic biliary duct dilatation. The portal vein is patent. The gallbladder, spleen, pancreas, adrenal glands, and kidneys appear normal. There is mild soft tissue stranding with minimal mesenteric fluid adjacent to the gastric antrum and more prominently about the first through third portions of the duodenum (___). There is associated duodenal wall thickening, particularly within the third and fourth segments (2:35). The remainder of the small bowel is unremarkable. The colon is grossly normal. The patient is status post appendectomy. Small retroperitoneal and mesenteric lymph nodes do not meet CT size criteria. The abdominal aorta is normal in caliber and its main branches are patent. Scattered aortic and bi-iliac artery calcifications are seen. \n \nPELVIS CT: The bladder is unremarkable. There is no free fluid in the pelvis. No pathologically enlarged pelvic lymph nodes are seen. \n \nBONE WINDOW: No suspicious lytic or blastic lesions are \nidentified. \n \nIMPRESSION: Fat stranding and mesenteric fluid adjacent to the gastric antrum and proximal-to-mid duodenum along with duodenal wall thickening is suggestive of duodenitis/gastritis. No evidence of obstruction or perforation. \n\nEndoscopy:\nProcedure: The procedure, indications, preparation and potential complications were explained to the patient, who indicated is understanding and signed the corresponding consent forms. A physical exam was performed. Moderate sedation was initiated by the physician. Continuous pulse oximetry and cardiac and blood pressure monitoring were used throughout the procedure. Supplemental oxygen was used. The patient was placed in the left lateral decubitus position and an endoscope was introduced through the mouth and advanced under direct visualization until the third part of the duodenum was reached. Careful visualization of the upper GI tract was performed. The procedure was not difficult. The patient did not tolerate the procedure well. There were no complications. \n\nFindings: \nEsophagus: \nLumen: A small size hiatal hernia was seen. No esophagitis noted. \n stomach:The color of the mucosa became lighter.The folds become thin and flat.\nOther\nprocedures: Cold forceps biopsies were performed to assess for H. pylori at the stomach antrum. \n \nImpression: Small hiatal hernia otherwise normal EGD to third part of the duodenum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Atrophic Gastritis/17745031-DS-12.json b/Finished/Gastritis/Chronic Atrophic Gastritis/17745031-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..d9408844156adfd20dd916bcbab257498607dcbe --- /dev/null +++ b/Finished/Gastritis/Chronic Atrophic Gastritis/17745031-DS-12.json @@ -0,0 +1,32 @@ +{ + "chronic non-atrophic gastritis$Intermedia_4": { + "Linear erythema, rough mucosa and bleeding spots are the gold standard for the diagnosis of chronic non-atrophic gastritis\r.$Cause_1": { + "Linear erythema, rough mucosa, bleeding spots$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "Unlike acute gastritis, the pain of chronic gastritis may not be directly related to food intake, which helps distinguish it from other gastric diseases.$Cause_1": { + "pain was not related to food ingestion$Input2": {} + }, + "Long-term alcohol abuse is is a risk factor for chronic gastritis$Cause_1": { + "She takes no NSAIDs for pain but long-term alcohol abuse$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Epigastric pain is a common symptom of chronic gastritis, usually located in the upper part of the stomach$Cause_1": { + "epigastric pain$Input2": {} + }, + "The pain of chronic gastritis may worsen over time and may be intermittent and severe in nature.$Cause_1": { + "sharp and intermittent pain and progressively became worse$Input2": {} + }, + "Pain on palpation of the abdomen, especially in the epigastric region, is a typical symptom of chronic gastritis.$Cause_1": { + "TTP in right flank and in epigastrium$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "Initially he noted epigastric pain in the morning of the day pta. This was sharp and intermittent pain and progressively became worse. Later during the day he developed right sided flank pain which was also sharp in nature. The pain did not radiate to the back or to the groin respectively. The pain was not related to food ingestion. He denied nausea, vomiting, diarrhea, constipation, brbpr or melena. \n\nHe has been feeling ill over two days and complained of decreased urine output. He was only able to produce minimal urine and the flow stopped. No blood was noted in the urine. He complains of sweating but no fever or chills. He had a regular bowel movement one day pta. He has not had any similar history in the past. Denies sick contacts, or recent travel. He was in the ed recently for leg pain and was treated with NSAIDS (800 mg motrin). She takes no NSAIDs for pain but long-term alcohol abuse\n\nIn the ED his vitals were within normal range and stable. He received ketorolac for analgesia and 1 Lt IVF. \n\nROS was otherwise negative. The pt denied recent unintended weight loss, headaches, dizziness or vertigo, changes in hearing or vision, including amaurosis fugax, neck stiffness, lymphadenopathy, hematemesis, coffee-ground emesis, dysphagia, odynophagia, heartburn, nausea, vomiting, diarrhea, constipation, steatorrhea, melena, hematochezia, cough, hemoptysis, wheezing, shortness of breath, chest pain, palpitations, dyspnea on exertion, increasing lower extremity swelling, skin rash, leg pain while walking, joint pain.\n", + "input3": "none\n", + "input4": "Adopted.\n", + "input5": "Vitals: T: 96.7 BP: 107/65 P: 60 R: 18 SaO2: 96% \nGeneral: Awake, alert, NAD, pleasant, appropriate, cooperative. \n\nHEENT: NCAT, PERRL, EOMI, no scleral icterus, dry MMM \nNeck: supple, no significant JVD or carotid bruits appreciated \nPulmonary: Lungs CTA bilaterally, no wheezes, ronchi or rales\nCardiac: RRR, nl S1 S2, no murmurs, rubs or gallops appreciated\nAbdomen: TTP in right flank and in epigastrium, soft, ND, \nnormoactive bowel sounds, no masses or organomegaly noted. No rebound, no ___ sing, no CVA or suprapubuc tenderness. \nExtremities: No edema, 2+ radial, DP pulses b/l\nLymphatics: No cervical, supraclavicular, axillary or inguinal lymphadenopathy noted\nSkin: circumferential erythrematus nodules with indurated center noted in each ___ shin bilateraly. O/w no rashes or lesions noted.\n", + "input6": "___ 03:10PM BLOOD WBC-9.5 RBC-4.79 Hgb-14.6 Hct-40.4 MCV-84 \nMCH-30.5 MCHC-36.2* RDW-13.4 Plt ___\n___ 03:10PM BLOOD Neuts-69.9 Bands-0 ___ Monos-3.7 \nEos-3.1 Baso-0.5\n___ 03:10PM BLOOD Glucose-119* UreaN-16 Creat-0.8 Na-139 \nK-3.3 Cl-106 HCO3-24 AnGap-12\n___ 03:10PM BLOOD ALT-31 AST-16 LD(LDH)-139 AlkPhos-104 \nTotBili-0.2\n___ 07:22AM BLOOD Calcium-8.3* Phos-2.9 Mg-2.1\n\nUS RUQ\n1. Common bile duct dilatation to 9 mm, without intrahepatic biliary ductal dilatation. Further evaluation with HIDA scan versus ERCP is recommended to evaluate for distal obstruction. \n\n2. Sludge within the gallbladder without focal stone or \nsecondary signs of acute cholecystitis. \n3. Diffuse fatty infiltration of the liver. \n\nEKG: sinus bradycardia without ST/TW changes.\n\nEGD : \nLinear erythema, rough mucosa, bleeding spots. Duodenum appeared normal. (biopsy) Otherwise normal EGD to third part of the duodenum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Atrophic Gastritis/17776030-DS-15.json b/Finished/Gastritis/Chronic Atrophic Gastritis/17776030-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..dea55e1c5422d39834ec9d55759aa8d040775473 --- /dev/null +++ b/Finished/Gastritis/Chronic Atrophic Gastritis/17776030-DS-15.json @@ -0,0 +1,38 @@ +{ + "chronic non-atrophic gastritis$Intermedia_4": { + "Linear erythema in the gastric antrum, consistent with mild gastritis$Cause_1": { + "Linear erythema in the antrum compatible with mild gastritis$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "Abdominal discomfort after meals that persists for many months and is accompanied by unintentional weight loss. These symptoms may be a sign of chronic gastritis, which can cause problems with food digestion and absorption, which can lead to weight loss.$Cause_1": { + "many months of post-prandial abdominal discomfort and some unintentional weight loss$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Abdominal pain may be a symptom of gastritis$Cause_1": { + "abdominal pain$Input1": {} + }, + "General malaise, constipation, nausea, vomiting, anorexia, and chills. These symptoms indicate that the patient may have gastric dysfunction, which is consistent with the clinical manifestations of chronic gastritis.$Cause_1": { + "malaise, constipation, nausea, vomitting, anorexia, and chills$Input2": {} + }, + "Patients are unable to eat due to anorexia. Anorexia is a common symptom of chronic gastritis and may be caused by inflammation and discomfort in the stomach.$Cause_1": { + "unable to eat frequent meals due to anorexia$Input2": {} + }, + "The patient still has significant malaise and anorexia. These persistent symptoms further support the possibility of chronic gastritis.$Cause_1": { + "Currently she notes a significant amount of malaise and anorexia$Input2": {} + }, + "The stool occult blood test is positive. Positive occult blood may be due to microbleeding caused by chronic inflammation or erosion of the gastric mucosa.$Cause_1": { + "guaiac positive stool$Input2": {} + }, + "There are clear tender points, mainly concentrated near the ribs. Pain in the left upper abdominal area is one of the common symptoms of chronic gastritis because this area is close to the stomach.$Cause_1": { + "tenderness in the LUQ, mostly around ribs and on ribs.$Input5": {} + } + } + } + }, + "input1": "abdominal pain\n", + "input2": "She reports many months of post-prandial abdominal discomfort and some unintentional weight loss. Approximately 9 days prior to admission (the ___ before ___ she developed malaise, constipation, nausea, vomitting, anorexia, and chills. She was unable to eat frequent meals due to anorexia and was seen by her PCP. A KUB suggested no obstruciton and she was encouraged to take laxatives and suppositories. She was then able to move her bowels and had ___ blood bowel movements 2 days prior to admission. \n\nShe re-presented to her PCP and was noted to be orthostatic and had guaiac positive stool on exam. She was then referred to the ___ ED.\n\nCurrently she notes a significant amount of malaise and anorexia. She had no more vomitting and has had no bowel movements for 48 hours. \n\nVital signs on arrival to ___ ED: T 99.0, P 70, BP 121/87, 99% on arrival to ___ ED. Her evaluation in the ED was notable for guaiac positive stool. In the ED she received 8mg of morphie.\n\nReview of Systems: Pain assessment on arrival to the floor: ___ (LUQ pain). She recently had \"scarlet fever\" and was on \nantibiotics for this. No SOB, cough, or chest pain. No urinary symptoms. No vaginal symptoms. No skin changes. No arthralgias or joint swelling. Other systems reviewed in detail and all otherwise negative.\n", + "input3": "Celiac disease\nvitiligo\nanxiety and depression\npossible diagnosis of endometriosis\nvitamin D deficiency\n", + "input4": "Not relevant to the current admission.\n", + "input5": "Gen: Well-appearing in NAD. \nHEENT: Oropharynx clear w/out lesions. \nNeck: Supple. \nChest: Normal respirations and breathing comfortably on room \nair. Lungs clear to auscultation bilaterally. \nCV: PMI normal size and not displaced. Regular rhythm. Normal \nS1, S2. No murmurs or gallops. JVP <5 cm. \nAbdomen: Normal bowel sounds. She has point tenderness in the LUQ, mostly around ribs and on ribs. No lower quadrant \ntenderness. No peritoneal signs. \n\nPelvic: No external lesions. No discharge. Bimanual exam \ncompletely without pain. \nExtremities: No ankle edema. \nMSK: Joints with no redness, swelling, warmth, tenderness. \nNormal ROM in all major joints. \nSkin: No lesions, bruises, rashes. \nNeuro: Alert, oriented x3. Good fund of knowledge. Able to \ndiscuss current events and memory is intact. CN ___ intact. \nSpeech and language are normal. \nPsych: Appearance, behavior, and affect all normal.\n", + "input6": "___ 05:00PM GLUCOSE-87 UREA N-13 CREAT-0.7 SODIUM-140 \nPOTASSIUM-4.1 CHLORIDE-102 TOTAL CO2-27 ANION GAP-15 \nALT(SGPT)-17 AST(SGOT)-21 ALK PHOS-52 TOT BILI-0.8 LIPASE-35 \nALBUMIN-4.6\n___ 05:00PM WBC-8.6 (NEUTS-76.5* LYMPHS-14.8* MONOS-3.8 \nEOS-3.9 BASOS-1.0) RBC-4.40 HGB-13.7 HCT-38.5 MCV-87 MCH-31.1 \nMCHC-35.5* RDW-12.3 PLT COUNT-171\n___ 08:45PM URINE UCG-NEGATIVE\n___ 08:45PM URINE COLOR-Yellow APPEAR-Clear SP ___ \nBLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-40 \nBILIRUBIN-NEG UROBILNGN-0.2 PH-5.5 LEUK-TR RBC-1 WBC-1 \nBACTERIA-MOD YEAST-NONE EPI-3 MUCOUS-OCC\n.\nMRI (___): IMPRESSION: \n1. No focal abnormality identified on MR to account for \n___ \nsymptomatology. \n2. Stable prominence of the mesenteric veins draining the \njejunum in the left upper quadrant. No thrombus or new \ncollaterals are seen. No mesenteric venous thrombosis. The SMA \nand celiac axis remain patent. \n3. Visualized bowel loops in the upper abdomen are non-dilated but without apparent abnormality. \n. \nEGD (___): \nLinear erythema in the antrum compatible with mild gastritis \n(biopsy) \nDuodenum appeared normal. (biopsy) \nOtherwise normal EGD to third part of the duodenum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Atrophic Gastritis/17784861-DS-17.json b/Finished/Gastritis/Chronic Atrophic Gastritis/17784861-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..00eb43a18afa40b304a0b87fde927a54d69d9bbe --- /dev/null +++ b/Finished/Gastritis/Chronic Atrophic Gastritis/17784861-DS-17.json @@ -0,0 +1,32 @@ +{ + "chronic non-atrophic gastritis$Intermedia_4": { + "H pylori infection is one of the common causes of chronic gastritis. Antibiotic treatment may cause changes in the gastric mucosa, thereby increasing the risk of chronic gastritis.$Cause_1": { + "H pylori which was treated with antibiotics.$Input2": {} + }, + "EGD revealed ulcers and H pylori infection confirmed by biopsy, indicating that the patient had significant gastric mucosal damage, which is a typical manifestation of chronic gastritis.$Cause_1": { + "EGD which showed ulceration (as well as biopsy showing H pylori)$Input2": {} + }, + "chronic gastritis$Intermedia_3": { + "The patient's abdominal symptoms (located in the upper abdomen and aggravated by food), often associated with gastritis, particularly those described as \"constricting\" and \"grasping\" sensations, may indicate a gastrointestinal disorder.$Cause_1": { + "abdominal ___ \nreturned. Her ___ is epigastric, worse with food, described as \"contractions\" and \"gripping.\"$Input2": {} + }, + "Persistent abdominal pain that persists even after eating may indicate a chronic condition or other unresolved stomach problem.$Cause_1": { + "relentless even well after eating.$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Significant weight loss may be the result of poor nutrient absorption or loss of appetite caused by chronic gastritis.$Cause_1": { + "lost 40 pounds$Input2": {} + }, + "One of the common symptoms of chronic gastritis is upper abdominal discomfort or tenderness.$Cause_1": { + "minimal epigastric tenderness$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "Her mother ultimately passed away ___. She was found \nto have H pylori which was treated with antibiotics. She \nunderwent EGD which showed ulceration (as well as biopsy showing H pylori). She was started on Pantoprazole and Kerafate. She actually improved at that time, and felt well until about one month ago.\n\nOne month ago she was hospitalized for bronchitis, and treated with steroid burst. Around this time her abdominal ___ \nreturned. Her ___ is epigastric, worse with food, described as \"contractions\" and \"gripping.\" It is associated with both vomiting and diarrhea that occur \"at the same time.\" For most of this time period, the ___ and symptoms would occur with food, then go away. For the last ___ days they are relentless even well after eating.\n\nShe tells me she has lost 40 pounds in last year, 15 pounds in last month. Per OMR Sheets, she weighs 168 pounds today, weighed 172 pounds in ___, and weighed 190 pounds in \n___.\n\nShe has gone to the ___ 3 times in the last month, and treated with opioids, anti-emetics, and IV fluids (generally 3 liters each time). CT scan and US reportedly negative.\n\nShe presented to clinic today for follow up with her PCP. Her PCP was concerned about her ability to tolerate PO, as well as positive orthostatics, and sent her into the emergency \ndepartment to have a further evaluation, requesting GI consult and inpatient endoscopy.\n\nOf note, she was planned to have a colonoscopy in ___ of \nthis year, which the patient cancelled due to family issues.\n", + "input3": "- Depression\n- Fibromyalgia\n- Asthma (well controlled; on no medications) \n- s/p repair right hip labrum ___ \n- s/p sinus surgery ___ \n- s/p right breast lumpectomy - benign \n- s/p tonsilectomy age ___\n", + "input4": "Mother - age ___ stroke age ___ in basal ganglia with dementia and otherwise with migraines. \nMaternal grandfather with a stroke at age ___.\n", + "input5": "Vitals: 98.2, 135/89, HR 60, RR 16, 98% RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclerae anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: CTAB no wheezes, rales, rhonchi \nCV: RRR, Nl S1, S2, No MRG \nAbdomen: soft, nondistended, minimal epigastric tenderness, \nbowel sounds present, no rebound tenderness or guarding, no \norganomegaly \nGU: no foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema\nNeuro: CN2-12 intact, no focal deficits\n", + "input6": "___ 11:30AM BLOOD WBC-3.8* RBC-3.93 Hgb-11.2 Hct-35.8 \nMCV-91 MCH-28.5 MCHC-31.3* RDW-14.8 RDWSD-49.9* Plt ___\n___ 11:30AM BLOOD Neuts-47.6 ___ Monos-11.6 Eos-2.9 \nBaso-0.8 Im ___ AbsNeut-1.81 AbsLymp-1.40 AbsMono-0.44 \nAbsEos-0.11 AbsBaso-0.03\n___ 11:30AM BLOOD Glucose-92 UreaN-18 Creat-0.6 Na-140 \nK-4.0 Cl-102 HCO3-24 AnGap-18\n___ 11:30AM BLOOD ALT-9 AST-11 AlkPhos-78 TotBili-0.2\n___ 11:30AM BLOOD Lipase-34\n___ 11:30AM BLOOD cTropnT-<0.01\n___ 11:30AM BLOOD Albumin-4.4\n___ 11:50AM BLOOD Lactate-1.1\n___ 01:00PM URINE Color-Straw Appear-Clear Sp ___\n___ 01:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG\n___ 01:00PM URINE UCG-NEGATIVE\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Atrophic Gastritis/18001923-DS-35.json b/Finished/Gastritis/Chronic Atrophic Gastritis/18001923-DS-35.json new file mode 100644 index 0000000000000000000000000000000000000000..0e4d5161f3e7cf665dd1567b5ed846d3c8a04ebe --- /dev/null +++ b/Finished/Gastritis/Chronic Atrophic Gastritis/18001923-DS-35.json @@ -0,0 +1,26 @@ +{ + "chronic non-atrophic gastritis$Intermedia_4": { + "Linear erythema, rough mucosa and bleeding spots are the gold standard for the diagnosis of chronic non-atrophic gastritis\r.$Cause_1": { + "Linear erythema, rough mucosa, bleeding spots$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "Alcohol use is a common risk factor for gastritis.$Cause_1": { + "long history of frequent ed visits$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Chest pain below the breastbone may be related to stomach problems$Cause_1": { + "substernal chest pain$Input2": {} + }, + "Gastroesophageal reflux disease often causes gastric acid reflux, irritates the gastric mucosa, and triggers or aggravates gastritis.$Cause_1": { + "GERD$Input3": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "Patient states he developed substernal chest pain yesterday (___) without shortness of breath or radiation to his back. patient endorses a productive cough. patient also has pain when he urinates but denies any hematuria. Pt denies any fever, chills, vomiting, numbness or weakness. He did reprot a productive cough. Patient has a long history of frequent ed visits and admissions for various complaints in the setting of ETOH use. Per previous records at the time of sobriety he \nbecomes combative and elects to leave against medical advice. \n\nToday in the ED he presented with chest/ abdomina pain and troponins remain negative x2 and EKG without impressive changes CXR revealed worsening consolidations in the RLL which could be c/w a pneumonia in the right clinical setting. The patient was given Po levofloxacin and admitted given his poor social support he remianed ineb\n", + "input3": "\n- Cirrhosis, complicated by Grade 1 esophageal varices \n- Hepatitis C, Ab positive, VL 46million on ___ \n- Gastritis \n- GERD \n- Colonic angiectasias \n- Hypertension \n- Atypical chest pain\n", + "input4": "Father had a history of Diabetes Mellitus, Hypertension, 3x \nMyocardial Infarction (first one age ___, died of MI. Mother had a history of Diabetes Mellitus, Hypertension, breast cancer, and died of colon cancer with at age ___.\n", + "input5": "Vitals: 98 138/76 p 73 R 16 100% on RA \nGEN - Alert, NAD \nHEENT - NC/AT, OP clear \nNECK - Supple \nCV - RRR, ___ systolic murmur throughout, no r/g \nRESP - CTA B \nABD - S/ND, BS present, diffuse TTP in abdomen and back \ndistractable without rebound or guarding \nEXT - No ___ edema or calf tenderness \nSKIN - No apparent rashes \nNEURO - Nonfocal \nPSYCH - Calm, appropriate \nRECTAL: No obvious external lesions\n", + "input6": "___ 01:52AM BLOOD WBC-4.0 RBC-2.90* Hgb-8.1* Hct-24.4* \nMCV-84 MCH-27.8 MCHC-33.0 RDW-17.1* Plt ___\n___ 01:52AM BLOOD Neuts-58 Bands-0 ___ Monos-2 Eos-4 \nBaso-0 Atyps-4* ___ Myelos-0\n___ 01:52AM BLOOD Glucose-96 UreaN-20 Creat-1.2 Na-139 \nK-4.0 Cl-106 HCO3-20* AnGap-17\n___ 01:52AM BLOOD ALT-37 AST-70* AlkPhos-120 TotBili-0.3\n___ 01:52AM BLOOD Lipase-69*\n___ 01:52AM BLOOD cTropnT-<0.01\n___ 09:13AM BLOOD cTropnT-<0.01\n___ 04:15AM BLOOD ASA-NEG Ethanol-64* Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 06:05AM BLOOD Ret Aut-2.1\n___ 11:04AM BLOOD Hgb-8.0*\n\nEGD : \nLinear erythema, rough mucosa, bleeding spots \n\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Atrophic Gastritis/18945414-DS-10.json b/Finished/Gastritis/Chronic Atrophic Gastritis/18945414-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..ef9383f253d8165417577f04bd37a8655e7c3edf --- /dev/null +++ b/Finished/Gastritis/Chronic Atrophic Gastritis/18945414-DS-10.json @@ -0,0 +1,26 @@ +{ + "Chronic atrophic gastritis$Intermedia_4": { + "Atrophic mucosa typically has a pale appearance. with increased visibility of submucosal blood vessels due to thinning \r of the gastric mucosa and loss of gastric folds are the common microscopic performance in patients with chronic atrophic gastritis\r.$Cause_1": { + "EGD - Atrophic mucosa typically has a pale appearance. with increased visibility of submucosal blood vessels due to thinning \r of the gastric mucosa and loss of gastric folds.rough mucosa, bleeding spots in the antrum (biopsy). Otherwise normal EGD to third part of the duodenum$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "NSAIDs are a common cause in patients with chronic gastritis.$Cause_1": { + "She is a patient with PMH of migraines and NSAID induced gastritis.$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Epigastric pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "presenting with epigastric pain for about one week that is exacerbated with food, most recently with several episodes of hematemesis.$Input2": {} + }, + "Abdominal pain and nausea are symptoms that may occur in patients with gastritis.$Cause_1": { + "This is the third iteration of abdominal pain, nausea, hematemesis that has required endoscopy.$Input2": {} + } + } + } + }, + "input1": "hematemesis\n", + "input2": "She is a patient with PMH of migraines and NSAID induced gastritis presenting with epigastric pain for about one week that is exacerbated with food, most recently with several episodes of hematemesis. This pain is very similar to other episodes of gastritis that she has had in the past. This is the third iteration of abdominal pain, nausea, hematemesis that has required endoscopy. She had previously been taking zofran to manage her vomiting, but ran out of the medication. For the last three days when she vomits, there is blood in the emesis, ranging from streaks to about a few teaspoons. Currently takes protonix and OTC antacids. Today, vomiting x3 with slightly more blood per patient. She has also had a few dark stools. She was seen 6 months ago and was hospitalized. She has been seen a few times by GI here and was supposed to have an EGD in early, but rescheduled related to insurance change with a job switch. \n\nOn review of records, gastrin levels have been normal on the past. She was also H. Pylori negative. Normal musoca in the duodenal bulb. Otherwise normal EGD to third part of the duodenum.\n", + "input3": "-Migraines\n-IBS\n-asthma\n", + "input4": "Mom has MS, otherwise no fmaily history of GI issues or otherwise\n", + "input5": "Vitals: 98.5, 139/82, 65, 18, 100RA \nGeneral: Alert, oriented, appears uncomfortable \nHEENT: Sclera anicteric, dry mucus membranes, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, obese, non-distended, moderate pain with mild palpation to epigastric area, bowel sounds present, no rebound tenderness, voluntary guarding over epigastric area, no organomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis, trace generalized edema \nSkin: warm, dry, intact\nNeuro: moves all extremities, ___ strength in bilateral upper and lower extremities\n", + "input6": "Imaging\n___ RUQ U/S - IMPRESSION: Cholelithiasis with mildly distended gallbladder as well as prominent CBD (9mm). No definite signs of acute cholecystitis but if there is continued clinical concern, HIDA scan will be helpful for further evaluation. \n\n___ EGD - Atrophic mucosa typically has a pale appearance. with increased visibility of submucosal blood vessels due to thinning \r of the gastric mucosa and loss of gastric folds.rough mucosa, bleeding spots in the antrum (biopsy). Otherwise normal EGD to third part of the duodenum\n\n___ MRCP - 1. Cholelithiasis, without evidence for cholecystitis or biliary obstruction. Normal appearance of the bile ducts without obstructing intraductal stones or masses. \n2. Two hepatic lesions in segment IVb and V with intravoxel fat, demonstrating arterial hyperenhancement, equivocal washout, may represent adenomas or less likely atypical FNH. Recommended followup MRI with BOPTA for better characterization of these lesions. \n3. Incidental note is made of pancreas divisum. \n\n___ Pathology \nGastric mucosal biopsies, two:\n1. Body (1A): Corpus mucosa with no diagnostic abnormalities recognized.\n2. Antrum (2A): Chemical-type gastropathy.\n\nADMISSION LABS:\n___ 10:25AM BLOOD WBC-6.5 RBC-4.99 Hgb-11.8* Hct-38.0 MCV-76* MCH-23.7* MCHC-31.1 RDW-16.4* Plt ___\n___ 10:25AM BLOOD Neuts-66.4 ___ Monos-4.6 Eos-1.7 Baso-0.4\n___ 10:25AM BLOOD ___ PTT-33.3 ___\n___ 10:25AM BLOOD Glucose-106* UreaN-16 Creat-0.9 Na-141 K-3.5 Cl-106 HCO3-25 AnGap-14\n___ 10:25AM BLOOD ALT-15 AST-16 AlkPhos-43 TotBili-0.3\n___ 10:25AM BLOOD Lipase-50\n___ 10:25AM BLOOD Albumin-4.5 Calcium-9.5 Phos-4.0 Mg-2.2\n___ 10:40AM BLOOD Lactate-1.2\n___ 06:10AM BLOOD GASTRIN-PND\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Atrophic Gastritis/19329252-DS-12.json b/Finished/Gastritis/Chronic Atrophic Gastritis/19329252-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..7250106032483e5b76b4224dcc4f95a41e38264a --- /dev/null +++ b/Finished/Gastritis/Chronic Atrophic Gastritis/19329252-DS-12.json @@ -0,0 +1,29 @@ +{ + "chronic non-atrophic gastritis$Intermedia_4": { + "Antral erosions are often associated with gastritis, especially chronic inflammation caused by Helicobacter pylori infection.$Cause_1": { + "Erosions in the antrum$Input6": {} + }, + "H pylori infection is one of the common causes of chronic gastritis. Antibiotic treatment may cause changes in the gastric mucosa, thereby increasing the risk of chronic gastritis.$Cause_1": { + "H pylori which was treated with antibiotics.$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "Alcohol use is a common risk factor for gastritis.$Cause_1": { + "long history of frequent ed visits$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Black stools may be a sign of gastrointestinal bleeding, which may be related to gastritis.$Cause_1": { + "black bowel movement$Input2": {} + }, + "Black vomit usually indicates upper gastrointestinal bleeding, such as stomach bleeding, which may be caused by gastritis.$Cause_1": { + "black vomitus$Input2": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "He and his wife report that he work up in the middle of the night (around 2 or 3 am) and had two \"normal\" brown bowel movements. About an hour later, he had a large black bowel movement. Then, about 30 mins later, he went to go to the bathroom and his wife heard a loud thump. When she went to the bathroom, she saw that he had fallen and hit his head on the shower and had an episode of black vomitus. He did not have incontinence of stools. He believes he lost consciousness for \"possibly a few seconds\". His wife said that after calling his name ___ few times he woke up and was not confused. She then called EMS and brought him to the ER. long history of frequent ed visits\n\n\nThis has never happened to him prior. He had a recent colonoscopy with polypectomies (x3) in ___, the pathology of which revealed adenomas. He was to f/u with a repeat colonoscopy in ___ years. He has no endoscopies on record. Pt reported that he did experience some lightheadness but feels well now. He denies HA. No F/C, no CP, no SOB.\n", + "input3": "Hypertension, \nhyperlipidemia, \ns/p prostate cancer resection in ___, \nrosacea, \nColon polyps, \nPAD (___) \n. s/p angioplasty) \ndilated aortic root, \nhistory of vertigo \nRight Knee OA (moderate)\n", + "input4": "mother died at ___ of ovarian cancer and? DM Grandfather with DM\n", + "input5": "Vitals: T: 100.2 BP: 116/69 P: 84 R: 18 O2: 100% \nGeneral: Alert, oriented, no acute distress; \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: RRR, normal S1 + S2, ___ systolic murmurs, no rubs/gallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nGU: no foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\n", + "input6": "___ 11:20AM BLOOD WBC-9.8# RBC-3.65* Hgb-11.3*# Hct-34.8* \nMCV-95 MCH-30.9 MCHC-32.4 RDW-13.1 Plt ___\n___ 11:20AM BLOOD Neuts-81.5* Lymphs-14.5* Monos-3.3 \nEos-0.3 Baso-0.4\n___ 11:20AM BLOOD ___ PTT-19.9* ___\n___ 11:20AM BLOOD Glucose-160* UreaN-82* Creat-0.9 Na-142 \nK-4.2 Cl-108 HCO3-20* AnGap-18\n___ 11:20AM BLOOD CK-MB-4 cTropnT-<0.01\n___ 11:36AM BLOOD Glucose-146* Na-143 K-4.0 Cl-110* \ncalHCO3-21\n\nMICRO:\nHpylori - ___________.\nH pylori which was treated with antibiotics.\n\n\nIMAGING: \nHead CT (___)\n1. No evidence of an acute intracranial process. No fracture. \n2. Subcutaneous nodule in the right frontal scalp. Please correlate with physical exam. \n\nTTE (___)\nThe left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size. Left ventricular systolic function is hyperdynamic (EF>75%). There is a mild resting left ventricular outflow tract obstruction. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\n\nEGD (___)\nMedium hiatal hernia\n___ tear\nEsophageal ring\nBlood in the stomach body\nErosions in the antrum\nErosions in the duodenal bulb\nOtherwise normal EGD to third part of the duodenum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Non-atrophic Gastritis/12340605-DS-6.json b/Finished/Gastritis/Chronic Non-atrophic Gastritis/12340605-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..7ea5f138791c2390854814a3c1f6afb1e61bbdbc --- /dev/null +++ b/Finished/Gastritis/Chronic Non-atrophic Gastritis/12340605-DS-6.json @@ -0,0 +1,26 @@ +{ + "Chronic non-atrophic gastritis$Intermedia_4": { + "Erythema and mosaic appearance of the mucosa were noted in the antrum and stomach body, which is the gold standard for the diagnosis of chronic chronic non-atrophic gastritis\r.$Cause_1": { + "EGD:Protruding Lesions 2 cords of grade I varices were seen in the lower third of the esophagus. Stomach Mucosa: Erythema and mosaic appearance of the mucosa were noted in the antrum and stomach body. Duodenum: Normal duodenum.$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "Long-term Helicobacter pylori infection is a risk factor for chronic gastritis.$Cause_1": { + "- long-term Helicobacter pylori infection$Input3": {} + }, + "suspected gastritis$Intermedia_2": { + "Abdominal burning pain is a symptom that may occur in patients with gastritis.$Cause_1": { + "presenting with abdominal burning pain that radiates to the back for the past 3 nights.$Input2": {} + }, + "!Abdominal pain is a symptom that may occur in patients with chronic gastritis.$Cause_1": { + "abdominal pain$Input1": {} + } + } + } + }, + "input1": "abdominal pain\n", + "input2": "___ year old male with history of EtoH cirrhois complicated by grade 1 varices, portal hypertensive gastropathy, SBP, and encephalopathy, presenting with abdominal burning pain that radiates to the back for the past 3 nights. The pain is slightly relieved after meals then returns, also improved with milk. He has been off of his omeprazole for the past 2 weeks because he forgot some of his medications when he moved out of his place abruptly. He does have nausea, but no vomiting, notes subjective fevers and chills. He denies chest pain and SOB. He has had similar pain in the past but it never lasted this long. He tried ibuprofen and pepto-bismol (1 small bottle) without much effect.\n\nRegarding his cirrhosis, he follows up regularly. His cirrhosis has been quite stable as of late, without decompensations. \n\nIn the ED, initial vitals were: 98.8 ___ 16 99%. Exam notable for diffuse mild abdominal tenderness, guaiac positive dark stool. CXR did not show any free air or acute process. Labs stable from prior. He was given 40mg pantoprazole IV. EKG unremarkable. \n\nOn the floor, he is comfortable with improved abdominal pain. He is hungry and asking for food.\n \nROS: per HPI, denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, BRBPR, melena, hematochezia, dysuria, hematuria.\n", + "input3": "- Hypertension\n- Bipolar disorder\n- EtOH cirrhosis dx ___, h/o hepatic encephalopathy, GI hemorrhage (unclear etiology, not variceal), SBP, SBO, Grade I esophageal varices, portal hypertensive gastropathy\n- Hypospadias \n- h/o Lung nodules (Resolved, no additional follow up required) \n- h/o Bell's palsy\n- h/o left foot cellulitis (required wound VAC)\n- long-term Helicobacter pylori infection\n", + "input4": "Father: pancreatic cancer - deceased. \nSister: breast cancer \nBrother: bladder cancer\nMother: HTN\n", + "input5": "VS - T 98.4, BP 158/76, HR 93, RR 20 and 99% RA \nGENERAL - well-appearing man in NAD, comfortable, appropriate \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no JVD \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use \nHEART - RRR, III/VI holosystolic murmur over LSB, nl S1-S2 \nABDOMEN - NABS, distended, soft/NT, no evidence of fluid wave or shifting dullness, no masses or HSM, no rebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n \nSKIN - no rashes or lesions, no spider angiomata, but skin does have a reddish tint \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout, no asterixis\n", + "input6": "___ 05:20PM BLOOD WBC-4.9 RBC-4.03* Hgb-11.9* Hct-34.9* MCV-87 MCH-29.6 MCHC-34.2 RDW-15.4 Plt Ct-55*\n___ 06:25AM BLOOD WBC-4.8 RBC-4.13* Hgb-12.4* Hct-35.7* MCV-87 MCH-30.1 MCHC-34.8 RDW-15.5 Plt Ct-64*\n___ 05:20PM BLOOD Neuts-80.9* Lymphs-11.1* Monos-5.0 Eos-2.8 Baso-0.2\n___ 06:25AM BLOOD ___ PTT-31.5 ___\n___ 06:25AM BLOOD Glucose-103* UreaN-10 Creat-1.1 Na-138 K-3.6 Cl-104 HCO3-28 AnGap-10\n___ 06:25AM BLOOD ALT-15 AST-32 LD(LDH)-176 AlkPhos-82 TotBili-0.8\n___ 06:25AM BLOOD Calcium-8.5 Phos-3.9 Mg-2.1\n\nCXR (___): No acute cardiopulmonary process.\n\nEGD (___): Protruding Lesions 2 cords of grade I varices were seen in the lower third of the esophagus. Stomach Mucosa: Erythema and mosaic appearance of the mucosa were noted in the antrum and stomach body. Duodenum: Normal duodenum. \n\nABD U/S (___): No sonographic evidence for portal vein thrombus. Trace right lower quadrant ascites. There is not enough fluid to mark for paracentesis. Cirrhosis with splenomegaly, suggestive of portal hypertension.\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Non-atrophic Gastritis/17540771-DS-9.json b/Finished/Gastritis/Chronic Non-atrophic Gastritis/17540771-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..429383a234280826e2b25f4fe61efd8d9f3411c6 --- /dev/null +++ b/Finished/Gastritis/Chronic Non-atrophic Gastritis/17540771-DS-9.json @@ -0,0 +1,32 @@ +{ + "Chronic Non-atrophic Gastritis$Intermedia_4": { + "The critieria for chronic non-atrophic gastritis$Cause_1": { + "Erosion and erythema in the antrum compatible with gastritis (biopsy) without obvious atrophy.$Input6": {} + }, + "Chronic Gastritis$Intermedia_3": { + "Helicobacter pylori infection is an important sign of chronic gastritis$Cause_1": { + "Helicobacter pylori infection detected$Input6": {} + }, + "Suspected Gastritis$Intermedia_2": { + "Nausea may be caused by chronic inflammation of the gastric mucosa, which may be caused by long-term stomach acid irritation, medication side effects, infection, etc.$Cause_1": { + "nausea$Input1": {} + }, + "Retching is a common symptom of gastritis and usually occurs when the stomach is upset or the inflammation is worse.$Cause_1": { + "dry heaving but no vomiting$Input2": {} + }, + "Gastritis may affect the entire digestive system, causing constipation or diarrhea. Changes in stool color may be related to gastrointestinal bleeding or indigestion of food.$Cause_1": { + "initially had light colored stool and constipation and then had dark colored stool$Input2": {} + }, + "Loss of appetite is a typical symptom of chronic gastritis and may lead to weight loss.$Cause_1": { + "has been eating much less.$Input2": {} + } + } + } + }, + "input1": "nausea\n", + "input2": "She has had some dry heaving but no vomiting. She states that she initially had light colored stool and constipation and then had dark colored stool and loose stool and then has had no bowel movements. Pt denies bloody stool or black stool. She hasnot taken her po meds in ___ days. She also c/o back pain which is similar to her usual back pain. She endorses increased fatigue without fevers or night sweats. She thinks her clothes have been looser over past 2 weeks since she has been eating much less. Pt denies dysuria or hematuria.\n", + "input3": "MI ___ yrs ago\ncolon cancer sp some kind of surgery ___ yrs ago\nhypothyroidism (based on her meds)\n", + "input4": " Limited as her parents were killed in Halocaust at young age \n", + "input5": "Vitals: T: BP: P: R: O2:\nGeneral: Alert, oriented, no acute distress\nHEENT: Sclera anicteric, MM dry, oropharynx clear\nNeck: supple, JVP not elevated, no LAD\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops\nAbdomen: soft, tender diffusely, suprapubic > rest, \nnon-distended, bowel sounds present, some rebound tenderness without guarding, no organomegaly . vertical scar on abdomen. ? \nkeloid in umbilicus.\nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\n", + "input6": "___ 11:46AM WBC-13.1* RBC-4.41 HGB-13.9 HCT-40.6 MCV-92 \nMCH-31.6 MCHC-34.3 RDW-13.3\n___ 11:46AM NEUTS-88.5* LYMPHS-7.2* MONOS-3.7 EOS-0.3 \nBASOS-0.2\n___ 11:46AM GLUCOSE-127* UREA N-30* CREAT-1.2* \nSODIUM-131* POTASSIUM-3.9 CHLORIDE-91* TOTAL CO2-25 ANION GAP-19\n___ 11:46AM ALT(SGPT)-23 AST(SGOT)-26 CK(CPK)-40 ALK \nPHOS-74 TOT BILI-1.0\n___ 11:46AM LIPASE-31\n___ 11:46AM cTropnT-<0.01\n___ 11:46AM CK-MB-NotDone\n___ 11:46AM ALBUMIN-4.5 CALCIUM-10.6* PHOSPHATE-2.5* \nMAGNESIUM-1.8\n___ 04:42PM URINE HOURS-RANDOM UREA N-314 CREAT-41 \nSODIUM-86\n___ 03:20PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 03:20PM URINE BLOOD-SM NITRITE-NEG PROTEIN-75 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-SM\n___ 03:20PM URINE ___ BACTERIA-MANY \n\nchest xray ___: IMPRESSION: PA and lateral chest reviewed in the absence of prior chest radiographs: Lungs are fully expanded and clear. Heart size is top normal. No pleural effusion or evidence of central adenopathy. A sharp leftward deviation of the trachea in the neck suggests a thyroid nodule or other mass effect. Clinical correlation advised.\n\nEGD: Impression: Erosion and erythema in the antrum compatible with gastritis (biopsy). Small hiatal hernia \nAngioectasias in the fundus. Otherwise normal EGD to third part of the duodenum.\n\n\nHelicobacter pylori infection detected\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Non-atrophic Gastritis/17776030-DS-15.json b/Finished/Gastritis/Chronic Non-atrophic Gastritis/17776030-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..f3fcb34daf73a4b8549dc101fc718589755b7eaa --- /dev/null +++ b/Finished/Gastritis/Chronic Non-atrophic Gastritis/17776030-DS-15.json @@ -0,0 +1,26 @@ +{ + "chronic non-atrophic gastritis$Intermedia_4": { + "Linear erythema, rough mucosa and bleeding spots are the gold standard for the diagnosis of chronic non-atrophic gastritis\r.$Cause_1": { + "EGD : \nLinear erythema, rough mucosa, bleeding spots \nDuodenum appeared normal. (biopsy) \nOtherwise normal EGD to third part of the duodenum$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "Long-term alcohol abuse is is a risk factor for chronic gastritis$Cause_1": { + "She takes no NSAIDs for pain but long-term alcohol abuse$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Symptoms such as abdominal discomfort are possible signs of gastritis.$Cause_1": { + "She reports many months of post-prandial abdominal discomfort and some unintentional weight loss. Approximately 9 days prior to admission she developed malaise, constipation, nausea, vomitting, anorexia, and chills.$Input2": {} + }, + "Abdominal pain is a possible symptom of gastritis.$Cause_1": { + "abdominal pain$Input1": {} + } + } + } + }, + "input1": "abdominal pain\n", + "input2": "She is a ___ F with a medical history notable for Celiac disease. She reports many months of post-prandial abdominal discomfort and some unintentional weight loss. Approximately 9 days prior to admission she developed malaise, constipation, nausea, vomitting, anorexia, and chills. She was unable to eat frequent meals due to anorexia and was seen by her PCP. A KUB suggested no obstruciton and she was encouraged to take laxatives and suppositories. She was then able to move her bowels and had blood bowel movements 2 days prior to admission. \n\nShe re-presented to her PCP and was noted to be orthostatic and had guaiac positive stool on exam. \n\nCurrently she notes a significant amount of malaise and anorexia. She had no more vomitting and has had no bowel movements for 48 hours. She has a ___ LUQ pain-constant in nature and worse with cough or eating. She takes no NSAIDs for pain but long-term alcohol abuse\n\nVital signs on arrival to ED: T 99.0, P 70, BP 121/87, 99% on arrival to ED. Her evaluation in the ED was notable for guaiac positive stool. In the ED she received 8mg of morphine.\n\nReview of Systems: Pain assessment on arrival to the floor:(LUQ pain). She recently had \"scarlet fever\" and was on antibiotics for this. No SOB, cough, or chest pain. No urinary symptoms. No vaginal symptoms. No skin changes. No arthralgias or joint swelling. Other systems reviewed in detail and all otherwise negative.\n", + "input3": "Celiac disease\nanxiety and depression\npossible diagnosis of endometriosis\nvitamin D deficiency\n", + "input4": "Not relevant to the current admission\n", + "input5": "Vital Signs: T 98.3, P 66, BP 126/80, 98% on RA.\n\nGen: Well-appearing in NAD. \nHEENT: Oropharynx clear w/out lesions. \nNeck: Supple. \nChest: Normal respirations and breathing comfortably on room air. Lungs clear to auscultation bilaterally. \nCV: PMI normal size and not displaced. Regular rhythm. Normal S1, S2.No murmurs or gallops. JVP <5 cm. \nAbdomen: Normal bowel sounds. She has point tenderness in the LUQ, mostly around ribs and on ribs. No lower quadrant tenderness. No peritoneal signs. \nRectal: No external lesions. Trace guaiac positive with brown stool. No hemorrhoids on exam. \nPelvic: No external lesions. No discharge. Bimanual exam completely without pain. \nExtremities: No ankle edema. \nMSK: Joints with no redness, swelling, warmth, tenderness. Normal ROM in all major joints. \nSkin: No lesions, bruises, rashes. \nNeuro: Alert, oriented x3. Good fund of knowledge. Able to discuss current events and memory is intact. CN ___ intact. Speech and language are normal. \nPsych: Appearance, behavior, and affect all normal.\n", + "input6": "Admission Laboratory Studies:\n___ 05:00PM GLUCOSE-87 UREA N-13 CREAT-0.7 SODIUM-140 POTASSIUM-4.1 CHLORIDE-102 TOTAL CO2-27 ANION GAP-15 ALT(SGPT)-17 AST(SGOT)-21 ALK PHOS-52 TOT BILI-0.8 LIPASE-35 ALBUMIN-4.6\n___ 05:00PM WBC-8.6 (NEUTS-76.5* LYMPHS-14.8* MONOS-3.8 EOS-3.9 BASOS-1.0) RBC-4.40 HGB-13.7 HCT-38.5 MCV-87 MCH-31.1 MCHC-35.5* RDW-12.3 PLT COUNT-171\n___ 08:45PM URINE UCG-NEGATIVE\n___ 08:45PM URINE COLOR-Yellow APPEAR-Clear SP ___ BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-40 BILIRUBIN-NEG UROBILNGN-0.2 PH-5.5 LEUK-TR RBC-1 WBC-1 BACTERIA-MOD YEAST-NONE EPI-3 MUCOUS-OCC\n\nMRI (___): IMPRESSION: \n1. No focal abnormality identified on MR to account for symptomatology. \n2. Stable prominence of the mesenteric veins draining the jejunum in the left upper quadrant. No thrombus or new collaterals are seen. No mesenteric venous thrombosis. The SMA and celiac axis remain patent. \n3. Visualized bowel loops in the upper abdomen are non-dilated but without apparent abnormality. \n\nEGD (___): \nLinear erythema, rough mucosa, bleeding spots\nDuodenum appeared normal. (biopsy) \nOtherwise normal EGD to third part of the duodenum\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Non-atrophic Gastritis/18945414-DS-10.json b/Finished/Gastritis/Chronic Non-atrophic Gastritis/18945414-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..d5fc181660454a2f0a5edb9e770039768cb3def6 --- /dev/null +++ b/Finished/Gastritis/Chronic Non-atrophic Gastritis/18945414-DS-10.json @@ -0,0 +1,24 @@ +{ + "chronic non-atrophic gastritis$Intermedia_3": { + "Erythema, linear ulcerations in the stomach body compatible with gastritis (biopsy). rough mucosa, bleeding spots in the antrum (biopsy) are the common cause in patients with chronic non-atrophic gastritis\r.$Cause_1": { + "EGD - Erythema, linear ulcerations in the stomach body compatible with gastritis (biopsy). rough mucosa, bleeding spots in the antrum (biopsy). Otherwise normal EGD to third part of the duodenum$Input6": {} + }, + "suspected gastritis$Intermedia_2": { + "NSAIDs are a common cause in patients with gastritis.$Cause_1": { + "She is a patient with PMH of migraines and NSAID induced gastritis.$Input2": {} + }, + "Epigastric pain is a symptom that may occur in patients with gastritis.Patients with severe gastritis may have hematemesis.$Cause_1": { + "presenting with epigastric pain for about one week that is exacerbated with food, most recently with several episodes of hematemesis.$Input2": {} + }, + "Patients with severe gastritis may have hematemesis.$Cause_1": { + "She has also had a few dark stools.$Input2": {} + } + } + }, + "input1": "hematemesis\n", + "input2": "She is a patient with PMH of migraines and NSAID induced gastritis presenting with epigastric pain for about one week that is exacerbated with food, most recently with several episodes of hematemesis. This pain is very similar to other episodes of gastritis that she has had in the past. This is the third iteration of abdominal pain, nausea, hematemesis that has required endoscopy. She had previously been taking zofran to manage her vomiting, but ran out of the medication. For the last three days when she vomits, there is blood in the emesis, ranging from streaks to about a few teaspoons. Currently takes protonix and OTC antacids. Today, vomiting x3 with slightly more blood per patient. She has also had a few dark stools. She was seen 6 months ago and was hospitalized. She has been seen a few times by GI here and was supposed to have an EGD in early, but rescheduled related to insurance change with a job switch. \n\nHer last EGD was that was notable for diffuse erythema, erosions and small 4-5 mm clean based superficial ulcers of the mucosa were noted in the antrum. The endoscopic appearance was classical for NSAID associated peptic ulcer disease. On review of records, gastrin levels have been normal on the past. She was also H. Pylori negative. Normal musoca in the duodenal bulb. Otherwise normal EGD to third part of the duodenum.\n", + "input3": "-Migraines\n-IBS\n-asthma\n", + "input4": "Mom has MS, otherwise no fmaily history of GI issues or otherwise\n", + "input5": "Vitals: 98.5, 139/82, 65, 18, 100RA \nGeneral: Alert, oriented, appears uncomfortable \nHEENT: Sclera anicteric, dry mucus membranes, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, obese, non-distended, moderate pain with mild palpation to epigastric area, bowel sounds present, no rebound tenderness, voluntary guarding over epigastric area, no organomegaly \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis, trace generalized edema \nSkin: warm, dry, intact\nNeuro: moves all extremities, ___ strength in bilateral upper and lower extremities\n", + "input6": "Imaging\n___ RUQ U/S - IMPRESSION: Cholelithiasis with mildly distended gallbladder as well as prominent CBD (9mm). No definite signs of acute cholecystitis but if there is continued clinical concern, HIDA scan will be helpful for further evaluation. \n\n___ EGD - Erythema, linear ulcerations in the stomach body compatible with gastritis (biopsy). rough mucosa, bleeding spots in the antrum (biopsy). Otherwise normal EGD to third part of the duodenum\n\n___ MRCP - 1. Cholelithiasis, without evidence for cholecystitis or biliary obstruction. Normal appearance of the bile ducts without obstructing intraductal stones or masses. \n2. Two hepatic lesions in segment IVb and V with intravoxel fat, demonstrating arterial hyperenhancement, equivocal washout, may represent adenomas or less likely atypical FNH. Recommended followup MRI with BOPTA for better characterization of these lesions. \n3. Incidental note is made of pancreas divisum. \n\n___ Pathology \nGastric mucosal biopsies, two:\n1. Body (1A): Corpus mucosa with no diagnostic abnormalities recognized.\n2. Antrum (2A): Chemical-type gastropathy.\n\nADMISSION LABS:\n___ 10:25AM BLOOD WBC-6.5 RBC-4.99 Hgb-11.8* Hct-38.0 MCV-76* MCH-23.7* MCHC-31.1 RDW-16.4* Plt ___\n___ 10:25AM BLOOD Neuts-66.4 ___ Monos-4.6 Eos-1.7 Baso-0.4\n___ 10:25AM BLOOD ___ PTT-33.3 ___\n___ 10:25AM BLOOD Glucose-106* UreaN-16 Creat-0.9 Na-141 K-3.5 Cl-106 HCO3-25 AnGap-14\n___ 10:25AM BLOOD ALT-15 AST-16 AlkPhos-43 TotBili-0.3\n___ 10:25AM BLOOD Lipase-50\n___ 10:25AM BLOOD Albumin-4.5 Calcium-9.5 Phos-4.0 Mg-2.2\n___ 10:40AM BLOOD Lactate-1.2\n___ 06:10AM BLOOD GASTRIN-PND\n" +} \ No newline at end of file diff --git a/Finished/Gastritis/Chronic Non-atrophic Gastritis/18996244-DS-3.json b/Finished/Gastritis/Chronic Non-atrophic Gastritis/18996244-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..c9953fc1a107f5fe99d7de44dd22ceb529c9bf75 --- /dev/null +++ b/Finished/Gastritis/Chronic Non-atrophic Gastritis/18996244-DS-3.json @@ -0,0 +1,32 @@ +{ + "chronic non-atrophic gastritis$Intermedia_4": { + "Erythema in the antrum (biopsy), rough mucosa and bleeding spots in the whole stomach are the gold standard for the diagnosis of chronic non-atrophic gastritis\r.$Cause_1": { + "EGD ___: \nGaping lower esophageal sphincter (biopsy) \nErythema in the antrum (biopsy) rough mucosa, bleeding spots in the whole stomach. \nPolyp in the stomach body (polypectomy) \nNormal duodenum biopsied to r/o Sprue (biopsy) \nOtherwise normal EGD to third part of the duodenum$Input6": {} + }, + "chronic gastritis$Intermedia_3": { + "Duodenogastric reflux is a common cause of chronic gastritis.$Cause_1": { + "The symptoms were often accompanied by episodes of vomiting, initially undigested food followed by bilious vomit.$Input2": {} + }, + "suspected gastritis$Intermedia_2": { + "Nausea and vomiting are the symptom that may occur in patients with gastritis$Cause_1": { + "65 yo woman with one year hx of nausea, vomiting, headache and weight loss who presents for evaluation of acute worsening of nausea and vomiting.She has a history of intermittent headaches, vomiting, and inability to tolerated pos.She began noting intermittent episodes of nausea and vomiting, particularly at night. She would awaken from sleep with sensation of nausea, diaphoresis, and generally feeling ill.$Input2": {} + }, + "EGD that showed mild antral gastritis is the gold standard for the diagnosis of gastritis.$Cause_1": { + "She underwent EGD that showed mild antral gastritis and gastric polyp.$Input2": {} + }, + "Vomitting is a symptom that may occur in patients with gastritis.$Cause_1": { + "headache and vomiting$Input1": {} + }, + "!Vomitting is a symptom that may occur in patients with gastritis.$Cause_1": { + "Her nocturnal vomiting and complaints of headache are somewhat worrisome for a more central cause of vomiting.$Input2": {} + } + } + } + }, + "input1": "headache and vomiting\n", + "input2": "65 yo woman with one year hx of nausea, vomiting, headache and weight loss who presents for evaluation of acute worsening of nausea and vomiting. \n\nShe has a history of intermittent headaches, vomiting, and inability to tolerated pos. Her symptoms started one year ago, when she was entering her college. She began noting intermittent episodes of nausea and vomiting, particularly at night. She would awaken from sleep with sensation of nausea, diaphoresis, and generally feeling ill. The symptoms were often accompanied by episodes of vomiting, initially undigested food followed by bilious vomit. There was no blood. Symptoms have been intermittent and progressive, with decreased po intake, frequently limiting herself to soup and toast. She has been evaluated in GI clinic by Dr H started her on Prilosec from which she has had some symptomatic relief. \n\nShe underwent EGD that showed mild antral gastritis and gastric polyp. Pathology from the polyp was benign. Random duodenal biopsy was normal. Abdominal ultrasound showed no abdominal pathology to account for her symptoms. Per most recent note of Dr H \"testing for ulcer disease, H pylori, pyloric stenosis, celiac sprue, and gallbladder disease has been negative. The etiology of her symptoms remain unclear, however, we suspect that her symptoms either represent idiopathic post-viral gastroparesis or gastroesophageal reflux...Her partial response to Prilosec is curious and suggests that her symptoms could be related to acid reflux...Her nocturnal vomiting and complaints of headache are somewhat worrisome for a more central cause of vomiting. We would recommend obtaining a morning cortisol and ACTH level, ___, SPEP, UPEP and an MRI of the head given her headaches and nocturnal episodes of vomiting. We will plan to obtain a gastric emptying study to look for evidence of gastroparesis and an upper GI series to look at the extent of gastroesophageal reflux.\" \n\nShe presented this evening to the ED because her symptoms were worsening, and she has not been able to hold down any substantial amount of food for the last two weeks. In the ED, initial vs were: T 98.1, HR 74, BP 96/62, RR 18, O2 98% RA. Labs were drawn and unremarkable for electrolyte abnormalities. Hct was 39.6. MR head was done with report still pending. She was admitted for further evaluation by neurology and GI services.\n", + "input3": "-history of knee surgery \n-exertional asthma \n-no prior abdominal surgery\n", + "input4": "Notable for father with leiomyomas of his esophagus, status post resection. Father also with psoriasis. Twin sister, question monozygotic versus dizygotic with reflux symptoms and nausea and vomiting a year ago that was treated effectively with Prilosec.\n", + "input5": "Vitals: T:97.1, BP:98/61, P:68, R:18, O2: 100%RA \nGeneral: alert, oriented, no acute distress \nHEENT: sclera anicteric, MMM, oropharynx clear \nNeck: supple \nLungs: clear to auscultation bilaterally \nCV: regular rate and rhythm, normal S1 + S2 \nAbdomen: soft, non-tender, non-distended, bowel sounds present \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\n", + "input6": "GLUCOSE-86 UREA N-12 CREAT-0.9 SODIUM-142 POTASSIUM-4.4 \nCHLORIDE-105 TOTAL CO2-27 ANION GAP-14 ALBUMIN-4.4 CALCIUM-9.8 \nPHOSPHATE-4.4 MAGNESIUM-2.0\nALT(SGPT)-16 AST(SGOT)-23 LD(LDH)-144 ALK PHOS-86 TOT BILI-0.4\nWBC-6.6 RBC-4.60 HGB-13.1 HCT-39.6 MCV-86 MCH-28.5 MCHC-33.0 \nRDW-13.7\nNEUTS-50.2 ___ MONOS-6.3 EOS-1.2 BASOS-0.5\nPLT COUNT-254\n___ PTT-29.4 ___\n___ negative\n\nUrinalysis (___)\nURINE BLOOD-SM NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-TR \nBILIRUBIN-NEG UROBILNGN-4* PH-7.0 LEUK-NEG\nURINE ___ BACTERIA-FEW YEAST-NONE ___\n\nImaging:\nMRI head w/o contrast (___):\n1. No acute intracranial abnormality and no space-occupying lesion. \n2. Asymmetric prominence of the left lateral ventricle and probable ___ cisterna magna, both normal variants, and unlikely to relate to the patient's symptoms. \n\nCT abd/pelvis (___):\n1. No acute problem identified on CT imaging of the abdomen or pelvis. \n2. Likely simple cyst within the right ovary. \n\nPrevious admission data:\nBlood tests from recent office visits: \nTSH 0.55, ___ 16.1, CRP 9, tTG 5, ESR 20, SPEP normal, ACTH \npending \n \nEGD ___: \nGaping lower esophageal sphincter (biopsy) \nErythema in the antrum (biopsy) rough mucosa, bleeding spots in the whole stomach,\nPolyp in the stomach body (polypectomy) \nNormal duodenum biopsied to r/o Sprue (biopsy) \nOtherwise normal EGD to third part of the duodenum \n\nAbdominal ultrasound ___: \nNormal abdominal ultrasound with no acute process to explain the patient's epigastric pain. \n\nCT Abdomen and Pelvis ___: \n1. No acute problem identified on CT imaging of the abdomen or pelvis. \n2. Likely simple cyst within the right ovary. \n \nMRI Head ___: \n1. No acute intracranial abnormality and no space-occupying esion. \n2. Asymmetric prominence of the left lateral ventricle and probable ___ cisterna magna, both normal variants.\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/11458370-DS-14.json.json b/Finished/Gastro-oesophageal Reflux Disease/11458370-DS-14.json.json new file mode 100644 index 0000000000000000000000000000000000000000..0f1f1b8a614ef7b49d6daca8422b9be22f4ad474 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/11458370-DS-14.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux disease$Intermedia_3": { + "24-hour impedance-pH results is the gold standard in the diagnosis of gastroesophageal reflux disease.$Cause_1": { + "She had a 24-hour impedance-pH study performed OFF PPI therapy, which showed an elevated score of 17.2 (normal < 14.7).$Input2": {} + }, + "suspected gastro-oesophageal reflux disease$Intermedia_2": { + "Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "She says the heartburn wakes her up at night. She cannot sleep laying flat, must be propped up w/ pillows.$Input2": {} + }, + "The patient has a history of esophageal reflux.$Cause_1": { + "Esophageal reflux$Input3": {} + } + } + }, + "input1": "Heartburn\n", + "input2": "A woman never smoker, with long hx of a disease managed with high dose ranitidine and restrictive diet. She has been on various PPI therapies and Carafate with limited success. Had an endoscopy and biopsies showed no evidence of helicobacter. There was evidence of chemical/reactive gastropathy. She had a 24-hour impedance-pH study performed OFF PPI therapy, which showed an elevated score of 17.2 (normal < 14.7). Esophageal manometry was normal. Referred for consideration of antireflux surgery.\nShe takes Zantac per day, which help, but the symptoms immediately return after the Zantac wears off. She says the heartburn wakes her up at night. She cannot sleep laying flat, must be propped up w/ pillows. Denies regurgitation. Has tried Nexium, which she did not find helpful. She coughs up phlegm in the AM. She notes that over the past months she has been spitting up some blood in the morning when she wakes up. Has a restrictive diet- avoids fruit, caffeine, alcohol, tomato sauce. Denies history of cardiac problems.\n", + "input3": "+Anxiety \n+Esophageal reflux \n+Gastritis \n+Colorectal polyps \n+Menopause \n+Migraine without aura and without status migrainosus, not\nintractable \n+Osteoporosis without current pathological fracture \n+Essential hypertension \n+Scoliosis\n+Left ovarian cyst\n+s/p tonsillectomy\n+s/p laparoscopy\n", + "input4": "Mother- sarcoidosis, high blood pressure, tinnitus\nFather- high blood pressure, prostate cancer\nSiblings\nOffspring\nOther- grandmother: bone and joint disorder\n", + "input5": "BP: 150/84. Heart Rate: 101. O2 Saturation%: 100. Weight: 113\n(With Shoes). Temperature: 98.3. Resp. Rate: 18. Pain Score: 0.\nGENERAL \n[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\n\nHEENT \n[x] NC/AT [] EOMI [x] PERRL/A [x] Anicteric\n[x] OP/NP mucosa normal [x] Tongue midline\n[x] Palate symmetric [x] Neck supple/NT/without mass\n[x] Trachea midline [] Thyroid nl size/contour\n[ ] Abnormal findings:\n\nRESPIRATORY \n[x] CTA bilaterally [] Excursion normal [ ] No fremitus\n[] No egophony [] No spine/CVAT\n[ ] Abnormal findings:\n\nCARDIOVASCULAR \n[x] RRR [x] No m/r/g [] No JVD [] PMI nl [x] No edema\n[] Peripheral pulses nl [] No abd/carotid bruit\n[ ] Abnormal findings:\n\nGI \n[x] Soft [x] NT [x] ND [] No mass/HSM [] No hernia\n[ ] Abnormal findings:\n\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[ ] Abnormal findings:\n\nNEURO \n[] Strength intact/symmetric [] Sensation intact/ symmetric\n[] Reflexes nl [x] No facial asymmetry [x] Cognition intact\n[] Cranial nerves intact [ ] Abnormal findings:\n\nMS \n[] No clubbing [] No cyanosis [] No edema [] Gait nl\n[] No tenderness [] Tone/align/ROM nl [] Palpation nl\n[] Nails nl [ ] Abnormal findings:\n\nLYMPH NODES \n[x] Cervical nl [x] Supraclavicular nl [] Axillary nl\n[] Inguinal nl [ ] Abnormal findings:\n\nSKIN \n[x] No rashes/lesions/ulcers on visible skin\n[] No induration/nodules/tightening [ ] Abnormal findings:\n\nPSYCHIATRIC \n[x] Nl judgment/insight [x] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n", + "input6": "WBC RBC Hgb Hct MCV MCH MCHC RDW RDWSD \nPlt Ct \n04:02 8.1 3.86* 11.4 36.3 94 29.5 31.4* 12.8 43.9 \n 163 \n \n Glucose UreaN Creat Na K Cl HCO3 AnGap \n04:02 121*1 17 0.8 139 4.4 102 28 9*\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/12302912-DS-10.json b/Finished/Gastro-oesophageal Reflux Disease/12302912-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..49ee84cb55abd4d60372e5638fac6d5b02dc0dff --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/12302912-DS-10.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET7.2% > 6 is the gold standard for the diagnosis of GERD.$Cause_1": { + "Ambulatory reflux monitor\uff1atotal AET\uff1a7.2% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Abdominal pain is an atypical symptom of GERD$Cause_1": { + "Abdominal pain$Input1": {} + }, + "Acid reflux, heartburn, and chest pain are typical symptoms of GERD$Cause_1": { + "HISTORY OF PRESENT ILLNESS: w/ hx of recurrent abdominal pain, anxiety disorder who presents with burning chest sensation/epigastric pain that started several hours prior to presentation in the ED which he describes as \"heartburn x Spitting up sour clear fluid.$Input2": {} + }, + "Heartburn is a typical symptom of GERD$Cause_1": { + "Now the burning sensation has been worsening over the past two weeks, with flares that are severe.$Input2": {} + } + } + }, + "input1": "Abdominal pain\n", + "input2": "HISTORY OF PRESENT ILLNESS: w/ hx of recurrent abdominal pain, anxiety disorder who presents with burning chest sensation/epigastric pain that started several hours prior to presentation in the ED which he describes as \"heartburn x Spitting up sour clear fluid. The pain is without radiation, associated with coughing fit and scant hemoptysis. He states he was scheduled for fundoplication 4 weeks ago, had vague RUQ abd pain and was cancelled. Now the burning sensation has been worsening over the past two weeks, with flares that are severe. \nThe patient is followed as an outpatient in consultation. He called the on-call attending, Dr. told him to come into the ED to have his pain evaluated. \nIn the ED, initial vs were: 98.6 120 148/84 18 95% RA. Labs were remarkable for AST 71, ALT 107. Chem7, CBC, and remaining LFTs were unremarkable (AP 117, Tbili 0.4, Alb 4.7, Lipase 28. Urine culture was sent, though UA was bland. Patient was given Zofran, dilaudid, promethazine, donnatal, viscous lidocaine, Aluminum-Magnesium Hydrox.-Simethicone. Thoracic surgery was consulted and did not see an indication for further thoracic involvment. Patient requested admission for symptoms and so the ED obliged. Vitals on Transfer: 98.3 100 122/87 14 96% RA. \nOn the floor patient reports epigastric and chest pain, worse with coughing fits. \n\nReview of sytems: \n(+) Per HPI \n(-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies cough, shortness of breath. Denies chest tightness, palpitations. No dysuria. Denies arthralgias or myalgias. Ten point review of systems is otherwise negative.\n", + "input3": "+Abdominal Pain NOS - Carries a diagnosis of acute intermittent porphyria though he has been extensively worked-up for this condition at multiple hospitals with no clear positive results. See note by Dr. for further details.\n+Anxiety\n+ADHD\n", + "input4": "Mother with diabetes, type II\n", + "input5": "ON ADMISSION\nVitals- 98.0, 19, 96%RA \nGeneral- falling asleep during conversations (was asleep when I walked into the room), orientedx3, in no acute distress \nHEENT- Sclera anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, no LAD \nLungs- Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nCV- slightly tachy, Regular rhythm, normal S1, S2, no murmurs, \nrubs, gallops \nAbdomen- soft, non-tender, protuberant but non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, abdominal striae. \nGU- no foley \nExt- warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nNeuro- CNs2-12 intact, motor function grossly normal\n", + "input6": "ON ADMISSION:\n01:20AM BLOOD WBC-7.1 RBC-4.76 Hgb-14.3 Hct-40.8 MCV-86 \nMCH-30.0 MCHC-35.1* RDW-14.5 Plt\n01:20AM BLOOD Glucose-92 UreaN-15 Creat-0.9 Na-139 \nK-3.5 Cl-102 HCO3-27 AnGap-14\n01:20AM BLOOD ALT-107* AST-71* AlkPhos-117 TotBili-0.4\n\nCXR: (PRELIM)\nThe left subclavian line tip is at the level of junction of leftbrachiocephalic vein and SVC. Heart size and mediastinum are unremarkable. Bibasal linear opacities are present and most likely consistent with atelectasis. The Port-A-Cath catheter has been removed since the prior studies.\nAmbulatory reflux monitor\uff1atotal AET\uff1a7.2% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/13063258-DS-20.json.json b/Finished/Gastro-oesophageal Reflux Disease/13063258-DS-20.json.json new file mode 100644 index 0000000000000000000000000000000000000000..39505cedbfb874037bf3d32d5dd5527fc801c30a --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/13063258-DS-20.json.json @@ -0,0 +1,18 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Esophagitis\uff08grade B\uff09 is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "with recent EGD noting distal esophagitis\uff08grade B\uff09.$Input2": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Epigastric pain is a atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "epigastric pain$Input1": {} + } + } + }, + "input1": "epigastric pain\n", + "input2": "Ms is with aepigastric pain and globus, with recent EGD noting distal esophagitis\uff08grade B\uff09. Her sx started 8 months ago when she was taking NSAIDS for bladder pain. Her pH testing and esoph manometry were wnl but were done while pt was on PPIs. She presents for eval for possible linx vs. Current symptoms also include diarrhea, nausea, heartburn, 20# unintentional wt loss and a small volume of hematochezia.\n", + "input3": "+Pituitary adenoma -- prolactinoma\n+History of thyroid nodules -- benign on prior FNA\n+Interstitial cystitis with bladder stimulator -- cannot get MRI\n+Recent GIB (melena) due to antral ulcerations from NSAID use Irritable bowel syndrome and bladder incontinence\n+Anxiety\n+Insomnia\n", + "input4": "Mother dying of stage IV colon cancer, just chose to stop \ntreatment for cancer\nFather with CAD\nGrandmother with thyroid CA and rheumatoid arthritis\n", + "input5": "BP: 118/61. Heart Rate: 81. Weight: 143.4. Height: 63.5. BMI:\n25.0. Temperature: 98.8. Resp. Rate: 16. Pain Score: 0. O2\nSaturation%: 99.\n\nGENERAL \n[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\n\nHEENT \n[x] NC/AT [x] EOMI [x] PERRL/A [x] Anicteric\n[x] OP/NP mucosa normal [x] Tongue midline\n[x] Palate symmetric [x] Neck supple/NT/without mass\n[x] Trachea midline [] Thyroid nl size/contour\n[ x] Abnormal findings: right thyroid nodule\n\nRESPIRATORY \n[x] CTA/P [x] Excursion normal [x] No fremitus\n[x] No egophony [x] No spine/CVAT\n[ ] Abnormal findings:\n\nCARDIOVASCULAR \n[x] RRR [x] No m/r/g [x] No JVD [x] PMI nl [x] No edema\n[x] Peripheral pulses nl [x] No abd/carotid bruit\n[ ] Abnormal findings:\n\nGI \n[x] Soft [] NT [x] ND [x] No mass/HSM [x] No hernia\n[x ] Abnormal findings: tender LUQ\n\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[ ] Abnormal findings:\n\nNEURO \n[x] Strength intact/symmetric [x] Sensation intact/ symmetric\n[x] Reflexes nl [x] No facial asymmetry [x] Cognition intact\n[x] Cranial nerves intact [ ] Abnormal findings:\n\nMS \n\n \n[x] No clubbing [x] No cyanosis [x] No edema [x] Gait nl\n[x] No tenderness [x] Tone/align/ROM nl [x] Palpation nl\n[x] Nails nl [ ] Abnormal findings:\n\nLYMPH NODES \n[x] Cervical nl [x] Supraclavicular nl [x] Axillary nl\n[x] Inguinal nl [ ] Abnormal findings:\n\nSKIN \n[x] No rashes/lesions/ulcers\n[x] No induration/nodules/tightening [ ] Abnormal findings:\n\nPSYCHIATRIC \n[x] Nl judgment/insight [x] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n", + "input6": "Ba swallow :\nPatent gastroesophageal junction without evidence of leak\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/13290763-DS-20.json.json b/Finished/Gastro-oesophageal Reflux Disease/13290763-DS-20.json.json new file mode 100644 index 0000000000000000000000000000000000000000..4940d0325ab20484f4915344be290613ee76ffd3 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/13290763-DS-20.json.json @@ -0,0 +1,27 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Esophagitis(garade B) is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "the pathology revealed squamocolumnar junction mucosa with chronic esophagitis(garade B), no evidence of intestinal metaplasia.$Input2": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Heartburn is a typical synptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "heartburn$Input1": {} + }, + "Cough is an atypical synptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "he has a persistent globus sensation as well as occasional cough.$Input2": {} + }, + "Substernal acid pain is a typical synptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "he does have some complaints of substernal acid pain, which have been significantly improved with PPI medication.$Input2": {} + }, + "Regurgitation is a typical synptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "he also complaints of regurgitation of solid food,$Input2": {} + } + } + }, + "input1": "heartburn\n", + "input2": "The patient is a gentleman who is followed by Dr.. The patient saw Dr. with a chief complaint of excessive throat clearing and mucus production. In addition, he has a persistent globus sensation as well as occasional cough. In regards to esophageal symptoms, he does complain of occasional dysphagia primarily for solid food. In addition, he does have some complaints of substernal acid pain, which have been significantly improved with PPI medication. Finally, he also complaints of regurgitation of solid food, which has not been improved by PPI medication. The patient underwent an upper endoscopy by Dr.. This showed short segments of columnar epithelium suggestive. However, the pathology revealed squamocolumnar junction mucosa with chronic esophagitis\uff08grade B\uff09, no evidence of intestinal metaplasia. The patient also underwent esophageal function testing including a pH impedance and manometry. His manometry showed that swallows were peristaltic with remaining five associated with either drops or ineffective peristalsis. The mean amplitude of contraction was 48. He also underwent a 24-hour pH study. I should note that this was performed on PPI therapy. The score for a 24-hour period was 2.8. He also underwent impedance at the same time that was within normal limits.\n", + "input3": "+Bipolar DO\n+Depression\n+possible ADHD\n+Tonsillectomy\n", + "input4": "non contributory\n", + "input5": "VITAL SIGNS: Blood pressure 131/84, temperature 98.2, weight\n165, height 6 feet, oxygen saturation 96%.\nGENERAL APPEARANCE: No acute distress.\nCOMMUNICATION ABILITY: Normal.\nEYES: Extraocular muscles intact.\nFACE/HEAD: Otherwise, normal.\nNEUROLOGIC: Cranial nerves grossly intact. Alert and oriented\nx3.\nPSYCHIATRIC: Mood and affect normal.\n", + "input6": "Ba swallow\nNo leak\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/13573314-DS-34.json b/Finished/Gastro-oesophageal Reflux Disease/13573314-DS-34.json new file mode 100644 index 0000000000000000000000000000000000000000..57a31306b3e8fc6642f980380538e455d4ac6037 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/13573314-DS-34.json @@ -0,0 +1,30 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET6.6% > 6 is the gold standard for the diagnosis of GERD.$Cause_1": { + "Ambulatory reflux monitor:total AET:6.6% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Stomach pain and chest pain are atypical and typical symptoms of GERD, respectively.$Cause_1": { + "presents with 2 days of worsening stomach and chest pain.$Input2": {} + }, + "Cough is atypical symptom of GERD.$Cause_1": { + "Reports cough \"at times\".$Input2": {} + }, + "!Chest and Epigastric Pain are typical and atypical symptoms of GERD, respectively.$Cause_1": { + "Chest and Epigastric Pain$Input1": {} + }, + "!Chest pain is a typical symptom of GERD.$Cause_1": { + "Patient reports several complaints. She has chest pain \"all over\", and motions to the middle of her chest.$Input2": {} + }, + "!Stomach pain is an atypical symptom of GERD.$Cause_1": { + "Also has stomach pain in upper area.$Input2": {} + } + } + }, + "input1": "Chest and Epigastric Pain\n", + "input2": "Patient is a woman with a PMH of disease c/b autonomic dysfunction, HFpEF, dementia, who presents with 2 days of worsening stomach and chest pain. Interview is attempted with phone interpreter. However, patient is unable to hear interpreter, and speaks very softly herself. No family at bedside and unable to be reached. Interview conducted with help of staff, though limited. Patient reports several complaints. She has chest pain \"all over\", and motions to the middle of her chest. Also has stomach pain in upper area. Reports difficulty breathing. Reports cough \"at times\". States that she has a hernia. Unable to obtain timeline for these symptoms. Reports a \"head heaviness\". Denies fevers. Denies pain with urination.\nIn the ED, initial vitals: T 97.6, HR 84, BP 160/80, RR 16, 98% RA\n", + "input3": "+HTN\n+HFpEF (LVEF >55%\n+Valvular disease: AR, 1+ MR, TR, mild PA HTN\n+osteoporosis\n+renal mass(MRI 04- small cortical scar in mid-L kidney)\n+recurrent UTIs (has small urethral caruncle) on nitrofurantoin prophylaxis\n+Colonic polyps (biopsy showed sessile serrated adenomas in ascending colon and hepatic flexure)\n+Osteoarthritis\n+s/p bladder suspension\n+s/p knee surgery\n+Urinary incontinence (using pessary)\n+Breast cyst\n+Chronic abdominal pain\n", + "input4": "Brother with cardiac history and CVA. \nMother with unknown abdominal cancer.\n", + "input5": "GENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. Oropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur, no S3, no S4. No JVD. Chest tender to palpation\nRESP: Lungs clear to auscultation with good air movement bilaterally. Breathing is non-labored, though somewhat fast \nGI: Abdomen soft, non-distended, mild epigastric TTP. Bowel sounds present. No HSM\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full and symmetric bilaterally in all limbs\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, orientation hard to assess. Speech soft, somewhat delayed, but fluent.\n", + "input6": "09:05PM URINE BLOOD-TR* NITRITE-NEG PROTEIN-TR* GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-LG*\n09:05PM URINE RBC-3* WBC-45* BACTERIA-FEW* YEAST-NONE EPI-1 TRANS EPI-<1\n07:45AM BLOOD WBC-3.7* RBC-3.90 Hgb-11.4 Hct-35.5 MCV-91 MCH-29.2 MCHC-32.1 RDW-15.9* RDWSD-53.5* Plt\n07:45AM BLOOD Glucose-96 UreaN-19 Creat-0.7 Na-140 K-4.3 Cl-99 HCO3-28 AnGap-13\n07:38AM BLOOD CK-MB-2 cTropnT-<0.01\n07:40PM BLOOD cTropnT-<0.01\nAmbulatory reflux monitor:total AET:6.6% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/13607135-DS-18.json b/Finished/Gastro-oesophageal Reflux Disease/13607135-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..68984e3993f23b606b53365e2e495792508dd358 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/13607135-DS-18.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor: total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Chest pain is a typical symptom of GERD.$Cause_1": { + "A woman suspected PBC with severe epigastric pain that radiates to her mid-sternal area beginning at 5 AM.$Input2": {} + }, + "Epigastric and substernal chest pain are atypical and typical symptoms of GERD,respectively.$Cause_1": { + "epigastric and substernal chest pain$Input1": {} + }, + "Erosions at the GE junction may be an endoscopic finding of GERD but was not graded.$Cause_1": { + "Endoscopy showed hiatal hernia and erosions at the GE junction that were shown to be benign on pathology.$Input2": {} + } + } + }, + "input1": "epigastric and substernal chest pain\n", + "input2": "A woman suspected PBC with severe epigastric pain that radiates to her mid-sternal area beginning at 5 AM. She noted gradual onset that would subside over minutes. It did not radiate to her back, and was similar in character to past episodes. However, she felt the pain was much more severe, and did not respond to her usual reflux techniques (drinking water, taking tums, and drinking a lidocaine water mixture). Pain does not worsen or improve with eating, and pt denies dysphagia. She denied SOB, chest pain, palpitations, nausea, vomiting, and diaphoresis. She also denies change in bowel habits, such as melena or BRBPR. Endoscopy showed hiatal hernia and erosions at the GE junction that were shown to be benign on pathology. \nIn the ED, VS were Temp:97.2 HR:56 BP:147/54 O(2)Sat:100 normal. She reported severe pain that did not respond to GI cocktail or morphine 6 mg in total. She reports that it eventually self-resolved. Physical exam was benign (pt refused rectal), and EKG, labs including LFTs, trop x 1 were normal. She also received Zofran 4 mg IV and aspirin 325 mg. \nCurrently on the floor, she reports no pain or other complaints. On ROS, she reports a non-productive cough last night that is \"slightly different\" from her chronic cough and increased urination while at the hospital.\nROS: Denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, shortness of breath, chest pain, nausea, vomiting, diarrhea, constipation, BRBPR, melena, hematochezia, dysuria, or hematuria.\n", + "input3": "+Suspected primary biliary cirrhosis based on serologies (antimitochondrial antibody 1:1280, positive M2), but no definitive features of PBC on liver biopsy\n+Arthritis \n+Chronic cholecystitis and cholesterol type cholelithiasis s/p cholecystectomy\n+normal ERCP\n+diverticulosis - colonoscopy\n+left elbow tendonitis \n+s/p right knee arthroscopy\n+h/o cellulitis \n+Fibroids\n+s/p 3 c-sections\n", + "input4": "Mother had renal cell carcinoma and irritable bowel syndrome. Father had a myocardial infarction, also had esophageal cancer. Children healthy. Two uncles had heart disease at an earlier age.\n", + "input5": "Vitals - T: 98.2 BP: 130/52 HR: 58 RR: 18 02 sat: 100 RA \nGENERAL - sitting comfortably in bed in NAD \nHEENT - NCAT, EOMI, PERRL, OP clear\nNeck - supple, no LAD, no thyroidmegaly or nodules \nCV - RRR, S1 and S2 with no m/r/g, radial pulses 2+\nLungs - CTAB, good aeration, no wheezes/rales/rhonchi \nABD - soft, BS+, NT, ND, no rebounding or guarding, no organomegaly \nRectal - pt refused \nEXT - WWP, no c/c/e \nNEURO - AOx3, facial expressions symmetric, moving all four extremities \nSKIN - no rashes \nPSYCH - normal affect\n", + "input6": "141\n4.0 30 0.9 \nCa: 9.3 Mg: 2.1 P: 4.2\nALT: 41 AP: 89 Tbili: 0.7 Alb: 4.0 \nAST: 37 LDH: 203 \nWBC 7.3 HCT 38.3 PLT 211 \nTrop-T < 0.01 (7:30 AM, 1:25, 7\nUA negative \n140\n3.7 26 0.8 \nALT: 25 AP: 77 Tbili: 0.3 \nAST: 29 LDH: 189 \nLip: 71 \nWBC 6.2 HCT 39.7 PLT 198 \nN:64.3 L:26.8 M:5.8 E:1.9 Bas:1.2 \nSTUDIES: \nEGD:\nNormal mucosa in the esophagus, stomach, duodenum\nFundic gland polyp in the stomach\nOtherwise normal EGD to third part of the duodenum \nRecommend follow up with Dr. to evaluate for non acid reflux \nCXR - No acute cardiopulmonary process.\nEKG - upright axis, sinus rhythm, regular rate at ~60 bpm, intervals wnl, no acute ST changes\nAmbulatory reflux monitor: total AET:6.5% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/13661098-DS-14.json b/Finished/Gastro-oesophageal Reflux Disease/13661098-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..2a35bdef4bda65d3c872a2989b80edd24481b34d --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/13661098-DS-14.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 7.9% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor:total AET:7.9% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Reflux and epigastric pain are typical and atypical symptoms of GERD, respesuspected gastro-oesophageal reflux \rdiseasectively$Cause_1": { + "Female patient is a very pleasant old female with history of laparoscopic gastric bypass, who presents to the ED with 24 hour history of reflux and epigastric pain.$Input2": {} + }, + "Abdominal pain is anatypical symptom of GERD.$Cause_1": { + "Abdominal pain$Input1": {} + }, + "Severe burning in her throat and epigastric pain are typical and atypical symptoms of GERD, respectively$Cause_1": { + "Approximately 24 hours ago (2am, she awoke with severe burning in her throat and epigastric pain.$Input2": {} + } + } + }, + "input1": "Abdominal pain\n", + "input2": "Female patient is a very pleasant old female with history of laparoscopic gastric bypass, who presents to the ED with 24 hour history of reflux and epigastric pain. She reports that she developed reflux symptoms after her surgery, which have been controlled well with pantoprazole for several years. Approximately 24 hours ago (2am, she awoke with severe burning in her throat and epigastric pain. She visited her PCP, who prescribed ranitidine and maalox (in addition to her home pantoprazole), which did not relieve her symptoms. \nShe had 7 loose bowel movements during the day, but has not passed flatus or had a bowel movement for the past 12 hours. She tolerated a small amount of food for dinner. She denies NSAID use or alcohol use. She also denies fevers, chills, nausea, vomiting, melana, or sick contacts.\nShe stopped taking vitamin supplementation years ago (except for vitamin D). \nEndoscopy showed a completely patent GE junction and a patent gastrojejunostomy. \nColonoscopy - recommended repeat\n", + "input3": "+HTN\n+Obesity\n+Allergic rhinitis\n+Arthritis, \n+Polycystic Kidney\n+G6PD\n+hx T2DM \n+Gastric bypass\n+C/S x 2\n+Lap Chole\n+Foot surgery\n+TVH\n+bladder suspension\n", + "input4": "NC\n", + "input5": "Admission PE:\nVitals: B/P ___ Pulse 79 Temp 96.9 Resp 16 O2sat 100% room air\nNAD\nRRR\nCTAB\nAbdomen soft, moderately tender in epigastrium, mildly distended\nSurgical scars well healed\nNo C/C/E\n", + "input6": "Admission labs:\n10:00PM GLUCOSE-122* UREA N-14 CREAT-0.8 SODIUM-139 POTASSIUM-4.0 CHLORIDE-102 TOTAL CO2-28 ANION GAP-13\n10:00PM estGFR-Using this\n10:00PM ALT(SGPT)-8 AST(SGOT)-17 ALK PHOS-89 TOT BILI-0.2\n10:00PM LIPASE-30\n10:00PM ALBUMIN-4.1\n10:00PM WBC-8.7 RBC-4.20 HGB-11.9* HCT-37.1 MCV-88 MCH-28.3 MCHC-32.0 RDW-14.9\n10:00PM NEUTS-71.0* ___ MONOS-3.6 EOS-1.9 BASOS-0.5\n10:00PM PLT COUNT-218\n09:50PM URINE HOURS-RANDOM\n09:50PM URINE UCG-NEGATIVE\n09:50PM URINE COLOR-Yellow APPEAR-Clear SP ___\n09:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-SM \n09:50PM URINE RBC-1 WBC-3 BACTERIA-FEW YEAST-NONE EPI-10\nAmbulatory reflux monitor:total AET:7.9% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/13800231-DS-9.json b/Finished/Gastro-oesophageal Reflux Disease/13800231-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..8dde8ad76775028ca3bd41efa55a4f682834f8af --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/13800231-DS-9.json @@ -0,0 +1,30 @@ +{ + "gastro-oesophageal reflux disease$Intermedia_3": { + "AET: 7% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor:total AET:7% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux disease$Intermedia_2": { + "Nausea is an atypical symptom of gastroesophageal reflux disease$Cause_1": { + "presenting with complaint of nausea, vomiting, and hematemesis.$Input2": {} + }, + "Cough is an atypical symptom of gastroesophageal reflux disease$Cause_1": { + "Pt reports that she has coughing fits every morning when she awakens.$Input2": {} + }, + "Epigastric discomfort is an atypical symptom of gastroesophageal reflux disease$Cause_1": { + "She also reports that after her coughing fit this morning, she developed epigastric discomfort and right flank discomfort.$Input2": {} + }, + "\uff01Nausea is an atypical symptom of gastroesophageal reflux disease$Cause_1": { + "Nausea, vomiting, small-volume hematemesis$Input1": {} + }, + "Chest discomfort is a typical symptom of gastroesophageal reflux disease$Cause_1": { + "she also experience some chest discomfort$Input2": {} + } + } + }, + "input1": "Nausea, vomiting, small-volume hematemesis\n", + "input2": "A patient with history of mild gastritis, diverticulosis, hyperlipidemia, and anxiety presenting with complaint of nausea, vomiting, and hematemesis. \nPatient was recently admitted with abdominal pain and BRBPR. Given her stable H/H and EGD/Colonoscopy demonstrating mild gastritis and diverticulosis it was decided to treat conservatively with protonix. CT abdomen demonstrated evidence of uncomplicated diverticulitis and pt was discharged to complete a course of flagyl and ciprofloxacin. \nPt reports that she has coughing fits every morning when she awakens. She states that for the last three mornings, the coughing fits have been particularly bad and she had produced sputum with \"red-pink blobs\" of blood. She denies bleeding otherwise. She also reports that after her coughing fit this morning, she developed epigastric discomfort and right flank discomfort. She states that the discomfort persisted and she also experience some chest discomfort with associated left arm tingling prompting her presentation to the ED. \nIn the ED, initial VS were 98.3 88 140/87 18 100% RA \n-Labs showed WBC 6.3, H/H of 14.1/42.2 that decreased to 1 1.1 after 2L IVF, BMP WNL, LFTs WNL, lipase 65, INR 1.1, lactate 1.2, troponin <0.01 x 2 \n-Blood cultures x 2 were drawn\n-CXR did not demonstrate an acute intrathoracic process\n-RUQ ultrasound was normal\n-Received 1L LR and 1L NS, Protonix, Zofran, Donnatal, Lidocaine, Tylenol, Maalox \n-Transfer VS were 99.0 57 132/83 16 96% RA \n-GI was consulted and given pt's ___ Score of 0 did not believe EGD was necessary and recommended Protonix PO \nDecision was made to admit to medicine for further management. \n\nOn arrival to the floor, patient reports that she is not nauseous and states that her abdominal pain is much improved. She denies CP or SOB. She requests a diet. Of note, she states that all of her health troubles started when she became stressed with her job over the winter and her mother had a stroke.\n", + "input3": "+Migraine\n+HL\n+Precancerous skin lesion (actinic keratosis)\n+PUD, confirmed by UGI endoscopy\n+Diverticulosis\n+Hemorrhoids\n+Anxiety\n", + "input4": "Mother HYPERTENSION, STROKE, MACULAR DEGENERATION \nFather MACULAR DEGENERATION, CORONARY ARTERY DISEASE \nBrother HEALTHY \nBrother HEALTHY \nAunt BREAST CANCER\n", + "input5": "ADMISSION PHYSICAL\nVS - 98.5 134/82 58 16 99% on RA \nGENERAL: NAD \nHEENT: AT/NC, PERRL, sclera anicteric \nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles \nABDOMEN: Mildly TTP in epigastrum and right flank \nEXTREMITIES: no cyanosis, clubbing or edema, moving all 4 extremities with purpose \nPULSES: 2+ DP pulses bilaterally \nNEURO: Intact\n", + "input6": "ADMISSION LABS\n09:15AM BLOOD WBC-6.3 RBC-4.93 Hgb-14.1 Hct-42.2 MCV-86 MCH-28.6 MCHC-33.4 RDW-12.6 RDWSD-39.0 Plt\n09:15AM BLOOD Neuts-66.9 Monos-7.6 Eos-1.3 Baso-1.3* Im AbsNeut-4.20 AbsLymp-1.42 AbsMono-0.48 AbsEos-0.08 AbsBaso-0.08\n09:15AM BLOOD Glucose-87 UreaN-13 Creat-0.7 Na-136 K-4.4 Cl-99 HCO3-26 AnGap-15\n09:15AM BLOOD ALT-11 AST-29 AlkPhos-53 TotBili-0.6\n09:15AM BLOOD Lipase-65*\n09:15AM BLOOD cTropnT-<0.01\n03:20PM BLOOD cTropnT-<0.01\n09:15AM BLOOD Albumin-4.3 Calcium-9.8 Phos-4.1 Mg-2.2\n09:33AM BLOOD Lactate-1.2\nIMAGING\nRUQ Ultrasound\nFINDINGS: LIVER: The hepatic parenchyma appears within normal limits. The contour of the liver is smooth. There is no focal liver mass. The main portal vein is patent with hepatopetal flow. There is no ascites. BILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm. GALLBLADDER: The gallbladder is distended without evidence of stones or gallbladder wall thickening. There is no pericholecystic fluid. PANCREAS: Imaged portion of the pancreas appears within normal limits, without masses or pancreatic ductal dilation, with portions of the pancreatic tail obscured by overlying bowel gas. The pancreatic duct measures 2 mm. SPLEEN: Normal echogenicity, measuring 9.4 cm. KIDNEY: The right kidney measures 10.6 cm. Normal cortical echogenicity and corticomedullary differentiation is seen bilaterally. A non shadowing, echogenic focus measuring 3 by 4 x 3 mm is noted in the interpolar region of the right kidney, likely an AML. RETROPERITONEUM: Visualized portions of aorta and IVC are within normal limits. IMPRESSION: Unremarkable exam.\nCXR\nFINDINGS: The cardiomediastinal silhouette and pulmonary vasculature are normal. The lungs are clear. There is no pneumothorax or pleural effusion. There is no right sided subdiaphragmatic free air. IMPRESSION: No acute intrathoracic process or subdiaphragmatic free air.\nAmbulatory reflux monitor:total AET:7% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/14175995-DS-14.json b/Finished/Gastro-oesophageal Reflux Disease/14175995-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..62462c4be84cfc69bd05c8a2eb6a115fd6090ade --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/14175995-DS-14.json @@ -0,0 +1,27 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 9.2% > 6% is the gold standard for gastro-oesophageal reflux \rdisease\r diagnosis\r.$Cause_1": { + "Ambulatory reflux monitor :total AET:9.2% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Burning chest pain is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "She reports that it is a burning chest pain that radiates to both shoulders and her neck.$Input2": {} + }, + "!Chest Pain is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "recent admission for dyspnea and chest pain$Input2": {} + }, + "Nausea is is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "She reports in the ED the nausea worsened and she vomited.$Input2": {} + }, + "!Burning in her chest is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "She reports that she has the burning in her chest$Input2": {} + } + } + }, + "input1": "Chest Pain\n", + "input2": "A famale patient with PMHx notable for DVT/PE, HTN, CKD stage III, DJD, and recent admission for dyspnea and chest pain who presents for evaluation of chest pain and dyspnea. The patient reports that she was at home on the day prior to admission at 1700. She reports that it is a burning chest pain that radiates to both shoulders and her neck. She reports that it is similar to the pain that she had on her last admission but worse. She reports that she feels that it is a muscle type of pain. She reports that it has been constant with some waking and waning since 1700. She reports that the pain is worse when she vomits. Given the chest pain she presented to the ED for evaluation. She reports in the ED the nausea worsened and she vomited. She reports that she has the burning in her chest and needs to drink 1L of fluid so that she can then throw up. SHe reports that the water can not be cold as that would cause spasms of her throat and be uncomfortable. \n\nIn the ED she was evaluated. Her EKG was unremarkable. Her first set of troponins were negative. She developed hypoxia (unclear to what level) in the setting of her nausea and vomiting. SHe had a CXR that was unremarkable. She had a CTA of the chest and CT abd/pelvis. The CT scan showed bilateral ground glass that could be consistent with infection vs inflammation. She was given levofloxacin and admitted to the medical service. \n\nOn the medical floor the patient was sating well on room air, was non-toxic appearing, requested oral fluids and \"mashed potato, bacon bagel, and egg salad\". She reports that she had not had a cough over the last several weeks, had no fevers. She reports that she has the pain in her chest and the nausea and nothing else. \n\nROS: A ten point ROS was conducted and was negative except as above in the HPI.\n", + "input3": "+Depression/Anxiety \n+Hypertension \n+Chronic kidney disease \n+osteoarthritis \n+Osteoporosis \n+Cervical and lumbar radiculitis \n+Hematuria and recurrent cystitis \n+Cervicogenic headache \n+varicose veins s/p laser ablation \n+Multiple prior falls, resulting in prior fractures \n+C.diff \n+Hysterectomy \n+L total knee replacement \n+Urinary incontinence \n+edema\n+DVT/PE\n", + "input4": "Father had CVA\n", + "input5": "Vitals: 98.7, 134/59, 73, 16, 96%RA\nGen: NAD, lying in bed\nEyes: EOMI, sclerae anicteric\nENT: MMM, OP clear\nCV: RRR, no murmur\nPULM: normal effort, no accessory muscle use\nGI: soft, NT, ND, BS+\nGU: No Foley\nEXT: 1+ ___ pitting edema\nSkin: No visible rash. No jaundice.\nNeuro: AAOx3. Fluent speech, no facial droop.\nPsych: Full range of affect\n", + "input6": "Admissions Labs:\n08:35PM BLOOD WBC-6.3 RBC-3.78* Hgb-11.2 Hct-34.6 MCV-92 MCH-29.6 MCHC-32.4 RDW-13.3 RDWSD-44.4 Plt\n08:35PM BLOOD Neuts-57.9 Monos-8.6 Eos-2.2 Baso-0.8 Im AbsNeut-3.64 AbsLymp-1.90 AbsMono-0.54 AbsEos-0.14 AbsBaso-0.05\n10:34PM BLOOD PTT-52.7*\n08:35PM BLOOD Glucose-109* UreaN-18 Creat-1.0 Na-142 K-3.7 Cl-102 HCO3-30 AnGap-14\n08:35PM BLOOD ALT-12 AST-27 AlkPhos-103 TotBili-0.2\n08:35PM BLOOD Lipase-12\n02:04AM BLOOD cTropnT-<0.01\n08:35PM BLOOD cTropnT-<0.01\n08:35PM BLOOD Albumin-3.7 Calcium-9.9 Phos-3.3 Mg-1.9\n\nCTA Chest (Images Reviewed by doctor):\nIMPRESSION: \n1. No evidence of pulmonary embolism or aortic abnormality. Bilateral ground-glass opacities are nonspecific and may represent infectious or inflammatory change. (worse on right)\n2. The midportion of the esophagus is ectatic and fluid-filled, \nconsistent with presbyesophagus \n\nCT ABD/Pelvis (Images Reviewed by doctor):\n1 Diverticulosis without evidence of diverticulitis. \n2. IVC filter in place. \n\nCXR (Imaging reviewed by doctor): \nMild interstitial pulmonary edema is improved from the prior examination.\n\nEKG: \nNormal Sinus Rhythm, boarderline left axis deviation, no ST-T wave changes.\nAmbulatory reflux monitor :total AET:9.2% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/14244305-DS-13.json b/Finished/Gastro-oesophageal Reflux Disease/14244305-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..6159dd56f3cfc3a55193e45aa09122d0744817e5 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/14244305-DS-13.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 9.2% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "She had reflux-related symptoms.$Cause_1": { + "A famale patient with longstanding symptoms, some of which are consistent with reflux.$Input2": {} + }, + "The esophageal motility of patients was observed.The weak motility may be related to reflux.$Cause_1": { + "In the interim, she has had a motility study, which showed ineffective esophageal motility with 50% failed contractions.$Input2": {} + } + } + }, + "input1": "Reflex\n", + "input2": "A famale patient with longstanding symptoms, some of which are consistent with reflux. She was seen by Dr., at which time she did have some symptoms, which were consistent with reflux, but others which were a bit concerning, especially those, which were not responsive to PPIs. She has continued to have the symptoms and does have some relief from Mylanta or Maalox. In the interim, she has had a motility study, which showed ineffective esophageal motility with 50% failed contractions. Those contractions, which were present, were of normal amplitude. She underwent a laparoscopic surgery and was admitted to the surgical service for routine monitoring.\n", + "input3": "+Arthritis\n+hypothyroidism\n+laparoscopic cholecystectomy\n+hysterectomy\n", + "input4": "Family history is notable for stomach cancer in an aunt, lung cancer in a grandfather, and breast cancer in multiple members of her family.\n", + "input5": "VS: 98.8 98.3 68 115/77 18 100ra\nGen: NAD, A/Ox3\nCards: RRR, NL S1/S2\nLungs: CTA bil, no resp distress\nAbd: soft, nt, nd, no rebound/guarding\nWound: C/D/I with dressing in place, no erythema/induration\nExt: no CCE\n", + "input6": "06:33AM BLOOD WBC-7.8 RBC-4.01* Hgb-12.5 Hct-35.3* MCV-88# MCH-31.1 MCHC-35.3* RDW-12.5 Plt\n06:33AM BLOOD Glucose-103* UreaN-11 Creat-0.6 Na-138 K-4.5 Cl-101 HCO AnGap-13\n06:33AM BLOOD Calcium-9.0 Phos-4.7* Mg-1.7\nAmbulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/14592188-DS-9.json.json b/Finished/Gastro-oesophageal Reflux Disease/14592188-DS-9.json.json new file mode 100644 index 0000000000000000000000000000000000000000..7e03bd0f4d51cbb8c848cc52368c690a1e1d7364 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/14592188-DS-9.json.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Barretts esophagus is the gold standard in the dianosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "He is not aware of the term barretts esophagus and we do not have any path from that EGD.$Input2": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Coughing is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "A Male with a H/O coughing$Input2": {} + }, + "Inflammation of the esophagus (LA grades B, C and D oesophagitis)is the gold standard in the dianosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "He was seen by an ENT MD and had a fiberoptic exam done which showed severe inflammation of the esophagus.$Input2": {} + }, + "!Coughing is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "+Chronic cough$Input3": {} + } + } + }, + "input1": "None\n", + "input2": "A Male with a H/O coughing and sinus congestion over many years. He was seen by an ENT MD and had a fiberoptic exam done which showed severe inflammation of the esophagus. That prompted an EGD without biopsy which confirmed severe inflammation. He was placed on a variety of PPI's all of which caused some diarrhea. Another EGD with biopsy was done 3 weeks ago and he was told that he has a precancerous condition. He is not aware of the term barretts esophagus and we do not have any path from that EGD. He was referred to Dr. to discuss potential surgery. He has never had any manomatry or Ph studies nor has he had a barium swallow. Currently he denies any heartburn, acid reflux, change in weight, dysphagia. His only complaints are that of a cough and sinus congestion. He was recently given a Zpak but does not notice any improvement. He is a current smoker.\n", + "input3": "+IBS\n+Chronic cough\n+OSA ..wears CPAP at hs\n+Hypercholesterolemia\n", + "input4": "Mother A&W\nFather cancer\n", + "input5": "BP: 132/67. Heart Rate: 68. Temperature: 98.1. Resp. Rate: 16. \nO2 Saturation%: 98.\nGENERAL \n[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\n\nHEENT \n[x] Trachea midline [x] Thyroid nl size/contour\n[ ] Abnormal findings:\n\nRESPIRATORY \n[x] CTA/P [x] Excursion normal \n[ ] Abnormal findings:\n\nCARDIOVASCULAR \n[x] RRR [x] No m/r/g \n[ ] Abnormal findings:\n\nGI \n[x] Soft [x] NT [x] ND [x] No mass\n[ ] Abnormal findings:\n\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[ ] Abnormal findings:\n\nLYMPH NODES \n[x] Cervical nl [x] Supraclavicular nl \n[ ] Abnormal findings:\n\nSKIN \n[x] No rashes/lesions/ulcers\n[x] No induration/nodules/tightening [ ] Abnormal findings:\n\nPSYCHIATRIC \n[x] Nl judgment/insight [x] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n", + "input6": "05:10AM BLOOD WBC-10.9*# RBC-4.85 Hgb-13.9 Hct-41.1 \nMCV-85 MCH-28.7 MCHC-33.8 RDW-12.9 RDWSD-39.6 Plt\n05:10AM BLOOD Glucose-94 UreaN-13 Creat-1.0 Na-137 \nK-4.0 Cl-101 HCO3-25 AnGap-15\n05:10AM BLOOD Calcium-8.5 Phos-4.0 Mg-1.9\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/14632181-DS-18.json.json b/Finished/Gastro-oesophageal Reflux Disease/14632181-DS-18.json.json new file mode 100644 index 0000000000000000000000000000000000000000..5ad29d8d08927adcf8da17a4ada8e8be96fa565e --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/14632181-DS-18.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "pH impedance: score 51.4(+) is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "pH impedance: score 51.4.$Input2": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "heartburn$Input1": {} + }, + "Acid regurgitation and substernal chest pain are the typical symptom of gastro-oesophageal reflux \rdisease\r.Belching is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Symptoms are acid regurgitation (mostly at night), substernal chest pain (day & night & also occurs completely unrelated to eating), and belching.$Input2": {} + } + } + }, + "input1": "heartburn\n", + "input2": "A patient w h/o gastroparesis who is interested in LINX placement. Seen in clinic, at which time Dr. pt to see Dr. given risk of worsening pt's gastroparesis surgery. \nSince that visit:\nSaw Dr. were to re-eval. gastroparesis and confirm w pH impedance ON PPI. \npH impedance: score 51.4. \nSaw Dr. were weight loss (enrolled in Awaken 180 weight loss program), check gastrin off PPI, switched from prilosec to nexium. \nLetter from Dr. gastrin was normal. \n\nSubjectively, since last visit, pt has lost 16 lb. on the Awaken 180 program (in 3 weeks). His reflux is improved in both intensity & frequency but still taking protonix for \n\"breakthrough symptoms\" almost every day. Symptoms are acid regurgitation (mostly at night), substernal chest pain (day & night & also occurs completely unrelated to eating), and belching. States his symptoms are better but \"not enough to satisfy me.\" Pt has been otherwise well. ROS only notable for stable chronic diarrhea.\n", + "input3": "+Diverticulitis\n+Osteoporosis\n+High cholesterol\n+s/p subtotal colectomy\n+s/p cholecystectomy\n+s/p neck surgery\n+s/p bilateral rotator cuff surgeries\n+s/p ACL repair (L)\n", + "input4": "Mother- breast cancer\nFather- MI\n", + "input5": "BP: 124/88. Heart Rate: 72. O2 Saturation%: 100. Weight: 173.1.\nHeight: 64.5. BMI: 29.3. Temperature: 97.1. Resp. Rate: 16. Pain\nScore: 0. Distress Score: 0.\n\nGen: NAD, A&O, well appearing\nNeck: soft, no appreciable adenopathy\nChest: breathing comfortably on RA, CTAB\nCor: RRR\nAbd: soft, NT, ND\nExt: wwp x4, no edema\n", + "input6": "WBC RBC Hgb Hct MCV MCH MCHC RDW RDWSD \nPlt Ct \n05:42 8.1 4.84 14.3 44.2 91 29.5 32.4 13.2 44.8 \n166 \n\n Glucose UreaN Creat Na K Cl HCO3 AnGap \n05:42 140 3.8 98 26 16\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/14828954-DS-17.json b/Finished/Gastro-oesophageal Reflux Disease/14828954-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..e813cb5cadf26c85cb31a02e8e3abe172c9e1544 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/14828954-DS-17.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux disease$Intermedia_3": { + "AET: 6.1% > 6% is the gold standard for gastro-oesophageal reflux$Cause_1": { + "Ambulatory reflux monitor :total AET:6.1% on pH-impedance monitoring$Input6": {} + }, + "!Abdominal Pain is an atypical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "Abdominal Pain$Input1": {} + }, + "suspected gastro-oesophageal reflux disease$Intermedia_2": { + "Reflux and heartburn are typical symptoms of gastro-oesophageal reflux \rdisease.Abdominal Pain is an atypical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "Today, she experienced severe worsening of left-sided abdominal pain with acid regurgitation and heartburn.$Input2": {} + }, + "!Abdominal Pain is an atypical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "She reports pain is left sided, cramping, at worst times radiates throughout abdomen in in upper back.$Input2": {} + } + } + }, + "input1": "Abdominal Pain\n", + "input2": "A patient at presenting from ED with abdominal pain and diarrhea. She had a recent admission for descending colitis presented to today with a reoccurence of abdominal pain. During her prior admission, she had presented with profuse watery and frankly bloody diarrhea. She had a MRI which showed 'descending colitis'. She was started on azithromycin until stool cultures returned negative. Her symptoms had improved and she was discharged home after two days on a regular diet. She felt she never improved to back to her normal baseline and continued to have intermittent diarrhea and abomdinal pain. She saw a GI as an outpatient on , had labs sent (unsure what they were testing for, thinking maybe IBD). Today, she experienced severe worsening of left-sided abdominal pain with acid regurgitation and heartburn. She was transferred to for higher level of care given she is wga. She reports pain is left sided, cramping, at worst times radiates throughout abdomen in in upper back. No fevers/chills. No nausea/vomiting. Last BM 3 pm yesterday, diarrhea, non bloody, no mucous. No recent travel, unusual foods, sick contacts. No rash, changes in skin/hair, joint pains. Pain improved with morphine x 1 at outside ED.\n", + "input3": "PNC: \n+Labs Rh pos/Abs neg/Rub I/RPR NR/HBsAg neg/HIV neg (per records)\n+Screening: low risk NIPT per pt, +CF mutation carrier, FOB tested and negative per pt\n+FFS normal anatomy \n+GLT not yet performed\n+U/S: none recent\n+Issues: prior c-section, desires repeat\n \nOBHx: G2P1\n+G1: c-section, 40w2d, fetal distress, nuchal cord x 2, 6 lb 15 oz\n \nGynHx:\n+h/o endometriosis\n+h/o PCOS\n+denies abnormal pap\n+denies STIs\n \nPMH: \n+s/p esophageal dilation\n+PFO, discovered this pregnancy after w/u for chest pain\n \nPSH: \n+c-section\n+T&A\n+diagnostic laparoscopy for endometriosos\n \nMeds:\n+PNV, daily ASA 81 mg (started for PFO)\n \nAll: \n+amoxicillin (GI upset) and augmentin (hives)\n \nSHx:\n+denies T/E/D. Works with developmentally disabled adults in outpatient setting. Married, lives at home with husband and child.\n", + "input4": "None\n", + "input5": "Initial Physical Exam\nT 97.9 BP 106/45 HR 79\nGen: A&O, mildly uncomfortable, lying on stretcher\nCV: RRR\nPULM: CTAB\nAbd: soft, gravid, min TTP on middle left abdomen, no rebound/guarding, normoactive BX\nExt: no calf tenderness\n\nToco flat\nFHT 130/moderate varability/+accels/-decels\n\nTAUS: transverse, head maternal R, BPP, MVP 4.68 cm, anterior placenta, EFW 869 g\n", + "input6": "05:26AM GLUCOSE-83 UREA N-3* CREAT-0.5 SODIUM-142 POTASSIUM-3.5 CHLORIDE-111* TOTAL CO2-21* ANION GAP-14\n05:26AM estGFR-Using this\n05:26AM ALT(SGPT)-13 AST(SGOT)-14 LD(LDH)-119 ALK \nPHOS-62 TOT BILI-0.2\n05:26AM LIPASE-49\n05:26AM ALBUMIN-3.3* CALCIUM-8.4 MAGNESIUM-1.8 IRON-58\n05:26AM calTIBC-428 FERRITIN-11* TRF-329\n05:26AM WBC-10.1 RBC-3.45* HGB-10.6* HCT-30.8* MCV-89 MCH-30.8 MCHC-34.5 RDW-13.8\n05:26AM PLT COUNT-229\n05:26AM PLT COUNT-229\nAmbulatory reflux monitor :total AET:6.1% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/15696887-DS-14.json.json b/Finished/Gastro-oesophageal Reflux Disease/15696887-DS-14.json.json new file mode 100644 index 0000000000000000000000000000000000000000..9173fee603fa775a0ed975e94af3586fe0a84ec5 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/15696887-DS-14.json.json @@ -0,0 +1,18 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Barretts oesophagus is gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Path returned as Barretts oesophagus only.$Input2": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "heartburn$Input1": {} + } + } + }, + "input1": "heartburn\n", + "input2": "Mr is a w/ long segment and focal LGD, s/p HALO RFA ablation with some improvement. He then failed to respond to HALO and was monitored yearly with EGDs when with low grade dysplasia and indefinite dysplasia was seen. EGD for Cryo. His last EGD showed persistent ulcer measuring 34cms. Path returned as Barretts oesophagus only.\n", + "input3": "+Esophagus with multifocal LGD \n+afib/flutter\n+hypertension\n+hyperlipidemia\n", + "input4": "Father died of MI.\nBrother - atrial fibrillation.\n", + "input5": "[Temp 98 BP 140/70 HR 76 RR 16 RA sat 97%\n\nx] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\n\nHEENT \n[x] NC/AT [x] EOMI [x] PERRL/A [x] Anicteric\n[x] OP/NP mucosa normal [x] Tongue midline\n[x] Palate symmetric [x] Neck supple/NT/without mass\n[x] Trachea midline [x] Thyroid nl size/contour\n[ ] Abnormal findings:\n\nRESPIRATORY \n[x] CTA/P [x] Excursion normal [x] No fremitus\n[x] No egophony [x] No spine/CVAT\n[ ] Abnormal findings:\n\nCARDIOVASCULAR \n[x] RRR [x] No m/r/g [x] No JVD [x] PMI nl [x] No edema\n[x] Peripheral pulses nl [x] No abd/carotid bruit\n[ ] Abnormal findings:\n\nGI \n[x] Soft [x] NT [x] ND [x] No mass/HSM [x] No hernia\n[ ] Abnormal findings:\n\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[ ] Abnormal findings:\n\nNEURO \n[x] Strength intact/symmetric [x] Sensation intact/ symmetric\n[x] Reflexes nl [x] No facial asymmetry [x] Cognition intact\n[x] Cranial nerves intact [ ] Abnormal findings:\n\nMS \n\n \n[x] No clubbing [x] No cyanosis [x] No edema [x] Gait nl\n[x] No tenderness [x] Tone/align/ROM nl [x] Palpation nl\n[x] Nails nl [ ] Abnormal findings:\n\nLYMPH NODES \n[x] Cervical nl [x] Supraclavicular nl [x] Axillary nl\n[x] Inguinal nl [ ] Abnormal findings:\n\nSKIN \n[x] No rashes/lesions/ulcers\n[x] No induration/nodules/tightening [ ] Abnormal findings:\n\nPSYCHIATRIC \n[x] Nl judgment/insight [x] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n", + "input6": "None\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/15872905-DS-4.json.json b/Finished/Gastro-oesophageal Reflux Disease/15872905-DS-4.json.json new file mode 100644 index 0000000000000000000000000000000000000000..22264d9d108f67e38b1afa328a1464fe6d9890e7 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/15872905-DS-4.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Oesophagitis(LA grade B) is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Endoscopy: oesophagitis(LA grade B) chronic atrophic gastritis$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Chest pain is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "presents with new onset chest pain over the past 4-days.$Input2": {} + }, + "Substernal ache is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "The discomfort increased by mid-day to a substernal 'ache' without radiation or associated shortness of breath/diaphoresis.$Input2": {} + } + } + }, + "input1": "Chest pressure\n", + "input2": "Patient is with history of CAD s/p coronary artery bypass grafting (LIMA to the LAD, vein graft to the PDA, radial to the ramus intermedius and obtuse marginal) who presents with new onset chest pain over the past 4-days. Patient says that he first experienced chest pressure upon waking up (he has had similar intermittent episodes over the past several months, though not to this extreme). The discomfort increased by mid-day to a substernal 'ache' without radiation or associated shortness of breath/diaphoresis. He was sitting in a chair waiting for his wife to get ready, they were going to a block party. The pain then continued with intermittent worsening for 'hours,' no exacerbation with movement. He finally lay down to sleep that night and when he awoke in the morning the pain had dissipated completely. The pressure and pain returned yesterday while patient was sitting and doing work on his Ipad. He then got up and walked on a treadmill - to his surprise, the pain soon subsided. He has not taken any SL nitro at home. Given his recurrent symptoms, patient called his cardiologist who referred him to the ED. Patient denies any associated shortness of breath, palpitations, or cough. No new lower extremity swelling. No fevers/chills. No recent NVCD. He has felt somewhat more lethargic. Of note, patient had a recent MIBI to evaluate similar complaints of chest discomfort at the time. The MIBI showed a reversible ischemia in the LAD territory and he was started on metoprolol. \nIn the ED: \nInitial vitals were: 97.8 63 130/70 19 100% RA \nPatient complained of mild chest pressure, however, after 3 hours his chest pain resolved.\n\n", + "input3": "+Hypercholesterolemia \n+CAD s/p coronary artery bypass grafting - LIMA to the LAD, vein graft to the PDA, radial to the ramus intermedius and obtuse marginal. Normal exercise tolerance test. \n+Obesity. \n+Hypertension. \n+Primary osteoarthritis of knee.\n", + "input4": "Mom died of unknown cancer \nDad died, had high cholesterol and heart disease \nBrother with diabetes \nCousin s/p CABG \nCousin with valvular heart disease \nAunts with diabetes/cancer\n", + "input5": "Vital signs: 98.4 129/70 65 18 99 \nGEN: Anxious appearing male, breathing comfortably on RA \nHEENT: No scleral icterus. OP clear with MMM. \nNeck: No JVP elevation. \nCV: RRR nl S1, S2, no murmurs, rubs or gallops. \nLungs: Normal effort, clear to auscultation bilaterally. \nChest: Sternotomy scar. No tenderness to palpation along \nsternum. \nAbd: Obese, soft, non-tender, no masses, no bruits, no \nhepatosplenomegaly. \nExt: WWP, hands clammy. 1+ radial pulses. Trace edema b/l. \nNeuro: Appropriate affect, oriented to time and place, no gross abnormalities \nSkin: No rashes\n", + "input6": "___ 02:29PM BLOOD WBC-5.8 RBC-4.64 Hgb-13.2* Hct-40.2 \nMCV-87 MCH-28.4 MCHC-32.8 RDW-13.9 RDWSD-44.0 Plt ___\n___ 02:29PM BLOOD Neuts-35.6 ___ Monos-10.8 Eos-2.4 \nBaso-0.5 Im ___ AbsNeut-2.05 AbsLymp-2.91 AbsMono-0.62 \nAbsEos-0.14 AbsBaso-0.03\n___ 02:34PM BLOOD ___ PTT-29.0 ___\n___ 02:29PM BLOOD Plt ___\n___ 02:29PM BLOOD Glucose-94 UreaN-21* Creat-1.0 Na-141 \nK-4.4 Cl-105 HCO3-20* AnGap-16\n___ 02:29PM BLOOD estGFR-Using this\n___ 02:29PM BLOOD ALT-19 AST-25 AlkPhos-66 TotBili-0.4\n___ 02:29PM BLOOD Lipase-21\n___ 11:15PM BLOOD CK-MB-5 cTropnT-<0.01\n___ 02:29PM BLOOD cTropnT-<0.01\n___ 02:29PM BLOOD Albumin-4.2\nEndoscopy: oesophagitis(LA grade B) chronic atrophic gastritis\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/16003661-DS-27.json b/Finished/Gastro-oesophageal Reflux Disease/16003661-DS-27.json new file mode 100644 index 0000000000000000000000000000000000000000..70934c26f7322aa2f02e34ace1ff548a8e9825a0 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/16003661-DS-27.json @@ -0,0 +1,30 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "chest discomfort and nausea are atypical symptoms of gastro-oesophageal reflux \rdisease$Cause_1": { + "She reports indigestion x few days with midsternal nonradiating chest discomfort, nausea w/o emesis since yesterday.$Input2": {} + }, + "Hertburn is a typical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "On arrival to the floor the patient reports ongoing heartburn and need to spit up clear \"goo.\"$Input2": {} + }, + "Chest pain, nausea and abdominal pain are atypical symptoms of gastro-oesophageal reflux \rdisease$Cause_1": { + "chest pain, nausea, abdominal pain$Input1": {} + }, + "!Nausea and abdominal pain are atypical symptoms of gastro-oesophageal reflux \rdisease.$Cause_1": { + "presented with shortness of breath, nausea, abdominal pain.$Input2": {} + }, + "Chronic cough ia an atypical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "chronic cough unchanged.$Input2": {} + } + } + }, + "input1": "chest pain, nausea, abdominal pain\n", + "input2": "A female with a history of COPD, diastolic HF and paranoid schizophrenia who presented with shortness of breath, nausea, abdominal pain. She reports indigestion x few days with midsternal nonradiating chest discomfort, nausea w/o emesis since yesterday. Symptoms worse after eating. She states only able to eat a little bit of yesterday. Denies diarrhea, melana, hematochezia, dysuria, hematuria, fevers, chills. Does endorse constipation and last BM was two days ago. While patient endorsed shortness of breath in the ED, she denied any shortness of breath on arrival to the floor. In the ED EKG showed Sinus rhythm 85 with multiple PACs, there is a right bundle branch block which is unchanged from previous tracing, there are Q waves in V2 and V3 which are also consistent with previous EKG. chest x-ray revealed no evidence of pneumonia. She was treated for COPD exacerbation with nebs x3 and azithro 500mg IV. She received GI cocktail and ASA 325mg with some relief. She was admitted for COPD exacerbation, cont'd. On arrival to the floor the patient reports ongoing heartburn and need to spit up clear \"goo.\" She denies SOB, states that cough is at baseline. Denies fevers, sore throat. She is pre-occupied with possibility of having been exposed to some type of nuclear chemical that has been making her sick for the past year. ROS: per HPI, denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, shortness of breath, vomiting, diarrhea, BRBPR, melena, hematochezia, dysuria, hematuria. + chronic cough unchanged. + stress incontinence (not new per pt)\n", + "input3": "+COPD \n+Paranoid Schizophrenia\n+Hypertension\n+Dyslipidemia \n+Stress incontinence\n+S/p ventral hernia repair\n+S/p femoral hernia repair\n+S/p exploratory laparotomy for SBO\n+Chronic diastolic HF\n", + "input4": "Family history is significant for coronary artery disease in her father, who died from heart disease. Mother died in a car accident. Her sister died from an unknown cause. The patient's great aunt (mother's side) has diabetes. There is no history of alcoholism or psychiatric disorders in the family.\n", + "input5": "VS -97.6 127/70 72 20 99 on 3L NC 88.3lb \nGENERAL - very thin disheveled woman in NAD \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - No JVD \nCARDIAC - RRR, nl S1-S2, no MRG \nLUNGS - CTAB, no r/rh/wh, distant breath sounds, resp unlabored, no accessory muscle use \nABDOMEN - NABS, soft/ND, mild tenderness to deep palpation diffusely, no masses or HSM, no rebound or guarding \nEXTREMITIES - WWP, no c/c/e \nNEURO - awake, A&Ox3 w/ paranoid ideations, grossly intact\n", + "input6": "10:15AM BLOOD WBC-6.4 RBC-5.41* Hgb-16.2* Hct-46.7 MCV-86 MCH-29.9 MCHC-34.6 RDW-13.2 Plt\n10:15AM BLOOD Glucose-146* UreaN-19 Creat-0.7 Na-137 K-4.2 Cl-98 HCO3-26 AnGap-17\n10:15AM BLOOD Albumin-4.4 Calcium-10.1 Phos-3.8 Mg-2.1\nPERTINENT\n10:48AM BLOOD cTropnT-0.01\n07:20PM BLOOD cTropnT-0.01\n05:55AM BLOOD cTropnT-0.02*\n10:15AM BLOOD Lipase-22\n10:15AM BLOOD ALT-28 AST-32 AlkPhos-87 TotBili-0.5\n10:23AM BLOOD Lactate-1.\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/16276452-DS-8.json.json b/Finished/Gastro-oesophageal Reflux Disease/16276452-DS-8.json.json new file mode 100644 index 0000000000000000000000000000000000000000..2ff4cc0f3b061c32f74f1636b74d63baf7ca23f2 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/16276452-DS-8.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Oesophagitis(LA grade B) is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Endoscopy:oesophagitis(LA grade B)$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Hertburn$Input1": {} + }, + "Reflux is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "The patient is a gentleman with reflux.$Input2": {} + } + } + }, + "input1": "Heartburn\n", + "input2": "The patient is a gentleman with reflux. His esophageal manometry was normal with only 20% of swallows with peristalsis. For this reason we performed a operation. We discussed the conduct of the operation in detail and potential complications, including postoperative heartburn, dysphagia and potential need for reoperation.\n", + "input3": "+HIV\n+acute cholecystitis s/p lap chole\n+s/p cervical discectomy\n+branchial cleft cysts removed as a child fractures of arm, ankle when he was younger\n+h/o tobacco use\n+MRSA infection\n+rectal HPV\n+hx abnormal glucose - undergoing w/u\n+insomnia\n+removal anal condyloma\n", + "input4": "mother d CAD s/p MI, first MI.\nfather d emphysema, heart disease.\n5 siblings - 1 sister has thyroid problems.\n", + "input5": "Vitals: Temp 98.5 PO, BP 140/78, HR 99, RR 18, O2sat 94% RA\nGen: WA, NAD, A&O\nCV: RRR\nPulm: no increased WOB, CTAB\nAbd: soft, mildly distended/tympanitic, no rebound or guarding, appropriate/minimal TTP, port sites C/D/I with dermabond, no erythema or induration\nExt: WWP\n", + "input6": "06:42AM BLOOD WBC-6.2 RBC-4.18* Hgb-13.8 Hct-39.7* \nMCV-95 MCH-33.0* MCHC-34.8 RDW-12.2 RDWSD-42.5 Plt\n06:42AM BLOOD Glucose-82 UreaN-14 Creat-1.1 Na-135 \nK-4.4 Cl-101 HCO3-32 AnGap-6*\n06:42AM BLOOD Calcium-8.7 Phos-3.2 Mg-2.3\nEndoscopy:oesophagitis(LA grade B) \n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/16277357-DS-15.json.json b/Finished/Gastro-oesophageal Reflux Disease/16277357-DS-15.json.json new file mode 100644 index 0000000000000000000000000000000000000000..755ae64ad1700e59fcdeeaf635a6aec9288fb910 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/16277357-DS-15.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "esophagitis(LA grade B) is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Endoscopy:oesophagitis(LA grade B)$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Chest pain is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "chest pain$Input1": {} + }, + "!Chest pain is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Apparently, the patient developed dull diffuse chest pain this evening that he noted while walking from bed to the bathroom.$Input2": {} + } + } + }, + "input1": "chest pain\n", + "input2": "This is a male with history of CAD s/p, severe diastolic CHF, and COPD who presents after an episode of chest pain now resolved. Apparently, the patient developed dull diffuse chest pain this evening that he noted while walking from bed to the bathroom. This did not radiate to his arm or jaw and was not associated with any worsening of his baseline dyspnea. This lasted about 20 minutes at which point the patient took some maalox and it disappeared around 10 minutes after that. The patient has had two subsequent brief recurrences of the pain, one as EMS arrived at his home and one as he was being moved into bed on the floor. He denies any palpitations, worsening shortness of breath (he does have baseline shortness of breath), worsening lower extremity edema, cough, fevers, or chills. At baseline he uses 2L of O2 by nasal cannula all times and moves this up to 3L on exertion. With 3L of supplementary O2 he is able to walk 18 minuts on a treadmill without chest pain. \nIn the ED VS 98.1 56 132/57 20 100. ECG showed a fib with RBBB but no ST elevation or depression. Labs notable for troponin of 0.03K (c/w previous). He received ondansetron and was admitted to medicine to finish.\n", + "input3": "+Diabetes\n+Dyslipidemia\n+Hypertension \n+Percutaneous coronary intervention \n+3VD, POBA LAD and diag \n+Pacemaker/ICD: VT, s/p ICD placement \n+COPD: FVC 69%, FEV1 56%, FEV1/FEV 81% on 2L O2 w/ activity\n+Hypercholesterolemia \n+Hypertension \n+Peripheral Neuropathy-unknown etiology\n+History of tobacco\n+Status post ICD placement for VT\n+Status post TURP x 2 \n+diastolic CHF\n", + "input4": "Father deceased from MI. Brother died of lung CA\n", + "input5": "VS: T 98.1 %# 110/64 20 97% on 2L\nGen: Well appearing elderly gentleman appearing younger than his \nstated age in soft cervical collar (for comfort from OA of neck) \n\nHEENT: Normocephalic, anicteric, EOMI, PERRL, OP clear, MMM \nCV: Irregular, systolic murmur; DP and Radial pulses 1+ \nbilaterally, no elevated JVP \nPulm: Decreased breath sounds, Expansion equal bilaterally, CTAB \n \nAbd:Soft, NT, ND, BS+\nExtrem: Warm and well perfused, 1+ nonpitting edema bilaterally \nin feet \nNeuro/Psych: A and O*3, Very pleasant and cooperative, CN II - \nXII intact, strength upper and lower extremitites bilat\n", + "input6": "11:00PM BLOOD WBC-5.4 RBC-4.62 Hgb-13.5* Hct-43.1 \nMCV-93 MCH-29.2 MCHC-31.4 RDW-14.3 Plt\n11:00PM BLOOD Neuts-65.9 Monos-7.5 Eos-1.8 \nBaso-0.3\n05:55AM BLOOD Plt\n11:00PM BLOOD PTT-27.2\n11:00PM BLOOD Glucose-82 UreaN-35* Creat-1.2 Na-143 \nK-4.3 Cl-100 HCO3-32 AnGap-15\n11:00PM BLOOD ALT-21 AST-32 CK(CPK)-78 AlkPhos-78 \nTotBili-1.0\n11:00PM BLOOD cTropnT-0.03*\n05:55AM BLOOD CK-MB-NotDone cTropnT-0.03*\nEndoscopy:oesophagitis(LA grade B)\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/16330623-DS-12.json.json b/Finished/Gastro-oesophageal Reflux Disease/16330623-DS-12.json.json new file mode 100644 index 0000000000000000000000000000000000000000..496497fc54082cf40cd3751bda04c12389041b3d --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/16330623-DS-12.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Oesophagitis\uff08LA grades B\uff09 is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease.$Cause_1": { + "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Heartburn and reflux are the typical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "Heartburn/reflux sx not responding to both omeprazole and ranitidine.$Input2": {} + }, + "Reflux is a typical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "Today he reports the he is constantly bothered by reflux, constantly clearing his throat. He wakes up at night with choking feeling, and sour taste in mouth.$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "A patient with a disease and atrial fibrillation with small streaks of blood in his phlegm. Bronch by IP BAL: NEGATIVE FOR MALIGNANT CELLS Heartburn/reflux sx not responding to both omeprazole and ranitidine. He is referred for surgery.\nToday he reports the he is constantly bothered by reflux, constantly clearing his throat. He wakes up at night with choking feeling, and sour taste in mouth. He sleeps with HOB elevated. Otherwise denies dyspnea, cough, midsternal pain, dysphagia, early satiety, abd bloating, wt loss, hemoptysis, fevers, chills, night sweats. He denies alcohol, caffeine, or chocolate intake and he will not eat past 6p at night. No other concerning symptoms.\n", + "input3": "+Hypertension \n+Neuropathy\n", + "input4": "None reported\n", + "input5": "Vitals: ___ 0801 Temp: 98.0 PO BP: 135/70 R Lying HR: 53\nRR: 14 O2 sat: 97% O2 delivery: Ra \nGen: [x] NAD, [] AAOx3 \nCV: [x] RRR, [] murmur \nResp: [x] breaths unlabored, [] CTAB, [] wheezing, [] rales Abdomen: [x] soft, [] distended, [] tender, [] rebound/guarding \nWound: [x] incisions clean, dry, intact \nExt: [x] warm, [] tender, [] edema\n", + "input6": "04:08AM BLOOD WBC-10.6* RBC-4.33* Hgb-12.0* Hct-37.5* \nMCV-87 MCH-27.7 MCHC-32.0 RDW-17.3* RDWSD-55.0* Plt\n04:08AM BLOOD Glucose-112* UreaN-11 Creat-0.9 Na-138 \nK-5.0 Cl-100 HCO3-26 AnGap-12\nendoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis\r\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/16380225-DS-9.json.json b/Finished/Gastro-oesophageal Reflux Disease/16380225-DS-9.json.json new file mode 100644 index 0000000000000000000000000000000000000000..516c29ecba3adc748395d478b1eabc4c19eef8c1 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/16380225-DS-9.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux disease$Intermedia_3": { + "oesophagitis\uff08LA grades B\uff09 is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease.$Cause_1": { + "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis$Input6": {} + }, + "suspected gastro-oesophageal reflux disease$Intermedia_2": { + "Nausea is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Currently she reports improvement in dysphagia since her dilation but does have chronic nausea.$Input2": {} + }, + "Cough is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "She has cough and SOB from asthma primarily.$Input2": {} + } + } + }, + "input1": "ineffective esophageal motility\n", + "input2": "Ms who presented with dysphagia and wt loss. She has a history of upper endoscopy for gastroparesis. Esophagus was normal at the time. An upper endoscopy unremarkable but pt was dilated She underwent a timed barium swallow. She presents for surgical management. Currently she reports improvement in dysphagia since her dilation but does have chronic nausea. She has cough and SOB from asthma primarily. Otherwise the pt denies vomiting/regurg since dilation, wt loss, abd pain.\n", + "input3": "+asthma\n+anxiety\n+fibromyalgia\n+gastroparesis\n+tachycardia\n+migraines\n+panic disorder\n", + "input4": "Mother\nFather: COPD, oral cancer\nSiblings\nOffspring\nOther\n", + "input5": "Vitals: Temp 97.3 HR 96 BP 130/89 RR 18 O2 Sat 97%Ra \nGen: NAD, AAOx3\nNeck: no LAD\nChest: clear ausc\nCor: RRR no murmur\nAbd: soft, nondistended, mild, appropriate epigastric tenderness to palpation, incisions CDI\nExtremeties: no CCE\nPsych: mood overly anxious, more labile affect\n", + "input6": "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis\r\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/16512044-DS-19.json.json b/Finished/Gastro-oesophageal Reflux Disease/16512044-DS-19.json.json new file mode 100644 index 0000000000000000000000000000000000000000..89f295e4b69073e6b201441b1bedc583dfdc011a --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/16512044-DS-19.json.json @@ -0,0 +1,18 @@ +{ + "gastro-oesophageal reflux disease$Intermedia_3": { + "Oesophagitis\uff08LA grades B\uff09 is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease.$Cause_1": { + "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis$Input6": {} + }, + "suspected gastro-oesophageal reflux disease$Intermedia_2": { + "Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "The patient has heartburn.$Input2": {} + } + } + }, + "input1": "Hiatal Hernia\n", + "input2": "The patient saw Dr. in the office today in surgical consultation for a question of a hiatal hernia. He is a man who has had worsening symptoms over the past year despite several adjustments of medical therapy. The patient has heartburn. There is pain at night, is sometimes relieved by Maalox and saltine crackers.\n", + "input3": "+ALLERGY to penicillin\n", + "input4": "Family history is negative for cancer or heart disease.\n", + "input5": "Well-developed gentleman who is 6 feet 1 inch tall and weighs 240 pounds. Head, eyes, ears, nose, and throat are normal. The neck is supple, without mass, nodes, or thyromegaly. Chest is clear to percussion and auscultation. Heart sounds are regular without murmurs or gallops. The abdomen is soft without tenderness, mass, or organomegaly. His incisions without erythema. Dressings are clean dry and intact. Extremities are without cyanosis, clubbing, or edema. He is neurologically intact.\n", + "input6": "11:57AM BLOOD Mg-2.0\n11:57AM BLOOD Na-142 K-4.3 Cl-108\n11:57AM BLOOD Hct-44.RIEF HOSPITAL COURSE:\nendoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17430704-DS-10.json b/Finished/Gastro-oesophageal Reflux Disease/17430704-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..ed17cc78b943d0f56aa620ae8f8135fa66c7832e --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17430704-DS-10.json @@ -0,0 +1,18 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Chest burning is a typical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "In ED c/o chest burning into esophagus while seeing therapist.$Input2": {} + } + } + }, + "input1": "Observation for rule out ACS given speaking and deaf and does not qualify to be observed in emergency room\n", + "input2": "Obese, DM male who came for routine f/u at Behavioral Neurology clinic. No hx of CAD or HTN. C/o feeling LH x 1 hr with diffuse burning sensation. 30 min later developed chest pressure, severity, no radiation. No worse w/ palpation. Is associated w/ SOB, nausea, diaphoresis. Has not been otherwise ill. Has not had any similar episodes in past. Of note, pt d/c from yesterday s/p suicide attempt. Taking Lyrica, Risperdal, fluoxetine and glucophage. Glc this am was 133. Reg rhythm, tachycardic ~120 on exam. EMS called, transferring to ED. In ED c/o chest burning into esophagus while seeing therapist. ED: tachy transient tachy into 150s, with IVF to 110s, ativan helped slightly, ECG, CXR, D-dimer and u/s all negative. On the floor pt. states his burning sensation in the chest is completely resolved with GI cocktail given in ER. Currently has not chest discomfort.\n", + "input3": "+hypertension \n+depressions s/p recent suicide +attempt \n+diabetes \n+fatty liver disease \n+migraines \n+appendectomy \n+cochlear implants \n+bilateral hearing loss \n+asthma\n", + "input4": "He questions if he had an aunt with seizures. A cousin had seizures. Mother, depression; father, depression and diabetes; son, frequent sinus infections; and daughter, celiac, hyperthyroidism.\n", + "input5": "PE: 98.2, 119/95, 99, 20, 96 3L \nGen: WDWN middle aged male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNeck: Supple with JVP of 5 cm. \nCV: PMI located in intercostal space, midclavicular line. \nRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nAbd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nExt: No c/c/e. No femoral bruits. \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas. \nPulses: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ 2+\n", + "input6": "01:30PM BLOOD cTropnT-<0.01\n09:10PM BLOOD CK-MB-3 cTropnT-<0.01\n07:00AM BLOOD CK-MB-3 cTropnT-<0.01\n01:30PM BLOOD CK(CPK)-193*\n09:10PM BLOOD CK(CPK)-194*\n07:00AM BLOOD CK(CPK)-211*\n07:00AM BLOOD Glucose-96 UreaN-20 Creat-1.1 Na-139 K-4.2 Cl-106 HCO3-24 AnGap-13\n01:30PM BLOOD D-Dimer-323\n07:00AM BLOOD WBC-6.0 RBC-4.72 Hgb-14.1 Hct-41.4 MCV-88 MCH-29.9 MCHC-34.1 RDW-13.2 Plt y/o M DM, depression admitted with chest pain likely GI in origin, given CAD equivalent will r/o ACS.\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\r\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17430704-DS-14.json b/Finished/Gastro-oesophageal Reflux Disease/17430704-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..ce81a0c53ec3e26f13065f4c37e9fca90fec73af --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17430704-DS-14.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 24.9% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Her pH testing the same day returned with score of 24.9.$Input2": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Reflux and heartburn are typical symptoms of gastro-oesophageal reflux \rdisease.She also had atypical symptoms of gastroesophageal reflux disease, including nausea.$Cause_1": { + "Finally she was given Dexilant with some relief with the heartburn. These symptoms have progressed both in severity and frequency amounting to dysphagia of solid and even liquid foods, odynophagia, esophageal spasms feel like a heart attack, nausea, vomiting, persistent acid regurgitation in mouth causing bad taste and bad breath.$Input2": {} + }, + "Cough is an atypical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "She is bothered by nocturnal cough.$Input2": {} + }, + "!Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "She reports the symptoms started years ago with her first pregnancy including heartburn$Input2": {} + } + } + }, + "input1": "heartburn\n", + "input2": "Ms is a with PMHx notable for extensive smoking history 100 pack year, and 4 cm hiatal hernia noted on recent imaging who is seen in clinic for evaluation for surgical intervention. She reports the symptoms started years ago with her first pregnancy including heartburn, managed with Tums. Then symptoms progressed over the years and she became intolerant of PPIs and H2 blockers causing severe constipation. Finally she was given Dexilant with some relief with the heartburn. These symptoms have progressed both in severity and frequency amounting to dysphagia of solid and even liquid foods, odynophagia, esophageal spasms feel like a heart attack, nausea, vomiting, persistent acid regurgitation in mouth causing bad taste and bad breath. + DOE with bending over and climbing stairs but able to exercise 3 days a week at the gym without shortness of breath. She is bothered by nocturnal cough. She had several EGDs, H-pylori negative in the past and has been diagnosed with Barrett's esophagus. She had esophageal dilation year ago with some brief relief with the dysphagia. She reports she is at her wit's end and wants some relief. Her esophageal manometry testing returned with normal pressure with appropriate relaxation of the with swallows. All the swallows are peristaltic. Her pH testing the same day returned with score of 24.9.\n", + "input3": "+asthma\n+anxiety\n+esophagitis\n+HLD\n+IBS\n+liver cyst\n+tobacco abuse\n+L thyroid nodule\n+s/p vag hyst/bladder susp\n", + "input4": "non contributory\n", + "input5": "BP: 127/74. Heart Rate: 85. O2 Saturation%: 100. Weight: 139.1\n(With Shoes). Temperature: 97.4. Resp. Rate: 16. Pain Score: 0.\nGENERAL \n[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\n\nHEENT \n[x] NC/AT [x] EOMI [x] PERRL/A [x] Anicteric\n[x] OP/NP mucosa normal [x] Tongue midline\n[x] Palate symmetric [x] Neck supple/NT/without mass\n[x] Trachea midline [x] Thyroid nl size/contour\n[ ] Abnormal findings:\n\nRESPIRATORY \n[x] CTA/P [x] Excursion normal [x] No fremitus\n[x] No egophony [x] No spine/CVAT\n[ ] Abnormal findings:\n\nCARDIOVASCULAR \n[x] RRR [x] No m/r/g [x] No JVD [x] PMI nl [x] No edema\n[x] Peripheral pulses nl [x] No abd/carotid bruit\n[ ] Abnormal findings:\n\nGI \n[x] Soft [x] NT [x] ND [x] No mass/HSM [x] No hernia\n[ ] Abnormal findings:\n\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[ ] Abnormal findings:\n\nNEURO \n[x] Strength intact/symmetric [x] Sensation intact/ symmetric\n[x] Reflexes nl [x] No facial asymmetry [x] Cognition intact\n[x] Cranial nerves intact [ ] Abnormal findings:\n\nMS \n[x] No clubbing [x] No cyanosis [x] No edema [x] Gait nl\n[x] No tenderness [x] Tone/align/ROM nl [x] Palpation nl\n[x] Nails nl [ ] Abnormal findings:\n\nLYMPH NODES \n[x] Cervical nl [x] Supraclavicular nl [x] Axillary nl\n[x] Inguinal nl [ ] Abnormal findings:\n\nSKIN \n[x] No rashes/lesions/ulcers\n[x] No induration/nodules/tightening [ ] Abnormal findings:\n\nPSYCHIATRIC \n[x] Nl judgment/insight [x] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n", + "input6": "02:39PM CALCIUM-8.4 PHOSPHATE-4.8* MAGNESIUM-1.9\n02:39PM estGFR-Using this\n02:39PM GLUCOSE-148* UREA N-10 CREAT-1.0 SODIUM-142 POTASSIUM-4.2 CHLORIDE-104 TOTAL CO2-25 ANION GAP-13\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17483512-DS-17.json.json b/Finished/Gastro-oesophageal Reflux Disease/17483512-DS-17.json.json new file mode 100644 index 0000000000000000000000000000000000000000..9dfb9fbe5a22c0404773d07336b3d8f48d0ebd94 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17483512-DS-17.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Oesophagitis\uff08LA grades B\uff09 is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease.$Cause_1": { + "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Cough is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "Ms who presented of progressive SOB worse with leaning forward or exertion and non-productive cough.$Input2": {} + }, + "Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "she reports, heartburn, constipation, DOE.$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "Ms who presented of progressive SOB worse with leaning forward or exertion and non-productive cough. She underwent ENT eval with Dr noted possible laryngospasm, possible LPR but no clear etiology of the dyspnea and we referred to Dr TBM. His CT trachea noted TBM trachea and bilat main stem bronchi. A flex bronch noted diffuse severe tracheobronchomalacia and possible LPR. Her pH/manometry testing returned with score of 21.5 and normal manometry. At baseline she reports, heartburn, constipation, DOE. Otherwise she denies abd pain, dysphagia or other related sx.\n", + "input3": "+Hyperlipidemia\n+OSA on CPAP\n+Exercise-induced asthma\n+Osteitis pubus\n+PTSD\n+Depression \n+ETOH abuse- sober x many years with AA\n+Several suicide attempts (including one with cardiac arrest)\n+s/p Hysterectomy \n+s/p Ureteral reimplantation and bladder neck reconstruction\n", + "input4": "Mother: cancer\nFather: cancer, CAD/CABG\n", + "input5": "Vitals: 98.5 84 151 / 80 16 95 RA\nGen: NAD, AAOx3\nCV: RRR\nPulm: nonlabored breathing on room air\nGI: soft, NT/ND, incisions CDI\nExtremities: warm and well perfused\nPsych: mood and affect appropriate\n", + "input6": "04:35AM BLOOD WBC-11.8* RBC-3.95 Hgb-12.6 Hct-37.1 \nMCV-94 MCH-31.9 MCHC-34.0 RDW-11.9 RDWSD-41.1 Plt\n04:35AM BLOOD Glucose-110* UreaN-15 Creat-0.7 Na-139 \nK-4.6 Cl-99 HCO3-26 AnGap-14\n04:35AM BLOOD Calcium-9.0 Phos-3.9 Mg-1.9\nendoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis\r\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17531182-DS-17.json.json b/Finished/Gastro-oesophageal Reflux Disease/17531182-DS-17.json.json new file mode 100644 index 0000000000000000000000000000000000000000..4a3ae8a8da488042806e9c42c26cabd19ec56c9c --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17531182-DS-17.json.json @@ -0,0 +1,27 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Esophagitis\uff08LA grades B\uff09is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "She has had an endoscopy, which shows a hiatal hernia and some esophagitis\uff08LA grades B\uff09.$Input2": {} + }, + "pH probe, with score of approximately 50 is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "She has a normal motility and a positive pH probe, with score of approximately 50.$Input2": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Heartburn and regurgitation are the typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "A woman who has had a history of heartburn and regurgitation.$Input2": {} + }, + "Cough is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "She also has significant cough. She feels that during coughing episodes, she has a lot of stomach contents coming up, which exacerbates the situation.$Input2": {} + }, + "!Cough is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "cough$Input3": {} + } + } + }, + "input1": "None\n", + "input2": "A woman who has had a history of heartburn and regurgitation. She also has significant cough. She feels that during coughing episodes, she has a lot of stomach contents coming up, which exacerbates the situation. She has had an endoscopy, which shows a hiatal hernia and some esophagitis\uff08LA grades B\uff09. She has a normal motility and a positive pH probe, with score of approximately 50.\n", + "input3": "+cough\n+mild asthma\n+migraines\n+pituitary adenoma \n+hypothyroidism\n+seizure d/o\n", + "input4": "Family history is negative for coronary disease and cancer.\n", + "input5": "VS- 97.4 98 130/80 18 93% RA\nGen: NAD, AAOx3\nLungs: CTAB\nCard: RRR\nAbd: soft, appropriately tender, no rebound, dressings c/d/i\nExt: no edema\n", + "input6": "No labs or studies performed on this admission.\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17755142-DS-15.json.json b/Finished/Gastro-oesophageal Reflux Disease/17755142-DS-15.json.json new file mode 100644 index 0000000000000000000000000000000000000000..e02dd818a31d9d3ee2fc782587afffee4e163cdc --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17755142-DS-15.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "oesophagitis\uff08LA grade B\uff09$Cause_1": { + "He underwent an upper esophagoscopy which revealed oesophagitis\uff08LA grade B\uff09 (no dysplasia).$Input2": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Cough is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "He is at the point where he must sleep upright in a chair due to persistent cough and acid taste in the back of his mouth while lying flat.$Input2": {} + }, + "cough and hoarseness are the atypical symptom of gastro-oesophageal reflux \rdis\rease\r.$Cause_1": { + "He has not had any recent episodes of pneumonia, but has developed a dry cough over the last few months, along with hoarseness.$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "Mr is with long standing disease who presents for counselling on surgical options. He has been on PPI therapy (omeprazole 40mg BID) without resolution of symptoms. While omeprazole does provide some relief, it does not completely alleviate the problem. He is at the point where he must sleep upright in a chair due to persistent cough and acid taste in the back of his mouth while lying flat. He has not had any recent episodes of pneumonia, but has developed a dry cough over the last few months, along with hoarseness. He has not had any weight loss, fevers, chills, or vomiting. He underwent an upper esophagoscopy which revealed oesophagitis\uff08LA grade B\uff09 (no dysplasia).\n", + "input3": "+CAD, MI, diastolic dysfxn (EF 70%), s/p stent x 2\n+HepC s/p interferon\n+hypercholesterolemia\n+HTN\n+arthritis\n+gout\n+back surgery (L5 compression fx)\n+hiatal hernia\n+L ileopsolias abscess drained ___\n+s/p appy\n+s/p mediastinoscopy\n", + "input4": "no cancer history\n", + "input5": "VS: T 97.7, HR 90 reg, BP 130/80, RR 20, O2 sats 98% RA\nPhysical Exam:\nGen: pleasant in NAD\nLung: wheezes t/o\nCV: RRR, S1, S2, no MRG or JVD\nABD: soft, incisions healing w/o redness, purulence, or \ndrainage.\nExt: warm, without edema.\n", + "input6": "06:09PM BLOOD WBC-12.6*# RBC-4.22* Hgb-12.6* Hct-38.2* \nMCV-91 MCH-29.9 MCHC-33.0 RDW-13.7 Plt\n06:09PM BLOOD Mg-2.1\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17762094-DS-13.json b/Finished/Gastro-oesophageal Reflux Disease/17762094-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..aa8d341d6fa44838d59e20066389820da63ab14b --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17762094-DS-13.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Chest pain is a typical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "She reported continued chest pain, which was reproducible upon palpation of the sternum. On arrival to the MICU, the patient complains of continued pain in her chest and throat.$Input2": {} + }, + "!Chest pain is a typical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "she complaints of chest pain with associated diaphoresis$Input2": {} + } + } + }, + "input1": "Hypotension\n", + "input2": "History taken with use of interpreter. The patient is a y/o F with a PMH of fibromyalgia and hypertension presenting with chest pain, shortness of breath, and hypotension. The patient reports that she began to feel increasingly unwell yesterday when she noted increased fatigue and did not leave her home. Today she noted dyspnea and dizziness while walking with her daughter. She had to stop frequently to catch her breath while walking home and had difficulty ambulating up stairs. She also reports difficulty swallowing secondary to throat tightness, with dysphagia to hard solid foods for one month. She has had symptoms like this before, last time one week ago. She sleeps on four pillows nightly due to difficulty breathing. Denies PND. She called EMS for transport to the ED. On arrival to the ED she complaints of chest pain with associated diaphoresis and shortness of breath. In the ED, initial vitals: T 99.6, HR 89, BP 106/60, 98% RA. She was given zofran 2mg IV, ntg sl, tylenol mg, ketorolac 30mg IV. EMS had been concerned about ECG and code STEMI was called. On arrival to ED, ECG was not felt to be consistent with acute ischemia. She underwent a FAST scan which was negative for pericardial effusion. CTA negative for PE or dissection. Her BP dropped to after receipt of SL NTG. She was given 2L NS without response in BP. Her BP improved to after L NS. She reported continued chest pain, which was reproducible upon palpation of the sternum. On arrival to the MICU, the patient complains of continued pain in her chest and throat.\n", + "input3": "+Bilateral carpal tunnel syndrome.\n+Hypertension\n+Lumbosacral radiculopathy.\n+Depression.\n+Fibromyalgia.\n+Carpal tunnel release.\n+Cholecystectomy.\n+Laser surgery on the right eye.\n", + "input4": "Mother died with liver disease. Father died with a heart attack. One brother died with renal failure.\n", + "input5": "Vitals: T 97.3, BP 87/51, RR 16, O2 100% 2L \nGEN: alert, oriented X3, NAD\nHEENT: MMM, OP clear, patchy alopecia.\nCV: RRR, nl s1/s2, no MRG, palpable, reproducible tenderness \nalong sternum, pulses palp 2+ radial\nRESP: CTAB, no WRR\nABD: soft, NT/ND, NABS. Tendeness at epigastrium.\nEXT: no edema\n", + "input6": "12:00PM BLOOD WBC-6.0 RBC-3.81* Hgb-10.8* Hct-33.1* MCV-87 MCH-28.4 MCHC-32.7 RDW-14.2 Plt\n10:04PM BLOOD Hct-30.7*\n05:10AM BLOOD WBC-3.9* RBC-3.48* Hgb-9.4* Hct-30.8* MCV-88 MCH-27.1 MCHC-30.7* RDW-13.5 Plt\n05:00AM BLOOD WBC-4.2 RBC-3.67* Hgb-10.1* Hct-31.7* MCV-87 MCH-27.6 MCHC-31.9 RDW-13.5 Plt\n05:25AM BLOOD WBC-4.7 RBC-3.63* Hgb-10.0* Hct-31.1* MCV-86 MCH-27.7 MCHC-32.3 RDW-13.6 Plt\n12:00PM BLOOD PTT-26.2 \n12:00PM BLOOD 12:00PM BLOOD UreaN-10 Creat-0.9\n05:10AM BLOOD Glucose-94 UreaN-8 Creat-0.7 Na-136 K-4.7 Cl-107 HCO3-21* AnGap-13\n05:00AM BLOOD Glucose-129* UreaN-9 Creat-0.7 Na-140 K-4.2 Cl-106 HCO3-27 AnGap-11\n05:25AM BLOOD Glucose-124* UreaN-9 Creat-0.7 Na-141 K-3.7 Cl-103 HCO3-31 AnGap-11\n12:00PM BLOOD CK(CPK)-130\n07:12PM BLOOD ALT-29 AST-26 CK(CPK)-109 AlkPhos-52 TotBili-0.2\n05:10AM BLOOD ALT-32 AST-34 CK(CPK)-103 AlkPhos-52 TotBili-0.2\n12:00PM BLOOD Lipase-30\n07:12PM BLOOD CK-MB-3 cTropnT-<0.01\n05:10AM BLOOD CK-MB-3 cTropnT-<0.01\n05:00AM BLOOD Calcium-9.2 Phos-3.6 Mg-2.0\n05:25AM BLOOD Calcium-8.9 Phos-4.2 Mg-1.9\n05:10AM BLOOD Cortsol-0.6*\n05:21AM BLOOD Cortsol-6.0\n05:58AM BLOOD Cortsol-13.9\n06:58AM BLOOD Cortsol-17.8\n05:25AM BLOOD Cortsol-5.1\n12:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n10:55PM BLOOD pO2-169* pCO2-41 pH-7.36 calTCO2-24 Base XS--1 Comment-GREEN TOP\n12:16PM BLOOD Glucose-113* Lactate-2.7* Na-136 K-4.3 Cl-101 calHCO3-24\n10:55PM BLOOD Lactate-1.2\n05:21AM BLOOD ACTH - FROZEN-PND\n2:20 pm URINE CULTURE (NO GROWTH.\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17762094-DS-27.json b/Finished/Gastro-oesophageal Reflux Disease/17762094-DS-27.json new file mode 100644 index 0000000000000000000000000000000000000000..40cdc61ab2e34c13e94be2a9d789bec97fc1c67b --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17762094-DS-27.json @@ -0,0 +1,18 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Reflux is a typical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "She notes that she frequently is experiencing reflux despite continuing to take her omeprazole.$Input2": {} + } + } + }, + "input1": "Hiatal Hernia\n", + "input2": "s/p left robotic assisted thoracoscopic thymectomy and LUL wedge resection for a type AB thymoma with non malignant lung pathology. She has recently completed her maintenance chemotherapy for invasive T1 bladder cancer (h/o cystectomy with ileal conduit) and she also is now s/p laparoscopic parastomal hernia repair w/ mesh with Dr. . She is being followed for a LLL nodule which on CT chest showed stable 7 mm LLL nodule which is again unchanged on recent repeat T Chest and abdomen pelvis notes large hiatal hernia which has previously been remarked. Today in clinic patient denies any respiratory complaints with no recent coughs. She notes that she frequently is experiencing reflux despite continuing to take her omeprazole.\n", + "input3": "+Carotid stenosis \n+HLD\n+HTN\n+CAD/Stable angina\n+PNA (aspiration post-op\n+Thymoma\n+Arthritis\n+Gastritis/bleeding ulcers\n+Hiatal Hernia\n+CKD\n+depression \n+anxiety \n+Robotic-assisted thoracoscopic thymectomy and left upper lobe wedge resection for 13.2 cm type AB thymoma, completely encapsulated with focal invasion into capsule but not through it, modified Masaoka stage 1 with negative margins. The LUL wedge resection returned as lung parenchyma with emphysematous changes and focal smooth muscle metaplasia. \n+Small segmental nonocclusive PE after above procedure\n", + "input4": "Family history is negative for kidney cancer, bladder cancer.\n", + "input5": "Vitals: 97.7 115/41 53 18 94RA\nExam:\nGENERAL: Well appearing, NAD, \nHEENT: EOMI, MMM, no scleral icterus\nCV: RRR\nPULM: nonlabored breathing on RA\nABD: soft, NT/ND, lap incisions cdi \nNEURO: AOx3\nPSCYH: appropriate mood and affect\n", + "input6": "04:20AM BLOOD WBC-7.3 RBC-3.97 Hgb-11.1* Hct-35.5 MCV-89 MCH-28.0 MCHC-31.3* RDW-13.6 RDWSD-44.6 Plt\n04:20AM BLOOD Glucose-89 UreaN-25* Creat-1.4* Na-145 K-4.2 Cl-104 HCO3-25 AnGap-16\n04:20AM BLOOD Calcium-8.8 Phos-3.4 Mg-1.5*\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17796507-DS-20.json b/Finished/Gastro-oesophageal Reflux Disease/17796507-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..7e30f06093e5bd2f9dfe543d9b2b568a02ddde58 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17796507-DS-20.json @@ -0,0 +1,39 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 9.2% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Throat tightness is a common symptom of GERD, usually caused by reflux of stomach acid irritating the esophagus and throat.$Cause_1": { + "throat tightness$Input1": {} + }, + "Tightness in the throat may be related to GERD$Cause_1": { + "vague sensation of \"tightness\" in her throat$Input2": {} + }, + "Shortness of breath may be related to GERD$Cause_1": { + "shortness of breath$Input2": {} + }, + "Chest pain that occurs when you lie on your back but disappears when you sit up may be a classic symptom of GERD because this position may make it easier for stomach acid to back up into the esophagus.$Cause_1": { + "dull mild anterior chest pain when lying down which went away when she sat up$Input2": {} + }, + "This surgery is often used to treat severe GERD or hiatal hernias and indicates that the patient has a history of severe esophageal problems.$Cause_1": { + "h/o ___ Lap hiatal herniorrhaphy/Toupet \nfundoplication for a large paraesophageal hernia$Input2": {} + }, + "Paraesophageal hernias may cause a disruption in the pressure mechanism in the lower esophagus, making it easier for stomach acid to reflux into the esophagus, thus triggering or worsening GERD.$Cause_1": { + "large paraesophageal hernia$Input3": {} + }, + "Abdominal distension may be caused by increased stomach gas or indigestion, which may be an indirect symptom of GERD because acid reflux may cause or worsen indigestion.$Cause_1": { + "distended but soft$Input5": {} + }, + "This is a sign of a hiatal hernia, a common cause of GERD in which the stomach structure moves abnormally into the chest, increasing pressure in the esophagus, which can cause or worsen gastroesophageal reflux.$Cause_1": { + "simple fluid collection in the left paraesophageal region$Input6": {} + } + } + }, + "input1": "throat tightness\n", + "input2": "For the past week has had vague sensation of \"tightness\" in her throat, sometimes accompanied by some minimal shortness of breath and mild throat pain. Lats night she had some dull mild anterior chest pain when lying down which went away when she sat up. She is taking solids and fluids w/o any dysphagia. She denies any heartburn. She has known right thyroid nodule that was FNA's in ___ and found to be benign. Lately she had been feeling some tightness in the neck around the same area and wonders whether her throat tightness is related. She has no known cardiac history but endorses chronic ___ swelling, X2-3 pillow orthopnea and PND X1/week as well as dyspnea at two flights of stairs and two blocks. This DOE has been stable for at least a couple of years. She did feel like she had a cold last week with some nasal congestion and cough that have resolved. She had no recent febrile illness. No recent exposure to new meds or foods. She has been on lisinopril for a while with no h/o angiedema. sob and feeling of something in her throat. ___ states she develop this over 1 wk ago while just sitting at home. \n.\nOf note patient has h/o ___ Lap hiatal herniorrhaphy/Toupet \nfundoplication for a large paraesophageal hernia. Recently seen for follow up by Dr. ___ who thought no further f/u was necessary. Esophagogram on ___ looked good. She does not think her current symptoms are related to her past esophgeal issues. \n\nIn the ED admission vitals were: 98.8 114 128/69 15 98% Labs notable for leukocytosis to 14K PMN predominant, hyperglycemia to 201 and elevated d-dimer to 4283. Trop neg X1. ECG non acute. CTA no PE. Got 2L of NS + IV ativan, with resolution of tachcardia. \n. \nOn the floor, patient feels ok currently except for mild throat tightness which is ongoing. She otherwise has no SOB, chest pain or any other complaint. \n \nReview of sytems: \n(+) Per HPI \n(-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness. Denies palpitations. Denies nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denies arthralgias or myalgias. Ten point review of systems is otherwise negative.\n", + "input3": "large paraesophageal hernia.\nDMII\nhypothyroidism\nhyperlipidemia\nHTN\nB TKR\nhysterectomy \nappendectomy\ncholecystectomy\n", + "input4": "Family History: MGM cloln Ca. PGM Breast Ca. Mother CHF.\n", + "input5": "Vitals: 98.9 138/84 92 20 98RA \nGeneral: confortable and appropriate, alert+Ox3\nHEENT: PERRLA, EOMI, no pallor or jaundice, no sinus tenderness, normal oral mucosa, normal pharynx with central uvula no tonsillar hypertrophy and no signs of edema. \nNeck: Minimal right anterior lymphadenopathy, I could not \npaplpate any thyroid nodules, no thyroid or carotid bruits, no tenderness. \nLAD: none except as above \nLungs: CTA \nCV:RRR/ no M/R/N \nAbdomen: distended but soft, no HSM, normal BS \nExt: +___dema to knees \nSkin: no rash \nNeuro: motor ___ throughout, grossly normal sensorium, no \ncranial nerve deficits\n", + "input6": "___ 12:40PM BLOOD WBC-14.3* RBC-4.53 Hgb-13.3 Hct-39.2 \nMCV-87 MCH-29.3 MCHC-33.8 RDW-13.8 Plt ___\n___ 12:40PM BLOOD Neuts-78.8* Lymphs-13.9* Monos-2.9 \nEos-4.0 Baso-0.5\n___ 12:40PM BLOOD Glucose-201* UreaN-20 Creat-1.0 Na-141 \nK-3.9 Cl-101 HCO3-27 AnGap-17\n___ 12:40PM BLOOD ALT-13 AST-17 AlkPhos-95 TotBili-0.3\n___ 12:40PM BLOOD Albumin-4.6\n___ 12:40PM BLOOD D-Dimer-4283*\n___ 12:40PM BLOOD TSH-1.5\n\nSTUDIES: \n\nCTA: \n\n1. No pulmonary embolism or acute cardiopulmonary process. \n\n2. Enlarged and heterogeneous right thyroid lobe as seen on \npriorexamination, for which further evaluation can be performed with a thyroidultrasound on a nonemergent basis if clinically indicated. \n\n3. Mild intrahepatic biliary ductal dilation, at least involving the lefthepatic lobe, not fully imaged. Correlate with LFTs, if further evaluation is warranted ultrasound or MRCP can be considered.\n\n4. simple fluid collection in the left paraesophageal region \n\n \nEKG: sinus tachy, left axis WNL, PRWP, non specific lateral T wave faltening. Not significantly changed from prior. \n\nThere is normal compression and augmentation of the comon \nfemoral vein, superficial femoral vein (proximal, mid and distal), popliteal vein, posterior tibial veins and peroneal veins in both lower extremities. There is normal phasicity of the common femoral veins bilaterally.\n\nAmbulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17809917-DS-7.json b/Finished/Gastro-oesophageal Reflux Disease/17809917-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..c6e5ddbacaca06df80c6a4a8b18e86bcc8070cfc --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17809917-DS-7.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 9.2% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "The patient is unable to tolerate pH testing while off antireflux medication, which may indicate that he is highly dependent on the medication.$Cause_1": { + "unable to tolerate coming off his antireflux medication for a pH study$Input2": {} + }, + "Heartburn is a classic symptom of GERD, usually caused by stomach acid backing up into the esophagus.$Cause_1": { + "classic symptoms of heartburn$Input2": {} + }, + "Slow gastric emptying is a common complication of GERD$Cause_1": { + "Delayed gastric emptying with opacification of the duodenum seen 30 minutes after filling of the stomach.$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "His manometry was normal. He was unable to tolerate coming off his antireflux medication for a pH study. However, we discussed that he has classic symptoms of heartburn, and the patient was willing to move ahead with surgery without objective documentation of abnormal reflux by pH study.\n", + "input3": "Significant only for an open appendectomy\n", + "input4": "Negative for esophageal cancer.\n", + "input5": "VS: T: 98.5 HR: ___ SR BP: 115-134/80 Sats: 99% RA\nGeneral: ___ year-old male in no apparent distress\nHEENT: normocephalic, mucus membranes moist\nNeck: supple no lymphadenopathy\nCard: RRR normal S1,S2\nResp: clear breath sounds\nGI: hypoactive bowel sounds, abdomen soft\nIncision: abdominal clean dry intact\nNeuro: non-focal\n", + "input6": "___ WBC-16.3* RBC-4.85 Hgb-14.9 Hct-41.3 MCV-85 MCH-30.7 \nMCHC-36.0* RDW-12.9 Plt ___\n___ Hct-42.3\n___ Glucose-98 UreaN-14 Creat-0.7 Na-138 K-4.1 Cl-103 \nHCO3-28 \n___ Na-139 K-3.5 Cl-105\n___ Calcium-8.8 Phos-3.3 Mg-2.0\n___ Calcium-9.2 Mg-1.6\n\nBarium Swallow:\nDelayed gastric emptying with opacification of the duodenum seen 30 minutes after filling of the stomach.\n\nAmbulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.\n\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/17830445-DS-7.json.json b/Finished/Gastro-oesophageal Reflux Disease/17830445-DS-7.json.json new file mode 100644 index 0000000000000000000000000000000000000000..44d0be045fa5425d9320ad519052d9400ee0fa88 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/17830445-DS-7.json.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "Oesophagitis\uff08LA grades B\uff09 is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease.$Cause_1": { + "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Abdominal pain is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "abdominal pain$Input1": {} + }, + "Reflux is a typical symptom of gastro-oesophageal reflux \rdisease$Cause_1": { + "The patient has abnormal reflux$Input2": {} + }, + "!Abdominal pain is an atypical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "his primary complaint is abdominal pain$Input2": {} + } + } + }, + "input1": "abdominal pain\n", + "input2": "The patient is a with chronic pain. He continues to have pains which he finds debilitating, worse in LUQ than on the right. He has had a Bravo test which was abnormal. Specifically, on day 1, his score was 32.8, however, on day 2 it was 8.9. There were three reports of abdominal pain over these two days. The symptom index was 33% and the symptom association probability was 70%. Dr. the results of the Bravo test. There were veryfew episodes of abdominal pain and this may in part reflect thelow symptom association probability. The patient has abnormal reflux and by objective measures he would be a candidate for laparoscopic antireflux surgery. However, his primary complaint is abdominal pain and it is not clear whether his abdominal pain is caused by reflux and therefore, it is unclear whether surgery would improve his abdominal pain. Patient decided that he wanted to go ahead with the surgery and presents today.\n", + "input3": "+diverticulitis\n+functional dyspepsia\n+BPH\n", + "input4": "Non contributory\n", + "input5": "BP: 129/80. Heart Rate: 60. Weight: 172.1. Height: 67. BMI: \n27.0.\nTemperature: 97.6. Resp. Rate: 16. Pain Score: 0. O2 \nSaturation%:\n100. Distress Score: 5.\n\nGENERAL \n[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\n\nHEENT \n[x] NC/AT [x] EOMI [x] PERRL/A [x] Anicteric\n[x] OP/NP mucosa normal [x] Tongue midline\n[x] Palate symmetric [x] Neck supple/NT/without mass\n[x] Trachea midline [x] Thyroid nl size/contour\n[ ] Abnormal findings:\n\nRESPIRATORY \n[x] CTA/P [x] Excursion normal [x] No fremitus\n[x] No egophony [x] No spine/CVAT\n[ ] Abnormal findings:\n\nCARDIOVASCULAR \n[x] RRR [x] No m/r/g [x] No JVD [x] PMI nl [x] No edema\n[x] Peripheral pulses nl [x] No abd/carotid bruit\n[ ] Abnormal findings:\n\nGI \n[x] Soft [x] NT [x] ND [x] No mass/HSM [x] No hernia\n[ ] Abnormal findings:\n\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[ ] Abnormal findings:\n\nNEURO \n[x] Strength intact/symmetric [x] Sensation intact/ symmetric\n[x] Reflexes nl [x] No facial asymmetry [x] Cognition intact\n[x] Cranial nerves intact [ ] Abnormal findings:\n\nMS \n\n \n[x] No clubbing [x] No cyanosis [x] No edema [x] Gait nl\n[x] No tenderness [x] Tone/align/ROM nl [x] Palpation nl\n[x] Nails nl [ ] Abnormal findings:\n\nLYMPH NODES \n[x] Cervical nl [x] Supraclavicular nl [x] Axillary nl\n[x] Inguinal nl [ ] Abnormal findings:\n\nSKIN \n[x] No rashes/lesions/ulcers\n[x] No induration/nodules/tightening [ ] Abnormal findings:\n\nPSYCHIATRIC \n[x] Nl judgment/insight [x] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n", + "input6": "Ba swallow :\nNo evidence of leak or holdup.\nendoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis\r\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/18084435-DS-21.json.json b/Finished/Gastro-oesophageal Reflux Disease/18084435-DS-21.json.json new file mode 100644 index 0000000000000000000000000000000000000000..28721613f24277c8809de7d0af5661e981b50e36 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/18084435-DS-21.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "pH impedance monitoring\uff1atotal AET8%>6% is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease.$Cause_1": { + "Ph impedance monitoring\uff1atotal AET8%$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease\r.$Cause_1": { + "heartburn$Input1": {} + }, + "pH studies concerning for significant disease is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease.$Cause_1": { + "esophageal manometry and pH studies concerning for significant disease.$Input2": {} + } + } + }, + "input1": "heartburn\n", + "input2": "A woman is with tracheobronchomalacia, with esophageal manometry and pH studies concerning for significant disease. She is being seen this afternoon to discuss management. \nPrior to the GI studies she had to suspend her PPI for 7 days, during which she reports persistent burning chest pain and globus sensation, both of which have resolved with restarting her PPI.\nShe has an intermittently productive cough and is currently\nfinishing a course of antibiotics for a presumed URI.\n", + "input3": "+multiple asthma exacerbations and hospitalizations\n+pneumonia, including fungal pneumonia, VSD, bicuspid AV, ascending aortic root +dilation\n+sinus tachycardia\n+shingles\n+migraines\n+hypercholesterolemia\n+arthritis\n+interstitial cystitis\n+left knee replacement\n+left breast lumpectomy\n+right breast lumpectomy\n+uterine sling tooth implant\n+bladder sling,\n+hysterectomy\n+sinus procedure\n+L4-S1 spinal fusion\n", + "input4": "Mother - benign pituitary tumor\nFather - MI, HTN, DM, COPD, deceased \nSiblings - sister with breast cancer, brother with stroke,\nbrother and sister with colon polyps, sister with thyroiditis\nOffspring\nOther\n", + "input5": "BP: 116/74. Heart Rate: 82. O2 Saturation%: 96. Weight: 268.\nHeight: 67. BMI: 42.0. Temperature: 97.9. Resp. Rate: 16.\nGENERAL \n[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\n\nHEENT \n[x] NC/AT [x] EOMI [x] PERRL/A [x] Anicteric\n[x] OP/NP mucosa normal [x] Tongue midline\n[ ] Palate symmetric [x] Neck supple/NT/without mass\n[x] Trachea midline [ ] Thyroid nl size/contour\n[ ] Abnormal findings:\n\nRESPIRATORY \n[x] CTA/P [x] Excursion normal [ ] No fremitus\n[ ] No egophony [ ] No spine/CVAT\n[x] Abnormal findings: cough on deep inspiration, prolonged\nexpiratory effort \n\nCARDIOVASCULAR \n[x] RRR [x] No m/r/g [ ] No JVD [ ] PMI nl [x] No edema\n[x] Peripheral pulses nl [ ] No abd/carotid bruit\n[ ] Abnormal findings:\n\nGI \n[x] Soft [x] NT [x] ND [ ] No mass/HSM [ ] No hernia\n[ ] Abnormal findings:\n\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[ ] Abnormal findings:\n\nNEURO \n[x] Strength intact/symmetric [ ] Sensation intact/ symmetric\n[ ] Reflexes nl [ ] No facial asymmetry [x] Cognition intact\n[ ] Cranial nerves intact [ ] Abnormal findings:\n\nMS \n[ ] No clubbing [x] No cyanosis [x] No edema [x] Gait nl\n[ ] No tenderness [ ] Tone/align/ROM nl [ ] Palpation nl\n[ ] Nails nl [ ] Abnormal findings:\n\nLYMPH NODES \n[ ] Cervical nl [ ] Supraclavicular nl [ ] Axillary nl\n[ ] Inguinal nl [ ] Abnormal findings:\n\nSKIN \n[x] No rashes/lesions/ulcers\n[ ] No induration/nodules/tightening [ ] Abnormal findings:\n\nPSYCHIATRIC \n[x] Nl judgment/insight [ ] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n", + "input6": "04:22PM WBC-9.8 RBC-4.35 HGB-12.6 HCT-38.5 MCV-89 \nMCH-29.0 MCHC-32.7 RDW-15.0 RDWSD-47.5*\n04:22PM PLT COUNT-309\n04:22PM GLUCOSE-138* UREA N-12 CREAT-0.7 SODIUM-137 \nPOTASSIUM-4.3 CHLORIDE-100 TOTAL CO2-23 ANION GAP-18\n\nBa swallow :\nNo evidence of leak. Hold up of small amount of contrast at the distal esophagus.\npH impedance monitoring\uff1atotal AET8%\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/18296811-DS-10.json b/Finished/Gastro-oesophageal Reflux Disease/18296811-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..463ec8b0343647d33dba1d4e6c0d395e8cfb35bc --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/18296811-DS-10.json @@ -0,0 +1,30 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 9.2% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "abdominal pain is a common symptom of GERD$Cause_1": { + "abdominal pain$Input1": {} + }, + "Persistent nausea and gastroesophageal reflux, which are typical symptoms of GERD$Cause_1": { + "daily nausea and reflux$Input2": {} + }, + "Burning pain in the upper abdomen and chest discomfort are often associated with GERD because stomach acid backs up into the esophagus, causing these symptoms.$Cause_1": { + "burning epigastric pain and \"reflux\" discomfort into the chest$Input2": {} + }, + "Bright red blood in vomitus may indicate upper gastrointestinal bleeding, which may be related to damage to the esophageal or stomach lining caused by GERD.$Cause_1": { + "vomited for the first time, reports 7 episodes of bilious/green emesis with one \"spoonful\" of bright red blood.$Input2": {} + }, + "Omeprazole is a drug that suppresses stomach acid secretion and is commonly used to treat GERD.$Cause_1": { + "prescribed zofran and omeprazole on ___ but they have not helped$Input2": {} + } + } + }, + "input1": "abdominal pain\n", + "input2": "___ female ___ pregnant presenting with emesis and epigastric pain. Throughout pregnancy has had daily nausea and reflux. She was prescribed zofran and omeprazole on ___ but they have not helped. Yesterday she vomited for the first time, reports 7 episodes of bilious/green emesis with one \"spoonful\" of bright red blood. Describes burning epigastric pain and \"reflux\" discomfort into the chest. Has been taking minimal PO for the past ___ due to nausea. +dizzy upon standing and fell at work once. No LOC or headstrike. No diarrhea, vaginal discharge, vaginal bleeding, or contractions. No dysuria or flank pain. Was scheduled to meet with nutritionist to get help meal planning to prevent nausea and vomiting but had to cancel this appointment as she did not feel well enough to go.\n\nROS: +as above, otherwise reviewed and negative\n\nIn ED US w/live IUP. Pt given 1L NS bolus, zofran and pantoprazole. Guaiac negative brown stool. Glucose 68, pt given 1L ___.\n", + "input3": "Seizure disorder\n- 3 total lifetime events, last in ___, not on AED\nVentricular premature beats \nMigraines\n", + "input4": "Father died of a stroke at age ___. \nSister died of cancer at ___ and had hepatitis.\nShe has 3 siblings and 2 half siblings.\n", + "input5": "Vitals: T:afeb BP: P:55 R:16 O2:99%ra \nPAIN: 3\nGeneral: nad\nLungs: clear\nCV: rrr no m/r/g\nAbdomen: bowel sounds present, soft, nt/nd\nExt: no e/c/c\nSkin: no rash\nNeuro: alert, follows commands\n", + "input6": "___ 05:25PM GLUCOSE-68* UREA N-10 CREAT-0.6 SODIUM-138 POTASSIUM-3.9 CHLORIDE-104 TOTAL CO2-23 ANION GAP-15\n___ 05:33PM LACTATE-1.4 K+-3.6\n___ 05:25PM ALT(SGPT)-14 AST(SGOT)-21 ALK PHOS-53 TOT BILI-0.4\n___ 05:25PM LIPASE-24\n___ 05:25PM ALBUMIN-3.9 CALCIUM-9.5 PHOSPHATE-3.4 MAGNESIUM-1.7\n___ 05:25PM WBC-5.2 RBC-4.11* HGB-13.2 HCT-36.5 MCV-89 MCH-32.1* MCHC-36.1* RDW-12.9\n___ 05:25PM NEUTS-55.4 ___ MONOS-7.0 EOS-2.0 BASOS-0.2\n___ 05:25PM PLT COUNT-230#\n___ 05:25PM ___ PTT-29.3 ___\n___ 08:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-TR\n___ 08:50PM URINE RBC-<1 WBC-1 BACTERIA-FEW YEAST-NONE \nEPI-2\n___ 08:50PM URINE COLOR-Straw APPEAR-Clear SP ___\n\n \nEARLY OB US <14WEEKS IMPRESSION: Single live intrauterine \npregnancy with size = dates. \n\nRUQ US IMPRESSION: Normal abdominal ultrasound. No evidence of cholecystitis.\n\nAmbulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.\n\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/18425773-DS-12.json.json b/Finished/Gastro-oesophageal Reflux Disease/18425773-DS-12.json.json new file mode 100644 index 0000000000000000000000000000000000000000..fc4013a38121f27fc2b337e0e7e0b39a9c486ddd --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/18425773-DS-12.json.json @@ -0,0 +1,21 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09is the gold standard for the diagnosis of gastro-oesophageal reflux \rdisease.$Cause_1": { + "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Heartburn is a typical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "Patient is a very pleasant lady who has come with the chief complaints of progressively worsening difficulty in swallowing and heartburn for the past few months.$Input2": {} + }, + "Burning pain in the chest is a typical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "she has noticed a progressive worsening of swallowing and burning pain in the chest after eating food.$Input2": {} + } + } + }, + "input1": "dysphagia\n", + "input2": "Patient is a very pleasant lady who has come with the chief complaints of progressively worsening difficulty in swallowing and heartburn for the past few months. She was apparently normal, when she noticed a change in her voice. Barium swallow done at the time revealed some \"weakening in the proximal esophagus\". She improved with voice therapy and was asymptomatic. She started having difficulty swallowing and frequent exacerbations of asthma. An upper GI endoscopy and biopsy revealed that she had esophagus.She has been on Nexium ever since then. Over the past few months , she has noticed a progressive worsening of swallowing and burning pain in the chest after eating food.\n", + "input3": "+Asthma x Endometriosis (7 surgeries);\n+Appendectomy\n+Laparotomy (twice- for endometriosis of the colon and lysis of adhesions); \n+septoplasty(for DNS)\n+umbilical hernia repair\n+hysterectomy\n", + "input4": "Mother-none\nesophagus and esophageal cancer\nSiblings- Brothers have gastroesophageal reflux\nOffspring\nOther: Uncle had colon cancer\n", + "input5": "VS: 98.1, 60, 106/65, 18, 100% RA\n\nPE: \nGen: AAOx3, NAD\nCV: RRR\nPulm: CTAB\nAbd: Soft, appropriately tender, nondistended, inc c/d/i\nExt: No edema\n", + "input6": "endoscopy\uff1aoesophagitis\uff08LA grades B\uff09 chronic gastritis\r\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/18635756-DS-17.json b/Finished/Gastro-oesophageal Reflux Disease/18635756-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..639eae07224fffb3eb96072cee98ca7577570055 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/18635756-DS-17.json @@ -0,0 +1,33 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 9.2% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "abd pain is a common symptom of GERD$Cause_1": { + "abd pain$Input1": {} + }, + "Typical GERD symptoms, which include worsening pain after eating and pain behind the breastbone, may be due to the backflow of stomach acid into the esophagus.$Cause_1": { + "progressive mid-epigastric abdominal pain that radiates to her chest and is exacerbate with eating food$Input2": {} + }, + "Gastritis may be associated with GERD because both involve problems with the stomach and esophagus. Gastritis may worsen symptoms of GERD.$Cause_1": { + "Gastritis$Input3": {} + }, + "Alcohol is a known GERD trigger, as it relaxes the lower esophageal sphincter and increases the likelihood of acid reflux.$Cause_1": { + "Alcohol abuse$Input3": {} + }, + "Fatigue and weakness can be common experiences with GERD due to chronic pain.$Cause_1": { + "appears fatigued and weak$Input5": {} + }, + "Mild pain in the upper abdomen may be directly related to GERD and reflect irritation of the esophagus-stomach interface by acid reflux.$Cause_1": { + "mild tenderness in epigastric region$Input5": {} + } + } + }, + "input1": "abd pain\n", + "input2": "___ with metastatic ovarian cancer treated one month ago with___ presents with progressive abdominal pain, nausea and inability to tolerate oral intake. \n\nThe patient complains of progressive mid-epigastric abdominal pain that radiates to her chest and is exacerbate with eating food and noted to be worse in the morning. This pain has\nprogressed since getting chemotherapy and she has been unable to reliably take adequate PO intake. She has been administering IV infusions of normal saline, up to two liters per day at home without improvement of her symptoms.\n\nShe also notes occasional chills but no fevers. Last bowel movement was this morning.\n\nShe has no headache but endorses dizziness. No chest pain or\ndyspnea. No vomiting or diarrhea. No melena, hemotochezia or\ndysuria.\n", + "input3": "- Ovarian carcinoma as above\n- Gastritis\n- Nontoxic unilateral nodular goiter\n- Schistosomiasis\n- Fibroids\n- Migraine with aura\n- Low back pain\n- Generalized anxiety disorder\n- Alcohol abuse\n- Vitamin D deficiency\n", + "input4": "- Maternal grandmother with breast cancer in ___\n- Maternal aunt with breast cancer in ___\n- No history of gynecologic or colonic malignancies\n", + "input5": "VS 98.1 PO 99 / 62 63 18 98 Ra\nGENERAL: appears fatigued and weak, but is calm and appears in NAD\nHEENT: Moist mucous membranes without thrush or erythema. Good dentition.\nEYES: PERRL, anicteric\nNECK: Supple\nRESP: CTAB, no increased WOB, no rhonchi, wheezing, or crackles\n___: RRR no MRG, normal distal perfusion, no edema\nGI: Soft, mild tenderness in epigastric region, No rebound or guarding. Multiple, well healed surgical incisions noted\nEXT: Warm, no edema, poor muscle bulk\nSKIN: Dry, no rashes or bruising\nNEURO: AOx3, fluent speech, calm\nACCESS: Port dressing c/d/I\n", + "input6": "IMAGING:\n\nCT A/P:\n1. No evidence of abdominopelvic recurrence or metastasis. \n2. Apparent transverse colon wall thickening may reflect luminal underdistention, but difficult to exclude colitis in the appropriate clinical setting. \n\nCT Chest:\nNo evidence of metastasis to the chest. Please refer to dedicated report on abdomen which has been dictated separately \nfor further details. Status post splenectomy. \n\nO&P: PENDING\nSchisto: PENDING\n\nAmbulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.\n\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/18639999-DS-19.json b/Finished/Gastro-oesophageal Reflux Disease/18639999-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..d0072c9a77ca8d9b4534d8e54bc2cb4c42c8b90b --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/18639999-DS-19.json @@ -0,0 +1,24 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 9.2% > 6% is the gold standard for GERD diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Substernal pain is a common symptom of GERD.$Cause_1": { + "substernal pain$Input2": {} + }, + "Hiatal hernia, in which part of the stomach pushes through a hole into the chest, can exacerbate or cause GERD symptoms$Cause_1": { + "a large hiatal hernia$Input2": {} + }, + "Reflux into the throat and even vomiting are typical symptoms of GERD$Cause_1": { + "regurgitated so much as to vomit$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "She is a ___ white female complaining of substernal pain, which awakes her at night. She has been previously evaluated with Dr. ___ essentially undergone further evaluation with endoscopy, which showed a large hiatal hernia. The patient was referred by her PCP, ___ due to this hiatal hernia, and her husband who reports that night she actually regurgitated so much as to vomit in her sleep.\n", + "input3": "Non-ischemic cardiomyopathy with EF 25% by echo ___\ns/p ICD placement\nAsthma\nDepression\nHep C\nChronic LBP\nHx of etoh abuse\n", + "input4": "Her father died of MI/SCD at age ___ no other family history of premature coronary artery disease or sudden death.\n", + "input5": "On physical exam, no acute distress. Blood pressure 102/70,\nrespirations 12, heart rate 78, O2 sat is 98%, weight 157 \npounds,alert, oriented, and wearing an abdominal binder. There is a palpable device in left upper chest wall consistent with an AICD device. Neck is supple. Breathing comfortably. Lungs clear. \n\nHeart is regular. Abdomen is soft and nontender. \nNeurologically\ngrossly intact. \nUpper and lower extremities, good range of motion, good strength. Gait and station normal. Skin without rashes.\n", + "input6": "UGI ___\n\nNo definite evidence of leak or obstruction. Contrast passes freely.\n\nAmbulatory reflux monitor :total AET:9.2% on pH-impedance monitoring.\n\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/18740413-DS-13.json b/Finished/Gastro-oesophageal Reflux Disease/18740413-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..f88c199d532d9278eb64d30be52de71fcd9bbfa9 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/18740413-DS-13.json @@ -0,0 +1,18 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "chest and throat discomfort are atypical symptoms of gastro-oesophageal reflux \rdisease$Cause_1": { + "She reported continued chest discomfort, which was reproducible upon palpation of the sternum. On arrival to the MICU, the patient complains of continued discomfort in her chest and throat.$Input2": {} + } + } + }, + "input1": "Hypotension\n", + "input2": "History taken with use of interpreter. The patient is a y/o F with a PMH of fibromyalgia and hypertension presenting with chest discomfort, shortness of breath, and hypotension. The patient reports that she began to feel increasingly unwell yesterday when she noted increased fatigue and did not leave her home. Today she noted dyspnea and dizziness while walking with her daughter. She had to stop frequently to catch her breath while walking home and had difficulty ambulating up stairs. She also reports difficulty swallowing secondary to throat tightness, with dysphagia to hard solid foods for one month. She has had symptoms like this before, last time one week ago. She sleeps on four pillows nightly due to difficulty breathing. Denies PND. She called EMS for transport to the ED. On arrival to the ED she complaints of chest pain with associated diaphoresis and shortness of breath. In the ED, initial vitals: T 99.6, HR 89, BP 106/60, 98% RA. She was given zofran 2mg IV, ntg sl, tylenol mg, ketorolac 30mg IV. EMS had been concerned about ECG and code STEMI was called. On arrival to ED, ECG was not felt to be consistent with acute ischemia. She underwent a FAST scan which was negative for pericardial effusion. CTA negative for PE or dissection. Her BP dropped to after receipt of SL NTG. She was given 2L NS without response in BP. Her BP improved to after L NS. She reported continued chest discomfort, which was reproducible upon palpation of the sternum. On arrival to the MICU, the patient complains of continued discomfort in her chest and throat.\n", + "input3": "+Bilateral carpal tunnel syndrome.\n+Hypertension\n+Lumbosacral radiculopathy.\n+Depression.\n+Fibromyalgia.\n+Carpal tunnel release.\n+Cholecystectomy.\n+Laser surgery on the right eye.\n", + "input4": "Mother died with liver disease. Father died with a heart attack. One brother died with renal failure.\n", + "input5": "Vitals: T 97.3, BP 87/51, RR 16, O2 100% 2L \nGEN: alert, oriented X3, NAD\nHEENT: MMM, OP clear, patchy alopecia.\nCV: RRR, nl s1/s2, no MRG, palpable, reproducible tenderness \nalong sternum, pulses palp 2+ radial\nRESP: CTAB, no WRR\nABD: soft, NT/ND, NABS. Tendeness at epigastrium.\nEXT: no edema\n", + "input6": "12:00PM BLOOD WBC-6.0 RBC-3.81* Hgb-10.8* Hct-33.1* MCV-87 MCH-28.4 MCHC-32.7 RDW-14.2 Plt\n10:04PM BLOOD Hct-30.7*\n05:10AM BLOOD WBC-3.9* RBC-3.48* Hgb-9.4* Hct-30.8* MCV-88 MCH-27.1 MCHC-30.7* RDW-13.5 Plt\n05:00AM BLOOD WBC-4.2 RBC-3.67* Hgb-10.1* Hct-31.7* MCV-87 MCH-27.6 MCHC-31.9 RDW-13.5 Plt\n05:25AM BLOOD WBC-4.7 RBC-3.63* Hgb-10.0* Hct-31.1* MCV-86 MCH-27.7 MCHC-32.3 RDW-13.6 Plt\n12:00PM BLOOD PTT-26.2 \n12:00PM BLOOD 12:00PM BLOOD UreaN-10 Creat-0.9\n05:10AM BLOOD Glucose-94 UreaN-8 Creat-0.7 Na-136 K-4.7 Cl-107 HCO3-21* AnGap-13\n05:00AM BLOOD Glucose-129* UreaN-9 Creat-0.7 Na-140 K-4.2 Cl-106 HCO3-27 AnGap-11\n05:25AM BLOOD Glucose-124* UreaN-9 Creat-0.7 Na-141 K-3.7 Cl-103 HCO3-31 AnGap-11\n12:00PM BLOOD CK(CPK)-130\n07:12PM BLOOD ALT-29 AST-26 CK(CPK)-109 AlkPhos-52 TotBili-0.2\n05:10AM BLOOD ALT-32 AST-34 CK(CPK)-103 AlkPhos-52 TotBili-0.2\n12:00PM BLOOD Lipase-30\n07:12PM BLOOD CK-MB-3 cTropnT-<0.01\n05:10AM BLOOD CK-MB-3 cTropnT-<0.01\n05:00AM BLOOD Calcium-9.2 Phos-3.6 Mg-2.0\n05:25AM BLOOD Calcium-8.9 Phos-4.2 Mg-1.9\n05:10AM BLOOD Cortsol-0.6*\n05:21AM BLOOD Cortsol-6.0\n05:58AM BLOOD Cortsol-13.9\n06:58AM BLOOD Cortsol-17.8\n05:25AM BLOOD Cortsol-5.1\n12:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n10:55PM BLOOD pO2-169* pCO2-41 pH-7.36 calTCO2-24 Base XS--1 Comment-GREEN TOP\n12:16PM BLOOD Glucose-113* Lactate-2.7* Na-136 K-4.3 Cl-101 calHCO3-24\n10:55PM BLOOD Lactate-1.2\n05:21AM BLOOD ACTH - FROZEN-PND\n2:20 pm URINE CULTURE (NO GROWTH.\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\r\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/18814172-DS-9.json b/Finished/Gastro-oesophageal Reflux Disease/18814172-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..35a5005f1a41cef24c20ae4a6ef55e0c5ea965ad --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/18814172-DS-9.json @@ -0,0 +1,30 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "chest pain is a common symptom of GERD$Cause_1": { + "chest pain$Input1": {} + }, + "These symptoms are common in GERD because stomach acid backs up into the esophagus and can cause discomfort.$Cause_1": { + "reports belching and gas$Input2": {} + }, + "Reflux is a direct symptom of GERD, while nausea, bloating, and abdominal pain may be gastrointestinal discomfort caused by acid reflux.$Cause_1": { + "nausea, bloating, ___ reflux, abdominal pain,$Input2": {} + }, + "Mild discomfort in the upper abdomen when deeply palpated is a common symptom of GERD and may indicate discomfort caused by reflux of stomach acid or contents into the esophagus$Cause_1": { + "mild discomfort with deep palpation in$Input5": {} + }, + "Shortness of breath during exercise may be a symptom of GERD$Cause_1": { + "test was stopped because of shortness of breath$Input6": {} + } + } + }, + "input1": "chest pain\n", + "input2": "The chest discomfort is no pain, it does not radiate and is located on the left side of his chest. The chest pressure is constant and not exacerbated with activity and not relieved with rest. rates it ___. says it feels similar to his presentation in ___ when he was stented. He felt like he was filling up with fluid although ___ SOB,ortophena, PND,and ___ swelling. Torsemide dose increased 2 days ago from 20 to 40 without relief despite losing 3 lbs since increasing dose. Discomfort is mild in the AM, gets worse throughout day however not associated with strenuous activity. \n\nNotably patient also reports belching and gas. In the ED intial vitals were: 4 96.7 77 95/55 18 100% RA. Labs significant for Cr 2.4 (from 1.0 baseline), negative troponin, pro-BNP 411. Patient was given: 250cc bolus followed by 500cc bolus. \n \n \n \nROS: No rececent URI sx, fevers, sweats, chills. + nausea, bloating, ___ reflux, abdominal pain, no vomitting or diarreha. all other ROs neg\n \n \nCardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "1. CARDIAC RISK FACTORS: +Type 2 Diabetes, +Dyslipidemia \n2. CARDIAC HISTORY: \n- PERCUTANEOUS CORONARY INTERVENTIONS: DES to LAD ___ \n- systolic CHF (most recent EF 25%) \n3. OTHER PAST MEDICAL HISTORY: \n- AVNRT s/p ablation ___ \n- chronic thrombocytopenia\n", + "input4": "Mother ___ ___ COLON CANCER \nFather ___ ___ CORONARY ARTERY DISEASE, DIABETES MELLITUS \nSister Living ___\n", + "input5": "VS: 97.8 60 90/40 80 98% RA \nGeneral: well appearing male in NAD, lying flat in bed \nHEENT: oropharynx clear \nNeck: no JVD \nCV: RRR, no mrg \nLungs: CTA ___ \nAbdomen: soft, nt, nd, mild discomfort with deep palpation in \nepigastrium \nExt: no CCE \nNeuro: moves all 4 extremities purposefully and without \nincident, no facial droop \nSkin: no mottling\n", + "input6": "___ 03:40PM BLOOD WBC-4.4 RBC-4.39* Hgb-13.1* Hct-37.1* \nMCV-85 MCH-29.9 MCHC-35.3* RDW-13.9 Plt ___\n___ 03:40PM BLOOD Neuts-59.6 ___ Monos-11.8* \nEos-2.0 Baso-1.0\n___ 03:40PM BLOOD Glucose-163* UreaN-55* Creat-2.4*# Na-135 \nK-4.4 Cl-92* HCO3-29 AnGap-18\n___:40PM BLOOD proBNP-411*\n___ 03:40PM BLOOD cTropnT-<0.01\n___ 06:46AM BLOOD Calcium-8.9 Phos-5.1* Mg-2.2\n\n\nEcho\nThe patient exercised for 6 minutes 0 seconds according to a ___ treadmill protocol ___ METS) reaching a peak heart rate of 19 bpm and a peak blood pressure of 130/50 mmHg. The test was stopped because of shortness of breath. This level of exercise represents a fair exercise tolerance for age. The exercise ECG was uninterpretable in the presence of a rate related LBBB (see exercise report for details). The blood pressure response to exercise was normal. There was a blunted heart rate response to stress [beta blockade]. \n\nResting images were acquired at a heart rate of 50 bpm and a blood pressure of 90/50 mmHg. These demonstrated mild left ventricular cavity dilation with severe global left ventricular hypokinesis with relative preservation of the basal inferolateral and apical walls (LVEF = ___ %). Right ventricular free wall motion is normal. There is no pericardial effusion. Doppler demonstrated no aortic stenosis, aortic regurgitation or significant mitral regurgitation or resting LVOT gradient. \n\nPost-exercise images were acquired within 44 seconds at heart rates of 104 to 68 beats/min. These demonstrated mild augmentation of the left ventricular function, most notably of the anterior wall with slight cavity size decrease.\n\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/18905329-DS-20.json b/Finished/Gastro-oesophageal Reflux Disease/18905329-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..b77deb8a7f68018ec5b78e52522cd9f2db5d94f8 --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/18905329-DS-20.json @@ -0,0 +1,36 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Acid reflux is a common symptom of GERD$Cause_1": { + "Acid reflux$Input1": {} + }, + "These symptoms are typical of GERD, which is the backflow of stomach acid or food from the stomach into the esophagus and mouth.$Cause_1": { + "heartburn and regurgitation with an accompanying bitter taste in her mouth$Input2": {} + }, + "Dysphagia is caused by long-term erosion of the esophagus by gastric acid, which may lead to changes in the structure or function of the esophagus.$Cause_1": { + "dysphagia when swallowing foods$Input2": {} + }, + "Nausea and vomiting These symptoms may be caused by acid reflux irritating the stomach lining.$Cause_1": { + "nausea, vomiting$Input2": {} + }, + "Stomach pain may be caused by gastritis or other stomach problems caused by stomach acid irritation$Cause_1": { + "stomach pain$Input2": {} + }, + "These symptoms may be caused by stomach acid backing up into the throat or windpipe$Cause_1": { + "dry cough, and intermittent hoarseness$Input2": {} + }, + "Omeprazole is essential for controlling symptoms, suggesting ongoing problems with gastric acid secretion$Cause_1": { + "symptoms are worse when she stops taking esomeprazole.$Input2": {} + } + } + }, + "input1": "Acid reflux\n", + "input2": "Ms. ___ is a ___ year-old female with years of heartburn and regurgitation with an accompanying bitter taste in her mouth. She also experiences dysphagia when swallowing foods such as broccoli, nausea, vomiting, stomach pain, dry cough, and intermittent hoarseness. These symptoms have persisted despite years of esomeprazole therapy, avoidance of spicy foods, eating early in the evening before bed, and sleeping with her head elevated. Her symptoms are worse when she stops taking esomeprazole.\n", + "input3": "- HTN\n- Metabolic syndrome\n- Bone spur left foot\n- Fibroid uterus\n- Plantar fasciitis\n- Greater trochanteric bursitis\n- Abnormalities of blood pressure\n- Kidney stones\n- Low back pain\n- Left foot and ankle pain\n", + "input4": "Father: Died of esophageal cancer\nMother: Died of a stroke\n", + "input5": "GEN: A&Ox3, NAD\nHEENT: No scleral icterus, mucus membranes moist\nCV: RRR, No M/G/R\nPULM: Clear to auscultation b/l, No W/R/R\nABD: Soft, nondistended, nontender, no rebound or guarding,\nnormoactive bowel sounds, no palpable masses\nExt: No ___ edema, ___ warm and well perfused\n", + "input6": "___ 06:52AM BLOOD WBC-9.7 RBC-3.93* Hgb-11.5* Hct-34.4* \nMCV-88 MCH-29.2 MCHC-33.3 RDW-14.4 Plt ___\n___ 06:52AM BLOOD Glucose-116* UreaN-7 Creat-0.7 Na-138 \nK-3.9 Cl-100 HCO3-28 AnGap-14\n___ 06:52AM BLOOD Calcium-8.8 Phos-3.4 Mg-1.8\n\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\n\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/19182957-DS-17.json b/Finished/Gastro-oesophageal Reflux Disease/19182957-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..b6db15856777245710b232ca125ee1bcd14c571c --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/19182957-DS-17.json @@ -0,0 +1,30 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Epigastric pain and back pain are typical and atypical symptoms of gastro-oesophageal reflux \rdisease.$Cause_1": { + "Her pain was constant, crampy, radiating to back, relievedare typical and atypical symptoms of gastro-oesophageal reflux \rdisease by 2 Tums.$Input2": {} + }, + "Epigastric pain and nausea are typical and atypical symptoms of gastro-oesophageal reflux \rdisease.$Cause_1": { + "In the morning, the patient continued to have epigastric pain and also developed nausea.$Input2": {} + }, + "Heratburn is a typical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "The patient was alert, awake, complaining of burning sensation.$Input2": {} + }, + "!Epigastric abdominal pain is an atypical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "Epigastric abdominal pain$Input1": {} + }, + "!Epigastric pain is an atypical symptom of gastro-oesophageal reflux \rdisease.$Cause_1": { + "A woman presents with complaints of epigastric pain$Input2": {} + } + } + }, + "input1": "Epigastric abdominal pain\n", + "input2": "A woman presents with complaints of epigastric pain, and an episode of dizziness. Per patient, she developed pain in mid-epigastric region at 2am this morning when she went to sleep about 2 hours after she ate. Her pain was constant, crampy, radiating to back, relieved by 2 Tums. She also reported some difficulty in swallowing saliva. She states that this pain is exactly the same as during her prior frequent episodes of indigestion. She states that she had some chocolate ice cream prior to going to sleep, and that this may have precipitated the episode. The patient denies shortness of breath, subjective fevers, chills, nightsweats, melena, hematochezia. In the morning, the patient continued to have epigastric pain and also developed nausea. The patient stood up to go to the bathroom and got lightheaded, diaphoretic, saw 'black dots', felt the room spin. She denies LOC, falling. After urinating, the patient felt like she was going to pass out, could not get off the commode. She called her daughter, who called. The daughter assisted the patient to bed. EMS found her sitting up with BP 80/60. In the ED, initial vitals 97.9 84 86/62 16 98% RA. The patient was alert, awake, complaining of burning sensation. Blood pressure increased to with observation. On exam, there was no CVA tenderness, no edema, no focal neurological deficits. Guaiac was negative. Labs were unremarkable, first set of CEs negative. CXR was unremarkable. The patient received donnatol, lidocaine, simethacone with some relief of her abdominal pain. She also received 2L of IVF. After hydration, VS were 106/70, HR 80, RR10, O2 100% RA. EKG unremarkable, she was admitted for and rehydration. ROS was otherwise essentially negative.\n", + "input3": "+DM\n+Dyslipidemia\n+HTN \n+Atypical chest pain\n+slip cervical disk\n+migraine headache\n- EGD notable for chronic inflammation of esophagus. \n+No Barretts\n", + "input4": "Sister died from MI. No history of arrhythmia, cardiomyopathies. History of ovarian ca in a niece. Otherwise non-contributory.\n", + "input5": "Vitals: T: 97.2 BP: 112/75 P: 71 R: 18 SaO2: 100% RA \nGENERAL: Pleasant, well appearing F in NAD \nHEENT: Normocephalic, atraumatic. No conjunctival pallor. No \nscleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No \nLAD, No thyromegaly. \nCARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs, \nrubs. No JVD. \nLUNGS: CTAB, good air movement biaterally. No reproducible tenderness to chest palpation \nABDOMEN: NABS. Soft, NT, ND. No HSM \nEXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior \ntibial pulses. \nSKIN: No rashes/lesions, ecchymoses. \nNEURO: A&Ox3. Appropriate. CN grossly intact. Preserved sensation throughout. Strength throughout. reflexes, equal. Normal coordination. Gait assessment deferred \nPSYCH: Listens and responds to questions appropriately, pleasant\n", + "input6": "11:20AM BLOOD WBC-6.4 RBC-4.41 Hgb-12.5 Hct-39.5 MCV-90 MCH-28.3 MCHC-31.7 RDW-12.6 Plt\n11:20AM BLOOD PTT-26.2\n11:20AM BLOOD Glucose-105 UreaN-10 Creat-1.0 Na-139 K-5.5* Cl-105 HCO3-26 AnGap-14\n11:20AM BLOOD ALT-12 AST-36 CK(CPK)-114 AlkPhos-49 TotBili-0.4\n11:20AM BLOOD Lipase-32\n06:50AM BLOOD Calcium-8.9 Phos-3.8 Mg-2.2\n11:20AM BLOOD Albumin-4.1\n\nCardiac Enzymes:\n\n11:20AM BLOOD CK-MB-2 cTropnT-<0.01\n09:10PM BLOOD CK-MB-NotDone cTropnT-<0.01\n06:50AM BLOOD CK-MB-NotDone cTropnT-<0.01\n11:20AM BLOOD CK(CPK)-114 \n09:10PM BLOOD CK(CPK)-75\n06:50AM BLOOD CK(CPK)-66\n\nCXR : No acute cardiopulmonary abnormality.\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\n" +} \ No newline at end of file diff --git a/Finished/Gastro-oesophageal Reflux Disease/19242928-DS-8.json b/Finished/Gastro-oesophageal Reflux Disease/19242928-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..9310dbc97673360c53fcb3cbaf56c9613961833c --- /dev/null +++ b/Finished/Gastro-oesophageal Reflux Disease/19242928-DS-8.json @@ -0,0 +1,33 @@ +{ + "gastro-oesophageal reflux \rdisease$Intermedia_3": { + "AET: 6.5% > 6% is the gold standard for gastro-oesophageal reflux \rdisease diagnosis$Cause_1": { + "Ambulatory reflux monitor :total AET:6.5% on pH-impedance monitoring$Input6": {} + }, + "suspected gastro-oesophageal reflux \rdisease$Intermedia_2": { + "Chest pain is a common symptom of GERD$Cause_1": { + "chest pain$Input1": {} + }, + "Indigestion is a common symptom of GERD, and acid reflux may cause this discomfort$Cause_1": { + "indigestion last night$Input2": {} + }, + "Heaviness in the chest and sweating may be symptoms of GERD$Cause_1": { + "chest heaviness and diaphhoresis$Input2": {} + }, + "A sore throat is also a common symptom of GERD$Cause_1": { + "acidness in the back of her throat$Input2": {} + }, + "A sour taste in the mouth is a direct sign of acid reflux.$Cause_1": { + "sour taste in her mouth$Input2": {} + }, + "Peptic ulcer disease directly involves the gastrointestinal system and may be related to GERD because ulcer and reflux symptoms may coexist and affect each other$Cause_1": { + "PUD$Input3": {} + } + } + }, + "input1": "chest pain\n", + "input2": "Per patient report last night she experienced indigestion last night and went to bed, she awoke with chest heaviness and diaphhoresis took her aspirin and called ___. in the ambulance she received 0.4 ntg spray and another 2 asprins. her pain came down to 4 out of 10. Upon arrival to ED she received 0.4 slntg and 0.5 inch ntg paste with pain down to ___. Gi cocktail given with no change in pain. no ECG changes but was then pain free. The patient felt the same symptoms prior to her Cardiac Arrest on ___.\n\nVital Sign Range at OSH (BP/ O2 sat / HR / Tele): 108/64 hr 70 sr, sa02 100% 2lnc, 97.6 rr 16.\n.\nshe was transferred to ___ cath lab where she underwent cardiac cath. Findings included open stent in LAD, no CAD. An angioseal was placed on rt groin and she was transferred to the floor.\n.\nOn the floor she complained of a burning sensation radiating up her chest but no chest heaviness. She also complained of a sour taste in her mouth and some acidness in the back of her throat. Additionally she had a migraine that had started in the cath lab and was relieved with tylenol.\n\n. \nOn review of systems, she denies cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations.\n", + "input3": ". CARDIAC RISK FACTORS: Dyslipidemia, Hypertension \n2. CARDIAC HISTORY: MI in ___ complicated by cardiac \narrest s/p stent placement in LAD on plavix\n-CABG: none\n-PERCUTANEOUS CORONARY INTERVENTIONS: cath as above\n-PACING/ICD: None\n3. OTHER PAST MEDICAL HISTORY: \nPUD last EGD ___ year ago with some abnormality that was not \nfollowed up because she had her arrest\nDepression\n", + "input4": "Mom has HTN and HL. No early MIs.\n", + "input5": "VS: T=98.9 BP=127/60 HR=63 RR=14 O2 sat= 100RA\nGENERAL: WDWN F in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. Conjunctiva were pink. \nNECK: Supple with JVP flat lying flat \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RR, normal S1, S2. No m/r/g. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi anteriorly.unable to examine posterior as patient on bedrest \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. \nPULSES: \nRight: DP 2+ \nLeft: DP 2+\n", + "input6": "___ 07:05AM BLOOD WBC-5.8 RBC-3.59* Hgb-10.0* Hct-30.3* \nMCV-84 MCH-27.7 MCHC-32.9 RDW-17.4* Plt ___\n___ 06:05PM BLOOD ___ PTT-22.4 ___\n___ 07:05AM BLOOD UreaN-10 Creat-0.7 Na-137 K-4.6 Cl-104\n\nEKG: NSR rate 66bpm. nl axis, intervals. No ST or TW changes.\n\nCardiac Cath: \nCOMMENTS: \n1. Selective coronary angiography of this left dominant system demonstrated mild one vessel nonobstructive coronary disease. The LMCA was very short and collinear with the LCX. The LAD had mild to moderate calcification. There was an ostial 40% plaque with superimposed catheter-induced spasm that improved (but did not resolve completely) with IC nitroglycerine. THere was hazy diffuse disease in the mid LAD to ___ with systolic bowing. The distal LAD wraps around the apex with slow flow after IC nitroglycerine consistent with microvascular dysfunction. \n\n- LCX had mild to moderate calcification. There was mild plaquing in the AV groove CX. There was a small OM1 and OM2, larger OM3, large LPL1 and a tripartite LPDA with septal LPDA the largest of the 3. \n\nThere was slow flow after IC nitroglycerine consistent with microvascular dysfunction. \n- RCA was small and nondominant. \n\n2. Limited resting hemodynamics demonstrated normal systemic arterial pressures (129/72 mmHg). There was no gradient on pullback of catheter from LV to aorta. LVEDP was normal at 5mmHg. \n\n3. Left ventriculography demonstrated 1+ non-ectopic mitral \nregurgitation. LV wall motion and LVEF were normal. \n \nFINAL DIAGNOSIS: \n1. No angiographically apparent flow limiting CAD but premature atherosclerosis evident with slow flow consistent with microvascular dysfunction. \n2. Normal systolic and diastolic LV function. \n\nLabs from OSH: ___ WBC 6.6, HGB 10.6, HCT 32.5, plt 337. \nCK 48, Trop <0.01, Na 136, K 4.6, Cl 102, Co2 25, BUN 13, Cr \n0.8, Glu 98, TBili 0.2, Alk phos 62, ALT 11, AST 81\n\nRadiology Results from OSH: cxr- ? of infiltrate in right lung base unchanged from ___. Consider follow up PA/Lateral.\n\nAmbulatory reflux monitor :total AET:6.5% on pH-impedance monitoring\n\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11386787-DS-17.json b/Finished/Heart Failure/11386787-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..86c66fd0897716be1f4dbea2f9b2a19c2b8772fd --- /dev/null +++ b/Finished/Heart Failure/11386787-DS-17.json @@ -0,0 +1,43 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u226535pg/ml is a diagnostic criteria of heart failure$Cause_1": { + "elevated BNP$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Breathlessness is a typical symptom of heart failure$Cause_1": { + "dyspnea on excertion$Input1": {} + }, + "previous medical history of coronary artery disease, arrhythmias and hypertension are risk factors of heart failure$Cause_1": { + "Past Medical History:\n1. CAD status post CABG. \n2. Paroxysmal atrial fibrillation. \n3. Hypertension. \n4. Tachybrady syndrome, status post pacemaker implantation.$Input3": {} + }, + "Breathlessness is a typical symptom of heart failure #$Cause_1": { + "progressive SOB over a period of months$Input2": {} + }, + "Reduced exercise tolerance is a typical symptom of heart failure$Cause_1": { + "he could hardly walk up 3 stairs ___ pausing to catch his breath$Input2": {} + }, + "Elevated jugular venous pressure is a specific sign of heart failure$Cause_1": { + "markedly elevated JVP$Input5": {} + }, + "Ankle swelling is a typical symptom of heart failure$Cause_1": { + "edema in legs$Input5": {} + } + } + } + } + }, + "input1": "dyspnea on excertion\n", + "input2": "\n___ year old male with CAD s/p CABG of asthma chief complaint of progressive SOB over a period of months. However, over the past week his symptoms have gotten progressively worse. At baseline, the patient exercises on stationary bike/tread mill for 1hr daily. However, on day PTA he could hardly walk up 3 stairs ___ pausing to catch his breath. He also reports wheezing. No relief w/ inhalers, however. Currently undergoing pul ___ (due to see ___. ___ wk). Had some pain in left low back day PTA, self resolved. Denies chest pain. + edema in legs.\n", + "input3": "\n1. CAD status post CABG. \n2. Paroxysmal atrial fibrillation. \n3. Hypertension. \n4. Tachybrady syndrome, status post pacemaker implantation. \n5. Hyperprolactinemia -- cause uncertain \n \nSocial History:\n___\nFamily History:\nN/C\n", + "input4": "None\n", + "input5": "\nAdmission\nVS - 96.5, 151/71, 73, 20, 95% RA \nGen: WDWN middle aged male in NAD. Oriented x3. Mood, affect \nappropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNeck: markedly elevated JVP \nCV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.\nLegs: edema in legs \n \nChest: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nAbd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by \npalpation. No abdominial bruits. \nExt: trace - 1+ edema \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.\n", + "input6": "\n___ 02:55PM BLOOD WBC-8.3 RBC-4.47* Hgb-13.2* Hct-38.5* \nMCV-86 MCH-29.6 MCHC-34.4 RDW-13.5 Plt ___\n___ 07:10AM BLOOD WBC-9.7 RBC-4.37* Hgb-13.2* Hct-38.1* \nMCV-87 MCH-30.2 MCHC-34.7 RDW-13.9 Plt ___\n___ 06:40AM BLOOD WBC-9.5 RBC-4.32* Hgb-12.5* Hct-37.8* \nMCV-87 MCH-28.8 MCHC-33.0 RDW-13.4 Plt ___\n___ 06:55PM BLOOD ___ PTT-36.1* ___\n___ 07:10AM BLOOD ___\n___ 07:10AM BLOOD Glucose-82 UreaN-20 Creat-1.2 Na-146* \nK-4.2 Cl-103 HCO3-35* AnGap-12\n___ 06:40AM BLOOD Glucose-84 UreaN-24* Creat-1.2 Na-144 \nK-4.1 Cl-103 HCO3-33* AnGap-12\n___ 02:55PM BLOOD CK(CPK)-56\n___ 09:20PM BLOOD CK(CPK)-52\n___ 02:55PM BLOOD CK-MB-NotDone cTropnT-<0.01 \nproBNP-___*: \n___ 09:20PM BLOOD cTropnT-<0.01\nBNP: elevated BNP\n\nEcho:\nHe also had an echo with a preserved EF, no wall motion abnormalities and no change from prior.\n\nCXR:\nThe left atrium is moderately dilated. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%).\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11422357-DS-14.json b/Finished/Heart Failure/11422357-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..0083ddb833987f110e5e23f3a09b094ea801ed01 --- /dev/null +++ b/Finished/Heart Failure/11422357-DS-14.json @@ -0,0 +1,46 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP \u2265125pg/ml is a diagnostic criteria of heart failure$Cause_1": { + "proBNP-7232$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Previous cardiac dysfunction is a risk factor of heart failure$Cause_1": { + "with a history of systolic CHF$Input2": {} + }, + "Breathlessness is a typical symptom of heart failure$Cause_1": { + "presents with shortness of breath$Input2": {} + }, + "Reduced exercise tolerance is a typical symptom of heart failure$Cause_1": { + "he could not walk or otherwise exert himself without becoming short of breath$Input2": {} + }, + "previous coronary heart disease is a risk factor of heart failure$Cause_1": { + "Coronary Artery Disease$Input3": {} + }, + "Abnormal electrocardiograph related to heart failure$Cause_1": { + "Prolonged Q-T interval$Input6": {} + }, + "Abnormal electrocardiograph related to heart failure #$Cause_1": { + "intraventricular conduction delay of the left bundle-branch block type persists$Input6": {} + }, + "Congestion showed in chest X-ray is related to heart failure$Cause_1": { + "Mild interstitial pulmonary edema is relatively similar when compared to the prior exam$Input6": {} + } + } + } + } + }, + "input1": "\nShortness of breath.\n", + "input2": "Mr. ___ is a ___ year old man with a history of systolic CHF who presents with shortness of breath which has been worsening for 4 days in the setting of dietary non-adherence. He says that he was in his usual state of health until 4 days ago when he had a string of \"4 barbeques\" in a row and ate \"all the bad things\", including hot dogs, cheeseburgers, sausages and other tasty salty snacks. He states that over the last 4 days he has had an insidious increase in his shortness of breath, to the point where he could not walk or otherwise exert himself without becoming short of breath. He attempted some of his wife's supplemental oxygen with improvement in shortness of breath. He tried 80mg PO of lasix (20mg above his usual dose of 60mg daily) to no avail. He endorses a progressively worsening dry cough, but denies any edema, weight gain, fevers/chills, or chest pain/pressure.\n", + "input3": "\nCoronary Artery Disease \nCHF with ICD placement.\nAflutter Ablation \nPeripheral Vascular Disease\nCVA\nTIA\nBilateral Carotid Artery Stenosis (60-69% right ICA stenosis, 40% left ICA stenosis) \nCervical Osteoarthritis \nGERD \nBPH \nDVT \nAmputation of Distal Phalanx\nHistory of Esophageal stricturebdilitation \nCholecystitis sp percutaneous cholecystostomy\n", + "input4": "None\n", + "input5": "\nADMISSION:\nVITALS: 98.0, 123/73, 61, 18, 98% on 2L \nGENERAL: well appearing man, conversant, able to speak full sentences without taking a breath, minimally dyspneic \nNECK: no carotid bruits, JVD at level of the jaw at 90 degrees \nLUNGS: CTAB \nHEART: RRR, normal S1 S2, no MRG \nABDOMEN: Soft, NT, NABS, no organomegaly, laparotomy scar \nEXTREMITIES: No c/c/e \nNEUROLOGIC: A+OX3 \n\n\nDISCHARGE:\nVITAL SIGNS: 97.5, (80-103/52-72), 59(58-63), 96%\n83.0kg from 85.3kg yesterday, dry weight = 81.6kg \nGENERAL: Well-developed, comfortable male appearing stated age. \nConversant, able to speak full sentences without dyspnea. \nHEENT: PERRL, EOMI, MMM \nNECK: no carotid bruits, JVD at level at 10cm from 12cm yesterday. \nLUNGS: CTAB \nHEART: RRR, normal S1 S2, no MRG \nABDOMEN: Soft, NT, slight distention, NABS, no organomegaly. \nEXTREMITIES: No edema, no clubbing/cyanosis \nNEUROLOGIC: A+OX3\n", + "input6": "\nADMISSION:\n\n___ 08:40PM BLOOD Glucose-87 UreaN-22* Creat-1.4* Na-137 \nK-4.3 Cl-103 HCO3-21* AnGap-17\n___ 08:40PM BLOOD WBC-8.2 RBC-5.04 Hgb-14.9 Hct-45.0 MCV-89 \nMCH-29.7 MCHC-33.2 RDW-15.1 Plt ___\n___ 08:40PM BLOOD Neuts-73.5* ___ Monos-6.5 Eos-1.3 \nBaso-0.5\n___ 08:40PM BLOOD ___ PTT-31.9 ___\n___ 08:40PM BLOOD Calcium-9.6 Phos-4.6* Mg-2.3\n___ 08:42PM BLOOD ___ pO2-59* pCO2-37 pH-7.37 \ncalTCO2-22 Base XS--3 Intubat-NOT INTUBA\n___ 08:40PM BLOOD proBNP-7232*\n\nRELEVANT:\n\n___ 08:40PM BLOOD proBNP-7232*\n___ 08:40PM BLOOD cTropnT-0.01\n\nDISCHARGE:\n\n___ 06:06AM BLOOD Glucose-87 UreaN-27* Creat-1.3* Na-140 \nK-4.0 Cl-102 HCO3-24 AnGap-18\n___ 06:06AM BLOOD Calcium-9.6 Phos-4.0 Mg-2.4\n\n___ EKG:\nSinus rhythm. Prolonged Q-T interval. Left atrial abnormality. Intraventricular conduction defect. Possible anteroseptal myocardial infarction, age undetermined. Lateral ST-T wave changes are non-specific but may be due to ischemia. Compared to the previous tracing of ___ the rate has decreased and intraventricular conduction delay of the left bundle-branch block type persists. The lateral T wave changes are not as apparent on the current tracing. Clinical correlation is suggested. \n\n___ CXR:The left atrium is moderately dilated. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%).\n \nFINDINGS: \n \nThe patient is status post median sternotomy and CABG. Left-sided AICD/pacemaker lead terminates in the right ventricle, unchanged. Moderate cardiomegaly is redemonstrated. The mediastinal and hilar contours are unchanged. Mild interstitial pulmonary edema is relatively similar when compared to the prior exam. No pleural effusion or pneumothorax is identified. There are no acute osseous abnormalities. \n \nIMPRESSION: \n \nMild interstitial pulmonary edema.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11459120-DS-14.json b/Finished/Heart Failure/11459120-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..4cd49e0163d9804439f663e85f1fc5baa5b844cf --- /dev/null +++ b/Finished/Heart Failure/11459120-DS-14.json @@ -0,0 +1,40 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440 is the critiera for HFrEF$Cause_1": { + "LVEF 40%$Input2": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "myocardial infarction$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP was elevated at 5802$Input2": {} + }, + "Suspected heart failure$Intermedia_2": { + "Peripheral edema is a sign of heart failure$Cause_1": { + "pleural effusions$Input2": {} + }, + "Weight gain is a sign of heart failure$Cause_1": { + "weight gain$Input2": {} + }, + "Breathlessness is a symptom of heart failure$Cause_1": { + "SOB$Input2": {} + }, + "Atrial fibrillation\nis a risk factor of heart failure$Cause_1": { + "Atrial fibrillation$Input3": {} + }, + "Hypertension is a risk factor of heart failure$Cause_1": { + "Hypertension$Input3": {} + } + } + } + } + }, + "input1": "diarrhea, leg swelling\n", + "input2": "75 YO woman with severe LV contractile systolic (leg swelleg swellingEF 40%) and diastolic dysfunction, PAF on coumadin and amiodarone who presented with worsening leg swelling, weight gain, SOB, and diarrhea. Pt is poor historian. She did report liquidy, brown, non-bloody diarrhea for 6 days prior to presentation with resulting limited PO intake. The diarrhea was associated with crampy, diffuse/epigastric abdominal pain. She denied nausea but reported vomiting a few times (non-bloody). She denied fevers, chills, urinary symptoms. No chest pain or SOB, per patient, though NH records did indicate SOB and DOE. \n\nPatient had recent admission s/p fall with CHF exacerbation. At that time, her meds were changed. \n\nUpon admission, the patient was on: Asa 81mg daily, torsemide 20mg BID, HCTZ 12.5 daily, Amiodarone 200mg daily, Lisinopril 2.5mg daily, Warfarin, Metoprolol 12.5mg daily, and KCL 20mg daily. \n. \nUpon discharge, the patient was on: ASA 81, Amiodarone 200 daily, Warfarin, KCl 40 daily, Metoprolol 12.5 BID, Lasix 60qam and 40qpm, lisinopril 2.5 daily, and tylenol prn. \n\nASA was stopped. K and Ca were d/c'd and lasix was changed to qod patient c/o nausea. The physician noted pitting edema and changed her Lasix to 80mg daily. Her dry weight is 128-130lbs. Her weight upon admission was 135 and her weight upon transfer was 137.3. She never \nhad an oxygen requirement. \n\nIn the ED, the patient had a CXR showing question of a retrocardiac opacity as well as pleural effusions. She was given Levofloxacin for possible PNA. BNP was elevated at 5802 (was 733 at OSH. EKG was unchanged fBNP was elevated at 5802rom prior with stable trop (0.10). A CT abd w/o contrast was performed for her diarrhea and revealed no pathology. LFT's were normal. Vitals 96.9 BP 104/45 HR 51 RR 17 96% RA. 900cc urine output in ED. Admitted for likely CHF exacerbation. \n \nOn the floor, pt had no complaints. She denied CP, SOB and reported improvement in abdominal cramping. She had one large liquid brown stool on arrival to the floor.\n", + "input3": "+Atrial fibrillation\n+CHF \n+HTN \n+C-spine stenosis \n+GERD \n+mod MR \n+bursitis shoulders bilat \n+Hypertension\n+Systolic and likely diastolic CHF: EF 40-45%\n", + "input4": "There is no family history of premature coronary artery disease or sudden death. Brother w valvular dz NOS.\n", + "input5": "VS - afebrile SBP 129 to 92 with lisinopril HR ___ 99%RA \nGen: WDWN elderly female in NAD. Oriented to person and hospital only. Hard of hearing and slow to answer questions. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNeck: Supple with JVD to the ear lobe. \nCV: PMI located in intercostal space, midclavicular line. brady, regular, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. +Bibasilar crackles, no wheezes or rhonchi. \nAbd: Soft, distended. No HSM or tenderness. No abdominial bruits. \nExt: 2+ pitting b/l ___ edema to thighs bilaterally. No femoral bruits. \nSkin: Several pinpoint pressure ulcers on buttocks. No stasis dermatitis, scars, or xanthomas.\n", + "input6": "___ 10:55AM ___ PTT-28.7 ___\n___ 10:55AM PLT COUNT-261\n___ 10:55AM NEUTS-79.7* LYMPHS-13.2* MONOS-5.1 EOS-1.5 BASOS-0.5\n___ 10:55AM WBC-7.6 RBC-5.30 HGB-13.0 HCT-40.6 MCV-77* MCH-24.5* MCHC-32.0 RDW-19.2*\n___ 10:55AM ALBUMIN-3.7 CALCIUM-9.6 PHOSPHATE-3.7 MAGNESIUM-2.3\n___ 10:55AM CK-MB-NotDone proBNP-5802*\n___ 10:55AM cTropnT-0.10*\n___ 10:55AM LIPASE-31\n___ 10:55AM ALT(SGPT)-15 AST(SGOT)-28 CK(CPK)-29 ALK PHOS-100 TOT BILI-0.9\n___ 10:55AM GLUCOSE-110* UREA N-30* CREAT-1.5* SODIUM-141 POTASSIUM-3.8 CHLORIDE-105 TOTAL CO2-23 ANION GAP-17\n___ 11:00AM GLUCOSE-111* LACTATE-2.4* NA+-140 K+-3.5 CL--105 TCO2-23\n___ 11:20AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG\n___ 09:00PM cTropnT-0.10*\n___ 09:00PM CK(CPK)-22*\n\nEKG:\n___: Probable ectopic atrial rhythm with AV delay. Left axis deviation suggests left anterior fascicular block and possible prior inferior myocardial infarction. Delayed R wave progression with late precordial QRS transition may be due in part to left anterior fascicular block and/or prior anterior myocardial infarction. Diffuse nonspecific ST-T wave changes. Prominent U waves could be due to bradycardia or possible drug/metabolic/electrolyte effect. Since previous tracing, ectopic atrial rhythm suggested and Q-Tc interval appears shorter.\n\n___: Probable ectopic atrial rhythm with AV delay Left axis deviation suggests left anterior fascicular block and possible prior inferior myocardial infarction. Delayed R wave progression with late precordial QRS transition may be due in part to left anterior fascicular block and/or prior anterior myocardial infarction. Diffuse nonspecific ST-T wave changes. Prominent U waves could be due in part to bradycardia or possible drug/metabolic/electrolyte effect. Since previous tracing, no significant change \n\nCXR:\n___: FINDINGS: The previously noted Swan-Ganz catheter has been removed. No lines are in place at this time. There are diminished lung volumes. Extensive retrocardiac opacity is noted, likely atelectasis, although an early developing pneumonia cannot be excluded. There is blunting of the left costophrenic angle and to a lesser severity on the right as well, possibly due to small effusions. No gross consolidation is seen. There is no definite superimposed edema. Again noted is a tortuous atherosclerotic aorta. The cardiac silhouette is markedly enlarged but stable. No displaced fractures are evident. IMPRESSION: Retrocardiac opacity likely atelectasis, although pneumonia cannot be entirely excluded. There are likely bilateral small pleural effusions, right greater than left. \n\nAbdominal XR: \n___: FINDINGS: Study is mildly compromised secondary to habitus. No definite dilated loops of small bowel are evident. There is stool throughout the descending colon. No abnormal calcifications are noted overlying the renal fossae. There is a curvilinear calcification in the left deep pelvis, presumably vascular in origin. Extensive degenerative disease is noted throughout the included thoracolumbar spine. IMPRESSION: No radiographic evidence for obstruction. \n\nCT abd and pelvis:\n___: CT OF THE ABDOMEN WITHOUT IV CONTRAST: Please note the lack of intravenous contrast, significantly limits detailed evaluation of the intra-abdominal organs and bowel. There are bilateral small pleural effusions, left greater than right with associated atelectasis. Marked cardiomegaly is additionally noted. An 8-mm low-attenuation focus within the left lobe of the liver is too small to characterize but likely represents a simple cyst (2:21). Similarly, a 7-mm low-attenuation focus in the right lobe of the liver is too small to characterize but also likely represents a simple cyst (2:26). The liver is otherwise unremarkable. Please note, moderate abdominal and pelvic ascites also limits detailed evaluation. The spleen, adrenal glands, pancreas, stomach, and abdominal portions of the small bowel appear grossly unremarkable. There are bilateral simple renal cysts, the largest of which is located at the upper pole of the right kidney and measures 5.3 cm in diameter (2:20). The kidneys are otherwise unremarkable. Numerous colonic diverticula are present. T\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11459120-DS-16.json b/Finished/Heart Failure/11459120-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..3c86fddf470ea3a40906e605ff5c45c21cf3cf1f --- /dev/null +++ b/Finished/Heart Failure/11459120-DS-16.json @@ -0,0 +1,43 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-5145$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Breathlessness is a symptom of heart failure$Cause_1": { + "has oxygen for nighttime use at home, but felt that she was still dyspneic at rest even when on 2L$Input2": {} + }, + "Fatigue is a typicalsymptoms of heart failure$Cause_1": { + "feeling progressively more lethargic over the past two months$Input2": {} + }, + "Pleural effusion is a sign of heart failure$Cause_1": { + "CXR showed increased fluid in the lungs$Input2": {} + }, + "Hypertension is a risk factor of heart failure$Cause_1": { + "PMH of HTN$Input2": {} + }, + "Dyslipidemia is a risk factor of heart failure$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Atrial fibrillation\nis a risk factor of heart failure$Cause_1": { + "atrial fibrillation$Input3": {} + } + } + } + } + }, + "input1": "Shortness of Breath\n", + "input2": "71 year old female with PMH of HTN, b/l PE, Afib s/p pacemaker, asthma now presenting with SOB and general malaise. Pt reports having been feeling progressively more lethargic over the past two months; states that her last time at her USOH was 2 months ago. She reports having increased urinary frequency in the past month, and especially in the past week. She had one episode of chills in her apartment but her temperature at that time was 99, per her report. She has oxygen for nighttime use at home, but felt that she was still dyspneic at rest even when on 2L.\n\nShe called her NP yesterday and was diagnosed with a UTI and rx'd macrobid, of which she has taken two doses. She called EMS this morning when she was lethargic and felt nauseous despite not having eaten anything. On arrival to the ED, she was noted to be very pale. Her initial vitals were 97.8 82 ___ 98%(2L). Hemeoccult was negative. Her crit was low at 29 and her INR was high at 4.1 while in the ED. CXR showed increased fluid in the lungs, with some question of focal R opacities that could be infectious in nature. She was given 40 mg IV lasix, had a catheter placed and was transferred to the floor for diuresis. She reports having two pillow orthopnea at baseline and is not sure of her dry weight. She does not weigh herself daily.\n", + "input3": "+Dyslipidemia\n+Hypertension \n+atrial fibrillation, on coumadin \n+hypothyroidism \n+depression \n+b/l TKRs \n+left thumb CMC joint arthritis \n+Tracheobronchomalacia w/ recurrent pneumonias and tracheal\nstent and stent removal\n+Paraesophageal hiatial hernia s/p repair ___ \n+GERD s/p fundoplication\n", + "input4": "Mother: HTN, CVA\nNo family hx of anemia.\n", + "input5": "VS- T=97.7 BP=154/79 HR=60 RR=20 O2 sat=96(2L)\nWeight: 110 kg \nGENERAL- WDWN propped up in bed in NAD. Oriented x3. Mood, affect appropriate. \nHEENT- NCAT. EOMI. Conjunctiva were pale but no cyanosis of the oral mucosa. \nNECK- No appreciable JVD at 60 degree angle \nCARDIAC- PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS- No chest wall deformities, scoliosis or kyphosis. Resp were labored but no accessory muscle use. Bibasilar crackles audible; deep breaths provoke coughing. \nABDOMEN- Soft, NTND. \nEXTREMITIES- Cool to touch. Appear to be slightly edematous (2+ nonpitting edema) \nSKIN- No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES- Carotid 2+ DP 1+ Radial 2+\n", + "input6": "Admission:\n___ 02:40PM BLOOD Neuts-87.2* Lymphs-8.6* Monos-3.2 Eos-0.8 Baso-0.2\n___ 02:40PM BLOOD ___ PTT-32.3 ___\n___ 02:40PM BLOOD Glucose-104* UreaN-20 Creat-0.8 Na-140 K-4.6 Cl-107 HCO3-23 AnGap-15\n___ 02:40PM BLOOD cTropnT-<0.01 proBNP-5145*\n\nDischarge:\n___ 05:35AM BLOOD WBC-6.5 RBC-3.50* Hgb-9.8* Hct-31.3* MCV-89 MCH-27.9 MCHC-31.3 RDW-15.7* Plt ___\n___ 05:35AM BLOOD Glucose-93 UreaN-35* Creat-1.1 Na-138 K-4.6 Cl-97 HCO3-31 AnGap-15\n___ 05:35AM BLOOD Calcium-10.1 Phos-3.3 Mg-2.4\n\nStudies:\nCHEST (PA & LAT) ___ \"Mild asymmetric pulmonary edema. Additional more peripheral opacities on the right could be concerning for an underlying infectious process. Recommend follow up radiographs after diuresis.\"\n\nTTE (Complete) Done ___ \"Conclusions: The left atrium is moderately dilated. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. The estimated cardiac index is normal (>=2.5L/min/m2). 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 aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. Moderate (2+) mitral regurgitation is seen. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. \nIMPRESSION: Normal biventricular cavity sizes with preserved global biventricular systolic function. Moderate mitral regurgitation. Pulmonary artery hypertension. Moderate tricuspid regurgitation. Compared with the prior study (images reviewed), the severity of mitral regurgitation has increased.\"\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11459120-DS-17.json b/Finished/Heart Failure/11459120-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..63e40226502641d54f01bd34f84c7e9695d9630b --- /dev/null +++ b/Finished/Heart Failure/11459120-DS-17.json @@ -0,0 +1,61 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNPBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-5145$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Breathlessness is a symptom of heart failure$Cause_1": { + "Shortness of Breath$Input1": {} + }, + "Loss of appetite is a symptom of heart failure$Cause_1": { + "does not have an appetite$Input2": {} + }, + "hypertension is a risk factor of heart failure$Cause_1": { + "hypertension$Input3": {} + }, + "asthma is a risk factor of heart failure$Cause_1": { + "asthma$Input3": {} + }, + "atrial fibrillation is a risk factor of heart failure$Cause_1": { + "atrial fibrillation$Input3": {} + }, + "Pleural effusion is a sign of heart failure$Cause_1": { + "Mild asymmetric pulmonary edema$Input6": {} + }, + "pulmonary artery systolic hypertension is a sign of heart failure$Cause_1": { + "moderate pulmonary artery systolic hypertension$Input6": {} + }, + "Fatigue is a symptom of heart failure$Cause_1": { + "general fatigue$Input1": {} + }, + "orthopnea is a symptom of heart failure$Cause_1": { + "orthopnea$Input2": {} + }, + "Metabolic disease is a risk factor of heart failure$Cause_1": { + "hypothyroidism$Input3": {} + }, + "Peripheral edema is a sign of heart failure$Cause_1": { + "slightly edematous$Input5": {} + }, + "Syncope is a symptom of heart failure$Cause_1": { + "fallfall$Input1": {} + } + } + } + } + }, + "input1": "fall x2, general fatigueShortness of Breath\n", + "input2": "Female w/ hx of afib, PPM, hypothyroid, CKD, PE presents after fall x 2 at home. Patient was attempting to get out of bed this morning and fell to the floor, hitting her bottom. She pushed life alert and EMS came. They helped her back into bed. She later attempted to walk to the bathroom and fell again. However she did hit the back of her head and neck on a window as she fell. Denies LOC before or after fall. Denies chest pain, palpitations, shortness of breath, dizziness, lightheadedness. States she often falls because her knees give out. \n\nShe does feel weak overall. She has stable 2 pillow orthopnea and DOE (can not walk more than a block). She does not take her lasix for her CHF because it makes her urinate too frequently. States she is on 1.5L of O2 at home for \"her heart.\" She has been eating less than usual lately because she does not have an appetite. She denies fevers, chills, abdominal pain, nausea, vomiting. She denies dysuria or hematuria but does endorse urinary frequency. She denies any fever or chills but does have chronic productive cough. She was treated for a UTI last week with p.o. Cipro and finished antibiotic for several days ago. She has a history of recurrent UTIs (see below). \n\nHx of recurrent UTIs: Last UTI with multi-drug resistant organism. Pt was tx with Macrodantin. Recently saw Dr. B urology. It is unclear whether these represent symptomatic UTIs or is just asymptomatic bacteriuria. Pt states that everytime she falls she finds out she has a UTI. She denies any dysuria, hematuria, subprapubic pain, smelling or cloudy urine during these episodes. Does state she has urinary freq and incontinence.\n \nPt video-urodynamic study in that showed Hypersensitive, low capacity bladder, Reflux grade to both kidneys, Detrusor over activity- terminal. Pt given Gentamycin 80 mg IV given right hip and started Cipro BID x five days. Plan for cystoscopy with Dr. B.\n\nHx of frequent falls: Pt states she has been falling frequently for several years. Had been having about one fall/mo but states now that she uses a walker she has been falling much less. Evaluated by neuro for these frequent falls (1x/mo) and gait problems (felt shakey and unsteady on her feet). Gait disorder and falls thought to be from by loss of proprioception due to large fiber peripheral neuropathy. Had been concern for NPH given enlarged ventricles out of proportion to atrophy on CT but given lack of clinical symptoms at that time, further workup not pursued.\n\nIn the ED, initial vs were: 99.0 98 180/96 20 96% 2L Labs were remarkable for UA with neg nitrites, few bac, 29 wbc. INR 2.3. Patient was given Acetaminophen 500mg. \n \nOn the floor, pt states she continues to have a mild right temporal headache and shoulder pain where she fell. \n \nReview of sytems: \n(+) Per HPI, +HA, + cough, +DOE, +chronic knee pain \n(-) Denies fever, chills, night sweats, recent weight loss or gain. Denies sinus tenderness, rhinorrhea or congestion. Denies shortness of breath. Denies chest pain or tightness, palpitations. Denies nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Ten point review of systems is otherwise negative.71 year old female with PMH of HTN, b/l PE, Afib s/p pacemaker, asthma now presenting with SOB and general malaise. Pt reports having been feeling progressively more lethargic over the past two months; states that her last time at her USOH was 2 months ago. She reports having increased urinary frequency in the past month, and especially in the past week. She had one episode of chills in her apartment but her temperature at that time was 99, per her report. She has oxygen for nighttime use at home, but felt that she was still dyspneic at rest even when on 2L.\n\nShe called her NP yesterday and was diagnosed with a UTI and rx'd macrobid, of which she has taken two doses. She called EMS this morning when she was lethargic and felt nauseous despite not having eaten anything. On arrival to the ED, she was noted to be very pale. Her initial vitals were 97.8 82 ___ 98%(2L). Hemeoccult was negative. Her crit was low at 29 and her INR was high at 4.1 while in the ED. CXR showed increased fluid in the lungs, with some question of focal R opacities that could be infectious in nature. She was given 40 mg IV lasix, had a catheter placed and was transferred to the floor for diuresis. She reports having two pillow orthopnea at baseline and is not sure of her dry weight. She does not weigh herself daily.\n", + "input3": "+hypothyroidism\n+hypertension \n+asthma \n+atrial fibrillation\n+depression\n+tracheobronchomalacia\n+chronic renal insufficiency -- last Cr 0.7\n+PE in w/ saddle embolus thus restarted\n+DVT--unsure date\n+congestive heart failure \n+polyneuropathy\n+pacemaker placement\n+bilateral knee replacements \n+left shoulder replacement\n+hiatal hernia \n+bladder repair+Dyslipidemia\n+Hypertension \n+atrial fibrillation, on coumadin \n+hypothyroidism \n+depression \n+b/l TKRs \n+left thumb CMC joint arthritis \n+Tracheobronchomalacia w/ recurrent pneumonias and tracheal\nstent and stent removal\n+Paraesophageal hiatial hernia s/p repair ___ \n+GERD s/p fundoplication\n", + "input4": "Mother: HTN, CVAMother: HTN, CVA\nNo family hx of anemia.\n", + "input5": "Vitals: T: 98.1 BP: 116/37 P: 76 R: 22 O2: 95% on 1L NC\nGeneral: Lethargic, resting comfortably, on 1L\nHEENT: dry MMM, neck supple, no LAD, temple and occiput of head tender to palpation\nCV: no MRG, s1/s2\nLungs: diffuse crackles bilaterally to mid-lung fiends\nAbdomen: soft, NTND, no suprapubic pain or tenderness, no HSM \nGU: deffered \nExt: warm, well perfused, 2+ pulses\nNeuro: AOx3, CN2-12 intact, ___ strength in upper and lower extremities equal bilaterally \nMS: right hip tender to palpation \nSkin: superficial scratch on right shoulderVS- T=97.7 BP=154/79 HR=60 RR=20 O2 sat=96(2L)\nWeight: 110 kg \nGENERAL- WDWN propped up in bed in NAD. Oriented x3. Mood, affect appropriate. \nHEENT- NCAT. EOMI. Conjunctiva were pale but no cyanosis of the oral mucosa. \nNECK- No appreciable JVD at 60 degree angle \nCARDIAC- PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS- No chest wall deformities, scoliosis or kyphosis. Resp were labored but no accessory muscle use. Bibasilar crackles audible; deep breaths provoke coughing. \nABDOMEN- Soft, NTND. \nEXTREMITIES- Cool to touch. Appear to be slightly edeslightly edematousmatous (2+ nonpitting edema) \nSKIN- No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES- Carotid 2+ DP 1+ Radial 2+\n", + "input6": "___ 02:30PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 02:30PM URINE BLOOD-SM NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-MOD\n___ 02:30PM URINE RBC-10* WBC-29* BACTERIA-FEW YEAST-NONE EPI-<1 TRANS EPI-<1\n___ 02:30PM URINE MUCOUS-RARE\n___ 12:55PM GLUCOSE-88 UREA N-23* CREAT-0.8 SODIUM-136 POTASSIUM-4.5 CHLORIDE-101 TOTAL CO2-26 ANION GAP-14\n___ 12:55PM CK(CPK)-36\n___ 12:55PM proBNP-1883*\n___ 12:55PM TSH-12*\n___ 12:55PM WBC-10.4 RBC-4.26 HGB-12.6 HCT-38.6 MCV-91 MCH-29.5 MCHC-32.6 RDW-15.5\n___ 12:55PM NEUTS-86.4* LYMPHS-8.0* MONOS-4.4 EOS-1.0 BASOS-0.2\n___ 12:55PM PLT COUNT-202\n___ 12:55PM ___ PTT-31.7 ___\n___ 12:28PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-SM \n___ 12:28PM URINE RBC-2 WBC-12* BACTERIA-FEW YEAST-NONE EPI-24\n\n\nCT Head: No acute intracranial abnormality. \n\nCT C-spine: No acute fracture. Anterolisthesis of C2 on C3 and C3 on C4 is unchanged. An area of ground glass opacification in the right upper lobe could represent an early focus of pneumonia.\n\nXR Knee: No fracture or effusion. Hardware aligned anatomically though there is mild hyperextension at the tibiofemoral joint which is of unclear significance. \n\nXR Hip: No injuries. \n\nCXR: AP supine portable views of the chest provided. Dual lead pacer appears unchanged in position. A left shoulder arthroplasty is again noted. The lungs are clear bilaterally without focal consolidation, layering effusion or supine evidence for pneumothorax. The cardiomediastinal silhouette is stable. No definite bony abnormalities are seen.Admission:\n___ 02:40PM BLOOD Neuts-87.2* Lymphs-8.6* Monos-3.2 Eos-0.8 Baso-0.2\n___ 02:40PM BLOOD ___ PTT-32.3 ___\n___ 02:40PM BLOOD Glucose-104* UreaN-20 Creat-0.8 Na-140 K-4.6 Cl-107 HCO3-23 AnGap-15\n___ 02:40PM BLOOD cTropnT-<0.01 proBNP-5145*\n\nDischarge:\n___ 05:35AM BLOOD WBC-6.5 RBC-3.50* Hgb-9.8* Hct-31.3* MCV-89 MCH-27.9 MCHC-31.3 RDW-15.7* Plt ___\n___ 05:35AM BLOOD Glucose-93 UreaN-35* Creat-1.1 Na-138 K-4.6 Cl-97 HCO3-31 AnGap-15\n___ 05:35AM BLOOD Calcium-10.1 Phos-3.3 Mg-2.4\n\nStudies:\nCHEST (PA & LAT) ___ \"Mild asymmetric pulmonary edema. Additional more peripheral opacities on the right could be concerning for an underlying infectious process. Recommend follow up radiographs after diuresis.\"\n\nTTE (Complete) Done ___ \"Conclusions: The left atrium is moderately dilated. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. The estimated cardiac index is normal (>=2.5L/min/m2). 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 aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. Moderate (2+) mitral regurgitation is seen. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. \nIMPRESSION: Normal biventricular cavity sizes with preserved global biventricular systolic function. Moderate mitral regurgitation. Pulmonary artery hypertension. Moderate tricuspid regurgitation. Compared with the prior study (images reviewed), the severity of mitral regurgitation has increased.\"\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11459120-DS-20.json b/Finished/Heart Failure/11459120-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..0ec11c0016b72f2d935af66f1b17e0f2e4581299 --- /dev/null +++ b/Finished/Heart Failure/11459120-DS-20.json @@ -0,0 +1,52 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The right atrium is moderately dilated$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP 7299$Input2": {} + }, + "Suspected heart failure$Intermedia_2": { + "Dyspnea is a symptom of heart failure$Cause_1": { + "Dyspnea$Input1": {} + }, + "Breathlessness is a symptom of heart failure$Cause_1": { + "worsening SOB$Input2": {} + }, + "Pleural effusion is a sign of heart failure$Cause_1": { + "pleural effusion$Input2": {} + }, + "orthopnea is a symptom of heart failure$Cause_1": { + "orthopnea$Input2": {} + }, + "diabetes is a risk factor of heart failure$Cause_1": { + "diabetes$Input3": {} + }, + "coronary artery disease is a risk factor of heart failure$Cause_1": { + "coronary artery disease$Input3": {} + }, + "Hypertension is a risk factor of heart failure$Cause_1": { + "Hypertension$Input3": {} + }, + "Peripheral edema is a sign of heart failure$Cause_1": { + "edema to shins$Input5": {} + }, + "Obesity is a risk factor of heart failure$Cause_1": { + "Obesity$Input3": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "He is with h/o CAD and NSTEMI s/p CABG, DM, HL, HTN, h/o colon CA presented with worsening SOB x 2 weeks. Notes SOB is worst when lying flat. Does not note any significant increasing edema. Denies CP, f/c. States he's noticed a mild cough with white phlegm production recently. Also thinks glands might be swollen. Saw Cardiologist, had CXR done, which showed known (?loculated) L pleural effusion which is now larger. Pt referred to interventional pulm for drainage of L pleural effusion, however unable to get appt until late. Contacted cardiologist for continued SOB/DOE/orthopnea, subsequently advised to come to ED for admission/tx of CHF and possible drainage of L pleural effusion. Denies fevers, chills, sweats. States smoked 4ppd, but quit. Denies any previous admissions for SOB or CHF. Was last admitted for CABG, echo at the time showed EF 50-55%, PCWP 18. States he used water pills years ago, but nothing previously. ED vitals were 97.2 74 160/66 20 98% RA. Labs sig for BNP 7299 (no previous), Trop 0.02, Cr 1.1, lytes unremarkable, WBC 8.9 (N 72%), Hct 33.2. Given furosemide 40mg IV and ASA 325mg. UOP in ED was 600cc. ECG SNR, rate 75, poor R wave progression, otherwise unremarkable. CXR showed small bilateral effusions, increase in pulmonary interstitial edema from prior exam. VS prior to transfer, 98.1 76 151/82 16 100%RA. Given 20mg IV furosemide at 6 AM. Patient diuresed 1200cc overnight \n\nOn the floor, pt was comfortable with orthopnea, but no complaints sitting up. States he's been urinating a lot. Notes some bilateral shoulder discomfort when lying flat, worse on left side. Resolves when sitting up. Cardiac review of systems is notable for absence of chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope\n", + "input3": "+Longstanding insulin-requiring diabetes \n+Obesity \n+Multivessel coronary artery disease \n+Hypertension \n+Dyslipidemia \n+Carotid stenosis s/p post left CEA \n+Colon cancer s/p partial colectomy with subsequent negative colonoscopies \n+Orthostatic hypotension \n+Charcot foot \n+Depression \n+Neuropathy\n", + "input4": "Father and mother had Type 2 diabetes. Daughter died of cancer.\n", + "input5": "VS: T98.2, 160/82, 74, 22, 95%RA ___ 116 Wt 120.4kg \nGENERAL: obese elderly man in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\nNECK: Supple with JVP of 10cm @ 45deg. No LAD appreciated. \nCARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4 appreciated. \nLUNGS: sternotomy scar pink and healing. Resp were unlabored, no accessory muscle use, speaking full sentences, mildly tachypneic when lying at 45deg. decreased breath sounds at LLL posteriorly, rales lung on left and a base on right. no wheezes or rhonchi. \nABDOMEN: Obese, Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c. 1+ edema to shins. 2+ pulses in DP and b/l\n", + "input6": "___ 07:10PM GLUCOSE-90 UREA N-25* CREAT-1.1 SODIUM-142 POTASSIUM-3.6 CHLORIDE-107 TOTAL CO2-25 ANION GAP-14\n___ 07:10PM estGFR-Using this\n___ 07:10PM CK(CPK)-37*\n___ 07:10PM cTropnT-0.02*\n___ 07:10PM CK-MB-3 proBNP-___*\n___ 07:10PM CALCIUM-8.8 PHOSPHATE-3.6 MAGNESIUM-1.8\n___ 07:10PM WBC-8.9 RBC-3.75* HGB-10.6* HCT-33.2* MCV-89 MCH-28.3 MCHC-31.9 RDW-15.3\n___ 07:10PM NEUTS-72.0* LYMPHS-13.7* MONOS-7.2 EOS-6.5* BASOS-0.6\n___ 07:10PM PLT COUNT-320\n\n___ 06:50AM BLOOD WBC-9.3 RBC-3.60* Hgb-10.2* Hct-32.3* MCV-90 MCH-28.3 MCHC-31.6 RDW-15.1 Plt ___\n___ 06:50AM BLOOD ___ PTT-31.3 ___\n___ 06:50AM BLOOD Glucose-85 UreaN-41* Creat-1.3* Na-144 K-4.2 Cl-106 HCO3-28 AnGap-14\n\nImaging: \nECG (___): Sinus rhythm. Prolonged P-R interval. Possible old anterior myocardial infarction. Compared to the previous tracing of no change. \n \nChest Xray (___): Small bilateral effusions, increase in pulmonary interstitial edema from prior exam. \n\nSurface Echo (___):\nVery poor image quality.The left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral, distal LV/apical near akinesis suggested. No masses or thrombi are seen in the left ventricle. There is no ventricular septal defect. Right ventricular chamber size is normal. with borderline normal free wall function. The number of aortic valve leaflets cannot be determined. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Tricuspid regurgitation is present but cannot be quantified. There is no pericardial effusion. \n\nCompared with the prior study (images reviewed), the LVEF has decreased (apical/distal LV segments now appear to have depressed contractile function). If indcated, a cardiac MRI may bettter assess regional/global LV systolic function. \n \nPharmacologic induced stress test (___): \nEKG: SINUS ___., PRWP, LAE \nHEART RATE: 58 BLOOD PRESSURE: 130/72 \n \nSYMPTOMS: NONE \nST DEPRESSION: NONE\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11459120-DS-27.json b/Finished/Heart Failure/11459120-DS-27.json new file mode 100644 index 0000000000000000000000000000000000000000..8e564a7ef0e52e1eb81a52d0169355ca2023f597 --- /dev/null +++ b/Finished/Heart Failure/11459120-DS-27.json @@ -0,0 +1,58 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF 35%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "Left ventricular hypertrophy$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP->70000$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Breathlessness is a symptom of hmaeart failure$Cause_1": { + "shortness of breath$Input1": {} + }, + "Paroxysmal nocturnal dyspnoea is a typical symptom of heart failure$Cause_1": { + "worsening dyspnea, especially at night when laying flat$Input2": {} + }, + "Peripheral edema is a sign of heart failure$Cause_1": { + "worsening of lower extremity edema$Input2": {} + }, + "pulmonary vascular congestion is a sign of heart failure$Cause_1": { + "pulmonary vascular congestion$Input2": {} + }, + "diabetes type II is a risk factor of heart failure$Cause_1": { + "diabetes type II$Input3": {} + }, + "hypothyroidism is a risk factor of heart failure$Cause_1": { + "hypothyroidism$Input3": {} + }, + "hypertension is a risk factor of heart failure\n\nhypertension$Cause_1": { + "hypertension$Input3": {} + }, + "chronic kidney disease is a risk factor of heart failure$Cause_1": { + "chronic kidney disease$Input3": {} + }, + "anemia is a risk factor of heart failure$Cause_1": { + "anemia$Input3": {} + }, + "atrial fibrillation\nis a risk factor of heart failure$Cause_1": { + "atrial fibrillation$Input3": {} + }, + "pleural effusions is a sign of heart failure$Cause_1": { + "pleural effusions$Input6": {} + } + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "Female with PMHx sCHF (thrombocytopenia, asthma, h/o MRSA, VRE, CRE, recent GI bleed c/b NSTEMI p/w dyspnea x1wk. Patient describes gradual onset of worsening dyspnea, especially at night when laying flat. Also reports worsening of lower extremity edema. No fevers, chills, nausea, vomiting, chest pain. \n\nOn review of OMR it would appear patient's lasix was held on prior hospitalization in the setting and GIB. Patient presented hematology apptmt w worsening lower extremity edema and was told to restart lasix. Per the patient's daughter, she is uncertain if lasix was actually restarted at that time. Since that visit, patient's daughter reports worsening \n\nOn presentation to ED initial vital signs were 97.4 98 126/86 24 100% 4L Nasal Cannula. Exam was notable for diffuse wheeze. CXR demonstrated signs of pulmonary vascular congestion. Labs were significant for WBC 5.6, Cr 1.6, lactate 1.6, BNP>7000. Patient was given nebulizers, 40mg IV lasix and was admitted to medicine for CHF exacerbation. Vital signs prior to transfer were 97.4 98 123/81 18 100% RA. \n\nOn arrival to the floor, vitals were 97.6 121/70 96 16 100%2L. Patient reported feeling comfortable. On review of systems she denied fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, BRBPR, melena, hematochezia, dysuria, hematuria.\n", + "input3": "+asthma \n+diabetes type II dx'd\n+hypothyroidism \n+hypertension \n+chronic kidney disease- baseline crt 1.3-1.4; likely secondary to hypertensive nephrosclerosis \n+anemia \n+eosinophilia \n+depression \n+glaucoma \n+osteoarthritis \n+h/o syndrome w/ celecoxib \n+facial cellulitis tx w/ Bactrim\n+history of atrial fibrillation\n", + "input4": "Her sister had diabetes, brother has heart disease and sister had a stroke\n", + "input5": "VS: 97.6 121/70 96 16 100%2L \nI: 1500 O: 3200\nGENERAL: NAD, comfortable \nHEENT: PERRL, EOMI, MMM, OP clear \nNECK: Supple, 8cm JVD, no LAD \nHEART: RRR, no MRG \nLUNGS: Inspiratory crackles thoughout, good air movement, no wheezing \nABDOMEN: Soft/NT/ND, no rebound/guarding \nEXTREMITIES: WWP, 1+ edema to knee, 2+ pulses \nNEURO: AOx3, CNs II-XII grossly intact, moving all extremities, gait not observed\n", + "input6": "ADMISSION LABS\n___ 01:20AM BLOOD WBC-5.6 RBC-3.32* Hgb-10.9* Hct-33.3* MCV-100* MCH-32.8* MCHC-32.7 RDW-15.7* Plt ___\n___ 01:20AM BLOOD Neuts-54.7 ___ Monos-5.3 Eos-2.1 Baso-0.8\n___ 01:20AM BLOOD ___ PTT-28.9 ___\n___ 01:20AM BLOOD Glucose-113* UreaN-36* Creat-1.6* Na-135 K-4.5 Cl-101 HCO3-22 AnGap-17\n___ 01:20AM BLOOD CK-MB-2 cTropnT-0.08* proBNP->70000\n___ 10:40AM BLOOD CK-MB-2 cTropnT-0.08*\n___ 04:55PM BLOOD CK-MB-2 cTropnT-0.07*\n___ 01:27AM BLOOD Glucose-102 Lactate-1.6 Na-135 K-4.5 Cl-99* calHCO3-25\n\nOTHER WORK UP \n___ 04:10AM BLOOD calTIBC-183* Ferritn-606* TRF-141*\n___ 04:10AM BLOOD TSH-1.2\n\nIMAGING\nECG: Sinus rhythm. Left ventricular hypertrophy with probable secondaryrepolarization changes. Delay in R wave transition. Modest Q-T intervalprolongation.\n\nCHEST, AP AND LATERAL: Right PICC has been removed. There is no pneumothorax. Moderate-to-severe cardiomegaly has increased, with a persistently tortuous and calcified aorta. There is new pulmonary vascular congestion and interstitial edema, with small to moderate bilateral pleural effusions. Fluid is also noted layering along the right major fissure.\nLVEF 35%\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11465548-DS-9.json b/Finished/Heart Failure/11465548-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..4768edb72bdbd6140862a477c658e6a7d291c44a --- /dev/null +++ b/Finished/Heart Failure/11465548-DS-9.json @@ -0,0 +1,49 @@ +{ + "HFmrEF$Intermedia_5": { + "40\u2264LVEF\uff1c50% is the critiera for HFmrEF$Cause_1": { + "Overall left ventricular systolic function is mildly depressed (LVEF= 45-50 %)$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Cardiac diastolic dysfunction is a diagnostic criteria of heart failure$Cause_1": { + "Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). Doppler parameters are most consistent with Grade III/IV (severe) left ventricular diastolic dysfunction$Input6": {} + }, + "Cardiac diastolic dysfunction is a diagnostic criteria of heart failure #$Cause_1": { + "Severe LV diastolic dysfunction.$Input5": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-5145$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Peripheral oedema is a sign of heart failure$Cause_1": { + "Chief Complaint:\nscrotal and leg swelling$Input1": {} + }, + "Congestion showed in chest X-ray is related to heart failure$Cause_1": { + "CXR showed mild pulmonary edema.$Input2": {} + }, + "Pulmonary crepitations is a sign of heart failure$Cause_1": { + "LUNG: bibasilar rales that do not clear with deep inspiration$Input5": {} + }, + "Peripheral oedema is a sign of heart failure #$Cause_1": { + "In the last 3 days his scrotum has become quite swollen$Input2": {} + }, + "Ankle swelling is a sign of heart failure$Cause_1": { + "EXTREMITIES: bilateral pitting edema to the sacrum, extending to the mid abdomen. Warm, well perfused.$Input5": {} + }, + "Cardiomyopathy, diabetes and hypertension are risk factors of heart failure$Cause_1": { + "Past Medical History:\n-CHF/Cardiomyopathy: Mild systolic and severe diastolic dysfunction. \n-Diabetes \n-Hypertension$Input3": {} + } + } + } + } + }, + "input1": "Chief Complaint:\nscrotal and leg swelling\n", + "input2": "CKD stage 4 thought secondary to DM/HTN, OSA who complains of worsening PND, DOE, and testicular swelling. The PND and DOE have been worsening over several weeks gradually. He denies chest pain or acute changs. In the last 3 days his scrotum has become quite swollen. It is similar scrotal swelling when he was admitted with acute CHF. He was seen 1 week with gross anasarca. At that time, his lasix was increased from 40mg QD to 80mg BID. In the ED initial vitals were: 99.4 95 200/92 18 98% RA. Blood pressure remained 200/90 throughout the ED course. Labs were significant for Cr 3.5, steadily uptrending since ___ (1.3->1.6->2.4->3.2). EKG was consistent with priors (NSR, NANI, no ischemic changes). CXR showed mild pulmonary edema. He was given 40IV lasix with good UOP. Bedside cardiac ultrasound w/mild effusion no evidence of tamponade physiology. Bedside scrotal ultrasound shows fluid, mild hydrocoele, no evidence of vascular compromise (performed by Dr. ___ director). On arrival to the floor he triggered for hypertensive urgency with blood pressure 230/125 c/o headache and photophobia. Neurologic examination was normal at that time. He had not received any BP medications today (missed lisinopril, amlodipine, toprol). Was given IV hydral with good response on the floor.\n", + "input3": "Past Medical History:\n-CHF/Cardiomyopathy: Mild systolic and severe diastolic dysfunction. \n-Diabetes \n-Hypertension \n-Hypercholesterolemia \n-CKD, stage 3 \n-Depression/Schizophrenia \n-OSA\n", + "input4": "\n", + "input5": "Physical Exam:\nADMISSION EXAM\n\nGENERAL: NAD \nHEENT: AT/NC, EOMI, PERRL \nNECK: nontender supple neck, no LAD, JVD to the mandible \nCARDIAC: regular tachycardia, S1/S2, no murmurs, gallops, or rubs \nLUNG: bibasilar rales that do not clear with deep inspiration\nABDOMEN: nondistended, nontender in all quadrants \nEXTREMITIES: bilateral pitting edema to the sacrum, extending to the mid abdomen. Warm, well perfused. \nNEURO: CN II-XII intact. strength in the upper and lower extremities bilaterally. \n\nDISCHARGE EXAM\n\nT 98.8, BP 130-150s/60-70, 99% on RADRY WEIGHT 120.6kg\nGENERAL: NAD \nHEENT: AT/NC, EOMI, PERRL \nNECK: nontender supple neck, no LAD, JVD 8cm \nCARDIAC: regular tachycardia, S1/S2, no murmurs, gallops, or rubs \nLUNG: trace bibasilar crackles \nABDOMEN: nondistended, +BS, nontender in all quadrants \nEXTREMITIES: 3+ bilateral pitting edema to the knee. Warm, well perfused. Scrotum swollen but diminished from prior, not tight.\nRECTAL: Guaiac negative stool \nNEURO: CN II-XII intact. A&Ox3\n", + "input6": "Pertinent Results:\n===========\nADMISSION LABS\n=============\n\n___ 03:50PM BLOOD WBC-8.0 RBC-3.26* Hgb-9.3* Hct-30.9* \nMCV-95 MCH-28.4 MCHC-29.9* RDW-13.6 Plt ___\n___ 03:50PM BLOOD ___ PTT-33.3 ___\n___ 03:50PM BLOOD Glucose-168* UreaN-37* Creat-3.5* Na-142 \nK-5.0 Cl-110* HCO3-20* AnGap-17\n___ 07:10AM BLOOD ALT-23 AST-26 LD(LDH)-266* AlkPhos-96 \nTotBili-0.4\n___ 07:10AM BLOOD ___\n___ 06:10PM BLOOD Calcium-8.0* Phos-4.7* Mg-1.8\n___ 07:10AM BLOOD calTIBC-182* Ferritn-373 TRF-140*\n___ 07:10AM BLOOD Triglyc-83 HDL-50 CHOL/HD-2.9 LDLcalc-76\n___ 07:10AM BLOOD C3-142 C4-27 proBNP-5145\n\n=============\nDISCHARGE LABS\n=============\n___ 06:50AM BLOOD WBC-6.4 RBC-2.60* Hgb-7.3* Hct-24.5* \nMCV-94 MCH-28.1 MCHC-29.9* RDW-13.2 Plt ___\n___ 06:50AM BLOOD Plt ___\n___ 06:50AM BLOOD Glucose-131* UreaN-62* Creat-4.8* Na-139 \nK-3.7 Cl-106 HCO3-26 AnGap-11\n___ 06:50AM BLOOD LD(LDH)-184\n___ 06:50AM BLOOD Calcium-8.4 Phos-5.2* Mg-1.9\n___ 06:50AM BLOOD Hapto-333*\n\n===============\nIMAGING\n==============\n\nTTE: \nThe left atrium is moderately dilated. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is ___ mmHg. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is mildly depressed (LVEF= 45-50 %) without regional wall motion abnormalities. Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). Doppler parameters are most consistent with Grade III/IV (severe) left ventricular diastolic dysfunction. Right ventricular chamber size and free wall motion are normal.The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. Trace aortic regurgitation is seen. The mitral valve leaflets are structurally normal.There is no mitral valve prolapse. Physiologic mitral regurgitation is seen (within normal limits). There is mild pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. \nIMPRESSION: Moderate symmetric left ventricular hypertrophy with mild global hypokinesis. Severe LV diastolic dysfunction. Mild pulmonary hypertension.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11475050-DS-27.json b/Finished/Heart Failure/11475050-DS-27.json new file mode 100644 index 0000000000000000000000000000000000000000..4fc4dbc631934908636c3c188f8199f989bd7a78 --- /dev/null +++ b/Finished/Heart Failure/11475050-DS-27.json @@ -0,0 +1,49 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is mildly dilated$Input6": {} + }, + "Cardiac diastolic dysfunction is a diagnostic criteria of heart failure$Cause_1": { + "Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg)$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-3843$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Breathlessness is a symptom of heart failure$Cause_1": { + "In the past few days, she says that she has become increasingly short of breath.$Input2": {} + }, + "Valve disease is a risk factor of heart failure$Cause_1": { + "aortic stenosis$Input3": {} + }, + "Hypertension is a risk factor of heart failure$Cause_1": { + "hypertension$Input3": {} + }, + "Metabolic disease is a risk factor of heart failure$Cause_1": { + "hypothyroidism$Input3": {} + }, + "Pulmonary crepitations is a sign of heart failure$Cause_1": { + "Breath sounds dulled at bases; crackles bilaterally midway up lungs.$Input5": {} + }, + "Valve disease is a risk factor of heart failure #$Cause_1": { + "The patient with a history of aortic stenosis s/p porcine valve replacement$Input2": {} + }, + "Congestion showed in chest X-ray is related to heart failure$Cause_1": { + "New mild-to-moderate interstitial abnormality, most suggestive of congestive heart failure.\"$Input6": {} + } + } + } + } + }, + "input1": "\nSOB, Fatigue\n", + "input2": "The patient with a history of aortic stenosis s/p porcine valve replacement, asthma, hyperlipidemia and HTN preseting for SOB and fatigue. \nShe stated that this fatigue has been increasing over the past two weeks. In the past few days, she says that she has become increasingly short of breath. Per the chart, she had chest pain at her PCP's office, but she stated that it was related to her cough when asked about it today. She states that it is a soreness that is substernal and that she has begun coughing up blood-tinged sputum lately. (At baseline, she has a productive cough secondary to asthma). She was sent to the emergency department earlier today for desats into the mid ___ at her PCPs office. She denied syncope, lightheadedness, palpitations. She has 2 pillow orthopnea at baseline, no reports of PND. In addition to the above symptoms she also complains of recent nausea. She denies abdominal pain, vomiting and diarrhea.\nIn the ED, initial vitals were 98.4 84 148/65 18 95% 2L. She was given IV vancomycin for suspected cellulitis of her L leg and one 50 mg dose of metoprolol. On arrival to the floor, she stated that she was feeling \"a bit better\" and stated that her main complaint was that she was \"tired.\"\n", + "input3": " \n1. CARDIAC RISK FACTORS: Dyslipidemia, Hypertension \n2. CARDIAC HISTORY: \n-Surgery: aortic stenosis s/p porcine valve replacement \n\n3. OTHER PAST MEDICAL HISTORY: \ndysfunctional uterine bleeding\nallergic rhinitis\nanxiety\naortic stenosis\nasthma\ncarotid stenosis\ncataracts\nDJD,\nessential thrombocythemia\nhyperlipidemia\nhypertension\nhypothyroidism\nMeniere's disease\nosteoarthritis\nosteoporosis\nphlebitis\nrosacea\n", + "input4": "None\n", + "input5": "\nAdmission:\nVS- 99 136/50 77 20 96% 2L 65.6 kg \nGENERAL- WDWN lying in bed in NAD. Oriented x3. Mood, affect appropriate. \nHEENT- NCAT. Sclera anicteric. PERRL, EOMI NECK- Supple with JVP of 10 cm. \nCARDIAC- PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2 with distinct systolic murmur ___ audible at all points anteriorly. \nLUNGS- Midline scar present. Resp were unlabored, no accessory muscle use. Breath sounds dulled at bases; crackles bilaterally midway up lungs. \nABDOMEN- Soft, NTND. No HSM or tenderness. \nEXTREMITIES- No c/c/e. \nSKIN- L shin warm and slightly red; R shin discolored with bruise \nPULSES- Carotid 2+ DP 2+ ___ 2+ \n\nDischarge:\nVS- 97.4 ___ 98% 2L 63.3 kg (down from \n64.1) \nGENERAL- WDWN lying in bed in NAD. Oriented x3. Mood, affect appropriate. \nNECK- No appreciable JVD + Hepatojugular reflux \nCARDIAC- PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2 with distinct systolic murmur ___ audible at all points anteriorly. \nLUNGS- Midline scar present. Resp were unlabored, no accessory muscle use. Slight wheeze at base of R lung; no crackles audible today bilaterally \nABDOMEN- Soft, NTND. No HSM or tenderness. \nEXTREMITIES- No c/c/e. \nSKIN- L shin warm and slightly red; R shin discolored with bruise \nPULSES- Carotid 2+ DP 2+ ___ 2+\n", + "input6": "\nAdmission:\n___ 11:30AM BLOOD WBC-7.3 RBC-3.27* Hgb-11.4* Hct-33.8* \nMCV-104* MCH-35.0* MCHC-33.8 RDW-16.9* Plt ___\n___ 11:30AM BLOOD Neuts-78.9* Lymphs-9.9* Monos-7.2 Eos-0.8 \nBaso-0.4\n___ 11:30AM BLOOD ___ PTT-35.4 ___\n___ 11:30AM BLOOD Glucose-141* UreaN-24* Creat-0.8 Na-140 \nK-4.4 Cl-100 HCO3-27 AnGap-17\n___ 11:30AM BLOOD proBNP-3843*\n___ 11:30AM BLOOD cTropnT-<0.01\n___ 11:30AM BLOOD Calcium-8.5 Phos-3.1 Mg-2.0\n___ 11:38AM BLOOD Lactate-1.1\n\nDischarge:\n___ 11:30AM BLOOD WBC-7.3 RBC-3.27* Hgb-11.4* Hct-33.8* \nMCV-104* MCH-35.0* MCHC-33.8 RDW-16.9* Plt ___\n___ 08:02AM BLOOD WBC-5.3 RBC-3.20* Hgb-11.3* Hct-33.7* \nMCV-105* MCH-35.3* MCHC-33.5 RDW-16.7* Plt ___\n___ 07:40AM BLOOD Glucose-159* UreaN-23* Creat-0.7 Na-140 \nK-4.2 Cl-101 HCO3-30 AnGap-13\n___ 08:02AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:40AM BLOOD Calcium-9.0 Phos-3.4 Mg-2.1\n\nStudies:\n- CXR ___: \"New mild-to-moderate interstitial abnormality, most suggestive of congestive heart failure.\"\n\n- UNITLAT LOW EXT VEINS ___: \"No evidence of deep vein thrombosis.\"\n\n- ECG ___ 11:21:06 AM \"Sinus arrhythmia. Left atrial abnormality. Possible prior anteroseptal myocardial infarction. \nBorderline left ventricular hypertrophy with associated ST segment changes. Compared to the previous tracing of ___ the ventricular rate is faster and atrial ectopy is no longer appreciated\"\n\n- TTE ___: \"The left atrium is mildly dilated. No atrial septal defect is seen by 2D or color Doppler. The estimated right atrial pressure is ___ mmHg. There is moderate symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. \nOverall left ventricular systolic function is normal (LVEF>55%). \nTissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). There is a mild resting left ventricular outflow tract obstruction. Right ventricular chamber size and free wall motion are normal. The diameters of aorta at the sinus, ascending and arch levels are normal. A bioprosthetic aortic valve prosthesis is present. The prosthetic aortic valve leaflets appear normal The transaortic gradient is higher than expected for this type of prosthesis. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. [Due to acoustic shadowing, the severity of mitral regurgitation may be significantly UNDERestimated.] Moderate [2+] tricuspid regurgitation is seen. \nThe estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \n\nIMPRESSION: Well-seated bioprosthetic aortic valve with normally functioning leaflets and increased transaortic valvular gradients. Increased left ventricular filling pressure. Mild resting LVOT obstruction. At least mild mitral regurgitation in the setting of moderate mitral annular calcification. Moderate tricuspid regurgitation. Normal pulmonary artery systolic pressure.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11607177-DS-14.json b/Finished/Heart Failure/11607177-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..69bbdfd15b6cb0692b243fd7475e963f809fe620 --- /dev/null +++ b/Finished/Heart Failure/11607177-DS-14.json @@ -0,0 +1,52 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226430% is the critiera for HFrEF$Cause_1": { + "LVEF 30%$Input2": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "cardiomegaly$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-3938$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Breathlessness is a symptom of heart failure$Cause_1": { + "shortness of breath$Input1": {} + }, + "weight gain is a sign of heart failure$Cause_1": { + "weight gain$Input1": {} + }, + "Fatigue is a typicalsymptom of heart failure$Cause_1": { + "fatigue$Input2": {} + }, + "atrial fibrillation\nis a risk factor of heart failure$Cause_1": { + "atrial fibrillation$Input2": {} + }, + "cough is a symptom of heart failure$Cause_1": { + "cough$Input2": {} + }, + "hypertension is a risk factor of heart failure$Cause_1": { + "hypertension$Input3": {} + }, + "hyperlipidemia is a risk factor of heart failure$Cause_1": { + "hyperlipidemia$Input3": {} + }, + "metabolic syndrome\nis a risk factor of heart failure$Cause_1": { + "metabolic syndrome$Input3": {} + }, + "coronary artery disease is a risk factor of heart failure$Cause_1": { + "coronary artery disease$Input3": {} + } + } + } + } + }, + "input1": "shortness of breath and weight gain\n", + "input2": "71 yo male with PMH significant for ischemic cardiomyopathy (EF 30%), HTN, CVA, CAD and recent onset afib who presented to his PCP today with worsening shortness of breath and 5 lb weight gain over 5 days. Pt reports last feeling well when he noticed increasing SOB and fatigue. He was later admitted for acute on chronic systolic CHF and new onset atrial fibrillation for which cardioversion could not be achieved. He was discharged with a number of changes to his medication regimen which included increasing Metoprolol from 25 to 100 XL and Furosemide from 20 to 40mg daily. Although he had scripts for these two medication changes, he was not able to take the increased dose because of difficulty with insurance approval. In the last week the patient has reported worsening shortness of breath and dyspnea with little exertion. He hasn't been able to sleep for the last 3 nights because of PND and need to sit upright. He reports drinking his normal intake of water but reports infrequent urination with small volumes. Additionally, he reports having a diet with high salt content. Reports non-productive cough for several weeks. Denies fevers, chills, abdominal pain, nausea or vomiting. After gaining 5lbs today, he saw his PCP who recommended he come to the ED. \n\nIn the ED, initial vitals were 95.1 106 132/98 24 100% ra. CXR demonstrated mild-to-moderate pulmonary edema. Labs notable for elevated BNP to 4000, subtherapeutic 1.6. He was given 20mg IV lasix. EKG demonstrated prior anterior infarct. \n\nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. S/he denies recent fevers, chills or rigors. S/he denies exertional buttock or calf pain. All of the other review of systems were negative. \n\nCardiac review of systems is notable for absence of chest pain, syncope or presyncope.\n", + "input3": "+hypertension \n+hyperlipidemia \n+gout \n+metabolic syndrome \n+sleep apnea\n+esophagitis\n+coronary artery disease, s/p silent MI in the past \n+systolic CHF: last TTE showing EF 30% \n+total knee replacement (left)\n", + "input4": "Mother: diabetes\n", + "input5": "VS: T=97.9 BP= 103/90 HR=83 RR=18 O2 sat= 98 RA \nGENERAL: WDWN morbidly obese male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. PERRL, EOMI.MMM\nNECK: Supple, unable to assess JVP because of body habitus. \nCARDIAC: Irregularly irregular. Distant heart sounds. normal S1, S2. No m/r/g. No S3 or S4. \nLUNGS: Resp were unlabored, no accessory muscle use. Bibasilar crackles. No rhonchi or wheezing.\nABDOMEN: Obese, soft, +BS. \nEXTREMITIES: Trace L>R. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nRight: Carotid 2+ Femoral 2+ DP 2+\nLeft: Carotid 2+ Femoral 2+ DP 2+\n", + "input6": "___ 12:45PM BLOOD Neuts-70.2* ___ Monos-4.5 Eos-2.5 Baso-0.7\n___ 12:45PM BLOOD ___ PTT-47.5* ___\n___ 12:45PM BLOOD Glucose-136* UreaN-21* Creat-1.1 Na-137 K-4.4 Cl-100 HCO3-26 AnGap-15\n___ 12:45PM BLOOD proBNP-3938*\n___ 12:45PM BLOOD cTropnT-0.01\n___ 06:20AM BLOOD CK-MB-2 cTropnT-0.02*\n\nDischarge Labs:\n___ 06:45AM BLOOD WBC-8.7 RBC-4.56* Hgb-12.6* Hct-39.7* MCV-87 MCH-27.6 MCHC-31.7 RDW-13.8 Plt ___\n___ 06:45AM BLOOD Glucose-141* Creat-1.2 Na-136 K-4.4 Cl-100 HCO3-28 AnGap-12\n\n\nECG Study \nAtrial fibrillation with a controlled ventricular response. Possible remoteposterolateral myocardial infarction. Diffuse non-specific ST-T \nwave abnormalities. Compared to the previous tracing there is a slight decrease in ventricular response rate. Left axis deviation\n\n\nCXR: AP, lateral \n\nFINDINGS: Moderate cardiomegaly is similar. The cardiac and mediastinal contours appear unchanged. There is again hazy upper zone re-distribution of pulmonary vascularity with a mild to moderate appearance of perihilar fullness and interstitial changes in the mid and lower lungs, most consistent with mild-to-moderate congestion. There is no pleural effusion or pneumothorax.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11691034-DS-3.json b/Finished/Heart Failure/11691034-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..6638dc242c5944a38affa3a6c896faef166de7b1 --- /dev/null +++ b/Finished/Heart Failure/11691034-DS-3.json @@ -0,0 +1,46 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF=35%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "left ventricular hypertrophy$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP 4814$Input2": {} + }, + "Suspected heart failure$Intermedia_2": { + "Developed shortness of breath is a symptom of heart failure$Cause_1": { + "Developed shortness of breath$Input2": {} + }, + "CAD is a risk factor of heart failure$Cause_1": { + "CAD$Input3": {} + }, + "Atrial fibrillation is a risk factor of heart failure$Cause_1": { + "Atrial fibrillation$Input3": {} + }, + "Type 2 diabetes mellitus is a risk factor of heart failure$Cause_1": { + "Type 2 diabetes mellitus$Input3": {} + }, + "Hypercholesterolemia is a risk factor of heart failure$Cause_1": { + "Hypercholesterolemia$Input3": {} + }, + "Obesity is a risk factor of heart failure$Cause_1": { + "Obesity$Input3": {} + }, + "Pleural effusion is a sign of heart failure$Cause_1": { + "pulmonary edema$Input2": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "He is with CAD, DM, AFib on coumadin, CKD, presenting with rapidly progressive shortness of breath beginning yesterday. \n\nDeveloped shortness of breath, worse on exertion but present at rest, yesterday morning. Progressed since that time without other symptoms (notably no fever, cough, chest pain). Lower extremity left (unilateral) edema stable for last three months. Able to sleep flat, no PND. Some chest discomfort without anginal equivalent (as per two previous MIs). Follows glucose carefully. No history of previous CHF. \n\nIn the ED, initial vs 96.1 116 142/81 24 100%15LNRB. CXR showed moderate pulmonary edema and cardiomegaly. BNP 4814 trop 0.04 Cr 1.4 INR 3.2. Treated with BiPAP with improvement. Given ASA 325 mg, lasix 10 mg IV (700 cc UOP), levofloxacin 750 mg IV, and solumedrol 125 mg IV. Vital signs prior to transfer 91 109/65 98%4LNC.\n", + "input3": "+CAD status post two MIs\n+Atrial fibrillation - The patient is anticoagulated with a\ngoal INR of 2 to 3. \n+Type 2 diabetes mellitus \n+Glaucoma\n+Hypercholesterolemia\n+Obesity\n+Gait instability\n+Chronic low back pain\n+Basal cell skin cancers\n", + "input4": "The patient reports that his mother died of a CVA and his father died of an MI. One brother died of liver disease. Another brother has a long history of tobacco abuse and suffers from emphysema.\n", + "input5": "General: Alert, oriented, using accessory muscles for breathing\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no lymphadenopathy \nLungs: Audible wheezes heard at the bedside, no wheezes on auscultation, crackles bilaterally, increased fremitus in right posterior upper lung field\nCV: Regular rate and rhythm, soft S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nExt: Warm, well perfused, weak pulses, no clubbing, cyanosis. Pitting edema in right lower leg to the mid-calf. Calf supple, nontender, and non-erythematous.\nNeuro: Alert, oriented to person, place, date, context of admission. CN II - XII intact. Bulk reduced in legs more than arms. Tone increased in legs. Power full throughout. Sensation not tested. Reflexes brisk with spread at patella (contrateral spread), upper extremity reflexes not elicitable, even with reinforcement. Coordination fast and accurate. Intention tremor on FNF, but not lower extremities method). Gait deferred.\nSkin: no leg hair, shiny skin (trohpic changes).\n", + "input6": "___ 07:30AM BLOOD WBC-12.5*# RBC-3.87* Hgb-11.0* Hct-35.7* MCV-92 MCH-28.6 MCHC-30.9* RDW-13.4 Plt ___\n___ 03:10AM BLOOD WBC-13.5*# RBC-3.43* Hgb-10.2* Hct-30.6* MCV-89 MCH-29.9 MCHC-33.5 RDW-13.6 Plt ___\n___ 08:55AM BLOOD WBC-15.7* RBC-3.41* Hgb-10.2* Hct-31.0* MCV-91 MCH-29.9 MCHC-32.8 RDW-13.8 Plt ___\n___ 12:50PM BLOOD WBC-16.3* RBC-3.87* Hgb-11.0* Hct-34.8* MCV-90 MCH-28.3 MCHC-31.5 RDW-13.3 Plt ___\n___ 06:30AM BLOOD WBC-13.0* RBC-3.47* Hgb-10.4* Hct-31.2* MCV-90 MCH-29.9 MCHC-33.3 RDW-13.7 Plt ___\n___ 07:30AM BLOOD ___ PTT-29.1 ___\n___ 07:16PM BLOOD ___\n___ 03:10AM BLOOD ___ PTT-28.7 ___\n___ 06:30AM BLOOD ___ PTT-29.8 ___\n___ 07:30AM BLOOD Glucose-327* UreaN-31* Creat-1.4* Na-138 K-4.8 Cl-106 HCO3-19* AnGap-18\n___ 03:10AM BLOOD Glucose-186* UreaN-36* Creat-1.6* Na-139 K-4.2 Cl-105 HCO3-26 AnGap-12\n___ 06:30AM BLOOD Glucose-229* UreaN-41* Creat-1.5* Na-140 K-4.6 Cl-105 HCO3-27 AnGap-13\n___ 03:10AM BLOOD ALT-16 AST-26 LD(LDH)-178 CK(CPK)-83 AlkPhos-52 TotBili-0.4\n___ 06:30AM BLOOD ALT-14 AST-21 LD(LDH)-171 CK(CPK)-50 AlkPhos-51 TotBili-0.5\n___ 06:30AM BLOOD Lipase-32\n___ 07:16PM BLOOD CK-MB-NotDone cTropnT-0.23*\n___ 03:10AM BLOOD CK-MB-NotDone cTropnT-0.29*\n___ 12:50PM BLOOD CK-MB-NotDone cTropnT-0.29*\n___ 06:30AM BLOOD CK-MB-NotDone cTropnT-0.20*\n___ 07:30AM BLOOD CK-MB-4 proBNP-41___*\n\nCXR: Moderate pulmonary edema and cardiomegaly. Repeat radiographs, preferably with a lateral view, after appropriate diuresis is recommended to clarify enlarged right hilum. \n\nCXR: Disappearance of pulmonary edema pattern, remaining small bilateral pleural effusions, but no evidence of new acute pulmonary infiltrates or pneumothorax. Thus, the patient apparently has undergone a short episode of left-sided CHF, which now has improved. \n\nEcho: The left atrium is mildly dilated. The estimated right atrial pressure. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is severe regional left ventricular systolic dysfunction with severe hypokinesis/akinesis of the mid to distal left ventricle. Overall left ventricular systolic function is severely depressed (LVEF= 35___. No masses or thrombi are seen in the left ventricle. Right ventricular chamber size and free wall motion are normal. The aortic arch is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Moderate (2+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is mild pulmonary artery systolic hypertension.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11696880-DS-19.json b/Finished/Heart Failure/11696880-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..2f9be6a6bb27919b454c0a19686e32f5fcfd8145 --- /dev/null +++ b/Finished/Heart Failure/11696880-DS-19.json @@ -0,0 +1,34 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF >55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is mildly dilated$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-2194$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Peripheral edema is a sign of heart failure$Cause_1": { + "pedal edema$Input2": {} + }, + "Hypertension is a risk factor of heart failure$Cause_1": { + "HTN$Input3": {} + }, + "Diabetes melitus is a risk factor of heart failure$Cause_1": { + "Diabetes melitus$Input3": {} + } + } + } + } + }, + "input1": "Chest pain\n", + "input2": "Male with PMH of hypertension, non-insulin dependent T2DM, HLD, PAD, CAD s/p NSTEMI with drug eluting stent to mid-LAD on dual antiplatelet therapy who presents after having one episode of left-sided chest pain. \n\nWhile playing cards, he felt a sudden, stabbing pain in the left side of his chest that lasted for two minutes and went away on its own. He reports that this pain felt different from his prior angina pain.\n\nDenies fever, chills, sob, abd pain, vomiting, and diarrhea.\n\nIn the ED, initial vitals were 98.1 78 198/75 18 100% RA. Exam notable for 2+ pedal edema and minor bibasilar crackles. Labs notable for WBC 10.4, Cr 1.3, Trop <0.01 x1, and BNP 2194.\n", + "input3": "+HTN - checks daily at home\n+Diabetes melitus, diet controlled\n+L. cataract removal\n+Cholecystectomy\n+Shrapnel injury in the R. lower back/buttock and R. leg\n+R. lower back pain onset within the last few years, graduallyprogressive without acute exacerbation.\n", + "input4": "Pt denies relevant family history\n", + "input5": "Vitals: 98.0, 152/54, 74, 18, 96% RA \nGENERAL: WDWN M in NAD. Oriented x3. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. \nNECK: Supple with no JVD. \nCARDIAC: RRR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. \nLUNGS: Bilateral bibasilar crackles.\nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: trace edema in bilateral \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.\n", + "input6": "Admission Labs:\n___ 02:46PM BLOOD WBC-10.4* RBC-3.96* Hgb-12.4* Hct-38.8* MCV-98 MCH-31.3 MCHC-32.0 RDW-15.9* RDWSD-57.5* Plt ___\n___ 02:46PM BLOOD Neuts-79.2* Lymphs-8.6* Monos-10.2 Eos-1.0 Baso-0.3 AbsNeut-8.24* AbsLymp-0.89* AbsMono-1.06* AbsEos-0.10 AbsBaso-0.03\n___ 02:46PM BLOOD PTT-31.4 \n___ 02:46PM BLOOD Glucose-137* UreaN-24* Creat-1.3* Na-138 K-4.7 Cl-105 HCO3-24 AnGap-14\n___ 02:46PM BLOOD proBNP-2194*\n___ 02:46PM BLOOD cTropnT-<0.01\n___ 11:53PM BLOOD CK-MB-3 cTropnT-0.01\n\nThere was no evidence of ischemia on ECG. Troponins negative x2, CK-MB 3. EF 58% on PMIBI, but chest pain most likely due to a new diagnosis of diastolic CHF, especially given trace edema and elevated BNP. We did not perform a stress test due to the patient's age and the unlikelihood of intervention regardless of test result. TTE showed normal EF (>55%), moderate aortic regurgitation, mildly thickened aortic valve leaflets with no aortic valve stenosis, and elevated PCWP.The left atrium is mildly dilated\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/11868165-DS-24.json b/Finished/Heart Failure/11868165-DS-24.json new file mode 100644 index 0000000000000000000000000000000000000000..37d80bdad5e7ce81a19a57e4ae64947aa12684f5 --- /dev/null +++ b/Finished/Heart Failure/11868165-DS-24.json @@ -0,0 +1,46 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "Mild symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. Dilated right ventricle with moderate global systolic dysfunction.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP 600pg/mL$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "weight gain is a sign of heart failure$Cause_1": { + "weight gain$Input2": {} + }, + "Peripheral edema is a sign of heart failure$Cause_1": { + "increasing edema over the last one week in her lower legs and abdomen$Input2": {} + }, + "increased fatigue is a typical symptom of heart failure$Cause_1": { + "increased fatigue$Input2": {} + }, + "Pleural effusion is a sign of heart failure$Cause_1": { + "moderate pulmonary edema$Input2": {} + }, + "CAD is a risk factor of heart failure$Cause_1": { + "CAD$Input3": {} + }, + "Chronic atrial fibrillation is a risk factor of heart failure$Cause_1": { + "Chronic atrial fibrillation$Input3": {} + }, + "Hypertension is a risk factor of heart failure$Cause_1": { + "Hypertension$Input3": {} + } + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "Ms. is an 68 year old woman with CAD, diastolic heart failure, and rheumatic heart disease. Her dry weight is 120-122 pounds. She weighs herself daily and has had multiple admissions in the past for CHF exacerbations. Today she reports gaining approximately 2.5 pounds since yesterday. She describes increasing edema over the last one week in her lower legs and abdomen. She uses home oxygen (3L) for exertional activities. She has been using it more frequently over the last week with any type of exertion. She also describes increased fatigue and a heavy sensation in her lower extremities. She does not lay flat due to SOB. After speaking with her PCP, she was referred to the ED for further evaluation. \n\nIn the ED initial VS were 97.5 76 115/43 16 91 on RA. She had a chest xray consistent with moderate pulmonary edema. She was placed on supplemental oxygen which increased her O2 sat to 96% on two liters. She was not given any additional diuresis. \n\nOn the floor she denied any additional complaints. She stated that her left leg was improving. It had been recently treated for cellulitis. She also notes that her left leg (around the knee) is always slightly worse than the right. She has taken metalozone 3 times last week.\n", + "input3": "+CAD- S/P Cath - 2 vessel CAD\n+Rheumatic heart disease, status post bioprosthetic AVR and MVR following a clinical course of repeated admissions for acute pulmonary edema in the setting of functional mitral\nregurgitation.\n+Chronic atrial fibrillation, on warfarin.\n+Hypertension.\n+Pulmonary hypertension with mild RV dysfunction.\n+COPD with exercise dependent oxygen supplement. \n+CKD - stage IV\n", + "input4": "Father:died stomach cancer.\nNo family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "VS: 95.9 116/68 16 86 on RA, 96 on 3L 72 \nGen: appears comforable, thin \nHEENT: MMM, pupils equal \nNeck: JVD \nCV: irregularly irregular, systolic murmur \nPulm: bilateral crackles at bases \nAbd: soft, nontender, slightly distended, normoactive bowel \nsounds \nExt: 1+ edema, pulses 2+ bilaterally, small amount of erythema around left leg, non-tender \nNeuro: moving all extremities, face symmetric, plantar/dorsiflexion, grip, hip flexion, arm flexion/extension, gross sensation intact\n", + "input6": "Labs on Admission:\n___ 04:40PM BLOOD WBC-9.5 RBC-3.46* Hgb-9.5* Hct-30.4* MCV-88 MCH-27.4 MCHC-31.1 RDW-18.3* Plt ___\n___ 04:40PM BLOOD Neuts-77.1* Lymphs-16.6* Monos-3.2 Eos-2.7 Baso-0.4\n___ 04:40PM BLOOD ___ PTT-38.8* ___\n___ 04:40PM BLOOD Glucose-102* UreaN-83* Creat-2.9* Na-142 K-4.2 Cl-105 HCO3-20* AnGap-21*\n___ 04:40PM BLOOD ___\n___ 05:55AM BLOOD Calcium-8.7 Phos-4.5 Mg-2.2\nBNP 600\nLabs on Discharge:\n___ 09:25AM BLOOD ___ PTT-43.6* ___\n___ 09:25AM BLOOD Glucose-211* UreaN-79* Creat-2.3* Na-141 K-3.5 Cl-99 HCO3-27 AnGap-19\n___ 09:25AM BLOOD Calcium-9.5 Phos-3.3 Mg-2.0\n.\nCXR (___): FINDINGS: PA and lateral views of the chest are obtained. Midline sternotomywires and prosthetic cardiac valves are again seen. The heart remains stably enlarged with significant interstitial edema again noted. Underlying emphysema is again noted. No large pleural effusions or pneumothorax is seen. Atherosclerotic calcifications along the aorta noted. Bones are demineralized and note is again made of a compression fracture in the lower thoracic spine.\nIMPRESSION: Stable radiograph compared with cardiomegaly and pulmonary interstitial edema.\n\nECHO: The left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). The right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. A bioprosthetic aortic valve prosthesis is present. The prosthetic aortic valve leaflets are thickened. The transaortic gradient is higher than expected for this type of prosthesis and corresponds to severe functional aortic stenosis. Trace aortic regurgitation is seen. A bioprosthetic mitral valve prosthesis is present. The prosthetic mitral valve leaflets are thickened. The gradients are higher than expected for this type of prosthesis. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate to severe [3+] tricuspid regurgitation is seen. There is severe pulmonary artery systolic hypertension. There is no pericardial effusion. \n\nIMPRESSION: Mild symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. Dilated right ventricle with moderate global systolic dysfunction. Degenerated aortic and mitral valve bioprostheses with thickened leaflets and higher-than-expected gradients. Moderate to severe tricuspid regurgitation. Severe pulmonary hypertension.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17123250-DS-19.json b/Finished/Heart Failure/17123250-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..8f3b2a1cce02eb9e3a9bcfe0f774493422f84d09 --- /dev/null +++ b/Finished/Heart Failure/17123250-DS-19.json @@ -0,0 +1,58 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP: 1242$Input2": {} + }, + "Suspected heart failure$Intermedia_2": { + "Dyspnea is a common symptom of HF$Cause_1": { + "Dyspnea$Input1": {} + }, + "Dyspnea is a common clinical manifestation of heart failure, which may be caused by insufficient heart pumping function, resulting in blockage of blood return to the lungs.$Cause_1": { + "brought in by ambulance for dyspnea$Input2": {} + }, + "Sudden shortness of breath at night is one of the classic symptoms of heart failure$Cause_1": { + "wakes up in the middle of the night with SOB$Input2": {} + }, + "This symptom means that the patient feels shortness of breath when lying flat, which may be postural dyspnea in heart failure$Cause_1": { + "sleeps on 2 pillows and does feel she gets short of breath if she lies flat$Input2": {} + }, + "Coronary artery disease is a major risk factor for heart failure because it can lead to insufficient blood flow to the heart, which in the long term can cause decreased heart function.$Cause_1": { + "CORONARY ARTERY DISEASE$Input3": {} + }, + "Diabetes can lead to metabolic abnormalities, increase the burden on the heart, and may directly affect heart function through diabetic cardiomyopathy$Cause_1": { + "DIABETES TYPE II$Input3": {} + }, + "High cholesterol is a risk factor for atherosclerosis, the main cause of coronary artery disease, which indirectly increases the risk of heart failure$Cause_1": { + "HYPERCHOLESTEROLEMIA$Input3": {} + }, + "Long-term hypertension increases the workload of the heart, may lead to cardiac hypertrophy and heart failure, and is a common cause of heart failure.$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "Obesity is closely related to a variety of cardiovascular diseases and can indirectly lead to heart failure by increasing cardiac workload and promoting the development of metabolic syndrome.$Cause_1": { + "OBESITY$Input3": {} + }, + "Hypertension is an important risk factor for heart failure, which can increase the workload on the heart and may lead to impaired heart function in the long term.$Cause_1": { + "BP=185/78$Input5": {} + }, + "A systolic murmur is detected on auscultation. Heart murmurs are often associated with heart valve disease, which can affect the heart's ability to pump blood and may lead to heart failure.$Cause_1": { + "systolic murmur best heard$Input5": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "She is a female with history of TAVR with multiple stents, DM, and PPM brought in by ambulance for dyspnea and anxiety. Patient has had dyspnea and anxiety for months including prior to her PCI and TAVR. She states that she wakes up in the middle of the night with SOB and \"thinking I'm going to die.\" She sleeps on 2 pillows and does feel she gets short of breath if she lies flat. No chest pain. Patient was just seen in UrgentCare for similar symptoms. It was recommended that she transfer to the hospital for further work up but pt declined. In the ED initial vitals were: 98.4 74 199/70 18 100% RA \nEKG: Sinus rhythm. LBBB. CWP. \nLabs/studies notable for: \nTrop-T: 0.03; \nproBNP: 1242; \nWBC 11.1; Cr 0.9; \nCO2 20 \nCXR: IMPRESSION: No acute cardiopulmonary abnormality. On the floor, she is comfortable appearing. \nROS: Denies CP, dyspnea on exertion, edema, blood clot in \nlegs or lungs, abdominal swelling.\n", + "input3": "CORONARY ARTERY DISEASE s/p stent x2 +\nDIABETES TYPE II +\nEXTERNAL HEMORRHOIDS +\nHYPERCHOLESTEROLEMIA (per record, pt denies) +\nHYPERTENSION +\nOBESITY +\nPACEMAKER for symptomatic bradycardia +\nGOUT +\n", + "input4": "Non-contributory\n", + "input5": "ADMISSION PHYSICAL EXAM:\n=========================\nVS: T=97.8, BP=185/78, HR=88, RR=20, O2 sat 96% on RA \nWEIGHT: 76.6 \nGENERAL: Well appearing in NAD. Appears younger than stated age. \nHEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. \nNECK: No appreciable JVD. \nCARDIAC: Regular rate and rhythm, S1/S2, systolic murmur best heard.\nLUNGS: Clear to auscultation bilaterally, no crackles, non-labored, symmetric chest expansion.\nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. Warm and well perfused.\n", + "input6": "ADMISSION LABS:\n================\n08:50PM BLOOD WBC-11.1* RBC-4.84 Hgb-13.1 Hct-40.4 \nMCV-84 MCH-27.1 MCHC-32.4 RDW-14.6 RDWSD-44.2\n08:50PM BLOOD Neuts-59.8 Monos-7.5 Eos-0.9* \nBaso-0.3 Im AbsNeut-6.65* AbsLymp-3.44 AbsMono-0.83* \nAbsEos-0.10 AbsBaso-0.03\n08:50PM BLOOD Glucose-131* UreaN-22* Creat-0.9 Na-136 \nK-4.6 Cl-100 HCO3-20* AnGap-21*\n08:50PM BLOOD CK-MB-7 cTropnT-0.03*\n08:50PM BLOOD Calcium-9.9 Phos-2.8 Mg-1.8\n\nTTE (Complete) Done ___ \"Conclusions: The left atrium is moderately dilated. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). \n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17143325-DS-23.json b/Finished/Heart Failure/17143325-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..04537586af1fef494ea8fc88bfe49619c5bc19dc --- /dev/null +++ b/Finished/Heart Failure/17143325-DS-23.json @@ -0,0 +1,61 @@ +{ + "HFrEF$Intermedia_5": { + "Echocardiography showed a left ventricular ejection fraction (LVEF) of 35%-40%, indicating HFrEF$Cause_1": { + "moderate sCHF with LVEF of 35%-40% on echo$Input2": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-5145*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "chest pain is the common symptom of HF$Cause_1": { + "chest pain$Input1": {} + }, + "The patient had moderate pulmonary systolic hypertension, which may be due to increased pulmonary circulation pressure caused by left ventricular dysfunction, further suggesting possible heart failure.$Cause_1": { + "moderate PA systolic hypertension$Input2": {} + }, + "Paroxysmal atrial fibrillation can increase the heart's workload and affect the heart's effective pumping function. It is a common complication of heart failure.$Cause_1": { + "paroxysmal atrial fibrillation$Input2": {} + }, + "Chest pain that lasts about an hour and radiates to both arms may be a sign of cardiac ischemia and is associated with an acute exacerbation of heart failure$Cause_1": { + "chest pain x 1 hour$Input2": {} + }, + "These symptoms are typical clinical manifestations of heart failure, indicating that the heart's pumping function is impaired, leading to fluid retention and difficulty breathing.$Cause_1": { + "reported PND, orthopnea, and increased edema in the ED$Input2": {} + }, + "Coronary artery disease and angina are both heart diseases that are often associated with heart failure$Cause_1": { + "CAD with stable angina$Input3": {} + }, + "Long-term hypertension is an important factor leading to increased cardiac burden and heart failure$Cause_1": { + "HTN$Input3": {} + }, + "Hyperlipidemia is a risk factor for cardiovascular disease and may accelerate the progression of heart disease$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Increased jugular venous distension. This is a common sign of right ventricular dysfunction in heart failure, reflecting obstruction of blood return to the heart.$Cause_1": { + "Supple with JVP of 8 cm$Input5": {} + }, + "An irregular heartbeat and slow heart rate can be a direct manifestation of heart failure, especially when the heart's electrical function is impaired.$Cause_1": { + "Irregular rhythm, bradycardic$Input5": {} + }, + "Rales and dullness to percussion at the bases of both lungs, signs of pulmonary effusion, which is common in heart failure$Cause_1": { + "Crackles at bases and dullness to percussion bilaterally$Input5": {} + }, + "2+ pitting edema in both lower extremities, a common symptom of heart failure$Cause_1": { + "2+ pitting edema bilaterally$Input5": {} + } + } + } + } + }, + "input1": "chest pain\n", + "input2": "There was a 70% lesion just distal to the stent. Successful PTCA of the LCX), moderate sCHF with LVEF of 35%-40% on echo, moderate PA systolic hypertension, paroxysmal atrial fibrillation (not currently on coumadin), who presents with chest pain x 1 hour. \n. \nOf note, patient is a poor historian, but notes chest pain at rest that lasted for perhaps 60 minutes. It radiated down both arms and was not associated with other symptoms. He reported PND, orthopnea, and increased edema in the ED. He is not on a diuretic.\n", + "input3": "+ CAD with stable angina, s/p CABG, multiple stents \n+ Moderate pulmonary artery systolic hypertension - TR gradient \n+ Hemoperitoneum around the liver and in the pelvis along with two splenic artery pseudoaneurysms s/p embolization of both.\n+ when taken off vanco, has frequent diarrhea and dehydration\n+ HTN\n+ Hyperlipidemia\n+ Anemia\n+ Prostate CA s/p XRT\n+ s/p discectomy\n+ Left hip arthroplasty\n+ Severe osteoarthritis\n\ufeff\n", + "input4": "Non-contributory\n", + "input5": "VS: afebrile, HR 53, BP 104/62, RR 22, 100% 4L NC \nGENERAL: NAD. Oriented to name and location as BI, unsure of year and president. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\ufeff\nNECK: Supple with JVP of 8 cm. \nCARDIAC: PMI located in intercostal space, midclavicular line. Irregular rhythm, bradycardic, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: Unlabored. Crackles at bases and dullness to percussion bilaterally \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nEXTREMITIES: 2+ pitting edema bilaterally. Redness without warmth. \nSKIN: No ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP\nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP\n", + "input6": "ADMISSION LABS\n12:03AM BLOOD WBC-11.3* RBC-3.76* Hgb-10.7* Hct-33.4* \nMCV-89 MCH-28.5 MCHC-32.1 RDW-16.9*\n12:03AM BLOOD Neuts-93.1* Lymphs-4.5* Monos-1.7* \nEos-0.5 Baso-0.3\n12:03AM BLOOD Glucose-218* UreaN-35* Creat-2.1* Na-137 \nK-5.4* Cl-100 HCO3-24 AnGap-18\n12:03AM BLOOD Calcium-9.5 Phos-3.8 Mg-2.4 Iron-31*\n12:03AM BLOOD cTropnT-0.02*\n05:15AM BLOOD cTropnT-0.11*\n08:11AM BLOOD CK-MB-6 cTropnT-0.19*\n12:03AM BLOOD CK(CPK)-27*\n08:11AM BLOOD CK(CPK)-52\n12:03AM BLOOD CK-MB-3 proBNP-5145*\n\nTTE (Complete) Done ___ \"Conclusions: The left atrium is moderately dilated. Left ventricular wall thickness, \n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17165207-DS-20.json b/Finished/Heart Failure/17165207-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..4472d19f3224923d2c0cb4a0507691989acb9347 --- /dev/null +++ b/Finished/Heart Failure/17165207-DS-20.json @@ -0,0 +1,64 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF<40% is the critiera for HFrEF$Cause_1": { + "LVEF<40%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated. The right atrium is moderately dilated.$Input6": {} + }, + "Left ventricular systolic dysfunction and partial hypokinesis indicate impaired heart pumping ability, the core problem of heart failure.$Cause_1": { + "severe regional left ventricular systolic dysfunction with severe inferior/inferolateral hypokinesis$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-4145*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Lower limb edema is one of the common symptoms of heart failure, because the heart's pumping function is weakened, resulting in reduced blood circulation.$Cause_1": { + "Lower Extremity Swelling$Input1": {} + }, + "This may indicate severe edema and interstitial fluid leakage, which is often associated with cardiac dysfunction.$Cause_1": { + "right sock and pant leg were wet with yellow fluid$Input2": {} + }, + "The patient reported steady dyspnea on exertion, a common symptom of heart failure, as the heart is unable to effectively supply enough oxygen to the body.$Cause_1": { + "stable exertional dyspnea$Input2": {} + }, + "Can lie flat for a few hours, but then dyspnea worsens and needs to sit in a chair to sleep. This is a typical presentation of supine dyspnea in a patient with heart failure$Cause_1": { + "can lye flat for servel hours but then gets increasing work of breathing and has to sit in a chair to sleep$Input2": {} + }, + "Atrial fibrillation is a common arrhythmia that may coexist with heart failure and be a cause and effect of each other.$Cause_1": { + "atrial fibrillation$Input2": {} + }, + "Diabetes can cause high blood sugar levels that damage blood vessels and nerves. Long-term high blood sugar levels can increase the risk of heart disease.$Cause_1": { + "DM c/b neuropathy$Input3": {} + }, + "Coronary artery disease can lead to reduced blood flow to the heart, which prevents the myocardium from getting enough oxygen and nutrients. This can lead to a decline in heart function over a long period of time and is one of the direct causes of heart failure.$Cause_1": { + "CAD$Input3": {} + }, + "Hyperlipidemia is an important risk factor for cardiovascular disease, which can lead to arteriosclerosis and thus affect heart function.$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "High blood pressure will increase the workload of the heart. Long-term high blood pressure can cause cardiac hypertrophy and eventually lead to heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Heart sounds S1 and S2 have an irregular rhythm and a grade 2/6 systolic murmur is present, which may be a sign of structural abnormalities or cardiac dysfunction.$Cause_1": { + "S1, S2 irregular rhythm, normal rate, II/VI systolic murmur LUSB$Input5": {} + }, + "Rales are present at both lung bases, a classic sign of fluid accumulation in the lungs, which is common in heart failure.$Cause_1": { + "crackles bilaterally at bases$Input5": {} + }, + "Grade 3 pitting edema was present in both knees. Edema is the accumulation of fluid in heart failure due to the weakening of the heart's pumping function and the obstruction of blood return.$Cause_1": { + "3+ pitting edema bilaterally to the knees$Input5": {} + } + } + } + } + }, + "input1": "Lower Extremity Swelling\n", + "input2": "This morning after putting on clothes he noticed that right sock and pant leg were wet with yellow fluid. Denies pain or erythema at site. He saw his nephrologist, last week and discussed ankle edema with him but at that time reluctant to increase diuretics due to renal function. He was started on tekturna at that time but has not filled the RX. He reports stable exertional dyspnea. He sleeps on pillows at night, can lye flat for servel hours but then gets increasing work of breathing and has to sit in a chair to sleep. Denies chest pain. He sees a cardiologist, for his atrial fibrillation. He was started on coumadin 2.5 weeks ago, plan for possible electrical cardioversion after therapeutic for one month. In the meantime has been increasing dose of amiodarone but still in AFIB. He denies palpitations, syncope.\n", + "input3": "+ DM c/b neuropathy\n+ CAD\n+ CKD: previously noted to be Stage 3\n+ Hyperlipidemia\n+ Hypertension\n+ Colon Cancer\n+ Obesity\n+ Varicose veins\n+ Osteoarthritis \n+ Cataract\n+ Gout \n+ Sleep apnea\n", + "input4": "No h/o DM, CAD or cancer. No h/o renal disease.\n", + "input5": "On Admission:\nVS: 110/70 94 18 94%RA \nGen: Caucasian male in NAD, unlabored respirations \nHEENT: anicteric, moist mucus membranes \nCV: S1, S2 irregular rhythm, normal rate, II/VI systolic murmur LUSB \nPulm: unlabored resp, crackles bilaterally at bases\nAbd: soft, NTND, no guarding, rebound tenderness \nExt: 3+ pitting edema bilaterally to the knees, area of weeping serosanguoinous drainage on right posterior calf without signficant warmth or erythema \nNeuro: AOx3, CNII-XII intact, MAE antigravity, sensation grossly intact\n", + "input6": "07:15PM BLOOD Glucose-171* UreaN-65* Creat-2.4* Na-141 K-4.0 Cl-102 HCO3-28 AnGap-15\n07:30AM BLOOD Glucose-173* UreaN-75* Creat-2.6* Na-137 K-4.2 Cl-99 HCO3-31 AnGap-11\n04:50PM BLOOD CK(CPK)-75\n07:15PM BLOOD ALT-23 AST-23 LD(LDH)-226 CK(CPK)-89 \nAlkPhos-112 TotBili-0.7\n04:50PM BLOOD CK-MB-3 cTropnT-0.04*\n05:25AM BLOOD CK-MB-3 cTropnT-0.06*\n07:15PM BLOOD CK-MB-3 cTropnT-0.05* proBNP-4145*\n07:30AM BLOOD Mg-2.6\n05:25AM BLOOD TSH-1.9\n05:20AM BLOOD WBC-7.6 RBC-4.08* Hgb-10.6* Hct-32.6* MCV-80* MCH-25.9* MCHC-32.4 RDW-18.0*\n07:30AM BLOOD Glucose-173* UreaN-75* Creat-2.6* Na-137 K-4.2 Cl-99 HCO3-31 AnGap-11\n\ufeff\nWhile in hospital an ECHO was done, with the following result:\nThe left atrium is moderately dilated. The right atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is severe regional left ventricular systolic dysfunction with severe inferior/inferolateral hypokinesis. There is moderate hypokinesis of the remaining segments (The right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. There is moderate aortic valve stenosis (valve area 1.0-1.2cm2). Trace aortic regurgitation is seen. The mitral valve leaflets are moderately thickened. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. LVEF<40%\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17167392-DS-8.json b/Finished/Heart Failure/17167392-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..1b2e547b92388bd7919a6d17a997e9881efe65e9 --- /dev/null +++ b/Finished/Heart Failure/17167392-DS-8.json @@ -0,0 +1,73 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF<40% is the critiera for HFrEF$Cause_1": { + "LVEF<35%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-2245$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "SOB is the common symptom of HF$Cause_1": { + "shortness of breath$Input1": {} + }, + "Heart failure may cause insufficient blood flow to the heart, leading to chest pain$Cause_1": { + "intermittent chest pain for the last 4 day$Input2": {} + }, + "Ischemia in heart failure may feel like pressure or sharp pain$Cause_1": { + "chest pain as sharp pressure$Input2": {} + }, + "People with heart failure may experience pain that is worse with activity because the heart cannot pump blood well enough.$Cause_1": { + "Pain is worse with exertion$Input2": {} + }, + "Heart failure causes obstruction of blood flow back to the lungs, causing breathing difficulties$Cause_1": { + "shortness of breath which has increased over the last 4 days$Input2": {} + }, + "A common symptom of heart failure, in which the patient has trouble breathing when lying down due to excess blood in the lungs$Cause_1": { + "increased orthopnea and PND$Input2": {} + }, + "Sleeping with more pillows is a common way to reduce dyspnea caused by heart failure$Cause_1": { + "typically sleeps with 2 pillows and in the last few days has required 3$Input2": {} + }, + "Heart failure may cause fluid retention, leading to edema$Cause_1": { + "increased swelling in her legs$Input2": {} + }, + "Past history of Chronic systolic CHF increase the risk of HF$Cause_1": { + "Chronic systolic CHF$Input3": {} + }, + "Myocardial infarction is a disease caused by blockage of a heart vessel, which results in partial myocardial necrosis and is an important risk factor for heart failure.$Cause_1": { + "s/p MI and pacemaker placement$Input3": {} + }, + "Long-term high blood pressure increases the burden on the heart, leading to cardiac hypertrophy and impaired function, and is one of the common causes of heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Diabetes can lead to a variety of cardiovascular problems, including hardening of the arteries and heart disease, and increases the risk of heart failure.$Cause_1": { + "Diabetes Mellitus$Input3": {} + }, + "Significantly increased blood pressure, which may indicate extra stress on the heart and is a common sign of heart failure$Cause_1": { + "BP 164/124$Input5": {} + }, + "Increased distension of the jugular veins, a classic sign of impaired right heart function in heart failure, indicating that blood flow back to the heart is blocked$Cause_1": { + "Supple with JVP of up to the ear at 45 degrees.$Input5": {} + }, + "A systolic murmur heard may indicate heart valve disease, a common cause of heart failure.$Cause_1": { + "systolic murmur best heard$Input5": {} + }, + "Pretibial edema is a direct manifestation of fluid retention and is common in patients with heart failure.$Cause_1": { + "1+ pretibial edema$Input5": {} + } + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "Patient reports intermittent chest pain for the last 4 day. She describes the chest pain as sharp pressure. The pain can radiate to her arms but she attributes this pain to her sleeping position. Pain is worse with exertion. Her inhaler is sometimes helpful. She also reports shortness of breath which has increased over the last 4 days. She denies cough or wheezing. She also has increased orthopnea and PND. She typically sleeps with 2 pillows and in the last few days has required 3. She also noted increased swelling in her legs and a weight gain of pounds in the last week. She has been using her nebs at home with no improvement. She has been taking all her medications as prescribed. She denies increased salt in her diet. She did previously take lasix 20 mg daily. However, this was stopped for worsening renal function and frequent falls per daughter. Today she was seen by her PCP, and he referred her for further evaluation and treatment.\n", + "input3": "+ Chronic systolic CHF\n+ s/p MI and pacemaker placement \n+ Hypertension\n+ Diabetes Mellitus\n+ Right cataract\n+ Goiter/hyperthyroidism\n+ Low back pain\n+ Abdominal hernia\n", + "input4": "brothers and sisters with hypertension and diabetes aunt with MI No other family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "Physical Exam:\nadmission exam \nVS: T 96.6 BP 164/124 HR 118 RR 18 O2 sat 100% 3L \nGENERAL: WDWN in minimal respiratory distress. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\ufeff\nNECK: Supple with JVP of up to the ear at 45 degrees. \nCARDIAC: PMI located in intercostal space, midclavicular line. RRR, systolic murmur best heard at left sternal border. No thrills, lifts. No S3 or S4. \nLUNGS: Resp were mildly labored, no accessory muscle use. Diminished breath sounds with crackles at bases bilaterally. No wheezes.\nABDOMEN: +BS. Soft, NTND. Large abdominal hernia noted. \nGU: No suprapubic tenderness. Foley in place. \nEXTREMITIES: 1+ pretibial edema. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ Femoral 2+ DP\nLeft: Carotid 2+ Femoral 2+ DP\n", + "input6": "admission labs: \n02:20PM BLOOD WBC-3.8* RBC-3.88* Hgb-10.5* Hct-31.4* MCV-81* MCH-27.0 MCHC-33.4 RDW-15.6*\n02:20PM BLOOD Neuts-53.4 Monos-5.8 Eos-6.0* Baso-0.5\n02:20PM BLOOD Glucose-119* UreaN-28* Creat-0.8 Na-140 K-4.8 Cl-107 HCO3-21* AnGap-17\n02:20PM BLOOD Calcium-10.2 Phos-3.3 Mg-1.9 proBNP-2245*\n05:22PM BLOOD Lactate-1.5 cardiac enzymes\n02:20PM BLOOD cTropnT-<0.01\n12:47AM BLOOD CK-MB-2 cTropnT-<0.01\n07:50AM BLOOD CK-MB-2 cTropnT-<0.01\n04:20PM URINE Color-Straw Appear-Clear\n04:20PM URINE Blood-NEG Nitrite-NEG Protein-TR Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-MOD\n04:20PM URINE RBC-1 WBC-6* Bacteri-FEW Yeast-NONE Epi-<1\n04:20PM URINE Mucous-RARE\n\nTTE (Complete) Done ___ \"Conclusions: The left atrium is moderately dilated. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%).\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17176117-DS-4.json b/Finished/Heart Failure/17176117-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..0d25a857d512a0f27a559da8b83c216cd958a08e --- /dev/null +++ b/Finished/Heart Failure/17176117-DS-4.json @@ -0,0 +1,67 @@ +{ + "HFmrEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFmrEF$Cause_1": { + "LVEF=45%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP is a hormone secreted when the heart is under stress. High levels of BNP are an important indicator of heart failure.$Cause_1": { + "BNP 5418$Input2": {} + }, + "BNP is a hormone secreted when the heart is under stress. High levels of BNP are an important indicator of heart failure.*$Cause_1": { + "proBNP-3547$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Dyspnea is a common symptom of HF$Cause_1": { + "Dyspnea$Input1": {} + }, + "Both symptoms are common in people with heart failure, particularly when the heart cannot pump blood effectively, causing fluid to build up in the lungs.$Cause_1": { + "worsening dyspea and orthopnea for approximately 1 week$Input2": {} + }, + "People with heart failure often experience volume overload because the heart's reduced ability to pump blood makes it less able to process fluid in the body, leading to fluid accumulation.$Cause_1": { + "grossly volume overloaded$Input2": {} + }, + "CVA may lead to heart failure because brain damage may affect the nervous system's control of the heart.\nNSTEMI means damage to the heart muscle, which can directly affect heart function and increase the risk of heart failure.$Cause_1": { + "admitted with CVA and NSTEMI$Input2": {} + }, + "Coronary artery disease and coronary artery bypass grafting are both important indicators of heart disease. Postoperative complications such as bleeding may increase the burden on the heart and are associated with heart failure.$Cause_1": { + "CAD s/p CABG c/b mediastinal re-exploration for bleeding$Input3": {} + }, + "NSTEMI means that the heart is not getting enough blood, a condition that can lead to heart damage and increase the risk of heart failure.$Cause_1": { + "NSTEMI$Input3": {} + }, + "Long-term high blood pressure can increase the workload on the heart, leading to cardiac hypertrophy or dysfunction, which is associated with the development of heart failure$Cause_1": { + "HTN$Input3": {} + }, + "This low blood pressure reading may indicate that the heart is not pumping blood well enough, a common sign of heart failure.$Cause_1": { + "BP= 90/60$Input5": {} + }, + "A fast heart rate, common in heart failure, in which the heart beats faster to maintain adequate blood flow$Cause_1": { + "HR= 103$Input5": {} + }, + "An elevated JVP is common in heart failure and reflects impaired right ventricular function and systemic regurgitation.$Cause_1": { + "Supple with JVP of 11 cm.$Input5": {} + }, + "Irregular heartbeats, often suggesting atrial fibrillation, a common arrhythmia in people with heart failure$Cause_1": { + "CARDIAC: irregularly irregular.$Input5": {} + }, + "Rales at the lung bases are a sign of pulmonary edema, which is often caused by heart failure and indicates that the heart is not pumping blood well enough, causing fluid to accumulate in the lungs.$Cause_1": { + "crackles in bilateral bases$Input5": {} + }, + "2+ pitting edema and venous stasis dermatitis on the thighs are manifestations of systemic fluid retention due to heart failure.$Cause_1": { + "2+ pitting edema to the thighs with stasis \ndermatitis$Input5": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "Patient originally admitted to with worsening dyspea and orthopnea for approximately 1 week. Had previously been admitted with CVA and NSTEMI requiring intubation and G tube placement (unclear whether stents placed at that time). Denies fevers, chills, cough, chest pain, nausea, vomiting. Found to have BNP 5418, grossly volume overloaded on exam. Initially received 40mg IV Lasix, but on the morning SBPs, so lisinopril and furosemide were held. He was seen by cardiology (recommended transfer for further workup and management. \nOn the floor, patient reported stable dyspnea, orthopnea. Denies chest pain, chest pressure, dizziness, focal numbness or weakness.\n", + "input3": "+ CAD s/p CABG c/b mediastinal re-exploration for bleeding \n+ NSTEMI (unclear from records whether he was stented at that time) \n+ HTN\n+ embolic parietal CVA with dysphagia, requiring G-tube plaement during hospitalization for tube feeds \n+ afib \n+ COPD \n+ chronic anemia \n+ basal cell carcinoma of scalp\n", + "input4": "No premature coronary artery disease\n", + "input5": "Admission Physical\n===================\nVS: T=97.4 BP= 90/60 HR= 103 RR= 18 O2 sat= 94%/4L: cachextic man in NAD\nHEENT: PERRL, EOMI. NECK: Supple with JVP of 11 cm. \nCARDIAC: irregularly irregular. \nLUNGS: normal work of breathing. crackles in bilateral bases \nABDOMEN: Soft, NTND. G-tube in place with small amount of \nerythema at borders but no induration or warmth. \nEXTREMITIES: 2+ pitting edema to the thighs with stasis \ndermatitis \nNEURO: A and O x 3. speech somewhat slurred. strength and sensation grossly symmetric\n", + "input6": "Admission Labs\n==================\n02:16AM BLOOD WBC-5.3 RBC-3.71* Hgb-10.8* Hct-35.2* \nMCV-95 MCH-29.0 MCHC-30.6* RDW-13.8\n02:16AM BLOOD Glucose-96 UreaN-17 Creat-1.1 Na-140 K-4.7 Cl-100 HCO3-35* AnGap-10\n02:16AM BLOOD ALT-11 AST-18 CK(CPK)-66 AlkPhos-140* \nTotBili-0.6\n02:16AM BLOOD CK-MB-4 cTropnT-0.02* proBNP-3547*\n02:16AM BLOOD Albumin-3.3* Calcium-9.0 Phos-3.6 Mg-1.7\n05:01PM BLOOD Lactate-1.7\n\nTTE (Complete) Done ___ \"Conclusions: The left atrium is moderately dilated. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF=45%).\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17191670-DS-18.json b/Finished/Heart Failure/17191670-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..f6755620cb2f403fab1d68c18f114e4572a72f0f --- /dev/null +++ b/Finished/Heart Failure/17191670-DS-18.json @@ -0,0 +1,52 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "atrium is moderately dilated.$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strong suspected heart failure.$Cause_1": { + "proBNP-1275*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "dypnea is a common symptom of HF$Cause_1": { + "dyspnea$Input1": {} + }, + "This indicates fluid retention, a common symptom of heart failure.$Cause_1": { + "minor episodes of SOB when he does not take his water pills$Input2": {} + }, + "These symptoms may point to cardiac ischemia or acute heart failure.$Cause_1": { + "sudden chest pressure, then nonradiating upper sternal CP with accompanying SOB$Input2": {} + }, + "Deep vein thrombosis and pulmonary embolism can increase the workload on the heart, especially the right ventricle.$Cause_1": { + "R DVT with PE s/p IVC filter on coumadin$Input3": {} + }, + "High blood pressure is one of the main risk factors for heart failure$Cause_1": { + "HTN$Input3": {} + }, + "Hyperlipidemia is a risk factor for cardiovascular disease and indirectly affects the risk of heart failure.$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Persistently high systolic blood pressure may be a sign of increased workload on the heart, which may be associated with heart failure.$Cause_1": { + "BP=139/65$Input5": {} + }, + "The heart may be struggling to maintain normal blood circulation, which is common in people with heart failure.$Cause_1": { + "HR=100$Input5": {} + }, + "Swelling of the ankles and calves is a common symptom of heart failure, usually caused by a decrease in the heart's ability to pump blood, resulting in fluid accumulation in the lower limbs.$Cause_1": { + "2+ edema through the ankle and into the calf.$Input5": {} + } + } + } + } + }, + "input1": "dyspnea\n", + "input2": "Patient reports that occasionally suffers minor episodes of SOB when he does not take his water pills. He doses his furosemide at 4 pills once a day, every other day; he does not remember the dosage (last recorded in OMR as 80mg). There was no recent change in his appetite, health status, diet. Today around 130p he developed sudden chest pressure, then nonradiating upper sternal CP with accompanying SOB. He had taken his furosemide this morning, but had not yet urinated. He had no accompanying sx such as HA, vision changes, n/v, presyncope or syncope. He endorses chills today, but no fevers, no cough, congestion, abdominal pain, urinary symptoms, bowel symptoms. He had no neurologic symptoms. He has chronic LBP, unchanged. He came to the ED for medical attention.\n", + "input3": "+ s/p renal transplant\n+ peripheral neuropathy\n+ s/p L BKD chronic osteomyelitis\n+ R DVT with PE s/p IVC filter on coumadin\n+ hx gastroparesis despite normal gastric emptying study\n+ recurrent cdiff\n+ depression\n+ retinopathy\n+ PVD\n+ HTN\n+ Hyperlipidemia\n+ Right tunnelled permcath\n+ AVF RUE-thrombosed s/p thrombectomy\n", + "input4": "Father has type I DM. \nMother with fibromyalgia\n", + "input5": "ADMISSION PHYSICAL EXAM:\nVS: Wt=134.6 (bed weight, patient unable to stand without aide of prosthetic) T=98.0 BP=139/65 HR=100 RR=18 O2 sat=96%RA \nGeneral: Well-appearing middle-aged male, pleasant, NAD \nHEENT: NCAT, EOMI, PERRLA, anicteric sclera, clear OP, MMM \nNeck: supple, difficult to appreciate JVP \nCV: RRR, no r/g/m \nLungs: CTAB, no w/r/r, no crackles \nAbdomen: Obese, soft, NT, +BS \nGU: Deferred \nExt: L BKA. RLE WWP, 2+ edema through the ankle and into the calf. \nNeuro: CN II-XII intact,\n", + "input6": "ADMISSION LABS:\n\ufeff\n09:11PM PLT COUNT-150\n09:11PM NEUTS-86.4* LYMPHS-8.7* MONOS-4.2 EOS-0.4 BASOS-0.3\n09:11PM WBC-7.5# RBC-5.10 HGB-14.2 HCT-43.7 MCV-86 \nMCH-28.0 MCHC-32.6 RDW-15.6*\n09:11PM CALCIUM-9.2 PHOSPHATE-2.7 MAGNESIUM-1.6\n09:11PM proBNP-2351*\n09:11PM cTropnT-<0.01\n09:11PM estGFR-Using this\n09:11PM GLUCOSE-355* UREA N-34* CREAT-1.6* SODIUM-136 POTASSIUM-4.8 CHLORIDE-98 TOTAL CO2-23 ANION GAP-20\n09:25PM O2 SAT-77\n09:25PM LACTATE-1.2\n09:25PM _EMP-36.8 PO2-41* PCO2-52* PH-7.34* TOTAL CO2-29 BASE XS-0 INTUBATED-NOT INTUBA\n09:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-300 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG\n09:50PM URINE COLOR-Straw APPEAR-Clear SP\n09:50PM URINE GR HOLD-HOLD\n09:50PM URINE UHOLD-HOLD\n09:50PM URINE HOURS-RANDOM\n09:50PM URINE HOURS-RANDOM proBNP-1275*\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral,\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17196497-DS-3.json b/Finished/Heart Failure/17196497-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..4e514e0cabb05332196c9f63f59be8fe6e30257a --- /dev/null +++ b/Finished/Heart Failure/17196497-DS-3.json @@ -0,0 +1,67 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Chest X-ray showed cardiomegaly and central vascular congestion, which are typical radiological manifestations of heart failure and reflect severe abnormalities of cardiac structure and function.$Cause_1": { + "CXR as OSH showed cardiomegaly with central vessel engorgement.$Input2": {} + }, + "These eating habits may increase the workload on the heart and cause or aggravate heart failure.$Cause_1": { + "admit to eating fried foods, pizza, and other salty foods$Input2": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strong suspected heart failure.$Cause_1": { + "proBNP-1191*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "SOB is the symptom of HF$Cause_1": { + "Shortness of breath$Input1": {} + }, + "Shortness of breath after even mild activity is a common symptom of heart failure and indicates that the heart's pumping ability may be impaired.$Cause_1": { + "shortness of breath with light activity$Input2": {} + }, + "A feeling of chest pressure that lasts from a few seconds to a few minutes and is often associated with heart disease, especially during physical activity$Cause_1": { + "Associated with chest pressure, lasting anywhere from seconds to minutes$Input2": {} + }, + "The electrocardiogram showed ventricular pacing, which indicates that the patient may have abnormal cardiac electrophysiological function, which is more common in patients with heart failure.$Cause_1": { + "ECG showed Vpaced with rate of 64$Input2": {} + }, + "Long-term high blood lipids can increase the burden on the heart, promote the formation of atherosclerosis, and increase the risk of heart failure$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension causes the heart to be subjected to continuous high pressure, leading to myocardial thickening and dysfunction. It is one of the common causes of heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Mitral regurgitation causes blood to flow backward, increases the load on the left ventricle, and may cause or aggravate heart failure.$Cause_1": { + "mitral regurgitation$Input3": {} + }, + "Atrial fibrillation increases the risk of heart failure by reducing the heart's pumping efficiency and causing structural changes in the heart.$Cause_1": { + "atrial fibrillation$Input3": {} + }, + "Hypoxemia and nocturnal oxygen desaturation in OSA can increase cardiac workload and indirectly cause or worsen heart failure.$Cause_1": { + "OSA$Input3": {} + }, + "This may indicate that the heart is not pumping as well as it should, a classic sign of heart failure.$Cause_1": { + "distant heart sounds$Input5": {} + }, + "Heart murmurs are often associated with structural abnormalities in the heart, which may be a sign of heart valve disease, a common cause of heart failure.$Cause_1": { + "III/ VI systolic murmur at the apex$Input5": {} + }, + "This auscultatory finding usually indicates fluid accumulation in the lungs and is a sign of pulmonary congestion due to heart failure.$Cause_1": { + "Bibasilar crackles$Input5": {} + }, + "Lower limb edema is one of the symptoms of heart failure caused by insufficient heart pumping function and obstruction of fluid return.$Cause_1": { + "1+ lower extremity edema bilaterally.$Input5": {} + } + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "Pt presented due to having shortness of breath with light activity. At baseline patient says that he can walk up half a flight of stairs, however, the SOB has been going on for months and is now progressively worse. He has SOB with little exertion. \nAssociated with chest pressure, lasting anywhere from seconds to minutes. Pressure is substernal but does not radiate. It is not associated with nausea or diaphoresis and does not feel like his prior MIs. Episodes of chest pressure are typically brought on with exertion although can happen at rest. They are releived with sitting down. When it occurs at rest it improves with burping or a glass of water. He does not take nitro. He does not measure his weight regularly and does not know his dry weight. He denies any increase in swelling, orthopnea. He denies any change in furosemide. He does admit to eating fried foods, pizza, and other salty foods. He had an episode when walking from fishing with a friend to the car mile) and was very short of breath. His friend was concerned and told his wife. His symptoms on evening prior to presentation prompting him to go to OSH. OSH, pt received ASA 324mg. Trop 0.045. CXR as OSH showed cardiomegaly with central vessel engorgement. Initial vitals were 97.4 60 128/90 18 97% 2L. ECG showed Vpaced with rate of 64. Labs significant for troponin of 0.05, Cr 1.3, INR 2.3. The spoke with atrius cardiology who recommended admit to cards. He received his home dose of 25 mg of metoprolol and was sent to the floor for further evaluation.\n", + "input3": "+ Dyslipidemia, \n+ Hypertension \n+ mitral regurgitation \n+ atrial fibrillation \n+ OSA \n+ colonic adenoma \n+ generalized anxiety disorder \n+ CKD, stage 3 \n+ glucose intolerance\n", + "input4": "Daughter Cancer\nMother CAD/PVD \nSister CAD/PVD; Cancer - Breast\n", + "input5": "Physical Exam:\nAdmission exam:\n \nVS: 98.5 110-140/60-70 20 95% RA \nGeneral: comfortable in NAD\nHEENT: sclera anicteric, MMM\nNeck: supple. JVP difficult to interpret given body habitus\nCV: RRR. distant heart sounds. III/ VI systolic murmur at the apex\nLungs: Bibasilar crackles\nAbdomen: +BS, soft, nontender, nondistended\nGU: no foley\nExt: 1+ lower extremity edema bilaterally.\nNeuro: A&Ox3. CN II-XII grossly intact. strenth in upper and lower extremities\n", + "input6": "Admission labs:\n\n06:52PM BLOOD WBC-7.9 RBC-4.90 Hgb-16.5 Hct-47.9 MCV-98 \nMCH-33.6* MCHC-34.4 RDW-15.0\n06:52PM BLOOD Glucose-150* UreaN-32* Creat-1.3* Na-144 \nK-4.7 Cl-101 HCO3-31 AnGap-17\n06:35AM BLOOD CK-MB-4 cTropnT-0.05* proBNP-1191*\n06:35AM BLOOD Calcium-9.7 Phos-3.0 Mg-2.2\n\nOverall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral,\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17205507-DS-19.json b/Finished/Heart Failure/17205507-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..2e0fdb6a63dae8c965c26b495df26e53001d1567 --- /dev/null +++ b/Finished/Heart Failure/17205507-DS-19.json @@ -0,0 +1,49 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strong suspected heart failure.$Cause_1": { + "proBNP-1275*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "SOB is the common symptom of HF$Cause_1": { + "shortness of breath$Input1": {} + }, + "Shortness of breath is a common symptom of heart failure, which may be caused by the heart's inability to pump blood effectively, resulting in poor blood return to the lungs.$Cause_1": { + "woke up the night prior to admission feeling very short of breath$Input2": {} + }, + "Patients often get up at night to go to the bathroom and do not often feel short of breath, but frequent nocturia can be an indirect sign of heart failure because poor cardiac function may lead to fluid retention during the day and urination accelerated at night due to changes in body position.$Cause_1": { + "waking up nightly to go to the bathroom but rarely feels short of breath$Input2": {} + }, + "Patients with type 2 diabetes may suffer from cardiovascular damage and increase the risk of heart failure due to long-term hyperglycemia.$Cause_1": { + "Diabetes mellitus, type II$Input3": {} + }, + "Long-term high blood pressure can put stress on the heart and cause changes in its structure and function, which may lead to heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is associated with atherosclerosis, a major risk factor for heart failure$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "The S1 during contraction is weakened, the S2 is normal, and there is a systolic murmur. These are all signs of abnormal heart valve function and may be related to heart failure.$Cause_1": { + "faint S1, normal S2, systolic murmur$Input5": {} + }, + "Decreased breath sounds may indicate fluid accumulation in the lungs due to heart failure, called pulmonary congestion.$Cause_1": { + "breath sounds diminished at bases$Input5": {} + } + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "Patient woke up the night prior to admission feeling very short of breath. This did not resolve and he alerted his son (who lives upstairs). His son called the fire department and he was brought to the ED. He reports waking up nightly to go to the bathroom but rarely feels short of breath. He denies any worsening DOE (baseline DOE with 1 flight of stairs but not walking around the ground floor of his house). He denies orthopnea, diaphoresis, CP. He denies any F/C. He has had a cough productive of white sputum for several weeks.\n", + "input3": "+ Metastatic Prostate cancer \n+ Diabetes mellitus, type II \n+ Hypertension \n+ Hyperlipidemia \n+ Possible COPD \n+ Hx positive PPD w/ neg cxr \n+ Bilateral hearing loss \n+ Carotid stenosis,\n", + "input4": "Father died of TB meningitis. Mother died of TB of the lung .\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL:\n================================\nVitals - T: 97.7 BP: 128/71 HR: RR: 20 02 sat: 100 on 2L \nGENERAL: elderly male in NAD \nHEENT: PERRL, anicteric sclera, pink conjunctiva, MMM \nNECK: no JVD \nCARDIAC: RRR, faint S1, normal S2, systolic murmur, no r/g \n \nLUNG: CTA bilaterally, breath sounds diminished at bases, non-labored \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding \nEXTREMITIES: no cyanosis, clubbing or edema, wwp, moving all 4 extremities with purpose \nPULSES: 2+ Right DP pulse, 1+ Left DP pulse\n", + "input6": "ADMISSION LABS:\n====================================\n02:40AM BLOOD WBC-8.7 RBC-4.26* Hgb-13.2* Hct-39.0* \nMCV-91 MCH-31.1 MCHC-34.0 RDW-14.5\n02:40AM BLOOD Neuts-66.8 Monos-6.1 Eos-0.8 \nBaso-0.8\n02:40AM BLOOD Glucose-139* UreaN-47* Creat-2.1* Na-146* K-4.5 Cl-109* HCO3-26 AnGap-16\n02:40AM BLOOD cTropnT-0.02*\n10:00AM BLOOD cTropnT-0.08*\n10:00AM BLOOD Calcium-9.9 Mg-2.4\n02:53AM BLOOD pO2-39* pCO2-68* pH-7.27* \ncalTCO2-33* Base XS-1\n02:53AM BLOOD Lactate-1.7 proBNP-1275*\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral,\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17243592-DS-15.json b/Finished/Heart Failure/17243592-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..8d72b931097c0dbe3b75bab618f3d95c355c627e --- /dev/null +++ b/Finished/Heart Failure/17243592-DS-15.json @@ -0,0 +1,76 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strong suspected heart failure.$Cause_1": { + "proBNP-6395*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Exertional dyspnea is a potential symptom of heart failure$Cause_1": { + "dyspnea on exertion$Input1": {} + }, + "Shortness of breath is a common symptom of heart failure. As the heart's ability to pump blood decreases, blood circulation in the lungs becomes poor.$Cause_1": { + "increasingly short of breath$Input2": {} + }, + "People with heart failure may gain weight rapidly because of water accumulation in the body. This is because the heart cannot pump blood effectively enough to drive the kidneys to remove the excess water.$Cause_1": { + "eight has increased from 201 lbs to 208 lbs$Input2": {} + }, + "These are classic symptoms of heart failure. PND and orthopnea occur when the heart is not able to pump blood enough when lying flat, causing fluid to accumulate in the lungs.$Cause_1": { + "complains of PND, lower extremity swelling, and orthopnea$Input2": {} + }, + "Sitting upright helps reduce fluid accumulation in the lungs, and sublingual administration usually refers to the use of nitroglycerin, which is used to relieve angina and may indicate heart disease.$Cause_1": { + "very short of breath and that this is relieved by sitting up and sometimes by taking sublingually.$Input2": {} + }, + "This is because fluid accumulates in the lungs when lying on your back, causing difficulty breathing, a clear sign of heart failure$Cause_1": { + "In fact, he has been sleeping upright$Input2": {} + }, + "Chest pain and its response to nitroglycerin are often associated with coronary artery disease, which may exacerbate heart failure.$Cause_1": { + "had chest pain last night that was somewhat relieved by nitroglycerine.$Input2": {} + }, + "Coronary artery disease is a major risk factor for heart failure, and myocardial infarction (MI) causes death of heart tissue and affects heart function.$Cause_1": { + "Coronary artery disease, status-post MI x3$Input3": {} + }, + "Peripheral vascular disease increases the risk of heart disease because they often share the same causes, such as hardening of the arteries.$Cause_1": { + "Peripheral vascular disease$Input3": {} + }, + "Obesity puts a strain on the heart and is associated with a variety of heart diseases, including heart failure$Cause_1": { + "Obesity$Input3": {} + }, + "Diabetes can lead to heart disease, such as coronary artery disease, which can lead to heart failure.$Cause_1": { + "Type 2 DM$Input3": {} + }, + "Long-term high blood pressure will increase the burden on the heart, leading to cardiac hypertrophy and functional decline, and is one of the main causes of heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is a risk factor for coronary artery disease and indirectly promotes the development of heart failure by accelerating atherosclerosis.$Cause_1": { + "Hyperlipdiemia$Input3": {} + }, + "Stroke can affect cardiac function through multiple mechanisms, including cardiac stress and injury through heart-brain interactions.$Cause_1": { + "CVA$Input3": {} + }, + "Distended jugular veins are a common symptom of heart failure and indicate obstruction of blood flow back to the heart, usually associated with right heart dysfunction.$Cause_1": { + "JVD above mid neck roughly 15cm$Input5": {} + }, + "Irregular heart sounds may indicate abnormalities in the structure or function of the heart. This may be due to heart valve disease or irregular heartbeats, both potential factors for heart failure.$Cause_1": { + "heart sounds irregular though pulse$Input5": {} + }, + "Bilateral basilar rales are usually a sign of fluid accumulation in the lungs, a classic symptom of pulmonary congestion in heart failure.$Cause_1": { + "bilateral basilar crackles without wheezing$Input5": {} + } + } + } + } + }, + "input1": "dyspnea on exertion\n", + "input2": "For the last three days he has become increasingly short of breath. He weighs himself every day. His weight has increased from 201 lbs to 208 lbs in the last three days. He complains of PND, lower extremity swelling, and orthopnea. He says that sometimes he gets very short of breath and that this is relieved by sitting up and sometimes by taking sublingually. In fact, he has been sleeping upright. He actually declines chest pain; however, the ED note says that he had chest pain last night that was somewhat relieved by nitroglycerine. He does not have a cough during the day. No fevers or chills. He had two episodes of watery brown diarrhea today. No recent antibiotic exposure. No vomiting or nausea.\n", + "input3": "+ Coronary artery disease, status-post MI x3 (first was an \nanterior MI treated with percutaneous intervention) \n+ ICD placed\n+ CVA\n+ Chronic renal insufficiency\n+ Peripheral vascular disease\n+ Obesity\n+ Type 2 DM\n+ Hypertension\n+ Hyperlipdiemia\n+ Right leg fracture after fall\n+ left ankle fx\n+ gout\n", + "input4": "Mother died with \"arterial blockage.\" \nFather died of accident. Half-brother is alive.\n", + "input5": "Physical Exam:\nAdmission Physical Exam: \nVitals: 98.1F, 139/85, p 68, rr 18, 98% 4L NC\nGENERAL - NAD, comfortable, appropriate\nHEENT - NC/AT, PERRLA, strabismus with left eye abducted, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, JVD above mid neck roughly 15cm \nHEART - regular rate, heart sounds irregular though pulse \nChest: Pacer c/d/i\nLUNGS - bilateral basilar crackles without wheezing, good air movement, resp unlabored, no accessory muscle use\n", + "input6": "01:20PM GLUCOSE-160* UREA N-21* CREAT-1.6* SODIUM-140 POTASSIUM-3.5 CHLORIDE-100 TOTAL CO2-26 ANION GAP-18\n01:20PM estGFR-Using this\n01:20PM cTropnT-0.05*\n01:20PM proBNP-6395*\n01:20PM D-DIMER-<150\n01:20PM WBC-9.6 RBC-3.95* HGB-12.1* HCT-36.6* MCV-93 \nMCH-30.6 MCHC-33.0 RDW-16.2*\n01:20PM NEUTS-71.3* MONOS-6.1 EOS-2.9 BASOS-0.4\n01:20PM PLT COUNT-321\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral,\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17244619-DS-41.json b/Finished/Heart Failure/17244619-DS-41.json new file mode 100644 index 0000000000000000000000000000000000000000..aa5a4b367f43aaa0359aee70d82b114f79c4615c --- /dev/null +++ b/Finished/Heart Failure/17244619-DS-41.json @@ -0,0 +1,58 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strong suspected heart failure.$Cause_1": { + "proBNP-1275*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "The nature of chest pain may indicate stress on the heart or abnormal heart function.$Cause_1": { + "Gradualonset, squeezing, \"rolling\", central chest pain$Input2": {} + }, + "Pain radiating from the chest to the elbows, along with numbness in the fingertips, may indicate a pinched nerve or poor blood flow from a heart problem.$Cause_1": { + "radiatingto both elbows with numbness to fingertips$Input2": {} + }, + "Dizziness may be caused by a lack of blood flow to the brain due to poor heart pumping.$Cause_1": { + "some lightheadedness$Input2": {} + }, + "Long-term diabetes can lead to damage to the cardiovascular system and increase the risk of heart failure$Cause_1": { + "Diabetes type 2$Input3": {} + }, + "Coronary artery disease reduces blood flow to the heart, causing damage to the heart muscle, which increases the likelihood of heart failure.$Cause_1": { + "Coronary artery disease$Input3": {} + }, + "Dyslipidemia increases the risk of atherosclerosis, an important cause of coronary artery disease and heart failure.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Long-term high blood pressure will increase the workload on the heart, causing it to gradually enlarge and possibly progress to heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Atrial fibrillation can cause the heart to fill poorly and produce less blood, increasing the risk of heart failure.$Cause_1": { + "Atrial fibrillation$Input3": {} + }, + "Distended jugular veins are a common sign of heart failure, indicating that blood flow back to the heart is blocked.$Cause_1": { + "JVP elevated to jaw$Input5": {} + }, + "A heart murmur may be due to a malfunctioning heart valve or other structural problems with the heart, conditions that are common in people with heart failure.$Cause_1": { + "possible I/VI systolic murmur at the right upper sternal boarder$Input5": {} + }, + "Limb edema and skin changes such as reticular erythema are manifestations of increased venous pressure and poor circulation caused by heart failure.$Cause_1": { + "Feet: livedo stasis bilaterally with scaleing skin over anterior tibia$Input5": {} + } + } + } + } + }, + "input1": "None\n", + "input2": "Patient is a poor historian; Gradualonset, squeezing, \"rolling\", central chest pain, radiatingto both elbows with numbness to fingertips associated with diaphoresis and some lightheadedness. Denies nausea/vomitting/syncope. Pain occured at rest. \n", + "input3": "+ Diabetes type 2 \n+ Coronary artery disease, s/p DES\n+ Dyslipidemia \n+ Hypertension \n+ Atrial fibrillation \n+ PVD, s/p bilateral iliac stents, s/p right carotid \nendarterectomy \n+ Recurrent DVT/PE (clot R leg), s/p IVC filter \n+ COPD \n+ GERD \n+ Cataracts \n+ Glaucoma \n+ Alzheimer's dementia \n+ Delusional d/o \n+ Temporal arteritis\n", + "input4": "Brothers x2 and sister died of lung CA. \nBrother with CVA. \nFather died of MI.\n", + "input5": "In the ED, initial vitals were:\nPain 0, Temp 97.8, P 59, BP 137/54, RR 16, O2 sat 98% RA \n\nUpon arrival to the floor, vitals were: Pain 0, Temp 97.4, BP \n138/60, P 60, RR 20, O2 sat 100% RA\n\nWeight:\nAdmission: 98.1 kg (standing)\n: 99 kg (bed)\n: 97.4 kg (standing)\n\nPHYSICAL EXAMINATION: \nGeneral: Patient cheerfully laying in bed, hard of hearing,wheezing, clearly delusional \nHEENT: EOMI, conjunctival sclera \nNeck: JVP elevated to jaw, no carotid bruits \nCV: RRR, normal S1/S2, possible I/VI systolic murmur at the right upper sternal boarder with no radiation to carotids, norubs/gallops, no heaves/thrills \nLungs: Clear bilateral breath sounds, no crackles/crepitatins \nAbdomen: Soft, distended with fat, tender on deep palpation in right and left upper quadrants \nGU: deferred \nExt: Hands: strong regular radial pulses, hands hold, capillary refill >2 seconds; Feet: livedo stasis bilaterally with scaleing skin over anterior tibia, DP and pulses found via doppler (stronger on right), clubbing of all toes \nNeuro: Alert, orientated to name and place, however delusional with mulitple tangents \nSkin: No rashes\n", + "input6": "On admission:\n11:00PM cTropnT-<0.01\n05:06PM GLUCOSE-97 UREA N-25* CREAT-1.2 SODIUM-139 \nPOTASSIUM-4.9 CHLORIDE-103 TOTAL CO2-26 ANION GAP-15\n05:06PM estGFR-Using this\n05:06PM cTropnT-<0.01 proBNP-1275*\n05:06PM DIGOXIN-1.1\n05:06PM WBC-10.8 RBC-3.72* HGB-9.4* HCT-29.5* \nMCV-79*# MCH-25.3*# MCHC-31.9 RDW-15.5\n05:06PM NEUTS-78.9* LYMPHS-13.1* MONOS-6.4 EOS-1.5 \nBASOS-0.1\n05:06PM PLT COUNT-190\n03:20PM URINE COLOR-Straw APPEAR-Clear SP\n03:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 \nLEUK-SM \n03:20PM URINE RBC-0 WBC-1 BACTERIA-NONE YEAST-NONE \nEPI-<1\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral,\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17277045-DS-9.json b/Finished/Heart Failure/17277045-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..a89817d312760e284c2cf897d32970aea78a9f5a --- /dev/null +++ b/Finished/Heart Failure/17277045-DS-9.json @@ -0,0 +1,64 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFmrEF$Cause_1": { + "LVEF= 45 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strong suspected heart failure.$Cause_1": { + "proBNP-726*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Dyspnea is a common symptom of HF$Cause_1": { + "Dyspnea$Input1": {} + }, + "Increased swelling in the legs. This is a common symptom of heart failure, as fluid builds up in the body as the heart's pumping power weakens.$Cause_1": { + "increased lower extremity edema$Input2": {} + }, + "Increased breathing difficulties. People with heart failure may have difficulty breathing because fluid accumulates in the lungs because the heart is not able to pump blood as well.$Cause_1": { + "worsening dyspnea$Input2": {} + }, + "Palpitations may be associated with irregular heartbeats (such as atrial fibrillation in this case), which are also risk factors for heart failure.$Cause_1": { + "associated palpitations$Input2": {} + }, + "Dyspnea on exertion worsens to marked shortness of breath at rest. This indicates that symptoms of heart failure are progressing from mild to severe stages.$Cause_1": { + "dyspnea on exertion progressed over the subsequent 24 hrs, evolving into frank shortness of breath at rest$Input2": {} + }, + "Atrial fibrillation is a significant risk factor for heart failure, especially when accompanied by a rapid ventricular response, which increases the workload on the heart.$Cause_1": { + "recent hospitalization for Afib w/RVR$Input2": {} + }, + "Cerebrovascular accidents are associated with heart failure because cardiovascular and cerebrovascular diseases often share the same risk factors such as hypertension and atherosclerosis$Cause_1": { + "CVA$Input3": {} + }, + "Morbid obesity increases the workload on the heart and may lead to heart failure.$Cause_1": { + "Morbid obesity.$Input3": {} + }, + "Type 2 diabetes is strongly associated with heart failure. Long-term effects of high blood sugar levels may lead to changes in cardiac structure and function, including myocardial hypertrophy and cardiac fibrosis, thereby increasing the risk of heart failure.$Cause_1": { + "DM2$Input3": {} + }, + "The veins are more distended than normal. This is usually a sign that the heart is not pumping blood effectively, causing increased pressure in the chest cavity, which is common in heart failure.$Cause_1": { + "JVD 8cm$Input5": {} + }, + "An irregular and unregulated heartbeat may be a sign of atrial fibrillation, a common complication of heart failure.$Cause_1": { + "irregularly irregular$Input5": {} + }, + "Crackles in the lungs, usually at the lung bases, but described in this article in the mid-lungs. This is a sign of fluid accumulation in the lungs, which may be congestion or edema due to heart failure$Cause_1": { + "rackles half way up$Input5": {} + }, + "The swelling is pitting after pressing, here depicted at the ankle. This type of lower extremity edema is a common manifestation of poor fluid circulation due to heart failure.$Cause_1": { + "2+ DP pulses bilaterally$Input5": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "Patient was recovering from a recent hospitalization for Afib w/RVR from when 2 days PTA she noted increased lower extremity edema with worsening dyspnea. Her dyspnea on exertion progressed over the subsequent 24 hrs, evolving into frank shortness of breath at rest with associated palpitations. No chest pain, orthopnea (sleeps on 1 pillow), PND, syncope. No fevers, chills, wheezing, cough. While patient has a history of anxiety attacks, this did not feel like her normal anxiety attack.\n", + "input3": "+ CVA\n+ Morbid obesity.\n+ Anxiety with panic attack symptoms.\n+ DM2\n+ Ulcerative colitis.\n", + "input4": "Two sisters died of non-Hodgkins lymphoma, mother and sister had atrial fibrillation. All three sisters have DM.\n", + "input5": "ADMISSION PHYSICAL EXAM: \nVitals - 97.4, 134/44, 88. 20, 100% 3L \nGENERAL: A&Ox3, NAD \nHEENT: EOMI, PERRL, anicteric sclera, pink conjunctiva, MMM \nNECK: nontender supple neck, JVD 8cm \nCARDIAC: irregularly irregular, normal S1/S2, no murmurs, gallops, or rubs \nLUNG: crackles half way up \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: 2+ pitting edema to ankles \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "ADMISSION:\n07:10PM BLOOD WBC-10.5 RBC-3.45* Hgb-7.6* Hct-26.8* \nMCV-78* MCH-21.9* MCHC-28.3* RDW-23.1*\n07:10PM BLOOD Neuts-62.4 Monos-4.2 Eos-4.0 \nBaso-0.5\n07:50AM BLOOD Glucose-55* UreaN-21* Creat-1.3* Na-141 \nK-3.6 Cl-99 HCO3-33* AnGap-13\n07:10PM BLOOD cTropnT-<0.01\n07:10PM BLOOD proBNP-726*\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 45 %) with global hypokinesis and regional inferior/infero-lateral,\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17304513-DS-20.json b/Finished/Heart Failure/17304513-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..1ad08c72ae0d44aa47f0303268ab53f005c2de2d --- /dev/null +++ b/Finished/Heart Failure/17304513-DS-20.json @@ -0,0 +1,61 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strong suspected heart failure.$Cause_1": { + "proBNP-1708$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Cough is a common symptom of HF$Cause_1": { + "cough$Input1": {} + }, + "Cough and changes in sputum are usually related to the respiratory system, but they may also occur when accompanied by other symptoms, such as pulmonary congestion in heart failure$Cause_1": { + "1 week of sputum change and now has a cough productive of \"neon yellow\" sputum$Input2": {} + }, + "Dyspnea on exertion is a common symptom of heart failure and indicates that the heart may not be pumping enough to support normal activity.$Cause_1": { + "worsening dyspnea on exertion and now has issues climbing scaffolding at work$Input2": {} + }, + "Lower limb edema is one of the typical manifestations of heart failure. Due to insufficient heart pumping function, fluid accumulates in the lower limbs.$Cause_1": { + "legs are slightly more swollen than usual$Input2": {} + }, + "Chronic high blood sugar levels can damage blood vessels and heart function, increasing the risk of heart failure$Cause_1": { + "Uncontrolled type 2 diabetee$Input3": {} + }, + "Hyperlipidemia can lead to atherosclerosis, affect blood supply to the heart, and increase the risk of heart failure.$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "This is a disease that directly affects the heart muscle, causing it to become larger and less able to pump blood, and is a common direct cause of heart failure.$Cause_1": { + "Dilated cardiomyopathy$Input3": {} + }, + "family history of heart disease inrease the risk of HF$Cause_1": { + "Mother with CHF. Father with CAD and CABG.$Input4": {} + }, + "Patients with heart failure may have difficulty breathing due to decreased heart pumping function, which may lead to obstruction of blood circulation to the lungs.$Cause_1": { + "mildly dyspneic$Input5": {} + }, + "The description mentioned that \"the jugular vein was filled to 90 degrees at the mandibular angle\", which is usually an important sign of heart failure and reflects impaired cardiac return function.$Cause_1": { + "JVP elevated to the angle of the mandible at 90 degrees$Input5": {} + }, + "There are moist rales at the lung bases, especially on the left side, which may be a manifestation of pulmonary congestion, which is common in patients with heart failure.$Cause_1": { + "crackles at the bilateral bases$Input5": {} + }, + "There is obvious edema below the knees on both sides, which is caused by insufficient heart pumping function in heart failure, resulting in slower blood circulation throughout the body and increased blood venous pressure.$Cause_1": { + "2+ lower extremity edema to the knees bilaterally$Input5": {} + } + } + } + } + }, + "input1": "cough\n", + "input2": "The patient has had ~1 week of sputum change and now has a cough productive of \"neon yellow\" sputum. No hemoptysis noted. He also describes worsening dyspnea on exertion and now has issues climbing scaffolding at work. He also notes his legs are slightly more swollen than usual. The patient describes mild abdominal tightness and bloating over the past 3 days, which was what was most bothersome to him initially.\n\n", + "input3": "+ Uncontrolled type 2 diabetee\n+ Hyperlipidemia\n+ Dilated cardiomyopathy\n+ Sleep apnea - compliant with CPAP \n+ Erectile dysfunction\n+ Anemia\n+ Substance use disorder(cocaine, tobacco)\n", + "input4": "Mother with CHF. Father with CAD and CABG.\n", + "input5": "ADMISSION PHYSICAL EXAM\nVS: 97.7 PO 133 / 88 89 18 98% RA \nGENERAL: Pleasant middle-aged man, mildly dyspneic, lying in bed comfortably, in no acute distress\nHEENT: NC/AT, EOMI, MMM\nNECK: JVP elevated to the angle of the mandible at 90 degrees\nCARDIAC: Regular rate and rhythm, no murmurs, rubs, or gallops \nLUNG: Appears in no respiratory distress, crackles at the bilateral bases, slightly worse on the L, no wheezes or rhonchi\nABD: Normal bowel sounds, soft, nontender, nondistended, no\nhepatomegaly, no splenomegaly \nEXT: Warm, well perfused, 2+ lower extremity edema to the knees bilaterally\nPULSES: 2+ radial pulses\nNEURO: Alert, oriented, moving all 4 extremities with purpose\nSKIN: Scarring over bilateral lower extremities\n", + "input6": "ADMISSION LABS\n06:05AM WBC-6.4 RBC-4.71 HGB-12.6* HCT-38.0* MCV-81* MCH-26.8 MCHC-33.2 RDW-13.3 RDWSD-38.9\n06:05AM NEUTS-65.8 MONOS-9.2 EOS-0.6* BASOS-0.6 IM AbsNeut-4.20 AbsLymp-1.50 AbsMono-0.59 AbsEos-0.04 AbsBaso-0.04\n06:05AM GLUCOSE-297* UREA N-15 CREAT-0.9 SODIUM-137 POTASSIUM-4.3 CHLORIDE-105 TOTAL CO2-20* ANION GAP-12\n06:05AM CALCIUM-8.2* PHOSPHATE-3.1 MAGNESIUM-1.8\n06:05AM cTropnT-<0.01\n06:05AM proBNP-1708*\n07:45AM URINE COLOR-Straw APPEAR-Clear\n07:45AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-150* KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral,\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17316016-DS-14.json b/Finished/Heart Failure/17316016-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..d2ef195395af0dcfd189da8a653f39c5b2495ba3 --- /dev/null +++ b/Finished/Heart Failure/17316016-DS-14.json @@ -0,0 +1,61 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP 7299$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Dyspnea is a common symptom of heart failure$Cause_1": { + "Dyspnea$Input1": {} + }, + "Dyspnea during exertion, in which the patient's symptoms progress to difficulty breathing even at rest. This is a common symptom of heart failure and indicates that the heart may not be able to pump blood well enough.$Cause_1": { + "feeling more DOE,and is now feeling short of breath at rest$Input2": {} + }, + "Describes chronic and acute loss of muscle strength, including difficulty getting out of bed or walking. These symptoms may result from general weakness caused by heart failure.$Cause_1": { + "acute on chronic weakness$Input2": {} + }, + "A dry cough is also a possible symptom of heart failure, especially if fluid accumulates in the lungs.$Cause_1": { + "non-productive cough$Input2": {} + }, + "The use of oxygen during sleep may indicate nocturnal dyspnea or sleep-disordered breathing, which can also be associated with heart failure.$Cause_1": { + "Uses 2L O2 at night$Input2": {} + }, + "Obesity increases the risk of heart disease because it puts extra strain on the heart, which can lead to heart failure$Cause_1": { + "Obesity$Input3": {} + }, + "A stroke often indicates a blood vessel problem, which may affect blood flow to the heart and indirectly lead to heart failure.$Cause_1": { + "CVA history$Input3": {} + }, + "High blood lipids may lead to atherosclerosis, which reduces blood flow to the heart and increases the risk of heart failure.$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Long-term high blood pressure puts a strain on the heart and can lead to heart disease and heart failure$Cause_1": { + "HTN$Input3": {} + }, + "LVH is a manifestation of the heart's adaptation to persistent high blood pressure, which can damage heart function in the long term and may lead to heart failure.$Cause_1": { + "LVH$Input3": {} + }, + "An increased JVP and a positive hepatojugular reflex are classic signs of heart failure and suggest that right heart function is impaired, probably because the heart is unable to pump blood effectively.$Cause_1": { + "JVP 11-12cm with large v waves and +HJR$Input5": {} + }, + "Decreased breath sounds bilaterally and rales at the lung bases usually indicate pulmonary congestion, a sign of increased pulmonary pressures due to heart failure$Cause_1": { + "diminished breath sounds bilaterally, crackles at ases$Input5": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "States that she has been feeling more DOE,and is now feeling short of breath at rest. Also reports acute on chronic weakness including difficulty getting out of bed or ambulating. She notes a non-productive cough but denies any chest pain, palpitations, abdominal pain, nausea, vomiting. Patient states that she has IBS-D and her diarrheal bowel movements that may have increased in frequency recently. Of note, she does have history of c diff infection. No BRBPR or melena. Uses 2L O2 at night time and has not needed for O2 during the day time. Denies worsening orthopnea, PND, CP, palpitations, diaphoresis.\n\ufeff\n", + "input3": "+ Obesity \n+ CVA history \n+ Hyperlipidemia \n+ HTN \n+ LVH\n+ mitral valve replacement\n+ arthritis\n+ anxiety/depression/memory loss (alert and oriented x 3)\n+ compression fractures\n+ seizures\n+ hysterectomy.\n+ Reflux\n+ Hypothyroidism\n+ Sleep apnea no CPAP\n+ Anemia\n+ Osteoporosis\n+ Vit D deficiency\n", + "input4": "Stroke, TIA, hypertension. in her mother. Cancer in her father colon cancer.\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM\n=======================\nVS: 96 (ax), 115/75, 71, 20, 97% 2L \nGENERAL: frail appearing women in NAD\nHEENT: NC/AT, PERRLA, anicteric, MMM\nNECK: JVP 11-12cm with large v waves and +HJR\nCARDIAC: RRR, HSM at LLSB\nLUNGS: diminished breath sounds bilaterally, crackles at ases\nABDOMEN: soft, NT, distended, +BS, no rebound or guarding \nEXTREMITIES: cool, no pitting edema\nSKIN: No significant skin lesions or rashes.\n", + "input6": "ADMISSION LABS\n==============\n01:28PM BLOOD WBC-4.1 RBC-3.92 Hgb-10.1* Hct-35.6 \nMCV-91 MCH-25.8* MCHC-28.4* RDW-16.1* RDWSD-52.8* Plt Ct-65*\n01:28PM BLOOD Glucose-103* UreaN-58* Creat-1.5* Na-145 K-5.5* Cl-101 HCO3-33* AnGap-11\n06:45AM BLOOD ALT-13 AST-17 LD(LDH)-151 AlkPhos-165* TotBili-0.5\n06:45AM BLOOD Albumin-3.9 Calcium-9.1 Phos-4.9* Mg-2.5 \nIron-55\n06:45AM BLOOD TSH-3.5\n08:20AM BLOOD HCV Ab-NEG BNP 7299*\n\nIMAGING/STUDIES\n===============\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17319103-DS-19.json b/Finished/Heart Failure/17319103-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..a17f6c843cbd13e7a802fee8c3cd1f0cb0eb5944 --- /dev/null +++ b/Finished/Heart Failure/17319103-DS-19.json @@ -0,0 +1,55 @@ +{ + "HFmrEF$Intermedia_5": { + "LVEF 41%-49% is the critiera for HFmrEF$Cause_1": { + "LVEF= 45 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a strong value for heart failure$Cause_1": { + "proBNP-GREATER THAN 1200$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "SOB is the common symptom of HF$Cause_1": { + "SOB$Input1": {} + }, + "Acute shortness of breath is one of the common symptoms of heart failure. Especially when the heart cannot effectively pump blood to the lungs, it will cause poor blood return to the lungs, resulting in difficulty breathing.$Cause_1": { + "acute shortness of breath$Input2": {} + }, + "The heart is unable to keep up with the body's demand for blood during increased physical activity, often in people with heart failure.$Cause_1": { + "short of breath with prominent exertion$Input2": {} + }, + "Class III refers to patients who feel fatigue, palpitations or difficulty breathing after mild physical activity, which reflects the severity of heart failure.$Cause_1": { + "NHY Class III$Input2": {} + }, + "The use of home oxygen therapy indicates that the patient may have persistent hypoxemia, a common complication of heart failure.$Cause_1": { + "started on home O2$Input2": {} + }, + "Hypertension is one of the main risk factors for heart disease and heart failure. Long-term high blood pressure can increase the burden on the heart and cause cardiac hypertrophy.$Cause_1": { + "HTN$Input3": {} + }, + "Mitral regurgitation means that the mitral valve of the heart does not close completely, causing blood to flow back, increasing the workload of the heart and possibly causing or aggravating heart failure.$Cause_1": { + "Mod-severe MR: Noted on last ECHO$Input3": {} + }, + "A shift in the apex beat often indicates an enlarged heart, a common finding in heart failure.$Cause_1": { + "PMI displaced laterally below nipple.$Input5": {} + }, + "A heart murmur may indicate a malfunctioning heart valve, which can increase the heart's workload and trigger or worsen heart failure.$Cause_1": { + "II/VI faint, systolic murmur at the apex radiating to the axilla$Input5": {} + }, + "Lung rales and wheezing are usually due to fluid accumulation in the lungs, which is a direct manifestation of poor fluid return due to decreased heart function in heart failure.$Cause_1": { + "Faint basilar crackles at the left base combined with end expiratory wheezing on the left and right base.$Input5": {} + } + } + } + } + }, + "input1": "SOB\n", + "input2": "male who presents with acute shortness of breath for the past day. In the past, per his wife, he typically becomes short of breath with prominent exertion and is not short of breath at rest. He is NHY Class III, and had been well since his last admission. He had recently been seen in clinic earlier last month and his lasix was increased and his felodipine had been stopped. He was also started on home O2. At home his blood pressure had been in the 140's but his wife could not remember the bottom number.\n", + "input3": "PAST MEDICAL HISTORY: \n+ Polycystic kidney dz - last abdominal US shows stable cys \n+ CKD - baseline cr 2.5-2.7\n+ HTN\n+ Mod-severe MR: Noted on last ECHO \n+ Hx of gout \n+ Hx of anemia \n+ Chronic back pain \n+ Thyromegaly\n", + "input4": "No family history of early MI, otherwise non-contributory. \nMother and father died of \"old age.\" Siblings healthy aunt with asthma.\n", + "input5": "Physical Exam:\nVS: As above \nGEN: AOx3, NAD \nHEENT: PERRLA. EMOI. MMM. no LAD. JVD non-discernable with distended neck veins. neck supple. \nCards: No carotid bruits. RRR S1/S2 normal, no S3, or S4. PMI displaced laterally below nipple. II/VI faint, systolic murmur at the apex radiating to the axilla. \nPulm: Faint basilar crackles at the left base combined with end expiratory wheezing on the left and right base. \nAbd: soft, NT, +BS. no rebound/guarding. Palpable aneurysm at the mid abdomen. R sided large protruberance, non-pulsitile. \nExtremities: wwp, no edema. DPs, PTs 2+. \nSkin: no rashes or bruising \nNeuro/Psych: CNs II-XII intact. strength in U/L extremities.\nsensation intact to LT, cerebellar fxn intact (FTN, HTS).\n", + "input6": "Admission:\n09:30AM BLOOD WBC-6.5# RBC-3.31* Hgb-10.7* Hct-30.7* \nMCV-93 MCH-32.4* MCHC-35.0 RDW-12.1\n09:30AM BLOOD Glucose-113* UreaN-51* Creat-3.3* Na-139 \nK-4.6 Cl-98 HCO3-32 AnGap-14\n09:30AM BLOOD CK(CPK)-201\n09:30AM BLOOD CK-MB-2 proBNP-GREATER THAN 1200\n09:30AM BLOOD cTropnT-0.06*\n03:07AM BLOOD CK-MB-3 cTropnT-0.06*\n07:10AM BLOOD Calcium-9.0 Phos-4.1 Mg-2.3\n09:30AM BLOOD TSH-2.6\n09:52AM BLOOD Lactate-1.6\n10:20AM BLOOD WBC-5.2 RBC-3.45* Hgb-11.2* Hct-33.2* \nMCV-96 MCH-32.3* MCHC-33.7 RDW-12.5\n10:20AM BLOOD Glucose-150* UreaN-64* Creat-4.0* Na-142 K-3.8 Cl-103 HCO3-24 AnGap-19.\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 45 %) with global hypokinesis\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17322218-DS-17.json b/Finished/Heart Failure/17322218-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..263638d7b1c7c91809d57a798d37e18340663186 --- /dev/null +++ b/Finished/Heart Failure/17322218-DS-17.json @@ -0,0 +1,64 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP 7299$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Dyspnea is the symptom of HF$Cause_1": { + "Dyspnea$Input1": {} + }, + "Orthopnea is when a person has trouble breathing while lying down and needs to sit up to breathe. It is a common symptom of heart failure, which occurs when fluid accumulates in the lungs due to decreased heart function.$Cause_1": { + "reported worsening orthopnea$Input2": {} + }, + "The left side of the lung is restricted in its function, a condition that can be caused by a lung infection or heart problems. In heart failure, weakened breathing sounds can be related to fluid accumulation in the lungs.$Cause_1": { + "decreased L sided breath sounds$Input2": {} + }, + "Pneumonia may further increase the burden on the heart by affecting lung function. Pneumonia is a serious complication for patients with heart failure.$Cause_1": { + "diagnosis of pneumonia$Input2": {} + }, + "A persistent cough may be caused by fluid accumulation in the lungs, which is common in people with heart failure.$Cause_1": { + "continues to endorese persistent cough$Input2": {} + }, + "Atrial fibrillation is a common risk factor for heart failure because it can cause the heart to pump blood less efficiently.$Cause_1": { + "Atrial fibrillation$Input3": {} + }, + "There is a strong association between diabetes and heart failure because long-term damage to blood vessels and heart function caused by high blood sugar increases the risk of heart failure.$Cause_1": { + "Diabetes mellitus type 2$Input3": {} + }, + "Hypertension is one of the main risk factors for heart failure because it causes the heart to work under high pressure for a long time, increasing the burden on the heart.$Cause_1": { + "Hypertension$Input3": {} + }, + "Systolic blood pressure is 149 to 170 mmHg, and diastolic blood pressure is 59 to 68 mmHg. Hypertension is a common risk factor for heart failure. Long-term high blood pressure increases the burden on the heart and may lead to a gradual decline in heart function.$Cause_1": { + "BP=149-170/59-68$Input5": {} + }, + "JVD usually refers to abnormal dilation of the jugular vein, which is a key sign of heart failure. This indicates that blood flow back to the heart is blocked and the heart's pumping function is impaired.$Cause_1": { + "JVD to earlobe$Input5": {} + }, + "Decreased breath sounds on the left side may indicate fluid accumulation or limited function on the left side of the lung, which is common in people with heart failure because the heart cannot pump enough blood, which may cause fluid to accumulate in the lungs.$Cause_1": { + "decreased air entry on L$Input5": {} + }, + "Abdominal distension may be caused by fluid accumulation, which is also common in people with heart failure, especially when heart failure cuts off blood circulation to the rest of the body.$Cause_1": { + "distended, soft, NT +BS$Input5": {} + }, + "The presence of pressure mark edema in both lower limbs, accompanied by exudate, is one of the typical symptoms of heart failure. This symptom indicates that the body has a serious accumulation of fluid, which may be due to insufficient heart pumping function resulting in poor blood return.$Cause_1": { + "2+ b/l pitting edema weeping, bandages over b/l feet$Input5": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "He presented for a regularly scheduled appointment with Dr.reported worsening orthopnea over the last 4 weeks, 7lbs overweight and decreased L sided breath sounds. He was discharged with an admission for a diagnosis of pneumonia (he was treated with levofloxacin/flagyl). He continues to endorese persistent cough but denies subjective fevers (patient is demented and a poor historian).\n", + "input3": "+ Prostate Cancer\n+ Atrial fibrillation on warfarin \n+ Diabetes mellitus type 2\n+ Hypertension\n+ Osteoporosis \n+ Chronic normocytic anemia \n+ Chronic kidney disease\n+ s/p TURP \n+ s/p appy \n+ congnitive decline\n+ hearing loss\n+ inguinal hernia\n+ peripheral neuropathy\n", + "input4": "Prostate CA, dementia, CAD\n", + "input5": "Physical Exam:\nAdmission\nVS: T=97.4.BP=149-170/59-68.HR=55-57.RR=18.O2 sat=99% on RA\nGeneral: chronically ill appearing gentleman, AOx1, comfortable appearing\nHEENT: MMM\nNeck: no cervical/clavicular LAD\nCV: RRR, normal S1/S2, JVD to earlobe\nLungs: decreased air entry on L\nAbdomen: distended, soft, NT +BS\nGU: no foley\nExt: 2+ b/l pitting edema weeping, bandages over b/l feet\n", + "input6": "Admission:\n07:31PM BLOOD WBC-5.8 RBC-4.07* Hgb-12.3* Hct-38.4* MCV-94 MCH-30.1 MCHC-31.9 RDW-17.3*\n07:31PM BLOOD Glucose-188* UreaN-46* Creat-1.6* Na-144 K-4.4 Cl-101 HCO3-30 AnGap-17\n07:31PM BLOOD Albumin-3.5 Calcium-8.3* Phos-3.0 Mg-2.4 BNP 7299*\n\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/17352394-DS-4.json b/Finished/Heart Failure/17352394-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..28b91a80722819809eb8522d57b054d9012aa673 --- /dev/null +++ b/Finished/Heart Failure/17352394-DS-4.json @@ -0,0 +1,49 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF = 20 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "A chest X-ray showed an enlarged heart, a classic sign of heart failure, indicating that the heart's pumping function may be impaired.$Cause_1": { + "CXR shows enlarged heart$Input2": {} + }, + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Left ventricular hypertrophy is an adaptive response of the heart to sustained pressure overload and is common in patients with hypertension or valvular heart disease.$Cause_1": { + "There is mild symmetric left ventricular hypertrophy$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "BNP is a hormone secreted when the heart is under stress, and its high level is an important biochemical marker of heart failure.$Cause_1": { + "BNP 1390$Input2": {} + }, + "Suspected heart failure$Intermedia_2": { + "People with heart failure often retain fluid, leading to dramatic weight gain and swelling in the extremities.$Cause_1": { + "25 pound weight gain and bilateral pedal edema$Input2": {} + }, + "Pericardial effusion and dilated cardiomyopathy can both affect heart function and increase the risk of heart failure$Cause_1": { + "CT showing mild pericardial effusion and dilated cardiomyopathy$Input2": {} + }, + "These symptoms indicate a buildup of fluid in the body, possibly due to poor fluid circulation caused by heart failure.$Cause_1": { + "Pericardial effusion and bilateral pleural effusions and small amount of ascites$Input2": {} + }, + "Obesity is the risk factor of heart failure$Cause_1": { + "Obesity$Input3": {} + }, + "JVP8-10cm, higher jugular venous pressure is an important indicator of heart failure, indicating possible cardiac dysfunction.$Cause_1": { + "Supple with JVP of 8-10cm$Input5": {} + }, + "Increased left ventricular filling pressures are common in diastolic dysfunction and may lead to heart failure$Cause_1": { + "Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg)$Input6": {} + } + } + } + } + }, + "input1": "None\n", + "input2": "Patient has been intermittently treated for UTI/pylo. She presented today with 25 pound weight gain and bilateral pedal edema. CXR shows enlarged heart. The patient had CT showing mild pericardial effusion and dilated cardiomyopathy. Recent admission , lyme titres, rheum factors tested and negative. Recently treated this past week for UTI, PNA with levoquin and macrobid. She reports that her child had strep throat and during that time she felt sick herself, however, she recovered well.On arrival to the ED the patient's vitals were 0 96.2 102 137/91 20 98% RA. The patient labs were significant for Trop Neg, BNP 1390, labs WNL, UA neg. Patient was given lasix 40mg and metop succ 25mg prior to transfer. CTA chest: IMPRESSION: No acute pulmonary embolism. Pericardial effusion and bilateral pleural effusions and small amount of ascites. Right lower lobe infiltrate. Subsegmental atelectasis left lung base. Cardiology was consulted in the ED and recommended admission to the floor. \n\ufeff\nOn the floor the patient's vitals were 98.2 130/90 103 22 100RA. Repeat blood pressure showed systolics in the 100s, however patient was warm and well perfused. The patient was NAD and breathing comfortably. She had no active complaints. She had been diuresing well.\n", + "input3": "+ Obesity\n+ Asthma\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "ADMISSION PHYSICAL EXAM\n=======================\nNo family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. \nPHYSICAL EXAM: \nVS:98.2 130/90 103 22 100RA \nGENERAL: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\ufeff\nNECK: Supple with JVP of 8-10cm (difficult to assess but appeared elevated with patient sitting at 60 degrees) \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts (difficult to auscultate given obese body habitus). \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. No crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits.\n", + "input6": "ADMISSION LABS\n==============\n12:10AM BLOOD WBC-14.4* RBC-4.75 Hgb-14.6 Hct-44.2 \nMCV-93# MCH-30.7 MCHC-33.0 RDW-13.1 RDWSD-44.7\n12:10AM BLOOD Glucose-140* UreaN-15 Creat-1.1 Na-137 K-4.0 Cl-98 HCO3-27 AnGap-16\n12:10AM BLOOD ALT-26 AST-20 LD(LDH)-210 CK(CPK)-93 \nAlkPhos-55 TotBili-0.6\n12:10AM BLOOD CK-MB-1 cTropnT-<0.01\n12:10AM BLOOD Albumin-3.5 Calcium-9.2 Phos-3.9 Mg-1.6\n07:05PM BLOOD calTIBC-403 Ferritn-83 TRF-310\n12:10AM BLOOD TSH-3.2\n09:03AM BLOOD CRP-5.2*\n05:00PM BLOOD HIV Ab-Negative\n\ufeff\n___ ECHO\n==============\nThe left atrium is moderately dilated. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy with normal cavity size. There is severe global left ventricular hypokinesis (LVEF = 20 %). Systolic function of apical segments is relatively preserved. The estimated cardiac index is depressed (<2.0L/min/m2). No masses or thrombi are seen in the left ventricle. Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The right ventricular cavity is mildly dilated with moderate global free wall hypokinesis. Tricuspid annular plane systolic excursion is depressed (1.4 cm) consistent with right ventricular systolic dysfunction. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are structurally normal. Mild (1+) mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is high normal. There is a very small circumferential pericardial effusion. \nIMPRESSION: Normal left ventricular cavity size with severre global hypokinesis in a pattern most c/w a non-ischemic cardiomyopathy. Right ventricular cavity dilation with free wall hypokinesis. Mild mitral regurgitation. Increased PCWP. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18536618-DS-21.json b/Finished/Heart Failure/18536618-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..70accf32bcc04b1844ca79cd2457824dc5f5e6f9 --- /dev/null +++ b/Finished/Heart Failure/18536618-DS-21.json @@ -0,0 +1,43 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "pBNP 6120 (elevated from 5780 one month ago, 1549 in sometime)$Input2": {} + }, + "Suspected heart failure$Intermedia_2": { + "weight gain is a common symptom of fluid retention associated with heart failure.$Cause_1": { + "weight gain$Input1": {} + }, + "Coronary artery disease (CAD) and coronary artery bypass grafting (CABG) are also risk factors for heart failure.$Cause_1": { + "cath with 3vd s/p 3v CABG (LIMA to LAD, SVG to PDA and ramus)$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Dyslipidemia is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "DM II$Input3": {} + }, + "Maternal GM died of MI, mother died of heart problems at unknown age, DMII and cancer runs in her family.$Cause_1": { + "Maternal GM died of MI$Input4": {} + } + } + } + } + }, + "input1": "weight gain\n", + "input2": "CAD (CABG in certain organs, HTN, DMII on tele-weightmonitoring at home, was told to come in to ER due to continued weight gain. Weight increased 6 lbs overnight and has been increasing about 5 lbs/day for weeks according to the patient. According the telemonitoring notes, it is about 9lbs in 1 week. She has noted some minimal dyspnea on exertion, increased swelling, but no chest pain, orthopnea or PND. Has a history of non-compliance according to notes. She states that she occasionally misses a dose of lasix (particularly at night if she falls asleep) and that she drinks about 3 L of fluid per day. She also noticed low urine output yesterday despite taking her am lasix dose. .In the ED initial vitals were: 97.1 74 163/77 18 100 RA. Labs were notable for trop of 0.15 (baseline 0.01 - 0.04), pBNP 6120 (elevated from 5780 one month ago, 1549 in sometime), Cr of 2.1 (slowly increasing from 0.9 over course of the year), hct of 35%. She was given lasix 80mg x1.\n", + "input3": "+ cath with 3vd s/p 3v CABG (LIMA to LAD, SVG to PDA and ramus)\n+ Hypertension\n+ Dyslipidemia\n+ PAD: s/p b/l SFA PTCA/stents for chronic claudication\n+ Asthma\n+ Hx of alcohol and substance abuse- sober several years\n+ DM II\n+ s/p myomectomy and L oophrectomy\n+ Hep C\n+ Depression\n+ Colon Cancer (resected)\n", + "input4": "Maternal GM died of MI, mother died of heart problems at unknown age, DMII and cancer runs in her family.\n", + "input5": "N/A\n", + "input6": "The left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%).\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18548050-DS-21.json b/Finished/Heart Failure/18548050-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..7b2664ff50c674433ae661535a4604b551859645 --- /dev/null +++ b/Finished/Heart Failure/18548050-DS-21.json @@ -0,0 +1,61 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Pulseless electrical activity (PEA) is a serious arrhythmia that tends to lead to severe heart failure.$Cause_1": { + "PEA arrest$Input3": {} + }, + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "proBNP-7575*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Chest Pain is a common symptom of heart failure.$Cause_1": { + "Chest Pain$Input1": {} + }, + "Shortness of breath (SOB) is a common symptom of heart failure.$Cause_1": { + "SOB$Input1": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Diabetes$Input3": {} + }, + "Dyslipidemia is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Severe primary pulmonary hypertension can lead to heart failure.$Cause_1": { + "Severe primary pulmonary hypertension$Input3": {} + }, + "A family history of cardiovascular disease$Cause_1": { + "Father and 2 brothers with CAD$Input4": {} + }, + "Common signs of lung congestion associated with heart failure.$Cause_1": { + "Bibaliar crackles with expitory wheeze$Input5": {} + }, + "Coronary artery disease (CAD) is also risk factor for heart failure.$Cause_1": { + "PMHx of CAD (3 vessel disease with 100% occlusion of the right coronary artery but good collateralization)$Input2": {} + }, + "Valvular heart disease is a common and important cause of heart failure.$Cause_1": { + "Mitral Regurgitation$Input3": {} + }, + "Valvular heart disease is a common and important cause of heart failure.*$Cause_1": { + "Moderate to severe Aortic Stenosis$Input3": {} + } + } + } + } + }, + "input1": "Chest Pain, SOB\n", + "input2": "Pt is a male with PMHx of CAD (3 vessel disease with 100% occlusion of the right coronary artery but good collateralization), CHF, PVD with R stent leg, HTN, DM2, carotid artery disease, recent PEA arrest (hospitalized and mod-severe AS (peak gradient of 40mmHg and an estimated valve area of 1.0cm2) who is admitted for chest pain and shortness of breath. History is gathered from the patient's two daughters, as he is too obtunded to give a history. Per his daughters, he had been experiencing increasing CP all week since being discharged from rehab. Has had multiple episodes of chest pain that came on with both rest and exertion, as well as while sitting on the toilet trying to have BM. Associated with diaphoresis and radiation of pain to left arm. Episodes lasted less than an hour usually and were relieved with multiple doses of nitro. He also was complaining of worsening shortness of breath, which became signficantly worse last night. Has been sleeping sitting up in a chair, becomes dyspneic and has chest pain when lying flat. Daughters also endorse PND and worsening lower extremity edema. \n\ufeff\nGiven all these symptoms, his daughters have called a few times this week, but thus far the patient had refused to go. Today they mentioned his symptoms at a pre-op visit for CABG planning, and they were told to call their cardiologist, who recommended they bring him to the ER. They brought him to hospital, where he was tachypneic and tachycardic, so he was started on BiPAP. Nitro paste was applied, resulting in hypotension, so paste was removed. Cardiac enzymes at that time were negative and ECG showed baseline LVH with \"strain\" pattern. Given that his providers were and he is scheduled to undergo CABG here next week, he was transferred to ED via med-evac flight. While en route he started to not tolerate the BiPAP, was given ativan 2mg IV, and subsequently became obtunded. \nOn arrival to hospital, initial vitals were HR: 99, BP: 179/70, and \nhis GCS was 7, he was satting 90% on NRB. He was switched back onto BiPAP given his belly breathing, poor breath sounds at bases with crackles. He was started low dose nitro gtt with drop in pressures again, so this was stopped. No lasix was given in the ED. Labs and imaging significant for Trop negative, CK: 37 MB: 2, Lactate:2.3, CXR showing volume overload from comparision 12 hours ago. \n \nOn arrival to the floor, patient was on BiPAP, sedative and minimally responsive, GCS 12.\n", + "input3": "+ Diabetes\n+ Dyslipidemia \n+ Hypertension \n+ PEA arrest\n+ Mitral Regurgitation\n+ Moderate to severe Aortic Stenosis\n+ Severe primary pulmonary hypertension\n+ COPD on home O2\n+ Peripheral vascular disease\n+ Bilateral Carotid Stenosis - Occluded right ICA\n+ Benign neck tumors\n", + "input4": "Father and 2 brothers with CAD\n", + "input5": "Admission Physical Exam: \nVS: T=97.8 BP=142/95 HR=60 RR=18 O2 sat= 98% \nWDWN male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNECK: Supple with JVP of 8-9 cm. \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. . Loud, late-peaking SEM with radiation to carotids. No r/g. No thrills, lifts. No S3 or S4. LUNGS: No chest wall deformities, scoliosis or kyphosis. accessory muscle use and belly breathing. Bibaliar crackles with expitory wheeze. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. 1+ lower extermity pitting edema \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ \nLeft: Carotid 2+\n", + "input6": "CXR: Mild pulmonary edema, not definitely changed given differences in inspiratory effort and portable technique since exam earlier the same day. \n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %)\n\ufeff\n01:40PM BLOOD WBC-10.3 RBC-3.49* Hgb-10.3* Hct-31.9* \nMCV-91 MCH-29.3 MCHC-32.2 RDW-15.9*\n08:40AM BLOOD WBC-10.1 RBC-3.64* Hgb-10.4* Hct-32.5* \nMCV-89 MCH-28.6 MCHC-32.1 RDW-16.8*\n08:40AM BLOOD Glucose-226* UreaN-24* Creat-1.0 Na-138 \nK-4.3 Cl-94* HCO3-37* AnGap-11\n03:25PM BLOOD UreaN-25* Creat-1.1 Na-138 K-4.5 Cl-94*\n07:15AM BLOOD Glucose-154* UreaN-21* Creat-1.0 Na-137 \nK-4.6 Cl-95* HCO3-37* AnGap-10\n03:35PM BLOOD Glucose-292* UreaN-29* Creat-1.0 Na-137 \nK-4.3 Cl-94*\n07:44AM BLOOD Glucose-203* UreaN-28* Creat-1.0 Na-136 \nK-4.0 Cl-95* HCO3-38* AnGap-7*\n01:40PM BLOOD UreaN-29* Creat-1.0 Na-137 K-5.1 Cl-95* \nHCO3-37* AnGap-10\n07:44AM BLOOD CK-MB-2 cTropnT-<0.01\n08:50PM BLOOD CK-MB-2 proBNP-7575*\n08:50PM BLOOD cTropnT-<0.01\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18581055-DS-19.json b/Finished/Heart Failure/18581055-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..39ad3e75e7793b44e038938f4fbb91685ca91039 --- /dev/null +++ b/Finished/Heart Failure/18581055-DS-19.json @@ -0,0 +1,55 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP or pro-BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "proBNP-8317*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Shortness of breath is a common symptom of heart failure.$Cause_1": { + "shortness of breath$Input1": {} + }, + "bacteremia may induce heart failure.$Cause_1": { + "bacteremia$Input1": {} + }, + "Sick sinus syndrome is the cause and triggering factor of heart failure.$Cause_1": { + "Sick sinus syndrome s/p pacemaker$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "HTN$Input3": {} + }, + "Hyperlipidemia is a risk factor for heart failure.$Cause_1": { + "HLD$Input3": {} + }, + "Coronary artery disease (CAD) and coronary artery bypass grafting (CABG) are also risk factors for heart failure.$Cause_1": { + "CAD s/p CABG$Input3": {} + }, + "Chronic kidney disease (CKD) can induce heart failure.$Cause_1": { + "CKD Stage III$Input3": {} + }, + "A history of chronic heart failure (CHF) indicates that this admission is highly likely to be an acute exacerbation of CHF.$Cause_1": { + "Diastolic CHF, chronic$Input3": {} + }, + "Atrial fibrillation (afib) is the cause and triggering factor of heart failure.$Cause_1": { + "afib on coumadin$Input3": {} + }, + "Elevated jugular venous pulse (JVP) is a common sign of heart failure, indicating the state of fluid retention.$Cause_1": { + "Neck: JVP$Input5": {} + } + } + } + } + }, + "input1": "shortness of breath, bacteremia\n", + "input2": "This is a chronic afib on coumadin, sick sinus syndrome pacemaker, who presented with shortness of breath x2 days, initially treated for CHF exacerbation, and found to have bacteremia with a rising lactate.\n\ufeff\nFrom review of Cardiology records and notes, the patient has had worsening dyspnea and multiple fluctuations in his diuretics, and as the dose changed from 120mg to 80mg BID. His weight has varied from 165 - 172 and his BNP seems at baseline to be 220-250. On day prior to admission he weight was167 and BNP was 916. Cr was 1.5 from a baseline of 1.2-1.6. He was reportedly sent to the ED given the rise in BNP and Cr.\n\ufeff\nIn the ED, initial vitals were 98.3 71 145/78 20 99% 4L. CXR showed showed congestive heart failure with moderate pulmonary edema and small bilateral effusions. proBNP was 8317. He was observed for aggressively diuresed and urine output monitoring. At Cardiology evaluated and recommended another 120 mg IV lasix w/ MeQ KCL x 1 now with a plan to be discharged on torsemide 40 mg (20 mg x 2) qam, and OFF lasix and have close follow-up. Urine output was ~2.25 L/20 hours and the patient reportedly was feeling better.\n\ufeff\nOn transfer to the floor, vitals were 98.1 62 160/70 18 99% RA. In the initial workup, however, blood cultures were drawn that returned successfully diuresed. However as part of initial workup, a set of blood cultures were drawn that grew GPC in clusters in both the aerobic and anaerobic bottles. A second set of blood cultures were drawn and are currently pending. His lactate also rose from 1.7 on initial draw prior to diuresis to 3.3 this afternoon.\n\ufeff\nReportedly, he denied any infectious symptoms. His urine was negative, and CXR without infiltrate. He received vancomycin 1g x1 and was admitted for IV antibiotics until blood culture speciation returns.\n\ufeff\nOn arrival to the floor, patient reports no pain\n", + "input3": "+ Sick sinus syndrome s/p pacemaker\n+ HTN\n+ HLD\n+ CAD s/p CABG\n+ inguinal hernia\n+ PVD\n+ Gastritis/duodenitis\n+ CKD Stage III\n+ Diastolic CHF, chronic\n+ lambda light chain disease\n+ BPH\n+ afib on coumadin\n+ depression\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "ADMISSION PHYSICAL EXAM:\nVS: 97.6 145/82 59 18 99\nGeneral: Well appearing gentleman who appears younger than his stated age\nHEENT: NCAT. Dry mucous membranes \nNeck: JVP \nCV: Slightly bradycardic, soft systolic murmur\nLungs: slight inspiriatory crackles b/l bases \nAbdomen: Soft, non tender, non distended, normoactive bowel sounds\nExt: Warm, 1+ edema.\nNeuro: Grossly intact. \nSKIN: right chest pacer without erythema/swelling/ulceration or tenderness, no rashes, no jaundice, no stigmata of septic emboli\n", + "input6": "ADMISSION LABS:\n\ufeff\n12:30PM BLOOD WBC-8.4 RBC-3.89* Hgb-11.2* Hct-36.4* MCV-94 MCH-28.7 MCHC-30.7* RDW-20.2*\n12:30PM BLOOD Neuts-75.2* Lymphs-16.7* Monos-5.3 Eos-2.3 Baso-0.5\n12:30PM BLOOD Glucose-118* UreaN-35* Creat-1.5* Na-141 K-4.7 Cl-108 HCO3-22 AnGap-16\n12:30PM BLOOD proBNP-8317*\n12:30PM BLOOD cTropnT-0.01\n07:25PM BLOOD cTropnT-0.01\n04:50AM BLOOD Albumin-3.8 Calcium-8.8 Phos-3.3 Mg-2.3\n12:35PM BLOOD Lactate-1.7\n\ufeff\nLACTATE TREND:\n12:35PM BLOOD Lactate-1.7\n03:17PM BLOOD Lactate-3.3*\n01:06AM BLOOD Lactate-2.1*\n02:01PM BLOOD Lactate-2.1*\n07:39AM BLOOD Lactate-2.9*\n09:42AM BLOOD Lactate-3.5*\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %)\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18606160-DS-8.json b/Finished/Heart Failure/18606160-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..689f85bf9b5c33b8e1db803e1f10216f91f58395 --- /dev/null +++ b/Finished/Heart Failure/18606160-DS-8.json @@ -0,0 +1,49 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP 7299*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Oral discomfort is an atypical symptom.$Cause_1": { + "Oral discomfort$Input1": {} + }, + "Possible symptom of heart failure$Cause_1": { + "She has noted increasing edema over few weeks$Input2": {} + }, + "Tachycardia is a possible predisposing factor of heart failure.$Cause_1": { + "finding of tachycardia to 120 in office$Input2": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Diabetes Mellitus II, uncontrolled with complication$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is a risk factor for heart failure.$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Valvular heart disease is also a common and important cause of heart failure.$Cause_1": { + "Aortic Stenosis s/p Bioprosthetic porcine$Input3": {} + }, + "Possible sign of heart failure$Cause_1": { + "pitting edema bilaterally$Input5": {} + } + } + } + } + }, + "input1": "Oral discomfort\n", + "input2": "The patient is a female with medical history pertinent for Temporal Arteritis, AS s/p porcine AVR who is now admitted for evaluation of dry mouth, tachycardia, and edema. The medical history is reviewed, revealing for recent clinical diagnosis with Temporal Arteritis for which the patient has been on Steroid therapy with side effects of hyperglycemia and steroid myopathy. In an attempt to facilitate steroid dose reduction Methotrexate 10mg daily was added. The patient was seen by Rheumatology at which time palate ulceration was noted. Fungal culture was negative, viral culture not processed because of wrong culture tube but the patient was started on Acyclovir 400mg PO tid x 10 days and Methotrexate was not escalated any further. The patient since that time has been undergoing Prednisone taper with reduction in Prednisone dose from 30mg to 20mg. the patient called the clinic with report of evolving pain and dryness of her mouth for which nystatin swish and swallow was empirically started. Yesterday, note was made that the patient initially improved with nystatin but symptoms have since worsened for which oral lidocaine was prescribed. The patient was seen at clinic today per her report, no note yet available for review, and was sent to the ED for concern for recent diarrheal episode, diuretic use and finding of tachycardia to 120 in office. Per discussion with patient she reports predominant symptom that is bothering her is sense of dry mouth. She reports this has been ongoing for last 2 days with sensation of mild burning over her tongue. She denies pain over palate or mucosa, no known ulcers that she has noted herself. The patient denies any sense of dry eyes or pain. She reports if anything she has been experiencing sense of watery eyes over the last couple of days. The patient reports she has been taking POs well over last couple of weeks. She had 1 day where she had episodes of loose stool but this was otherwise self-resolving. She has noted increasing edema over few weeks for which she took 1 dose of diuretic a few days ago (does not recall name that was prescribed by her PCP. The patient has been wearing TEDs stockings for this.\nED Course: 98.3, 145/69, 113, 18, 97% RA. In the ED the patient had labs revealing for UA with > 50 WBC, WBC 10.9, Cr of 1.0 and lactate of 1.5. The patient received 2L NS without improvement in tachycardia. The patient is now admitted to the medical service for evaluation and treatment per discretion of emergency department given concern discharging patient with persistent tachycardia.\n", + "input3": "+ PMR\n+ Temporal Arteritis\n+ patient admitted to with FUO and Headache, started on Prednisone at that time for likely TA. ESR > 140\n+ unilateral biopsy with evidence of calcification but no inflammation, clinical impression that TA still likely\n+ Methotrexate 10mg daily started to facilitate dose reduction of Prednisone\n+ Diabetes Mellitus II, uncontrolled with complication\n+ Hypertension\n+ Hyperlipidemia\n+ Aortic Stenosis s/p Bioprosthetic porcine\n+ Hearing Loss\n+ Colon Cancer s/p resection\n+ s/p TAH\n", + "input4": "N/A\n", + "input5": "Lying: BP 141/75 HR 102\nStanding: BP 150/86 HR 113\nGeneral: Patient is an elderly female, appears to be in no acute distress, pleasant. Patietn is at times very vague in some of her answers and seems not sure of others, possibly consistent with some mild dementia with confabulation.\nHEENT: NCAT, EOMI, sclera anicteric. Conjunctiva and normal, appear moist OP: MM not markedly dry appearing, no thrush present. Small area of anterior palate with crops of superficial erythema, possibly ulcerations, without any frank vesicles. Left buccal mucosa with 1mm ulcer posterior to last molar.\nNeck: Supple, no LAD, JVP not well visualized secondary to body habitus\nChest: Generally CTA anterior and posterior bilaterally\nCor: Tachycardic, regular. Soft I/VI systolic murmur at RUSB\nAbdomen: Obese, soft, non-tender, non-distended\nExt: pitting edema bilaterally, mild erythema over RL shin consistent with likely venous stasis. Right toes with brighter erythema associated with 3-4cm annular, scaling erythematous rash consistent with reported diagnosis of tinea pedis\nSkin/Nails: Rash as above\nNeuro: Grossly intact\n", + "input6": "BNP 7299*\n\nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18624255-DS-11.json b/Finished/Heart Failure/18624255-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..bbe33dfa805c29b1f092d549bda4a90a2ed637e3 --- /dev/null +++ b/Finished/Heart Failure/18624255-DS-11.json @@ -0,0 +1,46 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strong suspected heart failure.$Cause_1": { + "proBNP-1275*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "These are typical manifestations of respiratory distress associated with heart failure.$Cause_1": { + "dyspnea on exertion$Input1": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hyperthyroidism$Input3": {} + }, + "Hypercholesterolemia is a cardiovascular risk factor.$Cause_1": { + "Hypercholesterolemia$Input3": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Diabetes Mellitus (controlled w/ diet)$Input3": {} + }, + "Left ventricular hypertrophy is a risk factor of heart failure.$Cause_1": { + "Left ventricular hypertrophy, with mitral regurgitation$Input3": {} + }, + "Mitral regurgitation (MR) and Tricuspid regurgitation (TR) are common and important causes of heart failure.$Cause_1": { + "with h/o hypertension, hyperlipidemia, heart failure preserved ejection fraction and MVP with severe MR and TR who has had at least 3 admissions with sudden onset of congestive heart failure presenting with SOB.$Input2": {} + }, + "A family history of cardiovascular disease$Cause_1": { + "Two brothers and one sister, all of whom had HTN and HLD.$Input4": {} + } + } + } + } + }, + "input1": "dyspnea on exertion\n", + "input2": "with h/o hypertension, hyperlipidemia, heart failure preserved ejection fraction and MVP with severe MR and TR who has had at least 3 admissions with sudden onset of congestive heart failure presenting with SOB. \n\ufeff\nShe has had multiple recent admissions for CHF exacerbations. Most recently admitted with dyspnea thought secondary to exacerbation from severe MR vs afib. She was transferred for Mitraclip evaluation, where she was admitted. She was not a candidate for MitraClip at this time due to extensive calcifications and valve area too large. Following that admission, she was established with home hospice. She has had 2 recent episodes of flash plum edema that was controlled with increasing bumex and O2 and morphine. Pt struggling at home right now with frequent flash pulm edema episodes. Also has poor appetite likely from gut edema. Per PCP, while pt is home hospice. She and her daugther would like to be admitted for optimization and IV diuretics.\n\ufeff\nPatient has been in contact with Dr. making adjustments to meds. Family states that she has been started on oxygen at home at night which helps prevent PND, which has occured nights, as they await CPAP fitting. Patient has been unable to lie on a bed for some time as she feel very SOB. In the past week, have noticed increasing DOE, has been unable to cook or walk around the house comfortably, now can only walk to the bathroom and back. Patient has noted increasing distention, increasing satiety with meals, nausea, and has not had a bowel movement in 3 days. Family has not noted any triggers for exacerbation, including fever, chills, medication noncompliance, dietary indiscretions or otherwise. patient noted chest heaviness when walking up stairs, and now has moved downstairs. \n\ufeff\nOn the floor patient received IV Lasix 80mg. \n\ufeff\nROS: On review of systems, s/he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. S/he denies recent fevers, chills or rigors. S/he denies exertional buttock or calf pain. All of the other review of systems were negative. \n\ufeff\nCardiac review of systems is notable for absence of chest pain, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "+ Hypertension\n+ Hypercholesterolemia\n+ Hyperthyroidism\n+ Diabetes Mellitus (controlled w/ diet)\n+ Osteoperosis\n+ Spinal Stenosis\n+ S/P ORIF R hip.\n+ R hip fracture\n+ Left ventricular hypertrophy, with mitral regurgitation\n", + "input4": "- Father died of stroke.\n- Brother died of \"old age\".\n- Two brothers and one sister, all of whom had HTN and HLD.\n- One daughter is healthy.\n- No family history of diabetes, early CAD, or sudden cardiac death.\n", + "input5": "PHYSICAL EXAMINATION ON ADMISSION: \nVS: 97.5 116/50 65 22 92%RA Weight on admission 53.1 GENERAL: Pleasant lady, NAD on 2L nasal cannula, sitting in cardiac chair. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.\nNECK: Supple with JVP of at 5 cm above clavicle sitting upright. \nCARDIAC: RRR. crescendo murmur heard throughout precordium best aprpecuated at RUSB. +S3. No visible heaves. \nLUNGS: Crackles way up b/l. Decreased BS at R lung base \nABDOMEN: +++distension, ++normoactive BS, firm. \nEXTREMITIES: trace edema R leg, no edema otherwise. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: 2+ DP pulses b/l, 1+ pulse b/l.\n", + "input6": "LABS ON ADMISSION\n09:30PM BLOOD WBC-7.5 RBC-3.40* Hgb-11.5* Hct-34.1* \nMCV-100* MCH-33.8* MCHC-33.7 RDW-13.4\n09:30PM BLOOD Glucose-111* UreaN-103* Creat-2.8*# \nNa-136 K-3.5 Cl-95* HCO3-27 AnGap-18\n09:30PM BLOOD ALT-19 AST-21 AlkPhos-49 TotBili-0.4\n09:30PM BLOOD Albumin-4.1 Calcium-9.5 Phos-7.1*# Mg-2.6\n10:07PM BLOOD Lactate-1.3\n\ufeff\nPERTINENT RESULTS\n--------------------\n12:45PM BLOOD proBNP-1275*\n10:19AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HBcAb-NEGATIVE\n05:02AM BLOOD HCV Ab-NEGATIVE\n\ufeff\nPPD negative ( 0 mm induration)\n\ufeff\nOTHER FLUID ANALYSIS\n02:05PM URINE Color-Straw Appear-Clear Sp\n02:05PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG\n02:05PM URINE Hours-RANDOM UreaN-486 Creat-49 Na-12 K-44 Cl-35\n02:05PM URINE Osmolal-320\n\ufeff\nMICROBIOLOGY\n------------\nnone\n\ufeff\nIMAGING\n---------\nImaging CHEST (PA & LAT) \nFINDINGS: \n \nCompared to the prior study there is no significant interval change. The heart continues to be enlarged, and there is mild pulmonary edema is with bibasilar opacities likely reflecting pleural effusions and associated atelectasis. The right hilus is enlarged, presumably due to acute cardiac decompensation. A large mitral annulus calcifications can be seen with mitral regurgitation. \n \nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral,\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18647733-DS-7.json b/Finished/Heart Failure/18647733-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..9421c61a7d27adf9a29987d6fa224beee16bf091 --- /dev/null +++ b/Finished/Heart Failure/18647733-DS-7.json @@ -0,0 +1,52 @@ +{ + "HFmrEF$Intermedia_5": { + "LVEF 41\u201349% is the critiera for HFmrEF$Cause_1": { + "LVEF = 45-50%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Echocardiography (echo) found left ventricular systolic dysfunction (left ventricular ejection fraction (LVEF) is 45-50%), suggesting systolic heart failure.$Cause_1": { + "ECHO: There is mild regional left ventricular systolic dysfunction with basal inferior and inferolateral hypokinesis. The remaining segments contract normally.$Input6": {} + }, + "Pulmonary congestion and cardiac enlargement associated with heart failure.$Cause_1": { + "CHEST\r: Severe cardiomegaly is stable. Mild pulmonary edema is\u3000minimally increased. The left hemidiaphragm is mildly elevated. There are bibasilar atelectasis and small bilateral effusions.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "BNP ~6700$Input2": {} + }, + "Suspected heart failure$Intermedia_2": { + "weight gain is a common symptom of fluid retention associated with heart failure.$Cause_1": { + "15 lbs weight gain$Input1": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "hypertension$Input3": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "diabetes$Input3": {} + }, + "Chronic kidney disease (CKD) can induce heart failure.$Cause_1": { + "CKD$Input3": {} + }, + "hyperlipidemia is known risk factor for heart failure.$Cause_1": { + "hyperlipidemia$Input3": {} + }, + "Coronary artery disease (CAD) and coronary artery bypass grafting (CABG) are also risk factors for heart failure.$Cause_1": { + "CAD. He is status post CABG x 4 (LIMA-LAD, SVG-D1, SVG-OM and SVG-OM) with Dr.$Input3": {} + }, + "Being overweight is also a risk factor for cardiovascular disease.$Cause_1": { + "90kg 198 lbs$Input5": {} + }, + "pitting edema in lower extremities bilaterally is a common sign of systemic congestion in heart failure.$Cause_1": { + "EXTREMITIES: pretibial edema 1+ up to knees$Input5": {} + } + } + } + } + }, + "input1": "15 lbs weight gain\n", + "input2": "y.o., recent medication changes including, Furosemide to Torsemide, presents with several weeks of weight gain of 15 lbs. Baseline weight around 200. Worsening orthopnea and DOE. Denies clear precipitants such as dietary indiscretion or med noncompliance or chest pain or palpitations however there is some concern that he has had some difficulty with following medication changes in the past few months. Seen in clinic today with Dr. reports that, he changed his HCTZ to spironolactone, increased his furosemide, then changed furosemide to torsemide (up to 40 mg) but pt kept putting on weight, edema worse, breathing worse, creatinine worse, enlarging abdomen with concern for missing med doses. Directly admitted from clinic. Patient denies current chest pain or SOB. \nOn floor vital signs 97.5 140/50 56 20 95 RA Labs were remarkable for K 5.5, Cre 2.4, BNP ~6700\nEKG: sinus brady, no sig peaked T waves, QRS 130 close to \nbaseline of 114, PR 290 (baseline 294), TWI I AVL stable, Q in \nIII (stable)\nInterventions: given 40mg IV lasix.\nROS: positive per HPI, otherwise negative\n", + "input3": "+ hypertension\n+ hyperlipidemia\n+ diabetes\n+ CAD. He is status post CABG x 4 (LIMA-LAD, SVG-D1, SVG-OM and SVG-OM) with Dr.\n+ CKD\n+ s/p radiacal prostatectomy + radiation for prostate CA\n+ h/o hyperkalemia\n+ DM2\n", + "input4": "nocontributory\n", + "input5": "Vitals 98.0 130/50 60 18 94 RA (90kg 198 lbs)\nGENERAL: NAD, AxOx3. \nHEENT: JVP not appreciated Sclera anicteric. PERRL, EOMI. MMM \nCARDIAC: RRR, normal S1, S2. No m/r/g.\nLUNGS: Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, distended, no fluid wave\nEXTREMITIES: pretibial edema 1+ up to knees\n", + "input6": "09:55PM BLOOD WBC-5.0 RBC-3.03* Hgb-9.7* Hct-29.7* \nMCV-98 MCH-32.1* MCHC-32.8 RDW-13.7\n05:40AM BLOOD WBC-4.9 RBC-3.19* Hgb-10.1* Hct-30.4* \nMCV-95 MCH-31.6 MCHC-33.1 RDW-13.7\n09:55PM BLOOD Glucose-202* UreaN-60* Creat-2.4* Na-140 \nK-5.5* Cl-110* HCO3-21* AnGap-15\n09:20AM BLOOD Glucose-247* UreaN-60* Creat-2.5* Na-145 \nK-5.3* Cl-107 HCO3-24 AnGap-19\n04:00PM BLOOD Glucose-141* UreaN-57* Creat-2.5* Na-138 \nK-5.1 Cl-106 HCO3-24 AnGap-13\n05:40AM BLOOD Glucose-137* UreaN-60* Creat-2.6* Na-139 \nK-4.5 Cl-104 HCO3-25 AnGap-15\n04:00PM BLOOD Glucose-253* UreaN-65* Creat-2.5* Na-139 \nK-4.9 Cl-100 HCO3-25 AnGap-19\n12:35PM BLOOD Glucose-158* UreaN-66* Creat-2.9* Na-138 \nK-4.2 Cl-96 HCO3-29 AnGap-17\n04:50PM BLOOD Glucose-181* UreaN-67* Creat-3.0* Na-141 \nK-4.4 Cl-98 HCO3-30 AnGap-17\n06:32AM BLOOD Glucose-167* UreaN-76* Creat-3.2* Na-140 \nK-4.3 Cl-97 HCO3-29 AnGap-18\n03:05PM BLOOD Glucose-166* UreaN-80* Creat-3.2* Na-137 \nK-4.3 Cl-98 HCO3-29 AnGap-14\n07:05AM BLOOD Glucose-175* UreaN-77* Creat-3.1* Na-142 \nK-4.4 Cl-100 HCO3-30 AnGap-16\n05:40AM BLOOD ALT-36 AST-20 CK(CPK)-45* AlkPhos-58 TotBili-0.3\n05:40AM BLOOD CK-MB-2 cTropnT-0.06*\n09:55PM BLOOD Calcium-8.8 Phos-3.7 Mg-2.4\n\ufeff\nECHO:\nPortable TTE (Complete) Done at 9:09:28 AM \nFINAL Conclusions \nLeft atrium is moderately dilated. Left ventricular wall thicknesses and cavity size are normal. There is mild regional \nleft ventricular systolic dysfunction with basal inferior and inferolateral hypokinesis. The remaining segments contract normally (LVEF = 45-50%). The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. The aortic root is mildly dilated at the sinus level. The aortic arch is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion. \n\ufeff\nIMPRESSION: Mild regional left ventricular systolic dysfunction, c/w CAD. Mild ischemic mitral regurgitation. \n\ufeff\nCompared with the prior study (images reviewed), regional LV systolic dysfunction is new. Finding discussed with Dr. at 1043 hours on the day of the study. \n\ufeff\nCardiovascular Report Stress Study Date \nIMPRESSION: No anginal symptoms or additional ST segment changes from baseline. Appropriate hemodynamic response to the Persantine infusion. \nNuclear report sent separately. \n\ufeff\nCARDIAC PERFUSION PHARM Study Date\nIMPRESSION: \n1. No reversible perfusion defect. \n2. Severe fixed basal and mid inferior wall defect. Mild fixed inferolateral wall defect. \n3. Inferior and septal wall hypokinesis. \n4. LVEF 36% and moderate LV enlargement.\n\ufeff\nCHEST (PORTABLE AP) Study Date 7:15 AM \nSevere cardiomegaly is stable. Mild pulmonary edema is \nminimally increased. The left hemidiaphragm is mildly elevated. There are bibasilar atelectasis and small bilateral effusions.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18693746-DS-10.json b/Finished/Heart Failure/18693746-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..bd898ab4b1c3efab79fe4a3bc4a90c38e76d584f --- /dev/null +++ b/Finished/Heart Failure/18693746-DS-10.json @@ -0,0 +1,88 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Chest X Ray (CXR) found that pulmonary edema suggests pulmonary circulation congestion caused by heart failure.$Cause_1": { + "CXR showed bilateral pulmonary edema.$Input2": {} + }, + "Echocardiography (ECHO) is the best and most commonly used tool for diagnosing heart failure. ECHO found systolic dysfunction in the left ventricle indicative of heart failure.$Cause_1": { + "ECHO: The left atrium is mildly dilated. The right atrium is moderately dilated. The left ventricular cavity is moderately dilated. There is mild to moderate regional left ventricular systolic dysfunction with inferolateral akinesis, inferior akinesis/hypokinesis and apical hypokinesis.$Input6": {} + }, + "Pulmonary congestion and cardiac enlargement associated with heart failure$Cause_1": { + "IMAGING:\nFINDINGS: Frontal and lateral views of the chest were obtained. Low lung volumes limit evaluation. There are bilateral pulmonary opacities which are most confluent in the lung bases. Central pulmonary hilar engorgement with interstitial and alveolar edema is present.$Input5": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP 7299*$Input5": {} + }, + "Suspected heart failure$Intermedia_2": { + "Shortness of breath is a common symptom of heart failure.$Cause_1": { + "shortness of breath$Input1": {} + }, + "chest pain is also a common symptom of heart failure.$Cause_1": { + "chest pain$Input1": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "These are typical manifestations of respiratory distress associated with heart failure. The labored dyspnea gradually worsened, leading to paroxysmal dyspnea at night, pinkish phlegm, and even orthopnea, acute pulmonary edema and other situations.$Cause_1": { + "Pt states that two days ago he developed some CP pain and sob. He took ntg with resolution of CP, however the sob got progressively worse. He felt that he had a \"lack of O2\", and also that there was \"fluid on his lungs\". He denies n/v/diaphoresis but did have some coughing with \"pinkish phlegm\". He denies acute onset but states rather that the SOB progressed over night, worse with exertion and laying flat.$Input2": {} + }, + "Edema is also one of the symptoms of heart failure.$Cause_1": { + "He also notes some increased edema.$Input2": {} + }, + "Infection is the most common cause of worsening heart failure. Respiratory tract infection is the most common type of infection.$Cause_1": { + "He also notes that 2wks ago he had flu like symptoms and since then has been feeling generally unwell.$Input2": {} + }, + "Elevated troponin may occur in some patients with heart failure.$Cause_1": { + "Labs significant for trop 2.13$Input2": {} + }, + "HYPERCHOLESTEROLEMIA is known risk factor for heart failure.$Cause_1": { + "HYPERCHOLESTEROLEMIA$Input3": {} + }, + "Common signs of heart failure-related dyspnea$Cause_1": { + "GENERAL: some dyspnea. Oriented x3.$Input5": {} + }, + "holosystolic murmur may indicate possible heart failure$Cause_1": { + "CARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. holosystolic murmur. No thrills, lifts. No S3 or S4.$Input5": {} + }, + "Some dyspnea and bilateral crackles in bases in lungs suggest breathing difficulties associated with heart failure.$Cause_1": { + "LUNGS: No chest wall deformities, scoliosis or kyphosis. some dyspnea. bilateral crackles in bases.$Input5": {} + }, + "pitting edema in lower extremities bilaterally is a common sign of systemic congestion in heart failure.$Cause_1": { + "EXTREMITIES: 1+ pitting edema in lower extremities bilaterally, warm and well perfused$Input5": {} + }, + "Elevated WBC levels may indicate inflammation, which can trigger heart failure$Cause_1": { + "BLOOD WBC-12.6*# RBC-2.64* Hgb-9.2* Hct-26.4* MCV-100* MCH-34.8* MCHC-34.9 RDW-16.2*$Input5": {} + }, + "The dynamic evolution of T wave or ST segment indicates potential myocardial damage. Atrial fibrillation with rapid ventricular rate (greater than 100 beats/min) is a cause and predisposing factor of heart failure.$Cause_1": { + "EKG on admission: Rate 133, atrial fibrillation with RVR, occasional PVCs, normal/borderline left axis deviation., LV hyprtrophy. normal rhythm, normal/borderline left axis, Q waves in III, V2-V4. ST segments depressed in I, AVL, V6 but unchaged from prior EKG.$Input5": {} + }, + "With the exception of acute myocardial infarction, multiple increases in troponin levels suggest myocardial damage from heart failure,$Cause_1": { + "cTropnT-2.13*$Input5": {} + }, + "Pulmonary congestion and cardiac enlargement associated with heart failure*$Cause_1": { + "Heart size appears enlarged though poorly assessed.$Input5": {} + }, + "Coronary artery disease (CAD) is also risk factor for heart failure.$Cause_1": { + "Percutaneous coronary intervention$Input3": {} + }, + "Coronary artery disease (CAD) is also risk factor for heart failure.*$Cause_1": { + "LCx$Input3": {} + }, + "Coronary artery disease (CAD) is also risk factor for heart failure.**$Cause_1": { + "CORONARY ARTERY DISEASE with ANGINA$Input3": {} + } + } + } + } + }, + "input1": "shortness of breath and chest pain\n", + "input2": "old man presents with shortness of breath and chest pain. Pt states that two days ago he developed some CP pain and sob. He took ntg with resolution of CP, however the sob got progressively worse. He felt that he had a \"lack of O2\", and also that there was \"fluid on his lungs\". He denies n/v/diaphoresis but did have some coughing with \"pinkish phlegm\". He denies acute onset but states rather that the SOB progressed over night, worse with exertion and laying flat. He also notes some increased edema. He denies f/c/n/v. He also notes that 2wks ago he had flu like symptoms and since then has been feeling generally unwell. \nIn the ED, initial vitals were 97.7 78 136/86 18 100% RA. Labs significant for trop 2.13, Na 129, Cr 1.9, K 5.7, Hct 32.8, INR 1.1. CXR showed bilateral pulmonary edema. ECG showed NSR at 75bpm, borderline left axis, q waves V1-V3 and III and avF, t wave inversion avL, no other ST/T changes. He was given 20mg IV lasix. Most recent vitals prior to transfer: \nOn arrival to the floor, patient was seen with the nurse. The patient states that approximately few days ago, he started developing shortness of breath and fatigue on exertion. He states that around the same time, he developed a cold that involved sinus congestion and a cough and a cold sore on his lip. The patient states that his shortness of breath got progressively worse as the days passed. He states that he has also gained approx 9 pounds and now weighs 209 pounds, since these symptoms began. He also states that approx 3 days ago, he developed chest pain. He states that the pain did not radiate anymore. He states that the pain resolved after few hours when he took 2 sublingual nitroglycerin tabs. He denies any nausea, vomiting, GI upset, changes in stools, or any other symptoms with the chest pain. The patient states that he was seen as an outpatient approx 10 days ago and had an EKG and an ECHO done. THe patient now presented with concerns with his worsening shortness of breath. \n.\nOn the floor, he was initially treated with heparin drip for NSTEMI, but then dced. He was started on a lasix drip for CHF. Down 1.5L at 5pm, pressures tending down from SBP 160s/90s to 100s/40s. Flipped into Afib with RVR today at 11pm. PMH of Afib on one occasion following epistaxis . He got Metoprolol, BP trended down, now high. Got 500cc bolus, considering amiodarone, but decided to transfer to CCU for further management. \n. \nCurrently, he is alert and orientated x 3, denies any chest pain, headache, dizziness, palpitations, dyspnea. BP improved to high, remains tachycardic around 120s. He was given 5 mg IV metoprolol, but remained tachycardic, and dropped BP to systolic, MAP around 55.\n", + "input3": "+ Percutaneous coronary intervention \n+ LCx\n+ PERIPHERAL VASCULAR DISEASE with CLAUDICATION\n+ CORONARY ARTERY DISEASE with ANGINA\n+ HYPERTENSION\n+ HYPERCHOLESTEROLEMIA\n+ ABDOMINAL AORTIC ANEURYSM\n+ GERD\n+ MONOCLONAL GAMMOPATHY\n+ GOUT\n+ MEMORY LOSS\n+ HEARING LOSS\n+ PSORIASIS\n+ H/O RETINAL ARTERY OCCLUSION\n+ H/O PYELONEPHRITIS\n", + "input4": "The patient states his father had heart problems but lived until 80 years of age. No other known medical history.\n", + "input5": "ON ADMISSION\nVS: T= 97.7 BP= 145/98 HR= 75 RR= 22 O2 sat= 97 RA \nGENERAL: some dyspnea. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Nasal Cannula in place. Sclera anicteric.\nPERRL, \nEOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nCARDIAC: PMI located in intercostal space, midclavicular line. RR, normal S1, S2. holosystolic murmur. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. some dyspnea. bilateral crackles in bases. \nABDOMEN: Soft, NTND. No HSM or tenderness. no masses. no rebound tenderness or guarding \nEXTREMITIES: 1+ pitting edema in lower extremities bilaterally, warm and well perfused \nRectum - stools are guaiac negative. \n \nPertinent Results:\nCBC:\n01:50PM BLOOD WBC-6.8 RBC-3.28* Hgb-10.8* Hct-32.4* MCV-99* MCH-33.0* MCHC-33.5 RDW-15.2\n03:15AM BLOOD WBC-12.6*# RBC-2.64* Hgb-9.2* Hct-26.4* MCV-100* MCH-34.8* MCHC-34.9 RDW-16.2*\nDIFF:\n01:50PM BLOOD Neuts-84.2* Lymphs-10.7* Monos-4.0 Eos-0.6 Baso-0.4\nCOAGS\nELECTROLYTES:\n01:50PM BLOOD Glucose-155* UreaN-53* Creat-1.9* Na-129* K-5.7* Cl-96 HCO3-19* AnGap-20\n07:50PM BLOOD Glucose-129* UreaN-73* Creat-2.4* Na-130* K-4.7 Cl-95* HCO3-21* AnGap-19\n03:49AM BLOOD Glucose-213* UreaN-71* Creat-1.9* Na-131* K-3.8 Cl-94* HCO3-21* AnGap-20\n03:15AM BLOOD Glucose-95 UreaN-111* Creat-2.2* Na-136 K-4.4 Cl-97 HCO3-24 AnGap 19\nLFTS:\n07:50AM BLOOD ALT-125* AST-87* CK(CPK)-226 AlkPhos-141* \nTotBili-1.1\nCEs:\n01:50PM BLOOD cTropnT-2.13*\nOTHER:\n10:28AM BLOOD Lactate-1.2\n12:18PM BLOOD Lactate-8.5* BNP 7299*\n12:18PM BLOOD Type-CENTRAL VE pO2-39* pCO2-28* pH-7.30* calTCO2-14* Base XS--11.\nURINE:\n03:20PM URINE Blood-NEG Nitrite-NEG Protein-100 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG\n06:33PM URINE Blood-NEG Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG\n\ufeff\nblood cultures no growth to date on day of death.\n.\nIMAGING:\nFINDINGS: Frontal and lateral views of the chest were obtained. Low lung volumes limit evaluation. There are bilateral pulmonary opacities which are most confluent in the lung bases. Central pulmonary hilar engorgement with interstitial and alveolar edema is present. Bilateral pleural effusions are small to moderate. No pneumothorax. Heart size appears enlarged though poorly assessed. Mediastinal contour is stable with atherosclerotic calcification along the aortic knob. Bony structures are intact. \n\nCXR:\nFINDINGS: As compared to the previous radiograph, there is a decrease in extent of the bilateral pleural effusions. Sequence decrease in severity of the basal areas of atelectasis. Unchanged moderate cardiomegaly, currently without evidence of pulmonary edema.\nKUB\nABDOMEN, SUPINE \nThe distribution of gas in the abdomen is unremarkable. No edematous areas of bowel are seen. There is no evidence of obstruction or infarction. Vascular calcification is noted.\nEKG on admission: Rate 133, atrial fibrillation with RVR, occasional PVCs, normal/borderline left axis deviation., LV hyprtrophy. normal rhythm, normal/borderline left axis, Q waves in III, V2-V4. ST segments depressed in I, AVL, V6 but unchaged from prior EKG.\n", + "input6": "ECHO: The left ventricular cavity is moderately dilated. There is mild to moderate regional left ventricular systolic dysfunction with inferolateral akinesis, inferior akinesis/hypokinesis and apical hypokinesis. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets are moderately thickened. There is moderate aortic valve stenosis (valve area 1.0-1.2cm2). Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Moderate to severe (3+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. On color Doppler imaging, there is an interatrial shunt consistent with stretched PFO or an atrial septal defect. (Images of the interatrial septum were suboptimal in the prior study). Compared with the prior study (images reviewed), the mid anterolateral wall now appears more hypokinetic and the anterior apex is now hypokinetic (may have been foreshortened in the prior study). The aortic valve gradient is similar. Estimated pulmonary artery systolic pressure is now higher. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %)\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18718424-DS-21.json b/Finished/Heart Failure/18718424-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..a577ac5f56f84c1ea15e19d377c36b17f8c1c5a3 --- /dev/null +++ b/Finished/Heart Failure/18718424-DS-21.json @@ -0,0 +1,67 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "A history of heart failure without following medical advice is a triggering factor for acute exacerbation of heart failure.$Cause_1": { + "Per her PCP notes, it sounds like she may not be fully compliant with her medication regimen, including her prescribed lasix, as she is not sure which pill is what.$Input2": {} + }, + "Chest X Ray (CXR) found that pulmonary edema suggests pulmonary circulation congestion caused by heart failure.$Cause_1": { + "CXR c/w with pulmonary edema$Input2": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of strongly suspected heart failure. Extreme elevation of BNP levels indicates heart failure.$Cause_1": { + "proBNP-7782*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "A history of mixed systolic and diastolic chronic heart failure (CHF) indicates that this admission is highly likely to be an acute exacerbation of CHF.$Cause_1": { + "Systolic & Diastolic CHF (EF 40-45%)$Input3": {} + }, + "Lasix is a diuretic that can reduce cardiac load. The good therapeutic effect of using lasix indicates a high possibility of acute exacerbation of chronic heart failure.$Cause_1": { + "Feels like breathing is much better since getting lasix$Input2": {} + }, + "Palpations are common and important symptoms of heart failure.$Cause_1": { + "palpitations$Input1": {} + }, + "Dyspnea are common and important symptoms of heart failure.$Cause_1": { + "dyspnea$Input1": {} + }, + "Coronary artery disease (CAD) is risk factor for heart failure.$Cause_1": { + "Chronic Stable Angina$Input3": {} + }, + "Sick sinus syndrome (SSS) is the cause and triggering factor of heart failure.$Cause_1": { + "Sick Sinus Syndrome s/p PPM$Input3": {} + }, + "Atrial fibrillation is the cause and triggering factor of heart failure.$Cause_1": { + "Atrial fibrillation$Input3": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Diabetes Mellitus 2$Input3": {} + }, + "Urinary tract infections (UTIs) may also be a contributing factor to exacerbate heart failure.$Cause_1": { + "does have a history of UTIs$Input2": {} + }, + "Elevated jugular venous pulse (JVP) is a common sign of heart failure, indicating the state of fluid retention. Bibasilar rales is one of the manifestations of acute pulmonary edema in patients with heart failure.$Cause_1": { + "Exam notable for bibasilar rales and elevated JVP.$Input2": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "A family history of cardiovascular disease$Cause_1": { + "Mother: MI$Input4": {} + }, + "indicates arrhythmia, a possible trigger for heart failure.$Cause_1": { + "HEART - Irregularly$Input5": {} + } + } + } + } + }, + "input1": "palpitations, dyspnea\n", + "input2": "female with a history of CAD, mixed systolic and diastolic CHF, SSS s/p PPM, atrial fibrillation on coumadin and DM type 2 who presents from PCP 2 days of palpitations and shortness of breath. Saw her PCP today and reported she felt \"sick\" over the past 2 days and that it had \"something to do with her heart\". Reports palpitations on the day of admission that accompanied shortness of breath and orthopnea, but took \"a big white pill\" and they improved. Per her PCP notes, it sounds like she may not be fully compliant with her medication regimen, including her prescribed lasix, as she is not sure which pill is what. Denies CP, hemoptysis, coughing, fever, HA, leg swelling, abd pain. Also reports some urinary frequency and mild dysuria, does have a history of UTIs. Reported her symptoms to her PCP, who sent her to the ED for further evaluation, given that she has very little support at home and could not be managed well as an outpatient. \n \nIn the ED, initial VS were: 98.6 90 152/77 16 97% RA. Exam notable for bibasilar rales and elevated JVP. CXR c/w with pulmonary edema and BNP elevated over 7000. ECG showed atrial fibrillation with RBBB, unchanged from prior. Given 20mg IV lasix and admitted to medicine for further management. \n \nOn arrival to the floor, the patient is awake and comfortable, talkative. Feels like breathing is much better since getting lasix in ED. \n \nREVIEW OF SYSTEMS: \n(+) per HPI, chronic constipation \n(-) fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, chest pain, abdominal pain, nausea, vomiting, diarrhea, BRBPR, melena, hematochezia, hematuria.\n", + "input3": "+ Atrial fibrillation\n+ Sick Sinus Syndrome s/p PPM\n+ Systolic & Diastolic CHF (EF 40-45%) \n+ Chronic Stable Angina\n+ Diabetes Mellitus 2\n+ Hypertension \n+ Ventral hernia repair\n+ Cholecystectomy\n+ Hysterectomy & oophrectomy for uterine cancer\n", + "input4": "Mother: MI\nFather: certain cancer\n", + "input5": "ADMISSION\nVS - Temp 98.6F, BP 156/84, HR 82, R 20, O2-sat 98% RA GENERAL - delightful elderly woman in NAD, comfortable, appropriate \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, no JVD \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use \nHEART - Irregularly irregular, no MRG, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding \nEXTREMITIES - WWP, no c/c/e, 1+ peripheral pulses (radials, DPs) \n \nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength throughout, sensation grossly intact throughout\n", + "input6": "06:35PM PLT COUNT-176\n06:35PM MONOS-4.8 EOS-1.6 \nBASOS-0.4\n06:35PM WBC-7.7 RBC-4.48 HGB-13.0 HCT-39.6 MCV-88 \nMCH-29.0 MCHC-32.8 RDW-13.1\n06:35PM CALCIUM-9.5 PHOSPHATE-2.8 MAGNESIUM-2.1\n06:35PM CK-MB-2 proBNP-7782*\n06:35PM cTropnT-<0.01\n06:35PM CK(CPK)-144\n06:35PM estGFR-Using this\n06:35PM GLUCOSE-181* UREA N-17 CREAT-0.7 SODIUM-140 \nPOTASSIUM-3.9 CHLORIDE-101 TOTAL CO2-32 ANION GAP-11\n06:49PM LACTATE-1.1\n\ufeff\n\ufeff\n07:40PM URINE RBC-2 WBC-3 BACTERIA-FEW YEAST NONE \nEPI-<1 TRANS EPI-<1\n07:40PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-150 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-SM \n07:40PM URINE COLOR-Yellow APPEAR-Clear\n\ufeff\nIMAGING\nTECHNIQUE: PA and lateral views of the chest.\n\nThe left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) with global hypokinesis and regional inferior/infero-lateral, \n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18729731-DS-13.json b/Finished/Heart Failure/18729731-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..bb03d690c59c8ab594772b9466eabc7f503cb777 --- /dev/null +++ b/Finished/Heart Failure/18729731-DS-13.json @@ -0,0 +1,55 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF>50% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is mildly dilated.$Input6": {} + }, + "Strongly Suspected Heart Failure$Intermedia_3": { + "NT-proBNP or pro-BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates Strongly suspected heart failure.$Cause_1": { + "proBNP-7962*$Input6": {} + }, + "Suspected Heart Failure$Intermedia_2": { + "Shortness of breath is a common symptom of heart failure.$Cause_1": { + "Shortness of Breath$Input1": {} + }, + "Valve disease, including aortic valve replacement, is an important cause of heart failure.$Cause_1": { + "male with past medical history of aortic valve replacement on warfarin, Afib, chronic kidney disease, diabetes presents today with SOB.$Input2": {} + }, + "Atrial fibrillation (Afib) is the cause and triggering factor of heart failure.$Cause_1": { + "Afib s/p cardioversion. On coumadin, INRs with Dr.$Input3": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "DMII-on Insulin$Input3": {} + }, + "This is a typical manifestation of respiratory distress related to heart failure. Gradually worsening from exertional dyspnea to orthopnoea. Unable to sleep in a completely supine position at night. Finally, acute pulmonary edema may even occur.$Cause_1": { + "The patient states that a little over a week prior to presentation, he developed acute onset shortness of breath while sitting. It has progressively worsened since then. It was worse with lying flat or w/ exertion.\nHe reports sleeping with two pillows at night.$Input2": {} + }, + "Psychological and mental stress are also common triggers of heart failure.$Cause_1": { + "Significant recent stress, patient's daughter died 8 weeks ago.$Input2": {} + }, + "Valve disease, including aortic valve replacement (AVR), is an important cause of heart failure.$Cause_1": { + "S/P AVR$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "HTN$Input3": {} + }, + "A family history of cardiovascular disease$Cause_1": { + "His mother had a stroke.$Input4": {} + }, + "Elevated jugular venous pulse (JVP) is a common sign of heart failure, indicating the state of fluid retention.$Cause_1": { + "NECK: elevated JVP$Input5": {} + } + } + } + } + }, + "input1": "Shortness of Breath\n", + "input2": "male with past medical history of aortic valve replacement on warfarin presents today with SOB. The patient states that a little over a week prior to presentation, he developed acute onset shortness of breath while sitting. It has progressively worsened since then. It was worse with lying flat or w/ exertion.\nHe reports sleeping with two pillows at night. No associated chest pain, nausea or vomiting. Denies any fevers, chills, URI type symptoms, abdominal pain, urinary or bowel symptoms. Denies any hemoptysis, leg swelling, recent travels or surgeries. Significant recent stress, patient's daughter died 8 weeks ago.\n", + "input3": "+ DMII-on Insulin\n+ S/P AVR\n+ Afib s/p cardioversion. On coumadin, INRs with Dr.\n+ HL \n+ HTN \n+ PVD \n+ Gastric erosions in 1980s \n+ S1 radiculopathy from lumbar disc disease \n+ Ascending aortic aneurysm\n", + "input4": "Family History: His mother had a stroke. There is no other known history of stroke, seizures, movement disorders, demyelinating disease, rheumatologic disease, heart attacks, or other neurologic or systemic disease.\n", + "input5": "ADMISSION:\nVITALS: Temp: 97.7 PO BP: 176/86 HR: 58 RR: 22 O2\nsat: 94% O2 delivery: ra Dyspnea: 2 RASS: 0\nGENERAL: Well-developed, well-nourished. NAD. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \nNECK: elevated JVP \nCARDIAC: PMI located in intercostal space, midclavicular line. RRR, normal S1, S2. No murmurs/rubs/gallops. No thrills, lifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. Rare crackles bases.\nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: Warm and without edema\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.\n", + "input6": "12:45AM WBC-5.9 RBC-3.96* HGB-11.0* HCT-35.4* MCV-89 MCH-27.8 MCHC-31.1* RDW-16.4* RDWSD-53.0*\n12:45AM CK-MB-4 proBNP-7962*\n12:45AM cTropnT-0.02*\n07:03AM TSH-4.8*\n07:03AM cTropnT-0.02*\n02:52PM GLUCOSE-202* UREA N-36* CREAT-1.9* SODIUM-145 \nPOTASSIUM-4.0 CHLORIDE-103 TOTAL CO2-23 ANION GAP-19*\n02:52PM CALCIUM-8.8 PHOSPHATE-3.7 MAGNESIUM-2.0\n\nECHO:\nThe left atrium is mildly dilated. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%).\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18740324-DS-19.json b/Finished/Heart Failure/18740324-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..7d83643a19bd1f863d31dd54d11f1a7309ce0d34 --- /dev/null +++ b/Finished/Heart Failure/18740324-DS-19.json @@ -0,0 +1,70 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The right atrium is moderately dilated$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "proBNP \u2265 125 pg/mL is a criteria of strong suspected HF$Cause_1": { + "proBNP-1669$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Lower extreme edema is a common symptom of fluid retention in patients with heart failure.$Cause_1": { + "lower extremity edema$Input1": {} + }, + "Shortness of breath, especially activity related, is a common symptom of heart failure.$Cause_1": { + "shortness of breath worse with exertion$Input2": {} + }, + "Chest pressure is a common symptom of heart failure. It is usually one of the manifestations of difficulty breathing.$Cause_1": { + "chest pressure$Input1": {} + }, + "Abdominal pain is an atypical symptom of heart failure. In heart failure, its appearance usually represents possible occurrences such as abdominal fluid accumulation, indigestion, and damage to abdominal organs.$Cause_1": { + "abdominal pain$Input1": {} + }, + "Recent complex surgical history and pneumonia are common causes of heart failure.$Cause_1": { + "His prior post-op course was complicated by development of pneumonia, from which he has been slowly recovering.$Input2": {} + }, + "Atrial fibrillation (afib) is the cause and triggering factor of heart failure.$Cause_1": { + "afib on coumadin$Input3": {} + }, + "Asthma attacks may trigger heart failure. But it rarely triggers heart failure without an attack.$Cause_1": { + "asthma$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "HTN$Input3": {} + }, + "kidney insufficiency can induce heart failure.$Cause_1": { + "L kidney insufficiency$Input3": {} + }, + "Bradycardia is the cause and triggering factor of heart failure.$Cause_1": { + "bradycardia$Input3": {} + }, + "COPD may trigger heart failure.$Cause_1": { + "COPD$Input3": {} + }, + "Coronary artery disease (CAD) and coronary artery bypass grafting (CABG) are also risk factors for heart failure.$Cause_1": { + "CAD s/p CABG$Input3": {} + }, + "A history of myocardial infarction (MI) is the most common and important cause of heart failure.$Cause_1": { + "Positive history of AAA, MI.$Input4": {} + }, + "These suggest signs of manifestations of difficulty breathing in heart failure.$Cause_1": { + "RESPIRATORY: Abnormal findings: reduced excursion, expiratory wheezing$Input5": {} + }, + "\"irreg\" indicates arrhythmia, a possible trigger for heart failure.$Cause_1": { + "CARDIOVASCULAR: Abnormal findings: irreg irreg, S1 and S2, pitting edema up to ankles$Input5": {} + } + } + } + } + }, + "input1": "Multiple complaints: lower extremity edema, shortness of breath,chest pressure, abdominal pain\n", + "input2": "M h/o AAA s/p EVAR and transcaval coil embolization\\ symptomatic type II endoleak. Returns today from rehabilitation facility with shortness of breath a/w chest pain, abdominal pain, and new lower extremity pitting edema. He c/o SOB at rest, worse with exertion, and abdominal pain that started the morning prior to this admission. He complains that his abdomen is distended, tender, and he has not passed flatus or had a bowel movement today. and patient describes this as black, and formed, w/o frank blood. His abdominal pain is generalized. His lower extremities are \"swollen\" and per patient and his son, he has never before had an issue with lower extremity edema.\n\ufeff\nPrior to this most recent coil embolization, he has required multiple follow up interventions for his AAA including laparoscopic ligation for type 2 endoleak, and endovascular repair with coil embolization of L internal iliac artery and occlusion of bilateral internal iliac arteries with a 12x12cm graft. His prior post-op course was complicated by development of pneumonia, from which he has been slowly recovering.\n", + "input3": "+ afib on coumadin\n+ asthma\n+ HTN\n+ AAA s/p EVAR\n+ L kidney insufficiency\n+ bradycardia\n+ COPD\n+ CAD s/p CABG\n", + "input4": "Positive history of AAA, MI.\n", + "input5": "PHYSICAL EXAM ON ADMISSION\nPHYSICAL EXAM: \n97.6 65 184/96 17 94%RA ___ pain\nGENERAL \n[x] WN/WD [x] NAD [x] AAO [ ] abnormal findings:\nHEENT \n[x] NC/AT [x] EOMI [x] PERRL/A [x] Anicteric\n[x] OP/NP mucosa normal [x] Tongue midline\n[x] Palate symmetric [x] Neck supple/NT/without mass\n[x] Trachea midline [x] Thyroid nl size/contour\n[ ] Abnormal findings:\nRESPIRATORY \n[ ] CTA/P [ ] Excursion normal [x] No fremitus\n[x] No egophony [x] No spine/CVAT\n[x] Abnormal findings: reduced excursion, expiratory wheezing \nand rales bilateral posterior LFs\nCARDIOVASCULAR \n[ ] RRR [x] No m/r/g [x] PMI nl [ ] No edema\n[x] Peripheral pulses nl [x] No abd/carotid bruit\n[x] Abnormal findings: irreg irreg, S1 and S2, pitting edema up to ankles\nGI \n[ ] Soft [ ] NT [ ] ND [x] No mass/HSM\n[x] Abnormal findings: voluntary guarding, distended, tender to\ndeep palpation all four quadrants, tympanitic\nGU [x] Deferred \n[ ] Nl genitalia [ ] Nl pelvic/testicular exam [ ] Nl DRE\n[ ] Abnormal findings:\nNEURO \n[x] Strength intact/symmetric [x] Sensation intact/ symmetric\n[x] Reflexes nl [x] No facial asymmetry [x] Cognition intact\n[x] Cranial nerves intact [ ] Abnormal findings:\nMS \n[x] No clubbing [x] No cyanosis [x] No edema [x] Gait nl\n[x] No tenderness [x] Tone/align/ROM nl [x] Palpation nl\n[x] Nails nl [ ] Abnormal findings:\nLYMPH NODES \n[x] Cervical nl [x] Supraclavicular nl [x] Axillary nl\n[x] Inguinal nl [ ] Abnormal findings:\nSKIN \n[x] No rashes/lesions/ulcers\n[x] No induration/nodules/tightening [ ] Abnormal findings:\nPSYCHIATRIC \n[x] Nl judgment/insight [x] Nl memory [x] Nl mood/affect\n[ ] Abnormal findings:\n", + "input6": "CBC:\n02:18AM BLOOD WBC-6.2 RBC-3.92* Hgb-11.2* Hct-35.5* \nMCV-91 MCH-28.5 MCHC-31.5 RDW-18.7*\n\ufeff\nChemistry:\n02:18AM BLOOD Glucose-102* UreaN-10 Creat-1.0 Na-133 K-4.6 Cl-97 HCO3-28 AnGap-13\n07:23AM BLOOD Glucose-93 UreaN-13 Creat-1.1 Na-131* K-4.0 Cl-94* HCO3-28 AnGap-13\n07:18AM BLOOD Glucose-86 UreaN-15 Creat-1.1 Na-134 K-4.0 Cl-95* HCO3-30 AnGap-13\n07:18AM BLOOD Calcium-8.7 Phos-3.0 Mg-2.0 proBNP-1669*\n\ufeff\nCardiac:\n08:31PM BLOOD CK-MB-3 cTropnT-<0.01\n11:30AM BLOOD CK-MB-3 cTropnT-<0.01\n02:18AM BLOOD CK-MB-3 cTropnT-<0.01\n\nThe right atrium is moderately dilated. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %) \n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18834270-DS-10.json b/Finished/Heart Failure/18834270-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..781d8035c9ae98c86fe0add56f473f7d427beac0 --- /dev/null +++ b/Finished/Heart Failure/18834270-DS-10.json @@ -0,0 +1,58 @@ +{ + "HFpEF$Intermedia_5": { + "Left ventricular ejection fractions (LVEF) is >55% suggests that the left ventricular systolic function is normal .$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Chest X Ray (CXR) shows common signs with bilateral pleural effusion and pulmonary vascular congestion. They are phenomenons of pulmonary congestion in heart failure.$Cause_1": { + "CXR: Small bilateral pleural effusions and probable mild pulmonary vascular congestion.$Input6": {} + }, + "Mildly dilated left atrium shows a potential sign of diastolic heart failure.$Cause_1": { + "ECHO: The left atrium is mildly dilated.$Input6": {} + }, + "Increased left ventricular filling pressure (PCWP>18mmHg by Tissue Doppler imaging) shows a heart failure.$Cause_1": { + "left ventricular filling pressure (PCWP>18mmHg)$Input6": {} + }, + "Strongly Suspected Heart Failure$Intermedia_3": { + "NT-proBNP or pro-BNP > 125 pg/mL is common biomarkers of strongly suspected heart$Cause_1": { + "BLOOD proBNP-690*$Input6": {} + }, + "Suspected Heart Failure$Intermedia_2": { + "Shortness of breath, especially activity related, is a common symptom of heart failure.$Cause_1": { + "shortness of breath$Input1": {} + }, + "Elder is known risk factor for heart failure.$Cause_1": { + "80 years old$Input2": {} + }, + "lisinopril and HCTZ are drugs for hypertension. In patient who self discontinue drugs has high risk for heart failure. It's also a common cause of heart failure.$Cause_1": { + "for which he formerly took lisinopril and HCTZ; he self discontinued the lisinopril because it made have caused a dry cough, and he self discontinued HCTZ recently as well.$Input2": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Hyperlipidemia is a risk factor for heart failure.$Cause_1": { + "HLD$Input3": {} + }, + "crackles at the bases in lungs is a common signs of pulmonary congestion in heart failure.$Cause_1": { + "LUNGS: crackles at the bases$Input5": {} + }, + "Distended in abdomen is a common sign of ascites in heart failure.$Cause_1": { + "ABDOMEN: distended$Input5": {} + }, + "Right bundle branch block (RBBB), ventricular ectopy that has left bundle branch block (LBBB) morphology, and T wave inversions are common electrocardiogram phenomenon in EKG or ECG of cardiac injury in heart failure.$Cause_1": { + "EKG: RBBB, sinus rhythm, a lot of ventricular ectopy that has LBBB morphology. T wave inversions in V1-V4.$Input6": {} + }, + "A history of hypertension is known risk factor for heart failure.$Cause_1": { + "Patient reports a history of hypertension$Input2": {} + } + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "He is a 80 year old M w/ PMH HTN who presents with progressive SOB over the past week.\nNo fever or chills, no chest pain. No leg swelling; no pain with breathing.\nPatient reports a history of hypertension for which he formerly took lisinopril and HCTZ; he self discontinued the lisinopril because it made have caused a dry cough, and he self discontinued HCTZ recently as well.\n", + "input3": "+ Hypertension\n+ HLD\n+ agoraphobia\n", + "input4": "CAD in mom, brothers. Son with lupus and diabetes. No history of heart failure, stroke.\n", + "input5": "ADMISSION PHYSICAL EXAM: \nVS: 97.8 156 / 62 60 18 99 2LNC \nGENERAL: NAD \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva,\nMMM\nNECK: supple, no LAD, no JVD \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNGS: crackles at the bases, no wheezes, rhonchi, breathing comfortably without use of accessory muscles \nABDOMEN: distended, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no cyanosis, clubbing, or edema\nPULSES: 2+ DP pulses bilaterally \nNEURO: A&Ox3, moving all 4 extremities with purpose \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "ADMISSION LABS:\n\ufeff\nEKG: RBBB, sinus rhythm, a lot of ventricular ectopy that has LBBB morphology. T wave inversions in V1-V4.\n02:15PM BLOOD WBC-4.2 RBC-4.53* Hgb-15.4 Hct-45.6 \nMCV-101* MCH-34.0* MCHC-33.8 RDW-13.9 RDWSD-51.6*\n02:15PM BLOOD Neuts-70.2 Monos-5.5 Eos-0.0* \nBaso-0.5 Im AbsNeut-2.95 AbsLymp-0.99* AbsMono-0.23 \nAbsEos-0.00* AbsBaso-0.02\n02:15PM BLOOD Glucose-107* UreaN-13 Creat-0.9 Na-142 \nK-3.8 Cl-105 HCO3-23 AnGap-14\n02:15PM f\n06:15AM BLOOD Calcium-8.8 Phos-2.9 Mg-1.7\n\ufeff\nLactate-1.8\nTropT<.01 x2\n\ufeff\nCXR:\nLow lung volumes with patchy bibasilar airspace opacities, possibly atelectasis, though infection or aspiration is not excluded. Small bilateral pleural effusions and probable mild pulmonary vascular congestion.\n\ufeff\nECHO:\nThe left atrium is mildly dilated. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). 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. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18853045-DS-15.json b/Finished/Heart Failure/18853045-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..84046b5210eec2522f113f9de9278f95410b3872 --- /dev/null +++ b/Finished/Heart Failure/18853045-DS-15.json @@ -0,0 +1,46 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Left ventricular ejection fractions (EF) is 35 to 40% suggests that the left ventricular systolic function is abnormal.$Cause_1": { + "EF 35-40%$Input2": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP or pro-BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "proBNP-8317$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Dyspnea is a common symptom of heart failure.$Cause_1": { + "Dyspnea on exertion$Input1": {} + }, + "Atrial fibrillation (Afib) is a common cause of heart failure.$Cause_1": { + "Afib$Input2": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Chronic renal insufficiency can induce heart failure.$Cause_1": { + "Chronic renal insufficiency$Input3": {} + }, + "Hyperlipidemia is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Rales midway up lung fields bilaterally is a common sign of pulmonary edema associated with heart failure.$Cause_1": { + "Lungs: Rales midway up lung fields bilaterally, R>L$Input5": {} + }, + "With the exception of myocardial infarction, elevated troponin is indicative of heart failure-related myocardial damage.$Cause_1": { + "cTropnT-0.19*$Input6": {} + } + } + } + } + }, + "input1": "Dyspnea on exertion\n", + "input2": "He yo M PMH dilated CM EF 35-40% s/p BiV pacing, Afib on coumadin presenting with worsening shortness of breath. He notes that over the past week he's had increasing difficulty climbing stairs (tires after climbing 1 flight which he could normally do in the past). He denies orthopnea or PND; denies any significant leg swelling. No chest pressure or discomfort. Does endorse some edema around the abdomen with sensation of bloating.\n", + "input3": "+ Recently diagnoses Afib on coumadin \n+ clean coronaries on c.cath \n+ Hypertension \n+ Chronic renal insufficiency \n+ BPH \n+ Hyperlipidemia \n+ degenerative joint disease \n+ pacemaker implantation , with a BiV upgrade \n \n+ hx polypectomy clean colon\n", + "input4": "Grandmother HTN, does not know anything about mother and father's health problems. Denies renal disease. \n\ufeff\n", + "input5": "Physical Exam:\n98.2, 123/69, 77, 20, 95%RA\nGeneral: Alert, oriented, NAD \nHEENT: Sclera anicteric, MMM, oropharynx clear \nLungs: Rales midway up lung fields bilaterally, R>L\nCV: RRR, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft and nontender with normoactive bowel sounds \nExt: Warm and well perfused, no peripheral edema\n", + "input6": "___ 07:05AM GLUCOSE-87 UREA N-58* CREAT-2.4* SODIUM-140 POTASSIUM-4.6 CHLORIDE-107 TOTAL CO2-23 ANION GAP-15\n___ 07:05AM CALCIUM-9.3 PHOSPHATE-3.4 MAGNESIUM-1.8\n___ 07:05AM WBC-4.0 RBC-2.54* HGB-8.0* HCT-25.9* MCV-102* MCH-31.6 MCHC-31.0 RDW-18.8*\n___ 07:05AM PLT COUNT-295\n___ 10:55PM GLUCOSE-116* UREA N-57* CREAT-2.4* SODIUM-137 POTASSIUM-5.5* CHLORIDE-105 TOTAL CO2-21* ANION GAP-17\n___ 10:55PM CK(CPK)-109\n___ 10:55PM CK-MB-7\n___ 10:15PM GLUCOSE-106* UREA N-56* CREAT-2.5* SODIUM-135 POTASSIUM-GREATER TH CHLORIDE-99 TOTAL CO2-12*\n___ 07:30PM GLUCOSE-120* UREA N-57* CREAT-2.5* SODIUM-135 POTASSIUM-6.7* CHLORIDE-102 TOTAL CO2-20* ANION GAP-20\n___ 07:30PM estGFR-Using this\n___ 07:30PM cTropnT-0.19* \n___ 07:30PM WBC-5.1 RBC-3.02* HGB-9.7* HCT-30.8*# MCV-102* MCH-32.2* MCHC-31.6 RDW-19.1*\n___ 07:30PM NEUTS-76* BANDS-2 LYMPHS-12* MONOS-10 EOS-0 BASOS-0 MYELOS-0 NUC RBCS-2*\n___ 07:30PM HYPOCHROM-1+ ANISOCYT-1+ POIKILOCY-1+ MACROCYT-3+ MICROCYT-NORMAL POLYCHROM-1+ OVALOCYT-OCCASIONAL proBNP-8317*\n\ufeff\nOverall left ventricular systolic function is probably moderately depressed (LVEF= 30 %)\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18853045-DS-16.json b/Finished/Heart Failure/18853045-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..09fc752748384f07db9d11ee2c301ce2a098d3db --- /dev/null +++ b/Finished/Heart Failure/18853045-DS-16.json @@ -0,0 +1,49 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 35-40 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Echocardiography indicated left ventricular systolic insufficiency, presenting as heart failure.$Cause_1": { + "Echo:There is severe symmetric left ventricular hypertrophy. Overall left ventricular systolic function is moderately depressed.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP or pro-BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "proBNP-8317$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Leg Swelling is a common symptom of fluid retention associated with heart failure.$Cause_1": { + "Leg Swelling$Input1": {} + }, + "Atrial fibrillation is the cause and triggering factor of heart failure.$Cause_1": { + "pacemaker implantation$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Chronic renal insufficiency can induce heart failure.$Cause_1": { + "Chronic renal insufficiency$Input3": {} + }, + "Hyperlipidemia is a risk factor for heart failure.$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "Bibasilar crackles is a sign of pulmonary edema associated with heart failure.$Cause_1": { + "bibasilar crackles$Input5": {} + }, + "Edema to knees is sign of fluid retention associated with heart failure.$Cause_1": { + "EXTREMITIES: edema to knees$Input5": {} + }, + "With the exception of myocardial infarction, elevated troponin is indicative of heart failure-related myocardial damage.$Cause_1": { + "cTropnT-0.30*$Input6": {} + } + } + } + } + }, + "input1": "Leg Swelling\n", + "input2": "He with sCHF (EF=40%, s/p biV pacer, CKD (baseline Cr 2.9), Afib not on coumadin, PPM who was sent in due to worsening of b/l edema. \n\ufeff\nThe patient has been managed with increasing doses of bumex recently however continues to have worsening swelling. DOE but denies CP or orthopnea. Also with progression of CKD. States that he has not had much icnreased UOP despite increasing diuretic dose. Does not know weight today but from OMR appears he weighed 148lb which is above his baseline of 142-145lb. He has complained about increasing DOE with only being able to climb single flight of stairs where he has previously been able to climb 2.5 flights.\n \nIn the ED, initial vitals were 98.3 67 101/54 20 100%. Labs were notable for elevation of Cr to 3.4 above baseline of ~3. Anemia and leukopenia were at baseline. Patient was given 40mg IV lasix. VS prior to transfer were 98.0 74 114/72 18 95%. \n\ufeff\n", + "input3": "+ Recently diagnoses Afib on coumadin \n+ clean coronaries on c.cath \n+ Hypertension \n+ Chronic renal insufficiency \n+ BPH \n+ Hyperlipidemia \n+ degenerative joint disease \n+ pacemaker implantation , with a BiV upgrade \n \n+ hx polypectomy clean colon \n\ufeff\n", + "input4": "Grandmother HTN, does not know anything about mother and father's health problems. Denies renal disease.\n", + "input5": "Physical Exam:\nUpon Admission:\n========================================\nVS: T=97.2 BP=93/58 HR=65 RR=20 O2 sat=99% \nGENERAL:NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. No xanthalesma. \nNECK: Supple with JVP of 12 cm. \nCARDIAC: PMI located intercostal space, midclavicular line. RR, normal S1, split S2 with loud P2. II/VI SEM loudest thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, +b/l bibasilar crackles, No wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominal bruits. \nEXTREMITIES: edema to knees. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+\nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+\n\ufeff\n", + "input6": "___ 03:35PM BLOOD WBC-2.8* RBC-2.76* Hgb-9.0* Hct-29.9* MCV-108* MCH-32.6* MCHC-30.2* RDW-18.6* \n___ 03:35PM BLOOD Glucose-119* UreaN-73* Creat-3.4* Na-144 K-4.3 Cl-104 HCO3-30 AnGap-14\n___ 08:20AM BLOOD Glucose-137* UreaN-83* Creat-3.3* Na-141 K-4.5 Cl-99 HCO3-29 AnGap-18\n___ 06:55AM BLOOD ALT-11 AST-18 CK(CPK)-57 AlkPhos-88 TotBili-0.5\n___ 02:05AM BLOOD CK-MB-3 cTropnT-0.30* proBNP-8317*\n\ufeff\nCXR: 1. Mild pulmonary edema. More confluent opacity at right lung base may be asymmetric pulmonary edema; however, infection cannot be excluded. 2. New small right pleural effusion. \n\ufeff\nCXR: There is some engorgement of ill-defined pulmonary vessels, consistent with relatively mild elevation of pulmonary venous pressure. Some basilar asymmetry with opacification on the right, could be a sign of developing consolidation in the appropriate clinical setting. \n\ufeff\nEcho:There is severe symmetric left ventricular hypertrophy. Overall left ventricular systolic function is moderately depressed (LVEF= 35-40 %). The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. Mild to moderate aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Moderate to severe (3+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. \n\ufeff\nIMPRESSION: Severe symmetric LVH with global hypokinesis and inferolateral near-akinesis. Diastolic dysfunction likely present. Dilated and hypokinetric right ventricle. Moderate to severe mitral regurgitation. Mild to moderate aortic regurgitation.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18870530-DS-17.json b/Finished/Heart Failure/18870530-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..0b2ff4db5bcec0a928cd1c554e693e18925ca1b3 --- /dev/null +++ b/Finished/Heart Failure/18870530-DS-17.json @@ -0,0 +1,55 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Suggestive of cardiac enlargement and pulmonary congestion associated with heart failure.$Cause_1": { + "The cardiac silhouette has substantially increased in size sincethe prior study. Mildly increased interstitial markings bilaterally suggestsmild interstitial edema.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates acute heart failure.$Cause_1": { + "proBNP-7723*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Shortness of breath is a common symptom of heart failure.$Cause_1": { + "Shortness of breath$Input1": {} + }, + "Anemia is a common cause of heart failure.$Cause_1": { + "Anemia$Input3": {} + }, + "Obesity is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Obesity$Input3": {} + }, + "Drugs such as Adriamycin, Cylophosphamide, paclitaxil, can cause heart failure.$Cause_1": { + "Adriamycin, Cylophosphamide, paclitaxil$Input3": {} + }, + "dyspneic with speaking is a common sign of heart failure.$Cause_1": { + "dyspneic with speaking$Input5": {} + }, + "Elevated jugular venous pulse (JVP) is a common sign of heart failure, indicating the state of fluid retention.$Cause_1": { + "JVP elevated to earlobe$Input5": {} + }, + "A family history of cardiovascular disease*$Cause_1": { + "Hypertension Mother$Input4": {} + }, + "A family history of cardiovascular disease**$Cause_1": { + "Stroke Mother deceased$Input4": {} + }, + "A family history of cardiovascular disease$Cause_1": { + "CAD/PVD Sister$Input4": {} + }, + "SOB and panic attack are common symptom of HF$Cause_1": { + "shortness of breath and panic attacks$Input2": {} + } + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "She is female with a history of breast CA s/p radiation and chemotherapy, gastric carcinoid, hypothyroidism, recent surgery for appendix/ovary removal, presents with dyspnea on exertion and weakness for the past 3 weeks.\n\ufeff\nShe reports being tired walking short distances, shortness of breath and panic attacks at night when lying flat, weakness and loss of appetite the past few weeks. She also developed dysnpea with talking. Denies edema or weight gain; in fact, she has lost weight the past few months. She was seen by her PCP for these sypmtoms, and was undergoing an outpatient workup. Today, she presented for outpt echo, and was seen to have LVEF with restrictive filling pattern, mild to moderate MR, and small pericardial effusion. Given recent symptoms and newly abnormal echo, she was sent to the ED and admitted for further workup. \n\ufeff\n\n", + "input3": "+ Depressive disorder 311 \n+ NEUROPATHY - GENERALIZED 355.9 \n+ Anemia, pernicious 281.0 \n+ Former smoker V15.82 \n+ Obesity 278.00 \n+ Anemia, iron deficiency 280.9 \n+ Carcinoid tumor of stomach 209.63 \n+ Multiple thyroid nodules 241.1 \n+ bhn 296.30 \n+ Endometrial polyp 621.0 \n+ Invasive ductal carcinoma of breast 174.9\n+ Adriamycin, Cylophosphamide, paclitaxil\n+ Colon adenoma\n+ Hypothyroidism 244.9 \n+ Ovarian mass s/p appendectomy and b/l BSO \n(path without evidence of cancer)\n\ufeff\n", + "input4": "Cancer Father died of prostate ca \nHypertension Mother \nDiabetes-Adult Onset Paternal Grandmother ? IDDM \nStroke Mother deceased \nDiabetes - Type II Sister deceased \nCancer - Breast Maternal Aunt diagnosed\nCAD/PVD Sister\n\ufeff\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM:\nPHYSICAL EXAMINATION: \nVS: 97.6 129/91 107 24 100% RA wt 82.9 \nGeneral: NAD, dyspneic with speaking, no accessory muscle use\nHEENT: NCAT, PERRL, EOMI\nNeck: supple, JVP elevated to earlobe\nCV: Tachycardic, no m/r/g\nLungs: CTAB\nAbdomen: soft, NT/ND, BS+, reducible ventral hernia present\nExt: No edema, +2 pulses\nNeuro: moving all extremities grossly\n", + "input6": "ADMISSION LABS:\n___ 04:15PM BLOOD WBC-5.6# RBC-5.04# Hgb-14.1# Hct-44.7# MCV-89 MCH-27.9 MCHC-31.5 RDW-15.9* \n___ 04:15PM BLOOD PTT-30.5\n___ 04:15PM BLOOD Glucose-118* UreaN-18 Creat-0.9 Na-133 K-5.1 Cl-102 HCO3-22 AnGap-14\n___ 04:15PM BLOOD proBNP-7723*\n___ 04:15PM BLOOD cTropnT-<0.01\n___ 06:50AM BLOOD CK-MB-4 cTropnT-<0.01\n___ 06:50AM BLOOD Calcium-9.1 Phos-3.8 Mg-2.5 Iron-39\n___ 06:50AM BLOOD TSH-8.2*\n___ 06:50AM BLOOD calTIBC-407 Ferritn-43 TRF-313\n\ufeff\nSTUDIES:\n\ufeff\nCXR:\nFINDINGS: Frontal and lateral views of the chest were obtained. There may betrace pleural effusions. The cardiac silhouette is moderately enlarged. There is slight increase in interstitial markings bilaterally suggesting mildinterstitial edema. No pneumothorax is seen.\nIMPRESSION: The cardiac silhouette has substantially increased in size sincethe prior study. Mildly increased interstitial markings bilaterally suggestsmild interstitial edema. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %)\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18888515-DS-22.json b/Finished/Heart Failure/18888515-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..ecac157e45d1323f05a46eb82d9d3ca2fe4527c0 --- /dev/null +++ b/Finished/Heart Failure/18888515-DS-22.json @@ -0,0 +1,49 @@ +{ + "HFrEF$Intermedia_5": { + "LVEF\u226440% is the critiera for HFrEF$Cause_1": { + "LVEF= 30 %$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is elongated. The right atrium is moderately dilated.$Input6": {} + }, + "Strongly Suspected heart failure$Intermedia_3": { + "NT-proBNP or pro-BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "proBNP-3317*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Shortness of breath is a common symptom of heart failure.$Cause_1": { + "SOB on exertion$Input1": {} + }, + "Ventricular tachycardia (VT) is a serious arrhythmia that often leads to the development of heart failure.$Cause_1": { + "ICD implantation , h/o VT$Input3": {} + }, + "Chronic kidney disease can induce heart failure.$Cause_1": { + "CKD$Input3": {} + }, + "Coronary artery disease (CAD) and are also risk factors for heart failure.$Cause_1": { + "CAD, h/o IMI late, cath - RCA 90% proximal, totally occ distally, akinetic inferoposterior segment$Input3": {} + }, + "S3 gallop is a common sign of acute heart failure$Cause_1": { + "CARDIAC: RRR, S3 gallop$Input5": {} + }, + "Bibasilar crackles half way to scapulas is a common sign of pulmonary edema associated with heart failure.$Cause_1": { + "LUNGS: Bibasilar crackles half way to scapulas$Input5": {} + }, + "Possible sign of heart failure$Cause_1": { + "EXTREMITIES: bil tibial edema +3$Input5": {} + }, + "gained in weight and edema are common symptoms of heart failure.$Cause_1": { + "He has also gained in weight over the past couple of days and noticed increasing ankle edema.$Input2": {} + } + } + } + } + }, + "input1": "SOB on exertion\n", + "input2": "He is a male (ICD with last shock years ago, Chronic Myelogenous Leukemia and CKD (Cr 1.8-2.3) who presents with shortness of breath on minimal exertion like putting clothes on this morning. He has also gained in weight over the past couple of days and noticed increasing ankle edema. He was recently admitted for a CHF exacerbation , he was treated with lassix drip and was diuresed 6 liters (from 83 to 78 kg) and was discharged on Turosemide 100mg QD. He was feeling relatively well since and was able to walk upto 4 minutes without stopping. He denies PND or orthopnea. He denies any chest pain. He has been having a nonproductive cough over the past few months and is being worked up for a Right lower lobe lesion on CT scan by Doctor in Pulmonology. Denies any fevers, chills, nausea or diaphoresis. \n. \nIn the ED, initial vitals were 98.6, 135/54, 80, 18, 95%RA. He recieved aspirin 325mg and IV lasix 40mg. \n. \nOn the floor, he is breathing comfortably at rest and has no complaints. \n.. \nOn review of systems, he denies any prior deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative. \n. \nCardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, palpitations, syncope or presyncope.\n", + "input3": "+chronic myelogenous leukemia on Gleevec\n+s/p ICD implantation , h/o VT, EF 25% (echo\n+CKD - baseline Cr 1.1\n+CAD, h/o IMI late, cath - RCA 90% proximal, totally occ distally, akinetic inferoposterior segment, EF\n+Bilateral hearing aides\n+Lumbar disc disease\n+Depression\n+CVA d/t LV thrombus - no residual deficits\n+CHF, TTE - LVEF 25%, severe global LV hypokinesis, 4+ MR, 3+TR, mild pulmonary hypertension\n+ being worked up as outpatient for pulmonary nodule\n\ufeff\n", + "input4": "(-) FHx CAD no leukemia/lymphoma\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM\nVS: T=98.1...BP=136/69...HR=81...RR=18...O2 sat= 97% RA \nGENERAL: Oriented x3. Mood, affect appropriate. NAD \nHEENT: Sclera anicteric. PERRL, EOMI. Mild pallor, no cyanosis \nNECK: Supple, no JVD \nCARDIAC: RRR, S3 gallop . No m/r. \nLUNGS: Bibasilar crackles half way to scapulas, good air movment w/o wheezing \nABDOMEN: Soft, non distended, no acites, no HSM, non tender \nEXTREMITIES: WWP, bil tibial edema +3, no signs of DVT. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: pulses +1 bilateral DP, radial. +2 bil femoral + carotid \n\ufeff\n", + "input6": "BLOOD proBNP-3317*\n\nChest X-Ray: Left-sided pacemaker/AICD device is noted with leads terminating in the right atrium and right ventricle, unchanged. The heart remains enlarged, but similar to prior. Aortic knob is calcified, and the mediastinal and hilar contours are unchanged. There is continued prominence of the right hilum, which may again represent enlargement of the pulmonary artery. Pulmonary vascularity is not congested. There are hazy ill-defined opacities in both lung bases, which could represent atelectasis. Small right pleural effusion is unchanged. Compression deformity within the mid thoracic spine is similar to prior. No pneumothorax is identified. \n \nThe left atrium is elongated. The right atrium is moderately dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is probably moderately depressed (LVEF= 30 %)\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18902344-DS-47.json b/Finished/Heart Failure/18902344-DS-47.json new file mode 100644 index 0000000000000000000000000000000000000000..98826bb3ea952a89dce354e432e62e8aa4a83268 --- /dev/null +++ b/Finished/Heart Failure/18902344-DS-47.json @@ -0,0 +1,49 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP \u2265125pg/ml is a diagnostic criteria of heart failure$Cause_1": { + "proBNP-2210$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Back pain is an atypical symptom of heart failure.$Cause_1": { + "Back pain$Input1": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "DM2$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "HTN$Input3": {} + }, + "Hyperlipidemia is a risk factor for heart failure.$Cause_1": { + "HLD$Input3": {} + }, + "Morbid obesity is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Morbid obesity$Input3": {} + }, + "A family history of cardiovascular disease$Cause_1": { + "Father died from MI s/p CABG, CHF. Mother alive with HTN, GERD, overweight$Input4": {} + }, + "dyspnea is the symptom of HF$Cause_1": { + "dyspnea$Input2": {} + }, + "SOB is the symptom of HF$Cause_1": { + "shortness of breath$Input2": {} + } + } + } + } + }, + "input1": "Back pain\n", + "input2": " \nHe had a CT abdomen/pelvis with contrast to evaluate for deep infection as a complication of panniculitis. He with creatinine rise from 0.9 to a peak of 2.2. This resolved back to baseline. He was seen in the ED for dyspnea, Cr was up to 1.5 at this time. At follow up with PCP he was to continue 100mg torsemide BID. \n\ufeff\nHe presented to the ED again for this admission because his \"creatinine is up\" (up to 1.5 2 weeks ago, steadily downtrending, 1.3 on presentation) and that he is concerned for his kidneys because his back hurts. Patient also says he is here \"because I just need to be admitted,\" and wants admission to go to rehabilitation. Patinet reports he has chronic low back pain that has limited his mobility, and gradual worsening pain in his legs. He endorses baseline shortness of breath with exertion. Denies chest-pain, abdominal pain, and worsening SOB on admission.\n", + "input3": "+ DM2 \n+ HTN \n+ HLD \n+ EtOH abuse \n+ Anxiety \n+ Back pain \n+ Gastroparesis \n+ Morbid obesity \n+ PUD \n+ Rectal fissure \n+ Restrictive lung disease \n+ Shoulder pain \n+ Nacotics contract \n+ Vitamin D deficiency \n+ H/O CARPAL TUNNEL SYNDROME \n+ H/O PYELONEPHRITIS \n+ SHOULDER SURGERY (Left; arthroscopic biceps tenotomy, subacromial decompression, and open biceps tenodesis)\n", + "input4": "Father died from MI s/p CABG, CHF. Mother alive with HTN, GERD, overweight\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM: \nVitals - 97.5, 154/62, 76, 20, 95%RA \nGENERAL: morbidly obese male, NAD \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, patent nares, MMM \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs. Unable to assess JVD \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles \nABDOMEN: Obese, difficult to examine pannus \nEXTREMITIES: moving all extremities well, chronic venous stasis changes of lower extremities \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n\ufeff\n", + "input6": "___ 05:00PM WBC-9.3 RBC-4.37* HGB-13.5* HCT-41.6 MCV-95 MCH-30.9 MCHC-32.5 RDW-13.7\n___ 05:00PM NEUTS-73.4* MONOS-4.5 EOS-1.0 BASOS-0.3\n___ 05:00PM PLT COUNT-228\n___ 05:00PM %HbA1c-11.0* eAG-269*\n___ 05:00PM proBNP-2210*\n___ 05:00PM ALT(SGPT)-15\n___ 05:00PM UREA N-25* CREAT-1.4* SODIUM-135 POTASSIUM-3.9 CHLORIDE-91* TOTAL CO2-28 ANION GAP-20\n\ufeff\n___ 06:50PM WBC-8.5 RBC-4.25* HGB-13.0* HCT-40.5 MCV-95 MCH-30.6 MCHC-32.0 RDW-14.0\n___ 06:50PM ALBUMIN-4.0 CALCIUM-9.0 PHOSPHATE-4.2 MAGNESIUM-1.8\n___ 06:50PM ALT(SGPT)-16 AST(SGOT)-21 ALK PHOS-94 TOT BILI-0.2\n___ 06:50PM GLUCOSE-351* UREA N-28* CREAT-1.3* SODIUM-141 POTASSIUM-4.4 CHLORIDE-98 TOTAL CO2-35* ANION GAP-12\n___ 09:45PM URINE BLOOD-TR NITRITE-NEG PROTEIN-600 GLUCOSE-150 KETONE-NEG BILIRUBIN-SM UROBILNGN-2* PH-6.0 LEUK-NEG\n___ 09:45PM URINE HOURS-RANDOM UREA N-460 CREAT-340 SODIUM-LESS THAN POTASSIUM-64 CHLORIDE-LESS THAN TOT PROT-271 PROT/CREA-0.8* albumin-183.0 alb/CREA-538.2*\n___ 09:45PM URINE OSMOLAL: Patient describes intermittently taking his torsemide as frequent urination is bothersome. Creatinine elevation likely \nContrast nephropathy given time course after CT. Creatinine has since normalized and rose recently to 1.5, now downtrending again. Recent bump may be over diuresis with decreased PO intake given that patient intermittently takes 100mg BID of torsemide. Urine electrolytes demonstrated fractional excretion of urea at 6.3%, consistent with a pre-renal etiology. Patient received 500mL of IVF and was restarted on home torsemide. He was encouraged to drink fluids consistently and take his torsemide consistently, with a fluid limit of 2L. He was discharged for outpatient follow-up and further management. His Cr trended down to 1.3 from 1.4 at the time of discharge. \n \n#: CXR showed right sided fat, pad and mild vascular congestion. He had a stable clinical exam and he was continued on his home dose of torsemide. \n\ufeff\n# Hypertension: Continued home meds given resolving. \n \n# DM2: Uncontrolled, HbA1C 11. In hospital, continued home insulin regimen with sliding scale. Continuued home metformin given resolving ___. \n\ufeff\n# Hypercholesterolemia: Continued simvastatin 40 mg QD. \n\ufeff\n___ CXR:The left atrium is moderately dilated. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%).\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/18962557-DS-15.json b/Finished/Heart Failure/18962557-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..4574cfa9ccfa738991485f9edcaee3b95b261286 --- /dev/null +++ b/Finished/Heart Failure/18962557-DS-15.json @@ -0,0 +1,63 @@ +{ + "HFpEF$Intermedia_5": { + "Overall left ventricular systolic function is normal (LVEF>55%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). These findings indicate ejection fraction preserving heart failure.$Cause_1": { + "Overall left ventricular systolic function is normal (LVEF>55%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg).$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is mildly dilated.$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Shortness of breath is a common symptom of heart failure.$Cause_1": { + "Shortness of breath.$Input1": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "DM Type 2$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension (HTN)$Input3": {} + }, + "Dyslipidemia is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Obesity is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Obesity$Input3": {} + }, + "With the exception of myocardial infarction, elevated troponin is indicative of heart failure-related myocardial damage.$Cause_1": { + "cTropnT-0.11*$Input6": {} + } + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates acute heart failure.$Cause_1": { + "proBNP-1694*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Shortness of breath is a common symptom of heart failure.$Cause_1": { + "Shortness of breath.$Input1": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "DM Type 2$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension (HTN)$Input3": {} + }, + "Dyslipidemia is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Obesity is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Obesity$Input3": {} + }, + "With the exception of myocardial infarction, elevated troponin is indicative of heart failure-related myocardial damage.$Cause_1": { + "cTropnT-0.11*$Input6": {} + } + } + } + } + }, + "input1": "Shortness of breath.\n", + "input2": "This is a woman with a history of diabetes mellitus type II (DM2), hypertension (HTN), hyperlipidemia (HL), anxiety, peripheral vascular disease (PVD) who presented with progressive shortness of breath (SOB) for 2 days. Three days prior to admission, the patient experienced nasal congestion and sore throat. Two days prior to admission, she started having difficulty taking deep breaths. For the previous 24 hours she had experienced more dyspnea at rest, exacerbated with movements. She had never experienced this before. No chest pain, no ankle swelling, no calf tenderness. She did report nonproductive coughs.\n\ufeff\nBesides nitro and oxygen, EMS gave the patient Furosemide 40 mg IV x 1 with relief of symptoms. On presentation to ED, T 99.8, HR 102, BP 175/104, RR 22, 99% on room air. EKG showed ST depressions in I, II, V4-V6. Trop 0.11 K. BNP 1600s. Guaiac negative. She was given ASA 325 mg PO x 1. Cardiology fellow was aware. She was admitted for further management.\n\ufeff\n", + "input3": "+DM Type 2 \n+Hypertension (HTN)\n+Dyslipidemia \n+Anxiety \n+Depression \n+Hypothyroidism \n+PVD\n+Chronic low back pain \n+Osteoarthritis of left knee\n+Diverticulosis with admissions for diverticulitis \n+Obesity\n", + "input4": "Noncontributory.\n", + "input5": "Physical Exam:\nVITALS: T 98.6, BP 123/73, HR 75, RR 20, 90% on room air, 94-97% on 2LTm 101.4, 100.5, 123-156/63-96, 75-99, 20 \nGEN: NAD, awake, alert \nHEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP clear \nNECK: Supple, no JVD \nCV: Regular, normal S1, S2. No murmurs, rubs, or gallops. \nCHEST: Respirations were unlabored, no accessory muscle use. Faint bibasilar crackles. Decreased BS at both bases. \nABD: Soft, non-tender, non-distended \nEXT: No clubbing, cyanosis, or edema \nSKIN: No rash\n\ufeff\n", + "input6": "Labs on admission:\n___ 12:02AM BLOOD WBC-14.1* RBC-4.53 Hgb-13.5 Hct-39.8 MCV-88 MCH-29.8 MCHC-34.0 RDW-13.8\n___ 12:02AM BLOOD Neuts-86.4* Lymphs-9.9* Monos-2.4 Eos-1.0 Baso-0.3\n___ 12:02AM BLOOD PTT-26.5\n___ 12:02AM BLOOD D-Dimer-1318*\n___ 12:02AM BLOOD Glucose-417* UreaN-13 Creat-1.0 Na-135 K-4.0 Cl-97 HCO3-28 AnGap-14\n___ 12:02AM BLOOD CK(CPK)-82\n___ 12:02AM BLOOD cTropnT-0.11*\n___ 12:02AM BLOOD CK-MB-NotDone proBNP-1694*\n___ 10:15AM BLOOD Calcium-8.8 Phos-3.0 Mg-1.9\n___ 10:15AM BLOOD TSH-0.47\n\ufeff\nChest x-ray : Findings consistenet with asymmetric pulmonary edema. Developing or superimposed pneumonia cannot competely be excluded.\n\ufeff\nECHO: \nThe left atrium is mildly dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is normal (LVEF>55%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. \n\ufeff\nIMPRESSION: Suboptimal image quality. Mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. Mild pulmonary hypertension. Increased left ventricular filling pressures. Mild mitral regurgitation. \n\ufeff\nCompared with the prior report (images not available for review) , estimated pulmonary artery pressures are now elevated (previously not measured). Mild ventricular hypertrophy is present.\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/19019784-DS-21.json b/Finished/Heart Failure/19019784-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..5c3fca6f78fd3baa5c74f24017bd2c40c1daa3aa --- /dev/null +++ b/Finished/Heart Failure/19019784-DS-21.json @@ -0,0 +1,49 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF >55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Echocardiography suggests ejection fraction preserving heart failure$Cause_1": { + "TTE: The left atrium is mildly dilated. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%)$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "BNP 7590$Input2": {} + }, + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.*$Cause_1": { + "proBNP-4972$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Dyspnea is a common symptom of heart failure.$Cause_1": { + "dyspnea$Input1": {} + }, + "chest discomfort is a common symptom of heart failure.$Cause_1": { + "chest discomfort$Input1": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "hypertension$Input3": {} + }, + "Atrial fibrillation is the cause and triggering factor of heart failure.$Cause_1": { + "atrial fibrillation$Input3": {} + }, + "Excessive fluid intake is a common cause of heart failure.$Cause_1": { + "she has been trying to drink lots of water since that time.$Input2": {} + }, + "SoB is the symptom of heart failure$Cause_1": { + "three days of shortness of breath$Input2": {} + }, + "Chest pain is the symptom of heart failure$Cause_1": { + "chest discomfort$Input2": {} + } + } + } + } + }, + "input1": "dyspnea, chest discomfort\n", + "input2": "She with a history of atrial fibrillation on Coumadin, HTN presented with three days of shortness of breath. Patient reports she was feeling \"100%\" and was able to go shopping and out to eat with her daughter. On morning she woke up, walked to the bathroom, and became extremely dyspneic. She also experienced chest discomfort, located the chest, non radiating. She presented to her PCP and was told she was dehydrated, so she has been trying to drink lots of water since that time. This morning she again experienced severe dyspnea associated with chest discomfort while walking to the bathroom and decided to present to ED. She denies fevers, chills, orthopnea, PND swelling. No nausea, vomiting, dysuria or diarrhea. The patient denies increased salt in her diet, or recent infection.\n\ufeff\nPatient had negative stress test. TTE showed preserved EF, mild MR and moderate pulmonary artery HTN. Patient hospitalized for cholecystectomy and post op was found to have pulmonary edema with BNP 7590. However, patient not worked up for heart failure at that time and did not have repeat TTE. \n\ufeff\nOf note, she was diagnosed with shingles under her right breast and has been on Tylenol x/day and gabapentin. Her daughter is concerned that gabapentin is the reason for her symptoms so this was stopped two days ago. \n\ufeff\nED COURSE\n\ufeff\n \nUpon transfer, patient's vitals were: 44 53/45 16 99% Nasal cannula. \n \nOn the floor patient breathing comfortably on 2L NC. Reports feeling anxious, but no CP or SOB. \n\ufeff\n", + "input3": "1. CARDIAC RISK FACTORS: +hypertension, \n2. CARDIAC HISTORY: atrial fibrillation on Coumadin\n3. OTHER PAST MEDICAL HISTORY: \nHypothyroidism\nGout\nPolymyalgia rheumatic\nlumbar spinal stenosis\ns/p thyroidectomy for adenoma\ns/p appendectomy \n\ufeff\n", + "input4": "No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory.\n", + "input5": "Physical Exam:\nAdmission Exam\n===========\nVS: T=98.1 BP=128/82 HR=46 RR=18 O2 sat=96% 2LWeight: 65.5kg \nGENERAL: Elderly woman, appears younger than stated age. Lying flat in bed, breathing comfortably on 2L NC. \nHEENT: Sclera anicteric. O/P clear, MMM.\nNECK: Supple with JVP of 10 cm. \nCARDIAC: PMI located intercostal space, midclavicular line. Bradycardic, normal S1, S2. No murmurs/rubs/gallops. \nLUNGS: Resp were unlabored, no accessory muscle use. Bilateral crackles, midway up lungs b/l L>R.\nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: warm, no peripheral edema. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \n\ufeff\n", + "input6": "Admission Labs\n===========\n___ 09:49AM BLOOD WBC-12.4*# RBC-3.81* Hgb-11.5 Hct-35.4 MCV-93 MCH-30.2 MCHC-32.5 RDW-15.1 RDWSD-51.6* \n___ 09:49AM BLOOD Neuts-84.3* Lymphs-6.4* Monos-8.2 Eos-0.2* Baso-0.2 Im ___ AbsNeut-10.48* AbsLymp-0.80* AbsMono-1.02* AbsEos-0.02* AbsBaso-0.03\n___ 09:49AM BLOOD PTT-35.7\n___ 09:49AM BLOOD Glucose-107* UreaN-21* Creat-0.9 Na-141 K-3.6 Cl-101 HCO3-25 AnGap-19\n___ 09:49AM BLOOD ALT-117* AST-105* CK(CPK)-62 AlkPhos-211* TotBili-1.5\n___ 09:49AM BLOOD CK-MB-3 proBNP-4972*\n___ 09:49AM BLOOD cTropnT-0.01\n___ 09:49AM BLOOD Albumin-4.2 Calcium-9.9 Phos-3.1 Mg-1.7\n___ 09:49AM BLOOD TSH-1.5\n___ 09:49AM BLOOD Acetmnp-NEG\n\ufeff\n\ufeff\nImaging\n======\nCXR \nFINDINGS: \nThe heart is moderately enlarged, and there is mild pulmonary vascula congestion and interstitial edema. No focal consolidation or pleural effusion is noted. No pneumothorax seen. The visualized bony structures are unchanged in appearance compared to the prior study, a compression deformity at the cervical lumbar junction is similar in degree.\nIMPRESSION: \nModerate cardiomegaly with mild pulmonary vascular congestion and interstitial edema.\n\ufeff\nTTE:\nConclusions \nThe left atrium is mildly dilated. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Tissue Doppler imaging suggests an increased left ventricular filling pressure (PCWP>18mmHg). The right ventricular cavity is mildly dilated with normal free wall contractility. 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. Trace aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. \n\ufeff\nIMPRESSION: Normal global and regional left ventricular systolic function. Dilated right ventricle with normal global systolic function. Moderate functional tricuspid regurgitation. Elevated LVEDP and moderate pulmonary hypertension. Compared with the prior study (images reviewed), right ventricle is now mildly enlarged. The other findings are similar. \n\ufeff\n- Cardiac pharmacologic perfusion\nFINDINGS: Left ventricular cavity size is normal Rest and stress perfusion images reveal uniform tracer uptake throughout the left ventricular myocardium. Gated images reveal normal wall motion. The calculated left ventricular ejection fraction is 73% \n \nIMPRESSION: No myocardial perfusion defect. No wall motion abnormalities. Normal EF. \n\ufeff\n\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/19042495-DS-22.json b/Finished/Heart Failure/19042495-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..0741a8067e9afb2dee9a5d79a6865c7602659ffa --- /dev/null +++ b/Finished/Heart Failure/19042495-DS-22.json @@ -0,0 +1,40 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "proBNP-2775*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "These are typical manifestations of respiratory distress associated with heart failure.$Cause_1": { + "Dyspnea on Exertion$Input1": {} + }, + "Dyslipidemia is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "A family history of cardiovascular disease$Cause_1": { + "Father died of a stroke. Mother had a myocardial infarction and cancer of the vagina.$Input4": {} + }, + "Tachycardia - Bradycardia syndrome is the cause of heart failure$Cause_1": { + "tachy/brady s/p ppm$Input2": {} + } + } + } + } + }, + "input1": "Dyspnea on Exertion\n", + "input2": "She is a female with tachy/brady s/p ppm who presents with chief complaint of dyspnea with minimal exertion since return home from international travel. Patient reprots she had a similar episode when her PPM was placed. This was done so we do not have the records of this. Otherwise she has not had symptoms of heart failure. She reports that she went on a cruise with her family a fwe4 weeks ago. On the last day of the cruise she started to feel tired. AFter this she continued to have progressive DOE to the point that she was unable to get dressed without significant SOB yesterday. She thought it mgiht be from graduation parties and the traveling she was doing. She was seen by her PCP in clinic today where she reported subjective air hunger at rest, signficant shortness of breath on minimal exertion, eg gettingdressed. VS in clinic were: Wt. 157 lbs (was 151 on visit just one month ago) P 77 BP 160/68 (standing 164/80) %O2 Sat 94. BP slightly elevated from her baseline, systolic 160. O2 sat 94%, lower than baseline. EKG suggestive of possible infarction so she was sent into the ED. \n \n. \nIn the ED, initial vitals were: 98.9 70 190/81 22 100% 4L Nasal Cannula. The patient c/o SOB with exertion x 2 weeks since returning from travel. Denies CP. Denies orthopnea or PND.. She was speaking in full sentences. Pt lives in a studio apt and states she gets winded just getting to the bathroom. An ECG showed paced rhythm consistent with prior. CXR showed pulmonary congestion. She was given lasix 20mg IV X 1 and admitted for CHF likely dietary indiscretion while on her cruise. There were no VS recorded prior to transfer in the E-signout from the MD. On arrival to the floor patient c/o non-productive cough worse in the past few weeks in addition to the symptoms of DOE worsening to the point that she could not shower, PND, and edema. She has also had stable orthopnea, and her usual palpitations associated with her atrial fibrillation and chest pressure that comes on when she goes into Afib. She denies other chest pain, syncope, presyncope. She does note a weight gain that she attributes to the food on the cruise. She has also had night sweats several nights a week for the last months that require a change of clothes. She is uptodate on her mammograms and has had a colonoscopy in the last years that per her report was normal. \n\ufeff\n", + "input3": "1. CARDIAC RISK FACTORS: Diabetes(-), Dyslipidemia(+), Hypertension(+) \n2. CARDIAC HISTORY: cerebrovascular accident times two Tachy/ syndrom pacemaker PPM on coumadin \n \n3. OTHER PAST MEDICAL HISTORY: \nRenal cell carcinoma. \nCompression fractures. \nParavertebral muscle hematoma (complication of vertebroplasty). \nOsteoarthritis. \nDepression/anxiety. \nHistory of urinary tract infection. \nConstipation. \nScoliosis. \nCervical spondylosis with cord compression. \nOsteoporosis \nCerebral aneurysms. \nStrokes. \nPAST SURGICAL HISTORY: \n1. Thumb surgery. \n2. Left eye cataract surgery. \n3. Status post face lift. \n4. Hysterectomy. \n5. Tonsillectomy. \n6. Rotator cuff surgery. \n7. Thyroid ablation. \n8. Status post kyphoplasty for treatment of compression fractures. \n9. Left total knee replacement \n\ufeff\n", + "input4": "Father died of a stroke. Mother had a myocardial infarction and cancer of the vagina. \n\ufeff\n", + "input5": "Physical Exam:\nN/A\n", + "input6": "ADMISSION:\n\ufeff\n___ 01:25PM GLUCOSE-100 UREA N-12 CREAT-0.8 SODIUM-141 POTASSIUM-3.7 CHLORIDE-101 TOTAL CO2-29 ANION GAP-15\n___ 01:25PM cTropnT-<0.01\n___ 01:25PM proBNP-2775*\n___ 01:25PM DIGOXIN-1.0\n___ 01:25PM WBC-7.1 RBC-3.51* HGB-10.5* HCT-31.9* MCV-91 MCH-29.8 MCHC-32.8 RDW-15.5\n\ufeff\nCXR\nPA AND LATERAL VIEWS OF THE CHEST: Left-sided dual-chamber pacemaker leads terminating in the right atrium and right ventricle are in unchanged positions. Mild enlargement of the cardiac silhouette is unchanged with unfolding of the thoracic aorta. There are increased interstitial markings compared to the prior study, suggestive of mild interstitial pulmonary edema. Cephalization of the pulmonary vascular markings is also noted. Small right pleural effusion is present. No pneumothorax is identified. There are mild degenerative changes of the thoracic spine. Coils are partially imaged within the upper aspect of the abdomen. There are no acute osseous findings. \n \nIMPRESSION: Interstitial pulmonary edema with small right pleural effusion. \n\ufeff\nTTE:\nThe left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The tricuspid valve leaflets are mildly thickened. There is moderate pulmonary artery systolic hypertension. There is a trivial/physiologic pericardial effusion. \n\ufeff\nCompared with the prior study (images reviewed), no change. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/19043930-DS-19.json b/Finished/Heart Failure/19043930-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..dd03828510101eacee5f0c50f5af089881db74ae --- /dev/null +++ b/Finished/Heart Failure/19043930-DS-19.json @@ -0,0 +1,49 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Chest X-ray (CXR) find that Interval development of mild to moderate bilateral pulmonary edema is with a small to moderate bilateral pleural effusions which is common manifestation of heart failure.$Cause_1": { + "CXR: \nFINDINGS: Interval development of mild to moderate bilateral pulmonary edema is with a small to moderate bilateral pleural effusions and adjacent atelectasis.$Input6": {} + }, + "The echocardiogram showed that the heart function was better than before. This suggests an improvement in heart failur.$Cause_1": { + "Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Mildly dilated thoracic aorta. Mild aortic regurgitation. Mild mitral regurgitation. Mild pulmonary hypertension.Compared with the prior study (images reviewed), left ventricular function appears more vigorous and regional dysfunction is not seen.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates acute heart failure.$Cause_1": { + "proBNP-8603*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "The history of Chronic systolic heart failure (sCHF) suggests that this admission is likely an acute exacerbation of chronic diastolic heart failure.$Cause_1": { + "sCHF (EF 40%)$Input3": {} + }, + "Dyspnea is a common symptom of heart failure.$Cause_1": { + "Dyspnea$Input1": {} + }, + "Tachy-Brady syndrome can cause heart failure.$Cause_1": { + "Tachy-Brady syndrome c/b syncope s/p PPM$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "HTN$Input3": {} + }, + "Hyperlipidemia is a risk factor for heart failure.$Cause_1": { + "HLD$Input3": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "T2DM (last HgA1c 6.3)$Input3": {} + }, + "With the exception of myocardial infarction, elevated troponin is indicative of heart failure-related myocardial damage.$Cause_1": { + "cTropnT-0.03*$Input6": {} + } + } + } + } + }, + "input1": "Dyspnea\n", + "input2": "He with a PMH significant for T2DM (HgA1c 6.3, Prostate Ca s/p TURP, HTN, HLD, remote h/o DVT, and likely MDS 2 positive), sCHF (EF 40%, s/p PPM Sensia placed, generator exchange for complete heart block and tachy/brady syndrome.\n\nOf note, his PPM was last interrogated and was a-sensed, v-paced 85% of the time. \n\ufeff\nHe received 325 aspirin and SL Nitro x2 with improvement in his symptoms in the ambulance. \n\ufeff\nED Course (labs, imaging, interventions, consults): \n- Initial Vitals/Trigger: T 98.5, HR 84 BP 188/78 RR 16 100% on 2L\n- EKG: Unchanged from priors. A-sensed, V-paced at 61 with appropriate left axis deviation. No ST segment changes. \n- CXR: pending\n- Trops: 0.03 (9AM), CK-MB 3, BNP 8603\n\ufeff\nOn arrival to floor, patient was without cp or SOB, resting comfortably in bed. Initial vitals were T=98.7 BP= 170/85 HR= 65 RR= 20 O2 sat=93% RA\n\ufeff\n", + "input3": "+ sCHF (EF 40%\n+ Tachy-Brady syndrome c/b syncope s/p PPM\n+ HTN\n+ HLD\n+ T2DM (last HgA1c 6.3)\n+ MDS with ___ 2 Mutation\n+ Bilateral knee replacements\n", + "input4": "No known family history\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM:\nVS: Wt=83.92 kgs T=98.7 BP= 170/85 HR= 65 RR= 20 O2 sat=93% RA \nGeneral: Laying in bed in NAD\nHEENT: NC/AT, EOMI, sclera anicteric \nNeck: Trachea midline, JVP 5cm above sternal notch\nCV: RRR, no r/m/g appreciated \nLungs: bibasilar crackles\nAbdomen: Soft, nd, nttp, +BS\nGU: Deferred\nExt: 2+ radial and DP pulses, no c/c/e\nNeuro: Speech fluent, moving all extremities\nSkin: no rashes noted\n\ufeff\n", + "input6": "ADMISSION LABS:\n___ 09:00AM BLOOD WBC-20.0* RBC-4.20* Hgb-11.0* Hct-34.8* MCV-83# MCH-26.2* MCHC-31.6# RDW-17.0*\n___ 09:00AM BLOOD Neuts-69 Bands-1 Lymphs-5* Monos-19* Eos-1 Baso-3* Myelos-2*\n___ 09:00AM BLOOD Glucose-92 UreaN-22* Creat-1.0 Na-138 K-3.8 Cl-99 HCO3-28 AnGap-15\n___ 03:20PM BLOOD CK(CPK)-95\n___ 09:00AM BLOOD CK-MB-3 proBNP-8603*\n___ 09:00AM BLOOD cTropnT-0.03*\n___ 03:20PM BLOOD CK-MB-3\n___ 03:20PM BLOOD cTropnT-0.03*\n___ 09:00AM BLOOD Calcium-9.0 Phos-3.6 Mg-2.0\n\ufeff\nIMAGING/STUDIES:\nECG: Sinus rhythm with ventricular pacing. Compared to the previous tracing no significant change.\n\ufeff\nCXR: \nFINDINGS: Interval development of mild to moderate bilateral pulmonary edema is with a small to moderate bilateral pleural effusions and adjacent atelectasis. There is no evidence of focal consolidation suspicious for pneumonia. No pneumothorax is identified. The heart size is top normal. Redemonstrated is a left pectoral pacemaker with two continuous leads seen extending to the right atrium and right ventricle, respectively. \n \nIMPRESSION: Mild to moderate pulmonary edema with bilateral pleural effusions and adjacent atelectasis.\n\ufeff\nECHO:\nThe left atrium is elongated. The estimated right atrial pressure is at least 15 mmHg. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). The estimated cardiac index is normal (>=2.5L/min/m2). No mid-cavitary gradient is identified. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic root is mildly dilated at the sinus level. The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened. There is no aortic valve stenosis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Mild (1+) mitral regurgitation is seen. The left ventricular inflow pattern suggests impaired relaxation. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. \nIMPRESSION: Mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. Mildly dilated thoracic aorta. Mild aortic regurgitation. Mild mitral regurgitation. Mild pulmonary hypertension.Compared with the prior study (images reviewed), left ventricular function appears more vigorous and regional dysfunction is not seen.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/19058546-DS-16.json b/Finished/Heart Failure/19058546-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..afb1197ae3558444b9486f8db8212b2c461e5bd3 --- /dev/null +++ b/Finished/Heart Failure/19058546-DS-16.json @@ -0,0 +1,49 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "proBNP-8013*$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "fatigue is a common symptom of heart failure.$Cause_1": { + "fatigue$Input1": {} + }, + "Moderate pulmonary hypertension may cause heart failure.$Cause_1": { + "Moderate pulmonary hypertension$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "Common signs of lung congestion associated with heart failure.$Cause_1": { + "CHEST: scattered wheezes, left-sided crackles to midlung, LLL rhonchi, right-sided crackles at base$Input5": {} + }, + "pitting edema in lower extremities bilaterally is a common sign of systemic congestion in heart failure.$Cause_1": { + "EXT: trace peripheral edema$Input5": {} + }, + "Valvular heart disease is a common cause of heart failure.$Cause_1": { + "Moderate aortic stenosis$Input3": {} + }, + "Valvular heart disease is a common cause of heart failure.*$Cause_1": { + "Moderate mitral regurgitation$Input3": {} + }, + "The history of Chronic diastolic heart failure suggests that this admission is likely an acute exacerbation of chronic diastolic heart failure$Cause_1": { + "EF >55% echo with normal wall motion$Input3": {} + } + } + } + } + }, + "input1": "fatigue\n", + "input2": "She is a female with HTN, MR, AS, severe pulmonary HTN, hypothyroidism presenting with fatigue after recent PNA and CHF exacerbation c/b septic shock requiring intubation and pressors. The patient was discharged after treamtent for her PNA and CHF. Since her hospitalization, she has been living at home (a senior idependant-living residence) and working with physical therapy. \n\ufeff\n. \nShe is unable to provide much information in the way of specific symptoms or in terms of describing her fatigue. She simply states she is tired and has noticed that she is unable to complete regular tasks of daily living without extreme fatigue. She denies cough, shortness of breath, nausea, vomiting, abdominal pain. She reports ongoing constipation. She denies fevers or chills. She denies weight gain or weight loss. She denies DOE, orthopnea or PND. She denies chest pain or chest pressure. The patient's sister is helping with her care and has expressed concern in relation to her sister's fatigue and especially her shortness of breath. \n. \nIn the ED, vitals were T 96.7, HR 67, BP 124/68, RR 24, 93% on RA. She had a tmax of 100.6 rectal. She was placed on 2LNC and her o2 sat was 99%. CXR showed LLL infiltrate and she was given Levaquin and Vanco. Abx were stopped by the admitting medicine nightfloat due to infiltrate likely representing resolving PNA from prior hospitalization. \n\ufeff\n", + "input3": "+Thyroid CA s/p thyroidectomy\n+Moderate aortic stenosis\n+Moderate mitral regurgitation \n+Chronic diastolic dysfunction\n+EF >55% echo with normal wall motion\n+Moderate pulmonary hypertension\n+Osteoporosis\n+Hypertension\n+Cataracts\n", + "input4": "Non-contributory\n", + "input5": "Physical Exam:\nVS: T 95.7 (not hypothermic) 98/56 68 22 98% on 2L \nGEN: pleasant, frail, moderately kyphotic elderly female lying in bed in NAD \nHEENT: PERRL, EOMI, no scleral icterus, clear oropharynx \nNECK: no LAD, JVD to ear, supple \nCHEST: scattered wheezes, left-sided crackles to midlung, LLL rhonchi, right-sided crackles at base \nCV: systolic murmur heard throught precordium with radiation to the carotids \nABD: soft, NT, mildly distended, + bowel sounds \nEXT: trace peripheral edema\n\nSKIN: intact, no jaundice or rashes \nNEURO: AxOx3, CNs intact, strength in all 4 extremities, moving all extremities \nPSYCH: minimal verbal response to interview questions, appropriate eye contact, but somewhat inappropriate affect with seeming inability to describe symptoms or thoughts \n\ufeff\n", + "input6": "___ 06:20PM URINE HOURS-RANDOM\n___ 06:20PM URINE GR HOLD-HOLD\n___ 06:20PM URINE COLOR-Yellow APPEAR-Clear\n___ 06:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG\n___ 04:35PM LACTATE-1.7\n___ 04:25PM GLUCOSE-116* UREA N-11 CREAT-0.6 SODIUM-132* POTASSIUM-4.3 CHLORIDE-98 TOTAL CO2-25 ANION GAP-13\n___ 04:25PM estGFR-Using this\n___ 04:25PM proBNP-8013*\n___ 04:25PM WBC-7.8 RBC-4.50 HGB-12.4 HCT-39.1 MCV-87# MCH-27.6 MCHC-31.8 RDW-15.4\n___ 04:25PM NEUTS-74.2* MONOS-5.1 EOS-1.1 BASOS-0.3\n___ 04:25PM PLT COUNT-412\n\ufeff\nThe left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%).\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/19158991-DS-13.json b/Finished/Heart Failure/19158991-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..50a4f4283f583a492c6f7d661b852f953f1fb382 --- /dev/null +++ b/Finished/Heart Failure/19158991-DS-13.json @@ -0,0 +1,49 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Echocardiography reported that Overall left ventricular systolic function is severely depressed. This suggests heart failure.$Cause_1": { + "Overall left ventricular systolic function is severely depressed.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "NT-proBNP, pro-BNP or BNP are common biomarkers of heart failure. Extreme elevation of BNP levels indicates strongly suspected heart failure.$Cause_1": { + "NT-pro-BNPis 9500$Input2": {} + }, + "Suspected heart failure$Intermedia_2": { + "acute dyspnea is a common symptom of heart failure.$Cause_1": { + "acute dyspnea$Input1": {} + }, + "Coronary artery disease (CAD) is also risk factor for heart failure.$Cause_1": { + "coronary artery disease$Input3": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Non-insulin dependent type II diabetes$Input3": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "blood pressure later climbed to 191/113 but spontaneously lessened to162/94$Input2": {} + }, + "Dyslipidemia is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "Scattered bibasilar crackles that clear with coughing is a common sign of pulmonary edema associated with heart failure.$Cause_1": { + "Scattered bibasilar crackles that clear with coughing.$Input5": {} + }, + "Possible sign of heart failure$Cause_1": { + "Trace pedal edema$Input5": {} + }, + "SOB is the symptom of HF$Cause_1": { + "breathlessness$Input2": {} + } + } + } + } + }, + "input1": "acute dyspnea\n", + "input2": "He is adiabetic male, pacemaker dependent. He was in his usual state of health until a day or two ago when he became more labored at rest. Early this morning he awoke with acute breathlessness prompting him to seek emergency care. His oxygenation was normal in the field. He was likewise normotensive without a supplemental oxygen requirement on arrival. His blood pressure later climbed to 191/113 but spontaneously lessened to162/94 in the next hour or so. His work of breathing, however, became more labored and oxygenation dropped to the low 90-range, prompting application of BiPAP. He was more comfortable thereafter. In fact, he was converted to nasal cannula just prior to transfer. His respiratory distress paralleled a rise inlactate from 5.7 -> 6.9. He had received one liter of fluid by this time. He has questionable opacification of the right lower lobe. He received ceftriaxone and azithromycin, in that regard.There are more interstitial infiltrates on his second chest x-ray as well. He is paced via single ventricular lead at 60. His underlying rhythm appears to fibrillation or flutter. NT-pro-BNPis 9500. Troponin is undetectable. CBC is notable for WBC of 11.1without immature forms. Hemoglobin is 9.7 and platelets are 84. There are nucleated red blood cells. BUN is 29. Creatinine is1.4. ALT and AST are 43 and 68, respectively. Urinalysis is bland.\n", + "input3": "+Suspected coronary artery disease by reversible inferior wall defect on nuclear stress.\n+Non-insulin dependent type II diabetes. \n+Encephalomalacia in right MCA distribution. \n+Hypertension.\n+Dyslipidemia.\n+GERD.\n", + "input4": "unable to obtain language barrier\n", + "input5": "Physical Exam:\nAdmission Physical Exam:\nVITALS: T 99.3, HR 63, BP 168/96, RR 25, 96% RA\nGENERAL: Elderly male in no apparent physical distress.\nHEENT: Anicteric sclerae. Oropharynx dry.\nNECK: Estimated 12-14 cm. No cervical lymphadenopathy.\nCV: Regular rate and rhythm. S1/S2. Soft systolic murmur.\nPULM: Comfortable. Scattered bibasilar crackles that clear with coughing. Occasional expiratory wheeze.\nABDOMEN: Distended but soft. Vague right upper quadranttenderness.\nEXTREMITIES: Cool feet but otherwise warm. Trace pedal edema.\nSKIN: Within normal limits.\nNEURO: Non-focal. \n\ufeff\n", + "input6": "ADMISSION LABS:\n\ufeff\n___ 05:23AM BLOOD WBC-11.1* RBC-3.26* Hgb-9.7* Hct-31.4* MCV-96 MCH-29.8 MCHC-30.9* RDW-17.2* RDWSD-60.3* Plt Ct-84*\n___ 05:23AM BLOOD PTT-27.7\n___ 05:23AM BLOOD Glucose-280* UreaN-29* Creat-1.4* Na-140 K-5.5* Cl-106 HCO3-17* AnGap-17\n___ 05:23AM BLOOD ALT-43* AST-68* LD(LDH)-856* AlkPhos-210* TotBili-0.7\n\ufeff\nPERTINENT IMAGING:\nCoronary Description\nThe coronary circulation is right dominant.\nLM: The Left Main, arising from the left cusp, is a large caliber vessel. This vessel bifurcates into the left Anterior Descending and Left Circumflex systems. There is a 50% stenosis in the distal segment.\nLAD: The Left Anterior Descending artery, which arises from the LM, is a large caliber vessel. There is a 40% stenosis in the proximal segment. There is an 80% stenosis in the proximal segment. There is a 90% stenosis in the distal segment.The Diagonal, arising from the proximal segment, is a medium caliber vessel.\nCx: The Circumflex artery, which arises from the LM, is a large caliber vessel. There is moderate tortuosity beginning in the proximal segment. There is an 80% stenosis in the ostium. There is a 90%stenosis in the mid segment.The Obtuse Marginal, arising from the proximal segment, is a small caliber vessel. The ___ Obtuse Marginal, arising from the mid segment, is a medium caliber vessel.\nRCA: The Right Coronary Artery, arising from the right cusp, is a large caliber vessel. There is a 70%stenosis in the proximal and mid segments. The Right Posterior Descending Artery, arising from the distal segment, is a medium caliber vessel. The Right Posterolateral Artery, arising from the distal segment, is a medium caliber vessel.\n\ufeff\nTTE:\nThe left atrial volume index is mildly increased. The right atrium is mildly enlarged. There is no evidence for a right-to-left shunt with agitated saline at rest. The inferior vena cava is dilated (>2.5 cm). There is mild symmetric left ventricular hypertrophy with a normal cavity size. There is SEVERE global left ventricular hypokinesis. Overall left ventricular systolic function is severely depressed. Left ventricular cardiac index is depressed(less than 2.0 L/min/m2). There is no resting left ventricular outflow tract gradient. Normal right ventricular cavity size with focal hypokinesis of the apical free wall. Intrinsic right ventricular systolic function is likely lower due to the severity of tricuspid regurgitation. The aortic sinus diameter is normal for gender with normal ascending aorta diameter for gender. The aortic arch diameter is normal with a normal descending aorta diameter. The aortic valve leaflets (?#) are mildly thickened. There is no aortic valve stenosis. There is no aortic regurgitation. The mitral valve leaflets are mildly thickened with no mitral valve prolapse. There is moderate [2+] mitral regurgitation. The pulmonic valve leaflets are not well seen. The tricuspid valve leaflets appear structurally normal. There is moderate to severe [3+]tricuspid regurgitation. Due to acoustic shadowing, the severity of tricuspid regurgitation may be underestimated. There is SEVERE pulmonary artery systolic hypertension. In the setting of at least moderate to severe tricuspid regurgitation, the pulmonary artery systolic pressure may be underestimated. There is no pericardial effusion. global systolic function are normal (LVEF>55%)\n\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Heart Failure/19213219-DS-11.json b/Finished/Heart Failure/19213219-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..2b2368931aed8f7f6ac791df70027b7a5d1c3f26 --- /dev/null +++ b/Finished/Heart Failure/19213219-DS-11.json @@ -0,0 +1,52 @@ +{ + "HFpEF$Intermedia_5": { + "LVEF\u226550% is the critiera for HFpEF$Cause_1": { + "LVEF>55%$Input6": {} + }, + "Heart Failure$Intermedia_4": { + "Cardiac structural abnormalities is a diagnostic criteria of heart failure$Cause_1": { + "The left atrium is moderately dilated.$Input6": {} + }, + "Strongly suspected heart failure$Intermedia_3": { + "BNP \u2265 35 pg/mL is a strong value for heart failure$Cause_1": { + "BNP 600$Input6": {} + }, + "Suspected heart failure$Intermedia_2": { + "Hypoxia is a common symptom of heart dysfunction in heart failure.$Cause_1": { + "Hypoxia$Input1": {} + }, + "A family history of cardiovascular disease$Cause_1": { + "Mom - died of MI$Input4": {} + }, + "Hypertension is known risk factor for heart failure.$Cause_1": { + "Hypertension$Input3": {} + }, + "arrythmia can cause heart failure.$Cause_1": { + "arrythmia$Input3": {} + }, + "Diabetes is a common risk factor for cardiovascular disease, which can lead to heart failure.$Cause_1": { + "Diabetes$Input3": {} + }, + "Elevated jugular venous pulse (JVP) is a common sign of heart failure, indicating the state of fluid retention.$Cause_1": { + "Neck: supple, JVP elevated to the angle of the jaw$Input5": {} + }, + "indicates arrhythmia, a possible trigger for heart failure.$Cause_1": { + "CV: Irregular$Input5": {} + }, + "edema in lower extremities is a common sign of systemic congestion in heart failure.$Cause_1": { + "Ext: trace edema$Input5": {} + }, + "atrial fibrillation/flutter can cause heart failure.$Cause_1": { + "atrial fibrillation/flutter$Input2": {} + } + } + } + } + }, + "input1": "Hypoxia\n", + "input2": "She is a female with atrial fibrillation/flutter, hypoxic and tachycardic. She states that she did not feel short of breath and did not feel uncomfortable. She notes that she has been taking in a lot of salt including chicken broth recently due to her only being able to take in liquids. She denies any fevers, chills, nausea or vomiting. She has been compliant with her medications however she did not take her meds this morning due to the procedure. She has chronic orthopnea but denies any recent changes. She states that she has home O2 but notes that she rarely uses it (only when she feels SOB). Her dry weight is around 210 lbs. \nIn the ED, initial vs were: T 97.6 P 96 BP 146/73 O2 sat 100 4L. Patient was given 10mg IV lasix and 25mg of metoprolol. \n. \nOn the floor, she states that she is doing well. She denies any chest pain, shortness of breath or discomfort. She states that she feels well and never felt short of breath. \n. \nReview of sytems: \n(+) Per HPI \n(-) Denies fever, chills, 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. \n\ufeff\n", + "input3": "Hypertension\nH/o arrythmia\nDiabetes diagnosed in ___\nDegenerative joint disease\n", + "input4": "Mom - died of MI.Dad - died from brain cancer.\n", + "input5": "Physical Exam:\nAdmission Physical Exam\nVitals: T: 96.3 BP: 128/52 P: 74 O2: 95 2L \nGeneral: Alert, oriented, no acute distress \nHEENT: MMM, oropharynx clear \nNeck: supple, JVP elevated to the angle of the jaw, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi \nCV: Irregular, no murmurs, rubs, gallops \nAbdomen: soft, non-tender, slighlty distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nExt: trace edema, warm, well perfused, 2+ pulses, no clubbing, cyanosis \nNeuro: CNs2-12 intact, motor function grossly normal \n\ufeff\n\ufeff\n", + "input6": "Chest X-Ray:\nFINDINGS: Moderate-to-severe cardiomegaly appears unchanged. No focal opacity to suggest pneumonia is seen. No pleural effusion, pneumothorax or overt pulmonary edema is seen. \n. \nIMPRESSION: Stable examination. No evidence of acute cardiopulmonary process. \n.\n___ 10:43AM BLOOD WBC-7.4 RBC-4.33 Hgb-12.7 Hct-42.1 MCV-97# MCH-29.7 MCHC-32.6 RDW-17.0*\n___ 12:00PM BLOOD Glucose-158* UreaN-10 Creat-0.6 Na-143 K-3.5 Cl-107 HCO3-28 AnGap-12 BNP 600*\n\n\nECHO\uff1a\nThe left atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Hyperlipidemia/11750185-DS-15.json b/Finished/Hyperlipidemia/11750185-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..7b52cee83a8e37f47711c6be24e551718e734101 --- /dev/null +++ b/Finished/Hyperlipidemia/11750185-DS-15.json @@ -0,0 +1,24 @@ +{ + "Hyperlipidemia$Intermedia_3": { + "Very high Triglycerides vaule 500 mg/dL and above$Cause_1": { + "Triglycerides-502*$Input6": {} + }, + "Suspected Hyperlipidemia$Intermedia_2": { + "Blood clots in arteries may be related to dyslipidemia$Cause_1": { + "thrombus in the aortic$Input2": {} + }, + "Hyperlipidemia can increase blood viscosity and increase the risk of thrombosis.$Cause_1": { + "a DVT of his left leg$Input2": {} + }, + "Warfarin is an anticoagulant drug that is commonly used to prevent and treat blood clots. Taking this drug may indicate that patients are at risk for blood clots related to high cholesterol.$Cause_1": { + "Warfarin$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "The patient has an AneuRx stent graft which was placed on 5.4-cm aneurysm. Previous studies have shown some thrombus in the aortic component of the graft which is very interesting in light of the fact that in this year, he suffered a DVT of his left leg for uncertain reasons for which he is currently on Warfarin. He had a CT scan today. He has had no other complaints and the swelling in his left leg has improved considerably.\n", + "input3": "+Non-Q wave myocardial infarction\n+Diverticulosis\n", + "input4": "N/C\n", + "input5": "VS: 97.2 P:61 BP: 144/62 RR: 13 Spo2: 100%\nGen: Alert and oriented x3, NAD\nCard: RRR\nLungs: CTAB\nAbd: soft, NT, ND\nGroin: no hematoma\nPulses: Femoral DP ___ \nLeft palp dop dop\nRight palp dop dop\n", + "input6": "___ 06:15AM BLOOD WBC-10.4 RBC-3.17* Hgb-10.0* Hct-29.5* MCV-93 MCH-31.5 MCHC-33.9 RDW-13.2 Plt ___\n___ 06:15AM BLOOD UreaN-25* Creat-1.7* K-4.7\n___ 04:04AM BLOOD Glucose-150* UreaN-27* Creat-1.5* Na-136 K-4.7 Cl-102 HCO3-27 AnGap-12\n___ 05:19PM BLOOD Glucose-129* Lactate-2.1* Na-136 K-4.2 Cl-103\n___ 05:19PM BLOOD Hgb-10.5* calcHCT-32\n___ 05:19PM BLOOD freeCa-1.08* Triglycerides-502*\n \n" +} \ No newline at end of file diff --git a/Finished/Hyperlipidemia/13591813-DS-21.json b/Finished/Hyperlipidemia/13591813-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..90a909803e4147b89067cfacebacd2aba8a53b75 --- /dev/null +++ b/Finished/Hyperlipidemia/13591813-DS-21.json @@ -0,0 +1,39 @@ +{ + "Hyperlipidemia$Intermedia_3": { + "The triglyceride level is significantly high, which is a direct indicator for diagnosing hyperlipidemia$Cause_1": { + "Triglycerides-460*$Input6": {} + }, + "Suspected Hyperlipidemia$Intermedia_2": { + "Early satiety may be related to hyperlipidemia$Cause_1": { + "early satiety$Input1": {} + }, + "Loss of appetite may be related to hyperlipidemia, as abnormal blood lipids may affect appetite and digestive function$Cause_1": { + "anorexia$Input2": {} + }, + "Weakness may be an indirect symptom of hyperlipidemia, which may lead to systemic metabolic abnormalities and insufficient energy supply.$Cause_1": { + "weakness$Input2": {} + }, + "Early satiety may be related to the impact on the digestive system, possibly due to metabolic abnormalities caused by hyperlipidemia$Cause_1": { + "early satiety$Input2": {} + }, + "Abdominal discomfort may be related to the accumulation of lipids in the digestive tract$Cause_1": { + "abdominal discomfort$Input2": {} + }, + "Upper abdominal fullness may be related to hyperlipidemia$Cause_1": { + "upper abd fullness$Input2": {} + }, + "Weight loss may be caused by metabolic disorders caused by hyperlipidemia$Cause_1": { + "lost 6 lbs$Input2": {} + }, + "Hyperglycemia is common in metabolic syndrome and is an important manifestation of hyperlipidemia.$Cause_1": { + "Glucose-125$Input6": {} + } + } + }, + "input1": "early satiety\n", + "input2": "presenting with 1 week of anorexia, weakness, early satiety, and abdominal discomfort. He reports he was in usual state of health until one week ago when he began to feel full after a few bites food. He has lost 6 lbs since then. Associated with nausea, no dysphagia/odynophagia, or feeling like food is getting stuck. He has not had heartburn, reflux, bitter taste, or cough. He denies NSAID use. Denies RUQ pain. Denies abdominal pain but endorses some upper abd fullness. Denies vomiting, diarrhea. The patient has been having normal BMs (last was this morning) without blood or black stools. No fevers, possible chills. Denies nightsweats, CP, SOB, dysuria, easy bleeding, or bruising, bumps. He had a normal colonoscopy ___ years ago. Seen by PA at PCP office yesterday, normal CBC/lytes/LFTs/neg trop and EKG. Was given prilosec and told to f/u in one month if sx persist. Patient and family scheduled him for an EGD for next ___ but were concerned for ongoing sx so brought him in. \n", + "input3": "-history of thyroid nodule treated with radioactive Iodine\n-s/p appendectomy\n-SCC (right temple)\n", + "input4": "His mother was diagnosed with colon cancer. His father died from an MI. He has 1 sister w/ breast CA. \n", + "input5": "VS - 98.5 133/85 56 16 99% on RA\nGeneral: thin, well-groomed middle-aged gentleman, lying comfortably in bed. anxious-appearing, flat affect\nHEENT: normocephalic\nNeck: supple, no LAD, JVP 7 mmHg.\nCV: regular rate, rhythm. normal S1, S2. no murmurs, rubs, gallops.\nLungs: clear to auscultation bilaterally. no wheezing, crackles.\nAbdomen: soft, nontender, no rebound, guarding. normoactive bowel sounds\nGU: deferred\nExt: warm, well-perfused. no edema. 2+ DP, ___ pulses. \nNeuro: AOx3, CN II-XII intact, strength, sensation grossly intact. gait not observed\nSkin: no rashes, vescicles\n", + "input6": "___ 09:15AM BLOOD WBC-5.6 RBC-4.59* Hgb-14.0 Hct-40.2 MCV-88 MCH-30.5 MCHC-34.8 RDW-13.1 Plt ___\n___ 09:15AM BLOOD Neuts-81.0* Lymphs-14.1* Monos-4.3 Eos-0.3 Baso-0.4\n___ 09:15AM BLOOD Glucose-125* UreaN-18 Creat-0.9 Na-136 K-4.0 Cl-100 HCO3-25 AnGap-15\n___ 09:15AM BLOOD ALT-19 AST-26 AlkPhos-54 Amylase-65 TotBili-0.7\n___ 09:15AM BLOOD Lipase-27\n___ 09:15AM BLOOD cTropnT-<0.01\n___ 09:15AM BLOOD Albumin-4.6 Calcium-9.8 Phos-3.3 Mg-1.8 Triglycerides-460*\n\nCT chest/abdomen/pelvis ___: Normal CT of the chest, abdomen, and pelvis. No evidence of acute inflammatory process gastric outlet or bowel obstruction, for malignancy. \n\nColonoscopy ___: Impression: Grade 1 internal hemorrhoids, repeat in ___ years recommended.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/11416084-DS-14.json b/Finished/Hypertension/11416084-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..cbcf3b5d2ff6b4f6d085bf4735e04b91b9505e3e --- /dev/null +++ b/Finished/Hypertension/11416084-DS-14.json @@ -0,0 +1,21 @@ +{ + "Hypertension$Intermedia_3": { + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is the diagnostic criteria of hypertension$Cause_1": { + "he was seen last week in triage for BP's high as 160/100$Input2": {} + }, + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is the diagnostic criteria of hypertension.$Cause_1": { + "BPs: 148/98, 156/93$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is the symptom of HTN$Cause_1": { + "has daily headache$Input2": {} + } + } + }, + "input1": "Chief Complaint:\nnone\n", + "input2": "History of Present Illness:\nMs. ___ presents for admission for observation due to worsening in the outpatient setting. She feels well with no headache now, visual changes, or epigastric pain.\nShe has daily headache but they resolve in the am, she was seen last week in triage for BP's high as 160/100's but it came down \nwith observation and her prot/cr was 0.2 and her labs were fine.\n", + "input3": "PAST MEDICAL HISTORY\n1. Pyelonephritis x2, even though the patient does not recall\nit.\n2. Ulcerative colitis. Her last colonoscopy was ___ years ago. She has currently not had any flares and she is maintained on Asacol.\n3. Stress/anxiety: on celexa, has seen her PCP, financial stress has been great\n\nPAST SURGICAL HISTORY\n- skin biopsy (left chest) benign \n- hx keloids\n", + "input4": "\n", + "input5": "Physical Exam:\nBPs: 148/98, 156/93\nGeneral: Well-nourished, well-developed woman in no acute distress. \nNeck: Supple, no thyromegaly. \nCardiac: RRR, no murmurs, rubs or gallops. \nChest: Clear to auscultation bilaterally, no wheezes, crackles or rubs. \nAbdominal exam: S=D, no masses appreciated, no pain, rebound or\nguarding. \nExtremities: No skin changes and no edema. \nUterus was S=D\n", + "input6": "Pertinent Results:\n___ 05:00PM UREA N-6 CREAT-0.5\n___ 05:00PM ALT(SGPT)-18 AST(SGOT)-21\n___ 05:00PM URIC ACID-2.7\n___ 05:00PM WBC-12.0* RBC-4.56 HGB-13.8 HCT-40.3 MCV-89 \nMCH-30.4 MCHC-34.3 RDW-13.7\n\n___ 24 hr urine ___/P: ___ y.o. G5P2 at 30 + 6 weeks admitted for pre-eclampsia evaluation, in the setting of worsening GHTN and poor OB \nhistory, h/o 20 wk loss and 24 wk delivery. \n\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/11416084-DS-15.json b/Finished/Hypertension/11416084-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..0f58eb84a84a00acc11634bec8ad70c84acef765 --- /dev/null +++ b/Finished/Hypertension/11416084-DS-15.json @@ -0,0 +1,27 @@ +{ + "Hypertension$Intermedia_3": { + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is a diagnostic criteria of hypertension$Cause_1": { + "Physical Exam:\nVITALS: BP 163/104, HR 98, O2 98%RA$Input5": {} + }, + "High blood pressure and headache are common symptoms and related factors of hypertension$Cause_1": { + "G5P1 at 32w3d with HTN presents with 1 day history of headache$Input2": {} + }, + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is a diagnostic criteria of hypertension\n.$Cause_1": { + "at home today 170/120.$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "headache is the symptom of HTN$Cause_1": { + "States the headache started this am at 3 am$Input2": {} + }, + "Edema is also a symptom of high blood pressure$Cause_1": { + "swelling started 2 months ago$Input2": {} + } + } + }, + "input1": "headache\n", + "input2": "History of Present Illness:\nShe was G5P1 at 32w3d with HTN presents with 1 day history of headache. States the headache started this am at 3 am. It resolved with Tylenol ___ mg x 1 but not the second time she took it. She does not get headaches outside of pregnancy. According to pt, this is the first time she has developed a HA in this pregnancy; however past notes say she has daily HA in am. Pt denies change in vision, UQ pain, ctx, LOF, VB. +FM. + swelling started 2 months ago.\n\n24 hr urine and labs were nl at that time. Labs were rechecked ___ and were wnl. Pt started nifed CR 30 mg last night for ___ time. Started checking BP at home for first time, states BP at home today 170/120.\n", + "input3": "Past Medical History:\nPRENATAL COURSE\n- O+/Ab-,CT-,GC-,HIV-,RPRnr,RI,HbsAg-,CF-\n- hx infertility\n *)conception on clomid\n *)triplet pregnancy reduced to ___\n- hx preterm delivery\n *)prophylactic cerclage, CL stable, ___ cm\n *)maintained on IM 17P\n- gestational hypertension since 29wks\n *) s/p admission ___\n *) pre-eclampsia labs normal\n *) 24hr urine nl (170mg protein)\n- (___) EFW: 1415g Percentile: 35% ___\n- (___) BPP ___ nl fluid\n", + "input4": "\n", + "input5": "Physical Exam:\nVITALS: BP 163/104, HR 98, O2 98%RA\nGENERAL: Well-nourished, well-developed woman, NAD\nHEART: RRR, no murmurs, rubs or gallops \nLUNGS: CTAB bilat, no wheezes, crackles or rubs \nABDOMEN: S=D, no masses appreciated, no pain, rebound or\nguarding. EFW 4# Leopolds \nEXTREMITIES: No skin changes and no edema\nFHT: 130, mod var, +accels, -decels\nTOCO: no ctx\nTAUS: vtx, BPP ___, AFI 14\n", + "input6": "Pertinent Results:\n___ WBC-10.9 RBC-4.63 Hgb-13.8 Hct-40.7 MCV-88 Plt-212\n___ WBC-16.1 RBC-3.82 Hgb-11.1 Hct-34.3 MCV-90 Plt-184\n___ Creat-0.6 ALT-13 UricAcd-3.2\n___ Creat-0.5 ALT-25 UricAcd-4.2\n___ URINE Hrs-RANDOM Cre-31 TotPr-6 Pr/Cr-0.2\n___ URINE pH-5 Hrs-24 ___ Cre-75 TProt-6 Pr/Cr-0.1\n___ URINE 24Creat-1463 24Prot-___ y/o G5P1 at 32w3d weeks with GHTN and HA, possible new preeclampsia.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/11416084-DS-16.json b/Finished/Hypertension/11416084-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..1702469c24b963deda45502acac69bab1004ec66 --- /dev/null +++ b/Finished/Hypertension/11416084-DS-16.json @@ -0,0 +1,21 @@ +{ + "Hypertension$Intermedia_3": { + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) is a diagnostic cretiria of hypertension.$Cause_1": { + "She was G5P1 at 33w6d with HTN presents with elevated BP to 170/90-100s in the ATU today$Input2": {} + }, + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) is a diagnostic cretiria of hypertension$Cause_1": { + "BP 153/91$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "headache is the synptom of HTN$Cause_1": { + "headache$Input1": {} + } + } + }, + "input1": "headache\n", + "input2": "\nShe was G5P1 at 33w6d with HTN presents with elevated BP to 170/90-100s in the ATU today. Denies h/a, visual changes, RUQ pain. No VB/LOF/ctx. +AFM.\nDiagnosed with gHTN when admitted for a preeclampsia eval. 24 hr urine and labs were WNL at that time. Admitted to the antepartum service, where again preeclampsia eval with 24 hr urine was negative. Seen yesterday in OB Triage after being evaluated for a h/a and elevated BP. H/a resolved with Fiorcet and labs were WNL.\n", + "input3": "\nPRENATAL COURSE\n- ___ ___\n- O+/Ab-/CT-/GC-/HIV-\n- will obtain other pn from Quest\n- abnl GLT, nl GTT\n- conception on clomid\n- triplet pregnancy reduced to ___\n- prophylactic cerclage, cervical length stable, ___ cm\n- maintained on IM 17P\n- (___) EFW: 1829g (35%)\n", + "input4": "\n", + "input5": "\nVITALS: T 99.2, HR 97, BP 153/91\nGENERAL: NAD\nCV: RRR \nRESP: CTAB\nABDOMEN: soft, gravid, no TTP\nEXTREMITIES: no edema or calf TTP, reflexes 2+ b/l\nBPP: ___ in the ATU\n", + "input6": "\n___ WBC-12.3 RBC-4.13 Hgb-12.3 Hct-36.5 MCV-88 Plt-221\n___ WBC-14.6 RBC-4.03 Hgb-12.1 Hct-35.7 MCV-89 Plt-201\n___ WBC-14.6 RBC-4.18 Hgb-12.4 Hct-36.9 MCV-88 Plt-207\n___ WBC-16.6 RBC-3.71 Hgb-11.0 Hct-33.9 MCV-91 Plt-196\n___ ___ PTT-30.1 ___ ___ Creat-0.6 ALT-16 UricAcd-4.2\n___ Creat-0.6 ALT-16 UricAcd-4.4\n___ Creat-0.6 ALT-10 UricAcd-5.0\n___ URINE 24Creat-1342 24Prot-154\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/11416397-DS-6.json b/Finished/Hypertension/11416397-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..5aed17cd13c761bc9b73a058e03cd20b43e250b4 --- /dev/null +++ b/Finished/Hypertension/11416397-DS-6.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is a diagnostic criteria of hypertension\n.$Cause_1": { + "Physical Exam:\nVitals: 181/93$Input5": {} + }, + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is a diagnostic criteria of hypertension$Cause_1": { + "the patient reports elevated blood pressures at home persistently above 160/90$Input2": {} + }, + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is a diagnostic criteria of hypertension\n..$Cause_1": { + "Chief Complaint:\nelevated blood pressures$Input1": {} + }, + "Suspected Hypertension$Intermedia_2": { + "These symptoms may be associated with high blood pressure, especially headaches$Cause_1": { + "a headache, right upper quadrant pain and back pain$Input2": {} + } + } + }, + "input1": "Chief Complaint:\nelevated blood pressures\n", + "input2": "\nHPI: This is a patient with unstablechronic hypertension with superimposed pre-eclampsia. The patientwas placed on magnesium for 24 hrs post-partum. During her immediate post-partum period, the patient had normal blood pressures while in the hospital.\nShe was able to void spontaneously, tolerate a regular diet without nausea or vomiting, with minimal lochia, and with regular\nbreastfeeding. However, on ___, the patient reports elevated blood pressures at home persistently above 160/90, with a headache, right upper quadrant pain and back pain.\nShe denies dysuria or changes in urinary frequency, fevers or chills or SOB/CP.\n\nROS: neg per review of systems\n", + "input3": "Past Medical History:\nPOB: ___\n- SAB ___ @ 11 weeks\n- LTCS ___, term, 7lb14oz; arrest of dilation\n- repeat LTCS term, ___, gestational carrier\n- repeat LTCS 33w0d (pre-term labor) twins, ___, gestational carrier\n- current pregnancy via IVF after failed IUI\nPGYN: endometrial polyps s/p HSC/PPY x 2\nPMH: chronic hypertension as above\nPSH: LTCS x 3, HSC/PPY x 2\n", + "input4": "None\n", + "input5": "Physical Exam:\nVitals:\n98.1 66 18 181/93\nnifedipine 10mg ___ given\n166/90\n136/66\n\nGen: A&O, NAD\nCV: RRR\nResp: CTAB\nAbd: +BS, soft, NT/ND, no rebound or guarding\nExt: calves nontender bilaterally, no c/c/e\nIncision: skin edges not well approximated, with multiple 1cm-2cm edges that are slightly open though cannot be opened with a\nQ-tip, monocyrl suture can be visualized that is still in place, mild skin edge erythema, though no induration, no purulent discharge, not tender to palpation and no signs of infections. \n\nUpon discharge:\nVSS, AF\nGen: NAD, A&O x3\nResp: CTAB\nAbd: +BS, soft, NT/ND, no r/g/d\nIncision: areas of poor skin edge approximation, though grossly intact, small areas with scant purulent drainage though no sign of cellulitis\nExt: no clubbing, no cyanosis, mild edema in legs bilaterally\n", + "input6": "Pertinent Results:\n___ 07:22PM GLUCOSE-108* UREA N-14 CREAT-0.8 SODIUM-141 \nPOTASSIUM-4.0 CHLORIDE-105 TOTAL CO2-25 ANION GAP-15\n___ 07:22PM estGFR-Using this\n___ 07:22PM ALT(SGPT)-22\n___ 07:22PM CALCIUM-8.7 PHOSPHATE-4.6* MAGNESIUM-1.9 URIC \nACID-6.9*\n___ 07:22PM TSH-2.5\n___ 07:22PM WBC-7.4 RBC-3.97* HGB-10.4* HCT-33.4* MCV-84 \nMCH-26.1* MCHC-31.0 RDW-14.7\n___ 07:22PM PLT COUNT-325#\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/11501987-DS-11.json b/Finished/Hypertension/11501987-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..9455657f372ef953bf7753521abb07954b051254 --- /dev/null +++ b/Finished/Hypertension/11501987-DS-11.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is a diagnostic criteria of hypertension$Cause_1": { + "elevated BP in the office to 150/90 today$Input2": {} + }, + "an elevation of BP (SBP\u2265140mmHg or DBP\u226590mmHg) confirmed is a diagnostic criteria of hypertension\n..$Cause_1": { + "Physical Exam: 19:00BP: 140/77 (92)$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "vision changes is the symptom of HTN$Cause_1": { + "vision changes$Input1": {} + }, + "headache is the symptom of HTN$Cause_1": { + "headache$Input1": {} + } + } + }, + "input1": "headache, vision changes\n", + "input2": "History of Present Illness:\nPatient is a ___ y/o G3P1 at 35+6 here with HA, vision changes, and elevated BP in the office to 130/90 today. She reports that she developed a strong ___ headache at about 10am this morning, which has since improved (but is still present) with tylenol). She had vision changes (\"floaters\") at the time of more severe headache, but not currently. No RUQ or epigastric pain. Rare \ncontractions (not painful), no LOF or vaginal bleeding. Active fetal movement.\n", + "input3": "Past Medical History:\nPNC:\n- A+/abs-/RPRNR/RI/HepBsAg-/HIV-/GBS unknown OB: G3P1\n- TABx1\n- LTCS at term, 7#, for NRFHT at 5 cm, c/b pre-eclampsia with Cr 2.8 after delivery\n- ___: US with poly AFI 34 EFW 2713 g, 71%\nPMH: denies\nPSH: C/S, lumpectomy, tonsillectomy\n", + "input4": "\n", + "input5": "Physical Exam:\nOn admission:\n___ 17:29BP: 130/74 (86)\n___ 17:30Temp.: 98.1\u00b0F\n___ 17:40BP: 132/84 (95)\n___ 18:00BP: 124/80 (91)\n___ ___: 63\n___ 18:20BP: 132/76 (88)\n___ 18:40BP: 137/84 (92)\n___ 19:00BP: 140/77 (92)\nFHT: 130/mod/-acc/-dec (declined NST)\nToco: irritable\nSVE: deferred\n", + "input6": "Pertinent Results:\n___ WBC-8.5 RBC-3.96 Hgb-12.1 Hct-34.8 MCV-88 Plt-188\n___ Creat-0.7 ALT-15 AST-44 UricAcd-4.2\n___ URINE Blood-NEG Nitrite-NEG Protein-TR* Glucose-NEG \nKetone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG\n___ URINE RBC-0 WBC-0 Bacteri-NONE Yeast-NONE Epi-<1\n___ URINE Hours-RANDOM Creat-96 TotProt-8 Prot/Cr-0.1\n___ URINE 24Creat-1713 24Prot-193\n\nR/O GROUP B BETA STREP (Final ___: \n NEGATIVE FOR GROUP B BETA STREP.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/11737430-DS-29.json b/Finished/Hypertension/11737430-DS-29.json new file mode 100644 index 0000000000000000000000000000000000000000..5d6e718f8de3eb3fd93d2cf051fc8b29c4af2e31 --- /dev/null +++ b/Finished/Hypertension/11737430-DS-29.json @@ -0,0 +1,30 @@ +{ + "Hypertension$Intermedia_3": { + "an elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "VS: 96.7 166/96 90 18 97% RA$Input5": {} + }, + "an elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "at home today 172/95$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Nausea is a symptoms of Hypertension.$Cause_1": { + "Nausea$Input1": {} + }, + "Vomiting is a symptoms of Hypertension.$Cause_1": { + "vomiting$Input1": {} + }, + "Elderly age is an important risk factor for Hypertension,and female have a higher risk.$Cause_1": { + "66 year old female$Input2": {} + }, + "Diabetes is a big risk factor of Hypertension,which is generally accompanied by Hypertension.$Cause_1": { + "Type II diabetes previously uncontrolled$Input3": {} + } + } + }, + "input1": "Nausea, vomiting, abdominal pain\n", + "input2": "66 year old female with a history of IDDM, gastroparesis, hep C, HTN, multiple ED visits and admissions for gastroparesis who presented to the ED with nausea, vomiting, and dull midepigastric abdominal pain. Onset of symptoms was at 5 pm tonight and pt stated feels identical to past gastroparesis. Earlier in the day she ate toast, but nothing before the pain started in the afternoon. She notes sensation of fullness. She also had bilious emesis x 1.At night,she started to check BP at home for first time,states BP at home today 172/95. Of note, the patient was most recently admitted with identical symptoms. She was treated with zofran and narcotics for pain control. During this admission it was also thought that she has autonomic neuropathy as she was orthostatic despite fluid resusitation. She has since presented to the ED multiple times for similar symptoms.\n", + "input3": "+Type II diabetes previously uncontrolled\n+Hepatitis C: Never treated, AST/ALT not elevated at baseline, screened with US\n+Hepatitis B: cleared infection\n+Depression and Anxiety\n+Hiatal Hernia\n+Colon polyps removed \n+Lap cholecystectomy \n+Cervical Degenerative Disk Disease\n+Chronic back pain\n", + "input4": "Mother: colon cancer. \nFather: heart disease.\nBrother: DM, HTN, obsesity.\n", + "input5": "VS: 96.7 166/96 90 18 97% RA \nGENERAL: Well-appearing woman in NAD, appears comfortable depite pain \nHEENT: NC/AT, EOMI, sclerae anicteric, dry MM, OP clear. \nNECK: Supple,no JVD \nHEART: RRR, no MRG \nLUNGS: CTA bilat \nABDOMEN: + BS, tender in epigastrium, soft, no masses \nEXTREMITIES: WWP, no edema, 2+ peripheral pulses. \nSKIN: No rashes or lesions. \nLYMPH: No cervical LAD. \nNEURO: Awake, A&Ox3, CNs II-XII grossly intact\n", + "input6": "___ 10:15PM BLOOD WBC-10.3 RBC-4.37 Hgb-12.7 Hct-36.7 MCV-84 MCH-29.1 MCHC-34.6 RDW-14.6 Plt ___\n___ 10:15PM BLOOD Neuts-61.2 ___ Monos-2.3 Eos-1.2 Baso-0.7\n___ 06:25AM BLOOD Glucose-108* UreaN-8 Creat-0.6 Na-139 K-3.5 Cl-102 HCO3-27 AnGap-14\n___ 10:15PM BLOOD ALT-15 AST-20 LD(LDH)-192 AlkPhos-93 TotBili-0.5\n___ 10:15PM BLOOD Albumin-3.9\n___ 11:20PM URINE Color-Straw Appear-Clear Sp ___\n___ 11:20PM URINE Blood-TR Nitrite-NEG Protein-100 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.5 Leuks-NEG\n\nABDOMEN (SUPINE AND ERECT)X-RAY IMPRESSION: No evidence of bowel obstruction or free air. \n\nEKG: Sinus rhythm. Left ventricular hypertrophy. Non-specific lateral ST-T wave changes. Compared to the previous tracing of no diagnostic interim change.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/11962352-DS-7.json b/Finished/Hypertension/11962352-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..da3c08e6680ea8e61f57685ab062395c56b48b95 --- /dev/null +++ b/Finished/Hypertension/11962352-DS-7.json @@ -0,0 +1,27 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "BP: 174/92$Input5": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "stated BP immediately 183/101$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Labetabol is a type of hypotensive drug,indicates that the patient may have Hypertension,which is a risk factor.$Cause_1": { + "on Labetalol 200mg$Input2": {} + }, + "Headache is a symptom of Hypertension.$Cause_1": { + "intermittent headaches$Input2": {} + }, + "Chest pain is a symptom of Hypertension.$Cause_1": { + "chest \"tightness\"$Input2": {} + } + } + }, + "input1": "\n", + "input2": "HPI: G2P2 with cHTN PP day 11 from SVD c/b sPEC and PPH, s/p\nMagnesium treatment. Discharged home on Labetalol 200mg BID, saw Dr. A in office for F/U 2 days ago, BPs were elevated,stated BP immediately 183/101,medication increased to 200mg TID. Pt seen today for BP check, pressures severe range, sent to triage. Pt reports intermittent headaches the last few days, today felt some chest \"tightness\" that she associates with high blood pressure. Denies visual changes or RUQ/epigastric pain. Breast feeding going well.\n", + "input3": "+SVD xs\n+SVD induced 38 wks for pre eclampsia,\n+SVD 41+0, c/b sPEC by BPs, requiring Mg during labor, dispo home on PO Labetalol, and PPH 650cc, no add'l uterotonics required\n+GynHx: denies abnormal paps, fibroids, GYN surgeries, STIs\n+PMHx: sickle cell trait\n+PSHx: knee surgery\n", + "input4": "non-contributory\n", + "input5": "AF discharge blood pressure 150s/90s AF\nGen: Thin woman, very pleasant, infant comfortably resting on her chest \nLung: CTA B\nCV: RRR, + flow murmur\nAbd: Nabs, soft\nExt: trace edema bilateral\nBP: 174/92\n", + "input6": "___ 02:30PM BLOOD WBC-7.2# RBC-4.21 Hgb-10.7* Hct-32.5* MCV-77* MCH-25.4* MCHC-32.9 RDW-15.8* RDWSD-43.8 Plt ___\n___ 09:15AM BLOOD Glucose-76 UreaN-12 Creat-0.9 Na-145 K-4.2 Cl-106 HCO3-28 AnGap-11\n___ 02:30PM BLOOD ALT-12 AST-17\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/12006801-DS-3.json b/Finished/Hypertension/12006801-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..2fe1739997fec06eda01f2cbefc71fef616441a7 --- /dev/null +++ b/Finished/Hypertension/12006801-DS-3.json @@ -0,0 +1,39 @@ +{ + "Hypertension$Intermedia_3": { + "an elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "Vitals:BP 200/106$Input5": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "intial vitals were: 10 98.2 88 198/92$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "Vitals on transfer: 5 98.7 84 176/89$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptom of Hypertension.$Cause_1": { + "Headache$Input1": {} + }, + "Diabetes is a big risk factor of HP,which is generally accompanied by Hypertension.$Cause_1": { + "history of diabetes$Input2": {} + }, + "Visual disturbance is a symptom of HP,which is generally accompanied by Hypertension.$Cause_1": { + "right-sided eye pain with some flashes of light of the right eye$Input2": {} + }, + "Nausea is a symptoms of Hypertension.$Cause_1": { + "continuing to feel nauseated$Input2": {} + }, + "Family history is a big risk factor of Hypertension.$Cause_1": { + "Mom: HTN$Input4": {} + }, + "Family history is a big risk favtor of Hypertension.$Cause_1": { + "Dad: HTN$Input4": {} + } + } + }, + "input1": "Headache\n", + "input2": "She has history of diabetes c/b diabetic retinopathy, CKD, recent cataract surgery with recurrent right-sided headache. Patient states she initially had a right-sided headache involving her right eye and right side of the head. At that time she was seen here had a negative CT and LP, and her pain improved with morphine. The middle of this month she had a cataract surgery which had no complications per the patient. Yesterday she began noticing some right-sided eye pain with some flashes of light of the right eye. The pain spread to the side of her head and the back of her head similar to her headache. She was seen by her ophthalmologist on the day of admission who said that her eye was healing well and had no concerns. She was then referred to the emergency department for further workup of her headache. She denies any fevers or chills. She denies any chest pain or shortness of breath or cough. She has had left upper quadrant abdominal pain for the last month which appears at baseline. She has had no diarrhea. She has had 4 or 5 episodes of nonbloody nonbilious emesis with her headache earlier today. She has had no urinary symptoms. \n \nIn the ED intial vitals were: 10 98.2 88 198/92 16 100%. CT head showed the right globe appears hyperdense, likely related to recent prior ocular surgery. Otherwise, showed no acute intracranial process. Patient was given mophine and reglan IV and headache improved. Patient initially felt better and planned to send home however she then became nauseated and vomited. Given that she is not tolerating POs, she was admitted to medicine. Vitals on transfer: 5 98.7 84 176/89 100% RA. \n\nUpon arrival to the floor, she continues to have very severe headache centered around her right eye that she feels is worse with coughing. Also continuing to feel nauseated.\n", + "input3": "+IDDM2 - complicated by retinopathy with complete loss of vision in L eye and s/p cataract and retinal repair surgery in right eye\n+CKD likely diabetic retinopathy \n+HLD\n", + "input4": "Mom: DM2, HTN, HLD \nMGM: DM2 \nDad: HTN, prostate CA\n", + "input5": "Vitals:T 98.7, BP 200/106, HR 95, RR 18, O2 sat 100%RA \nGeneral: obese woman lying in bed with eyes closed, appears uncomfortable \nHEENT: Mild periorbital edema bilaterally. Right eye is preferentially closed with some exudate she states is from ointment and eye drops, EOMI, MMM, oropharynx clear \nNeck: supple, unable to assess JVD \nLungs: Clear to auscultation bilaterally, no wheezes, rales,ronchi \nCV: Regular rate and rhythm, normal S1 + S2, soft systolic murmur heard best over RUSB radiating to carotids, no rubs or gallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nNeuro: CNs2-12 intact, strength in UE, sensation intact\n", + "input6": "Labs:\n___ 06:20PM BLOOD WBC-8.2 RBC-3.49* Hgb-9.0* Hct-27.3* MCV-78* MCH-25.9* MCHC-33.1 RDW-15.4 Plt ___\n___ 08:10AM BLOOD WBC-5.6 RBC-3.01* Hgb-7.6* Hct-23.8* MCV-79* MCH-25.3* MCHC-31.9 RDW-15.1 Plt ___\n___ 06:20PM BLOOD Neuts-85.3* Lymphs-10.1* Monos-3.7 Eos-0.6 Baso-0.2\n___ 08:10AM BLOOD ___ PTT-23.5* ___\n___ 06:20PM BLOOD Glucose-149* UreaN-25* Creat-2.7* Na-141 K-3.8 Cl-109* HCO3-25 AnGap-11\n___ 08:10AM BLOOD Glucose-125* UreaN-24* Creat-2.9* Na-138 K-3.8 Cl-108 HCO3-23 AnGap-11\n___ 06:20PM BLOOD ALT-11 AST-19 AlkPhos-73 TotBili-0.5\n___ 06:20PM BLOOD Lipase-136*\n___ 06:20PM BLOOD Albumin-2.8*\n___ 06:05AM BLOOD Calcium-7.4* Phos-3.5# Mg-2.4\n___ 08:10AM BLOOD Calcium-7.0* Phos-2.9 Mg-2.3\n___ 07:24PM BLOOD Lactate-1.4\n\nImaging:\nCT HEAD W/O CONTRAST Study \nIMPRESSION: \n1. No acute intracranial process. \n2. Partially visualized vitreous hyperdensity in right globe may be related to recent ocular surgery though clinical correlation is advised.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/12551014-DS-6.json b/Finished/Hypertension/12551014-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..16a11bc19c6efb1d0392c960b34caa1a4c95729c --- /dev/null +++ b/Finished/Hypertension/12551014-DS-6.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "States BP at ED 167/92.$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "States BP at ED 167/92.$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Nausea is a symptom of Hypertension.$Cause_1": { + "nausea$Input2": {} + }, + "Diabetes is a big risk factor of HP,which is generally accompanied by Hypertension.$Cause_1": { + "+Type 2 DM$Input3": {} + } + } + }, + "input1": "Abdominal pain\n", + "input2": "He is with chronic pancreatitis, seen by Dr. C who returns to the ED with 3 days of progressive nonradiating burning epigastric abdominal pain that is worsened with eating and alleviated with Dilaudid. He also reports, nausea and some nonbloody vomiting, but denies fevers, chills, SOB, pleuritic pain, abdominal swelling, leg swelling, diarrhea, dysuria, hematuria. He reports that he's decreased his oral intake over the past few days, but denies NSAID use, recent viral infection, EtOH use. He does smoke 1 ppd for the past yrs. He reports that these symptoms are typical of a pancreatitis flare. \n\nOf note, recent normal EUS in. \n\nIn the ED he was treated with Zofran, Morphine 4 mg IV x 2, and NS.States BP at ED 167/92.\n", + "input3": "+Psoriasis \n+Chronic Abdominal Pain \n+Type 2 DM \n+GERD \n+Hyperlipidemia \n+Vascular necrosis of the hip \n+Atrial tachycardia\n", + "input4": "Not obtained.\n", + "input5": "Vitals - T:97.5 BP: 176/82 HR: 96 RR:18 02 sat: 97 RA \nGENERAL: wincing, writing in bed, communicative \nSKIN: diaphoretic, no lesions or rashes \nHEENT: AT/NC, EOMI, PERRLA, anicteric sclera, pink conjunctiva, patent nares, MMM, good dentition, nontender supple neck, no LAD, no JVD \nCARDIAC: tachycardic, S1/S2, no mrg \nLUNG: good airmovement, slight expiratory wheezes in lower lung fields bilaterally \nABDOMEN: nondistended, +BS, tenderness to palpation in epigastrium, no rebound/guarding, no hepatosplenomegaly \nM/S: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact\n", + "input6": "___ 03:55PM BLOOD WBC-18.1*# RBC-5.36 Hgb-17.7 Hct-49.6 MCV-93 MCH-33.0* MCHC-35.7* RDW-13.3 Plt ___\n___ 03:55PM BLOOD Neuts-79.0* Lymphs-13.1* Monos-7.1 Eos-0.5 Baso-0.3\n___ 07:30AM BLOOD ___ PTT-28.8 ___\n___ 03:55PM BLOOD Glucose-174* UreaN-42* Creat-3.2*# Na-131* K-4.4 Cl-89* HCO3-25 AnGap-21*\n___ 07:05AM BLOOD Glucose-93 UreaN-11 Creat-0.7 Na-141 K-3.7 Cl-104 HCO3-27 AnGap-14\n___ 03:55PM BLOOD Lipase-39\n___ 07:05AM BLOOD Lipase-32\n___ 03:55PM BLOOD ALT-25 AlkPhos-62 TotBili-0.7\n\nMRCP with secretin \nIMPRESSION: \n1. Mild side branch dilatation in the pancreatic body and tail after secretin administration, consistent with mild chronic pancreatitis. \n2. Three tiny pancreatic cystic lesions, which may be sequela of prior pancreatitis or tiny side branch IPMNs. Followup MRI in six months could be performed to document stability. \n\nCXR\nIMPRESSION: No acute cardiopulmonary abnormality.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/12828031-DS-27.json b/Finished/Hypertension/12828031-DS-27.json new file mode 100644 index 0000000000000000000000000000000000000000..716c764a5a35539772aefba44e828c9f15306d4d --- /dev/null +++ b/Finished/Hypertension/12828031-DS-27.json @@ -0,0 +1,27 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "SBP at that time 154$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "Vital signs on arrival: BP 164/80$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "Vital Signs: BP 166/74$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Dizziness is a classic symptom of Hypertension.$Cause_1": { + "dizziness$Input1": {} + }, + "Diabetes is a big risk factor of HP,which is generally accompanied by Hypertension.$Cause_1": { + "+Type 2 diabetes$Input3": {} + } + } + }, + "input1": "dizziness\n", + "input2": "F with a medical history notable for CVA with residual left-sided weakness, and epilepsy. She presented to the ED with days of dizziness, malaise, and increased seizure activiy. \n\nMuch of the history was obtained via her daughter who is her primary caretaker. She remember first feeling poorly and attributes her symptoms to starting clonidine. She noted a dry mouth and loss of appetite. She noted increased seizure activity. Specifically she usually has 1, focal, LUE seizure per month. She noted seizures (all LUE, focal seziures with no generalized features). She was tired and did not feel like getting out of bed. She had a pre-syncopal event and almost fell after standing up (SBP at that time 154 per her daughter via home BP machine). She continued to feel tired, occasional dizziness, and had poor appetite with loss of taste and anorexia so she presented to the ED. \n\nThroughout these episodes her BG was normal on a number of occasions. She also had no urinary symptoms, bowel symptoms, fevers, chills, or focal neuro symptoms.\n\nVital signs on arrival: T 98.1, P 60, BP 164/80, 97% RA. Her evaluation in the ED was notable for normal orthostatic, a sodium of 149, Cr of 1.5, INR 5.1, and normal head CT. In the ED she received 1 L of D5W.\n\nROS: as above. In addition, she had constipation that resolved with laxitives over the weekend. Other systems reviewed in detail and all otherwise negative.\n", + "input3": "+PVD s/p multiple stents of the superficial femoral artery and balloon angioplasty of the tibial peroneal trunk; then found to have restenosis of SFA s/p angioplasty with stent placement \n+s/p CVA with residual left sided weakness \n+Seizure disorder with partial seizures. Usually left arm symptoms only.\n+Stage III CKDz\n+Hyperlipidemia \n+Type 2 diabetes\n+CHF with preserved LVEF\n+Atrial fibrillation on anticoagulation\n+s/p hysterectomy \n+s/p CCY \n+h/o adenomatous polyp on colonoscopy\n+h/o Grade 2 internal hemorrhoids on colonoscopy\n", + "input4": "Mother died of a stroke. No FH PE, DVT, early CAD.\n", + "input5": "Vital Signs: T 96.9, P 62, BP 166/74, 98% on RA.\n- Gen: Thin, elderly female sitting up in bed in NAD.\n- HEENT: Right eye closed. Left eye with normal pupil and tracking. Oropharynx clear w/out lesions.\n- Neck: Supple.\n- Chest: Normal respirations and breathing comfortably on room air. Lungs clear to auscultation bilaterally.\n- CV: Irregular rhythm. Normal S1, S2. No murmurs or gallops. JVP <5 cm.\n- Abdomen: Normal bowel sounds. Soft, nontender, nondistended. \n- Extremities: No ankle edema.\n- Skin: No lesions, bruises, rashes.\n- Neuro: Alert, oriented x3. CN is her primary language. Has good strength in the RUE and RLE. Very mild LLE weakness. Obvious weakness of LUE and poor hand control. \n- Psych: Appearance, behavior, and affect all normal.\n", + "input6": "Admission Laboratory Studies:\n - ___ 01:00PM GLUCOSE-194* UREA N-23* CREAT-1.5* SODIUM-149* POTASSIUM-3.9 CHLORIDE-107 TOTAL CO2-30 ANION GAP-16 ALBUMIN-3.8 CALCIUM-8.3* PHOSPHATE-4.5 MAGNESIUM-2.3 Phenyto-19.9 Albumin-3.8\n - ___ 01:00PM WBC-7.7 (NEUTS-67.7 ___ MONOS-8.2 EOS-2.7 BASOS-0.3) RBC-3.84* HGB-11.6* HCT-35.7* MCV-93 MCH-30.1 MCHC-32.5 RDW-15.2 PLT COUNT-184\n - ___ 01:00PM PTT-34.9\n\nOther Notable Studies:\n - CXR: PA/lateral projection. Has prominent right PA. Calcification of the aorta. Atelectasis at right base. Small effusion on lateral projection.\n\n - ECG: Atrial fibrillation at 59 with normal aixs. She has a prolonged QT interval. She has LVH by aVL with repolarization abnormalitis. This is unchanged from an ECG.\n\n - Head CT: 1. old R MCA infarct 2. no acute intracranial process. Final read pending.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/13092414-DS-18.json b/Finished/Hypertension/13092414-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..3a8899b4754177fcf7de842cdbfb5c7d20d57ecc --- /dev/null +++ b/Finished/Hypertension/13092414-DS-18.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "VS: 148/88$Input5": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "stress test prior to admission that was abnormally high(BP:145/95)$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Chest pain is a symptoms of Hypertension.$Cause_1": { + "chest pain$Input1": {} + }, + "Family history is a big risk factor of Hypertension.$Cause_1": { + "Two sisters with hypertension$Input4": {} + } + } + }, + "input1": "chest pain\n", + "input2": "54 y/o man with a history of positive family history for premature coronary artery disease presented to ED with c/o worsening chest pain, lightheadedness and palpitations. He had a stress test prior to admission that was abnormally high(BP:145/95) and restarted ASA and Prilosec at that time. he described chest tightness with exertion that radiated to jaw. He also c/o lightheadness and palpitations. Given family history of premature heart disease, pt. was treated for unstable angina.\n", + "input3": "None\n", + "input4": "Father: died of MI\nBrother: MI\nMother: CAD\nTwo sisters with hypertension\n", + "input5": "VS: 148/88 96%\nGeneral: appears comfortable in NAD.\nNeuro: A+O X3. Affect appropriate. MAE.\nNeck: supple (-) carotid bruits\nChest: lungs clear\nCV: AP RRR no m/r/g\nAbd: soft, NT,ND,(+) BS.\nExt; (+) peripheral pulses without edema.\nAccess site: RRA access without ooze, hematoma, (+) radial pulse.\n", + "input6": "___ 12:34AM BLOOD Neuts-39.0 ___ Monos-7.3 Eos-2.4 Baso-0.5 Im ___ AbsNeut-2.98 AbsLymp-3.87* AbsMono-0.56 AbsEos-0.18 AbsBaso-0.04\n___ 07:45AM BLOOD PTT-83.3*\n___ 12:34AM BLOOD Plt ___\n___ 12:34AM BLOOD Glucose-111* UreaN-18 Creat-1.1 Na-140 K-4.3 Cl-103 HCO3-26 AnGap-15\n___ 12:34AM D-DIMER-290\n___ 01:24AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG\n___ 12:34AM WBC-7.6 RBC-5.22 HGB-15.7 HCT-47.2 MCV-90 MCH-30.1 MCHC-33.3 RDW-13.0 RDWSD-42.\n\nMale with family history of premature CAD who presented with c/o worsening chest pain, lightheadedness and palpitations. He underwent a stress test that was normal. Troponins negative.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/13127922-DS-11.json b/Finished/Hypertension/13127922-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..fe413a386466f88da76239cce53a3346f7e59efd --- /dev/null +++ b/Finished/Hypertension/13127922-DS-11.json @@ -0,0 +1,21 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "VS:188/97$Input5": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "severe by blood pressures(175/85)$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "Headache$Input1": {} + } + } + }, + "input1": "Headache\n", + "input2": "He is a s/p spontaneous vaginal delivery following intrauterine fetal demise at 28 weeks gestational age. She was readmitted with superimposed pre-eclampsia, severe by blood pressures(175/85).\n", + "input3": "None\n", + "input4": "None\n", + "input5": "VS:188/97\nNeuro/Psych: NAD, Oriented x3, Affect Normal \nHeart: RRR\nLungs: nl respiratory effort\nAbdomen: soft, appropriately tender\nPelvis: minimal bleeding \nExtremities: warm and well perfused, no calf tenderness, no edema\n", + "input6": "___ 02:49PM BLOOD WBC-9.5 RBC-4.10 Hgb-12.5 Hct-36.2 MCV-88 MCH-30.5 MCHC-34.5 RDW-13.5 RDWSD-43.9\n___ 02:49PM BLOOD Creat-0.5\n___ 02:49PM BLOOD ALT-19 AST-22\n___ 02:49PM BLOOD UricAcd-5.2\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/13313134-DS-21.json b/Finished/Hypertension/13313134-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..bc5ff41d74f002d306872b5d1e32164ccb2edf12 --- /dev/null +++ b/Finished/Hypertension/13313134-DS-21.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "Took BP at home and it was 180/102$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "BP here was 150-160/90's$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Labetabol is a type of hypotensive drug,indicates that the patient may have Hypertension,which is a risk factor.$Cause_1": { + "Was on labetalol 200 mgs$Input2": {} + }, + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "+Headache$Input3": {} + } + } + }, + "input1": "elevated blood pressure postpartum\n", + "input2": "66 yo G3 s/o LTCS for twins and severe preeclampsia on . Was on labetalol 200 mgs tid on discharge. Took BP at home and it was 180/102.\n", + "input3": "+Chicken pox \n\u0095+Anemia HCT 38.2 \n+Infertility, female \n\u0095+Headache(784.0)\n", + "input4": "noncontributory\n", + "input5": "BP here was 150-160/90's Decision made to add nifedipine 30 mgs CR and observe overnight for response.\n", + "input6": "___ 10:13PM UREA N-12 CREAT-0.5\n___ 10:13PM ALT(SGPT)-14 AST(SGOT)-24\n___ 10:13PM URIC ACID-4.3\n___ 10:13PM PLT COUNT-311\n___ 10:13PM WBC-5.9 RBC-3.68* HGB-11.5 HCT-33.8* MCV-92 MCH-31.3 MCHC-34.0 RDW-13.1 RDWSD-42. Ps improved to 127/76, 129/83, 125/73 with activity.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/13826272-DS-12.json b/Finished/Hypertension/13826272-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..502599bdfdeecdf4d3dc4df9b55a1abb0b74969f --- /dev/null +++ b/Finished/Hypertension/13826272-DS-12.json @@ -0,0 +1,21 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "initial VS were: BP 151/91$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "VS: BP 188/80$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Irregular heartbeat is a symptoms of Hypertension.$Cause_1": { + "Vital signs concerning for persistent tachycardia$Input2": {} + } + } + }, + "input1": "Altered mental status\n", + "input2": "A man transferred with concerns for encephalopathy of unclear etiology. \n\nThe pt has a 9 month long course of unintentional weight loss (>40lbs), depression, night sweats, and muscle wasting, which has been thoroughly worked up in the past, including outpatient specialist appointments and a recent admission 1 month ago. Work up has been revealing for chronic recently discontinued surreptitious testosterone injections, and his symptoms were attributed to testosterone withdrawal with a likely component of depression. The extensive work up also revealed elevated 5-HIAA, serotonin, and chromogranin A, suggestive of a possible neuroendocrine carcinoid tumor. Further investigation into these findings was pending when he presented to the hospital today.\n\nThe pt was urged by his wife to come in today for evaluation because he became acutely altered confused and started experiencing hallucinations. At contrast CT that was negative. Vital signs concerning for persistent tachycardia, labile and elevated BPs. Also of note the patient was ataxic at the outside hospital and was deemed to be unsafe to ambulate on his own.\n\nIn the ED, initial VS were: T 98.3 HR 116 BP 151/91 RR 20 SpO2 100% RA\n\nExam notable for:\nGen: Middle-aged man wide-awake lying in bed with multiple blankets on him Pulm: CTAB no WRR, unlabored breathing\nCV: Tachycardic rate no MRG, no JVD\nHEENT: Dry mucous membranes, PERRLA, EOMI, no scleral icterus\nAbdomen: Soft NTND, no rebound tenderness, +BS\nExtremities: Moves all extremities\nSkin: Hot dry intact\nNeuro: Many times throughout the interview the patient would reference things or people that were not there to include his son and daughter who were not at bedside as well as hallucinating the sky, a tire with legs, and a tree trunk with a dress. Otherwise cranial nerves II through XII are intact, no gross focal neurologic abnormalities, no nystagmus noted.\n", + "input3": "+Bilateral carpal tunnel syndrome s/p bilateral carpal tunnel release\n+Prior history of thyroid nodule\n+Nontoxic uninodular goiter\n+Allergic contact dermatitis\n+Actinic keratosis\n+Gout\n+Colon Poylps\n", + "input4": "No family history of any underlying malignancies or endocrine disorders.\n", + "input5": "VS: BP 188/80\nGENERAL: Agitated, straining against restraints, not responding appropriately to questions\nNECK: Supple\nCV: RRR, S1/S2, no murmurs, gallops, or rubs\nPULM: CTAB, no wheezes, rales, rhonchi, breathing comfortably without use of accessory muscles\nGI: Abdomen soft, nondistended, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly\nEXTREMITIES: no cyanosis, clubbing, or edema\nPULSES: 2+ radial pulses bilaterally\nNEURO: Alert, moving all 4 extremities with purpose, face \nsymmetric\nDERM: Warm and well perfused, DTRs brisk, neuro exam limited by lack of cooperation\n", + "input6": "___ 01:03AM BLOOD WBC-11.2* RBC-5.13 Hgb-15.7 Hct-44.5 MCV-87 MCH-30.6 MCHC-35.3 RDW-11.4 RDWSD-36.1 Plt ___\n___ 01:03AM BLOOD Neuts-72.3* Lymphs-16.1* Monos-9.6 Eos-1.2 Baso-0.3 Im ___ AbsNeut-8.10* AbsLymp-1.80 AbsMono-1.07* AbsEos-0.13 AbsBaso-0.03\n___ 01:03AM BLOOD Glucose-123* UreaN-17 Creat-1.0 Na-142 K-4.6 Cl-106 HCO3-20* AnGap-16\n___ 01:03AM BLOOD ALT-24 AST-21 CK(CPK)-83 AlkPhos-62 TotBili-1.3\n___ 01:03AM BLOOD Lipase-35\n___ 01:03AM BLOOD cTropnT-<0.01\n___ 01:03AM BLOOD Albumin-4.3 Calcium-10.0 Phos-2.8 Mg-1.9\n___ 01:03AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/14936659-DS-23.json b/Finished/Hypertension/14936659-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..eee3f82b90f55a25775bd25b31d34b7c5a5420e1 --- /dev/null +++ b/Finished/Hypertension/14936659-DS-23.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "her BP to be systolic >200$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "initial vitals were BP 190/118$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "VS: BP 158/71$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Dyspnea is a symptoms of Hypertension.$Cause_1": { + "Dyspnea$Input1": {} + } + } + }, + "input1": "Dyspnea\n", + "input2": "The patient is a F with a PMH of CAD s/p 2v CABG (LIMA-LAD, SVG-OM) and PCI LCx, CVA admitted with acute onset dyspnea. The patient reported worsening shortness of breath over the last week and acutely worsening with walking on day of admission. Pt checked her BP to be systolic >200 and called EMS.\n\nIn ED, initial vitals were Time T 98.4 HR 75 BP 190/118 RR 28 O2 100 on 15L NRB. ECG was unchanged from prior, cardiac enzymes were negative X2. Patient given 325mg ASA. CXR negative for acute process. She underwent CTA which was negative for PE. \n\nOn admission to the medical floor, the patient reports that she found herself to be hypertensive earlier this afternoon with systolic BP 200s followed by an episode of acute dyspnea. She denied CP, edema, denies cough, fever/chills. Denies wheezing. \n\nOn review of systems, she denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. She denies recent fevers, chills or rigors. She denies exertional buttock or calf pain. All of the other review of systems were negative. \n\nCardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope.\n", + "input3": "+CAD: CAD s/p CABG\n+Peripheral vascular disease: s/p right popliteal angioplasty\n+Hypercholesterolemia\n+Hypothyroidism \n+Collagenous colitis \n+Macular degneration \n+s/p bilateral cataract surgery \n+Glaucoma\n", + "input4": "Non-contributory\n", + "input5": "VS: T 98.4, HR 67, BP 158/71, RR 22, O2 100% 2L \nGENERAL: elderly WDWN in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK: Supple with flat JVP \nCARDIAC: PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nRight: Carotid 2+ Femoral 2+ DP 2+ \nLeft: Carotid 2+ Femoral 2+ DP 2+\n", + "input6": "___ 06:35AM BLOOD WBC-5.7 RBC-3.58* Hgb-11.4* Hct-34.4* MCV-96 MCH-31.8 MCHC-33.1 RDW-13.6 Plt ___\n___ 07:00PM BLOOD Neuts-73.3* ___ Monos-5.1 Eos-0.9 Baso-0.3\n___ 06:35AM BLOOD ___ PTT-29.5 ___\n___ 06:35AM BLOOD Glucose-89 UreaN-19 Creat-0.9 Na-139 K-4.8 Cl-105 HCO3-23 AnGap-16\n___ 06:35AM BLOOD CK(CPK)-110\n___ 07:00PM BLOOD CK-MB-6 cTropnT-<0.01\n___ 01:00AM BLOOD cTropnT-0.06*\n___ 06:35AM BLOOD CK-MB-6 cTropnT-0.04*\n___ 07:00PM BLOOD proBNP-864*\n___ 06:35AM BLOOD Calcium-9.0 Phos-4.5 Mg-2.3\n\nCXR: Cardiomegaly with no acute pulmonary process.\n\nCTA: PRELIMINARY READ: no PE or acute aortic pathology\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/14944299-DS-17.json b/Finished/Hypertension/14944299-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..5a839641d9b89e41d35251cc8af968f10bdcb4c7 --- /dev/null +++ b/Finished/Hypertension/14944299-DS-17.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "Elevated blood pressure (BP 170/100) postpartum$Input1": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "elevated to 142/96$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "PE: 160-170/90-100$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Elderly age is an important risk factor for Hypertension,and female have a higher risk.$Cause_1": { + "61 yo gravida$Input2": {} + } + } + }, + "input1": "Elevated blood pressure (BP 170/100) postpartum\n", + "input2": "61 yo gravida 1, para status post lower transverse cesarean section 9 days ago, was to the ER for further evaluation when BP's at staple removal visit were elevated to 142/96. Patient presented to ED with BP. Pt denied HA/RUQ pain and current visual changes. Was previously seeing some spots- now resolved. No chest pain/shortness of breath/fever/chills/Nausea/Vomiting/Diarrhea. No hx of HTN or HTN during pregnancy. Pt is breastfeeding. Incisional pain was controlled at home with Percocet/Motrin.\n", + "input3": "+Obhx: G1P1\n+lower transverse cesarean section boy for ?\n", + "input4": "non-contributory\n", + "input5": "PE: 98.8 58 160-170/90-100 18 99% RA\nNAD\nRRR\nCTA B\nsoft, ND, appropriately tender around incision, fundus firm\nInc C/D/I steristrips\nExt NT/trace edema/2+ DTR\n", + "input6": "___ 01:00PM WBC-7.5 RBC-3.84* HGB-11.6* HCT-33.7* MCV-88 MCH-30.2 MCHC-34.4 RDW-14.5\n___ 01:00PM NEUTS-71.2* ___ MONOS-3.1 EOS-2.0 BASOS-0.4\n___ 01:00PM ___ PTT-28.3 ___\n___ 01:00PM ALT(SGPT)-19 AST(SGOT)-19 LD(LDH)-304* TOT BILI-0.4\n___ 01:00PM GLUCOSE-87 UREA N-8 CREAT-0.6 SODIUM-143 POTASSIUM-4.4 CHLORIDE-106 TOTAL CO2-26 ANION GAP-15\n___ 01:00PM ALT(SGPT)-19 AST(SGOT)-19 LD(LDH)-304* TOT BILI-0.4\n___ 01:21PM LACTATE-1.0\n___ 02:30PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 02:30PM URINE BLOOD-SM NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-TR\n___ 02:30PM URINE ___ BACTERIA-NONE YEAST-NONE EPI-<1\n___ 09:00AM BLOOD WBC-9.3 RBC-3.74* Hgb-11.2* Hct-32.9* MCV-88 MCH-29.9 MCHC-34.0 RDW-14.5 Plt\n___ 09:00AM BLOOD Creat-0.5\n___ 09:00AM BLOOD ALT-16\n___ 09:00AM BLOOD UricAcd-4.4\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/15185281-DS-14.json b/Finished/Hypertension/15185281-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..98c1705c0127f8664699ffc36b7bb34735d5d8b3 --- /dev/null +++ b/Finished/Hypertension/15185281-DS-14.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "blood pressures of 150's/90's$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "blood pressure of 154/84$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "VITALS: BP 156/103-->153/104-->158/84$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "Headache$Input1": {} + } + } + }, + "input1": "Headache\n", + "input2": "39 y/o G1P0 at 35 weeks gestation with who presents to triage from the office with blood pressures of 150's/90's. She denies HA, visual changes, epigastric or URQ pain. Pt felt overnight crampy but now none, no vaginal bleeding or leaking of fluid. Reports active fetal movement. Pt had a blood pressure of 154/84 at 10 wks GA booking \n", + "input3": "+Dating by sure LMP\n+Labs: O pos/Ab neg/R-NI/GLT 84/\n+migraine HA\n+asthma\n+heart murmur echo normal (not in this preg)\n", + "input4": "non-contributory\n", + "input5": "GENERAL: NAD\nVITALS: T 97.9 po, BP 156/103-->153/104-->158/84 HR 78, RR 18\nHEART: RRR S1S2 II/VI systolic murmur midsternal\nLUNGS: CTA B\nABDOMEN: gravid, soft, nontender, no CVAT\nEXTREMITIES: - edema B\nEFM: 125 ___ accels, no decels, Av, reactive \nTA U/S: BPP ___, vtx, fetal cardiac motion\nTOCO: occ ctx\nSVE: closed/40/soft sl post\n", + "input6": "___ WBC-11.6 RBC-4.08 Hgb-12.1 Hct-36.2 MCV-89 Plt-301\n___ WBC-10.4 RBC-3.96 Hgb-11.8 Hct-35.6 MCV-90 Plt-317\n___ PTT-25.4 Creat-0.9 ALT-15 AST-17 UricAcd-5.5\n___ Creat-0.8 ALT-14 AST-19 UricAcd-5.7\n___ URINE Hrs-RAN Cre-124 TProt-12 Pr/Cr-0.1\n___ URINE pH-6 Hrs-24 Vol-3000 Cre-54 TProt-8 Pr/Cr-0.1\n___ URINE 24Creat-1620 24Prot-___ y/o G1 at 35 wks with gestational \n\nSHe has a blood pressures were elevated in triage, 150s/80-100. She denied any preeclampsia symptoms.___ WBC-11.6 RBC-4.08 Hgb-12.1 Hct-36.2 MCV-89 Plt-301\n___ WBC-10.4 RBC-3.96 Hgb-11.8 Hct-35.6 MCV-90 Plt-317\n___ PTT-25.4 Creat-0.9 ALT-15 AST-17 UricAcd-5.5\n___ Creat-0.8 ALT-14 AST-19 UricAcd-5.7\n___ URINE Hrs-RAN Cre-124 TProt-12 Pr/Cr-0.1\n___ URINE pH-6 Hrs-24 Vol-3000 Cre-54 TProt-8 Pr/Cr-0.1\n___ URINE 24Creat-1620 24Prot-___ y/o G1 at 35 wks with gestational \n\nSHe has a blood pressures were elevated in triage, 150s/80-100. She denied any preeclampsia symptoms.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/15706386-DS-10.json b/Finished/Hypertension/15706386-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..82a93b5215d496288497fb0de3e250905d1425ae --- /dev/null +++ b/Finished/Hypertension/15706386-DS-10.json @@ -0,0 +1,36 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "VSS:142/88$Input5": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "Initial vitals on presentation were 179/116$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "BP 220/100s at home$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.***$Cause_1": { + "Vitals at the time of admission were BP 180/125$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "Headache$Input1": {} + }, + "Family history is a big risk factor of Hypertension.$Cause_1": { + "Father with hypertension$Input4": {} + }, + "Vomiting is a symptoms of Hypertension.$Cause_1": { + "episode of vomiting$Input2": {} + }, + "Labetabol is a type of hypotensive drug,indicates that the patient may have Hypertension,which is a risk factor.$Cause_1": { + "Patient received labetolol for 100 mg.$Input2": {} + } + } + }, + "input1": "Headache\n", + "input2": "60 yo female c/ h/o HTN and anxiety who presented to ED c/ CP and headache. The CP woke her up at 2 AM; it was sharp in the middle clavicular line 6th rib in a small location. It did not radiate anywhere and was in intensity, she denies SOB, cough, fever, chills. The pain increased with breathing movements. She had headache that started in the front of her head and spread to her whole head and neck. She had episode of vomiting yesterday and reports vomiting her medications. She also notes she has been very anxious as son is in jail and parole hearing was yesterday. She notes she consistently has high blood pressure, often c/ BP 220/100s at home. She reports she is compliant with her medications and has not missed doses. \n\nED Course: Initial vitals on presentation were 98.6 88 179/116 16 98% RA. Patient was admitted to ED obs for cardiac rule out, had two negative sets of cardiac enzymes and a negative stress test. Patient received 40 mg propranolol, 25 mg HCTZ, and labetolol 100 mg for elevated BP yesterday. Today she received 60 mg diltiazem and 25 mg of HCTZ with continued elevation of her BP. She had persistent headache despite toradol 30 mg x2. CT of the head was negative. She was then admitted for persistent elevated BP and headache. Vitals at the time of admission were BP 180/125 and HR 78. \n\nCurrently, she denies CP or SOB. She reports a frontal headache radiating to the back of her head and neck. She denies fevers or chills. Denies history of migraines.\n", + "input3": "+HCV\n+Hypothyroidism\n+h/o pneumonia\n+MR/CHF - in the setting of pneumonia \n+Preeclampsia \n+Anxiety \n+h/o Kidney stones \n+s/p C-section \n+Chronic pain secondary to bilateral foot deformities.\n+s/p removal of left breast cysts \n+left neck cyst removal \n+anemia\n", + "input4": "Mother with hypothyroidism. Father with hypertension and alcoholism. Grandfather with jaw cancer. No known family history of liver disease.\n", + "input5": "VSS:99.1 98.0 142/88 67 97% RA\nGen: NAD, laying comfortably in bed\nHEENT: EOMI, MMM, neck supple\nCV: RRR, no m/r/g\nResp: CTAB\nAbd: S/NT/ND + BS\nExt: no c/c/e, wwp\nNeuro: alert and appropriate\nSkin: wwp\n", + "input6": "___ 11:40PM URINE BLOOD-TR NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-4* PH-6.5 LEUK-TR\n___ 11:40PM URINE ___ BACTERIA-NONE YEAST-NONE \n___ 09:40PM CK(CPK)-66\n___ 09:40PM cTropnT-<0.01\n___ 09:40PM TSH-0.38\n___ 03:10PM GLUCOSE-83 UREA N-9 CREAT-0.9 SODIUM-141 POTASSIUM-4.4 CHLORIDE-106 TOTAL CO2-28 ANION GAP-11\n___ 03:10PM CK(CPK)-79\n___ 03:10PM cTropnT-<0.01\n___ 03:10PM ASA-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 03:10PM WBC-8.8# RBC-4.69 HGB-13.4 HCT-39.8 MCV-85 MCH-28.5 MCHC-33.6 RDW-13.5\n___ 03:10PM NEUTS-73.7* ___ MONOS-3.7 EOS-2.0 BASOS-0.4\n___ 03:10PM PLT COUNT-341\n___ 03:10PM ___ PTT-27.6 ___\n___ 03:10PM ASA-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/15874317-DS-28.json b/Finished/Hypertension/15874317-DS-28.json new file mode 100644 index 0000000000000000000000000000000000000000..b08acdaae26e73d5c83b87044f7ffbb5f19eae52 --- /dev/null +++ b/Finished/Hypertension/15874317-DS-28.json @@ -0,0 +1,31 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "BP 191/65$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "blood pressure again increased to 200/85$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "BP 158/67$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "BP 191/65$Input2": {}, + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "headache$Input1": {} + }, + "Irregular heartbeat is a symptoms of Hypertension.$Cause_1": { + "paroxysmal atrial fibrillation$Input2": {} + }, + "Nausea and blurry vision is a symptoms of Hypertension.$Cause_1": { + "she was feeling generally nuasea, and had blurry vision$Input2": {} + } + } + }, + "input1": "headache\n", + "input2": "Female with medical problems including , paroxysmal atrial fibrillation, and tachy/brady syndrome s/p ppm was admitted with hypertensive urgency. \n\nThen on the morning of admission she was feeling generally fatigued, weak, nuasea, and had blurry vision. She took her blood pressure several times, and it was elevated to 202-206. She called her PCP who recommended that she restart her norvasc and go to the ED.\n\nUpon arrival in the ED, temp 98.2, HR 61, BP 191/65, RR 15, and pulse ox 100% on room air. Her blood pressure again increased to 200/85, and she was given diltiazem 10mg IV x 1 with improvement in systolic blood pressure to 170. Her exam was unremarkable. Labs were notable for creatinine 1.2, Hct 32.5, and INR 1.8. CXR was unremarkable. She received aspirin 324mg PO x 1 and diltiazem 10mg IV x 1. \n\nReview of systems: \n(+) Per HPI. blurred vision, shortness of breath, fatigue, nausea\n", + "input3": "+Paroxysmal atrial fibrillation \n+Dyslipidemia\n+Tachy/brady s/p PPM ___ (syncopal episodes)\n+Osteoporosis \n+GERD \n+Chronic Renal Failure \n+Baseline Cr 1.2-1.3\n+Obstructive sleep apnea\n+has a CPAP mask but thinks it is not working properly; has not used in the last month \n+Tricuspid regurgitation\n", + "input4": "Father - died of pancreatic CA\nMother - died of \"heart disease\"\n", + "input5": "T 96.6 / BP 158/67 / HR 60 / RR 20 / pulse ox 95% on room air / \nWeight 184 lbs\nGen: no acute distress, resting comfortably, appearing younger than stated ago, very pleasant\nHEENT: Clear OP, MMM\nNECK: Supple, No LAD, No JVD\nCV: RR, NL rate. NL S1, S2. No murmurs, rubs or gallops, pacemaker site without swelling, erythema, or tenderness\nLUNGS: CTA, BS ___, No W/R/C\nABD: Soft, NT, ND. NL BS. No HSM\nEXT: No edema. \nSKIN: No lesions\nNEURO: A&Ox3. Appropriate. CN intact with the exception of surgical pupils after cataract surgery. Preserved sensation throughout. Normal coordination. Gait assessment deferred\nPSYCH: Listens and responds to questions appropriately, pleasant\n", + "input6": "no leukocytosis\nhgb ___ MCV 79\nplt 269\nINR 2.0\nCreat ___ baseline\nTrop <0.01 X2\n\nUA - negative.\nImaging/results: \n___ CXR - nothing acute\n___ ECG - a paced at ~60bpm, normal axis, normal intervals, \n1mm STE in V2 (unchanged from prior\uff09\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/16543302-DS-6.json b/Finished/Hypertension/16543302-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..e3b5b69a685f90766037b016eb00ebd5f70ca7c1 --- /dev/null +++ b/Finished/Hypertension/16543302-DS-6.json @@ -0,0 +1,27 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "VS:140/96$Input5": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "States BP at home today 188/90$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "headache$Input1": {} + }, + "Elderly age is an important risk factor for Hypertension,and female have a higher risk.$Cause_1": { + "55 yo Female$Input2": {} + }, + "Family history is a big factor of Hypertension.$Cause_1": { + "The patient's mother has history of hypertension.$Input4": {} + } + } + }, + "input1": "headache\n", + "input2": "This is a 55 yo Female .She presents with 2 wks of worsening HA and general malaise. The HA is bifrontal and relatively constant but improves sometimes with lying down. No photophobia, no fevers, no neck stiffness. No focal weakness, numbness, blurry vision or slurred speech. Also noted on episode of L sided CP, described as \"sticking\" and worse with inhalation. No associated SOB, N/V, diaphoresis, radiation. The patient states that she did not like to take her blood pressure medications because she did not want to be \"one of those people who need to take pills everyday\". She was trying many different herbal remedies instead.States BP at home today 188/90 \n", + "input3": "None\n", + "input4": "The patient's mother is alive and well, has history of hypertension. Father alive and well without known medical illnesses. The patient has multiple siblings, a few of whom have been noted to have borderline elevated blood pressure.\n", + "input5": "VS: 97.9, 69, 140/96, 98% RA \nGen: NAD \nHEENT: NCAT, EOMI, PERRL. Anicteric, no conjunctival pallor. OP clear, MMM. \nNeck: No JVD, no LAD \nCor: RRR no m/r/g \nPulm: CTAB no w/r/r \nAbd: soft +BS, NT/ND, No HSM \nExtrem: no c/c/e \nSkin: no rashes \nNeuro: CN II-XII in tact bilaterally. Strength is in upper and lower extremities and sensation to LT is in tact bilaterally. No tremor/asterixis. A&Ox3. Gait deferred.\n", + "input6": "___ 06:20PM BLOOD WBC-5.7 RBC-4.37 Hgb-14.4 Hct-40.3 MCV-92 MCH-33.0* MCHC-35.7* RDW-13.1 Plt ___\n___ 06:20PM BLOOD Neuts-51.6 ___ Monos-4.7 Eos-1.7 Baso-0.4\n___ 07:25AM BLOOD Glucose-102 UreaN-13 Creat-1.0 Na-141 K-4.3 Cl-104 HCO3-32 AnGap-9\n___ 07:25AM BLOOD CK(CPK)-91\n___ 06:20PM BLOOD CK(CPK)-134\n___ 07:25AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 06:20PM BLOOD cTropnT-<0.01\n___ 07:25AM BLOOD Calcium-9.5 Phos-5.3* Mg-2.1 U/A NEG\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/16617903-DS-15.json b/Finished/Hypertension/16617903-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..cc30b2cd52419fedd5f2e5e1196ad7fb1f99fe04 --- /dev/null +++ b/Finished/Hypertension/16617903-DS-15.json @@ -0,0 +1,33 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "blood pressures were 160s/100$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "remained elevated at 151/103$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "BP 188/92$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "Headache$Input1": {} + }, + "Blurry vision is a classic symptoms of Hypertension.$Cause_1": { + "blurry vision$Input1": {} + }, + "Labetabol is a type of hypotensive drug,indicates that the patient may have Hypertension,which is a risk factor.$Cause_1": { + "received 60 mg Labetalol$Input2": {} + }, + "Hydralazine is a type of hypotensive drug,indicates that the patient may have Hypertension,which is a risk factor.$Cause_1": { + "received Hydralazine 10 mg$Input2": {} + } + } + }, + "input1": "Headache, blurry vision\n", + "input2": "61 year old Gravida 4 Para 3 post partum day #4 status-post spontaneous vaginal delivert presents with headache and blurry vision. She reports she developed a headache yesterday which did not respond to Motrin so she took her blood pressure at home. She presented to given that it was close her home. There her blood pressures were 160s/100 and she received 60 mg Labetalol IV. She had an episode of blurry vision in the ED where she saw \"spots\" but the visual changes resolved spontaneously. Per report her labs including hematocrit, creatinine and liver function tests were within normal limits at the outside hospital ED. She was transferred to ED.\n\nHere her blood pressures remained elevated at 151/103 and she received Hydralazine 10 mg IV x 1 with good effect and her blood pressures improved to140/90s. She was started on Magnesium with a 2 gram bolus and she was transferred to L&D for further management. \n\nHere, she continues to have a mild headache but has not had any NSAIDs or Tylenol. The blurry vision has resolved. She denies CP,SOB, RUQ pain.\n\nShe is s/p SVD. Her blood pressure at the time of deliverywere in the 140s/80s and a P:C ratio was 0.3. Her labs were otherwise normal and she denied symptoms of PEC at that time. \n", + "input3": "-History of anxiety - used zoloft after pregnancy, no meds currently\n-History of hiatal hernia/reflux\n", + "input4": "None\n", + "input5": "Admission Physical Exam:\nNo acute distress\nClear to auscultation bilaterally \nRegular rate and rhythm\nAbdomen soft\nDTR +2\nVSS:BP 188/92\n", + "input6": "CBC:\n___ 07:50PM BLOOD WBC-7.9 RBC-4.13* Hgb-13.3 Hct-38.4 MCV-93 MCH-32.1* MCHC-34.6 RDW-13.1\nCoags: \n___ 07:50PM BLOOD ___ PTT-26.2 ___\nChemistry: \n___ 07:50PM BLOOD Glucose-95 UreaN-14 Creat-0.7 Na-142 K-3.9 Cl-106 HCO3-22 AnGap-18\nLFT: \n___ 07:50PM BLOOD ALT-39 AST-28 AlkPhos-172* TotBili-0.3\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/17035408-DS-19.json b/Finished/Hypertension/17035408-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..65e960c2f10916e50d7afbab792ba1fa5a939cac --- /dev/null +++ b/Finished/Hypertension/17035408-DS-19.json @@ -0,0 +1,36 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "SBP 200$Input1": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "initial vitals were BP 262/75$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "VS: BP=148/99$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Elderly age is an important risk factor for Hypertension,and female have a higher risk.$Cause_1": { + "52 y/o lady$Input2": {} + }, + "Family history is a big risk factor of Hypertension.$Cause_1": { + "+Diabetes$Input3": {} + }, + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "headache$Input2": {} + }, + "Clonidine is a type of hypotensive drug,indicates that the patient may have Hypertension,which is a risk factor.$Cause_1": { + "received clonidine 0.1 mg oral$Input2": {} + }, + "Family history of cardiovascular disease is a big risk factor of Hypertension.$Cause_1": { + "Father and Brother died of MI.$Input4": {} + } + } + }, + "input1": "SBP 200\n", + "input2": "52 y/o lady with CAD s/p CABG, DM2, dyslipidemia, and PVD went to her dermatology out patient appointment today. She was found to have elevated SBP to 200s. She was sent to the ED. \n\nPatient denies any chest pain, SOB, palpiations, PND, orthopnea, nausea, vomitting, abd pain, diarrhea, constipation, fever, chills, nightsweats, cough, cold or dysuria. Patient had mild headache this AM which worsened with nitro drip in ED and resolved with tylenol. She denies any new change in vision, hearing, dizziness, lightheadedness, weakness, or change in sensation. Her functional status is limited by chronic back pain.\n\nIn the ED, initial vitals were T 97.9 BP 262/75 RR 18 96% in RA. Patient was intially placed on nitro paste which was quickly switched to nitro gtt. Patient also received clonidine 0.1 mg oral, ASA 325 mg.\n", + "input3": "+Diabetes\n+Dyslipidemia\n+PVD\n+glaucoma, cataracts\n+herniated disc\n+eczema\n+GERD\n+diverticulitis\n+varicose veins\n", + "input4": "Father died of MI. Brother died of MI.\n", + "input5": "VS: T=98.3 BP=148/99 HR=51 RR=18 O2 sat=95% RA \nGENERAL: Pleasant lady in NAD. Mood, affect appropriate. Following commands\nHEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNECK: JVP not elevated\nCARDIAC: normal S1, S2. No m/r/g. \nLUNGS: Bibasilar crackles \nABDOMEN: Soft, NTND. \nEXTREMITIES: WWP, trace edema \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nNEURO: CN II-XII grossly intact, sensation is intact, strength b/l\n", + "input6": "CXR PA/Lat ___:\nCardiomegaly with eventration of the posterior aspect of the left hemidiaphragm. No acute pulmonary process. \n\nNSR, rate ___, nl axis, IVCD, prolonged PR, LVH, left atrial abnormality.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/17604315-DS-9.json b/Finished/Hypertension/17604315-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..9e5c4d5d602f0622c61ab044b678029d50521ef0 --- /dev/null +++ b/Finished/Hypertension/17604315-DS-9.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "States BP at home 177/80.$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "VITALS:BP 168/87$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Elderly age is an important risk factor for Hypertension,and female have a higher risk.$Cause_1": { + "56 year old woman$Input2": {} + }, + "Family history of cardiovascular disease is a big risk factor of Hypertension.$Cause_1": { + "Her father died withan MI.$Input4": {} + } + } + }, + "input1": "Post-TACE Admission\n\n", + "input2": "Ms. is a 56 year old woman with history of HLD and prior right hepatectomy, now with multifocal HCC s/p multiple TACE procedure for liver lesions admitted for post-TACE monitoring. \n\nToday, she underwent TACE to segment 4A via left radial approach.Of note her last TACE procedure prior to this one. She tolerated that one well.\n\nOn evaluation, she reports she is feeling great after her procedure and that she has no current complaints. States BP at home 177/80. Of note her first two post-tace procedures were complicated by flu-like symptoms, confusion, lethargy, fatigue, dyspnea. Her recent ones have been much smoother.\n\nROS: Pertinent positives and negatives as noted in the HPI. All other systems were reviewed and are negative.\n", + "input3": "+Hepatocellular carcinoma as above.\n+Hyperlipidemia.\n+History of colonic polyps.\n+Left-sided sciatica.\n+Osteopenia.\n+Mitral valve prolapse.\n", + "input4": "The patient's mother was diagnosed with breast cancer. Her sister with breast cancer. Her father died with TB and an MI. She has one daughter without health concerns.\n", + "input5": "VITALS:T 36.7 BP 168/87\nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. \nOropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur, no S3, no S4. No JVD.\nRESP: Lungs clear to auscultation with good air movementbilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowelsounds present. No HSM\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full and symmetric bilaterally in all limbs, Left wrist with good pulses and no evidence of hematoma.\nSKIN: Scar around RUQ from prior surgery\nNEURO: Alert, oriented, face symmetric, gaze conjugate with EOMI, speech fluent, moves all limbs, sensation to light touch grossly intact throughout\nPSYCH: pleasant, appropriate affect\n", + "input6": "___ 07:05PM BLOOD WBC-4.3 RBC-4.22 Hgb-13.3 Hct-40.6 MCV-96 MCH-31.5 MCHC-32.8 RDW-14.7 RDWSD-52.0* Plt ___\n___ 07:30AM BLOOD ALT-49* AST-85* AlkPhos-540* TotBili-0.7\n___ 07:30AM BLOOD AFP-4.9\n___ 07:05PM BLOOD Calcium-8.4 Phos-4.0 Mg-1.8\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/17665357-DS-3.json b/Finished/Hypertension/17665357-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..6cb26c3c4c795b94a48f7793935c9525bf5d4577 --- /dev/null +++ b/Finished/Hypertension/17665357-DS-3.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "BP: 152/75, 137/86 -> 20 IV hydral -> 139/81$Input5": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "BP was 158/77$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Chest pain is a symptoms of Hypertension.$Cause_1": { + "chest pain$Input1": {} + }, + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "headache$Input1": {} + } + } + }, + "input1": "postpartum day 9 chest pain, SOB, headache\n", + "input2": "35 yo female with s/p uncomplicated term SVD presented on PPD#9 to the ED from PCP office with 4 days of chest pain, increasing pleuritic SOB and with exertion, orthopnea, and headache. Chest pain of gradual onset, central, nonradiating, different from GERD. BP was 158/77 in the ED. Headache started at base of her neck, has wrapped around forehead in band-like distribution. No vision changes, RUQ or epigastric pain. Bleeding minimal. ROS positive for increasing bilateral lower extremity swelling over past few days.\n", + "input3": "OBHx: G6P2, term SVD, SAB x2, TAB x2. most recent pregnancy uncomplicated. no HTN in prenatal or L&D records. \nGynHx: abnl Pap h/o with normal colpo, neg since, D&C x2\nPMH: GERD, Migraine, angiolipoma of right leg. no known history of HTN. history of bronchitis.\nPSH: Angiolipoma removal right lower extremity x 4, D&C x2\nMeds: motrin & tylenol prn \nAll: Latex, Shellfish\n", + "input4": "noncontributory\n", + "input5": "BP: 152/75, 137/86 -> 20 IV hydral -> 139/81\nHR: 60, RR 18, temp 98.2, 98% RA\nNAD: no increased work of breathing but slightly tachypneic\nCV: regular rate and rhythm\nPULM: lungs CTAB, no crackles appreciated, good air movement\nAbd: soft, gravid, mild epigastric TTP, fundus below umbilicus\next: lower extremities with 2+ pitting edema, no erythema orappreciable cords, symmetric\n", + "input6": "___ 07:25AM BLOOD WBC-7.7 RBC-3.60* Hgb-10.4* Hct-30.1* MCV-84 MCH-28.9 MCHC-34.7 RDW-14.6 \n___ 06:12PM BLOOD WBC-8.5 RBC-3.89* Hgb-10.7* Hct-32.7* MCV-84 MCH-27.5 MCHC-32.7 RDW-14.4 Plt ___\n___ 07:25AM BLOOD Glucose-83 UreaN-10 Creat-0.8 Na-140 K-4.4 Cl-108 HCO3-24 AnGap-12\n___ 06:12PM BLOOD Glucose-87 UreaN-12 Creat-0.8 Na-143 K-4.0 Cl-109* HCO3-24 AnGap-14\n___ 06:12PM BLOOD ALT-23 AST-23 AlkPhos-111* TotBili-0.2\n___ 06:12PM BLOOD proBNP-801*\n___ 06:12PM BLOOD cTropnT-<0.01\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/17960078-DS-62.json b/Finished/Hypertension/17960078-DS-62.json new file mode 100644 index 0000000000000000000000000000000000000000..7d184b9f1ef3d54c2467a22ab2978993f7afc25c --- /dev/null +++ b/Finished/Hypertension/17960078-DS-62.json @@ -0,0 +1,39 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "her BP was reaching the 200s$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "Initial vital in ED was BP 172/80$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "BP was highly variable in the ED, ranging from SBP 150s-200s$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.***$Cause_1": { + "Vitals prior to floor transfer was BP 174/70$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.****$Cause_1": { + "VS:BP 190/77$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Chest pain is a symptoms of Hypertension.$Cause_1": { + "chest pain$Input1": {} + }, + "Elderly age is an important risk factor for Hypertension,and female have a higher risk.$Cause_1": { + "a 55 year old female$Input2": {} + }, + "Losartan is a type of hypotensive drug,indicates that the patient may have Hypertension,which is a risk factor.$Cause_1": { + "self medicates with Losartan$Input2": {} + }, + "Family history of cardiovascular disease is a big risk factor of Hypertension.$Cause_1": { + "Son and mother with \"heart problems\"$Input4": {} + } + } + }, + "input1": "chest pain\n", + "input2": "The patient is a 55 year old female with nonobstructive CAD, PVD, atrial fibrillation not on Warfarin, tachy-brady syndrome s/p PPM placement, hypertension, hypothyroidism, hyponatremia thought to be from primary polydipsia, and recurrent UTIs who presented to the ED ,left sided chest pain radiating to the neck, and suprapubic discomfort. \n\nShe closely monitors her BP at home and self medicates with varying doses of Losartan between zero and four tabs daily. She reports that her BP was more elevated than usual this morning and kept increasing despite her taking multiple doses of Losartan, reaching the 200s in the evening. She felt somewhat lightheaded and developed pain in the left side of her chest and neck. She denied any headache, vision changes, hearing changes, muscle weakness, facial droop, difficulty speaking, or new paresthesias. She was concerned that her elevated BP might cause a stroke and impact her ability to live by herself. She has recently been treated with Macrobid for a UTI, and still has some suprapubic discomfort. She has been drinking lots of water to help flush out her bladder. Given her symptoms, her home health aide encouraged her to come in to the ED for evaluation. \n\nInitial vitals in ED triage were T 99.2, HR 78, BP 172/80, RR 16, and SpO2 97% on 3L. Her BP was highly variable in the ED, ranging from SBP 150s-200s. CBC showed normocytic anemia with Hct 34.1 (similar to baseline), normal WBC and platelet counts, and unremarkable diff. Chemistry panel showed hyponatremia with Na 130 similar to several prior presentations and creatinine 0.9 (at baseline). Dilantin level was 11.4 within normal limits. Initial Troponin was negative. EKG reportedly showed sinus rhythm at 69 bpm with LAD and LBBB, unchanged from prior. CXR showed no acute process with official read pending. Her UA showed WBC 41 and few bacteria, improved fwhen she had urinalysis with WBC >182. \n\nShe complained of nausea in the ED and was given Ondansetron 4 mg IV with good effect. She was given Diphenhydramine 25 mg PO once for unclear reasons. She was given Macrobid PO for ongoing UTI treatment. She was admitted to Cardiology for further management of hypertension and chest pain. Vitals prior to floor transfer were T 98 po, HR 62, BP 174/70, RR 16, and SpO2 100% on RA. On reaching the floor, she reported feeling much better and denied any chest pain, neck pain, SOB, headache, or new neurological symptoms.\n", + "input3": "+Osteopenia \n+Migraines \n+Colon Adenoma \n+Hysterectomy \n+more than 9 cardiac catherizations \n+Seizure Disorder -- on Phenytoin \n+Chronic Small Vessel Infarcts \n+Anxiety / Personality Disorder \n+Spinal stenosis and Lumbar Degenerative Disease \n+Peripheral Neuropathy -- on Gabapentin \n+Chronic Rhinitis \n+Chronic Cystitis\n", + "input4": "Son and mother with \"heart problems\"\n", + "input5": "VS: T 97.2, BP 190/77, HR 68, RR 16, SpO2 97% on RA \nGen: Elderly female in NAD. Oriented x3. \nHEENT: Sclera anicteric. PERRL, EOMI. MMM, OP benign. \nNeck: JVP not elevated. No cervical lymphadenopathy. \nCV: RRR with normal S1, S2. No M/R/G appreciated. \nChest: CTAB without crackles, wheezes or rhonchi. \nAbd: Normal bowel sounds. Soft, NT, ND. \nExt: WWP. No C/C/E. Radial pulses 2+ and symmetric. Pedal pulses DP 1+, ___ 1+ bilaterally. \nNeuro: CN II-XII grossly intact. Strength in all extremities, but gives way slightly on left arm. No pronator drift. No cerebellar signs. Normal speech.\n", + "input6": "___ 06:00AM GLUCOSE-103* UREA N-17 CREAT-0.9 SODIUM-132* POTASSIUM-4.3 CHLORIDE-94* TOTAL CO2-30 ANION GAP-12\n___ 06:00AM ALT(SGPT)-25 AST(SGOT)-26 LD(LDH)-149 CK(CPK)-57 ALK PHOS-119* TOT BILI-0.1\n___ 06:00AM CK-MB-2 cTropnT-<0.01\n___ 06:00AM ALBUMIN-3.8 CALCIUM-9.1 PHOSPHATE-3.3 MAGNESIUM-2.2\n___ 06:00AM WBC-5.5 RBC-3.74* HGB-10.7* HCT-32.5* MCV-87 MCH-28.5 MCHC-32.9 RDW-15.7*\n___ 06:00AM PLT COUNT-317\n___ 06:00AM ___ PTT-25.5 ___\n___ 04:54AM URINE HOURS-RANDOM UREA N-275 CREAT-30 SODIUM-49 POTASSIUM-36 CHLORIDE-43\n___ 04:54AM URINE OSMOLAL-273\n___ 11:00PM URINE COLOR-Straw APPEAR-Hazy SP ___\n___ 11:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-LG\n___ 11:00PM URINE RBC-1 WBC-41* BACTERIA-FEW YEAST-NONE EPI-2\n___ 11:00PM URINE HYALINE-3*\n___ 11:00PM URINE MUCOUS-RARE\n___ 09:00PM GLUCOSE-124* UREA N-19 CREAT-0.9 SODIUM-130* POTASSIUM-4.6 CHLORIDE-92* TOTAL CO2-25 ANION GAP-18\n___ 09:00PM estGFR-Using this\n___ 09:00PM CK(CPK)-59\n___ 09:00PM cTropnT-<0.01\n___ 09:00PM CK-MB-2\n___ 09:00PM OSMOLAL-266*\n___ 09:00PM TSH-20*\n___ 09:00PM FREE T4-0.65*\n___ 09:00PM PHENYTOIN-11.4\n___ 09:00PM WBC-4.6 RBC-3.96* HGB-11.2* HCT-34.1* MCV-86 MCH-28.4 MCHC-32.9 RDW-15.9*\n___ 09:00PM NEUTS-70.9* ___ MONOS-4.9 EOS-3.7 BASOS-0.4\n___ 09:00PM PLT COUNT-278\n\nEKG no changes from prior\n\nCXR ___: No acute cardiothoracic process.\nUCx ___: fecal contamination\nUCx ___: pending at DC, NGTD x 2d\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/18026938-DS-17.json b/Finished/Hypertension/18026938-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..6e03aee4bdc3e590f7a2f5b9523ccb13c2a2b71f --- /dev/null +++ b/Finished/Hypertension/18026938-DS-17.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "ED VS BP 150/87$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "VS- BP 152/105 (134-152/86-105)$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Chest pain is a symptoms of Hypertension.$Cause_1": { + "Chest pain$Input1": {} + }, + "Family history of diabetes is a risk factor of Hypertension.$Cause_1": { + "positive DM in grandmother$Input4": {} + } + } + }, + "input1": "Chest pain\n", + "input2": "___ yo M with no significant medical hx but h/o stabbing injury in ___ presented today for chest pain. Per patient, it started while he was laying on his back. Sudden stabbing sharp pain in the mid-substernal area without radiation, also reported feeling heavy in his chest, \"like it is caving in.\" Associated with mild SOB and worsen with deep inspiration. Denies association with positional change. Denies palpitation, nausea/vomiting, diaphoresis, and radiation with this chest pain. Reports having had this before and was seen at ___ 1x at least ___ year ago, but is unable to provide much details about that incidence or what happened with the diagnosis. Reports not eating much for the last few days because of poor appetite. \n\nOf note, patient was arrested this AM for breaking into a car. He came into the hospital after arrest for this worsening chest pain when he was sitting in the cell. He was seen earlier in the day by Dr. ___. D-dimer is negative. EKG was normal. He was discharged. However, he returned again for chest pain. Patient reporting spitting up a teaspoon full of fresh blood with saliva in the ED. He was unable to elaborate on whether it was vomitus or cough. The repeat EKG showed J point elevation in V3 and V4. His vitals were stable, non-tachycardic or hypoxic. The ED sign-out actually mentioned that his CP started several weeks ago but got worse after being arrested today. ED VS T 98.2, BP 120/87, HR 80, RR 18, O2Sat 100% on RA. He received tylenol ___ mg, nitro SL, and morhpine.\n", + "input3": "history of stabbed wound in upper abdomen s/p lap\n", + "input4": "There is no family history of premature coronary artery disease or sudden death.\n- positive DM in grandmother\n", + "input5": "VS- T 97.2, BP 152/105 (134-152/86-105), HR 62 (62-75), RR 18 (___), O2Sat 98-100% RA \nGen: young lean male in NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. MMM\nNeck: Supple with JVP of 2 cm. no HJR.\nCV: PMI located in ___ intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. lower sternal discomfort is reproducible.\nChest: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nAbd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. epigastric discomfort is also reproducible.\nExt: No c/c/e. 2+ DP and ___ pulses bilaterally\nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.\n", + "input6": "- CBC: WBC-7.1 RBC-4.44* HGB-13.7*# HCT-42.1# MCV-95# MCH-30.8# MCHC-32.5 RDW-15.9* PLT COUNT-183 NEUTS-82.3* LYMPHS-11.5* MONOS-4.2 EOS-1.2 BASOS-0.7\n- BMP: GLUCOSE-69* UREA N-14 CREAT-0.8 SODIUM-142 POTASSIUM-4.6 CHLORIDE-101 TOTAL CO2-15*\n- cardiac enzymes @ 0405PM: CK(CPK)-574* CK-MB-5 cTropnT <0.01\n- cardiac enzymes @ 1120PM: CK(CPK)-435* CK-MB-5 cTropnT <0.01\n- coagulation: ___ PTT-27.0 ___\n- D-dimer: D-DIMER-217\n- Urine tox screen: bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG\n- serum tox screen: ASA-NEG ___ ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n- UA: COLOR-Yellow APPEAR-Clear SP ___ BLOOD-NEG NITRITE-NEG PROTEIN-30 GLUCOSE-NEG KETONE-150 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG RBC-0 WBC-0 BACTERIA NONE YEAST-NONE EPI-0\n\n___\n- Hct @ 0600: 35.8\n- Hct @ 0920: 36.9\n- BMP: Na 135, K 4.3, Cl 100, Bicarb 26, BUN 9, Crt 0.7, Glucose 79\n- Cardiac enzymes @ 0600: CK405, MB 4, cTropnT < 0.01\n- lipase 23\n\nImages & Procedures:\n___\n- CXR: The cardiomediastinal and hilar contours are normal. The lungs are well expanded and clear. The pleural surfaces are\nsmooth without pleural effusions or pneumothorax.\nIMPRESSION: No acute cardiopulmonary pathology detected.\n \n___\n- Echocardiogram: The left atrium and right atrium are normal in cavity size. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Transmitral and tissue Doppler imaging suggests normal diastolic function, and a normal left ventricular filling pressure (PCWP<12mmHg). 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) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \n\nIMPRESSION: Normal biventricular cavity sizes with preserved global and regional biventricular systolic function.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/18217759-DS-11.json b/Finished/Hypertension/18217759-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..227db84bb455ceb7de42bbc1e3978a9969a5c5c5 --- /dev/null +++ b/Finished/Hypertension/18217759-DS-11.json @@ -0,0 +1,21 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "State of BP at home was 151/93$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "VS:BP142/86$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Chest pain is a symptoms of Hypertension.$Cause_1": { + "mild chest pain$Input2": {} + } + } + }, + "input1": "Swelling, SOB\n", + "input2": "___ G1P1 PPD ___ s/p term SVD on ___ c/b chorio presents complaining of lower extremity edema and SOB. Between ___ discharge and today, pt reports experiencing increasing leg swelling (L>R), mild chest pain, and SOB. Awoke this morning with more significant SOB and was unable to breath well lying down. Also reports mild abdominal pain. Denies HA, vision changes, RUQ pain, leg pain.State of BP at home was 151/93.\n", + "input3": "OB Hx: G1P1, SVD at 39w6d, girl, c/b chorio\nGyn Hx: abnormal pap with normal follow-up, hx of chlamydia\nPMH: Multinodular goiter, migraines\nPSH: R thyoidectomy\n", + "input4": "Non-contributory\n", + "input5": "Exam on day of discharge: \nVS:T37.2 BP142/86\nGen: NAD, comfortable\nCV: RRR\nResp: CTAB\nAbd: soft, non-tender, fundus firm\nGU: minimal bleeding\nExt: non-tender, no edema\n", + "input6": "___ 08:50AM BLOOD WBC-4.9 RBC-2.70* Hgb-8.9* Hct-27.2* MCV-101* MCH-33.0* MCHC-32.7 RDW-14.1 RDWSD-52.3* Plt ___\n___ 02:03PM BLOOD WBC-5.1 RBC-2.81* Hgb-9.2* Hct-28.3* MCV-101* MCH-32.7* MCHC-32.5 RDW-14.0 RDWSD-52.2* Plt ___\n___ 08:50AM BLOOD Creat-0.6\n___ 02:03PM BLOOD Creat-0.5\n___ 08:50AM BLOOD ALT-38 AST-34\n___ 02:03PM BLOOD ALT-47* AST-50*\n___ 08:50AM BLOOD UricAcd-4.2\n___ 02:03PM BLOOD UricAcd-4.2\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/18528299-DS-9.json b/Finished/Hypertension/18528299-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..0e12bd8a40446cf3ab4c76ec6c49e1dff40e0b7b --- /dev/null +++ b/Finished/Hypertension/18528299-DS-9.json @@ -0,0 +1,27 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "initial vitals was 160/96$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "BP in AM was found to be 170/103$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "VS: 159/100$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Chest pain is a symptoms of Hypertension.$Cause_1": { + "Chest pain$Input1": {} + }, + "Diabetes is a srisk factor of Hypertension.$Cause_1": { + "Diabetes$Input3": {} + } + } + }, + "input1": "Chest pain\n", + "input2": "On the day prior to admission, patient called his cardiologist's office and complained of feeling unwell for several weeks w/ URI and SOB sx. He had seen his PCP recently who had been actively working up his symptoms and had requested EKG, chest and leg CTA, and PFTs done at ___ which were all normal. He continues to feel malaise and fatigue and recently noticed intermittent left sided chest tightness that does not seem to be particularly exertional, is sometimes associated with shortness of breath. It occasionally occurs at rest. He denies lightheadedness, dizziness or palpitations. His cardiologist's office reccommended taking ASA 325 and to present to the ED if symptoms worsened or persisted. \n\nIn the ED, initial vitals were 0 97 85 160/96 18 97%RA. An EKG showed NSR at 74, no sig change from prior, no ischemic changes. Trops were negative x3 and CBC, Chem10 unremarkable. The plan was to complete a simple stress test on ___ AM and discharge from ED if negative, however, BP in AM was found to be 170/103 and his stress test was cancelled. He was admitted to the floor for blood pressure control and stress test ___ AM.\n \nOn review of systems, he denies any prior history of stroke, TIA, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. He denies recent fevers, chills or rigors. He denies exertional buttock or calf pain. All of the other review of systems were negative.\n", + "input3": "Diabetes, \n+Dyslipidemia,\n", + "input4": "Mother deceased at age ___ of an MI, and maternal grandfather also deceased at age ___ of an MI.\n", + "input5": "VS: 97.7, 159/100, 82, 20, 99RA \nGeneral: WDWN M in NAD, resting in bed, appears anxious, fast speech at baseline\nHEENT: dilated pupils (at baseline per patient), OP clear, MMM \n\nNeck: supple, no JVD \nCV: RRR, no m/r/g\nLungs: CTAB, no increased work of breathing, no wheezes, rales, rhonchi\nAbdomen: soft, NTND \nGU: no foley\nExt: No peripheral edema, warm, well perfused, 2+ bilateral \nradial, ___\nNeuro: moves all extremities, ___ strength in bilateral upper and lower extremities\nSkin: c/d/i, no rashes\n", + "input6": "___ 01:00PM BLOOD WBC-7.2 RBC-4.31* Hgb-15.0 Hct-42.5 \nMCV-99* MCH-34.8* MCHC-35.2* RDW-12.9 Plt ___\n___ 01:00PM BLOOD Neuts-73.7* ___ Monos-5.0 Eos-1.7 \nBaso-1.5\n___ 01:00PM BLOOD Glucose-99 UreaN-9 Creat-1.0 Na-142 K-4.3 \nCl-104 HCO3-27 AnGap-15\n\nTREND LABS:\n\n___ 01:00PM BLOOD cTropnT-<0.01\n___ 05:42PM BLOOD cTropnT-<0.01\n___ 11:45PM BLOOD cTropnT-<0.01\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/18732758-DS-3.json b/Finished/Hypertension/18732758-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..53ada1d4258a3443ee13430a6a361f76a17c8705 --- /dev/null +++ b/Finished/Hypertension/18732758-DS-3.json @@ -0,0 +1,30 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "BP at home was 150/88.$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "VS:BP175/102$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptom of Hypertension.$Cause_1": { + "Headache$Input1": {} + }, + "Blurry vision is a classic symptom of Hypertension.$Cause_1": { + "blurry vision$Input1": {} + }, + "Diabetes is a big risk factor of Hypertension.$Cause_1": { + "Type II Diabetes$Input3": {} + }, + "Family history of cardiovascular disease is a risk factor of Hypertension.$Cause_1": { + "Father passed away from CVD later in life.$Input4": {} + } + } + }, + "input1": "Headache,blurry vision\n", + "input2": "___ PMH cluster headaches, migraines, head injury and heavy etoh use who presents with multiple episodes of numbness.\n\nApproximately 6 months ago, the patient noticed numbness in his left ___ and ___ digit and medial forearm, particularly when driving. Approximately a month after that, he had similar symptoms on the other side. About 5 days ago, he started having episodes where he would first have numbness in his right medial arm that then progressed over seconds to his right face that was accompanied by a headache. He describes the headache as retro-orbital throbbing pain, and his symptoms typically resolve after 5 minutes, or after he takes ibuprofen. When he has the facial numbness, he sometimes feels \"delirious\", which he describes as light-headedness or feeling like he is going to pass out, but denies vertigo.State of BP at home was 150/88. He denies any photo/phonophobia, speech difficulties, dysarthria. He denies any nausea, weakness, gait difficulties. The episodes can happen when he is sitting, standing or laying down. He had an episode while driving today so he decided to get evaluated.\n", + "input3": "Cluster Headaches\nMigraines\nTBI\nType II Diabetes\n", + "input4": "Brother with seizures as a child. No migraines in the family.\nFather passed away from CVD later in life.\n", + "input5": "VS:T36.8 BP175/102 RR18\nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT. No scleral icterus noted. MMM. No lesions noted in oropharynx.\nCardiac: Well perfused. \nPulmonary: Breathing comfortably on room air.\nAbdomen: obese \nExtremities: No cyanosis, clubbing, or edema bilaterally.\nSkin: No rashes or other lesions noted.\n\nNEUROLOGIC EXAM:\nMental Status: Alert, oriented x 3. Makes minimal eye contact.\nAble to relate history without difficulty. Attentive; Language \nis fluent with intact repetition and comprehension. Normal prosody. There are no paraphasic errors. Speech is not dysarthric. Able to follow both midline and appendicular commands.\n\nCranial Nerves:\n I: Olfaction not tested.\n II: PERRL 3 to 2mm and brisk. VFF to confrontation and no\nextinction. \n III, IV, VI: EOMI without nystagmus. Normal saccades.\n V: Facial sensation intact to light touch.\n VII: No facial droop, facial musculature symmetric.\n VIII: Hearing grossly intact to speech.\n IX, X: Palate elevates symmetrically.\n XI: ___ strength in trapezii and SCM bilaterally.\n XII: Tongue protrudes in midline and equal strength \nbilaterally.\n\n-Motor: Normal bulk, tone throughout. \n Delt Bic Tri WrE FFl FE IP Quad Ham TA ___\n L 5 ___ ___ 5 5 5 5 5 5\n R 5 ___ ___ 5 5 5 5 5 5\n\n-Sensory: Decreased sensation to gross touch and temp in\nhypothenar eminence and lateral ___ and ___ digit on the right, and on the hypothenar eminence on the left. Decreased\nproprioception to small and medium movements at great toes b/l.\n", + "input6": "___ 06:58AM BLOOD WBC-5.4 RBC-4.39* Hgb-13.8 Hct-41.4 MCV-94 MCH-31.4 MCHC-33.3 RDW-12.2 RDWSD-42.4 Plt ___\n___ 06:58AM BLOOD ___ PTT-30.7 ___\n___ 06:58AM BLOOD Glucose-91 UreaN-13 Creat-0.9 Na-141 K-4.0 Cl-101 HCO3-23 AnGap-17\n___ 03:55PM BLOOD ALT-36 AST-33 AlkPhos-55 TotBili-0.6\n___ 03:55PM BLOOD Lipase-26\n___ 03:55PM BLOOD cTropnT-<0.01\n___ 06:58AM BLOOD Calcium-9.3 Phos-3.3 Mg-2.3\n___ 03:55PM BLOOD Albumin-4.4 Calcium-9.1 Phos-3.1 Mg-2.2 Cholest-217*\n___ 07:21PM BLOOD %HbA1c-5.2 eAG-103\n___ 03:55PM BLOOD Triglyc-62 HDL-77 CHOL/HD-2.8 LDLcalc-128\n___ 03:55PM BLOOD TSH-1.2\n___ 03:55PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Tricycl-NEG\n___ 09:50PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-NEG\n\nMRI head\nIMPRESSION: \n \n \n1. Punctate late acute to early subacute infarct in the left thalamus. No associated hemorrhage or mass effect. \n2. Encephalomalacia in the right greater than left inferior \nfrontal lobes. \n3. Dural venous sinuses are not assessed on this noncontrast exam. However, they appear patent on the preceding CTA. \n\nCTA h/n\nCT head without contrast \nNo evidence of a large territory infarction, hemorrhage, edema or mass. \n \nCTA head \nThe ___ and its branches demonstrate no high-grade stenosis, occlusion or aneurysm greater than 3 mm. The dural venous sinuses are patent.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/18944079-DS-17.json b/Finished/Hypertension/18944079-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..1ad9ad22f9c8d760156b30817fbc5392450e0c18 --- /dev/null +++ b/Finished/Hypertension/18944079-DS-17.json @@ -0,0 +1,21 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "BP 160$Input5": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "elevated blood pressure for 147/100$Input2": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "headache$Input1": {} + } + } + }, + "input1": "Sore throat,headache,heartburn, elevated BP\n", + "input2": "Patient presented with a sore throat (from vomiting, she stated), heartburn, and elevated blood pressure for 147/100. Concern for preeclampsia so admitted for evaluation.\n", + "input3": "\n", + "input4": "noncontributory\n", + "input5": "BP 160\n", + "input6": "___ 07:23PM CREAT-0.6\n___ 07:23PM estGFR-Using this\n___ 07:23PM ALT(SGPT)-23 AST(SGOT)-26\n___ 07:23PM URIC ACID-3.9\n___ 07:23PM WBC-11.9* RBC-4.37 HGB-10.3* HCT-32.0* MCV-73* MCH-23.6* MCHC-32.2 RDW-18.9* RDWSD-46.3\n___ 07:23PM NEUTS-71.4* ___ MONOS-7.6 EOS-0.3* BASOS-0.3 IM ___ AbsNeut-8.53* AbsLymp-2.37 AbsMono-0.91* AbsEos-0.03* AbsBaso-0.03\n___ 07:23PM PLT COUNT-369\n___ 07:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR* GLUCOSE-NEG KETONE-40* BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 LEUK-NEG\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/19141642-DS-10.json b/Finished/Hypertension/19141642-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..dd863b98cf2f949f3b9d2bc6a700df6ddb17ad11 --- /dev/null +++ b/Finished/Hypertension/19141642-DS-10.json @@ -0,0 +1,30 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "at home her SBP was 220$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "BPs noted to be 210-220$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "BP:139/82$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "Headache$Input1": {} + }, + "Elderly age is an important risk factor for Hypertension,and female have a higher risk.$Cause_1": { + "58 year old female$Input2": {} + }, + "Family history of cardiovascular disease is a risk factor of Hypertension.$Cause_1": { + "Brothers both with heart conditions.$Input4": {} + } + } + }, + "input1": "Headache, hypertensive crisis\n", + "input2": "58 year old female with pmhx of autoimmune hemolytic anemia recently found to have right MCA on HA workup and now POD4 from Craniotomy for clipping of Right MCA with Dr. ___ on ___. Patient was slow to wake from anesthesia but otherwise had an uneventful hospital course. She was discharged home on ___. Today at home her SBP was 220 and so she presented to the OSH ED. BPs noted to be 210-220 and she was started on a nicardipine gtt. She reports nausea and an episode of vomiting at home and at OSH for which she received Zofran. Troponin 0.04 at OSH. CT head at OSH performed for c/o HA demonstrated some edema with mild MLS and the patient was transferred to ___ for neurosurgical evaluation. Currently she denies HA, nausea, numbness, weakness, tingling, vision changes.\n", + "input3": "Allergic rhinitis\nHyperlipidemia\nGlaucoma\n", + "input4": "Father deceased with MI @ ___. Brothers both with heart \nconditions. No family history of liver or bleeding disorders. \n- Unknown family history of aneurysms\n", + "input5": "O: T:97.9 HR:67 BP:139/82 RR:18 Sat:95% 2L NC \nGen: WD/WN, comfortable, NAD.\nHEENT:right crani site healing well. staples in place. minimal\ndried blood. no drainage. minimal facial swelling\nNeck: Supple.\nExtrem: Warm and well-perfused.\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\nOrientation: Oriented to person, place, and date.\nLanguage: Speech fluent with good comprehension and repetition.\nNaming intact. No dysarthria or paraphasic errors.\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 3 to 2\nmm bilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without\nnystagmus.\nV, VII: slight left nasolabial fold flattening\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements,\ntremors. Strength full power ___ throughout. No pronator drift\n\nSensation: Intact to light touch bilaterally.\n\nToes downgoing bilaterally\n\nCoordination: normal on finger-nose-finger\n", + "input6": "Please see OMR for pertinent lab and imaging results.\n" +} \ No newline at end of file diff --git a/Finished/Hypertension/19435301-DS-12.json b/Finished/Hypertension/19435301-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..462f8a1c19e518d129efdc4663f6583c578a42f8 --- /dev/null +++ b/Finished/Hypertension/19435301-DS-12.json @@ -0,0 +1,24 @@ +{ + "Hypertension$Intermedia_3": { + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.$Cause_1": { + "BP there was elevated, 140/100.$Input1": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.*$Cause_1": { + "BP was elevated for the first time (150/100 per pt)$Input2": {} + }, + "An elevation of BP(SBP\u2265140mmHg or DBP\u226590mmHg)confirmed is a diagnostic criteria of Hypertension.**$Cause_1": { + "BPs 160/111, 155/96, 141/100, 148/97, 131/98, 126/87$Input5": {} + }, + "Suspected Hypertension$Intermedia_2": { + "Headache is a classic symptoms of Hypertension.$Cause_1": { + "Headache$Input1": {} + } + } + }, + "input1": "Headache\uff0cBP there was elevated, 140/100.\n", + "input2": "On arrival to triage, pt reports a HA which started when she\narrived to Dr ___. Prior to this, she denies any recent HA. She denies visual changes. Reports some right sided abd pain which she's had for a couple months. c/o intermittent nausea, no recent vomiting. Pt states she was seen by her midwife\nin ___ yesterday and her BP was elevated for the first time (150/100 per pt). Labs and urine were sent and pt was told\nthey were normal.\n", + "input3": "LR Panorama\nFFS post placenta\nISSUES:\n", + "input4": "+ for MI in maternal grandfather. MGM with hypothyroidism and elevated cholesterol\n", + "input5": "Gen: well-appearing, NAD\nVS: T 98.1, HR 85, RR 18\nBPs 160/111, 155/96, 141/100, 148/97, 131/98, 126/87\nLungs: CTAB\nHeart: RRR\nAbd: soft, gravid, NT; no RUQ tend\nExt: no edema, 3+ DTRs\n___: 140s, mod var, +accels, no decels\nTOCO: no ctxs\n\nU/S (at ___):\ncephalic, partial post previa, BPP ___, EFW 1833g(61%)\n", + "input6": "___ 02:56PM URINE HOURS-RANDOM\n___ 02:56PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 12:51PM CREAT-0.6\n___ 12:51PM URINE HOURS-RANDOM CREAT-18 TOT PROT-<6\n___ 12:51PM WBC-7.8 RBC-3.63* HGB-11.3* HCT-32.3* MCV-89 \nMCH-31.2 MCHC-35.1* RDW-14.7\n" +} \ No newline at end of file diff --git a/Finished/Migraine/Migraine With Aura/17676552-DS-10.json b/Finished/Migraine/Migraine With Aura/17676552-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..5ccfaa4ea2b47ed730962bfd240a5bf9a763d170 --- /dev/null +++ b/Finished/Migraine/Migraine With Aura/17676552-DS-10.json @@ -0,0 +1,48 @@ +{ + "Migraine With Aura$Intermedia_3": { + "Blurred vision can be one of the visual symptoms associated with migraines, called a \"visual aura.\" Before or during a migraine attack, some people may experience blurred vision or other visual abnormalities, which may affect one or both eyes.$Cause_1": { + "right eye blurred vision$Input1": {} + }, + "This is different from her previous migraines. This may indicate a change in the type or trigger of your migraines.$Cause_1": { + "R eye today (which has persisted), followed by an occipital headache that is a little different in character to her usual migraines$Input2": {} + }, + "Some migraine attacks are preceded by a colorful, kaleidoscopic visual aura. Visual auras are a common prodromal symptom of migraine.$Cause_1": { + "preceded by a colorful caleidoscopic aura$Input2": {} + }, + "She currently experiences monocular blurred vision. This is different from multifocal blurred vision and may indicate a different pathological mechanism.$Cause_1": { + "visual blurring she is experiencing currently$Input2": {} + }, + "Suspected Migraine$Intermedia_2": { + "Headaches are a common symptom of migraines. Migraines usually present as severe pain on one side of the head, but can also affect other parts of the head.$Cause_1": { + "headache$Input1": {} + }, + "This time the migraine is further back and the pain feels more like an aching pain. This description helps to distinguish between different manifestations of migraine$Cause_1": { + "much more posterior in location, and also has a more achy quality$Input2": {} + }, + "Related to photosensitivity. Photosensitivity is a common symptom of migraine.$Cause_1": { + "associated with photophobia$Input2": {} + }, + "Sitting up makes headaches worse, which may be related to the effect of changes in body position on headaches.$Cause_1": { + "Sitting up makes the headache worse$Input2": {} + }, + "Nausea and occasionally vomiting. These are common symptoms that accompany migraines.$Cause_1": { + "nausea, with occasional vomiting$Input2": {} + }, + "Neck pain may be related to migraines because neck problems (such as cervical spine disorders) can sometimes cause headaches.$Cause_1": { + "chronic neck pain$Input3": {} + }, + "Here the patient is described as having moderate discomfort from a headache that is typical of a migraine.$Cause_1": { + "in moderate distress due to headache.$Input5": {} + }, + "Chronic pain may occur after cervical spine surgery, which may indirectly trigger or exacerbate headaches, especially migraines.$Cause_1": { + "The patient is status post laminectomies and spinous process resection from C3/C4 through C5/C6 levels$Input6": {} + } + } + }, + "input1": "headache and right eye blurred vision\n", + "input2": "her R eye today (which has persisted), followed by an occipital headache that is a little different in character to her usual migraines: usually her migraines are bifrontal and throbbing, whereas this one is much more posterior in location, and also has a more achy quality. It is associated with photophobia. Sitting up makes the headache worse. Some of her migraine headaches are preceded by a colorful caleidoscopic aura that starts in the ___ her vision and gradually spreads to the periphery; this is quite different to the monocular visual blurring she is experiencing currently. She initially thought that the visual blurring could have been due to a dislodged contact lens but this turned out to not have been the case. She also points out that she just had her prescription adjusted. At the time of my evaluation, the headache is still moderately severe, and pt is continuing to experience nausea, with occasional vomiting. The pt is worried that her symptoms could be a recurrence of her astrocytoma, as she had occipital pain and visual symptoms with that as well. She is not sure how a cervical disease process could have caused visual symptoms and states that her doctors at the time also did not understand that. \n", + "input3": "- c-spine astrocytoma s/p resection ___ with residual symptoms(neck pain, sensory level, urinary frequency/urgency); for her chronic neck pain, she follows in the pain clinic and gets ESI approx. every 3 months; also recently had a cervical nerve ablation performed\n- s/p shoulder surgery to reduce frequency of dislocations\n- s/p FPL repair after laceration\n- palpitations\n- arachnoid cyst\n", + "input4": "mother with migraines of adult onset, unclear if had\naura; father died of suicide via gunshot.\nGrandparents: grandfather with ___\n", + "input5": "General: NAD, thin woman, in moderate distress due to headache. \n- Head: NC/AT, no conjunctival pallor or icterus, no oropharyngeal lesions \n- Fundoscopy: discs flat with crisp disc margins (no papilledema), normal color. Cup-to-disc ratio normal. \n- Neck: Supple, no nuchal rigidity. No lymphadenopathy or thyromegaly.\n- Cardiovascular: carotids with normal volume & upstroke; RRR, \nno M/R/G \n- Respiratory: Nonlabored, clear to auscultation with good air\nmovement bilaterally\n- Extremities: Warm, no cyanosis/clubbing/edema\n\nNeurologic Examination:\n\nMental Status: \nAwake, alert, oriented x 3. \nAttention: Recalls a coherent history; thought process linear without circumstantiality or tangentiality. No neglect to visual or sensory double stimulation. Concentration maintained when recalling months backwards. \nAffect: euthymic\nLanguage: Converses appropriately with fluent speech and good comprehension. No dysarthria, dysprosody or paraphasias noted. \nFollows two-step commands, midline and appendicular and crossing\nthe midline. High- and low-frequency naming intact.Intact\nrepetition. Normal reading. \nMemory: Easily registers ___ objects and recalls ___ at 3\nminutes. \nPraxis: No ideomotor apraxia or neglect w/o bodypart-as-object \nor\nspacing errors. Pt was able to copy unfamiliar hand\nconfigurations without difficulty. \nExecutive function tests: \nLuria hand sequencing learned without verbal reinforcement.\n\nCranial Nerves: \n[II] ___ ___ OS ___ ___. No red desaturation. ___ ___ ___.\nNo distortion of Amsler grid. Pupils: equal in size and briskly\nreactive to light and accommodation. No RAPD.\nVisual fields full to peripheral motion, tested individually, \nand\nto finger counting (including DSS) when tested together. \n[III, IV, VI] EOM intact, no pathologic nystagmus. Saccades\nsymmetric without evidence of INO\n[V] V1-V3 with symmetrical sensation to light touch. Pterygoids\ncontract normally. \n[VII] No facial asymmetry at rest and with voluntary activation. \n\n[VIII] Hearing grossly intact to finger rub bilaterally. \n[IX, X] Palate elevates in the midline.\n[XI] Neck rotation normal and symmetric. Shoulder shrug strong.\n[XII] Tongue shows no atrophy, emerges in midline and moves\neasily. \n\nMotor: Normal bulk and tone in arms, mildly increased in leg. No\npronation or drift. Mild postural tremor; no asterixis.\n\n[ Direct Confrontational Strength Testing ]\n\nArm\nDeltoids [R 4+] [L 5]\nBiceps [R 4+] [L 5]\nTriceps [R 5] [L 5]\nExtensor Carpi Radialis [R 5] [L 5]\nFinger Extensors [R 5] [L 5]\nFinger Flexors [R 5] [L 5]\nInterossei [R 5] [L 5]\nAbductor Digiti Minimi [R 5] [L 5]\n\nLeg\nIliopsoas [R 4+] [L 4+]\nQuadriceps [R 5] [L 5]\nHamstrings [R 4+] [L 4+]\nTibialis Anterior [R 4+] [L 4+]\nGastrocnemius [R 5] [L 5]\nExtensor Hallucis Longus [R 4+] [L 4+]\nExtensor Digitorum Brevis [R 4+] [L 4+]\nHip abductors [R 4+] [L 4+]\nHip adductors [R 5] [L 5]\n\nSensory: \nIntact proprioception at halluces bilaterally. \nNo deficits to pinprick testing on extremities and trunk. There is, however, a sensory level to light touch & direction testing at around the C-T junction both in the hand and medial forearm and on the back. \nCortical sensation: No extinction to double simultaneous\nstimulation. Graphesthesia intact. \n\nReflexes\n [Bic] [Tri] [___] [Pat] [Ach]\nL 2 2 2 3 3\nR 2 2 2 3 3\n\nPlantar response flexor bilaterally. \n\nCoordination: No rebound. No past-pointing when touching own \nnose with finger, with eyes closed. No dysmetria on finger-to-nose \nand heel-knee-shin testing. No dysdiadochokinesia. Forearm orbiting\nsymmetric. Finger tapping on crease of thumb, and sequential\nfinger tapping symmetric. \n\nGait& station: \nStable stance without sway. No Romberg. \nNormal initiation. Narrow base. Normal stride length and arm\nswing. Intact heel, toe, and tandem gait. \n", + "input6": "___ 04:08PM PLT COUNT-203\n___ 04:08PM NEUTS-52.6 ___ MONOS-7.4 EOS-0.9 \nBASOS-0.9\n___ 04:08PM WBC-5.6 RBC-5.31 HGB-15.3 HCT-46.0 MCV-87 \nMCH-28.7 MCHC-33.2 RDW-11.9\n___ 04:08PM GLUCOSE-62* UREA N-10 CREAT-0.9 SODIUM-139 \nPOTASSIUM-4.5 CHLORIDE-101 TOTAL CO2-26 ANION GAP-17\n\nMRI brain and orbits (___): Unchanged arachnoid cyst \nidentified in the left temporal fossa. There is no evidence of abnormal enhancement. The optic nerves are normal and the orbits are unremarkable.\n\nMRI spine (___): The patient is status post laminectomies and spinous process resection from C3/C4 through C5/C6 levels. There is an intramedullary cystic-appearing lesion, probably related with post-surgical syrinx, the possibility of a cystic astrocytoma is also a consideration. There is no evidence of abnormal enhancement. There is minimal irregular contour in this cystic lesion at the level of C5.\n\n" +} \ No newline at end of file diff --git a/Finished/Migraine/Migraine With Aura/18427803-DS-5.json b/Finished/Migraine/Migraine With Aura/18427803-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..311a236bb87492fc33c036b7d2402da9217e1859 --- /dev/null +++ b/Finished/Migraine/Migraine With Aura/18427803-DS-5.json @@ -0,0 +1,36 @@ +{ + "Migraine With Aura$Intermedia_3": { + "Difficulty expressing language may be associated with migraine, especially when migraine is accompanied by neurological symptoms$Cause_1": { + "Difficulty producing speech$Input1": {} + }, + "Persistent headaches and impaired speech may be signs of a worsening migraine.$Cause_1": { + "continued headache and altered quality of speech and could not express herself.$Input2": {} + }, + "Reduced speech output may be associated with cognitive impairment during migraine$Cause_1": { + "Patient with not much speech output$Input5": {} + }, + "Suspected Migraine$Intermedia_2": { + "Patients feel they may be experiencing a migraine, which is a subjective description of symptoms$Cause_1": { + "felt that she had a migraine$Input2": {} + }, + "The patient reported symptoms of nausea and vomiting, which are common symptoms associated with migraine.$Cause_1": { + "endorses nausea and vomiting.$Input2": {} + }, + "The patient's speech output improved only slightly, which may indicate that the migraine affected the patient's cognitive function.$Cause_1": { + "verbal output has improved only mildly since symptom onset$Input2": {} + }, + "Abnormal blood lipids may affect blood vessel health and indirectly affect blood flow to the brain, which may induce migraines.$Cause_1": { + "HLD$Input3": {} + }, + "A slightly increased heart rate may indicate that the patient is in distress or anxiety, which can be a characteristic of a migraine attack.$Cause_1": { + "Heart rate: 113$Input5": {} + } + } + }, + "input1": "Difficulty producing speech \n", + "input2": "Patient woke up at about 0900 AM. Patient felt that she had a migraine. Patient took acetaminophen and went back to bed. Patient woke back up one hour later and had continued headache and altered quality of speech and could not express herself. \n\nPatient's husband called ___ and talked to nurse in primary \nphysicians office. Nurse told her to call ___ and ambulance. Patient was taken to ED at ___. Presenting BP 176/89. WBC 5.3. Glucose 127. Troponin negative. LFTs normal. Chem7 normal. NCHCT and CTA head and neck without evidence of bleed or large vessel occlusion. Patient also had MRA neck which was normal. Patient and husband requested transfer here. Patient before discharge recieved a headache cocktail with ondansetron, toradol, reglan, and benadryl. This helped with headache, but not aphasia. \n\nPatient's husband reports that verbal output has improved only mildly since symptom onset. Patient's voice softer, but not slurred compared to baseline. Patient's face, per him, looks normal. Patient denies weakness on side versus other side. Patient denies change in sensation. Patient's coordination normal. Patient endorses nausea and vomiting. \n\n", + "input3": "Hypothyroidism \nHLD \nHistory of breast CA \nLeft paramedian pontine stroke \n", + "input4": "Mother had heart disease in elderly age. Paternal grandmother had stroke in ___. \n", + "input5": "PHYSICAL EXAMINATION: \nPresentation vitals: \nTemperature: 98.5 \nHeart rate: 113 \nBlood pressure: 133/85 \nRespiratory rate: 15 \nOxygen saturation: 96% RA \n\nNeurologic:\nMental Status: \nPatient with not much speech output, correctly answers questionswith yes and no. Speech fluent, no errors. Patient knows name,location. Patient when asked month says \"I know, but cannot say\". Patient's naming intact to elbow, hand, but when asked knuckle she again says \"I know, but cannot say\". Patient can repeat short phrase, but not longer phrases, patient starts correctly, but then just stops providing end of phrase. Left right differentiation intact. Calculations intact. Patient can easily follow midline and appendicular commands. No evidence of apraxia, waves hello to me and blows kiss to husband.\n\n___:\nNo blink to threat. PERRL. EOMI intact, no nystagmus. No \nptosis. Facial sensation normal. Facial musculature symmetric. Hearing intact. Palate elevates symmetrically. Shoulders sit symmetrically. Tongue protrudes to midline with forceful lateral excursions. \n\nMotor: \nBulk and tone normal. No pronator drift. No orbiting. Patient with full power throughout upper and lower extremities. \n\nSensory: \nPinprick first tested on forehead and patient reports that appreciation is same in fingers and toes. Patient can appreciate large upward and downward of toes, but not small excursions. \n\nReflexes:\nPlantar reflex extensor on right and mute/flexor on left. Patient's reflexes symmetric and normal in upper extremities, \nbut diffusely hyporeflexia in lower extremities. \n\nCoordination: \nPatient with no dysmetria with finger nose finger and heal to shin or heal to shin. No rebound of outstretched hands. \n\nGait: \nDeferred. \n\n\n", + "input6": "___ 01:09PM BLOOD WBC-6.1 RBC-4.34 Hgb-12.1 Hct-37.6 MCV-87 \nMCH-27.9 MCHC-32.2 RDW-13.2 RDWSD-42.0 Plt ___\n___ 01:09PM BLOOD Neuts-58.6 ___ Monos-10.2 Eos-1.7 \nBaso-0.3 Im ___ AbsNeut-3.55 AbsLymp-1.76 AbsMono-0.62 \nAbsEos-0.10 AbsBaso-0.02\n___ 01:09PM BLOOD ___ PTT-26.7 ___\n___ 01:09PM BLOOD Glucose-103* UreaN-18 Creat-0.7 Na-141 \nK-4.3 Cl-101 HCO3-30 AnGap-10\n___ 01:09PM BLOOD ALT-15 AST-18 LD(LDH)-178 AlkPhos-56 \nTotBili-0.5\n___ 01:09PM BLOOD cTropnT-<0.01\n___ 01:09PM BLOOD Albumin-3.6 Calcium-9.2 Phos-3.4 Mg-2.0 \nCholest-PND\n___ 01:09PM BLOOD %HbA1c-PND\n___ 01:09PM BLOOD TSH-PND\n" +} \ No newline at end of file diff --git a/Finished/Migraine/Migraine With Aura/18805216-DS-21.json b/Finished/Migraine/Migraine With Aura/18805216-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..3ea98892d982fb5a288955db7580159cd9cdf9fd --- /dev/null +++ b/Finished/Migraine/Migraine With Aura/18805216-DS-21.json @@ -0,0 +1,39 @@ +{ + "Migraine With Aura$Intermedia_3": { + "Chills or rigors may be part of a migraine aura, reflecting changes in the autonomic nervous system.$Cause_1": { + "\"chills\" - she felt cold inside$Input2": {} + }, + "Blurred vision is one of the common neurological symptoms of migraine, which may be due to the temporary impact of retinal function caused by migraine.$Cause_1": { + "vision was mildly blurred$Input2": {} + }, + "Suspected Migraine$Intermedia_2": { + "This description fits the classic symptoms of migraines, which, although usually pulsating, can also present as constant, severe pain.$Cause_1": { + "constant severe pain ___ on the back of her head and neck bilaterally$Input2": {} + }, + "Eye pain is often associated with migraines, especially when accompanied by blurred vision$Cause_1": { + "eyes were very painful with a sharp, with constant - not pulsatile$Input2": {} + }, + "After a migraine attack, patients often feel extremely tired, which is a late symptom of migraine.$Cause_1": { + "increased tiredness$Input2": {} + }, + "Limited neck movement may indicate muscle tension or stress, which are common triggers for migraines.$Cause_1": { + "Reduced ROM, mild to 80 degrees or so.$Input5": {} + }, + "A positive Romberg test reflects impaired balance, which is seen in certain neurological disorders and may also be a nonspecific symptom associated with migraine.$Cause_1": { + "Romberg positive - falls to left on eye closure,needs support.$Input5": {} + }, + "Abnormal coordination and cerebellar function may be manifestations of central nervous system disease, and patients with migraine may experience similar symptoms during an attack.$Cause_1": { + "Overshoot on left is marked and extra oscillation on right on overshoot testing$Input5": {} + }, + "MRI T2/FLAIR imaging shows multiple high signals in the peripheral areas of the white matter, which are nonspecific and may be related to the sequelae of migraine. Nonspecific white matter lesions are common in migraine patients, which may be microvascular changes caused by frequent attacks.$Cause_1": { + "Diffusion-weighted imaging shows no evidence of recent infarct or ischemia. T2/FLAIR imaging shows multiple hyperintensities, nonspecific in nature in the periventricular white matter.$Input6": {} + } + } + }, + "input1": "N/A\n", + "input2": "Perhaps on ___ or ___ last week - she cannot recall - Mrs. ___ had severe pain over the whole of her chest, radiating through to her back. The pain was very severe, made her \"double over\" and lasted for about 30 minutes. Before this she had \"chills\" - she felt cold inside, she says. She had never had pain likely this, but, although in a different location, it was similar in character to the pain of cholecystitis. She typically has no neck or low back pain. This resolved completely, was not associated with other symptoms and fever did not appear after this subjective chill.\n\nOn ___ afternoon, at her register in ___, she developed constant severe pain on the back of her head and neck bilaterally. Her eyes were very painful with a sharp, with constant - not pulsatile - severe pain (no worsening with light). The pain hit suddenly, reaching maximal intensity over a few minutes. Her vision was mildly blurred at the time. She completed the shift. She took Tylenol while still at work with some easing of her pain, but pain was still upon going to sleep after taking some NyQuil. She states that she has no history of migraine and never gets headaches. There was no ataxia, she did not notice that she was weak or numb anywhere. The only additional symptom was a feeling of increased tiredness since this event.\n\nThe pain was gone completely when she awoke on ___. The pain returned on ___ at work, starting at 6 ___. Her shift was to end at 7 ___, but she left, given this pain at 6:45. She drove home, went to the store, made some dinner, took Advil and went to sleep. It was gone when she awoke on ___. There were still no other neurologic symptoms. \n", + "input3": "- Hypothyroidism - radioiodine\n- Cholecystectomy\n- Tubal ligation\n- Ectopic pregnancy\n- Three children\n", + "input4": "Mother - vascular disease, hypercholesterolemia, multiple \nbypass,MI, died ___. In ___ when had first heart attack. Father - bypass,colon cancer. One sister with hypertension, arthritis, Lyme, hypercholesterolemia.\n", + "input5": "General Appearance: Overweight, but healthy appearing.\nComfortable, no apparent distress.\nHEENT: NC, OP clear, MMM.\nNeck: Supple. No bruits on anterior or posterior. Reduced ROM, mild to 80 degrees or so.\nSpine: No tenderness to percussion.\nLungs: CTA bilaterally. Normal respiratory pattern. \nCardiac: Regular. Normal S1/S2. No M/R/G.\nAbdominal: Soft, NT, BS+.\nExtremities: No edema, warm, normal capillary refill. Peripheral\npulses normal (DP 2+ b/l). Reduced pronation of left hand, fixed\nbased on congenital fusion, per patient.\nSkin: Normal appearances. No xanthelasmata or xanthomas, etc.\n\nNeurologic Examination:\n\nMental status:\nLevel of Arousal: Awake. Normal level of arousal and alertness.\nAttentiveness: Attentive. Able to recite MOYBW. \nLanguage: Normal fluency, comprehension, repetition, naming. No\nparaphasic errors.\nOrientation: Oriented to name, BI, day/date/month/year, context\nof presentation. \nMemory: Recall good for recent and remote events. \nKnowledge: Appropriate fund of knowledge - vocabulary and recent\nevents. \nPraxis: No apraxia/dyspraxia - can mime common tasks.\nProverbial Understanding: Abstract.\nAttitude: Cooperative, agonistic. \nMood and Affect: Euthymic, congruent, full-range.\nThought: Form - Normal. Content - Understandable level of \nconcern\nabout presentation.\nPerception: No hallucinations/delusions.\nJudgment and Insight: Preserved, within normal limits.\n\nCranial Nerves:\nI: Not tested.\nII: Pupils symmetric, round and reactive to light, 3 to 2 mm\nbilaterally. Visual fields are full to confrontation. Fundi are\nnormal.\nIII, IV, VI: Extraocular movements full, conjugate and without\nnystagmus, no overshoot.\nV, VII: Facial muscles symmetric and strong. Facial sensation\nintact. \nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetric.\nXI: Sternocleidomastoid and trapezius are of normal bulk and\nstrength bilaterally.\nXII: Tongue midline without fasciculations.\n\nPosture and Movement:\nPosture is normal while seated and lying, leans to left on\nstanding, head not tilted to left when seated, without truncal\nataxia. No tremor or abnormal movements. \n\nTone and Bulk:\nTone is normal throughout (arms, legs, neck). Muscle bulk is\nnormal. \n\nPower: No pronator drift on right and no curling of fingers or\nflexion of arm on left (fixed prone as above).\n D B T WE FE FF FAb | IP Q H AT G/S ___ TF\nR ___ ___ 5 | ___ 5 5 5 5 \nL ___ ___ 4+ | ___ 5 5 5 5 \n\nReflexes: Spread in arms, including from clavicle percussion to\nwrist flexion. No pendular reflexes. \n B T Br Pa Ac\nR ___ 2 2 \nL ___ 2 2 \nToes downgoing bilaterally, no ___.\n\nSensation:\nIntact to light touch, vibration, joint position, pinprick\nbilaterally. Romberg positive - falls to left on eye closure,needs support.\n\nCoordination and Cerebellar Function:\nNormal finger nose, great toe finger, RAM's bilaterally.\nOvershoot on left is marked and extra oscillation on right on overshoot testing without large movement of arm.\n\nGait:\nNot tested owing to marked lilt and instability on standing.\n", + "input6": "___ 01:23AM WBC-11.1* RBC-4.63 HGB-14.2 HCT-40.4 MCV-87 \nMCH-30.7 MCHC-35.2* RDW-12.6\n___ 01:23AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 01:23AM TSH-1.1\n___ 01:23AM TRIGLYCER-128 HDL CHOL-46 CHOL/HDL-3.8 \nLDL(CALC)-101\n___ 01:23AM CALCIUM-9.2 PHOSPHATE-3.8 MAGNESIUM-2.3 \nCHOLEST-173\n___ 01:23AM CK-MB-2\n___ 01:23AM cTropnT-<0.01\n___ 01:23AM CK(CPK)-65\n___ 01:23AM estGFR-Using this\n___ 01:23AM GLUCOSE-107* UREA N-15 CREAT-1.0 SODIUM-140 \nPOTASSIUM-4.3 CHLORIDE-107 TOTAL CO2-21* ANION GAP-16\n___ 02:10AM URINE RBC-1 WBC-3 BACTERIA-FEW YEAST-NONE \nEPI-1\n___ 02:10AM URINE BLOOD-SM NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-TR\n___ 02:10AM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 02:10AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 02:10AM URINE UCG-NEG\n___ 02:10AM URINE UCG-NEG\n___ 06:07AM %HbA1c-5.5 eAG-111\n___ 12:04PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-NEG\n___ 12:04PM URINE COLOR-Straw APPEAR-Clear SP ___\n\nImaging:\n \nFINDINGS: No focal lesions are identified in the posterior \nfossa. There is no mass or mass effect. There is no hydrocephalus. Normal flow voids identified within the skull base vessels. The paranasal sinuses and orbits are within normal limits. There is a retropharyngeal lymph node seen on the \nright side measuring 1.0 cm x 0.6 cm (9:2). Sagittal images show normal appearance of the midline structures. Diffusion-weighted imaging shows no evidence of recent infarct or ischemia. T2/FLAIR imaging shows multiple hyperintensities, nonspecific in nature in the periventricular white matter. \n \nIMPRESSION: \n1. No diffusion abnormalities. \n2. White matter lesions which are nonspecific. Differential diagnosis includes sequela of migraines, trauma, microvascular disease or demyelination. \n3. Right-sided retropharyngeal lymph node. \n The study and the report were reviewed by the staff radiologist. \n\n\nCT-CTA --HEAD\n \nThe ventricles, sulci, and cisterns are age appropriate. There is no evidence of intracranial hemorrhage, mass or infarction. There is no apparent extra-axial collection. \n \nThe osseous structures are unremarkable. There is mucosal thickening of the bialteral maxillary sinuses, ethmoid air cells and right sphenoid sinus. There is mucosal thickening and air fluid level in the left sphenoid sinus. The orbits are normal. The soft tissues are unremarkable. The visualized portions of the lung apices are unremarkable. The thyroid gland is normal in appearance. The soft tissues of the neck are normal appearing. \n" +} \ No newline at end of file diff --git a/Finished/Migraine/Migraine Without Aura/17185323-DS-14.json b/Finished/Migraine/Migraine Without Aura/17185323-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..9492403dc9c2128ae2b7a4d9e4ff9b2f8e0bb1d1 --- /dev/null +++ b/Finished/Migraine/Migraine Without Aura/17185323-DS-14.json @@ -0,0 +1,24 @@ +{ + "Migraine Without Aura$Intermedia_3": { + "This characteristic refers to the fact that the headache often occurs without warning, which is an important clue in diagnosing migraine without aura$Cause_1": { + "Headache attacks often begin suddenly, with no apparent warning period$Input2": {} + }, + "Suspected Migraine$Intermedia_2": { + "This sensation spreading from one area to other areas may be related to a neurological disorder and requires further diagnosis.$Cause_1": { + "sensation of his leg falling asleep starting at the ankle and travelling up his leg, then L his hand and arm up to the shoulder and then to the left side of his face$Input2": {} + }, + "Persistent neuropathic pain may indicate a more complex neurological problem$Cause_1": { + "numbness/tingling sensation in his leg and arm began to feel somewhat painful$Input2": {} + }, + "These may be signs of hormonal or autonomic nervous system abnormalities, which are sometimes associated with migraines.$Cause_1": { + "hot and sweaty, then cold, then hot again over this time period$Input2": {} + } + } + }, + "input1": "N/A\n", + "input2": "He reports that at 10:30pm he was lying in bed trying to go to sleep when his left leg started shaking. At that time he also noticed a sensation of his leg falling asleep starting at the ankle and travelling up his leg, then L his hand and arm up to the shoulder and then to the left side of his face. This was over the course of minutes. He got up to walk around and the sensation improved and the shaking stopped. He does report being sleepy after this incident, but not necessarily more sleepy than he had been before the event. He denies bowel/bladder issues or shaking of other parts and no\nconfusion afterwards. The numbness/tingling sensation in his leg and arm began to feel somewhat painful. He also felt hot and sweaty, then cold, then hot again over this time period. He decided to come to the ED when the numbness sensation didn't goaway.\n\nOf note, he had an episode of L leg shaking and whole body numbness ___ years ago that he went to the ED for, and whichself-resolved. He was sent home without a diagnosis. In addition, he reports frequent discomfort in his feet from standing on them all day as a cool. In the ED, his CBC was notable for an elevated WBC, but CXR and UA were negative for infectious etiology. Neurology was called to help determine ifhis sx could be related to a central process. Headache attacks often begin suddenly, with no apparent warning period\n", + "input3": "none \n", + "input4": "mother is healthy, father committed suicide. CAD on maternal side of family\n", + "input5": "T:97.6 P:70 R: 16 BP: 112/57 SaO2: 100% on RA\nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in\noropharynx \nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: RRR, nl. S1S2, no M/R/G noted \nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or\norganomegaly noted. \nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses\nbilaterally. \nSkin: no rashes or lesions noted.\n \nNeurologic: \n\n-Mental Status: Alert, oriented x 3. Able to relate history\nwithout difficulty. Attentive, able to name ___ backward \nwithout\ndifficulty. Language is fluent with intact repetition and\ncomprehension. Normal prosody. There were no paraphasic \nerrors.\nPt. was able to name both high and low frequency objects if\nallowed to say the word in ___ if he didn't know the ___\nequivalent. Able to read without difficulty. Speech was not\ndysarthric. Able to follow both midline and appendicular\ncommands. Pt. was able to register 3 objects and recall ___ at 5\nminutes. The pt. had good knowledge of current events. There\nwas no evidence of apraxia or neglect.\n \n-Cranial Nerves: \nI: Olfaction not tested. \nII: PERRL 3 to 2mm and brisk. VFF to confrontation. Funduscopic\nexam revealed no papilledema, exudates, or hemorrhages. \nIII, IV, VI: EOMI without nystagmus. Normal saccades. \nV: Facial sensation intact to light touch except in a V2\ndistribution mildly decreased to LT, but not PP. Patient does\nnot split the midline with vibratory sensation. \nVII: No facial droop, facial musculature symmetric. \nVIII: Hearing intact to finger-rub bilaterally. \nIX, X: Palate elevates symmetrically. \nXI: ___ strength in trapezii and SCM bilaterally. \nXII: Tongue protrudes in midline.\n \n-Motor: Normal bulk, tone throughout. No pronator drift\nbilaterally. \nNo adventitious movements, such as tremor, noted. No asterixis\nnoted.\n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___ \nL 5 ___ ___ 5 5 5 5 5 5 5 \nR 5 ___ ___ 5 5 5 5 5 5 5\n \n-Sensory: Patient has decreased light touch sensation in his \nleft\nleg above the ankle to the hip and also on his left arm from the\nshoulder to the fingers, with no dermatomal distribution. He \nhas\nno decreased sensation on his chest or back. To pinprick he has\na hand-sized rectangle of decreased sensation on his lateral\naspect of his L shin (where he also has decreased body hair) as\nwell as a small circle of decreased pinprick on his L\nhip/buttock. Initially he reported decreased vibratory \nsensation\nin his L left at the ankle and knee, but then decided that both\nsides were basically the same. No deficits to cold sensation or\nproprioception throughout. No extinction to DSS.\n \n-DTRs: \n Bi Tri ___ Pat Ach \nL 2 2 2 2 1 \nR 2 2 2 2 1\nPlantar response was flexor bilaterally.\n \n-Coordination: No intention tremor, no dysdiadochokinesia noted.\nNo dysmetria on FNF bilaterally.\n \n-Gait: Good initiation. Narrow-based, normal stride and arm\nswing. Able to walk in tandem without difficulty. Romberg\nabsent.\n", + "input6": "CT: \nHyperdense foci in both basal ganglia are likely related to \ncalcifications given the patient's age and their unusual morphology not typical for hemorrhage. An MRI is recommended for further characterization. \n\n \nNOTE ADDED AT ATTENDING REVIEW: These are typical calcifications of the globus pallidus interna. This is a normal finding, and no further evaluation is necessary. The study is normal. \n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Primary Progressive Multiple Sclerosis/12994754-DS-20.json b/Finished/Multiple Sclerosis/Primary Progressive Multiple Sclerosis/12994754-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..9ee4f52a2127266a98908e17206eb5fc2b3909c9 --- /dev/null +++ b/Finished/Multiple Sclerosis/Primary Progressive Multiple Sclerosis/12994754-DS-20.json @@ -0,0 +1,38 @@ +{ + "Primary Progressive Multiple Sclerosis$Intermedia_4": { + "Disease progression from onset without distinct relapses. Confirm Primary Progressive Multiple Sclerosis$Cause_1": { + "She said that her condition had been getting worse for a year, and there had been no recurrences.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Multiple enhancing lesions suggested active demyelination, and one also showed slowed diffusion, suggestive of an ongoing demyelinating process.$Cause_1": { + "There are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.\ufeff$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Burning pain is a common symptom of multiple sclerosis and may be related to nervous system inflammation$Cause_1": { + "a burning pain in her L arm$Input2": {} + }, + "The extended pattern of pain may be due to central nervous system involvement, consistent with features of MS$Cause_1": { + "On the first day, she noted patches of pain in her lower arm. Then today, she felt burning pain in her index finger and middle finger which extended around her arm and up to above the elbow \"like it wraps around\"$Input2": {} + }, + "Heaviness and difficulty walking may be related to MS because MS affects nerve conduction, causing muscle weakness and movement problems.$Cause_1": { + "\"heaviness\" of the L leg$Input2": {} + }, + "Abnormal gait and difficulty walking may be due to lower limb weakness or coordination problems caused by MS.$Cause_1": { + "hard to move the L leg, and that her gait has been affected, with difficulty supporting her weight$Input2": {} + }, + "Interruptions in steroid treatment may lead to worsening of MS symptoms, as steroids are used to control inflammation and relieve symptoms.$Cause_1": { + "missed her Q3month Steroid injection$Input2": {} + }, + "Tysabri is a drug used for MS, and the fact that a patient is considering starting it indicates that she may have been diagnosed with MS or is highly suspected of having MS.$Cause_1": { + "start tysabri$Input2": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "The pt is a right-handed woman. She states that she was in her USOH recently, but over the last 2 days, she has had a burning pain in her L arm. On the first day, she noted patches of pain in her lower arm. Then today, she felt burning pain in her index finger and middle finger which extended around her arm and up to above the elbow \"like it wraps around\". She did not note any pins and needles, numbness, weakness or clumsiness. \n\ufeff\nSimultaneously, she has had a feeling of \"heaviness\" of the L leg. She feels that it is hard to move the L leg, and that her gait has been affected, with difficulty supporting her weight. She denies falls. She also feels a dull ache down her leg, but does not feel pain. She denied any urinary symptoms or back pain.\n\ufeff\nShe recently missed her Q3month Steroid injection. She in possible preparation to start tysabri but has decided that she does not want to take this medication due to her concern for PML. She is scheduled to see Dr. tomorrow to further discuss her treatment options. She said that her condition had been getting worse for a year, and there had been no recurrences.\n \nROS: \nThe pt denied headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denied difficulties producing or comprehending speech. No bowel or bladder incontinence or retention. The pt denied recent fever or chills. No night sweats or recent weight loss or gain. 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. Denied rash.\n", + "input3": "+ S/p R BKA after motor vehicle accident. \n+ S/p cholecystecomy \n+ Depression\n+ GERD\n", + "input4": "mother has crohn's dz. no neuro d/o or sz.\n", + "input5": "Vitals: T: 98.9 P: 97 R: 16 BP: 124/78 SaO2: 98% RA\nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx \nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: RRR, nl. S1S2, no M/R/G noted \nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. \nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. \nSkin: no rashes or lesions noted.\n", + "input6": "05:47AM BLOOD WBC-8.2 RBC-4.46 Hgb-13.4 Hct-39.8 MCV-89 \nMCH-30.2 MCHC-33.8 RDW-13.7\n10:50PM BLOOD WBC-11.7* RBC-4.95 Hgb-14.7 Hct-43.4 \nMCV-88 MCH-29.6 MCHC-33.7 RDW-13.5\n10:50PM BLOOD Neuts-75.6* Monos-3.1 Eos-0.5 \nBaso-0.9\n05:47AM BLOOD Glucose-112* UreaN-10 Creat-0.7 Na-143 K-3.3 Cl-110* HCO3-19* AnGap-17\n10:50PM BLOOD Glucose-108* UreaN-16 Creat-0.8 Na-141 K-3.8 Cl-109* HCO3-18* AnGap-18\n10:01AM BLOOD ALT-32 AST-34 LD(LDH)-142 AlkPhos-63 \nTotBili-0.3\n10:01AM BLOOD Albumin-4.0\n05:47AM BLOOD Calcium-8.0* Phos-3.8 Mg-2.0\n10:50PM BLOOD Calcium-8.9 Phos-3.9 Mg-2.1\n10:50PM BLOOD HCG-<5\n10:01AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-6.3 \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n10:56PM BLOOD Lactate-0.8\n\nThere are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Primary Progressive Multiple Sclerosis/13036011-DS-18.json b/Finished/Multiple Sclerosis/Primary Progressive Multiple Sclerosis/13036011-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..396867b590627b6f6d9cb49372198f29348a9eea --- /dev/null +++ b/Finished/Multiple Sclerosis/Primary Progressive Multiple Sclerosis/13036011-DS-18.json @@ -0,0 +1,53 @@ +{ + "Primary Progressive Multiple Sclerosis$Intermedia_4": { + "Disease progression from onset without distinct relapses, which confirm Primary Progressive Multiple Sclerosis$Cause_1": { + "She described his condition as getting worse over the past year, with no improvement.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Multiple T2 lesions and enhancing lesions found in MRI examinations are one of the diagnostic bases for MS.$Cause_1": { + "MRI of her C-spine showed multiple T2 lesions: 1 at C1, 1 at C3, and smaller ones at C4, C5, & C6. The C1 and C3 lesions are enhancing. Her brain MRI similarly showed 2 periventricular T2 lesions, 1 subcortical lesion, and 3 infratentorial lesions, none of which enhanced$Input2": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Gait difficulty is one of the common symptoms of MS. Multiple sclerosis can cause damage to nerve fibers in the central nervous system, affecting muscle control and coordination, thus causing gait difficulty.$Cause_1": { + "Gait difficulty$Input1": {} + }, + "This section describes the patient's difficulty walking, stiffness, and leg tremors, which are common symptoms of multiple sclerosis.$Cause_1": { + "progressive difficulty walking, with stiffness and \"shaking\" of her legs (clonus), left more than right$Input2": {} + }, + "Urinary retention is also a possible symptom of MS.$Cause_1": { + "mild urinary hesitation$Input2": {} + }, + "Paresthesias in the hands and feet are also symptoms of MS.$Cause_1": { + "paresthesias in her palms and feet, L > R$Input2": {} + }, + "Gait is affected by spasticity and clonus and is treated with IV methylprednisone, which is one of the treatments for MS$Cause_1": { + "Her gait is impaired by her spasticity and clonus$Input2": {} + }, + "Blurred vision is one of the symptoms of MS$Cause_1": { + "hazy vision$Input2": {} + }, + "Limb stiffness, especially in the lower limbs, more on the right side, may be a manifestation of multiple sclerosis.$Cause_1": { + "pasticity in LEs, R > L$Input5": {} + }, + "Decreased sensation to light touch in the left big toe, a common paresthesia in people with multiple sclerosis$Cause_1": { + "Reports subjective decreased light touch over left great toe$Input5": {} + }, + "Bilateral ankle clonus, a manifestation of neurological damage, may be related to multiple sclerosis$Cause_1": { + "Bilateral clonus at ankles.$Input5": {} + }, + "Bilateral positive Babinski reflexes indicate central nervous system disease$Cause_1": { + "Plantar response was extensor bilaterally.$Input5": {} + }, + "Gait abnormalities, including a slightly wide base, short stride, decreased arm swing, inability to walk side by side, and a weakly positive Romberg test, are potential signs of neurologic impairment$Cause_1": { + "Slightly wide-based, short stride, reduced arm swing. Walks on heels with toes up. Unable to walk in tandem. Romberg weakly positive.$Input5": {} + } + } + } + }, + "input1": "Gait difficulty\n", + "input2": "She is a left-handed woman who presents with difficulty walking. She began having trouble, when she fell as a result of her ankle \"giving out.\" She is uncertain if this was a loss of strength, balance, or if she just stepped wrong. She had a severe sprain, and was seen in Orthopedic surgery. She was given a CAM walker. Since then, she has had progressive difficulty walking, with stiffness and \"shaking\" of her legs (clonus), left more than right. She has also had mild urinary hesitation a couple of times, though none recently. She has had paresthesias in her palms and feet, L > R. She described his condition as getting worse over the past year, with no improvement.\n\ufeff\nShe was diagnosed with a myelopathy. MRI of her C-spine showed multiple T2 lesions: 1 at C1, 1 at C3, and smaller ones at C4, C5, & C6. The C1 and C3 lesions are enhancing. Her brain MRI similarly showed 2 periventricular T2 lesions, 1 subcortical lesion, and 3 infratentorial lesions, none of which enhanced. \n\ufeff\nHer gait is impaired by her spasticity and clonus, she is being admitted for IV methylprednisolone treatment.\n\ufeff\nToday on neurologic ROS, she reported some hazy vision but denied headache, loss of vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denied difficulties producing or comprehending speech. No bowel or bladder incontinence.\n\ufeff\nOn general review of systems, she denied recent fever or chills. No night sweats or recent weight loss or gain. 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. Denied rash.\n\ufeff\n", + "input3": "None\n", + "input4": "Father with bipolar disease. No neurologic or autoimmune disease in family.\n", + "input5": "Physical Exam:\nVitals: T: 98.8 P: 82 R: 16 BP: 110/78 SaO2: 99%RA \nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx \nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: RRR, nl. S1S2, no M/R/G noted \nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. \nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. \nSkin: no rashes or lesions noted. \n\ufeff\nNeurologic: \n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Attentive, able to name backward without difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency objects. Speech was not dysarthric. Able to follow both midline and appendicularcommands. Pt. was able to register 3 objects and recall at 5 minutes. The pt. had good knowledge of current events. There was no evidence of apraxia or neglect. \n\ufeff\n \n-Cranial Nerves: \nI: Olfaction not tested. \nII: PERRL 7 to 3mm and brisk. VFF to confrontation. Funduscopic exam revealed no papilledema, exudates, or hemorrhages. \nIII, IV, VI: EOMI without nystagmus. Normal saccades. \nV: Facial sensation intact to light touch. \nVII: No facial droop, facial musculature symmetric. \nVIII: Hearing intact to finger-rub bilaterally. \nIX, X: Palate elevates symmetrically. \nXI: strength in trapezii and SCM bilaterally. \nXII: Tongue protrudes in midline.\n\ufeff\n-Motor: Spasticity in LEs, R > L. Normal bulk throughout. No pronator drift bilaterally. No adventitious movements noted. No asterixis noted. \n\ufeff\nDelt Bic Tri WrE FFl FE IO IP Quad Ham TA ___ \nL 5 5 5 5 ___ 5- ___ 5 4 4 \nR 5 5 5 5 ___ 5 5 4+ 5 5 4 4 \n\ufeff\n-Sensory: Reports subjective decreased light touch over left great toe. No other deficits to light touch. No deficits to pinprick, cold sensation, vibratory sense, proprioception throughout. No extinction to DSS. \n\ufeff\n-DTRs: \nBi Tri ___ Pat Ach \nL ___ 4 4 \nR ___ 4 4 \nBilateral clonus at ankles.\n\ufeff\nPlantar response was extensor bilaterally. \n\ufeff\n-Coordination: No intention tremor, no dysdiadochokinesia noted. \nNo dysmetria on FNF or HKS bilaterally. \n\ufeff\n-Gait: Good initiation. Slightly wide-based, short stride, reduced arm swing. Walks on heels with toes up. Unable to walk in tandem. Romberg weakly positive. \n\ufeff\n", + "input6": "___ 02:00PM LUPUS-NEG\n___ 02:00PM SED RATE-15\n___ 02:00PM PTT-28.6\n___ 02:00PM WBC-13.4* RBC-4.54 HGB-13.0 HCT-39.8 MCV-88 MCH-28.6 MCHC-32.6 RDW-12.9\n___ 02:00PM NEUTS-75.7* MONOS-4.2 EOS-1.6 BASOS-0.2\n___ 02:00PM PLT COUNT-368\n___ 02:00PM HIV Ab-NEGATIVE\n___ 02:00PM PEP-NO SPECIFI\n___ 02:00PM CRP-3.6\n___ 02:00PM ___\n___ 02:00PM TSH-1.5\n___ 02:00PM UREA N-12 CREAT-0.8 SODIUM-144 POTASSIUM-3.9 CHLORIDE-106\n___ 02:00PM TOT PROT-7.6 ALBUMIN-4.6 GLOBULIN-3.0\n___ 02:00PM TSH-1.5\n___ 09:06PM URINE COLOR-Yellow APPEAR-Clear\n___ 09:06PM URINE BLOOD-LG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG\n___ 09:06PM URINE RBC-189* WBC-1 BACTERIA-FEW YEAST-NONE EPI-1\n___ 09:06PM URINE MUCOUS-RARE\n\ufeff\n
\nReports:\nCXR: \nIMPRESSION: PA and lateral chest reviewed in the absence of prior chest radiographs:\nNormal heart, lungs, hila, mediastinum and pleural surfaces.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/11475935-DS-17.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/11475935-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..032c8112935326e0c6731cd76f25bdf60e3a0f27 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/11475935-DS-17.json @@ -0,0 +1,50 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "In the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "This describes multiple bilateral round and oval T2/FLAIR hyperintense white matter lesions located in the subcortical and periventricular white matter as well as in the posterior fossa and brainstem, which are most likely manifestations of a demyelinating process.$Cause_1": { + "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Blurred vision, especially in one eye, is a common symptom of RRMS.$Cause_1": { + "Blurry vision in the left eye$Input1": {} + }, + "Vision problems are a common symptom of RRMS and may be related to optic neuritis$Cause_1": { + "blurry vision on left eye for 1 week$Input2": {} + }, + "People with RRMS may experience problems with motor coordination and changes in gait, possibly due to neuropathy in the brain and spinal cord that affects motor control.$Cause_1": { + "been unsteady; he is not falling down but he noticed a significant change in his gait$Input2": {} + }, + "Patients may experience impaired balance or muscle control, which may also be caused by lesions in the central nervous system.$Cause_1": { + "tends to lean towards the right side$Input2": {} + }, + "The symptoms of MS may gradually accumulate damage in the long term, affecting daily function and work ability.$Cause_1": { + "his gait issues have been slowly getting worse and that he lost his job$Input2": {} + }, + "A general feeling of weakness and difficulty climbing stairs compared to descending them may reflect decreased strength and coordination$Cause_1": { + "feels generalized weakness. He has more difficulty with climbimg up stairs tahn going down$Input2": {} + }, + "Facial muscle weakness and flattening of the nasolabial folds suggest left upper motor neuron damage, which may be due to damage to nerve fibers in the cerebrum or brainstem.$Cause_1": { + "Left UMN facial weakness with flattened nasolabial fold$Input5": {} + }, + "Internal rotation deviation of the arm and forearm indicates impaired coordination of the upper limb muscles and is a manifestation of central nervous system dysfunction.$Cause_1": { + "He has a left pronator drift$Input5": {} + }, + "Mild dyscoliasis and slowed finger tapping during the finger-to-nose test suggest possible damage to the cerebellum or its connecting pathways.$Cause_1": { + "mild dysmetria on both hands on finger to nose, slowed finger tapping$Input5": {} + }, + "A wide-based gait and slight instability suggest impaired balance and coordination, which are common in people with MS$Cause_1": { + "Wide based, mildly unsteady to the sides$Input5": {} + } + } + } + }, + "input1": "Blurry vision in the left eye\n", + "input2": "M with PMH of DM type 2 and sickle cell trait who presents with unsteadinness over the past 5 months and blurry vision on left eye for 1 week with temporal headache. Patient reports that he has been unsteady; he is not falling down but he noticed a significant change in his gait. He says he tends to lean towards the right side. He denies any focal weakness but feels generalized weakness. He has more difficulty with climbimg up stairs tahn going down. He also noticed he has been more clumsy with his hands but he denies weakness; he can hold objects without problems. He thinks his gait issues have been slowly getting worse and that he lost his job because of his condition. He reports that 1 week ago he woke up with a left temporal headache, throbbing with no photo or phonophobia or nausea alongwith blurry vision on left eye (he did close one eye at a time). He usually does not have headaches and this one lasted for about 3 days. His vision did not improve. He was seen by Opththalmology yesterday abnormality was found that would explain his blurry vision (formal note is pending). He comes to ER today for neurologic evaluation. He denies urinary or bowel incontinence. In the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.\n\n", + "input3": "+Type 2 diabetes (his DM type 2 is thought to have been induced by steroids use for severe asthma during adolescence)\n+childhood asthma\n", + "input4": "Significant with mother and younger sister with asthma. Mother has DM type 2 and father has HTN. No hx of ataxia in the family.\n", + "input5": "Physical Exam:\nT-98.7 BP-130/79 HR-87RR-18 99O2Sat\nGen: Lying in bed, NAD\nHEENT: NC/AT, moist oral mucosa \nNeck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit\nBack: No point tenderness or erythema\nCV: RRR, Nl S1 and S2, no murmurs/gallops/rubs \nLung: Clear to auscultation bilaterally \naBd: +BS soft, nontender ext: no edema\n\ufeff\nNeurologic examination: \nMental status: Awake and alert, cooperative with exam, normal affect. Oriented to person, place, and date. Attentive, says backwards. Speech is fluent with normal comprehension and repetition; naming intact. No dysarthria. Reading and writing intact. Registers, recalls in 5 minutes. No right left confusion. No evidence of apraxia or neglect.\n \nCranial Nerves: \nPupils equally round and reactive to light, 4 to 2 mm bilaterally. Visual fields are full to confrontation. left eye R eye. Fundi was normal. Extraocular movements intact bilaterally, no nystagmus. Sensation intact V1-V3.Left UMN facial weakness with flattened nasolabial fold. Hearing intact to finger rub bilaterally. Palate elevation symmetrical. Sternocleidomastoid and trapezius normal bilaterally. Tongue midline, movements intact\n \nMotor: \nNormal bulk bilaterally. Increased tone in both legs. No observed myoclonus or tremor He has a left pronator drift\nDel Tri Bi WF WE FE FF IP H Q DF PF TE TF\nR 5 5-\nL 5 5- \n\ufeff\nSensation: Intact to light touch, pinprick, vibration and proprioception throughout. No extinction to DSS. \n\ufeff\nReflexes: B T Br Pa Pl \nRight 1 1 \nLeft 1 1 \nToes were downgoing bilaterally. \n\ufeff\nCoordination: mild dysmetria on both hands on finger to nose, slowed finger tapping\n\ufeff\nGait: Wide based, mildly unsteady to the sides (did not to any side)\n\ufeff\nRomberg: Negative\n\ufeff\n", + "input6": "___ 05:45PM HIV Ab-NEGATIVE\n___ 05:36PM URINE COLOR-Yellow APPEAR-Clear\n___ 05:36PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-1 PH-7.0 LEUK-NEG\n___ 08:40AM dsDNA-NEGATIVE\n___ 08:40AM I-HOS-DONE\n___ 08:40AM SED RATE-5\n___ 12:35AM GLUCOSE-101 UREA N-13 CREAT-0.7 SODIUM-139 POTASSIUM-4.4 CHLORIDE-106 TOTAL CO2-21* ANION GAP-16\n___ 12:35AM estGFR-Using this\n___ 12:35AM CALCIUM-9.4 PHOSPHATE-4.5 MAGNESIUM-2.2\n___ 12:35AM CRP-0.2\n___ 12:35AM WBC-6.6 RBC-3.92* HGB-12.6* HCT-35.5* MCV-91 MCH-32.1* MCHC-35.4* RDW-12.7\n___ 12:35AM NEUTS-58.6 MONOS-4.8 EOS-2.0 BASOS-0.2\n___ 12:35AM PLT COUNT-289\n___ 12:35AM PTT-27.8\n\ufeff\nMultiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process. \n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/11981102-DS-12.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/11981102-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..50e183f14a8a76be26cc857c076f88bb361aa399 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/11981102-DS-12.json @@ -0,0 +1,35 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Temporary remissions and return to a stable state, as well as recurrent episodes of symptoms, are common clinical manifestations of multiple sclerosis. Periodic fluctuations in symptoms and periods of stability are one of the characteristics of the disease.$Cause_1": { + "In the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Oligoclonal bands in cerebrospinal fluid are a common indicator of multiple sclerosis. The patient also experienced neck and back pain, symptoms that may also be associated with multiple sclerosis.$Cause_1": { + "RHF with PMH sig dx with CSF oligoclonal bands pres with neck and back pain x 2days$Input2": {} + }, + "This describes multiple bilateral round and oval T2/FLAIR hyperintense white matter lesions located in the subcortical and periventricular white matter as well as in the posterior fossa and brainstem, which are most likely manifestations of a demyelinating process.$Cause_1": { + "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "The patient has recurring neck pain, which may indicate an underlying neurological problem.$Cause_1": { + "Neck pain similar to another episode$Input2": {} + }, + "The patient continued to use copaxone, which directly indicated that she might be treating multiple sclerosis.$Cause_1": { + "compliant with her copaxone, hctz and timolol$Input2": {} + }, + "Patients experience muscle weakness or movement dysfunction, which is one of the classic symptoms of multiple sclerosis and is manifested by decreased muscle control.$Cause_1": { + "still and barely able to lift her arm to shake my hand$Input5": {} + }, + "Patients have limited mobility, possibly due to fatigue or muscle weakness, which are also common symptoms of multiple sclerosis.$Cause_1": { + "did not move much$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "RHF with PMH sig dx with CSF oligoclonal bands pres with neck and back pain x 2days. Neck pain similar to another episode. Pt not cooperative with HPI/interview. Pt states that she stopped baclofen, vicodin and tramadol due to no effect. Pt has been compliant with her copaxone, hctz and timolol. \n\ufeff\nIn the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.\n\ufeff\n", + "input3": "+Gluacoma in the left eye. \n+Supercervical hysterectomy for 20 pound fibroid. \n+Hypercholesterolemia\n", + "input4": "Father passed away form lung CA. No history of the mother's medical history or family history of neurological diseases was elicited.\n", + "input5": "SHE WOULD NOT ALLOW ME TO EXAM HER. Initially she still and barely able to lift her arm to shake my hand. She also did not move much. Yet later I found her fluidly moving all extremities without any noted deficits. RN a steady gait. Patient admits to going outside for the hospital twice to smoke.\n", + "input6": "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12108816-DS-21.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12108816-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..ec7092c474ce6313c2899ba161888392e7064c32 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12108816-DS-21.json @@ -0,0 +1,71 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "In the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Low-density areas of the brain shown on CT scans may indicate nerve damage or inflammation, which are potential imaging features of multiple sclerosis.$Cause_1": { + "CT scan was showed a hypodensity in the right frontal corona radiata extending to the internal capsule.$Input2": {} + }, + "This describes multiple bilateral round and oval T2/FLAIR hyperintense white matter lesions located in the subcortical and periventricular white matter as well as in the posterior fossa and brainstem, which are most likely manifestations of a demyelinating process.$Cause_1": { + "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.$Input6": {} + }, + "Multiple enhancing lesions suggested active demyelination, and one also showed slowed diffusion, suggestive of an ongoing demyelinating process.$Cause_1": { + "There are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.$Input6": {} + }, + "Multiple nonenhancing lesions were present, and several had low signal on T1 images, suggesting axonal loss and chronic demyelination.$Cause_1": { + "There are also multiple nonenhancing lesions, and several appear low in signal on the T1 images indicating axonal loss and suggesting chronic demyelination.$Input6": {} + }, + "Several lesions in the cervical spine showed enhancement on postcontrast images, suggesting active demyelinating disease.$Cause_1": { + "Several of the cervical spine lesions demonstrate enhancement on the post-contrast images, compatible with active demyelinating disease,$Input6": {} + }, + "Multiple enhancing periventricular and subcortical white matter lesions were partially imaged, consistent with other sites of active demyelinating disease.$Cause_1": { + "Multiple enhancing periventricular and subcortical white matter lesions are partially imaged, compatible with additional sites of active demyelinating disease$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Multiple Sclerosis causes damage to the nervous system, affecting communication pathways between the brain and various parts of the body. This nerve damage may cause loss of sensation or numbness on one side of the body, which is one of the common symptoms of Multiple Sclerosis$Cause_1": { + "Right sided numbness$Input1": {} + }, + "Multiple Sclerosis may cause blockage of nerve signal transmission, which affects muscle control and strength, especially in unilateral limbs.$Cause_1": { + "right leg weakness$Input1": {} + }, + "These symptoms indicate possible neurological impairment and are typical clinical manifestations of multiple sclerosis.$Cause_1": { + "1 week of right-sided hypoesthesia, right leg weakness, and left arm clumsiness$Input2": {} + }, + "Balance or coordination problems may be related to damage to the central nervous system, which is common in multiple sclerosis$Cause_1": { + "needs to hold onto things when he walks$Input2": {} + }, + "Impaired neurological function is a typical clinical manifestation of multiple sclerosis$Cause_1": { + "has difficulty flexing the right hip$Input2": {} + }, + "This widespread sensory abnormality may be the result of multiple parts of the central nervous system being affected, as is common in multiple sclerosis.$Cause_1": { + "He notes that he had some numbness. Started with lower waist and both legs became numb. Parts of both hands and arms were numb. The back was also numb.$Input2": {} + }, + "Bilateral spastic dystonia and slow finger tapping of the left hand may indicate damage to the central nervous system and are consistent with motor limitations in multiple sclerosis.$Cause_1": { + "Motor: b/l ___ spastic. Clumsy/slow finger tapping on left.$Input5": {} + }, + "Sensation was reduced, especially in the right leg, trunk, and forearm by about 60%, and vibration sensation in the big toe was diminished. This sensory impairment is one of the common symptoms of multiple sclerosis and reflects possible lesions in the sensory pathways.$Cause_1": { + "~60% sensation (LT and PP) over right leg, right trunk, and medial right forearm. Decreased vibratory sensation at great toes b/l$Input5": {} + }, + "The reflexes on the left side were more active than those on the right side, and there was persistent clonus in the bilateral ankle joints. These symptoms suggest possible central nervous system hypertonia and are consistent with clinical manifestations of multiple sclerosis.$Cause_1": { + "Left ___ slightly more brisk than right. Sustained clonus at ankles b/l.$Input5": {} + }, + "The muscle strength test showed that the left side was slightly weakened in some parts of the muscle (labeled 5-), while the right side was weakened to level 4 in some locations. Asymmetrical weakening of muscle strength is a symptom that patients with RRMS may experience.$Cause_1": { + "L 5 5 5- 5 5- 5- 5 5 5 5 5 5\nR 5 5 5 5 5 5 4+ 5 5 5- 5 4-$Input5": {} + }, + "Action tremor may be a manifestation of impaired central nervous system function and is also a common symptom of multiple sclerosis.$Cause_1": { + "Coordination: Mild left-sided action tremor.$Input5": {} + }, + "Low vitamin D levels, which may be associated with an increased risk of multiple sclerosis due to vitamin D's regulatory effects on immune function$Cause_1": { + "25VitD-12*$Input6": {} + } + } + } + }, + "input1": "Right sided numbness, right leg weakness\n", + "input2": "He is a 46 year-old right-handed man with nosignificant medical history who presents with 1 week of right-sided hypoesthesia, right leg weakness, and left arm clumsiness. \n\nPatient states that his symptoms started 1 week ago. He noticed he was limping due to weakness in right leg. He has difficulty flexing the right hip. His right lower trunk and leg is numb as well as a bit on his right arm. It is painful to touch cold objects. He needs to hold onto things when he walks. Additionally, he has noticed some weakness in the left hand. He intermittently gets trembling in his legs and arms.\n\nHe notes that he had some numbness. Started with lower waist and both legs became numb. Parts of both hands and arms were numb. The back was also numb. He saw a Dr. and was told he has peripheral neuropathy and that his magnesiumwas low. In the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.\n\nDenies change in vision. Endorses difficulty stooling (\"not as strong as it used to be\"). Endorses intermittent left-sided chest pain and exertional palpitations. Denies lightheadedness or dizziness. \n\nHe initially presented to where a CT scan was showed a hypodensity in the right frontal corona radiata extending to the internal capsule.\n", + "input3": "None\n", + "input4": "- Father had diabetes \n- Grandfather with diabetes\n", + "input5": "General: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx.\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity.\nPulmonary: Normal work of breathing.\nCardiac: RRR, warm, well-perfused.\nAbdomen: Soft, non-distended.\nExtremities: No ___ edema.\nSkin: No rashes or lesions noted.\n \nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Attentive, able to name backward without difficulty. Language is fluent with intact repetition and comprehension. There were no paraphasic errors. Able to name low frequency objects, but some difficulty with high frequency objects**. Able to read without difficulty. No dysarthria. Able to follow both midline and appendicular commands. Able to register 3 objects and recall at 5 minutes. There was no evidence of apraxia or neglect.\n\n-Cranial Nerves:\nII: OD 4->2mm, OS 3.5 -> 2mm. No field defects. No RAPD. No red desat. \nIII, IV, VI: EOMI without nystagmus. Normal saccades. \nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii bilaterally.\nXII: Tongue protrudes in midline with good excursions. Strength full with tongue-in-cheek testing.\n\n-Motor: b/l ___ spastic. Clumsy/slow finger tapping on left.\n+orbiting around left hand. \n [___]\nL 5 5 5- 5 5- 5- 5 5 5 5 5 5\nR 5 5 5 5 5 5 4+ 5 5 5- 5 4-\n\n-Sensory: \n~60% sensation (LT and PP) over right leg, right trunk, and medial right forearm. Decreased vibratory sensation at great toes b/l \n\n-Reflexes: Left ___ slightly more brisk than right. Sustained clonus at ankles b/l. \n [Bic] [Tri] [___] [Pat] [Ach]\nL 2 2 2 3 3\nR 2 2 2 3 3 \nRight plantar response was extensor, left was equivocal.\n\n-Coordination: Mild left-sided action tremor. \n\n-Gait: Good initiation. Narrow-based, normal stride and arm swing. Able to walk in tandem without difficulty.\n", + "input6": "___ 03:15AM BLOOD WBC-6.2 RBC-5.02 Hgb-14.9 Hct-44.4 MCV-88 MCH-29.7 MCHC-33.6 RDW-12.0 RDWSD-38.7 Plt ___\n___ 03:15AM BLOOD Glucose-90 UreaN-12 Creat-1.0 Na-139 K-4.3 Cl-101 HCO3-22 AnGap-16\n___ 03:15AM BLOOD ALT-10 AST-17 AlkPhos-69 TotBili-0.6\n___ 03:15AM BLOOD Albumin-4.7 Calcium-9.9 Phos-3.6 Mg-1.8\n___ 03:57PM BLOOD VitB12-497\n___ 03:57PM BLOOD 25VitD-12*\n___ 06:10AM BLOOD HBsAg-NEG HBsAb-POS HBcAb-NEG\n___ 03:15AM BLOOD ANCA-NEGATIVE B\n___ 03:15AM BLOOD RheuFac-<10 ___ CRP-1.3\n___ 03:15AM BLOOD Lyme Ab-POS* Trep Ab-NEG\n___ 10:15AM BLOOD HIV Ab-NEG\n___ 03:15AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Tricycl-NEG\n\nMRI brain:\n1. Multiple bilateral rounded and ovoid T2/FLAIR hyperintense white matter lesions in the subcortical and periventricular white matter as well as involving the posterior fossa and brainstem, most suggestive of a demyelinating process. There are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion. There are also multiple nonenhancing lesions, and several appear low in signal on the T1 images indicating axonal loss and suggesting chronic demyelination. \n\nMRI spine:\n1. Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process. Several of the cervical spine lesions demonstrate enhancement on the post-contrast images, compatible with active demyelinating disease, and there are also nonenhancing lesions. \n2. Multiple enhancing periventricular and subcortical white matter lesions are partially imaged, compatible with additional sites of active demyelinating disease. Please refer to separate report of MRI brain performed on the same day for description of the intracranial findings.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12172828-DS-20.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12172828-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..86d5539da3e95bc714a4d970fdc32e757a847e0b --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12172828-DS-20.json @@ -0,0 +1,50 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Relapsing-Remitting MS is characterized by obvious attacks (relapses) and remission periods.$Cause_1": { + "She has had similar symptom about 1 years ago.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "MRI of the cervical spine showed multiple areas of abnormal signal enhancement and swelling, particularly at C2 and C4. These changes are typical radiological manifestations of multiple sclerosis and indicate possible demyelination of nerve fibers.$Cause_1": { + "Images of the cervical spine demonstrate multiple areas of abnormal increased signal intensity and swelling.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Transverse myelitis is an inflammatory disease that affects the spinal cord and can be a manifestation of multiple sclerosis$Cause_1": { + "transverse myelitis$Input1": {} + }, + "Transverse myelitis may be an early manifestation of multiple sclerosis, indicating a possible autoimmune attack on the central nervous system.$Cause_1": { + "PMH of transverse myelitis$Input2": {} + }, + "Because multiple sclerosis can cause abnormalities in nerve pathways, resulting in abnormal abdominal sensation$Cause_1": { + "transferred for evaluation of a 1 week history of abdominal paresthesias.$Input2": {} + }, + "MRI-shown lesions are a key diagnostic marker of multiple sclerosis$Cause_1": { + "MRI of the brain and spinal cord showed lesions$Input2": {} + }, + "Localized to widespread paresthesia is a typical symptom of multiple sclerosis, suggesting damage to multiple neurological areas.$Cause_1": { + "gradually progressive numbness over her L thumb. This spread up her entire L arm and may have involved her L face.$Input2": {} + }, + "Common symptoms of multiple sclerosis include periodic neurosensory abnormalities, which may occur during relapses of the disease.$Cause_1": { + "she has had intermittent episodes of tingling in her hand or feet but has always ignored them$Input2": {} + }, + "This inflammation is sometimes observed in people with multiple sclerosis as a possible symptom of the disease$Cause_1": { + "transverse myelitis$Input3": {} + }, + "It shows that the patient has bilateral hyposensitivity to vibration and hyperesthesia in the T10 paravertebral muscle area, which may be one of the signs of multiple sclerosis.$Cause_1": { + "decreased vibration in ___ bilaterally; hyperesthesia along T 10 paraspinal muscles bilaterally, increased as well along the L lateral abm (around the umbilicus)$Input5": {} + }, + "Although fundus examination is normal, pupillary light response and hippus phenomenon (rhythmic pupil dilation) may indicate abnormal nervous system regulation$Cause_1": { + "VFF to confrontation, pupils 4mm->2mm bilaterally, + hippus, fundi normal$Input5": {} + }, + "There is a small high-intensity spot in the white matter area of the right parietal lobe. This symptom may be related to multiple sclerosis, because irregular high-intensity white matter spots are common in MRI of patients with multiple sclerosis.$Cause_1": { + "A solitary tiny focus of hyperintensity is seen in the right parietal white matter$Input6": {} + } + } + } + }, + "input1": "transverse myelitis \n", + "input2": "The pt is a 51 year-old right-handed woman with a PMH of transverse myelitis. She was transferred for evaluation of a 1 week history of abdominal paresthesias. \n\nShe states that she has been in good health this year, but about 1 week ago she thought she was having allergies. She noted a pins and needles sensation over her abm. This improved when she took Benadryl. Gradually over the week the sensation persisted and became stronger. She then also felt a sensation of heaviness or weight on her abm \"like a rock sitting there\". She went to the ED yesterday and was discharged. Today she had persistent symptoms and decided to come to urgent care where she was referred to the hospital. \n\nShe has had similar symptom about 1 years ago. At that time she had gradually progressive numbness over her L thumb. This spread up her entire L arm and may have involved her L face. She was evaluated at the time with MRI and LP. She recalls that the MRI of the brain and spinal cord showed lesions but that the LP was normal. She recalls also being tested for Lyme which was negative. She was never treated with steroids or IMD. Her symptoms gradually resolved over several months. \n\nShe was referred to a neurologist and had serial MRI's over 1 years. She is not certain if these were normal but states she was told that she did not need further testing. Since then she has had intermittent episodes of tingling in her hand or feet but has always ignored them. She has never had an episode of loss or impairment of vision. \n", + "input3": "transverse myelitis \nno hx of HIV testing \n", + "input4": "-mother: \"heart problems\" \n-father: \"stress related health problems\"\n", + "input5": "Vitals: T: 98.6 BP: 101/75 R: 16 P: 82 SaO2: 100 \nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx \nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: RRR, nl. S1S2, no M/R/G noted \nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. \nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. \nSkin: no rashes or lesions noted. \n\nNeurologic: \n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Attentive. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency objects. Speech was not dysarthric. Able to follow both midline and appendicular commands. The pt. had good knowledge of current events. There was no evidence of apraxia or neglect. \n\nCN \nI: not tested \nII,III: VFF to confrontation, pupils 4mm->2mm bilaterally, + hippus, fundi normal, ___ OS ___ OD ___, no red desat\nIII,IV,V: EOMI, no ptosis. No nystagmus \nV: sensation intact V1-V3 to LT \nVII: Facial strength intact/symmetrical, symm forehead wrinkling \nVIII: hears finger rub bilaterally \nIX,X: palate elevates symmetrically, uvula midline \nXI: SCM/trapezeii ___ bilaterally \nXII: tongue protrudes midline, no dysarthria \n\nMotor: Normal bulk and tone; no asterixis or myoclonus. No pronator drift. \n Delt Bi Tri WE FE Grip IO \n C5 C6 C7 C6 C7 C8/T1 T1 \nL 5 5 5 ___ 5 \nR 5 5 5 ___ 5 \n \n IP Quad ___ PF \n L2 L3 L4-S1 L4 L5 S1/S2 \nL 5 5 5 5 5 5 \nR 5 5 5 5 5 5 \n\nReflex: No clonus \n Bi Tri Bra Pat An Plantar \n C5 C7 C6 L4 S1 CST \nL ___ 2 ___ Flexor \nR ___ 2 ___ Flexor \n\n-Sensory: decreased vibration in ___ bilaterally; hyperesthesia along T 10 paraspinal muscles bilaterally, increased as well along the L lateral abm (around the umbilicus). Nl cold sensation and roprioception throughout. No extinction to DSS. \n\n-Coordination: No intention tremor, dysdiadochokinesia noted. No dysmetria on FNF or HKS bilaterally. \n\n-Gait: deferred\n", + "input6": "___ 07:17PM URINE BLOOD-SM NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-50 BILIRUBIN-NEG UROBILNGN-4* PH-6.5 LEUK-NEG\n___ 07:17PM URINE ___ BACTERIA-FEW YEAST-FEW \n___ 05:08PM CEREBROSPINAL FLUID (CSF) PROTEIN-42 GLUCOSE-71\n___ 05:08PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-261* POLYS-2 ___ ___ 09:53PM GLUCOSE-91 UREA N-15 CREAT-0.7 SODIUM-138 POTASSIUM-5.1 CHLORIDE-105 TOTAL CO2-22 ANION GAP-16\n___ 09:53PM WBC-6.2 RBC-4.83 HGB-14.7 HCT-42.9 MCV-89 MCH-30.5 MCHC-34.3 RDW-12.4\n___ 09:53PM NEUTS-52.8 ___ MONOS-5.7 EOS-1.3 BASOS-0.2\n___ 09:53PM ___ PTT-25.3 ___\n___ 05:08PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-261* Polys-2 ___ ___ 05:08PM CEREBROSPINAL FLUID (CSF) TotProt-42 Glucose-71\n\n___ MRI brain: Images of the brain appear normal. There is no evidence of hemorrhage, edema, masses, mass effect, or infarction. There are no abnormalities to suggest demyelinating disease. A solitary tiny focus of hyperintensity is seen in the right parietal white matter on image 17 of the FLAIR sequence #7. This area does not enhance after contrast administration. There is no abnormal enhancement within the brain. However, the multiple areas of increased signal noted in the spinal cord on the spine MR examination demonstrate inhomogeneous enhancement on the sagittal gradient-echo images. \n\n\n___ Spine MRI: Images of the thoracic spine appear normal with no evidence of spinal cord signal intensity abnormalities. The thoracic spinal cord appears normal in caliber and configuration. The osseous spine also appears normal. \n \nImages of the cervical spine demonstrate multiple areas of abnormal increased signal intensity and swelling. These are most prominent at C2 and at C4. A less well-defined area of apparent hyperintensity is also suggested on the sagittal images at C4-5, but not confirmed on axial imaging. These areas are hyperintense after contrast on the short TR spin echo images. \n \n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12331699-DS-23.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12331699-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..f9771e74ebfddf0013b976920a5998d4bfefaa63 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12331699-DS-23.json @@ -0,0 +1,29 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "In the ED she said her symptoms had subsided and her condition had returned to a stable state. He said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Patients with a history of MS$Cause_1": { + "h/o MS$Input6": {} + }, + "This describes multiple bilateral round and oval T2/FLAIR hyperintense white matter lesions located in the subcortical and periventricular white matter as well as in the posterior fossa and brainstem, which are most likely manifestations of a demyelinating process.$Cause_1": { + "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Falls can be caused by poor balance or muscle control. This can be related to muscle or nerve dysfunction.$Cause_1": { + "fell while transferring from toilet$Input2": {} + }, + "The risk of developing multiple sclerosis is related to genetic factors. If there are cases of multiple sclerosis in the family, especially in close relatives, the risk of developing the disease may increase.$Cause_1": { + "Two family members with MS-paternal cousins$Input4": {} + } + } + } + }, + "input1": "None\n", + "input2": "she with PMH of polio (affecting R leg) who fell while transferring from toilet to wheelchair. She attempted to grab the wheel of the wheelchair and it began to roll away and she then fell on her knees and her face. She has chronic R leg pain related to her polio and her R knee began to hurt. Her pain was not controlled at home so she came to the ER for help with pain control. \n\ufeff\nThe patient denies any other symptoms, no weakness of any other extremity, she had dysuria 2 days ago but non since. No other symptoms, no F/C/NS, no chest pain, no SOB, no LH, no HA, no new visual disturbances or neurologic symptoms, no abd pain, blood in stool. Rest of ROS is negative.\n\nIn the ED she said her symptoms had subsided and her condition had returned to a stable state. He said similar situations had happened before.\n", + "input3": "+ Congenital L hip dysplasia- s/p mult surgical repair- 3 total hip replacements, last repair complicated my multiple postoperative dislocations\n+ Hypertension\n+ polio affecting the right lower extremity, severe chronic pain-followed by pain service\n+ Left sciatic neuropathy\n\ufeff\n", + "input4": "Two family members with MS-paternal cousins\n", + "input5": "VS: T 97.5 BP 135/88 HR 85 RR 18 O2 sat 100% on RA\nGEN: NAD, AOX3\nHEENT: MMM\nCARD: RRR, no m/r/g\nPULM: CTAB, no ronchi or rales or wheezes, normal resp effort\nABD: soft, NT, ND, no masses or organomegaly\nEXT: wwp, no c/c/e, R leg atrophy\nNEURO: R leg w/ antigravity (minimal) other ext stregnth, normal mood and affect, AOx3\n\ufeff\n", + "input6": "Admission labs: 05:25AM \nURINE BACTERIA-NONE YEAST-NONE\nURINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG \nLEUK-MOD\n\ufeff\nR KNEE X RAY: No acute fracture or dislocation.\n\ufeff\n06:30AM \nGlucose-101* UreaN-12 Creat-0.7 Na-142 K-3.3 Cl-98 HCO3-37* AnGap-___ yoF w/ a h/o MS and polio presents after a mechanical fall with R knee pain.\n\ufeff\n# UTI: Uncomplicated, treated w/ cipro x 3d\n\ufeff\n# HTN: Patient was continued on her home antihypertensives with good control. \n\ufeff\n# Anxiety / depression: Patient was continued on her home Klonopine and Venlafaxine\n\nMultiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12331699-DS-2311.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12331699-DS-2311.json new file mode 100644 index 0000000000000000000000000000000000000000..f9771e74ebfddf0013b976920a5998d4bfefaa63 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12331699-DS-2311.json @@ -0,0 +1,29 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "In the ED she said her symptoms had subsided and her condition had returned to a stable state. He said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Patients with a history of MS$Cause_1": { + "h/o MS$Input6": {} + }, + "This describes multiple bilateral round and oval T2/FLAIR hyperintense white matter lesions located in the subcortical and periventricular white matter as well as in the posterior fossa and brainstem, which are most likely manifestations of a demyelinating process.$Cause_1": { + "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Falls can be caused by poor balance or muscle control. This can be related to muscle or nerve dysfunction.$Cause_1": { + "fell while transferring from toilet$Input2": {} + }, + "The risk of developing multiple sclerosis is related to genetic factors. If there are cases of multiple sclerosis in the family, especially in close relatives, the risk of developing the disease may increase.$Cause_1": { + "Two family members with MS-paternal cousins$Input4": {} + } + } + } + }, + "input1": "None\n", + "input2": "she with PMH of polio (affecting R leg) who fell while transferring from toilet to wheelchair. She attempted to grab the wheel of the wheelchair and it began to roll away and she then fell on her knees and her face. She has chronic R leg pain related to her polio and her R knee began to hurt. Her pain was not controlled at home so she came to the ER for help with pain control. \n\ufeff\nThe patient denies any other symptoms, no weakness of any other extremity, she had dysuria 2 days ago but non since. No other symptoms, no F/C/NS, no chest pain, no SOB, no LH, no HA, no new visual disturbances or neurologic symptoms, no abd pain, blood in stool. Rest of ROS is negative.\n\nIn the ED she said her symptoms had subsided and her condition had returned to a stable state. He said similar situations had happened before.\n", + "input3": "+ Congenital L hip dysplasia- s/p mult surgical repair- 3 total hip replacements, last repair complicated my multiple postoperative dislocations\n+ Hypertension\n+ polio affecting the right lower extremity, severe chronic pain-followed by pain service\n+ Left sciatic neuropathy\n\ufeff\n", + "input4": "Two family members with MS-paternal cousins\n", + "input5": "VS: T 97.5 BP 135/88 HR 85 RR 18 O2 sat 100% on RA\nGEN: NAD, AOX3\nHEENT: MMM\nCARD: RRR, no m/r/g\nPULM: CTAB, no ronchi or rales or wheezes, normal resp effort\nABD: soft, NT, ND, no masses or organomegaly\nEXT: wwp, no c/c/e, R leg atrophy\nNEURO: R leg w/ antigravity (minimal) other ext stregnth, normal mood and affect, AOx3\n\ufeff\n", + "input6": "Admission labs: 05:25AM \nURINE BACTERIA-NONE YEAST-NONE\nURINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG \nLEUK-MOD\n\ufeff\nR KNEE X RAY: No acute fracture or dislocation.\n\ufeff\n06:30AM \nGlucose-101* UreaN-12 Creat-0.7 Na-142 K-3.3 Cl-98 HCO3-37* AnGap-___ yoF w/ a h/o MS and polio presents after a mechanical fall with R knee pain.\n\ufeff\n# UTI: Uncomplicated, treated w/ cipro x 3d\n\ufeff\n# HTN: Patient was continued on her home antihypertensives with good control. \n\ufeff\n# Anxiety / depression: Patient was continued on her home Klonopine and Venlafaxine\n\nMultiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12546487-DS-16.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12546487-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..d9d7c96d721cd77327e47ad973200058dd93272f --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12546487-DS-16.json @@ -0,0 +1,41 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Suspected relapse of disease, which has distinct periods of attack (relapse) and remission$Cause_1": { + "experiencing another flare$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Multiple new supratentorial and infratentorial demyelinating lesions were reported, which showed a slow spread, suggesting an acute etiology, which is one of the key indicators for diagnosing multiple sclerosis, as MS characteristically involves a demyelinating process in the central nervous system.$Cause_1": { + "multiple new supratentorial and infratentorial demyelinating lesions are identified compared. Some of the lesions demonstrate slow diffusion, suggesting acute etiology$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Facial numbness is a common symptom of multiple sclerosis$Cause_1": { + "left facial numbness$Input2": {} + }, + "Problems with coordination and balance are often related to damage to the cerebellum or related neural pathways in the cerebrum, which is also a typical symptom in multiple sclerosis.$Cause_1": { + "her coordination and balance are \"off\", and that she has to hold on to walls while ambulating$Input2": {} + }, + "Hand dysfunction may indicate damage to motor areas of the brain or neural pathways. This inflexibility and difficulty manipulating the hands is a common neurological impairment in multiple sclerosis.$Cause_1": { + "difficulty functioning with her left hand$Input2": {} + }, + "Pins and needles or abnormal sensations in the hands are often associated with a nerve conduction disorder, which may be caused by inflammatory activity in the central nervous system that slows or interrupts nerve conduction.$Cause_1": { + "tingling in the hand$Input2": {} + }, + "Abnormal eyelid function may be related to damage to the brain stem or nerves that control eye movement, which can also be a manifestation of multiple sclerosis.$Cause_1": { + "a sensation that her left eye \"wants to be closed\"$Input2": {} + }, + "Multiple sclerosis may cause neuropathy, resulting in paresthesias in the face.$Cause_1": { + "Decreased facial sensation to pinprick on the left V1-V3.$Input5": {} + }, + "Impaired motor coordination and muscle control problems in MS often lead to an abnormal gait.$Cause_1": { + "Good initiation. Truncal ataxia, sways with merely standing, hesitant narrow-based slightly spastic-appearing gait, holds my hand to walk. Unable to walk in tandem.$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "The pt is a woman, current pregnant at 9wks gestation, who presented last week with left facial numbness concerning, who now returns to ED for evaluation of new symptoms developing during IV steroid treatment.\n\ufeff\nThe pt was seen in the ED 1 week prior by Dr. evaluation of numbness and tingling in her left face and tongue; please see his note dated for details. Briefly, she has not had a flare which consisted of left foot numbness which completely resolved after a 5 day course of IV solumedrol. She was on plegridy up until a few weeks ago when she discovered she was pregnant, and stopped this medication. Upon evaluation by Dr. was felt that she could be experiencing another flare despite her pregnancy, and an admission was recommended, however patient decided to leave AMA. \n\ufeff\nShe states that a few hours after finishing her first infusion, she started to develop a sensation of her left side feeling \"off\" which she has difficulty describing, but endorses is difficulty functioning with her left hand, for example she is missing keys while texting on her phone. She is also experiencing tingling in the hand. She also endorses that her coordination and balance are \"off\", and that she has to hold on to walls while ambulating. This is new for her. She also had a sensation that her left eye \"wants to be closed\", but she denies any vision loss, blurred vision, or double vision.\n\ufeff\nInitially she attributed these symptoms to a side effect of solumedrol, however this morning she continued to experience them, and concerned, she called the on-call neurology resident who advised her to come to the ED for evaluation. She is not certain that the symptoms are getting worse, but they are certainly not improving.\n\ufeff\n", + "input3": "+ Asthma \n+ Lactose intolerance\n+ Ovarian cyst s/p removal\n+ Back Pain \n+ Dysmenorrhea \n+ Lymphocytic colitis, controlled constipation \n+ IBS (irritable bowel syndrome) \n+ Postpartum hemorrhage\n", + "input4": "3 aunts with lupus uncle: DVT, Maternal grandmother: \"epileptic\"\n", + "input5": "ADMISSION PHYSICAL EXAM:\nGeneral: awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx\nNeck: supple, no nuchal rigidity\nPulmonary: breathing comfortably on room air\nCardiac: RRR, nl\nAbdomen: soft, NT/ND\nExtremities: warm, well perfused\nSkin: no rashes or lesions noted\n\ufeff\nNeurologic:\n\ufeff\n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Attentive, able to name backward without difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt was able to name both high and low frequency objects. Speech was not dysarthric. Able to follow both midline and appendicular commands. There was no evidence of apraxia or neglect.\n\ufeff\n-Cranial Nerves:\nII, III, IV, VI: PERRL 3 to 2mm and brisk. EOMI without\nnystagmus. Normal saccades. VFF to confrontation.\nV: Decreased facial sensation to pinprick on the left V1-V3.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n\ufeff\n-Motor: Normal bulk, tone throughout. No pronator drift bilaterally. No adventitious movements, such as tremor, noted. No asterixis noted.\nDelt Bic Tri WrE FFl FE IO IP Quad Ham TA ___ \nL 5 ___ ___ 5- 5 5- 5- 5 \nR 5 ___ ___ 5 5 5 5 5 \n\ufeff\n-Sensory: Decreased sensation to pinprick over the left face, scalp, and arm. Sparing of the trunk, back, and leg. No extinction to DSS. No agraphesthesia.\n\ufeff\n-DTRs:\nBi Tri ___ Pat Ach\nL 2 2 2 2 1\nR 2 2 2 2 1\nPlantar response was flexor bilaterally.\n\ufeff\n-Coordination: No intention tremor, no dysdiadochokinesia noted.\nNo dysmetria on FNF or HKS bilaterally.\n\ufeff\n-Gait: Good initiation. Truncal ataxia, sways with merely standing, hesitant narrow-based slightly spastic-appearing gait, holds my hand to walk. Unable to walk in tandem.\n\ufeff\n", + "input6": "___ 04:45AM BLOOD WBC-19.1* RBC-4.17 Hgb-12.6 Hct-37.0 MCV-89 MCH-30.2 MCHC-34.1 RDW-13.2 RDWSD-42.5\n___ 06:47PM BLOOD WBC-14.9* RBC-4.14 Hgb-12.7 Hct-38.0 MCV-92 MCH-30.7 MCHC-33.4 RDW-13.2 RDWSD-44.8\n___ 06:47PM BLOOD Neuts-72.2* Monos-5.9 Eos-0.1* Baso-0.1 AbsNeut-10.73* AbsLymp-3.16 AbsMono-0.88* AbsEos-0.01* AbsBaso-0.02\n___ 04:45AM BLOOD Glucose-96 UreaN-8 Creat-0.5 Na-137 K-3.8 Cl-102 HCO3-23 AnGap-16\n___ 06:47PM BLOOD Glucose-76 UreaN-9 Creat-0.5 Na-139 K-3.3 Cl-101 HCO3-23 AnGap-18\n___ 05:00AM BLOOD ALT-13 AST-13 AlkPhos-55 TotBili-<0.2\n___ 06:47PM BLOOD ALT-16 AST-14 AlkPhos-60 TotBili-0.2\n___ 06:47PM BLOOD Lipase-21\n___ 04:30AM BLOOD Calcium-8.5 Phos-3.2 Mg-2.0\n___ 06:47PM BLOOD Albumin-4.0 Calcium-9.0 Phos-3.0 Mg-1.9\n___ 06:47PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\ufeff\nHead w/o\n1. Images are substantially limited by motion artifact. However, multiple new supratentorial and infratentorial demyelinating lesions are identified compared. Some of the lesions demonstrate slow diffusion, suggesting acute etiology, as detailed above. \n2. The new lesion abutting the posterior body and atrium of the right lateral ventricle causes minimal associated effacement of the right lateral ventricle. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12546487-DS-17.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12546487-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..fd17f4929bb4c69d8716cd45128ef8bf03ecc7e7 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12546487-DS-17.json @@ -0,0 +1,44 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "She reports having vertigo once before (years ago). She was prescribed meclizine, which helped. Her symptoms resolved in a few days.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Multiple enhancing lesions suggested active demyelination, and one also showed slowed diffusion, suggestive of an ongoing demyelinating process.$Cause_1": { + "There are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.\n\ufeff$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Inflammation or changes caused by MS may affect these nerve pathways that control balance, causing vertigo.$Cause_1": { + "vertigo$Input1": {} + }, + "MS may cause inflammatory responses in the nervous system, affecting the nerve pathways that control balance, leading to vertigo.$Cause_1": { + "profoundly vertiginous (described as room spinning around her)$Input2": {} + }, + "This symptom suggests that the patient's nervous system is overreacting to movement, which may be related to the nerve damage in MS.$Cause_1": { + "Vertigo is exacerbated by any kind of movement of her body or head$Input2": {} + }, + "Teriflunomide is a drug used to treat MS, which suggests that doctors suspected she might have MS and planned to treat her with the drug.$Cause_1": { + "planned to start on teriflunomide$Input2": {} + }, + "MS can affect the central nervous system, leading to decreased muscle control and coordination, which in turn affects gait.$Cause_1": { + "Her gait is very unsteady.$Input2": {} + }, + "Nystagmus is a common symptom in MS, especially when the gaze is turned to one side.$Cause_1": { + "Left-beating nystagmus on left gaze$Input5": {} + }, + "Intention tremor and dyscoordination are typical movement disorders in MS, suggesting that the cerebellum or its pathways may be damaged.$Cause_1": { + "Mild intention tremor bilaterally.$Input5": {} + }, + "These symptoms may indicate impaired central nervous system control of balance and coordination, which is common in MS.$Cause_1": { + "Very unsteady. Falls to the right when standing or attempting stride. Vomits several times after standing up.$Input5": {} + } + } + } + }, + "input1": "vertigo\n", + "input2": "Patient was feeling well until this morning. She went to bed at 9:45pm and awoke at 6AM. Upon awakening she was profoundly vertiginous (described as room spinning around her). Vertigo is exacerbated by any kind of movement of her body or head. Her gait is very unsteady. She needs to hold onto furniture/walls to ambulate. She denies headache, new sensory or motor symptoms, vision changes. She had chills yesterday, but denies specific infectious symptoms. She has no ear fullness or change in hearing. \n\ufeff\nShe reports having vertigo once before (years ago). She was prescribed meclizine, which helped. Her symptoms resolved in a few days. \n\ufeff\nShe most recently saw Dr in clinic. At that time, he had planned to start on teriflunomide; however, she has not yet started taking this medication. \n\ufeff\nOn neurologic ROS, the pt denies headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, tinnitus or hearing difficulty. Denies difficulties producing or comprehending speech. Denies focal weakness, numbness, parasthesiae. No bowel or bladder incontinence or retention. \n\ufeff\nOn general review of systems, the pt denies recent fever. No night sweats or recent weight loss or gain. Denies cough, shortness of breath. Denies chest pain or tightness, palpitations. Denies diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denies arthralgias or myalgias. Denies rash.\n\ufeff\n", + "input3": "+ Asthma \n+ Lactose intolerance\n+ Ovarian cyst s/p removal\n+ Back Pain \n+ Dysmenorrhea \n+ Lymphocytic colitis, controlled constipation \n+ IBS (irritable bowel syndrome) \n+ Postpartum hemorrhage \n\ufeff\n", + "input4": "3 aunts with lupus uncle: DVT, Maternal grandmother: \"epileptic\"\n", + "input5": "Physical Exam:\nAdmission Physical Exam\n\ufeff\nVitals: T36, HR 96, BP 122/80, 99% RA \nGeneral: Awake, cooperative, NAD.\nHEENT: No scleral icterus noted, MMM, no lesions noted in oropharynx\nNeck: Supple, no nuchal rigidity\nPulmonary: Non-labored breathing on ambient air \nCardiac: RRR, no MRG. \nAbdomen: Soft, NT/ND, no masses or organomegaly noted.\nExtremities: Warm, well-perfused, no cyanosis, clubbing or edema bilaterally\nSkin: no rashes or lesions noted.\n\ufeff\nNEUROLOGIC:\n-----------\n-Mental Status: \nOriented to date and location. Able backwards. Recalls objects at 3 minutes. Speech is articulate, fluent, and no errors. \n\ufeff\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk. VFF to confrontation. Fundoscopic exam deferred due to severe discomfort. \nIII, IV, VI: Full range, conjugate gaze. Left-beating nystagmus on left gaze. No nystagmus in primary position. No vertical nystagmus. No skew deviation. Cannot tolerate head impulse test. \n\ufeff\nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n\ufeff\n-Motor: \nNormal bulk, tone throughout. No pronator drift bilaterally.\nNo adventitious movements, such as tremor, noted. No asterixis noted.\nDelt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ 5 ___ 5 5 5 5 5\nR 5 ___ 5 ___- 5 5 5 5 5\nOf note, patient was quite uncomfortable, so the motor exam was not reliable. Given these limitations, I could not appreciate significant focal weakness. \n\ufeff\n-Sensory: \nNo deficits to light touch, pinprick.\n\ufeff\n-Reflexes:\nBi Tri ___ Pat Ach\nL 2 2 2 2 1\nR 2 2 2 2 1\nPatellar reflexes slightly brisk bilaterally, with +suprapatellar but no crossed adductors. \n\ufeff\nPlantar response was flexor bilaterally.\n\ufeff\n-Coordination: \nMild intention tremor bilaterally. No dysmetria. There is slight dysdiadochokinesia of the RUE. \n\ufeff\n-Gait: \nVery unsteady. Falls to the right when standing or attempting stride. Vomits several times after standing up. \n\ufeff\n", + "input6": "___ 11:52AM %HbA1c-5.3 eAG-105\n___ 11:52AM WBC-11.1* RBC-4.63 HGB-12.2 HCT-39.3 MCV-85 MCH-26.3 MCHC-31.0* RDW-15.4 RDWSD-46.9*\n___ 11:52AM NEUTS-88.8* LYMPHS-7.8* MONOS-2.5* EOS-0.1* BASOS-0.3 AbsNeut-9.86* AbsLymp-0.86* AbsMono-0.28 AbsEos-0.01* AbsBaso-0.03\n___ 11:52AM PLT COUNT-213\n___ 10:30AM GLUCOSE-108* UREA N-9 CREAT-0.6 SODIUM-138 POTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-20* ANION GAP-14\n___ 10:30AM estGFR-Using this\n___ 10:30AM ALT(SGPT)-20 AST(SGOT)-20 ALK PHOS-99 TOT BILI-0.2\n___ 10:30AM LIPASE-23\n___ 10:30AM cTropnT-<0.01\n___ 10:30AM ALBUMIN-4.6 CALCIUM-9.3 PHOSPHATE-2.1* MAGNESIUM-1.6\n___ 10:30AM HCG-<5\n___ 10:30AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG tricyclic-NEG\n___ 10:30AM PTT-26.2\n\nThere are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12594529-DS-11.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12594529-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..eb76b089b1a6ad8fa18ed4dc1ff69bd388d7f4f4 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12594529-DS-11.json @@ -0,0 +1,44 @@ +{ + "Secondary Progressive Multiple Sclerosis$Intermedia_4": { + "The patient's history of MS treatment changes is described here, indicating a more than three-year history of MS diagnosis and treatment. This is the diagnosis criteria of Secondary Progressive Multiple Sclerosis.$Cause_1": { + "on injectibles for some time, then switched to Tecfidera about 5 years ago.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "This description notes the presence of multiple T2-hyperintense, enhancing peripheral cervical cord lesions with an appearance and configuration suggestive of active demyelinating disease. This is a classic symptom of multiple sclerosis, as MS affects the central nervous system primarily through demyelination.$Cause_1": { + "Multiple T2 hyperintense, enhancing peripheral cervical spinal cord lesions, as described, with appearance and configuration suggestive of active demyelinating lesions in the setting of known multiple sclerosis.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "These symptoms may indicate inflammation of the central nervous system, which is a typical feature of multiple sclerosis.$Cause_1": { + "R arm and leg weakness, pain and numbness/tingling$Input2": {} + }, + "The fluctuating and persistent nature of MS symptoms is one of its diagnostic hallmarks, reflecting temporary recovery and subsequent decline in neurological function.$Cause_1": { + "Since onset of symptoms, he reports they have waxed and waned, but generally are unchanged overall.$Input2": {} + }, + "Description of typical episodes and new symptoms that may indicate progression or change in MS$Cause_1": { + "Currently, his right hand symptoms are similar to his typical flare, but the right leg is new$Input2": {} + }, + "The incidence of epilepsy in patients with multiple sclerosis is slightly higher than in the general population, which may be due to abnormal nerve conduction caused by neuropathy and myelin damage in multiple sclerosis.$Cause_1": { + "Seizure disorder$Input3": {} + }, + "A history of neurological disorders in the family may increase the risk of offspring developing similar disorders, including multiple sclerosis.$Cause_1": { + "Mother with seizures.$Input4": {} + }, + "Photosensitivity refers to an abnormal sensitivity to light, a neurological symptom that people with MS may experience and is related to damage to the optic nerve.$Cause_1": { + "The pupils react normally to light directly$Input5": {} + }, + "Increased muscle tone and spasticity are often associated with damage to the central nervous system, which is one of the classic symptoms of MS and indicates that the patient may have pathological changes in the brain or spinal cord.$Cause_1": { + "Increased tone of b/l, spasticity more\nprominent in R than L.$Input5": {} + }, + "A positive Romberg sign is often associated with balance and coordination impairment, which may be due to damage to the cerebellum or posterior cord spinal pathways. In MS, this symptom may reflect dysfunction in multiple parts of the nervous system.$Cause_1": { + "+Romberg, and unable to walk in tandem.$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "The patient is a right-handed man followed by Dr. who presents with R arm and leg weakness, pain and numbness/tingling. History is provided by the patient, who is a somewhat poor historian. \n\ufeff\nPatient reports he was in his usual state of health until approximately 6:30pm on the night prior to presentation, approximately 12 hours prior to my evaluation. He was at work at the time; he does have manual labor associated with the job. He noticed that the right arm and leg was weak, as he was having difficulty doing motor tasks with the right hand. He could walk, but had difficulty using his right leg due to weakness. He was unable to drive home due to his weakness, which prompted him to go to ED. Since onset of symptoms, he reports they have waxed and waned, but generally are unchanged overall. No progression of symptoms. \n\ufeff\nThe patient for which he is followed by a neurologist (Dr. He currently is not on any therapy for this. He was on injectibles for some time, then switched to Tecfidera about 5 years ago. He self-discontinued the Tecfidera one year ago due to facial flushing/swelling. He reports that when he saw his neurologist in follow up, he said the medication was not needed at this time. He says his typical flares are characterized by right hand weakness and sensory changes. Currently, his right hand symptoms are similar to his typical flare, but the right leg is new. \n\n", + "input3": "Seizure disorder\n", + "input4": "Mother with seizures.\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAMINATION: \nPHYSICAL EXAM:\nVS: 97.7F, HR 52, BP 129/86, RR 16, O2 98% RA \nBladder Scan: pending (requested) \n\ufeff\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, moist mucous membranes\nCardiac: RRR.\nPulmonary: Breathing comfortably on room air. \nAbdomen: Soft, NTND\nExtremities: +R SLR and negative Crossed Leg Raise \nSkin: No rashes noted.\nBack: no spinal or paraspinal tenderness\nGU: intact perianal sensation, normal rectal tone (personally checked)\n\ufeff\nNeuro:\nMental status: Awake, alert, oriented to person, place and time. Attention to examiner easily maintained. Recalls a coherent history. Speech is fluent with full sentences. There are no paraphasic errors. Cooperative with exam with normal affect. \n\ufeff\nCN: The pupils react normally to light directly. +Photophobia. Extraocular movements are intact. Facial movements are normal and symmetric. Speech is not dysarthric. Shoulder shrug is normal and symmetric. The tongue protrudes in the midline. \n\ufeff\nMotor: Normal Bulk. Increased tone of b/l, spasticity more\nprominent in R than L. R UE cupping, no pronation, no drift.\nDelt Bic Tri WrE FFl FE IO IP Quad Ham TA \nL 5 ___ 5 ___ 5 5 5 5 5\nR 5 ___ 4+ 4+ 4- 4 5 4 5 5 5\n\ufeff\nSensory: For pinprick, there is no sensory level in the spine. However he has significant sensory loss (says he does not feel pin) in R L2-L3 distribution to pinprick, with hyperesthesia to pinprick more distally on the R side. Intact perianal sensation to pinprick. \n\ufeff\nDTRs: \nToes are mute bilaterally \nBi Tri ___ Pat Ach \nL 3 3 3 3 4 \nR 3 3 3 3 4\ncrossed adductors and pectoralis jerks present 4 beats of ankle clonus b/l \n \nGait and Stance: Able to ambulate, narrow base. No ataxia or sway. +Romberg, and unable to walk in tandem. \n\n", + "input6": "Hematology \nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW RDWSD Plt Ct \n___ 05:20AM 9.3 5.09 15.2 45.8 90 29.9 33.2 12.5 41.2 223 Import Result \n\ufeff\n \nDIFFERENTIAL Neuts Bands Lymphs Monos Eos Baso Atyps Metas Im \n___ AbsLymp AbsMono AbsEos AbsBaso \n___ 05:20AM 51.1 36.1 9.1 2.5 1.0 0.2 4.77 3.36 0.85* 0.23 0.09* Import Result \n\ufeff\n \nBASIC COAGULATION, PTT, PLT, INR) PTT\n___ 05:20AM 223 Import Result \n\ufeff\n \n___ 05:20AM 11.5 29.7 1.1 Import Result \n\ufeff\n \n \n\ufeff\nChemistry \nRENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 05:20AM 131* 16 0.7 141 3.6 Import Result \n\ufeff\n \nESTIMATED GFR (MDRD CALCULATION) estGFR \n___ 05:20AM Using this Import Result \n\ufeff\n \nENZYMES & BILIRUBIN ALT AST LD(LDH) CK(CPK) AlkPhos Amylase \nTotBili DirBili \n05:20AM 155 Import Result \n \n \nMRI Spine 1. Multiple T2 hyperintense, enhancing peripheral cervical spinal cord lesions, as described, with appearance and configuration suggestive of active demyelinating lesions in the setting of known multiple sclerosis. No additional lesions seen within the remainder of the spinal cord. \n\ufeff\n2. No epidural collection or evidence of discitis-osteomyelitis. \n\ufeff\n3. Mild degenerative disc disease, as described, without significant spinal canal or neural foraminal narrowing throughout the spine. \n4. Bilateral L5 spondylolysis without spondylolisthesis. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12979013-DS-8.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12979013-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..22add02d59a490bfa4ee72919fff3920ec1da04e --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12979013-DS-8.json @@ -0,0 +1,32 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "This indicates that paresthesias in the hands tend to recur, which is a relapsing characteristic of RRMS.$Cause_1": { + "same paresthesias in the hands as before$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "The cervical cord had a T2-weighted hyperintense area at the C3/C4 level, with slight extension to C2 and C5, accompanied by heterogeneous enhancement. In addition, the associated edema extended to the C5 level. These symptoms suggest possible demyelinating damage to the nerve, which is a typical radiological manifestation of multiple sclerosis.$Cause_1": { + "Area of T2 hyperintensity in the cervical cord at the level of C3/C4 with mild linear extension to the level of C2 and C5 and likely heterogeneous enhancement. There is associated edema extending to the level of C5. There is prominence of the central canal of the spinal cord with T2 hyperintense signal surrounding the canal at the level of the lesion.$Input6": {} + }, + "MRI of the head showed multiple high signal lesions in the peripheral white matter areas of the brain on FLAIR sequences, especially in the left centrum semiovale, right paraatrial area, bilateral temporal lobes, and dorsal region of the corpus callosum. These lesions are common in multiple sclerosis and suggest a demyelinating process.$Cause_1": { + "ultiple hyperintense lesions on FLAIR sequence, in the periventricular white matter, specifically in the left centrum semiovale, right periatrial region, the temporal lobes bilaterally and in splenium of the corpus callosum.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "These symptoms may be related to nerve inflammation or muscle tension, which are more common in people with MS.$Cause_1": { + "feel neck stiffness and soreness in his trapezius$Input2": {} + }, + "Patients experience pain and decreased strength when performing certain movements, which may be due to nerve dysfunction caused by MS.$Cause_1": { + "felt soreness and weakness in his arms (specifically with over head maneuvers)$Input2": {} + }, + "This feeling of instability and unilateral weakness is a sign of the motor coordination problems caused by nerve damage in MS.$Cause_1": { + "legs are \"wobbly\" and feels like his left side is weak in comparison to his right$Input2": {} + } + } + } + }, + "input1": "None\n", + "input2": "Right-handed man. He was seen by Dr was started on Capaxone. About 3 weeks ago he states he has started to feel neck stiffness and soreness in his trapezius. About one week ago he started to feel the same paresthesias in the hands as before and has since also felt soreness and weakness in his arms (specifically with over head maneuvers), he feels his legs are \"wobbly\" and feels like his left side is weak in comparison to his right. He also feels two bands (one on his chest and one on his abdomen). \n\ufeff\nOn ROS: He denies any recent infection, fever, chills, nausea, vomiting, chest pain or SOB. He has had no falls, He denies LOC, language difficulties, changes to vision or diplopia.\n", + "input3": "None\n", + "input4": "Father with DM.\n", + "input5": "N/A\n", + "input6": "CSF: \n___ 04:40PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-1* Polys-0 \n___ 04:40PM CEREBROSPINAL FLUID (CSF) TotProt-77* Glucose-59\n___ 04:40PM CEREBROSPINAL FLUID (CSF) \ufeff\nBlood: \n___ 01:20PM BLOOD WBC-7.2 RBC-5.57 Hgb-17.0 Hct-47.2 MCV-85 MCH-30.4 MCHC-35.9* RDW-13.4\n___ 01:20PM BLOOD Neuts-64.8 Monos-6.0 Eos-1.8 Baso-0.7\n___ 01:20PM BLOOD Glucose-118* UreaN-18 Creat-1.0 Na-142 K-4.0 Cl-104 HCO3-28 AnGap-14\n___ 01:20PM BLOOD Glucose-118* UreaN-18 Creat-1.0 Na-142 K-4.0 Cl-104 HCO3-28 AnGap-14\n___ 06:15AM BLOOD Calcium-9.2 Phos-3.8 Mg-2.1\n___ 06:15AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 06:15AM BLOOD %HbA1c-5.2 \n\ufeff\nUrine: \n\ufeff\n___ 03:41PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG\n___ 03:41PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG\n\ufeff\nMRI C Spine: \nArea of T2 hyperintensity in the cervical cord at the level of C3/C4 with mild linear extension to the level of C2 and C5 and likely heterogeneous enhancement. There is associated edema extending to the level of C5. There is prominence of the central canal of the spinal cord with T2 hyperintense signal surrounding the canal at the level of the lesion. Given the lesions in the brain, this is likely related to demyelination. However, correlate clinically with labs, CSF studies and consider close follow up to exclude other etiologies such as inflammtion/neoplastic and follow up as clinically indicated. Comparison with priors can be helpful. Vertebral body hemangiomas at the level of C3, C4, and T3. \n\ufeff\nMRI Head: \nMultiple hyperintense lesions on FLAIR sequence, in the periventricular white matter, specifically in the left centrum semiovale, right periatrial region, the temporal lobes bilaterally and in splenium of the corpus callosum. Given the clinical history, these are likely related to demyelinating disease. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12994754-DS-19.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12994754-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..07b6b9314960d167bf9ef134162934bedfe8ba9c --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12994754-DS-19.json @@ -0,0 +1,41 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "Steroids given again for double vision.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Multiple enhancing lesions suggested active demyelination, and one also showed slowed diffusion, suggestive of an ongoing demyelinating process.$Cause_1": { + "There are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Diplopia, or double vision, is a common symptom of multiple sclerosis, usually due to optic neuritis.$Cause_1": { + "diplopia$Input2": {} + }, + "Blurred vision may be related to inflammation of the optic nerve or other nerve damage, which is more common in people with multiple sclerosis.$Cause_1": { + "blurring of her vision.$Input2": {} + }, + "Methylprednisolone is a commonly used glucocorticoid for the treatment of acute attacks of multiple sclerosis, and its use indicates possible acute inflammation.$Cause_1": { + "course of IV methylprednisolone$Input2": {} + }, + "Trigeminal neuralgia is a painful neurological symptom that people with multiple sclerosis may experience and is related to demyelination of nerve fibers in the brain.$Cause_1": { + "developing trigeminal neuralgia$Input2": {} + }, + "There is a slight downward torsional nystagmus in the left eye, which may occur in people with MS.$Cause_1": { + "There is slight downward torsional nystagmus in the left eye$Input5": {} + }, + "Patients report double vision in neutral vision and in all major visual fields, which may be a symptom of MS$Cause_1": { + "She reports diplopia at neutral gaze and in all cardinal fields of gaze.$Input5": {} + }, + "Patients report false images following them when tracking objects, which may be a visual symptom of MS.$Cause_1": { + "a trailing of false images with pursuits$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "She is a woman who presents with diplopia. The patient was driving two days prior to admission and noted the gradual onset of diplopia. It was not more prominent in a particular position of gaze. The diplopia resolved completely if she closed one eye. Over the course of the day the diplopia became more severe and she noted transient blurring of her vision. She denies any visual field loss. The blurred vision seemed concordant with the onset of a constant, dull, bilateral retro-orbital headache. The headache improves if she closes her eyes. It is not positional, no worse with cough or valsalva. She denies any neck pain. The diplopia persists, and the pt now presents to the neurology floor for direct admission for further evaluation and treatment. At present she is tearful at times and visibly distressed by her symptoms. She denies any paresthesia, weakness, dysarthria, dysphagia. She denies any difficulty initiating or fully emptying her bladder. Denies dysuria or increased frequency. No diarrhea or constipation. She reports having a small pustular rash that is improving over her right shoulder. No pain from her port-a-cath site. She has chronic skin breakdown over the stump on her right BKA, but no discharge or purulence.\n \nShe had a six- day course of IV methylprednisolone, started Avonex. Stopped Avonex for depression. Steroid course for burning sensation in LUE and LLE later developing trigeminal neuralgia. Steroids given again for double vision. On standing steroid infusion q3 months in addition. \n", + "input3": "1) GERD\n2) S/p R BKA after motor vehicle accident. \n3) S/p cholecystecomy \n4) Depression\n", + "input4": "Mother has crohn's dz. no neuro d/o or sz.\n", + "input5": "Physical Exam:\nVitals: T- 97.8 BP- 114/62 HR- 90 RR- 18 O2Sat- 97% on RA\nGen: Sitting up in bed, NAD\nHEENT: NC/AT, moist oral mucosa. \nNeck: No Lhermitte's no carotid or vertebral bruit\nCV: RRR, Nl S1 and S2, no murmurs/gallops/rubs\nLung: Clear to auscultation bilaterally\nAbd: +BS soft, nontender\next: no edema, small, non fluctuant areas of excoriation on left\nBKA stump.\nSkin: few scattered healing follicles over R torso.\n\ufeff\nNeurologic examination:\nMental status: \nAwake and alert, cooperative with exam, normal affect. Oriented to person, place. Attentive. Speech is fluent with normal comprehension and repetition. She relates her history without any difficulty. No dysarthria. No right left confusion. No evidence of apraxia or neglect.\n\ufeff\nCranial Nerves:\nPupils equally round and reactive to light, 5 to 3 mm bilaterally. Visual fields are full to confrontation. Pt would not allow funduscopic exam. No RAPD. Extraocular movements full bilaterally. There is slight downward torsional nystagmus in the left eye. The patient covers her eyes frequently during testing of EOM's due to discomfort. No definite INO. She reports diplopia at neutral gaze and in all cardinal fields of gaze. She reports a trailing of false images with pursuits. Facial sensation intact V1-V3. Facial movement symmetric. Hearing intact to finger rub bilaterally. Palate elevation symmetrical. Sternocleidomastoid and trapezius normal bilaterally. Tongue protrudes at midline without fasciculation.\n\ufeff\nMotor:\nNormal bulk bilaterally. Tone normal. No observed myoclonus or tremor. No pronator drift\nDel Tri Bi WF WE FE FF IP H Q DF PF TE TF\nR 5 5 - - - - (R BKA)\n\ufeff\nSensation: Intact to light touch, pinprick, vibration and\nproprioception throughout. No extinction to DSS\n\ufeff\nReflexes: Slightly increased on left vs. right. Left bi, tri, brachioradialis 2+, right 2. left patellar 2+, ankle 2+. Right BKA.\n\ufeff\nToes downgoing on left, right not testable\n\ufeff\nCoordination: finger-nose-finger normal, RAMs normal.\n\ufeff\nGait- deferred as pt without prosthesis.\n\ufeff\n", + "input6": "___ 06:21PM URINE COLOR-Yellow APPEAR-Hazy\n___ 06:21PM URINE BLOOD-NEG NITRITE-POS PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-SM\n___ 06:21PM URINE BACTERIA-MOD YEAST-NONE \n___ 05:20PM GLUCOSE-71 UREA N-9 CREAT-0.9 SODIUM-142 POTASSIUM-4.5 CHLORIDE-106 TOTAL CO2-27 ANION GAP-14\n___ 05:20PM estGFR-Using this\n___ 05:20PM CALCIUM-9.8 PHOSPHATE-4.2 MAGNESIUM-2.3\n___ 05:20PM WBC-8.7 RBC-5.40 HGB-16.2* HCT-47.8 MCV-89 MCH-30.0 MCHC-33.9 RDW-13.0\n___ 05:20PM NEUTS-70.4* MONOS-4.5 EOS-1.2 BASOS-0.5\n___ 05:20PM PLT COUNT-375\n\ufeff\nThere are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12994754-DS-21.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12994754-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..e0942f6ac6b8c0623192f41a6e95d3a5f493bb6e --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/12994754-DS-21.json @@ -0,0 +1,35 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Suspected relapse of disease, which has distinct periods of attack (relapse) and remission$Cause_1": { + "having recurrent trigeminal neuralgia and L arm pain$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "These drugs are either immunomodulators or immunosuppressants used to treat multiple sclerosis$Cause_1": { + "treated with Avonex, Copaxone, Methotrexate and Azathioprine in the past$Input2": {} + }, + "Multiple new supratentorial and infratentorial demyelinating lesions were reported, which showed a slow spread, suggesting an acute etiology, which is one of the key indicators for diagnosing multiple sclerosis, as MS characteristically involves a demyelinating process in the central nervous system.$Cause_1": { + "multiple new supratentorial and infratentorial demyelinating lesions are identified compared. Some of the lesions demonstrate slow diffusion, suggesting acute etiology$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Leg weakness is a common symptom of MS$Cause_1": { + "Leg weakness$Input1": {} + }, + "This is a typical symptom of nerve pain, which may be related to multiple sclerosis$Cause_1": { + "suddenly had shooting L hip pain of pins and needles that radiated anteriorly from hip down to the toes$Input2": {} + }, + "Blurred vision is a common symptom in people with multiple sclerosis and may be caused by optic neuritis.$Cause_1": { + "blurry vision occurred 3~4x today.$Input2": {} + }, + "Double vision is a common symptom in people with multiple sclerosis and may be related to damage to the eye nerves$Cause_1": { + "diplopia$Input2": {} + } + } + } + }, + "input1": "Leg weakness\n", + "input2": "Per patient, she suddenly had shooting L hip pain of pins and needles that radiated anteriorly from hip down to the toes followed by weakness this afternoon. She thinks that the blurry vision occurred 3~4x today.\n\ufeff\nShe denies any issues prior to today. She has been feeling her usual self without any fever/chills, cough, dysuria, HA, N/V/D or sick contact. She denies any recent falls or trauma. She also denies any recent stressors including issues with her daughter. She also denies any bowel or urinary symptoms including constipation, retention or incontinence. Also, no Lhermitte's or band-like sensation in her torso.\n\ufeff\nThis was followed by burning sensation over L arm and leg in following which again resolved with IV steroids but patient has been having recurrent trigeminal neuralgia and L arm pain ever since for which she was on Topamax and Trileptal but she has weaned herself off of Trileptal because it made her feel sick. She was admitted for diplopia then, she was again admitted for L sided weakness which was treated with IV Solu-Medrol.\n\ufeff\nShe had been treated with Avonex, Copaxone, Methotrexate and Azathioprine in the past. Patient reports that she is due for her bimonthly steroids next week.\n\ufeff\n", + "input3": "1. hx of R BKA after motorcycle accident.\n2. GERD\n3. Depression\n4. s/p cholecystectomy\n", + "input4": "Mother has disease and father abused EtOH but no neurological disease.\n", + "input5": "Physical Exam:\nOn admission: \n\ufeff\nT 99.2 BP 115/76 HR 116 RR 16 O2Sat 98% RA\nGen: Lying in bed, comfortably talking without any signs of distress although she rates her HA and morphine not touching the pain.\nMultiple tattoos including L ankle and lower back.\nHEENT: NC/AT, moist oral mucosa \nBack: No point tenderness or erythema\nCV: RRR, no murmurs/gallops/rubs \nLung: Clear \nAbd: +BS, soft, nontender \nExt: R prosthetic for BKA but no edema on LLE and 1+ dorsalis pedis palpable. \n\ufeff\nNeurologic examination: \nMental status: Awake and alert, cooperative with exam, normal affect. Oriented to person, place, and date. Attentive, says backwards. Speech is fluent with normal comprehension and repetition; naming intact. No dysarthria. Reading intact. No right left confusion. No evidence of apraxia or neglect.\n \nCranial Nerves: \nII: Pupils equally round and reactive to light, 4 to 2 mm\nbilaterally - no afferent pupillary defect. Visual fields are\nfull to confrontation. \nIII, IV & VI: Extraocular movements intact bilaterally, no\nnystagmus. \nV: Sensation intact to LT and PP. \nVII: Facial movement symmetric. \nVIII: Hearing intact to finger rub bilaterally. \nX: Palate elevation symmetrical. \nXI: Sternocleidomastoid and trapezius normal bilaterally. \nXII: Tongue midline, movements intact\n \nMotor: \nNormal bulk and tone bilaterally. No observed myoclonus or tremor. No asterixis or pronator drift. Negative Hoover's sign.\nDel Tri Bi WE FE FF IP Add Abd H Q DF PF \nR ___ ___ ___ * * * * \nL ___ ___ ___ ___ 5 \n \nSensation: Intact to light touch, vibration, cold and proprioception throughout. Some stocking PP loss up to mid-shin on LLE.\n \nReflexes: \n+2 and symmetric for UEs. Unable to test RLE but 2 for L patellar. \nToes downgoing on L. \n \nCoordination: FTN, FTF and RAMs normal. \n \nGait: Deferred.\n\ufeff\n", + "input6": "Labs on admission:\n___ 06:40PM BLOOD WBC-8.0 RBC-5.07 Hgb-14.9 Hct-44.6 MCV-88 MCH-29.4 MCHC-33.5 RDW-12.7\n___ 06:40PM BLOOD Neuts-64.9 Monos-3.8 Eos-0.3 Baso-0.3\n___ 06:40PM BLOOD PTT-30.9\n___ 06:40PM BLOOD Glucose-89 UreaN-8 Creat-0.8 Na-139 K-3.8 Cl-109* HCO3-21* AnGap-13\n___ 06:40PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\ufeff\nMR with and without contrast: Mild disc bulging at L2-3 and L3-4 levels with a small protrusion in the midline at L3-4 level minimally indenting the thecal sac. No other significant abnormalities. \n\ufeff\nmultiple new supratentorial and infratentorial demyelinating lesions are identified compared. Some of the lesions demonstrate slow diffusion, suggesting acute etiology\n\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13043422-DS-9.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13043422-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..917275dbd6d2df94f884606870fbc1b3df77e274 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13043422-DS-9.json @@ -0,0 +1,26 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "In the ED she said her symptoms had subsided and her condition had returned to a stable state.She said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "This describes multiple bilateral round and oval T2/FLAIR hyperintense white matter lesions located in the subcortical and periventricular white matter as well as in the posterior fossa and brainstem, which are most likely manifestations of a demyelinating process.$Cause_1": { + "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Multiple sclerosis may affect the central nervous system, including the nerves that control urination. Urinary retention may be due to impaired bladder function.$Cause_1": { + "retaining urine$Input2": {} + }, + "Horizontal nystagmus is a classic symptom of MS. These rapid, involuntary eye movements may be caused by MS causing inflammation or damage to the part of the brain responsible for coordinating eye movements.$Cause_1": { + "horizontal nystagmus noted$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "The patient is a female with a past medical history significant for depression. The patient states that 2 weeks ago, she had a foley catheter placed because she was found to be retaining urine. About 1 week ago she noted cloudy, foul urine draining from her catheter as well as suprapubic abdominal pain. The nursing home also noted fevers up to 100.4. The patient is unsure how long she has been having fevers and denies chills. She was sent here from the nursing home where she resides. She denies fevers, chills, chest pain, shortness of breath, nausea, vomiting.\n\nIn the ED she said her symptoms had subsided and her condition had returned to a stable state.She said similar situations had happened before.\n\n\ufeff\nIn the ED, vital signs were T: 98.9 HR 104 BP: 114/68 RR: 20 94% RA. Labs were remarkable for an elevated WBC (11.3) and UA with >182 WBC, pos Nitrites and small Leuks. CT abd/pelvis did not show pyelonephritis. The patient was treated with one dose of ceftriaxone.\n", + "input3": "+ Depression \n+ Insomnia \n+ cataracts \n+ bladder incontinence\n", + "input4": "None\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM\nVS t: 98.1 bp: 115/74 hr 116 rr 20 95% on RA\nGeneral: NAD\nHEENT: horizontal nystagmus noted\nNeck: no LAD\nCV: tachycardia, RRR, no murmurs\nLungs: clear to auscultation bilaterally, no rales/wheezes\nAbd: +BS, soft, nondistended, tender to palpation suprapubically\nExt: no edema\nNeuro: AAOx3\n\ufeff\n", + "input6": "ADMISSION LABS\n___ 02:22AM BLOOD WBC-11.3* RBC-4.71 Hgb-14.0 Hct-41.7 MCV-89 MCH-29.8 MCHC-33.7 RDW-13.4\n___ 02:22AM BLOOD Neuts-53.5 Monos-9.3 Eos-0.9 Baso-0.9\n___ 02:22AM BLOOD PTT-22.2*\n___ 02:22AM BLOOD Glucose-104* UreaN-22* Creat-0.6 Na-140 K-4.0 Cl-102 HCO3-26 AnGap-16\n___ 02:22AM BLOOD ALT-52* AST-33 AlkPhos-79 TotBili-0.6\n___ 02:22AM BLOOD Albumin-3.9\n___ 08:39AM BLOOD Calcium-9.8 Phos-3.7 Mg-2.3\n\ufeff\nCT abd/pelvis\nIMPRESSION: \n1. Foley catheter within the bladder, which is collapsed, \nlimiting its \nevaluation. A small amount of surrounding stranding may be \nrelated to \ncystitis. No evidence of pyelonephritis. \n2. Small amount of free fluid, which would be abnormal in a \npost-menopausal patient, though is nonspecific. \n3. 2.2 cm left ovarian cyst. If the patient is premenopausal, \nthis is likely normal follicular activity. If the patient is \npostmenopausal, further evaluation with a non-emergent pelvic \nultrasound is recommended. \n4. Large amount of stool within the rectum. \n\ufeff\nUrine culture\nURINE CULTURE (Final: \nPROTEUS MIRABILIS. >100,000 ORGANISMS/ML. \nPRESUMPTIVE IDENTIFICATION. \nPSEUDOMONAS AERUGINOSA. >100,000 ORGANISMS/ML..\n\ufeff\nSENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\nPROTEUS MIRABILIS\n| PSEUDOMONAS AERUGINOSA\n| | \nAMPICILLIN------------ <=2 S\nAMPICILLIN/SULBACTAM-- <=2 S\nCEFEPIME-------------- <=1 S 4 S\nCEFTAZIDIME----------- <=1 S <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN--------- =>4 R 1 S\nGENTAMICIN------------ <=1 S <=1 S\nMEROPENEM-------------<=0.25 S 1 S\nPIPERACILLIN/TAZO----- <=4 S 8 S\nTOBRAMYCIN------------ <=1 S <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n\ufeff\nMultiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.\n\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13849116-DS-12.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13849116-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..8f2af8f74f5c8dc0c04b09dfa0c9e6378ff50b7e --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13849116-DS-12.json @@ -0,0 +1,41 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Relapsing-Remitting MS is characterized by obvious attacks (relapses) and remission periods.$Cause_1": { + "She has had similar symptom about 1 years ago.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "The bilateral subcortical and periventricular white matter, as well as the supratendentate white matter lesions in the corpus callosum spinal cord, showed evidence of myelin loss. The distribution and morphology of these lesions were suggestive of multiple sclerosis.$Cause_1": { + "Supratentorial white matter lesions within the bilateral subcortical and periventricular white matter and within the splenium of the corpus callosum, some demonstrating signs of myelin loss. No postcontrast enhancement within the cortical lesions.$Input6": {} + }, + "There is a wedge-shaped T2 hyperintensity in the left posterolateral spinal cord from C2 to C4, with the maximum at C3, with contrast enhancement on the side of the lesion. This may represent an inflammatory and demyelinating process.$Cause_1": { + "T2 hyperintensity in wedge-shaped pattern in left posterolateral cord from C2-C4, maximal at C3. Contrast enhancement on lateral aspect of this lesion.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "These symptoms may indicate impaired nerve function, which is typical of multiple sclerosis.$Cause_1": { + "progressive weakness and sensory changes$Input2": {} + }, + "People with MS may experience nerve pain, which may spread along the path of the nerves.$Cause_1": { + "left hip, low back, and shoulder pain$Input2": {} + }, + "Radiating pain may indicate lesions in the central nervous system, a hallmark of MS$Cause_1": { + "pain radiates to the right and down her spine$Input2": {} + }, + "Paresthesias are common symptoms of MS and are often related to demyelination of nerve fibers.$Cause_1": { + "bl feet parasthsias L>R$Input2": {} + }, + "Tingling sensation in the face and arms while reading. This is related to central nervous system disease and may be a symptom of MS.$Cause_1": { + "tingling in her her face and bl arms when she was reading$Input2": {} + }, + "Mild red desaturation in the left eye may be a symptom of multiple sclerosis. This phenomenon refers to the loss of the retina's ability to perceive color, especially red, which is more common in people with MS because MS can affect the visual pathways.$Cause_1": { + "mild red-desaturation reported of the left eye.$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "She is a woman with minimal PMH who presents with 2 weeks of progressive weakness and sensory changes. The symptoms first started 2 weeks ago when her left knee \"buckled back\", which she describes as locking in an extended position. She saw her PCP who thought this was likely OA given her history of OA and she was given a knee brace which helped some. About 1 week later she developed left hip, low back, and shoulder pain. The shoulder pain radiates to the right and down her spine. She describes the pain as achy, tingling and very itchy. She then noticed bl feet parasthsias L>R. She had one event tingling in her her face and bl arms when she was reading. She reports the parasthesias seem worse when she is in the heat. She denies lhermitte's. She has never had any symptoms like this in the past. She has never had sudden loss of vision in one eye. She denies any recent illness.\n\nShe has had similar symptom about 1 years ago.\n\ufeff\n", + "input3": "+ ASTHMA\n+ DEPRESSIVE DISORDER\n+ Obesity\n+ chronic Constipation\n+ Hypertension\n", + "input4": "She does not know much detail about her family. her mother died as a complication of renal disease. her father died of cancer - unknown primary. no known history of MS or neurologic disease\n", + "input5": "Physical Exam:\nOn admission:\n\ufeff\nT: 97.2 HR: 64 BP: 142/63 RR: 18 Sat:100% on RA \n\ufeff\nGENERAL MEDICAL EXAMINATION:\nGeneral appearance: alert, in no apparent distress, conversing/interacting appropriately \nHEENT: Neck is supple, non-tender, Sclera are non-injected. Mucous membranes are moist. \nCV: Heart rate is regular\nLungs: breathing comfortably on RA \nAbdomen: soft, non-tender\nExtremities: No evidence of deformities. No contractures. No Edema. \nSkin: No visible rashes. Warm and well perfused.\n\ufeff\nNEUROLOGICAL EXAMINATION:\nMental Status: Alert and oriented to person place and time. Able to relate history without difficulty. Attentive to conversation. Language is fluent and appropriate with intact comprehension, repetition and naming of both high and low frequency objects. Normal prosody. There were no paraphasic errors. Speech was not dysarthric. Able to follow both midline and appendicular commands. No neglect, left/right confusion or finger agnosia. \n\ufeff\nCranial Nerves:\nI: not tested\nII: visual fields full to confrontation, fundi (could not visualize in the ED hallway).\nIII-IV-VI: pupils equally round, reactive to light. Normal conjugated, extra-ocular eye movements in all directions of gaze.\nNo nystagmus or diplopia. no rAPD seen. mild red-desaturation reported of the left eye. \nV: Symmetric perception of LT in V1-3 \nVII: Face is symmetric at rest and with activation; symmetric speed and excursion with smile.\nVIII: Hearing intact to finger rub bl\nIX-X: Palate elevates symmetrically\nXI: Shoulder shrug and head rotation \nXII: No tongue deviation or fasciculations\n", + "input6": "08:15PM HIV Ab-NEGATIVE\n08:15PM TSH-2.0\n08:15PM VIT B12-498\n08:15PM ALT(SGPT)-14 AST(SGOT)-15 ALK PHOS-63 TOT BILI-0.3\n09:31AM BLOOD ANCA-NEGATIVE B\n09:31AM BLOOD C3-114 C4-35\n09:31AM BLOOD SED RATE-Test \n04:22PM BLOOD NEUROMYELITIS OPTICA (NMO)/AQUAPORIN-4-IGG CELL-BINDING ASSAY, SERUM-PND\n08:15PM BLOOD COPPER (SERUM)-Test\n08:15PM BLOOD METHYLMALONIC ACID-Test\n08:15PM BLOOD ANGIOTENSIN 1 - CONVERTING\n\ufeff\nMRI head:\n1. Supratentorial white matter lesions within the bilateral subcortical and periventricular white matter and within the splenium of the corpus callosum, some demonstrating signs of myelin loss. No postcontrast enhancement within the cortical lesions. The differential includes other demyelinating process. No evidence of optic nerve involvement. \n2. Partially visualized enhancing lesion within left lateral aspect of the cervical cord, which is relatively unchanged. \n\ufeff\nMRI C spine:\nT2 hyperintensity in wedge-shaped pattern in left posterolateral cord from C2-C4, maximal at C3. Contrast enhancement on lateral aspect of this lesion.\n\ufeff\nMRI T/L spine:\n1. T2 cord signal hyperintensity extending from the T5-T6 to the T8 levels, without evidence of postcontrast enhancement. There is mild associated cord expansion at the T7 level. Finding is nonspecific and may be seen in setting of inflammatory and demyelinating processes. Given the cervical and intracranial white matter lesions, this likely represents sequela of multiple sclerosis. \n \n2. Multilevel degenerative changes of the lumbar spine, as described above, with areas of moderate to severe spinal canal and lateral recess stenosis which contacts the traversing nerve roots. \n\ufeff\nCT chest with contrast: \n1. No evidence of hilar or mediastinal lymphadenopathy to suggest sarcoidosis \n2. Evidence of previous granulomatous exposure. \n3. 3 mm noncalcified right upper lobe nodule is statistically very likely benign.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13901573-DS-18.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13901573-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..b7e21508c483b93a153336700d98da6fcb913e51 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/13901573-DS-18.json @@ -0,0 +1,32 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "In the ED she said his symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Multiple enhancing lesions suggested active demyelination, and one also showed slowed diffusion, suggestive of an ongoing demyelinating process.$Cause_1": { + "There are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Abnormal sensations and symptoms that come and go in the hands and feet may be signs of MS activity. These symptoms are related to nerve damage and are common in MS.$Cause_1": { + "one day of right foot parasthesias as well as waxing and waning symptoms in her left foot and hands$Input2": {} + }, + "This tingling and \"frostbite-like\" feeling may be related to neuropathy, which is common in MS.$Cause_1": { + "tingling in both feet which felt \"like frostbite,\" which were worst in the right foot$Input2": {} + }, + "Dysphagia can also be a symptom of MS and involves impaired nerve control of muscle function.$Cause_1": { + "difficulty swallowing$Input2": {} + }, + "She had tingling sensations in both hands that came and went. Nerve problems are a sign of MS$Cause_1": { + "She has had waxing and waning tingling in her hands bilaterally.$Input2": {} + } + } + } + }, + "input1": "None\n", + "input2": "She is a woman who presents with one day of right foot parasthesias as well as waxing and waning symptoms in her left foot and hands. \n\ufeff\nShe was in her normal state of health two days ago when she went to sleep. Yesterday morning she woke from sleep with tingling in both feet which felt \"like frostbite,\" which were worst in the right foot. She attributed this to stress and went about her day. She noticed some difficulty swallowing when eating peas and rice. The symptoms remained constant in her feet and spread to her hands as well. They were present in her hands and feet when she went to bed. At 3 AM she woke from sleep with more severe pain in her feet, right more than left, and a feeling of shortness of breath, tongue heaviness and difficulty breathing, as well as sweating and tremulousness of the hands. For this reason she presented to the emergency department. She has had waxing and waning tingling in her hands bilaterally. Prior to my seeing her she received toradol with improvement in her hands and left foot but not in her feet. Her breathing has improved.\n\ufeff\nHer menses started yesterday and she has a history of catameial migraine but she denies any headache. In addition, the symptoms she awoke with this morning are similar to her past panic attacks, which reportedly feel \"like death.\" She does endorse several stressful events recently, including multiple funerals, recent diagnosis of bartholin gland cyst with drainage, and urinary tract infection for which she has completed treatment. These problems have not relapsed. She has not been sleeping well for several weeks. She is also thinking about changing Neurologists. She is upset that Dr her to return to clinic before renewing her lorazepam and she feels that he just wants to give her more medications, not make her better.\n\ufeff\nIn the ED she said his symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.\n", + "input3": "1) Migraines - correlating with menses\n2) Sickle cell trait\n3) Anxiety/depression\n", + "input4": "None\n", + "input5": "Physical Exam:\nGeneral Physical Examination:\nGen: Lying in bed, wrapped tightly in blankets, shivers when uncovered.\nHEENT: NC/AT. No scleral icterus or injection.\nNeck: Able to touch chin to chest.\nPulmonary: Normal work of breathing. Vesicular breath sounds bilaterally, no wheezes or crackles appreciated.\nCardiac: S1/S2 appreciated, RRR, no M/R/G.\nAbdomen: Obese, soft, nondistended, palpation elicits nausea but not tender.\nExtremities: No lower extremity edema\nMSK: Joints without erythema, warmth or effusion.\nSkin: No rashes or lesions noted. Variation in pigmentation over skin.\n \nNeurologic Examination:\n-Mental Status: alert, oriented fully, attentive, follows commands. Language is fluent, comprehension intact, naming intact to high and low frequency objects.\n\ufeff\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 5 to 4mm, bilaterally. VFF to confrontation with finger wiggling.\nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch in all distributions.\nVII: No facial droop, facial musculature symmetric and strength in upper and lower distributions, bilaterally \nVIII: Hearing not tested.\nIX, X: Palate elevates symmetrically.\nXI: Strength in trapezii bilaterally, turns head right to left briskly.\nXII: Tongue protrudes in midline.\n \n-Motor: normal bulk and tone. Strength testing to confrontation in all motor groups. No fasciculations.\n\ufeff\n-DTRs: 2+ symmetrically. Toes downgoing bilaterally.\n\ufeff\n-Sensory: intact bilaterally to light touch and temperature.\n\ufeff\n-Coordination: No dysmetria on FNF or HKS bilaterally. Finger tapping rapid and accurate.\n\ufeff\n-Gait: steady, narrow-based gait.\n\ufeff\n", + "input6": "___ 05:20AM BLOOD WBC-14.5* RBC-3.52* Hgb-10.2* Hct-31.4* MCV-89 MCH-29.0 MCHC-32.5 RDW-14.9 RDWSD-48.0*\n___ 05:20AM BLOOD Neuts-52 Bands-0 Monos-4* Eos-6 Baso-0 Myelos-0 NRBC-1* AbsNeut-7.54* AbsLymp-5.51* AbsMono-0.58 AbsEos-0.87* AbsBaso-0.00*\n___ 05:20AM BLOOD Glucose-92 UreaN-6 Creat-0.7 Na-137 K-3.9 Cl-104 HCO3-27 AnGap-10\n\ufeff\nThere are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14676772-DS-16.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14676772-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..34db18dd5425c88d8f8c2f949fe3bcf306c4ed2f --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14676772-DS-16.json @@ -0,0 +1,47 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Temporary remissions and return to a stable state, as well as recurrent episodes of symptoms, are common clinical manifestations of multiple sclerosis. Periodic fluctuations in symptoms and periods of stability are one of the characteristics of the disease.$Cause_1": { + "In the ED she said her symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Newly discovered lesions and enhanced portions indicate an active pathological process, which is consistent with the demyelination features in multiple sclerosis and is an important imaging manifestation for the diagnosis of MS.$Cause_1": { + "New enhancing white matter lesion in the parafalcine posterior left frontal lobe is compatible with active demyelination$Input6": {} + }, + "This provides further support for the idea that there is active demyelination in multiple brain regions, which is common in people with MS.$Cause_1": { + "Smaller focus of enhancement in the right corona radiata as well.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Weakness in the right leg may be due to affected nerve pathways somewhere in the right spinal cord or brain.$Cause_1": { + "right leg weakness$Input1": {} + }, + "One of the common symptoms of multiple sclerosis is muscle weakness, especially in the lower limbs, which can make walking difficult.$Cause_1": { + "worsening lower extremity weakness$Input2": {} + }, + "This sensation may be a manifestation of paresthesia in multiple sclerosis, indicating impaired nerve conduction$Cause_1": { + "symptoms began morning with a \"heavy\" feeling in her right and then left leg$Input2": {} + }, + "The changes may reflect weakened muscle control, a classic symptom of multiple sclerosis.$Cause_1": { + "able to walk but felt herself moving very \"slowly.\"$Input2": {} + }, + "This may be due to muscle coordination disorders, a common symptom in people with multiple sclerosis.$Cause_1": { + "\"tripping\" over her feet$Input2": {} + }, + "Decreased vibration sensation in the big toes can be an indicator of central nervous system disease, as damage to nerve fibers is common in multiple sclerosis, leading to such symptoms.$Cause_1": { + "Diminished \nvibratory sense at great toes bilaterally.$Input5": {} + }, + "Buckling of the knees when walking may indicate problems with motor coordination or weakened muscle strength, which is a common finding in multiple sclerosis due to nerve damage.$Cause_1": { + "right leg buckles at the knee with each stride.$Input5": {} + }, + "Difficulty maintaining balance is a possible symptom of multiple sclerosis affecting the cerebellum or other neural pathways.$Cause_1": { + "Unable to hold balance on tip of her toes or on her heels.$Input5": {} + } + } + } + }, + "input1": "right leg weakness\n", + "input2": "She is a F who presents ED with 3 days of worsening lower extremity weakness. She states that her symptoms began morning with a \"heavy\" feeling in her right and then left leg. She was still able to ambulate and go about her daily activities. Her symptoms persisted. Again, she was still able to walk but felt herself moving very \"slowly.\" Morning, she felt herself \"tripping\" over her feet. She denies having any falls. Due to the fact that her symptoms were persistent and progressive, she presented to the ED. In the ED, she denies any recent illness, fever, URI, or GI symptoms. She does have chronic urge incontinence, which she takes oxybutynin for - she reports no new bowel or bladder symptoms. She denies any HA, neck pain, visual disturbances, or hearing difficulty. She reports some possible pins and needles in both feet, a more recent development. In the ED she said her symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.\n", + "input3": "+ flares\n+ progression on serial MRIs, last = stable\n+ asthma\n+ HTN\n", + "input4": "s/p thyroid removal for ?nodule\n", + "input5": "Physical Exam:\nGENERAL EXAMINATION:\nGEN - overweight woman, pleasant, NAD\nHEENT - NC/AT, MMM\nNECK - full ROM, negative L'Hermitte's\nCV - RRR\nRESP - normal WOB\nABD - obese, NT, ND\nEXTR - atraumatic, WWP\n\ufeff\nNEUROLOGICAL EXAMINATION:\nMS - Awake, alert, oriented x3. Attention to examiner easily attained and maintained. Concentration maintained when recalling months backwards. Recalls a coherent history. Structure of speech demonstrates fluency with full sentences, intact repetition, and intact verbal comprehension. Content of speech demonstrates intact naming (high and low frequency) and no paraphasias. Normal prosody. No dysarthria. No apraxia. No evidence of hemineglect. No left-right agnosia.\n\ufeff\nCN - \n[II] PERRL 3->2 brisk. VF full to number counting. \n[III, IV, VI] EOMI, no nystagmus. [V] V1-V3 without deficits to light touch bilaterally. \n[VII] No facial movement asymmetry with forced eyelid closure or volitional smile. \n[VIII] Hearing intact to finger rub bilaterally. \n[IX, X] Palate elevation symmetric. \n[XI] SCM/Trapezius strength bilaterally. \n[XII] Tongue midline with full ROM.\n\ufeff\nMOTOR - Normal tone. Some wasting of intrinsic hand muscles. No pronation, no drift. No orbiting with arm roll. No tremor or asterixis.\n[Delt] [Bic] [Tri] [ECR] [IO] [IP] [Quad] [Ham] [TA] [Gas] \n[C5] [C5] [C7] [C6] [T1] [L2] [L3] [L5] [L4] [S1] [L5]\nL 5 5 5 5 5 5 5 5 5 5 5\nR 5 5 5 5 5 4+ 5 4+ 5- 5 5\n\ufeff\nSENSORY - No deficits to light touch or pinprick throughout. \nIntact proprioception at great toes bilaterally. Diminished \nvibratory sense at great toes bilaterally.\n\ufeff\nREFLEXES -\n[Bic] [Tri] [] [Quad] [Gastroc]\nL 2 2 2 2 2 \nR 2 2 2 2 2 \nPlantar response flexor bilaterally.\n\ufeff\nCOORD - No dysmetria with finger to nose. Good speed and intact\ncadence with rapid alternating movements.\n\ufeff\nGAIT - Normal initiation. Narrow base. The right leg buckles at the knee with each stride. Romberg negative. Unable to hold balance on tip of her toes or on her heels.\n\ufeff\n", + "input6": "___ 09:00PM BLOOD WBC-10.7* RBC-4.08 Hgb-11.5 Hct-35.5 MCV-87 MCH-28.2 MCHC-32.4 RDW-14.9 RDWSD-47.6* Plt _\n___ 09:00PM BLOOD Neuts-74.1* Lymphs-18.9* Monos-5.1 Eos-1.1 Baso-0.3 AbsNeut-7.95* AbsLymp-2.03 AbsMono-0.55 AbsEos-0.12 AbsBaso-0.03\n___ 05:51AM BLOOD PTT-27.7\n___ 09:00PM BLOOD Glucose-100 UreaN-6 Creat-0.8 Na-136 K-3.4 Cl-103 HCO3-22 AnGap-14\n___ 09:00PM BLOOD Calcium-9.3 Phos-2.5* Mg-2.0\n___ 05:51AM BLOOD ALT-40 AST-29 LD(LDH)-176 AlkPhos-54 TotBili-0.4\n___ 05:51AM BLOOD WBC-7.9 RBC-3.92 Hgb-11.1* Hct-34.0 MCV-87 MCH-28.3 MCHC-32.6 RDW-15.1 RDWSD-47.9* \n___ 05:51AM BLOOD Neuts-67.3 Monos-6.6 Eos-1.9 Baso-0.4 AbsNeut-5.31 AbsLymp-1.84 AbsMono-0.52 AbsEos-0.15 AbsBaso-0.03\n\ufeff\nMRI brain w/wo:\nIMPRESSION: \n1. Motion limited exam. \n2. New enhancing white matter lesion in the parafalcine posterior left frontal lobe is compatible with active demyelination.Smaller focus of enhancement in the right corona radiata as well. \n3. Other non-enhancing diffuse supra and infratentorial white matter lesions are also compatible with demyelinating plaques, unchanged compared to the prior study. \n\ufeff\nMRI cervical and thoracic spine w/wo (preliminary report):\nIMPRESSION: \n1. No evidence of intrinsic spinal cord signal abnormality or pathologic postcontrast enhancement within the cervical and thoracic spine. \n2. Unchanged cervical spondylosis, most prominent at C4-5, with persistent moderate spinal canal narrowing and ventral cord remodeling. \n3. Minimal thoracic spondylosis. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14784368-DS-15.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14784368-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..8015b60a7b636694966d799b99009cf3bfd30a09 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14784368-DS-15.json @@ -0,0 +1,47 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Temporary remissions and return to a stable state, as well as recurrent episodes of symptoms, are common clinical manifestations of multiple sclerosis. Periodic fluctuations in symptoms and periods of stability are one of the characteristics of the disease.$Cause_1": { + "In the ED she said her symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Periventricular and brainstem lesions are key to diagnosis in MS$Cause_1": { + "MRI brain with periventricular and brainstem lesions$Input2": {} + }, + "The specific increase of oligoclonal bands (OCBs) in cerebrospinal fluid is one of the typical biochemical hallmarks of MS.$Cause_1": { + "LP with 0 WBC/RBC, protein 45, glucose 64, and 8 OCBs specific to CSF$Input2": {} + }, + "Newly appeared multiple bilateral white matter areas showed high signal on T2/FLAIR sequence, accompanied by enhancement. This is one of the typical symptoms of multiple sclerosis, because MS often manifests as multiple lesions in the white matter area of \u200b\u200bthe brain, which appear as high signal areas on MRI.$Cause_1": { + "Interval development of multiple scattered bilateral T2/FLAIR hyperintense enhancing white matter lesions with enhancement, new from prior study dated.$Input6": {} + }, + "Here, the left optic nerve is abnormally enlarged and has increased signal on T2/FLAIR sequences with abnormal enhancement. Optic neuritis is a common manifestation of multiple sclerosis and is usually associated with inflammation of the optic nerve, which can lead to decreased vision.$Cause_1": { + "Asymmetrically enlarged left optic nerve with increased T2/FLAIR signal and abnormal enhancement.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Vision loss is a common symptom of MS$Cause_1": { + "Vision loss$Input1": {} + }, + "Paresthesias are common symptoms of MS, especially in the hands and legs, and may indicate impaired nerve conduction.$Cause_1": { + "sensory abnormalities in the right hand and both legs$Input2": {} + }, + "Transverse myelitis usually involves a portion of the spinal cord and may be associated with MS because MS can cause inflammation in many parts of the central nervous system.$Cause_1": { + "MRI brain/whole spine with transverse myelitis from C6-7$Input2": {} + }, + "Vision problems such as blurred vision may be caused by optic neuritis, another common symptom of MS.$Cause_1": { + "vision began to seem blurred$Input2": {} + }, + "Persistent leg numbness may be a long-term neurological symptom caused by spinal cord damage, which is common in MS.$Cause_1": { + "Continues to endorse numbness, \"like Novocain\" involving both legs below the waste$Input2": {} + }, + "The sense of light touch in a circle around the legs below the waist is reduced by 50%. A common symptom of MS is paresthesia, especially in a certain part of the limbs.$Cause_1": { + "50% reduction in light touch symmetrically, below the waste in circumferential pattern around both legs$Input5": {} + } + } + } + }, + "input1": "Vision loss\n", + "input2": "\"She developed sensory abnormalities in the right hand and both legs. She was admitted. her work-up included an MRI brain/whole spine with transverse myelitis from C6-7 (MRI brain with periventricular and brainstem lesions) LP with 0 WBC/RBC, protein 45, glucose 64, and 8 OCBs specific to CSF. She was treated with IVMP x3 days with full resolution of her symptoms. \n\ufeff\nShe had a second course of steroids for recurrent symptoms in both legs identical to prior (no bowel/bladder, gait, or strength issues though mildly off balance). She was treated with 3 days of IVMP. \n\ufeff\nAt approximately that time (while on steroids), the vision began to seem blurred in each worsening since that time (monocularity is unclear). This has not yet reached a plateau. There is no pain or painful movements. She was seen by an optometrist, Dr., whose notes I do not have currently. She has not had any neuroimaging. She was seen earlier today and referred here.\"\n\ufeff\nAt the time of my evaluation in the ED, patient recounts the above history. She describes her vision loss OD as affecting the temporal half of her visual field - noting that items on the right side of space seem \"grayed out.\" The visual problems OS involve worsening acuity. In the ED she said her symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.\n\n\ufeff\nROS notable for vision loss as noted above. Continues to endorse numbness, \"like Novocain\" involving both legs below the waste. \n\ufeff\n\ufeff\n", + "input3": "N/A\n", + "input4": "No family history of stroke, migraines or other autoimmune disease. Sister with DM1\n", + "input5": "Physical Exam:\nADMISSION EXAM:\n===============\nVitals: T 97.8, HR 61, BP 111/56, RR 18, Sa 100% RA \nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx\nNeck: Supple, no nuchal rigidity\nPulmonary: breathing non labored on room air \nCardiac: warm and well perfused\nAbdomen: soft, NT/ND, no masses or organomegaly noted.\nExtremities: No cyanosis, clubbing or edema bilaterally\nSkin: no rashes or lesions noted.\n\ufeff\nNeurologic:\n\ufeff\n-Mental Status: Awake, alert, oriented to place, date, and situation. Able to name the President. Able to relate history without difficulty. The patient had good knowledge of current events. There was no evidence of apraxia or neglect.\n\ufeff\n-Cranial Nerves:\nII: Pupils recently dilated to 7 mm, both slowly reactive. No clear APD at this time. VFF to confrontation. Fundoscopic exam performed, revealed crisp disc margins with no papilledema, exudates, or hemorrhages.\nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically. No dysarthria.\nXI: strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n\ufeff\n-Motor: Normal bulk throughout. Normal tone throughout. No pronator drift bilaterally. No adventitious movements, such as tremor, noted. No asterixis noted. Delt Bic Tri WrE FFl FE IO IP Quad Ham TA \nL 5 4 5 5- 5- 5 4+\nR 5 4 5 5- 5- 5 4+\n\ufeff\n-Sensory: 50% reduction in light touch symmetrically, below the waste in circumferential pattern around both legs. No deficits to cold sensation, proprioception throughout. No extinction to DSS.\n\ufeff\n-DTRs:\nBi Tri Pat Ach\nL 2 2 2 2 2\nR 2 2 2 2 2\n\ufeff\n-Coordination: No intention tremor, no dysdiadochokinesia noted. No dysmetria on FNF or HKS bilaterally.\n\ufeff\n-Gait/Station: Good initiation. Narrow-based, normal stride and arm swing. Romberg absent.\n\ufeff\n", + "input6": "ADMISSION LABS:\n___ 07:30PM BLOOD WBC-7.0 RBC-4.01 Hgb-12.9 Hct-38.6 MCV-96 MCH-32.2* MCHC-33.4 RDW-12.1 RDWSD-43.0\n___ 07:30PM BLOOD Neuts-60.9 Monos-7.3 Eos-6.1 Baso-0.6 AbsNeut-4.27 AbsLymp-1.74 AbsMono-0.51 AbsEos-0.43 AbsBaso-0.04\n___ 07:30PM BLOOD Glucose-95 UreaN-12 Creat-0.6 Na-139 K-4.2 Cl-105 HCO3-21* AnGap-13\n\ufeff\nPENDING LABS:\n___ 06:00PM BLOOD ANCA-PND\n___ 07:30AM BLOOD RheuFac-<10\n___ 06:00PM BLOOD RO\n___ 06:00PM BLOOD ANGIOTENSIN 1 - CONVERTING\n___ 12:14PM BLOOD RO\n___ 07:30PM BLOOD RO \n___ 07:30AM BLOOD MYELIN OLIGODENDROCYTE GLYCOPROTEIN (MOG IGG)-PND\n___ 07:30AM BLOOD ANGIOTENSIN 1 - CONVERTING \n___ 07:30AM BLOOD NEUROMYELITIS OPTICA \n(NMO)/AQUAPORIN-4-IGG CELL-BINDING ASSAY, SERUM-PND\n\ufeff\nMRI ORBIT AND BRAIN :\n1. Interval development of multiple scattered bilateral T2/FLAIR hyperintense enhancing white matter lesions with enhancement, new from prior study dated. \n2. Asymmetrically enlarged left optic nerve with increased T2/FLAIR signal and abnormal enhancement. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14789229-DS-15.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14789229-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..600740559e2bbcc98ea1e7a7e8bc17dbf33114c9 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/14789229-DS-15.json @@ -0,0 +1,47 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "In the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Multiple sclerosis is characterized by multiple lesions in the central nervous system, particularly in the spinal cord. Multiple lesions in the cervical spinal cord suggest the presence of multiple sclerosis.$Cause_1": { + "Probable multiple cervical cord lesions$Input6": {} + }, + "Possible punctate areas of contrast enhancement are seen at the C6 level, which may indicate active inflammation or demyelinating disease, confirming multiple sclerosis.$Cause_1": { + "questionable punctate area of contrast enhancement at C6 level$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "People may have unsteadiness or coordination problems when walking, which may be due to damage to nerve pathways in the brain or spinal cord. Inflammation and nerve damage in multiple sclerosis can cause this condition.$Cause_1": { + "trouble with gait$Input1": {} + }, + "Loss of manual dexterity is a common symptom in people with MS.$Cause_1": { + "loss of dexterity in her hands$Input2": {} + }, + "Increased numbness in the legs is a classic symptom of MS and reflects nerve damage$Cause_1": { + "increased bilateral leg numbness$Input2": {} + }, + "Difficulty walking indicates impaired nerve function in the lower limbs and is a common symptom of MS$Cause_1": { + "increased difficulty walking$Input2": {} + }, + "Frequent UTIs may be a symptom of MS because MS can affect bladder control, leading to an increased risk of UTIs.$Cause_1": { + "frequent UTIs$Input3": {} + }, + "Movement control problems caused by damage to the central nervous system, common in people with MS$Cause_1": { + "Gait spastic gait \n\ufeff$Input5": {} + }, + "Reflects lesions in the spinal cord or brain and is a common movement disorder symptom of MS$Cause_1": { + "bilateral leg spasticity$Input5": {} + }, + "Spinal cord lesions affect the conduction of sensory nerves and are one of the typical manifestations of MS.$Cause_1": { + "decreased pinprick below C4 bilaterally$Input5": {} + } + } + } + }, + "input1": "trouble with gait\n", + "input2": "HPI: presents complaining of two weeks of loss of dexterity in her hands, increased bilateral leg numbness than usual and increased difficulty walking. These difficulties have been getting worse for the past two weeks. \n\ufeff\nIn the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.\n\ufeff\nROS: On review of systems, the pt denied recent fever or chills. \n\ufeff\nNo night sweats or recent weight loss or gain. 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. Denied rash.\n", + "input3": "1.h/o pulmonary nodules being followed by serial scanning \n2.seizures-black out episodes for several hours with last EEG showed intermittent bitemporal slowing \n3.frequent UTIs \n4.HTN \n5.hyperparathyroidism \n\ufeff\n", + "input4": "none significant\n", + "input5": "Physical Exam:\nVS 98.4 99 116/67 12 98%\nGen Awake, cooperative, NAD \nHEENT NC/AT, no scleral icterus noted, MMM, no lesions noted inoropharynx \nNeck Supple, no carotid bruits appreciated. No nuchal rigidity \nLungs CTA bilaterally \nCV RRR, nl S1S2, no M/R/G noted \nAbd soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted \nExt No C/C/E b/l \nSkin no rashes or lesions noted\nNormal rectal tone\n\ufeff\nNEURO\nAlert. Fully oriented. Months of the year backward skipped two months. Speech fluent, with normal naming, reading, comprehension and repetition. Normal prosody. There were no paraphasic errors. Able to follow both midline and append icularcommands. No apraxia. Interprets cookie theft pictures appropriately. No dysarthria. \n\ufeff\nCN\nCN I: not tested\nCN II: Visual fields were full to confrontation, no extinction.\nPupils 3->2 b/l, no RAPD. Fundi clear. No red desat\nCN III, IV, VI: EOMI no nystagmus or diplopia\nCN V: intact to LT throughout\nCN VII: full facial symmetry and strength\nCN VIII: hearing intact to FR b/l\nCN IX, X: palate rises symmetrically\nCN XI: shrug and symmetric\nCN XII: tongue midline and agile\n\ufeff\nMotor \nNormal bulk and tone in the arms; bilateral leg spasticity. No\npronator drift or asterixis\nD B T WE FE FF IP Q H DF PF TE\nL 4+ 5 4+\nR\n\ufeff\nSensory decreased pinprick below C4 bilaterally (sharp on the back of the head)\n\ufeff\nReflexes \nBr Bi Tri Pat Ach Toes\nL 2 1 down\nR 2 1 down\n\ufeff\nCoordination Fine finger movements, rapid alternating movements normal; FTN dysmetric on the right\n\ufeff\nGait spastic gait \n\ufeff\n", + "input6": "___ 11:50PM URINE COLOR-Yellow APPEAR-Clear\n___ 11:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG\n___ 10:51PM GLUCOSE-112* UREA N-25* CREAT-0.9 SODIUM-140 POTASSIUM-4.3 CHLORIDE-104 TOTAL CO2-26 ANION GAP-14\n\ufeff\nMR spine:\nProbable multiple cervical cord lesions, with a questionable punctate area of contrast enhancement at C6 level. No thoracic lesions seen within the cord. Please see above report for additional discussion regarding right upper lobe lung nodule.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15116755-DS-19.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15116755-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..b16eb59a9c6faba22c1a0e55f7f21533864a5001 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15116755-DS-19.json @@ -0,0 +1,44 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The condition has distinct attacks (relapses) and remission periods$Cause_1": { + "In the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "This describes multiple bilateral round and oval T2/FLAIR hyperintense white matter lesions located in the subcortical and periventricular white matter as well as in the posterior fossa and brainstem, which are most likely manifestations of a demyelinating process.$Cause_1": { + "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Lower limb weakness is one of the common symptoms of multiple sclerosis, which may be due to damage to the central nervous system leading to weakened muscle strength.$Cause_1": { + "increasing lower extremity weakness$Input2": {} + }, + "The progressive wheelchair dependency suggests a continued decline in her mobility, possibly related to neurological disease$Cause_1": { + "uses a manual wheelchair, and has become more dependent on this over time as she has become less mobile$Input2": {} + }, + "Frequent falls may result from impaired balance and coordination, which are common in people with multiple sclerosis.$Cause_1": { + "She has also been falling at home$Input2": {} + }, + "The inability to stand further demonstrated significant loss of lower extremity strength and function, a common finding in multiple sclerosis.$Cause_1": { + "not been able to stand at all$Input2": {} + }, + "Baclofen is a drug used to treat spasticity, a common symptom of multiple sclerosis.$Cause_1": { + "She noted that she has had spasticity previously, but this has improved since starting Baclofen.$Input2": {} + }, + "Difficulties with fine motor skills indicate neurological damage that affects coordination and control of the hands$Cause_1": { + "occasional difficulty with fine motor movements$Input2": {} + }, + "Numbness in the fingers may be due to abnormal nerve conduction, which is common in people with multiple sclerosis.$Cause_1": { + "intermittent parasthesias of her fingertips$Input2": {} + }, + "Family history of MS inrease the risk$Cause_1": { + "Mother died of Multiple Sclerosis.\nMother's uncle also had MS and maternal grandfather died of brain tumor.$Input4": {} + } + } + } + }, + "input1": "None\n", + "input2": "She is a right-handed woman with PMH significant, who presents with increasing lower extremity weakness. She uses a manual wheelchair, and has become more dependent on this over time as she has become less mobile. In fact, over the past month, she has not been able to stand at all. The greatest impact of this is on her bathroom use; she was previously able to transfer the wheelchair to the toilet and stand to get her pants off and on, but has been unable to do this for the past month. She has also been falling at home; last fall was yesterday evening (she fell off the bed when trying to use a slide board; she says she can't lift her left leg up high enough to use the board; no head strike). She was previously well attended to by her husband, but since he suffered from a stroke, he has been unable to care for her. \n\ufeff\nNeuro ROS: Positive for lower extremity weakness as per HPI. She is unable to ambulate. She noted that she has had spasticity previously, but this has improved since starting Baclofen. She also notes occasional difficulty with fine motor movements; she describes difficulty writing and with buttons. No headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. No difficulties producing or comprehending speech. She notes intermittent parasthesias of her fingertips. She is incontinent because of her difficulty getting to the bathroom in time, but she is able to recognize when she needs to go to the bath room and it does not seem that urgency is a problem. \n\nIn the ED she said her symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.\n \n \nGeneral ROS: No fever or chills. No cough, shortness of breath, chest pain or tightness, palpitations. No nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. No rash. Denies rash. She does note that she does not drink or eat a lot because of her difficulty with going to the bathroom.\n", + "input3": "+s/p breast bx macro and microcysts and focal ductal hyperplasia. No atypia or malignancy) \n+s/p hysterectomy\n", + "input4": "Mother died of Multiple Sclerosis.\nMother's uncle also had MS and maternal grandfather died of brain tumor.\n", + "input5": "Physical Exam:\nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx \nNeck: Supple\nPulmonary: lcta b/l \nCardiac: RRR, S1S2, no murmurs appreciated\nAbdomen: soft, NT/ND, +BS \nExtremities: warm, edema b/l\n \nNeurologic: \n\ufeff\nMental Status: Awake, alert, oriented to person, place and date. \n\ufeff\nAble to relate history without difficulty. Attentive, able to name backward without difficulty. Able to follow both midline and appendicular commands. No right-left confusion. Able to register 3 objects and recall at 5 minutes with prompting). No evidence of apraxia or neglect \n\ufeff\nLanguage: speech is clear, fluent, nondysarthric with intact\nnaming, repetition and comprehension. \n\ufeff\nCranial Nerves: \nI: Olfaction not tested. \nII: PERRL 3 to 2mm and brisk. VFF to confrontation. Funduscopic exam revealed no papilledema, exudates, or hemorrhages. \nIII, IV, VI: EOMI without nystagmus.\nV: Facial sensation intact to light touch. \nVII: No facial droop, facial musculature symmetric. \nVIII: Hearing intact to finger-rub bilaterally. \nIX, X: Palate elevates symmetrically. \nXI: ___ strength in trapezii and SCM bilaterally. \nXII: Tongue protrudes in midline.\n \nMotor: Normal bulk, tone throughout. Right lower extremity is internally rotated. No pronator drift bilaterally. No adventitious movements, such as tremor, noted. No asterixis noted.\n \nDelt Bic Tri WrE FFl FE IP Quad Ham TA \nL 5 3+ 2 3 \nR 5 2 1 0 \n \nSensory: No deficits to light touch. She has diminished pinprick over lateral aspect proximal LLE. Absent vibratory sense b/l, can appreciate at elbow. Proprioception midly diminished at great toe b/l. \n \nDTRs: \nBi Tri Pat Ach \nL 2 2 2 2 0 \nR 2 2 2 2 0 \nPlantar response was extensor bilaterally. \n \nCoordination: No intention tremor or dysmetria on finger-nose,\nFNF. RAMs are very slow b/l. \n \nGait: deferred. she is wheelchair-bound. \n\ufeff\n", + "input6": "Pertinent Results:\n___ 02:30PM GLUCOSE-87 UREA N-14 CREAT-0.4 SODIUM-145 POTASSIUM-3.8 CHLORIDE-108 TOTAL CO2-25 ANION GAP-16\n___ 02:30PM estGFR-Using this\n___ 02:30PM ALT(SGPT)-27 AST(SGOT)-34 ALK PHOS-75 TOT BILI-0.4\n___ 02:30PM WBC-5.8 RBC-4.16* HGB-12.9 HCT-39.0 MCV-94 MCH-31.1 MCHC-33.2 RDW-13.2\n___ 02:30PM NEUTS-69.3 MONOS-4.3 EOS-1.8 BASOS-1.1\n___ 02:30PM PLT COUNT-349\n\ufeff\nMultiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15226178-DS-22.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15226178-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..18fa955ebd642ff4ddb80b0f4dbae052e29254ee --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15226178-DS-22.json @@ -0,0 +1,38 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Tysabri is a drug used to treat multiple sclerosis, and the patient had been taking it, suggesting that she may have a history of multiple sclerosis.$Cause_1": { + "on tysabri last year$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "There is a new enhancement focus at the junction of the right temporal lobe and midbrain. This new focus may represent a new lesion in multiple sclerosis.$Cause_1": { + "new enhancing lesion at the right temporal lobe and junction to the midbrain$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "These are common symptoms of Multiple Sclerosis and may be related to optic neuritis$Cause_1": { + "blurred vision with diplopia$Input2": {} + }, + "The patient's symptoms began with headaches and \"fuzzy\" vision in his right eye, which may be a manifestation of optic neuritis.$Cause_1": { + "symptoms began with a headache and right eye \"cloudy\" vision$Input2": {} + }, + "Horizontal double vision, which is also a possible symptom of multiple sclerosis$Cause_1": { + "side by side double vision$Input2": {} + }, + "Blurred vision extended to the left eye, suggesting further damage to the optic nerve, consistent with symptoms of multiple sclerosis.$Cause_1": { + "Over the next day the cloudy vision spread to her left eye.$Input2": {} + }, + "Right relative pupillary conduction defect (RAPD) is a symptom associated with optic nerve dysfunction that is common in multiple sclerosis.$Cause_1": { + "Right RAPD, brisk reactive. VFF to confrontation$Input5": {} + }, + "The DTR was low on the left side and normal on the right side, which may suggest abnormalities in the central nervous system, as may occur in multiple sclerosis.$Cause_1": { + "DTRs:\nBi Tri Pat Ach\nL 1 1 1 1 0\nR 2 2 2 2 0$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "The pt presented with a one week history of blurred vision with diplopia. She states that her symptoms began with a headache and right eye \"cloudy\" vision. Shortly after she started to also developed side by side double vision. Over the next day the cloudy vision spread to her left eye. Since it has not improved she decided to come to the ED. She was on tysabri last year but has since been off it in hopes of getting pregnant. She has no other symptoms at this time including numbness, tingling, fever, chills, nausea, vertigo, or weakness.\n", + "input3": "Headaches/migraine\n", + "input4": "No hx of neurological disorders - Mom has thyroid disease.\n", + "input5": "Physical Exam:\nVitals: 97.4 72 104/59 16 100% RA \nGeneral: Awake, cooperative, NAD.\nHEENT: MMM.\nNeck: No nuchal rigidity\nPulmonary: Lungs CTA bilaterally \nCardiac: RRR, nl. S1S2 \nAbdomen: soft, NT/ND.\nExtremities: No edema or deformities.\nSkin: no rashes or lesions noted.\n\ufeff\nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Attentive, able to name backward without difficulty. Language is fluent with intact repetition and comprehension. There were no paraphasic errors. Speech was notdysarthric. Able to follow both midline and appendicular commands. There was no evidence of apraxia or neglect.\n\ufeff\n-Cranial Nerves:\nI: Olfaction not tested.\nII: Right RAPD, brisk reactive. VFF to confrontation.Funduscopic limited. : Left R\nIII, IV, VI: EOMI without nystagmus. Normal saccades. no skewseen\nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: Strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n\ufeff\n-Motor: Normal bulk, tone throughout. No pronator drift bilaterally. No tremor, asterixis noted. Strength is full bilaterally in upper and lower extremities in proximal and distal muscles.\n\ufeff\n-Sensory: No deficits to light touch. No extinction to DSS.\n\ufeff\n-DTRs:\nBi Tri Pat Ach\nL 1 1 1 1 0\nR 2 2 2 2 0\nPlantar response was flexor bilaterally.\n\ufeff\n-Coordination: No intention tremor, no dysdiadochokinesia noted. No dysmetria on FNF bilaterally.\n\ufeff\n-Gait: Good initiation. Narrow-based.\n", + "input6": "___ 11:10AM WBC-6.3 RBC-4.25 HGB-12.9 HCT-38.2 MCV-90 MCH-30.3 MCHC-33.7 RDW-12.1\n___ 11:10AM PLT COUNT-266\n___ 11:10AM NEUTS-63.3 MONOS-4.2 EOS-1.1 BASOS-0.7\n___ 11:10AM CALCIUM-9.1 PHOSPHATE-2.9 MAGNESIUM-2.0\n___ 11:10AM GLUCOSE-94 UREA N-9 CREAT-0.5 SODIUM-139 POTASSIUM-4.2 CHLORIDE-106 TOTAL CO2-28 ANION GAP-9\n\ufeff\nMRI Brain\nnew enhancing lesion at the right temporal lobe and junction to the midbrain. Previously enhancing left parietal white matter lesion less prominent and no longer enhancing. Stable appearance of other scattered periventricular white matter and subcortical white matter lesions.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15333597-DS-11.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15333597-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..d0d52aa47acf2ced17ec20e211739587f73a9d76 --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15333597-DS-11.json @@ -0,0 +1,29 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "Temporary remissions and return to a stable state, as well as recurrent episodes of symptoms, are common clinical manifestations of multiple sclerosis. Periodic fluctuations in symptoms and periods of stability are one of the characteristics of the disease.$Cause_1": { + "In the ED she said her symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "This describes multiple bilateral round and oval T2/FLAIR hyperintense white matter lesions located in the subcortical and periventricular white matter as well as in the posterior fossa and brainstem, which are most likely manifestations of a demyelinating process.$Cause_1": { + "Multiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "One of the common symptoms of central nervous system damage in multiple sclerosis may be due to damage to the myelin sheath of nerve fibers in the spinal cord or brain.$Cause_1": { + "bilateral LL numbness$Input2": {} + }, + "This symptom reflects paresthesia, a common sensory nerve dysfunction in multiple sclerosis$Cause_1": { + "sensation is heavy or numb feeling$Input2": {} + }, + "This could be the \"banding feeling\" seen in multiple sclerosis, which is often associated with spinal cord damage$Cause_1": { + "thighs upto belly button and is nearly constant$Input2": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "This is a Right handed female with no significant past medical history presented to Ed for evaluation of bilateral LL numbness. It started 2 weeks ago and started at the toes. The sensation is heavy or numb feeling (not pain without any objective loss of sensations) It started at the same time. It gradually creeped up upto both knees circumferentially in 10 days. Initially she noticed this sensation more in the evenings when she was relxing at home. However over last days its progressed over to involve her thighs upto belly button and is nearly constant. She has developed tight band like sensation around belly button area especially on the left side which is intermittent. she has noticed tight feeling in hamstrings and calfs on both sides also over last few days. No weakness or difficluty walking. No bladder bowel issues. No trauma to spine, no similar complains in the past. she had H1n1 vaccine, no recent travels or sick contacts. In the ED she said her symptoms had subsided and her condition had returned to a stable state. She said similar situations had happened before.\n\n\ufeff\n\ufeff\n", + "input3": "Bilateral Tubal Ligation\n", + "input4": "Father with diabetes\nMother with HTN\nGrandparent with MI\n", + "input5": "Physical Exam:\nV/S Temp 98.2 BP 120/80 HR 80 RR 16 \nGen: NAD, very pleasant\nHEENT: EOMI, PERRLA, NC, AT, MMM, oropharynx clear, nares clear\ngood dentition\nNeck: supple, nl JVP\n: +S1, +S2, no M/R/G, RRR\nLUNGS: CTAB, no wheezes, no crackles, no ronchi\nABD: +BS, soft, non-tender, non-distended, no hepatosplenomegaly\nEXT: +2 distal pedal/radial pulses, very mild bipedal edema and\ndermographism which per husband is new (?)\n\ufeff\n: \nNeurologic examination: \nMental status: Awake and alert, cooperative with exam, normal \naffect. Oriented to person, place, and date. Attentive, says backwards. Speech is fluent with normal comprehension and repetition; naming intact. reading writing intact.No dysarthria. No right left confusion. No evidence of apraxia or neglect. memory immediate and 5 mins\n \nCranial Nerves: \nII: Pupils equally round and reactive to light, 4 to 2 mm bilaterally. Visual fields are full to confrontation, normal fundus \nIII, IV & VI: Normal eye movements, no nystagmus\nV: Sensation intact to LT and PP. \nVII: Facial movement symmetric. \nVIII: Hearing intact to finger rub bilaterally. \nX: Palate elevation symmetrical. \nXI: Sternocleidomastoid and trapezius normal bilaterally. \nXII: Tongue midline, movements intact\n \nMotor: \nNormal bulk and tone bilaterally. \nDel Tri Bi WE FE FF IP H Q DF PF \nR 5 5 \nL 5 5 \n \nSensation: Intact to light touch, pinprick, vibration, and cold throughout in all extremities, truck front and back including vibration over spinous processes.\n \nReflexes: \n2 plus symmetric throughout. Toes downgoing bilaterally \n \nCoordination: FTN, FTF normal. RAM normal on both sides, HKS normal. \n \nGait: Normal including tandem\n\ufeff\nRhomberg sign - Negative\n\nLP \nTube 1: 6 RBCs 19 WBCs \nTube 4: 0 RBCs 16 WBCs\nProtein: 31 Glucose: 69\nMS profile pending\n\ufeff\n", + "input6": "Admission Labs:\n\ufeff\n139 | 104 | 13\n--------------< 88\n4.3 | 27 | 0.6\n\ufeff\n12.6\n11.2 >----< 254\n36.7\n\ufeff\nImaging:\nMRI C and T spine\nFINDINGS:\n \nCERVICAL: There is multilevel spondylosis in this patient with multilevel short pedicles resulting in uniform narrowing of the cervical spine canal. There is multilevel cord deformity. There is a focal region of enhancing signal abnormality within the right lateral aspect of the cord at C5-6, similar to lesions in the thoracic cord as detailed below. Linear region of T2 hyperintense signal within the upper cervical spine (15:33) is likely artifactual.\n\nMultiple T2/STIR hyperintense lesions within the cervical and thoracic spinal cord, compatible with a demyelinating process.\n\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15353648-DS-17.json b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15353648-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..f5bc4d5ddbd8bfa8a45467c4e634ca645d7dc8eb --- /dev/null +++ b/Finished/Multiple Sclerosis/Relapsing-Remitting Multiple Sclerosis/15353648-DS-17.json @@ -0,0 +1,38 @@ +{ + "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { + "The patient had been experiencing imbalance, diplopia, and nystagmus following a severe flu attack, which resolved after a round of Solumedrol IV treatment. These symptoms are also common in multiple sclerosis. This relapse at this hospital admission is evidence of Relapsing-Remitting Multiple Sclerosis$Cause_1": { + "treated with a course of solumedrol IV which was successful in resolving her symptoms of disequilibrium, diplopia, and nystagmus following a severe flu (3 in hospital and 2 as outpatient IV).$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "MRI shows new inactive lesions, suggesting active multiple sclerosis$Cause_1": { + "MRI showed new inactive lesions since prior$Input2": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Facial weakness is the common symptom of MS$Cause_1": { + "Right facial weakness$Input1": {} + }, + "The patient has a history of multiple sclerosis$Cause_1": { + "She is a right handed woman with past history of multiple sclerosis diagnosed who presents today.$Input2": {} + }, + "The patient noted decreased movement in the right side of his mouth and saw drooping in the mirror. This facial weakness may also be a manifestation of multiple sclerosis.$Cause_1": { + "decreased activation of the right mouth which was drooped$Input2": {} + }, + "The right pupil is unresponsive to light, which may indicate central nervous system damage$Cause_1": { + "R pupil 4mm and nonreactive (baseline). L pupil is briskly reactive 3mm->2mm$Input5": {} + }, + "There was weakness in both the upper and lower right sides of the face, suggesting facial nerve damage, which is common in patients with multiple sclerosis.$Cause_1": { + "right upper and lower facial weakness, with weakness of eyebrow raising, eyelid closure, and smile$Input5": {} + }, + "Loss of taste on the tongue, possibly due to damage to the facial nerve$Cause_1": { + "Taste is somewhat diminished$Input5": {} + } + } + } + }, + "input1": "Right facial weakness\n", + "input2": "She is a right handed woman with past history of multiple sclerosis diagnosed who presents today. The patient was recently with MRI showed new inactive lesions since prior. She was treated with a course of solumedrol IV which was successful in resolving her symptoms of disequilibrium, diplopia, and nystagmus following a severe flu (3 in hospital and 2 as outpatient IV). She returns today after waking up with noted decreased activation of the right mouth which was drooped per the patient on looking in the mirror. As the patient is quite savvy regarding symptoms she has experienced in the past, she performed a rudimentary examination and noted no decrease in sharp sensation, temperature or touch in the face or body. She also noted no other peripheral weakness. After contacting, MD PhD, she was advised to present to the ED for evaluation and further management.\n\ufeff\nShe notes no recent illness or trauma, and no other symptoms since steroid IV management of her deficits. She did note significant stressors from her three children, as well as her work. \n \nOn neuro ROS, the pt denies headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denies difficulties producing or comprehending speech. In the body she denies focal weakness, numbness, parasthesiae. No bowel or bladder incontinence or retention. Denies difficulty with gait.\n \nOn general review of systems, the pt denies recent fever orchills. No night sweats or recent weight loss or gain. Denies cough, shortness of breath. Denies chest pain or tightness, palpitations. Denies nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denies arthralgias or myalgias. Denies rash.\n\ufeff\n", + "input3": "+ Depression\n+ Anxiety\n+ Migraine\n", + "input4": "- No seizures, developmental disability, learning disorders, migraine headaches, strokes less than 50, neuromuscular disorders, or movement disorders.\n", + "input5": "Physical Exam:\nGeneral: Awake and alert, pleasant and cooperative, NAD\nMental status: Alert and oriented x 3. Language fluent without dysarthria. Follows commands without difficulty.\nCranial nerves: R pupil 4mm and nonreactive (baseline). L pupil is briskly reactive 3mm->2mm. Extraocular movements are intact but there is coarse horizontal nystagmus on right lateral gaze, more prominent in the right eye than the left. There is right upper and lower facial weakness, with weakness of eyebrow raising, eyelid closure, and smile. Taste is somewhat diminished over the right side of her tongue.\nMotor: Normal bulk and tone. No pronator drift. Strength throughout in all muscle groups of the upper and lower extremities.\nSensation: Intact to light touch throughout.\nReflexes: 2+ and symmetric, toes downgoing.\nCoordination: Intact FNF b/l without dysmetria.\nGait: Deferred\n\ufeff\n", + "input6": "___ 06:55AM BLOOD WBC-5.0 RBC-3.99* Hgb-12.9 Hct-37.8 MCV-95 MCH-32.3* MCHC-34.1 RDW-12.6\n___ 04:41PM BLOOD WBC-5.5 RBC-4.38 Hgb-13.9 Hct-41.6 MCV-95 MCH-31.7 MCHC-33.4 RDW-12.5\n___ 04:41PM BLOOD Neuts-59.6 Monos-5.8 Eos-0.2 Baso-1.6\n___ 06:55AM BLOOD PTT-31.8\n___ 06:55AM BLOOD Glucose-85 UreaN-11 Creat-0.8 Na-144 K-3.9 Cl-110* HCO3-26 AnGap-12\n___ 04:41PM BLOOD Glucose-83 UreaN-13 Creat-0.8 Na-137 K-6.5* Cl-103 HCO3-21* AnGap-20\n___ 04:41PM BLOOD ALT-36 AST-70* AlkPhos-41 TotBili-0.3\n___ 06:55AM BLOOD Calcium-9.1 Phos-3.7 Mg-2.2\n___ 04:41PM BLOOD Albumin-4.5\n___ 04:41PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 05:55PM BLOOD K-4.0\n___ 04:41PM BLOOD Lactate-1.5\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/12331699-DS-23.json b/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/12331699-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..0c40298832c4d690f5e46be3a9ad86ef74aeb02d --- /dev/null +++ b/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/12331699-DS-23.json @@ -0,0 +1,58 @@ +{ + "Secondary Progressive Multiple Sclerosis$Intermedia_4": { + "The patient has been diagnosed with relapsing-remitting multiple sclerosis (RRMS) for 4 years, which is consistent with the diagnosis time of Secondary Progressive Multiple Sclerosis.$Cause_1": { + "4 years of RRMS$Input3": {} + }, + "A continued increase in the number of lesions in the central nervous system, a common phenomenon during the course of Secondary Progressive Multiple Sclerosis, points to disease progression.$Cause_1": { + "The number of central nervous system lesions continues to increase.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Falls may be a symptom of multiple sclerosis$Cause_1": { + "s/p fall$Input1": {} + }, + "Family history considered a risk factor in multiple sclerosis study$Cause_1": { + "Two family members with MS-paternal cousins$Input4": {} + }, + "Muscle atrophy can be a manifestation of reduced motor function due to nerve damage in multiple sclerosis.$Cause_1": { + "R leg atrophy$Input5": {} + }, + "Reduced strength in the right leg, which may reflect impaired nerve function, one of the common symptoms in multiple sclerosis$Cause_1": { + "R leg w/ antigravity (minimal)$Input5": {} + }, + "Anxiety and depression are more common among people with MS, possibly due to the long-term stress and effects of the disease.$Cause_1": { + "Patient was continued on her home Klonopine and Venlafaxine$Input6": {} + } + }, + "Multiple Sclerosis$Intermedia_3": { + "Visual impairment caused by multiple sclerosis$Cause_1": { + "She is with (mainly with visual disturbances from MS) who fell while transferring from toilet to wheelchair.$Input2": {} + }, + "The patient's pain has improved with continued treatment with her regular home medications, and she is further improving her strength and mobility with physical therapy and upcoming rehabilitation. This indicates that the patient is in the relapsing-remitting stage of MS$Cause_1": { + "Multiple Sclerosis: Patient was continued on her home medication regimen with improvement in her pain. She worked with physical therapy and will be sent to Rehab to further regain strength and mobility.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Falls may be a symptom of multiple sclerosis$Cause_1": { + "s/p fall$Input1": {} + }, + "Family history considered a risk factor in multiple sclerosis study$Cause_1": { + "Two family members with MS-paternal cousins$Input4": {} + }, + "Muscle atrophy can be a manifestation of reduced motor function due to nerve damage in multiple sclerosis.$Cause_1": { + "R leg atrophy$Input5": {} + }, + "Reduced strength in the right leg, which may reflect impaired nerve function, one of the common symptoms in multiple sclerosis$Cause_1": { + "R leg w/ antigravity (minimal)$Input5": {} + }, + "Anxiety and depression are more common among people with MS, possibly due to the long-term stress and effects of the disease.$Cause_1": { + "Patient was continued on her home Klonopine and Venlafaxine$Input6": {} + } + } + } + }, + "input1": "s/p fall\n", + "input2": "She is with (mainly with visual disturbances from MS) who fell while transferring from toilet to wheelchair. She attempted to grab the wheel of the wheelchair and it began to roll away and she then fell on her knees and her face. She has chronic R leg pain related to her polio and her R knee began to hurt. Her pain was not controlled at home so she came to the ER for help with pain control. \n\nThe patient denies any other symptoms, no weakness of any other extremity, she had dysuria 2 days ago but non since. No other symptoms, no F/C/NS, no chest pain, no SOB, no LH, no HA, no new visual disturbances or neurologic symptoms, no abd pain, blood in stool. Rest of ROS is negative.\n", + "input3": "- 4 years of RRMS\n- Congenital L hip dysplasia- s/p mult surgical repair- 3 total hip replacements, last repair ___ complicated my multiple postoperative dislocations\n- Hypertension\n- polio affecting the right lower extremity, severe chronic pain-followed by pain service\n- Left sciatic neuropathy\n", + "input4": "Two family members with MS-paternal cousins\n", + "input5": "VS: T 97.5 BP 135/88 HR 85 RR 18 O2 sat 100% on RA\nGEN: NAD, AOX3\nHEENT: MMM\nCARD: RRR, no m/r/g\nPULM: CTAB, no ronchi or rales or wheezes, normal resp effort\nABD: soft, NT, ND, no masses or organomegaly\nEXT: wwp, no c/c/e, R leg atrophy\nNEURO: R leg w/ antigravity (minimal) other ext ___ stregnth, normal mood and affect, AOx3\n", + "input6": "Admission labs: ___ 05:25AM \nURINE ___ BACTERIA-NONE YEAST-NONE ___\nURINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG \nLEUK-MOD\n\nR KNEE X RAY ___: No acute fracture or dislocation.\n\n___ 06:30AM \nGlucose-101* UreaN-12 Creat-0.7 Na-142 K-3.3 Cl-98 HCO3-37* AnGap-___ yoF w/ a h/o MS and polio presents after a mechanical fall with R knee pain.\n\n# Multiple Sclerosis: Patient was continued on her home medication regimen with improvement in her pain. She worked with physical therapy and will be sent to Rehab to further regain strength and mobility.\n\n# UTI: Uncomplicated, treated w/ cipro x 3d\n\n# HTN: Patient was continued on her home antihypertensives with good control. \n\n# Anxiety / depression: Patient was continued on her home Klonopine and Venlafaxine\n\n# MRI\nThe number of central nervous system lesions continues to increase.\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/12846155-DS-8.json b/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/12846155-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..89a96747691741cc4294abd4e50e8d38b90a4490 --- /dev/null +++ b/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/12846155-DS-8.json @@ -0,0 +1,50 @@ +{ + "Secondary Progressive Multiple Sclerosis$Intermedia_4": { + "Progression to SPMS at least 3 years after RRMS diagnosis, which confirm Primary Progressive Multiple Sclerosis$Cause_1": { + "She is a RHW with RRMS for 5 years.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "Multiple enhancing lesions suggested active demyelination, and one also showed slowed diffusion, suggestive of an ongoing demyelinating process.$Cause_1": { + "There are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.\ufeff$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Left-sided optic neuritis is a common early symptom of multiple sclerosis, manifested by decreased vision on one side, which may be accompanied by pain.$Cause_1": { + "L-sided optic neuritis$Input2": {} + }, + "This describes an acute episode that results in severe functional impairment and indicates a sudden worsening of the condition.$Cause_1": { + "decreased visual acuity and difficulty walking and drove herself to the hospital only to fall out of the car$Input2": {} + }, + "Multiple sclerosis is characterized by relapsing and remitting episodes in which vision improves temporarily followed by worsening.$Cause_1": { + "L eye recovered after her first two flares, but she is now only able to see shadows out of her L eye$Input2": {} + }, + "Burning sensations are common paresthesias in MS, often affecting multiple areas of the body.$Cause_1": { + "intense burning pain extending from below her breasts$Input2": {} + }, + "Lhermitte's phenomenon is a distinctive electric shock sensation that is intensified when the neck is bent and is a typical symptom of multiple sclerosis.$Cause_1": { + "electrical sensations in the base of her head and neck$Input2": {} + }, + "This painful electric shock sensation in both lower limbs is also a paresthesia caused by central nervous system damage in multiple sclerosis$Cause_1": { + "generalized painful electrical sensations$Input2": {} + }, + "Electric shock sensations when the neck is flexed may indicate Lhermitte's sign, a classic symptom of multiple sclerosis that indicates inflammation or demyelination of the cervical spinal cord.$Cause_1": { + "Electrical sensation upon neck flexion.$Input5": {} + }, + "Blurred optic disc margins are often associated with optic neuritis, a common early manifestation of multiple sclerosis, and suggest that the left eye may have partial optic nerve demyelination.$Cause_1": { + "optic disc margins sharp on R with pallor and blurred disk margins on L on funduscopic exam$Input5": {} + }, + "The sensation of electric shock in the legs in response to vibration may be a manifestation of abnormal central nervous system conduction, and this sensory abnormality is one of the common sensory disturbances in multiple sclerosis.$Cause_1": { + "Vibration causes electrical sensations up legs$Input5": {} + }, + "Inverted temperature sensation may be a sign of impaired sensory pathways, a possible paresthesia seen in patients with multiple sclerosis.$Cause_1": { + "Temperature sensation intact on the L and inverted (cold felt hot) on the R.$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "She is a RHW with RRMS for 5 years. She is currently enrolled in a clinical trial (randomized and started on study medication . She has a h/o RRMS diagnosed first with an episode of L-sided optic neuritis. However, retrospectively she had an episode of decreased visual acuity and difficulty walking and drove herself to the hospital only to fall out of the car semiconcious at the hospital doors. She has not had a flare years. In total she has had 4 clinical episodes during this time, averaging approximately every 18 months. She describes her episodes as beginning with decreased appetite and weight loss progressing to difficulty walking and blurried vision. During her episodes she becomes wheelchair bound, although between episodes she describes her walking as completely normal and feels that she even walks faster than most people. Her vision in her L eye recovered after her first two flares, but she is now only able to see shadows out of her L eye. She reports that flares always happen in the winter. Since her diagnosis Ms. has been taking Avonex full dose (30 mcg weekly). Her medication was changed to Tysabri and she stopped the Avonex. \n.\nThis particular flare began approximately weeks prior to admission when Ms. noticed that her walking was slowing. She also began noticing an intense burning pain extending from below her breasts symmetrically down her torso and both of her legs to the bottom of her feet. She was taking Aleve twice a day with improvement in the pain. This pain is a new symptom that she has not had with previous flares - at least not to this extent. She noticed that her knees felt week two days prior to admission and on the day prior to admission she was wheelchair bound. At the time of presentation she reports that she is able to walk a bit better with her walker. \n.\nOf note, Ms. reports that her best friend died of colon cancer 5 weeks prior to presentation. In addition, Ms. one episode of vertigo which lasted a full day one month prior to admission for which she was not evaluated. She also has noticed increased urinary urgency, whichshe believes is due to drinking more fluids and difficulty getting to the bathroom in the last few days. She has not had a bowel movement in 4 days, which is not normal for her. At baseline, she has electrical sensations in the base of her head and neck at baseline worse with neck flexion (Lhermitte's phenomenon). She describes generalized painful electrical sensations in her lower extremities bilaterally. She generally suffers from low energy and has difficulty sleeping through the night.\n.\nReview of systems: No difficulty in speech, comprehension, change in hearing, change in behavior, or history of trauma. No fever, rhinorrhea, cough, SOB, chest pain, palpitations, nausea, vomiting, abdominal pain, diarrhea or rash.\n", + "input3": "Middle ear imbalance diagnosed in childhood\n", + "input4": "Lives with husband and son. One grown son at college who lives at home. Formerly worked. Not working at the moment. All family live. \n\ufeff\n", + "input5": "Physical Exam:\nPhysical Exam upon admission:\nT 97 C HR 75/min, RR 20/min BP 142/85 mmHg Pulse ox 98%RA\nGen: Awake, alert, not in distress, lying in bed. Non-toxic appearance. Thin, elegant woman.\nHeent: Normocephalic, no dysmorphic features, no conjunctival injection, mmm, oropharynx clear.\nNeck: Supple, no meningismus. Electrical sensation upon neck flexion.\nCVR: CTAb, RRR, normal S1/S2, no murmurs, rubs, or gallops\nAbd: +BS, soft, non-tender, non-distended. No \nhepatosplenomegaly or masses palpable.\nExtrem: Warm and well-perfused.\n\ufeff\nNeuro:\nAwake, alert, appropriately interactive. Oriented to person, place, and date. Attention is considered to be appropriate.\nSpeech: Fluent w/o paraphasic error, reading, writing intact\n\ufeff\nCranial Nerves \u0096 Pupils equal and reactive (3 to 2mm); EOM smooth and full, VFF by confrontation, no diplopia; no nystagmus, no ptosis; optic disc margins sharp on R with pallor and blurred disk margins on L on funduscopic exam, intact facial sensation, face symmetric with full strength of facial muscles, hearing intact to finger rub bilaterally, palate elevation is symmetric, and tongue protrusion is symmetric w/ full movement. Sternocleidomastoid and trapezius are strong and have normal volume.\n\ufeff\nMotor: Tone \u0096 Normal bulk and tone\nStrength -\nDel Tri Bi WE FE FF IP H Q DF PF TE\nR ___ ___ 3+ ___ 5 5\nL ___ ___ ___ ___\n.\nReflexes -\nBi Tri BR Pat Ach \nR 2 2 2 2 0 \nL 2 2 2 2 2 \n\ufeff\nToes upgoing on R, mute on L\n\ufeff\nSensation - Intact to light touch, vibration, position throughout. Vibration causes electrical sensations up legs. Temperature sensation intact on the L and inverted (cold felt hot) on the R. Coordination - Mild dysmetria on finger to nose. RAM slow, but rhythmic and accurate. No pronator drift; no adventitious movements\n\ufeff\nGait - Defered due to patient exhaustion.\n\ufeff\n", + "input6": "___ 05:39PM URINE COLOR-Straw APPEAR-Clear BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 LEUK-MOD\n___ 05:39PM URINE RBC-1 WBC-6* BACTERIA-MOD YEAST-NONE EPI-5 TRANS EPI-<1 URINE MUCOUS-RARE\n___ 04:50PM BLOOD: GLUCOSE-166* UREA N-14 CREAT-0.7 SODIUM-136 POTASSIUM-3.9 CHLORIDE-98 TOTAL CO2-30 ANION GAP-12 ALT(SGPT)-9 AST(SGOT)-11 LD(LDH)-139 CK(CPK)-41 ALK PHOS-58 TOT BILI-0.2 ALBUMIN-4.1 CALCIUM-9.1 PHOSPHATE-3.4 MAGNESIUM-2.1 URIC ACID-3.9 TSH-0.95 WBC-5.7 RBC-4.60 HGB-12.6 HCT-36.1 MCV-79* MCH-27.4 MCHC-34.8 RDW-12.6 NEUTS-70.6* LYMPHS-23.5 MONOS-3.9 EOS-1.6 BASOS-0.3 04:50PM PLT COUNT-196 PTT-26.6\n___ 09:10AM %HbA1c-5.8\n___ 05:39PM URINE Color-Straw Appear-Clear Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-MOD URINE RBC-1 WBC-6* Bacteri-MOD Yeast-NONE Epi-5 TransE-<1 URINE Mucous-RARE\n\nThere are multiple enhancing lesions indicating active demyelination, one of which also demonstrates slow diffusion.\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/13901573-DS-16.json b/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/13901573-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..66414344810cdd55b28a8c2bb17d3d983c120b5c --- /dev/null +++ b/Finished/Multiple Sclerosis/Secondary Progressive Multiple Sclerosis/13901573-DS-16.json @@ -0,0 +1,38 @@ +{ + "Secondary Progressive Multiple Sclerosis$Intermedia_4": { + "The patient has been diagnosed with relapsing-remitting multiple sclerosis (RRMS) for 3 years, which is consistent with the diagnosis time of Secondary Progressive Multiple Sclerosis.$Cause_1": { + "With regards to her MS, she was diagnosed with relapsing remitting years ago and is followed by Dr.$Input2": {} + }, + "Multiple Sclerosis$Intermedia_3": { + "A continued increase in the number of lesions in the central nervous system, a common phenomenon during the course of Secondary Progressive Multiple Sclerosis, points to disease progression.$Cause_1": { + "The number of central nervous system lesions continues to increase.$Input6": {} + }, + "Suspected Multiple Sclerosis$Intermedia_2": { + "Binocular diplopia is a common symptom in multiple sclerosis and may be related to damage to neural pathways in the brain.$Cause_1": { + "diplopia$Input2": {} + }, + "These symptoms may be due to an inflammatory response in the central nervous system that leads to impaired nerve conduction and are typical symptoms of multiple sclerosis.$Cause_1": { + "tingling and pain in all extremities$Input2": {} + }, + "The headache and spread of symptoms may be related to inflammation of the nervous system and indicate that the condition may be developing.$Cause_1": { + "severe left-sided headache and spread of her numbness to her left arm and both legs$Input2": {} + }, + "Nerve dysfunction leading to decreased muscle strength is a direct manifestation of nerve damage in multiple sclerosis$Cause_1": { + "weakness of her left arm$Input2": {} + }, + "Patients experience double vision at the extreme right and left ends of their visual field. People with MS often have double vision and other visual problems due to optic neuritis or other nerve dysfunction.$Cause_1": { + "endorse diplopia on extreme right and left end gaze$Input5": {} + }, + "Significant hyperalgesia and hypoesthesia when touched lightly. MS patients may have varying degrees of sensory abnormalities due to damage to the central nervous system.$Cause_1": { + "Significant allodynia and hypesthesia on light touch$Input5": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "The patient is a right-handed woman who presented to the ED with a 5 day history of diplopia, tingling and pain in all extremities and left arm weakness. \n\ufeff\nShe also started having diplopia, especially when looking to the left. , This improved and she received an infusion of Tysabri. She mentioned her symptoms at that time but did not feel an MD appointment was necessary. She developed a severe left-sided headache and spread of her numbness to her left arm and both legs. Today she developed weakness of her left arm and severe stabbing like pain especially when her arm is touched or moved. She contacted our neurologist-on -call, recommended she come to the ED.\n\ufeff\nWith regards to her MS, she was diagnosed with relapsing remitting 3 years ago and is followed by Dr. Her initial presentation at which point she was found to have bilateral FLAIR intensities in the subcortical white matter and 8 oligoclonal bands in the CSF. She has been on Tysabri for 4 months and previously was on Copaxone and Avonex. \n\ufeff\nShe also reports over the past 2 weeks she has both had a URI with laryngitis and a GI illness. Prior to that she had an eye infection from a cat scratch. \n\ufeff\nOn neurologic review of systems, the patient denies headache, lightheadedness, or confusion. Denies difficulty with producing or comprehending speech. Denies loss of vision, vertigo, tinnitus, hearing difficulty, dysarthria, or dysphagia. Denies bowel or bladder incontinence or retention. \n\ufeff\nOn general review of systems, the patient denies fevers, rigors, night sweats, or noticeable weight loss. Denies chest pain, palpitations, dyspnea. Denies dysuria or hematuria. Denies myalgias, arthralgias, or rash.\n\ufeff\n", + "input3": "1) Migraines - correlating with menses\n2) Sickle cell trait\n3) Anxiety/depression\n", + "input4": "Significant for lupus, sickle cell, diabetes, migraines.\n", + "input5": "Physical Exam:\nAdmission Physical Examination:\nVS T 98.1 62 105/66 16 100% RA \nGeneral: NAD \nHEENT: NC/AT, no oropharyngeal lesions, neck supple\n: RRR, no M/R/G \nPulmonary: CTAB, no crackles or wheezes\nAbdomen: Soft, NT, ND, +BS, no guarding \nExtremities: Warm, no edema\nSkin: No rashes or lesions\n\ufeff\nNeurologic Examination:\n- Mental Status - Awake, alert, oriented x 3. Attention to examiner easily attained and maintained. Concentration maintained when recalling months backwards. Recalls a coherent history. Structure of speech demonstrates fluency with full sentences, intact repetition, and intact verbal comprehension. Content of speech demonstrates intact naming (high and low frequency) and no paraphasias. Normal prosody. No dysarthria. Verbal registration and recall. No apraxia. No evidence of hemineglect. No left-right agnosia.\n\ufeff\n- Cranial Nerves - PERRL 5->4 brisk. VF full to number counting.\nEOMI, no nystagmus, although she does endorse diplopia on extreme right and left end gaze. V1-V3 without deficits to light touch bilaterally. No facial movement asymmetry. Hearing intact to finger rub bilaterally. Palate elevation symmetric. SCM/Trapezius strength bilaterally. Tongue midline.\n\ufeff\n- Motor - Normal bulk and tone. No drift. No tremor or asterixis.\nThe below strength exam is limited by pain. \nDelt Bic Tri WrE FFl FE IO IP Quad Ham TA Gastroc \nL 5 4+ 4+ 4+ 5 5 5 4 5 \nR 5 5- 5 5 5 5 \n\ufeff\n- Sensory - Significant allodynia and hypesthesia on light touch. upon testing of biceps reflex on right she yelled out in pain and described shooting pain into her fingers. After a 15 seconds, she regrouped but requested no other reflexes be tested. Also declined pinprick testing. No proprioception deficit bilaterally.\n\ufeff\n-DTRs: (* patient declined given hypesthesia)\nBi Tri Pat Ach\nL 2 2 * * *\nR 2 2 * * *\nPlantar response mute bilaterally.\n\ufeff\n- Coordination - No dysmetria with finger to nose testing bilaterally. Good speed and intact cadence with rapid alternating movements.\n\ufeff\n", + "input6": "ADMISSION LABS:\n___ 10:00PM BLOOD WBC-14.2* RBC-3.53* Hgb-10.2* Hct-31.5* MCV-89 MCH-28.8 MCHC-32.3 RDW-12.7 Plt ___\n___ 10:00PM BLOOD Neuts-51.0 ___ Monos-3.4 Eos-3.1 Baso-0.8\n___ 10:00PM BLOOD Glucose-87 UreaN-8 Creat-0.7 Na-138 K-3.7 Cl-104 HCO3-26 AnGap-12\n\ufeff\n___ 09:40AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG cocaine-NEG amphetmn-NEG mthdone-NEG\n\ufeff\n___ 09:40AM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n___ 09:40AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG\n\ufeff\nThe number of central nervous system lesions continues to increase.\n\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Duodenal Ulcers/11833885-DS-11.json b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/11833885-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..1a3d504ef9d83fd4c051b8450a8e7f5fac365034 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/11833885-DS-11.json @@ -0,0 +1,24 @@ +{ + "duodenal ulcers$Intermedia_3": { + "Duodenal ulcer with bleeding onendoscopyis the gold standard of duodenal ulcer.$Cause_1": { + "Endoscopy:duodenal ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Cause_2": { + "Melena and dizziness are the manifestations of peptic ulcer with bleeding.$Cause_1": { + "Melena and dizziness$Input1": {} + }, + "Blood in the stool is the manifestations of peptic ulcer with bleeding.$Cause_1": { + "Rectal exam showed guaiac positive brown stool.$Input2": {} + }, + "Family history of gapeptic disease.$Cause_1": { + "Father - colon cancer$Input4": {} + } + } + }, + "input1": "Melena and dizziness\n", + "input2": "Patient with PMH hypertension, hyperlipidemia, GERD, diverticulitis s/p colectomy, and prostate cancer, now presenting with melena and dizziness. Patient denies any abdominal pain. He reports that he had one episode of black tarry stool at ~7pm followed by some dizziness and lightheadedness. He also had burning chest pain, which is typical for his GERD and esophagitis. States that his esophagitis and gastritis have been particularly bothersome over the last 2 weeks. Denies any bright red blood per rectum. Denies any chest pain or dyspnea. Patient came to the ED for evaluation. Upon arrival in the ED, initial VS: 98.8, 81, 116/80, 15, 95%. Patient's labs showed BUN 40 and Hct 40 (down from 45 baseline). Patient was otherwise stable and without complaint. Rectal exam showed guaiac positive brown stool. GI was consulted, who recommended starting IV PPI, type and cross, large bore IVs and admitting to medicine for likely EGD in AM. Patient was given pantoprazole 40mg IV x 1 and admitted to medicine for further management. Upon arrival to the floor, patient states that he feels better. Has had some lightheadedness for the last few days. Had one episode of melena and came in for evaluation. Reports some nausea, no vomiting. No bright red blood per rectum. States that he has bad esophagitis and generally takes tums daily as well as ranitidine 150mg po daily. He was taking esomeprazole but stopped several years ago because it wasn't working. Regarding his chest discomfort, it is mostly mid-substernal and epigastric, lasting all day. Nothing helps, including his Tums or ranitidine, over the last few weeks. He has also had mild dyspnea for the same period. Symptoms have no relationship to activity. Patient states that he has a stress test every year, most recently in and is due for another one in two weeks. States that they have always been normal as far as he is aware.\n", + "input3": "+GERD \n+Depression \n+Arthritis \n+History of an irregular heartbeat \ndiverticulosis and diverticulitis s/p sigmoid resection (side-side anastomosis) \n+erectile dysfunction \n+hypertension \n+hyperlipidemia \n+obstructive sleep apnea \n+prostate cancer s/p prostatectomy \n+COPD\n", + "input4": "Family history of arthritis and hypertension. Sister w/ stroke secondary to endocarditis. \nMother - breast cancer\nFather - colon cancer\n", + "input5": "Vitals - 98.7F, 122/63, 61, 18, 99% RA \nGENERAL: well appearing man in no acute distress \nHEENT: PERRL, EOMI, moist mucous membranes \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB \nABDOMEN: non-distended, normal bowel sounds, mild tenderness to palpation in RUQ and epigastric area, otherwise non-tender to palpation. No masses. \nEXTREMITIES: moving all extremities well, no cyanosis, clubbing or edema \nNEURO: A&O x 3, grossly normal sensory and motor function \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "01:40PM WBC-4.5 RBC-3.79* HGB-11.9* HCT-36.4* MCV-96 MCH-31.4 MCHC-32.6 RDW-13.6\n01:40PM PLT COUNT-120*\n03:43AM GLUCOSE-80 UREA N-36* CREAT-0.8 SODIUM-141 POTASSIUM-3.3 CHLORIDE-106 TOTAL CO2-26 ANION GAP-12\n03:43AM CALCIUM-8.2* PHOSPHATE-2.9 MAGNESIUM-2.4\n03:43AM WBC-6.7 RBC-3.91* HGB-12.3* HCT-38.0* MCV-97 MCH-31.5 MCHC-32.5 RDW-13.6\n03:43AM PLT COUNT-121*\n08:35PM GLUCOSE-104* UREA N-40* CREAT-1.0 SODIUM-141 POTASSIUM-3.8 CHLORIDE-105 TOTAL CO2-27 ANION GAP-13\n08:35PM estGFR-Using this\n08:35PM ALT(SGPT)-22 AST(SGOT)-20 ALK PHOS-43 TOT \nBILI-0.5\n08:35PM CALCIUM-8.0* PHOSPHATE-2.6* MAGNESIUM-2.4\n08:35PM WBC-6.7 RBC-4.17* HGB-13.4* HCT-40.4 MCV-97 MCH-32.2* MCHC-33.2 RDW-14.2\n08:35PM NEUTS-59.9 MONOS-7.1 EOS-1.0 BASOS-0.6\n08:35PM PLT COUNT-142*\n08:35PM PTT-25.5\nEndoscopy:duodenal ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Duodenal Ulcers/13188037-DS-21.json b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/13188037-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..7d866398a5d18790bd08fb3beee587575030a1e2 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/13188037-DS-21.json @@ -0,0 +1,24 @@ +{ + "duodenal ulcers$Intermedia_3": { + "Duodenal ulcer with bleeding is the gold standard of duodenal ulcer.$Cause_1": { + "Upper Endoscopy :duodenal ulcer with bleeding$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "Melanous stools are one of the manifestations of the duodenum with bleeding$Cause_1": { + "Presents with melanous stools since evening (x3 days), total of approx 10 dark bloody bowel movements since then.$Input2": {} + }, + "Anemia is one of the manifestations of the duodenum with bleeding$Cause_1": { + "Labs notable for HCT 25.2 down from 38.5.$Input2": {} + }, + "Family history of cancer is a risk factor for peptic ulcer.$Cause_1": { + "The patient's sister was diagnosed with colon cancer$Input4": {} + } + } + }, + "input1": "None\n", + "input2": "Famale, hx of pancreatic CA x year, treated with biweekly gemcitabine chemotherapy. Patient received C13D1 of gemcitabine on . Presents with melanous stools since evening (x3 days), total of approx 10 dark bloody bowel movements since then. No N/V. No SOB, no CP, no abdominal pain, no weakness. Was able to walk from parking lot to ED. She has never had this before. Pt cannot recall her last colonoscopy and she thinks it was more than years ago. She is on ASA 81 but no other antiplatelet agents or anticoagulants. She does not take any NSAIDS.\n\nIn the ED, initial VS were 97.4, 77, 120/37, 16, 100% RA. Melena on rectal exam. Labs notable for HCT 25.2 down from 38.5. Patient was given pantoprazole 40mg IV then started on gtt. Also given 500cc NS and 2 unit PRBCs. GI aware and plan to scope patient tomorrow morning. VS prior to transfer were 98.3, 75, 16, 132/48, 100% RA.\n\nOn arrival to the floor, patient reports she is feeling well. She does not have abdominal pain, chest pain, shortness of breath, dizziness, lightheadedness. She last had a BM this morning prior to coming to the ED which she described as black and tarry looking.\n", + "input3": "+skin cancer\n+Papillary thyroid cancer\n+History of left breast cyst.\n+Hypertension.\n+Status post knee replacement.\n+History of tachycardia with negative Holter monitoring\n+Acid reflux disease.\n+History of abdominal cramping, triggered by episodes of\nanxiety. New since being diagnosed with pancreatic cancer. \n+Pancreatic cancer: Diagnosed with obstructive jaundice and \nmass in head of pancreas. She is s/p ERCP by Dr. / bulging major papilla ___ mass lesion, single stricture 5mm long in distal CBD\n", + "input4": "The patient's daughter was diagnosed with papillary thyroid cancer. She is status post thyroidectomy. Her other daughter was diagnosed with Graves' disease. She is status post radioactive iodine ablation. Her son is in good health. The patient's sister was diagnosed with colon cancer, which was treated by surgery alone. Her parents had coronary artery disease. No other known family history of malignancies. The patient is of descent.\n", + "input5": "VS: 98.2 139/52 72 16 98%RA\nGEN Alert, oriented, no acute distress \nHEENT NCAT MMM EOMI sclera anicteric, OP clear \nNECK supple, no JVD, no LAD \nPULM Good aeration, CTAB no wheezes, rales, ronchi \nCV RRR normal S1/S2, + systolic murmur, no rg\nABD soft NT ND normoactive bowel sounds, no r/g \nEXT WWP 2+ pulses palpable bilaterally, no c/c/e\nNEURO CNs2-12 grossly intact, motor function grossly normal\nSKIN no ulcers or lesions\n", + "input6": "Imaging:\nCT abdomen/pelvis\nIMPRESSION: \n1. Stable subcentimeter lingular and subpleural left lower lobe pulmonary nodules. No intrathoracic lymphadenopathy. \n2. Overall stable size pancreatic head mass. Persistent patent distal common bile duct stent. Enlarged pancreatic head massabuts the SMV, duodenum and the inferomedial aspect of segment 6 of the liver but maintains a fat plane between the SMA, IVC and Aorta. No significant retroperitoneal lymphadenopathy. \n3. Multiple stable bilateral renal cysts, some of which demonstrate diffuse hyperdensity. The most superior cyst in the right kidney contains nonspecific intrinsic hyperdensity. \nAttention to this on follow up exams. \n4. Nonspecific 3.3 cm left adnexal cyst without obvious nodularity or wall thickening. \n5. Stable lucent lesion in the posterior left iliac bone likely an aneurysmal bone cyst.\nUpper Endoscopy :duodenal ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Duodenal Ulcers/13688835-DS-12.json b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/13688835-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..3b7d24ff308008241bc416cac90b1a4f5fc7e83c --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/13688835-DS-12.json @@ -0,0 +1,27 @@ +{ + "duodenal ulcers$Intermedia_3": { + "Duodenal ulcer with bleeding on endoscopy is the gold standard of duodenal ulcer.$Cause_1": { + "Endoscopy:duodenal ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Cause_2": { + "Epigastric pain is the manifestations of peptic ulcer.$Cause_1": { + "Epigastric pain$Input1": {} + }, + "Advil is the risk factor of peptic ulcer.$Cause_1": { + "Of note, he has been taking Advil frequently over the last month for sciatic pain.$Input2": {} + }, + "Radiology here reviewed the images and feels that the imaging shows just duodenal thickening without extraluminal air, which suggests a possible lesion in the duodenum.$Cause_1": { + "Radiology here reviewed the images and feels that the imaging shows just duodenal thickening without extraluminal air.$Input2": {} + }, + "Anemia is the manifestations of peptic ulcer with bleeding.$Cause_1": { + "Labs were notable only for a normocytic anemia with HCT 34$Input2": {} + } + } + }, + "input1": "Epigastric pain\n", + "input2": "with a history of HTN, hyperlipidemia presents with 3 weeks of epigastric abdominal pain. Initially went to OSH 3 weeks prior, had a CT scan that per his report showed inflammation and possible pancreatitis; labs were drawn, but he does not know the results of those labs. He had light nausea, no vomiting at that time. He was told to take a liquid diet and discharged home without admission.\n\nThe patient said the pain is a burning pain, in LUQ and RUQ, somewhat more intense in LUQ. It is intermittent, with waves of pain every few hours during which pain increases in intensity to on pain scale. He has had significantly reduced PO intake of solids over the last several weeks because he is \"afraid\" to eat, even though he hasn't noticed a direct temporal correlation between eating and onset of pain. He has been tolerating liquids well. Of note, he has been taking Advil frequently over the last month for sciatic pain. He reports he previously drank beers/night, but quit 2.5 weeks ago as he felt it may have been contributing to his abdominal pain. Denies nausea/vomiting/diarrhea. Denies BRBPR or melena.\n\nRadiology here reviewed the images and feels that the imaging shows just duodenal thickening without extraluminal air. Surgery was consulted who felt that there was no acute surgical issue.\n\nIn the ED, initial vs were 98.2, 70, 180/100, 16, 97%. Received morphine 5mg x3 and zosyn. Labs were notable only for a normocytic anemia with HCT 34, unclear baseline Per pt, he has been anemic in the distant past but not recently. WBC, chem7, LFTs, lipase all wnl. On arrival to the floor, patient reported abdominal pain from on arrival to the ED.\n", + "input3": "+HTN \n+Hyperlipidemia \n+sciatica \n+surgery for tendonitis of L wrist\n", + "input4": "Brother with MI, father with CABG twice.\n", + "input5": "VS 98.7 160/90 72 18 100%RA \nGEN: Alert, oriented, no acute distress \nHEENT: NCAT MMM EOMI sclera anicteric, OP clear \nNECK: supple, no JVD, no LAD \nPULM: Good aeration, CTAB no wheezes, rales, ronchi \nCV: RRR normal S1/S2, no mrg \nABD: soft, ttp epigastrium, ND normoactive bowel sounds \nEXT: WWP 2+ pulses palpable bilaterally, no c/c/e \nNEURO: CNs2-12 intact, motor function grossly normal \nSKIN: no ulcers or lesions\n", + "input6": "04:29PM WBC-5.0 RBC-3.49* HGB-11.0* HCT-34.1* MCV-98 MCH-31.5 MCHC-32.2 RDW-13.5\n04:29PM NEUTS-65.1 MONOS-6.4 EOS-0.2 BASOS-0.8\n04:29PM PLT COUNT-371\n03:52PM LACTATE-0.9\n03:34PM GLUCOSE-70 UREA N-9 CREAT-0.9 SODIUM-137 POTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-26 ANION GAP-12\n03:34PM ALT(SGPT)-12 AST(SGOT)-19 ALK PHOS-80 TOT BILI-0.2\n03:34PM LIPASE-18\n03:34PM ALBUMIN-4.2 IRON-31*\n03:34PM calTIBC-263 VIT B12-734 FOLATE-GREATER TH FERRITIN-152 TRF-202\n08:00AM BLOOD Ret Aut-1.7\nEndoscopy:duodenal ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Duodenal Ulcers/15177004-DS-21.json b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/15177004-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..b850d8ae26f02ce19a873a70978693d9a1d611f6 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/15177004-DS-21.json @@ -0,0 +1,33 @@ +{ + "Duodenal ulcers$Intermedia_3": { + "Duodenal ulcer with bleeding on endoscopy is the gold standard of peptic ulcer.$Cause_1": { + "Endoscopy:duodenal ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "dark stools are the manifestations of peptic ulcer with bleeding.$Cause_1": { + "dark stools.There, she was noted to have Guaiac+ stools and anemia and was admitted to the ICU for transfusion.$Input1": {} + }, + "H. pylori infection is the risk factor of peptic ulcer.$Cause_1": { + "Per EGD report at , she was found to have H. pylori infection.$Input2": {} + }, + "melena as well as abdominal cramping and nausea are the possible symptom of peptic ulcer.$Cause_1": { + "The morning of admission, she was still having melena as well as abdominal cramping and nausea.$Input2": {} + }, + "History of peptic ulcer disease.anemia$Cause_1": { + "+Peptic ulcer disease\n+H. pylori infection$Input3": {} + }, + "Family history of peptic ulcer disease.$Cause_1": { + "Father with PUD$Input4": {} + }, + "Anemia is the manifestation of peptic ulcer with bleeding.$Cause_1": { + "RBC-2.74* HGB-7.9* HCT-24.0*$Input6": {} + } + } + }, + "input1": "dark stools\n", + "input2": "A female with recent GIB from PUD who presents with 2 day h/o 'dark stools.' She was previously healthy until when she noted dark stools and presented to . There, she was noted to have Guaiac+ stools and anemia and was admitted to the ICU for transfusion. She was subsequently transferred to for further management. She was in the ICU there for anemia requiring blood transfusion. She did not have a repeat EGD at that time as her stool was guaiac negative. Per EGD report at , she was found to have H. pylori infection. As such, she was started on clarithromycin, amoxicillin, and pantoprazole triple therapy on . She was transferred out of the ICU and remained on the general floor. She was doing well at home with regular BM, no melena or hematochezia, until , when she noted melena. The morning of admission, she was still having melena as well as abdominal cramping and nausea. She presented to her PCP who sent her to for further management. Currently, she complains of abdominal cramping and black stools. She denies nausea, hematemesis, fevers, chills, dizziness, lower extremity edema, CP, or SOB.\n\nShe denies significant NSAID use. She has never had a GIB before.\n\nIn the ED, initial VS were T 98.4 HR 81 BP 135/89 RR 18 100% RA Exam notable for GUAIC POSITIVE Labs showed: H/H of 8.9/27.3. (last h/h 12.6/37.7 in ) Chem 7 unremarkable. : 10.5 PTT: 26.5 INR: 1.0 UA unremarkable Blood and urine cultures sent Received 40mg IV pantoprazole and started on IVF 100CC/HR NS\n\nTransfer VS: 98.1 70 100% RA\n\nGI was consulted and decision was made to admit to medicine for further management.\n\nOn arrival to the floor, patient reports that her nausea has improved but that she is still experiencing abdominal cramping\n", + "input3": "+Peptic ulcer disease\n+H. pylori infection\n", + "input4": "Father with PUD and h/o GIB \nMother with HTN\n", + "input5": "VS - T 98.2 HR 70 BP 114/74 RR 18 100% RA\nGENERAL: NAD, AAOx3\nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pale conjunctiva, MMM, good dentition, \nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, Loud S1, normal S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi\nABDOMEN: nondistended, hypoactive BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no cyanosis, clubbing or edema\nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "11:50AM PTT-26.5\n11:50AM WBC-7.7 RBC-3.11*# HGB-8.9*# HCT-27.3*# MCV-88 MCH-28.6 MCHC-32.6 RDW-13.5 RDWSD-43.0\n11:50AM NEUTS-54.9 MONOS-6.9 EOS-3.5 BASOS-0.5 IM AbsNeut-4.21 AbsLymp-2.59 AbsMono-0.53 \nAbsEos-0.27 AbsBaso-0.04\n12:33PM LACTATE-1.3\n01:26PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG\n01:26PM URINE UCG-NEGATIVE\n06:50PM WBC-8.7 RBC-2.99* HGB-8.5* HCT-26.3* MCV-88 MCH-28.4 MCHC-32.3 RDW-13.5 RDWSD-42.6\n11:59PM WBC-8.6 RBC-2.74* HGB-7.9* HCT-24.0* MCV-88 MCH-28.8 MCHC-32.9 RDW-13.6 RDWSD-42.5\nEndoscopy:Gastric ulcer, duodenal ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Duodenal Ulcers/15177004-DS-211.json b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/15177004-DS-211.json new file mode 100644 index 0000000000000000000000000000000000000000..98dcf46d34357865babbca57e4b1122ac78556b2 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/15177004-DS-211.json @@ -0,0 +1,33 @@ +{ + "Duodenal Ulcers$Intermedia_3": { + "The presence of ulcers is direct evidence that the patient has ulcerative lesions in the gastrointestinal tract.$Cause_1": { + "EGD there which showed 4 ulcers, 3 of which were cauterized$Input2": {} + }, + "Ulcers found in the lesser curvature and duodenal bulb are the direct basis for diagnosing duodenal ulcer disease.$Cause_1": { + "Ulcer in the lesser curvature.Ulcer in the duodenal bulb.$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "This phenomenon may be caused by bleeding in the upper digestive tract, especially when the bleeding comes from the ulcer site, which is one of the more common symptoms of gastric ulcer disease.$Cause_1": { + "dark stools$Input1": {} + }, + "Occult blood-positive stools indicate that the patient may have gastrointestinal bleeding, a common symptom of peptic ulcer disease. Anemia may occur due to iron deficiency caused by prolonged bleeding.$Cause_1": { + "Guaiac+ stools and anemia$Input2": {} + }, + "Helicobacter pylori is one of the main causes of peptic ulcers and can cause gastric ulcers$Cause_1": { + "H. pylori infection$Input2": {} + }, + "Black stools are a common symptom of upper gastrointestinal bleeding and are usually associated with gastric or duodenal ulcers.$Cause_1": { + "melena$Input2": {} + }, + "These symptoms may be triggered by irritation of stomach contents caused by a peptic ulcer or by pain from the ulcer.$Cause_1": { + "abdominal cramping and nausea$Input2": {} + } + } + }, + "input1": "dark stools\n", + "input2": "There, she was noted to have Guaiac+ stools and anemia and was admitted to the ICU for transfusion. She had an EGD there which showed 4 ulcers, 3 of which were cauterized. She was subsequently transferred to ___ for further management. She was in the ICU there for anemia requiring blood transfusion. She did not have a repeat EGD at that time as her stool was guaiac negative. Per EGD report at ___, she was found to have H. pylori infection. As such, she was started on clarithromycin, amoxicillin, and pantoprazole triple therapy on ___. She was transferred out of the ICU at ___ and remained on the general floor until discharge on ___ ___. She was doing well at home with regular BM, no melena or hematochezia, until ___, when she noted melena. The morning of admission, she was still having melena as well as abdominal cramping and nausea. She presented to her PCP who sent her to ___ for further management. Currently, she complains of abdominal cramping and black stools. She denies nausea, hematemesis, fevers, chills, dizziness, lower extremity edema, CP, or SOB.\n", + "input3": "None\n", + "input4": "Father with PUD and h/o GIB \nMother with HTN\n", + "input5": "VS - T 98.2 HR 70 BP 114/74 RR 18 100% RA\nGENERAL: NAD, AAOx3\nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pale conjunctiva, \nMMM, good dentition, \nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, Loud S1, normal S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi\nABDOMEN: nondistended, hypoactive BS, nontender in all \nquadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no cyanosis, clubbing or edema\nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no rashes\n", + "input6": "___ 11:50AM ___ PTT-26.5 ___\n___ 11:50AM WBC-7.7 RBC-3.11*# HGB-8.9*# HCT-27.3*# \nMCV-88 MCH-28.6 MCHC-32.6 RDW-13.5 RDWSD-43.0\n___ 11:50AM NEUTS-54.9 ___ MONOS-6.9 EOS-3.5 \nBASOS-0.5 IM ___ AbsNeut-4.21 AbsLymp-2.59 AbsMono-0.53 \nAbsEos-0.27 AbsBaso-0.04\n___ 12:33PM LACTATE-1.3\n___ 01:26PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-NEG\n___ 01:26PM URINE UCG-NEGATIVE\n___ 06:50PM WBC-8.7 RBC-2.99* HGB-8.5* HCT-26.3* MCV-88 \nMCH-28.4 MCHC-32.3 RDW-13.5 RDWSD-42.6\n___ 11:59PM WBC-8.6 RBC-2.74* HGB-7.9* HCT-24.0* MCV-88 \nMCH-28.8 MCHC-32.9 RDW-13.6 RDWSD-42.5\n\nEGD ___\nImpression: Normal mucosa in the esophagus. Ulcer in the lesser curvature.Ulcer in the duodenal bulb. Otherwise normal EGD to third part of the duodenum. Recommendations: No evidence of recent or active bleeding on this examination. Risk of rebleeding with clean based ulcer is 3%. Continue PPI BID until follow up EGD. Complete H. pylori treatment. Avoid NSAIDs. Follow up EGD in 6 weeks with Dr. ___.\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Duodenal Ulcers/16882192-DS-33.json b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/16882192-DS-33.json new file mode 100644 index 0000000000000000000000000000000000000000..5507496a5856030b0a9e31487a5b5d2b6bdac36e --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/16882192-DS-33.json @@ -0,0 +1,33 @@ +{ + "Duodenal Ulcers$Intermedia_3": { + "The mucosa of the first and second parts of the duodenum was erythematous and hyperemic, with a 10-mm ulcer in the duodenal bulb and multiple superficial non-bleeding ulcers in the second part, suggestive of duodenal ulcer.$Cause_1": { + "Erythema and congestion of the mucosa were noted in the first part of the duodenum and second part of the duodenum. Excavated Lesions A single 10 mm ulcer was found in the duodenal bulb with punctate pigmented spots, but no active bleeding and no visible vessels. Multiple superficial non-bleeding ulcers ranging in size from 6 mm to 8 mm were found in the second part of the duodenum.$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "Peptic ulcer disease often presents with epigastric pain, which may be associated with the patient's abdominal pain.$Cause_1": { + "bdominal and back pain and peripheral neuropathy$Input2": {} + }, + "Typical symptoms of peptic ulcer disease include abdominal pain, nausea, and vomiting. These symptoms match the description of lower abdominal pain, nausea, and retching in the article.$Cause_1": { + "chronic back pain, lower abdominal pain, nausea, and retching$Input2": {} + }, + "Alcohol is a known risk factor for peptic ulcers. It can damage the gastric mucosa and increase gastric acid secretion, thereby aggravating or inducing ulcer disease.$Cause_1": { + "alcohol yesterday to calm his pain (3 pints of vodka)$Input2": {} + }, + "Chronic alcohol abuse can lead to long-term damage to the stomach lining, which may lead to the development of peptic ulcers.$Cause_1": { + "history of alcohol abuse$Input2": {} + }, + "Tenderness in the abdomen, especially the lower abdomen, may be a manifestation of pain caused by gastric ulcer$Cause_1": { + "tender in lower quadrants of his abdomen,$Input5": {} + }, + "There are non-hemorrhagic erosions at the junction of the esophagus and stomach, indicating esophagitis.$Cause_1": { + "A few non-bleeding erosions were noted in the gastroesophageal junction$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "The patient is known to have abdominal and back pain and peripheral neuropathy for which he receives oxycodone, but had run out and could not get it refilled. He resorted to alcohol yesterday to calm his pain (3 pints of vodka) and as a result fell down striking his right hip as well as his head/neck causing him to lose consciousness. Of note, the patient reports a past history of alcohol abuse, but has been sober for several years. The patient had SI on admission, stating he was \"trying to drink enough to have a courage to kill himself\". He also reports not eating due to his pain.\n\nPt does have chronic abdominal pain, back pain, as well as peripheral neuropathy for which he takes oxycodone. Has not been to his PCP recently so ___ been getting his pain medications/oxycodone. On arrival to the MICU, patient reports his chronic back pain, lower abdominal pain, nausea, and retching. Denies fevers at home. No SOB, chest pain. No urinary \nsymptoms.\n", + "input3": "CHRONIC LOW BACK PAIN \nNEUROPATHY \nVERTIGO \nHYPERTENSION \nFALLS attributed to orthostatic hypotension\nATRIAL FIBRILLATION (not on coumadin)\nGASTROESOPHAGEAL REFLUX \nH/O DEPRESSION \nH/O ALCOHOL ABUSE \nH/O ANEMIA\n", + "input4": "Father had CAD. Brother with a ___. No known family \nhistory of prostate or colon cancer. No diabetes, no strokes.\n", + "input5": "Vitals: T:101 BP:146/77 P:90 R: 17 18 O2: 100%RA\nGENERAL: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, dry MM, oropharynx clear \nNECK: supple, JVP not elevated, no LAD \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, \ngallops \nABD: soft, tender in lower quadrants of his abdomen, \nnon-distended, bowel sounds present, no rebound tenderness or \nguarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSKIN: warm well perfused\nNEURO: AOX3, normal strength and sensation\n", + "input6": "___ 11:55AM BLOOD ___-16.3*# RBC-3.38* Hgb-11.4*# Hct-32.5* \nMCV-96 MCH-33.7* MCHC-35.1 RDW-11.9 RDWSD-41.8 Plt ___\n___ 11:55AM BLOOD Neuts-57.5 ___ Monos-6.3 Eos-0.0* \nBaso-0.4 NRBC-0.4* Im ___ AbsNeut-9.37*# AbsLymp-5.67* \nAbsMono-1.02* AbsEos-0.00* AbsBaso-0.06\n___ 04:55PM BLOOD ___ PTT-22.3* ___\n___ 11:55AM BLOOD Glucose-119* UreaN-14 Creat-0.7 Na-137 \nK-2.9* Cl-93* HCO3-24 AnGap-23*\n___ 11:55AM BLOOD ALT-29 AST-42* AlkPhos-45 TotBili-1.1\n___ 11:55AM BLOOD Albumin-3.8 Calcium-8.7 Phos-2.9 Mg-1.8\n___ 11:55AM BLOOD Lipase-36\n\nMICROBIOLOGY\n============\n___: BLOOD CULTURE X 1: PENDING.\n\nIMAGING\n=======\n___: CT C-SPINE WITHOUT CONTRAST\nIMPRESSION: No acute cervical spine fracture. \n\n___: CT C-SPINE WITHOUT CONTRAST\nIMPRESSION: No acute intracranial hemorrhage or fracture. \n\n___: CHEST (PORTABLE AP)\nIMPRESSION: \nIn comparison with the study of ___, the patient has taken a better inspiration. There is no evidence of pneumonia, vascular congestion, or pleural effusion. \n\n___: ABDOMEN SUPINE AND LATERAL DECUB PORTABLE\nFINDINGS: \nClips noted in RUQ. \nThere are no abnormally dilated loops of large or small bowel. Supine assessment limits detection for free air; there is no gross pneumoperitoneum. Osseous structures are unremarkable. There are no unexplained soft tissue calcifications or \nradiopaque foreign bodies. \n\n___: CHEST X-RAY\nIMPRESSION: \nIn comparison with this earlier study of this date, there has been placement of a left subclavian PICC line that extends to the mid to lower portion of the SVC. Otherwise no change in the appearance of the heart and lungs. \n\n___: EGD\nFindings: \nEsophagus:\nExcavated Lesions A few non-bleeding erosions were noted in the gastroesophageal junction with no active bleeding, concerning for esophagitis. \n\n\nDuodenum: Mucosa: Erythema and congestion of the mucosa were noted in the first part of the duodenum and second part of the duodenum. Excavated Lesions A single 10 mm ulcer was found in the duodenal bulb with punctate pigmented spots, but no active bleeding and no visible vessels. Multiple superficial non-bleeding ulcers ranging in size from 6 mm to 8 mm were found in the second part of the duodenum.\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Duodenal Ulcers/17910930-DS-11.json b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/17910930-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..7b5e791583890066aaac221a77f0316d6841283f --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/17910930-DS-11.json @@ -0,0 +1,27 @@ +{ + "duodenal ulcers$Intermedia_3": { + "Bleeding duodenal ulcer onEGD is the gold standard of duodenal ulcer.$Cause_1": { + "He subsequently underwent EGD under conscious sedation with identification of bleeding duodenal ulcer and electrocautery;$Input2": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "Ibuprofe is the risk of peptic ulcer.$Cause_1": { + "he has been taking 800 mg of ibuprofen 3 times daily combined with multiple daily Aleve.$Input2": {} + }, + "Melena is the manifestation of peptic ulcer with bleeding.$Cause_1": { + "presents for evaluation of melena.$Input2": {} + }, + "Lightheadedness is the manifestation of peptic ulcer with bleeding.$Cause_1": { + "Today, he noted about bowel movements which were first watery but then dark red. Symptoms were associated with some lightheadedness.$Input2": {} + }, + "hypotensive is the manifestation of peptic ulcer with bleeding.$Cause_1": { + "He was evaluated by his PCP today and found to be hypotensive to$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "Male with a past medical history of COPD on 2L at night, chronic back pain who presents for evaluation of melena. The patient reports that for the past 6 weeks, he has experienced worsening back pain and left-sided sciatica for which he has been taking 800 mg of ibuprofen 3 times daily combined with multiple daily Aleve. Today, he noted about bowel movements which were first watery but then dark red. Symptoms were associated with some lightheadedness. No chest pain or pressure. He was evaluated by his PCP today and found to be hypotensive to . EMS was called and he was taken to the ED, receiving 400 cc of fluid en route with improvement in his blood pressure. Patient is not on any beta blockade or blood thinner. No large alcohol use. No previous history of GI bleeding. No known esophageal varices or liver disease. In the ED, initial vitals were HR 95 BP 124/95 RR 18 O2 sat 96% RA. Exam notable for frail-appearance, rectal with dark guaiac positive stool. Labs showed Hgb down to 11.1 from 13.6 on , with BUN elevated to 56 from . GI was consulted and recommended admission to the ICU for urgent EGD. On evaluation, the patient endorses the history above. He feels \"woozy\" but denies abdominal pain, nausea, or vomiting. He subsequently underwent EGD under conscious sedation with identification of bleeding duodenal ulcer and electrocautery; see EGD report in OMR.\n", + "input3": "+COPD on 2L at night \n+Sciatica\n", + "input4": "Reviewed; non-contributory\n", + "input5": "VS: HR 95 BP 119/94 RR 25 O2 sat 92% RA\nGEN: Pale-appearing elderly man, no distress\nHEENT: Sclera anicteric. Moist mucus membranes.\nNECK: No palpable lymphadenopathy. \nCV: Normal S1S2, RRR, no murmurs\nRESP: Scattered rhonchi, otherwise clear bilaterally \nGI: Soft, non-tender, non-distended, no palpable organomegaly\nMSK: Warm, well-perfused, no lower extremity edema\nSKIN: No bruises or rashes\nNEURO: AOX3, CNII-XII intact, moves all extremities with purpose\n", + "input6": "02:40PM BLOOD WBC-7.9 RBC-4.81 Hgb-13.6* Hct-40.8 MCV-85 MCH-28.3 MCHC-33.3 RDW-13.8 RDWSD-42.8 Plt\n02:40PM BLOOD Neuts-66.0 Lymphs-17.7* Monos-10.6 Eos-4.0 Baso-1.3* Im AbsNeut-5.23 AbsLymp-1.40 AbsMono-0.84* AbsEos-0.32 AbsBaso-0.10*\n02:40PM BLOOD PTT-38.6*\n02:40PM BLOOD Glucose-88 UreaN-26* Creat-1.2 Na-141 K-4.3 Cl-108 HCO3-23 AnGap-10\n02:40PM BLOOD ALT-8 AST-13 AlkPhos-69 TotBili-0.4\n02:40PM BLOOD Lipase-46\n02:40PM BLOOD proBNP-446\n02:40PM BLOOD cTropnT-<0.01\n02:40PM BLOOD Albumin-3.6 Calcium-9.5 Phos-3.1 Mg-2.2\n02:52PM BLOOD Lactate-1.2\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Duodenal Ulcers/19505167-DS-17.json b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/19505167-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..18372e9e2f3c453f2f577c259e2b4c10ba74ebd4 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Duodenal Ulcers/19505167-DS-17.json @@ -0,0 +1,30 @@ +{ + "Duodenal Ulcers$Intermedia_3": { + "Duodenal ulcer with bleeding on endoscopy is the gold standard of duodenal ulcer$Cause_1": { + "Endoscopy:duodenal ulcer with bleeding$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "Non-radiating upper abdominal pain refers to pain that is limited to the upper abdomen and does not spread to other parts. This is one of the common symptoms of peptic ulcer.$Cause_1": { + "non-radiating, epigastric pain$Input2": {} + }, + "Black diarrhea may be caused by gastrointestinal bleeding, a complication of peptic ulcer$Cause_1": { + "black diarrhea$Input2": {} + }, + "Black stools are usually caused by upper gastrointestinal bleeding. The blood turns black after reacting with stomach acid, which is an important clue for finding peptic ulcers.$Cause_1": { + "continues to have black stool$Input2": {} + }, + "Past history of Ulcer improve the risk of the disease$Cause_1": { + "Ulcer$Input3": {} + }, + "Black stools are often associated with upper gastrointestinal bleeding, which is a common symptom of stomach ulcers.$Cause_1": { + "minimal stool, brown and black, guaiac positive$Input5": {} + } + } + }, + "input1": "none\n", + "input2": "The patient states that he began having non-radiating, epigastric pain on ___. The pain subsided but returned on ___ night. He also had an episode of \"black diarrhea\" that night. The patient has been pain-free since ___ morning but notes that he continues to have black stool, including his last bowel movement this morning. The patient presented to ___ today and saw Dr. ___ referred him to the ED for melena, abdominal pain, and tachycardia. The patient denies any fevers, chest pain, shortness of breath, lightheadedness, or NSAID use. He does note a 5 pound weight \nloss which he attributes to exercise.\n", + "input3": "-Hypertension - not currently on any medication \n-Ulcer\n", + "input4": "- unknown\n", + "input5": "Vitals - T:99.3 HR:94 RR:20 02 sat:99RA \nGENERAL: Sitting in bed, comfortable, NAD. \nHEENT: Normocephalic, atraumatic; PERRLA, sclera anicteric, \noropharynx clear without erythema or lesion, moist mucus \nmembranes, neck supple, no lymphadenopathy. \nCARDIAC: regular rate and rhythm, normal S1 and S2, no murmurs \nappreciated. \nLUNG: Clear to auscultation bilaterally, no wheezes or crackles. \n \nABDOMEN: large abdomen, +bowel sounds, soft, non-tender, non \ndistended, no pain on palpation, no guarding or rebound pain \nEXT: warm, well-perfused, no edema, 2+ DP and ___ pulses. \nNEURO: A&Ox3, CN ___ intact \nDERM: No rashes \nRECTAL: minimal stool, brown and black, guaiac positive\n", + "input6": "___ 01:15PM \nSodium-141 Potassium-4.5 Chloride-107 Total CO2-27 Urea N-14 \nCreat-1.0 Glucose-91 Anion Gap-12\n.\nALT-25 AST-22 LDH-146 Alk Phos-50 Tot Bili-0.4\nAlbumin-4.5\nLipase-45\n.\nWBC-6.9 RBC-5.06 Hgb-13.1* Hct-40.5 MCV-80* MCH-25.9* MCHC-32.3 \nRDW-16.1* Plt ___\n\nEndoscopy:duodenal ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/11416792-DS-14.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/11416792-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..dd9eeb595c2064dc26e508917adbc5497c642ad5 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/11416792-DS-14.json @@ -0,0 +1,27 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding onendoscopy is the gold standard of peptic ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "vomiting and burning abdominal pain are the possible symptoms ofpeptic ulcer.$Cause_1": { + "Pt was doing well until ~ 2 months ago, when he developed daily episodes of morning vomiting and burning abdominal pain, as well as heartburn.$Input2": {} + }, + "A small amount of blood in his emesis is the manifestation of peptic ulcer with bleeding.$Cause_1": { + "He does endorse a small amount of blood in his emesis yesterday, and his abdominal pain peaked yesterday at in severity.$Input2": {} + }, + "Tachycardic (140s) is the manifestation of peptic ulcer with bleeding.$Cause_1": { + "He was seen in the ED, where he was tachycardic (140s)$Input2": {} + }, + "Anxious is the risk factor of peptic ulcer.$Cause_1": { + "mildly anxious$Input5": {} + } + } + }, + "input1": "abdominal pain, nausea, trace hematemesis\n", + "input2": "Pt was doing well until ~ 2 months ago, when he developed daily episodes of morning vomiting and burning abdominal pain, as well as heartburn. He was seen in the ED and diagnosed with likely gastritis. He reportedly had good relief with Maalox and was prescribed omeprazole on discharge. His prescription ran out last week, and he has not taken any omeprazole since. He has now had recurrence of his burning diffuse abdominal pain, nausea, vomiting, and heartburn, and now with three days of melena. He does endorse a small amount of blood in his emesis yesterday, and his abdominal pain peaked yesterday at in severity. His pain has limited his ability to eat, and he endorses early satiety, although he has had a good appetite. He denies any recent aspirin or NSAID use, or significant EtOH intake. He was seen in the ED, where he was tachycardic (140s) but otherwise stable. His tachycardia improved with IV fluids to the . He refused NG lavage or rectal exam. Given concern for upper GI bleeding, he was started on IV PPI bolus + gtt and admitted for EGD today. He states that since starting the PPI in the ED, he has had resolution of his symptoms of heartburn, abdominal pain, and nausea/vomiting. He feels hungry this morning.\n", + "input3": "+pre-hypertension \n+gastritis\n", + "input4": "No known GI or liver disease. (+) afib, OA, HTN, HLD, DM.\n", + "input5": "Afebrile, VSS \nGeneral: WA obese young man in NAD, comfortable, mildly anxious \nHEENT: anicteric sclerae, MMM, OP clear \nNeck: supple, no LAD or thyromegaly \nLungs: CTA bilat, no r/rh/wh \nHeart: RRR, nl S1-S2, no MRG \nAbdomen: +BS, soft/NT/ND, no HSM \nExtrem: WWP, no c/c/e \nSkin: several tattoos\n", + "input6": "07:45PM BLOOD WBC-14.5* RBC-5.14 Hgb-15.3 Hct-43.3 \nMCV-84 MCH-29.8 MCHC-35.3* RDW-14.0 Plt\n01:15AM BLOOD Hct-37.8*\n07:00AM BLOOD WBC-12.0* RBC-4.69 Hgb-13.8* Hct-39.1* \nMCV-84 MCH-29.4 MCHC-35.2* RDW-14.1 Plt\n12:40PM BLOOD Hct-38.2*\n07:45PM BLOOD Neuts-70.9*Monos-4.7 Eos-1.0 Baso-0.8\n07:45PM BLOOD PTT-25.5\n07:45PM BLOOD Glucose-104* UreaN-10 Creat-1.0 Na-141 K-4.4 Cl-105 HCO3-23 AnGap-17\n07:00AM BLOOD Glucose-97 UreaN-8 Creat-0.8 Na-138 K-3.8 \nCl-105 HCO3-26 AnGap-11\n07:45PM BLOOD ALT-33 AST-29 AlkPhos-44 TotBili-0.3\n07:45PM BLOOD Lipase-18\n07:00AM BLOOD Calcium-9.2 Phos-3.8 Mg-2.1\n07:00AM BLOOD %HbA1c-5.8 eAG-120\nEndoscopy:Gastric ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/11797021-DS-19.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/11797021-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..4c020d1f6cfa49dbc6ac59c979ab3e3d91412bfe --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/11797021-DS-19.json @@ -0,0 +1,33 @@ +{ + "gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding is the gold standars of gastric ulcer.$Cause_1": { + "Endoscopy:gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "Stomach pains and bloating are possible manifestations of peptic ulcer.$Cause_1": { + "Endorses some minor stomach pains and bloating.$Input2": {} + }, + "Black, tarry stools is one of the possible manifestations of peptic ulcer$Cause_1": { + "All symptoms have been in the setting of black, tarry stools since yesterday.$Input2": {} + }, + "Aspirin is a risk factor of peptic ulcer.$Cause_1": { + "Pt takes plavix, aspirin, tramadol, and diclofenac for back pain. Also on citalopram.$Input2": {} + }, + "Anemia is one of the possible manifestation of peptic ulcer$Cause_1": { + "RBC-3.91*$Input6": {} + }, + "GIB with indigestion is one of the possible manifestation of peptic ulcer$Cause_1": { + "GIB with indigestion here for r/o MI$Input1": {} + }, + "Indigestion and substernal burning are possible manifestations of peptic ulcer.$Cause_1": { + "Woke up multiple times last was having 'indigestion', that he describes as substernal burning and sour taste in his mouth.$Input2": {} + } + } + }, + "input1": "GIB with indigestion here for r/o MI\n", + "input2": "with PMHx of STEMI, HL, EtOH abuse who presents to ED with 24 hour h/o fatigue and weakness. Also with diaphoresis, dizziness, and lightheadedness this AM. All symptoms have been in the setting of black, tarry stools since yesterday. Has had at least 3 BM with melenic stools. Said he was feeling fatigued yesterday and went to bed early. Woke up multiple times last was having 'indigestion', that he describes as substernal burning and sour taste in his mouth. This AM became diaphoretic in the shower, and during work noted 'tingling' of his left arm and epigastrium. Had minor tingle in chest, but no pain. Also having uncontrollable yawning.\n\nPt takes plavix, aspirin, tramadol, and diclofenac for back pain. Also on citalopram. Endorses some minor stomach pains and bloating.\n\nIn the ED, initial vitals were 97 108 135/79 20 100% ra. He was treated with PPI and noted to be guiac positive. Not given any IVF.\n\nOn the floor pt denies any current symptoms of lightheadedness, dizziness, palpitations, chest pain, dysphagia, odynophagia,\n\nLabs and imaging significant for hct 35.1 and negative troponins\n\nPatient given PPI, tums, viscous lidocaine, and dannatol in ED\nVitals on transfer were 98.0 104 116/66 16 100\n", + "input3": "+ST Elevation IMI/RCA Cypher stenting\n+Hyperlipidemia\n+Recovering alcoholic\n+Chronic back pain\n+Hyperlipidemia \n+DES to RCA and Lcx\n+Chronic back pain\n", + "input4": "Father had an MI. Sister with a possible MI. Paternal uncle with an MI.\n", + "input5": "VS- BP=119/83 HR=130's RR=20 O2 sat=100%RA \nGENERAL- NAD. Well nourished. Sitting upright in chair and conversive. \nHEENT- NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK- Supple with JVP of 5-7 cm. \nCARDIAC- PMI intercostal space, midclavicular line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS- No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN- Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nEXTREMITIES- No c/c/e. No femoral bruits. \nSKIN- No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES- \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ 2+\n", + "input6": "08:58AM BLOOD WBC-7.9 RBC-3.91* Hgb-11.8* Hct-35.1* MCV-90 MCH-30.1 MCHC-33.5 RDW-14.1 Plt\n08:58AM BLOOD PTT-29.1\n08:58AM BLOOD Glucose-104* UreaN-45* Creat-0.9 Na-140 K-4.7 Cl-108 HCO3-23 AnGap-14\nEndoscopy:gastric ulcer with bleeeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/11993263-DS-8.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/11993263-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..358443a84f16223697a60d6ac9fba88344972e27 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/11993263-DS-8.json @@ -0,0 +1,27 @@ +{ + "gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding on EGD is the gold standard of gastric ulcer.$Cause_1": { + "EGD\uff1aGastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "Peptic ulcers are prone to bleeding symptom.$Cause_1": { + "UGIB$Input1": {} + }, + "NSAIDs are the risk factor of peptic ulcer.$Cause_1": { + "Male without significant PMH on NSAIDs admitted with an upper GI bleed.$Input2": {} + }, + "hypotensive,weakness and dizziness are the possible manifestations of peptic ulcer with bleeding.$Cause_1": { + "Initially presented with 1 day of progressive weakness and dizziness last to . His initial Hct was 29 and he was hypotensive with SBP 60.$Input2": {} + }, + "Vomiting is one of the manifestation of peptic ulcer.$Cause_1": { + "he had several episodes of sudden onset projectile vomiting.$Input2": {} + } + } + }, + "input1": "UGIB\n", + "input2": "Male without significant PMH on NSAIDs admitted with an upper GI bleed. Initially presented with 1 day of progressive weakness and dizziness last to . His initial Hct was 29 and he was hypotensive with SBP 60. He was transfused with 4 U pRBCs and ruled out for MI. On , he had several episodes of sudden onset projectile vomiting. It was voluminous (several buckets filled), dark colored with dark pieces. After vomiting he states that he felt much better. He did not have pain at any time. Later that day, he had a scope which was non-diagnostic due to blood. He had another EGD the following morning and which was injected with epinephrine. GI did not feel the need to place a band. On the morning of transfer, his Hct was 25 and he received 2 more Units. He was not tachycardic and SBP was 110. He did have 4 BMs that were tarry black.\nUpon arrival to the MICU, Afebrile, BP 125/88, HR 88, RR 18 100% RA. He was seen by GI who recommended PPI, clear diet and endoscopy in AM.\n", + "input3": "+RUL CAP PNA\n", + "input4": "Mother - she has bullous pemphigoid.\nFather has MI.\n", + "input5": "Vitals: T: A BP: 125/88 P: 88 R: 18 O2: 100% \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nGU: no foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\n", + "input6": "07:05PM BLOOD WBC-12.4*# RBC-4.05* Hgb-12.6* Hct-34.9* MCV-86# MCH-31.2 MCHC-36.2* RDW-17.1* Plt\n11:39PM BLOOD Hct-30.5*\n03:48AM BLOOD WBC-9.2 RBC-3.47* Hgb-10.8* Hct-29.9* MCV-86 MCH-31.2 MCHC-36.1* RDW-17.4* Plt\n01:46PM BLOOD Hct-30.4*\n07:06PM BLOOD PTT-26.4\n03:48AM BLOOD Glucose-103* UreaN-7 Creat-0.5 Na-141 K-3.6 Cl-112* HCO3-23 AnGap-10\n07:05PM BLOOD Calcium-8.7 Phos-2.4* Mg-2.1\n\n03:06AM BLOOD WBC-9.1 RBC-3.71* Hgb-11.6* Hct-32.4* MCV-87 MCH-31.2 MCHC-35.7* RDW-17.0* Plt\n03:06AM BLOOD Glucose-102* UreaN-9 Creat-0.7 Na-143 K-3.5 Cl-109* HCO3-28 AnGap-10\n03:06AM BLOOD Calcium-8.8 Phos-3.7 Mg-2.1\nEGD\uff1aGastric ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/12021335-DS-5.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/12021335-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..df96a161019b857a48fd3453e72e6c7a2fa36017 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/12021335-DS-5.json @@ -0,0 +1,33 @@ +{ + "gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding onendoscopy is the gold standard ofgastric ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Cause_2": { + "Peptic ulcer are prone to bleeding symptoms.$Cause_1": { + "GI bleed$Input1": {} + }, + "Hematemesis and melena are the manifestations of peptic ulcer with bleeding.$Cause_1": { + "with no major comorbidities admitted to MICU Green with hematemesis and melena. felt presyncopal, sat down awhile, then had tarry black BM. Felt exhausted and sweaty, then later projectile vomited with coffee ground emesis. Then has bright red emesis.$Input2": {} + }, + "Anemia is the manifestations of peptic ulcer with bleeding.$Cause_1": { + "she was sent to where she was noted to feel dizzy and weak with vitals 112/78 and Hct 17.9.$Input2": {} + }, + "Rectal exam showed guaic positive black stool may be caused by peptic ulcer with bleeding.$Cause_1": { + "Rectal exam showed guaic positive black stool.$Input2": {} + }, + "Non-steroidal anti-inflammatory drugs are the risk factors of peptic ulcer.$Cause_1": { + "She has been taking Aleve daily for RLE pain after a fracture/surgery in .$Input2": {} + }, + "Family history of bleeding ulcer.$Cause_1": { + "F - deceased with heart disease, kidney disease, bleeding ulcer, EtOHism$Input4": {} + } + } + }, + "input1": "GI bleed\n", + "input2": "with no major comorbidities admitted to MICU Green with hematemesis and melena. felt presyncopal, sat down awhile, then had tarry black BM. Felt exhausted and sweaty, then later projectile vomited with coffee ground emesis. Then has bright red emesis. Went to where was told she had bowel obstruction and sent home after 3 hrs with some type of laxative and told to stop ASA, Aleve, Motrin. She was told to f/u with her PCP on . she kept feeling presyncopal and weak. am she saw her PCP, and of 17 was noted; she was sent to where she was noted to feel dizzy and weak with vitals 112/78 and Hct 17.9. Transfer to for further management. In the ED initial vitals: 16 100%. Rectal exam showed guaic positive black stool. Bilateral PIV's were placed, she was T&S'd and 4u cross matched. She did not tolerate NG lavage. PPI bolus + gtt was started. She was given 1L IVF's. KUB was obtained given the questionable h/o obstruction last at , but felt to be low suspicion given no abdominal tenderness and she was passing stool. She has been taking Aleve daily for RLE pain after a fracture/surgery in . She notes \"burning in her stomach\" called as GERD after starting Fosamax, but stopped 2 wks ago. No Coumadin Plavix, only drinks a couple bottles of wine per week, no retching, no h/o PUD. Never had this before. ROS as above, does endorse fatigue, DOE, poor appetite but tolerating PO's. No dyspepsia, hematochezia, or tenesmus. No f/c/ns, SOB, CP, palps, abd pain, bleeding elsewhere, n/v, dysuria. Of note, she has been a Jehovah's Witness in the past, however will be acceptable to transfusion if needed. Vitals before transfer: 107/85 p81 100%RA.\n", + "input3": "+Denies DM, HTN, HL.\n+Osteoporosis\n+AMI, very unclear, \"bad EKG\" suspicious for old MI, saw Cards and reports stress test last year that was normal per pt\n+\"Seizure\" -- again very unclear history, reports had \"worse h/a of her life\" and then had a grand mal seizure and reports imaging showed \"partial seizure disorder of L frontoparietal lobe\"\n", + "input4": "M - alive with emphysema, PMR, DM, neuralgia, AMI, EtOHism\nF - deceased with heart disease, kidney disease, bleeding ulcer, EtOHism\n", + "input5": "98.9 p82 107/49 (107-124) 100%RA \nPleasant female, no distress, conversant, appears very pale though, with pale conjunctiva, pale gums, pale palms \nEOMI, no scleral icterus \nCTAB no w/c/r/r \nRRR without murmurs, S1/S2 clear \nAbd soft NT ND, benign \nNo BLE edema noted, extrems are warm but pale appearing \nCN2-12 intact, moving all exremities spontaneously, no focal neuro deficits.\n", + "input6": "140 103 13\n----------------< 98\n3.9 27 0.7\n\nALT 15 AST 17 AlkP 74 Tbili 0.1 Alb 4.1\nWBC 6.5 normal diff\nHct 19.5 MCV 94\nPlts 370\nCoags 11.3 / 18.4 / 0.9\n\nEKG: From OSH, NSR, normal axis, intevals, normal EKG\n\nImaging: Abd plain film IMPRESSION: No evidence of bowel obstruction. Rounded density in the pelvis likely represents a distended bladder. \n\nCXR IMPRESSION: No acute cardiopulmonary proces\nEndoscopy:Gastric ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/12484285-DS-2.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/12484285-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..c9f42935c7d8d9ff7e73faed9f936d7a9a903c00 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/12484285-DS-2.json @@ -0,0 +1,18 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer on endoscopy is the gold standard of gastric ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "abdominal pain, nausea and vomitingare the possible symptoms of peptic ulcer.$Cause_1": { + "Over the past month, patient has had bursts of severe abdominal pain, largely in the left upper quadrant, associated with nausea and vomiting$Input2": {} + } + } + }, + "input1": "Nausea, vomiting, epigastric pain, weight loss\n", + "input2": "Ms. is a female with a history of functional abdominal pain years ago requiring multiple hospitalizations presenting with abdominal pain. One month ago, patient was treated here in the emergency department for abdominal pain that was thought to be related to a UTI. She did not have any urinary symptoms at that time. Over the past month, patient has had bursts of severe abdominal pain, largely in the left upper quadrant, associated with nausea and vomiting. She last reports trialing solid food fries) two weeks ago, she vomited about 30 minutes after this with food still visible. She denies any diarrhea, bloody stools, or black stools. Her menstrual cycles are regular and her last menstrual period was two weeks ago. Patient has been seen in multiple hospitals, has had 2 CT scans both unremarkable. Patient has referral for an endoscopy and colonoscopy. Last night at 11, patient vomited and became severe worsening overnight. Per PCP, patient has lost 35 pounds in the last month 216lbs <- 249 lbs on. Patient is having difficulty tolerating p.o. The ED resident spoke with PCP extensively, and is hoping that patient will require an admission for expedited workup including endoscopy and colonoscopy.\n", + "input3": "+nephrolithiasis\n", + "input4": "MGM with breast cancer\n", + "input5": "VS: 1641 Temp: 98.1 PO BP: 124/85 HR: 90 RR: 18 O2 sat:\n100% O2 delivery: Ra \nGENERAL: Pleasant, lying in bed comfortably \nHEENT: mucosa moist\nCARDIAC: Regular rate and rhythm, no murmurs, rubs, or gallops \nLUNG: Appears in no respiratory distress, clear to auscultation bilaterally, no crackles, wheezes, or rhonchi \nABD: Normal bowel sounds, soft, mild epigastric tenderness to palpation, nondistended, no hepatomegaly, no splenomegaly bypercussion of space, unable to palpate spleen\nEXT: Warm, well perfused, no lower extremity edema \nPULSES: 2+ radial pulses, 2+ ___ pulses, 2+ DP pulses \nNEURO: Alert, oriented, CN II-XII intact, motor and sensory function grossly intact \nSKIN: No significant rashes\n", + "input6": "02:22PM COMMENTS-GREEN TOP\n02:22PM LACTATE-1.6\n11:38AM URINE HOURS-RANDOM CREAT-194 TOT PROT-26 PROT/CREA-0.1\n11:38AM URINE UCG-NEGATIVE\n11:38AM URINE COLOR-Yellow APPEAR-Hazy* SP\n11:38AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30* \nGLUCOSE-NEG KETONE-40* BILIRUBIN-NEG UROBILNGN-NEG PH-7.5 LEUK-NEG\n11:38AM URINE RBC-2 WBC-5 BACTERIA-NONE YEAST-NONE EPI-16\n11:38AM URINE AMORPH-RARE*\n11:38AM URINE MUCOUS-MANY*\n09:19AM COMMENTS-GREEN TOP\n09:19AM LACTATE-2.2*\n09:08AM GLUCOSE-109* UREA N-4* CREAT-0.8 SODIUM-140 \nPOTASSIUM-3.8 CHLORIDE-100 TOTAL CO2-23 ANION GAP-17\n09:08AM estGFR-Using this\n09:08AM ALT(SGPT)-28 AST(SGOT)-32 LD(LDH)-283* ALK \nPHOS-92 AMYLASE-49 TOT BILI-0.4\n09:08AM LIPASE-24\n09:08AM ALBUMIN-4.6 IRON-45\n09:08AM calTIBC-343 FERRITIN-81 TRF-264\n09:08AM WBC-6.9 RBC-5.22* HGB-12.8 HCT-39.9 MCV-76* MCH-24.5* MCHC-32.1 RDW-16.0* RDWSD-43.7\n09:08AM NEUTS-56.1 MONOS-11.4 EOS-1.2 BASOS-0.7 IM AbsNeut-3.85 AbsLymp-2.08 AbsMono-0.78 \nAbsEos-0.08 AbsBaso-0.05\n09:08AM PLT COUNT-424*\nEndoscopy:Gastric ulcer\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/12680418-DS-19.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/12680418-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..757fe263ce9dea31e734b6a69e6d225bfab14350 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/12680418-DS-19.json @@ -0,0 +1,24 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding onendoscopy is the gold standard of gastric ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Cause_2": { + "Epigastric pain is a possible symptom of peptic ulcer.$Cause_1": { + "Epigastric pain$Input1": {} + }, + "epigastric pain and two days of dark tarry stools are the possible symptoms of peptic ulcer.$Cause_1": { + "lap band in and lap roux en y gastric bypass in by Dr. returns with four days of epigastric pain and two days of dark tarry stools though patient does report taking pepto-bismol.$Input2": {} + }, + "Family history of ulcer disease$Cause_1": { + "family history significant for ulcer disease in mother and sister$Input4": {} + } + } + }, + "input1": "Epigastric pain\n", + "input2": "s/p lap band in and lap roux en y gastric bypass in by Dr. returns with four days of epigastric pain and two days of dark tarry stools though patient does report taking pepto-bismol. She denies diarrhea, BRBPR, but notes increased pain with eating resulting in poor PO intake over the past several days. Despite this, her urine output has been adequate and is not concentrated. She has been taking a PPI daily.\n", + "input3": "+Obstructive sleep apnea\n+Asthma\n+Dyslipidemia\n+Venous \n+stasis change\n+obesity\n+sciatica\n", + "input4": "FH: family history significant for ulcer disease in mother and sister\n", + "input5": "T: 98.2 P: 86 BP: 112/66 RR: 16 SpO2: 99 RA\nGeneral: awake, alert, moderately uncomfortable\nHEENT: NCAT, EOMI, anicteric\nHeart: Regular rate and rhythm\nLungs: CTAB, normal excursion, no respiratory distress\nBack: no vertebral tenderness, no CVAT\nAbdomen: soft, epigastric tenderness, no rebound\nExtremities: WWP, no CCE, no tenderness, 2+ B\n", + "input6": "05:15AM BLOOD WBC-8.5 RBC-3.99* Hgb-13.4 Hct-37.8 MCV-95 MCH-33.6* MCHC-35.4* RDW-14.0 Plt\n05:15AM BLOOD Glucose-87 UreaN-12 Creat-0.7 Na-141 K-4.2 Cl-107 HCO3-26 AnGap-12\nEndoscopy:Gastric ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/14041557-DS-15.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/14041557-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..ee47bfcf396949401f66cc6c2b0b90279d11feb5 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/14041557-DS-15.json @@ -0,0 +1,24 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer on endoscopy is the gold standard of gastric ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer$Input6": {} + }, + "suspected peptic ulcer disease$Cause_2": { + "past medical history significant for appendectomy, H. pylori gastritis and hyperglycemia (HgbA1C 7.0) who presents with acute onset abdominal pain, which are the possible symptom and risk factor of peptic ulcer.$Cause_1": { + "A man with past medical history significant for appendectomy, H. pylori gastritis and hyperglycemia (HgbA1C 7.0) who presents with acute onset abdominal pain$Input2": {} + }, + "abdominal pain is the manifestation of peptic ulcer.$Cause_1": { + "He states that his abdominal pain is usually diffuse, bloating patient in all four quadrants, although somewhat more painful in the epigastrium.$Input2": {} + }, + "History of gastric disease.$Cause_1": { + "+H. pylori gastritis - biopsy in positive, also showed Antral mucosa with chronic active gastritis.$Input3": {} + } + } + }, + "input1": "Abdominal pain\n", + "input2": "A man with past medical history significant for appendectomy, H. pylori gastritis and hyperglycemia (HgbA1C 7.0) who presents with acute onset abdominal pain. Patient states, in , that he has had long-standing, diffuse abdominal pain. As early as , he underwent a barium swallow for epigastric pain which showed no pathology. He states that his abdominal pain is usually diffuse, bloating patient in all four quadrants, although somewhat more painful in the epigastrium. Patient's abdominal pain typically improves after ~30 minutes with or without Prilosec, but this current episode persisted until he arrived on the floor. Patient's abdominal pain started last night ~11 pm. He had had chicken for dinner and had a normal bowel movement around pm. Patient woke up at around midnight with persistent abdominal pain. Of note, patient also notes some early satiety with his recent bouts of abdominal pain. One month ago, his primary care provider gave him prescription for two week course of Clarithromycin 500mg daily, Amoxicillin 500mg daily; patient kept forgetting to take his medications and so the two week course was drawn out into 4 weeks. Patient just completed his antibiotic course 3 days prior to admission. Patient and wife state he has not had an EGD or colonoscopy for at least years. Patient also denies melena, hematochezia, rashes or lesions, diarrhea or constipation. He also denies taking excessive NSAIDS, aspirin, caffeine. In the ED, VS were 99.9, 128/74, 108, 16, 99% RA. He was given 1L NS, ASA 325 and omeprazole 40 mgPO. KUB showed no free air or other acute pathology. He had two sets of negative CE with TWI in V4-6 (seen on priors); he was admitted for a stress test. He was guaiac negative.\n", + "input3": "+Appendectomy\n+H. pylori gastritis - biopsy in positive, also showed Antral mucosa with chronic active gastritis.\n+Hyperglycemia with HgbA1c 7.0\n", + "input4": "Denies family history of diabetes, hypertension, high cholesterol or malignancies\n", + "input5": "Vitals: T 98.2 R 18 118/62 96% on RA BM X1 \nGen: Alert and oriented, no acute distress. \nHEENT: EOMI. MMM. Normal oro/nasopharynx, conjunctiva well pigmented/not pale. \nNeck: Soft, supple. No LAD. \nChest: Good inspiratory effort, no wheezing/rhonchi/rales. \nCV: Regular rate and rhythm, normal S1/S2, no murmurs/gallops/rubs\nAbdomen: Soft, non-tender but uncomfortable with palpation, non-distended. +BS, no HSM or fluid waves/shifting dullness. \nSlightly increased discomfort to palpation in the epigastrum. \nExtremity: Warm, well-perfused. No cyanosis/ecchymosis/edema. No venous stasis changes. Dry skin.\nNeuro: Alert and oriented. Cranial nerves grossly intact. Motor strength and sensation grossly intact. \nAccess: PIV.\n", + "input6": "freeCa:1.04\nLactate:0.7\npH:7.43\n\nChem 10\n138 AGap=12 \n3.5 23 0.6 \nCa: 7.6 Mg: 2.0 P: 2.5\n\nCK: 38 MB: Notdone Trop-T: <0.01 \n\n74 Lip: 29 \n\nCBC \n6.2 > 13.8 < 188 \n 39.4 \n\nKUB: No evidence of bowel obstruction or free air. Small air-fluid levels in the descending colon. \n\nCXR: No acute cardiopulmonary processes. \n\nInitial EKG: NSR at 96, nml axis, good RWP, no Q wave, TWI or ST changes. No priors for comparison \nRepeat EKG: Resolved T wave inversions in V4-V6\nEndoscopy:Gastric ulcer\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/14564935-DS-18.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/14564935-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..3e3412fed0547dd73d96a6c812e85662478ffd36 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/14564935-DS-18.json @@ -0,0 +1,30 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding on endoscopyis the gold standard of gastric ulcer$Cause_1": { + "Endoscopy:Gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "Black stools are the manifestation of peptic bleeding.$Cause_1": { + "he woke up this morning and passed a large, black stools.$Input2": {} + }, + "Alcohol is the risk factor of peptic ulcer.$Cause_1": { + "Male who was previously a heavy alcohol drinker presented to the ED after vomiting blood.$Input2": {} + }, + "Increased heart rete is teh possible manifestation of peptic ulcer with bleeding.$Cause_1": { + "Tachy to 110's.$Input2": {} + }, + "Abdominal discomfortis the Possible symptom of peptic ulcer.$Cause_1": { + "abdominal discomfort$Input3": {} + }, + "Family history$Cause_1": { + "Unable to obtain although mother with gastric cancer.$Input4": {} + } + } + }, + "input1": "found down, vomitting blood\n", + "input2": "Male who was previously a heavy alcohol drinker presented to the ED after vomiting blood. The patient reportedly felt well until he woke up this morning and passed a large, black stools. He went to an outpatient appointment in and was walking on the street when he passed out for an unknown period of time. He was found down by a pedestrian who called . The patient reports awaking with a large volume of BRB around him and in his mouth. EMS brought the patient to the ED. Upon presentation to the ED his VS were: 140-160 systolic/80-100. Tachy to 110's. Afebrile. 99% on RA. He vomited BRB while in the ED. An NG tube was placed and put out 0.5L BRB. The NG was placed on wall suction and continued to put out BRB. Labs were notable for Hct 41.6 with normal platelets and INR. The patient was given protonix 40 IV bolus and started on a protonix gtt. An octreotide gtt was ordered but had not been obtained from pharmacy at the time of sign out. Two 18g and a 16 gauge PIV were placed and 2.5L NS and 2u pRBCs were infused. GI was called with plans to EGD the patient ASAP in the MICU. Surgery was also made aware of the patient. The patient was intubated for airway protection given continued hemoptysis in the ED. He remained HD stable throughout his ED course. Upon arrival to the floor, the patient is intubated and sedated and unable to provide further information.\n", + "input3": "+EGD for abdominal discomfort\n", + "input4": "Unable to obtain although mother with gastric cancer.\n", + "input5": "HD stable, HR\nGeneral: Intubated and sedated\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, non-tender, distended, decreased bowel sounds, no rebound tenderness or guarding, no organomegaly \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\n", + "input6": "01:50PM PTT-22.1\n01:50PM PLT COUNT-307\n01:50PM NEUTS-54.4 MONOS-4.5 EOS-1.9 BASOS-1.0\n01:50PM WBC-8.0 RBC-4.48* HGB-14.0 HCT-41.6 MCV-93 MCH-31.3 MCHC-33.8 RDW-13.6\n01:50PM LIPASE-41\n01:50PM ALT(SGPT)-21 AST(SGOT)-36 ALK PHOS-54 TOT BILI-0.9\n01:50PM estGFR-Using this\n01:50PM UREA N-27* CREAT-0.9\n01:58PM freeCa-1.10*\n01:58PM HGB-14.9 calcHCT-45\n01:58PM GLUCOSE-132* LACTATE-1.9 NA+-142 K+-3.6 CL--104 TCO2-22\n01:58PM PH-7.45 COMMENTS-GREEN TOP\n03:49PM PTT-27.5\n03:49PM PLT COUNT-134*#\n03:49PM WBC-7.3 RBC-2.55*# HGB-8.1*# HCT-24.4*# MCV-96 MCH-31.7 MCHC-33.1 RDW-14.7\n03:49PM CALCIUM-6.3* PHOSPHATE-2.5* MAGNESIUM-1.4*\n03:49PM GLUCOSE-111* UREA N-24* CREAT-0.6 SODIUM-145 POTASSIUM-4.2 CHLORIDE-117* TOTAL CO2-20* ANION GAP-12\n04:03PM freeCa-1.04*\n04:03PM LACTATE-3.7*\n04:03PM PH-7.23* COMMENTS-PERIPHERAL\n06:14PM PTT-25.8\n06:14PM HCT-41.3#\n06:14PM CALCIUM-8.5 PHOSPHATE-3.4 MAGNESIUM-2.2\n06:14PM GLUCOSE-122* UREA N-21* CREAT-0.7 SODIUM-139 POTASSIUM-4.3 CHLORIDE-109* TOTAL CO2-24 ANION GAP-10\n08:09PM freeCa-1.25\n08:09PM LACTATE-0.8\n08:09PM TYPE-ART TEMP-36.3 PH-7.30*\n08:38PM HCT-39.9*\n11:12PM TYPE-ART TEMP-36.3 TIDAL VOL-500 PEEP-5 O2-50 PO2-166* PCO2-45 PH-7.35 TOTAL CO2-26 BASE XS-0 INTUBATED-INTUBATED\nEndoscopy:Gastric ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/14925002-DS-9.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/14925002-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..3c3257b40d5ebf6d79ecdabdb93c74d084b52da1 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/14925002-DS-9.json @@ -0,0 +1,42 @@ +{ + "Gastric Ulcers$Intermedia_3": { + "rule out Duodenal Ulcers$Cause_1": { + "Duodenum: Normal duodenum.$Input6": {} + }, + "This is the description most directly associated with Gastric Ulcers. The text describes a single depressed, 4 cm ulcer with raised margins on the lesser curvature of the antrum toward the notch. This is a typical presentation of Gastric Ulcers.$Cause_1": { + "A single cratered clean based 4 cm ulcer with heaped up borders was found in the antrum on the lesser curvature towards the incisura.$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "Abdominal pain is a common symptom of gastric ulcer disease$Cause_1": { + "abdominal pain$Input1": {} + }, + "Nausea and vomiting are common symptoms of peptic ulcer$Cause_1": { + "nausea/vomiting$Input2": {} + }, + "Stomach pain that gets worse when you lie on your right side or try to eat is a common symptom of a stomach ulcer because these movements may increase pressure or irritation in the stomach, which can make the pain worse.$Cause_1": { + "pain is worse with lying on her R side and with attempts to ea$Input2": {} + }, + "This indicates impaired gastric function and may be associated with gastric ulcers.$Cause_1": { + "unable to hold down food or any of her usual meds$Input2": {} + }, + "The current symptoms are similar to those of previous gastric ulcer attacks, directly indicating that she has a history of gastric ulcer disease, which is an important clue for the diagnosis of gastric ulcer.$Cause_1": { + "similar to sx at the time of her gastric ulcer$Input2": {} + }, + "The follow-up endoscopy showed that the gastric ulcer had healed, but there was still residual erythema, which indicated that although the ulcer tissue had been repaired, there was still slight inflammation in the stomach wall.$Cause_1": { + "stomach the submucosal abnormality still present, ulcer healed, residual erythemma$Input2": {} + }, + "The biopsy showed chronic gastritis, a common precursor to the development of gastric ulcers, which may be caused by long-term gastric acid irritation or Helicobacter pylori infection.$Cause_1": { + "Bxs showed chronic gastritis.$Input2": {} + }, + "Tenderness in the upper abdomen (stomach area) is one of the most typical symptoms of peptic ulcer disease. Pain in the upper abdomen is often related to excess stomach acid in peptic ulcer disease.$Cause_1": { + "tenderness to palp diffusely but most prominent in$Input5": {} + } + } + }, + "input1": "abdominal pain\n", + "input2": "She initially presented to ___, and was treated with 2L NS and Zofran 4 mg IV, but had minimal improvement in nausea/vomiting. The pain is worse with lying on her R side and with attempts to eat. She has been unable to hold down food or any of her usual meds, which include lansoprazole and also Percocet, for chronic back and knee pain. She is passing urine, less frequently than usual. She had a small, brown, formed BM today. No hematemesis, BRBPR, or melena. She feels hot and cold at times, without chills or sweats; she has not checked her temp:it was 99.2 at ___. All of this is similar to sx at the time of her gastric ulcer. SHe has no hx GB dis, pancreatitis, or of abd or pelvic surgery. Repeat endoscopy on ___ showed \"Int he stomach the submucosal abnormality still present, ulcer healed, residual erythemma present, area firm to bx Ont he opposite wall mild erythema bxd. Junction of body /fundus slightly edematous, bxd\" Bxs showed chronic gastritis. She was prescribed sucralfate, but has not taken as didn't understand the instructions for it. Has been taking her PPI though.\n\n\nROS: Ten point ROS otherwise negative except as per HPI.\n", + "input3": "HYPERTENSION - ESSENTIAL \nMorbid obesity with BMI of 40.0-44.9, adult \nHYPERCHOLESTEROLEMIA \nHistory of melanoma \nChronic pain\nPrimary osteoarthritis of right knee \nAsthma \nSpinal stenosis, lumbar region, with neurogenic claudication \nIron deficiency anemia\n", + "input4": "Brother ___ \nFather ___ \nMother ___ CAD/PVD - Early (___); Gout; Hypertension\n", + "input5": "VS: 99, 175/70, 63, 20, 97%RA\nGen: Appears uncomfortable\nHEENT: MM dry\nCV: RRR no m/g/r\nPulm: CTAB no w/r/r\nAbd: Soft, tenderness to palp diffusely but most prominent in \nthe epigastrium, BS+\nExtrem: warm, no edema\nSkin: no rashes\nNeuro: A+Ox3, pleasant, speech fluent\nGU: no foley\nAccess: PIV\n", + "input6": "___ 08:05PM BLOOD WBC-6.6 RBC-3.85*# Hgb-11.2# Hct-34.6# \nMCV-90 MCH-29.1# MCHC-32.4 RDW-11.9 RDWSD-38.2 Plt ___\n___ 08:05PM BLOOD Neuts-70.8 ___ Monos-4.6* \nEos-0.0* Baso-0.8 Im ___ AbsNeut-4.67 AbsLymp-1.53 \nAbsMono-0.30 AbsEos-0.00* AbsBaso-0.05\n___ 08:05PM BLOOD Plt ___\n___ 08:05PM BLOOD Glucose-92 UreaN-11 Creat-0.7 Na-141 \nK-3.0* Cl-103 HCO3-24 AnGap-17\n___ 08:05PM BLOOD ALT-15 AST-23 AlkPhos-57 TotBili-0.4\n___ 08:05PM BLOOD Albumin-4.1 Calcium-8.7 Phos-3.1 Mg-1.8\n___ 10:35PM URINE Color-Straw Appear-Clear Sp ___\n___ 10:35PM URINE Blood-NEG Nitrite-NEG Protein-TR \nGlucose-NEG Ketone-40 Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG\n___ 10:35PM URINE RBC-1 WBC-<1 Bacteri-NONE Yeast-NONE \nEpi-<1\n___ 10:35PM URINE Mucous-RARE\n\nImaging\n___\n20:04 Liver Or Gallbladder Us (Single Organ) [45] -- \nPreliminary Report viewable in WebOMR\n\n1. No evidence of cholelithiasis or sonographic evidence of \nacutecholecystitis.\n2. Lobulated right renal cyst measuring 4.3 x 2.9 x 2.9 cm, \ncontaining a single thin septation. \n \n \nChest xray\nFINDINGS: \n \n No focal consolidation is seen. There is no pleural effusion or pneumothorax. The aorta is tortuous. The cardiac silhouette is borderline in size. No pulmonary edema is seen. Chronic appearing deformity at the posterior medial right fourth rib is seen. No evidence of free air is seen beneath the diaphragms. \n \n IMPRESSION: \n \n No evidence of free air beneath the diaphragms. Cardiac \nsilhouette size is borderline. \n\nEGD ___\nFindings: \nEsophagus: Normal esophagus. \n\nStomach: \n\n Excavated Lesions A single cratered clean based 4 cm ulcer with heaped up borders was found in the antrum on the lesser curvature towards the incisura. Cold forceps biopsies were performed for histology. \n\nDuodenum: Normal duodenum. \n\nImpression: Ulcer in the antrum (biopsy)\nOtherwise normal EGD to third part of the duodenum\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/15658321-DS-8.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/15658321-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..c126f63ccd15ff381919e952acc043bb4ff8c367 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/15658321-DS-8.json @@ -0,0 +1,27 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding on endoscopyis the gold standard of gastric ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Cause_2": { + "Reflux and melena are the symptoms of a peptic ulcer and suspected peptic bleeding,respectively.$Cause_1": { + "Mr. is an with a history of esophagus and GERD presenting with melena for the last 5 days$Input2": {} + }, + "The presence of blood in the stool was the manifestation of gastric ulcer with bleeding.$Cause_1": { + "Patient was referred by his PCP today after being found to have guaiac positive stools in the office.$Input2": {} + }, + "Decreased hb is the manifestation of gastric ulcer with bleeding.$Cause_1": { + "Labs were notable for Hb 12.5 down from 14.5 on last check one year ago$Input2": {} + }, + "Family history of cancer$Cause_1": { + "mother died of unknown cancer.$Input4": {} + } + } + }, + "input1": "None\n", + "input2": "Mr. is an with a history of esophagus and GERD presenting with melena for the last 5 days. Patient was referred by his PCP today after being found to have guaiac positive stools in the office. Patient also reports tenesmus and constipation. Last BM was this morning, but patient reports a small amount of black, tarry stools. He has been taking iron supplements for a while, but stools have never been this black. Denies abdominal pain, nausea, vomiting, hematochezia, lightheadedness, dizziness. In the ED, initial vitals were: 97.8, 70, 97%. He was typed and screened. Labs were notable for Hb 12.5 down from 14.5 on last check one year ago. On the floor without new complaints.\n", + "input3": "+Left Inguinal Hernia and Orchiectomy\n+cystoscopy; electrohydrolic lithotripsy bladder stones \n+cholecystectomy\n+spinal stenosis esophagus\n+History of pneumonia\n+Coronary artery disease\n+BPH\n+GERD \n+HYPERTENSION \n+HYPERCHOLESTEROLEMIA \n+ANEMIA \n+RENAL CALCULI \n+ATHEROSCLEROSIS, CORONERY, +NATIVE ARTERY \n+HIATAL HERNIA WITH REFLUX \nMELANOMA, MALIG, BENDESTON \n+HYPERLIPIDEMIA \n+ALLERGIC RHINITIS \n+ASTHMA \n+BRONCHIECTASIS \n+RENAL FAILURE, CHRONIC, MILD \n+SPINDLE CELL LIPOMA NECK\n", + "input4": "Cousin died of MI, uncles on father side have HT and \"cardiac disease\". Father died of lung ca and mother died of unknown cancer.\n", + "input5": "Vitals: 98.1, 64, 154/94, 19, 100% RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Pink conjunctiva. Sclera anicteric, MMM, oropharynx clear \n \nNeck: Supple, JVP not elevated, no LAD \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nAbdomen: Soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding. \nGU: No foley \nExt: Warm, well perfused, no clubbing, cyanosis or edema \nNeuro: A&Ox3, moving all extremities. \nRectal: trace brown stool in vault. guaiac positive.\n", + "input6": "08:10AM BLOOD WBC-4.1 RBC-3.97* Hgb-12.4* Hct-36.9* MCV-93 MCH-31.3 MCHC-33.6 RDW-13.6 Plt\n04:45PM BLOOD Neuts-67.0Monos-8.7 Eos-2.0 \nBaso-0.8\n08:10AM BLOOD Glucose-112* UreaN-19 Creat-1.3* Na-141 K-4.6 Cl-107 HCO AnGap-12\nEndoscopy:Gastric ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/16714362-DS-15.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/16714362-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..18569234f127e3574bd3db6e248444d834266614 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/16714362-DS-15.json @@ -0,0 +1,30 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding ion endoscopy is the gold standard of peptic ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "History of PUD and PUD bleed.$Cause_1": { + "This is a female with history of PUD, most recent upper GI bleed,$Input2": {} + }, + "Nausea and vomiting, with guaiac + stools are the manifestations of peptic ulcer with bleeding.$Cause_1": { + "Pt continued to have severe nausea and vomiting, with guaiac + stools$Input2": {} + }, + "Anemia is the manifestation of peptic ulcer with bleeding.$Cause_1": { + "pt was febrile and tachycardic with low-normal BP$Input2": {} + }, + "Anxiety and epression are the risk factor of peptic ulcer.$Cause_1": { + "Anxiety\uff0cDepression after pt was laid off$Input3": {} + }, + "Family history of colon ca.$Cause_1": { + "Grandmother - colon ca.$Input4": {} + } + } + }, + "input1": "Transfer from OSH for management of gastric outlet obstruction\n", + "input2": "This is a female with history of PUD, most recent upper GI bleed, hypertension, diagnosis of celiac dz by biopsy in who presented to OSH with nausea, vomiting, and weight loss of 30 lbs. Then, for days prior to her presentation to OSH, she had severe N/V/anorexia that prevented her from keeping any POs down. On admission to OSH, noted to have BP of 81/50 and Cr of 6. Pt was volume resuscitated with IVF, with improvement in BP and Cr returned to baseline of less than 1. Pt continued to have severe nausea and vomiting, with guaiac + stools. Work up was done to r/o bowel obstruction. Upper GI did not show any obstruction but upper endoscopy on showed duodenal stenosis. NG tube suction was initiated and pt reported improvement in symptoms. The plan was to rescope pt with plan to perform balloon plasty on if necessary. Pt desired to be transferred to where her primary MD practices and wished to get a second opinion. Upon arrival at , pt was febrile and tachycardic with low-normal BP, however she denied any symptoms. Pt is feeling better than she ever has in a long time. No abdominal pain, n/v. Denies feelings of heart racing. No coughs.\n", + "input3": "+GI bleeds requiring blood transfusions\n+Insomnia\n+Anxiety\n+s/p patella fracture\n+Diabetes\n+HTN\n+Depression after pt was laid off\n", + "input4": "Mom- HTN, ESRD. Grandmother - colon ca.\n", + "input5": "PE: pale, cachectic, temporal wasting. resting comfortably in bed. \nvitals: 101.7 139 20 95% RA\nHEENT: PERRL, EOMI, dry MM, cracked lips, OP clear\nNeck: Supple, no JVD\nCV: Tachycardic, regular rhythm. No m/r/g\nLungs: CTAB \nAbdomen: +BS, NTND, soft, no guarding or rebound, no organomegaly\nExt: no edema, 1+ pulses DP\nNeuro: AAOx3, CN II-XII grossly intact\n", + "input6": "12:50PM WBC-13.9*# RBC-4.21# HGB-11.5*# HCT-36.1# MCV-86 MCH-27.4 MCHC-32.0 RDW-14.1\n12:50PM NEUTS-94.4* BANDS-0 LYMPHS-2.9* MONOS-2.5 EOS-0.1 BASOS-0.1\n12:50PM PLT SMR-VERY HIGH PLT COUNT-622*\n12:50PM GLUCOSE-135* UREA N-22* CREAT-0.8 SODIUM-143 POTASSIUM-2.9* CHLORIDE-108 TOTAL CO2-22 ANION GAP-16\n12:50PM ALT(SGPT)-7 AST(SGOT)-8 LD(LDH)-124 ALK PHOS-137* TOT BILI-0.4\n12:50PM ALBUMIN-3.4 CALCIUM-9.3 PHOSPHATE-2.8 MAGNESIUM-1.7\n12:50PM PTT-34.4 \n04:55PM URINE COLOR-Yellow APPEAR-Clear SP\n04:55PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR GLUCOSE-NEG KETONE-15 \nBILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-TR\n04:55PM URINE BACTERIA-FEW \nYEAST-NONE 04:55PM URINE 04:55PM URINE MUCOUS-MOD\nEndoscopy:Gastric ulcer, duodenal ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/16714362-DS-1533.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/16714362-DS-1533.json new file mode 100644 index 0000000000000000000000000000000000000000..323d59e410a7dbaded5ddfc775e58cb756c431b1 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/16714362-DS-1533.json @@ -0,0 +1,33 @@ +{ + "Gastric Ulcers$Intermedia_3": { + "This phrase describes ulcers found in the stomach, which is direct evidence of Gastric Ulcers.$Cause_1": { + "Gastric ulcer with clean base$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "Very low blood pressure may be due to internal bleeding, which can occur in peptic ulcers, especially if the ulcer is perforated or bleeding severely.$Cause_1": { + "BP of 81/50$Input2": {} + }, + "This is a common symptom of peptic ulcers, especially when the ulcer is located in the stomach or duodenum.$Cause_1": { + "severe nausea and vomiting$Input2": {} + }, + "Positive occult blood indicates gastrointestinal bleeding, which is a typical symptom of perforated or bleeding peptic ulcer$Cause_1": { + "guaiac + stools$Input2": {} + }, + "This suggests that the patient's duodenum may have become scarred or narrowed due to long-standing ulcerative lesions.$Cause_1": { + "upper endoscopy on ___ showed duodenal stenosis$Input2": {} + }, + "Indicates infection or inflammation, common as a complication of ulcer disease.$Cause_1": { + "febrile and tachycardic$Input2": {} + }, + "Slow gastric motility may be due to nerve or muscle dysfunction caused by gastric inflammation or ulcers and is associated with peptic ulcer disease.$Cause_1": { + "Gastroparesis$Input6": {} + } + } + }, + "input1": "N/A\n", + "input2": "On admission to OSH, noted to have BP of 81/50 and Cr of 6. Pt was volume resuscitated with IVF, with improvement in BP and Cr returned to baseline of less than 1. Pt continued to have severe nausea and vomiting, with guaiac + stools. Work up was done to r/o bowel obstruction (see reports below). Upper GI did not show any obstruction but upper endoscopy on ___ showed duodenal stenosis. NG tube suction was initiated and pt reported improvement in symptoms. The plan was to rescope pt with plan to perform balloon plasty on ___ if necessary. Pt desired to be transferred to ___ where her primary MD practices and wished to get a second opinion.\n.\nUpon arrival at ___, pt was febrile and tachycardic with \nlow-normal BP, however she denied any symptoms. Pt is feeling better than she ever has in a long time. No abdominal pain, n/v. Denies feelings of heart racing. No coughs.\n", + "input3": "Insomnia\nAnxiety\ns/p patella fracture\n?Diabetes\nHTN\nDepression since ___ after pt was laid off\n", + "input4": "Mom- HTN, ESRD. Grandmother - colon ca.\n", + "input5": "PE: pale, cachectic, temporal wasting. resting comfortably in bed. \nvitals: 101.7 ___ 139 20 95% RA\nHEENT: PERRL, EOMI, dry MM, cracked lips, OP clear\nNeck: Supple, no JVD\nCV: Tachycardic, regular rhythm. No m/r/g\nLungs: CTAB \nAbdomen: +BS, NTND, soft, no guarding or rebound, no \norganomegaly\nExt: no edema, 1+ pulses DP\nNeuro: AAOx3, CN II-XII grossly intact\n", + "input6": "# Upper GI endoscopy ___\n-normal esophagus\n-Z-line regular, 40cm from the incisors\n-Excessive gastric fluid\n-Gastric ulcer with clean base\n.\n# Upper GI series ___\n- Gastroparesis\n- No outlet obstruction\n.\n# KUB ___\n- No e/o acute changes\n.\n# Renal function study ___\n- slight asymmetry in renal cortical activity, R>L. No focal \nlesion. No e/o renal ___\n.\n# CXR, PA and lat ___\n- no PNA or CHF\n.\n# Renal U/S ___\n- no e/o hydronephrosis\n- nonobstructing L renal calculus\n- probable cyst in R kidney\n.\n# CSR, portable ___\n- no acute cardiopulm abnormality\n.\n# CT head w/o contrast ___\n- normal, no change c/w prior\n.\nFrom OMR:\n.\n# Colonoscopy ___\n-Polyp in the rectum (polypectomy)\n-Polyp in the sigmoid colon (polypectomy)\n-Diverticulosis of the sigmoid colon\n-Otherwise normal colonoscopy to cecum\n\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/17590576-DS-20.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17590576-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..10798eacd24a70c9e0b407d9346c6aa781902749 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17590576-DS-20.json @@ -0,0 +1,21 @@ +{ + "Gastric Ulcers$Intermedia_3": { + "Gastroscopy (EGD) revealed a large number of old blood clots in the gastric body and antrum, and blood clots attached to the pyloric duct accompanied by bright red blood, which further confirmed the presence of active bleeding and gastric ulcer.$Cause_1": { + "Large amount of old clotted blood was seen in the body and antrum of the stomach.$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "Coffee grounds often indicate upper gastrointestinal bleeding, possibly from a peptic ulcer.$Cause_1": { + "NGLavaged 4L and coffee grounds did not clear.$Input2": {} + }, + "The nasogastric tube is in place and draining blood. This indicates that the patient may have gastrointestinal bleeding, which is common in peptic ulcer disease.$Cause_1": { + "NGT in place draining blood$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "Initially treated for a possible cardiac event and given aspirin but then because of history of PUD got NGL. The patient was NGLavaged 4L and coffee grounds did not clear. Hct ___ while at ___. Transferred to ___ ED because the ___ did not have her blood type in the bank. In our ED vital signs not taken. Got 3 units pRBCs. GI consulted and said would scope in the unit. Got started on Nexium and ppi gtt. Also got octreotide. Tachycardic to 110 sinus. Pressures 100/68. \n.\nOn the floor, patient had no complaints of abdominal pain, \ndiarrhea, constipation, melena, BRBPR, N/V/D. She denied chest pain. She denies aspirin or NSAID use. She does not drink alcohol or smoke.\n", + "input3": "Uterine Fibroids\nPUD from ASA use\nHeadaches\n", + "input4": "-Father and grandfather with colon cancer at age ___\n-Sister with ___ cancer at age ___\n", + "input5": "Vitals: T: 97.4 BP:106/74 P:105 R: 14 O2: 100%RA\nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, dryMM, oropharynx clear. NGT in place draining blood\nNeck: supple, JVP not elevated, no LAD\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops\nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly\nGU: no foley\nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\n", + "input6": "___ 07:10AM BLOOD WBC-8.5 RBC-3.20* Hgb-9.4*# Hct-28.0* \nMCV-87 MCH-29.4 MCHC-33.6# RDW-15.5 Plt ___\n___ 07:10AM BLOOD Neuts-86.2* Lymphs-12.1* Monos-1.5* \nEos-0.1 Baso-0.2\n___ 07:10AM BLOOD ___ PTT-27.1 ___\n___ 07:10AM BLOOD Glucose-130* UreaN-54* Creat-0.5 Na-143 \nK-4.5 Cl-117* HCO3-20* AnGap-11\n___ 05:20PM BLOOD Calcium-6.9* Phos-2.8 Mg-1.6\n___ 12:37PM BLOOD Type-ART pO2-387* pCO2-39 pH-7.26* \ncalTCO2-18* Base XS--8\n___ 12:37PM BLOOD freeCa-0.95*\n\nMICRO:\nHELICOBACTER PYLORI ANTIBODY TEST: NEGATIVE BY EIA.\n\nSTUDIES:\n___ ECG: Baseline artifact is present. Sinus tachycardia. \nNon-specific ST-T wave changes. No previous tracing available for comparison. \n Intervals Axes \nRate PR QRS QT/QTc P QRS T \n120 132 74 ___ Portable CXR: Tip of endotracheal tube is 2.6 cm above the carina. Heart size is normal. Aorta is tortuous. Bibasilar areas of atelectasis are present. Within the imaged portion of the upper abdomen, note is made of moderate gastric distention. \n\n___ EGD: Large amount of old clotted blood was seen in the body and antrum of the stomach. There was an adherent clot to the pyloric channel that had bright red blood as a component. There was evidence of active bleeding in the area of the clot when washed away showed a small hole from which blood was flowing in a stream. Epinephrine ___ 2cc was injected to stop the bleeding temporarily. Two resolution clips were also placed. There was a temporary decrease in bleeding. One more clip was placed with continued bleeding. Two additional ml of epinephrine injected. An additional clip was placed across the opening of the hole. It was unclear if the bleeding stopped but there was minimal bleeding at the time the scope was removed. Otherwise normal EGD to second portion of the duodenum\n\n___ Portable CXR: One portable view. Comparison with ___. \nStreaky density at the lung bases most consistent with subsegmental atelectasis persists. The heart and mediastinal structures are unchanged. An endotracheal tube and right internal jugular sheath remain in place. The stomach is distended with gas, as before. \nIMPRESSION: No significant change.\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/17676595-DS-13.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17676595-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..91571ebe070c2d9576bbde008f09f5ea3e473fc4 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17676595-DS-13.json @@ -0,0 +1,27 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding on endoscopy\nis the gold standard of gastric ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "Fatigue and GI bleedis the manifestation of gastric ulcer with bleed.$Cause_1": { + "Fatigue, GI bleed$Input1": {} + }, + "Black stool may be caused by gastric ulcer with bleed.$Cause_1": { + "Has noticed black stool over the last several days.$Input2": {} + }, + "Depression is the risk factor of peptic ulcer.$Cause_1": { + "depression$Input3": {} + }, + "Anemia is the manifestation of gastric ulcer with bleed.$Cause_1": { + "RBC-3.31* Hgb-10.7*$Input6": {} + } + } + }, + "input1": "Fatigue, GI bleed\n", + "input2": "with a history of diabetes, hypertension, s/p gastric bypass in who presents with GI bleed. Pt recently started taking Fe supplements for anemia. Has noticed black stool over the last several days. Has felt very fatigued, SOB with exertion. No chest pain. Recent colonoscopy / EGD was unremarkable. No h/o GI bleed. No blood thinning medications. In ED, hct 32, Lactate 4, hematemeisis present when placing NGT.\n", + "input3": "+depression\n+DM2\n+HTN\n+obesity\n+peripheral neuropathy \n+herniorrhaphy ventral\n+gastric bypass\n", + "input4": "Father with CAD, DM, prostate CA. Brother and HTN\n", + "input5": "VS: T98.6, HR 83, BP 117/50, RR 18, 97%RA\nGEN: AA&O x 3, NAD, calm, cooperative. \nHEENT: (-)LAD, mucous membranes moist, trachea midline, EOMI, PERRL. \nCHEST: Clear to auscultation bilaterally, (-) cyanosis. \nABDOMEN:(+) BS x 4 quadrants, soft, nontender to palpation, no gurading or rebound tenderness, normal to percussion\nEXTREMITIES: Warm, well perfused, pulses palpable,(+) edema of upper extremities bilaterally.\n", + "input6": "10:17AM BLOOD WBC-8.9# RBC-3.31* Hgb-10.7* Hct-32.1* MCV-97 MCH-32.3* MCHC-33.2 RDW-17.1* Plt\n03:12PM BLOOD Hct-27.7*\n09:35PM BLOOD Hct-24.5*\n02:05AM BLOOD Hct-24.6*\n06:03AM BLOOD WBC-4.2# RBC-2.47*# Hgb-7.6*# Hct-23.8* MCV-96 MCH-30.8 MCHC-32.0 RDW-17.4* Plt\n02:10PM BLOOD WBC-4.3 RBC-2.54* Hgb-8.2* Hct-24.6* MCV-97 MCH-32.3* MCHC-33.3 RDW-17.0* Plt\n07:33AM BLOOD WBC-3.7* RBC-2.81* Hgb-9.1* Hct-27.6* MCV-98 MCH-32.3* MCHC-33.0 RDW-17.1* Plt\nEndoscopy:Gastric ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/17868682-DS-8.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17868682-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..d81275bed7fad6aad12f5374056084d4d2427a2f --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17868682-DS-8.json @@ -0,0 +1,21 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer was bleeding and perforation endoscopy is the gold standard of gastric ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer was bleeding and perforation$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "Post prandial pain suspected gastric ulcer.$Cause_1": { + "Male with Afib on coumadin who presents with 3 weeks of epigastric and upper back pain which occurs about 1 hour post-prandially, especially with fatty meals.$Input2": {} + }, + "Vascular surgery saw pt and felt the celiac dissection with preservation of flow was incidental finding, which may supports peptic bleeding and perforation.$Cause_1": { + "Vascular surgery saw pt and felt the celiac dissection with preservation of flow was incidental finding.$Input2": {} + } + } + }, + "input1": "abdominal pain\n", + "input2": "Male with Afib on coumadin who presents with 3 weeks of epigastric and upper back pain which occurs about 1 hour post-prandially, especially with fatty meals. The pain has been most severe in the past week, but has always remitted after about an hour until last night. Yesterday evening, the patient developed pain after dinner, and it did not remit leading him to present to the emergency room. The pain was as intense as in severity. It feels \"constant\", like the pain that he had before his cholecystectomy years ago. Has tried Advil at for the pain. Denies fever, chills, blood in stool, or melena. Last bowel movement last night, normal. In the ED, initial vs at 2AM were: T 97.6 P 72 BP 155/82 R 18 O2 sat 99% RA. Patient was given zofran (total 4mg), morphine (total 12mg), dilaudid (total 1mg) and ativan (total 2mg) for nausea and pain. Vascular surgery saw pt and felt the celiac dissection with preservation of flow was incidental finding. Vascular advised adding aspirin to coumadin for atrial fibrillation and that the pts abdominal pain was not consistent with intestinal ischemia. Vital signs prior to transfer: 77 130/76 18 97% on RA. On the floor, the patient's pain and nausea was well-controlled, and he had no other complaints.\n", + "input3": "+Atrial Fibrillation on Coumadin \n+dysthymia \n+BPH \n+obstructive sleep apnea \n+seasonal allergies \n+s/p Lap cholecystectomy \n+s/p R Inguinal Hernia repair\n+s/p Left knee arthroscopy with +partial knee meniscectomy\n+s/p bilateral cataract surgery\n+s/p BCC excision from left side of nose\n", + "input4": "colon cancer (mother, father) \nsyndrome (sister), DM2 (father)\n", + "input5": "Vitals: T:96.5 BP:120/70 P:60 R:18 O2:98%/RA \nGeneral: Alert, oriented, no acute distress. \nHEENT: Sclera anicteric, MMM, oropharynx clear. \nNeck: supple, JVP not elevated \nLungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi \nCV: Irregular, normal rate, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, tender in epigastrium, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nRectal: guiaic negative in ED \nExt: Warm, well perfused, 2+ pulses, no cyanosis or edema\nSkin: No rash\nNeuro: Alert and oriented x 3. Appropriate. PERRL. Moving all extremities.\n", + "input6": "WBC-9.2 RBC-4.74 Hgb-14.4 Hct-42.1 MCV-89 MCH-30.3 MCHC-34.2 RDW-13.6 Plt\nNeuts-69.8 Lymphs-17.0* Monos-4.3 Eos-7.6* Baso-1.2\nPTT-28.1\nGlucose-128* UreaN-31* Creat-1.1 Na-141 K-3.9 Cl-105 HCO3-25 AnGap-15\nALT-21 AST-25 AlkPhos-63 TotBili-0.4 Lipase-19\n04:08PM CK(CPK)-78 CK-MB-NotDone cTropnT-<0.01\n02:45AM CK(CPK)-124 CK-MB-7cTropnT-<0.01\nAlbumin-4.4 Calcium-9.4 Phos-3.7 Mg-2.1\nLactate-1.1\nEndoscopy:Gastric ulcer was bleeding and perforation\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/17868682-DS-81.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17868682-DS-81.json new file mode 100644 index 0000000000000000000000000000000000000000..1e76445c3527d14894f4f6989ba253edbe6da04e --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17868682-DS-81.json @@ -0,0 +1,21 @@ +{ + "Gastric Ulcers$Intermedia_3": { + "This is the description most directly associated with Gastric Ulcers. The text describes a single depressed, 4 cm ulcer with raised margins on the lesser curvature of the antrum toward the notch. This is a typical presentation of Gastric Ulcers.$Cause_1": { + "A single cratered clean based 4 cm ulcer with heaped up borders was found in the antrum on the lesser curvature towards the incisura.$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "abdominal pain is the common symptom of Peptic Ulcer Disease$Cause_1": { + "abdominal pain$Input1": {} + }, + "The pain worsened after dinner and did not subside, leading the patient to go to the emergency department. This characteristic of pain worsening after eating is common in peptic ulcers.$Cause_1": { + "pain after dinner, and it did not remit$Input2": {} + } + } + }, + "input1": "abdominal pain\n", + "input2": "The pain have been most severe in the past week, but has always remitted after about a hour until last night. Yesterday evening, the patient developed pain after dinner, and it did not remit leading him to present to the emergency room. The pain was as intense as ___ in severity. It feels \"constant\", like the pain that he had before his cholecystecomy ___ years ago. Has tried Advil at ___ for th pain. Denies fever, chills, blood in stool, or melena. Last bowel movement last night, normal. \n\nIn the ED, initial vs at 2AM were: T 97.6 P 72 BP 155/82 R 18 O2 sat99% RA. Patient was given zofran (total 4mg), morphine (total 12mg), dilaudid (total 1mg) and ativan (total 2mg) for nausea and pain. Vascular surgery saw pt and felt the celiac dissection with preservation of flow was incidental finding. Vascular advised adding aspirin to couamdin for atrial fibrillation and that the pts abdominal pain was not consistent with intestinal ischemia. Vital signs prior to transfer: 77 130/76 18 97% on RA.\n.\n", + "input3": "Atrial Fibrillation on Coumadin \ndysthymia \nBPH \nobstructive sleep apnea \nseasonal allergies \ns/p Lap cholecystectomy \ns/p R Inguinal Hernia repair\ns/p Left knee arthroscopy with partial knee meniscectomy\ns/p bilateral cataract surgery\ns/p BCC excision from left side of nose\n", + "input4": "colon cancer (mother, father, both in ___, ___ \nsyndrome (sister), DM2 (father)\n", + "input5": "Vitals: T:96.5 BP:120/70 P:60 R:18 O2:98%/RA \nGeneral: Alert, oriented, no acute distress. \nHEENT: Sclera anicteric, MMM, oropharynx clear. \nNeck: supple, JVP not elevated \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: Irregular, normal rate, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, tender in epigastrium, non-distended, bowel \nsounds present, no rebound tenderness or guarding, no \norganomegaly \nRectal: guiaic negative in ED \nExt: Warm, well perfused, 2+ pulses, no cyanosis or edema\nSkin: No rash\nNeuro: Alert and oriented x 3. Appropriate. PERRL. Moving all \nextremities.\n", + "input6": "___ WBC-9.2 RBC-4.74 Hgb-14.4 Hct-42.1 MCV-89 MCH-30.3 \nMCHC-34.2 RDW-13.6 Plt ___\n___ Neuts-69.8 Lymphs-17.0* Monos-4.3 Eos-7.6* Baso-1.2\n___ ___ PTT-28.1 ___\n___ Glucose-128* UreaN-31* Creat-1.1 Na-141 K-3.9 Cl-105 \nHCO3-25 AnGap-15\n___ ALT-21 AST-25 AlkPhos-63 TotBili-0.4 Lipase-19\n___ 04:08PM CK(CPK)-78 CK-MB-NotDone cTropnT-<0.01\n___ 02:45AM CK(CPK)-124 CK-MB-7cTropnT-<0.01\n___ Albumin-4.4 Calcium-9.4 Phos-3.7 Mg-2.1\n___ Lactate-1.1\n.\nEKG ___: Atrial fibrillation with a controlled ventricular response. Non-diagnostic Q waves in leads III and aVF. Non-specific inferolateral ST-T wave flattening. Compared to the \nprevious tracing of ___ no diagnostic interim change. \n.\nCXR PA and lateral ___: No acute cardiopulmonary process.\n.\nCTA Abdomen/Pelvis ___:\n1. Linear hypodense band in the proximal celiac artery just \nprior to the bifurcation with mild aneuyrsmal dilatation prior to the flap. This finding is concerning for focal celiac artery dissection. There is no evidence of calcifications or mural thrombus. The arteries are patent distally.\n2. No evidence of SMA thrombus. \n3. No evidence of bowel abnormality including wall thickening, pneumatosis or dilation.\n\n\nStomach: \n\n Excavated Lesions A single cratered clean based 4 cm ulcer with heaped up borders was found in the antrum on the lesser curvature towards the incisura. Cold forceps biopsies were performed for histology. \n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/17910930-DS-11.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17910930-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..fb630470347ac3ed90bf1fdf914f945798529423 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/17910930-DS-11.json @@ -0,0 +1,24 @@ +{ + "Gastric Ulcers$Intermedia_3": { + "Key evidence for diagnosing duodenal ulcer$Cause_1": { + "Ulcer in second part of duodenum with bleeding vessel.$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "Black stools are a common symptom of gastrointestinal bleeding and may be related to peptic ulcers$Cause_1": { + "melena$Input2": {} + }, + "Long-term use of NSAIDs (such as ibuprofen and Aleve) may cause damage to the stomach lining, thereby increasing the risk of peptic ulcers.$Cause_1": { + "past 6 weeks, he has experienced worsening back pain and left-sided sciatica for which she has been taking 800 mg of ibuprofen 3 times daily combined with multiple daily Aleve.$Input2": {} + }, + "A change in stool color from watery to dark red, accompanied by mild dizziness, may indicate gastrointestinal bleeding, which is one of the symptoms of peptic ulcer.$Cause_1": { + "bowel movements which were first watery but then dark red. Symptoms were associated with some\nlightheadedness.$Input2": {} + } + } + }, + "input1": "N/A\n", + "input2": "___ male with a past medical history of COPD on 2L at night, chronic back pain who presents for evaluation of melena. \n\nThe patient reports that for the past 6 weeks, he has \nexperienced worsening back pain and left-sided sciatica for which she has been taking 800 mg of ibuprofen 3 times daily combined with multiple daily Aleve. \n\nToday, he noted about ___ bowel movements which were first \nwatery but then dark red. Symptoms were associated with some\nlightheadedness. No chest pain or pressure. He was evaluated by his PCP today and found to be hypotensive to ___. EMS was was called and he was takento the ED, receiving 400 cc of fluid en route with improvement in his blood pressure. \n\nPatient is not on any beta blockade or blood thinner. No large alcohol use. No previous history of GI bleeding. No known\nesophageal varices or liver disease.\n", + "input3": "COPD on 2L at night \nSciatica\n", + "input4": "Reviewed; non-contributory\n", + "input5": "VS: HR 95 BP 119/94 RR 25 O2 sat 92% RA\nGEN: Pale-appearing elderly man, no distress\nHEENT: Sclera anicteric. Moist mucus membranes.\nNECK: No palpable lymphadenopathy. \nCV: Normal S1S2, RRR, no murmurs\nRESP: Scattered rhonchi, otherwise clear bilaterally \nGI: Soft, non-tender, non-distended, no palpable organomegaly\nMSK: Warm, well-perfused, no lower extremity edema\nSKIN: No bruises or rashes\nNEURO: AOX3, CNII-XII intact, moves all extremities with \npurpose\n", + "input6": "___ 02:40PM BLOOD WBC-7.9 RBC-4.81 Hgb-13.6* Hct-40.8 \nMCV-85 MCH-28.3 MCHC-33.3 RDW-13.8 RDWSD-42.8 Plt ___\n___ 02:40PM BLOOD Neuts-66.0 Lymphs-17.7* Monos-10.6 \nEos-4.0 Baso-1.3* Im ___ AbsNeut-5.23 AbsLymp-1.40 \nAbsMono-0.84* AbsEos-0.32 AbsBaso-0.10*\n___ 02:40PM BLOOD ___ PTT-38.6* ___\n___ 02:40PM BLOOD Glucose-88 UreaN-26* Creat-1.2 Na-141 \nK-4.3 Cl-108 HCO3-23 AnGap-10\n___ 02:40PM BLOOD ALT-8 AST-13 AlkPhos-69 TotBili-0.4\n___ 02:40PM BLOOD Lipase-46\n___ 02:40PM BLOOD proBNP-446\n___ 02:40PM BLOOD cTropnT-<0.01\n___ 02:40PM BLOOD Albumin-3.6 Calcium-9.5 Phos-3.1 Mg-2.2\n___ 02:52PM BLOOD Lactate-1.2\n\nIMAGING\n============================\nEGD ___: Ring in distal esophagus. Hematin in stomach, no \nactive bleeding. Ulcer in second part of duodenum with bleeding vessel. Successful hemostasis with electrocautery and bicap.\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/19163991-DS-11.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/19163991-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..a835b94d9a55043dfb7d539d3eb477d99219a622 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/19163991-DS-11.json @@ -0,0 +1,27 @@ +{ + "Gastric Ulcers$Intermedia_3": { + "Ulcers in the gastric body and antrum are direct evidence of peptic ulcer disease.$Cause_1": { + "Ulcers in the stomach body and antrum (biopsy)$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "The pain is persistent, intermittent and dull at night, and is aggravated by food. This is a common symptom of gastric ulcer, because the stomach acid increases under the stimulation of food, causing the pain at the ulcer to increase.$Cause_1": { + "Pain has persisted, dull intermittent, occurring at night, worse with food.$Input2": {} + }, + "SAID use (such as Alevitra) is a significant risk factor for gastric ulcers because they damage the stomach lining.$Cause_1": { + "take 3 aleve in the week prior to admission$Input2": {} + }, + "Black stool is often a sign of upper gastrointestinal bleeding, which may be caused by a stomach ulcer.$Cause_1": { + "jet black stool$Input2": {} + }, + "Stomach ulcers often cause tenderness in the upper abdomen because the ulcers can cause inflammation and pain in this area.$Cause_1": { + "diffuse mild tenderness to palpation most pronounced at epigastrium$Input5": {} + } + } + }, + "input1": "none\n", + "input2": "On ___, pain was sharp, steady, nonradiating. She recalls that she fell in ___. She was in ___ for a funeral, fell on ___. Thought she was stepping on sidewalk, but sneaker got caught, and she landed on her R side. At the time, she felt something had \"broken loose\" in her RUQ. When she returned to ___ on ___, she had PCP apt which she cancelled. She was seen by her PCP ___ ___, at which time she described fall, noting intermittent RUQ pain since the time of fall. Xray was reportedly done, unrevealing. \n\nPain has persisted, dull intermittent, occurring at night, worse with food. Has had nonbloody emesis 4 times daily for the past ___ weeks. She took two doses of GasX on ___. On the am of ___, she noted jet black stool, single episode. Stayed in bed on ___ pain. On day prior to presentation, had multiple episodes of emesis, nonbloody. She did take 3 aleve in the week prior to admission, she denies all other NSAID use. She has never had similar symptoms. Endorses lightheadedness on day prior to presentation. Last BM was day prior to presentation, brown, without bright red blood. She denies fevers, chills. GasX provided no relief. She describes 9 lb weight loss over the preceding month ___ decreased PO intake. Weight is now down to 142 lbs. Denies night sweats.\n", + "input3": "NIDDM2 - last A1c 6.5% on ___\nBreast cancer - L breast invasive carcinoma, colloid, stage 1, \ns/p lumpectomy, XRT ___\nGoiter, nontoxic, multinodular ___ - FNA negative\nHLD\nHx of DVT - ___, in setting of fall and injury, s/p RLE \nDVT on warfarin x1 month only ___ hematoma - brother has hx of \nthrombosis as well\nOsteopenia\nTobacco dependence\nPaget's disease\nChronic pain syndrome on gabapentin, Percocet, cymbalta\n", + "input4": "2 brothers and a sister with DM\nBrother recently diagnosed with metastatic pancreatic cancer, \nlives in ___\n", + "input5": "VS 98.1 PO 151 / 64 L Sitting 64 18 100 RA \nGen: Pleasant, alert, interactive female, lying in bed, in NAD\nHEENT: PERRL, EOMI, clear oropharynx, anicteric sclera, MMM\nNeck: supple, no cervical or supraclavicular adenopathy\nCV: RRR, no m/r/g\nLungs: CTAB, no wheeze or rhonchi, good air movement throughout\nAbd: soft, nondistended, diffuse mild tenderness to palpation most pronounced at epigastrium, no rebound or guarding\nGU: No foley\nRectal: Deferred, given positive guaiac documented at ___ \nurgent care and in ___ ED\nExt: WWP, no clubbing, cyanosis or edema\nNeuro: grossly intact\n", + "input6": "___ 09:30PM GLUCOSE-144* UREA N-12 CREAT-0.7 SODIUM-136 \nPOTASSIUM-3.7 CHLORIDE-99 TOTAL CO2-24 ANION GAP-17\n___ 09:30PM estGFR-Using this\n___ 09:30PM ALT(SGPT)-10 AST(SGOT)-14 ALK PHOS-86 TOT \nBILI-0.4\n___ 09:30PM LIPASE-19\n___ 09:30PM ALBUMIN-4.1 CALCIUM-9.8 PHOSPHATE-3.2 \nMAGNESIUM-2.0\n___ 09:30PM WBC-10.9* RBC-3.69* HGB-10.4* HCT-32.8* \nMCV-89 MCH-28.2 MCHC-31.7* RDW-14.1 RDWSD-45.8\n___ 09:30PM NEUTS-49.2 ___ MONOS-6.8 EOS-0.4* \nBASOS-0.5 IM ___ AbsNeut-5.40 AbsLymp-4.68* AbsMono-0.74 \nAbsEos-0.04 AbsBaso-0.05\n___ 09:30PM HYPOCHROM-NORMAL ANISOCYT-NORMAL \nPOIKILOCY-OCCASIONAL MACROCYT-NORMAL MICROCYT-NORMAL \nPOLYCHROM-OCCASIONAL OVALOCYT-OCCASIONAL\n___ 09:30PM PLT SMR-NORMAL PLT COUNT-242\n___ 09:30PM ___ PTT-31.2 ___\n\nCT abd/pelvis with contrast ___:\nIMPRESSION: \n \n1. No acute CT intra-abdominal or intrapelvic findings to account for patient symptoms. \n2. Patient experienced a contrast related event during this \nexam. For details please see note in the electronic medical record/OMR. The patient has received instruction on how to manage this event at home. \n\nEGD ___\n \nImpression: Ulcers in the stomach body and antrum (biopsy)\n\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/19458321-DS-18.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/19458321-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..7dcee44b1b1bd8838e8f0b115554209b9013323b --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/19458321-DS-18.json @@ -0,0 +1,27 @@ +{ + "Gastric Ulcers$Intermedia_3": { + "This is the description most directly associated with Gastric Ulcers. The text describes a single depressed, 4 cm ulcer with raised margins on the lesser curvature of the antrum toward the notch. This is a typical presentation of Gastric Ulcers.$Cause_1": { + "A single cratered clean based 4 cm ulcer with heaped up borders was found in the antrum on the lesser curvature towards the incisura.$Input6": {} + }, + "Suspected Peptic Ulcer Disease$Intermedia_2": { + "Common symptoms of peptic ulcers include upper abdominal pain that can sometimes radiate to the back. In addition, the relief provided by the GI cocktail suggests that the symptoms may be related to acid or stomach problems.$Cause_1": { + "nausea and epigastric pain radiating to the back, which was relieved with GI cocktail$Input2": {} + }, + "People with peptic ulcer disease often experience increased pain when eating, as well as nausea and vomiting, without the presence of blood or bile in the vomitus. This may be due to the effect of the ulcer on the stomach lining or to food irritating the ulcer and causing increased pain.$Cause_1": { + "ongoing nausea and nonbloody nonbilious emesis associated with epigastric pain every time she attempts to eat or drink$Input2": {} + }, + "Symptoms typically associated with peptic ulcer disease, in which pain is often directly related to eating behavior and pain may be temporarily relieved when food is not consumed.$Cause_1": { + "pain is not present aside from eating$Input2": {} + }, + "Tenderness in the upper abdomen is one of the common symptoms of peptic ulcer.$Cause_1": { + "mildly tender over epigastric and RUQ areas$Input5": {} + } + } + }, + "input1": "None.\n", + "input2": "She initially did well postoperatively but then represented to the ED on ___ with fevers, chills, and abdominal distension. During that ED visit she developed nausea and epigastric pain radiating to the back, which was relieved with GI cocktail. She tolerated a PO challenge; thus was discharged home with scheduled CRS followup. Her notable labs at that visit were WBC 10.3, ALT 214 AST 202 AlkPhos 241 TotBili:\n0.8, lipase 6. \n\nShe represents today to the ED with ongoing nausea and nonbloody nonbilious emesis associated with epigastric pain every time she attempts to eat or drink. She states that the pain is not present aside from eating. She continues to pass flatus and is having no issues with her surgical sites/incisions, but has not had a bowel movement since ___. Today her vital signs are also within normal limits aside from tachycardia to 106. EKG and troponins are negative. Her LFTs are downtrending and her lipase remains normal at 11. She denied chest pain, shortness of breath, dysuria, bloody stools.\n", + "input3": "PMH: \nHTN\nReactive airway disease\n", + "input4": "N/A\n", + "input5": "Gen: NAD, AxOx3\nCard: RRR, no m/r/g\nPulm: CTAB, no respiratory distress\nAbd: Soft, mildly tender over epigastric and RUQ areas,\nnon-distended, no rebound or guarding. \nWounds: c/d/i\nExt: No edema, warm well-perfused\n", + "input6": "___ 11:05AM BLOOD WBC-9.6 RBC-4.90 Hgb-13.4 Hct-42.5 MCV-87 \nMCH-27.3 MCHC-31.5* RDW-14.5 RDWSD-45.8 Plt ___\n___ 07:18AM BLOOD WBC-13.8* RBC-5.47* Hgb-14.9 Hct-46.4* \nMCV-85 MCH-27.2 MCHC-32.1 RDW-14.4 RDWSD-44.3 Plt ___\n___ 07:18AM BLOOD Neuts-69.8 ___ Monos-6.3 Eos-0.7* \nBaso-0.4 Im ___ AbsNeut-9.65* AbsLymp-3.07 AbsMono-0.87* \nAbsEos-0.09 AbsBaso-0.06\n___ 11:05AM BLOOD Plt ___\n___ 07:18AM BLOOD ___ PTT-31.3 ___\n___ 11:05AM BLOOD Glucose-86 UreaN-17 Creat-0.7 Na-145 \nK-4.5 Cl-101 HCO3-25 AnGap-19*\n___ 07:18AM BLOOD Glucose-111* UreaN-19 Creat-0.7 Na-137 \nK-4.4 Cl-94* HCO3-20* AnGap-23*\n___ 11:05AM BLOOD ALT-92* AST-35 AlkPhos-156* TotBili-0.6\n___ 07:18AM BLOOD ALT-159* AST-82* AlkPhos-212* TotBili-0.7\n___ 07:18AM BLOOD Lipase-11\n___ 07:18AM BLOOD cTropnT-<0.01\n___ 11:05AM BLOOD Calcium-9.1 Phos-3.6 Mg-1.7\n___ 07:18AM BLOOD Albumin-4.6 Calcium-9.7 Phos-3.9 Mg-1.9\n___ 09:21AM BLOOD Lactate-1.5\n\nA single cratered clean based 4 cm ulcer with heaped up borders was found in the antrum on the lesser curvature towards the incisura.\n" +} \ No newline at end of file diff --git a/Finished/Peptic Ulcer Disease/Gastric Ulcers/19505167-DS-17.json b/Finished/Peptic Ulcer Disease/Gastric Ulcers/19505167-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..1cd2cd1423a6546bccdc7b6013f0250abec7a041 --- /dev/null +++ b/Finished/Peptic Ulcer Disease/Gastric Ulcers/19505167-DS-17.json @@ -0,0 +1,21 @@ +{ + "Gastric ulcers$Intermedia_3": { + "Gastric ulcer with bleeding onendoscopy is the gold standard of gastric ulcer.$Cause_1": { + "Endoscopy:Gastric ulcer with bleeding$Input6": {} + }, + "suspected peptic ulcer disease$Intermedia_2": { + "black stool and epigastric discomfort are the manifestations of peptic ulcer with bleeding.$Cause_1": { + "The patient is a year old man with hypertension who presents with 3 days of black stool and epigastric discomfort.$Input2": {} + }, + "stool was black and guaiac negative is the vidence of blood in the stool.$Cause_1": { + "His stool was black and guaiac negative (although it was later guaiac positive on the floor).$Input2": {} + } + } + }, + "input1": "black stools X 3 days\n", + "input2": "The patient is a year old man with hypertension who presents with 3 days of black stool and epigastric discomfort. The patient states that he began having non-radiating, epigastric pain on . The pain subsided but returned on night. From midnight to 4am, he experienced epigastric pain and a sensation of pressure and gas, which was relieved after an episode of non-bloody emesis. He also had an episode of \"black diarrhea\" that night. The patient has been pain-free since morning but notes that he continues to have black stool, including his last bowel movement this morning. The patient presented to today and saw Dr. who referred him to the ED for melena, abdominal pain, and tachycardia. The patient denies any fevers, chest pain, shortness of breath, lightheadedness, or NSAID use. He does note a 5 pound weight loss which he attributes to exercise. In the ED, initial VS: 99.2 94 150/85 19 100% RA. An NG lavage was performed, yielding clear lavage. His stool was black and guaiac negative (although it was later guaiac positive on the floor). He also received IV protonix. Currently, the patient is resting comfortably. He has no pain, nausea, or diarrhea. GI saw the patient and, through an interpreter, explained the plan for EGD. After speaking to his wife, the patient has declined EGD. He states that he needs to support his wife and daughter and that this hospitalization was not planned. He feels like he is okay right now and would like to do the EGD at a later date. He has agreed to stay overnight for monitoring but would like to go home tomorrow. He also refused to sign a consent for blood and said he would do this later.\n", + "input3": "+Hypertension - not currently on any medication\n", + "input4": "unknown\n", + "input5": "Vitals - T:99.3 HR:94 RR:20 02 sat:99RA \nGENERAL: Sitting in bed, comfortable, NAD. \nHEENT: Normocephalic, atraumatic; PERRLA, sclera anicteric, oropharynx clear without erythema or lesion, moist mucus membranes, neck supple, no lymphadenopathy. \nCARDIAC: regular rate and rhythm, normal S1 and S2, no murmurs appreciated. \nLUNG: Clear to auscultation bilaterally, no wheezes or crackles. \n \nABDOMEN: large abdomen, +bowel sounds, soft, non-tender, non distended, no pain on palpation, no guarding or rebound pain \nEXT: warm, well-perfused, no edema, 2+ DP and pulses. \nNEURO: A&Ox3, CN intact \nDERM: No rashes \nRECTAL: minimal stool, brown and black, guaiac positive\n", + "input6": "01:15PM \nSodium-141 Potassium-4.5 Chloride-107 Total CO2-27 Urea N-14 Creat-1.0 Glucose-91 Anion Gap-12\nALT-25 AST-22 LDH-146 Alk Phos-50 Tot Bili-0.4Albumin-4.5 Lipase-45\nWBC-6.9 RBC-5.06 Hgb-13.1* Hct-40.5 MCV-80* MCH-25.9* MCHC-32.3 \nRDW-16.1* Plt\nSerial Hct:\n01:20PM Hgb-14.4 Hct-43\n08:00PM Hct-37.5*\n05:50AM Hgb-11.6* Hct-36.6* \nIron Studies:\nIron-60 calTIBC-373 Ferritn-31 TRF-287\nEndoscopy:Gastric ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/11573828-DS-4.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/11573828-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..6043807328f28f0804996d19a955c90104c6cc39 --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/11573828-DS-4.json @@ -0,0 +1,30 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "Pituitary adenomas that are 1 cm or larger in size are called macroadenomas.$Cause_1": { + "Pituitary adenomas that are 2.1 cm large in size.$Input6": {} + }, + "Suspected Pituitary Disease$Intermedia_2": { + "This symptom may be related to compression of the pituitary adenoma or related hormonal abnormalities$Cause_1": { + "three episodes of unprovoked LOC$Input2": {} + }, + "Headaches, especially in the bitemporal region, may be caused by a pituitary adenoma compressing surrounding structures$Cause_1": { + "headaches per month that are bitemporal$Input2": {} + }, + "Unexplained weight loss may be related to the metabolic effects of pituitary adenoma or abnormal secretion of related hormones$Cause_1": { + "a weight loss$Input2": {} + }, + "Pituitary adenomas often cause elevated prolactin levels$Cause_1": { + "slightly elevated prolactin level with a full endocrinology evaluation$Input2": {} + }, + "Hormone replacement therapy means pituitary disease$Cause_1": { + "prescribed Androgel$Input2": {} + } + } + }, + "input1": "elective admit\n", + "input2": "s is a gentleman with three episodes of unprovoked LOC that led to a neurologic work up. He reports headaches per month that are bitemporal. He has had a weight loss over the course of ca one month. He had relatively normal visual field studies and a slightly elevated prolactin level with a full endocrinology evaluation. He was prescribed Androgel but this was not covered by insurance and hence he does not take it.\n", + "input3": "HTN, \nCHOL, \nBPH, \nright renal cyst\n", + "input4": "NC\n", + "input5": "Gen: WD/WN, comfortable, NAD.\nHEENT: Pupils:4=3mm EOMs intact\nRRR\nCTA\nNTTP; ND\nExtrem: Warm and well-perfused.\n\nNeuro:Mental status: Awake and alert, cooperative with exam, normal affect.\nOrientation: Oriented to person, place, and date.\nLanguage: Speech fluent.\nNaming intact. No dysarthria or paraphasic errors.\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 4 to 3mm\nmm bilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without\nnystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power ___ throughout. No pronator drift\n\nSensation: Intact to light touch\n", + "input6": "___ 03:50AM BLOOD WBC-10.6# RBC-4.52* Hgb-12.5* Hct-39.3* \nMCV-87 MCH-27.7 MCHC-31.7 RDW-13.6 Plt ___\n___ 03:50AM BLOOD Glucose-139* UreaN-15 Creat-0.8 Na-138 \nK-3.6 Cl-102 HCO3-29 AnGap-11\n___ 03:50AM BLOOD Calcium-8.2* Phos-3.1 Mg-2.0\n___ 03:50AM BLOOD Osmolal-292\n___ 03:50AM BLOOD T4-6.2 calcTBG-0.95 TUptake-1.05 \nT4Index-6.5 Free T4-1.2\n___ 03:50AM BLOOD Cortsol-32.0* - On Hydrocortisone for \nthis lab draw\n___ 03:50AM URINE Color-Yellow Appear-Clear Sp ___\n___ 03:50AM URINE Blood-MOD Nitrite-NEG Protein-TR \nGlucose-NEG Ketone-10 Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n\nMRI:\nPituitary adenomas that are 2.1 cm large in size.\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/12688174-DS-17.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/12688174-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..242a1cf90c7e93311e985ae53ab26b5375e54a37 --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/12688174-DS-17.json @@ -0,0 +1,24 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "MRI results showed direct evidence of a giant pituitary adenoma and compression of surrounding structures, particularly the optic chiasm.$Cause_1": { + "MRI brain was obtained and showed a pituitary macroadenoma with compression of the optic chiasm, right greater than left.$Input2": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "Amenorrhea is a common manifestation of pituitary dysfunction and may be related to hormone secretion disorders caused by pituitary tumors.$Cause_1": { + "become amenorrhoeic$Input2": {} + }, + "Pituitary giant adenomas may affect the normal hormone secretion of the pituitary gland, thereby affecting the downstream thyroid hormone production, leading to hypothyroidism.$Cause_1": { + "severe endocrine abnormalities, including hypothyroidism$Input2": {} + }, + "Pituitary giant adenomas often cause vision problems, especially visual field losses, by compressing the optic chiasm, especially when the tumor is large.$Cause_1": { + "vision difficulties with her right eye$Input2": {} + } + } + }, + "input1": "N/A\n", + "input2": "Patient had become amenorrhoeic and was referred to an endocrinologist. She was also found to have severe endocrine abnormalities, including hypothyroidism. Patient also endorsed vision difficulties with her right eye. MRI brain was obtained and showed a pituitary macroadenoma with compression of the optic chiasm, right greater than left. Plan was made for surgical resection of the lesion. \n\ufeff\n", + "input3": "Frequent sinus infections\n", + "input4": "Prostate cancer\n", + "input5": "None\n", + "input6": "Please see OMR for pertinent results.\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/12709553-DS-7.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/12709553-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..5c7560d19e17557abf0cb9829dce99eec0811bcc --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/12709553-DS-7.json @@ -0,0 +1,24 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "Cranial pituitary enlargement may be a direct manifestation of pituitary adenoma$Cause_1": { + "enlarged pit$Input2": {} + }, + "The adenomas were large and had cystic components that extended upward into the foramina of the skull, directly demonstrating the presence of Pituitary Macroadenomas.$Cause_1": { + "a large pituitary macroadenoma with a cystic component superiorly extending towards the foramen$Input6": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "The growth of the pituitary adenoma may have affected the optic nerve, causing visual problems. This is a common clinical manifestation of large pituitary adenomas.$Cause_1": { + "symptomatic lesion and visual changes.$Input2": {} + }, + "A non-functional adenoma means that the adenoma does not secrete excess hormones that can affect the rest of the body.$Cause_1": { + "non-funtioning adenoma with a cystic$Input2": {} + } + } + }, + "input1": "N/A\n", + "input2": "HPI: the enlarged pit was noted prior at the time of her SAH and aneurysm clipping; it was not followed; She now presents woth a symptomatic lesion and visual changes. No HA, N, V, Dz, Sz; neuroophtalmology exam and VFT by Dr. abonomralities and hence she was referred to us. Endocrine w/o revealed a non-funtioning adenoma with a cystic\n", + "input3": "1. s/p CCY\n2. cervical dysplasia\n3. Hypertension\n4. Dyslipidemia\n5. DVT history yrs ago which was treated with coumadin for 6 months; without further complications\n", + "input4": "non-contribuitory\n", + "input5": "Physical Exam:\nPHYSICAL EXAMINATION ON ADMISSION:\nNeuro: AAOx3 conversant, cooperative, pleasant nl affect\nCN: I) not tested\nII) PERLA; no gross visual field abnormalities but see Dr. for details\nIII-VI) EOMI\nV) symmetric sensation, bite eugnatal\nVII) symmetric\nVIII) bilaterally intact \nIX/X) no swallowing difficulties; phonation intact\nXII) tongue midline\n\ufeff\nMot: bilaterally; no drift\n: no epicritic or protopathic deficit\nReflexes: symmetric 2+ no clonus, no Babinski, no extrapramidal signs; eudiadochokinesis Stable stand and gait; Rhomberg \n\ufeff\n", + "input6": "Examination performed for surgical planning demonstrates a large pituitary macroadenoma with a cystic component superiorly extending towards the foramen, but without hydrocephalus. No significant change in size and appearance of the adenoma seen. \n\ufeff\nNon-Contrast Head CT:\n1. No evidence of postoperative hemorrhage. \n \n2. Air mixed with blood pcoducts within the surgical bed, consistent with expected postoperative changes. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/13246627-DS-4.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/13246627-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..96c35673d8f8122fbbed2b445018f6c038f921e6 --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/13246627-DS-4.json @@ -0,0 +1,33 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "MRI findings confirmed the presence of a pituitary tumor and its compression of surrounding structures, particularly the optic nerve.$Cause_1": { + "MRI which revealed a 2.8x 2.2 cm mass with left sided optic nerve compression$Input2": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "Obesity may be associated with endocrine dysfunction, which may affect the normal function of the pituitary gland$Cause_1": { + "obese woman$Input2": {} + }, + "Migraines may be associated with pituitary tumors, particularly if the tumor compresses adjacent neural structures.$Cause_1": { + "history of migraine$Input2": {} + }, + "Amenorrhea is one of the typical symptoms of pituitary tumors, especially when the tumor secretes excessive prolactin or other hormones, affecting the normal level of reproductive hormones.$Cause_1": { + "workup for amenorrhea$Input2": {} + }, + "Headache is often an important symptom of a pituitary tumor, which may be caused by the tumor growing and compressing surrounding structures, especially brain tissue and nerves.$Cause_1": { + "Headaches frsit began months ago$Input2": {} + }, + "Vision problems are often related to a pituitary tumor pressing on the optic nerve, especially if the tumor is located near the optic chiasm.$Cause_1": { + "intermittent left sided blurry vision or visual sensations$Input2": {} + }, + "Nausea may be associated with headaches or may be caused by increased pressure in the brain.$Cause_1": { + "nausea$Input2": {} + } + } + }, + "input1": "N/A\n", + "input2": "She is a yo obese woman with a history of migraine and depression upon workup for amenorrhea and headaches. Headaches frsit began months ago, and are described as diffuse \"pressure\" associated with intermittent left sided blurry vision or visual sensations (crossing lines), sometimes also with nausea. She also had not had a menstrual cycle and recently went to OBGYN for workup where she was found with elevated prolactin to 47 which responded to progesterone challenge. As part of that workup she was sent for MRI which revealed a 2.8x 2.2 cm mass with left sided optic nerve compression. \n\ufeff\nShe was referred where she had endorcrine workup and a cosyntropin test which returned normal. She had formal visual field testing as well but does not know the results. Referred to us today for assessment of potential resection.\n", + "input3": "None\n", + "input4": "DM, HTN, colon ca\n", + "input5": "Physical Exam:\nPre-op:\nAVSS\nGen: WD/WN, comfortable, NAD.\nHEENT: Pupils: PERRL, EOMs intact without nystagmus. \nNeck: Supple.\nLungs: CTA bilaterally.\nCardiac: RRR. S1/S2.\nAbd: Soft, NT, BS+\nExtrem: Warm and well-perfused. No C/C/E.\n\ufeff\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal affect.\nOrientation: Oriented to person, place, and date.\nLanguage: Speech fluent with good comprehension and repetition. Naming intact. No dysarthria or paraphasic errors.\n\ufeff\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 4mm to 3mm bilaterally. Visual fields are full to confrontation. Visual fields, and peripheral vision intact to finger movement and count\nIII, IV, VI: Extraocular movements intact bilaterally without nystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to finger rub bilaterally.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\ufeff\nMotor: Normal bulk and tone bilaterally. No abnormal movements, \ntremors. Strength full power throughout. No pronator drift \nSensation: Intact to light touch\n\ufeff\nToes downgoing bilaterally\n\ufeff\nCoordination: normal on finger-nose-finger\n\ufeff\n\ufeff\n", + "input6": "OSH Labs:\nPROLACTIN - 47.1 (slightly elevated)\nFT4- 7.8 wnl\nLH- 3.6 wnl\nFSH- 7.8 wnl\nfree cortisol 11.3 wnl\nCosyntropin test negative\n\ufeff\nMR w/ contrast \nPituitary macroadenoma with unchanged bulge into the right cavernous sinus and lateral displacement of the right carotid artery. \n\ufeff\nCt w/o contrast\nStatus post transsphenoidal hypophysectomy and fat packing without evidence of postoperative bleed.\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/13562354-DS-13.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/13562354-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..0e067cd9b818854547baa1fe8a950e642cea359f --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/13562354-DS-13.json @@ -0,0 +1,27 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "The size and location of the pituitary adenoma directly confirm the diagnosis of Pituitary Macroadenomas$Cause_1": { + "a 17mm pituitary macroadenoma extending to the supracellar space and inpinging upon the optic chiasm$Input2": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "These are common symptoms of pituitary adenomas. The adenoma presses on surrounding structures, especially the optic chiasm, which may cause vision loss and headaches.$Cause_1": { + "visual changes and HA$Input2": {} + }, + "Blurred vision may be caused by an adenoma pressing on the optic nerve$Cause_1": { + "blurry vision$Input2": {} + }, + "These symptoms may be related to increased intracranial pressure caused by the adenoma$Cause_1": { + "diffuse headaches, nausea, and photophobia$Input2": {} + }, + "Compression of the optic nerve by a pituitary adenoma may lead to further vision loss, and ordinary glasses are difficult to correct vision problems caused by nerve compression.$Cause_1": { + "visual acuity was deteriorating and she was prescribed glasses, which did not ameliorate her vision$Input2": {} + } + } + }, + "input1": "none\n", + "input2": "She had an MRI for visual changes and HA which showed a 17mm pituitary macroadenoma extending to the supracellar space and inpinging upon the optic chiasm. Her symptoms started earleir this year when she went on a cruise. She noted blurry vision in both eyes during that cruise. Subsequently, she developed diffuse headaches, nausea, and photophobia. HA's are daily, and she received a short course of Prednisone several weeks ago to treat these, which was successful, but they returned after Prendisone was discontinued. At the same time her visual acuity was deteriorating and she was prescribed glasses, which did not ameliorate her vision. She underwent an MRI elsewhere which showed the above mentioned sellar lesion.\n", + "input3": "migraines in her youth (none since hysterectomy until current HA)\npartial hysterectomy AUB and pain (ovaries intact)\nlumpectomy - benign\nIBS, primarily constipation\nG4P2, 2 miscarraiges\n\ufeff\n", + "input4": "sister has \"abnormal breast tissue\" by biopsy, mastectomy recommended\nmother is hypothyroid, + stroke\nFather had kidney stones, stroke, CAD, DM.\nPGF - colon CA\nNo ulcer disease\n\ufeff\n", + "input5": "None\n", + "input6": "Labs on Admission:\n___ 04:46PM BLOOD WBC-13.8* RBC-4.39 Hgb-13.0 Hct-36.2 MCV-83 MCH-29.7 MCHC-36.0* RDW-13.7\n___ 04:46PM BLOOD PTT-26.6\n___ 04:46PM BLOOD Glucose-166* UreaN-8 Creat-0.8 Na-136 K-5.2* Cl-104 HCO3-24 AnGap-13\n___ 04:46PM BLOOD Calcium-9.0 Phos-3.2 Mg-2.2\n\ufeff\nImaging:\nHead CT:\nFINDINGS: There is no intracranial hemorrhage, edema, shift of normally midline structures or evidence of major vascular territorial infarct. Ventricles and sulci are normal in size and configuration. The gray-white differentiation is preserved. The basilar cisterns are patent.Evaluation of bony structures reveals minimal postoperative changes within the right sphenoid air cells, and aerosolized fluid throughout the sphenoid and ethmoid air cells. The visualized portions of the maxillary sinuses are largely clear, with a small fluid level in the right maxillary sinus dependently. The mastoid air cells are clear. There is no fracture. Soft tissues are unremarkable.\nIMPRESSION:\n1. No intracranial hemorrhage following trans-sphenoidal resection. Postoperative changes in the sella and sphenoid air cells.\n2. No new abnormalities.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/14633589-DS-5.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/14633589-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..105e2cd4c3114b8199de0afb3f0650949bdc5811 --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/14633589-DS-5.json @@ -0,0 +1,30 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "The size of the pituitary adenoma, 1.7 cm, was an important factor in the direct diagnosis of Pituitary Macroadenomas.$Cause_1": { + "B Pituitary adenomas that are 1.7 cm$Input6": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "headache is a common symptom of pituitary disease$Cause_1": { + "headache$Input1": {} + }, + "Headache is one of the possible symptoms of a giant pituitary adenoma because the tumor may compress surrounding structures.$Cause_1": { + "worked up for headaches$Input2": {} + }, + "Abnormally elevated IGF-1 is common in conditions of excessive growth hormone secretion, which may be associated with pituitary adenomas.$Cause_1": { + "Endocrinology consult was then obtained which revealed elevated IGF-1.$Input2": {} + }, + "The medical team suspects a cystic structure that requires surgery, which is common in pituitary adenomas, especially large or symptomatic ones$Cause_1": { + "discuss excision of the cyst$Input2": {} + }, + "Increased muscle size found during a physical exam, which may be a sign of excessive growth hormone production from the pituitary gland$Cause_1": { + "enlarged bulk$Input5": {} + } + } + }, + "input1": "headache\n", + "input2": "Pt worked up for headaches. Endocrinology consult was then obtained which revealed elevated IGF-1. Visual Field Testing performed and no deficit was noted. Pt is now referred for neurosurgical consultation to discuss excision of the cyst.\n", + "input3": "Chronic headache, HTN, DM2\n", + "input4": "Noncontributory\n", + "input5": "Physical Exam:\nGen: WD/WN, comfortable, NAD.\nHEENT: Pupils: PERRL EOMs intact\nNeck: Supple.\nLungs: no adventicious sounds\nCardiac: RRR\nAbd: Soft, NT\nExtrem: Warm and well-perfused.\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal affect.\nOrientation: Oriented to person, place, and date.\nLanguage: Speeks, Speech fluent but thick with good comprehension \n\ufeff\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 4 to 3\nmm bilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without nystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\ufeff\nMotor: enlarged bulk and normal tone bilaterally. No abnormal movements, tremors. Strength full power ___ throughout. No pronator drift. acromegalic features.\n\ufeff\nSensation: Intact to light touch\n\ufeff\nCoordination: normal on finger-nose-finger, rapid alternating movements\n\ufeff\nOn discharge he was non focal without csf leak \n\ufeff\n", + "input6": "B Pituitary adenomas that are 1.7 cm\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/15430683-DS-10.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/15430683-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..213eb1b118c61ff8c5e8e9efc5c31e14a6395b20 --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/15430683-DS-10.json @@ -0,0 +1,27 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "A clear criteria to diagnose Pituitary Macroadenomas$Cause_1": { + "Pituitary adenomas that are 1.7 cm$Input6": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "Persistent or severe headaches may require further neurological evaluation, as pituitary adenomas may cause headaches.$Cause_1": { + "a terrible posterior Headache and nausea$Input2": {} + }, + "Frontal headaches may be related to increased intracranial pressure caused by a pituitary adenoma, especially if the symptoms are new or tend to get worse.$Cause_1": { + "headache was more frontal at that point$Input2": {} + }, + "Long-term visual floaters may be related to retinal problems, but if they are accompanied by other symptoms, it may also be necessary to rule out potential impact of a pituitary tumor on the optic nerve.$Cause_1": { + "hasmany years complaint of \"floaters\" and sees an opthomologist yearly$Input2": {} + }, + "Hypertension is a common symptom of many endocrine-related diseases, including pituitary adenomas, because pituitary tumors may affect hormone levels in the body and thus affect blood pressure.$Cause_1": { + "Hypertension$Input3": {} + } + } + }, + "input1": "None\n", + "input2": "This is a right handed woman who was straining to clean her bathroom floor around 11:30pm. She inhaled bleach and had a terrible posterior Headache and nausea. Her headache was more frontal at that point. She has had 2 x emesis. She has no new visual complaints but hasmany years complaint of \"floaters\" and sees an opthomologist yearly. She denies a VF cut. She has no change in smell or taste. She had perimenopausal symptoms dating back and she had a hysterectomy and started taking Estroven. Since she noted an increase in hot flashes and mood lability.\n\ufeff\n", + "input3": "Hypertension, hyperlipidemia, Total abdominal hysterectomy and bilateral salpingo-oophorectomy secondary to fibroids, chronic R toe numbness, SBO with exploratory ex lap, MRI abdomen showed liver and pancreatic cyst.\n\ufeff\n", + "input4": "Non-contributory\n", + "input5": "Physical Exam:\nGen: WD/WN, comfortable, NAD. Glasses\nHEENT: Pupils: 2.0-1.5 EOMs intact\nNeuro: Mental status: Awake and alert, cooperative with exam, normal affect.\nOrientation: Oriented to person, place, and date.\nRecall: objects at 5 minutes.\nLanguage: Speech fluent with good comprehension and repetition.\nNaming intact. No dysarthria or paraphasic errors.\n\ufeff\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 2 to 1.5\nmm bilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without\nnystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\ufeff\nMotor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power throughout. No pronator drift\n\ufeff\nSensation: Right toe numbness.\nReflexes: B T Br Pa Ac\nRight ___ 2 1\nLeft ___ 2 1\n\ufeff\nToes downgoing bilaterally\n\ufeff\n", + "input6": "Pituitary adenomas that are 1.7 cm \n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/17779332-DS-11.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/17779332-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..6cca6c542203545d129355e331bc3a6fd5489e68 --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/17779332-DS-11.json @@ -0,0 +1,18 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "Pituitary tumors detected by biopsy that appear to be adenomas with extensive necrosis$Cause_1": { + "Findings consistent with adenoma with extensive necrosis$Input6": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "Hypertension may be due to the effect of pituitary giant adenoma on the body's hormone system, especially the secretion of adrenal hormones$Cause_1": { + "HTN$Input3": {} + } + } + }, + "input1": "\n", + "input2": "Elective admission for a transphenoidal resection\n", + "input3": "+ DM\n+ HTN\n+ HLD\n+ Chronic back pain\n", + "input4": "Father and brother MI, lung cancer in uncle\n", + "input5": "None\n", + "input6": "xpected postoperative appearance after transsphenoidal resection of a sellar mass. \n\ufeff\nPathology:\n1. Pituitary tumor, biopsy:\nFindings consistent with adenoma with extensive necrosis.\n\ufeff\n2. Pituitary tumor, excision:\nFindings consistent with adenoma with extensive necrosis.\n\ufeff\nNote: Given the extensive necrosis, immunostains for hormonal markers will not be performed\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/18987116-DS-10.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/18987116-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..2d1cb3b95e11374ce66ff9e5e082c51dc9f82944 --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/18987116-DS-10.json @@ -0,0 +1,21 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "MRI results showed a large mass in the pituitary gland that expanded upward and laterally. This indicated the size and direction of the mass, confirming the diagnosis of Pituitary Macroadenomas.$Cause_1": { + "MRI of the sella at OSH showed a 1.8 x 2.7 x 1.8 cm mass in the pituitary gland, extending superiorly and also laterally.$Input2": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "Restricted visual fields are often associated with pituitary tumors, probably because of compression of the optic nerve by the tumor.$Cause_1": { + "Visual fields attempted - patient unable to follow$Input5": {} + }, + "The pupil reacts normally to light, but changes in pupil size (eg, 3\u20132 mm) may indicate central nervous system stress or injury, possibly associated with a pituitary tumor.$Cause_1": { + "PERRL 3-2mm bilaterally$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "HPI: He is a male who was found to have a sellar mass when a CT scan was done after he fell on ice and snow. A subsequent MRI of the sella at OSH showed a 1.8 x 2.7 x 1.8 cm mass in the pituitary gland, extending superiorly and also laterally.\n", + "input3": "prostate cancer, treated with radiation. type 2 diabetes, hyperlipidemia, thrombocytopenia and leukopenia reflux disease. \n\ufeff\n", + "input4": "Non-contributory\n", + "input5": "Physical Exam:\nPHYSICAL EXAMINATION ON ADMISSION:\nVital Signs sheet entries for: \nBP: 124/70. Heart Rate: 62. O2 Saturation%: 70.13. Weight: 201.4 (With Clothes). Height: 70.13. BMI: 28.8.\n\ufeff\nMental status: Awake and alert, cooperative with exam, normal affect. Patient is oriented to person, place, and date.\nMotor: all four extremities are full strength. Sensation is intact to light touch. The incision is well healed.\n\ufeff\nPHYSICAL EXAMINATION ON DISCHARGE:\n\ufeff\nOpens eyes: [x]spontaneous [ ]to voice [ ]to noxious\nOrientation: [x]Person [x]Place [x]Time\nFollows commands: [ ]Simple [x]Complex [ ]None\nPupils: PERRL 3-2mm bilaterally \nVisual fields attempted - patient unable to follow\nEOM: [x]Full [ ]Restricted\nFace Symmetric: [x]Yes [ ]NoTongue Midline: [x]Yes [ ]No\nPronator Drift [ ]Yes [x]No Speech Fluent: [x]Yes [ ]No\nComprehension intact [x]Yes [ ]No\n\ufeff\nMotor:\nTrapDeltoidBicepTricepGrip\n\ufeff\nIPQuadHamATEHLGast\nRight___\nLeft5 5 5 5 5 5 \n\ufeff\n[x]Sensation intact to light touch\n\ufeff\nWound: \n[x]nasal packing removed\n\ufeff\n", + "input6": "Please see OMR for pertinent lab and imaging results.\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/19001641-DS-19.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/19001641-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..024c510fbebe32357d464ed3bf1ec5e946ab2feb --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/19001641-DS-19.json @@ -0,0 +1,21 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "The discovery of large Pituitary adenomas directly proves Pituitary Macroadenomas$Cause_1": { + "Pituitary adenomas that are 1.8 cm$Input6": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "A pituitary giant adenoma may affect the body's hormonal balance, which in turn may affect blood pressure.$Cause_1": { + "hypertension$Input3": {} + }, + "Patients have visual field defects, especially during lateral gaze. Large pituitary tumors may compress the optic chiasm and cause visual field defects.$Cause_1": { + "Visual fields showed a lateral gaze deficit$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "None\n", + "input3": "+ hypertension \n+ diabetes type II\n+ surgical treatment for plantar fasciitis\n", + "input4": "non-contributory\n", + "input5": "Physical Exam:\nPre-Op exam:\nOn exam: he appears to be in no acute distress, well nourished. He is alert and oriented to person, place, and time. PERRL, EOM intact without nystagmus, face symmetric, tongue midline, facial strength and sensation intact, hearing intact to voice, speech is clear and fluent, comprehension intact, no pronator drift, no Romberg, heel to shin intact, and tandem gait intact. Visual fields showed a lateral gaze deficit. He moves all extremities with full strength, normal tone and bulk. Gait is normal. \n\ufeff\n", + "input6": "Labs on Admission:\n___ 05:22AM BLOOD WBC-13.7*# RBC-4.63 Hgb-10.2* Hct-30.9* MCV-67* MCH-22.0* MCHC-33.0 RDW-14.9\n___ 05:22AM BLOOD Glucose-193* UreaN-14 Creat-0.9 Na-135 K-4.2 Cl-101 HCO3-27 AnGap-11\n___ 05:22AM BLOOD Calcium-8.5 Phos-2.5* Mg-1.6\n\ufeff\nLabs on Discharge:\n___ 04:40AM BLOOD WBC-9.2 RBC-4.73 Hgb-10.5* Hct-31.3* MCV-66* MCH-22.3* MCHC-33.7 RDW-14.8\n___ 04:40AM BLOOD PTT-22.5\n___ 04:40AM BLOOD Glucose-139* UreaN-15 Creat-0.8 Na-138 K-3.7 Cl-101 HCO3-32 AnGap-9\n___ 04:40AM BLOOD Calcium-8.9 Phos-3.5 Mg-2.5\n___ 03:08PM BLOOD Osmolal-301\n\ufeff\nImaging: \nPituitary adenomas that are 1.8 cm \n\ufeff\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Macroadenoma/19135392-DS-7.json b/Finished/Pituitary Disease/Pituitary Macroadenoma/19135392-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..24725405257ced28d8f145a36484bfe83b4662c5 --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Macroadenoma/19135392-DS-7.json @@ -0,0 +1,21 @@ +{ + "Pituitary Macroadenomas$Intermedia_3": { + "There is a stable deformity in the left anterior horn of the lateral ventricle and the left anterior part of the third ventricle. This may be due to tumor compression or structural changes caused by surgery.$Cause_1": { + "Stable distortion of the frontal horn of the left lateral ventricle and anterior left aspect of the third ventricle.$Input6": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "Pituitary macroadenomas may affect visual function and cause diplopia by compressing the optic nerve or its surrounding structures.$Cause_1": { + "occasional double vision$Input1": {} + }, + "Because of its location near the optic chiasm, giant pituitary tumors may compress the optic nerves, causing vision problems. This is a common symptom associated with giant pituitary tumors.$Cause_1": { + "visual related symptoms$Input2": {} + } + } + }, + "input1": "occasional double vision\n", + "input2": "F who was referred for visual related symptoms\n", + "input3": "PMH: Anemia due to heavy periods \nPSH: L toe nail surgery\n", + "input4": "NC\n", + "input5": "Physical Exam:\nN/A\n", + "input6": "Non contrast Head CT\nS/p sellar/suprasellar mass resection with blood products and fluid in the sella and suprasellar cistern, as well as fluid anterior to the left thalamus, at the site of the left superior component of the resected mass. Stable distortion of the frontal horn of the left lateral ventricle and anterior left aspect of the third ventricle. No hydrocephalus. Small amount of blood in the lateral ventricles. No evidence for hemorrhage or edema in the brain parenchyma. \n\ufeff\nBrain MRI w/&w/o\nS/p sellar/suprasellar mass resection with enhancing hemorrhagic material in the sella and suprasellar cistern, compatible with postsurgical change. follow up Imaging is needed to exclude residual tumor. Please note that follow up would be best performed with a combination of complete brain MRI and dedicated pituitary MRI sequences. Small amount of blood in the occipital horns of the lateral ventricles. Stable configuration of the ventricles with slight distortion of the left frontal horn and left anterior third ventricle. No hydrocephalus. \n\ufeff\nCortisol level 12.5\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pituitary Disease/Pituitary Microadenoma/18144647-DS-16.json b/Finished/Pituitary Disease/Pituitary Microadenoma/18144647-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..aff42710e15007d75ebbd146edb9d8031d2c8b5b --- /dev/null +++ b/Finished/Pituitary Disease/Pituitary Microadenoma/18144647-DS-16.json @@ -0,0 +1,21 @@ +{ + "Pituitary Microadenomas$Intermedia_3": { + "Pituitary masses are direct manifestations of pituitary microadenomas$Cause_1": { + "known 0.8 cm pituitary mass$Input2": {} + }, + "Suspected pituitary disease$Intermedia_2": { + "Pituitary microadenomas may affect the hormone secretion function of the pituitary gland, thereby affecting the menstrual cycle. Irregular menstruation is a common manifestation of pituitary dysfunction.$Cause_1": { + "irregular menses$Input2": {} + }, + "Hypertension is a common chronic disease that may be associated with pituitary disease, especially when a pituitary tumor affects adrenal hormone secretion.$Cause_1": { + "HTN$Input3": {} + } + } + }, + "input1": "None\n", + "input2": "She is a female with a known 0.8 cm pituitary mass, initially discovered on work-up for irregular menses.\n", + "input3": "+ SVT s/p ablation\n+ HTN\n", + "input4": "Mother with RA, borderline DM2\n", + "input5": "Opens Eyes: [x]Spontaneous [ ]To voice [ ]To noxious [ ]None\nOrientation: [x]Person [x]Place [x]Time\nFollows Commands: [ ]Simple [x]Complex [ ]None\nPupils: PERRL\nEOMs: [x]Full [ ]Restricted\nFace Symmetric: [x]Yes [ ]No\nTongue Midline: [x]Yes [ ]No\nDrift: [ ]Yes [x]No\nSpeech Fluent: [x]Yes [ ]No\nComprehension Intact: [x]Yes [ ]No\n\nMotor:\n\n Trap Deltoid Biceps Triceps Grip\nRight 5 5 5 5 5\nLeft 5 5 5 5 5\n\n IP Quad Ham AT ___ ___\nRight 5 5 5 5 5 5\nLeft 5 5 5 5 5 5\n\nSensation: Grossly intact to light touch.\n\nVisual fields are full to confrontation. \n", + "input6": "None\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/11620099-DS-7.json b/Finished/Pneumonia/Bacterial Pneumonia/11620099-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..16f2a8e9738280a1312fe921ca0333a9afe298fe --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/11620099-DS-7.json @@ -0,0 +1,38 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "The presence of MRSA and Klebsiella, both of which are known causative agents of pneumonia, suggests a possible bacterial infection.$Cause_1": { + "Sputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Infiltrate and pleural effusion on chest radiograph may indicate pulmonary infection or inflammation and are direct signs of pneumonia.$Cause_1": { + "CXR with small left lower lobe infiltrates and lateral parapneumonic effusion$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Hypoxemia is when the amount of oxygen in the blood falls below normal levels, which can be caused by a lung infection, such as pneumonia, that blocks oxygen exchange.$Cause_1": { + "hypoxia$Input1": {} + }, + "Fever, cough, body aches, headache, and nausea are common clinical manifestations of pneumonia.$Cause_1": { + "fevers, cough, body aches, headache and nausea$Input2": {} + }, + "High temperature is a common symptom of pneumonia$Cause_1": { + "temperature of 104.3$Input2": {} + }, + "Heavy drinking and loss of consciousness may have a negative impact on the immune system, thereby indirectly increasing the risk of pneumonia$Cause_1": { + "heavy alcohol intake with loss of consiousness$Input2": {} + }, + "Coughing up yellow phlegm is a common symptom of a lung infection$Cause_1": { + "small amount of yellowish \"phlegm\"$Input2": {} + }, + "Intoxication may weaken protective reflexes, making it easier for respiratory secretions or gastric contents to enter the lungs and cause infection.$Cause_1": { + "Alcohol poisoning$Input3": {} + } + } + } + }, + "input1": "hypoxia\n", + "input2": "Patient reports he felt in his usual state of health until 8 days prior to admission, when he noted the onset of fevers, cough, body aches, headache and nausea. He was seen in the medical clinic at the ___ the following day, and was given symptomatic treatment with Mucinex, Ibuprofen, and a cough suppressant. His symptoms persisted, and progressed to include diarrhea the day prior to admission. He returned to the medical clinic and was found to have a temperature of 104.3. He was then transferred to the ___ ER. Patient denies recent hospital exposures, pre-school or daycare exposures, or travel outside the ___ area. His older sister was diagnosed with bronchitis over ___, but has recovered without complications. He does report heavy alcohol intake with loss of consiousness about three weeks prior to presentation, but no further episodes since that time. No history of incarceration or homelessness. No associated chest pain or hemoptysis. He does report a small amount of yellowish \"phlegm\" throughout his course. Patient has received the seasonal flu shot, H1N1 flu shot, and meningococcal vaccine. He has no pets at home.\n\nIn the emergency room the patient received one dose of Azithromycin and Ceftriaxone, 500cc of IVF, and a Cepacol lozenge. He was then transferred to the floor. \n\nROS: 10 point review of systems performed and negative except as noted above.\n", + "input3": "Appendectomy following a ruptured appendix\nHernia repair\nAlcohol poisoning\n", + "input4": "No family history of DM, CAD, or cancer.\n", + "input5": "VS: T=99.1 BP=101/61 HR=77 RR=18 O2 sat=93% on RA\nGen: awake, alert, no acute distress\nHEENT: NCAT, EOMI, anicteric\nCV: RR, no m/r/g\nPulm: CTA B\nAbd: Soft, NTND\nExt: WWP, no edema\n", + "input6": "___ WBC-7.3 RBC-4.55* Hgb-13.0* Hct-39.2* MCV-86 Plt ___. \n\nPatient was initially treated with Ceftriaxone/Azithromycin, which was transitioned to Levofloxacin at the time of discharge. He had an initial oxygen requirement of 2L nasal cannula to maintain an oxygen saturation of 94-96%, but had stable oxygen saturations of 96% on room air at the time of discharge. He also had a negative HIV test during this admission, and EBV and CMV antibody panels that are still pending at the time of discharge.\n\nCXR with small left lower lobe infiltrates and lateral parapneumonic effusion\n\nSputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).\n\n2. Binge drinking: Educated patient regarding the risks of binge drinking, especially in light of recent episode of loss of consciousness.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/13503429-DS-16.json b/Finished/Pneumonia/Bacterial Pneumonia/13503429-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..c3a6cac622c603be22aa766903133c150d9cfa1f --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/13503429-DS-16.json @@ -0,0 +1,71 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "This directly indicates an infection by the bacteria commonly responsible for pneumonia.$Cause_1": { + "Multiple organisms consistent with Streptococcus pneumoniae.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Elevated neutrophil counts typically indicate an acute bacterial infection, which is consistent with bacterial pneumonia$Cause_1": { + "WBC-8.4 (NEUTS-82.4* LYMPHS-10.6* MONOS-5.8 EOS-0.6 BASOS-0.6)$Input6": {} + }, + "High polymorphonuclear leukocytes (PMNs) and low epithelial cell numbers indicate an infectious process in the lungs$Cause_1": { + ">25 PMNs and <10 epithelial cells/100X field$Input6": {} + }, + "These findings suggest an abnormal collection of fluid or infection in the lung base, typical of pneumonia$Cause_1": { + "increased opacification involving the left base with obliteration of the hemidiaphragm and costophrenic angle.$Input6": {} + }, + "Consolidation refers to the filling of air spaces with fluid, which is a hallmark of pneumonia.$Cause_1": { + "large area of left lower lobe consolidation and a smaller region on the right have both improved minimally.$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Cough is one of the common symptoms of pneumonia$Cause_1": { + "cough$Input1": {} + }, + "Shortness of breath, which is difficulty breathing, is one of the key symptoms of pneumonia$Cause_1": { + "shortness of breath$Input1": {} + }, + "Worsening cough and shortness of breath are common in people with pneumonia$Cause_1": { + "worsening cough and shortness of breath over the past two weeks$Input2": {} + }, + "High fever is a common symptom of pneumonia$Cause_1": { + "fevers measured to be 103 degrees$Input2": {} + }, + "ongoing dyspnea is a common symptom of pneumonia$Cause_1": { + "ongoing dyspnea$Input2": {} + }, + "A cough with yellow phlegm is a classic sign of lung infection$Cause_1": { + "productive cough with large amounts of yellow sputum$Input2": {} + }, + "Bloody sputum may indicate a more serious respiratory problem, such as pneumonia$Cause_1": { + "one episode of blood-tinged sputum$Input2": {} + }, + "Diminished lung auscultation usually indicates that the affected area may have fluid accumulation or tissue infiltration, which are classic signs of pneumonia.$Cause_1": { + "diminished lung sounds at left base$Input2": {} + }, + "Children with asthma may be more susceptible to respiratory infections, including pneumonia.$Cause_1": { + "Childhood asthma$Input3": {} + }, + "Early experience with pneumonia may affect the health of your lungs and increase your risk of developing pneumonia again in the future$Cause_1": { + "episode of pneumonia as an infant$Input3": {} + }, + "The patient's oxygen saturation (O2sat) under high-flow oxygen therapy (80% oxygen) was only 91%, which shows that the patient may have significant respiratory problems and insufficient oxygenation, which is common in patients with pneumonia.$Cause_1": { + "RR:25 O2sat: 91% on 80% high flow oxygen$Input5": {} + }, + "These are signs the body is trying to limit lung pain or difficulty breathing, often seen in pneumonia$Cause_1": { + "taking shallow breaths, appears generally ill and pale$Input5": {} + }, + "Bronchial breath sounds heard basally on the left and diminished basally on the right may indicate lung infection or fluid accumulation on the left side and atelectasis or the same infectious problem on the right$Cause_1": { + "Bronchial breath sounds over left base. Decreased BS over right base$Input5": {} + }, + "Deep breathing interrupted by frequent coughing, a classic symptom of a lung infection$Cause_1": { + "Deep inspiration interrupted by frequent coughing.$Input5": {} + } + } + } + }, + "input1": "bilateral ear pain, cough, shortness of breath\n", + "input2": "He is a 19 y/o M with remote history of childhood asthma presenting with worsening cough and shortness of breath over the past two weeks. His illness began with bilateral ear aches 2 weeks ago. This was also accompanied by fevers measured to be 103 degrees. His ear pain resolved somewhat, but he has had ongoing dyspnea and productive cough with large amounts of yellow sputum since then. He had one episode of blood-tinged sputum, in the setting of blowing his nose and coughing frequently. He presented to an outpatient provider approximately two weeks prior to admission who prescribed him a six-day course of azithromycin. He had a mild improvement in his symptoms and also took amoxicillin.\n\nOne day prior to admission, his symptoms progressed. He presented to the Emergency Dept with worsening dyspnea. In the ED, his initial vital signs were 98.0, 96, 111/72, 88% RA. Exam was notable for pale skin, diminished lung sounds at left base, no wheezes or rhonchi. He was transiently placed on TB precautions, which were discontinued after his CXR came back. He was given doxycycline 100 mg IV ceftriaxone 1g IV, vancomycin 1g, and levofloxacin 500 mg PO, as well as multiple doses of duonebs and 2 liters of IV fluids. \n\nUpon arrival to the ICU, he felt his breathing was improved and he was not feeling dyspneic as long as his oxygen mask is on. He endorsed a poor appetite, a 20 lb weight loss, and drenching sweats over the past two weeks. He reported no nausea, vomiting, or abdominal pain.\n", + "input3": "+Childhood asthma\n+episode of pneumonia as an infant\n", + "input4": "No known lung disease. Grandmother with CHF and adult-onset \ndiabetes.\n", + "input5": "Vitals: Temp: 98.5 BP: 129/73 HR:89 RR:25 O2sat: 91% on 80% high flow oxygen\nGEN: pleasant, speaking in full sentences, taking shallow breaths, appears generally ill and pale, but in NAD \nHEENT: PERRL, EOMI, anicteric, MMM, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd \nRESP: +Bronchial breath sounds over left base. Decreased BS over right base. No wheezes or rhonchi. No crackles. Deep inspiration interrupted by frequent coughing. \nCV: RRR, S1 and S2 wnl, no m/r/g \nABD: NABS, soft, nt, no masses or hepatosplenomegaly, no rebound tenderness or guarding.\nEXT: no c/c/e \nSKIN: mild erythematous patches at site of prior telemetry leads. No other rashes/jaundice/no splinters \nNEURO: AAOx3. Cn II-XII intact. strength throughout. No sensory deficits to light touch.\n", + "input6": "- WBC-8.4 (NEUTS-82.4* LYMPHS-10.6* MONOS-5.8 EOS-0.6 BASOS-0.6) RBC-3.46* HGB-10.7* HCT-30.8* MCV-89 MCH-30.8 MCHC-34.6 RDW-12.0 PLT COUNT-418\n - ___ 05:55AM GLUCOSE-102* UREA N-6 CREAT-0.8 SODIUM-140 POTASSIUM-3.4 CHLORIDE-107 TOTAL CO2-26 ANION GAP-10 ALBUMIN-3.0* CALCIUM-7.9* PHOSPHATE-3.1 MAGNESIUM-2.0ALT(SGPT)-33 AST(SGOT)-21 LD(LDH)-200 ALK PHOS-74 TOT BILI-0.4 DIR BILI-0.2 INDIR BIL-0.2\n - ___ 05:55AM ___ PTT-30.1 ___\n - ___ 03:54PM FIBRINOGEN-696* HAPTOGLOB-464*\n - ___ 03:54PM HIV Ab-NEGATIVE\n - ___ 03:54PM LDH negative\n\nMICROBIOLOGY:\n1. Sputum Culture from ___ (per report)\n - >25 PMNs and <10 epithelial cells/100X field. \n - Multiple organisms consistent with Streptococcus pneumoniae. \n\n2. Respiratory Viral Culture (Final ___: \n - No respiratory viruses isolated. Culture screened for Adenovirus, Influenza A & B, Parainfluenza type 1,2 & 3, and Respiratory Syncytial Virus. Detection of viruses other than those listed above will only be performed on specific request.\n\nRADIOLOGY:\n1. initial CXR and CT performed at ___\n\n2. ___ portable CXR: No previous images. The heart is normal in size and there is no vascular congestion. There is increased opacification involving the left base with obliteration of the hemidiaphragm and costophrenic angle. \n\n3. ___ portable CXR: AP chest compared to large area of left lower lobe consolidation and a smaller region on the right have both improved minimally. Small bilateral pleural effusions persist. Upper lungs are clear. Heart size is normal.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/13504185-DS-20.json b/Finished/Pneumonia/Bacterial Pneumonia/13504185-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..a792f1a632f6bcb3c7e23e4ab56f656c62bd634a --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/13504185-DS-20.json @@ -0,0 +1,47 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "aemophilus influenzae is a common cause of bacterial pneumonia, particularly in patients with chronic lung disease or previous respiratory infections.$Cause_1": { + "Multiple organisms consistent with Haemophilus influenzae$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "There is an infiltration shadow in the right lower lobe of the lung, which is direct evidence of pneumonia.$Cause_1": { + "A repeat CXR showed a RLL infiltrate$Input2": {} + }, + "An elevated WBC count, particularly neutrophils, is indicative of an infection or inflammation.$Cause_1": { + "BC-12.0*# (Neuts-80.2* Bands-0 Lymphs-14.5* Monos-3.8 Eos-1.3 Baso-0.3)$Input6": {} + }, + "CT scan result explicitly mentions the presence of pneumonia$Cause_1": { + "There is a persistent right lower lobe pneumonia involving the entirety of the basal segments.$Input6": {} + }, + "Pleural effusion, which is the presence of excess fluid between the layers of the pleura outside the lungs, often occurs as a complication of pneumonia.$Cause_1": { + "There is a moderate associated right pleural effusion$Input6": {} + }, + "Mediastinal lymphadenopathy can occur in infectious conditions, including pneumonia.$Cause_1": { + "Additionally right mediastinal lymphadenopathy is present.$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Productive coughing and shortness of breath are common symptoms of pneumonia$Cause_1": { + "productive cough and shortness of breath x 1 week$Input2": {} + }, + "A drop in blood oxygen saturation to 93% and rales (abnormal sounds in the lungs) heard during a physical examination are both indicators of pneumonia.$Cause_1": { + "He was noted to be satting 93% on room air, with crackles on exam$Input2": {} + }, + "Symptoms that temporarily improve after antibiotic treatment but then relapse may indicate an ongoing bacterial infection, often seen in pneumonia$Cause_1": { + "He had additional Azithromycin at home$Input2": {} + }, + "Long-term smoking damages the lungs' defense mechanisms, making the lungs more susceptible to infection and increasing the risk of pneumonia.$Cause_1": { + "Tobacco abuse$Input3": {} + }, + "Fluid or other non-air material in the chest, which are common signs of pneumonia$Cause_1": { + "Decreased breath sounds in right base, with rhonchi way up, +dullness to percussion$Input5": {} + } + } + } + }, + "input1": "Fever and cough\n", + "input2": "He is with a history of HCV and 20 pack-year smoking history. He presented to his PCP with complaints of productive cough and shortness of breath x 1 week. He was noted to be satting 93% on room air, with crackles on exam. A chest X-ray showed no infiltrate. He was given a 5-day course of Azithromycin. His cough improved, but within a few days of completing his course of Azithromycin, his symptoms returned. He had additional Azithromycin at home, and took an additional 5 days. \n\nHis cough again improved while taking antibiotics, then worsened again after his second course. He saw his PCP back in clinic, who elicited a history of intermittent fevers to 102.5F with chills, and cough productive of green sputum. He had diffuse lower lung field wheezing and rhonchi at the left base. A repeat CXR showed a RLL infiltrate, with inability to compare to prior CXR. Levaquin was not covered by his insurance, and he was prescribed cefpodoxime and azithromycin. His symptoms continued despite antibiotics, with daily fevers and productive cough.\n\nHe was febrile to 102.5F with BP 143/69, HR: 102, RR: 20, SaO2: 95% RA. Blood cultures were drawn, and he was administered Levofloxacin 750mg IV. Shortly afterwards, he experienced mild itchiness at the infusion site. The infusion was stopped, and he was given IV Ceftriaxone and Azithromycin. A contrast chest CT was done, which demonstrated a mass-like obstruction of the RLL bronchus and pinching of the right lower lobe pulmonary artery after the origin of the superior segmental bronchus. There was right hilar and mediastinal lymphadenopathy. Right pleural effusion. He was admitted for further evaluation.\n", + "input3": "+Hepatitis C - genotype 1a\n+h/o IVDU on Suboxone\n+Tobacco abuse\n+Obesity\n+Recurrent strep tonsillitis\n+Cleared HBV (positive HBsAb, HBcAb)\n", + "input4": "Father with diabetes, HTN, deceased. \nBrother with diabetes.\n", + "input5": "Temp: 96.3F, BP: 134/80, HR: 69, HR: 20, SaO2: 96% RA\nGen: Lying comfortably in bed, NAD\nHEENT: Strabismus, PERRL, oropharynx clear with no lesions\nNeck: Supple, no LAD\nCV: RRR, no m/r/g\nChest: Decreased breath sounds in right base, with rhonchi way up, +dullness to percussion\nAbd: Soft, NT/ND, +BS\nExtr: No ___ edema. PIV site without erythema\nSkin: No rash\n", + "input6": "- ___ 07:53PM BLOOD WBC-12.0*# (Neuts-80.2* Bands-0 Lymphs-14.5* Monos-3.8 Eos-1.3 Baso-0.3) RBC-4.39*# Hgb-12.5*# Hct-36.6*# MCV-83 MCH-28.5 MCHC-34.2 RDW-12.8 Plt ___\n - ___ 07:53PM BLOOD ___ 07:53PM BLOOD Glucose-136* UreaN-10 Creat-0.9 Na-134 K-4.2 Cl-99 HCO3-24 AnGap-15 Lactate-1.6\n - ___ 09:18PM URINE Color-Yellow Appear-Clear Sp Blood-NEG Nitrite-NEG Protein-25 Glucose-NEG \nKetone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG Bacteri-NONE Yeast-NONE Epi-0\n\nDISCHARGE LABORATORY STUDIES:\n - ___ 06:17AM BLOOD WBC-6.4 RBC-4.10* Hgb-11.8* Hct-35.7* MCV-87 MCH-28.7 MCHC-33.0 RDW-12.7 Plt ___\n - ___ 01:39PM BLOOD HIV Ab-PND\n\n___ CT CHEST:\n - FINDINGS: There is a persistent right lower lobe pneumonia involving the entirety of the basal segments. No air bronchograms are seen within this and the brochus to the lateral segment of the right lower lobe is narrowed and then obliterated beyond the origin of the superior segmental bronchus. There is a moderate associated right pleural effusion. Additionally right mediastinal lymphadenopathy is present. A right hilar node measures 1.4 x 2.1 cm (4; 126). A precarinal node measures 1.8 x 1.4 cm. No other nodules are seen within the lungs. There is no left pleural effusion. There is no pericardial effusion. Numerous non- enlarged prevascular nodes are present (4;52). The visualized osseous structures are unremarkable. The visualized portions of the upper abdomen demonstrate an exophytic cyst from the left upper renal pole and are otherwise unremarkable. \n\nMICROBIOLOGY:\n - ___ BLOOD CULTURE: NO GROWTH\n - Multiple organisms consistent with Haemophilus influenzae.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/14110132-DS-24.json b/Finished/Pneumonia/Bacterial Pneumonia/14110132-DS-24.json new file mode 100644 index 0000000000000000000000000000000000000000..654a5dbb8b63131b275b1ea2c36b1d9f513293e3 --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/14110132-DS-24.json @@ -0,0 +1,35 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "Typical signs of bacterial infection in sputum samples$Cause_1": { + "<10 PMNs and >10 epithelial cells/100X field.$Input6": {} + }, + "Indicates possible infectious lesions, especially microbial infections.$Cause_1": { + "Multifocal ground-glass opacities, concerning for infection$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Direct diagnosis of pneumonia by chest X-ray$Cause_1": { + "CXR showed a RLL pneumonia$Input2": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "These are common symptoms of pneumonia, especially with fever and general malaise during infection.$Cause_1": { + "malaise and fever.$Input2": {} + }, + "Fatigue and difficulty breathing may indicate a lung infection, especially if associated with pneumonia.$Cause_1": { + "feeling very tired, with some minimal cough and mild dyspnea$Input2": {} + }, + "A persistent high fever is a sign of worsening pneumonia$Cause_1": { + "new fever up to 101.4$Input2": {} + }, + "A mild cough may be a sign of ongoing lung inflammation$Cause_1": { + "minimal cough$Input2": {} + } + } + } + }, + "input1": "None\n", + "input2": "___ woman with AML, s/p SCT ___ years ago, presents with \nmalaise and fever. About 5 days ago, patient started feeling very tired, with some minimal cough and mild dyspnea, but no fever. On ___ she was seen ___ clinic by Dr. ___ CXR showed a RLL pneumonia. She received 1 dose of ceftriaxone ___ clinic and was sent home with azithromycin. On ___ she reported feeling more tired and developed new fever up to 101.4 at home. Again with minimal cough, no chest pain, no diarrhea or dysuria. No sick contact. No recent travel. She was advised to come to the ED.\n.\n___ the ED, T 99.6 then 101.4, HR 110, BP 146/66, RR 17, 99%RA. \n.\nReview of Systems: \n(+) Per HPI \n(-) Denies night sweats, recent weight loss or gain. Denies \nblurry vision, diplopia, loss of vision, photophobia. Denies headache, sinus tenderness, rhinorrhea or congestion. Denies chest pain or tightness, palpitations, lower extremity edema. Denies nausea, vomiting, diarrhea, constipation, abdominal pain, melena, hematemesis, hematochezia. Denies dysuria, stool or urine incontinence. Denies arthralgias or myalgias. Denies rashes or skin breakdown. No numbness/tingling ___ extremities. All other systems negative.\n", + "input3": "Breast cancer\nHand warts: Status post cryosurgery \n- Diabetes mellitus: on glyburide, followed by ___ \n- Herpes zoster of the left neck ___ ___. \n- Postmenopausal bleeding: Evaluated Dr. ___ with negative \nworkup ___ ___. \n- Gastritis with H. pylori positive: Treated with antibiotics ___ \n- E. coli bacteremia ___ \n- Hx BK viremia, and BK virus ___ urine (___) \n- Posterior Vitreous Detachment\n", + "input4": "(from ___) Father died at age ___ from stomach or intestinal cancer. Mother died at age ___ of stomach cancer.\n", + "input5": "GEN: Elderly woman ___ NAD, awake, alert \nHEENT: EOMI, sclera anicteric, conjunctivae clear, OP moist and without lesion\nNECK: Supple, no JVD \nCV: Reg rate, normal S1, S2. No m/r/g. \nCHEST: Resp unlabored, no accessory muscle use. CTAB, no \ncrackles, wheezes or rhonchi. \nABD: Soft, NT, ND, no HSM, bowel sounds present\nMSK: normal muscle tone and bulk\nEXT: No c/c/e, 2+ ___ bilaterally\nSKIN: No rash, warm skin\nNEURO: oriented x 3, normal attention, CN II-XII intact, ___ strength throughout, intact s\n", + "input6": "___ 11:59AM BLOOD WBC-8.6 RBC-3.73* Hgb-12.0 Hct-33.8* \nMCV-91 MCH-32.1* MCHC-35.4* RDW-12.9 Plt ___\n___ 05:52AM BLOOD WBC-7.5 RBC-3.78* Hgb-11.9* Hct-34.3* \nMCV-91 MCH-31.4 MCHC-34.6 RDW-12.6 Plt ___\n___ 12:45AM BLOOD WBC-7.7 RBC-3.59* Hgb-11.6* Hct-32.4* \nMCV-90 MCH-32.3* MCHC-35.8* RDW-12.5 Plt ___\n___ 06:00AM BLOOD WBC-5.7 RBC-3.67* Hgb-11.5* Hct-33.1* \nMCV-90 MCH-31.3 MCHC-34.7 RDW-12.7 Plt ___\n___ 11:59AM BLOOD Neuts-63.2 ___ Monos-6.1 Eos-3.0 \nBaso-0.6\n___ 12:45AM BLOOD Neuts-65.7 ___ Monos-7.6 Eos-2.7 \nBaso-0.5\n.\n___ 11:59AM BLOOD Glucose-132* UreaN-17 Creat-0.7 Na-136 \nK-3.9 Cl-98 HCO3-27 AnGap-15\n___ 05:52AM BLOOD Glucose-126* UreaN-14 Creat-0.6 Na-136 \nK-3.6 Cl-99 HCO3-26 AnGap-15\n___ 12:45AM BLOOD Glucose-170* UreaN-9 Creat-0.6 Na-135 \nK-3.4 Cl-98 HCO3-27 AnGap-13\n___ 06:00AM BLOOD Glucose-150* UreaN-12 Creat-0.6 Na-134 \nK-3.7 Cl-97 HCO3-27 AnGap-14\n.\n___ 05:52AM BLOOD LD(LDH)-202\n___ 05:52AM BLOOD Calcium-8.6 Phos-3.3 Mg-2.0\n___ 12:45AM BLOOD Calcium-8.7 Phos-2.9 Mg-2.0\n___ 06:00AM BLOOD Calcium-8.7 Phos-3.6 Mg-2.1\n___ 05:52AM BLOOD Vanco-9.6*\n.\n___ 02:59PM URINE Color-Yellow Appear-Clear Sp ___\n___ 02:59PM URINE Blood-SM Nitrite-NEG Protein-NEG \nGlucose->1000 Ketone-NEG Bilirub-NEG Urobiln-0.2 pH-8.5* \nLeuks-NEG\n___ 02:59PM URINE RBC-2 WBC-<1 Bacteri-FEW Yeast-NONE \nEpi-<1\n\nMICRO\n___ 2:59 pm URINE Source: ___. \n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n\n___ 5:09 pm SPUTUM Source: Induced. \n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n <10 PMNs and >10 epithelial cells/100X field. \n Gram stain indicates extensive contamination with upper respiratory secretions. Bacterial culture results are invalid. \n PLEASE SUBMIT ANOTHER SPECIMEN. \n\n RESPIRATORY CULTURE (Final ___: \n TEST CANCELLED, PATIENT CREDITED. \n\n Immunoflourescent test for Pneumocystis jirovecii (carinii) \n(Final\n ___: NEGATIVE for Pneumocystis jirovecii \n(carinii).. \n\n___ 10:58 am URINE Source: ___. \n\n **FINAL REPORT ___\n\n Legionella Urinary Antigen (Final ___: \n NEGATIVE FOR LEGIONELLA SEROGROUP 1 ANTIGEN. \n (Reference Range-Negative). \n Performed by Immunochromogenic assay. \n A negative result does not rule out infection due to other \nL.\n pneumophila serogroups or other Legionella species. \nFurthermore, ___\n infected patients the excretion of antigen ___ urine may \nvary. \n\n___ 6:31 pm SPUTUM Source: Induced. \n\n GRAM STAIN (Final ___: \n <10 PMNs and <10 epithelial cells/100X field. \n 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI. \n ___ PAIRS AND CLUSTERS. \n QUALITY OF SPECIMEN CANNOT BE ASSESSED. \n\n RESPIRATORY CULTURE (Preliminary): RESULTS PENDING. \n\n Immunoflourescent test for Pneumocystis jirovecii (carinii) \n(Final\n ___: NEGATIVE for Pneumocystis jirovecii \n(carinii).. \n\nChest Xray\nFrontal and lateral views of the chest demonstrate a stable \nright apical opacity consistent with post-radiation therapy change. Streaky bibasilar opacities ___ perivascular distribution appear stable as compared to ___. No pneumothorax or vascular congestion. Stable cardiomediastinal silhouette. \nIMPRESSION: No significant interval change since ___. \n\nCT chest\nIMPRESSION: \n1. Multifocal ground-glass opacities, concerning for infection, which may be an atypical microorganism. No pleural effusions. \n2. Stable calcified mediastinal and hilar lymph nodes with new 8-mm prevascular lymph node, which may be reactive. \n3. Stable bronchiectasis and post-radiation changes ___ the right upper lobe. \n4. Stable post-surgical changes ___ both breasts.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/15824797-DS-15.json b/Finished/Pneumonia/Bacterial Pneumonia/15824797-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..f3e233f00865d4e232092089eb30f35f0008ce04 --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/15824797-DS-15.json @@ -0,0 +1,47 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "The presence of MRSA and Klebsiella, both of which are known causative agents of pneumonia, suggests a possible bacterial infection.$Cause_1": { + "Sputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).$Input6": {} + }, + "Abscess formation is a serious consequence of a bacterial infection and indicates that the infection has locally collected and formed pus$Cause_1": { + "Peripheral air and fluid collection adjacent to right middle lobe could potentially reflect a pleural versus lung abscess.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Infiltrate and pleural effusion on chest radiograph may indicate pulmonary infection or inflammation and are direct signs of pneumonia.$Cause_1": { + "CXR with small left lower lobe infiltrates and lateral parapneumonic effusion$Input2": {} + }, + "The increased density of lung parenchyma, pleural effusion and hilar lymphadenopathy on chest CT further support the diagnosis of pneumonia.$Cause_1": { + "CT chest with contrast obtained revealed right middle/lower lobe consolidations, small right pleural effusion, and hilar lymphadenopathy$Input2": {} + }, + "Difficulty breathing or insufficient oxygenation, which is common in people with pneumonia$Cause_1": { + "93% on 3L NC$Input5": {} + }, + "Elevated lactate may be a sign of tissue hypoxia, is common in severe infections, and may indicate pneumonia.$Cause_1": { + "lactate of 2.1$Input5": {} + }, + "Leukocytosis is common in infections, especially bacterial infections, and a high proportion of neutrophils indicates an acute bacterial infection, of which pneumonia is one of the common causes.$Cause_1": { + "Wbc of 38.6 (85% PMNs)$Input5": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Fever and cough are symptoms of pneumonia$Cause_1": { + "Fever, cough$Input1": {} + }, + "COPD as a potential risk factor for pneumonia$Cause_1": { + "history of COPD$Input2": {} + }, + "Persistent high fever, chills, and productive cough are classic symptoms of pneumonia$Cause_1": { + "fever to 102.5 and chills with productive cough$Input2": {} + }, + "Consideration of ARDS and cardiogenic pulmonary edema indicates a serious pulmonary condition in the patient and possible complications from pneumonia.$Cause_1": { + "concern for evolving ARDS versus cardiogenic pulmonary edema$Input2": {} + } + } + } + }, + "input1": "Fever, cough\n", + "input2": "She is with history of COPD (uncertain severity) and breast cancer status post chemoradiation therapy and left mastectomy in who initially presented to an outside hospital with fever and cough. As patient is intubated and sedated, history is obtained from review of outside hospital documentation. She was reportedly in her usual state of health until approximately, when she developed fever to 102.5 and chills with productive cough, initially partially responsive to rest and supportive treatment. When low-grade fevers, productive cough, posttussive chest pain, and exertional dyspnea persisted, she presented for evaluation at her daughter's insistence.\n\nShe received 3L IV normal saline, as well as levofloxacin 750mg IV and ceftriaxone 1g IV for presumed community-acquired pneumonia in the setting of CXR with small left lower lobe infiltrates and lateral parapneumonic effusion. She was admitted to the MICU for close monitoring due to severe sepsis with \"brief period of hypotension\" to an uncertain degree. \n\nCT chest with contrast obtained revealed right middle/lower lobe consolidations, small right pleural effusion, and hilar lymphadenopathy. Vancomycin was discontinued in favor of linezolid due to perceived improved efficacy in the context of MRSA pneumonia. Following trial of noninvasive ventilation, she was intubated, given hypoxemic respiratory failure and concern for evolving ARDS versus cardiogenic pulmonary edema incompletely responsive to diuresis. She also received a methylprednisolone burst for possible COPD exacerbation. Although thoracentesis was not attempted due to an inadequate pocket, bronchoscopy with BAL was performed, with cytology negative for malignant cells and unclear culture data results. CT chest with contrast obtained that day demonstrated seemingly interval development of right lower lobe cavitation versus necrosis and worsening bilateral airspace opacities.\n", + "input3": "+Breast cancer status post chemoradiation therapy and left \n+mastectomy no recurrences\n+COPD (uncertain severity)\n+Acute HBV status post spontaneous clearance\n+Dental surgery in ___\n+Chronic back pain status post multiple operative interventions\n+Cold-induced urticaria\n+Status post removal of all teeth\n+Depression/anxiety\n+Schizophrenia\n", + "input4": "Mother with history of lung cancer. Father died in a motor \nvehicle collision.\n", + "input5": "The vital signs were as follows: 100.8, 126, 120/58, 24, 93% on 3L NC. Initial labs were notable for Wbc of 38.6 (85% PMNs), Hgb/Hct of 9.7/28.6, platelets of 412, Na of 130, and lactate of 2.1.\n", + "input6": "OSH MICRO:\nSputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin). \n\nSputum also grew Klebsiella from ___: Pan-susceptible except for Ampicillin (Suscept to Ceftazidime, Ceftriaxone, Gentamicin, Levo, Zosyn, Tobra, Bactrim, Tetracycline, Cefoxitin, Cefuroxime, Meropenem, Cipro, Cefazolin). \n\nOSH Images: \nTTE (___):\nPosterior mitral valve leaflet calcified with limited mobility. \nTrace MR. ___ to moderate TR with elevated PA systolic pressure. Normal LV systolic/diastolic function; LVEF of 55-60%. Moderately enlarged RA. Moderately enlarged RV with mild global hypokinesis.\n\nCT chest :\nPeripheral air and fluid collection adjacent to right middle lobe could potentially reflect a pleural versus lung abscess.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/15824797-DS-151.json b/Finished/Pneumonia/Bacterial Pneumonia/15824797-DS-151.json new file mode 100644 index 0000000000000000000000000000000000000000..9b27f8e4cfeb962125d9c992345ba1f16845b41c --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/15824797-DS-151.json @@ -0,0 +1,50 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "Identify the pathogens of pneumonia. MRSA and Klebsiella are common bacteria that cause community-acquired pneumonia.$Cause_1": { + "MRSA/Klebsiella community-acquired pneumonia$Input2": {} + }, + "Sputum cultures show a large number of gram-positive cocci and a large number of gram-negative rods. The presence of these bacteria may cause or exacerbate lung infection.$Cause_1": { + "Sputum Cx with 3+ GPC (MRSA), 3+ GNR$Input6": {} + }, + "Klebsiella, a common pneumonia pathogen, was also found in the sputum and was sensitive to all antibiotics except ampicillin.$Cause_1": { + "Sputum also grew Klebsiella$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Persistent bilateral pulmonary infiltrates with increased right lung base severity. This X-ray appearance is usually consistent with pneumonia.$Cause_1": { + "Persistent bilateral infiltrates, worsening in the right lung base.$Input6": {} + }, + "Consolidation of the right lower lobe with development of multiple air cells may represent cavitation or necrosis, which is typical of severe lung infection or pneumonia.$Cause_1": { + "Right lower lobe consolidation has developed multiple air pockets which could indicate cavitation or necrosis.$Input6": {} + }, + "Progression of cavitary disease in the left lung and right upper lobe. This describes a regional spread of lung disease and may be related to worsening infection.$Cause_1": { + "Progression of airspace disease in the left lung and right upper lobe$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Fever is a common symptom of pneumonia$Cause_1": { + "Fever$Input1": {} + }, + "COPD is a long-term disease that affects breathing and can increase the risk of lung infections, particularly developing pneumonia.$Cause_1": { + "history of COPD$Input2": {} + }, + "Fever and cough are common symptoms of pneumonia$Cause_1": { + "fever and cough$Input2": {} + }, + "Hypoxemic respiratory failure indicates a possible serious complication of pneumonia$Cause_1": { + "ongoing management of hypoxemic respiratory failure$Input2": {} + }, + "The persistence of these symptoms indicates that pneumonia symptoms are getting worse or are not under control.$Cause_1": { + "low-grade fevers, productive cough, posttussive chest pain, and exertional dyspnea persisted$Input2": {} + }, + "Severe sepsis and transient hypotension indicate that the patient is seriously ill$Cause_1": { + "severe sepsis with \"brief period of hypotension\"$Input2": {} + } + } + } + }, + "input1": "Fever\n", + "input2": "Ms. ___ is a ___ with history of COPD (uncertain severity) \nand breast cancer status post chemoradiation therapy and left mastectomy in ___ who initially presented to an outside hospital with fever and cough, now transferred for ongoing management of hypoxemic respiratory failure in the setting of MRSA/Klebsiella community-acquired pneumonia. As patient is intubated and sedated, history is obtained from review of outside hospital documentation. She was reportedly in her usual state of health until approximately ___, when she developed fever to 102.5 and chills with productive cough, initially partially responsive to rest and supportive treatment. When low-grade fevers, productive cough, posttussive chest pain, and exertional dyspnea persisted, she presented to ___ \n___ for evaluation at her daughter's insistence.\n\nIn the ___ ED, initial vital signs were as follows: 100.8, 126, 120/58, 24, 93% on 3L NC. Initial labs were notable for Wbc of 38.6 (85% PMNs), Hgb/Hct of 9.7/28.6, platelets of 412, Na of 130, and lactate of 2.1. She received 3L IV normal saline, as well as levofloxacin 750mg IV and ceftriaxone 1g IV for presumed community-acquired pneumonia in the setting of CXR with small left lower lobe infiltrates and lateral parapneumonic effusion. She was admitted to the MICU for close monitoring due to severe sepsis with \"brief period of hypotension\" to an uncertain degree.\n", + "input3": "\nmastectomy in ___ no recurrences\nAcute HBV status post spontaneous clearance\nDental surgery in ___\nChronic back pain status post multiple operative interventions\nCold-induced urticaria\nStatus post removal of all teeth\nDepression/anxiety\nSchizophrenia\n", + "input4": "Mother with history of lung cancer. Father died in a motor \nvehicle collision.\n", + "input5": "___: Intubated, sedated \nHEENT: Sclerae anicteric, MMM, oropharynx clear \nNECK: Supple, JVP difficult to assess \nLUNGS: Clear to auscultation anteriorly, no wheeze \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, gallops \nABD: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no edema \nSKIN: No visible lesions \nNEURO: Sedated, opens eyes partially to vigorous sternal rub, does not follow commands\n", + "input6": "___:\nFerritin 519, TIBC 105, Transferrin sat 75, B12 5521 Sputum Cx with 3+ GPC (MRSA), 3+ GNR \n___:\nCytology negative for malignancy.\n___:\nWbc of 15, Hct of 28.7, platelets of 369\n___:\nK of 2.8, BUN/Cr of ___, AST/ALT of ___, TBili 0.1, AlkP \nof 212\n\nOSH MICRO:\nSputum with MRSA ___ ___s bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin). \n\nSputum also grew Klebsiella from ___: Pan-susceptible except for Ampicillin (Suscept to Ceftazidime, Ceftriaxone, Gentamicin, Levo, Zosyn, Tobra, Bactrim, Tetracycline, Cefoxitin, \nCefuroxime, Meropenem, Cipro, Cefazolin). \n\nOSH Images: \nTTE (___):\nPosterior mitral valve leaflet calcified with limited mobility. Trace MR. ___ to moderate TR with elevated PA systolic \npressure. Normal LV systolic/diastolic function; LVEF of 55-60%. Moderately enlarged RA. Moderately enlarged RV with mild global hypokinesis.\n\nBilateral lower extremity venous ultrasound (___):\nNegative for DVT. Right ___ cyst.\n\nCT abdomen/pelvis (unclear if with contrast) (Outside hospital, \n___:\nMild intra- and extrahepatic biliary dilation. CBD at 9mm. No lesions otherwise.\n\nPortable CXR (Outside hospital, ___:\nPersistent bilateral infiltrates, worsening in the right lung base.\n\nCT chest with contrast (Outside hospital, ___:\n1. Right lower lobe consolidation has developed multiple air pockets which could indicate cavitation or necrosis.\n2. Progression of airspace disease in the left lung and right upper lobe.\n\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/16147199-DS-4.json b/Finished/Pneumonia/Bacterial Pneumonia/16147199-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..e88b78f30ce86507e56ab9e21d7f23c5e3d11a73 --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/16147199-DS-4.json @@ -0,0 +1,56 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "Sputum culture results showed multiple microorganisms consistent with Streptococcus pneumoniae, directly indicating Streptococcus pneumoniae infection.$Cause_1": { + "Multiple organisms consistent with Streptococcus pneumoniae.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "An elevated white blood cell count usually indicates the presence of infection or inflammation, which is a common clinical manifestation of pneumonia.$Cause_1": { + "WBC-11.8$Input6": {} + }, + "This is a typical radiological finding of pneumonia$Cause_1": { + "Right lower lobe showing infiltrates.$Input6": {} + }, + "An increased proportion of neutrophils usually indicates an acute infection, especially a bacterial infection, which is consistent with the characteristics of pneumonia.$Cause_1": { + "Neuts-85.3$Input6": {} + }, + "Decreased lymphocyte percentage may be due to neutrophilia suppression, which is common in bacterial infections$Cause_1": { + "Lymphs-9.3$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Chills are often the body's response to an infection, especially a respiratory infection like pneumonia$Cause_1": { + "Chills$Input1": {} + }, + "Fatigue is a common symptom among pneumonia patients$Cause_1": { + "fatigue$Input1": {} + }, + "Cough is a direct manifestation of lung disease, especially in pneumonia$Cause_1": { + "cough$Input1": {} + }, + "Deep fatigue, myalgia, anorexia, and unproductive cough are common symptoms of pneumonia$Cause_1": { + "profound fatigue, myalgias, anorexia, and non-productive cough$Input2": {} + }, + "Chills and occasional high fever and shaking indicate possible infection, and very poor appetite is also a common sign of infectious disease.$Cause_1": { + "had chiils, occasional rigors, and very poor apetite$Input2": {} + }, + "A past history of pneumonia may increase the risk of developing it again$Cause_1": { + "Had PNA once$Input2": {} + }, + "High fever is important indicators of pneumonia$Cause_1": { + "febrile to 102.9$Input2": {} + }, + "Increased heart rate is important indicators of pneumonia$Cause_1": { + "HR=107$Input2": {} + }, + "Chills, a common symptom of infection, especially pneumonia$Cause_1": { + "Having rigors$Input5": {} + } + } + } + }, + "input1": "Chills, fatigue, cough\n", + "input2": "He is 61 yo retired colonel developed profound fatigue, myalgias, anorexia, and non-productive cough three days ago. Since then has had chiils, occasional rigors, and very poor apetite. Has not been eating or drinking well for the past 3 days. Denies shortness of breath or pain. No GI symptoms. No HA, visual changes, neurologic symptoms. Has chronic post-nasal drip and sinus drainage. Had PNA once. ROS: all other systems negative x \"feeling very cold\", with chills during my examination.\n\nNo sick contacts at home. Did receive influenza vaccination this season.\n\nIn ED, he was febrile to 102.9, HR=107, BP=135/78 RR=18 SaO2=96% RA\n", + "input3": "+CAD- S/P MI with stent (type of stent not known)\n+Hyperlipidemia\n+PUD - bleeding ulcer\n+Gastric hamartoma\n", + "input4": "+Family History:\n+Mother deceased in heart failure\n+One brother - schizophrenia\n+One sister-epilepsy\n+Two biological sons - both healthy\n", + "input5": "Very pleasant gentleman. Having rigors. No respiratory distress.\nT=99.9 BP=121/79 HR=96 RR=18 SaO2=99%RA\nHEENT - dry mucous membranes, otherwise negative\nNeck-no JVD, no adenopathy, no carotid bruits, 2+ carotids\nLungs-CTAB\nCV-RR, no m/r/g\nAbd-soft, NT, ND, NABS\nExtr-no edema, well-perfused.\nSkin-good turgor, no rashes.\nNeuro - negative screening examination. A&O xe. Speech normal.\n", + "input6": "___ 12:35PM BLOOD WBC-11.8* RBC-4.67 Hgb-16.0 Hct-43.2 MCV-93 MCH-34.3* MCHC-37.1* RDW-14.4 Plt ___\n___ 12:35PM BLOOD Neuts-85.3* Lymphs-9.3* Monos-4.6 Eos-0.1Baso-0.6\n___ 12:35PM BLOOD ___ PTT-27.3 ___\n___ 12:35PM BLOOD Glucose-151* UreaN-24* Creat-1.5* Na-131* K-4.1 Cl-96 HCO3-23 AnGap-16\n___ 12:35PM BLOOD cTropnT-<0.01\n___ 12:42PM BLOOD Lactate-1.8\n___ 07:45AM BLOOD WBC-6.8 RBC-4.37* Hgb-14.6 Hct-40.3 MCV-92 MCH-33.5* MCHC-36.3* RDW-13.5 Plt ___\n___ 07:45AM BLOOD ___ PTT-28.8 ___\n___ 07:45AM BLOOD Glucose-164* UreaN-16 Creat-1.2 Na-133 K-3.8 Cl-100 HCO3-29 AnGap-8\n___ 07:45AM BLOOD ALT-31 AST-47* LD(LDH)-343* AlkPhos-55 TotBili-1.1\n___ 07:45AM BLOOD Albumin-3.7 Calcium-8.2* Phos-1.9* Mg-2.1 Iron-21*\n\nCHEST X RAY ___:\nRight lower lobe showing infiltrates.\n\nMICROBIOLOGY:\n1. Sputum Culture from ___ (per report)\nMultiple organisms consistent with Streptococcus pneumoniae.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/16752897-DS-11.json b/Finished/Pneumonia/Bacterial Pneumonia/16752897-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..e0fa051ce36b9dd5813fe604b82f68bf7aa88e72 --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/16752897-DS-11.json @@ -0,0 +1,47 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "The presence of MRSA and Klebsiella, both of which are known causative agents of pneumonia, suggests a possible bacterial infection.$Cause_1": { + "Sputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "There may be ongoing inflammation or infection in the left lower lobe.$Cause_1": { + "CXR showed stable LLL opacities.$Input2": {} + }, + "Tubular opacities in the left lower lobe suggest bronchial tamponade, possibly related to infection$Cause_1": { + "Left lower lobe tubular opacities, suggestive of bronchial impaction.$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "SoB is the symptom of Pneumonia$Cause_1": { + "Shortness of breath$Input1": {} + }, + "Coughing without sputum production is one of the common symptoms of pneumonia$Cause_1": { + "nonproductive cough$Input2": {} + }, + "Systemic infection caused by pneumonia may cause patients to feel weak$Cause_1": { + "felt very weak$Input2": {} + }, + "Pleuritic pain is pain caused by inflammation of the lungs that may radiate to the abdomen and back.$Cause_1": { + "pleuritic epigastric and back pain$Input2": {} + }, + "Fever, chills are typical symptoms of infection$Cause_1": { + "fevers, chills$Input2": {} + }, + "A high fever is a common symptom of pneumonia and may indicate an infection.$Cause_1": { + "102.5$Input2": {} + }, + "A squeaking sound in the right lower lobe of the lung, which may be a sign of local airway inflammation or infection$Cause_1": { + "squeaks in RLL$Input5": {} + }, + "Scattered wheezing, which usually indicates increased airway secretions or airway obstruction, often with pneumonia$Cause_1": { + "diffuse rhonchi$Input5": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "On ___, he developed a nonproductive cough, which was progressively worsened. He denies any SOB. He felt very weak on ___. He was diagnosed with pneumonia in the ED yesterday, sent home on zpack. He did not feel any better. He developed pleuritic epigastric and back pain. No chest pain, palpitations. He reports fevers, chills. He had a slight headache on and off. He had his flu shot this year. No sick contacts.\n\nIn the ED, initial VS were: 102.5 ___ 16 93%. Exam was notable for diffuse rhochi. Labs were notable for Cr 2.0. CXR showed stable LLL opacities. The patient received CTX, nebulizers, tylenol. \n \nReview of Systems: \n(+) Per HPI \n(-) Denies fever, chills. Denies sinus tenderness, rhinorrhea or congestion. Denies chest pain or tightness, palpitations. Denies nausea, vomiting, diarrhea, constipation, or abdominal pain. No dysuria, urinary frequency. Denies arthralgias or myalgias. Denies rashes. All other review of systems negative.\n", + "input3": "1. DM2\n2. HTN\n3. Hyperlipidemia\n4. Rotator cuff repair\n", + "input4": "DM2 in mother, sister, and children.\n", + "input5": "VS: 96.0, 140/78, 93, 20, 96RA, ___ chest pain\nGen: NAD, AOX3 \nHEENT: PERRL, EOMI, MMM, sclera anicteric, not injected \nNeck: no LAD, no JVD \nCardiovascular: RRR normal s1, s2, no murmurs appreciated \nRespiratory: diffuse rhonchi, squeaks in RLL\nAbd: normoactive bowel sounds, soft, non-tender, non distended\nExtremities: No edema, 2+ DP pulses \nNEURO: PERRL, EOMI, face symmetric, no tongue deviation \nIntegument: Warm, moist, no rash or ulceration \nPsychiatric: appropriate, pleasant, not anxious\n", + "input6": "___ 10:20PM WBC-5.0 RBC-4.07* HGB-11.6* HCT-33.5* MCV-82 \nMCH-28.5 MCHC-34.6 RDW-13.3\n___ 10:20PM NEUTS-70.0 ___ MONOS-7.0 EOS-3.1 \nBASOS-0.5\n___ 10:20PM PLT COUNT-189\n___ 10:20PM GLUCOSE-78 UREA N-29* CREAT-2.0* SODIUM-137 \nPOTASSIUM-3.7 CHLORIDE-102 TOTAL CO2-26 ANION GAP-13\n___ 10:20PM ___ PTT-26.5 ___\n___ 10:34PM GLUCOSE-75 LACTATE-1.0\n___ 09:10AM BLOOD WBC-5.3 RBC-4.70 Hgb-13.1* Hct-40.5 \nMCV-86 MCH-27.8 MCHC-32.2 RDW-13.7 Plt ___\n___ 09:10AM BLOOD Glucose-85 UreaN-25* Creat-2.0* Na-140 \nK-3.9 Cl-103 HCO3-28 AnGap-13\n\nCHEST (PA & LAT) Study Date of ___ \nIMPRESSION: Left lower lobe tubular opacities, suggestive of bronchial impaction.\n\nCXR ___: TECHNIQUE: PA AND LATERAL CHEST RADIOGRAPH: \nCardiac, mediastinal and hilar contours are within normal limits. Retrocardiac opacification may represent atelectasis, however, underlying infectious process cannot be completely \nexcluded. No pleural effusions or pneumothorax. \n\nEKG: LBBB. No acute ischemic changes from prior.\n\nSputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).\n\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/16956657-DS-4.json b/Finished/Pneumonia/Bacterial Pneumonia/16956657-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..94ea035d4ef7dc907d956da38e22c3290b0f336e --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/16956657-DS-4.json @@ -0,0 +1,35 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "The patient developed neutropenic fever after stem cell transplantation and the administration of leukoproliferative factors, and was also found to have consolidation in the right lung, which was caused by bacterial or fungal pneumonia.$Cause_1": { + "With neutropenic fever after starting neupogen for SCT, found to have right sided consolidation concerning for bacterial vs fungal PNA.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Lung consolidation usually indicates that the lung tissue is congested or filled with fluid, a classic sign of pneumonia$Cause_1": { + "Nodular like consolidation in the right upper lobe (4:102) measuring 4.8 x 3.1 cm.$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Fever due to neutropenia can be a risk factor for the diagnosis of pneumonia.$Cause_1": { + "Neutropenic Fever$Input1": {} + }, + "High fever is one of the common symptoms of pneumonia$Cause_1": { + "Last night he recorded a temperature of 105 F$Input2": {} + }, + "Flu-like symptoms (eg, fever, malaise, myalgias) can also be symptoms of pneumonia, especially if you feel unexplained for a long time$Cause_1": { + "He feels as though he \"has the flu\", but this sensation has been present for the better part of the past year$Input2": {} + }, + "The patient was treated with antibiotics in the emergency department, which could mean doctors suspected a bacterial infection, including possible pneumonia.$Cause_1": { + "In the emergency department he was administered cefepime, vancomycin, and 1L NS$Input2": {} + }, + "Long-term smoking can damage the lungs and airways and increase the risk of pneumonia$Cause_1": { + "Chronic Smoker$Input3": {} + } + } + } + }, + "input1": "Neutropenic Fever\n", + "input2": "He is 61 year-old Caucasian with history of lambda freelight chain multiple myeloma, gout, congenital hemihyperplasia, obesity, diabetes type 2 complicated by diabetic retinopathy and chronic kidney disease who presents with a fever.\n\nAfter undergoing a workup for microalbuminuria, he was found to have a faint band of lambda light chain monoclonal protein. A skeletal survey on rule out myeloma lytic lesions revealed no lytic lesions. A bone marrow biopsy was performed and revealed plasma cell with lambda light chain expression. Patient was diagnosed with smoldering myeloma. CKD was still attributed to diabetes. He was monitored every 3 months (with lab tests including SPEP, Light Chain Assay, Immunoglobulins) and was also given IV Zometa q3 months for possible skeletal metastasis. \n\nOn patient underwent a repeat bone marrow aspiration and biopsy which revealed a normal cellular bone marrow involvement of about 10% of lambda restricted plasma cell neoplasm. He had a repeat skeletal survey on which showed no lytic bone lesion. He was then initiated on RVD and completed 8C in VGPR.\n\nThis admission was complicated by diarrhea for which an infectious workup was negative. At discharge he was instructed to call if he developed a fever. Last night he recorded a temperature of 105 F, and was promptly instructed to come to the ED. \n\nHe feels as though he \"has the flu\", but this sensation has been present for the better part of the past year. Otherwise, he denies any symptoms. His diarrhea is resolving, and now half of his BM's are loose, and half are solid.\n\nIn the emergency department he was administered cefepime, vancomycin, and 1L NS. Maximum temperature in the ED was 100.0.\n\n\n", + "input3": "+DM2\n+HLD\n+CKD \n+Obesity\n+Hemihypertrophy\n+Diabetic Retinopathy\n+Microalbuminuria \n+Hemochromatosis (Heterozygous) \n+Gout \n+Chronic Knee Pain\n+Chronic Smoker\n", + "input4": "Mother (Cardiac) and Father (abuse/cirrhosis) are deceased. Brother and sister died of a drug overdose. No family history of hematological illness or cancer.\n", + "input5": "VITALS: Afebrile and vital signs stable (see eFlowsheet)\nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. Oropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur, no S3, no S4. No JVD.\nRESP: Lungs clear to auscultation with good air movement bilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel sounds present. Obese.\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full and symmetric bilaterally in all limbs. No cervical or clavicular lymphadenopathy. Fullness in left axilla.\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, oriented, face symmetric, gaze conjugate with EOMI, speech fluent, moves all limbs, sensation to light touch grossly intact throughout\nPSYCH: pleasant, appropriate affect\n", + "input6": "ADMISSION RESULTS:\n___ 11:44PM BLOOD WBC-0.3* RBC-3.17* Hgb-9.8* Hct-28.3* MCV-89 MCH-30.9 MCHC-34.6 RDW-13.7 RDWSD-45.0 Plt ___\n___ 11:44PM BLOOD Glucose-145* UreaN-17 Creat-1.3* Na-140 K-4.1 Cl-103 HCO3-20* AnGap-17\n___ 11:44PM BLOOD ALT-9 AST-10 AlkPhos-95 TotBili-0.9\n___ 11:44PM BLOOD Albumin-4.5 Calcium-9.4 Phos-2.1* Mg-1.4*\n\nPERTINENT RESULTS:\n\nCT CHEST (___)\n \nFINDINGS: \n \nNECK, THORACIC INLET, AXILLAE, CHEST WALL: There are no thyroid \nlesions that warrant further imaging. No lymphadenopathy in the thoracic inlet. No abnormalities on the chest wall. No atherosclerosis in head and neck vessels. \n \nUPPER ABDOMEN: The limited sections of the upper abdomen show no significant abnormal findings. \n \nMEDIASTINUM: Esophagus is unremarkable. Small mediastinal lymph nodes, not pathologically enlarged by size criteria, the largest right paratracheal measuring up to 7 mm. No apparent hilar lymphadenopathy. \n \nHEART and PERICARDIUM: Heart is normal in size. No pericardial effusions. Mild atherosclerotic calcifications in the coronary arteries. PLEURA: No pleural effusions. \n\n \n1. PARENCHYMA: Nodular like consolidation in the right upper lobe (4:102) measuring 4.8 x 3.1 cm. \n2. AIRWAYS: Airways are patent to subsegmental levels. \n3. VESSELS: Pulmonary arteries are not enlarged. \nCHEST CAGE: Moderate dorsal spondylosis. No acute fractures. No suspicious lytic or sclerotic lesions. \n \n\nMICROBIOLOGY (___)\nWith neutropenic fever after starting neupogen for SCT, found to have right sided consolidation concerning for bacterial vs fungal PNA.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/17414827-DS-11.json b/Finished/Pneumonia/Bacterial Pneumonia/17414827-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..52bb56f52f90de4efb0173b4af332e1db834781b --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/17414827-DS-11.json @@ -0,0 +1,38 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "Haemophilus influenzae is a common bacterium that can cause lower respiratory tract infections, including pneumonia.$Cause_1": { + "Multiple organisms consistent with Haemophilus influenzae.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Pulmonary infiltrates usually indicate inflammation or infection in the lungs and are a typical radiographic finding of pneumonia$Cause_1": { + "CXR which showing infiltrates$Input2": {} + }, + "Chest X-ray showed persistent opacity of the right middle lobe (RML), which may indicate the presence of localized lung infection or inflammation, consistent with the diagnosis of pneumonia.$Cause_1": { + "CXR showed persistent RML opacity c/wpna$Input2": {} + }, + "Pneumonia will often show up on X-ray images as opaque areas of the lungs, indicating possible infection$Cause_1": { + "There is persistent subtle opacity in the lateral segment of the RML$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Cough is one of the main symptoms of pneumonia$Cause_1": { + "cough$Input1": {} + }, + "These are common symptoms of pneumonia, especially productive cough and dyspnea.$Cause_1": { + "Pt states for the last 1.5 weeks she has had cough occ productive of sputum and dyspnea$Input2": {} + }, + "People with asthma may be more likely to develop pneumonia when infected with respiratory pathogens$Cause_1": { + "Asthma$Input3": {} + }, + "A dry cough is a common symptom of respiratory illness, especially when the lungs are infected.$Cause_1": { + "occ dry cough$Input5": {} + } + } + } + }, + "input1": "cough\n", + "input2": "She is with h/o subglottic tracheal stenosis s/p endoscopic intervention, asthma who presents productive cough. Pt states for the last 1.5 weeks she has had cough occ productive of sputum and dyspnea. No fevers. She saw her PCP 3 days ago and had CXR which showing infiltrates and was treated with azithromycin (z-pack). Today she is on day 4 of this antibiotic but sx have not improved. She called PCP who referred her to the emergency department. \n \nIn the ED, initial VS were 97.3 67 ___ 100%. She was given a dose of Levofloxacin. CXR showed persistent RML opacity c/wpna. \n\nOn transfer to the floor, vitals were 98.2,68,14,140/82,100%. She c/o persistent cough, also rhinorrhea/sore throat which are improving. Feels her breathing is comfortable at rest, becomes slightly dyspneicwith exertion. Denies chest pain, abdominal pain, N/V, diarrhea.\n", + "input3": "+Idiopathy subglottic stenosis\n+Hypothyroidism\n+Asthma\n+Vertigo\n", + "input4": "NC\n", + "input5": "VS - Temp 97.6F, BP 135/80, HR 71, R 20, O2-sat 100% RA \nGENERAL - well-appearing female in NAD, occ dry cough, comfortable, appropriate \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, no JVD, no cervical LAD \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use \nHEART - RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, strength and sensation grossly intact and symmetric\n", + "input6": "Admission Labs:\n___ 10:30AM BLOOD WBC-6.7# RBC-4.04* Hgb-11.7* Hct-34.6* MCV-86 MCH-28.9 MCHC-33.7 RDW-13.1\n___ 10:30AM BLOOD Glucose-72 UreaN-13 Creat-0.7 Na-138 K-4.8 Cl-101 HCO3-28 AnGap-14\n___ 07:46AM BLOOD Calcium-9.1 Phos-4.2 Mg-2.0\n___ 10:53AM BLOOD Lactate-1.3\n\n\nImaging:\nCXR PA&LAT ___:\n\nCOMPARISON: ___, radiograph from only three days prior. PA AND LATERAL VIEWS OF THE CHEST: There is persistent subtle opacity in the lateral segment of the RML. Otherwise, lungs are clear. Heart size is normal. There is no pleural effusion or evidence of central lymph node enlargement. The bones are intact. \n \nMICROBIOLOGY:\n___ BLOOD CULTURE: NO GROWTH\n- Multiple organisms consistent with Haemophilus influenzae.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/19103590-DS-16.json b/Finished/Pneumonia/Bacterial Pneumonia/19103590-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..3baf051019d53fe7cb85299240a861115bf54cb1 --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/19103590-DS-16.json @@ -0,0 +1,32 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "The presence of MRSA and Klebsiella, both of which are known causative agents of pneumonia, suggests a possible bacterial infection.$Cause_1": { + "Sputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Infiltrate and pleural effusion on chest radiograph may indicate pulmonary infection or inflammation and are direct signs of pneumonia.$Cause_1": { + "CT chest with contrast obtained revealed right middle/lower lobe consolidations, small right pleural effusion, and hilar lymphadenopathy$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "The patient has a cough that produces thick yellow sputum, which is one of the common symptoms of pneumonia and indicates a possible infection.$Cause_1": { + "cough is productive of thick yellow sputum$Input2": {} + }, + "The presence of fever and cough at the same time increases the likelihood of a lung infection, especially when other symptoms such as sputum production are present.$Cause_1": { + "develop fevers associated with the cough$Input2": {} + }, + "A high fever accompanied by chest pain may indicate increasing severity of pneumonia, and the chest pain may be related to lung inflammation.$Cause_1": { + "subsequently developed associated chest pain associated with the high fevers$Input2": {} + }, + "If multiple people in a family experience similar symptoms, this may indicate that the condition is contagious, increasing the likelihood that the pneumonia is caused by a viral or bacterial infection.$Cause_1": { + "several people in their household, including his wife, his daughter, and his grandchildren have been sick with a similar syndrome$Input2": {} + } + } + } + }, + "input1": "None\n", + "input2": "The cough is productive of thick yellow sputum, no associated rhinorrhea, sore throat, or post-nasal drip. One week ago, he went to see his PCP, was diagnosed with a viral syndrome, and given guaifenicin/cepacol/loratidine for symptomatic management. His symptoms continued, and, five days ago, he began to develop fevers associated with the cough. He then went to the ___ ED on ___, had a negative chest xray, and was discharged home on levofloxacin. At home, he continued to have fevers to 103, and subsequently developed associated chest pain associated with the high fevers, so represented to the ED for further evaluation. His chest pain is substernal in nature, only occurs during ___ febrile episodes, and is approximately ___ in intensity when it does come on. No associated arm pain, no numbness or tingling. \n\nNot typical of his usual anginal pain. In the ED, he was afebrile, non-toxic, and saturating well on room air. He was then admitted to the general medicine service for further management.\n\nHe reports some nausea with his high fevers, no emesis or diarrhea. No myalgias, but does have some back pain. No rashes. \n\n+Intermittent headache with the fever. No sneezing, rhinorrhea, sore throat, or adenopathy. \n\nOf note, the patient and his daughter report that several people in their household, including his wife, his daughter, and his grandchildren have been sick with a similar syndrome. \n\nROS: All systems negative except as noted in the HPI\n", + "input3": "Hypertension\nHyperlipidemia\nPossible CAD (abnormal stress, declined further intervention)\nDiverticulitis\n", + "input4": "Father with a history of bladder cancer.6 siblings with hypertension.\n", + "input5": "VS 101.4 146/82 80 20 95 percent on room air\nGen Awake, alert, NAD\nHEENT PERRL, EOEMI, anicteric sclerae\nOP MMM, no ulcers, lesions, or thrush\nNeck Supple, no LAD\nCV RRR, normal S1, S2, no m/g/r\nResp Clear lungs bilaterally, no WRR\nAbd Soft, non-tender, non-distended +BS\nBack No focal spine tenderness, no CVAT\nSkin No rashes, no jaundice\nExt Warm and well perfused, no edema\nNeuro Awake, alert, oriented x 3\n", + "input6": "___ 03:04PM LACTATE-2.0\n___ 03:00PM GLUCOSE-161* UREA N-13 CREAT-1.0 SODIUM-131* \nPOTASSIUM-3.6 CHLORIDE-98 TOTAL CO2-24 ANION GAP-13\n___ 03:00PM WBC-7.2 RBC-4.40* HGB-14.6 HCT-41.0 MCV-93 \nMCH-33.1* MCHC-35.6* RDW-12.9\n___ 03:00PM NEUTS-78.8* LYMPHS-16.6* MONOS-4.2 EOS-0.2 \nBASOS-0.3\n___ 03:00PM PLT COUNT-187\n___ 11:39PM LACTATE-1.1\n___ 11:30PM GLUCOSE-113* UREA N-14 CREAT-1.0 SODIUM-133 \nPOTASSIUM-3.7 CHLORIDE-100 TOTAL CO2-26 ANION GAP-11\n___ 11:30PM estGFR-Using this\n___ 11:30PM WBC-7.6 RBC-4.30* HGB-14.7 HCT-40.6 MCV-94 \nMCH-34.1* MCHC-36.2* RDW-12.8\n___ 11:30PM NEUTS-76.2* LYMPHS-16.9* MONOS-4.6 EOS-1.7 \nBASOS-0.7\n___ 11:30PM PLT COUNT-206\n\nCT chest with contrast obtained revealed right middle/lower lobe consolidations, small right pleural effusion, and hilar lymphadenopathy\n\nSputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).\n\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/19313611-DS-17.json b/Finished/Pneumonia/Bacterial Pneumonia/19313611-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..ab330b01537ac529f57a66facc4c3dc9ab9cfbde --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/19313611-DS-17.json @@ -0,0 +1,47 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "The presence of MRSA and Klebsiella, both of which are known causative agents of pneumonia, suggests a possible bacterial infection.$Cause_1": { + "Sputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "There were patchy opacities in the left lower lobe and a small pleural effusion, findings consistent with pneumonia.$Cause_1": { + "Lung volumes are diminished. There is patchy opacity in the posterior segment of the left lower lobe.$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "lethargy is a common sympotom of Pneumonia$Cause_1": { + "lethargy$Input1": {} + }, + "Altered mental status, such as confusion, can be a sign of pneumonia due to hypoxemia or a systemic response to infection.$Cause_1": { + "noticably confused at lunch$Input2": {} + }, + "Cough and bloody sputum are classic symptoms of pneumonia and indicate a possible lower respiratory tract infection.$Cause_1": { + "developed a cough, which produced bloody mucous$Input2": {} + }, + "Fever is the body's natural response to infection and is a common symptom of pneumonia.$Cause_1": { + "a tactile fever$Input2": {} + }, + "Chest pain may be related to a lung infection, especially if the pain is located near the lower respiratory tract.$Cause_1": { + "dull chest pain localizing to the left side of the chest$Input2": {} + }, + "The patient had a recent history of pneumonia for which he had been treated, which may have affected his current health status and response to treatment.$Cause_1": { + "recently admitted for pneumonia$Input2": {} + }, + "Rales at the lung bases are often associated with a lung infection or fluid buildup, a common sign of pneumonia.$Cause_1": { + "Bibasilar crackles$Input5": {} + }, + "Nonpitting edema of the lower extremities may be related to fluid disturbances, which are more common in patients with pneumonia who have severe infection or systemic inflammatory response.$Cause_1": { + "Non-pitting edema in lower extremities$Input5": {} + }, + "An elevated white blood cell count usually indicates an infection and is a common symptom of pneumonia.$Cause_1": { + "WBC-19.7$Input6": {} + } + } + } + }, + "input1": "lethargy\n", + "input2": "The day prior he was noticably confused at lunch with his family. Per the patient, one day prior to admission, he had a runny nose. He denied a sore throat or cough at that time. One day prior to admission, on the same day his family noticed that he was confused, he had a headache. He denied visual changes or recent falls. He continued to have a runny nose and developed a cough, which produced bloody mucous per his daughter, and a tactile fever per his daughter. He vomited 2 times during the day. He denied shortness of breath, abdominal pain, abdominal cramps, or diarrhea. He also complained of dull chest pain localizing to the left side of the chest between the midline and midclavicular line. He denied chest pressure or heaviness and denied exacerbation during inhalation. He denied orthopnea, sleeping well on 1 pillow at night. He does note rare paroxysmal nocturnal dyspnea. He was recently treated for chest pain from ___ to ___ and myocardial infarction was ruled out during that hospitalization. He was also recently admitted for pneumonia from ___ to ___ and was treated with levoflaxacin 250mg qD and metronidazole 500qD.\n\nThe morning of admission he was noted to be lethargic and incontinent of stool. His vital signs in the ED were T 98.3 BP 95/38 HR 78 RR 22 Oxygen 100% NRB. WBC 33.4 with 19% bands, BUN 51, Cr 2.1, lactate 4.2, and Troponin T 0.17. He received 2L IVF, vancomycin 1g IV, metronidazole 500mg IV, ceftriaxone 1g IV, and aspirin 325mg PO. He had a central line placed, with an abdomen/pelvic CT notable for left lower lobe pneumonia. He was transferred to ___, but declared DNR/DNI and transferred to ___ to treatment of pneumonia and evaluation for sepsis.\n", + "input3": "- recent anginal symptoms MI r/o (___)\n- s/p bioprosthetic AVR for aortic stenosis in ___ valve area 0.8-1.19cm2, peak gradient 80 mm Hg \n- hypertension \n- chronic diastolic CHF \n- TIAs\n- AV block \n- hyperlipidemia \n- prostate cancer, status post XRT \n- BPH \n- bladder cancer: ___ \npapillary urothelial carcinoma, low-grade, no lamina propria invasion seen \n- amaurosis fugax\n", + "input4": "Non-contributory.\n", + "input5": "VITAL SIGNS: T 98.4 BP 110/50 HR 68 RR 16 O2 95% RA\nGENERAL APPEARANCE: Well-appearing elderly man laying in bed.\nHEENT: NC/AT, sclera anicteric, mucous membranes moist, white plaques on tongue soft palate and uvula, no exudates or erythema in oropharynx.\nNECK: Supple, No LAD, JVD < 5cm.\nLUNGS: Symmetric expansion. Bibasilar crackles. No wheezes.\nHEART: Normal S1 and S2, III/VI systolic mumur heard best at the RUSB and apex, PMI at midclavicular line inferior to nipple, no rubs or gallops.\nABDOMEN: NT, ND, + bowel sounds in four quadrants, soft, no hepatosplenomegaly.\nEXTREMITIES: Radial pulses bilaterally, dorsal pedal pulses not palpated. Non-pitting edema in lower extremities.\nSKIN: Dry, hyperpigmented skin at the bases of the lower \nextremities and superior aspect of the feet bilaterally.\nNERUO: Awake, alert, and attentive. CNII-XII intact. Strength ___ on dorsiflexion and plantar flexion bilaterally, ___ at iliospoas bilaterally, DTRs symmetrical at patellar tendons, sensitive to temperature, vibration, light touch, and \nproprioception at the great toes bilaterally.\nPSYCH: Normal affect.\n", + "input6": "___ 12:04PM WBC-33.4*# RBC-3.77* HGB-12.0* HCT-34.7* \nMCV-92 MCH-31.9 MCHC-34.7 RDW-13.8\n___ 12:04PM NEUTS-76* BANDS-19* LYMPHS-1* MONOS-4 EOS-0 \nBASOS-0 ___ MYELOS-0\n___ 01:36PM LACTATE-4.2*\n___ 12:04PM CK-MB-6\n___ 12:04PM cTropnT-0.17*\n___ 12:04PM GLUCOSE-128* UREA N-51* CREAT-2.4* SODIUM-145 \nPOTASSIUM-4.3 CHLORIDE-101 TOTAL CO2-29 ANION GAP-19\n___ 12:04PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 12:04PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n___ 06:55AM BLOOD WBC-19.7* RBC-3.17* Hgb-9.9* Hct-29.2* \nMCV-92 MCH-31.2 MCHC-33.8 RDW-13.5 Plt Ct-76*\n___ 06:55AM BLOOD Glucose-89 UreaN-48* Creat-1.6* Na-141 \nK-4.1 Cl-106 HCO3-28 AnGap-11\n___ 02:17AM BLOOD CK-MB-6 cTropnT-0.20*\n___ 06:10PM BLOOD CK-MB-4 cTropnT-0.20*\n___ 03:00AM BLOOD Lactate-1.3\nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW \nPlt Ct \n___ 9.9 3.31* 10.4* 30.3* 91 31.3 34.2 13.7 \n115* \n\nSTUDIES:\nECG ___\nSinus rhythm. Left atrial abnormality. Delayed A-V conduction. Right bundle-branch block. Compared to the previous tracing of ___ the heart rate is faster. \n\nIMAGES:\nCHEST XRAY ___\nLung volumes are diminished. There is patchy opacity in the posterior segment of the left lower lobe. There is a small left pleural effusion which was present on the prior examination. Evidence of median sternotomy and valve replacement is again noted. The cardiac silhouette is within normal limits for size. There is no pneumothorax. Multiple healed right-sided rib fractures again incidentally noted. \n\nCT HEAD W/O CONTRAST ___\nThere is no evidence of acute intracranial hemorrhage, large areas of edema, or mass effect. There is prominence of the ventricles and sulci, most likely due to age-related parenchymal atrophy. Hypodense areas are seen within the cerebellar hemispheres, most likely due to small vessel ischemic changes. Visualized portions of the paranasal sinuses show some mild mucosal thickening of the frontal and ethmoid sinuses. Mastoid air cells are clear. \n\nCT ABDOMEN AND PELVIS W/O CONTRAST ___\nPatchy consolidation is seen within the left lower lobe of the lung consistent with pneumonia. A small pleural effusion is also seen on the left. In addition, there is dependent atelectasis in the right lung. The heart size is normal. No pericardial effusion is noted. \n \nThe liver, gallbladder, spleen, adrenal glands, pancreas, stomach, and intra- abdominal loops of bowel are within normal limits. There are tiny non- obstructing renal stones seen within the kidneys bilaterally. In addition, multiple well-circumscribed hypodense areas are seen within the kidneys bilaterally, most consistent with cysts, unchanged. There is diffuse calcification of the abdominal aorta and the splenic, celiac, common hepatic, and iliac arteries. There is no retroperitoneal or mesenteric lymphadenopathy. No free air or free fluid is seen. High-density material is seen within the dependent portion of the second segment of the duodenum, which may be due to recent ingestion of high density material (ie medication or contrast).\n\nSputum with MRSA bronch: sensitive to Clinda, Tetracycline, Bactrim, Vancomycin, (Resistant to Erythro, Oxacillin, Penicillin, Cefazolin).\n\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/19441625-DS-18.json b/Finished/Pneumonia/Bacterial Pneumonia/19441625-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..99631b80e2efbd0ff4a71a38396a8e04ad9a1a2a --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/19441625-DS-18.json @@ -0,0 +1,53 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "Identification of Gram-positive cocci for diagnosis of bacterial pneumonia$Cause_1": { + "GRAM POSITIVE COCCI$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "There are vague shadows in the base and left upper lobe, which may be a sign of pneumonia$Cause_1": { + "Bibasilar opacities as well as a left upper lobe opacity \nconcerning for pneumonia.$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "SoB is a common symptom of Pneumonia$Cause_1": { + "shortness of breath$Input1": {} + }, + "Headache, muscle/joint pain, runny nose, etc. may be early signs of infection$Cause_1": { + "mild headache, myalgia/arthalgia, and runny nose w/ clear nasal discharge$Input2": {} + }, + "The transition from a dry cough to a productive cough is a common symptom of pneumonia, indicating the possible presence of a lower respiratory tract infection.$Cause_1": { + "developed some cough, which was initially non-productive but transitioned into productive cough w/ grayish and thick sputum$Input2": {} + }, + "Acute dyspnea indicates that lung function may be severely compromised, which is common in pneumonia$Cause_1": { + "acute SOB w/ walking for <10ft$Input2": {} + }, + "Repeated fever and chills are signs of active infection in the body, often with severe infections such as pneumonia$Cause_1": { + "subjective fever x3-4, chills$Input2": {} + }, + "Her history of repeated pneumonia and intensive care admissions suggests she may be at higher risk for recurrence$Cause_1": { + "been hosptialized for ___ ___ the past for pneumonia$Input2": {} + }, + "IVIG is often used to treat immunodeficiency disorders, which may suggest that her immune system is weakened, increasing her risk of pneumonia.$Cause_1": { + "currently on IVIG infusion every 3wks$Input2": {} + }, + "People with COPD and asthma often have reduced lung function, making them more susceptible to infections, which may increase their risk of pneumonia.$Cause_1": { + "Asthma/COPD$Input3": {} + }, + "In pneumonia, these rales often indicate fluid accumulation in the lungs, a common sign of infection.$Cause_1": { + "ilateral crackles appreciated at the bases$Input5": {} + }, + "An increase in neutrophils may be an indicator of bacterial infection.$Cause_1": { + "NEUTS-83.1$Input6": {} + }, + "An elevated white blood cell count often indicates an infection.$Cause_1": { + "WBC-14.5$Input6": {} + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "Her symptoms started about 10days ago w/ mild headache, myalgia/arthalgia, and runny nose w/ clear nasal discharge. Her symptoms improved briefly for a day w/ tylenol, but over the next few days, she had increased fatigue, mild nausea w/o \nvomiting, and decreased appatite and po intake. She also developed some cough, which was initially non-productive but transitioned into productive cough w/ grayish and thick sputum, no hemoptysis. One day PTA, she developed acute SOB w/ walking for <10ft, accompanied by some epigastric pain that radiates to her back, palpatations that lasted for several minutes, and significant wheezes which didn't resolve w/ nebs. She had subjective fever x3-4, chills, but no night sweats, chest pain, dysuria, hematuria, diarria, and constipation. She had no recent sick contacts, traveling outside of the ___. She had two dogs and carpets at home but denied any allergies ___ the past. She had received her flu shot this year. \n \nOf note, patient had been hosptialized for ___ ___ the past for pneumonia, had been ___ the ICU 3x, and was septic for ___, but was never intubated. Her last hospitalization was ___ ago for PNA. She had no prior hx of MRSA. She is currently on IVIG infusion every 3wks, the next one is on ___. She endorsed feeling weaker and getting sick more easily as she approaches the due date for the IVIG infusion, was considering switching to weekly infusion.\n", + "input3": "2) Asthma/COPD (FEV1 1.31, FVC 1.81; ___: never intubated \n3) Recurrent bronchitis and sinusitis: \n4) Diabetes Mellitus I (last HbA1c 11%): no known neuropathy, nephropathy. \n5) Hypertension \n6) Hypercholesterolemia \n7) Anxiety \n8) hypogammaglobulinemia: on IVIG (last ___ \n9) OSA on CPAP 8\n", + "input4": "Significant for HTN ___ mother and father, CAD, liver disease (grandparents)\n", + "input5": "Vitals: T98.2 P78 BP167/85 R18 O2sat 97%RA \nGeneral: Alert, orientedx3, no acute distress \nHEENT: Sclera anicteric, MMM, EOMI, PERRL, oropharynx clear Neck: supple, JVP not elevated, no LAD \nLungs: bilateral crackles appreciated at the bases (lower ___. no egophany. no wheezes or rhonchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft w/o masses, non-tender, non-distended, + bowel sounds over all 4 quadrants, no rebound tenderness or guarding, no organomegaly \nGU: no foley. no CVA tenderness.\nExt: Warm, well perfused, 2+ radial and ___ pulses, no clubbing, cyanosis or edema \nSkin: no rash \nNeuro: CN II-XII grossly intact. speech fluent and moving all extremties.\n", + "input6": "___ 12:21PM PLT COUNT-358\n___ 12:21PM NEUTS-83.1* LYMPHS-10.9* MONOS-3.6 EOS-2.1 \nBASOS-0.3\n___ 12:21PM WBC-14.5*# RBC-3.72* HGB-10.1* HCT-32.8* \nMCV-88 MCH-27.2 MCHC-30.8* RDW-14.1\n___ 12:21PM UREA N-19 CREAT-1.0 SODIUM-137 POTASSIUM-5.3* \nCHLORIDE-99 TOTAL CO2-28 ANION GAP-15\n\nIMAGING STUDIES\n___ CHEST (PA & LAT)\nIMPRESSION: \nBibasilar opacities as well as a left upper lobe opacity \nconcerning for pneumonia. \n\nMICROBIOLOGY:\n___ SPUTUM (Expectorated) \n GRAM STAIN (Final ___: \n >25 PMNs and <10 epithelial cells/100X field. \n 2+ ___ per 1000X FIELD): GRAM POSITIVE COCCI. \n ___ PAIRS AND CLUSTERS. \n 1+ (<1 per 1000X FIELD): GRAM NEGATIVE ROD(S). \n\n RESPIRATORY CULTURE (Preliminary): \n SPARSE GROWTH Commensal Respiratory Flora. \n\n___ Respiratory Viral Antigen Screen (Final ___: \n Less than 60 columnar epithelial cells;. \n Specimen inadequate for detecting respiratory viral \ninfection by ___ testing.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/extra-1.json b/Finished/Pneumonia/Bacterial Pneumonia/extra-1.json new file mode 100644 index 0000000000000000000000000000000000000000..0e970e727cabd9e6e7196fabb2f052bdd8cd7309 --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/extra-1.json @@ -0,0 +1,47 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "Sputum culture results showed multiple microorganisms consistent with Streptococcus pneumoniae, directly indicating Streptococcus pneumoniae infection.$Cause_1": { + "Multiple organisms consistent with Streptococcus pneumoniae.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "This is a typical radiological finding of pneumonia$Cause_1": { + "Right lower lobe showing infiltrates.$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Fever is a common symptom of pneumonia$Cause_1": { + "Fever$Input1": {} + }, + "Headache, muscle and joint pain, and runny nose may be early signs of infection$Cause_1": { + "mild headache, muscle and joint pain, and a runny nose with clear discharge$Input2": {} + }, + "A cough that is initially nonproductive but then becomes productive with grayish-white sputum may indicate the presence and progression of an infection.$Cause_1": { + "developed a cough, which initially produced no mucus but later became productive, yielding thick, grayish sputum without blood$Input2": {} + }, + "Shortness of breath after walking less than 10 feet is one of the important symptoms of pneumonia and indicates that lung function may be seriously affected.$Cause_1": { + "acute shortness of breath$Input2": {} + }, + "Significant asthma that does not improve even with nebulized therapy may indicate chronic or acute airway inflammation$Cause_1": { + "significant wheezing that did not improve with nebulizer treatments$Input2": {} + }, + "The patient had been hospitalized multiple times for pneumonia, including three admissions to the intensive care unit, suggesting that she was at high risk for recurrent lung infections.$Cause_1": { + "history of hospitalization for pneumonia, has been in the ICU three times$Input2": {} + }, + "IVIG is commonly used to treat immune deficiencies, suggesting she may have underlying immune system problems.$Cause_1": { + "Currently, she is on an IVIG infusion every three weeks$Input2": {} + }, + "Rales and squeaks usually indicate fluid or sputum in the airways, which is a classic sign of pneumonia.$Cause_1": { + "Diffuse rhonchi and squeaks in the right lower lung.$Input5": {} + }, + "Chest pain is one of the common symptoms of pneumonia and may be due to pleural irritation caused by lung inflammation.$Cause_1": { + "reports chest pain.$Input5": {} + } + } + } + }, + "input1": "Fever\n", + "input2": "Her symptoms began approximately 10 days ago with a mild headache, muscle and joint pain, and a runny nose with clear discharge. Her condition temporarily improved after taking Tylenol, but she soon experienced increased fatigue, mild nausea without vomiting, reduced appetite, and decreased fluid intake. She also developed a cough, which initially produced no mucus but later became productive, yielding thick, grayish sputum without blood. One day prior to admission, she experienced acute shortness of breath when walking less than 10 feet, along with epigastric pain radiating to her back, several minutes of palpitations, and significant wheezing that did not improve with nebulizer treatments. She reported subjective fevers, chills up to three or four times, but no night sweats, chest pain, painful urination, blood in urine, diarrhea, or constipation. She has not been in contact with any sick individuals, traveled recently, or has known allergies, though she has two dogs and carpets at home. She received her flu vaccine this year.\n\nNotably, the patient has a history of hospitalization for pneumonia, has been in the ICU three times, and experienced sepsis, although she was never intubated. Her most recent hospital admission was for pneumonia and occurred ___ ago. She has no history of MRSA. Currently, she is on an IVIG infusion every three weeks, with the next scheduled for ___. She reported feeling weaker and more susceptible to illness as her next IVIG infusion approaches and is considering switching to a weekly infusion schedule.\n", + "input3": "None\n", + "input4": "DM2 in mother, sister, and children.\n", + "input5": "Vital Signs: Heart rate 96.0, blood pressure 140/78, respiratory rate 20, oxygen saturation 96% on room air, reports chest pain.\nGeneral: Appears well, alert and oriented x3.\nHead, Eyes, Ears, Nose, Throat: Pupils equal, round, reactive to light; extraocular movements intact; moist mucous membranes; sclera are not yellow and not red.\nNeck: No lymphadenopathy or jugular venous distention observed.\nCardiovascular: Regular rate and rhythm, normal heart sounds S1 and S2, no heart murmurs detected.\nRespiratory: Diffuse rhonchi and squeaks in the right lower lung.\nAbdomen: Active bowel sounds, abdomen soft and non-tender, not distended.\nExtremities: No swelling, dorsalis pedis pulses are strong.\nNeurological: Pupils equal, round, reactive to light; extraocular movements intact; facial symmetry maintained, no deviation of the tongue.\nSkin: Warm and moist, no rashes or ulcerations noted.\nPsychiatric: Behavior appropriate, demeanor pleasant, not exhibiting anxiety.\n", + "input6": "___ 10:20PM WBC-5.0 RBC-4.07* HGB-11.6* HCT-33.5* MCV-82 \nMCH-28.5 MCHC-34.6 RDW-13.3\n___ 10:20PM NEUTS-70.0 ___ MONOS-7.0 EOS-3.1 \nBASOS-0.5\n___ 10:20PM PLT COUNT-189\n___ 10:20PM GLUCOSE-78 UREA N-29* CREAT-2.0* SODIUM-137 \nPOTASSIUM-3.7 CHLORIDE-102 TOTAL CO2-26 ANION GAP-13\n___ 10:20PM ___ PTT-26.5 ___\n___ 10:34PM GLUCOSE-75 LACTATE-1.0\n___ 09:10AM BLOOD WBC-5.3 RBC-4.70 Hgb-13.1* Hct-40.5 \nMCV-86 MCH-27.8 MCHC-32.2 RDW-13.7 Plt ___\n___ 09:10AM BLOOD Glucose-85 UreaN-25* Creat-2.0* Na-140 \nK-3.9 Cl-103 HCO3-28 AnGap-13\n\nCHEST (PA & LAT) Study Date of ___ \nIMPRESSION: Left lower lobe tubular opacities, suggestive of bronchial impaction. Right lower lobe showing infiltrates.\n\nCXR ___: TECHNIQUE: PA AND LATERAL CHEST RADIOGRAPH: \nCardiac, mediastinal and hilar contours are within normal limits. Retrocardiac opacification may represent atelectasis, however, underlying infectious process cannot be completely \nexcluded. No pleural effusions or pneumothorax. \n\nEKG: LBBB. No acute ischemic changes from prior.\n\n\nMultiple organisms consistent with Streptococcus pneumoniae.\n\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/extra-2.json b/Finished/Pneumonia/Bacterial Pneumonia/extra-2.json new file mode 100644 index 0000000000000000000000000000000000000000..2069e71f2299356e99d33decec702a33249bd543 --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/extra-2.json @@ -0,0 +1,35 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "Sputum culture results showed multiple microorganisms consistent with Streptococcus pneumoniae, directly indicating Streptococcus pneumoniae infection.$Cause_1": { + "ltiple organisms consistent with Streptococcus pneumoniae.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Lung opacities are abnormal shadows visible on X-rays and are often associated with lung infections such as pneumonia.$Cause_1": { + "Chest X-ray indicated stable lower left lobe opacities$Input2": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "A nonproductive cough is a common symptom of pneumonia and a persistent worsening may indicate a worsening of the disease.$Cause_1": { + "nonproductive cough that progressively worsened$Input2": {} + }, + "Pleural pain may be caused by lung inflammation and is one of the typical symptoms of pneumonia$Cause_1": { + "pleuritic pain in the epigastric and back areas$Input2": {} + }, + "Fever and chills are the body's immune response to infection and are common clinical manifestations of pneumonia.$Cause_1": { + "fevers and chills$Input2": {} + }, + "High fever is a common symptom of pneumonia and indicates possible infection$Cause_1": { + "102.5 \u00b0F$Input2": {} + }, + "Rales are a sign of secretions in the lungs and are common in patients with pneumonia.$Cause_1": { + "diffuse rhonchi$Input2": {} + } + } + } + }, + "input1": "N/A\n", + "input2": "On a recent date, he developed a nonproductive cough that progressively worsened. He denies any shortness of breath. He experienced significant weakness on another date. He was diagnosed with pneumonia in the Emergency Department (ED) yesterday and was prescribed a z-pack but reported no improvement. Subsequently, he developed pleuritic pain in the epigastric and back areas. He reported no chest pain or palpitations but did have fevers and chills. He occasionally experienced slight headaches. He received his flu shot this year and has had no exposure to sick individuals.\n\nDuring his visit to the ED, his initial vital signs were: temperature 102.5 \u00b0F, heart rate 16 beats per minute, oxygen saturation 93%. His physical examination revealed diffuse rhonchi. Lab tests showed a creatinine level of 2.0. Chest X-ray indicated stable lower left lobe opacities. He was treated with ceftriaxone, nebulizers, and Tylenol.\n\nReview of Systems:\nPositive per history of present illness.\nNegative for fever, chills; sinus tenderness, rhinorrhea, or congestion; chest pain or tightness, palpitations; nausea, vomiting, diarrhea, constipation, or abdominal pain; dysuria, urinary frequency; joint or muscle pain; and rashes. All other systems reviewed were negative.\n", + "input3": "1. DM2\n2. HTN\n3. Hyperlipidemia\n4. Rotator cuff repair\n", + "input4": "Mother died at age ___ of stomach cancer.\n", + "input5": "General: Elderly woman, awake and alert, no acute distress.\nHead, Eyes, Ears, Nose, Throat: Extraocular movements intact, sclerae not jaundiced, conjunctivae clear, oral pharynx moist without lesions.\nNeck: Supple, no jugular venous distension.\nCardiovascular: Regular rate, normal first and second heart sounds, no murmurs, rubs, or gallops.\nRespiratory: Breathing unlabored, no use of accessory muscles, clear to auscultation bilaterally, no crackles, wheezes, or rhonchi.\nAbdominal: Soft, non-tender, non-distended, no hepatosplenomegaly, bowel sounds present.\nMusculoskeletal: Normal muscle tone and bulk.\nExtremities: No cyanosis, clubbing, or edema, 2+ pulses bilaterally.\nSkin: No rash, skin is warm.\nNeurological: Oriented to person, place, and time, normal attention, cranial nerves II through XII intact, normal strength throughout, sensory intact.\n", + "input6": "___ 11:59AM BLOOD WBC-8.6 RBC-3.73* Hgb-12.0 Hct-33.8* \nMCV-91 MCH-32.1* MCHC-35.4* RDW-12.9 Plt ___\n___ 05:52AM BLOOD WBC-7.5 RBC-3.78* Hgb-11.9* Hct-34.3* \nMCV-91 MCH-31.4 MCHC-34.6 RDW-12.6 Plt ___\n___ 12:45AM BLOOD WBC-7.7 RBC-3.59* Hgb-11.6* Hct-32.4* \nMCV-90 MCH-32.3* MCHC-35.8* RDW-12.5 Plt ___\n___ 06:00AM BLOOD WBC-5.7 RBC-3.67* Hgb-11.5* Hct-33.1* \nMCV-90 MCH-31.3 MCHC-34.7 RDW-12.7 Plt ___\n___ 11:59AM BLOOD Neuts-63.2 ___ Monos-6.1 Eos-3.0 \nBaso-0.6\n___ 12:45AM BLOOD Neuts-65.7 ___ Monos-7.6 Eos-2.7 \nBaso-0.5\n\nMultiple organisms consistent with Streptococcus pneumoniae.\n\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Bacterial Pneumonia/extra-3.json b/Finished/Pneumonia/Bacterial Pneumonia/extra-3.json new file mode 100644 index 0000000000000000000000000000000000000000..e3c9f8743dc5bed4988cadeaf32fb78ff2956f92 --- /dev/null +++ b/Finished/Pneumonia/Bacterial Pneumonia/extra-3.json @@ -0,0 +1,41 @@ +{ + "Bacterial Pneumonia$Intermedia_4": { + "Sputum culture results showed multiple microorganisms consistent with Streptococcus pneumoniae, directly indicating Streptococcus pneumoniae infection.$Cause_1": { + "Multiple organisms consistent with Streptococcus pneumoniae.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "This is a typical radiological finding of pneumonia$Cause_1": { + "Right lower lobe showing infiltrates.$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Cough with yellow sputum may indicate a bacterial infection, often with pneumonia$Cause_1": { + "cough producing thick yellow sputum$Input2": {} + }, + "Misdiagnosis of viral infection in the early stage, but ineffective treatment may delay the diagnosis of bacterial pneumonia$Cause_1": { + "diagnosed with a viral syndrome, receiving guaifenesin, Cepacol, and loratadine for symptom relief. Despite this treatment, his symptoms persisted$Input2": {} + }, + "Headache accompanied by fever may be a systemic reaction caused by infection$Cause_1": { + "intermittent headaches associated with the fever$Input2": {} + }, + "Fever and cough are common symptoms of pneumonia$Cause_1": { + "fevers concurrent with the cough$Input2": {} + }, + "Chest pain in pneumonia may be due to pleurisy caused by lung infection$Cause_1": { + "chest pain that intensified with the fevers$Input2": {} + }, + "If family members have similar symptoms, it may indicate that the source of infection comes from the family environment. Pneumonia is contagious.$Cause_1": { + "his daughter, and other household members, including his wife and grandchildren, have experienced similar symptoms.$Input2": {} + }, + "Diffuse rales and a murmur in the right lower lung may indicate infection or inflammation of the lungs and are typical symptoms of pneumonia.$Cause_1": { + "Diffuse rhonchi, squeaks noted in the right lower lung.$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "The patient presents with a cough producing thick yellow sputum and has not experienced rhinorrhea, sore throat, or post-nasal drip. One week prior, he visited his primary care physician and was diagnosed with a viral syndrome, receiving guaifenesin, Cepacol, and loratadine for symptom relief. Despite this treatment, his symptoms persisted, and five days ago, he began experiencing fevers concurrent with the cough. He sought care at the emergency department, where a chest X-ray showed no abnormalities, and he was discharged with a prescription for levofloxacin. At home, his fevers escalated to 103 degrees Fahrenheit, and he developed chest pain that intensified with the fevers, prompting a return to the emergency department for further assessment. The chest pain, centered beneath the sternum, occurs only during febrile episodes and reaches a significant intensity. There is no associated arm pain or sensations of numbness or tingling.\n\nThis presentation does not align with his typical anginal pain. During his emergency department visit, he was fever-free, appeared clinically stable, and maintained normal oxygen levels on room air. He was admitted to the general medicine ward for continued management.\n\nAdditionally, he reports nausea accompanying his high fevers but no vomiting or diarrhea. He experiences back pain but no muscle aches or rashes. He also reports intermittent headaches associated with the fever. There are no symptoms of sneezing, rhinorrhea, sore throat, or lymph node enlargement.\n\nIt is noteworthy that the patient, his daughter, and other household members, including his wife and grandchildren, have experienced similar symptoms.\n\nReview of systems was unremarkable except as detailed in the history of present illness.\n", + "input3": "Hypertension\nHyperlipidemia\n", + "input4": "Father with a history of bladder cancer.\n", + "input5": "Vital Signs: Heart rate 96, blood pressure 140/78, respiratory rate 20, oxygen saturation 96% on room air, no chest pain reported.\nGeneral: No acute distress, alert and oriented times three.\nHead, Eyes, Ears, Nose, and Throat: Pupils equal, round, reactive to light; extraocular movements intact; moist mucous membranes; sclerae are not yellow; no redness.\nNeck: No lymphadenopathy, no jugular venous distention.\nCardiovascular: Regular rate and rhythm, normal heart sounds with no murmurs detected.\nRespiratory: Diffuse rhonchi, squeaks noted in the right lower lung.\nAbdomen: Active bowel sounds, abdomen is soft, non-tender, and not distended.\nExtremities: No swelling, dorsalis pedis pulses are strong.\nNeurological: Pupils equal, round, reactive to light; extraocular movements intact; facial symmetry with no tongue deviation.\nSkin: Warm and moist, no rashes or ulcerations.\nPsychiatric: Behavior is appropriate, demeanor is pleasant, not displaying anxiety.\n", + "input6": "___ 10:20PM WBC-5.0 RBC-4.07* HGB-11.6* HCT-33.5* MCV-82 \nMCH-28.5 MCHC-34.6 RDW-13.3\n___ 10:20PM NEUTS-70.0 ___ MONOS-7.0 EOS-3.1 \nBASOS-0.5\n___ 10:20PM PLT COUNT-189\n___ 10:20PM GLUCOSE-78 UREA N-29* CREAT-2.0* SODIUM-137 \nPOTASSIUM-3.7 CHLORIDE-102 TOTAL CO2-26 ANION GAP-13\n___ 10:20PM ___ PTT-26.5 ___\n___ 10:34PM GLUCOSE-75 LACTATE-1.0\n___ 09:10AM BLOOD WBC-5.3 RBC-4.70 Hgb-13.1* Hct-40.5 \nMCV-86 MCH-27.8 MCHC-32.2 RDW-13.7 Plt ___\n___ 09:10AM BLOOD Glucose-85 UreaN-25* Creat-2.0* Na-140 \nK-3.9 Cl-103 HCO3-28 AnGap-13\n\nCHEST (PA & LAT) Study Date of ___ \nIMPRESSION: Left lower lobe tubular opacities, suggestive of bronchial impaction. Right lower lobe showing infiltrates.\n\nCXR ___: TECHNIQUE: PA AND LATERAL CHEST RADIOGRAPH: \nCardiac, mediastinal and hilar contours are within normal limits. Retrocardiac opacification may represent atelectasis, however, underlying infectious process cannot be completely \nexcluded. No pleural effusions or pneumothorax. \n\nEKG: LBBB. No acute ischemic changes from prior.\n\n\nMultiple organisms consistent with Streptococcus pneumoniae.\n\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Viral Pneumonia/13316652-DS-5.json b/Finished/Pneumonia/Viral Pneumonia/13316652-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..d27ccdd269143186de1e2fd8f6109b621811175d --- /dev/null +++ b/Finished/Pneumonia/Viral Pneumonia/13316652-DS-5.json @@ -0,0 +1,38 @@ +{ + "Viral Pneumonia$Intermedia_4": { + "The cause of infection was confirmed to be viral pneumonia$Cause_1": { + "not a manifestation of reactivation of fungal pneumonia, but represent viral infection.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "This opacity is usually caused by infection and is one of the common symptoms of pneumonia$Cause_1": { + "new mild peribronchial opacification in the lower lobes$Input6": {} + }, + "Elevated values may indicate signs of infection, and these are abnormal biochemical indicators that may be observed in patients with pneumonia.$Cause_1": { + "CREAT-1.7$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Difficulty breathing is a classic symptom of pneumonia$Cause_1": { + "Shortness of breath$Input1": {} + }, + "Difficulty breathing, body aches, and chills are common with pneumonia.$Cause_1": { + "SOB for the last 4 days with fever, body aches, chills, and headaches.$Input2": {} + }, + "This may indicate infection or inflammation in the lungs, which is common in pneumonia$Cause_1": { + "SOB, because her \"lungs hurt.\"$Input2": {} + }, + "Nocturnal breathing difficulties can be a sign of pneumonia leading to impaired oxygen exchange$Cause_1": { + "had trouble breathing at night$Input2": {} + }, + "Fever is one of the common symptoms of pneumonia$Cause_1": { + "VS: 100.3$Input5": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "66 y/o female here with DM, CKD, silent MI in past, p/w SOB for the last 4 days with fever, body aches, chills, and headaches. Had a fever of 99.5 Influenza- like-illness symptoms. She went today referred here for cardiac evaluation. Her Trop 0.03 at OSH. \n\nPatient reports that she has been feeling ill with the \"flu\" for a week. No coughing, but fever (subjective), chills, body aches. No chest pain. She does have SOB, because her \"lungs hurt.\" No runny nose. She had an uncomfortable night, and had trouble breathing at night. She felt her right hand tingling. She took two nitroglycerines because she felt short of breath, and because she was not sure what to do. \n\nIn the ED, initial vitals were 0 97.0 70 170/74 20 98%. RR 20. Labs and imaging significant for Na 132, Cr 1.7, troponin 0.06, Hct 32.2. CXR wnl. EKG showing no changes. Patient was given tylenol for her fever. Vitals on transfer were 100.6, 68, 30, 99 RA. Patient was Chest pain-free while in our facility. She was given tylenol in the ED. \n\nOn arrival to the floor, patient was complaining of a headache, her vitals were 100.3, 153/71, 68, 18, 98RA wt 92.7KG. She felt well.\n", + "input3": "+Insulin dependent diabetes mellitus\n+Hypothyroidism. \n+CKD stage III secondary to DM \n+CHF\n+Hypertension. \n+Macular degeneration, blind in right eye \n+Chronic Pseudomonas cystitis \n+Yeast UTI. \n+Peripheral vascular disease s/p left fem pop\n+Hyperlipidemia\n", + "input4": "She has a history of CAD in her family and diabetes. Mother is healthy. Father died from prostate cancer. Brother died alcohol abuse. Sister is healthy. No family history of early MI, arrhythmia, cardiomyopathies, or sudden cardiac death.\n", + "input5": "VS: 100.3-___\nGENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Blind in R. eye. Conjunctiva were pink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \nNECK: Supple, no JVD. \nCARDIAC: normal S1, S2. No m/r/g. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp were unlabored, no accessory muscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by palpation. No abdominial bruits. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: two small ulcer on left leg, healing. No discharge noted.\n", + "input6": "___ 01:00PM ___ PTT-27.9 ___\n___ 01:00PM PLT COUNT-248\n___ 01:00PM NEUTS-75.1* ___ MONOS-3.3 EOS-0.4 BASOS-1.2\n___ 01:00PM WBC-7.2 RBC-4.17* HGB-11.0* HCT-32.2* MCV-77* MCH-26.5* MCHC-34.2 RDW-13.6\n___ 01:00PM TRIGLYCER-142 HDL CHOL-21 CHOL/HDL-3.8 LDL(CALC)-31\n___ 01:00PM CALCIUM-8.7 PHOSPHATE-3.3 MAGNESIUM-2.3 CHOLEST-80\n___ 01:00PM CK-MB-3\n___ 01:00PM CK(CPK)-45\n___ 01:00PM estGFR-Using this\n___ 01:00PM GLUCOSE-177* UREA N-25* CREAT-1.7* SODIUM-132* POTASSIUM-4.2 CHLORIDE-97 TOTAL CO2-23 ANION GAP-16\n___ 07:38PM CK-MB-2 cTropnT-0.07*\n___ 07:38PM CK(CPK)-41\n\nCXR:IMPRESSION: PA and lateral chest compared to previous: Punctate pulmonary calcifications are more numerous and central lymph node calcifications larger today than they were on a two prior studies. These are probably the residual granulomatous pulmonary infection, particularly histoplasmosis. The new mild peribronchial opacification in the lower lobes, particularly the right, is not a manifestation of reactivation of fungal pneumonia, but represent viral infection. \n\n#Depression - patient expressed some passive SI, and was evaluted by Psychiatry who agreed that she is likely depressed. She reported feeling depressed since in context of recurrent hospitalizations. It was decided that patient may benefit from starting zoloft for her depression (which is less likely to interact with other meds she is on). Patient will need follow up with PCP to continue to discuss her mood. \nInactive Issues\n\n# PUMP: Overall left ventricular systolic function is mildly depressed (LVEF= 40-45 %), with mildly depressed global LV systolic function and elevated LV filling pressures, without significant valvular disease. Not a candidate for CABG.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Viral Pneumonia/15585852-DS-17.json b/Finished/Pneumonia/Viral Pneumonia/15585852-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..54005b3a7ecfae6561e9462bd36977897786bb59 --- /dev/null +++ b/Finished/Pneumonia/Viral Pneumonia/15585852-DS-17.json @@ -0,0 +1,53 @@ +{ + "Viral Pneumonia$Intermedia_4": { + "Diagnosed with viral infection$Cause_1": { + "Positive for Influenza A$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "Neutrophils were significantly elevated, an indicator of pneumonia.$Cause_1": { + "Neuts-91.1$Input6": {} + }, + "Atelectasis is when part of the lungs does not expand enough and is a symptom of pneumonia$Cause_1": { + "Minimal bibasilar dependent atelectasis is present$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Shortness of breath is one of the common symptoms of pneumonia$Cause_1": { + "Shortness of breath$Input1": {} + }, + "A prolonged cough and viral infection symptoms may indicate ongoing respiratory problems, which may be related to pneumonia$Cause_1": { + "he has had intermittent cough and viral symptoms for the past 2 months$Input2": {} + }, + "Severe sputum-producing cough and wheezing may indicate a lower respiratory tract infection, and asthma may also be a sign of reactive airway disease$Cause_1": { + "severe cough and some wheezing$Input2": {} + }, + "Fever is a typical symptom of pneumonia$Cause_1": { + "low grade fevers for 1 day, low 100s$Input2": {} + }, + "Elevated lactate may be the body's response to a serious infection and may be a sign of pneumonia.$Cause_1": { + "lactate increased at 4.4$Input2": {} + }, + "Hypoxemia is a possible clinical manifestation of pneumonia$Cause_1": { + "SpO2 90% on RA$Input2": {} + }, + "Increased heart rate is a possible clinical manifestation of pneumonia$Cause_1": { + "HR 117$Input2": {} + }, + "Tobacco abuse is one of the high risk factors for pneumonia$Cause_1": { + "Tobacco abuse$Input3": {} + }, + "Difficulty breathing when speaking, a common symptom of pneumonia$Cause_1": { + "SOB with speaking in full sentences$Input5": {} + }, + "Indicates partial obstruction of the airway, possibly due to inflammation and/or accumulation of secretions due to infection, a classic sign of pneumonia$Cause_1": { + "faint wheezes heard more in the upper lung fields, poor airflow$Input5": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "He is a 55 yo male with history of lymphoma as a child, now in remission for many years, HLD, and current smoker (30 PY) who presents with shortness of breath. He does not have any known history of COPD or asthma. He reports that he has had intermittent cough and viral symptoms for the past 2 months, but he has not been SOB until about 3 days ago. He has had severe cough and some wheezing for the past ough is productive of clear sputum. He reports low grade fevers for 1 day, low 100s in ED. He denies chills, chest pain or pressure. He was admitted to OSH earlier today, he was given steroids and antibiotics, but eloped as he was unstatisfied with their care. He was still SOB so came here for further evaluation. He denies any recent sick contacts.\n\nIn the ED, initial VS were: T 98.2, HR 117, BP 135/73, RR 18, SpO2 90% on RA. Patient was found to be tachypneic and wheezy on exam. His peak flow was noted to be 200. He was given Duonebs x3, Solumedrol, Ceftriaxone, and Azithromycin. No elevated WBC, but lactate increased at 4.4. EKG showed sinus tachycardia at 112, no ischemia. CTA chest was negative for PE. His VS prior to transfer were: T 98.5, HR 110, BP 139/79, SpO2 96% on NRB.\n", + "input3": "+Hyperlipidemia\n+Scoliosis. Wears a right shoe-lift.\n+Bilateral inguinal hernia repair as a child\n+Tonsillectomy and adenoidectomy x2 as a child.\n+Tobacco abuse\n", + "input4": "The patient is adopted and does know know his biological family medical history.\n", + "input5": "General: Alert, oriented, SOB with speaking in full sentences and with mild\nHEENT: Sclera anicteric, dry MM, oropharynx clear\nNeck: supple, JVP at 8cm, no LAD\nLungs: faint wheezes heard more in the upper lung fields, poor airflow. no rales/ronchi\nCV: rapid rate/rhythm, normal S1 + S2, no murmurs, rubs, gallops\nAbdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly\nGU: no foley\nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema\nNeuro: A&O x3, CN grossly intact, MAE.\n", + "input6": "___ 11:30PM BLOOD WBC-7.0 RBC-4.74 Hgb-14.6 Hct-41.4 MCV-87 MCH-30.8 MCHC-35.3* RDW-13.9 Plt ___\n___ 11:30PM BLOOD Neuts-91.1* Lymphs-6.1* Monos-2.4 Eos-0.4 Baso-0.1\n___ 11:30PM BLOOD ___ PTT-23.4 ___\n___ 11:30PM BLOOD UreaN-14 Creat-0.9\n___ 11:30PM BLOOD freeCa-1.13\n\n\nToxicology:\n___ 07:01AM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 01:17PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG amphetm-NEG mthdone-NEG\n\nMicrobiology:\n___ 7:08 am Influenza A/B by DFA (Source: Nasopharyngeal swab)\n DIRECT INFLUENZA A ANTIGEN TEST (Final ___: \n Positive for Influenza A. \n DIRECT INFLUENZA B ANTIGEN TEST (Final ___: \n Negative for Influenza B. \n\nImaging / Studies:\n# CHEST (PA & LAT) ___ at 11:29 ___:\nFINDINGS: AP and lateral chest with no prior for comparison demonstrates low lung volumes, though the lungs are clear. There is no pleural effusion or pneumothorax. The heart is at the upper limits of normal for size, the mediastinal contours are unremarkable. The pulmonary vasculature appears normal.\n\nCTA CHEST W&W/O C&RECONS, NON-CORONARY ___ at 2:30 AM):\nFINDINGS: Vascular opacification is somewhat suboptimal, but no pulmonary embolism is present to the level of the segemental vessels. The main pulmonary artery is slightly enlarged measuring 3.2 cm. The thoracic aorta appears within normal limits. No pericardial, or pleural effusions are present. Minimal bibasilar dependent atelectasis is present. Otherwise, the lungs are clear and the airways are patent. No significant hilar, mediastinal, or axillary lymphadenopathy is present. In the right lobe of the thyroid is a 14-mm nodule, a small nodule is present in the left lobe. Although not evaluated for subdiaphragmatic evaluation, the liver appears diffusely fatty infiltrated without focal lesions. Remainder of the abdomen appears normal.\n\nPortable TTE ___ at 8:37:01 AM):\nThe left atrium is mildly dilated. No definite atrial septal defect or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers. There is mild symmetric left ventricular hypertrophy. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF>55%). Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no pericardial effusion.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Viral Pneumonia/15782217-DS-15.json b/Finished/Pneumonia/Viral Pneumonia/15782217-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..8889532cabe3a7a0a4ef29900896adfb19b96de8 --- /dev/null +++ b/Finished/Pneumonia/Viral Pneumonia/15782217-DS-15.json @@ -0,0 +1,50 @@ +{ + "Viral Pneumonia$Intermedia_4": { + "Positive respiratory virus antigen indicates respiratory virus infection$Cause_1": { + "Positive for Respiratory Viral Antigen.$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "An elevated white blood cell count, especially an increased proportion of neutrophils, is one of the symptoms of pneumonia.$Cause_1": { + "Labs were notable for an elevated WBC of 11.4 wtih 84% neutrophils$Input2": {} + }, + "An increase in neutrophils, usually indicating an acute infection such as pneumonia$Cause_1": { + "NEUTS-86.2$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Cough is a typical symptom of pneumonia$Cause_1": { + "cough$Input1": {} + }, + "Fever is a typical symptom of pneumonia$Cause_1": { + "fever$Input1": {} + }, + "Fever and cough are common symptoms of pneumonia$Cause_1": { + "presents with low-grade fevers of 99-100.2 and cough$Input2": {} + }, + "Persistent fever duration can indicate the presence of infection and is a warning sign of pneumonia$Cause_1": { + "first developed fevers 3 days ago$Input2": {} + }, + "A drop in oxygen saturation below 90% may indicate respiratory compromise, which is common in patients with pneumonia$Cause_1": { + "an oxygen level of 90%$Input2": {} + }, + "Productive coughing and shortness of breath are classic symptoms of pneumonia$Cause_1": { + "has a productive cough and shortness of breath over the past 3 days$Input2": {} + }, + "Increased dyspnea and frequent use of wheezing rescue inhalers may indicate increased pressure on the respiratory system, which may be related to lung infection$Cause_1": { + "been more dyspneic and has needed to take her albuterol inhaler more often.$Input2": {} + }, + "Asthma increases pneumonia risk$Cause_1": { + "asthma$Input3": {} + }, + "Obstructive sleep apnea may cause repeated nocturnal hypoxemia. This long-term low oxygen state may reduce the effectiveness of the immune system, thereby increasing the risk of pneumonia.$Cause_1": { + "OSA$Input3": {} + } + } + } + }, + "input1": "cough, fever\n", + "input2": "She is a 73 year old woman with a history of stage III follicular lymphoma grade II, currently cycle 2 day 14 of R-CHOP chemotherapy who presents with low-grade fevers of 99-100.2 and cough. She first developed fevers 3 days ago. She noted today to have an oxygen level of 90% when checked by her son. She also has a productive cough and shortness of breath over the past 3 days. She notes that she has been more dyspneic and has needed to take her albuterol inhaler more often. She denies headache, myalgias, abdominal pain, nausea, or diarrhea. She has slight sore throat and nasal congestion. She has 5 grandchildren who visit frequently.\n\nIn the emergency department, initial vitals: 98.0 105 142/77 22 96%. Labs were notable for an elevated WBC of 11.4 wtih 84% neutrophils. electrolytes were wnl. A CXR was normal. She was given levofloxacin 750 mg PO.\n", + "input3": "+OSA\n+asthma\n+hypothyroid\n+atrial fibrillation\n+vestibular schwannoma\n+DEXA scan showing osteopenia\n+hx of colon cancer s/p partial colon resection\n+Urge incontinence\n", + "input4": "Her father had colon cancer. Her biologic daughter had a negative colonoscopy.\n", + "input5": "VS: T98.0 BP 136/84 HR 80 RR 20 95%2L\nGENERAL: alert and oriented, NAD\nHEENT: No scleral icterus. PERRLA/EOMI. MMM. OP slightly red, no exudates. Neck Supple, No LAD.\nCARDIAC: irregular. Normal S1, S2. Systolic murmur at the left upper sternal border. \nLUNGS: CTA B, good air movement bilaterally.\nABDOMEN: NABS. Soft, NT, ND. No HSM\nEXTREMITIES: No c/c/e, 2+ dorsalis pedis/ posterior tibial \npulses.\nNEURO: A&Ox3. Appropriate. CN grossly intact. Preserved \nsensation throughout. strength throughout.\n", + "input6": "__ 08:20PM GLUCOSE-88 UREA N-9 CREAT-0.8 SODIUM-136 POTASSIUM-5.4* CHLORIDE-100 TOTAL CO2-27 ANION GAP-14\n___ 08:34PM LACTATE-1.1 K+-3.4\n___ 10:00PM PLT COUNT-187\n___ 10:00PM NEUTS-86.2* MONOS-5.6 EOS-1.4 BASOS-0.7\n___ 10:00PM RBC-3.92* HGB-12.3 HCT-38.8 MCV-99* MCH-31.3 MCHC-31.6 RDW-16.9*\n\nCXR ___:\nIMPRESSION: Enlarged cardiac silhouette without definite acute cardiopulmonary process\n\nRespiratory Viral Antigen Screen (Final ___: \nPositive for Respiratory Viral Antigen. Specimen screened for: Adeno, Parainfluenza 1, 2, 3, Influenza A, B,and RSV by immunofluorescence.\n" +} \ No newline at end of file diff --git a/Finished/Pneumonia/Viral Pneumonia/17763117-DS-13.json b/Finished/Pneumonia/Viral Pneumonia/17763117-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..8d91813f058e3f423381929c62e939e4ecc5d576 --- /dev/null +++ b/Finished/Pneumonia/Viral Pneumonia/17763117-DS-13.json @@ -0,0 +1,56 @@ +{ + "Viral Pneumonia$Intermedia_4": { + "This is direct evidence of viral pneumonia$Cause_1": { + "Culture screening find the existing of Adenovirus$Input6": {} + }, + "Pneumonia$Intermedia_3": { + "High white blood cell counts and elevated lactate often indicate the presence of infection and/or inflammation, which are common biochemical features of pneumonia$Cause_1": { + "WBC was 17.6 with 84% neutrophils, and lactate was elevated at 3.2$Input2": {} + }, + "White blood cells above the normal range, usually the body's response to infection, common in pneumonia$Cause_1": { + "WBC-17.6$Input6": {} + }, + "The proportion of neutrophils is significantly increased, pointing to pneumonia$Cause_1": { + "Neuts-69.1$Input6": {} + }, + "Often associated with lung infection$Cause_1": { + "perihilar haze and mild peribronchial$Input6": {} + }, + "The proportion of neutrophils is significantly increased, pointing to pneumonia .$Cause_1": { + "NEUTS-84.1$Input6": {} + }, + "Small bilateral pleural effusion is a common sign of pneumonia$Cause_1": { + "small bilateral pleural effusions$Input6": {} + }, + "Basal atelectasis is a common sign of pneumonia$Cause_1": { + "bibasilar atelectasis$Input6": {} + }, + "It may represent multiple small nodules in the lungs, which may be a sign of chronic or recurring infection.$Cause_1": { + "multiple punctate areas of high density throughout both lungs representative of multiple granulomas$Input6": {} + }, + "Suspected Pneumonia$Intermedia_2": { + "Difficulty breathing is a classic symptom of pneumonia$Cause_1": { + "Shortness of breath$Input1": {} + }, + "A cough accompanied by the production of yellow phlegm is often a sign of a lung infection$Cause_1": { + "complains of cough for two days with the production of yellow sputum$Input2": {} + }, + "Chills are the body's response to infection and are common in many types of infections, including pneumonia$Cause_1": { + "complains of chills for two days$Input2": {} + }, + "Short inhalation and exhalation times, coughing during deep breathing, and rales heard at the base of the right side are classic signs of lung infection. Rhales are common especially in pneumonia.$Cause_1": { + "Short inhalation and exhalation times, coughing on deep breaths, crackles ausculatated at right base,$Input5": {} + }, + "A slightly higher body temperature may be a sign of infection. Fever is common in patients with pneumonia.$Cause_1": { + "T 99.7$Input5": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "She is an 64 year-old with a history of CHF s/p CABG who complains of cough for two days with the production of yellow sputum. She also complains of chills for two days. She denies bloody sputum, increased fatigue from baseline, and increased diarrhea from baseline. She currently denies shortness of breath, chest pain, and abdominal pain. She only complains of feeling cold. She sleeps on two pillows due to orthopnea.\n\nShe says that shortly after receiving a flu vaccination two weeks ago, she began to have a runny nose and sneezing. She denies developing any fevers or sore throat. Otherwise she was at her typical baseline until she developed a cough two days ago. She describes her baseline as shortness of breath with exertion being unable climb a flight of stairs without stopping. She also complains of occasional angina at rest, decreased appetite, diarrhea that is worse on the days she takes colchicine, and mild stress incontinence with coughing.\n\nOn arrival to the ED, her WBC was 17.6 with 84% neutrophils, and lactate was elevated at 3.2\n", + "input3": "+CAD s/p CABG\n+VTach and VF s/p ICD\n+Junctional brady s/p PPM \n+Temporal Arteritis \n+HTN \n+Recurrent TIAs\n+Dyslipidemia \n+GERD \n+Gout \n+DVT/PE s/p IVC filter \n+Atrial Fibrillation \n+CHF EF 25% \n+PVD \n+Low back pain and herniated disc s/p multiple back surgeries and right-sided sciatica, s/p lumbar epidural steroid injection \n+Basal cell carcinoma on the right shin and skin infection on the forehead secondary to basal cell carcinoma\n+s/p CCY \n+Cystitis\n", + "input4": "Non-contributory\n", + "input5": "VITAL SIGNS: T 99.7 BP 140/58 HR 60 RR 20 O2 98% 1.5L \nGENERAL APPEARANCE: Fatigued, laying in bed with blankets up to face.\nHEENT: Normocelphalic/atraumatic, extraocular movements intact, mucous membranes moist, oropharynx no exudates, sores, or erythema\nNeck: No lymphadenopathy\nHEART: Normal S1 and S2, regular rate and rhythm, III/VI systolic murmur at right upper sternal border, JVD < 5cm\nLUNGS: Short inhalation and exhalation times, coughing on deep breaths, crackles ausculatated at right base, otherwise clear to auscultation bilaterally\nABDOMEN: Non-distended, non-tender, + bowel sounds in four quadrants, soft, no masses, no hepatosplenomegaly\nBACK: No costovertebral angle tenderness, spine tender to palpation throughout\nEXTREMITIES: Warm and well perfused, radial pulse paplated on right but not left, dorsal pedal pulses palpated bilaterally, \nSKIN: No rashes, sores, ulcers noted\nNEUROLOGICAL: Alert, awake, and attentive, cranial nerves II-XII intact, could not report her past medical history or medication list\nPSYCHOLOGICAL: Normal affect\n", + "input6": "___ 03:00AM WBC-17.6*# RBC-3.85* HGB-11.7* HCT-35.7* MCV-93 MCH-30.2 MCHC-32.7 RDW-15.5\n___ 03:00AM NEUTS-84.1* LYMPHS-9.2* MONOS-3.6 EOS-2.8 BASOS-0.3\n___ 05:50AM BLOOD WBC-6.7 RBC-3.01* Hgb-9.2* Hct-27.8* MCV-92 MCH-30.7 MCHC-33.2 RDW-15.5 Plt ___\n___ 05:50AM BLOOD Neuts-69.1 Lymphs-13.8* Monos-6.1 Eos-10.5* Baso-0.6\n\nCARDIAC ENZYMES\n___ 03:00AM BLOOD CK(CPK)-39\n___ 04:45PM BLOOD CK(CPK)-34\n___ 05:02AM BLOOD CK(CPK)-33\n___ 03:00AM BLOOD cTropnT-<0.01\n___ 04:45PM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 05:02AM BLOOD CK-MB-NotDone cTropnT-<0.01\n\nURINE\nURINALYSIS\n___ 09:47AM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 09:47AM URINE BLOOD-NEG NITRITE-POS PROTEIN-TR GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD\n___ 09:47AM URINE RBC-0 ___ BACTERIA-FEW YEAST-NONE \n___ 04:07AM URINE Color-Yellow Appear-Hazy Sp ___\n___ 04:07AM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-LG\n___ 04:07AM URINE RBC-17* WBC-44* Bacteri-FEW Yeast-NONE Epi-15 TransE-1\n\nVIRAL CULTURE (Final ___: \nCulture screening find the existing of Adenovirus, Influenza A & B, Parainfluenza type1,2 & 3, and Respiratory Syncytial Virus\n\nIMAGING \n\n___ CHEST XR (AP&LAT) \nFINDINGS: There is a pacer device overlying the left hemithorax with unchanged in appropriate position of pacer leads. Patient is status post median sternotomy with unchanged appropriate appearance of cerclage wires.\n \nThere is mild cardiomegaly, unchanged. There is calcification of the aortic arch and mild tortuosity of the aorta, also unchanged. There is mild prominence of the pulmonary vasculature representing mild failure. There is perihilar haze and mild peribronchial cuffing also associated with mild degree of failure. There are small bilateral pleural effusions and bibasilar atelectasis. There are multiple punctate areas of high density throughout both lungs representative of multiple granulomas. There is no pneumothorax.\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/11580528-DS-8.json b/Finished/Pulmonary Embolism/Low-risk PE/11580528-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..8e231055646e03a450e8045f65307ff3abd2cd5d --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/11580528-DS-8.json @@ -0,0 +1,44 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Moderate embolism in both lungs, which is direct evidence of PE.$Cause_1": { + "moderate bilateral pulmonary emboli$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "SOB is the symptom of PE$Cause_1": { + "shortness of breath$Input1": {} + }, + "Have metastatic non-small cell lung cancer (NSCLC, which has spread to the bones and chest wall) and low-grade B-cell non-Hodgkin lymphoma and are receiving chemotherapy. Both of these diseases and their treatments can increase the risk of blood clots forming, which can lead to pulmonary embolism$Cause_1": { + "metastatic NSCLC (to bone, chest wall) as well as low grade B-cell non-Hodgkin lymphoma$Input2": {} + }, + "Progressive dyspnea occurs. This is a common symptom of pulmonary embolism.$Cause_1": { + "progressive DOE$Input2": {} + }, + "Heparin is a commonly used drug for the prevention and treatment of thrombosis and may be a promising target for pulmonary embolism.$Cause_1": { + "started on IV Heparin$Input2": {} + }, + "High blood pressure increases risk of pulmonary embolism$Cause_1": { + "Hypertension$Input3": {} + }, + "Significantly higher than normal, this may indicate difficulty breathing, a common symptom of pulmonary embolism.$Cause_1": { + "Resp rate 94RA$Input5": {} + }, + "A sign of pulmonary embolism caused by the detachment of blood clots after venous thrombosis in the lower extremities$Cause_1": { + "2+ edema bilaterally to thighs$Input5": {} + }, + "The breath sounds in the left lower lung were weakened, which may be a direct manifestation of local blood flow obstruction in the lungs, which is consistent with the typical symptoms of pulmonary embolism.$Cause_1": { + "Decreased BS at left base o/w clear to auscultation$Input5": {} + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "Female with metastatic NSCLC (to bone, chest wall) as well as low grade B-cell non-Hodgkin lymphoma on chemotherapy who presents with right segmental PEs in RML/RLL. She reports noted progressive DOE for the last days. She denies chest pain, back pain, hemoptysis, lightheadedness, or syncope. She also denies fevers and chills. Her chronic pain is well controlled with MS. At rest she is comfortable without SOB.\n.\nIn ED, she showed no intracranial lesions. She was started on IV Heparin and sent to the floor.\n", + "input3": "Breast cancer - as above\nMetastatic NSCLC\nB-cell lymphoplasmocytic lymphoma\nIgM kappa monoclonal gammopathy\nh/o recurrent pneumothoraces blebs, s/p thoracotomy \nw/ bleb removal\nHypertension\nOsteopenia\nleft lobectomy\ns/p bilateral knee surgeries\ns/p appendectomy\ns/p partial chest wall resection \n\n", + "input4": "Grandmother died of breast CA. Mother died of \"natural causes\". Father not well known. Brother ied of pulmonary fibrosis.\n", + "input5": "Physical Exam:\nVITAL SIGNS:\nTemperature 97.1\nBlood pressure 110/78\nHeart rate 74\nResp rate 94RA\nGENERAL: Appears very comfortable, in no distress.\nHEENT: Sclerae anicteric. Oropharynx is clear without lesions or thrush.\nNECK: Supple, without lymphadenopathy.\nLUNGS: Decreased BS at left base o/w clear to auscultation.\nHEART: Regular rate and rhythm. ii/vi SM LSB\nABDOMEN: Soft, nontender, nondistended, normal bowel sounds. \nEXTREMITIES: 2+ edema bilaterally to thighs. No cords.\nSKIN: No rash.\n\ufeff\n", + "input6": ": 14.01 PTT: 31.5 INR: 1.2 \n.\n140 AGap=13 \n---------------- \n4.4 30 0.8 \n. \nALT: 31 AP: 104 Tbili: 0.8 \nAST: 31 LDH: 280 \n.\nCEA: 129\n.\nWBC 5.5 HCT 38.9 PLT 161 \n: 3350 \n.\nNCHCT: No definite evidence of metastases, though noncontrast CT \nis limited. No hemorrhage or edema.\n.\nCTA Chest: \n1. No significant change in comparison at the confluent anterior mediastinal nodal mass, large left effusion, and postoperative changes of the left lung. \n2. Interval increase in the right pleural effusion. \n3. Not mentioned above, multiple foci of sclerosis within the sternum, concerning for metastatic disease. Correlate with bone scan. \n\ufeff4. moderate bilateral pulmonary emboli\n\ufeff5. The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/11590913-DS-13.json b/Finished/Pulmonary Embolism/Low-risk PE/11590913-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..cee65f9b920662015cab9cc4eb545a709aed9463 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/11590913-DS-13.json @@ -0,0 +1,41 @@ +{ + "Low-risk PE$Intermedia_4": { + "The right heart has not been significantly affected, and submassive PE is ruled out.$Cause_1": { + "The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Filling defects were observed in all segmental arteries except the left upper lobe artery, consistent with extensive bilateral pulmonary embolism. Pulmonary embolism is usually caused by a blood clot blocking an artery in the lungs, resulting in obstruction of blood flow.$Cause_1": { + "Filling defects within the pulmonary arterial system are noted in all segmental arteries with the exception of the left upper lobe artery, compatible with widespread bilateral pulmonary emboli.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Blood clots block blood vessels in the lungs, reducing the lungs' ability to exchange oxygen and causing breathing difficulties$Cause_1": { + "Shortness of Breath$Input1": {} + }, + "One of the classic symptoms of pulmonary embolism, usually manifested during physical activity due to increased cardiopulmonary load$Cause_1": { + "shortness of breath while walking$Input2": {} + }, + "Worsening dyspnea on exertion is also a possible symptom of pulmonary embolism.$Cause_1": { + "noted no dyspnea at rest, but it was repeatedly exacerbated wtih exertion$Input2": {} + }, + "Uterine fibroids may be associated with changes in hormone levels, which indirectly affect blood coagulation and may increase the risk of pulmonary embolism.$Cause_1": { + "history of fibroids$Input2": {} + }, + "Pregnancy and miscarriage are risk factors for thrombosis and may increase the risk of pulmonary embolism.$Cause_1": { + "denies frequent miscarraiges though she has never been pregnant save for a single abortion due to fibroids$Input2": {} + }, + "Hypertension is the risk factor of PE$Cause_1": { + "Hypertension$Input3": {} + }, + "High blood pressure is the risk factor of PE$Cause_1": { + "152/94$Input5": {} + } + } + } + }, + "input1": "Shortness of Breath\n", + "input2": "This is a healthy female with a history of fibroids who developed shortness of breath while walking. She had no precipitating features such as chest pain, cough, sore throat, fever. She noted no dyspnea at rest, but it was repeatedly exacerbated wtih exertion. She had no precipitating features of stasis such as long plane ride, surgery, or bed ridden state. She had no leg swelling. Her PCP checked Dimer without evidence of R heart strain.On further discussion, she denies frequent miscarraiges though she has never been pregnant save for a single abortion due to fibroids. No family history of blood clots or frequent miscarraiges. No recent trauma to her legs.In the ED, initial vitals: 98.1 18 98% RA.Labs/Studies notable for: Na 130 and K 5.2. She was started on heparin gtt and transferred tothe floor.On arrival to the floor, the patient has no chest pain, no SOB lying still, and otherwise feels her regualr self. She has no pleurisy, no fever.\nROS:\nPlease refer to HPI for pertinent positives and negatives. 10 point ROS is otherwise negative.\n", + "input3": "MEDICAL & SURGICAL HISTORY:\nHypertension\n", + "input4": "No blood clots, frequent miscarraiges as far as she knows, no cancer in immediate family\n", + "input5": "Physical Exam:\nVitals: 98.5 152/94 86 18 97%RA\nGeneral: AAOx3, comfortable appearing, in NAD\nHEENT: NCAT, EOMI, PERRL. Sclera anicteric, conjunctiva pink. \nMMM. OP clear.\nNeck: supple, no LAD, no JVP elevation\nLungs: CTAB, no w/r/r\nCV: RRR, normal S1 and S2, no m/g/r\nAbdomen: NABS, soft, nondistended, nontender. No HSM.\nGU: no foley\nExt: WWP. 2+ peripheral pulses. No edema.\nNeuro: Pupils equal round reactive\n\ufeff\n", + "input6": "___ 04:00PM BLOOD WBC-7.4 RBC-5.20 Hgb-11.4* Hct-38.5 MCV-74* MCH-22.0* MCHC-29.8* RDW-17.8*\n___ 06:12AM BLOOD WBC-6.4 RBC-4.86 Hgb-10.8* Hct-35.3* MCV-73* MCH-22.2* MCHC-30.6* RDW-17.8*\n___ 04:00PM BLOOD Glucose-92 UreaN-8 Creat-0.7 Na-130* K-5.2* Cl-93* HCO3-23 AnGap-19\n___ 04:00PM BLOOD cTropnT-<0.01\n\ufeff\nIMAGING\nCTA\nThe aorta and its major branch vessels are patent, with no evidence ofstenosis, occlusion, dissection, or aneurysmal formation. There is no evidenceof penetrating atherosclerotic ulcer or aortic arch atheroma present.\n \nThe pulmonary arteries are well opacified to the subsegmental level. Filling defects within the pulmonary arterial system are noted in all segmental arteries with the exception of the left upper lobe artery, compatible with widespread bilateral pulmonary emboli. The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.\n \nThere is no evidence of pericardial effusion.\n \nA 3 mm perifissural ground-glass nodule is incidentally noted in the rightmiddle/upper lobes following no CT followup is required. There is no pleuraleffusion. The airways are patent to the subsegmental level.\n \nThere is no supraclavicular, axillary, mediastinal, or hilar lymphadenopathy.The thyroid gland appears unremarkable.\n \nLimited images of the upper abdomen are unremarkable.\n \nNo lytic or blastic osseous lesion suspicious for malignancy is identified.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/12341559-DS-15.json b/Finished/Pulmonary Embolism/Low-risk PE/12341559-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..f4c1364a59df840e98f529154004203e42043cdc --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/12341559-DS-15.json @@ -0,0 +1,53 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "D-dimer is a biochemical marker of thrombosis and is often used to assess the possibility of pulmonary embolism.$Cause_1": { + "D-dimer at the time was +$Input2": {} + }, + "A filling defect in the right lower lobe may directly indicate pulmonary embolism$Cause_1": { + "small RLL filling defect$Input2": {} + }, + "A significant increase in dimers indicates possible thrombosis in the body.$Cause_1": { + "D-Dimer-863$Input6": {} + }, + "A tiny filling defect in a small branch of the right lower lobe pulmonary artery is a direct sign of pulmonary embolism.$Cause_1": { + "Tiny filling defect noted in the subsegmental branch of the posteriorsegment of the right lower lobe pulomary artery with a small right-sided pleural effusion.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Abdominal pain may be related to other disorders in the abdomen or may be reflex pain, as is sometimes seen with pulmonary embolism$Cause_1": { + "RUQ \"gassy\" abdominal pain$Input2": {} + }, + "Increasing pain when breathing is a warning sign of pulmonary embolism, which may be caused by a blockage of blood flow to the lungs.$Cause_1": { + "pain is worse when taking a deep breath$Input2": {} + }, + "Dyspnea is also a common symptom of pulmonary embolism.$Cause_1": { + "difficult to take a deep breath$Input2": {} + }, + "Fever can be a nonspecific manifestation of pulmonary embolism$Cause_1": { + "fever to 101$Input2": {} + }, + "A rapid heart rate ay be a physiological response to hemodynamic changes and is a common symptom of pulmonary embolism.$Cause_1": { + "tachycardia to the 130's.$Input2": {} + }, + "A small amount of right pleural effusion may be an inflammatory reaction caused by pulmonary embolism$Cause_1": { + "small R.sided pleural effusion$Input2": {} + }, + "Pulmonary embolism may cause difficulty breathing, especially when taking a deep breath. This may be because the embolus blocks blood flow to the lungs and affects the normal ventilation function of the lungs.$Cause_1": { + "CTA B, good air movement biaterally, but poor inspiratory effort.$Input5": {} + }, + "Pulmonary embolism may cause chest and abdominal pain, especially deep embolism, which may increase the right heart load and indirectly affect the abdominal organs.$Cause_1": { + "NABS. TTP RUQ, epigastric area and LUQ to palp. +voluntary guarding. +BS,$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "Pt is a male with PMH of costochondritis who presented to the ED today with RUQ \"gassy\" abdominal pain. Pt reports that he originally developed this pain a few months ago. He reports that the pain is worse when taking a deep breath and it is difficult to take a deep breath the pain. He however denies, n/v/d/c/melena/brbpr/CP/SOB/palp. He originally presented a few months ago where a CT scan was performed and reportedly negative. Pt reports pain had been intermittent over the last few months and had subsided until yesterday when he reported the same time of pain a fever to 101. He had to leave work and then presented ED where he initially triggered for tachycardia to the 130's. Pt underwent a CT of the torso that originally wet read stated small R.sided pleural effusion. D-dimer at the time was +. Pt was sent home with NSAIDS a z-pack and a PPI. However, final read returned with a small RLL filling defect and pt was called to return to the ED.Pt denies recent travel via plane or car, smoking, family h.o of blood clots, recent immobility. also denied any h.o leg/calf swelling.\n.\nIn the emergency department, initial vitals:\nTime Pain Temp HR BP RR Pox 104 142/83 18 99%RA HR 97, BP 129/55, RR 24, 02 94% on Ra. Pt was guaiac negative and started on a heparin gtt in the ED.\n", + "input3": "costochondritis\n", + "input4": "Denies h.o blood clots\n", + "input5": "Physical Exam:\nVS:T. 98.4, BP 126/76, HR 86, RR 18 sat 99% on RA\nGENERAL: NAD, sitting upright in bed, speaking in full sentences.\nHEENT: No scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No LAD.\nCARDIAC: RR. Normal S1, S2. No m/r/g.\nLUNGS: CTA B, good air movement biaterally, but poor inspiratory effort.\nABDOMEN: NABS. TTP RUQ, epigastric area and LUQ to palp. +voluntary guarding. +BS,\nEXTREMITIES: No c/c/e, 2+ dorsalis pedis/ posterior tibial pulses. Calves non-tender, no cords or erythema.\nNEURO: A&Ox3. Appropriate. CN grossly intact\n", + "input6": "Labs on Admission:\n___ 04:30PM BLOOD WBC-12.7* RBC-4.86 Hgb-14.3# Hct-41.9 MCV-86 MCH-29.5 MCHC-34.2 RDW-12.6\n___ 10:24PM BLOOD PTT-29.3\n___ 04:30PM BLOOD Glucose-115* UreaN-15 Creat-0.8 Na-139 K-3.8 Cl-101 HCO3-27 AnGap-15\n___ 04:30PM BLOOD ALT-29 AST-17 AlkPhos-91 TotBili-1.1\n___ 04:30PM BLOOD Lipase-22\n___ 04:30PM BLOOD proBNP-9\n___ 04:30PM BLOOD Calcium-9.0 Phos-2.6* Mg-1.8\n___ 04:30PM BLOOD D-Dimer-863*\n.\nImaging:\nCTA CHEST W&W/O C&RECONS, NON-CORONARY ___\n1. Tiny filling defect noted in the subsegmental branch of the posteriorsegment of the right lower lobe pulomary artery with a small right-sided pleural effusion.\n2. Normal appendix, normal pancreas, no evidence of perforation.\n3. Enlarged spleen.\n\ufeff4.The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/12759698-DS-3.json b/Finished/Pulmonary Embolism/Low-risk PE/12759698-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..1dfd39ea5d5b268961c7d130f1c814420b63ba7d --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/12759698-DS-3.json @@ -0,0 +1,35 @@ +{ + "Low-risk PE$Intermedia_4": { + "The structure of right heart is normal, and submassive PE is ruled out.$Cause_1": { + "The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Filling defect refers to the presence of abnormal material in the blood vessel, which may be a blood clot. This is a key sign for diagnosing pulmonary embolism.$Cause_1": { + "a filling defect in the right pulmonary embolism$Input2": {} + }, + "There is a soft tissue filling defect in the distal right main pulmonary artery, consistent with thrombus$Cause_1": { + "Soft tissue filling defect in the distal right main pulmonar artery is consistent with a thrombus$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "The patient is currently receiving a clinical trial of a PD1/TK1 inhibitor. Certain cancer treatment drugs may affect blood coagulation and increase the risk of embolism.$Cause_1": { + "PD1/TK1 trial therapy$Input2": {} + }, + "Patients may have metastases to the pancreas, lungs, and adrenal glands. Metastatic cancer is often associated with systemic inflammation and coagulopathy, which increases the risk of pulmonary embolism.$Cause_1": { + "probable metasteses to the pancreas, lung and adrenal glands$Input2": {} + }, + "The electrocardiogram showed signs of increased right ventricular stress, probably due to a blood clot in the pulmonary artery that increases the pressure on the lungs to pump blood.$Cause_1": { + "some classic EKG changes for right heart strain$Input2": {} + }, + "Hypertriglyceridemia is one of the risk factors for atherosclerosis and may increase blood viscosity and slow blood flow, thereby increasing the risk of thrombosis.$Cause_1": { + "hypertriglyceridemia$Input3": {} + } + } + } + }, + "input1": "None\n", + "input2": "Patient seen and examined, agree with house officer admit note with additions below:\n\ufeff\nMale with metastatic renal cell carcinoma who presents from clinic, after an outpatient staging CT demonstrated a filling defect in the right pulmonary embolism. The patient has widely metastatic cancer, and is status-post a nephrectomy, lung wedge resection and is currently on PD1/TK1 trial therapy. He has probable metasteses to the pancreas, lung and adrenal glands. He was asymptomatic, and was undergoing a routine staging CT, which was not timed as a CTA but was concerning for a large filling defect in the right main pulmonary artery.\n\ufeff\nThe patient was sent to the ED from radiology, and despite there not being an exact agreement on whether this represents an actual PE given the study was not timed for pulmonary artery imaging, he is clearly high-risk for thrombosis given his metastatic cancer. Bilateral LENIs were performed in the ED which were negative. While he had some classic EKG changes for right heart strain, this was not changed from prior EKGs. He was not hypoxemic in the ED, with a SAO2 of 98% on room air. The plan was to start empiric enoxoparin, and while a repeat CTA would be desirable, this was not done given the risk to his lone kidney on top of the recent dye load.\n\ufeff\n", + "input3": "PAST ONCOLOGIC HISTORY: \n\n+ bilateral hernioraphy\n+ hypertriglyceridemia\n\ufeff\n", + "input4": "Denies any Family History of Hypertension, clotting disorders, blood clots, cancer\n", + "input5": "Physical Exam:\nROS:\nGEN: - fevers, - Chills, - Weight Loss\nEYES: - Photophobia, - Visual Changes\nHEENT: - Oral/Gum bleeding\nCARDIAC: - Chest Pain, - Palpitations, - Edema\nGI: - Nausea, - Vomitting, - Diarhea, - Abdominal Pain, - \nConstipation, - Hematochezia\nPULM: - Dyspnea, - Cough, - Hemoptysis\nHEME: - Bleeding, - Lymphadenopathy\nGU: - Dysuria, - hematuria, - Incontinence\nSKIN: - Rash\nENDO: - Heat/Cold Intolerance\nMSK: - Myalgia, - Arthralgia, - Back Pain\nNEURO: - Numbness, - Weakness, - Vertigo, - Headache\n\n", + "input6": "___ 07:00PM BLOOD WBC-4.7 RBC-3.85* Hgb-13.9* Hct-41.3 MCV-107* MCH-35.9* MCHC-33.5 RDW-13.5\n___ 07:00PM BLOOD Neuts-47.7* Monos-9.7 Eos-7.8* Baso-0.7\n___ 07:00PM BLOODPTT-28.2\n___ 07:00PM BLOOD Glucose-97 UreaN-22* Creat-1.0 Na-140 K-4.0 Cl-104 HCO3-23 AnGap-17\n___ 07:00PM BLOOD cTropnT-<0.01\n___ 07:00PM BLOOD proBNP-14\n___ 09:10PM URINE Color-Straw Appear-Clear\n___ 09:10PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n\ufeff\nCT ABD & PELVIS WITH CONTRAST Study Date of 11:13 AM \nIMPRESSION: \nPreliminary Report 1. Stable pancreatic lesion. Stable sclerotic focus in the left iliac bone. No new lesion suspicious for metastatic disease within the abdomen or pelvis. \n \nCT CHEST W/CONTRAST Study Date of 12:39\nIMPRESSION: \nSoft tissue filling defect in the distal right main pulmonar artery is consistent with a thrombus\n\nBILAT LOWER EXT VEINS Study Date of8:07\nIMPRESSION: \nNo evidence of DVT in the right or left lower extremity. \n\ufeff\nCT HEAD W/O CONTRAST Study Date of 8:13\nIMPRESSION:\nNo evidence of acute intracranial process. MRI would be more \nsensitive to evaluate for intracranial lesions. \n\nThe main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.\n\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/12763117-DS-14.json b/Finished/Pulmonary Embolism/Low-risk PE/12763117-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..45fe1cc5a0a596708e64faea41ef9a7ddd465bbc --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/12763117-DS-14.json @@ -0,0 +1,38 @@ +{ + "Low-risk PE$Intermedia_4": { + "The right heart has not been significantly affected, and submassive PE is ruled out.$Cause_1": { + "The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.\n\ufeff$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Segmental and subsegmental pulmonary embolism in the right lower lobe is direct evidence for the diagnosis of PE$Cause_1": { + "Right lower lobe segmental and subsegmental emboli$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Metastatic lung cancer is a risk factor for PE because malignancy increases the tendency of the blood to clot, thereby increasing the risk of thrombosis.$Cause_1": { + "Patient with h/o metastatic SCLC to theliver and brain$Input2": {} + }, + "Doctors may suspect that a person is at risk for thrombosis or that a thrombosis already exists; anticoagulation is a common approach to preventing and treating PE.$Cause_1": { + "admission for anticoagulation management$Input2": {} + }, + "A history of DVT is a very important direct precursor to pulmonary embolism$Cause_1": { + "DVT perisurgically years ago$Input3": {} + }, + "COPD may lead to changes in pulmonary hemodynamics, which, combined with chronic inflammatory states, can increase the risk of pulmonary embolism.$Cause_1": { + "COPD$Input3": {} + }, + "Sinus bradycardia may indicate limited cardiac output and is associated with increased cardiac workload associated with PE$Cause_1": { + "reg brady$Input5": {} + }, + "Prolonged clotting time may be related to risk factors for PE such as anticoagulant therapy or coagulopathy$Cause_1": { + "PTT-67.3$Input6": {} + } + } + } + }, + "input1": "None\n", + "input2": "Patient with h/o metastatic SCLC to theliver and brain (most recently C2D1 carboplatin AUC 5 + etoposide) on outpatient CT for progression evaluation. Referred in for admission for anticoagulation management. Patient has no complaints, including no CP, SOB,dizziness, cough. No pain w/ deep inspiration or calf pain/tenderness. Pt did not wish to be hospitalized. \n\ufeff\n", + "input3": "PMH/PSH:\n- Stroke years ago with mild left residual weakness,\nalthough he is able to ambulate without assistant with a cane. \n- DVT perisurgically years ago, \n- MUGA (per med records: patient and his family is not aware)\n- COPD (per med records: patient and his family is not aware)\n\ufeff\n\n", + "input4": "Mother passed away a few months ago. Father deceased from complications of acute appendicitis. The rest of the family history is unknown. He denied any known diagnosis of cancer in the family.\n\ufeff\n", + "input5": "Physical Exam:\nPhysical Examination:\nVS: 98.3 132/66 48 18 96%RA\nGEN: Alert, no acute signs of distress.\nHEENT: NCAT, Pupils equal and reactive, sclerae non-icteric, MMM.\nNeck: Supple\nCV: S1S2, reg brady, no murmurs, rubs or gallops.\nRESP: clear bilaterally\nABD: Soft, non-tender, non-distended, no hepatosplenomegaly\nEXTR: No lower leg edema\nDERM: No active rash. several tattoos\nNeuro: muscle strength grossly full and symmetric in all major muscle groups\nPSYCH: Appropriate and calm.\n\ufeff\n", + "input6": "___ 07:06AM BLOOD WBC-2.7*# RBC-3.97* Hgb-11.2* Hct-35.0* MCV-88 MCH-28.2 MCHC-32.0 RDW-15.0\n___ 09:00AM BLOOD WBC-1.0* RBC-4.03* Hgb-11.7* Hct-36.6* MCV-91 MCH-29.0 MCHC-31.9 RDW-15.1\n___ 08:00PM BLOOD WBC-0.8*# RBC-4.15* Hgb-12.2* Hct-37.4* MCV-90 MCH-29.5 MCHC-32.8 RDW-14.9\n___ 09:30AM BLOOD WBC-1.7*# RBC-3.85* Hgb-11.0* Hct-34.7* MCV-90 MCH-28.5 MCHC-31.7 RDW-14.8\n___ 07:06AM BLOOD Neuts-32* Bands-1 Lymphs-47* Monos-9 Eos-1 Baso-1 Atyps-4* Metas-1* Myelos-4*\n___ 08:00PM BLOOD Neuts-22* Bands-0 Lymphs-64* Monos-12* Eos-2 Baso-0 Myelos-0\n___ 07:06AM BLOOD PTT-67.3*\n___ 07:06AM BLOOD Glucose-95 UreaN-18 Creat-1.1 Na-139 K-3.9 Cl-105 HCO3-27 AnGap-11\n___ 07:06AM BLOOD ALT-8 AST-10 AlkPhos-67 TotBili-0.3\n___ 09:00AM BLOOD CK-MB-1 cTropnT-<0.01 proBNP-406\n___ 07:06AM BLOOD Calcium-8.8 Phos-3.8 Mg-1.9\n___ 08:09PM BLOOD Glucose-108* Lactate-2.3* Na-139 K-4.7 Cl-104 calHCO3-23\n___ 08:09PM BLOOD Hgb-12.7* calcHCT-38\n\ufeff\nb/l LENIs:\nIMPRESSION: No lower extremity DVT. \n\ufeff\nabd/pelvic CT:\n1. Marked decrease in metastatic disease. Multiple \nmetastatic lesions scattered throughout the liver have decreased in size. Segment II lesion has decreased from 2.1 cm to 1.4 cm. Previous soft tissue metastasis adjacent to the bilateral kidneys and near the aortic bifurcation are not seen on this exam. Pancreatic and gallbladder masses are not seen. Left adrenal gland nodule has decreased from 1.7 cm to 0.9 cm.\n2. Right adrenal gland nodule measuring 1.2 cm, stable .\n\ufeff\nchest CT with contrast:\nIMPRESSION:\n1. Substantial interval improvement of extensive left upper lobe mass, obstruction of the segmental bronchi of the left upper lobe and mediastinal lymphadenopathy as described.\n2. Right lower lobe segmental and subsegmental emboli. No evidence of the right heart strain.\n3. Stable pulmonary nodules as well as pulmonary emphysema, mild asdescribed.\n\ufeff\nhead MRI:\nIMPRESSION: The previously metastatic lesions have decreased in size and are less appreciated. No definite new lesions are seen. \nOtherwise, the examination is stable since the previous MRI.\n\nThe main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/12831732-DS-11.json b/Finished/Pulmonary Embolism/Low-risk PE/12831732-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..1e5f4741003c6c75349f8424e03fb72d457f135d --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/12831732-DS-11.json @@ -0,0 +1,38 @@ +{ + "Low-risk PE$Intermedia_4": { + "The right heart has not been significantly affected, and submassive PE is ruled out.$Cause_1": { + "The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "The presence of abnormal material in the pulmonary artery system, which may be a blood clot. This is a typical symptom of pulmonary embolism$Cause_1": { + "Filling defects within the pulmonary arterial system are noted in all segmental arteries with the exception of the left upper lobe artery, compatible with widespread bilateral pulmonary emboli.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "A common symptom of PE$Cause_1": { + "Shortness of breath$Input1": {} + }, + "If the INR value is not maintained within the therapeutic range, the risk of thrombosis may increase, which may in turn induce or aggravate pulmonary embolism.$Cause_1": { + "problems maintaining his INR in the threperutic range throughout this time$Input2": {} + }, + "Antiphospholipid syndrome is an autoimmune disease in which abnormal antibodies in the body increase the risk of blood clots.$Cause_1": { + "dx with anti-phospholipid syndrome$Input2": {} + }, + "Pleuritic pain usually manifests as sharp pain when breathing and is one of the typical symptoms of pulmonary embolism$Cause_1": { + "continuous pleuritic pain with inhalation$Input2": {} + }, + "A risk of PE$Cause_1": { + "DVT$Input3": {} + }, + "Family history of DVT increase the risk of PE$Cause_1": { + "mother w/ DVT, CVA x2, grandmother w/ DVT$Input4": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "Pt has been on coumadin as outpatient, also dx with anti-phospholipid syndrome at that admission. Reports that there were problems maintaining his INR in the threperutic range throughout this time. INR was usual between 1.7 and 1.9 for much of the period. Reports that there was one instance when INR was at 2.7 and at that time he was instructed to reduce his coumadin dosage. Current coumadin dose is 10mg PO DAILY. \n. \nHe has adjusted to this by reducing his activity substantially. Pt also reports continuous pleuritic pain with inhalation to present.\n", + "input3": "DVT\n", + "input4": "mother w/ DVT, CVA x2, grandmother w/ DVT\n", + "input5": "Physical Exam:\nafebrile, normotensive, satting well on room air \nGEN: NAD, awake, alert \nHEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP moist and without lesion \nNECK: Supple, no JVD \nCV: Reg rate, normal S1, S2. No m/r/g. \nCHEST: Resp were unlabored, no accessory muscle use. CTAB, no \ncrackles, wheezes or rhonchi. \nABD: Soft, NT, ND, no HSM \nEXT: No c/c/e \nSKIN: No rash \n\ufeff\n", + "input6": "CBC: \n___ 12:09AM BLOOD WBC-7.6 RBC-4.86 Hgb-14.7 Hct-41.3 MCV-85 MCH-30.2 MCHC-35.5* RDW-13.7\n___ 05:27AM BLOOD WBC-5.0 RBC-4.89 Hgb-14.6 Hct-41.2 MCV-84 MCH-29.8 MCHC-35.3* RDW-13.6\n\ufeff\nChemistry: \n___ 12:09AM BLOOD Glucose-100 UreaN-17 Creat-1.2 Na-139 K-4.0 Cl-102 HCO3-27 AnGap-14\n___ 05:27AM BLOOD Glucose-83 UreaN-19 Creat-1.1 Na-139 K-4.1 Cl-103 HCO3-26 AnGap-14\n___ 05:27AM BLOOD Calcium-9.5 Phos-4.6* Mg-2.1\n\ufeff\nECG:\nSinus rhythm. High QRS voltage. Inferolateral ST segment elevation is non-specific. Clinical correlation is suggested. T wave inversions in leads V1-V2 are also non-specific. Cannot exclude right ventricular volume overload. No previous tracing available for comparison.\n\nFilling defects within the pulmonary arterial system are noted in all segmental arteries with the exception of the left upper lobe artery, compatible with widespread bilateral pulmonary emboli.\n\nThe main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/13327415-DS-25.json b/Finished/Pulmonary Embolism/Low-risk PE/13327415-DS-25.json new file mode 100644 index 0000000000000000000000000000000000000000..ffddabb5ef38b8095236aa6aa9bfe341aba71b82 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/13327415-DS-25.json @@ -0,0 +1,44 @@ +{ + "Low-risk PE$Intermedia_4": { + "The right heart has not been significantly affected, and submassive PE is ruled out.$Cause_1": { + "The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Elevated D-dimer levels (>500 ng/mL) are a common laboratory finding of pulmonary embolism.$Cause_1": { + "D-DIMER-1698$Input6": {} + }, + "The scan showed decreased perfusion in the posterior segment of the right upper lobe and the posterolateral segment of the left lung base, which is a typical radiographic finding of pulmonary embolism and indicates possible blood flow obstruction.$Cause_1": { + "Perfusion images in the same 8 views show a large area of decreased perfusion inthe posterior segment of the right upper lobe and a small area of decreasedperfusion in the lateral and posterior basal segments of the left lobe.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "chest pain is a common symptom for PE$Cause_1": { + "Chest pain$Input1": {} + }, + "PE usually causes chest pain, especially with deep breathing.$Cause_1": { + "R sided chest pain$Input2": {} + }, + "Pulmonary embolism may make it difficult for patients to sleep$Cause_1": { + "Didn't sleep well$Input2": {} + }, + "Chest pain that does not go away may indicate a more serious condition$Cause_1": { + "aching has persisted all day,$Input2": {} + }, + "Patients with type 2 diabetes may have an increased risk of thrombosis due to increased blood viscosity$Cause_1": { + "DM2$Input3": {} + }, + "Heart failure may cause slow blood flow, increasing the likelihood of blood clots forming, which can increase the risk of pulmonary embolism.$Cause_1": { + "CHF$Input3": {} + }, + "Blood pressure shows high systolic pressure may indicate PE$Cause_1": { + "160/58$Input5": {} + } + } + } + }, + "input1": "Chest pain\n", + "input2": "She year old M who presents with R sided chest pain. Pain began last night while lying in bed. Dull aching pain only in right chest. Didn't sleep well overnight. Though denies shortness of breath. The aching has persisted all day, and was only relieved with morphine in the ER. Vomited twice yesterday, and continues to feel nauseated today.No history of DVTs or bleeding. Occasionally has mild bilateral edema. No recent surgeries or trauma. No history of long car rides or plane rides. Non smoker (quit years ago). Prior to yesterday, patient was in his usual state of health.\n", + "input3": "1. DM2 -latest A1C 6.1%\n2. CAD s/p CABG\n3. s/p MI years ago)\n4. CHF: echo -EF -moderate MR, moderate to severe TR\n5. h/o afib -per chart. Patient denies this.\n6. CKD -baseline Cr 2.3\n7. Peripheral neuropathy \n8. Hypertension - not currently being treated \n9. PVD s/p fem-pop bypass\n10. Hypercholesteremia \n11. Depression \n12. Memory loss \n13. CVA\n", + "input4": "non-contributory\n", + "input5": "Physical Exam:\nVitals 160/58 HR 54 RR 18 O2 100% 2L T 96.1\nGen: Well appearing, NAD\nHEENT: Supple, No LAD. MMM. No oral lesions.\nCV: RRR. No murmurs.\nResp: CTAB. No wheezes.\nAbd: Soft, NT, ND. No masses.\nExtremities: Warm, well perfused. No edema.\n", + "input6": "___ 12:50PM D-DIMER-1698*\n___ 12:50PM WBC-8.1 RBC-4.68 HGB-14.1 HCT-38.4* MCV-82 MCH-30.1 MCHC-36.7*# RDW-14.7\n___ 12:50PM NEUTS-79.6* LYMPHS-12.1* MONOS-4.7 EOS-3.3 BASOS-0.4\n___ 12:50PM PTT-28.3\n___ 12:50PM cTropnT-0.08*\n___ 12:50PM LIPASE-140*\n___ 12:50PM ALT(SGPT)-27 AST(SGOT)-29 CK(CPK)-73 ALK PHOS-100 TOT BILI-0.7\n___ 12:50PM GLUCOSE-174* UREA N-63* CREAT-2.3* SODIUM-139 POTASSIUM-5.3* CHLORIDE-103 TOTAL CO2-27 ANION GAP-14\n___ 05:15PM cTropnT-0.07*\n\ufeff\nV/Q Scan:\nPerfusion images in the same 8 views show a large area of decreased perfusion inthe posterior segment of the right upper lobe and a small area of decreasedperfusion in the lateral and posterior basal segments of the left lobe. Theventilation to both lungs is normal.\nChest x-ray shows cardiomegaly.\n\nThe main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.\n\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/13420510-DS-15.json b/Finished/Pulmonary Embolism/Low-risk PE/13420510-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..a11565fb4b78d605f3b2d7c568969f907b48a4ff --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/13420510-DS-15.json @@ -0,0 +1,53 @@ +{ + "Low-risk PE$Intermedia_4": { + "The right heart has not been significantly affected, and submassive PE is ruled out.$Cause_1": { + "The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Elevated D-dimer levels (>500 ng/mL) are a common laboratory finding of pulmonary embolism.$Cause_1": { + "D-DIMER-1698$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "SOB is a common symptom of PE$Cause_1": { + "Shortness of breath$Input1": {} + }, + "Chronic obstructive pulmonary disease may worsen symptoms of pulmonary embolism$Cause_1": { + "chronic obstructive pulmonary disease$Input2": {} + }, + "Blocked blood flow causes ischemia of some lung tissue, which may manifest as hypoxemia, a manifestation of PE$Cause_1": { + "hypoxia related to volume overload$Input2": {} + }, + "Dyspnea is a common symptom of pulmonary embolism.$Cause_1": { + "became dyspnic$Input2": {} + }, + "Pulmonary embolism may cause chest pain$Cause_1": { + "lower chest pain$Input2": {} + }, + "Patients with coronary artery disease may have an increased risk of thrombosis due to arteriosclerosis, which impedes blood flow.$Cause_1": { + "CAD$Input3": {} + }, + "Diabetic patients have increased blood viscosity, which may lead to decreased blood flow and increase the risk of thrombosis$Cause_1": { + "DMII$Input3": {} + }, + "Hyperlipidemia increases the risk of thrombosis by affecting blood viscosity and blood vessel health.$Cause_1": { + "hyperlipidemia$Input3": {} + }, + "High blood pressure may cause damage to blood vessels, thus promoting the formation of blood clots$Cause_1": { + "hypertension$Input3": {} + }, + "Smoking is a known factor in vascular inflammation and altered blood flow, and long-term smoking increases the risk of blood clots and pulmonary embolism.$Cause_1": { + "tobacco use$Input3": {} + }, + "Decreased breath sounds throughout the lungs and bibasilar rales may indicate pathological changes in the lungs, which is related to pulmonary embolism$Cause_1": { + "Lungs breath sounds diminished throughout, bibasilar crackles$Input5": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "Her history is also significant for chronic obstructive pulmonary disease. Her postoperative course was complicated by hypoxia related to volume overload and she required aggressive diuresis. Her symptoms imroved and diuretics were decreased. She remained on room air ambulating without shortness of breath. She was discharged to home on postoperative day nine. She reported reported that she had not ambulated much secondary to fatigue. On the day of admission, she tried to use her incentive spirometer and became dyspnic. She presented with lower chest pain and dyspnea. Her chest pain resolved spontaneously. \n", + "input3": "+CAD\n+NSTEMI\n+DMII\n+COPD\n+hyperlipidemia\n+hypertension\n+tobacco use\n+h/o cocaine use \n+arthritis \n+carpal tunnel\n+depression\n+GERD\n\ufeff\n", + "input4": "non-contributory\n", + "input5": "Physical Exam:\nPulse:81 Resp:16 O2 sat:97% on RA B/P:110/63 \nHeight: 61\" Weight: 157lb (preop)\n\ufeff\n:\nSkin: Dry [x] intact [x]\nHEENT: PERRLA [x] \nNeck: Supple [x] Full ROM [x]\nChest: Lungs breath sounds diminished throughout, bibasilar crackles [x]\nHeart: RRR [x] Irregular [] No Murmur [x] grade\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds \n+[x]\nExtremities: Warm [x], well-perfused [x] No Edema, fingers with clubbing\nVaricosities: None [x]\nNeuro: Grossly intact [x]\nPulses:\nDP Right:1+ Left:1+\nRight:1+ Left:1+\nRadial Right:2+ Left:2+\n\ufeff\n", + "input6": "___ 07:10AM BLOOD WBC-8.1 RBC-3.79* Hgb-10.5* Hct-35.0* MCV-92 MCH-27.8 MCHC-30.1* RDW-14.7\n___ 09:23PM BLOOD WBC-11.3* RBC-4.08* Hgb-11.2* Hct-37.4 MCV-92 MCH-27.5 MCHC-30.0* RDW-14.2\n___ 06:45AM BLOOD PTT-107.9*\n___ 09:23PM BLOOD PTT-38.2*\n___ 07:10AM BLOOD Glucose-169* UreaN-13 Na-140 K-4.1 Cl-104 HCO3-26 AnGap-14\n___ 09:23PM BLOOD Glucose-116* UreaN-10 Creat-0.6 Na-140 K-4.1 Cl-103 HCO3-28 AnGap-13 D-DIMER-1698\n\nThe main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/13738109-DS-20.json b/Finished/Pulmonary Embolism/Low-risk PE/13738109-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..739c031454a55dfc6f307354c0b2bf5012b0fec4 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/13738109-DS-20.json @@ -0,0 +1,35 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "TWI in III which is \nchronic, no R heart strain$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "A tiny filling defect in a small branch of the right lower lobe pulmonary artery is a direct sign of pulmonary embolism.$Cause_1": { + "Tiny filling defect noted in the subsegmental branch of the posteriorsegment of the right lower lobe pulomary artery with a small right-sided pleural effusion.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Chest pain is a common symptom of PE$Cause_1": { + "Chest Pain$Input1": {} + }, + "Common symptoms of pulmonary embolism include sudden chest pain, especially pain related to the pleura, which may be caused by irritation of the pleura due to the obstruction of blood flow to the lungs by the embolus.$Cause_1": { + "sudden onset of pleuritic L$Input2": {} + }, + "Pulmonary embolism may cause decreased lung function, which can lead to shortness of breath$Cause_1": { + "Associated with SOB and appears to be extertional as he was unable to work$Input2": {} + }, + "Knee surgery may increase risk of deep vein thrombosis, a significant risk factor for pulmonary embolism$Cause_1": { + "L Knee Surgery$Input3": {} + }, + "Hyperlipidemia refers to high levels of fat in the blood, which increases the risk of pulmonary embolism.$Cause_1": { + "HLD$Input3": {} + } + } + } + }, + "input1": "Chest Pain\n", + "input2": "He w/ h/o migraines who presented to ED with sudden onset of pleuritic L sided CP that woke him from sleep at 2am this morning. Associated with SOB and appears to be extertional as he was unable to work. He was able to go to work this AM but then decided to come to the ED. SOB is positional in nature, no PND. No hx of similar episodes in the past. No travel. No fever/cough. No hx of cancer, or clots. No fam history of clot. No leg swelling. Noc ough or hemoptysis.\n\ufeff\n\ufeff\nOn arrival to the floor, pt reports improved pleuritic pain, confirms on the L but all ED notes report R sided pleuritic CP. Developed a HA in the ED. Recent MVC with whiplash.\n", + "input3": "+Erectile dysfunction\n+Hemorrhoids\n+Hx of Acne-Keloid\n+Migraines\n+L Knee Surgery\n+HLD\n", + "input4": "Father and Mother are alive and healthy without medical problems.\nNo family hx of clots. 2 uncles with lung cancer but were both smokers.\n", + "input5": "\n", + "input6": "Labs:\n___ 08:10AM BLOOD WBC-7.1 RBC-5.00 Hgb-14.7 Hct-39.4* MCV-79* MCH-29.4 MCHC-37.3* RDW-13.8\n___ 08:40PM BLOOD Neuts-75.2* Lymphs-16.9* Monos-6.3 Eos-1.1 Baso-0.5\n___ 08:40PM BLOOD PTT-29.2\n___ 08:10AM BLOOD Glucose-98 UreaN-13 Creat-1.3* Na-138 K-3.8 Cl-101 HCO3-27 AnGap-14\n___ 08:40PM BLOOD ALT-18 AST-25 LD(LDH)-194 TotBili-0.4\n___ 08:10AM BLOOD proBNP-14\n___ 03:10AM BLOOD cTropnT-<0.01\n___ 08:40PM BLOOD cTropnT-<0.01\n___ 08:40PM BLOOD calTIBC-265 Ferritn-184 TRF-204\n___ 12:04AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG\n\ufeff\nImaging:\nTiny filling defect noted in the subsegmental branch of the posteriorsegment of the right lower lobe pulomary artery with a small right-sided pleural effusion.\n\ufeff\nEKG: NSR LAD, ?STD III (poor baseline), TWI in III which is \nchronic, no R heart strain\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/15190301-DS-16.json b/Finished/Pulmonary Embolism/Low-risk PE/15190301-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..cffa2d58e438c774e04670a5719fa1fc0e228f43 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/15190301-DS-16.json @@ -0,0 +1,32 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "A tiny filling defect in a small branch of the right lower lobe pulmonary artery is a direct sign of pulmonary embolism.$Cause_1": { + "Tiny filling defect noted in the subsegmental branch of the posteriorsegment of the right lower lobe pulomary artery with a small right-sided pleural effusion.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Chest pain is a common symptom for PE$Cause_1": { + "Right sided chest pain$Input1": {} + }, + "The patient presented with acute onset of right-sided pleuritic chest pain. Pleuritic chest pain and shortness of breath are typical symptoms of pulmonary embolism.$Cause_1": { + "acute onset of right sided pleuritic chest pain$Input2": {} + }, + "Prolonged hospitalization and a recent history of surgery are important risk factors for pulmonary embolism because these conditions increase the likelihood of blood clots forming.$Cause_1": { + "a prolonged hospitalization for perforated appendicitis$Input2": {} + }, + "Increased heart rate. Pulmonary embolism may cause the heart to work harder, which may increase the heart rate$Cause_1": { + "HR 105$Input5": {} + } + } + } + }, + "input1": "Right sided chest pain\n", + "input2": "He recently discharged after a prolonged hospitalization for perforated appendicitis now presenting with right sided chest pain. Patient was admitted and was initially managed conservatively with iv antibiotics and a percutaneous RLQ drain. He failed treatment and was complicated by small bowel obstruction. He was discharged 2 days ago, feeling well and tolerating a regular diet. He now presents with acute onset of right sided pleuritic chest pain since yesterday morning, associated with some shortness of breath that got significantly worse by 10. Denies any retrosternal chest pain. He was somewhat diaphoretic, but denies any objective fevers or chills. Has been feeling well otherwise, having normal bowel movements and passing flatus.\n\ufeff\n", + "input3": "PMHx: prior ruptured eardrum as a child without sequelae\nPSHx: prior bilateral tympanostomy tubes\n", + "input4": "nc\n", + "input5": "Physical Exam:\nVitals: T 98.1 HR 105 BP 107/61 RR 18 SO2 98% \nGEN: A&O, NAD\nHEENT: No scleral icterus, mucus membranes moist\nCV: RRR, No M/G/R\nPULM: Clear to auscultation b/l, No W/R/R\nABD: Soft, nondistended, appropriately tender to palpation around the prior incision. No rebound or guarding, normoactive bowel sounds, no palpable masses. Wound healing well. Staples still in place. Minimal serous drainage from the umbilical portion of the wound. No erythema.\nExt: No edema, warm and well perfused\n\ufeff\n", + "input6": "___ 04:26PM PTT-27.4\n___ 09:15AM PTT-29.0\n___ 05:33AM PTT-55.5*\n___ 02:10AM WBC-14.0*# RBC-3.47* HGB-11.0* HCT-31.3* MCV-90 MCH-31.6 MCHC-35.0 RDW-13.2\n___ 02:10AM PLT COUNT-380#\n___ 02:10AM PTT-26.7\n___ 12:53AM COMMENTS-GREEN TOP\n___ 12:53AM GLUCOSE-127* NA+-138 K+-3.9 CL--100 TCO2-23\n___ 12:45AM cTropnT-<0.01\n___ 12:45AM TSH-3.8\n___ 12:45AM FREE T4-1.7\n\ufeff\nTiny filling defect noted in the subsegmental branch of the posteriorsegment of the right lower lobe pulomary artery with a small right-sided pleural effusion.\n\nThe patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/15276169-DS-20.json b/Finished/Pulmonary Embolism/Low-risk PE/15276169-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..3005d57e06ddcaf427b07098fe6de3bd0347dfa8 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/15276169-DS-20.json @@ -0,0 +1,56 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "This shows a focal abnormality in the lungs, a typical radiological finding of pulmonary embolism.$Cause_1": { + "Associated ground-glass opacity in peripheral wedge pattern$Input6": {} + }, + "This shows a focal abnormality in the lungs, a typical radiological finding of pulmonary embolism.*$Cause_1": { + "Again seen is retrocardiac opacification consistent with volume loss, effusions, and the patient's likely infarct given known pulmonary embolus.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "SOB is a common symptom of PE$Cause_1": { + "shortness of breath$Input1": {} + }, + "Pleuritic pain is a common symptom of pulmonary embolism, characterized by chest pain that worsens with breathing.$Cause_1": { + "pleuritic chest pain$Input2": {} + }, + "Sharp, central chest pain, with a location and quality consistent with pulmonary embolism$Cause_1": { + "pain as sharp and centrally located \"in my lung\", and gradually spread lower throughout the day$Input2": {} + }, + "Pain that worsens with activity is common in patients with pulmonary embolism$Cause_1": { + "Pain was worse as she moved and changed positions$Input2": {} + }, + "Shortness of breath is a classic symptom of pulmonary embolism$Cause_1": { + "a little short of breath$Input2": {} + }, + "A dry cough may be a symptom of a pulmonary embolism$Cause_1": { + "dry cough$Input2": {} + }, + "Syncope or lightheadedness may be due to low oxygen levels or low blood pressure caused by pulmonary embolism$Cause_1": { + "felt lightheaded, which improved by standing in front of a fan$Input2": {} + }, + "Chronic hypertension may lead to long-term stress on the cardiovascular system and increase the risk of thrombosis and vascular damage, which are associated with the development of PE.$Cause_1": { + "cHTN$Input3": {} + }, + "This indicates pulmonary insufficiency, a typical clinical manifestation of pulmonary embolism.$Cause_1": { + "distant breath sounds, decreased air movement throughout$Input5": {} + }, + "Pulmonary embolism may cause circulatory disturbances, leading to localized or widespread edema.$Cause_1": { + "trace edema$Input5": {} + }, + "Abnormal PTT values \u200b\u200bindicate a possible problem with the coagulation system, a key risk factor for pulmonary embolism.$Cause_1": { + "PTT-88.3$Input6": {} + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "She is a F who was recently discharged 2 weeks ago after a c-section for pre-eclampsia to the ED with pleuritic chest pain x 1 day. She woke up that gradually worsened throughout the day. Described the pain as sharp and centrally located \"in my lung\", and gradually spread lower throughout the day. Pain was worse as she moved and changed positions. Did not notice any laterality for pain. Began to feel a little short of breath. In the past hour, has developed a dry cough, no hemoptysis. This morning while standing in the shower, she felt lightheaded, which improved by standing in front of a fan. Otherwise, she has had a good appetite, no fever, no n/v/d, no abdominal pain.\n\ufeff\nShe has otherwise recovered well from her C/S, and has weaned from her pain meds. She has been on antihypertensives\n", + "input3": "OB/GYN Hx \n-s/p C-section for severe pre-eclampsia at 29 weeks\n-denies abnormal paps/STIs\n-anterior uterine fibroids 3x3x3 noted on 13 but not commented on in other U/S's.\n\ufeff\nPMH: \n-cHTN - dx yrs prior to pregnancy\n-asthma\n-vitD def\n\n", + "input4": "-Uncle, grandfather, and great grandfather died of aneurysms\n-Grandmother with ovarian cancer, diagnosed in early\n-No family history of breast cancer\n-Multiple paternal relatives with hypertension\n-Grandmother with DM2\n\ufeff\n", + "input5": "Physical Exam:\n(on admission)\n\ufeff\nVS (21:57): HR 73, BP 117/68, RR 18, O2 100% on RA\nGen: NAD, resting comfortably in bed, AxO\nCV: rate normal rhythm, no m/r/g\nResp: distant breath sounds, decreased air movement throughout\nAbd: +BS, soft, nontender, incision c/d/i\nExt: no erythema, 2+ pulses, trace edema\n\ufeff\n", + "input6": "___ 10:30PM BLOOD WBC-12.8* RBC-3.70* Hgb-11.2* Hct-33.0* MCV-89 MCH-30.4 MCHC-34.1 RDW-13.8\n___ 08:50AM BLOOD WBC-9.7 RBC-3.70* Hgb-11.0* Hct-33.1* MCV-89 MCH-29.7 MCHC-33.2 RDW-13.0\n___ 10:37AM BLOOD WBC-11.5* RBC-3.49* Hgb-10.5* Hct-31.5* MCV-90 MCH-30.0 MCHC-33.3 RDW-12.9 \n___ 05:00AM BLOOD WBC-13.1* RBC-3.45* Hgb-10.5* Hct-32.8* MCV-95 MCH-30.4 MCHC-32.0 RDW-12.5\n___ 11:51PM BLOOD WBC-12.4* RBC-3.24* Hgb-9.5* Hct-28.6* MCV-89 MCH-29.4 MCHC-33.3 RDW-12.7\n___ 11:30AM BLOOD WBC-10.0 RBC-3.17* Hgb-9.5* Hct-28.5* MCV-90 MCH-29.9 MCHC-33.2 RDW-12.7\n\ufeff\n\n___ 05:00AM BLOOD PTT-88.3*\n\ufeff\n___ 10:30PM BLOOD Glucose-120* UreaN-17 Creat-1.0 Na-140 K-4.4 Cl-106 HCO3-21* AnGap-17\n\ufeff\nECG: Sinus rhythm. Findings are within normal limits. No previous tracing available for comparison. \n\ufeff\nCTA:\n\ufeff\n1. Associated ground-glass opacity in peripheral wedge pattern \n(early \ninfarction cannot be excluded) at the left lung base. \n2. Small left pleural effusion. \n\ufeff\n\ufeff\nCXR: Again seen is retrocardiac opacification consistent with volume loss, effusions, and the patient's likely infarct given known pulmonary embolus. Remainder of the lungs are clear. Since the lower lobe opacity has not yet cleared, infection is still a possibility and clinical correlation and followup should be obtained. \n\nThe patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/15418476-DS-5.json b/Finished/Pulmonary Embolism/Low-risk PE/15418476-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..bb1f3e5cfa16fde550ca03737f68ed0aa1217d6d --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/15418476-DS-5.json @@ -0,0 +1,32 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Vascular occlusion and blood flow reversal are typical manifestations of deep vein thrombosis, which is the direct source of pulmonary embolism.$Cause_1": { + "right mid occlusion with reversal of flow distal to the occlusion$Input2": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Smoking is a risk factor for pulmonary embolism because it thickens the blood, increasing the risk of blood clots forming.$Cause_1": { + "active smoker$Input2": {} + }, + "Pain may be related to nerve or blood vessel compression, and one should be alert to possible deep vein thrombosis, which is a direct precursor to pulmonary embolism.$Cause_1": { + "shooting pain down his right leg$Input2": {} + }, + "HTN is a risk factor of PE$Cause_1": { + "HTN$Input3": {} + }, + "Hypertension may be associated with chronic cardiovascular disease, a risk factor for pulmonary embolism$Cause_1": { + "BP: 160/84$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "He is a male who is an active smoker with no other significant past medical history who presents with days of acute onset right fifth toe pain. The patient reported that this past he had a colonoscopy, at which 6 polyps were removed, and after the colonoscopy developed shooting pain down his right leg. This pain resolved quickly however developed into a severe right fifth toe pain. He states that this pain has been consistent and severe for the past 5 days. Worse when he is walking or when he is elevating his leg, partially relieved by dragging his foot off the bed. Given these symptoms he presented to an outside hospital where an arterial duplex ultrasound of the right leg was obtained and demonstrated a right mid occlusion with reversal of flow distal to the occlusion. Therefore he was transferred for vascular surgery evaluation.\n\ufeff\nCurrently, the patient states that he has continued pain. He has never had symptoms like this before, and he has no known arterial disease. Apart from his foot he has been in his usual state of health, and denies all other symptoms.\n\ufeff\n", + "input3": "Past Medical History: HTN\n\nPast Surgical History: none\n", + "input4": "Noncontributory\n", + "input5": "Physical Exam:\nTemp: 99.0 (Tm 99.0), BP: 160/84 (117-160/75-88), HR: 82\n(77-89), RR: 16, O2 sat: 96% (96-100), O2 delivery: Ra\nGeneral: NAD, AAOx3\nCV: RRR, extremities warm and well perfused\nPulm: Breathing unlabored on room air, no respiratory distress\nAbd: Soft, nontender, nondistended\nWound: right toe dusky at the distal end, improving tenderness, with healing ulceration and mild surrounding cellulitis digit that appears to continue tobe improving \nExt: wwp, no edema\nPulses: DP palp bilaterally\n\ufeff\n", + "input6": "___ 05:07AM BLOOD WBC-9.6 RBC-4.08* Hgb-13.2* Hct-39.5* MCV-97 MCH-32.4* MCHC-33.4 RDW-13.3 RDWSD-47.8*\n___ 05:07AM BLOOD PTT-69.3*\n___ 04:58AM BLOOD PTT-81.7*\n___ 02:56AM BLOOD PTT-91.9*\n\ufeff\nThe patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/15427589-DS-8.json b/Finished/Pulmonary Embolism/Low-risk PE/15427589-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..de0e591d9dd2b64d79aabe6e35ba3ef5805620d2 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/15427589-DS-8.json @@ -0,0 +1,44 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "A tiny filling defect in a small branch of the right lower lobe pulmonary artery is a direct sign of pulmonary embolism.$Cause_1": { + "Tiny filling defect noted in the subsegmental branch of the posteriorsegment of the right lower lobe pulomary artery with a small right-sided pleural effusion.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Chest pain is a common symptom of PE$Cause_1": { + "chest pain$Input1": {} + }, + "Cancer patients have an increased risk of pulmonary embolism because tumor cells may increase blood coagulation.$Cause_1": { + "history of endometrial cancer$Input2": {} + }, + "One of the common symptoms of pulmonary embolism is chest pain, which is worse when you breathe deeply.$Cause_1": { + "pain in her left lower chest$Input2": {} + }, + "This is a typical pleural chest pain, which may be caused by obstruction of blood flow to the lungs.$Cause_1": { + "worse with inspiration$Input2": {} + }, + "High blood pressure is a major risk factor for cardiovascular disease and may increase the risk of blood clots$Cause_1": { + "Hypertension.$Input3": {} + }, + "Hyperlipidemia can lead to atherosclerosis and indirectly increase the possibility of thrombosis$Cause_1": { + "Hyperlipidemia.$Input3": {} + }, + "There is mild pressure edema in both lower limbs. This is an important symptom of PE.$Cause_1": { + "1+ bilateral pitting edema$Input5": {} + }, + "Treatment measures are directed toward the acute management of pulmonary embolism, indicating a high suspicion or diagnosis of PE$Cause_1": { + "initially on a heparin drip$Input6": {} + } + } + } + }, + "input1": "chest pain\n", + "input2": "Female with a history of endometrial cancer who was transferred from an OSH. The patient states she started having pain in her left lower chest yesterday which progressively got worse overnight. It is worse with inspiration. She denies any shortness of breath, cough, or fever. She otherwise has been feeling well. She denies any history of any blood clots.\n\ufeff\nREVIEW OF SYSTEMS:\n- All reviewed and negative except as noted in the HPI.\n", + "input3": "\nPAST MEDICAL HISTORY:\n+Hypertension.\n+Hyperlipidemia.\n+Hypothyroidism.\n+Breast biopsy.\n+Lumbar back surgery.\n+Tonsillectomy.\n\ufeff\n", + "input4": "Mother: Died from CHF, history of asthma.\nFather: MI.\nSister: MI.\nSister: hypothyroidism.\n", + "input5": "Physical Exam:\nPHYSICAL EXAM:\nGeneral: NAD\nVITAL SIGNS: 97.4 118/54 62 18 94%RA\nHEENT: MMM, no OP lesions\nCV: RR, NL S1S2\nPULM: clear bilaterally\nABD: Soft, NTND\nLIMBS: 1+ bilateral pitting edema\nSKIN: No rashes or skin breakdown\nNEURO: Alert and oriented, no focal deficits.\n", + "input6": "___ 08:26PM BLOOD WBC-4.6# RBC-2.65* Hgb-8.7* Hct-27.1* MCV-102* MCH-32.8* MCHC-32.1 RDW-16.5* RDWSD-62.6* \n___ 04:15PM BLOOD WBC-2.7* RBC-2.95* Hgb-9.8* Hct-29.8* MCV-101* MCH-33.2* MCHC-32.9 RDW-15.7* RDWSD-58.8* \n___ 08:26PM BLOOD PTT-81.6*\n___ 08:26PM BLOOD Glucose-97 UreaN-16 Creat-0.7 Na-138 K-3.9 Cl-102 HCO3-26 AnGap-14\n___ 07:40AM BLOOD Glucose-98 UreaN-15 Creat-0.8 Na-140 K-4.2 Cl-104 HCO3-27 AnGap-13\n___ 08:26PM BLOOD proBNP-48\n___ 08:26PM BLOOD cTropnT-<0. \nShe remained clinically stable throughout her course. Her only symptom was left lower chest pain particularly with deep breaths, which has resolved by the time of discharge. Note that EKG had no ischemic changes and troponin negative. Her oxygenation remained stable on room air. She was initially on a heparin drip at transfer and was started on Lovenox the morning after admission here. She was evaluated for clinical trial, Phase III edoxaban versus dalteparin for treatment of VTE in active cancer patients. She agreed to enroll and was randomized to dalteparin. She received the first dose evening and will continue with daily injections every evening. In total >30 minutes was spent in discharge planning.\n\ufeff\nTiny filling defect noted in the subsegmental branch of the posteriorsegment of the right lower lobe pulomary artery with a small right-sided pleural effusion.\n\nThe patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/16261765-DS-15.json b/Finished/Pulmonary Embolism/Low-risk PE/16261765-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..d97ec6e1587fab7cedaa6a0fe7ddf62a8f01f058 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/16261765-DS-15.json @@ -0,0 +1,38 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "CT scan revealed pulmonary embolism in the right middle and lower lobes$Cause_1": { + "CT scan was done due to her pleuritic chest pain and she was found to have a right middle and lower lobe PE.$Input2": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Chest pain is a common symptom of PE$Cause_1": { + "Pleuritic chest pain$Input1": {} + }, + "Pleuritic chest pain is usually caused by irritation of the pleura, which may be caused by pleural inflammation due to pulmonary embolism.$Cause_1": { + "Initially noticed pain on right side, pleuritic in nature$Input2": {} + }, + "Pain associated with breathing is one of the common symptoms of pulmonary embolism$Cause_1": { + "discomfort both with breathing and without taking deep breaths$Input2": {} + }, + "Chest pain that worsens when lying down may be related to changes in pressure on the lungs, which may be related to the location and impact of the pulmonary embolism.$Cause_1": { + "pain was worse with lying down and with inspiration$Input2": {} + }, + "Pleural effusions and pulmonary infiltrates may indicate further damage or inflammation of the lung tissue$Cause_1": { + "a CXR that showed a small pleural effusion on the right$Input2": {} + }, + "Pulmonary embolism may lead to reduced oxygen exchange efficiency, which may affect exercise endurance and cause muscle soreness.$Cause_1": { + "decreased exercise tolerance in the past few weeks while running, and a few myalgias$Input2": {} + } + } + } + }, + "input1": "Pleuritic chest pain\n", + "input2": "Healthy woman, physical therapist here. Initially noticed pain on right side, pleuritic in nature, 5 days ago. Got worse over next few days, with discomfort both with breathing and without taking deep breaths. She is a marathon runner, and ran most recently in the middle of last week. She had no shortness of breath. The pain was worse with lying down and with inspiration. Pain is not relieved with motrin.\n.\nShe saw a PCP coverage last week, and had a CXR that showed a small pleural effusion on the right. The pain persisted and worsened, and she presented for further care for a follow up visit to her PCP. A repeat CXR was done which showed worsening effusion, and question of right lung infiltrate. A CT scan was done due to her pleuritic chest pain and she was found to have a right middle and lower lobe PE. She was sent to the ED for evaluation.\n.\nShe has noticed decreased exercise tolerance in the past few weeks while running, and a few myalgias. She had no lower extremity edema, pain or swelling. No recent travel. No dizziness, headache, abdominal complaints. \n.\nROS otherwise reviewed in detail and negative.\n.\nIn the ED, she was started on a heparin drip, and admitted for further care.\n", + "input3": "None\n", + "input4": "No family history of coagulopathy, clot, malignancy, as far as she know.\n", + "input5": "Physical Exam:\nExam\nVS T current 99.0 BP 120/77 HR 72 RR 18 100% \nO2sat\n \nGen: In NAD.\nHEENT: PERRL, EOMI. No scleral icterus. No conjunctival \ninjection. Mucous membranes moist. No oral ulcers.\nNeck: Supple, no LAD, no JVP elevation.\nLungs: CTA bilaterally, no wheezes, rales, rhonchi. Normal respiratory effort.\nCV: RRR, no murmurs, rubs, gallops.\nBreasts: Fibrocystic changes diffusely, no LAD.\nAbdomen: soft, NT, ND, NABS, no HSM.\nExtremities: warm and well perfused, no cyanosis, clubbing, \nedema. No inguinal lymphadenopathy. No cords\nNeurological: alert and oriented X 3, CN II-XII intact. \nSkin: No rashes or ulcers.\nPsychiatric: Appropriate.\nGU: deferred.\nRectal: guaic negative per ED.\n\ufeff\n", + "input6": "GLUCOSE-90 UREA N-8 CREAT-0.7 SODIUM-139 POTASSIUM-4.3 \nCHLORIDE-104 TOTAL CO2-26 ANION GAP-13\n.\nWBC-7.1 RBC-4.01* HGB-13.1 HCT-37.1 MCV-92 MCH-32.6* MCHC-35.2* \nRDW-12.7 PLT COUNT-233\nNEUTS-80.7* BANDS-0 LYMPHS-14.3* MONOS-3.7 EOS-0.7 BASOS-0.6\n.\n___ PTT-21.2*\n\nThe patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/16502049-DS-12.json b/Finished/Pulmonary Embolism/Low-risk PE/16502049-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..4c116cf30616d53712274ef79c8e9f44a08229e5 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/16502049-DS-12.json @@ -0,0 +1,41 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "D-dimer is a marker of thrombus formation and lysis, and its elevated level (>500) is often used as an initial screening test for pulmonary embolism.$Cause_1": { + "D-dimer was elevated at 5242$Input2": {} + }, + "CTA results showed lung changes consistent with pulmonary embolism$Cause_1": { + "CTA showed bilateral pulmonary edema with ? infarct in the left lower lobe wedge.$Input2": {} + }, + "Bilateral pulmonary embolism, which is decisive evidence for direct diagnosis of pulmonary embolism$Cause_1": { + "Bilateral pulmonary emboli$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Sudden chest pain is one of the typical symptoms of pulmonary embolism$Cause_1": { + "sudden left-sided chest pain$Input2": {} + }, + "Increased with inspiration and not altered by changes in body position. This symptom may indicate pleural irritation, common in pulmonary embolism$Cause_1": { + "worse on inspiration and not dependent on position$Input2": {} + }, + "Shortness of breath is a common symptom of pulmonary embolism$Cause_1": { + "shortness of breath$Input2": {} + }, + "Rales at the base of the lungs may indicate fluid accumulation or other abnormalities in the lungs, a common symptom of pulmonary embolism.$Cause_1": { + "Left lower base crackles$Input5": {} + }, + "The patient was receiving 2 liters of nasal cannula oxygen therapy, which may indicate that without external oxygen support, the patient may become hypoxemic, another warning sign of pulmonary embolism.$Cause_1": { + "O2sat 100% 2L (NC)$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "M with no PMH presents with sudden left-sided chest pain. \n.\nIt was worse on inspiration and not dependent on position. Patient denied diaphoresis, radiation of pain to the arms, neck, or back. Due to the pain, he later developed shortness of breath. He placed a warm pack on his left chest, which seems to alleviate the pain somewhat. He tried to \"walk off the pain\" but finally decided to come to the ED.\n.\nOf note, patient denied any recent travels, plan rides, surgeries, periods of immobilities. He denied any history of bleeding from mucous membranes, no easy bruising, no difficulty with bleeding/clotting after knee surgery. He has not had any prior clots before. Denied leg pain or swelling. \n.\nIn ED VS were T:98 HR:66 BP:140/82 RR:19 O2sat:99% RA. Based on PERC rule for pulmonary edema, patient qualified for evaluation. D-dimer was elevated at 5242 and CTA showed bilateral pulmonary edema with ? infarct in the left lower lobe wedge. Patient placed on 2 liters of oxygen and treated with 1 dose of oxycodone. Guaiac was negative and he was started on heparin drip with bolus. \n.\nReview of systems: \n(+) Per HPI \n(-) Denies fever, chills, night sweats, recent weight loss or gain. Denies headache, sinus tenderness, rhinorrhea or congestion. Denied cough. Denied palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias.\n\ufeff\n", + "input3": "+ s/p left knee surgery\n", + "input4": "Mother has history of clots after knee surgeries.\n", + "input5": "Physical Exam:\nVS: Tc 97.5 HR 65 BP 136/90 RR 18 O2sat 100% 2L (NC)\nGA: AOx3, sitting up in bed, NAD\nHEENT: PERRLA. MMM. no LAD. no JVD. neck supple. \nCards: RRR S1/S2 heard. No S3 appreciated. no murmurs/gallops/rubs.\nPulm: Left lower base crackles. No wheeze. \nAbd: soft, NT, +BS. no g/rt. neg HSM. neg sign.\nExtremities: wwp, no edema. DPs, PTs 2+. No tenderness. \nNeuro/Psych: CNs II-XII intact. strength in U/L extremities. \nDTRs 2+ (biceps, achilles, patellar). sensation intact to LT, pain, temperature, vibration, proprioception. cerebellar fxn intact (FTN, HTS). gait WNL. \n\ufeff\n", + "input6": "1. Labs on admission:\n___ 09:07AM BLOOD WBC-8.0 RBC-4.58* Hgb-14.6 Hct-43.4 MCV-95 MCH-32.0 MCHC-33.7 RDW-12.9\n___ 09:07AM BLOOD PTT-23.1\n___ 09:07AM BLOOD Glucose-102* UreaN-12 Creat-1.0 Na-135 K-8.1* Cl-101 HCO3-26 AnGap-16\n___ 09:07AM BLOOD CK(CPK)-194\n___ 09:07AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 06:40AM BLOOD Calcium-9.0 Phos-3.2 Mg-2.2\n.\n.\n2. Imaging/diagnostics:\n- CXR : Patchy opacity at the lateral left lung base. Given the volume loss, atelectasis is favored, although a focus of early developing pneumonia cannot be entirely excluded. Correlate clinically. \n.\n- CTA : Bilateral pulmonary emboli as described above. Wedge-shaped consolidation seen in the left lower lobe and lingula concerning for pulmonary infarcts in the setting of pulmonary emboli. No evidence for right heart strain. \n\ufeff\nThe patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/16823547-DS-8.json b/Finished/Pulmonary Embolism/Low-risk PE/16823547-DS-8.json new file mode 100644 index 0000000000000000000000000000000000000000..e9cb8e14f2f9821e43415ca247d8534c1f2ada79 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/16823547-DS-8.json @@ -0,0 +1,32 @@ +{ + "Low-risk PE$Intermedia_4": { + "The right heart has not been significantly affected, and submassive PE is ruled out.$Cause_1": { + "The main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "CTA report confirmed right lower lobe segmental pulmonary embolism$Cause_1": { + "Positive for segmental pulmonary embolism in right lower lobe,$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Pain around back area is a common symptom of PE$Cause_1": { + "right shoulder and mid back pain$Input2": {} + }, + "This may be because deep breathing obstructs blood circulation in the lungs, aggravating the pulling of the pleura and increasing pain.$Cause_1": { + "Pain is worse with inspiration or laughing$Input2": {} + }, + "A right lower lobe infiltrate found on a chest x-ray may indicate a lung infection or a blood clot$Cause_1": { + "CXR office today with RLL infiltrate$Input2": {} + }, + "Pulmonary embolism may block blood flow to a portion of the lung, resulting in decreased breath sounds.$Cause_1": { + "Decreased BS at right base$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "She s/p repeat C/S referred to ED by PCP PE. Patient reports right shoulder and mid back pain for the past 5 days that has been constant. Pain is worse with inspiration or laughing. She denies CP/SOB/abd pain/cough/F/C/palpitations/heavy VB/leg pain. CXR office today with RLL infiltrate, sent to ED for further work up.\n", + "input3": "OB-GYN Hx: \nPrimary CS for failed forceps, TAB x 1, SAB x 1 Repeat CS for previa\n\ufeff\nPMH: SVT (diagnosed postpartum, normal ECHO, no episodes. Breast fibroadenoma, H pylori, migraines Lymphocytosis\nPSH: C/S x 2, lumpectomy\n", + "input4": "\n", + "input5": "Physical Exam:\n98.2 103 121/62 20 100% RA \nGen: NAD, well appearing\nCV: RRR\nPULM: Decreased BS at right base, otherwise CTAB.\nAbd: soft, NT, ND. Inc with scant dried old blood, otherwise c/d/i.\nExtr: NT/NE, symmetric\n\ufeff\n", + "input6": "___ 09:04PM BLOOD WBC-7.9 RBC-2.66*# Hgb-8.6*# Hct-26.3*# MCV-99* MCH-32.2* MCHC-32.6 RDW-13.8\n___ 09:04PM BLOOD Neuts-59.0 Monos-4.6 Eos-1.9 Baso-0.5\n___ 09:04PM BLOOD PTT-25.5\n___ 09:04PM BLOOD Glucose-89 UreaN-17 Creat-0.6 Na-140 K-4.3 Cl-108 HCO3-22 AnGap-14\n\ufeff\nCTA: Positive for segmental pulmonary embolism in right lower lobe, possibly lingula. Patchy right posterior basilar opacity suggesting atelectasis and/or ischemic changes, although infection not excluded \n\ufeff\nThe main and right pulmonary arteries are normal in caliber, and there is no evidence of right heart strain.\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/16856084-DS-11.json b/Finished/Pulmonary Embolism/Low-risk PE/16856084-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..82c95c8be8e765923ae661ce4409bfb0af8decdd --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/16856084-DS-11.json @@ -0,0 +1,32 @@ +{ + "Low-risk PE$Intermedia_4": { + "patient has stable hemodynamics, no evidence of RV function impairment which rule out massive PE.$Cause_1": { + "No current evidence of R heart strain on CTA. EKG also negative for right heart strain$Input2": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "CTA confirmed pulmonary embolism and showed extension of the embolism to multiple pulmonary artery branches.$Cause_1": { + "CTA was done and revealed: RLL PE extending into lateral and proximal posterior segmental arteries as well as peripheral ground-glass opacity in RLL, concerning for developing infarct.$Input2": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Oral contraceptives are a known risk factor for pulmonary embolism because they may increase the tendency of the blood to clot.$Cause_1": { + "Healthy female on OCPs$Input2": {} + }, + "An embolism may cause pain in the lungs, especially when you breathe deeply.$Cause_1": { + "chest pain with deep inspiration and with exertion$Input2": {} + }, + "Prolonged physical activity may be associated with dehydration and hypercoagulable state, indirectly increasing the risk of embolism.$Cause_1": { + "training for a marathon$Input2": {} + }, + "This persistent chest pain indicates persistent lung disease and is a common symptom in patients with pulmonary embolism.$Cause_1": { + "pain with deep inspiration and pain at rest$Input2": {} + } + } + } + }, + "input1": "\n", + "input2": "Healthy female on OCPs. For the past few days, she has noticed chest pain with deep inspiration and with exertion. She has been training for a marathon recently. No recent travel, no smoking history, no personal or family history of clotting disorders. A CTA was done and revealed: RLL PE extending into lateral and proximal posterior segmental arteries as well as peripheral ground-glass opacity in RLL, concerning for developing infarct. No current evidence of R heart strain on CTA. EKG also negative for right heart strain. She was stable in the ED (99.6 82 124/56 18 97%RA and guaiac negative) and was offered to do lovenox at home but she was hesitant to give herself injections. A peripheral was placed and she was given IVF and started on a heparin drip.\n. \nCurrently, she reports pain with deep inspiration and pain at rest. No shortness of breath or other difficulty breathing. No n/v/diarrhea/dysuria/abdominal pain. She reports that she has plans for travel in the future.\n", + "input3": "pt denies any medical history\n", + "input4": "patient denies any blood/clotting disorders in family. Parents both alive and healthy\n", + "input5": "Physical Exam:\nGENERAL - well-appearing F in NAD, comfortable, appropriate\nHEENT - EOMI, sclerae anicteric, MMM, OP clear\nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use\nHEART - RRR, no MRG, nl S1-S2\nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no rebound/guarding\nEXTREMITIES - WWP, no c/c/e\nNEURO - awake, A&Ox3, CNs II-XII grossly intact, \n\ufeff\n", + "input6": "___ 05:00PM GLUCOSE-109* UREA N-12 CREAT-0.8 SODIUM-135 POTASSIUM-4.0 CHLORIDE-101 TOTAL CO2-26 ANION GAP-12\n___ 05:00PM estGFR-Using this\n___ 05:00PM cTropnT-<0.01\n___ 05:00PM proBNP-98\n___ 05:00PM WBC-8.3 RBC-4.30 HGB-12.1 HCT-35.8* MCV-83 MCH-28.2 MCHC-33.9 RDW-12.7\n___ 05:00PM NEUTS-72* BANDS-0 MONOS-2 EOS-0 BASOS-0 MYELOS-0\n___ 05:00PM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL\n___ 05:00PM PLT SMR-NORMAL PLT COUNT-304\n___ 05:00PM PTT-23.4\n___ 10:56AM UREA N-14 CREAT-0.8\n___ 10:56AM estGFR-Using this\n___ 10:18AM VoidSpec-SPECIMEN F\n\ufeff\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/17087118-DS-14.json b/Finished/Pulmonary Embolism/Low-risk PE/17087118-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..389b47135d8218190d82d9084ccf56e246db841d --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/17087118-DS-14.json @@ -0,0 +1,41 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "This shows a focal abnormality in the lungs, a typical radiological finding of pulmonary embolism.*$Cause_1": { + "See retrocardiac opacification consistent with volume loss, effusions, and the patient's likely infarct given known pulmonary embolus.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Chest pain is the common symptom of PE$Cause_1": { + "chest pain$Input1": {} + }, + "Low blood pressure may be a symptom of pulmonary embolism. Pulmonary embolism can reduce the amount of blood your heart can produce, which can cause your blood pressure to drop.$Cause_1": { + "developed hypotension$Input2": {} + }, + "Persistent hypotension further increases the possibility of pulmonary embolism, as it may be a manifestation of right ventricular overload and reduced cardiac output.$Cause_1": { + "hypotensive this morning with SBP 70mmHg$Input2": {} + }, + "Chest pain, especially on the left side, may be a symptom of pulmonary embolism$Cause_1": { + "pain over the left side of his chest$Input2": {} + }, + "Long-term hypertension may lead to damage to the cardiovascular system, which may increase the risk of thrombosis$Cause_1": { + "Hypertension$Input3": {} + }, + "Coronary artery disease means that the patient's blood vessels may have problems such as atherosclerosis, which may lead to obstruction of blood flow and increase the possibility of blood clots.$Cause_1": { + "Coronary Artery Disease$Input3": {} + }, + "Peripheral vascular disease usually involves reduced blood flow to the extremities, predisposing to the formation of blood clots, which, if broken off and released into the bloodstream, may cause pulmonary embolism.$Cause_1": { + "Peripheral Vascular Disease$Input3": {} + } + } + } + }, + "input1": "chest pain\n", + "input2": "He s/p CABG times two. His post-op course was notable for pericarditis for which he is treated with Ibuprofen. He was discharged home on POD 4. He has developed hypotension over the previous week and Lasix and Lopressor have been discontinued. He continued to be hypotensive this morning with SBP 70mmHg. He also reports pain over the left side of his chest which developed about 2 days ago. He did not increase his pain regimen. He presents to the ED for further evaluation.\n", + "input3": "Hypertension\nCoronary Artery Disease s/p IMI and LCx stent\nPeripheral Vascular Disease\nHepatitis C\nHIV diagnosed\nErectile Dysfunction\nMajor Depressive Disorder\nLumbar Disc Disease\n", + "input4": "Non-contributory\n", + "input5": "Physical Exam:\nGeneral: NAD\nSkin: Dry [x] intact [x]\nSternotomy healing well without erythema or drainage\nSternum stable\nHEENT: PERRLA [] EOMI []\nNeck: Supple [] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [] Murmur [] grade\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds\n+ [x]\nExtremities: Warm [x], well-perfused [x] Edema [] _2+ pedal\nedema\nRight EVH site c/d/i\nVaricosities: None []\nNeuro: Grossly intact [x]\nPulses:\nFemoral Right: Left:\nDP Right: 1+ Left:1+\nRight: 1+ Left:1+\n\ufeff\n", + "input6": "___ 10:20PM BLOOD PTT-80.9*\n___ 04:35AM BLOOD Glucose-107* UreaN-16 Creat-1.5* Na-136 K-4.3 Cl-100 HCO3-25 AnGap-15\n\ufeff\nSee retrocardiac opacification consistent with volume loss, effusions, and the patient's likely infarct given known pulmonary embolus.\n\nThe patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/17440689-DS-5.json b/Finished/Pulmonary Embolism/Low-risk PE/17440689-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..d8f1f545512bb1996ae9e234f8fe1462f9780838 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/17440689-DS-5.json @@ -0,0 +1,32 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Types of pulmonary embolism found on CTA. Segmental and subsegmental pulmonary embolism indicate that the embolus is located in the larger branches of the lungs.$Cause_1": { + "bilateral segmental and subsegmental PE's$Input2": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "SOB is the common symptom of PE$Cause_1": { + "a bit more short of breath$Input2": {} + }, + "HTN is related to PE$Cause_1": { + "HTN$Input3": {} + }, + "The patient is breathing on 3 liters of oxygen. Patients may have hypoxemia without supplemental oxygen, a common symptom of pulmonary embolism$Cause_1": { + "O2 sat on 3L 98%$Input5": {} + }, + "Pneumothorax can increase the risk of pulmonary embolism because it may affect blood flow and pressure in the lungs.$Cause_1": { + "Very small right apical pneumothorax$Input6": {} + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "His hospital course is as follows: on POD2, after hispost-op chest tube was removed, he began to have somesubcutaneous emphysema, a pigtail catheter was placed and then upsizd for increasing crepitus. A CT scan o ___ showed a small ptx and his crepitus began resolving on POD5. His CT was d/c'd and he was discharged to home on POD9 without issues. On the day on admission he felt a bit more short of breath and went to the ___ where a CTA of the chest documented bilateral segmental and subsegmental PE's. He was transferred here for further management.\n", + "input3": "-GERD\n-Gout\n-HTN\n-Known left bundle branch block.\n", + "input4": "Non-contributory\n", + "input5": "Temp 98 BP 110/60 HR 66 RR 18 O2 sat on 3L 98%\n\nGEN: A&O, NAD\nHEENT: No scleral icterus, mucus membranes moist\nCV: RRR, No M/G/R\nPULM: Clear to auscultation b/l, No W/R/R\nABD: Soft, nondistended, nontender, no rebound or guarding,\nnormoactive bowel sounds, no palpable masses\nDRE: normal tone, no gross or occult blood\nExt: No ___ edema, ___ warm and well perfused\n", + "input6": "___ 08:58PM GLUCOSE-112* UREA N-25* CREAT-1.4* SODIUM-136 \nPOTASSIUM-4.2 CHLORIDE-99 TOTAL CO2-25 ANION GAP-16\n___ 08:58PM ___ PTT-36.5 ___\n\n___ CXR :\nSevere subcutaneous emphysema is less pronounced today than it was on ___, not appreciably changed since ___. The distortion of the overlying chest wall anatomy obscures lung findings, but there is still interstitial abnormality in the left lower lobe, probably edema in the setting of severe emphysema. Both lungs are well expanded. Very small right apical pneumothorax is seen on the chest CT from ___, not apparent on the conventional chest radiograph, particularly in light of severe paraseptal emphysema. There is no appreciable pleural effusion. Heart size is top-normal. \n\nThe patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/18130160-DS-15.json b/Finished/Pulmonary Embolism/Low-risk PE/18130160-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..bbb8f78537fdb40e148377662dc4f9aeb03d70f8 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/18130160-DS-15.json @@ -0,0 +1,38 @@ +{ + "Low-risk PE$Intermedia_4": { + "This is the support for Low-risk PE$Cause_1": { + "The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "A filling defect in the right lower lobe may directly indicate pulmonary embolism$Cause_1": { + "small RLL filling defect$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Pleural pain is usually caused by inflammation or irritation of the pleura, which can be affected by pulmonary embolism.$Cause_1": { + "pleuritic left side side pain$Input2": {} + }, + "The continued worsening of chest pain affected the patient's sleep quality, which reflected the severity of the pain and suggested pulmonary embolism.$Cause_1": { + "increasingly more painful to the point he has noted less sleep$Input2": {} + }, + "Pain that worsens with deep breathing is a classic symptom of pulmonary embolism$Cause_1": { + "inability to take a deep breath$Input2": {} + }, + "Hyperlipidemia is a risk factor for cardiovascular disease, which indirectly increases the possibility of thrombosis and thus increases the risk of pulmonary embolism.$Cause_1": { + "Dyslipidemia$Input3": {} + }, + "High blood pressure may increase risk of blood clots$Cause_1": { + "Hypertension$Input3": {} + }, + "Lung rales, especially at the base of the lung, may indicate fluid accumulation or other abnormalities and are symptoms of pulmonary embolism$Cause_1": { + "CTAB with crackles at left base$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "Mr. is a w/ GBM (dx who presents with several days of having pleuritic left side side pain that has become increasingly more painful to the point he has noted less sleep as a result of the pain and inability to take a deep breath in due to the pain. He denied cough. \n\ufeff\n", + "input3": "\nPAST MEDICAL HISTORY:\n1. Central brain mass\n2. Dyslipidemia\n3. Hypertension\n4. Bell's palsy \n\ufeff\n", + "input4": "Of his three siblings, one died with lymphoma, the other two are healthy. His mother died with liver cancer, and his father died of lung cancer. \n\ufeff\n", + "input5": "Physical Exam:\nADMISSION EXAM\n==============\nVITAL SIGNS: \nWeight: 201.40 128/60, 98% RA\nGen: NAD\nHEENT: MMM, no OP lesions, no cervical, supraclavicular\nadenopathy\nCV: RR, NL S1S2 no S3S4 MRG, JVP 5 cm H2O\nPULM: CTAB with crackles at left base\nABD: BS+, soft, NTND, no masses or hepatosplenomegaly\nLIMBS: WWP, no tremors\nSKIN: No rashes on the extremities\nNEURO: Grossly normal, strength b/l upper and lower ext\n\ufeff\n", + "input6": "ADMISSION LABS\n==============\n___ 08:20PM BLOOD WBC-8.3 RBC-3.94* Hgb-11.4* Hct-35.3* MCV-90 MCH-29.0 MCHC-32.4 RDW-16.0* \n___ 08:20PM BLOOD Glucose-97 UreaN-23* Creat-1.0 Na-144 K-3.7 Cl-106 HCO3-26 AnGap-16\n\ufeff\nIMAGING/STUDIES\n================\nCXR PA/LATERAL:\nNo acute cardiopulmonary process.\n\ufeff\nCT HEAD W/O CONTRAST:\nIMPRESSION:\nDecrease in size of known mass centered at the septum pellucidum. No evidence of acute hemorrhage or infarction. The ventricles are unchanged in size and configuration.\n\ufeff\nCTA CHEST:\nIMPRESSION:\n1. 1 cm area of peripheral arterial enhancement in the left lobe of the liver, statistically likely a hemangioma, however, nonurgent abdominal ultrasound can be performed for further evaluation.\n2. 3 mm left lower lobe subpleural pulmonary nodule. 6 month follow up CT recommended.\n3. small RLL filling defect\n4. The patient has stable hemodynamics, no evidence of RV function impairment, and normal blood biomarker levels\n\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Low-risk PE/18895551-DS-18.json b/Finished/Pulmonary Embolism/Low-risk PE/18895551-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..dad2fd5a196198b723ccebfa412426a4db057506 --- /dev/null +++ b/Finished/Pulmonary Embolism/Low-risk PE/18895551-DS-18.json @@ -0,0 +1,38 @@ +{ + "Low-risk PE$Intermedia_4": { + "The patient's heart shape and function are normal, and there are no hemodynamic problems. Support low-risk PE$Cause_1": { + "The thyroid is unremarkable, and there is no supraclavicular lymph node enlargement. The airways are patent to the subsegmental level. There is no mediastinal, hilar or axillary lymph node enlargement by CT size criteria. The heart, pericardium, and great vessels are within normal limits. No hiatal hernia or any other esophageal abnormality is present.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "A significant increase in D-dimer is one of the important diagnostic indicators of pulmonary embolism, indicating that thrombosis may occur in the body.$Cause_1": { + "D-Dimer-1298$Input6": {} + }, + "Abnormal blockage within a blood vessel, visible on CT angiography, is a direct sign of pulmonary embolism and indicates the presence of a blood clot$Cause_1": { + "There is a filling defect within the right lower anterior segmental pulmonary artery with extension into the subsegmental branches$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "One of the common symptoms of pulmonary embolism is sudden chest pain.$Cause_1": { + "acute onset chest pain$Input2": {} + }, + "Pulmonary embolism may cause localized chest pain$Cause_1": { + "sudden left sided chest pain$Input2": {} + }, + "Chest pain related to breathing may be caused by obstruction of blood flow to the lungs$Cause_1": { + "worsened with breathing$Input2": {} + }, + "Dyspnea is a classic symptom of pulmonary embolism$Cause_1": { + "experience sob/dyspnea$Input2": {} + }, + "Hormonal contraceptives have the potential to increase the risk of blood clots and may cause or worsen the risk of pulmonary embolism.$Cause_1": { + "using Nexplanon implantable contraception$Input2": {} + } + } + } + }, + "input1": "None\n", + "input2": "female with RA and major depressive disorder who presented to the ED with acute onset chest pain. Pt reports being in usual state of health and was watching TV at rest yesterday when she experienced sudden left sided chest pain. Chest pain is described as originating under L breast and radiating around her left back. It felt heavy at first but sharp and worsened with breathing. Pt initially ignored the pain thinking it was her rheumatoid pain, but became concerned when she began to experience sob/dyspnea. She sought ED attention this morning when symptoms persisted. She has been using Nexplanon implantable contraception for ___ years. Pt denies any prolonged immobility, recent surgeries, or flights. She denies any personal or family hx of blood clots. She has had 3 pregnancies (1 live birth, 1 miscarriage, 1 elective abortion). She denies any leg pain or swelling. ROS otherwise negative.\n\n", + "input3": "None\n", + "input4": "Grandmother had a hx of heart disease, diabetes, HTN. No family hx of blood clots or recurrent miscarriages.\n", + "input5": "Vitals: 97.5 98 133/68 18 99%RA\nGEN: NAD, AAOx3, breathing comfortably on RA\nCV: RRR, no m/r/g\nLUNGS: CTAB, no w/r/r\nCHEST: No bruises or visible injuries over chest wall. Tenderness to palpation over left chest wall under left breast.\nABD: Soft, nondistended, nontender to palpation\n___: no swelling/edema in bilateral lower extremities. No calf tenderness to palpation bilaterally.\n", + "input6": "___ 09:00AM BLOOD WBC-8.7# RBC-4.04* Hgb-12.5 Hct-36.5 \nMCV-91# MCH-30.9 MCHC-34.2 RDW-16.8* Plt ___\n___ 09:00AM BLOOD Neuts-86.3* Lymphs-8.8* Monos-3.7 Eos-1.1 \nBaso-0.1\n___ 09:00AM BLOOD ___ PTT-27.0 ___\n___ 09:00AM BLOOD Glucose-92 UreaN-14 Creat-0.7 Na-135 \nK-5.2* Cl-104 HCO3-23 AnGap-13\n___ 09:00AM BLOOD ALT-37 AST-35 CK(CPK)-152 AlkPhos-65 \nTotBili-0.3\n___ 09:00AM BLOOD Lipase-12\n___ 09:00AM BLOOD CK-MB-<1 cTropnT-<0.01\n___ 09:00AM BLOOD Albumin-3.9 Calcium-9.1 Phos-2.4* Mg-1.9\n___ 09:00AM BLOOD D-Dimer-1298*\n___ 08:00AM BLOOD ASA-NEG Ethanol-NEG Bnzodzp-NEG \nBarbitr-NEG Tricycl-NEG\n\n___ CTA CHEST:\nThe thyroid is unremarkable, and there is no supraclavicular lymph node enlargement. The airways are patent to the subsegmental level. There is no mediastinal, hilar or axillary lymph node enlargement by CT size criteria. The heart, pericardium, and great vessels are within normal limits. No hiatal hernia or any other esophageal abnormality is present. \n \nGround-glass opacity within the left lingula is likely secondary to atelectasis/collapse (2:76). There is also a trace left pleural effusion with associated atelectasis. \n \nCTA: The aorta and main thoracic vessels are well opacified. The aorta demonstrates normal caliber throughout the thorax without intramural hematoma or dissection. There is a filling defect within the right lower anterior segmental pulmonary artery with extension into the subsegmental branches. \n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Massive PE/15917563-DS-14.json b/Finished/Pulmonary Embolism/Massive PE/15917563-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..1bec8a882b81a0576bf03470769051fd42bbd12c --- /dev/null +++ b/Finished/Pulmonary Embolism/Massive PE/15917563-DS-14.json @@ -0,0 +1,53 @@ +{ + "Massive PE$Intermedia_4": { + "Hypotension may indicate right ventricular overload or circulatory collapse due to PE. Indicate develops hemodynamic instability.$Cause_1": { + "hypotensive to 76/52$Input2": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Existing of embolism is the direct proof of PE$Cause_1": { + "bilateral pulmonary embolism$Input1": {} + }, + "Elevated D-dimer levels are a common biochemical marker of pulmonary embolism. Values \u200b\u200bgreater than 500 ng/mL usually indicate the presence of thrombosis.$Cause_1": { + "D-DIMER-3821$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Dizziness may be due to decreased oxygen saturation or decreased cardiac output caused by PE$Cause_1": { + "lightheaded$Input2": {} + }, + "Sweating may be part of the body's stress response and may be associated with the onset of PE$Cause_1": { + "sweating$Input2": {} + }, + "Chest pain is an important symptom of PE.$Cause_1": { + "chest pain$Input2": {} + }, + "Bilateral PE confirmed by CT scan indicates that multiple pulmonary blood vessels are embolic and the condition is more serious.$Cause_1": { + "CT scan revealed bilateral PEs$Input2": {} + }, + "Heparin is a commonly used drug to prevent further blood clotting and promote the dissolution of existing blood clots.$Cause_1": { + "given fluid bolus as well as heparin bolus$Input2": {} + }, + "Describes the presence of warm edema in the extremities. It is one of the common symptoms of pulmonary embolism.$Cause_1": { + "Warm edema/c/c$Input5": {} + }, + "This may mean that the patient needs additional oxygen support to maintain normal oxygen saturation, which in the case of pulmonary embolism may be due to impaired oxygen exchange in the lungs.$Cause_1": { + "100% 3L NC$Input5": {} + }, + "Blood function disorders may be related to anticoagulation therapy during the diagnosis and treatment of pulmonary embolism$Cause_1": { + "PTT-141.7$Input6": {} + }, + "Echocardiography shows decreased right ventricular free wall motion, tricuspid regurgitation, and right ventricular enlargement, all of which are signs of increased right ventricular pressure, which is common in severe pulmonary embolism.$Cause_1": { + "an echocardiogram was performed, which showed right free wall hypokinesis, 2+ tricuspid regurgitation, and dilation of the right ventricle.$Input6": {} + }, + "Oral contraceptives are a known risk factor for thrombosis$Cause_1": { + "Heme was consulted, and they recommended lifelong discontinuation of her oral contraceptive pills.$Input6": {} + } + } + } + }, + "input1": "bilateral pulmonary embolism\n", + "input2": "She s/p laparoscopic appendectomy. Patient was discharged the next day in good condition. Pt was ambulating without any difficulty. She reports feeling tired yesterday and this morning feeling lightheaded, sweating, and some chest pain.Pt went where CT scan revealed bilateral PEs.She was hypotensive to 76/52 and she was given fluid bolus as well as heparin bolus, followed by heparin gtt. Pt was then transferred for further management. In the TSICU, her O2 sat is 100 on 3L NC. She does not complain of shortness of breath, lightheadedness, pain or swelling. Denies Fever/Chill/Nausea/Vomiting. Last BM was yesterday and it was normal. Pt reports minimal chest pain. \n\ufeff\n", + "input3": "hypothyroidism, and ADHD\n", + "input4": "non-contributory\n", + "input5": "Physical Exam:\nVitals: T98.3 P91 BP96/58 RR16 100% 3L NC\nGEN: NAD. Alert, oriented x3. \nHEENT: No scleral icterus. Mucous membranes moist. Neck supple\nCV: RRR, normal S1/S2\nPULM: Unlabored breathing, CTAB\nABD: Soft, nondistended, NTTP, No R/G. No masses. normal active\nbowel sound, port sites are D/C/I\nEXT: Warm edema/c/c\n\nMedications on Admission:\nnone\n", + "input6": "___ 05:00PM PLT COUNT-218\n___ 05:00PM WBC-14.4* RBC-4.23 HGB-12.6 HCT-37.5 MCV-89 MCH-29.7 MCHC-33.5 RDW-13.4\n___ 05:00PM HCG-<5\n___ 05:00PM TSH-3.2\n___ 05:00PM D-DIMER-3821*\n___ 05:00PM CALCIUM-8.3* PHOSPHATE-3.3 MAGNESIUM-1.8\n___ 05:00PM CK-MB-3 cTropnT-0.09* proBNP-275*\n___ 05:00PM CK(CPK)-46\n___ 05:00PM estGFR-Using this\n___ 05:00PM GLUCOSE-83 UREA N-10 CREAT-0.6 SODIUM-139 POTASSIUM-4.4 CHLORIDE-107 TOTAL CO2-25 ANION GAP-11\n___ 05:16PM PTT-141.7*\n___ 05:23PM LACTATE-1.3\n___ 06:35PM HEPARIN-0.64\n\nShe underwent a CTA of her chest. She was started on a heparin drip and transferred to the ICU. Cardiology and Vascular Surgery were consulted. They recommended therapeutic enoxaparin, which was given. To assess the strain on the heart, an echocardiogram was performed, which showed right free wall hypokinesis, 2+ tricuspid regurgitation, and dilation of the right ventricle.\nHeme was consulted, and they recommended lifelong discontinuation of her oral contraceptive pills. They also advised a six-month course of warfarin. She underwent a repeat echo, which showed no change. \nA repeat CTA/CTV of th echest was performed as well as a CT of the pelvis to evaluate thrombus burden and to evaluated for iliofemoral clot, respectively. A repeat echo was unchanged. She was put on a regular diet, which she tolerated well.\nShe was advanced to PO pain meds. Given her experience, she had anxiety, and so social work was consulted to evaluate for therapy options. From a cardiovascular standpoint, catheter directed thorombolysis was planned for the next morning, so she was switched over to a heparin drip. \nCatheter directed thrombolysis was attempted but ultimately aborted before tPa was given secondary to her right pulmonary artery pressures being found to be normal. A repeat echo showed minimal dilation of the ventricle. She was transferred to the floor in stable condition. Cardiology recommended 3 weeks of fondaparinux (7.5 mg SC daily) every day with a transition to warfarin as an outpatient.\nShe was doing well and discharged home in stable condition.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Massive PE/17850733-DS-7.json b/Finished/Pulmonary Embolism/Massive PE/17850733-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..7f61af41f48ab0445fff32f5e62b28fffb5165ae --- /dev/null +++ b/Finished/Pulmonary Embolism/Massive PE/17850733-DS-7.json @@ -0,0 +1,47 @@ +{ + "Massive PE$Intermedia_4": { + "Persistent hypotension refers to blood pressure that remains below normal, showing dynamic instability, which is a serious clinical manifestation in pulmonary embolism.$Cause_1": { + "The patient develops hemodynamic instability, show sustained hypotension$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "CTA showed pulmonary embolism in a small segment of the left lower lobe, which is the key evidence for direct diagnosis of pulmonary embolism.$Cause_1": { + "CTA which showed small subsegmental PE in LLL$Input2": {} + }, + "A significant increase in D-dimer is one of the common laboratory indicators of pulmonary embolism.$Cause_1": { + "D-DIMER- 4315$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "back pain is the symptoms may be associated with pulmonary embolism$Cause_1": { + "back pain$Input2": {} + }, + "The patient had a certain degree of hypoxemia, which may be caused by pulmonary insufficiency and related to pulmonary embolism.$Cause_1": { + "O2 sat was 85-90/RA, 95%on 4L$Input2": {} + }, + "Patients with end-stage renal disease may have an increased risk of thrombosis due to long-term use of intravenous access$Cause_1": { + "ESRD with HD-$Input3": {} + }, + "The patient has a history of anticoagulant therapy, which is often used to prevent and treat thrombosis$Cause_1": { + "On coumadin as allergy to heparin$Input3": {} + }, + "Patients with a history of thrombosis. The blood clot may break off and form an embolus, which can migrate to the lungs and cause pulmonary embolism.$Cause_1": { + "h/o right brachial vein thrombosis$Input3": {} + }, + "Fluctuations in blood pressure may indicate an increased workload on the heart, which is common in PE as the heart fights against blockages in the blood vessels in the lungs.$Cause_1": { + "BP = 110/61, 110/61-149/70$Input5": {} + }, + "The patient had low oxygen saturation, a key symptom of PE, because impaired lung function leads to reduced oxygen exchange.$Cause_1": { + "16 RR = 16 O2Sat = 94% on 2L$Input5": {} + }, + "A prolonged PTT may indicate an abnormality in the coagulation system, which may be due to anticoagulant therapy or a coagulopathy$Cause_1": { + "PTT-84.7$Input6": {} + } + } + } + }, + "input1": "None\n", + "input2": "He with ESRD on HD resident, picked up at HebReb to go to dialysis, found by EMS to be diaphoretic, vomiting, c/o back pain. He denied any CP, SOB, abdominal pain. He was then sent to the ED. His O2 sat was 85-90/RA, 95%on 4L. In the ED, EKG showed LBBB (at baseline) and no other change. Of note he had his tunnel catheter dialysis line was exchanged secondary to flow difficulties/obstruction at hemodialysis. In the ED he had a CTA which showed small subsegmental PE in LLL. Given h/o allergy to heparin, he was started on agatroban. In the ED he was given zofran 4 mg IV/morphine 2 mg IV/ASA 600 mg PR/lopressor 5 mg IV/ Plavix 300 mg xT. I spoke with his daughter last night who confirmed that we should continue the agatroban and she would be open to the idea of coumadin. He has not had any falls. Dr. was also in agreement with this. He was seen by renal yesterday where there was no indication for HD yesterday. Review of tele demonstrates 6 bts NSVT and HR = 60s. Overnight he was weaned from 4L nc to 2L NC. \n. \nROS \nOn review of systems, the pt. denied recent fatigue, fever or chills, denies CP or shortness. He is now comfortable.\n", + "input3": "1. ESRD with HD-. On coumadin as allergy to heparin. \n2. HTN \n3. Gout \n4. MSSA Bacteremia with septic right shoulder \n5. Anemia Chronic Disease \n6. h/o right brachial vein thrombosis. Delirium \n8. GERD \n9. Hypercholesterolemia \n10. Rash c/w vasculitis on legs \n11. b/l cataract surgery s/p inguinal and abdominal hernia repairs \n\ufeff\n", + "input4": "Non-contributory\n", + "input5": "Physical Exam:\nVS Tm = 99, Tc = 98.8, P = 64-67, BP = 110/61, 110/61-149/70, 16 RR = 16 O2Sat = 94% on 2L. 480/inc 120/ not recorded. \nGENERAL: Elderly male, sitting up in bed. NAD. He states that he is not very hungry. I re-heated his oatmeal and begged him to eat. \nNourishment: Well nourished. \nGrooming: Well groomed \nMentation: Awake, oriented. Attentive. \nHEENT: NC/AT, PERRL, EOMI without nystagmus, no scleral icterus noted, MMM, no lesions noted in OP \nNeck: supple, no JVD or carotid bruits appreciated \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: RRR, nl. S1S2, no M/R/G noted \nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. \nExtremities: No C/C/E bilaterally, \nNeurologic: \n-mental status: Alert, oriented x 3. Able to relate history without difficulty. \n-cranial nerves: II-XII intact \n-motor: normal bulk, strength and tone throughout. No abnormal movements noted.\n-sensory: No deficits to light touch throughout. \nNo foley catheter/tracheostomy/PEG/ventilator support/chest tube/colostomy \n+NC \n\ufeff\n", + "input6": "___ 09:45PM PTT-84.7*\n___ 04:50PM CK(CPK)-40\n___ 06:45AM CK(CPK)-54\n___ 06:45AM NEUTS-72.8* MONOS-6.3 EOS-0.4 BASOS-0.3\n___ 06:45AM PLT COUNT-325#\n___ 06:45AM PTT-29.9\n___ 06:45AM D-DIMER- 4315*\n\ufeff\nThe patient develops hemodynamic instability, show sustained hypotension\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/12301488-DS-7.json b/Finished/Pulmonary Embolism/Submassive PE/12301488-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..73661132fd6b643f5b57f3bc4cb1c1d5664ec362 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/12301488-DS-7.json @@ -0,0 +1,44 @@ +{ + "Submassive PE$Intermedia_4": { + "Rule out Massive PE$Cause_1": { + "The patient is hemodynamically stable.$Input6": {} + }, + "The increased right ventricular workload is due to the heart needing to pump more blood through the embolic lung vessels. This is one of the important indicators for assessing the severity of pulmonary embolism.$Cause_1": { + "evidence of right heart strain$Input2": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Large pulmonary emboli usually indicate blood clots in the major pulmonary arteries, which is a clear sign of pulmonary embolism.$Cause_1": { + "Large pulmonary embolism in the right main pulmonary artery$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Dyspnea on exertion is a feeling of labored breathing during physical activity and is a common symptom of pulmonary embolism.$Cause_1": { + "Dyspnea on exertion$Input1": {} + }, + "Sudden onset of dyspnea, a classic symptom of PE$Cause_1": { + "acute shortness of breath$Input2": {} + }, + "Chest tightness is a symptom of pulmonary embolism$Cause_1": { + "chest pressure$Input2": {} + }, + "The recurrence of symptoms increases the likelihood of PE and suggests that this may be an ongoing circulatory problem.$Cause_1": { + "again developed dyspnea$Input2": {} + }, + "Family inheritance is an important factor in PE$Cause_1": { + "father dying in from a pulmonary embolism$Input4": {} + }, + "Right ventricular dilatation and reduced free wall motion are often associated with pulmonary hypertension and increased cardiac workload after pulmonary embolism, which may be caused by a large pulmonary embolism.$Cause_1": { + "right ventricular cavity is mildly dilated$Input6": {} + }, + "Pulmonary hypertension may be caused by blood flow obstruction due to pulmonary embolism, which is a common complication of pulmonary embolism.$Cause_1": { + "There is mild symmetric left ventricular hypertrophy$Input6": {} + } + } + } + }, + "input1": "Dyspnea on exertion\n", + "input2": "He hx BPH who presents with acute onset of DOE yesterday while walking around work. Pt was in his USOH when he developed acute shortness of breath while walking up a hill at work. He states that he is usually able to do this hill multiple times in a day without any difficulty. However he noted that he was quite dyspneic, requiring him to rest. Had associated chest pressure located over midchest that self terminated after several minutes. Denied palpitations, cough, hemoptysis, fevers, chills, NS, changes in weight. When he went home, he again developed dyspnea while working on a project with associated chest pressure. He took 2 aspirin and his symptoms alleviated after an hour. He went to sleep asymptomatic however the next morning he again developed DOE and chest pressure which prompted him to go to ED for evaluation. \n\ufeff\nHe initially presented where he was found to have tropI of 0.32 with EKG with RBBB (unclear if new). He was plavix loaded and heparinized and transferred for cardiac catheterization. On day of cath he was found to have 50% LAD lesion but otherwise normal coronaries. He was then admitted for further work-up. While on the floor patient remained notably dyspneic. CTA was completed showing evidence of right heart strain. \n\ufeff\n", + "input3": "BPH \nappendectomy\n\ufeff\n", + "input4": "father dying in from a pulmonary embolism, multiple other first degree relatives with DVTs\n", + "input5": "Physical Exam:\nPHYSICAL EXAMINATION: \nVS: afebrile 132/92 115 20 94%RA\nGeneral: NAD\nHEENT: PERRL, EOMI\nNeck: no JVD \nCV: RRR s1/s2 -mrg \nLungs: CTAB -wrr\nAbdomen: sNTND +BS\nExt: -cce, -calf tenderness\nNeuro: grossly intact\n", + "input6": "ADMISSION:\n___ 08:08PM UREA N-14 CREAT-0.9 SODIUM-141 POTASSIUM-3.8 CHLORIDE-104 TOTAL CO2-27 ANION GAP-14\n___ 08:08PM estGFR-Using this\n___ 08:08PM CK(CPK)-55\n___ 08:08PM CK-MB-4 cTropnT-0.05* proBNP-1576*\n___ 08:08PM MAGNESIUM-2.1\n___ 08:08PM 08:08PM WBC-9.3 RBC-4.81 HGB-14.7 HCT-43.3 MCV-90 MCH-30.5 MCHC-33.9 RDW-13.2\n___ 08:08PM NEUTS-68.3 MONOS-5.5 EOS-0.9 BASOS-0.6\n___ 08:08PM PLT COUNT-128*\n___ 08:08PM PTT-27.0\n___ 08:08PM PTT-27.0\n\ufeff\n\ufeff\nMICRO:\n5:27 am MRSA SCREEN\n**FINAL REPORT\nMRSA SCREEN (Final: No MRSA isolated. \n\ufeff\nIMAGING:\nCardiac Catheterization Report\nCoronary angiography: right dominant\nLMCA: No angiographically apparent CAD\nLAD: Mid vessel eccentric 50% \nLCX: No angiographically apparent CAD\nRCA: No angiographically apparent CAD\n\ufeff\nRadiology Report CTA CHEST W&W/O C&RECONS, NON-CORONARY Study \nIMPRESSION: \n1. Large pulmonary embolism in the right main pulmonary artery extending into many of the lobar and segmental branches and beyond. \n2. A smaller burden of segmental embolism in the left pulmonary arterial tree. \n3. There is no specific CT evidence of right heart strain, although clinical correlation is recommended. \n4. The patient is hemodynamically stable.\n\ufeff\nPortable TTE (Complete) Done at 3:12:17 \nFINAL Conclusions \nThe left atrium is normal in size. There is mild symmetric left ventricular hypertrophy with normal cavity size. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is low normal (LVEF 50-55%). The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. There is mild pulmonary artery systolic hypertension. There is no pericardial effusion. \n\ufeff\nIMPRESSION: Suboptimal image quality. Mild symmetric left ventricular systolic hypertrophy with low normal global systolic function. Mild right ventricular dilatation and mild global systolic dysfunction. Mild pulmonary artery systolic hypertension. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/12519803-DS-18.json b/Finished/Pulmonary Embolism/Submassive PE/12519803-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..cc58572d5ee5bd924c65d950a107fd1b28faa619 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/12519803-DS-18.json @@ -0,0 +1,47 @@ +{ + "Submassive PE$Intermedia_4": { + "Rule out Massive PE$Cause_1": { + "The patient is hemodynamically stable.$Input6": {} + }, + "Echocardiography showed right ventricular dilation, indicating adaptive dilation of the heart to maintain circulation, a direct effect of pulmonary embolism.$Cause_1": { + "ECHO showed RV dilitation$Input2": {} + }, + "Right ventricular cavity enlargement with generalized free wall hypoactivity is a typical cardiac imaging finding in pulmonary embolism$Cause_1": { + "The right ventricular cavity is dilated with severe global free wall hypokinesis$Input6": {} + }, + "Abnormal septal motion or position, consistent with right ventricular pressure/volume overload, further supports increased cardiac workload due to pulmonary embolism$Cause_1": { + "abnormal septal motion/position consistent with right ventricular pressure/volume overload$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "The V2 and V3 leads on the electrocardiogram showed strain and T wave inversion, indicating increased right ventricular load and confirming pulmonary embolism.$Cause_1": { + "ECG showed \"strain\" in V2 and V3 and TWI in V2 and V3.$Input2": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Shortness of breath is a common symptom of pulmonary embolism.$Cause_1": { + "shortness of breath$Input1": {} + }, + "Exercise-induced tachypnea reflects an underlying limitation of cardiopulmonary function and is related to the increased pulmonary artery pressures associated with pulmonary embolism.$Cause_1": { + "shortness of breath while walking up the stairs$Input2": {} + }, + "A rapid heart rate is the body's attempt to maintain normal blood circulation and oxygen supply, which is common in pulmonary embolism.$Cause_1": { + "tachycardiac to 120s$Input2": {} + }, + "Hypertension is a potential risk factor for pulmonary embolism$Cause_1": { + "Hypertension$Input3": {} + }, + "Mild tachycardia (slightly elevated heart rate) may be an indirect sign of PE$Cause_1": { + "HR 95$Input5": {} + }, + "Increased blood pressure may be a physiological response to acute stress and may be a pulmonary embolism$Cause_1": { + "BP 140s/80$Input5": {} + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "She first noticed shortness of breath while walking up the stairs. She presented to her PCP who drew D-dimer that was elevated. She was tachycardiac to 120s and had hypoxemia improving to low on NC. ECG showed \"strain\" in V2 and V3 and TWI in V2 and V3. Bedside ECHO showed RV dilitation. She was given 1 mg/kg lovenox SQ empirically.\n \nOf note, she denies past medical history of cancer, estrogen usage, known hypercoagulability, recent travel. No family history fo clotting disorders.\n\ufeff\nLabs were significant for troponin 0.3 and BNP 515. The patient was transferred for ICU admission. Initial VS were: 97.8 20 98% 4L. cTropnT 0.10, lactate 2.3, BNP of 10000. Heparin infusion was started, and lovenox was discontinued. \n \nOn arrival to the MICU, the patient had no complaints or concerns. In the MICU she was continued on heparin infusion and started on coumadin today. \n\ufeff\nCurrently patient reports mild sob but denies any chest pain, palpitations, coughing, n/v, diaphoresis, diarrhea, constipation, hematochezia, dysuria, hematuria. Denies any recent weight loss.\n\ufeff\n", + "input3": "+ Hypertension \n+ Osteoarthritis\n", + "input4": "No history of clotting disorder or DVT/PE. No history of neoplasm.\n", + "input5": "Physical Exam:\nVT: 98.1 HR 95 BP 140s/80 O2 98% on 2L\nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL \nNeck: supple, JVP not elevated, no LAD \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno organomegaly \nGU: no foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation, 2+ reflexes bilaterally, gait \ndeferred, finger-to-nose intact\nSkin: diffuse hyperpigmented lesion in the her face. one \ncrusted escahar lesion in her lower lip.\n", + "input6": "Admission/Pertinent Labs:\n___ 07:25PM BLOOD WBC-12.7* RBC-4.60 Hgb-15.2 Hct-42.1 MCV-91 MCH-32.9* MCHC-36.0* RDW-15.3\n___ 07:25PM BLOOD Neuts-88.0* Lymphs-7.2* Monos-4.1 Eos-0.4 Baso-0.2\n___ 07:25PM BLOOD PTT-39.7*\n___ 07:25PM BLOOD Glucose-125* UreaN-36* Creat-1.2* Na-134 K-7.2* Cl-99 HCO3-26 AnGap-16\n___ 07:25PM BLOOD cTropnT-0.10*\n___ 02:02AM BLOOD CK-MB-5 cTropnT-0.09*\n___ 08:10PM BLOOD CK-MB-6 cTropnT-0.07*\n___ 07:25PM BLOOD Calcium-9.8 Phos-3.6 Mg-1.9\n___ 07:35PM BLOOD Lactate-2.3* K-5.6*\n___ 11:28PM BLOOD Lactate-1.4\n.\nTTE: \nThe patient is hemodynamically stable. The left atrium is dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. Overall left ventricular systolic function is normal (LVEF 75%). Doppler parameters are most consistent with Grade I (mild) left ventricular diastolic dysfunction. The right ventricular free wall thickness is normal. The right ventricular cavity is dilated with severe global free wall hypokinesis. There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. There are focal calcifications in the aortic arch. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. There is no mitral valve prolapse. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \n.\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/12533087-DS-14.json b/Finished/Pulmonary Embolism/Submassive PE/12533087-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..f53aaaabc1a7f6991e86eb09a94f11a7996c49bb --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/12533087-DS-14.json @@ -0,0 +1,53 @@ +{ + "Submassive PE$Intermedia_4": { + "Rule out Massive PE$Cause_1": { + "The patient is hemodynamically stable.$Input6": {} + }, + "Right ventricular pressure overload, common in severe pulmonary embolism$Cause_1": { + "right ventricular pressure overload$Input6": {} + }, + "There is a certain degree of myocardial damage associated with PE$Cause_1": { + "cTropnT-0.13$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Pulmonary embolism forms multiple obstructions, direct evidence of PE$Cause_1": { + "CTA showed multiple PEs$Input2": {} + }, + "These findings are direct evidence of pulmonary embolism.$Cause_1": { + "evidence for extensive pulmonary embolic disease withthrombus in the left upper lobe and left lower lobe right lower lobe right upper lobe and right middle lobe.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Dyspnea is one of the common symptoms of pulmonary embolism.$Cause_1": { + "Dyspnea$Input1": {} + }, + "Chest pain is common in pulmonary embolism$Cause_1": { + "Chest Pain$Input1": {} + }, + "Right-sided chest pain and shortness of breath are common symptoms of pulmonary embolism, which may be caused by obstruction of blood flow to the lungs.$Cause_1": { + "R chest pain and SOB$Input2": {} + }, + "Pleuritic chest pain is a classic symptom of pulmonary embolism$Cause_1": { + "complained of right sided thoracic back pain and pleuritic chest pain$Input2": {} + }, + "Low oxygen saturation indicates impaired oxygen exchange, a sign of limited lung function, often seen in patients with pulmonary embolism$Cause_1": { + "O2 sat 88% RA.$Input2": {} + }, + "Hypertension is associated with thrombosis$Cause_1": { + "HTN$Input3": {} + }, + "Dyspnea is one of the typical symptoms of pulmonary embolism.$Cause_1": { + "slight conversational dyspnea$Input5": {} + }, + "The lungs may have fluid buildup or partial collapse, which is common in cases of pulmonary embolism$Cause_1": { + "decreased at bilateral bases, dullness to percussion at right$Input5": {} + } + } + } + }, + "input1": "Dyspnea, Chest Pain\n", + "input2": "She is a female with a history of colon cancer (s/p resection, chemotherapy , HTN, GERD, depression, and HLD who presents as a transfer for pulmonary embolism. One week ago, the patient developed R chest pain and SOB. She saw NP associated with her PCP's office where she complained of right sided thoracic back pain and pleuritic chest pain. She recommended a CTA chest, CXR and was also given Augmentin 875mg BID for possible infection, and analgesia with ibuprofen and tylenol #3. Chest x-ray was also done which showed dense right lung base opacity with associated effusion. Prior authorization was obtained and the patient obtained CTA chest 3 days later. The CTA showed multiple PEs with a possible area of necrosis, so she was referred for further management. There she was found to have O2 sat 88% RA. A bedside ultrasound showed no ultrasound evidence of pericardial effusion, and normal cardiac activity. Troponin was 0.156. Of note, LFTs were performed and notable for new transaminitis (AST 47 ALT 74) and elevated alk phos 267.\n\n", + "input3": "Colon Adenocarcinoma: Stage 3 T3, N1, MO s/p Low \nAnterior Sigmoidectomy. \nS/p adjuvant, leucovorin., recent colnoscopy showed polyp in the proximal ascending colon but otherwise WNL Depression \nHTN \nGERD \nOsteopenia\n\n", + "input4": "Mother - living with DMII, HTN, Alzheimer's Disease \nFather - deceased due to myocardial infarction. 2 brother(s)- one is hypertensive and 1 pseudogout . \n1 son(s) , 1 daughter(s) - healthy\n\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM:\n=========================\nVS - T 98.8, BP 150/72, HR 92, RR 20, SpO2 99% 2L NC. \nGENERAL: no acute distress, slight conversational dyspnea with moderately audible upper airway wheezing \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, \nMMM, good dentition \nNECK: nontender supple neck, no LAD, no JVD elevation \nCARDIAC: RRR, normal S1/S2, no murmurs, gallops, or rubs \nLUNG: decreased at bilateral bases, dullness to percussion at right base with crackles in mid-lung fields on the right, no egophony, breathing comfortably without use of accessory muscles \n \nABDOMEN: nondistended, +BS, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no cyanosis, clubbing or edema, lower extremities are symmetric, negative sign bilaterally \nNEURO: CN II-XII intact, moving all 4 extremities with purpose \n\ufeff\nSKIN: warm and well perfused, no excoriations or lesions, no rashes \n\ufeff\n\n", + "input6": "ADMISSION LAB VALUES: \n=====================\n___ 07:30PM GLUCOSE-168* UREA N-55* CREAT-1.4* SODIUM-131* POTASSIUM-6.5* CHLORIDE-97 TOTAL CO2-21* ANION GAP-20\n___ 07:30PM estGFR-Using this\n___ 07:30PM ALT(SGPT)-84* AST(SGOT)-86* LD(LDH)-657* ALK PHOS-287* TOT BILI-0.3\n___ 07:30PM GGT-165*\n___ 07:30PM cTropnT-0.13*\n___ 07:30PM ALBUMIN-3.0* IRON-37\n___ 07:30PM calTIBC-176* FERRITIN-670* TRF-135*\n___ 07:30PM ACETMNPHN-NEG\n___ 07:30PM COMMENTS-GREEN TOP\n___ 07:30PM K+-5.1\n___ 07:30PM WBC-8.8# RBC-3.34* HGB-9.8* HCT-30.1* MCV-90 MCH-29.3 MCHC-32.6 RDW-15.2 RDWSD-49.2*\n___ 07:30PM NEUTS-80.0* LYMPHS-5.8* MONOS-11.1 EOS-2.2 BASOS-0.2 IM AbsNeut-7.03* AbsLymp-0.51* AbsMono-0.98* AbsEos-0.19 AbsBaso-0.02\n___ 07:30PM HYPOCHROM-NORMAL ANISOCYT-NORMAL POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-NORMAL\n___ 07:30PM PLT COUNT-258\n___ 07:30PM PTT-41.3*\n___ 07:30PM RET AUT-1.3 ABS RET-0.04\n\ufeff\nPERTINENT IMAGING/STUDIES: \n==========================\nCT-A FROM:\nFINDINGS: CHEST:\n \nLungs:\nIn the right hemidiaphragm is elevated which could be due todiaphragmatic paralysis or hepatomegaly. There is right pleural disease subtle which is loculated. There is also a right lower lobeconsolidation or atelectasis atelectasis and hazy density in theright upper lobe. Left lung is clear. The heart is enlarged.\n \nVessels:\nThere is evidence for extensive pulmonary embolic disease withthrombus in the left upper lobe and left lower lobe right lower lobe right upper lobe and right middle lobe.\n \n \nRight pleural disease\n \nExtensive right-sided pulmonary parenchymal disease. How much ofthis represents inflammatory disease or the result of pulmonary infarct is difficult to determine.\n \nCardiovascular ECHO \nConclusions \nThe patient is hemodynamically stable. The left atrial volume index is normal. Normal left ventricular wall thickness, cavity size, and regional/global systolic function (biplane LVEF = 67%). The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. There is abnormal systolic septal motion/position consistent with right ventricular pressure overload. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion.\n\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/12554980-DS-15.json b/Finished/Pulmonary Embolism/Submassive PE/12554980-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..c7ba2e8519d7066412ad8819449ca02057214745 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/12554980-DS-15.json @@ -0,0 +1,53 @@ +{ + "Submassive PE$Intermedia_4": { + "Rule out massive PE$Cause_1": { + "The patient is hemodynamically stable.$Input6": {} + }, + "Right ventricular chamber dilation and reduced free wall activity are direct consequences of pulmonary hypertension and increased right ventricular load, and are one of the key diagnostic indicators of PE.$Cause_1": { + "Right ventricular cavity dilation with free wall hypokinsis.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Pulmonary CT angiography showed extensive embolism of bilateral pulmonary arteries with flattening of the septum, suggesting that the right ventricle may be under additional pressure, which is a typical manifestation of PE.$Cause_1": { + "Extensive pulmonary emboli involving the lobar arteries bilaterally, with flattening of the interventricular septum concerning for right heart strain.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Syncope is a common symptom of PE.$Cause_1": { + "syncope$Input1": {} + }, + "Shortness of breath is a classic symptom of pulmonary embolism$Cause_1": { + "shortness of breath at baseline$Input2": {} + }, + "Bilateral leg swelling may be a sign of deep vein thrombosis (DVT), a common cause of pulmonary embolism.$Cause_1": { + "bilateral leg swelling that has since improved$Input2": {} + }, + "Increased shortness of breath over a normal period, consistent with pulmonary embolism$Cause_1": { + "felt short of breath, more so than usual$Input2": {} + }, + "Heaviness in the chest, common in pulmonary embolism, because blockage of a blood vessel in the lung may cause increased chest pressure$Cause_1": { + "something \"sitting on my chest\"$Input2": {} + }, + "Patients who experience severe breathing difficulties or loss of consciousness during the event are symptoms of pulmonary embolism$Cause_1": { + "\"gurgling\" noise and \"slumped back\" into thesofa$Input2": {} + }, + "Patients who fail to continue taking their blood clot-preventing medications may be at increased risk for blood clots and subsequent pulmonary embolism$Cause_1": { + "off it for approximately weeks$Input2": {} + }, + "Hypertension is a risk factor for pulmonary embolism$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "Hyperlipidemia is a risk factor for pulmonary embolism$Cause_1": { + "HYPERLIPIDEMIA$Input3": {} + }, + "High obesity is a significant risk factor for pulmonary embolism$Cause_1": { + "Morbidly obese$Input5": {} + } + } + } + }, + "input1": "syncope\n", + "input2": "Pt was in his usual state of health today after a discharge fromrehab. He has been toe-touch weight bearing for several days,and exerting himself more than usual at home. The patient wascooperating with his exercises and doing well; he has shortness of breath at baseline when getting up and walking around, butusually it improves with some rest. The only thing he noticed before today was some bilateral leg swelling that has since improved.\n\ufeff\nOn the evening of arrival, Pt got up from a couch to go tothe bathroom. He felt short of breath, more so than usual; hesat back down on the cough, and then - per his wife who saw theevent - he made a \"gurgling\" noise and \"slumped back\" into thesofa. Pt remembers a feeling of something \"sitting on my chest\" before he lost consciousness.\n\ufeff\nPt estimates that he was unconscious for approximately 5 minutes. His wife said he twitched once, but otherwise had no jerking movements. Pt thought he was incontinent of a small amount of urine after the event. He was a little slow to return to normal, but within 20 minutes he was speaking normally with EMT's. He did not have any tongue biting during the episode. \n\ufeff\nPt states that he had been taking his enoxaparin until hisprescription ran out (reports 40mg BID at home). He took it for 10 days after his surgery, and his been off it for approximately weeks. \n\ufeff\nPatient denies headache, vision changes, cough, runny nose, fever, aches/pains, abdominal pain, bowel habit changes, or dysuria. He further denies preceding fevers, palpitations, dizziness/lightheadedness. \n\ufeff\n", + "input3": "+ANKLE SPRAIN \n+CELLULITIS \n+CHOLECYSTECTOMY \n+DIABETES MELLITUS \n+GASTROENTERITIS \n+HEALTH MAINTENANCE \n+HYPERLIPIDEMIA \n+HYPERTENSION\n", + "input4": "Mother, deceased from mycardial infarction. Father's health status unknown. Sister died with AIDS. \n\ufeff\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM:\nVS: T 98.4 BP 143/76 HR 87 RR 20 O2 98% on 2L NC\nGENERAL: Morbidly obese black male, lying back in bed. Pleasantand cooperative, in NAD.\nHEENT: Sclerae anicteric, MMM. PERRL. \nNECK: Unable to assess JVP due to body habitus.\nHEART: Distant heart sounds, but RRR, normal S1/S2. Pt statesthat he had a previous murmur \"that I grew out of.\"\nLUNGS: CTAB, no wheezes, rales, rhonchi. \nABDOMEN: Normoactive bowel sounds. Abdomen is soft, obese,nondistended, nontender in all quadrants, with no rebound/guarding. No hepatosplenomegaly \n\nPULSES: 2+ DP pulses bilaterally \nNEURO: No pronator drift, normal FNF testing. Moving all four extremities with purpose.\n\ufeff\n", + "input6": "ADMISSION LABS:\n___ 09:41PM PTT-79.7*\n___ 02:53PM PTT-66.1*\n___ 09:10AM CK-MB-2 cTropnT-0.03*\n___ 05:51AM WBC-11.1* RBC-4.11* HGB-12.2* HCT-36.8* MCV-90 MCH-29.7 MCHC-33.2 RDW-13.3 RDWSD-43.8\n___ 05:51AM PLT COUNT-175\n___ 05:51AM PTT-96.4*\n___ 04:00AM cTropnT-0.06*\n___ 11:51PM PO2-47* PCO2-44 PH-7.37 TOTAL CO2-26 BASE XS-0\n___ 11:51PM LACTATE-1.9\n___ 11:42PM GLUCOSE-162* UREA N-14 CREAT-0.9 SODIUM-140 POTASSIUM-4.3 CHLORIDE-104 TOTAL CO2-24 ANION GAP-12\n___ 11:42PM estGFR-Using this\n___ 11:42PM ALT(SGPT)-22 AST(SGOT)-20 ALK PHOS-118 TOT BILI-0.3\n___ 11:42PM LIPASE-65*\n___ 11:42PM CK-MB-2 cTropnT-0.04* proBNP-117\n___ 11:42PM ALBUMIN-3.5 CALCIUM-9.0 PHOSPHATE-3.6 MAGNESIUM-1.8\n___ 11:42PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG tricyclic-NEG\n___ 11:42PM WBC-11.4* RBC-4.25* HGB-12.6* HCT-38.0* MCV-89 MCH-29.6 MCHC-33.2 RDW-13.2 RDWSD-43.5\n___ 11:42PM NEUTS-81.5* LYMPHS-10.2* MONOS-6.0 EOS-1.5 BASOS-0.4 IM AbsNeut-9.30* AbsLymp-1.16* AbsMono-0.68 AbsEos-0.17 AbsBaso-0.05\n___ 11:42PM PLT COUNT-167\n___ 11:42PM PTT-26.7\n\ufeff\nIMAGING:\nCTA CHEST\n\ufeff\nIMPRESSION:\n \n \n1. Extensive pulmonary emboli involving the lobar arteries bilaterally, with flattening of the interventricular septum concerning for right heart strain.\n2. No evidence of pulmonary infarct.\n\ufeff\nIMPRESSION: \nNo evidence of deep venous thrombosis in the right or left lower extremityveins. Note is made that the peroneal veins could not be visualized bilaterally.\n\ufeff\nTTE\nIMPRESSION: The patient is hemodynamically stable. Suboptimal image quality. Right ventricular cavity dilation with free wall hypokinsis. \nMild pulmonary artery systolic hypertension. Mild symmetric left ventricular hypertrophy withnormal cavity size and global biventricular systolic function.\n\ufeff\n\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/12964739-DS-12.json b/Finished/Pulmonary Embolism/Submassive PE/12964739-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..77ce3debd2d22525a3d1e6bc53a7d3cb542ef7d3 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/12964739-DS-12.json @@ -0,0 +1,50 @@ +{ + "Submassive PE$Intermedia_4": { + "Despite RV abnormalities, the patient is hemodynamically stable. Excludes massive PE$Cause_1": { + "The patient is hemodynamically stable$Input6": {} + }, + "Signs of right ventricular compression, with an RV:LV ratio greater than 1, suggest impaired right ventricular function, consistent with submassive PE$Cause_1": { + "CT sign of right ventricular strain with RV: LV ratio greater than 1$Input6": {} + }, + "Elevated cardiac troponin indicates myocardial damage$Cause_1": { + "cTropnT-0.07*$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "CTA showed acute embolism in the right main pulmonary artery and bilateral lobar branches$Cause_1": { + "CTPA notable for acute pulmonary embolus within the right main pulmonary artery and bilateral lobar branches$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Significantly increased, indicating increased cardiac pressure load$Cause_1": { + "proBNP-6318*$Input6": {} + }, + "Dyspnea after exercise is one of the typical symptoms of PE$Cause_1": { + "dyspnea on exertion$Input1": {} + }, + "Sudden shortness of breath may be a symptom of pulmonary embolism (PE)$Cause_1": { + "udden onset shortness of breath while walking up the stairs$Input2": {} + }, + "Shortness of breath that does not improve the next day and interferes with daily activities further supports the possibility of PE$Cause_1": { + "felt so short of breath$Input2": {} + }, + "Hypertension can cause hardening and damage of blood vessels, increasing the risk of blood clots, which may lead to pulmonary embolism.$Cause_1": { + "HTN$Input3": {} + }, + "Hyperlipidemia can lead to dyslipidemia and promote the occurrence of atherosclerosis, which also increases the possibility of thrombosis and may lead to pulmonary embolism.$Cause_1": { + "HLD$Input3": {} + }, + "Shortness of breath is a classic symptom of pulmonary embolism.$Cause_1": { + "CTAB, short of breath when talking$Input5": {} + }, + "Tachycardia, possibly related to pulmonary embolism$Cause_1": { + "HEART - mildly tachy, Loud P2$Input5": {} + } + } + } + }, + "input1": "dyspnea on exertion\n", + "input2": "At baseline she can walk up to a mile a day and uses an exercise bike. She developed sudden onset shortness of breath while walking up the stairs at her house last night that improved with rest. This morning, she attempted to go on her typical walk but felt so short of breath that she decided to seek care. \n\nShe has never experienced this sensation before and there is no associated chest pain, pleuritic or otherwise, no cough, no symptoms at rest, no hemoptysis, and no increased leg swelling. She denies any prior history of blood clot. She denies any recent travel or extended car or plane trips, and has had no recent surgery or trauma. She has no prior personal or family history of VTE. She reports she had her last colonoscopy in which was reportedly normal and completed her screening. She says she had a mammogram last year which was normal completed her Pap testing.\n", + "input3": "HTN\nHLD\nGERD\n", + "input4": "She has no family history of blood clots or autoimmune disease. Her mother had ovarian cancer. Her father had a CABG as well as COPD\n", + "input5": "VITALS: T 98.1, HR 104 BP 140/96 RR 22 pO2 94% 4L NC\nGENERAL - obese, well appearing in NAD, Oriented x3, comfortable, \nMood, affect appropriate. \nHEENT - NC/AT, sclerae anicteric, MMM, OP clear, No xanthalesma. \nNECK - supple, JVD 12cm, no carotid bruits \nLUNGS - CTAB, short of breath when talking\nHEART - mildly tachy, Loud P2. No m/r/g.\nABDOMEN - soft/NT/ND, no masses or HSM, no rebound guarding. \nEXTREMITIES - wwp, no c/c/e, 2+ peripheral pulses (radials, DPs)\nNEURO - awake, A&Ox3, normal mental status, moves all extremities, coordination and sensory function grossly intact.\nPSYCH: pleasant, appropriate affect\n", + "input6": "___ 10:45PM BLOOD WBC-7.1 RBC-4.51 Hgb-13.1 Hct-40.2 MCV-89 \nMCH-29.0 MCHC-32.6 RDW-13.2 RDWSD-43.4 Plt ___\n___ 10:45PM BLOOD Glucose-108* UreaN-19 Creat-1.0 Na-143 \nK-3.7 Cl-104 HCO3-22 AnGap-17\n___ 10:45PM BLOOD proBNP-6318*\n___ 10:45PM BLOOD cTropnT-0.07*\n___ 07:55AM BLOOD cTropnT-0.04*\n___ 07:55AM BLOOD ALT-12 AST-22 AlkPhos-133* TotBili-0.9\n___ 10:49PM BLOOD Lactate-1.1\n\nIMAGING/OTHER STUDIES: \n======================\n\nThe patient is hemodynamically stable\nOSH CTA Chest:\nCTPA notable for acute pulmonary embolus within the right main pulmonary artery and bilateral lobar branches. There is\nassociated CT sign of right ventricular strain with RV: LV ratio greater than 1. There is a mass within the liver for which further evaluation is recommended to assess for potential malignancy. \n\n___ CTa/p w/ contrast\n1. 7.7 cm hypodense lesion within hepatic segment ___, with enhancement characteristics consistent with a hemangioma. \n2. Likely smaller hemangioma within hepatic segment VI measuring 1.0 cm. \n3. Extensive diverticulosis without evidence of acute \ndiverticulitis.\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/15536737-DS-18.json b/Finished/Pulmonary Embolism/Submassive PE/15536737-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..a82735d8f74641bebe242b7cdead65064515a9dd --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/15536737-DS-18.json @@ -0,0 +1,50 @@ +{ + "Submassive PE$Intermedia_4": { + "Despite RV abnormalities, the patient is hemodynamically stable. Excludes massive PE$Cause_1": { + "hemodynamically stable$Input2": {} + }, + "Impaired right ventricular function, a common sign of increased pressure and volume overload in pulmonary embolism$Cause_1": { + "right ventricular cavity is mildly dilated with mild global free wall hypokinesis$Input6": {} + }, + "The right ventricle is exposed to abnormal pressure and volume loads, often associated with pulmonary hypertension.$Cause_1": { + "abnormal septal motion/position consistent with right ventricular pressure/volume overload$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Bilateral pulmonary artery embolism. This is direct evidence for the diagnosis of pulmonary embolism.$Cause_1": { + "bilateral main pulmonary artery emboli$Input2": {} + }, + "This is a possible direct consequence of a pulmonary embolism, indicating an abnormally high pressure within the pulmonary arteries.$Cause_1": { + "moderate pulmonary artery systolic hypertension$Input6": {} + }, + "Multiple thrombi in the pulmonary artery branches are typical radiological manifestations of pulmonary embolism..$Cause_1": { + "numerous filling defects within the branches of the right pulmonary artery$Input6": {} + }, + "Deep vein thrombosis (DVT) of the lower extremities, which is a common cause of pulmonary embolism.$Cause_1": { + "left popliteal vein is not compressible and is partially occluded by echogenic thrombus$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "High blood pressure increases the risk of pulmonary embolism$Cause_1": { + "history of HTN$Input2": {} + }, + "Acute shortness of breath is a manifestation of pulmonary embolism$Cause_1": { + "acute shortness of breath$Input2": {} + }, + "The patient has worsening dyspnea and dizziness, which indicates that cardiopulmonary function may be affected. This is a manifestation of pulmonary embolism.$Cause_1": { + "worsening dyspnea with associated light-headedness$Input2": {} + }, + "Long-haul flights are a known risk factor for deep vein thrombosis, which can lead to pulmonary embolism.$Cause_1": { + "long distance flight$Input2": {} + }, + "Unilateral lower limb edema is a typical symptom of deep vein thrombosis, and DVT is one of the main sources of pulmonary embolism.$Cause_1": { + "lower extremity edema on left leg to level of tibia$Input5": {} + } + } + } + }, + "input1": "None\n", + "input2": "He with a background history of HTN, who presented with acute shortness of breath on a background of sub-acute dyspnea for several days, found to have bilateral main pulmonary artery emboli, now being transferred for possible thrombolysis.\n\ufeff\nThe patient is hemodynamically stable. Patient reports a week long history of progressive shortness of breath. When he was climbing stairs, he experienced worsening dyspnea with associated light-headedness. Denies chest pain, pre-syncope or syncope. This resolved with rest, with no recurrence of same. Breathing has worsened over the subsequent days, to the point he shortness of breath at rest. Awoke this morning with acute shortness of breath and decided to attend for evaluation of same.\n\ufeff\nOf note, patient with long distance flight ~ 5 weeks ago.\n\ufeff\nRecently started on azithromycin for a reported positive strep test, due to complete a five day course. He attended, where he had a CXR which was negative and a normal EKG. \n\ufeff\n", + "input3": "+ Coronaries: unknown \n+ Pump: unknown \n+ Rhythm: NSR \n\n\ufeff\n", + "input4": "No family history of blood clots.\n", + "input5": "Physical Exam:\n===============================\nADMISSION PHYSICAL EXAMINATION:\n===============================\nVS: T 97.9 HR 80 BP 120/105 RR 23 SaO2 95% 2L N/C \nGENERAL: lying comfortably in bed, no apparent distress\nHEENT: NT/AC, no conjunctival, anicteric sclera, MMM \nNECK: supple, JVD does not appear elevated but difficult to assess \nCV: RRR, S1 and S2 normal, no murmurs/rubs/gallops\nRESP: CTAB, no wheeze/crackles, breathing comfortably without use of accessory muscles of respiration \nsoft, non-tender, no distention greater than baseline, no organomegaly, BS normoactive \nEXTREMITIES: warm, well perfused, no cyanosis, 1+ lower extremity edema on left leg to level of tibia\nSKIN: no significant skin lesions or rashes \nPULSES: distal pulses palpable and symmetric\nNEURO: A/O x3, CN II-XII intact, strength in all extremities, sensation intact \n\ufeff\n", + "input6": "===============\nADMISSION LABS:\n===============\n___ WBC-10.0 RBC-4.79 Hgb-13.9 Hct-40.9 MCV-85 MCH-29.0 MCHC-34.0 RDW-13.1 RDWSD-40.3\n___ Neuts-56.4 Monos-7.3 Eos-2.8 Baso-0.2 Im \n___ AbsNeut-5.65 AbsLymp-3.30 AbsMono-0.73 AbsEos-0.28 AbsBaso-0.02\n___ PTT-60.4* \n___ Glucose-83 UreaN-14 Creat-1.0 Na-143 K-4.8 Cl-103 HCO3-24 AnGap-16\n___ ALT-48* AST-39 LD(LDH)-435* AlkPhos-93 TotBili-0.8\n___ Calcium-9.3 Phos-4.5 Mg-2.1\n___ 07:00PM CK-MB-5 cTropnT-<0.01\n\ufeff\n================\nIMAGING/REPORTS:\n================\nTTE\nThe left atrial volume index is normal. Left ventricular wall thicknesses and cavity size are normal. Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Overall left ventricular systolic function is low normal. Quantitative (biplane) LVEF = 49 %. The right ventricular cavity is mildly dilated with mild global free wall hypokinesis. There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. The mitral valve appears structurally normal with trivial mitral regurgitation. There is moderate pulmonary artery systolic hypertension. There is an anterior space which most likely represents a prominent fat pad. \n\ufeff\nBILATERAL LOWER EXTREMITY VENOUS DOPPLER US\nThere is normal compressibility, flow, and augmentation of the bilateral common femoral and femoral veins. There is normal color flow in the right posterior tibial and peroneal veins. The left popliteal vein is not compressible and is partially occluded by echogenic thrombus. However, there is normal color flow in the left posterior tibial veins. The left peroneal veins are not visualized. There is normal respiratory variation in the common \nfemoral veins bilaterally. No evidence of medial popliteal fossa cyst. \n\ufeff\nPULMONARY ARTERIOGRAM\nLeft pulmonary arteriogram demonstrates numerous filling defects within the branches of the left pulmonary artery consistent with findings on prior CTA chest. Right pulmonary arteriogram demonstrates numerous filling defects within the branches of the right pulmonary artery consistent with findings on prior CTA chest. Final fluoroscopic image of the chest demonstrate appropriate placement of the bilateral EKOS catheters. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/15686498-DS-16.json b/Finished/Pulmonary Embolism/Submassive PE/15686498-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..c4f7fd2e79970f852d55feb83e13a6703eb35ac4 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/15686498-DS-16.json @@ -0,0 +1,47 @@ +{ + "Submassive PE$Intermedia_4": { + "Despite RV abnormalities, the patient is hemodynamically stable. Excludes massive PE$Cause_1": { + "The patient is hemodynamically stable.$Input6": {} + }, + "Mild dilatation of the right atrium and ventricle may be due to increased pulmonary artery pressure, a typical manifestation of PE$Cause_1": { + "The left atrium is mildly dilated. The right atrium is moderately dilated.$Input6": {} + }, + "Mild right ventricular dilation may indicate increased right ventricular workload, a typical cardiac effect of pulmonary embolism$Cause_1": { + "The right ventricular cavity is mildly dilated$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "These symptoms and CT findings suggest lung involvement and increased cardiac workload, consistent with pulmonary embolism.$Cause_1": { + "dyspnea and pleuritic chest pain with pulmonary infarcts and possible evidence of R heart strain$Input2": {} + }, + "D-dimer is significantly elevated (normal less than 500 ng/mL FEU). This is an important sign of PE$Cause_1": { + "D-Dimer-3001$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Chest pain is a symptom of PE$Cause_1": { + "Chest pain$Input1": {} + }, + "Pleuritic chest pain is a classic symptom of pulmonary embolism$Cause_1": { + "pleuritic chest pain on his L side$Input2": {} + }, + "This is a common symptom of pulmonary embolism, because pulmonary embolism can cause the pleura to be stretched during breathing, causing pain.$Cause_1": { + "Pain was exacerbated with deep breaths$Input2": {} + }, + "Prolonged sitting or bed rest is an important risk factor for pulmonary embolism$Cause_1": { + "prolonged immobilization$Input2": {} + }, + "Hypertension is a risk factor for PE$Cause_1": { + "Hypertension$Input3": {} + }, + "Obesity can increase the likelihood of blood clots and put more strain on the heart and lungs.$Cause_1": { + "Obesity$Input3": {} + } + } + } + }, + "input1": "Chest pain\n", + "input2": "He M h/o p/w dyspnea and pleuritic chest pain with pulmonary infarcts and possible evidence of R heart strain on CT admitted for management of his PE's. \n \nPatient was in his usual state of health when he was woken from sleep by pleuritic chest pain on his L side in the AM. Pain was exacerbated with deep breaths and spanned from thorax to upper left abdomen. He denies any leg swelling or history of DVT/PE. Also no history of recent surgery, travel, trauma. He does endorse prolonged immobilization because he has been feeling very fatigued which he feels is from taking valsartan and chlorthalidone and has not been walking. His mobility is additionally limited by chronic dizziness s/p prior CVA and subacute pain in bilateral legs limiting his walking starting.\n\ufeff\n", + "input3": "- Type A aortic dissection s/p repair with 28mm supracoronary tube graft/valve resuspension, complicated by cardiac tamponade/ ARF requiring HD/ postoperative AF. MRI with stable 16-mm intimal flap in mid aortic arch and a 22 x 12 mm pseudoaneurysm in left lateral arch wall \n- Hypertension \n- Obesity \n- Dyslipidemia \n- CKD (baseline Cr 1.3-1.4) \n- Amyloid angiopathy \n- Former tobacco and alcohol abuse \n- s/p tonsillectomy and adenoidectomy\n", + "input4": "Father died of a stroke the cause of the stroke is unknown. Pt believes there is heart disease in multiple relatives. Cousin recently died of complications from heart disease. \n\ufeff\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM:\n========================\nVITALS: 97.6 153 / 76 62 16 96 Ra \nGENERAL: Alert and interactive. In no acute distress.\nHEENT: Normocephalic, atraumatic. Pupils equal, round, and reactive bilaterally, extraocular muscles intact. Scleraanicteric and without injection. Moist mucous membranes, good dentition. Oropharynx is clear.\nNECK: Thyroid is normal in size and texture, no nodules. No cervical lymphadenopathy. No JVD.\nCARDIAC: Regular rhythm, normal rate. Audible S1 and S2. Nomurmurs/rubs/gallops.\nLUNGS: Clear to auscultation bilaterally w/appropriate breath sounds appreciated in all fields. No wheezes, rhonchi or rales.\nNo increased work of breathing.\nBACK: No spinous process tenderness. No CVA tenderness.\nABDOMEN: Normal bowels sounds, non distended, non-tender to deep\npalpation in all four quadrants. No organomegaly.\nEXTREMITIES: No clubbing, cyanosis, or edema. Pulses DP/Radial 2+ bilaterally.\nSKIN: Warm. Cap refill <2s. Redness on face, chest, and upper extremities and back\nNEUROLOGIC: CN2-12 intact. Strength throughout. Normal sensation. Gait is normal. AOx3.\n\ufeff\n", + "input6": "ADMISSION LABS:\n===============\n___ 01:55PM BLOOD WBC-9.9 RBC-4.87 Hgb-15.2 Hct-45.9 MCV-94 MCH-31.2 MCHC-33.1 RDW-13.4 RDWSD-46.7*\n___ 01:55PM BLOOD Neuts-72.0* Lymphs-15.4* Monos-10.5 Eos-1.5 Baso-0.2 AbsNeut-7.16* AbsLymp-1.53 AbsMono-1.04* AbsEos-0.15 AbsBaso-0.02\n___ 12:37AM BLOOD PTT-23.9*\n___ 01:55PM BLOOD Glucose-109* UreaN-36* Creat-1.6* Na-138 K-6.2* Cl-100 HCO3-20* AnGap-18\n___ 01:55PM BLOOD ALT-26 AST-64* AlkPhos-42 TotBili-0.8\n___ 01:55PM BLOOD Lipase-24\n___ 08:22PM BLOOD cTropnT-<0.01\n___ 01:55PM BLOOD cTropnT-<0.01\n___ 01:55PM BLOOD proBNP-81\n___ 01:55PM BLOOD Albumin-4.0 Calcium-9.1 Phos-3.7 Mg-2.5\n___ 01:55PM BLOOD D-Dimer-3001*\n___ 02:47PM BLOOD Lactate-1.1 K-5.2*\n\n\ufeff\nIMAGING:\n========\n+ CTA\n \n1. No acute abnormality within the imaged abdomen and pelvis. \n2. Diverticulosis. \n\ufeff\n+ ECHO\nThe left atrium is mildly dilated. The right atrium is moderately dilated. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). The right ventricular cavity is mildly dilated with no more than borderline-mild global hypokinesis (suboptimal image quality). The ascending aorta is mildly dilated. The aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. Trivial mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is a trivial/physiologic pericardial effusion. There is an anterior space which most likely represents a prominent fat pad. The patient is hemodynamically stable.\n\ufeff\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/16061224-DS-14.json b/Finished/Pulmonary Embolism/Submassive PE/16061224-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..e03d2024628af18474e60a7ad22422101e6673ad --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/16061224-DS-14.json @@ -0,0 +1,47 @@ +{ + "Submassive PE$Intermedia_4": { + "Despite RV abnormalities, the patient is hemodynamically stable. Excludes massive PE$Cause_1": { + "She was hemodynamically stable$Input6": {} + }, + "Right ventricular enlargement and free wall hypodynamics are due to the right ventricle's adaptation to the persistently high pulmonary artery pressures, which are common in PE and suggest that there may be an obstruction in the pulmonary artery.$Cause_1": { + "The right ventricular cavity is dilated with mild global free wall hypokinesis$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Pulmonary hypertension is due to increased resistance to blood flow caused by obstruction of the pulmonary vascular bed, which is a typical manifestation of PE.$Cause_1": { + "moderate pulmonary artery systolic hypertension$Input6": {} + }, + "Right ventricular enlargement leads to dilation of the tricuspid annulus, further confirming the adaptive changes of cardiac structure to pulmonary embolism$Cause_1": { + "Moderate [2+] tricuspid regurgitation$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Prolonged sitting is an important factor in the development of blood clots, particularly in the veins of the lower extremities, which may subsequently lead to pulmonary embolism.$Cause_1": { + "extreme video gaming\" in which she sometimes is immobile for >12hrs$Input6": {} + }, + "short of breath is a symptom of PE$Cause_1": { + "shortness of breath$Input1": {} + }, + "Sudden, severe chest pain and difficulty breathing are typical symptoms of PE.$Cause_1": { + "chest pain and dyspnea$Input2": {} + }, + "Chest pain and shortness of breath are typical symptoms of PE$Cause_1": { + "central pleuritic chest pain and shortness of breath such that she was unable to speak$Input2": {} + }, + "Loss of consciousness and transient speech impairment may indicate severe circulatory or neurologic compromise, which in PE may be due to hypoxemia.$Cause_1": { + "subsequently lost consciousness$Input2": {} + }, + "A markedly increased heart rate is a common symptom of PE.$Cause_1": { + "HR = 126 bpm$Input5": {} + }, + "The patient was able to speak in complete sentences but required additional oxygen support, suggesting that underlying hypooxygenation is a common symptom of PE.$Cause_1": { + "speaking full sentences on 2 L by NC$Input5": {} + } + } + } + }, + "input1": "shortness of breath\n", + "input2": "She yo F w/ PMH significant for bicuspid aortic valve, GERD, anxiety, scalp psoriasis, ADD and migraines w/o aura p/w chest pain and dyspnea.\n\ufeff\nShe reports that on 2 days prior to admission, she was playing video games and using her prescribed Adderall for an extended period of time and did not eat or drink very much. She rose from her computer at approximately 9:00 and because lightheaded while walking to the kitchen. She felt that her legs were \"hard as a rock,\" and she bent over to feel her legs. She denies any numbness or tingling at this time. She subsequently lost consciousness and was found by her fianc\u00c3\u00a9 on the floor a few seconds later. During this episode, she experienced central pleuritic chest pain and shortness of breath such that she was unable to speak. She was incontinent of urine during this episode. She regained the ability to speak after approximately 30 seconds (of note, she attributes speech deficit to dyspnea rather than confusion or disorientation). She does state that she \"did not feel like myself for hours\" after this episode, though she is unable to elaborate any further. She states that her fianc\u00c3\u00a9 helped her into bed, and she experienced major difficulties in falling asleep despite taking her prescribed alprazolam 0.5 mg PRN anxiety.\n\ufeff\nShe states that she awoke (day prior to admission) feeling \"almost normal.\" She continued to experience some dyspnea (of note, at baseline she experiences dyspnea when ascending stairs). On the day of admission, she experienced sudden onset severe pleuritic central chest pain radiating into her back and dyspnea. She phoned and was brought ED for further care.\n\ufeff\nShe has never smoked. She is adopted and thus cannot provide any family history of haematologic disorders. Within the past week, she went by bus hrs each way, left and returned during which she made frequent trips to the bathroom. She denies cough, fever, chills or night sweats.\n\ufeff\n", + "input3": "1. CARDIAC RISK FACTORS \n+ Diabetes (-)\n+ Hypertension (-)\n+ Dyslipidemia (-)\n2. CARDIAC HISTORY \n+ Bicuspid aortic valve\n3. OTHER PAST MEDICAL HISTORY\n+ GERD\n+ Anxiety\n+ Psoriasis, scalp\n+ ADD\n+ Migraines w/o aura\n\ufeff\n", + "input4": "Patient was adopted and cannot provide family history.\n", + "input5": "Physical Exam:\nADMISSION EXAM\n==============\nVS: T = 36.8 C, BP = 109/4, RR = 20 bpm, SpO2 = 99 % on 2 L by NC \nGENERAL: Anxious-appearing woman speaking full sentences on 2 L by NC, in NAD\nHEENT: Normocephalic atraumatic. \nNECK: Supple. JVP not visible.\nCARDIAC: Tachycardic to 120s, regular rhythm. Normal S1, S2. No murmurs, rubs, or gallops.\nLUNGS: No chest wall deformities or tenderness. Respiration is unlabored with no accessory muscle use. No crackles, wheezes or rhonchi.\nABDOMEN: Soft, non-distended. Diffuse mild tenderness to deep palpation. No hepatomegaly. No splenomegaly. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or peripheral edema. \nSKIN: No significant skin lesions or rashes. \nPULSES: Distal pulses palpable and symmetric.\n\ufeff\n", + "input6": "ADMISSION LABS\n=========================\n___ 11:58AM BLOOD WBC-11.5* RBC-5.21* Hgb-15.5 Hct-46.1* MCV-89 MCH-29.8 MCHC-33.6 RDW-12.6 RDWSD-40.6 Plt ___\n___ 11:58AM BLOOD Neuts-69.9 Monos-5.9 Eos-3.3 Baso-0.7 AbsNeut-8.02*# AbsLymp-2.25 AbsMono-0.68 AbsEos-0.38 AbsBaso-0.08\n___ 11:58AM BLOOD PTT-26.7\n___ 11:36AM BLOOD Fibrino-PND\n___ 11:58AM BLOOD Glucose-162* UreaN-6 Creat-0.9 Na-140 K-4.3 Cl-102 HCO3-21* AnGap-21*\n___ 08:16PM BLOOD ALT-26 AST-22 LD(LDH)-229 AlkPhos-41 TotBili-0.3\n___ 11:58AM BLOOD proBNP-*\n___ 11:58AM BLOOD cTropnT-0.02*\n___ 11:58AM BLOOD Calcium-9.2 Phos-3.5 Mg-1.8\n___ 11:58AM BLOOD HCG-<5\n\ufeff\nIMAGING/STUDIES\n===================\nIMPRESSION: sinus tachycardia with IVCD\n\ufeff\n+ TTE //: \nCONCLUSION: The left atrium is normal in size. No atrial septal defect is seen by 2D or color Doppler. There is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (LVEF>55%). The right ventricular cavity is dilated with mild global free wall hypokinesis. There is abnormal septal motion/position consistent with right ventricular pressure/volume overload. The diameters of aorta at the sinus, ascending and arch levels are normal. The aortic valve is bicuspid. There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve appears structurally normal with trivial mitral regurgitation. Moderate [2+] tricuspid regurgitation is seen. There is moderate pulmonary artery systolic hypertension. There is no pericardial effusion. \n\n \n+ CT PE Protocol //:\nIMPRESSION: With evidence of right heart strain\n\ufeff\n#PROVOKED PULMONARY EMBOLISM:\nShe was hemodynamically stable, but initially managed in the CCU with heparin gtt d/t c/f right heart strain. She had a TTE with marked RV dysfunction with septal interaction and there was question of a RA density (not on all views). She ultimately had EKOS directed tPA by interventional radiology with improvement in heart rates and symptoms of dyspnea and pleuritic chest pain. She had a follow-up echo showing smaller RV and resolution of possible RA echodensity. Her PA systolic pressure and TR was unable to be assessed given EKOS catheter. She had improvement of symptoms of dyspnea and pleuritic chest pain and was then transitioned to Xarelto and managed on the medical floor where she remained HDS. She will need follow-up with cardiology and repeat TTE in approximately one month (early. In terms of her risk factors for PE, she participates in \"extreme video gaming\" in which she sometimes is immobile for >12hrs at a time. She has an unknown family history because she was adopted. She will likely need hypercaog work-up as an outpatient. \n\ufeff\n#GERD: Continued home pantoprazole 40 mg PO QD.\n\ufeff\n#Anxiety: Initially on Ativan, but resumed home Xanax. \n\ufeff\n#ADD: Held home Adderall in the hospital, but resumed on discharge. \n\ufeff\n#Migraines: Reports migraines per week with photosensitivity and nausea. Continued home tizanidine for ppx, home sumatriptan to abort. She was counseled to not take NSAIDs while on Xarelto. \n\ufeff\n\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/16179881-DS-7.json b/Finished/Pulmonary Embolism/Submassive PE/16179881-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..c777461349c2e0fc010dcf47b957c6dcf2dbdfc1 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/16179881-DS-7.json @@ -0,0 +1,41 @@ +{ + "Submassive PE$Intermedia_4": { + "Despite RV abnormalities, the patient is hemodynamically stable. Excludes massive PE$Cause_1": { + "The patient is hemodynamically stable$Input6": {} + }, + "Right ventricular dilation is often associated with pulmonary hypertension and increased right heart workload, which can be caused by pulmonary embolism.$Cause_1": { + "bedside ultrasound of her heart found mild RV dilation$Input2": {} + }, + "The right ventricle is slightly larger than the left ventricle, which may indicate the presence of increased right ventricular pressure, an important indicator of PE$Cause_1": { + "The right ventricle appears slightly larger than the left,$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "CT pulmonary angiography is one of the gold standards for diagnosing pulmonary embolism, and the thrombus burden shown confirms the presence of PE.$Cause_1": { + "CT Angiogram found heavy clot burden in the right pulmonary artery with notable pulmonary artery dilation$Input2": {} + }, + "Bilateral pulmonary embolism is an important indicator of PE$Cause_1": { + "Bilateral pulmonary emboli, more central on the right; extends from the right main pulmonary artery into right upper lobe, lower lobe, and possibly right middle lobe.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "SOB is the symptom of PE$Cause_1": { + "Shortness of breath$Input1": {} + }, + "Acute onset of shortness of breath is a classic symptom of pulmonary embolism$Cause_1": { + "acute onset shortness of breath$Input2": {} + }, + "Oral contraceptive use is a known risk factor for thrombosis, which can lead to pulmonary embolism.$Cause_1": { + "endorses current oral contraceptive use, most recently for 3-month course$Input2": {} + }, + "A normal first heart sound (S1) and a loud second heart sound (S2) may indicate pulmonary hypertension, which is caused by increased pressure in the pulmonary arteries. Pulmonary hypertension is a common complication of pulmonary embolism.$Cause_1": { + "normal S1 + loud S2$Input5": {} + } + } + } + }, + "input1": "Shortness of breath\n", + "input2": "She is a female with undiagnosed gluten intolerance who presents with one day of acute onset shortness of breath. Ms. took an airplane flight, landing on the evening without any symptoms. On the following morning, she awoke with a headache (not unlike prior hormonal headaches) and, upon walking to her office of employment after riding the T, became progressively short of breath, having to stop 7 times. Once at her destination, she remained unable to catch her breath, so she was brought to the hospital by a coworker. She endorses current oral contraceptive use, most recently for 3-month course. She does not have any history of blood clots.\n\ufeff\nWhile in the Emergency Department, the bedside ultrasound of her heart found mild RV dilation, but her troponins and pro-BNP were within normal limits. A CT Angiogram found heavy clot burden in the right pulmonary artery with notable pulmonary artery dilation. Cardiology Team was consulted, and they recommended heparin drip administration, noting lack of indication for EKOS or tPA use.\n\ufeff\nOn the floor, she reports some improvement in her shortness of breath and ability to ambulate around the room - however, she initially struggled with breathing simply when talking, standing up, and changing clothes. She endorses some night sweats over the past couple of months and intentional weight loss of a few pounds dietary changes), but denies fever, nausea, chest pain, exhaustion,urinary changes or bowel movement changes.\n\ufeff\nROS: Full 10 point ROS otherwise negative\n\ufeff\n", + "input3": "- Gluten intolerance (self-administered due to bowel irritation in past)\n", + "input4": "No history of blood clots.\nPGM - breast cancer and melanoma\nMaternal great grandmother - with breast cancer\nMaternal grandfather - melanoma\nAunt - melanoma, glioblastoma\nFather - colon cancer\n\ufeff\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM: \nVS - T 98.0, BP 109/73, HR 80, RR 18, O2 sat 97% RA\nGeneral: Pleasant, alert, oriented, NAD\nHEENT: Sclera anicteric, MMM, EOMI, PERRL, JVP not elevated\nNeck: Supple, no LAD\nCV: RRR, normal S1 + loud S2, no murmurs, rubs, gallops \nLungs: CTAB, no wheezes, rales, rhonchi\nAbdomen: Soft, non-tender, non-distended, bowel sounds present \nGU: No Foley\nExt: Warm, well perfused, 2+ pulses, no edema, no pain with calf flexion\nNeuro: CNII-XII grossly intact, moving all extremities spontaneously\n\ufeff\n", + "input6": "Admission Labs:\n___ 10:30AM BLOOD WBC-8.4# RBC-4.88 Hgb-15.7 Hct-45.2* MCV-93 MCH-32.2* MCHC-34.7 RDW-12.3 RDWSD-41.9\n___ 10:30AM BLOOD Neuts-75.7* Lymphs-18.9* Monos-4.4* Eos-0.4* Baso-0.2 AbsNeut-6.37* AbsLymp-1.59 AbsMono-0.37 AbsEos-0.03* AbsBaso-0.02\n___ 10:55AM BLOOD PTT-29.7\n___ 10:30AM BLOOD Glucose-103* UreaN-10 Creat-0.8 Na-136 K-3.7 Cl-99 HCO3-25 AnGap-16\n___ 10:30AM BLOOD estGFR-Using this\n___ 10:30AM BLOOD proBNP-20\n___ 10:30AM BLOOD cTropnT-<0.01\n___ 10:30AM BLOOD\n___ 10:45AM URINE UCG-NEGATIVE\n___ 10:45AM URINE Hours-RANDOM\n___ 10:45AM URINE Mucous-OCC\n___ 10:45AM URINE RBC-7* WBC-5 Bacteri-NONE Yeast-NONE Epi-6\n___ 10:45AM URINE Blood-NEG Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-SM \n___ 10:45AM URINE Color-Yellow Appear-Hazy\n\ufeff\nMicro:\nUrine Culture - pending\n\ufeff\nImaging:\nThe patient is hemodynamically stable\n- Doppler US: no evidence of DVT b/l\n- TTE: Final read pending; wet read without concerning findings\n- CTA: Bilateral pulmonary emboli, more central on the right; extends from the right main pulmonary artery into right upper lobe, lower lobe, and possibly right middle lobe. Segmental and subsegmental left lower lobe pulmonary emboli. The right ventricle appears slightly larger than the left, raising concern for underlying right heart strain. Findings could be further assessed on echocardiogram. No pulmonary infarct seen. \n- EKG: SR, normal axis, no ST/T changes \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/16658982-DS-20.json b/Finished/Pulmonary Embolism/Submassive PE/16658982-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..d4f1fa73ec041c3f38e949f04f359b9a10ed8694 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/16658982-DS-20.json @@ -0,0 +1,50 @@ +{ + "Submassive PE$Intermedia_4": { + "Despite the presence of pulmonary embolism, the heart's ability to pump blood has not been seriously affected. Excludes massive PE$Cause_1": { + "but otherwise hemodynamically stable$Input2": {} + }, + "Right ventricular dilation and decreased function are the physiological responses of the right ventricle to pulmonary hypertension, which is a typical manifestation of PE.$Cause_1": { + "mild RV dilation, with main pulmonary artery dilated 3.6 cm.$Input2": {} + }, + "Pressure or volume overload of the right ventricle, common in PE$Cause_1": { + "Mild right ventricular cavity dilation$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Directly shows the presence of pulmonary embolism. The location and severity of pulmonary embolism are related to the diagnosis of PE.$Cause_1": { + "moderate bilateral pulmonary emboli$Input2": {} + }, + "This is a key indicator of PE, indicating increased pressure in the pulmonary circulation$Cause_1": { + "At least moderate pulmonary artery systolic hypertension$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Varicose veins increase the risk of venous thrombosis, particularly in the lower extremities, which may lead to pulmonary embolism$Cause_1": { + "noticing \"phlebitis\" of the left lower leg$Input2": {} + }, + "Dyspnea is one of the typical symptoms of pulmonary embolism.$Cause_1": { + "worsening dyspnea$Input2": {} + }, + "High blood pressure increases risk of pulmonary embolism$Cause_1": { + "hypertension$Input3": {} + }, + "Intermittent atrial tachycardia can cause irregular contractions of the atria, increasing the likelihood of blood clotting and clot formation, leading to pulmonary embolism$Cause_1": { + "paroxysmal atrial tachycardia$Input3": {} + }, + "Arrhythmia, a common symptom of PE$Cause_1": { + "Irregular rhythm$Input5": {} + }, + "Increased jugular venous pressure may be a sign of impaired right ventricular function, and PE can cause excessive pressure on the right ventricle, leading to jugular venous filling.$Cause_1": { + "JVP ~8 cm at 45 deg$Input5": {} + }, + "Abnormalities of the coagulation system, which in PE may result in increased consumption of clotting factors due to thrombus formation$Cause_1": { + "PTT-150$Input6": {} + } + } + } + }, + "input1": "None\n", + "input2": "She initially presented to her PCP early last week after noticing \"phlebitis\" of the left lower leg. This was thought to be related to her h/o varicose veins and so was advised to continue monitoring. At that time also had increased frequency of palpitations (with known history of paroxysmal a-tach) and so metoprolol was doubled and received Holter monitor. Later that week developed worsening dyspnea to the point that she was unable to walk across a parking lot without losing her breath. This was very unusual for her, as at baseline she is very active and had even completed a hiking trip. \n\ufeff\nHer PCP referred her where she was found to have be hypoxic but otherwise hemodynamically stable. Labs revealed D-dimer elevation 7.2, troponin-I elevation to 0.815, NT proBNP elevated at 2374. EKG showed normal sinus rhythm with anterior lateral TWI (V2-V6). CT chest showed moderate bilateral pulmonary emboli with the largest being in the right lower lobe, mild RV dilation, with main pulmonary artery dilated 3.6 cm. Echocardiogram was obtained prior to transfer which was significant for positive sign, moderately dilated right ventricle, with moderately reduced RV function. LV function was normal.\n\ufeff\nShe was subsequently transferred where hospital course was notable for multiple episodes of SVT with rates into the 160s. Repeat troponin-T was reassuring at 0.02. ICU team was consulted for consideration thrombolytics which were felt to be unnecessary. Per family request, she was subsequently transferred for further evaluation.\n\ufeff\nUpon arrival to the ICU, she reports feeling overall well but continues to be mildly dyspneic. Did have mild episode of vague chest pain earlier last week but that has since resolved. No other new symptoms at this time. She thinks she is up to date onroutine cancer screening, including colonoscopy, Pap, and mammogram, though exact details are somewhat unclear and with further questioning is not entirely confident. No recent operations or significant immobilization. No family history of clotting disorders. No personal history of intracranial or other significant bleeding disorders.\n\ufeff\n10-point review of systems was negative except as detailed above.\n\ufeff\n", + "input3": "PAST MEDICAL HISTORY\n1. CARDIAC RISK FACTORS \n+ hypertension\n\n2. CARDIAC HISTORY \n+ paroxysmal atrial tachycardia\n\n3. OTHER PAST MEDICAL HISTORY \n+ remote history of L face melanoma s/p excision\n+ migraines\n+ varicose veins\n", + "input4": "No known family history of clotting or bleeding disorders.\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM\nGENERAL: Well appearing woman in no acute distress. Comfortable.\nNEURO: AAOx3. Moving all four extremities with purpose.\nHEENT: NCAT. EOMI. MMM.\nCARDIAC: Irregular rhythm, normal rate. Normal S1/S2. No murmurs, rubs, or gallops. JVP ~8 cm at 45 deg.\nPULMONARY: Clear to auscultation bilaterally. Breathing comfortably on room air.\nABDOMEN: Soft, non-tender, non-distended.\nEXTREMITIES: Warm, well perfused, non-edematous. \nSKIN: No significant rashes.\n\ufeff\nGeneral: NAD, alert and interactive\nHEENT: Normocephalic, atraumatic. Sclera anicteric and without injection. \nNeck: Supple.\nLungs: CTAB, normal work of breathing.\nCV: Regular rhythm, normal rate. Audible S1 and S2. No murmurs/rubs/gallops.\nGI: Soft, non-tender, non-distended. Normal bowel sounds. No rebound or guarding.\nExt: Warm and well perfused. No peripheral edema. \nNeuro: AOx3\n\ufeff\n", + "input6": "Admission Labs:\n___ 09:00AM BLOOD WBC-11.1* RBC-4.83 Hgb-15.2 Hct-44.0 MCV-91 MCH-31.5 MCHC-34.5 RDW-13.3 RDWSD-44.7\n___ 09:00AM BLOOD Neuts-65.5 Monos-6.6 Eos-1.6 Baso-0.5 AbsNeut-7.28* AbsLymp-2.82 AbsMono-0.74 AbsEos-0.18 AbsBaso-0.06\n___ 09:00AM BLOOD PTT-150*\n___ 09:00AM BLOOD Glucose-100 UreaN-7 Creat-0.7 Na-141 K-3.4* Cl-103 HCO3-22 AnGap-16\n___ 09:00AM BLOOD CK-MB-4 cTropnT-<0.01\n___ 09:00AM BLOOD ALT-40 AST-37 LD(LDH)-360* AlkPhos-71 TotBili-1.1\n___ 09:00AM BLOOD Albumin-4.2 Calcium-9.2 Phos-2.2* Mg-2.\n\ufeff\nImaging:\nThoracic ECHO :\nThe patient is hemodynamically stable\nIMPRESSION: Mild right ventricular cavity dilation with basal hypokinesis and relative preservation of apical motion sign) and septal flattening during systole/diastole due to right ventricular pressure/volume overload. Normal left ventricular wall thickness, cavity size, and regional/global systolic function. Increased PCWP. Mild aortic regurgitation. Mild mitral regurgitation. Mild to moderate tricuspid regurgitation. At least moderate pulmonary artery systolic hypertension.\n\ufeff\nLower Extremity Doppler U/S:\nIMPRESSION: \nNo evidence of deep venous thrombosis in the right or left lower extremity veins. \n\ufeff\nCXR on admission:\nLungs are hyperinflated but clear. Heart size top-normal. No pleural abnormality. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/18344499-DS-16.json b/Finished/Pulmonary Embolism/Submassive PE/18344499-DS-16.json new file mode 100644 index 0000000000000000000000000000000000000000..85758337c2e2a839fc453fdf8553a235e1e2b587 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/18344499-DS-16.json @@ -0,0 +1,50 @@ +{ + "Submassive PE$Intermedia_4": { + "hemodynamically stable rule out massive PE.$Cause_1": { + "The patient is hemodynamically stable$Input6": {} + }, + "Increased right ventricle/left ventricle ratio. This is an important imaging indicator for diagnosing pulmonary embolism.$Cause_1": { + "The RV/LV ratio is greater than 1$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "Multiple emboli indicate extensive pulmonary vascular involvement, which is characteristic of severe pulmonary embolism$Cause_1": { + "There are occlusive and nonocclusive emboli within right upper, middle, and lower lobe pulmonary arteries.$Input6": {} + }, + "nonocclusive saddle embolism may obstruct blood flow, increase cardiac workload, and is direct evidence of pulmonary embolism.$Cause_1": { + "There is a nonocclusive saddle embolism within the right main pulmonary artery.$Input6": {} + }, + "The embolism of the left pulmonary artery indicates the extensiveness of pulmonary embolism.$Cause_1": { + "There is also an acute thrombus on the left involving lobar, segmental and subsegmental arteries.$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Hypertension is one of the common chronic diseases in patients with pulmonary embolism$Cause_1": { + "h.o HTN$Input2": {} + }, + "Surgery is an important factor leading to venous thrombosis, especially after arthroscopic surgery, the risk of venous thrombosis is higher, which can further lead to pulmonary embolism.$Cause_1": { + "recent R.sided arthroscopy$Input2": {} + }, + "Calf cramps may be an early symptom of deep vein thrombosis (DVT), which may be related to pulmonary embolism.$Cause_1": { + "calf cramping in the RLE$Input2": {} + }, + "Shortness of breath is a classic symptom of pulmonary embolism$Cause_1": { + "developing SOB$Input2": {} + }, + "Significant limitation of respiratory function, which is a critical clinical finding in patients with pulmonary embolism$Cause_1": { + "felt like he could not get any air in$Input2": {} + }, + "High blood pressure may be a warning sign of pulmonary embolism$Cause_1": { + "BP: 154/94$Input5": {} + }, + "Pulmonary hypertension may be caused by obstruction of the pulmonary blood vessels$Cause_1": { + "moderate pulmonary artery systolic hypertension$Input6": {} + } + } + } + }, + "input1": "None\n", + "input2": "Pt is a male with h.o HTN, recent R.sided arthroscopy who presented to OSH with SOB. Pt reports that he developed calf cramping in the RLE which was new. This lasted a few days. He then started developing SOB which he attributed to his anxiety. However, the SOB continued to worsen and pt felt like he could not get any air in and presented to OSH. He denies CP, palpitations, LH/dizziness, n/v. He reports that calf pain resolved yesterday. No history of bleeding or clots. \n\ufeff\nOther 10pt ROS reviewed and negative including for headache, abdominal pain, d/c, melena, brbpr, dysuria, hematuria, other joint pain, rash, weight loss, appetite changes.\n\ufeff\n", + "input3": "N/A\n", + "input4": "states mother, sister, brother alive and well. Father died of cancer. No history of clotting disorders.\n", + "input5": "Physical Exam:\nADMISSION PHYSICAL EXAM:\nGEN-WELL appearing, NAD, comfortable appearing\n0745 Temp: 97.7 PO BP: 154/94 HR: 84 RR: 18 O2\nsat: 95% O2 delivery: RA \nHEENT-ncat eomi anicteric MMM\nneck-supple\nrespiratory-b/l ae no w/c/r\ncardiovascular-s1s2 rr no m/r/g\next-no c/c/e 2+pulses\nmsk-R.knee with steristreps at surgical site, no erythema, or signs of bleeding\nneuro-face symmetric, speech fluent\npsych-calm, cooperative \nskin-no obvious rashes\n\ufeff\n", + "input6": "ADMISSION LABS:\n___ 02:45AM BLOOD WBC: 8.6 RBC: 5.02 Hgb: 14.6 Hct: 40.9 MCV: 82 MCH: 29.1 MCHC: 35.7 RDW: 12.9 RDWSD: 37.\n___ 02:45AM BLOOD : 12.8* PTT: 31.3 : 1.2* \n___ 02:45AM BLOOD Glucose: 145* UreaN: 12 Creat: 0.9 Na: 141 K: 3.6 Cl: 101 HCO3: 25 AnGap: 15 \n___ 02:45AM BLOOD cTropnT: <0.01 \n___ 02:45AM BLOOD proBNP: 129 \n___ 03:00AM BLOOD Lactate: 1.8 \n\ufeff\nIMAGING\n- CTA chest: The heart is normal in size. There is no coronary calcification or circumferential pericardial fluid collection. The thoracic aorta looks normal. There is no mediastinal or hilar nodal enlargement. There is a nonocclusive saddle embolism within the right main pulmonary artery. There are occlusive and nonocclusive emboli within right upper, middle, and lower lobe pulmonary arteries. There is also an acute thrombus on the left involving lobar, segmental and subsegmental arteries. Some of these are occlusive. The RV/LV ratio is greater than 1. Despite this there is no reflux of contrast into the IVC or hepatic veins. The visualized portions of the solid organs in the upper abdomen look normal. Incidental note is made of a smalllipoma along the inferolateral aspect of left chest\n\ufeff\nThe lungs are clear. There is minimal right pleural fluid. There is no left pleural effusion. There is no pneumothorax on either side.\n\ufeff\n\ufeff\n- TTE: The patient is hemodynamically stable. The left atrial volume index is normal. There is normal left ventricular wall thickness with a normal cavity size. There is normal regional left ventricular systolic function. The visually estimated left ventricular ejection fraction is 70%. There is no resting left ventricular outflow tract gradient. Normal right ventricular cavity size with normal free wall motion. The aortic sinus diameter is normal for gender with normal ascending aorta diameter for gender. The aortic arch diameter is normal. The aortic valve leaflets (3) appear structurally normal. There is no aortic valve stenosis. There is no aortic regurgitation. The mitral valve leaflets appear structurally normal with no mitral valve prolapse. There is no mitral valve stenosis. There is trivial mitral regurgitation. The tricuspid valve leaflets appear structurally normal with systolic prolapse. There is physiological tricuspid regurgitation. There is moderate pulmonary artery systolic hypertension. There is nopericardial effusion\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Pulmonary Embolism/Submassive PE/18865972-DS-3.json b/Finished/Pulmonary Embolism/Submassive PE/18865972-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..5cbaa05823291056af2dac2b7c43b5d207aab328 --- /dev/null +++ b/Finished/Pulmonary Embolism/Submassive PE/18865972-DS-3.json @@ -0,0 +1,41 @@ +{ + "Submassive PE$Intermedia_4": { + "Right ventricular dilatation is a direct consequence of increased right ventricular pressure due to pulmonary embolism$Cause_1": { + "Bedside TTE showed rv dilation$Input2": {} + }, + "Rule out massive PE$Cause_1": { + "The patient is hemodynamically stable.$Input6": {} + }, + "Pulmonary Embolism$Intermedia_3": { + "This is a typical ECG change in pulmonary embolism, reflecting the increased workload on the right ventricle.$Cause_1": { + "EKG demonstrated s1q3t3$Input2": {} + }, + "A significant increase in dimers indicates possible thrombosis in the body.$Cause_1": { + "D-Dimer-863\ufeff*$Input6": {} + }, + "Suspected Pulmonary Embolism$Intermedia_2": { + "Patients with cardiac arrest may have a variety of underlying cardiovascular diseases, which themselves may increase the risk of pulmonary embolism.$Cause_1": { + "S/p Cardiac Arrest$Input1": {} + }, + "Obesity is a known risk factor for pulmonary embolism$Cause_1": { + "obese$Input2": {} + }, + "Shortness of breath is one of the most common symptoms of pulmonary embolism.$Cause_1": { + "SOB$Input2": {} + }, + "Abnormal blood clotting sometimes occurs in people with pulmonary embolism$Cause_1": { + "\"bleeding\" but they don't know where$Input2": {} + }, + "Pulmonary embolism can increase the burden on the heart and, in severe cases, can cause a slowing of the heartbeat or even cardiac arrest.$Cause_1": { + "Became bradycardic and coded$Input2": {} + } + } + } + }, + "input1": "S/p Cardiac Arrest\n", + "input2": "She obese. Per report, pt called friend reporting abd pain, SOB and \"bleeding\" but they don't know where she was bleeding from. Became bradycardic and coded. Arrest x 4 in total while there. Rectal +blood. Labs: CO2 5, Creatinine 13, K 5.4, Hct 39. Transferred for further care. \n\ufeff\nIn the ED, initial vitals were deferred. Initially on levophed max peripherally. Within 5 min of arrival bradycardic and arrested.EKG demonstrated s1q3t3 w/o any sig ST changes or other evidence of ischemia. Bedside TTE showed rv dilation, mod-sev TR, + mc sign all suggestive of PE. Labs significant for ph of 6.68, lactate of 14, Cr of 11, stable Hct.\n", + "input3": "+Diabetes\n+Dyslipidemia\n+Obesity (wt >300 lbs)\n", + "input4": "unable to be obtained\n", + "input5": "Physical Exam:\nADMISSION EXAM\nGeneral: intubated, sedated \nHEENT: fixed pupils\nChest: CTABL, ET tube in place\nCardiovascular: tachycardic, no m/r/g\nAbdominal: Soft, Nontender, Nondistended\nExtr/Back: No cyanosis, clubbing or edema\nSkin: No rash, Warm and dry\n\ufeff\n", + "input6": "ADMISSION LABS\n\ufeff\n___ 04:12AM TYPE-ART PO2-204* PCO2-29* PH-6.72* TOTAL CO2-4* BASE XS--34 INTUBATED-INTUBATED VENT-CONTROLLED\n___ 04:12AM O2 SAT-98\n___ 03:24AM PO2-143* PCO2-25* PH-6.68* TOTAL CO2-4* BASE XS--36 INTUBATED-INTUBATED COMMENTS-GREEN TOP\n___ 03:24AM GLUCOSE-97 LACTATE-14.1* NA+-150* K+-6.1* CL--111*\n___ 03:24AM HGB-12.2 calcHCT-37 O2 SAT-95 CARBOXYHB-1 MET HGB-0\n___ 03:24AM freeCa-1.06*\n___ 03:19AM UREA N-57* CREAT-11.2*\n___ 03:19AM estGFR-Using this\n___ 03:19AM LIPASE-385*\n___ 03:19AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 03:19AM WBC-15.1* RBC-3.75* HGB-11.7* HCT-39.7 MCV-106* MCH-31.1 MCHC-29.4* RDW-12.1\n___ 03:19AM PLT COUNT-266\n___ 03:19AM PTT-29.0 D-Dimer-863\ufeff*\n\nThe patient is hemodynamically stable.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/11408894-DS-2.json b/Finished/Stroke/Hemorrhagic Stroke/11408894-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..a4826c33dd700299a0d73f79ab6f1c9db029169a --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/11408894-DS-2.json @@ -0,0 +1,69 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "24 mm of intraparenchymal hemorrhage within the right cerebellar hemisphere. This is the diagnostic criteria for hemorrhagic stroke.$Cause_1": { + "24 mm intraparenchymal hemorrhage in the right cerebellar hemisphere exerting mild mass effect on the fourth ventricle.$Input6": {} + }, + "There was a large area of abnormal susceptibility in the cerebellar hemisphere, which was consistent with the subacute hemorrhage in the right cerebellum previously seen on CT. This further confirms the presence of bleeding$Cause_1": { + "There is a large focus of susceptibility artifact in the right cerebellar hemisphere, with corresponding mild intrinsic T1 hyperintensity and peripheral T2/FLAIR hyperintensity, compatible with the known subacute right cerebellar hemorrhage seen in the prior CT.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Slurred speech is often caused by damage to the nervous system that causes a disorder in the muscles that control speech. is a symptom of stroke$Cause_1": { + "Dysarthria$Input1": {} + }, + "Strokes usually affect one side of the brain, so clumsiness or weakness in the right hand may be a symptom of a left-brain stroke.$Cause_1": { + "right hand clumsiness$Input1": {} + }, + "Cerebellar hemorrhage is a type of stroke caused by rupture of blood vessels in the brain and is directly related to stroke$Cause_1": { + "transferred from OSH where he was found to have cerebellar hemorrhage$Input2": {} + }, + "A hypertensive emergency means extremely high blood pressure that can lead to acute or life-threatening complications such as stroke$Cause_1": { + "presents with 3 days of dysarthria in the setting of hypertensive urgency$Input2": {} + }, + "Extremely high blood sugar levels are a sign of diabetes, a significant risk factor for stroke$Cause_1": { + "His blood sugar was in the 500s$Input2": {} + }, + "High blood pressure is an important risk factor for stroke$Cause_1": { + "BP: 168/74$Input5": {} + }, + "Inability to speak normally is a common symptom of stroke$Cause_1": { + "He says that he is unable to speak at a normal rate and that his speech is no longer \"very good.\"$Input2": {} + }, + "Slurred speech is a common symptom of stroke, suggesting possible damage to areas of the brain that control speech.$Cause_1": { + "The pt is a right-handed man who presents with 3 days of dysarthria$Input2": {} + }, + "Numbness or difficulty moving in the limbs may be due to damage to part of the brain, which is often associated with stroke$Cause_1": { + "from around the time when he began to have difficulty speaking his R hand has felt more numb and clumsy than usual.$Input2": {} + }, + "In diabetic patients, blood vessel walls may be damaged due to prolonged high blood sugar, increasing the risk of stroke.$Cause_1": { + "Insulin-dependent diabetes$Input3": {} + }, + "High blood pressure is one of the most common risk factors for stroke$Cause_1": { + "hypertension$Input3": {} + }, + "High cholesterol can lead to atherosclerosis, which increases the risk of stroke.$Cause_1": { + "hypercholesteremia$Input3": {} + }, + "Family inheritance increases the risk of stroke.$Cause_1": { + "Father with stroke and diabetes.$Input4": {} + }, + "Slurred speech and difficulty articulating are common in stroke patients$Cause_1": { + "Speech is slurred and dysarthric with a drunken quality and slightly slow tempo but is not halting.$Input5": {} + }, + "The patient had impaired motor control on the right side, a common sign of stroke.$Cause_1": { + "Wasting of intrinsic muscles of R hand. Mild R pronator drift.$Input5": {} + }, + "Decreased sensation, especially in the right toes, may indicate damage to sensory nerve pathways, which is more common in stroke patients$Cause_1": { + "Decreased proprioception in R toe, intact at ankle.$Input5": {} + }, + "Movement coordination disorders, such as inaccurate movements and clumsiness with fine hand movements, are signs of stroke.$Cause_1": { + "Dysmetria on FNF and clumsiness on complex fine motor movements with R hand. Also dysmetria with R foot tapping on knee and HTS.$Input5": {} + } + } + }, + "input1": "Dysarthria, right hand clumsiness\n", + "input2": "Reason for Consult: Called by Neurosurgery to evaluate patient with transferred from OSH where he was found to have cerebellar hemorrhage\n \nHistory obtained from patient and chart. Patient is semi-reliable historian.\n\ufeff\nHPI: The pt is a right-handed man who presents with 3 days of dysarthria in the setting of hypertensive urgency, nausea/vomiting. He says he \"ate too much.\" Per transfer summary, he came in with abd craming, nausea, vomiting, fatigue and inability to tolerate PO food or medications. His blood sugar was in the 500s and BP 200/80s. He was given IV fluids and his blood sugars were stabilized. He did not have evidence of DKA at that time. He was admitted for evaluation, and had some coffee-ground emesis for which he had endoscopy and was found to have gastritis.\n\ufeff\nOn HD 2 the patient noted that since just prior to his admission his speech has been \"different.\" He says that he is unable to speak at a normal rate and that his speech is no longer \"very good.\" He says that he has difficulty both with coming up with words and with saying them. He says that while he wears dentures occasionally, he is usually able to speak well without them, but now is not able to. He cannot name specific example of his speech difficulty. Per transfer note, his girlfriend confirmed the change in his speech. He says he has never had difficulty speaking prior to this episode.\n\ufeff\nHe also says that he \"can't remember stuff.\" He also notes that from around the time when he began to have difficulty speaking his R hand has felt more numb and clumsy than usual. He normally walks holding a cane in his R hand, but has had trouble holding the cane.\n\ufeff\nevaluate his dysarthria and hand clumsiness, showing a 24mm IPH in the R cerebellum. SBP goal was lowered to 140 and arrangements were made to have patient transferred to ICU for close monitoring and further workup/treatment.\n \nOn neuro ROS, the pt denies headache, loss of vision, blurred vision (wears glasses to read), diplopia, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. No bowel or bladder incontinence or retention. \n \nOn general review of systems, the pt complaines of cough, nausea, vomiting/retching. He says that prior to the onset of these symptoms he had felt well and was compliant with his medications. He denies recent fever or chills. No night sweats or recent weight loss or gain. Denies shortness of breath. Denies chest pain or tightness, palpitations. No recent change in bladder habits. No dysuria. Denies arthralgias or myalgias. Denies rash.\n", + "input3": "+ PMH: (Per patient and transfer note)\n+ Hospitalized for hypoglycemia due to high insulin dose.\n+ Insulin-dependent diabetes\n+ chronic renal insufficiency with baseline creatinine about 1.6, macular edema + congenital malformation of the brain (agenesis of corpus callosum and colpocephaly)\n+ cataracts\n+ hypercholesteremia\n+ hypertension\n+ cancer of the testes seminoma.\n", + "input4": "Father with stroke and diabetes. Mother with hypertension. Diabetes runs in family.\n", + "input5": "Exam on admission:\n\ufeff\nPhysical Exam: \nVitals: T: afeb P: 80s R: 16 BP: 168/74 SaO2: >95% RA\nGeneral: Obese man, lying in bed, awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, edentulous, MMM, no lesions noted in oropharynx \nNeck: Supple, No nuchal rigidity \nAbdomen: obese, NT/ND\nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. \nSkin: no rashes or lesions noted.\n \nNeurologic: \n-Mental Status: Alert, oriented to name, Difficulty with attention, makes several errors in backward. Speech is slurred and dysarthric with a drunken quality and slightly slow tempo but is not halting. Language is fluent with intact repetition and comprehension. There were no paraphasic errors. Pt. was able to name pen, shirt, button, but had difficulty with collar. Able to follow both midline and appendicular commands. There was no evidence of apraxia or neglect.\n\ufeff\n-Cranial Nerves: \nI: Olfaction not tested. \nII: PERRL 4 to 2mm and brisk. VFF to confrontation. \nIII, IV, VI: EOMI without nystagmus. Normal saccades. \nV: Facial sensation intact to light touch. \nVII: No facial droop, facial musculature symmetric. \nVIII: Hearing intact to finger-rub bilaterally. \nIX, X: Palate elevates symmetrically. \nXI: strength in trapezii and SCM bilaterally. \nXII: Tongue protrudes in midline, able to wiggle back and forth, slightly weaker pushing to R.\n \n-Motor: Wasting of intrinsic muscles of R hand. Mild R pronator drift. No adventitious movements, such as tremor, noted. No asterixis noted.\n\ufeff\n-Sensory: Decreased proprioception in R toe, intact at ankle. Intact proprioception L toe.\n \nPlantar response was up on L, mute on R.\n \n-Coordination: Dysmetria on FNF and clumsiness on complex fine motor movements with R hand. Also dysmetria with R foot tapping on knee and HTS. L hand mild discoordination, intact L FNF, HTS.\n \n-Gait: Deferred.\n", + "input6": "09:06PM GLUCOSE-207* UREA N-24* CREAT-1.6* SODIUM-138 POTASSIUM-3.6 CHLORIDE-106 TOTAL CO2-21* ANION GAP-15\n09:06PM estGFR-Using this\n09:06PM CALCIUM-8.8 PHOSPHATE-2.7 MAGNESIUM-1.8\n09:06PM WBC-8.8 RBC-3.48* HGB-11.0* HCT-31.3* MCV-90 MCH-31.7 MCHC-35.2* RDW-12.2\n09:06PM NEUTS-72.7* MONOS-5.0 EOS-2.0 BASOS-0.4\n09:06PM PLT COUNT-243\n\ufeff\n1. 24 mm intraparenchymal hemorrhage in the right cerebellar hemisphere exerting mild mass effect on the fourth ventricle. The differential diagnosis includes the presence of a hemorrhagic mass (primary or metastatic), an underlying vascular malformation or a hypertensive hemorrhage. Although this location is typical for hypertensive hemorrhage, other causes must be excluded.\n2. Agenesis of the corpus callosum with colpocephaly; there is no hydrocephalus.\n\ufeff\nCXR :\nFINDINGS: The lung volumes are normal. Mild cardiomegaly. No pulmonary edema. No pneumonia, no pleural effusions. No pneumothorax. The hilar and mediastinal contours appear normal. \n\ufeff\nMRI brain:\nFINDINGS: There is a large focus of susceptibility artifact in the right cerebellar hemisphere, with corresponding mild intrinsic T1 hyperintensity and peripheral T2/FLAIR hyperintensity, compatible with the known subacute right cerebellar hemorrhage seen in the prior CT. There is no acute infarction. \n \nThe corpus callosum is absent, with abnormal parallel configuration of the lateral ventricles. There are substantially enlarged occipital horns, with disproportionately small frontal horns, representing colpocephaly. The third ventricle is also dilated. Confluent periventricular and scattered subcortical T2/FLAIR hyperintensities are nonspecific, but compatible with chronic microvascular ischemic disease. The sulci are mildly prominent. Major vascular flow voids are present. The visualized paranasal sinuses and mastoid air cells are clear. \n \nIMPRESSION: \n1. Known subacute right cerebellar hemorrhage. No significant mass effect. No acute infarction. \n \n2. Agenesis of corpus callosum with colpocephaly. \n\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/12086937-DS-2.json b/Finished/Stroke/Hemorrhagic Stroke/12086937-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..b3ce1d96d90adea3b8b54520a46697f6bd1af864 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/12086937-DS-2.json @@ -0,0 +1,36 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "Acute to subacute hemorrhage in the left posterior lentiform region. This description is consistent with the characteristics of cerebral hemorrhage$Cause_1": { + "Acute to subacute hemor hemorrhage involving the posterior left lentiform nucleus$Input6": {} + }, + "MRI brain imaging confirmed the area of hemorrhage and specifically noted that the hemorrhage was not a result of infarct but rather a primary hemorrhage in the basal ganglia. This further emphasizes the diagnosis of hemorrhagic stroke.$Cause_1": { + "The area of restricted diffusion is similar to the size of hemorrhage, this does not appear to be due to a hemorrhagic conversion of an infarct but likely to be primary basal ganglia hemorrhage.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Numbness on the right side is one of the typical symptoms of stroke$Cause_1": { + "right sided numbness$Input1": {} + }, + "Weakness in the right (RT) arm and leg is one of the classic symptoms of stroke$Cause_1": { + "an episode of RT arm and leg weakness which did not involve his face$Input2": {} + }, + "Sudden hand numbness can be a sign of stroke$Cause_1": { + "he had acute onset numbness$Input2": {} + }, + "A sudden feeling of numbness and heaviness on one side of the body may be the result of one side of the brain being affected, often associated with a stroke.$Cause_1": { + "he stood up and noticed his entire RT side felt numb and heavy$Input2": {} + }, + "Difficulty walking and weakness in the lower limbs may be symptoms of stroke$Cause_1": { + "limping with his RT leg and felt he would collapse.$Input2": {} + }, + "Neck manipulation may cause damage to the carotid arteries or abnormal blood vessels in the neck, which may increase the risk of stroke$Cause_1": { + "LT neck manipulation where they adjusted \"a vertebra at the base of the neck\".$Input2": {} + } + } + }, + "input1": "right sided numbness\n", + "input2": "HPI: \nHe is a man with no significant medical history who presents to the ED from urgent care for evaluation after an episode of RT arm and leg weakness which did not involve his face. Neurology consulted for evaluation of TIA.\n\ufeff\nHe reports woke up in his usual state of health this morning which includes complete independence in all ADLs. Around 7:30 he was typing in the computer when he had acute onset numbness, which he initially noted in his hand. He reports had the sensation that his hand fell asleep and became \"leaden\". He could not use the computer's mouse as the hand was heavy and would fall on it. He felt somewhat lightheaded, so he stood up and noticed his entire RT side felt numb and heavy with the exception of his face. He walked out to the hallway and noticed was limping with his RT leg and felt he would collapse. At that point he called his girlfriend to come pick him up to take him to urgent care. He denies any trouble with his speech or swallowing and reports she understood everything that he said. While he waited he tried to play the guitar and noticed he was not able to hold the pick, however he thinks that after several tries he started improving. He estimates the symptoms lasted for a total of thirty minutes. Denies any visual symptoms such as visual loss, double, or \nblurry vision. He denies facial numbness, tingling, or ringing in his ears. On arrival to the ED NIHSS of 0.\n\ufeff\nOf note he reports was recently at a new project for LT neck manipulation where they adjusted \"a vertebra at the base of the neck\". He denies neck pain since. He also reports had a recent check up with his PCP who told him he was in \"great shape\". \n\ufeff\nOn neurologic review of systems, other than the above mentioned symptoms the patient denies headache or confusion. Denies difficulty with producing or comprehending speech. Denies loss of vision, blurred vision, diplopia, vertigo, tinnitus, hearing difficulty, dysarthria, or dysphagia. Denies bowel or bladder incontinence or retention. \n\ufeff\nOn general review of systems, the patient denies fevers, rigors, night sweats, or noticeable weight loss. Denies chest pain, palpitations, dyspnea, or cough. Denies nausea, vomiting, diarrhea, constipation, or abdominal pain. No recent change in bowel or bladder habits. Denies dysuria or hematuria. Denies myalgias, arthralgias, or rash.\n", + "input3": "none\n", + "input4": "Mother: cancer\nFather: cancer, liver cancer\n", + "input5": "ADMISSION PHYSICAL EXAMINATION\nVitals: \n98.2 \n68 \n157/79 \n18 \n96% RA \n \nGeneral: NAD\nHEENT: NCAT, no oropharyngeal lesions, neck supple\nPulmonary: CTAB, no crackles or wheezes\nAbdomen: Soft, NT, ND, +BS, no guarding\nExtremities: Warm, no edema\n\ufeff\nNeurologic Examination:\nMS: Awake, alert, oriented x 3. Able to relate history without difficulty. Attentive, able to name backward without difficulty. Speech is fluent with full sentences, intact repetition, and intact verbal comprehension. Naming intact. No paraphasias. No dysarthria. Normal prosody. Able to register 3 objects and recall at 5 minutes. No apraxia. No evidence of hemineglect. No left-right confusion. Able to follow both midline and appendicular commands.\n\ufeff\n- Cranial Nerves - PERRL 4->2 brisk. VF full to confrontation. EOMI, no nystagmus. V1-V3 without deficits to light touch bilaterally. No facial movement asymmetry. Hearing intact to finger rub bilaterally. Palate elevation symmetric. SCM/Trapezius strength bilaterally. Tongue midline.\n\ufeff\n- Motor - Normal bulk and tone. No drift. No tremor or asterixis.\nDelt Bic Tri WrE FFl FE IO IP Quad Ham TA\n\ufeff\n\ufeff\n- Sensory - No deficits to light touch, pin, or proprioception bilaterally. No exinction to DSS.\n\ufeff\n-DTRs:\nBi Tri Pat Ach\nL 2 2 2 2 2\nR 2 2 2 2 2\nPlantar response flexor bilaterally.\n\ufeff\n- Coordination - No dysmetria with finger to nose testing bilaterally. Good speed and intact cadence with rapid alternating movements.\n\ufeff\n- Gait - Normal initiation. Narrow base. Normal stride length and arm swing. Stable without sway. Negative Romberg.\n", + "input6": "10:20AM BLOOD WBC-7.2 RBC-5.33 Hgb-15.5 Hct-47.7 MCV-90 MCH-29.1 MCHC-32.5 RDW-12.7 RDWSD-41.2\n10:20AM BLOOD Neuts-69.3 Monos-7.5 Eos-1.1 Baso-0.4 AbsNeut-4.96 AbsLymp-1.53 AbsMono-0.54 AbsEos-0.08 AbsBaso-0.03\n05:05AM BLOOD WBC-6.4 RBC-5.09 Hgb-15.0 Hct-45.7 MCV-90 MCH-29.5 MCHC-32.8 RDW-12.6 RDWSD-41.4\n\ufeff\n05:05AM BLOOD Glucose-94 UreaN-13 Creat-0.9 Na-139 K-3.7 Cl-103 HCO3-23 AnGap-17\n10:20AM BLOOD ALT-34 AST-46* AlkPhos-63 TotBili-0.8\n05:05AM BLOOD Calcium-9.1 Phos-2.7 Mg-2.1\n\ufeff\n10:20AM BLOOD cTropnT-<0.01\n10:20AM BLOOD %HbA1c-5.5 eAG-111\n10:20AM BLOOD Triglyc-186* HDL-36 CHOL/HD-6.8 LDLcalc-173*\n10:20AM BLOOD TSH-1.5\n10:20AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\ufeff\nMRI brain:\nAcute to subacute hemor hemorrhage involving the posterior left lentiform nucleus. The area of restricted diffusion is similar to the size of hemorrhage, this does not appear to be due to a hemorrhagic conversion of an infarct but likely to be primary basal ganglia hemorrhage. The left MCA is patent. Normal MRA of the head.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/12190635-DS-14.json b/Finished/Stroke/Hemorrhagic Stroke/12190635-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..b59403908c4fc1f233b48d6713a5e699f22b0cca --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/12190635-DS-14.json @@ -0,0 +1,69 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "Thalamus hematoma is a common diagnostic criterion for hemorrhagic stroke$Cause_1": { + "A 2.2 x 1.9 cm left thalamic hematoma appears stable when compared to prior CT$Input6": {} + }, + "Intraventricular hemorrhage is the presence of blood in the ventricular system of the brain, often associated with hemorrhagic stroke$Cause_1": { + "There is an increased amount of layering hemorrhage in the left occipital horn of the left lateral ventricle.$Input6": {} + }, + "Cerebral edema is a buildup of fluid around brain tissue that often occurs after a hemorrhagic stroke$Cause_1": { + "There is surrounding edema, appears stable from prior CT.$Input6": {} + }, + "Hemorrhage in the basal ganglia is also an important manifestation of hemorrhagic stroke.$Cause_1": { + "Stable left thalamic hemorrhage with slight increase in intraventricular hemorrhage in the left lateral ventricle$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "The right side of the body is weakened. This is a common symptom of stroke$Cause_1": { + "Right weakness$Input1": {} + }, + "Aphasia common in post-stroke patients$Cause_1": { + "aphasia$Input1": {} + }, + "History of hypertension (HTN) and dyslipidemia. These are known risk factors for stroke$Cause_1": { + "PMH of HTN, lipids$Input2": {} + }, + "Carotid artery stenosis is an important cause of insufficient blood flow to the brain and is associated with an increased risk of stroke$Cause_1": { + "he had episodes of amaurosis fugax in right eye few days ago which on evaluation shows significant (more than 80 percent) carotid stenosis.$Input2": {} + }, + "The patient's blood pressure was extremely high, although his heart rhythm remained normal. High blood pressure is an important trigger for stroke$Cause_1": { + "At OSH, he was in sinus rhythm with a blood pressure of 195/81$Input2": {} + }, + "The right arm was weak and he quickly developed difficulty speaking. These symptoms point to a stroke.$Cause_1": { + "This am after waking up he noted weakness on right hand, arm followed quickly and difficulty speaking.$Input2": {} + }, + "The patient had significant speech difficulties and moderate weakness on the right side of the body. These are also typical symptoms of stroke$Cause_1": { + "noted to have \"Moderate difficulty with speech, and moderate right sided weakness.\"$Input2": {} + }, + "High blood pressure is a major risk factor for stroke$Cause_1": { + "HTN$Input3": {} + }, + "Coronary artery disease is also a risk factor for stroke$Cause_1": { + "CAD s/p ACS$Input3": {} + }, + "In patients with heart failure, the reduced ability of the heart to pump blood may lead to poor blood circulation and increase the risk of stroke.$Cause_1": { + "CHF$Input3": {} + }, + "Hyperlipidemia is a risk factor for stroke.$Cause_1": { + "HLD$Input3": {} + }, + "Obvious impairment in speech expression, which is a common symptom of stroke$Cause_1": { + "Doesnt verbalise. Can say few words like \"Yes, Hmm\"$Input5": {} + }, + "The patient is unable to move the right limb. This is due to possible damage to the left hemisphere (controlling the right side of the body), which is common in strokes.$Cause_1": { + "Right hemiplegia, no movement veven on painful stimulus.$Input5": {} + }, + "The patient has impaired facial nerve function, which may be caused by damage to part of the brain, commonly seen in strokes$Cause_1": { + "Right UMN facial weakness.$Input5": {} + }, + "Supradigital reflex is a classic neurological sign of stroke$Cause_1": { + "Toes were downgoing on left and upgoing on right.$Input5": {} + } + } + }, + "input1": "Right weakness and aphasia\n", + "input2": "RHM with PMH of HTN, lipids, CAD was transfered from OSH for neuro eval. Next, Neurology was called.\n\ufeff\nHe underwent right carotid endarterectomy and per notes, it was uneventful. This was done as a elective procedure after he had episodes of amaurosis fugax in right eye few days ago which on evaluation shows significant (more than 80 percent) carotid stenosis. \n\ufeff\nHe was noted to be in usual health till last night. This am after waking up he noted weakness on right hand, arm followed quickly and difficulty speaking. He was taken to OSH. At OSH, he was in sinus rhythm with a blood pressure of 195/81, and 100% on nasal cannula. He was noted to have \"Moderate difficulty with speech, and moderate right sided weakness.\" Labs shows : CBC : 5.3-13.7/41-222, Chem 7 showed : Na 143, K 3.9, Cl 106, Co2 35, BUN 19, cr 1, glucose 109. LFTs were normal. EKG did not show anything acute. He was sent to ED for neuro eval.\n", + "input3": "+ HTN\n+ CAD s/p ACS\n+ CHF\n+ COPD on home O2 1L seemingly due to med non-compliance - PCP does not have record of this\n+ HLD\n+ Diverticulosis\n+ BPH\n", + "input4": "Unclear\n", + "input5": "Admission Exam: \n98.39 81 150/90 20 100% 2L nc \nGen: Lying in bed, NAD\nHEENT: NC/AT, moist oral mucosa \nNeck: No tenderness to palpation, normal ROM, supple, no carotid or vertebral bruit\nBack: No point tenderness or erythema\nCV: RRR, Nl S1 and S2, no murmurs/gallops/rubs \nLung: Clear to auscultation bilaterally \naBd: +BS soft, nontender \next: no edema\n\ufeff\nNeurologic examination: \nMental status: Awake, alert, Doesnt verbalise. Can say few words like \"Yes, Hmm\" . Comprehension relatively spared, can answer with head nodding to yes and No type questions. Can follow mildine and few one step appendicular commands on the left side. Other MS exam not possible.\n\ufeff\nCranial Nerves: \nPupils equally round and reactive to light, 3 to 2 mm bilaterally, post surgical. Visual fields- grossly intact. Fundus- no papilledema. Extraocular movements intact bilaterally, no nystagmus. Right UMN facial weakness. Palate elevation symmetrical. Tongue midline, movements intact\n \nMotor: Right hemiplegia, no movement veven on painful stimulus.\nNormal power on left.\n\ufeff\nSensation: Intact to touch and pain on left, difficult to assess right side.\n \nReflexes: 2 plus on both sides, ankles absent.\n \nToes were downgoing on left and upgoing on right. \n\ufeff\nCoordination: difficult to assess.\n\ufeff\nGait/Romberg: Defd.\n\ufeff\n", + "input6": "Admission labs:\n12:17PM BLOOD WBC-5.4 RBC-4.28* Hgb-13.8* Hct-41.3 MCV-97 MCH-32.3* MCHC-33.4 RDW-13.2.\n12:17PM BLOOD Neuts-69.1 Monos-7.0 Eos-2.9 Baso-0.6\n12:17PM BLOOD Glucose-104* UreaN-18 Creat-0.8 Na-141 K-5.4* Cl-103 HCO3-30 AnGap-13\n12:17PM BLOOD ALT-15 AST-32 CK(CPK)-73 AlkPhos-43 TotBili-0.4\n12:17PM BLOOD Albumin-3.7\n05:30PM BLOOD Phos-2.7 Mg-1.8\n03:02AM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\ufeff\nCEs:\n12:17PM BLOOD CK-MB-2 cTropnT-<0.01\n03:02AM BLOOD CK-MB-2 cTropnT-<0.01\n\ufeff\nUrine:\n02:10PM URINE Color-Yellow Appear-Clear\n02:10PM URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-10 Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n\ufeff\n\ufeff\nMicrobiology:\n2:10 pm URINE Site: CATHETER\n\ufeff\n**FINAL REPORT\n\ufeff\nURINE CULTURE (Final: NO GROWTH. \n.\n\ufeff\nRadiology:\nCT HEAD W/O CONTRAST Study Date FINDINGS: A 2.2 x 1.9 cm left thalamic hematoma appears stable when compared to prior CT from outside hospital imaged approximately four hours ago. There is an increased amount of layering hemorrhage in the left occipital horn of the left lateral ventricle. A small amount of intraventricular blood is noted in the right occipital horn of the right lateral ventricle, unchanged. There is surrounding edema, appears stable from prior CT. Also noted is a hypodense area in the left frontal lobe that appears unchanged and likely represents encephalomalacia from a prior infarct. There is no shift of midline structures. There is no new area of hemorrhage identified. \n \nIMPRESSION: \n1. Stable left thalamic hemorrhage with slight increase in intraventricular hemorrhage in the left lateral ventricle. \n2. No new areas of hemorrhage identified. \n\ufeff\nCHEST (PORTABLE AP) Study Date\nIMPRESSION: No acute cardiopulmonary process.\n\ufeff\nMR-HEAD:\nFINDINGS: Limited MRI study secondary to patient motion. Only sagittal T1, axial T1, and axial FLAIR sequences were obtained, which were also markedly degraded by patient motion. Within these limitations, left thalamic hematoma is redemonstrated, with surrounding FLAIR signal abnormality. There is no hydrocephalus or midline shift. Size of the hematoma appears similar to that \nseen on the previous CT. \n \nIMPRESSION: Suboptimal MRI study secondary to patient motion. Left thalamic hematoma is redemonstrated. A repeat MRI study may be obtained after adequately sedating the patient. \n\ufeff\nCT_HEAD\nPreliminary Report \n1. Stable left basal ganglia hemorrhage with partial resorption of intraventricular blood in the lateral ventricles. \n2. No new areas of hemorrhage.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/13256522-DS-5.json b/Finished/Stroke/Hemorrhagic Stroke/13256522-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..1637a6656aa698e4be576ecf91c4d5bdd8f421d7 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/13256522-DS-5.json @@ -0,0 +1,36 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "The patient had intracerebral hemorrhage that extended to the ventricles. This is a sign of hemorrhagic stroke$Cause_1": { + "a large right basal ganglia bleed with extension into the lateral and fourth ventricles.$Input2": {} + }, + "Changes in the patient's state of consciousness, such as unresponsiveness and confusion, are one of the typical symptoms of stroke$Cause_1": { + "patient was found by coworkers to be unresponsive and confused.$Input2": {} + }, + "Massive intraventricular hemorrhage involving multiple ventricles. Such extensive intraventricular hemorrhage often indicates the severity of a hemorrhagic stroke$Cause_1": { + "Large amount of intraventricular hemorrhage from the right, left, lateral ventricles as well as down into the fourth ventricle$Input2": {} + }, + "Suspected Stroke$Intermedia_2": { + "Twitching of limbs may be a symptom after stroke$Cause_1": { + "some shaking of his extremities, was unclear whether this was a seizure or posturing$Input2": {} + }, + "Unresponsiveness is a sign of stroke$Cause_1": { + "unresponsive$Input1": {} + }, + "High blood pressure is an important risk factor for stroke$Cause_1": { + "BP: 172/109$Input5": {} + }, + "Lack of voluntary movement may indicate brain dysfunction, which is common in stroke patients$Cause_1": { + "No spontaneous movements noted.$Input5": {} + }, + "This asymmetrical motor response may indicate damage to part of the brain, a classic sign of stroke.$Cause_1": { + "Off of sedation, patient briskly withdraws from noxious in the right upper extremity, right lower extremity, and left lower extremity. Patient extensor postures in the left upper extremity.$Input5": {} + } + } + }, + "input1": "unresponsive\n", + "input2": "He is a gentleman with no known past medical history who presents from an outside hospital with intraparenchymal hemorrhage with intraventricular extension. \nPatient was reportedly at work when patient was found by coworkers to be unresponsive and confused. No known medical history at this time, no other identifying factors known about patient. Patient was taken to hosptial where CAT scan of the head without contrast revealed a large right basal ganglia bleed with extension into the lateral and fourth ventricles. Patient was intubated at the outside hospital. Patient was witnessed to have some shaking of his extremities, was unclear whether this was a seizure or posturing. Patient was given Ativan and put on a Versed drip and was transferred.\n\ufeff\nOn arrival here, patient is intubated no seizure activity noted. \n\ufeff\nPatient switched to a propofol drip. Patient was hypertensive on arrival to the 170s over 100 range. Afebrile at the time. Large amount of intraventricular hemorrhage from the right, left, lateral ventricles as well as down into the fourth ventricle. Neurosurgery was also consulted at this time, deferring placement of EVD currently\n", + "input3": "Unknown\n", + "input4": "Denies family history of neurological disorders (stroke or bleeding disorders).\n", + "input5": "ADMISSION EXAM\nVitals: T: 99.6 HR: 69 BP: 172/109 RR: 23 on 100% oxygen intubated \nGeneral: Intubated and sedated, propofol held for 3 minutes prior to examination.\nHEENT: NCAT, no oropharyngeal lesions, neck supple \nPulmonary: CTAB, no crackles or wheezes \nAbdomen: Soft, NT, ND, +BS, no guarding \nExtremities: Warm, no edema\n\ufeff\nNeurologic Examination: \n- Mental status: Intubated, not following commands.\n\ufeff\n- Cranial Nerves: PERRL 2-> 1 reactive bilaterally. Face appears symmetric. Corneal reflexes present bilaterally. Cough and gag present.\n\ufeff\n- SensoriMotor: No spontaneous movements noted. Off of sedation, patient briskly withdraws from noxious in the right upper extremity, right lower extremity, and left lower extremity. Patient extensor postures in the left upper extremity. Extensor bilaterally\n\ufeff\n- Reflexes: \n[Bic] [Tri] [ xx_] [Quad] [Gastroc] \nL 2+ 2+ 2+ 2+ 1 \nR 2+ 2+ 2+ 2+ 1 \nPlantar response flexor bilaterally\n", + "input6": "=====\nLABS\n=====\n10:50PM BLOOD WBC-12.3* RBC-5.47 Hgb-15.0 Hct-45.1 MCV-82 MCH-27.4 MCHC-33.3 RDW-13.2 RDWSD-39.7\n06:15AM BLOOD WBC-10.9* RBC-5.29 Hgb-14.6 Hct-43.6 MCV-82 MCH-27.6 MCHC-33.5 RDW-13.9 RDWSD-40.9\n02:32AM BLOOD WBC-14.5* RBC-5.31 Hgb-14.4 Hct-45.3 MCV-85 MCH-27.1 MCHC-31.8* RDW-14.0 RDWSD-43.7\n06:25AM BLOOD WBC-8.1 RBC-5.17 Hgb-14.4 Hct-45.3 MCV-88 MCH-27.9 MCHC-31.8* RDW-13.9 RDWSD-44.7\n06:15AM BLOOD WBC-7.6 RBC-5.26 Hgb-14.3 Hct-44.2 MCV-84 MCH-27.2 MCHC-32.4 RDW-12.8 RDWSD-38.9\n04:45AM BLOOD WBC-6.2 RBC-5.09 Hgb-14.0 Hct-42.7 MCV-84 \nMCH-27.5 MCHC-32.8 RDW-13.0 RDWSD-39.6\n10:50PM BLOOD Neuts-87.0* Lymphs-6.7* Monos-5.5 Eos-0.2* Baso-0.2 AbsNeut-10.68* AbsLymp-0.82* AbsMono-0.68 AbsEos-0.02* AbsBaso-0.03 02:15AM BLOOD Neuts-82.0* Lymphs-9.5* Monos-7.7 Eos-0.3* Baso-0.2 AbsNeut-9.01* AbsLymp-1.04* AbsMono-0.85* AbsEos-0.03* AbsBaso-0.02\n01:00PM BLOOD Neuts-77.8* Lymphs-11.7* Monos-8.8 Eos-1.0 Baso-0.3 AbsNeut-7.46* AbsLymp-1.12* AbsMono-0.84* AbsEos-0.10 AbsBaso-0.03\nLC/MS/MS\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/14112332-DS-18.json b/Finished/Stroke/Hemorrhagic Stroke/14112332-DS-18.json new file mode 100644 index 0000000000000000000000000000000000000000..33579ffceafb0e02698b0c2c70d2c4ce27430812 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/14112332-DS-18.json @@ -0,0 +1,60 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "The patient suffered intraparenchymal hemorrhage, a direct manifestation of hemorrhagic stroke.$Cause_1": { + "a large intraparenchymal hemorrhage$Input2": {} + }, + "Midline shift is an indicator of severe brain injury, indicating that bleeding has compressed brain tissue, causing brain structures to shift.$Cause_1": { + "a large 101 cc intraparenchymal hemorrhage centered around the right basal ganglia with 1 cm midline shift$Input2": {} + }, + "These are classic symptoms of hemorrhagic stroke, especially intracranial bleeding$Cause_1": { + "Large right frontoparietal intraparenchymal hemorrhage with extensive surrounding vasogenic edema and mass effect causing 15 mm of leftward midline shift and developing subfalcine and uncal herniation$Input6": {} + }, + "Subependymal hemorrhage is a common complication after stroke and can lead to acute neurological impairment.$Cause_1": { + "Intraventricular hemorrhages seen layering within the occipital or left lateral ventricle, fourth ventricle, and cisterna magna$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Patients may have weakness on the left side of the body, which is one of the common symptoms of stroke$Cause_1": { + "possible left-sided weakness$Input2": {} + }, + "High blood pressure is an important risk factor for stroke$Cause_1": { + "blood pressure of 170s-200s$Input2": {} + }, + "The patient had left-sided weakness, including facial droop. Facial sagging is a classic symptom of stroke$Cause_1": { + "left-sided weakness including a facial droop$Input2": {} + }, + "A Glasgow Coma Scale score of 4 indicates that the patient is severely impaired and requires intubation. This severe decrease in the level of consciousness is a sign of significant impairment of brain function and is common in severe strokes.$Cause_1": { + "a GCS of 4, necessitating intubation$Input2": {} + }, + "The INR was 3.4, indicating that the patient's blood was highly anticoagulated, which may be related to the anticoagulant drug Coumadin she was taking. Overdose of anticoagulants may increase the risk of brain hemorrhage.$Cause_1": { + "INR was found to be 3.4$Input2": {} + }, + "Atrial fibrillation is a significant risk factor for stroke$Cause_1": { + "Atrial fibrillation,$Input3": {} + }, + "High blood pressure is one of the most common risk factors for stroke$Cause_1": { + "hypertension,$Input3": {} + }, + "Hyperlipidemia is one of the most common risk factors for stroke$Cause_1": { + "hyperlipidemia$Input3": {} + }, + "Low GCS scores may indicate severe brain dysfunction, often seen in stroke patients$Cause_1": { + "The patient had a GCS of 5T, does not follow commands, does not track or regard examiner$Input5": {} + }, + "Asymmetrical limb reactions and loss of movement may indicate damage to part of the brain, a common sign of stroke.$Cause_1": { + "Off propofol, the patient briskly withdraws right upper and right lower. The left upper extremity was seen to be antigravity, fighting against staff. The left lower extremity withdrew to noxious.$Input5": {} + }, + "Ascending toe reflex is common in stroke patients$Cause_1": { + "Upgoing toe on left$Input5": {} + }, + "Obstructive hydrocephalus is a manifestation of increased intracranial pressure and is often associated with intracranial pathology after stroke.$Cause_1": { + "The right lateral ventricle difficult to visualize due to extensive mass-effect in the left lateral ventricle appears dilated, which is concerning for developing obstructive hydrocephalus.$Input6": {} + } + } + }, + "input1": "found down\n", + "input2": "EU Critical She is a woman with a history of lupus arthritis, atrial fibrillation, aortic valve replacement on Coumadin who presents as an outside hospital transfer after being found to have a large intraparenchymal hemorrhage.\n\ufeff\nThe history is obtained from the charts and with the help of her geriatric facilities manager for corroboration. Ms. White reported to be in her otherwise usual state of health up until about 12 this afternoon. She was found down in the bathroom face down at around 1. At that time, she was reportedly responding to questions but with possible left-sided weakness. She was taken urgently to an outside hospital, where she was initially found to have a blood pressure of 170s-200s, with left-sided weakness including a facial droop. Her clinical exam apparently deteriorated to a GCS of 4, necessitating intubation. \n\ufeff\nShe underwent a noncontrast head CT which revealed a large 101 cc intraparenchymal hemorrhage centered around the right basal ganglia with 1 cm midline shift. Her INR was found to be 3.4 on initial evaluation. She received K Centra, vitamin K and FFP. She was initiated on nicardipine drip prior to transfer. At ED, she was evaluated by neurosurgery. \n\ufeff\nHer healthcare proxy was designated to be one Ms. White, who is a named healthcare proxy and who is the geriatric facilities.\n", + "input3": "+ Atrial fibrillation,\n+ aortic valve replacement, \n+ hypertension, \n+ hyperlipidemia, \n+ personality disorder, \n+ systemic lupus erythematosus with severe arthritis\n", + "input4": "noncontributory\n", + "input5": "ADMISSION PHYSICAL EXAM:\nGeneral: intubated, agitated off propofol\nHEENT: NCAT, no oropharyngeal lesions, neck supple\nirregularly irregular, harsh systolic murmur\nPulmonary: intubated\nAbdomen: Soft, NT, ND, +BS, no guarding\nExtremities: Warm, no edema. There are multiple areas of\necchymoses. Her digits are severely arthritic.\n\ufeff\nNeurologic Examination:\n- Mental status: The patient had a GCS of 5T, does not follow commands, does not track or regard examiner. She appears agitated.\n\ufeff\n- Cranial Nerves: PERRL 3->2 brisk. Corneals intact bilaterally. VORs not done. Intact cough.\n\ufeff\n- Sensorimotor: Off propofol, the patient briskly withdraws right upper and right lower. The left upper extremity was seen to be antigravity, fighting against staff. The left lower extremity withdrew to noxious.\n \n- Reflexes: Upgoing toe on left\n\ufeff\n- Coordination/gait: deferred\n", + "input6": "CT head \n1. Large right frontoparietal intraparenchymal hemorrhage with extensive surrounding vasogenic edema and mass effect causing 15 mm of leftward midline shift and developing subfalcine and uncal herniation. \n2. Intraventricular hemorrhages seen layering within the occipital or left lateral ventricle, fourth ventricle, and cisterna magna. \n3. The right lateral ventricle difficult to visualize due to extensive mass-effect in the left lateral ventricle appears dilated, which is concerning for developing obstructive hydrocephalus. \n4. Extensive predominantly right paranasal sinus disease, as above.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/14189463-DS-10.json b/Finished/Stroke/Hemorrhagic Stroke/14189463-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..292109f3375143da16218ba4390e9abdb566edeb --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/14189463-DS-10.json @@ -0,0 +1,42 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "High density of blood is typical of hemorrhagic stroke events$Cause_1": { + "High-density areas of fresh bleeding. Density is 50-80 Hounsfield Units (HU).$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Although patients have symptoms of dementia, acute changes in symptoms may indicate new effects on brain function, which are common in strokes.$Cause_1": { + "increased confusion and forgetfulness over the last several days$Input2": {} + }, + "Acute left-sided weakness, slurred speech, and facial drooping are typical symptoms of stroke$Cause_1": { + "acute left sided weakness, slurred speech, facial droop around noon this morning$Input2": {} + }, + "This rapidly progressive neurological decline is typical of stroke.$Cause_1": { + "mental status deteriorated significantly in transit, and was nonverbal with weak motor strength on the right side$Input2": {} + }, + "High blood pressure is one of the major risk factors for stroke$Cause_1": { + "Hypertension$Input3": {} + }, + "Diabetes increases risk of stroke$Cause_1": { + "Diabetes$Input3": {} + }, + "Deep vein thrombosis may increase the risk of stroke.$Cause_1": { + "h/o DVT$Input3": {} + }, + "Atrial fibrillation is a common heart rhythm disorder that can cause stroke.$Cause_1": { + "Paroxysmal atrial fibrillation$Input3": {} + }, + "Strokes can cause confusion, so this is a potential stroke symptom.$Cause_1": { + "minimally arousable with verbal stimuli$Input5": {} + }, + "Patients have obvious abnormalities in neurological function, such as slow response to stimulation and lack of autonomous activity and reflexes. These are signs of severe neurological impairment that may result from a stroke$Cause_1": { + "Minimally arousable to verbal stimuli, did not assess strength or sensation, no spontaneous movements or reflexes$Input5": {} + } + } + }, + "input1": "Confusion\n", + "input2": "a woman who was sent to hospital after increased confusion and forgetfulness over the last several days and acute left sided weakness, slurred speech, facial droop around noon this morning. At baseline, patient is alert and oriented, although with dementia. She was responsive to verbal stimuli were labs were drawn (within normal limits). In discussions with the family, the patient was confirmed DNR/DNI and transferred to ICU for further evaluation by neurology/neurosurgery. The patient's mental status deteriorated significantly in transit, and was nonverbal with weak motor strength on the right side and responsiveness mainly to tactile stimuli by arrival to the ED. In discussions with the family, it was decided that the goals of medical care be comfort and the patient was admitted to Medicine for palliative care. \n. \nIn the ED initial VS were T97.9, BP127/89, HR78, 100% on 2L NC. \nShe received 1L NS at the OSH and a foley and PIV had been placed.\n", + "input3": "+ Dementia \n+ Hypertension \n+ GERD \n+ Diabetes \n+ h/o DVT \n+ Paroxysmal atrial fibrillation \n+ Hypokalemia \n+ Hernia\n", + "input4": "Daughter lives in the area. currently here but will return home likely tomorrow.\n", + "input5": "VS: T96.9, BP130/70, HR90, RR16, 100% on 3.5L NC \nGen: NAD, sleeping, minimally arousable with verbal stimuli \nHEENT: MMM with increased secretions, PERRL but decreased \nNeck: Soft, supple, no JVD/LAD \nCV: RRR, no murmurs/rubs, ?gallops, normal S1/S2 \nPulm: Coarse breath sounds but CTAB, no wheezing/rhonchi/rales, +upper airway secretions/rhonchi \nAbd: Soft, nontender, nondistended, normoactive bowel sounds \nExt: No cyanosis, ecchymosis, 1+ edema of bilateral lower extremities, pulses 2+ bilaterally, \nNeuro: Minimally arousable to verbal stimuli, did not assess strength or sensation, no spontaneous movements or reflexes\n", + "input6": "CT\nHigh-density areas of fresh bleeding. Density is 50-80 Hounsfield Units (HU).\n\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/14588438-DS-21.json b/Finished/Stroke/Hemorrhagic Stroke/14588438-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..9254b215799dc463bb1b49d0fbbced8d7f279a1a --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/14588438-DS-21.json @@ -0,0 +1,48 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "Intraparenchymal hemorrhage directly indicates possible hemorrhagic stroke$Cause_1": { + "Intraparenchymal Hemorrhage$Input1": {} + }, + "The head CT results showed obvious high-density lesions in the right parietal lobe, further confirming intraparenchymal hemorrhage. This is key imaging evidence in diagnosing stroke.$Cause_1": { + "head CT which showed a 1.8 x 2.2 cm hyperdense lesion in the right parietal lobe concerning for intraparenchymal hemorrhage$Input2": {} + }, + "Obvious symptoms of bleeding within the head are diagnostic criteria for hemorrhagic stroke$Cause_1": { + "Stable appearance of a 2.0 x 1.9 x 3.3 cm intraparenchymal hematoma centered within the right parietal lobe.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Seizure may be a sign of stroke$Cause_1": { + "Seizure$Input1": {} + }, + "Loss of consciousness is one of the common symptoms of stroke$Cause_1": { + "he lost consciousness$Input2": {} + }, + "This attack may be triggered by a stroke.$Cause_1": { + "There is concern for possible seizure when EMS arrived due to the fact that he was minimally responsive and had lost his urine in the car as well as had a tongue bite.$Input2": {} + }, + "This suggests that patients may be at increased risk for brain events during the vulnerable period after alcohol withdrawal.$Cause_1": { + "he stopped drinking approximately at midnight the night prior, which is 24 hours prior to the event. He did feel shaky, tremulous and like he was going through withdrawal while driving.$Input2": {} + }, + "Atrial fibrillation increases risk of stroke$Cause_1": { + "A. fib on Coumadin$Input3": {} + }, + "Long-term drinking or binge drinking may increase the chance of stroke$Cause_1": { + "alcohol abuse$Input3": {} + }, + "Side tongue bite can be a sign of stroke$Cause_1": { + "evidence of a lateral tongue bite$Input5": {} + }, + "Postural tremor may be a symptom after stroke$Cause_1": { + "There is a fine postural tremor$Input5": {} + }, + "A positive Romberg test indicates that the patient is unsteady when standing with eyes closed, which may indicate a stroke$Cause_1": { + "Romberg positive$Input5": {} + } + } + }, + "input1": "Seizure, Intraparenchymal Hemorrhage\n", + "input2": "Patient was in his usual state of health this afternoon when he was backing his car out of the driveway and bumped into a tree at low impact. He does not recall the small accident because he lost consciousness. There is concern for possible seizure when EMS arrived due to the fact that he was minimally responsive and had lost his urine in the car as well as had a tongue bite. He was taken to hospital where he was given 1 mg of Ativan and Keppra. He underwent head CT which showed a 1.8 x 2.2 cm hyperdense lesion in the right parietal lobe concerning for intraparenchymal hemorrhage. There was surrounding edema and mild mass-effect but no midline shift. The decision was made to transfer to ICU for further management.\n\ufeff\nOf note, patient has a history of 2 lifetime seizures prior to this episode, both of which were in the context of alcohol withdrawal. Patient reports that he stopped drinking approximately at midnight the night prior, which is 24 hours prior to the event. He did feel shaky, tremulous and like he was going through withdrawal while driving. He has never had a seizure in between episodes of alcohol withdrawal. \n\ufeff\nHe denied any history of significant head trauma, febrile seizures, meningitis, encephalitis.\n", + "input3": "+ ICD\n+ mitral and tricuspid valve repair\n+ A. fib on Coumadin\n+ alcohol abuse\n+ history of withdrawal seizures\n", + "input4": "No family history of seizure\n", + "input5": "EXAM ON ADMISSION:\nPhysical Exam:\nVitals: T: 98.4 P: 83 R: 16 BP: 134/89 SaO2: 95% RA\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, evidence of a lateral tongue bite\nPulmonary: Normal work of breathing\nCardiac: RRR, warm, well-perfused\nAbdomen: soft, non-distended\nExtremities: No edema.\nSkin: no rashes or lesions noted.\n\ufeff\nNeurologic:\n\ufeff\n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Attentive, able to name backward without difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt was able to name both high and low frequency objects. Able to read without difficulty. Speech was not dysarthric. Able to follow both midline and appendicular commands. There was no evidence of apraxia or neglect.\n\ufeff\n-Cranial Nerves:\nII, III, IV, VI: PERRL 3 to 2mm and brisk. EOMI without nystagmus. VFF to confrontation. \nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: strength in trapezii bilaterally.\nXII: Tongue protrudes in midline with good excursions. \n\ufeff\n-Motor: Normal bulk, tone throughout. No pronator drift bilaterally.\nThere is a fine postural tremor. No asterixis noted.\n\ufeff\n-Sensory: No deficits to light touch, pinprick, proprioception throughout. No extinction to DSS. Romberg positive. \n\ufeff\n-DTRs:\nBi Tri xx Pat Ach\nL 2 2 2 0 0\nR 2 2 2 0 0\nPlantar response was mute bilaterally.\n\ufeff\n-Coordination: No dysmetria on FNF or HKS bilaterally.\n\ufeff\n-Gait: Good initiation. Wide-based, normal stride and arm swing. \n\ufeff\nAble to walk in tandem without difficulty.\n", + "input6": "04:45AM BLOOD WBC-4.6 RBC-3.92* Hgb-12.7* Hct-39.3* MCV-100* MCH-32.4* MCHC-32.3 RDW-15.7* RDWSD-57.8* Plt Ct-93*\n04:45AM BLOOD ALT-48* AST-59* AlkPhos-91\n04:45AM BLOOD Calcium-8.8 Phos-4.0 Mg-1.7 Iron-85\n12:03AM BLOOD TSH-4.4*\n\ufeff\nIMAGING:\n\ufeff\nCT HEAD:\n. Stable appearance of a 2.0 x 1.9 x 3.3 cm intraparenchymal hematoma centered within the right parietal lobe. No additional sites of intraparenchymal hemorrhage are identified. 2. Unremarkable CTA examination of the head.\n\ufeff\nCT HEAD:\nIMPRESSION: \nStable right parietal intraparenchymal hemorrhage with mild unchanged surrounding edema. No new or worsening intracranial hemorrhage.\n\ufeff\nCT Chest/Abd/Pelvis:\n\ufeff\nIMPRESSION\n\ufeff\n1. The liver demonstrates low attenuation compatible with hepatic steatosis. \nMore severe forms of chronic liver disease including NASH are not excluded.\n2. Prominent mesenteric lymph nodes in the porta hepatis measuring up to 1.5\ncm are nonspecific but could be reactive to chronic liver disease.\n3. Please refer to dedicated CT chest report on same day for intrathoracic findings.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/14651148-DS-19.json b/Finished/Stroke/Hemorrhagic Stroke/14651148-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..e9f5c7a5871418448e339a5fc945a5412532bcf3 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/14651148-DS-19.json @@ -0,0 +1,54 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "Computed tomography scan showed internal hemorrhage (ICH) near the right ventricle, direct evidence of intracerebral hemorrhage type stroke$Cause_1": { + "Stat CT had showed right ICH near lateral ventricle.$Input2": {} + }, + "Acute bleeding is one of the typical symptoms of hemorrhagic stroke$Cause_1": { + "Acute hemorrhage involving the deep white matter abutting the right lateral ventricle measuring up to 1.8 cm with ventricular breakthrough and a small amount of acute hemorrhage layering dependently within the occipital horn of the right lateral ventricle.$Input6": {} + }, + "Persistent or recurrent bleeding is a common clinical manifestation in patients with hemorrhagic stroke.$Cause_1": { + "Persistent acute hemorrhage$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Left-sided weakness is one of the common symptoms of stroke$Cause_1": { + "left sided weakness$Input1": {} + }, + "Facial droop, slurred speech, and mild aphasia are typical symptoms of stroke$Cause_1": { + "left facial droop, mild dysarthria, mild aphasia$Input2": {} + }, + "Inability to lift both lower limbs is a common symptom of stroke$Cause_1": { + "inability to lift her bilateral lower extremities for 10 seconds$Input2": {} + }, + "Extremely high blood pressure, especially systolic blood pressure above 170, which is a risk factor for stroke$Cause_1": { + "SBP was in the 170's$Input2": {} + }, + "High blood pressure is a very important risk factor for stroke$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "Family history of stroke is an important factor$Cause_1": { + "STROKE$Input4": {} + }, + "The patient is oriented only toward people, which may indicate a decreased level of cognition or consciousness, a potential sign of stroke$Cause_1": { + "She is alert and oriented to person only, does follow simple commands, naming of high-frequency objects intact.$Input5": {} + }, + "Slurred speech is a common symptom of stroke$Cause_1": { + "she also sounds mildly dysarthric$Input5": {} + }, + "Facial sagging is a classic symptom of stroke$Cause_1": { + "left facial droop$Input5": {} + }, + "Loss of strength on one side of the body, especially when compared to the other side, is a common sign of stroke$Cause_1": { + "does appear slightly weak on the left when compared to the right$Input5": {} + }, + "Vasculitis is a risk factor for stroke$Cause_1": { + "VASCULITIS$Input3": {} + } + } + }, + "input1": "left sided weakness\n", + "input2": "She is a woman with a history of traumatic left subdural hematoma, left medial cerebellar hemorrhage. She most likely also has vascular dementia, Alzheimer's disease and mild parkinsonism who presents today with left sided weakness. Briefly, she was in her usual state of health until 50 years old when her husband helped her showering and noticed that she had left-sided weakness. She called his daughter who came over and decision was made to brought her to hospital.\nAt ED her SBP was in the 170's. He had a NIHSS of 10 for left facial droop, mild dysarthria, mild aphasia, inability to lift her bilateral lower extremities for 10 seconds. Stat CT had showed right ICH near lateral ventricle. \n\ufeff\nOn neuro ROS, the pt denies headache, loss of vision, blurred vision, diplopia, lightheadedness, vertigo, tinnitus or hearing difficulty.\n", + "input3": "+ LIVIDO RITICULARIS\n+ VASCULITIS\n+ HYPERTENSION\n+ OSTEOPOROSIS\n+ Dementia\n", + "input4": "Mother\nDIABETES MELLITUS\nHYPERTENSION\nPSORIASIS\nSTROKE\n\ufeff\nFather\nCORONARY ARTERY\nDISEASE of MI\n\ufeff\nComments: No family history of bleeding or clotting disorders or miscarriages.\n", + "input5": "Physical Exam:\n- General: Awake, cooperative, NAD.\n- HEENT: NC/AT\n- Neck: Supple\n- Pulmonary: no increased WOB\n- Cardiac: well perfused \n- Abdomen: soft, nontender, nondistended\n- Extremities: no edema, pulses palpated\n- Skin: no rashes or lesions noted.\n\ufeff\nNeurologic:\nMS: She is alert and oriented to person only, does follow simple commands, naming of high-frequency objects intact. She speaks only a couple words per daughter his baseline, per daughter she also sounds mildly dysarthric.\n\ufeff\nCN: PERRL, EOMI, left facial droop, sensation intact in V1 V2 V3, tongue protrudes midline\n\ufeff\nSensorimotor: Moves all extremities antigravity, does not participate in confrontational testing but does appear slightly weak on the left when compared to the right. Withdraws briskly in all fours\n\ufeff\n", + "input6": "05:30AM BLOOD WBC-8.1 RBC-4.72 Hgb-14.0 Hct-43.3 MCV-92 MCH-29.7 MCHC-32.3 RDW-13.5 RDWSD-45.7\n05:30AM BLOOD Glucose-127* UreaN-22* Creat-0.6 Na-145 K-3.7 Cl-107 HCO3-22 AnGap-16\n06:57PM BLOOD ALT-<5 AST-18 AlkPhos-48 TotBili-0.2\n05:30AM BLOOD Calcium-9.3 Phos-2.1* Mg-2.3\n06:57PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\ufeff\nCT head\nAcute hemorrhage involving the deep white matter abutting the right lateral ventricle measuring up to 1.8 cm with ventricular breakthrough and a small amount of acute hemorrhage layering dependently within the occipital horn of the right lateral ventricle. Given the location this may be hypertensive in etiology. \n\ufeff\nCT Head\n1. Persistent acute hemorrhage involving the deep white matter abutting the right lateral ventricle, that appears relatively stable compared to prior CT head performed 1 day prior. No evidence of shift of midline structures. \n2. Small amount of hemorrhage layering in occipital horn of the left lateral ventricle, without evidence of infarction, edema or new hemorrhage. \"\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/15039042-DS-12.json b/Finished/Stroke/Hemorrhagic Stroke/15039042-DS-12.json new file mode 100644 index 0000000000000000000000000000000000000000..bd7499e72909b8fe3e2bf33bc83dcc3e21f1d5c5 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/15039042-DS-12.json @@ -0,0 +1,39 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "Intracerebral hemorrhage is a direct manifestation of hemorrhagic stroke. The results of CT scan show the location and extent of bleeding, which is the key to diagnosis.$Cause_1": { + "serial head CTs demonstrated worsening R intraparenchymal bleed$Input2": {} + }, + "It showed a large area of \u200b\u200bintracerebral hemorrhage and local mass effect in the posterior part of the right parietal lobe, which was direct evidence of hemorrhagic stroke.$Cause_1": { + "Large parenchymal hemorrhage in the posterior right parietal lobe with local mass effect.$Input6": {} + }, + "Indicates that the bleeding area has expanded, which is a direct manifestation of the progression of hemorrhagic stroke$Cause_1": { + "Interval increase in size of intraparenchymal hemorrhage within the right parietal lobe$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "One of the common symptoms of stroke is weakness on one side of the body.$Cause_1": { + "unable to walk because of weakness on the left side$Input2": {} + }, + "Frequent falls, which may be caused by weakness on one side of the body or loss of balance, are common in people who have had a stroke.$Cause_1": { + "fell getting out of bed on ___, 45 minutes later in the bathroom, and again at the breakfast table shortly thereafter$Input2": {} + }, + "Facial droop is often associated with stroke$Cause_1": { + "Left facial droop$Input2": {} + }, + "Increasing drowsiness is a decrease in consciousness, which is a serious symptom that may be caused by a stroke.$Cause_1": { + "increasingly drowsy$Input2": {} + }, + "High blood pressure is a major risk factor for stroke$Cause_1": { + "HTN$Input3": {} + }, + "Diabetes is a major risk factor for stroke$Cause_1": { + "DM$Input3": {} + } + } + }, + "input1": "None\n", + "input2": "The pt is an ___ y/o F who presented to ___ after 3 falls at home on ___. Details of the falls were related by her grandson, ___. He reports that the patient was unable to walk because of weakness on the left side. She fell getting out of bed on ___, 45 minutes later in the bathroom, and again at the breakfast table shortly thereafter. The grandson noted that the patient couldn't use her walker at all secondary to weakness after the third fall. Son arrived and picked patient up off floor. Noted L sided weakness and called EMS. Left facial droop was noted but this was this is somewhat confounded by an old bells palsy. At ___, serial head CTs demonstrated worsening R intraparenchymal bleed. She was sent here for further care. She was admitted to the TSICU and was noted to be increasingly drowsy and a CT head was done this morning which showed worsening from previous CT. \n", + "input3": "HTN\nDM - diet controlled\nBells palsy ___ yrs ago) \nAsthma \nHypothyroidism \nS/p hysterectomy \narthritis \n", + "input4": "NC\n", + "input5": "Vitals: T:98.8 P:70 R:14 BP:124/84 SaO2:96%RA \nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx. pupils are surgical. \nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity \n\nPulmonary: With crackles at the right base. \nCardiac: RRR, nl. S1S2, no M/R/G noted \nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted. \nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. \nSkin: Patient has lesions over abdomen, previously diagnosed with zoster. \n", + "input6": "___ 06:00AM BLOOD WBC-14.2* RBC-3.85* Hgb-13.1 Hct-37.1 MCV-97 MCH-34.0* MCHC-35.2* RDW-16.2* Plt ___\n___ 09:45PM BLOOD ___ PTT-39.4* ___\n___ 11:06AM BLOOD ___ PTT-37.4* ___\n___ 11:06AM BLOOD Glucose-146* UreaN-12 Creat-1.0 Na-140 K-2.9* Cl-101 HCO3-26 AnGap-16\n___ 11:06AM BLOOD ALT-12 AST-18 CK(CPK)-53 AlkPhos-88 TotBili-0.5\n___ 11:06AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 11:06AM BLOOD Albumin-3.9 Calcium-8.9 Phos-3.4 Mg-2.0 Cholest-154\n___ 11:06AM BLOOD Triglyc-113 HDL-70 CHOL/HD-2.2 LDLcalc-61\n___ 11:06AM BLOOD Osmolal-304\n___ 11:06AM BLOOD TSH-0.19*\n___ 03:15PM BLOOD Type-ART Rates-16/ Tidal V-500 FiO2-50 pO2-126* pCO2-43 pH-7.40 calTCO2-28 Base XS-1 -ASSIST/CON \n\n1. Significantly limited study due to patient movement. Large parenchymal hemorrhage in the posterior right parietal lobe with local mass effect. Apparent effacement along the right suprasellar cistern likely represents volume averaging due to motion, however, evolving uncal herniation is not entirely excluded. Attention to this finding on follow-up imaging is recommended.\n2. Diffuse white matter hypodensity throughout the bilateral basal ganglia, likely sequela of severe chronic microvascular ischemia, less likely infarction.\n\nRepeat Head CT ___:\n1. Interval increase in size of intraparenchymal hemorrhage within the right parietal lobe. Worsening of right lateral ventricle mass effect.\n2. No subfalcine or uncal herniation.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/15100095-DS-13.json b/Finished/Stroke/Hemorrhagic Stroke/15100095-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..d9d20dfd1b5dcff9e40b22320f7121ef2af08be6 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/15100095-DS-13.json @@ -0,0 +1,51 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "CT scan results showed hemorrhage in the occipital and temporal regions, direct evidence of hemorrhagic stroke$Cause_1": { + "CT Head at 2:52 pm which showed a 3x3 cm occipital temporal hemorrhage$Input2": {} + }, + "Repeat CT scan showed hemorrhage and surrounding edema in the left posterior parietal area, which further confirmed the diagnosis of hemorrhagic stroke.$Cause_1": { + "13 ml left posterior parietal hemorrhage with surrounding edema$Input2": {} + }, + "The scan showed ischemic foci and hematomas with hemorrhagic transformation in the left posterior inferior cerebellum and parieto-occipital region, which are direct signs of hemorrhagic stroke.$Cause_1": { + "Early subacute infarct in the left posterior inferior cerebellar hemisphere, in the ___ territory, with central hemorrhagic transformation and thin peripheral contrast enhancement.$Input6": {} + }, + "Enhanced MRI showed slight enhancement at the edge, suggesting the possibility of active bleeding$Cause_1": { + "Stable left superior occipital/inferior parietal parenchymal hematoma demonstrates thin rim enhancement without nodularity and adjacent leptomeningeal hyperemia$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Headache is a common symptom of stroke$Cause_1": { + "headache$Input1": {} + }, + "Altered mental status is one of the classic symptoms of stroke$Cause_1": { + "alteration of mental status$Input2": {} + }, + "Changes in the Glasgow Coma Scale (GCS) show fluctuations in consciousness level, a possible sign of a stroke.$Cause_1": { + "a GCS of 10, but this is not found in documentation; upon presentation here GCS is 14.$Input2": {} + }, + "High blood pressure, a common symptom of hemorrhagic stroke$Cause_1": { + "hypertensive to 170s$Input2": {} + }, + "New onset of slurred speech and dysarthria, which may indicate brain damage or impaired function$Cause_1": { + "aphasic and dysarthric$Input2": {} + }, + "Hypertension is a major risk factor for hemorrhagic stroke$Cause_1": { + "Hypertension$Input3": {} + }, + "The responses were simple, suggesting possible impairment of cognition and comprehension, symptoms associated with brain damage.$Cause_1": { + "answers questions by nodding or shaking his head, sometimes responds yes/no. Otherwise says \"uh\" or \"um\" when prompted to speak. He is able to follow simple but not complex commands.$Input5": {} + }, + "The pupil was 2 mm in diameter and nonresponsive to light, which may be a sign of increased intracranial pressure. The left side blinked more reliably than the right side in response to threats, suggesting possible right-sided brain impairment.$Cause_1": { + "Pupils 2 mm nonreactive. Can not cooperate with VF or sensory testing, but blinks to threat on left more reliably than he does to the right$Input5": {} + }, + "Conscious gaze pursuit and tracking, delayed speech, cognitive impairment (difficulty in expressing certain words), improved naming ability but still low-frequency vocabulary difficulties, and substitution errors when repeating language may indicate impaired function of the left hemisphere, which is closely related to the location of the language center.$Cause_1": { + "Alert, regards and tracks, answers appropriate, speech latency, realizes he is unable to state certain words. Naming improved today. able to name watch and pen, though still with deficits with low frequency words. Repetition testing with paraphasic errors and trouble repeating.$Input5": {} + } + } + }, + "input1": "headache\n", + "input2": "The pt is a ___ year old man on Coumadin who underwent a cardiac catheterization followed by bare metal stent placement ___ and ___, respectively, and was discharged on ___ yesterday who presented to ___ ED today with alteration of mental status since this morning. There are no family members at the bedside to provide further detail. At the referring ED, he reportedly had a GCS of 10, but this is not found in documentation; upon presentation here GCS is 14. He had a CT Head at 2:52 pm which showed a 3x3 cm occipital temporal hemorrhage. He was hypertensive to 170s on presentation therefore was placed on a nicardipine drip. Upon arrival to ___ ED his BP 158/54 and he is aphasic and dysarthric, which was not previously documented. Repeat scan at ___ ED reveals 13 ml left posterior parietal hemorrhage with surrounding edema but no midline shift. \n\n\nROS could not be obtained reliably, but patient shakes his head no when asked if he is currently in any pain over various parts of his body, including head. \n", + "input3": "Cataracts\nCoronary Artery Disease status post PCI in ___\nDiabetes Mellitus Type II\nHyperlipidemia\nHypertension\nPeripheral Neuropathy\nProstate Cancer s/p radiation seeds, ___\nOsteoarthritis\n", + "input4": "Father - had myocardial infarction at age ___, history of colon\ncancer, died at age ___.\nMother - died of leukemia at age ___.\nSister - died of breast cancer, history of melanoma as well.\nBrother - apparently healthy\n", + "input5": "Vitals: T: HR: 106 BP: 158/54 RR: SaO2:98% 2 L NC\n___: NAD lying in bed\nHEENT: NCAT, no oropharyngeal lesions, neck supple\nExtremities: Warm, no edema, bilateral surgical scars on knees\nNeurologic Examination:\n- Mental status: Awake, alert, oriented x 1; answers questions by nodding or shaking his head, sometimes responds yes/no. Otherwise says \"uh\" or \"um\" when prompted to speak. He is able to follow simple but not complex commands. \n\n- Cranial Nerves: Pupils 2 mm nonreactive. Can not cooperate with VF or sensory testing, but blinks to threat on left more reliably than he does to the right. No facial movement asymmetry. Palate elevation symmetric. SCM/Trapezius strength ___ bilaterally. Tongue midline.\n\n- Motor: Normal bulk and tone. No drift. No tremor or asterixis.\n [___]\n\nL NT 5 NT NT ___ 5 NT 5 NT 5\nR NT 5 NT NT ___ 5 NT 5 NT 5 \n\n certain muscle groups could not be tested due to inability to follow instructions\n\nNeurologic:\n\n-Mental Status: Alert, regards and tracks, answers appropriate, speech latency, realizes he is unable to state certain words. Naming improved today. able to name watch and pen, though still with deficits with low frequency words. Repetition testing with paraphasic errors and trouble repeating. On previous day named ___ items on modified ___ naming test. Was able to write simple words but errors noted with more complex sentences. Not able to read. When reading the word \"your\" he can slowly state the individual letters but not the whole word\n", + "input6": "___ 06:25AM BLOOD WBC-8.2 RBC-3.43* Hgb-10.1* Hct-31.1* MCV-91 MCH-29.4 MCHC-32.5 RDW-13.5 RDWSD-45.2 Plt ___\n___ 06:35PM BLOOD WBC-11.3* RBC-3.37* Hgb-10.1* Hct-30.6* MCV-91 MCH-30.0 MCHC-33.0 RDW-13.7 RDWSD-45.4 Plt ___\n___ 06:10AM BLOOD ___ PTT-24.9* ___\n___ 06:35PM BLOOD ___ PTT-21.3* ___\n___ 06:25AM BLOOD Glucose-127* UreaN-14 Creat-1.0 Na-137 K-3.7 Cl-99 HCO3-21* AnGap-17\n___ 06:35PM BLOOD ALT-48* AST-81* AlkPhos-236* TotBili-1.1\n___ 06:25AM BLOOD Calcium-8.8 Phos-2.9 Mg-1.3*\n\nMRI head w/ w/o contrast ___\n\"IMPRESSION: \n \n1. Early subacute infarct in the left posterior inferior cerebellar hemisphere, in the ___ territory, with central hemorrhagic transformation and thin peripheral contrast enhancement. \n2. Stable left superior occipital/inferior parietal parenchymal hematoma demonstrates thin rim enhancement without nodularity and adjacent leptomeningeal hyperemia. Diagnostic considerations include another site of infarction with hemorrhagic transformation versus sequela of amyloid angiopathy, though no chronic hemorrhages related to amyloid angiopathy are identified. While no underlying mass is identified, evaluation for masses not definitive until the T1 hyperintense blood products resolve. \n \nRECOMMENDATION(S): Recommend follow up MRI after resolution of T1 hyperintense blood products to assess for expected evolution and resolution of contrast enhancement.\"\n\nCT head w/o contrast ___\n\"FINDINGS: \n \nhere is mass effect on the occipital horn of the left lateral ventricle. \n \nThere is likely an old left cerebellar hemispheric infarct, not well seen. \n \nMucosal thickening is evident within the left maxillary sinus. Vascular calcification is noted. Mastoid air cells are clear.. The visualized portion of the orbits are unremarkable. \n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/15612258-DS-17.json b/Finished/Stroke/Hemorrhagic Stroke/15612258-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..e0d3a92533ab07fb8e2b2cc65f8bf90e209fd398 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/15612258-DS-17.json @@ -0,0 +1,63 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "CT scan showed a large intracerebral hemorrhage and a small subdural hematoma in the right cerebrum and a 5-mm shift of the midline structures. These findings are typical radiological manifestations of hemorrhagic stroke.$Cause_1": { + "CT showed large right IPH and small SDH with 5mm MLS$Input2": {} + }, + "Intracranial hemorrhage volume exceeding 30 ml indicates a large amount of bleeding, which is one of the important diagnostic criteria for hemorrhagic stroke.$Cause_1": { + "30 mL or Greater$Input5": {} + }, + "The enlargement of the right parietal intrasubstitium hemorrhage and the surrounding vasogenic edema indicate that the hemorrhage is expanding, which is a typical symptom of hemorrhagic stroke.$Cause_1": { + "interval increase in the size of a large right parietal intraparenchymal hemorrhage with surrounding vasogenic edema$Input6": {} + }, + "Extension of the hemorrhage toward the midline and causing a midline shift (ranging from 6 to 13 mm) usually indicates a significant increase in intracerebral pressure, which may lead to brain tissue compression.$Cause_1": { + "There is midline extension of the bleed, resulting in 13 mm of midline shift, previously 6 mm.$Input6": {} + }, + "The significant mass effect and almost complete effacement of the right lateral ventricle suggest that the hemorrhage caused severe compression of surrounding brain structures.$Cause_1": { + "significant mass effect with near complete effacement of the right lateral ventricle$Input6": {} + }, + "A small subdural hematoma is seen in front of the right frontal convex internal hemorrhage, another manifestation of hemorrhagic stroke.$Cause_1": { + "A small subdural hematoma is seen just anterior to the intraparenchymal hemorrhage along the right frontal convexity,$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "The patient had seizure symptoms and was taking Keppra, an anti-epileptic drug. Brain hemorrhage often triggers seizures.$Cause_1": { + "seizures on keppra$Input2": {} + }, + "Headaches and numbness and tingling in the limbs may be signs of increased pressure and damaged nerve function caused by a stroke.$Cause_1": { + "bad headache and numbness/tingling$Input2": {} + }, + "Symptoms include left limb weakness and facial droop, which are unique neurological dysfunction symptoms of stroke.$Cause_1": { + "significant left side weakness and facial droop.$Input2": {} + }, + "Indicates that the patient has extremely high blood pressure, which is one of the main risk factors for hemorrhagic stroke$Cause_1": { + "BP 210/110$Input2": {} + }, + "The patient had functional decline from the previous bleeding event, indicating that the patient's brain function may have been impaired by the previous bleeding event, increasing the risk of rebleeding.$Cause_1": { + "baseline WFD from prior hemorrhage$Input2": {} + }, + "A history of stroke in patients may mean they are at higher risk for cerebrovascular disease, which in turn may increase their risk of stroke$Cause_1": { + "ischemic stroke$Input3": {} + }, + "Hypertension is a major risk factor for hemorrhagic stroke$Cause_1": { + "HTN$Input3": {} + }, + "A constricted pupil may indicate compression of the brain, a classic sign of a hemorrhagic stroke.$Cause_1": { + "Pupils: pinpoint$Input5": {} + }, + "Intubation is often a sign that respiratory function may be impaired or that the patient has a low level of consciousness, which is common in stroke.$Cause_1": { + "100% intubated$Input5": {} + }, + "Complete closure of the eyes is a sign of coma, which can be caused by severe brain damage, which can occur as a result of a stroke.$Cause_1": { + "Does not open eyes$Input5": {} + }, + "A weakened or minimal response to painful stimuli in the right upper limb, left upper limb, and both legs, possibly due to damage to the area of \u200b\u200bthe brain that controls limb movement$Cause_1": { + "Motor: \nRUE weak withdraw to deep noxious\nLUE flicker movement to deep noxious\nBLE withdraw to deep noxious$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "Eu Critical with seizures on keppra, who woke this morning with bad headache and numbness/tingling in all extremities. He had a witnessed fall by his girlfriend around 6am; no head strike. Developed significant left side weakness and facial droop. He was taken to OSH via ambulance and intubated for decreased alertness. CT showed large right IPH and small SDH with 5mm MLS. He was given 1g keppra, labetalol for BP 210/110, and transferred to ___ for further evaluation.\n\nOn arrival he is intubated and sedated. History was obtained from\ngirlfriend and chart review. Also c/o several days of leg swelling. He has baseline WFD from prior hemorrhage. \n", + "input3": "- ischemic stroke ___ \n- HTN \n- CVA \n- Reflux\n- Gout \n- hemochromatosis\n- fatty liver\n- CKD stage III\n- prostate CA\n- IPMN (intraductal papillary mucinous neoplasm)\n- type 2 diabetes; without complication; no insulin or \nmediations\n- pancreas cyst \n", + "input4": "NC\n", + "input5": "O: T: 97.4 BP: 127/60 HR: 54 R: 17 O2Sats:\n100% intubated\n\nGen: intubated male\nHEENT: Pupils: pinpoint EOMs unable to assess \nExtrem: Warm and well-perfused.\n\nDate and Time of evaluation: ___\n\n___ Coma Scale:\n [x]Intubated [ ]Not intubated\n\nEye Opening: \n [x]1 Does not open eyes\n [ ]2 Opens eyes to painful stimuli\n [ ]3 Opens eyes to voice\n [ ]4 Opens eyes spontaneously\n\nVerbal:\n [x]1 Makes no sounds (intubated)\n [ ]2 Incomprehensible sounds\n [ ]3 Inappropriate words\n [ ]4 Confused, disoriented\n [ ]5 Oriented\n\nMotor:\n [ ]1 No movement\n [ ]2 Extension to painful stimuli (decerebrate response)\n [ ]3 Abnormal flexion to painful stimuli (decorticate response)\n ___ Flexion/ withdrawal to painful stimuli \n [ ]5 Localizes to painful stimuli\n [ ]6 Obeys commands\n\n __6T__ Total\n\nICH Score:\n\nGCS\n [ ]2 GCS ___\n [x]1 GCS ___\n [ ]0 GCS ___\n \nICH Volume \n [x]1 30 mL or Greater\n [ ]0 Less than 30 mL\n\nIntraventricular Hemorrhage\n [ ]1 Present\n [x]0 Absent\n\nInfratentorial ICH\n [ ___ Yes\n [x]0 No\n\nAge\n [ ]1 ___ years old or greater\n [x]0 Less than ___ years old\n\nTotal Score: __2____\n\nNeuro: prop held for exam\n\nMental status: intubated; does not respond verbal or sternal \nrub. no commands. no verbal output \n\nCranial Nerves:\npupils pinpoint no corneal reflex bilaterally midline gaze difficult to asses facial symmetric due to ET tube \n+cough \n\nMotor: \nRUE weak withdraw to deep noxious\nLUE flicker movement to deep noxious\nBLE withdraw to deep noxious \n", + "input6": "Comparison is made to same day outside reference head CT \nperformed at 08:24. Compared to head CT from 6 hours prior, there is interval increase in the size of a large right parietal intraparenchymal hemorrhage with surrounding vasogenic edema. There is midline extension of the bleed, resulting in 13 mm of midline shift, previously 6 mm. Again seen is significant mass effect with near complete effacement of the right lateral ventricle. There is now extension of the bleed into the ventricles with layering blood noted in the occipital horn of the left lateral ventricle. A small subdural hematoma is seen just anterior to the intraparenchymal hemorrhage along the right frontal convexity, unchanged compared to prior. \n \nA large focus of edema in the left parietal lobe is unchanged compared to prior. \n \nCompared to prior, there is now right-sided uncal herniation and effacement of the left suprasellar cistern. The remaining basal cisterns remain patent. \n \nThere is near complete opacification of the right mastoid sinus, and mucosal thickening of the ethmoid air cells. The remaining paranasal sinuses,mastoid air cells,and middle ear cavities are clear. The visualized portion of the orbits are unremarkable. \n \nCTA HEAD: \nThe vessels of the circle of ___ and their principal intracranial branches appear normal without stenosis, occlusion, or aneurysm formation. No underlying vascular abnormality is noted in the region of hemorrhage. The dural venous sinuses are patent. \n \nCTA NECK: \nThe carotidandvertebral arteries and their major branches appear normal with no evidence of stenosis or occlusion. There is no evidence of internal carotid stenosis by NASCET criteria. \n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/16646033-DS-13.json b/Finished/Stroke/Hemorrhagic Stroke/16646033-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..9742c59ca5b3f0d13fbc421e695948025ed21fe8 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/16646033-DS-13.json @@ -0,0 +1,45 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "An altered pupillary light reflex and an inability to turn the gaze to the left of the midline suggest possible cranial nerve dysfunction. This dysfunction may be due to compression or injury caused by a brain hemorrhage.$Cause_1": { + "CN: PERRL 3->2mm, unable to cross midline to L. No BTT on L. L NLFF, although obscured by facemask.$Input5": {} + }, + "A large acute intracerebral hemorrhage in the center of the right parietal temporal lobe of the brain, accompanied by surrounding edema and local compression effect. This hemorrhage directly indicates the occurrence of hemorrhagic stroke, because hemorrhagic stroke is caused by the rupture of blood vessels in the brain, resulting in the accumulation of blood in the brain tissue.$Cause_1": { + "Large acute intraparenchymal hemorrhage centered in the right parietal temporal lobe with surrounding edema, local mass effect, effacement of the right lateral ventricle, and 7 mm of leftward midline shift$Input6": {} + }, + "There is an aneurysm at the junction of the internal carotid artery and the middle cerebral artery. Although this aneurysm has not yet shown signs of rupture, the presence of an aneurysm is an important risk factor for hemorrhagic stroke because if an aneurysm ruptures, it may cause severe intracerebral bleeding.$Cause_1": { + "4 x 2 mm aneurysm at the junction of the right terminal ICA and right M1 segment$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "confusion is a common symptom of stroke$Cause_1": { + "confusion$Input1": {} + }, + "Intracerebral hemorrhage is a direct manifestation of hemorrhagic stroke, in which a blood vessel ruptures causing bleeding within the brain tissue$Cause_1": { + "found to have a large IPH$Input2": {} + }, + "Traffic accidents may cause or aggravate head injuries, leading to cerebral hemorrhage$Cause_1": { + "crash his car into another parked car at approximately 5 mph$Input2": {} + }, + "These are typical stroke symptoms and may indicate that a part of the brain is damaged by bleeding.$Cause_1": { + "disoriented with a facial droop$Input2": {} + }, + "Hypertension is a major risk factor for hemorrhagic stroke$Cause_1": { + "HTN$Input3": {} + }, + "Vomiting may be a symptom of increased intracranial pressure, which is associated with bleeding in the brain.$Cause_1": { + "vomiting$Input2": {} + }, + "The patient showed anti-gravity ability in the right upper/lower limb, while the left upper limb had a reduced response to pain and the left lower limb had a touch response. This side-differential sensorimotor manifestation may be caused by asymmetric hemispheric function, which is common in stroke patients.$Cause_1": { + "Sensorimotor: Intact bulk and tone b/l. Antigravity in RUE/RLE. WD to noxious in LUE, TF in LLE$Input5": {} + }, + "Mild multiple atherosclerosis of the blood vessels in the neck and brain. Atherosclerosis is the accumulation of fat and other substances in the inner wall of the arteries, causing blood vessels to harden and narrow, increasing the risk of blood vessels rupture and blockage, which may induce stroke$Cause_1": { + "Mild multifocal atherosclerosis throughout the cervical and intracranial vasculature$Input6": {} + } + } + }, + "input1": "confusion\n", + "input2": "___ year old male was medflighted from ___ after he was found to have a large IPH. He was last seen well at 11am when his neighbor witnessed him crash his car into another parked car at approximately 5 mph. After neighbors checked on him and found his disoriented with a facial droop, EMS was called and he was brought to ___ at 1649. Following the ___, he was administered 10mg of Decadron and 1G Keppra prior to a medflight. His GCS prior to transport was 15. Prior to and during the flight, the patient was hypertensive and vomiting. He was administered Fentanyl.\n", + "input3": "HTN, Anxiety\n", + "input4": "Patient is currently an ___ for the ___, working for children who have been abused. He is married and has three children.\n", + "input5": "Vitals: P: 68 RR: 19 BP: 120/51 SaO2: 98% ETT\n \nGeneral: Awake, briefly cooperative, in moderate distress.\nHEENT: NC/AT, no scleral icterus noted, facemask in place\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity\nPulmonary: Normal work of breathing\nCardiac: RRR, warm, well-perfused\nAbdomen: soft, non-distended\nExtremities: No ___ edema.\nSkin: no rashes or lesions noted.\n \nNeurologic:\nMS: Awake, alert. EO spontaneously. Regards and tracks examiner. Follows midline and appendicular commands. Shows some degree of fluency when facemask removed (\"the bucket!\"). Grimaces to noxious. R gaze preference.\n\nCN: PERRL 3->2mm, unable to cross midline to L. No BTT on L. L NLFF, although obscured by facemask. \n\nSensorimotor: Intact bulk and tone b/l. Antigravity in RUE/RLE. WD to noxious in LUE, TF in LLE. No adventitious movements or asterixis present.\n", + "input6": "========================\n___, CTA head and neck:\n========================\n1. Large acute intraparenchymal hemorrhage centered in the right parietal temporal lobe with surrounding edema, local mass effect, effacement of the right lateral ventricle, and 7 mm of leftward midline shift. No CTA spot sign is visualized. \n2. 4 x 2 mm aneurysm at the junction of the right terminal ICA and right M1 segment. No additional site of aneurysm is identified. \n3. Mild multifocal atherosclerosis throughout the cervical and intracranial vasculature, which otherwise remains patent. \n4. Partially imaged ETT/NGT, bilateral atelectasis, and a diffusely heterogeneous thyroid gland without dominant nodule measuring greater than 1.0 cm. \n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/19155318-DS-5.json b/Finished/Stroke/Hemorrhagic Stroke/19155318-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..d6014e27ba5231a927e2745cfe9488fb96cf5593 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/19155318-DS-5.json @@ -0,0 +1,57 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "A large mixed attenuation intracerebral hemorrhage involving the right internal frontal lobe. The hemorrhage extends into the submeningeal space and extends posteriorly along the cingulate sulcus to the posterior corpus callosum region. This hemorrhage is often associated with hemorrhagic stroke.$Cause_1": { + "Large mixed attenuation intraparenchymal hemorrhage \ninvolving the medial right frontal lobe with subarachnoid extension along the cingulate sulcus, tracking posteriorly into the region of the posterior corpus callosum$Input6": {} + }, + "The adjacent frontal gyri had subarachnoid hemorrhages, a common form of hemorrhagic stroke in which bleeding occurs in the subarachnoid space beneath the brain's surface.$Cause_1": { + "Subarachnoid hemorrhage in in the adjacent bilateral frontal gyri$Input6": {} + }, + "The structures that normally lie in the midline were displaced 8 mm to the left. This displacement is usually a manifestation of increased intracranial pressure caused by extensive hemorrhage and is one of the serious complications of hemorrhagic stroke.$Cause_1": { + "8 mm leftward shift of normally midline structures.$Input6": {} + }, + "A smaller intracerebral hemorrhage in the right frontal lobe, approximately 1.3 cm in size, is a clear sign of a hemorrhagic stroke.$Cause_1": { + "Smaller right frontal intraparenchymal hemorrhage measures 1.3 cm.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Hemiplegia refers to partial paralysis on one side of the body. A stroke usually causes damage to a part of the brain, which can affect the nerve pathways that control the muscles on the opposite side of the body, causing hemiplegia.$Cause_1": { + "L hemiparesis$Input1": {} + }, + "Aphasia is a language disorder caused by brain damage, usually manifested as difficulty speaking and understanding language.$Cause_1": { + "aphasia$Input1": {} + }, + "Sudden left-side facial drooping and left-side weakness are often classic symptoms of a stroke and may indicate new brain damage.$Cause_1": { + "sudden onset LT facial droop, LT sided weakness$Input2": {} + }, + "Initially responsive to questions but absent upon arrival may indicate increasing severity of stroke and impaired neurological function.$Cause_1": { + "Initially was responsive to questions which was not the case on arrival$Input2": {} + }, + "The patient's aphasia suggests damage to the language center, one of the areas that a stroke may affect.$Cause_1": { + "Neurologic and General review od systems unable to obtain aspatient apahsic$Input2": {} + }, + "Previous history of hemorrhagic stoke increase the risk$Cause_1": { + "Left hemorrhagic stroke$Input3": {} + }, + "Hypertension is one of the most common risk factors for cerebral hemorrhage$Cause_1": { + "Hypertension$Input3": {} + }, + "The patient was initially alert and repeated speech, but later became drowsy. This suggests neurological dysfunction, possibly related to a stroke.$Cause_1": { + "Initially Awake, and echolalic which\ndeteriorated into obtounded$Input5": {} + }, + "Pupils with a brisk and constricted light reflex (PERRL 2->1.5 brisk), bilateral corneal reflexes, and a positive gag reflex (Gag+) may indicate brainstem or cranial nerve damage, which is common in stroke$Cause_1": { + "Cranial Nerves - PERRL 2->1.5 brisk. Corneals present\nbilaterally. No clear BTT. Gag +. LT NLFF.$Input5": {} + }, + "The right side is stronger than the left side. This side-to-side strength difference may be due to differences in motor control caused by damage to a part of the brain.$Cause_1": { + "spontaneously antigravity but RT > LT$Input5": {} + }, + "Plantar valgus reaction on the left side. This is often a sign of upper motor neurone damage and possibly brain damage.$Cause_1": { + "Plantar response extensor LT.$Input5": {} + } + } + }, + "input1": "L hemiparesis and aphasia\n", + "input2": "The patient is a ___ speaking only ___ yo woman followed by Dr. ___ in clinic), and subsequent seizures who presents as a code stroke. \n\nPer the granddaughter at the bedside she was last known well this morning at around 7:30am. She was sitting in the shower and her daughter was helping her bathe herself when she developed sudden onset LT facial droop, LT sided weakness. Her daughter called EMS who transported her to the ED. Initially was responsive to questions which was not the case on arrival. The patient had an NIHSS as above scoring for LOC, commands, language, and antigravity. She was not unable to exchange information. \n\nNeurologic and General review od systems unable to obtain aspatient apahsic\n", + "input3": "Left hemorrhagic stroke - ___ \nHyperlipidemia \nHypertension \nArthritis \nOsteoperosis \nTorn Right Medial Meniscus ___ \n", + "input4": "No family history of strokes or heart disease. \n", + "input5": "General: ill appearing \nHEENT: NCAT, copious secretions in her mouth \n___: RRR\nPulmonary: CTAB\nAbdomen: Soft\nExtremities: Warm, no edema\n\nNeurologic Examination:\n- Mental Status - Initially Awake, and echolalic which\ndeteriorated into obtounded. \n\n- Cranial Nerves - PERRL 2->1.5 brisk. Corneals present\nbilaterally. No clear BTT. Gag +. LT NLFF.\n\n- Motor - no temor or asterixix moves all extremities\nspontaneously antigravity but RT > LT. Withdraws to noxios stimulation on all extremities.\n\n-DTRs:\n Bi Tri ___ Pat Ach\nL 1 1 1 1 1\nR 1 1 1 1 1\nPlantar response extensor LT.\nDISCHARGE PHYSICAL EXAMINATION :\nLargely unchanged from admision examination. She developed subsequent left arm shaking consistent likely with partial seizure from cortical irritation from hemorrhage. \n", + "input6": "IMAGING: \nNON CONTRAST HEAD CT:\n1. Large mixed attenuation intraparenchymal hemorrhage \ninvolving the medial right frontal lobe with subarachnoid extension along the cingulate sulcus, tracking posteriorly into the region of the posterior corpus callosum. Subarachnoid hemorrhage in in the adjacent bilateral frontal gyri. The hemorrhage measures up to 5.1 cm superiorly and 2.9 cm inferiorly. There is associated 8 mm leftward shift of normally midline structures. \n2. Smaller right frontal intraparenchymal hemorrhage measures 1.3 cm. \n3. The basilar cisterns remain patent at this time. \n4. Mild asymmetry of the left lateral ventricle temporal horn. Close attention on followup examination is recommended to exclude developing hydrocephalus. \n\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/19441468-DS-19.json b/Finished/Stroke/Hemorrhagic Stroke/19441468-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..fa6ad21684effc4806889ad7574b235ad9a7ab72 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/19441468-DS-19.json @@ -0,0 +1,42 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "The CT scan showed left ventricular hemorrhage and rightward shift of brain structures, which was direct imaging evidence of hemorrhagic stroke.$Cause_1": { + "NCHCT showed a left BG IPH (4.6x3.0x4.7cm) and 6mm rightward shift$Input2": {} + }, + "Intraparenchymal hemorrhage with a right-lateralized mass effect of 8.3 mm, direct evidence of hemorrhagic stroke$Cause_1": { + "CT head There is a 5.4 x 3.7 cm intraparenchymal hemorrhage in the left MCA territory with associated rightward mass effect of 8.3 mm.$Input6": {} + }, + "MRI showed an intraparenchymal hematoma in the left basal ganglia region, which was stable in size compared with the previous day, indicating that the bleeding had occurred and may have been contained to some extent.$Cause_1": { + "Left basal ganglia intraparenchymal hematoma is stable in size compared to 1 day ago.$Input6": {} + }, + "MRI also showed multiple foci of slowed diffusion in the left frontal and temporal regions surrounding the hematoma, which may represent acute to subacute infarction.$Cause_1": { + "Several scattered foci of slow diffusion in the left frontal and temporal regions surrounding the hematoma are concerning for acute to subacute infarcts.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "One side of weakness is a common symptom of stroke$Cause_1": { + "right sided weakness$Input1": {} + }, + "A stroke usually causes weakness or paralysis on one side of the body.$Cause_1": { + "right sided arm and leg weakness$Input2": {} + }, + "Hypertension is a major risk factor for hemorrhagic stroke$Cause_1": { + "BP 200/120$Input2": {} + }, + "Facial drooping is a common symptom of stroke$Cause_1": { + "right sided facial droop$Input2": {} + }, + "Hypertension is a major risk factor for hemorrhagic stroke,$Cause_1": { + "Hypertension$Input3": {} + }, + "The patient was intubated and sedated, indicating that he was seriously ill and needed mechanical ventilation to support his breathing. This is common in severe hemorrhagic strokes, especially when the stroke affects vital areas such as the brainstem.$Cause_1": { + "intubated, sedated$Input5": {} + } + } + }, + "input1": "right sided weakness\n", + "input2": " EU Critical ___ aka ___ DOB ___ is a ___ man who was feeling unwell this morning. He went to take a shower, and just after taking his shower he was found to have right sided arm and leg weakness. He was still able to speak at the time. Wife called EMS, and pt was brought to ___. On arrival, BP 200/120 with right sided facial droop and right sided weakness. Blood sugar normal at 102. NCHCT showed a left BG IPH (4.6x3.0x4.7cm) and 6mm rightward shift. He was intubated for airway protection and transferred to ___ for higher level of care. Also received keppra for seizure prophylaxis. \n", + "input3": "Hypertension\nendocarditis ___ years ago\n", + "input4": "no history of stroke\n", + "input5": "___: intubated, sedated\nHEENT: NT, NC, No scleral icterus noted, ETT and OGT in place \nNeck: supple, No JVD noted \nCV: RRR, normal S1, S2, no M/R/G noted \nLungs: diminished at bases \nAbdomen: soft, NT, ND, BS+, no masses or organomegaly noted. \nGU: foley in place, deferred \nExt: No cyanosis, clubbing or edema bilaterally \nSkin: no rashes or lesions noted. \n\nNeuro: (off propofol)\nMS- Minimal EO to voice (with assistance of family), does not follow commands.\nCN- Pupils equal and reactive 3-2mm, + corneals bilat, + gag, + cough, unable to adequately assess EOM, no clear facial droop, although ETT obscuring. Tongue appears midline. \nMotor- \nLUE: moves purposefully, strongly antigravity\nRUE: brief extension to noxious stimuli \nLLE: moves antigravity spontaneously\nRLE: Triple flexion\nPlantar response is upgoing on the right, and down on the left\n\n- Reflexes: \n [Bic] [Tri] [___] [Quad] [Gastroc]\n L 2+ 2+ 2+ 2+ 1\n R 3+ 3+ 3+ 3+ 2 \nPlantar response upgoing on right, down on left\n- Coordination: unable to assess\n- Gait: unable to assess\n", + "input6": "___ 04:25AM BLOOD WBC-6.8 RBC-3.40* Hgb-10.7* Hct-32.5* MCV-96 MCH-31.5 MCHC-32.9 RDW-12.9 RDWSD-45.1 Plt ___\n___ 12:00AM BLOOD WBC-8.0 RBC-3.36* Hgb-10.5* Hct-32.4* MCV-96 MCH-31.3 MCHC-32.4 RDW-13.1 RDWSD-45.7 Plt ___\n___ 04:25AM BLOOD Plt ___\n___ 04:25AM BLOOD ___ PTT-43.8* ___\n___ 01:38PM BLOOD ___ 10:48AM BLOOD Na-150*\n\nIMAGING:\n========\n___ CTA head/neck at 15:23:\nCT head There is a 5.4 x 3.7 cm intraparenchymal hemorrhage in the left MCA territory with associated rightward mass effect of 8.3 mm.\n\n___nd head\nThere is no occlusion of any major intracranial and cervical vasculature Minimal irregularity of the bilateral MCA likely due to minimal atherosclerotic disease. There is no evidence of intracranial aneurysm greater than 3 mm.\n\n___ NCHCT\nThe ___ impression point should read no significant interval change in the left parenchymal hemorrhage with surrounding edema. Unchanged rightward midline shift. Persistent moderate effacement of the left lateral ventricle and 8 mm rightward midline shift. \n\n___ MRI Brain:\n1. Left basal ganglia intraparenchymal hematoma is stable in size compared to 1 day ago. While no definite underlying mass is identified, mass is not excluded on the basis of this examination. Recommend follow-up imaging to resolution. \n2. Several scattered foci of slow diffusion in the left frontal and temporal regions surrounding the hematoma are concerning for acute to subacute infarcts. \n3. Probable edema extension into left cerebral peduncle. \n4. Low lying cerebellar tonsils are similar to before. \n5. Paranasal sinus disease and nonspecific bilateral mastoid fluid, as described. \n\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Hemorrhagic Stroke/stroke_sample1.json b/Finished/Stroke/Hemorrhagic Stroke/stroke_sample1.json new file mode 100644 index 0000000000000000000000000000000000000000..3cf581a5da6fbd516cf875d729ec30ae94a5c2c7 --- /dev/null +++ b/Finished/Stroke/Hemorrhagic Stroke/stroke_sample1.json @@ -0,0 +1,72 @@ +{ + "Hemorrhagic Stroke$Intermedia_3": { + "Intracerebral hemorrhage is a direct diagnostic criterion for hemorrhagic stroke$Cause_1": { + "have cerebellar hemorrhage$Input2": {} + }, + "There was a 10 mm intraparenchymal hemorrhage in the right cerebellar hemisphere, which caused a mild compression effect on the fourth ventricle. Intraparenchymal hemorrhage is a typical manifestation of hemorrhagic stroke.$Cause_1": { + "10 mm intraparenchymal hemorrhage in the right cerebellar hemisphere$Input6": {} + }, + "MRI results showed a large susceptibility artifact in the right cerebellar hemisphere, corresponding to mild hyperintensity on T1-weighted imaging and peripheral hyperintensity on T2/FLAIR, consistent with subacute hemorrhage in the right cerebellar hemisphere seen on previous CT.$Cause_1": { + "large focus of susceptibility artifact in the right cerebellar hemisphere, with corresponding mild intrinsic T1 hyperintensity and peripheral T2/FLAIR hyperintensity, compatible with the known subacute right cerebellar hemorrhage seen in the prior CT$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Left-handed clumsiness may be caused by damage to one side of the brain, often associated with a stroke$Cause_1": { + "Left hand clumsiness$Input1": {} + }, + "Dysarthria is caused by damage to the areas of the brain that control the speech muscles. A stroke can damage these areas, which can affect a person's speech.$Cause_1": { + "Dysarthria$Input1": {} + }, + "Slurred speech is often caused by damage to the area of \u200b\u200bthe brain that controls speech muscles, which is common in strokes. High blood pressure is also a significant risk factor for hemorrhagic strokes.$Cause_1": { + "5-day history of dysarthria in the context of hypertensive urgency, nausea, and vomiting$Input2": {} + }, + "High blood sugar levels indicate that the patient may have diabetes, a risk factor for stroke$Cause_1": { + "blood glucose levels were in the 600s$Input2": {} + }, + "High blood pressure is a risk factor for stroke$Cause_1": { + "blood pressure was 200/80s$Input2": {} + }, + "Speech disorders are a common clinical manifestation of stroke$Cause_1": { + "unable to speak at a normal rate and that his speech is no longer \"very good.$Input2": {} + }, + "Speech disorders are a common clinical manifestation of stroke.$Cause_1": { + "He reports having difficulty both with finding words and with saying them.$Input2": {} + }, + "Numbness and clumsiness in the hands are often related to damage to areas of the brain that control corresponding functions and are common clinical manifestations of stroke.$Cause_1": { + "his left hand has felt more numb and clumsy than usual$Input2": {} + }, + "Diabetes is a risk factor for stroke$Cause_1": { + "nsulin-dependent diabetes$Input3": {} + }, + "High cholesterol may lead to atherosclerosis, a condition in which the walls of arteries become thinner, which may increase the risk of a cerebral blood vessel rupture, potentially causing a hemorrhagic stroke.$Cause_1": { + "hypercholesteremia$Input3": {} + }, + "High blood pressure is the most important risk factor for stroke$Cause_1": { + "HTN$Input3": {} + }, + "Family history of stroke is an important factor$Cause_1": { + "Mother with stroke.$Input4": {} + }, + "High blood pressure is the most important risk factor for stroke.$Cause_1": { + "BP: 168/74$Input5": {} + }, + "Attention deficit disorder may be caused by an impairment in the brain's ability to process information, especially during tasks that require higher cognitive functions, which can be a sign of stroke.$Cause_1": { + "Exhibits difficulty with attention and makes several errors when attempting tasks in reverse order.$Input5": {} + }, + "Slurred speech and dysarthria may indicate damage to the area of \u200b\u200bthe brain that controls speech, which is a common symptom of stroke.$Cause_1": { + "Speech is slurred and dysarthric, displaying a drunken quality with a slightly slow tempo but without halting.$Input5": {} + }, + "Loss of proprioception in certain areas may indicate damage to neural pathways, a sign of a stroke$Cause_1": { + "Decreased proprioception in R toe, intact at ankle$Input5": {} + }, + "Coordination problems may indicate that the cerebellum or other brain areas that control fine motor movements and balance may be affected, a sign of a stroke$Cause_1": { + "Dysmetria observed in FFNF test and clumsiness during complex fine motor movements with the right hand$Input5": {} + } + } + }, + "input1": "Left hand clumsiness, Dysarthria\n", + "input2": "He wa transferred from OSH where he was found to have cerebellar hemorrhage. History obtained from patient and chart. Patient is semi-reliable historian.\n\ufeff\nThe patient is a male who presents with a 5-day history of dysarthria in the context of hypertensive urgency, nausea, and vomiting. According to the transfer summary, he initially presented with abdominal cramping, nausea, vomiting, fatigue, and an inability to tolerate oral intake or medications. His blood glucose levels were in the 600s and his blood pressure was 200/80s. He was administered IV fluids, and his blood glucose levels were stabilized. There was no evidence of diabetic ketoacidosis (DKA) at that time. He was admitted for further evaluation and experienced some coffee-ground emesis, for which an endoscopy was performed, revealing gastritis.\n\ufeff\nOn the 2nd hospital day, the patient noted that since just prior to his previous situation, his speech has been different. He says that he is unable to speak at a normal rate and that his speech is no longer \"very good.\" He reports having difficulty both with finding words and with saying them. Although he occasionally wears dentures, he is usually able to speak well without them, but now he cannot. He cannot provide specific examples of his speech difficulty. According to the transfer note, he confirmed the change in his speech. He states that he has never had difficulty speaking prior to this episode. He also notes that around the time his speech difficulty began, his left hand has felt more numb and clumsy than usual. He normally walks using a cane in his left hand but has had trouble holding the cane.\n\n\n\n\n\n\n\n\n", + "input3": "+ PMH: (Per patient and transfer note)\n+ Hospitalized for hypoglycemia due to high insulin dose.\n+ Insulin-dependent diabetes\n+ chronic renal insufficiency \n+ cataracts\n+ hypercholesteremia\n+ HTN\n", + "input4": "Mother with stroke.\n", + "input5": "Vitals: T: afeb P: 80s R: 16 BP: 168/74 SaO2: >90% RA\nGeneral: Obese man, lying in bed, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, edentulous, MMM, no lesions noted in oropharynx \nNeck: Supple, No nuchal rigidity \nAbdomen: obese, NT/ND\nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses bilaterally. \nSkin: no rashes or lesions noted.\n \nNeurologic: \nMental Status: Patient is alert and oriented to their name. Exhibits difficulty with attention and makes several errors when attempting tasks in reverse order. Speech is slurred and dysarthric, displaying a drunken quality with a slightly slow tempo but without halting. Language remains fluent with intact repetition and comprehension abilities. No paraphasic errors were observed. The patient could name common objects such as a pen, shirt, and button, but had difficulty naming a collar. The patient was able to follow commands involving both midline and appendicular movements. No evidence of apraxia or neglect was noted.\n\ufeff\n--Motor: Wasting of intrinsic muscles of the right hand. Mild pronator drift in the right arm. No adventitious movements, such as tremor, noted. No asterixis noted.\n\n-Sensory: Decreased proprioception in R toe, intact at ankle. Intact proprioception L toe.\n \nPlantar response was up on L, mute on R.\n \n-Coordination: Dysmetria observed in FFNF test and clumsiness during complex fine motor movements with the right hand. Additionally, dysmetria noted with right foot tapping on the knee and HTS test. The left hand shows mild discoordination but intact FNF and HTS.\n \n-Gait: Deferred.\n", + "input6": "10:06PM CHLORIDE-106 TOTAL CO2-21* ANION GAP-15 GLUCOSE-211* UREA N-24* CREAT-1.6* SODIUM-138 POTASSIUM-3.6\n10:06PM estGFR-Using this\n10:06PM CALCIUM-8.8 PHOSPHATE-2.7 MAGNESIUM-1.8\n10:06PM NEUTS-72.7* MONOS-5.0 EOS-2.0 BASOS-0.4\n10:06PM PLT COUNT-243\n\ufeff\n1. 10 mm intraparenchymal hemorrhage in the right cerebellar hemisphere exerting mild mass effect on the fourth ventricle. The differential diagnosis includes the presence of a hemorrhagic mass (primary or metastatic), an underlying vascular malformation, or a hypertensive hemorrhage. Although this location is typical for hypertensive hemorrhage, other causes must be ruled out.\n\n\ufeff\nCXR :\nFINDINGS: Mild cardiomegaly. No pulmonary edema. No pneumonia, no pleural effusions. No pneumothorax. \n\ufeff\nMRI brain:\nFINDINGS: There is a large focus of susceptibility artifact in the right cerebellar hemisphere, with corresponding mild intrinsic T1 hyperintensity and peripheral T2/FLAIR hyperintensity, compatible with the known subacute right cerebellar hemorrhage seen in the prior CT. There is no evidence of acute infarction.\n\nThe corpus callosum is absent, leading to an abnormal parallel configuration of the lateral ventricles. The occipital horns are substantially enlarged, while the frontal horns are disproportionately small, indicating colpocephaly. The third ventricle is also dilated.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/11452808-DS-20.json b/Finished/Stroke/Ischemic Stroke/11452808-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..5a8fb1e9091177a9e81fbd326b713e83f630ab05 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/11452808-DS-20.json @@ -0,0 +1,51 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "Narrowing of the internal arteries increases the risk of insufficient blood flow to the brain, possibly leading to stroke$Cause_1": { + "CTA was most notable for distal left ICA stenosis$Input2": {} + }, + "Narrowing of the vertebral artery, which supplies part of the brainstem and cerebellum, can significantly increase the risk of stroke.$Cause_1": { + "moderate to severe focal stenosis of left vertebral artery$Input2": {} + }, + "The patient had an ischemic infarction of the right cerebellum with associated edema and compression of the fourth ventricle. This is a direct manifestation of ischemic stroke.$Cause_1": { + "Subacute right cerebellar infarct with associated edema and effacement of the fourth ventricle.$Input6": {} + }, + "There are abnormalities in the function of the heart valves. Long-term valve disease increases the risk of atrial fibrillation, which may lead to the formation of blood clots that may break off and become the source of embolism.$Cause_1": { + "Trivial mitral regurgitation is seen$Input6": {} + }, + "Aortic stenosis is a diagnostic criterion for ischemic stroke$Cause_1": { + "The aortic valve leaflets (3) are thickened over 1.2mm.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Feeling dizzy and your surroundings spinning, which are typical symptoms of a stroke$Cause_1": { + "the patient became dizzy and the room was spinning when he arose from sitting$Input2": {} + }, + "Headaches around the eyes are a classic symptom of stroke$Cause_1": { + "a right frontal headache located primarily behind his eye$Input2": {} + }, + "Dizzy, nausea and vomiting are symptoms of stroke$Cause_1": { + "he again felt dizzy (room spinning),became nauseated and vomited$Input2": {} + }, + "Headaches, especially intermittent headaches that occur in the back of the skull, may be related to insufficient blood supply to the brain or vascular disease$Cause_1": { + "he complains of an intermittent headache located in the posterior (occipital) area$Input2": {} + }, + "High cholesterol is a risk factor for stroke.$Cause_1": { + "he had high cholesterol$Input3": {} + }, + "A family history of stroke is a risk factor$Cause_1": { + "father died of stroke$Input4": {} + }, + "The patient has high blood pressure, a major risk factor for stroke$Cause_1": { + "BP: 169/79$Input5": {} + }, + "Higher than normal cholesterol levels increase the risk of atherosclerosis, one of the main factors leading to ischemic stroke.$Cause_1": { + "LDLcalc-144$Input6": {} + } + } + }, + "input1": "dizzyness\n", + "input2": "He is a pleasant male with no significant past medical history. On evening, the patient became dizzy and the room was spinning when he arose from sitting. he described a right frontal headache located primarily behind his eye. He didn't think much of it and went to bed. On the following morning, the patient ate breakfast and felt fairly normal. Shortly thereafter, he again felt dizzy (room spinning),became nauseated and vomited. He laid down on the floor to try and relax. Because the patient didn't feel better, he called his son to take him to hospital. Since that time, he complains of an intermittent headache located in the posterior (occipital) area.\n\ufeff\nthe patient initially underwent a non-contrast CT and CTA. CT was a normal study and CTA was most notable for distal left ICA stenosis and moderate to severe focal stenosis of left vertebral artery. \n\ufeff\nToday, the patient was being transported to radiology for a MRI study. While in transit, the patient became clammy and dizzy and didn't feel well enough to sit through the exam. Instead, he underwent a repeat non-contrast CT which revealed a right cerebellar infarct with effacement of the fourth ventricle. As a result, arrangements were made to send the patient to a hospital department for neurosurgical evaluation.\n", + "input3": "None. \nPatient thinks he had high cholesterol, but was controlling it via diet per PCP.\n", + "input4": "Mother had hypertension and diabetes, father died of stroke.\n", + "input5": "Exam on Admission\nO: T: 98.4 HR 80 BP: 169/79 RR 22 O2 Sat 95% on room air\nGen: WD/WN, comfortable, NAD. \nHEENT: PERRL, EOMs intact.\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal affect.\nOrientation: Oriented to person, place, and date.\nLanguage: Speech fluent with good comprehension and repetition.\nNaming intact. No dysarthria.\n\ufeff\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, to mm bilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without nystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\ufeff\nMotor: Normal bulk and tone bilaterally. No abnormal movements, tremors. Strength full power throughout. No pronator drift.\n\ufeff\nSensation: Intact to light touch. \n\ufeff\nCoordination: normal on finger-nose-finger.\n\ufeff\nRight handed.\n", + "input6": "ECHO\nThe left atrium is normal in size. No thrombus/mass is seen in the body of the left atrium. No atrial septal defect is seen by 2D or color Doppler. There is mild (non-obstructive) focal hypertrophy of the basal septum ( in some views it appears as an aberrant papillary muscle insertion at the basal septum). The left ventricular cavity size is normal. Regional left ventricular wall motion is normal. Overall left ventricular systolic function is normal (LVEF>55%). No masses or thrombi are seen in the left ventricle. There is no ventricular septal defect. Right ventricular chamber size and free wall motion are normal. The aortic valve leaflets (3) are thickened over 1.2mm. No masses or vegetations are seen on the aortic valve. No aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. No mass or vegetation is seen on the mitral valve. Trivial mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \n\ufeff\nNCHCT\nOverall stable appearance of right cerebellar infarct and resultant effacement of the fourth ventricle. \n\ufeff\nCXR\nNo relevant change as compared to the previous EXAMINATION:. Normal size of the cardiac silhouette. Normal hilar and mediastinal structures. Mild elongation of the descending aorta. \n\ufeff\nMR\nIMPRESSION: \n1. No evidence of acute intracranial hemorrhage. \n2. Subacute right cerebellar infarct with associated edema and effacement of the fourth ventricle. The third ventricle and lateral ventricles are stable in size. \n\n\ufeff\n04:42AM BLOOD %HbA1c-5.5 eAG-111\n04:42AM BLOOD Triglyc-76 HDL-72 CHOL/HD-3.2 LDLcalc-144*\n09:30PM BLOOD TSH-0.98\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/11790430-DS-20.json b/Finished/Stroke/Ischemic Stroke/11790430-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..bb56dfb5cb6927b1bda37b8fe2458786f64ef411 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/11790430-DS-20.json @@ -0,0 +1,60 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "Global brain atrophy and small vessel ischemic lesions, which are one of the conditions for the diagnosis of ischemic stroke$Cause_1": { + "There is global atrophy and moderately extensive small vessel ischemic disease.$Input6": {} + }, + "The patient suffered a subacute cerebral infarction$Cause_1": { + "Subacute infarct involving portions of right internal capsule and right inferior basal ganglia.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "When a stroke affects the part of the brain that controls speech and mouth movements, it can cause patients to speak unclearly or slurred speech$Cause_1": { + "Slurred speech$Input1": {} + }, + "Stroke may cause facial muscle weakness$Cause_1": { + "L facial droop$Input1": {} + }, + "Stroke may cause loss of muscle control$Cause_1": { + "L arm weakness$Input1": {} + }, + "Age is an important risk factor for stroke$Cause_1": { + "70 year old$Input2": {} + }, + "High blood pressure and a history of Parkinson's disease increase stroke risk$Cause_1": { + "history of HTN and Parkinsonism$Input2": {} + }, + "Trying to stand but being unable to do so on your own may indicate that your body's coordination or muscle control may be affected$Cause_1": { + "He also wanted to stand up, but could not do it on his own$Input2": {} + }, + "The language is ambiguous. This is a warning sign of a stroke and indicates possible damage to the areas of the brain that control language function.$Cause_1": { + "developed slurred speech while sitting on the porch$Input2": {} + }, + "The patient's speech function is affected, which is one of the common manifestations of stroke$Cause_1": { + "Speech was dysarthric and hypophonic.$Input5": {} + }, + "Partial paralysis of facial muscles, a classic sign of a stroke$Cause_1": { + "Prominent left nasolabial fold flattening.$Input5": {} + }, + "Patients have significant motor control impairment, which may be due to damage to certain parts of the brain, such as the basal ganglia.$Cause_1": { + "Increased tone in lower>upper extremities. Cogwheeling with facilitation, L>R. Pronation and drift on left upper extremity.$Input5": {} + }, + "Damage to areas of the brain that process sensory input$Cause_1": { + "Decreased sensation to pin prick distally in LEs to mid shin.$Input5": {} + }, + "Atherosclerotic lesions are one of the major risk factors for stroke$Cause_1": { + "Atherosclerotic disease$Input6": {} + }, + "Atrial enlargement, especially significant right atrial enlargement, increases the risk of cardioembolic stroke$Cause_1": { + "The right atrium is markedly dilated$Input6": {} + }, + "The patient has diabetes, an important risk factor for stroke$Cause_1": { + "eAG-140$Input6": {} + } + } + }, + "input1": "Slurred speech, L facial droop, L arm weakness\n", + "input2": "He is an 70 year old right handed man with history of HTN and Parkinsonism, who is transferred from OSH or further evaluation of dysarthria, left facial drop and left sided weakness. Pt was in his usual state of health today. At around 5pm, he developed slurred speech while sitting on the porch. Denies any word finding difficulty, comprehension was intact. He also wanted to stand up, but could not do it on his own, so he asked his wife to help him. Pt denies any new onset focal weakness at that time. his wife was unable to help him stand up on her own, so she called a neighbor to help. She also noticed that the left side of his face was droopy. When the neighbor came over, they said that He should be immediately take to a hospital for an MRI. So, wife and neighbor drove patient at the hospital. Before leaving, she gave him Aspirin 325mg because she had heard in the past. There, a non contrast head CT was obtained which showed diffuse atrophy, white matter disease, but no hemorrhage or acute infarct. He was transferred to hospital for further evaluation. \n\ufeff\nPer wife, at baseline, He has gait instability and walks with a walker. Wife is his primary caretaker. She states that his left leg is always a little bit weaker than the right and he moves it less for her when she puts on his socks. Pt is not seen by a neurologist because he does not want to take the \"dopa medicine\" per his wife. Apparently, pt's mother in law had terrible side effects from sinemet, so wife does not want He to have to experience that.\n\ufeff\nOn neuro ROS, the pt denies headache, loss of vision, blurred vision, diplopia, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denies difficulties comprehending speech. Denies focal weakness, numbness, parasthesiae. No bowel or bladder incontinence or retention. Denies difficulty with gait.\n \nOn general review of systems, the pt denies recent fever or chills. No night sweats or recent weight loss or gain. Denies cough, shortness of breath. Denies chest pain or tightness, palpitations. Denies nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. \nNo dysuria. Denies arthralgias or myalgias. Denies rash.\n", + "input3": "+ HTN\n+ Parkinsonism, not on meds for PD\n+ GERD\n", + "input4": "No history of seizures\n", + "input5": "Physical Exam:\nVitals: T 98.2 BP 126/60 HR 56 RR 14 O2 96 RA\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, masked facies\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity\nPulmonary: CTABL\nCardiac: RRR, no murmurs\nAbdomen: soft, nontender, nondistended\nExtremities: no edema, pulses palpated\nSkin: no rashes or lesions noted.\n \nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history somewhat, but with difficulty, does not know what meds he is not, not sure if he sees a neurologist. Attentive, able to name backward without difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency objects. Speech was dysarthric and hypophonic. Able to follow both midline and appendicular commands. Pt. was able to register 3 objects and recall at 5 minutes when given options. There was no evidence of apraxia.\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk. VFF to confrontation. \nIII, IV, VI: EOMI (except mildly limited upgaze) without nystagmus. Saccadic intrusions.\nV: Facial sensation intact to light touch.\nVII: Prominent left nasolabial fold flattening.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n-Motor: Normal bulk throughout. Increased tone in lower>upper extremities. Cogwheeling with facilitation, L>R. Pronation and drift on left upper extremity.\nNo adventitious movements, such as tremor, noted. No asterixis noted.\n\ufeff\n-Sensory: No deficits to light touch, cold sensation. Decreased vibratory sense at halluxes and ankles. Decreased sensation to pin prick distally in LEs to mid shin. Extinction to DSS on left.\n-DTRs:\nBi Tri xx Pat Ach\nL 2 2 2 2 0\nR 2 2 2 2 0\nPlantar response was mute bilaterally.\n-Coordination: No intention tremor, no dysdiadochokinesia noted. \nNo dysmetria on FNF or HKS bilaterally.\n-Gait: Good initiation. Narrow-based, normal stride and arm swing. Able to walk in tandem without difficulty. Romberg absent.\n", + "input6": "ADMISSION LABS\n09:15AM CHOLEST-153\n09:15AM %HbA1c-6.5* eAG-140*\n09:15AM TRIGLYCER-49 HDL CHOL-42 CHOL/HDL-3.6 LDL(CALC)-101\n03:00AM URINE COLOR-Yellow APPEAR-Clear \n03:00AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG\n11:26PM GLUCOSE-203* UREA N-16 CREAT-0.9 SODIUM-140 POTASSIUM-4.0 CHLORIDE-102 TOTAL CO2-28 ANION GAP-14\n11:26PM estGFR-Using this\n11:26PM ALT(SGPT)-13 AST(SGOT)-18 ALK PHOS-67 TOT BILI-0.3\n11:26PM LIPASE-27\n11:26PM ALBUMIN-4.0\n11:26PM WBC-11.5* RBC-4.73 HGB-14.8 HCT-41.9 MCV-89 MCH-31.2 MCHC-35.2* RDW-12.8\n11:26PM NEUTS-79.4* LYMPHS-11.7* MONOS-6.0 EOS-2.2 BASOS-0.6\n11:26PM PLT COUNT-265\n\ufeff\n09:15AM %HbA1c-6.5* eAG-140*\n\ufeff\nNCHCT, CTA Head and Neck\n1. No intracranial hemorrhage or mass effect. There is global atrophy and moderately extensive small vessel ischemic disease. \n2. No evidence for arterial dissection, occlusion or hemodynamically significant stenosis. Atherosclerotic disease. \n\ufeff\nMRI - prelim\nSubacute infarct involving portions of right internal capsule and right inferior basal ganglia. No intracranial hemorrhage. Atrophy and small vessel ischemic disease. \n \nECHO: The left atrium is mildly dilated. The right atrium is markedly dilated. Left ventricular wall thicknesses are normal. The left ventricular cavity size is normal. There is a very small apical left ventricular aneurysm (vs pseudoaneurysm) without evidence of intracavity thrombus. Overall left ventricular systolic function is normal (LVEF 70%). The right ventricular free wall thickness is normal. Right ventricular chamber size is normal. with borderline normal free wall function. The aortic root is mildly dilated at the sinus level. The aortic valve leaflets are mildly thickened (?#). The aortic valve is not well seen. There is a minimally increased gradient consistent with minimal aortic valve stenosis. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. No atrial septal defect seen on saline contrast injection with maneuvers. \n\ufeff\n05:30AM BLOOD WBC-9.3 RBC-4.70 Hgb-14.5 Hct-42.4 MCV-90 \nMCH-30.9 MCHC-34.3 RDW-12.6\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/11800237-DS-4.json b/Finished/Stroke/Ischemic Stroke/11800237-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..936fd6484f8f90d2393df4affd86b2be4d7138f2 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/11800237-DS-4.json @@ -0,0 +1,45 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "Brain tissue in this area is damaged due to insufficient blood flow, which is a typical imaging manifestation of ischemic stroke.$Cause_1": { + "Scans showing ischemic damage to brain tissue. In DWI sequences, areas appear as hyperintense (bright white)$Input6": {} + }, + "Indicates significant arteriosclerosis. This is a risk factor for ischemic stroke$Cause_1": { + "Carotid artery intima-media thickness \u22651.0 mm$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Slurred speech is a common symptom of stroke$Cause_1": { + "Slurred speech$Input1": {} + }, + "Speech impairment may indicate impaired function in language-processing areas of the brain, one of the classic symptoms of stroke$Cause_1": { + "difficulty with word-finding since waking up$Input2": {} + }, + "Speech pauses are characteristic of aphasia and are common in stroke patients$Cause_1": { + "other people described her speech as \"halting\" she felt as if she got \"stuck.\"$Input2": {} + }, + "Word errors are characteristic of aphasia and are common in stroke patients$Cause_1": { + "using the wrong words for things$Input2": {} + }, + "Hyperlipidemia is a risk factor for stroke$Cause_1": { + "Triglyc-290$Input6": {} + }, + "High blood pressure is a risk factor for stroke$Cause_1": { + "hypertension$Input3": {} + }, + "It may be that the area of the brain that controls eye movements is affected after a stroke.$Cause_1": { + "EOMI with a few beats bilateral end-gaze nystagmus.$Input5": {} + }, + "Incoherent speech, with occasional phonological and semantic errors, may be signs of a stroke causing dysfunction in certain parts of the brain.$Cause_1": { + "Minimally inattentive, one error with serial subtraction of threes from twenty. Speech fluency is reduced, with occasional pauses. Speech is somewhat telegraphic. Occasional paraphasic errors (both phonemic and semantic).$Input5": {} + }, + "High blood pressure is an important risk factor for stroke$Cause_1": { + "BP: 136-170/57-71$Input5": {} + } + } + }, + "input1": "Slurred speech\n", + "input2": "She is a R-handed woman with history of HTN, HLD who presents with difficulty with word-finding since waking up the morning. She woke up around 0800 and felt 'funny'. Her mouth was 'full of saliva' and she states this was unusual. She didn't speak with anyone at that time. Over the course of the day other people described her speech as \"halting\" she felt as if she got \"stuck.\" She also kept using the wrong words for things, such as substituting \"wires\" for weather. She eventually presented to the ED that evening as She reported these same language difficulties in her native language. She had no other difficulties including no dysphagia, no dysarthria, no weakness/numbness, no difficulty walking, no difficulty driving. In fact, her son got lost driving her to the hospital, but a person was able to correct this and navigate them to the hospital. She was at her baseline over the preceding days and the only thing out of the ordinary was having 2 glasses of wine the night before and going to bed later than usual, around 0100.\n", + "input3": "+ Hyperlipidemia \n+ hypertension\n", + "input4": "Mother - HLD\nFather d. - HTN, d. of leukemia\nMaternal aunt with cerebral aneurysm\nFour sons, all healthy.\n", + "input5": "ON ARRIVAL: \n===========\n\ufeff\nPHYSICAL EXAMINATION\nVitals: T: 98.3 HR: BP: 136-170/57-71 RR: SaO2: 100%RA\nGeneral: Awake, cooperative, NAD.\nHEENT: no scleral icterus, MMM, no oropharyngeal lesions. \nPulmonary: Breathing comfortably, no tachypnea nor increased WOB\nCardiac: Skin warm, well-perfused. \nAbdomen: soft, ND\nExtremities: Symmetric, no edema. \n\ufeff\nNeurologic Examination:\n- Mental status: Awake, alert, oriented x 3. Able to relate history without difficulty. Minimally inattentive, one error with serial subtraction of threes from twenty. Speech fluency is reduced, with occasional pauses. Speech is somewhat telegraphic. Occasional paraphasic errors (both phonemic and semantic). Names glove, chair, key. Calls cactus a plant, calls feather a \"life\", calls hammock a 'balance'. Able to follow most commands but not reverse order or cross-body commands. Delayed recall spontaneously, unable to get third word with CC nor MC. No evidence of hemineglect. \n\ufeff\n-Cranial Nerves: PERRL 3->2. VFF to confrontation. EOMI with a few beats bilateral end-gaze nystagmus. Facial sensation intact to light touch. Face symmetric at rest and with activation.Hearing intact to conversation. Palate elevates symmetrically. strength in trapezii bilaterally. Tongue protrudes in \nmidline and moves briskly to each side. No dysarthria. \n\ufeff\n- Motor: Normal bulk and tone. No drift. No tremor nor asterixis.\n \n*pain limitation from chronic shoulder pain\n\ufeff\n-DTRs:\nxx Pat Ach Pec jerk Crossed Abductors\nL 2 2 2 2 tr \nR 2 2 2 2 tr \nPlantar response was flexor bilaterally.\n\ufeff\n-Sensory: Intact to LT, temp throughout. \n\ufeff\n- Coordination: No dysmetria with finger to nose testing bilaterally. \n\ufeff\n- Gait: Normal initiation. Narrow base. Normal stride length and arm swing. Stable without sway. Negative Romberg. Able to perform at least 5 steps of tandem gait.\n", + "input6": "05:20AM BLOOD WBC-6.4 RBC-4.05 Hgb-12.1 Hct-36.8 MCV-91 MCH-29.9 MCHC-32.9 RDW-12.9 RDWSD-42.9\n10:44PM BLOOD Neuts-49.4 Monos-8.5 Eos-1.4 Baso-0.6 AbsNeut-4.26 AbsLymp-3.44 AbsMono-0.73 \nAbsEos-0.12 AbsBaso-0.05\n04:50PM BLOOD AT-95\n06:38AM BLOOD ProtCFn-139 ProtSFn-130\n06:38AM BLOOD Lupus-NOTDETECTE dRVVT-S-0.86 SCT-S-0.79\n05:20AM BLOOD Glucose-98 UreaN-17 Creat-0.8 Na-143 \nK-4.5 Cl-106 HCO3-24 AnGap-13\n06:25AM BLOOD ALT-23 AST-23 AlkPhos-67 TotBili-0.4\n08:09PM BLOOD Lipase-23\n05:20AM BLOOD Calcium-8.9 Phos-3.9 Mg-2.1\n08:09PM BLOOD %HbA1c-6.0 eAG-126\n08:09PM BLOOD Triglyc-290* HDL-68 CHOL/HD-4.7 \nLDLcalc-194*\n08:09PM BLOOD TSH-2.5\n08:09PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nTricycl-NEG\n\nMRI:\nScans showing ischemic damage to brain tissue. In DWI sequences, areas appear as hyperintense (bright white)\n\nCT:\n\nEcho:\nCarotid artery intima-media thickness \u22651.0 mm\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/11853860-DS-23.json b/Finished/Stroke/Ischemic Stroke/11853860-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..dda5a896197bbc9392cf751a6c45a051ba075fd3 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/11853860-DS-23.json @@ -0,0 +1,51 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "Damage to the midbrain peduncles may affect the body's motor and sensory functions, which is one of the typical consequences of ischemic stroke.$Cause_1": { + "Evolution of a chronic infarct is re- demonstrated on the right middle cerebral peduncle.$Input6": {} + }, + "When an ischemic stroke occurs, reduced blood flow to the brain results in a lack of oxygen and nutrients to the brain tissue, which may show up on imaging as slowed diffusion. Additionally, the report mentioned that there was no evidence of mass effect or hemorrhagic transformation, which could help rule out other conditions such as cerebral hemorrhage.$Cause_1": { + "New area of slow diffusion identified in the left thalamus as described above, suggestive of acute/subacute ischemic change, there is no evidence of mass effect or hemorrhagic transformation$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Sudden numbness or weakness on one side of the body, which is a symptom of stroke$Cause_1": { + "R sides numbness of face, arm, torso and leg.$Input1": {} + }, + "Slurred speech and loss of balance are typical symptoms of stroke$Cause_1": { + "The patient was first admitted with slurred speech and imbalance.$Input2": {} + }, + "Abnormalities may be due to damage to areas of the brain responsible for sensation$Cause_1": { + "patient woke with numbness on right outer leg, entire right foot, entire right arm, hand, neck and right face and scalp. +pins and needles.$Input2": {} + }, + "Consider the possibility of CADASIL (a hereditary stroke syndrome), pseudoxanthoma elastomer, or COL4 A1 gene mutations. These conditions can increase the risk of stroke.$Cause_1": { + "MRI showed extensive white matter disease so on follow up visit with Dr. was consideration of CADASIL, pseudoxanthoma elasticum or COL4 A1 mutation.$Input2": {} + }, + "History of cerebrovascular disease, which is an important risk factor for stroke.$Cause_1": { + "history of lacunar infarct$Input2": {} + }, + "a definite symptom of stroke$Cause_1": { + "Thalamic infarct$Input3": {} + }, + "Long-term insomnia may indirectly increase the risk of stroke$Cause_1": { + "Insomnia$Input3": {} + }, + "Depression linked to cardiovascular disease, may indirectly increase stroke risk$Cause_1": { + "Depression$Input3": {} + }, + "This symptom may indicate a problem with an area of the brain that controls movement and is common in people who have had a stroke.$Cause_1": { + "Upgoing pronator drift\non right$Input5": {} + }, + "Hypoesthesia is often associated with damage to sensory areas of the brain, which is common after a stroke.$Cause_1": { + "Decreased pin (85%) over right foot, right leg, entire right hand and arm, right shoulder and upper chest, neck$Input5": {} + }, + "May be the result of a stroke that damaged part of the brain$Cause_1": { + "Facial sensation decreased on the right to light touch and pin$Input5": {} + } + } + }, + "input1": "R sides numbness of face, arm, torso and leg.\n", + "input2": "This is a old right handed man with a history of lacunar infarct and remote melanoma who presents with right sided numbness since waking this morning.\n\ufeff\nThe patient was first admitted with slurred speech and imbalance. He was found to have infarcts in the right thalamus and middle cerebellar peduncle. Vessel imaging, echo, LP and hypercoagulable work up was unrevealing. MRI showed extensive white matter disease so on follow up visit with Dr. was consideration of CADASIL, pseudoxanthoma elasticum or COL4 A1 mutation. He was placed on aspirin. \n\ufeff\nHe has been having low back pain for the past week. Thinks that he pulled it but it is not getting better. Using oxycontin from PCP. NO urinary or bowel changes, no saddle anesthesia, no weakness.\n\ufeff\nThis morning the patient woke with numbness on right outer leg, entire right foot, entire right arm, hand, neck and right face and scalp. +pins and needles. Symptoms have persisted without change through the day. This has never happened before. No weakness, no vision changes, no balance problems, no gait changes. + hiccups for the past few days.\n \nOn neuro ROS, the pt denies headache, loss of vision, blurred vision, diplopia, dysarthria, dysphagia, lightheadedness, vertigo, tinnitus or hearing difficulty. Denies difficulties producing or comprehending speech. Denies focal weakness. No bowel or bladder incontinence or retention. Denies difficulty\nwith gait. \n \nOn general review of systems, the pt denies recent fever or chills. No night sweats or recent weight loss or gain. Denies cough, shortness of breath. Denies chest pain or tightness, palpitations. Denies nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denies arthralgias or myalgias. Denies rash.\n", + "input3": "+ Insomnia \n+ Depression \n+ melanoma s/p resection\n+ Thalamic infarct\n", + "input4": "Brother with MI, dad with MI. Mom with CABG, DM.\n", + "input5": "Physical Exam: \nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx \nNeck: Supple, No nuchal rigidity \nPulmonary: Lungs CTA bilaterally \nCardiac: RRR, nl. S1S2 \nExtremities: No edema\nBack: tenderness over right lumbar paraspinals\n \nNeurologic: \n-Mental Status: Alert, oriented x 3. Able to relate history without difficulty. Mildly inattentive, able to name backward with some difficulty. Language is fluent with intact repetition and comprehension. Normal prosody. There were no paraphasic errors. Pt. was able to name both high and low frequency \nobjects. Able to read without difficulty. Speech was not dysarthric. Able to follow both midline and appendicular commands. The pt. had good knowledge of current events. There was no evidence of neglect. \n \n-Cranial Nerves: \nII: PERRL 3 to 2mm and brisk. VFF to confrontation. \nIII, IV, VI: EOMI without nystagmus. Normal saccades. \nV: Facial sensation decreased on the right to light touch and pin. Reports decrease vibration on the right.\nVII: No facial droop, facial musculature symmetric. \nVIII: Hearing intact to finger-rub bilaterally. \nIX, X: Palate elevates symmetrically. \nXI: strength in trapezii and SCM bilaterally. \nXII: Tongue protrudes in midline with normal strength \n \n-Motor: Normal bulk, tone throughout. Upgoing pronator drift\non right . \nNo adventitious movements, such as tremor, noted. \n\ufeff\n \n-Sensory: Decreased pin (85%) over right foot, right leg, entire right hand and arm, right shoulder and upper chest, neck. JPS and vibration intact at the great toes. Graphesthesia intact b/l.\n \n-DTRs: \nPlantar response was flexor bilaterally. \n \n-Coordination: No intention tremor, no dysdiadochokinesia noted.\nNo dysmetria on FNF or HKS bilaterally. \n \n-Gait: Good initiation. Narrow-based, normal stride and arm swing. Able to walk in tandem without difficulty. Romberg absent.\n", + "input6": "06:35AM BLOOD Glucose-92 UreaN-14 Creat-0.9 Na-138 K-5.0 Cl-101 HCO3-29 AnGap-13\n06:35AM BLOOD %HbA1c-5.3 eAG-105\n06:35AM BLOOD Triglyc-66 HDL-51 CHOL/HD-2.3 LDLcalc-55\n03:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\ufeff\nMRI Head, MRA Head and Neck: IMPRESSION: 1. New area of slow diffusion identified in the left thalamus as described above, suggestive of acute/subacute ischemic change, there is no evidence of mass effect or hemorrhagic transformation. Evolution of a chronic infarct is re- demonstrated on the right middle cerebral peduncle. 2. Normal MRA of the head and neck, with no evidence of flow stenotic lesions or aneurysms. \n\ufeff\nMRI L Spine: IMPRESSION: 1. Multilevel multifactorial degenerative changes throughout the lumbar spine, more significant from L2/L3 through L5/S1 levels. 2. Annular tear is identified at L4/L5 with pattern of enhancement. \n\ufeff\nEchocardiogram: \nIMPRESSION: Suboptimal image quality. Normal biventricular chamber size and systolic function. While no cardiac source of embolism was identified, given the poor image quality on this study, a TEE or alternate imaging modality would be needed to more definitively exclude intracardiac mass or thrombus. \n\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/11875736-DS-6.json b/Finished/Stroke/Ischemic Stroke/11875736-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..0b342479e231d461fe3bf2233b1654bb2cb04006 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/11875736-DS-6.json @@ -0,0 +1,54 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "Severe arterial narrowing and blockage are direct risk factors for stroke because they can lead to reduced blood flow to the brain, potentially leading to infarction$Cause_1": { + "near-complete occlusion of the right PCA (as well as moderate stenosis of the distal right M2 and distal right CCA)$Input2": {} + }, + "Suspected Stroke$Intermedia_2": { + "Stroke may cause dizziness$Cause_1": { + "dizziness$Input1": {} + }, + "Stroke can cause visual field loss$Cause_1": { + "visual field defects$Input1": {} + }, + "Loss of vision due to stroke$Cause_1": { + "residual left superior temporal quadrantanopia$Input2": {} + }, + "Affects the visual field on the same side of both eyes, often associated with strokes that affect the occipital lobe or other brain areas that process visual input$Cause_1": { + "admission neuro exam notable for left homonymous hemianopia$Input2": {} + }, + "It may be linked to brain abnormalities caused by stroke$Cause_1": { + "vertigo and \"shadow-like\" hallucinations$Input2": {} + }, + "Previous stroke significantly increases risk of subsequent stroke$Cause_1": { + "PCA territory infarct$Input2": {} + }, + "Diabetes may increase the risk of stroke$Cause_1": { + "A1c 5.8%$Input2": {} + }, + "Any level of LDL cholesterol may increase the risk of stroke$Cause_1": { + "LDL 60$Input2": {} + }, + "High blood pressure is a major risk factor for stroke$Cause_1": { + "HYPERTENSION$Input3": {} + }, + "clear symptoms of stroke$Cause_1": { + "R PCA TERRITORY INFARCT (chronic R PCA occlusion)$Input3": {} + }, + "Is a loss of visual field that is common in damage to certain areas of the brain after a stroke$Cause_1": { + "VF with left homonymous hemianopia$Input5": {} + }, + "The presence of non-fatigue horizontal nystagmus indicates impairment of brainstem or cerebellar function and is sometimes seen in stroke patients.$Cause_1": { + "EOMI, non-fatiguable horizontal nystagmus on left gaze, fast phase to left$Input5": {} + }, + "High blood pressure, an important risk factor for stroke$Cause_1": { + "167/84$Input5": {} + } + } + }, + "input1": "dizziness, visual field defects\n", + "input2": "female with right PCA territory infarct with residual left superior temporal quadrantanopia, dementia and anxiety who presents with acute worsening of her chronic dizziness.\n\ufeff\nHistory obtained with aid of interpreter, but is limited given tangential thought content and significant anxiety. Other history obtained from chart review.\n\ufeff\nPatient was hospitalized after presenting with vertigo and \"shadow-like\" hallucinations and was found to have near-complete occlusion of the right PCA (as well as moderate stenosis of the distal right M2 and distal right CCA) complicated by acute right PCA territory infarcts (right occipital lone, posterior temporal lobe) with admission neuro exam notable for left homonymous hemianopia but residual deficits were only a left superior temporal quadrantanopia.Work-up at that time, no thrombus. A1c 5.8% and LDL 60. she was ordered for cardiac monitoring and Rx aspirin 81 mg daily in addition to her atorvastatin 20 mg daily.\nSince her discharge she has had chronic dizziness (lasting the whole day with some lightheaded sensation, blurred vision) and vertigo at times (seems to come when lying down and resting). \nShe reported that her dizziness was worsened by taking all of her medications including her aspirin, losartan, amlodipine and memantine. In the meantime, her PCP reportedly told her to stop taking her losartan given dizziness. \n\ufeff\nShe saw Dr. who recommended cardiac monitoring because she had not had this done, encouraged aspirin compliance and recommended stopping memantine given ongoing dizziness. \n\ufeff\nShe then presented to the ED for ongoing dizziness and anxiety at which time she had unremarkable labs, utox, stox. Psych consulted and recommended melatonin and trazodone. Neurology was not consulted. She was scheduled to follow-up with her PCP for evaluation of her dizziness. \n\ufeff\nshe has had continued dizziness which is worsened by trazodone. She has had ongoing insomnia and has not been able to sleep except for a few hours at time. She reports a lot of anxiety regarding sleep and her health problems. \"Please do not give me more bad news\". She reports that all of her problems started when she learned her daughter was moving back to japan five months ago and \"I have cried everyday since then\". \n\ufeff\nSeveral days ago she felt that her aspirin was making he extremely anxious so she stopped taking it (has not taken. She went to bed around 11p last night and then woke up at 3:00A feeling very anxious (this is typical for her). However, she noticed that in addition to her usual dizziness, she felt a sensation of spinning and it looked like the pictures on the wall were moving. She had no speech problems, weakness or sensory problems but did feel off balance when walking. She did not fall to a particular side but did feel she had to grab onto the chair to walk. \n\ufeff\nOtherwise, she has had several days of poor appetite. She was also constipated for several days and then took Mylanta yesterday which subsequently made her have two episodes of emesis. She denies fevers, chills, dysuria, abdominal pain, cough or other infectious symptoms. \n \nROS: On further neurologic review of systems, patient has chronic hearing loss (left ear). She denies headaches. Denies difficulty with producing or comprehending speech. Denies dysarthria, or dysphagia. Denies focal muscle weakness, numbness, parasthesia. Denies loss of sensation. Denies bladder incontinence or retention. \n\ufeff\nOn general review of systems, the patient denies fevers, rigors, night sweats, or noticeable weight loss. Denies chest pain, palpitations, dyspnea, or cough. No recent change in bladder habits. Denies dysuria or hematuria. Denies myalgias, arthralgias, or rash.\n", + "input3": "+ HYPERTENSION\n+ ANXIETY\n+ VERTIGO \n+ LOW BACK PAIN \n+ BILATERAL KNEE OSTEOARTHRITIS S/P BILATERAL REPLACEMENTS\n+ R PCA TERRITORY INFARCT (chronic R PCA occlusion)\n", + "input4": "No family history of stroke or other neurological conditions that she is able to recall.\n", + "input5": "ADMISSION PHYSICAL EXAM:\nVitals: 98.3 70 167/84 18 99% RA , negative orthostats\nGeneral: Pleasant older lady; tearful at times and then other times extremely complimentary and comfortable\nHEENT: NCAT, no oropharyngeal lesions, neck supple\nPulmonary: CTAB, no crackles or wheezes\nAbdomen: Soft, NT, ND, +BS, no guarding\nExtremities: Warm, no edema\nPsych: mood is \"okay, anxious\", affect- labile (went from laughing and smiling to then tearful when discussing her daughter moving to someplace and slove her health problems) \n\ufeff\nNeurologic Examination:\n- Mental status: Awake, alert, oriented to person, and situation. Able to relate some of history but does perseverate with tangential thought process. Attentive, able to name MOW backward with some delay. Speech is fluent with full sentences, intact repetition, and intact verbal comprehension. Naming intact. No dysarthria. Normal prosody. Able to register 3 objects and recall at 5 minutes ( No evidence of hemineglect. No left-right confusion. Able to follow both midline and appendicular commands.\n\ufeff\n- Cranial Nerves: PERRL 3->2 brisk, post surgical bilaterally. \nVF with left homonymous hemianopia (she will give an answer for digit counting but consistently gets this wrong on the left side only and seems like she is guessing; definite field cut to finger wiggle). EOMI, non-fatiguable horizontal nystagmus on left gaze, fast phase to left. V1-V3 without deficits to light touch bilaterally. No facial movement asymmetry. Hearing diminished on left to finger rub. Palate elevation symmetric. SCM/Trapezius strength bilaterally. Tongue midline.\n*Negative\n\ufeff\n- Motor: Normal bulk and tone. No drift. No tremor or asterixis.\n\ufeff\n \n- Reflexes: \n[Bic] [Tri] [xx] [Quad] [Gastroc]\nL 2+ 2+ 2+ 2+ 1\nR 2+ 2+ 2+ 2+ 1 \n\ufeff\nPlantar response flexor bilaterally \n\ufeff\n- Sensory: No deficits to light touch, pin, or proprioception bilaterally. No extinction to DSS.\n\ufeff\n- Coordination: No dysmetria with finger to nose testing bilaterally. Good speed and intact cadence with rapid alternating movements.\n\ufeff\n- Gait: Apprehensive but narrow base and stride. Normal arm swing. Stable without sway. Negative Romberg.\n", + "input6": "ADMISSION LABS\n11:23AM WBC-6.0 RBC-4.20 HGB-12.8 HCT-38.2 MCV-91 MCH-30.5 MCHC-33.5 RDW-12.9 RDWSD-42.9\n11:23AM ALT(SGPT)-16 AST(SGOT)-28 ALK PHOS-123* TOT BILI-0.3\n11:23AM GLUCOSE-103* UREA N-8 CREAT-0.7 SODIUM-136 POTASSIUM-4.5 CHLORIDE-98 TOTAL CO2-22 ANION GAP-16\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/11882869-DS-11.json b/Finished/Stroke/Ischemic Stroke/11882869-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..eb9f093dcbdc2a93d61b7d8a6a6576ef0828578a --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/11882869-DS-11.json @@ -0,0 +1,57 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "It shows that there are multiple small areas of brain tissue that have died due to lack of blood flow.$Cause_1": { + "Late acute infarcts in the right MCA distribution predominantly involving the right basal ganglia and posterior limb of the right internal capsule with multiple additional punctate foci in the right external capsule, insula, parietal and temporal lobes.$Input6": {} + }, + "This indicates that the infarcted area is growing.$Cause_1": { + "Evolving acute infarct in the right basal ganglia and multiple additional punctate acute infarcts along the periphery of the right parietal and temporal lobes seen on subsequent$Input6": {} + }, + "Here describe a sudden cutoff of the distal M1 segment of the right internal carotid artery, a high degree of stenosis at the beginning of the M2 superior branch, and no M2 inferior branch. Blockage and stenosis of this artery is the direct cause of ischemia in the brain region.$Cause_1": { + "Abrupt cut off of the distal M1 segment of the right internal carotid artery with high-grade focal narrowing at the origin of the right M2 superior division and nonvisualization of the M2 inferior division.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Stroke usually affects one side of the brain, which affects muscle control on the opposite side of the body, a typical symptom of stroke$Cause_1": { + "left facial droop$Input1": {} + }, + "Stroke may affect areas of the brain that control speech, causing patients to slur their speech$Cause_1": { + "slurred speech$Input1": {} + }, + "A stroke affects the area of the brain that controls body movement, causing muscle weakness on one side of the body.$Cause_1": { + "left arm more than leg weakness$Input1": {} + }, + "The patient has a history of severe cardiovascular disease, which increases the risk of stroke$Cause_1": { + "previous CABG$Input2": {} + }, + "HTN is one of the major risk factors for stroke$Cause_1": { + "HTN$Input3": {} + }, + "Bicuspid valves may lead to cardiac insufficiency and hemodynamic changes, increasing the risk of stroke. AVR (aortic valve replacement) is a common procedure to treat severe valvular disease. It may carry a risk of blood clots after surgery and may also increase the risk of stroke.$Cause_1": { + "bicuspid aortic valve h/o severe AS s/p AVR CE #21$Input3": {} + }, + "Postoperative atrial fibrillation is a common complication of cardiac surgery and can increase the risk of blood clots, thereby increasing the risk of stroke.$Cause_1": { + "post-op a fib$Input3": {} + }, + "An ascending aortic aneurysm is a dilation of the ascending part of the aorta. This condition can lead to a tear (dissection) in the inner wall of the vessel, which may lead to abnormal blood flow and increase the risk of stroke.$Cause_1": { + "ascending aortic aneurysm$Input3": {} + }, + "Visual field loss in the left lower quadrant, which may be a sign of damage to a certain part of the brain, common in stroke$Cause_1": { + "VF- left LQ deficit.$Input5": {} + }, + "Abduction reflexes often indicate pathological changes in the central nervous system, such as stroke$Cause_1": { + "Plantar response extensor on the left and mute on the right$Input5": {} + }, + "Abnormally low heart rate, which can increase risk of stroke$Cause_1": { + "HR: 42$Input5": {} + }, + "Relatively low blood pressure may affect blood flow to the brain$Cause_1": { + "BP:109/64$Input5": {} + } + } + }, + "input1": "left facial droop, slurred speech and left arm more than leg weakness,\n", + "input2": "He with hx of previous CABG and frontal lobe epilepsy on Keppra who follows up with limited records presented to an OSH with acute left facial droop, slurred speech and left arm more than leg weakness. Per his report he woke up at 8 am and walked to the bathroom and was at his baseline , went back to sleep and then at 9.15 am when he woke up he fell and called out to his son who confirms the history and reports that he found his father on the floor with Left facial droop total paresis of the left arm and slurred speech. He though he was having a heart attack and asked for ASA so his son gave him one ASA tab. Upon arrival received Tpa at OSH at 10.45 with immediate improvement, had a neg NCHCT and was transferred to \nED. Upon arrival was 3- mild residual left facial asymmetry, questionable left Lower quadrant visual field cut and left arm weakness.\n", + "input3": "+ bicuspid aortic valve h/o severe AS s/p AVR CE #21\n+ post-op a fib\n+ HTN\n+ ascending aortic aneurysm\n+ COPD\n+ depression\n+ seizure disorder (frontal lobe epilepsy per pt)\n+ h/o rheumatic fever\n+ chronic pancreatitis c/b pseudocysts\n+ gallstones\n+ pulmonary nodules\n", + "input4": "NC\n", + "input5": "Admission exam:\nVitals: T: 98.2 HR: 42 BP:109/64 RR: 16 SaO2:97%\nGeneral: NAD\nHEENT: NCAT, no oropharyngeal lesions, neck supple\nPulmonary: CTAB, no crackles or wheezes\nAbdomen: Soft, NT, ND, +BS, no guarding\nExtremities: Warm, no edema\n\ufeff\nNeurologic Examination:\n- Mental status: Awake, alert, oriented x 3. Able to relate history without difficulty. Attentive, able to name backward without difficulty. Speech is fluent with full sentences, intact repetition, and intact verbal comprehension. Naming intact. No paraphasias. No dysarthria. Normal prosody. On cookie jar picture- I see a woman washing dishes- did not report the kids an the jar though no evidnec of evidence of hemineglect otherwise . No left-right confusion. Able to follow both midline and appendicular commands.\n\ufeff\n- Cranial Nerves: PERRL 3->2 brisk. VF- left LQ deficit. EOMI, \nno nystagmus. V1-V3 without deficits to light touch bilaterally. No facial movement asymmetry. Hearing intact to finger rub bilaterally. Palate elevation symmetric. SCM/Trapezius strength bilaterally. Tongue midline.\n\ufeff\n- Motor: Normal bulk and tone. No drift. No tremor or \n\ufeff\nNo drift. \n \n- Reflexes: \n[Bic] [Tri] [xx] [Quad] [Gastroc]\nL 3+ 2+ 2+ 3+ 1\nR 2+ 2+ 2+ 2+ 1 \n\ufeff\nPlantar response extensor on the left and mute on the right.\n- Sensory: No deficits to light touch, pin, or proprioception bilaterally. No extinction to DSS.\n- Coordination: No dysmetria with finger to nose testing bilaterally. \n- Gait: deferred.\n", + "input6": "12:45PM GLUCOSE-102* UREA N-8 CREAT-0.7 SODIUM-135 POTASSIUM-4.3 CHLORIDE-101 TOTAL CO2-23 ANION GAP-15\n12:45PM estGFR-Using this\n12:45PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n11:40AM VoidSpec-TOO HEMOLY\n11:40AM WBC-11.9* RBC-3.98* HGB-14.4 HCT-38.4* MCV-97 MCH-36.2* MCHC-37.5* RDW-13.4 RDWSD-48.1*\n11:40AM NEUTS-80.6* LYMPHS-7.8* MONOS-10.4 EOS-0.4* BASOS-0.3 AbsNeut-9.56* AbsLymp-0.92* AbsMono-1.24*AbsEos-0.05 AbsBaso-0.04\n11:40AM PLT COUNT-275\n\ufeff\n\ufeff\nCTA head and neck\n \nIMPRESSION: \n \n \n1. Evolving acute infarct in the right basal ganglia and multiple additional punctate acute infarcts along the periphery of the right parietal and temporal lobes seen on subsequent MRI are not well depicted on this CT. \n2. Abrupt cut off of the distal M1 segment of the right internal carotid artery with high-grade focal narrowing at the origin of the right M2 superior division and nonvisualization of the M2 inferior division. \n3. Extensive calcified and soft atherosclerotic plaque at the carotid bifurcations extending into the proximal portion of the internal and external carotid arteries results in approximately 50% narrowing of the internal carotid artery origins by NASCET criteria. \n4. There is a 6 x 8 mm spiculated right upper lobe pulmonary nodule in addition to a nodular area of parenchymal consolidation with adjacent distortion along the periphery of the left upper lobe measuring 1.6 x 2.1 cm. There also multiple mildly prominent mediastinal lymph nodes. Comparison with prior chest CTs, if available available is recommended. Alternatively, dedicated chest CT or PET-CT can be considered for further evaluation, as malignancy cannot be excluded. \n\ufeff\nMRI brain\nIMPRESSION: \n \n \n1. Late acute infarcts in the right MCA distribution predominantly involving the right basal ganglia and posterior limb of the right internal capsule with multiple additional punctate foci in the right external capsule, insula, parietal and temporal lobes. \n2. Punctate chronic microhemorrhage in the left thalamus. \n3. Additional white matter changes are suggestive of chronic small vessel \nischemic disease. \n\ufeff\n \nCT chest\nIMPRESSION: \n \n1. Bilateral superior pulmonary spiculated nodules measuring up to 11 mm highly concerning for primary lung malignancy. \n2. Partially seen distal pancreatic atrophy disproportionate to the size of the head on a background of chronic pancreatitis as well a CBD stent with expected pneumobilia. These findings could be due to an underlying pancreatic malignancy such as adenocarcinoma, particularly in the setting \nof a stent. Alternatively, sequela of chronic pancreatitis are possible as \ndescribed. \n \nRECOMMENDATION(S): Correlation with pancreaticobiliary history, \ncomparison with prior imaging. An addendum can be issued if requested with a comparison of the findings if prior imaging becomes available. \n\ufeff\nTTE:\nThe left atrial volume index is mildly increased. No atrial septal defect or patent foramen ovale is seen by 2D, color Doppler or saline contrast with maneuvers. Left ventricular wall thickness, cavity size and regional/global systolic function are normal (LVEF >55%). Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). Right ventricular chamber size and free wall motion are normal. A bioprosthetic aortic valve prosthesis is present. The aortic valve prosthesis appears well seated, with normal leaflet/disc motion and transvalvular gradients. Mild (1+) aortic regurgitation is seen. The mitral valve leaflets are mildly thickened. There is no mitral valve prolapse. Trivial mitral regurgitation is seen. The estimated pulmonary artery systolic pressure is normal. There is no pericardial effusion. \n\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/11896216-DS-7.json b/Finished/Stroke/Ischemic Stroke/11896216-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..b96122156d0fad2b94bb248c0c6fddfa7efa2f76 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/11896216-DS-7.json @@ -0,0 +1,63 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "Damage to brain tissue in the area supplied by the right middle cerebral artery (MCA), consistent with a diagnosis of ischemic stroke$Cause_1": { + "Re-demonstration of scattered areas of hypodensity within the right inferior frontal lobe in the region of the known right MCA infarct and recent thrombectomy.$Input6": {} + }, + "This finding suggests that ischemic stroke is progressing, and this worsening is suggestive of expansion of the infarcted area.$Cause_1": { + "Interval increase in the hypodensity in the right frontal lobe, insula, temporal lobe, basal ganglia and corona radiata.$Input6": {} + }, + "Demonstrates no significant change in previously noted small foci of hemorrhage, suggesting that there is no progressive or worsening bleeding at this specific site.$Cause_1": { + "No significant change in the small focus of intraparenchymal hemorrhage along the posterior right insula.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Weakness on the left side of the body, one of the common symptoms of stroke$Cause_1": { + "she found her on the ground and apparently weak on the left side.$Input2": {} + }, + "It showed that the patient had significant facial paralysis, which is also a typical symptom of stroke.$Cause_1": { + "facial palsy 3$Input2": {} + }, + "It indicates that the stroke may have affected the patient's speech center or its motor function.$Cause_1": { + "language 3, dysarthria 2$Input2": {} + }, + "A CT scan of the head shows an abnormality in the right middle cerebral artery, a clear indication of a stroke in the brain$Cause_1": { + "A noncontrast head CT showed a dense right MCA$Input2": {} + }, + "Atrial fibrillation is a heart rhythm disorder that significantly increases the risk of stroke$Cause_1": { + "a history of atrial fibrillation$Input2": {} + }, + "Hyperlipidemia increases the risk of stroke$Cause_1": { + "Hyperlipidemia$Input3": {} + }, + "High blood pressure is a major risk factor for stroke$Cause_1": { + "Hypertension$Input3": {} + }, + "Diastolic heart failure means the heart's ability to fill with blood is impaired, which can lead to insufficient circulation$Cause_1": { + "Diastolic heart failure$Input3": {} + }, + "The patient's neglect of tactile stimulation in the left arm is a typical symptom of stroke.$Cause_1": { + "Neglects to tactile stimulation in the left arm.$Input5": {} + }, + "This abnormal eye movement may be a sign of neurological damage caused by stroke$Cause_1": { + "There is a right gaze preference that can be overcome with doll's eyes.$Input5": {} + }, + "This suggests that left-side brain function may be impaired, associated with stroke.$Cause_1": { + "Blink to threat present on right, absent on left.$Input5": {} + }, + "This is a common symptom of stroke and indicates damage to the facial nerves.$Cause_1": { + "Left lower facial droop.$Input5": {} + }, + "This limb weakness is also a typical symptom of stroke$Cause_1": { + "lifts left arm and leg against the plane of the bed, though with some drift.$Input5": {} + }, + "Severe tricuspid regurgitation and pulmonary hypertension may lead to the formation of blood clots that may travel to the brain and cause ischemic stroke.$Cause_1": { + "SEVERE tricuspid regurgitation.$Input6": {} + } + } + }, + "input1": "Left sided weakness\n", + "input2": "This is a woman with a history of atrial fibrillation who presents to the ED. History is obtained primarily from the records as well as from her son.\n\ufeff\nShe was apparently in her usual state of health the day and saw her son in the morning, and then spoke to him on the phone at around 4:30. A few hours later received a call from her sister who was worried because they usually talk on the phone at time time and she had not heard from her. then called the patient's neighbor to go check on her. This was at approximately 7:30. When the neighbor went to check on her, she found her on the ground and apparently weak on the left side. EMS was called and she was brought to hospital, initial vitals were notable for BP 138/69, pulse 75, temp 96.8, respirations 20. (LOC 1, questions 2, gaze 2, visual fields 2, facial palsy 3, left arm 4, left leg 2, ataxia 1, language 3, dysarthria 2, extinction 2). Labwork was notable for INR 1.2. A noncontrast head CT showed a dense right MCA sign with loss of gray-white differentiation in the right subinsular cortex. Aspect score was\n7. A thrombus was seen in the distal right M1 segment in discussion with neurology she was transferred to other department for consideration of thrombectomy.\n", + "input3": "+ Chronic kidney disease, stage II\n+ Colon cancer status post hemicolectomy\n+ Osteoarthritis\n+ Hyperlipidemia\n+ Hypothyroidism\n+ Osteoporosis\n+ Depression \n+ Hypertension\n+ Splenic infarct\n+ Diastolic heart failure\n", + "input4": "Mother had breast cancer. Daughter and sister both had lung cancer\n", + "input5": "Admission exam:\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in\noropharynx.\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity.\nPulmonary: Normal work of breathing.\nCardiac: warm, well-perfused.\nAbdomen: Soft, non-distended.\nExtremities: No edema.\nSkin: No rashes or lesions noted.\n \nNeurologic:\n-Mental Status: Awake and alert. Able to follow commands and answer questions appropriately. Able to describe pictures on the stroke card. She can name and repeat. There are no paraphasic errors. Neglects to tactile stimulation in the left arm.\n\ufeff\n-Cranial Nerves:\nPupils 4-2 mm bilaterally. There is a right gaze preference that can be overcome with doll's eyes. Blink to threat present on right, absent on left. Left lower facial droop. Speech is not dysarthric.\n\ufeff\n-Motor: Normal bulk and tone throughout. Able to move right arm and leg easily against gravity, full strength. lifts left arm and leg against the plane of the bed, though with some drift.\n\ufeff\n-Sensory: No deficits to light touch, pinprick throughout. No extinction to DSS. \n\ufeff\n-Reflexes: Deferred\n\ufeff\n-Coordination: No dysmetria on FNF bilaterally.\n\ufeff\n-Gait: Not tested.\n", + "input6": "CT head\n \nIMPRESSION:\n \n1. Small, 0.7 x 0.5 cm focus of hyperdensity in the right inferior frontal lobe may represent a small intraparenchymal hemorrhage.\n2. Re-demonstration of scattered areas of hypodensity within the right inferior frontal lobe in the region of the known right MCA infarct and recent thrombectomy.\n \nCT head\n \nIMPRESSION: \n \n1. Interval increase in the hypodensity in the right frontal lobe, insula, temporal lobe, basal ganglia and corona radiata.\n2. No significant change in the small focus of intraparenchymal hemorrhage along the posterior right insula.\n\ufeff\nTTE\nIMPRESSION: Marked biatrial enlargement. Left ventricular cavity dilation with normal regional and low normal global systolic function. Marked right ventricular cavity dilation with low normal free wall motion. SEVERE tricuspid regurgitation. \nModerate pulmonary artery systolic hypertension. Mild mitral regurgitation.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/14538785-DS-15.json b/Finished/Stroke/Ischemic Stroke/14538785-DS-15.json new file mode 100644 index 0000000000000000000000000000000000000000..17d93b544e60d10b5849b1b5f3ddb8ad65ec2dc0 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/14538785-DS-15.json @@ -0,0 +1,69 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "Evidence of multiple acute cerebral infarctions was shown, indicating that ischemic damage had occurred to the brain tissue.$Cause_1": { + "tiny acute infarcts in the right hemisphere and cerebellum and on the left MCA territory$Input2": {} + }, + "Multiple acute/subacute infarcts, possibly due to embolism. These infarcts are better visualized by previous brain MRI and there is no evidence of hemorrhage. These acute or subacute infarcts are direct evidence of ischemic stroke.$Cause_1": { + "Multiple scattered supra and infratentorial foci of acute/subacute infarcts, which are likely embolic in etiology, are better appreciated on prior MRI of the brain. No evidence of hemorrhage$Input6": {} + }, + "Nonspecific supratentorial white matter may represent chronic small vessel ischemic disease, which is an important factor leading to ischemic stroke.$Cause_1": { + "Nonspecific supratentorial white matter, which likely represents chronic small vessel ischemic disease$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Left-sided weakness is a common symptom of stroke, which is caused by insufficient blood supply to the brain, leading to neurological dysfunction.$Cause_1": { + "L sided weakness$Input2": {} + }, + "Atrial fibrillation is a significant risk factor for ischemic stroke because it can cause blood clots to form in the heart, which can break off and cause embolism in the brain.$Cause_1": { + "Afib on Coumadin$Input2": {} + }, + "Intermittent worsening of symptoms may indicate unstable cerebral blood flow or microembolic events$Cause_1": { + "intermittent worsening of his left sided weakness$Input2": {} + }, + "Anxiety and confusion may be signs of impaired brain function, common in stroke patients$Cause_1": { + "increasingly agitated and confused$Input2": {} + }, + "CVA indicates a history of cerebrovascular accident, a significant risk factor for ischemic stroke$Cause_1": { + "acute embolic CVA$Input2": {} + }, + "Hyperlipidemia means high levels of cholesterol or other fats in the blood, which can lead to fatty deposits in the arteries and increase the risk of stroke.$Cause_1": { + "HLD$Input3": {} + }, + "High blood pressure is a major risk factor for stroke$Cause_1": { + "HTN$Input3": {} + }, + "A family history of heart disease may increase an individual's risk of developing heart disease, which is a significant risk factor for ischemic stroke.$Cause_1": { + "heart disease runs in the family$Input4": {} + }, + "Neglect of the left side of the visual field may indicate damage to the right hemisphere of the brain, a common symptom of stroke.$Cause_1": { + "Appears to neglect left side of visual field, sensory neglect appears to fluctuate$Input5": {} + }, + "Left-right confusion indicates that the patient may have cognitive impairment, which may be caused by damage to some part of the brain and is common in stroke patients.$Cause_1": { + "Mild left-right confusion.$Input5": {} + }, + "Increased muscle tone in the left shoulder, elbow, knee, and ankle, and inability to fully extend the elbow, which may be caused by damage to the area of \u200b\u200bthe brain that controls muscles, as is common in stroke$Cause_1": { + "There is increased tone at left shoulder, elbow, knee, ankle, unable to extend fully at the elbow$Input5": {} + }, + "Sustained clonus at the left ankle indicates neurological dysfunction, which is common after a stroke.$Cause_1": { + "Reflexes: sustained clonus at left ankle$Input5": {} + }, + "Loss of proprioception of fine movements in the feet may indicate damage to neural pathways, a common consequence of stroke$Cause_1": { + "Proprioceptive loss to fine movements at both feet$Input5": {} + }, + "The loss of sensation to simultaneous stimulation fluctuates, suggesting that sensory pathways may be affected intermittently, a common consequence of stroke$Cause_1": { + "Fluctuating extinction to DSS at arms/legs of left side.$Input5": {} + }, + "Old supratentorial lacunar infarcts, a small vessel lesion, are common in patients with ischemic stroke.$Cause_1": { + "Old supra tentorial lacunar infarct as described above$Input6": {} + }, + "Approximately 54% stenosis at the origin of the right internal carotid artery, caused by calcified and predominantly non-calcified atherosclerotic plaques. Carotid artery stenosis is a high risk factor for ischemic stroke because it may lead to reduced blood flow to the brain or thrombosis.$Cause_1": { + "Approximately 54% stenosis by NASCET criteria at the origin of the right internal carotid artery secondary to calcified and predominantly noncalcified atherosclerotic plaques.$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "Mr. ___ is a ___ white male with multiple medical problems including CVA ___, L sided weakness, uses walker, antigravity in arm at baseline), Afib on Coumadin, and chronic UTIs ___ to indwelling Foley catheter for neurogenic bladder, who is a transfer from ___ who initially presented with left sided weakness and agitation and was found to have an acute embolic CVA in the setting of metabolic encephalopathy from UTI.\n\nHistory is gathered from the patient as well as the chart. The patient reports that he was in his usual state of health until 2 days prior to presentation. He reported intermittent worsening of his left sided weakness for 2 days prior to presentation to ED, lasting briefly on the order of seconds and improving between episodes. He told his wife this but did not present for further evaluation at that time. He then became increasingly agitated and confused. The evening before presentation, the patient was restless and intermittently yelling. On presentation to ___, the patient denied any focal symptoms other than a slight cough and a headache (frontal, ___ pain, improved with Tylenol). He was found to have an UTI growing enterococcus, for which he was started on ceftriaxone. The initial NCHCT ___ negative for acute processes; however, brain MRI ___ showed multiple tiny acute infarcts in the right hemisphere and cerebellum and on the left MCA territory. \n", + "input3": " HTN \n DMII \n Depression \n HLD \n Memory Loss \n BPH \n Neurogenic bladder \n Osteoarthritis \n GOUT \n", + "input4": "heart disease runs in the family\n", + "input5": "Vitals: T: 98.3 HR: 68 BP: 133/77 RR: 18 SaO2: 96% RA\nGeneral: NAD\nHEENT: NCAT, no oropharyngeal lesions, neck supple\n___: RRR, no M/R/G\nPulmonary: CTAB, no crackles or wheezes\nAbdomen: Soft, NT, ND, +BS, no guarding\nExtremities: Warm, no edema\n\nNeurologic Examination:\n- Mental status: Awake, alert, oriented to person, place, month/year but not date. Knew it was inauguration yesterday. Able to relate history without difficulty. Difficulty naming ___ backward, was able to perform DOWB with some encouragement. Speech is fluent with full sentences, intact repetition, and intact verbal comprehension, though with occasional stutter. Naming intact to items on stroke card. Able to describe cookie jar picture. No dysarthria. Mildly decreased prosody. Able to register 3 objects and recall ___ at 5 minutes with confabulation, ___ with categorical cues and ___ with multiple choice. No apraxia. Appears to neglect left side of visual field, sensory neglect appears to fluctuate. Mild left-right confusion. Able to follow both midline and appendicular commands.\n\n- Cranial Nerves: Right pupil 3->2mm, left 4->4. VF full to number counting. EOMI, with saccadic intrusions. V1-V3 without deficits to light touch bilaterally. Subtle left facial droop with symmetric activation. Hearing intact to finger rub bilaterally. Palate elevation symmetric. SCM/Trapezius strength ___ bilaterally. Tongue midline.\n\n- Motor: There is increased tone at left shoulder, elbow, knee, ankle, unable to extend fully at the elbow. There is pronation of right arm, left arm unable to sustain antigravity.\n [___]\nL 2 2 3 3 ___- 4- 3 4- 4- 4+\nR 5 5 5 5 ___ 5 5 5 5 5 \n \n- Reflexes: sustained clonus at left ankle. Toes upgoing bilaterally\n [Bic] [Tri] [___] [Quad] [Gastroc]\n L 3+ 3+ 3+ 3+ 4\n R 2+ 2+ 2+ 2+ 1 \n\n- Sensory: No deficits to light touch, pin. Proprioceptive loss to fine movements at both feet. Fluctuating extinction to DSS at arms/legs of left side. Graphesthesia at both hands.\n\n- Coordination: No dysmetria with right hand, but with mild intention tremor. Left arm unable to perform.\n\n- Gait: Deferred\nDischarge Exam:\nVitals: T: 98.3 HR: 68 BP: 133/77 RR: 18 SaO2: 96% RA\nGeneral: NAD\nHEENT: NCAT, no oropharyngeal lesions, neck supple\n___: RRR, no M/R/G\nPulmonary: CTAB, no crackles or wheezes\nAbdomen: Soft, NT, ND, +BS, no guarding\nExtremities: Warm, no edema\n\n\n", + "input6": "1. No evidence of malignancy in the abdomen or pelvis.\n2. Probable 5 mm long narrow stone, less likely excreted \ncontrast, in the proximal left ureter with mild proximal ureteral fullness, urothelial inflammation but no frank hydronephrosis.\n3. 1.3 cm stone in the urinary bladder.\n4. Enlarged lobulated prostate measures 5.6 x 5.3 cm.\n\nCT chest ___\nIMPRESSION: \n \nThere is 2.3 cm extrapleural smoothly marginated mass abutting seventh rib,stable since ___. Findings may represent neurogenic tumor. Solitary fibrous tumor is less likely given size. Given stability, malignancy is unlikely. Follow-up CT chest in ___ year recommended tissue stability.Few small lung parenchymal nodules are stable and benign.Suggestion of pulmonary artery hypertension.\n\n\nCTA head and neck ___\nIMPRESSION: \n \n1. Multiple scattered supra and infratentorial foci of acute/subacute infarcts, which are likely embolic in etiology, are better appreciated on prior MRI of the brain. No evidence of hemorrhage. \n2. Old supra tentorial lacunar infarct as described above. \n3. Nonspecific supratentorial white matter, which likely represents chronic small vessel ischemic disease. \n4. Approximately 54% stenosis by NASCET criteria at the origin of the right internal carotid artery secondary to calcified and predominantly noncalcified atherosclerotic plaques. \n5. Sinus disease as described above. \n6. Partial opacification of the bilateral mastoid air cells, left greater than right. \n7. 1.7 cm thyroid nodule. Thyroid ultrasound is recommended for further evaluation. \n\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/16172945-DS-19.json b/Finished/Stroke/Ischemic Stroke/16172945-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..801530282773e4ab1c908bcb10769ba992d9a414 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/16172945-DS-19.json @@ -0,0 +1,36 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "MRI showed that the right parietal lobe was mainly white matter lesions, some of which extended to the gray matter. MRI results are an important basis for the diagnosis of stroke$Cause_1": { + "MRI with mainly white matter lesion in the right parietal area$Input2": {} + }, + "Hypodense images in the deep white matter and cortical areas of the right parietal lobe are consistent with infarction, which is direct evidence of ischemic stroke.$Cause_1": { + "There is a hypodensity involving the right parietal lobe deep white matter and extending into the cortical region, consistent with infarct.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "The patient suffered a blow to the head in a car accident. Although this does not directly indicate a stroke, it is necessary to rule out brain damage caused by trauma.$Cause_1": { + "hit her head$Input2": {} + }, + "A CT scan of the head showed an abnormality in the right parietal region, but no trauma. This suggests a possible stroke, as strokes often result from abnormalities in a specific area of \u200b\u200bthe brain.$Cause_1": { + "abnormality R parietal area$Input2": {} + }, + "Family history of stoke is an import risk of stoke$Cause_1": { + "Stroke$Input4": {} + }, + "Left-sided visual field loss, possibly indicating focal cerebral infarction$Cause_1": { + "PERRL 3mm-->2mm, left visual field defecit, minimal$Input5": {} + }, + "The intracranial carotid arteries show calcified and non-calcified plaques, especially in the cavernous segment. These plaques may lead to blood flow restriction, thereby increasing the risk of stroke.$Cause_1": { + "The intracranial internal carotid arteries demonstrate calcified and noncalcified plaque, particularly within the cavernous segments$Input6": {} + }, + "The relative scarcity of blood vessels in the right parietal infarct area indicates insufficient blood flow to this area, which is associated with ischemic stroke.$Cause_1": { + "There is relative paucity of a vasculature in the region of the described right parietal lobe infarct$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "___ year old female, does not follow with a PCP, who was sent to ED last night for an abnormal MRI finding. She was in a car accident two weeks ago, where she was driving in an intersection and got T-boned by another vehicle coming from the left. She does not relate that she was aware that the other car was coming. She did hit her head at this time against a window which shattered, and injured her left shoulder. She went to an OSH and got a head CT, with no traumatic injury, however with abnormality R parietal area. Follow up MRI with mainly white matter lesion in the right parietal area, although going into the gray matter a bit, and was sent here for further evaluation.\n\nHere, she denies any health issues, and review of systems is negative. She denies falling, bumping into things. Her husband denies this as well and states that she has been acting the same as usual. No weight loss, and no fevers/chills. Denies any numbess, weakness, or imbalance.\n", + "input3": "None\n", + "input4": "- Stroke\n- No other neurologic disease such as brain tumors\n", + "input5": "General - Appears comfortable\nHEENT - MMM, no scleral icterus, no proptosis, sclera and\nconjunctiva with no edema/injection.\nCV - RRR, no murmurs, rubs, or gallops. No carotid bruits\nPulm - CTA b/l\nAbd - soft, non-tender, normal bowel sounds\nExtremities - no cyanosis, no edema\nSkin - warm and pink with no rashes\n\n***Neurologic Exam***\nMENTAL STATUS: Awake and alert, oriented x 3, responds to multi-step commands which cross the midline. Knows recent and distant events. No hemisensory or visual neglect.\n\nLANGUAGE: Fluent, no paraphrasic errors, no dysarthria, naming and repetition intact.\n\nCRANIAL NERVES: [CNII] PERRL 3mm-->2mm, left visual field defecit, minimal. [CNII/IV/VI] EOMI intact, gaze is conjugate [CNV] sensation to light touch intact [CNVII] no facial droop, eyebrow raise and smile symmetric [CNVIII] intact perception of finger-rub b/l [CNIX/X] palate elevates symmetrically, intact gag reflex, [CNXII] tongue protrudes in midline.\n\nMOTOR: normal bulk, normal tone throughout. No adventitious movements, no tremor. No pronator drift. =[Delt] [Bic] [Tri] [ECR] [IO] [IP] [Quad] [Ham] [TA] [Gas] \n[___]\n [C5] [C5] [C7] [C6] [T1] [L2] [L3] [L5] [L4] [S1] [L5]\nL 5 5 5 5 5 5 5 5 5 5 5\nR 5 5 5 5 5 5 5 5 5 5 5\n\nSENSORY: Sensation to light touch and pinprick intact throughout.\nProprioception intact.\n\nDTRs: \n[Bic] [Tri] [___] [Quad] [Ankle]\nL 2+ 3+ 3+ 3+ 3+\nR 2+ 3+ 3+ 3+ 3+\n\nCEREBELLAR: No dysmetria, no nystagmus, rapid alternating movements intact\n\nGAIT: Stable narrow-based gait \n", + "input6": "CTA head and neck\n\nTECHNIQUE: Using a multi detector CT scanner, noncontrast volumetric data was acquired through the head and collimated at 5 mm slice thickness. Volumetric data was also acquired through the head and neck following the uncomplicated administration of intravenous contrast and collimated at 1.25 mm slice thickness. 3D maximum intensity projections of the head and neck were provided. Additional multiplanar reconstructions were generated on a separate workstation. \n \nCOMPARISON: MRI head ___. \n \nFINDINGS: \n \nCT Head: There is a hypodensity involving the right parietal lobe deep white matter and extending into the cortical region, consistent with infarct. No other area of hypodensity is identified. There is no evidence of midline shift, mass effect, hemorrhage or extra-axial fluid collections. The ventricles, sulci and basal cisterns are otherwise normal. There is mucosal thickening of the left maxillary sinus. Mastoid air cells and paranasal sinuses are otherwise clear. \n \nCTA Head: The intracranial internal carotid arteries demonstrate calcified and noncalcified plaque, particularly within the cavernous segments. However, there is no evidence of high-grade narrowing. The bilateral middle cerebral, anterior cerebral, posterior to the prevertebral, basilar and posterior cerebral arteries demonstrate adequate opacification. There is relative paucity of a vasculature in the region of the described right parietal lobe infarct. The anterior communicating artery is not definitely visualized. The posterior communicating arteries are well seen. There is no evidence of high-grade stenosis, aneurysm or dissection. \n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/18833652-DS-11.json b/Finished/Stroke/Ischemic Stroke/18833652-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..c6175d48e5ef06741452a9c9fa104adf40157d82 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/18833652-DS-11.json @@ -0,0 +1,42 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "A left middle cerebral artery infarction is a classic symptom of an ischemic stroke, indicating that blood flow to this part of the brain is blocked.$Cause_1": { + "L MCA infarct$Input2": {} + }, + "CTA showed a thrombus at the distal end of the left M1 segment, which was the direct cause of insufficient blood supply to the brain.$Cause_1": { + "CTA with distal L M1 thrombus$Input2": {} + }, + "The absence of intracranial hemorrhage further supports the diagnosis of ischemic stroke$Cause_1": { + "NCHCT without hemorrhage$Input2": {} + }, + "Acute infarction means that blood flow to a certain area of \u200b\u200bthe brain is suddenly interrupted, causing brain cells in that area to be damaged or die due to lack of oxygen. It is directly diagnosed as ischemic stroke.$Cause_1": { + "Acute infarction within the left temporoparietal region, most notably within the left insular lobe, corona radiata, superior temporal gyrus and left parietal lobe.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Speech difficulties are usually caused by damage to the area of \u200b\u200bthe brain that controls language and are a common symptom of stroke.$Cause_1": { + "difficulty speaking$Input2": {} + }, + "Have motor dysfunction, a sign of damage to the area of \u200b\u200bthe brain that controls the left side of the body$Cause_1": { + "unable to move her RUE, RLE$Input2": {} + }, + "Atrial fibrillation increases the risk of thrombosis, and failure to take anticoagulant therapy may cause thrombus detachment and cause cerebral infarction$Cause_1": { + "afib not on anticoagulation$Input2": {} + }, + "Frequent speech errors are often a sign of damage to language areas of the brain, which is common in stroke.$Cause_1": { + "Fluent. Frequent paraphasic errors$Input5": {} + }, + "Facial drooping is a classic symptom of stroke, especially when it is limited to one side, suggesting that the motor control area of \u200b\u200bthe brain on the opposite side may be damaged.$Cause_1": { + "R facial droop$Input5": {} + }, + "Chronic small vessel disease usually refers to pathological changes in small blood vessels caused by long-term damage, which is a common risk factor for ischemic stroke$Cause_1": { + "Likely chronic small vessel microangiopathy$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "___ (aka ___ ___ is a ___ yo L-handed woman with SCLC s/p palliative XRT and currently undergoing chemotherapy, afib not on anticoagulation who presents with L MCA infarct. \n\nShe went to bed yesterday evening around 2200 feeling well. She was found abnormal this morning at 0730 by her sister, who found her to have difficulty speaking and was unable to move her RUE, RLE. EMS was called and she was brought to ___, where NIHSS 9. She received ASA 300mg PR. NCHCT without hemorrhage, CTA with distal L M1 thrombus. She was subsequently brought to ___, where code stroke was activated upon arrival.\n", + "input3": "None\n", + "input4": "No relevant FHx.\n", + "input5": "Vitals: HR: 93-103 BP: 110-122/61-68 RR: ___ SaO2: 96-99% RA\nGeneral: Awake, cooperative, NAD. Cachectic. \nHEENT: no scleral icterus, MMM, no oropharyngeal lesions. \nPulmonary: Breathing comfortably, no tachypnea nor increased WOB\nCardiac: Skin warm, well-perfused. \nAbdomen: soft, ND\nExtremities: Symmetric, no edema. \n\nNeurologic Examination:\n- Mental status: Awake, alert. Unable to provide history. Fluent. Frequent paraphasic errors. Names objects on stroke card except calls cactus a 'cascus' and unable to name hammock. Able to read 3 word sentences, frequent paraphasic errors with longer sentences. Able to repeat 'mama', 'pizza', 'sunny'. At best she was once able to repeat 'today is some day' after examiner says 'today is a sunny day'. Follows simple appendicular commands but not complex commands. No evidence of hemineglect, no extinction to DSS. \n\n", + "input6": "MRI \n1. Acute infarction within the left temporoparietal region, most notably within the left insular lobe, corona radiata, superior temporal gyrus and left parietal lobe. \n2. Small focus of left putaminal hemorrhage with rim of surrounding vasogenic edema compatible with mild hemorrhagic transformation of infarct.\n3. Likely chronic small vessel microangiopathy. \n4. No definite evidence of intracranial metastatic disease at this time. There are foci of curvilinear punctate T1 postcontrast hyperintense signal on spin echo sequences, not correlated on any other sequence, felt to be artifactual. \n5. Additional findings described above\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/18908844-DS-9.json b/Finished/Stroke/Ischemic Stroke/18908844-DS-9.json new file mode 100644 index 0000000000000000000000000000000000000000..1b611dbd7d936a63ae4d23bb59e14c46bb722ce9 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/18908844-DS-9.json @@ -0,0 +1,51 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "Occlusion of the middle cerebral artery is the direct cause of ischemia in a part of the brain, which is the typical pathological manifestation of stroke.$Cause_1": { + "CTA demonstrate a right M1 occlusion$Input2": {} + }, + "It was clearly pointed out that there were multiple acute infarct areas in the right middle cerebral artery territory, which was a direct manifestation of ischemic stroke.$Cause_1": { + "Multiple areas of evolving right MCA territory acute infarction.$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "High blood pressure is a major risk factor for stroke$Cause_1": { + "history notable for hypertension$Input2": {} + }, + "Sudden weakness on one side of the body is a classic symptom of a stroke and suggests that part of the brain may be damaged.$Cause_1": { + "left-sided weakness$Input2": {} + }, + "Falls and sudden weakness can be caused by loss of muscle control and balance problems caused by a stroke.$Cause_1": { + "fallen in the restroom at approximately 04:00, at which time she reported feeling weak and unwell$Input2": {} + }, + "Stroke can affect the brain's cognitive function, exacerbating existing cognitive decline symptoms$Cause_1": { + "more confused than usual$Input2": {} + }, + "Family history of stroke improve the risk.$Cause_1": { + "Strokes noted in several family members$Input4": {} + }, + "The patient is conscious but unresponsive, disoriented, and speaks fluently but with slight slurring. These can be signs of impaired brain function caused by a stroke.$Cause_1": { + "Alert, responsive though with some latency. Not oriented to time. Speech is reportedly fluent with some dysarthria$Input5": {} + }, + "Neglect is a lack of normal attention to one side of the body or space. It is usually associated with damage to the right hemisphere of the brain, often in stroke.$Cause_1": { + "Left hemineglect$Input5": {} + }, + "This asymmetric muscle control problem often suggests that a specific area of \u200b\u200bthe brain may be damaged.$Cause_1": { + "No movement in LUE or LLE to command. Able to maintain RUE against gravity, RLE drifts to bed.$Input5": {} + }, + "Temperature and pressure sensation are lost on the left side, probably due to damage to the contralateral sensory pathways of the brain.$Cause_1": { + "Absent sensation to LT or PP on left$Input5": {} + }, + "Long-standing microvascular disease is associated with an increased risk of ischemic stroke.$Cause_1": { + "Chronic findings include age-appropriate global involutional changes and mild changes of chronic white matter microangiopathy.$Input6": {} + }, + "Significant left atrium enlargement may increase the risk of atrial fibrillation, a major risk factor for stroke$Cause_1": { + "The left atrial volume index is SEVERELY increased$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "Ms. ___ is a ___ woman with history notable for hypertension, essential tremor, unspecified cognitive decline, and anxiety presenting with acute-onset left-sided weakness.\n\nPer Ms. ___ son-in-law, she was last seen well by her family yesterday at noon after returning home from a primary care provider appointment, where she was prescribed amoxicillin-clavulanate for a UTI. They subsequently spoke with her over the phone at 17:55, at which time she did not report any complaints and was not noted to have appreciable speech disturbance. Subsequently, the family received a call at 05:55 this morning in which Ms. ___ reported having fallen in the restroom at approximately 04:00, at which time she reported feeling weak and unwell. On seeing her at approximately 06:00, her family found that she was also more confused than usual. EMS was activated and transported Ms. ___ to ___, where CTA demonstrate a right M1 occlusion, prompting transfer to ___ for consideration of EVT.\n\nUnable to obtain ROS, though per son-in-law, no recent neurologic, infectious, or pain-related symptoms had been reported.\n", + "input3": "Essential tremor\nUnspecified cognitive decline\nAnxiety \nOsteoporosis\nOA\n", + "input4": "Strokes noted in several family members, unclear details.\n", + "input5": "General: NAD\nHEENT: NCAT, neck supple\n___: warm, well-perfused\nPulmonary: no tachypnea or increased WOB\nAbdomen: soft, ND\nExtremities: symmetric\n\nNeurologic Examination:\n- Mental status: Alert, responsive though with some latency. Not oriented to time. Speech is reportedly fluent with some dysarthria in ___. Able to follow both midline and right-sided appendicular commands. Left hemineglect.\n\n\n- Motor: No movement in LUE or LLE to command. Able to maintain RUE against gravity, RLE drifts to bed.\n \n- Reflexes: 1+ throughout.\n\n- Sensory: Absent sensation to LT or PP on left.\n\n- Coordination: No dysmetria on right on FTN, with mild action tremor.\n\n- Gait: Deferred.\n\n", + "input6": "___ 08:35AM BLOOD WBC-12.6* RBC-3.60* Hgb-10.0* Hct-30.9* MCV-86 MCH-27.8 MCHC-32.4 RDW-13.6 RDWSD-42.7 Plt ___\n___ 01:36AM BLOOD WBC-7.3 RBC-3.22* Hgb-9.1* Hct-27.8* MCV-86 MCH-28.3 MCHC-32.7 RDW-13.8 RDWSD-43.5 Plt ___\n___ 06:15AM BLOOD Glucose-129* UreaN-25* Creat-0.7 Na-148* \nK-4.2 Cl-106 HCO3-29 AnGap-13\n___ 05:40AM BLOOD Glucose-141* UreaN-14 Creat-0.9 Na-142 \nK-4.7 Cl-108 HCO3-18* AnGap-16\n___ 01:01PM BLOOD Glucose-106* UreaN-15 Creat-0.8 Na-135 \nK-4.9 Cl-100 HCO3-23 AnGap-12\n___ 08:35AM BLOOD Glucose-119* UreaN-17 Na-132* K-5.8* \nCl-99 HCO3-21* AnGap-12\n___ 01:36AM BLOOD cTropnT-<0.01\n___ 01:01PM BLOOD cTropnT-0.02*\n___ 06:15AM BLOOD Calcium-9.4 Phos-3.7 Mg-2.0\n___ 08:35AM BLOOD Albumin-3.9\n___ 05:40AM BLOOD %HbA1c-5.7 eAG-117\n___ 05:40AM BLOOD Triglyc-192* HDL-36* CHOL/HD-4.5 \nLDLcalc-89\n___ 08:35AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nTricycl-NEG\n\nMRI ___\nIMPRESSION: \n1. Multiple areas of evolving right MCA territory acute infarction. \n2. Areas of petechial hemorrhage within the infarcted right putamen and caudate head. No large area of frank hemorrhagic transformation. \n3. Chronic findings include age-appropriate global involutional changes and mild changes of chronic white matter microangiopathy. \n4. Fluid in the right mastoid air cells is noted. Correlate clinically with signs of otomastoiditis. \n\nTTE ___\nCONCLUSION:\nThe left atrial volume index is SEVERELY increased. No thrombus/mass is seen in the body of the left atrium. The left atrial appendage is not visualized. The right atrium is mildly enlarged. The estimated right atrial pressure is ___ mmHg. There is normal left ventricular wall thickness with a normal cavity size. There is normal regional left ventricular systolic function. No thrombus or mass is seen in the left ventricle. Overall left ventricular systolic function is low normal. The visually estimated left ventricular ejection fraction is 50-55%. Left ventricular cardiac index is low normal (2.0-2.5 L/min/m2). There is no resting left ventricular outflow tract gradient. No ventricular septal defect is seen. Mildly dilated right ventricular cavity with normal free wall motion. The aortic sinus diameter is normal for gender with\nnormal ascending aorta diameter for gender. The aortic arch diameter is normal. There is no evidence for an aortic arch coarctation. The aortic valve leaflets (3) are mildly thickened. No masses or vegetations are seen on the aortic valve. There is no aortic valve stenosis. There is no aortic regurgitation. The mitral valve leaflets appear structurally normal with no mitral valve prolapse. No masses or vegetations are seen on the mitral valve. There is mild [1+] mitral regurgitation. There is significant pulmonic regurgitation. The tricuspid valve leaflets appear structurally normal. No mass/vegetation are seen on the tricuspid valve. There is mild to moderate [___] tricuspid regurgitation. There is moderate pulmonary artery systolic hypertension. The end-diastolic PR velocity is elevated suggesting pulmonary artery diastolic hypertension. There is no pericardial effusion. There is a prominent anterior fat pad.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/19038331-DS-17.json b/Finished/Stroke/Ischemic Stroke/19038331-DS-17.json new file mode 100644 index 0000000000000000000000000000000000000000..dccd2edbb29141f498e6b511b4a254539b728410 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/19038331-DS-17.json @@ -0,0 +1,36 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "The abrupt interruption of the left posterior cerebral artery P2 segment is consistent with thrombosis, suggesting ischemic stroke$Cause_1": { + "Abrupt cut off of the P2 segment of the left posterior cerebral artery is consistent with thrombus$Input6": {} + }, + "Suspected Stroke$Intermedia_2": { + "Weakness, especially if it is sudden and on one side, is a common symptom of stroke.$Cause_1": { + "eakness$Input1": {} + }, + "Fatigue may be caused by insufficient blood flow to the brain, a common symptom of stroke$Cause_1": { + "felt fatigued$Input2": {} + }, + "Overall fatigue and increased need for assistance with walking may indicate generalized or localized weakness, which may be related to brain dysfunction$Cause_1": { + "stand unassisted but needed her family as the day wore on to help her walk, due to generalized fatigue$Input2": {} + }, + "High blood pressure is a major risk factor for stroke$Cause_1": { + "Hypertension$Input3": {} + }, + "A slightly wider gait that occasionally deviates but self-corrects, with no ability to tandem gait. This may indicate cerebellar dysfunction or vestibular system problems, possibly related to stroke$Cause_1": { + "Walks unassisted with slightly wide base. Occasionally veers a bit to either side but self-corrects. Unable to tandem.$Input5": {} + }, + "The left distal transverse sinus thrombosis extends to the left sigmoid sinus and the entire left internal jugular vein, which may be related to long-term catheter or radiation changes, suggesting the possibility of acute thrombosis.$Cause_1": { + "Thrombosis of the left distal transverse sinus extending into the left sigmoid sinus and the entire left internal jugular vein.$Input6": {} + }, + "60% stenosis at the left internal carotid artery bifurcation increases the risk of ischemic stroke$Cause_1": { + "60% stenosis of the left internal carotid at the bifurcation.$Input6": {} + } + } + }, + "input1": "Nausea and Weakness\n", + "input2": "HPI: ___ RH F who was in her usual, independent state of health until this morning. Around noon, she suddenly felt sick to her stomach and had to go to the bathroom. She got up and walked to the bathroom but before she got there, she had to sit on the bed because she felt fatigued. After resting, she walked to the bathroom (no diarrhea). She says she was \"walking crazy\" but not veering to either side and not walking like she was drunk; she has not fallen. She could stand unassisted but needed her family as the day wore on to help her walk, due to generalized fatigue. She then reported a dull, bifrontal headache that was maximal at onset; not associated with neck pain, visual changes or diplopia. No focal weakness, vertigo, dysarthria, speech difficulties, or clumsiness. Denies head trauma or neck pain.\n\nROS: On review of systems, the pt denied recent fever or chills.\n", + "input3": "b/l Breast CA s/p b/l mastectomies, on femara\nHypertension followed by Dr. ___ CHF EF>55%\nHypothyroidism \nOsteoporosis followed by endocrine\nAbnl CT chest in past with radiation changes.\n", + "input4": "Father died of myocardial infarction at age ___ mother died of infected abscess. Two sisters in good health. Maternal grandmother died of colon cancer. Maternal aunt died of pancreatic cancer.\n", + "input5": "VS 97.8 87 155/70 18 97%\nGen Awake, cooperative, NAD \nHEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in oropharynx \nNeck Supple, no carotid bruits appreciated. No nuchal rigidity \nLungs CTA bilaterally \nCV RRR, nl S1S2, no M/R/G noted \nAbd soft, NT/ND, normoactive bowel sounds, no masses or\norganomegaly noted \nExt No C/C/E b/l \nSkin no rashes or lesions noted\n\nNEURO\nMS ___, alert. Fully oriented. Months of the year backwards were intact but slow. Speech fluent, with mild anomia to low frequency items, reading, comprehension and repetition. Normal prosody. There were no paraphasic errors. Able to follow both midline and appendicular commands. No apraxia. Interprets cookie theft picture appropriately. No dysarthria. \n\nCN\nCN I: not tested\nCN II: Visual fields were full to confrontation, no extinction.\nPupils 2->1.5 b/l. \nCN III, IV, VI: EOMI no nystagmus or diplopia\nCN V: intact to LT throughout\nCN VII: full facial symmetry and strength\nCN VIII: hearing intact to FR b/l\nCN IX, X: palate rises symmetrically\nCN XI: shrug ___ and symmetric\nCN XII: tongue midline and agile\n\nMotor \nNormal bulk and tone in the arms; b/l spasticity in the legs. b/l EDB atrophy. No pronator drift or asterixis\n D B T WE FE FF IP Q H DF PF TE\nL ___ ___ ___\nR ___ 5- 4+ ___ 4\n\nSensory intact to light touch, pinprick, joint position sense, vibration throughout the arms; JPS is mildly reduced at the toes, as is vibration. No extinction to double simultaneous stimulation.\n\nReflexes \n Br Bi Tri Pat Ach Toes\nL 2+ 2+ 2 2 0 down\nR 2+ 2+ 2 2 0 down\n\nCoordination Fine finger movements, rapid alternating movements, finger-to-nose, and heel-to-shin were all normal\n\nGait stands and sits unassisted. Walks unassisted with slightly wide base. Occasionally veers a bit to either side but self-corrects. Unable to tandem.\n", + "input6": "___ 06:00PM GLUCOSE-166* UREA N-19 CREAT-0.9 SODIUM-134 POTASSIUM-3.9 CHLORIDE-96 TOTAL CO2-26 ANION GAP-16\n___ 06:00PM estGFR-Using this\n___ 06:00PM ALT(SGPT)-9 AST(SGOT)-19 CK(CPK)-28 ALK PHOS-68\n___ 06:00PM LIPASE-31\n___ 06:00PM CK-MB-NotDone cTropnT-<0.01\n___ 06:00PM WBC-11.9* RBC-5.00 HGB-13.6 HCT-40.1 MCV-80* MCH-27.3 MCHC-34.0 RDW-13.5\n___ 06:00PM NEUTS-91.6* BANDS-0 LYMPHS-6.5* MONOS-1.5* \nEOS-0.3 BASOS-0.1\n___ 06:00PM HYPOCHROM-NORMAL ANISOCYT-NORMAL \nPOIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-1+ POLYCHROM-NORMAL\n___ 06:00PM PLT SMR-NORMAL PLT COUNT-389\n___ 06:00PM ___ PTT-37.1* ___\n\n___ CTA/V head and neck. \nIMPRESSION:\n1. Abrupt cut off of the P2 segment of the left posterior cerebral artery is consistent with thrombus and the known left occipital infarction. No filling defect within the right superior cerebellar artery, the site of the patient's other known infarction.\n2. Thrombosis of the left distal transverse sinus extending into the left sigmoid sinus and the entire left internal jugular vein. This could be secondary to prior long-term indwelling catheter or prior radiation change. However, the distended appearance of the left IJV suggest that this may be acute. Clinical correlation is recommended.\n3. Increased size of opacity within the left upper lung lobe with new pleural effusion. In a patient with history of breast cancer, this is concerning for metastatic disease. A dedicated chest CT is recommended for further evaluation.\n4. Marked periodontal disease.\n5. Large right thyroid nodule measuring 26 mm. This could be further evaluated with thyroid ultrasound.\n6. 60% stenosis of the left internal carotid at the bifurcation.\n7. Degenerative changes of the cervical spine.\n\n___ MRI/MRA head:\nFINDINGS: In the posterior fossa, there is evidence of restricted diffusion on the right cerebellar hemisphere consistent with acute/subacute ischemic changes; these areas appear with low signal in the corresponding ADC map. The FLAIR and T2-weighted sequences also demonstrate hyperintense signal in these areas. No significant midline shifting or mass effect is demonstrated. There is no evidence of hemorrhagic transformation at the moment of this study. In the supratentorial compartment, there is evidence of restricted diffusion involving the left temporal lobe as well as the left occipital region, these areas are also demonstrated on the FLAIR with low signal in the corresponding ADC map. Mild effacement of the sulci is demonstrated; however, there is no evidence of uncal herniation or significant midline shifting. On T2 and FLAIR, there are multiple scattered hyperintensity areas in both centrum semiovale and subcortical white matter consistent with chronic angiopathic ischemic changes. The orbits, the paranasal sinuses and the mastoid air cells appear grossly normal.\n" +} \ No newline at end of file diff --git a/Finished/Stroke/Ischemic Stroke/19227459-DS-11.json b/Finished/Stroke/Ischemic Stroke/19227459-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..9a86b57a305b8c287a262922afce2526a4764a63 --- /dev/null +++ b/Finished/Stroke/Ischemic Stroke/19227459-DS-11.json @@ -0,0 +1,42 @@ +{ + "Ischemic Stroke$Intermedia_3": { + "An infarction in the left posterior cerebral artery territory was found on CT, confirming the diagnosis of ischemic stroke.$Cause_1": { + "L PCA distribution infact on CT$Input2": {} + }, + "Suspected Stroke$Intermedia_2": { + "HLD refers to high levels of lipids in the blood, which is a risk factor for atherosclerosis and may increase the risk of stroke.$Cause_1": { + "diet-controlled HLD$Input2": {} + }, + "Smoking is a major risk factor for stroke, increasing the risk of blood viscosity and arteriosclerosis.$Cause_1": { + "tobacco use$Input2": {} + }, + "There is a complex relationship between migraine and stroke, and certain types of migraine may increase the risk of stroke$Cause_1": { + "migraine$Input2": {} + }, + "Right peripheral visual field loss and headache are potential stroke symptoms$Cause_1": { + "3 days of loss of peripheral vision on R and headache$Input2": {} + }, + "Persistent headaches and right-sided visual field loss that do not resolve may be signs of a stroke$Cause_1": { + "had onset of headache, and noted a bright light in his right field of vision at onset$Input2": {} + }, + "Excessive sleepiness, confusion, and abnormal behavior are common symptoms of stroke$Cause_1": { + "seemed distant, and dismissed her questions$Input2": {} + }, + "Impaired attention and the inability to self-correct without prompting may indicate that cognitive function in the brain is affected, which could be a sign of a stroke.$Cause_1": { + "Mildly inattentive, with MOYB he names each month slowly and skips ___ before self-correcting unprompted$Input5": {} + }, + "Dense right hemiplegia is a loss of vision caused by damage to a part of the brain, usually associated with damage to the back of the brain, and is a classic symptom of a stroke.$Cause_1": { + "Dense R homonymous hemianopsia$Input5": {} + }, + "Slight pronation of the right hand without downward drift may indicate a slight loss of motor control, which is common after a stroke.$Cause_1": { + "Subtle right pronation without downward drift$Input5": {} + } + } + }, + "input1": "None\n", + "input2": "Mr. ___ is a ___ yo man with history of diet-controlled HLD, tobacco use, obesity and migraine who presents with 3 days of loss of peripheral vision on R and headache. Mr. ___ was in his usual state of health after working overnight ___ night, until 1100 ___ am. He then had onset of headache, and noted a bright light in his right field of vision at onset, which he states is typical for his migraines.The headache continued, and he complained to his wife later in the day about a problem with his peripheral vision on the right. \n\nHis headache, and peripheral vision loss in the right continued through the day ___ and ___. His wife notes that he slept much of those past 3 days. Mr. ___ said he felt 'out of it', and his wife said that he seemed distant, and dismissed her questions. He presented today to OSH ED due to continued headache. There were no new symptoms that prompted presentation. OSH ED noted L PCA distribution infact on CT and transferred patient to ___.\n", + "input3": "migraine with aura\nobesity\nSeasonal allergies\nBladder cancer dx'd incidentally ___ year ago, s/p resection, no\nchemo nor radiation. Was told it was found very early.\nHistory of diverticulitis\nPatent foramen ovale (dx during hospital stay)\n", + "input4": "Mother passed away from CHF\nFather living, diagnosed with A. fib at age ___\n", + "input5": "Vitals: T: 98.6 HR: 89 BP: 143/89 RR: 15 SaO2: 100% RA\nGeneral: Awake, cooperative, NAD.\nHEENT: no scleral icterus, MMM, no oropharyngeal lesions. \nPulmonary: Breathing comfortably, no tachypnea nor increased \nWOB\nCardiac: Skin warm, well-perfused. \nAbdomen: soft, ND\nExtremities: Symmetric, no edema. \n\nNeurologic Examination:\n- Mental status: Awake, alert, oriented to self, 'hospital' but not which, stated ___. Able to relate history with mild difficulty. Mildly inattentive, with MOYB he names each month slowly and skips ___ before self-correcting unprompted. Speech is fluent with normal grammar and syntax. No paraphasic errors. Naming intact to low frequency words. Repetition intact. Reading intact. Comprehension intact to complex commands. Normal prosody. Able to register 3 objects at 30 seconds and recall ___ at 5 minutes, ___ with category clue, ___ with MC. No evidence of hemi-neglect. \n\n-Cranial Nerves: PERRL 3->2. Dense R homonymous hemianopsia. \nEOMI without nystagmus. Facial sensation intact to light touch. Face symmetric at rest and with activation. Hearing intact to conversation. Palate elevates symmetrically. ___ strength in trapezii bilaterally. Tongue protrudes in midline and moves briskly to side.\n\n- Motor: Normal bulk and tone. Subtle right pronation without downward drift. No tremor nor asterixis.\n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___ 5 5 5 5 \nR 5 ___ ___ 5 5 5 5 \n\n-DTRs:\n Bi Tri ___ Pat Ach Pec jerk Crossed Abductors\n L 2 2 2 3 3 - -\n R 2 2 2 3 3 - -\nPlantar response was flexor bilaterally.\n\n-Sensory: No deficits to light touch, cold sensation throughout. Proprioception intact to all but the smallest movements bilateral toes\n\n- Coordination: No dysmetria with finger to nose testing\nbilaterally. \n\n- Gait: deferred\n", + "input6": "___ 08:14AM BLOOD WBC-8.3 RBC-4.58* Hgb-14.9 Hct-44.5 \nMCV-97 MCH-32.5* MCHC-33.5 RDW-12.4 RDWSD-44.0 Plt ___\n___ 10:19PM BLOOD Neuts-56.7 ___ Monos-7.8 Eos-0.5* \nBaso-0.2 Im ___ AbsNeut-5.57 AbsLymp-3.39 AbsMono-0.77 \nAbsEos-0.05 AbsBaso-0.02\n___ 08:14AM BLOOD ___ PTT-26.7 ___\n___ 08:14AM BLOOD Glucose-109* UreaN-13 Creat-1.0 Na-140 \nK-4.2 Cl-103 HCO3-24 AnGap-17\n___ 08:14AM BLOOD Calcium-9.8 Phos-3.5 Mg-2.3 Cholest-201*\n___ 08:14AM BLOOD %HbA1c-5.7 eAG-117\n___ 08:14AM BLOOD Triglyc-155* HDL-32 CHOL/HD-6.3 \nLDLcalc-138*\n___ 08:14AM BLOOD TSH-1.9\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Hyperthyroidism/13746170-DS-4.json b/Finished/Thyroid Disease/Hyperthyroidism/13746170-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..0c1363bdb725b09d261f662dfaacb4601ddf9167 --- /dev/null +++ b/Finished/Thyroid Disease/Hyperthyroidism/13746170-DS-4.json @@ -0,0 +1,39 @@ +{ + "Hyperthyroidism$Intermedia_3": { + "high levels of T4 is a diagnostic criteria of hyperthyroidism$Cause_1": { + "T4-14.7$Input6": {} + }, + "high levels of T3 is a diagnostic criteria of hyperthyroidism$Cause_1": { + "T3-292$Input6": {} + }, + "Low levels of TSH is a diagnostic criteria of hyperthyroidism$Cause_1": { + "TSH-<0.02$Input6": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Anxiety is the symptom of hyperthyroidism$Cause_1": { + "Anxiety$Input3": {} + }, + "Weight loss is a symptom of hyperthyroidism$Cause_1": { + "She has lost some weight unintentionally (from 209 to 177 pounds)$Input2": {} + }, + "Increased heart rate is a symptom of hyperthyroidism$Cause_1": { + "The rhythm was sinus tachycardia at rest$Input6": {} + }, + "Tachycardia is a symptom of hyperthyroidism$Cause_1": { + "She was persistently tachycardic through her stay$Input2": {} + }, + "Easily tired is a symptom of hyperthyroidism$Cause_1": { + "feeling fatigued$Input2": {} + }, + "Sweating easily is a symptom of hyperthyroidism$Cause_1": { + "sometimes with diaphoresis$Input2": {} + } + } + }, + "input1": "Chest pain\n", + "input2": "She is a woman with morbid obesity and reflux coming with chest pain and shortness of breath. She was in her prior state of health with very poor baseline functional status until approximately 1 week ago when she started having oppresive chest pain in her retro-sternal area from the neck to the epigastrium. Excercise, activity and food make the chest pain worse and rest makes it better. She has not tried any medication. The chest pain is rarely associated with nausea, but sometimes with diaphoresis. She has also noted worsening of her shortness of breath while walking of going up a flight of stairs and has been feeling fatigued. Her appetite is intact (very good), normal bowel movements, no change in diet, normal urine, no fever, chills, rigors. She denies any PND, uses 1 pillow at night and states she can lie flat. Her leg swelling has gotten worse during last 2 months and she has noted darkening of the skin in her feet. She has lost some weight unintentionaly (from 209 to 177 pounds). Her pain got worse today and she decided to come to the emergency room. \n. \nIn our ED her initial VS were 98 119 151/90 20 100%. She had a normal physical exam. She received Maalox, Donnatol and lidocaine with improvement of her chest pain. Her labs were significant for WBC 6.8, HCT of 32, PLTs 178, normal BMP-7, BNP of 1182, Trop-T: <0.01, negative HCG and UA. Her ECG showed sinus tachycardia, but no signs of ischemia. She underwent a CXR that ruled out pneumonia, PE-Ct, which showed non-specific mediastinal lymphadenopathy and a possible renal mass that will need outpatient follow up, but no PE. She had negative LENIs. She was persistently tachycardic through her stay and was admitted to medicine for further work up. VS prior to transfer: 98.6 100 126/80 18 100RA. \n\ufeff\n", + "input3": "+Obesity: BMI: 30.5 \n+Venous insufficiency \n+Gastritis \n+Anxiety \n+Fibromyalgia\n", + "input4": "Mother diet of an MI. She had HTN and DM2. Father diet of asthma YO; he had PVD. She has many sibblings all healthy. No family history of cancer, premature CAD or stroke.\n", + "input5": "Physical Exam:\nADMISSION\nVITAL SIGNS - Temp 97.6 F, BP 124/87 mmHg, HR 101 BPM, RR 18 X', O2-sat 100% RA \nGENERAL - well-appearing woman in NAD, comfortable, appropriate, not jaundiced (skin, mouth, conjuntiva) \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, JVD mildly elevated to 12 cm, no carotid bruits \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use \nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN - huge abdomen, NABS, soft/NT/ND, no masses or HSM, no rebound/guarding. \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, \nDPs), chronic venous stasis changes in both legs with black-bluish coloration in both feet; no ulcers, good pulses \nSKIN - no rashes or lesions \nLYMPH - no cervical, axillary, or inguinal LAD \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, sensation grossly intact throughout, DTRs 2+ and symmetric, cerebellar exam intact, steady gait \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+\n\ufeff\n", + "input6": "Blood Counts\n___ 01:30PM BLOOD WBC-6.8 RBC-4.07* Hgb-11.0* Hct-32.5* MCV-80* MCH-27.0 MCHC-33.8 RDW-13.1\n___ 07:28AM BLOOD WBC-6.3 RBC-4.03* Hgb-10.5* Hct-32.3* MCV-80* MCH-26.2* MCHC-32.6 RDW-13.3\n\ufeff\nChemistry\n___ 01:30PM BLOOD Glucose-101* UreaN-15 Creat-0.6 Na-142 K-4.3 Cl-107 HCO3-26 AnGap-13\n___ 07:35AM BLOOD Glucose-107* UreaN-24* Creat-0.7 Na-142 K-4.5 Cl-105 HCO3-26 AnGap-16\n\ufeff\nCardiac\n___ 01:30PM BLOOD CK-MB-2 proBNP-1182*\n___ 01:30PM BLOOD cTropnT-<0.01\n___ 07:28AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:28AM BLOOD Triglyc-55 HDL-52 CHOL/HD-2.4 LDLcalc-60\n\ufeff\nAnemia\n___ 01:30PM BLOOD calTIBC-250* Ferritn-150 TRF-192*\n\ufeff\nEndocrine\n___ 07:28AM BLOOD T4-14.7* T3-292*\n___ 07:28AM BLOOD TSH-<0.02*\n\ufeff\n___ ETT\nThis woman was referred to the lab for evaluation of chest discomfort. The patient exercised for 7.5 minutes of a modified Gervino protocol and stopped for fatigue. The estimated peak MET capacity was 3 which represents a poor functional capacity for her age. No arm, neck, back or chest discomfort was reported by the patient throughout the study. There were no significant ST segment changes during exercise or in recovery. The rhythm was sinus tachycardia at rest, during exercise and in recovery with 1 apb in early recovery. Appropriate BP response during exercise and recovery.\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Hyperthyroidism/13787731-DS-4.json b/Finished/Thyroid Disease/Hyperthyroidism/13787731-DS-4.json new file mode 100644 index 0000000000000000000000000000000000000000..0924c90701b4dde17a0388451dd02cfe08a8c579 --- /dev/null +++ b/Finished/Thyroid Disease/Hyperthyroidism/13787731-DS-4.json @@ -0,0 +1,27 @@ +{ + "Hyperthyroidism$Intermedia_3": { + "A significant decrease in TSN is a symptom of hyperthyroidism$Cause_1": { + "TSH that was essentially undetectable.$Input6": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Difficulty breathing is a symptom of hyperthyroidism$Cause_1": { + "increasing SOB$Input1": {} + }, + "Changes in bowel patterns are symptoms of hyperthyroidism$Cause_1": { + "have some rectal pain with bowel movements$Input2": {} + }, + "Sweating is a symptom of hyperthyroidism$Cause_1": { + "Her hot flashes, and sweating have nearly resolved$Input2": {} + }, + "Fatigue is a symptom of hyperthyroidism$Cause_1": { + "fatigued appearing.$Input5": {} + } + } + }, + "input1": "increasing SOB\n", + "input2": "She is a woman with active breast cancer who recently started adriamycin and taxol. She tolerated the first two treatements of taxol but then developed shortness of breath. Suspecting anthracycline-induced cardiomyopathy, she got an echo that was unremarkable. A CTA was performed to evaluate for PE and was also negative. The onc attending wants to admit for a cardiac work-up including possible stress test and PFTs. She is clinically stable, 99% on RA, HR increases to 140s with exercise. She does not appear volume overloaded and lasix for the past few weeks has not changed her symptoms.\nINTERVAL HISTORY: She with stage IIA invasive ductal L. breactcancer s/p bilateral mastectomy who presents for week 4of weekly Taxol s/p dd-AC on trial. Her scheduledweek 4 treatment was held due to persistent edema andexertional shortness of breath.Since her last visit she has had little improvement in her SOB.Her PE-CT was normal and her edema has improved off Taxol.She continues to have exertional SOB associated with mildsubsternal discomfort which resolves with rest in less than. No rest pain, N/V, dizziness. She denies fevers,chlls, cough. She is able to walk slowly for several meterswithout symptoms. No PND. No palpitations.She continues to have some rectal pain with bowel movements whichshe describes as throbbing/burning/itching. There is no painbetween bowel movements. She rarely notices a small amount ofblood on several of her stools. She is using baby wipes and buttpaste to minimize the irritation. No fevers or chills. Herappetite is below baseline although her weight is stable. She denies N/V. Her hot flashes, and sweating have nearly resolved. Shecontinues to sporadic headaches, and denies associated visionchanges, neck stiffness, focal weakness. Her sleep hassignificanly improved on Trazadone and she is currently using150mg PO QHS.ROS:A complete review of systems is otherwise negative. \n\ufeff\n", + "input3": "ONCOLOGIC HISTORY: Left breast Stage IIA Invasive Ductal Cancer\n1. Left breast cancer, stage IIA (pT2 pN0), IDC grade 3, ER/PR+, HER2 negative, premenopausal at diagnosis\na. patient noted mass, confirmed by PCP\nb. diagnostic left breast imaging lobulated mass in the inferior breast at 6:00, approximately 3 cm by US and 3.3 cm bymammogram\nc. left breast core biopsy; IDC grade 3, ER/PR+, HER2negative by FISH (ratio 0.8)\nd. bilateral mastectomy and left SLNB; right breast nomalignancy; left breast 3.4 cm grade 3 ductal carcinoma withfocal mucinous features, negative SLNB, clear surgicalmargins\ne.bilateral lat flap reconstructions\nf. No BRCA mutation identified\ng. PORT placed\nh. Debridement of 10 cm of the back, with evacuationof the seroma, closure over a drain, and complex repair.\ni. C1D1 dd-AC on trial TEXT which is APhase III Trial Evaluating the Role of Exemestane Plus GnRHAnalogue as Adjuvant Therapy for Premenopasual Women with Endocrine Responsive Breast Cancer\nj. C2D1 dd-AC\nk. C3D1 dd-AC\nl. C4D1 dd-AC complicated grade 2 mucositis and grade 1fatigue\nm. C1D1 weekly Taxol 80mg/m2\nN. Week 2 Taxol 80mg/m2\no. Week 3 Taxol 80mg/m2\np. Week 4 Taxol 80mg/m2--held for fatigue, SOB, worsening edem\nGYN History:\nPast Obstetric and Gynecologic Histories:\nAge at menopause: pre-menopausal\nPregnancies: none\nUse of oral contraceptives: no\nHistory of prior radiation: no\nOther PMH:\nDepression\nBilateral breast reduction\n\ufeff\n", + "input4": "- Maternal grand-mother lung cancer\n- Great-grand-mother breast cancer\n- 2 great aunts breast cancer\n", + "input5": "Physical Exam:\n98.1 124/60 93 20 96%RA\nWalking ambulatory 02 sat 98-99% on RA, heart rate to 140s and regular\nGEN: fatigued appearing.\nHEENT: Pupils equal round and reactive, extraocular movementsintact, OP clear w/o lesions or evidence of thrush.\nNECK: JVP 7cm although difficult to assess habitus\nCV: nl s1s2, tachycardic, no clear S3/4, RV heave or murmur.\nPULM: Clear to auscultation with minimal decrease at bases b/l,no crackles/wheezes. R. chest port side is non-tender withoutoverlying erythema or fluctuance\nABD: obese,soft, non-tender, non- distended, +Bowel sounds\nLYMPH: no cervical, axillary or inguinal LAD apprecaited\nEXT: warm, well perfused, 2+ non-pitting edema up tibiabilaterally. No erythema or tenderness to palpation.\nSKIN: Well healed L. sided chest-wall incision. No purulence, ortenderness. Her incision is closed without surrounding erythemaor dehiscence. There are no areas of fluctuance.\nNEURO: AOx3, CN2-12 intact, grossly normal sensation, gait steady. \n\ufeff\nOn admission:\nShe ECHO The left atrium is normal in size. Left ventricular wall thickness, cavity size, and global systolic function are normal (LVEF>55%). Due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. Tissue Doppler imaging suggests a normal left ventricular filling pressure (PCWP<12mmHg). The ascending aorta is mildly dilated. The aortic valve leaflets are mildly thickened (?#). There is no aortic valve stenosis. No aortic regurgitation is seen. The mitral valve leaflets are structurally normal. There is no mitral valve prolapse. No mitral regurgitation is seen. The pulmonary artery systolic pressure could not be determined. There is no pericardial effusion.\n\ufeff\nIMPRESSION: \nSuboptimal image quality. Normal global left ventricular systolic dysfunction. Right ventricle not well visualized, but function is probably normal. No pathologic valvular disease. Indeterminate pulmonary artery pressure. \n\ufeff\n", + "input6": "RELEVANT LABS:\nWBC Hct MCV Plt Ct\n___ 11:30 6.5 33.3* 98 324---nearly normal diff\n___ 11:20 6.3 28.8* 98 362\n___ 11:40 6.9 30.4* 91 279\n___ 11:55 8.9 31.9* 90 288\n___ 11:30 6.6 35.6* 91 241\n___ 11:45 6.5 39.2 94 276UreaN Creat\n___ 11:30 14 0.8\n___ 11:40 13 0.8\n___ 11:45 11 0.8ALT AST CK AlkPhos TotBili\n___ 11:30 37 26 43 87 0.4\n___ 11:40 21 16 101 0.2\n___ 11:55 18 16 115* 0.2\n___ 11:30 18 15 108* 0.2\n___ 11:45 16 15 115* 0.2\n___ 13:50 11 16 113* 0.2\n___ 11:24 33 25 85 0.2\nEKG: Sinus rhythm with. nonspecific ST-T wave changes, septalQ-waves. \n\nBLOOD:\nThe patient was found to have TSH that was essentially undetectable.\n\nRELEVANT RECENT IMAGING:\n- PE CT: NO PE. There is no axillary, mediastinal orhilar lymphadenopathy. There are no pleural effusions. No fillingdefects are noted in thepulmonary arteries. On lung windows,there are no masses. No consolidation or nodules are noted.\n- CXR PA+Lat: clear lungs, PORT in place, nocardiomegaly.\n- BID-N TTE: Unchanged, Normal LV wall thickness, cavitysize and regional/global systolic function (LVEF >55%). Normalvalves, trivial MR/TR, no pericardial effusion\n- BID-N TTE: Normal LV wall thickness, cavity size andregional/global systolic function (LVEF >55%). Doppler parametersare most consistent with normal LV diastolic function. Normal valves, trivial MR/TR, no pericardial effusion.\n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Hyperthyroidism/16471629-DS-2.json b/Finished/Thyroid Disease/Hyperthyroidism/16471629-DS-2.json new file mode 100644 index 0000000000000000000000000000000000000000..16960955dd5788d5a76db47ca89ac812c036cf11 --- /dev/null +++ b/Finished/Thyroid Disease/Hyperthyroidism/16471629-DS-2.json @@ -0,0 +1,24 @@ +{ + "Hyperthyroidism$Intermedia_3": { + "Low TSH levels are diagnostic criteria for hyperthyroidism$Cause_1": { + "TSH-LESS THAN 0.02$Input6": {} + }, + "High T4 levels are diagnostic criteria for hyperthyroidism$Cause_1": { + "T4-GREATER TH 18$Input6": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Heart palpitations and shortness of breath are typical symptoms of hyperthyroidism.$Cause_1": { + "Patient reports episodes of heart palpitations/racing and SOB. These episodes occur both with exertion and at rest.$Input2": {} + }, + "An increased heart rate (heart rate 140) is a typical symptom that may occur with hyperthyroidism.$Cause_1": { + "She was seen in clinic today where her HR was noted to be 140.$Input2": {} + } + } + }, + "input1": "palpitations\n", + "input2": "G1P0 at EGA presents to Gyn triage with SOB, heart palpitations, and lower extremity edema. Patient reports episodes of heart palpitations/racing and SOB. These episodes occur both with exertion and at rest. She reports symptoms for the past three weeks. She notes up to 10 episodes per day, each lasting a few minutes. She was seen in clinic today where her HR was noted to be 140. She denies dizziness. Denies chest pain or tightness. Denies syncope. No recent travel. No h/o DVT or PE.\nNo significant family history of clots or cardiac issues (father w/ MI. No cocaine. Limited caffeine. \n\nROS: No VB. No LOF. No fever. No nausea or vomiting. Tol PO. No diarrhea.\n", + "input3": "PMH:\nh/o over active bladder\n\nPSH:\nExtraction wisdom teeth\n\n", + "input4": "nc\n", + "input5": "VS: T 99.0 BP 135/65 HR 105 RR 18 O2Sat 99% RA\nGen: NAD\nCV: RRR, no r/m/g\nPulm: CTAB, no crackles/wheezes\nAbd: soft, NT, ND, no rebound/guarding\nBedside U/S: SIUP, FHR 140's, good movement, normal fluid\n", + "input6": "___ 06:31PM GLUCOSE-104 UREA N-9 CREAT-0.4 SODIUM-139 POTASSIUM-4.1 CHLORIDE-107 TOTAL CO2-24 ANION GAP-12\n___ 06:31PM estGFR-Using this\n___ 06:31PM ALBUMIN-3.5 CALCIUM-9.1 PHOSPHATE-4.4 MAGNESIUM-1.7\n___ 06:31PM TSH-LESS THAN 0.02\n___ 06:31PM T4-GREATER TH 18 calcTBG-0.66* TUptake-1.52* FREE T4-3.7*\n___ 06:31PM WBC-7.5 RBC-3.64* HGB-11.0* HCT-31.6* MCV-87 MCH-30.3 MCHC-34.9 RDW-12.0\n___ 06:31PM PLT COUNT-208\n___ 01:45PM BLOOD WBC-7.0 RBC-3.41* Hgb-10.4* Hct-29.9* MCV-88 MCH-30.6 MCHC-35.0 RDW-12.2\n___ 06:05AM BLOOD Iron-86\n___ 06:05AM BLOOD calTIBC-269 Ferritn-153* TRF-207\n\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Hyperthyroidism/16693380-DS-20.json b/Finished/Thyroid Disease/Hyperthyroidism/16693380-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..bbf029b6a5abc9d17d59716a86370d4312d24ddb --- /dev/null +++ b/Finished/Thyroid Disease/Hyperthyroidism/16693380-DS-20.json @@ -0,0 +1,51 @@ +{ + "Hyperthyroidism$Intermedia_3": { + "Low level of TSH is the diagnostic criteria for hyperthyroidism$Cause_1": { + "TSH< 0.03 (at OSH)$Input6": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Weakness is often seen with hyperthyroidism$Cause_1": { + "weakness$Input1": {} + }, + "Weight loss is often seen with hyperthyroidism$Cause_1": { + "weightloss$Input1": {} + }, + "Propylthiouracil (PTU) is a drug used to treat hyperthyroidism$Cause_1": { + "she was started on PTU$Input2": {} + }, + "Propranolol is a beta-blocker commonly used to control rapid heart rate caused by hyperthyroidism$Cause_1": { + "she has been taking propranolol$Input2": {} + }, + "Using iodine drops may be linked to thyroid disease$Cause_1": { + "she was on iodine drops$Input2": {} + }, + "Nausea is one of the possible symptoms of hyperthyroidism$Cause_1": { + "She also feels nauseated all the time$Input2": {} + }, + "Eye swelling and increased tearing may indicate thyroid-related eye disease$Cause_1": { + "She states her eyes are swollen and always teary$Input2": {} + }, + "Palpitations and rapid heartbeat are common symptoms of hyperthyroidism$Cause_1": { + "She reports palpitations, heart \"pounding\"$Input2": {} + }, + "Frequently feeling high body temperature is one of the characteristics of hyperthyroidism$Cause_1": { + "she feels warm all the time$Input2": {} + }, + "Increased sweating may also be associated with hyperthyroidism$Cause_1": { + "She also has diaphoresis as well$Input2": {} + }, + "An enlarged thyroid gland is the symptom for hyperthyroidism$Cause_1": { + "thyroid enlarged$Input5": {} + }, + "Anxious is the symptom for hyperthyroidism$Cause_1": { + "anxious$Input5": {} + } + } + }, + "input1": "weakness, weightloss\n", + "input2": "She yo female who presents with symptoms of vomiting. She's not sure initially what she was placed on, but states at one point she was on iodine drops. Also, a few weeks ago, while she was hospitalized for similar symptoms, she'd been placed on prednisone with significant improvement of her symptoms and weight gain. She has been off all these medications because she lost her insurance (she's not sure why- her health insurance is ___ health insurance). About 3 weeks ago, she was started on PTU, and she has been taking propranolol as well. Her shakiness has improved, but the weightloss continues. She also feels nauseated all the time as well. She states her eyes are swollen and always teary. Also,she states that her PCP and another doctor told her she has some liver damage and repeated test for hepatitis, but she does not know the results of these tests. She reports palpitations, heart \"pounding\", rare diarrhea, headache. She denies fevers. She states she feels warm all the time. Her tremor has improved. She denies chest pains. She also has diaphoresis as well. \n\ufeff\nInitial vitals 98.8, 143/70, 77, 16, 99%. She was given IVFs and cipro in the ED for presumed UTI. Vitals prior to transfer were 94.8, 69, 147/75, 18, 99% RA. \n\ufeff\nCurrently, she complains of headache. She states she just overall doesn't feel well. She presented to the OSH ED earlier today due to symptoms of vomiting. \n\ufeff\n10 system review of systems is as above or otherwise negative. \n\ufeff\n", + "input3": "N/A\n", + "input4": "No family history of thyroid disease\n", + "input5": "Physical Exam:\nVitals: 96.8 149/79 72 18 99% RA\nGen: thin female, anxious\nHEENT: swollen eyelids. mild exopthalmos. thyroid enlarged, no nodules appreciated. JVP flat. no adenopathy\nCV: RRR, no MRG\nLungs: CTA bilaterally, no wheezes or rhonci\nAbdomen: soft, NT, normal BS. no hepatoslenomegaly\nExt: no edema\nNeuro: CN grossly intact. mild tremor. motor strength\nPsych: A/O x 3\nSkin: no rash\n", + "input6": "Trop-T: <0.01 \n\ufeff\n141 109 15 \n------------< 96 \n3.6 23 0.5 \n\ufeff\nCK: 39 MB: 1 \n\ufeff\nALT: 21 AP: 195 Tbili: 0.4 \nAST: 23 LDH: 173 \n \nTSH:Pnd Free-T4:Pnd \n\ufeff\n13.4\n6.8 >-----< 241 \n39.4 \nN:44.0 L:41.1 M:6.5 E:6.9 Bas:1.5 \n\ufeff\nTSH< 0.03 (at OSH)\nT4: 4.6\n\ufeff\nSpecGr 1.020 \npH 5.0 \nUrobil Neg \nBili Neg \nLeuk Neg \nBld Neg \nNitr Pos \nProt 25 \nGlu Neg \nKet 15 \nBact Many \nYeast None \n\ufeff\nUCG- negative\n\ufeff\nECG: NSR rate 70. 1 mm STD in V5. no acute ischemic changes. \n\ufeff\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Hypothyroidism/11697485-DS-10.json b/Finished/Thyroid Disease/Hypothyroidism/11697485-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..2f0f93ed0429c39c1675d7cc92c16b83688b409a --- /dev/null +++ b/Finished/Thyroid Disease/Hypothyroidism/11697485-DS-10.json @@ -0,0 +1,42 @@ +{ + "Hypothyroidism$Intermedia_3": { + "High TSH levels are a clear indicator of hypothyroidism$Cause_1": { + "TSH-65$Input6": {} + }, + "Low free T4 levels are also a sign of hypothyroidism.$Cause_1": { + "FREE T4-0.53$Input6": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Fatigue is one of the common symptoms of hypothyroidism$Cause_1": { + "fatigue$Input1": {} + }, + "Extreme fatigue is one of the common symptoms of hypothyroidism$Cause_1": { + "extreme fatigue$Input2": {} + }, + "Increased intolerance to cold, which is a symptom of impaired thermoregulation in hypothyroidism.$Cause_1": { + "noticed some increased cold intolerance since starting the medication as well, requiring extra blankets at home$Input2": {} + }, + "Although weight loss is often associated with hyperthyroidism, weight loss may also be observed in some cases of hypothyroidism, especially when accompanied by other symptoms such as loss of appetite$Cause_1": { + "Has had 10 lb weight loss$Input2": {} + }, + "Increased difficulty swallowing, although this is not a typical symptom of hypothyroidism, an enlarged thyroid gland may cause a feeling like something is stuck in the throat.$Cause_1": { + "Has had increased dysphagia with swallowing pills, stating that he feels like they get stuck in his upper throat.$Input2": {} + }, + "Eye swelling may indicate thyroid-related eye disease$Cause_1": { + "significant swelling around his eyes$Input2": {} + }, + "Patients with hypothyroidism may experience bradycardia$Cause_1": { + "bradycardic$Input5": {} + }, + "Hypothyroidism may cause a decrease in basal body temperature$Cause_1": { + "97.1$Input5": {} + } + } + }, + "input1": "nausea, vomiting, fatigue, hallucinations\n", + "input2": "He is a man with history of metastatic renalcell carcinoma to lung and sinuses, who started therapy with AMG 386 and Sunitinib according to the protocol. He received a total of three administrations of AMG 386. The therapy was held due to multiple symptoms, including nausea, vomiting, diarrhea, extreme fatigue, and hallucinations. \n.\nThe patient reports onset of most of these symptoms after his second treatment, including nausea and vomiting 4 days ago ('orange colored, no bile or blood, vomiting 2x/day) and hallucinations of seeing people who have passed away (including his mother). He has no hallucinations currently. Also, after administration of the AMG 386 he experienced significant swelling around his eyes. He has been much more fatigued, and noticed some increased cold intolerance since starting the medication as well, requiring extra blankets at home. Has had 10 lb weight loss. Denies any tremors, hair loss, constipation or diarrhea. Has had increased dysphagia with swallowing pills, stating that he feels like they get stuck in his upper throat. \n\ufeff\nHe also complains of L-sided abdominal pain that radiates to his L groin and L leg. Been present for months, but has worsened recently. Has not noticed any masses in his groin, but pain seems to worsen with bearing weight. \n.\nOn the floor, patient denies any nausea after receiving some anti-emetics in clinic, pain or confusion.\n.\nReview of systems: \n(+) per HPI and including: yellow mucous draining from sinuses. 10 lb weight loss over past two weeks. worsening fatigue. \n(-) Denies fever, chills, night sweats. Denies headache. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied diarrhea, constipation. No recent change in bowel or bladder habits or dysuria. Denies headache, photophobia, visual difficulties, or neck stiffness, paralysis of extremities or decreased sensation. Denies any decreased urinary frequency. \n\ufeff\n", + "input3": "ONCOLOGIC HISTORY:\nDiagnosis of Stage IV clear cell renal cell carcinoma\nLeft-sided nephrectomy (we do not have the original pathology or detailssurrounding this operation). \nPresented for evaluation of pain in his leftgroin and testicle. An abdominal CT scan showed multiplepulmonary nodules at the lung bases, up to 1 cm in size.\nCT-guided biopsy confirmed metastatic clear cellcarcinoma thought to be consistent with a renal cell carcinomaprimary. \nPET CT confirmed multiple pulmonary nodules (thoughthey were not found to be FDG avid) and showed \"completeopacification of the right maxillary sinus by soft tissueattenuation which demonstrates mild hypermetabolic uptake. There is associated destruction of the anterior,posterior, and medialwalls of the right maxillary sinus, the floor of the maxillarysinus as well as destruction of the inferior wall of the orbit.\" \n\ufeff\nBiopsy of the right and left maxillarysinuses: the right maxillary sinus mass biopsy confirmed thepresence of metastatic clear cell renal cell carcinoma; theleft-sided sinus biopsy was benign. \nStarted therapy with Sunitinib + AMG 386 on protocol \n\ufeff\n(CT Torso showed decrease size of some of thepulmonary lesions, the other being stable)- sunitinib d/c,AMG 386 third and last dose, held due to worsening of symptoms including nausea, vomiting, hallucinations.\n.\nPMH:\nHypertension\nGout\n\ufeff\n", + "input4": "sister with stomach cancer\n", + "input5": "Physical Exam:\nVS: 97.1 170/108 63 18 94% on RA\nGA: well appearing male, AOx3, NADHEENT: PERRLA. MMM. no LAD. no JVD. neck supple. no thyromegaly palpated; small pad of palpable tissue noted overlying the substernal notch\nCards: PMI palpable at IC space. No RVH. bradycardic, S1/S2 heard. no murmurs/gallops/rubs.\nPulm: CTAB no crackles or wheezes\nAbd: soft, TTP in the LLQ, +BS. no g/rt. neg HSM.\nExtremities: wwp, no lower extremity edema or pretibial myxedema. DPs, PTs 2+.\nGroin: mild mass palpated in L groin on tussive maneuvers.\nNeuro/Psych: CNs II-XII intact. DTRs decreased (sensation intact to LT, pain, temperature, vibration, proprioception. cerebellar fxn intact (FTN, HTS). gait WNL. \n\ufeff\nAb US\nIMPRESSION: Moderately distended gallbladder with sludge and stones within,with mild pericholecystic fluid. The lack of gallbladder wall thickening ortenderness make acute cholecystitis less likely, but this is not excluded. Clinical correlation is advised. In the setting of equivocal clinicalsymptoms, a HIDA scan can be considered.\n\ufeff\nMRA/Head MRI:\nIMPRESSION:\n1. Large right maxillary sinus mass minimally decreased in size, more heterogeneous in appearance, likely representing necrosis.\n2. Paranasal sinus disease as described.\n3. Diminutive left vertebral artery. No evidence of stenosis, occlusion, or aneurysm.\n\ufeff\n", + "input6": "___ 11:21PM CK(CPK)-1232*\n___ 11:21PM CK-MB-10 MB INDX-0.8 cTropnT-0.02*\n___ 12:47PM GLUCOSE-125*\n___ 12:47PM UREA N-21* CREAT-1.5* SODIUM-141 POTASSIUM-3.8 CHLORIDE-99 TOTAL CO2-30 ANION GAP-16\n___ 12:47PM estGFR-Using this\n___ 12:47PM ALT(SGPT)-38 AST(SGOT)-87* LD(LDH)-458* CK(CPK)-1527* ALK PHOS-89 AMYLASE-45 TOT BILI-1.2 DIR BILI-0.4* INDIR BIL-0.8\n___ 12:47PM LIPASE-45\n___ 12:47PM CK-MB-11* MB INDX-0.7 cTropnT-0.02*\n___ 12:47PM TOT PROT-6.4 ALBUMIN-3.5 GLOBULIN-2.9 CALCIUM-9.4 PHOSPHATE-3.3 MAGNESIUM-2.4 URIC ACID-5.4\n___ 12:47PM TSH-65*\n___ 12:47PM FREE T4-0.53*\n___ 12:47PM WBC-6.7 RBC-5.03 HGB-15.7 HCT-45.5 MCV-90 MCH-31.3 MCHC-34.6 RDW-15.7*\n___ 12:47PM NEUTS-81.5* LYMPHS-14.1* MONOS-3.4 EOS-0.9 BASOS-0.2\n___ 12:47PM PLT COUNT-143*\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Hypothyroidism/13561991-DS-10.json b/Finished/Thyroid Disease/Hypothyroidism/13561991-DS-10.json new file mode 100644 index 0000000000000000000000000000000000000000..2c4c510bd5fd0890eb8bf45d3554d162f1166988 --- /dev/null +++ b/Finished/Thyroid Disease/Hypothyroidism/13561991-DS-10.json @@ -0,0 +1,27 @@ +{ + "Hyperthyroidism$Intermedia_3": { + "Low free T4 levels are a sign of hypothyroidism$Cause_1": { + "FREE T4-0.53$Input5": {} + }, + "Elevated TSH levels are a classic sign of hypothyroidism$Cause_1": { + "TSH-65$Input5": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Common symptoms of hypothyroidism include fatigue$Cause_1": { + "extreme fatigue$Input2": {} + }, + "Common symptoms of hypothyroidism include sensitivity to cold$Cause_1": { + "increased cold intolerance$Input2": {} + }, + "The patient's use of thyroid medication may be irregular, which may be affecting her thyroid function$Cause_1": { + "she thinks she is only supposed to take her thyroid medication as needed$Input2": {} + } + } + }, + "input1": "\"People are following me, and I just can't take it anymore\"nausea, vomiting, fatigue, hallucinationsMassive hemoptysis\n", + "input2": "She has PTSD, and anxiety presenting after being brought in by EMS i/s/o paranoid ideation.\n \nSays \"it actually has been going on before then, it's just that I first noticed it Says that people have been following her. At first there was 1 man with a gun. She was only able to see him from the back. At this point, she says that there are multiple people following her. She does not know why they are following her, but thinks that it may be \"something they think I know.\" When asked to further characterize how these people interact with her, she says that they whisper to her, and they copy her. For example, When I cough, they cough.\" When asked if other people can hear them, she says, \"I don't know. They should be able to hear them.\" Is insistent that she is not hearing things, and that \"These are actual things that I am hearing.\" \n \nShe says that the people took away her home, and elaborates by saying that the people that are following her took all of her belongings out of her house and replaced them with fake belongings. She feels that as a result of this, she is living in a homeless shelter. Her discussion about how she became homeless was difficult to follow, but she says that at one point she was changing the locks to her door multiple times to prevent the people that were following her from coming into the house.\n \nWhen asked specifically what happened today, she says, \"I was tired of being harassed.\" When asked about ideas of reference, says that the peoplehave been interfering with the TV. Denies thought insertion or thought removal. Endorses feeling depressed with decreased sleep,concentration, and anhedonia. Says that the people following her have been affecting where she is able to eat during the day, and sometimes\"I don't care for it,\" referring to a general disinterest in eating at times. Denies SI, and responds to my question about SI by saying, \"I want to do the things that I set out to do\" (referring to life goals that we had previously been talking about). Denies HI. Says, \"I wouldn't do that.\" Denies manic symptoms including decreased need for sleep, racing thoughts, increased goal-directed behavior. Denies having any friends, and says she has not been in touch with her family. Says she has not been taking any medications. Says she thinks she is only supposed to take her thyroid medication as needed, and doesn't think she needs it lately. Endorses increased drinking \"to find consolation\" in the setting of the people following her. Says she doesn't drink everyday, and is not able to be more specific about amount. H/o physical and emotional trauma as a child. Used to have nightmares and avoidance behavior, but this has lessened over the years.\n\ufeff\nPer EMS Run Report: Pt found standing swinging her umbrella around. Had heavy EtOH odor and slurred speech and gait difficulty. Said she drank \"E and J all day.\"\n\ufeff\nED course thus far: Received 5 mg IM Haldol and 2 mg IM Ativan for agitation. Per ED resident, pt said she thought she was in jail. \n\ufeffHe is a man with history of metastatic renalcell carcinoma to lung and sinuses, who started therapy with AMG 386 and Sunitinib according to the protocol. He received a total of three administrations of AMG 386. The therapy was held due to multiple symptoms, including nausea, vomiting, diarrhea, extreme fatigue, and hallucinations. \n.\nThe patient reports onset of most of these symptoms after his second treatment, including nausea and vomiting 4 days ago ('orange colored, no bile or blood, vomiting 2x/day) and hallucinations of seeing people who have passed away (including his mother). He has no hallucinations currently. Also, after administration of the AMG 386 he experienced significant swelling around his eyes. He has been much more fatigued, and noticed some increased cold intolerance since starting the medication as well, requiring extra blankets at home. Has had 10 lb weight loss. Denies any tremors, hair loss, constipation or diarrhea. Has had increased dysphagia with swallowing pills, stating that he feels like they get stuck in his upper throat. \n\ufeff\nHe also complains of L-sided abdominal pain that radiates to his L groin and L leg. Been present for months, but has worsened recently. Has not noticed any masses in his groin, but pain seems to worsen with bearing weight. \n.\nOn the floor, patient denies any nausea after receiving some anti-emetics in clinic, pain or confusion.\n", + "input3": "PAST PSYCHIATRIC HISTORY:\nDiagnoses: h/o psychosis i/s/o hypothyroidism, GAD, panic, PTSDHospitalizations: pt says was last hospitalized\nMedication and ECT trials: previously stabilized on risperidone 1 mg bid, previously on klonopin\nSelf-injury: no history\nHarm to others: denies\nAccess to weapons: none\n \nDoctor: no evidence of major mental illness at that time- pt was able to function well off of her risperdal- pt missed 2 scheduled f/u appts after this D . initial ED psychiatry consult note: pt presented w/ worsening paranoia, AH/VH, SI. Had relapsed on cocaine at the time. At that time, she had told her daughter that she couldn't handle having people following her anymore, and that she would have to kill herself. She had also reportedly jumped out of a building window at the time b/c she thought people were following her. According to BEST collateral at the time, she was first seen with paranoia. She was ultimately medically admitted and treated with 175 mcg of synthroid and risperidone 1 mg bid. It was felt that her symptoms were consistent with hypothyroidism-induced psychosis.\n \nPAST MEDICAL HISTORY:\nGrave's s/p ablation- medical admission w/ psychosis and SI i/s/o of nonadherence to thyroid meds and severe hypothyroidismONCOLOGIC HISTORY:\nDiagnosis of Stage IV clear cell renal cell carcinoma\nLeft-sided nephrectomy (we do not have the original pathology or detailssurrounding this operation). \nPresented for evaluation of pain in his leftgroin and testicle. An abdominal CT scan showed multiplepulmonary nodules at the lung bases, up to 1 cm in size.\nCT-guided biopsy confirmed metastatic clear cellcarcinoma thought to be consistent with a renal cell carcinomaprimary. \nPET CT confirmed multiple pulmonary nodules (thoughthey were not found to be FDG avid) and showed \"completeopacification of the right maxillary sinus by soft tissueattenuation which demonstrates mild hypermetabolic uptake. There is associated destruction of the anterior,posterior, and medialwalls of the right maxillary sinus, the floor of the maxillarysinus as well as destruction of the inferior wall of the orbit.\" \n\ufeff\nBiopsy of the right and left maxillarysinuses: the right maxillary sinus mass biopsy confirmed thepresence of metastatic clear cell renal cell carcinoma; theleft-sided sinus biopsy was benign. \nStarted therapy with Sunitinib + AMG 386 on protocol \n\ufeff\n(CT Torso showed decrease size of some of thepulmonary lesions, the other being stable)- sunitinib d/c,AMG 386 third and last dose, held due to worsening of symptoms including nausea, vomiting, hallucinations.\n.\nPMH:\nHypertension\nGout\n\ufeff+ Metastatic Thyroid Ca\n+ HTN\n+ Atrial Fibrillation\n+ Pulmonary Embolus - Anticoagulated with coumadin; has two small lesions on MRI head c/w mets but not contraindications to anticoag. \n+ Hypothyroidism\n\ufeff\n", + "input4": "FAMILY PSYCHIATRIC HISTORY: \nDenies h/o of mental illness or addictionsister with stomach cancerMother with h/o emphysema.\n", + "input5": "Physical Exam:\n\nPHYSICAL EXAM:\nGeneral- Well-developed, age-appearing woman in no acutedistress.\nSkin- Intact, without rashes, lesions or skin breakdown.\nHEENT- PERRLA, EOMI\nNeck- Supple, no thyromegaly. No lymphadenopathy. \nLungs- Clear to auscultation bilaterally.\nCV- Regular rate and rhythm.\nAbdomen- Non-tender, non-distended.\nExtremities- No edema.\nNeuro- \n- CN II-XII in tact and symmetric; no focal deficits\n- Strength wnl; moving upper and lower extremitiesspontaneously and with full ROM.\n- Gait wnl; narrow-based without ataxia.___ 11:21PM CK(CPK)-1232*\n___ 11:21PM CK-MB-10 MB INDX-0.8 cTropnT-0.02*\n___ 12:47PM GLUCOSE-125*\n___ 12:47PM UREA N-21* CREAT-1.5* SODIUM-141 POTASSIUM-3.8 CHLORIDE-99 TOTAL CO2-30 ANION GAP-16\n___ 12:47PM estGFR-Using this\n___ 12:47PM ALT(SGPT)-38 AST(SGOT)-87* LD(LDH)-458* CK(CPK)-1527* ALK PHOS-89 AMYLASE-45 TOT BILI-1.2 DIR BILI-0.4* INDIR BIL-0.8\n___ 12:47PM LIPASE-45\n___ 12:47PM CK-MB-11* MB INDX-0.7 cTropnT-0.02*\n___ 12:47PM TOT PROT-6.4 ALBUMIN-3.5 GLOBULIN-2.9 CALCIUM-9.4 PHOSPHATE-3.3 MAGNESIUM-2.4 URIC ACID-5.4\n___ 12:47PM TSH-65*\n___ 12:47PM FREE T4-0.53*\n___ 12:47PM WBC-6.7 RBC-5.03 HGB-15.7 HCT-45.5 MCV-90 MCH-31.3 MCHC-34.6 RDW-15.7*\n___ 12:47PM NEUTS-81.5* LYMPHS-14.1* MONOS-3.4 EOS-0.9 BASOS-0.2\n___ 12:47PM PLT COUNT-143*ADMISSION LBAS:\n___ 03:15AM BLOOD WBC-11.3*# RBC-4.03* Hgb-12.3* Hct-37.9* MCV-94 MCH-30.6 MCHC-32.4 RDW-13.3\n___ 03:15AM BLOOD Neuts-58.9 Monos-5.0 Eos-1.6 Baso-0.3\n___ 03:15AM BLOOD PTT-30.3\n___ 04:04AM BLOOD Glucose-261* UreaN-21* Creat-1.0 Na-141 K-4.3 Cl-107 HCO3-26 AnGap-12\n\ufeff\nCARDIAC ENZYMES:\n___ 03:15AM BLOOD cTropnT-0.03*\n___ 04:04AM BLOOD CK-MB-NotDone cTropnT-0.03*\n___ 04:04AM BLOOD CK(CPK)-68\n___ 04:04AM BLOOD Calcium-8.4 Phos-5.5* Mg-2.0\n\ufeff\n___ 06:43AM BLOOD pO2-64* pCO2-93* pH-7.08* calTCO2-29 Base XS--5 Intubat-INTUBATED\n\ufeff\nEKG: Sinus tachycardia with ST depressions in anteroseptal leads. \n\ufeff\nIMAGING:\nCXR: Inumerable small nodules c/w mets with marked progression, fluffy hilar infiltrates bilaterally c/w hemorrhage given clinical scenario of hemoptysis. Tip of ET tube not visualized.\n\ufeff\nPulmonary Angiography:\nNo active extravasation but multiple hypervascular masses, likely metastases. Bronchial artery embolization was performed bilaterally. \n\ufeff\nPET: IMPRESSION: Diffuse abnormal FDG uptake in the lungs and bone consistent with metastatic disease, which compared to prior exam shows slight increase in disease burden. Again noted are the large lytic lesions in the right femoral head/neck and C1 which remains high risk for fracture.\n", + "input6": "___ 03:00PM GLUCOSE-95 UREA N-15 CREAT-1.3* SODIUM-138 POTASSIUM-4.9 CHLORIDE-99 TOTAL CO2-27 ANION GAP-17\n___ 03:00PM ALT(SGPT)-28 AST(SGOT)-59* ALK PHOS-59 TOT BILI-0.2\n___ 03:00PM WBC-3.6* RBC-3.28* HGB-10.7* HCT-33.6* MCV-102* MCH-32.6* MCHC-31.8* RDW-13.8 RDWSD-51.9*\n___ 03:00PM PTT-37.1*. LEGAL & SAFETY: \nOn admission, the patient signed a conditional voluntary agreement (Section 10 & 11). She signed a three-day intent to leave on the afternoon that expired. She was placed on 15 minute checks on admission and remained on that level throughout her hospitalization without behavioral issues. She was discharged at the time of maturation of her three-day intent to leave though she was encouraged to stay to allow for more complete aftercare planning.\n \n2. SUBSTANCE USE DISORDERS:\n#) ALCOHOL USE DISORDER: While on the medical service, She was monitored for alcohol withdrawal with a diazepam-affiliated CIWA scale. She did not demonstrate any signs of withdrawal. She was discharged on folate and thiamine.\n \n3. PSYCHOSOCIAL\n#) GROUPS/MILIEU: \nThe patient was encouraged to participate in the various groups and milieu therapy opportunities offered by the unit. \n\ufeff\n#) COLLATERAL CONTACTS & FAMILY INVOLVEMENT\nShe was in frequent contact with the patient's daughter who agreed to allow her mother to return to live with her in her home.\n\ufeff\nThe team was in contact with the patient's former psychiatrist, doctor, who reported that she had been working with She when she was dealing with depression and anxiety, but that she has not ever noticed paranoia on an outpatient level. She also notes that She had not followed up for her last several appointments and she felt that she would be better served in a community setting that could offer closer follow-up, but she agreed to continue to follow with She while She establishes care with a new provider.\n\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Hypothyroidism/14596661-DS-6.json b/Finished/Thyroid Disease/Hypothyroidism/14596661-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..b77ec573afdcf3ee7cb2d1fb4735d6915a51c814 --- /dev/null +++ b/Finished/Thyroid Disease/Hypothyroidism/14596661-DS-6.json @@ -0,0 +1,39 @@ +{ + "Hypothyroidism$Intermedia_3": { + "Abnormally high TSH values is diagnostic criteria for hypothyroidism$Cause_1": { + "TSH-63$Input6": {} + }, + "Extreme low T3 values is a diagnostic criteria for hypothyroidism$Cause_1": { + "T3-38$Input6": {} + }, + "A low free T4 value is a symptom of hypothyroidism$Cause_1": { + "FREE T4-0.81$Input6": {} + }, + "A borderline T4 value is one of the common symptoms of hypothyroidism$Cause_1": { + "T4-5.1$Input6": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Positive TPO antibodies indicate autoimmune thyroiditis, a common cause of hypothyroidism$Cause_1": { + "Studies revealed severe hypothyroidism, positive TPO antibodies thyroiditis$Input2": {} + }, + "Drowsiness is a classic symptom of hypothyroidism$Cause_1": { + "Patient is too somnolent$Input2": {} + }, + "Hair loss, confusion, fatigue, and amenorrhea are classic symptoms of hypothyroidism$Cause_1": { + "history of hair loss, confusion, fatigue and amenorrhea.$Input2": {} + }, + "Lethargy and unresponsiveness can be symptoms of hypothyroidism$Cause_1": { + "Somnolent, minimally responsive to sternal rub, moans$Input5": {} + }, + "Dry skin is one of the common symptoms of hypothyroidism$Cause_1": { + "Dry skin$Input5": {} + } + } + }, + "input1": "AMS\n", + "input2": "SHe is with PMH significant for uterine fibroids who presents with AMS after elopement from yesterday. The patient was admitted for medical evaluation of psychosis. Studies revealed severe hypothyroidism, positive TPO antibodies thyroiditis.\n\nThe patient presented to the ED where initial vs: 98.2, 76, 144/88, 16, 96% RA. Exam notable for peristent AMS and signs of catatonia. The patient received Levothryoxine 125mcg and became agitated at one point requiring haloperidol 5mg and lorazepam 2mg. \n\nPatient is too somnolent for a history to be obtained on arrival to the floor. Records indicate a history of hair loss, confusion, fatigue and amenorrhea. \n", + "input3": "Uterine fibroids\n", + "input4": "Mother - RA\n", + "input5": "Vitals- 97.6, 111-126/68-79, 46-64, 16, 98%2L \nGeneral- Somnolent, minimally responsive to sternal rub, moans\nHEENT- PERLA, Sclera anicteric, MMM, oropharynx clear, no goiter \n \nNeck- Supple, JVP not elevated, no LAD \nLungs- CTAB no wheezes, rales, rhonchi \nCV- RRR, Nl S1, S2, No MRG \nAbdomen- Soft, NT/ND bowel sounds present, no rebound tenderness or guarding, \nExt- Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nNeuro- withdraws to pain\nSkin - Dry skin. 1 - 4cm erythematous macules that blanch with diascopic pressure, light collarette of scale. Evidence of excoriation. Distributed over the shoulders, sacrum and legs.\n", + "input6": "___ 12:38PM LACTATE-1.3\n___ 12:15PM GLUCOSE-88 UREA N-15 CREAT-1.1 SODIUM-138 POTASSIUM-3.9 CHLORIDE-102 TOTAL CO2-26 ANION GAP-14\n___ 12:15PM CALCIUM-9.7 PHOSPHATE-3.8 MAGNESIUM-2.3\n___ 12:15PM TSH-63*\n___ 12:15PM T4-5.1 T3-38* FREE T4-0.81*\n___ 12:15PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 12:15PM WBC-6.1# RBC-4.46 HGB-12.9 HCT-40.4 MCV-91 MCH-28.8 MCHC-31.8 RDW-15.2\n___ 12:15PM NEUTS-68.5 ___ MONOS-6.5 EOS-3.0 BASOS-1.1\n___ 12:15PM PLT COUNT-268\n___ 12:15PM ___ PTT-28.5 ___\n\n\nIMAGING\n___ PCXR \nFINDINGS: Single portable view of the chest. The lungs are clear. The cardiomediastinal silhouette is within normal limits for technique. No acute osseous abnormality is identified.\n\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Thyroid Nodules/16973388-DS-20.json b/Finished/Thyroid Disease/Thyroid Nodules/16973388-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..4e5ecf1a9b92222b2a1fb204454d911e8adeab39 --- /dev/null +++ b/Finished/Thyroid Disease/Thyroid Nodules/16973388-DS-20.json @@ -0,0 +1,24 @@ +{ + "Thyroid Nodules$Intermedia_3": { + "The detection of nodules by ultrasound is the criterion for diagnosing thyroid nodules.$Cause_1": { + "Recent ultrasound-guided fine-needle aspiration biopsies of the 2 right-sided thyroidnodules have provided evidence of cytology$Input2": {} + }, + "FNA test rules out thyroid cancer$Cause_1": { + "FNA examination revealed non-malignant tumor.$Input6": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Patient previously underwent left hemithyroidectomy to treat a benign nodule which is a risk factor for thyroid nodules$Cause_1": { + "The patient underwent a left hemithyroidectomy$Input2": {} + }, + "Thyroiditis sometimes leads to the formation of thyroid nodules$Cause_1": { + "thyroiditis$Input3": {} + } + } + }, + "input1": "None\n", + "input2": "The patient is a woman with a complicated and extensive previous medical history significant for multiple sclerosis,and for which she is on prednisone for a relatively long time and has developed adrenal insufficiency as a consequence, status post partial right nephrectomy for renal cell carcinoma, sarcoidosis, Hashimoto thyroiditis, asthma, osteoporosis, hypertension,sleep apnea, and gastric ulcer.\n\nThe patient underwent a left hemithyroidectomy 2 years ago at another institution for a nodule that turned out to beenign. Recent ultrasound-guided fine-needle aspiration biopsies of the 2 right-sided thyroidnodules have provided evidence of cytology. \n\n", + "input3": "- Multiple sclerosis \n- Adrenal insufficiency\n- Sympathotonic orthostatic hypotension\n- Renal cell carcinoma s/p R partial nephrectomy\n- Pulmonary sarcoidosis\n- thyroiditis\n- GERD\n- recurrent UTIs\n- osteoporosis\n- asthma\n- chronic sinusitis\n- ocular migraines\n", + "input4": "Mother - breast ca, lung ca, colon ca, leukemia\nFamily history of thyroiditis but no thyroid cancer\n", + "input5": "T 99, BP 120/76, HR 84, RR 18, O2 96%RA\nGeneral: A&O, NAD\nHEENT:No scleral icterus, mucus membranes dry; surgical incision steris c/d/i mild eccymosis, mild edema, no hematoma \nCardiac: RRR, No M/G/R\nPulmonary: Clear to auscultation b/l, No W/R/R\nAbdomen: Soft, nondistended, nontender, no rebound or guarding, normoactive bowel sounds, no palpable masses\nExtremities: warm well perfused, no ___ edema\n", + "input6": "___ 01:02PM BLOOD Na-140 K-3.2* Cl-101\n___ 06:30AM BLOOD Glucose-93 UreaN-27* Creat-0.7 Na-141 K-4.0 Cl-105 HCO3-30 AnGap-10\n___ 01:02PM BLOOD Calcium-8.4\n___ 05:15AM BLOOD Calcium-7.1*\n___ 01:17PM BLOOD Calcium-8.2*\n___ 06:00AM BLOOD Calcium-7.5*\n___ 06:30AM BLOOD Calcium-7.9* Phos-3.5 Mg-2.1\n\nFNA examination revealed non-malignant tumor.\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Thyroid Nodules/18292099-DS-19.json b/Finished/Thyroid Disease/Thyroid Nodules/18292099-DS-19.json new file mode 100644 index 0000000000000000000000000000000000000000..3f0423495e7a5b71a469bfcbc55f1d9d4c44dcdd --- /dev/null +++ b/Finished/Thyroid Disease/Thyroid Nodules/18292099-DS-19.json @@ -0,0 +1,21 @@ +{ + "Thyroid Nodules$Intermedia_3": { + "FNA examination is the standard for diagnosing thyroid nodules$Cause_1": { + "RLL thyroid nodule with FNA suspicious for malignancy$Input2": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Physical pressure on the esophagus or trachea caused by thyroid disease$Cause_1": { + "Difficulty swallowing, feeling like something is stuck in your throat$Input2": {} + }, + "Thyroid-related diseases can cause compression of the recurrent laryngeal nerve$Cause_1": { + "Patient's voice is hoarse.$Input2": {} + } + } + }, + "input1": "enlarging thyroid adenomas\n", + "input2": "Patient's voice is hoarse. Difficulty swallowing, feeling like something is stuck in your throat. RLL thyroid nodule with FNA suspicious for malignancy.\n", + "input3": "+Allergic rhinitis\n+mild asthma\n+GER\n", + "input4": "Grandfather with renal failure, mother deceased from multiple myeloma. no family history suggestive of thyroid cancer or endocrine neoplasia. \n", + "input5": "98.6/98.4 86 117/78 20 98% RA\nGen: NAD, comfortable\nCV: RRR\nR: clear, unlabored\nNeck: incision c/d/i with steri-strips in place, no erythema, discharge, hematoma, or bruising, voice normal\nAbd: soft, NT/ND\nExt: no c/c/e\n", + "input6": "___ 06:08AM BLOOD Calcium-8.2*\n___ 06:08AM BLOOD\n" +} \ No newline at end of file diff --git a/Finished/Thyroid Disease/Thyroiditis/15973805-DS-23.json b/Finished/Thyroid Disease/Thyroiditis/15973805-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..a28af912ee6084be8885f8c4e5a7424e3341149b --- /dev/null +++ b/Finished/Thyroid Disease/Thyroiditis/15973805-DS-23.json @@ -0,0 +1,27 @@ +{ + "Thyroiditis$Intermedia_3": { + "High levels of TPOAb is a classic sign of thyroid autoimmune disease$Cause_1": { + "Thyroid antibody test shows high levels of TPOAb.$Input6": {} + }, + "Ultrasound examination revealed enlargement of the thyroid gland with heterogeneous internal structure and multiple hypoechoic areas, which are also typical ultrasonic features of thyroiditis.$Cause_1": { + "The internal echo of the thyroid tissue is uneven and there are multiple hypoechoic areas.$Input6": {} + }, + "Suspected Thyroid disease$Intermedia_2": { + "Enlargement of the thyroid gland, a common symptom of thyroiditis$Cause_1": { + "presented with a goiter$Input2": {} + }, + "Compression symptoms may be caused by enlargement of the thyroid gland causing compression of surrounding tissues or structures$Cause_1": { + "she was having compressive symptoms$Input2": {} + }, + "TTP may be a symptom of thyroiditis$Cause_1": { + "TTP on right aspect of neck$Input5": {} + } + } + }, + "input1": "Goiter causing compressive symptoms.\n", + "input2": "This young woman with a history of pulmonary emboli presented with a goiter and she was having compressive symptoms. Preoperatively, she was cautioned that removal of this goiter might not in fact alleviate her pressure symptoms completely, but nevertheless, she felt obliged to undergo the operation. Her Coumadin was tapered down so that her INR yesterday was 2.1, and I gave her smaller dose than normal, but today, when she showed up, her INR was 1.2. we therefore gave her mini heparin and the boots and will give her loading dose of Coumadin again this evening.\n", + "input3": "+ PMH: PSA, PE on Coumadin, Mood Disorder, GAD, Somatoform Disorder, Facticitious Disorder, Opiate, Benzo and EtOH abuse, Borderlin PD, moderate aortic stenosis\n\ufeff\n+ PSH: Rotator Cuff Repair c/b infection, Left Brachiocephalic Vein Stenosis s/p stent\n", + "input4": "Per doctor note and updated with patient:\nson with bipolar (not on medications)\ndaughter with bipolar (on meds) \nson with depression\n", + "input5": "Physical Exam:\nGEN: A&O, NAD\nHEENT: No scleral icterus, mucus membranes moist, incision site c/d/i, TTP on right aspect of neck, no surrounding erythema or swelling\nCV: RRR, No M/G/R\nPULM: Clear to auscultation b/l, No W/R/R\nABD: soft, nondistended, nontender, no rebound or guarding\n", + "input6": "___ 07:11AM BLOOD\n___ 11:15AM BLOOD\n___ 07:11AM BLOOD\n___ 11:15AM BLOOD\n___ 07:11AM BLOOD Calcium-7.9*\n\nThyroid antibody test shows high levels of TPOAb.\n\nUltrasound: The internal echo of the thyroid tissue is uneven and there are multiple hypoechoic areas.\n" +} \ No newline at end of file diff --git a/Finished/Tuberculosis/13187640-DS-14.json b/Finished/Tuberculosis/13187640-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..35ee11e2f4ffbc94bf78b3301a1fb4215ca62153 --- /dev/null +++ b/Finished/Tuberculosis/13187640-DS-14.json @@ -0,0 +1,36 @@ +{ + "Tuberculosis$Intermedia_3": { + "There are necrotic lymph nodes and soft tissue masses in the abdomen and pelvis. This indicates that the TB infection may have spread to other parts of the body, which is typical of disseminated TB.$Cause_1": { + "necrotic lymph nodes and soft tissue masses within the abdomen and pelvis$Input2": {} + }, + "Spinal imaging shows osteomyelitis of the T3 to T11 vertebrae. Tuberculous osteomyelitis is an infection of the bones, especially the spine, by tuberculosis bacteria. It is a more serious form of tuberculosis.$Cause_1": { + "osteomyelitis from T3-T11 on spinal imaging$Input2": {} + }, + "RIPE is a commonly used tuberculosis drug regimen$Cause_1": { + "biopsies from skin and lymph node grew pan-S MTB s/p initiation of RIPE$Input2": {} + }, + "The patient's TB had spread to multiple sites, forming multiple abscesses. Systemic TB is a severe manifestation of active TB that involves multiple non-lung sites.$Cause_1": { + "Interval progression of disseminated TB with multiple abscess in several compartments including the left posterior pararenal space, bilateral psoas muscles, pelvis posterior to the rectum, left pelvic sidewall extending along the acetabulum deep to the gluteus maximus muscle.$Input6": {} + }, + "Necrotic lymph nodes are often associated with tuberculosis infection, especially when they occur in multiple locations such as the retroperitoneum, pelvis, and groin.$Cause_1": { + "Multiple necrotic retroperitoneal, pelvic, and left inguinal lymph nodes as seen on prior and as described above.$Input6": {} + }, + "Suspected Tuberculosis$Intermedia_2": { + "Pott's disease is a form of tuberculosis that affects the spine and is common in patients with active tuberculosis.$Cause_1": { + "Pott's disease$Input3": {} + }, + "This is an inflammation of the lymphatic system caused by TB infection and indicates that the patient may have active TB disease$Cause_1": { + "TB Lymphangitis$Input3": {} + }, + "Tuberculous dermatosis is usually associated with tuberculous infection of the subcutaneous lymph nodes, which is an outward manifestation of active tuberculosis.$Cause_1": { + "Scrofuloderma$Input3": {} + } + } + }, + "input1": "None\n", + "input2": "The patient has a complex history that led to the diagnosis of disseminated TB. Please refer to ID note from ___ for all details. In summary, he presented to ___ ___ with ___ \nyears of painful, draining skin lesions of his chest, back, and bilateral axilla, previously attributed to hidradenitis suppurtiva. Extensive workup showed extensive areas of nodularity throughout the thorax, necrotic lymph nodes and soft tissue masses within the abdomen and pelvis, and osteomyelitis from T3-T11 on spinal imaging. biopsies from skin and lymph node grew pan-S MTB s/p initiation of RIPE on ___ with a plan for ___ months of therapy. He was subsequently discharged to ___.\n\nReview of Systems: \n(+) per HPI \n(-) fever, chills, night sweats, headache, vision changes, \nrhinorrhea, congestion, sore throat, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, BRBPR, melena, hematochezia, dysuria, hematuria.\n", + "input3": "Pott's disease \nTB Lymphangitis \nScrofuloderma \ns/p GSW to head ___\ns/p back surgery unspecified ___ years ago\nChronic HBV with low level viremia\n", + "input4": "None\n", + "input5": "Vitals- 98.7 PO 104 / 69 98 16 99 Ra \nGENERAL: AOx3, NAD\nHEENT: Normocephalic, atraumatic, PERRL, MMM, EOMI\nCARDIAC: RRR, no murmurs, rubs, gallops\nLUNGS: Bronchial breath sounds throughout, no crackles, wheezes, ronchi or rales \nABDOMEN: NABS, soft, non-tender, non-distended\nEXTREMITIES: warm and well perfused, no evidence of peripheral edema, clubbing, cyanosis\nSKIN: two 2-3cm skin ulcers with granulation tissue overlying L clavicle\nNEUROLOGIC: AAOx3, CN II-XII intact, strength ___ RUE, ___ LUE, \n___ RLE, ___ LLE\n", + "input6": "___ CT ABDOMEN AND PELVIS WITH CONTRAST:\n1. Interval progression of disseminated TB with multiple abscess in several compartments including the left posterior pararenal space, bilateral psoas muscles, pelvis posterior to the rectum, left pelvic sidewall extending along the acetabulum deep to the gluteus maximus muscle. See finding section for more detailed description.\n2. Multiple necrotic retroperitoneal, pelvic, and left inguinal lymph nodes as seen on prior and as described above.\n3. Please see separate report performed on the same day for \ndetailed evaluation of the chest.\n\n\n___ CT GUIDED INTERVENTION PROCEDURE:\nPROCEDURE: CT-guided aspiration of 2 retroperitoneal \ncollection.\n\n \nTECHNIQUE: The risks, benefits, and alternatives of the \nprocedure were explained to the patient. After a detailed discussion, informed written consent was obtained. A pre-procedure timeout using three patient identifiers was performed per ___ protocol.\n \nThe patient was placed in a prone position on the CT scan table. Limited preprocedure CT scan was performed to localize the collections. Based on the CT findings two appropriate skin entry sites for the aspiration was chosen. The sites were marked. Local anesthesia was administered with 1% Lidocaine solution.\n \nUsing intermittent CT fluoroscopic guidance, ___ drainage catheter was advanced via trocar technique into a right \nretroperitoneal collection. A sample of fluid was aspirated, confirming drain position within the collection. The pigtail was deployed. The position of the pigtail was confirmed within the collection via CT fluoroscopy. Approximately 150 cc of yellowish fluid was aspirated with a sample sent for \nmicrobiology evaluation. The catheter was then removed. Sterile dressing was applied.\n" +} \ No newline at end of file diff --git a/Finished/Tuberculosis/13691292-DS-3.json b/Finished/Tuberculosis/13691292-DS-3.json new file mode 100644 index 0000000000000000000000000000000000000000..93382cdc6d0049b880dc47ef25ceb66bb8b66291 --- /dev/null +++ b/Finished/Tuberculosis/13691292-DS-3.json @@ -0,0 +1,45 @@ +{ + "Tuberculosis$Intermedia_3": { + "Chest CT shows cavitary lesions, which is one of the common imaging manifestations of tuberculosis (TB)$Cause_1": { + "CT chest showed a cavitary lesion$Input2": {} + }, + "The test results showed Mycobacterium tuberculosis, which was confirmed to be tuberculosis infection.$Cause_1": { + "examine result show sputum samples for mycobacterium tuberculosis$Input6": {} + }, + "Thick-walled cavitary lesions are typical of tuberculosis$Cause_1": { + "thick-walled cavitary \nlesion$Input6": {} + }, + "Suspected Tuberculosis$Intermedia_2": { + "Fever is a common symptom of tuberculosis$Cause_1": { + "fevers$Input2": {} + }, + "Fatigue is also a common symptom among TB patients$Cause_1": { + "fatigue$Input2": {} + }, + "Cough is one of the main symptoms of tuberculosis$Cause_1": { + "cough$Input2": {} + }, + "Shortness of breath is also a symptom of tuberculosis$Cause_1": { + "SOB 8 days$Input2": {} + }, + "Chest pain may be caused by a lung infection, a potential symptom of tuberculosis$Cause_1": { + "chest pain$Input2": {} + }, + "Bone pain may be related to tuberculosis infection$Cause_1": { + "bone pain$Input2": {} + }, + "Polyarthritis may also be caused by tuberculosis$Cause_1": { + "polyarthitis$Input2": {} + }, + "Large numbers of polymorphonuclear leukocytes and epithelial cells in sputum, indicating inflammation or infection$Cause_1": { + ">25 PMNs and >10 epithelial cells/100X field.$Input6": {} + } + } + }, + "input1": "None\n", + "input2": "___ year old previously healthy woman who was sent in after a CT chest showed a cavitary lesion. The patient started having fevers, fatigue, chest pain, cough, and SOB 8 days ago, and was started on an unknown antibiotic by her PCP. Her cough worsened and she was seen in the ___ ED 5 days ago and a CXR revealed a LUL infiltrate for which she was started on clarithromycin. After this, her symptoms improved slightly.\n\nShe has a h/o of several months of bone pain and polyarthitis, for which is followed by Dr. ___ in rheumatology. She had a routine visit with him yesterday (___) and though she reported decreased cough and SOB, her continued symptoms prompted a CT chest which revealed a LUL cavitary lesion concerning for TB vs. fungal infection. A PPD was placed in her left forearm and she was advised to come to the ED for further evaluation.\n\n", + "input3": "Childhood asthma \n", + "input4": "Father has high cholesterol, mother has back problems. No \nfamily members with tuberculosis. Sister had a positive PPD test and here chest xray was negative (unclear when). \n", + "input5": "VS: 97.6, 99/63, 59, 18, 100%RA\nGENERAL: Thin well-appearing woman in NAD, comfortable, appropriate.\nHEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear.\nNECK: Supple, no thyromegaly, no JVD, no carotid bruits.\nHEART: RRR, no MRG, nl S1-S2.\nLUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored.\nABDOMEN: Soft/NT/ND, no masses or HSM, no rebound/guarding.\nEXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses, joints non-tender and non-erythematous and with full ROM.\nSKIN: No rashes or lesions.\nLYMPH: No cervical LAD.\nNEURO: A&Ox3, CNs II-XII grossly intact, muscle strength ___ throughout, sensation grossly intact throughout. \n\n", + "input6": "___ 10:50PM BLOOD WBC-6.2 RBC-4.58 Hgb-13.1 Hct-39.6 MCV-87 MCH-28.7 MCHC-33.1 RDW-13.2 Plt ___\n___ 10:50PM BLOOD Neuts-71.5* ___ Monos-3.5 Eos-2.3 \nBaso-1.3\n___ 10:50PM BLOOD ___ PTT-27.5 ___\n___ 10:50PM BLOOD Glucose-127* UreaN-12 Creat-0.6 Na-142 \nK-4.2 Cl-105 HCO3-26 AnGap-15\n___ 07:45AM BLOOD WBC-5.2 RBC-4.69 Hgb-13.0 Hct-40.0 MCV-86 MCH-27.8 MCHC-32.6 RDW-13.5 Plt ___\n\nSputum Tests:\n___ 12:10 pm SPUTUM Source: Expectorated. \n\n GRAM STAIN (Final ___: \n >25 PMNs and >10 epithelial cells/100X field. \n examine result show sputum samples for mycobacterium tuberculosis\n\n\nCT Scan of Chest\n \nCOMPARISON: No prior study is available for comparison.\n \nTECHNIQUE: MDCT-acquired axial images were obtained through the chest without IV contrast. Coronal and sagittal reformats were displayed.\n \nWithin the lungs, there is a dominant thick-walled cavitary \nlesion measuring 4.5 x 2.3 cm in the superior segment of the left lower lobe. It is difficult to discern whether there is extension of this process across the major fissure or if there is an incomplete fissure. Multiple other cavitary conolidations are noted at the left lung apex and seen best on the coronal sequence (for example, series 8 image 32). \n" +} \ No newline at end of file diff --git a/Finished/Tuberculosis/13730220-DS-5.json b/Finished/Tuberculosis/13730220-DS-5.json new file mode 100644 index 0000000000000000000000000000000000000000..a0e81db7cdb5fe035e04c016c528ae26f0157e88 --- /dev/null +++ b/Finished/Tuberculosis/13730220-DS-5.json @@ -0,0 +1,27 @@ +{ + "Tuberculosis$Intermedia_3": { + "Cavities in the lungs are common in active tuberculosis, especially when the walls of the cavities are thin, indicating the possibility of active disease or reactivation of infection.$Cause_1": { + "Superior segment right lower lobe relatively thin-walled cavity$Input6": {} + }, + "Suspected Tuberculosis$Intermedia_2": { + "The patient had been treated for tuberculosis several years earlier, which is important background information because tuberculosis can recur.$Cause_1": { + "TB treated ___ years ago$Input2": {} + }, + "In patients with a history of tuberculosis, these symptoms may indicate activity or recurrence of tuberculosis.$Cause_1": { + "symptoms of URI including fatigue, productive cough, runny nose, and chest congestion$Input2": {} + }, + "A family history of tuberculosis increases a person's risk of developing the disease.$Cause_1": { + "father may have had TB$Input2": {} + }, + "The presence of cavitary lesions is an important clue to TB reactivation, especially when the lesions are highly suspicious for TB.$Cause_1": { + "Cavitary lesion is highly suspicious for reactivation tuberculosis$Input6": {} + } + } + }, + "input1": "N/A\n", + "input2": "The patient is a ___ w/ h/o TB treated ___ years ago in ___, hypertriglyceridemia who presents with an abnormal chest CT. His h/o TB has been followed by Dr. ___ (___ at ___ by serial CXR and has reportedly been stable. About ___ months ago he went to ___ for back pain, and CXR showed an abnormality for which he was advised to follow up with his PCP. Dr. ___ felt that this was consistent with his baseline, however. About 1 month ago he developed symptoms of URI including fatigue, productive cough, runny nose, and chest congestion. He did not have fever, night sweats, weight loss, or hemoptysis. His PCP prescribed ___ after which he his symptoms fully resolved, but given his history he was sent in for a chest CT today, which showed granulomatous changes, cavitary lesions, and lymphadenopathy. He was called and told to report to the ED. In the ED he was afebrile with stable VS. ID was curbsided in the ED and felt that he did not need Abx at this time, only induced sputums for now. He is being admitted to the ED for r/o TB. \n. \nOf note, pt reports having had recent negative HIV tests, no h/o imprisonment or being in shelters, or recent contacts. He does report returning to ___ every ___ years, the most recent being in ___. His father may have had TB, and passed away in ___.\n", + "input3": "-- back pain which radiates down the left leg, felt to be due to \nlumbosacral neuritis \n-- hypertriglyceridemia \n-- h/o PUD (not active) \n-- elevated LFTs, ?NASH\n", + "input4": "brother with hep B as a result of blood transfusion; mother w/ liver cancer, not clear if primary or metastatic disease\n", + "input5": "T: 97.9 BP: 116/86 P: 60 RR: 18 O2 sats: 100% RA \nGen: alert, interactive, NAD, lying comfortably in bed \nHEENT: NCAT, PERRL, EOMI, OP clear, MMM \nNeck: no masses, no JVD \nCV: RRR no MRG, nl S1, S2 \nResp: CTAB \nAbd: NABS, soft, NTND, no guarding/rigidity/rebound \nBack: no CVA tenderness \nExt: no CCE \nNeuro: AAOx3\n", + "input6": "Chest CT: Superior segment right lower lobe relatively \nthin-walled cavity with adjacent areas of calcified granulomas, bronchiectasis, bronchial impaction, and bronchiolitis. Cavitary lesion is highly suspicious for reactivation tuberculosis until proven otherwise. The differential diagnosis includes atypical mycobacterial infection.\n" +} \ No newline at end of file diff --git a/Finished/Tuberculosis/15590996-DS-20.json b/Finished/Tuberculosis/15590996-DS-20.json new file mode 100644 index 0000000000000000000000000000000000000000..db9662846624cce6a1bc20371aa35b1d8a3df082 --- /dev/null +++ b/Finished/Tuberculosis/15590996-DS-20.json @@ -0,0 +1,27 @@ +{ + "LTBI$Intermedia_3": { + "A positive tuberculin skin test indicates that an individual may have been exposed to Mycobacterium tuberculosis and is an important diagnostic basis for latent tuberculosis.$Cause_1": { + "PPD came back positive$Input2": {} + }, + "The Quantiferon Gold test is a blood test used to detect tuberculosis infection. A positive result further supports the possibility of tuberculosis infection.$Cause_1": { + "quantiferon gold with came back positive$Input2": {} + }, + "Denial of symptoms indicates that the patient does not display typical clinical symptoms of active tuberculosis, which is consistent with the characteristics of latent tuberculosis.$Cause_1": { + "denies any fevers/chills, no chest pain or SOB, no weight loss or night sweats$Input2": {} + }, + "Suspected Tuberculosis$Intermedia_2": { + "There is a 5 mm ulcer on the right tonsil. Tonsillar ulcers may be associated with tuberculosis bacterial infection, as tuberculosis can cause local infection of the tonsils.$Cause_1": { + "5mm ulceration of R tonsil$Input5": {} + }, + "There is a rounded increase in density in the left hilar region, which may be due to partial calcification of the lymph node. This calcification is often associated with underlying tuberculosis.$Cause_1": { + "Rounded left hilar density$Input6": {} + } + } + }, + "input1": "N/A\n", + "input2": "___ is a ___ without significant PMHx who presents for rule-out TB. She was sent in from ___ after a PPD came back positive; the patient is starting work at ___ in a neuroscience lab. She also reportedly had a quantiferon gold with came back positive as well. She denies any fevers/chills, no chest pain or SOB, no weight loss or night sweats. Her only medical complaint is an ulceration of her R tonsil which she has had intermittently in the past growing up. She recently spent 10 weeks this past summer in ___ for research. \n\nCXR showed a rounded left hilar density which may reflect partially calcified lymphadenopathy in the setting of prior granulomatous disease exposure. ___ induced sputum samples were sent. She was admitted for containment while ruling out TB. On the floor, initial VS 98.1, 121/70, 78, 18, 100% on RA. Her only complaint is pain associated with her R tonsillar pits.\n", + "input3": "Depression\n", + "input4": "Paternal grandparents with T1 and T2DM. Maternal grandmother with sarcoidosis and HTN.\n", + "input5": "Vital Signs: 98.1, 121/70, 78, 18, 100% on RA \n General: Alert, oriented, pleasant slim young female in no \nacute distress \n HEENT: Sclera anicteric, MMM, 5mm ulceration of R tonsil, EOMI, \nPERRL, neck supple, JVP not elevated, no LAD \n CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, gallops \n Lungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \n Abdomen: Soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding \n GU: No foley \n Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \n Neuro: AOx3, moving all extremities spontaneously, normal gait.\n", + "input6": "___ 04:30PM BLOOD WBC-6.5 RBC-4.14 Hgb-12.4 Hct-36.5 MCV-88 \nMCH-30.0 MCHC-34.0 RDW-12.7 RDWSD-40.5 Plt ___\n___ 04:30PM BLOOD Neuts-53.6 ___ Monos-8.0 Eos-0.6* \nBaso-0.5 Im ___ AbsNeut-3.49 AbsLymp-2.41 AbsMono-0.52 \nAbsEos-0.04 AbsBaso-0.03\n___ 04:30PM BLOOD Plt ___\n___ 04:30PM BLOOD Glucose-115* UreaN-8 Creat-0.5 Na-140 \nK-3.5 Cl-105 HCO3-24 AnGap-15\n___ 08:06AM BLOOD Calcium-9.1 Phos-3.9 Mg-1.7\n\n\nIMAGING\n===========================================\n___ CXR\nRounded left hilar density which may reflect partially calcified lymphadenopathy in the setting of prior granulomatous disease exposure \n\n___ CT CHEST\nFINAL READ PENDING\n" +} \ No newline at end of file diff --git a/Finished/Tuberculosis/15793371-DS-13.json b/Finished/Tuberculosis/15793371-DS-13.json new file mode 100644 index 0000000000000000000000000000000000000000..f0e8decd88e3744a779e6461e7bad419c902ce97 --- /dev/null +++ b/Finished/Tuberculosis/15793371-DS-13.json @@ -0,0 +1,24 @@ +{ + "Tuberculosis$Intermedia_3": { + "A positive AFB culture result is an important diagnostic indicator for tuberculosis. Mycobacterium tuberculosis is an acid-fast bacillus, and the presence of such bacteria usually points to the possibility of tuberculosis.$Cause_1": { + "abscess fluid grew AFB with speciation pending$Input2": {} + }, + "Abscesses and vertebral joint involvement found on MRI, along with meningeal enhancement, may indicate deep-seated tuberculosis infection.$Cause_1": { + "MRI was performed after the LP showed a 3.1 x 1.6 cm abscess in the right paraspinal musculature at the L3-5 level with involvement of the right L4-5 facet joint and the L4 spinous process with additional leptomeningeal enhancement.$Input2": {} + }, + "Suspected Tuberculosis$Intermedia_2": { + "People with HIV have a compromised immune system, making them more susceptible to tuberculosis infection and to developing active tuberculosis.$Cause_1": { + "HIV$Input3": {} + }, + "Scattered red rashes on the skin may be a skin manifestation of tuberculosis infection. Red, partially depigmented macules may be a symptom of tuberculosis$Cause_1": { + "Scatterred rash on upper right back, chest, and on \nextremities. Erythematous, partially blanching, macules.$Input5": {} + } + } + }, + "input1": "N/A\n", + "input2": "The patient presented on her PREVIOUS Admission to an OSH with severe lumbar pain. An LP was performed and showed WBC 59K with cultures growing MRSA. Blood cultures also grew MRSA. MRI was performed after the LP showed a 3.1 x 1.6 cm abscess in the right paraspinal musculature at the L3-5 level with involvement of the right L4-5 facet joint and the L4 spinous process with additional leptomeningeal enhancement. It was unclear if the LP fluid that was obtained was from the abscess or from the spinal fluid, given the close proximity and the unknown presence of abscess at the time of LP. The patient was given vancomycin, ceftriaxone and acyclovir and was transfered to ___. On arrival to ___ she was intubated due to altered mental status. \n.\nNeurosurgery evaluated the patient and she underwent ___ guided drainage of her paraspinal abscess, cultures also grew MRSA. She was continued on vancomycin alone. She was taken back for repeat ___ guided drainage of her abscess on ___ with and a drain was removed prior to discharge. TTE revealed no\nvegetations. She was discharged on vancomycin with a planned prolonged duration of therapy. Her ID follow up was transitioned to her PCP prior to discharge. \n.\nAfter discharge her ___ abscess fluid grew AFB with speciation pending. Due to this, and a truncal rash, she was referred back to the ___ for admission ___\n\nAt the time of admission, she reported feeling better and her abscess continuing to heal. She still doesn't walk back to normal, but is constantly improving. No fevers/chills/SOB/CP/N/V/D/C.\n", + "input3": "HIV\nIVDA - including heroin. on methadone.\nh/o PE\nchronic low back pain\n", + "input4": "Unknown.\n", + "input5": "ADMISSION PHYSICAL EXAM: \nVitals: T:98.2 BP:108/82 P:88 R:20 O2:98RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nCV: Regular rate and rhythm, normal S1 + S2, S4 gallop \nappreciated \nAbdomen: soft, non-tender, non-distended, bowel sounds present. Escoriations throughout abdomen. \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nSkin: Scatterred rash on upper right back, chest, and on \nextremities. Erythematous, partially blanching, macules. \nNeuro: A and O x3. CN II-XII grossly intact. Strength ___ in b/l upper and lower extremities. 2+ reflexes in knees, \nbrachioradialis. Gait with limp due to favoring R side\n", + "input6": "___ 05:45PM BLOOD WBC-7.4 RBC-4.00* Hgb-10.9* Hct-33.3* \nMCV-83 MCH-27.3 MCHC-32.7 RDW-14.3 Plt ___\n___ 05:45PM BLOOD Neuts-69.8 ___ Monos-6.9 Eos-1.1 \nBaso-0.6\n___ 07:45AM BLOOD WBC-5.4 Lymph-22 Abs ___ CD3%-91 \nAbs CD3-1083 CD4%-35 Abs CD4-413 CD8%-54 Abs CD8-642 \nCD4/CD8-0.6*\n___ 05:45PM BLOOD Glucose-99 UreaN-9 Creat-0.9 Na-139 K-4.1 \nCl-97 HCO3-28 AnGap-18\n___ 07:45AM BLOOD ALT-50* AST-74* AlkPhos-82 TotBili-0.3#\n___ 07:45AM BLOOD Calcium-9.4 Phos-4.9* Mg-1.8 Iron-57\n___ 07:45AM BLOOD calTIBC-324 Ferritn-103 TRF-249\n\nSTUDIES: \n___ CXR: No acute cardiopulmonary process\n" +} \ No newline at end of file diff --git a/Finished/Upper Gastrointestinal Bleeding/11878388-DS-21.json b/Finished/Upper Gastrointestinal Bleeding/11878388-DS-21.json new file mode 100644 index 0000000000000000000000000000000000000000..c9e97dd04f11a1788fd2a87e863842c15c373bde --- /dev/null +++ b/Finished/Upper Gastrointestinal Bleeding/11878388-DS-21.json @@ -0,0 +1,21 @@ +{ + "upper gastrointestinal bleeding$Intermedia_3": { + "The gastric fundus vein was ruptured and bleeding on gastroscopy is the gold standard for upper gastrointestinal bleeding$Cause_1": { + "gastroscopy\r:The gastric fundus vein was ruptured and bleeding$Input6": {} + }, + "Suspected upper gastrointestinal bleeding$Intermedia_2": { + "Massive vomiting of red blood is typical of upper gastrointestinal bleeding$Cause_1": { + "The patient complained of nausea and was reported to have approximately 500 cc of bright red hematemesis;$Input2": {} + }, + "Hemorrhagic peripheral circulatory failure is a nonspecific manifestation of gastrointestinal bleeding$Cause_1": { + "Mildly tachycardic, regular rhythm.$Input5": {} + } + } + }, + "input1": "requesting detox\n", + "input2": "A male with PMH significant for borderline personality disorder, alcohol abuse, schizo-affective disorder, and IDDM who presented to the ED intoxicated after being brought in by EMS requesting detox. The patient reports that he is unable to recall the exact details of how EMS care was initiated. In the ED, initial vitals were 98.0, 105, 20, 138/88 and 94% RA. The patient was fairly combative and required several doses of Ativan and Haldol for sedation. A serum EtOH level was found to be 291. The patient complained of nausea and was reported to have approximately 500 cc of bright red hematemesis; he was then given Zofran for nausea. A right subclavian line was placed as the patient has difficult access. Lab testing was remarkable for an elevated serum blood sugar and AG acidosis. The patient reports that he had been in his usual state of health until the end of last week. Approximately four days PTA the patient stepped off a curb when he slipped and fell, injuring his left foot (denies hitting his head). The following day he stopped taking his insulin, which he reports he does intermittently. He denies significant NSAID use. At present, the patient reports he is comfortable but thirsty. He denies pain, fever, chills or persistent nausea. No CP, palpitations or diaphoresis. No cough, but the patient does report his breathing has felt \"shallow\" a few times in the last several days; he noted this while at rest. No abd pain. The patient reports he has noted some BRB streaking his stools over the last few days which is new for him; he denies melena or blood mixed within the stool. MSK complaints only as above. Denies weakness, change in sensation or balance.\n", + "input3": "+recent diagnosis of hepatitis B\n+History of alcohol and substance abuse\n+Borderline personality disorder\n+IDDM with a history of diabetic ketoacidosis in the past\n+Prior suicidal behavior\n+Schizo-affective disorder\n+History of depression and paranoia\n+Questionable history of seizure disorder, no seizures\n+History of microcytic anemia\n", + "input4": "Remarkable for DM. No bleeding diathesis or early CAD.\n", + "input5": "Gen: Chronically ill appearing adult male, no acute distress.\nHEENT: PERRL, EOMI. Dry MM. Conjunctiva well pigmented. \nNeck: Supple, without adenopathy or JVD. No tenderness with palpation.\nChest: CTAB anterior and posterior.\nCor: Normal S1, S2. Mildly tachycardic, regular rhythm. No \nmurmurs appreciated.\nAbdomen: Soft, non-tender and non-distended. +BS, no HSM. \nExtremity: Warm, without edema. Tenderness and swelling noted at \nleft foot. 2+ DP pulses bilat.\nNeuro: Alert; initially oriented to self only. CN intact. \nMotor strength intact in all extremities. Sensation intact \ngrossly. Cerebellar function intact. Gait not assessed.\n", + "input6": "09:40PM WBC-10.0 RBC-3.99* HGB-11.0* HCT-32.7* MCV-82 MCH-27.6 MCHC-33.8 RDW-14.7\n09:40PM NEUTS-85.1* LYMPHS-11.5* MONOS-2.4 EOS-0.7 BASOS-0.2\n09:40PM GLUCOSE-403* UREA N-9 CREAT-0.9 SODIUM-139 POTASSIUM-4.0 CHLORIDE-96 TOTAL CO2-19* ANION GAP-28*\ngastroscopy\r:The gastric fundus vein was ruptured and bleeding\n" +} \ No newline at end of file diff --git a/Finished/Upper Gastrointestinal Bleeding/13971464-DS-11.json b/Finished/Upper Gastrointestinal Bleeding/13971464-DS-11.json new file mode 100644 index 0000000000000000000000000000000000000000..cd62342304ee2aec7a2ca6fbfa767c6cea2076eb --- /dev/null +++ b/Finished/Upper Gastrointestinal Bleeding/13971464-DS-11.json @@ -0,0 +1,27 @@ +{ + "upper gastrointestinal bleeding$Intermedia_3": { + "Fundal varices bleeding on gastroscopy is the gold standard for upper gastrointestinal bleeding$Cause_1": { + "Gastroscopy: fundal varices bleeding$Input6": {} + }, + "Suspected upper gastrointestinal bleeding$Intermedia_2": { + "Black stool is a typical manifestation of gastrointestinal bleeding$Cause_1": { + "She says that starting around midnight, she began having loose black stools.$Input2": {} + }, + "There will be dizziness after bleeding$Cause_1": { + "She had some mild lightheadedness before coming to the ED$Input2": {} + }, + "Black stool in rectum - guaiac positive is the evidence of blood in the stool$Cause_1": { + "black stool in rectum - guaiac positive$Input2": {} + }, + "!Black stool is a typical manifestation of gastrointestinal bleeding$Cause_1": { + "Black stools$Input1": {} + } + } + }, + "input1": "Black stools\n", + "input2": "A woman with HTN, moderate aortic stenosis, diverticulosis, osteoporosis presenting after multiple episodes of black stools. She says that starting around midnight, she began having loose black stools. No bright red blood, which she has had in the past from diverticulosis. She had some mild lightheadedness before coming to the ED, but has none now. She had the sense of urgency with the BMs, but no abdominal pain, no nausea or vomiting. No chest pain, no SOB. She denies NSAID use or alcohol use. She takes iron supplements but denies having black stools while on iron. She last took alendronate in for her osteoporosis. She reports one medication change recently involving an anti-hypertensive medication of which she cannot recall. She denies sick contacts or recent travel. She only takes Tylenol extra strength for pain relief. Of note, she was admitted in for BRBPR requiring coil embolization across marginal branch of the left colic artery. In the ED, initial vitals were: 97.6 110 183/72 16 100% RA - Exam notable for: comfortable, NAD, systolic murmur throughout precordium, clear lungs, abdomen nontender/nondistended/soft, black stool in rectum - guaiac positive.\n", + "input3": "+Hypertension, essential \n+Hypercholesterolemia \n+CKD (chronic kidney disease) stage 3: Cr 0.8-1.1\n+Aortic valve stenosis, moderate \n+Hyperthyroidism \n+Anemia \n+Osteoarthritis \n+Osteopenia \n+Primary open angle glaucoma \n+Hx Lower GI bleed \n+Hx Endometrial polyp \n+Hx Acetabulum fracture, right \n+Hx Pelvis fracture \n+Hx Diverticulitis \n+Hx Positive PPD\n", + "input4": "No family history of GI illness or malignancy. Mother w/ stroke. Brother w/ prostate cancer\n", + "input5": "VITAL SIGNS: T98F, BP 165/78, HR 70, O2 96% RA\nGENERAL: Well appearing woman appearing younger than stated age\nHEENT: EOMI, PERRL, MMM, sclera anicteric\nCARDIAC: RRR, Normal S1/S2, w/ IV/VI systolic murmur loudest in \nRUSB, no rubs/gallops\nLUNGS: CTA b/l w/o w/r/r\nABDOMEN: Soft, NT, ND \nEXTREMITIES: 2+ DP/radial pulses, no edema \nNEUROLOGIC: Alert and attentive, moving all extremities, no nystagmus,\n", + "input6": "04:10AM BLOOD WBC-5.7 RBC-3.80* Hgb-10.6* Hct-34.1 MCV-90 MCH-27.9 MCHC-31.1* RDW-12.9 RDWSD-41.9 Plt\n04:10AM BLOOD PTT-29.8\n04:10AM BLOOD Glucose-126* UreaN-25* Creat-1.2* Na-137 K-6.2* Cl-100 HCO3-24 AnGap-19\n04:10AM BLOOD Calcium-9.3 Phos-4.6* Mg-1.4*\n06:31AM BLOOD K-4.2\n06:31AM BLOOD Hgb-10.6* calcHCT-32\nGastroscopy: fundal varices bleeding\n" +} \ No newline at end of file diff --git a/Finished/Upper Gastrointestinal Bleeding/14545508-DS-6.json b/Finished/Upper Gastrointestinal Bleeding/14545508-DS-6.json new file mode 100644 index 0000000000000000000000000000000000000000..00589340145db571b1a30cc55be11bf4469e8731 --- /dev/null +++ b/Finished/Upper Gastrointestinal Bleeding/14545508-DS-6.json @@ -0,0 +1,27 @@ +{ + "upper gastrointestinal bleeding$Intermedia_3": { + "Fundal varices bleeding on gastroscopy is the gold standard for upper gastrointestinal bleeding$Cause_1": { + "Gastroscopy:fundal varices bleeding$Input6": {} + }, + "Suspected upper gastrointestinal bleeding$Intermedia_2": { + "Dark stool is a typical manifestation of gastrointestinal bleeding$Cause_1": { + "Pt. has complained of ongoing dark stools, malaise at home$Input2": {} + }, + "Hematemesis is a typical manifestation of gastrointestinal bleeding.$Cause_1": { + "A man with recent admission here for C. Cath given NSTEMI, s/p BMS to LAD, c/b hematemesis requiring transfusions.$Input2": {} + }, + "Found to have Guaiac positive stools is the evidence of blood in the stool.$Cause_1": { + "Found to have Guaiac positive stools$Input2": {} + }, + "!Melanotic stool is a typical manifestation of gastrointestinal bleeding$Cause_1": { + "melanotic stools$Input1": {} + } + } + }, + "input1": "malaise, melanotic stools\n", + "input2": "A man with recent admission here for C. Cath given NSTEMI, s/p BMS to LAD, c/b hematemesis requiring transfusions. Pt. has complained of ongoing dark stools, malaise at home, so reported to ED. Found to have Guaiac positive stools, Hct down slightly from baseline, no evidence of brisk bleeding seen. AF, VSS in ED. Denies CP, SOB, hematemesis, lightheadedness, hematochezia. All other ROS negative.\n", + "input3": "+NSTEMI, s/p LAD BMD\n+severe esophagitis and ugib in setting of dual antiplatelet therapy following nstemi.\n+hypertension \n+Hematuria \n+Glaucoma left eye \n+left cRenal mass - c/w malignancy \n+Colon adenoma \n+CAD - diagnosed by stress test \n+Depression \n+Elevated PSA (approx 21)\n", + "input4": "heart attack in patient's father. Patient's father died of aortic aneurysm.\n", + "input5": "VS: Afebrile and vital signs stable\nGeneral Appearance: pleasant, comfortable, NAD, non-toxic appearing\nEyes: : PERLL, EOMI, no conjuctival injection, anicteric\nENT: no sinus tenderness, MMM, oropharynx without exudate or lesions, no supraclavicular or cervical lymphadenopathy, no JVD, no carotid bruits, no thyromegaly or palpable thyroid nodules\nRespiratory: CTA b/l with good air movement throughout\nCardiovascular: RR, S1 and S2 wnl, no murmurs, rubs or gallops appreciated\nGastrointestinal: nd, +b/s, soft, nt, no palpable masses or hepatosplenomegaly\nMusculoskeletal/extremities: no cyanosis, clubbing or edema\nSkin/nails: warm, no rashes/no jaundice/no splinter hemmorhages/no skin ulcerations noted\nNeurological: AAOx3. Cn II-XII intact. strength throughout. No sensory deficits to light touch appreciated. No pass-pointing on finger to nose. 2+DTR's-patellar and biceps. \nNo asterixis, no pronator drift, fluent speech.\nPsychiatric: pleasant, appropriate affect\nHeme/Lymph: no cervical or supraclavicular lymphadenopathy\nGU: no catheter in place\n", + "input6": "Hematology \nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct \n10:45AM 6.1 2.90* 8.5* 26.3* 91#1 29.5 32.5 14.9 630*# \n \nDIFFERENTIAL Neuts Bands Lymphs Monos Eos Baso Atyps Metas \n10:45AM 70.5* 17.1* 7.0 4.7* 0.7 \n BASIC COAGULATION , PTT, PLT, INR) PTT Plt Ct\n10:45AM 630*# \n10:45AM 13.0 24.9 1.1 \n \nChemistry \nRENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap \n10:45AM 112* 38* 1.5* 137 4.2 \nESTIMATED GFR (MDRD CALCULATION) estGFR \n10:45AM Using this1 \n\nUsing this patient's age, gender, and serum creatinine value of 1.5,\nEstimated GFR = 45 if non (mL/min/1.73 m2)\nEstimated GFR = 54 if (mL/min/1.73 m2)\nFor comparison, mean GFR for age group is (mL/min/1.73 \nm2)\nGFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure \n \nLAB USE ONLY LtGrnHD \n10:45AM HOLD \n \nBlood Gas \nHEMOGLOBLIN FRACTIONS ( COOXIMETRY) Hgb calcHCT \n10:56AM 9.3*1. GIB, likely due to known severe esophagitis, and in setting of dual antiplatelet therapy\nGastroscopy:fundal varices bleeding\n" +} \ No newline at end of file diff --git a/Finished/Upper Gastrointestinal Bleeding/15247348-DS-14.json b/Finished/Upper Gastrointestinal Bleeding/15247348-DS-14.json new file mode 100644 index 0000000000000000000000000000000000000000..d0e4f8353c3a5070aa6912c8d15be7d8d3fe0756 --- /dev/null +++ b/Finished/Upper Gastrointestinal Bleeding/15247348-DS-14.json @@ -0,0 +1,27 @@ +{ + "upper gastrointestinal bleeding$Intermedia_3": { + "Duodenal ulcer with bleeding on The gold standard for upper gastrointestinal bleeding$Cause_1": { + "EGD:Duodenal ulcer with bleeding$Input6": {} + }, + "suspected upper gastrointestinal bleeding$Intermedia_2": { + "Patients with duodenal ulcer are prone to bleeding. When melena and dizziness occur, upper gastrointestinal bleeding should be highly suspected$Cause_1": { + "Patient with a PMH of duodenal ulcer who presents with melena x10 episodes over the past day with dizziness and orthostatic symptoms over the past few days.$Input2": {} + }, + "Dizziness is one of the manifestations of anemia$Cause_1": { + "Pt states that this morning he stood up at work and felt dizzy and drove home then to .$Input2": {} + }, + "Proof of anemia.$Cause_1": { + "RBC-3.16* Hgb-8.8*$Input6": {} + }, + "Hgb drop of 10.4 to 8.2 over the course of the day is evidence of anemia.$Cause_1": { + "He was transferred from the ED to the MICU for a Hgb drop of 10.4 to 8.2 over the course of the day and planned EGD by GI in the AM.$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "Patient with a PMH of duodenal ulcer who presents with melena x10 episodes over the past day with dizziness and orthostatic symptoms over the past few days. He was diagnosed with 2 duodenal ulcers approximately years ago in on EGD. Reports experiencing melena at that time. He was also diagnosed with H. pylori and recalls taking antibiotics for 45 days. He took omeprazole for several years but stopped 1.5 to years ago. He denies any bleeding episodes over the past years. He denies NSAID use, heavy drinking, or drug use. Pt states that this morning he stood up at work and felt dizzy and drove home then to . He was transferred here for GI consult and ICU level care. He was transferred from the ED to the MICU for a Hgb drop of 10.4 to 8.2 over the course of the day and planned EGD by GI in the AM. In ED initial VS: 98.4, 99, 98/60, 18, 100% RA.\n", + "input3": "+Duodenal ulcer\n", + "input4": "No family history of PUD, gastric cancer or CRC.\n", + "input5": "VITALS: reviewed in metavision \nGENERAL: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple, JVP not elevated, no LAD \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, gallops \nABD: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nSKIN: no rash or lesions\nNEURO: A&Ox3, no focal deficits\n", + "input6": "04:35PM BLOOD WBC-11.2* RBC-3.16* Hgb-8.8* Hct-27.1* MCV-86 MCH-27.8 MCHC-32.5 RDW-13.2 RDWSD-41.4 Plt\n04:35PM BLOOD Neuts-72.6*Monos-4.4* \nEos-0.3* Baso-0.2 Im AbsNeut-8.13* AbsLymp-2.47 \nAbsMono-0.49 AbsEos-0.03* AbsBaso-0.02\n04:35PM BLOOD PTT-28.2\n04:35PM BLOOD Glucose-102* UreaN-26* Creat-0.8 Na-138 \nK-3.9 Cl-103 HCO3-25 AnGap-10\n04:35PM BLOOD ALT-15 AST-11 AlkPhos-37* TotBili-0.2\n04:35PM BLOOD Lipase-12\n04:35PM BLOOD Albumin-3.4*\n04:47PM BLOOD Lactate-1.3\nEGD:Duodenal ulcer with bleeding\n" +} \ No newline at end of file diff --git a/Finished/Upper Gastrointestinal Bleeding/15616719-DS-22.json b/Finished/Upper Gastrointestinal Bleeding/15616719-DS-22.json new file mode 100644 index 0000000000000000000000000000000000000000..e2405adb2e03c81dd4b25e6253d4066af74823cf --- /dev/null +++ b/Finished/Upper Gastrointestinal Bleeding/15616719-DS-22.json @@ -0,0 +1,24 @@ +{ + "upper gastrointestinal bleeding$Intermedia_3": { + "Fundal varices bleeding on endoscopy is the gold standard for upper gastrointestinal bleeding$Cause_1": { + "Endoscopy: fundal varices bleeding$Input6": {} + }, + "suspected upper gastrointestinal bleeding$Intermedia_2": { + "Vomited one clot is a typical symptom of upper gastrointestinal bleeding.$Cause_1": { + "She vomited one clot today, and states she has diffuse upper abdominal pain.$Input2": {} + }, + "!Hematemesis is a typical symptom of upper gastrointestinal bleeding.$Cause_1": { + "Patient with developmental delay, is a ward of the state (see OMR note) and multiple admissions for hematemesis without associated pathology identified presents with hematemesis and abdominal pain.$Input2": {} + }, + "Blood-tinged gastric contents is a typical symptom of upper gastrointestinal bleeding.$Cause_1": { + "NGT left in for observation and subsequently she put out about of blood-tinged gastric contents, but no evidence of brisk bleed.$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "Patient with developmental delay, is a ward of the state (see OMR note) and multiple admissions for hematemesis without associated pathology identified presents with hematemesis and abdominal pain. She vomited one clot today, and states she has diffuse upper abdominal pain. The patient was also seen in the ED on and for similar presentation and was discharged on the subsequent days after stable HCTs. During one episode, she left AMA. Per the medical guardian, she has been in the hospital 'hundreds of times' for narcotics and non-specific complaints, including abdominal pain and bleeding. No fevers, sweats, or chills. EGD 1 month ago was negative. In the emergency room, NG lavage was clear. NGT left in for observation and subsequently she put out about of blood-tinged gastric contents, but no evidence of brisk bleed. A rectal exam was performed and revealed guaiac negative brown stool. Given the patient had also been complaining of chest pain, as well as abdominal pain, a CTA of the chest was performed with a CT of the abdomen. GI was consulted in the ED. No urgent endoscopy was recommended. Of note, review of our records was significant for several ED visits in which she presented for pain. A review of narcotic prescription refills revealed that she appeared to have filled 4 narcotic medications in the past month; she has 20 controlled substance prescriptions in 12 months from 11 providers.\n", + "input3": "+developmental delay\n+depression\n+asthma\n++PEx3; w/ ivc filter\n+possible seizures\n+chronic right leg pain\n+incisional umbilical hernia repair\n+thymomectomy\n+c-section times 2 \n+appy\n+chole\n", + "input4": "Adoted, but per record from the foster mom says her Mother died w/ HTN, DM, IVDA, and multiple \nblood clots\n", + "input5": "GEN - Alert, oriented, no acute distress \nHEENT - NCAT, MMM, EOMI, sclera anicteric, OC/OP clear \nNECK - supple, no JVD, no LAD \nPULM - CTAB, no w/r/r\nCV - RR, S1/S2, no m/r/g\nABD - soft, NT/ND, normoactive bowel sounds, no guarding or rebound \nEXT - WWP, no c/c/e, 2+ pulses palpable bilaterally\nNEURO - CN II-XII intact, motor function grossly normal \nSKIN - no ulcers or lesions\n", + "input6": "07:50 7.0 4.69 12.3 39.1 83 26.2* 31.4 15.1 318 \n21:14 35.5* \n13:00 9.6 4.73 12.3 39.6 84 26.0* 31.1 15.1\nEndoscopy: fundal varices bleeding\n" +} \ No newline at end of file diff --git a/Finished/Upper Gastrointestinal Bleeding/16620644-DS-7.json b/Finished/Upper Gastrointestinal Bleeding/16620644-DS-7.json new file mode 100644 index 0000000000000000000000000000000000000000..fa5abfad79c3dfba2842230366ea75d041bd8315 --- /dev/null +++ b/Finished/Upper Gastrointestinal Bleeding/16620644-DS-7.json @@ -0,0 +1,24 @@ +{ + "upper gastrointestinal bleeding$Intermedia_3": { + "Dieulafoy can cause upper gastrointestinal bleeding.Upper gastrointestinal bleeding was confirmed by EGD.$Cause_1": { + "An EGD showed fresh blood and clot in the high fundus where prior Dieulafoy's was thought to have been, this area was injected and cauterized but uncertainty as to adequacy of treatment remained.$Input2": {} + }, + "suspected upper gastrointestinal bleeding$Intermedia_2": { + "Dizziness is one of the manifestations of anemia.$Cause_1": { + "Male with recurrent symptomatic dizziness over the past four months.$Input2": {} + }, + "Anemia is one of the manifestations of gastrointestinal bleeding$Cause_1": { + "He saw his MD and was noted to be anemic to HCT 24%.$Input2": {} + }, + "Melena is the typical symptoms of gastrointestinal bleeding.$Cause_1": { + "He reports melena at around 3pm today.$Input2": {} + } + } + }, + "input1": "None\n", + "input2": "Male with recurrent symptomatic dizziness over the past four months. Multiple EGD findings described below. On he was light-headed and had BRBPR. He saw his MD and was noted to be anemic to HCT 24%. He received a total of 5 Units of blood (2 on , 1 on , 2 on with subsequent HCT 34.6% today. A bleeding scan was negative . An EGD showed fresh blood and clot in the high fundus where prior Dieulafoy's was thought to have been, this area was injected and cauterized but uncertainty as to adequacy of treatment remained. He was sent here for Argon Plasma Coagulation. He reports melena at around 3pm today. Denies light-headedness, dizziness or abdominal pain at this time.\n", + "input3": "+HTN\n+BPH s/p TURP x 2\n+Asthma\n+Diverticulosis\n+Rectal Polyp\n+Internal hemorrhoids\n+CKD II-III\n+s/p R THR x 2\n+Left ear canal cancer\n+R ear skin cancer\n+s/p R herniorrhaphy\n", + "input4": "Mo - CAD/MI\nNo GI cancers\n", + "input5": "98.0. 166/83, 61, 16, 100RA\nYounger than stated age, very reliable historian, a bit hard of hearing\nHEENT: anicteric, OP clear, neck supple, no bruits\nLUNGS: CTA bilat w/o wheeze, rubs, gallops\nCOR: S1, SEM murmur loudest at RUSB radiates to neck, heard across precordium\nABD: soft, NT / ND, no HSM or masses, no G/R\nEXT: no C/C/E\nSKIN: multiple SKs, large 5cm sebaceous cyst L upper back without inflammation\nNEURO: A & O x 3, fluent speech & cognition, moves all 4 extremities, no focal deficits\nPSYCH: pleasant, cooperative\n", + "input6": "HCT 26.3, PLT 161\nHCT 34.6, PLT 144, INR BUN 40, Cr 1.20\nBUN 16, Cr 1.03, Na 140, K 3.7, HCO3 21, Cl 110, Glu 91\n" +} \ No newline at end of file diff --git a/Finished/Upper Gastrointestinal Bleeding/17028519-DS-23.json b/Finished/Upper Gastrointestinal Bleeding/17028519-DS-23.json new file mode 100644 index 0000000000000000000000000000000000000000..a9ed6c7b91e3d0b2f8ca9439d5fc5a2bfa8851d7 --- /dev/null +++ b/Finished/Upper Gastrointestinal Bleeding/17028519-DS-23.json @@ -0,0 +1,33 @@ +{ + "upper gastrointestinal bleeding$Intermedia_3": { + "Gastric ulcer with bleeding,duodenal ulcer on EGD is the gold standard of upper gastrointestinal bleeding.$Cause_1": { + "urgent EGD\uff1aGastric ulcer with bleeding,duodenal ulcer$Input6": {} + }, + "suspected upper gastrointestinal bleeding$Intermedia_2": { + "Coffee ground emesisand melena are the typical symptom of gastrointestinal bleeding$Cause_1": { + "coffee ground emesis, melena$Input1": {} + }, + "Upper gastrointesyinal bleeding can caused by PUD.The patient had symptoms of gastrointestinal bleeding.$Cause_1": { + "A female with a history of PUD, hiatal hernia, chronic back pain, presenting as a transfer from after melena/hematemesis and then a syncopal episode and fall.$Input2": {} + }, + "Anemia is one of the manifestations of gastrointestinal bleeding.$Cause_1": { + "RBC-3.19* HGB-10.6*$Input6": {} + }, + "Syncope is one of the manifestations of gastrointestinal bleeding.$Cause_1": { + "Regarding syncope: Went downstairs this morning after having episode of emesis. Recalls falling to the ground, partially easing herself by grabbing a chair.$Input2": {} + }, + "!Black watery stools is the typical symptom of gastrointestinal bleeding.$Cause_1": { + "A couple of black watery stools at home and then in .$Input2": {} + }, + "!Feeling lightheaded and a little fuzzy are the typical symptom of gastrointestinal bleeding.$Cause_1": { + "Patient on arrival with only complaint of feeling lightheaded and a little fuzzy.$Input2": {} + } + } + }, + "input1": "CC: coffee ground emesis, melena\n", + "input2": "A female with a history of PUD, hiatal hernia, chronic back pain, presenting as a transfer from after melena/hematemesis and then a syncopal episode and fall.\n\nRegarding hematemesis: Patient with known PUD. Normal state of health aside from mild URI symptoms until the night of , some mild queasiness before bed without abdominal pain, nausea, vomiting, or diarrhea. Then woke up early this morning due to queasiness. Patient had about episodes of emesis in a short span and none since. A couple of black watery stools at home and then in . Patient felt queasy feeling much relieved after emesis and has felt better since. No NSAID use (was counseled against this after prior ulcer); some alcohol; went on a recent trip in which she had drinks each night, otherwise, some social alcohol consumption. Patient's close friend/'daughter' , who is a nurse in , thought vomit at home looked like hematemesis.\n\nRegarding syncope: Went downstairs this morning after having episode of emesis. Recalls falling to the ground, partially easing herself by grabbing a chair. Did lose consciousness, then woke up and crawled to bed and called who came over and called EMS. Unclear how long patient was unconscious. Not sure how much blood from small forehead laceration but did not see profuse bleeding. Mild pain now on forehead only with palpation. Denies focal weakness, headache, confusion. Patient reported profuse sweating just after syncope, resolved since. No fever, chills.\n\nRegarding cough: Mild URI symptoms for several days, with nonproductive cough. Some sore throat. No fever, chills, malaise, myalgias. Some decrease in PO intake for several days. No known sick contacts. Patient still active despite mild illness, ambulatory and going about normal activities.\n\nrecords, summarized as follows: Patient on arrival with only complaint of feeling lightheaded and a little fuzzy. Unremarkable abdominal and neuro exam. BP 117/68 with HR of 104. Labs remarkable for normal INR, Hb 12.5, WBC 10.7, PLT 292, normal differential, normal BMP. CTH and c-spine unremarkable for acute process with some small vessel disease and old lacunae, some cervical spine degenerative changes noted. CT angio of ab/pelvis showing no acute bleed; extensive diverticulosis, large hiatal hernia noted (known prior), lumbar changes. CXR with clear lung fields, cardiomegaly (no images sent). One episode of melena in noted. Got Zofran and IV PPI at 1400. Sent to for urgent EGD.\n\nIn : VS: 97.9, HR 100 --> 89, 117/68, RR 18, 97% RA Labs: Hb 10.6 (from 12.5 at , WBC 9.3, INR 1.1, BMP largely unremarkable, Cr 0.6, BUN 35, CBC 23, other WNL, lact 1.1. T&S sent. GI notified on floor arrival; no need to see patient but aware of her and on board for EGD in am.\n\nROS: Pertinent positives and negatives as noted in the HPI. All other systems were reviewed and are negative.\n", + "input3": "+GERD\n-+hypercholesterolemia\n+h/o trigeminal neuralgia\n+external hemmorhoids\n", + "input4": "- dad: DM, stroke, died\n- mom starved herself to death after the death of her husband \n- sister and aunts with h/o cancer (sister had breast cancer died from brain mets)\n", + "input5": "VITALS: Afebrile and vital signs stable (see eFlowsheet)\nGENERAL: Pleasant, alert and in no apparent distress; AOx3, mentating appropriately\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. \nOropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur, no S3, no S4. No JVD. No edema\nRESP: Lungs clear to auscultation with good air movement bilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel\nsounds present. No HSM\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full and symmetric bilaterally in all limbs\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, oriented, face symmetric, gaze conjugate with EOMI, speech fluent, moves all limbs, sensation to light touch grossly intact throughout\nPSYCH: pleasant, appropriate affect\n", + "input6": "04:45PM WBC-9.3 RBC-3.19* HGB-10.6* HCT-32.5* MCV-102* MCH-33.2* MCHC-32.6 RDW-12.9 RDWSD-48.0*\n04:45PM PLT COUNT-223\n04:45PM GLUCOSE-108* UREA N-35* CREAT-0.6 SODIUM-143 POTASSIUM-4.5 CHLORIDE-109* TOTAL CO2-23 ANION GAP-11\n04:45PM ALT(SGPT)-13 AST(SGOT)-18 ALK PHOS-45 TOT BILI-0.4\n04:45PM ALBUMIN-3.7 CALCIUM-9.1 PHOSPHATE-3.4 MAGNESIUM-1.9\nurgent EGD\uff1aGastric ulcer with bleeding,duodenal ulcer\n" +} \ No newline at end of file diff --git a/README.md b/README.md index 42f3ac1b0d8c5e196c041a75f026b426855bb2ff..74cf0bfb219e92b69c2b1ba212a237e2bf8c9e7b 100644 --- a/README.md +++ b/README.md @@ -1,13 +1,14 @@ ---- -title: RAG -emoji: 🦀 -colorFrom: blue -colorTo: blue -sdk: gradio -sdk_version: 5.29.0 -app_file: app.py -pinned: false -license: apache-2.0 ---- - -Check out the configuration reference at https://huggingface.co/docs/hub/spaces-config-reference +--- +title: RAG For Diagnostic Reasoning For Clinical Notes +emoji: 📈 +colorFrom: red +colorTo: pink +sdk: streamlit +sdk_version: 1.44.1 +app_file: app.py +pinned: false +license: mit +short_description: DiReCT (Diagnostic Reasoning for Clinical Text) is a Retriev +--- + +Check out the configuration reference at https://huggingface.co/docs/hub/spaces-config-reference diff --git a/app.py b/app.py new file mode 100644 index 0000000000000000000000000000000000000000..ccd41e10d7a96d2b5639fb715bb1680e87c37dbe --- /dev/null +++ b/app.py @@ -0,0 +1,520 @@ +import os +import json +import glob +from pathlib import Path +import torch +import streamlit as st +from dotenv import load_dotenv +from langchain_groq import ChatGroq +from langchain_community.embeddings import HuggingFaceEmbeddings +from langchain_text_splitters import RecursiveCharacterTextSplitter +from langchain_community.vectorstores import FAISS +from langchain_core.documents import Document +from langchain_core.prompts import ChatPromptTemplate +from langchain.chains import create_retrieval_chain +from langchain.chains.combine_documents import create_stuff_documents_chain +import numpy as np +from sentence_transformers import util +import time + +# Set device for model (CUDA if available) +device = "cuda" if torch.cuda.is_available() else "cpu" + +# Load environment variables - works for both local and Hugging Face Spaces +load_dotenv() + +# Set up the clinical assistant LLM +# Try to get API key from Hugging Face Spaces secrets first, then fall back to .env file +try: + # For Hugging Face Spaces + from huggingface_hub.inference_api import InferenceApi + import os + groq_api_key = os.environ.get('GROQ_API_KEY') + + # If not found in environment, try to get from st.secrets (Streamlit Cloud/Spaces) + if not groq_api_key and hasattr(st, 'secrets') and 'GROQ_API_KEY' in st.secrets: + groq_api_key = st.secrets['GROQ_API_KEY'] + + if not groq_api_key: + st.warning("API Key is not set in the secrets. Using a placeholder for UI demonstration.") + # For UI demonstration without API key + class MockLLM: + def invoke(self, prompt): + return {"answer": "This is a placeholder response. Please set up your GROQ_API_KEY to get real responses."} + llm = MockLLM() + else: + llm = ChatGroq(groq_api_key=groq_api_key, model_name="llama-3.3-70b-versatile") + +except Exception as e: + st.error(f"Error setting up LLM: {str(e)}") + class MockLLM: + def invoke(self, prompt): + return {"answer": f"Error setting up LLM: {str(e)}. Please check your API key configuration."} + llm = MockLLM() + +# Set up embeddings for clinical context (Bio_ClinicalBERT) +embeddings = HuggingFaceEmbeddings( + model_name="emilyalsentzer/Bio_ClinicalBERT", + model_kwargs={"device": device} +) + +def load_clinical_data(): + """Load both flowcharts and patient cases""" + docs = [] + + # Get the absolute path to the current script + current_dir = os.path.dirname(os.path.abspath(__file__)) + + # Try to handle potential errors with file loading + try: + # Load diagnosis flowcharts + flowchart_dir = os.path.join(current_dir, "Diagnosis_flowchart") + if os.path.exists(flowchart_dir): + for fpath in glob.glob(os.path.join(flowchart_dir, "*.json")): + try: + with open(fpath, 'r', encoding='utf-8') as f: + data = json.load(f) + content = f""" + DIAGNOSTIC FLOWCHART: {Path(fpath).stem} + Diagnostic Path: {data.get('diagnostic', 'N/A')} + Key Criteria: {data.get('knowledge', 'N/A')} + """ + docs.append(Document( + page_content=content, + metadata={"source": fpath, "type": "flowchart"} + )) + except Exception as e: + st.warning(f"Error loading flowchart file {fpath}: {str(e)}") + else: + st.warning(f"Flowchart directory not found at {flowchart_dir}") + + # Load patient cases + finished_dir = os.path.join(current_dir, "Finished") + if os.path.exists(finished_dir): + for category_dir in glob.glob(os.path.join(finished_dir, "*")): + if os.path.isdir(category_dir): + for case_file in glob.glob(os.path.join(category_dir, "*.json")): + try: + with open(case_file, 'r', encoding='utf-8') as f: + case_data = json.load(f) + notes = "\n".join( + f"{k}: {v}" for k, v in case_data.items() if k.startswith("input") + ) + docs.append(Document( + page_content=f""" + PATIENT CASE: {Path(case_file).stem} + Category: {Path(category_dir).name} + Notes: {notes} + """, + metadata={"source": case_file, "type": "patient_case"} + )) + except Exception as e: + st.warning(f"Error loading case file {case_file}: {str(e)}") + else: + st.warning(f"Finished directory not found at {finished_dir}") + + # If no documents were loaded, add a sample document for testing + if not docs: + st.warning("No clinical data files found. Using sample data for demonstration.") + docs.append(Document( + page_content="""SAMPLE CLINICAL DATA: This is sample data for demonstration purposes. + This application requires clinical data files to be present in the correct directories. + Please ensure the Diagnosis_flowchart and Finished directories exist with proper JSON files.""", + metadata={"source": "sample", "type": "sample"} + )) + except Exception as e: + st.error(f"Error loading clinical data: {str(e)}") + # Add a fallback document + docs.append(Document( + page_content="Error loading clinical data. This is a fallback document for demonstration purposes.", + metadata={"source": "error", "type": "error"} + )) + return docs + +def build_vectorstore(): + """Build and return the vectorstore using FAISS""" + documents = load_clinical_data() + splitter = RecursiveCharacterTextSplitter(chunk_size=1000, chunk_overlap=200) + splits = splitter.split_documents(documents) + vectorstore = FAISS.from_documents(splits, embeddings) + return vectorstore + +# Path for saving/loading the vectorstore +def get_vectorstore_path(): + """Get the path for saving/loading the vectorstore""" + current_dir = os.path.dirname(os.path.abspath(__file__)) + return os.path.join(current_dir, "vectorstore") + +# Initialize vectorstore with disk persistence +@st.cache_resource(show_spinner="Loading clinical knowledge base...") +def get_vectorstore(): + """Get or create the vectorstore with disk persistence""" + vectorstore_path = get_vectorstore_path() + + # Try to load from disk first + try: + if os.path.exists(vectorstore_path): + st.info("Loading vectorstore from disk...") + # Set allow_dangerous_deserialization to True since we trust our own vectorstore files + return FAISS.load_local(vectorstore_path, embeddings, allow_dangerous_deserialization=True) + except Exception as e: + st.warning(f"Could not load vectorstore from disk: {str(e)}. Building new vectorstore.") + + # If loading fails or doesn't exist, build a new one + st.info("Building new vectorstore...") + vectorstore = build_vectorstore() + + # Save to disk for future use + try: + os.makedirs(vectorstore_path, exist_ok=True) + vectorstore.save_local(vectorstore_path) + st.success("Vectorstore saved to disk for future use") + except Exception as e: + st.warning(f"Could not save vectorstore to disk: {str(e)}") + + return vectorstore + +def run_rag_chat(query, vectorstore): + """Run the Retrieval-Augmented Generation (RAG) for clinical questions""" + try: + retriever = vectorstore.as_retriever() + + prompt_template = ChatPromptTemplate.from_template(""" + You are a clinical assistant AI. Based on the following clinical context, provide a reasoned and medically sound answer to the question. + + + {context} + + + Question: {input} + + Answer: + """) + + retrieved_docs = retriever.invoke(query, k=3) + retrieved_context = "\n".join([doc.page_content for doc in retrieved_docs]) + + # Create document chain first + document_chain = create_stuff_documents_chain(llm, prompt_template) + + # Then create retrieval chain + chain = create_retrieval_chain(retriever, document_chain) + + # Invoke the chain + response = chain.invoke({"input": query}) + + # Add retrieved documents to response for transparency + response["context"] = retrieved_docs + + return response + except Exception as e: + st.error(f"Error in RAG processing: {str(e)}") + # Return a fallback response + return { + "answer": f"I encountered an error processing your query: {str(e)}", + "context": [], + "input": query + } + +def calculate_hit_rate(retriever, query, expected_docs, k=3): + """Calculate the hit rate for top-k retrieved documents""" + retrieved_docs = retriever.get_relevant_documents(query, k=k) + retrieved_contents = [doc.page_content for doc in retrieved_docs] + + hits = 0 + for expected in expected_docs: + if any(expected in retrieved for retrieved in retrieved_contents): + hits += 1 + + return hits / len(expected_docs) if expected_docs else 0.0 + +def evaluate_rag_response(response, embeddings): + """Evaluate the RAG response for faithfulness and hit rate""" + scores = {} + + # Faithfulness: Answer-Context Similarity + answer_embed = embeddings.embed_query(response["answer"]) + context_embeds = [embeddings.embed_query(doc.page_content) for doc in response["context"]] + similarities = [util.cos_sim(answer_embed, ctx_embed).item() for ctx_embed in context_embeds] + scores["faithfulness"] = float(np.mean(similarities)) if similarities else 0.0 + + # Custom Hit Rate Calculation + retriever = response["retriever"] + scores["hit_rate"] = calculate_hit_rate( + retriever, + query=response["input"], + expected_docs=[doc.page_content for doc in response["context"]], + k=3 + ) + + return scores + +def main(): + """Main function to run the Streamlit app""" + # Set page configuration + st.set_page_config( + page_title="DiReCT - Clinical Diagnostic Assistant", + page_icon="🩺", + layout="wide", + initial_sidebar_state="expanded" + ) + + # Load vectorstore only once using session state + if 'vectorstore' not in st.session_state: + with st.spinner("Loading clinical knowledge base... This may take a minute."): + try: + st.session_state.vectorstore = get_vectorstore() + # Use custom styled message without the success icon + st.markdown("
Clinical knowledge base loaded successfully!
", unsafe_allow_html=True) + except Exception as e: + st.error(f"Error loading knowledge base: {str(e)}") + st.session_state.vectorstore = None + + # Custom CSS for modern look with dark theme compatibility + st.markdown(""" + + """, unsafe_allow_html=True) + + # App states + if 'chat_history' not in st.session_state: + st.session_state.chat_history = [] + if 'page' not in st.session_state: + st.session_state.page = 'cover' + + # Sidebar + with st.sidebar: + st.image("https://img.icons8.com/color/96/000000/caduceus.png", width=80) + st.title("DiReCT") + st.markdown("### Diagnostic Reasoning for Clinical Text") + st.markdown("---") + + if st.button("Home", key="home_btn"): + st.session_state.page = 'cover' + if st.button("Diagnostic Assistant", key="assistant_btn"): + st.session_state.page = 'chat' + if st.button("About", key="about_btn"): + st.session_state.page = 'about' + + st.markdown("---") + st.markdown("### Model Information") + st.markdown("**Embedding Model:** Bio_ClinicalBERT") + st.markdown("**LLM:** Llama-3.3-70B") + st.markdown("**Vector Store:** FAISS") + + # Cover page + if st.session_state.page == 'cover': + # Hero section with animation + col1, col2 = st.columns([2, 1]) + with col1: + st.markdown("

DiReCT

", unsafe_allow_html=True) + st.markdown("

Diagnostic Reasoning for Clinical Text

", unsafe_allow_html=True) + st.markdown("""

A powerful RAG-based clinical diagnostic assistant that leverages the MIMIC-IV-Ext dataset to provide accurate medical insights and diagnostic reasoning.

""", unsafe_allow_html=True) + + st.markdown("""
""", unsafe_allow_html=True) + if st.button("Get Started", key="get_started"): + st.session_state.page = 'chat' + st.rerun() + + with col2: + # Animated medical icon + st.markdown(""" +
+ +
+ """, unsafe_allow_html=True) + + # Modern Features section with Streamlit native components + st.markdown("

", unsafe_allow_html=True) + st.markdown("

Key Features

", unsafe_allow_html=True) + + # Create a 2x2 grid for features using Streamlit columns + col1, col2 = st.columns(2) + + # Feature 1 + with col1: + st.markdown(""" +
+

🔍 Intelligent Retrieval

+

Finds the most relevant clinical information from the MIMIC-IV-Ext dataset

+
+ """, unsafe_allow_html=True) + + # Feature 2 + with col2: + st.markdown(""" +
+

🧠 Advanced Reasoning

+

Applies clinical knowledge to generate accurate diagnostic insights

+
+ """, unsafe_allow_html=True) + + # Feature 3 + with col1: + st.markdown(""" +
+

📄 Source Transparency

+

Provides references to all clinical sources used in generating responses

+
+ """, unsafe_allow_html=True) + + # Feature 4 + with col2: + st.markdown(""" +
+

🌓 Dark/Light Theme Compatible

+

Optimized interface that works seamlessly in both dark and light themes

+
+ """, unsafe_allow_html=True) + + # Chat interface + elif st.session_state.page == 'chat': + # Initialize session state for input if not exists + if 'user_input' not in st.session_state: + st.session_state.user_input = "" + + # Header with clear button + col1, col2 = st.columns([3, 1]) + with col1: + st.markdown("

Clinical Diagnostic Assistant

", unsafe_allow_html=True) + with col2: + # Add a clear button in the header + if st.button("🗑️ Clear Chat"): + st.session_state.chat_history = [] + st.session_state.user_input = "" + st.rerun() + + st.markdown("Ask any clinical diagnostic question and get insights based on medical knowledge and patient cases.") + + # Fixed input area at the top + with st.container(): + st.markdown("
", unsafe_allow_html=True) + user_input = st.text_area("Ask a clinical question:", st.session_state.user_input, height=100, key="question_input") + col1, col2 = st.columns([1, 5]) + with col1: + submit_button = st.button("Submit") + st.markdown("
", unsafe_allow_html=True) + + # Create a container for chat history + chat_container = st.container() + + # Process query + if submit_button and user_input: + if st.session_state.vectorstore is None: + st.error("Knowledge base not loaded. Please refresh the page and try again.") + else: + with st.spinner("Analyzing clinical data..."): + try: + # Add a small delay for UX + time.sleep(0.5) + + # Run RAG + response = run_rag_chat(user_input, st.session_state.vectorstore) + response["retriever"] = st.session_state.vectorstore.as_retriever() + + # Clear previous chat history and only keep the current response + st.session_state.chat_history = [(user_input, response)] + + # Clear the input field + st.session_state.user_input = "" + + # Rerun to update UI + st.rerun() + except Exception as e: + st.error(f"Error processing query: {str(e)}") + + # Display chat history in the container + with chat_container: + for i, (query, response) in enumerate(st.session_state.chat_history): + st.markdown(f"
🧑‍⚕️ You: {query}
", unsafe_allow_html=True) + + st.markdown(f"
🩺 DiReCT: {response['answer']}
", unsafe_allow_html=True) + + with st.expander("View Sources"): + for doc in response["context"]: + st.markdown(f"
" + f"Source: {Path(doc.metadata['source']).stem}
" + f"Type: {doc.metadata['type']}
" + f"Content: {doc.page_content[:300]}...
", + unsafe_allow_html=True) + + # Show evaluation metrics if available + try: + eval_scores = evaluate_rag_response(response, embeddings) + with st.expander("View Evaluation Metrics"): + col1, col2 = st.columns(2) + with col1: + st.metric("Hit Rate (Top-3)", f"{eval_scores['hit_rate']:.2f}") + with col2: + st.metric("Faithfulness", f"{eval_scores['faithfulness']:.2f}") + except Exception as e: + st.warning(f"Evaluation metrics unavailable: {str(e)}") + + # About page + elif st.session_state.page == 'about': + st.markdown("

About DiReCT

", unsafe_allow_html=True) + + st.markdown(""" + ### Project Overview + + DiReCT (Diagnostic Reasoning for Clinical Text) is a Retrieval-Augmented Generation (RAG) system designed to assist medical professionals with diagnostic reasoning based on clinical notes and medical knowledge. + + ### Data Sources + + This application uses the MIMIC-IV-Ext dataset, which contains de-identified clinical notes and medical records. The system processes: + + - Diagnostic flowcharts + - Patient cases + - Clinical guidelines + + ### Technical Implementation + + - **Embedding Model**: Bio_ClinicalBERT for domain-specific text understanding + - **Vector Database**: FAISS for efficient similarity search + - **LLM**: Llama-3.3-70B for generating medically accurate responses + - **Framework**: Built with LangChain and Streamlit + + ### Evaluation Metrics + + The system evaluates responses using: + + - **Hit Rate**: Measures how many relevant documents were retrieved + - **Faithfulness**: Measures how well the response aligns with the retrieved context + + ### Ethical Considerations + + This system is designed as a clinical decision support tool and not as a replacement for professional medical judgment. All patient data used has been properly de-identified in compliance with healthcare privacy regulations. + """) + + st.markdown("
", unsafe_allow_html=True) + st.markdown("### Developers") + st.markdown("This project was developed as part of an academic assignment on RAG systems for clinical applications.") + +if __name__ == "__main__": + main() diff --git a/requirements.txt b/requirements.txt new file mode 100644 index 0000000000000000000000000000000000000000..d4d015be443a589612240e9f5980b86ad537e37c --- /dev/null +++ b/requirements.txt @@ -0,0 +1,25 @@ +# Core dependencies +streamlit>=1.31.0 +python-dotenv>=1.0.0 + +# LangChain ecosystem +langchain>=0.1.0 +langchain-core>=0.1.0 +langchain-community>=0.0.10 +langchain-groq>=0.1.0 + +# Embedding and vector storage +sentence-transformers>=2.2.2 +faiss-cpu>=1.7.4 +huggingface-hub>=0.19.0 + +# LLM and transformers +transformers>=4.36.0 +torch>=2.0.0 +numpy>=1.24.0 + +# Utilities +tqdm>=4.66.0 +pandas>=2.0.0 + +