From aaf29d13aa9b85ad508ef9767ec36867dce259ba Mon Sep 17 00:00:00 2001 From: JerryCodeGrind Date: Mon, 5 May 2025 18:27:56 -0400 Subject: [PATCH] added deductive reasoning, counter deductive reasoning, and ign questions datasets. --- .DS_Store | Bin 8196 -> 6148 bytes IGNQuestions/.gitignore | 46 + IGNQuestions/cases.py | 1649 ++++++++++++++++++++++++ IGNQuestions/generating_cases.py | 218 ++++ IGNQuestions/information_gain.py | 257 ++++ IGNQuestions/main.py | 146 +++ IGNQuestions/medical_cases.json | 2002 ++++++++++++++++++++++++++++++ IGNQuestions/results.json | 488 ++++++++ 8 files changed, 4806 insertions(+) create mode 100644 IGNQuestions/.gitignore create mode 100644 IGNQuestions/cases.py create mode 100644 IGNQuestions/generating_cases.py create mode 100644 IGNQuestions/information_gain.py create mode 100644 IGNQuestions/main.py create mode 100644 IGNQuestions/medical_cases.json create mode 100644 IGNQuestions/results.json diff --git a/.DS_Store b/.DS_Store index 680bb92d8f0826a7d84602a34eca0d5973d52c93..f3df748bb66b3cebe0416b584e44a8433cb36c91 100644 GIT binary patch delta 319 zcmZp1XfcprU|?W$DortDU=RQ@Ie-{MGjdEU6q~50D9QrjfW=Z7QW#1Zk{L=EGA9-; zuLnu+G9)tO0AUIPk|aYJh?kRY7@VA+TL4rA19(*D=DWBg<>V&;m2&v~HH&F~a?BCP z#-qb3H$R0$Ed?16Cv7ZrW?Rh8!6C>DahU)&kah+6d1K*s=E?jrmI@#Vps$&rG{~Yc#AyJf6`)E8DTuX{q?8{OOB&Ll151No;DYzoRVgcF z;x9oANQ_MU3H$*pY#rE`;Cp8`IwxsIgp|AJ?%8+mdw1`9@9bPcM55BON<_;?kJkE8Zq~e~dkOFwxcKv3<^&7a)PiX57&46Y=GoTsJ3}^=a2L|xY=3<=k-j7Cg zs~OM?%p?Q+d?=u@EXQ&fN%`nNBaZ-(X>`kiYx&h5vcMgXsW| zJ~@a8j`4D=Ka6AqCn0Bsop@#upHM`6@DK&5PNE!1-D(Cj1CtE!**#6G)FOw%vGe;! zjBWmrMFK~9ZmU#l`t3mWp8s{M+GzXLYWy33@wL+b`T57U&E&Xs=6JBH*j_C26bmQo z!x~%Ukxw16lWP^%pr@{N9+*Da(C&|Ez8}-fk%>=0`_!a5>Ml^|Nur2-Q0*J&c|_Z^ zMK^I3P>|G5;qfHiDcogYyN&hR(66&Tt&Jh}fH+bR`4PgT*W^-vY3n@w-UPrRUFOjEs>pUetE|K`pF@ zy>6x6dB%5-ecx@IT-O^<9D88qFFo|Vuv*p3wHSz+1y4TW9?HB5_f-UljEIq>-w5p=<=CpmV2@{*_&+gIbUh}`9T zuH>%-SX^xo+vXipa~k_TZ-@uh=3Os7C_W;% zy38m8bCKW6ImoTkfB&CRcC_1?f!Sa{q^q@R1-|mvp=pKB+6B~Cs9acY7)c31Bah>d k@;DAT`oj>{1*kHn9Lr%O(S!2Oe+ba;fBpWKnK#?bUs+7+RsaA1 diff --git a/IGNQuestions/.gitignore b/IGNQuestions/.gitignore new file mode 100644 index 00000000..e90fb65b --- /dev/null +++ b/IGNQuestions/.gitignore @@ -0,0 +1,46 @@ +# Python +__pycache__/ +*.py[cod] +*$py.class +*.so +.Python +build/ +develop-eggs/ +dist/ +downloads/ +eggs/ +.eggs/ +lib/ +lib64/ +parts/ +sdist/ +var/ +wheels/ +*.egg-info/ +.installed.cfg +*.egg + +# Virtual Environment +venv/ +env/ +ENV/ + +# IDE +.idea/ +.vscode/ +*.swp +*.swo + +# API Keys and Secrets +api_key.py +*.key +*.pem +*.env +.env + +# Logs +*.log + +# Local development +.DS_Store +Thumbs.db diff --git a/IGNQuestions/cases.py b/IGNQuestions/cases.py new file mode 100644 index 00000000..40a33106 --- /dev/null +++ b/IGNQuestions/cases.py @@ -0,0 +1,1649 @@ +cases = [ { 'diagnosis': 'Paraneoplastic hypercalcemia', + 'doctor_vignette': 'A 72-year-old man presents to his primary care physician with complaints of persistent ' + 'fatigue and recent episodes of confusion.', + 'patient_profile': 'You are a 72-year-old man named Robert, a retired high school teacher who lives alone in a ' + 'small apartment. You have a close-knit family; your daughter and her two children visit ' + 'often, and your son lives a few hours away but calls regularly. Over the past month, ' + "you've been experiencing persistent fatigue that seems to come out of nowhere. You find " + 'yourself needing to take frequent naps during the day and still feel exhausted. Recently, ' + 'you’ve also noticed some unusual symptoms: your appetite has decreased significantly, and ' + 'you’ve unintentionally lost about 5 kg in weight, which worries you. \n' + '\n' + "Additionally, you've been feeling quite thirsty, needing to drink water constantly, and " + 'you’ve noticed that you urinate more frequently than before, especially at night. You’ve ' + 'had some mild confusion and difficulty concentrating, which feels unusual for you. You’ve ' + 'also experienced intermittent bone pain, particularly in your lower back and hips, which ' + 'you initially attributed to aging. \n' + '\n' + 'You have a history of hypertension, managed with medication, and you were treated for ' + 'prostate cancer five years ago with surgery and radiation. Your cancer was thought to be ' + 'resolved, but you can’t shake the feeling that something might be wrong again. You have no ' + 'known allergies and take lisinopril for blood pressure and a daily multivitamin. \n' + '\n' + 'In your family history, your father passed away from lung cancer, and your mother had ' + 'osteoporosis. You’ve been a non-smoker for over 30 years and have a moderate alcohol ' + 'intake, about 10 units a week, usually enjoying a glass of wine with dinner. \n' + '\n' + 'You feel anxious about these new symptoms and worry that they might be indicative of ' + 'another serious illness, possibly related to your previous cancer. You have not done any ' + 'research on your symptoms, as you feel overwhelmed and unsure where to start. Your main ' + 'concern is understanding what’s happening to your body, and you hope the doctor will run ' + 'some tests to clarify the situation. You are eager to find out if there’s a diagnosis and ' + 'what the next steps might be.'}, + { 'diagnosis': 'Pemphigus vulgaris', + 'doctor_vignette': 'A 54-year-old man presents with painful blisters on his chest and back, accompanied by a ' + 'persistent burning sensation and occasional skin peeling.', + 'patient_profile': 'You are a 54-year-old woman who works as a high school teacher and lives alone with your ' + "two cats. Over the past two months, you've started to notice painful blisters developing " + 'inside your mouth, particularly on your gums and the roof of your mouth. At first, you ' + 'thought it was just a canker sore, but these sores have persisted and seem to be getting ' + 'worse, making it difficult for you to eat and talk. You’ve also developed skin blisters on ' + 'your chest and back that are itchy and painful; these blisters sometimes burst, leaving ' + 'raw areas that take a long time to heal.\n' + '\n' + 'You’ve been feeling increasingly fatigued, which you initially attributed to your busy ' + 'work schedule, but now you find that you’re exhausted even after a full night’s sleep. ' + 'You’ve lost about 5 kg in the last month without trying, as eating has become a struggle ' + 'due to the pain in your mouth. You’ve noticed that your skin is becoming more sensitive ' + "and redder than usual, and you have a general feeling of discomfort that you can't quite " + 'place. \n' + '\n' + 'You’ve done a bit of reading online and are worried this could be a serious autoimmune ' + 'condition, but you don’t know much about it. Your main concern is that these symptoms will ' + 'affect your ability to teach and maintain your daily activities. You hope the doctor will ' + 'be able to explain what is happening and offer a solution to relieve your symptoms.\n' + '\n' + 'In terms of your medical history, you have a history of seasonal allergies and mild ' + 'asthma, for which you take an inhaler as needed. You had your gallbladder removed five ' + 'years ago due to gallstones, and you have no other significant medical history. You take ' + 'no regular medications, although you occasionally use over-the-counter pain relievers for ' + 'headaches.\n' + '\n' + 'Family history includes your mother, who has rheumatoid arthritis, and your father, who ' + 'has hypertension. You have two older siblings who are generally healthy. Socially, you ' + 'enjoy spending time with friends and attending community events, but you’ve been feeling ' + 'isolated lately due to your symptoms. You have never smoked and drink alcohol socially, ' + 'about 2-3 glasses of wine on weekends.\n' + '\n' + 'You are anxious about your current symptoms and concerned that they could lead to ' + 'something more serious. You want to understand what is happening to your body and are ' + 'hoping for a clear diagnosis and treatment plan that will help you return to your normal ' + 'life.'}, + { 'diagnosis': 'Tubo-ovarian abscess', + 'doctor_vignette': 'A 32-year-old woman presents with persistent pelvic pain and the discovery of a palpable ' + 'adnexal mass during a routine examination.', + 'patient_profile': 'You are a 32-year-old woman who works as a graphic designer and lives alone in a small ' + "apartment. For the past week, you've been experiencing severe abdominal pain that started " + 'suddenly and has been progressively worsening. The pain is primarily located in your lower ' + 'abdomen and radiates to your lower back. It is sharp and intermittent, often accompanied ' + "by a feeling of heaviness. You've also noticed some swelling in your abdomen, which has " + 'made your clothes feel tight. \n' + '\n' + 'In addition to the pain, you have been experiencing fever and chills, along with nausea ' + "that has led to a loss of appetite. You've been feeling fatigued and have had difficulty " + 'sleeping due to the discomfort. You also recently had an episode of vomiting after trying ' + 'to eat a small meal. You have a history of irregular menstrual cycles, and your last ' + 'period was about two weeks late, which is unusual for you. \n' + '\n' + 'You are worried that something serious is happening, possibly related to your reproductive ' + 'health, as you have heard of conditions like ovarian cysts or infections but do not know ' + 'much about them. Your biggest concern is that this pain could indicate a severe problem, ' + 'and you hope the doctor will provide clarity and relief.\n' + '\n' + 'In terms of your medical history, you had a laparoscopic appendectomy at age 22. You have ' + 'no known drug allergies and currently take a daily multivitamin. You are not on any other ' + 'medications. Your family history includes your mother, who had endometriosis, and your ' + 'sister, who has polycystic ovary syndrome (PCOS). There are no significant medical ' + 'conditions noted in your father’s side of the family.\n' + '\n' + 'Socially, you lead a relatively active lifestyle, enjoy yoga, and occasionally go out with ' + 'friends on weekends. You do not smoke and drink alcohol moderately, about 5-7 units per ' + 'week. You are currently single and not in a relationship, and your social support ' + 'primarily comes from a close-knit group of friends. \n' + '\n' + 'You are anxious about the possibility of needing surgery or facing a chronic condition, ' + 'and you hope the doctor will run tests and provide a diagnosis to help you understand what ' + 'is happening with your body.'}, + { 'diagnosis': 'Leprosy', + 'doctor_vignette': 'A 45-year-old man presents to the clinic with multiple hypopigmented lesions on his arms ' + 'and back, accompanied by occasional numbness in his hands.', + 'patient_profile': 'You are a 45-year-old man who works as a mechanic in a small auto repair shop. You live ' + "alone in a modest apartment and have no children. Over the last three months, you've " + 'noticed some unusual changes in your skin. Initially, it was just a few small patches that ' + 'appeared on your arms and legs, which you thought were dry skin or minor rashes. However, ' + 'these patches have slowly spread and are becoming more noticeable. Some areas have ' + 'developed a lighter color compared to your natural skin tone, and a couple of them have ' + 'begun to feel numb. You also have a persistent tingling sensation in your hands and feet, ' + 'which has made it difficult for you to work on intricate tasks at the shop.\n' + '\n' + "Lately, you've been feeling a bit more fatigued than usual, but you chalked it up to long " + 'hours at work. You’ve also experienced some mild joint pain in your knees and elbows, ' + 'which you dismissed as the typical wear and tear from your job. A few weeks ago, you ' + 'noticed that small cuts on your hands heal much slower than they used to, and you’ve ' + 'developed a couple of small, painless lumps on your face that you’re worried might be ' + 'something serious.\n' + '\n' + 'You have no significant medical history, aside from occasional seasonal allergies. You are ' + 'not currently taking any medications, but you do take over-the-counter antihistamines when ' + 'your allergies flare up. Your family history is notable for diabetes in your mother and ' + 'hypertension in your father, but no history of skin conditions or neurological disorders.\n' + '\n' + 'Socially, you enjoy spending time with friends at the local bar or playing pool, and you ' + 'drink around 10-15 units of alcohol a week. You have never smoked. You’re concerned that ' + 'these skin changes and the numbness might indicate a serious health issue, possibly ' + 'something like a neurological condition or an autoimmune disorder. You have not done any ' + 'research on your symptoms because you’re afraid of what you might find. Your main ' + 'expectation from this visit is to understand what is happening with your body and to find ' + 'a way to alleviate your symptoms. You hope the doctor will conduct some tests to get to ' + 'the bottom of it.'}, + { 'diagnosis': 'Goodpasture syndrome', + 'doctor_vignette': 'A 32-year-old man presents to the emergency department with sudden onset shortness of ' + 'breath and significant hemoptysis. He also reports darkening of his urine over the past ' + 'several days.', + 'patient_profile': 'You are a 32-year-old man who works as a civil engineer and lives alone in a small ' + 'apartment. Over the past month, you have been experiencing persistent fatigue that seems ' + 'to worsen each week. You find it increasingly difficult to get out of bed in the morning, ' + "and even simple tasks at work leave you feeling drained. Alongside the fatigue, you've " + 'noticed that your urine has become darker and frothy, which has you feeling quite ' + 'concerned. You also have been experiencing intermittent episodes of coughing, which are ' + 'sometimes accompanied by a small amount of blood—this has frightened you the most. \n' + '\n' + 'You mention that you have had some mild headaches lately, but you attributed them to ' + 'stress from your job, especially with the recent project deadlines. You’ve had a few ' + 'episodes of shortness of breath, particularly when climbing stairs or after physical ' + 'exertion, which is unusual for you as you typically enjoy running on the weekends. You ' + 'haven’t had any significant weight loss, but you feel like your appetite has decreased. \n' + '\n' + 'In terms of your medical history, you had a minor knee surgery a few years ago after an ' + 'injury from a soccer game, but you have no chronic medical conditions. You do not take any ' + 'regular medications, but you occasionally use over-the-counter pain relievers like ' + 'ibuprofen for headaches. You are a non-smoker and drink alcohol socially, about 5-7 units ' + 'on weekends. \n' + '\n' + 'Your family history includes hypertension and diabetes in your parents, but no autoimmune ' + 'diseases or kidney issues. You are concerned that your symptoms could signal something ' + 'serious like a kidney problem or lung disease, especially given the hemoptysis. You ' + 'haven’t done any research on these symptoms, but you feel anxious and hope the doctor can ' + 'provide clarity and run some tests to understand what’s happening. Your biggest fear is ' + 'that this could be something life-threatening, and you are eager for a diagnosis and ' + 'treatment plan that can help you feel normal again.'}, + { 'diagnosis': 'Arrhythmogenic right ventricular cardiomyopathy', + 'doctor_vignette': 'A 42-year-old man presents to the clinic with episodes of exercise-induced syncope and ' + 'occasional palpitations over the past few months. He reports feeling lightheaded during ' + 'physical activity, which has prompted his visit.', + 'patient_profile': 'You are a 42-year-old man who works as a high school physical education teacher and lives ' + "with your wife and two children, ages 10 and 12. Over the past few months, you've " + 'experienced episodes of palpitations that leave you feeling anxious and confused. These ' + 'episodes often occur during physical activity, such as playing soccer with your kids or ' + 'even when climbing stairs. You describe the sensation as a racing heart that sometimes ' + 'feels irregular, and it can last from a few seconds to several minutes. You’ve also ' + 'noticed an increase in fatigue; you find yourself needing to take breaks during activities ' + 'that used to be easy for you. \n' + '\n' + 'Recently, you’ve had a couple of fainting spells—once while teaching a class and another ' + 'time while getting ready for bed. You were able to recover quickly, but it left you ' + 'feeling shaken. You’ve also felt lightheaded on several occasions, especially when ' + 'standing up quickly. You’ve been sleeping poorly, often waking up in the middle of the ' + 'night feeling anxious and restless.\n' + '\n' + 'Your family has a history of heart problems: your father had a heart attack at 55, and ' + 'your older brother was diagnosed with a heart condition in his late 30s, though you’re not ' + "sure of the details. You're worried that your symptoms could indicate a serious heart " + 'problem, especially given your family history. You have no known drug allergies, and you ' + 'take no regular medications, but you occasionally use over-the-counter ibuprofen for ' + 'headaches. You don’t smoke and have never been a heavy drinker, typically having only a ' + 'couple of beers on weekends. \n' + '\n' + 'In terms of your past medical history, you had a minor knee surgery five years ago after a ' + 'sports injury, but otherwise, you’ve been generally healthy. You feel frustrated and ' + 'scared about these new symptoms, and you hope the doctor can offer some clarity and ' + 'possibly run some tests to find out what’s going on. You’re also concerned about how this ' + 'might affect your ability to keep up with your kids and your job.'}, + { 'diagnosis': 'Long QT syndrome', + 'doctor_vignette': 'A 28-year-old man presents to the emergency department after experiencing recurrent ' + 'episodes of syncope and occasional palpitations over the past month. She reports feeling ' + 'dizzy and lightheaded prior to these episodes.', + 'patient_profile': 'You are a 28-year-old man who works as a software developer and lives alone in a small ' + 'apartment. Over the past few months, you have been experiencing episodes of ' + 'lightheadedness and palpitations, especially during moments of stress or after intense ' + 'workouts. These episodes often come with a sensation of your heart racing or fluttering in ' + 'your chest, sometimes accompanied by a feeling of tightness in your throat. You’ve noticed ' + 'that these symptoms can last anywhere from a few seconds to a couple of minutes, and they ' + 'often leave you feeling anxious and fatigued afterward.\n' + '\n' + 'About three weeks ago, you experienced a particularly alarming episode while jogging, ' + 'where you felt faint and had to sit down for several minutes before you felt stable enough ' + 'to walk home. Since then, you’ve been hesitant to engage in physical activity, fearing ' + 'another episode. You also experienced a near-syncope episode while standing in line at a ' + 'coffee shop last week, which has heightened your concerns.\n' + '\n' + 'You have no known chronic medical conditions, but you did have a minor surgery to remove ' + 'your appendix at age 12. You take no regular medications, although you occasionally use ' + 'over-the-counter antihistamines for seasonal allergies. You have no known drug ' + 'allergies. \n' + '\n' + 'In terms of family history, your father has a history of hypertension, and your mother has ' + 'type 2 diabetes. You are unaware of any history of heart problems in your family, but you ' + 'have a cousin who died suddenly in his early 30s, and the cause was never clearly ' + 'explained to you. \n' + '\n' + 'Socially, you are a non-smoker and drink alcohol socially, averaging about 5-7 units a ' + 'week. You lead a generally healthy lifestyle, focusing on a balanced diet and regular ' + 'exercise, although you admit that the recent symptoms have made you less active. You are ' + 'concerned that your symptoms may indicate a serious heart condition, and your biggest fear ' + 'is that you could have something like a heart arrhythmia or Long QT syndrome, especially ' + 'given the family history of sudden death. You are hoping the doctor will conduct some ' + 'tests to get to the bottom of what’s going on and provide you with some reassurance.'}, + { 'diagnosis': 'Myelodysplastic syndrome', + 'doctor_vignette': 'A 72-year-old man presents to his physician with persistent fatigue and recent laboratory ' + 'findings of macrocytosis, seeking evaluation for his symptoms.', + 'patient_profile': 'You are a 72-year-old man who has been retired for five years after a long career as a ' + 'high school history teacher. You live alone in a modest apartment and have two adult ' + "children who visit occasionally. Recently, you've been feeling increasingly fatigued, " + 'which you initially attributed to age. However, over the past couple of months, this ' + 'fatigue has worsened significantly. You find yourself struggling to complete daily tasks, ' + 'such as grocery shopping or even taking a short walk around your neighborhood. \n' + '\n' + "Alongside the fatigue, you've noticed that your skin has become unusually pale, and you " + "often feel cold even when others are comfortable. You've also experienced episodes of " + 'dizziness, particularly when standing up quickly. More recently, you observed small red ' + 'spots on your legs, which you initially thought were just skin blemishes, but now seem to ' + 'be spreading. You’ve had some episodes of shortness of breath, especially when climbing ' + 'stairs, and you’ve noticed that your heart races unexpectedly at times. \n' + '\n' + 'You have a history of hypertension, which you manage with medication, and you had a hip ' + 'replacement surgery about five years ago due to arthritis. You are a former smoker, having ' + 'quit over a decade ago, and you drink a small glass of red wine occasionally. You have no ' + 'known drug allergies, but you take lisinopril and a low-dose aspirin daily. \n' + '\n' + 'In terms of your family history, your father passed away from heart disease at 75, and ' + 'your mother had a history of anemia, but you are unsure of the specifics. You have no ' + 'siblings. \n' + '\n' + 'Your main concern is that this overwhelming fatigue and the changes in your skin could ' + 'signify a serious health issue. You have no idea what could be causing these symptoms, but ' + "you worry it might be something like leukemia or another blood disorder. You're hoping the " + 'doctor will take your symptoms seriously and run the necessary tests to identify what’s ' + 'going on. You want to understand what is happening to your body and how it might affect ' + 'your ability to live independently.'}, + { 'diagnosis': 'Disseminated gonorrhea', + 'doctor_vignette': 'A 28-year-old man presents to the clinic with a recent onset of fever and migratory joint ' + 'pain affecting multiple joints over the past week. He denies any recent trauma or known ' + 'infections.', + 'patient_profile': 'You are a 28-year-old woman who works as a graphic designer and lives alone in a small ' + "apartment in the city. Over the past week, you've developed a painful rash on your left " + 'leg that started as a small red spot but has since spread and become swollen. The rash is ' + 'warm to the touch, and you’ve noticed several small, painful bumps around it. Along with ' + 'the rash, you have been experiencing feverish chills and a persistent headache. You also ' + 'feel fatigued and have had difficulty concentrating at work. \n' + '\n' + 'About two weeks ago, you had unprotected sex with a new partner, which is unusual for you, ' + 'as you typically use protection. Since then, you have noticed some discharge that is ' + 'yellowish and has a strong odor, which has made you anxious. You have not experienced any ' + 'pain during urination, but you do feel a general discomfort in your lower abdomen. \n' + '\n' + 'You are worried that these symptoms could indicate something serious, such as a sexually ' + 'transmitted infection (STI), especially given your recent sexual encounter. Your main ' + 'concerns are about the implications for your health and whether you might have transmitted ' + 'anything to your partner. You haven’t done any research on your symptoms, but you hope the ' + 'doctor will provide clarity and possibly run tests to determine what’s going on.\n' + '\n' + 'In terms of your medical history, you have a history of mild asthma, which is ' + 'well-controlled with an albuterol inhaler. You have never had any major surgeries and have ' + 'no known drug allergies. You take the occasional ibuprofen for headaches but are otherwise ' + 'not on any regular medications. Your family history is significant for hypertension in ' + 'your mother and diabetes in your father, but no history of STIs or other sexually ' + 'transmitted diseases.\n' + '\n' + 'Socially, you enjoy a vibrant social life with friends, often going out for drinks on ' + 'weekends, where you typically consume about 10-15 units of alcohol. You are a non-smoker ' + 'and practice yoga regularly to help manage stress. Your biggest hope is that this rash and ' + 'the other symptoms are easily treatable and that you can get back to your normal life ' + 'without any long-term complications. You feel embarrassed discussing your symptoms but are ' + 'motivated to seek help for your health concerns.'}, + { 'diagnosis': 'Thin basement membrane disease', + 'doctor_vignette': 'A 32-year-old man presents to the clinic with recurrent episodes of blood in his urine, ' + 'accompanied by intermittent flank pain.', + 'patient_profile': 'You are a 32-year-old man who works as a software developer and lives alone in a small ' + "apartment. Over the past two months, you've been experiencing episodes of blood in your " + 'urine, which initially alarmed you but you thought it might just be a one-time occurrence. ' + 'However, the hematuria has become more frequent, happening about once a week. You’ve also ' + 'noticed some mild swelling in your ankles and a feeling of pressure in your lower abdomen. ' + 'Recently, you’ve been feeling fatigued, often needing to take naps during the day, which ' + 'is unusual for you.\n' + '\n' + 'You have no known allergies and take no regular medications. Occasionally, you take ' + 'over-the-counter ibuprofen for headaches, which you’ve had sporadically. You don’t smoke, ' + 'but you do enjoy socializing with friends and have a few beers on the weekends. You’ve ' + 'never had any significant health issues, but you did have a mild case of chickenpox as a ' + 'child. \n' + '\n' + 'Your family history includes a father with hypertension and a mother who had type 2 ' + 'diabetes. You are not aware of any kidney diseases in your family. You’ve never undergone ' + 'any surgeries, and your vaccinations are up to date.\n' + '\n' + 'You are concerned about the blood in your urine and the swelling in your ankles. You have ' + 'no idea what could be causing these symptoms, but you fear it might be something serious, ' + 'like kidney disease or cancer. You are hoping the doctor will run tests to figure out ' + 'what’s happening and provide some reassurance. You expect to leave the appointment with a ' + 'clear diagnosis or at least some answers about what might be going on.'}, + { 'diagnosis': 'Addison’s disease', + 'doctor_vignette': 'A 45-year-old woman presents to the clinic with persistent fatigue. She denies any recent illness or changes in his diet.', + 'patient_profile': 'You are a 45-year-old woman who works as a school teacher and lives alone with your two ' + "cats. Over the past few months, you've experienced increasing fatigue that doesn't seem to " + 'improve with rest. You find it challenging to keep up with your daily responsibilities, ' + 'and you often feel overwhelmed by tasks that used to be manageable. You’ve also noticed ' + 'some unusual weight loss—about 5 kg—without any changes to your diet or exercise ' + 'routine. \n' + '\n' + 'Recently, you’ve been experiencing frequent episodes of dizziness, particularly when ' + "standing up quickly, and you've had moments of intense cravings for salty snacks, which is " + 'unusual for you. Additionally, you’ve noticed darkening of your skin, especially around ' + 'your elbows and knees, and some patches on your face that have become more pronounced. ' + 'Your friends have commented on how tired you look, and you’ve had to take more sick days ' + 'from work due to feeling unwell. \n' + '\n' + 'You are worried that these symptoms could indicate a serious health issue, but you haven’t ' + 'done any research. Your biggest fear is that you might have a chronic illness that could ' + 'affect your ability to work and care for yourself. You hope the doctor will be able to ' + 'explain what’s happening and provide some clarity about your health.\n' + '\n' + 'In terms of your medical history, you have no major past illnesses and have never had any ' + 'surgeries. You do not take any regular medications but occasionally use over-the-counter ' + 'ibuprofen for headaches. You have a family history of autoimmune diseases, as your mother ' + 'was diagnosed with rheumatoid arthritis in her 50s, and your father has type 2 diabetes. ' + 'You have no known allergies.\n' + '\n' + 'Socially, you enjoy a quiet life; you don’t smoke, and you drink alcohol socially, about ' + '5-7 units per week. You have a supportive circle of friends, but you feel increasingly ' + 'isolated due to your fatigue and lack of energy. You are hoping for answers during this ' + 'visit, as you feel that something is definitely not right with your health.'}, + { 'diagnosis': 'Tuberous sclerosis', + 'doctor_vignette': 'A 28-year-old woman presents to the clinic with a persistent facial rash and recurrent ' + 'seizures over the past several months.', + 'patient_profile': 'You are a 28-year-old woman named Sarah, working as a graphic designer in a bustling city. ' + 'You live alone in a small apartment and enjoy a quiet lifestyle, spending your weekends ' + "painting and hiking. Over the past few months, you've noticed some unusual changes in your " + 'body that have started to concern you. \n' + '\n' + 'About six months ago, you began to develop small, raised, and discolored patches on your ' + 'skin, particularly on your arms and face. These patches have a rough texture and are ' + "sometimes itchy, but they don’t seem to cause any pain. Recently, you've also observed a " + 'few small, white bumps under your fingernails, which you initially dismissed as a cosmetic ' + 'issue. \n' + '\n' + 'More troubling, however, is the sudden onset of frequent headaches that have started to ' + 'affect your daily life. These headaches typically occur in the late afternoon and are ' + 'often accompanied by a sensation of pressure behind your eyes. You’ve also experienced ' + 'some episodes of dizziness and mild confusion, particularly when you’re stressed or ' + 'tired. \n' + '\n' + 'Concerned about these symptoms, you visited your primary care physician, who referred you ' + 'for further evaluation. You have no significant past medical history, aside from mild ' + 'asthma that you manage with an inhaler. You take no regular medications and have no known ' + 'drug allergies. Your family history is notable for a mother with a history of epilepsy and ' + 'a father who has hypertension. \n' + '\n' + 'You are worried that your symptoms might indicate a serious condition, such as a ' + 'neurological disorder or skin cancer, even though you have no prior knowledge of these ' + 'conditions. Your biggest concern is that the headaches and skin changes could be related, ' + 'and you hope that the doctor will provide clarity and possibly run some tests to rule out ' + 'any serious issues.\n' + '\n' + 'Socially, you are generally healthy and maintain a balanced diet, though you do enjoy a ' + 'glass of wine on weekends with friends. You have never smoked and exercise regularly, ' + 'taking yoga classes a few times a week. You are currently single and have a supportive ' + 'group of friends who you often confide in about your worries. \n' + '\n' + 'As you sit in the waiting room, you feel anxious about what the doctor might say, hoping ' + 'for reassurance and a clear plan moving forward.'}, + { 'diagnosis': 'Cutaneous lupus erythematosus', + 'doctor_vignette': 'A 34-year-old woman presents with a persistent photosensitive rash on her arms and face, ' + 'accompanied by intermittent joint pain. She is seeking evaluation due to the increasing ' + 'discomfort and visibility of the rash.', + 'patient_profile': 'You are a 34-year-old woman who works as a graphic designer and lives alone in a small ' + 'apartment. Over the past few months, you’ve become increasingly concerned about a ' + 'persistent rash on your face and scalp. It started as a small, red, scaly patch on your ' + 'cheeks, but it has now spread and become more prominent, particularly across your nose and ' + 'forehead, resembling a butterfly shape. You’ve also noticed that the rash seems to flare ' + 'up after sun exposure, causing you to feel self-conscious and anxious about going ' + 'outside.\n' + '\n' + 'In addition to the rash, you’ve been experiencing episodes of fatigue that were not ' + 'typical for you. You often feel drained, even after a full night’s sleep, and find it ' + 'difficult to concentrate at work. You’ve also developed joint pain in your fingers and ' + 'wrists that comes and goes, sometimes making it difficult to type or hold objects. ' + 'Recently, you’ve noticed some hair thinning, particularly around your temples, which has ' + 'added to your distress. \n' + '\n' + 'You have no known drug allergies, and you take an oral contraceptive for birth control. ' + 'You occasionally take ibuprofen for headaches but have not needed any regular medications. ' + 'You have a family history of autoimmune diseases; your mother has rheumatoid arthritis, ' + 'and your sister was diagnosed with Hashimoto’s thyroiditis. You are concerned that your ' + 'symptoms might indicate a serious condition, and you fear that you could be developing an ' + 'autoimmune disease like lupus, although you don’t have much information about it.\n' + '\n' + 'Socially, you enjoy spending time with friends but have been avoiding outdoor gatherings ' + 'due to your skin issues. You’re single and have been feeling more isolated as a result of ' + 'your symptoms. You have no significant past medical history and have never undergone any ' + 'surgeries. You are worried about the potential impact of these symptoms on your health and ' + 'your ability to work effectively. Your primary expectation from today’s visit is to ' + 'understand what might be causing these symptoms and to get guidance on how to manage them ' + 'moving forward.'}, + { 'diagnosis': 'Chronic mesenteric ischemia', + 'doctor_vignette': 'A 72-year-old man presents to the clinic with postprandial abdominal pain and ' + 'unintentional weight loss over the past few months, expressing concern about his ' + 'difficulty in maintaining his usual diet.', + 'patient_profile': 'You are a 72-year-old retired school teacher living alone in a small apartment. You have ' + 'enjoyed a relatively healthy life, but over the past six months, you have been ' + 'experiencing recurrent episodes of abdominal pain. The pain typically occurs after eating, ' + 'particularly after larger meals, and is often accompanied by a feeling of fullness and ' + 'bloating. Initially, you attributed this discomfort to indigestion, but as the episodes ' + "became more frequent and severe, you started to worry. You've also noticed that you have " + 'lost about 5 kg unintentionally over the last few months, which has left you feeling ' + 'weaker than usual.\n' + '\n' + 'You often feel a dull ache in your abdomen that can last for hours, and occasionally, it ' + 'becomes sharp and severe enough to make you feel nauseous. You have not vomited but have ' + 'experienced a few episodes of diarrhea following these painful episodes. You’ve been ' + 'trying to eat smaller meals to see if that helps, but the pain persists. You are ' + 'particularly concerned because your late husband had similar symptoms before being ' + 'diagnosed with pancreatic cancer, and the thought of having something serious is weighing ' + 'heavily on your mind. You are hoping the doctor can provide clarity on what might be ' + 'causing your symptoms.\n' + '\n' + 'Your past medical history includes hypertension, which is well-controlled with lisinopril, ' + 'and you had a cholecystectomy (gallbladder removal) about 15 years ago due to gallstones. ' + 'You have no known drug allergies and take no other medications besides the lisinopril. You ' + 'have a family history of cardiovascular disease, with both parents having suffered heart ' + 'attacks in their late 70s.\n' + '\n' + 'Socially, you are active in your community, volunteering at the local library and ' + "participating in a book club, though you've recently found it harder to keep up with these " + 'activities due to your discomfort. You live alone and have a close-knit group of friends, ' + 'but you feel hesitant to share your concerns with them, fearing they will worry. You have ' + 'never smoked and drink alcohol occasionally, about 2-3 glasses of wine per week.\n' + '\n' + "You arrive at the doctor's office feeling anxious and hopeful for answers. You expect the " + 'doctor to conduct a thorough examination and possibly some tests to determine the cause of ' + 'your abdominal pain, and you are eager to understand what is happening with your body.'}, + { 'diagnosis': 'Platypnea-orthodeoxia syndrome', + 'doctor_vignette': 'A 58-year-old man presents to the clinic with episodes of shortness of breath that worsen ' + 'when sitting or standing upright, accompanied by occasional lightheadedness.', + 'patient_profile': 'You are a 58-year-old man who has worked as a civil engineer for the past 30 years. You ' + 'live with your wife and two adult children in a suburban neighborhood. Over the past few ' + 'months, you have been experiencing increasing difficulty breathing when standing up. You ' + 'first noticed this symptom while attending a family gathering where you felt lightheaded ' + 'and had to sit down after standing for a while. Since then, the shortness of breath has ' + 'worsened, and you’ve begun to feel unsteady when you stand for too long. You also noticed ' + 'that when you lie down, your breathing feels normal, which is puzzling to you.\n' + '\n' + 'You have no history of lung disease, but you were diagnosed with hypertension five years ' + 'ago and have been managing it with lisinopril. You are a non-smoker and drink alcohol ' + 'occasionally, about 2-3 beers on weekends. You have a family history of cardiovascular ' + 'disease; your father had a heart attack at 65, and your mother has high cholesterol.\n' + '\n' + 'You are worried that your symptoms may indicate a serious heart or lung condition. You ' + 'have considered the possibility of a blood clot or even heart failure, as you have been ' + 'feeling more fatigued than usual. You hope the doctor will be able to identify the cause ' + 'of your symptoms and provide a clear treatment plan, as you are anxious about the impact ' + 'this may have on your ability to work and enjoy time with your family. You have not done ' + 'any research on your symptoms, as you are concerned about jumping to conclusions and ' + 'prefer to hear from a professional.\n' + '\n' + "In addition to your breathing difficulties, you've occasionally experienced mild chest " + 'discomfort, but you attribute it to anxiety about your health. You have been under more ' + 'stress lately due to work deadlines, but you do not believe that this is related to your ' + 'symptoms. You have no known drug allergies and take no other medications besides your ' + 'blood pressure medication. You have not had any surgeries in the past and are generally in ' + 'good health aside from your hypertension. You hope to leave the appointment with a better ' + 'understanding of what is happening and reassurance that it is not something ' + 'life-threatening.'}, + { 'diagnosis': 'Neuroleptic malignant syndrome', + 'doctor_vignette': 'A 42-year-old man presents to the emergency department with sudden onset confusion and ' + 'generalized muscle rigidity. His family reports he has been increasingly disoriented over ' + 'the past two days.', + 'patient_profile': 'You are a 42-year-old man who works as a high school math teacher and lives alone in a ' + "small apartment. Over the past week, you've been feeling increasingly restless and " + 'agitated. It started with a general sense of unease, but now you find it difficult to sit ' + 'still for even a few minutes. You’ve also developed a high fever of 39°C (102°F), ' + 'accompanied by muscle rigidity, especially in your neck and back. Your muscles feel stiff, ' + 'and you’ve noticed an unusual tremor in your hands, which makes it difficult to write on ' + 'the board during class. \n' + '\n' + 'You’re concerned because you’ve been taking a new antipsychotic medication, haloperidol, ' + "for the past three weeks after being diagnosed with schizophrenia. You didn't think much " + 'of the side effects at first, but now you feel overwhelmed by these physical symptoms. You ' + 'also feel confused and have trouble concentrating, which is unusual for you. Your appetite ' + 'has decreased, and you’ve lost about 2 kg in the past week without trying. \n' + '\n' + 'You have a history of anxiety and depression, and you were hospitalized for a brief period ' + 'about five years ago due to a severe depressive episode. You’ve been on various ' + 'medications since then, but haloperidol is the first antipsychotic you’ve tried. You’re ' + 'worried that these new symptoms might be a sign that something is seriously wrong with ' + 'your health. Your biggest fear is that you might be experiencing severe side effects from ' + 'the medication or that your mental health is deteriorating. You hope the doctor will be ' + 'able to give you some answers and perhaps adjust your treatment.\n' + '\n' + 'In terms of family history, your mother has a history of bipolar disorder, and your father ' + 'has hypertension. You have no significant surgical history, and you don’t smoke. You ' + 'occasionally drink alcohol, about 5 units a week, but you’ve cut back recently due to your ' + 'medication. You live alone and often feel isolated, which has been challenging for you, ' + 'especially with the added stress of your symptoms. You have a supportive group of friends, ' + "but you haven't shared your recent experiences with them yet. You’re feeling anxious about " + 'this visit, hoping to find a solution to regain your stability and health.'}, + { 'diagnosis': 'Bronchiectasis', + 'doctor_vignette': 'A 45-year-old man presents to the clinic with recurrent episodes of pneumonia over the ' + 'past year and intermittent, productive cough. He also reports experiencing occasional ' + 'shortness of breath.', + 'patient_profile': 'You are a 45-year-old man who works as a school janitor and lives alone in a small ' + 'apartment. Over the past six months, you’ve been experiencing a persistent cough that ' + 'seems to be getting worse. Initially, it was just a dry cough, but now it has developed ' + 'into a productive cough, bringing up greenish-yellow sputum almost daily. You’ve noticed ' + 'that the cough is particularly bad in the mornings and after physical activity, and it ' + 'sometimes wakes you up at night. Along with the cough, you’ve been feeling increasingly ' + 'short of breath, especially when climbing stairs or walking quickly. \n' + '\n' + 'You also mention feeling fatigued more often than usual, and you’ve lost about 5 kg in the ' + 'last couple of months without trying to diet. You’ve had a few episodes of wheezing, ' + 'particularly when exposed to cold air or dust, which is common in your line of work. ' + 'You’re worried that this might be something serious, and although you haven’t done any ' + 'research, you can’t shake the feeling that your lungs are not functioning properly. \n' + '\n' + 'In terms of your medical history, you have a history of asthma that was diagnosed in your ' + 'late 30s, but you haven’t used your inhaler in years. You also had pneumonia about three ' + 'years ago, which required a course of antibiotics. You have no known drug allergies, but ' + 'you take over-the-counter antihistamines occasionally for seasonal allergies. \n' + '\n' + 'Your family history includes a father who had chronic obstructive pulmonary disease (COPD) ' + 'and a mother who passed away from lung cancer. You are a former smoker, having quit about ' + 'five years ago after smoking a pack a day for nearly 20 years. You occasionally drink ' + 'alcohol, about 10 units per week, and you don’t use recreational drugs. \n' + '\n' + 'You are concerned that your symptoms might indicate a serious lung condition, particularly ' + 'given your family history, and you hope the doctor will perform tests to determine what is ' + 'going on. Your primary expectations are to get a clear diagnosis and discuss potential ' + 'treatment options, as you’re quite worried about how this is affecting your daily life and ' + 'ability to work.'}, + { 'diagnosis': 'Lymphangioleiomyomatosis', + 'doctor_vignette': 'A 34-year-old woman presents to the clinic with persistent dyspnea and a dry cough that ' + 'has developed over the past few months. She reports that these symptoms have progressively ' + 'worsened, especially during physical exertion.', + 'patient_profile': 'You are a 34-year-old woman who works as a graphic designer and lives alone in a small ' + 'apartment in the city. Over the past six months, you’ve been experiencing increasing ' + 'shortness of breath, particularly during activities that used to be easy for you, like ' + 'walking your dog or climbing a flight of stairs. You’ve also noticed a persistent cough ' + 'that sometimes produces a small amount of clear mucus, but it’s not always present. ' + 'Recently, you’ve begun to feel a tightness in your chest, which can sometimes be ' + 'accompanied by a strange sensation of heaviness in your lungs. \n' + '\n' + 'You are worried because these symptoms seem to be getting worse, and you’ve also noticed ' + 'some unusual skin changes: small, painless lumps on your arms and back that look like tiny ' + 'tumors, which you’ve never seen before. You’ve lost about 5 kg without trying, and while ' + 'you initially thought this was a good thing, you’re now concerned it might be related to ' + 'your breathing issues. \n' + '\n' + 'Your medical history includes asthma diagnosed in your early twenties, which you’ve ' + 'managed with an inhaler, though you haven’t needed to use it frequently in recent years. ' + 'You have no known drug allergies, and you take a daily multivitamin but no prescribed ' + 'medications. You don’t smoke, but you occasionally enjoy a glass of wine with dinner. \n' + '\n' + 'Your family history includes a mother with a history of lung cancer who passed away at 58, ' + 'and a father who has hypertension and type 2 diabetes. You have two older brothers, both ' + 'of whom are healthy. \n' + '\n' + 'In terms of your social history, you are single and live a relatively active lifestyle, ' + 'often going to yoga classes and hiking on weekends. However, you’ve started to feel more ' + 'isolated as your symptoms have progressed, and you’ve been less enthusiastic about social ' + 'events. \n' + '\n' + 'Your biggest concerns are that this might be something serious, like lung disease or ' + 'cancer, and you’re anxious about the possibility of needing extensive treatment or facing ' + 'a chronic condition. You hope the doctor will order some tests to determine what’s causing ' + 'your symptoms, as you feel increasingly fatigued and worried about your health.'}, + { 'diagnosis': 'Hereditary angioedema', + 'doctor_vignette': 'A 28-year-old man presents to the clinic with recurrent episodes of severe abdominal pain ' + 'and an intermittent, non-itchy rash. He reports that the abdominal pain and rash have been ' + 'occurring sporadically for several months.', + 'patient_profile': 'You are a 28-year-old woman who works as a graphic designer and lives alone with your two ' + 'cats. Over the past few months, you have experienced several episodes of sudden swelling ' + 'in various parts of your body, particularly around your eyes, lips, and hands. These ' + 'episodes often occur without any apparent cause and can last from a few hours to a couple ' + 'of days. You’ve also noticed that the swelling sometimes accompanies a tingling sensation ' + 'and mild abdominal pain, which you initially attributed to indigestion. \n' + '\n' + "Recently, you had a particularly alarming episode while attending a friend's wedding, " + 'where your face swelled dramatically, causing you to feel self-conscious and embarrassed. ' + 'You were unable to enjoy the event and left early. Since then, you have become ' + 'increasingly anxious about when the next episode might occur, fearing it could happen in a ' + 'public setting or while at work. You have avoided social gatherings and have been hesitant ' + 'to make plans with friends, which has led to feelings of isolation.\n' + '\n' + 'You have no known allergies and have never experienced anything like this before. You take ' + 'a daily multivitamin and occasionally use over-the-counter antihistamines for seasonal ' + 'allergies, but they have not helped with the swelling. You have no history of significant ' + 'medical issues, and your family history is notable for a father with high blood pressure ' + 'and a mother with asthma. You are concerned that these episodes might be a sign of a ' + 'serious condition, and your biggest fear is that you might have a severe allergic reaction ' + 'or something worse.\n' + '\n' + 'In terms of your past medical history, you had your appendix removed at age 21, and you ' + 'have been generally healthy since then. You do not smoke, drink alcohol occasionally, and ' + 'maintain a balanced diet. You are currently in a stable relationship but have found it ' + 'hard to connect with others lately due to your symptoms. You hope the doctor will provide ' + 'some answers and possibly run tests to determine what is causing these episodes of ' + 'swelling.'}, + { 'diagnosis': 'Multiple myeloma', + 'doctor_vignette': 'A 58-year-old man presents with persistent fatigue and diffuse bone pain, which has ' + 'gradually worsened over the past few months, prompting concern and a visit to the clinic.', + 'patient_profile': 'You are a 58-year-old man who has worked as a high school teacher for the past 30 years. ' + 'You live alone in a modest apartment and have two adult children who have recently moved ' + 'out. Over the past few months, you’ve been experiencing persistent back pain that started ' + 'as a dull ache but has progressively worsened, making it difficult for you to engage in ' + 'activities you once enjoyed, like gardening and playing tennis. The pain is particularly ' + 'severe at night, often waking you from sleep, and you find it difficult to find a ' + 'comfortable position.\n' + '\n' + 'In addition to the back pain, you’ve noticed an increase in fatigue. You used to feel ' + 'energized after a full day of teaching, but now you often feel exhausted by midday, ' + "requiring frequent breaks. You've also experienced some unintentional weight loss of about " + '5 kg over the last two months, which you initially attributed to a new diet plan aimed at ' + 'losing a few pounds. However, you now worry that the weight loss is not healthy.\n' + '\n' + 'You have also experienced episodes of weakness in your legs, making it challenging to walk ' + 'up stairs or carry heavy books. There have been a couple of instances where you felt ' + 'lightheaded upon standing up too quickly. You’ve had some recurrent infections, including ' + 'a recent bout of bronchitis that took longer than usual to resolve. \n' + '\n' + 'You have a history of hypertension, well-controlled with medication, and a family history ' + 'of heart disease; your father had a heart attack at 62. You have no history of cancer or ' + 'other significant illnesses. You are a non-smoker and drink alcohol moderately, about 10 ' + 'units a week. \n' + '\n' + 'Your biggest concern is the back pain and fatigue, and you are worried that something ' + 'serious might be wrong. You have no prior knowledge of conditions like multiple myeloma, ' + 'but you fear the symptoms you’re experiencing could indicate a serious illness. You hope ' + 'the doctor will run tests to determine the cause of your symptoms and provide clarity on ' + 'what might be happening. You expect a thorough examination and possibly some imaging or ' + 'blood tests to help understand your condition.'}, + { 'diagnosis': 'Pheochromocytoma', + 'doctor_vignette': 'A 42-year-old man presents to the clinic with episodes of palpitations and intermittent ' + 'high blood pressure, seeking evaluation for these recurring symptoms.', + 'patient_profile': 'You are a 42-year-old man who works as an IT consultant and lives alone in a small ' + 'apartment. Over the past three months, you have been experiencing episodes of severe ' + 'headaches that come on suddenly, often accompanied by a racing heart and feelings of ' + 'anxiety. These episodes can last anywhere from 15 minutes to an hour, and you have noticed ' + 'that they tend to occur after stressful meetings at work. During these episodes, you also ' + 'feel a sense of impending doom, which leaves you feeling unsettled for hours afterward.\n' + '\n' + 'You have recently started to feel more fatigued than usual, requiring longer periods of ' + 'rest to recover after these episodes. Additionally, you’ve been experiencing occasional ' + 'bouts of sweating, particularly at night, which have disrupted your sleep. You’ve lost ' + 'about 5 kg over the last few months without trying, and while you initially appreciated ' + 'the weight loss, you are now concerned that it may indicate an underlying health issue.\n' + '\n' + 'You have no significant past medical history except for mild seasonal allergies and ' + 'occasional heartburn, for which you take over-the-counter antacids. You are not currently ' + 'taking any prescription medications and have no known drug allergies. You do not smoke and ' + 'drink alcohol socially, about 4-5 units per week.\n' + '\n' + 'In your family history, your father had hypertension and passed away from a heart attack ' + 'at the age of 65. Your mother has a history of type 2 diabetes but remains healthy at 68. ' + 'You are concerned that your symptoms may indicate a serious condition like a heart problem ' + 'or something related to your hormones, although you have no idea what might be causing ' + 'these headaches and feelings of anxiety. You hope that the doctor will run some tests to ' + "find out what's going on and alleviate your fears about your health. \n" + '\n' + 'Overall, you feel anxious about these symptoms and are eager for an explanation, hoping it ' + 'will lead to a plan for management or treatment.'}, + { 'diagnosis': 'Cholangiocarcinoma', + 'doctor_vignette': 'A 58-year-old man presents with fluctuating jaundice and recent onset of dull abdominal ' + 'discomfort. He also mentions experiencing intermittent episodes of nausea over the past ' + 'month.', + 'patient_profile': 'You are a 58-year-old man who works as a mechanic in a small auto shop. You live with your ' + "partner and have two adult children who have moved out. Over the past few months, you've " + 'been experiencing persistent abdominal discomfort, which you initially dismissed as ' + 'indigestion. However, the pain has now become more pronounced, located in the upper right ' + 'quadrant of your abdomen, and it often radiates to your back. You’ve also noticed a ' + 'yellowish tint to your skin and eyes, which has made you increasingly worried. \n' + '\n' + 'About six weeks ago, you began to experience severe itching, particularly on your palms ' + 'and soles, which has been bothersome and disrupting your sleep. Your appetite has ' + 'decreased, and you’ve unintentionally lost about 5 kg during this period. You’ve also felt ' + 'unusually fatigued, struggling to keep your energy up during the day, which is concerning ' + 'given your physically demanding job. \n' + '\n' + 'You have a history of hypertension, which is well-controlled with medication. You were ' + 'diagnosed with type 2 diabetes five years ago and manage it with metformin. You have no ' + 'known drug allergies but do take over-the-counter ibuprofen occasionally for joint pain. \n' + '\n' + 'In terms of family history, your father passed away from liver cancer at the age of 65, ' + 'and your mother had gallbladder issues, requiring surgery. You are a lifelong non-smoker ' + 'and drink alcohol socially, about 10-12 units per week, primarily on weekends. \n' + '\n' + 'Your biggest concern is the yellowing of your skin and the abdominal pain, and you can’t ' + "shake the feeling that something serious might be going on. You haven't done any research " + 'yet, but you have heard of liver-related issues, and this thought is unsettling. You hope ' + "the doctor will run some tests to clarify what's happening and provide some reassurance " + 'about your symptoms.'}, + { 'diagnosis': 'Cushing’s syndrome', + 'doctor_vignette': 'A 42-year-old woman presents to her physician with complaints of unexplained weight gain ' + 'and increasing weakness over the past few months. She also notes the recent appearance of ' + 'purplish lines on her abdomen.', + 'patient_profile': 'You are a 42-year-old woman who works as a school teacher and lives alone with your two ' + "cats. Over the past few months, you've noticed some significant changes in your body that " + 'have left you feeling concerned. You’ve gained about 10 kg without making any changes to ' + 'your diet or exercise routine, and your clothes have become increasingly tight. You’ve ' + 'also observed that your face appears rounder, and your skin has developed a purplish hue, ' + 'particularly on your abdomen and the back of your neck. \n' + '\n' + 'In addition to these physical changes, you’ve been experiencing persistent fatigue, even ' + "after a full night's sleep. You often feel like you need to take naps during the day to " + 'keep up with your energy levels. Moreover, you’ve noticed that you bruise easily; even ' + 'minor bumps leave large, dark bruises that take longer to heal than they used to. You’ve ' + 'also been having difficulty concentrating at work, which worries you because you care ' + 'deeply about your students and want to be at your best for them.\n' + '\n' + 'You have a history of hypertension, which has been managed with medication for the past ' + 'five years. You also suffered from mild depression in your 30s, which was treated with ' + 'therapy and a short course of antidepressants. You don’t have any known allergies and take ' + 'no other medications besides your blood pressure pills. You’re a non-smoker and drink ' + 'alcohol socially, about 5-6 units per week. \n' + '\n' + 'Your family history is notable for your mother, who had type 2 diabetes and your father, ' + 'who suffered from heart disease. You are particularly concerned about your recent weight ' + 'gain and fatigue, fearing that there might be something seriously wrong with you, possibly ' + 'related to your heart or diabetes, given your family history. You’ve done no research on ' + 'your symptoms but have been discussing your concerns with a close friend, who encouraged ' + 'you to see a doctor. You hope the doctor will take your symptoms seriously and run some ' + 'tests to find out what’s going on. \n' + '\n' + 'Your biggest expectation is to gain clarity on your symptoms and to receive a treatment ' + 'plan that will help you feel like yourself again.'}, + { 'diagnosis': 'Leptospirosis', + 'doctor_vignette': 'A 32-year-old man presents with persistent fever and jaundice following recent travel ' + 'abroad.', + 'patient_profile': 'You are a 32-year-old male who works as a landscaper and lives in a small apartment with ' + 'your partner and their two dogs. Over the past week, you have been experiencing a sudden ' + 'onset of fever and chills that come and go, along with severe headaches that make it hard ' + 'to concentrate. You also noticed that your muscles feel achy and sore, especially in your ' + 'lower back and legs, as if you had just finished an intense workout. \n' + '\n' + 'Three days ago, you developed a rash that started as small red spots on your wrists and ' + 'ankles but has now spread to your arms and torso. The rash itches but is not painful. ' + 'You’ve also been feeling nauseous and have had episodes of vomiting, which have made it ' + 'difficult to keep food down. You’re worried about these symptoms because you’ve never felt ' + 'this unwell before, and you fear it could be something serious like a viral infection or ' + 'even something worse.\n' + '\n' + 'You’ve been camping and hiking in a nearby national park over the past month, where you ' + 'spent time in muddy areas and near water sources. You recall stepping in some stagnant ' + 'water during one of your hikes, but you didn’t think much of it at the time. You have no ' + 'known allergies and take no medications regularly, but you do occasionally take ibuprofen ' + 'for headaches. \n' + '\n' + 'Your family history is significant for autoimmune diseases; your mother has lupus, and ' + 'your father has rheumatoid arthritis. You do not smoke and drink alcohol socially, about ' + '5-6 units per week. You’re currently in a stable relationship and have a supportive ' + 'partner who is concerned about your health.\n' + '\n' + 'Your main concerns are about the fever and the rash, as you’ve never experienced anything ' + 'like this before. You’re anxious about being away from work, as you rely on your job for ' + 'income, and you hope the doctor can provide a diagnosis and some relief for your symptoms ' + 'soon. You expect that blood tests or other diagnostics may be necessary to understand ' + 'what’s happening to you.'}, + { 'diagnosis': 'Myasthenia gravis', + 'doctor_vignette': 'A 58-year-old man presents to his physician with complaints of intermittent muscle ' + 'weakness and drooping of the eyelids, which have progressively worsened over the past few ' + 'months.', + 'patient_profile': 'You are a 58-year-old man who works as a high school history teacher and lives alone in a ' + 'modest apartment. Over the past few months, you’ve started to experience significant ' + 'weakness in your arms and legs. Initially, you attributed this fatigue to the long hours ' + 'spent grading papers and preparing lessons, but it has recently escalated to the point ' + 'where you struggle to lift your coffee cup in the morning. You’ve also noticed that your ' + 'eyelids feel heavy and droopy, especially by the end of the day, which makes reading ' + 'difficult. Occasionally, you find yourself slurring your words, particularly after a long ' + 'day of teaching, which has made you anxious about how your students perceive you.\n' + '\n' + 'You’ve lost interest in activities you once enjoyed, like hiking and playing in a local ' + 'trivia league, because you often feel too tired to participate. Recently, you’ve also ' + 'experienced episodes of double vision, particularly when you’re tired or stressed, which ' + 'you find disconcerting. You’ve been sleeping well, but you wake up feeling as if you ' + 'haven’t rested at all. You’ve unintentionally lost about 5 kg over the last couple of ' + 'months due to decreased appetite and a lack of energy to cook.\n' + '\n' + 'In terms of your medical history, you have hypertension, which is well-controlled with ' + 'medication, and you had a hernia repair surgery five years ago. You have no known drug ' + 'allergies, and your only regular medication is lisinopril. You do not smoke and drink ' + 'alcohol socially, about 2-3 units per week. There is no significant family history of ' + 'neurological disorders, but your mother had rheumatoid arthritis.\n' + '\n' + 'Your main concerns are the weakness and fatigue that seem to be worsening, as well as the ' + 'episodes of double vision, which you fear might indicate a serious underlying condition. ' + 'You have no prior knowledge or research about these symptoms, but you are worried they ' + 'could be signs of something like a stroke or a neurological disease. You hope the doctor ' + 'will conduct a thorough examination and possibly some tests to identify what is going on, ' + 'as you are eager to regain your strength and return to your normal activities.'}, + { 'diagnosis': 'Pulmonary arterial hypertension', + 'doctor_vignette': 'A 52-year-old woman presents with progressive dyspnea over the past few months and ' + 'occasional episodes of lightheadedness. He notes that his shortness of breath has been ' + 'gradually worsening, particularly with exertion.', + 'patient_profile': 'You are a 52-year-old woman who works as a high school teacher and lives alone with your ' + 'two cats. Over the past six months, you’ve started to notice a persistent feeling of ' + 'fatigue that doesn’t seem to improve with rest. You’ve also experienced increasing ' + 'shortness of breath, particularly when climbing stairs or walking quickly. Recently, ' + 'you’ve found yourself becoming easily winded during activities that previously didn’t ' + 'bother you, such as carrying groceries or playing with your niece. \n' + '\n' + 'In addition to the fatigue and shortness of breath, you’ve developed a dry cough that ' + 'occasionally interrupts your sleep. You’ve noticed that your ankles sometimes swell, ' + 'especially after a long day at work, and you feel a bit lightheaded when standing up ' + 'quickly. You’ve also been feeling a bit anxious about your symptoms, as you’re worried ' + 'they could indicate something serious, though you haven’t done any research on what it ' + 'might be.\n' + '\n' + 'Your medical history includes a diagnosis of asthma in your early 30s, which has been ' + 'well-controlled with an albuterol inhaler used occasionally. You have no history of heart ' + 'disease or significant lung issues beyond asthma. You take a daily multivitamin but no ' + 'other medications. You have no known drug allergies and do not smoke. You drink a glass of ' + 'wine occasionally on weekends, but you’re not a heavy drinker.\n' + '\n' + 'In your family history, your mother has a history of hypertension and your father had a ' + 'heart attack in his late 60s. You are concerned that your symptoms might be related to ' + 'your father’s heart issues, and you fear that you might have a serious heart or lung ' + 'condition. Your biggest hope is that the doctor will be able to identify what’s causing ' + 'your symptoms and provide a clear plan for treatment.\n' + '\n' + 'Socially, you’re active in your community and enjoy spending time with friends, but your ' + 'symptoms have started to limit your ability to participate in activities you once enjoyed, ' + 'like hiking and attending exercise classes. You feel frustrated and a bit isolated because ' + 'of this, and you’re eager to find out what’s going on so you can return to your normal ' + 'lifestyle. You hope that the doctor will run some tests to get to the bottom of your ' + 'symptoms.'}, + { 'diagnosis': 'Axial spondyloarthritis', + 'doctor_vignette': 'A 28-year-old man presents with persistent back pain and stiffness, particularly in the ' + 'morning, which gradually improves as the day progresses. He reports that the discomfort ' + 'has been interfering with his sleep and daily activities.', + 'patient_profile': 'You are a 28-year-old man named Alex who works as a software engineer and lives alone in a ' + 'small apartment. Over the past six months, you have been experiencing persistent lower ' + 'back pain that seems to worsen in the morning and improves slightly with movement ' + 'throughout the day. The pain is often accompanied by stiffness that makes it difficult for ' + 'you to get out of bed in the mornings. You’ve noticed that on some days, the stiffness ' + 'lasts for several hours before you feel more limber. \n' + '\n' + 'In addition to the back pain, you have recently started feeling discomfort in your hips ' + 'and occasionally in your knees. You find it challenging to sit for long periods at work, ' + "and you often have to take breaks to stretch. You also mention that you've started " + 'experiencing fatigue, which you initially attributed to your busy work schedule. However, ' + 'this fatigue has been persistent, making it difficult to concentrate and complete tasks ' + 'efficiently.\n' + '\n' + 'You have no significant past medical history, although you were diagnosed with mild asthma ' + 'as a child. You take a daily inhaler as needed, but it has not caused any issues in recent ' + 'years. You have no known drug allergies and currently take no regular medications aside ' + 'from the inhaler. You are a non-smoker and occasionally drink alcohol on weekends, ' + 'averaging about 4-6 units.\n' + '\n' + 'In terms of family history, your father has a history of rheumatoid arthritis, and your ' + 'mother has osteoarthritis. You are concerned about these familial patterns and wonder if ' + 'they could be related to your symptoms. You have not done any research on your symptoms, ' + 'but you are worried that they might indicate a serious condition, especially since you are ' + 'experiencing pain at such a young age. Your primary concern is that this pain and ' + 'stiffness might be a sign of something progressive that could affect your mobility in the ' + 'future.\n' + '\n' + 'You hope that the doctor will be able to provide a diagnosis and possibly recommend ' + 'treatments to help alleviate your symptoms. You are particularly anxious about the thought ' + 'of being unable to participate in activities you enjoy, such as cycling and hiking, due to ' + 'this pain. You are eager to understand what might be causing your symptoms and what steps ' + 'you can take to manage them effectively.'}, + { 'diagnosis': 'Parietal lobe stroke', + 'doctor_vignette': 'A 72-year-old man presents with sudden, unexplained unilateral sensory loss affecting his ' + 'right arm, accompanied by occasional difficulty in identifying objects by touch.', + 'patient_profile': 'You are a 72-year-old retired schoolteacher living alone in a small apartment in the city. ' + 'You have two grown children who live out of state and visit occasionally. Recently, you’ve ' + 'been experiencing some troubling symptoms that you can’t quite explain. About three weeks ' + 'ago, you noticed that you were having difficulty with spatial awareness; for instance, ' + 'you’ve bumped into furniture more often and have trouble judging distances, especially ' + 'when trying to park your car. You’ve also had episodes where you feel a tingling sensation ' + 'on the right side of your body, particularly in your right arm and leg, which lasts for a ' + 'few minutes and then goes away. \n' + '\n' + 'You’ve been feeling increasingly frustrated and anxious about these issues. You worry that ' + 'you may be developing a serious condition, possibly something like a stroke or dementia, ' + "but you haven't done any research because you’re afraid of what you might find. Your " + 'biggest concern is that you might not be able to live independently if your symptoms ' + 'worsen.\n' + '\n' + 'In terms of your medical history, you have hypertension and take lisinopril daily. You had ' + 'a hip replacement surgery five years ago, which went well, and you have no known drug ' + 'allergies. You are a non-smoker and drink a glass of wine occasionally, about once or ' + 'twice a week. You have a family history of cardiovascular disease; your father had a heart ' + 'attack in his 70s, and your mother had a stroke in her late 80s.\n' + '\n' + 'You live a relatively active life, enjoying gardening and attending local book club ' + 'meetings. However, since the onset of your symptoms, you’ve started to withdraw from ' + 'social activities, feeling embarrassed about your spatial difficulties. You also mentioned ' + 'having trouble with finding the right words during conversations, which adds to your ' + 'frustration.\n' + '\n' + 'You hope that the doctor will take your symptoms seriously and perform the necessary tests ' + 'to determine what’s going on. You expect to discuss your symptoms in detail and are hoping ' + 'for some reassurance or a clear diagnosis that can help you understand what you are ' + 'experiencing.'}, + { 'diagnosis': 'Aplastic anemia', + 'doctor_vignette': 'A 45-year-old man presents to the clinic with persistent fatigue and episodes of ' + 'unexplained bleeding, including frequent nosebleeds and gum bleeding over the past month.', + 'patient_profile': 'You are a 45-year-old man who works as an accountant and lives alone in a modest ' + 'apartment. Lately, you have been feeling more fatigued than usual, despite getting what ' + 'you consider to be a full night’s sleep. You find it increasingly difficult to concentrate ' + "at work, and your productivity has noticeably declined. Over the past few weeks, you've " + "also developed a persistent headache that doesn't seem to respond to over-the-counter pain " + 'medication. \n' + '\n' + 'You’ve noticed that you’re more prone to bruising, with dark purple marks appearing on ' + 'your arms and legs after minor bumps. You’ve also observed small red spots (petechiae) on ' + "your lower extremities, which has made you anxious. Additionally, you've experienced " + 'occasional nosebleeds that seem to occur spontaneously, and your gums bleed more easily ' + 'when you brush your teeth. \n' + '\n' + 'In terms of your medical history, you suffered from allergic rhinitis as a child, which ' + 'you have managed with antihistamines. You had a laparoscopic appendectomy at age 30, and ' + 'apart from that, you have no significant past medical issues. You have no known drug ' + 'allergies and are currently taking a daily multivitamin. You do not smoke and drink ' + 'alcohol socially, averaging about 5 units on the weekends.\n' + '\n' + 'Your family history includes your father, who had prostate cancer, and your mother, who ' + 'has diabetes. You have one younger sister who is healthy. You are concerned that your ' + 'recent symptoms could indicate a serious underlying condition, possibly something like ' + 'leukemia or another blood disorder. You have no prior knowledge of aplastic anemia but are ' + 'frightened by the thought of it being something severe. You hope the doctor will conduct ' + 'blood tests to explain your symptoms and provide some clarity. \n' + '\n' + 'Your biggest concern is the fatigue and the bruising; you feel as though your body is not ' + 'functioning as it should, and you’re worried about how this might affect your job and ' + 'daily life. You expect the doctor to help you understand what’s going on and to provide a ' + 'treatment plan if necessary.'}, + { 'diagnosis': 'Focal segmental glomerulosclerosis', + 'doctor_vignette': 'A 42-year-old man presents to the clinic with persistent swelling in his legs and frothy ' + 'urine over the past month, along with a recent decrease in urine output.', + 'patient_profile': 'You are a 42-year-old man who works as a software engineer and lives alone in a small ' + "apartment. Over the past few months, you've noticed that your ankles and feet have been " + 'swelling, particularly by the end of the day. At first, you thought it was just the result ' + 'of sitting for long hours at your desk, but the swelling has become more pronounced, and ' + 'you’re starting to feel uncomfortable in your shoes. Alongside the swelling, you’ve also ' + 'observed that your urine has become frothy, which has alarmed you. You’ve never ' + 'experienced anything like this before and have no idea what could be causing it.\n' + '\n' + 'Additionally, you’ve been feeling more fatigued than usual, often needing an afternoon nap ' + "to get through the day. You've lost about 5 kg over the past month without trying, and " + 'while you initially thought it was a positive change, you’re now concerned that it might ' + 'indicate something wrong. You’ve also had episodes of mild shortness of breath when ' + 'climbing stairs, which has never happened to you before. \n' + '\n' + 'Your family history includes hypertension and type 2 diabetes in your parents, but they ' + 'are both relatively healthy now. You don’t have any significant past medical history; ' + 'however, you were treated for a mild case of pneumonia two years ago. You don’t take any ' + 'medications regularly and have no known drug allergies. You occasionally take ibuprofen ' + 'for headaches but try to avoid medications unless absolutely necessary.\n' + '\n' + 'Socially, you enjoy playing video games and occasionally go out for drinks with friends, ' + 'averaging about 10 units of alcohol per week. You don’t smoke and have never used ' + 'recreational drugs. You’re worried that these symptoms might signal a serious health ' + 'issue, possibly something related to your kidneys, but you have no specific ideas about ' + 'what could be wrong. Your biggest concern is that you might have a chronic condition that ' + 'could affect your quality of life, and you hope the doctor can provide some clarity and ' + 'run the necessary tests to understand what is happening.'}, + { 'diagnosis': 'Insulinoma', + 'doctor_vignette': 'A 42-year-old man presents to the clinic with recurrent episodes of dizziness and ' + 'confusion, often occurring in the late morning, despite eating regular meals.', + 'patient_profile': 'You are a 42-year-old man who works as a software engineer and lives alone in a small ' + "apartment. Over the past few months, you've been experiencing episodes of confusion and " + 'dizziness that come on suddenly and leave you feeling disoriented. These episodes often ' + 'occur after you’ve gone several hours without eating, and you’ve noticed that you feel ' + 'better after consuming something sugary, like a soda or candy. Recently, these symptoms ' + 'have become more frequent, occurring at least once a week, and they are starting to ' + 'interfere with your ability to concentrate at work.\n' + '\n' + 'In addition to the confusion and dizziness, you have been experiencing persistent fatigue ' + 'that you can’t seem to shake off, despite getting an adequate amount of sleep. You also ' + 'find yourself feeling irritable and anxious, especially when you haven’t eaten for a ' + 'while. There have been a couple of instances where you felt shaky and sweaty, which ' + 'prompted you to eat something immediately. You’ve lost about 5 kg over the last two months ' + 'without any intentional dieting, which is concerning you.\n' + '\n' + 'You have a history of mild anxiety and take an SSRI (sertraline) for it, but you don’t ' + 'think this is related to your current symptoms. You’re not on any other medications and ' + 'have no known drug allergies. In your family history, your father had type 2 diabetes, and ' + 'your mother has hypothyroidism. You are otherwise healthy and have no history of ' + 'significant medical or surgical issues.\n' + '\n' + 'Socially, you lead a relatively sedentary lifestyle, often working long hours at a desk. ' + 'You enjoy cooking but have been relying more on takeout and quick meals lately, especially ' + 'during busy workweeks. You occasionally drink alcohol, about 2-3 units per week, and you ' + 'don’t smoke or use recreational drugs.\n' + '\n' + 'You’ve come to the clinic today because you’re worried about these episodes of confusion ' + 'and dizziness. You have no idea what could be causing them, but you are concerned that it ' + "might be something serious like a neurological issue or diabetes, given your father's " + 'history. You hope the doctor will be able to provide some answers and run tests to ' + 'determine what’s going on with your health.'}, + { 'diagnosis': 'Eosinophilic esophagitis', + 'doctor_vignette': 'A 32-year-old man presents with persistent heartburn despite medication and reports ' + 'experiencing difficulty swallowing solid foods.', + 'patient_profile': 'You are a 32-year-old man who works as a software engineer and lives alone in a small ' + "apartment. For the past six months, you've been experiencing persistent difficulty " + 'swallowing, which has been increasingly bothersome. It feels like food often gets stuck in ' + 'your throat, especially when eating bread or meat. You’ve also noticed episodes of chest ' + 'pain after meals, which you describe as a tightness that sometimes radiates to your back. ' + 'These symptoms have made you anxious about eating, leading to a noticeable reduction in ' + 'your appetite. Over the last month, you’ve unintentionally lost about 5 kg, and you often ' + 'feel bloated and uncomfortable after meals.\n' + '\n' + 'You have no known allergies and take no regular medications. However, you occasionally ' + 'take over-the-counter antacids for heartburn, which you’ve had intermittently for years. ' + 'You’ve never had any major surgeries and have a history of mild asthma that has been ' + 'well-controlled with a rescue inhaler. Your family history is significant for ' + 'gastrointestinal issues; your father has been diagnosed with gastroesophageal reflux ' + 'disease (GERD), and your mother has a history of food allergies.\n' + '\n' + "Socially, you enjoy cooking and trying new recipes, but lately, you've become hesitant to " + 'eat out or try new foods due to fear of choking. You also live a relatively sedentary ' + 'lifestyle, spending long hours at your desk, and you’ve noticed increased stress levels at ' + 'work, especially with deadlines approaching.\n' + '\n' + 'Your main concerns are about the swallowing difficulties and the potential for a serious ' + 'underlying condition. You’ve started to worry that this might be something as serious as ' + 'cancer, though you have no specific reason to think that. You are hoping for answers ' + 'today, possibly an explanation for your symptoms, and you expect the doctor to run some ' + 'tests or provide a treatment plan to alleviate your discomfort. You’ve done no research on ' + 'your symptoms, feeling overwhelmed and unsure where to start.'}, + { 'diagnosis': 'Periodic paralysis (Hypokalemic)', + 'doctor_vignette': 'A 32-year-old man presents to the clinic with sudden episodes of muscle weakness occurring ' + 'after physical activity, accompanied by transient difficulty in moving his limbs.', + 'patient_profile': 'You are a 32-year-old man who works as a software engineer and lives alone in a small ' + 'apartment. Over the past few months, you’ve experienced several episodes of sudden muscle ' + 'weakness, particularly in your arms and legs. These episodes occur after intense physical ' + 'activity, such as playing basketball or going for a run, and typically last from a few ' + 'minutes to a couple of hours. Recently, you’ve also begun to notice that your legs feel ' + 'unusually heavy, and you sometimes struggle to climb stairs. \n' + '\n' + 'You’ve had a couple of unsettling experiences where you felt your heart racing and your ' + 'palms were sweaty, which made you anxious. You’ve never had these symptoms before, and ' + 'they have started to interfere with your daily life and fitness routine. You are concerned ' + "that something serious might be happening, and you can't shake the feeling that this could " + 'be a neurological issue. \n' + '\n' + 'You have a family history of hypertension and diabetes, but no known genetic disorders. ' + 'Your father had a heart attack at 55, and your mother is managing her diabetes with ' + 'medication. You are currently taking no regular medications and have no known allergies. ' + 'You occasionally take ibuprofen for headaches but nothing else. \n' + '\n' + 'You lead a relatively healthy lifestyle, exercising regularly and following a balanced ' + 'diet. However, you do have a habit of consuming energy drinks to boost your performance ' + 'during workouts, especially when you feel fatigued. You’ve noticed that your symptoms seem ' + "to worsen after consuming these drinks, but you haven't made the connection yet.\n" + '\n' + 'Your biggest concern is that these episodes could be related to a serious condition like ' + 'multiple sclerosis or a heart problem. You hope that the doctor will conduct tests to ' + 'determine the cause of your muscle weakness and provide a clear diagnosis. You feel ' + 'anxious about what the future may hold and are eager to find answers to alleviate your ' + 'fears.'}, + { 'diagnosis': 'Tularemia', + 'doctor_vignette': 'A 42-year-old man presents to the clinic with a persistent fever and a painful skin ulcer ' + 'on his right forearm that appeared spontaneously a week ago.', + 'patient_profile': 'You are a 42-year-old male wildlife biologist who spends much of your time outdoors, often ' + 'working in remote areas where you study small mammals and their habitats. You live alone ' + 'in a small cabin near a national park and enjoy hiking in your free time. Over the past ' + 'week, you have developed a sudden onset of fever, chills, and severe fatigue that has made ' + 'it difficult for you to get out of bed. You have also noticed a painful ulcer on your ' + 'right hand that started as a small bump and has now become larger and more tender. The ' + 'area around the ulcer is red and swollen. \n' + '\n' + 'A few days ago, you experienced muscle aches and joint pain, particularly in your knees ' + 'and elbows, which you initially attributed to a long hike you took a week prior. However, ' + 'these symptoms have persisted and worsened, leading you to feel increasingly concerned. ' + 'You have also developed a dry cough that occasionally brings up small amounts of blood, ' + 'which has alarmed you. \n' + '\n' + 'You have no significant past medical history, but you did have a mild case of Lyme disease ' + 'two years ago, which resolved without treatment. You are up to date on all vaccinations, ' + 'including the flu shot. You do not take any regular medications and have no known drug ' + 'allergies. \n' + '\n' + 'In terms of family history, your father had a history of heart disease, and your mother ' + 'has asthma. You have no siblings. \n' + '\n' + 'Socially, you do not smoke and drink alcohol occasionally, about 1-2 beers on weekends. ' + 'You are worried that your symptoms could indicate a serious infection or disease, ' + 'especially considering your work with wildlife. You have no idea what might be causing ' + 'your symptoms but are anxious about the possibility of something severe like a zoonotic ' + 'disease. You hope the doctor will run tests to determine the cause of your fever and the ' + 'ulcer on your hand, as well as provide some relief for your other symptoms.'}, + { 'diagnosis': 'Dermatomyositis', + 'doctor_vignette': 'A 52-year-old woman presents to her dermatologist with purple papules on her knuckles and ' + 'reports experiencing persistent muscle weakness.', + 'patient_profile': 'You are a 52-year-old woman who works as a high school math teacher and lives alone with ' + "your two cats in a small apartment. Over the past two months, you've noticed a persistent " + 'rash on your face, particularly around your eyes and cheeks. The rash started as small, ' + 'red patches that have since spread and become more pronounced, often feeling itchy and ' + 'uncomfortable. You’ve also experienced significant muscle weakness, especially in your ' + 'upper arms and thighs, making it difficult to lift objects or climb stairs. On some days, ' + 'even brushing your hair feels exhausting.\n' + '\n' + "Aside from the rash and muscle weakness, you've been feeling unusually fatigued and have " + 'had difficulty keeping up with your usual activities. You often find yourself needing to ' + "take naps during the day, which is unusual for you. You've also noticed a dry cough that " + 'comes and goes, but it hasn’t been severe enough to disrupt your daily life. \n' + '\n' + 'You are worried that these symptoms might indicate something serious, as you have no idea ' + 'what could be causing them. You have no family history of autoimmune diseases, but your ' + 'mother had rheumatoid arthritis, and your father had heart disease. You have no known ' + 'allergies and take no regular medications, aside from an occasional over-the-counter ' + 'antihistamine for seasonal allergies. You do not smoke and drink alcohol socially, about ' + '2-3 glasses of wine a week.\n' + '\n' + 'In the past, you’ve dealt with mild anxiety, which you manage through exercise and ' + 'mindfulness techniques. You are currently single and have a supportive circle of friends, ' + 'but you feel embarrassed about your symptoms and haven’t shared them with anyone yet. ' + 'You’re hoping the doctor will be able to provide clarity on what’s happening with your ' + 'body and would like to know if there are any treatments available that could help ' + 'alleviate the rash and muscle weakness. Your biggest concern is that this might be a ' + 'chronic condition that will limit your ability to teach and enjoy life as you used to.'}, + { 'diagnosis': 'Hyperemesis gravidarum', + 'doctor_vignette': 'A 28-year-old pregnant woman presents with persistent severe vomiting, leading to ' + 'significant dehydration and weight loss over the past few weeks. She reports difficulty ' + 'keeping any food or fluids down.', + 'patient_profile': 'You are a 28-year-old woman who works as a graphic designer and lives with your partner in ' + 'a small apartment. You recently found out that you are pregnant, and while you were ' + 'initially excited, you have been feeling increasingly unwell. Over the past three weeks, ' + 'you have experienced severe nausea and vomiting that occurs multiple times a day, making ' + 'it difficult for you to keep any food or fluids down. You dread the thought of eating, as ' + 'even the smell of food makes you feel queasy. You’ve lost about 5 kg since finding out you ' + 'were pregnant, and you feel weak and fatigued. You’ve tried drinking ginger tea and eating ' + 'crackers, but nothing seems to help.\n' + '\n' + 'You are worried about your ability to care for yourself and your pregnancy, and you fear ' + 'that your symptoms might harm your baby. You have heard of morning sickness but are ' + 'concerned that what you are experiencing is much worse. You have been feeling isolated, as ' + 'your friends and family don’t seem to understand how debilitating your condition is. You ' + 'hope the doctor will be able to provide relief and reassure you that everything will be ' + 'okay.\n' + '\n' + 'In terms of your medical history, you have no chronic illnesses and have never been ' + 'hospitalized before. You had a straightforward appendectomy at age 20. You take a daily ' + 'multivitamin but no other medications. You have no known drug allergies. Your family ' + 'history is notable for your mother having experienced severe nausea during her ' + 'pregnancies, but she never mentioned anything like what you are going through. Your father ' + 'is healthy, and there are no significant hereditary conditions in your family.\n' + '\n' + 'Socially, you have a supportive partner who is very concerned about your health and has ' + 'been helping as much as possible, but they also have a demanding job and can’t always be ' + 'there. You enjoy going out with friends and staying active, but your current condition has ' + 'made you withdraw from social activities. You are feeling anxious about the future, ' + 'especially about how this might affect your career and your relationship, and you are ' + 'hoping for a solution that will allow you to enjoy your pregnancy instead of enduring it.'}, + { 'diagnosis': 'Sjögren’s syndrome', + 'doctor_vignette': 'A 54-year-old woman presents to her physician with persistent dry eyes and mouth, ' + 'alongside intermittent joint pain, seeking evaluation for these ongoing symptoms.', + 'patient_profile': 'You are a 54-year-old woman who works as a librarian and lives alone with your two cats. ' + 'Over the past six months, you have been experiencing persistent dryness in your mouth and ' + 'eyes that seems to worsen throughout the day. You find it increasingly difficult to ' + 'swallow dry foods, and you often have to sip water or chew gum to alleviate the ' + 'discomfort. Your eyes feel gritty and irritated, and you frequently use artificial tears, ' + 'but they provide only temporary relief. \n' + '\n' + "In addition to these symptoms, you've started to notice joint pain in your hands and " + 'knees, which feels worse in the morning and improves slightly as the day goes on. You’ve ' + 'also been feeling more fatigued than usual, often needing to take naps during the day to ' + "make it through your work shifts. Recently, you've developed a persistent cough that seems " + 'to be dry and unproductive, which has been concerning you. \n' + '\n' + 'You have no significant past medical history, except for mild asthma that you manage with ' + 'an inhaler, and you take no regular medications. You are allergic to penicillin, which ' + 'causes a rash. You have never smoked and consume alcohol socially, about 1-2 glasses of ' + 'wine on weekends. \n' + '\n' + 'In your family history, your mother had rheumatoid arthritis, and your father had type 2 ' + 'diabetes. You are worried that your symptoms might indicate a serious autoimmune ' + 'condition, especially given your family history. You have been trying to connect the dots ' + 'but have not done any specific research. You are hoping the doctor will listen to your ' + 'concerns and perhaps run some tests to figure out what’s going on. You are particularly ' + 'anxious about how these symptoms might affect your ability to continue working, as you ' + 'love your job and the routine it provides. \n' + '\n' + 'Your biggest concern is that you may have a chronic illness that could worsen over time, ' + 'and you are eager to understand what is happening to your body. You expect the doctor to ' + 'provide a diagnosis and suggest a treatment plan to help manage your symptoms.'}, + { 'diagnosis': 'Antiphospholipid syndrome', + 'doctor_vignette': 'A 34-year-old woman visits her physician due to recurring episodes of unexplained swelling ' + 'in her legs and occasional chest discomfort. She describes a sensation of heaviness and ' + 'warmth in the affected areas during these episodes.', + 'patient_profile': 'You are a 34-year-old woman who works as a graphic designer and lives alone in a small ' + "apartment in the city. Over the past month, you've been experiencing recurrent episodes of " + 'swelling in your legs and feet, which you initially attributed to long hours spent sitting ' + 'at your desk. However, the swelling has become more pronounced, and you’ve also noticed ' + 'that your skin feels tender and warm to the touch. Along with this, you’ve had several ' + 'episodes of severe headaches that seem to come out of nowhere, accompanied by a sensation ' + 'of blurred vision that lasts for a few minutes. Recently, you had an alarming incident ' + 'where you developed a deep bruise on your thigh after bumping into the edge of your desk, ' + 'and it took much longer than usual to heal.\n' + '\n' + 'In addition to these symptoms, you’ve experienced occasional chest pain, especially when ' + 'you take deep breaths, which has made you anxious. You find yourself feeling fatigued and ' + 'have difficulty concentrating at work. You’ve also had a couple of episodes of heavy ' + 'menstrual bleeding that have left you feeling weak and lightheaded. \n' + '\n' + 'You are concerned that these symptoms might indicate a serious health issue, possibly ' + 'something like a clotting disorder or even a heart condition. You’ve heard about blood ' + 'clots in the past but don’t know much about them. You worry that your lifestyle—working ' + 'long hours and not exercising enough—might be contributing to your problems. Your ' + 'expectation is that the doctor will run tests to find out what’s causing these troubling ' + 'symptoms.\n' + '\n' + 'Your past medical history includes mild asthma, which you’ve managed with an inhaler, and ' + 'you had your appendix removed at age 23. You don’t take any regular medications, but you ' + 'occasionally use over-the-counter pain relievers for headaches. You have no known drug ' + 'allergies. \n' + '\n' + 'Your family history is notable for your mother, who had a history of hypertension and ' + 'suffered a stroke at age 60. Your father had type 2 diabetes and passed away from ' + 'complications at 65. You have one younger brother who is healthy and active. \n' + '\n' + 'Socially, you enjoy a relatively active lifestyle, engaging in yoga classes a couple of ' + 'times a week, although you’ve found it hard to keep up with them recently due to fatigue. ' + 'You don’t smoke and drink alcohol occasionally, about 2-3 glasses of wine on weekends. ' + 'You’re feeling overwhelmed and anxious about your health, and you hope the doctor will ' + 'help you find answers and a way to feel better.'}, + { 'diagnosis': 'Behçet’s disease', + 'doctor_vignette': 'A 30-year-old woman presents to the clinic with recurrent oral and genital ulcers, noting ' + 'persistent pain and difficulty eating and walking due to the lesions.', + 'patient_profile': 'You are a 30-year-old woman named Aisha, who works as a graphic designer in a bustling ' + 'city. You live alone in a small apartment and enjoy painting and hiking during your free ' + "time. For the past three months, you've been experiencing recurrent painful sores in your " + 'mouth that make eating and drinking quite difficult. The sores appear suddenly and are ' + "often accompanied by a burning sensation. Alongside these oral ulcers, you've noticed red, " + 'inflamed spots on your legs and arms that sometimes swell and itch. Recently, you’ve also ' + 'had episodes of joint pain, particularly in your knees and wrists, which can be ' + 'debilitating at times.\n' + '\n' + 'You’ve been feeling increasingly fatigued, often needing to take naps during the day to ' + 'cope with the exhaustion. Additionally, you have had a couple of episodes where your ' + 'vision blurred for a short time, leaving you feeling disoriented. You’ve also experienced ' + 'a few headaches that are more intense than usual, but they don’t occur frequently.\n' + '\n' + 'You have no significant medical history, but you did have a severe allergic reaction to ' + 'penicillin as a child. You take no regular medications, but you occasionally use ' + 'over-the-counter pain relievers for headaches. You have no known drug allergies other than ' + 'penicillin. Your family history is notable for autoimmune conditions; your mother has ' + 'lupus, and your younger brother has psoriasis. \n' + '\n' + 'You have a healthy lifestyle, exercising regularly and maintaining a balanced diet, but ' + 'the recent symptoms have made it hard for you to stay active. You are concerned that the ' + 'combination of mouth sores, skin rashes, and joint pain might indicate a serious ' + 'underlying condition. You’ve read about autoimmune diseases but haven’t pinpointed ' + 'anything specific. Your main expectation from this visit is to understand what’s happening ' + 'with your body and to find a solution to alleviate your symptoms. You hope the doctor will ' + 'perform tests to identify the cause of your symptoms and provide you with a treatment plan ' + 'so you can return to your normal life.'}, + { 'diagnosis': 'Idiopathic intracranial hypertension', + 'doctor_vignette': 'A 30-year-old woman presents to her physician with episodes of transient vision loss ' + 'occurring multiple times daily, accompanied by intermittent headaches. She denies any ' + 'recent trauma or known vision problems.', + 'patient_profile': 'You are a 30-year-old woman working as an administrative assistant in a busy law firm. You ' + 'live alone in a small apartment in the city and enjoy spending your weekends hiking and ' + 'practicing yoga. Over the past few months, you have been experiencing persistent headaches ' + 'that have become increasingly severe and frequent. Initially, they felt like typical ' + 'tension headaches, but now they are often accompanied by a pulsating sensation and a ' + 'feeling of pressure behind your eyes. Lately, you’ve also noticed that your vision ' + 'occasionally blurs, especially when the headaches are at their worst, and you sometimes ' + 'see spots or flashes of light.\n' + '\n' + 'You have tried over-the-counter pain relievers, but they provide little relief. The ' + 'headaches typically worsen in the evenings and are often accompanied by nausea, which has ' + 'led to a significant decrease in your appetite. You have lost about 5 kg in the last month ' + 'without trying to diet, and this weight loss has left you feeling weak and fatigued. You ' + 'are concerned that something might be seriously wrong, as you’ve never experienced such ' + 'debilitating headaches before. Your biggest fear is that you might have a brain tumor or ' + 'some other serious neurological condition.\n' + '\n' + 'In your medical history, you have a mild case of asthma, which is well-controlled with an ' + 'inhaler that you rarely need. You have no history of migraines, and there are no previous ' + 'head injuries. Your family history is notable for hypertension in your mother and a ' + 'history of migraines in your older sister. You are a non-smoker and drink alcohol ' + 'occasionally, about 1-2 glasses of wine on weekends. You take no regular medications and ' + 'have no known drug allergies.\n' + '\n' + 'You are hoping the doctor will conduct some tests to help figure out what is causing your ' + 'headaches and blurry vision. You have done no research on your symptoms, as you are too ' + 'overwhelmed and anxious about what might be happening. You just want to understand what is ' + 'going on and find a way to alleviate your pain and discomfort.'}, + { 'diagnosis': 'Endometriosis', + 'doctor_vignette': 'A 32-year-old woman presents with chronic pelvic pain and difficulty conceiving despite ' + 'regular unprotected intercourse for over a year. She seeks evaluation for her persistent ' + 'symptoms and potential underlying causes.', + 'patient_profile': 'You are a 32-year-old woman who works as a graphic designer and lives alone in a small ' + "apartment. You've recently been experiencing severe pelvic pain that seems to coincide " + 'with your menstrual cycle; however, it has become increasingly persistent, lasting longer ' + 'than usual and sometimes radiating to your lower back and thighs. The pain is sharp and ' + 'often debilitating, making it difficult to concentrate at work or engage in social ' + 'activities. You’ve also noticed that your periods have become heavier, accompanied by ' + 'large blood clots, and you often feel fatigued and lightheaded during your menstruation.\n' + '\n' + "Over the past few months, you've also begun to experience pain during intercourse, which " + 'has made intimate relationships challenging and left you feeling frustrated and anxious. ' + 'You’ve tried over-the-counter pain relievers, but they provide only minimal relief. You ' + 'are concerned that this may be something serious, as your mother had a history of ' + 'reproductive health issues, including fibroids, but you are unsure what this could ' + 'indicate for you.\n' + '\n' + 'Your medical history is otherwise unremarkable; you have no chronic illnesses and are not ' + 'currently taking any medications. You had a laparoscopic appendectomy in your early ' + 'twenties, but other than that, you have not undergone any significant surgeries. You have ' + 'no known drug allergies, and you drink socially on weekends, averaging about 5-8 units of ' + 'alcohol per week. You do not smoke.\n' + '\n' + 'In terms of family history, your mother had fibroids and underwent a hysterectomy at 45. ' + 'Your father has hypertension, and your sister has no significant medical issues. You are ' + 'currently single and have been feeling increasingly isolated due to your symptoms, which ' + 'has affected your mental health, leading to anxiety about your future and concerns about ' + 'your fertility.\n' + '\n' + 'Your main fears revolve around the possibility of a serious condition like endometriosis ' + 'or another reproductive health issue, and you hope that the doctor will conduct a thorough ' + 'evaluation, including a pelvic exam and possibly imaging studies, to determine the cause ' + 'of your symptoms. You are eager for answers and hope to find a treatment plan that will ' + 'allow you to regain control of your life and alleviate the pain.'}, + { 'diagnosis': 'Whipple’s disease', + 'doctor_vignette': 'A 45-year-old man presents to his primary care physician with persistent diarrhea and ' + 'unintentional weight loss over the past few months. He is concerned about the ongoing ' + 'symptoms and seeks a medical evaluation.', + 'patient_profile': 'You are a 50-year-old man who works as a mechanic and lives alone in a small apartment. ' + 'Over the past few months, you’ve been experiencing persistent abdominal pain that seems to ' + 'come and go, primarily in the upper abdomen. The pain is often accompanied by episodes of ' + 'diarrhea, which have become increasingly frequent and sometimes watery. You’ve also ' + 'noticed that your stools have a strange, pale color and float in the toilet, which has ' + 'made you feel uneasy. Recently, you’ve experienced significant fatigue, and you find ' + 'yourself feeling weak and dizzy, especially after working long hours. \n' + '\n' + 'You’ve tried to manage the abdominal pain with over-the-counter antacids, but they haven’t ' + 'provided much relief. You’ve also been feeling unusually hungry, but when you eat, you ' + 'often feel nauseous and sometimes vomit. You’ve lost about 5 kg in the last month without ' + 'trying, which has added to your concern. Your appetite is erratic; some days you feel ' + 'ravenous, while other days, the thought of food makes you feel sick.\n' + '\n' + 'You have a history of high cholesterol and were put on statins, but you stopped taking ' + 'them about a year ago because of muscle aches. You have no known drug allergies, and you ' + 'occasionally drink alcohol, averaging about 10 units a week, primarily on weekends. You’ve ' + 'never smoked. \n' + '\n' + 'In terms of family history, your father had diabetes and passed away from complications ' + 'related to it, and your mother has a history of autoimmune disorders. You have no siblings ' + 'and were raised by your grandparents, who were generally healthy. \n' + '\n' + 'Your biggest worry is that these symptoms might indicate something serious, like cancer or ' + 'a chronic digestive disease. You have no idea what could be causing your symptoms, but ' + 'you’re anxious and hope that the doctor will conduct some tests to find out what’s wrong. ' + 'You expect to gain clarity on your condition and are hoping for a treatment plan that will ' + 'help alleviate your symptoms and restore your quality of life.'}, + { 'diagnosis': 'Systemic lupus erythematosus', + 'doctor_vignette': 'A 30-year-old woman presents to her physician with migratory polyarthritis and a ' + 'persistent facial rash that worsens with sun exposure.', + 'patient_profile': 'You are a 32-year-old woman who works as a graphic designer and lives alone in a small ' + 'apartment. Over the past three months, you have been experiencing persistent joint pain, ' + 'predominantly in your hands and knees. The pain is worse in the morning, making it ' + 'difficult for you to get out of bed, and it often improves slightly as the day goes on. ' + 'You also noticed that your fingers sometimes feel stiff, especially after sitting still ' + 'for a while. Recently, you have developed a rash across your cheeks and nose that ' + "resembles a butterfly, which seems to flare up when you're exposed to the sun, making you " + 'feel self-conscious about your appearance.\n' + '\n' + 'In addition to these symptoms, you’ve been feeling unusually fatigued, even after a full ' + "night's sleep. This fatigue has been affecting your concentration at work, and you find it " + 'hard to keep up with deadlines. You’ve also experienced occasional mouth sores that are ' + 'painful but heal within a week. You have not had any significant weight changes, but you ' + 'have lost about 2 kg in the last month without trying. \n' + '\n' + 'You have no significant past medical history, but you did have a bout of pneumonia when ' + 'you were a teenager and have been generally healthy since. You take a multivitamin daily ' + 'but no other medications. You do not smoke and drink alcohol socially, about 2-3 units a ' + 'week. \n' + '\n' + 'Your family history includes your mother, who has rheumatoid arthritis, and your father, ' + 'who has type 2 diabetes. You are concerned that your symptoms might indicate a serious ' + 'condition, and you have no idea what could be causing them. You worry that the joint pain ' + 'might lead to long-term damage and that the rash could be a sign of something more severe. ' + 'Your biggest expectation is to receive a clear diagnosis and treatment plan that can help ' + 'manage your symptoms, so you can return to your normal life without pain or fatigue. You ' + 'hope the doctor will perform blood tests to determine what is going on.'}, + { 'diagnosis': 'Typhoid fever', + 'doctor_vignette': 'A 30-year-old man presents to the clinic with persistent high fever and notably low heart ' + 'rate over the past week. He also reports experiencing generalized malaise.', + 'patient_profile': 'You are a 32-year-old man who works as a software engineer and lives alone in a small ' + "apartment. Over the past week, you've been feeling increasingly unwell. It started with a " + 'persistent headache that you initially dismissed as stress from work. However, you soon ' + 'developed a high fever that has been fluctuating between 39°C (102°F) and 40°C (104°F). ' + 'You also have been experiencing chills and night sweats that leave you drenched in the ' + 'morning.\n' + '\n' + "In addition to the fever, you've noticed significant gastrointestinal issues. You have had " + 'a loss of appetite and have been feeling nauseous, which has led to unintentional weight ' + 'loss of about 5 kg in the last week. You’ve had episodes of diarrhea, which are frequent ' + 'and watery, and you feel fatigued and weak. You’ve also noticed some abdominal pain, ' + 'particularly in the right lower quadrant, which worsens after eating.\n' + '\n' + 'You have no known allergies and take no regular medications, but you occasionally use ' + 'over-the-counter pain relievers like ibuprofen for headaches. You have a history of mild ' + 'asthma that is well-controlled with a rescue inhaler, which you use infrequently. You have ' + 'not had any surgeries in the past.\n' + '\n' + 'Your family history is significant for your father, who had type 2 diabetes and ' + 'hypertension, and your mother, who has a history of autoimmune disease. Both parents are ' + 'alive and well. You do not have any siblings.\n' + '\n' + 'Socially, you are single and enjoy socializing on weekends, often going out for meals with ' + 'friends. You travel occasionally for work, but have not been outside the country in over a ' + 'year. You recently returned from a short trip to a rural area where you ate at a local ' + 'restaurant and drank untreated water. You have not been vaccinated for typhoid fever.\n' + '\n' + 'You are quite worried about your symptoms, especially the high fever and diarrhea, and you ' + 'have no idea what could be causing them. You are concerned that it could be something ' + 'serious, like an infection, and you feel anxious about the possibility of being ' + 'hospitalized. You hope the doctor will perform tests to identify the cause of your ' + 'symptoms and provide you with a treatment plan so you can feel better soon.'}, + { 'diagnosis': 'Adult-onset Still’s disease', + 'doctor_vignette': 'A 32-year-old man presents to the clinic with persistent fever and severe joint pain over ' + 'the past few weeks, accompanied by a transient rash on his trunk and limbs.', + 'patient_profile': 'You are a 34-year-old man who works as a software engineer and lives alone in a small ' + "apartment. Over the past few months, you've been experiencing intermittent fevers that " + 'come and go without any clear reason. These fevers are often accompanied by severe joint ' + 'pain, primarily affecting your knees and wrists, making it difficult for you to type or ' + 'even walk up the stairs to your apartment. You’ve also noticed a persistent rash that ' + 'appears on your trunk and arms, which seems to worsen with the fevers. It’s a ' + 'salmon-colored, slightly raised rash that you first thought was an allergic reaction, but ' + 'it hasn’t improved with over-the-counter antihistamines.\n' + '\n' + 'In addition to these symptoms, you’ve been feeling unusually fatigued, struggling to get ' + 'out of bed in the morning, and often needing to take breaks during work to rest. You’ve ' + 'also experienced a loss of appetite, and in the last month, you’ve lost about 5 kg without ' + 'trying. You’re worried that something serious might be going on, but you haven’t done any ' + 'research because you’re afraid of what you might find. Your biggest fear is that you might ' + 'have a chronic illness that could affect your ability to work and live independently.\n' + '\n' + 'Your past medical history includes mild asthma, which you manage with an inhaler, and you ' + 'had a minor appendectomy at the age of 20. You have no known drug allergies and currently ' + 'take no medications aside from your asthma inhaler. You do not smoke, but you occasionally ' + 'drink alcohol on weekends, averaging about 5-6 units. Your family history is significant ' + 'for autoimmune diseases; your mother has rheumatoid arthritis, and your sister was ' + 'diagnosed with lupus a few years ago.\n' + '\n' + 'You’re hoping the doctor will run some tests to get to the bottom of your symptoms, and ' + 'you expect to find out what’s causing your fevers and joint pain. You’re anxious about the ' + 'possibility of being diagnosed with an autoimmune condition, given your family history, ' + 'but you’re also relieved to finally seek help for what has been an increasingly ' + 'debilitating situation.'}, + { 'diagnosis': 'Hemophagocytic lymphohistiocytosis', + 'doctor_vignette': 'A 30-year-old man presents to the clinic with persistent high fever and generalized ' + 'fatigue over the past week, alongside blood test results indicating pancytopenia.', + 'patient_profile': 'You are a 30-year-old man who works as a software developer and lives alone in a small ' + 'apartment in the city. Over the past month, you have been experiencing persistent fevers ' + 'that come and go, often accompanied by chills and night sweats. You’ve also noticed ' + 'significant fatigue, which is unusual for you, as you typically have a lot of energy. In ' + 'addition to feeling tired, you have developed a rash on your torso that started as small ' + 'red spots but has now spread and become more pronounced. You’ve had some abdominal ' + 'discomfort, particularly in the upper left quadrant, and have experienced a few episodes ' + 'of nausea that left you feeling weak.\n' + '\n' + 'You are particularly worried about the fever and the rash, as they seem to be worsening. ' + 'You’ve also lost about 5 kg without trying, which is concerning to you. You have not done ' + 'any research on your symptoms but have spoken to a friend who suggested it might be an ' + 'infection. You are concerned that it could be something serious, like an autoimmune ' + 'disease or a blood disorder. Your expectation is that the doctor will be able to provide ' + 'answers and possibly run some tests to determine the cause of your symptoms.\n' + '\n' + 'Your past medical history includes a childhood diagnosis of asthma, which has been ' + 'well-controlled and has not required medication in several years. You have no history of ' + 'surgeries. You take an occasional over-the-counter antihistamine for seasonal allergies ' + 'but are otherwise not on any medications. You do not have any known drug allergies.\n' + '\n' + 'In terms of family history, your father has a history of hypertension, while your mother ' + 'has Type 2 diabetes. You have one younger sister who is healthy. There is no family ' + 'history of autoimmune diseases or blood disorders that you are aware of.\n' + '\n' + 'Socially, you live alone and lead a relatively quiet lifestyle. You enjoy playing video ' + 'games and going for occasional runs, but your energy levels have made it difficult to ' + 'maintain your usual routine. You do not smoke and drink alcohol only occasionally, ' + 'typically on weekends. You are worried about how these symptoms might affect your work and ' + 'social life, and you hope the doctor can address your concerns and provide a clear ' + 'diagnosis.'}, + { 'diagnosis': 'Vocal cord dysfunction', + 'doctor_vignette': 'A 28-year-old woman presents to the clinic with a persistent night cough and intermittent ' + 'wheezing, seeking evaluation for these bothersome symptoms.', + 'patient_profile': 'You are a 28-year-old woman who works as a high school teacher and lives alone in a small ' + 'apartment. Over the past few months, you have been experiencing episodes of sudden ' + 'shortness of breath, particularly during physical activities or when you are feeling ' + 'stressed. These episodes often come on unexpectedly, making you feel like you can’t get ' + 'enough air, and you have had to pause during conversations to catch your breath. You’ve ' + 'also noticed a tightness in your throat and a feeling of constriction that makes it ' + 'difficult to speak clearly, especially when you are anxious or excited. \n' + '\n' + 'These symptoms have been particularly distressing during your teaching, where you often ' + 'find yourself feeling lightheaded and panicked in front of your students. You have never ' + 'had asthma or any other respiratory conditions before, and you are unsure why this is ' + 'happening. You are concerned that there might be something seriously wrong with your lungs ' + 'or throat, and you fear that it could affect your ability to teach effectively. You have ' + 'been avoiding physical activities and social gatherings to prevent these episodes, which ' + 'has made you feel isolated and anxious.\n' + '\n' + 'In terms of your past medical history, you have a history of anxiety, for which you ' + 'occasionally take a low dose of an SSRI (selective serotonin reuptake inhibitor). You have ' + 'never had any surgeries and you are not currently on any other medications. You do not ' + 'smoke and drink alcohol socially, about 2-3 glasses of wine on the weekends. You have no ' + 'known drug allergies.\n' + '\n' + 'Your family history is notable for asthma in your father and anxiety disorders in your ' + 'mother, but there are no other significant respiratory issues in your family. Socially, ' + 'you are single and have a close group of friends, but you have recently felt withdrawn due ' + 'to your symptoms. You are hoping that the doctor will help you understand what is causing ' + 'these episodes and provide some relief so you can return to your normal life and teaching ' + 'without fear. You’ve done no research on your symptoms and are coming to the appointment ' + 'primarily to seek answers and reassurance.'}, + { 'diagnosis': 'Liddle’s syndrome', + 'doctor_vignette': 'A 30-year-old man presents to his physician with persistent fatigue and muscle weakness. ' + 'He also reports episodes of dizziness, which have become more frequent over the past few ' + 'weeks.', + 'patient_profile': 'You are a 30-year-old man who works as a software engineer and lives alone in a small ' + 'apartment. Over the past few months, you’ve been experiencing episodes of persistent ' + 'headaches and a sensation of pressure in your head, which you initially dismissed as ' + 'stress from work. However, in the last few weeks, you’ve also noticed that you’ve been ' + 'feeling unusually fatigued and have developed a persistent, mild swelling in your legs. ' + 'You’ve been measuring your blood pressure at home, and it has consistently been elevated, ' + 'averaging around 160/100 mmHg, which is much higher than your usual readings of 120/80 ' + 'mmHg.\n' + '\n' + 'You also mention that your heart feels like it races at times, especially during moments ' + 'of stress, and you occasionally experience palpitations. You’ve never had issues with ' + 'blood pressure before, and you’re worried that this could lead to something serious, like ' + 'heart disease or a stroke. You’ve been avoiding caffeine and salty foods, thinking that ' + 'might help, but the symptoms persist. \n' + '\n' + 'In terms of your medical history, you’ve been generally healthy, with no major illnesses ' + 'or surgeries. You don’t take any medications regularly, but you do take ibuprofen ' + 'occasionally for headaches. You have no known drug allergies. There is a family history of ' + 'hypertension; your father has been on medication for high blood pressure since his 40s. \n' + '\n' + 'Your social history reveals that you live alone and have a sedentary lifestyle due to your ' + 'job. You enjoy playing video games and watching movies, but you know you should be more ' + 'active. You occasionally drink alcohol, about 2-3 beers on weekends, but you don’t smoke ' + 'or use recreational drugs. \n' + '\n' + 'Your biggest concern is that your symptoms might indicate a serious underlying condition. ' + 'You’ve been doing some reading online, but you’re overwhelmed with the information and ' + 'unsure of what might be wrong. You hope the doctor will run some tests to determine the ' + 'cause of your symptoms and help you understand what’s happening with your body.'}, + { 'diagnosis': 'Nocardia infection', + 'doctor_vignette': 'A 50-year-old man presents to the clinic with a persistent cough lasting several months, ' + 'accompanied by unexplained weight loss.', + 'patient_profile': 'You are a 50-year-old man who works as a landscape architect and lives alone in a small ' + 'apartment. Over the past month, you have been experiencing a persistent cough that has ' + 'progressively worsened. Initially, it was dry, but now it has become productive, with ' + 'yellowish-green sputum. You find yourself coughing more at night, which disrupts your ' + 'sleep. Alongside the cough, you’ve noticed a low-grade fever that comes and goes, with ' + 'chills that leave you feeling cold and sweaty. You feel fatigued and have lost about 5 kg ' + 'over the past month without trying. \n' + '\n' + 'You also mention a pain in your left side, particularly when you take deep breaths or ' + 'cough, which you describe as a sharp, stabbing sensation. You haven’t had any significant ' + 'respiratory issues in the past, but you do have a history of asthma that you managed well ' + 'with an inhaler. You’ve been using it more frequently lately, but it doesn’t seem to help ' + 'much. \n' + '\n' + 'You have no known drug allergies and take only an over-the-counter antihistamine for ' + 'seasonal allergies. You do not smoke and have never smoked, but you occasionally drink ' + 'alcohol, about 5-7 units per week. \n' + '\n' + 'You are worried that your symptoms could be something serious like pneumonia or lung ' + 'cancer, as you’ve heard stories from friends about similar situations turning out badly. ' + 'You have a family history of respiratory issues; your father had chronic obstructive ' + 'pulmonary disease (COPD) and passed away from complications related to it. Your mother is ' + 'healthy but has a history of hypertension.\n' + '\n' + 'You have not done any research on your symptoms but feel anxious and want to understand ' + 'what is happening to your body. You expect the doctor to perform some tests, such as a ' + 'chest X-ray or blood work, to help figure out what’s going on and to provide you with a ' + 'treatment plan. You hope to get back to your normal routine and be able to breathe easily ' + 'again.'}, + { 'diagnosis': 'Lichen sclerosus', + 'doctor_vignette': 'A 47-year-old woman presents to her gynecologist with persistent vulvar pruritus and an ' + 'unusual discharge over the past few weeks, seeking evaluation for these symptoms.', + 'patient_profile': 'You are a 47-year-old woman who lives alone in a small apartment and works as a librarian. ' + 'Over the past few months, you have been experiencing persistent itching and discomfort in ' + 'the genital area, which has become increasingly bothersome. The itching is particularly ' + 'intense at night, making it difficult for you to sleep. You’ve also noticed some white ' + 'patches of skin in the genital region, which you find alarming. Initially, you thought it ' + 'might be a yeast infection or perhaps a reaction to a new soap, but over time, the ' + 'symptoms have not improved despite trying over-the-counter antifungal creams and changing ' + 'your hygiene products.\n' + '\n' + 'You’ve been feeling anxious about these changes, especially since you’ve never experienced ' + 'anything like this before. You worry that it could be something serious, like an infection ' + 'or even cancer, and you’re concerned about how it might affect your intimate relationships ' + 'in the future. You also fear that this could be a long-term condition that will require ' + 'ongoing treatment.\n' + '\n' + 'In terms of your medical history, you have a history of mild asthma, which is ' + 'well-controlled with an albuterol inhaler, and you have not had any major surgeries. You ' + 'have never had any sexually transmitted infections and have been in a monogamous ' + 'relationship for the past 10 years, although you are currently single. You do not have any ' + 'known allergies and take no regular medications other than the occasional ibuprofen for ' + 'headaches.\n' + '\n' + 'Your family history includes your mother, who had rheumatoid arthritis, and a father who ' + 'suffered from high blood pressure. You have no siblings. Socially, you enjoy reading and ' + 'gardening, and you have a close-knit group of friends with whom you often spend time. You ' + 'do not smoke, and you drink alcohol occasionally, usually just a glass of wine on ' + 'weekends.\n' + '\n' + 'You’re hoping the doctor will provide some clarity on what’s happening with your body and ' + 'offer a treatment plan to alleviate the itching and discomfort. You are eager to ' + 'understand if this condition is something that can be resolved or managed effectively.'}] \ No newline at end of file diff --git a/IGNQuestions/generating_cases.py b/IGNQuestions/generating_cases.py new file mode 100644 index 00000000..86a20766 --- /dev/null +++ b/IGNQuestions/generating_cases.py @@ -0,0 +1,218 @@ +from openai import OpenAI +import json +import time +import os +from typing import Dict, List +from concurrent.futures import ThreadPoolExecutor, as_completed +from api_key import key + +# Set your OpenAI API key +API_KEY = key + +# Track generated diseases +generated_diseases: List[str] = [] + +def validate_case(case): + # Ensure the case is a dict with the required fields and non-empty values + if not isinstance(case, dict): + return False + if "doctor_vignette" not in case or "actual_diagnosis" not in case: + return False + if not case["doctor_vignette"].strip() or not case["actual_diagnosis"].strip(): + return False + return True + +def parse_case_response(response_content): + # Try to parse as JSON, fallback to extracting fields manually + try: + # First try to find JSON content within the response + start_idx = response_content.find('{') + end_idx = response_content.rfind('}') + if start_idx != -1 and end_idx != -1: + json_str = response_content[start_idx:end_idx+1] + case = json.loads(json_str) + if validate_case(case): + return case + except Exception: + pass + + # Fallback: try to extract fields manually + try: + lines = response_content.splitlines() + vignette = "" + diagnosis = "" + for line in lines: + if 'doctor_vignette' in line.lower(): + vignette = line.split(':', 1)[-1].strip(' ",') + if 'actual_diagnosis' in line.lower(): + diagnosis = line.split(':', 1)[-1].strip(' ",') + if vignette and diagnosis: + return {"doctor_vignette": vignette, "actual_diagnosis": diagnosis} + except Exception: + pass + return None + +def validate_diagnosis(diagnosis: str, diseases_to_avoid: List[str]) -> bool: + """Validate that the diagnosis is not in the list of diseases to avoid.""" + diagnosis_lower = diagnosis.lower() + for disease in diseases_to_avoid: + if disease.lower() in diagnosis_lower or diagnosis_lower in disease.lower(): + print(f"REJECTED: '{diagnosis}' is too similar to existing diagnosis '{disease}'") + return False + return True + +def generate_unique_diseases(num_diseases: int = 500) -> List[str]: + """Generate a list of unique medical diagnoses with ICD-10 codes.""" + prompt = """You are an expert physician. Generate a list of unique medical diagnoses with their ICD-10 codes. + Each diagnosis must be: + 1. A real medical condition with a valid ICD-10 code + 2. Completely distinct from other diagnoses (no variations or subtypes) + 3. Cover a wide range of medical specialties + 4. Include both common and rare conditions + + Format each diagnosis as: "Diagnosis name, ICD-10 code X00.0" + Separate each diagnosis with a newline. + + Example: + Acute appendicitis, ICD-10 code K35.2 + Pulmonary embolism, ICD-10 code I26.9 + Multiple sclerosis, ICD-10 code G35 + """ + + diseases = [] + print(f"\nGenerating unique diseases (target: {num_diseases})...") + + while len(diseases) < num_diseases: + try: + client = OpenAI(api_key=API_KEY) + response = client.chat.completions.create( + model="gpt-4o-mini", + messages=[ + {"role": "system", "content": "You are an expert physician. Generate unique medical diagnoses with ICD-10 codes."}, + {"role": "user", "content": prompt} + ], + temperature=0.7, + max_tokens=1000 + ) + content = response.choices[0].message.content + new_diseases = [line.strip() for line in content.split('\n') if line.strip()] + + # Validate and add unique diseases + for disease in new_diseases: + if disease not in diseases: + diseases.append(disease) + print(f"Generated unique disease {len(diseases)}/{num_diseases}: {disease}") + if len(diseases) >= num_diseases: + break + + except Exception as e: + print(f"Error generating diseases: {e}") + time.sleep(1) + + print(f"\nSuccessfully generated {len(diseases)} unique diseases!") + return diseases[:num_diseases] + +def generate_case_for_disease(disease: str) -> Dict: + """Generate a medical case for a specific disease.""" + prompt = f"""You are an expert physician. Generate a realistic medical case for this diagnosis: {disease} + +CRITICAL REQUIREMENTS: +1. The vignette must be 3-4 sentences maximum +2. Choose appropriate demographics (age and sex) that are typical for this condition +3. The vignette must be clinically accurate for the diagnosis +4. The vignette must include: demographics, chief complaint, key physical exam findings, and critical lab/imaging results + +Output format (must be valid JSON): +{{ + "doctor_vignette": "A concise medical vignette that includes: 1) Demographics (age, sex), 2) Chief complaint, 3) Key physical exam findings, and 4) Critical lab/imaging results", + "actual_diagnosis": "{disease}" +}} + +Generate a case following the exact format above, ensuring the vignette is appropriate for the typical demographic affected by {disease}.""" + + content = None + for attempt in range(3): + try: + client = OpenAI(api_key=API_KEY) + response = client.chat.completions.create( + model="gpt-4o-mini", + messages=[ + {"role": "system", "content": "You are an expert physician. You must return a valid JSON object with exactly two fields: 'doctor_vignette' and 'actual_diagnosis'."}, + {"role": "user", "content": prompt} + ], + temperature=0.7, + max_tokens=150 + ) + content = response.choices[0].message.content + case = parse_case_response(content) + if validate_case(case): + return case + except Exception as e: + print(f"Error generating case (attempt {attempt+1}): {e}") + if content: + print(f"Response content: {content}") + time.sleep(1) + return {"doctor_vignette": "Failed to generate vignette.", "actual_diagnosis": disease} + +def generate_cases_parallel(num_cases=500, max_workers=5): + """Generate cases in parallel using ThreadPoolExecutor""" + # Load existing cases if any + cases = load_cases() + start_idx = len(cases) + + if start_idx >= num_cases: + print(f"Already have {start_idx} cases. No new cases needed.") + return + + print(f"Found {start_idx} existing cases. Generating {num_cases - start_idx} new cases...") + + # First generate unique diseases + print("Generating unique diseases...") + unique_diseases = generate_unique_diseases(num_cases - start_idx) + print(f"Generated {len(unique_diseases)} unique diseases") + + # Generate cases in parallel + with ThreadPoolExecutor(max_workers=max_workers) as executor: + # Submit all tasks + futures = [executor.submit(generate_case_for_disease, disease) for disease in unique_diseases] + + # Process completed tasks + for i, future in enumerate(as_completed(futures)): + try: + case = future.result() + cases.append(case) + + # Save after each case + save_cases(cases) + + # Print progress + print(f"\nGenerated case {start_idx + i + 1}/{num_cases}:") + print(f"Diagnosis: {case['actual_diagnosis']}") + print(f"Vignette: {case['doctor_vignette']}") + print("-" * 80) + + except Exception as e: + print(f"Error processing case: {e}") + + print(f"\nGeneration complete! Total cases: {len(cases)}") + print("Results have been saved to 'medical_cases.json'") + +def save_cases(cases, filename="medical_cases.json"): + """Save cases to JSON file with pretty printing""" + with open(filename, 'w') as f: + json.dump(cases, f, indent=2) + +def load_cases(filename="medical_cases.json"): + """Load existing cases from JSON file""" + try: + with open(filename, 'r') as f: + cases = json.load(f) + # Initialize the generated_diseases list with diseases from existing cases + global generated_diseases + generated_diseases = [case["actual_diagnosis"] for case in cases] + return cases + except (FileNotFoundError, json.JSONDecodeError): + return [] + +if __name__ == "__main__": + generate_cases_parallel(num_cases=500, max_workers=5) \ No newline at end of file diff --git a/IGNQuestions/information_gain.py b/IGNQuestions/information_gain.py new file mode 100644 index 00000000..c13095d7 --- /dev/null +++ b/IGNQuestions/information_gain.py @@ -0,0 +1,257 @@ +import numpy as np +from typing import Dict, List, Tuple +import random +from openai import OpenAI +import os +from api_key import key + +# Initialize OpenAI client +API_KEY = key +client = OpenAI(api_key=API_KEY) + +def calculate_entropy(probabilities: Dict[str, float]) -> float: + """Calculate the entropy of a probability distribution.""" + return -sum(p * np.log2(p) for p in probabilities.values() if p > 0) + +def generate_questions(patient_info: str, num_questions: int = 20) -> List[str]: + """Generate relevant diagnostic questions based on patient information.""" + response = client.chat.completions.create( + model="gpt-4o-mini", + messages=[ + {"role": "system", "content": f""" +You are an expert medical diagnostician. Based on the patient information provided, generate {num_questions} highly specific diagnostic questions that would help narrow down the diagnosis. + +Patient Information: {patient_info} + +Instructions: +1. Generate EXACTLY {num_questions} specific questions a doctor would ask this patient +2. Questions should be phrased to be answerable with Yes, No, or Not Sure +3. Focus on symptoms, risk factors, and relevant medical history +4. Make questions specific and directly relevant to likely diagnoses +5. Vary the questions to cover different body systems and potential diagnoses +6. Each question should be on its own line with no numbering or additional text +7. Questions should help differentiate between the most likely diagnoses +8. Do not include any explanations or additional text +"""} + ] + ) + + questions = [q.strip() for q in response.choices[0].message.content.strip().split('\n') if q.strip()] + return questions[:num_questions] # Ensure we have exactly num_questions + +def calculate_scenario_probabilities(patient_info: str, question: str) -> Dict[str, float]: + """Calculate probabilities of different answer scenarios for a given question.""" + print(f" Calculating scenario probabilities for question: {question}") + + response = client.chat.completions.create( + model="gpt-4o-mini", + messages=[ + {"role": "system", "content": f""" +You are an expert in medical probability estimation. Given the patient information and a diagnostic question, generate 3 possible responses and their probabilities. + +Patient Information: {patient_info} + +Question: {question} + +Instructions: +1. Generate EXACTLY 3 possible responses to this question +2. Each response should be a natural, patient-like answer +3. Assign a probability to each response +4. Probabilities must sum to exactly 1.0 +5. Express each probability as a decimal between 0 and 1 +6. Consider the patient's demographics, symptoms, and history +7. Base your estimates on medical knowledge and typical disease presentations +8. Return ONLY the responses and probabilities in this exact format: +Response 1|0.XX +Response 2|0.XX +Response 3|0.XX +"""} + ] + ) + + scenario_probs = {} + for line in response.choices[0].message.content.strip().split('\n'): + if '|' in line: + scenario, prob_str = line.split('|', 1) + try: + scenario_probs[scenario.strip()] = float(prob_str.strip()) + except ValueError: + pass + + # Validate and normalize probabilities + if not scenario_probs or abs(sum(scenario_probs.values()) - 1.0) > 0.01: + # If probabilities don't sum to ~1, assign equal probabilities + scenarios = [f"Response {i+1}" for i in range(3)] + scenario_probs = {scenario: 1.0/3 for scenario in scenarios} + + print(f" Scenario probabilities calculated: {scenario_probs}") + return scenario_probs + +def update_disease_probabilities(patient_info: str, diseases_with_probs: List[Tuple[str, float]], + question: str, answer: str, base_diseases: List[str]) -> Dict[str, float]: + """Update disease probabilities based on a new question and answer.""" + print(f" Updating disease probabilities for answer: {answer}") + diseases_str = "\n".join([f"{disease}|{prob}" for disease, prob in diseases_with_probs]) + + response = client.chat.completions.create( + model="gpt-4o-mini", + messages=[ + {"role": "system", "content": f""" +You are an expert medical diagnosis assistant. Given the patient information, current disease probabilities, and a new question with its answer, update the disease probabilities. + +Patient Information: {patient_info} + +Base Diseases (these are the only possible diagnoses): +{', '.join(base_diseases)} + +Current disease probabilities: +{diseases_str} + +New Information: +Question: {question} +Answer: {answer} + +Instructions: +1. Consider how the new information impacts each disease probability +2. Update each probability based on medical knowledge +3. The probabilities must sum to exactly 1.0 +4. Return only the updated probabilities in this exact format: +Disease name 1|0.XXX +Disease name 2|0.XXX +etc. +5. Only include diseases from the base diseases list +6. Do not include any explanations or additional text +"""} + ] + ) + + updated_probs = {} + for line in response.choices[0].message.content.strip().split('\n'): + if '|' in line: + disease, prob_str = line.split('|', 1) + try: + if disease.strip() in base_diseases: # Only include base diseases + updated_probs[disease.strip()] = float(prob_str.strip()) + except ValueError: + pass + + # If we got invalid output, return original probabilities + if not updated_probs or abs(sum(updated_probs.values()) - 1.0) > 0.01: + return {disease: prob for disease, prob in diseases_with_probs} + + print(f" Updated probabilities: {updated_probs}") + return updated_probs + +def evaluate_question_info_gain(patient_info: str, question: str, + diseases_with_probs: List[Tuple[str, float]], base_diseases: List[str]) -> float: + """Calculate information gain for a single question.""" + print(f" Evaluating information gain for question: {question}") + # Current entropy + current_probs = {disease: prob for disease, prob in diseases_with_probs} + current_entropy = calculate_entropy(current_probs) + print(f" Current entropy: {current_entropy:.4f}") + + # Calculate scenario probabilities + scenario_probs = calculate_scenario_probabilities(patient_info, question) + + # Calculate expected entropy + expected_entropy = 0 + for scenario, prob in scenario_probs.items(): + print(f" Processing scenario: {scenario}") + # Update probabilities based on scenario + new_probs = update_disease_probabilities(patient_info, diseases_with_probs, question, scenario, base_diseases) + + # Calculate entropy for this scenario + scenario_entropy = calculate_entropy(new_probs) + expected_entropy += prob * scenario_entropy + print(f" Scenario entropy: {scenario_entropy:.4f}") + + # Calculate information gain + info_gain = current_entropy - expected_entropy + print(f" Information gain: {info_gain:.4f}") + return info_gain + +def information_gain_network(patient_info: str, diseases: List[str]) -> str: + """ + Main function that calculates the question with the highest information gain. + + Args: + patient_info: Patient vignette/information + diseases: List of possible diseases + + Returns: + The question with the highest information gain + """ + print("\nStarting information gain network...") + # Initialize equal probabilities for all diseases + num_diseases = len(diseases) + initial_prob = 1.0 / num_diseases + diseases_with_probs = [(disease, initial_prob) for disease in diseases] + print(f"Initialized {num_diseases} diseases with equal probabilities") + + # Generate questions + print("Generating questions...") + questions = generate_questions(patient_info) + print(f"Generated {len(questions)} questions") + + # Evaluate information gain for each question + print("Evaluating information gain for each question...") + info_gains = [] + for i, question in enumerate(questions, 1): + print(f"\nEvaluating question {i}/{len(questions)}") + try: + info_gain = evaluate_question_info_gain(patient_info, question, diseases_with_probs, diseases) + info_gains.append((question, info_gain)) + except Exception as e: + print(f"Error evaluating question '{question}': {str(e)}") + info_gains.append((question, 0.0)) + + # Sort by information gain in descending order + info_gains.sort(key=lambda x: x[1], reverse=True) + + # Return the question with the highest information gain + if info_gains: + best_question, best_gain = info_gains[0] + print(f"\nBest question found with information gain {best_gain:.4f}:") + print(f"Question: {best_question}") + return best_question + else: + return "Do you have any other symptoms you haven't mentioned?" + +def get_initial_probabilities(patient_info: str, num_diseases: int = 10) -> List[Tuple[str, float]]: + """Get initial disease probabilities from the patient information.""" + # Use probabilistic_inference function from main.py if it's imported + # Otherwise, we'll implement a simplified version here + try: + from main import probabilistic_inference + return probabilistic_inference(patient_info, num_diseases) + except ImportError: + # Fallback implementation if probabilistic_inference isn't available + response = client.chat.completions.create( + model="gpt-4o-mini", + messages=[ + {"role": "system", "content": f""" +You are an expert medical diagnosis assistant. Based on the patient information provided below, determine the top {num_diseases} most likely diagnoses, ordered from most to least likely with their probabilities. + +Patient Information: {patient_info} + +Instructions: +1. Return EXACTLY {num_diseases} diseases with their probabilities +2. Probabilities must sum to exactly 1.0 +3. Format each line as: Disease name|0.XXX +4. Use the FULL, proper medical name for each diagnosis +5. Do not include any additional text or explanations +"""} + ] + ) + + diseases = [] + for line in response.choices[0].message.content.strip().split('\n'): + if '|' in line: + name, prob = line.split('|', 1) + try: + diseases.append((name.strip(), float(prob.strip()))) + except ValueError: + pass + + return diseases diff --git a/IGNQuestions/main.py b/IGNQuestions/main.py new file mode 100644 index 00000000..998016a3 --- /dev/null +++ b/IGNQuestions/main.py @@ -0,0 +1,146 @@ +from openai import OpenAI +import os +import json +from api_key import key +from information_gain import information_gain_network + +API_KEY = key +client = OpenAI(api_key=API_KEY) + +def load_cases(filename="medical_cases.json"): + """Load cases from JSON file""" + try: + with open(filename, 'r') as f: + return json.load(f) + except (FileNotFoundError, json.JSONDecodeError) as e: + print(f"Error loading cases: {e}") + return [] + +def probabilistic_inference(doctor_vignette, num_diseases=10): + response = client.chat.completions.create( + model="gpt-4o-mini", + messages=[ + {"role": "system", "content": f""" +You are an expert medical diagnosis assistant with extensive knowledge of internal medicine, symptomatology, and differential diagnosis. +Based on the information provided below, determine the SPECIFIC top {num_diseases} most likely diagnoses along with their updated probabilities. + +Patient Information: {doctor_vignette} + +### Medical Knowledge Guidelines: +- Consider the epidemiology and prevalence of different conditions +- Analyze the temporal sequence of symptom development +- Evaluate risk factors and comorbidities +- Assess the specificity and sensitivity of reported symptoms +- Factor in demographic information appropriately +- Recognize common symptom patterns and clinical presentations +- Consider both common and rare diagnoses that fit the symptom profile + +### Key Instructions: +- Consider how each new piece of information impacts the differential diagnosis +- Adjust probabilities based on justifiable evidence. Once updated, normalize the set so the total equals 1.00000 exactly +- If a symptom is not relevant to a condition, do not adjust that condition's probability. +- Your output should be explainable—each probability should reflect an evidence-based assessment. +- Always use the FULL, proper medical name for each diagnosis (e.g., "Heart Failure" not "Failure", "Chronic Obstructive Pulmonary Disease" not "COPD") +- You MUST return EXACTLY {num_diseases} diagnoses, even if some have very low probabilities. + +### CRITICAL OUTPUT FORMAT: +You MUST return EXACTLY {num_diseases} diagnoses with their probabilities, formatted as follows: + +Disease name 1|0.XXX +Disease name 2|0.XXX +Disease name 3|0.XXX +Disease name 4|0.XXX +Disease name 5|0.XXX +(etc. until you have provided exactly {num_diseases} diseases) + +Where: +- Each disease-probability pair must be on its own line +- Use the pipe character | between disease name and probability +- The sum of all probabilities MUST equal 1.00000 EXACTLY +- Do not include any narrative text, explanations, or additional information + +Before outputting the probabilities, make sure to normalize them so the total equals 1.00000 exactly. Do whatever you need to normalize them. + +This exact format is required for automated parsing. Do not deviate from it in any way. +"""} + ] + ) + answer = response.choices[0].message.content + diseases = [] + for line in answer.split('\n'): + if '|' in line: + name, prob = line.split('|', 1) + diseases.append((name.strip(), float(prob.strip()))) + return diseases + +def process_cases(): + # Load cases from JSON file + try: + with open("medical_cases.json", "r") as f: + cases = json.load(f) + except FileNotFoundError: + print("Error: medical_cases.json file not found. Please make sure the file exists in the current directory.") + return + except json.JSONDecodeError: + print("Error: medical_cases.json is not a valid JSON file.") + return + + if not cases: + print("No cases found in medical_cases.json") + return + + results = [] + + # Create or clear results.json + with open('results.json', 'w') as f: + json.dump([], f) + + for case_idx, case in enumerate(cases, 1): + case_result = { + "case_number": case_idx, + "doctor_vignette": case['doctor_vignette'], + "actual_diagnosis": case['actual_diagnosis'], + "diseases": [], + "question": "" + } + + print(f"\nProcessing Case {case_idx}...") + doctor_vignette = case['doctor_vignette'] + diseases_with_probs = probabilistic_inference(doctor_vignette) + diseases = [disease for disease, _ in diseases_with_probs] + + # Store all diseases + case_result["diseases"] = diseases + + # Generate question using information gain network + question = information_gain_network(doctor_vignette, diseases) + case_result["question"] = question + + print(f"\nAll Diseases (most to least likely):") + for i, (disease, prob) in enumerate(diseases_with_probs, 1): + print(f"{i}. {disease} ({prob:.3f})") + print(f"\nActual Diagnosis: {case['actual_diagnosis']}") + print(f"Generated Question: {question}") + + # Add the new case result + results.append(case_result) + + # Update results.json after each case + with open('results.json', 'w') as f: + json.dump(results, f, indent=2) + print("\nUpdated results.json with current case") + + print(f"\nTotal cases processed: {len(cases)}") + print("\nFinal results have been saved to results.json") + +def main(): + # Original code for testing probabilistic_inference + doctor_vignette = "A 50-year-old male presents with acute chest pain. He is a smoker and has a family history of heart disease. On examination, he has a palpable thrill in the left sternal border and a systolic murmur heard best in the second intercostal space. ECG shows ST-segment elevation in leads V1-V3." + diseases = probabilistic_inference(doctor_vignette) + print(diseases) + + # Process all cases + process_cases() + +if __name__ == "__main__": + main() diff --git a/IGNQuestions/medical_cases.json b/IGNQuestions/medical_cases.json new file mode 100644 index 00000000..d6eefec4 --- /dev/null +++ b/IGNQuestions/medical_cases.json @@ -0,0 +1,2002 @@ +[ + { + "doctor_vignette": "A 54-year-old female presents with persistent joint pain and swelling, primarily in her hands and wrists. On examination, there is significant tenderness, bilateral swelling, and morning stiffness lasting over an hour. Laboratory tests reveal elevated rheumatoid factor and anti-CCP antibodies, along with an increased ESR. X-rays show joint erosions in the metacarpophalangeal joints.", + "actual_diagnosis": "Rheumatoid arthritis, ICD-10 code M05.79" + }, + { + "doctor_vignette": "A 67-year-old male presents with a chief complaint of increasing shortness of breath and a chronic cough producing sputum for the past few months. Physical examination reveals prolonged expiratory phase, wheezing, and decreased breath sounds bilaterally. A chest X-ray shows hyperinflation of the lungs, and spirometry indicates a reduced FEV1/FVC ratio consistent with obstructive airway disease.", + "actual_diagnosis": "Chronic obstructive pulmonary disease, ICD-10 code J44.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with chronic diarrhea and abdominal bloating that has persisted for several months. On physical examination, she has notable weight loss and signs of malnutrition, including dry skin and hair loss. Serological tests reveal elevated tissue transglutaminase antibodies (tTG-IgA) and positive IgA endomysial antibodies, suggesting an autoimmune process. A subsequent duodenal biopsy confirms the presence of villous atrophy.", + "actual_diagnosis": "Celiac disease, ICD-10 code K90.0" + }, + { + "doctor_vignette": "A 58-year-old male presents to the emergency department with severe chest pain radiating to his left arm, accompanied by shortness of breath. On physical examination, he is diaphoretic and has a blood pressure of 90/60 mmHg with an elevated heart rate of 110 bpm. An ECG shows ST-segment elevation in the anterior leads, and cardiac troponin levels are significantly elevated. ", + "actual_diagnosis": "Acute myocardial infarction, ICD-10 code I21.9" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of tremors in his right hand that have progressively worsened over the past year. Physical examination reveals a resting tremor, bradykinesia, and rigidity in the upper limbs. There is a shuffling gait noted during ambulation, and he demonstrates difficulty initiating movement. MRI of the brain shows no acute changes, supporting the clinical diagnosis of Parkinson's disease.", + "actual_diagnosis": "Parkinson's disease, ICD-10 code G20" + }, + { + "doctor_vignette": "A 10-year-old male presents with recurrent episodes of spontaneous bleeding from the gums and prolonged bleeding after minor cuts. Physical examination reveals easy bruising and joint swelling in the knees. Laboratory tests show aPTT of 60 seconds (normal 30-40 seconds) and normal PT, indicating a deficiency in factor VIII.", + "actual_diagnosis": "Hemophilia A, ICD-10 code D66" + }, + { + "doctor_vignette": "A 10-year-old female presents with a chief complaint of wheezing and shortness of breath, especially during play and at night. Physical examination reveals diffuse wheezing on auscultation and decreased breath sounds. Peak expiratory flow rate measurement shows a reduction of 60% from her personal best, indicating obstructive airflow limitation.", + "actual_diagnosis": "Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 35-year-old female presents with unintentional weight loss, increased anxiety, and palpitations over the past month. On examination, she has a rapid heart rate of 110 beats per minute, fine tremors in her hands, and an enlarged thyroid gland. Laboratory tests reveal elevated levels of free T4 and suppressed TSH, confirming hyperthyroidism.", + "actual_diagnosis": "Hyperthyroidism, ICD-10 code E05.90" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of persistent joint pain and fatigue for the past three months. Physical examination reveals a butterfly rash across her cheeks and photosensitivity. Laboratory tests show elevated anti-nuclear antibodies (ANA) and low complement levels, consistent with autoimmune activity.", + "actual_diagnosis": "Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with persistent fatigue and mild lower extremity edema. On physical examination, she has elevated blood pressure and decreased urine output. Laboratory results reveal a serum creatinine level of 2.5 mg/dL and a glomerular filtration rate (GFR) of 30 mL/min, indicating significant renal impairment.", + "actual_diagnosis": "Chronic kidney disease, ICD-10 code N18.9" + }, + { + "doctor_vignette": "A 10-year-old male presents with a chief complaint of persistent cough and difficulty breathing. Physical exam reveals digital clubbing and wheezing on auscultation. A sweat test demonstrates an elevated chloride level of 80 mmol/L, confirming the suspicion of cystic fibrosis.", + "actual_diagnosis": "Cystic fibrosis, ICD-10 code E84.9" + }, + { + "doctor_vignette": "A 55-year-old male presents with severe pain and swelling in his right big toe, which started suddenly during the night. On examination, the toe is erythematous, warm, and tender to touch, with limited range of motion. Serum uric acid levels are markedly elevated at 9.2 mg/dL, and joint aspiration reveals needle-shaped monosodium urate crystals under polarized light.", + "actual_diagnosis": "Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "A 22-year-old female presents with excessive daytime sleepiness and episodes of sudden muscle weakness triggered by laughter. Physical examination reveals normal neurological function except for mild cataplexy. Polysomnography shows decreased REM latency and multiple sleep onset REM periods. The MSLT confirms a mean sleep latency of 4 minutes with two sleep-onset REM episodes.", + "actual_diagnosis": "Narcolepsy, ICD-10 code G47.419" + }, + { + "doctor_vignette": "A 65-year-old male with a history of chronic obstructive pulmonary disease presents with a chief complaint of worsening cough and fever for three days. Physical examination reveals decreased breath sounds and dullness to percussion in the right lower lung field. A chest X-ray shows a right lower lobe consolidation, and sputum culture identifies Klebsiella pneumoniae.", + "actual_diagnosis": "Pneumonia due to Klebsiella pneumoniae, ICD-10 code J15.0" + }, + { + "doctor_vignette": "A 45-year-old female presents with progressive chorea and difficulty with coordination over the past year. Neurological examination reveals abnormal movements of her limbs and facial grimacing, along with mild cognitive decline. Genetic testing reveals the presence of the CAG repeat expansion in the HTT gene, confirming the diagnosis.", + "actual_diagnosis": "Huntington's disease, ICD-10 code G10" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of recurrent abdominal pain and bloating, often relieved by defecation. Physical examination reveals mild tenderness in the lower abdomen without guarding or rebound tenderness. Laboratory tests, including complete blood count and metabolic panel, are unremarkable, and no imaging studies are indicated. The symptoms have been occurring for over six months with no identifiable organic cause.", + "actual_diagnosis": "Irritable bowel syndrome, ICD-10 code K58.9" + }, + { + "doctor_vignette": "A 5-year-old boy presents with recurrent fractures after minimal trauma. On physical examination, he has blue sclera and a noticeable bowing of his lower limbs. X-rays reveal multiple healed and healing fractures in various stages, along with osteopenic changes. Genetic testing confirms a mutation in the COL1A1 gene, consistent with osteogenesis imperfecta.", + "actual_diagnosis": "Osteogenesis imperfecta, ICD-10 code Q78.0" + }, + { + "doctor_vignette": "A 25-year-old female presents with persistent fatigue and recurrent infections over the past month. On physical examination, she exhibits pallor and petechiae on her extremities. Complete blood count reveals a hemoglobin level of 8 g/dL, a platelet count of 30,000/mm\u00b3, and a white blood cell count of 2,000/mm\u00b3, indicating severe cytopenias.", + "actual_diagnosis": "Aplastic anemia, ICD-10 code D61.9" + }, + { + "doctor_vignette": "A 10-year-old male of Mediterranean descent presents with fatigue and pallor. On physical examination, he has noticeable splenomegaly and conjunctival pallor. A complete blood count reveals microcytic anemia with a hemoglobin level of 8 g/dL and elevated levels of fetal hemoglobin (HbF).", + "actual_diagnosis": "Thalassemia, ICD-10 code D56.9" + }, + { + "doctor_vignette": "A 34-year-old female presents with a chief complaint of recurrent headaches occurring more than 15 days per month for the past six months. Physical examination reveals tenderness in the pericranial muscles and no neurological deficits. A brain MRI shows no acute abnormalities, ruling out secondary causes of headache.", + "actual_diagnosis": "Chronic migraine, ICD-10 code G43.709" + }, + { + "doctor_vignette": "A 52-year-old female presents with a chief complaint of persistent joint pain and swelling in her hands and wrists for the past three months. Physical examination reveals bilateral tenderness and swelling of the metacarpophalangeal joints, with morning stiffness lasting over an hour. Laboratory tests show elevated rheumatoid factor and anti-CCP antibodies, along with an elevated ESR.", + "actual_diagnosis": "Rheumatoid arthritis, ICD-10 code M05.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with fatigue, bruising, and recurrent infections over the past month. Physical examination reveals pallor and multiple ecchymoses on the extremities. Complete blood count shows anemia (Hb 8.5 g/dL), thrombocytopenia (platelets 45,000/\u03bcL), and leukocytosis with 25% blasts. Bone marrow biopsy confirms the presence of myeloblasts consistent with acute myeloid leukemia.", + "actual_diagnosis": "Acute myeloid leukemia, ICD-10 code C92.0" + }, + { + "doctor_vignette": "A 35-year-old female presents with a chief complaint of red, scaly patches on her elbows and knees that have been persistent for several months. On physical exam, there are well-defined, erythematous plaques covered with silvery-white scales. No laboratory tests are necessary for diagnosis; however, a skin biopsy may confirm the presence of hyperkeratosis and neutrophilic infiltration. The patient has a family history of psoriasis, further supporting the diagnosis.", + "actual_diagnosis": "Psoriasis, ICD-10 code L40.9" + }, + { + "doctor_vignette": "A 32-year-old African American female presents with persistent cough and shortness of breath for the past three months. Physical examination reveals bilateral hilar lymphadenopathy and erythema nodosum on her lower extremities. A chest X-ray shows enlarged lymph nodes and a CT scan confirms the presence of granulomas in the lungs. Laboratory tests show elevated serum angiotensin-converting enzyme (ACE) levels, supporting the diagnosis.", + "actual_diagnosis": "Sarcoidosis, ICD-10 code D86.9" + }, + { + "doctor_vignette": "A 75-year-old male presents to the emergency department with complaints of increasing shortness of breath and swelling in his legs over the past month. On examination, he has elevated jugular venous pressure, bilateral pitting edema, and crackles in the lung fields. A chest X-ray reveals cardiomegaly and pulmonary congestion, and a BNP level is markedly elevated at 800 pg/mL.", + "actual_diagnosis": "Congestive heart failure, ICD-10 code I50.9" + }, + { + "doctor_vignette": "A 12-year-old male presents with a chief complaint of excessive thirst and frequent urination over the past month. On physical examination, he is noted to have a thin build and dry mucous membranes. Laboratory results show a fasting blood glucose level of 250 mg/dL and a HbA1c of 9.5%.", + "actual_diagnosis": "Type 1 diabetes mellitus, ICD-10 code E10.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Physical examination reveals dry skin, bradycardia, and a swollen face. Laboratory tests show elevated TSH levels and low free T4 levels, confirming the diagnosis.", + "actual_diagnosis": "Hypothyroidism, ICD-10 code E03.9" + }, + { + "doctor_vignette": "A 68-year-old female presents with a chief complaint of persistent low back pain after a minor fall. Physical examination reveals a decreased height of 3 cm since her last visit and tenderness over the lumbar spine. A DEXA scan shows a T-score of -2.8 at the lumbar spine and -2.5 at the hip, indicating significant bone density loss.", + "actual_diagnosis": "Osteoporosis, ICD-10 code M81.0" + }, + { + "doctor_vignette": "A 45-year-old male presents to the emergency department with severe abdominal pain radiating to his back, accompanied by nausea and vomiting. On physical examination, he exhibits tenderness in the epigastric region and mild jaundice. Laboratory tests reveal elevated serum lipase and amylase levels, and an abdominal ultrasound shows peritoneal fluid suggesting pancreatitis.", + "actual_diagnosis": "Acute pancreatitis, ICD-10 code K85.9" + }, + { + "doctor_vignette": "A 72-year-old male presents to the emergency department with palpitations and shortness of breath that began earlier in the day. On examination, his heart rate is irregularly irregular at 130 beats per minute, and he has mild edema in his lower extremities. An ECG reveals atrial fibrillation with a rapid ventricular response, and his electrolytes show a potassium level of 3.2 mEq/L.", + "actual_diagnosis": "Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 24-year-old male presents with auditory hallucinations, reporting that he hears voices telling him to harm himself. On physical examination, he shows signs of disorganized thinking and has difficulty maintaining coherent speech. Routine lab tests, including complete blood count and metabolic panel, are unremarkable, and a CT scan of the head reveals no structural abnormalities.", + "actual_diagnosis": "Schizophrenia, ICD-10 code F20.9" + }, + { + "doctor_vignette": "A 72-year-old female presents with fatigue and weakness for the past few months. On physical examination, she has pale conjunctiva and a heart rate of 92 bpm. Laboratory tests reveal a hemoglobin level of 10.2 g/dL, low serum iron, and normal ferritin levels, suggestive of anemia of chronic disease. A history of rheumatoid arthritis is noted, contributing to her condition.", + "actual_diagnosis": "Anemia due to chronic disease, ICD-10 code D63.8" + }, + { + "doctor_vignette": "A 65-year-old male presents with fatigue and mild edema in the lower extremities. Physical examination reveals elevated blood pressure of 150/90 mmHg and bilateral ankle swelling. Laboratory tests show a serum creatinine level of 2.2 mg/dL and an estimated glomerular filtration rate (eGFR) of 45 mL/min, indicating moderate kidney impairment.", + "actual_diagnosis": "Chronic kidney disease stage 3, ICD-10 code N18.3" + }, + { + "doctor_vignette": "A 10-year-old African American male presents with severe abdominal pain and fatigue after experiencing a recent upper respiratory infection. On examination, he has pallor and tenderness in the right upper quadrant. A complete blood count shows a hemoglobin level of 6.5 g/dL, and peripheral blood smear reveals sickle-shaped red blood cells. The patient also has elevated bilirubin levels, indicating hemolysis.", + "actual_diagnosis": "Sickle cell disease, ICD-10 code D57.9" + }, + { + "doctor_vignette": "A 35-year-old female presents with widespread musculoskeletal pain lasting over six months, accompanied by fatigue and sleep disturbances. On physical exam, tenderness is noted in multiple tender points, particularly in the neck, shoulders, and lower back. Routine lab tests including CBC and metabolic panel show no significant abnormalities, and imaging studies are unremarkable.", + "actual_diagnosis": "Fibromyalgia, ICD-10 code M79.7" + }, + { + "doctor_vignette": "A 24-year-old male presents with a chief complaint of persistent fatigue and night sweats for the past month. Physical examination reveals cervical lymphadenopathy and splenomegaly. A chest X-ray shows mediastinal lymphadenopathy, and a lymph node biopsy confirms the presence of Reed-Sternberg cells.", + "actual_diagnosis": "Hodgkin lymphoma, ICD-10 code C81.90" + }, + { + "doctor_vignette": "A 54-year-old male presents with increased thirst and frequent urination over the past several months. On physical examination, he is overweight with a BMI of 32 and has reduced sensation in his feet. Laboratory tests reveal a fasting blood glucose level of 160 mg/dL and an HbA1c of 7.5%.", + "actual_diagnosis": "Type 2 diabetes mellitus, ICD-10 code E11.9" + }, + { + "doctor_vignette": "A 22-year-old male presents to the emergency department with a chief complaint of severe headache and high fever for the past 24 hours. On physical examination, he exhibits neck stiffness and photophobia. A lumbar puncture reveals cloudy cerebrospinal fluid with a white blood cell count of 1,200 cells/mm\u00b3, predominantly neutrophils, and positive Gram stain for Streptococcus pneumoniae.", + "actual_diagnosis": "Bacterial meningitis, ICD-10 code G00.9" + }, + { + "doctor_vignette": "A 25-year-old female presents to the emergency department with her first seizure episode, characterized by a generalized tonic-clonic seizure lasting approximately two minutes. On physical examination, she is alert but disoriented postictally, with no focal neurological deficits noted. A CT scan of the head shows no acute intracranial abnormalities, and routine blood tests reveal normal electrolytes and glucose levels.", + "actual_diagnosis": "Epilepsy, ICD-10 code G40.909" + }, + { + "doctor_vignette": "A 55-year-old male presents to the emergency department with sudden onset of severe chest pain radiating to the back. On examination, he has a blood pressure differential of 30 mmHg between the arms and a diastolic murmur. Chest X-ray shows a widened mediastinum, and a CT angiogram confirms an aortic dissection extending from the ascending aorta.", + "actual_diagnosis": "Aortic dissection, ICD-10 code I71.0" + }, + { + "doctor_vignette": "A 28-year-old female presents with fatigue and shortness of breath on exertion. Physical examination reveals pale conjunctiva and a heart rate of 110 bpm. Laboratory tests show a hemoglobin level of 9.5 g/dL, low serum ferritin at 10 ng/mL, and elevated total iron-binding capacity (TIBC).", + "actual_diagnosis": "Anemia due to iron deficiency, ICD-10 code D50.9" + }, + { + "doctor_vignette": "A seventeen-year-old female presents with a chief complaint of persistent facial acne for the past six months. Physical examination reveals multiple open and closed comedones, papules, and pustules primarily on the forehead and cheeks, with some scarring noted. No laboratory tests or imaging studies are required for diagnosis, as the condition is clinically evident.", + "actual_diagnosis": "Acne vulgaris, ICD-10 code L70.9" + }, + { + "doctor_vignette": "A 35-year-old female presents with a 6-month history of persistent nasal congestion and facial pressure. Physical examination reveals tenderness over the maxillary sinuses and postnasal drip. A CT scan of the sinuses shows mucosal thickening and obstruction of the ostiomeatal complex. Allergy testing indicates sensitivity to dust mites.", + "actual_diagnosis": "Chronic sinusitis, ICD-10 code J32.9" + }, + { + "doctor_vignette": "A 55-year-old male presents to the clinic with complaints of frequent headaches and dizziness. On physical examination, his blood pressure is recorded at 160/100 mmHg, and he exhibits mild bilateral retinal changes. Laboratory tests reveal an elevated serum creatinine level of 1.5 mg/dL, indicating possible kidney involvement due to hypertension.", + "actual_diagnosis": "Hypertension, ICD-10 code I10" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of cough and shortness of breath for the past three days. Upon examination, she exhibits decreased breath sounds and crackles in the right lower lung field. A chest X-ray reveals a right lower lobe infiltrate consistent with pneumonia. Blood tests show elevated white blood cell count and CRP levels, indicating infection.", + "actual_diagnosis": "Pneumonia, unspecified organism, ICD-10 code J18.9" + }, + { + "doctor_vignette": "A 67-year-old male presents with a chief complaint of increasing shortness of breath and a chronic cough producing sputum for the past year. Physical examination reveals wheezing, decreased breath sounds bilaterally, and use of accessory muscles during respiration. A chest X-ray shows hyperinflation of the lungs, and pulmonary function tests indicate an FEV1/FVC ratio of 0.58, consistent with obstructive lung disease.", + "actual_diagnosis": "Chronic obstructive pulmonary disease (COPD), ICD-10 code J44.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of persistent knee pain, especially after prolonged walking or standing. On physical examination, there is notable crepitus and tenderness along the medial joint line of the right knee, with a reduced range of motion. X-rays reveal joint space narrowing and osteophyte formation, consistent with osteoarthritis.", + "actual_diagnosis": "Osteoarthritis of the knee, ICD-10 code M17.9" + }, + { + "doctor_vignette": "A 32-year-old male presents with a chief complaint of itchy, red patches on his elbows and knees that have persisted for several months. On physical examination, erythematous plaques with silvery scales are noted on extensor surfaces, and there is evidence of nail pitting. No significant lab tests are required for diagnosis, but a skin biopsy reveals hyperkeratosis and acanthosis, consistent with psoriasis.", + "actual_diagnosis": "Psoriasis vulgaris, ICD-10 code L40.0" + }, + { + "doctor_vignette": "A 45-year-old female presents with progressive unilateral hearing loss in the right ear over the past six months, accompanied by occasional tinnitus. On physical examination, there is a diminished response to auditory stimuli on the right side. MRI of the brain reveals a 2.5 cm mass at the cerebellopontine angle consistent with an acoustic neuroma.", + "actual_diagnosis": "Acoustic neuroma, ICD-10 code D33.3" + }, + { + "doctor_vignette": "A 58-year-old female presents with severe, sharp facial pain along the right side of her face, described as electric shocks triggered by light touch. Physical examination reveals tenderness over the right trigeminal nerve distribution with no neurological deficits. MRI of the brain shows a neurovascular conflict at the root entry zone of the right trigeminal nerve.", + "actual_diagnosis": "Trigeminal neuralgia, ICD-10 code G50.0" + }, + { + "doctor_vignette": "A 4-year-old male presents with a 5-day history of high fever, conjunctival injection, and a rash on his torso. On examination, he has cracked lips, strawberry tongue, and cervical lymphadenopathy. Laboratory tests reveal elevated inflammatory markers, including a significantly elevated ESR and CRP, along with thrombocytosis.", + "actual_diagnosis": "Kawasaki disease, ICD-10 code I72.9" + }, + { + "doctor_vignette": "A 24-year-old female presents with joint hypermobility and recurrent joint dislocations, particularly in the shoulders and knees. Physical examination reveals skin that is velvety and hyper-elastic, along with bruising easily. Genetic testing confirms the presence of pathogenic variants in the COL5A1 gene, consistent with Ehlers-Danlos syndrome.", + "actual_diagnosis": "Ehlers-Danlos syndrome, ICD-10 code Q79.6" + }, + { + "doctor_vignette": "An 8-year-old male presents with progressive muscle weakness and difficulty climbing stairs. Physical examination reveals waddling gait, calf hypertrophy, and positive Gowers' sign. Serum creatine kinase levels are markedly elevated at 12,000 U/L, and genetic testing confirms the presence of mutations in the dystrophin gene.", + "actual_diagnosis": "Duchenne muscular dystrophy, ICD-10 code G71.0" + }, + { + "doctor_vignette": "A 35-year-old male from rural South America presents with persistent fatigue and mild chest pain. Physical examination reveals mild edema in the lower extremities and a heart rate of 110 bpm. An ECG shows signs of right bundle branch block, and serologic tests are positive for Trypanosoma cruzi antibodies, confirming the diagnosis.", + "actual_diagnosis": "Chagas disease, ICD-10 code B57.0" + }, + { + "doctor_vignette": "A 5-year-old male presents with developmental delay and seizures. On physical examination, he has facial angiofibromas and a hypopigmented macule on his left arm. MRI of the brain reveals multiple cortical tubers and subependymal nodules, consistent with the diagnosis.", + "actual_diagnosis": "Tuberous sclerosis, ICD-10 code Q85.1" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of extreme mood swings over the past six months, including episodes of elevated energy and decreased need for sleep followed by periods of severe depression. Physical examination reveals a labile affect, with inappropriate laughter during the interview and a flat mood during depressive phases. No critical lab or imaging results are necessary for this diagnosis, as the evaluation is primarily clinical based on symptomatology.", + "actual_diagnosis": "Bipolar disorder, ICD-10 code F31.9" + }, + { + "doctor_vignette": "A 67-year-old male presents with progressive dyspnea and a persistent dry cough over the past six months. On physical examination, fine crackles are auscultated at the bases of the lungs, and there is clubbing of the fingers. High-resolution computed tomography (HRCT) of the chest reveals reticular patterns and honeycombing consistent with interstitial lung disease.", + "actual_diagnosis": "Idiopathic pulmonary fibrosis, ICD-10 code J84.112" + }, + { + "doctor_vignette": "A 45-year-old male presents with complaints of enlarged hands and feet over the past several years, along with facial changes including a protruding jaw and enlarged nose. Physical examination reveals coarse facial features, increased spacing between teeth, and a glove size increase from large to extra-large. Serum insulin-like growth factor 1 (IGF-1) levels are markedly elevated, and an MRI of the pituitary gland shows a 2 cm adenoma.", + "actual_diagnosis": "Acromegaly, ICD-10 code E22.0" + }, + { + "doctor_vignette": "A 15-year-old male presents with progressive fatigue, tremors, and personality changes over the past few months. Physical examination reveals Kayser-Fleischer rings in the cornea and a liver enlargement. Serum ceruloplasmin is significantly low at 10 mg/dL, and 24-hour urinary copper excretion is elevated at 500 mcg.", + "actual_diagnosis": "Wilson's disease, ICD-10 code E83.0" + }, + { + "doctor_vignette": "A 28-year-old female presents with double vision and persistent muscle weakness, especially in her arms and legs that worsens with activity. On physical examination, she demonstrates ptosis and increased fatigue after prolonged eye closure. Repetitive nerve stimulation shows a decremental response, and acetylcholine receptor antibodies are positive.", + "actual_diagnosis": "Myasthenia gravis, ICD-10 code G70.0" + }, + { + "doctor_vignette": "A 22-year-old male presents to the emergency department with a chief complaint of severe right lower quadrant abdominal pain that began 12 hours ago. On physical examination, he has tenderness at McBurney's point and rebound tenderness is noted. A CT scan of the abdomen reveals an enlarged, non-complex appendix with surrounding inflammatory changes.", + "actual_diagnosis": "1. Acute appendicitis, ICD-10 code K35.2" + }, + { + "doctor_vignette": "A 28-year-old female presents with recurrent episodes of blurred vision and right-sided weakness. Neurological examination reveals decreased sensation in the right arm and a positive Babinski sign on the right side. MRI of the brain shows multiple periventricular white matter lesions consistent with demyelination.", + "actual_diagnosis": "3. Multiple sclerosis, ICD-10 code G35" + }, + { + "doctor_vignette": "A 30-year-old female presents with muscle cramps and tingling in her fingers. On physical exam, she exhibits Chvostek's sign and Trousseau's sign. Laboratory tests reveal low serum calcium levels (6.5 mg/dL) and elevated phosphate levels (5.5 mg/dL).", + "actual_diagnosis": "Hypoparathyroidism, ICD-10 code E20.9" + }, + { + "doctor_vignette": "A 65-year-old female presents to the emergency department with sudden onset shortness of breath and chest pain that worsens with deep breathing. On examination, she is tachypneic with decreased breath sounds on the right side and exhibits unilateral leg swelling. A CT pulmonary angiogram reveals a large pulmonary embolism in the right main pulmonary artery.", + "actual_diagnosis": "2. Pulmonary embolism, ICD-10 code I26.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with fatigue and decreased appetite over the past few months. On physical examination, he has bilateral lower extremity edema and a blood pressure of 150/90 mmHg. Laboratory tests reveal a serum creatinine level of 2.1 mg/dL and a glomerular filtration rate (GFR) of 45 mL/min, indicating chronic kidney impairment.", + "actual_diagnosis": "4. Chronic kidney disease, ICD-10 code N18.9" + }, + { + "doctor_vignette": "A 54-year-old male presents with complaints of persistent headaches and occasional dizziness. On physical examination, his blood pressure is measured at 160/100 mmHg, and he exhibits mild bilateral edema in the lower extremities. Laboratory tests show normal renal function and no evidence of secondary causes of hypertension.", + "actual_diagnosis": "5. Hypertension, ICD-10 code I10" + }, + { + "doctor_vignette": "A 28-year-old female presents with chronic diarrhea and abdominal bloating for the past six months. On physical examination, she has noticeable weight loss and signs of malnutrition, including dry skin and hair loss. Serological tests reveal elevated levels of tissue transglutaminase antibodies (tTG-IgA), confirming the diagnosis.", + "actual_diagnosis": "6. Celiac disease, ICD-10 code K90.0" + }, + { + "doctor_vignette": "A 68-year-old female presents with a chief complaint of persistent lower back pain that worsens with standing. On physical exam, she has a height loss of 3 cm compared to her previous records and exhibits tenderness over the lumbar spine. A DEXA scan reveals a T-score of -2.8 in the lumbar spine, indicating osteoporosis.", + "actual_diagnosis": "8. Osteoporosis, ICD-10 code M81.0" + }, + { + "doctor_vignette": "A 72-year-old male presents to the emergency department with palpitations and shortness of breath. Physical examination reveals an irregularly irregular pulse and elevated blood pressure of 160/95 mmHg. An EKG shows rapid atrial fibrillation with a ventricular rate of 120 bpm. Laboratory tests indicate elevated levels of B-type natriuretic peptide (BNP) at 500 pg/mL, suggesting heart strain.", + "actual_diagnosis": "7. Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 28-year-old woman presents with a chief complaint of persistent joint pain and fatigue for the past three months. On physical examination, she has a malar rash, oral ulcers, and swelling in her wrists and knees. Laboratory tests reveal positive antinuclear antibodies (ANA) and low complement levels, supporting the diagnosis.", + "actual_diagnosis": "9. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 32-year-old female presents with palpitations, weight loss despite increased appetite, and heat intolerance. On physical examination, she exhibits a fine tremor, tachycardia, and a diffusely enlarged thyroid gland. Laboratory tests reveal suppressed TSH levels with elevated free T4 and T3.", + "actual_diagnosis": "10. Hyperthyroidism, ICD-10 code E05.9" + }, + { + "doctor_vignette": "A 10-year-old male presents with a chief complaint of wheezing and shortness of breath, particularly at night and during physical activity. On physical examination, he exhibits prolonged expiratory phase and bilateral wheezing. A peak flow measurement reveals 60% of his personal best, indicating significant obstruction. No recent infections or other respiratory illnesses were noted, and chest X-ray shows hyperinflation consistent with asthma.", + "actual_diagnosis": "11. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 54-year-old male presents with increased thirst and frequent urination over the past few months. Physical examination reveals a BMI of 32, blood pressure of 140/85 mmHg, and diminished sensation in the feet. Laboratory results show a fasting blood glucose level of 180 mg/dL and an HbA1c of 8.2%.", + "actual_diagnosis": "13. Type 2 diabetes mellitus, ICD-10 code E11.9" + }, + { + "doctor_vignette": "A 62-year-old male presents to the emergency department with chest pain radiating to his left arm, which started 30 minutes ago. On examination, he is diaphoretic, with a blood pressure of 90/60 mmHg and heart rate of 110 bpm. ECG shows ST-segment elevation in leads II, III, and aVF, and cardiac troponin levels are markedly elevated. ", + "actual_diagnosis": "14. Acute myocardial infarction, ICD-10 code I21.9" + }, + { + "doctor_vignette": "A 54-year-old female presents with a chief complaint of morning stiffness lasting over an hour, affecting her hands and wrists. Physical examination reveals symmetrical swelling and tenderness in the metacarpophalangeal joints, as well as decreased grip strength. Laboratory tests show a positive rheumatoid factor and elevated anti-CCP antibodies, along with an ESR of 45 mm/hr.", + "actual_diagnosis": "12. Rheumatoid arthritis, ICD-10 code M06.9" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of tremors in his right hand that have progressively worsened over the past six months. Physical examination reveals bradykinesia, rigidity in the upper extremities, and a shuffling gait. A dopamine transporter (DAT) scan shows reduced uptake in the putamen, consistent with Parkinson's disease.", + "actual_diagnosis": "15. Parkinson's disease, ICD-10 code G20" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of persistent, itchy red patches on her elbows and knees that have been worsening over the past month. Physical examination reveals well-defined, erythematous plaques covered with silvery scales on extensor surfaces and a few lesions on her scalp. No significant laboratory findings are noted, but a skin biopsy confirms the diagnosis of psoriasis.", + "actual_diagnosis": "16. Psoriasis, ICD-10 code L40.9" + }, + { + "doctor_vignette": "A 16-year-old female presents to the emergency department with a chief complaint of recurrent seizures over the past month. Physical examination reveals postictal confusion and no focal neurological deficits. An EEG shows generalized spike-and-wave discharges, consistent with epilepsy. MRI of the brain is unremarkable, ruling out structural causes.", + "actual_diagnosis": "17. Epilepsy, ICD-10 code G40.909" + }, + { + "doctor_vignette": "A 32-year-old female presents with widespread musculoskeletal pain lasting for over three months, accompanied by fatigue and sleep disturbances. Physical examination reveals tenderness in multiple trigger points, including the neck, shoulders, and lower back. Routine lab tests, including CBC and thyroid function, are unremarkable, and no imaging studies show structural abnormalities.", + "actual_diagnosis": "19. Fibromyalgia, ICD-10 code M79.7" + }, + { + "doctor_vignette": "A 62-year-old male presents with gradually worsening peripheral vision over the last six months. On examination, intraocular pressure is measured at 24 mmHg in both eyes, and a visual field test reveals significant loss in the peripheral fields. Fundoscopic examination shows optic nerve cupping consistent with glaucoma.", + "actual_diagnosis": "18. Glaucoma, ICD-10 code H40.9" + }, + { + "doctor_vignette": "An 8-year-old male presents with fatigue and pallor over the past month. Physical examination reveals significant splenomegaly and petechiae on the skin. Complete blood count shows leukocytosis with a high percentage of blast cells, along with low hemoglobin and platelets.", + "actual_diagnosis": "Acute lymphoblastic leukemia, ICD-10 code C91.0" + }, + { + "doctor_vignette": "A 30-year-old female presents with a chief complaint of palpitations and unintentional weight loss over the past month. On physical examination, she exhibits a fine tremor, increased heart rate of 110 beats per minute, and a noticeable goiter. Thyroid function tests reveal a suppressed TSH level and elevated free T4 levels, confirming a diagnosis of hyperthyroidism.", + "actual_diagnosis": "Hyperthyroidism, ICD-10 code E05.9" + }, + { + "doctor_vignette": "A 12-year-old African American male presents with severe abdominal pain and fatigue. On physical examination, he has pale conjunctiva and splenomegaly. A complete blood count reveals hemoglobin levels of 6.5 g/dL with a high reticulocyte count, and a peripheral blood smear shows sickle-shaped red blood cells.", + "actual_diagnosis": "Sickle cell disease, ICD-10 code D57.1" + }, + { + "doctor_vignette": "A 32-year-old male presents with a persistent cough lasting three weeks, accompanied by night sweats and weight loss. On physical examination, there are decreased breath sounds and dullness to percussion on the right lower lung field. A chest X-ray reveals a right upper lobe infiltrate with cavitation, and sputum analysis shows acid-fast bacilli.", + "actual_diagnosis": "Tuberculosis, ICD-10 code A15.9" + }, + { + "doctor_vignette": "A 67-year-old male presents with progressive shortness of breath and a persistent dry cough over the past six months. On physical examination, there are fine inspiratory crackles noted bilaterally, and clubbing of the fingers is observed. A high-resolution CT scan of the chest reveals reticular opacities and honeycombing consistent with interstitial lung disease.", + "actual_diagnosis": "Pulmonary fibrosis, ICD-10 code J84.10" + }, + { + "doctor_vignette": "A 12-year-old male presents with recurrent joint swelling and pain in his left knee after playing soccer. On physical examination, there is significant swelling and tenderness in the left knee joint, with a range of motion limited by pain. Lab tests reveal aPTT of 60 seconds (normal 30-40 seconds) and a normal PT, indicating a clotting factor deficiency. Genetic testing confirms a mutation in the F8 gene, consistent with Hemophilia A.", + "actual_diagnosis": "20. Hemophilia A, ICD-10 code D66" + }, + { + "doctor_vignette": "A 62-year-old male presents with chest pain and exertional dyspnea. On physical examination, he has a blood pressure of 140/90 mmHg, elevated BMI, and a third heart sound (S3) is noted. An ECG shows ST-segment depression, and a subsequent coronary angiogram reveals significant stenosis in the left anterior descending artery.", + "actual_diagnosis": "Coronary artery disease, ICD-10 code I25.10" + }, + { + "doctor_vignette": "A 25-year-old female presents to the emergency department after ingesting a peanut butter cookie, complaining of difficulty breathing and swelling of the lips. On examination, she has hives covering her arms and torso, and her vital signs show hypotension with a blood pressure of 80/50 mmHg. A rapid response team notes significant bronchospasm on auscultation, and her oxygen saturation is at 85%.", + "actual_diagnosis": "Anaphylaxis, ICD-10 code T78.2" + }, + { + "doctor_vignette": "A 22-year-old male presents to the emergency department with a chief complaint of severe headache and fever. On examination, he exhibits neck stiffness, photophobia, and a positive Brudzinski's sign. A lumbar puncture reveals cloudy cerebrospinal fluid with an elevated white blood cell count, predominantly neutrophils, and a positive Gram stain for Streptococcus pneumoniae.", + "actual_diagnosis": "Bacterial meningitis, ICD-10 code A39.9" + }, + { + "doctor_vignette": "A 58-year-old male presents with increased thirst and frequent urination over the past month. Physical examination reveals a BMI of 32, and blood pressure is 145/90 mmHg. Laboratory tests show a fasting blood glucose level of 180 mg/dL and HbA1c of 8.5%.", + "actual_diagnosis": "Diabetes mellitus type 2, ICD-10 code E11.9" + }, + { + "doctor_vignette": "A 68-year-old male presents with persistent bone pain and fatigue over the past three months. On examination, he has notable tenderness in the lumbar region and pallor. Laboratory tests reveal a serum protein electrophoresis showing monoclonal spike (M-protein) and elevated serum creatinine levels. A skeletal survey demonstrates lytic bone lesions in the vertebrae.", + "actual_diagnosis": "Multiple myeloma, ICD-10 code C90.0" + }, + { + "doctor_vignette": "A 45-year-old male presents with a chief complaint of persistent heartburn and regurgitation after meals for the past three months. On physical examination, he is overweight with tenderness in the epigastric region but no rebound tenderness. An upper gastrointestinal endoscopy reveals moderate esophagitis, consistent with acid reflux disease.", + "actual_diagnosis": "Acid reflux disease, ICD-10 code K21.9" + }, + { + "doctor_vignette": "A 45-year-old male presents with worsening asthma and new-onset purpura on his lower extremities. Physical examination reveals wheezing, nasal polyps, and tender subcutaneous nodules. Laboratory tests show eosinophilia and elevated ANCA (anti-neutrophil cytoplasmic antibodies) levels. A chest CT scan reveals bilateral pulmonary infiltrates.", + "actual_diagnosis": "Churg-Strauss syndrome, ICD-10 code M30.1" + }, + { + "doctor_vignette": "A 72-year-old male presents with progressive memory loss and visual hallucinations, stating he frequently sees animals in his home. Physical examination reveals a shuffling gait and mild rigidity in the arms. Neuroimaging shows diffuse cortical atrophy with prominent changes in the occipital lobe. Cognitive testing indicates impaired executive function and attention.", + "actual_diagnosis": "Dementia with Lewy bodies, ICD-10 code G31.83" + }, + { + "doctor_vignette": "A 24-year-old female with a history of type 1 diabetes presents with abdominal pain, nausea, and excessive thirst. On exam, she is tachycardic, has dry mucous membranes, and her breath has a fruity odor. Lab results reveal a blood glucose level of 450 mg/dL, arterial blood gas shows metabolic acidosis with a pH of 7.2, and urine analysis is positive for ketones.", + "actual_diagnosis": "Diabetic ketoacidosis, ICD-10 code E11.10" + }, + { + "doctor_vignette": "A 10-year-old male presents with difficulties in social interactions and a strong focus on collecting train schedules. Physical examination reveals normal growth parameters and no neurological deficits, but he avoids eye contact and struggles with understanding social cues. There are no significant lab or imaging findings, but a detailed developmental history indicates delayed social milestones.", + "actual_diagnosis": "Asperger syndrome, ICD-10 code F84.5" + }, + { + "doctor_vignette": "A 62-year-old female presents with a chief complaint of swelling and pain in her right leg that developed over the past three days. On physical examination, there is notable unilateral edema in the right calf, with tenderness upon palpation and a positive Homan's sign. A Doppler ultrasound reveals a thrombus in the right popliteal vein, confirming the suspicion of deep vein thrombosis.", + "actual_diagnosis": "Deep vein thrombosis, ICD-10 code I82.90" + }, + { + "doctor_vignette": "A 34-year-old male presents with progressive weakness in both legs over the past week, accompanied by tingling sensations and difficulty walking. On examination, he shows reduced deep tendon reflexes and ascending muscle weakness. Nerve conduction studies reveal significantly reduced motor nerve conduction velocities, and lumbar puncture indicates elevated protein levels with normal white cell counts in the cerebrospinal fluid.", + "actual_diagnosis": "Guillain-Barr\u00e9 syndrome, ICD-10 code G61.0" + }, + { + "doctor_vignette": "A 62-year-old male presents with acute left lower abdominal pain and fever. Physical examination reveals tenderness in the left lower quadrant with rebound tenderness and mild guarding. A CT scan of the abdomen shows inflamed diverticula in the sigmoid colon without abscess formation. Laboratory tests reveal leukocytosis with a white blood cell count of 14,000 cells/mm\u00b3.", + "actual_diagnosis": "Diverticulitis, ICD-10 code K57.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with severe pelvic pain and dysmenorrhea that has worsened over the past year. On physical examination, there is tenderness in the posterior fornix and adnexal tenderness bilaterally. Transvaginal ultrasound reveals cystic lesions on the ovaries consistent with endometriomas. A pelvic MRI confirms the presence of endometrial tissue outside the uterus.", + "actual_diagnosis": "Endometriosis, ICD-10 code N80.9" + }, + { + "doctor_vignette": "A 16-year-old female presents with complaints of inflamed, painful pimples on her face and back that have worsened over the past six months. On physical examination, multiple comedones, papules, and pustules are noted on the forehead, cheeks, and upper back. There are no significant lab or imaging results required for diagnosis as this condition is typically diagnosed clinically.", + "actual_diagnosis": "Acne vulgaris, ICD-10 code L70.0" + }, + { + "doctor_vignette": "A 65-year-old male presents with a chief complaint of persistent dry cough and progressive shortness of breath over the past six months. On physical examination, bibasilar crackles are noted upon auscultation, and the patient demonstrates clubbing of the fingers. A chest CT scan reveals ground-glass opacities and reticular patterns consistent with interstitial lung disease.", + "actual_diagnosis": "Interstitial lung disease, ICD-10 code J84.9" + }, + { + "doctor_vignette": "A 75-year-old female presents with progressive memory loss and difficulty performing daily tasks over the past year. On physical exam, she exhibits disorientation to time and place, and her Mini-Mental State Examination score is 22/30. MRI of the brain shows bilateral hippocampal atrophy, consistent with Alzheimer's disease.", + "actual_diagnosis": "Dementia due to Alzheimer's disease, ICD-10 code G30.9" + }, + { + "doctor_vignette": "A 68-year-old female presents to the emergency department with a chief complaint of high fever and confusion for the past 24 hours. On examination, she is tachycardic, hypotensive, and exhibits altered mental status. Laboratory results show elevated white blood cell count (18,000 cells/mm\u00b3) and a positive blood culture for E. coli.", + "actual_diagnosis": "Sepsis, ICD-10 code A41.9" + }, + { + "doctor_vignette": "A 27-year-old female presents with a chief complaint of abnormal vaginal discharge that has a fishy odor, particularly after intercourse. On physical examination, there is a thin, grayish discharge observed with a pH of 5.5 and a positive whiff test. Microscopic examination of the discharge reveals a significant presence of clue cells and a decrease in lactobacilli.", + "actual_diagnosis": "Bacterial vaginosis, ICD-10 code N76.0" + }, + { + "doctor_vignette": "A 55-year-old male presents with excessive daytime sleepiness and loud snoring reported by his partner. On physical examination, he has a body mass index (BMI) of 32, enlarged tonsils, and a crowded oropharynx. A sleep study reveals multiple episodes of apnea and hypopnea, confirming the diagnosis.", + "actual_diagnosis": "Obstructive sleep apnea, ICD-10 code G47.33" + }, + { + "doctor_vignette": "A 35-year-old male from rural South America presents with fatigue, fever, and swollen lymph nodes. Physical examination reveals conjunctivitis and a notable cardiomegaly on chest X-ray. Serology testing shows positive results for Trypanosoma cruzi antibodies.", + "actual_diagnosis": "Chagas disease, ICD-10 code B57.9" + }, + { + "doctor_vignette": "A 12-year-old male presents with a chief complaint of excessive thirst and frequent urination over the past month. Physical exam reveals signs of dehydration, including dry mucous membranes and decreased skin turgor. Critical lab results show a fasting blood glucose level of 250 mg/dL and the presence of ketones in the urine.", + "actual_diagnosis": "Diabetes mellitus type 1, ICD-10 code E10.9" + }, + { + "doctor_vignette": "A 27-year-old female presents with fatigue and shortness of breath on exertion. On physical examination, she has pale conjunctiva and tachycardia. Laboratory tests reveal a hemoglobin level of 9.5 g/dL, a mean corpuscular volume of 70 fL, and low serum ferritin levels.", + "actual_diagnosis": "Iron deficiency anemia, ICD-10 code D50.9" + }, + { + "doctor_vignette": "A 62-year-old male presents with chest pain and shortness of breath on exertion. Physical examination reveals elevated blood pressure of 160/100 mmHg and bilateral pitting edema in the lower extremities. An echocardiogram shows left ventricular hypertrophy and reduced ejection fraction. Laboratory tests indicate elevated B-type natriuretic peptide (BNP) levels.", + "actual_diagnosis": "Hypertensive heart disease, ICD-10 code I11.9" + }, + { + "doctor_vignette": "A 7-year-old male presents with developmental delays and learning difficulties. On physical examination, he exhibits a long face, large ears, and hyperflexible joints. Genetic testing reveals a CGG repeat expansion in the FMR1 gene, consistent with Fragile X syndrome.", + "actual_diagnosis": "Fragile X syndrome, ICD-10 code F84.81" + }, + { + "doctor_vignette": "A 4-year-old male presents with a 5-day history of fever, irritability, and a rash. On physical examination, he has conjunctival injection, strawberry tongue, and cervical lymphadenopathy. Laboratory tests reveal elevated inflammatory markers, including an increased C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).", + "actual_diagnosis": "Kawasaki disease, ICD-10 code I38" + }, + { + "doctor_vignette": "A 28-year-old male presents with chronic low back pain and stiffness that improves with activity but worsens during rest. Physical examination reveals limited lumbar flexion and tenderness over the sacroiliac joints. X-rays show bilateral sacroiliitis, and HLA-B27 testing is positive.", + "actual_diagnosis": "Ankylosing spondylitis, ICD-10 code M45.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of persistent fatigue and joint pain, particularly in her wrists and knees. On examination, she has palpable purpura on her lower extremities and mild edema. Laboratory tests reveal elevated ESR and CRP levels, alongside a positive ANCA test. Imaging studies show no evidence of vascular occlusion but suggest inflammation in the surrounding tissues.", + "actual_diagnosis": "Vasculitis, unspecified, ICD-10 code M31.9" + }, + { + "doctor_vignette": "A 45-year-old woman presents with progressive shortness of breath on exertion and fatigue over the past six months. Physical examination reveals a loud P2 heart sound and peripheral edema. Echocardiography shows an estimated right ventricular systolic pressure of 45 mmHg, indicating elevated pulmonary artery pressure. A chest CT scan shows no significant pulmonary embolism, but mild enlargement of the right ventricle is noted.", + "actual_diagnosis": "Pulmonary hypertension, ICD-10 code I27.0" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of recurrent severe headaches lasting 4 to 72 hours. Physical examination reveals tenderness in the pericranial muscles and normal neurological findings. No abnormalities are found in routine lab tests or brain imaging, which shows no acute changes.", + "actual_diagnosis": "Migraine without aura, ICD-10 code G43.009" + }, + { + "doctor_vignette": "A 45-year-old female presents with complaints of persistent skin tightening and difficulty swallowing. On physical exam, she exhibits thickened skin on her fingers and face, along with Raynaud's phenomenon. Laboratory tests reveal elevated anti-Scl-70 antibodies and pulmonary function tests indicate mild restrictive lung disease.", + "actual_diagnosis": "Scleroderma, ICD-10 code M34.9" + }, + { + "doctor_vignette": "A 26-year-old female presents with recurrent painful nodules and abscesses in the axillary and groin areas over the past year. Physical examination reveals multiple draining sinuses, scarring, and inflammatory lesions in these regions. No laboratory abnormalities are noted, and imaging studies show subcutaneous inflammation without abscess formation.", + "actual_diagnosis": "Hidradenitis suppurativa, ICD-10 code L73.2" + }, + { + "doctor_vignette": "A 45-year-old female presents with a palpable, painless nodule on the right side of her neck that has gradually increased in size over the past six months. Physical examination reveals a firm, non-tender mass in the right thyroid lobe, with no cervical lymphadenopathy noted. Ultrasound shows a solid, hypoechoic lesion measuring 2.5 cm with irregular margins, and fine needle aspiration cytology indicates suspicious for malignancy.", + "actual_diagnosis": "Thyroid cancer, ICD-10 code C73" + }, + { + "doctor_vignette": "A 24-year-old male presents with infertility and decreased libido. On physical examination, he is noted to have tall stature, gynecomastia, and reduced muscle mass. Laboratory tests reveal elevated serum estradiol levels and low testosterone levels, while karyotyping shows 47,XXY chromosomes.", + "actual_diagnosis": "Klinefelter syndrome, ICD-10 code Q98.1" + }, + { + "doctor_vignette": "A 45-year-old female presents with worsening muscle weakness, particularly in her eyelids and limbs, over the past month. On physical examination, she exhibits ptosis and significant fatigability with repetitive testing of the upper extremities. Serological testing reveals elevated acetylcholine receptor antibodies, supporting the diagnosis.", + "actual_diagnosis": "Myasthenia gravis, ICD-10 code G70.00" + }, + { + "doctor_vignette": "A 65-year-old male presents with fatigue, recurrent fevers, and easy bruising over the past month. Physical examination reveals pallor, petechiae on the lower extremities, and splenomegaly. Complete blood count shows a white blood cell count of 45,000/\u00b5L with 60% myeloblasts, hemoglobin of 8 g/dL, and platelet count of 30,000/\u00b5L.", + "actual_diagnosis": "Acute myeloid leukemia, ICD-10 code C92.00" + }, + { + "doctor_vignette": "A 12-year-old male presents with excessive thirst, frequent urination, and unintentional weight loss over the past month. On physical examination, he is noted to have dry mucous membranes and a fruity odor on his breath. Critical lab results show a fasting blood glucose level of 250 mg/dL and an HbA1c of 10.5%.", + "actual_diagnosis": "4. Type 1 diabetes mellitus, ICD-10 code E10.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with fatigue, joint pain, and a butterfly-shaped rash across her cheeks. On examination, there is tenderness and swelling in multiple joints, particularly the wrists and knees. Laboratory tests reveal a positive antinuclear antibody (ANA) test and low complement levels, consistent with an autoimmune process.", + "actual_diagnosis": "7. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 67-year-old female presents with a chief complaint of worsening knee pain, particularly after prolonged standing and walking. On physical examination, there is noticeable crepitus, joint tenderness, and a decreased range of motion in the right knee. X-rays reveal joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "6. Osteoarthritis of the knee, ICD-10 code M17.9" + }, + { + "doctor_vignette": "A 54-year-old male presents with complaints of persistent headaches and dizziness over the past month. On physical examination, his blood pressure is found to be 160/98 mmHg, with a notable finding of mild obesity. Routine laboratory tests show elevated serum creatinine levels at 1.4 mg/dL, suggesting possible kidney dysfunction related to hypertension.", + "actual_diagnosis": "9. Hypertension, ICD-10 code I10" + }, + { + "doctor_vignette": "A 75-year-old male presents to the emergency department with palpitations and shortness of breath that began suddenly two hours ago. On examination, his heart rate is irregularly irregular at 120 beats per minute, and he has mild edema in his lower extremities. An electrocardiogram shows atrial fibrillation with a rapid ventricular response. Basic labs reveal an elevated B-type natriuretic peptide (BNP) level, indicating heart failure.", + "actual_diagnosis": "5. Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of persistent cough and shortness of breath, worsening over the last six months. Physical examination reveals wheezing, decreased breath sounds bilaterally, and a prolonged expiratory phase. A chest X-ray shows hyperinflation of the lungs, and spirometry indicates an FEV1/FVC ratio of 0.55, confirming airflow limitation.", + "actual_diagnosis": "8. Chronic obstructive pulmonary disease, ICD-10 code J44.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with chronic diarrhea and abdominal bloating for the past six months. Physical examination reveals mild abdominal distension and tenderness in the left lower quadrant. Laboratory tests show positive tissue transglutaminase (tTG) antibodies and a low hemoglobin level indicating anemia.", + "actual_diagnosis": "11. Celiac disease, ICD-10 code K90.0" + }, + { + "doctor_vignette": "A 55-year-old male presents with a chief complaint of severe pain and swelling in his right big toe, which started suddenly last night. On physical examination, the affected joint is erythematous, warm, and tender to touch, with a limited range of motion. Serum uric acid levels are found to be elevated at 8.5 mg/dL, confirming the suspicion of gout.", + "actual_diagnosis": "14. Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "A 72-year-old female presents with worsening shortness of breath and fatigue over the past month. Physical examination reveals bilateral lower extremity edema, an elevated jugular venous pressure, and crackles on lung auscultation. A chest X-ray shows cardiomegaly and pulmonary congestion, while laboratory tests reveal elevated B-type natriuretic peptide (BNP) levels.", + "actual_diagnosis": "10. Congestive heart failure, ICD-10 code I50.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of itchy, scaly patches on her elbows and knees that have worsened over the past month. On physical examination, there are well-defined, erythematous plaques covered with silvery scales on the extensor surfaces. No significant laboratory abnormalities were noted, and a skin biopsy confirms the presence of psoriatic changes.", + "actual_diagnosis": "12. Psoriasis, ICD-10 code L40.9" + }, + { + "doctor_vignette": "A 45-year-old male presents with severe epigastric pain radiating to the back, accompanied by nausea and vomiting. On physical examination, he exhibits tenderness in the upper abdomen and a slightly elevated heart rate. Laboratory tests reveal elevated serum lipase and amylase levels, while an abdominal ultrasound shows peritoneal fluid and an enlarged pancreas.", + "actual_diagnosis": "13. Acute pancreatitis, ICD-10 code K85.9" + }, + { + "doctor_vignette": "A 32-year-old female presents with a chief complaint of unintentional weight loss and palpitations over the past month. Physical examination reveals a finely tremulous hand, moist skin, and a markedly enlarged thyroid gland (goiter). Laboratory tests show elevated free T4 and suppressed TSH levels, indicating hyperthyroidism.", + "actual_diagnosis": "15. Hyperthyroidism, ICD-10 code E05.90" + }, + { + "doctor_vignette": "A 45-year-old female presents with recurrent episodes of vertigo lasting 20-30 minutes, accompanied by tinnitus and a sensation of fullness in her left ear. On physical examination, she demonstrates nystagmus during the episodes and reports fluctuating hearing loss in the affected ear. An audiogram reveals low-frequency hearing loss consistent with endolymphatic hydrops, while MRI of the brain shows no other abnormalities.", + "actual_diagnosis": "16. M\u00e9ni\u00e8re's disease, ICD-10 code H81.0" + }, + { + "doctor_vignette": "A 68-year-old male presents with fatigue and weakness over the past month. Physical examination reveals pallor and mild splenomegaly. Laboratory tests show a hemoglobin level of 10 g/dL, elevated C-reactive protein, and low serum iron with normal ferritin levels, indicating anemia of chronic disease.", + "actual_diagnosis": "17. Anemia due to chronic disease, ICD-10 code D63.8" + }, + { + "doctor_vignette": "A 35-year-old female presents with widespread musculoskeletal pain lasting for more than three months, accompanied by fatigue and sleep disturbances. Physical examination reveals tenderness in multiple trigger points and a reduced range of motion in her shoulders and hips. Laboratory tests, including complete blood count and inflammatory markers, return normal, ruling out other conditions.", + "actual_diagnosis": "18. Fibromyalgia, ICD-10 code M79.7" + }, + { + "doctor_vignette": "A 12-year-old African American male presents to the emergency department with severe abdominal pain and fatigue. Physical examination reveals pallor, jaundice, and splenomegaly. Laboratory tests show a hemoglobin level of 6.5 g/dL, elevated reticulocyte count, and peripheral blood smear reveals sickle-shaped red blood cells.", + "actual_diagnosis": "20. Sickle cell disease, ICD-10 code D57.1" + }, + { + "doctor_vignette": "A 67-year-old female presents with a complaint of persistent lower back pain that has worsened over the past month. Physical examination reveals a decrease in height and a kyphotic posture. A DEXA scan shows a T-score of -2.8 at the lumbar spine, indicating significant bone density loss. Laboratory tests reveal normal calcium and vitamin D levels.", + "actual_diagnosis": "21. Osteoporosis, ICD-10 code M81.0" + }, + { + "doctor_vignette": "A 25-year-old female presents with a chief complaint of intense itching and dry patches on her hands and elbows. On physical examination, there are erythematous, scaly lesions with crusting and lichenification noted in the affected areas. No specific lab tests are needed for diagnosis, but a skin scraping shows no evidence of fungal infection.", + "actual_diagnosis": "22. Eczema, ICD-10 code L30.9" + }, + { + "doctor_vignette": "A 45-year-old male presents with a chief complaint of worsening left lower abdominal pain for two days, associated with fever and nausea. On physical examination, he has tenderness in the left lower quadrant with rebound tenderness and guarding. A CT scan of the abdomen reveals inflamed diverticula and pericolic fat stranding, consistent with diverticulitis.", + "actual_diagnosis": "23. Diverticulitis, ICD-10 code K57.9" + }, + { + "doctor_vignette": "A 14-year-old female presents to the emergency department with wheezing and shortness of breath after playing soccer. On physical examination, she exhibits use of accessory muscles for breathing and diffuse wheezing is heard on auscultation. A peak flow measurement reveals a score of 60% of her personal best, indicating significant airflow obstruction. Chest X-ray shows no acute abnormalities, ruling out other causes of her symptoms.", + "actual_diagnosis": "19. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 58-year-old male presents with complaints of chest pain and shortness of breath on exertion. Physical exam reveals elevated blood pressure of 160/100 mmHg, a displaced apex beat, and mild bilateral pedal edema. An echocardiogram shows left ventricular hypertrophy and wall motion abnormalities, while lab tests indicate elevated BNP levels.", + "actual_diagnosis": "25. Hypertensive heart disease, ICD-10 code I11.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with severe pelvic pain and dysmenorrhea that has worsened over the past year. On physical examination, tenderness is noted in the lower abdominal region, and a bimanual exam reveals nodules in the posterior fornix. Ultrasound shows cystic lesions on the ovaries suggestive of endometriomas. Serum CA-125 levels are elevated, supporting the suspicion of endometriosis.", + "actual_diagnosis": "24. Endometriosis, ICD-10 code N80.9" + }, + { + "doctor_vignette": "A 5-year-old male presents with parental concerns about delayed speech and lack of social interactions. Physical examination reveals a lack of eye contact and repetitive hand movements. Developmental assessment indicates significantly delayed language skills, particularly in expressive communication. No abnormalities were found on hearing tests or metabolic screening.", + "actual_diagnosis": "Autism spectrum disorder, ICD-10 code F84.0" + }, + { + "doctor_vignette": "A 65-year-old male presents with a chief complaint of decreased urine output over the past three days. Physical examination reveals mild edema in the lower extremities and elevated blood pressure. Laboratory results show elevated serum creatinine levels at 3.2 mg/dL and a BUN of 45 mg/dL, indicating acute renal impairment.", + "actual_diagnosis": "Acute kidney injury, ICD-10 code N17.9" + }, + { + "doctor_vignette": "A 55-year-old female presents with persistent bilateral joint pain and swelling, particularly in the hands and wrists, lasting for over six weeks. On physical examination, there is notable tenderness and morning stiffness lasting more than an hour. Laboratory tests reveal elevated rheumatoid factor and anti-CCP antibodies, along with elevated ESR and CRP levels.", + "actual_diagnosis": "Rheumatoid arthritis, ICD-10 code M06.9" + }, + { + "doctor_vignette": "A 52-year-old female presents with persistent dryness of the mouth and eyes, reporting difficulty swallowing and a gritty sensation in her eyes. Physical examination reveals bilateral parotid gland enlargement and decreased tear production on Schirmer's test. Laboratory results show positive anti-Ro (SSA) antibodies and elevated erythrocyte sedimentation rate (ESR).", + "actual_diagnosis": "Sjogren's syndrome, ICD-10 code M35.0" + }, + { + "doctor_vignette": "A 28-year-old woman presents with joint pain and a facial rash that worsens in sunlight. Upon examination, she has a malar rash and tenderness in multiple joints, including the wrists and knees. Laboratory tests reveal positive antinuclear antibodies (ANA) and elevated anti-double-stranded DNA antibodies. Urinalysis shows mild proteinuria, suggesting possible kidney involvement.", + "actual_diagnosis": "Lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of weight gain and fatigue over the past six months. Physical examination reveals a rounded face, thin skin with easy bruising, and abdominal striae. Laboratory tests show elevated cortisol levels and a 24-hour urinary free cortisol level significantly above normal ranges.", + "actual_diagnosis": "Cushing's syndrome, ICD-10 code E24.9" + }, + { + "doctor_vignette": "A 22-year-old male presents to the emergency department with a 24-hour history of worsening right lower abdominal pain, associated with nausea and loss of appetite. On physical examination, he has tenderness in the right lower quadrant with rebound tenderness and guarding. A CT scan of the abdomen shows an enlarged, fluid-filled appendix with surrounding inflammation, confirming the diagnosis.", + "actual_diagnosis": "Acute appendicitis, ICD-10 code K35.2" + }, + { + "doctor_vignette": "A 45-year-old female presents with recurrent episodes of vertigo lasting several hours, accompanied by tinnitus and a sensation of fullness in the left ear. On physical examination, she shows unsteadiness during the Romberg test. Audiometry reveals a low-frequency hearing loss in the left ear. MRI of the brain is unremarkable, ruling out other causes of her symptoms.", + "actual_diagnosis": "Meniere's disease, ICD-10 code H81.0" + }, + { + "doctor_vignette": "A 58-year-old male presents to the emergency department with sudden onset shortness of breath and chest pain that worsens with deep breathing. On examination, he is tachycardic and has decreased breath sounds on the right side. A chest CT angiogram reveals a large pulmonary embolism in the right main pulmonary artery. Arterial blood gas analysis shows hypoxemia with a low PaO2.", + "actual_diagnosis": "Pulmonary embolism, ICD-10 code I26.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with complaints of intermittent numbness and tingling in her right arm and leg over the past month. On physical examination, she demonstrates a positive Babinski sign and ataxia in her right limb. MRI of the brain reveals multiple demyelinating lesions in the periventricular white matter. Cerebrospinal fluid analysis shows oligoclonal bands, supporting the diagnosis.", + "actual_diagnosis": "Multiple sclerosis, ICD-10 code G35" + }, + { + "doctor_vignette": "A 32-year-old female presents with unintentional weight loss, palpitations, and increased anxiety. On examination, she exhibits a diffusely enlarged thyroid gland, exophthalmos, and brisk deep tendon reflexes. Laboratory tests reveal elevated free T4 and suppressed TSH levels, confirming hyperthyroidism.", + "actual_diagnosis": "Graves' disease, ICD-10 code E05.9" + }, + { + "doctor_vignette": "A 10-year-old female presents with complaints of multiple skin lesions and recurrent headaches. Physical examination reveals caf\u00e9-au-lait spots scattered across her torso and axillary freckling. Additionally, a palpable neurofibroma is noted on her left flank. MRI of the brain shows no abnormalities, but the characteristic skin findings are suggestive of neurofibromatosis type 1.", + "actual_diagnosis": "Neurofibromatosis type 1, ICD-10 code Q85.00" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of severe right upper quadrant pain that began suddenly after a fatty meal. On physical examination, she exhibits tenderness and guarding in the right upper quadrant, with a positive Murphy's sign. Ultrasound reveals gallbladder wall thickening and pericholecystic fluid, indicative of inflammation. Laboratory tests show elevated white blood cell count and elevated liver enzymes.", + "actual_diagnosis": "Acute cholecystitis, ICD-10 code K81.0" + }, + { + "doctor_vignette": "A 22-year-old male presents with complaints of recurrent chest pain and palpitations. Physical examination reveals tall stature, long limbs, and arachnodactyly, along with a significant murmur suggestive of aortic regurgitation. An echocardiogram shows dilation of the aortic root and mitral valve prolapse, confirming the suspected diagnosis.", + "actual_diagnosis": "Marfan syndrome, ICD-10 code Q87.40" + }, + { + "doctor_vignette": "A 65-year-old female presents with chronic knee pain, particularly worsening with activity and improved with rest. On physical examination, there is noticeable joint swelling, crepitus, and reduced range of motion in the right knee. X-rays reveal joint space narrowing and osteophyte formation, consistent with degenerative changes.", + "actual_diagnosis": "Osteoarthritis, ICD-10 code M15.9" + }, + { + "doctor_vignette": "A 58-year-old male presents with fatigue and jaundice. On physical examination, he has notable ascites and spider angiomata. Liver function tests reveal elevated AST and ALT levels, with a low platelet count. An abdominal ultrasound shows hepatic steatosis and signs of portal hypertension.", + "actual_diagnosis": "Chronic liver disease, ICD-10 code K74.60" + }, + { + "doctor_vignette": "A 68-year-old male presents with persistent fatigue and bone pain, particularly in the lower back. On physical examination, there is tenderness over the lumbar spine and decreased range of motion. Laboratory tests reveal a serum protein electrophoresis showing a monoclonal spike in IgG, and a bone marrow biopsy confirms over 30% clonal plasma cells.", + "actual_diagnosis": "Multiple myeloma, ICD-10 code C90.00" + }, + { + "doctor_vignette": "A 55-year-old male presents with a chief complaint of worsening abdominal pain and a noticeable bulge in the right groin area for the past week. On physical examination, a palpable, reducible mass is found in the right inguinal region, which increases in size upon coughing. An abdominal ultrasound reveals a hernia sac without any signs of incarceration or strangulation.", + "actual_diagnosis": "Hernia, unspecified, ICD-10 code K44.9" + }, + { + "doctor_vignette": "A 16-year-old male presents with delayed puberty and concerns about his height. On physical examination, he is noted to be 6 feet tall with gynecomastia and reduced testicular size. Laboratory tests reveal low testosterone levels and elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH). A karyotype analysis shows the presence of an extra X chromosome, confirming the diagnosis.", + "actual_diagnosis": "Klinefelter syndrome, ICD-10 code Q98.0" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of persistent cough and difficulty breathing for the past week. On physical examination, he has decreased breath sounds on the right side and dullness to percussion. A chest X-ray reveals a right lower lobe opacity consistent with pneumonia. Laboratory tests show elevated white blood cell count and elevated C-reactive protein.", + "actual_diagnosis": "Pneumonia due to unspecified organism, ICD-10 code J18.9" + }, + { + "doctor_vignette": "A 32-year-old female presents with a chief complaint of unintentional weight loss and increased anxiety over the past month. On examination, she has a fine tremor in her hands, a rapid heart rate of 110 beats per minute, and prominent exophthalmos. Laboratory tests reveal elevated free T4 and suppressed TSH levels, confirming hyperthyroidism.", + "actual_diagnosis": "4. Hyperthyroidism, ICD-10 code E05.9" + }, + { + "doctor_vignette": "A 68-year-old male presents with fatigue and swelling in his legs. On physical examination, he has bilateral lower extremity edema and a blood pressure of 150/90 mmHg. Laboratory results reveal a serum creatinine level of 2.5 mg/dL, and a urinalysis shows proteinuria. The patient's history includes type 2 diabetes and hypertension.", + "actual_diagnosis": "5. Chronic kidney disease, ICD-10 code N18.9" + }, + { + "doctor_vignette": "A 75-year-old male presents with increasing shortness of breath and fatigue during exertion over the past few months. On physical examination, a harsh systolic ejection murmur is auscultated at the right second intercostal space, with a diminished carotid pulse. An echocardiogram reveals severe aortic stenosis with a valve area of 0.7 cm\u00b2 and significant left ventricular hypertrophy.", + "actual_diagnosis": "Aortic stenosis, ICD-10 code I35.0" + }, + { + "doctor_vignette": "A 45-year-old male presents with persistent abdominal pain and weight loss over the past six months. On physical examination, he has tenderness in the upper abdomen and signs of malnutrition. Laboratory tests reveal elevated serum lipase levels and a CT scan shows calcifications in the pancreas. The patient has a history of heavy alcohol use, which is significant for his condition.", + "actual_diagnosis": "Chronic pancreatitis, ICD-10 code K86.1" + }, + { + "doctor_vignette": "A 72-year-old male presents to the emergency department with palpitations and shortness of breath that started suddenly. On physical examination, he is found to have an irregularly irregular pulse at 120 beats per minute and mild bilateral lower extremity edema. An ECG reveals atrial fibrillation with a rapid ventricular response, and a chest X-ray shows mild cardiomegaly.", + "actual_diagnosis": "6. Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of persistent knee pain, especially during activities such as climbing stairs and prolonged sitting. On physical examination, there is notable crepitus and tenderness over the medial joint line of the right knee, with limited range of motion. X-rays reveal joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "7. Osteoarthritis, ICD-10 code M15.9" + }, + { + "doctor_vignette": "A 32-year-old female presents with persistent abdominal bloating and diarrhea for the past six months. Physical examination reveals signs of malnutrition, including weight loss and pallor. Serologic tests show elevated tissue transglutaminase (tTG) IgA antibodies and a low hemoglobin level. Endoscopy reveals villous atrophy in the duodenum.", + "actual_diagnosis": "8. Celiac disease, ICD-10 code K90.0" + }, + { + "doctor_vignette": "A 28-year-old female presents with fatigue, joint pain, and a butterfly-shaped rash across her cheeks. On physical examination, she has bilateral swelling of the wrists and knees, as well as oral ulcers. Laboratory tests reveal positive antinuclear antibodies (ANA) and low complement levels (C3 and C4).", + "actual_diagnosis": "10. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 24-year-old male presents with auditory hallucinations and persistent delusions of persecution. On examination, he appears disheveled, has poor eye contact, and demonstrates disorganized thinking. Routine lab tests are unremarkable, and a brain MRI shows no structural abnormalities.", + "actual_diagnosis": "9. Schizophrenia, ICD-10 code F20.9" + }, + { + "doctor_vignette": "A 35-year-old female presents with a chief complaint of widespread musculoskeletal pain lasting over six months, accompanied by fatigue and sleep disturbances. Physical examination reveals tenderness in multiple trigger points and a body mass index within the normal range. Laboratory tests show normal complete blood count and metabolic panel, with no signs of inflammation or other underlying conditions.", + "actual_diagnosis": "13. Fibromyalgia, ICD-10 code M79.7" + }, + { + "doctor_vignette": "A 15-year-old male presents with polyuria, excessive thirst, and unexplained weight loss over the past month. On examination, he is found to be dehydrated with a blood pressure of 100/60 mmHg and a heart rate of 110 bpm. Laboratory tests reveal a blood glucose level of 350 mg/dL and ketones in the urine, indicating diabetic ketoacidosis.", + "actual_diagnosis": "12. Type 1 diabetes mellitus, ICD-10 code E10.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with fatigue and pallor. On physical examination, she has conjunctival pallor and a heart rate of 100 beats per minute. Laboratory tests reveal a hemoglobin level of 9.5 g/dL and a low serum ferritin of 10 ng/mL.", + "actual_diagnosis": "17. Iron deficiency anemia, ICD-10 code D50.9" + }, + { + "doctor_vignette": "A 62-year-old male presents with persistent fatigue and unintentional weight loss over the past three months. Physical examination reveals lymphadenopathy in the cervical and axillary regions, along with splenomegaly. A CT scan of the abdomen shows multiple enlarged lymph nodes, and a biopsy confirms the presence of atypical lymphoid cells.", + "actual_diagnosis": "16. Non-Hodgkin lymphoma, ICD-10 code C85.90" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of red, scaly patches on her elbows and knees that have persisted for several months. On physical exam, there are well-defined plaques with silvery scales and some areas of erythema. No significant lab results are noted, but a skin biopsy confirms the diagnosis of psoriasis.", + "actual_diagnosis": "18. Psoriasis, ICD-10 code L40.9" + }, + { + "doctor_vignette": "A 32-year-old male presents with severe abdominal pain that started suddenly after a heavy meal. On examination, he has tenderness in the epigastric region and guarding. Laboratory tests reveal elevated serum amylase and lipase levels, and an abdominal ultrasound shows inflammation of the pancreas with no evidence of gallstones. ", + "actual_diagnosis": "19. Acute pancreatitis, ICD-10 code K85.9" + }, + { + "doctor_vignette": "A 25-year-old female presents with joint hypermobility and recurrent joint dislocations, particularly in her shoulders and knees. On physical exam, she exhibits skin that is velvety and hyper-elastic, along with visible bruising and scarring. A genetic test reveals a mutation in the COL5A1 gene, confirming the diagnosis.", + "actual_diagnosis": "20. Ehlers-Danlos syndrome, ICD-10 code Q79.6" + }, + { + "doctor_vignette": "A 58-year-old female presents with recurrent headaches and episodes of dizziness over the past month. On physical examination, she has a palpable splenomegaly. Laboratory tests reveal an elevated platelet count of 1,200,000/\u00b5L and normal white blood cell and hemoglobin levels. Bone marrow biopsy shows hypercellularity with increased megakaryocytes, consistent with myeloproliferative neoplasm.", + "actual_diagnosis": "Essential thrombocythemia, ICD-10 code D75.81" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of persistent shortness of breath and a chronic cough producing sputum for the past few months. On physical examination, he exhibits wheezing, decreased breath sounds bilaterally, and a barrel-shaped chest. A chest X-ray reveals hyperinflated lungs, and spirometry shows a reduced FEV1/FVC ratio consistent with obstructive lung disease.", + "actual_diagnosis": "15. Chronic obstructive pulmonary disease, ICD-10 code J44.9" + }, + { + "doctor_vignette": "A 5-year-old female presents with a chief complaint of itchy, red patches on her elbows and knees. On physical examination, there are well-defined, erythematous plaques with overlying scale and excoriations. There are no significant laboratory results, as the diagnosis is made clinically based on the characteristic appearance and distribution of the rash.", + "actual_diagnosis": "Eczema, ICD-10 code L30.9" + }, + { + "doctor_vignette": "A 17-year-old female presents with a chief complaint of significant weight loss over the past three months, reporting a current weight of 85 pounds with a height of 5'5\". Physical examination reveals bradycardia, lanugo, and a body mass index (BMI) of 14.2. Laboratory tests show electrolyte imbalances, including hypokalemia and hyponatremia, with normal thyroid function tests.", + "actual_diagnosis": "Anorexia nervosa, ICD-10 code F50.01" + }, + { + "doctor_vignette": "A 65-year-old female presents with gradual vision loss in her peripheral fields over the past few months. On examination, her intraocular pressure is measured at 28 mmHg bilaterally, and a visual field test reveals significant peripheral vision loss. Fundoscopic examination shows cupping of the optic discs, indicating possible glaucomatous changes.", + "actual_diagnosis": "Glaucoma, ICD-10 code H40.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of persistent heartburn and regurgitation occurring several times a week. Physical examination reveals mild epigastric tenderness but no signs of acute distress. An upper gastrointestinal endoscopy shows evidence of esophagitis and the presence of reflux. No additional lab tests are necessary, as the history and endoscopic findings are consistent with GERD.", + "actual_diagnosis": "Acid reflux disease (GERD), ICD-10 code K21.9" + }, + { + "doctor_vignette": "A 30-year-old female presents with fatigue and pallor. On physical examination, she has conjunctival pallor and a heart rate of 100 bpm. Laboratory tests reveal a hemoglobin level of 9.0 g/dL and a mean corpuscular volume of 75 fL, indicating microcytic anemia. Iron studies show low serum ferritin and low serum iron levels.", + "actual_diagnosis": "Anemia, ICD-10 code D64.9" + }, + { + "doctor_vignette": "A 5-year-old female presents with a chief complaint of persistent shortness of breath during play. Physical examination reveals a noticeable cyanosis of the lips and fingertips, a heart murmur, and tachycardia. An echocardiogram shows a ventricular septal defect with right-to-left shunting and pulmonary artery hypoplasia. Chest X-ray indicates cardiomegaly and decreased pulmonary vascular markings.", + "actual_diagnosis": "Rare congenital heart defect, ICD-10 code Q24.9" + }, + { + "doctor_vignette": "A 58-year-old male presents with jaundice and fatigue. Physical examination reveals ascites, spider angiomata, and palmar erythema. Laboratory tests show elevated liver enzymes (ALT and AST), low platelet count, and a serum albumin level of 2.5 g/dL. Ultrasound of the abdomen reveals a nodular liver consistent with cirrhosis.", + "actual_diagnosis": "Cirrhosis of the liver, ICD-10 code K74.60" + }, + { + "doctor_vignette": "An 82-year-old female presents with increasing forgetfulness and difficulty performing daily activities over the past year. On physical examination, she demonstrates disorientation to time and place, and has trouble recalling recent events. Cognitive assessment reveals moderate impairment in memory and judgment. MRI shows mild cortical atrophy consistent with neurodegenerative changes.", + "actual_diagnosis": "Dementia, ICD-10 code F03.90" + }, + { + "doctor_vignette": "A 65-year-old female presents with fatigue and swelling in her legs. Physical examination reveals bilateral lower extremity edema and hypertension. Laboratory tests show a serum creatinine level of 2.1 mg/dL and an estimated glomerular filtration rate (eGFR) of 45 mL/min.", + "actual_diagnosis": "Chronic kidney disease, stage 3, ICD-10 code N18.3" + }, + { + "doctor_vignette": "A 32-year-old female presents with fatigue and pallor. On physical examination, she has conjunctival pallor and a heart rate of 100 beats per minute. Laboratory tests reveal a hemoglobin level of 8.5 g/dL and a mean corpuscular volume (MCV) of 75 fL, indicating microcytic anemia. Iron studies show low serum ferritin and transferrin saturation.", + "actual_diagnosis": "Anemia, unspecified, ICD-10 code D64.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with a chief complaint of worsening cough and fever for three days. Physical examination reveals decreased breath sounds and crackles in the right lower lung field. Chest X-ray shows right lower lobe consolidation, and a complete blood count indicates leukocytosis with a left shift.", + "actual_diagnosis": "Pneumonia, ICD-10 code J18.9" + }, + { + "doctor_vignette": "A 55-year-old male presents with a chief complaint of persistent headaches and fatigue. On physical examination, his blood pressure is measured at 160/100 mmHg, and he exhibits mild edema in the lower extremities. Laboratory results show normal renal function but elevated serum cholesterol levels.", + "actual_diagnosis": "1. Hypertension, ICD-10 code I10" + }, + { + "doctor_vignette": "A 58-year-old female presents with increased thirst and frequent urination for the past month. On physical examination, she is overweight with a BMI of 32, and her blood pressure is 145/90 mmHg. Laboratory results show a fasting blood glucose level of 190 mg/dL and HbA1c of 8.5%.", + "actual_diagnosis": "2. Type 2 diabetes mellitus, ICD-10 code E11.9" + }, + { + "doctor_vignette": "A 35-year-old male presents with a chief complaint of itchy, red patches on his elbows and knees that have been worsening over the past month. Physical examination reveals well-defined, erythematous plaques covered with silvery scales on the extensor surfaces. There are no significant lab findings, but a thorough skin examination confirms the characteristic appearance of psoriasis.", + "actual_diagnosis": "5. Psoriasis, ICD-10 code L40.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with worsening shortness of breath and a chronic productive cough. On physical examination, he exhibits wheezing and decreased breath sounds bilaterally. A chest X-ray shows hyperinflation of the lungs, and pulmonary function tests reveal a reduced FEV1/FVC ratio consistent with obstructive lung disease.", + "actual_diagnosis": "3. Chronic obstructive pulmonary disease, ICD-10 code J44.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with persistent knee pain that worsens with activity and improves with rest. On physical examination, there is crepitus and limited range of motion in the right knee, along with tenderness along the joint line. X-rays reveal joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "4. Osteoarthritis, ICD-10 code M15.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with chronic diarrhea, abdominal bloating, and fatigue for the past six months. Physical examination reveals a distended abdomen and signs of malnutrition, including dry skin and hair loss. Lab results show elevated tissue transglutaminase antibodies (tTG-IgA) and a low hemoglobin level, indicating anemia.", + "actual_diagnosis": "7. Celiac disease, ICD-10 code K90.0" + }, + { + "doctor_vignette": "A 58-year-old male presents to the emergency department with severe chest pain radiating to his left arm and shortness of breath. On physical examination, he is diaphoretic and has a blood pressure of 90/60 mmHg with a heart rate of 110 bpm. An ECG shows ST-segment elevation in the inferior leads, and cardiac troponin levels are markedly elevated at 3.5 ng/mL. ", + "actual_diagnosis": "6. Acute myocardial infarction, ICD-10 code I21.9" + }, + { + "doctor_vignette": "A 5-year-old male presents with recurrent joint swelling and pain in the knees after minor injuries. Physical examination reveals significant swelling and tenderness in both knees with limited range of motion. Laboratory tests show a prolonged activated partial thromboplastin time (aPTT) and normal prothrombin time (PT), indicating a coagulopathy. The factor VIII level is markedly low, confirming the diagnosis.", + "actual_diagnosis": "9. Hemophilia A, ICD-10 code D66" + }, + { + "doctor_vignette": "A 54-year-old female presents with complaints of dry mouth and dry eyes for the past six months. On examination, there is reduced salivary flow and bilateral conjunctival injection. Lab tests reveal positive anti-SSA/Ro antibodies and a Schirmer test showing less than 5 mm of tear production in 5 minutes, consistent with aqueous tear deficiency.", + "actual_diagnosis": "10. Sj\u00f6gren's syndrome, ICD-10 code M35.0" + }, + { + "doctor_vignette": "A 54-year-old male presents with a sudden onset of severe pain and swelling in his right big toe, which began overnight. On examination, the affected joint is erythematous, warm, and tender to touch. Serum uric acid levels are notably elevated at 8.5 mg/dL, and joint aspiration reveals needle-shaped monosodium urate crystals under polarized light microscopy.", + "actual_diagnosis": "11. Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "An 8-year-old male presents with difficulty focusing in school, frequently interrupts classmates, and struggles to complete homework. On examination, he exhibits fidgeting behaviors and an inability to sit still. There are no significant physical abnormalities, and behavioral assessments indicate a high level of impulsivity and inattention. Teacher reports corroborate symptoms with consistent observations of hyperactivity and distractibility during classroom activities.", + "actual_diagnosis": "12. Attention-deficit hyperactivity disorder, ICD-10 code F90.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with persistent fatigue and recurrent infections over the past month. Physical examination reveals pallor and petechiae on her lower extremities. Complete blood count shows leukopenia, thrombocytopenia, and a markedly low hemoglobin level of 7 g/dL, with a bone marrow biopsy indicating hypoplastic marrow.", + "actual_diagnosis": "14. Aplastic anemia, ICD-10 code D61.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with fatigue, weight gain, and cold intolerance over the past six months. On physical examination, she has dry skin, bradycardia, and myxedema. Laboratory tests reveal elevated TSH levels (12 mIU/L) and low free T4 levels (0.6 ng/dL), confirming the diagnosis.", + "actual_diagnosis": "13. Hypothyroidism, ICD-10 code E03.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of joint pain and swelling, particularly in her hands and knees. On physical examination, she exhibits a malar rash, oral ulcers, and signs of arthritis in multiple joints. Laboratory tests reveal a positive antinuclear antibody (ANA) test and elevated anti-double-stranded DNA antibodies, along with a low complement level.", + "actual_diagnosis": "8. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 30-year-old female presents with sudden onset of right-sided facial drooping and inability to close her right eye. On examination, she shows weakness in the right side of her face, with a flattened nasolabial fold and inability to smile on that side. Neurological examination is otherwise normal, and a CT scan of the head is unremarkable, ruling out other causes.", + "actual_diagnosis": "15. Bell's palsy, ICD-10 code G51.0" + }, + { + "doctor_vignette": "A 15-year-old female presents with recurrent joint dislocations and skin that is unusually stretchy. On physical examination, she exhibits hypermobile joints and a velvety skin texture with easy bruising. Genetic testing reveals a mutation associated with Ehlers-Danlos syndrome.", + "actual_diagnosis": "17. Ehlers-Danlos syndrome, ICD-10 code Q79.6" + }, + { + "doctor_vignette": "A 68-year-old female presents with a chief complaint of persistent back pain and height loss over the past year. Physical examination reveals a decreased spinal range of motion and tenderness in the lumbar region. A DEXA scan shows a T-score of -2.8, indicating severe osteoporosis.", + "actual_diagnosis": "19. Osteoporosis, ICD-10 code M81.0" + }, + { + "doctor_vignette": "A 10-year-old male presents with a productive cough and frequent respiratory infections. Physical examination reveals digital clubbing and wheezing on auscultation, along with abdominal distension. Sweat chloride testing shows elevated levels of 90 mmol/L, indicating cystic fibrosis.", + "actual_diagnosis": "20. Cystic fibrosis, ICD-10 code E84.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of persistent heartburn and regurgitation occurring after meals. Physical examination reveals mild epigastric tenderness, but no signs of acute distress. An upper gastrointestinal endoscopy shows esophagitis and a 24-hour pH monitoring confirms excessive acid exposure in the esophagus.", + "actual_diagnosis": "Gastroesophageal reflux disease, ICD-10 code K21.9" + }, + { + "doctor_vignette": "A 55-year-old male presents with progressive muscle weakness and difficulty speaking over the past six months. Physical examination reveals fasciculations in the tongue and atrophy of the hand muscles, with hyperreflexia noted in the upper extremities. An electromyogram (EMG) shows evidence of widespread denervation and reinnervation, confirming lower motor neuron involvement.", + "actual_diagnosis": "Amyotrophic lateral sclerosis, ICD-10 code G12.21" + }, + { + "doctor_vignette": "A 34-year-old male presents with severe abdominal pain radiating to the back, accompanied by nausea and vomiting. On physical examination, he exhibits tenderness in the upper abdomen and a mildly distended abdomen. Laboratory tests reveal elevated serum amylase and lipase levels, and an abdominal ultrasound shows evidence of pancreatic inflammation.", + "actual_diagnosis": "16. Acute pancreatitis, ICD-10 code K85.9" + }, + { + "doctor_vignette": "A 24-year-old female presents with worsening muscle weakness, particularly in her eyelids and limbs, over the past month. On physical examination, she exhibits ptosis and diplopia, with a notable increase in weakness after prolonged activity. A serum acetylcholine receptor antibody test returns positive, confirming the diagnosis.", + "actual_diagnosis": "18. Myasthenia gravis, ICD-10 code G70.00" + }, + { + "doctor_vignette": "A 30-year-old woman presents with persistent fatigue, weight loss, and increased pigmentation of the skin. On physical exam, she has low blood pressure and hyperpigmented patches on her elbows and knees. Laboratory tests reveal hyponatremia, hyperkalemia, and an elevated ACTH level with low cortisol levels. These findings are suggestive of adrenal insufficiency.", + "actual_diagnosis": "Addison's disease, ICD-10 code E27.1" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of persistent cough and fever for three days. On physical examination, he exhibits decreased breath sounds in the right lower lung field and crackles upon auscultation. A chest X-ray reveals a right lower lobe infiltrate, and laboratory tests show elevated white blood cell count with a left shift.", + "actual_diagnosis": "Pneumonia, unspecified, ICD-10 code J18.9" + }, + { + "doctor_vignette": "A 24-year-old female presents with a 3-month history of intermittent abdominal pain, diarrhea, and weight loss of 10 pounds. Physical examination reveals tenderness in the right lower quadrant and a palpable mass. Laboratory tests show elevated C-reactive protein (CRP) levels and anemia. An abdominal MRI demonstrates thickening of the ileal wall with skip lesions consistent with Crohn's disease.", + "actual_diagnosis": "Crohn's disease, ICD-10 code K50.90" + }, + { + "doctor_vignette": "A 55-year-old male presents with fatigue and jaundice. On physical examination, he has scleral icterus and hepatomegaly. Laboratory tests reveal elevated liver enzymes (ALT 150 U/L, AST 180 U/L) and positive HCV RNA with a high viral load. Liver function tests indicate a low platelet count of 120,000/mm\u00b3.", + "actual_diagnosis": "Hepatitis C, chronic, ICD-10 code B18.2" + }, + { + "doctor_vignette": "A 22-year-old male presents with a chief complaint of severe headache and fever for the past two days. Physical examination reveals neck stiffness, photophobia, and a positive Brudzinski's sign. Lumbar puncture shows elevated white blood cell count with a predominance of neutrophils and a low glucose level, consistent with bacterial meningitis.", + "actual_diagnosis": "Bacterial meningitis, unspecified, ICD-10 code G00.9" + }, + { + "doctor_vignette": "A 32-year-old female presents with a chief complaint of a dull, bilateral headache that has persisted for the last three days. Physical examination reveals tenderness in the pericranial muscles and no neurological deficits. Vital signs are normal, and a CT scan of the head shows no acute abnormalities.", + "actual_diagnosis": "Tension-type headache, ICD-10 code G44.2" + }, + { + "doctor_vignette": "A 65-year-old male presents with fatigue and swelling in his legs. Physical examination reveals bilateral pedal edema and decreased urine output. Laboratory tests show a serum creatinine level of 8.5 mg/dL and a glomerular filtration rate (GFR) of 10 mL/min, indicating severely reduced kidney function.", + "actual_diagnosis": "End-stage renal disease, ICD-10 code N18.6" + }, + { + "doctor_vignette": "A 55-year-old female presents with sudden onset of right leg swelling and pain after a long-haul flight. On examination, there is significant edema and tenderness in the right calf, with a positive Homan's sign. Doppler ultrasound reveals a right popliteal vein thrombus. D-dimer levels are markedly elevated, indicating a possible thrombotic event.", + "actual_diagnosis": "Venous thromboembolism, ICD-10 code I82.90" + }, + { + "doctor_vignette": "A 45-year-old male presents with fatigue and jaundice. On physical examination, he has scleral icterus and right upper quadrant tenderness. Laboratory tests reveal elevated liver enzymes (ALT 250 U/L, AST 220 U/L) and positive anti-HCV antibodies with a confirmed HCV RNA level of 1,000,000 IU/mL.", + "actual_diagnosis": "Hepatitis C, ICD-10 code B17.1" + }, + { + "doctor_vignette": "A 5-year-old male presents with a chief complaint of itchy, red patches on his cheeks and behind his knees. Physical examination reveals dry, erythematous lesions with excoriations and lichenification. No significant lab results are necessary for diagnosis, as the clinical presentation is typical of atopic eczema.", + "actual_diagnosis": "Eczema, atopic, ICD-10 code L20.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with persistent anxiety and flashbacks following a car accident six months ago. She reports difficulty sleeping, irritability, and avoidance of driving. Physical exam reveals increased heart rate and sweating when discussing the incident. No critical lab or imaging results are necessary for this diagnosis, as symptoms are primarily psychological.", + "actual_diagnosis": "Post-traumatic stress disorder, ICD-10 code F43.10" + }, + { + "doctor_vignette": "A 55-year-old male presents for a routine check-up with a chief complaint of increased fatigue over the past month. Physical examination reveals a BMI of 32, and xanthomas are noted on his elbows. Laboratory tests show a total cholesterol level of 280 mg/dL and LDL cholesterol of 180 mg/dL, indicating significantly elevated lipid levels.", + "actual_diagnosis": "Hyperlipidemia, ICD-10 code E78.5" + }, + { + "doctor_vignette": "A 55-year-old male presents with a chief complaint of persistent headaches and dizziness over the past month. On physical examination, his blood pressure is measured at 150/95 mmHg, and there is mild edema noted in his lower extremities. Routine lab tests reveal elevated serum creatinine levels, indicating potential kidney involvement.", + "actual_diagnosis": "4. Hypertension, ICD-10 code I10" + }, + { + "doctor_vignette": "A 28-year-old female presents with fatigue and pallor. On physical examination, she has conjunctival pallor and a heart rate of 110 bpm. Laboratory tests reveal a hemoglobin level of 9.0 g/dL and a serum ferritin level of 10 ng/mL, indicating iron deficiency.", + "actual_diagnosis": "7. Iron deficiency anemia, ICD-10 code D50.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of persistent knee pain that worsens with activity and improves with rest. On physical examination, there is noticeable crepitus and tenderness over the medial joint line of the right knee, along with limited range of motion. X-rays reveal joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "9. Osteoarthritis, ICD-10 code M17.9" + }, + { + "doctor_vignette": "A 72-year-old male presents with worsening shortness of breath and edema in the lower extremities. On examination, he has elevated jugular venous pressure, bilateral crackles on lung auscultation, and 2+ pitting edema in both legs. Chest X-ray reveals cardiomegaly and pulmonary congestion, while BNP levels are markedly elevated at 600 pg/mL.", + "actual_diagnosis": "6. Congestive heart failure, ICD-10 code I50.9" + }, + { + "doctor_vignette": "A 58-year-old male presents with increased thirst and frequent urination over the past month. Physical examination reveals a BMI of 32, mild hypertension, and acanthosis nigricans on the neck. Fasting blood glucose is measured at 180 mg/dL and HbA1c is 8.5%.", + "actual_diagnosis": "5. Type 2 diabetes mellitus, ICD-10 code E11.9" + }, + { + "doctor_vignette": "A 55-year-old female presents with a chief complaint of persistent joint pain and stiffness in her hands and wrists, particularly in the morning. On physical examination, there is symmetrical swelling of the metacarpophalangeal joints and tenderness in the proximal interphalangeal joints. Laboratory tests reveal elevated rheumatoid factor and anti-citrullinated protein antibodies, alongside increased inflammatory markers such as ESR and CRP.", + "actual_diagnosis": "10. Rheumatoid arthritis, ICD-10 code M06.9" + }, + { + "doctor_vignette": "A 28-year-old male presents with a chief complaint of itchy, red patches on his elbows and knees. On physical exam, there are well-defined, erythematous plaques covered with silvery scales. No significant laboratory abnormalities are noted, and a skin biopsy reveals hyperkeratosis and acanthosis, consistent with psoriasis.", + "actual_diagnosis": "11. Psoriasis, ICD-10 code L40.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with chronic diarrhea and abdominal bloating after meals. On physical examination, she has signs of malnutrition, including weight loss and pallor. Serological tests reveal elevated tissue transglutaminase antibodies (tTG-IgA) and low hemoglobin levels. A subsequent duodenal biopsy confirms villous atrophy consistent with celiac disease.", + "actual_diagnosis": "12. Celiac disease, ICD-10 code K90.0" + }, + { + "doctor_vignette": "A 10-year-old male presents with a chief complaint of wheezing and shortness of breath, particularly during physical activity. Physical examination reveals prolonged expiratory phase, bilateral wheezing on auscultation, and use of accessory muscles for breathing. A peak expiratory flow rate (PEFR) reading shows 60% of predicted value, indicating significant airway obstruction.", + "actual_diagnosis": "14. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 65-year-old male presents to the emergency department with complaints of decreased urine output and swelling in his legs over the past week. Physical examination reveals bilateral lower extremity edema and mild hypertension. Laboratory tests show elevated serum creatinine levels at 3.5 mg/dL and a BUN of 40 mg/dL, indicating acute kidney injury.", + "actual_diagnosis": "16. Acute kidney injury, ICD-10 code N17.9" + }, + { + "doctor_vignette": "A 34-year-old female presents with severe right upper quadrant pain radiating to her back after a fatty meal. On physical examination, she has tenderness in the right upper quadrant with a positive Murphy's sign. Ultrasound reveals multiple gallstones and gallbladder wall thickening. Laboratory tests show elevated liver enzymes and bilirubin levels.", + "actual_diagnosis": "17. Gallbladder stones, ICD-10 code K80.20" + }, + { + "doctor_vignette": "A 24-year-old male presents with a chief complaint of persistent abdominal pain and diarrhea for the past three months. Physical examination reveals tenderness in the right lower quadrant and signs of malnutrition. Laboratory tests show elevated inflammatory markers (CRP and ESR) and a colonoscopy reveals skip lesions consistent with Crohn's disease.", + "actual_diagnosis": "13. Crohn's disease, ICD-10 code K50.90" + }, + { + "doctor_vignette": "A 32-year-old female presents with a chief complaint of persistent cough for the past week, accompanied by mild chest discomfort. On examination, she has a low-grade fever of 99.5\u00b0F, wheezing on auscultation, and clear nasal discharge. A chest X-ray shows no signs of pneumonia, and a rapid influenza test is negative.", + "actual_diagnosis": "15. Acute bronchitis, ICD-10 code J20.9" + }, + { + "doctor_vignette": "A 34-year-old female presents with fatigue, weight gain, and cold intolerance. On physical examination, she demonstrates dry skin, bradycardia, and a delayed relaxation phase of deep tendon reflexes. Laboratory tests reveal an elevated thyroid-stimulating hormone (TSH) level of 8.5 mIU/L and a low free thyroxine (T4) level of 0.7 ng/dL.", + "actual_diagnosis": "19. Hypothyroidism, ICD-10 code E03.9" + }, + { + "doctor_vignette": "A 32-year-old female presents to the emergency department with a chief complaint of palpitations, fever, and confusion. Physical examination reveals tachycardia with a heart rate of 150 bpm, hyperthermia with a temperature of 39.5\u00b0C, and tremors in her hands. Laboratory results show significantly elevated free T4 and suppressed TSH levels, confirming hyperthyroidism.", + "actual_diagnosis": "Thyroid storm, ICD-10 code E05.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with fatigue and pallor. On physical examination, she has a smooth, beefy-red tongue and slight jaundice. Laboratory results reveal a low hemoglobin level of 8.5 g/dL, elevated mean corpuscular volume (MCV) of 110 fL, and a positive intrinsic factor antibody test.", + "actual_diagnosis": "Pernicious anemia, ICD-10 code D51.0" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of increased anxiety and unintentional weight loss over the past month. Physical examination reveals a rapid heart rate of 110 bpm, a fine tremor in her hands, and palpable enlargement of the thyroid gland. Laboratory results show elevated free T4 and suppressed TSH levels, confirming the diagnosis.", + "actual_diagnosis": "18. Hyperthyroidism, ICD-10 code E05.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of joint pain and fatigue persisting for several weeks. On physical examination, she has a malar rash, oral ulcers, and swelling in her wrists and knees. Laboratory tests reveal a positive antinuclear antibody (ANA) test and elevated anti-double stranded DNA antibodies, indicating active disease.", + "actual_diagnosis": "20. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 5-year-old male presents for evaluation of short stature. Physical examination reveals disproportionately short limbs, a prominent forehead, and a flattened nasal bridge. X-rays show characteristic features of skeletal dysplasia, including shortened long bones consistent with achondroplasia. Genetic testing confirms a mutation in the FGFR3 gene.", + "actual_diagnosis": "Achondroplasia, ICD-10 code Q77.1" + }, + { + "doctor_vignette": "A 22-year-old male presents to the emergency department with a chief complaint of severe headache and fever for the past 24 hours. On examination, he exhibits a positive Brudzinski's sign and has a stiff neck. Lumbar puncture reveals cloudy cerebrospinal fluid with elevated white blood cell count and positive Gram stain for Neisseria meningitidis.", + "actual_diagnosis": "Bacterial meningitis, ICD-10 code A87.9" + }, + { + "doctor_vignette": "A 72-year-old female presents to the emergency department with dizziness and fainting spells. On physical examination, her blood pressure is noted to be 80/50 mmHg, and she exhibits signs of dehydration with dry mucous membranes. Laboratory results reveal elevated creatinine levels at 1.8 mg/dL, indicating possible renal impairment due to decreased perfusion.", + "actual_diagnosis": "Hypotension, ICD-10 code I95.9" + }, + { + "doctor_vignette": "A 10-year-old female presents with a chief complaint of multiple skin lesions that have been increasing in number. On physical examination, caf\u00e9-au-lait spots are noted on her torso and a few neurofibromas are palpable on her back. Additionally, she has optic nerve glioma confirmed by MRI, which shows an associated mass in the optic pathway.", + "actual_diagnosis": "Neurofibromatosis type 1, ICD-10 code Q85.01" + }, + { + "doctor_vignette": "A 45-year-old male presents with a chief complaint of persistent pain and stiffness in his right shoulder, worsening with overhead activities. On physical examination, there is tenderness over the rotator cuff, decreased range of motion, and a positive Neer test. An MRI of the shoulder reveals signs of tendinitis with associated edema in the supraspinatus tendon.", + "actual_diagnosis": "Tendinitis of the shoulder, ICD-10 code M75.1" + }, + { + "doctor_vignette": "A 25-year-old male presents with a chief complaint of persistent fatigue and night sweats for the past month. On physical examination, there is notable cervical lymphadenopathy and splenomegaly. A chest CT scan reveals enlarged mediastinal lymph nodes, and laboratory tests show elevated lactate dehydrogenase (LDH) levels.", + "actual_diagnosis": "Hodgkin lymphoma, ICD-10 code C81.9" + }, + { + "doctor_vignette": "A 16-year-old male presents with neurological symptoms including tremors and difficulty speaking. Physical examination reveals Kayser-Fleischer rings in the cornea and hepatomegaly. Laboratory tests show elevated serum copper and decreased ceruloplasmin levels, confirming copper metabolism disorder.", + "actual_diagnosis": "Wilson\u2019s disease, ICD-10 code E83.0" + }, + { + "doctor_vignette": "A 4-year-old male presents with a 5-day history of high fever, conjunctival injection, and a rash. On physical examination, there is notable cervical lymphadenopathy and cracked lips. Laboratory tests reveal elevated inflammatory markers with a significantly increased erythrocyte sedimentation rate (ESR) and thrombocytosis. Echocardiography shows mild dilation of the coronary arteries.", + "actual_diagnosis": "Kawasaki disease, ICD-10 code I25.89" + }, + { + "doctor_vignette": "A 65-year-old female presents with involuntary facial movements and tongue protrusions that have developed over the past six months. On physical examination, she exhibits rhythmic, repetitive movements of the lips and jaw, along with dystonic posturing of the tongue. Her medication history reveals long-term use of antipsychotics for schizophrenia. Neurological imaging is unremarkable, and routine lab tests show no abnormalities.", + "actual_diagnosis": "Tardive dyskinesia, ICD-10 code G24.03" + }, + { + "doctor_vignette": "A 68-year-old male presents with worsening abdominal pain and significant weight loss over the past three months. On physical examination, he has jaundice and a palpable mass in the upper abdomen. Ultrasound reveals an enlarged pancreas with a suspicious mass, and CA 19-9 levels are elevated at 250 U/mL.", + "actual_diagnosis": "Pancreatic cancer, ICD-10 code C25.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with chronic neck pain and stiffness that has progressively worsened over the past year. On physical examination, there is reduced range of motion in the cervical spine and tenderness along the cervical vertebrae. An MRI of the cervical spine shows degenerative disc disease and osteophyte formation at C5-C6. No acute fractures or significant spinal canal narrowing are noted.", + "actual_diagnosis": "Cervical spondylosis, ICD-10 code M47.9" + }, + { + "doctor_vignette": "A 2-week-old male infant presents with failure to pass meconium within the first 48 hours of life and abdominal distension. On physical examination, the abdomen is markedly distended with palpable loops of bowel and decreased bowel sounds. An abdominal X-ray shows a dilated colon with a transition zone to a normal caliber rectum. A rectal biopsy reveals the absence of ganglion cells, confirming the diagnosis.", + "actual_diagnosis": "Hirschsprung disease, ICD-10 code Q43.1" + }, + { + "doctor_vignette": "A 15-year-old male presents with persistent pain in his right knee, which has worsened over the past month and is accompanied by swelling. On examination, there is notable tenderness and a palpable mass over the distal femur. X-rays reveal a sunburst pattern of bone destruction and a large soft tissue mass, raising suspicion for a malignant process.", + "actual_diagnosis": "Osteosarcoma, ICD-10 code C40.0" + }, + { + "doctor_vignette": "A 10-year-old African American male presents with severe pain in his chest and back lasting for the past 24 hours. On physical examination, he exhibits pallor, tachycardia, and tenderness over the thoracic spine. A complete blood count reveals a hemoglobin level of 6 g/dL, and a peripheral blood smear shows sickle-shaped red blood cells.", + "actual_diagnosis": "Sickle cell disease, ICD-10 code D57.0" + }, + { + "doctor_vignette": "A 35-year-old female presents with a chief complaint of severe palpitations and confusion. On examination, she is found to have a heart rate of 150 bpm, elevated blood pressure of 180/110 mmHg, and hyperthermia with a temperature of 39.5\u00b0C. Laboratory tests reveal a significantly elevated free T4 level of 5.6 ng/dL and suppressed TSH levels, confirming hyperthyroidism.", + "actual_diagnosis": "Thyroid storm, ICD-10 code E05.01" + }, + { + "doctor_vignette": "A 12-year-old female presents with a chief complaint of lower back pain that worsens with prolonged standing. On physical examination, there is an increased lumbar curvature noted, and tenderness is palpated over the lumbar region. X-ray imaging reveals a significant lordotic curve of the lumbar spine without any signs of fracture or degenerative changes.", + "actual_diagnosis": "Lordosis, ICD-10 code M40.4" + }, + { + "doctor_vignette": "A 10-year-old female presents with a chief complaint of multiple skin lesions. On physical examination, there are several caf\u00e9-au-lait spots and two palpable neurofibromas on her back. Additionally, an MRI of the brain reveals a sphenoid wing dysplasia. Family history is significant for similar skin findings in her mother, suggesting a genetic component.", + "actual_diagnosis": "Neurofibromatosis, ICD-10 code Q85.00" + }, + { + "doctor_vignette": "A 32-year-old female presents with a chief complaint of recurrent headaches occurring at least 15 days per month for the past six months. On examination, she exhibits tenderness in the pericranial muscles and photophobia. An MRI of the brain shows no abnormalities, ruling out secondary causes of headache.", + "actual_diagnosis": "Chronic migraines, ICD-10 code G43.709" + }, + { + "doctor_vignette": "A 67-year-old female presents with worsening knee pain, particularly after prolonged standing or walking. On physical examination, there is notable crepitus and tenderness over the medial joint line of the right knee, along with mild swelling. X-rays reveal joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "5. Osteoarthritis, ICD-10 code M17.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with persistent bone pain in his pelvis and lower back. On physical examination, there is noticeable enlargement of the left tibia and tenderness over the affected areas. Radiographic imaging reveals thickened bone and disorganized trabecular patterns consistent with Paget's disease. Serum alkaline phosphatase levels are elevated, indicating increased osteoblastic activity.", + "actual_diagnosis": "Paget's disease of bone, ICD-10 code M88.9" + }, + { + "doctor_vignette": "A 58-year-old male presents with increased thirst and frequent urination for the past month. On physical examination, he has a BMI of 32 and notable acanthosis nigricans on his neck. Laboratory tests reveal a fasting blood glucose level of 180 mg/dL and an HbA1c of 8.2%.", + "actual_diagnosis": "4. Diabetes mellitus type 2, ICD-10 code E11.9" + }, + { + "doctor_vignette": "A 55-year-old female presents with involuntary, repetitive movements of her face and tongue, having been on antipsychotic medication for over five years for schizophrenia. On physical exam, she exhibits lip smacking and facial grimacing, with no signs of acute distress. Neurological examination reveals no other focal deficits, and routine blood tests show normal results. MRI of the brain is unremarkable, ruling out other neurological conditions.", + "actual_diagnosis": "Tardive dyskinesia, ICD-10 code F32.81" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of increasing shortness of breath and a persistent cough producing yellow sputum for the past three months. Physical examination reveals wheezing, decreased breath sounds bilaterally, and use of accessory muscles for breathing. A chest X-ray shows hyperinflation of the lungs, and a spirometry test indicates a forced expiratory volume in one second (FEV1) of 55% of predicted, consistent with obstructive lung disease.", + "actual_diagnosis": "7. Chronic obstructive pulmonary disease, ICD-10 code J44.9" + }, + { + "doctor_vignette": "A 54-year-old male presents to the clinic with complaints of persistent headaches and occasional dizziness. On physical examination, his blood pressure is measured at 160/95 mmHg, and he is noted to have mild bilateral edema in the lower extremities. Laboratory tests reveal elevated serum creatinine levels at 1.5 mg/dL, indicating possible kidney involvement due to hypertension.", + "actual_diagnosis": "11. Hypertension, ICD-10 code I10" + }, + { + "doctor_vignette": "A 35-year-old male presents with a chief complaint of itchy, red patches on his elbows and knees that have been worsening over the past three months. Physical examination reveals well-defined erythematous plaques covered with silvery scales on extensor surfaces and the scalp. No significant laboratory abnormalities were noted, and a skin biopsy was performed, confirming the diagnosis of psoriasis.", + "actual_diagnosis": "10. Psoriasis, ICD-10 code L40.9" + }, + { + "doctor_vignette": "A 32-year-old female presents with palpitations and unintentional weight loss over the past month. On physical examination, she has a diffusely enlarged thyroid gland and exhibits tremors in her hands. Laboratory tests reveal a suppressed TSH level and elevated free T4, confirming hyperthyroidism.", + "actual_diagnosis": "12. Hyperthyroidism, ICD-10 code E05.90" + }, + { + "doctor_vignette": "A 10-year-old male presents to the emergency department with wheezing and shortness of breath after playing outside. Physical examination reveals prolonged expiratory phase, use of accessory muscles, and decreased breath sounds bilaterally. A peak expiratory flow rate (PEFR) shows a reading of 60% of predicted value, indicating moderate obstruction. There are no signs of infection on chest X-ray.", + "actual_diagnosis": "13. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 42-year-old female presents with chronic widespread pain and fatigue lasting over six months. Physical examination reveals tenderness in multiple trigger points, including the neck, shoulders, and lower back. Routine lab tests, including CBC and inflammatory markers, return normal, and no imaging studies show any abnormalities. The patient also reports sleep disturbances and cognitive difficulties, commonly known as 'fibro fog.'", + "actual_diagnosis": "14. Fibromyalgia, ICD-10 code M79.7" + }, + { + "doctor_vignette": "A 72-year-old male presents to the emergency department with palpitations and shortness of breath that started an hour ago. On examination, his heart rate is irregularly irregular at 120 beats per minute, and he has a blood pressure of 90/60 mmHg. An ECG shows no identifiable P waves and a rapid ventricular response. Laboratory results reveal elevated troponin levels and a potassium level of 5.5 mEq/L.", + "actual_diagnosis": "15. Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 65-year-old male presents with fatigue and swelling in his legs and ankles. On examination, he has elevated blood pressure, pitting edema in the lower extremities, and a decreased urine output. Laboratory results reveal a serum creatinine level of 8.2 mg/dL and a GFR of 10 mL/min, indicating severely impaired kidney function.", + "actual_diagnosis": "16. End-stage renal disease, ICD-10 code N18.6" + }, + { + "doctor_vignette": "A 25-year-old female presents with fatigue and palpitations. On examination, she has pale conjunctiva and a heart rate of 110 bpm. Laboratory results reveal a hemoglobin level of 9.5 g/dL and low serum ferritin of 10 ng/mL, indicating iron deficiency.", + "actual_diagnosis": "17. Anemia due to iron deficiency, ICD-10 code D50.9" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of tremors in his right hand that have progressively worsened over the past six months. On physical examination, he exhibits bradykinesia, rigidity in the upper extremities, and a shuffling gait. A dopamine transporter scan shows reduced uptake in the putamen, consistent with Parkinson's disease.", + "actual_diagnosis": "18. Parkinson's disease, ICD-10 code G20" + }, + { + "doctor_vignette": "A 68-year-old woman presents with a chief complaint of persistent lower back pain that has worsened over the past month. Physical examination reveals reduced spinal mobility and tenderness over the lumbar region, with a noticeable decrease in height. A DEXA scan shows a T-score of -2.8, indicating osteoporosis.", + "actual_diagnosis": "20. Osteoporosis, ICD-10 code M81.0" + }, + { + "doctor_vignette": "A 24-year-old male presents with auditory hallucinations and delusions of persecution over the past six months. On examination, he exhibits disorganized speech and a flat affect. There are no significant findings on laboratory tests or neuroimaging, which show normal brain structure. His symptoms have significantly impaired his social and occupational functioning.", + "actual_diagnosis": "22. Schizophrenia, ICD-10 code F20.9" + }, + { + "doctor_vignette": "A 6-year-old male presents with recurrent joint swelling and pain after minor falls. Physical examination reveals significant hemarthrosis in the right knee and bruising on the forearms. Laboratory tests show a prolonged activated partial thromboplastin time (aPTT) with normal prothrombin time (PT), and factor VIII levels are markedly decreased.", + "actual_diagnosis": "24. Hemophilia, ICD-10 code D66" + }, + { + "doctor_vignette": "A 45-year-old male presents with severe pain and swelling in his right big toe, which started suddenly during the night. On physical examination, the toe is erythematous, warm, and exquisitely tender to touch. Serum uric acid levels are found to be elevated at 9.2 mg/dL, and synovial fluid analysis shows needle-shaped crystals under polarized light microscopy, confirming the diagnosis.", + "actual_diagnosis": "23. Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "A 12-year-old African American male presents with severe pain in his chest and back, reporting that the pain began suddenly while playing basketball. On physical examination, he exhibits pallor and splenomegaly. Lab results reveal a hemoglobin level of 6.5 g/dL with a peripheral blood smear showing sickle-shaped cells and reticulocytosis of 12%.", + "actual_diagnosis": "21. Sickle cell disease, ICD-10 code D57.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of persistent knee pain that worsens with activity and improves with rest. Physical examination reveals crepitus and tenderness over the medial joint line of the right knee, with limited range of motion. X-rays show joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "Osteoarthritis, ICD-10 code M19.90" + }, + { + "doctor_vignette": "A 10-year-old male presents with a persistent cough and frequent respiratory infections. Physical examination reveals digital clubbing and wheezing on auscultation. Sweat chloride testing shows an elevated level of 90 mmol/L, indicating abnormal chloride transport.", + "actual_diagnosis": "25. Cystic fibrosis, ICD-10 code E84.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with complaints of persistent feelings of restlessness and difficulty concentrating for the past six months. On physical examination, she exhibits mild tachycardia and diaphoresis but has no significant findings on neurological or cardiovascular assessments. Routine laboratory tests, including complete blood count and thyroid function tests, return normal, and no imaging studies are indicated.", + "actual_diagnosis": "Anxiety disorder, unspecified, ICD-10 code F41.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of persistent sadness and lack of interest in activities she once enjoyed. On physical examination, she exhibits psychomotor retardation, poor eye contact, and flat affect. Laboratory tests, including a complete blood count and thyroid function tests, show no abnormalities, ruling out other potential causes of her symptoms.", + "actual_diagnosis": "Clinical depression, ICD-10 code F32.9" + }, + { + "doctor_vignette": "A 45-year-old male presents with a chief complaint of persistent heartburn and regurgitation after meals. On physical examination, he exhibits epigastric tenderness but no signs of acute distress. An upper gastrointestinal endoscopy shows evidence of mild esophagitis, and a pH monitoring test indicates abnormal acid exposure.", + "actual_diagnosis": "Acid reflux, ICD-10 code K21.9" + }, + { + "doctor_vignette": "An 82-year-old female presents with increasing forgetfulness and confusion over the past year, often misplacing items and repeating questions. Physical examination reveals disorientation to time and place, as well as difficulty following simple commands. Cognitive testing shows significant impairment in memory and executive function, while CT imaging of the brain indicates generalized atrophy without acute process.", + "actual_diagnosis": "Dementia, unspecified, ICD-10 code F03.90" + }, + { + "doctor_vignette": "A 10-year-old girl presents with a chief complaint of multiple skin lesions. On physical examination, several caf\u00e9-au-lait spots and neurofibromas are noted on her back and arms. A recent MRI of the brain shows no evidence of tumors, ruling out complications. The family history reveals a maternal uncle with similar findings, raising suspicion for neurofibromatosis type 1.", + "actual_diagnosis": "Neurofibromatosis, type 1, ICD-10 code Q85.00" + }, + { + "doctor_vignette": "A 4-year-old male presents with a 5-day history of high fever, conjunctival injection, and a rash. On examination, he has swollen cervical lymph nodes and red, cracked lips. Laboratory results show elevated inflammatory markers, including CRP and ESR, along with a normocytic anemia.", + "actual_diagnosis": "Kawasaki disease, ICD-10 code I72.5" + }, + { + "doctor_vignette": "A 52-year-old female presents with a chief complaint of bilateral joint pain and swelling in her hands and feet, which has persisted for the past three months. On physical examination, there is notable morning stiffness lasting over an hour, and tenderness with swelling in the metacarpophalangeal joints. Laboratory tests reveal positive rheumatoid factor and elevated anti-CCP antibodies, alongside an increased ESR.", + "actual_diagnosis": "5. Rheumatoid arthritis, ICD-10 code M05.79" + }, + { + "doctor_vignette": "A 55-year-old male presents to the clinic with complaints of persistent headaches and occasional dizziness. On physical examination, his blood pressure is measured at 160/100 mmHg, and he is noted to have a BMI of 29. Laboratory results show elevated serum creatinine levels of 1.3 mg/dL and a lipid panel indicating hyperlipidemia.", + "actual_diagnosis": "6. Hypertension, ICD-10 code I10" + }, + { + "doctor_vignette": "An 82-year-old female presents with progressive memory loss, frequently forgetting recent conversations and misplacing items. On physical examination, she demonstrates disorientation to time and place, along with difficulty in performing simple tasks. A CT scan of the brain shows mild cortical atrophy, particularly in the temporal lobes, consistent with neurodegenerative changes. Laboratory tests reveal no significant abnormalities in routine blood work.", + "actual_diagnosis": "9. Alzheimer's disease, ICD-10 code G30.9" + }, + { + "doctor_vignette": "A 7-year-old male presents with recurrent episodes of joint bleeding and prolonged bleeding after minor cuts. Physical examination reveals swollen knees and bruising on the forearms. Laboratory tests show aPTT of 45 seconds (normal range 25-35 seconds) while PT and platelet count are normal. Factor VIII levels are significantly low, confirming the diagnosis.", + "actual_diagnosis": "11. Hemophilia A, ICD-10 code D66" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of joint pain and fatigue lasting for several weeks. On physical examination, she has bilateral swelling of the wrists and knees, a butterfly rash across her cheeks, and oral ulcers. Laboratory tests reveal positive antinuclear antibodies (ANA) and low complement levels, indicating an autoimmune process.", + "actual_diagnosis": "15. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with persistent abdominal pain and diarrhea for the past six months. Physical examination reveals a distended abdomen and signs of malnutrition, including weight loss and dry skin. Laboratory tests show positive tissue transglutaminase antibodies (tTG-IgA) and low hemoglobin levels indicating anemia.", + "actual_diagnosis": "10. Celiac disease, ICD-10 code K90.0" + }, + { + "doctor_vignette": "A 72-year-old male presents with worsening shortness of breath and fatigue over the past month. Physical examination reveals bilateral lower extremity edema, jugular venous distension, and a third heart sound (S3). Chest X-ray shows cardiomegaly and pulmonary congestion, while BNP levels are elevated at 550 pg/mL.", + "actual_diagnosis": "13. Congestive heart failure, ICD-10 code I50.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with complaints of unintentional weight loss, increased heart rate, and anxiety. On physical examination, she exhibits tremors, a warm and moist skin texture, and a noticeable goiter. Laboratory tests reveal elevated free T4 and suppressed TSH levels, indicating hyperthyroidism.", + "actual_diagnosis": "16. Hyperthyroidism, ICD-10 code E05.90" + }, + { + "doctor_vignette": "A 25-year-old female presents with excessive daytime sleepiness and episodes of sudden muscle weakness triggered by laughter. Physical examination reveals no abnormalities, but the patient reports experiencing vivid hallucinations during sleep onset. A polysomnography study shows short sleep latency and REM sleep occurring within 15 minutes of falling asleep, consistent with narcolepsy.", + "actual_diagnosis": "20. Narcolepsy, ICD-10 code G47.419" + }, + { + "doctor_vignette": "A 22-year-old male presents with auditory hallucinations and disorganized speech. On physical examination, he appears unkempt, with flat affect and impaired insight. Neurological assessment reveals no focal deficits, and routine laboratory tests, including CBC and metabolic panel, are within normal limits. A brain MRI shows no structural abnormalities, ruling out other causes of his symptoms.", + "actual_diagnosis": "19. Schizophrenia, ICD-10 code F20.9" + }, + { + "doctor_vignette": "A 54-year-old male presents with acute pain and swelling in his right big toe, which started suddenly during the night. On examination, the toe is erythematous, warm, and exquisitely tender to touch. Serum uric acid levels are found to be elevated at 9.5 mg/dL, and a joint aspiration reveals needle-shaped monosodium urate crystals under polarized light.", + "actual_diagnosis": "17. Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "A 25-year-old female presents with persistent abdominal pain and diarrhea for the past three months. On physical examination, she has tenderness in the right lower quadrant and mild abdominal distension. Laboratory tests reveal elevated C-reactive protein (CRP) and a colonoscopy shows skip lesions and cobblestoning in the terminal ileum.", + "actual_diagnosis": "18. Crohn\u2019s disease, ICD-10 code K50.90" + }, + { + "doctor_vignette": "A 45-year-old female presents with fatigue, recurrent infections, and easy bruising over the past month. On physical examination, she has pallor, petechiae on her lower extremities, and splenomegaly. Complete blood count reveals a leukocytosis with 80% immature white blood cells and thrombocytopenia. Bone marrow biopsy confirms the diagnosis of acute leukemia.", + "actual_diagnosis": "Acute leukemia, ICD-10 code C91.9" + }, + { + "doctor_vignette": "A 29-year-old male presents with fatigue and jaundice for the past week. On physical examination, he has scleral icterus and a tender hepatomegaly. Laboratory tests reveal elevated liver enzymes (AST 150 U/L, ALT 180 U/L) and a positive Hepatitis B surface antigen (HBsAg).", + "actual_diagnosis": "Hepatitis B, ICD-10 code B16.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with severe right upper quadrant pain after a fatty meal. On physical examination, she exhibits tenderness in the right upper quadrant and a positive Murphy's sign. Laboratory tests show elevated bilirubin levels and a complete blood count indicating mild leukocytosis. An abdominal ultrasound reveals multiple gallstones in the gallbladder with no signs of cholecystitis.", + "actual_diagnosis": "Cholelithiasis, ICD-10 code K80.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of itchy, red rash on her hands after using a new dishwashing detergent. Physical examination reveals erythematous, scaly patches with vesicles on the dorsal surfaces of both hands. No systemic symptoms are noted, and patch testing confirms sensitivity to one of the detergent's ingredients.", + "actual_diagnosis": "Contact dermatitis, ICD-10 code L23.9" + }, + { + "doctor_vignette": "A 3-year-old female presents with developmental delays and difficulty with motor skills. Physical examination reveals spasticity in the lower extremities, an exaggerated deep tendon reflex, and a scissor gait. MRI of the brain shows periventricular leukomalacia, consistent with a diagnosis of cerebral palsy.", + "actual_diagnosis": "Cerebral palsy, ICD-10 code G80.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with a chief complaint of worsening shortness of breath and cough for the past week. Physical examination reveals decreased breath sounds and crackles on auscultation. A chest X-ray shows bilateral infiltrates, and a PCR test for COVID-19 returns positive.", + "actual_diagnosis": "Pneumonia due to COVID-19, ICD-10 code J12.82" + }, + { + "doctor_vignette": "A 63-year-old female presents with persistent fatigue and recurrent kidney stones. On physical examination, she has noticeable muscle weakness and abdominal tenderness. Laboratory results reveal elevated serum calcium levels of 12.5 mg/dL and increased parathyroid hormone levels, confirming the diagnosis.", + "actual_diagnosis": "Hyperparathyroidism, ICD-10 code E21.9" + }, + { + "doctor_vignette": "A 68-year-old female presents with progressive rigidity and bradykinesia of the right arm, accompanied by difficulty in speech and occasional episodes of dystonia. On physical examination, there is marked asymmetry, with the right side showing more severe motor impairment and a grasp reflex. MRI of the brain reveals asymmetrical cortical atrophy, particularly in the parietal lobe. Neurological assessment indicates significant cognitive decline with visuospatial deficits.", + "actual_diagnosis": "Corticobasal degeneration, ICD-10 code G31.83" + }, + { + "doctor_vignette": "A 7-year-old male presents with a chief complaint of swelling in the legs and around the eyes for the past week. On physical examination, he has significant bilateral lower extremity edema and periorbital swelling. Laboratory results reveal a 24-hour urine protein of 4.5 grams and serum albumin level of 2.0 g/dL, indicating hypoalbuminemia.", + "actual_diagnosis": "Nephrotic syndrome, ICD-10 code N04.9" + }, + { + "doctor_vignette": "A 55-year-old male presents with a chief complaint of persistent headaches and dizziness for the past month. On physical examination, his blood pressure is measured at 150/95 mmHg, with no other significant findings. Laboratory tests reveal normal renal function and electrolyte levels, ruling out secondary causes of hypertension.", + "actual_diagnosis": "Essential hypertension, ICD-10 code I10" + }, + { + "doctor_vignette": "A 67-year-old male presents with complaints of increased urinary frequency, nocturia, and a weak urinary stream. On physical examination, a smooth, enlarged prostate is palpated on digital rectal exam. Urinalysis shows no signs of infection, and a bladder ultrasound reveals post-void residual urine of 150 mL, indicating urinary retention.", + "actual_diagnosis": "Benign prostatic hyperplasia, ICD-10 code N40.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with sudden onset of right-sided facial weakness, unable to smile or close her right eye. On physical examination, there is a notable droop of the right side of her mouth and inability to raise her right eyebrow. Neurological examination shows no other deficits and a CT scan of the head is unremarkable, ruling out other causes.", + "actual_diagnosis": "Bell's palsy, ICD-10 code G51.0" + }, + { + "doctor_vignette": "A 35-year-old female presents with a chief complaint of a dull, bilateral headache that has persisted for the past week. Physical examination reveals tenderness in the scalp and neck muscles, with no neurological deficits noted. Laboratory tests and imaging studies, including a CT scan of the head, are unremarkable.", + "actual_diagnosis": "Tension-type headache, ICD-10 code G44.209" + }, + { + "doctor_vignette": "A 72-year-old female presents with increasing forgetfulness over the past year, often misplacing items and struggling to recall recent conversations. On physical examination, she demonstrates difficulty with short-term memory tasks and her Mini-Mental State Examination score is 22/30. MRI of the brain shows mild cortical atrophy, particularly in the temporal lobes. There are no acute intracranial abnormalities.", + "actual_diagnosis": "Alzheimer's disease, ICD-10 code G30.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of numbness and tingling in her right hand, particularly affecting the thumb, index, and middle fingers, which worsens at night. On physical exam, she demonstrates positive Tinel's sign and Phalen's maneuver. Nerve conduction studies reveal delayed median nerve conduction at the wrist, consistent with carpal tunnel syndrome.", + "actual_diagnosis": "Carpal tunnel syndrome, ICD-10 code G56.0" + }, + { + "doctor_vignette": "A 28-year-old male recently returned from a trip to West Africa presents with a chief complaint of high fever and chills. Physical examination reveals splenomegaly and jaundice. Laboratory tests show a positive rapid diagnostic test for Plasmodium falciparum and a hemoglobin level of 9 g/dL indicating anemia.", + "actual_diagnosis": "Malaria, ICD-10 code B50.9" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of increasing difficulty with movement and noticeable tremors in his right hand. Upon physical examination, he exhibits a resting tremor, bradykinesia, and rigidity in the upper extremities. Neurological imaging shows no evidence of structural lesions, but a DaTscan indicates decreased dopamine transporter uptake in the striatum, consistent with Parkinson\u2019s disease.", + "actual_diagnosis": "Parkinson\u2019s disease, ICD-10 code G20" + }, + { + "doctor_vignette": "A 62-year-old male presents with persistent fatigue and unexplained weight loss of 15 pounds over the past two months. Physical examination reveals palpable lymphadenopathy in the cervical and axillary regions. Laboratory tests show elevated lactate dehydrogenase (LDH) levels and a biopsy of the lymph nodes reveals atypical lymphoid cells. CT imaging confirms multiple enlarged lymph nodes throughout the abdomen and thorax.", + "actual_diagnosis": "Non-Hodgkin lymphoma, ICD-10 code C85.9" + }, + { + "doctor_vignette": "A 30-year-old male presents with a persistent cough for the past three weeks, accompanied by night sweats and unintentional weight loss. On physical examination, there are decreased breath sounds and crackles in the right upper lung field. A chest X-ray reveals a right apical cavitary lesion, and sputum analysis shows acid-fast bacilli.", + "actual_diagnosis": "Tuberculosis of the lung, ICD-10 code A15.0" + }, + { + "doctor_vignette": "A 27-year-old female presents with a chief complaint of persistent intrusive thoughts about contamination and excessive handwashing rituals. Physical examination reveals no significant findings, but the patient reports spending over three hours daily on these compulsions, leading to distress and impairment in her work and social life. No lab tests or imaging are necessary for diagnosis, as symptoms align with obsessive-compulsive disorder criteria.", + "actual_diagnosis": "Obsessive-compulsive disorder, ICD-10 code F42.9" + }, + { + "doctor_vignette": "A 58-year-old male presents to the emergency department with severe chest pain radiating to his left arm and shortness of breath. On examination, he is diaphoretic, with a blood pressure of 90/60 mmHg and a heart rate of 110 bpm. An ECG reveals ST elevation in the anterior leads, and cardiac troponin levels are significantly elevated. These findings are consistent with acute myocardial infarction.", + "actual_diagnosis": "Myocardial infarction, ICD-10 code I21.9" + }, + { + "doctor_vignette": "A 3-year-old male presents with a 2-day history of irritability and pulling at his right ear. On physical exam, there is significant erythema and bulging of the right tympanic membrane with purulent discharge noted. No additional imaging is necessary as the clinical findings are consistent with acute otitis media.", + "actual_diagnosis": "Acute otitis media, ICD-10 code H66.90" + }, + { + "doctor_vignette": "A 65-year-old male presents with progressive shortness of breath and a persistent cough over the past six months. Physical examination reveals crackles on auscultation and clubbing of the fingers. High-resolution computed tomography (HRCT) of the chest shows ground-glass opacities and reticular patterns consistent with interstitial lung disease.", + "actual_diagnosis": "Interstitial lung disease, ICD-10 code J84.10" + }, + { + "doctor_vignette": "A 35-year-old male presents with fatigue, weight loss, and decreased libido over the past six months. Physical examination reveals hypotension and diminished body hair. Laboratory tests show low levels of ACTH, LH, and TSH, along with low cortisol and testosterone levels. MRI of the pituitary gland indicates an empty sella.", + "actual_diagnosis": "Hypopituitarism, ICD-10 code E23.0" + }, + { + "doctor_vignette": "A 45-year-old male presents with fatigue and joint pain in his hands. On physical examination, he has a bronze discoloration of the skin and hepatomegaly. Laboratory tests reveal elevated serum ferritin levels of 800 ng/mL and transferrin saturation of 95%.", + "actual_diagnosis": "Hereditary hemochromatosis, ICD-10 code E83.110" + }, + { + "doctor_vignette": "A 65-year-old male presents with fatigue and weakness over the past month. On physical examination, he is pale, and there is mild splenomegaly. Laboratory tests reveal a hemoglobin level of 10.5 g/dL, elevated serum ferritin, and normal iron studies, consistent with anemia of chronic disease.", + "actual_diagnosis": "Anemia due to chronic disease, ICD-10 code D63.9" + }, + { + "doctor_vignette": "A 67-year-old male presents with a chief complaint of worsening cough and shortness of breath for the past three days. On physical examination, he has decreased breath sounds in the right lower lung field and dullness to percussion. Chest X-ray reveals right lower lobe consolidation, and a sputum culture returns positive for Streptococcus pneumoniae.", + "actual_diagnosis": "Pneumonia due to Streptococcus pneumoniae, ICD-10 code J18.0" + }, + { + "doctor_vignette": "A 14-year-old female presents to the emergency department with her mother after experiencing a generalized tonic-clonic seizure at school. On examination, she is currently alert but reports confusion and fatigue following the seizure. A brain MRI shows no structural abnormalities, and her serum electrolyte levels are within normal limits. The patient has a history of similar seizure episodes occurring sporadically over the past six months.", + "actual_diagnosis": "Epilepsy, ICD-10 code G40.9" + }, + { + "doctor_vignette": "A 35-year-old male presents with a persistent cough lasting three weeks, accompanied by night sweats and weight loss. On physical examination, he has decreased breath sounds in the right lung and dullness to percussion. A chest X-ray reveals an apical cavitary lesion, and sputum analysis shows acid-fast bacilli, confirming the diagnosis.", + "actual_diagnosis": "Tuberculosis of the lung, ICD-10 code A15.9" + }, + { + "doctor_vignette": "A 15-year-old male presents with increasing fatigue and abdominal pain. On physical examination, he has a Kayser-Fleischer ring in his eyes and hepatomegaly. Laboratory tests reveal elevated serum copper levels and low ceruloplasmin. MRI of the liver shows signs of hepatic cirrhosis.", + "actual_diagnosis": "Wilson's disease, ICD-10 code E83.01" + }, + { + "doctor_vignette": "A 7-year-old male presents with a chief complaint of wheezing and shortness of breath after playing outside. Physical examination reveals bilateral expiratory wheezing and a prolonged expiratory phase. A peak flow measurement shows 60% of his personal best. The patient has a history of asthma-like symptoms exacerbated by environmental allergens, particularly pollen.", + "actual_diagnosis": "Reactive airway disease, ICD-10 code J45.909" + }, + { + "doctor_vignette": "An 8-year-old male presents with a rapidly growing mass in the left thigh, which has been painful for the past month. Physical examination reveals a firm, non-tender, 5 cm palpable mass with limited range of motion. An MRI of the thigh shows a soft tissue mass extending into the surrounding muscles, consistent with a malignant neoplasm.", + "actual_diagnosis": "Rhabdomyosarcoma, ICD-10 code C49.9" + }, + { + "doctor_vignette": "A 68-year-old male presents with sudden, severe chest pain radiating to the back. On physical examination, a pulsatile abdominal mass is noted, and the patient exhibits hypotension. A chest X-ray reveals a widened mediastinum, and a subsequent CT scan confirms the presence of a thoracic aortic aneurysm.", + "actual_diagnosis": "Aortic aneurysm, ICD-10 code I71.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with complaints of aching and swelling in her legs, particularly after prolonged standing. On physical examination, there are prominent, tortuous veins visible on the medial aspect of both lower extremities, with a notable increase in skin pigmentation around the ankles. Venous Doppler ultrasound reveals reflux in the great saphenous vein, confirming the diagnosis.", + "actual_diagnosis": "Varicose veins of lower extremities, ICD-10 code I83.90" + }, + { + "doctor_vignette": "A 54-year-old male presents with a chief complaint of a bulge in the right groin that increases in size with standing and decreases when lying down. On physical examination, a soft, reducible mass is palpated in the right inguinal region, with no signs of tenderness or bowel obstruction. An abdominal ultrasound confirms the presence of an inguinal hernia without any complications.", + "actual_diagnosis": "Hernia, unspecified, ICD-10 code K40.90" + }, + { + "doctor_vignette": "A 45-year-old female presents with extreme fatigue, weight loss, and low blood pressure. Physical examination reveals hyperpigmentation of the skin and orthostatic hypotension. Laboratory tests show hyponatremia, hyperkalemia, and an elevated ACTH level with low cortisol levels in the morning.", + "actual_diagnosis": "Adrenal insufficiency, ICD-10 code E27.9" + }, + { + "doctor_vignette": "A 20-year-old male presents with complaints of chest pain and palpitations. On physical examination, he is noted to have tall stature, long limbs, and arachnodactyly. A transthoracic echocardiogram reveals a dilated aortic root. Genetic testing confirms a mutation in the FBN1 gene associated with Marfan syndrome.", + "actual_diagnosis": "Marfan syndrome, ICD-10 code Q87.4" + }, + { + "doctor_vignette": "A 45-year-old male presents with severe lower back pain radiating down his left leg. On examination, he demonstrates positive straight leg raise and reduced sensation in the left S1 dermatome. MRI of the lumbar spine reveals a herniated disc at the L5-S1 level compressing the left S1 nerve root.", + "actual_diagnosis": "Herniated disc, ICD-10 code M51.2" + }, + { + "doctor_vignette": "A 45-year-old female presents with severe right upper quadrant pain that started suddenly after a fatty meal. On physical examination, she exhibits tenderness in the right upper quadrant with a positive Murphy's sign. An abdominal ultrasound reveals multiple gallstones within the gallbladder and thickening of the gallbladder wall. Laboratory tests show elevated liver enzymes and bilirubin levels.", + "actual_diagnosis": "Gallbladder stones, ICD-10 code K80.9" + }, + { + "doctor_vignette": "A 34-year-old female presents to the emergency department with difficulty breathing and facial swelling after eating shrimp at a restaurant. Physical examination reveals angioedema of the face and lips, wheezing on auscultation, and a rash covering her torso. Laboratory results show elevated serum tryptase levels and a low oxygen saturation of 85%.", + "actual_diagnosis": "Severe allergic reaction, ICD-10 code T78.2" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of facial pain and pressure for the past week. On physical examination, there is tenderness over the maxillary sinuses and purulent nasal discharge is observed. A CT scan of the sinuses shows mucosal thickening and fluid levels in the maxillary sinuses, consistent with sinusitis.", + "actual_diagnosis": "Acute sinusitis, ICD-10 code J01.90" + }, + { + "doctor_vignette": "A 35-year-old female presents with a chief complaint of debilitating headaches occurring 15 or more days per month for the past six months, often accompanied by nausea and light sensitivity. Physical examination reveals no neurological deficits, but she exhibits tenderness to palpation in the pericranial muscles. MRI of the brain is unremarkable, ruling out secondary causes of headache.", + "actual_diagnosis": "Chronic migraine, ICD-10 code G43.701" + }, + { + "doctor_vignette": "A 28-year-old woman presents with fatigue, joint pain, and a butterfly rash across her cheeks. On examination, she has mild oral ulcers and swelling in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) test and low complement levels (C3 and C4).", + "actual_diagnosis": "6. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 10-year-old male presents with concerns about social interactions and difficulty understanding nonverbal cues. On examination, he displays limited eye contact, has a narrow range of interests, and engages in repetitive behaviors such as hand-flapping. No significant findings are noted on developmental screening tests, and laboratory tests are within normal limits.", + "actual_diagnosis": "Asperger's syndrome, ICD-10 code F84.5" + }, + { + "doctor_vignette": "A 54-year-old male presents with increased thirst and frequent urination over the past month. Physical examination reveals a BMI of 32, elevated blood pressure at 145/90 mmHg, and a fasting blood glucose level of 180 mg/dL. His HbA1c is measured at 8.5%, indicating poor glycemic control.", + "actual_diagnosis": "4. Type 2 diabetes mellitus, ICD-10 code E11.9" + }, + { + "doctor_vignette": "A 24-year-old male presents with auditory hallucinations, stating he hears voices telling him to harm himself. On examination, he exhibits disorganized speech and a flat affect. There are no acute medical issues noted on laboratory tests, and a CT scan of the brain reveals no structural abnormalities. He has a history of declining social and occupational functioning over the past six months.", + "actual_diagnosis": "12. Schizophrenia, ICD-10 code F20.9" + }, + { + "doctor_vignette": "A 45-year-old male presents with progressive enlargement of his hands and feet over the past five years, along with deepening of his voice and increased sweating. Physical examination reveals pronounced facial changes, including a prominent jaw and enlarged nose, as well as increased spacing between his teeth. Serum growth hormone levels are elevated, and MRI of the sella shows a pituitary adenoma.", + "actual_diagnosis": "10. Acromegaly, ICD-10 code E22.0" + }, + { + "doctor_vignette": "A 6-year-old boy presents with recurrent episodes of joint swelling and pain after minor injuries. On physical examination, there is notable hemarthrosis in his right knee and a history of easy bruising. Laboratory tests reveal a prolonged activated partial thromboplastin time (aPTT) and a normal prothrombin time (PT), with factor VIII levels significantly decreased. These findings suggest a bleeding disorder consistent with his symptoms.", + "actual_diagnosis": "14. Hemophilia A, ICD-10 code D66" + }, + { + "doctor_vignette": "A 55-year-old male presents with severe pain and swelling in his right big toe, which began suddenly overnight. On examination, the affected joint is erythematous, warm, and tender to touch. Serum uric acid levels are measured at 9.5 mg/dL, indicating hyperuricemia. Joint aspiration reveals the presence of monosodium urate crystals.", + "actual_diagnosis": "13. Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "A 28-year-old male presents with a chief complaint of red, scaly patches on his elbows and knees that have been persistent for several months. On physical examination, there are well-defined erythematous plaques covered with silvery scales. There is no evidence of joint swelling or tenderness. Laboratory results show elevated serum levels of inflammatory markers but no signs of infection or other dermatological conditions.", + "actual_diagnosis": "17. Psoriasis, ICD-10 code L40.9" + }, + { + "doctor_vignette": "A 32-year-old African American female presents with persistent dry cough and fatigue for the past three months. On examination, she has bilateral hilar lymphadenopathy noted on chest X-ray and mild erythema nodosum on her lower extremities. Laboratory tests reveal elevated serum angiotensin-converting enzyme (ACE) levels and hypercalcemia, raising suspicion for granulomatous disease.", + "actual_diagnosis": "19. Sarcoidosis, ICD-10 code D86.9" + }, + { + "doctor_vignette": "A 45-year-old male presents with confusion and ataxia after a prolonged period of alcohol abuse. On examination, he demonstrates ophthalmoplegia and nystagmus. MRI of the brain reveals lesions in the thalamus and mammillary bodies. Serum thiamine levels are significantly low, confirming deficiency.", + "actual_diagnosis": "Wernicke's encephalopathy, ICD-10 code G93.89" + }, + { + "doctor_vignette": "A 54-year-old obese male presents with complaints of excessive daytime sleepiness and loud snoring, as reported by his partner. Physical examination reveals a thick neck circumference and signs of hypertension. A home sleep study shows recurrent apneas and hypopneas during sleep, leading to significant oxygen desaturation.", + "actual_diagnosis": "Obstructive sleep apnea, ICD-10 code G47.30" + }, + { + "doctor_vignette": "A 12-year-old male presents with a chief complaint of wheezing and shortness of breath that worsens at night. On physical examination, he has prolonged expiratory phase and diffuse wheezing bilaterally. Peak expiratory flow rate is measured at 60% of predicted value, indicating significant airway obstruction. A history of allergen exposure and previous asthma attacks is noted.", + "actual_diagnosis": "Bronchial asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 35-year-old male presents with a chief complaint of high fever and severe cough lasting for three days. Physical examination reveals tachypnea, hypoxia with an oxygen saturation of 88%, and bilateral crackles on auscultation. Chest X-ray shows bilateral infiltrates, and a PCR test for SARS-CoV-2 is positive.", + "actual_diagnosis": "Severe acute respiratory syndrome, ICD-10 code B97.21" + }, + { + "doctor_vignette": "A 65-year-old male with a history of rheumatic heart disease presents with fever, chills, and a new heart murmur. On examination, he has splinter hemorrhages and petechiae on his extremities. Blood cultures reveal the presence of Streptococcus viridans, and an echocardiogram shows vegetations on the mitral valve.", + "actual_diagnosis": "Infective endocarditis, ICD-10 code I33.0" + }, + { + "doctor_vignette": "A 32-year-old female presents with complaints of unintentional weight loss, increased heart rate, and anxiety over the past three months. Physical examination reveals a fine tremor in her hands, and a thyroid exam shows a diffusely enlarged gland. Laboratory results indicate elevated free T4 and suppressed TSH levels, confirming hyperthyroidism.", + "actual_diagnosis": "8. Hyperthyroidism, ICD-10 code E05.90" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of tremors in his right hand that have been progressively worsening over the past six months. Physical examination reveals a resting tremor, bradykinesia, and rigidity in the right upper extremity. Gait analysis shows shuffling steps and decreased arm swing. MRI of the brain shows no significant abnormalities, ruling out other causes of the symptoms.", + "actual_diagnosis": "12. Parkinson's disease, ICD-10 code G20" + }, + { + "doctor_vignette": "A 28-year-old female presents to the emergency department with difficulty breathing and swelling of the face and throat after eating shellfish. On exam, she exhibits hives, wheezing, and tachycardia. Vital signs show a blood pressure of 85/50 mmHg, and an oxygen saturation of 88% on room air. Serum tryptase levels are elevated, confirming an anaphylactic reaction.", + "actual_diagnosis": "13. Severe allergic reaction, ICD-10 code T78.2" + }, + { + "doctor_vignette": "A 10-year-old male presents with a persistent productive cough and difficulty gaining weight. On examination, he has digital clubbing and coarse lung sounds bilaterally. Sweat chloride test results show elevated levels, confirming the diagnosis. His family history reveals that his older sister was diagnosed with cystic fibrosis at a young age.", + "actual_diagnosis": "14. Cystic fibrosis, ICD-10 code E84.9" + }, + { + "doctor_vignette": "A 55-year-old male presents with a chief complaint of severe pain and swelling in his right big toe that started suddenly overnight. On physical exam, the toe is erythematous, swollen, and extremely tender to touch. Serum uric acid levels are found to be significantly elevated at 9.5 mg/dL, confirming the diagnosis of gout.", + "actual_diagnosis": "16. Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "A 24-year-old male presents with auditory hallucinations and disorganized speech, expressing beliefs that he is being watched. On physical exam, he displays flat affect and poor eye contact. No abnormalities are found on routine laboratory tests, and a brain MRI shows no structural abnormalities. His symptoms have persisted for over six months, impacting his social and occupational functioning.", + "actual_diagnosis": "11. Schizophrenia, ICD-10 code F20.9" + }, + { + "doctor_vignette": "A 30-year-old female presents with chronic diarrhea and abdominal bloating for the past six months. Physical examination reveals significant weight loss and abdominal tenderness. Serological tests show elevated tissue transglutaminase antibodies (tTG-IgA) and a low hemoglobin level indicating iron deficiency anemia. A duodenal biopsy confirms villous atrophy.", + "actual_diagnosis": "9. Celiac disease, ICD-10 code K90.0" + }, + { + "doctor_vignette": "A 65-year-old male presents with a chief complaint of increasing shortness of breath and a chronic cough that has persisted for several months. On physical examination, he exhibits wheezing, decreased breath sounds, and use of accessory muscles for breathing. A chest X-ray shows hyperinflation of the lungs, and pulmonary function tests reveal an FEV1/FVC ratio of 60%, consistent with obstructive disease.", + "actual_diagnosis": "18. Chronic obstructive pulmonary disease, ICD-10 code J44.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with progressive chorea and cognitive decline over the past year. Physical examination reveals involuntary movements, slurred speech, and rigidity. Family history is significant for Huntington's disease, with her mother diagnosed in her early 50s. Genetic testing confirms the CAG repeat expansion in the HTT gene.", + "actual_diagnosis": "20. Huntington's disease, ICD-10 code G10" + }, + { + "doctor_vignette": "A 12-year-old male presents with a chief complaint of persistent wheezing and coughing, especially at night. Physical exam reveals prolonged expiratory phase and use of accessory muscles for breathing. Peak expiratory flow rate is measured at 60% of predicted values, indicating significant airway obstruction. No acute infections are noted on chest X-ray, ruling out pneumonia.", + "actual_diagnosis": "17. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 68-year-old female presents with a chief complaint of persistent back pain after a recent fall. Physical examination reveals a stooped posture and tenderness over the lumbar spine. A DEXA scan shows a T-score of -3.2, indicating severe osteoporosis. No fractures are noted on X-ray, but the patient's history of frequent falls raises concerns for future complications.", + "actual_diagnosis": "6. Osteoporosis, ICD-10 code M81.0" + }, + { + "doctor_vignette": "A 10-year-old female presents with a chief complaint of frequent respiratory infections and persistent cough. On physical examination, she has fingertip clubbing and wheezing upon auscultation. Sweat chloride test reveals a high chloride concentration of 90 mmol/L, consistent with cystic fibrosis.", + "actual_diagnosis": "9. Cystic fibrosis, ICD-10 code E84.9" + }, + { + "doctor_vignette": "A 26-year-old female presents with a chief complaint of persistent abdominal pain and diarrhea for the past three months. On physical examination, she has tenderness in the right lower quadrant and signs of malnutrition. Laboratory tests reveal elevated C-reactive protein (CRP) and anemia, while a CT scan shows thickening of the terminal ileum consistent with inflammation.", + "actual_diagnosis": "8. Crohn's disease, ICD-10 code K50.90" + }, + { + "doctor_vignette": "A 58-year-old male presents to the emergency department with chest pain radiating to his left arm, accompanied by shortness of breath and diaphoresis. On examination, he is diaphoretic and has a blood pressure of 90/60 mmHg, with a heart rate of 100 bpm and an irregular rhythm. An ECG shows ST-segment elevation in the anterior leads, and cardiac troponin levels are elevated at 5.0 ng/mL, indicating myocardial injury.", + "actual_diagnosis": "7. Acute myocardial infarction, ICD-10 code I21.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with fatigue, weight gain, and cold intolerance. On physical examination, she has dry skin, thinning hair, and bradycardia. Laboratory tests reveal an elevated TSH level of 8.5 mIU/L and a low free T4 level of 0.7 ng/dL, indicating hypothyroidism.", + "actual_diagnosis": "11. Hypothyroidism, ICD-10 code E03.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with complaints of gradual peripheral vision loss over the past year. On physical examination, the intraocular pressure is measured at 28 mmHg in both eyes, and a visual field test reveals significant constriction of the visual fields. Fundoscopic examination shows cupping of the optic nerves consistent with glaucoma.", + "actual_diagnosis": "13. Glaucoma, ICD-10 code H40.9" + }, + { + "doctor_vignette": "A 62-year-old male presents to the emergency department with a chief complaint of high fever and confusion for the past two days. On physical exam, he is noted to be tachycardic with a heart rate of 120 bpm, hypotensive with a blood pressure of 85/55 mmHg, and has warm, flushed skin. Laboratory results reveal a white blood cell count of 18,000 cells/mm\u00b3 and blood cultures are pending, suggesting a possible infectious source.", + "actual_diagnosis": "14. Sepsis, ICD-10 code A41.9" + }, + { + "doctor_vignette": "A 12-year-old female presents with a chief complaint of wheezing and shortness of breath, especially at night and during physical activity. On physical examination, she exhibits prolonged expiratory wheezes and uses accessory muscles for breathing. Peak flow measurements show a marked reduction in her expiratory flow rate, indicating significant airway obstruction.", + "actual_diagnosis": "16. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 24-year-old male presents with auditory hallucinations and delusions of persecution, stating that he believes he is being watched. On examination, he appears disheveled, with flat affect and disorganized speech. Neurological exam is unremarkable, and routine blood tests show no abnormalities. A psychiatric evaluation confirms the presence of psychotic symptoms persisting for over six months.", + "actual_diagnosis": "15. Schizophrenia, ICD-10 code F20.9" + }, + { + "doctor_vignette": "A 10-year-old male presents with recurrent joint swelling and pain in his knees after minor injuries. On physical examination, there is notable swelling and tenderness in the right knee joint, and he has a history of easy bruising. Laboratory tests reveal a significantly prolonged activated partial thromboplastin time (aPTT) with normal prothrombin time (PT) and low factor VIII levels.", + "actual_diagnosis": "17. Hemophilia A, ICD-10 code D66" + }, + { + "doctor_vignette": "A 24-year-old male presents with chronic lower back pain and stiffness that improves with physical activity but worsens at rest. On physical examination, he exhibits decreased lumbar flexion and tenderness over the sacroiliac joints. MRI of the pelvis reveals bilateral sacroiliitis. He also tests positive for HLA-B27 antigen.", + "actual_diagnosis": "18. Ankylosing spondylitis, ICD-10 code M45.9" + }, + { + "doctor_vignette": "A 55-year-old male presents with severe pain and swelling in his right big toe that began suddenly overnight. On examination, the joint is erythematous, warm, and exquisitely tender to touch. Elevated serum uric acid levels of 8.5 mg/dL are noted, and joint aspiration reveals needle-shaped crystals under polarized light.", + "actual_diagnosis": "20. Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "An 8-year-old boy presents with complaints of difficulty concentrating in school and impulsiveness at home. On examination, he exhibits fidgeting behavior and struggles to stay seated during the visit. No laboratory tests are indicated for diagnosis, but teacher reports confirm persistent inattention and hyperactivity across multiple settings.", + "actual_diagnosis": "21. Attention-deficit hyperactivity disorder (ADHD), ICD-10 code F90.9" + }, + { + "doctor_vignette": "A 45-year-old male presents for a routine check-up with complaints of fatigue and occasional chest discomfort. Physical examination reveals a BMI of 29, with a notable xanthoma on his elbows. Laboratory results show total cholesterol of 280 mg/dL, LDL of 180 mg/dL, and triglycerides of 200 mg/dL, indicating elevated lipid levels.", + "actual_diagnosis": "22. Hyperlipidemia, ICD-10 code E78.5" + }, + { + "doctor_vignette": "A 20-year-old female college student presents with fatigue and pallor. On physical examination, she exhibits conjunctival pallor and tachycardia. Laboratory results reveal a hemoglobin level of 10 g/dL and low ferritin levels of 8 ng/mL, indicating iron deficiency. The patient reports heavy menstrual periods, which may contribute to her condition.", + "actual_diagnosis": "19. Iron deficiency anemia, ICD-10 code D50.9" + }, + { + "doctor_vignette": "A 58-year-old male with a history of diabetes and hypertension presents with fatigue and swelling in his legs. On physical exam, he has elevated blood pressure, bilateral lower extremity edema, and decreased urine output. Laboratory results show a serum creatinine level of 8.5 mg/dL and a glomerular filtration rate (GFR) of 10 mL/min, indicating severe renal impairment.", + "actual_diagnosis": "23. End-stage renal disease, ICD-10 code N18.6" + }, + { + "doctor_vignette": "A 22-year-old female college student presents with excessive daytime sleepiness and episodes of sudden muscle weakness triggered by laughter. Physical examination reveals no neurological deficits, but the patient reports difficulty staying awake during lectures and frequent naps throughout the day. A polysomnography study shows short sleep latency and REM sleep onset within 15 minutes, consistent with narcolepsy.", + "actual_diagnosis": "25. Narcolepsy, ICD-10 code G47.419" + }, + { + "doctor_vignette": "A 55-year-old male presents with progressive muscle weakness and difficulty speaking over the past six months. Physical examination reveals fasciculations in the tongue, atrophy of the hand muscles, and hyperreflexia in the lower extremities. Electromyography shows widespread denervation and reinnervation patterns, supporting a diagnosis of motor neuron disease.", + "actual_diagnosis": "24. Amyotrophic lateral sclerosis, ICD-10 code G12.21" + }, + { + "doctor_vignette": "A 30-year-old female veteran presents with persistent nightmares and flashbacks related to her combat experience. On examination, she exhibits signs of hypervigilance and avoids discussions about her military service. There are no abnormal lab results, but a PTSD checklist reveals significant distress. She reports difficulty concentrating and has a heightened startle response.", + "actual_diagnosis": "Post-traumatic stress disorder, ICD-10 code F43.12" + }, + { + "doctor_vignette": "A 65-year-old male presents with a chief complaint of worsening cough and shortness of breath over the past three days. On physical examination, he exhibits decreased breath sounds and crackles in the right lower lung field. A chest X-ray reveals a right lower lobe infiltrate, and a rapid influenza test is positive for influenza A.", + "actual_diagnosis": "Pneumonia due to influenza, ICD-10 code J10.9" + }, + { + "doctor_vignette": "A 3-year-old male presents with a chief complaint of ear pain and irritability for the past two days. On physical examination, the child exhibits a fever of 102\u00b0F, and the otoscopic exam reveals a bulging, erythematous tympanic membrane in the right ear with decreased mobility. No imaging is necessary as the clinical findings are consistent with the diagnosis.", + "actual_diagnosis": "Acute otitis media, ICD-10 code H65.9" + }, + { + "doctor_vignette": "A 5-year-old male presents with a chief complaint of fatigue and frequent infections. Physical examination reveals significant muscle wasting, a distended abdomen, and skin changes indicating edema. Laboratory tests show a serum albumin level of 2.0 g/dL and a weight-for-height z-score below -3 standard deviations, consistent with severe acute malnutrition.", + "actual_diagnosis": "Severe acute malnutrition, ICD-10 code E40" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of painful anal bleeding during bowel movements that has persisted for two weeks. On physical examination, there are external hemorrhoids visible at the anal verge, and tenderness is noted on palpation. No significant lab or imaging results are required for diagnosis, as the findings are consistent with hemorrhoidal disease.", + "actual_diagnosis": "Hemorrhoids, ICD-10 code I84.9" + }, + { + "doctor_vignette": "A 22-year-old female college student presents with excessive daytime sleepiness, experiencing uncontrollable sleep episodes during lectures and while studying. On physical examination, she shows no neurological deficits, but reports cataplexy episodes triggered by laughter. Polysomnography reveals a shortened sleep latency of 2 minutes and multiple sleep-onset REM periods.", + "actual_diagnosis": "Narcolepsy, ICD-10 code G47.4" + }, + { + "doctor_vignette": "A 35-year-old female presents with persistent headaches, palpitations, and episodes of sweating. On examination, her blood pressure is noted to be 180/110 mmHg during these episodes. Urinary catecholamine levels are significantly elevated, and a CT scan reveals a 3 cm adrenal mass consistent with a pheochromocytoma.", + "actual_diagnosis": "Pheochromocytoma, ICD-10 code C74.1" + }, + { + "doctor_vignette": "A 35-year-old female presents with a chief complaint of persistent fatigue lasting over six months, unrelieved by rest. Physical examination reveals mild cervical lymphadenopathy and tenderness in the muscles. Laboratory tests show normal complete blood count and thyroid function, ruling out other causes of fatigue.", + "actual_diagnosis": "Chronic fatigue syndrome, ICD-10 code G93.3" + }, + { + "doctor_vignette": "A 12-year-old female presents with her mother, complaining of dark, velvety patches on her neck and armpits that have been gradually increasing over the past six months. Physical examination reveals thickened, hyperpigmented skin in these areas, with no signs of inflammation or pruritus. Laboratory tests show elevated insulin levels, and the patient's BMI is in the 95th percentile, indicating obesity.", + "actual_diagnosis": "Acanthosis nigricans, ICD-10 code L82" + }, + { + "doctor_vignette": "A 45-year-old male presents with elevated cholesterol levels and a recent history of chest pain. Physical examination reveals xanthomas on the elbows and tendons, along with a BMI of 32. Laboratory tests show a total cholesterol level of 320 mg/dL and triglycerides at 180 mg/dL, indicating a lipid metabolism disorder.", + "actual_diagnosis": "Lipid metabolism disorder, ICD-10 code E78.9" + }, + { + "doctor_vignette": "A 4-year-old male presents with a 5-day history of fever, conjunctivitis, and a rash. On examination, he has swollen cervical lymph nodes and cracked lips. Laboratory tests show elevated inflammatory markers, including an increased ESR and CRP, along with thrombocytosis. Echocardiogram reveals a dilated coronary artery, raising concern for vasculitis.", + "actual_diagnosis": "Kawasaki disease, ICD-10 code I00" + }, + { + "doctor_vignette": "A 45-year-old male presents with fatigue, jaundice, and abdominal discomfort. On physical examination, he has palpable hepatomegaly and scleral icterus. Laboratory tests reveal elevated liver enzymes (AST 150 U/L, ALT 180 U/L) and positive anti-HCV antibodies, confirming chronic hepatitis C infection.", + "actual_diagnosis": "Hepatitis C, ICD-10 code B18.2" + }, + { + "doctor_vignette": "A 28-year-old female presents with sudden onset of lower extremity weakness and sensory loss. On physical examination, she demonstrates decreased strength in both legs, along with hyperreflexia and a sensory level at T10. MRI of the spine reveals a T2 hyperintense lesion involving the spinal cord at the thoracic level, consistent with inflammation. Laboratory tests show elevated oligoclonal bands in the cerebrospinal fluid, indicating an inflammatory process.", + "actual_diagnosis": "Transverse myelitis, ICD-10 code G37.3" + }, + { + "doctor_vignette": "A 25-year-old male presents to the emergency department with difficulty breathing and swelling of the lips after eating a peanut butter sandwich. Physical examination reveals wheezing, urticaria on the trunk, and hypotension. Serum tryptase is elevated, confirming an anaphylactic reaction.", + "actual_diagnosis": "Anaphylaxis due to food, ICD-10 code T78.2" + }, + { + "doctor_vignette": "A 68-year-old female presents with a chief complaint of persistent knee pain that worsens with activity and improves with rest. On physical examination, there is notable crepitus and tenderness over the medial aspect of the right knee, along with decreased range of motion. X-rays reveal joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "Osteoarthritis, ICD-10 code M17.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with persistent fatigue and unexplained weight loss over the past three months. Physical examination reveals lymphadenopathy in the cervical and axillary regions, as well as splenomegaly. A CT scan of the abdomen shows enlarged lymph nodes in the retroperitoneal space, and a biopsy confirms lymphoproliferative disorder. Blood tests reveal elevated lactate dehydrogenase (LDH) levels and anemia.", + "actual_diagnosis": "Non-Hodgkin lymphoma, ICD-10 code C85.90" + }, + { + "doctor_vignette": "A 24-year-old female presents with excessive daytime sleepiness and episodes of sudden muscle weakness triggered by laughter. Physical examination reveals no neurological deficits, but the patient is observed to fall asleep during the visit. A polysomnography study shows reduced REM sleep latency and multiple sleep-onset REM periods, consistent with narcolepsy.", + "actual_diagnosis": "Narcolepsy, ICD-10 code G47.41" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of worsening cough and fever for the past three days. On examination, she has decreased breath sounds in the right lung and crackles on auscultation. A chest X-ray reveals right lower lobe infiltrates, and rapid influenza testing is positive for Influenza A.", + "actual_diagnosis": "Pneumonia due to influenza, ICD-10 code J10.1" + }, + { + "doctor_vignette": "A 5-year-old male presents with a 5-day history of high fever, persistent conjunctival injection, and a strawberry tongue. On physical examination, he has a diffuse rash and cervical lymphadenopathy. Laboratory tests reveal elevated inflammatory markers, including ESR and CRP, along with a normal white blood cell count.", + "actual_diagnosis": "Kawasaki disease, ICD-10 code I25.1" + }, + { + "doctor_vignette": "A 28-year-old female presents with joint pain and a rash on her cheeks that worsens with sun exposure. On physical exam, there is a butterfly rash noted on the face, and tenderness is present in multiple joints. Laboratory tests reveal a positive antinuclear antibody (ANA) test and elevated anti-double-stranded DNA antibodies.", + "actual_diagnosis": "Lupus erythematosus, systemic, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 3-year-old male presents with a high fever, irritability, and vomiting. On physical exam, he exhibits a positive Brudzinski's sign and neck stiffness. A lumbar puncture reveals cloudy cerebrospinal fluid with an elevated white blood cell count predominantly consisting of neutrophils, and a positive culture for Streptococcus pneumoniae.", + "actual_diagnosis": "Bacterial meningitis, ICD-10 code A37.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with fatigue and persistent lower extremity edema. On physical examination, there is notable bilateral pitting edema and a blood pressure of 150/90 mmHg. Laboratory tests reveal an elevated serum creatinine level of 2.5 mg/dL and a glomerular filtration rate (GFR) of 30 mL/min, indicating impaired kidney function.", + "actual_diagnosis": "8. Chronic kidney disease, ICD-10 code N18.9" + }, + { + "doctor_vignette": "A 68-year-old female presents with a chief complaint of persistent lower back pain that worsened over the past few months. On physical examination, she exhibits a decreased range of motion in the lumbar spine and has a noticeable kyphotic posture. A DEXA scan reveals a T-score of -2.8 in the lumbar spine, indicating significant bone density loss.", + "actual_diagnosis": "7. Osteoporosis, ICD-10 code M81.0" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of progressive loss of skin pigmentation over the past 6 months. Physical examination reveals well-defined, depigmented macules on the face, hands, and elbows. No other significant findings are noted, and laboratory tests show normal complete blood count and thyroid function tests, ruling out autoimmune conditions.", + "actual_diagnosis": "Vitiligo, ICD-10 code L80" + }, + { + "doctor_vignette": "A 10-year-old male presents with a chief complaint of wheezing and shortness of breath after playing soccer. On examination, he exhibits prolonged expiratory phase and diffuse wheezing bilaterally. A peak flow measurement shows a reading of 60% of his predicted value, indicating significant airway obstruction. A recent chest X-ray is unremarkable, ruling out other causes of his symptoms.", + "actual_diagnosis": "6. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 55-year-old male presents with a chief complaint of severe pain and swelling in his right big toe, which began suddenly overnight. On examination, the toe is erythematous, warm, and tender to touch, with marked swelling. Serum uric acid levels are found to be elevated at 9.2 mg/dL, supporting the diagnosis of gout.", + "actual_diagnosis": "10. Gout, ICD-10 code M10.9" + }, + { + "doctor_vignette": "A 29-year-old female presents with a chief complaint of unintentional weight loss and increased heart rate. On physical examination, she has a fine tremor in her hands, moist skin, and a palpable goiter. Laboratory tests reveal elevated free T4 and suppressed TSH levels, confirming hyperthyroidism.", + "actual_diagnosis": "13. Hyperthyroidism, ICD-10 code E05.90" + }, + { + "doctor_vignette": "A 72-year-old male presents to the emergency department with palpitations and shortness of breath for the past two days. On examination, his heart rate is irregularly irregular, and he exhibits mild edema in the lower extremities. An ECG shows atrial fibrillation with a rapid ventricular response, and a chest X-ray reveals mild cardiomegaly.", + "actual_diagnosis": "14. Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 42-year-old male presents with severe abdominal pain radiating to the back, onset after a weekend of heavy drinking. On physical examination, he is diaphoretic with tenderness in the epigastric region and decreased bowel sounds. Laboratory tests reveal elevated serum amylase and lipase levels, and an abdominal ultrasound shows peritoneal fluid and inflammation around the pancreas.", + "actual_diagnosis": "15. Acute pancreatitis, ICD-10 code K85.9" + }, + { + "doctor_vignette": "A 22-year-old male presents with auditory hallucinations and disorganized thoughts, stating he hears voices telling him to harm himself. On examination, he displays flat affect and poor eye contact, with no significant neurological deficits. Routine lab tests are unremarkable, and a CT scan of the brain shows no structural abnormalities, ruling out other causes of his symptoms.", + "actual_diagnosis": "18. Schizophrenia, ICD-10 code F20.9" + }, + { + "doctor_vignette": "A 35-year-old female presents with widespread musculoskeletal pain, fatigue, and sleep disturbances lasting over six months. On physical examination, tenderness is noted in multiple trigger points, including the neck, shoulders, and hips. Routine laboratory tests, including complete blood count and metabolic panel, show no abnormalities, and imaging studies reveal no structural issues. The patient reports significant daily functional impairment due to her symptoms.", + "actual_diagnosis": "17. Fibromyalgia, ICD-10 code M79.7" + }, + { + "doctor_vignette": "A 75-year-old male presents with shortness of breath and fatigue that worsens with exertion. Physical examination reveals bilateral lower extremity edema, jugular venous distention, and crackles upon auscultation of the lungs. A chest X-ray shows cardiomegaly and pulmonary congestion, while a B-type natriuretic peptide (BNP) level is significantly elevated at 900 pg/mL.", + "actual_diagnosis": "12. Congestive heart failure, ICD-10 code I50.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with worsening muscle weakness, particularly in her eyelids and limbs, that increases throughout the day. On examination, she exhibits ptosis and diplopia, with normal strength in the morning that declines by afternoon. Repetitive nerve stimulation test reveals a decremental response, and acetylcholine receptor antibody test returns positive. ", + "actual_diagnosis": "21. Myasthenia gravis, ICD-10 code G70.00" + }, + { + "doctor_vignette": "A 62-year-old male presents with worsening fatigue and decreased urine output over the past month. On physical exam, he has bilateral peripheral edema and a blood pressure of 180/100 mmHg. Laboratory tests reveal a serum creatinine level of 8.5 mg/dL and a glomerular filtration rate (GFR) of 10 mL/min, indicating severely impaired kidney function.", + "actual_diagnosis": "20. End-stage renal disease, ICD-10 code N18.6" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of persistent joint pain and fatigue. On physical examination, she has a butterfly-shaped rash on her face, along with swelling in her wrists and knees. Laboratory tests reveal a positive antinuclear antibody (ANA) test and elevated anti-dsDNA antibodies, with a mild anemia noted in her complete blood count.", + "actual_diagnosis": "11. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 19-year-old female presents with joint hypermobility and recurrent shoulder dislocations. Physical examination reveals hyperextensible skin and a positive Beighton score of 7/9. Family history is notable for similar symptoms in her mother and sister. Genetic testing confirms a mutation associated with Ehlers-Danlos syndrome.", + "actual_diagnosis": "22. Ehlers-Danlos syndrome, ICD-10 code Q79.6" + }, + { + "doctor_vignette": "A 10-year-old female presents with a chief complaint of persistent cough and recurrent respiratory infections. Physical examination reveals digital clubbing and wheezing on auscultation. Sweat chloride test shows elevated levels at 90 mmol/L, confirming the diagnosis.", + "actual_diagnosis": "24. Cystic fibrosis, ICD-10 code E84.9" + }, + { + "doctor_vignette": "A 35-year-old male presents with complaints of progressive enlargement of his hands and feet, along with facial changes such as a protruding jaw and enlarged nose. On physical examination, notable features include thickened skin, wider hands, and a prominent brow. Serum insulin-like growth factor 1 (IGF-1) levels are significantly elevated, and MRI reveals a pituitary adenoma. ", + "actual_diagnosis": "23. Acromegaly, ICD-10 code E22.0" + }, + { + "doctor_vignette": "A 7-year-old male presents with recurrent episodes of easy bruising and prolonged bleeding following minor injuries. On physical examination, multiple bruises of varying ages are noted on his arms and legs, and there is slight swelling in his right knee after a fall. APTT is significantly prolonged, while PT and platelet count remain normal, indicating a potential factor VIII deficiency.", + "actual_diagnosis": "25. Hemophilia A, ICD-10 code D66" + }, + { + "doctor_vignette": "A 24-year-old African American female presents to the emergency department with severe abdominal pain and fatigue. On physical examination, she exhibits splenomegaly and has pallor. Laboratory tests reveal a hemoglobin level of 6.5 g/dL, elevated reticulocyte count, and the presence of sickle-shaped red blood cells on the peripheral blood smear.", + "actual_diagnosis": "26. Sickle cell disease, ICD-10 code D57.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with swelling and pain in her right leg, particularly in the calf. On physical examination, there is notable tenderness and warmth in the affected area, with a positive Homan's sign. Doppler ultrasound confirms the presence of a thrombus in the right popliteal vein.", + "actual_diagnosis": "19. Deep vein thrombosis, ICD-10 code I82.90" + }, + { + "doctor_vignette": "A 30-year-old female presents with fatigue, weight loss, and increased pigmentation of her skin. On physical examination, she has low blood pressure and hyperkalemia is noted on her lab results. Serum cortisol levels are low, and an ACTH stimulation test shows inadequate response, confirming adrenal insufficiency.", + "actual_diagnosis": "27. Addison's disease, ICD-10 code E27.1" + }, + { + "doctor_vignette": "A 25-year-old male presents with progressive muscle weakness and atrophy in his lower extremities. On physical examination, he exhibits areflexia, high-arched feet, and a noticeable foot drop. Nerve conduction studies reveal reduced conduction velocities consistent with a demyelinating neuropathy. Genetic testing confirms a mutation in the PMP-22 gene, supporting the diagnosis.", + "actual_diagnosis": "28. Charcot-Marie-Tooth disease, ICD-10 code G60.0" + }, + { + "doctor_vignette": "A 25-year-old male presents with complaints of increasing chest pain and palpitations. Upon examination, he demonstrates a tall stature, long limbs, and arachnodactyly, with a high arched palate. An echocardiogram reveals a dilated aortic root consistent with Marfan syndrome.", + "actual_diagnosis": "30. Marfan syndrome, ICD-10 code Q87.4" + }, + { + "doctor_vignette": "A 25-year-old female presents with excessive daytime sleepiness and episodes of sudden muscle weakness triggered by laughter. Physical examination reveals no neurological deficits, but she demonstrates difficulty maintaining wakefulness during a brief cognitive assessment. Polysomnography indicates a short sleep latency and multiple sleep-onset REM periods, confirming the diagnosis.", + "actual_diagnosis": "29. Narcolepsy, ICD-10 code G47.419" + }, + { + "doctor_vignette": "A 65-year-old male presents with left calf swelling and pain after a long flight. Physical examination reveals a tender, swollen left calf with a positive Homan's sign. Ultrasound of the lower extremity shows a non-compressible deep vein consistent with thrombosis. D-dimer levels are elevated, further supporting the diagnosis.", + "actual_diagnosis": "Deep vein thrombosis, ICD-10 code I82.409" + }, + { + "doctor_vignette": "A 65-year-old male presents with a chief complaint of worsening shortness of breath and persistent cough for the past week. On physical examination, he exhibits fever, decreased breath sounds on the right side, and crackles upon auscultation. A chest X-ray reveals right lower lobe consolidation, and a PCR test confirms SARS-CoV-2 infection.", + "actual_diagnosis": "Pneumonia due to Covid-19, ICD-10 code U07.1" + }, + { + "doctor_vignette": "A 35-year-old female presents with a chief complaint of severe anxiety and palpitations. On examination, she is febrile with a temperature of 102\u00b0F, tachycardic at 150 beats per minute, and exhibits tremors and a diffuse goiter. Laboratory results show elevated free T4 levels at 5.5 ng/dL and suppressed TSH levels at <0.01 mIU/L.", + "actual_diagnosis": "Thyroid storm, ICD-10 code E05.0" + }, + { + "doctor_vignette": "A 67-year-old male presents with lower back pain radiating to both legs, worsening with walking and relieved by sitting. Physical examination reveals diminished reflexes in the lower extremities and bilateral lower limb weakness. MRI of the lumbar spine shows significant narrowing of the spinal canal at L3-L4 due to degenerative changes.", + "actual_diagnosis": "Spinal stenosis, ICD-10 code M48.0" + }, + { + "doctor_vignette": "A 25-year-old male presents to the emergency department with sudden-onset sharp chest pain and dyspnea after lifting heavy weights. On physical examination, he exhibits decreased breath sounds on the right side and hyper-resonance on percussion. A chest X-ray reveals a large right-sided pneumothorax with mediastinal shift. Oxygen saturation is 92% on room air.", + "actual_diagnosis": "Pneumothorax, ICD-10 code J93.9" + }, + { + "doctor_vignette": "A 19-year-old female presents with complaints of frequent episodes of binge eating followed by purging. On physical examination, she is underweight with a BMI of 17, dental erosion is noted, and her skin has signs of dehydration. Laboratory tests reveal hypokalemia and metabolic alkalosis.", + "actual_diagnosis": "Bulimia nervosa, ICD-10 code F50.2" + }, + { + "doctor_vignette": "A 67-year-old male presents with progressive stiffness and difficulty using his right hand, which he describes as feeling clumsy. On examination, there is marked rigidity in the right arm and an asymmetric posture with the right side slightly flexed. He exhibits a phenomenon known as 'alien hand syndrome,' where he cannot control his right hand's movements. MRI shows asymmetric cortical atrophy, particularly in the parietal and frontal lobes, consistent with corticobasal degeneration.", + "actual_diagnosis": "Corticobasal degeneration, ICD-10 code G31.8" + }, + { + "doctor_vignette": "An 11-year-old female presents with excessive thirst, frequent urination, and unexplained weight loss over the past month. Physical examination reveals dehydration and a fruity-smelling breath. Blood glucose level is found to be 350 mg/dL, and ketones are present in the urine.", + "actual_diagnosis": "4. Diabetes mellitus type 1, ICD-10 code E10.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of persistent knee pain that worsens with activity and improves with rest. On physical examination, there is tenderness and crepitus on palpation of the right knee, along with limited range of motion. X-rays reveal joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "6. Osteoarthritis, ICD-10 code M15.9" + }, + { + "doctor_vignette": "A 10-year-old male presents to the emergency department with a chief complaint of wheezing and shortness of breath after playing outside in cold weather. On physical examination, he exhibits prolonged expiratory phase, use of accessory muscles for breathing, and decreased breath sounds bilaterally. Peak expiratory flow rate is measured at 60% of predicted, indicating significant airflow obstruction.", + "actual_diagnosis": "7. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 24-year-old female presents with abdominal pain and diarrhea that has persisted for the last three months. On physical examination, she has tenderness in the right lower quadrant and a palpable mass. Laboratory tests reveal elevated C-reactive protein (CRP) and anemia, while a CT scan shows transmural inflammation of the terminal ileum with strictures.", + "actual_diagnosis": "9. Crohn's disease, ICD-10 code K50.90" + }, + { + "doctor_vignette": "A 24-year-old female presents with a chief complaint of extreme mood swings, ranging from euphoric to deeply depressed over the past six months. On physical examination, she demonstrates rapid speech and increased energy during the manic phase, while during the depressive phase, she appears lethargic and withdrawn. No significant lab abnormalities are noted, and a mood chart reveals episodes of mania and depression lasting several days each.", + "actual_diagnosis": "13. Bipolar disorder, ICD-10 code F31.9" + }, + { + "doctor_vignette": "A 25-year-old female presents to the emergency department after experiencing a generalized tonic-clonic seizure lasting approximately 3 minutes. On physical examination, she is alert but disoriented postictally, with no focal neurological deficits noted. A CT scan of the head is unremarkable, and routine blood tests show normal electrolyte levels. This is her first seizure episode.", + "actual_diagnosis": "14. Epilepsy, ICD-10 code G40.909" + }, + { + "doctor_vignette": "A 67-year-old male presents with fatigue and decreased urine output over the past month. Physical examination reveals bilateral lower extremity edema and hypertension. Laboratory tests show a serum creatinine level of 2.5 mg/dL and an estimated glomerular filtration rate (eGFR) of 45 mL/min, indicating stage 3 chronic kidney disease.", + "actual_diagnosis": "15. Chronic kidney disease stage 3, ICD-10 code N18.3" + }, + { + "doctor_vignette": "A 42-year-old female presents to the emergency department with severe right upper quadrant pain and nausea lasting 24 hours. On physical examination, she has tenderness in the right upper quadrant with a positive Murphy's sign. Laboratory tests reveal leukocytosis with a white blood cell count of 14,500/\u00b5L, and an abdominal ultrasound shows gallbladder wall thickening and pericholecystic fluid, consistent with acute cholecystitis.", + "actual_diagnosis": "11. Acute cholecystitis, ICD-10 code K81.0" + }, + { + "doctor_vignette": "A 68-year-old male presents with a chief complaint of tremors in his right hand that have progressively worsened over the last six months. During the physical exam, notable findings include a resting tremor, bradykinesia, and rigidity in the upper extremities. Dopamine transporter (DAT) imaging reveals decreased uptake in the putamen, consistent with Parkinsonian syndromes.", + "actual_diagnosis": "17. Parkinson's disease, ICD-10 code G20" + }, + { + "doctor_vignette": "A 72-year-old male presents to the emergency department with palpitations and shortness of breath that started suddenly three hours ago. Upon examination, his heart rate is irregularly irregular, and he has a blood pressure of 110/70 mmHg. An ECG reveals atrial fibrillation with a rapid ventricular response, and laboratory tests show elevated levels of BNP, indicating heart strain.", + "actual_diagnosis": "18. Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 12-year-old African American male presents with severe fatigue and recurrent pain episodes in his chest and abdomen. On physical examination, he has pallor and mild jaundice, with splenomegaly noted on palpation. A complete blood count reveals a hemoglobin level of 7.5 g/dL and a peripheral blood smear shows sickle-shaped red blood cells.", + "actual_diagnosis": "Sickle cell anemia, ICD-10 code D57.1" + }, + { + "doctor_vignette": "A 45-year-old male presents for a routine check-up, expressing concern about his family history of heart disease. Physical examination reveals a BMI of 30, with xanthomas noted on his elbows. Laboratory tests show elevated total cholesterol at 280 mg/dL and triglycerides at 180 mg/dL. LDL levels are significantly high at 170 mg/dL, prompting further evaluation.", + "actual_diagnosis": "19. Hyperlipidemia, ICD-10 code E78.5" + }, + { + "doctor_vignette": "A 67-year-old male presents with a chief complaint of persistent shortness of breath and a chronic cough with sputum production. On physical examination, he exhibits wheezing and prolonged expiration, along with decreased breath sounds bilaterally. A chest X-ray shows hyperinflation of the lungs, and spirometry reveals a FEV1/FVC ratio of 0.55, indicating obstructive lung disease.", + "actual_diagnosis": "5. Chronic obstructive pulmonary disease, ICD-10 code J44.9" + }, + { + "doctor_vignette": "A 28-year-old woman presents with fatigue and pallor. On physical examination, she has conjunctival pallor and tachycardia. Laboratory tests reveal a hemoglobin level of 9.2 g/dL, low ferritin of 10 ng/mL, and low serum iron. These findings are consistent with iron deficiency anemia.", + "actual_diagnosis": "11. Iron deficiency anemia, ICD-10 code D50.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of persistent heartburn and regurgitation, especially after meals. On physical examination, she has epigastric tenderness and reports a sour taste in her mouth. An upper endoscopy reveals erosive esophagitis, and a pH probe test shows abnormal acid exposure in the esophagus.", + "actual_diagnosis": "14. Gastroesophageal reflux disease, ICD-10 code K21.9" + }, + { + "doctor_vignette": "A 72-year-old female presents with increasing forgetfulness, particularly misplacing items and repeating questions. On physical examination, she shows signs of disorientation to time and place, along with mild aphasia. A CT scan of the head reveals generalized cortical atrophy, particularly in the temporal and parietal lobes, consistent with neurodegenerative changes. Neuropsychological testing indicates significant impairment in memory and executive function.", + "actual_diagnosis": "15. Alzheimer\u2019s disease, ICD-10 code G30.9" + }, + { + "doctor_vignette": "A 58-year-old female presents with swelling and pain in her left leg, which she noticed after a long-haul flight. On physical examination, there is significant unilateral edema and tenderness in the calf, with a positive Homan's sign. Doppler ultrasound reveals a thrombus in the left popliteal vein.", + "actual_diagnosis": "16. Deep vein thrombosis, ICD-10 code I82.409" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of worsening knee pain, especially during weight-bearing activities. On physical examination, there is noticeable crepitus, tenderness along the joint line, and limited range of motion in the right knee. An X-ray shows joint space narrowing and osteophyte formation, consistent with osteoarthritis.", + "actual_diagnosis": "8. Osteoarthritis of the knee, ICD-10 code M17.9" + }, + { + "doctor_vignette": "A 28-year-old female presents with a chief complaint of unintentional weight loss and increased anxiety. On physical examination, she exhibits a fine tremor, heat intolerance, and a rapid heart rate of 110 beats per minute. Laboratory tests reveal a suppressed TSH level and elevated free T4 and T3 levels, indicating hyperthyroidism.", + "actual_diagnosis": "17. Hyperthyroidism, ICD-10 code E05.90" + }, + { + "doctor_vignette": "A 35-year-old female presents with widespread musculoskeletal pain and fatigue persisting for over six months. Physical examination reveals tender points in multiple areas, including the neck, shoulders, and hips, with no significant neurological deficits. Comprehensive lab tests show normal results, ruling out other conditions such as rheumatoid arthritis and thyroid dysfunction.", + "actual_diagnosis": "21. Fibromyalgia, ICD-10 code M79.7" + }, + { + "doctor_vignette": "A 45-year-old female presents with a chief complaint of persistent joint pain and stiffness, particularly in the hands and wrists, which worsens in the morning. On physical exam, there is notable swelling and tenderness in the metacarpophalangeal joints bilaterally, along with a decreased range of motion. Laboratory tests reveal a positive rheumatoid factor and elevated C-reactive protein levels, indicating inflammation.", + "actual_diagnosis": "18. Rheumatoid arthritis, ICD-10 code M06.9" + }, + { + "doctor_vignette": "A 12-year-old male presents with a chief complaint of wheezing and shortness of breath, especially during physical activity. On physical examination, he exhibits prolonged expiratory wheezes and decreased breath sounds bilaterally. Peak expiratory flow rate (PEFR) is recorded at 60% of predicted, indicating significant airflow obstruction. No chest X-ray abnormalities are noted, supporting the diagnosis of asthma exacerbation.", + "actual_diagnosis": "20. Asthma, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 10-year-old male presents with persistent fatigue, fever, and easy bruising over the past month. Physical examination reveals pallor, petechiae on the extremities, and splenomegaly. Complete blood count shows leukocytosis with 80% lymphoblasts and thrombocytopenia. Bone marrow biopsy confirms the presence of acute lymphoblastic leukemia.", + "actual_diagnosis": "22. Acute lymphoblastic leukemia, ICD-10 code C91.0" + }, + { + "doctor_vignette": "A 32-year-old male presents for a routine check-up, reporting no specific complaints. Physical examination reveals a body mass index of 29 and xanthomas on his elbows. A lipid panel shows total cholesterol of 280 mg/dL and LDL cholesterol of 180 mg/dL. Family history is significant for hyperlipidemia and coronary artery disease.", + "actual_diagnosis": "23. Hyperlipidemia, ICD-10 code E78.5" + }, + { + "doctor_vignette": "An 18-month-old male presents with a 5-day history of high fever, persistent irritability, and a rash. On physical examination, he has conjunctival injection, cracked lips, and cervical lymphadenopathy. Laboratory tests reveal an elevated ESR and thrombocytosis, while echocardiography shows no coronary artery abnormalities.", + "actual_diagnosis": "Kawasaki disease, ICD-10 code I.max" + }, + { + "doctor_vignette": "A 68-year-old male presents to the emergency department with palpitations and shortness of breath that started abruptly over the last hour. Physical examination reveals an irregularly irregular pulse with a rapid heart rate of 130 beats per minute and bilateral lung crackles. An ECG shows atrial fibrillation with a rapid ventricular response, and a chest X-ray reveals mild pulmonary congestion.", + "actual_diagnosis": "25. Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 5-year-old male presents with a chief complaint of itchy, red patches on his arms and cheeks. Physical examination reveals dry, scaly skin with excoriated areas and erythematous lesions typical of atopic dermatitis. No lab tests are indicated, as the diagnosis is clinical based on the characteristic appearance of the skin.", + "actual_diagnosis": "24. Eczema, ICD-10 code L30.9" + }, + { + "doctor_vignette": "A 45-year-old female presents with recurrent episodes of vertigo lasting 20 minutes to several hours, accompanied by tinnitus and a sensation of fullness in the right ear. On physical examination, she demonstrates a positive Romberg test and nystagmus on lateral gaze. Audiometry reveals a moderate sensorineural hearing loss in the right ear, and an MRI of the brain shows no abnormalities, ruling out other causes of her symptoms.", + "actual_diagnosis": "Meniere's disease, ICD-10 code H81.1" + }, + { + "doctor_vignette": "A 68-year-old male presents with persistent abdominal pain and significant weight loss over the past few months. Physical examination reveals a palpable mass in the epigastric region and mild jaundice. A CT scan of the abdomen shows a thickened gastric wall and enlarged regional lymph nodes, while a biopsy confirms malignant cells consistent with gastric adenocarcinoma.", + "actual_diagnosis": "Stomach cancer, ICD-10 code C16.9" + }, + { + "doctor_vignette": "A 68-year-old female presents to the emergency department with confusion and a high fever of 39.5\u00b0C. On examination, she is hypotensive with a blood pressure of 85/50 mmHg, tachycardic at 120 bpm, and has cool, clammy skin. Laboratory results reveal leukocytosis with a white blood cell count of 18,000/\u00b5L and positive blood cultures for E. coli.", + "actual_diagnosis": "Septic shock, ICD-10 code R65.21" + }, + { + "doctor_vignette": "A 55-year-old male with a history of chronic alcoholism presents with hematemesis and melena. On physical exam, he is noted to have jaundice and ascites, along with spider angiomata. Liver function tests reveal elevated AST and ALT levels, and an abdominal ultrasound shows signs of portal hypertension with splenomegaly.", + "actual_diagnosis": "Esophageal varices, ICD-10 code I85.00" + }, + { + "doctor_vignette": "A 28-year-old female presents with fatigue, joint pain, and a facial rash that appears in a butterfly distribution across her cheeks. On examination, she has oral ulcers and signs of arthritis in her hands. Laboratory tests reveal a positive anti-nuclear antibody (ANA) test and low complement levels, consistent with systemic lupus erythematosus.", + "actual_diagnosis": "4. Systemic lupus erythematosus, ICD-10 code M32.9" + }, + { + "doctor_vignette": "A 10-year-old female presents with excessive thirst, frequent urination, and fatigue over the past two weeks. On physical examination, she is noted to have dry mucous membranes and weight loss of 5 kg since her last visit. Laboratory tests reveal a random blood glucose level of 350 mg/dL and an HbA1c of 11.5%.", + "actual_diagnosis": "6. Type 1 diabetes mellitus, ICD-10 code E10.9" + }, + { + "doctor_vignette": "A 67-year-old female presents with persistent right knee pain that worsens with activity and improves with rest. On physical examination, there is notable crepitus, decreased range of motion, and tenderness along the medial joint line. X-rays reveal joint space narrowing and osteophyte formation consistent with osteoarthritis.", + "actual_diagnosis": "9. Osteoarthritis of the knee, ICD-10 code M17.9" + }, + { + "doctor_vignette": "A 58-year-old male presents to the emergency department with severe chest pain radiating to his left arm and shortness of breath. Physical examination reveals diaphoresis, tachycardia, and elevated blood pressure. An ECG shows ST-segment elevations in leads II, III, and aVF, and cardiac troponin levels are markedly elevated. The patient has a history of hypertension and smoking.", + "actual_diagnosis": "11. Acute myocardial infarction, ICD-10 code I21.9" + }, + { + "doctor_vignette": "A 5-year-old male presents to the emergency department with a chief complaint of excessive bleeding following a minor fall while playing. On physical examination, there are multiple bruises on his arms and legs, and his right knee is swollen and tender. Laboratory tests reveal a prolonged activated partial thromboplastin time (aPTT) of 60 seconds, while prothrombin time (PT) and platelet count are normal.", + "actual_diagnosis": "7. Hemophilia A, ICD-10 code D66" + }, + { + "doctor_vignette": "A 62-year-old male presents with fatigue and persistent lower back pain. On physical examination, there is mild edema in the lower extremities and hypertension is noted at 150/90 mmHg. Laboratory results show an elevated serum creatinine level of 2.1 mg/dL and a glomerular filtration rate (GFR) of 45 mL/min, indicating moderate chronic kidney disease.", + "actual_diagnosis": "15. Chronic kidney disease, stage 3, ICD-10 code N18.30" + }, + { + "doctor_vignette": "A 22-year-old female presents to the emergency department after experiencing a generalized tonic-clonic seizure at home. On examination, she is postictal, exhibiting confusion and muscle soreness, with no focal neurological deficits noted. A CT scan of the head is unremarkable, and routine laboratory tests including electrolytes and toxicology screen return normal. The patient has no previous history of seizures.", + "actual_diagnosis": "13. Epilepsy, unspecified, ICD-10 code G40.909" + }, + { + "doctor_vignette": "A 72-year-old male presents with increasing shortness of breath and fatigue during exertion. Physical examination reveals a systolic ejection murmur best heard at the right second intercostal space, along with a weak pulse and elevated blood pressure. An echocardiogram shows a significantly narrowed aortic valve with a peak gradient of 60 mmHg and a left ventricular hypertrophy pattern on EKG.", + "actual_diagnosis": "17. Aortic stenosis, ICD-10 code I35.0" + }, + { + "doctor_vignette": "A 35-year-old female presents with widespread musculoskeletal pain and fatigue lasting for over six months. On physical examination, she exhibits tenderness in multiple trigger points, including the neck, shoulders, and lower back. Laboratory tests show normal complete blood count and metabolic panel, ruling out other conditions. No imaging studies were performed as they would not provide additional diagnostic information.", + "actual_diagnosis": "20. Fibromyalgia, ICD-10 code M79.7" + }, + { + "doctor_vignette": "A 12-year-old female presents to the emergency department with a chief complaint of shortness of breath and wheezing that worsened after playing outside. Physical examination reveals increased respiratory effort with a prolonged expiratory phase and diffuse wheezing on auscultation. Peak flow measurements indicate a significant reduction in airflow, at 60% of her personal best. There are no abnormal findings on chest X-ray, ruling out other acute respiratory conditions.", + "actual_diagnosis": "18. Asthma, unspecified, ICD-10 code J45.909" + }, + { + "doctor_vignette": "A 32-year-old female presents with complaints of unintentional weight loss, increased heart rate, and anxiety over the past three months. On examination, she exhibits a fine tremor in her hands, and her thyroid gland is palpably enlarged. Laboratory tests reveal elevated levels of free T4 and suppressed TSH.", + "actual_diagnosis": "9. Hyperthyroidism, ICD-10 code E05.90" + }, + { + "doctor_vignette": "A 65-year-old female presents with gradual vision loss and halos around lights. On examination, her intraocular pressure is found to be elevated at 28 mmHg in both eyes, and a visual field test reveals peripheral vision loss. Fundoscopic examination shows cupping of the optic nerve head, indicating possible glaucomatous damage.", + "actual_diagnosis": "12. Glaucoma, ICD-10 code H40.9" + }, + { + "doctor_vignette": "A 72-year-old female presents to the emergency department with palpitations and shortness of breath that started suddenly two hours ago. On physical examination, her heart rate is irregularly irregular at 130 beats per minute, and she has mild bilateral pedal edema. An ECG shows atrial fibrillation with a rapid ventricular response, and her electrolytes reveal hypokalemia.", + "actual_diagnosis": "13. Atrial fibrillation, ICD-10 code I48.91" + }, + { + "doctor_vignette": "A 70-year-old female presents with fatigue and weakness over the past few months. On physical examination, she has pale conjunctiva and mild splenomegaly. Laboratory tests reveal a hemoglobin level of 10 g/dL, low serum iron, and elevated ferritin levels, indicating anemia of chronic disease likely related to her history of rheumatoid arthritis.", + "actual_diagnosis": "16. Anemia due to chronic disease, ICD-10 code D63.8" + }, + { + "doctor_vignette": "A 25-year-old female presents with worsening muscle weakness, particularly in her eyelids and arms, over the past month. On physical examination, she exhibits ptosis and diplopia, with muscle strength significantly improved after rest and worsened with repetitive testing. Serological tests reveal positive acetylcholine receptor antibodies, supporting the diagnosis.", + "actual_diagnosis": "19. Myasthenia gravis, ICD-10 code G70.00" + }, + { + "doctor_vignette": "A 35-year-old male presents to the emergency department with severe epigastric pain radiating to the back, accompanied by nausea and vomiting. On physical examination, he has significant tenderness in the upper abdomen and is noted to have a mild fever. Laboratory tests reveal elevated serum amylase and lipase levels, and an abdominal ultrasound shows peritoneal fluid consistent with acute pancreatitis.", + "actual_diagnosis": "17. Acute pancreatitis, ICD-10 code K85.9" + }, + { + "doctor_vignette": "A 28-year-old female veteran presents with persistent anxiety and flashbacks to combat experiences. On physical examination, she exhibits hypervigilance and a startle response to sudden noises. She reports sleep disturbances and avoidance of situations that remind her of the trauma. No significant abnormalities are found on routine lab tests and imaging.", + "actual_diagnosis": "20. Post-traumatic stress disorder, ICD-10 code F43.12" + }, + { + "doctor_vignette": "A 65-year-old male presents with worsening fatigue and shortness of breath over the past month. Physical examination reveals bilateral lower extremity edema and a blood pressure of 180/100 mmHg. Laboratory tests show serum creatinine of 7.5 mg/dL and a BUN of 60 mg/dL, indicating severe renal dysfunction. Additionally, a urinalysis reveals proteinuria and hematuria.", + "actual_diagnosis": "18. End-stage renal disease, ICD-10 code N18.6" + }, + { + "doctor_vignette": "A 45-year-old male presents with complaints of progressive enlargement of his hands and feet over the past few years, along with noticeable facial changes including a protruding jaw and enlarged nose. Physical examination reveals increased hand and foot size, thickened skin, and frontal bossing. Serum IGF-1 levels are markedly elevated, and an MRI of the pituitary gland shows a large adenoma.", + "actual_diagnosis": "22. Acromegaly, ICD-10 code E22.0" + }, + { + "doctor_vignette": "A 32-year-old female presents with progressive dyspnea and a persistent dry cough over the past six months. On physical examination, she exhibits bilateral crackles on auscultation and clubbing of the fingers. A high-resolution CT scan of the chest reveals ground-glass opacities and reticular patterns consistent with interstitial lung disease. Pulmonary function tests show a restrictive pattern with a reduced forced vital capacity.", + "actual_diagnosis": "23. Interstitial lung disease, ICD-10 code J84.10" + }, + { + "doctor_vignette": "A 52-year-old female presents with a chief complaint of dry mouth and dry eyes for the past six months. On examination, she exhibits bilateral parotid gland enlargement and has a decreased tear production test. Laboratory findings reveal positive anti-Ro (SSA) antibodies and a labial salivary gland biopsy shows focal lymphocytic sialadenitis, consistent with Sj\u00f6gren's syndrome.", + "actual_diagnosis": "24. Sj\u00f6gren's syndrome, ICD-10 code M35.0" + }, + { + "doctor_vignette": "A 28-year-old female presents with persistent feelings of worry and restlessness over the past six months. On physical examination, she exhibits mild tachycardia and tremors of the hands. Routine lab tests, including complete blood count and thyroid function tests, return within normal limits, ruling out physiological causes of her symptoms.", + "actual_diagnosis": "Anxiety disorder, ICD-10 code F41.9" + }, + { + "doctor_vignette": "A 12-year-old African American male presents to the emergency department with severe abdominal pain and fatigue. On examination, he demonstrates pallor and jaundice, with splenomegaly noted on palpation. A complete blood count reveals a hemoglobin level of 6.5 g/dL and a peripheral blood smear shows sickle-shaped cells.", + "actual_diagnosis": "Sickle cell anemia, ICD-10 code D57.9" + }, + { + "doctor_vignette": "A 65-year-old male presents with persistent fatigue and unexplained weight loss over the past three months. On physical examination, he has palpable lymphadenopathy in the cervical and axillary regions as well as splenomegaly. Laboratory tests reveal elevated lactate dehydrogenase (LDH) and a lymphocyte count of 5,000/mm\u00b3. A CT scan of the abdomen shows enlarged lymph nodes in the retroperitoneal space.", + "actual_diagnosis": "Non-Hodgkin lymphoma, ICD-10 code C82.9" + }, + { + "doctor_vignette": "A 65-year-old male presents to the emergency department with a chief complaint of decreased urine output for the past 48 hours. Physical examination reveals hypertension and peripheral edema. Laboratory tests show elevated serum creatinine levels at 4.5 mg/dL and blood urea nitrogen (BUN) of 35 mg/dL, indicating acute renal impairment.", + "actual_diagnosis": "Acute renal failure, ICD-10 code N17.9" + }, + { + "doctor_vignette": "A 3-week-old male infant presents with a chief complaint of failure to pass meconium within the first 48 hours of life. Physical examination reveals abdominal distension and a palpable fecal mass in the lower abdomen. A contrast enema shows a narrow distal colon with proximal dilation, indicating a lack of ganglion cells.", + "actual_diagnosis": "Hirschsprung disease, ICD-10 code Q43.0" + }, + { + "doctor_vignette": "A 23-year-old female presents with left lower abdominal pain that started two days ago, worsening with movement. On physical examination, there is tenderness in the left adnexal area and a palpable mass. An ultrasound reveals a 5 cm simple cyst on the left ovary, with no signs of torsion or rupture.", + "actual_diagnosis": "25. Ovarian cyst, ICD-10 code N83.20" + }, + { + "doctor_vignette": "A 35-year-old female presents with progressive dysphagia for solids and liquids over the past six months, accompanied by episodes of regurgitation and weight loss. On physical examination, she is mildly dehydrated with a distended abdomen. A barium swallow study reveals a dilated esophagus and incomplete lower esophageal sphincter relaxation. Endoscopy shows no obstruction but confirms the absence of peristalsis in the esophagus.", + "actual_diagnosis": "Achalasia, ICD-10 code K22.0" + }, + { + "doctor_vignette": "A 62-year-old male presents with worsening shortness of breath over the past month. On physical examination, he has elevated blood pressure of 160/95 mmHg, bilateral lower extremity edema, and a third heart sound (S3 gallop). A recent echocardiogram reveals left ventricular hypertrophy and reduced ejection fraction of 45%.", + "actual_diagnosis": "5. Hypertensive heart disease, ICD-10 code I11.9" + }, + { + "doctor_vignette": "A 65-year-old female presents with a chief complaint of persistent knee pain that worsens with activity and improves with rest. On physical examination, there is notable crepitus and tenderness upon palpation of the medial joint line, along with a decreased range of motion. X-rays reveal joint space narrowing and osteophyte formation in the knee, consistent with degenerative changes.", + "actual_diagnosis": "7. Osteoarthritis, ICD-10 code M19.90" + }, + { + "doctor_vignette": "A 65-year-old male presents with a chief complaint of increasing shortness of breath and a persistent cough for the past six months. On physical exam, he has expiratory wheezes, decreased breath sounds, and a prolonged expiratory phase. A chest X-ray shows hyperinflated lungs, and spirometry reveals a FEV1/FVC ratio of 60%, indicating obstructive lung disease.", + "actual_diagnosis": "6. Chronic obstructive pulmonary disease, ICD-10 code J44.9" + } +] \ No newline at end of file diff --git a/IGNQuestions/results.json b/IGNQuestions/results.json new file mode 100644 index 00000000..c3a4e865 --- /dev/null +++ b/IGNQuestions/results.json @@ -0,0 +1,488 @@ +[ + { + "case_number": 1, + "doctor_vignette": "A 54-year-old female presents with persistent joint pain and swelling, primarily in her hands and wrists. On examination, there is significant tenderness, bilateral swelling, and morning stiffness lasting over an hour. Laboratory tests reveal elevated rheumatoid factor and anti-CCP antibodies, along with an increased ESR. X-rays show joint erosions in the metacarpophalangeal joints.", + "actual_diagnosis": "Rheumatoid arthritis, ICD-10 code M05.79", + "diseases": [ + "Rheumatoid Arthritis", + "Psoriatic Arthritis", + "Systemic Lupus Erythematosus", + "Sj\u00f6gren's Syndrome", + "Gout", + "Osteoarthritis", + "Infectious Arthritis", + "Reactive Arthritis", + "Polymyalgia Rheumatica", + "Tendinitis" + ], + "question": "Have you noticed any nodules or lumps near your joints?" + }, + { + "case_number": 2, + "doctor_vignette": "A 67-year-old male presents with a chief complaint of increasing shortness of breath and a chronic cough producing sputum for the past few months. Physical examination reveals prolonged expiratory phase, wheezing, and decreased breath sounds bilaterally. A chest X-ray shows hyperinflation of the lungs, and spirometry indicates a reduced FEV1/FVC ratio consistent with obstructive airway disease.", + "actual_diagnosis": "Chronic obstructive pulmonary disease, ICD-10 code J44.9", + "diseases": [ + "Chronic Obstructive Pulmonary Disease", + "Asthma", + "Bronchiectasis", + "Pulmonary Fibrosis", + "Lung Cancer", + "Congestive Heart Failure", + "Interstitial Lung Disease", + "Chronic Bronchitis", + "Pulmonary Embolism", + "Pneumonia" + ], + "question": "Has your cough worsened over time?" + }, + { + "case_number": 3, + "doctor_vignette": "A 28-year-old female presents with chronic diarrhea and abdominal bloating that has persisted for several months. On physical examination, she has notable weight loss and signs of malnutrition, including dry skin and hair loss. Serological tests reveal elevated tissue transglutaminase antibodies (tTG-IgA) and positive IgA endomysial antibodies, suggesting an autoimmune process. A subsequent duodenal biopsy confirms the presence of villous atrophy.", + "actual_diagnosis": "Celiac disease, ICD-10 code K90.0", + "diseases": [ + "Celiac Disease", + "Irritable Bowel Syndrome", + "Lactose Intolerance", + "Inflammatory Bowel Disease", + "Chronic Pancreatitis", + "Small Intestinal Bacterial Overgrowth", + "Celiac Disease-Associated Malignancy", + "Hypothyroidism", + "Food Allergies", + "Gastrointestinal Infection" + ], + "question": "Are you currently taking any medications, including over-the-counter supplements?" + }, + { + "case_number": 4, + "doctor_vignette": "A 58-year-old male presents to the emergency department with severe chest pain radiating to his left arm, accompanied by shortness of breath. On physical examination, he is diaphoretic and has a blood pressure of 90/60 mmHg with an elevated heart rate of 110 bpm. An ECG shows ST-segment elevation in the anterior leads, and cardiac troponin levels are significantly elevated. ", + "actual_diagnosis": "Acute myocardial infarction, ICD-10 code I21.9", + "diseases": [ + "Myocardial Infarction", + "Unstable Angina", + "Aortic Dissection", + "Pulmonary Embolism", + "Pneumothorax", + "Acute Heart Failure", + "Acute Coronary Syndrome", + "Pericarditis", + "Gastric Ulcer Perforation", + "Esophageal Rupture" + ], + "question": "Have you had any recent changes in your physical activity level?" + }, + { + "case_number": 5, + "doctor_vignette": "A 68-year-old male presents with a chief complaint of tremors in his right hand that have progressively worsened over the past year. Physical examination reveals a resting tremor, bradykinesia, and rigidity in the upper limbs. There is a shuffling gait noted during ambulation, and he demonstrates difficulty initiating movement. MRI of the brain shows no acute changes, supporting the clinical diagnosis of Parkinson's disease.", + "actual_diagnosis": "Parkinson's disease, ICD-10 code G20", + "diseases": [ + "Parkinson's Disease", + "Essential Tremor", + "Corticobasal Degeneration", + "Dementia with Lewy Bodies", + "Multiple System Atrophy", + "Alzheimer's Disease", + "Vascular Parkinsonism", + "Drug-Induced Parkinsonism", + "Wilson's Disease", + "Huntington's Disease" + ], + "question": "Are you currently seeing any other specialists for your symptoms?" + }, + { + "case_number": 6, + "doctor_vignette": "A 10-year-old male presents with recurrent episodes of spontaneous bleeding from the gums and prolonged bleeding after minor cuts. Physical examination reveals easy bruising and joint swelling in the knees. Laboratory tests show aPTT of 60 seconds (normal 30-40 seconds) and normal PT, indicating a deficiency in factor VIII.", + "actual_diagnosis": "Hemophilia A, ICD-10 code D66", + "diseases": [ + "Hemophilia A", + "Von Willebrand Disease", + "Acquired Hemophilia", + "Liver Disease", + "Platelet Dysfunction", + "Factor XI Deficiency", + "Vitamin K Deficiency", + "Disseminated Intravascular Coagulation", + "Thrombocytopenic Purpura", + "Sepsis" + ], + "question": "Have you had any rashes or unusual skin markings that resemble bruising?" + }, + { + "case_number": 7, + "doctor_vignette": "A 10-year-old female presents with a chief complaint of wheezing and shortness of breath, especially during play and at night. Physical examination reveals diffuse wheezing on auscultation and decreased breath sounds. Peak expiratory flow rate measurement shows a reduction of 60% from her personal best, indicating obstructive airflow limitation.", + "actual_diagnosis": "Asthma, ICD-10 code J45.909", + "diseases": [ + "Asthma", + "Exercise-Induced Bronchospasm", + "Allergic Rhinitis", + "Respiratory Syncytial Virus Infection", + "Viral Croup", + "Bronchial Hyperreactivity", + "Foreign Body Aspiration", + "Chronic Obstructive Pulmonary Disease", + "Vocal Cord Dysfunction", + "Anaphylaxis" + ], + "question": "Is there a family history of asthma or other allergic conditions?" + }, + { + "case_number": 8, + "doctor_vignette": "A 35-year-old female presents with unintentional weight loss, increased anxiety, and palpitations over the past month. On examination, she has a rapid heart rate of 110 beats per minute, fine tremors in her hands, and an enlarged thyroid gland. Laboratory tests reveal elevated levels of free T4 and suppressed TSH, confirming hyperthyroidism.", + "actual_diagnosis": "Hyperthyroidism, ICD-10 code E05.90", + "diseases": [ + "Graves' Disease", + "Thyroiditis (Subacute or Lymphocytic)", + "Toxic Multinodular Goiter", + "Thyroid Hormone Resistance", + "Pheochromocytoma", + "Anxiety Disorder", + "Hyperthyroid-related Cardiovascular Events", + "Caffeine-induced Anxiety and Tachycardia", + "Systemic Lupus Erythematosus", + "Hyperparathyroidism" + ], + "question": "Have you experienced any swelling in your legs or feet?" + }, + { + "case_number": 9, + "doctor_vignette": "A 28-year-old female presents with a chief complaint of persistent joint pain and fatigue for the past three months. Physical examination reveals a butterfly rash across her cheeks and photosensitivity. Laboratory tests show elevated anti-nuclear antibodies (ANA) and low complement levels, consistent with autoimmune activity.", + "actual_diagnosis": "Systemic lupus erythematosus, ICD-10 code M32.9", + "diseases": [ + "Systemic Lupus Erythematosus", + "Rheumatoid Arthritis", + "Sj\u00f6gren's Syndrome", + "Dermatomyositis", + "Mixed Connective Tissue Disease", + "Psoriatic Arthritis", + "Systemic Sclerosis", + "Hypothyroidism", + "Vasculitis", + "Fibromyalgia" + ], + "question": "Do you have a history of sunburn or skin rashes after sun exposure?" + }, + { + "case_number": 10, + "doctor_vignette": "A 65-year-old female presents with persistent fatigue and mild lower extremity edema. On physical examination, she has elevated blood pressure and decreased urine output. Laboratory results reveal a serum creatinine level of 2.5 mg/dL and a glomerular filtration rate (GFR) of 30 mL/min, indicating significant renal impairment.", + "actual_diagnosis": "Chronic kidney disease, ICD-10 code N18.9", + "diseases": [ + "Chronic Kidney Disease", + "Hypertensive Nephropathy", + "Heart Failure", + "Diabetes Mellitus with Renal Complications", + "Acute Kidney Injury", + "Chronic Glomerulonephritis", + "Nephrotic Syndrome", + "Acute Tubular Necrosis", + "Renal Artery Stenosis", + "Multiple Myeloma" + ], + "question": "Do you have a history of heart disease or congestive heart failure?" + }, + { + "case_number": 11, + "doctor_vignette": "A 10-year-old male presents with a chief complaint of persistent cough and difficulty breathing. Physical exam reveals digital clubbing and wheezing on auscultation. A sweat test demonstrates an elevated chloride level of 80 mmol/L, confirming the suspicion of cystic fibrosis.", + "actual_diagnosis": "Cystic fibrosis, ICD-10 code E84.9", + "diseases": [ + "Cystic Fibrosis", + "Asthma", + "Bronchiectasis", + "Allergic Bronchopulmonary Aspergillosis", + "Chronic Obstructive Pulmonary Disease", + "Interstitial Lung Disease", + "Pulmonary Edema", + "Tuberculosis", + "Foreign Body Aspiration", + "Lung Cancer" + ], + "question": "Have you noticed any changes in your weight or growth patterns?" + }, + { + "case_number": 12, + "doctor_vignette": "A 55-year-old male presents with severe pain and swelling in his right big toe, which started suddenly during the night. On examination, the toe is erythematous, warm, and tender to touch, with limited range of motion. Serum uric acid levels are markedly elevated at 9.2 mg/dL, and joint aspiration reveals needle-shaped monosodium urate crystals under polarized light.", + "actual_diagnosis": "Gout, ICD-10 code M10.9", + "diseases": [ + "Gouty Arthritis", + "Pseudogout (Calcium Pyrophosphate Deposition Disease)", + "Septic Arthritis", + "Osteoarthritis", + "Rheumatoid Arthritis", + "Traumatic Arthritis", + "Psoriatic Arthritis", + "Infectious Tenosynovitis", + "Bursitis", + "Transient Synovitis" + ], + "question": "Have you noticed any other joint swelling or pain in your body?" + }, + { + "case_number": 13, + "doctor_vignette": "A 22-year-old female presents with excessive daytime sleepiness and episodes of sudden muscle weakness triggered by laughter. Physical examination reveals normal neurological function except for mild cataplexy. Polysomnography shows decreased REM latency and multiple sleep onset REM periods. The MSLT confirms a mean sleep latency of 4 minutes with two sleep-onset REM episodes.", + "actual_diagnosis": "Narcolepsy, ICD-10 code G47.419", + "diseases": [ + "Narcolepsy Type 1", + "Obstructive Sleep Apnea", + "Idiopathic Hypersomnia", + "Periodic Limb Movement Disorder", + "Multiple Sclerosis", + "Hypothyroidism", + "Psychoactive Substance Induced Sleep Disorder", + "Klein-Levin Syndrome", + "Depression", + "Chronic Fatigue Syndrome" + ], + "question": "Do you often feel a sudden urge to sleep during daytime activities?" + }, + { + "case_number": 14, + "doctor_vignette": "A 65-year-old male with a history of chronic obstructive pulmonary disease presents with a chief complaint of worsening cough and fever for three days. Physical examination reveals decreased breath sounds and dullness to percussion in the right lower lung field. A chest X-ray shows a right lower lobe consolidation, and sputum culture identifies Klebsiella pneumoniae.", + "actual_diagnosis": "Pneumonia due to Klebsiella pneumoniae, ICD-10 code J15.0", + "diseases": [ + "Klebsiella pneumonia", + "Acute bronchitis", + "Lung abscess", + "Chronic Obstructive Pulmonary Disease exacerbation", + "Pulmonary embolism", + "Lung cancer", + "Pleural effusion", + "Tuberculosis", + "Pneumothorax", + "Asthma exacerbation" + ], + "question": "Are you currently experiencing any joint pain or stiffness?" + }, + { + "case_number": 15, + "doctor_vignette": "A 45-year-old female presents with progressive chorea and difficulty with coordination over the past year. Neurological examination reveals abnormal movements of her limbs and facial grimacing, along with mild cognitive decline. Genetic testing reveals the presence of the CAG repeat expansion in the HTT gene, confirming the diagnosis.", + "actual_diagnosis": "Huntington's disease, ICD-10 code G10", + "diseases": [ + "Huntington's Disease", + "Wilson's Disease", + "Chorea due to Thyrotoxicosis", + "Parkinson's Disease", + "Subacute Sclerosing Panencephalitis", + "Multiple Sclerosis", + "Sydenham's Chorea", + "Drug-induced Chorea", + "Cerebral Vascular Accident", + "Normal Pressure Hydrocephalus" + ], + "question": "Are you currently taking any medications for neurological or psychiatric issues?" + }, + { + "case_number": 16, + "doctor_vignette": "A 28-year-old female presents with a chief complaint of recurrent abdominal pain and bloating, often relieved by defecation. Physical examination reveals mild tenderness in the lower abdomen without guarding or rebound tenderness. Laboratory tests, including complete blood count and metabolic panel, are unremarkable, and no imaging studies are indicated. The symptoms have been occurring for over six months with no identifiable organic cause.", + "actual_diagnosis": "Irritable bowel syndrome, ICD-10 code K58.9", + "diseases": [ + "Irritable Bowel Syndrome", + "Functional Dyspepsia", + "Celiac Disease", + "Lactose Intolerance", + "Bacterial Overgrowth", + "Crohn's Disease", + "Ulcerative Colitis", + "Pelvic Inflammatory Disease", + "Endometriosis", + "Gastroesophageal Reflux Disease" + ], + "question": "Do you often notice mucus in your stools?" + }, + { + "case_number": 17, + "doctor_vignette": "A 5-year-old boy presents with recurrent fractures after minimal trauma. On physical examination, he has blue sclera and a noticeable bowing of his lower limbs. X-rays reveal multiple healed and healing fractures in various stages, along with osteopenic changes. Genetic testing confirms a mutation in the COL1A1 gene, consistent with osteogenesis imperfecta.", + "actual_diagnosis": "Osteogenesis imperfecta, ICD-10 code Q78.0", + "diseases": [ + "Osteogenesis Imperfecta", + "Familial Osteoporosis", + "Non-accidental Trauma", + "Rickets due to Vitamin D Deficiency", + "Brittle Bone Disease", + "Hypophosphatasia", + "Marfan Syndrome", + "Ehlers-Danlos Syndrome", + "Childhood Cancer (e.g., Leukemia)", + "Osteomyelitis" + ], + "question": "Has the child previously been diagnosed with any genetic conditions?" + }, + { + "case_number": 18, + "doctor_vignette": "A 25-year-old female presents with persistent fatigue and recurrent infections over the past month. On physical examination, she exhibits pallor and petechiae on her extremities. Complete blood count reveals a hemoglobin level of 8 g/dL, a platelet count of 30,000/mm\u00b3, and a white blood cell count of 2,000/mm\u00b3, indicating severe cytopenias.", + "actual_diagnosis": "Aplastic anemia, ICD-10 code D61.9", + "diseases": [ + "Aplastic Anemia", + "Acute Leukemia", + "Hypoplastic Anemia", + "Myelodysplastic Syndromes", + "Autoimmune Thrombocytopenic Purpura", + "Paroxysmal Nocturnal Hemoglobinuria", + "Viral Infections (e.g., Epstein-Barr Virus)", + "Iron Deficiency Anemia", + "Bone Marrow Infiltration (e.g., Metastatic Disease)", + "Thiamine Deficiency (Wernicke's Encephalopathy)" + ], + "question": "Do you have any history of autoimmune diseases?" + }, + { + "case_number": 19, + "doctor_vignette": "A 10-year-old male of Mediterranean descent presents with fatigue and pallor. On physical examination, he has noticeable splenomegaly and conjunctival pallor. A complete blood count reveals microcytic anemia with a hemoglobin level of 8 g/dL and elevated levels of fetal hemoglobin (HbF).", + "actual_diagnosis": "Thalassemia, ICD-10 code D56.9", + "diseases": [ + "Sickle Cell Disease", + "Beta Thalassemia Major", + "Iron Deficiency Anemia", + "Acute Leukemia", + "Aplastic Anemia", + "Secondary Hemolytic Anemia", + "Hereditary Spherocytosis", + "G6PD Deficiency", + "Vitamin B12 Deficiency Anemia", + "Autoimmune Hemolytic Anemia" + ], + "question": "Do you have a history of fragile bones or fractures?" + }, + { + "case_number": 20, + "doctor_vignette": "A 34-year-old female presents with a chief complaint of recurrent headaches occurring more than 15 days per month for the past six months. Physical examination reveals tenderness in the pericranial muscles and no neurological deficits. A brain MRI shows no acute abnormalities, ruling out secondary causes of headache.", + "actual_diagnosis": "Chronic migraine, ICD-10 code G43.709", + "diseases": [ + "Tension-Type Headache", + "Migraine Without Aura", + "Cervicogenic Headache", + "Medication Overuse Headache", + "Chronic Daily Headache", + "Hypnic Headache", + "Post-Traumatic Headache", + "Cluster Headache", + "Psychomyogenic Headache", + "Secondary Headache (Unspecified Etiology)" + ], + "question": "Have you noticed any relationship between your menstrual cycle and the occurrence of headaches?" + }, + { + "case_number": 21, + "doctor_vignette": "A 52-year-old female presents with a chief complaint of persistent joint pain and swelling in her hands and wrists for the past three months. Physical examination reveals bilateral tenderness and swelling of the metacarpophalangeal joints, with morning stiffness lasting over an hour. Laboratory tests show elevated rheumatoid factor and anti-CCP antibodies, along with an elevated ESR.", + "actual_diagnosis": "Rheumatoid arthritis, ICD-10 code M05.9", + "diseases": [ + "Rheumatoid Arthritis", + "Osteoarthritis", + "Psoriatic Arthritis", + "Systemic Lupus Erythematosus", + "Reactive Arthritis", + "Sjogren's Syndrome", + "Gout", + "Infectious Arthritis", + "Vasculitis", + "Fibromyalgia" + ], + "question": "Have you noticed any joint symptoms that improve with activity during the day?" + }, + { + "case_number": 22, + "doctor_vignette": "A 65-year-old male presents with fatigue, bruising, and recurrent infections over the past month. Physical examination reveals pallor and multiple ecchymoses on the extremities. Complete blood count shows anemia (Hb 8.5 g/dL), thrombocytopenia (platelets 45,000/\u03bcL), and leukocytosis with 25% blasts. Bone marrow biopsy confirms the presence of myeloblasts consistent with acute myeloid leukemia.", + "actual_diagnosis": "Acute myeloid leukemia, ICD-10 code C92.0", + "diseases": [ + "Acute Myeloid Leukemia", + "Aplastic Anemia", + "Acute Lymphoblastic Leukemia", + "Myelodysplastic Syndrome", + "Chronic Myeloid Leukemia", + "Hypersplenism", + "Vitamin B12 Deficiency Anemia", + "Thrombotic Thrombocytopenic Purpura", + "Liver Disease (Cirrhosis)", + "HIV/AIDS" + ], + "question": "Have you noticed any abnormal bleeding, such as from the gums or nose?" + }, + { + "case_number": 23, + "doctor_vignette": "A 35-year-old female presents with a chief complaint of red, scaly patches on her elbows and knees that have been persistent for several months. On physical exam, there are well-defined, erythematous plaques covered with silvery-white scales. No laboratory tests are necessary for diagnosis; however, a skin biopsy may confirm the presence of hyperkeratosis and neutrophilic infiltration. The patient has a family history of psoriasis, further supporting the diagnosis.", + "actual_diagnosis": "Psoriasis, ICD-10 code L40.9", + "diseases": [ + "Psoriasis", + "Seborrheic Dermatitis", + "Eczema (Atopic Dermatitis)", + "Nummular Eczema", + "Lichen Planus", + "Drug-Induced Exanthema", + "Chronic Plaque Psoriasis", + "Pityriasis Rosea", + "Tinea Corporis", + "Granuloma Annulare" + ], + "question": "Have you had any recent changes in medications or a new medication prescribed?" + }, + { + "case_number": 24, + "doctor_vignette": "A 32-year-old African American female presents with persistent cough and shortness of breath for the past three months. Physical examination reveals bilateral hilar lymphadenopathy and erythema nodosum on her lower extremities. A chest X-ray shows enlarged lymph nodes and a CT scan confirms the presence of granulomas in the lungs. Laboratory tests show elevated serum angiotensin-converting enzyme (ACE) levels, supporting the diagnosis.", + "actual_diagnosis": "Sarcoidosis, ICD-10 code D86.9", + "diseases": [ + "Sarcoidosis", + "Tuberculosis", + "Lymphoma", + "Histoplasmosis", + "Granulomatosis with Polyangiitis", + "Coccidioidomycosis", + "Primary Pulmonary Hypertension", + "Interstitial Lung Disease", + "Pulmonary Fibrosis", + "Vasculitis" + ], + "question": "Do you currently take any medications, including over-the-counter or herbal supplements?" + }, + { + "case_number": 25, + "doctor_vignette": "A 75-year-old male presents to the emergency department with complaints of increasing shortness of breath and swelling in his legs over the past month. On examination, he has elevated jugular venous pressure, bilateral pitting edema, and crackles in the lung fields. A chest X-ray reveals cardiomegaly and pulmonary congestion, and a BNP level is markedly elevated at 800 pg/mL.", + "actual_diagnosis": "Congestive heart failure, ICD-10 code I50.9", + "diseases": [ + "Heart Failure", + "Pulmonary Edema", + "Chronic Obstructive Pulmonary Disease", + "Venous Insufficiency", + "Pulmonary Hypertension", + "Coronary Artery Disease", + "Atrial Fibrillation", + "Kidney Disease", + "Pneumonia", + "Lung Cancer" + ], + "question": "Do you have a history of hypertension?" + }, + { + "case_number": 26, + "doctor_vignette": "A 12-year-old male presents with a chief complaint of excessive thirst and frequent urination over the past month. On physical examination, he is noted to have a thin build and dry mucous membranes. Laboratory results show a fasting blood glucose level of 250 mg/dL and a HbA1c of 9.5%.", + "actual_diagnosis": "Type 1 diabetes mellitus, ICD-10 code E10.9", + "diseases": [ + "Type 1 Diabetes Mellitus", + "Type 2 Diabetes Mellitus", + "Diabetes Insipidus", + "Cushing's Syndrome", + "Hypercalcemia", + "Chronic Kidney Disease", + "Psychogenic Polydipsia", + "Chronic Hyperglycemia due to other causes", + "Hyperosmolar Hyperglycemic State", + "Renal Glycosuria" + ], + "question": "Have you had increased sweating or changes in body odor?" + }, + { + "case_number": 27, + "doctor_vignette": "A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Physical examination reveals dry skin, bradycardia, and a swollen face. Laboratory tests show elevated TSH levels and low free T4 levels, confirming the diagnosis.", + "actual_diagnosis": "Hypothyroidism, ICD-10 code E03.9", + "diseases": [ + "Hypothyroidism", + "Chronic Fatigue Syndrome", + "Depression", + "Sleep Apnea", + "Adrenal Insufficiency", + "Diabetes Mellitus Type 2", + "Anemia", + "Hypopituitarism", + "Subclinical Hypothyroidism", + "Congestive Heart Failure" + ], + "question": "Do you often feel constipated or have changes in your bowel habits?" + } +] \ No newline at end of file