153 lines
10 KiB
JSON
153 lines
10 KiB
JSON
{
|
||
"orders": [],
|
||
"cases": [
|
||
{
|
||
"externalId": "ccs-gastro-duodenal-ulcer-office-001",
|
||
"isPublished": true,
|
||
"title": "Office Visit — 44-year-old man",
|
||
"system": "Gastrointestinal System",
|
||
"presentingLocation": "office",
|
||
"realTimeMinutes": 10,
|
||
"difficulty": 1,
|
||
"tags": ["history taking", "dyspepsia", "duodenal ulcer", "Helicobacter pylori"],
|
||
"experienceMode": "graphical_interview",
|
||
"graphicalPresentation": {
|
||
"sceneKey": "doctor_office",
|
||
"patientAssetKey": "patient_44_white_male"
|
||
},
|
||
"initialChart": {
|
||
"patientSummary": "44-year-old man attending an office visit",
|
||
"reasonForEncounter": "The reason for the visit has not yet been elicited.",
|
||
"appearance": "He is seated comfortably, attentive, and in no acute distress.",
|
||
"history": "Several weeks of intermittent lightheadedness and fatigue accompany sleep-disrupting, gnawing epigastric discomfort that is worse on an empty stomach and temporarily relieved by food or antacids. He has no symptoms of gastrointestinal bleeding or other alarm features.",
|
||
"historySections": [
|
||
{ "code": "chief_concern", "title": "Chief concern", "text": "Intermittent lightheadedness and fatigue for several weeks." },
|
||
{ "code": "abdominal_symptoms", "title": "Abdominal symptoms", "text": "Gnawing epigastric discomfort occurs when his stomach is empty and at night, and improves temporarily after food or antacids." },
|
||
{ "code": "alarm_features", "title": "Alarm features", "text": "No melena, hematemesis, persistent vomiting, dysphagia, unintentional weight loss, or syncope." }
|
||
],
|
||
"vitals": {
|
||
"temperature": "36.8 C (98.2 F)",
|
||
"bloodPressure": "122/76 mm Hg",
|
||
"pulse": "76/min",
|
||
"respirations": "14/min",
|
||
"oxygenSaturation": "99% on room air"
|
||
},
|
||
"simulatedStartUtc": "2026-08-05T09:00:00Z",
|
||
"initialOrderCodes": []
|
||
},
|
||
"initialInterview": {
|
||
"openingPatientText": "Good morning, doctor.",
|
||
"finishChoiceText": "Thank you. I have enough history for now.",
|
||
"closingPatientText": "Thank you, doctor. I hope we can figure out what has been going on.",
|
||
"topics": [
|
||
{
|
||
"id": "chief_concern",
|
||
"clinicianText": "Good morning. What brings you in today?",
|
||
"patientText": "For the past few weeks, I have felt worn out, and every so often I get lightheaded—especially when I stand up quickly.",
|
||
"required": false
|
||
},
|
||
{
|
||
"id": "dizziness_character",
|
||
"clinicianText": "Tell me more about the dizziness. Does the room spin, and have you fainted?",
|
||
"patientText": "The room does not spin. It is more like I might black out for a second when I get up, but I have never actually fainted. I have had no weakness, numbness, trouble speaking, chest pain, or racing heartbeat.",
|
||
"required": true,
|
||
"prerequisiteTopicIds": ["chief_concern"]
|
||
},
|
||
{
|
||
"id": "fatigue_course",
|
||
"clinicianText": "How has the fatigue affected you, and how have you been sleeping and eating?",
|
||
"patientText": "My energy is down by the afternoon. I have been eating less because my stomach bothers me, and the discomfort sometimes wakes me at night, so I am not sleeping well.",
|
||
"required": true,
|
||
"prerequisiteTopicIds": ["chief_concern"]
|
||
},
|
||
{
|
||
"id": "abdominal_symptoms",
|
||
"clinicianText": "You mentioned your stomach. Please describe the discomfort and when it occurs.",
|
||
"patientText": "It is a dull, gnawing ache high in the middle of my abdomen. It is usually worse late at night or when I have not eaten. A snack or an antacid settles it for a while, but then it comes back.",
|
||
"required": true,
|
||
"prerequisiteTopicIds": ["chief_concern"]
|
||
},
|
||
{
|
||
"id": "bleeding_alarm_features",
|
||
"clinicianText": "Have you had black stools, blood in vomit or stool, trouble swallowing, persistent vomiting, weight loss, or severe sudden pain?",
|
||
"patientText": "No. My stools look normal, I have not vomited blood, swallowing is fine, and my weight has been steady. I have not had severe or sudden pain.",
|
||
"required": true,
|
||
"prerequisiteTopicIds": ["chief_concern"]
|
||
},
|
||
{
|
||
"id": "medications",
|
||
"clinicianText": "What medicines do you take, including aspirin, ibuprofen, naproxen, or other over-the-counter products?",
|
||
"patientText": "I do not take any prescriptions. I use acetaminophen once in a while for a headache, but I do not use aspirin, ibuprofen, or naproxen.",
|
||
"required": false,
|
||
"prerequisiteTopicIds": ["chief_concern"]
|
||
},
|
||
{
|
||
"id": "medical_history",
|
||
"clinicianText": "Do you have prior stomach problems, other medical conditions, surgeries, or medication allergies?",
|
||
"patientText": "I have never been diagnosed with an ulcer and have not had surgery. I am generally healthy and have no known medication allergies.",
|
||
"required": false,
|
||
"prerequisiteTopicIds": ["chief_concern"]
|
||
},
|
||
{
|
||
"id": "social_history",
|
||
"clinicianText": "Do you smoke, drink alcohol, or use recreational drugs?",
|
||
"patientText": "I do not smoke or use drugs. I might have one or two beers on a weekend, but not every week.",
|
||
"required": false,
|
||
"prerequisiteTopicIds": ["chief_concern"]
|
||
},
|
||
{
|
||
"id": "additional_review",
|
||
"clinicianText": "Any fever, shortness of breath, headaches, bowel changes, or urinary symptoms?",
|
||
"patientText": "No fever, shortness of breath, unusual headaches, bowel changes, or urinary trouble.",
|
||
"required": false,
|
||
"prerequisiteTopicIds": ["chief_concern"]
|
||
}
|
||
],
|
||
"debrief": {
|
||
"likelyDiagnosis": "Probable uncomplicated H. pylori–associated duodenal ulcer",
|
||
"summary": "The key pattern is gnawing epigastric discomfort when fasting or at night with temporary relief from food or antacids. The interview found no evidence of active gastrointestinal bleeding or other alarm features. H. pylori infection is a leading cause, but it would require confirmatory testing.",
|
||
"teachingPoints": [
|
||
"Clarify whether dizziness is vertigo, presyncope, or disequilibrium and screen for neurologic and cardiac warning symptoms.",
|
||
"Ask directly about melena, hematemesis, syncope, weight loss, dysphagia, persistent vomiting, and sudden severe pain.",
|
||
"Review NSAID and aspirin exposure even when the history suggests H. pylori infection."
|
||
]
|
||
}
|
||
},
|
||
"allowedLocations": ["office"],
|
||
"exams": [],
|
||
"orderResponses": [],
|
||
"events": [],
|
||
"scoringCriteria": [
|
||
{ "id": "elicit_chief_concern", "title": "Elicit the chief concern", "actionType": "dialogue_choice", "targetCode": "chief_concern", "points": 10, "rationale": "An open-ended opening allows the patient to identify lightheadedness and fatigue in his own words." },
|
||
{ "id": "characterize_dizziness", "title": "Characterize the dizziness", "actionType": "dialogue_choice", "targetCode": "dizziness_character", "points": 15, "rationale": "Distinguishing presyncope from vertigo and screening for neurologic and cardiac warning symptoms focuses the differential." },
|
||
{ "id": "explore_fatigue", "title": "Explore fatigue, sleep, and intake", "actionType": "dialogue_choice", "targetCode": "fatigue_course", "points": 10, "rationale": "Poor intake and sleep disruption provide a coherent context for the nonspecific fatigue." },
|
||
{ "id": "characterize_abdominal_pain", "title": "Characterize abdominal symptoms", "actionType": "dialogue_choice", "targetCode": "abdominal_symptoms", "points": 20, "rationale": "Timing, location, quality, and relieving factors establish the ulcer-like dyspepsia pattern." },
|
||
{ "id": "screen_alarm_features", "title": "Screen for bleeding and alarm features", "actionType": "dialogue_choice", "targetCode": "bleeding_alarm_features", "points": 20, "rationale": "Bleeding and other alarm features would change the urgency and evaluation." },
|
||
{ "id": "review_medications", "title": "Review NSAID and aspirin exposure", "actionType": "dialogue_choice", "targetCode": "medications", "points": 10, "rationale": "Medication exposure is a major alternative cause of peptic ulcer disease." },
|
||
{ "id": "review_background", "title": "Review medical history and allergies", "actionType": "dialogue_choice", "targetCode": "medical_history", "points": 5, "rationale": "Background history informs risk and future treatment selection." },
|
||
{ "id": "review_social_history", "title": "Review social history", "actionType": "dialogue_choice", "targetCode": "social_history", "points": 5, "rationale": "Tobacco and heavy alcohol exposure can affect symptoms and risk." },
|
||
{ "id": "complete_review", "title": "Complete a focused review of systems", "actionType": "dialogue_choice", "targetCode": "additional_review", "points": 5, "rationale": "A focused review checks for competing causes and associated illness." }
|
||
],
|
||
"references": [
|
||
{
|
||
"title": "Peptic Ulcer Disease",
|
||
"publisher": "American College of Gastroenterology",
|
||
"url": "https://gi.org/topics/peptic-ulcer-disease/",
|
||
"supports": "Typical ulcer symptoms, bleeding warning symptoms, NSAID history, H. pylori evaluation, and endoscopic diagnosis",
|
||
"accessedOn": "2026-08-05",
|
||
"reviewer": "Question bank editorial review"
|
||
},
|
||
{
|
||
"title": "ACG Guideline on Treatment of Helicobacter pylori: New Recommendations",
|
||
"publisher": "American College of Gastroenterology",
|
||
"url": "https://gi.org/journals-publications/ebgi/schoenfeld_sep2024/",
|
||
"supports": "H. pylori treatment principles and confirmation of eradication",
|
||
"accessedOn": "2026-08-05",
|
||
"reviewer": "Question bank editorial review"
|
||
}
|
||
]
|
||
}
|
||
],
|
||
"validateOnly": false
|
||
}
|