104 lines
6.0 KiB
JSON
104 lines
6.0 KiB
JSON
{
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"orders": [],
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"cases": [
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{
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"externalId": "ccs-gastro-duodenal-ulcer-office-001",
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"isPublished": true,
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"title": "Office Visit — 44-year-old man",
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"system": "Gastrointestinal System",
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"presentingLocation": "office",
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"realTimeMinutes": 10,
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"difficulty": 1,
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"tags": ["history taking", "dyspepsia", "duodenal ulcer", "Helicobacter pylori"],
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"experienceMode": "graphical_interview",
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"graphicalPresentation": {
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"sceneKey": "doctor_office",
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"patientAssetKey": "patient_44_white_male"
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},
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"initialChart": {
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"patientSummary": "44-year-old man attending an office visit",
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"reasonForEncounter": "The reason for the visit has not yet been elicited.",
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"appearance": "He is seated comfortably, attentive, and in no acute distress.",
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"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.",
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"historySections": [
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{ "code": "chief_concern", "title": "Chief concern", "text": "Intermittent lightheadedness and fatigue for several weeks." },
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{ "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." },
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{ "code": "alarm_features", "title": "Alarm features", "text": "No melena, hematemesis, persistent vomiting, dysphagia, unintentional weight loss, or syncope." }
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],
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"vitals": {
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"temperature": "36.8 C (98.2 F)",
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"bloodPressure": "122/76 mm Hg",
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"pulse": "76/min",
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"respirations": "14/min",
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"oxygenSaturation": "99% on room air"
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},
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"simulatedStartUtc": "2026-08-05T09:00:00Z",
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"initialOrderCodes": []
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},
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"initialInterview": {
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"openingPatientText": "Good morning, doctor.",
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"finishChoiceText": "Thank you. I have enough history for now.",
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"closingPatientText": "Thank you, doctor. I hope we can figure out what has been going on.",
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"topics": [
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{
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"id": "chief_concern",
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"clinicianText": "Good morning. What brings you in today?",
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"patientText": "For the past few weeks, I have felt worn out, and every so often I get lightheaded—especially when I stand up quickly.",
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"required": false
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},
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{
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"id": "dizziness_character",
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"clinicianText": "Tell me more about the dizziness. Does the room spin, and have you fainted?",
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"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.",
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"required": true,
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"prerequisiteTopicIds": ["chief_concern"]
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},
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{
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"id": "fatigue_course",
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"clinicianText": "How has the fatigue affected you, and how have you been sleeping and eating?",
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"patientText": "My energy is down by the afternoon, even on days when I sleep normally. I have not noticed fever, shortness of breath, chest pain, or a major change in my appetite.",
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"required": true,
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"prerequisiteTopicIds": ["chief_concern"]
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}
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],
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"debrief": {
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"likelyDiagnosis": "Lightheadedness and fatigue requiring further evaluation",
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"summary": "The focused opening interview identifies intermittent orthostatic lightheadedness without vertigo or syncope and several weeks of nonspecific fatigue. Additional clinical assessment would be needed before assigning a diagnosis.",
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"teachingPoints": [
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"Clarify whether dizziness is vertigo, presyncope, or disequilibrium and screen for neurologic and cardiac warning symptoms.",
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"Characterize the timing and functional impact of fatigue and ask about sleep, intake, and associated systemic symptoms."
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]
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}
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},
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"allowedLocations": ["office"],
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"exams": [],
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"orderResponses": [],
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"events": [],
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"scoringCriteria": [
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{ "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." },
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{ "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." },
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{ "id": "explore_fatigue", "title": "Explore fatigue, sleep, and intake", "actionType": "dialogue_choice", "targetCode": "fatigue_course", "points": 10, "rationale": "The course and associated symptoms help characterize the nonspecific fatigue." }
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],
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"references": [
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{
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"title": "Peptic Ulcer Disease",
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"publisher": "American College of Gastroenterology",
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"url": "https://gi.org/topics/peptic-ulcer-disease/",
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"supports": "Typical ulcer symptoms, bleeding warning symptoms, NSAID history, H. pylori evaluation, and endoscopic diagnosis",
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"accessedOn": "2026-08-05",
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"reviewer": "Question bank editorial review"
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},
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{
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"title": "ACG Guideline on Treatment of Helicobacter pylori: New Recommendations",
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"publisher": "American College of Gastroenterology",
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"url": "https://gi.org/journals-publications/ebgi/schoenfeld_sep2024/",
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"supports": "H. pylori treatment principles and confirmation of eradication",
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"accessedOn": "2026-08-05",
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"reviewer": "Question bank editorial review"
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}
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]
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}
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],
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"validateOnly": false
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}
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