| { | |
| "Relapsing-Remitting Multiple Sclerosis$Intermedia_4": { | |
| "The condition has distinct attacks (relapses) and remission periods$Cause_1": { | |
| "In the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.$Input2": {} | |
| }, | |
| "Multiple Sclerosis$Intermedia_3": { | |
| "Multiple sclerosis is characterized by multiple lesions in the central nervous system, particularly in the spinal cord. Multiple lesions in the cervical spinal cord suggest the presence of multiple sclerosis.$Cause_1": { | |
| "Probable multiple cervical cord lesions$Input6": {} | |
| }, | |
| "Possible punctate areas of contrast enhancement are seen at the C6 level, which may indicate active inflammation or demyelinating disease, confirming multiple sclerosis.$Cause_1": { | |
| "questionable punctate area of contrast enhancement at C6 level$Input6": {} | |
| }, | |
| "Suspected Multiple Sclerosis$Intermedia_2": { | |
| "People may have unsteadiness or coordination problems when walking, which may be due to damage to nerve pathways in the brain or spinal cord. Inflammation and nerve damage in multiple sclerosis can cause this condition.$Cause_1": { | |
| "trouble with gait$Input1": {} | |
| }, | |
| "Loss of manual dexterity is a common symptom in people with MS.$Cause_1": { | |
| "loss of dexterity in her hands$Input2": {} | |
| }, | |
| "Increased numbness in the legs is a classic symptom of MS and reflects nerve damage$Cause_1": { | |
| "increased bilateral leg numbness$Input2": {} | |
| }, | |
| "Difficulty walking indicates impaired nerve function in the lower limbs and is a common symptom of MS$Cause_1": { | |
| "increased difficulty walking$Input2": {} | |
| }, | |
| "Frequent UTIs may be a symptom of MS because MS can affect bladder control, leading to an increased risk of UTIs.$Cause_1": { | |
| "frequent UTIs$Input3": {} | |
| }, | |
| "Movement control problems caused by damage to the central nervous system, common in people with MS$Cause_1": { | |
| "Gait spastic gait \n\ufeff$Input5": {} | |
| }, | |
| "Reflects lesions in the spinal cord or brain and is a common movement disorder symptom of MS$Cause_1": { | |
| "bilateral leg spasticity$Input5": {} | |
| }, | |
| "Spinal cord lesions affect the conduction of sensory nerves and are one of the typical manifestations of MS.$Cause_1": { | |
| "decreased pinprick below C4 bilaterally$Input5": {} | |
| } | |
| } | |
| } | |
| }, | |
| "input1": "trouble with gait\n", | |
| "input2": "HPI: presents complaining of two weeks of loss of dexterity in her hands, increased bilateral leg numbness than usual and increased difficulty walking. These difficulties have been getting worse for the past two weeks. \n\ufeff\nIn the ED he said his symptoms had subsided and his condition had returned to a stable state. He said similar situations had happened before.\n\ufeff\nROS: On review of systems, the pt denied recent fever or chills. \n\ufeff\nNo night sweats or recent weight loss or gain. Denied cough, shortness of breath. Denied chest pain or tightness, palpitations. Denied nausea, vomiting, diarrhea, constipation or abdominal pain. No recent change in bowel or bladder habits. No dysuria. Denied arthralgias or myalgias. Denied rash.\n", | |
| "input3": "1.h/o pulmonary nodules being followed by serial scanning \n2.seizures-black out episodes for several hours with last EEG showed intermittent bitemporal slowing \n3.frequent UTIs \n4.HTN \n5.hyperparathyroidism \n\ufeff\n", | |
| "input4": "none significant\n", | |
| "input5": "Physical Exam:\nVS 98.4 99 116/67 12 98%\nGen Awake, cooperative, NAD \nHEENT NC/AT, no scleral icterus noted, MMM, no lesions noted inoropharynx \nNeck Supple, no carotid bruits appreciated. No nuchal rigidity \nLungs CTA bilaterally \nCV RRR, nl S1S2, no M/R/G noted \nAbd soft, NT/ND, normoactive bowel sounds, no masses or organomegaly noted \nExt No C/C/E b/l \nSkin no rashes or lesions noted\nNormal rectal tone\n\ufeff\nNEURO\nAlert. Fully oriented. Months of the year backward skipped two months. Speech fluent, with normal naming, reading, comprehension and repetition. Normal prosody. There were no paraphasic errors. Able to follow both midline and append icularcommands. No apraxia. Interprets cookie theft pictures appropriately. No dysarthria. \n\ufeff\nCN\nCN I: not tested\nCN II: Visual fields were full to confrontation, no extinction.\nPupils 3->2 b/l, no RAPD. Fundi clear. No red desat\nCN III, IV, VI: EOMI no nystagmus or diplopia\nCN V: intact to LT throughout\nCN VII: full facial symmetry and strength\nCN VIII: hearing intact to FR b/l\nCN IX, X: palate rises symmetrically\nCN XI: shrug and symmetric\nCN XII: tongue midline and agile\n\ufeff\nMotor \nNormal bulk and tone in the arms; bilateral leg spasticity. No\npronator drift or asterixis\nD B T WE FE FF IP Q H DF PF TE\nL 4+ 5 4+\nR\n\ufeff\nSensory decreased pinprick below C4 bilaterally (sharp on the back of the head)\n\ufeff\nReflexes \nBr Bi Tri Pat Ach Toes\nL 2 1 down\nR 2 1 down\n\ufeff\nCoordination Fine finger movements, rapid alternating movements normal; FTN dysmetric on the right\n\ufeff\nGait spastic gait \n\ufeff\n", | |
| "input6": "___ 11:50PM URINE COLOR-Yellow APPEAR-Clear\n___ 11:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG\n___ 10:51PM GLUCOSE-112* UREA N-25* CREAT-0.9 SODIUM-140 POTASSIUM-4.3 CHLORIDE-104 TOTAL CO2-26 ANION GAP-14\n\ufeff\nMR spine:\nProbable multiple cervical cord lesions, with a questionable punctate area of contrast enhancement at C6 level. No thoracic lesions seen within the cord. Please see above report for additional discussion regarding right upper lobe lung nodule.\n" | |
| } |