[
  {
    "Case Number": 2000,
    "Chief Complaint (CC)": "Severe headache and blurred vision for the last 3 days.",
    "History of Present Illness (HPI)": "Mr. John Doe, a 45-year-old male with a history of hypertension, reports experiencing severe, constant headaches for the past 3 days, accompanied by episodes of blurred vision. He describes the pain as throbbing, located in the frontal area, rated 8/10 in severity. Denies nausea or vomiting. He has been taking Tylenol with minimal relief. No recent head injury.",
    "Past Medical History (PMH)": [
      "Hypertension, diagnosed 5 years ago.",
      "Hyperlipidemia."
    ],
    "Medication History": [
      "Lisinopril 10 mg daily.",
      "Atorvastatin 20 mg at bedtime."
    ],
    "Social History (SH)": [
      "Accountant.",
      "Smokes 1 pack of cigarettes daily for 20 years.",
      "Social alcohol use, denies illicit drug use.",
      "Married with 3 children."
    ],
    "Family History (FH)": [
      "Mother with history of stroke.",
      "Father with type 2 diabetes."
    ],
    "Review of Systems (ROS)": "Negative for fever, chest pain, cough, abdominal pain, dysuria. Positive for headaches and blurred vision as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Awake, alert, in no acute distress.",
      "Vital Signs": "BP 150/95 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 99% on room air.",
      "HEENT": "Pupils equal, round, reactive to light and accommodation. No neck stiffness.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs.",
      "Respiratory": "Clear to auscultation bilaterally.",
      "Neurologic": "Alert and oriented, cranial nerves II-XII intact, no motor or sensory deficits."
    },
    "Diagnostic Test Results": [
      "MRI of the brain: No acute intracranial abnormalities.",
      "Fundoscopic exam: Mild bilateral papilledema."
    ],
    "Assessment and Plan": {
      "Assessment": "Severe headache with blurred vision, likely secondary to hypertensive urgency with signs of increased intracranial pressure.",
      "Plan": [
        "Admit for close monitoring and blood pressure control with IV antihypertensives.",
        "Consult ophthalmology for evaluation of papilledema.",
        "Headache management with IV pain relief as needed.",
        "Further evaluation for secondary causes of hypertension.",
        "Patient education on blood pressure management and lifestyle modifications."
      ]
    },
    "Problem List": [
      "Hypertensive urgency.",
      "Headache with blurred vision.",
      "Papilledema."
    ]
  },
  {
    "Case Number": 2001,
    "Chief Complaint (CC)": "Chest pain radiating to the left arm starting 1 hour ago.",
    "History of Present Illness (HPI)": "Mrs. Emily White, a 63-year-old female with a past medical history of type 2 diabetes and smoking, presents with acute onset of chest pain that started 1 hour ago while she was gardening. She describes the pain as squeezing, 9/10, radiating to her left arm and jaw. She also reports feeling nauseous and sweaty.",
    "Past Medical History (PMH)": [
      "Type 2 diabetes mellitus, diagnosed 8 years ago.",
      "Smoker, 1 pack per day for 30 years."
    ],
    "Medication History": [
      "Metformin 1000 mg twice daily.",
      "Insulin glargine 20 units at bedtime."
    ],
    "Social History (SH)": [
      "Retired teacher.",
      "Smokes, as noted.",
      "Occasional alcohol, denies illicit drug use.",
      "Widowed, lives with her daughter."
    ],
    "Family History (FH)": [
      "Father died of a heart attack at age 60.",
      "Mother has hypertension."
    ],
    "Review of Systems (ROS)": "Negative for fever, cough, dyspnea, abdominal pain, diarrhea. Positive for chest pain, nausea as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Awake, appears distressed due to pain.",
      "Vital Signs": "BP 160/100 mmHg, HR 100 bpm, RR 18/min, Temp 98.6°F (37°C), O2 Sat 97% on room air.",
      "Cardiovascular": "Tachycardic, regular rhythm, no murmurs. Jugular venous pressure not elevated.",
      "Respiratory": "Clear to auscultation bilaterally.",
      "Abdomen": "Soft, non-tender."
    },
    "Diagnostic Test Results": [
      "ECG shows ST-segment elevation in anterior leads.",
      "Troponin levels elevated."
    ],
    "Assessment and Plan": {
      "Assessment": "Acute ST-elevation myocardial infarction (STEMI), anterior wall.",
      "Plan": [
        "Immediate cardiology consultation for primary percutaneous coronary intervention (PCI).",
        "Start aspirin, clopidogrel, heparin, and beta-blockers per ACS protocol.",
        "Admit to coronary care unit for monitoring.",
        "Diabetes management review and adjustment as needed.",
        "Smoking cessation counseling."
      ]
    },
    "Problem List": [
      "Acute ST-elevation myocardial infarction (STEMI).",
      "Type 2 diabetes mellitus.",
      "Smoking."
    ]
  },
  {
    "Case Number": 2002,
    "Chief Complaint (CC)": "Swelling and pain in the right knee for 2 days.",
    "History of Present Illness (HPI)": "Mr. Alex Green, a 55-year-old male with a history of osteoarthritis, presents with a 2-day history of right knee swelling and pain. The pain is constant, worsens with movement, and is rated as 7/10. He denies injury or recent strenuous activity. He has been applying ice and taking ibuprofen with little relief.",
    "Past Medical History (PMH)": [
      "Osteoarthritis, diagnosed 3 years ago.",
      "Hypertension."
    ],
    "Medication History": [
      "Ibuprofen 400 mg as needed for pain.",
      "Lisinopril 20 mg daily."
    ],
    "Social History (SH)": [
      "Engineer.",
      "Non-smoker.",
      "Moderate alcohol use.",
      "Married, two children."
    ],
    "Family History (FH)": [
      "Father with history of osteoarthritis.",
      "Mother healthy."
    ],
    "Review of Systems (ROS)": "Negative for fever, rash, chest pain, shortness of breath, abdominal pain. Positive for knee pain and swelling as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Awake, alert, in no acute distress.",
      "Vital Signs": "BP 140/90 mmHg, HR 72 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Musculoskeletal": "Right knee is swollen, warm, with limited range of motion due to pain. No erythema or signs of trauma."
    },
    "Diagnostic Test Results": [
      "X-ray of the right knee: Joint space narrowing with osteophytes, consistent with osteoarthritis. No acute fracture or dislocation.",
      "CRP elevated, suggesting inflammation."
    ],
    "Assessment and Plan": {
      "Assessment": "Exacerbation of osteoarthritis in the right knee with acute inflammatory symptoms.",
      "Plan": [
        "Increase ibuprofen to 600 mg three times daily with food for 7 days.",
        "Consider intra-articular corticosteroid injection for pain management.",
        "Physical therapy referral for knee strengthening exercises.",
        "Follow-up in 2 weeks or sooner if symptoms worsen."
      ]
    },
    "Problem List": [
      "Osteoarthritis of the right knee.",
      "Hypertension."
    ]
  },
  {
    "Case Number": 2003,
    "Chief Complaint (CC)": "Frequent urination and excessive thirst for the past month.",
    "History of Present Illness (HPI)": "Ms. Rachel Brown, a 29-year-old female with no significant past medical history, presents with a one-month history of polyuria and polydipsia. She reports urinating more frequently, especially at night, and an unquenchable thirst. She has noticed a 5-pound weight loss despite no changes in diet or exercise. Denies pain on urination, fever, or vaginal discharge.",
    "Past Medical History (PMH)": "None.",
    "Medication History": "None.",
    "Social History (SH)": [
      "Software developer.",
      "Non-smoker.",
      "Occasional social drinker, denies illicit drug use.",
      "Single, lives alone."
    ],
    "Family History (FH)": [
      "Mother with type 2 diabetes.",
      "Father with hypertension."
    ],
    "Review of Systems (ROS)": "Negative for headache, chest pain, cough, abdominal pain. Positive for increased thirst and urination as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Awake, alert, appears well.",
      "Vital Signs": "BP 120/80 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "HEENT": "Pupils equal, round, reactive to light. Mucous membranes moist.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs.",
      "Respiratory": "Clear to auscultation bilaterally."
    },
    "Diagnostic Test Results": [
      "Fasting blood glucose 250 mg/dL.",
      "HbA1c 9.0%."
    ],
    "Assessment and Plan": {
      "Assessment": "Newly diagnosed type 1 diabetes mellitus.",
      "Plan": [
        "Initiate insulin therapy with basal and prandial insulin.",
        "Diabetes education with a focus on insulin administration, monitoring blood glucose, diet, and exercise.",
        "Refer to endocrinology for ongoing management.",
        "Follow-up in 1 week to adjust insulin regimen."
      ]
    },
    "Problem List": [
      "Type 1 diabetes mellitus."
    ]
  },
  {
    "Case Number": 2004,
    "Chief Complaint (CC)": "Abdominal pain and diarrhea for 2 weeks.",
    "History of Present Illness (HPI)": "Mr. Kevin Martinez, a 38-year-old male with no significant past medical history, presents with a 2-week history of crampy abdominal pain and watery diarrhea. He reports 4-5 loose bowel movements per day, no blood or mucus in the stool. He has not traveled recently or eaten out. Denies fever, vomiting, or recent antibiotic use.",
    "Past Medical History (PMH)": "None.",
    "Medication History": "None.",
    "Social History (SH)": [
      "Graphic designer.",
      "Non-smoker.",
      "Denies alcohol or illicit drug use.",
      "Single, lives with a roommate."
    ],
    "Family History (FH)": [
      "No known family history of gastrointestinal diseases."
    ],
    "Review of Systems (ROS)": "Negative for fever, cough, dyspnea, urinary symptoms. Positive for abdominal pain and diarrhea as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Awake, alert, mildly distressed due to abdominal pain.",
      "Vital Signs": "BP 125/75 mmHg, HR 85 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Abdomen": "Soft, mildly tender in the left lower quadrant, no rebound or guarding. Normal bowel sounds."
    },
    "Diagnostic Test Results": [
      "Stool studies: Positive for Clostridium difficile toxin.",
      "CBC: Slight leukocytosis."
    ],
    "Assessment and Plan": {
      "Assessment": "Clostridium difficile colitis.",
      "Plan": [
        "Start oral vancomycin treatment for 14 days.",
        "Advise on fluid intake to prevent dehydration.",
        "Follow-up in 1 week or sooner if symptoms worsen.",
        "Patient education on hand hygiene and avoiding spread to household contacts."
      ]
    },
    "Problem List": [
      "Clostridium difficile colitis."
    ]
  },
  {
    "Case Number": 2005,
    "Chief Complaint (CC)": "Shortness of breath and chest tightness during exercise.",
    "History of Present Illness (HPI)": "Ms. Sarah Lee, a 22-year-old female college student with a history of mild intermittent asthma, presents with worsening shortness of breath and chest tightness during exercise over the past month. She reports using her albuterol inhaler more frequently, which provides temporary relief. She is concerned as these symptoms now occur with minimal exertion.",
    "Past Medical History (PMH)": [
      "Mild intermittent asthma, diagnosed in childhood."
    ],
    "Medication History": [
      "Albuterol inhaler PRN."
    ],
    "Social History (SH)": [
      "College student studying biology.",
      "Non-smoker, denies alcohol or illicit drug use.",
      "Active in intramural sports."
    ],
    "Family History (FH)": [
      "Mother with history of asthma.",
      "Father with allergies."
    ],
    "Review of Systems (ROS)": "Negative for fever, cough, wheezing outside of exercise, heart palpitations. Positive for shortness of breath and chest tightness during exercise as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Athletic, in no acute distress at rest.",
      "Vital Signs": "BP 110/70 mmHg, HR 68 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs.",
      "Respiratory": "Clear to auscultation bilaterally at rest."
    },
    "Diagnostic Test Results": [
      "Spirometry: Decreased FEV1/FVC ratio post-exercise, improves with bronchodilator."
    ],
    "Assessment and Plan": {
      "Assessment": "Exercise-induced bronchoconstriction.",
      "Plan": [
        "Prescribe a combination inhaler with corticosteroid and long-acting beta-agonist to use daily.",
        "Continue albuterol inhaler PRN for acute symptoms.",
        "Asthma education focusing on inhaler technique and avoiding triggers.",
        "Follow-up in 3 months to reassess control and adjust treatment as necessary."
      ]
    },
    "Problem List": [
      "Exercise-induced bronchoconstriction.",
      "Mild intermittent asthma."
    ]
  },
  {
    "Case Number": 2006,
    "Chief Complaint (CC)": "Sudden loss of vision in the right eye this morning.",
    "History of Present Illness (HPI)": "Mr. Thomas Hill, a 68-year-old male with a history of hypertension and hypercholesterolemia, presents with sudden, painless loss of vision in his right eye upon waking up this morning. He denies any prior episodes, headache, eye pain, or recent trauma to the eye.",
    "Past Medical History (PMH)": [
      "Hypertension, managed with medication.",
      "Hypercholesterolemia."
    ],
    "Medication History": [
      "Amlodipine 5 mg daily.",
      "Atorvastatin 40 mg at bedtime."
    ],
    "Social History (SH)": [
      "Retired bank manager.",
      "Non-smoker, moderate alcohol use.",
      "Married, two adult children."
    ],
    "Family History (FH)": [
      "No known family history of eye diseases.",
      "Parents deceased, causes unrelated to current complaint."
    ],
    "Review of Systems (ROS)": "Negative for headache, pain, double vision, or other sensory changes. Positive for sudden loss of vision in the right eye as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Alert, oriented, in no acute distress.",
      "Vital Signs": "BP 145/85 mmHg, HR 70 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Eyes": "Right eye: No direct or consensual pupillary response to light. Left eye: Normal pupillary response."
    },
    "Diagnostic Test Results": [
      "Fundoscopic exam of the right eye: Evidence of retinal artery occlusion.",
      "Carotid ultrasound: Plaque formation without significant stenosis."
    ],
    "Assessment and Plan": {
      "Assessment": "Acute right retinal artery occlusion.",
      "Plan": [
        "Immediate ophthalmology consultation for possible retinal artery occlusion treatment.",
        "Start aspirin and consider anticoagulation therapy after evaluating for contraindications.",
        "Cardiology referral for cardiovascular risk assessment.",
        "Strict control of hypertension and hypercholesterolemia."
      ]
    },
    "Problem List": [
      "Acute right retinal artery occlusion.",
      "Hypertension.",
      "Hypercholesterolemia."
    ]
  },
  {
    "Case Number": 2007,
    "Chief Complaint (CC)": "Pain and redness in the left lower leg for 3 days.",
    "History of Present Illness (HPI)": "Ms. Angela Wright, a 52-year-old female with a history of varicose veins, presents with pain and redness in her left lower leg that started 3 days ago. She describes the pain as constant, aching, and worsening with standing. She also notes swelling in the same area. Denies fever, trauma, or previous similar episodes.",
    "Past Medical History (PMH)": [
      "Varicose veins, diagnosed 5 years ago."
    ],
    "Medication History": "None.",
    "Social History (SH)": [
      "Elementary school teacher.",
      "Non-smoker, occasional wine drinker.",
      "Married, three children."
    ],
    "Family History (FH)": [
      "Mother with history of deep vein thrombosis (DVT).",
      "Father deceased, heart attack."
    ],
    "Review of Systems (ROS)": "Negative for chest pain, shortness of breath, headache. Positive for leg pain, swelling, and redness as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Awake, alert, in no acute distress.",
      "Vital Signs": "BP 130/80 mmHg, HR 88 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Extremities": "Left lower leg is swollen, warm, and erythematous from the knee to the ankle. Palpable cords."
    },
    "Diagnostic Test Results": [
      "Doppler ultrasound of the left leg: Shows thrombosis in the superficial saphenous vein."
    ],
    "Assessment and Plan": {
      "Assessment": "Superficial vein thrombosis (SVT) of the left leg.",
      "Plan": [
        "Advise leg elevation and application of warm compresses.",
        "Prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.",
        "Consider anticoagulation therapy based on risk assessment.",
        "Follow-up in 1 week or sooner if symptoms worsen or signs of DVT develop."
      ]
    },
    "Problem List": [
      "Superficial vein thrombosis (SVT).",
      "Varicose veins."
    ]
  },
  {
    "Case Number": 2008,
    "Chief Complaint (CC)": "Intermittent abdominal pain and weight loss over the last 6 months.",
    "History of Present Illness (HPI)": "Mr. Miguel Sanchez, a 60-year-old male with no significant past medical history, presents with a 6-month history of intermittent, crampy abdominal pain and an unintentional weight loss of 20 pounds. He reports that the pain is mostly in the lower abdomen and does not radiate. Denies blood in stool, vomiting, or changes in bowel habits. Appetite has decreased.",
    "Past Medical History (PMH)": "None.",
    "Medication History": "None.",
    "Social History (SH)": [
      "Chef.",
      "Smokes cigars occasionally, social alcohol use.",
      "Divorced, lives alone."
    ],
    "Family History (FH)": [
      "Mother died of breast cancer.",
      "Father alive with hypertension."
    ],
    "Review of Systems (ROS)": "Negative for fever, nausea, vomiting, diarrhea, constipation. Positive for abdominal pain and weight loss as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Cachectic appearance.",
      "Vital Signs": "BP 110/70 mmHg, HR 90 bpm, RR 18/min, Temp 98.6°F (37°C), O2 Sat 97% on room air.",
      "Abdomen": "Soft, non-tender, no palpable masses or organomegaly. Normal bowel sounds."
    },
    "Diagnostic Test Results": [
      "CT abdomen/pelvis: Mass in the sigmoid colon with associated lymphadenopathy.",
      "Colonoscopy: Biopsy of sigmoid mass confirms adenocarcinoma."
    ],
    "Assessment and Plan": {
      "Assessment": "Sigmoid colon adenocarcinoma.",
      "Plan": [
        "Refer to oncology for evaluation and management.",
        "Discuss surgical options, chemotherapy, and radiation therapy as appropriate.",
        "Nutritional support and counseling.",
        "Psychosocial support and referral to cancer support groups."
      ]
    },
    "Problem List": [
      "Sigmoid colon adenocarcinoma."
    ]
  },
  {
    "Case Number": 2009,
    "Chief Complaint (CC)": "Increasing forgetfulness and difficulty finding words over the past year.",
    "History of Present Illness (HPI)": "Mrs. Elizabeth Clark, a 70-year-old female with a past medical history of hypertension, presents with concerns of increasing forgetfulness and difficulty finding words over the past year. Her family has noticed her repeating questions and stories. She has difficulty managing her finances, which was previously not an issue. Denies depression, anxiety, or changes in sleep patterns.",
    "Past Medical History (PMH)": [
      "Hypertension, controlled with medication."
    ],
    "Medication History": [
      "Hydrochlorothiazide 25 mg daily."
    ],
    "Social History (SH)": [
      "Retired librarian.",
      "Non-smoker, occasional wine drinker.",
      "Widow, lives with her son."
    ],
    "Family History (FH)": [
      "Mother had Alzheimer's disease.",
      "Father deceased, cause unknown."
    ],
    "Review of Systems (ROS)": "Negative for headache, vision changes, chest pain, shortness of breath, abdominal pain. Positive for memory loss and difficulty with word-finding as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Well-groomed, cooperative, appears her stated age.",
      "Vital Signs": "BP 135/85 mmHg, HR 72 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Neurologic": "Alert and oriented to person, place, and time. Difficulty recalling three objects at 5 minutes. Difficulty finding words."
    },
    "Diagnostic Test Results": [
      "MRI brain: Mild cortical atrophy with no acute intracranial process.",
      "Neuropsychological testing: Impaired memory and executive function."
    ],
    "Assessment and Plan": {
      "Assessment": "Mild cognitive impairment, possibly early Alzheimer's disease.",
      "Plan": [
        "Refer to neurology for further evaluation and management.",
        "Initiate donepezil to potentially improve cognitive symptoms.",
        "Family meeting to discuss support, safety concerns, and advance planning.",
        "Regular follow-up appointments to monitor progression."
      ]
    },
    "Problem List": [
      "Mild cognitive impairment.",
      "Hypertension."
    ]
  },
  {
    "Case Number": 2010,
    "Chief Complaint (CC)": "Recurrent nosebleeds for the past 2 months.",
    "History of Present Illness (HPI)": "Mr. Kyle Anderson, a 34-year-old male with no significant past medical history, presents with recurrent, spontaneous nosebleeds for the past 2 months. Each episode lasts about 10 minutes and resolves with pressure. He denies trauma, use of blood thinners, or illicit drugs. No history of similar issues in the family.",
    "Past Medical History (PMH)": "None.",
    "Medication History": "None.",
    "Social History (SH)": [
      "High school math teacher.",
      "Non-smoker, occasional beer on weekends.",
      "Single, active in outdoor sports."
    ],
    "Family History (FH)": [
      "No significant family history."
    ],
    "Review of Systems (ROS)": "Negative for headache, vision changes, chest pain, shortness of breath, abdominal pain. Positive for recurrent nosebleeds as noted in HPI.",
    "Physical Examination (PE)": {
      "General": "Awake, alert, in no acute distress.",
      "Vital Signs": "BP 125/78 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "ENT": "Anterior nasal septum shows a small area of crusting with a likely source of bleeding. No polyps or masses."
    },
    "Diagnostic Test Results": [
      "Complete blood count (CBC): Within normal limits.",
      "Coagulation profile: Normal."
    ],
    "Assessment and Plan": {
      "Assessment": "Epistaxis, likely due to local nasal trauma or dryness.",
      "Plan": [
        "Advise on humidifying the home environment.",
        "Recommend saline nasal sprays to keep nasal passages moist.",
        "Educate on gentle nasal hygiene and avoiding picking or blowing nose forcefully.",
        "Consider cauterization if episodes persist or worsen.",
        "Follow-up as needed."
      ]
    },
    "Problem List": [
      "Recurrent epistaxis."
    ]
  },
  {
    "Case Number": 2011,
    "Chief Complaint (CC)": "Intermittent chest pain for 2 weeks.",
    "History of Present Illness (HPI)": "Mr. Henry Ford, a 42-year-old male with a past medical history of gastroesophageal reflux disease (GERD), presents with intermittent, sharp chest pain localized to the mid-sternal area, lasting for minutes and resolving spontaneously. Pain is not related to exercise but is exacerbated by lying down. Reports relief with sitting up and antacids.",
    "Past Medical History (PMH)": ["Gastroesophageal reflux disease (GERD)."],
    "Medication History": ["Omeprazole 20 mg daily."],
    "Social History (SH)": ["Engineer, non-smoker, occasional alcohol consumption, denies illicit drug use."],
    "Family History (FH)": ["Father with coronary artery disease (CAD).", "Mother with type 2 diabetes mellitus."],
    "Review of Systems (ROS)": "Negative for dyspnea, palpitations, fever, cough. Positive for regurgitation and occasional heartburn.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, in no acute distress.",
      "Vital Signs": "BP 130/85 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rhythm, no murmurs, rubs, or gallops.",
      "Respiratory": "Clear to auscultation bilaterally.",
      "Abdomen": "Soft, non-tender, no hepatosplenomegaly."
    },
    "Diagnostic Test Results": ["ECG normal.", "Upper endoscopy shows mild esophagitis."],
    "Assessment and Plan": {
      "Assessment": "GERD with esophagitis, likely cause of chest pain.",
      "Plan": [
        "Increase omeprazole to 40 mg daily.",
        "Recommend dietary modifications including avoiding late meals and foods that trigger symptoms.",
        "Review proper medication use and lifestyle modifications.",
        "Follow-up in 4 weeks to reassess symptoms."
      ]
    },
    "Problem List": ["GERD with esophagitis"]
  },
  {
    "Case Number": 2012,
    "Chief Complaint (CC)": "Right ankle pain and swelling following a fall.",
    "History of Present Illness (HPI)": "Ms. Julia Evans, a 35-year-old female, presents with right ankle pain and swelling after twisting her ankle stepping off a curb earlier today. Describes immediate onset of pain and difficulty bearing weight. Denies previous injury to the ankle.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["High school teacher, non-smoker, occasional social drinker, denies illicit drug use."],
    "Family History (FH)": ["No significant family medical history."],
    "Review of Systems (ROS)": "Negative for fever, chest pain, shortness of breath. Positive for right ankle pain and swelling.",
    "Physical Examination (PE)": {
      "General": "In mild distress due to pain.",
      "Vital Signs": "BP 120/80 mmHg, HR 88 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Musculoskeletal": "Right ankle is swollen with tenderness over the lateral malleolus. Limited range of motion due to pain."
    },
    "Diagnostic Test Results": ["X-ray of the right ankle: No fracture seen, soft tissue swelling."],
    "Assessment and Plan": {
      "Assessment": "Right ankle sprain.",
      "Plan": [
        "RICE (Rest, Ice, Compression, Elevation) therapy.",
        "Prescribe NSAIDs for pain and inflammation as needed.",
        "Recommend an ankle brace for support.",
        "Refer to physical therapy for rehabilitation.",
        "Follow-up in 1-2 weeks or if symptoms worsen."
      ]
    },
    "Problem List": ["Right ankle sprain"]
  },
  {
    "Case Number": 2013,
    "Chief Complaint (CC)": "Exacerbation of chronic back pain.",
    "History of Present Illness (HPI)": "Mr. Alan Scott, a 50-year-old male with a history of chronic lower back pain, reports worsening of his back pain over the past week. Describes the pain as constant, dull, and localized to the lumbar region, exacerbated by movement and partially relieved by rest. No recent injury.",
    "Past Medical History (PMH)": ["Chronic lower back pain, diagnosed 5 years ago."],
    "Medication History": ["Ibuprofen 600 mg as needed for pain.", "Paracetamol 1 g as needed for pain."],
    "Social History (SH)": ["Construction worker, smokes 10 cigarettes a day, occasional alcohol consumption."],
    "Family History (FH)": ["Father with osteoarthritis.", "Mother with hypertension."],
    "Review of Systems (ROS)": "Negative for fever, weight loss, neurological symptoms. Positive for chronic lower back pain.",
    "Physical Examination (PE)": {
      "General": "Appears uncomfortable.",
      "Vital Signs": "BP 140/90 mmHg, HR 86 bpm, RR 18/min, Temp 98.6°F (37°C), O2 Sat 97% on room air.",
      "Musculoskeletal": "Tenderness over the lumbar spine. Normal range of motion with pain on extension."
    },
    "Diagnostic Test Results": ["Lumbar spine X-ray: Degenerative changes without acute fracture."],
    "Assessment and Plan": {
      "Assessment": "Exacerbation of chronic lower back pain, likely due to degenerative disc disease.",
      "Plan": [
        "Continue NSAIDs as needed, consider starting a muscle relaxant.",
        "Recommend physical therapy focusing on lumbar stabilization exercises.",
        "Consider MRI if symptoms persist or worsen for further evaluation.",
        "Follow-up in 6 weeks or sooner if needed."
      ]
    },
    "Problem List": ["Chronic lower back pain", "Degenerative disc disease"]
  },
  {
    "Case Number": 2014,
    "Chief Complaint (CC)": "Recurrent urinary tract infections.",
    "History of Present Illness (HPI)": "Ms. Brenda Walsh, a 28-year-old female, presents with symptoms of a urinary tract infection (UTI), including dysuria, frequency, and urgency. Reports similar episodes in the past year, with the last episode occurring 3 months ago. Denies fever or flank pain.",
    "Past Medical History (PMH)": ["Recurrent urinary tract infections."],
    "Medication History": ["No regular medications. Has used nitrofurantoin for previous UTIs."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, denies illicit drug use, sexually active with one partner."],
    "Family History (FH)": ["No significant family medical history."],
    "Review of Systems (ROS)": "Positive for urinary frequency, urgency, and dysuria. Negative for fever, back pain.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 115/75 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Abdomen": "Soft, non-tender, no costovertebral angle tenderness."
    },
    "Diagnostic Test Results": ["Urinalysis: Positive for leukocyte esterase and nitrites."],
    "Assessment and Plan": {
      "Assessment": "Urinary tract infection, recurrent.",
      "Plan": [
        "Prescribe a 5-day course of nitrofurantoin.",
        "Advise on urinary hygiene practices.",
        "Discuss prophylactic antibiotics vs. post-coital antibiotics as strategies for prevention.",
        "Schedule follow-up for urine culture results and to discuss long-term management strategies."
      ]
    },
    "Problem List": ["Recurrent urinary tract infections"]
  },
  {
    "Case Number": 2015,
    "Chief Complaint (CC)": "New onset of seizures.",
    "History of Present Illness (HPI)": "Mr. Chris Turner, a 32-year-old male, presents after experiencing a generalized tonic-clonic seizure witnessed by his wife. This was his first seizure, lasting approximately 2 minutes, followed by postictal confusion. He regained full consciousness within 30 minutes. Denies any prior seizures, head trauma, or known triggers.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Software developer, non-smoker, occasional alcohol, denies illicit drug use."],
    "Family History (FH)": ["No known family history of seizures or neurological diseases."],
    "Review of Systems (ROS)": "Positive for seizure. Negative for headache, visual disturbances, weakness, fever.",
    "Physical Examination (PE)": {
      "General": "Awake, alert, oriented, no acute distress.",
      "Vital Signs": "BP 125/80 mmHg, HR 64 bpm, RR 12/min, Temp 98.6°F (37°C), O2 Sat 99% on room air.",
      "Neurologic": "Cranial nerves II-XII grossly intact. Normal muscle strength and tone. Coordination and sensation intact."
    },
    "Diagnostic Test Results": ["EEG: No epileptiform discharges.", "MRI brain: No acute intracranial abnormalities."],
    "Assessment and Plan": {
      "Assessment": "First unprovoked seizure.",
      "Plan": [
        "Advise against driving per local regulations until cleared by a neurologist.",
        "Refer to neurology for further evaluation and management.",
        "Educate on seizure precautions.",
        "Follow-up with neurology within 2 weeks."
      ]
    },
    "Problem List": ["First unprovoked seizure"]
  },
  {
    "Case Number": 2016,
    "Chief Complaint (CC)": "Sudden onset of right-sided weakness.",
    "History of Present Illness (HPI)": "Mr. George Newman, a 68-year-old male, presents with sudden onset of right-sided weakness and difficulty speaking that began 1 hour prior to arrival. Symptoms partially improved on the way to the hospital. Denies headache, seizure, or previous similar episodes.",
    "Past Medical History (PMH)": ["Hypertension.", "Type 2 diabetes mellitus."],
    "Medication History": ["Lisinopril 20 mg daily.", "Metformin 500 mg twice daily."],
    "Social History (SH)": ["Retired postal worker, smokes 1 pack of cigarettes daily, occasional alcohol."],
    "Family History (FH)": ["Father had a stroke at age 72.", "Mother with atrial fibrillation."],
    "Review of Systems (ROS)": "Positive for right-sided weakness and speech difficulty. Negative for headache, seizure, vision changes.",
    "Physical Examination (PE)": {
      "General": "Alert, oriented, anxious.",
      "Vital Signs": "BP 160/90 mmHg, HR 88 bpm, RR 18/min, Temp 98.6°F (37°C), O2 Sat 97% on room air.",
      "Neurologic": "Mild right-sided weakness, dysarthria. No facial droop. Normal sensation."
    },
    "Diagnostic Test Results": ["CT brain: No evidence of acute hemorrhage.", "MRI brain: Small acute infarct in the left middle cerebral artery territory."],
    "Assessment and Plan": {
      "Assessment": "Transient ischemic attack (TIA) with partial resolution of symptoms.",
      "Plan": [
        "Admit to stroke unit for monitoring and further evaluation.",
        "Start aspirin 81 mg daily and statin therapy.",
        "Risk factor modification: Blood pressure control, diabetes management, smoking cessation.",
        "Refer to neurology and cardiology for further evaluation.",
        "Educate patient and family on stroke warning signs and importance of rapid hospital presentation."
      ]
    },
    "Problem List": ["Transient ischemic attack (TIA)"]
  },
  {
    "Case Number": 2017,
    "Chief Complaint (CC)": "Progressive difficulty walking and balance.",
    "History of Present Illness (HPI)": "Ms. Nancy Thompson, a 55-year-old female, presents with a 6-month history of progressive difficulty walking and poor balance. Reports frequent falls without loss of consciousness. Denies pain, weakness, or sensory changes. No bowel or bladder incontinence.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["High school principal, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["No known family history of neurological diseases."],
    "Review of Systems (ROS)": "Positive for gait instability and falls. Negative for headache, seizure, vision changes, or speech difficulties.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, no acute distress.",
      "Vital Signs": "BP 130/80 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Neurologic": "Normal muscle strength. Wide-based gait. Impaired heel-to-toe walking. No sensory deficits."
    },
    "Diagnostic Test Results": ["MRI brain and spinal cord: No significant abnormalities.", "Nerve conduction studies and EMG: Normal."],
    "Assessment and Plan": {
      "Assessment": "Gait disturbance, etiology unclear.",
      "Plan": [
        "Refer to neurology for further evaluation, including possible cerebellar or proprioceptive pathway disorders.",
        "Physical therapy referral for gait training and fall prevention.",
        "Follow-up in 4-6 weeks or sooner if symptoms progress."
      ]
    },
    "Problem List": ["Gait disturbance"]
  },
  {
    "Case Number": 2018,
    "Chief Complaint (CC)": "Chronic cough and wheezing.",
    "History of Present Illness (HPI)": "Mr. Derek Shepherd, a 45-year-old male, presents with a chronic cough and wheezing that has persisted for over 3 months. Cough is productive of clear sputum. Wheezing worsens with exercise and at night. Reports a history of seasonal allergies but no prior asthma diagnosis.",
    "Past Medical History (PMH)": ["Seasonal allergies."],
    "Medication History": ["Over-the-counter antihistamines as needed."],
    "Social History (SH)": ["Architect, non-smoker, occasional social alcohol use, denies illicit drug use."],
    "Family History (FH)": ["Mother with asthma.", "Father with hypertension."],
    "Review of Systems (ROS)": "Positive for chronic cough and wheezing. Negative for fever, weight loss, chest pain.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 120/78 mmHg, HR 76 bpm, RR 20/min, Temp 98.6°F (37°C), O2 Sat 96% on room air.",
      "Respiratory": "Diffuse wheezing bilaterally on auscultation. No respiratory distress."
    },
    "Diagnostic Test Results": ["Spirometry: Reduced FEV1/FVC ratio, improved with bronchodilator administration."],
    "Assessment and Plan": {
      "Assessment": "Asthma, likely previously undiagnosed.",
      "Plan": [
        "Initiate low-dose inhaled corticosteroid.",
        "Provide asthma action plan and educate on inhaler technique.",
        "Advise avoidance of known allergens and triggers.",
        "Schedule follow-up in 4 weeks to assess response to treatment."
      ]
    },
    "Problem List": ["Asthma"]
  },
  {
    "Case Number": 2019,
    "Chief Complaint (CC)": "Fever, sore throat, and fatigue for 4 days.",
    "History of Present Illness (HPI)": "Ms. Samantha Carter, a 22-year-old female university student, presents with a 4-day history of fever, sore throat, and significant fatigue. Reports subjective fevers at home, maximal temperature of 101.5°F (38.6°C). Sore throat is severe, making swallowing difficult. Also notes generalized fatigue and malaise.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Ibuprofen for fever and pain relief."],
    "Social History (SH)": ["University student, non-smoker, social drinker, denies illicit drug use."],
    "Family History (FH)": ["No significant family medical history."],
    "Review of Systems (ROS)": "Positive for fever, sore throat, fatigue. Negative for rash, cough, abdominal pain, joint pains.",
    "Physical Examination (PE)": {
      "General": "Appears fatigued.",
      "Vital Signs": "BP 110/70 mmHg, HR 88 bpm, RR 16/min, Temp 100.9°F (38.3°C), O2 Sat 98% on room air.",
      "HEENT": "Oropharynx erythematous with bilateral tonsillar enlargement and exudates. No cervical lymphadenopathy.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs.",
      "Respiratory": "Clear to auscultation bilaterally."
    },
    "Diagnostic Test Results": ["Rapid strep test negative.", "Monospot test positive."],
    "Assessment and Plan": {
      "Assessment": "Infectious mononucleosis.",
      "Plan": [
        "Advise symptomatic treatment with rest, hydration, and analgesics.",
        "Inform about the possibility of prolonged fatigue and need to avoid contact sports due to risk of splenic rupture.",
        "Schedule follow-up in 2 weeks or sooner if symptoms worsen or if new symptoms develop."
      ]
    },
    "Problem List": ["Infectious mononucleosis"]
  },
  {
    "Case Number": 2020,
    "Chief Complaint (CC)": "Bilateral knee pain worsening over the past year.",
    "History of Present Illness (HPI)": "Ms. Gloria Estefan, a 65-year-old female, presents with a 1-year history of bilateral knee pain. Describes the pain as a constant, dull ache, worsening with walking and climbing stairs. Notes occasional swelling, particularly in the right knee. Over-the-counter NSAIDs provide partial relief.",
    "Past Medical History (PMH)": ["Hypertension.", "Type 2 diabetes mellitus."],
    "Medication History": ["Hydrochlorothiazide 25 mg daily.", "Metformin 850 mg twice daily."],
    "Social History (SH)": ["Retired school teacher, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["Mother with osteoarthritis.", "Father with history of heart disease."],
    "Review of Systems (ROS)": "Positive for bilateral knee pain and occasional swelling. Negative for fever, rash, back pain, morning stiffness.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, overweight.",
      "Vital Signs": "BP 135/85 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 97% on room air.",
      "Musculoskeletal": "Bilateral knee crepitus with range of motion. Mild effusion in the right knee. No warmth or erythema."
    },
    "Diagnostic Test Results": ["X-ray of both knees: Bilateral joint space narrowing with osteophytic changes, consistent with osteoarthritis."],
    "Assessment and Plan": {
      "Assessment": "Osteoarthritis of the knees, bilateral.",
      "Plan": [
        "Continue NSAIDs as needed for pain control, with stomach protection if necessary.",
        "Recommend weight loss to reduce joint stress.",
        "Refer to physical therapy for knee strengthening exercises.",
        "Discuss options for intra-articular corticosteroid injections for flare-ups.",
        "Consider orthopedic consultation if symptoms significantly impact quality of life or if conservative management fails."
      ]
    },
    "Problem List": ["Osteoarthritis of the knees, bilateral"]
  },
  {
    "Case Number": 2021,
    "Chief Complaint (CC)": "Acute abdominal pain and vomiting.",
    "History of Present Illness (HPI)": "Ms. Erica Johnson, a 29-year-old female, presents with acute onset of abdominal pain and vomiting since early this morning. Pain is localized to the right lower quadrant, described as sharp and worsening with movement. Reports nausea and three episodes of vomiting, no blood. Denies fever, diarrhea, or urinary symptoms.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, occasional wine consumption, denies illicit drug use."],
    "Family History (FH)": ["Mother with gallstones, father with hypertension."],
    "Review of Systems (ROS)": "Positive for acute abdominal pain, nausea, vomiting. Negative for fever, diarrhea, dysuria, flank pain.",
    "Physical Examination (PE)": {
      "General": "Appears in distress due to pain.",
      "Vital Signs": "BP 120/75 mmHg, HR 100 bpm, RR 20/min, Temp 99.1°F (37.3°C), O2 Sat 98% on room air.",
      "Abdomen": "Tender in the right lower quadrant with rebound tenderness. No distension or guarding."
    },
    "Diagnostic Test Results": ["CBC: Mild leukocytosis.", "CT abdomen/pelvis: Appendicitis with no perforation."],
    "Assessment and Plan": {
      "Assessment": "Acute appendicitis.",
      "Plan": [
        "Surgical consultation for appendectomy.",
        "Start IV fluids and antibiotics.",
        "NPO (nothing by mouth) to prepare for possible surgery.",
        "Pain management as needed."
      ]
    },
    "Problem List": ["Acute appendicitis"]
  },
  {
    "Case Number": 2022,
    "Chief Complaint (CC)": "Persistent dry cough and shortness of breath.",
    "History of Present Illness (HPI)": "Mr. Kyle Thompson, a 53-year-old male with a history of smoking, presents with a 3-month history of persistent dry cough and progressive shortness of breath. Reports worsening of symptoms with exertion. Denies fever, chest pain, or recent infections.",
    "Past Medical History (PMH)": ["20-year pack-a-day smoking history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Truck driver, current smoker, occasional alcohol use."],
    "Family History (FH)": ["Father died of lung cancer.", "Mother with chronic obstructive pulmonary disease (COPD)."],
    "Review of Systems (ROS)": "Positive for dry cough, shortness of breath. Negative for fever, chest pain, weight loss.",
    "Physical Examination (PE)": {
      "General": "Cachectic appearance, using accessory muscles to breathe.",
      "Vital Signs": "BP 135/85 mmHg, HR 95 bpm, RR 22/min, Temp 98.6°F (37°C), O2 Sat 92% on room air.",
      "Respiratory": "Diminished breath sounds bilaterally with prolonged expiration. No wheezes or crackles."
    },
    "Diagnostic Test Results": ["Chest X-ray: Hyperinflation with flattened diaphragms.", "Pulmonary function tests: Reduced FEV1/FVC ratio."],
    "Assessment and Plan": {
      "Assessment": "Chronic obstructive pulmonary disease (COPD), likely due to long-term smoking.",
      "Plan": [
        "Initiate treatment with inhaled bronchodilators (short-acting and long-acting).",
        "Start inhaled corticosteroid for persistent symptoms.",
        "Smoking cessation counseling and support.",
        "Pulmonary rehabilitation referral.",
        "Follow-up in 4 weeks to reassess symptoms and adjust treatment."
      ]
    },
    "Problem List": ["COPD", "Smoking"]
  },
  {
    "Case Number": 2023,
    "Chief Complaint (CC)": "Severe headache with photophobia.",
    "History of Present Illness (HPI)": "Ms. Laura Wells, a 27-year-old female, presents with a 1-day history of severe, throbbing headache located primarily in the frontal region. Reports sensitivity to light and nausea without vomiting. Denies recent head trauma or similar past episodes.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Occasional ibuprofen for menstrual cramps."],
    "Social History (SH)": ["Graphic designer, non-smoker, social drinker, denies illicit drug use."],
    "Family History (FH)": ["Mother with migraines.", "Father with hypertension."],
    "Review of Systems (ROS)": "Positive for headache, photophobia, nausea. Negative for fever, neck stiffness, rash, vision changes.",
    "Physical Examination (PE)": {
      "General": "Appears uncomfortable, photophobic.",
      "Vital Signs": "BP 110/70 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Neurologic": "Alert and oriented. Cranial nerves II-XII intact. No neck stiffness. Normal strength and sensation."
    },
    "Diagnostic Test Results": ["MRI brain: Normal.", "Lumbar puncture: Normal opening pressure, normal CSF analysis."],
    "Assessment and Plan": {
      "Assessment": "Migraine without aura.",
      "Plan": [
        "Prescribe triptan for acute migraine attacks.",
        "Advise on lifestyle modifications to avoid known triggers.",
        "Consider prophylactic medication if frequency of migraine attacks increases.",
        "Follow-up as needed or if symptoms change."
      ]
    },
    "Problem List": ["Migraine without aura"]
  },
  {
    "Case Number": 2024,
    "Chief Complaint (CC)": "Blood in stool.",
    "History of Present Illness (HPI)": "Mr. James Peterson, a 60-year-old male, presents with a 2-week history of noticing blood mixed with stool. Describes stools as partially formed with no associated pain. Denies changes in bowel habits, weight loss, or abdominal pain.",
    "Past Medical History (PMH)": ["Hypertension.", "Hypercholesterolemia."],
    "Medication History": ["Lisinopril 10 mg daily.", "Simvastatin 20 mg at bedtime."],
    "Social History (SH)": ["Retired military officer, non-smoker, moderate alcohol use."],
    "Family History (FH)": ["Father had colon cancer.", "Mother with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for blood in stool. Negative for abdominal pain, weight loss, fever, nausea, vomiting.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 140/90 mmHg, HR 78 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Abdomen": "Soft, non-tender, no palpable masses."
    },
    "Diagnostic Test Results": ["Colonoscopy: 2 cm mass in ascending colon, biopsy taken.", "CT abdomen/pelvis: No evidence of metastasis."],
    "Assessment and Plan": {
      "Assessment": "Colonic mass, pending biopsy results.",
      "Plan": [
        "Await biopsy results for definitive diagnosis.",
        "Surgical consultation for potential resection.",
        "Discuss potential diagnoses and treatment options pending results.",
        "Arrange follow-up appointment for discussion of biopsy results and surgical planning."
      ]
    },
    "Problem List": ["Colonic mass"]
  },
  {
    "Case Number": 2025,
    "Chief Complaint (CC)": "Swollen, painful left calf.",
    "History of Present Illness (HPI)": "Mr. Steven Clark, a 38-year-old male, presents with a 3-day history of swelling and pain in his left calf. Denies trauma, recent surgery, or prolonged travel. Notes increased pain with walking.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Accountant, non-smoker, occasional alcohol use, denies illicit drug use."],
    "Family History (FH)": ["No significant family medical history."],
    "Review of Systems (ROS)": "Positive for left calf pain and swelling. Negative for chest pain, shortness of breath, fever.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 125/80 mmHg, HR 85 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Extremities": "Left calf is swollen, warm, and tender to palpation. No erythema or palpable cords."
    },
    "Diagnostic Test Results": ["Doppler ultrasound of the left leg: Deep vein thrombosis (DVT) in the left popliteal vein."],
    "Assessment and Plan": {
      "Assessment": "Deep vein thrombosis (DVT) in the left leg.",
      "Plan": [
        "Initiate anticoagulation therapy with low molecular weight heparin followed by oral anticoagulant.",
        "Advise leg elevation and use of compression stockings.",
        "Refer to hematology for evaluation of possible thrombophilia.",
        "Schedule follow-up in 1 week to monitor treatment response and adjust anticoagulation therapy."
      ]
    },
    "Problem List": ["Deep vein thrombosis (DVT)"]
  },
  {
    "Case Number": 2026,
    "Chief Complaint (CC)": "Palpitations and lightheadedness.",
    "History of Present Illness (HPI)": "Ms. Rachel Kim, a 44-year-old female, presents with episodes of palpitations and lightheadedness for the past month. Episodes last for a few minutes and resolve spontaneously. Denies syncope, chest pain, or shortness of breath.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Marketing consultant, non-smoker, social drinker, denies illicit drug use."],
    "Family History (FH)": ["Mother with atrial fibrillation.", "Father with hypertension."],
    "Review of Systems (ROS)": "Positive for palpitations and lightheadedness. Negative for syncope, chest pain, dyspnea.",
    "Physical Examination (PE)": {
      "General": "Appears anxious but in no acute distress.",
      "Vital Signs": "BP 130/85 mmHg, HR 76 bpm (regular), RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs, rubs, or gallops."
    },
    "Diagnostic Test Results": ["ECG: Normal sinus rhythm.", "Holter monitor: Occasional premature ventricular contractions (PVCs)."],
    "Assessment and Plan": {
      "Assessment": "Palpitations with occasional PVCs.",
      "Plan": [
        "Reassure about the benign nature of PVCs.",
        "Advise on lifestyle modifications including caffeine and alcohol reduction.",
        "Consider beta-blocker if symptoms are bothersome and frequent.",
        "Follow-up in 3 months or sooner if symptoms worsen."
      ]
    },
    "Problem List": ["Palpitations", "Premature ventricular contractions"]
  },
  {
    "Case Number": 2027,
    "Chief Complaint (CC)": "Weight loss and night sweats.",
    "History of Present Illness (HPI)": "Mr. Michael Brown, a 55-year-old male, presents with unintentional weight loss of 15 pounds over the last 3 months and night sweats. Denies fever, cough, or changes in appetite. No history of similar symptoms.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["High school principal, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["No significant family medical history."],
    "Review of Systems (ROS)": "Positive for weight loss and night sweats. Negative for fever, cough, abdominal pain, dysuria.",
    "Physical Examination (PE)": {
      "General": "Cachectic appearance.",
      "Vital Signs": "BP 110/70 mmHg, HR 88 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Abdomen": "Soft, non-tender, no palpable masses."
    },
    "Diagnostic Test Results": ["CBC: Mild anemia.", "CT chest/abdomen/pelvis: Enlarged mediastinal lymph nodes.", "Biopsy of lymph node: Non-Hodgkin lymphoma."],
    "Assessment and Plan": {
      "Assessment": "Non-Hodgkin lymphoma.",
      "Plan": [
        "Refer to oncology for evaluation and management.",
        "Initiate staging workup and discuss treatment options based on subtype and stage.",
        "Supportive care for symptoms management.",
        "Schedule follow-up for ongoing monitoring and treatment adjustment."
      ]
    },
    "Problem List": ["Non-Hodgkin lymphoma"]
  },
  {
    "Case Number": 2028,
    "Chief Complaint (CC)": "Tingling and weakness in both hands.",
    "History of Present Illness (HPI)": "Ms. Anita Singh, a 49-year-old female, presents with a 6-month history of tingling and progressive weakness in both hands. Reports difficulty with gripping objects and buttoning clothes. Denies trauma or previous similar episodes.",
    "Past Medical History (PMH)": ["Type 2 diabetes mellitus."],
    "Medication History": ["Metformin 1000 mg twice daily."],
    "Social History (SH)": ["Office manager, non-smoker, moderate alcohol use."],
    "Family History (FH)": ["Father with type 2 diabetes.", "Mother with hypothyroidism."],
    "Review of Systems (ROS)": "Positive for tingling and weakness in hands. Negative for pain, swelling, or color changes in the hands.",
    "Physical Examination (PE)": {
      "General": "Well-appearing.",
      "Vital Signs": "BP 135/85 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Neurologic": "Reduced grip strength bilaterally. Sensory loss to light touch over the palmar aspect of both hands."
    },
    "Diagnostic Test Results": ["Nerve conduction studies: Evidence of median nerve compression at the wrist bilaterally."],
    "Assessment and Plan": {
      "Assessment": "Carpal tunnel syndrome, bilateral.",
      "Plan": [
        "Recommend wrist splints for nighttime use.",
        "Initiate non-steroidal anti-inflammatory drugs (NSAIDs) for symptom relief.",
        "Refer to physical therapy for hand exercises.",
        "Consider corticosteroid injection or surgical referral if no improvement."
      ]
    },
    "Problem List": ["Carpal tunnel syndrome"]
  },
  {
    "Case Number": 2029,
    "Chief Complaint (CC)": "Frequent episodes of dizziness and near fainting.",
    "History of Present Illness (HPI)": "Mr. Omar Patel, a 68-year-old male, presents with several episodes of dizziness and near fainting over the past 2 months. Episodes occur suddenly, especially upon standing from a seated or lying position. Denies loss of consciousness, chest pain, or palpitations.",
    "Past Medical History (PMH)": ["Hypertension.", "Hyperlipidemia."],
    "Medication History": ["Amlodipine 5 mg daily.", "Atorvastatin 10 mg at bedtime."],
    "Social History (SH)": ["Retired engineer, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["No significant family medical history."],
    "Review of Systems (ROS)": "Positive for dizziness and near fainting. Negative for headache, seizure, chest pain, shortness of breath.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 110/60 mmHg sitting, 90/50 mmHg standing; HR 70 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Cardiovascular": "Normal heart sounds, no murmurs. Regular rhythm."
    },
    "Diagnostic Test Results": ["Holter monitor: Normal sinus rhythm.", "Echocardiogram: Normal left ventricular function."],
    "Assessment and Plan": {
      "Assessment": "Orthostatic hypotension.",
      "Plan": [
        "Review and adjust antihypertensive therapy as necessary.",
        "Educate on slow positional changes to prevent symptoms.",
        "Ensure adequate hydration.",
        "Follow-up in 2 weeks to reassess blood pressure management and symptom control."
      ]
    },
    "Problem List": ["Orthostatic hypotension"]
  },
  {
    "Case Number": 2030,
    "Chief Complaint (CC)": "Sudden loss of vision in the left eye.",
    "History of Present Illness (HPI)": "Ms. Diane Roberts, a 72-year-old female, presents with sudden, painless loss of vision in her left eye upon waking this morning. Denies previous episodes, eye pain, or trauma. No headache or neurological symptoms.",
    "Past Medical History (PMH)": ["Hypertension.", "Atrial fibrillation."],
    "Medication History": ["Lisinopril 20 mg daily.", "Warfarin with INR target 2-3."],
    "Social History (SH)": ["Retired librarian, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["Mother with glaucoma.", "Father with macular degeneration."],
    "Review of Systems (ROS)": "Positive for sudden loss of vision in the left eye. Negative for pain, redness, double vision, headache.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 150/90 mmHg, HR 82 bpm (irregular), RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Eyes": "Left eye: No direct or consensual pupillary response. Right eye: Normal exam."
    },
    "Diagnostic Test Results": ["Fundoscopic exam: Left eye shows pale retina with cherry-red spot at the macula.", "Carotid ultrasound: No significant stenosis."],
    "Assessment and Plan": {
      "Assessment": "Central retinal artery occlusion (CRAO) in the left eye.",
      "Plan": [
        "Immediate referral to ophthalmology for possible intervention.",
        "Review anticoagulation therapy and adjust as necessary.",
        "Cardiology consultation for atrial fibrillation management.",
        "Educate on importance of regular eye examinations and monitoring for further symptoms."
      ]
    },
    "Problem List": ["Central retinal artery occlusion (CRAO)"]
  },
  {
    "Case Number": 2031,
    "Chief Complaint (CC)": "Intermittent episodes of palpitations and dizziness.",
    "History of Present Illness (HPI)": "Mr. Marcus Reed, a 34-year-old male, presents with a 6-month history of intermittent palpitations and episodes of dizziness, lasting several minutes at a time. Denies syncope, chest pain, or shortness of breath. Episodes occur both at rest and during physical activity.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Software developer, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Mother with hyperthyroidism.", "Father with hypertension."],
    "Review of Systems (ROS)": "Positive for palpitations and dizziness. Negative for syncope, chest pain, dyspnea.",
    "Physical Examination (PE)": {
      "General": "Appears well, in no acute distress.",
      "Vital Signs": "BP 120/80 mmHg, HR 88 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs, rubs, or gallops.",
      "Neurologic": "Alert and oriented, no focal deficits."
    },
    "Diagnostic Test Results": ["ECG: Occasional premature atrial contractions.", "Holter monitor: Frequent PACs, no significant arrhythmias."],
    "Assessment and Plan": {
      "Assessment": "Frequent premature atrial contractions (PACs), causing palpitations and dizziness.",
      "Plan": [
        "Reassurance about the benign nature of PACs.",
        "Lifestyle modifications: Reduce caffeine and alcohol intake, stress management techniques.",
        "Follow-up if symptoms persist or worsen for possible beta-blocker therapy.",
        "Cardiology referral if new symptoms develop."
      ]
    },
    "Problem List": ["Premature atrial contractions"]
  },
  {
    "Case Number": 2032,
    "Chief Complaint (CC)": "Chronic diarrhea and abdominal pain.",
    "History of Present Illness (HPI)": "Ms. Julia Martinez, a 28-year-old female, presents with a 1-year history of chronic diarrhea and intermittent abdominal pain. Reports 4-6 loose bowel movements daily, occasionally bloody. Associated with cramping abdominal pain. Denies fever, weight loss.",
    "Past Medical History (PMH)": ["Irritable bowel syndrome (IBS) diagnosed 5 years ago."],
    "Medication History": ["As needed loperamide for diarrhea."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, rarely drinks alcohol."],
    "Family History (FH)": ["Father with Crohn's disease.", "Mother healthy."],
    "Review of Systems (ROS)": "Positive for chronic diarrhea, abdominal pain. Negative for fever, weight loss, joint pain.",
    "Physical Examination (PE)": {
      "General": "Appears well-nourished, in mild distress from pain.",
      "Vital Signs": "BP 110/70 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Abdomen": "Soft, mild diffuse tenderness, no rebound or guarding."
    },
    "Diagnostic Test Results": ["Colonoscopy: Patchy colitis with granulomas.", "Biopsy: Non-caseating granulomas consistent with Crohn's disease."],
    "Assessment and Plan": {
      "Assessment": "Crohn's disease, newly diagnosed.",
      "Plan": [
        "Initiate mesalamine therapy.",
        "Consider corticosteroids for acute flare management.",
        "Refer to gastroenterology for further evaluation and management.",
        "Nutritional counseling and support.",
        "Follow-up in 4 weeks to assess response to therapy."
      ]
    },
    "Problem List": ["Crohn's disease"]
  },
  {
    "Case Number": 2033,
    "Chief Complaint (CC)": "Recurrent urinary tract infections.",
    "History of Present Illness (HPI)": "Ms. Heather Smith, a 42-year-old female, presents with symptoms of a urinary tract infection (UTI), including dysuria, frequency, and urgency. This is her third UTI in the last six months. Denies flank pain or fever.",
    "Past Medical History (PMH)": ["Recurrent UTIs."],
    "Medication History": ["Multiple courses of antibiotics for UTIs."],
    "Social History (SH)": ["Marketing manager, non-smoker, moderate alcohol consumption."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for dysuria, urinary frequency, and urgency. Negative for fever, flank pain.",
    "Physical Examination (PE)": {
      "General": "Appears healthy, in no acute distress.",
      "Vital Signs": "BP 125/78 mmHg, HR 72 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 99% on room air.",
      "Abdomen": "Soft, non-tender, no suprapubic tenderness."
    },
    "Diagnostic Test Results": ["Urinalysis: Pyuria, bacteriuria.", "Culture: E. coli sensitive to ciprofloxacin."],
    "Assessment and Plan": {
      "Assessment": "Recurrent urinary tract infection.",
      "Plan": [
        "Prescribe a 7-day course of ciprofloxacin.",
        "Post-treatment urine culture to confirm eradication.",
        "Discuss preventive measures including hydration and voiding habits.",
        "Consider referral to urology for evaluation of anatomic abnormalities if infections recur."
      ]
    },
    "Problem List": ["Recurrent urinary tract infections"]
  },
  {
    "Case Number": 2034,
    "Chief Complaint (CC)": "Numbness and tingling in both feet.",
    "History of Present Illness (HPI)": "Mr. Alan Rodriguez, a 55-year-old male with a history of type 2 diabetes, presents with 6 months of progressive numbness and tingling in both feet. Describes the sensation as 'walking on cotton'. Denies pain or weakness.",
    "Past Medical History (PMH)": ["Type 2 diabetes mellitus, diagnosed 10 years ago."],
    "Medication History": ["Metformin 1000 mg twice daily.", "Simvastatin 20 mg at bedtime."],
    "Social History (SH)": ["High school teacher, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Mother with type 2 diabetes.", "Father with hypertension."],
    "Review of Systems (ROS)": "Positive for numbness and tingling in feet. Negative for weakness, pain, or urinary symptoms.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, overweight.",
      "Vital Signs": "BP 140/85 mmHg, HR 80 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Neurologic": "Decreased sensation to light touch and vibration in both feet. Reflexes are diminished bilaterally at the ankles."
    },
    "Diagnostic Test Results": ["HbA1c: 7.8%.", "Nerve conduction studies: Reduced amplitude and slowed conduction velocities in lower extremities."],
    "Assessment and Plan": {
      "Assessment": "Diabetic peripheral neuropathy.",
      "Plan": [
        "Optimize glycemic control.",
        "Consider medications for neuropathic pain management if symptoms develop.",
        "Refer to diabetes education for comprehensive management.",
        "Annual foot exams to monitor for complications."
      ]
    },
    "Problem List": ["Diabetic peripheral neuropathy", "Type 2 diabetes mellitus"]
  },
  {
    "Case Number": 2035,
    "Chief Complaint (CC)": "Progressive memory loss and confusion.",
    "History of Present Illness (HPI)": "Mrs. Elizabeth Nguyen, a 72-year-old female, presents with her family reporting a 2-year history of progressive memory loss and confusion. Increasing difficulty in managing daily activities and occasional disorientation to time and place. Denies depression or anxiety.",
    "Past Medical History (PMH)": ["Hypertension.", "Hyperlipidemia."],
    "Medication History": ["Hydrochlorothiazide 25 mg daily.", "Atorvastatin 10 mg at bedtime."],
    "Social History (SH)": ["Retired bank clerk, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["Father with late-onset Alzheimer's disease."],
    "Review of Systems (ROS)": "Positive for memory loss, confusion. Negative for headache, seizures, focal weakness.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, cooperative but easily confused.",
      "Vital Signs": "BP 135/80 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Neurologic": "Oriented to person, confused about date and place. Memory impairment noted on recall tests."
    },
    "Diagnostic Test Results": ["MRI brain: Mild cortical atrophy and increased white matter changes.", "Neuropsychological testing: Cognitive deficits consistent with Alzheimer's disease."],
    "Assessment and Plan": {
      "Assessment": "Alzheimer's disease, early stage.",
      "Plan": [
        "Initiate cholinesterase inhibitor therapy.",
        "Discuss safety and support needs with family.",
        "Refer to neurology for further management and support services.",
        "Schedule follow-up appointments for monitoring disease progression."
      ]
    },
    "Problem List": ["Alzheimer's disease"]
  },
  {
    "Case Number": 2036,
    "Chief Complaint (CC)": "Sudden onset of right-sided facial droop.",
    "History of Present Illness (HPI)": "Mr. Kevin Lee, a 50-year-old male, presents with sudden onset of right-sided facial droop this morning. Unable to close right eye completely or smile on the right side. Denies headache, vision changes, or limb weakness. No history of similar symptoms.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Construction worker, smokes half a pack of cigarettes daily, occasional alcohol use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for facial droop. Negative for headache, vision changes, limb weakness, dysphagia.",
    "Physical Examination (PE)": {
      "General": "Appears well, in no acute distress.",
      "Vital Signs": "BP 130/80 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Neurologic": "Right-sided facial weakness, including forehead. Unable to close right eyelid completely. Smile is asymmetric."
    },
    "Diagnostic Test Results": ["MRI brain: No evidence of stroke.", "Lyme serology: Pending."],
    "Assessment and Plan": {
      "Assessment": "Bell's palsy.",
      "Plan": [
        "Start prednisone within 72 hours of symptom onset.",
        "Eye care to prevent corneal drying (lubricating eye drops during the day, eye ointment at night).",
        "Consider adding antiviral therapy if severe symptoms or within 72 hours of onset.",
        "Follow-up in 1 week or sooner if symptoms worsen."
      ]
    },
    "Problem List": ["Bell's palsy"]
  },
  {
    "Case Number": 2037,
    "Chief Complaint (CC)": "Painful rash on the left torso.",
    "History of Present Illness (HPI)": "Ms. Sonia Patel, a 62-year-old female, presents with a 3-day history of a painful rash on her left torso. Describes the pain as burning and severe. Rash is localized to a single dermatomal distribution without crossing the midline.",
    "Past Medical History (PMH)": ["Hypothyroidism."],
    "Medication History": ["Levothyroxine 100 mcg daily."],
    "Social History (SH)": ["Retired teacher, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["Mother with breast cancer.", "Father with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for rash and pain. Negative for fever, headache, vision changes.",
    "Physical Examination (PE)": {
      "General": "Appears uncomfortable due to pain.",
      "Vital Signs": "BP 120/78 mmHg, HR 82 bpm, RR 16/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Skin": "Clustered vesicular lesions on an erythematous base, localized to the left T5 dermatome."
    },
    "Diagnostic Test Results": ["PCR of lesion swab: Positive for varicella-zoster virus."],
    "Assessment and Plan": {
      "Assessment": "Herpes zoster (shingles).",
      "Plan": [
        "Initiate antiviral therapy with valacyclovir.",
        "Pain management with gabapentin and NSAIDs.",
        "Counsel on lesion care and infection control.",
        "Follow-up in 1 week or sooner if new symptoms or complications develop."
      ]
    },
    "Problem List": ["Herpes zoster"]
  },
  {
    "Case Number": 2038,
    "Chief Complaint (CC)": "Increasing shortness of breath on exertion.",
    "History of Present Illness (HPI)": "Mr. Robert King, a 67-year-old male with a history of chronic obstructive pulmonary disease (COPD), presents with increasing shortness of breath on exertion over the past month. Reports using his inhaler more frequently with limited relief.",
    "Past Medical History (PMH)": ["Chronic obstructive pulmonary disease (COPD).", "Former smoker."],
    "Medication History": ["Tiotropium inhaler daily.", "Albuterol inhaler as needed."],
    "Social History (SH)": ["Retired postal worker, quit smoking 5 years ago after 30 years of smoking."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for shortness of breath on exertion. Negative for chest pain, fever, cough.",
    "Physical Examination (PE)": {
      "General": "Mildly distressed due to dyspnea.",
      "Vital Signs": "BP 140/85 mmHg, HR 92 bpm, RR 20/min, Temp 98.6°F (37°C), O2 Sat 90% on room air.",
      "Respiratory": "Prolonged expiration, diffuse wheezes bilaterally."
    },
    "Diagnostic Test Results": ["Spirometry: FEV1 50% predicted, minimal response to bronchodilator."],
    "Assessment and Plan": {
      "Assessment": "COPD exacerbation.",
      "Plan": [
        "Start oral corticosteroid therapy.",
        "Increase frequency of albuterol use.",
        "Consider antibiotics if signs of bacterial infection.",
        "Evaluate need for long-term oxygen therapy.",
        "Pulmonary rehabilitation referral.",
        "Follow-up in 2 weeks or sooner if worsening symptoms."
      ]
    },
    "Problem List": ["COPD exacerbation"]
  },
  {
    "Case Number": 2039,
    "Chief Complaint (CC)": "Acute right lower quadrant abdominal pain.",
    "History of Present Illness (HPI)": "Ms. Emily Clark, a 25-year-old female, presents with 24 hours of acute right lower quadrant abdominal pain. Pain is sharp, worsens with movement, and is associated with nausea but no vomiting. Denies fever, diarrhea, or previous similar episodes.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Graduate student, non-smoker, social drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for abdominal pain and nausea. Negative for fever, vomiting, diarrhea, urinary symptoms.",
    "Physical Examination (PE)": {
      "General": "Appears in mild distress.",
      "Vital Signs": "BP 125/75 mmHg, HR 100 bpm, RR 18/min, Temp 98.7°F (37.1°C), O2 Sat 98% on room air.",
      "Abdomen": "Tender in the right lower quadrant with rebound tenderness. No guarding or rigidity."
    },
    "Diagnostic Test Results": ["CBC: Leukocytosis.", "CT abdomen/pelvis: Appendicitis without perforation."],
    "Assessment and Plan": {
      "Assessment": "Acute appendicitis.",
      "Plan": [
        "Surgical consultation for appendectomy.",
        "Start IV fluids and antibiotics.",
        "NPO status in preparation for surgery.",
        "Pain management as needed."
      ]
    },
    "Problem List": ["Acute appendicitis"]
  },
  {
    "Case Number": 2040,
    "Chief Complaint (CC)": "Gradual vision loss in both eyes.",
    "History of Present Illness (HPI)": "Mr. Lawrence Fisher, a 72-year-old male, presents with a complaint of gradual vision loss in both eyes over the past year. Describes difficulty reading and navigating stairs. Denies acute changes, pain, or redness in the eyes.",
    "Past Medical History (PMH)": ["Hypertension.", "Type 2 diabetes mellitus."],
    "Medication History": ["Lisinopril 20 mg daily.", "Metformin 500 mg twice daily."],
    "Social History (SH)": ["Retired school principal, non-smoker, moderate alcohol use."],
    "Family History (FH)": ["Mother with glaucoma.", "Father with age-related macular degeneration."],
    "Review of Systems (ROS)": "Positive for gradual bilateral vision loss. Negative for pain, redness, flashes, floaters.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, no acute distress.",
      "Vital Signs": "BP 130/80 mmHg, HR 68 bpm, RR 14/min, Temp 98.6°F (37°C), O2 Sat 98% on room air.",
      "Eyes": "Bilateral cataracts noted on examination."
    },
    "Diagnostic Test Results": ["Visual acuity: 20/50 both eyes.", "Slit lamp examination: Bilateral nuclear sclerotic cataracts."],
    "Assessment and Plan": {
      "Assessment": "Bilateral cataracts contributing to vision loss.",
      "Plan": [
        "Refer to ophthalmology for cataract evaluation.",
        "Discuss surgical options for cataract extraction and intraocular lens implantation.",
        "Optimize systemic conditions prior to surgery.",
        "Schedule follow-up after ophthalmology consultation."
      ]
    },
    "Problem List": ["Bilateral cataracts", "Gradual vision loss"]
  },
  {
    "Case Number": 2041,
    "Chief Complaint (CC)": "Sudden onset of left-sided weakness.",
    "History of Present Illness (HPI)": "Mr. Daniel Lee, a 68-year-old male, experienced sudden onset of left-sided weakness while watching TV this morning. Symptoms began suddenly, affecting his left arm and leg, without any preceding headache, trauma, or loss of consciousness.",
    "Past Medical History (PMH)": ["Hypertension.", "Hyperlipidemia."],
    "Medication History": ["Lisinopril 10 mg daily.", "Atorvastatin 20 mg at bedtime."],
    "Social History (SH)": ["Retired mechanic, smoker for 30 years, quit 5 years ago.", "Occasional alcohol use."],
    "Family History (FH)": ["Father had a stroke at age 72.", "Mother with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for left-sided weakness. Negative for headache, seizures, visual changes.",
    "Physical Examination (PE)": {
      "General": "Awake, alert, oriented x3, appears anxious.",
      "Vital Signs": "BP 150/90 mmHg, HR 88 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Neurologic": "Noted left-sided facial droop, left arm and leg weakness (3/5 strength), normal sensation."
    },
    "Diagnostic Test Results": ["CT head: No hemorrhage, early signs of right MCA territory ischemia.", "EKG: Normal sinus rhythm."],
    "Assessment and Plan": {
      "Assessment": "Acute ischemic stroke.",
      "Plan": [
        "Immediate administration of IV tPA considering within window period.",
        "Admission to stroke unit for monitoring and further care.",
        "Start antiplatelet therapy post-tPA.",
        "Order carotid Doppler and echocardiogram to evaluate for embolic sources.",
        "Physical therapy evaluation for rehabilitation potential.",
        "Risk factor management, including blood pressure and lipid control."
      ]
    },
    "Problem List": ["Acute ischemic stroke"]
  },
  {
    "Case Number": 2042,
    "Chief Complaint (CC)": "Fever, cough, and shortness of breath.",
    "History of Present Illness (HPI)": "Ms. Sarah Kim, a 55-year-old female, presents with a 3-day history of fever reaching up to 101°F, productive cough with yellowish sputum, and worsening shortness of breath.",
    "Past Medical History (PMH)": ["Asthma.", "Type 2 diabetes mellitus."],
    "Medication History": ["Inhaled corticosteroids and long-acting beta agonists.", "Metformin."],
    "Social History (SH)": ["High school teacher, non-smoker, non-drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for fever, cough, shortness of breath. Negative for chest pain, leg swelling.",
    "Physical Examination (PE)": {
      "General": "Moderate distress due to dyspnea.",
      "Vital Signs": "BP 120/80 mmHg, HR 102 bpm, RR 22/min, Temp 101°F, O2 Sat 92% on room air.",
      "Respiratory": "Diffuse wheezes, crackles at right lower lung."
    },
    "Diagnostic Test Results": ["Chest X-ray: Right lower lobe consolidation.", "CBC: Elevated WBC with left shift."],
    "Assessment and Plan": {
      "Assessment": "Community-acquired pneumonia, asthma exacerbation.",
      "Plan": [
        "Start broad-spectrum antibiotics.",
        "Increase frequency of inhaled short-acting bronchodilators.",
        "Administer systemic corticosteroids.",
        "Supplemental oxygen to maintain Sat >92%.",
        "Monitor blood glucose levels closely due to steroid therapy.",
        "Follow-up chest X-ray in 6 weeks."
      ]
    },
    "Problem List": ["Community-acquired pneumonia", "Asthma exacerbation"]
  },
  {
    "Case Number": 2043,
    "Chief Complaint (CC)": "Chronic lower back pain.",
    "History of Present Illness (HPI)": "Mr. Alex Johnson, a 42-year-old male, complains of chronic lower back pain for the past 2 years, worsening over the last 3 months. Pain is described as constant, dull ache, aggravated by prolonged standing and lifting.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["NSAIDs as needed."],
    "Social History (SH)": ["Construction worker, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Mother with osteoarthritis."],
    "Review of Systems (ROS)": "Positive for lower back pain. Negative for radiating pain, numbness, or weakness in the legs.",
    "Physical Examination (PE)": {
      "General": "Appears healthy.",
      "Vital Signs": "BP 130/85 mmHg, HR 78 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Tenderness over lumbar paraspinal muscles, no spinal deformity, normal range of motion."
    },
    "Diagnostic Test Results": ["Lumbar spine X-ray: Mild degenerative disc disease at L4-L5."],
    "Assessment and Plan": {
      "Assessment": "Chronic lower back pain, likely due to degenerative disc disease.",
      "Plan": [
        "Continue NSAIDs with caution for gastric protection.",
        "Initiate physical therapy focusing on back strengthening and flexibility exercises.",
        "Consider referral to pain management for additional options such as epidural steroid injections if no improvement.",
        "Review proper lifting techniques and ergonomics at work."
      ]
    },
    "Problem List": ["Chronic lower back pain", "Degenerative disc disease"]
  },
  {
    "Case Number": 2044,
    "Chief Complaint (CC)": "Generalized itching without rash.",
    "History of Present Illness (HPI)": "Mrs. Linda Green, a 58-year-old female, presents with 6 weeks of generalized itching without any visible rash. Itching is severe, disturbing her sleep, and not relieved by over-the-counter antihistamines.",
    "Past Medical History (PMH)": ["Hypothyroidism."],
    "Medication History": ["Levothyroxine."],
    "Social History (SH)": ["Retired bank clerk, non-smoker, drinks wine occasionally."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for generalized itching. Negative for rash, jaundice, abdominal pain, change in bowel habits.",
    "Physical Examination (PE)": {
      "General": "No acute distress.",
      "Vital Signs": "BP 135/85 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Skin": "No rash, lesions, or erythema noted."
    },
    "Diagnostic Test Results": ["Liver function tests: Elevated ALP and bilirubin.", "Abdominal ultrasound: Dilated intrahepatic bile ducts."],
    "Assessment and Plan": {
      "Assessment": "Generalized pruritus, likely secondary to cholestasis of unknown origin.",
      "Plan": [
        "Order MRCP to further evaluate bile ducts.",
        "Refer to gastroenterology for evaluation of possible biliary obstruction.",
        "Start cholestyramine for symptom management.",
        "Monitor liver function tests closely."
      ]
    },
    "Problem List": ["Generalized pruritus", "Cholestasis"]
  },
  {
    "Case Number": 2045,
    "Chief Complaint (CC)": "Acute right ankle sprain.",
    "History of Present Illness (HPI)": "Ms. Rebecca Smith, a 30-year-old female, presents after twisting her right ankle while running. Immediate onset of pain and swelling in the right ankle. Difficulty bearing weight.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, active lifestyle."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for right ankle pain and swelling. Negative for fever, chest pain, shortness of breath.",
    "Physical Examination (PE)": {
      "General": "In mild distress from pain.",
      "Vital Signs": "BP 120/78 mmHg, HR 88 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling and tenderness over lateral malleolus, decreased range of motion due to pain."
    },
    "Diagnostic Test Results": ["X-ray of the right ankle: No fracture seen, soft tissue swelling."],
    "Assessment and Plan": {
      "Assessment": "Right ankle sprain.",
      "Plan": [
        "RICE (Rest, Ice, Compression, Elevation) protocol.",
        "NSAIDs for pain and inflammation.",
        "Ankle brace for support and to prevent further injury.",
        "Physical therapy referral for rehabilitation.",
        "Follow-up in 1-2 weeks to assess recovery."
      ]
    },
    "Problem List": ["Right ankle sprain"]
  },
  {
    "Case Number": 2046,
    "Chief Complaint (CC)": "Newly diagnosed type 2 diabetes mellitus.",
    "History of Present Illness (HPI)": "Mr. George Hill, a 52-year-old male, presents for a follow-up after routine lab tests revealed elevated fasting glucose levels on two separate occasions. Reports increased thirst and frequent urination over the last few months.",
    "Past Medical History (PMH)": ["Hypertension."],
    "Medication History": ["Hydrochlorothiazide 25 mg daily."],
    "Social History (SH)": ["Insurance agent, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Mother with type 2 diabetes.", "Father with coronary artery disease."],
    "Review of Systems (ROS)": "Positive for polydipsia and polyuria. Negative for weight loss, blurred vision, or neuropathy.",
    "Physical Examination (PE)": {
      "General": "Overweight, otherwise well.",
      "Vital Signs": "BP 142/88 mmHg, HR 84 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Abdomen": "Obese, no tenderness."
    },
    "Diagnostic Test Results": ["Fasting glucose: 126 mg/dL on two occasions.", "HbA1c: 7.2%."],
    "Assessment and Plan": {
      "Assessment": "Newly diagnosed type 2 diabetes mellitus.",
      "Plan": [
        "Initiate metformin therapy, starting at 500 mg daily and titrate based on tolerance and follow-up glucose measurements.",
        "Lifestyle modifications including diet and exercise.",
        "Diabetes education and nutritional counseling.",
        "Monitor HbA1c in 3 months to assess control.",
        "Annual diabetic eye exams and monitor for other complications."
      ]
    },
    "Problem List": ["Type 2 diabetes mellitus"]
  },
  {
    "Case Number": 2047,
    "Chief Complaint (CC)": "Episodes of severe headaches.",
    "History of Present Illness (HPI)": "Ms. Emily Tanner, a 38-year-old female, reports episodes of severe, unilateral headaches occurring 1-2 times per month, lasting 4-6 hours. Associated with nausea, photophobia, and phonophobia. No aura. OTC pain relievers provide minimal relief.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Ibuprofen as needed."],
    "Social History (SH)": ["Graphic designer, non-smoker, social drinker."],
    "Family History (FH)": ["Mother with migraines."],
    "Review of Systems (ROS)": "Positive for unilateral headaches, nausea, photophobia, phonophobia. Negative for aura, weakness, vision changes.",
    "Physical Examination (PE)": {
      "General": "Appears healthy, not in acute distress.",
      "Vital Signs": "BP 118/76 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Neurologic": "Normal exam, no focal deficits."
    },
    "Diagnostic Test Results": ["None performed, clinical diagnosis based on history."],
    "Assessment and Plan": {
      "Assessment": "Migraine without aura.",
      "Plan": [
        "Prescribe triptans for acute migraine attacks.",
        "Discuss preventive strategies, including trigger avoidance and possible prophylactic medication.",
        "Lifestyle modifications to reduce stress.",
        "Follow-up as needed for management of symptoms or to initiate preventive therapy."
      ]
    },
    "Problem List": ["Migraine without aura"]
  },
  {
    "Case Number": 2048,
    "Chief Complaint (CC)": "Bilateral knee osteoarthritis.",
    "History of Present Illness (HPI)": "Mr. Robert Jackson, a 65-year-old male, presents with chronic knee pain worsened over the past year. Describes pain as aching and stiffness, especially in the morning or after prolonged sitting. Limited by pain in daily activities such as walking and climbing stairs.",
    "Past Medical History (PMH)": ["Hypertension.", "Hyperlipidemia."],
    "Medication History": ["Lisinopril 20 mg daily.", "Simvastatin 40 mg at bedtime.", "Acetaminophen as needed for pain."],
    "Social History (SH)": ["Retired school principal, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Mother with osteoarthritis.", "Father with hypertension."],
    "Review of Systems (ROS)": "Positive for joint stiffness, pain in knees. Negative for swelling, redness, or warmth of the joints.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, overweight.",
      "Vital Signs": "BP 138/82 mmHg, HR 76 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Bilateral knee crepitus with range of motion, tenderness on palpation, no effusion."
    },
    "Diagnostic Test Results": ["X-rays of knees: Bilateral joint space narrowing with osteophytic changes."],
    "Assessment and Plan": {
      "Assessment": "Bilateral knee osteoarthritis.",
      "Plan": [
        "Continue acetaminophen, consider NSAIDs with gastric protection.",
        "Physical therapy referral for strengthening and range of motion exercises.",
        "Weight loss counseling to reduce joint stress.",
        "Intra-articular corticosteroid injections if symptoms are severe.",
        "Discuss surgical options if conservative management fails."
      ]
    },
    "Problem List": ["Bilateral knee osteoarthritis"]
  },
  {
    "Case Number": 2049,
    "Chief Complaint (CC)": "Suspected carpal tunnel syndrome.",
    "History of Present Illness (HPI)": "Ms. Nicole Brown, a 40-year-old female, presents with a 6-month history of numbness, tingling, and occasional pain in her right hand, particularly affecting the thumb, index, and middle fingers. Symptoms worsen at night, disturbing her sleep.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Office administrator, frequent computer use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for hand numbness and tingling. Negative for weakness, neck pain.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 120/80 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Neurologic": "Positive Tinel's sign at the wrist, negative Phalen's test. Normal muscle strength and bulk in the upper extremities."
    },
    "Diagnostic Test Results": ["Nerve conduction studies: Delayed conduction in the median nerve across the carpal tunnel."],
    "Assessment and Plan": {
      "Assessment": "Carpal tunnel syndrome, right hand.",
      "Plan": [
        "Wrist splinting, especially at night.",
        "NSAIDs for pain management.",
        "Ergonomic adjustments at work.",
        "Consider corticosteroid injection if symptoms persist.",
        "Surgical referral for carpal tunnel release if conservative treatment fails."
      ]
    },
    "Problem List": ["Carpal tunnel syndrome"]
  },
  {
    "Case Number": 2050,
    "Chief Complaint (CC)": "High blood pressure discovered during routine exam.",
    "History of Present Illness (HPI)": "Mr. Ethan Moore, a 50-year-old male, presents for a follow-up after a routine health screening revealed elevated blood pressure readings on three separate occasions. Denies any symptoms such as headache, chest pain, or dizziness.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Engineer, non-smoker, exercises regularly."],
    "Family History (FH)": ["Father with early-onset coronary artery disease.", "Mother with hypertension."],
    "Review of Systems (ROS)": "Negative for headache, chest pain, shortness of breath, visual changes.",
    "Physical Examination (PE)": {
      "General": "Appears healthy, fit.",
      "Vital Signs": "BP 145/90 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs or gallops."
    },
    "Diagnostic Test Results": ["Blood tests: Normal renal function, lipid profile within normal limits.", "ECG: Normal."],
    "Assessment and Plan": {
      "Assessment": "Hypertension, newly diagnosed.",
      "Plan": [
        "Lifestyle modifications including dietary changes (DASH diet) and increased physical activity.",
        "Monitor blood pressure at home.",
        "Start hydrochlorothiazide if BP remains elevated in 1 month or consider alternative based on follow-up readings.",
        "Schedule follow-up in 1 month to evaluate response to lifestyle modifications and need for pharmacotherapy."
      ]
    },
    "Problem List": ["Hypertension"]
  },
  {
    "Case Number": 2051,
    "Chief Complaint (CC)": "Difficulty swallowing and weight loss.",
    "History of Present Illness (HPI)": "Mr. Keith Thompson, a 62-year-old male, reports progressive difficulty swallowing solid foods over the past 6 months, accompanied by unintentional weight loss of 20 pounds during the same period. Describes the sensation of food 'sticking' in his mid-chest.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Retired postal worker, smoked 1 pack of cigarettes daily for 40 years, quit 5 years ago. Occasional alcohol use."],
    "Family History (FH)": ["Father died of lung cancer.", "Mother alive with hypertension."],
    "Review of Systems (ROS)": "Positive for dysphagia and weight loss. Negative for vomiting, cough, or dyspnea.",
    "Physical Examination (PE)": {
      "General": "Cachectic appearance.",
      "Vital Signs": "BP 130/80 mmHg, HR 90 bpm, RR 18/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Neck": "No lymphadenopathy.",
      "Abdomen": "Soft, non-tender, no hepatosplenomegaly."
    },
    "Diagnostic Test Results": ["Barium swallow: Irregular narrowing of the distal esophagus.", "Endoscopy with biopsy: Adenocarcinoma of the esophagus."],
    "Assessment and Plan": {
      "Assessment": "Esophageal adenocarcinoma.",
      "Plan": [
        "Refer to oncology for evaluation and management.",
        "CT chest/abdomen/pelvis for staging.",
        "Nutritional support and counseling.",
        "Discuss treatment options, including surgery, chemotherapy, and radiation therapy, based on staging and patient preference."
      ]
    },
    "Problem List": ["Esophageal adenocarcinoma"]
  },
  {
    "Case Number": 2052,
    "Chief Complaint (CC)": "Recurrent nosebleeds.",
    "History of Present Illness (HPI)": "Ms. Rachel Evans, a 25-year-old female, presents with recurrent episodes of spontaneous nosebleeds over the last 3 months, occurring approximately once a week. Bleeds are usually unilateral and last for about 5-10 minutes. Denies trauma or use of anticoagulants.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, denies illicit drug use, occasional wine drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for recurrent nosebleeds. Negative for headache, vision changes, bruising, or bleeding elsewhere.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 115/75 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "ENT": "Anterior nasal septum with evidence of recent bleeding, no active bleeding noted."
    },
    "Diagnostic Test Results": ["Complete blood count: Within normal limits.", "Coagulation profile: Normal."],
    "Assessment and Plan": {
      "Assessment": "Epistaxis, likely due to local irritation or dryness.",
      "Plan": [
        "Recommend humidifying the living area.",
        "Nasal saline sprays for moisture.",
        "Avoidance of nasal picking or trauma.",
        "Consider cauterization if recurrent bleeding from a specific site is identified."
      ]
    },
    "Problem List": ["Epistaxis"]
  },
  {
    "Case Number": 2053,
    "Chief Complaint (CC)": "Chronic fatigue and joint pain.",
    "History of Present Illness (HPI)": "Ms. Laura Anderson, a 45-year-old female, presents with a 1-year history of chronic fatigue and diffuse joint pain involving her hands, knees, and feet. Reports stiffness in the morning lasting more than 1 hour. Denies recent infections or fever.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Ibuprofen as needed for pain."],
    "Social History (SH)": ["Graphic designer, non-smoker, moderate alcohol consumption."],
    "Family History (FH)": ["Mother with rheumatoid arthritis.", "Father with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for fatigue, joint pain, and stiffness. Negative for rash, abdominal pain, or chest pain.",
    "Physical Examination (PE)": {
      "General": "Appears tired.",
      "Vital Signs": "BP 120/80 mmHg, HR 80 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling and tenderness of the metacarpophalangeal and proximal interphalangeal joints bilaterally. No deformities."
    },
    "Diagnostic Test Results": ["Rheumatoid factor: Elevated.", "Anti-CCP antibodies: Positive.", "C-reactive protein: Elevated."],
    "Assessment and Plan": {
      "Assessment": "Rheumatoid arthritis.",
      "Plan": [
        "Initiate low-dose methotrexate.",
        "Folic acid supplementation.",
        "Physical therapy referral for joint protection strategies.",
        "Rheumatology referral for disease management.",
        "Follow-up in 4 weeks to assess response to therapy."
      ]
    },
    "Problem List": ["Rheumatoid arthritis"]
  },
  {
    "Case Number": 2054,
    "Chief Complaint (CC)": "Severe sunburn with blistering.",
    "History of Present Illness (HPI)": "Mr. Tyler Brown, a 22-year-old male, presents with severe sunburn on his back and shoulders after spending the day at the beach without sun protection. Noticed blistering and severe pain this morning.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["College student, occasional smoker, frequent alcohol use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for skin pain and blistering. Negative for fever, chills, headache.",
    "Physical Examination (PE)": {
      "General": "In moderate distress due to pain.",
      "Vital Signs": "BP 130/85 mmHg, HR 88 bpm, RR 18/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Skin": "Diffuse erythema with large bullae over the upper back and shoulders, tender to touch."
    },
    "Diagnostic Test Results": ["None performed, diagnosis based on clinical presentation."],
    "Assessment and Plan": {
      "Assessment": "Second-degree sunburn with blistering.",
      "Plan": [
        "Cool compresses and aloe vera for symptomatic relief.",
        "Prescribe silver sulfadiazine cream to affected areas.",
        "Oral NSAIDs for pain management.",
        "Advise on wound care and signs of infection to monitor.",
        "Educate on sun protection and risk of skin cancer."
      ]
    },
    "Problem List": ["Second-degree sunburn"]
  },
  {
    "Case Number": 2055,
    "Chief Complaint (CC)": "Flank pain and hematuria.",
    "History of Present Illness (HPI)": "Ms. Amanda Fisher, a 35-year-old female, presents with acute onset of right flank pain radiating to the groin, accompanied by visible blood in urine since this morning. Denies any recent trauma or infections.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Accountant, non-smoker, denies illicit drug use, occasional wine drinker."],
    "Family History (FH)": ["Father with history of kidney stones."],
    "Review of Systems (ROS)": "Positive for flank pain and hematuria. Negative for fever, dysuria, or frequency.",
    "Physical Examination (PE)": {
      "General": "Appears in discomfort.",
      "Vital Signs": "BP 145/90 mmHg, HR 100 bpm, RR 20/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Abdomen": "Tenderness in the right flank, no abdominal guarding or rebound tenderness."
    },
    "Diagnostic Test Results": ["CT abdomen/pelvis without contrast: 5 mm stone in the right ureter.", "Urinalysis: Hematuria."],
    "Assessment and Plan": {
      "Assessment": "Urolithiasis with right ureteral stone.",
      "Plan": [
        "Hydration and pain management with NSAIDs.",
        "Tamsulosin to facilitate stone passage.",
        "Strain urine to capture the stone for analysis.",
        "Follow-up in 1 week or sooner if symptoms worsen or if fever develops.",
        "Dietary counseling to prevent future stones."
      ]
    },
    "Problem List": ["Urolithiasis", "Hematuria"]
  },
  {
    "Case Number": 2056,
    "Chief Complaint (CC)": "Acute gout attack.",
    "History of Present Illness (HPI)": "Mr. Ethan Wright, a 50-year-old male, presents with acute onset of severe pain, redness, and swelling in the right big toe since yesterday. Reports similar episode 2 years ago. Denies alcohol use prior to onset.",
    "Past Medical History (PMH)": ["History of gout.", "Hypertension."],
    "Medication History": ["Hydrochlorothiazide 25 mg daily.", "Occasional ibuprofen."],
    "Social History (SH)": ["Engineer, non-smoker, moderate alcohol consumption."],
    "Family History (FH)": ["Father with history of gout.", "Mother with osteoarthritis."],
    "Review of Systems (ROS)": "Positive for joint pain, redness, and swelling. Negative for fever, rash, or other joint involvement.",
    "Physical Examination (PE)": {
      "General": "In distress due to pain.",
      "Vital Signs": "BP 140/90 mmHg, HR 90 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling, erythema, and tenderness over the right first metatarsophalangeal joint."
    },
    "Diagnostic Test Results": ["Serum uric acid: Elevated.", "Joint aspiration: Presence of monosodium urate crystals."],
    "Assessment and Plan": {
      "Assessment": "Acute gouty arthritis.",
      "Plan": [
        "Colchicine for acute attack management.",
        "NSAIDs for additional pain control, with gastrointestinal protection if needed.",
        "Discontinue hydrochlorothiazide and consider alternative antihypertensive.",
        "Lifestyle and dietary modifications to reduce uric acid levels.",
        "Follow-up to reevaluate uric acid levels and discuss long-term management."
      ]
    },
    "Problem List": ["Gout", "Hyperuricemia"]
  },
  {
    "Case Number": 2057,
    "Chief Complaint (CC)": "Anxiety and panic attacks.",
    "History of Present Illness (HPI)": "Ms. Sophia Martinez, a 28-year-old female, presents with a 6-month history of recurrent episodes of intense fear accompanied by palpitations, sweating, and shortness of breath. Identifies stress at work as a possible trigger.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Occasional lorazepam for acute episodes."],
    "Social History (SH)": ["Software developer, non-smoker, occasional social drinker."],
    "Family History (FH)": ["Mother with generalized anxiety disorder."],
    "Review of Systems (ROS)": "Positive for anxiety, palpitations, sweating. Negative for chest pain, dizziness.",
    "Physical Examination (PE)": {
      "General": "Appears anxious.",
      "Vital Signs": "BP 125/80 mmHg, HR 88 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs."
    },
    "Diagnostic Test Results": ["None performed, diagnosis based on clinical presentation."],
    "Assessment and Plan": {
      "Assessment": "Panic disorder.",
      "Plan": [
        "Cognitive-behavioral therapy referral.",
        "Consider SSRI for long-term management.",
        "Continue lorazepam for acute episodes with caution regarding dependency.",
        "Regular follow-up to monitor response to treatment."
      ]
    },
    "Problem List": ["Panic disorder"]
  },
  {
    "Case Number": 2058,
    "Chief Complaint (CC)": "Progressive hearing loss.",
    "History of Present Illness (HPI)": "Mr. Michael Davis, a 70-year-old male, presents with progressive bilateral hearing loss over the past 5 years, recently noticing difficulty understanding conversations in noisy environments and asking people to repeat themselves frequently.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Retired school teacher, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for hearing loss. Negative for tinnitus, vertigo, or ear pain.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 130/80 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "ENT": "Bilateral decreased hearing to conversational voice. Ear canals clear, tympanic membranes intact."
    },
    "Diagnostic Test Results": ["Audiometry: Bilateral sensorineural hearing loss."],
    "Assessment and Plan": {
      "Assessment": "Bilateral sensorineural hearing loss.",
      "Plan": [
        "Refer to audiology for hearing aids evaluation and fitting.",
        "Discuss potential benefits of assistive listening devices.",
        "Educate on strategies to improve communication in the presence of hearing loss.",
        "Schedule follow-up to assess adaptation to hearing aids and any further needs."
      ]
    },
    "Problem List": ["Sensorineural hearing loss"]
  },
  {
    "Case Number": 2059,
    "Chief Complaint (CC)": "Swelling and pain in the right wrist.",
    "History of Present Illness (HPI)": "Ms. Lisa Wong, a 32-year-old female, presents with a 1-week history of swelling and pain in her right wrist following a fall during a volleyball game. Denies any previous injury to the wrist. Pain is exacerbated by movement or pressure.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Ibuprofen as needed for pain."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, active lifestyle."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for wrist swelling and pain. Negative for fever, rash, joint pain elsewhere.",
    "Physical Examination (PE)": {
      "General": "In mild distress due to pain.",
      "Vital Signs": "BP 120/78 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling and tenderness over the right wrist, particularly over the scaphoid. Range of motion limited due to pain."
    },
    "Diagnostic Test Results": ["X-ray of the right wrist: No fracture seen.", "MRI of the right wrist: Scaphoid bone fracture."],
    "Assessment and Plan": {
      "Assessment": "Scaphoid fracture of the right wrist.",
      "Plan": [
        "Immobilization with a thumb spica cast.",
        "Pain management with NSAIDs.",
        "Orthopedic referral for possible surgical intervention given the scaphoid fracture.",
        "Follow-up in 1 week for reassessment and cast check."
      ]
    },
    "Problem List": ["Scaphoid fracture"]
  },
  {
    "Case Number": 2060,
    "Chief Complaint (CC)": "Intermittent claudication.",
    "History of Present Illness (HPI)": "Mr. Robert Allen, a 66-year-old male, presents with a 6-month history of intermittent claudication, experiencing cramping pain in his calves after walking more than two blocks. Pain resolves with rest. Recently noted decreased hair growth on his lower legs.",
    "Past Medical History (PMH)": ["Hypertension.", "Hyperlipidemia.", "Smoking history of 30 pack-years, quit 10 years ago."],
    "Medication History": ["Lisinopril 20 mg daily.", "Simvastatin 40 mg at bedtime."],
    "Social History (SH)": ["Retired electrician, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Father died of myocardial infarction.", "Mother with peripheral artery disease."],
    "Review of Systems (ROS)": "Positive for lower extremity pain with exertion. Negative for chest pain, dyspnea, or rest pain in legs.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 140/85 mmHg, HR 78 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Diminished pulses in both feet. No bruits over carotid or abdominal aorta.",
      "Extremities": "Decreased hair growth on lower legs, no ulcers or color change."
    },
    "Diagnostic Test Results": ["Ankle-brachial index (ABI): 0.7 bilaterally.", "Doppler ultrasound: Significant stenosis in bilateral superficial femoral arteries."],
    "Assessment and Plan": {
      "Assessment": "Peripheral artery disease (PAD) with intermittent claudication.",
      "Plan": [
        "Initiate antiplatelet therapy with aspirin.",
        "Statins for lipid control.",
        "Structured exercise program for claudication.",
        "Refer to vascular surgery for evaluation of revascularization options.",
        "Smoking cessation reinforcement.",
        "Follow-up in 3 months to assess symptom improvement and ABI."
      ]
    },
    "Problem List": ["Peripheral artery disease", "Intermittent claudication"]
  },
  {
    "Case Number": 2051,
    "Chief Complaint (CC)": "Difficulty swallowing and weight loss.",
    "History of Present Illness (HPI)": "Mr. Keith Thompson, a 62-year-old male, reports progressive difficulty swallowing solid foods over the past 6 months, accompanied by unintentional weight loss of 20 pounds during the same period. Describes the sensation of food 'sticking' in his mid-chest.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Retired postal worker, smoked 1 pack of cigarettes daily for 40 years, quit 5 years ago. Occasional alcohol use."],
    "Family History (FH)": ["Father died of lung cancer.", "Mother alive with hypertension."],
    "Review of Systems (ROS)": "Positive for dysphagia and weight loss. Negative for vomiting, cough, or dyspnea.",
    "Physical Examination (PE)": {
      "General": "Cachectic appearance.",
      "Vital Signs": "BP 130/80 mmHg, HR 90 bpm, RR 18/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Neck": "No lymphadenopathy.",
      "Abdomen": "Soft, non-tender, no hepatosplenomegaly."
    },
    "Diagnostic Test Results": ["Barium swallow: Irregular narrowing of the distal esophagus.", "Endoscopy with biopsy: Adenocarcinoma of the esophagus."],
    "Assessment and Plan": {
      "Assessment": "Esophageal adenocarcinoma.",
      "Plan": [
        "Refer to oncology for evaluation and management.",
        "CT chest/abdomen/pelvis for staging.",
        "Nutritional support and counseling.",
        "Discuss treatment options, including surgery, chemotherapy, and radiation therapy, based on staging and patient preference."
      ]
    },
    "Problem List": ["Esophageal adenocarcinoma"]
  },
  {
    "Case Number": 2052,
    "Chief Complaint (CC)": "Recurrent nosebleeds.",
    "History of Present Illness (HPI)": "Ms. Rachel Evans, a 25-year-old female, presents with recurrent episodes of spontaneous nosebleeds over the last 3 months, occurring approximately once a week. Bleeds are usually unilateral and last for about 5-10 minutes. Denies trauma or use of anticoagulants.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, denies illicit drug use, occasional wine drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for recurrent nosebleeds. Negative for headache, vision changes, bruising, or bleeding elsewhere.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 115/75 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "ENT": "Anterior nasal septum with evidence of recent bleeding, no active bleeding noted."
    },
    "Diagnostic Test Results": ["Complete blood count: Within normal limits.", "Coagulation profile: Normal."],
    "Assessment and Plan": {
      "Assessment": "Epistaxis, likely due to local irritation or dryness.",
      "Plan": [
        "Recommend humidifying the living area.",
        "Nasal saline sprays for moisture.",
        "Avoidance of nasal picking or trauma.",
        "Consider cauterization if recurrent bleeding from a specific site is identified."
      ]
    },
    "Problem List": ["Epistaxis"]
  },
  {
    "Case Number": 2053,
    "Chief Complaint (CC)": "Chronic fatigue and joint pain.",
    "History of Present Illness (HPI)": "Ms. Laura Anderson, a 45-year-old female, presents with a 1-year history of chronic fatigue and diffuse joint pain involving her hands, knees, and feet. Reports stiffness in the morning lasting more than 1 hour. Denies recent infections or fever.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Ibuprofen as needed for pain."],
    "Social History (SH)": ["Graphic designer, non-smoker, moderate alcohol consumption."],
    "Family History (FH)": ["Mother with rheumatoid arthritis.", "Father with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for fatigue, joint pain, and stiffness. Negative for rash, abdominal pain, or chest pain.",
    "Physical Examination (PE)": {
      "General": "Appears tired.",
      "Vital Signs": "BP 120/80 mmHg, HR 80 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling and tenderness of the metacarpophalangeal and proximal interphalangeal joints bilaterally. No deformities."
    },
    "Diagnostic Test Results": ["Rheumatoid factor: Elevated.", "Anti-CCP antibodies: Positive.", "C-reactive protein: Elevated."],
    "Assessment and Plan": {
      "Assessment": "Rheumatoid arthritis.",
      "Plan": [
        "Initiate low-dose methotrexate.",
        "Folic acid supplementation.",
        "Physical therapy referral for joint protection strategies.",
        "Rheumatology referral for disease management.",
        "Follow-up in 4 weeks to assess response to therapy."
      ]
    },
    "Problem List": ["Rheumatoid arthritis"]
  },
  {
    "Case Number": 2054,
    "Chief Complaint (CC)": "Severe sunburn with blistering.",
    "History of Present Illness (HPI)": "Mr. Tyler Brown, a 22-year-old male, presents with severe sunburn on his back and shoulders after spending the day at the beach without sun protection. Noticed blistering and severe pain this morning.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["College student, occasional smoker, frequent alcohol use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for skin pain and blistering. Negative for fever, chills, headache.",
    "Physical Examination (PE)": {
      "General": "In moderate distress due to pain.",
      "Vital Signs": "BP 130/85 mmHg, HR 88 bpm, RR 18/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Skin": "Diffuse erythema with large bullae over the upper back and shoulders, tender to touch."
    },
    "Diagnostic Test Results": ["None performed, diagnosis based on clinical presentation."],
    "Assessment and Plan": {
      "Assessment": "Second-degree sunburn with blistering.",
      "Plan": [
        "Cool compresses and aloe vera for symptomatic relief.",
        "Prescribe silver sulfadiazine cream to affected areas.",
        "Oral NSAIDs for pain management.",
        "Advise on wound care and signs of infection to monitor.",
        "Educate on sun protection and risk of skin cancer."
      ]
    },
    "Problem List": ["Second-degree sunburn"]
  },
  {
    "Case Number": 2055,
    "Chief Complaint (CC)": "Flank pain and hematuria.",
    "History of Present Illness (HPI)": "Ms. Amanda Fisher, a 35-year-old female, presents with acute onset of right flank pain radiating to the groin, accompanied by visible blood in urine since this morning. Denies any recent trauma or infections.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Accountant, non-smoker, denies illicit drug use, occasional wine drinker."],
    "Family History (FH)": ["Father with history of kidney stones."],
    "Review of Systems (ROS)": "Positive for flank pain and hematuria. Negative for fever, dysuria, or frequency.",
    "Physical Examination (PE)": {
      "General": "Appears in discomfort.",
      "Vital Signs": "BP 145/90 mmHg, HR 100 bpm, RR 20/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Abdomen": "Tenderness in the right flank, no abdominal guarding or rebound tenderness."
    },
    "Diagnostic Test Results": ["CT abdomen/pelvis without contrast: 5 mm stone in the right ureter.", "Urinalysis: Hematuria."],
    "Assessment and Plan": {
      "Assessment": "Urolithiasis with right ureteral stone.",
      "Plan": [
        "Hydration and pain management with NSAIDs.",
        "Tamsulosin to facilitate stone passage.",
        "Strain urine to capture the stone for analysis.",
        "Follow-up in 1 week or sooner if symptoms worsen or if fever develops.",
        "Dietary counseling to prevent future stones."
      ]
    },
    "Problem List": ["Urolithiasis", "Hematuria"]
  },
  {
    "Case Number": 2056,
    "Chief Complaint (CC)": "Acute gout attack.",
    "History of Present Illness (HPI)": "Mr. Ethan Wright, a 50-year-old male, presents with acute onset of severe pain, redness, and swelling in the right big toe since yesterday. Reports similar episode 2 years ago. Denies alcohol use prior to onset.",
    "Past Medical History (PMH)": ["History of gout.", "Hypertension."],
    "Medication History": ["Hydrochlorothiazide 25 mg daily.", "Occasional ibuprofen."],
    "Social History (SH)": ["Engineer, non-smoker, moderate alcohol consumption."],
    "Family History (FH)": ["Father with history of gout.", "Mother with osteoarthritis."],
    "Review of Systems (ROS)": "Positive for joint pain, redness, and swelling. Negative for fever, rash, or other joint involvement.",
    "Physical Examination (PE)": {
      "General": "In distress due to pain.",
      "Vital Signs": "BP 140/90 mmHg, HR 90 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling, erythema, and tenderness over the right first metatarsophalangeal joint."
    },
    "Diagnostic Test Results": ["Serum uric acid: Elevated.", "Joint aspiration: Presence of monosodium urate crystals."],
    "Assessment and Plan": {
      "Assessment": "Acute gouty arthritis.",
      "Plan": [
        "Colchicine for acute attack management.",
        "NSAIDs for additional pain control, with gastrointestinal protection if needed.",
        "Discontinue hydrochlorothiazide and consider alternative antihypertensive.",
        "Lifestyle and dietary modifications to reduce uric acid levels.",
        "Follow-up to reevaluate uric acid levels and discuss long-term management."
      ]
    },
    "Problem List": ["Gout", "Hyperuricemia"]
  },
  {
    "Case Number": 2057,
    "Chief Complaint (CC)": "Anxiety and panic attacks.",
    "History of Present Illness (HPI)": "Ms. Sophia Martinez, a 28-year-old female, presents with a 6-month history of recurrent episodes of intense fear accompanied by palpitations, sweating, and shortness of breath. Identifies stress at work as a possible trigger.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Occasional lorazepam for acute episodes."],
    "Social History (SH)": ["Software developer, non-smoker, occasional social drinker."],
    "Family History (FH)": ["Mother with generalized anxiety disorder."],
    "Review of Systems (ROS)": "Positive for anxiety, palpitations, sweating. Negative for chest pain, dizziness.",
    "Physical Examination (PE)": {
      "General": "Appears anxious.",
      "Vital Signs": "BP 125/80 mmHg, HR 88 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs."
    },
    "Diagnostic Test Results": ["None performed, diagnosis based on clinical presentation."],
    "Assessment and Plan": {
      "Assessment": "Panic disorder.",
      "Plan": [
        "Cognitive-behavioral therapy referral.",
        "Consider SSRI for long-term management.",
        "Continue lorazepam for acute episodes with caution regarding dependency.",
        "Regular follow-up to monitor response to treatment."
      ]
    },
    "Problem List": ["Panic disorder"]
  },
  {
    "Case Number": 2058,
    "Chief Complaint (CC)": "Progressive hearing loss.",
    "History of Present Illness (HPI)": "Mr. Michael Davis, a 70-year-old male, presents with progressive bilateral hearing loss over the past 5 years, recently noticing difficulty understanding conversations in noisy environments and asking people to repeat themselves frequently.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Retired school teacher, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for hearing loss. Negative for tinnitus, vertigo, or ear pain.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 130/80 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "ENT": "Bilateral decreased hearing to conversational voice. Ear canals clear, tympanic membranes intact."
    },
    "Diagnostic Test Results": ["Audiometry: Bilateral sensorineural hearing loss."],
    "Assessment and Plan": {
      "Assessment": "Bilateral sensorineural hearing loss.",
      "Plan": [
        "Refer to audiology for hearing aids evaluation and fitting.",
        "Discuss potential benefits of assistive listening devices.",
        "Educate on strategies to improve communication in the presence of hearing loss.",
        "Schedule follow-up to assess adaptation to hearing aids and any further needs."
      ]
    },
    "Problem List": ["Sensorineural hearing loss"]
  },
  {
    "Case Number": 2059,
    "Chief Complaint (CC)": "Swelling and pain in the right wrist.",
    "History of Present Illness (HPI)": "Ms. Lisa Wong, a 32-year-old female, presents with a 1-week history of swelling and pain in her right wrist following a fall during a volleyball game. Denies any previous injury to the wrist. Pain is exacerbated by movement or pressure.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Ibuprofen as needed for pain."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, active lifestyle."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for wrist swelling and pain. Negative for fever, rash, joint pain elsewhere.",
    "Physical Examination (PE)": {
      "General": "In mild distress due to pain.",
      "Vital Signs": "BP 120/78 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling and tenderness over the right wrist, particularly over the scaphoid. Range of motion limited due to pain."
    },
    "Diagnostic Test Results": ["X-ray of the right wrist: No fracture seen.", "MRI of the right wrist: Scaphoid bone fracture."],
    "Assessment and Plan": {
      "Assessment": "Scaphoid fracture of the right wrist.",
      "Plan": [
        "Immobilization with a thumb spica cast.",
        "Pain management with NSAIDs.",
        "Orthopedic referral for possible surgical intervention given the scaphoid fracture.",
        "Follow-up in 1 week for reassessment and cast check."
      ]
    },
    "Problem List": ["Scaphoid fracture"]
  },
  {
    "Case Number": 2060,
    "Chief Complaint (CC)": "Intermittent claudication.",
    "History of Present Illness (HPI)": "Mr. Robert Allen, a 66-year-old male, presents with a 6-month history of intermittent claudication, experiencing cramping pain in his calves after walking more than two blocks. Pain resolves with rest. Recently noted decreased hair growth on his lower legs.",
    "Past Medical History (PMH)": ["Hypertension.", "Hyperlipidemia.", "Smoking history of 30 pack-years, quit 10 years ago."],
    "Medication History": ["Lisinopril 20 mg daily.", "Simvastatin 40 mg at bedtime."],
    "Social History (SH)": ["Retired electrician, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Father died of myocardial infarction.", "Mother with peripheral artery disease."],
    "Review of Systems (ROS)": "Positive for lower extremity pain with exertion. Negative for chest pain, dyspnea, or rest pain in legs.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 140/85 mmHg, HR 78 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Diminished pulses in both feet. No bruits over carotid or abdominal aorta.",
      "Extremities": "Decreased hair growth on lower legs, no ulcers or color change."
    },
    "Diagnostic Test Results": ["Ankle-brachial index (ABI): 0.7 bilaterally.", "Doppler ultrasound: Significant stenosis in bilateral superficial femoral arteries."],
    "Assessment and Plan": {
      "Assessment": "Peripheral artery disease (PAD) with intermittent claudication.",
      "Plan": [
        "Initiate antiplatelet therapy with aspirin.",
        "Statins for lipid control.",
        "Structured exercise program for claudication.",
        "Refer to vascular surgery for evaluation of revascularization options.",
        "Smoking cessation reinforcement.",
        "Follow-up in 3 months to assess symptom improvement and ABI."
      ]
    },
    "Problem List": ["Peripheral artery disease", "Intermittent claudication"]
  },
  {
    "Case Number": 2061,
    "Chief Complaint (CC)": "Chronic right knee pain worsening over the past month.",
    "History of Present Illness (HPI)": "Ms. Angela Simmons, a 55-year-old female, reports chronic right knee pain that has worsened over the past month. Describes the pain as a constant ache with episodes of sharp pain on movement. Reports increased stiffness in the morning.",
    "Past Medical History (PMH)": ["Osteoarthritis diagnosed 5 years ago.", "Hypertension."],
    "Medication History": ["Ibuprofen as needed.", "Lisinopril 20 mg daily."],
    "Social History (SH)": ["High school teacher, non-smoker, occasional alcohol consumption."],
    "Family History (FH)": ["Mother with osteoarthritis.", "Father with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for knee pain and morning stiffness. Negative for fever, weight loss, or swelling in other joints.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, in no acute distress.",
      "Vital Signs": "BP 135/85 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Right knee with mild effusion, crepitus on movement, and tenderness on palpation of the medial joint line."
    },
    "Diagnostic Test Results": ["X-ray of the right knee: Joint space narrowing and osteophyte formation consistent with osteoarthritis."],
    "Assessment and Plan": {
      "Assessment": "Worsening osteoarthritis of the right knee.",
      "Plan": [
        "Increase ibuprofen to 600 mg three times daily with meals, with stomach protection.",
        "Physical therapy referral for strengthening and range of motion exercises.",
        "Consider intra-articular corticosteroid injection for symptom relief.",
        "Follow-up in 6 weeks or sooner if symptoms worsen."
      ]
    },
    "Problem List": ["Osteoarthritis of the right knee", "Hypertension"]
  },
  {
    "Case Number": 2062,
    "Chief Complaint (CC)": "Intermittent chest pain for the past 3 weeks.",
    "History of Present Illness (HPI)": "Mr. Brian Clark, a 48-year-old male, reports intermittent chest pain described as a tightness, lasting for up to 10 minutes. Pain occurs both at rest and during exertion, relieved by nitroglycerin.",
    "Past Medical History (PMH)": ["Hypertension.", "Hyperlipidemia."],
    "Medication History": ["Lisinopril 10 mg daily.", "Atorvastatin 20 mg at bedtime.", "Nitroglycerin as needed for chest pain."],
    "Social History (SH)": ["Accountant, smokes half a pack of cigarettes daily, moderate alcohol use."],
    "Family History (FH)": ["Father had a myocardial infarction at age 52.", "Mother with hypertension."],
    "Review of Systems (ROS)": "Positive for chest pain. Negative for dyspnea, palpitations, or syncope.",
    "Physical Examination (PE)": {
      "General": "Appears anxious but in no acute distress.",
      "Vital Signs": "BP 140/90 mmHg, HR 85 bpm, RR 16/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Cardiovascular": "Normal heart sounds, no murmurs, rubs, or gallops."
    },
    "Diagnostic Test Results": ["ECG: Normal.", "Exercise stress test: Positive for inducible ischemia."],
    "Assessment and Plan": {
      "Assessment": "Stable angina.",
      "Plan": [
        "Continue current medications and adjust as needed.",
        "Refer to cardiology for further evaluation and management.",
        "Advise smoking cessation and lifestyle modifications.",
        "Follow-up after cardiology consultation."
      ]
    },
    "Problem List": ["Stable angina", "Hypertension", "Hyperlipidemia"]
  },
  {
    "Case Number": 2063,
    "Chief Complaint (CC)": "Recurrent palpitations and lightheadedness.",
    "History of Present Illness (HPI)": "Ms. Emily Turner, a 30-year-old female, reports recurrent episodes of palpitations and lightheadedness over the past 6 months. Episodes last several minutes and occur both at rest and during activity. Denies syncope or chest pain.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Graphic designer, non-smoker, occasional social drinker."],
    "Family History (FH)": ["No significant family history of cardiac disease."],
    "Review of Systems (ROS)": "Positive for palpitations and lightheadedness. Negative for dyspnea, chest pain, or edema.",
    "Physical Examination (PE)": {
      "General": "Appears well, in no acute distress.",
      "Vital Signs": "BP 120/78 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs, rubs, or gallops."
    },
    "Diagnostic Test Results": ["ECG: Occasional premature ventricular contractions.", "Holter monitor: Frequent PVCs, no other arrhythmias."],
    "Assessment and Plan": {
      "Assessment": "Premature ventricular contractions.",
      "Plan": [
        "Reassure the patient regarding the benign nature of PVCs.",
        "Lifestyle modifications including caffeine and alcohol reduction.",
        "Follow-up in 3 months or sooner if symptoms persist or worsen.",
        "Consider beta-blocker if symptoms are bothersome."
      ]
    },
    "Problem List": ["Premature ventricular contractions"]
  },
  {
    "Case Number": 2064,
    "Chief Complaint (CC)": "Gradual vision loss in the right eye.",
    "History of Present Illness (HPI)": "Mr. Michael Roberts, a 70-year-old male, reports a gradual loss of vision in his right eye over the past year. Describes a decrease in visual acuity and difficulty with night vision. Denies pain or redness in the eye.",
    "Past Medical History (PMH)": ["Type 2 diabetes mellitus."],
    "Medication History": ["Metformin 500 mg twice daily.", "Lisinopril 20 mg daily."],
    "Social History (SH)": ["Retired postal worker, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Mother with glaucoma.", "Father with age-related macular degeneration."],
    "Review of Systems (ROS)": "Positive for gradual vision loss in the right eye. Negative for pain, redness, or double vision.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, in no acute distress.",
      "Vital Signs": "BP 135/85 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Eyes": "Decreased visual acuity in the right eye, no redness or discharge. Fundoscopic exam shows changes consistent with diabetic retinopathy."
    },
    "Diagnostic Test Results": ["Visual acuity test: 20/50 in the right eye, 20/20 in the left eye.", "Fundoscopy: Diabetic retinopathy in the right eye."],
    "Assessment and Plan": {
      "Assessment": "Diabetic retinopathy in the right eye.",
      "Plan": [
        "Refer to ophthalmology for further evaluation and treatment.",
        "Optimize glycemic control to slow progression.",
        "Monitor blood pressure and adjust medication as needed.",
        "Annual diabetic eye exams recommended."
      ]
    },
    "Problem List": ["Diabetic retinopathy", "Type 2 diabetes mellitus"]
  },
  {
    "Case Number": 2065,
    "Chief Complaint (CC)": "Acute lower back pain after lifting heavy object.",
    "History of Present Illness (HPI)": "Ms. Lisa Nguyen, a 40-year-old female, reports acute onset of lower back pain after lifting a heavy box yesterday. Describes the pain as sharp and localized to the lumbar area, worsening with movement.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Office worker, non-smoker, regular exercise."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for lower back pain. Negative for radiating pain, numbness in legs, or bladder/bowel incontinence.",
    "Physical Examination (PE)": {
      "General": "Appears in mild distress due to pain.",
      "Vital Signs": "BP 120/80 mmHg, HR 85 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Tenderness over the lumbar spine, limited range of motion due to pain. No neurological deficits noted."
    },
    "Diagnostic Test Results": ["X-ray of lumbar spine: No fracture or dislocation noted."],
    "Assessment and Plan": {
      "Assessment": "Acute mechanical back pain.",
      "Plan": [
        "NSAIDs for pain management.",
        "Muscle relaxants if spasms are present.",
        "Physical therapy referral for back strengthening exercises.",
        "Advise on proper lifting techniques to prevent recurrence.",
        "Follow-up in 2 weeks or sooner if symptoms worsen."
      ]
    },
    "Problem List": ["Acute mechanical back pain"]
  },
  {
    "Case Number": 2066,
    "Chief Complaint (CC)": "Frequent episodes of nosebleeds.",
    "History of Present Illness (HPI)": "Mr. James Peterson, a 29-year-old male, presents with frequent episodes of spontaneous nosebleeds over the last 2 months, occurring 2-3 times per week. Bleeds are often prolonged and difficult to control.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, occasional alcohol consumption."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for nosebleeds. Negative for bruising, bleeding gums, or fatigue.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 110/70 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "ENT": "Anterior nasal mucosa dry with evidence of recent bleeding. No active bleeding at the time of examination."
    },
    "Diagnostic Test Results": ["Complete blood count: Within normal limits.", "Coagulation profile: Normal."],
    "Assessment and Plan": {
      "Assessment": "Epistaxis likely secondary to nasal mucosa dryness.",
      "Plan": [
        "Humidify living spaces.",
        "Nasal saline sprays for moisturization.",
        "Petroleum jelly to protect nasal mucosa.",
        "Cauterization of bleeding vessels if recurrent episodes persist.",
        "Follow-up in 1 month or sooner if episodes increase in frequency or severity."
      ]
    },
    "Problem List": ["Epistaxis"]
  },
  {
    "Case Number": 2067,
    "Chief Complaint (CC)": "Persistent sore throat and difficulty swallowing.",
    "History of Present Illness (HPI)": "Ms. Rebecca Turner, a 26-year-old female, reports a persistent sore throat and difficulty swallowing for the past 2 weeks. Describes the pain as constant, worsening with swallowing. Denies fever or cough.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Graphic designer, non-smoker, social drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for sore throat and dysphagia. Negative for fever, rash, joint pain.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 120/80 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "ENT": "Pharyngeal erythema without exudate, no tonsillar enlargement, no cervical lymphadenopathy."
    },
    "Diagnostic Test Results": ["Rapid strep test: Negative.", "Throat culture: Pending."],
    "Assessment and Plan": {
      "Assessment": "Pharyngitis, etiology to be determined.",
      "Plan": [
        "Symptomatic treatment with saline gargles and analgesics.",
        "Await throat culture results to determine need for antibiotics.",
        "Advise on hydration and soft diet to ease swallowing.",
        "Follow-up in 3-5 days or sooner if symptoms worsen or fever develops."
      ]
    },
    "Problem List": ["Pharyngitis"]
  },
  {
    "Case Number": 2068,
    "Chief Complaint (CC)": "Exacerbation of chronic obstructive pulmonary disease (COPD).",
    "History of Present Illness (HPI)": "Mr. Edward Barnes, a 72-year-old male with a history of COPD, presents with increased shortness of breath, wheezing, and productive cough with greenish sputum over the past 3 days.",
    "Past Medical History (PMH)": ["Chronic obstructive pulmonary disease.", "Smoking history of 50 pack-years, quit 10 years ago."],
    "Medication History": ["Tiotropium inhaler daily.", "Salbutamol inhaler as needed."],
    "Social History (SH)": ["Retired construction worker, non-smoker, denies alcohol or illicit drug use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for increased shortness of breath, wheezing, productive cough. Negative for fever, chest pain.",
    "Physical Examination (PE)": {
      "General": "In moderate distress due to dyspnea.",
      "Vital Signs": "BP 140/85 mmHg, HR 90 bpm, RR 22/min, Temp 98.6°F, O2 Sat 89% on room air.",
      "Respiratory": "Increased expiratory phase, diffuse wheezes, no crackles."
    },
    "Diagnostic Test Results": ["Chest X-ray: Hyperinflation with no acute infiltrates.", "Arterial blood gas: Mild hypoxemia with respiratory alkalosis."],
    "Assessment and Plan": {
      "Assessment": "COPD exacerbation.",
      "Plan": [
        "Start oral corticosteroids.",
        "Increase frequency of salbutamol use.",
        "Initiate antibiotics due to signs of bacterial infection.",
        "Supplemental oxygen to maintain O2 saturation > 92%.",
        "Arrange follow-up in 1 week or sooner if symptoms do not improve."
      ]
    },
    "Problem List": ["COPD exacerbation"]
  },
  {
    "Case Number": 2069,
    "Chief Complaint (CC)": "Severe abdominal pain and vomiting.",
    "History of Present Illness (HPI)": "Ms. Sophia Martinez, a 34-year-old female, presents with sudden onset of severe abdominal pain and vomiting since early this morning. Pain is localized to the right lower quadrant and described as sharp and constant. Reports fever and chills.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, social drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for abdominal pain, vomiting, fever, chills. Negative for diarrhea, dysuria.",
    "Physical Examination (PE)": {
      "General": "Appears ill and in pain.",
      "Vital Signs": "BP 130/90 mmHg, HR 110 bpm, RR 20/min, Temp 101.3°F, O2 Sat 97% on room air.",
      "Abdomen": "Tender in the right lower quadrant with rebound tenderness and guarding."
    },
    "Diagnostic Test Results": ["CBC: Elevated WBC count.", "CT abdomen/pelvis: Appendicitis with periappendiceal inflammation."],
    "Assessment and Plan": {
      "Assessment": "Acute appendicitis.",
      "Plan": [
        "Surgical consultation for appendectomy.",
        "Start IV fluids and broad-spectrum antibiotics.",
        "NPO status in preparation for surgery.",
        "Pain management as needed."
      ]
    },
    "Problem List": ["Acute appendicitis"]
  },
  {
    "Case Number": 2070,
    "Chief Complaint (CC)": "Generalized itching without rash for 2 months.",
    "History of Present Illness (HPI)": "Mr. Kevin Brooks, a 50-year-old male, reports generalized itching without rash for the past 2 months. Itching is worse at night and does not respond to over-the-counter antihistamines. Denies new soaps, detergents, or medications.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Office manager, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for generalized itching. Negative for rash, jaundice, abdominal pain, weight loss.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 120/80 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Skin": "No visible rash or lesions."
    },
    "Diagnostic Test Results": ["Liver function tests: Normal.", "Renal function tests: Normal.", "Complete blood count: Normal."],
    "Assessment and Plan": {
      "Assessment": "Generalized pruritus of unknown origin.",
      "Plan": [
        "Moisturizing skin care routine and cool baths.",
        "Trial of non-sedating antihistamine.",
        "Consider referral to dermatology if no improvement.",
        "Blood tests for thyroid function and chest X-ray to rule out systemic causes."
      ]
    },
    "Problem List": ["Generalized pruritus"]
  },
  {
    "Case Number": 2071,
    "Chief Complaint (CC)": "Sudden onset of severe headache.",
    "History of Present Illness (HPI)": "Mr. Carlos Ramirez, a 45-year-old male, presents with a sudden onset of a severe headache that started 2 hours ago, described as the worst headache of his life. The pain is primarily located in the occipital region. Denies any trauma or prior similar episodes.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["High school teacher, non-smoker, moderate alcohol consumption."],
    "Family History (FH)": ["Mother with migraine headaches.", "Father with hypertension."],
    "Review of Systems (ROS)": "Positive for severe headache. Negative for nausea, vomiting, vision changes, or neurological deficits.",
    "Physical Examination (PE)": {
      "General": "Appears anxious and in pain.",
      "Vital Signs": "BP 150/90 mmHg, HR 100 bpm, RR 18/min, Temp 98.6°F, O2 Sat 99% on room air.",
      "Neurologic": "Alert and oriented, cranial nerves II-XII intact, no focal neurological deficits."
    },
    "Diagnostic Test Results": ["CT head without contrast: No evidence of hemorrhage.", "Lumbar puncture: Clear cerebrospinal fluid with normal opening pressure and normal cell count."],
    "Assessment and Plan": {
      "Assessment": "Thunderclap headache, negative for subarachnoid hemorrhage.",
      "Plan": [
        "Admit for observation and further evaluation including MRI of the brain and MR angiography to rule out secondary causes.",
        "Pain management with IV fluids and analgesics.",
        "Neurology consultation for further assessment and management.",
        "Follow-up on imaging results and adjust plan accordingly."
      ]
    },
    "Problem List": ["Thunderclap headache"]
  },
  {
    "Case Number": 2072,
    "Chief Complaint (CC)": "Persistent left-sided abdominal pain.",
    "History of Present Illness (HPI)": "Ms. Jenna Collins, a 32-year-old female, reports persistent left-sided abdominal pain for the past week, described as a dull, constant ache. Pain is localized to the lower abdomen without radiation. Associated with bloating but denies nausea or vomiting.",
    "Past Medical History (PMH)": ["Irritable bowel syndrome (IBS)."],
    "Medication History": ["Occasional ibuprofen for menstrual cramps."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, social drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for abdominal pain and bloating. Negative for fever, diarrhea, constipation, or urinary symptoms.",
    "Physical Examination (PE)": {
      "General": "Appears comfortable.",
      "Vital Signs": "BP 120/78 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Abdomen": "Tender to palpation in the left lower quadrant without rebound or guarding."
    },
    "Diagnostic Test Results": ["Ultrasound of the abdomen: Normal ovaries and no free fluid.", "CBC: Within normal limits."],
    "Assessment and Plan": {
      "Assessment": "Left-sided abdominal pain, likely gastrointestinal in origin.",
      "Plan": [
        "Increase dietary fiber intake and hydration.",
        "Consider a trial of antispasmodic medication for IBS.",
        "Follow-up in 2 weeks to assess response to treatment.",
        "Gastroenterology referral if no improvement or if symptoms worsen."
      ]
    },
    "Problem List": ["Persistent left-sided abdominal pain", "Irritable bowel syndrome"]
  },
  {
    "Case Number": 2073,
    "Chief Complaint (CC)": "Recurrent episodes of syncope.",
    "History of Present Illness (HPI)": "Mr. Evan Wright, a 28-year-old male, reports three episodes of syncope in the past month, occurring without warning. Each episode was preceded by lightheadedness and palpitations. Recovers quickly with no confusion post-event.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Software engineer, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Brother with vasovagal syncope."],
    "Review of Systems (ROS)": "Positive for syncope, lightheadedness, and palpitations. Negative for chest pain, shortness of breath, or seizures.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 110/70 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Regular rate and rhythm, no murmurs."
    },
    "Diagnostic Test Results": ["ECG: Normal.", "Holter monitor: No significant arrhythmias.", "Tilt table test: Positive for vasovagal syncope."],
    "Assessment and Plan": {
      "Assessment": "Vasovagal syncope.",
      "Plan": [
        "Educate on avoidance of triggers and recognition of prodromal symptoms.",
        "Increase salt and fluid intake.",
        "Consider wearing compression stockings to improve venous return.",
        "Follow-up as needed or if episodes increase in frequency or severity."
      ]
    },
    "Problem List": ["Vasovagal syncope"]
  },
  {
    "Case Number": 2074,
    "Chief Complaint (CC)": "Bilateral swelling and pain in the knees.",
    "History of Present Illness (HPI)": "Mr. Thomas Lee, a 50-year-old male, presents with bilateral knee swelling and pain worsening over the past 6 months. Reports stiffness in the morning lasting about 30 minutes and difficulty climbing stairs.",
    "Past Medical History (PMH)": ["Hypertension."],
    "Medication History": ["Hydrochlorothiazide 25 mg daily."],
    "Social History (SH)": ["Accountant, non-smoker, moderate alcohol consumption."],
    "Family History (FH)": ["Father with osteoarthritis.", "Mother with rheumatoid arthritis."],
    "Review of Systems (ROS)": "Positive for knee swelling, pain, and morning stiffness. Negative for skin rash, abdominal pain, or chest pain.",
    "Physical Examination (PE)": {
      "General": "Overweight, in no acute distress.",
      "Vital Signs": "BP 140/90 mmHg, HR 80 bpm, RR 16/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Musculoskeletal": "Bilateral knee effusions, warmth, and tenderness. Reduced range of motion due to pain."
    },
    "Diagnostic Test Results": ["X-ray of knees: Bilateral joint space narrowing, subchondral sclerosis, and osteophyte formation.", "CBC: Within normal limits.", "CRP: Elevated."],
    "Assessment and Plan": {
      "Assessment": "Osteoarthritis of the knees, exacerbated by hypertension and obesity.",
      "Plan": [
        "Weight loss counseling and low-impact exercise program.",
        "NSAIDs for pain management with gastrointestinal protection.",
        "Physical therapy referral for knee strengthening exercises.",
        "Intra-articular corticosteroid injections for acute flare-ups.",
        "Orthopedic consultation if no improvement or functional decline."
      ]
    },
    "Problem List": ["Osteoarthritis of the knees", "Hypertension", "Obesity"]
  },
  {
    "Case Number": 2075,
    "Chief Complaint (CC)": "Tingling and numbness in the hands.",
    "History of Present Illness (HPI)": "Ms. Nicole Johnson, a 45-year-old female, reports tingling and numbness in both hands, worsening over the past 3 months. Symptoms are more pronounced at night and interfere with her sleep. Denies weakness or pain.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Graphic designer, non-smoker, occasional social drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for tingling and numbness in hands. Negative for pain, weakness, or balance problems.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 120/80 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Neurologic": "Positive Tinel’s sign and Phalen’s test bilaterally. Normal muscle strength and tone in upper extremities."
    },
    "Diagnostic Test Results": ["Nerve conduction studies: Delayed median nerve conduction at the wrist bilaterally, consistent with carpal tunnel syndrome."],
    "Assessment and Plan": {
      "Assessment": "Carpal tunnel syndrome, bilateral.",
      "Plan": [
        "Ergonomic assessment and modifications at work.",
        "Wrist splints for night use.",
        "NSAIDs for symptomatic relief.",
        "Physical therapy for hand and wrist exercises.",
        "Follow-up in 6 weeks. Consider corticosteroid injections or surgical referral if no improvement."
      ]
    },
    "Problem List": ["Carpal tunnel syndrome"]
  },
  {
    "Case Number": 2076,
    "Chief Complaint (CC)": "Weight loss and night sweats.",
    "History of Present Illness (HPI)": "Mr. David Smith, a 55-year-old male, reports unexplained weight loss of 15 pounds over the last 2 months and frequent night sweats. Denies fever, cough, or change in appetite.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Lawyer, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for weight loss and night sweats. Negative for fever, cough, abdominal pain.",
    "Physical Examination (PE)": {
      "General": "Cachectic appearance.",
      "Vital Signs": "BP 130/85 mmHg, HR 88 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Abdomen": "Soft, non-tender, no palpable masses or hepatosplenomegaly."
    },
    "Diagnostic Test Results": ["CBC: Anemia and elevated ESR.", "CT chest/abdomen/pelvis: Enlarged mediastinal lymph nodes.", "Biopsy of lymph node: Non-Hodgkin lymphoma."],
    "Assessment and Plan": {
      "Assessment": "Non-Hodgkin lymphoma.",
      "Plan": [
        "Refer to oncology for evaluation and treatment planning.",
        "Initiate workup for staging including bone marrow biopsy.",
        "Discuss treatment options based on specific subtype and stage, including chemotherapy and targeted therapy.",
        "Supportive care for symptoms management.",
        "Follow-up closely with oncology."
      ]
    },
    "Problem List": ["Non-Hodgkin lymphoma"]
  },
  {
    "Case Number": 2077,
    "Chief Complaint (CC)": "Severe acne on face and back.",
    "History of Present Illness (HPI)": "Ms. Emily Walters, a 22-year-old female, presents with severe acne on her face and back that has not responded to over-the-counter topical treatments. Reports painful, cystic lesions and scarring.",
    "Past Medical History (PMH)": ["Mild acne during adolescence."],
    "Medication History": ["Topical benzoyl peroxide."],
    "Social History (SH)": ["University student, non-smoker, denies illicit drug use, occasional alcohol consumption."],
    "Family History (FH)": ["Sister with acne vulgaris."],
    "Review of Systems (ROS)": "Positive for severe acne with cystic lesions. Negative for fever, joint pain.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 110/70 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Skin": "Multiple inflammatory nodules, cysts, and scarring noted on the face and back."
    },
    "Diagnostic Test Results": ["None performed, diagnosis based on clinical examination."],
    "Assessment and Plan": {
      "Assessment": "Severe acne vulgaris.",
      "Plan": [
        "Initiate oral isotretinoin after discussing risks, benefits, and need for contraception in females of childbearing potential.",
        "Topical retinoid as adjunct therapy.",
        "Follow-up monthly to monitor response and side effects of treatment.",
        "Discuss potential impact on mental health and monitor."
      ]
    },
    "Problem List": ["Severe acne vulgaris"]
  },
  {
    "Case Number": 2078,
    "Chief Complaint (CC)": "Chronic insomnia worsening over the past 6 months.",
    "History of Present Illness (HPI)": "Mr. Mark Johnson, a 40-year-old male, reports difficulty falling and staying asleep, affecting his daily functioning. Denies significant stressors or changes in lifestyle.",
    "Past Medical History (PMH)": ["Depression treated with sertraline."],
    "Medication History": ["Sertraline 50 mg daily."],
    "Social History (SH)": ["Software developer, non-smoker, moderate alcohol use."],
    "Family History (FH)": ["Mother with history of insomnia.", "Father with hypertension."],
    "Review of Systems (ROS)": "Positive for insomnia. Negative for anxiety, depression (current treatment effective), or substance abuse.",
    "Physical Examination (PE)": {
      "General": "Appears tired.",
      "Vital Signs": "BP 125/80 mmHg, HR 68 bpm, RR 12/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Psychiatric": "Mood and affect are congruent with stated mood, no signs of acute distress."
    },
    "Diagnostic Test Results": ["None performed, diagnosis based on clinical interview and history."],
    "Assessment and Plan": {
      "Assessment": "Chronic insomnia.",
      "Plan": [
        "Cognitive behavioral therapy for insomnia (CBT-I) referral.",
        "Review sleep hygiene practices and make necessary adjustments.",
        "Consider a short course of sleep medication with careful consideration of dependency and tolerance issues.",
        "Follow-up in 4 weeks to assess sleep improvement and reevaluate the need for pharmacologic intervention."
      ]
    },
    "Problem List": ["Chronic insomnia", "Depression"]
  },
  {
    "Case Number": 2079,
    "Chief Complaint (CC)": "Increased thirst and frequent urination.",
    "History of Present Illness (HPI)": "Ms. Sarah Bennett, a 29-year-old female, reports experiencing increased thirst and urinating more frequently over the past 2 months. Also notes unintentional weight loss of 10 pounds during the same period.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, exercises regularly."],
    "Family History (FH)": ["Mother with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for polydipsia, polyuria, and weight loss. Negative for vision changes, pain, or fatigue.",
    "Physical Examination (PE)": {
      "General": "Appears well, slightly underweight.",
      "Vital Signs": "BP 110/70 mmHg, HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air."
    },
    "Diagnostic Test Results": ["Fasting glucose: 186 mg/dL.", "HbA1c: 8.5%."],
    "Assessment and Plan": {
      "Assessment": "Newly diagnosed type 2 diabetes mellitus.",
      "Plan": [
        "Initiate metformin, starting at 500 mg daily, with titration based on tolerance and follow-up glucose testing.",
        "Dietary and lifestyle modifications, including carbohydrate counting and increased physical activity.",
        "Diabetes education session for self-management skills.",
        "Follow-up in 4 weeks to evaluate control and adjust treatment as needed."
      ]
    },
    "Problem List": ["Type 2 diabetes mellitus"]
  },
  {
    "Case Number": 2080,
    "Chief Complaint (CC)": "Right ankle sprain from playing soccer.",
    "History of Present Illness (HPI)": "Mr. Alex Thompson, a 23-year-old male, presents with right ankle pain and swelling after twisting it during a soccer game yesterday. Reports immediate pain and difficulty bearing weight.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["College student, non-smoker, social drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for ankle pain and swelling. Negative for fever, previous injuries to the same ankle.",
    "Physical Examination (PE)": {
      "General": "Appears in mild distress due to pain.",
      "Vital Signs": "BP 120/78 mmHg, HR 80 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling and tenderness over the lateral aspect of the right ankle. Limited range of motion due to pain."
    },
    "Diagnostic Test Results": ["X-ray of the right ankle: No fractures seen.", "MRI of the right ankle: Ligamentous injury consistent with a sprain."],
    "Assessment and Plan": {
      "Assessment": "Right ankle sprain.",
      "Plan": [
        "RICE protocol (Rest, Ice, Compression, Elevation).",
        "NSAIDs for pain and inflammation control.",
        "Ankle brace for stabilization and to prevent further injury.",
        "Physical therapy referral for rehabilitation exercises.",
        "Follow-up in 2 weeks to reassess healing progress."
      ]
    },
    "Problem List": ["Right ankle sprain"]
  },
  {
    "Case Number": 2081,
    "Chief Complaint (CC)": "Excessive daytime sleepiness.",
    "History of Present Illness (HPI)": "Ms. Karen Foster, a 38-year-old female, presents with excessive daytime sleepiness despite sleeping more than 8 hours at night. Reports frequent awakenings and a feeling of choking or gasping for air during sleep. Partner reports loud snoring.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Lawyer, non-smoker, occasional wine drinker."],
    "Family History (FH)": ["Father with obstructive sleep apnea."],
    "Review of Systems (ROS)": "Positive for daytime sleepiness and snoring. Negative for headache, weight loss, or palpitations.",
    "Physical Examination (PE)": {
      "General": "Overweight, otherwise appears healthy.",
      "Vital Signs": "BP 135/85 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Neck": "Cervical circumference 17 inches."
    },
    "Diagnostic Test Results": ["Polysomnography: Apnea-Hypopnea Index (AHI) of 30, consistent with moderate to severe obstructive sleep apnea."],
    "Assessment and Plan": {
      "Assessment": "Obstructive sleep apnea (OSA), moderate to severe.",
      "Plan": [
        "Initiate CPAP therapy.",
        "Weight loss counseling and support.",
        "Avoidance of alcohol and sedatives before bedtime.",
        "Follow-up in 3 months to assess CPAP adherence and efficacy."
      ]
    },
    "Problem List": ["Obstructive sleep apnea"]
  },
  {
    "Case Number": 2082,
    "Chief Complaint (CC)": "New onset of generalized tonic-clonic seizures.",
    "History of Present Illness (HPI)": "Mr. Steven Miller, a 42-year-old male, experienced a generalized tonic-clonic seizure for the first time last night. Seizure lasted approximately 3 minutes and was followed by postictal confusion. No history of seizures in the family.",
    "Past Medical History (PMH)": ["Mild hypertension."],
    "Medication History": ["Lisinopril 10 mg daily."],
    "Social History (SH)": ["Accountant, non-smoker, rarely drinks alcohol."],
    "Family History (FH)": ["No significant family history of seizures."],
    "Review of Systems (ROS)": "Positive for seizure. Negative for recent illness, trauma, or unusual stress.",
    "Physical Examination (PE)": {
      "General": "Appears well, postictal state resolved.",
      "Vital Signs": "BP 130/80 mmHg, HR 72 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Neurologic": "Normal examination, no focal neurological deficits."
    },
    "Diagnostic Test Results": ["EEG: Generalized epileptiform discharges.", "MRI brain: No structural abnormalities."],
    "Assessment and Plan": {
      "Assessment": "Generalized tonic-clonic seizure, new onset.",
      "Plan": [
        "Initiate antiepileptic drug (AED) therapy with levetiracetam.",
        "Advise against driving until seizure control is achieved.",
        "Follow-up EEG in 3 months or sooner if seizures recur.",
        "Neurology referral for further evaluation and management."
      ]
    },
    "Problem List": ["Generalized tonic-clonic seizure"]
  },
  {
    "Case Number": 2083,
    "Chief Complaint (CC)": "Acute gout flare in the right big toe.",
    "History of Present Illness (HPI)": "Mr. Daniel Wright, a 60-year-old male, presents with sudden onset of severe pain, redness, and swelling in his right big toe since yesterday. Has a history of similar episodes in the past.",
    "Past Medical History (PMH)": ["History of gout.", "Hyperlipidemia."],
    "Medication History": ["Allopurinol 100 mg daily.", "Atorvastatin 20 mg at bedtime."],
    "Social History (SH)": ["Retired police officer, smokes occasionally, regular alcohol consumption."],
    "Family History (FH)": ["Father with history of gout."],
    "Review of Systems (ROS)": "Positive for joint pain and swelling. Negative for fever, rash, or other joint involvement.",
    "Physical Examination (PE)": {
      "General": "In distress due to pain.",
      "Vital Signs": "BP 140/90 mmHg, HR 80 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Swelling, erythema, and tenderness over the right first metatarsophalangeal joint."
    },
    "Diagnostic Test Results": ["Serum uric acid: Elevated.", "Joint aspiration: Presence of monosodium urate crystals."],
    "Assessment and Plan": {
      "Assessment": "Acute gout flare.",
      "Plan": [
        "Prescribe colchicine for the acute flare and NSAIDs for pain management.",
        "Continue allopurinol with consideration for dose adjustment.",
        "Lifestyle modifications including diet and reducing alcohol intake.",
        "Follow-up in 2 weeks to reassess and evaluate the need for further adjustments in gout management."
      ]
    },
    "Problem List": ["Acute gout flare", "Hyperlipidemia"]
  },
  {
    "Case Number": 2084,
    "Chief Complaint (CC)": "Chronic lower back pain.",
    "History of Present Illness (HPI)": "Ms. Rebecca Green, a 35-year-old female, reports chronic lower back pain for over a year, worsening in the past 3 months. Pain exacerbates with prolonged sitting and physical activity.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["Ibuprofen as needed."],
    "Social History (SH)": ["Office worker, non-smoker, active lifestyle."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for lower back pain. Negative for radiating leg pain, numbness, or weakness.",
    "Physical Examination (PE)": {
      "General": "Appears healthy.",
      "Vital Signs": "BP 120/80 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Localized tenderness over lumbar paraspinal muscles, no neurological deficits."
    },
    "Diagnostic Test Results": ["X-ray lumbar spine: Mild degenerative changes without acute pathology."],
    "Assessment and Plan": {
      "Assessment": "Chronic lower back pain, likely musculoskeletal.",
      "Plan": [
        "Physical therapy referral for core strengthening and flexibility exercises.",
        "Continue NSAIDs as needed for pain control.",
        "Consider a trial of muscle relaxants if spasms are present.",
        "Ergonomic evaluation for workplace adjustments.",
        "Follow-up in 6 weeks to evaluate progress."
      ]
    },
    "Problem List": ["Chronic lower back pain"]
  },
  {
    "Case Number": 2085,
    "Chief Complaint (CC)": "Persistent cough and shortness of breath.",
    "History of Present Illness (HPI)": "Mr. Michael Anderson, a 55-year-old male with a history of smoking, reports a persistent cough with occasional sputum production and shortness of breath for the past 2 months. Reports a 30-pack-year smoking history.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Construction worker, currently smokes."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for cough and shortness of breath. Negative for fever, chest pain, or weight loss.",
    "Physical Examination (PE)": {
      "General": "Appears chronically ill.",
      "Vital Signs": "BP 130/85 mmHg, HR 88 bpm, RR 20/min, Temp 98.6°F, O2 Sat 94% on room air.",
      "Respiratory": "Decreased breath sounds bilaterally with wheezes, no crackles."
    },
    "Diagnostic Test Results": ["Chest X-ray: Hyperinflation with flattened diaphragms.", "Pulmonary function tests: Reduced FEV1/FVC ratio indicative of obstructive pattern."],
    "Assessment and Plan": {
      "Assessment": "Chronic obstructive pulmonary disease (COPD), likely related to smoking history.",
      "Plan": [
        "Initiate long-acting bronchodilator therapy.",
        "Smoking cessation counseling and resources.",
        "Pulmonary rehabilitation referral.",
        "Influenza and pneumococcal vaccinations.",
        "Follow-up in 3 months to assess response to therapy."
      ]
    },
    "Problem List": ["Chronic obstructive pulmonary disease", "Smoking"]
  },
  {
    "Case Number": 2086,
    "Chief Complaint (CC)": "Palpitations and anxiety.",
    "History of Present Illness (HPI)": "Ms. Lauren Thompson, a 28-year-old female, reports episodes of palpitations and feelings of anxiety occurring several times a week for the past 6 months. Episodes last for minutes to hours and are associated with stress.",
    "Past Medical History (PMH)": ["Generalized anxiety disorder."],
    "Medication History": ["Sertraline 50 mg daily."],
    "Social History (SH)": ["Marketing specialist, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Mother with anxiety disorder.", "Sister with panic disorder."],
    "Review of Systems (ROS)": "Positive for palpitations and anxiety. Negative for chest pain, shortness of breath, or dizziness.",
    "Physical Examination (PE)": {
      "General": "Appears anxious.",
      "Vital Signs": "BP 120/78 mmHg, HR 90 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Tachycardic with regular rhythm, no murmurs."
    },
    "Diagnostic Test Results": ["ECG: Normal sinus tachycardia.", "Thyroid function tests: Within normal limits."],
    "Assessment and Plan": {
      "Assessment": "Anxiety disorder with palpitations.",
      "Plan": [
        "Continue sertraline, consider dosage adjustment.",
        "Cognitive behavioral therapy referral for anxiety management.",
        "Monitor and manage triggers for anxiety and palpitations.",
        "Follow-up in 4 weeks to assess response to treatment adjustments."
      ]
    },
    "Problem List": ["Generalized anxiety disorder", "Palpitations"]
  },
  {
    "Case Number": 2087,
    "Chief Complaint (CC)": "Unintentional weight loss and fatigue.",
    "History of Present Illness (HPI)": "Mr. Ethan Hughes, a 47-year-old male, presents with unintentional weight loss of 20 pounds over the last 3 months and persistent fatigue. Denies any changes in diet or exercise habits.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Engineer, non-smoker, rarely drinks alcohol."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for weight loss and fatigue. Negative for fever, night sweats, or lymphadenopathy.",
    "Physical Examination (PE)": {
      "General": "Cachectic appearance.",
      "Vital Signs": "BP 120/80 mmHg, HR 70 bpm, RR 12/min, Temp 98.6°F, O2 Sat 97% on room air."
    },
    "Diagnostic Test Results": ["CBC: Normocytic anemia.", "CT chest/abdomen/pelvis: No masses or lymphadenopathy.", "Colonoscopy: Normal."],
    "Assessment and Plan": {
      "Assessment": "Unexplained weight loss and fatigue.",
      "Plan": [
        "Refer to endocrinology for evaluation of potential metabolic causes.",
        "Nutritional counseling and support.",
        "Further workup for occult malignancy including esophagogastroduodenoscopy (EGD) and PET scan.",
        "Follow-up in 4 weeks to review additional test results and adjust the diagnostic plan as needed."
      ]
    },
    "Problem List": ["Unintentional weight loss", "Fatigue"]
  },
  {
    "Case Number": 2088,
    "Chief Complaint (CC)": "Recurrent urinary tract infections.",
    "History of Present Illness (HPI)": "Ms. Jessica Allen, a 30-year-old female, presents with symptoms of a urinary tract infection (UTI), including dysuria, urgency, and frequency. This is her third UTI in the past year.",
    "Past Medical History (PMH)": ["Recurrent UTIs."],
    "Medication History": ["Trimethoprim/sulfamethoxazole for previous UTIs."],
    "Social History (SH)": ["Graphic designer, non-smoker, social drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for dysuria, urgency, and frequency. Negative for fever, flank pain.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 110/70 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Abdomen": "Soft, non-tender, no suprapubic tenderness."
    },
    "Diagnostic Test Results": ["Urinalysis: Pyuria and bacteriuria.", "Urine culture: E. coli sensitive to ciprofloxacin."],
    "Assessment and Plan": {
      "Assessment": "Recurrent urinary tract infection.",
      "Plan": [
        "Prescribe a course of ciprofloxacin.",
        "Discuss preventive measures including hydration and voiding post-intercourse.",
        "Consider referral to urology for further evaluation if recurrent infections continue.",
        "Follow-up after treatment completion to reassess symptoms."
      ]
    },
    "Problem List": ["Recurrent urinary tract infections"]
  },
  {
    "Case Number": 2089,
    "Chief Complaint (CC)": "Dizziness and episodes of near-syncope.",
    "History of Present Illness (HPI)": "Ms. Sophia Martinez, a 36-year-old female, reports several episodes of dizziness and near-syncope over the past month, especially when standing up quickly. Denies any loss of consciousness or recent illness.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, occasional wine drinker."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for dizziness and near-syncope. Negative for chest pain, palpitations, or dyspnea.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 115/75 mmHg sitting, 100/60 mmHg standing; HR 72 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Normal heart sounds, no murmurs."
    },
    "Diagnostic Test Results": ["ECG: Normal.", "Blood tests: Normal electrolytes, CBC, and thyroid function tests."],
    "Assessment and Plan": {
      "Assessment": "Orthostatic hypotension.",
      "Plan": [
        "Advise on slow positional changes to prevent dizziness.",
        "Increase fluid and salt intake.",
        "Consider compression stockings to improve venous return.",
        "Follow-up in 4 weeks to assess improvement and reevaluate if symptoms persist."
      ]
    },
    "Problem List": ["Orthostatic hypotension"]
  },
  {
    "Case Number": 2090,
    "Chief Complaint (CC)": "Chronic diarrhea and abdominal pain.",
    "History of Present Illness (HPI)": "Mr. Jason Lee, a 28-year-old male, presents with a 6-month history of chronic diarrhea and intermittent abdominal pain. Describes 4-5 loose bowel movements daily, sometimes with blood. Pain is crampy in nature, relieved temporarily after bowel movements.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Software developer, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["Mother with Crohn's disease."],
    "Review of Systems (ROS)": "Positive for chronic diarrhea and abdominal pain. Negative for fever, weight loss, joint pain.",
    "Physical Examination (PE)": {
      "General": "Appears well-nourished.",
      "Vital Signs": "BP 120/80 mmHg, HR 78 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Abdomen": "Soft, mild diffuse tenderness, no rebound or guarding."
    },
    "Diagnostic Test Results": ["Colonoscopy: Patchy colitis with granulomas.", "Biopsy: Non-caseating granulomas consistent with Crohn's disease."],
    "Assessment and Plan": {
      "Assessment": "Crohn's disease.",
      "Plan": [
        "Initiate mesalamine therapy.",
        "Consider corticosteroids for acute flare management.",
        "Refer to gastroenterology for comprehensive management.",
        "Dietary counseling to identify and avoid trigger foods.",
        "Follow-up in 6 weeks to assess response to treatment."
      ]
    },
    "Problem List": ["Crohn's disease"]
  },
  {
    "Case Number": 2091,
    "Chief Complaint (CC)": "Constant fatigue and weakness.",
    "History of Present Illness (HPI)": "Ms. Diana Scott, a 43-year-old female, reports constant fatigue and weakness for the past two months. States that she feels 'tired all the time,' regardless of sleep quality. Additionally, she has noticed a mild, persistent headache and difficulty concentrating.",
    "Past Medical History (PMH)": ["Hypothyroidism, diagnosed 5 years ago."],
    "Medication History": ["Levothyroxine 100 mcg daily."],
    "Social History (SH)": ["High school teacher, non-smoker, occasional social drinker."],
    "Family History (FH)": ["Mother with hypothyroidism.", "Father with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for fatigue, weakness, and mild headaches. Negative for fever, weight change, or vision changes.",
    "Physical Examination (PE)": {
      "General": "Appears lethargic.",
      "Vital Signs": "BP 120/80 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Thyroid": "No enlargement or nodules palpated."
    },
    "Diagnostic Test Results": ["TSH: Elevated above normal range.", "Free T4: Lower end of normal range."],
    "Assessment and Plan": {
      "Assessment": "Poorly controlled hypothyroidism.",
      "Plan": [
        "Increase levothyroxine dose to 125 mcg daily.",
        "Recheck thyroid function tests in 6 weeks.",
        "Advise patient on the importance of medication adherence.",
        "Evaluate for other causes of fatigue if symptoms do not improve with thyroid optimization."
      ]
    },
    "Problem List": ["Hypothyroidism", "Fatigue", "Weakness"]
  },
  {
    "Case Number": 2092,
    "Chief Complaint (CC)": "Intermittent chest pain over the last month.",
    "History of Present Illness (HPI)": "Mr. Michael Brown, a 50-year-old male, presents with intermittent chest pain that started one month ago. Describes the pain as a sharp, stabbing sensation lasting for a few minutes and occurring both at rest and during physical activity.",
    "Past Medical History (PMH)": ["Hypercholesterolemia."],
    "Medication History": ["Atorvastatin 20 mg daily."],
    "Social History (SH)": ["Engineer, smokes 1 pack of cigarettes daily, occasional alcohol consumption."],
    "Family History (FH)": ["Father died of a heart attack at age 55.", "Mother with hypertension."],
    "Review of Systems (ROS)": "Positive for chest pain. Negative for dyspnea, palpitations, or syncope.",
    "Physical Examination (PE)": {
      "General": "Appears well, no acute distress.",
      "Vital Signs": "BP 130/85 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Cardiovascular": "Normal heart sounds, no murmurs, rubs, or gallops."
    },
    "Diagnostic Test Results": ["ECG: Normal.", "Exercise stress test: Negative for ischemia."],
    "Assessment and Plan": {
      "Assessment": "Atypical chest pain, unlikely cardiac in origin.",
      "Plan": [
        "Continue monitoring symptoms.",
        "Encourage smoking cessation and provide resources.",
        "Maintain current statin therapy.",
        "Consider gastroesophageal reflux disease (GERD) as a possible cause and trial of a proton pump inhibitor (PPI).",
        "Follow-up in 3 months or sooner if symptoms persist or worsen."
      ]
    },
    "Problem List": ["Atypical chest pain", "Hypercholesterolemia"]
  },
  {
    "Case Number": 2093,
    "Chief Complaint (CC)": "Sudden vision loss in right eye.",
    "History of Present Illness (HPI)": "Mr. Ethan Kelly, a 65-year-old male, presents with sudden loss of vision in his right eye upon waking this morning. Denies pain, previous similar episodes, or recent head injury. Reports a history of hypertension.",
    "Past Medical History (PMH)": ["Hypertension."],
    "Medication History": ["Lisinopril 20 mg daily."],
    "Social History (SH)": ["Retired bank clerk, non-smoker, drinks wine occasionally."],
    "Family History (FH)": ["No significant family history of eye diseases."],
    "Review of Systems (ROS)": "Positive for sudden vision loss in right eye. Negative for headache, nausea, or eye pain.",
    "Physical Examination (PE)": {
      "General": "Appears anxious.",
      "Vital Signs": "BP 160/90 mmHg, HR 82 bpm, RR 16/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Eyes": "Right eye: No response to light. Left eye: Normal examination."
    },
    "Diagnostic Test Results": ["Fundoscopic exam: Right eye shows evidence of retinal detachment.", "CT head: No acute intracranial process."],
    "Assessment and Plan": {
      "Assessment": "Sudden vision loss due to retinal detachment in the right eye.",
      "Plan": [
        "Urgent referral to ophthalmology for evaluation and possible surgical intervention.",
        "Counsel patient on the urgency and potential outcomes of treatment.",
        "Manage hypertension more aggressively to reduce cardiovascular risk.",
        "Follow-up after ophthalmology assessment."
      ]
    },
    "Problem List": ["Sudden vision loss", "Retinal detachment", "Hypertension"]
  },
  {
    "Case Number": 2094,
    "Chief Complaint (CC)": "Recurrent right lower quadrant abdominal pain.",
    "History of Present Illness (HPI)": "Ms. Jessica Torres, a 27-year-old female, reports recurrent episodes of sharp right lower quadrant abdominal pain over the past 6 months. Each episode lasts several hours and resolves spontaneously. Associated with nausea but no vomiting or fever.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Elementary school teacher, non-smoker, social drinker."],
    "Family History (FH)": ["Mother with irritable bowel syndrome (IBS)."],
    "Review of Systems (ROS)": "Positive for abdominal pain and nausea. Negative for diarrhea, constipation, or urinary symptoms.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 110/70 mmHg, HR 75 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Abdomen": "Tender in the right lower quadrant without rebound or guarding. No palpable masses."
    },
    "Diagnostic Test Results": ["Ultrasound of the abdomen: Normal ovaries and appendix.", "CBC: Within normal limits."],
    "Assessment and Plan": {
      "Assessment": "Recurrent right lower quadrant abdominal pain, etiology unclear.",
      "Plan": [
        "Further evaluation with CT abdomen/pelvis to rule out appendicitis or other pathology.",
        "Consult gastroenterology for potential IBS and further diagnostic testing if CT is unremarkable.",
        "Pain management with NSAIDs as needed.",
        "Follow-up in 1 week or sooner if another episode occurs."
      ]
    },
    "Problem List": ["Recurrent abdominal pain"]
  },
  {
    "Case Number": 2095,
    "Chief Complaint (CC)": "High blood pressure readings at home.",
    "History of Present Illness (HPI)": "Mr. George Allen, a 56-year-old male, reports high blood pressure readings at home over the past 2 weeks, with systolic pressures frequently above 140 mmHg. Denies any symptoms such as headache, chest pain, or dizziness.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["Insurance agent, smokes 10 cigarettes a day, occasional alcohol consumption."],
    "Family History (FH)": ["Father with hypertension.", "Mother with type 2 diabetes."],
    "Review of Systems (ROS)": "Negative for headache, chest pain, dizziness, or visual disturbances.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 150/95 mmHg, HR 78 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Cardiovascular": "Normal heart sounds, no murmurs."
    },
    "Diagnostic Test Results": ["ECG: Normal.", "Blood tests: Normal renal function, lipid profile slightly elevated."],
    "Assessment and Plan": {
      "Assessment": "Newly diagnosed hypertension.",
      "Plan": [
        "Initiate lifestyle modifications including dietary changes, increased physical activity, and smoking cessation.",
        "Start antihypertensive medication, considering a thiazide diuretic or ACE inhibitor.",
        "Monitor blood pressure at home and schedule follow-up in 4 weeks.",
        "Lipid management with dietary counseling and possible statin therapy."
      ]
    },
    "Problem List": ["Hypertension"]
  },
  {
    "Case Number": 2096,
    "Chief Complaint (CC)": "Chronic joint pain and morning stiffness.",
    "History of Present Illness (HPI)": "Mrs. Elizabeth Martinez, a 65-year-old female, reports chronic joint pain affecting her hands, knees, and hips with morning stiffness lasting more than one hour. Symptoms have gradually worsened over the past year.",
    "Past Medical History (PMH)": ["Osteoarthritis diagnosed 10 years ago."],
    "Medication History": ["Ibuprofen 400 mg as needed for pain."],
    "Social History (SH)": ["Retired school teacher, non-smoker, does not drink alcohol."],
    "Family History (FH)": ["Mother with rheumatoid arthritis."],
    "Review of Systems (ROS)": "Positive for joint pain and stiffness. Negative for fever, rash, or gastrointestinal symptoms.",
    "Physical Examination (PE)": {
      "General": "Appears in no acute distress.",
      "Vital Signs": "BP 130/80 mmHg, HR 70 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "Musculoskeletal": "Bilateral hand joint swelling with tenderness, reduced range of motion in knees and hips."
    },
    "Diagnostic Test Results": ["X-rays of hands and knees: Joint space narrowing, osteophytes, and subchondral sclerosis consistent with osteoarthritis."],
    "Assessment and Plan": {
      "Assessment": "Osteoarthritis with worsening symptoms.",
      "Plan": [
        "Increase ibuprofen to 600 mg three times daily with meals; monitor for gastrointestinal side effects.",
        "Physical therapy referral for joint exercises and pain management strategies.",
        "Consider intra-articular corticosteroid injections for severe knee pain.",
        "Evaluate for surgical options if functional impairment progresses.",
        "Follow-up in 3 months to reassess pain and function."
      ]
    },
    "Problem List": ["Osteoarthritis"]
  },
  {
    "Case Number": 2097,
    "Chief Complaint (CC)": "Persistent sore throat and hoarseness.",
    "History of Present Illness (HPI)": "Mr. Alex Thompson, a 55-year-old male, presents with a persistent sore throat and hoarseness lasting more than 3 weeks. Denies significant cough or fever but reports a sensation of a lump in his throat.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["High school music teacher, non-smoker, occasional alcohol use."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for sore throat and hoarseness. Negative for dysphagia, weight loss, or lymphadenopathy.",
    "Physical Examination (PE)": {
      "General": "Appears well.",
      "Vital Signs": "BP 120/80 mmHg, HR 75 bpm, RR 14/min, Temp 98.6°F, O2 Sat 98% on room air.",
      "ENT": "Mild erythema of the throat, no visible lesions or masses."
    },
    "Diagnostic Test Results": ["Laryngoscopy: Mild vocal cord erythema without nodules or masses."],
    "Assessment and Plan": {
      "Assessment": "Laryngitis, possibly related to voice strain.",
      "Plan": [
        "Voice rest and hydration.",
        "Humidifier use at night.",
        "Reflux precautions and trial of a proton pump inhibitor if symptoms suggest laryngopharyngeal reflux.",
        "Follow-up in 4 weeks or sooner if symptoms persist or worsen."
      ]
    },
    "Problem List": ["Laryngitis", "Hoarseness"]
  },
  {
    "Case Number": 2098,
    "Chief Complaint (CC)": "Worsening dyspnea on exertion.",
    "History of Present Illness (HPI)": "Ms. Laura Sanchez, a 68-year-old female with a history of chronic heart failure, reports worsening dyspnea on exertion over the past month. Now becomes short of breath with minimal activity, such as walking across the room.",
    "Past Medical History (PMH)": ["Chronic heart failure.", "Type 2 diabetes mellitus."],
    "Medication History": ["Furosemide 40 mg daily.", "Metformin 500 mg twice daily.", "Lisinopril 20 mg daily."],
    "Social History (SH)": ["Retired nurse, non-smoker, does not drink alcohol."],
    "Family History (FH)": ["Mother with heart failure.", "Father with type 2 diabetes."],
    "Review of Systems (ROS)": "Positive for dyspnea on exertion. Negative for chest pain, orthopnea, or paroxysmal nocturnal dyspnea.",
    "Physical Examination (PE)": {
      "General": "Mildly distressed due to dyspnea.",
      "Vital Signs": "BP 130/85 mmHg, HR 88 bpm, RR 20/min, Temp 98.6°F, O2 Sat 94% on room air.",
      "Cardiovascular": "S3 heart sound present, no murmurs.",
      "Respiratory": "Crackles at the lung bases."
    },
    "Diagnostic Test Results": ["Chest X-ray: Pulmonary congestion.", "BNP: Elevated.", "Echocardiogram: Reduced ejection fraction."],
    "Assessment and Plan": {
      "Assessment": "Worsening heart failure.",
      "Plan": [
        "Increase furosemide to 60 mg daily and monitor for renal function and electrolytes.",
        "Optimize management of heart failure with possible addition of a beta-blocker or aldosterone antagonist.",
        "Cardiology referral for further evaluation and management.",
        "Patient education on salt and fluid restriction.",
        "Follow-up in 1 week to assess response to medication adjustment."
      ]
    },
    "Problem List": ["Chronic heart failure", "Dyspnea on exertion"]
  },
  {
    "Case Number": 2099,
    "Chief Complaint (CC)": "Numbness and tingling in feet.",
    "History of Present Illness (HPI)": "Mr. Robert Lee, a 60-year-old male with a history of type 2 diabetes mellitus, reports numbness and tingling in both feet, progressively worsening over the past year. Also notes occasional burning pain at night.",
    "Past Medical History (PMH)": ["Type 2 diabetes mellitus, diagnosed 10 years ago."],
    "Medication History": ["Metformin 1000 mg twice daily.", "Glyburide 5 mg daily."],
    "Social History (SH)": ["Engineer, non-smoker, moderate alcohol consumption."],
    "Family History (FH)": ["Mother with type 2 diabetes.", "Brother with hypertension."],
    "Review of Systems (ROS)": "Positive for numbness, tingling, and burning pain in feet. Negative for weakness, urinary incontinence, or vision changes.",
    "Physical Examination (PE)": {
      "General": "Well-appearing, overweight.",
      "Vital Signs": "BP 140/90 mmHg, HR 76 bpm, RR 14/min, Temp 98.6°F, O2 Sat 97% on room air.",
      "Neurologic": "Decreased sensation to light touch and vibration in both feet. Reflexes diminished in the ankles."
    },
    "Diagnostic Test Results": ["HbA1c: 7.8%.", "Nerve conduction studies: Reduced amplitude and conduction velocities in lower extremities."],
    "Assessment and Plan": {
      "Assessment": "Diabetic peripheral neuropathy.",
      "Plan": [
        "Optimize glycemic control.",
        "Initiate pregabalin for neuropathic pain.",
        "Refer to diabetes education for comprehensive management.",
        "Annual foot exams and patient education on foot care."
      ]
    },
    "Problem List": ["Diabetic peripheral neuropathy", "Type 2 diabetes mellitus"]
  },
  {
    "Case Number": 2100,
    "Chief Complaint (CC)": "Acute right flank pain and hematuria.",
    "History of Present Illness (HPI)": "Ms. Emily White, a 45-year-old female, presents with sudden onset of severe right flank pain radiating to the groin, accompanied by visible blood in the urine. Describes the pain as sharp and unbearable. No prior history of similar symptoms.",
    "Past Medical History (PMH)": ["No significant past medical history."],
    "Medication History": ["No regular medications."],
    "Social History (SH)": ["High school principal, non-smoker, rarely drinks alcohol."],
    "Family History (FH)": ["No significant family history."],
    "Review of Systems (ROS)": "Positive for flank pain and hematuria. Negative for fever, dysuria, or frequency.",
    "Physical Examination (PE)": {
      "General": "Appears in acute distress due to pain.",
      "Vital Signs": "BP 150/90 mmHg, HR 110 bpm, RR 18/min, Temp 98.6°F, O2 Sat 95% on room air.",
      "Abdomen": "Tenderness in the right flank, no peritoneal signs."
    },
    "Diagnostic Test Results": ["CT abdomen/pelvis without contrast: 6 mm stone in the right ureter.", "Urinalysis: Hematuria."],
    "Assessment and Plan": {
      "Assessment": "Urolithiasis with right ureteral stone.",
      "Plan": [
        "Pain management with NSAIDs and oral opioids as needed.",
        "Hydration to facilitate stone passage.",
        "Tamsulosin to aid in stone passage.",
        "Urology referral for possible intervention.",
        "Follow-up in 1 week or sooner if symptoms worsen or if unable to pass the stone."
      ]
    },
    "Problem List": ["Urolithiasis", "Hematuria"]
  }
]