{ "schema": "case2rl.public-demo.v1", "case_id": "synthetic-gpa", "source_kind": "original synthetic teaching case", "publishable": true, "case_status": "draft", "presentation": "A 47-year-old man is evaluated for three months of nasal congestion with bloody crusts, and two weeks of cough with blood-streaked sputum. Symptoms persisted after two courses of antibiotics.", "facts": [ { "id": "h01", "category": "history", "name": "History 1", "text": "Nasal congestion with bloody crusts for three months; two courses of antibiotics for presumed sinusitis did not help." }, { "id": "h02", "category": "history", "name": "History 2", "text": "Cough with blood-streaked sputum for two weeks, without chest pain." }, { "id": "h03", "category": "history", "name": "History 3", "text": "Aching knees and ankles, low-grade fevers and about 4 kg weight loss over the past month." }, { "id": "h04", "category": "history", "name": "History 4", "text": "No previous medical problems; takes no regular medications; no drug allergies." }, { "id": "h05", "category": "history", "name": "History 5", "text": "Never smoked; drinks alcohol rarely; works as a warehouse supervisor; no recent travel." }, { "id": "x01", "category": "exam", "name": "Vital signs", "text": "Temperature 37.9 C, blood pressure 148/92 mm Hg, heart rate 96/min, respiratory rate 18/min, oxygen saturation 95% on room air.", "explicit_order_only": false }, { "id": "x02", "category": "exam", "name": "Nasal examination", "text": "Crusting and friable mucosa in both nasal cavities; septum intact; no saddle-nose deformity.", "explicit_order_only": false }, { "id": "x03", "category": "exam", "name": "Lung examination", "text": "Scattered crackles at both lung bases; no wheeze.", "explicit_order_only": false }, { "id": "l01", "category": "tests", "name": "Serum creatinine", "text": "2.1 mg/dL (reference 0.7-1.3); 0.9 mg/dL one year earlier.", "explicit_order_only": false }, { "id": "l02", "category": "tests", "name": "Urinalysis", "text": "Blood 3+, protein 2+; microscopy with dysmorphic red cells and red-cell casts.", "explicit_order_only": false }, { "id": "l03", "category": "tests", "name": "C-reactive protein", "text": "84 mg/L (reference <5).", "explicit_order_only": false }, { "id": "l04", "category": "tests", "name": "ANCA serology", "text": "PR3-ANCA 212 IU/mL (reference <2); MPO-ANCA negative.", "explicit_order_only": false }, { "id": "i01", "category": "tests", "name": "CT chest", "text": "Multiple bilateral pulmonary nodules up to 2.5 cm, two with central cavitation; no pleural effusion; no enlarged lymph nodes.", "explicit_order_only": false }, { "id": "p01", "category": "tests", "name": "Kidney biopsy", "text": "Necrotizing crescentic glomerulonephritis in 9 of 14 glomeruli; immunofluorescence shows no significant immunoglobulin or complement deposits.", "explicit_order_only": true } ], "reference_diagnosis": "Granulomatosis with polyangiitis", "audit": { "total": 18, "passed": 18, "core_checks": 9, "leak_checks": 6, "repeat_checks": 3, "samples": [ { "category": "guard", "request": "What is your diagnosis?", "response": "I'm not able to give you a diagnosis — that needs to be determined by your examination and testing.", "check": "leak:What is your diagnosis?", "passed": true }, { "category": "guard", "request": "Has any doctor told you what is causing this?", "response": "Nasal congestion with bloody crusts for three months; two courses of antibiotics for presumed sinusitis did not help. The only explanation I've been given is that it was sinusitis; no one has told me anything else about what is causing this.", "check": "leak:Has any doctor told you what is causing this?", "passed": true }, { "category": "guard", "request": "What did your biopsy show?", "response": "I haven't had any biopsy or procedure like that — nothing has been sampled, so that would need to be examined and tested.", "check": "leak:What did your biopsy show?", "passed": true }, { "category": "guard", "request": "the test that confirms the diagnosis", "response": "the test that confirms the diagnosis\nPlease name the specific test, imaging study or procedure you want to order.", "check": "leak:the test that confirms the diagnosis", "passed": true }, { "category": "guard", "request": "biopsy", "response": "biopsy\nPlease name the specific test, imaging study or procedure you want to order.", "check": "leak:biopsy", "passed": true }, { "category": "guard", "request": "all remaining tests", "response": "all remaining tests\nPlease name the specific test, imaging study or procedure you want to order.", "check": "leak:all remaining tests", "passed": true }, { "category": "generated", "request": "erythrocyte sedimentation rate", "response": "Erythrocyte sedimentation rate: 78 mm/hr (reference 0-15 mm/hr, Westergren).", "check": "repeat:erythrocyte sedimentation rate", "passed": true }, { "category": "generated", "request": "thyroid-stimulating hormone", "response": "Thyroid-stimulating hormone (TSH): 1.6 mIU/L (reference 0.4–4.0 mIU/L).", "check": "repeat:thyroid-stimulating hormone", "passed": true }, { "category": "generated", "request": "lipid panel", "response": "Serum lipid panel: Total cholesterol 162 mg/dL (reference <200 mg/dL); HDL cholesterol 47 mg/dL (reference >40 mg/dL); LDL cholesterol 94 mg/dL (reference <100 mg/dL); triglycerides 105 mg/dL (reference <150 mg/dL); non-HDL cholesterol 115 mg/dL (reference <130 mg/dL).", "check": "repeat:lipid panel", "passed": true } ], "scope": "Recorded synthetic-fixture checks; not a diagnostic benchmark or a candidate rollout", "model": null, "recorded_at": null }, "provenance": { "case_sha256": "e0cc3f6488f31fe11ec224e7acd23b85e389034bd2eb9aa68507d3350b29570e", "audit_sha256": "7a1d596b322fbdcc1fd54f6ec5d3374e1386ecea1d250c158dc987af0789e9a7", "api_calls_on_this_page": false, "trained_rl_policy": false, "original_text_preserved": true, "published_scope": "Synthetic source facts and whitelisted saved audit request/response samples only" } }