qid int64 2.2M 5.29M | context stringlengths 327 2.78k | diagnosis stringlengths 6 49 | diagnosis_code stringlengths 7 7 |
|---|---|---|---|
2,212,463 | Patient Information:
Age: 24 years
Gender: Female
Chief Complaint: Skin scattered petechiae for over 1 month, discovered thrombocytopenia for 1 day.
Present Illness History: Skin scattered petechiae for over 1 month, discovered thrombocytopenia for 1 day.
Past Medical History: Healthy.
Physical Examination: Skin scatte... | Thrombocytopenic purpura | D69.405 |
2,218,808 | Patient Information:
Age: 30 years old
Gender: Female
Chief Complaint: Enlarged thyroid gland with nodules found during physical examination for 1 week
Present Illness: The patient discovered thyroid abnormalities during a physical examination. An ultrasound showed "enlarged thyroid with heterogeneous echogenicity and ... | Thyroid cyst | E04.101 |
2,224,301 | Patient Information:
Age: 43 years
Gender: Male
Chief Complaint: Vomiting 1 hour after drinking alcohol
Present Illness: The patient consumed approximately 400 ml of white liquor 1 hour ago and subsequently experienced vomiting of coffee-ground gastric contents, accompanied by unsteady gait, and therefore came for medi... | Alcoholism | F10.002 |
2,232,999 | Medical Record Description:
Patient Information:
Age: 76 years
Gender: Male
Chief Complaint: Discomfort and pain in the left side of the abdomen and kidney area for over 4 months.
Present Illness: The patient has been experiencing intermittent pain and discomfort in the left side of the abdomen for over 4 months. He wa... | Ureteral stones with hydronephrosis and infection | N13.602 |
2,254,405 | Medical Record Description:
Patient Information:
Age: 5 years
Gender: Male
Chief Complaint: Delayed language development at the age of 5 years
Present Illness History: The patient started to make sounds around the age of 1. Currently, there is no significant difficulty in communication for daily life. He responds when ... | Speech and language development disorders | F80.900 |
2,269,321 | **Medical Record Description:**
**Patient Information:**
- Age: 6 years and 10 months
- Gender: Female
**Chief Complaint:** Skin rash for 5 days
**Present Illness History:** The patient has developed a skin rash over the past 5 days, primarily on the lower limbs. There is no erosion, but the patient reports pain while ... | Allergic purpura | D69.001 |
2,317,850 | Medical Record Description:
Patient Information:
Age: 29 years
Gender: Male
Chief Complaint: Throat pain and discomfort for 5 days
Present Illness:
No hoarseness, no swallowing obstruction, experiencing fever, no palpitations, denies drug allergy history. No improvement after intravenous treatment at a local hospital.... | Acute tonsillitis | J03.903 |
2,347,236 | Patient information:
Age: 36 years
Gender: Female
Chief complaint: Dizziness and fatigue for six months
Present illness: The patient presented in July 2016 with dizziness, fatigue, and chest tightness without any obvious precipitating factors. There were no fever or bleeding symptoms. A blood routine test conducted at ... | Iron deficiency anemia | D50.902 |
2,376,580 | Patient Information:
Age: 60 years
Gender: Female
Chief Complaint: Uneven echo in the thyroid found during a physical examination, 1 week ago.
Present Illness: No symptoms of cold intolerance or heat intolerance.
Past Medical History: History of hypothyroidism ("hypothyroidism").
Physical Examination: Pulse rate 70 bea... | Chronic Lymphocytic Thyroiditis | E06.305 |
2,439,936 | Clinical Description:
Patient Information:
Age: 29 years
Gender: Female
Chief Complaint: Left lower wisdom tooth has not erupted for 2 years.
Present Illness History: The patient reports that she inadvertently discovered her left lower wisdom tooth partially erupted but has consistently been unable to erupt into a norm... | Impacted tooth | K01.100 |
2,442,174 | Patient Information:
Age: 39 years old
Gender: Male
Chief Complaint: Sudden onset of chest pain, chest tightness, and palpitations for 7 hours
Present Illness: The patient experienced chest pain behind the sternum around 9:00 PM yesterday without obvious triggers. The pain is persistent and unrelenting, described as sq... | Acute Myocardial Infarction | I21.902 |
2,462,979 | Patient Information:
Age: 60 years old
Gender: Male
Chief Complaint: Snoring and shortness of breath during sleep for 3 years
Present Illness: The patient has experienced snoring and shortness of breath during sleep for the past 3 years, along with dry throat and occasional sore throat, but no fever.
Past Medical Histo... | Obstructive Sleep Apnea Syndrome | G47.301 |
2,474,147 | Patient Information:
Age: 26 years old
Gender: Male
Chief Complaint: Nasal congestion and excessive nasal discharge for several days
Present Illness History: No diplopia, no fever; no medication allergy history.
Past Medical History: Denies history of hypertension or coronary heart disease; no special medical h... | Septa deviation | J34.201 |
2,493,310 | Medical Record Description:
Patient Information:
Age: 47 years
Gender: Male
Chief Complaint: Swelling and pain in the gum area of the right lower posterior teeth for six months
Present Illness: The patient reports that six months ago, he began experiencing swelling and pain in the gum area of the right lower posterior ... | Chronic periodontitis | K05.300 |
2,515,926 | Patient Information:
Age: 33 years
Gender: Female
Chief Complaint: Multiple thyroid nodules detected on ultrasound during health check-up, 6 days ago.
Medical History: No notable issues.
Past Medical History: No notable issues.
Physical Examination: Thyroid not palpated.
Examination Report: Color Dopple... | Thyroid nodule | E04.101 |
2,524,378 | Patient Information:
Age: 48 years
Gender: Male
Chief Complaint: Left-sided hemiplegia for 11 hours.
Present Illness: Eleven hours ago, the patient experienced left-sided hemiplegia, slurred speech, headache, nausea, and vomiting. A CT scan conducted at a local hospital revealed a cerebral infarction, after which the p... | Cerebral infarction | I63.902 |
2,531,459 | Patient Information:
Age: 53 years old
Gender: Male
Chief Complaint: Shortness of breath for more than one month.
Present Illness: The patient started experiencing shortness of breath and chest tightness one month ago, with no fever or palpitations. He received treatment at a local health center but it was ineffective.... | Bronchial Asthma | J45.903 |
2,534,235 | Patient Information:
Age: 23 years
Gender: Male
Chief Complaint: Discomfort in the relaxed scrotum after sitting or lying down for over 8 months
Examination Report: Ultrasound Color Doppler Examination of the bilateral scrotum, testes, epididymis, and spermatic cord: The examination revealed that the right testis measu... | Varicocele | I86.101 |
2,539,105 | Patient Information:
Age: 76 years
Gender: Female
Chief Complaint: Worsening dyspnea for 4 days, exacerbated for 2 hours
Present Illness: The patient has experienced difficulty breathing and cough for the past 4 days. Two hours ago, there was a sudden increase in dyspnea, with sitting-up breathing position, no palpitat... | Heart failure | I50.902 |
2,547,511 | Patient Information:
Age: 21 years old
Gender: Male
Chief Complaint: Limb convulsions. Loss of consciousness for 3 hours.
Present Illness: The patient experienced sudden limb rigidity and convulsions, along with loss of consciousness 3 hours ago, which lasted for several minutes before improving.
Past Medical H... | Epilepsy | G40.901 |
2,551,072 | **Medical Record Description:**
**Patient Information:**
- Age: 3 years 11 months
- Gender: Male
**Chief Complaint:**
Not speaking at 3 years of age.
**Present Illness:**
The patient began making sounds about three months ago but has not shown any language development since then. He does not respond to his name, show... | Childhood Autism | F84.000 |
2,554,848 | Patient Information:
Age: 7 years and 11 months
Gender: Male
Chief Complaint: Vomiting, abdominal pain, rash for 3 days
Present Illness: The patient has experienced vomiting for the past 3 days, which is non-projectile and consists of gastric contents, occurring approximately 5-6 times. This is accompanied by abd... | Allergic purpura | D69.001 |
2,580,749 | Patient Information:
Age: 43 years
Gender: Male
Chief Complaint: Left renal colic for 1 day
Current Medical History: Left renal colic for 1 day
Physical Examination: No abnormalities observed
Examination Report: CT scan of the kidneys, ureters, and bladder (dual regions) showed a small nodular dense shadow in the upper... | Ureteral Calculi | N20.100 |
2,583,507 | Patient Information:
Age: 29 years
Gender: Female
Chief Complaint: Paroxysmal unconsciousness with limb convulsions for half an hour.
Present Illness History: The patient experienced sudden limb convulsions accompanied by biting of the tongue and loss of consciousness half an hour ago, without obvious triggers. After t... | Epilepsy | G40.900 |
2,608,647 | **Medical Record Description:**
**Patient Information:**
- Age: 46 years
- Gender: Female
- Chief Complaint: Discovered lung nodules 1 week ago, requesting the following items.
**Present Illness History:** None
**Past Medical History:** None
**Physical Examination:**
- Blood Pressure: 120/80 mmHg
- General Cond... | Pulmonary Nodular Disease | D86.000 |
2,613,846 | Patient Information:
Age: 60 years
Gender: Female
Chief Complaint: Left facial pain for five years
Present Illness: The patient has experienced left facial pain for the past five years, with pain during activities such as washing her face and brushing her teeth. There are no obvious limb numbness symptoms.
Past Medical... | Trigeminal neuralgia | G50.000 |
2,646,722 | Medical Record Description:
Patient Information:
Age: 65 years
Gender: Female
Chief Complaint: Increased frequency of urination, urgency, and painful urination for 1 hour.
Present Illness: The patient experienced increased frequency of urination, urgency, and pain during urination one hour ago without any obvious trigg... | Urinary tract infection | N39.001 |
2,673,523 | Patient Information:
Age: 34 years
Gender: Male
Chief Complaint: Discomfort in the left lower abdomen for 1 day.
Present Illness: The patient experienced discomfort in the left lower abdomen 1 day ago without any obvious cause. Accompanied by tea-colored urine, with no nausea or vomiting. The discomfort does not radiat... | Urolithiasis | N20.900 |
2,708,364 | Medical Record Description:
Patient Information:
Age: 40 years
Gender: Male
Chief Complaint: Head injury accompanied by memory decline for over six months
Present Illness: Six months ago, the patient sustained a head injury, which resulted in memory decline. There were no obvious triggers for the subsequent onset of he... | Post-Traumatic Brain Syndrome (PTBS) | F07.201 |
2,716,848 | Medical Record Description:
Patient Information:
Age: 8 years and 8 months
Gender: Female
Chief Complaint: Noticed pubic hair for 5 days
Current Medical History: The patient noticed the appearance of pubic hair 5 days ago, with no breast development, and no height increase. Three months ago, facial rashes were observed... | Precocious puberty | E30.101 |
2,739,222 | Patient Information:
Age: 43 years
Gender: Female
Chief Complaint: Thyroid nodule discovered during routine health check-up about one month ago
Present Illness: The patient discovered a thyroid nodule about one month ago during a routine check-up at Yiling Maternal and Child Health Hospital. Ultrasound indicated "a low... | Nontoxic solitary thyroid nodule | E04.103 |
2,751,215 | Patient Information:
Age: 27 years
Gender: Female
Chief Complaint: Noticing a thickened neck for 1 month
Present Illness: The patient noticed neck thickening 1 month ago, with no pain or hoarseness, no palpitations, no fatigue, no swelling, and no bulging or swelling of the eyes. A visit to a local hospital showed decr... | Hashimoto's disease | E06.305 |
2,792,684 | Patient Information:
Age: 48 years
Gender: Female
Chief Complaint: Noticed a mass on the left side of the tongue with pain for 3 months.
Present Illness: The patient reports discomfort in the left tongue area 3 months ago, during which she discovered a hard nodule. There has been pain and discomfort while eating and sp... | Glossitis | K14.901 |
2,826,249 | Patient Information:
Age: 41 years
Gender: Female
Chief Complaint: Hoarseness for six months.
Present Illness: The patient has experienced recurrent hoarseness for the past six months, which worsens after exposure to cold or excessive use of her voice. No sore throat or difficulty swallowing reported.
Past Medical Hist... | Vocal cord polyp | J38.102 |
2,845,498 | Patient Information:
Age: 48 years
Gender: Male
Chief Complaint: Poor appetite for 1 week. Requesting medication treatment.
Present Illness: No acid reflux, heartburn, or sensation of food obstruction, no abdominal bloating or belching, no nausea or vomiting; dietary intake is acceptable, normal bowel movements, normal... | Chronic Gastritis | K29.500 |
2,850,101 | Medical Record Description:
Patient Information:
Age: 39 years
Gender: Female
Chief Complaint: Chest tightness and shortness of breath for 1 year, with 1 episode of syncope
Present Illness History: One and a half weeks ago, the patient experienced syncope for 10 minutes while at work, without incontinence of bowel or b... | Arrhythmia | I49.904 |
2,860,511 | Patient Information:
Age: 32 years old
Gender: Male
Chief Complaint: Sore throat and discomfort for half a day
Present Illness: Sore throat, pain on swallowing, no fever
Medical History: Unremarkable
Physical Examination: Redness and swelling of the soft palate, redness and swelling of both tonsils, no redness of the e... | Acute pharyngitis | J02.902 |
2,899,746 | Patient Information:
Age: 40 years
Gender: Male
Chief Complaint: Inability to achieve erection during sexual intercourse for 1 month
Present Illness: The patient reports an inability to achieve erection during sexual intercourse for the past month. He still experiences nocturnal and morning erections. He also notes dis... | Erectile Dysfunction | F52.203 |
2,912,852 | Patient Information:
Age: 4 years 8 months
Gender: Female
Chief Complaint: Nasal congestion and excessive nasal discharge for half a month
Present Illness History: No diplopia, no fever, no known drug allergies
Past Medical History: No significant history.
Physical Examination: Nasal mucosa congestion, swol... | Sinusitis | J32.901 |
2,928,072 | Medical Record Description:
Patient Information:
Age: 48 years
Gender: Female
Chief Complaint: Discomfort in the anterior neck for several years.
Present Illness: The patient has experienced discomfort in the anterior neck for the past few years, occasionally accompanied by pain, but no other significant issues. Recent... | Autoimmune Thyroiditis (Hashimoto's Disease) | E06.303 |
2,973,752 | Patient Information:
Age: 49 years
Gender: Female
Chief Complaint: Head injury 20 hours ago.
Present Illness: 20 hours ago, the patient accidentally fell and injured the occipital region, complaining of unclear vision.
Past Medical History: No significant history.
Physical Examination: Conscious, neck soft, muscle stre... | Post-Traumatic Brain Syndrome (PTBS) | F07.201 |
2,978,182 | Medical Record Description:
Patient Information:
Age: 61 years
Gender: Female
Chief Complaint: Cervical polyp discovered 1 week ago
Present Illness History: The patient has been postmenopausal for 11 years. One week ago, a local health check revealed a polyp-like growth at the cervical opening.
Physical Examination: Vi... | Cervical polyp | N84.100 |
2,978,297 | Patient Information:
Age: 36 years
Gender: Female
Chief Complaint: Abnormal thyroid function found during physical examination for ten days
Present Illness: The patient discovered elevated TSH ten days ago during a physical exam, and thyroid ultrasound suggested Hashimoto's thyroiditis. Further examination is planned.
... | Chronic Lymphocytic Thyroiditis | E06.305 |
3,025,479 | Patient Information:
Age: 15 days old
Gender: Male
Chief Complaint: Diarrhea for 2 days
Present Illness: Yesterday, the patient had yellow watery stools, 2 times a day, with no mucus or bloody diarrhea, no vomiting, and abdominal distension. No fever, no cough.
Past Medical History: No significant history
Physical Exam... | Infant diarrhea | K52.903 |
3,025,719 | Medical Record Description:
Patient Information:
Age: 41 years
Gender: Male
Chief Complaint: Chest tightness for 2 years
Present Illness: Chest tightness for 2 years
Past Medical History: No significant history
Physical Examination: Heart Rate 72 beats/min, rhythmic, no murmurs
Examination Report: Coronary Angiography ... | Coronary atherosclerotic heart disease | I25.105 |
3,056,183 | **Medical Record Description:**
**Patient Information:**
- Age: 51 years
- Gender: Female
**Chief Complaint:**
- Enlarged neck for 2 months.
**Present Illness:**
- The patient noticed an enlarged neck 2 months ago but did not seek special treatment. Today, she experiences slight pain in the neck, palpitations, heat s... | Hashimoto's disease | E06.305 |
3,061,996 | Patient Information:
Age: 29 years
Gender: Male
Chief Complaint: Weakness in the right eye for several months
Present Illness History: Weakness in the right eye for several months, noticeably worse with fatigue, no diplopia, no headache or dizziness.
Physical Examination: Conscious, speech clear and fluent, no cranial ... | Myasthenia Gravis | G70.902 |
3,098,429 | Medical Record Description:
Patient Information:
Age: 53 years
Gender: Female
Chief Complaint: Sensation of a foreign body in the throat and excessive secretions for 7 years
Present Illness: Able to eat but accompanied by intermittent hoarseness
Physical Examination: Throat redness, enlarged tonsils with congestion, an... | Pharyngitis | J02.907 |
3,115,760 | Patient Information:
Age: 78 years
Gender: Male
Chief Complaint: Discomfort and pain in the lower right back tooth for 5 days.
Present Illness: The patient reports experiencing discomfort and pain in the lower right back tooth for the past 5 days. He has previously taken anti-inflammatory medication but has not seen si... | Chronic Apical Periodontitis | K04.500 |
3,139,484 | Patient Information:
Age: 14 years old
Gender: Male
Chief Complaint: Recurrent oral ulcers for 2 years, recurrence for half a month
Present Illness: The patient has experienced recurrent oral ulcers for 2 years, typically occurring once a month, with one ulcer each time that heals in 5-6 days. Half a month ago, multipl... | Oral mucosal ulceration | K12.109 |
3,257,391 | Patient Information:
Age: 12 years and 6 months
Gender: Male
Chief Complaint: Discomfort in the throat and dry cough for 2 months.
Present Illness History: The patient started experiencing discomfort in the throat and a dry cough 2 months ago, without sore throat, fever, or difficulty breathing.
Past Medical History: N... | Chronic pharyngitis | J31.203 |
3,287,677 | Medical Record Description:
Patient Information:
Age: 53 years
Gender: Female
Chief Complaint: Increased blood sugar levels for 4 years
Present Illness: The patient experienced elevated blood sugar levels without obvious cause 4 years ago, with a fasting blood sugar of 7.8 mmol/L. There were no significant symptoms suc... | Type 2 diabetes mellitus | E11.901 |
3,316,574 | Patient Information:
Age: 42 years
Gender: Female
Chief Complaint: Abnormal thyroid findings during a physical examination.
Present Illness: In February 2023, a thyroid ultrasound during a physical examination suggested Hashimoto's thyroiditis? The patient reported no neck pain or hoarseness, no fatigue, and no palpita... | Hashimoto's thyroiditis | E06.304 |
3,392,846 | Medical Record Description:
Patient Information:
Age: 22 years old
Gender: Male
Chief Complaint: Swelling under the jaw for over 1 month.
Present Illness History: No sore throat; no obvious pain in the jaw area.
Past Medical History: No significant history.
Physical Examination: Throat mucosa is congested, with bilater... | Submandibular lymphadenitis | I88.904 |
3,393,836 | Patient information:
Age: 6 years and 5 months
Gender: Male
Chief Complaint: Noticed new lower anterior teeth erupting for 1 week
Present Illness: The patient's family reports that they noticed the erupting lower anterior teeth a week ago, with no significant discomfort.
Physical Examination: 81/Grade 2-3 mobility, 41 ... | Retained deciduous teeth | K00.608 |
3,396,942 | Patient Information:
Age: 29 years
Gender: Female
Chief Complaint: Reduced thyroid density found during physical examination.
Present Illness: Recently, during a physical examination at our hospital, reduced thyroid density was detected, prompting the visit. The patient reports routine generalized body pain. No other s... | Hashimoto's thyroiditis (autoimmune thyroiditis) | E06.306 |
3,421,291 | Medical Record Description:
Patient Information:
Age: 34 years
Gender: Female
Chief Complaint: Vulvar itching for over 1 week.
Present Illness: The patient has experienced itching in the vulvar and vaginal area since the beginning of her menstrual cycle, with increased vaginal discharge.
Gynecological Examination: Vulv... | Candidal vaginitis | N76.001 |
3,431,120 | Patient Information:
Age: 26 years
Gender: Female
Chief Complaint: Infertility for 1 year.
Present Medical History: Menstrual cycle regular, 30-36 days, PCOM (Polycystic Ovarian Morphology), husband's semen abnormality (oligoasthenozoospermia) without report available. Last Menstrual Period (LMP): 5-20, menstrual durat... | Female infertility | N97.900 |
3,437,659 | Patient Information:
Age: 7 months and 16 days
Gender: Male
Chief Complaint: Swelling of the penis for 3 hours
Present Illness: The family noticed swelling of the patient's penis and redness of the scrotum during bath time 3 hours ago.
Physical Examination: Slight swelling of the penis, no swelling of the scrotum.
Exam... | Hydrocele | N43.300 |
3,468,309 | Medical Record Description:
Patient Information:
Age: 84 years
Gender: Male
Chief Complaint: Chest tightness and shortness of breath for 1 day
Present Illness: The patient developed shortness of breath and difficulty breathing without obvious trigger last night, presenting with orthopnea, accompanied by cough and sputu... | Heart failure | I50.902 |
3,503,264 | Patient Information:
Age: 47 years
Gender: Male
Chief Complaint: Erectile dysfunction for 3 years
Present Illness: Night erections are present, and morning erections are also present. No erection with sexual stimulation of the penis. The patient had previously visited Zhengjian Hospital, underwent circumcision, vacuum ... | Erectile Dysfunction | F52.203 |
3,540,888 | Patient Information:
Age: 25 years old
Gender: Male
Chief Complaint: Fear of heat and excessive sweating for more than several years.
Present Illness History: The patient has experienced excessive sweating for several years, along with palpitations, increased appetite with rapid hunger, fatigue, and hand tremors. There... | Hyperthyroidism | E05.901 |
3,549,632 | Medical Record Description:
Patient Information:
Age: 44 years
Gender: Female
Chief Complaint: Discovery of cervical mass
Present Illness History: Last menstrual period: October 1. Previous examinations indicated ovarian cyst. Referral for follow-up suggested ovarian cyst with accompanying cervical polyp. Now undergoin... | Cervical polyp | N84.100 |
3,553,291 | Patient Information:
Age: 24 years
Gender: Female
Chief Complaint: Swelling and pain in the lower right posterior teeth area for one day
Present Illness: Noticed swelling and pain in the lower right posterior teeth area for one day. Self-administered artificial cattle bile metronidazole, with no significant improvement... | Acute pericarditis | K05.204 |
3,577,318 | Patient Information:
Age: 46 years
Gender: Male
Chief Complaint: History of hypothyroidism for over a year
Present Illness: The patient has been diagnosed with hypothyroidism for over a year and has been treated with thyroid tablets, currently taking 40mg/day. He has stopped the medication for over four months and repo... | Hypothyroidism | E03.901 |
3,611,352 | Patient Information:
Age: 44 years
Gender: Female
Chief Complaint: Nasal congestion, excessive nasal discharge for multiple days
Current Medical History: No diplopia, no fever, no known drug allergies, long-term use of nasal sprays
Previous Medical History: Denies history of hypertension or coronary heart disease, no s... | Chronic Rhinitis | J31.002 |
3,613,498 | Medical Record Description:
Patient Information:
Age: 38 years
Gender: Male
Chief Complaints: Snoring and shortness of breath during sleep for several years.
Present Illness: Daytime sleepiness, no significant nasal congestion.
Past Medical History: Hypertension, no history of diabetes.
Physical Examinati... | Sleep Apnea Hypoventilation Syndrome | G47.301 |
3,628,764 | Patient Information:
Age: 6 months and 20 days
Gender: Male
Chief Complaint: Diarrhea for 10 days
Present Illness: The child developed diarrhea 10 days ago without any obvious trigger, characterized by yellow-green watery stools containing mucus, with no pus or blood, occurring 6-8 times a day. There has been no vomiti... | Pediatric Diarrhea | K52.919 |
3,686,821 | Patient Information:
Age: 53 years
Gender: Male
Chief Complaint: Recurrent cough and shortness of breath for over 10 years, with worsening symptoms in the past month.
Present Illness: The patient started experiencing intermittent cough and sputum production over 10 years ago, with symptoms more pronounced in the early ... | Chronic Obstructive Pulmonary Disease (COPD) | J44.900 |
3,751,737 | Patient Information:
Age: 46 years
Gender: Male
Chief Complaint: Frequent urination, urgency, burning sensation during urination, incomplete urination, discomfort in the perineum for one month.
Current Medical History: One month ago, the patient experienced urinary frequency, urgency, burning sensation in the urethra, ... | Varicocele | I86.101 |
3,754,816 | Medical Record Description:
Patient Information:
Age: 29 years
Gender: Female
Chief Complaint: Thyroid nodule found during physical examination
Present Illness: The patient was found to have a thyroid nodule during a physical examination. Ultrasound showed a "slightly hypoechoic nodule in the right lobe of the thyroid.... | Nontoxic solitary thyroid nodule | E04.103 |
3,772,217 | Patient information:
Age: 42 years
Gender: Female
Chief complaint: Palpitations and excessive sweating for 2 months
Present illness: The patient has experienced palpitations, excessive sweating, and increased appetite for the past 2 months. Yesterday, she went to a local hospital for a thyroid function test, which show... | Hyperthyroidism | E05.901 |
3,848,529 | Patient Information:
Age: 47 years
Gender: Male
Chief Complaint: Discomfort in the upper abdomen 2 hours after drinking alcohol
Current Medical History: The patient experienced dizziness and discomfort in the upper abdomen 2 hours after consuming approximately 1 jin (500 grams) of white liquor. He also exhibited unstea... | Acute alcohol intoxication | F10.001 |
3,879,890 | **Medical Case Description:**
**Patient Information:**
- Age: 5 years and 11 months
- Gender: Male
- Chief Complaint: Not speaking spontaneously for more than 5 years, unable to communicate with peers.
**Present Illness:**
At the age of over 3 years, the patient was diagnosed with "Autism Spectrum Disorder" at a local ... | Pediatric Autism Spectrum Disorder | F84.000 |
3,900,798 | Patient Information:
Age: 8 years 8 months
Gender: Male
Chief Complaint: Rash for 1 week
Present Illness: The child has had skin purpura for the past week, mostly located on both lower limbs, symmetrical on both sides, does not blanch when pressed, no joint pain, has abdominal pain which occurs intermittently without v... | Allergic purpura | D69.001 |
3,919,566 | Patient Information:
Age: 8 years and 10 months
Gender: Male
Chief Complaint: Abdominal pain and diarrhea for one week
Present Illness: The patient's parents report that diarrhea started one week ago, occurring 6-7 times daily, with loose and watery stools, accompanied by intermittent abdominal pain, without chills or ... | Intestinal Obstruction | K56.702 |
3,922,427 | Patient Information:
Age: 70 years
Gender: Male
Chief Complaint: Varicose veins in the left lower limb for several decades
Present Illness History: The patient developed superficial venous dilation in the left lower limb several decades ago without any obvious inducement. Initially, there were only small protrusions on... | Varicose veins | I83.903 |
3,929,991 | Patient Information:
Age: 68 years
Gender: Female
Chief Complaint: Thyroid nodule found during health check-up
Present Illness: The patient was discharged from the Municipal Fifth Hospital one month ago due to "hypertension" and was found to have an uneven density and thyroid nodule during a health examination. Thyroid... | Hashimoto's thyroiditis (autoimmune thyroiditis) | E06.306 |
3,940,289 | Patient Information:
Age: 13 years and 11 months
Gender: Female
Chief Complaint: Dysmenorrhea for one year
Present Illness: The patient has experienced dysmenorrhea for one year. She began menstruating in November 2015, with abdominal pain during the first to third days of each menstrual period, accompanied by nausea a... | Dysmenorrhea | N94.601 |
3,940,870 | Medical Record Description:
Patient Information:
Age: 17 years old
Gender: Female
Chief Complaint: Cough and sputum for 4 days.
Present Illness: The patient developed a cough and sputum production 4 days ago after catching a cold, accompanied by fever, with the highest temperature reaching 38.5 degrees Celsius. The pat... | Upper Respiratory Tract Infection | J06.903 |
3,955,660 | Medical Record Description:
Patient Information:
Age: 8 years and 9 months
Gender: Female
Chief Complaint: Fever for 1 day
Present Illness History: The child developed a fever after being exposed to cold, with an irregular fever pattern and a maximum temperature of 37.8°C. There are no chills, throat pain, cough, or ho... | Acute upper respiratory tract infection | J06.902 |
3,983,639 | Patient Information:
Age: 47 years
Gender: Female
Chief Complaint: Diarrhea and abdominal pain for half a day
Present Illness: The patient began experiencing diarrhea in the afternoon, with watery yellow stools, accompanied by intermittent abdominal pain, nausea, and vomiting. There are no symptoms of chills or fever. ... | Acute Gastroenteritis | K52.908 |
3,999,378 | Medical Record Description:
Patient Information:
Age: 2 years and 7 months
Gender: Male
Chief Complaint: Nasal discharge for more than six months
Present Illness: The patient has had nasal discharge for six months, presenting with thick and purulent nasal discharge, no nasal bleeding, no sleep snoring, and breathing wi... | Chronic Rhinitis | J31.004 |
4,017,323 | Patient Information:
Age: 77 years old
Gender: Female
Chief Complaint: Right submandibular mass for 2 months.
Present Illness: No significant pain.
Past Medical History: No history of hypertension or diabetes. Has a history of bronchitis.
Physical Examination: Enlarged lymph nodes felt on the right submandibular area, ... | Submandibular lymphadenitis | I88.904 |
4,060,767 | Patient Information:
Age: 10 years and 6 months
Gender: Female
Chief Complaint: Breast enlargement noticed for over 1 year.
Present Illness: The patient noticed breast enlargement over 1 year ago. She experienced menarche on July 20, 2021, and has had a growth spurt in height this year, with no other discomfort. She co... | Precocious puberty | E30.100 |
4,086,809 | **Medical Record Description:**
**Patient Information:**
- Age: 54 years
- Gender: Female
**Chief Complaint:**
- Right-sided facial pain for 1 year
**Present Illness:**
- One year ago, the patient experienced facial pain without any obvious trigger, characterized as pulling pain on the right side of the face, which is ... | Trigeminal neuralgia | G50.002 |
4,206,729 | Medical Record Description:
Patient Information:
Age: 4 years and 1 month
Gender: Male
Chief Complaint: Nasal congestion, runny nose, and snoring for six months
Present Illness: The patient has nasal congestion, runny nose, dry cough, and snoring. No fever.
Past Medical History: Generally healthy. No history ... | Turbinate hypertrophy | J34.301 |
4,221,126 | Patient Information:
Age: 39 years
Gender: Male
Chief Complaint: Vomiting 1 hour after drinking alcohol
Present Illness History: The patient started vomiting gastric contents 1 hour after consuming alcohol (amount unspecified) and was accompanied by unsteady gait, and was brought to our department by family members.
Pa... | Alcoholism | F10.002 |
4,349,800 | Patient Information:
Age: 70 years old
Gender: Female
Chief Complaint: Consciousness disorder for over 5 hours.
Present Illness: The patient experienced vomiting at 9 PM yesterday and subsequently fell into a coma. Family members took her to the local Badong People's Hospital, where a head CT and chest CT indicated rig... | Intracerebral hemorrhage | I61.900 |
4,469,574 | Patient Information:
Age: 64 years old
Gender: Female
Chief Complaint: Recurrent cough and sputum for over 20 years, with exacerbation in the past month.
Present Illness: The patient has experienced recurrent episodes of cough and sputum production for over 20 years, often accompanied by wheezing, typically triggered b... | Chronic Obstructive Pulmonary Disease (COPD) | J44.900 |
4,477,105 | **Medical Record Description:**
**Patient Information:**
- Age: 19 years
- Gender: Male
**Chief Complaint:** Fever and diarrhea for 3 days
**Present Illness History:** The patient developed fever accompanied by abdominal pain and diarrhea 3 days ago without any obvious cause. He received treatment at another hospital w... | Acute Gastroenteritis | K52.905 |
4,611,202 | Medical Record Description:
Patient Information:
Age: 17 years
Gender: Male
Chief Complaint: Discovery of arachnoid cyst for 8 years
Present Illness: Discovered arachnoid cyst 8 years ago
Physical Examination: Blood pressure: 110/70 mmHg, pulse: 80 beats/min, respiration: 20 breaths/min, body temperature: 36.5°C. Consc... | Arachnoid cyst | G93.001 |
4,663,788 | Patient Information:
Age: 48 years
Gender: Female
Chief Complaint: Generalized weakness and discomfort for 2 hours, unconsciousness for 1 hour.
Current Medical History: The patient complained of generalized weakness and discomfort accompanied by nausea without vomiting 2 hours ago. She was diagnosed with “cerebral hemo... | Intracerebral hemorrhage | I61.900 |
4,698,773 | Patient Information:
Age: 2 years and 11 months
Gender: Male
Chief Complaint: Abnormal myocardial enzyme profile
Current Medical History: Re-examination of abnormal myocardial enzyme profile; normal spirit, appetite, and sleep; normal urination and defecation.
Physical Examination: Vital signs stable; general condition... | Myocardial injury | I50.906 |
4,748,764 | Patient Information:
Age: 9 years 2 months
Gender: Female
Chief Complaint: Fever for 1 day
Present Illness: The patient has had a fever since today, without cough or wheezing, reports dizziness, no vomiting or diarrhea, and is in acceptable spirits.
Physical Examination: Blood pressure not measured mmHg, pulse 100 beat... | Acute upper respiratory tract infection | J06.900 |
4,794,454 | Patient Information:
Age: 10 years 5 months
Gender: Male
Chief Complaint: Left-sided scrotal pain for 1 week
Present Illness: No fever or injury.
Past Medical History: No history of overseas travel, tourism, or residence in the two weeks prior to consultation; no contact with overseas returnees, asymptomatic infected i... | Orchitis | N45.906 |
4,819,125 | Patient Information:
Age: 10 years and 7 months
Gender: Male
Chief Complaint: Growth consultation.
Current Medical History: The patient was born via a full-term cesarean section, with a birth weight of 3.4 kg; birth length unknown. There were no asphyxia or birth injuries at birth. Over the past year, the patient... | Precocious puberty | E30.100 |
4,840,362 | Patient Information:
Age: 50 years
Gender: Male
Chief Complaint: Head fullness for 2 years
Present Illness: The patient has experienced head fullness without any obvious triggers for 2 years, with no headaches and normal sleep.
Past Medical History: The patient has a history of hypertension, no history of diabetes, no ... | Cerebral artery insufficiency | I67.803 |
4,864,474 | Patient Information:
Age: 14 years old
Gender: Male
Chief Complaint: Chest tightness for 3 months
Present Illness: The patient felt chest tightness after catching a cold 3 months ago, which worsens with activity, occasionally accompanied by breathlessness, with no other discomfort. He has visited our outpatient clinic ... | Myocarditis | I51.400 |
4,880,540 | Medical Record Description:
Patient Information:
Age: 32 years
Gender: Male
Chief Complaint: Pain in the right lumbar and abdominal region for 3 hours.
History of Present Illness: The patient experienced sudden onset of continuous colicky pain in the lumbar and abdominal area 3 hours ago, with associated nausea and vom... | Ureteral Calculi | N20.100 |
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