~/opd-casebook/generate_opd.py
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable, PageBreak
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
doc = SimpleDocTemplate(
"/tmp/workspace/opd-casebook/GP_OPD_Casebook.pdf",
pagesize=A4,
rightMargin=2*cm, leftMargin=2*cm,
topMargin=2*cm, bottomMargin=2*cm
)
styles = getSampleStyleSheet()
# Custom styles
title_style = ParagraphStyle('Title', parent=styles['Title'],
fontSize=22, textColor=colors.HexColor('#1a3a6b'), spaceAfter=6, alignment=TA_CENTER)
subtitle_style = ParagraphStyle('Subtitle', parent=styles['Normal'],
fontSize=12, textColor=colors.HexColor('#2e6da4'), spaceAfter=4, alignment=TA_CENTER)
case_title_style = ParagraphStyle('CaseTitle', parent=styles['Heading1'],
fontSize=14, textColor=colors.white, spaceAfter=4, spaceBefore=4)
section_style = ParagraphStyle('Section', parent=styles['Heading2'],
fontSize=11, textColor=colors.HexColor('#1a3a6b'), spaceAfter=3, spaceBefore=6)
body_style = ParagraphStyle('Body', parent=styles['Normal'],
fontSize=10, leading=14, spaceAfter=3, alignment=TA_JUSTIFY)
bullet_style = ParagraphStyle('Bullet', parent=styles['Normal'],
fontSize=10, leading=14, leftIndent=14, spaceAfter=2,
bulletIndent=4, bulletText='\u2022')
index_style = ParagraphStyle('Index', parent=styles['Normal'],
fontSize=10, leading=16)
def case_header(num, title, patient_info):
data = [[Paragraph(f"<b>CASE {num}: {title}</b>", case_title_style)]]
t = Table(data, colWidths=[17*cm])
t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#1a3a6b')),
('ROUNDEDCORNERS', [6,6,6,6]),
('TOPPADDING', (0,0), (-1,-1), 7),
('BOTTOMPADDING', (0,0), (-1,-1), 7),
('LEFTPADDING', (0,0), (-1,-1), 10),
]))
# Patient info row
pi_data = [[Paragraph(patient_info, ParagraphStyle('pi', parent=styles['Normal'],
fontSize=9, textColor=colors.HexColor('#444444')))]]
pi_t = Table(pi_data, colWidths=[17*cm])
pi_t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#eef3fb')),
('TOPPADDING', (0,0), (-1,-1), 4),
('BOTTOMPADDING', (0,0), (-1,-1), 4),
('LEFTPADDING', (0,0), (-1,-1), 10),
('BOX', (0,0), (-1,-1), 0.5, colors.HexColor('#2e6da4')),
]))
return [t, pi_t]
def section(title):
return Paragraph(f"<b>{title}</b>", section_style)
def bullets(items):
return [Paragraph(item, bullet_style) for item in items]
def rx_table(drugs):
"""drugs = list of (Drug, Dose, Frequency, Duration)"""
header = [Paragraph('<b>Drug</b>', styles['Normal']),
Paragraph('<b>Dose</b>', styles['Normal']),
Paragraph('<b>Frequency</b>', styles['Normal']),
Paragraph('<b>Duration</b>', styles['Normal'])]
data = [header]
for d in drugs:
data.append([Paragraph(d[0], styles['Normal']),
Paragraph(d[1], styles['Normal']),
Paragraph(d[2], styles['Normal']),
Paragraph(d[3], styles['Normal'])])
t = Table(data, colWidths=[6*cm, 3*cm, 4*cm, 4*cm])
t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,0), colors.HexColor('#2e6da4')),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#f5f9ff'), colors.white]),
('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#aaaaaa')),
('FONTSIZE', (0,0), (-1,-1), 9),
('TOPPADDING', (0,0), (-1,-1), 4),
('BOTTOMPADDING', (0,0), (-1,-1), 4),
('LEFTPADDING', (0,0), (-1,-1), 6),
]))
return t
def sp(n=1):
return Spacer(1, n*0.3*cm)
def hr():
return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor('#cccccc'))
# ============================================================
# CASES DATA
# ============================================================
cases = []
# ---- CASE 1: Upper Respiratory Tract Infection ----
cases.append({
'num': 1, 'title': 'UPPER RESPIRATORY TRACT INFECTION (URTI)',
'patient': 'Name: Ramesh Kumar | Age: 28 yrs | Sex: Male | OPD No: 001 | Date: 15/07/2026',
'cc': 'Sore throat, runny nose, mild fever and sneezing for 3 days.',
'hopi': [
'Patient was apparently well 3 days ago, then developed sudden onset sore throat.',
'Associated nasal discharge (clear, watery), sneezing, mild fever (measured 99.8°F at home).',
'Mild headache and body ache present. No difficulty swallowing. No ear pain.',
'No previous similar episodes. No known drug allergies.',
],
'pmh': 'No significant past medical history. No chronic illness. No previous surgeries.',
'fh': 'Non-contributory.',
'sh': 'Office worker. Non-smoker. Occasional alcohol. No recent travel.',
'gen': ['Patient is conscious, cooperative, well-oriented to time, place and person.',
'Not in acute distress. Afebrile (37.3°C). Well nourished.',
'No pallor, icterus, cyanosis, clubbing, lymphadenopathy or edema.'],
'vitals': [['Temperature', '37.7°C (99.8°F)'], ['Pulse', '84/min, regular, good volume'],
['BP', '118/76 mmHg'], ['RR', '16/min'], ['SpO2', '99% on room air']],
'sys': ['Throat: Mild pharyngeal erythema, no exudates, tonsils not enlarged.',
'Nasal mucosa: Congested, bilateral, no polyps.',
'Ears: Tympanic membranes intact bilaterally.',
'Chest: Clear to auscultation bilaterally. No wheeze or crepitations.',
'Abdomen: Soft, non-tender. No organomegaly.'],
'ix': ['No investigations required for uncomplicated URTI.',
'If symptoms persist >7 days: Throat swab for culture, CBC with differential.'],
'dx': 'Acute Viral Upper Respiratory Tract Infection (URTI) - Common Cold',
'ddx': ['Streptococcal pharyngitis', 'Influenza', 'Allergic rhinitis'],
'rx': [('Tab. Paracetamol 500 mg', '1 tab', 'TDS x 3 days (if fever/pain)', 'PRN'),
('Syp. Bromhexine + Guaifenesin', '10 ml', 'TDS', '5 days'),
('Tab. Cetirizine 10 mg', '1 tab', 'OD at night', '5 days'),
('Nasal drops Xylometazoline 0.1%', '2 drops each nostril', 'BD', '3 days only')],
'advice': ['Rest, adequate hydration (3-4 litres fluid/day).',
'Steam inhalation twice daily for nasal congestion.',
'Salt water gargles 3-4 times daily for sore throat.',
'Avoid cold drinks and ice cream.',
'Return if fever >38.5°C, dysphagia, ear pain or no improvement in 5-7 days.',
'Antibiotics NOT indicated (viral etiology).'],
'followup': '5-7 days if no improvement, or earlier if symptoms worsen.'
})
# ---- CASE 2: Acute Gastroenteritis ----
cases.append({
'num': 2, 'title': 'ACUTE GASTROENTERITIS',
'patient': 'Name: Sunita Devi | Age: 35 yrs | Sex: Female | OPD No: 002 | Date: 15/07/2026',
'cc': 'Vomiting, loose watery stools and abdominal cramps for 1 day.',
'hopi': [
'Acute onset vomiting (4-5 episodes) and loose watery stools (6-7 episodes) since yesterday.',
'Abdominal cramps, bloating, nausea present. No blood or mucus in stools.',
'Mild fever (100°F). Feels weak and dizzy on standing.',
'Similar food (street food) consumed by husband who also has loose motions.',
'No prior episodes. Not on any regular medication.',
],
'pmh': 'No significant history. No chronic illness.',
'fh': 'Non-contributory.',
'sh': 'Homemaker. Consumed street food yesterday.',
'gen': ['Conscious, cooperative but looks fatigued.',
'Mild dehydration signs: dry lips, slightly reduced skin turgor.',
'No pallor, icterus, cyanosis.'],
'vitals': [['Temperature', '37.9°C (100.2°F)'], ['Pulse', '96/min, slightly weak'],
['BP', '106/74 mmHg (mild postural drop)'], ['RR', '18/min'], ['SpO2', '98%']],
'sys': ['Abdomen: Soft, mild diffuse tenderness, hyperactive bowel sounds.',
'No guarding, rigidity or rebound tenderness.',
'No organomegaly. Rectum: Not examined.',
'CVS, RS, CNS: Within normal limits.'],
'ix': ['Stool routine & microscopy (R/E)',
'CBC - to look for leukocytosis',
'Serum electrolytes (if severe dehydration)',
'Blood glucose (to rule out hypoglycemia in prolonged illness)'],
'dx': 'Acute Gastroenteritis - likely Food-borne (Bacterial/Viral)',
'ddx': ['Cholera', 'Bacillary dysentery', 'Viral gastroenteritis (Rotavirus/Norovirus)', 'Food poisoning'],
'rx': [('ORS (Oral Rehydration Solution)', '200-400 ml', 'After each loose stool', 'Till diarrhea stops'),
('Tab. Ondansetron 4 mg', '1 tab', 'TDS (for vomiting)', '2-3 days'),
('Tab. Metronidazole 400 mg', '1 tab', 'TDS', '5 days'),
('Tab. Racecadotril 100 mg', '1 tab', 'TDS', '3-5 days'),
('Syp. Zinc 20 mg', '10 ml', 'OD', '14 days')],
'advice': ['Continue ORS - 200 ml after every loose stool.',
'Light diet: Rice, curd, banana, boiled vegetables (BRAT diet).',
'Avoid spicy, fatty, oily food until symptoms resolve.',
'Hand hygiene before eating and after using toilet.',
'Return immediately if: Blood in stool, high fever, signs of severe dehydration, no urine >6 hrs.'],
'followup': '2 days, or immediately if worsening.'
})
# ---- CASE 3: Hypertension ----
cases.append({
'num': 3, 'title': 'HYPERTENSION - NEW DIAGNOSIS',
'patient': 'Name: Mahesh Sharma | Age: 52 yrs | Sex: Male | OPD No: 003 | Date: 15/07/2026',
'cc': 'Headache and giddiness for 2 weeks. Incidental high BP found.',
'hopi': [
'Dull aching headache, occipital in location, more in mornings for past 2 weeks.',
'Associated giddiness, no tinnitus, no visual disturbance, no vomiting.',
'BP measured at workplace medical camp: 158/96 mmHg. Repeated next day: 160/98 mmHg.',
'No chest pain, palpitations, breathlessness, ankle swelling.',
'No hematuria, no facial puffiness. No episodes of syncope.',
],
'pmh': 'Nil significant. No DM, CAD, CKD. Non-smoker (quit 5 years ago). No prior medications.',
'fh': 'Father had hypertension and died of stroke at 65 years.',
'sh': 'Office executive. Sedentary lifestyle. High-salt diet. Social drinker (2-3 units/week). BMI 28.',
'gen': ['Obese male (BMI 28 kg/m²). Conscious, alert, no acute distress.',
'No pallor, icterus, cyanosis, edema, clubbing.',
'JVP not raised.'],
'vitals': [['BP (Right arm sitting)', '158/96 mmHg'], ['BP (Left arm)', '154/94 mmHg'],
['Pulse', '78/min, regular, good volume'], ['Temperature', '36.8°C'],
['RR', '16/min'], ['BMI', '28 kg/m²']],
'sys': ['CVS: S1 S2 heard. No murmurs. Apex in 5th ICS MCL.',
'RS: Clear bilaterally. No crackles.',
'Abdomen: Soft, no bruit over renal arteries.',
'Fundus: Not dilated today - refer ophthalmology for fundoscopy.',
'CNS: No focal neurological deficit.'],
'ix': ['CBC, FBS, PPBS, HbA1c',
'Lipid profile (total cholesterol, LDL, HDL, TG)',
'Serum creatinine, urea, electrolytes (Na, K)',
'Urine routine - protein, sugar, casts',
'ECG (12-lead) - to detect LVH',
'Chest X-ray PA view',
'Echo if ECG abnormal or symptoms suggest cardiac disease'],
'dx': 'Stage 1 Hypertension (JNC 8 / AHA 2017: Grade 1 HTN) - Essential / Primary',
'ddx': ['Secondary Hypertension (Renal, Endocrine)', 'White coat hypertension', 'Hypertensive urgency'],
'rx': [('Tab. Amlodipine 5 mg', '1 tab', 'OD morning', 'Ongoing'),
('Tab. Aspirin 75 mg', '1 tab', 'OD after food', 'After baseline labs'),
('Tab. Atorvastatin 10 mg', '1 tab', 'OD at night', 'After lipid profile review')],
'advice': ['Lifestyle modification is FIRST-LINE:',
'DASH diet - reduce salt intake (<5g NaCl/day), increase fruits and vegetables.',
'Regular aerobic exercise: 30 min brisk walking, 5 days/week.',
'Reduce alcohol to <14 units/week.',
'Achieve target weight (BMI < 25 kg/m²).',
'Home BP monitoring twice daily (morning & evening). Maintain BP diary.',
'Return in 4 weeks with all investigations and BP record.'],
'followup': '4 weeks (with investigation reports). Target BP <130/80 mmHg.'
})
# ---- CASE 4: Type 2 Diabetes Mellitus ----
cases.append({
'num': 4, 'title': 'TYPE 2 DIABETES MELLITUS',
'patient': 'Name: Kavitha Reddy | Age: 48 yrs | Sex: Female | OPD No: 004 | Date: 15/07/2026',
'cc': 'Excessive thirst, frequent urination and fatigue for 3 months.',
'hopi': [
'Gradually increasing polydipsia, polyuria (passing urine >8 times/day including 2 times at night).',
'Unexplained weight loss of about 4 kg over 3 months. Fatigue, lethargy.',
'Occasional blurred vision (transient). No pain while urinating.',
'No known diagnosis of DM before. Random blood sugar at pharmacy yesterday: 268 mg/dL.',
'No numbness/tingling in feet, no non-healing wounds.',
],
'pmh': 'HTN diagnosed 2 years ago (on Tab. Amlodipine 5 mg OD). No other illness.',
'fh': 'Mother and maternal uncle have Type 2 DM.',
'sh': 'Bank employee. Sedentary lifestyle. High carbohydrate diet. Non-smoker. Non-alcoholic.',
'gen': ['Overweight female (BMI 30 kg/m²). Conscious, alert.',
'No pallor, no icterus. No acanthosis nigricans (check neck/axilla).',
'No edema, no clubbing.'],
'vitals': [['BP', '136/84 mmHg'], ['Pulse', '82/min, regular'],
['Temperature', '36.9°C'], ['BMI', '30 kg/m²'], ['SpO2', '98%']],
'sys': ['CVS, RS, Abdomen: Within normal limits.',
'Feet examination: Intact sensation to monofilament (10g), pulses palpable.',
'Skin: No infections. No acanthosis nigricans noted.',
'Eyes: Referred for fundoscopy.'],
'ix': ['FBS (Fasting Blood Sugar)', 'PPBS (2h Post-prandial)', 'HbA1c',
'Urine routine - glucose, ketones, protein, microscopy', 'Urine microalbumin (spot)',
'CBC, LFT, RFT (Creatinine, BUN, eGFR)',
'Lipid profile', 'TSH', 'ECG', 'Ophthalmology referral for fundoscopy'],
'dx': 'Type 2 Diabetes Mellitus - Newly Diagnosed (ADA criteria: RBS >200 mg/dL + symptoms)',
'ddx': ['Type 1 DM (LADA)', 'MODY (Maturity-Onset Diabetes of the Young)', 'Stress hyperglycemia'],
'rx': [('Tab. Metformin 500 mg', '1 tab', 'BD with meals', 'Ongoing (titrate to 1000 mg BD)'),
('Tab. Amlodipine 5 mg', '1 tab (continue)', 'OD', 'Ongoing'),
('Tab. Atorvastatin 10 mg', '1 tab', 'OD at night', 'After lipid profile')],
'advice': ['Diabetic diet: Low glycemic index, reduce refined carbs, sugar, white rice.',
'Portion control. Small frequent meals (5-6 meals/day).',
'Regular exercise: 150 min/week moderate intensity.',
'Foot care: Daily inspection, avoid barefoot walking.',
'SMBG (Self Monitoring Blood Glucose) - fasting and post-meals.',
'HbA1c target: <7% (individualized). BP target: <130/80 mmHg.',
'Return with all investigations in 2 weeks for dose titration.'],
'followup': '2 weeks (with reports). Then monthly for first 3 months.'
})
# ---- CASE 5: Bronchial Asthma ----
cases.append({
'num': 5, 'title': 'BRONCHIAL ASTHMA - ACUTE EXACERBATION',
'patient': 'Name: Arjun Singh | Age: 22 yrs | Sex: Male | OPD No: 005 | Date: 15/07/2026',
'cc': 'Breathlessness, wheeze and chest tightness since morning (4-5 hours).',
'hopi': [
'Known asthmatic since age 14 years. Uses Salbutamol inhaler PRN.',
'Today developed acute breathlessness on exposure to dust while cleaning room.',
'Wheeze audible to patient. Chest tightness. Used 2 puffs Salbutamol - partial relief only.',
'No fever, no productive cough, no hemoptysis.',
'Last exacerbation 3 months ago - managed in OPD.',
],
'pmh': 'Bronchial asthma (mild persistent, uncontrolled). Allergic rhinitis. No hospitalization.',
'fh': 'Mother has asthma.',
'sh': 'Student. Lives in dusty hostel. No smoking. No pets.',
'gen': ['Anxious-looking young male. Able to speak in sentences.',
'Mild respiratory distress. Accessory muscle use (mild).',
'No cyanosis. No clubbing. No edema.'],
'vitals': [['Pulse', '102/min, regular'], ['BP', '124/80 mmHg'],
['RR', '24/min'], ['SpO2', '94% on room air'], ['PEF', '55% of predicted (moderate severity)']],
'sys': ['Chest: Symmetrical expansion, bilateral diffuse expiratory wheeze on auscultation.',
'Prolonged expiratory phase. No crepitations.',
'Abdomen, CVS, CNS: Normal.',
'No signs of severe attack (unable to speak, silent chest, cyanosis).'],
'ix': ['Peak Expiratory Flow (PEF) - repeat after bronchodilator',
'SpO2 monitoring', 'ABG if SpO2 <92%',
'Chest X-ray PA (to rule out pneumothorax, pneumonia)',
'CBC (eosinophilia), IgE levels (elective)',
'Spirometry (when stable) - to confirm reversible obstruction'],
'dx': 'Bronchial Asthma - Moderate Acute Exacerbation (GINA classification)',
'ddx': ['COPD exacerbation', 'Pneumonia', 'Acute cardiac asthma', 'Foreign body aspiration', 'Anaphylaxis'],
'rx': [('Salbutamol MDI 100 mcg', '4-6 puffs via spacer', 'Every 20 min x 3, then q4h', 'During attack'),
('Tab. Prednisolone 40 mg', '1 tab', 'OD morning', '5-7 days'),
('Ipratropium MDI 20 mcg', '2-4 puffs via spacer', 'Q6h', '24-48 hours'),
('ICS: Budesonide 200 mcg inhaler', '2 puffs', 'BD (maintenance)', 'Ongoing'),
('LABA: Formoterol 6 mcg inhaler', '1 puff', 'BD (add-on if uncontrolled)', 'Ongoing')],
'advice': ['Demonstrate and check inhaler technique.',
'Provide written Asthma Action Plan.',
'Identify and avoid triggers (dust, smoke, cold air, exercise).',
'Use spacer device with MDI for better lung deposition.',
'Step-up to ICS + LABA (Step 3 GINA) given frequent exacerbations.',
'Refer pulmonologist if uncontrolled on Step 3.'],
'followup': '48 hours for reassessment. Monthly review for control assessment.'
})
# ---- CASE 6: Urinary Tract Infection ----
cases.append({
'num': 6, 'title': 'URINARY TRACT INFECTION (UTI)',
'patient': 'Name: Priya Menon | Age: 29 yrs | Sex: Female | OPD No: 006 | Date: 15/07/2026',
'cc': 'Burning micturition, increased frequency and lower abdominal pain for 2 days.',
'hopi': [
'Sudden onset dysuria (burning sensation while urinating) for 2 days.',
'Increased urinary frequency (voiding every 1-2 hours). Urgency present.',
'Suprapubic pain (dull, constant). No hematuria (no visible blood in urine).',
'No fever, no chills, no loin pain, no nausea/vomiting.',
'Sexually active (married). Last menstrual period: 12 days ago. Not pregnant.',
'No vaginal discharge or itching. No previous UTI in last 6 months.',
],
'pmh': 'Nil. No known drug allergies.',
'fh': 'Non-contributory.',
'sh': 'Schoolteacher. Married. Good personal hygiene reported.',
'gen': ['Comfortable female, in mild distress due to dysuria.',
'Afebrile (36.9°C). No pallor, icterus, edema.'],
'vitals': [['Temperature', '36.9°C'], ['Pulse', '78/min'], ['BP', '112/72 mmHg'], ['RR', '16/min']],
'sys': ['Abdomen: Mild suprapubic tenderness on deep palpation.',
'NO costovertebral angle (CVA) tenderness bilaterally - rules out pyelonephritis.',
'External genitalia: Normal. No vaginal discharge.',
'CVS, RS, CNS: Normal.'],
'ix': ['Urine routine examination (colour, turbidity, pH, glucose, protein, cells)',
'Urine microscopy (pus cells, RBCs, casts, bacteria)',
'Urine culture & sensitivity (midstream clean catch sample)',
'Urine pregnancy test (hCG) - to exclude pregnancy',
'Blood glucose (to rule out DM as predisposing factor)'],
'dx': 'Uncomplicated Acute Cystitis (Lower UTI) in a non-pregnant woman',
'ddx': ['Pyelonephritis', 'Urethritis (STI - Chlamydia/Gonorrhea)', 'Vaginitis', 'Interstitial cystitis'],
'rx': [('Tab. Nitrofurantoin 100 mg (modified release)', '1 tab', 'BD with food', '5 days'),
('Tab. Phenazopyridine 200 mg', '1 tab', 'TDS', '2 days (symptomatic only, urine turns orange)'),
('Tab. Paracetamol 500 mg', '1 tab', 'SOS', 'For pain'),
('Encourage fluid intake', '>2.5 L water/day', '-', 'During treatment')],
'advice': ['Drink 2.5-3 litres of water daily.',
'Void urine immediately after intercourse (post-coital voiding).',
'Avoid holding urine for long periods.',
'Front-to-back wiping after using toilet.',
'Avoid tight synthetic underwear.',
'Complete the full antibiotic course.',
'Return if: Fever, rigors, loin pain (suggests pyelonephritis - needs IV treatment).'],
'followup': 'After 5 days to review urine culture & sensitivity result. Repeat urine routine if not settled.'
})
# ---- CASE 7: Migraine ----
cases.append({
'num': 7, 'title': 'MIGRAINE WITHOUT AURA',
'patient': 'Name: Deepa Nair | Age: 32 yrs | Sex: Female | OPD No: 007 | Date: 15/07/2026',
'cc': 'Recurrent severe headache with nausea for the last 2 years. Acute episode today.',
'hopi': [
'Recurrent episodic headaches since age 30 years (2-4 episodes/month).',
'Current episode: Severe, pulsating (throbbing), unilateral (right side), for last 6 hours.',
'Photophobia and phonophobia present. Nausea, one episode of vomiting.',
'No aura (no visual disturbances, no numbness before headache).',
'Worsened by climbing stairs. Relieved partially by lying in dark quiet room.',
'Triggers: Menstrual cycle, stress, missed meals, lack of sleep.',
'Duration of individual episodes: 12-24 hours. No headache between episodes.',
],
'pmh': 'Nil. Oral contraceptive pills - stopped 6 months ago. No family history of stroke.',
'fh': 'Mother has recurrent headaches (likely migraine).',
'sh': 'IT professional. High stress job. Irregular sleep schedule. Coffee 3-4 cups/day.',
'gen': ['Female, looks distressed, preferring dim light in consultation room.',
'No neurological deficit. Afebrile. No papilledema.',
'No pallor, no neck stiffness.'],
'vitals': [['BP', '118/76 mmHg'], ['Pulse', '76/min'], ['Temperature', '36.8°C'], ['RR', '16/min']],
'sys': ['Neurological exam: Normal. Power, tone, sensation, reflexes - all normal.',
'No meningeal signs (Kernig, Brudzinski negative).',
'Fundoscopy: Normal disc margins bilaterally (no papilledema).',
'Temporal artery: Not thickened/tender.',
'All other systems normal.'],
'ix': ['No investigations required for typical migraine in young female.',
'MRI brain (with contrast) if: Atypical features, progressive headache, neurological deficit.',
'CBC, ESR, CRP (if temporal arteritis suspected - age >50)',
'Headache diary to identify triggers (prescribe)'],
'dx': 'Migraine Without Aura (ICHD-3 criteria: ≥5 attacks, 4-72h, unilateral pulsating, moderate-severe, aggravated by activity + nausea/photo/phonophobia)',
'ddx': ['Tension-type headache', 'Cluster headache', 'Secondary headache (meningitis, subarachnoid hemorrhage, space-occupying lesion)'],
'rx': [('Tab. Sumatriptan 50 mg', '1 tab at onset', 'Repeat after 2h if needed (max 200 mg/day)', 'PRN'),
('Tab. Domperidone 10 mg', '1 tab', 'TDS (anti-emetic + enhances drug absorption)', '3 days'),
('Tab. Ibuprofen 400 mg', '1 tab (if Triptan unavailable)', 'With food at onset', 'PRN'),
('Tab. Amitriptyline 10 mg (prophylaxis)', '1 tab', 'OD at night', 'Ongoing if >2 attacks/month')],
'advice': ['Maintain headache diary: date, duration, severity, triggers, response to medication.',
'Regular sleep schedule (7-8 hours). Avoid sleep deprivation.',
'Regular meals - avoid fasting/skipping.',
'Reduce caffeine intake gradually.',
'Stress management: Yoga, meditation, relaxation techniques.',
'Avoid known triggers (aged cheese, red wine, chocolate, MSG).',
'Do NOT use analgesics >10 days/month (risk of medication overuse headache).'],
'followup': '4-6 weeks. Review headache diary and assess prophylaxis response.'
})
# ---- CASE 8: Iron Deficiency Anemia ----
cases.append({
'num': 8, 'title': 'IRON DEFICIENCY ANEMIA',
'patient': 'Name: Lata Kumari | Age: 25 yrs | Sex: Female | OPD No: 008 | Date: 15/07/2026',
'cc': 'Fatigue, pallor, breathlessness on exertion and hair fall for 4 months.',
'hopi': [
'Gradually increasing fatigue and weakness for 4 months.',
'Pallor noticed by family. Breathlessness on climbing one flight of stairs.',
'Palpitations on exertion. No chest pain. No syncope.',
'Hair loss (diffuse). Brittle nails, longitudinal ridging noted.',
'Menstrual history: Heavy periods (changing 5-6 pads/day, 7-day cycles), since 1 year.',
'Diet: Vegetarian. Poor dietary iron intake (no green leafy vegetables, pulses).',
'Pica: Craving for chalk (pagophagia) - noticed for 2 months.',
],
'pmh': 'Nil. No previous diagnosis of anemia. No GI symptoms.',
'fh': 'Mother had anemia during pregnancies.',
'sh': 'University student. Vegetarian. Poor dietary habits.',
'gen': ['Thin-built female. Pallor +++. No icterus, cyanosis.',
'Koilonychia (spoon-shaped nails) noted.',
'Glossitis (smooth, red tongue). Angular stomatitis.',
'No lymphadenopathy. No pedal edema.'],
'vitals': [['BP', '108/70 mmHg'], ['Pulse', '96/min, low volume, regular'],
['Temperature', '36.7°C'], ['RR', '18/min'], ['SpO2', '97%']],
'sys': ['CVS: Mild flow murmur in pulmonary area (Grade 2/6, soft, systolic). Normal S1 S2.',
'RS: Clear bilaterally.',
'Abdomen: Mild splenomegaly (just palpable). Liver not palpable. No ascites.',
'Nails: Koilonychia. Tongue: Glossitis. Oral corners: Angular stomatitis.',
'CNS: Normal.'],
'ix': ['CBC with peripheral smear: Microcytic hypochromic anemia, anisopoikilocytosis, pencil cells',
'Serum ferritin (most sensitive for iron stores)',
'Serum iron, TIBC, Transferrin saturation',
'Reticulocyte count',
'Blood glucose, LFT, RFT',
'Thyroid function (TSH)',
'Stool for occult blood (to rule out GI blood loss)',
'Gynecology referral for menorrhagia workup (USG pelvis, hormonal profile)'],
'dx': 'Iron Deficiency Anemia - Moderate (Hb likely 7-10 g/dL) secondary to Menorrhagia + Poor dietary intake',
'ddx': ['Thalassemia trait', 'Anemia of chronic disease', 'Sideroblastic anemia'],
'rx': [('Tab. Ferrous Sulfate 200 mg (65 mg elemental iron)', '1 tab', 'BD on empty stomach (or with Vit C)', '3-6 months'),
('Tab. Vitamin C 500 mg', '1 tab', 'BD (taken with iron for absorption)', '3-6 months'),
('Tab. Folic Acid 5 mg', '1 tab', 'OD', '3-6 months'),
('Dietary counselling', 'Iron-rich foods', '-', 'Ongoing')],
'advice': ['Iron-rich foods: Green leafy vegetables, legumes/pulses, jaggery, sesame seeds, dry fruits.',
'Take iron tablet on empty stomach (or with Vitamin C juice).',
'Avoid tea/coffee 1 hour before and after iron tablets (inhibit absorption).',
'Iron tablets may cause dark/black stools - reassure (normal).',
'Constipation is common - increase water and fiber intake.',
'Gynecology referral for menorrhagia management.',
'Recheck Hb in 4-6 weeks to assess response.'],
'followup': '4-6 weeks. Recheck CBC and ferritin. Treat underlying cause (menorrhagia).'
})
# ---- CASE 9: Osteoarthritis of Knee ----
cases.append({
'num': 9, 'title': 'OSTEOARTHRITIS OF KNEE',
'patient': 'Name: Venkatesan P | Age: 62 yrs | Sex: Male | OPD No: 009 | Date: 15/07/2026',
'cc': 'Bilateral knee pain, stiffness in the morning and difficulty walking for 2 years.',
'hopi': [
'Gradually worsening bilateral knee pain for 2 years (right > left).',
'Morning stiffness lasting <30 minutes. Pain worsens with prolonged standing/walking.',
'Crepitus (crackling sound) on movement. No locking or giving way.',
'Swelling of right knee - intermittent, after prolonged activity.',
'Difficulty climbing stairs, squatting and sitting cross-legged.',
'No night pain, no rest pain (at initial stages). Recent worsening at rest.',
'NSAID (Ibuprofen OTC) gives temporary relief.',
],
'pmh': 'Hypertension (on Tab. Amlodipine). No DM. Previous R knee injury 20 years ago.',
'fh': 'Mother had joint problems in old age.',
'sh': 'Retired government employee. Overweight (BMI 31). Former laborer (heavy knee use).',
'gen': ['Overweight male (BMI 31). Walks with slight antalgic gait.',
'No pallor, icterus, lymphadenopathy.'],
'vitals': [['BP', '138/86 mmHg'], ['Pulse', '74/min'], ['BMI', '31 kg/m²'], ['Temperature', '36.8°C']],
'sys': ['MSK - Right Knee: Bony enlargement, crepitus on ROM, tenderness over medial joint line.',
'Small effusion palpable (ballottement of patella positive - Right).',
'Varus deformity (bow-leg) - Right. ROM: 0-110° (limited, normal 0-135°).',
'Left Knee: Mild crepitus, no effusion, full ROM.',
'Heberden\'s nodes on DIP joints of hands (bilateral).',
'CVS, RS, Abdomen: Normal.'],
'ix': ['X-ray both knees (AP and lateral, weight-bearing)',
'Expected: Joint space narrowing, osteophytes, subchondral sclerosis, subchondral cysts',
'CBC, ESR, CRP (to rule out inflammatory arthritis)',
'RA factor, Anti-CCP (if bilateral symmetric - rule out RA)',
'Serum uric acid (if gout suspected)',
'If effusion: Joint aspiration for synovial fluid analysis'],
'dx': 'Bilateral Osteoarthritis of Knee - Kellgren-Lawrence Grade 3 (likely, Right) + Grade 2 (Left)',
'ddx': ['Rheumatoid arthritis', 'Gout', 'Pseudogout', 'Avascular necrosis of femoral condyle'],
'rx': [('Tab. Paracetamol 650 mg', '1 tab', 'TDS with food', 'Ongoing (first-line analgesic)'),
('Tab. Etoricoxib 60 mg', '1 tab', 'OD with food (selective COX-2)', 'Acute exacerbation only'),
('Cap. Glucosamine 500 mg + Chondroitin 400 mg', '1 cap', 'TDS', '3 months trial'),
('Topical Diclofenac 1% gel', 'Apply to knee', 'TDS topically', 'Ongoing'),
('Physiotherapy referral', 'Quadriceps strengthening, ROM exercises', '-', 'Ongoing')],
'advice': ['Weight reduction to BMI <25 - every 1 kg weight loss reduces 4 kg knee load.',
'Quadriceps strengthening exercises (isometric, straight leg raise).',
'Knee support/brace for ambulation.',
'Avoid high-impact activities, climbing stairs repeatedly.',
'Swimming and cycling are good low-impact alternatives.',
'Intra-articular steroid injection: Consider if not responding to oral treatment.',
'Orthopedic referral for knee replacement if severe Grade 4 OA.'],
'followup': '4 weeks. Review X-ray, assess pain scores, physiotherapy progress.'
})
# ---- CASE 10: Acute Tonsillitis ----
cases.append({
'num': 10, 'title': 'ACUTE TONSILLITIS',
'patient': 'Name: Rahul Verma | Age: 16 yrs | Sex: Male | OPD No: 010 | Date: 15/07/2026',
'cc': 'Severe sore throat, high fever and difficulty swallowing for 3 days.',
'hopi': [
'Sudden onset severe sore throat for 3 days. Fever up to 39.5°C (measured at home).',
'Marked odynophagia (painful swallowing). Able to swallow liquids with difficulty.',
'Muffled voice. Mouth breathing at night. No trismus (jaw opening normal).',
'No earache, no neck swelling, no drooling.',
'Similar episodes 3-4 times in the past year.',
'No rash. No joint pains.',
],
'pmh': 'Recurrent tonsillitis (4 episodes/year) for 3 years. No chronic illness.',
'fh': 'Non-contributory.',
'sh': 'School student. Lives in hostel. Cold weather exposure.',
'gen': ['Ill-looking young male with flushed face. Febrile (39.2°C).',
'Mouth-breathing. Voice slightly muffled. No drooling.',
'Bilateral anterior cervical lymphadenopathy (tender, mobile, 1-2 cm).'],
'vitals': [['Temperature', '39.2°C (102.6°F)'], ['Pulse', '104/min, regular'],
['BP', '116/74 mmHg'], ['RR', '18/min'], ['SpO2', '99%']],
'sys': ['Throat: Bilateral tonsils enlarged (Grade 3+), covered with whitish-yellow exudates.',
'Uvula: Midline (not deviated - rules out peritonsillar abscess).',
'Soft palate: Inflamed. Posterior pharyngeal wall: Congested.',
'Neck: Bilateral tender anterior cervical LN (shotty).',
'Ears: Tympanic membranes normal.',
'CVS, RS, Abdomen: Within normal limits.'],
'ix': ['Throat swab for culture & sensitivity (before antibiotics if possible)',
'Rapid Antigen Detection Test (RADT/Strep A Rapid Test)',
'CBC with differential (leukocytosis expected in bacterial tonsillitis)',
'ESR, CRP',
'Monospot test / Paul-Bunnell test (if Infectious Mononucleosis suspected)',
'ASO titre (if history of rheumatic fever)'],
'dx': 'Acute Bacterial Tonsillitis - Centor Score 4/4 (exudates, tender anterior LN, fever, no cough) - Streptococcal infection likely',
'ddx': ['Viral tonsillitis (Adenovirus, EBV)', 'Peritonsillar abscess', 'Diphtheria', 'Infectious Mononucleosis'],
'rx': [('Tab. Amoxicillin 500 mg', '1 tab', 'TDS', '10 days (full course - prevents RHD)'),
('Tab. Paracetamol 500 mg', '1 tab', 'QID (for fever and pain)', '5 days'),
('Tab. Ibuprofen 400 mg', '1 tab', 'TDS with food (anti-inflammatory)', '5 days'),
('Benzydamine HCl spray (antiseptic gargle)', '3-4 sprays', 'QID gargle', '5 days'),
('Syp. Vitamin C 500 mg', '10 ml', 'OD', '7 days')],
'advice': ['Complete the full 10-day course of amoxicillin (prevents rheumatic fever).',
'Salt water gargles 4-5 times daily.',
'Soft, semi-liquid diet. Adequate hydration.',
'Rest for 3-5 days. Avoid cold drinks.',
'Return IMMEDIATELY if: Trismus, drooling, inability to swallow, neck swelling, worsening.',
'ENT referral for tonsillectomy: >6 episodes/year or >4 episodes/year for 2 years.'],
'followup': '5 days (review response). ENT referral for recurrent tonsillitis assessment.'
})
# ---- CASE 11: Hypothyroidism ----
cases.append({
'num': 11, 'title': 'HYPOTHYROIDISM',
'patient': 'Name: Sneha Joshi | Age: 40 yrs | Sex: Female | OPD No: 011 | Date: 15/07/2026',
'cc': 'Weight gain, cold intolerance, constipation, fatigue and hair loss for 6 months.',
'hopi': [
'Gradual weight gain of ~5 kg over 6 months despite no change in diet.',
'Intolerance to cold - feels cold even in summer. Excessive sweating absent.',
'Constipation (stools every 3-4 days). Lethargy, excessive sleepiness.',
'Hair loss (diffuse), dry rough skin, puffy face in mornings.',
'Voice became slightly hoarse. Memory and concentration declined.',
'Heavy, prolonged menstrual periods for past 4 months.',
'No palpitations, no goitre noticed by patient.',
],
'pmh': 'Nil. Previous TSH was normal 2 years ago.',
'fh': 'Sister has Hashimoto\'s thyroiditis.',
'sh': 'Housewife. Not on any medications. Non-smoker.',
'gen': ['Obese female. Puffy face (periorbital edema). Dry, rough, cold skin.',
'Thinning of outer 1/3 of eyebrows (Queen Anne sign).',
'Hair: Dry, brittle, diffuse thinning. Pallor present.',
'Non-pitting edema bilateral lower limbs.'],
'vitals': [['BP', '124/82 mmHg'], ['Pulse', '58/min, slow, regular'],
['Temperature', '36.0°C (slightly below normal)'], ['BMI', '32 kg/m²']],
'sys': ['Thyroid: Diffuse firm goitre (Grade 2) - suggests Hashimoto\'s thyroiditis.',
'CVS: Bradycardia. Muffled heart sounds (? pericardial effusion - echo needed).',
'RS: Clear. Abdomen: Normal.',
'Reflexes: Delayed relaxation phase (hallmark of hypothyroidism).',
'CNS: Slowed mentation, slightly slurred speech.'],
'ix': ['TSH (Thyroid Stimulating Hormone) - will be markedly elevated',
'Free T4 (fT4) - will be low',
'Free T3 (fT3)',
'Anti-TPO antibodies (Anti-Thyroid Peroxidase) - elevated in Hashimoto\'s',
'Anti-thyroglobulin antibodies',
'CBC (normocytic or macrocytic anemia may be present)',
'Serum cholesterol and lipid profile (elevated in hypothyroidism)',
'Thyroid ultrasound',
'ECG (bradycardia, low voltage complexes)',
'Echocardiogram (if muffled heart sounds)'],
'dx': 'Primary Hypothyroidism - Likely Hashimoto\'s (Autoimmune) Thyroiditis',
'ddx': ['Subclinical hypothyroidism', 'Secondary hypothyroidism (pituitary)', 'Myxedema (severe)'],
'rx': [('Tab. Levothyroxine (L-T4) 25 mcg', '1 tab', 'OD 30 min before breakfast on empty stomach', 'Ongoing - titrate'),
('Note: Start low (25 mcg), increase by 25 mcg every 4-6 weeks until TSH normalizes', '', '', ''),
('Target: TSH 0.5-2.5 mIU/L', '', '', '')],
'advice': ['Take Levothyroxine on empty stomach, 30-60 min before breakfast.',
'Do NOT take with calcium, iron, antacids (they reduce absorption).',
'Regular TSH monitoring: 6-8 weeks after each dose change.',
'Symptoms take 4-6 weeks to improve after starting treatment.',
'Treatment is lifelong - do not stop on own.',
'Low-iodine diet not necessary unless autoimmune. Adequate dietary iodine important.',
'Recheck TSH annually once dose is stable.'],
'followup': '6-8 weeks (with TSH, fT4 reports). Annual review when stable.'
})
# ---- CASE 12: Peptic Ulcer Disease ----
cases.append({
'num': 12, 'title': 'PEPTIC ULCER DISEASE (PUD)',
'patient': 'Name: Suresh Kumar | Age: 45 yrs | Sex: Male | OPD No: 012 | Date: 15/07/2026',
'cc': 'Burning epigastric pain relieved by food, for 3 months.',
'hopi': [
'Burning/gnawing epigastric pain for 3 months. Pain comes 2-3 hours after meals (hunger pain).',
'Relieved by eating food or taking antacids. Pain wakes him at night (midnight pain).',
'Belching, bloating, nausea. No vomiting.',
'No hematemesis, no melena (no black tarry stools).',
'Reduced appetite, mild weight loss (~2 kg).',
'Taking NSAID (Diclofenac) regularly for back pain for 6 months.',
'Drinks tea (5-6 cups/day). Smokes 10 cigarettes/day.',
],
'pmh': 'No prior GI illness. No H. pylori treatment in past. Regular NSAID use.',
'fh': 'Father had peptic ulcer.',
'sh': 'Salesman. High stress. Irregular meal timings. Heavy tea drinker. Smoker.',
'gen': ['Thin-built male. Epigastric tenderness on palpation.',
'No pallor (no bleeding), icterus, lymphadenopathy, edema.',
'No abdominal mass.'],
'vitals': [['BP', '124/78 mmHg'], ['Pulse', '76/min'], ['Temperature', '36.8°C'], ['BMI', '21 kg/m²']],
'sys': ['Abdomen: Mild epigastric tenderness. No guarding, rigidity, organomegaly.',
'No succussion splash. Bowel sounds normal.',
'PR exam: No melena (brown stool on glove).',
'CVS, RS, CNS: Normal.'],
'ix': ['H. pylori testing: Urea Breath Test (UBT) or Stool Antigen Test (first-line non-invasive)',
'Upper GI Endoscopy (OGD): If >45 yrs, alarm symptoms, or H. pylori positive',
'CBC (to detect anemia from occult bleeding)',
'Stool for Occult Blood (FOBT)',
'LFT, RFT (baseline before PPIs)',
'Serum Gastrin (if refractory/Zollinger-Ellison suspected)'],
'dx': 'Peptic Ulcer Disease - Duodenal Ulcer (most likely) - H. pylori and/or NSAID-associated',
'ddx': ['Gastric ulcer', 'Gastritis', 'GERD', 'Functional dyspepsia', 'Gastric carcinoma (rule out in >45yr)'],
'rx': [('Tab. Pantoprazole 40 mg (PPI)', '1 tab', 'OD 30 min before breakfast', '4-8 weeks'),
('H. pylori Triple Therapy (if H. pylori positive):', '', '', ''),
('Tab. Clarithromycin 500 mg', '1 tab', 'BD', '14 days'),
('Tab. Amoxicillin 1g', '1 tab', 'BD', '14 days'),
('Tab. Pantoprazole 40 mg (as part of triple therapy)', '1 tab', 'BD', '14 days'),
('STOP NSAIDs - switch to Paracetamol for pain', '', '', ''),
('Tab. Sucralfate 1g (mucosal protectant)', '1 tab', 'QID 1 hr before meals', '4 weeks')],
'advice': ['Stop NSAIDs immediately. Use Paracetamol instead for pain relief.',
'Smoking cessation - cigarettes impair ulcer healing.',
'Reduce tea/coffee intake.',
'Regular small meals - avoid long fasting gaps.',
'Avoid spicy food, alcohol.',
'Sleep with head end elevated (helps with nighttime symptoms).',
'ALARM symptoms to watch for: Black tarry stools, blood in vomit, severe sudden pain - go to ER immediately.',
'Upper GI endoscopy recommended given age >45 and weight loss.'],
'followup': '4 weeks (with H. pylori test result and endoscopy if done). Confirm eradication 4 weeks after treatment.'
})
print("Cases 1-12 defined. Continuing...")
print("All cases ready.")
